Study questionWhat effect on body mass index, obesity and diabetes can we expect from the 1-peso-per-litre tax to sugar sweetened beverages in Mexico?MethodsUsing recently published estimates of the reductions in beverage purchases due to the tax, we modelled its expected long-term impacts on body mass index (BMI), obesity and diabetes. Microsimulations based on a nationally representative dataset were used to estimate the impact of the tax on BMI and obesity. A Markov population model, built upon an age-period-cohort model of diabetes incidence, was used to estimate the impact on diagnosed diabetes in Mexico. To analyse the potential of tax increases we also modelled a 2-peso-per-litre tax scenario.Study answer and limitationsTen years after the implementation of the tax, we expect an average reduction of 0.15 kg/m2 per person, which translates into a 2.54% reduction in obesity prevalence. People in the lowest level of socioeconomic status and those between 20 and 35 years of age showed the largest reductions in BMI and overweight and obesity prevalence. Simulations show that by 2030, under the current implementation of 1-peso-per-litre, the tax would prevent 86 to 134 thousand cases of diabetes. Overall, the 2-peso-per-litre scenario is expected to produce twice as much of a reduction. These estimates assume the tax effect on consumption remains stable over time. Sensitivity analyses were conducted to assess the robustness of findings; similar results were obtained with various parameter assumptions and alternative modelling approaches.What this study addsThe sugar-sweetened beverages tax in Mexico is expected to produce sizable and sustained reductions in obesity and diabetes. Increasing the tax could produce larger benefits. While encouraging, estimates will need to be updated once data on direct changes in consumption becomes available.

BackgroundSeveral strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity.Methods and findingsBaseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI −1.4 to −1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; −12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term.ConclusionsReformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.

Objective: The association between socioeconomic status (SES) and body mass index (BMI) in middleincome countries is mixed. Heterogeneity in SES indicators used could explain some differences. This study aimed to identify SES indicators consistently associated with BMI in Mexican adults in 2006, 2012, and 2016. Methods: Data were obtained from the Mexican National Health and Nutrition Surveys of 2006, 2012, and 2016, including adults 20 to 59 years old. Given expected differences by sex, sex-stratified linear regression models were fitted for each survey. Age-adjusted and multivariate models were fit by using seven noncollinear SES indicators. Results: In age-adjusted models, most SES indicators were associated with a higher BMI in men; mixed associations were found for women. In multivariate models, living in urban areas was associated with a higher BMI for both men and women in 2006 and 2012. Across all surveys, education was associated with a lower BMI in women, while household assets were associated with a higher BMI in men. Conclusions:The association between SES indicators and BMI is complex. Differences by sex need to be explicitly recognized when modeling this association. Approaches that rely on a single indicator could be confounded by other SES indicators. Adjusted models show the specific SES attributes that may influence BMI.

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Outdoor smoking is still frequent in outdoor areas where people gather, and an important source of littering. We found substantial public support towards the outdoor smoking ban, which should translate into easier implementation and compliance in Baja California, Mexico.