A few weeks ago, Coca-Cola disclosed that they have donated almost $120 million in grants to medical, health and community organizations since 2010. As medical students, we can all understand how scientists who receive grant funding from a corporation such as Coke are at increased risk for inserting biases, conscious or otherwise, into their scientific research.
What we have failed to acknowledge is the societal damage that is caused when the Academy of Pediatrics, the American College of Cardiology, the American Academy of Family Physicians and the Academy of Nutrition and Dietetics accept financial donations from Coca-Cola, a company interested in asserting that sugar-sweetened beverages are not associated with obesity, diabetes, metabolic syndrome or heart disease.
In an article from The New York Times published on September 28, Anahad O‘Connor interviews Sandy Douglas, the president of Coca-Cola North America, who stresses the company’s commitment to supporting “a healthy, active lifestyle.” Douglas also clearly articulates the company’s position on America’s current obesity epidemic: “Pediatricians are absolutely right to be stressing healthy eating and drinking to parents and kids. But I suspect that completely eliminating [sugary drinks] is not necessary for kids to be healthy any more than eliminating ice cream, birthday cakes or cookies. The key is moderation.”
“Moderation” is a dangerous word. Its use here implies that if only people could “moderate” their food intake — if only they had more self-control — they would not become obese or, by extension, fall victim to obesity’s dangerous consequences. It shifts the entire responsibility for the disease state to the patient’s willpower; implicit in this is the idea that only people with poor character become obese. Beyond reinforcing societal stereotypes regarding obese people, using this term also gives society permission to blame the individual for their Type II diabetes, excessive weight or metabolic syndrome. Forget biology, the environment and their various interactions as etiologies — in essence, “moderation” implies that an individual has complete control over these factors.
But clinicians who care for obese children and adults know all too well that individuals, regardless of their BMI, have limited control over biology and environment. Not only do patients have no control over their genes, they also have little say in their kids’ school lunch program menus, the high sugar content of supermarket products and the exorbitant price tags on high-end health foods.
Over the past few years, many community-based health organizations have fought to implement legislation that would impose a tax on soda in an effort to curtail consumption. As of November 2014, Berkeley, California became the only U.S. city so far to successfully pass legislation that imposes a penny-per-ounce soda tax, which has resulted in higher prices on soda as compared to those found in nearby communities.
Likewise, in 2014 the Mexican government implemented a 10 percent tax on sugar-sweetened beverages and became the first country to successfully pass a nationwide tax on sugar-sweetened beverages. According to a collaboration between the National Institute of Public Health of Mexico and the Carolina Population Center at UNC Chapel Hill, sales of sugar-sweetened beverages have dropped about 12 percent since the imposition of the tax. However, it will take more time before researchers can determine any direct improvements in public health or any changes in behavioral patterns resulting from these taxes.
Longtime public health proponent Marion Nestle notes that the American Beverage Association, the primary lobbying organization linked to the beverage industry, spent over $114 million between 2009 and 2014 to finance advertising campaigns countering legislation proposed by promoters of a soda tax. For comparison, the Senate Office of Public Records states that the tobacco industry spent over $149 million in the same period to fight cigarette taxes and anti-tobacco legislation. In today’s political environment, there are many reasons why politicians might oppose new taxes. However, the medical issues surrounding sugar-sweetened beverages are crystal clear: high sugar intake is linked to diabetes, heart disease and obesity. As student physicians, we have an obligation to speak out regarding the damaging effects of a diet high in sugar, an outcome for which the soda industry is partly responsible.
Until the medical community acknowledges the mounting scientific evidence that sugar in the form of soda is an obesity-promoting and addictive substance that is too readily available, we will not be able to help our patients stay healthy. As part of our duty to promote wellness, the healthcare community should work to eliminate these beverages from hospitals and other institutions that promote a healthy diet and lifestyle. We must stand on a firm base of medical evidence. If we no longer allow the sale of cigarettes in our hospitals or other public institutions, we should also no longer stand for the sale of sugar-sweetened beverages.
For the sake of our patients’ health, when discussing BMI and obesity, we must avoid using qualifiers such as “self-control” and “moderation.” At some point, we need to speak out against the widespread availability of sugar in our food and drink. As health care professionals, would we expect an alcoholic living in a neighborhood with bars on every corner to practice moderation and self-control? Until we recognize the role of the food industry in promoting an unhealthy and addictive diet, I fear the obesity epidemic will continue.
Nutrition & Wellness is a column about how nutrition applies to us as medical students and to the different specialties of the medical field. In this column, we’ll also talk about how medical students can maintain a healthy lifestyle despite our busy schedules.