Two of the country’s leading medical groups on Monday issued a call to arms against the soda industry, urging legislators and policymakers to embrace taxes, warning labels and advertising restrictions to deter young people from consuming the sugary beverages that are increasingly linked to the nation’s crisis of obesity and chronic disease.
Describing sweetened drinks as “a grave health threat to children and adolescents,” the American Academy of Pediatrics and the American Heart Association issued a set of bold policy recommendations they say are necessary to stem the epidemic of Type 2 diabetes, cancer, cardiovascular disease and other diet-related illnesses responsible for tens of thousands of premature deaths and billions of dollars in annual health care costs.
The organizations say such measures are needed if the United States is to adhere to federal dietary guidelines recommending that added sugars make up less than 10 percent of the total calories consumed by children and adolescents. The figure now stands at 17 percent, with nearly half of that coming from sugary sports drinks, carbonated sodas and fruit-flavored beverages, according to studies. The guidelines do not include sugars found naturally in 100 percent fruit juices.
“Sugary drinks are empty calories and they are the low-hanging fruit in the fight against childhood obesity,” said Dr. Sheela Magge, a pediatric endocrinologist at Johns Hopkins Children’s Center who took part in crafting the recommendations.
The statement, more than two years in the making, reflects the growing sense of urgency among doctors — and the frustration over what many describe as government inaction in the face of a national health emergency.
“I’ve seen 2-year-olds with fatty liver disease and teenagers with Type 2 diabetes,” said Dr. Natalie Muth, a California pediatrician and a lead author of the recommendations. “These are diseases we used to see in their grandparents. It’s frustrating because as pediatricians we feel like we’re doing everything we can, but it’s hard to compete with a $800-million-a-year marketing strategy by the soda industry.”
The recommendations embrace a range of initiatives, some of them untested — like federal curbs on junk food advertising — and measures like soda taxes that have been effective in reducing soda consumption.
Most are likely to face resistance from the powerful beverage industry, which has fought back vigorously against any government efforts to dampen consumption of sugar-laden drinks.
Still, some of the policy suggestions would be relatively easy to achieve, like increased funding for public education programs to highlight the dangers of excess sugar consumption or changes to the federal food program that serves millions of poor children. The Supplemental Nutrition Program, or SNAP, pays for 20 million servings of sugary drinks a day, at an annual cost of $4 billion. Barring recipients from using benefits to buy unhealthy beverages, researchers say, could prevent 52,000 deaths from Type 2 diabetes.
Other small, symbolic steps they recommend could have an outsize impact, like encouraging health care institutions to remove sugary drinks from cafeteria menus and vending machines.
“As with the ban on tobacco, leadership by hospitals and health plans to eliminate the sale of sugary drinks can improve the health of their employees, increase public awareness about the contribution of sugary drinks to obesity, and thereby change social norms,” the medical groups said.
William Dermody, a spokesman for the American Beverage Association, said sugary drinks were being unfairly blamed for soaring rates of obesity and diabetes, and he said there were better ways to discourage sugar consumption among children. The industry, he noted, was focused on creating healthier products, including bottled water and low-sugar drinks, part of an industry initiative to cut by 20 percent the calorie count in beverages by 2025.
“America’s beverage companies believe there’s a better way to help reduce the amount of sugar consumers get from beverages and it includes putting parents in the driver’s seat to decide what’s best for their children,” he said in a statement.
But parents, especially those who work long hours, are not always around to police what their children are drinking. When it comes to teenagers, the challenge is even greater.
“Parents can only do so much, especially in single-parent households,” Dr. Magge of Johns Hopkins said.
Jim Krieger, executive director of Healthy Food America, said the industry could not be trusted to oversee the consumption of the unhealthy products it depends on for its profits.
Take, for example, the initiative to voluntarily reduce the sugar content in beverages. Mr. Krieger said the effort was off to a slow start, with only a 3 percent reduction since the effort began in 2014.
Although sugary soda consumption in the United States has dropped since 2000, recent data suggests the decline has plateaued in recent years and rates remain stubbornly high in poor communities, and especially among minority adolescents. According to the Centers for Disease Control and Prevention, the obesity rate is nearly 19 percent among the poorest Americans ages 2 to 19, eight percentage points higher than those in wealthier communities.
Federal studies have also shown that beverage companies spend a disproportionate share of their marketing dollars on campaigns aimed at minority youth, and researchers say such advertisements have been growing in recent years despite a voluntary, industry-wide initiative to reduce ads for unhealthy products.
Many public health advocates have called for federal regulation, much like the 1971 rule that banned cigarette ads on radio and television. The medical associations acknowledged that such restrictions would face an uphill battle but suggested Congress could modify tax laws that allow beverage companies to deduct advertising costs for unhealthy food and beverages.
State governments, they added, could enact rules that ban the marketing of such foods in and around schools and prohibit the makers of sugary drinks from sponsoring youth sporting events.
But when it comes to curbing the zeal for sugary drinks, the medical groups say that higher taxes hold the greatest promise to change habits. From Mexico to Chile and from Philadelphia to Berkeley, Calif., the introduction of soda taxes in recent years has led to significant declines in soda consumption, with a 10 percent tax on average associated with a 7 percent drop in consumption, according to researchers.
Another study found that soda taxes, if widely enacted, could prevent more than a half-million cases of childhood obesity.
The medical associations’ recommendations acknowledge that soda taxes would disproportionately affect the poor but that such communities would stand to benefit if the revenue was spent to enhance early education and programs that subsidize the price of healthy food and beverages.
Benjamin Winig, vice president for law and policy at ChangeLab Solutions, an advocacy group, said he hoped the new recommendations would help build the political will needed to overcome increasingly muscular pushback from beverage manufacturers.
Faced with a surge of local soda taxes, the industry has been backing so-called pre-emptive legislation at the state level that prohibits municipalities from creating taxes on food and beverages. The effort has been successful in states including California, Michigan and Washington.
In the end, though, he said local municipalities were in the best position to address the growing crisis of childhood obesity.
“The public health community is winning, but it’s a very difficult battle,” he said. “Our kids are getting sick and dying and what we really need is for government to step up their mission to keep people safe.”