Last week in Los Angeles, I testified before a joint hearing of the California Senate Select Committee on Obesity and Diabetes and the Senate Health Committee. The hearing was convened to explore the alleged link between consumption of sugar-sweetened beverages and obesity and diabetes. There were several main points in my testimony:
First, energy balance is of paramount importance. All calories consumed must be balanced by all calories burned through all forms of physical activity in order to achieve and maintain a healthy weight.
Second, data from the USDA show that all calories in the food supply have increased over the last three decades and calories from added fats and oils increased 73 percent compared with a much smaller increase (14 percent) in calories from all added sugars. Furthermore, the data also show that added sugars availability has declined 10 percent in the last decade, yet obesity continued to rise.
Third, calories are calories and all calories from all sources in the diet count. Even calories from asparagus – as was brought up during the hearing – and calories from skim milk, if consumed in excess, will lead to obesity. These irrefutable facts are supported by studies funded by the National Institutes of Health and published in the peer-reviewed scientific literature by researchers from the Harvard School of Public Health and other well-respected academic institutions. Yes, asparagus and skim milk also provide other nutrients (vitamins and minerals), but the issue at hand is obesity. And, in that context, any food or beverage that has calories can contribute to weight gain if consumed in excess of caloric needs.
Fourth, 95 percent of the calories in the U.S. food supply come from something other than soft drinks, so focusing on a small piece of caloric intake will not solve the obesity problem. A National Cancer Institute analysis examined data including over 6,900 foods reported being consumed by Americans across the nation who participated in the National Health and Nutrition Examination Survey (NHANES) – a continuous survey conducted by the National Center for Health Statistics of the U.S. Department of Health and Human Services. Contrary to popular opinion, the analysis found that grain-based desserts are the number one source of calories in the food supply, not soft drinks. Furthermore, over 11 percent of calories come from the combined categories of grain-based desserts (cookies, cakes, donuts, etc.), dairy-based desserts, and candy.
Fifth, data from the Beverage Marketing Corporation shows that the volume of full-calorie carbonated soft drinks has been declining over the last 20 years. Bottled water volume has almost tripled. Yet, over the same time period, the prevalence of obesity has steadily increased.
Sixth, several review papers published in scientific journals, such as the International Journal of Obesity and funded by the World Cancer Research Fund, have found no link between sugar-sweetened beverage consumption and weight gain or obesity. A study funded by the Canadian government that looked at more than 137,000 school-aged children in 34 countries – including the United States – found no association between soft drink intake and body mass index (BMI). And, a 5-year study of adolescent beverage consumption patterns that was e-published in the American Journal of Clinical Nutrition a couple of weeks ago stated, “contrary to our hypothesis, sugar-sweetened beverages were not shown to be positively associated with weight gain.”
Finally, the linchpin of this hearing was a self-published report provocatively titled “Bubbling Over: Soda Consumption and Its Link to Obesity in California.” Issued by the UCLA Center for Health Policy Research, this report has not withstood the rigors of peer review and it is not published in the peer-reviewed scientific literature. The report is based on the California Health Interview Survey – a marathon telephone survey consisting of over 450 questions. Among these questions, participants were asked three questions about the frequency of consumption of non-alcoholic beverages and to provide their best guess on how frequently they consumed beverages – hardly a comprehensive survey on dietary consumption habits and one that cannot establish a cause-and-effect relationship between soft drink consumption and obesity or any other dietary component for that matter. Moreover, the UCLA report notes that over half of the adults who do not drink soda are overweight or obese.
So, what’s the bottom line? It’s about calories and energy balance. All calories consumed from all foods and beverages must be balanced by all forms of physical activity to achieve and maintain a healthy body weight.