​​In April 2018, the South African government, in response to a recommendation of the World Health Organisation, introduced a tax on sugar-sweetened beverages (SSB) known as the Health Promotion Levy (HPL) in an attempt to reduce citizens' sugar intake and to curb obesity in the country.

However, the jury is still out on whether this sugar tax alone will be enough to combat obesity, which is regarded as one of the risk factors for non-communicable diseases (NCDs) such as heart disease, stroke, cancer and diabetes. Among the unconvinced are registered dietitians and key industry role-players (KIRs), according to a study by researchers from the Division of Human Nutrition and the Centre for Statistical Consultation at Stellenbosch University.

The researchers surveyed dietitians and KIRs on their awareness and opinions of the HPL, perceived SSB purchasing of consumers and the barriers or facilitators for the implementation of the HPL.

The findings of their study were published recently in the South African Journal of Clinical Nutrition.

The research findings indicated that dietitians and KIRs held the perception that the HPL is not adequate to have a sustainable impact on lowering NCDs and obesity.

“Dietitians and KIRs were positive about the HPL although the majority agreed that the implementation of a sugar tax alone will not make a difference because multiple factors contribute to NCDs and obesity. They believed the HPL of 11% was too little to have an impact on the purchasing behaviour of consumers.

“Dietitians did report a perceived decrease in the daily purchasing of SSBs by their clients in favour of mainly sugar-free beverages and water since the implementation of the HPL. Some dietitians were concerned that SSBs were substituted with other sugar-containing food items."

According to the researchers, this corresponds with other studies showing that nutrition interventions targeting specific foods or beverages may lead to adverse compensatory behaviour, such as increased consumption of alternative but similarly unhealthy foods and beverages.

The researchers add that while most KIRs agreed that the food industry understood the Government's rationale to implement the HPL, they also held the opinion that consumers were unaware of, nor understood the sugar taxation legislation.

“Consumers' lack of knowledge as well as their habitual purchasing of sugary drinks were regarded as key barriers to the successful implementation of the HPL."

Both dieticians and KIRs emphasised the importance of educating consumers about the sugar tax legislation, say the researchers. This was also regarded as a key factor to enhance the successful implementation of the HPL.

“Some dietitians confirmed using the HPL as a motivational tool to encourage reduced consumption of SSBs, while others taught their clients to read the nutritional information table with an emphasis on total sugar content and glycaemic carbohydrates, and how to understand endorsement logos."

The researchers point out that most dieticians and KIRs were unsure how the revenue generated through the HPL would be utilised.

“They held the opinion that the revenue should be earmarked for the treatment and prevention of NCDs and for health promotion to garner consumers' trust and facilitate change. However, they were sceptical and believed that the money would only benefit the Government."

The researchers say both groups were also concerned that the sugar tax could be regarded as intrusive by some consumers and as inappropriate by those who are not at risk of developing obesity or NCDs.

Going forward, the researchers call for integrated intervention strategies requiring multi-sectoral engagement to reduce the consumption of sugary drinks and to prevent obesity in the long run.

“The HPL should form part of a multi-pronged approach that includes fiscal measures, consumer education and controlled marketing of SSBs to create a supportive environment in which consumers make healthy choices, for instance the combination of education, effective food labelling and banning of marketing SSBs to children.

“Politicians, the SSB industry, consumers, trained dietitians and public health experts all have a part to play.

“Health professionals, in particular, play a crucial role in facilitating behaviour change and creating an enabling environment to support successful implementation of the sugar tax, especially if they use their expertise to influence policy-makers and the media."

The researchers say the findings from their study underscore the importance of an enabling environment that supports the availability and accessibility of healthy food choices in various settings as a vital cornerstone of the effectiveness of the HPL.

They add that more should be done to educate South Africans about the goal of the sugar tax and to create a supportive environment to improve their overall health and nutritional status.

• ​Source: Yolande Smit, Zarina Ebrahim, Maritha Marais, Daan Nel & Nelene Koen (2023). Does sugar taxation on sugar-sweetened beverages alter purchasing behaviour of South African consumers? Perspectives of dietitians and key industry role-players. South African Journal of Clinical Nutrition 2023: 1–8: DOI: 10.1080/16070658.2023.2249246

​Photo by Doris Jungo from Pixabay

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