Coke did make America fat

Coca-Cola’s CEO Muhtar Kent recently wrote a much viewed op-ed in the Wall Street Journal titled “Coke Didn't Make America Fat,” in which he claims Americans need more exercise, not another tax, and should “enjoy the simple pleasures of a Coca-Cola.”

While it’s perfectly understandable that Mr. Kent would fight the soda tax idea—not because it threatens American’s freedom to choose, but because it will undermine soda companies’ profits and image—the article includes so many untruths and misleading statements that it begs a fact check and a response.

First off, I’ve read many of the proposals for a soda tax, and nowhere have I seen them selling it as “the solution” to our obesity issues. But it is one tool in what needs to be a very large tool box.

(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.)

Now, let's look at a few of Mr. Kent's points:

Kent: “Sugar-sweetened beverages have been singled out in spite of the fact that soft drinks, energy drinks, sports drinks and sweetened bottled water combined contribute 5.5% of the calories in the average American diet, according to the National Cancer Institute."

Not true! Sugary drinks are a major contributor of calories in American’s diet. The caloric contribution of added sugar from soft drinks in the average American's diet is much greater than what Mr. Kent cites. We can only wish the average American consumed 5.5% of their calories from sugary drinks. Studies show that they take in 2-3 times that!

A recent study published in the American Journal of Clinical Nutrition shows that the number of adults consuming sugar-sweetened beverages has increased dramatically in the past two decades. Two-thirds of adults now consume sugar-sweetened beverages, with an average daily intake from sugary drinks of almost 300 calories, or 15% of the 2,000 calories/day recommended for the typical diet.

Another recent study in Obesity paints an even grimmer picture: The average American gets twice as many calories from beverages as they did in the 1960's. The study quantified trends and patterns in beverage consumption among 46,576 American adults using nationally representative surveys of food intake, and over the past four decades total daily intake of calories from beverages increased by 94 percent.

I’m not sure where Mr. Kent found the 5.5% figure. What’s easier to find and ever present in the National Cancer Institute’s materials is a recommendation to stick to unsweetened beverages—such as water—in order to control weight and prevent obesity, which is an important risk factor for many types of cancer.

Perhaps an even better cancer-prevention resource is the World Cancer Research Fund and the American Institute for Cancer Research report, which looked at huge amounts of research and advises clearly: “Limit the Consumption of Energy-Dense Foods and Avoid Sugary Drinks.” Sugary drinks were targeted specifically in one of their recent reports where they wrote, “Such beverages appear to exert little influence on total daily self-selected energy intakes and their habitual consumption can lead to rapid and sustained weight gain even in the face of restricted solid food intake”.

Sugary drinks are different from other caloric dense foods

Kent: “It's difficult to understand why the beverages we and others provide are being targeted as the primary cause of weight gain when 94.5% of caloric intake comes from other foods and beverages.”

This is not difficult to understand at all! Some eating patterns are more conducive to overeating and overconsumption. Paramount among the foods that lead to an overconsumption pattern are sugary drinks.

There’s mounting evidence showing that when we drink beverages with calories we don’t compensate by eating less food (we might even eat more food), and that calories in liquid form produce less satiety than solid calories.

There are many studies to prove this point: In the cute Jelly bean study, researchers gave men and women 450 calories a day of either soda or jelly beans for a month, then switched them for the next month and kept track of total consumption. Candy eaters ate less food to compensate for the extra calories. Soda drinkers didn’t; they ate more calories than usual. Nutritionist Barbara Rolls from Penn State gave women water, diet soda, regular soda, orange juice, milk or no drink before lunch. Those given caloric beverages consumed about 100 calories more than those given diet soda, water or no beverage at the meal, without significantly affecting satiety ratings.

There’s also little question that sugary drinks are not just randomly associated with obesity, but actually contribute to it in a big way. Dozens of studies prove a connection between sugary drink consumption and obesity, and the only so-called “research” that tries to introduce doubt about this sad conclusion is industry-sponsored.

Taxing soda may very well change behavior

Kent: “Will a soft drink tax change behavior? Two states currently have a tax on sodas—West Virginia and Arkansas—and they are among the states with the highest rates of obesity in the nation.”

Actually, dozens of states impose some type of sales tax on sodas or snack products exceeding the standard state sales tax for food. The additional tax on soda is usually rather small.

Looking at The Kaiser Family foundation’s map of states with additional sales tax on soft drinks paints a clearer picture of which states have higher taxes on soda; neither West Virginia (2 percent tax) nor Arkansas (0 percent tax) are one of them.

The states with the highest soft drink tax are Rhode Island (7 percent), New Jersey (7 percent), Washington (6.5 percent) and Minnesota (6.5 percent). I’m not suggesting correlating soda taxation and obesity makes any sense—there are many other confounding variables—but since Mr. Kent suggested the method, lets humor ourselves and see how the high soda tax states rank in obesity rates (a scope of “1” would be the most obese state; “50” the thinnest) Rhode Island scores 46, New Jersey-42, Washington-32 and Minnesota-30. Eerie, isn’t it? The higher the soda tax the thinner the people!

Here’s a more scientific way to look for a correlation: A study in the American Journal of Preventive Medicine looked at the association between the presence of a soft drink/snack tax in the years 1991-1998 and the increase in obesity rates for those years at the state level. Adjusting for age, income, race on other variables, they found that states without a soft drink tax were more than four times as likely to have a high increase in obesity prevalence, and that states that repealed a soda/snack tax between 1991-1998 were more than 13 times more likely to see a high increase in obesity.

This data doesn’t prove that a tax reduces consumption—there can be other explanations: Maybe states in which a tax policy could be passed are those in which social norms act against obesogenic behaviors anyway. But it is encouraging data.

I’m sure that Mr. Kent predicts the tax will reduce consumption; that’s why the beverage industry opposes this idea so vehemently.

Lack of exercise didn’t make us fat; more exercise without cutting calories won’t make us thin

Kent: “If we're genuinely interested in curbing obesity, we need to take a hard look in the mirror and acknowledge that it's not just about calories in. It's also about calories out.”

Kent is right in his encouragement to be more active and spend less time in front of the TV. Exercise is very important to health, but won’t get us anywhere near an energy balance.

New research in the American Journal of Clinical Nutrition looked at the relative contributions of food and exercise habits to the development of the obesity epidemic and concluded that the rise in obesity in the United States in the last three decades was virtually all due to increased energy intake.

We need to be more active—no doubt about that—but that won’t exempt us from having to change our dietary habits. Even if we all met the recommendation of thirty minutes of vigorous exercise every day, we’d still need to cut our intake of sugary drinks and make them an infrequent special treat. Exercise just isn’t enough of an answer to our caloric imbalance. In order to reverse the obesity epidemic we’d need to add more than two hours of exercise every day; it’s much more realistic and logical to just cut out the soda and French fries.

The American Heart Association, American Academy of Pediatrics and many other medical authorities call for a severe reduction in the amounts of added sugar in our diet regardless of activity levels; high amounts of sugars have been linked not only to obesity and overconsumption, but also to high blood pressure, high triglycerides, diabetes and shortfalls of essential nutrients.

Many solutions are needed to address the obesity crisis--curbing the soda habit is an excellent way to start

Kent: “But a number of public-health advocates have already come up with what they think is the solution: heavy taxes on some routine foods and beverages that they have decided are high in calories.”

As noted earlier, I’ve not seen a soda tax being sold as “the solution” anywhere.

Wendell Berry said “Great problems call for many small solutions.” Obesity’s a big problem, and taxing sugary drinks can be one of the solutions.

Tax or no tax, drinking less soda has to be part of the solution—soda and sugary drinks are the number one source of added sugar in the American diet. Perhaps just talking about the soda tax informs more people about the adverse effects sugary drinks have on our waistlines and health. The conversation alone might be enough to motivate a change in habits.

But drinking fewer sugary drinks won’t be enough. Increasing physical activity also needs to be one of the solutions. On that point, Mr. Kent and I agree 100%.

Who wouldn’t?

Dr. Ayala

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