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

Autoři: Lindsey Smith Taillie aff001;  Marcela Reyes aff003;  M. Arantxa Colchero aff004;  Barry Popkin aff001;  Camila Corvalán aff003
Působiště autorů: Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America aff001;  Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America aff002;  Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile aff003;  Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico aff004
Vyšlo v časopise: 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. PLoS Med 17(2): e1003015. doi:10.1371/journal.pmed.1003015
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003015



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.


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.

Klíčová slova:

Advertising – Beverages – Fats – Chile (country) – Marketing – Regulations – Schools – Taxes


1. Popkin BM, Hawkes C. The sweetening of the global diet, particularly beverages: patterns, trends and implications for diabetes prevention. Lancet Diabetes Endo. 2015;4(2):174–86. doi: 10.1016/S2213-8587(15)00419-2; PubMed Central PMCID: PMC4733620.

2. Singh GM, Micha R, Khatibzadeh S, Shi P, Lim S, Andrews KG, et al. Global, Regional, and National Consumption of Sugar-Sweetened Beverages, Fruit Juices, and Milk: A Systematic Assessment of Beverage Intake in 187 Countries. PLoS ONE. 2015;10(8):e0124845. doi: 10.1371/journal.pone.0124845

3. Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356–64. Epub 2010/03/24. doi: 10.1161/CIRCULATIONAHA.109.876185 20308626; PubMed Central PMCID: PMC2862465.

4. Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33(11):2477–83. Epub 2010/08/10. doi: 10.2337/dc10-1079 20693348; PubMed Central PMCID: PMC2963518.

5. Johnson RJ, Sánchez-Lozada LG, Andrews P, Lanaspa MA. Perspective: a historical and scientific perspective of sugar and its relation with obesity and diabetes. Advances in Nutrition. 2017 May 5;8(3):412–22. doi: 10.3945/an.116.014654 28507007

6. Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D. Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. Circulation. 2015 Aug 25;132(8):639–66. doi: 10.1161/CIRCULATIONAHA.114.010636 26124185

7. Imamura F, O’Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. BMJ. 2015;351:h3576. doi: 10.1136/bmj.h3576 26199070

8. DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obesity. 2000;24(6):794–800.

9. Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, et al. The public health and economic benefits of taxing sugar-sweetened beverages. New Engl J Med. 2009;361(16):1599–605. doi: 10.1056/NEJMhpr0905723 19759377

10. Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obes Rev. 2013;14:159–68. doi: 10.1111/obr.12098 24103073

11. Sassi F, Belloni A, Mirelman AJ, Suhrcke M, Thomas A, Salti N, et al. Equity impacts of price policies to promote healthy behaviours. The Lancet. 2018;391(10134)2059–2070. doi: 10.1016/S0140-6736(18)30531-2

12. Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, Baugh V, Bekedam H, Billo N, Casswell S, Cecchini M. Priority actions for the non-communicable disease crisis. The Lancet. 2011 Apr 23;377(9775):1438–47. doi: 10.1016/S0140-6736(11)60393-0 PubMed PMID: ISI:000289963000033.

13. World Cancer Research Fund. International NOURISHING Database. Inform People. London: World Cancer Research Fund; 2019 [cited 2015 Jul 10]. Available from:

14. Goiana-da-Silva F, Cruz-e-Silva D, Gregório MJ, Miraldo M, Darzi A, Araújo F. The future of the sweetened beverages tax in Portugal. The Lancet Public Health. 2018;3(12):e562. doi: 10.1016/S2468-2667(18)30240-8 30522681

15. Silver LD, Ng SW, Ryan-Ibarra S, Taillie LS, Induni M, Miles DR, et al. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study. PLoS Med. 2017;14(4):e1002283. Epub 2017/04/19. doi: 10.1371/journal.pmed.1002283 28419108; PubMed Central PMCID: PMC5395172.

16. Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016;352:h6704. Epub 2016/01/08. doi: 10.1136/bmj.h6704 26738745.

17. Colchero MA, Rivera-Dommarco J, Popkin B, Ng SW. In Mexico, Evidence of Sustained Consumer Response Two Years after Implementing a Sugar-Sweetened Beverage Tax. Health Affair. 2017;36(3):564–571. doi: 10.1377/hlthaff.2016.1231

18. Briggs ADM, Mytton OT, Kehlbacher A, Tiffin R, Elhussein A, Rayner M, et al. Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study. The Lancet Public Health. 2017;2(1):e15–e22. doi: 10.1016/S2468-2667(16)30037-8 28804786

19. Ng SW, Rivera JA, Popkin BM, Colchero MA. Did high sugar-sweetened beverage purchasers respond differently to the excise tax on sugar-sweetened beverages in Mexico? Public Health Nutr. 2018:1–7.

20. World Cancer Research Fund International. WCRF International Food Policy Framework for Healthy Diets: NOURISHING London: World Cancer Reserach Fund International; 2014 [cited 2014 Jul 20]. Available from:

21. Springmann M, Clark M, Mason-D’Croz D, Wiebe K, Bodirsky BL, Lassaletta L, et al. Options for keeping the food system within environmental limits. Nature. 2018;562(7728):519–25. doi: 10.1038/s41586-018-0594-0 30305731

22. Nestle M. Public Health Implications of Front-of-Package Labels. AM J Public Health. 2018;108(3):320–1. doi: 10.2105/AJPH.2017.304285 29412718

23. Van Camp D, de Souza Monteiro DM, Hooker NH. Stop or go? How is the UK food industry responding to front-of-pack nutrition labels? Eur Rev Agric Econ. 2012;39(5):821–42. doi: 10.1093/erae/jbr063

24. Roodenburg A, Popkin B, Seidell J. Development of international criteria for a front of package nutrient profiling system: international Choices Programme. Eur J Clin Nutr. 2011;65(11):1190–1200. doi: 10.1038/ejcn.2011.101 21697817

25. Rayner M, Scarborough P, Kaur A. Nutrient profiling and the regulation of marketing to children. Possibilities and pitfalls. Appetite. 2013;62(0):232–5. doi: 10.1016/j.appet.2012.06.021 22885727

26. Sacks G, Rayner M, Swinburn B. Impact of front-of-pack ‘traffic-light’ nutrition labelling on consumer food purchases in the UK. Health Promot Int. 2009;24(4):344–52. doi: 10.1093/heapro/dap032 19815614

27. Crockett RA, King SE, Marteau TM, Prevost AT, Bignardi G, Roberts NW, Stubbs B, Hollands GJ, Jebb SA. Nutritional labelling for healthier food or non‐alcoholic drink purchasing and consumption. Cochrane Database of Systematic Reviews. 2018(2):CD009315.

28. Taillie LS, Busey E, Mediano Stoltze F, Dillman Carpentier FR. Governmental policies to reduce unhealthy food marketing to children. Nutr Rev. 2019. doi: 10.1093/nutrit/nuz021

29. Essman M, Popkin B, Corvalán C, Reyes M, Taillie L. Sugar-Sweetened Beverage Intake among Chilean Preschoolers and Adolescents in 2016: A Cross-Sectional Analysis. Nutrients. 2018;10(11):1767.

30. Caro JC, Corvalán C, Reyes M, Silva A, Popkin B, Taillie LS. Chile’s 2014 sugar-sweetened beverage tax and changes in prices and purchases of sugar-sweetened beverages: An observational study in an urban environment. PLoS Med. 2018;15(7):e1002597. doi: 10.1371/journal.pmed.1002597 29969444

31. Corvalán C, Reyes M, Garmendia ML, Uauy R. Structural responses to the obesity and non-communicable diseases epidemic: Update on the Chilean law of food labelling and advertising. Obes Rev. 2018;0(0). doi: 10.1111/obr.12802

32. Corvalán C, Garmendia M, Jones‐Smith J, Lutter C, Miranda J, Pedraza L, et al. Nutrition status of children in Latin America. Obesity Reviews. 2017;18:7–18.

33. Jones-Smith JC, Gordon-Larsen P, Siddiqi A, Popkin BM. Cross-National Comparisons of Time Trends in Overweight Inequality by Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys From 37 Developing Countries, 1989–2007. AM J Epidemiol. 2011;173(6):667–75. doi: 10.1093/aje/kwq428 21300855

34. Quezada AD, Lozada-Tequeanes AL. Time trends and sex differences in associations between socioeconomic status indicators and overweight-obesity in Mexico (2006–2012). BMC Public Health. 2015;15(1):1244.

35. Macario E, Emmons KM, Sorensen G, Hunt MK, Rudd RE. Factors influencing nutrition education for patients with low literacy skills. J Acad Nutr Diet. 1998;98(5):559–64.

36. Busselman KM, Holcomb CA. Reading skill and comprehension of the dietary guidelines by WIC participants. J Acad Nutr Diet. 1994;94(6):622–5.

37. Rothman RL, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T, et al. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med. 2006;31(5):391–8. doi: 10.1016/j.amepre.2006.07.025 17046410

38. Schnittker J. Education and the changing shape of the income gradient in health. J Health Soc Behav. 2004;45(3):286–305. doi: 10.1177/002214650404500304 15595508

39. Changes in Beverages Purchases After Chilean Law of Food Labelling and Advertising [Internet]. 2018 [cited 2019 Nov 6]. Available from:

40. Taillie LS, Reyes M, Colchero A, Popkin B, Corvalan C. Changes in sugar-sweetened beverage purchases one year after Chile’s front-of-package warning labels and marketing restrictions: a pre-post analysis:; 2019 [cited 2019 Oct 28]. doi: 10.17504/

41. Census Results 2017 [Internet]. 2018 [cited 2019 Jan 22]. Available from:

42. Kanter R, Reyes M, Corvalán C. Photographic methods for measuring packaged food and beverage products in supermarkets. Current Developments in Nutrition. 2017;1(10):e1001016. doi: 10.3945/cdn.117.001016

43. Ng SW, Popkin BM. The Healthy Weight Commitment Foundation pledge: calories purchased by US households with children, 2000–2012. Am J Prev Med. 2014 Oct 1;47(4):520–30. doi: 10.1016/j.amepre.2014.05.030 25240968

44. Slining MM, Ng SW, Popkin BM. Food companies' calorie-reduction pledges to improve U.S. diet. Am J Prev Med. 2013;44(2):174–84. Epub 2013/01/22. doi: 10.1016/j.amepre.2012.09.064 23332336; PubMed Central PMCID: PMC3583299.

45. Chile National Institute of Statistics. National Employment Survey 2018 [cited 2018 Dec 1]. Available from:

46. Batis C, Rivera JA, Popkin B, Taillie L. First-year Evaluation of Mexico’s Tax on Non-Essential Energy-Dense Foods: An Observational Study. PLoS Med. 2016;13(7):e1002057. doi: PubMed Central PMCID: PMC4933356.

47. Taillie LS, Rivera J, Popkin B, Batis C. Do high vs. low purchasers respond differently to a nonessential energy-dense food tax? Two-year evaluation of Mexico’s 8% nonessential food tax? Prev Med. 2017;105(Supplement):S37–S42. PubMed Central PMCID: PMC5732875.

48. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348–55. Epub 2016/06/11. doi: 10.1093/ije/dyw098 27283160; PubMed Central PMCID: PMC5407170.

49. Amrhein V, Greenland S, McShane B. Scientists rise up against statistical significance. Nature. 2019. 20 March 2019 [cited 2019 Oct 7]. Available from:

50. Belotti F, Deb P, Manning WG, Norton EC. twopm: Two-part models. Stata J. 2015;15(1):3–20.

51. Duan N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc. 1983;78(383):605–10.

52. Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, et al. Measuring socio-economic position for epidemiological studies in low-and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41(3):871–86. doi: 10.1093/ije/dys037 22438428

53. Buchmann C, Hannum E. Education and stratification in developing countries: A review of theories and research. Annu Rev Sociol. 2001;27(1):77–102.

54. Cha E, Kim KH, Lerner HM, Dawkins CR, Bello MK, Umpierrez G, et al. Health literacy, self-efficacy, food label use, and diet in young adults. Am J of Health Behav. 2014;38(3):331–9.

55. Kelly B, Hughes C, Chapman K, Louie JC-Y, Dixon H, Crawford J, et al. Consumer testing of the acceptability and effectiveness of front-of-pack food labelling systems for the Australian grocery market. Health Promot Int. 2009;24(2):120–9. doi: 10.1093/heapro/dap012 19336501

56. Sinclair S, Hammond D, Goodman S. Sociodemographic differences in the comprehension of nutritional labels on food products. J Nutr Educ Behav. 2013;45(6):767–72. doi: 10.1016/j.jneb.2013.04.262 23886777

57. Blitstein JL, Evans WD. Use of nutrition facts panels among adults who make household food purchasing decisions. J Nutr Educ Behav. 2006;38(6):360–4. doi: 10.1016/j.jneb.2006.02.009 17142192

58. Campos S, Doxey J, Hammond D. Nutrition labels on pre-packaged foods: a systematic review. Public Health Nutr. 2011;14(08):1496–506.

59. Ministry of Health M. National Health Survey, Chile 2009‐2010. 2010.

60. National Health Survey, 2016–2017: first results [Internet]. 2017 [cited 2019 Jan 23]. Available from:

61. Nakamura R, Mirelman AJ, Cuadrado C, Silva-Illanes N, Dunstan J, Suhrcke M. Evaluating the 2014 sugar-sweetened beverage tax in Chile: an observational study in urban areas. PLoS Med. 2018;15(7):e1002596. doi: 10.1371/journal.pmed.1002596 29969456

62. Caro JC, Ng SW, Taillie LS, Popkin BM. Designing a tax to discourage unhealthy food and beverage purchases: The case of Chile. Food Policy. 2017;71(Supplement C):86–100. doi: 10.1016/j.foodpol.2017.08.001

63. Teng AM, Jones AC, Mizdrak A, Signal L, Genç M, Wilson N. Impact of sugar‐sweetened beverage taxes on purchases and dietary intake: Systematic review and meta‐analysis. Obes Rev. 2019;20(9):1187–1204. doi: 10.1111/obr.12868 31218808

64. Roberto CA, Lawman HG, LeVasseur MT, Mitra N, Peterhans A, Herring B, Bleich SN. Association of a beverage tax on sugar-sweetened and artificially sweetened beverages with changes in beverage prices and sales at chain retailers in a large urban setting. JAMA. 2019;321(18):1799–810. doi: 10.1001/jama.2019.4249 31087022

65. Shangguan S, Afshin A, Shulkin M, Ma W, Marsden D, Smith J, et al. A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices. Am J Prev Med. 2019;56(2):300–314. doi: 10.1016/j.amepre.2018.09.024 30573335

66. Arrúa A, Curutchet MR, Rey N, Barreto P, Golovchenko N, Sellanes A, et al. Impact of front-of-pack nutrition information and label design on children's choice of two snack foods: Comparison of warnings and the traffic-light system. Appetite. 2017;116:139–46. doi: 10.1016/j.appet.2017.04.012 28428151

67. Arrúa A, Machín L, Curutchet MR, Martínez J, Antúnez L, Alcaire F, et al. Warnings as a directive front-of-pack nutrition labelling scheme: comparison with the Guideline Daily Amount and traffic-light systems. Public Health Nutr. 2017;20(13):2308–17. Epub 2017/06/19. doi: 10.1017/S1368980017000866 28625228

68. Khandpur N, Sato P, Mais L, Martins A, Spinillo C, Garcia M, et al. Are front-of-package warning labels more effective at communicating nutrition information than traffic-light labels? A randomized controlled experiment in a Brazilian sample. Nutrients. 2018;10(6):688.

69. Grummon AH, Taillie LS, Golden SD, Hall MG, Ranney LM, Brewer NT. Sugar-sweetened beverage health warnings and purchases: a randomized controlled trial. Am J Prev Med. 2019;57(5):601–610. doi: 10.1016/j.amepre.2019.06.019 31586510

70. Massri C, Sutherland S, Källestål C, Peña S. Impact of the Food-Labeling and Advertising Law Banning Competitive Food and Beverages in Chilean Public Schools, 2014–2016. Am J Public Health. 2019;109(9):1249–54. doi: 10.2105/AJPH.2019.305159 31318604

71. Correa T, Fierro C, Reyes M, Carpentier FRD, Taillie LS, Corvalan C. Responses to the Chilean law of food labeling and advertising: exploring knowledge, perceptions and behaviors of mothers of young children. International Journal of Behavioral Nutrition and Physical Activity. 2019;16(1):21. doi: 10.1186/s12966-019-0781-x 30760273

72. Dillman Carpentier FR, Correa T, Reyes M, Taillie LS. Evaluating the impact of Chile’s marketing regulation of unhealthy foods and beverages: pre-school and adolescent children’s changes in exposure to food advertising on television. Public Health Nutr. 2019 Dec 11. doi: 10.1017/S1368980019003355

73. Hammond D, Fong GT, Borland R, Cummings KM, McNeill A, Driezen P. Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study. Am J Prev Med. 2007;32(3):202–9. doi: 10.1016/j.amepre.2006.11.011 17296472

74. Euromonitor. Market Sizes— Historical— Soft Drinks; 2019 [cited 2019 Oct 7]. Database: Euromonitor Passport International [Internet]. Available from:

75. Endevelt R, Grotto I, Sheffer R, Goldsmith R, Golan M, Mendlovic J, Bar-Siman-Tov M, World Health Organization. Regulatory measures to improve nutrition policy towards a better food environment for prevention of obesity and associated morbidity in Israel. Public Health Panorama. 2017;3(04):566–74.

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