Beverage Industry Addresses Sugar-Sweetened Beverages and Obesity Articles in the New England Journal of Medicine

September 21, 2012 In response to today’s publication of the New England Journal of Medicine, which includes a number of studies and opinion pieces focused exclusively on sugar-sweetened beverages, the American Beverage Association issued the following statement:

Statement:

“Obesity is a serious and complex public health issue facing our nation and the rest of the world, and we all must work together to solve it. We know, and science supports, that obesity is not uniquely caused by any single food or beverage. Thus, studies and opinion pieces that focus solely on sugar-sweetened beverages, or any other single source of calories, do nothing meaningful to help address this serious issue.

The fact remains: sugar-sweetened beverages are not driving obesity. By every measure, sugar-sweetened beverages play a small and declining role in the American diet:

  • While Americans consume about 617 more calories today than they did in 1970, more than 90 percent of those incremental calories come from sources other than beverages.
  • Sugar-sweetened beverages contribute about 7 percent of the calories in the average American’s diet.
  • Caloric intake from sugar-sweetened beverages declined by more than 20 percent between 2001 and 2010, yet obesity rates continued to rise.
  • The average number of calories per beverage serving is down 23 percent since 1998 and about 45 percent of all non-alcoholic beverages purchased today have zero calories.
  • Forty-eight percent of overweight and obese individuals drink no sugar-sweetened beverages.

Importantly, the beverage industry is doing its part to help consumers make informed choices that are right for them. We’re taking common-sense steps that are having a meaningful and lasting impact:

  • We’re providing more beverage options than ever before, with a wide array of calorie and portion size options. According to Beverage Marketing Corporation data, the average number of calories per beverage serving is down 23 percent since 1998, and about 45 percent of all non-alcoholic beverages purchased today have zero calories.
  • Under a Global Policy on Marketing to Children, we voluntarily agreed to advertise only water, juice and milk-based drinks to any audience that is comprised predominantly of children under 12. Our members also follow the guidelines of the Children’s Advertising Review Unit (CARU) of the Council of Better Business Bureaus, the self-regulatory body for children’s advertising;
  • By working with President Clinton on national School Beverage Guidelines, we’ve removed full-calorie soft drinks from all K-12 schools and replaced them with more lower-calorie, smaller-portion choices in age-appropriate portion sizes, driving a 90 percent reduction in beverage calories shipped to schools between 2004 and the end of the 2009-2010 school year.
  • We’re supporting First Lady Michelle Obama’s ‘Let’s Move!’ campaign with our Clear on Calories initiative to display clear calorie information on the front of every bottle, can and pack we produce.”

Additional Background

On Obesity:

  • Obesity is caused by an imbalance between calories consumed from all foods and beverages and those burned through physical activity.

On Sugar-Sweetened Beverages:

  • Calories from sugar-sweetened beverages—including soft drinks, juice drinks, flavored waters and other beverages—make up only 7 percent of the calories in the average American diet according to a National Cancer Institute analysis of government data submitted to the U.S. Dietary Guidelines Advisory Committee. That means that 93 percent of the calories in the American diet come from other sources. Focusing on a small source of calories rather than the total diet is a misplaced allocation of resources.
  • Sales of regular soft drinks declined by 12.5 percent from 1999 to 2010. Furthermore, added sugars consumed from soda are down 39 percent since 2000, according to the Centers for Disease Control and Prevention. Yet, obesity rates continued to rise.

On this Issue of the New England Journal of Medicine:

  • Importantly, what this issue reinforces is that all calories count, and if excess calories are not balanced out through physical activity, weight gain will occur.
  • It should also be noted that several of these studies suggest that diet beverages can be a useful weight management tool, a position already supported by the Academy of Nutrition and Dietetics.

On the Study on Sugar-sweetened Beverages and Children (deRuyter et al):

  • This study shows that all calories count. Furthermore, if excess calories are not balanced out through physical activity, weight gain will occur.
  • Importantly, this study failed to take into consideration two critical factors when it comes to obesity: physical activity and total calorie consumption in the overall diet.
  • And while the authors found differences among those who consumed caloric and non-caloric beverages, they acknowledge that they do not know if these differences were primarily due to being instructed to consume a specific food above and beyond what was part of their normal diet.

On the Study on Sugar-sweetened Beverages and Adolescents (Ebbeling et al):

  • This study in actuality demonstrated that an intervention focused on sugar-sweetened beverage consumption was not effective in slowing the weight gain of adolescents.
  • The real outcome of importance is the lack of difference between outcomes for the two groups. At the end of the study there was no difference in change in BMI or weight between the two. Both groups consumed less sugar-sweetened beverages and fewer calories and grams of sugar at the end of the two years than at baseline, with the intervention accounting for barely half a serving of sugar-sweetened beverage per day.
  • The authors of the study acknowledge that the sustained decrease in sugar-sweetened beverage consumption observed in both groups between 2007 and 2011 was likely due in part to the policy changes voluntarily put in place by the beverage industry to remove full-calorie soft drinks from schools.

On the Study on Obesity, Genetics and Sugar-sweetened Beverages (Qi et al):

  • This study does not – and cannot – establish causation, nor does it present clinically meaningful findings. What this study does show is that those who consumed fewer sugar-sweetened beverages – meaning fewer calories – were thinner, but at the same time they had higher smoking rates and consumed more alcohol.
  • The finding that there is an interaction between liking of sweet foods or beverages and a genetic propensity for obesity is not new or surprising. The question, however, is how best to help address the obesity problem that results from this genetic propensity. Focusing on total diet and physical activity is most likely to have a real and lasting effect, rather than singling out one source of calories.
  • In addition, the study has a number of limitations acknowledged by the authors. In particular, the authors state, “it is unclear whether these factors linking the intake of SSBs to obesity modify the genetic effect, accounting for the observed interventions.” They also note that the mechanisms by which most of the established BMI-associated genes work are largely unknown, so the underlying mechanisms interaction between the intake of sugar-sweetened beverages and a genetic predisposition to elevated adiposity or obesity need to be clarified.
  • Other limitations include: measurement errors in the intake of sugar-sweetened beverages; self-reported height and weight; the potential for confounding or unknown factors; the lack of evaluation of the proportion of the total energy intake derived from sugar-sweetened beverages; and study cohorts restricted to persons of European ancestry. Furthermore, the analysis has been done for only the 32 known genes associated with BMI to-date, but these genes account for only a small amount of variation in BMI.

On the Editorial “Calories from Soft Drinks – Do They Matter?” by Caprio:

  • What matters is calories – regardless of the source. But when it comes to maintaining a healthy weight, we must look at the whole picture – including sedentary lifestyles, not just the 7 percent of calories in the average American’s diet that come from sugar-sweetened beverages.

On the Perspective Column from the Rudd Center’s Pomeranz and Brownell:

  • Contrary to the authors’ assertions, there is no evidence that Mayor Bloomberg’s soda ban will have any impact on obesity.
  • In fact, it is an arbitrary regulation that does nothing more than restrict choice.
  • There is no evidence that restricting any one source of calories would have an impact on obesity as the most likely outcome is substitution of the restricted item with other sources of calories.

On the Clinical Decision Column on Regulating Sugar-Sweetened Beverages:

  • It is not surprising that New York City Health Commissioner is advocating for regulation of sugar-sweetened beverages when his Board of Health recently passed an arbitrary ban on sodas over 16 ounces.
  • However, it is important to remember that the NYC ban is based on a misinterpretation of the research conducted by the authors of the opposing viewpoint.
  • Specifically, as Just and Wansink note, all foods can contribute to childhood obesity. Thus, singling out sugar-sweetened beverages – which account for 7 percent of calories in the average American’s diet – is a misguided approach that will have no meaningful impact.
  • Taxes, bans and other forms of government regulation are not the solution to childhood obesity – nutrition education, information and support for physical education are.

On Industry’s Efforts to be Part of Meaningful Solutions:

  • America’s beverage companies are delivering more choices, smaller portions, fewer calories and clearer labels across the country. By doing so, our companies are making a meaningful difference for families and individuals in our communities – making it easier to choose the drink that’s right for them.

More Choices:

  • Through innovation, our companies have broadened their product portfolio, offering beverages in a wide variety of type, portion size and calories. These innovations are evident on store shelves and in vending machines throughout our communities.
  • The broad choices in beverage type include soft drinks, ready-to-drink teas, water, sports drinks, flavored and enhanced waters, juices, energy drinks and more.
  • The new choices include an ever-increasing selection of low- and no-calorie beverage choices, as well as mid-calorie beverages. The innovation pipeline continues as our companies remain engaged in developing even more beverage options to fit the ways people live.

Smaller Portions:

  • Delivering a range of portion sizes is another way to help individuals and parents choose beverages that are right for them and their families. Soft drinks and other beverages packaged for individuals are now available in portion sizes ranging from 20-ounce bottles to 7.5-ounce cans, with several options in between.
  • As part of its School Beverage Guidelines, the beverage industry voluntarily reduced juice portion sizes in K-12 schools and capped portion sizes on sports drinks, which are only offered in high schools, to 12 ounces. The range of portion sizes for beverages – including more smaller-portion options – provide for even more choice.

Fewer Calories:

  • Through innovation and initiative, America’s beverage companies are cutting calories in stores and in schools across the country.
  • In the marketplace, the development of more low- and no-calorie beverages has helped drive a 23 percent reduction in the average calories per serving since 1998, according to Beverage Marketing Corporation, a leading analyst of industry sales data.
  • In schools, beverage companies cut total beverage calories shipped to schools by 90 percent between 2004 and the end of the 2009-2010 school year by delivering on its national School Beverage Guidelines. The companies voluntarily removed full-calorie soft drinks and replaced them with low- and no-calorie options as well as smaller portion sizes. We developed these guidelines with the William J. Clinton Foundation and its Alliance for a Healthier Generation.

Clear Calorie Labels:

  • America’s beverage companies are delivering on their Clear on Calories commitment to place clear calorie labels on the front of every bottle, can and pack they produce.
  • We are placing total calories on the front of all bottles and cans up to and including 20 ounces so consumers know exactly how many calories are in the beverage before making a purchase. For packaging larger than 20 ounces, the labels provide calories per serving.
  • The calorie labels put this information right at the fingertips of consumers so they can make a choice that’s right for them.
  • The beverage industry announced the Clear on Calories initiative in support of First Lady Michelle Obama’s “Let’s Move!” campaign.

The American Beverage Association is the trade association representing the broad spectrum of companies that manufacture and distribute non-alcoholic beverages in the United States.