by Marion Nestle
Sep 24 2012

Do sugar-sweetened beverages promote obesity? Yes, say papers in the New England Journal.

 The New England Journal of Medicine has just published a series of articles on sugar-sweetened beverages to  coincide with presentations at The Obesity Society’s annual meeting.  Here are links to the articles.  I’ve extracted brief quotes from some of them.  And here’s a summary in the New York Times.

Perspective: J.L. Pomeranz and K.D. Brownell, Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices.

Regulations that affect “ordinary commercial transactions” (such as the sale of a product) are presumed to be constitutional if they have a rational basis and if the government body enacting them has the appropriate knowledge and experience to do so.

In the case of New York City’s portion-size restrictions, for example, the health department is an expert public health body that reviewed relevant scientific evidence on the health hazards associated with consumption of sugar-sweetened beverages and the effect of portion sizes on consumption patterns. The proposed policy thus has a rational basis….

Original Article: Q. Qi and Others, Sugar-Sweetened Beverages and Genetic Risk of Obesity

The study concludes: “the genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages.”

Original Article: J.C. de Ruyter and Others,  A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children

We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools….Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.

Original Article: C.B. Ebbeling and Others, A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention….Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up

Editorial: S. Caprio, Calories from Soft Drinks — Do They Matter?

These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.

Clinical Decisions: T. Farley, D.R. Just, and B. Wansink, Regulation of Sugar-Sweetened Beverages

This one is a point/counterpoint.  On the basis of the evidence just presented, should government regulate sugary drinks?

New York City Health Commissioner Tom Farley says yes:

If a harmful chemical in schools were causing our children to get sick, people would demand government regulation to protect them. It is therefore difficult to argue against a government response to an epidemic of obesity that kills more than 100,000 persons a year in the United States and has an environmental origin.7

Federal, state, and local governments already regulate the food system, from farm to retail, in many ways and for many purposes, ranging from support of agriculture to prevention of foodborne illness. The question is not whether we should regulate food, but rather whether we should update food regulations to address this new epidemic.

David Just and Brian Wansink say no:

We must also recognize that the universe of foods that contribute to childhood obesity is much larger than sugar-sweetened beverages. Such a narrowly defined approach would have minimal chance for overall success. Rather, we must consider approaches that will involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity. In truth, we cannot hope to create regulations that restrict behavior holistically.

I’d say we now have plenty of evidence that habitual use of soft drinks raises risks for obesity, and plenty of evidence for the need for regulation.

Yes, it would be nice if “leading children to eat better” worked, but parents, teachers, and everyone else needs lots of help in coping with today’s food environment.

The New England Journal has done a great public service in publishing these papers as a series, and the authors all deserve much praise for taking on these difficult research projects.

OK city agencies: get to work!

  • Anthro

    “… involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity.”

    Yes, and it would be nice if I really did have a fairy godmother who would visit me when I’m trying to resist the thirteenth food outlet I’ve encountered while out for a couple of hours worth of errands and just wave her want and make it all go away–or zap my brain so that I cannot see or smell any of it.

    Many parents, most schools and almost all pediatricians are already “involved” in trying to reach and treat obese children. They are greatly outnumbered by television, et al, and the relentless onslaught of crap food messages these media spew out at them.

    They are greatly outnumbered by wealthy shareholders who require the companies they invest in to make ever larger profits to satisfy their own lust for more money. They are greatly outnumbered by people who try to lay the blame on overworked and ill-informed parents who are also advertised to day in and day out to provide the “best” and a “fun experience” to their children on an all too regular basis. They are greatly outnumbered by an entire culture awash in food, getting “treats” as a way of life, non-stop advertising which now includes “product placement” in their favorite shows, soda machines in their school hallways, prominent well-lit golden arches every mile they travel, and televisions spewing all of it at them in between, at home, and everywhere they go–sometimes even at the pediatrician’s office.

    It will NOT stop voluntarily or by wishful thinking, or by the appearance of a fairy godmother. Regulations are not only appropriate, but vital for public health. It is inhumane to let this continue while admonishing the only people who are trying at all to address the problem!

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  • Joe

    I fully understand that I have fundamentally different views that Dr. Nestle and others who regularly post comments here and to that end a variety of opinions has some merit. However in a country founded squarely on individual freedom and liberty I am bewildered at the confidence given to any government agency to enact policies and regulate the lives of those free people.

    Even if public health officials are highly educated and have a deep understanding of the issues that we face as a nation in regards to health that does not give them the right to regulate what an individual may purchase and consume.

    What is going on in NYC regarding regulating the size of soft drinks may hold for many the promise of utopian health ideals but it will most certainly fall foar short of the stated objectives if there are any to begin with.

    I, like you want folks to be healthy and enjoy a high quality of life. I simply believe that my methods of teaching and persuasion of individuals to that end rather than reliance on the regulatory power of the government is a better way to go in a nation of free people.

    If you think I am off base then take note of the dislike of the new school lunch mandates by high shcool kids nation wide.

  • Anthro, right on.

    Governments have a duty to provide a healthy, nurturing environment for their citizens. Safe drinking water? Clean air? Sidewalks to walk on? This is all part of taking care of citizens. These accomplishments would not have been achieved if left to the “liberty” of chemical and manufacturing plants, for example.

    We have reached a point in public health where we realize that teaching and persuasion of individuals does not work (I work in Public Health, please come see me if you would like to read peer-reviewed studies). If it did, then 60% of the American population would not be overweight or obese.

    I recently attended a forum in Austin, TX put on by TX Medical Association and the TX Public Health Coalition. The TX Ag Commissioner, Todd Staples, (whose politics I do not share), said this–“in the coming years, 50% of health care expenditures are lifestyle related.” In other words they are preventable, but telling someone not to drink two sugar sweetened beverages every day does not work.

    Government has to step in if it wants to avoid a more serious health and therefore economic catastrophe.

    You want to know why “people” are upset about the new school lunch standards? (1) Because it is is a change–there is always a lot of pessimistic chatter during change–humans are creatures are habit–we dont like change. (2) Because it requires that students be served healthier foods and these foods are not necessarily familiar to many of the food service directors, cafeteria staff or students. Unfortunately, much of the food is wasted because the kids do not want to eat it. But in your view, these children should know better and eat the vegetables and low-fat milk because their parents would persuade them to do this, right? Well good luck persuading all of the parents and children in the US to eat their vegetables!

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  • Joe

    You may have reached a point where teaching and persuading indivuduals doesn’t work but I sure have not (and I work in public health). Moreover if we cannot teach a person sitting eye ball to eye ball with them in a teaching setting how on earth is any policy going to have an effect from the federal level.

    Perhaps what you infer as the failure of people to get you message is just them ignoring you. Adults including me and you don’t take well to dictation of their lives especially when it comes to someone commenting on every morsel of food they eat.

    Finally a word of caution. Calling for government regulation and restriction is great when they are on your side but a government that is handed that much power is boud to end up encroaching on your freedoms.

  • Joy


    It’s interesting that you work in public health yet you do not support policies that protect the health of the masses. Care to disclose what you do exactly that you still have a magic voice that informs and persuades people to act in their best [health] interests?

    Shall we allow folks to choose whether or not to buckle up their children? Or even choose to have seat belts in vehicles? What about tobacco? Shall we allow tobacco-sponsored lunch trucks sit in front of schools? All of these public health policies were enacted to save lives and prevent ugly outcomes. I hate to think what it would look like if we did not have such policies now.

    Currently the gov’t is in bed with large food companies and having some regulations in the name of public health is needed. And if it’s about choice–choice is a myth–choice is what the few, very large food corporations like to have you think you have. But you really don’t. It’s crap vs. crap.

    As I see it–it’s about balancing the place of government–and right now the only way to balance the fact that we have serious diet-related problems is to use policies.

  • Joy


    Joe, are you not familiar with the socio-ecological model and the pressures that act on individual choices, as Anthro points out above? Policies have HUGE impacts on the lives of the public. These are all policies that I assume affect you, your family and your friends (whether you agree with them or not):

    Seat belt laws
    Smoking Ordinances
    Dumping chemicals into a stream bed
    Child Nutrition Re-authorization Act
    Labor Laws

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