Globally, 1.7 billion people are overweight or obese and 246 million have diabetes. Ninety percent of all diabetes cases are type 2, of which 90% are directly attributable to excess weight.1 Overweight and diabetes account for a large percentage of healthcare costs in most countries.2 Vartanian et al’s meta-analysis found a clear association of soft drink intake with increased calorie intake and body weight, lower intakes of milk, calcium and other nutrients and increased risk of several medical problems including diabetes.3 Based on the data, the authors appropriately recommend reductions in population soft drink consumption, a task easier said than done in today’s obesogenic environment.

Americans, for example, consume 38.3 gallons of full-calorie soft drinks per person per year.4 This corresponds to approximately 63,000 calories, or if consumed in excess of energy requirements, 18 pounds of weight gain per individual per year. In light of rapid globalization, the wide reach of soft drinks accompanies technological advances that lead to sedentary behavior, placing individuals, especially children and adolescents, at further risk for overweight and diabetes. But globalization can also be part of the solution. How can we utilize powerful globalizing forces to reduce sweetened soft drink consumption? The answer lies in structural, rather than educational, changes. Industry can and should be a part of the global response to obesity, but in what role? Development of new drinks like Diet Coke Plus, Tava and 7Up Plus are encouraging, and show that issues of obesity – and declining soda sales due to consumer anti-fat attitudes – are beginning to be taken seriously.5 Several reports by investment firms – Swiss Re, JP Morgan – show that investing in health and healthier drinks and products is profitable, and a report published by the HEAL Partnership in February recommends ways that companies should address consumer health and obesity issues, including strategy, governance and reformulating products.6 The May 2006 agreement between Clinton's Alliance for a Healthier Generation and Coca-Cola, PepsiCo and Cadbury Schweppes is a good example of industry’s role.7 Kraft, PepsiCo and others have created healthier products and voluntarily restricted advertising; more companies should follow.

Governments also have an important role. Cigarette taxes and advertising bans are known to be among the most effective ways to curb smoking, especially among youth. Considering skyrocketing obesity rates, and growing concern of diabetes, among children and adolescents, governments should discourage sweetened soda consumption by adding taxes to their sales and even subsidizing healthier beverages. Governments can also work with industry to encourage healthier drinks/foods, for example, by financially rewarding companies for innovation. The cost of treatment for obesity and diabetes far outweighs the cost of prevention: innovation costs can be viewed as minimal, even as investment.

Triumphant collaboration between public health and industry was demonstrated in early fortification of foods with iron and folic acid in the US. However, no successful attempts to reducing overweight have been reported anywhere; creative win-win solutions are crucial. Media campaigns, using cartoon characters and story formats to garner the attention of children and celebrities to appeal to teenagers, can encourage consumption of healthier foods and drinks. Finally, NGOs can bolster the above efforts by working to unite all actors toward the common goal of reducing obesity, an example of which is provided by the London- based Oxford Health Alliance. In light of unprecedented increases in overweight and diabetes globally, action is urgently needed to curb trends. Potentially cost-effective and pragmatic solutions – structural changes as opposed to educational interventions alone – that include industry are crucial. Excess calories from sweetened soft drinks is just one cause of the obesity epidemic, but collaborative efforts directed at reducing soft drink consumption can provide a focused start.

References

1. Hossain P, Kawar B, El Nahas M. Obesity and Diabetes in the Developing World – A Growing Challenge. N Eng J Med. 2007; 356(3): 213- 215.

2. Yach D, Stuckler D, Brownell KD. Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nature Medicine. 2006; 12(1):62-66.

3. Vartanian LR, Schwartz MB, Brownell KB. Effects of Soft drink Consumption on Nutrition and Health: A Systematic Review and Meta- Analysis. American Journal of Public Health. 2007; 97(3): 1-7.

4. American Beverage Association [homepage on the Internet]. Washington, DC: American Beverage Association; 2007 [updated 9 Mar 2007; cited 2007 Mar 9]. What America Drinks; [1 screen]. Available from: http://www.ameribev.org/all-about-beverage-products-manufacturing- marketing--consumption/what-america-drinks/index.aspx

5. Martin A. Makers of Sodas Try a New Pitch: They’re Healthy. The New York Times. 2007 Mar 7.

6. HEAL Global Partnership [homepage on the Internet]. London: IBLF; 2007 [updated 2007 Feb 8; cited 2007 Mar 7]. HEAL General Full Desc Page; [about 3 screens]. Available from: http://www.iblf.org/heal/general.jsp?id=123870