Sugar-Sweetened Beverage Warning Labels and Taxes: Simulated Impacts When Considering Implementation

Sugar-sweetened beverage warning label and excise tax policies hold promise for preventing Type 2 diabetes. Population-level impacts of sugar-sweetened beverage policies have been projected using simulation models, but the authors are unaware of any assessing the effect of warning labels on Type 2 diabetes or the effects of warning label and tax effects using the same modeling assumptions. Simulation models have also rarely considered how policy implementation factors such as design and sustainment affect policy outcomes.

Microsimulation model of Type 2 diabetes development in a closed cohort of U.S. adults aged 18-64 years over 10 years with 1,200 replications was performed. The model was developed using the National Health and Nutrition Examination Survey 2017-2018, U.S. Diabetes Surveillance System, and published literature. Policy implementation scenarios were modeled in 2025 for warning label (design: graphic or text warning label) and tax (sustainment: $0.02/fluid ounce excise tax sustained or repealed) policies, compared with the status quo.

Relative to the status quo, a graphic warning label was estimated to avert 945,000 cases of Type 2 diabetes over 10 years (95% uncertainty interval=442,000; 1,820,000) compared with 480,000 (95% uncertainty interval=147,000; 1,140,000) cases averted under a text warning label. A $0.02/fluid ounce excise tax was estimated to avert 1,260,000 (95% uncertainty interval=646,000; 2,160,000) cases of Type 2 diabetes over 10 years. If repealed after 1 year, the policy would only avert 78,000 (95% uncertainty interval=0; 469,000) cases of Type 2 diabetes.

Sugar-sweetened beverage policies may be an approach to meaningfully decrease the number of individuals with Type 2 diabetes. Policy design and sustainment drive the magnitude of effects.