Everyone besides the soda industry is trying to get us to drink less soda. The World Health Organization recently revised its guidelines and recommends that added sugars should account for no more than 5 percent of daily calories -- one can of soda exceeds that quota and it's hard to see how sugary drinks fit in a healthy diet. Health experts have been warning about the consequences of sugary drinks -- obesity, metabolic disease and diabetes -- for many years. The message is slowly sinking in and soda sales are in continuous decline that's intensifying despite ever increasing advertising and marketing propping up the category.
Teens probably pay the least attention to health warnings, so how can we get the group that drinks the most soda to notice?
A bunch of new studies experiment with simple, practical approaches to get the message across.
5 miles for a bottle of soda
Sara Bliech and her colleagues experimented with converting the calories-per-bottle into the more actual miles-of-walking and report the results in the American Journal of Public Health. They posted four types of signs in six corner stores in low-income neighborhoods in Baltimore: absolute calories, number of teaspoons of sugar, and number of minutes of running or miles of walking it takes to burn off a beverage. The miles-of-walking message, for instance, read: "Did you know that working off a bottle of soda or fruit juice takes about 5 miles of walking?" and performed best. After the signs were put up sugary drinks purchases were significantly reduced, a reduction that persisted even after the signs were removed. Kids bought fewer soda and sports drink bottles, smaller ones and more water.
According to this, signage, and putting calories in context could help change kids' behavior.
Mountains of sugar
Another recent study in Appetite translates the sugar content in sugary drinks -- it currently appears in grams in the nutrition label -- into something more tangible.
Bakers and cooks perhaps know that there are 4 grams in each teaspoon of sugar, but I doubt it's common knowledge -- a 20-ounce bottle of soda has about 65 grams of sugar, but what does that mean?
The researchers, led by John Milton Adams, found that when sugar content was translated into concrete representations of sugar cube pyramids the attractiveness and selection of sugary drinks went down, compared to when people read the sugar content in grams. There was no need to talk about the health issues related to overconsumption of sugar; people just found mountains of sugar unappealing. But furthermore, in a neat experiment in Adams' series, undergrads learned how to convert miles to kilometers, dollars to Euros or sugar in grams to sugar in cubes. They were then offered a drink as a reward, and the students that learned the sugar cube conversion chose the sugary drink less often.
Sixty-five grams of sugar are meaningless, but 16 teaspoons or 26 cubes don't look like something you should consume mindlessly. Take a look at Sugarstacks and see if you feel the same way. And here it is if you want empower yourself with an imaginary sugar cube pyramid: each cube (the usual type sold in supermarkets) is 2.5 grams of sugar (Sugarstacks uses a larger cube that's equivalent to 1 teaspoon).
When soda disappears
A practical way to lower consumption is to make these drinks less available. Parents have been doing it at home, and schools are increasingly adopting new rules that practically ban sugary drinks. The new Smart Snacks in School nutrition standards are part of the Healthy Hunger-Free Kids Act of 2010, are planned for implementation this year, and will do away with soda sold at school.
The Nationwide Children's Hospital in Columbus, Ohio implemented such a ban in 2011 in all food service, and an article in the American Journal of Public Health describes what happened following this sweeping step.
In the two years prior to the ban, the hospital had an extensive communications campaign that included posters, fliers, education tables and the recruitment of key people to champion the change. Cafeterias reduced sugary drink orders, almost ran out by January 2011, when whatever was left was removed -- from cafeterias, coffee shop, gift shops, food service venues and vending machines. The hospital still allowed diet drinks, a few sports drinks, 100 percent fruit juices and chocolate milk.
And here's what happened: The purchases just shifted. Families bought more milk, water, fruit juice and coffee and revenues didn't suffer -- revenues from beverages increased in 2011 by about 3 percent compared to the previous year. I'm sure that the hospital also gained from the positive image such a step brings with it. One of the common comments I hear is: How come there's soda vended in every hospital corner -- and especially next to the Healthy Weight Program and the diabetes clinic?
Indeed, how come?
Dr. Ayala
Full disclosure: I'm vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I'm also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.