Soda TNCs, Artificial Sweeteners, and Personal Choice

There’s potential good news on the Type II diabetes front: new data from the CDC shows United States cases leveling off. At the same time, though, new research into drinks that use artificial sweeteners proposes a connection between the consumption of these drinks and dietary habits that lead to obesity- and diabetes-supporting behaviors as the chemicals in these drinks are thought to alter the micro-biome of the digestive system in mice. In response to this new data and to a publicized effort on behalf of soda manufacturers to cut the number of calories United States Americans consume in the form of sugary drinks by 20% in the next ten years, Diane Rehm hosted several global health experts along with a representative of the American Beverage Association on her show titled “Soda Companies, Artificial Sweeteners, and the Fight Against Obesity.” Her guests in this segment are:

• Maya Rockeymoore, President of the Center for Global Policy Solutions; 
• Robert Lustig, Director of the UCSF Weight Assessment for Teen and Child Health Program; 
• Marion Nestle, NYU professor and food politics rock star; 
• Kristina Rother, Chief of the Pediatric Diabetes section of the NIH; and 
• Susan Neely, CEO of the ABA. 

There was a lot that happened in this hour-long broadcast, so I will attempt to highlight some of the more globally-focused debates in this blog post:

According to Maya Rockeymoore, the links between diabetes and obesity are not always clear. There are countries where we see high levels of obesity and overweight but little occurrence of diabetes (Iceland and Mongolia); and countries where we see high levels of diabetes occurring at weight levels far from what the US would consider acute (India and China). Studies cited by Robert Lustig indicate that even when people lose weight by cutting out fatty foods - the main culprits being french fries and potato chips - diabetes remains. According to Lustig, “It was the sugar all along.” We are seeing diabetes at increasingly low weight levels tied primarily to simple carbohydrate consumption. 

Equally concerning is the fact that diabetes has not leveled off in African American and Latino populations, a demographic that is expected to be the majority in the U.S. by 2043. It’s here that we see the tenuous relationship between soda companies and minority communities; soda companies all but refused to market in non-white neighborhoods until boycotts and other political action caused them to give in. Now marketing to these communities is rampant, and continuing this marketing is key to the ABA’s strategy in maintaining profits while decreasing the overall calorie intake of sugary beverages. During the broadcast, Diane interviews Ms. Neely, who says that as part of the push for decreased calorie consumption, they would be marketing artificially-sweetened beverages and smaller portion sizes to minority communities in the United States. 

I hope that you have a chance to listen to this broadcast as the reactions from Diane’s other guests following Ms. Neely’s departure from the conversation are palpably distressed. Marion Nestle (my hero!) points out that there is a trend away from high-calorie drinks in the first place, and that the ABA could cut the consumption of calories from drinks by 20% over the next ten years by sitting in their offices not doing anything. As transnational corporations, these soda companies of course don’t want to give up customers or have them drink less; instead, they will simply move their efforts overseas where there is little regulation and education about the dangers of overconsumption. Robert Lustig points out that even if you decrease calories, you have to replace the taste with something, and from what we know about diet drinks and the similar ways in which they spike insulin, artificial sweeteners won’t solve the problem. He argues further that developing countries do not have health care systems to deal with diabetes in the way our mediocre health care system manages here in the U.S. Maya Rockeymoore advocates for global policy solutions that are aimed at both kids and adults and that policy and psychosocial factors are just as important as basic behavior around nutrition. 

I found the most powerful takeaways here to be from Robert Lustig. While I am not against policy that seeks to regulate consumption of less-debatably “bad” foods (candy, soda, french fries, etc.) and would consider myself in favor of these policies in most instances (full disclosure: one reason is because I don’t buy them), I was raised in the U.S. And because I was raised in the U.S., there is always a little libertarian voice in my head (probably my dad’s) crying out for choice. I think Lusting deals with this very well. He agrees with these ideals of personal responsibility, but offers four caveats that have to be present before you can argue that personal responsibility is present:

1. the consumer has to have access to knowledge about the product (food labels or other marketing processes don’t obscure vital information about a product)
2. the consumer has to have access to alternative choices, either economic or geographic (those alternatives have to be within reach)
3. the consumer must be able to afford other options (you have to be able to afford your choice and society has to be able to afford your choice in terms of long-term health care implications)
4. the consumer can’t harm others by making this choice. 

And this, he says, is why personal responsibility does not apply to addictive substances like sugar.

The Diane Rehm Show. (2014, September 25). Soda Companies, Artificial Sweeteners And The Fight Against Obesity. Retrieved October 7, 2014, from http://thedianerehmshow.org/shows/2014-09-25/soda-companies-artificial-sweeteners-and-fight-against-obesity