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Weighing in on Sugary Beverages and Obesity

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Written in Collaboration with Jenny Shelby

Contained in one 20-ounce bottle of soda are 65 grams of sugar. This is equivalent to the sugar content of nearly three two-ounce chocolate candy bars or approximately 22 packets of table sugar. It is hard to imagine anyone adding 22 packets of sweetener to a morning cup of coffee, yet many Americans frequently consume this much sugar with just one large bottle of soda. Sugar-sweetened beverages, bought in convenience stores, restaurants, and vending machines worldwide, are finding a new home -- as fat deposited on the growing waistlines of Americans.

In the United States, two-thirds of adults and one-third of children are overweight or obese. Research has demonstrated a significant link between sugar consumption and weight gain. Cakes, cookies, and other sweet treats are well-known indulgences, but a stealth culprit in America's obesity epidemic comes in liquid form. Sodas and other sugary drinks do not make consumers feel full, and therefore, people do not compensate for these calories by reducing the amount of food they eat throughout the day. This phenomenon leads to weight gain. As our country addresses a growing health, economic and national security crisis caused by obesity, public health officials are seeking to address the most significant source of added sugar in the American diet: sugar-sweetened beverages (SSBs).

Sodas, sweet fruit juices, and even chocolate milk add, on average, an additional 140 calories per day to the American adult's diet. While this may not seem like much, sugary soft drinks account for 7 percent of total caloric intake in the United States and equate to an excess of 15 pounds per year per person, without any nutritional benefit. Adolescent consumption is even higher than that of adults: Youth (between the ages of 12 and 19) consume, on average, 327 calories each day in sugary drinks.

Obesity is not the only health-damaging complication of excess sugar intake in the American diet. It increases the risk of many debilitating and costly chronic diseases, including Type 2 diabetes, heart disease, stroke, and some types of cancer. One study found that women who drink one or more sugary soft drinks per day have a risk of developing diabetes nearly twice the rate of women who consume only one sugary drink every month. Rates of diabetes in the United States continue to rise, paralleling rising rates of obesity. Diabetes affects 8.3 percent of the total U.S. population, and 26.9 percent of adults age 65 or older. The diabetes rates among adolescents in the U.S. have skyrocketed. In 2008, 23 percent of youth age 12 to 19 had diabetes or pre-diabetes, a dramatic increase from 8 percent in 2000.

Public health experts are now focusing like a laser on this threat to our nation's health. The recent "Life's Sweeter National Soda Summit," convened by the Center for Science in the Public Interest, marked the first time that a broad range of national and local public health leaders gathered together to review the scientific evidence and to brainstorm new strategies to reduce sugar-sweetened beverage consumption in the United States. Keynote speakers included Philadelphia Mayor Michael Nutter and Connecticut Congresswoman Rosa DeLauro, leaders in developing anti-obesity policies. Both Nutter and DeLauro emphasized the important role that elected officials can play in raising awareness and developing effective health policies to address the growing obesity epidemic in our country.

Conference speakers and participants noted that public health officials and policymakers are up against "Big Soda" in addressing obesity in America, which strikingly resembles the roadblocks put up by "Big Tobacco" during the establishment of anti-smoking campaigns. Mayor Nutter called upon the Centers for Disease Control and Prevention (CDC) to produce a scientific report about the relationship of soda consumption and obesity in the United States, "a comprehensive study of what effects sugary drinks have on the body," similar to what the surgeon general and CDC produced on the health-damaging effects of tobacco use in 1964.

Unlike the national tobacco control and prevention public health campaign that commenced in the 1960s, the public health community's mobilization against SSB consumption is just beginning to gain traction on a national scale. Prominent health officials at the National Soda Summit, from Los Angeles to New York, lamented the lack of a unified national message. Different localities have conducted regional studies and adopted unique slogans and approaches, but there has yet to be one cohesive national campaign to tie together the themes of Boston's "Don't Get Smacked By Fat" or New York's "Pouring on the Pounds."

Some city and state strategies to reduce soda consumption have, in fact, seized national attention. New York City Mayor Michael Bloomberg recently proposed a 16 ounce limit on the size of soft drinks sold in restaurants, street carts, and movie theaters in the city. This announcement provoked an outcry by some groups against the perceived intrusion on personal freedoms. Yet, it is this kind of public health regulatory strategy that has been essential in reducing tobacco use, decreasing motor vehicle accidents, and advancing progress on a range of other health issues.

The health costs of consuming SSBs are enormous, and the sale of these products has high stakes. At the National Soda Summit, former Coca-Cola marketing executive Todd Putnam explained the soda industry's goal of obtaining a greater "share of stomach," selling more soda every day per person to increase profits. Putnam explained how soda advertisements target children and minorities, expanding into new demographics to build lifelong customers. A study from the Yale University Rudd Center for Food Policy and Obesity found that children's exposure to soda advertisements doubled in just two short years between 2008 and 2010. Sophisticated advertising campaigns contain messages that make people feel the need to regularly consume sugar-sweetened beverages, and to react with indignation when suggestions to limit consumption are proposed. One soda company has recently announced a plan to increase advertising by $500 to $600 million this year alone for its sugar-sweetened beverages, some of which contain a whopping 77 grams of sugar in a 20-ounce bottle. Another major soda company also recently revamped its business plan to direct an additional $550 to $650 million toward marketing and branding, on top of its approximately $3 billion advertising budget.

Yet the high costs of soda advertising cannot compare to the medical costs of obesity and diabetes, which have been estimated at $147 billion annually in the United States. In fact, obesity-related diseases account for 21 percent of all medical spending in America, an estimated cost of $190 billion annually. However, in contrast to the enormous amounts spent on soda advertising by companies, public health media campaigns to reduce SSB consumption in a typical major American city are limited to a budget of only one to two million dollars.

The National Soda Summit generated a great deal of public discussion, and captured the attention of "Big Soda" as well. In response to public alarm about SSB consumption, the American Beverage Association (the public relations arm of beverage companies) has populated the internet with advertisements to counter these concerns -- to "clear it up" as to whether soda is actually linked to obesity. It should be noted that "clearing it up" is the responsibility and role of the public health community to convey scientific facts about the health consequences of sugary drink consumption, not soda companies with their advertising campaigns. Given the health damaging effects of these products, the appropriateness of soda advertising, especially to children, must be further examined.

With strong public policy leadership, a movement to educate the public about the risks of sugar-sweetened beverages is beginning to take shape. The success of the anti-tobacco campaign can serve as a model for reducing sugar-sweetened beverage consumption in America. Smoking has decreased by 50 percent in the last 50 years due to the implementation of a broad range of effective strategies by governments, advocates, NGOs, health professionals, and educators. Thus, public health groups must develop innovative, multifaceted campaigns to promote healthy eating. Early intervention and prevention strategies should begin with America's youth. The practice of advertising unhealthy products to children must be curtailed. Already public schools have begun to eliminate soda and sugar-sweetened beverages from their campuses, and the Healthy, Hunger-Free Kids Act is beginning to improve the nutritional content of school lunch programs, as children consume one-third to one-half of their daily calories at school.

Significantly reducing sugar-sweetened beverage consumption is a key component in solving America's obesity crisis. That's why just last week, the American Medical Association (AMA), the nation's largest organization of physicians, formally adopted a policy addressing this issue.

The AMA recognizes that while a number of factors contribute to the obesity epidemic, taxes on beverages with added sweeteners are one way to finance consumer education campaigns and obesity-related programs. Where taxes on beverages with added sweeteners are implemented, the revenue generated should primarily be used for programs to prevent or treat obesity and related conditions.

The AMA also will advocate for more research on the long-term health effects of SSBs, particularly for children.

The bottom line: Reducing excessive consumption of sugar-sweetened beverages is a critical step forward. To significantly improve nutrition and boost physical activity for Americans, all sectors of society must be mobilized to develop innovative strategies and work together: individuals, families, communities, government, NGOs, researchers, health professionals, the food and beverage industry, the media, policymakers, and private industry. Only then can we truly tip the scales on obesity in the United States and achieve better health for all.

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is also the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, as Chief of the Behavioral Medicine and Basic Prevention Research Branch and as Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was named a Rock Star of Science by the Geoffrey Beene Foundation. To learn more about Susan Blumenthal, M.D., visit 4globalhealth.org

Jenny Shelby is a rising senior at Yale University, studying sociology and public health as a Yale Global Health Fellow. She leads Yale's largest undergraduate community service organization, Community Health Educators, serving as Co-Coordinator to mobilize a group of over 150 student volunteers who provide comprehensive health education in New Haven public schools. Jenny is currently a Health Policy Intern at the Center for the Study of the Presidency and Congress in Washington, D.C.

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