Regulation of soda was back in the news this week. Apparently the latest is a consideration of a tax on sugary drinks. (Soda-Makers Try To Fizz Out Of Bay Area Tax Campaigns) The article reminded me of two years ago, when I took this picture, as the Bloomberg administration was attempting to regulate soft drink sizes in New York City. The idea was to restrict sugary beverages over the size of 16 oz. All of these measures are of course aimed at combating rising obesity in the United States, especially among children. In New York then, as with the tax question now, there was backlash. Unfortunately a lot of the conversation is being skewed by arguments that are misleading and failing to address the heart of the issue.
One of the arguments that is being thrown around by opponents of regulation is that soda does not cause obesity. The organization that created the sign pictured above, NYCbeveragechoices.com, addresses this causal question in a very clever way. On their site under the tab ‘the Facts’ they pose the question “are sugar sweetened beverages the cause of obesity?”, to which they answer no. Worded that way, I am forced to agree. They are correct however, not because sugar-sweetened drinks don’t matter, but because obesity is multi-factoral and it is therefore incorrect to say that sugary drinks are the cause of it. The fact is they are not asking the right question. The right question is, “do sugar-sweetened beverages contribute to obesity?” That is a much more debatable topic.
Those who insinuate that sugary drinks are not a factor in obesity site studies that show a lack of a connection between sugary drinks and weight gain and highlight limitations and/or flaws in studies that do show a link. The reality is that scientifically, it can be hard to prove one way or the other. In one systematic review of studies from 1996-2005 the conclusion was that there is sufficient evidence to site sugary drinks as a contributor to weight gain.(1) In another, however, it was determined that the links were weak, with some positive association, some negative, and some inconclusive.(2) And if you poke around the web and read other articles, research papers, and studies you will find that some will say the two are linked and some that say they aren’t. The thing to remember though is what any of this proves. It proves that we can not say for sure if they are linked, and that is a far cry from saying that they are not. The fact that something has not been proven to be true does not mean it has therefore been proven to be false.
So, we are not certain. It is therefore fair to pose another question, which NYCbeveragechoices does, which is, “could the beverage restriction impact obesity rates in New York City?” Again, they answer no. They explain their answer by stating that according to the government only 7% of calories come from these beverages, leaving 93% of calories that come from other sources. This means, according to their argument, that we must all “look at the bigger picture.” I think there are some problems with this statement.
First, it is important to recognize that 7% is all that it takes. Assume for a moment that 2,000 calories is equilibrium for an individual, causing neither weight loss nor weight gain. Drinking one 12 oz bottle of coke would add 140 calories, representing 6.5% of the total number for the day. Doing that daily, which according to the CDC half of Americans do, would lead to a pound of weight gain in three and a half weeks.(3) A 16 oz coke, where the soda ban would have started, adds 182 calories and represents 8.3% of total calories for the day. This would lead to a pound of weight gain in just over two and a half weeks.* If anything, these percentages reinforce the idea that we need to do something about sizes because they clearly show that the bigger the drink, the faster the weight gain.
Beyond that, it is important to recognize that percentages can actually distort the issue more than clarify. In this particular case the statistics about overall calorie consumption are misleading because they are averaged out over the entire population which glosses over an important fact. The CDC’s report shows that consumption differs based on demographics. Some Americans consume a lot of sugary drink calories while others consume fewer. These lower consumers bring the overall percentage down which hides the lurking problem underneath. Teenagers and young adults for example consume more than other ages. If that trend continues then as baby boomers pass away they will leave just the Americans that are consuming the lion’s share of the sugar. The end result will be a change in the percentile distribution and, potentially, a heavier general populace.
Given these facts, I must say that the real answer to the question of whether or not beverage restrictions could impact obesity is, quite possibly! This leads us to a final important question which is, do we want the government (these “bureaucrats”) telling us what we can and can’t eat? This is a hefty debate and I won’t presume to have the ultimate answer but I will make one or two comments. The website brings up the fact that all calories matter in weight, not just ones from sugary drinks, and that is true. So, the question becomes, will we go down the slippery slope and let the government regulate everything that might make us fat? Tough question, but I for my part will say that I find this to be distracting. Note that the sign on the truck uses the word beverage, rather than sugary drink or soda. I’d say that is a clever way to drum up outrage and avoid the actual topic, which is certain sugar loaded drinks that come in giant cups too big to fit in a standard cup holder. That is what we are talking about, as opposed to say, water, which would not have been regulated. Both the American Heart Association and the American Academy of Pediatrics have taken the position that sugary drinks are a driver of childhood obesity and should be curbed. That is what we are talking about, not all beverages.
Lastly, now that the Bloomberg law has been overturned by the courts and the strategy has shifted to a soda tax, part of the argument comes down to economics. Many are concerned with how a tax would affect businesses. Not coincidentally, almost all of the members of the NYCbeveragechoices coalition are businesses such as restaurants, cafes, bodegas, convenient stores, etc. I understand their concern for their livelihoods. I think that only makes it more critical to have a real open conversation. When Americans become sick with weight related illness, which accounted for $147 Billion dollars of health care costs in 2012, it costs everyone.(4) Perhaps there could be a compromise. If we levy a tax hoping to save healthcare dollars at the expense of these business owners, maybe we could give them some taxes back in other areas?
In any event, a thoughtful discussion about sugary drinks is certainly warranted. There is more than enough reason to suspect that they are contributing to obesity in America. At the very least, let’s talk about that.
1) Intake of sugar-sweetened beverages and weight gain: a systematic review
3) Consumption of Sugar Drinks in the United States, 2005-2008
4) Harvard School of Public Health – Obesity Prevention Source, Economic Costs
* Both calculations using the common formula 3,500 Calories = 1 Lbs. body fat. Counting calories: get back to weight-loss basics
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