1. Addressing the Obesity Epidemic and Sugar-Sweetened Beverages Roberta R. Friedman, ScM Director of Public Policy Yale Rudd Center for Food Policy and Obesity Hospitals for a Healthy Environment in RI Conference April 2, 2010

2. The Rudd Center Strategic Science – Economics – Food Marketing to Youth – Law, Nutrition & Obesity – Public Policy – Schools, Families & Communities – Weight Bias & Stigma – Food & Addiction 2

3. Today Science Mechanisms Inconsistencies in literature

4. Definition

6. Added Sugars Sugar induces all of the diseases associated with metabolic syndrome, including: – Hypertension – High triglycerides and insulin resistance – Diabetes Lustig, Nature, 2012

7. Sources of added sugars, NHANES 2007-08

10. Lustig, Nature, 2012

11. Empty Calories 250 calories16 tsps sugar

12. 16 oz32 oz44 oz52 oz64 oz 48 Teaspoons Sugar Portion Sizes

13. Intake Average US intake = 45 gallons/yr Average US child = 193 calories/day Andreyeva, 2011; Smith, 2010

14. Wang et al. Pediatrics, 2008

15. Marketing

16. Health Outcomes Wt gain/obesity Type 2 diabetes Cardiovascular disease Diet Quality Dental caries Osteoporosis Gout No credible evidence of benefit

17. Obesity Children – Every additional serving of per day increased risk by 60% – More likely to be overweight and obese later in life Adults – 1 or more SSB/day = 27% more likely to be overweight

18. Clear association of intake w. increased calories, body wt., risk of diabetes AJPH, 2007

19. Recent large studies show relationship between long-term weight gain, type 2 diabetes, CVD Phys & Behav, 2010

20. Cardiovascular Disease Link to – Higher blood pressure – Adolescents’ risk of CVD and type 2 – Waist circumference – High LDL cholesterol – Low HDL – Hypertension

21. Other Concerns Deterioration in dietary quality – lower intakes of calcium, fiber, micronutrients, other protective compounds Dental caries – consistent observational and laboratory data Osteoporosis – displacement of calcium-containing foods, effects of phosphoric acid, other components

22. Mechanism Sugar in liquid form less filling than in solid We don’t compensate for extra liquid calories by eating fewer calories from solid food Mourao, IJO, 2007; DeCastro Physio Behav, 1993; Harnack, JADA 1999

23. …studies funded by the food industry reported significantly smaller effects than did non–industry-funded studies. AJPH, 2007

24. Industry funding increased likelihood of finding favorable to the sponsor by 4 to 8-fold Lesser, et al., PLoS, 2007

25. Thank you! Roberta.Friedman@yale.edu www.yaleruddcenter.org www.yaleruddcenter.org/ssbtax