Sugar-Sweetened Beverages — Polling Results
by James A. Colbert, M.D., and Jonathan N. Adler, M.D.
The New England Journal of Medicine
January 17, 2013

Recently, we gave you the opportunity to share your opinions regarding government regulation of sugar-sweetened beverages in Clinical Decisions, an interactive feature designed to assess how readers would manage a clinical problem for which there may be more than one appropriate approach. Two experts presented arguments, one in favor of government regulation and one opposed. Readers were asked to decide between these two approaches and to share their thoughts on this controversial topic.

We received 1290 votes from readers in 75 countries. A total of 68% of the voters favored government regulation of sugar-sweetened beverages to help reduce the burden of obesity. We observed a striking consistency in the results across all regions of the globe, with the exception of one outlier — the United States: 58% of voters from the United States supported government regulation of sugar-sweetened beverages, whereas 84% of voters from other countries supported such regulation (Figure 1).

Support for Government Regulation of Sugar-Sweetened Beverages
This pattern may not be surprising to people familiar with U.S. history and politics. Americans have long prided themselves on such values as individualism and personal responsibility. For many, the notion of freedom is intimately linked to the right to make personal decisions without interference from the state. Consider the recent debate over health care reform in Washington, D.C., in which there was a lack of support for a “public option” to provide health care. However, the U.S. government does have a history of intervention in the name of public health — most notably with regard to the regulation of tobacco.

The 92 comments from readers provide some insights. Readers opposed to government regulation of sugar-sweetened beverages pointed out that the problem of obesity involves much more than the excess consumption of sugary drinks and that limitations on portion size or taxes on soft drinks will not alter the fundamental issue — that people need to change the way they live their lives. Meals need to include more vegetables and whole grains, and portions need to be smaller. Children and adults need to spend less time sitting down and more time engaged in physical activity. Readers opposed to government regulation did not deny the seriousness of the obesity problem or the need for educational interventions aimed at changing behavior with respect to food consumption. They just disagreed with the concept of legislative restriction of personal choice regarding foods and beverages.

Many of the readers who wrote comments argued that regulation of sugar-sweetened beverages should be part of a comprehensive public health effort to curb the rising tide of obesity in the United States and internationally. Unlike other food items that have at least some small nutritional value, sugar-sweetened beverages do not have any true nutritional value. A fast-food hamburger may have high levels of saturated fat and sodium, but it also contains nutritionally beneficial protein and iron. A soft drink contains only sugar and water.

Some commenters countered the argument that people should be free to consume what they wish without government intervention by reminding us that the rest of society must bear the consequences of increasing rates of obesity, which include greater utilization of health care resources, rising health care costs for all, and lost wages and productivity. From an economic point of view, personal decisions regarding food and drink can have effects that extend far beyond the effects on the individual person.

A few readers pointed out the irony of government regulation of sugar-sweetened beverages at the same time that the government is providing generous subsidies to agricultural producers of sugar and high-fructose corn syrup, the very products that are helping to fuel the obesity epidemic. Finally, some physicians said that we should start by looking in the mirror and focusing on the food environment in the hospitals in which we practice. How many hospital cafeterias sell sugar-sweetened beverages, fried foods, and unhealthful treats?

New York City has already begun to regulate the sale of sugar-sweetened beverages, and other cities and states are currently debating similar measures. We can be sure that discussions regarding the proper role of government in controlling the obesity epidemic will continue in the coming years.

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