Curbing Sugary Beverages for Health and Economic Gains

Frequent, or regular, consumption of sugary beverages is defined as drinking between 1 and 2 cans per day, with these drinks reported to be the top source for calories in the US alone.^1-3 The implications of excessive sugar intake are numerous, with even 2 servings of sugar per week implicated in heart harm.⁴ The adverse effects extend beyond just this negative health impact, however.

According to the CDC, frequent consumption of sugary beverages can be blamed for damaging health outcomes that include obesity and weight gain; type 2 diabetes; tooth decay and cavities; gout, the most common form of inflammatory arthritis that can lead to intense pain and chronic persistent disease; and heart, kidney, and nonalcoholic liver disease.⁵

The guidance for daily sugar consumption suggests keeping the additive at low levels for both men and women. These upper limits have been placed at 6 teaspoons of added sugar per day for women and 9 teaspoons for men.^1,4,6 This is equivalent to 100 and 150 calories, respectively, and 25.2 g and 37.8 g of sugar, at an average of 4.2 g of sugar per teaspoon.^2,6

The trickle-down effect of sugary beverages is noteworthy, with the economic impact and public health impact both representing significant strains on the health care system. These effects are both direct, through medical costs and worsened health outcomes, and indirect, through productivity losses.

Health Outcomes and Beverage Tax Implications

One of the top adverse effects of excessive sugar consumption through sugar-sweetened beverages—whether they be soda, fruit drinks, juices, sports drinks, energy drinks, flavored or sweetened waters, coffee, or tea—is the systemic and chronic inflammation they produce, even when individuals get in the recommended amount of 150 minutes of weekly moderate physical exercise.^4,7,8

Inflammation is a principal component of the body’s immune response, and it can be either acute and last a few days or chronic and last for months or years.⁹ Symptoms are often disease dependent, but pain and fatigue are common. Further, chronic inflammation is more often the result of exposure to a diet that contains excessive levels of added sugar, with even a disturbed gut implicated in increased plaque buildup in major arteries, such as coronary and cerebral arteries.⁴

According to the CDC, frequent consumption of sugary drinks is linked to adverse health outcomes that include obesity, type 2 diabetes, heart disease, nonalcoholic liver disease, and gout. | Image Credit: © grzejnik1981-stock.adobe.com

Within the realm of cardiovascular disease risk, excessive sugar-sweetened beverage intake is linked to not only weight gain, but also higher levels of blood glucose and insulin, which subsequently will increase the glycemic load,³ or how different amounts of ingested carbohydrates will affect blood sugar levels.¹⁰ And for heart disease, both men and women who have even 1 canned sugary drink per day have higher risks of heart attack and dying from a myocardial infarction compared with individuals who rarely consume such beverages.¹

Experts note that the increased likelihood of obesity from consuming 1 or more sugary drinks per day, and the calories they contain, principally stems from the body not reducing its caloric intake from other sources, and that this outcome is seen regardless of income or ethnicity.

A study published in 2023 examined the effects of a $0.01 per-ounce beverage tax, commonly referred to as a "soda tax," implemented in Oakland, California, and compared its impact on sugary drink consumption with data from Richmond and Los Angeles, cities in California that do not have such a tax.^11,12 The study revealed a significant 26.8% decrease in sugary beverage consumption in Oakland over 2 years (July 1, 2017-December 31, 2019), suggesting a likelihood the tax may have influenced consumer behavior and reduced intake of high-sugar beverages. Considering the public health benefits, the researchers found that for every 10,000 residents, the tax likely led to an estimated gain of 94 quality-adjusted life-years, potentially reflecting both an increase in lifespan and overall improved quality of life.

Additionally, the investigators noted that their research findings estimate that the reduction in sugary beverage consumption contributed to more than $100,000 in health care–related cost savings and that they highlight the economic advantages of implementing similar taxation policies in other areas. Importantly, the data did not show any evidence that consumers attempted to circumvent the tax by purchasing untaxed sugary drinks elsewhere or by increasing their intake of sweet snacks to compensate for their reduced sugar intake elsewhere.

Findings from last year, which build on these results, show even more improved outcomes and from an expanded study area that encompassed 5 large cities: Boulder, Colorado; Philadelphia, Pennsylvania; Seattle, Washington; and Oakland and San Francisco, California.^13,14 Seen simultaneously with a 33% jump in sugar-sweetened beverages was a 33% drop in purchase of those beverages.

Looking Forward

The evidence linking sugary beverage consumption to chronic disease and increased adverse health outcomes underscores the urgent need for effective public health interventions. Policies such as beverage taxes have demonstrated measurable success in reducing intake, improving health outcomes, and lowering associated medical expenses. Ongoing research will be essential to assess long-term benefits and potential refinements. Ultimately, addressing excessive sugar consumption through policy and education can lead to a healthier population and a more sustainable health care system.

References

1. Sugary drinks. Center for Science in the Public Interest. Updated July 20, 2023. Accessed January 27, 2025. https://www.cspinet.org/advocacy/nutrition/sugary-drinks

2. Sugary drinks. The Nutrition Source. Accessed January 27, 2025. https://nutritionsource.hsph.harvard.edu/healthy-drinks/sugary-drinks

3. Pacheco LS, Tobias DK, Li P, et al. Sugar-sweetened or artificially-sweetened beverage consumption, physical activity, and risk of cardiovascular disease in adults: a prospective cohort study. Am J Clin Nutr. 2024;119(3):669-681. doi:10.1016/j.ajcnut.2024.01.001

4. Vogel K. Drinking 2 servings of sugary drinks like soda per week may harm heart health. MedicalNewsToday. March 7, 2024. Accessed January 27, 2025. https://www.medicalnewstoday.com/articles/drinking-2-servings-sugary-drinks-soda-per-week-may-harm-heart-health

5. Get the facts: sugar-sweetened beverages and consumption. CDC. Accessed January 27, 2025. https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html

6. How much sugar is too much? American Heart Association. Accessed January 27, 2025. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much

7. Laskowski ER. Health lifestyle/fitness: How much should the average adult exercise every day? Mayo Clinic. Accessed January 27, 2025. https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916

8. Adult activity: an overview. CDC. December 20, 2023. Accessed January 27, 2025. https://www.cdc.gov/physical-activity-basics/guidelines/adults.html

9. Felman A. Everything you need to know about inflammation. MedicalNewsToday. December 11, 2023. Accessed January 27, 2025. https://www.medicalnewstoday.com/articles/248423#types-and-symptoms

10. Glycemic load explained: definition, formula, benefits, and examples. Glycemic Index Guide. Accessed January 27, 2025. https://glycemic-index.net/glycemic-load/

11. Thiboonboon K, De Abreu Lourenco , Cronin P, Khoo T, Goodall S. Economic evaluations of obesity-targeted sugar-sweetened beverage (SSB) taxes–a review to identify methodological issues. Health Policy. 2024;144:105076. doi:10.1016/j.healthpol.2024.105076

12. Berthold J. Sugary drink tax improves health, lowers health care costs. UC Berkeley/Berkeley Public Health. April 21, 2023. Accessed January 28, 2025. https://publichealth.berkeley.edu/news-media/research-highlights/sugary-drink-tax-improves-health

13. Proulx E. Taxes on sugar-sweetened drinks drive decline in consumption. UC Berkeley/Berkeley Public Health. January 4, 2024. Accessed January 28, 2025. https://publichealth.berkeley.edu/news-media/research-highlights/taxes-on-sugar-sweetened-drinks-drive-decline-in-consumption

14. Kaplan S, White JS, Madsen KA, Basu S, Villas-Boas SB, Schillinger D. Evaluation of changes in prices and purchases following implementation of sugar-sweetened beverage taxes across the US. JAMA Health Forum. 2024;5(1):e234737. doi:10.1001/jamahealthforum.2023.4737