This week’s issue of The New England Journal of Medicine is devoted to the the role of sugar/high fructose corn syrup (HFCS)- sweetened beverages as a major cause of childhood obesity.

The first two paragraphs in Sonia Caprio, M.D.’s editorial are stunning:

Obesity has emerged as one of the greatest global health challenges of the 21st century. Its increase among children and adolescents is particularly frightening, given the associated metabolic and cardiovascular complications. Studies from developing countries with populations that are undergoing rapid changes in nutrition are showing increases in the prevalence of childhood obesity.

The increase in consumption of sugar-sweetened beverages among both adults and children in the United States and other countries is considered a potential contributor to the obesity pandemic. Sugar intake from sugar-sweetened beverages alone, which are the largest single caloric food source in the United States, approaches 15% of the daily caloric intake in several population groups. Adolescent boys in the United States consume an average of 357 kcal of the beverages per day. Sugar-sweetened beverages are marketed extensively to children and adolescents, and large increases in consumption of sugar-sweetened beverages have occurred among black and Mexican-American youth, who are known to be at higher risk for obesity and the development of type 2 diabetes than their white counterparts.

Obesity is a pandemic.  There are well-known cardiovascular and metabolic complications that few obese people escape.  Sugar intake from these beverages accounts for 15% of daily calories. An average of 357 calories per day in American teen boys.

How come we are missing something that appears to be so obvious?  Are we simply ignoring the facts when we allow our kids to drink sodas, or sports drinks, or other soft drinks instead of giving them a choice of water or low-fat milk or nothing? Nothing can be a choice, too.

The study by Qi and colleagues concludes that:

 participants with a greater genetic predisposition may be more susceptible to the adverse effects of sugar-sweetened beverages on obesity; this is a clear example of gene–environment interaction.

In the study by de Ruyter et al.:

the results clearly suggest that masked replacement of a sugar-containing beverage (104 kcal) with a sugar-free beverage significantly reduced weight gain and fat accumulation in normal-weight children.

Maggie Fox at NBC News summarizes the Ebbeling et al. study in an excellent article with video:

Providing water and diet drinks “virtually eliminated” drinking of sugary sodas and juices, the researchers report in the New England Journal of Medicine.

At the start, the kids drank on average nearly two sugary drinks a day – sodas, full-sugar fruit juices, sports drinks and so on. The group that got the sugar-free drinks and water, plus counseling and reminders, virtually stopped drinking sugary drinks at all. After a year, they also weighed less – four pounds less on average than the kids in the “control” group who kept on with their soda habit.

The effect on Hispanic kids was astounding. They gained 14 fewer pounds than the control group.

A fascinating discussion of whether or not to regulate sugar-sweetened beverages is here.

Dr. Caprio gets the last word here:

Taken together, these three studies suggest that calories from sugar-sweetened beverages do matter. Furthermore, policy decisions about sugar-sweetened beverages should not be considered in isolation. Other strategies to achieve and maintain normal weight, including increasing physical activity, will be important to stem the obesity epidemic and its effects. The time has come to take action and strongly support and implement the recommendations from the Institute of Medicine, the American Heart Association, the Obesity Society, and many other organizations to reduce consumption of sugar-sweetened beverages in both children and adults.