Sugary Drinks in Communities of Color

i Making the Connection: Physical Activity and Positive Youth Development
Sugary Drinks in
Communities of Color:
Recent Research and
Policy Options to Reduce
Consumption
March 2015
Leadership for Healthy Communities is a national program
of the Robert Wood Johnson Foundation.
www.leadershipforhealthycommunities.org
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ii Making the Connection: Physical Activity and Positive Youth Development
Copyright 2015 Robert Wood Johnson Foundation.
This brief was produced by the Center for Global Policy
Solutions with direction from the Robert Wood Johnson
Foundation (RWJF) for the RWJF Leadership for Healthy
Communities program.
Leadership for Healthy Communities is a national
program of the Robert Wood Johnson Foundation designed
to support local and state government leaders nationwide
in their efforts to reduce childhood obesity through public
policies that promote active living, healthy eating and
access to healthy foods. For more information, visit
www.leadershipforhealthycommunities.org.

1 Sugary Drinks in Communities of Color
Introduction
Sugary drinks are routinely available in the United States. In recent years, however,
such beverages—sodas, sports drinks, energy drinks, fruit drinks other than 100
percent fruit juice, and sugar-sweetened teas and coffees—have come under
increased public scrutiny. Research provides strong evidence of a link between
the consumption of sugary drinks and weight gain, metabolic syndrome and type
2 diabetes.1
Despite decreasing consumption of some of these beverages over the
past decade, Americans consume on average more than 150 calories from sugary
drinks each day, the equivalent of one 12-ounce can of soda.2
In communities of
color, where regular consumption of these drinks is more likely, the health impact is
particularly acute and obesity-related chronic diseases are more prevalent.
This policy brief investigates sugary drink consumption in communities of color,
focusing on the public health impact and marketing of such products, and policy
options to facilitate healthy beverage consumption. It discusses how decision makers
can work to prevent childhood obesity and related illnesses by advancing policies to
reduce the marketing and appeal of sugary drinks—and increase the availability of
healthy alternatives—in communities of color.
FACTS AT A GLANCE
Consumption of sugary
drinks is associated with
poor health outcomes,
including excessive weight
gain, childhood and adult
obesity, type 2 diabetes, and
tooth decay.
Children who drink a
12-ounce soda every day
are 60 percent more likely
to become obese than those
who do not.
People of color are more
likely to have limited access
to healthy beverages, more
inclined to consume sugary
beverages, and more
affected by preventable
chronic diseases.
Food and beverage
companies
disproportionately target
marketing efforts promoting
sugary drinks toward people
of color.

Consumption of
Sugary Beverages in
Communities of Color
For children of color, high daily consumption of sugary beverages early in life is
a significant risk factor for childhood obesity.3
African-American and Mexican-
American children typically consume a higher proportion of daily calories from these
drinks than do white children.4
(See Figure 1.) For teens, sugary drink consumption
exceeds current USDA recommendations, which state that less than 10 percent of
calories should be from “empty” sources, defined as calories from sugar or fat.5
In addition, about half of U.S. adults consume sugary drinks on any given day, with
one-quarter consuming at least 200 calories a day from these beverages.6
These
consumption levels exceed the American Heart Association’s recommendation that
adults consume no more than 450 calories from these drinks per week.7
Excessive
consumption of sugary beverages is associated with several socioeconomic factors,
including race, income, and educational attainment. African-American and Latino
adults consume more daily calories than white adults from such drinks, especially
sugar-loaded fruit-flavored drinks.8
Adults without a high school diploma are also
more likely to consume these drinks than those who have graduated.9
Furthermore, a disproportionate number of African-Americans and Latinos live in food
deserts with limited access to healthy, affordable food and beverages.11
Food deserts
typically have a plethora of corner stores, fast-food restaurants, and bodegas that sell
unhealthy beverages.12
Concurrently, full-service supermarkets, which are more likely
to offer a variety of healthy products at lower prices, are often missing or insufficient
in communities of color.13
In fact, African-American neighborhoods only have about
half the number of chain supermarkets as predominantly white neighborhoods.14
Children living in food deserts frequently purchase inexpensive but unhealthy
beverages in corner stores that are often located near schools. This increases caloric
intake among children in urban areas by about 350 additional calories a day.15
Figure 1. Percentage of daily caloric
intake from sugary drinks among
children, 2009-201010
DEFINITION
The Departments of Agriculture,
Treasury, and Health and Human
Services define a food desert as
“a census tract with a substantial
share of residents who live in low-
income areas that have low levels of
access to a grocery store or healthy,
affordable food retail outlet.”16
4.7
7
2-5 year olds 6-11 year olds 12-19 year olds
7
11.6
4
4
10.5
7
10.6
14
12
10
8
6
4
2
0
Mexican–American
African–American
DailyEnergyIntakeFrom
SugaryDrinks%
White

Contributions of Sugary
Drinks to Health Risks
in Communities of Color
Consumption of sugary drinks is associated with a number of health problems in
children and adults, including obesity, type 2 diabetes, and tooth decay.Based on
2010-2012 survey data, Latino and African-American adults are nearly twice as
likely to develop type 2 diabetes as white adults.17
Specific research on African-
American women found that regular consumption of sugary beverages increases
the risk of type 2 diabetes by 24 to 31 percent.18
Sugary drink consumption can also lead to tooth decay, the most common chronic
disease that affects children.This erosion of tooth enamel can be extremely painful
and can cost, on average, $700 in hospital-based emergency department charges
per child.19
Moreover, tooth decay in children can have serious consequences,
including lost school hours, difficulty learning, pain and suffering, and problems
with eating and speaking.20
African-American and Latino children and adults are
more likely to have tooth decay than whites of the same socioeconomic status are,
and also are more likely to have it go untreated.21
Obesity rates are significantly higher among minority children and adults than in
the general population. According to the most recent data from the National Health
and Nutrition Examination Survey, African-American women have the greatest risk
of becoming obese. About 36 percent of African-American girls ages 2 to 19 and
82 percent of adult African-American women are overweight or obese.22
Sugary
drink consumption only increases this risk.23
People who regularly consume such
beverages often feel less full than if they had eaten solid food with the same number
of calories, and this may lead them to consume more daily calories than needed.24
Figure 2. Prevalence of overweight
and obesity among children and
adults by race/ethnicity, 2011-
201225
Adult (ages 20+) Children (ages 2-19)
White Latino African —
American
White Latino African —
American
32.6
42.5 47.8
22.4
14.1 20.2
15.914.6
15.1
34.6
35.4 28.4
90
80
70
60
50
40
30
20
10
0
Overweight
Obese
Prevelance,%

Youth of color are more likely to be overweight or obese than are white youth, and
are at greater risk of developing preventable chronic diseases as adults.26
Figure 2
shows that a larger percentage of African-American and Latino children ages 2 to
19 are overweight or obese than white children. Also, recent studies of American
Indian and Alaska Native children ages 2 to 4 found that 21 percent are obese and 41
percent are overweight or obese compared to 12 percent and 28 percent respectively
for white children of the same age.27
Although adolescents of color are at higher risk,
childhood obesity is prevalent across all races and is exacerbated by sugary drink
consumption. In fact, children who drink a 12-ounce soda every day are 60 percent
more likely to become obese than are those who do not.28
Poor eating and drinking
habits in childhood matter because these dietary behaviors tend to persist into
adulthood.29
Obesity also presents a significant societal burden. It negatively affects
the economy by increasing the costs of direct medical services and human capital,
decreasing productivity, and contributing to disability and premature mortality.30
DEFINITION
Acculturation is the process by
which one cultural group adopts the
beliefs and behaviors of another.
LATINOS ACCULTURATE
TOWARD LESS HEALTHY
DIETARY BEHAVIORS
Research shows that
acculturation negatively
influences dietary behaviors,
including among many foreign-
born Latinos who tend to eat
healthier before adopting
American behaviors. The more
time Latinos spend in the
United States, the more likely
they are to develop unhealthy
dietary practices and become
obese.31
Latino families
who acculturate are more
inclined to eat at restaurants
and consume sugary drinks
than are Latino families who
prepare more nutritious,
traditional meals at home.32

Sugary Drinks in Schools
School foods and beverages are critical sources of nutrition for children, who
consume about 35 percent to 50 percent of their total daily calories at school.33
Per
passage of the Healthy, Hunger-Free Kids Act of 2010, updated nutrition standards
for the National School Lunch and Breakfast Programs went into effect in 2012, and
similar standards known as “Smart Snacks in Schools” were implemented in 2014 for
snacks and beverages sold in schools.
The “Smart Snacks in School” nutrition standards limit schools to selling only water,
fat-free milk, non-flavored low-fat milk, and 100 percent fruit or vegetable juice
during the school day, though they do not address sugary drinks marketed and/or
sold outside of school time. Among other provisions, the Smart Snacks standards
require that free drinking water be available to students on an unlimited basis.
Water fountain availability, however, is still limited in many schools. Roughly four
in 10 youths ages 9 to 19 report few functional water fountains or dispensers in
their schools in a recent national survey, and one in 25 report no such resources.34
Underscoring the need for moderation and balance in student diets, the standards
also set maximum portion sizes for permitted beverages based on students’ ages.
These standards aim to reduce widespread access to sugary beverages and other
unhealthy snack foods, which were often available in vending machines, à la carte
lines, school stores and snack bars, classroom parties, and fundraisers.35
Fortunately,
many schools across the nation have implemented the standards and taken additional
proactive steps to reduce or eliminate sugary drinks with positive results.36
Unhealthy school snacks are particularly harmful to children from low-income
families, who often suffer the burden of poor nutritional quality, as well as the peer
pressure and stigma that drive students to buy snacks instead of healthier school
meals.37
Moreover, schools with a higher proportion of minority students have
historically had more access to sodas and weaker school policies regarding snack
foods than schools with predominantly white students.38
These factors increase
the likelihood that youth of color will consume more sugary drinks than their white
peers. However, full implementation of the new Smart Snack guidelines across the
country aims to remedy these disparities.
USDA “SMART SNACKS
IN SCHOOL” NUTRITION
STANDARDS
Require schools to make
drinking water available to
all students at no cost.
Permits schools to sell
only water, fat-free milk,
non-flavored low-fat milk,
and 100-percent fruit or
vegetable juice.
Introduce portion sizes for
allowable beverages based
on age.
Elementary schools are
permitted to sell up to
8-ounce portions.
Middle and high schools can
sell up to 12-ounce portions.
Create beverage options for
older students.
High schools are permitted
to sell calorie-free
beverages in up to 20 ounce
portions, and low calorie
beverages with up to 40
calories in 8-ounce portions
and up to 60 calories in 12
ounce portions.

Impact of Marketing
Sugary Drinks to Youth
of Color
Advertisers spend about $866 million a year on television, print, and digital
marketing aimed at selling sugary drinks.39
In addition, children (ages 6 to 11)
and adolescents (ages 12 to 17) are exposed to about 269 and 287 of these
advertisements, respectively, per year.40
Children and adolescents’ exposure to fast-
food marketing is significantly higher—an estimated 1,168 and 1,752 advertisements
per year, respectively.41
Strong evidence shows that television advertising influences young children’s
short-term food consumption, food preferences, and caloric intake.42
Television
advertisements still dominate youth-directed advertising, but beverage companies
are increasingly shifting to digital marketing using social media, mobile devices,
video games, and other web-based platforms to market sugary drinks, frequently to
young children.43
Beverage companies also target children and adolescents through
cross-promotions and product placement. For example, the product packaging for
fruit drinks often feature licensed characters from children’s television shows and
movies, such as SpongeBob SquarePants.44
Marketing efforts can also mislead people to believe that sugary drinks are healthy,
especially when they are advertised as “all natural” or “real.” For example, sports
drinks like Gatorade and Vitaminwater are often marketed as healthy alternatives
to soda, which many parents believe.45
Their sugar content, however, comprises
the majority of the product’s calories.46
The American Academy of Pediatrics
recommends that most youths refrain from consuming sports drinks because they do
not engage in enough physical activity to warrant their consumption.47
Nonetheless,
sports drinks have a critical share of the market. In 2013, Gatorade spent $108
million on advertising in all media, the second most among all major sugary drink
brands.48
African-American youth have also been found to be more than 60 percent
more likely to visit Gatorade.com compared to the national average.49
Minority youth are more exposed to sugary drink advertisements and more heavily
targeted by food, beverage, and fast-food companies than are white youth.50,51
(See Figure 3.) In part, this is because minority youth spend significantly more
time watching television than do white youth.52
As such, many sugary drink
advertisements strategically use minority celebrity icons, entertainers, and athletes
to appeal to minority youth.53
In 2013, African-American children and teens saw
more than double the number of television advertisements for sugary beverages and
energy drinks than did their white peers.54
Youth of color are a desirable target for
DEFINITION
Cross-promotions are cooperative
marketing tactics whereby two or
more companies agree to promote
each other’s products.
DEFINITION
Product placement occurs when a
product, service, or trademark is
either referenced or placed, visually
or audibly, within mass-media
programming.

advertisers because they tend to consume more media than general consumers do,
use social networking to share opinions about products and brands, and are early
adopters of new technology, often helping to set new trends.55
Advertisements for sugary drinks on Spanish-language television have been on
the rise since 2008, likely a result of booming Latino population growth in the
United States combined with deliberate strategies by companies to capitalize on
the potential growth opportunity. In 2010, Latino preschoolers and teens viewed
33 percent and 49 percent more sugary beverage advertisements, respectively,
on Spanish-language TV than in 2008.57
Exposure increased again between 2010
and 2013 by 23 percent for Latino preschoolers and 32 percent for teens.58
Indeed,
Latino preschoolers viewed almost 80 percent more advertisements for full-calorie
Coca-Cola Classic on Spanish-language television than the average preschooler
saw on English-language television.59
Additionally, Spanish-language television
advertisements targeted at children are more likely to promote nutritionally poor
food products than those on English-language channels.60
Figure 3. Soda as a percentage of
packaged food advertising during
prime-time television programming
by market56
African–American Market General Market
12
10
8
6
4
2
0
%ofPackagedFoodAdvertisements

Industry’s Voluntary
Commitments to Limit
Advertising to Children
In response to growing public health concerns about the poor nutritional quality
of foods and drinks marketed to children, the food and beverage industry has
made efforts at self-regulation.61
In 2006, the Council of Better Business Bureaus
established the Children’s Food and Beverage Advertising Initiative (CFBAI), whose
member companies pledged to devote 100 percent of advertising targeted at
children under age 12 to promote healthier or “better for you” products.62
During
that same year, three leading beverage companies—Coca-Cola Company, PepsiCo,
Inc., and Dr. Pepper Snapple Group—and the American Beverage Association made a
commitment, in conjunction with the Alliance for a Healthier Generation, to create
and implement voluntary School Beverage Guidelines that would “alter the mix of
beverages available to students during the day.”63
Research is mixed as to whether industry self-regulation has significantly reduced
the availability and consumption of sugary drinks among youths.Although CFBAI
members have complied with their pledges, more than two-thirds of all CFBAI
company advertising is still devoted to products of the poorest nutritional quality.64,65
Further, since establishing CFBAI and other self-regulatory groups, companies have
significantly shifted their marketing tactics to focus more on teens and other topics
AMERICAN INDIAN HIGH SCHOOL STUDENTS
CONSUME FEWER SUGARY DRINKS AFTER INTERVENTION
In an effort to counter steadily increasing rates of type 2 diabetes, the Zuni
Pueblo tribe of New Mexico worked with the Zuni Public School District and
the University of Arizona to implement a school-based diabetes prevention
program. Before the intervention, students at Zuni High School were drinking,
on average, 24 ounces of sugary beverages per week. The intervention educated
students about the connection between unhealthy foods and diabetes, and
provided healthy food and beverage alternatives including water in coolers. The
program also replaced all regular sodas in vending machines with diet (sugar-
free) sodas. Students made posters that alerted their peers to the link between
unhealthy foods and diabetes, and placed them on vending machines and in the
fitness center and school cafeteria. Following the intervention, the students
showed significant and steady declines in plasma insulin levels, a marker for
metabolic syndrome and type 2 diabetes. Three years after the intervention
began, the 400 students of Zuni High School were consuming virtually no
sugary drinks at school and were no longer bringing canned sodas to school.68

SAN FRANCISCO LIMITS ACCESS TO SUGARY BEVERAGES AND
INCREASES REVENUES FOR SCHOOLS
San Francisco—where more than 80 percent of the county’s public school
students were from racial or ethnic minority populations in 2012—has taken
several steps to limit access to sugary beverages in schools.69
In 1999, the city
passed the Commercial-Free School Act, which prohibits the San Francisco
Unified School District (SFUSD) from entering into an exclusive contract with
a soda or snack food company and eliminates the use of curriculum materials
that feature brand names.70
SFUSD also phased out the sale of sports drinks
from schools and maintained stable à la carte food and beverage revenues, in
part because administrators replaced unhealthy foods and beverages with
healthier products requested by students.71
In fact, Aptos Middle School, the
most racially and socioeconomically diverse middle school in the city, saw
increased revenues after school administrators replaced sodas with bottled
water in vending machines and à la carte lines.72
Another SFUSD school reaped
a $3,000 net increase in food service revenue after one month due to increased
school lunch participation.73
The success of such interventions led SFUSD to
implement these changes throughout the district in 2003 and 2004.74
of marketing, such as digital, social and mobile media, that aren’t covered by their
CFBAI pledges.66
Also, the validity of some research findings is questionable because
studies funded by the beverage industry are four to eight times more likely to show a
finding favorable to industry than independently funded studies.67
DEFINITION
In this context, exclusive contracts
are agreements in which school
districts agree to sell only one
company’s products in vending
machines and at all school events in
exchange for direct payments from
that company.
PHILADELPHIA’S OBESITY RATES DROP FOLLOWING PASSAGE OF
COMPREHENSIVE POLICIES TO EXPAND HEALTHY EATING AND
PHYSICAL ACTIVITY
The city of Philadelphia, which is more than 43 percent African-American,
has taken several steps to improve its local food system and the health of its
neighborhoods and schools.75
In 2010, Mayor Michael Nutter and the city’s
Department of Public Health spearheaded “Get Healthy Philly,” a collaborative,
multi-sector initiative to improve nutrition and physical activity.76
In two years,
this initiative helped enable more than 630 corner stores to sell healthier
foods and beverages, including produce, water, and low-fat dairy products.
Get Healthy Philly also launched a media campaign to raise public awareness
about the link between sugary drinks, obesity, and diabetes that was seen or
heard more than 40 million times.
With respect to schools, Philadelphia passed a district-wide beverage policy in
2004 that restricted vending machine and à la carte sales on school premises
to 100-percent juice, water, and low- or non-fat milk.77
School administrators
also created school wellness councils in 171 public schools, reaching more
than 100,000 students, and worked to remove unhealthy foods including
sugary drinks from classrooms, school stores, and fundraisers. These changes
may have contributed to an overall drop of nearly 5 percent in the obesity rates
of Philadelphia students in grades K-12 from 2006 to 2010.78
DEFINITION
School wellness councils are
advisory groups concerned with the
health and wellbeing of students
and staff. Councils typically include
school staff, students, family
members, and community members.

Policy Options
While policymakers face difficult challenges to limiting the role of sugary drink
marketing and consumption in communities of color, there are also opportunities for
action. Policymakers representing schools, cities, counties, and states can use public
policy to reduce access to these beverages and promote healthier alternatives for
their constituents. The following highlights some effective policy options.
School-Based Policies:
•Create Comprehensive Wellness Policies and School Wellness Councils
In accordance with the Healthy, Hunger-Free Kids Act of 2010, schools
participating in the National School Lunch Program or other federal child
nutrition programs need to strengthen and fully implement local school wellness
policies to improve student nutrition and health.79
This includes permitting
school-based food and/or drink advertisements or marketing only for those
items that meet the Smart Snack guidelines. In addition to establishing goals for
promoting healthy foods and beverages, physical activity, and student wellness,
schools are required to ensure participation of all relevant stakeholders in the
review and implementation of the local school wellness policy. This can be
accomplished through the creation of a school wellness council.
Ideally, school wellness councils should include school administrators, physical
education and health teachers, food service staff, students, family members,
and community members such as parks and recreation representatives. These
stakeholder groups can be given important responsibilities such as identifying
ways to improve the health of students and staff, coordinating nutrition
education programs, and monitoring the implementation of comprehensive
school wellness policies. Councils can also promote student engagement
by directly involving them in such activities as tasting sample beverages,
designing healthy beverage marketing campaigns, and selecting healthy drinks
for vending machines. Because many changes will directly affect students,
their input and support throughout the process is often critical to success.80
School administrators and wellness councils should clearly communicate the
rationale for any decisions to reduce or eliminate access to sugary drinks with all
stakeholders throughout the process.

•Fully Implement USDA’s Smart Snacks in Schools Guidelines
Limit the Availability of Sugary Drinks During the School Day:
School administrators should ensure the availability of healthy food and
beverage options during the school day in cafeterias, vending machines, snack
bars, and any other venue offering foods and beverages.
Increase Healthy Food and Beverage Availability:
Under the Smart Snacks in Schools guidelines, drinking water must be available
to students at no cost during all school meals. School water fountains should be
accessible and maintained regularly so that children have the ability and desire
to use them. School administrators can promote water consumption further by
providing cups and containers, water dispensers, water bottles, or chilled or
filtered drinking stations. They can also involve students in developing social
marketing plans to encourage their classmates to drink water.
•Change Food Marketing Practices
School administrators should not only restrict
the marketing of sugary drinks in schools,
they should also implement social marketing
strategies to promote healthier beverages
such as water. Other potential actions could
include reviewing marketing practices in
existing contracts with beverage companies and
prohibiting exclusive contracts—which can limit
options for schools—in the future.81
•Promote Nutrition Education
Schools and local governments should promote
culturally relevant nutrition education programs
for communities of color. They can partner
with universities, health departments, and
community- or faith-based organizations to
disseminate information to parents and the
local community. School administrators should
communicate with parents and caregivers about what the school or district is
doing to improve student nutrition and how parents and caregivers can encourage
students to drink healthy beverages. Such information should be communicated
with parents in culturally appropriate languages.
•Limit Sugary Drink Sales on School Premises Before and After School, and at
Other Child-Centered Locations
It is also critical to limit the sale of sugary drinks on school premises before and
after the school day, particularly during sports events. Current USDA standards
do not include provisions regarding the sale of beverages outside of school hours.
School administrators should consider going beyond the existing standards and
follow best practices to implement these rules.

Community-Based Policies:
Local governments can launch multi-sector campaigns to raise public awareness
about the health consequences of excessive sugary drink consumption. They can
also create social marketing campaigns to promote healthy beverages such as those
launched in New York City,82
Philadelphia,83
Kansas City, Kan.,84
Santa Clara, Calif.,85
and Howard County, Md.86
Additionally, community- and faith-based organizations
can set positive examples by adopting their own healthy workplace policies that
encourage serving healthier beverages where and when they meet. Workplace
policies, such as those that influence the type of food and drinks available during
meetings or in the office setting, can be designed to help promote employee health.87
Local leaders can also advance policies that restrict the availability and marketing of
sugary beverages, particularly to youth.
•Ensure that Government Facilities and Government-Sponsored Events Promote
Citizens’ Health
Local governments can set a good example for schools and neighborhoods by
providing only healthy beverage options in their facilities and promoting healthy
beverages at city- and county-sponsored programs and events, especially those
attended by children, such as after-school programs and parks and recreational
facilities. Officials should eliminate sugary drink sponsorships and advertising
at city and county events, including sports leagues, facilities, and programs.
The San Francisco Unified School District sought to address this issue with its
Commercial-Free Schools Act, which requires approval by the Board of Education
for any corporate sponsorship of athletic teams or clubs.88
Water fountains
should be provided in all public venues where beverages are available, including
schools, parks, and government buildings. Similarly, community- and faith-based
organizations can be encouraged to serve healthier beverages in their after-
school and summer programs.
•Make Restaurants Healthier for All
One-third of the sugary drinks Americans consume away from home are obtained
in restaurants or fast-food establishments.89
In 2011, the Food and Drug
Administration (FDA) proposed a rule that would establish requirements for
nutrition labeling of standard food and drink items on menus and menu boards
in chain restaurants and similar retail food establishments with 20 or more
locations.90
The final rule, issued in 2014, covers not only chain restaurants but
also grocery stores, convenience stores, and other food service establishments
like movie theaters and pizza parlors.91
In addition to the posting of calories,
additional nutrient information (such as total sugars) must be made available
upon request. Food establishments should properly implement these new
regulations. Though not subject to the current rule, non-chain restaurants should
consider following it on a voluntary basis.
DEFINITION
Social marketing is an approach
that uses traditional marketing
techniques and concepts to
influence individual behavior for the
betterment of both the individual
and his or her community.

•Support Healthy Community Design
Local governments can also establish minimum distances between fast-food
restaurants and places that children frequent, such as schools or playgrounds.
At fast-food restaurants such as McDonald’s, sugary drinks can account for more
than 40 percent of drinks ordered with a kids’ meal.92
As counties and cities
review their zoning policies, they can identify opportunities to limit new fast-food
restaurants from opening near schools. Detroit, Mich. and Arden Hills, Minn.,
for example, both have local ordinances that prohibit fast-food restaurants from
being located within 500 feet of elementary, middle, or high schools.93
•Increase Consumer Awareness to Encourage Healthy Choices
Local governments can help provide consumers with the information they need
to make healthier choices. They can help educate consumers about products
marketed as healthy alternatives to soda, such as fruit drinks, sports drinks, and
flavored water, which often contain significant amounts of sugar.
•Use Sugary Drink Tax Revenues for Obesity-Prevention Initiatives
State and local officials can consider levying excise taxes on sugary beverages
in an effort to reduce consumption directly through higher prices. The revenues
generated by the tax can then be applied to nutrition education and obesity-
prevention initiatives, especially targeting vulnerable communities.96
A 2011
study estimated that a national penny-per-ounce tax on sugary drinks would
generate $79 billion over the period of 2010 to 2015.97
Several experts have
also suggested that earmarking these tax revenues for obesity prevention and
reduction efforts would improve weight outcomes.98
Such taxes have the potential
to cut consumption as evidenced by the public health success of reduced tobacco
use from taxes.99
While some states have levied relatively small sales taxes on
certain unhealthy beverages, research suggests that sugary drink taxes need to
be as high as 20 percent to result in significant weight loss.100
In 2014, Berkeley,
Calif. became the first city in the U.S. to pass a law taxing sugary drinks.101
The new law, receiving roughly 75 percent of votes, established a
penny-per-ounce tax.
HOSPITALS USE INNOVATIVE STRATEGIES TO PROMOTE
HEALTHY DRINKS IN CAFETERIAS
Ten Boston hospitals partnered with the city’s government in 2012 to
implement innovative point-of-sale strategies to promote healthy drinks in
their cafeterias. The hospitals established a “red-yellow-green” stoplight
system to help consumers choose healthier options, increased the visibility of
healthy beverages by putting them at the consumers’ eye-level, and installed
free water dispensers.94
An evaluation of the initiative found that 50 percent
more customers reported looking at nutrient information after the intervention
and that those who saw the information were more likely to purchase healthier
items.95
Many hospitals around the country have since emulated Boston’s
policies by creating healthier environments for patients, staff, and visitors.
DEFINITION
An excise tax is a tax on a specific
good or service. It can be either
a specific excise tax based on
quantity—for example, a gallon of
gasoline or a pack of cigarettes—or
an ad valorem excise tax based on
the value or price of the item sold.
Excise taxes are typically levied
on producers or wholesalers, who
pass on the cost to retailers and
ultimately to consumers.

Conclusion
Growing research connecting the consumption of sugary drinks to obesity, type 2
diabetes, tooth decay, and other chronic conditions highlights a clear imperative for
policy changes. Sugary drink marketing also continues to target the most vulnerable
communities, including communities of color, but research shows that there are
many effective policy options for reducing the marketing of these beverages and
increasing the availability of more nutritious choices. Schools are an important area
of focus because children consume a large share of their daily calories at school,
and significant policy advances are already underway. However, policymakers must
continue to explore a variety of levers to reduce sugary drink consumption and
ensure that existing federal guidelines are fully implemented. Continued progress in
preventing childhood obesity in America must include policy efforts to limit sugary
drink marketing and consumption in communities of color and increase access to
healthier alternatives.
Resources
Rudd Center for Food Policy & Obesity: Sugary Drink FACTS 2014
Center for Science in the Public Interest: “Sugar Drinks”
African-American Collaborative Obesity Research Network: “Impact of Sugar-
Sweetened Beverage Consumption on Black Americans’ Health”
Salud America: The RWJF Research Network to Prevent Obesity Among Latino
Children
Rudd Center for Food Policy & Obesity: “Fast Food FACTS 2013: Measuring
Progress in Nutrition and Marketing to Children and Teens”
Berkeley Media Studies Group: “The New Age of Food Marketing”
Bridging the Gap: “Availability of Competitive Foods and Beverages”
Bridging the Gap: “Beverage and Snack Taxes”

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