Sugar tax and product reformulation proposals reduce the perceived legitimacy of health-promotion institutions a randomized population-based survey experiment

Background: Structural nutrition interventions like a sugar tax or a product reformulation are strongly supported among the public health community but may cause a considerable backlash (e.g., inspiring aversion to institutions initiating the interventions among citizens). Such a backlash potentially undermines future health-promotion strategies. This study aims to uncover whether such backlash exists.

Methods: We fielded a pre-registered randomized, population-based survey experiment among adults from the Longitudinal Internet Studies for the Social Sciences panel (n=1765; based on a random sampling of the Dutch population register). Participants were randomly allocated to the control condition (brief facts about health-information provision/nudging), or one of two experimental groups (the same facts, expanded with either a proposed sugar tax or reformulation of sugar-sweetened beverages). Ordinary least squares regression was used to estimate the proposed interventions’ effects on four outcome variables: trust in health-promotion institutions involved; perceptions that these institutions have citizens’ well-being in mind (i.e., benevolence); perceptions that these institutions’ perspectives are similar to those of citizens (i.e., alignment of perspectives); and attitudes toward nutrition information.

Results: Trust, perceived benevolence, and perceived alignment of perspectives were affected negatively by a proposed sugar tax (-0.24, 95% CI -0.38 to -0.10; -0.15, -0.29 to -0.01; -0.15, -0.30 to 0.00) or product reformulation (-0.32, -0.46 to -0.18; -0.24, -0.37 to -0.11; -0.18, 0.33 to -0.03), particularly among the non-tertiary educated respondents.

Conclusions: Sugar taxes or product reformulations may delegitimize health-promotion institutions, potentially causing public distancing from or opposition to these bodies. This may be exploited by political and commercial parties to undermine official institutions.