1. Rethink Your Drink: Sugar – Loaded Beverages & Obesity

2. 2

3. LEARNING OBJECTIVES
Identify sugar-loaded beverages and their sugar content
Identify negative health impacts of sugar-loaded beverages
Understand the insidiousness of these drinks
Share alternatives to sugar-loaded beverages
Share effective strategies to reduce consumption
NARRATIVE:
At the end of this presentation, you will be able to:

4. Obesity & Chronic disease
The Context
Obesity & Chronic disease

5. Obesity: A Global Epidemic
Throughout the world, between 1980 to 2008, obesity rates almost doubled. 146 million adults were overweight; 502 million were obese in 2008.
NARRATIVE:
Obesity is a global epidemic.
From 1980 to 2008, according to the World Health Organization, worldwide obesity rates almost doubled. A recent study in the Lancet medical journal concluded that in 2008, about 146 million adults globally were overweight and 502 million were obese. Around half of the adult population in Brazil, Russia, and South Africa are overweight and about 8 percent of all African adults are obese. According to the Lancet study, the worldwide health cost attributable to obesity and its consequences added up to 36 million disability-adjusted life-years (a measure of healthy years of life lost to a disease).

6. In the USA
Our nation is in the midst of a public health crisis so profound that is it undermining our national well-being, our economic competitiveness and even our long-term national security.
Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future - June 2012

7. In the USA
In US, 1/3 of children and 2/3 of adults are overweight or obese.
By 2030, 42 % of all adults will be obese, costing an additional $550 billion in health care expenditures.
NARRATIVE:
According to the CDC and Weight of the Nation, a recent 4 part documentary that aired on HBO about the obesity epidemic……(read bullets above).
In other words, an additional 30 million Americans will count themselves among the way-fat within 18 years, and about 11% of the population will be severely obese — that is, at least 100 pounds overweight.
This number does not include children.
Despite reports that obesity levels were tapering off, scientists found that Americans are gaining weight all the time. There has also been a surge in severe obesity (being overweight enough to reduce your life expectancy by at least seven years.

8. Obesity in Illinois
In 1995, Illinois’ obesity rate was 15.5%; today it is nearly double. By 2030, the predicted rate will be 53.7%.
Nearly two-thirds (64%) of all Illinoisans are overweight or obese.
Illinois is one of the top ten states for obese/overweight adolescents (ages years).
NARRATIVE:
Percentage of normal weight Illinois adults has steadily decreased as percentage who are overweight or obese has steadily increased.
References: Bullet 1: This data comes from the 2011 F as in Fat Report: How Obesity Threatens America’s Future compiled by the Trust for America’s Health. And from Bending the Obesity Curve in Illinois, Trust for America’s Health, September, 2012.
Bullet 2 and 3:
Levi, J., Vinter, Segal, L., St. Laurent, R., Kohn, D.(2011) F as in Fat: How Obesity Threatens America’s Future 2011 Retrieved from Trust for America’s Health website:

9. 1 in 5 Illinois children are obese; the fourth worst rate in the US.
Mississippi
Georgia
Kentucky
Illinois & Louisiana are tied.
NARRATIVE:
READ THE SLIDE.
NOTE TO PRESENTER: Now is a good time to share community specific information about obesity for your audience.
Reference:
Levi, J, et al. (2011) F as in Fat Report: How Obesity Threatens America’s Future 2011 Retrieved from Trust for America’s Health website:

10. Obesity is Expensive
Obesity costs the Illinois health care system and taxpayers $3.4 billion per year – including $1 billion to Medicaid and $800 million to Medicare. Adjusting for inflation, it is an estimated $4.4 billion expenditure.
If nothing changes, experts predict the cost of obesity could increase to $14 billion or more a year by 2018; $27 billion by 2030.
References: Bullet 1
Levi, J., Vinter, S. Richardson, L., St. Laurent, R, Segal, L. (2009) F as in Fat: How Obesity Threatens America’s Future 2011 Retrieved from Trust for America’s Health website:
Chaloupka, F., Wang, Y.C., Powell, L., Andreyeva, T., Chriqui, J., Rimkus, L. (2011) Estimating the Potential Impact of Sugar-Sweetened and Other Beverage Excise Taxes in Illinois.
Bullet 2
United Health Foundation. America’s Health Rankings (2009) Direct Health Costs Associated with Obesity: 2018; Retrieved from.
Bending the Obesity Curve in Illinois. Trust for America’s Health, September, 2012

11. Obese people suffer more injuries and disabilities and have more non-productive work days, creating loss of productivity.
For the first time in history, the current generation may have a shorter lifespan than their parents.
NARRATIVE:
Every year, obesity costs US employers $73 billion in lost productivity. Lost productivity impacts both the organization and the individual. Self esteem is linked to work for many people.
There are lots of other issues.
Military, police forces and firefighting units are having trouble recruiting people.
The transportation industry spends as many as 1 billion additional gallons of gas; producing carbon dioxide emissions of nearly 10 billion tons.
Airlines are spending an extra $275 million annually for 350 miilion more gallons of fuel, which releases an extra 3.8 million tons of carbon dioxide.
Manufacturers have to provide products for bigger bodies: Clothing, public seating, furniture, bathroom fixtures, health care facilities and cemetary supplies.
…..
For the first time since the Civil War, life expectancy is falling (David Ludwig, cite radio program)
Read second bullet
Reference: Bullet #2
Olshansky, S, J., Passaro, D,, Hershow, R., Layden, J., Carnes,B., Brody, J., … Ludwig D.S. (2005).A Potential Decline in Life Expectancy in the United States in the 21st Century New England Journal of Medicine; 352:1138 – Retrieved from

12. Sugar-Loaded Beverages
NARRATIVE:
Beverages, in general, are a big part of our lives. They are important to a healthy diet as sources of hydration. They also provide calories, macro- and micro- nutrients.
And they are part of our everyday socialization process. When we are at social functions, we drink…we meet for tea or coffee, have a glass of wine, finish a tennis game and drink a sports drink and have a burger, fries and a soft drink.
Over-consumption of unhealthy drinks with no nutritional value is our concern.
Consumption

13. More than 1/3 of all sugars are consumed in sugary beverages – the greatest source of added sugar in the US diet.
NARRATIVE:
While acknowledging the complexity of the obesity epidemic and all of the circumstances that got us here, today we are focusing on the one choice that could have the fastest impact on weight loss and the reversal of the epidemic. Consumption of sugar loaded beverages.
Reference:
Guthrie JF, Morton JF. Food sources of added sweeteners in the diets of Americans. J Am Diet Assoc
2000;100:43–51.

14. What is a sugar-loaded beverage?
Any beverage with added caloric sweetener including soda, other carbonated soft drinks, juice drinks, sports drinks, energy drinks, powdered drinks, sweetened milk or milk alternatives, sweetened tea or coffee drinks & flavor-enhanced water.
Caloric sweeteners include: high fructose corn syrup, cane sugar, fructose, fruit juice concentrate, glucose, sucrose, honey, brown sugar, dextrose, agave syrup and corn sweetener.
NARRATIVE: You will hear lots of terms to describe these drinks and they are used interchangeably in most cases…sugar-sweetened beverages, sugar-loaded beverages, sugary drinks…
All of these terms mean the same thing. .
Between 1985 and 2005, the overall availability of SSBs in US increased by 8.5 gallons per capita per year; 40% of this increase is due to sports drinks and fruit flavored drinks.
Spotting added sugar on the food label requires a bit of detective work. Food and beverage manufacturers must list a product's total amount of sugar per serving on the Nutrition Facts Panel. But they are not required to list how much of that sugar is added sugar. 

15. Added vs. Naturally-Occurring
NARRATIVE:
Remember, we are not talking about drinks with naturally occurring sugar, like the lactose in milk products or the fructose in fruit that might end up in 100% fruit juice drinks.
We are discussing drinks with added sugar.
A glass of milk provides nutritents, a fruit drink or a soda provides lots of calories, no nutrients.

16. US Consumption Trends Reference: Data taken from three resources
Nationwide Food Consumption Survey ( )
Continuing Survey of Food Intakes by Individuals ( , 1994 – 1996; National Health and Nutrition Examination Survey (1999 – 2001)

17. Who Drinks Sugar Drinks on a Given Day?

18. Beverages account for 1/5 of all weight gained by Americans between 1977 and 2007.
NARRATIVE:
Some reasons for this result include:
SLBs increase hunger, decrease satiety and decrease fullness. (Ranawana, Henry. Int J Food Sci Nutr feb;62(1):71-81)
Bodies don’t compensate for liquid calories in the same way as solid food.
Sugar highs and lows. Sugary foods and drinks tend to hold you over for 10 – 15 minutes. A lean protein of a complex carb can hold you over for 3 hours.
They add calories without providing nutrients.
Reference:
Woodward-Lopez G., Kao, J, Ritchie, L... (2010) To What Extent Have Sweetened Beverages Contributed to the Obesity Epidemic?
Public Health Nutrition, 2010 Retrieved from

19. One soda a day equals 25 extra pounds a year.
Half of US population over the age of two consumes sugar-loaded beverages daily.
One soda a day equals 25 extra pounds a year.
Every additional serving of sugar-loaded beverages per day increased risk of obesity in children by 60%.
Adults who drink one or more daily are 27% more likely to be overweight or obese.
Illinoisans consumed 620 million gallons of sugar-loaded beverages in 2011.
References:
Bullet #1:
Ogden CL, Kit BK, Carroll MD, Park S. (2011) Consumption of sugar drinks in the United States, 2005–2008. NCHS data brief, no 71. Hyattsville, MD: National Center for Health Statistics. Retrieved from
Bullet#2: Cook County Rethink Your Drink materials
Bullet #3: Yale Rudd Center for Food Policy and Obesity (2009) Rudd Report: Soft Drink Taxes Policy Brief. Retrieved from
Bullet #4: Ludwig, D.S., Peterson, K.E., & Gortmaker, S.L. “Relationship between Consumption of Sugar-Sweetened Beverages and Childhood Obesity: A Prospective, Observational Analysis”, Lancet, Retrieved from:
Bullet #5: Chaloupka, F., Wang, Y.C., Powell, L., Andreyeva, T., Chriqui, J., Rimkus, L. (2011) Estimating the Potential Impact of Sugar-Sweetened and Other Beverage Excise Taxes in Illinois.

20. Source: Dietary Guidelines for Americans 2010
NARRATIVE:
When you add up the calories from the added sugars in tea, fruit drinks, soda, energy drinks and sports drinks you see that these beverages are the sources of 51% of the added sugars in our diets.
Source: Dietary Guidelines for Americans 2010

21. American Heart Association warns the daily intake of sugar for an adult woman should be no more than 6 teaspoons (tsp) and no more than 9 tsp for adult men. For children the recommended daily amount should not exceed 3 tsp and for teens the maximum amount is 8 tsp.
BEVERAGE
Serving
Amount of Sugar
COLA
12 oz
10 tsp
20 oz
17 tsp
ORANGE SODA
13 tsp
LEMONADE ICED TEA
16 oz
ENERGY DRINK
16 tsp
8 oz
7 tsp
SPORTS DRINK
9 tsp
FLAVORED WATER
8 tsp
JUICE DRINK
6.75 oz
4 tsp
6 oz
Read the American Heart Association recommendation
NARRATIVE: The average American consumes 22 teaspoons of sugar daily which is about 51 Pixie Stix (powdered candy) or 17 four pound bags of sugar in one year.
I have a caveat, we will be using lots of brand names in this presentation, but that is merely to give context and share information that will resonate.
We are not targeting one as worse than another. We chose certain brands that are popular so that you would recognize them. Later we will talk about why.
A woman who drinks a 20 oz cola has had almost three times the maximum amount. She has had 17 teaspooons of sugar.
A teenager who drinks an Energy drink has doubled the max.
Child who drinks a fruit drink has had four teaspooons.
Man who drinks a bottle of iced tea has had 13 teaspoons of sugar.
Presenters Notes: Be creative about how you share this information; this is a good place to engage the audience. Ask them are they surprised by any of this information?

22. This profile beverage sugar and calories shows how easily sugar can be hidden in beverages that have been deemed healthy. Portion sizes have gotten way out of control and been lead by industry rather than by public health. Cranberry Juice cocktail, which many hospitals serve and mistake as a healthy choice, has the highest calories and has the most sugar, even orange juice has 170 kcal and 10 tsp of sugar in 12 ounces.
Harvard University, 2009
37.008

23. Sugar-Loaded Beverages
The Science

24. Sugar -Loaded Drinks & Disease
Direct scientific evidence links sugary drinks, not just to obesity but also to:
Type 2 Diabetes
Cardiovascular Disease
Hypertension
Gout
Kidney Damage
Dental Issues
Cancer
Sleep Disturbances
NARRATIVE: Various methodologies have been used to study the impact of sugary drinks on diseases including:
Physiological Mechanisms
Prospective
Cross-sectional
Randomized Control Trials (the “gold standard” of studies). All have shown a link. .
IPHI recently hosted a symposium and four experts shared information about sugar loaded drinks and disease. This list is based on their presentations.
The Rudd Center for Food Policy & Obesity has compiled a bibliography of 127 studies of ssb impact on obesity (adult and child) and other diseases, as of August, 2012.
According to Rudd, where there is inconsistency, it is often based on bias arising from conflicts of interest. Many of the studies that discount this connection have been funded by the beverage industry. Others have biological variations.

25. Sugary Drinks and Oral Health
Nearly doubles the risk of dental caries.
Acid in sugary drinks causes tooth erosion, OFTEN AFTER ONE SIP. (Diet drinks contain acid)
Provide fuel for bacteria causing tooth decay.
Associated with plaque deposits in arteries. 25

26. Mucca et al. Intern Emerg Med. 2011 May 5.26

27. Cardiovascular Disease Asthma Hypertension Osteoporosis
SLB Links
Obesity Links
Type 2 Diabetes
Cardiovascular Disease
Asthma
Hypertension
Osteoporosis
Poor Diet Quality
Arthritis
Cancer
Sleep Apnea
Obesity
Type 2 Diabetes
Cardiovascular Disease
Hypertension
Gout
Poor Diet Quality
Kidney Damage
Cancer
Sleep Disturbances
Dental Issues
PRESENTERS NOTES:
Ask the audience to look at the slides and note the similarities.
Depending on your audience, you may want to highlight some of these things that are relevant to the health of your community.
. Good place to talk about the AHA research that says slb intake can increase cv disease risk regardless of weight.

28. Sugar-Loaded Beverages
portions & Products

29. NARRATIVE:
We can’t talk about consumption of sugar-loaded beverages without discussing the portion sizes.
The original Coke bottle size was 6.5 ounces in the 1920s; smaller than the bottle on the left side of the slide which is 8 oz. 12 ounce cans were introduced in the 1960x.
20 oz bottles were introduced in the early 1990s and I liters in the late 1990s.

30. 16 ounces served 3 people! . NARRATIVE:
Here is an ad that we found that is from the Coca-Cola Museum. I don’t know the year of the ad, but you can tell from the way the woman is dressed that it is not in the 21st century -- but not that long ago, in a more formal time. A good guess is the 60s, early 70s.
At one time, the message sent was that 16 ounces served 3 people. We are a long way away from that now. Some 20 oz bottles are sold as single servings.

31. Super Size Me! 48 teaspoons of sugar 16 oz 32 oz 44 oz 52oz 64oz
NARRATIVE:
That double gulp not only has 48 teaspoons of sugar, it is 720 calories.
There are 4.2 grams in one teaspoon.
We pick on convenience stores and fast food restaurants (the size of McDonald’drinks has grown 457% since 1955, But let’s not forget movie theatres, sporting arenas that host lots of different arenas. These cups could come from just about any place.
In sit-down restaurants the cups are sizable and many offer free refills.
16 oz oz oz oz oz

33. Share of Sales: 2010 644 Products 61 Brands 14 Companies
NARRATIVE:
There are 644 products on the market that are defined as sugary drinks. 61 different brands from 14 companies.
In the following slides, we will talk about the products. Here are some things to think about. Marketers want to make these drinks seem as healthy as possible, so that you will buy them. More than half of sugary drinks and energy drinks use positive attributes on their packaging. Words like “all-natural”, or “real” ingredients or “low-sodium”. They often make claims that they have “fewer calories thatn the leading beverage”. This is one of the reasons that so few people know what they are drinking.
Source: Rudd Center for Food Policy & Obesity Yale University

34. Fruit Juice & Drinks… Soda by Another Name?
NARRATIVE:
A recent infographic from healthscience.net calls fruit juice, “soda in disguise” Some call it concentrated sugar.
FRUIT DRINKS
The FDA states that any drink can be called a fruit drink, as long as it has some fruit juice. Only 44% of fruit drinks contain any juice.
Fruit drinks often have more sugar and more calories than soda, the 18 most sugary beverages on the market are fruit drinks not soda.
Fruit drinks made up more than 50% of all sugar-loaded beverages marketed in One-third of those drinks were for children.
Parents often believe nutrient claims about vitamin C, real and natural ingredients mean these products are healthful options for their children.
Some products even have BOTH added sugar and artificial sweeteners. 34 34

35. Source: SugarStacks.com
NARRATIVE:
We’ve talked about fruit drinks, let’s talk about fruit juice. An 8oz glass of orange juice has 24 grams of sugar ). The bottle is 48 grams or 12 sugar cubes.
The apple juice on the right has as much sugar as a soda.
Source: SugarStacks.com 35

36. Flavored Water…Sugar Water
NARRATIVE:
Flavored water contains any variety of added ingredients including fruit and other flavorings, herbs, vitamins, minerals, anti-oxidants, sodium, protein, fiber and caffeine. Mostly marketed as health enhancing, but also as a sports drinks.
Words like "endurance," "energy," "essential," and "focus” are used to describe these drinks. Yet, some brands have between 6-8 teaspoons per 20 ounce bottles ( calories).
For example VitaminWater Power C has 13 grams of sugar per 8 oz (compared to Coke which has 27 grams per 8 ounces) VitaminWater is a 20 oz bottle so it has 32.5 grams per bottle.
Crystalline fructose is the sugar in the drink.
You will note that we have used a campaign for Vitamin Water Zero which does not have sugar on the right. We wanted to show you the language marketers use. 36

37. ENERGY DRINKS
American Academy of Pediatrics recommends that energy drinks NEVER be consumed by children or adolescents. One in three teenagers regularly drinks them. These energy drinks contain a comparable number of calories as soda and juice drinks.
NARRATIVE:
Two of the most active sectors of the beverage market are energy drinks and sports drinks. Energy drinks are often as caffeinated as coffee. In most energy drinks, nearly all calories come from added sugar
16 oz can = 13 teaspoons of sugar + caffeine in 4 or more cans of soda
Java Monster Coffee + Energy Loca Moca (15 fl oz) has 200 calories, 3 g fat (1 g saturated fat) and 32 g of sugar.
5 Hour Energy is the exception in this grouping; it has 4 calories, no fat and no sugar.
An 8 oz can of Red Bull has 7 teaspoons of sugar.
In a recent Pediatrics article, anywhere between 30% and 50% of teen and young adults drink energy drinks. 37

38. Sports Drinks
For the average child engaged in routine physical activity, the use of sports drinks in place of water on the sports field or in the school lunchroom is generally unnecessary.
American Academy
of Pediatrics
NARRATIVE:
Sports drinks are recommended for hydration only after intense exercising lasting more than 60 minutes and are unnecessary for shorter exercise periods (American College of Sports Medicine and American Dietetic Association)
The share of slb consumption attributable to sports drinks increased threefold among adolescents (Wang, etal, 2008)
Between , the purchase of traditional carbonated soft drinks in schools decreased by 24%, while at the same time, the purchase of sports drinks increased by 70%. (Wescott, RF. 2005)
The acid in sports drinks erodes the teeth from the first sip until 45 mins after the last sip, when the saliva returns the mouth to its natural ph balance.
Sports drinks have sodium in them. 38

39. Coffee & Tea in Bottles and Cans
NARRATIVE: We drink them in bottles and cans. Here is some information about the amount of sugar in some pre-sweetened coffees and teas.
Some examples of how much:
One brand (8 oz) has 80 calories, O g fat and 22 g of sugar. That is 10 calories per ounce.
Another brand that is 20 oz has 200 calories and 53 grams of sugar.
A third bottle that is 17.5 fl oz is 140 calories and 33 g of sugar.
Relating to contributions to weight gain, coffee drinks are not just full of sugar they have fat grams in them as well.
Starbuck’s Frappucino (9.5 fl oz) 200 calories, 3 g fat (2 are saturated fat) with 32 g of sugar.
POM Café au lait Iced Coffee (10.5 fl oz) 170 calories, 3 g fat (2 g of saturated fat) and 20 g of sugar.

40. Sugar-Loaded Beverages
NARRATIVE:
Billions are spent by beverage companies to market their products.
Marketing

41. TV Advertising
From , exposure to TV ads for full calorie soda doubled for children and teens.
2/3 of all radio ads heard by teens were for full calorie soda.
In 2010, teens saw 18% more energy drink tv ads and heard 46% more radio ads than adults.
63% of all full calorie soda and energy drink ads on national TV include sponsorship of an athlete, sports league or team, event or cause.
NARRATIVE:
While reducing their TV advertising, they have increased their outreach to children and teens through other outlets like Facebook, mobile marketing and product placement in television and movies.
The information on this and the next few slides comes from Sugary Drink FACTS, a report done by the Rudd Center.

42. Target Markets
Beverage companies see Latinos, African Americans and teens as a source for future sales.
Black children and teens saw 80% to 90% more ads than white youth.
Marketing for Spanish market TV is growing. Between 2008 – 2010, Latino children saw 49% more ads for sugary drinks and energy drinks and teens saw 99% more ads.
Latino pre-schoolers saw more ads than Latino children and teens.
Reference: Sugary Drink FACTS

43. “We’re changing fundamentally from being TV commercial producers to content developers…We’re leading a new and unique approach…from purely mass marketing to one-on-one marketing.” CEO, Coca-Cola, 2009
NARRATIVE: While not giving up on television and radio, the beverage industry has expanded their efforts in social media where they can have, as you can see from this quote, “one-on-one conversations”.

44. NARRATIVE:
Beverage companies using mobile apps (applications), banner ads, banner ads on third party websites, text messages, Facebook and Twitter., etc. etc. All of these mechanisms allow to direct “conversation” with their market.
According to a Senior Vice President of Coca-Cola (2011) “We can’t afford not to TALK to teens. You can’t think ‘Teens already know us,’ and skip a couple of years. Every six years there’s a new population of teens in the world”.
Coca-Cola is the number one beverage company on Facebook with 50 million fans! Red Bull is number 8 with over 29 million.

45. NARRATIVE: Here is an example of a recent campaign done by Capri Sun to introduce the Big Pouch This product is bigger than other Capri Sun pouches (11.2 oz, has a new shape and a reclosable cap. The suggested retail is 79 cents.
The Facebook page went live in November before the product was on the shelves in May. The page advertises the limited availability of the drinks. The target is 12 – 15 year old boys.
“For the first time, our intended consumer may be old enough to engage with us through social platforms like Facebook”. Capri Sun Exec
Today, the page has over 125,000 likes. 45

46. Not just for kids! 46 NARRATIVE:
Marketing is not just for children and young adults. Here is something for the fashionistas.
Since 2003, Coca-Cola has been colllaborating has been collaborating with designers like Matthew Williamson, Marni and Karl Lagerfeld .
Samples of Karl Lagerfeld (2011) and Diane Von Furstenburg. (2011), Patricia Fields (2008) and Jean Paul Gaultier (2012) . 46

47. President, Brand Manager, Sparkling Beverages, Coca-Cola North America
“We have a timeless commitment to enhance well-being in all of its forms. Encouraging people to get active and providing them with opportunities to do so, has always been at the heart of our brand values.”
President, Brand Manager, Sparkling Beverages, Coca-Cola North America
NARRATIVE:
This year for the 2012 summer Olympics, Coca-Cola and McDonalds were the major sponsors. Coca-Cola created an 8-pack of cans. Move to the Beat was targeted to teens and connects the brand to a healthier lifestyles.
They celebrate the best of us and pull at our heart strings, plus they share their story about supporting the athletes in their pursuit of excellence.
This is also complicated because Coca-Cola is a major sponsor directly for the athletes. 47

48. Sugar-loaded Beverages
Reducing Consumption

49. Context that makes Default Healthy
Education is important, but rarely improves health outcomes.
Changes in policy, systems, and environments broadly affect the way we live and shape the patterns of our health.
Counseling
and Education
Clinical Interventions
Population Impact
Individual Impact
Long-lasting Protective Interventions
Context that makes Default Healthy
NARRATIVE:
To make lasting changes, we must use our living democracy to advocate for coordinated systems changes.
Why policy?
Programs are one time, limited reach, medical models, can’t really influence the default change.
Policy is “permanent”, have universal reach, gets us to the optimal default and is the public health model.
Source: Frieden TR. A framework for public
health action: health impact pyramid. Am J Public Health  2010 Apr;100(4): Epub 2010 Feb 18.
Copyright: American Public Health Association, 2010
Socioeconomic Factors
The Health Impact Pyramid

50. Where You Live Affects How You Live
Being healthy is not just about individual choices.
Many communities and institutions offer far more unhealthy food/beverage options and choices than healthy ones.
Healthy options more expensive than unhealthy options.

51. Reducing Consumption
Change institutional settings to encourage healthy drink options
Create Healthy Beverage Policy in workplaces, hospitals, schools, child care and other community settings
Remove from vending machines, cafeterias, etc.
Change mix of drinks in machines
Product placement – water at eye level
Pricing Strategies: Water costs less than sugary drinks
Serve drinks that are no more than 25 calories per 8 oz. at meetings, events, conferences, etc.
No marketing at public events (arenas, sporting events, playgrounds)
Ban them on property

52. Reducing Consumption
Increased education about negative health effects of sugary drinks
Students, staffs, patients and other constituents
Health care leaders/hospitals, doctors, nurses
Counter-marketing strategies (e.g. Rethink Your Drink & Pouring on the Pounds)
Media outreach
Community engagement and empowerment
Public health policy strategies
Excise tax to support a prevention fund
Restrict portion sizes (a la New York)
Restrict sales & use in schools
NARRATIVE: Other Campaigns:
Rethink Your Drink Campaign
Changing public perceptions of healthy drink choices
Re-introducing water and other healthy choices as the default choices
Cook County Rethink Your Drink
Ad campaigns in New York City (example shown in this presentation, Philadelphia, Seattle
Boston CPPW Project
Beverages are prohibited in vending machines in San Antonio and San Francisco.
Failed proposal in New York to not allow SNAP recipients to use their benefits to purchase soda.
Kick The Can
IAPO Speakers Bureau

53. Reducing Consumption Excise Tax on Sugar-loaded Beverages
Generate more money
Easier to administer
Reflected in the shelf prices that would lower consumption
Provides stable revenue

54. Just a Penny per Ounce
A one-cent per ounce excise tax on sugar-loaded beverages would produce:
23.5% drop in consumption;
185,127 fewer obese Illinoisans (9.3% reduction in the number of obese youth between the ages of and 5.2% reduction in number of obese adults);
3,442 fewer people with diabetes;
Reduction in health care costs related to diabetes and other obesity related diseases totaling $171.5 million in the first year; and
New tax revenues totaling $606.7 million to invest in prevention.
NARRATIVE:
Why would this work? The concept of price elasticity is in play. SLBs are not necessities. As price increases, demand will decrease since they are not considered essential. The experiences we have had with cigarette and alcohol taxes are illustrative.
PRESENTERS NOTES:
Refer to/share the Chaloupka Report
Note: This proposal is for drinks in containers. The average size is 2 oz cans and 20 oz bottles.

55. Obesity Prevention Fund
Tax Revenue used to transform policy & environment
Develop safe routes for children to walk or bike to school
Build protected bike lanes and jogging/walking paths
Increase access to healthier foods and beverages
Subsidize healthy food
Fix water fountains
Support low cost physical activity options
Presenter Notes: Share local examples of how this money could be used to positively impact YOUR community and THE AUDIENCE’S community.

56. Political Will?
Polls show support for tax that directly funds obesity prevention efforts
People don’t want money to close funding gaps
Similar efforts in Boston, Seattle, Los Angeles, New York, Philadelphia, Mexico, France, California
In places where efforts have been thwarted, proposals continue

58. Rethink Your Drink – Healthy Choices
Stock the fridge with seltzer, unsweetened tea, low-fat milk and other low-calorie drinks.
Serve cold tap water during meals. Tap water is delicious, clean and free!
Add fresh fruit and herbs to your water.
Read labels. Choose drinks with no more than 25 calories per 8 ounces.
If you buy fruit juice, make sure it’s 100% juice.
Serve in a small glass or dilute with water.
NARRATIVE:
Here are some ideas for individuals wanting to make healthier choices.
Presenters Notes:
A note about diet drinks….first of all while they don’t have sugar, they have other things in them. Recent study also links sugar free drinks to increased risk of cv. (not a lot of studies on this). Some theorize that artifiicial sweeteners increases the urge for other sweetened food and drinks.
There are also some questions your audience may raise about tap water: taste…lead in pipes….fear that water is unsafe…water bottles as an environmental issue as well as the plastic of some bottles contaminating water.

59. Call to Action!
Take Rethink Your Drink Pledge:
Spread the word. Talk to family, friends & neighbors.
Write letters to your local newspaper & policymaker.
Go to: and for more info. 59

60. Thank you!