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The Real Thing. What is the biggest Source of Calories in America?

Sep 21, 2004

Which food is the biggest single source of calories in America? Burgers? Pizza? Aunt Celia’s fruitcake? Actually, the biggest source of calories is not really a food at all (although I suppose the same could be said about the fruitcake). The answer is in that 44 ounce Super Big Gulp cup sitting next to you: sugar-containing soft drinks supply just over 7% of all the calories consumed in the U.S. every year. As you might expect, most of those calories are going right into our spreading waistlines. Studies have already shown that high consumption of non-diet soda is highly associated with childhood obesity, so it shouldn’t be too much of a surprise that the same thing seems to hold true in adults.

Nonetheless, this seemingly common-sense notion (that is, drinking too much sugary soda leads to obesity) hasn’t been so clear to some folks. Just last year, the World Health Organization released a report that noted that many chronic diseases were attributable to excess body fat, and recommended the restriction of sugary soft drinks in addition to other “energy-dense, micronutrient-poor food.” The food industry didn’t take this lying down, and retorted that this conclusion was not supported by the scientific literature. A modified report was finally approved with its teeth removed, with no specific recommendations for limiting soda or other junk foods.


Well, a new study was just released showing what I think most people not affiliated with the food industry could probably figure out: the more soda you drink, the fatter you are likely to get. Furthermore, the soda and the extra weight that results from it will give you a significantly elevated risk of developing type 2 diabetes. The data came from the huge Nurses Health Study II run by the Harvard School of Public Health, which has been tracking the health and habits of thousands of women for more than a decade. Interestingly, the study found that women who maintained a steady consumption of non-diet soft drinks (either high or low) gained an average of seven pounds over a four year period. Women who had been drinking less than one soda per week but who starting drinking as much as one a day gained over ten pounds, while those who gave up frequent soft drinks gained closer to three pounds over the four year study period. And those women who drank more than one soda per day had twice the risk of type 2 diabetes as those who drank less than one per week.

One of the more interesting details of this study was the finding that women who drank a lot of soda had an overall higher caloric intake than those who drank less. This has been seen before, and one interpretation that seems likely is that sugary liquids do not cause you to feel full, despite the huge calorie load. This is of enormous importance, because it has been calculated that an extra can of soda daily without reducing calories in some other part of the diet can cause a 15 pound weight gain over the course of a year.

So what’s to be done about this? Many people feel that the government needs to take steps, including the taxation of sugary sodas, removal of soft drink vending machines from schools and other places frequented by children, and restrictions on advertising. If these measures sound familiar, you may be recalling the fight against tobacco, in which government action was ultimately required to push through almost exactly the same sorts of interventions. In the case of tobacco, these measures ultimately led to significant reductions in smoking-related illnesses in this country. It remains to be seen if there will be a similar movement in the fight against obesity, which will clearly rankle the food industry, one of the most powerful lobbies in America.
I agree with a lot of these measures, but I would also call for common sense among consumers. Soda pop is not as addictive as tobacco, and it should be easier for folks to switch to non-sugary beverages than for smokers to kick the habit. Part of the problem is that soda flies under the radar for many people. Just last week I was talking with an obese, diabetic patient in my office, who couldn’t understand why she wasn’t losing weight after modifying her diet and starting an exercise program. “It just doesn’t make sense,” she said, between sips of her Coke.

Viewpoint is an editorial column that expresses the opinion of the specific Medical Director, who is solely responsible for its content. Viewpoint does not represent the views or opinions of Veritas Medicine and does not reflect the opinions of other physicians and researchers.

Journal of the American Medical Association. 292:927 (2004)

This information was last reviewed August 4, 2004.

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