ABSTRACT

Sugar-sweetened beverage (SSB) consumption is established as a major risk factor for overweight and obesity, as well as an array of cardio-metabolic conditions, especially type 2 diabetes [1],[2]. The individual risk of type 2 diabetes attributable to SSB consumption remains statistically significant after adjustment for total energy consumption and body mass index (BMI) [3],[4]. While taxes on SSBs have been proposed in highincome countries to lower obesity and type 2 diabetes risks given limited success from other population measures and individual-level interventions

[5], recent assessments reveal a majority of SSB sales now occur outside the US and Europe, where marketing efforts appear most focused [6]– [8]. SSB sales in India, for example, have increased by 13% year-on-year since 1998, exceeding 11 liters per capita per year (Figure 1) [9]. At the population level, the acceleration of SSB consumption among middle-income country populations has been statistically associated with increased obesity, overweight, and type 2 diabetes prevalence rates, independent of concurrent changes in other caloric consumption, physical inactivity, and aging [6],[10],[11].