Abstract
Sugar-sweetened beverages (SSBs) generally designate non-alcoholic beverages containing added sugars. Conclusive epidemiological evidence indicates that overconsuming those beverages places individuals at greater risk of developing overweight, type 2 diabetes, and dental caries. SSB overconsumption is supported by intense marketing practices in terms of offer, distribution, price and promotion. In Canada, sugar-sweetened beverages are a significant dietary source of sugars in some groups of the population, particularly in adolescents. Specific prevention efforts are required at a large scale to tackle SSB consumption trends at population level and to limit SSB contribution to daily energy intakes at individual level.
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Notes
- 1.
According to WHO’s definition, free sugars include “monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates” (WHO 2015, p. 4).
- 2.
Combination of the monosaccharides glucose and fructose.
- 3.
According to Agriculture and Agri-Food Canada (2015), corn sugar (mainly imported from the US) is much more commonly used than cane or beet sugar by the Canadian soft drink industry.
- 4.
In the future, if the contribution of these beverages to daily energy intakes appears to be significant in some groups of the population, greater consideration should be deserved to their possible inclusion in the SSB definition.
- 5.
In the framework of a food policy targeting specifically the presence (or not) or the amount of added sugars in a beverage, this situation makes technically and administratively burdensome the distinction between on-site prepared drinks containing added sugars or not. The fact that some consumers (and not others) add sweeteners themselves at the point of purchase also raises concerns. Finally, since many of these beverages contain milk, including it in our SSB definition would interfere with the aforementioned exclusion of all forms of sugar-sweetened milk.
- 6.
Over the last 10 years, nearly 20 literature reviews have been published as regards the relationship between sugar-sweetened beverages and body weight (Massougbodji et al. 2014). Until recently, these reviews offered dissenting conclusions: some of them concluded that the evidence of a causal relation was weak or limited (e.g. Forshee et al. 2008; Mattes et al. 2011) whereas others concluded that the evidence was strong or significant (e.g. Malik et al. 2006; Woodward-Lopez et al. 2011). In 2012, the controversy reached a turning point, as shown by the opening debate of the 30th Annual scientific meeting of the Obesity society (Billes 2012) and the subsequent release of new findings from two randomized controlled trials supporting the hypothesis that limiting access to SSBs may contribute to prevent weight gain in youth (Rabin 2012). Subsequent reviews still offer methodological debates and contrasting conclusions, but clearly tend to agree that increasing SSB intake increases the risk of weight gain (Kaiser et al. 2013; Hu 2013). Additionally, two studies have looked at the funding source of reviews on SSB consumption and weight gain (2006–2013) and suggest that it may have introduced a bias in their conclusions, since industry-funded reviews are significantly more likely to suggest weak evidence of an association than other reviews (Bes-Rastrollo et al. 2013; Massougbodji et al. 2014).
- 7.
In Canada, some cross-sectional and longitudinal studies have analyzed the association between SSB consumption and body weight. We did not particularly emphasize these results in this section since the cause-to-effect relationship between SSB and weight has been largely covered in methodologically more robust systematic reviews and meta-analyses at international level (see the previous footnote). These reviews provide the best available evidence to date. However, on an indicative basis, we refer the reader to some Canadian studies on youth SSB consumption and body weight published over the last years. On the one hand, significant positive associations (with at least one weight-related outcome for the whole population) have been found in several studies based on a cross-sectional design (Gillis and Bar-Or 2003; Reid et al. 2015) or a longitudinal design (Dubois et al. 2007). Absence of any significant positive association was also reported in studies based on a cross-sectional design (Janssen et al. 2005; Vanderlee et al. 2014) or a longitudinal design (Mundt et al. 2006). Finally, mixed results (depending on gender/age group) have been reported in cluster analyses (Danyliw et al. 2012).
- 8.
For a definition of body mass index (BMI), see Chap. 1, footnote 2.
- 9.
Popkin and Hawkes’ calculations are based on the Euromonitor Passport International database, for the period 2009–2014.
- 10.
Expressed in Kcal per person per day.
- 11.
Popkin and Hawkes’ analyses are based on three SSB categories: caloric soft drinks (carbonated and non-carbonated); fruit drinks (sweetened beverages of diluted fruit juice and often other caloric sweeteners and flavourings); and sports and energy drinks (including sugar-sweetened waters).
- 12.
Before Canada ranked Chile, Mexico, USA, Argentina, Saudi Arabia, Germany, Netherlands, Slovakia, Austria, Brazil, Belgium, Israel and Ireland.
- 13.
Provided by the Canadian Soft Drink Association.
- 14.
Excluding juices.
- 15.
Indeed, the fact that SSB intake has been frequently associated with overall energy intake could be partly related to the fact that SSB consumption is a marker of food patterns involving other dietary factors favouring excessive energy intake (Woodward-Lopez et al. 2011). Anyway, considering the evidence presented overall in this section, it seems plausible that the increase in SSB consumption over the last decades has somewhat contributed in itself to increase energy intakes in some groups of the Canadian population.
- 16.
Independently of neighbourhood-level post-secondary education and school setting (urban/suburban/rural) at school level, and independently of age and sex at student level.
- 17.
This “Policy framework for a health turn at school” (Politique cadre pour un virage santé à l’école) has been set up in 2007. A process evaluation has been published in 2009. For the food environment, this evaluation is based on data collected from 720 schools. The sample was further weighted to make it representative of all Quebec schools (according to type, network and region). Results indicate that 94 % of primary schools (eq. to elementary schools) and 59 % of secondary schools (eq. to middle and high schools) report having removed SSBs and NCSBs from their main food service. Very few primary schools offer vending machines (2 %) but among secondary schools, 47 % report having removed these beverages from vending machines (Ministère de l’Éducation, du Loisir et du Sport 2012).
- 18.
These guidelines prone the removal of soft drinks from elementary and middle schools and displacement by water, 100 % juice and milk. In high schools, the guidelines indicate that “at least 50 % of the beverages offered […] should be water and low- or no-calorie options” and also encourage capped caloric content for SSBs, capped portion sizes for SSBs, and non-availability of energy drinks. According to the Canadian beverage association, its members have “completed [the] implementation of the guidelines during the 2009–2010 school year” (CBA 2012, §1).
- 19.
The multilevel logistic modelling procedures used in this study made possible to appreciate the school built environment effect on daily SSB consumption independently of other variables that may influence consumption at individual level (gender, academic cycle, cultural origin, participation in organized physical activities) and independently of the school socioeconomic status. Concerning the school built environment’s vicinity, it is noteworthy that none of the contextual characteristics measured (number of fast-food restaurants, number of convenience stores, walkability, degree of vegetation cover, distance to the closest fast-food restaurant, distance to the closest convenient store) had a significant association with SSB consumption when taken separately. However, the combination of these characteristics showed an important difference in students’ SSB consumption between schools. This observation confirms the complex aetiology of eating habits and the most probable influence of a pattern of contextual characteristics rather than a significant influence of one risk factor considered in isolation.
- 20.
In this study, three types of price promotions were considered: “temporary price reductions”, “multibuy” offers (e.g. “buy 2 for 5$” or “buy one and get one free”) and “extra free” offers (i.e. portions larger than usual for the same price). The analysts emphasize that food price promotions are heavily practised in the UK and may represent a proportion of purchases that is twice as much elevated than in other European countries (i.e. ≈40 % vs. ≈20 %).
- 21.
With equal percentage found for chocolate and cakes.
- 22.
59 % decrease (adjusted for inflation) in child-directed marketing of carbonated beverages (from US$96 million to $US42 million) and 29 % decrease (adjusted for inflation) in teen-directed marketing of carbonated beverages (from US$508 million to US$382 million).
- 23.
The US Federal Trade Commission (2012, p. ES-5) observes that drinks marketed to youth (2–17 years old) “averaged 20 fewer calories per serving in 2009 than in 2006”.
- 24.
Consisting of “company-sponsored websites, Internet, digital, word-of-mouth, and viral marketing” (FTC 2012, p. 9).
- 25.
50.5 % increase (adjusted for inflation) for all food categories (from US$76.6 million in 2006 to US$122.5 million in 2009).
- 26.
Moreover, between 2006 and 2009, the relative increase in child-directed new media expenditures focused on juices and non-carbonated beverages has been substantial (+617 %, adjusted for inflation) (FTC 2012).
- 27.
Using Nielsen Media Research data specific to Vancouver and Toronto cities.
- 28.
Considering the evolution of TV advertisements targeting kids in Toronto between 2006 and 2011, Potvin Kent et al. (2014) note that this decrease was particularly due to the fact that companies adhering to CAI had eliminated soft drinks advertisements on these stations, which was not the case of non-CAI members.
- 29.
Including regular soft drinks and fruit drinks.
- 30.
Regular soft drinks volumes expressed in grams (g) or in millilitres (ml) are generally close. For instance, according to the Canadian Nutrient File (CNF), 100 ml of cola-type soft drinks is equivalent to 104.2 g (Source: Health Canada, file consulted in March 2012 from: http://webprod3.hc-sc.gc.ca/cnf-fce/index-fra.jsp).
- 31.
Excluding fruit beverages and fruit juices.
- 32.
Including regular soft drinks and fruit drinks.
- 33.
As for all self-reported data, measurement errors may occur (e.g. underreporting of SSB consumption) and may influence the results.
- 34.
In this survey, beyond the proportion of daily consumers, the proportion of occasional SSB consumers is sizeable. For instance, 36 % of students report consuming fruit-based drinks from one to six times per week (38 % for boys vs. 33 % for girls) and 36 % of students report consuming carbonated drinks between once to six times per week (43 % for boys vs. 29 % for girls).
- 35.
In addition to fruit-flavoured drinks, regular soft drinks, sports drinks and high-energy drinks, SSBs here also include hot chocolate, cappuccino or frappuccino, slurpees, and shakes.
- 36.
In this survey, the term “junk food” encompasses foods that should only be consumed exceptionally according to official Quebec guidelines, such as French fries, hamburgers, pizza, chicken wings, fried chicken, hot dogs.
- 37.
i.e. having SSB at least once a day.
- 38.
Difference statistically significant (p ≤ 0.05).
- 39.
In the CCHS-Nutrition survey, the fruit juice category corresponds to 100 % pure juice. It includes the “juice portion of alcoholic beverages and juice recipes (concentrate and water)”. Fruit drinks correspond to “beverages that contain less than 100 % fruit juice” (Garriguet 2008b, p. 27).
- 40.
Difference statistically significant (p ≤ 0.05).
- 41.
Actually, the inclusion of NCSBs in the French soda tax was not part of the initial bill. It was even strongly fought by the government during parliamentary sessions, who considered that it was jeopardizing the public health credibility of the tax. The extension of the SSB tax scope to NCSBs rather holds to budgetary considerations defended by members of the parliament whose intent was to raise greater fiscal revenues in order to fund a reduction of wage costs in the farming sector. However, once the extension of the tax scope was voted at the parliament, the French government also invoked NCSBs’ potential harmful nutritional effects to justify this political move (French Constitutional Council 2011) (see also Sect. 13.6).
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Le Bodo, Y., Paquette, MC., De Wals, P. (2016). Reasons for Specifically Targeting Sugar-Sweetened Beverages. In: Taxing Soda for Public Health. Springer, Cham. https://doi.org/10.1007/978-3-319-33648-0_2
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