Ten Miles Square


June 15, 2012 11:33 AM It’s Not Just the Soft Drinks

By Aaron Carroll

A number of readers took exception to my saying that banning large soft drinks wouldn’t work. Some of you think it’s not “prohibition”. Some of you think it’s still worth a try. Some of you absolutely think it’s going to work. I still disagree. I think it’s cherry-picking, it’s mostly for optics, and it’s not going to lead to a slippery slope of success.

Here’s one reason why: a new study entitled, “Beverage patterns among Canadian children and relationship to overweight and obesity”:

Sweetened beverage intake has risen in past decades, along with a rise in prevalence of overweight and obesity among children. Our objective was to examine the relationship between beverage intake patterns and overweight and obesity among Canadian children. Beverage intake patterns were identified by cluster analysis of data from the cross-sectional Canadian Community Health Survey 2.2. Intake data were obtained from a single 24-hour recall, height and weight were measured, and sociodemographic data were obtained via interview. Data on children and adolescents aged 2-18 years who met inclusion criteria (n = 10 038) were grouped into the following categories: 2-5 years (male and female), 6-11 years (female), 6-11 years (male), 12-18 years (female), and 12-18 years (male). χ2 test was used to compare rates of overweight and obesity across clusters. Logistic regression was used to determine the association between overweight and obesity and beverage intake patterns, adjusting for potential confounders.

In short, this study was looking for a relationship between beverage consumption and obesity after adjusting for other factors. What did they find? First, here’s the unadjusted analysis. You’ll see age and sex categories in the left column. The other columns are the beverage cluster the children fell into, or the dominant beverage they consumed. For each age/sex group you get the percent of kids who are normal weight, overweight, and obese for each beverage.

See a pattern? No? Me neither. For 6-11 yo females, being in the “soft drink” cluster gave you the lowest chance of being obese. Same for 12-18 yo males. But it’s all over the place. All of those p values on the right hand side show that in none of the age/sex groups was BMI classification associated with beverage cluster.

Here are the results of the logistic regression. For the record, they controlled for age, total energy intake, ethnicity, a measure of sedentary activity, and sociodemographic characteristics:

What you’re looking at here are odds ratios, and then 95% confidence intervals in parentheses after them. An odds ratio above 1 means that you’re more likely to be overweight and obese; and odds ratio less than 1 means you’re less likely. If the 95% confidence interval includes 1, then the results are not significant.

Only one result was significant. Soft drinks were found to be significantly associated with a higher odds of overweight and obesity in boys 6-11 yo. No other relationships were seen for any beverages (including soft drinks) and any of the other age/sex groups. Looking at the prevalences in the first table I showed you that’s not surprising. But I find it fascinating that this relationship is totally missing in the 12-18 yo males. This means that either it’s a totally new phenomenon in young boys, who will continue to be obese, or this relationship disappears as they grow older.

Regardless, it’s hard to look at these data and say that it’s definitively soft drinks that need to go. Why single them out? As I said on Wednesday, we need to fidn a way to get people to consume less calories overall, not from one beverage (halfheartedly) only in certain settings.

[Cross-posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Childrens Health Services Research at Indiana University School of Medicine.
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  • Big River Bandido on June 15, 2012 8:31 PM:

    It's a rather specious argument. The problem with soft drinks and all processed food, for that matter is not the calories, but the high content of High Fructose Corn Syrup.

  • notquite on June 15, 2012 8:43 PM:

    Not necessarily. Arguably the problem is that High Fructose Corn Syrup make high calorie foods cheap. If high calorie, high fat foods were expensive, as they used to be, people would consume them less often.

  • Big River Bandido on June 16, 2012 9:50 AM:

    That, too, is a side issue. High Fructose Corn Syrup is cheap. It's also terrible for the human body.

  • POed Lib on June 16, 2012 11:04 AM:

    High fructose corn syrup is not the issue. The issue is that you can ride all over the city and see no one outside. The kids are all inside, playing video games. Video games are far more the culprit than food. You can eat whatever you want when you are a kid, if you are outside, running around, playing. When I was a kid in the 1960s, my mother regulated TV - we didn't watch much. We had no video games. We were outside a lot. Today, you see kids in restaurants. Everyone is talking, the kid is focused on some idiotic video game. DO NOT GIVE YOUR KID A SMART PHONE!! If the phone is smarter than the kid, which is increasingly the case, we are a civilization in decline.

  • Crissa on June 16, 2012 4:40 PM:

    Evils of video games, books, etc?

    What were kids doing at restaurants before video games? Destroying the restaurant or being left home with a sitter, I wager.

  • Anonymous on June 16, 2012 5:27 PM:

    Crissa: You clearly spent too much time playing video games to have an ability to comprehend complex material at the level of, say, a Superman comic.

    The point that I was making, and you were missing, is obviously that kids are not getting exercise. I hope that you can now follow along. Use your forefinger to trace the words. You too can improve your mind with direction and careful mentoring.

  • zandru on June 17, 2012 12:13 PM:

    Near-Useless Data

    Before spinning off on your prejudice-confirming analyses, look again at the conditions of the study: asking some number of two year olds on up to 18 yo exactly what they drank over a 24 hour period. What kind of data are you going to get from a two year old? A 3 yo? 4? 5? 6? And by the time they get up in years a little more, they'll know what the researchers want to hear. They'll know what makes them (the children) "look bad."

    And, like I said - it's just a 24 hour span. Could it be someone's birthday? The day Daddy gets custody? The day the child started the diet?

    At best, these data offer suggestions for a real, more detailed study. Preferably one which does not rely on the memories of small children, or require honest self-reporting. A study that spans at least a week. One that takes into account "special" days.

    And, if you're going off on your high horse about America's fat-a$$, lazy children, then study American children.

    Like DUH.

  • Gov't Mule on June 18, 2012 9:25 AM:

    You can cite any study you wish, but it sounds not only self serving but it defies common sense. The tobacco companies did so for years. For years, children in America (and sadly now many other countries too) have become more and more obese and less active. Are sugared drinks solely responsible for this? Absolutely not, but logic says that they lead to weight gain and a constant hungry feeling because the caloric intake from these soft drinks is the very definition of "empty calories."

    I have worked in school systems that claimed to ban soda from the cafeteria. The claim was meaningless. Instead of having a Coca-Cola vending machine in the cafeteria, the vending machine just sold products owned by the greater Coca-Cola family. A "sports drink" actually had more carbohydrates from sugar than even a can of coke.

    Moreover, sugar is not limited to soft drinks. Many foods that you wouldn't think contain sugar. The prudent thing to do is to reduce or eliminate the amount of sugar in school lunches. The reality says otherwise as schools now have become dependent on the increased money from selling junk food snacks, fast food style meals, and soft drinks. Pressure to cut school funding means that the temptation to increase this revenue stream is greater than the desire to actually do something that could help make school children less obese.

  • neil b on June 18, 2012 1:00 PM:

    Aaron, considering the likely factor that obese kids who didn't drink lots of soft drinks got carbs from other things instead, maybe a straight carb or sugars tax per se (at least on things where it is added, contrived, not "intrinsic") would be the way to go? But even if not, wouldn't a targeted tax that helped boys 6-11 be worthwhile - you seem to forget that those boys will likely stay obese as they get older, so it would help "boys" and lots of girls, too.

    Heh, "Physician" indeed.

  • TerryS on June 19, 2012 12:35 AM:

    Much better than banning large soft drinks, would be banning junk food advertising that target children.

    "A ban on fast food advertisements in the United States could reduce the number of overweight children by as much as 18 percent, according to a new study being published this month in the Journal of Law and Economics. The study also reports that eliminating the tax deductibility associated with television advertising would result in a reduction of childhood obesity, though in smaller numbers."

    Science Daily (Nov 2008)

    "University students who watched over four hours or more of TV per day snacked more frequently while watching TV, recognized more TV advertisements and consumed more energy-dense snacks than students who viewed less than one hour of TV per day."

    Science Daily (July 2008)

    "TV Bombards Children With Commercials For High-Fat And High-Sugar Foods"

    Science Daily (Nov 2008)

    "TV Food Advertising Increases Children's Preference for Unhealthy Foods, Study Finds"

    Science Daily (June 2011)

    Social science data illustrates that latter truism. In 2010 and 2011, for instance, researchers from Yale University and Texas A&M University both found that fast-food ads successfully change kids eating expectations and shape their culinary desires. Likewise, the American Academy of Pediatrics recently reported that greater familiarity with fast-food restaurant advertising on television is associated with obesity likely because kids who see the ads develop food consumption patterns that include many types of high-calorie food brands being advertised.

    David Sirota (Salon, June 18, 2012)

    Note: I tried putting in the links, but WM considered it spam.