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Reducing the intake of sugary drinks is presently quite important to many public health advocates. Taxes on sweet drinks are one effective way to do this. And advocates are convinced that the result will be better health – less obesity and less diabetes. But it’s worth asking: what will take the place of those sugary drinks? New data from Australia suggests that alcohol might be part of the answer. ConscienHealth’s Ted Kyle reports.

See saw
OBSERVATIONS OF ALCOHOL AND SUGARY DRINKS Tommy Wong and colleagues looked at self-reported alcohol and sugar sweetened beverage (SSB) consumption. They also analyzed waist circumference measures. Data came from the 2012 Australian Health Survey. Overall, about a third of adults drank no SSBs. But it turns out that those adults made up for the calories from sugar with calories from alcohol. A substitution model found no difference in waist circumference when trading SSBs for alcohol. In other words, they found no evidence here that people who swapped alcohol for sugar did better on this indicator for obesity.

HUMANS PUSH BACK Humans are tricky creatures. Push them to do something you want and they find ways to push back. History is littered with strong responses to constraints on beverage choices. The Tea Party and the Whisky Rebellion are just two examples that come to mind.

Rebellion isn’t the only response. People adapt in unpredictable ways. For example, seltzer is an increasingly trendy alternative to sugary sodas. Smart people don’t drink soda, right? But hey, we need a dash of pleasure with our seltzer. So, voilà. We have a trend in hard (alcoholic) seltzers in the US. White Claw is a brand that embodies this trend and it’s become so popular that there’s a nationwide shortage. Tax policy plays a role, too, because taxes are lighter on these seltzers than on distilled spirits. Unintended consequences everywhere you look.

PITFALLS OF A NARROW FOCUS The systems that drive obesity are complex and adaptive. Push on one thing and the systems push back somewhere else. Simply taxing sweet beverages sounds like a good idea. But it’s worth watching to see how all these human systems adapt.

And we might do well to think more broadly, as one of the co-authors of the Wong paper, Prof Jennie Brand-Miller, told us recently: “Humans have always liked to drink calories, starting with day one. I think the harms of excessive soft drink consumption pale in comparison to alcohol. And Australia’s experience tells us that we shouldn’t expect declining consumption of soft drinks to make any difference to obesity trends. If we focus more on calories from alcohol, we might get somewhere.”

Indeed. A serving of breast milk – nature’s perfect food – has 17 grams of sugars. Will we wean humans from sweet and pleasurable beverages? Maybe not. So perhaps a more nuanced and thoughtful approach to promoting healthful behaviors would be wise.

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