Los Angeles Collaborative for Healthy Active Children -I am here today to share with you the Los Angeles Collaborative for Healthy Active Children’s Educational Initiative: Rethink Your Drink. -First I want to tell you a little bit about the Collaborative and then the components of the Initiative. Los Angeles Collaborative for Healthy Active Children

LA Collaborative “Children and families of Los Angeles County are physically active, eat healthy foods, and live in communities where policies and environments promote a healthy lifestyle.” -The Collaborative’s goal is to address the nutrition and physical activity related health issues and disparities in LA County. -The Collaborative is comprised of over 100 community stakeholders: Schools Health-Care Providers Community-Based Organizations Faith Based Organizations Many More!

Goals of LA Collaborative RYD Initiative Reduce or eliminate the consumption of sugar-sweetened beverages—especially soda! Promote the consumption of water

What is a Sugar-Sweetened Beverage (SSB)? Definition: Sugar-sweetened beverages (SSB’s) include all beverages that contain added caloric sweeteners. Examples: sodas fruit drinks and “juices” sport drinks energy drinks flavored milk sweetened tea and coffee rice drinks/horchata sugar cane beverages -Before we get started, let’s define exactly what a sugar-sweetened beverage is. (read definition) -This list covers examples of sugar sweetened beverages you may come across everyday. (read examples) -Are there any other examples of beverages that you think should be included in this list? (let participants give answers) -Examples: sodas fruit drinks and juices: Tampico, Sunny D, Snapple, Slurpees, Jamba Juice, Robeks, Orange Julius sport drinks: Vitamin Water, Gatordade, Powerade energy drink: Red-bull, Monster flavored milk sweetened tea and coffee: Snapple, mochas, Frappacinno rice drinks/horchata sugar cane beverages: Jones soda, Pepsi Throwback, sugar cane juice

-(Read headline) Why has this become such a hot issue? -Obesity and obesity-related diseases like diabetes are a growing epidemic and we are seeing co-morbidities at a younger age. -The current generation is the first generation of children who are projected to have a shorter life-expectancy than their parents. -Demonstrating the current health disparities, this article discloses the staggering odds that 1 in 3 U.S. children born in the year 2000 will become diabetic. The odds are even more unbelievable for Latino and African-American children because it is predicted that 1 in 2 are likely to develop the disease. Reference: McConnaughey, J. (2003, June 15). CDC: Diabetes to afflict 1 in 3 born in 2000 The Atlanta Journal-Constitution.

-There is a proposed link between obesity and sugar-sweetened beverages. The sale of beverages has grown significantly in the last 20 years, especially sweetened beverages. Because of this, the idea of taxing snack foods and beverages is a hot topic and has been in the media since at least the year 2000. -In the Highest Strategic Priorities to Improve Nutritional Policy and Programs for Public Health, The Los Angeles County Department of Public Health (DPH) recommends to advocate for an additional tax or fee on sugar-sweetened beverages. They suggest the generated revenue to be used, at least in part, for obesity prevention, nutrition education, and health promotion activities. -Consider a similar tax or fee at the county level. Currently, 33 states including CA have a sales tax on soft drinks, with an average tax rate of 5.2%. However taxes may be too small to discourage consumption and revenues are not used for programs to improve health. -A telephone survey of 503 registered voters in California was conducted in March of this year. A solid majority, 56%, of California voters support taxing sodas and other sweetened beverages to fund childhood obesity programs. Reference: California Center for Public Health Advocacy (2010). Soda tax poll: Majority of Californians support soda tax to fund obesity prevention programs. Retrieved from http://publichealthadvocacy.org/sodataxpoll.html

-This is a soda advertisement from many decades ago -This is a soda advertisement from many decades ago. It mirrors similar advertisements done by the tobacco industry that also targeted children. A tax on soda is similar to the successful model which was used to reduce the use of tobacco. -A federal excise tax of 1 cent per 12-oz serving would raise about $1.5 billion per year. Higher taxes, 4 cents or 8 cents per 12-oz serving, would raise $6 billion and $11 billion, respectively. One cent per ounce would raise more than $16 billion in revenue! -This type of tax may reduce consumption and could be used to fund health-promoting programs, such as media campaigns, encouraging physical activity and healthier diets, providing more fruits & vegetables to school children, healthier school meals, state & local departments of health, biking/hiking paths, and inner-city athletic programs.

Obesity Rates are Climbing in America Adult obesity has doubled since 1980 Since 1990 rates have increased in every state 1990 2008 -Let’s take a look at the obesity rates in America. Since 1990 adult obesity rates have jumped in every state in the Nation. -(Point at the map of 1990) In the 90’s all US states had obesity rates less than 15% of the population. -(Point at the map of 2008) In 2008 the rates jumped to an average of 25-29% of adults with obesity. That is 1 in 4 people! -The latest National Health and Nutrition Examination Survey (NHANES) in the United States found that percentage of people who are overweight, obese, or extremely obese is 72.9%, or about 3/4th of the country's population. Obesity rates are rising in the county among adults (from 14.3% in 1997 to 22.2% in 2007), school-aged children (from 18.9% in 1999 to 23.1% in 2008 among 5th, 7th, and 9th grade public school students), and younger children (from 16.7% in 2003 to 21.8% in 2008 among children 3-4 years of age receiving WIC services). County Reference: LA County Health Survey. (2007). California Dept of Education, Fitness Gram Data. WIC National Reference: Centers for Disease Control and Prevention. (2009). [Graph illustration of U.S. obesity trends by state 1985-2008]. U.S. Obesity Trends. Retrieved from http://www.cdc.gov/obesity/data/trends.html No Data <10% 10%–14 15%–19% 20%–24% 25%–29% ≥30% Centers for Disease Control and Prevention. (2009). [Graph illustration of U.S. obesity trends by state 1985-2008]. U.S. Obesity Trends. Retrieved from http://www.cdc.gov/obesity/data/trends.html

Trend: Sweetened Drink Consumption ml/day -This chart shows soft drinks available in the food supply per person. Look at the chart, there is an increasing trend of sweetened drink consumption since the 1940’s. ( Note: 600 ml soft drink = 19 fl oz). Soft drinks are now the largest beverage category in our country. - Energy intake from beverages more than doubled between 1965 and 2001. Beverages provided 11.8% of a 1,993 calorie diet in 1965 versus 21.0% of 2,185 calorie diet in 2002 according to national survey data. -There has been an increase in consumption of other sweetened beverages in addition to soda. -For example, the average portion size of fruit drinks consumed by Americans has increased from 11 oz/day in 1977-1978 to 15 oz/day in 1994-1996 (Nielsen, 2003). -In 1998, sports drinks were estimated as the sixth largest beverage category (Sfiligoj, 1998) and they are now the fourth (http://www.nutraingredients-usa.com/Consumer-Trends/Energy-drinks-outperform-all-other-beverages-report). -Coffees and teas, many of which are pre-sweetened or have sugar or fat calories added by the consumer, have also become one of the fastest growing beverage markets. Reference: Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R. H.,… Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health: A scientific statement from American Heart Association. Circulation: Journal of the American Heart Association, 120, 1011-1020. DOI: 10.1161/CIRCULATIONAHA.109.192627 (Jacobson, 2001)

Dramatic Increase in Consumption In California: 41 % of children ages 2-11 and 62% of adolescents ages 12-17 drink at least one soda or other sugar-sweetened beverage every day. In LA County: 38.8% of adults and 43.3% of children consume one or more sodas or sugar-sweetened beverages EACH DAY. Between 1977 & 2002 Americans increased their calorie intake from soft drinks by 228% -The previous slides have shown the dramatic increase in sugar sweetened beverage consumption nationally. In California: (read statistics on slide). In LA: (read statistics on slide). -Nationally, daily caloric intake from sugar sweetened beverages increased from only 55 kcal/day in 1965, to 204 kcal/day between 1988 and 1994, to 224 kcal/day between 1999 and 2004. -Between 1988-94 and 1999-2004, there was a 20% increase in consumption among children aged 6-11 years of age. -Among adolescents, the increase in intake was greater among Blacks and Latinos than Whites. Reference: New York State Department of Health. (2009, Jan 23). Evidence related to sugar-sweetened beverages and health: Sugar sweetened beverage tool kit. Retrieved from http://www.cspinet.org/new/pdf/sdtaxes_nys_soda_lit_rev.pdf. Sources: LA County Health Survey, 2007 and Babey SH, Jones M, Yu H, Goldstein H. Bubbling Over: Soda Consumption and Its Link to Obesity in California. UCLA Center for Health Policy Research and California Center for Public Health Advocacy, 2009.

-This graph is a representation of the changes in the percentage of children who are overweight. The increase in childhood overweight has been linked to sweetened beverages, however; a direct correlation has not yet been proven. -If you remember the increase in soft drink consumption that we just saw in the previous chart, you will see that it parallels the increase in obesity shown here. (point at chart)

Trend: Per Capita Soft Drink and Milk Consumption -The trend shown in this USDA chart is very alarming. Milk is the main source of calcium in the American diet and as its consumption has decreased, consumption of soft drinks has increased. -Frequent consumption of soft drinks may increase the risk of osteoporosis, especially in people who drink soft drinks instead of calcium-rich milk. -High soda consumption, particularly cola in children, poses a significant risk factor for calcium-breakdown in growing bones. -Consider this: in the 1950’s, children drank 3 cups of milk for every 1 cup of sugary drinks. Today that ratio is reversed; children now consume 3 cups of sugary drinks for every 1 cup of milk. Reference: eMedExpert (2007). 8 reasons why people drink soda & 16 reasons to give up soda drinking. Retrieved from http://www.emedexpert.com/tips/soft-drinks.shtml#ref8 (USDA/ERS, 2003)

1993 Energy from beverages added to, and did not displace, energy consumed in other forms De Castro, 1993 -In 1993, research showed: (read slide). -Calories from beverages are not well regulated. This research shows that people are consuming drinks in addition to the food they are eating. -For example, if you have a soda with lunch, you are adding calories to your meal that your body may not compensate for. Beverages may not make you feel full or satisfied, therefore, you may not cut back on other calories to balance your daily total. -Sometimes sugar sweetened beverages may be consumed instead of foods. When this happens, good sources of necessary nutrients found in those foods may be missing from the diet. -Children and adolescents who drink sugar sweetened beverages instead of choosing nutritious foods are at risk for developing deficiencies.

1996 Daily calorie intake is higher on days when an energy-containing beverage was consumed at lunch. -The intake of sugar sweetened beverages has consistently been associated with higher calorie intake. In 1996 (read slide). Although this slide specifically mentions lunch, the trend is across all meals. Anytime a sugar sweetened beverage is consumed, there are additional calories added to a person’s daily intake. Mattes, 1996

1999 Daily Calories increase with amount of soda consumed -This slide, showing data from 1999, proves the same trend. As consumption of soda increases, daily caloric intake also increases. Keep in mind that these additional calories from soda are empty, providing no beneficial nutrients. Soda consumption CSFII 1994 Harnack L., 1999

Soda is the largest source of added sugar in the diet -Where is the majority of sugar in our diet coming from? According to this chart by the Center for Science in the Public Interest, soft drinks are the largest source of added sugar in the diet, even above candy, cookies and other sweets. - NOTE: The "other" category in the 1999 chart would mean any sugar eaten separately, or found in a food (primarily processed and prepared foods) that doesn't fit into any other category in the chart. “Added sugars” includes “white sugar, brown sugar, raw sugar, corn syrup, honey, molasses, and artificial sweeteners containing carbohydrate that were eaten separately or used as ingredients in processed or prepared foods such as breads, cakes, soft drinks, jams, and ice cream.” Graph Reference: Center for Science in the Public Interest Newsroom. (1999). [Graph illustration of Where added sugar comes from]. Retrieved from http://www.cspinet.org/reports/sugar/sugarorigin.html Reference: Cleveland LE, et al. Pyramid Servings Data: Results from USDA’s 1996 Continuing Survey of Food Intakes by Individuals (USDA Agricultural Research Service, Beltsville Human Nutrition Research Center, 1997) at 26 (Table 6). Center for Science in the Public Interest Newsroom. (1999). [Graph illustration of Where added sugar comes from]. Retrieved from http://www.cspinet.org/reports/sugar/sugarorigin.html

2009 For both adults and adolescents, rates of overweight and obesity are 18% higher among those who drink one or more sodas every day compared to those who do not drink any soda at all. -A number of studies have found that greater sugar sweetened beverage consumption is associated with overweight and obesity among both adults and children. (read slide) -Randomized, controlled trials that examine the impact of reducing sugar sweetened beverage intake indicate that reducing consumption leads to reductions in overweight and obesity Reference: Babey, S. H., Jones, M., Yu, H., & Goldstein, H. (2009). Bubbling over: Soda consumption and its link to obesity in California. UCLA Center for Health Policy Research, pp 1-8. Retrieved from http://www.healthpolicy.ucla.edu/pubs/files/Soda%20PB%20FINAL%203-23-09.pdf Babey, S. H., Jones, M., Yu, H., & Goldstein, H. (2009). Bubbling over: Soda consumption and its link to obesity in California. UCLA Center for Health Policy Research, pp 1-8. Retrieved from http://www.healthpolicy.ucla.edu/pubs/files/Soda%20PB%20FINAL%203-23-09.pdf

Health at What Cost? McDonald’s Food/Drink Options -Super-sizing is often just pennies more than the smaller size but can add a tremendous amount of calories! People feel that they are getting a good deal, but as we have seen, these additional calories are not a good deal for their health. -In the 1960’s, an average soda was only 6.5 oz. In the 2000’s, an average soda increased in size to 24 oz.! (http://www.cspinet.org/new/pdf/liquid_candy_final_w_new_supplement.pdf) Reference: Center for Science in the Public Interest. (2000). [Graph illustration of calories in 7-eleven soft drinks]. From wallet to waistline: The hidden costs of super sizing. Retrieved from http://www.cspinet.org/w2w.pdf Center for Science in the Public Interest. (2000). [Graph illustration of calories in 7-eleven soft drinks]. From wallet to waistline: The hidden costs of super sizing. Retrieved from http://www.cspinet.org/w2w.pdf

Soda-Free Options Tap water Seltzer waters Fat-free or low-fat milk (plain) 100% fruit juices in limited amounts Unsweetened tea and coffee Beverages without added sugar are plentiful and many options are available. Some great beverage choices include (read slide). -Of all the mentioned drinking choices, water is the best option. Approximately two-thirds of our bodies are composed of water and we need it to live. -You will notice that plain milk is mentioned in this list but not flavored milk. All milk is an excellent source of calcium, Vitamin A, and Vitamin D, but flavored milk contains high amounts of sugar and should be considered a sugar sweetened beverage.

Water Quality Reports The water delivered by your local water company to your meter meets all water quality standards. However, it is important to know that your home plumbing may affect your water quality. To find your local water quality report: LA County Department of Public Works http://dpw.lacounty.gov/wwd/web/waterquality/ California Water Services http://www.calwater.com/your_water/ccr/2009/index.php If information for your city is not available on either of these sites, please contact your city’s Public Works department. -It is important to know about your local water supply because water quality can affect human health, the health and diversity of fish and wildlife, recreation, and aesthetics. -(read slide)

Los Angeles Collaborative for Healthy Active Children The LA Collaborative is a regional collaborative of public and private organizations involved in nutrition and physical activity promotion. www.lacollaborative.org Become a Member and Sign up for the Email Listserv!

Coordinator, LA Collaborative For further information about the LA Collaborative please contact: Lauren Neel, MPH, CHES Coordinator, LA Collaborative Network for a Healthy California, Los Angeles Region County of Los Angeles Public Health Nutrition Program 3530 Wilshire Blvd., Suite 800 Los Angeles, CA 90010 Phone: (213) 351-7337 Email: lneel@ph.lacounty.gov