Adianta taxar acucares para diminuir a obesidade?
Volume 362:368-369
January 28, 2010
Number 4
by Brownell, K. D.
To the Editor: Brownell et al. (Oct. 15 issue)1 provide support for a tax on sugar-sweetened beverages in part by citing the results of long-term, randomized, controlled trials. They cite a report of a 1-year trial involving students 7 to 11 years of age that showed a lower incidence of obesity in the dietary intervention group, although the difference in body-mass index was not significant.2 Follow-up 2 years after completion of the trial showed that the difference in the incidence of obesity was not sustained.3 This dietary intervention apparently only had a transient effect without affecting the long-term propensity for obesity. None of the three other long-term, randomized, controlled trials cited in the article met their primary end points; an analysis of a different subgroup within each trial was made in an attempt to show some benefit.
The essential failure of these trials should give us pause. Before assigning blame for the obesity epidemic, we should have clinical evidence that an intervention to reduce the consumption of sugar-sweetened beverages is effective in achieving this goal, is either more effective or additive to the effect of other proven dietary therapies, and will reduce the long-term propensity for obesity.
Michael G. Kaplan, M.D.
Maimonides Medical Center
Brooklyn, NY
No potential conflict of interest relevant to this letter was reported.
References
Brownell KD, Farley T, Willett WC, et al. The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med 2009;361:1599-1605. [Free Full Text]
James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004;328:1237-1237. [Free Full Text]
James J, Thomas P, Kerr D. Preventing childhood obesity: two year follow-up results from the Christchurch Obesity Prevention Programme in Schools (CHOPPS). BMJ 2007;335:762-762. [Free Full Text]
To the Editor: Although their intent is unquestionably noble, Brownell and coauthors do not produce an economic rationale for a soda tax; they merely present one side of the economic equation (cost–harm) without consideration of its usefulness. To maintain liberty, we defer to individual persons to balance the cost–utility equation. However, the authors point to market failure as a justification for intervention. Their first two rationales involve the argument that the population lacks the capacity to make free economic decisions. In attempting to restrict peoples' liberty, the onus is on the authors to convincingly show that the vast majority of the population has no concept that consuming junk food (including soda) in excess has the potential for adverse health effects. Yet, their article includes data showing that a majority of people support a tax on health grounds. Their final rationale involves health care expenditure. It is a legitimate political issue, but not an economic justification to override autonomy. If instituted for "health" reasons, such a tax would be the ethical equivalent of compulsory participation in a program for the sake of the greater good; this is an anathema to modern ethics.
Michael Keane, B.M., B.S.
Casey Hospital
Berwick, VIC, Australia
mikekeane00@hotmail.com
No potential conflict of interest relevant to this letter was reported.
To the Editor: Brownell et al. present a convincing argument for a link between the consumption of sugar-sweetened beverages and obesity and for the taxation of such beverages from a public health standpoint. Little discussion is given to the issue of consistency in the implementation of such a tax policy. Many behavioral choices involve costs borne by society. All high-caloric foods can be tied to obesity. If soda is taxed, should this tax also be applied to all "fast food," confections, or portion size? Why limit it to food? Should we not tax all behaviors linked to health care expenditures? Why not deter gun and motorcycle ownership or sedentary lifestyle through taxation? How parental should government be?
Government clearly has an important role in promoting public health, but singling out sugar-sweetened beverages may appear arbitrary. The authors cite favorable public opinion toward such a tax. How might public opinion change if the proposed tax was on all "unhealthy" personal choices? Where do the authors believe the line should be drawn? Which behaviors warrant taxation, and which should be excluded from taxation?
Michael J. Rinaldi, M.D.
Sanger Heart and Vascular Institute
Charlotte, NC
mrinaldi@carolinashealthcare.org
No potential conflict of interest relevant to this letter was reported
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