Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs

Abstract

Purpose of Review

Obesity has grown at an alarming rate in children and adolescents. Concurrently, consumption on sugar-sweetened beverages (SSBs) also rose significantly. This review provides an overview of obesity and type 2 diabetes mellitus (T2DM) related to SSBs and current policies restricting SSBs in schools, school-based interventions, and taxation on reducing SSB intake and obesity. We also discuss challenges of and future steps for these initiatives.

Recent Findings

Clinical and epidemiological studies suggest a strong association between SSB intake and obesity and T2DM. School food policies have been initiated at federal, state, and local levels. School-based interventions have shown positive effects on SSB intake and obesity reduction. Taxation on SSBs is promising in combating obesity and in generating revenue. Challenges towards compliance and implementation of the policies and programs exist.

Summary

The relationship between SSB and obesity and T2DM is a complex problem which requires comprehensive solutions. Continued efforts in restricting SSBs in schools are needed. Intervention programs should be tailored to age, gender, language, and culture and involve participation from families and local communities. Taxation can reduce SSB consumption by direct economic incentive, earmarking revenues to support healthy foods, and sending negative message. However, a higher tax rate may be necessary to have a measurable effect on weight.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 2012;307(5):483–90.

    Article  PubMed  Google Scholar 

  2. 2.

    Popkin BM. Patterns of beverage use across the lifecycle. Physiol Behav. 2010;100(1):4–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. 3.

    Johnson RK, Appel LJ, Brands M, Howard BV, Lefevre M, Lustig RH, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009;120(11):1011–20.

    Article  PubMed  CAS  Google Scholar 

  4. 4.

    Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics. 2008;121(6):e1604–14.

    Article  PubMed  Google Scholar 

  5. 5.

    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):372–81.

    Article  PubMed  CAS  Google Scholar 

  6. 6.

    Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: what foods are infants and toddlers eating? J Am Diet Assoc. 2004;104(1 Suppl 1):s22–30.

    Article  PubMed  Google Scholar 

  7. 7.

    DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord. 2000;24(6):794–800.

    Article  PubMed  CAS  Google Scholar 

  8. 8.

    Malik VS, Popkin BM, Bray GA, Després J-P, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes. A Meta-Analysis. 2010;33(11):2477–83.

    Google Scholar 

  9. 9.

    Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004;80(2):348–56.

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    Dubois L, Farmer A, Girard M, Peterson K. Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. J Am Diet Assoc. 2007;107(6):924–34. discussion 34-5

    Article  PubMed  Google Scholar 

  11. 11.

    Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001;357(9255):505–8.

    Article  PubMed  CAS  Google Scholar 

  12. 12.

    Malik VS, Willett WC, Hu FB. Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. Am J Clin Nutr. 2009;89(1):438–9. author reply 9-40

    Article  PubMed  CAS  Google Scholar 

  13. 13.

    Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667–75.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Olsen NJ, Heitmann BL. Intake of calorically sweetened beverages and obesity. Obes Rev. 2009;10(1):68–75.

    Article  PubMed  CAS  Google Scholar 

  15. 15.

    Nissinen K, Mikkila V, Mannisto S, Lahti-Koski M, Rasanen L, Viikari J, et al. Sweets and sugar-sweetened soft drink intake in childhood in relation to adult BMI and overweight. The Cardiovascular Risk in Young Finns Study. Public Health Nutr. 2009;12(11):2018–26.

    Article  PubMed  Google Scholar 

  16. 16.

    Viner RM, Cole TJ. Who changes body mass between adolescence and adulthood? Factors predicting change in BMI between 16 year and 30 years in the 1970 British Birth Cohort. Int J Obes. 2006;30(9):1368–74.

    Article  CAS  Google Scholar 

  17. 17.

    Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005;115(1):22–7.

    Article  PubMed  Google Scholar 

  18. 18.

    • Abbasi A, Juszczyk D, van Jaarsveld CHM, Gulliford MC. Body mass index and incident type 1 and type 2 diabetes in children and young adults: a retrospective cohort study. J Endoc Soc. 2017;1(5):524–37. A new study adds evidence that children with obesity face a significantly higher odds of having type 2 diabetes later in life.

    Article  Google Scholar 

  19. 19.

    Wojcicki JM, Heyman MB. Healthier choices and increased participation in a middle school lunch program: effects of nutrition policy changes in San Francisco. Am J Public Health. 2006;96(9):1542–7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Fletcher JM, Frisvold D, Tefft N. Taxing soft drinks and restricting access to vending machines to curb child obesity. Health Aff (Millwood). 2010;29(5):1059–66.

    Article  Google Scholar 

  21. 21.

    U.S. General Accounting Office. School meal programs: competitive foods are available in many schools; actions taken to restrict them differ by state and locality. Washington, D.C.: U.S. 2004.

  22. 22.

    U.S. Department of Agriculture, Food and Nutrition Service. National School Lunch Program (NSLP). Cited Feberary 20, 2018. Available at https://www.fns.usda.gov/nslp/national-school-lunch-program-nslp

  23. 23.

    “S. 2507 —108th Congress: Child Nutrition and WIC Reauthorization Act of 2004.” www.GovTrack.us. 2004. Cited February 2, 2018. Available at https://www.govtrack.us/congress/bills/108/s2507

  24. 24.

    Chriqui JF, Resnick, E, Schneider L, et al. School district wellness policies: evaluating progress and potential for improving children’s health five years after the federal mandate. School years 2006–07 through 2010-11. Chicago, IL: Bridging the Gap, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2013.

  25. 25.

    Institute of Medicine. Nutrition standards for foods in schools: leading the way toward healthier youth. Washington, DC: The National Academies Press; 2007.

    Google Scholar 

  26. 26.

    U.S. Department of Agriculture, Office of Communications, Agriculture Secretary Vilsack highlights new “smart snacks in school” standards; will ensure school vending machines, snack bars include healthy choices; 2013. Cited Feberary 2, 2018. Available at https://www.usda.gov/media/press-releases/2013/06/27/agriculture-secretary-vilsack-highlights-new-smart-snacks-school

  27. 27.

    Jeffrey Levi SV, Richardson L, St. Laurent R, Segal LM. F as in fat: how obesity policies are failing in America. In: Trust for America's health; 2009.

    Google Scholar 

  28. 28.

    Story M, Kaphingst KM, French S. The role of schools in obesity prevention. Futur Child. 2006;16(1):109–42.

    Article  Google Scholar 

  29. 29.

    San Francisco Unified School District. SFUSD Student Nutrition and Physical Fitness Plan Time: Revised. In: District SFUS, editor. San Francisco 2003.

  30. 30.

    Veugelers PJ, Fitzgerald AL. Effectiveness of school programs in preventing childhood obesity: a multilevel comparison. Am J Public Health. 2005;95(3):432–5.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Tipton JA. Reducing sugar-sweetened beverage intake among students: school-based programs and policies that work. NASN Sch Nurse. 2016;31(2):102–10.

    Article  PubMed  Google Scholar 

  32. 32.

    Budd GM, Volpe SL. School-based obesity prevention: research, challenges, and recommendations. J Sch Health. 2006;76(10):485–95.

    Article  PubMed  Google Scholar 

  33. 33.

    Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153(4):409–18.

    Article  PubMed  CAS  Google Scholar 

  34. 34.

    Nader PR, Stone EJ, Lytle LA, Perry CL, Osganian SK, Kelder S, et al. Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health. Arch Pediatr Adolesc Med. 1999;153(7):695–704.

    Article  PubMed  CAS  Google Scholar 

  35. 35.

    • Zhang Q, Liu S, Liu R, Xue H, Wang Y. Food policy approaches to obesity prevention: an international perspective. Curr Obes Rep. 2014;3(2):171–82. This paper provides a comprehensive overview of the recent obesity prevention-related food policies worldwide.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Franks A, Kelder SH, Dino GA, Horn KA, Gortmaker SL, Wiecha JL, et al. School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco. Prev Chronic Dis. 2007;4(2):A33.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Epstein LH, Paluch RA, Consalvi A, Riordan K, Scholl T. Effects of manipulating sedentary behavior on physical activity and food intake. J Pediatr. 2002;140(3):334–9.

    Article  PubMed  Google Scholar 

  38. 38.

    Austin SB, Field AE, Wiecha J, Peterson KE, Gortmaker SL. The impact of a school-based obesity prevention trial on disordered weight-control behaviors in early adolescent girls. Arch Pediatr Adolesc Med. 2005;159(3):225–30.

    Article  PubMed  Google Scholar 

  39. 39.

    Chavarro JE, Peterson KE, Sobol AM, Wiecha JL, Gortmaker SL. Effects of a school-based obesity-prevention intervention on menarche (United States). Cancer Causes Control. 2005;16(10):1245–52.

    Article  PubMed  Google Scholar 

  40. 40.

    Bjelland M, Bergh IH, Grydeland M, Klepp KI, Andersen LF, Anderssen SA, et al. Changes in adolescents' intake of sugar-sweetened beverages and sedentary behaviour: results at 8 month mid-way assessment of the HEIA study—a comprehensive, multi-component school-based randomized trial. Int J Behav Nutr Phys Act. 2011;8:63.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Burrows T, Warren JM, Baur LA, Collins CE. Impact of a child obesity intervention on dietary intake and behaviors. Int J Obes. 2008;32(10):1481–8.

    Article  CAS  Google Scholar 

  42. 42.

    Collins CE, Dewar DL, Schumacher TL, Finn T, Morgan PJ, Lubans DR. 12 month changes in dietary intake of adolescent girls attending schools in low-income communities following the NEAT Girls cluster randomized controlled trial. Appetite. 2014;73:147–55.

    Article  PubMed  Google Scholar 

  43. 43.

    Cunha DB, de Souza Bda S, Pereira RA, Sichieri R. Effectiveness of a randomized school-based intervention involving families and teachers to prevent excessive weight gain among adolescents in Brazil. PLoS One. 2013;8(2):e57498.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. 44.

    Ezendam NP, Brug J, Oenema A. Evaluation of the web-based computer-tailored FATaintPHAT intervention to promote energy balance among adolescents: results from a school cluster randomized trial. Arch Pediatr Adolesc Med. 2012;166(3):248–55.

    Article  PubMed  Google Scholar 

  45. 45.

    Lo E, Coles R, Humbert ML, Polowski J, Henry CJ, Whiting SJ. Beverage intake improvement by high school students in Saskatchewan, Canada. Nutr Res. 2008;28(3):144–50.

    Article  PubMed  CAS  Google Scholar 

  46. 46.

    Sichieri R, Paula Trotte A, de Souza RA, Veiga GV. School randomised trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr. 2009;12(2):197–202.

    Article  PubMed  Google Scholar 

  47. 47.

    Powell LM, Chriqui J, Chaloupka FJ. Associations between state-level soda taxes and adolescent body mass index. J Adolesc Health. 2009;45(3 Suppl):S57–63.

    Article  PubMed  Google Scholar 

  48. 48.

    Pomeranz JL. Advanced policy options to regulate sugar-sweetened beverages to support public health. J Public Health Policy. 2012;33(1):75–88.

    Article  PubMed  Google Scholar 

  49. 49.

    Institute of Medicine. Local government actions to prevent childhood obesity. Washington, DC: The National Academies Press; 2009.

    Google Scholar 

  50. 50.

    Sturm R, Powell LM, Chriqui JF, Chaloupka FJ. Soda taxes, soft drink consumption, and children's body mass index. Health Aff (Millwood). 2010;29(5):1052–8.

    Article  PubMed  PubMed Central  Google Scholar 

  51. 51.

    “H.R.5279 – 113th Congress: SWEET Act (2013-2014)”. Cited February 2, 2018. Available at https://www.congress.gov/bill/113th-congress/house-bill/5279

  52. 52.

    Levy DT, Friend KB, Wang YC. A review of the literature on policies directed at the youth consumption of sugar sweetened beverages. Adv Nutr. 2011;2(2):182S–200S.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Chriqui JF, Eidson SS, Bates H, Kowalczyk S, Chaloupka FJ. State sales tax rates for soft drinks and snacks sold through grocery stores and vending machines, 2007. J Public Health Policy. 2008;29(2):226–49.

    Article  PubMed  Google Scholar 

  54. 54.

    • Maa J. Taxing soda: strategies for dealing with the obesity and diabetes epidemic. Perspect Biol Med. 2016;59(4):448–64. This study describes the historical and scientific framework of policy on SSBs and lessons learned from implementing these efforts.

    Article  PubMed  Google Scholar 

  55. 55.

    Cook County Government. Sweetened beverage tax. Cited February 20, 2018. Available at https://www.cookcountyil.gov/service/sweetened-beverage-tax

  56. 56.

    Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, et al. The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med. 2009;361(16):1599–605.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  57. 57.

    Buhler S, Raine KD, Arango M, Pellerin S, Neary NE. Building a strategy for obesity prevention one piece at a time: the case of sugar-sweetened beverage taxation. Can J Diabetes. 2013;37(2):97–102.

    Article  PubMed  Google Scholar 

  58. 58.

    Thow AM, Jan S, Leeder S, Swinburn B. The effect of fiscal policy on diet, obesity and chronic disease: a systematic review. Bull World Health Organ. 2010;88(8):609–14.

    Article  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100(2):216–22.

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Joanne F. Guthrie CN, K Ralston, M Prell, and M Ollinger. Nutrition standards for competitive foods in schools: implications for foodservice revenues, EIB-114. In: U.S. Department of Agriculture ERS, editor. 2013.

  61. 61.

    Taber DR, Chriqui JF, Powell LM, Chaloupka FJ. Banning all sugar-sweetened beverages in middle schools: reduction of in-school access and purchasing but not overall consumption. Arch Pediatr Adolesc Med. 2012;166(3):256–62.

    Article  PubMed  Google Scholar 

  62. 62.

    Fernandes MM. The effect of soft drink availability in elementary schools on consumption. J Am Diet Assoc. 2008;108(9):1445–52.

    Article  PubMed  Google Scholar 

  63. 63.

    Forshee RA, Storey ML, Ginevan ME. A risk analysis model of the relationship between beverage consumption from school vending machines and risk of adolescent overweight. Risk Anal. 2005;25(5):1121–35.

    Article  PubMed  Google Scholar 

  64. 64.

    Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: an evidence-based review. Obesity. 2008;16(5):1009–18.

    Article  PubMed  Google Scholar 

  65. 65.

    Sallis JF, McKenzie TL, Conway TL, Elder JP, Prochaska JJ, Brown M, et al. Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. Am J Prev Med. 2003;24(3):209–17.

    Article  PubMed  Google Scholar 

  66. 66.

    Cyril S, Nicholson JM, Agho K, Polonsky M, Renzaho AM. Barriers and facilitators to childhood obesity prevention among culturally and linguistically diverse (CALD) communities in Victoria, Australia. Aust N Z J Public Health. 2017;41(3):287–93.

    Article  PubMed  Google Scholar 

  67. 67.

    Ickes MJ, McMullen J, Haider T, Sharma M. Global school-based childhood obesity interventions: a review. Int J Environ Res Public Health. 2014;11(9):8940–61.

    Article  PubMed  PubMed Central  Google Scholar 

  68. 68.

    Economos CD, Hyatt RR, Goldberg JP, Must A, Naumova EN, Collins JJ, et al. A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Obesity (Silver Spring). 2007;15(5):1325–36.

    Article  Google Scholar 

  69. 69.

    Mahmood S, Perveen T, Dino A, Ibrahim F, Mehraj J. Effectiveness of school-based intervention programs in reducing prevalence of overweight. Indian J Community Med. 2014;39(2):87–93.

    Article  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Silveira JA, Taddei JA, Guerra PH, Nobre MR. Effectiveness of school-based nutrition education interventions to prevent and reduce excessive weight gain in children and adolescents: a systematic review. J Pediatr. 2011;87(5):382–92.

    Article  Google Scholar 

  71. 71.

    Powell LM, Chaloupka FJ. Food prices and obesity: evidence and policy implications for taxes and subsidies. Milbank Q. 2009;87(1):229–57.

    Article  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Sturm R, Datar A. Food prices and weight gain during elementary school: 5-year update. Public Health. 2008;122(11):1140–3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  73. 73.

    French SA, Story M, Fulkerson JA, Hannan P. An environmental intervention to promote lower-fat food choices in secondary schools: outcomes of the TACOS Study. Am J Public Health. 2004;94(9):1507–12.

    Article  PubMed  PubMed Central  Google Scholar 

  74. 74.

    Wharton CM, Long M, Schwartz MB. Changing nutrition standards in schools: the emerging impact on school revenue. J Sch Health. 2008;78(5):245–51.

    Article  PubMed  Google Scholar 

  75. 75.

    Johnston LD, O’Malley PM, Terry-McElrath YM, Colabianchi N. School policies and practices to improve health and prevent obesity: National Secondary School Survey results: school years 2006–07 through 2010–11: Ann Arbor, MI, Bridging the Gap Program, Survey Research Center; 2013.

  76. 76.

    Hatfield DP, Chomitz VR. Increasing children’s physical activity during the school day. Curr Obes Rep. 2015;4(2):147–56.

    Article  PubMed  Google Scholar 

  77. 77.

    Fletcher J, Frisvold D, Tefft N. Substitution patterns can limit the effects of sugar-sweetened beverage taxes on obesity. Prev Chronic Dis. 2013;10:E18.

    Article  PubMed  PubMed Central  Google Scholar 

  78. 78.

    Julie Samia Mair MWP, SP Teret. The use of zoning to restrict fast food outlets: a potential strategy to combat obesity. Center for law and the public’s health at Johns Hopkins and Georgetown Universities; 2005.

  79. 79.

    U.S. Food and Drug Administration. Menu and vending machines labeling requirements. 2010. Cited Feberary 2, 2018. Available at https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm217762.htm

  80. 80.

    Harris JL, Graff SK. Protecting young people from junk food advertising: implications of psychological research for First Amendment law. Am J Public Health. 2012;102(2):214–22.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Dr. Eduardo J. Simoes reports grants from NIH/NIDDK. This publication was partially funded by Grant Number 1P30DK092950 from the NIDDK, and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIDDK.

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Yilin Yoshida and Eduardo J. Simoes declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by either of the authors.

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This article is part of the Topical Collection on Economics and Policy in Diabetes

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Yoshida, Y., Simoes, E.J. Sugar-Sweetened Beverage, Obesity, and Type 2 Diabetes in Children and Adolescents: Policies, Taxation, and Programs. Curr Diab Rep 18, 31 (2018). https://doi.org/10.1007/s11892-018-1004-6

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Keywords

  • Sugar-sweetened beverage
  • Obesity
  • Type 2 diabetes
  • Children and adolescents
  • Policies and programs