Soft Drinks, Soda, and Obesity

Although adults seem to be turning to diet drinks, the Center for Science in the Public Interest (CSPI) says that the data show teenagers are actually consuming more high-calorie soft drinks than ever -- and fewer diet drinks than in years past -- despite growing concerns about obesity.

"Just as the soaring rates of obesity have shocked Americans, so should the increasing consumption by teenagers of one of the causes of obesity," CSPI executive director Michael F. Jacobson said. "What was once a rare treat in a small serving is now served up morning, noon, and night, virtually everywhere Americans happen to be. How did a solution of high-fructose corn syrup, water, and artificial flavors come to be the default beverage?"

In a petition filed with the Food and Drug Administration (FDA), CSPI asked the agency to require a series of rotating health notices on containers of all non-diet soft drinks-carbonated and non-carbonated-containing more than 13 grams of refined sugars per 12 ounces. (The typical 12-ounce beverage contains 40 grams.) CSPI said that those messages could include:

• The U.S. Government recommends that you drink less (non-diet) soda to help prevent weight gain, tooth decay, and other health problems.
• To help protect your waistline and your teeth, consider drinking diet sodas or water.
• Drinking soft drinks instead of milk or calcium-fortified beverages may increase your risk of brittle bones (osteoporosis).

CSPI also said that caffeinated drinks should bear a notice that reads "This drink contains x grams of caffeine, which is a mildly addictive stimulant drug. Not appropriate for children."

"It is obvious to physicians who treat obese children that the extra 200, 300, or 400 empty calories kids get from soft drinks contribute to weight gain," said Dr. Caroline M. Apovian, director of the Nutrition and Weight Management Center at Boston Medical Center. "If you want to stop the epidemic of childhood obesity, curbing soda consumption is the place to start. Health messages on labels would certainly help parents and teens be aware of the risks."

In 2004, soft drink companies produced 37 gallons of carbonated non-diet soda-providing about 60,000 empty calories-for every man, woman, and child in the United States, according to Liquid Candy, a CSPI report first issued in 1998 and just re-released in updated form.

As high as that is, industry data show that per capita production of carbonated soda has dropped 7 percent since 1998. And because many adults have switched to diet soda, production of non-diet soda has declined 12 percent-the biggest decrease ever.

Nevertheless, despite that decline in overall production, soda consumption in kids has increased from the 1970s to the 2000s, as have their rates of obesity. Obesity has doubled in kids, and tripled in teens. Though the correlation is striking, recent studies have provided even more direct evidence implicating increased soda consumption with weight gain.

CSPI's new data show that one out of every 10 boys consumes 66 ounces-equivalent to five and a half 12-ounce cans, or about 800 calories-per day. One out of every 20 boys consumes the equivalent of 7 cans per day, or about 1,000 calories. The amount of refined sugars that soda-drinking teens get from soda exceeds the government's recommendations for their sugar consumption from all foods.

"Soda is bad not only for what is provides kids, but for what it takes away," said Lucy Nolan, executive director of End Hunger Connecticut!. That group recently lobbied successfully for legislation banning soda and other junk foods from schools only to see it vetoed by Governor Jodi Rell.

"Hardly any kids are getting enough calcium, vitamins, fiber, vegetables, or fruit. The more soda you drink, the less of those you get. If school systems spent half as much time trying to get more fruits and vegetables into schools as they did trying to keep soda contracts, our kids would be much better off."

Overweight or obese teens are increasingly at risk for type-2 diabetes, once called "adult-onset" diabetes and once rare in kids. And the decreased calcium intake that may accompany increased soda consumption can put people, particularly women, at greater risk for broken bones and osteoporosis.

CSPI's petition is supported by groups including the American Dental Hygienists Association, the American Society of Bariatric Surgeons, the Consumer Federation of America and the National Center for Health Education.

It is also supported by leading scientists and nutrition experts, including Gladys Block of the University of California, Berkeley, School of Public Health; George Bray of the Pennington Biomedical Research Center at Louisiana State University; Brian Burt of the University of Michigan School of Public Health; JoAnn Manson of Harvard Medical School; and Marion Nestle of New York University.

Besides health messages on labels, CSPI recommends requiring calorie labeling of beverages on chain restaurant menus and menu boards, and stopping soda sales in schools.

CSPI also says that states and local governments that levy small taxes on soda or other junk foods should consider earmarking those revenues for promoting health and fitness. A national 2-cent-per-can tax on soda would raise $3 billion annually-almost one thousand times as much money as the federal government spends promoting consumption of fruits and vegetables.

What happens if you get teens to cut back on sugary drinks? Well, among other things, their water consumption goes up.

That's among the findings of an Ohio State University study that used peer pressure at two rural Appalachian high schools. The program, called "Sodabriety," consisted of a 30-day challenge to teens to reduce their intake of sugar-sweetened drinks.

Participants lowered their overall sugar intake substantially and increased by two-thirds the number of students who shunned sugary drinks altogether.

In an unexpected result, water consumption among participants increased significantly by 60 days after the start of the program, even without any promotion of water as a substitute for sugar-sweetened drinks.

“The students’ water consumption before the intervention was lousy. I don’t know how else to say it. But we saw a big improvement in that,” said Laureen Smith, associate professor of nursing at Ohio State and lead author of the study. “And there was a huge reduction in sugar-sweetened beverage consumption. The kids were consuming them fewer days per week and when they were consuming these drinks, they had fewer servings.”

Largest source

Sugar-sweetened soft drinks, sports and energy drinks, and flavored milk and coffee are by far the largest source of added sugar in the U.S. diet and are a major contributor to obesity and the diabetes, heart disease and other diseases that accompany it.

The "Sodabriety" intervention was led by student advisory councils. They designed marketing campaigns, planned school assemblies and shared a fact per day about sugar-sweetened drinks over the morning announcements.

The primary message to their peers: Try to cut back on sugar-sweetened beverages for 30 days. Students opted not to promote eliminating these drinks entirely during the challenge.

Overall, participating teens did lower their intake of sugary drinks, and the percentage of youths who abstained from drinking sugar-sweetened beverages increased from 7.2 percent to 11.8 percent of the participants. That percentage was sustained for 30 days after the intervention ended.

Smith co-authored the study with Christopher Holloman, associate professor of statistics at Ohio State. The research is published in a recent issue of the Journal of School Health.

It's time to do something about unsafe levels of high-fructose corn syrup or sugar in soft drinks, according to Center for Science in the Public Interest (CSPI), because they cause obesity, diabetes, heart disease, and other health problems

Along with scientists and health-advocacy organizations, CSPI wants the Food and Drug Administration (FDA) to determine a safe level of added sugars for beverages. Public health departments in Baltimore, Boston, Los Angeles, Philadelphia, Seattle, Portland, OR, and other jurisdictions are also supporting the proposal.

Too much sugar

A typical 20-ounce bottle of soda pop contains about 16 teaspoons of sugars from high-fructose corn syrup -- twice the daily limit recommended by the American Heart Association. It advises consuming no more than 6 teaspoons of added sugars per day for women and no more than 9 teaspoons for men.

CSPI and the scientists say that despite the concerns over artificial sweeteners, diet drinks are safer than today's full-calorie soft drinks. A gradual change to safer drinks will be made easier by the use of new high-potency sweeteners like rebiana, according to the group, which is made from the stevia plant, and "sweetness enhancers" being developed by major manufacturers.

"As currently formulated, Coke, Pepsi, and other sugar-based drinks are unsafe for regular human consumption," said CSPI executive director Michael F. Jacobson. "Like a slow-acting but ruthlessly efficient bioweapon, sugar drinks cause obesity, diabetes, and heart disease. The FDA should require the beverage industry to re-engineer their sugary products over several years, making them safer for people to consume, and less conducive to disease."

In a 54-page regulatory petition filed with the FDA, CSPI details scientific evidence that added sugars -- especially in drinks -- causes weight gain, obesity, and chronic diseases like diabetes, heart disease, and gout. In particular, the group says a growing number of clinical trials have found that people who are assigned to drink sugary beverages gain more weight than those assigned to drink sugar-free beverages. Other clinical studies found that high-sugar diets increase triglycerides, LDL (“bad”) cholesterol, and liver fat.

Expert opinion

"If one were trying to ensure high rates of obesity, diabetes, or heart disease in a population, one would feed the population large doses of sugary drinks," said Walter Willett, professor of nutrition and epidemiology at the Harvard School of Public Health. "The evidence is so strong that it is essential that FDA use its authority to make sugary drinks safer." Willett is one of 41 scientists and physicians who signed a letter to FDA commissioner Margaret Hamburg in support of the petition. Willett and his colleagues have conducted epidemiology studies that strongly link consumption of sugary drinks to obesity, heart disease, diabetes, and gout.

Soda pop and other sugar drinks are the single biggest source of calories in the American diet. Americans, on average, consume between 18 and 23 teaspoons -- about 300 to 400 calories worth -- of added sugars per day. Teens and young adults consume half again more than the average. About one-fifth of adolescents aged 12 to 18 consume at least 25 percent of their calories from added sugars, according to the government’s 2007-2008 National Health and Nutrition Examination Survey. About 14 million people of all ages consume more than one-third of their calories in the form of added sugars.

Safe levels

The FDA classifies high-fructose corn syrup, sucrose and other sugars as "generally recognized as safe," or "GRAS" in agency parlance. To be GRAS, there must be a scientific consensus that the ingredient is safe at the levels consumed.

CSPI's petition contends that the current scientific consensus is that added sugars are unsafe at the levels consumed. The petition asks the FDA to determine what level of added sugars would be safe for use in beverages, and to require those limits to be phased in over several years. The petition did not propose a specific safe level, but notes that several health agencies identified two-and-a-half teaspoons (10 grams) as a reasonable limit in a healthier drink.

In 1982 and again in 1988, the FDA committed to undertake a new safety determination if sugar consumption increased, or if new scientific evidence indicated a public health hazard. Both of those conditions have been met, which CSPI says obligates the FDA to act.

Changes coming

Some in the soft drink industry seem to see the writing on the wall.

"You will see Pepsi and Coke and Dr Pepper coming up with a whole variety of no-calorie sweeteners," Harold Honickman, the CEO of a major East Coast Pepsi bottler, told The Philadelphia Inquirer in October, describing how the soda market will be changing in the next few years. "I honestly think that you will find 'regular' Pepsi, 'regular' Coke with new kinds of sweeteners. They will be better-tasting drinks than we have today."

Soda pop's role in causing obesity has led many health experts to compare the drinks to cigarettes, and local and state health departments are seeking to decrease the consumption of sugar drinks to prevent obesity.

Under Mayor Mike Bloomberg, New York City will soon cap soda serving sizes at 16 ounces in restaurants and other establishments regulated by the city's health department. Boston now prohibits the sale of sugar drinks on city property. New York City, Los Angeles, and King County (Seattle), Washington, have all run print or Internet advertising campaigns urging people to drink less soft drinks.

Soda pop and most other full-calorie sugar beverages are no longer sold in schools, and two weeks ago the U.S. Department of Agriculture proposed rules excluding high-sugar drinks from vending machines and elsewhere on school grounds. And state legislators have advocated excise taxes on sugar drinks to help reduce consumption and fund health programs.

Besides asking the FDA to reduce levels of added sugars in beverages, CSPI's petition urges the agency to encourage industry to voluntarily reduce added sugars in breakfast cereals, baked goods and other foods, though beverages are the biggest problem. CSPI says the agency should add a separate line for added sugars on Nutrition Facts labels and mount, perhaps with the Centers for Disease Control and Prevention, education campaigns aimed at curbing consumption of added sugars.

Coca-Cola and other soft-drink manufacturers may be feeling backed into a corner. Their sugary drinks are lambasted for contributing to the obesity epidemic and their "diet" drinks made with artificial sweeteners are condemned as health hazards.

It's enough to make you go into the bottled water business. Oh wait, they've done that and been blamed for contributing to environmental damage. 

But the soft-drink makers didn't get to be the globe-girdling giants that they are by turning the other cheek. Coca-Cola has been taking a more aggressive approach than its competitors and is about to launch an advertising campaign defending its use of artificial sweeteners, according to AdWeek. The newspaper ads are expected to roll out over the next few weeks.

"Our use of high-quality, low- and no- calorie sweeteners, including aspartame, allows us to give people great-tasting options they can feel good about," reads a copy of the ad posted to Twitter by Beverage Digest. "Time and again, these low- and no-calorie sweeteners have shown to be safe, high-quality alternatives to sugar."

That's not going down well with food safety advocates like Michael F. Jacobson, PhD, executive director of the Center for Science in the Public Interest, who issued a blunt statement saying the company would be better off getting rid of aspartame entirely.

Switch to water

"Aspartame has been found to cause cancer — leukemia, lymphoma, and other tumors — in laboratory animals, and it shouldn’t be in the food supply," Jacobson said. "We certainly want Coca-Cola to shift its product mix toward lower- and no-calorie drinks, but aspartame’s reputation isn’t worth rehabilitating with this propaganda campaign."

Jacobson said Coke would do better to shift to safer, natural sweeteners, like those made from the stevia plant, a type of sunflower widely used as a sweetener in Japan and other countries. Back in 2008, however, Jacobson objected to plans by Coca-Cola to use rebiana, which is made from stevia, saying it had not been adequately tested.

But leaving that aside, Jacobson argues that if aspartame and other artificial sweeteners are bad, the sugar versions of Coke and other drinks are worse.

"Consumers should know that the greater and more immediate danger to their health is posed not by artificial sweetened products, but by the full-calorie versions of Coke, Pepsi, and other sugar drinks. Rather than posing small risks of cancer, the high-fructose corn syrup or other sugars in these drinks cause obesity, diabetes, heart disease, and other health problems. Everyone would be better off drinking water or seltzer water instead," he said.

Coke fights back

But Coke's not ready to surrender. In fact, it's been running a public relations campaign defending aspartame for several months. Last month it released an infographic, "The Skinny on Aspartame," promoting the ability of the sweetener to help consumers cut back on calories and carbohydrates.

The campaign also seeks to let some of the fizz out of stories about potential negative health consequences of aspartame.

"As a scientist (as well as a consumer of these sweeteners), let me reassure you – these sweeteners are among the world’s most thoroughly studied ingredients. In fact, millions of people—from all over the world--have been enjoying these sweeteners safely for many decades," said Rhona Applebaum, PhD, Vice President and Chief Science and Health Officer for The Coca-Cola Company, in a blog posting.

She said the infographic "offers credible information from independent sources like the American Diabetes Association, the American Heart Association and U.S. Food and Drug Administration" and said it "highlights that aspartame has been proven safe time and time again with more than 200 studies spanning 40 years." 

As portion sizes have increased, Americans' waistlines have expanded. And as a new study in the Journal of Consumer Research suggests, consumers may be tricked into drinking more soft drinks when retailers eliminate small drink sizes.

No matter what the volume of the soft drink, customers tend to avoid the largest and smallest options, according to authors Kathryn M. Sharpe, Richard Staelin, and Joel Huber, all Duke University. "Our basic premise is that consumer purchases are altered by the portfolio of drink sizes made available," the authors said.

Fast-food restaurants, in an attempt to boost profit margins, have eliminated smaller drink sizes and added even larger sizes. The authors believe these policies have led to a 15 percent increase in the consumption of these high-calorie drinks.

"Consumers who purchased a 16-ounce drink when a 12-ounce drink was available later chose a 21-ounce drink when the 12-ounce drink option was removed, since now the 16-ounce soda is the smallest option," they write. "This effect also occurred at the large end of the spectrum; people who purchased a 21-ounce drink when the 32-ounce drink was the largest size available moved up to the 32-ounce drink when a 44-ounce drink was added to the range of drink sizes available.

By adding the 44-ounce option, the restaurant is able to shift the demand curve upward, even though the authors believe customers still want 12-ounce drinks.

The researchers go on to simulate policy directions for slimming America's waistlines. Their models show that for flat taxation of soft drinks to reduce consumption by 10 percent, it would need to be 28 cents per drink and would reduce corporate profits by at least 7 percent.

"Recommendations to reduce population soft drink consumption are strongly supported by the available science," concludes the review of 88 studies.

The American Beverage Association, however, presents a different view on its Web site. "It is not feasible to blame any one food product or beverage as being a sole contributor to obesity ... No science supports such a claim."

Carbonated soft drinks are the single largest source of calories in the American diet, according to a 2005 report called "Liquid Candy," produced by the nonprofit Center for Science in the Public Interest (CSPI).

Companies annually manufacture enough soda pop to provide more than 52 gallons to every man, woman and child in the United States.

"Nobody claims there is a single cause to the obesity problem, but the existing science certainly puts soft drinks in the list of leading contributors," said review co-author Kelly Brownell, Ph.D. He is director of the Rudd Center for Food Policy and Obesity at Yale University.

The systematic review appears in the April issue of the American Journal of Public Health. The work was supported in part by the Rudd Foundation, a private philanthropic organization focusing on obesity and education.

The authors say that a "true test" of links between a consumer product such as soft drinks and health outcomes requires a critical mass of large studies employing strong methods.

"These conditions now exist, and several clear conclusions are apparent," they say. One of the most "powerful" findings is the link between soft drink intake and increased calorie consumption.

Of 21 studies, 19 showed that as people drink more soda pop, the number of calories they consume rises. Moreover, the studies using the most reliable statistical methods showed the largest effects.

Instead of satisfying a sweet tooth, soft drinks may do just the opposite. Several studies found that the caloric increase is actually greater than that contained in the soda, raising "the possibility that soft drinks increase hunger, decrease satiety or simply calibrate people to a high level of sweetness that generalizes to preferences in other foods," the authors say.

"These results, taken together, provide clear and consistent evidence that people do not compensate for the added calories they consume in soft drinks by reducing their intake of other foods," the reviewers say.

The authors anticipated a weaker relationship between soft drink consumption and body weight, because there are many other calorie sources in the diet. Yet in the highest-quality studies, which controlled for a number of unrelated variables, a moderate relationship existed. The review also showed a slight correlation between soft drink consumption and lower intakes of milk, calcium, fruit and fiber.

Diabetes Link

The "most striking link" was between soft drink consumption and the incidence of type 2 diabetes, according to the reviewers. In a study of 91,249 women followed for eight years, those who consumed one or more soft drinks per day were twice as likely as those who consumed less than one per month to develop diabetes.

"This result alone warrants serious concern about soft drink intake, particularly in light of the unprecedented rise in type 2 diabetes among children," the review says.

The authors acknowledge that there is a great deal of variability among the studies included in this review, which incorporate differing methods, populations, beverage types and measurements of key factors such as body weight. Future research with more uniform approaches "would help clarify the impact of soft drink consumption on nutrition and health outcomes," they say.

CSPI, on the other hand, is satisfied with the research to date.

"There's so much damning evidence," says Michael F. Jacobson, Ph.D., executive director. "This is just sugar water. The real need is for laws and regulations that would help rein in soft drink consumption."

The consumer advocacy group calls for clearly presented calorie information at vending machines, convenience stores and restaurants. The group urges schools to stop selling full-calorie soft drinks. CSPI has also petitioned the federal government to require health notices on all nondiet sodas warning that they may promote obesity, diabetes, tooth decay, osteoporosis and other health problems.

The soft drink industry, for its part, has developed voluntary school beverage guidelines designed to limit the availability of sugary sodas and offer more water, milk, juice, energy drinks and diet soft drinks to students.

"All foods and beverages can play an important role in a healthy diet if they're consumed in moderation and also with regular exercise," said Tracey Halliday, a spokesperson for the American Beverage Association.

Diet soda often gets a bad rap from those who think it's really not much of an improvement over a real-sugar soft drink. One frequent criticism is that diet sodas leave you hungry -- and therefore more likely to pig out on sugary and fatty food and snacks.

But a new study says it's not so. 

Researchers at the University of North Carolina studied 318 overweight or obese adults who said they consumed at least 280 calories' worth of drinks each day.

One third of the participants were advised to substitute at least two daily servings of sugary beverages with water. Another third was instructed to substitute diet drinks, including Diet Coke and Diet Lipton Tea.

At the conclusion of the six-month study, water and diet beverage drinkers reduced their average daily calories from what they had been at the start of the study, from between 2,000 and 2,300 calories to 1,500 to 1,800 calories.

At both the three- and six-month points, researchers said people in the two groups were eating a similar amount of total calories, carbohydrates, fat and sugar. Everyone in the study lost weight.

Theory contradicted

The findings seem to contradict the theory that artificial sweeteners used in diet drinks could disrupt the hormones that are involved in hunger and satiety cues -- making diet soda drinkers feel hungrier than others.

Some have speculated that, because the artificial sweeteners are sweeter than sugar, they might cause regular users to develop what we might call a hyper-sweet tooth, causing them to go in search of more sugary snacks and drinks.

But that's not what the North Carolina study found.

"Our study does not provide evidence to suggest that a short-term consumption of diet beverages, compared with water, increases preferences for sweet foods and beverages," wrote lead researcher Carmen Piernas in the American Journal of Clinical Nutrition.

There are still studies out there that have suggested an increased risk of cancer related to artificial sweeteners, but most researchers say nothing is conclusive on that front.

It's worth mentioning that water is still the best thirst-quencher. It's sugar-free, has no calories and, if it's tap water, it's free. 

Death from diabetes, cardiovascular diseases and cancer are being laid at the doorstep of drinks sweetened with sugar.

According to research presented at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions, sugar-sweetened soda pop, sports drinks and fruit drinks may be associated with about 180,000 deaths around the world each year.

Sugar-sweetened beverages are consumed throughout the world, and contribute to excess body weight, which increases the risk of developing diabetes, cardiovascular diseases and some cancers. Using data collected as part of the 2010 Global Burden of Diseases Study, the researchers linked intake of sugar- sweetened beverages to 133,000 diabetes deaths, 44,000 deaths from cardiovascular diseases and 6,000 cancer deaths. Seventy-eight percent of these deaths due to over-consuming sugary drinks were in low and middle-income countries, rather than high-income countries.

"In the U.S., our research shows that about 25,000 deaths in 2010 were linked to drinking sugar-sweetened beverages," said Gitanjali M. Singh, Ph.D., co-author of the study and a postdoctoral research fellow at the Harvard School of Public Health in Boston, Mass.

Highs and lows

Researchers calculated the quantities of sugar-sweetened beverage intake around the world by age and sex; the effects of this consumption on obesity and diabetes; and the impact of obesity and diabetes-related deaths.

Of nine world regions, Latin America/Caribbean had the most diabetes deaths (38,000) related to the consumption of sugar-sweetened beverages in 2010. East/Central Eurasia had the largest numbers of cardiovascular deaths (11,000) related to sugary beverage consumption in 2010.

Among the world's 15 most populous countries, Mexico -- one of the countries with the highest per-capita consumption of sugary beverages in the world -- had the highest death rate due to these beverages, with 318 deaths per million adults linked to sugar-sweetened beverage intake.

Japan, one of the countries with lowest per-capita consumption of sugary beverages in the world, had the lowest death rate associated with the consumption of sugary beverages, at about 10 deaths due to per million adults.

Broadening the study

"Because we were focused on deaths due to chronic diseases, our study focused on adults. Future research should assess the amount of sugary beverage consumption in children across the world and how this affects their current and future health," Singh said.

The Global Burden of Disease Study 2010 is an international, collaborative, systematic effort to quantify the global distribution and causes of major diseases, injuries and health risk factors.

The American Heart Association recommends adults consume no more than 450 calories per week, from sugar-sweetened beverages, based on a 2,000 calorie diet and offers tips on how Life's Simple 7 can help you make better lifestyle choices and eat healthier.

Even though a judge struck down New York City's ban on oversized soft drinks, Mayor Bloomberg's message appears to be getting through. 

The trade publication Beverage Digest says Americans' consumption of carbonated soft drinks, which has been on the decline since 2005, fell last year to its lowest level since 1996. 

And not only are sales down, they're falling at an increasing rate. Sales volume fell 1.2% last year, compared with a 1% drop in 2011 and a 0.5%  drop in 2010.

Energy drinks like Red Bull and Monster are the only segments showing any, well, energy. Overall sales volume would have been down 1.7% without them.

Making us fat

Besides Mayor Bloomberg's campaign to take the fizz and sizzle, not to mention the sugar, out of large soft drinks, health authorities of all stripes have been warning that guzzling the sugary concoctions is contributing to the nationwide epidemic of obesity and diabetes.

Of course, health may not have much to do with it. It may just be that big sugary drinks are simply becoming uncool. Tastes change and while consumer attitudes can be slow to change, they can also flip quickly once a "tipping point" is reached.

That may be what's happened with soft drinks. In many circles, waddling around with a Big Gulp in hand is no longer seen as cool, while draining a potent energy drink is seen as daring, sort of like gunslingers flinging back shots of whiskey before saddling up and riding off into the sunset.

Nevertheless, carbonated soft drinks still make up the biggest category of nonalcoholic beverages and Coca-Cola and Pepsi are still the biggest drink makers. Each, of course, owns any number of water and energy drink brands, angling to remain in the picture no matter which way consumer tastes go.

The fastest-growing brands by volume were Monster, up 19.1%; Red Bull, up 17%; Dasani, up 9.1% and Rockstar, up 8%.

First, it was tobacco. Decades ago, the U.S. Surgeon General issued a report documenting the health risks associated with smoking. Slowly but surely, laws were passed and regulations were issued, discouraging and taxing smoking. 

But the tobacco industry fought back. It commissioned its own studies, which not surprisingly found that smoking wasn't all that bad. It worked to present smoking as an individual decision and encouraged smokers to resist government intrusion. It also opened a lobbying and public relations office in Washington, hoping to sway lawmakers, regulators and the press. Years later, most would say it was more successful than anyone had dared hope: Americans still smoke.

The process -- generously funded and meticulously research-driven -- became the blueprint for how an industry under siege should respond. It is hilariously described in Christopher Buckley's novel, "Thank You For Smoking," which was to the Washington communications game what "Mad Men" is to advertising. 

The process has since been adopted by interests as diverse as veal packers and the cell phone industry, as they fight back against allegations ranging from animal cruelty to a possible link between cell phones and cancer.

Now it is sugar's turn.

Everyone from Mayor Bloomberg to such tenacious, science-based health advocates as the Center for Science in the Public Interest have been lambasting sugar as the cause of the nation's epidemic of obesity, diabetes, heart disease and other assorted ills.

Battle plan

Now girding its loins for battle, the National Confectioners Association is reportedly talking with leading Washington, D.C., communications firms, preparing to pick one to devise and implement its strategy.

Advertising Age reports the confectioners have an initial budget of about $2 million. This might sound like a lot of money for some chubby little candy men to put together but these confectioners are not the mom-and-pop bodega on the corner. They are Mars, Nestle, Hershey and Mondelez, global giants whose corporate revenues dwarf the national budget of many countries.

Over at Advertising Age, they seem to think this is a big budget, referring to it as "sizeable for a PR assignment," thus betraying once again the ad business' myopic view that anything that is not advertising doesn't amount to much of anything.

In fact, a fully integrated strategic campaign on a topic this volatile -- and this vital to a huge and well-heeled industry -- needs to include everything from lavishly-funded research to social media campaigns to traditional media outreach and, most important, to a "grass-tops" organizing effort that brings together parents, educators, healthcare professionals and lawmakers to do the industry's bidding and give it a sheen of respectability.

Read the tea leaves

Such an effort, understood by Chris Buckley but seemingly no one else, organizes an industry's enemies and essentially co-opts them. Those who can truly read the tea leaves in Washington know that "Mothers for Sparkling Clean Water" is probably backed by the arsenic industry while "Citizens for Absolutely Ferocious Competition" would probably be backed by AT&T and Verizon. 

Already, the confectioners have a campaign called "Treat Right," which encourages candymakers to put calorie counts on the front of their wrappers, thus allowing them to don the cloak of health advocate. 

Prominent figures will be recruited for the campaign, many of them out-of-work politicians, former ambassadors, retired educators and doctors whose Aspen ski condo is beginning to feel a bit cramped. It's not easy to recruit these people but having a big checkbook helps.

Actual conversation with a "retired" (i.e., defeated) politician from my checkered past:

Politico: "God bless you son, you're doing the Lord's work here and I wish I could help you but I'm completely over-committed already."

Me: "Well, we are in a position to offer an appropriate honorarium."

Politico: "Oh well, let me see here. Maybe I could work it in ..."

 

Not small change

As becomes quickly evident, this will not be a small or short-term campaign. It will go on for years until, in the immortal words of Bill Clinton, "the last dog dies." Children will be put through high school and college on this campaign. Sailboats and Porsches will be christened and lovingly maintained. McLean homes will be abandoned for finer digs in Great Falls.

While there may be one or more public organizations created as part of the campaign -- Doctors for Healthy Kids, let's say -- the real work will be performed in the skunkworks, offices secreted in marble and teak splendor somewhere along K Street. 

So if, in a year or two, you hear someone prominent suggesting that candy makers really have children's best interests at heart, you will know that Operation Candyman is up and running and doing tricks for its masters.

---

(Disclosure: I labored in the D.C. vineyards for years designing and implementing strategies similar to those described here on behalf of major industry groups. Some would say my work at ConsumerAffairs is my penance. I do not have a sailboat).

How many sugary soft drinks is too many?  There's no single answer but a coalition of health and consumer groups would like to see Americans reduce their consumption to three cans per week.

The Center for Science in the Public Interest, the American Heart Association, the American Diabetes Association and more than 100 other groups are mounting a campaign to educate Americans about the risks of consuming too much sugar.

Sugary drinks are the single largest source of calories in the American diet and account for half of all added sugars consumed. And unlike any other food or beverage, only sugary drinks have been shown to have a causal role in promoting obesity.

Each additional sugary drink consumed per day, according to one study, increases the likelihood that a child will become obese by about 60 percent. A reason that sugary drinks are conducive to obesity is that the calories in beverages aren’t as satiating as solid foods.

The American Heart Association recommends that people limit their intake of sugary drinks to about 450 calories per week, or about three 12-ounce cans. Average consumption is now more than twice that.

“Life’s Sweeter’s goal is to broaden the battle against sugary drinks from health experts to civic organizations, youth groups, civil rights groups, and others,” said CSPI executive director Michael F. Jacobson, Ph.D. “The enormous health and economic benefits that would result from drinking less ‘liquid candy’ will be supported by a broad cross-section of America. Not since the anti-tobacco campaigns has there been a product so worthy of a national health campaign.”

Empty calories

The campaign’s web site, fewersugarydrinks.org, invites individuals and families to take the Life’s Sweeter challenge to drink fewer or no sugary drinks.

In addition, the campaign is encouraging employers, hospitals, and government agencies to adopt policies that would reduce soda consumption. Besides carbonated soda, the campaign targets fruit-flavored beverages with little or no juice, sweetened iced teas, lemonades, energy drinks, and so-called sports drinks such as Gatorade.

“Campaigns like Life’s Sweeter with Fewer Sugary Drinks and our own local efforts will help raise awareness of the harmful consequences of consuming too many sugary drinks, which add empty calories to our diets, inches to our waistlines, and risks to our health,” said Dr. Jonathan Fielding, Director of Public Health and Health Officer for the Los Angeles County Department of Public Health.

Many big cities are already campaigning to reduce soda consumption. In New York City, for instance, officials have run hard-hitting ad campaigns connecting soda to weight gain, and highlighting the sugar content of soft drinks. 

U.S consumers are drinking less soda pop, a development health advocates see as an encouraging trend in the fight against obesity and diet-related disease.

Per capita consumption of carbonated soft drinks has declined for 11 straight years, according to data from the Beverage Marketing Corporation. It now stands 22 percent below its peak in 1998, according to the trade publication Beverage Digest and calculations by the Center for Science in the Public Interest (CSPI).

Even with the declines in consumption in recent years, Coca-Cola, PepsiCo, Dr. Pepper Snapple, and other companies produced 9.4 billion cases of sugary soda pop and energy drinks in 2009.

At the 1998 peak, when CSPI first published its Liquid Candy report, companies were producing 638 8-ounce servings of non-diet soft drinks per person. By 2009, that figure was down to 543 8-ounce servings. Still, that's about 140 empty calories a day, for every man, woman, and child in the United States.

"The recognition that soda pop promotes weight gain and disease is gaining traction, contributing to the steady decline in soda consumption," said CSPI executive director Michael F. Jacobson. "Ten years from now, it would be great to see that Americans are drinking a can and a half a week, instead of a can and a half a day."

Besides concern over obesity, Jacobson said that the growing popularity of bottled water, the low-carb Atkins and South Beach diets, bans on soft drinks in schools, and rising unemployment rates are all partly responsible for the decline in soda consumption.

According the United States Department of Agriculture (USDA) and Beverage Digest, the proportion of carbonated soft drinks that are non-caloric diet drinks increased from 23 percent to 30 percent between 1998 and 2009.

CSPI and other health advocates are urging state legislators to increase soda taxes where they already exist, or to institute them for the first time. A state such as California, which already imposes a small sales tax on soft drinks, could raise nearly $2 billion each year if it added a penny-per-ounce excise tax on soda.

The state could put some of that money toward the state's share of the $10 billion in medical expenses incurred each year by obese Californians. The revenues could also fund programs to encourage healthy eating and physical activity, such as media campaigns to discourage the consumption of sugary beverages.

"Reasonable taxes could help drive down consumption a bit more, particularly among children," Jacobson said. "And if those taxes could fund hard-hitting media campaigns, like the one being run in New York City, that's even better. The goal should be to restore sugary soda to what it once was -- an occasional treat in a reasonable portion, not the every-day super-sized tub."

The idea of a soft-drink tax has also come under consideration on the federal level.

Another policy approach would be to require health notices on soft-drink containers, something that in 2005 CSPI petitioned the Food and Drug Administration (FDA) to do. CSPI proposed "The U.S. Government recommends that you drink less (non-diet) soda to help prevent weight gain, tooth decay, and other health problems," as one such notice.

The FDA has yet to act on that proposal.

With New York Mayor Michael Bloomberg proposing a ban on the sales of large sodas and other sugar-based drinks, the national debate on healthy verse non-healthy beverages is at an all-time high.

Between the vast array of diet sodas available, not to mention the bevy of health drinks, juices and organic beverages, consumers can feel quite confused about what's actually healthy and what's merely branded as such.

For starters, lets look at some of the more popular non-diet beverages and gauge what their actual calorie and sugar count is:

• Eight ounces of Coca-Cola contains 100 calories and 27 grams of sugar.
• Eight ounces of Pepsi has 100 calories and 28 grams of sugar
• Nestea Iced Tea with Lemon has 80 calories with 22 grams of sugar, in an eight ounce serving.
• Eight ounces of Rockstar Energy Drink contains 140 calories with 31 grams of sugar.
• Sprite contains 96 calories and 26 grams of sugar in an eight ounce serving.

Those who still consume heavy amounts of non-diet sodas, they run the risk of getting diabetes, tooth and even bone decay, according to health experts.

And what about diet sodas? The word diet alone engenders a feeling of safety for consumers who want a healthier beverage option, but many health experts say diet sodas can be more fattening than non-diet versions.

More fattening

In a recent study from the University of Texas, diet soda drinkers experienced a 70 percent increase in waist size compared with non-diet-soda-drinkers. 

The main culprit of weight gain among diet soda drinkers is an ingredient called aspartame, which is an artificial sweetener used in most diet sodas. Experts say perpetual consumption of aspartame could possibly lead to increased blood glucose levels, which could eventually cause diabetes.

Many consumers, who have been already hip to the health risks of drinking too much diet soda, have decided to drink zero calorie drinks instead. Many believe sodas like Coke Zero and Pepsi Max are a healthier product to buy, but experts say they're really not.

Many of the zero calorie beverages not only contain the aspartame ingredient, but also have an additive called Acesulfame Potassium, which is another artificial sweetener that could create even more health risks.

In lab tests, scientists have found the sugary additive potentially increased  the risk of cancer as well as insulin production levels in test animals.

Experts say Acesulfame Potassium is less risky than aspartame, but more research still needs to be done on both additives. The problem with zero calorie sodas, experts say, is they typically contain both artificial sweeteners, and each comes with its own potential health risk, not to mention possible weight gain.

But not always ...

But just as certain beverages can be the catalyst in weight gain and cause serious ailments, certain drinks can do the opposite, and thrust an individual into a healthier lifestyle.

"Some drinks have tremendous health benefits, from relieving minor ailments like indigestion to protecting against serious ones like osteoporosis," says Dan Nadeau, M.D., medical director of Exeter Hospital's HealthReach Diabetes, Endocrinology and Nutrition Center in Exeter, New Hampshire.

Besides water, here are some of the healthier drinks that experts say should be replacing your soda or sugary beverage intake:

Green Tea: Helps reduce risk of osteoporosis, cancer, heart disease and cavities. It also holds a natural antioxidant that can protect cells from receiving cancer-causing substances. Green tea can also lower the risk of heart disease, blood clots, and strokes.

Cranberry Juice: Prevents gum disease, urinary tract infection, and eliminates bacteria from the teeth and gums while eating. But doctors say to be mindful of your intake, as certain juices contain high levels of sugar. "Make sure the label says 100 percent juice, not 'juice drink' or 'cocktail,'" says Heidi Reichenberger, R.D., a spokesperson for the American Dietetic Association.

Low-Sodium Tomato Juice: Protects against certain cancer types. Processed tomato products have the richest source of the antioxidant lycopene, which has been known to lower the risk of lung and stomach cancer, say experts. Tomato juice has also been known to reduce the chances of getting  pancreatic, colorectal, esophageal, oral, breast and cervical cancers.

Orange Juice: Many already drink the popular breakfast beverage for its taste, but orange juice also has some wonderful health benefits. It's a high source of vitamin C, and has antioxidants that can thwart off diseases like, cataracts, and certain types of cancers. It's also known to boost the immune system. However, it's even better to eat an orange, as you get more fiber that way.

By Truman Lewis
ConsumerAffairs.com

May 12, 2009
For years, cigarette smokers have paid a whopping "sin tax" each time they buy a pack of coffin nails. Now the Senate is savoring the notion of doing something similar with soft drinks and other sugary confections. Proceeds would help finance comprehensive health care.

The Senate Finace Committee has a session scheduled today to hear varying proposals from experts who've been looking for ways to help finance President Obama's proposed universal health care plan, expected to cost $1.2 trillion.

Among the leading proponents of the idea is the Center for Science in the Public Interest (CSPI), a longtime crusader for less sugar, salt and other harmful food additives. It advocates a federal excise tax on sugary sodas as well as energy and sports drinks and sweetened tea drinks. Diet sodas would get a free ride.

Current thinking is that a tax of three cents per 12-ounce drink would generate about $24 billion over the next four years. That's a mere drop in the health-care bucket but CSPI founder Michael Jacobson says it's long overdue.

He calls soda "one of the most harmful products in the food supply" and thinks the tax would discourage consumers from slugging down so much of the stuff. Jacobson notes that sugary drinks contribute to obesity, diabetes and other modern scourges. He says at least a dozen states already tax sweetened drinks.

There's general agreement among researchers that liquid calories are a bigger health risk than those that come from solid foods. A study just last month found that sugary beverages had a stronger impact on weight than solid calorie intake. A study in the journal Pediatrics in 2006 showed a direct correlation between weight gain in teenagers and the consumption of soda and other sugary drinks.

Also in 2006, researchers at the Harvard School of Public Health reviewed the most credible scientific nutrition studies conducted over the last 40 years and found that one-third of all carbohydrate calories in the American diet come from added sweeteners. Of that total, the study claims, beverages account for about half those calories.

Research reported at a national meeting of the American Chemical Society in 2007 found that soft drinks sweetened with high-fructose corn syrup may contribute to the development of diabetes, particularly in children.

The beverage industry, not surprisingly, isn't sweet on the idea. The American Beverage Association argues that a tax won't teach children how to have a healthy lifestyle and claims the tax would unfairly target lower-income Americans.

The idea may not go down well with voters either. New York recently backed off a proposal to levy an 18 percent tax on sugary drinks despite experts' ringing endorsement of the idea.

Yale obesity expert Kelly Brownell and New York Health Commissioner Thomas R. Frieden were both among the supporters of New York's proposed penny-per-ounce tax, which they argued could reduce consumption by more than ten percent and raise $1.2 billion a year in New York state alone.