Large scale regulatory food-related government actions in Latin America: actions, impact, processes

Introduction: The prevalence of excess BMI in Mexico is one of the highest in the world. Over 70% of adults and about one-third of children are overweight or obese. The National Public Health Institute (INSP) has supported the Government in developing evidence based obesity prevention policies and civil society has had an important role in advancing the obesity prevention agenda. The objective is to present the history behind the Mexican set of regulatory actions and the role played by different actors. Development: Several regulatory actions for obesity prevention were implemented by the Ministry of Health in the 2006-2102 administration, including recommendations on beverage intake and a multifaceted National Agreement for Healthy Nutrition (ANSA) which led to banning sodas and unhealthy food in schools. A main challenge of the ANSA was lack of harmonization between industry interests and public health objectives and lack of effective accountability and monitoring mechanisms to assess implementation across government sectors. An evaluation of the school regulations showed progress but also important implementation challenges which has resulted in partial success. An obesity prevention strategy of the current administration, which was based largely on a position document by the National Academy of Mexico and INSP includes regulation of food marketing to children, implementation of a front-of-pack labeling system and nutrition and physical activity promotion. Estimations of own and cross price elasticity of the demand for SSB and modeling effects of different tax levels on weight loss and diabetes prevention by the INSP were used in the process for approval of taxes to SSB and junk food by the congress. A one peso per liter excise tax on sugar-sweetened beverages (approximately 10 percent of the SSB price) took effect in January 1, 2014).The tax applies to nondairy and non-alcoholic beverages with added sugar. In addition an 8% tax is applied on non-basic (processed) energy-dense products (energy-dense nutrient-poor foods). Civil society organizations have embraced the prevention of obesity as their goal and have used evidence from INSP to position obesity prevention in the public debate and the government agenda, and have been key in the approval of initiatives such as taxing SSB. The effects of the tax are currently being evaluated by INSP and The Carolina Population Center at the University of North Carolina. The evaluation has two components: 1) If the tax passed to consumers, 2) If the tax reduced the intake of taxed products. The first component of the evaluation has shown that overall taxes on SSB did pass to the consumers while for energy-dense nutrientpoor foods the tax passed partially for most of them. For the second component of the evaluation the data comes from a commercial panel of consumers that contains information on purchases of beverages from households living in 53 cities with at least 50,000 residents. The model adjusts for the preexisting downward trend of taxed beverages since 2012 and for macroeconomic variables that can affect purchases. Preliminary results just for SSB (the analysis of effects of the energy-dense nutrient-poor foods has not been completed) show a 6 percent average decline in purchases of taxed beverages over 2014 compared to pre-tax trends. This difference accelerated over 2014 and the reduction compared to pre-tax trends reached 12% by December 2014. All socioeconomic groups reduced purchases of taxed beverages. Reductions were higher among lower socio-economic households, averaging 9% decline over 2014 compared to pre-tax trends and up to a 17% decline by Dec 2014. Results also show roughly a 4 percent increase in purchases of untaxed beverages over 2014, mainly driven by an increase in purchased bottled plain water (tap water intake is not collected). Conclusions: Mexico is implementing a set of regulatory actions for obesity prevention including regulation of marketing to children and the school food environment, a new food labeling and taxes on SSB and energy-dense nutrient-poor foods. The main actors in the development, application and evaluation of these policies were the academia, which conducted strategic research and developed policy recommendations to the Government, Civil Society that mobilized public opinion and positioned obesity prevention in the policy agenda, and the Government (legislative and executive branches) which approved the regulations. Food industry has opposed most regulatory actions and has succeeded in abating some of them. The lessons learned from Mexico are important for Latin American countries that are planning to implement policies for the prevention of obesity. d) Key words: Mexico, obesity prevention, regulatory actions, fiscal policies.