Why South Asia needs a coordinated approach to SSB control

The regional policy landscape reveals both policy actions and gaps in coherence. Our scoping review of Bangladesh, India, Nepal, Pakistan and Sri Lanka found taxation as the most advanced SSB policy, with designs varying from sugar-content-based taxation in Sri Lanka to product- or value-based taxes elsewhere^{(Reference Abdullah, Chowdhury and Jayawardena10)}. Regulatory measures are less consistent: Sri Lanka uses traffic-light labels for SSBs^{(Reference Jayawardena, Arunatilake and Perera7)}, Pakistan restricts SSB availability in some educational settings^{(Reference Hasan12)}, while front-of-pack labelling (FOPL) remains under development or limited in India and Bangladesh^{(Reference Tao13,14)} . Across the region, marketing and availability restrictions remain less developed, and evidence on enforcement and policy effectiveness is limited^{(Reference Abdullah, Chowdhury and Jayawardena10)}.

Nutrient profiling further illustrates this fragmentation. Bangladesh, India, Nepal and Pakistan have introduced individual regulatory measures, but their application of nutrient profiling remains fragmented; Sri Lanka has the region’s most extensive use of nutrient thresholds across taxation, FOPL and marketing restrictions^{(Reference Jayawardena, Arunatilake and Perera7,Reference Abdullah, Chowdhury and Jayawardena10)} . Greater alignment between these policy instruments could strengthen regulatory consistency and incentives for product reformulation.

Policy fragmentation also contrasts with the multiple strategies used by food and beverage companies to influence affordability, availability, product formulation and consumer preferences^{(Reference Hawkes, Jewell and Allen15)}. A coordinated regulatory response therefore needs to address not only individual consumer choices but also the commercial and food environments in which those choices are made^{(Reference Hawkes, Jewell and Allen15,Reference Swinburn, Kraak and Allender16)} .

From MPOWER to S-POWER: an implementation framework for SSB regulation in South Asia

Tobacco control exemplifies translating evidence into coordinated regulation. The WHO MPOWER package translated the FCTC into six complementary policy actions guiding global tobacco control⁽¹¹⁾. Building on this and the increasing recognition of the commercial determinants of health^{(Reference Hawkes, Jewell and Allen15–Reference Mialon, Swinburn and Sacks17)}, we propose S-POWER as an implementation framework for coordinating evidence-based SSB policies in South Asia. Instead of new policies, S-POWER consolidates existing evidence into a coherent strategy that addresses surveillance, food environments, consumer information, marketing and fiscal policy (Figure 1). The six pillars represent complementary regulatory domains that together influence the availability, affordability, promotion and understanding of SSBs, alongside the governance required for implementation. The framework emphasises how these measures reinforce each other rather than operate separately.

Figure 1.

S-POWER framework for strengthening sugar-sweetened beverage regulation in South Asia.

S: Surveil consumption, product composition and policy impact

Robust surveillance is essential for effective SSB regulation. Yet many South Asian countries lack comprehensive systems to monitor beverage consumption, sugar content, product reformulation and policy implementation.

These information gaps limit the ability to evaluate interventions, identify emerging trends and monitor industry practices. Similar challenges were encountered during the early stages of tobacco control, where routine surveillance became essential for monitoring smoking prevalence, policy implementation and industry behaviour⁽¹⁸⁾. Surveillance systems should therefore track not only consumption patterns and product composition but also compliance with labelling requirements, taxation policies and marketing restrictions. Such data are critical for assessing policy effectiveness, identifying implementation gaps and informing future regulatory action.

P: Protect children from unhealthy food environments

Children and adolescents are particularly vulnerable to unhealthy food environments and the marketing of SSBs. Across South Asia, sugary drinks remain widely available within and around schools, while youth-oriented advertising and sponsorship encourage early consumption, increasing the risk of obesity and other NCDs later in life^{(Reference Menger-Ogle, Johnson and Morgan19)}.

Several South Asian countries have introduced measures to limit the availability of unhealthy foods and beverages in institutional settings, although implementation remains inconsistent^{(Reference Abdullah, Chowdhury and Jayawardena10)}. Evidence from a systematic review suggests that reducing SSB availability in schools is associated with lower SSB consumption, although the certainty of evidence was low^{(Reference von Philipsborn, Stratil and Burns20)}. International recommendations therefore support restrictions on the sale and promotion of SSBs in school settings^(21,22) . Evidence on the effectiveness of such policies in South Asian settings remains limited^{(Reference Abdullah, Chowdhury and Jayawardena10)}.

O: Offer healthier alternatives

Public institutions, including schools, healthcare facilities and government workplaces, can promote healthier food environments by providing safe drinking water, unsweetened beverages and healthy procurement standards^(23–26). Making healthier options readily available facilitates reduced SSB consumption, especially alongside measures discouraging unhealthy choices^{(Reference von Philipsborn, Stratil and Burns20)}. Such environmental changes can complement taxation, labelling and marketing restrictions by making healthier choices easier to adopt. However, evidence on their real-world effectiveness remains limited, particularly in South Asian settings^{(Reference Abdullah, Chowdhury and Jayawardena10)}.

W: Warn consumers through Front of Pack Nutrition Labelling (FOPNL)

Systematic-review evidence indicates that FOPNL, particularly interpretive labels, can improve consumers’ understanding and the healthfulness of food choices and purchases, while also encouraging product reformulation^{(Reference Guo, Ning and Mustafa27,Reference Kelly, Ng and Carrad28)} . Although South Asian countries are making progress, notably through Sri Lanka’s traffic-light labelling system and ongoing reforms in India, implementation remains limited and inconsistent across the region^{(Reference Jayawardena, Arunatilake and Perera7,Reference Abdullah, Chowdhury and Jayawardena10)} . Furthermore, evidence on FOPNL’s real-world effects on purchasing, reformulation and consumption in South Asia remains limited^{(Reference Abdullah, Chowdhury and Jayawardena10)}.

Key barriers include the absence of standardised nutrient profiling models, limited regulatory capacity and industry resistance to mandatory labelling^{(Reference Mialon, Swinburn and Sacks17)}. Addressing these challenges through harmonised standards and stronger enforcement could enhance the effectiveness of FOPNL as a cornerstone of SSB regulation, much as health warnings have done in tobacco control^(29,30) .

E: Enforce restrictions on marketing and promotion

SSBs are extensively promoted through television, digital media, sports sponsorships, social media and celebrity endorsements, particularly targeting children and adolescents.^{(Reference Menger-Ogle, Johnson and Morgan19)} However, comprehensive restrictions on SSB marketing remain limited across South Asia, and existing measures are often voluntary or weakly enforced^{(Reference Abdullah, Chowdhury and Jayawardena10)}.

Evidence from systematic reviews suggests that policies restricting unhealthy food and beverage marketing to children can reduce purchases and exposure to marketing, although the effects vary by policy design^{(Reference Boyland, McGale and Maden31)}. Mandatory restrictions appear more effective than voluntary approaches^{(Reference Boyland, McGale and Maden31)}. Restrictions should therefore encompass child-directed advertising, digital marketing, sports sponsorship and other forms of promotion⁽³²⁾. Evidence on the effectiveness of such restrictions in South Asia remains scarce^{(Reference Abdullah, Chowdhury and Jayawardena10)}.

R: Raise taxes on high-sugar beverages

Fiscal policy is an effective tool for reducing purchases of unhealthy products^{(Reference Andreyeva, Marple and Marinello33)}. Evidence indicated an average 15 % reduction in SSB sales after taxation and evidence of reformulation under tiered taxes^{(Reference Andreyeva, Marple and Marinello33)}. The success of tobacco taxation across South Asia demonstrates how price-based interventions can influence consumer behaviour while generating revenues that may be reinvested in health promotion and disease prevention^(18,30) . Similar evidence is emerging for SSB taxation, with studies from multiple countries demonstrating reductions in purchases following implementation of sugary drink taxes^{(Reference Andreyeva, Marple and Marinello33)}.

Within South Asia, Sri Lanka has adopted a sugar-content-based excise tax that aligns fiscal policy with public health objectives^{(Reference Jayawardena, Arunatilake and Perera7)}. In contrast, taxes in many other countries remain primarily revenue-oriented and provide limited incentives for reformulation. To maximise health benefits, SSB taxes should be linked to sugar content, adjusted regularly for inflation and income growth and implemented alongside other regulatory measures.

Together, these six pillars illustrate how complementary policy actions can be integrated through the S-POWER implementation framework to strengthen SSB regulation in South Asia (Figure 1).

The opportunity cost of delay

Delaying SSB regulatory action has consequences beyond rising disease prevalence. As obesity, type 2 diabetes and other diet-related NCDs increase across South Asia^(1,2,4) , governments risk locking in food environments that normalise high-sugar consumption and make future policy reforms more difficult. Early-life exposure to SSB may establish lifelong dietary behaviours, amplifying future health and economic burdens^{(Reference Monteiro, Louzada and Steele-Martinez3)}.

Policy inertia also creates opportunities for commercial interests to become further embedded in regulatory processes. Industry opposition can shape policy debates around taxation and other regulatory measures, with evidence from the UK Soft Drinks Industry Levy showing parallels with stakeholder arguments previously observed in tobacco and alcohol policy debates^{(Reference Mialon, Swinburn and Sacks17,Reference Hilton, Buckton and Patterson34)} .

Delaying action also represents a missed opportunity. Tobacco control and nutrition policy evidence consistently show that structural interventions are more effective than relying solely on consumer awareness^{(Reference Hawkes, Jewell and Allen15,30)} . Implementing evidence-based SSB policies likely incurs significantly lower upfront costs than the long-term expenses of preventable NCD. Investments in surveillance, FOPNL, marketing restrictions and fiscal measures can deliver significant health benefits and strengthen NCD prevention efforts. Moreover, appropriately designed SSB taxes can generate revenue that can be reinvested in health promotion, prevention programmes and health system strengthening.