Wednesday, July 21, 2010

What soft drinks and cigarettes have in common

Judging by the outrage sparked by the American Academy of Family Physicians' agreement with Coca-Cola to produce patient education materials about obesity, and the respected ScienceBlogs website's brief flirtation with a nutrition blog sponsored by PepsiCo, many health professionals consider soda to be nothing less than the "new tobacco." There are many good reasons to think so. The average American consumes approximately 50 gallons of soda each year, which is thought to be a major contributor to our current epidemic of obesity, the details of which I discussed in a previous post. In 2004, the Centers for Disease Control estimated that obesity killed almost as many people in the U.S. per year (about 400,000) as tobacco did, and predicted that it would soon surpass it as the number one cause of death.

Taxes on cigarettes have proven to be very effective at discouraging their use, and early versions of the U.S. health reform bill sought to do the same by taxing sugar-sweetened beverages. In addition to reducing soda consumption, the penny-per-ounce tax would have raised billions of dollars to expand coverage for the uninsured and fund public health campaigns targeting other lifestyle behaviors that lead to obesity, such as physical inactivity.

Using time-tested tactics borrowed from Big Tobacco a generation ago (when Phillip Morris and other tobacco companies openly attacked and distorted the science linking smoking to lung cancer, heart disease, and other causes of death), the beverage industry quickly flooded Washington, DC with lobbyists and challenged research linking soda consumption to obesity. As reported in the Los Angeles Times, an industry-funded coalition calling itself "Americans Against Food Taxes" spent millions of dollars in key states to discourage Congress from including the tax in the bill - and won. State governments lost, too. Earlier this year in New York State and in Washington, DC, websites and airwaves were blanketed with "anti-tax" messages that were so effective at generating political opposition that neither of these proposals even came to a vote.

I admit that connecting soft drinks with obesity and premature death isn't quite as instinctive as knowing that inhaling a burning carcinogen-delivery system is bad for you. After all, the beverage industry argues, extra calories can come from many sources other than what people drink. But sugar-sweetened beverages are unique among junk foods in that their calories don't make us feel "full." We just keep on drinking, adding empty calories in 40-ounce Big Gulp containers or going back to the dispenser for free refills.

The president of the American Academy of Family Physicians recently wrote in the Annals of Family Medicine that there was nothing unethical about the organization taking hundreds of thousands of dollars from Coca-Cola in order to produce apparently unbiased educational content. She is wrong, and I would say this if a candy or fast-food company stepped forward with a fistful (okay, a briefcase-full) of cash next year. No one expects an organization of family doctors to say that soft drinks are good for you, but in taking Coca-Cola's money, what the AAFP is effectively telling patients (few of whom will ever visit the website) that soft drinks aren't really bad for you. That's the message that smokers were hearing a few decades ago, and most of them aren't alive today to wish that they had been told otherwise.


  1. Kenny - Congratulations on your 1 year anniversary. I truly enjoy reading your insightful commentary. To play Devil's advocate on your comparison of tobacco and soda - no amount of tobacco is safe but soda in moderation is not harmful - the moderation is the problem. In response to the website - this site receives over 3 million unique visitors each month and the initial 10 handouts developed have received almost 20,000 page views in less than 6 months. Just a different perspective for consideration.

    Chris L

  2. What about diet soda?
    Are the artificial sugars harmful...aspartamine and sucralose?

    Some people tell me all soda pulls calcium out of the bones...any truth to that one?

    Is it true that the sensation of sweetness stimulates insulin production even if it isn't actually sugar requiring insulin to take it into the cell?

    If you know the answers to any of these questions I would be interested.

    One of my daughters has two sons who are obese. There is genetics involved as her children by another father are not obese. She still lets them drink soda sometimes, and when I suggest diet soda, she says she thinks the artificial sweeteners will be found to cause problems. I say that the danger of diabetes is a lot greater!

    Susan Peterson

  3. Great questions, Susan. The answer is that all of these issues are controversial. Although there isn't any good evidence that artificial sweeters lead to other health problems, some believe that drinking diet soda may paradoxically lead to incrreased ingestion of other sugars. And while soda does not "pull calcium out of the bones," some of its constituents may predispose people to being at higher risk of osteoporosis fractures, though the mechanism is uncertain. This article by experts at Duke University addresses these issues nicely:

    I completely agree that the real danger of obsity/diabetes from regular soda far outweighs the potential harms of diet soda ... though water would be preferable to both!