October 15, 2017


Shu Wen Ng, PhD
Associate professor of nutrition

Barry M. Popkin, PhD
W.R. Kenan Jr. Distinguished Professor of nutrition


Yes and no. Like tobacco, the sugar industry is vast and has very deep pockets. Any battle likely will last decades.

While excessive sugar intake increases risk of diabetes, liver and kidney damage, heart disease, some cancers and death, sugar can be consumed safely in low amounts – something we can’t say for tobacco. The World Health Organization (WHO) and World Cancer Research Fund have published guidelines showing that individuals should consume no more than 10 percent of total calories from added sugar, and preferably less than 5 percent. For most people in the United States – and increasingly, for the rest of the world – sugar consumption is far beyond recommended levels. On average, in the U.S., added sugars account for 16 percent of total calorie intake.

To provide a reference, a 20-oz. (600ml) bottle of regular soft drink, one of many types of sugary drinks, provides 12 percent of a day’s total calories from added sugars for an adult on a 2,000 kcal/day diet.

Q: Why are sugary beverages particularly bad for our health?

A: Sugary beverages are the lowest-hanging fruit in terms of ways to lower sugar intake. Most sugary beverages, including carbonated and noncarbonated soft drinks, fruit drinks, energy and sports drinks, and all milk and yogurt drinks with added sugar, provide zero nutritional benefits. Some argue that 100 percent fruit juices also should be considered a sugary drink, as the sugars in them are no different than added sugars.

Sugar in liquid form is absorbed more quickly than the liver likely can process and release it. Excess amounts are stored in the liver as fat or glycogen deposits. This can lead to fatty-liver disease and increased risks for diabetes and other chronic diseases.

Usually, intake of calories from sugary drinks is not balanced with an equivalent reduction in calories from other foods. When drinking sugary liquids, most people do not reduce food intake to adjust calories; hence, total calorie intake increases.

In developed countries, such as the U.S., sugary drinks are associated strongly with obesity. Paradoxically, they also can be associated with under-nutrition, particularly with having a lack of micronutrients, such as vitamins and minerals.

In developing countries, infants consume sugary drinks as a weaning food, which has adverse effects on increasing undernutrition and stunting. Stunted infants have a much greater risk of becoming obese and diabetic.

Ideally, consumers should limit and governments should regulate many other unhealthy foods, but sugary drinks are an obvious place to start.

Q: What are some early successes in the public health ‘sugar fight’?

A: A growing number of countries (e.g.,Mexico, France, South Africa, Saudi Arabia, India, the U.K. and Ireland) and U.S. localities – including Berkeley, San Francisco and Oakland (Calif.); Albany, N.Y.; Boulder, Colo.; Philadelphia; Cook County, Ill.; Seattle; and the Navajo nation – have instituted, or plan to implement, taxes on sugary drinks.

These places have recognized that sugary drink taxes are a win-win for governments because they reduce consumption while increasing government revenue. Such revenue can be re-invested in early childhood education, health promotion and improving community infrastructure.

Independent and rigorous peer-reviewed evaluations of the earlier taxes implemented in Mexico and Berkeley show that meaningful sugary drink taxes reduce consumption while increasing consumption of healthier beverages, such as water. Some locations also are tracking how tax revenues are used.

Beyond fiscal measures, other policies, such as regulations about front-of-package labeling and food marketing targeting children, also have had some early successes. Chile now uses scientifically-based nutrition criteria to determine which products sold in Chile require a front-of-package warning label and are subject to marketing restrictions. This is an excellent model for other countries and localities.

Q: How have the food and beverage industries responded?

A: As expected, leaders in the beverage industry generally have fought attempts to educate consumers and policy efforts by funding counter-campaigns and lobbying against regulations. They view these policies as being “bad for business,” but only because they can’t see the opportunities offered by the policy changes.

Business leaders should embrace becoming part of the solution. Why? Evaluation studies in Mexico and Berkeley found that water sales rose after sweet drinks were taxed – water that is sold by the very same beverage industry! In addition to the stable sales numbers, a healthier population is good for business. Loyal customers, with extended lifespans, result in more sales.

Q: What else should be done?

A: Everyone has a role to play and should do so. Consumers can vote with their dollars and gradually change their food choices in ways that improve their health and that of their families. Industry leaders must act in socially responsible ways to improve their customers’ health and their own bottom lines. Policy makers must consider the alarming health-care costs and productivity losses that will result if nothing meaningful is done to minimize nutrition-related diseases.

Clinicians and public health professionals can present data and educate people, but real change requires a truly concerted effort.

We are optimistic that larger and continued successes will happen. We must keep working hard at it – together.


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Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit sph.unc.edu/cph.