San Francisco Approves Warning Labels for Sugared Beverages

Young woman reaching for colorful bottles of soda
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Of all the dietary causes of obesity, consumption of added sugar leads the charge. A wealth of information now exists on the ever-increasing amounts of sugar steadily added to the American diet over the past several decades, largely in the form of packaged and processed foods. And now, one American city has recognized the direness of the situation by approving warning labels for sugared beverages.

Sugar-Sweetened Beverages Tied to Obesity

Particular attention has been paid to sugar-sweetened beverages as being directly linked to the obesity epidemic. According to some estimates, overweight and obese adolescents are drinking enough of these beverages to account for an average of 15% of their total daily energy intake.

Experts have noted how the increased consumption of sugar-sweetened beverages in the United States has paralleled the rise in obesity rates. And some have pointed out that the way the body reacts to calories in liquid form, in terms of release of obesity-related hormones such as ghrelin and leptin, is different from the greater satiety it experiences with solid foods.

In addition, sugar-sweetened beverages are lacking in fiber content, are nutrient-poor, and are commonly associated, particularly among children and adolescents (though not just), with consumption of other poor food choices, such as salty foods and fast foods.

In fact, many fast-food restaurants offer “combo meals” that incentivize the purchase of a soft drink or other artificially sweetened beverage as part of the meal.

Studies that have looked at the genetics of obesity have even found a stronger genetic association with higher body mass index (BMI) that corresponds to intake of sugared beverages.

As these researchers note, studies like these point to a causal relationship between sugared beverages and weight gain—and the risk of obesity.

Other studies have brought forth evidence that supports an association between sugar-sweetened beverages and chronic diseases like type 2 diabetes and cardiovascular disease, including high blood pressure (hypertension) and coronary heart disease.

San Francisco Lawmakers Approve Warning Labels

On June 9, 2015, lawmakers in the city of San Francisco voted unanimously to approve warning labels for all advertisements mentioning sugared beverages. This law is the first of its kind in the nation, and will go into effect this summer.

The law will require soda ads, such as those on billboards, taxis or other signage, to include the following message:

WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay. This is a message from the City and County of San Francisco.

In addition, San Francisco’s board of supervisors voted to ban ads for sugar-sweetened beverages on publicly owned property and to disallow the use of any city funds for the purchase of sugared beverages.

Health advocates have largely hailed San Francisco’s move as a step in the right direction toward curtailing causes of the obesity epidemic.

Recommendations on Added Sugar Intake

The American Heart Association (AHA) recommends that the intake of added sugar not exceed 6 teaspoons (approximately 24 g) daily for women and 9 teaspoons (approximately 36 g) daily for men.

Meanwhile, according to the United States Department of Agriculture (USDA), the average 12-ounce can of cola contains over 8 teaspoons of sugar. So, by drinking just one small soft drink, a woman would have already far exceeded her recommended daily sugar maximum, and a man would have nearly reached his. With numbers like this, it is easy to see how the average American can consume 22 teaspoons of added sugar per day, far beyond the AHA’s recommended maximum.

And, extrapolating from that, it is even easier to see how this level of high-calorie sugared intake could contribute to the rise of the obesity epidemic over the course of time.


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Qi Q, Chu AY, Kang JH, Jensen MK, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012; 367:1387-1396.​

Caprio S. Editorial: Calories from soft drinks—do they matter? N Engl J Med 2012; 367:1462-1463.

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