How far do they go in promoting healthy hydration?

What’s the one thing that proponents and opponents in the bitter battle over sugar taxes can agree on? That sugar taxes, by themselves, are no silver bullet in the war against sugar.

If soda taxes reduce soda consumption, the question is then what people choose to drink instead. Researchers from Virginia Tech say that sugar taxes should be accompanied by strong healthy eating guidelines so that people know what to drink instead of soda.

They set out to analyse 93 taxes on sugar-sweetened beverages to find out how well governments did at promoting positive healthy hydration messages alongside the taxes.

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Encouraging water consumption

The researchers looked at countries that brought in sugary-drink taxation between 2000 and 2023, and then analyzed the recommendations made by national dietary guidelines from various countries to see how they encourage people to replace sugary drinks such as soda with water.

They assigned a ‘healthy hydration recommendation score’ to rank how well governments had accompanied sugar taxes with dietary guidelines to ensure consumers completed their journey away from soda and towards something healthier.

This study focused on the promotion of water: although authors acknowledge other beverages can be considered as ‘healthy’.

Sugary beverages can include soda, fruit drinks, sports drinks and energy drinks (What is and isn’t covered by a soda tax is down to each country).

Regular consumption of sugary beverages is associated with low diet quality and contributes to unhealthy weight gain, obesity, and other health risks including: insulin resistance and type 2 diabetes, cardiovascular disease, dental caries and cancer among children, adolescents, and adults.

Of the 93 countries that had targeted sugary beverage taxes in 2023, 58 countries had food-based dietary guidelines.

Breaking the data down further, the researchers found that 48 of the countries had complementary messages that encouraged water and discouraged sugary beverages.

The researchers ranked the countries, using a healthy hydration recommendation score ranging from 0-12.

The score factored in message clarity, access, justification, actions, specificity, and visual content of the guidelines.

Unexpected winners

Bolivia, Peru, and Brunei scored the highest with the full HHR score of 12 points: because they included ‘fully comprehensive guidelines’ helping consumers understand what, where, why how and how often they should be consuming water.

They also scored highly because they included visual representations, which help engage consumers.

Nine other countries scored highly in terms of providing guidelines with a HHR score of 11: Belgium, Chile, Ghana, Ecuador, Ethiopia, Malaysia, Maldives, Pakistan, Philippines and Sri Lanka.

Coming in with a decent HHR score of 9-10 included Canada, the UK, South Africa and France and India.

While sugar taxes in the US are applied by separate jurisdictions, the country as a whole scored 7 (The next edition of the Dietary Guidelines for Americans and the USDA’s MyPlate is due to be released in 2025).

But 35 countries – 38% of the total – scored poorly because they did not issue any food-based dietary guidelines.

“Sugary beverage tax and levy legislation are an effective policy approach that is increasing, globally,” note the authors of the study.

“However, no one policy approach will mitigate sugary beverage consumption and related health risks. Integrated coherent policy solutions are needed to establish healthy hydration patterns and decrease consumption of sugary beverages.”

What is ‘good’ healthy hydration messaging?

So what should recommendations for healthy hydration cover?

The researchers’ HHR scoring system reveals what public health policies can base their messaging on: based on six key areas.

Firstly is the clarity of the message: with a clear message to drink water and limit sugary beverage intake.

Then there’s the aspect of accessibility – where messages are displayed.

Good messages should also explain why it’s important to limit sugary beverage consumption, and why water consumption is important.

Then comes the idea of action. Good messaging gives clear and actionable recommendations on how to increase water increase and decrease sugary beverage consumption. And going to the next level includes giving clear guidelines for the best quantity and frequency of consumption in measurable terms.

Finally, the best messaging includes visual graphics of water to fully capture consumers’ attention.

Study: An Evaluation of Healthy Hydration Recommendations for 93 Countries with Sugary Beverage Tax Legislation Globally, 2000–2023

Nutrients, 2024,

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