May 8, 2013
Do we need more discussion about the problem with sugary drinks, or is it time to act? Recognition of the harms of sugar-sweetened beverages (SSBs)—any drink with added sugar—is increasing as evidence mounts regarding their negative impact on health. However, little progress has been made in curtailing the high prevalence of consumption; 50 percent of adults and 70 percent of kids and teens consume at least one 12-ounce drink daily according to recent national data. Debate regarding whether sugary drinks warrant public health action should transition to focusing on strategies that work to reduce consumption and on how to get those strategies implemented.
Evidence of harm
SSBs are associated with weight gain, which can result in a host of chronic health issues including cancer, cardiovascular disease, as well as type 2 diabetes. A recent estimate noted that almost 25,000 deaths in the U.S. in 2010 were attributable to SSB consumption. Even after accounting for the role that weight plays in disease, drinking SSBs may still raise heart and diabetes risk. A study published last month in a large European cohort observed that each 12-ounce drink a day was associated with an 18 percent increase in diabetes risk compared to individuals drinking less than one drink a month, even after accounting for body mass index.
What works and moving forward
The public health strategies that could be effective in reducing the continued high SSB prevalence and substantial toll of related chronic disease are constrained by their ability to be implemented—whether an individual consultation, community-level communication campaign, or state-wide regulation change.
We know what could work. From a behavioral science perspective, we know what could work to curb consumption, based on what has worked for other chronic disease risk factors in the U.S. like tobacco use and trans fats. Admittedly, in taking lessons learned from one behavior to another there are differences that need to be considered. We also have to be aware of the potential unintended consequences of modifying one harmful behavior that leads to another damaging behavior or that adversely impacts a community or group. However, this important work in research and practice is limited by a lack of understanding of how to garner public and political support for public health action, particularly in the form of policies and regulations.
We know less about implementation. It seems that we are more willing to accept that SSB consumption needs attention—that these drinks are causing weight gain and disease. We are less willing to accept many of the public health measures, particularly policy and regulatory actions that have the potential to make a lasting change. A recent example is the ongoing debate and legal action regarding the New York City (NYC) policy to restrict some SSBs over 16-ounces in size. Two commentaries recently published in the New England Journal of Medicine discussed the role of government intervention in public health issues broadly and in light of recent legal battles over the NYC policy restricting sugary beverages. These and other discussions provide a helpful frame for understanding public health measures through a historical lens. More work is needed though to understand where the public and decision makers are now regarding actions to reduce consumption. We can do this by learning from early successes in the obesity epidemic as a whole – particularly among children at the school- and community-level. In addition, we can study public health actions in progress, such as the NYC policy, efforts to remove SSBs in hospitals in Minnesota, and ongoing debates over a SSB tax in California.
As we move forward in debating and discussing SSB consumption, a greater emphasis is needed on the drivers and barriers to implementing strategies, including policies and others, to reduce SSB consumption.