Children's consumption of sugarsweetened beverages (SSBs) has increased dramatically in at least four ways In the past few decades:

* A greater proportion of children consume these beverages

* Serving sizes have increased

* The number of servings per day of SSBs has increased

* There is an increased variety of SSB choices

By 1996-1997, 85% of all children drank at least one such beverage on any given day, and the average serving size had increased by nearly 50% in the preceding two decades. Soft drink choices now include a variety of carbonated drinks (sodas), sports drinks, energy drinks, and fruit/frult-flavored drinks in an array of flavors.

Because these increases in consumption have occurred concomitantly with rising levels of childhood overweight and obesity across the population, there is growing consensus that that SSB consumption is an important driver of the obesity epidemic, and numerous studies show that consumption of SSBs is linked to excess weight gain in children. It is increasingly clear that limiting SSB consumption is a top priority in efforts to combat pediatric obesity.

Chronic consumption of SSBs contributes to weight gain in several ways. A typical serving of SSB contains anywhere from 30-70 gms of sugar. It has been estimated that daily consumption of the calories from just one can of soda can lead to a 15-lb weight gain in a year. SSBs also contribute to weight gain because "liquid calories" are less satiating than solid calories, and consumers do not compensate for these excess calories by reducing calories from other foods.

While the increased long-term risks for diabetes and heart disease resulting from such weight gain are well known, there Is a growing body of research that suggests that chronic SSB consumption may directly increase hypertension and cardiovascular risk through metabolic and inflammatory pathways mechanisms triggered by a sudden increase in blood sugar levels. The fructose fraction of SSB (from highfructose corn syrup), is particularly damaging in this regard.

Other health risks of SSB consumption include calcium deficiency and a consequent reduction in bone density (in girls and women). This likely occurs because the increase in SSB consumption with age frequently displaces milk intake, but there are direct physiological mechanisms that could explain calcium depletion by sodas as well. Dental caries (cavities) have also been shown to be associated with consumption of carbonated SSB.

Yet another pernicious effect of SSBs comes from their added caffeine content. A recent review concluded that the high caffeine content of energy drinks may have serious side effects, especially in children and adolescents. The reported effects of excessive caffeine consumption range from anxiety, headache and sleep disorders to seizures, diabetes, cardiac abnormalities and mood or behavioral disorders.

One aspect of SSB consumption that has received limited attention in the research literature is the behavioral concomitants of such consumption. A recent study by researchers at the Michael and Susan Dell Center for Healthy Living, part of the University of Texas School of Public Health, examined dietary and activity behaviors that typically accompany consumption of SSBs. They found that consumption of carbonated SSBs (sodas) is associated with higher levels of TV watching, lower levels of physical activity, a higher tendency to consume fried snacks such as chips and French fries, as well as fried meats and desserts, and lower levels of fruit and vegetable consumption.

While the study did not permit examination of whether these behaviors occurred at the same point in time, it is clear that soda consumption has become the centerpiece of a markedly obesogenlc lifestyle In children. Although the researchers In this study reported that consumption of sports drinks is less likely to be associated with this wide array of obesogenic behaviors, consuming any SSB in large quantities is a risky behavior in the long term, because of potential permanent alterations in taste preferences, i.e., the development of a "sweet tooth."

Efforts by the public health community to reduce SSB consumption through legislative measures have met with fierce resistance from the beverage industry, reminiscent of measures deployed by the tobacco Industry. While these moves play out In the public arena, small behavioral changes aimed at reducing access and availability in the immediate environment remain the most feasible way to address SSB consumption.

Author affiliation:

By Nalini Ranjit, PhD

Author affiliation:

Dr. Ranjit is an assistant professor at the Michael & Susan Dell Center for Healthy Living at the University of Texas School of Public Health, Austin Campus. She has a PhD from Cornell University. Her research is in the area of lifestyle risk factors for child obesity and cardiovascular disease.