An evaluation of Chile’s Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study

Background Chile’s Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases. Method and findings In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar WordPanel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as “high-in” or “not high-in” according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law’s warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] −22.9 to −22.7; p < 0.001), or 23.7% (95% CI −23.8% to −23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p < 0.001), but for high-educated households this amounted to a larger relative decline (−28.7%, 95% CI −28.8% to −28.6%) compared to low-educated households (−21.5%, 95% CI −21.6% to −21.4%), likely because of the high-educated households’ lower level of high-in beverage purchases in the preregulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI −12.0 to −11.9; p < 0.001) or 27.5% (95% CI −27.6% to −27.5%). Calories purchased from beverages classified as “not high-in” increased 5.7 kcal/capita/day (95% CI 5.7–5.7; p < 0.001), or 10.8% (10.8%–10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI −7.4 to −7.3; p < 0.001), or 7.5% (95% CI −7.6% to −7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies. Conclusions Purchases of high-in beverages significantly declined following implementation of Chile’s Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile’s policies on purchases of high-in foods, dietary intake, and long-term purchasing changes.
Lindsey Smith Taillie et al. describe the changes in purchases of sugary beverages after implementation of Chile's law on food labeling and advertising, implemented to combat childhood obesity.
Author summary Why was this study done? In 2016, Chile implemented the Law of Food Labeling and Advertising, a set of policies designed to prevent further increases in obesity prevalence by subjecting foods and beverages high in energy, sugar, sodium, and saturated fat content to marketing restrictions, banned sales in schools, and the first national mandatory front-of-package (FOP) warning-label system. Many countries are actively considering implementing similar policies, particularly the FOP warning-label policy. Understanding how beverage purchases changed following implementation of this policy package can inform development of future obesity prevention policies. What did researchers do and find? Using national data on household food purchases from before and after policy implementation, we examined changes in purchases of beverages high in sugar, saturated fat, sodium, or calories (i.e., “high-in” beverages). We compared observed beverage purchases after policy implementation to expected purchases had the policy not been implemented, based on preregulation trends. We found that the purchase volume of high-in beverages decreased by 22.8 mL per capita per day or 23.7% after the regulation was implemented. We also found that although high-educated households and low-educated households had similar absolute reductions in high-in beverage purchases, high-educated households had larger relative reductions in high-in beverage purchases. What do these findings mean? After Chile’s labeling, marketing, and school food sales policies were implemented, purchases of high-in beverages decreased. This observed decrease is greater than purchase changes that have been observed following implementation of single, standalone policies in Latin America, such as a sugar-sweetened-beverage tax. Future research will be needed to understand to what degree these changes are attributable to product reformulation of products and/or to changes in consumer behavior, as well as the impact of these regulations on dietary intake and health-related outcomes.