Last summer, the Journal of the American Medical Association published research on the association of sugar-sweetened beverages (SSBs) and liver disease, including liver cancer. Over 100,000 women, who were participants in a long term study on women’s health (“Women’s Health Initiative”), participated in the study.  

On average, women who drank more than one sugar* sweetened drink per day were compared to those who drank less than three per month.  The follow-up was over a median of 20 years.  Those who drank daily had almost twice the incidence of liver disease and liver cancer compared to the more abstemious group.  The number of those with disease was small, but the difference was real.  

This study is hardly the first to document the health problems associated with sugar intake of any kind.  Numerous studies have linked sugar ingestion to diabetes, obesity (including childhood obesity), heart disease, tooth decay and many other medical problems.  For instance, children risk becoming obese by a 60% increment per year for every additional serving of a SSB per day.

Nor is the study the first to demonstrate an association between sugar and cancer: sugar has been implicated in both prostate and breast cancer.

Sugar Fights Back

The sugar industry has not taken this research lying down.  It has produced its own studies, for instance, that contradict the association between childhood obesity and sugar ingestion.  The scientific community has repeatedly shown such efforts to be methodologically inadequate.

Taking a page from the tobacco industry’s advertising campaign to maintain sales of cigarettes, the sugar interests have targeted children in ads to keep the sweet train chugging.

The granddaddy of attempts to obfuscate the adverse health impact of sugar go back at least 50 years ago.  The New York Times recently uncovered internal industry communications that documented strategies to divert the public’s attention on the deleterious health effects of sugar.  The idea was to play up the danger of dietary saturated fat so as to dilute concern about sugar.  Given our nation’s preoccupation with dietary fat, I cannot help but think this initiative has had at least some success.

Pressure tactics to preserve sugar’s prominent standing in the American diet are part of the tool kit too.  When legislators in New York were considering bills that would decrease sales of soda,  Pepsico threatened to move its corporate headquarters out of New York City.  

In 2017, the Cook County Board of Commissioners in Illinois actually passed a measure to tax SSBs by a vote of 15 to 1.  A coalition of anti-tax groups, led by the American Beverage Association, mobilized, spending over three million dollars on radio and TV ads in opposition to the measure.  It also promised campaign funds to commissioners who reversed their votes.  Four months later, the tax was revoked.

Public Health Interventions: Mixed Results

The average American ingests 175 calories worth of sugar per day, and public health officials have viewed excessive sugar intake as a health crisis.  Even in the face of an assault by sugar interests, many measures to curb the sugar epidemic have been undertaken.  These efforts have centered on taxation strategies, the most common of which is the imposition of a one cent per ounce tax on SSBs.  This would result in an increase of a 15 to 20% in the cost of a bottle of soda.

These initiatives have met with limited success.  People who live in municipalities that have taxed SSBs simply travel to stock up on soda in neighboring towns.  To prevent “cross-border” shopping, it is obvious that regulation needs to encompass larger jurisdictions like states, or even the whole nation.

A more daunting impediment to reducing sugar consumption is the “sugar-gap.”  This term refers to peoples’ apparent need to consume a certain amount of sugar, no matter the source.  In cities that have actually imposed a tax on SSBs, sales of other sugared items (cookies, sweet rolls, cakes, etc.) have skyrocketed.  Despite the tax on SSBs, sugar use seems to become a zero sum game.

Going Forward

There is no question that Americans’ apparent need for sugar is dangerous, and difficult to dislodge.  Legislative attempts to deal with the problem have had limited success.  A new strategy is necessary —maybe something akin to public health initiatives like the successful media campaign against tobacco use.  The American Beverage Association can save its money, for now.

*Sugar is defined as: table sugar, brown sugar, high fructose corn syrup and fruit juice concentrate.