Seattle has a soda tax up for consideration, with the overall goal to improve health. But would it make a difference?

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On Nutrition

2016 has been called the Year of the Soda Tax, but 2017 is looking to match it. Last year, six cities — including San Francisco and Philadelphia — followed in the footsteps of the Berkeley, California, tax on soda and other sugar-sweetened beverages (SSBs), which went into effect in March 2015.

Seattle has a soda tax up for consideration this year (a public hearing is scheduled for May 17), and it’s likely that a number of other cities, towns and even entire states, will do the same. This isn’t just a U.S. thing — France, Hungary, Ireland, Mexico and the United Kingdom have passed similar taxes. But will these taxes improve health by reducing consumption of beverages sweetened with sugar or artificial sweeteners?

Health effects of sugary beverages

SSBs, which include “regular” soda, fruit drinks (Kool-Aid, lemonade) and other drinks sweetened with added sugar are unique among foods and beverages in that they are up to 100 percent sugar with essentially no nutritional value. Not only are they empty calories, but they are extra calories — when we drink sugary beverages, those calories don’t reduce appetite the way that food calories do, so we end up consuming more calories overall.

These aren’t just any calories, either. A study that compared intake of various beverages found that drinking two 16-ounce sugar-sweetened colas per day for six months increased fat deposits in the liver, muscles and abdominal area compared with the same level of intake of diet cola, milk or water.

Artificially sweetened beverages may save on calories, but both the American Heart Association and the American Diabetes Association have stated that it’s unclear whether they ultimately help people cut back on sugar or improve health.

Does this mean that a sip of soda should never cross your lips? Not necessarily. That’s one reason why we’re seeing soda taxes, not soda bans. There is room in life for foods and beverages that are about pleasure, not nutrition, but when they become a regular feature, it has implications for health.

The American Heart Association recommends that men limit added sugars to 150 calories per day (37.5 grams or 9 teaspoons), while women stay under 100 calories (25 grams or 6 teaspoons). A single can of soda has 40-50 grams of added sugar.

Some people might enjoy an occasional soda, but others — especially teenagers — are drinking them in large quantities, making sugar-sweetened beverages the largest source of added sugar and calories among both children and adults in the U.S.

The 2015-2020 Dietary Guidelines for Americans advises reducing added sugars to less than 10 percent of daily calories — and choosing beverages with no added sugars. Despite that, almost two-thirds of children and teens and about half of adults drank at least one SSB a day in 2011-2014. Many drank more than that: The average intake was 145 calories per day from SSBs alone, or 7 percent of total daily calories. That doesn’t count added sugars from foods.

Evidence from quality-research studies shows that reducing sugary beverages can reduce excess weight gain in children and adolescents — and reduce excess weight in adults — whereas increasing added sugar leads to weight gain.

Even worse, SSBs contribute to type 2 diabetes and obesity in a way that is different from other sources of added sugar or excess calories, and evidence is mounting that SSB intake contributes to the development of cardiovascular disease.

Soda taxes and soda consumption

In 2016, the World Health Organization recommended that governments tax SSBs significantly enough to lower consumption by at least 20 percent. In 2012, the Academy of Nutrition and Dietetics opted to remain neutral on the soda-tax issue, after a review of the limited evidence available at the time, but is currently revisiting the issue in light of newer data. Berkeley, Philadelphia, France and Mexico have seen significant drops in sugar-sweetened beverage sales after putting their taxes into effect.

This is reminiscent of cigarette taxes — people weren’t initially happy about those, either — which effectively reduced smoking to historic lows. But some argue that soda is a food, and food taxes are considered regressive because they affect lower-income households harder.

“While many argue we shouldn’t tax food, I hardly consider soda a ‘food,’ ” said Seattle dietitian Chris Vogliano, MS, RDN, a member of the academy’s soda-tax task force. “The definition of food is ‘any nutritious substance that people eat or drink in order to maintain life and growth.’ Soda does not fit that description. Soda is not a food.”

Soda has become relatively less expensive over time, while soda advertising has increased — and has particularly targeted children, minorities and low-income groups. Although sweetened-soda consumption has decreased slightly in the past decade, it increased dramatically over the last several decades — from 10.8 gallons per person in 1950 to 49.3 gallons per person in 2000 — in both children and adults.

When you consider what food and beverages cost, it’s not just what you pay at the register, but the downstream costs. Money spent on foods and beverages that help you stay healthy can save you money in the long run, because you spend less on health care.

Money spent on inexpensive foods and beverages that contribute to poor health ultimately cost a lot more. You could make a fair argument that a soda tax is a way of leveling the playing field.

Personal responsibility versus policy

There’s a lot of talk about personal responsibility for food and beverage choices — it’s a card that the soda industry plays frequently — but while we do have responsibility for our actions, we are not immune to factors that might influence us. For example, Big Soda’s big advertising budgets. Like it or not, this influences our actions.

A food environment can either encourage nutritious food choices or less-healthful food choices. Our modern food environment encourages not just overconsumption of food, but consumption of high-calorie, low-nutrient foods and beverages. This food environment — called obeseogenic by many researchers — essentially guarantees that anyone who is genetically predisposed to gain weight, will.

“As a dietitian, I support this soda tax,” Vogliano said. “The evidence is clear that it will help curb our elevating rates of chronic disease in our communities by reducing consumption of a beverage that provides zero nutritional benefit.”

I agree.