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藉由向垃圾食物徵稅，迫使這些食物的價格上升，使得消費者減少消費這些對健康會造成危害的食物，以達到減少肥胖人口的目的。

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由於肥胖問題導致患病的人數上升，預期這會增加未來公共醫療的開支。

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背景描述：

2020年05月，國內有立委提出擬針對高糖、高熱量的食物課徵「肥胖稅」，因此在國內開啟了一系列關於徵稅是否能有效降低肥胖的討論。

事實上，自2011年丹麥啟動肥胖稅後，國際上已有許多國家相繼施行含糖飲料稅（Sugary drink tax）、垃圾食物稅（junk food tax）、汽水稅（soda tax）、肥胖稅（fat tax）或罪惡稅（sin tax）。同時，世界衛生組織（World Health Organization, WHO）也曾於2016年發佈《 Fiscal policies for diet and the prevention of noncommunicable diseases 》報告，指出提高含糖飲料的售價，能降低消費量並改善肥胖、糖尿病及蛀牙。然各國相繼實施後，對於肥胖稅的實際成效褒貶不一，相關的討論與研究亦持續至今。

在了解完《 醣分類》與《 糖成癮 》後，專家針對肥胖稅在我國實施的可能性，以及推動前須考量的各個要素說明如下。

含糖飲料的攝取與肥胖、心血管疾病和牙齒疾病有顯著的正向關係，而肥胖不但影響生理機能、增加個人的醫療支出（國內已有研究發現，[1] 含糖飲料的攝取和家庭醫療支出有相關性），在全民健康保險制度下，也會加重整體醫療體系的財務負擔，因此有不少國家的政府對含糖飲料課稅。課徵的方式各國不同，有的是按每公升含糖量課稅，含糖量愈高，稅負愈重，例如英國、芬蘭、愛爾蘭等國便是；有的是按飲料價格課徵一定比率的稅，例如智利和多明尼加。

根據《 貨物稅條例 》，我國僅對工廠機器製造的清涼飲料（例如在超商出售的鋁箔包或瓶裝飲料）課稅，並按照飲料性質不同課徵不同比例的貨物稅，對稀釋天然蔬果汁按售價課徵8％、其他飲料課徵15％的貨物稅，純天然果汁則免稅。課稅的時間點，是在產品出廠或進口時，對廠商課稅。雖然是對廠商課徵，但稅負會含在售價中，轉嫁給消費者，由消費者負擔。

與此同時，國內並未對坊間為數眾多的手搖飲課稅。雖然有倡議者提議一併對手搖飲課稅，但國內目前手搖飲店除了連鎖店規模較大外，其他均屬小店戶，財務會計制度較為簡略。且手搖飲販售的飲料有無糖、少糖、半糖、全糖等多種選擇，未來如要對所有的含糖飲料課稅，如何設定課稅標準、執行租稅稽徵，有相當高的難度。而且因受影響的消費者人數眾多，如何爭取認同、凝聚共識，建立可行的課稅制度，還需要進一步釐清、思考和討論。

此外，含糖飲料的消費族群以中低所得者較多，高所得者較有能力節制飲食，追求更健康的代替品，消費反而較少。課徵含糖飲料稅，提高含糖飲料品的價格，固然可以減少中低所得者的糖類攝取，改善健康，但同時也會增加他們的租稅負擔，降低他們的幸福感和生活滿意度。因此，如何宣導正確的飲食觀念、推廣較低甜度的飲料代替品、建立低糖偏好的社會環境，將是建立含糖飲料稅之前，政府應審慎考量和推動的重要功課。
利益迴避聲明：
楊子菡教授：本人目前無進行相關議題的有償研究、或者正擔任與該產品、技術相關之公司之有償職位或自己與家人有投資該公司產品或技術等。
註釋：
[1] 參考資料：李昀儒、林翠芳（2019）。含糖飲料消費、醫療支出與政府政策。財稅研究，48(5)，89-104。

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肥胖稅事件之專家回應──肥胖稅

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在了解完《醣分類》與《糖成癮》後，專家針對肥胖稅在我國實施的可能性，以及推動前須考量的各個要素說明如下。

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每 28 公克 1 美分的含糖飲料稅，為兒童營養和社區健康計劃籌集了 140 萬美

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台灣科技媒體中心（作者：楊子菡）

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台灣科技媒體中心（作者：楊子菡）

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含糖飲料的攝取與肥胖、心血管疾病和牙齒疾病有顯著的正向關係，而肥胖不但影響生理機能、增加個人的醫療支出

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背景描述：

2020年05月，國內有立委提出擬針對高糖、高熱量的食物課徵「肥胖稅」，因此在國內開啟了一系列關於徵稅是否能有效降低肥胖的討論。

事實上，自2011年丹麥啟動肥胖稅後，國際上已有許多國家相繼施行含糖飲料稅（Sugary drink tax）、垃圾食物稅（junk food tax）、汽水稅（soda tax）、肥胖稅（fat tax）或罪惡稅（sin tax）。同時，世界衛生組織（World Health Organization, WHO）也曾於2016年發佈《 Fiscal policies for diet and the prevention of noncommunicable diseases 》報告，指出提高含糖飲料的售價，能降低消費量並改善肥胖、糖尿病及蛀牙。然各國相繼實施後，對於肥胖稅的實際成效褒貶不一，相關的討論與研究亦持續至今。

在了解完《 醣分類》與《 糖成癮 》後，專家針對肥胖稅在我國實施的可能性，以及推動前須考量的各個要素說明如下。

含糖飲料的攝取與肥胖、心血管疾病和牙齒疾病有顯著的正向關係，而肥胖不但影響生理機能、增加個人的醫療支出（國內已有研究發現，[1] 含糖飲料的攝取和家庭醫療支出有相關性），在全民健康保險制度下，也會加重整體醫療體系的財務負擔，因此有不少國家的政府對含糖飲料課稅。課徵的方式各國不同，有的是按每公升含糖量課稅，含糖量愈高，稅負愈重，例如英國、芬蘭、愛爾蘭等國便是；有的是按飲料價格課徵一定比率的稅，例如智利和多明尼加。

根據《 貨物稅條例 》，我國僅對工廠機器製造的清涼飲料（例如在超商出售的鋁箔包或瓶裝飲料）課稅，並按照飲料性質不同課徵不同比例的貨物稅，對稀釋天然蔬果汁按售價課徵8％、其他飲料課徵15％的貨物稅，純天然果汁則免稅。課稅的時間點，是在產品出廠或進口時，對廠商課稅。雖然是對廠商課徵，但稅負會含在售價中，轉嫁給消費者，由消費者負擔。

與此同時，國內並未對坊間為數眾多的手搖飲課稅。雖然有倡議者提議一併對手搖飲課稅，但國內目前手搖飲店除了連鎖店規模較大外，其他均屬小店戶，財務會計制度較為簡略。且手搖飲販售的飲料有無糖、少糖、半糖、全糖等多種選擇，未來如要對所有的含糖飲料課稅，如何設定課稅標準、執行租稅稽徵，有相當高的難度。而且因受影響的消費者人數眾多，如何爭取認同、凝聚共識，建立可行的課稅制度，還需要進一步釐清、思考和討論。

此外，含糖飲料的消費族群以中低所得者較多，高所得者較有能力節制飲食，追求更健康的代替品，消費反而較少。課徵含糖飲料稅，提高含糖飲料品的價格，固然可以減少中低所得者的糖類攝取，改善健康，但同時也會增加他們的租稅負擔，降低他們的幸福感和生活滿意度。因此，如何宣導正確的飲食觀念、推廣較低甜度的飲料代替品、建立低糖偏好的社會環境，將是建立含糖飲料稅之前，政府應審慎考量和推動的重要功課。
利益迴避聲明：
楊子菡教授：本人目前無進行相關議題的有償研究、或者正擔任與該產品、技術相關之公司之有償職位或自己與家人有投資該公司產品或技術等。
註釋：
[1] 參考資料：李昀儒、林翠芳（2019）。含糖飲料消費、醫療支出與政府政策。財稅研究，48(5)，89-104。

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肥胖稅事件之專家回應──肥胖稅

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在了解完《醣分類》與《糖成癮》後，專家針對肥胖稅在我國實施的可能性，以及推動前須考量的各個要素說明如下。

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中華民國肥胖研究學會理事長蕭敦仁：「糖本身有成癮性，你一直吃糖的話，對於肥胖症對於糖尿病，對於心臟病，這個因果關係是還滿明顯的。」

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綜合報導 / 台北市

國民健保連年虧損，衛福部確定今年健保費將再調漲，各界爭論不休，而立委高嘉瑜日前更是在質詢中表示，國人三高問題嚴重，造成健保負擔，向官員拋出了，要不要徵收肥胖稅的議題，引起集大反彈。

首先稅收名稱，針對特定體型的民眾，有人覺得遭到歧視了，而且實際採訪後發現，民眾會質疑，真的徵收了相關稅捐，也不見得能降低國人肥胖問題，還是說會淪為另立名目找財源的手段？這則新聞告訴你。

課徵肥胖稅爭議大，歧視找財源補健康捐，中華民國肥胖研究學會理事長蕭敦仁：「糖本身有成癮性，你一直吃糖的話，對於肥胖症對於糖尿病，對於心臟病，這個因果關係是還滿明顯的。」立委高嘉瑜：「針對會造成國人疾病的這些，高熱量高糖份的食品，未來是不是有可能，會課徵肥胖稅。」貨車司機Andy：「如果是真的胖的人，會覺得會遭到歧視吧，其實我也不是很喜歡這個名字。」

肥胖稅課不課各界爭論不休，衛福部研擬調高健保費，肉肉一族成為焦點，難道胖真的錯了嗎，稅捐名稱針對胖子，引起極大反彈，但其實所謂肥胖稅，近年開始正名為健康食品稅捐，跟菸捐類似，從上游廠商對高糖份飲食課稅，降低國人吃垃圾食物比例，立意雖好但仍遭到質疑，我吃什麼關國家什麼事，貨車司機Andy：「我要蘿蔔糕跟奶茶大杯的。」

一大早的生活從糖開始，他是Andy體重78公斤，BMI值29，一天的生活離不開熱量的誘惑，飲料甜食樣樣來，雖然體重超標，但是Andy目前，並沒有慢性病問題，他認為為什麼其他人的健保支出，要由他額外花錢買單，貨車司機Andy：「是要補貼健保，那我沒有三高，我喝是我家的事情啊。」

而且Andy工作的是勞力活，每天要上下貨，以及長時間開車，對他而言很需要，隨手可得的熱量，貨車司機Andy：「血糖低啊什麼的，我可能會比較累，想睡覺之類的，對我來說其實還滿危險的，都會買一些零食啊，放在車上準備著。」

Andy的反彈說出不少人心聲，在美食王國吃就是一種權力，但專家提出警訊，我國兩大健保支出，洗腎每年花513億元糖尿病213億元，都跟肥胖有連帶關係，而十大死因有7項是肥胖相關疾病，降低國人BMI絕對能，提升健康品質與降低健保負擔，中華民國肥胖研究學會理事長蕭敦仁！「我們的兒童大概有四分之一有肥胖問題，那我們女生大概有三分之一，我們男孩子大概是兩個就有一個，所以只好用稅捐來降低，因為世界各國的經驗還是這樣，你商品的售價比較高，大家購買的意願就會相對降低。」

泰國人比台灣更愛吃甜食，泰式奶茶除了糖還加煉乳，因此他們政府從2015年開始，就針對含糖飲料提出稅收，每100毫升飲料，如果含糖量在10-14公克，就徵收1泰銖，相當於台幣九毛四的稅收，而且吃越甜課越重，如果含糖量在18公克以上，將徵收五泰銖的稅收，也就是說像這樣，700毫升的泰式奶茶，有可能光是稅，你就要付30元台幣。

除了泰國，目前世界上約有三十個國家，開始徵收食品健康稅捐，但專家表示，目前並沒有有力證據證明，食品健康稅收能夠，降低肥胖率，但是這些稅收仍有其他用途，包括用來防治肥胖症，以及透過稅金壓力，讓製造商生產更健康的產品，台大公衛所所長陳端容：「它(製造商)就會嘗試，去做一個組合，可能一部分生產20%的含糖量，一部分生產30%的含糖量，以整個市場上，健康食品的選擇就會出來。」

要不要課糖捐，目前政府並未提出具體規劃，而專家樂觀其成，但能否讓國人接受，才是一大考驗，尤其一杯飲品多課個十塊錢，對有錢人來說九牛一毛，但對收入中下的民眾影響較大，反而變相讓糖成了窮人的奢侈品，吃美食的權力與健康之間，如何找到交集點是一大難題。

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2022 年 7 月於《Neurology》發表了一篇研究，總共納入了 7 萬多名受試者的健康數據，且研究初期並沒有失智症相關的病史，經過 10 年的追蹤後發現，有 518 名受試者罹患失智症。於是研究人員評估了受試者超加工食品攝取量與失智症風險之間的關係，結果發現，超加工食品攝取量每增加 10%，罹患失智症的機率將增加 25%，顯示吃下太多過度加工的食物確實會讓腦袋變笨，容易影響腦部的健康並降低認知功能。值得關注的是，如果使用 10% 的未加工或輕度加工的食物取代等量的超加工食品攝取，可以降低 19% 失智的風險。

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從早餐的火腿蛋餅，到下午的珍珠奶茶，我們的三餐無不被加工食品圍繞。加工製造為食品增添賣相、風味也更上一層樓，然而美味的背後是否會對健康產生影響？

超加工食品與加工食品差在哪？

隨著加工技術的發展，全球食物供應量每年都不斷地在成長，歐美國家日常飲食中的「超加工食品」竟佔總熱量的 50-60%。我們生活中所採買到的食物，或多或少都是經由工廠加工處理後的食物。

你知道加工食物還有分等級嗎？國際上最廣泛用來分類加工食品的系統為「NOVA 食品分類」，考量食物的加工性質、加工程度和目的，將食物分為 4 個等級：

1. 未加工或最少加工食物（Unprocessed or minimally processed foods）：食物未經加工或只做簡單處理，如乾燥、研磨、蒸煮、烘烤、殺菌、冷藏、冷凍等，即可供食用，主要目的為延長食品的保存期限，如糙米、白米、燕麥、麵粉、肉類、雞蛋、鮮奶、奶粉、茶、咖啡、飲用水等。

2. 經過加工烹飪的原料（Processed culinary ingredients）：透過萃取、精煉等方式從第 1 級食物或天然食物中所獲得的物質，如從植物中提取出的橄欖油、牛奶提煉出的奶油、從甘蔗提取出的糖或糖漿、玉米或其他植物中提取出的澱粉等。

3. 加工食品（Processed foods）：通常是第 1 級和第 2 級食品的組合，主要目的是為了要提高食物的保存度及提升風味，如各式罐頭食物、現做麵包、起司等。

4. 超加工食品（Ultra-processed foods）：添加了更多成分，除了糖、鹽、油之外，還會添加多種化學成分（防腐劑、甜味劑、色素等食品添加物），試圖讓食物外表變得更吸引人、把味道變得更濃郁等，如含糖飲料、玉米脆片、餅乾、蛋糕、超商販售的包裝麵包、香腸、薯條、微波即時食品等都是屬於這類食品。

吃超加工食品對健康有什麼影響？

一、肥胖

肚子餓時，吃下一包洋芋片可能不覺得飽，但是吃下一碗生菜沙拉的感受程度就有所不同了，因此在減重策略中，選擇低熱量密度食物，有助於提升飽足感、減少熱量攝取。然而超加工食品通常有高的升糖負荷（Glycemic load, GL）以及高熱量密度的特性，高 GL 會誘發胰島素反應增加，使吃下去的營養轉變為脂肪儲存起來，在相同份量下，高熱量密度食物容易造成熱量攝取過量，導致體重增加。

二、心血管疾病

2019 年權威期刊《British Medical Journal》發表的前瞻性世代研究指出，攝取超加工食品與心血管疾病、冠狀動脈疾病以及腦血管疾病的發生率增加有關。含糖飲料、蛋糕等超加工食物有比較多的糖化中產物（Advanced glycation end-products, AGEs），易促進發炎反應，長期下來可能會導致或加速心血管疾病發生。超加工食品通常有高鈉、飽和脂肪、添加糖、低纖維的特性，品質往往比未加工或加工食品要來的差，而過多的熱量攝取與過重、肥胖有關，也被認為是心血管疾病的主要因素。

三、癌症

研究指出，飲食中超加工食品的比例增加 10%，就會增加 12% 整體癌症、10% 乳腺癌風險，舉例來說：超加工食品缺乏足夠的膳食纖維，會增加罹患直腸癌風險；醃漬食物的鹽份過多，會增加罹患胃癌的風險。如果我們常常吃這些過度加工的食物，如餅乾、碳酸飲料、洋芋片、香腸、火腿等，攝取太多油、鹽、糖，不僅營養素易缺乏，且含有多種添加成分會對身體產生負擔，長期下來更容易致癌。

四、失智症

2022 年 7 月於《Neurology》發表了一篇研究，總共納入了 7 萬多名受試者的健康數據，且研究初期並沒有失智症相關的病史，經過 10 年的追蹤後發現，有 518 名受試者罹患失智症。於是研究人員評估了受試者超加工食品攝取量與失智症風險之間的關係，結果發現，超加工食品攝取量每增加 10%，罹患失智症的機率將增加 25%，顯示吃下太多過度加工的食物確實會讓腦袋變笨，容易影響腦部的健康並降低認知功能。值得關注的是，如果使用 10% 的未加工或輕度加工的食物取代等量的超加工食品攝取，可以降低 19% 失智的風險。

減少超加工食品攝取的飲食策略

從走出家門的那一刻起，到處都可以買的到可口、方便、好吃又廉價的超加工食品。早餐吃超商的奶酥麵包，午餐吃速食店的漢堡配薯條及可樂，晚餐到回家拿出冷凍庫中的冷凍蝦仁炒飯放到微波爐中等待數分鐘即可，然而這類食物通常含有大量的糖、鹽、脂肪及添加劑，沒有吃到新鮮的蔬菜和水果，容易導致飲食失衡。

偶爾吃一下不會有問題，關鍵是要掌握平衡，我們雖然不可能完全不碰加工食品，但是可以試著把每天的飲食增加一點新鮮的食物，或是降低超加工食品的比例，能少吃就少吃吧！舉例來說可將精緻麵包改成蒸地瓜或全麥饅頭、速食改成去小吃店點一碗麵加上燙青菜、下午肚子餓了點心就用水果取代果乾，比起買超商販售的微波食品不如改成去附近自助餐挑選菜色，花點心思審視食物與身體之間的關係，就能重新體驗到食物的美味，拾回健康。

1、Consumption of ultra-processed foods and health status: a systematic review and meta-analysis
2、Association of Ultraprocessed Food Consumption With Risk of Dementia A Prospective Cohort

文／劉思妤、圖／雷思瑜

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加工食物是健康殺手？營養師盤點超加工食品對身體的危害

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從早餐的火腿蛋餅，到下午的珍珠奶茶，我們的三餐無不被加工食品圍繞。加工製造為食品增添賣相、風味也更上一層樓，然而美味的背後是否會對健康產生影響？

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遭到農民和食品公司的反對，也不受消費者的歡迎

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各國食品健康稅捐政策之研究

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各國食品健康稅捐政策之研究

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若是徵稅的話可能導致國人因錢的問題營養不良

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正常攝入的情況是健康的

在飲食中去掉糖可能適得其反

像用更高熱量的東西取代糖

過量又會導致肥胖

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雖然現在難以想像，但曾幾何時，人類只能在水果成熟的幾個月裏吃到糖。大約8萬年前，從事狩獵和採集活動的人類只能偶爾吃到少量水果，還要跟鳥搶著吃。

現在，我們全年都能吃到大量的糖，糖的營養意義降低，吃到糖的難度也大大下降，開瓶汽水或者開盒麥片即可。不是專家也知道，現代人糖的攝入量不及以前四處找糖的時期健康。如今，糖已經成了公共健康的頭號敵人：政府對糖徵稅，學校和醫院不在自動售貨機裏賣糖，專家建議在飲食中完全不攝入糖。

但到目前為止，科學家還難以證明糖如何獨立於高熱量飲食之外影響著我們的健康。也有越來越多的聲音認為，將某種食物妖魔化十分危險，並且會造成困惑，可能導致我們停止食用至關重要的食物。

糖，又名「添加糖」，包括蔗糖、甜味劑、蜂蜜和果汁，經提取和精煉後加入食品和飲料中，以改善口味。

但糖其實是一個廣義概念，包括了成分或複雜或簡單的碳水化合物。碳水化合物經由人體消化分解成葡萄糖，幫助人體細胞產生能量，並維持大腦運轉。複雜的碳水化合物包括全谷物和蔬菜。簡單的碳水化合物更容易消化，會迅速將糖釋放到血液中，包括天然存在於食物中的糖，譬如果糖、乳糖、蔗糖和葡萄糖，以及其他人造糖，比如高果糖玉米糖漿。

在16世紀之前，只有富人才吃得起糖。但隨著殖民貿易，糖變得越來越普遍。

上世紀60年代，葡萄糖開始能夠被大規模地轉化為果糖，促生了高果糖玉米糖漿，一種葡萄糖和果糖的濃縮物。

很多倡導公共健康的人士認為，這種味道濃烈的混合物比其他任何單一糖類都危險。而很多人想到「糖」時，想到的就是高果糖玉米糖漿。

從1970年到1990年，美國的高果糖玉米糖漿消耗量增加了10倍，增幅比其他任何食品都高。研究人員指出，這也反映在了全美肥胖現象越來越多。這可能是因為高果糖玉米糖漿不同於其他食物，它不會增加瘦素。瘦素是一種激素，有助於我們產生飽腹感。

含糖飲料一般會使用高果糖玉米糖漿，在研究糖對人體健康的影響中一直是個重要對象。對88項研究進行的一項薈萃分析發現，飲用含糖飲料與體重高低相關。換句話說，人們不會因為喝了汽水獲得了熱量就少吃其他食物，可能因為這些飲料增加了饑餓感，或減少了飽腹感。

但研究人員認為，雖然美國汽水和添加糖的攝入量連同肥胖現象一起增加了，但數據只表示兩者大致相關。

不是所有人都認同高果糖玉米糖漿造成了肥胖危機。一些專家指出，過去10年中，包括美國在內的一些國家，糖消耗量持續下降，但肥胖水平卻一直上升。在澳大利亞和歐洲等幾乎或完全不使用高果糖玉米糖漿的地區，也出現了大量肥胖症和糖尿病。

高果糖玉米糖漿不是唯一被認為會引起健康問題的糖。添加糖，尤其是果糖，被認為是各種問題的罪魁禍首。

比如認為果糖會引起心臟病。肝細胞在分解果糖時，有個最終產物是甘油三酯。甘油三酯是一種脂肪，會不斷在肝細胞中累積。當甘油三酯進入血液，可能會導致動脈血管內部形成富含脂肪的斑塊。

一項為期15年的研究似乎證實了這一點：研究發現，每天攝入的熱量中，添加糖的比例佔25%或以上的人，死於心臟病的機率是佔比低於10%的人的兩倍多。食用添加糖還會引發2型糖尿病。上世紀90年代的兩項大型研究發現，相比於幾乎不喝汽水及果汁的女性，每天飲用超過一杯的女性患糖尿病的機率會高出一倍。

但目前還不清楚糖是否真的導致了心臟病或糖尿病。包括瑞士洛桑大學生理學教授塔皮（Luc Tappy）在內的很多科學家認為，造成糖尿病、肥胖症和高血壓的主要原因是熱量攝入過量，糖只是熱量的一種。

「長遠來看，無論何種飲食結構，只要能量攝入多於消耗，就會導致脂肪堆積、胰島素抵抗和脂肪肝，」他說，「而能量消耗和攝入相匹配的人，即使是高果糖/高糖飲食也完全沒問題。」

塔皮指出，比如運動員的糖消耗量往往更高，但患心血管疾病的機率卻更低，為了提高成績他們會進行運動，能將攝入的大量果糖代謝掉。

總的來說，添加糖直接導致2型糖尿病、心臟病、肥胖症或癌症的證據不足。添加糖攝入量較高確實與這些疾病有關，但臨牀試驗還沒有證實是糖導致了這些疾病。

常常還說糖會上癮，但這可能也並非如此。《英國運動醫學雜誌》2017年發表的一篇文章提到，多項研究發現老鼠可能會出現糖分戒斷症狀，並認為糖會產生與可卡因類似的作用，比如渴求感。但這篇文章飽受詬病，被認為誤解了相關證據。一種批評認為，動物吃糖的時間被限制在一天兩小時，如果允許它們像人類一樣想吃就吃，就不會出現類似上癮的行為。

但還有很多研究表明，糖會以其他方式影響我們的大腦。澳大利亞斯威本大學人類精神藥理學中心的研究員帕塞（Matthew Pase）請被試對象報告他們喝了多少含糖飲料，並用核磁共振掃描他們大腦的健康狀況，研究了攝入量與大腦健康的關係。喝汽水和果汁頻率更高的人，平均腦容量更小，記憶力更差。每天喝兩杯含糖飲料的人大腦比完全不喝的人老兩歲。但帕塞說，他只測算了果汁的攝入量，因此無法確定影響大腦健康的是不是只有糖。

帕塞說：「喝果汁或汽水較多的人可能都有其他影響大腦健康的飲食或生活習慣。比如，可能鍛煉得也少。」

最近的一項研究發現，糖甚至可能有助於改善老年人的記憶力和表現。研究人員給參試者一杯含少量葡萄糖的飲料，並請他們完成各種各樣的記憶任務，另外一些參試者作為參照喝的是含人工甜味劑的飲料。研究人員檢測了參試者的投入程度、記憶分數和他們自認為付出了多少努力。

結果表明，攝入糖分能夠讓老年人更積極地去全力完成困難的任務，同時不覺得自己付出了更多努力。血糖水平升高還會讓他們在完成任務的過程中更加快樂。

年輕人喝了葡萄糖飲料後會增加能量，但不會影響他們的情緒或記憶力。

儘管目前的指南建議添加糖不應超過每日熱量攝取的5%，但營養學家麥格雷戈（Renee McGregor）說，重要的是要明白健康和均衡的飲食因人而異。

「我指導的運動員在進行艱苦的訓練時必須增加糖的攝入量，因為糖容易消化。但他們擔心會超過指南規定的量。」她說。

對我們大部分普通人來說，添加糖確實不是健康飲食的關鍵。但一些專家警告說，我們不該認為只有添加糖有害健康。

麥格雷戈的客戶包括健康食品症患者，會對健康飲食過度迷戀。她說，給食物貼上「好」或「壞」的標籤是不合理的。禁止吃糖只會增加它的吸引力。「一旦你說不能吃什麼，你就越想吃什麼，」她說，「所以我從不說禁止吃某種食物，我會說它沒有營養價值。但有時，食物也有其他價值。」

美國詹姆斯麥迪遜大學副教授列文諾維茨（Alan Levinovitz）研究的是宗教與科學的關係。他說，我們認為糖邪惡的原因很簡單：縱觀歷史，我們總是把最難抗拒的東西妖魔化（譬如維多利亞時代將性快感妖魔化）。

「糖能給人帶來極大的愉悅，所以我們必須把它看成是頭等大罪。當我們用簡單的好壞二元論來看待事物時，想到邪惡的東西居然可以適量存在就會感到不可思議。對糖的看法就是這樣。」他說。

他認為，用如此極端的態度對待食物可能會讓我們擔心吃的東西，並在每天決定吃什麼時進行一場道德判斷，思考是否有必要吃。

在飲食中去掉糖甚至可能適得其反：可能意味著用熱量更高的東西取代糖，比如做菜時用脂肪代替糖。

有關糖的爭論越來越激烈，我們可能會將類似汽水這種含添加糖但缺少其他必需營養物質的食品和飲料，與水果等含糖的健康食品相混淆。

28歲的瑞典人格倫丁（Tina Grundin）就一度難以區分這兩者，她說過去以為所有的糖都不健康。她遵循高蛋白、高脂肪的純素飲食，導致患上了一種尚未確診的飲食失調。

「當我開始在飯後嘔吐時，我知道不能再這樣了。我從小到大一直害怕各種形式的糖，」她說，「後來我意識到，添加糖和碳水化合物中的糖是有區別的，於是我開始進行高果糖、高澱粉的飲食，接受水果、蔬菜、澱粉和豆類中的天然糖分。」

「從第一天開始，就像大霧散去，我終於看清了。我終於讓體內的細胞得到了能量，這些能量來自葡萄糖、碳水化合物和糖類。」

不同糖類對人體健康的影響還沒有定論，但可能考慮得越少越好。

麥格雷戈說：「我們真的把營養過分複雜化了，從根本上說，所有人都在尋找圓滿、完美和成功的感覺，但這其實並不存在。」

更多相關內容

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糖真的有害健康嗎？ - BBC 英伦网

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甜食吃得越多，患2型糖尿病、心臟病和癌症的風險就越高......但這可能並不是糖的錯。BBC Future對最新研究結果進行了考查。

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加工食品到底有多不健康？

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加工食品到底有多不健康？

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「攝入含有大量超強加工食品的飲食也可能是其他不健康飲食模式和生活方式行為的結果。」阿斯特伯裡說。

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根據含糖飲料消費稅從墨西哥商店購買的飲料：觀察性研究

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根據含糖飲料消費稅從墨西哥商店購買的飲料：觀察性研究

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課稅可以增加含糖飲料的價格

進而降低含糖飲料的購買率

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Patient involvement

No patients were involved in setting the research question or outcome measures, nor were they involved in the design and implementation of the study. There are no plans to involve patients in the dissemination of results.

Descriptive statistics

We present descriptive statistics of the households in the analytic data. Then we present the unadjusted trends in household purchases as reported during the period January 2012 through December 2014, which includes the first year of the post-tax period (beginning 1 January 2014). We conducted simple t tests to determine whether the volume of beverages purchased in each post-tax month was statistically different from that of the same month in 2012 and 2013. Stata 13 was used for all analyses. 35

Difference in difference fixed effects analyses

As the tax was implemented nationally, it was not possible to construct a true experimental design to study the association between the tax on sugar sweetened beverages and purchases. Therefore we applied a pre-post quasiexperimental approach using difference in difference analyses along with fixed effects models, 36 37 with fixed effects at the household level. Fixed effect models have several advantages, mainly that they account for non-time varying unobserved characteristics of households (for example, preference for certain types of beverages). As such, non-time varying measures (for example, region of household's residence) are omitted in the model.

As the distribution of beverage purchases per capita were skewed and not normally distributed, we used the logarithm of beverage purchases as outcomes in the models. The model adjusts for the seasonality of beverage purchases using a variable for each quarter of the year and demographic information on household composition, socioeconomic status, and contextual factors (unemployment rate and minimum salary).

To allow for interpretability, we back transformed the logged outcomes into milliliters per capita by calculating and applying Duan smearing factors. 38 Specifically, Duan smearing ensures that in the presence of non-zero variances in the volume purchased, the back transformed predicted outcome is not downward biased. 38 This also allowed us to compare in absolute and relative terms the estimated post-tax volume of beverages purchased in January through December 2014 to the estimated counterfactual post-tax volume assuming a pretax trend. We did consider presenting predicted values that also detrended seasonality, by setting all quarters to the same quarter, but these seasonal trends are interesting and more accurately reflect the changing demand for beverages over the course of the year. We also corrected the standard errors by clustering the analyses at household level.

The model also takes into consideration periods of non-purchases of beverage categories, when more than 10% of the observations using inverse probability weights were non-purchases. We calculated inverse probability weights by modeling the probability of purchasing, adjusted for the same covariates as the main regression for the log of purchases (the inverse of the predicted values obtained from this model being used in the main regression as a weighting factor). 39 40 We conducted analyses for the full sample and stratified the analyses by socioeconomic status (low, middle, high), using separate models to determine if there were differences for these subsamples. The supplemental materials provide additional details on the analytic approach. We used Stata 13 for all analyses. 35

Sensitivity analysis among untaxed beverages

We conducted sensitivity analysis for the untaxed beverages modeled from October 2012 to December 2014. Given the large number of missing values for dairy beverages from January to September 2012, imputation was not an adequate option. Instead, we repeated the models excluding dairy beverages and compared the results from January 2012 to December 2014 with those from October 2012 to December 2014.

Descriptive trends in household purchases

Table 1 ⇓ presents the unadjusted characteristics of the households for each year. This analytic sample of reported purchases represents more than 16 million households (approximately 90-100 million residents) in Mexico in each of these years.

Before controlling for any potential factors, strong seasonal effects on beverage purchases need to be considered. In Mexico, seasonality can be due to changes in temperature (though these temperature changes are not extreme in Mexico), holidays and festivities, and fewer purchases at the beginning of the year after the festivities in December (see supplemental fig 1). There is also a decrease in overall purchases of taxed beverages (see supplemental fig 1a), particularly in 2014. We are only able to present unadjusted purchases since October 2012 for untaxed beverages (see supplemental fig 1b), and there is an absolute increase in the volume purchased over time.

Model predicted differences in beverage purchases in stores: overall findings

Supplemental table 2 presents the coefficient estimates for each of the beverage categories from the difference in difference fixed effects models at the household level controlling for socioeconomic status, age, and sex, and for contextual measures of households. Based on these estimates, we back transformed the predicted log volumes for each of the 12 post-tax months using Duan smearing. 38 We compared estimated counterfactual volumes purchased in the post-tax period based on pretax trends (expected volumes if the tax had not been implemented) to adjusted volumes purchased in the post-tax period (based on predicted values from the model) and derived the absolute and relative differences from January to December 2014.

Table 2 ⇓ and figure 1 ⇓ show that for taxed beverages the absolute and relative differences between the post-tax volume and its counterfactual widened over the 12 post-tax months from −11 mL/capita/day (−5.6% relative to the counterfactual) in June to −22 mL/capita/day (−12% relative to the counterfactual) by December 2014, giving an average change of −6.1% over 2014. In total, during 2014 the average urban Mexican purchased 4241 mL (seven 600 mL or 20 oz bottles) fewer taxed beverages than expected (based on pretax trends). This was related to a decrease in purchases of non-carbonated sugar sweetened beverages (−17% relative to the counterfactual) and taxed sodas (−1.2% relative to the counterfactual). See supplemental Figure 2.

For untaxed beverages the absolute (and relative) differences were initially higher, at 63 mL/capita/day (7.5% relative to the counterfactual) in January 2014, and though the difference remained positive, it decreased over the 12 month post-tax period and was no longer statistically different from the counterfactual by November 2014. None the less, this represents an average increase in the purchase of untaxed beverages, of 36 mL/capita/day (4% relative to the counterfactual), which translates to the purchase of 12 827 mL (21 600 mL or 20 oz bottles) more untaxed beverages by the average urban Mexican over 2014 than expected.

Sensitivity analyses among the untaxed beverages showed that the model appears sensitive to the pretax period used. Limiting the analyses to untaxed beverages excluding dairy beverages, we found a relative increase in purchases by 2% when using January 2012 to December 2013 as the pretax period. This was 5% when using October 2012 to December 2013 as the pretax period. These results suggest that the estimated 4% for all untaxed beverages may be an overestimate, but positive (relative increase) none the less. Given the nature of incomplete data on beverages from the diaries, we are unable to provide an estimate on the magnitude of the overestimation without making major assumptions, but to provide context, dairy beverages represent 17% of the untaxed beverages since October 2012.

Difference in store purchases after the tax by household socioeconomic status

Supplemental table 3 provides the coefficient estimates for each of the beverage categories from the difference in difference fixed effects models stratified by socioeconomic status. Based on these estimates, we back transformed the predicted log volumes for each of the 12 post-tax months using Duan smearing. Supplemental table 4 presents the absolute and relative differences in the estimated counterfactual volumes that would have been purchased in the post-tax period based on pretax trends (expected volumes if the tax had not been implemented) and the predicted volumes purchased in the post-tax period by the three socioeconomic status levels. Figures 2 ⇓ and 3 present the results for taxed and untaxed beverages, respectively. Both figures show clear seasonal trends in the purchases of taxed and untaxed beverages, with higher purchases in April to September of each year.

Purchases of taxed beverages were already declining during the pretax period across all three socioeconomic status groups, and the households in the highest category had the steepest rates of decline during the pretax period (fig 2 ⇑ ). In the post-tax period both the absolute and the relative differences in predicted post-tax purchases compared with the counterfactual were largest for households of low socioeconomic status, reaching −35 mL/capita/day (−17.4%) by December 2014 and averaging −19 mL/capita/day (−9.1%). Households of middle and high socioeconomic status both reduced purchases of taxed beverages by about 5.5% to 5.6% compared with their counterfactuals.

The purchase levels of untaxed beverages before the tax were stable across all socioeconomic status households (fig 3 ⇓ ). In the post-tax period, households of middle socioeconomic status showed the greatest increase in purchase of untaxed beverages compared with their counterfactuals, averaging 53 mL/capita/day (5.9%), followed by households of low socioeconomic status (19 mL/capita/day; 2.4%). Households of high socioeconomic status had the smallest increase (15 mL/capita/day; 1.5%). However, households of middle and low socioeconomic status both showed larger differences in the earlier months that became smaller over the year, whereas changes among households of high socioeconomic status were less steep over the 12 months, maintaining a difference of 13 to 17 mL/capita/day (1.4% to 1.8%) throughout.

Comparison with other studies

This study shows the initial changes during the first year of the tax. Economic models of addiction and related behavioral models imply that the long term impact of a price change will be much larger than the short term effect, 41 but this has been shown only for tobacco, alcohol, and illicit drugs. 42 43 44 The acceleration of the reduction over time in the purchases of taxed sugar sweetened beverages suggests that this is true for these beverages, so in the future we might expect slightly greater decreases in purchases of sugar sweetened beverages and increases in purchases of untaxed beverages. Additionally, given that the tax on sugar sweetened beverages is approximately 10% of 2013 prices, the reduction of more than 10% in the last quarter of 2014 shows that the demand was price elastic (at least in that quarter), and that even a relatively small tax can make some difference in the demand for beverages (with potential substitution to plain bottled waters). The tax is to be adjusted for inflation every two years, so only a real growth in income might be expected to reduce the decline in purchases of taxed beverages. Moreover, Mexican scholars and most researchers who have focused on taxes for sugar sweetened beverages using model based approaches (owing to the lack of empirical data on actual taxations) recommend that taxes need to be set at a minimum of 20% to observe the higher reductions in purchases and consumption that may have an effect on health outcomes. 45 The current Mexican tax is half that level.

However, unpublished monitoring in-store and by the media has revealed aggressive in-store promotions and marketing to try to retain market shares for sugar sweetened beverages, which may limit both short term and long term effects. The impacts of these in-store and out of store marketing efforts are unclear. For example, industries may use a cost shifting strategy of passing more of the tax to the smaller beverage package sizes than to the larger packages. 26 Consequently, consumers may choose to purchase the larger versions, which are cheaper per liter. Future work that incorporates additional data and qualitative monitoring of industry marketing and promotions will allow the study of the longer term effects of the tax on sugar sweetened beverages and the response by industry.

We also found larger reductions in purchases of non-carbonated taxed beverages compared with carbonated taxed beverages. We hypothesize that this could be due to higher prices and high price elasticities of non-carbonated beverages, as shown in earlier work 46; and consumers shifting to lower priced versions of taxed carbonated beverages given the large variation in prices. 26 Moreover, the reduction in purchases of taxed sodas and carbonated beverages may be underestimated if purchases of smaller package sizes (which showed a larger increase in price than larger packages after the tax) are not well reported in the data, as these are individual purchases that may be consumed on the go and may be underreported by the key household informant.

Our findings on differential changes by socioeconomic status also shed light on the potential health implications of the tax in Mexico. Over the 12 month taxation period, households of low socioeconomic status reduced their intake of taxed beverages by more than 9%, but, more importantly, by December the decline was 17.1% more than the counterfactual, with a mean of almost 35 mL. Though prevalence rates for overweight and obesity in the low socioeconomic status group are not significantly higher than those in the higher socioeconomic status groups for all ages, trends in overweight and obesity are increasing faster in children and adolescents in low socioeconomic status groups than in the middle and high socioeconomic status groups. 17 Taxes on food and beverages have been argued to be regressive as the poor pay a higher proportion of their income. However, results from this study showing a larger reduction in purchases among households of low socioeconomic status suggest that the burden of the tax was lower than it would have been if there was no differential impact by socioeconomic status. Additionally, if the tax revenue is appropriated toward decreasing disparities in health or socioeconomic status, the broader fiscal effects of the tax could arguably be progressive. Although the tax revenue has not been specifically earmarked, the senate made a resolution to use part of the taxes for providing potable water to public schools, particularly in low income areas.

Strengths and limitations of this study

A major limitation of this work is that causality cannot be established, as other changes are occurring concurrent with the tax, including economic changes, health campaigns about sugar sweetened beverages, and antiobesity programs. We attempted to deal with potential contextual economic factors by controlling for state quarterly unemployment rates and state yearly minimum salaries, but this may have been insufficient. The difference in difference approach attempts to take into account any pre-existing (pretax) trends in purchases, but it assumes that these trends would have continued if the tax had not been instituted.

Weaknesses include the incomplete data on dairy beverages before October 2012, which limited the overall analysis for untaxed beverages to a shorter period and likely overestimated the relative increase in purchases of untaxed beverages during the post-tax period. This is not ideal, as a longer pretax period may have allowed findings to be more robust. This is true in general (for all beverages), but we were limited by how far back we were able to obtain the data from Nielsen Consumer Panel Survey, and, regardless, the incomplete data on use of dairy beverages would have persisted.

Also, the data only represent consumers in Mexican cities with more than 50 000 residents. Consequently, the sample does not represent a small but important subpopulation living in towns and rural localities with fewer than 50 000 people that comprise about 25% of food and beverage expenditures and around 37% of the population. 31 Given that we found a larger reduction in purchases of taxed beverages among households of low socioeconomic status, we hypothesize that reductions among rural households would be greater than those among urban households. However, without actual data, this assumption is purely speculative..

Additionally, we currently do not have data on nutrients for packaged beverages and foods in Mexico, so we cannot quantify any potential changes in calories and other nutrients purchased, and their potential health implications. We also do not have actual data on dietary intake and comparable data on purchases of taxed beverages out of stores. The average increase in purchases of untaxed beverages of 4% may be underestimated if households shifted to beverages not sold in stores and therefore not reported in the dataset, such as tap water or beverages prepared at home with or without sugar, including aguas frescas (drinks comprising fruits, flowers, cereals, or seeds blended with sugar and water). However, because the beverage tax was structured as an excise tax, these price changes should affect all venues, including fast food outlets using concentrates and syrups and street stalls. Thus our results probably underestimate the total impact, as we did not cover beverages consumed away from home, such as those purchased from street vendors or in restaurants. We are also currently unable to quantify the use of revenues from the tax on sugar sweetened beverages to supply potable water in schools, which could influence the demand for both taxed and untaxed beverages in the longer term.

Furthermore, not only must the effects of the tax be understood but also the effects of the tax on non-essential energy dense foods. On the basis of ENSANUT 2012 data, the two taxes covered approximately 19% of the daily caloric intake of Mexicans, with 7.5% coming from taxed beverages. 47 Since these taxes were implemented concurrently, we cannot determine the independent role of each until changes are made to one of them.

Conclusions and policy implications

This study documented the change in purchases of beverages after the implementation of a national excise tax on sugar sweetened beverages, and the findings are relevant for policy discussions and decisions. Other than a few business reports on beverage sales for specific companies in Mexico that seem to be in line with what we found, 48 49 50 no comparable studies have been done to date, as most research on the effects of price changes or taxes on sugar sweetened beverages is derived from model simulations. 1 France is the only other country to implement a tax on sugar sweetened beverages similar to that of Mexico. 51 However, France does not have comparable scanned data on household food purchases in relation to its tax, and analyses are limited to sales data (V Requillart, Toulouse School of Economics, personal communication, 2014). In the United States, Berkeley in California instituted a tax on sugar sweetened beverages in March 2015, and initial studies indicate that there is some price pass through, 52 though it is too early to determine how purchases or consumption would be affected and how generalizable these results would be given the limited geographic coverage of the Berkeley tax. The results for Mexico show that in the short term the tax on sugar sweetened beverages is generally passed on through prices (the tax passed close to 1 peso/L for carbonated beverages and <1 peso/L for non-carbonated beverages in urban areas) 26 27 to consumers, who reduced their purchases of taxed beverages.

These reductions became larger over time, while the purchases of untaxed beverages increased. This short term change is moderate but important, and it will be critical to continue monitoring purchases to note whether the trend continues or stabilizes; consumers substitute cheaper brands or untaxed foods and beverages for the taxed ones, or adjustments occur in the longer term. This will allow for an understanding of the long term effects of taxes on both sugar sweetened beverages and non-essential energy-dense food on purchases, diets, and ultimately health outcomes. In addition, future analysis will look at the distribution of changes in food purchases to determine if the tax on sugar sweetened beverages is more strongly associated with changes among consumers who purchase and consume larger quantities of sugar sweetened beverages.

View Abstract

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Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study

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Study question What has been the effect on purchases of beverages from stores in Mexico one year after implementation of the excise tax on sugar sweetened beverages? Methods In this observational study the authors used data on the purchase of beverages in Mexico from January 2012 to December 2014 from an unbalanced panel of 6253 households providing 205 112 observations in 53 cities with more than 50 000 inhabitants.

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現代人的健康問題，面臨最大的威脅是癌症、心臟病、中風、糖尿病、高血壓、高血脂症、腎臟病等慢性病，而這些疾病的主要成因，除了吸菸之外，很大的因素是來自代謝──肥胖

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文章日期：2020/06/19

立委高嘉瑜提徵「肥胖稅」救健保，引發熱烈討論。肥胖稅並非針對胖子個人課稅，而是針對高熱量、高糖食物課徵，在國外有許多國家早已有類似的稅收。加入「體重管理」行列

什麼是「肥胖稅」？

肥胖稅是針對促成肥胖的商品額外加收的稅，主要目的在於以價制量，減少民眾對不健康食品的攝取，進而降低肥胖率及非傳染性疾病的罹患率。

肥胖稅的國際流行狀況

14年前(2006年)世界衛生組織就有提出徵收「肥胖稅」建議，但因有歧視胖子的嫌疑而遭到反對。但歐洲仍有國家陸續落實肥胖稅，包括2008年英國人壽保險公司對投保人開徵「肥胖稅」；2009年愛爾蘭里安航空公司向超重乘客徵收「肥胖稅」。此外，還有直接對不健康食品課稅，例如丹麥的脂肪稅、法國及墨西哥的汽水稅、匈牙利的不健康食品稅等。

為什麼要課徵「肥胖稅」？

立委拋出課徵「肥胖稅」議題，並非針對個人課徵，而是針對「高糖、高熱量」的食品課徵額外收稅。因為這些食物對人體健康有害，可能衍生疾病與健保支出，因此得以課稅，概念類似目前針對菸品課徵健康捐。

現代人的健康問題，面臨最大的威脅是癌症、心臟病、中風、糖尿病、高血壓、高血脂症、腎臟病等慢性病，而這些疾病的主要成因，除了吸菸之外，很大的因素是來自代謝──肥胖。在抽菸方面，已有菸害防制法予以規範，而肥胖則尚沒有實際的規範，可供民眾做警惕。

肥胖稅真的能增進民眾健康嗎？

國人罹患慢性病比例高，光是糖尿病就花掉健保231億，若針對高熱量、高糖份的食物課徵「肥胖稅」，或許可達到些嚇阻作用，進而確保國人健康，也為面臨財務危機的健保拓展財源。

肥胖稅恐影響經濟　實行不易

肥胖稅若被通過，民眾在消費珍珠奶茶或可樂等含糖飲料或高糖、高熱量食物，將會被額外課稅。換言之，消費者若要品嚐這些食物，要多花些錢了！

肥胖稅雖立意良善，實際執行卻是困難重重，尤其肥胖稅實行後衍生的經濟不景氣、失業率攀升、跨境交易增加等問題，讓多國對肥胖稅抱持著觀望或暫且擱置的態度。

啟新專業健檢中心院長姜幼民醫師建議民眾，透過「健康檢查」、「體適能檢測」、「飲食管理」、「運動指導」及「健康生活習慣」等方法，更能全方位達到維持健康體重及增進個人健康狀態。i-Care健康促進服務雲的「體重管理」結合醫師、營養師、運動保健師等的「醫療專業團隊」，並應用「醫學健康促進輔助系統」促進訊息傳遞、相關諮詢與討論、活動執行狀況、各項成績統計排名等，以隨時掌握「減重」執行成效。

更能有效防範肥胖 ■ 「體重管理」
諮詢服務：02-25070723分機131

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i-Care健康促進服務雲

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i-Care健康促進服務雲、提供一般民眾、個人會員、團體會員，便利的網路平台，執行個人、家庭、企業、職場的健康促進管理。服務內容包含，健走活動、體重管理活動、個人健康促進、企業健康促進、職場健康促進、學校健康促進等，完整的活動舉辦範例。並結合健康檢查、體適能檢查、健康管理，配合飲食管理、運動指導、健康生活習慣，提昇民眾優質的健康人生，及維持增進健康狀態的目的。

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題目：我國是否應課徵肥胖稅

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題目：我國是否應課徵肥胖稅

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觀察到的現象：台灣肥胖率逐年增長

現象背後原因：食品的配糖比例太高

我們認為可以：以徵稅的方式來降低廠商的配糖比例

可以改善部分：可以改善食品廠商的配糖量，改善民眾購買食品的慾望