Are Soft Drink Calories A Problem?

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An editorial article out in the New England Journal of medicine has raised some interesting revisits to the questions concerning beverage selection and risk for obesity.[1] In particular the depressing increase in adolescent obesity not only in developed but developing countries because of the significant future health complications that spill out from these issues.

Sugars contained in soft drinks represent a substantial source of caloric intake in the USA and are likely to be similar here in the UK – that is almost 15% of daily calories are derived from soft drinks sweetened with sugar.

Unlike carbohydrates with high fibre content, sugar-sweetened beverages are nutrient-poor and are often associated with consumption of salty foods and fast foods. An emerging association between the increased consumption of sugar-sweetened beverages and chronic diseases such as type 2 diabetes, hypertension, and coronary heart disease is a major concern.[2]

Three papers published in the NEJM this month highlight potential explanations of mechanisms that increase risk for obesity.

The study by Qi and colleagues examined the interaction between the intake of sugar-sweetened beverages and a genetic-predisposition score that was calculated on the basis of 32 body-mass index (BMI) loci associated with obesity in women and men from two large prospective cohorts and in an independent replication cohort. This study provides strong evidence that there is a significant interaction between an important dietary factor — intake of sugar-sweetened beverages — and a genetic-predisposition score, obesity, and the risk of obesity. Hence, participants with a greater genetic predisposition may be more susceptible to the adverse effects of sugar-sweetened beverages on obesity; this is a clear example of gene–environment interaction.[3]

The study by de Ruyter et al looks at the effects on weight of swapping drinks. Whilst there are some limitations due to non-completion of 26% of the participants the results clearly suggest that masked replacement of a sugar-containing beverage (104 kcal) with a sugar-free beverage significantly reduced weight gain and fat accumulation in normal-weight children.[4]

Ebbeling and colleagues randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention consisting of home delivery of noncaloric beverages. This intervention was designed to decrease consumption of sugar-sweetened beverages, with a follow-up for an additional year.

The difference in the primary outcome, the change in BMI at 2 years between the experimental and control groups, was not significant. However, at 1 year, significant changes in BMI were observed, particularly among Hispanic participants suggesting that once the access to the drinks was discontinued that habits were restored.[5]


High fructose corn syrup has also been implicated as it promotes hepatic lipogenesis and the development of insulin resistance.[6] As such it may add additional complications in the attempt to manage peoples long term dietary choices.

Of course industry and politics resist attempts to apportion blame of impose taxation levies to encourage consumer choice, BUT….

“It is difficult to get a man to understand something when his salary depends upon his not understanding it”
— Upton Sinclair 1878-1968


[1] Caprio S. Calories from Soft Drinks – Do They Matter? N Engl J Med. 2012 Sep 21. View Abstract

[2] Malik VS, Popkin BM, Bray GA, Despres JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010;121:1356-1364 View Abstract

[3] Qi Q, Chu AY, Kang JH, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012.  View Abstract

[4] de Ruyter JC, Olthof MR, Seidell JC, Katan MB. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med 2012. View Abstract

[5] Ebbeling CB, Feldman HA, Chomitz VR, et al. A randomized trial of sugar-sweetened beverages and adolescent body weight. N Engl J Med 2012 View Abstract

[6] Stanhope KL, Schwarz JM, Keim NL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest 2009;119:1322-1334  View Abstract

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1 Comment. Leave new

  • Good article and nice quote! To which I would add “Ignorance is Strength” (Nineteen Eighty-Four, George Orwell, publ. 1949).

    High-energy (HE) diets, ie high in saturated fat and refined sugar may also cause changes to the brains of obese people and drive overconsumption of these foods, making weight loss even more challenging. This is according to new research which shows that rodents consuming HE diets display impaired hippocampal-dependent learning and memory.

    Studies such as this combined with recent evidence that obese people harbour specific gut microbiota that promote excess weight gain beg that all-important question: whose fault is it anyway when people get fat? The truth is that obesity is not simply a matter of common sense and not just a matter eating less and exercising more as ‘Big Food’ would have us believe.

    (Davidson TL et al. The effects of a high-energy diet on hippocampal-dependent discrimination performance and blood–brain barrier integrity differ for diet-induced obese and diet-resistant rats. Physiology & Behavior, 2012; 107 (1): 26)


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