The Case for Health-Warning Labels on Soda

A proposed California measure would affix warning labels to sugar-sweetened beverages, and that's not a terrible idea.
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Imagine you are at the beach in Malibu. The weather is perfect, the ocean is shimmering, and you are thirsty. You buy a Coke from a nearby bodega and prepare to take a hefty swig, only to be met with the following text:

"STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.”

This California dream could become reality under a new bill proposed in the state's legislature late last week. Citing obesity research, state Sen. Bill Monning, a Democrat from Carmel, proposed that the warning labels to be affixed to all containers of soda and juice that have added sugar and 75 or more calories per 12 ounces. The "added" sugar aspect means Monning would let orange juice slide. Sunny Delight, however, would not be so lucky.

Oh, you don't frequent beachside bodegas, you say? Rest assured, Big Label will find you, as the LA Times reports:

At fast food restaurants with self-serve soda dispensers, the label would be on the dispenser. In a movie theater or business where the dispenser is behind the counter and used by employees, the label would be on the counter. In sit-down restaurants, the label might be on the menus.

In many ways, California lives up to its stereotype as a kale-muncher's paradise, and it tends to set the tone for food-related public health policy nationwide. After New York, it was one of the first states to label fast-food menu items with calorie counts, a measure that was later included in the Affordable Care Act. It began banning soft drinks in schools more than a decade ago, and since 2007 it has been limiting the amount of fat, sugar, and calories in snack foods sold in school vending machines.

And it seems to be working: California students eat 160 fewer calories a day than their peers in other states. Given its track record, it makes sense for California to double down in its fight against obesity by treating soft drinks more like cigarettes.

So why sweet drinks in particular? After all, Californians could still eat Oreos with abandon, not to mention heaps of those little tacos that drip with red pork grease when you tip them to take a bite.

Public health experts say it's because soda, along with its sugary brethren, is different. Unlike Oreos or tacos, sweet drinks don't provide satiety.

"Calories consumed in liquid form don’t provide the same signals of fullness that calories consumed in solid form do," Sue Babey, a senior research scientist at the UCLA Center for Health Policy Research, told me. "They tend to be consumed on top of all the calories in solid form." 

2013 study in the British Journal of Medicine found that drinking just one soda a day increases an adult's likelihood of being overweight by 27 percent and a child's by 55 percent. And a meta-analysis published in 2010 found that drinking one to two sweetened beverages a day increases diabetes risk by 26 percent.

There are some signs that the measure would not be as effective as its proponents hope. Diet soda, after all, also seems to have a deleterious effect on health: "Diet-soda drinkers who are overweight or obese are eating more solid food during the day than overweight and obese people who drink sugary beverages," Sara Bleich, associate professor of health policy at the Johns Hopkins University Bloomberg School of Public Health, said last month in a statement.

And other research has cast doubt on the idea that posting calorie counts makes people eat less. After researchers gave New York City McDonald's customers information about calorie counts, they actually ate a bit more. But we don't know if there's another variable there, like the fact that people usually don't patronize McDonald's for its healthy offerings...or the fact that if you tell New Yorkers to eat better they will tell you just where to go.

The other way this could backfire is through terror management theory, which suggests that people use their self-esteem as a buffer against outside threats, like, say, health warnings. Smokers who associated positive feelings with cigarettes, for example, didn't smoke less after being told they would die—they smoked more.

Babey, along with the California public health groups who support the soda label measure, say this type of law might work better than simple calorie counts because consumers don't always know how many calories or grams of sugar are too many.

"People are already aware that they can read the nutrition facts," Babey said. "But they don’t know how many grams are too many for them to be eating or drinking."

Soda taxes have shown to be effective at reducing consumption, but they can also act like a regressive tax, punishing low-income groups for their taste preferences. The California labels, meanwhile, wouldn't cost consumers anything. 

And hey, if the measure passed, Californians could still get a scold-free Sprite. They would just have to take the 10 to the 405 to the 5 and drive to Oregon.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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