An article published in this month’s issue of Circulation calculated that sugar-sweetened beverage (SSB) consumption accounts for between 161,000 and 208,000 deaths per year worldwide and states that there is an “urgent need” for strong programs to decrease SSB consumption. One such program has been sitting as pending legislation before multiple sessions of the U.S. Congress: the SWEET Act. It simply proposes to place an excise tax on SSBs in proportion to the amount of sugar that they contain and designates that funds from that tax go “to the prevention, treatment, and research of diet-related health conditions.” This is a great bill for everyone except the sugar-sweetened beverage industry. It should be let out of the morass of congressional committee delay and enacted into law.
{mosads}The bill was first proposed by Rep. Rosa DeLauro (D-Conn.) as the Sugar-Sweetened Beverages Tax Act of 2014. The next day, it was referred to the House Subcommittee on Health and there it stayed until the end of the 113th Congress — back to square one. It was reintroduced to the 114th Congress on March 26, 2015 as H.R. 1687, a.k.a. the Sugar-Sweetened Beverages Tax Act of 2015, or the SWEET Act. It was promptly referred to the House Ways and Means Committee and the House Energy and Commerce Committee. In short, it has essentially made no progress.
There is ample reason to believe that passage of the SWEET Act would result in significant health and financial benefits. Obesity is, after all, the most common and costly health problem in the United States. Over 35 percent of U.S. adults are obese — about a 50 percent increase over the fraction who were obese 25 years ago. Over the same period of time, the U.S. per capita SSB consumption has increased from about 140 to 200 liters per year. Numerous cross-sectional and longitudinal studies have shown that SSB consumption correlates significantly with body fatness and weight gain in adults and children. The 2015 U.S. Dietary Guidelines are expected to state that evidence is “strong and consistent” linking sugar consumption to “excess body weight,” with significant links to the risks of Type 2 Diabetes, hypertension, stroke, coronary heart disease and, of course, cavities. Financially, approximately $200 billion per year, or 20 percent of our healthcare costs, are attributable to obesity and its complications.
If effective, this bill would improve national health and decrease healthcare expenditures and there is substantial evidence of its potential efficacy. It is well-known to the sugar industry that supersizing or lowering the price of SSBs increases their consumption. Well-designed studies have shown that raising the point of service price of sweetened beverages decreases their consumption. This decline is further enhanced if the price increase is coupled to an educational intervention that could be implemented in media, labeling, etc. Such educational incentives to eat less sugar could be developed with the tax allocations specified in the SWEET Act.
While it seems relatively certain that passage of the SWEET Act would decrease SSB consumption, there is no guarantee that it would promote weight loss. It is possible that the calories not ingested as sugar would be “replaced” by a similar number of calories from other sugar sources or as fat. The SWEET Act should be a wonderful way of testing these possibilities and has the added benefit of doing so without increasing government spending. One might think that the sugar lobby will strongly oppose any effort to tax SSBs. However, even the the Sugar Association agrees that SSBs are harmful. In a recent letter to the 2015 Dietary Guidelines Advisory Committee they state, “we strongly contend that without the substantial inclusion of SSB studies, there would be little or no scientific evidence to support or imply an association between ‘added sugars’ and disease outcomes.
This is not an effort to ban SSBs or infringe on freedom of beverage choice. Passage of the SWEET Act would serve as an alert to the consumer that is built into the price tag, instead of printed on the side of the cigarette package. It has a direct health benefit and provides money for development of better obesity treatment and preventative measures with a resultant “dent” in the rising obesity-related healthcare costs. The SWEET Act is a cost-effective opportunity to improve our health as well as our understanding and treatment of a disease that affects over two-thirds of the U.S. Our legislators can push it forward or just let it languish. If they choose to leave it, then they are sending a message that they are not compelled by the existing data this that is an important, and readily addressable, health issue. An unwillingness to confront this bill just leaves a sour taste.
Rosenbaum is a professor of pediatrics and medicine at Columbia University Medical Center in New York City and a graduate of the Columbia Public Voices Op-Ed program.