Underlying Data on the Risks of Sugar-Sweetened Beverage Consumption

Sugary Beverage

Sugary Beverage

During the course of the community discussion on a potential soda tax, we have cited our interview with Dr. Harold Goldstein. Some of his figures have come into question and so we asked Dr. Goldstein to provide the Vanguard with citations that back up the claims. He has done so.

Dr. Goldstein told us that the research suggests that the proliferation of sugar beverages over the last 40 years has greatly contributed to obesity problems. From 1977 to 2001, people consumed about 278 calories more and about 43 percent of those calories came from beverages.

He argued that consuming just one soda a day increases the risk of obesity by 50 percent and of diabetes by 30 percent.

In 2005, researchers SJ Nielsen and BM Popkin published a study in the American Journal of Preventative Medicine. They looked at changes in beverage intake between 1977 and 2001 and found for all age groups, “sweetened beverage consumption increased and milk consumption decreased. Overall, energy intake from sweetened beverages increased 135% and was reduced by 38% from milk, with a 278 total calorie increase.”

They add, “These trends were associated with increased proportions of Americans consuming larger portions, more servings per day of sweetened beverage, and reductions in these same measures for milk.”

In other words, the researchers found that the consumption of sweetened beverages more than doubled in that 24-year period and was a primary reason why caloric intake increased by 278 calories. This is backed up by subsequent research.

A 2010 meta-analysis published in Public Health Nutrition by Gail Woodward-Lopez, et al found that “Obesity rates and sweetened beverage intake have increased in tandem in the USA.”

They write, “Studies consistently show that higher intake of sweetened beverages is associated with higher energy intake. Energy in liquid form is not well compensated for by reductions in the intake of other sources of energy. Well-designed observational studies consistently show a significant positive relationship between sweetened beverage intake and adiposity. More importantly, several well-conducted randomized controlled trials have shown statistically significant changes in adiposity as a result of corresponding changes in sweetened beverage intake.”

They conclude, “All lines of evidence consistently support the conclusion that the consumption of sweetened beverages has contributed to the obesity epidemic. It is estimated that sweetened beverages account for at least one-fifth of the weight gained between 1977 and 2007 in the US population. Actions that are successful in reducing sweetened beverage consumption are likely to have a measurable impact on obesity.”

Pan A and Hu FB in 2011 published an article that found huge differences in the effects of carbohydrates on satiety between liquid and solid food. Satiety is the feeling of being full after eating food. It is a huge factor, because one of the problems with liquid drinks is that they do not fill people up like solid food does and thus many people will eat more.

The researchers here note, “A number of studies have examined the role of dietary fiber, whole grains, and glycemic index or glycemic load on satiety and subsequent energy intake, but results remain inconclusive. Intake of liquid carbohydrates, particularly sugar-sweetened beverages, has increased considerably across the globe in recent decades in both adolescents and adults. In general, liquid carbohydrates produce less satiety compared with solid carbohydrates. Some energy from liquids may be compensated for at subsequent meals but because the compensation is incomplete, it leads to an increase in total long-term energy intake.”

They find, “The physical form (solid vs. liquid) of carbohydrates is an important component that may affect the satiety process and energy intake. Accumulating evidence suggests that liquid carbohydrates generally produce less satiety than solid forms.”

In 2009, Harold Goldstein himself is a co-author on an article, “Bubbling over: soda consumption and its link to obesity in California.”

They write, “The prevalence of overweight and obesity has increased dramatically in both adults and children in the last three decades in the n California, 62% of adolescents ages 12-17 and 41% of children ages 2-11 drink at least one soda or other sweetened beverage every day. In addition, 24% of adults drink at least one soda or other sweetened beverage on an average day.”

For adults who drink soda occasionally (not every day), they “are 15% more likely to be overweight or obese,” but adults who drink one or more sodas per day “are 27% more likely to be overweight or obese than adults who do not drink soda, even when adjusting for poverty status and race/ethnicity.”

The research produced collaboratively by the California Center for Public Health Advocacy and the UCLA Center for Health Policy Research, examines soda consumption in California by cities and counties using data from the 2005 California Health Interview Survey (CHIS 2005). It also investigates whether there is an association between soda consumption and the prevalence of overweight and obesity.

They write, “There are major differences in soda consumption rates by geographic area in California, suggesting that social and environmental factors affect the consumption of soda. Also, the prevalence of overweight and obesity is higher among those who drink one or more sodas or other sweetened beverages every day than among those who do not consume these soft drinks. Establishing public policies that focus on reducing soda consumption could contribute to reversing California’s increasing overweight and obesity problem.”

The impact of sugar-sweetened beverages are even greater on children than adults. One meta-analysis looks at the odds of being overweight in children consuming one daily serving of sugar sweetened beverages, and found that children who drink at least one serving a day have 55 percent increased odds of being overweight or obese than children who rarely drink sugar-sweetened beverages. Mover, a 2009 study found that the “increase in consumption of sugar-sweetened soft drinks from childhood to adulthood was directly associated with BMI in adulthood in women,” but not in men.

They conclude “that direct associations exist between adulthood overweight and BMI and an increase in consumption of sugar-sweetened soft drinks in women. Thus sugar-sweetened soft drinks consumption may be important when considering weight management in women.”

Finally, other research indicates that “Latinos and African-Americans are more likely to consume sugar-sweetened beverages on a daily basis compared to whites.” The authors write, “This disparity is influenced by a lack of grocery stores, a high prevalence of convenience stores, and the low cost of sugar-sweetened beverages compared to healthier beverages in many predominantly Latino and African American communities, along with a long history of soda marketing that targets these communities.”

Recall that the beverage industry targeted their campaign against the San Francisco soda tax in the low-income neighborhoods, and found success.

—David M. Greenwald reporting

Author

  • David Greenwald

    Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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103 comments

    1. I’ve read more than a dozen studies on this over the last couple of days. Dr G is not someone I’m inclined to call ‘objective” on the matter as he seems more interested in product placement of his name and the California Center for Public Health Advocacy, prominently, in the newspapers. Studies by universities and even food industry groups are much less certain of the extent that fizzy drinks affect diabetes and obesity.

        1. I don’t have the luxury of searching my home history, while on the roaming laptop, I’m afraid.

          I’m not taking pot shots, I’m making an observation. You can type Soda-obesity into a search box as easily as I did and sift through the tonnes of crap to find a dozen scholarly studies. There are many that don’t find nearly so strong a link as Dr. Goldstein and several that simply say “calories are calories, consume fewer, burn more and there is no problem.” So far as I know Frankly didn’t fund them.

          As I’ve said from the outset of the discussion on taxes, I have no strong feelings one way or another, except that the argument put forth by Dr. Goldstein ” that consuming just one soda a day increases the risk of obesity by 50 percent and of diabetes by 30 percent.” is unsubstantiated by any research and a scare tactic. I also find his “one note samba” repeated in almost every interview with him that I found. You are welcome to draw your own conclusions. Obesity is indeed epidemic in America. It is a problem with many causes. Diet has an equal part in both the problem and the solution. Societal customs are an often overlooked factor. In much of Europe, breakfast is typically a cup of tea or coffee and a banana or apple, lunch is the big meal, in Paris lasting several hours, if you’re fortunate and dinner is a piece of bread and some cheese or potted meat. Very little snacking., lots of walking and dancing…

          I think the Pro tax side does itself and the cause a disservice by using scare tactics.

  1. I vote for 2016 to rename the “Davis Vanguard” as the “David Von Sodatax”.

    Anyone want to join me in a pool as to how many articles will be written in the Vanguard on this subject before it is either passed or dies (possibly of sugar over-consumption).  Anyone care to suggest at what number of articles there is nothing new to be said?  (Like around early December, 2015?).

    I want a meat tax!  I want a meat tax!

      1. As in  version of “Point/Counterpoint”?  Controversy “sells” papers/blog hits. WRH figured that out over 100 years ago.

        Perhaps we need to invent a new term:  “yellow blog journalism”…

  2. The problem with some of the studies that link soda consumption to obesity and diabetes is that most often the people that would consume a lot of soda would have terrible eating habits.  And to take away the soda does nothing to fix the problem with the bad eating habits.  In fact, if the soda is taken away it is likely that the person would just eat and drink other sugary junk to get their fix.  Only when people make the personal choice to stop or reduce their soda consumption for health reasons will their be a true solution to their problem of increased risk of obesity and diabetes.

    Over-consumption of soda is just a symptom of the larger problem of poor eating habits.  Those that have had this problem, or that have family and friends with this problem, I think, are pursuing a feel-good move by attacking soda as being the cause of the obesity or diabetes.  Because it is hurtful to a large degree to have to accept that poor personal choice is the root cause, it is easier to blame big bad business as being the source of the problem.

    Cigarettes are a bit different in that they have physiological addictive compounds in them.  Soda would only be psychologically-addictive and almost anything can be psychologically-addictive and so it is unfair to single out soda to be taxed.

    1. “The problem with some of the studies that link soda consumption to obesity and diabetes is that most often the people that would consume a lot of soda would have terrible eating habits. ”

      and you don’t believe a skilled researcher would control for that?

      1. The only way the study would work is if everyone had exactly the same eating and drinking habits but one group drank a extra sugary soda a day and the other group didn’t.  You know that didn’t happen.  People that drink sugary soda I’m sure have other bad eating habits.

        1. Also any study would also have to consider exercise habits, individual metabolisms, is one a couch potato or running around taking care of kids, stress, etc…..

          The possible discrepancies in the study from individual to individual are endless.

      2. The question is not “skill”, but ethics, dispassion (no axe to grind), honest/professional… remember, “figures don’t lie, but liars can figure”.  An ethical researcher would include, in their analysis, all the assumptions, limitations, biases that lead up to their conclusions.  If I don’t see that as part of the “research”, I tend to discount it.

        1. that’s why you have work that is peer reviewed and open source so it can be scrutinized.  i think you are discounting it out of hand without really understanding the mechanics of statistical analysis.

        2. “figures don’t lie, but liars can figure”

          I thought it was “figures don’t lie, but people who drink too much sugary soda have less attractive figures.”

        3. I think you didn’t understand a word I said… if it is “critically” peer reviewed by a true neutral third party, if it is open to scrutiny, if I can see that, I don’t necessarily disagree, but I was responding at a general level… I neither agree nor disagree with specific studies re: soda, etc… I’ve said that before…

          I have blood relatives in Missouri… the “show me” state… I do understand the “mechanics of statistical analysis”… it is like “the force”… can be used for good or evil… there is statistical analyses that show smoking tobacco is good for you… some have affirmative “peer reviews”… I still don’t buy those studies…

          I stand by my previous comment.  I believe you are spit-balling my comment [me?] for a reason I cannot fathom.  But no, I have no statistical analysis, that has been peer reviewed, for that belief.

        4. “I believe you are spit-balling my comment”

          i believe you are spit-balling my comment.  so there.  you raise possibilities only to deny them, you can’t have it both ways – either you trust the peer review process to work itself out.  some of these articles are six to ten years old, have they been discredited?  if not, then there is probably valid research there, but you’re using a broad-brush without getting into specifics.  so my response is, it takes one to know one.

        5. DP:  “… so there”… very mature, very professional, very persuasive.  You are SO right… I was wrong in expressing an opinion… mea culpa.  Please forgive me for questioning you.

        6. DP… I say again (third time?)… I am not questioning ANY specific study… a “general” comment.  Yeah, guess I might be ‘spit-balling’ the tendency of some folk who “cite studies” without credible corroboration… guilty as charged, plead guilty, and am actually quite proud of it.  Heck, look at the “studies” Trump cites!

          Do you trust everything you hear, see, barring any specific documentation that it is unethical, dishonest?  If so, there is a bridge in Manhatten I happen to own, and I can sell it to you at a huge discount…

          Trust is “earned”, not a “default”, to me at least.

        7. i agree with all of that.  where i disagree is that instead of reading the links and research and maybe googling to see if there were criticisms of the research, you and several others here made a bunch of unfounded assertions and in some cases took pot shots and cheap shots.  i find it interesting that not one person here has pointed either personally to flaws in the research or posted an article with counterveiling research.  to me that is very telling.

      3. DP:  “and you don’t believe a skilled researcher would control for that?”

        “you can control it statistically, someone like david could explain how.”

        There is a limit to what statistical analysis can tell us, especially with a problem as complex as the impacts of sugar or fat on human health.  That is why after decades of research the best that can often be concluded is that the connection between a certain food type and disease is ‘biologically plausible.’

        That is why the proclamations of public health officials are so important.  These are complex problems that most of the public do not have the education to understand, so the tendency of the public is to listen to what the public health official says and accept it as true. The problems arise when the health proclamations go beyond what can be supported by the evidence.  That is exactly what happened with the push to remove fat from the diet, and what we see again with this current campaign against sugar.

        Eating anything in excess will end up being bad for you, unfortunately, we don’t really have a good understanding of what constitutes ‘excess’ except in terms of total calories. Reducing sugar intake will likely be good for you, especially if you are already overweight.  That is sound health advice.  Proclaiming that a local tax on sugar will reduce the incidence of diabetes in the community is fantasy and based on suppositions that may or may not be connected.

         

        1. you’re seeking a more epistimological question than the ones posed here.  what the research shows is that people have increased calories over a 24 year period.  that somewhere around 43% of that is due to increased sugar intake through beverages.  and over that same period of time obesity and diabetes have increased.

          okay.  so then the next question is how do we fix that.  will a local tax on sugar reduce the incidence of diabetes in the community?  probably not.  but it does take a couple of key steps.  first, it creates a revenue stream for programs that may.  second, it begins to do what we really need to do which is a statewide tax which may have more teeth than a local one, but like plastic bags, it takes a growing consensus around the state to do that.

        2. but like plastic bags, it takes a growing consensus around the state to do that.

          At least with plastic bags there were hundreds of other cities on board.  The soda tax has, wait for it, one other city participating.

        3. If it is a useless thing to do, then we should not do it because it detracts us from doing useful things.

          This freaking focus on symbolic political moves is the monster that ate the world and the monster is fat and has a growing list of REAL “health” problems that are not being attended to.

        4. DP:  “we know sugar beverages are bad for us and particularly for our kids.”

          Actually, we don’t know that.  We know that overconsumption is bad in general and that excess sugar in the diet may correlate with increased adverse health issues, but the research data does not support the conclusion that drinking a sugar beverage in and of itself causes health problems. Correlation is not causation.

        5. I had a soda last night with some rum.  Tasted great.  I don’t think my vital signs crashed as a result, but maybe I should go get tested given the Fear of Soda campaign being waged.

        6. In fact, the studies I linked to yesterday were meta analyses based only on RCTs and cohort analysis.  These ARE gold standard trials that absolutely demonstrate causality.

          Frankly, I am not sure why you choose to ignore and show disdain towards what I have written about this tax in relation to the broader movement to curb sugar consumption–starting with this unique sugar delivery system which is the sugary beverage.  If I were to show the disdain for business practices in which you are expert you would pillory me. However, you feel free, as a non-expert in public health (and the studies that support our work) to blithely proclaim such efforts ineffective.

          You keep referring to symbolic actions but a tax is far more than that.  It is part of an effort–going global–to change the behavior of the beverage industry.  We will succeed just as we succeeded with reducing cigarette consumption; just like we reduced the destructive effects of breastmilk substitutes; just like we won safer working conditions for laborers in many industries.

        7. Frankly:  I had a soda last night with some rum.  Tasted great.  I don’t think my vital signs crashed as a result, but maybe I should go get tested given the Fear of Soda campaign being waged.

          How much tax was on the rum vs. the soda?

        8. “In fact, the studies I linked to yesterday were meta analyses based only on RCTs and cohort analysis.  These ARE gold standard trials that absolutely demonstrate causality.”

          Therein lies the problem with public health research Robb.  You all think your statistical analysis proves causation, but you have no idea what the mechanism of action is, so you really don’t know what the cause is. When you understand the mechanism of action, how sugar in the diet acts on human cells to create diabetes, and have defined the dosage required to cause disease in humans, then you will have proof of causation.  Until then you only have a theory, some supporting data and a lot of statistics. Correlation yes, proof of causation, no.

          We know that excess consumption is bad for our health, so why won’t the public health establishment focus on that problem instead.  I know it is not a splashy as screaming about how soda is killing us, but it would, at least, be based on facts rather than supposition. As Michael Pollan tells us, eat whole foods, mostly plants, and not too much. That message will do much more to improve public health than this reductionist ‘sugar is evil’ nonsense being put forward by public health officials.

          The soda tax is a revenue measure, not a public health one.

           

        9. How much tax was on the rum vs. the soda?

          I know almost everything about taxation of spirits and it absolutely nothing to do with health.  It first started to pay for the Revolutionary War.

          And if the soda taxers were honest about this just being another tax grab, they might have more support from many currently opposing it.

        10. Frankly:  I know almost everything about taxation of spirits and it absolutely nothing to do with health.  It first started to pay for the Revolutionary War.

          Good.  I would like to hear your point of view on this, then.

          Because I was thinking of taxing sodas as a sin tax, like what is charged for alcohol, which is considered more acceptable because it should reduce their usage.

        11. The federal tax on distilled spirits is $13.50 per proof gallon.  A proof gallon is one gallon of 100-proof alcohol.  100-proof is 50-percent alcohol.  Most spirits are bottled at 80-proof or 40-percent alcohol.

          Adding other liquid (usually water) to get distilled spirits to bottling proof of 80 results in about six 750ML bottles.  That is $2.35 per bottle.  And that is just the federal tax.

          Now we move to good ol’ high tax California.  It is $3.30 per proof gallon.   That adds another $.55 per bottle.

          Then there is retail state sales tax on that product.  Let’s say the bottle cost $25 retail.  8% of that is another $2.00.

          So next time you are at Costco buying that Kirkland vodka handle (1.75 liters) for $25 bucks understand that about $11 of that is tax going to government.

          And then ask yourself why a total 44% tax hasn’t stopped you from purchasing that bottle of vodka.

          Isn’t it funny how liberals demand a minimum wage hike and claim that everyone will just settle in to the new normal without any lasting economic impacts, yet also claim a soda tax will cause people to drink less soda?

          Humorous?  Yes.   Rational?  No.

          And the tax on alcohol is just a government revenue thing. It does not make a dent in consumption except for the very poor that just drink very cheap stuff that is mass-produced.

          1. Isn’t it funny how liberals demand a minimum wage hike and claim that everyone will just settle in to the new normal without any lasting economic impacts, yet also claim a soda tax will cause people to drink less soda?

            Should be just a matter of minutes now before someone flips this reasoning right around on you.

        12. Frankly:  And the tax on alcohol is just a government revenue thing. It does not make a dent in consumption except for the very poor that just drink very cheap stuff that is mass-produced.

          I see.  So you could safely tax any product and it wouldn’t affect the consumption of that product?

          This seems to be a new kind of conservative economics that I haven’t encountered before.

        13. You caught me on that.  Yes, in general the higher the tax the higher the over all price and sales of that product will fall.

          But some products are blessed (or cursed) with price elasticity.  My point was that soda and alcohol are going to be purchased even if you raise the tax.  But here is another thing that happens with high taxes on consumer goods.  You give advantage to the big producers that can drive down the cost of production with large economies of scale.  They can also invest in technology automation.  That is why Costco can sell 1.75 ML of very good vodka for cheap.

          In the beverage industry there has been a rise in the craft part of the industry to take market share away from the big producers.  Raise taxes on those products and you put more of the small producers out of business.

          Unfortunately for the soda industry the true craft producers hold such little market share that the big dogs are not worried about taking them down.

          1. This is a good explanation of why increased price doesn’t have a linear relation to demand.
            https://en.wikipedia.org/wiki/Price_point
            To use the jargon in this article, adding 67 cents to a 2-liter bottle of soda that presently sells between $1 (advertised price) and $2 (standard price) will probably not bump the shelf price of that bottle beyond the perceptual price point. Over time, if the tax is widely adopted, retail pricing strategies would change a bit — the advertised price will be higher, and the standard price will be higher. So the customary price point would rise. When you are talking about something that is under $5 (a well-known important price point) it is unlikely, even for lower-income buyers, that this change would have a significant effect on demand.

        14. ” it is unlikely, even for lower-income buyers, that this change would have a significant effect on demand.”

          and yet as the vanguard pointed out last week, the bev industry is not reacting as though it wouldn’t have a significant effect on demand.  are you suggesting they are wrong to pour millions into fighting these taxes?  that they suffer from the same narrow-minded thinking as frankly?  or that they know something you don’t?  i’m not trying to be antagonistic here, but someone is disconnected from reality, not sure who.

        15. I explained this to you already DP.  Every product company fights for market share for their products.  Products compete based on customer-perceived value.  Value is that juxtaposition of perceived quality and cost.

          It isn’t that the soda manufacturers are worried too much about a soda tax impacting overall beverage consumption, but that the aggregate impact will be lost market as some consumers chose another product and/or the threat of lost revenue as they have to reduce the price of their product to retain those customers.

          The frustration of social justice crusaders is their inability to control market forces.  The markets will just respond to tax increases justified by social engineering goals.  But there can be new winners and losers in those market responses, and this is what the soda manufactures are fighting to prevent.

          1. I expect they’re also concerned about the precedent, and want to fight hard and early to make sure this doesn’t become widespread. I know that when I was on our state nursery board, our legislative analyst would always report on local issues that concerned the national and state organizations because of their potential impact on the industry. Things like local bans on certain types of fertilizers (Florida cities ban nitrogen use during summer months near estuaries; some areas ban phosphate fertilizers) or particular garden pesticides. I would say their concern about local measures spreading is validated by the comments by local supporters.

        16. I would say their concern about local measures spreading is validated by the comments by local supporters.

          Good point  Yes, now we know this.  The soda industry is justified in fighting this local issue given the stated agenda of those pushing it.

      4. The biological mechanisms linking sugar consumption and fatty liver disease are well understood by now. The causal  mechanisms are not in question.  These are not merely statistical analyses, they are descriptions of biological processes.

        1. We know that excess consumption is bad for our health, so why won’t the public health establishment focus on that problem instead

          Umm… I think that is exactly what we are focusing on: overconsumption of a product that efficiently delivers sugar to vital organs that are overwhelmed by it.

          We know as much about the biology of sugar consumption  and fatty liver disease as we do about smoking and cancer.

        2. Robb Davis:  “Umm… I think that is exactly what we are focusing on”

          No, you are focusing on selling a new tax to the community on the basis of a bogus claim that it is a public health effort.