Every five years, the U.S. federal government releases its "Dietary Guidelines for Americans," a joint production of the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS). The new one is scheduled to be released in December.
According to the last one, released in 2010, sugary beverages are extremely popular, with soda, energy drinks and sports drinks making up the fourth highest source of calories among Americans overall — and the third highest source for children and adolescents up to the age of 18. These sweetened drinks also make up the lion's share (almost 36 percent) of the sources of added sugars in the American diet.
But tastes appear to be changing. As The New York Times recently noted, sales in full calorie soda in the U.S. have declined more than 25 percent over the last two decades, while bottled water sales have increased. Still, the overall dietary picture isn't great, as the majority of Americans continue to get their calories from unhealthy sources, including processed foods, grain-based desserts and alcohol. Pizza, often washed down with soda, is the fifth-highest source of Americans' caloric intake.
Looking more closely at the statistics reveals striking socioeconomic forces at work. In her new book Soda Politics:Taking on Big Soda (and Winning), Marion Nestle, chair of New York University's Department of Nutrition, Food Studies and Public Health, points out that soda drinking is split across race and class lines, with African and Hispanic Americans drinking more soda than their white counterparts, adding that their soda drinking habits "are strongly influenced by television advertising, especially when commercials feature celebrities of their own race and ethnicity." She also notes that "this diversity — in income, social status, and outlook — complicates efforts to reduce soda intake in minority communities."
And while the sharpest declines in soda consumption have occurred "among richer, white populations," according to the New York Times, Nestle said she expected "poor and minority customers would also reduce their soda intake over time, just as tobacco declines occurred first among educated consumers and then spread to a larger population."
I had a chance to ask Rebecca Spector, West Coast Director of the Center for Food Safety, a national non-profit public health and environmental advocacy organization, about the current state of soda drinking in the United States, how it cuts across race and class — and if we are heading towards a future free of sugary beverages.
Reynard Loki: For many health advocates, soda been used as a symbol for bad diets. Has the strategy worked?
Rebecca Spector: Soda has become the “poster child” for unhealthy foods for good reason: Sugary drinks are the single largest source of added sugars in the American diet. The ongoing campaign to educate the public about the risks associated with regular consumption of soda and sugary drinks — including greater risk of obesity, diabetes and tooth decay — has been successful in reducing soda consumption in the U.S. However, overall consumption of candy, potato chips and other processed foods is not declining. So the message about the negative health impacts from consuming soda and other sugary beverages is unfortunately not reducing consumption of other unhealthy foods. Curtailing soda consumption is an important goal, but it can’t be our only focus.
RL: Soda has been called the new tobacco. Is that a fair comparison?
RS: There are a lot of similarities between the soda industry and the tobacco industry. First, both industries are selling products that are unhealthy and are directly related to the onset of disease. Second, both have notoriously targeted children in their marketing. The difference right now is that one could argue that drinking soda in moderation is okay, while smoking, even in moderation, is not recommended. This is because of its strong links to lung and other cancers and its highly addictive nature. That said, research is showing that sugar is biologically addictive and I think that as the evidence grows in the coming years, we will realize how insidious sugar-laden products truly are.
RL: Is the decline in soda consumption temporary? What are soda companies doing to make up the loss in market share?
RS: The major soda manufacturers have already altered the portfolio of products they sell, diversifying into alternative beverages such as sports drinks, juices and bottled water, among other products. Such a market shift at the corporate level indicates that soda has lost its previous market share, and now the focus of these large beverage corporations will be on marketing other beverages and processed food products. What we’re seeing is that soda companies are now trying to tap into the current energy around healthy eating by developing supposedly healthy versions of their products, like Coca-Cola made with real sugar rather than high fructose corn syrup, or Pepsi with added vitamins. And we’re also seeing these companies buy up smaller brands that have healthy images, like Honest Tea. These corporations aren’t going away. They are just shifting to manufacturing and selling other (still mostly unhealthy) products.
RL: Sales of diet soda have also shrunk. How concerned should we be about the potential negative health effects of artificial sweeteners even though there hasn't been much evidence pointing to that?
RS: As you note, most mainstream medical associations have not linked artificial sweeteners to diseases or other health impacts. However, some independent studies have indicated otherwise, linking artificial sweeteners to a host of health problems, including cancer. We need many more independent studies to be conducted to ultimately shed more light on this controversial issue. One thing to note, however, is that consuming foods with artificial sweeteners can lead to cravings for other sweet foods, which may undermine any attempts to cut calories. In addition, some artificial sweeteners may be addictive. I think the answer is to severely limit the consumption of beverages that are sweetened with both sugar and artificial sweeteners and stick primarily to water, herbal teas (which are delicious as iced drinks) and diluted juices. And choose organic as much as possible to avoid exposure to pesticides used in the growing of fruits, vegetables, tea and coffee.
RL: Soda taxes have failed in New York State and San Francisco; only Berkeley has one. Is a soda tax is the right kind of tool to fight the obesity crisis?
RS: Soda taxes and other forms of legislation are great ways to educate the public about an issue — and that’s exactly what the soda tax fight has done. It’s accomplishing its mission by exposing and publicizing the truth about the impacts of sugary drinks and changing people’s diets through the power of information. In addition to taxes, laws requiring the labeling of sugary foods, stating that “drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay,” would provide the public with critical information before choosing a product. I hope to see more innovative legislation on this issue in the coming year.
RL: Former New York City Mayor Mike Bloomberg's fought to limit the size of sugary beverages sold at food service outlets. Though the New York Court of Appeals ruled that the board of health exceeded the scope of its authority in adopting the regulation, the ban may come back, at least for minors. The soda industry says it's an assault on consumer choice. Is the so-called "Big Gulp Ban" a good idea?
RS: Even if such a law to limit the size of sugary beverages sold at food service outlets was upheld, consumers would not be prohibited from consuming however much of these sugary beverages they want. The law would merely eliminate the sale of sodas larger than 16 ounces; it would not prevent a person from buying as many sodas as they want. Center for Food Safety argued that it is in fact the beverage companies that have taken away consumer choice when they replaced smaller sized fountain soda cups (7 or 12 ounces) with huge cups containing 42 to 128 ounces. The companies pushed the public into a consumption pattern that benefited their bottom line.
RL: The individual consumer choice argument eventually has to reckon with the public health issue. A more obese public may impact everyone through higher public expenses that go towards health care of obesity-related health issues, as well as the possibility of health care premiums going up across the board. Does this have a place in the overall narrative?
RS: When people’s individual choices affect other people, it becomes a public health issue. So yes, I think that as a society we have a responsibility to ensure our individual choices do not negatively impact others. When people become ill as a result of the individual choices they make, and that in turn increases public expenses towards health care, that is an issue for all of us. But obviously this applies to many things other than just food, such as alcohol, tobacco, and other drugs. But the onus should not just be on the individual. It should also be on corporations that are bringing products to market that cause cancer and other diseases. These corporations and their products should be properly regulated, including containing warning labels when necessary, and held liable if appropriate (such as the tobacco industry). Ultimately, we need to craft an environment where making healthy choices is easy and the norm. Right now, it is far too difficult for consumers to get the information they need and to access the food that will keep them healthy.
RL: Much of the success in reducing obesity rates in children has come from changes in food offerings at schools, many of which have stopped offering soda. Are schools the primary battleground for fighting the obesity epidemic?
RS: Schools are a critical place to get children on the right dietary track. Millions of children eat both breakfast and lunch (in addition to snacks) at school five days a week. So for many kids, approximately half of their meals are eaten at school. By eliminating soda and other sugary foods at school, children are significantly reducing their consumption of these products and also establishing healthier eating habits that will serve them for the rest of their lives.
RL: What is your advice to concerned parents who are trying to instill healthy diets at home but are worried when their child goes out into the world?
RS: The models we establish at home shape the choices our children make out in the world. Feeding our children home cooked meals made from whole, unprocessed foods (and organic when possible to avoid pesticide residues) is the path to good health and to establishing healthy eating habits. It’s difficult if not impossible to prevent school-aged children from consuming soda or other processed foods in moderation when they are out and about. Knowing that my child may have a soda or candy when at a party or at the movies, I do not serve these products at home, ensuring a healthy balance. I think it’s important to allow for moderation and not make these foods “forbidden fruit,” which can result in a backlash and increased desire for these products. I don’t see any place for routine consumption of processed foods in a healthy diet, especially for children.
RL: Alice Green, executive director for the Albany-based Center for Law and Justice, called race-targeted soda ads “environmental racism.” Do you agree? Should soda marketing be more heavily regulated, as some lawmakers desire?
RS: I agree that race-targeted soda ads are “environmental racism,” as they disproportionally target a specific audience based on race and class, putting that population at greater risk for obesity and diabetes. I think the iniquitousness of soda and junk food ads are a problem for all of American society and I would like to see greater regulation of those ads and soda marketing in general as a benefit to all Americans, especially children and African and Hispanic Americans.
RL: Do you agree with Katie Bayne, Coca-Cola's president of sparkling beverages in North America, who told USA TODAY that "there is no scientific evidence" that connects sugar beverages to obesity? Sugary drinks, she added, can be part of any good diet.
RS: There is absolutely evidence linking regular consumption of sugary beverages and other high-calorie processed foods to obesity. A healthy diet requires consuming a majority of our daily calories from whole, unprocessed foods low in sugar – and when a 64 ounce soda (which is not even the largest size available at some convenience stores) contains almost 750 calories and nearly 200 grams (one full cup) of sugar, there is no place for that amount of soda in someone’s regular diet. Most of us have very regular habits of what we eat and drink, and those habits can be deeply swayed by persuasive marketing. As such, it’s critical to develop healthy habits early, which means severely limiting regular consumption of soda and other sugary foods and beverages. Personally I do not believe that regular soda consumption can be part of a truly healthy diet.
RL: Do soda companies bear responsibility for effect of their products on public health?
RS: I believe that corporations should be held accountable for how their products affect our society, in particular our health and our environment. When a product is responsible for poisoning our water supply or contributing to the onset of obesity and diabetes, I think the corporations that produce those products should be regulated and held accountable.
RL: If people aren't going to drink less soda on their own, what can be done to reduce the public health impact?
RS: I’d like to see more legislation to increase the regulation of these products and the marketing of them, as allowed by law. In addition, we need more education campaigns in schools and elsewhere that reveal the true risks of regular soda consumption. These campaigns should be coupled with boycotts of these foods by the public and by celebrities who currently endorse them. The overall downward trend of soda intake is a positive development, but we can’t take that to mean that our work here is done. It means we need to redouble our efforts, assess which strategies have been effective and which haven’t, and commit ourselves to affecting change even where the problem seems most intractable. I think one part of that will be to encourage community-led educational campaigns that can help reshape eating and drinking habits in schools and neighborhoods where those most vulnerable reside.
RL: For consumers, what's the bottom line? Is a little soda okay, or is it a slippery slope that should be avoided altogether?
RS: Personally, I think extreme moderation of soda is okay, but that can be a slippery slope given the addictive nature of products containing sugar and sugar substitutes. As a parent, my child is occasionally allowed a non-caffeinated soda at a restaurant or at the movies — adding up to less than half a dozen small sodas a year. As such, she doesn’t crave soda or ask for it, except on rare occasions. But it also is not forbidden. The same holds true for candy — it’s reserved for special occasions such as birthday parties and Halloween, so, there is no expectation or craving for it as it’s never something we buy at the store or keep in the house. But every person needs to decide what set of rules works best for them or their children to prevent daily or even weekly consumption of these unhealthy products. There is no debate that eating whole foods that are unprocessed, such as fruits, vegetables, beans, nuts, legumes, fish, and lean meats, should be making up the majority of our daily diets.
RL: How do you see the soda issue evolving in the coming years?
RS: Just as smoking has decreased dramatically over the decades, I think soda consumption will also continue to decline; however, I do not think it will be eradicated completely. New and alternative beverages, many of which are equally sugary, are steadily gaining market share and will continue to grow in popularity. With the expansion of this new market we will need to monitor the ingredients of these products and determine how they may be contributing to obesity and disease. Soda is just one piece of the processed food explosion, which we must continue to closely examine in order to truly improve health. Only with the necessary research and data can we craft meaningful and impactful policies. I think there are a lot of creative solutions to our public health problems yet to be explored. The fact that we’re discussing this issue at every level of government and society is a positive sign for the future.