The Dilemma of Sugar-Sweetened Beverages

Abstract

Much recent evidence has shown that sugar-sweetened beverages (SSBs) are of serious concern in the etiology of obesity [1–3], type 2 diabetes [4–6], and possibly cardiovascular diseases [7–9]. While the great bulk of the evidence comes from highly developed countries, the problem may be even greater in low-income and middle-income countries (LIC andMIC) where urbanization is having dramatic effects on changing the diet towards a fast-food culture [10, 11]. It is predictable, therefore, that the producers of SSBs will view such countries as emerging markets and target themwith advertising in order to expand sales. Indeed, this is already happening. SSBs are now being heavily marketed in many LIC and MIC by varied means including television (TV), radio, billboards, and cinema. Both children and adults are exposed to advertising, often on a daily basis. Health educators cannot compete with this carefully orchestrated barrage of costly messages, of which TV is probably the most powerful. In dealing with the issue of SSBs one first has to unpick the sequence of events that brings SSBs to the lips of consumers. Much evidence from developed countries has shown that TV is a powerful marketing tool [12, 13]. Longer hours of watching TVare associated with increased consumption of SSBs and fast foods, and decreased consumption of fruit and vegetables [14, 15]. In addition, greater exposure to advertising for fast-food products is associated with a higher BMI among children [14]. A study undertaken on five continents, including Asia, showed that up to 87 % of advertising of food products was for those high in energy and undesirable nutrients [16]. A study that evaluated food marketing in 20 European Union countries found that confectionary and savoury snacks were the most commonly marketed products to children across all countries [17]. Furthermore, TV was found to be the prime promotional medium, followed by in-school and internet marketing. Using data fromNational Health and Nutrition Examination Survey (NHANES) 2003–04 and a mathematical simulation model, Veerman et al. [18] concluded that when TVadvertising was reduced to zero, the average BMI of 6–12-year-oldswould decrease by 0.38 kg/m, and the prevalence of obesity would decrease from 17.8 to 15.2% for boys and from 15.9 to 13.5% for girls. Magnus et al. [19] showed that restricting TV food advertising to children is the most cost-effective populationbased intervention strategy available to government. The withdrawal of advertisements for non-core foods and beverages to Australian children had a gross incremental cost-effectiveness ratio of US$3.70 per disability-adjusted life year (DALY). This saved a total of 37,000 DALYs. When the present value of potential savings in future health-care costs was considered (US$301 million), the intervention was regarded as being ideal, since it resulted in both a cost offset compared with current practice and also a health gain [19]. Clearly, TV advertising, particularly that aimed at children, needs to be addressed since it is one of the most powerful marketing tools used to boost sales of SSBs. One policy option for dealing with SSB consumption is to reduce (or ban) advertising of SSBs. The great potential of this strategy is shown by the ban of cigarette advertising by many governments, which proved a great success as part of efforts to reduce the prevalence smoking [20]. However, while most health consumer groups and public interest groups (in Europe) have for some years supported food marketing restrictions, N. P. Steyn (*) Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa e-mail: npsteyn@hsrc.ac.za