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Public health must address sugar-sweetened beverage consumption

Dr. Paula A. Johnson and Dr. Barbara Ferrer

Public health must address sugar-sweetened beverage consumption

America’s obesity epidemic jeopardizes our children’s health and overwhelms our health care system. According to a recent Brookings Institute report, it also saps our economy due to spiraling health care costs and lost productivity from workers suffering from diabetes, heart disease and other obesity-related conditions.

While no single factor causes or will prevent obesity, nutrition research clearly shows that sugar-sweetened beverage consumption is a major culprit in Americans’ weight gain. Consumption of soda, energy drinks, fruit punches and similar high sugar-content drinks with no nutritive value has dramatically increased over 30 years.

The average teenager now drinks more than 20 teaspoons of “liquid sugar” a day.  That can add up to more than 20 pounds of extra weight a year for a sedentary adolescent.   

In addition to obesity, there is accumulating evidence that this level of sugar-sweetened beverage consumption contributes directly to diabetes, metabolic syndrome, hypertension and other chronic conditions. Public health officials have a responsibility to lead community-wide efforts that will raise awareness and decrease consumption of sugar-sweetened beverages (SSBs, for short).

To succeed in this, we’ve first got to develop a shared public understanding of how these beverages became central in the obesity epidemic and of what steps we can collectively take to change that paradigm.

The dramatic increase in daily consumption is primarily due to three factors. Federal farm subsidies have made high fructose corn syrup, the major ingredient of SSBs, remarkably cheap. Intensive and pervasive beverage industry marketing, especially of soda as being part of a healthy, happy, refreshing, energy-filled lifestyle, has driven demand.

Industry product placement strategies and our fast-paced ‘grab-and-go’ modern lifestyles have resulted in an environment where high-calorie SSBs are at arm’s reach wherever we go. Vending machines with bold graphics beckon us to buy one more soda in many public and private venues. The result is that soda and its sugary cousins are no longer “treats” in the context of an otherwise balanced diet — they now account for up to 13 percent of daily calorie intake.

Public health strategies to reduce SSB consumption must account for these realities. While education and promoting personal behavior change is important, it can’t be the only solution in the face of these powerful countervailing forces. We need to create a community environment that makes the healthier choice the easier choice in people’s daily lives.  

Mayor Thomas Menino’s recent executive order that ends the sale and provision of SSBs in and around city buildings is a significant step in Boston’s efforts. The decision by Carney Hospital President Bill Walczak to end SSB availability at a leading Boston health care organization is also important.

The Boston Public Health Commission will continue its partnerships with community leaders, residents and nutrition experts in developing additional strategies that will work for Boston.

In public buildings, schools, health care organizations and other settings, we are providing clear, factual information about SSBs and healthier options at the point-of-purchase. We can also make those healthier options cost a little less or unhealthy SSBs cost a little more, as St. Elizabeth’s Hospital has begun to do. Or change the product mix and product placement to promote healthier beverages. We can limit beverage industry promotions, especially to our children. And we can decrease the universal availability of these empty-calorie, unhealthy beverages by not selling SSBs in every vending machine and concession stand.

Sure, adults can still consume their favorite drinks at their desks or walking down the street. But if they have to walk a little further to get it, maybe they’ll reach for a glass of water instead.

Dr. Paula A. Johnson, M.D., M.P.H., is chair of the Board of Health, Boston Public Health Commission and Dr. Barbara Ferrer, Ph.D., M.P.H., Med, is executive director, Boston Public Health Commission.