Long-term impact of a sugar-sweetened beverage tax and increased physical activity on obesity and diabetes burden in Central and Eastern European Countries: a microsimulation model.

AIMS: This study models the potential health impacts of combining fiscal and behavioral policies, specifically, sugar-sweetened beverage (SSB) taxation and increases in physical activity (PA), across six Central and Eastern European (CEE) countries.

METHODS

We simulated the effects of a 20 % SSB tax combined with a 15 % increase in PA on obesity, type 2 diabetes mellitus (T2DM), and mortality over 30 years in Bulgaria, Czechia, Hungary, Poland, Romania, and Slovakia. Sensitivity analyses examined alternative scenarios, including SSB substitution with water, a 30 % fruit and vegetable subsidy.

RESULTS

Combined SSB taxation and PA increases would have a significant impact on low-income adults aged 15-49 in Czechia, Hungary, and Romania, whereas high-income groups benefit most in Bulgaria, Poland, and Slovakia. It could prevent between 7,344 (95 % UI: 4,520, 10,168) T2DM cases in Slovakia and 24,142 (95 % UI: 18,809, 29,474) in Poland. Obesity reductions are projected to peak in the early to mid-2030 s, with T2DM and mortality benefits accruing more gradually.

CONCLUSIONS

Integrating fiscal and behavioural policies could reduce the burden of obesity, T2DM, and related inequalities in CEE countries, supporting strategies aligned with the WHO and Sustainable Development Goals.