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Public Health

Health Policy Analysis

Childhood Obesity and Other Harms of Sugary Beverage

Consumption by Children and Adolescents

              One out of four American children age 2-19 is or is going to be overweight or obese at some time in their life1. The prevalence of obesity rose dramatically in the last few decades of the 20th century and beginning of the 21st century2. The high prevalence of overweight and obesity has serious health consequences3. Being overweight or obese for the affected individuals is not just about the weight – it comes with a risk of serious comorbidities such as cardiovascular disease, endocrine, gastrointestinal, neurologic, orthopedic, pulmonary disorders and functional limitations4.

             Managing such disorders since young age brings along a greater severity of complications with every year. A number of epidemiologic studies confirmed the relationship between obesity and mortality5.

             Recent research predicts that a majority of today’s children (57%) will be obese at the age of 35 years. For children with severe obesity the chance that they will no longer be obese at the age 35 years fell from 21.0% if obese at the at the age of 2 years to 6.1% if obese at the age of 19 years6. That’s 60% of a future generation with severe illnesses.

             Studies analyzing Data for 52,375 public elementary schools show that the food environment within 0.5 mile around them is of significantly poorer quality than in the rest of the neighborhoods they are in7. Of course, it depends on a socioeconomic status of the neighborhood, but the truth remains that in terms of marketing children are a low hanging fruit and are more likely to make a bad nutrition choice in favor of a sweet taste/coolness factor imposed on them by advertising and social media. Therefore, selling the processed food products and sugary beverages is the most profitable in the areas with high population of children – schools. In addition, aggressive sugary drink marketing to young people is mostly unregulated – beverage companies spend four times as much to advertise unhealthy drinks as they did to advertise 100 percent fruit juice or water. Sugary drink and energy drink brands are extensively using Facebook, Twitter, and YouTube to reach youth8.

              In particular, consumption of sugar sweetened beverages (SSB) such as carbonated drinks may be a key contributing factor to the epidemic of overweight and obesity given these beverages’ exorbitant sugar content, low satiety and incomplete compensation for total energy. Soda consumption increases probability of the risk of diabetes, fractures and dental caries9. Detailed analysis reveals that most epidemiological studies strongly show that frequent sweetened sugary beverage intake contributes to the onset of metabolic syndrome and Type 2 Diabetes. There is also evidence that frequent soda intake is linked to hypertension and well known cardiovascular disease risk factors10.

             Apart from obesity and diabetes that are associated with SSB consumption, soda contains caramel coloring that is linked to cancer and vascular issues11. It depletes body’s mineral levels as well as is linked to asthma and COPD12. Acid in soda wears away dental enamel leading to an increase in caries among children and adults13. Potassium benzoate and sodium benzoate, types of mold inhibitor used in nearly all diet sodas, have an ability to cause severe damage to the DNA in the mitochondria. The preservatives have also been linked to hives, asthma and other allergic conditions. Both sodium and potassium benzoate were classified by the Food Commission in the UK as mild irritants to the eyes, skin, and mucous membranes11.

Proposed solution of the problem

           Studies in children and adults have found that reducing sugary drink consumption can lead to better weight control among those who are initially overweight14.

WHO agrees to the possible effectiveness of  population-wide policies and initiatives, such as marketing restrictions on unhealthy foods and nonalcoholic beverages to children3. The proposition is to limit advertisement and accessibility of sugary beverages to a young population by a variety of measures as well as to educate children about the consequences of soda consumption.

           A decrease in advertising of SSB should be implemented, especially on the channels and websites largely accessible to children. Children are vulnerable population when it comes to being susceptible to advertising as  they are going through the formation of personality and are curious to try everything. In addition, many metabolic disorders in children may remain asymptomatic for a while so, since they don’t feel any change in how they feel, they might think it’s not affecting them when in reality they are creating a long term damage to their organs4. This discrepancy can be addressed by a thorough education on all the risks and comorbidities associated with SB consumption.

          The average 20 ounce unhealthy beverage cost approximately 58 cents less than the average 20 ounce healthy beverage. According to several studies, this price difference may affect an individual’s choice, especially for the kids on a limited budget15. So is the difference in price warranted? How come SSB get a market niche that allows them to decrease the price so much as opposed to even water? The answer lies not in the cost of production but in ability to cut other costs, thus implementing a SSB tax in order to increase the SSB cost could positively reflect on publics choices when it comes to making a decision about the beverage purchase. Money from the tax should go to funding diabetes research as well as insulin subsidies.

Strengths:

A decrease in advertising exposure of SSB could lead to public’s better nutrition choices. Limiting access to sodas will hopefully shape healthier habits in future adults that can be a protective factor for future chronic illnesses. Preventing potential comorbidities will result in tremendous health care spending savings. Implementing a large sales tax on soda beverages as well as including disclaimers, just like with the cigarette sales, can lead the public to understanding that these products are not as innocuous as they seem. Revenue generated from SSB sales tax can be used to fund diabetes research, nutrition education, diabetes/cardiovascular disease awareness campaigns and Insulin subsidies.

Weaknesses:

Sodas are a big part of American culture, – the whole world associates Coca-Cola with American dream. Taxing and limiting access to the very American family beverage could be negatively met by the public. However, from the Ethical standpoint this paternalistic policy is warranted since it’s goal is to protect the public. Thinking in reverse psychology terms, since  marketing to the population of children is what’s being discussed (and that includes teenagers), limited access to something may make it seem more appealing and desirable, so the demand for SSB may increase. In terms of policy implementation, aforementioned changes may have a serious resistance from the SSB companies as it is a multibillion industry with growing profits: Coke reported a profit of $2.59 billion, up from $1.89 billion a year ago. Net revenue rose about 8% to $9.5 billion16. All of this was possible due to the current market environment so changing it may not be well received by the parties who pocket that profit.

Sources:

(1)https://www.cdc.gov/obesity/data/childhood.html

(2) https://www-uptodate-com.york.ezproxy.cuny.edu/contents/definition-epidemiology-and-etiology-of-obesity-in-children-and-adolescents?search=childhood%20obesity%20commorbidities&topicRef=5869&source=see_link

(3)https://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION_27nov_HR_PRINT_OK.pdf

(4) https://www-uptodate-com.york.ezproxy.cuny.edu/contents/overview-of-the-health-consequences-of-obesity-in-children-and-adolescents?search=childhood%20obesity%20commorbidities&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

(5) https://www-uptodate-com.york.ezproxy.cuny.edu/contents/overweight-and-obesity-in-adults-health-consequences?search=childhood%20obesity%20commorbidities&topicRef=5869&source=see_link

(6) Ward Z, Long M, Resch S, Giles C, Cradock A, Gortmaker S. Simulation of Growth Trajectories of Childhood Obesity into Adulthood. New England Journal of Medicine 2017;377(22):2145-2153.

(https://www-nejm-org.york.ezproxy.cuny.edu/doi/full/10.1056/NEJMoa1703860)

(7) 3. Li Y, Du T, Huff‐Corzine L, Johnson K, Noyongoyo B. Where is the fruit? Multidimensional inequalities in food retail environments around public elementary schools. Child: Care, Health and Development [Internet] 2019;Available from: http://web.b.ebscohost.com.york.ezproxy.cuny.edu/ehost/detail/detail?vid=0&sid=744f6b61-153d-4664-b5a4-f03568b836c2%40pdc-v-sessmgr03&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psyh&AN=2019-25944-001

(8) https://www.rwjf.org/en/library/research/2014/11/sugary-drinks-facts-2014.html

(9) Malik, V. S., Schulze, M. B., & Hu, F. B. (2006). Intake of sugar-sweetened beverages and weight gain: a systematic review. The American journal of clinical nutrition84(2), 274–288. doi:10.1093/ajcn/84.1.274

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210834/)

(10) https://www.ncbi.nlm.nih.gov/pubmed/29264461

(11) https://foodrevolution.org/blog/soda-health-risks/

(12)https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1843.2011.02115.x

(13) https://now.tufts.edu/articles/what-lies-beneath

(14) https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-drinks/

(15) Watters, C. A., Corrado, R. S., & Chaloupka, F. J. (2013). Prices of healthy and unhealthy beverages in high and low per capita income areas. Hawai’i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health, 72(3), 76–79.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602945/)

(16) https://www.wsj.com/articles/coca-cola-sales-rise-in-third-quarter-11571398312

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