We identi fi ed a relative discordance be tween the

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We identi fi ed a relative discordance be- tween the frequency of expert recommen- dations to focus on sugar 15,21,23,25,32 and the few proposed food tax bills or laws that fo- cused on this single ingredient. This novel fi nding highlights the need to investigate and understand the reasons behind this discor- dance. The reasons could include, for ex- ample, the national focus on taxing SSBs, which is a major source of added sugar in the diet; the relative newness of public focus on sugar in foods; the fact that sugar is often added to products deemed healthy or nec- essary (e.g., cereals, yogurts, breads); and the complexities of de fi ning and determining whether to tax total versus free versus added sugars. Interestingly, the 2 bills that taxed sugar directly were also the only 2 that included a graduated strategy, by which higher sugar products would be taxed more than lower sugar alternatives. Graduated taxes may be a promising method to guide consumers toward healthier products and encourage industry reformulation, and have also been suggested by economists in other health contexts. 33 In addition, a graduated junk food tax seems administratively feasible on the basis of identi fi ed evidence on existing federal graduated alcohol beverage taxes. Only 1 article and no tax bill or law focused on calories alone. This is consistent with scienti fi c evidence that foods rich in healthy fats (e.g., nuts) have more calories per gram than much less healthful foods high in starch and sugar, and that calorie content alone is a poor predictor of which foods are linked to long-term weight gain. 4 Thus, a tax on high calorie foods would not necessarily align with improving diet quality or averting diet-based diseases. Similarly, we did not identify a fat tax except for the history of the failed implementation of Denmark s satu- rated fat tax; such a tax raises political concerns about taxing staple foods like milk and cheese and scienti fi c concerns about de fi ning satu- rated fat as inherently unhealthy regardless of its amount or food source. 34 We also did not identify examples of taxes based on sodium alone or trans fats alone or within nutrition criteria. The FDA banned partially hydro- genated oils, the major source of arti fi cial trans fats, effective 2018; given the health impli- cations of this additive, implementation should be monitored and potential trans fat taxes considered accordingly. We did not identify legislative precedent for a tax de fi ned by multiple nutrient crite- ria in the absence of food categories. This is likely because such a tax would apply to all products in the food supply, dramatically increasingly complexity and administrative burden, 15 while also raising challenges for scienti fi c validity given the increased likeli- hood of misclassifying foods (for tax purposes) as more or less healthy based on nutrients alone. We also identi fi ed discordance be- tween previous research recommendations to target processed foods and actual empirical tax bills and laws, perhaps for similar reasons.
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