Food Reformulation Research Articles

Evidence on the effectiveness and equity of population-based policies to reduce the burden of type 2 diabetes: a narrative review

AbstractThere is increasing evidence for the effectiveness of population-based policies to reduce the burden of type 2 diabetes. Yet, there are concerns about the equity effects of some policies, whereby socioeconomically disadvantaged populations are not reached or are adversely affected. There is a lack of knowledge on the effectiveness and equity of policies that are both population based (i.e. targeting both at-risk and low-risk populations) and low agency (i.e. not requiring personal resources to benefit from the policy). In this narrative review, we selected 16 policies that were both population based and low agency and reviewed the evidence on their effectiveness and equity. Substantial evidence suggests that fruit and vegetable subsidies, unhealthy food taxes, mass media campaigns, and school nutrition and physical activity education are effective in promoting healthier lifestyle behaviours. Less evidence was available for mandatory food reformulation, reduced portion sizes, marketing restrictions and restriction of availability and promotion of unhealthy products, although the available evidence suggested that these policies were effective in reducing unhealthy food choices. Effects could rarely be quantified across different studies due to substantial heterogeneity. There is an overall lack of evidence on equity effects of population-based policies, although available studies mostly concluded that the policies had favourable equity effects, with the exception of food-labelling policies. Each of the policies is likely to have a relatively modest effect on population-level diabetes risks, which emphasises the importance of combining different policy measures. Future research should consider the type of evidence needed to demonstrate the real-world effectiveness and equity of population-based diabetes prevention policies. Graphical Abstract

Can Front-of-Pack Labeling Encourage Food Reformulation? A Cross-Sectional Study on Packaged Bread.

Front-of-pack labeling (FOPL) may represent an important instrument for the food industry in the promotion of food product reformulation. The present cross-sectional study used salt reduction in packaged breads as a case study, aiming to investigate whether two different types of FOPL (i.e., Nutri-Score (NS) and NutrInform battery (NIB)) can capture food reformulation and thus be effective tools for encouraging reformulation. The Nutri-Score and NIB were calculated by consulting the nutritional declarations and ingredient lists of 527 packaged breads currently sold in Italy before and after applying three different theoretical reformulation strategies: (i) a 25% salt decrease from the current median salt content in bread; (ii) a reduction of up to 0.825 g/100 g of salt, corresponding to the sodium benchmark of 330 mg/100 g set by the World Health Organization (WHO); and (iii) the minimum salt reduction needed to improve the NS by one grade. The results show that only ~44% of breads had improved NSs when the sodium was lowered to reach the WHO benchmark or when salt was reduced by 25%, whereas large variability was observed in the minimum salt reduction needed to improve the NS. Regarding the NIB, the battery for salt improved when both strategies of reformulation were applied. FOPL is not always effective in capturing food reformulation in terms of salt reduction, possibly discouraging the efforts of food companies to improve the nutritional quality of foods.

An exploration of progress made in the reformulation of food staples in the Republic of Ireland

One hundred and eleven countries currently have national policies, strategies or plans to implement food reformulation, a mechanism to passively improve the diets of consumers. Previous research by our group conducted between 2014 and 2017, showed that salt and sugar in - cereals, breads, spreads and milk had declined by 12% and 7%, respectively. The aim of this study was to explore if there has been further progress in reformulation during the period between 2017 and 2021.We conducted an audit of food staples in the Republic of Ireland. Nutrition labels of food staples were photographed and the extracted data was compared with data previously captured in 2017. We included Supermarkets with the leading market share in the Republic of Ireland at that time including - Dunnes Stores, Supervalu, Tesco, Aldi, Lidl, Marks & Spencer (M&S) and Centra. Two hundred and seventy products were directly compared across the two-time points (2017 & 2021). Overall across all food groups combined, this study shows that salt decreased by 1.9%, sugar levels decreased by 4.9% and saturated fat decreased by 0.1%. Total fat increased by 1.2%, protein increased by 1.1%, energy levels increased by 0.6%, fibre increased by 0.2% and carbohydrates increased by 0.1%. While it is encouraging to see that sugar has declined across all food groups and that salt has declined across most food groups in this study, the magnitude in reduction is lower than during the previous reporting period (2014–2017). Food manufacturers need to double down on their reformulation efforts.

Salt-related knowledge, attitudes and practices and their relationship with 24-h urinary sodium and potassium excretions among a group of healthy residents in the UAE: a cross-sectional study.

This study aimed to measure urinary sodium and potassium as a measure of sodium and potassium intake concerning the knowledge, attitude and practice towards sodium intake among a group of healthy residents in the UAE. A cross-sectional study on a sample of healthy adults in the UAE. In addition to the knowledge, attitude and practice questionnaire, sodium and potassium excretions and food records were taken. The UAE. A sample of 190 healthy individuals aged between 20 and 60 years. The mean (± sd) age of the sample was 38·6 (± 12·5) years, and 50·5 % were females. The mean urinary sodium and potassium intake were 2816·2 ± 675·7 mg/d and 2533·3 ± 615 mg/d, respectively. The means were significantly different compared with the WHO recommendation of sodium and potassium (P < 0·001). About 65 % of the participants exceeded the WHO recommendations for salt intake, and participants' knowledge classification for health-related issues was fair, while food-related knowledge was poor (P = 0·001). A two-stage stepwise multiple regression analysis revealed that knowledge, attitude and practice scores were negatively associated with urinary sodium excretion (r = -0·174; P = 0·017) and those older participants and females had lower urinary sodium excretion (P < 0·001). These findings may suggest an increase in the risk of hypertension in the UAE population. Moreover, these findings emphasise the need to establish education and public awareness programmes focusing on identifying the sodium contents of foods and establishing national regulations regarding food reformulation, particularly for staple foods such as bread.

The Impact of Non-Fiscal Mandatory and Voluntary Policies and Interventions on the Reformulation of Food and Beverage Products: A Systematic Review.

Background/Objectives: Low quality diets are a risk factor for non-communicable diseases; therefore, improving diet quality is a public health and policy priority in the UK and elsewhere. Reformulating food/beverage products to make them healthier may be an effective approach. Evidence suggests that fiscal interventions, notably taxes/levies on soft drinks, can lead to reformulation but the evidence for voluntary or mandated non-fiscal interventions is less clear. We aimed to review and synthesise contemporary evidence to determine whether non-fiscal policies/interventions result in the reformulation of food/beverage products Methods: In April 2023, we systematically searched ten international academic and nine grey literature databases. We included real-world study designs, all nutrients, in- and out-of-home sectors, and studies published from 2013, to ensure policy relevancy. We excluded modelling studies. Using the Synthesis Without Meta-Analysis method we conducted vote counting of studies based on the direction of effect and narrative synthesis by intervention type. Risk of bias was assessed using a tool developed by the EPPI-Centre and quality was assessed using GRADE. Results: We included 77 real-world studies from 19 countries, reporting 100 non-fiscal policies/interventions. Most commonly, these were reduction targets (n = 44), front-of-pack labels (n = 23), and advertising standards (n = 9). Most interventions were voluntary (n = 67), compared to mandatory (n = 33), and focused on the in-home sector (n = 63). The vote counting results showed non-fiscal policies/interventions overall led to improvements in reformulation in 60/63 studies with a valid direction of effect (95%, 95% CI 0.869, 0.984, p < 0.001). Mandatory implementations were more successful than voluntary implementations with 15/15 showing an improvement (100%, 95% CI 0.796, 1], p < 0.001), compared 40/43 showing an improvement (93%, 95% CI 0.814, 0.976, p < 0.001). Most of the studies were of low quality, due to the observational nature of the studies. Sodium was the most commonly targeted nutrient (n = 56) and was found to be reformulated in most studies. Causation is difficult to establish from real-world studies, but evidence suggests that regulatory and multi-component strategies may be effective at driving reformulation. Conclusions: Non-fiscal policies/interventions can play an important role in driving reformulation, alongside fiscal measures. This work was funded by the National Institute for Health and Care Research PRP-PRU-02-15-Healthy Weight and registered on Open Science Framework.

Comparison of the nutritional composition and calculated Nutri-score classifications of the Dutch food retail supply in 2018 and 2020.

In the Netherlands, reformulation strategies have been established for several years, whereas Nutri-Score was implemented in 2024. Besides being a helpful tool for consumers to make healthier food choices, Nutri-Score also aims to stimulate food reformulation by food manufacturers. The present study investigates whether changes in food composition could have led to different calculated Nutri-Score classifications. Food compositions and Nutri-Score classifications were calculated using the updated Nutri-Score algorithm. Food groups with the largest change in the distribution of Nutri-Score classifications were analysed in-depth by plotting frequency distributions and calculating median contents for nutrient contents that relatively changed the most in 2020. Food composition data were available from the Dutch Branded Food database in 2018 (n 38 295) and 2020 (n 48 091). Not applicable. In general, median nutrient contents and calculated Nutri-Score classifications were similar for 2018 and 2020. The median sugar and SFA contents were lower for some food groups (e.g. breakfast cereals, meat preserves, sweets and sweet goods) in 2020 compared to 2018. The median SFA content for meat preserves and sweets and sweet goods was relatively low in Nutri-Score classification A ascending towards higher median content in Nutri-Score classification E. Although food reformulation was not substantial in the Dutch food retail supply in 2018 and 2020, some differences in Nutri-Score classifications were observed. When implemented, Nutri-Score may encourage food manufacturers to increase their reformulation efforts. Repeated monitoring of food compositions and Nutri-Score classifications is recommended to establish reformulation efforts by food manufacturers.

Evolution of critical nutrients (salt, sugars and saturated fats) in Spanish foods and beverages in the last 25 years

Non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, etc.) are the leading cause of death worldwide, accounting for 71 % of global deaths. The risk factors for all of them are closely linked to lifestyle and in particular to diet. For this reason, public health policies in European Union countries, in line with World Health Organization (WHO) recommendations, include in their priority measures actions aimed at promoting healthier food environments. One of these measures are policies for the reformulation of processed foods to reduce critical nutrients: salt, saturated fats, trans fats and added sugars. In Spain, as part of the NAOS Strategy, food reformulation measures have been implemented since 2008. Of all of them, the Plan de Colaboración para la Mejora de la Composición de Alimentos y Bebidas y otras Medidas 2020 stands out, which has led to a reduction in the content of salt, sugar, saturated and total fat in foods belonging to 57 subcategories marketed by the main food manufacturing and marketing companies from 2016 to 2021. Despite this, to date no population-based study has been conducted to test the impact of the measure on the diet of the Spanish population. The present article, by way of example, shows results of the theoretical estimation of total sugar intake in the pre-reformulation period (2016) and post-reformulation period (2024) based on the consumption of beverages in Spain. Data highlight that reformulation policies could have positive effects that need to be evaluated in representative studies of the Spanish population assessing the overall diet, in order to solidly confirm their positive effects on the population's diet.

Exploring UK older adults' dietary fibre consumption habits and associated factors: a national diet and nutrition survey perspective.

The UK population is living longer; therefore, promoting healthy ageing via positive nutrition could have widespread public health implications. Moreover, dietary fibre intake is associated with health benefits; however, intake is below UK recommendations (30 g/d). Utilising national dietary survey data can provide up-to-date information on a large representative cohort of UK older adults, so that tailored solutions can be developed in the future. This study used cross-sectional data from the National Diet and Nutrition Survey (years 2008-2009 to 2018-2019) for older adults' (n 1863; 65-96 years) dietary fibre intake (three-to-four-day food diaries), top ten dietary fibre-rich foods, associated factors (demographics, dietary/lifestyle habits) and various health outcomes (anthropometric, blood and urine). Mean dietary fibre intake was 18·3 g/d (range: 2·9-55·1 g/d); therefore, below the UK dietary recommendations, with compliance at 5·7 %. In addition, there were five significant associations (P < 0·05) related to lower dietary fibre intake such as increasing age group, without own natural teeth, impaired chewing ability, lower education leaving age and poor general health. Older adults' key foods containing dietary fibre were mainly based on convenience such as baked beans, bread and potatoes. Positively, higher dietary fibre consumption was significantly associated (P = 0·007) with reduced diastolic blood pressure. In summary, the benefits of dietary fibre consumption were identified in terms of health outcomes and oral health were key modulators of intake. Future work should focus on a life course approach and the role of food reformulation to help increase dietary fibre intake.

The Potential Effectiveness of Front-of-Pack Nutrition Labeling for Improving Population Diets.

Nutrition labeling on the front of food packages can support more healthful purchase decisions and encourage favorable reformulation. This systematic literature review applied Cochrane methods to synthesize and appraise the evidence on the effectiveness of front-of-pack labeling (FOPL) on diet-related outcomes and food reformulation to inform policy recommendations. The search was conducted on 11 academic and gray literature databases, from inception to July 2022. Evidence was synthesized using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), vote counting, and meta-analyses, where appropriate. Overall, 221 articles were included in the review. The randomized controlled trial evidence suggested that, compared with when no FOPL was present, FOPL likely improved consumer understanding of the nutritional quality/content of foods (moderate certainty of evidence), and the healthfulness of food choices (moderate certainty) and purchases (moderate certainty). Interpretive FOPL had a greater effect on these outcomes compared with noninterpretive systems (moderate certainty). There was inconsistency in the best-performing interpretive FOPL system.

Antioxidant and Anti-inflammatory Effects of Marine Phlorotannins and Bromophenols Supportive of Their Anticancer Potential.

Following the goal of optimizing nutrition, the food industry has been continuously working on food reformulation, nutritional patterns, functional foods development, and the general promotion of a healthy lifestyle. To this end, the scientific community has been increasingly investigating natural compounds that could prevent or treat chronic diseases. Phlorotannins and bromophenols are phenolic compounds particularly present in marine organisms. There is extensive evidence that shows their potential in the prevention of noncommunicable diseases, including cancer, the second cause of mortality worldwide. Numerous studies have demonstrated the anticarcinogenic activity of polyphenolic algae compounds both in cell culture and experimental animal models. Although recent reviews are also available, the present update focuses on the most recent findings related to the antioxidant/anti-inflammatory effect of seaweed phenolics, as well as their regulatory capacity for new molecular targets. Additionally, the review addresses and discusses the close link between inflammation and oxidative stress, along with their relationship with tumor onset and progression, including the most recent findings supporting this correlation. Although clinical studies are still needed to support this evidence, phlorotannins and bromophenols constitute an emerging bioactive group with high potential as chemopreventive agents and/or potential adjuvants for existing cancer therapies.

Modelling the public health benefits of fibre fortification in the Chinese population through food reformulation

ObjectivesVarious studies have highlighted how consuming adequate dietary fibre (DF) foods could confer multiple potential health benefits to humans, though data suggested that the average intake of the population is...

The influence of food prices on what we purchase, prepare and eat. Survey results and implications for the Heart Foundation’s work

Healthy eating is a struggle for many families in New Zealand when they cannot adequately afford food. Statistics New Zealand has shown that the food price index rose 12.5 percent over the past year with an increase of 22 percent for fruit and vegetables prices(1). Food prices now rate as the number one concern for New Zealanders(2). To understand the changes households are making in response to increasing food prices 109 main household shoppers were surveyed. The survey was administered via Qualtrics in May/June 2023. Participants were recruited via social media and by direct email from researchers and Heart Foundation staff. Survey participants were asked about food prices, shopping behaviours and changes within specific food categories. Two thirds of the participants were female. The predominant age groups were 20-29 years (29%) and 60 and above (28%). The major ethnicities were European (53%), Pasifika (20%) and Māori (8%). Around 46% of people lived in Auckland with the next highest area being Nelson (and wider Tasman). The results showed 85% of participants expected food prices to get worse over the next year. To manage rising food prices 70% people had changed where they shopped or how they accessed food, 90% changed what they buy and 67% had changed the way they eat (e.g., cooking more at home). The most substantial changes were in the fruit and vegetable category where people changed the types purchased (73%) and purchased less (63%). In many food categories buying cheaper brands, in bulk and when foods were on special were common responses. Rationing or going without was a consistent theme highlighted with meat/poultry, eggs, fish, alcohol and more expensive snack foods. The implications for the Heart Foundation’s work include (1) reinforcing the importance of fruits and vegetables in the diet and to provide tips and tools around ingredient substitution, (2) promote alternative protein sources (e.g., beans and legumes) as an affordable ingredient and recipes to support their use and (3) supporting companies to improve the composition of cheaper brands through food reformulation. With this being a small sample size, it may not be fully generalisable to the entire population however given the survey found a high percentage of people making changes it does indicate the important role health agencies can play providing information, and advice to support people to manage high food prices.

Supporting companies to reform nutrition policies and practices (REFORM): a multi-centre cluster randomised controlled trial

Unhealthy food environments are major drivers of obesity and diet-related diseases(1). Improving the healthiness of food environments requires a widespread organised response from governments, civil society, and industry(2). However, current actions often rely on voluntary participation by industry, such as opt-in nutrition labelling schemes, school/workplace food guidelines, and food reformulation programmes. The aim of the REFORM study is to determine the effects of the provision of tailored support to companies on their nutrition-related policies and practices, compared to food companies that are not offered the programme (the control). REFORM is a two-country, parallel cluster randomised controlled trial. 150 food companies were randomly assigned (2:1 ratio) to receive either a tailored support intervention programme or no intervention. Randomisation was stratified by country (Australia, New Zealand), industry sector (fast food, other packaged food/beverage companies), and company size. The primary outcome is the nutrient profile (measured using Health Star Rating [HSR]) of foods and drinks produced by participating companies at 24 months post-baseline. Secondary outcomes include company nutrition policies and commitments, the nutrient content (sodium, sugar, saturated fat) of products produced by participating companies, display of HSR labels, and engagement with the intervention. Eighty-three eligible intervention companies were invited to take part in the REFORM programme and 21 (25%) accepted and were enrolled. Over 100 meetings were held with company representatives between September 2021 and December 2022. Resources and tailored reports were developed for 6 touchpoints covering product composition and benchmarking, nutrition labelling, consumer insights, nutrition policies, and incentives for companies to act on nutrition. Detailed information on programme resources and preliminary 12-month findings will be presented at the conference. The REFORM programme will assess if provision of tailored support to companies on their nutrition-related policies and practices incentivises the food industry to improve their nutrition policies and actions.

A systematic assessment of the revised Nutri‐Score algorithm: Potentials for the implementation of front‐of‐package nutrition labeling across Europe

AbstractFront‐of‐package nutrition labeling (FOPNL) is an important public health tool, and the introduction of harmonized FOPNL in Europe is one of the most ambitious food labeling changes in decades. Nutri‐Score (NS) has been considered for implementation across Europe. However, NS is subject to strong opposition, particularly from the food industry and some agricultural sectors (such as cheese and cured meat), but also from some nutrition scientists and public health professionals, which highlights that the system is not sufficiently aligned with food‐based dietary guidelines and the latest scientific literature. These concerns were recently addressed in a revised version of NS (NS2023), aiming to overcome the limitations of its predecessor (NS2021). Our aim was to assess whether these limitations were addressed and to investigate their alignment with dietary guidelines. A systematic literature review identified 20 limitations of NS, assigned to 3 groups (Food‐based, Component‐based, and Other Dimensions of Food Quality). Subsequent assessment of NS employed a large representative branded food database of 19,510 pre‐packed foods. Alignment with dietary guidelines was assessed based on agreement with the WHO Europe nutrient profile (WHOE). NS2023 was shown as notably stricter compared to NS2021 (7% fewer products received the higher grades A or B) and more aligned with WHOE (κNS2021 = .59, κNS2023 = .65). Overall, most (65%) of the limitations were addressed to some extent; these were mostly Food‐based limitations, followed by Component‐based, whereas the Other Dimension of Food Quality (processing, sustainability, portion sizes) remained mostly unaddressed. We can conclude that the revised NS2023 increased its potential for implementation across Europe. Our review identified all limitations, relevant or not, which were mentioned in the scientific literature. Therefore, some mentioned limitations may never be solvable in the scope of nutrient profiling. Others could be further addressed by adaptation of the visual presentation, but increased complexity of the labeling message would also reduce the potential of the FOPNL to support consumers in healthier food choices. Additional research is also necessary to explore the potential impact of the revised NS2023 on food reformulation and its perception among consumers.

How far can reformulation participate in improving the nutritional quality of diets at population level? A modelling study using real food market data in France

BackgroundFood reformulation is promoted as a tool to improve the nutritional quality of population diets. However, the potential impact of industry-wide reformulation on dietary intake has been investigated minimally.ObjectivesThe aim...

Promoting healthy diets through food reformulation: The demand for “better‐for‐you” beverage

AbstractThis study explores how nutrients, new ingredients, and health claims from product reformulation influence consumer decisions, dietary intake, and population health in the beverage market. We focus on the beverage market in the United States as a case study because of the emerging health demand for “better‐for‐you” beverage options. We formulate a random coefficient discrete choice model to evaluate consumer preference for reformulated products in the nonalcoholic beverages market. We find that new ingredients that provide functionality such as energy ingredients, carbonation, or no artificial flavors have a significant positive impact on consumer choices. Further, the use of health claims can significantly increase consumer demand for beverages. Results from simulations suggest that the use of “no/low sugar,” “no/low sodium,” and “no artificial sweetener” health claims will increase the net sugar and sodium intakes from sugar‐sweetened beverages, leading to an increase in body mass index and the incidence of coronary heart disease (CHD) and diabetes. The nutrient reformulation by cutting sugar and sodium content by 10%, on the other hand, will result in a decrease in sugar and sodium consumption, and further lower the incidence of CHD and stroke. However, the policy aimed at lowering the intake of one single nutrient may have an unintended spillover effect on other nutrient intakes, and policymakers should take a comprehensive approach and consider the broader nutrient impact of any policy aimed at reducing a specific nutrient.

Reformulation of processed foods: Mixed effects on salt and saturated fatty acids intake in France

AbstractEncouraging the food industry to reformulate their products is a possible public intervention to improve diet quality. In this paper, we assess the impact of food reformulation on per capita salt and saturated fatty acids (SFAs) intake, in France, for four product categories, namely, potato chips, fresh pizzas, frozen pizzas, and frozen meals, taking into account the changes in products' nutritional quality and consumer choices. Nutrient intake is calculated by matching data on food purchases and nutritional data, collected at the same date. An algorithm is run to disentangle the specific effect of food reformulation. We find that food reformulation, which is based on voluntary individual firm choices or voluntary industry‐wide agreement in our case studies, contributes to decrease SFAs and salt intake in seven out of eight cases. However, the magnitude of the impact is moderate, except in the case of potato chips for which a much stronger impact is observed. Product renewal has an ambiguous effect, depending on the nutrient considered. By contrast, changes in consumer behavior increase the intake of SFAs and salt in all cases. Finally, food reformulation generally benefits all consumers equally, regardless of income or age. For food categories with consumption disparities, product reformulation can reduce heterogeneity in nutrient intake across socioeconomic groups, provided that recipes are greatly and widely improved [EconLit Citations: D12, D22, I1].

Introduction to Agribusiness special issue: Economics of food reformulation

AbstractWe provide an introduction to the Special Issue on the Economics of Food Reformulation.

Time to define food salt targets in Italy starting with cereal-based products: A safe and practical way to reduce the heavy burden of cardiovascular disease

Background and aimsExcess salt intake is the leading dietary risk factor for cardiovascular disease in most countries, including Italy. While the cost-effectiveness of interventions aimed to reduce salt intake has been proved, the WHO recommendation to reduce salt intake by 30 % at the global level by 2025 is far from being reached. Methods and resultsIn Italy, two surveys of the general adult population have established that the average salt intake is still almost twice the WHO recommendation although it was reduced by 1.2 g/day between 2008–12 and 2018–19. Previous investigations had shown that non-discretionary salt added by the industry or by local craft producers represents at least 50 % of the total intake and indicated cereal-based products as the main source of non-discretionary salt.Two recent studies conducted by the Italian Society of Human Nutrition “Young Working Group” have provided updated information on the salt content of almost three thousand cereal-based products currently available on the Italian food market and shown that most of the items evaluated had a sodium content much higher than the sodium benchmarks recently proposed by WHO. ConclusionsItaly has built the foundations of an effective population strategy for salt intake reduction: it is time however to proceed with full commitment to food reformulation if any substantial further progress has to be made. Salt benchmarks for Italy need to be defined for the food categories most relevant to population salt intake and their implementation should ideally be mandatory after consultation with food producers.

Labels, taxes, and food reformulation: A tale of sugar in carbonated soft drinks in Ecuador

Abstract The prevalence of obesity has increased significantly worldwide, including in low- and middle-income countries. In Ecuador, a middle-income country, the government has implemented two policies to improve the quality of its population’s diet: (1) a traffic-light (TL) nutritional labeling requirement for processed foods and (2) a special tax scheme for drinks with a high sugar content (HSC). This study examines changes in carbonated soft drink (CSD) sugar formulation and its associated impacts on sugar consumption after the implementation of these two policies. Sugar content in soft drinks was obtained from the National Agency for Health Regulation, Control, and Surveillance (ARCSA) and directly from the labels of carbonated soft drinks sold in the country. CSD monthly purchase data from January 2013 to December 2019 were obtained from the Kantar World Panel (Ecuador). Mixed reactions followed the introduction of the TL in the sugar content reformulation of CSD. In contrast, the implementation of the HSC tax scheme was followed by extensive efforts to reformulate CSD as all brands studied decreased their sugar content. We also found evidence that CSD consumption reduced significantly after the HSC tax scheme was imposed. Overall, sugar consumption linked to CSD decreased after the implementation of these two policies. Still, most of this decrease is related to reformulation activities observed after the HSC tax scheme was implemented.