144 | Noncommunicable Diseases in Saudi Arabia
TABLE 7.17 Evidence
on cost-effectiveness of diet-related interventions
INTERVENTION
RESEARCH FINDINGS
REFERENCES
Excise taxes on unhealthy foods and beverages
Modeling studies find excise taxes on unhealthy foods and beverages to be cost-saving.
Andreyeva, Chaloupka, and Brownell 2011; Basto-Abreu et al. 2018; Briggs et al. 2013a; Briggs et al. 2013b; Gortmaker et al. 2015; Lal et al. 2017; Long et al. 2015a; Manyema et al. 2014; Sacks et al. 2011; Saxena et al. 2019a; Saxena et al. 2019b; Veerman et al. 2016; Wang et al. 2012; Wilde et al. 2019
FOP warning labels
FOP warning labels are both effective and cost-saving. FOP traffic light labeling appears to be cost saving.
Sacks et al. 2011
Menu warning labels
Warning labels on restaurant menus are more effective than calorie labels.
Musicus et al. 2019
Ban on child-targeted advertising of unhealthy foods and beverages
Child-targeted television advertising of unhealthy foods and beverages appear to be cost-effective or cost-saving. Though the studies of effectiveness are based on low-quality data, there is little doubt that child-centered advertising affects food preferences. Indirect evidence suggests that such effects eventually lead to increases in obesity and obesity-related NCDs.
Brown et al. 2018; Cecchini et al. 2010; Magnus et al. 2009
Nutrition standards and bans on unhealthy foods and beverages in schools, hospitals, and public health facilities
One modeling study concludes that nutrition standards in schools are either cost-effective or cost-saving, but the underlying evidence of effectiveness is weak.
Gortmaker et al. 2015
Limits on industrial trans fats
A modeling study finds that limits on industrial trans fats in England and Wales are cost-saving.
Pearson-Stuttard et al. 2017
Salt and sodium reformulation interventions
Mandated and voluntary reductions of sodium or salt are cost-effective or cost-saving.
Barton et al. 2011; Collins et al. 2014; Nghiem et al. 2015; Nghiem et al. 2016; Rubinstein et al. 2009; Wang and Labarthe 2011; Wilcox et al. 2015; Wilson et al. 2016
Mass media campaigns to reduce salt consumption
Effects are modest, but two modeling studies conclude that they are cost-saving.
Collins et al. 2014; Nghiem et al. 2015
Mandated limits on portions in packaged goods
An Australian modeling study finds that a 375-milliliter limit on the size of packaged SSBs is cost-saving.
Crino et al. 2017
Source: Original compilation for this publication. Note: FOP = front-of-package. SSB = sugar-sweetened beverage.
There is evidence that other diet-related interventions are cost-effective (table 7.17). A large number of modeling studies have found excise taxes on unhealthy foods and beverages to be cost-saving. The economic benefits of such taxes are even stronger if worker productivity gains are taken into consideration (Carter et al. 2019). Taxes on salt also have been found to be cost-saving (Nghiem et al. 2015; Smith-Spangler et al. 2010). Indirect evidence suggests that FOP warning labels are cost-saving. Since warning labels are at least as effective as traffic light labels in encouraging healthy purchasing decisions (if not more so) (Arrúa et al. 2017a; Temple 2020), it is reasonable to infer that FOP warning labels are also likely to be cost-saving. Indirect evidence suggests that menu warning labels are more cost-effective than menu calorie labels (Musicus et al 2019). Assuming that these two types of labels have the same costs, menu warning labels appear to be more cost-effective than menu calorie labels. The latter
