What's Up With Your Health?

HPHR Fellow Ananya Awasthi

By Dr. Ananya Awasthi


To know the amount of sugar and calories present in soda, juice, sports drinks and other popular beverages, check out guide- “How Sweet Is It?, developed by the researchers at the Nutrition Source, Harvard T.H. Chan School of Public Health.


We are increasingly living in obesogenic environments. While urbanization and modern transport have reduced the amount of energy expenditure, increasing access to high calorie food and intense marketing of carbonated “soft drinks” coupled with customary preference for sweets, have sparked a global epidemic in diabetes, overweight and cardiovascular diseases.9 To put it in real terms, do we know that drinking a cola bottle is equivalent to consuming more than 10 spoons full of sugar? I can’t even imagine what that would feel like! To know for yourself, check out guide- “How Sweet Is It?” developed by the researchers at the Nutrition Source, Harvard T.H. Chan School of Public Health, which tells you the amount of sugar and calories  present in soda, juice, sports drinks and other popular beverages.6



As these beverages have very high amounts of artificial sugar with almost zero nutritional value, we have strong evidence to explain the role that Sugar Sweetened Beverages (SSBs) are playing in growing epidemic of obesity and diabetes.8 Some glaring evidence on health risks associated with SSBs has been listed below:

  • People who consume sugary drinks regularly have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks. 7
  • Drinking even one can a day had a 20% higher risk of having a heart attack or dying from a heart attack than men who rarely consumed sugary drinks.4 
  • Large prospective cohort studies of men and women followed up for more than 20 years found, that increased consumption of sugar sweetened sodas was associated with significantly increased risk for strokes.2
Dr. Ananya Awasthi discusses why do need a campaign for soda tax to improve public health
From Soft drink : pour soda to a glass, By Nuttadol Kanperm, Shutterstock (https://www.shutterstock.com/image-photo/soft-drink-pour-soda-glass-focus-456390295)


While communicating public health risks of SSBs may be a challenging task, the use of economic modelling can be an alternative method to improve our understanding of the very “real” risks that SSBs pose to our lives-  


  • Studies from India show that a 20% tax on SSBs will prevent 2 million new cases of overweight and obesity, and 400,000 cases of type 2 diabetes over a decade.1
  • Evidence from South Africa show that, the government could save about US$140 million over 20 years; and could raise US$450 million in tax revenues per annum. 10



Before the start of 2020, nearly 42 countries around the world and 7 cities in the United States had implemented taxes on artificially sweetened drinks/SSBs to a varying extent.5 Mexico being a popular example, passed a resolution in 2014 for an excise tax of 1 peso per liter on non-dairy and non-alcoholic beverages with added sugar (Soft Drinks). This was 10% price increase for cola compared to the previous year price. Additionally, 8% tax ad valorem was applied on “junk food” with an energy density of 275 Kcal/100g. Moreover, another resolution was passed by the senate to use the revenue generated for obesity prevention programs in Mexico. The above tax regulation was preceded by a National Public Health Campaign for minimizing consumption of artificially sweetened beverages. An exemplar strategy used for spreading awareness and formally lobbying within the policy circles, included an Intensive exposure to messages through Public Service Advertisements highlighting the amount of free sugar- that was being consumed for every bottle of cola. This campaign was called “12 spoonsful of sugar”. 


Results: Effects on Purchases

  • Sales for the taxed artificially sweetened beverages declined by 5.5% in 2014 and 9.7% in 2015.
  • Sale for untaxed beverages increased by 5.3% in 2014 and decreased by 1.0% in 2015


Results: Effects on Weight & Diabetes

  • First 10 years: 54% reduction in obesity
  • Up to 2050: Prevent 86,000 to 134,000 cases (1.3% change in prevalence) of diagnosed diabetes
  • Biggest effects in younger age groups and lower SES groups – especially lower SES men. 3
Dr. Ananya Awasthi discusses why do need a campaign for soda tax to improve public health
From El Poder del Consumidor (http://elpoderdelconsumidor.org/)


In addition to taxing carbonated soda drinks and artificially sweetened juices, some complimentary strategies could be the following.



  • Integrating the national campaign for reducing the consumption of artificially sweetened beverages with the ongoing campaign on #HealthyEating #SwasthaBharat, as in India.
  • Spreading awareness on the interlinkages between carbonated soda and obesity, diabetes and cardio-vascular diseases.



  • The regulator should consider requiring the manufacturers to label the number of calories in the entire bottle and not “per serving” which is usually 1/3rd of the total volume
  • New labelling or color coding for beverages based on the sugar content



  • Incentivising the cola industry to produce “reduced sugar” options or beverages sourced from natural produce.



  • Regulating the sales of carbonated soda in and around schools
  • Encouraging schools to set up water fountains, filtered water and healthier beverages



  • Offering healthier choices in company canteens- beverages with less than 1 gram of sugar per 30 ml.


Conclusively, governments can play a critical role in creating a healthy food environment which generates demand for improved dietary behaviours resulting into better nutritional outcomes for the population. Policy institutions overseeing the mandate for food and nutrition security have a duty to enable people to adopt and maintain healthy dietary practices and are equally well positioned to incentivize all the other stakeholders in the supply chain. And as Gandhi once said, “Be The Change You Wish To See”. So next time, you wish to buy your favorite soft drink – think twice!!


  1. Basu, S., Vellakkal, S., Agrawal, S., Stuckler, D., Popkin, B., & Ebrahim, S. (2014). Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study. PLoS medicine, 11(1), e1001582.
  2. Bernstein, A. M., de Koning, L., Flint, A. J., Rexrode, K. M., & Willett, W. C. (2012). Soda consumption and the risk of stroke in men and women. The American journal of clinical nutrition95(5), 1190–1199. https://doi.org/10.3945/ajcn.111.030205
  3. Colchero M Arantxa, Popkin Barry M, Rivera Juan A, Ng Shu Wen. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study BMJ 2016; 352 :h6704
  4. De Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation. 2012 Apr 10;125(14):1735-41.
  5. Grummon, A. H., Lockwood, B. B., Taubinsky, D., & Allcott, H. (2019). Designing better sugary drink taxes. Science, 365(6457), 989-990.
  6. Harvard T.H. Chan School of Public Health, The Nutrition Source. (n.d.). How Sweet Is It? https://cdn1.sph.harvard.edu/wp-content/uploads/sites/30/2012/10/how-sweet-is-it-color.pdf
  7. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes care. 2010 Nov 1;33(11):2477-83.
  8. Malik, V. S., Schulze, M. B., & Hu, F. B. (2006). Intake of sugar-sweetened beverages and weight gain: a systematic review. The American journal of clinical nutrition, 84(2), 274–288. https://doi.org/10.1093/ajcn/84.1.274
  9. Misra, A.; Singhal, N.; Sivakumar, B.; Bhagat, N.; Jaiswal, A.; Khurana, L. Nutrition transition in India: Secular trends in dietary intake and their relationship to dietrelated non-communicable diseases. J. Diabetes 2011, 3, 278–292.
  10. Saxena, A., Stacey, N., Puech, P. D. R., Mudara, C., Hofman, K., & Verguet, S. (2019). The distributional impact of taxing sugar-sweetened beverages: findings from an extended cost-effectiveness analysis in South Africa. BMJ global health, 4(4), e001317.

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