Topic: Sugary Drinks

Coffee Chat: Exploring the Health Equity Benefits of Sugary Drink Excise Taxes

Posted on January 25, 2024

In this coffee chat hosted by the CHOICES Community of Practice, Matthew Lee, PhD Candidate from the Harvard T.H. Chan School of Public Health and California native who has researched sugary drink trends and the impacts of sugary drink excise taxes in the San Francisco Bay Area, discusses insights from his recent study published in the American Journal of Preventive Medicine that he led along with other researchers from the CHOICES Team. Matt also focuses on the ways in which these taxes, and the potential revenue raised from them, can benefit communities by improving health equity.

View the resource round-up from this coffee chat

Download the January 2024 coffee chat presentation slides

Disclaimer: Our guest speakers share their own perspectives and do not speak for Harvard.

← Back to Resources

Strategy Report: Reducing Exposure to Unhealthy Food and Beverage Advertising

Posted on November 17, 2023

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Reducing Exposure to Unhealthy Food and Beverage Advertising Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Banapsha Rahman, Ya Xuan Sun, Shilpi Agarwal, Ana Paula Bonner Septien, Jenny Reiner, Matt Lee, Zach Ward

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

← Back to Resources

Strategy Report: Creating Healthier Afterschool Environments

Posted on November 17, 2023

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Creating Healthier Afterschool Environments Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Dar Alon, Stella Zhu, Shilpi Agarwal, Ana Paula Bonner Septien, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

← Back to Resources

Strategy Report: Sugary Drink Excise Tax

Posted on November 17, 2023

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Sugary Drink Excise Tax Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Dar Alon, Banapsha Rahman, Ya Xuan Sun, Amy Bolton, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

← Back to Resources

Coffee Chat: An Action Kit for Prevention: Prioritizing Cost-Effective and Equitable Healthy Eating and Physical Activity Strategies

Posted on November 16, 2023

In this coffee chat hosted by the CHOICES Community of Practice, Dr. Steven Gortmaker, Principal Investigator of the CHOICES Project at the Harvard T.H. Chan School of Public Health, highlights the new features available in the Action Kit 2.0, including more detailed information on costs and health equity impacts. Dr. Gortmaker also discusses how this information can be helpful for planning and prioritization purposes to ensure responsible investments to improve child health, nutrition, physical activity, and health equity.

View the resource round-up from this coffee chat

Download the November 2023 coffee chat presentation slides

← Back to Resources

Strategy Profile: Creating Healthier Early Care and Education Environments

Posted on September 22, 2023

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Improving nutrition, physical activity, & screen time policies & practices for children ages 3-5 by incorporating the Nutrition & Physical Activity Self-Assessment for Child Care (NAP SACC) Program into state’s Quality Rating and Improvement Systems (QRIS) for early care and education programs.

What population benefits?

Children ages 3-5 attending licensed early care and education programs that participate in their state’s Quality Rating and Improvement Systems (QRIS).

What are the estimated benefits?

Relative to not implementing the strategy
Promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Train early care and education health professionals to work with early care and education programs • Time of state training consultant to train early care and education health professionals
• Time of early care and education health professionals to be trained		 State QRIS administrators
Provide consultation to early care and education program directors and staff for conducting self-assessments of program policies and practices, completing action plans, and implementing changes to improve nutrition, physical activity, and screen time environments in programs • Time of early care and education health professionals to provide consultation to early care and education programs
• Time of early care and education program directors and staff to participate in consultation		 Early care and education health professionals
Provide materials and equipment for implementing NAP SACC program • Cost for GO NAP SACC online license
• Physical activity equipment costs		 State QRIS administrators
Implement changes in early care and education programs to improve nutrition, physical activity, and screen time environments • Time of early care and education program directors to implement changes Early care and education program directors
Improve nutritional quality of meals served in early care and education programs • Food costs for improving nutritional quality of meals Early care and education program directors
Monitor compliance with NAP SACC program • Time of state-level QRIS Administrators to monitor compliance State QRIS administrators
Strategy Modification

In states where NAP SACC is already being implemented, the strategy could be modified to focus on increasing the number of early care and education programs that participate in NAP SACC. With this modification, the cost for the GO NAP SACC online license would not be needed, since it is a fixed annual cost paid per state (i.e., it does not depend on the number of participating programs). With this modification, the impact on health is expected to be similar, and the impact on reach and cost would vary according to the number of programs reached.

FOR ADDITIONAL INFORMATION

Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood). 2015 Nov;34(11):1932-9. doi: 10.1377/hlthaff.2015.0631. Supplemental Appendix with strategy details available at: https://www.healthaffairs.org/doi/suppl/10.1377/hlthaff.2015.0631/ suppl_file/2015-0631_gortmaker_appendix.pdf

Selected CHOICES research brief including cost-effectiveness metrics:

Adams B, Sutphin B, Betancourt K, Balamurugan A, Kim H, Bolton A, Barrett J, Reiner J, Cradock AL. Arkansas: Creating Healthier Child Care Environments: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) in the Quality Rating Improvement System (QRIS) {Issue Brief}. Arkansas Department of Health, Little Rock, AR, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. Available at: https://choicesproject.org/publications/brief-napsacc-arkansas

Kenney EL, Giles CM, Flax CN, Gortmaker SL, Cradock AL, Ward ZJ, Foster S, Hammond W. New Hampshire: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) Intervention {Issue Brief}. New Hampshire Department of Health and Human Services, Concord, NH, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2017. Available at: https:// choicesproject.org/publications/brief-napsacc-intervention-new-hampshire

Suggested Citation

CHOICES Strategy Profile: Creating Healthier Early Care and Education Environments. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

← Back to Resources

A Sugar-Sweetened Beverage Excise Tax in California: Projected Benefits for Population Obesity and Health Equity

Posted on August 6, 2023

Sugary drinks

This study evaluates the cost-effectiveness of a hypothetical 2-cent-per-ounce excise tax in California (CA) and implications for population health and health equity.

Lee MM, Barrett JL, Kenney EL, Gouck J, Whetstone L, McCulloch SM, Cradock AL, Long MW, Ward ZJ, Rohrer B, Williams DR, Gortmaker SL. A Sugar-Sweetened Beverage Excise Tax in California: Projected Benefits for Population Obesity and Health Equity. Am J Prev Med. 2024 Jan;66(1):94-103. doi: 10.1016/j.amepre.2023.08.004. Epub 2023 Aug 6. PubMed PMID: 37553037;

Abstract

Introduction

Amid the successes of local sugar-sweetened beverage (SSB) taxes, interest in state-wide policies has grown. This study evaluated the cost-effectiveness of a hypothetical 2-cent-per-ounce excise tax in California (CA) and implications for population health and health equity.

Methods

Using the CHOICES microsimulation model, tax impacts on health, health equity, and cost-effectiveness over ten years in CA were projected, both overall and stratified by race/ethnicity and income. Expanding upon prior models, differences in the effect of SSB intake on weight by BMI category were incorporated. Costing was performed in 2020, and analyses were conducted in 2021-2022.

Results

The tax is projected to save $4.55b in healthcare costs, prevent 266,000 obesity cases in 2032, and gain 114,000 QALYs. Cost-effectiveness metrics, including the cost/QALY gained, were cost-saving. Spending on SSBs was projected to decrease by $33/adult and by $26/child in the first year overall. Reductions in obesity prevalence for Black and Hispanic Californians were 1.8 times larger compared to White Californians, and reductions for adults with lowest incomes (<130%FPL) were 1.4 times the reduction among those with highest incomes (>350%FPL). The tax is projected to save $112 in obesity-related healthcare costs per $1 invested.

Conclusions

A state-wide SSB tax in California would be cost saving and lead to reductions in obesity and improved SSB-related health equity, and lead to overall improvements in population health. The policy would generate more than $1.6 billion in state tax revenue annually that can also be used to improve health equity.

Funding

This work was supported by The JPB Foundation (Grant No. 1085), the National Institutes of Health (Grant No. R01HL146625), the Centers for Disease Control and Prevention (CDC) (Grant No. U48DP006376). This work is solely the responsibility of the authors and does not represent official views of the CDC or other agencies. The findings and conclusions in this article are those of the author(s) and do not necessarily represent the views or opinions of the California Department of Public Health or the California Health and Human Services Agency. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

← Back to Resources

Brief: Creating Healthier Afterschool Environments (OSNAP) in Boston, MA

Posted on July 28, 2023

Three kids at the playground

The information in this brief is intended only to provide educational information.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the implementation of the Out of School Nutrition and Physical Activity (OSNAP) initiative that helps afterschool programs improve practices and policies that increase physical activity and consumption of healthy snacks.

The Issue

Every child should have opportunities to grow up healthy. Regular physical activity, healthy eating, and adequate hydration can help children maintain a healthy weight. Over 6,000 students in kindergarten to fifth grade participate in afterschool programs in Boston.1 These educational settings can provide essential opportunities for children to learn healthy eating habits and promote physical activity and wellness. However, not all programs offer the same opportunities for healthy eating and physical activity.2 Helping more afterschool programs adopt policies and practices that incorporate more physical activity, healthier snacks, and improved water access during program time can help ensure that all children in Boston’s afterschool programs have opportunities to grow up healthy.

About Creating Healthier Afterschool Environments

OSNAP is a proven initiative implemented in multiple communities that helps afterschool programs create environments that promote increased physical activity and consumption of healthy snacks.3-6 Creating healthier afterschool environments can contribute to higher quality afterschool programming. To implement this initiative, the Boston Public Health Commission would provide professional development opportunities for afterschool program leaders serving students in grades K-5. Afterschool staff leaders would participate in three learning collaborative sessions and receive technical assistance to assess7 and modify their programs’ practices and policies3 to meet the OSNAP nutrition and physical activity goals. The Boston Public Health Commission would supply program leaders with materials to support implementation and offer continuing education units for their participation.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2029) of implementing the OSNAP program with the costs and outcomes associated with not implementing the program.

Creating healthier afterschool environments is an investment in the future. By the end of 2029:
If creating healthier afterschool environments (OSNAP) was implemented in Boston, 10,800 children would be reached over 10 years, $34,100 would be saved in health care costs, and it would cost $18.30 per child per year to implement.

Conclusions and Implications

Opportunities for physical activity and access to healthy foods in afterschool programs are important to parents2 and can help enhance the quality of afterschool programing. Over 10 years, this strategy could train more than 600 afterschool teachers and directors. By equipping afterschool leaders with these skills and resources, afterschool programs could adopt healthier practices and policies and we project that 10,800 children would benefit from more physical activity and improved diet. We project that 37 cases of obesity would be prevented and $34,100 in healthcare costs related to excess weight would be saved in 2029. We expect this strategy would cost $18.30 per child per year to implement in Boston and is projected to be cost-effective at commonly accepted thresholds8 based on net population health improvement related to excess weight ($72,100 per quality-adjusted life year gained).

In addition to promoting healthy weight, this strategy may also support children’s health in other ways. Regular physical activity, healthy eating, and adequate hydration can improve children’s mental and emotional well-being and their heart, lung, and bone health.9 These healthy behaviors can also strengthen students’ attention, memory,10,11 and cognitive functioning,10 all important components for learning and academic performance. Incorporating physical activity and healthy snacks in afterschool programs can help children nurture healthy habits and lay a strong foundation for overall health and well-being.

This strategy builds upon Boston Public Health Commission’s demonstrated success where, in 2015, more than 120 programs took steps to improve their screen time, physical activity, and nutrition practices through OSNAP, creating higher quality afterschool programs across Boston.11 Broader implementation could reach all afterschool programs in Boston, improving practices and policies that promote increased physical activity and consumption of healthy snacks, furthering the Boston Public Health Commission’s goal of creating policy and systems changes in childcare to promote the health of all Boston residents.

References

  1. Boston AfterSchool & Beyond. SY 21-22 Programs. In. Boston, MA: Boston AfterSchool & Beyond; 2021.

  2. Kids on the Move: Afterschool Programs Promoting Healthy Eating and Physical Activity. Washington, D.C.: America After 3pm, Afterschool Alliance; 2015.

  3. Kenney EL, Giles CM, deBlois ME, Gortmaker SL, Chinfatt S, Cradock AL. Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial. Prev Med. 2014;66:159-166. doi:10.1016/j.ypmed.2014.06.011

  4. Cradock AL, Barrett JL, Giles CM, et al. Promoting Physical Activity With the Out of School Nutrition and Physical Activity (OSNAP) Initiative: A Cluster-Randomized Controlled Trial. JAMA Pediatr. 2016;170(2):155-162.

  5. Lee RM, Giles CM, Cradock AL, Emmons KM, Okechukwu C, Kenney EL, Thayer J, Gortmaker SL. Impact of the Out-of-School Nutrition and Physical Activity (OSNAP) Group Randomized Controlled Trial on Children’s Food, Beverage, and Calorie Consumption among Snacks Served. J Acad Nutr Diet. 2018 Aug;118(8):1425-1437. doi: 10.1016/j.jand.2018.04.011.

  6. Lee RM, Barrett JL, Daly JG, Mozaffarian RS, Giles CM, Cradock AL, Gortmaker SL. Assessing the effectiveness of training models for national scale-up of an evidence-based nutrition and physical activity intervention: a group randomized trial. BMC Public Health. 2019 Nov 28;19(1):1587. doi: 10.1186/s12889-019-7902-y.

  7. Lee RM, Emmons KM, Okechukwu CA, Barrett JL, Kenney EL, Cradock AL, Giles CM, deBlois ME, Gortmaker SL. Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs. Int J Behav Nutr Phys Act. 2014 Nov 28;11:145. doi: 10.1186/s12966-014-0145-5.

  8. Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. New England Journal of Medicine. 2014 Aug 28;371(9):796-7. DOI: 10.1056/NEJMp1405158. PMID: 25162885.

  9. Health Benefits of Physical Activity for Children. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/health-benefits-of-physical-activity-for-children.html. Published Jan 12, 2022. Updated 2022-01-12T05:06:09Z. Accessed Dec 7, 2022.

  10. Childhood Nutrition Facts. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyschools/nutrition/facts.htm. Published 2022. Updated 2022-08-05T03:49:26Z. Accessed Dec 12, 2022.

  11. Blanding N. Afterschool Programs in Boston, MA, Expand Opportunties for Obesity Prevention. Centers for Disease Control and Prevention; 2016. http://nccd.cdc.gov/nccdsuccessstories

Suggested Citation:

Carter S, Bovenzi M, Clarke J, Bolton AA, Reiner JF, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Creating Healthier Afterschool Environments (OSNAP) {Issue Brief}. Boston Public Health Commission, Massachusetts, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; July 2023.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

← Back to Resources

Fact Sheet: Sugary Drink Consumption

Posted on January 27, 2023

Mom giving glass of water to young daughter

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Sugary drinks include regular soda, fruit drinks with less than 100% juice, sweetened water, sports and energy drinks, and coffees and teas with added sugars.1,2 

  • Diet drinks, alcohol, coffee, and teas without added sugars and flavored milks that contain 50% dairy or more are usually not considered sugary drinks.3 
  • On average, US adults and children consume nearly 150 calories a day from sugary drinks, or about 6-12% of their daily caloric needs.2,4 

Sugary drinks account for nearly half of the total added sugars in a typical American diet.1 About half of adults and over 60% of kids consume a sugary drink on any given day.2-5 

  • Despite some decline in consumption in recent years, both adults and kids in the US continue to consume more sugary drinks and added sugars than recommended.1,6,7 Sugary drinks are often cheaper than bottled water, making them an attractive option when tap water is not safe to drink.8,9 
  • Beverage companies focus advertising10,11 and retail marketing12 efforts on African Americans and Hispanic Americans, as well as on children.13 
  • Research shows that African Americans and Hispanic Americans drink more sugary drinks compared to non-Hispanic White Americans.4,14,15 Among households with young children, those with lower incomes purchased more sweetened fruit drinks compared to households with higher incomes.16 

There is strong evidence suggesting that drinking too many sugary drinks substantially increases the risk of gaining excess weight and obesity,17,18 and developing chronic diseases including diabetes, cardiovascular disease, tooth decay, and cavities.19-22 

Experts recommend drinking water instead of sugary drinks.23 There are many ways to make drinking water more available: 

  • At home:
    • ✓Be a model to kids by limiting or eliminating your own consumption of sugary drinks.
    • ✓Offer drinking water or other non-sugary options.
  • At school:
    • ✓Teach students about the amount of sugar in common beverages and the importance of reducing intake for improved health outcomes.24,25
    • ✓Implement federal food and beverage standards that prohibit sales of unhealthy options like sugary drinks in schools.26,27
    • ✓Increase access to and promotion of free, safe drinking water in schools.28
  • In your city, county, or state:
    • ✓Limit sales of sugary drinks on city property.29
    • ✓Create healthier out-of-school time environments by training staff to adopt a healthy beverage policy in their programs.30,31
    • ✓Implement a sugary drink excise tax to discourage consumption, as many US jurisdictions have successfully done.32,33 This is projected to be a cost-saving strategy that can improve population health and health equity.

Additional Resources

References

  1. U.S. Department of Health and Human Services, U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture; 2015:144. Accessed November 29, 2021. https://health.gov/sites/default/files/2019-09/2015-2020_Dietary_Guidelines.pdf
  2. Rosinger A, Herrick K, Gahche J, Park S. Sugar-sweetened Beverage Consumption Among U.S. Youth, 2011-2014. NCHS Data Brief. 2017;(271):1-8.
  3. City of Philadelphia Department of Revenue. What is subject to the tax. City of Philadelphia. Published November 8, 2019. Accessed November 29, 2021. https://www.phila.gov/services/payments-assistance-taxes/business-taxes/philadelphia-beverage-tax/what-is-subject-to-the-tax
  4. Rosinger A, Herrick K, Gahche J, Park S. Sugar-sweetened Beverage Consumption Among U.S. Adults, 2011-2014. NCHS Data Brief. 2017;(270):1-8.
  5. Centers for Disease Control and Prevention. Get the Facts: Sugar-Sweetened Beverages and Consumption. Centers for Disease Control and Prevention. Published March 11, 2021. Accessed November 29, 2021. https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html
  6. Vercammen KA, Moran AJ, Soto MJ, Kennedy-Shaffer L, Bleich SN. Decreasing Trends in Heavy Sugar-Sweetened Beverage Consumption in the United States, 2003 to 2016. J Acad Nutr Diet. 2020;120(12):1974-1985.e5. doi:10.1016/j.jand.2020.07.012
  7. Bleich SN, Wang YC, Wang Y, Gortmaker SL. Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004. Am J Clin Nutr. 2009;89(1):372-381. doi:10.3945/ajcn.2008.26883
  8. Blecher E. Global Trends in the Affordability of Sugar-Sweetened Beverages, 1990–2016. Prev Chronic Dis. 2017;14. doi:10.5888/pcd14.160406
  9. Brooks CJ, Gortmaker SL, Long MW, Cradock AL, Kenney EL. Racial/Ethnic and Socioeconomic Disparities in Hydration Status Among US Adults and the Role of Tap Water and Other Beverage Intake. Am J Public Health. 2017;107(9):1387-1394. doi:10.2105/AJPH.2017.303923
  10. Powell LM, Wada R, Kumanyika SK. Racial/Ethnic and Income Disparities in Child and Adolescent Exposure to Food and Beverage Television Ads across U.S. Media Markets. Health Place. 2014;29:124-131. doi:10.1016/j.healthplace.2014.06.006
  11. Cassady DL, Liaw K, Miller LMS. Disparities in Obesity-Related Outdoor Advertising by Neighborhood Income and Race. J Urban Health. 2015;92(5):835-842. doi:10.1007/s11524-015-9980-1
  12. Adjoian T, Dannefer R, Sacks R, Van Wye G. Comparing Sugary Drinks in the Food Retail Environment in Six NYC Neighborhoods. J Community Health. 2014;39(2):327-335. doi:10.1007/s10900-013-9765-y
  13. Smith R, Kelly B, Yeatman H, Boyland E. Food Marketing Influences Children’s Attitudes, Preferences and Consumption: A Systematic Critical Review. Nutrients. 2019;11(4):875. doi:10.3390/nu11040875
  14. Kit BK, Fakhouri THI, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010. Am J Clin Nutr. 2013;98(1):180-188. doi:10.3945/ajcn.112.057943
  15. Bleich SN, Vercammen KA, Koma JW, Li Z. Trends in Beverage Consumption Among Children and Adults, 2003-2014. Obes Silver Spring Md. 2018;26(2):432-441. doi:10.1002/oby.22056
  16. Choi YY, Andreyeva T, Fleming-Milici F, Harris JL. U.S. Households’ Children’s Drink Purchases: 2006–2017 Trends and Associations With Marketing. Am J Prev Med. 2021;0(0). doi:10.1016/j.amepre.2021.06.013
  17. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet Lond Engl. 2001;357(9255):505-508. doi:10.1016/S0140-6736(00)04041-1
  18. Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013 Aug;14(8):606-19.
  19. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes 2005. 2011;35(7):891-898. doi:10.1038/ijo.2010.222
  20. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects), Lu Y, Hajifathalian K, et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants. Lancet Lond Engl. 2014;383(9921):970-983. doi:10.1016/S0140-6736(13)61836-X
  21. Singh GM, Danaei G, Farzadfar F, et al. The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis. PLOS ONE. 2013;8(7):e65174. doi:10.1371/journal.pone.0065174
  22. World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective.; 2008:537. Accessed November 29, 2021. http://choicereviews.org/review/10.5860/CHOICE.45-5024
  23. Water. The Nutrition Source, Harvard T.H. Chan School of Public Health. Accessed September 2, 2022. https://www.hsph.harvard.edu/nutritionsource/water
  24. Rauba J, Tahir A, Milford B, et al. Reduction of Sugar-Sweetened Beverage Consumption in Elementary School Students Using an Educational Curriculum of Beverage Sugar Content. Glob Pediatr Health. 2017;4:2333794X17711778. doi:10.1177/2333794X17711778
  25. Cheung PLYH, Dart H, Kalin S, Otis B, Gortmaker SL. Lesson 19: Beverage Buzz: Sack the Sugar; Lesson 20: Go for H2O. In: Eat Well and Keep Moving. 3rd Edition Champaign, Illinois: Human Kinetics Press, 2016.
  26. Centers for Disease Control and Prevention. Competitive Foods and Beverages in U.S. Schools, A State Policy Analysis.; 2012:32. Accessed November 29, 2021. https://www.cdc.gov/healthyschools/nutrition/pdf/compfoodsbooklet.pdf
  27. Muckelbauer R, Gortmaker SL, Libuda L, et al. Changes in water and sugar-containing beverage consumption and body weight outcomes in children. Br J Nutr. 2016;115(11):2057-2066. doi:10.1017/S0007114516001136
  28. Kenney EL, Cradock AL, Long MW, Barrett JL, Giles CM, Ward ZJ, Gortmaker SL. Cost-Effectiveness of Water Promotion Strategies in Schools for Preventing Childhood Obesity and Increasing Water Intake. Obesity (Silver Spring). 2019 Dec;27(12):2037-2045. doi: 10.1002/oby.22615. PMID: 31746555.
  29. Cradock AL, Kenney EL, McHugh A, Conley L, Mozaffarian RS, Reiner JF, et al. Evaluating the Impact of the Healthy Beverage Executive Order for City Agencies in Boston, Massachusetts, 2011–2013. Prev Chronic Dis 2015;12:140549. doi:10.5888/pcd12.140549
  30. Kenney EL, Austin SB, Cradock AL, Giles CM, Lee RM, Davison KK, Gortmaker SL. Identifying sources of children’s consumption of junk food in Boston afterschool programs, April-May 2011. Preventing Chronic Disease. 2014 Nov 20;11:E205.
  31. Salas TM, Meinen A, Kim H, McCulloch S, Reiner J, Barrett J, Cradock AL. Wisconsin: Supporting Healthy Beverage Choices in Out-of-School Time Programs {Issue Brief}. Wisconsin Department of Health Services & University of Wisconsin-Madison, Madison, WI, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. For more information, please visit www.choicesproject.org
  32. Krieger J, Bleich SN, Scarmo S, Ng SW. Sugar-Sweetened Beverage Reduction Policies: Progress and Promise. Annu Rev Public Health. 2021 Apr 1;42:439-461. doi: 10.1146/annurev-publhealth-090419-103005. Epub 2021 Nov 30. PMID: 33256536.
  33. Gortmaker SL, Bleich SN, Kenney EL, Barrett JL, Ward ZJ, Long MW, Cradock AL. Cost-Effective Strategies to Prevent Obesity and Improve Health Equity. Harvard T.H. Chan School of Public Health, 2021. https://choicesproject.org/publications/cost-effective-strategies-health-equity

Suggested Citation

Get the Facts: Sugary Drink Consumption. Prevention Research Center on Nutrition and Physical Activity Team at the Harvard T.H. Chan School of Public Health, Boston, MA; January 2023. 

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. 

← Back to Resources

Fact Sheet: Low- and No-Calorie Sweetened Drinks

Posted on November 3, 2022

Low-calorie soda

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Low- and no-calorie sweeteners are man-made sweeteners that are much sweeter than regular sugar but have few to no calories.1

  • Low- and no-calorie sweeteners are sometimes called artificial sweeteners, high-intensity sweeteners, and non-nutritive sweeteners.1-3

  • There are 19 different low- and no-calorie sweeteners,4 six of which are approved by the US Food and Drug Administration as food additives: advantame, aspartame, acesulfame potassium, neotame, saccharin, and sucralose.1

  • Two other kinds of low- and no-calorie sweeteners—steviol glycosides from the stevia plant and extracts from the monk fruit—are considered “Generally Recognized as Safe,” which allows them to be used in food and drinks.2 

Data from 2009-2012 show that about 19% of kids and 31% of adults in the US drink beverages made with low- and no-calorie sweeteners.5

  • This is a big increase from 1999-2000, when only 6% of kids and about 19% of adults were drinking these beverages.6 

  • During both of these time periods, non-Hispanic White Americans were more likely to report drinking these beverages than non-Hispanic African Americans and Hispanic Americans as well as those with a high income compared to those with a middle or low income.5,6

There are mixed findings about the health effects of drinking low- and no-calorie sweetened drinks and multiple concerning studies.7,8 Ongoing research is looking at long-term impacts on the body for kids and adults.9 

  • There’s some good evidence that suggests replacing sugary drinks (like soda) with low- and no-calorie sweetened drinks is a strategy to avoid excess weight gain in children.10 

  • However, experts suggest replacing sugary and artificially-sweetened drinks with water, if possible. Water is an excellent beverage choice, especially for kids. It’s perfect for hydration, very affordable, has no calories, and fluoridated water helps protect teeth.11

 

Additional Resources

References

  1. Food and Drug High-Intensity Sweeteners. FDA. Published online February 20, 2020. Accessed November 29, 2021. https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners
  2. USDA Food and Nutrition Information Nutritive and Nonnutritive Sweetener Resources. National Agricultural Library. Accessed November 29, 2021. https://www.nal.usda.gov/human-nutrition-and-food-safety/food-composition/sweeteners
  3. Center for Science in the Public Interest. Trends in Low Calorie Sweetener Consumption in the United States. CSPI. September 2021. Accessed June 9, 2022. https://www.cspinet.org/resource/trends-low-calorie-sweetener-consumption-united-states
  4. American Heart Non-Nutritive Sweeteners (Artificial Sweeteners). www.heart.org. Published April 16, 2018. Accessed November 29, 2021. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/nonnutritive-sweeteners-artificial-sweeteners
  5. Sylvetsky AC, Jin Y, Clark EJ, Welsh JA, Rother KI, Talegawkar Consumption of Low-Calorie Sweeteners among Children and Adults in the United States. J Acad Nutr Diet. 2017;117(3):441-448.e2. doi:10.1016/j.jand.2016.11.004
  6. Sylvetsky AC, Welsh JA, Brown RJ, Vos Low-calorie sweetener consumption is increasing in the United States123. Am J Clin Nutr. 2012;96(3):640-646. doi:10.3945/ajcn.112.034751
  7. Swithers SE. Artificial sweeteners are not the answer to childhood obesity. Appetite. 2015 Oct;93:85-90. doi: 10.1016/j.appet.2015.03.027. Epub 2015 Mar 28.
  8. Yin J, Zhu Y, Malik V, Li X, Peng X, Zhang FF, Shan Z, Liu L. Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages and Risk of Cardiovascular Disease: A Meta-Analysis and Systematic Review. Adv Nutr. 2021 Feb 1;12(1):89-101. doi: 10.1093/advances/nmaa084
  9. Johnson RK, Lichtenstein AH, Anderson CAM, et Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association. Circulation. 2018;138(9):e126-e140. doi:10.1161/CIR.0000000000000569
  10. de Ruyter JC, Olthof MR, Seidell JC, Katan A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children. N Engl J Med. 2012;367(15):1397-1406. doi:10.1056/NEJMoa1203034
  11. NIH Office of Dietary Fluoride. Published March 29, 2021. Accessed November 29, 2021. https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional

Suggested Citation

Get the Facts: Low- and No-Calorie Sweetened Drinks. Prevention Research Center on Nutrition and Physical Activity Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2022.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. 

← Back to Resources