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AAP: Tax Sugary Drinks

For the first time, the American Academy of Pediatrics (AAP) is recommending that sugary drinks should be taxed, the group said in a joint policy statement with the American Heart Association (AHA).

In an effort to combat childhood and adolescent obesity, prices for sugary drinks should be increased, such as through excise taxes on a local, state or national scale, reported Natalie D. Muth, MD, on behalf of the AAP Section on Obesity, Committee on Nutrition, and the AHA, and colleagues.

Moreover, at least part of the revenues should go to reducing health and socioeconomic disparities, the authors wrote in Pediatrics.

As evidence for their recommendations, the authors cited existing taxes on sugary drinks in other countries such as Mexico, and in U.S. cities, including Berkeley, San Francisco, and Oakland in California; Philadelphia; Seattle; and Boulder, Colorado. They also commented that taxing tobacco and alcohol products, particularly tobacco, reduced consumption “particularly among youth and people of lower socioeconomic status,” the authors wrote.

Stephen Cook, MD, of the University of Rochester Medical Center in Rochester, N.Y., who was not involved with the research, characterized this policy statement as “an important first step,” saying that it is critical to look at all strategies that “provide benefit and lead to no harm.”

“I do caution that we [society] can hang our hat on the sugary drink tax as a key policy to reverse obesity,” Cook told MedPage Today.

While Muth and colleagues highlighted “the success of tobacco and alcohol taxes in reducing adolescent use and consumption of these products,” Cook noted that there are big differences, especially with tobacco.

“Cigarettes, when used as intended, kill people. You can’t say the same thing about sugar-sweetened beverages,” he said. “Obesity is a disease that has many origins and pathways that lead to it, not just sugary beverage consumption.”

While the AAP has never officially weighed in on the policy of taxes, the organization did say children should avoid consuming “carbohydrate-containing” energy or sports drinks and instead drink water in their 2017 policy statement about fruit juice.

But Muth and colleagues noted that the AHA has touched on this issue before. In an email response to MedPage Today, the AHA said it issued a policy statement in support of these taxes in 2011 and have supported all the cities that currently have taxes in place.

Notably, Coca-Cola was once an AAP sponsor, but the organization severed its ties with the company in 2015 after input from membership, Cook noted.

“It’s important to be clear that we can’t allow the misperception to arise that it’s only sugar-sweetened beverages, so we can just throw all the other stuff away, like good schools and physical education, because we don’t need to do anything else for obesity,” Cook said, adding that funds from sugar-sweetened beverage taxes need to support evidence-based strategies to help prevent obesity.

“They could also support new clinical models to deliver evidence based treatment strategies that aren’t covered by Medicaid or insurers. We cannot let those funds go to different areas,” he noted.

‘Regressive Tax’

Muth and colleagues recommended that at least part of the revenue from these proposed taxes is allocated to public health initiatives, such as subsidizing healthier foods or going towards child health or obesity and diabetes prevention programs.

The authors acknowledged that while “people of lower socioeconomic status bear a greater burden from taxation, they also disproportionately benefit from the health and economic benefits from prevention of cardiovascular disease and type 2 diabetes mellitus.”

Another recommendation in the policy statement recommended that federal nutrition programs should not only ensure access to healthier food and beverages, but also discourage consumption of sugary drinks.

Muth and colleagues noted that the Supplemental Nutrition Assistance Program (SNAP) “is the only government feeding program that does not have nutrition standards to address diet quality,” adding that while the public and SNAP participants support the removal of SNAP benefits for sugary drinks, the USDA “has repeatedly rejected states’ requests for waivers and pilot studies that would eliminate sugary drinks from SNAP,” they wrote.

Cook said it’s a balance between insuring that people who are “looking at lean times with dollars” can be assured their dollars are going to the healthiest options, and telling those who are impoverished that they should deny their kids of something.

“People on food stamps will tell you they’ve been looked up and down when they’re in stores — it’s a stigmatizing and difficult enough experience already,” he said. “We don’t want the perception that we’re denying people something.”

In addition, Muth and colleagues recommended efforts by federal and state governments to decrease sugary drink marketing to children and adolescents.

“Stronger measures are needed to curtail advertising of sugary drinks to children and adolescents on television, on the Internet, and in places frequented by children, such as movie theaters, concerts, and sporting events,” they wrote.

The authors disclosed no conflicts of interest.

Cook is a past member of the AAP Section on Obesity and a former member of the Strategic Advisory Committee of Voices for Healthy Kids, the AHA’s section on childhood obesity, sponsored by the Robert Wood Johnson Foundation. He also serves on the New York governor’s Council on Hunger and Food Policy.