At Baltimores City Hall this month, I joined dozens of others giving testimony to the City Councils health committee on a bill that would require warning labels for sugary drinks on advertisements and wherever these products are sold in Baltimore. The bill, submitted by Councilman Nick Mosby, attempts to educate consumers that health consequences come with consumption of sugary drinks, including tooth decay, obesity, and diabetes (see graphic below). The warning label would be displayed at every point of sale (e.g., every cash register), with financial penalties to vendors for non-compliance.
The city would be the among the first in the nation to pass a law of this kind, with New York also currently considering a similar warning label, and San Franciscos warning label on printed advertisements, posters, and billboards is currently being challenged in the US Circuit Court of Appeals for the Ninth Circuit.
Last year, Berkeley, California, passed a sugary drink tax of $0.01 per ounce, and the city council of Philadelphia passed a $0.015 per ounce tax this month, which would raise an estimated $91 million a year for universal kindergarten, community schools, and park improvements, and avert an estimated 1,251 cases of diabetes, 18,450 cases of obesity, and 375 deaths over a decade. A similar 1 peso per liter tax in Mexico has decreased consumption by 12% over two years. Five other US cities are considering similar soda tax measures.
All of these policy attempts to reduce sugary drink consumption come in recognition of the increasing body of medical literature that implicates sugary drinks with a plethora of adverse health outcomes. Most striking, from Tufts University researcher Dariush Mozaffarian and his team estimating 184,000 preventable worldwide deaths each year are associated with sugary drink consumption. Harvard researcher Frank Hu and his team attribute one additional sugary drink per day with a 50% increased risk in developing obesity, 30% increased risk of heart disease, and a 26% increased risk of diabetes.
The Baltimore City Health Commissioner Dr Leana Wen, who is pushing for this warning label, is concerned that this is taking a toll on the people of Baltimore as well, where 1 out of every 4 children consumes at least one sugary drink daily and 1 out of every 6 Baltimore children is obese. Dr Wen argues that warning labels on cigarettes save lives, warning labels on alcohol prevent birth defects and liver disease, and that warning labels on sugary drinks acknowledge that they are dangerousand that knowledge will empower every Baltimorean to make an informed choice every time they purchase a beverage.
There is some research to show that such education can make a difference. Dr Sara Bleich and her team at the Johns Hopkins Bloomberg School of Public Health found an educational calorie sign reduced sugar-sweetened beverage consumption by nearly half for low-income Black adolescents.
Baltimore could be the first to take this approach city-wide and educate its inhabitants on the consequences of sugary drinks. Current labels list amount of sugar, but without a degree in medicine or nutrition, people may not know what that means for their bodies. A warning label provides transparency and simple clarity for everyone who lives or works in Baltimore.
This comes off the heels of the US Department of Health and Human Services Dietary Guidelines for Americans 2015, which recommend the amount of added sugars be limited to 10% of total daily calorie intake, where the current average is 13%with children, adolescents, and young adults being the highest consumers of added sugars. The guidelines note that a plurality of added sugar sources in the diets of US people over age 2 come from sugar-sweetened beverages (39%), and recommend, choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages.
This Policy Prescriptions® OP/note is written by Dr Richard Bruno. He is a resident physician in the Family & Preventive Medicine program at MedStar Franklin Square Medical Center and Johns Hopkins University Bloomberg School of Public Health.