New beverage recommendations for children to age 5 say to avoid all drinks with added sugar, and plant-based milks

By Melissa Patrick
Kentucky Health News

Health experts from four of the nation's most prominent health organizations have created a new set of beverage recommendations for children under the age of 5 that basically recommends breast milk and infant formula for infants under the age of 1 and water and cows' milk for older children.

The experts strongly caution against drinks with added sugar, including flavored milk, sodas and sugared fruit drinks, diet drinks, caffeinated drinks and plant-based and non-dairy milks -- and says to limit fruit juice.

“As a pediatrician, I know what a child drinks can be almost as important as what they eat, in terms of a healthy diet. This is especially true for very young children,” Dr. Natalie Muth, who represented the American Academy of Pediatrics on the expert panel, said in the news release. “We know that children learn what flavors they prefer at a very early age—as young as 9 months—and these preferences can last through childhood and adulthood. That’s why it’s important to set them on a healthy course, and this guide will help parents and caregivers do that.”

The recommendations were created by the AAP, the American Heart Association, the Academy of Nutrition and Dietetics and the American Academy of Pediatric Dentistry, under the direction of Healthy Eating Research, a nutrition research organization, and funding from the Robert Wood Johnson Foundation.

As Kentucky's children and adults continue to struggle with obesity, recommendations to cut back on empty calories match up with research showing that children who are obese or overweight often grow up to become obese and overweight adults.

"Overconsumption of unhealthy beverages along with inadequate consumption of healthy beverages in early childhood can contribute to risk of diet-related chronic diseases, such as obesity, type 2 diabetes, or dental caries," says the Healthy Eating Research report. "This makes beverages a critical target for improving the health and well-being of infants and young children."

Kentucky's children from 2 to 4 years old rank 32nd in the nation for obesity, with 13.3% of them obese. Those between 10-17 have the third highest obesity rate, at 19.3%; and the rate for high-school students is at 20.2%, ranking them third as well.

The release notes that the recommendations are intended for healthy children and do not address medical conditions that require specific nutritional guidance. Here's what the recommendations say:

• 0-6 months: Babies need only breast milk or infant formula.
• 6-12 months: In addition to breast milk or infant formula, offer a small amount of drinking water once solid foods are introduced to help babies get familiar with the taste—just a few sips at meal times is all it takes. Avoid fruit juices.
• 12-24 months: It’s time to add whole milk, which has many essential nutrients, along with some plain drinking water. A small amount of 100% juice is OK, which amounts to a half-a-cup a day. Better yet, the recommendation is to serve whole fruits instead.
• 2-5 years: Milk and water are the go-to beverages. Move away from whole milk to skim or 1% milk. And no more than a half-a-cup to 3/4 cup a day of 100% juice, with a recommendation to add water to make a little go a long way.

The recommendations are clear that plant based milks are generally not recommended unless there is a medical reason, like allergies or lactose intolerance, or a specific dietary preference.

The Healthy Eating Research report says, "Plant-based milks are growing in popularity, but it is important to note that they are not nutritionally equivalent to cow’s milk. They have varying nutritional profiles based on their plant source and many often contain added sugars. With the exception of soy milk, the [Dietary Guidelines for Americans] do not include these beverages as part of the dairy group because their overall nutritional content is not similar to dairy foods."

Click on the chart to view a larger version

“By providing caregivers, health care and early care and education providers, policymakers, and beverage industry representatives a clear set of objective, science-based recommendations for healthy drink consumption, we can use this opportunity to work together and improve the health and well-being of infants and young children throughout the United States," Megan Lott, deputy director of Healthy Eating Research, said in the release.

Mary Story and Tina Kauh report for the RWJF Culture of Health Blog that these recommendations grew out of a 2017 workshop convened by the National Academy of Sciences to identify policy strategies for reducing consumption of sugar-sweetened beverages among young children.

During the workshop, they report that they heard evidence that patterns of sugary drink consumption begin early in life—and disproportionately among black, Latinx, and American Indian children and among those from families with lower incomes -- but they add that this is a problem that exist "across the board," and "too many kids consume too many sugary drinks."

"The Feeding Infant and Toddler study found that, on any given day, nearly one in three (29 percent) children ages 12 to 23 months and nearly half (46 percent) of children 36 to 47 months have a sugary drink. Further, sugary drinks are the number one source of added sugar from all foods and beverages for children 12 to 47.9 months of age," they report.

New oral-health plan includes expanded role for hygienists, soft-drink tax to fund loans to get more dentists in under-served areas

The plan was completed in December 2017 but just released.

By Melissa Patrick
Kentucky Health News

Kentucky's new plan for oral health calls for the state to expand the role of public-health hygienists, find other ways to expand the dental workforce in under-served areas, and raise dentists' Medicaid fees. And to pay for part of the plan, it calls for a tax on soft drinks that cause tooth decay.

The challenge is that all of these suggestions require action by the Kentucky General Assembly.

The Strategic Plan on Oral Health was assembled after more than 120 stakeholders and oral-health advocates attended a two-day summit and small-group meetings to set the state's oral health priorities. The last plan was released in 2006.

One key strategy would require lawmakers to expand the scope of practice for public-health dental hygienists in Kentucky.

Current law says public-health hygienists have to be employed or contracted by a public health department. The state has only 18 hygenists, working in 10 programs in 33 counties. They largely provide preventive care, patient assessment and referrals for under-served children in public schools.

The plan calls for the hygienists to be allowed to practice in more settings, such as nursing homes, group homes, juvenile justice facilities and some correctional facilities, and to let them apply silver diamine fluoride, a liquid that stops tooth decay and reduces pain until the patient can see a dentist.

Map shows share of third- and sixth-graders with untreated dental cavities, by region;
Appalachian Kentucky is colored light purple. (Lexington Herald-Leader map)

The proposals are aimed at the widespread tooth decay in Kentucky children. A 2016 study by Delta Dental and Kentucky Youth Advocates found that two out of five Kentucky third and sixth graders have untreated cavities, and the problem is "significantly greater" in Appalachian Kentucky, where more than half of the children in the study had untreated cavities.

The plan also calls for allowing public-health hygienists to use tele-dentistry, which would allow them to see more patients in a more timely fashion.

“To expand the ‘scope of practice’ would allow public-health hygienists to assist in arresting disease and pain, while still focusing on getting them care by a dentist," Julie Watts McKee, dental director for the state Department of Public Health, said in an email. "It improves access. And access improves health."

Expanding the scope of practice for public-health hygienists was widely supported at the two oral health summits, but a survey before the events found that only 24 percent of the dentists in the poll supported expanding hygenists' scope of practice, compared to 97 percent of hygienists. The poll surveyed 64 dentists and 67 hygenists among 474 people defined as interested in Kentucky's oral health.

Another goal of the plan is to find ways to entice dentists to practice in Kentucky's under-served areas, such as tax incentives, educational debt reimbursement and increasing Medicaid fees.

The plan stresses that better data collection is needed to support its goals. It says one dentist who is listed as taking Medicaid patients made only 14 Medicaid claims in one year, indicating that the need for access to dental care is greater than is being reported. "Data drives good policy," McKee said at an October health committee meeting about the report.

Kentucky offers the Kentucky State Loan Repayment Program, which is funded though the National Health Service Corps and administered by the Kentucky Office of Rural Health. However, such loans are offered to only a dozen or so Kentuckians each year, and are available to not only dentists, but to other health-care providers willing to work two years at an "eligible site."

The strategic plan calls for a state-funded repayment program for new dentists who agree to practice in limited-access or under-served areas, a budget decision for the General Assembly. The report points out that Kentucky likely has enough dentists overall, but instead has a "maldistribution" problem: not enough of them in too many places.

Richard Whitehouse, executive director of the Kentucky Dental Association, said in an email that KDA supports the debt-relief proposal, and has lobbied the federal government for such funding, but "This is a difficult sell at this time."

Whitehouse wrote, "A properly run program of debt forgiveness or loan repayment would greatly expand access to care. I have heard of studies suggesting that if a provider establishes a practice for at least three years, they are likely to remain. So, this investment could have a lasting effect on improving access to care and oral health outcomes."

The plan notes that Kentucky Medicaid's low reimbursement for dental services is a huge challenge in getting dentist to work in under-served areas. The plan calls for the state to compare current Medicaid fees to the regional "usual and customary rates" and adjust them accordingly, a suggestion made by a Medicaid official at the summit.

Whitehouse said Medicaid usually pays 30 to 40 percent of what is considered a "usual and customary rate." He added that a practice can break even if its Medicaid patient base is below 25 percent of its total, but above that, "the dentist is actually losing money and the practice begins to suffer." He added, "This accounts for why it is difficult to encourage new dentists with $250,000 of student debt to start a practice in areas of greatest need."

Figures are as of May 2017; map is from state Oral Health Plan. For a larger version, click on the map.
UPDATE, July 27: A rural health center in Todd County now has a dental clinic that accepts Medicaid.

The report says slightly more than a third of dentists in Kentucky do not accept Medicaid, and one in five report that fewer than a third of their patients are covered by Medicaid. Ten Kentucky counties, mostly in Western Kentucky, have no dentist who cares for Medicaid patients.

To help fund the loan-repayment program, the plan calls for the state to implement a soft-drink tax. This idea was referred to the nongovernmental Kentucky Oral Health Coalition, which said in an email that its members would discuss the proposal and determine if it's a priority they want to tackle.

Whitehouse said KDA is in full support of a soft-drink tax, and has found a lot of stakeholder interest in it, but no support in Frankfort for it.

"Because of the correlation between soda and oral decay, this seems an appropriate response in order to improving oral health in Kentucky," he said. "Earmarking the revenue from such a tax to loan repayment or increasing Medicaid reimbursement would also expand access to care. We believe, if we can get off the bottom of national rankings relating to oral health, this will also have an economic benefit in terms of our workforce and tax base."

The report also calls for the Kentucky Oral Health Coalition to lead the effort in finding ways to improve the oral health literacy of non-dental health professionals, the general population and especially policy makers.

Foundation for a Healthy Kentucky calls for statewide smoking ban, pushing people to quit by raising tobacco tax $1 a pack

Ben Chandler

Kentucky's poor health is hurting its economy, and the state needs a smoking ban and a big increase in its cigarette tax to prevent disease, Foundation for a Healthy Kentucky President Ben Chandler told a legislative committee Wednesday.

"The poor health of the commonwealth is one of the main things that's holding our economy back," Chandler said, telling the Interim Joint Committee on Health and Welfare that among the 50 states, Kentucky's population is 26th but its economy is 45th.

"The single most effective policy changes we can make to improve the health of Kentuckians are changes that will reduce our smoking rates and exposure to secondhand smoke," Chandler said. "Passing smoke-free laws and raising the tobacco tax by $1 or more per pack will help reduce smoking, save health care costs, and won't cost the state a dime."

Kentucky has a relatively low cigarette tax, 60 cents a pack, and the highest smoking rate in the nation, 26 percent of adults, as well as the highest death rate from cancer. "If there's anything that needs dealing with, it's that," Chandler said. "Doing something about this smoking problem is absolutely critical to the future of this state . . . . Businesses are not going to locate here if they don't have a healthy workforce."

Republican Sen. Tom Buford of Nicholasville called for a larger increase than Chandler, "Even to a $1.60 a pack is probably not going to provide us the result that we would like to have," Buford said. But he added, "I don't know if the will is there." Alluding to the late-January filing deadline for legislative elections, he said, "I can tell you February the first if there's a chance for tax reform."

Critics of a tobacco-tax increase have said it would penalize lower-income people, who are more likely to smoke. Chandler told the House-Senate committee that a big increase is needed to push them into quitting.

"You have to raise the tax by $1 or more to get the health benefits," he said. "Otherwise, it's just an added tax burden on the poor." He said cigarette companies would counter an increase of 30 to 40 cents a pack with discount coupons.

Asked where he would spend the money, Chandler, a former congressman and state attorney general, said some should be spent to discourage Kentuckians from smoking.

"We have a very good, in many respects, health-care system, but it's a rescue system," he said. "And people don't want to talk about this, but . . . we spend money largely, for the most part, on health care, to rescue people who are already sick. And we ought to spend a bigger portion . . . on health, as opposed to health care."

Referring to a smoking ban, which she supports, Sen. Julie Raque Adams of Louisville, the committee co-chair, said, "It's not really a freedom issue because every one of us pays out of pocket for those costs."

Chandler told the committee, "We have to focus on promoting policy changes that lead to healthier outcomes by addressing the things that cause poor health in the first place. . . . now have a rescue system."

Appalachian Kentucky continues to be the least healthy region of the state, and the disparity is increasing, Chandler said.

"While all of Kentucky lags behind the nation as a whole, it's generally people living in more rural Eastern counties with more challenging health issues," he said. "The latest numbers show that the health disparities between Central Appalachia and the rest of the nation, or even the rest of Appalachia, are large. And they're continuing to grow."

For example, he said the national death rate from heart disease "declined nearly 58 percent from 1980 to 2014, but not in Eastern Kentucky. In Owsley County, cardiovascular disease mortality actually increased over that 34-year period."

Another big Kentucky health problem is obesity. Chandler said, "Some of the evidence-based programs that help reduce obesity include making the healthy choice the easiest choice by replacing sugary drinks and snacks in school and government vending machines with healthier options, such as fruit and water; increasing the tax on sugary drinks; passing policies that require new streets to be walkable and bikeable; building sidewalks, walking trails, playgrounds and other places where residents can safely engage in physical activity; and adopting policies that enable farmers' markets to thrive."

A video of Chandler's testimony is on the KET website.

10-year study: Having one or more diet sodas a day nearly triples the risk of having a stroke or Alzheimer's; overall risk is still low

A study suggests a connection between diet soda and both stroke and dementia, "with people drinking diet soda daily being almost three times as likely to develop stroke and dementia as those who consumed it weekly or less," Fred Barbash reports for The Washington Post.

The lead researcher, Matthew Pase of Boston University, said the findings “included a higher risk of ischemic stroke, where blood vessels in the brain become obstructed, and Alzheimer’s disease dementia, the most common form of dementia.”

Pase stressed that the study, published in the journal Stroke, showed only correlation, not causation, and a low overall risk of stroke and dementia, but said diet drinks “might not be a healthy alternative” to sugary ones. And he cautioned that diet-soda drinkers shouldn't go back to sugared drinks.

"They have been associated not only with obesity and its consequences, such as diabetes, but with poorer memory and smaller overall brain volumes," Barbash notes. "A parallel study of sugary drinks did not find an association with stroke or dementia."

The 10-year study looked at 2,888 people 45 and over for the development of a stroke, and 1,484 older than 59. It “found that those who reported consuming at least one artificially sweetened drink a day, compared to less than one a week, were 2.96 times as likely to have an ischemic stroke, caused by blood vessel blockage, and 2.89 times as likely to be diagnosed with dementia due to Alzheimer’s disease,” the American Heart Association said.

“So, the bottom line is, ‘Have more water and have less diet soda,” Christopher Gardner, director of Nutrition Studies at the Stanford Prevention Research Center, said in the AHA news release.

Barbash writes, "The artificial sweeteners consumed by those in the study included saccharin, acesulfame-K, and aspartame. Other sweeteners, including sucralose, neotame and stevia have been approved by the FDA since, the study said."

The American Beverage Association replied:  “Low-calorie sweeteners have been proven safe by worldwide government safety authorities as well as hundreds of scientific studies and there is nothing in this research that counters this well-established fact. . . . While we respect the mission of these organizations to help prevent conditions like stroke and dementia, the authors of this study acknowledge that their conclusions do not — and cannot — prove cause and effect.”

Sipping on sugary drinks ruins teeth, perhaps more from the acid in them; it's almost as corrosive as battery acid, VA dentist says

Many of us constantly sip on a soft drink, especially in Kentucky, but the habit could be ruining our teeth.

Most soft drinks have sugar, acid or both and repeated exposure to this combination "wears down tooth enamel, which leads to decay and, eventually, tooth loss," Patrick Reed reports for Kentucky Educational Television.

"Mountain Dew mouth"
{Photo from healthline.com)

This "sugar-acid double punch" is especially dangerous for soda drinkers, and particularly to those who sip on them constantly - leading to what is often referred to as "Mountain Dew mouth," a phenomenon most common in Appalachian Kentucky.

As part of KET’s "Inside Oral Health Initiative," funded in part by the Foundation for a Healthy Kentucky, several Kentucky dentists offered tips on how to minimize the effects of sugar and acid on the teeth.

It's an important topic in Kentucky, because the state ranks fifth in daily consumption of soft drinks and fruit drinks, with 43.2 percent of people in the commonwealth, according to the federal Centers for Disease Control and Prevention.

Threats to Tooth Enamel

Tooth enamel, which covers the visible, outer portion of the tooth, "is the strongest material in the human body and can keep teeth healthy for a lifetime," Reed writes. However, repeated exposure to sugar and acid will cause it to erode, and once it's gone, it's gone.

“On a scale of 1 to 10, if battery acid is a 1, then most soft drinks are a 2. That’s how acidic they are,” Robert Henry, chief of dentistry at the Department of Veterans Affairs Medical Center in Lexington, told Reed. “If you add sugar on top of that, you’re just setting up an environment that’s acidic,” he adds. “And then the sugar moves in and basically does the rest. It’s literally like throwing kerosene on an open flame.”

Reed said the erosion is intensified by repeated exposure to not only soda, but also any sugary drinks such as fruit juice, sports drinks, and energy drinks. And while diet soda seems like a good idea because it lacks sugar, many brands contain acid.

"If you take one sip of soda, it’s going to take three to four hours for your mouth to go to a pH of neutral,” Pikeville dentist Bill Collins told Reed. “So, if you’re sipping every 15 to 20 minutes, your acidic level in your mouth is down to a pH of 1 or 2. And you’re keeping it there, and it basically dissolves the enamel on your teeth.” (The numerical figure for neutral is a pH of 7).

Practicing in Eastern Kentucky, Dr. Collins and Dr. Nikki Stone of the University of Kentucky told Reed that even very young children in the region have a habit of sipping soda.

“Drinking pop is our culture – we have an actual ‘pop culture’ in Eastern Kentucky,” said Stone, who has created a "Drink Pyramid" graphic to educate children about healthy habits. It says soda should only be consumed at parties or on weekends.

 Tips for reducing the impact of sugary drinks

• If you must drink soda, do it fast, and once a day at most. This leaves less time for the sugar and acid to wash over the teeth and cause decay.
• Never drink soda before bedtime, and clean your teeth thoroughly at night. Collins recommends that heavy soda drinkers should rinse as much residue as possible from their teeth, with water, before they brush to decrease the risk of scrubbing the acid into their teeth.
• Avoid added sugar in food, as this too can cause enamel erosion and tooth decay.
• Brush twice a day, two minutes per session, in the morning and always before bedtime.

Medicaid expansion would have 'a big health impact,' and critical-access hospitals need to change, rural-health expert says

Expansion of the Medicaid program under federal health-care reform would have a major beneficial impact on the health of Kentucky, a doctor who ran the state and national rural-health agencies told a rural-health meeting in Louisville Tuesday.

"Medicaid expansion has a big health impact," Dr. Wayne Myers, left, told those at "Doing Care Differently in Rural Kentucky," a seminar sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association in Louisville, just before the opening of the National Rural Health Association's three-day conference in the city.

Myers said that in the three states that expanded Medicaid eligibility since 2000, one life was saved for every 176  people added to the program, according to a study by the Harvard University School of Public Health, published in the New England Journal of Medicine. If that figure were extrapolated to the entire nation, the number of lives saved would be greater than if breast, prostate and stomach cancer were eliminated, Myers said.

Skeptics argue that Kentucky can't afford the estimated 6.3 percent annual cost increase for expanding Medicaid eligibility up to 138 percent of the federal poverty level, but Myers said, "It would be nice to shift that argument from dollars to health impact." He said that if the three cancers were curable with a certain amount of money, and you argued that the nation should not spend it because of the cost, "You'd have an uphill argument."


Myers also said Eastern Kentucky would be an ideal place for Medicaid and Medicare to start rewarding small, rural hospitals for increasing their role in health promotion and disease prevention.

The federal designation of "critical access hospital" has kept open many rural hospitals, which get greater Medicare and Medicaid reimbursements in return for limiting beds, procedures and patient stays, but President Obama's proposed budget calls for revoking the CAH status of some hospitals, and rural political clout has declined with the rural share of the nation's population, Myers noted.

"The old models aren't working too well," Myers argued, saying "What people don't realize is that [critical-access] hospitals get three-fourths of their money from the outpatient department" and have relatively few traditional admissions. He said half of them have fewer than four acute-care patients per day, and fewer than two patients who are recuperating or getting skilled-nursing care.

Then he displayed maps showing that life expectancies of rural Americans are not keeping pace with the rest of the country, and in some areas, including Eastern Kentucky, are declining. "That's really scary," he said.

Myers said those trends mean that CAHs should add health promotion and disease prevention to their job description, and Medicare and Medicaid -- which provide 85 percent of their revenue -- should pay them for performing that function.

He said hospitals have space, expertise and equipment to serve as exercise and medical-education centers, while most rural health departments are "overwhelmed" with a wide array of duties.

The federal payments for disease prevention and health promotion could be limited to hospitals in counties that have a certain percentage of their population on government-subsidized insurance, he said.

"If it makes sense anywhere, does it not make sense in Kentucky?" Myers asked, reiterating the question to focus on the state's Fifth Congressional District, which he said has the nation's lowest life expectancy. When a questioner mentioned the district's congressman, House Appropriations Committee Chairman Hal Rogers, Myers suggested the program could be named for the Somerset Republican.

Other speakers at the seminar called for new approaches in rural health, despite obstacles.

"Change is not easy. . . . Almost all federal policy tends to shortchange rural, at least initially," said Craig Blakely, dean of the University of Louisville's School of Public Health and Information Sciences.

He said two important targets for prevention activities in rural America are smoking and obesity, which he said is exacerbated by high soft-drink consumption. Soft drinks are a $57-billion-a-year industry, jhe said, "so there's a lot of pushback we're going to be facing if we want to take that on."

Blakely added that much of rural America is poor, and that is associated with poor health, so rural health providers also need to focus on education and employment opportunities for their communities.

Many Ky. parents don't realize children are overweight, or won't acknowledge it, but many report kids' poor health behavior

By Al Cross
Kentucky Health News

Many Kentucky parents don't realize that their children are obese or overweight, or at least aren't willing to acknowledge it. That is the obvious conclusion to draw from the latest results of the Kentucky Parent Survey, released Tuesday by the Foundation for a Healthy Kentucky.

The poll found that only 14 percent of Kentucky parents say their child weighs too much, but the National Survey of Children's Health found that 37 percent of Kentucky children are overweight or obese. Conversely, 76 percent of parents in the poll think their child's weight is about right, but the national survey found that only 58 percent of Kentucky kids have healthy weight.

The Kentucky Parent survey, taken by land-line and cell telephone from July 19 to Aug. 22 by the Center for Survey Research at the University of Virginia, interviewed 1,006 Kentucky parents, step-parents, grandparents, foster parents or other legal guardians of children in Kentucky selected at random. The statistical margin of error for that sample size is plus or minus 3 percentage points.

The poll also found that 56 percent of Kentucky children are watching more than the maximum daily recommended amount of “screen time” – watching television, playing video games or using the Internet – and that 59 percent drink sugar-sweetened beverages every day. Both are major factors in childhood obesity, research has found, and experts recommend no more than two hours of screen time a day and no sugar-sweetened drinks at all.

“Parents can help reduce this risk by encouraging healthy behaviors for their children,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky.“Our children’s habits and behaviors impact their health today and shape their quality of life as they grow. When kids eat poorly and don’t get enough physical activity, it increases their risk for obesity, diabetes, heart disease and other chronic diseases. This poll data helps us understand what parents think about the behaviors that are so critical to health.”

The Kentucky Parent Survey also found that only 56 percent of Kentucky parents said their child got "enough" fruits and vegetables every day during the preceding week, and 66 percent of parents reported their child got "enough" physical activity every day during the preceding week. It also found that elementary and high-school students often get less than the recommended amount of sleep per day (chart).

The survey did not define "enough." The foundation noted that one strategy to reduce childhood obesity in Kentucky is "5-2-1-0," reflecting experts' recommendations that each day, children should eat at least five servings of fruits and vegetables, have no more than two hours of screen time, engage in one hour of physical activity, and drink zero sugar-sweetened beverages. For the foundation's press release, click here.

NYC deeply split on Bloomberg plan to ban supersize sodas

Bloomberg with Linda I. Gibbs, deputy mayor for health.
(New York Times photo by Chang W. Lee)

In a bold move to curb obesity, New York City Mayor Michael Bloomberg wants to ban the sale of supersize sodas and other sugary drinks by restaurants, movie theaters and street carts.

"The sale of any cup or bottle of sweetened drink larger than 16 fluid ounces — about the size of a medium coffee, and smaller than a common soda bottle — would be prohibited under the first-of-the-nation plan, which could take effect as soon as next March," reports Michael Grynbaum for The New York Times.

Exempt from the measure are diet sodas, fruit juice, dairy-based drinks and alcoholic drinks. The ban would include drinks sold in grocery or convenience stores.

"New York City is not about wringing your hands; it's about doing something," Bloomberg said. "I think that's what the public wants the mayor to do." In NYC, more than half of adults are obese or overweight.

A poll conducted Sunday showed about half of New Yorkers feel Bloomberg is going too far, while 42 percent said it would be good health policy, reports Samantha Gross for The Associated Press. The idea has been harshly criticized, with an editorial in the Times calling the plan "overreaching" and saying "Too much nannying with a ban might well cause people to tune out."

But conservative David Frum, a contributing editor for Newsweek and The Daily Beast, said "good for Bloomberg," pointing out: "Sugary drinks now provide 7 percent of the calories in the American diet, the largest single national source of calories. Teen boys average more than a quart of sugary soda per day. Even adults who say they are trying to lose weight still drink more two 12-ounces cans per day, on average."

"The campaign against obesity will have to look a lot less like the campaign against smoking (which involves just one decision, to smoke or not to smoke) and much more like the generation-long campaign against highway fatalities, which required the redesign of cars, the redesign of highways, and changes in personal behavior like seat-belt use and drunk driving," Frum argues.

Penny-per-ounce tax on sugar drinks could save $17 billion, cut consumption and prevent disease and death, academics say

More than $17 billion in medical costs over 10 years could be saved if sugared drinks were taxed at 1 cent per ounce, and it would prevent 95,000 cases of coronary heart disease, 8,000 strokes and 26,000 premature deaths, say researchers at Columbia University and the University of California.

The tax would mean an extra 12 cents per can or 20 cents per bottle, and would generate about $13 billion in annual tax revenue. The study, published in this month's HealthAffairs, found the consumption of sugary drinks, including soda, sports drinks like Gatorade and energy drinks like Red Bull, would be cut by 15 percent among adults ages 25 to 64.

"Even our conservative estimates show that a penny-per-ounce tax on sugar-sweetened beverages could substantially reduce the negative health and financial impacts of obesity, diabetes and cardiovascular disease," said Dr. Y. Claire Wang, assistant professor at the Mailman School of Public Health at Columbia  and lead author of the study. "Putting the money raised by the tax into efforts to prevent obesity and other health problems could potentially increase the impact of such a policy."

In 2009, Americans consumed 13.8 billion gallons of sugar-sweetened beverages, which translates to about 45 gallons per person. The average 20-ounce bottle of a sugar drink contains almost 17 teaspoons of sugar. (Read more)

Most beverage companies targeting kids, teens even more to sell sugary drinks, despite pledges; Pepsi an exception

A study analyzing the marketing practices for 600 products made by 14 companies found there is more advertising of sugary drinks to children, despite industry pledges to the contrary.

Child and teen exposure to TV ads for full-calorie soda doubled from 2008 to 2010. "This increase was driven by Coca-Cola and Dr. Pepper Snapple Group. Children were exposed to nearly twice as many TV ads for sugary drinks from these companies," the report by the Yale Rudd Center for Food Policy and Obesity reads. "In contrast, children were exposed to 22 percent fewer ads for PepsiCo sugary drink products." PepsiCo makes Mountain Dew, so sugary and popular among youth in Eastern Kentucky that dentists have identified a tooth-decay syndrome of "Mountain Dew mouth."

Coca-Cola, PepsiCo, Dr. Pepper Snapple Group and Kraft Foods produce two-thirds of the 900 products analyzed.

Coca-Cola accounted for three out of four brand appearances seen by children and teens. Nearly two-thirds of all full-calorie soda or energy drink ads on TV included sponsorship of an athlete, sports league or teams, or an event or cause.

In 2010, black children and Hispanic teens saw 80 to 90 percent more TV ads than white children. Marketing on Spanish-language TV is also growing. In 2010, Hispanic children and teens saw nearly twice the number of sugary drink and energy drink ads as in 2008.

The American Academy of Pediatrics says highly caffeinated energy drinks "have no place in the diet of children and adolescents." But in 2010, teenagers saw 18 percent more TV ads and heard nearly twice as many radio ads for energy drinks than adults did. (Read more)

Teens who drink sugary beverages add 300 calories a day to their diet, national survey finds

American teens who drink pop, energy drinks like Red Bull and other sugar-based beverages like Gatorade are consuming an average of 327 calories a day, the equivalent of two and a half cans of cola, according to an analysis conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Data also show half of Americans drink sugary drinks on any given day, reports Nanci Hellmich of USA Today. Teens and young adults are drinking more of them than any other age group. About 25 percent of people drink at least 200 calories from them. Another 5 percent of the population age 2 and older consume nearly 600 calories a day from these drinks.

"Sugar-sweetened beverages are the No. 1 single source of calories in the American diet and account for about half of all added sugars that people consume," said Rachel Johnson, spokeswoman for the American Heart Association. "These are empty calories with no health benefits," said Barry Popkin, a nutrition professor at the University of North Carolina-Chapel Hill.

The findings stem from the National Health and Nutrition Examination Survey, which studies the eating and drinking habits of Americans. The results are from more than 17,000 in-person interviews about dietary habits conducted from 2005 to 2008. Added calories can lead to obesity, which increases the risk of diabetes and heart disease. (Read more)

Drink bottles, cans must now show calorie content on front

In an effort to educate people about how many calories they're sucking back, the front labels of packaged beverages in bottles or cans of 20 ounces or less must now show the total number of calories they contain.

"Beverage containers traditionally 'hid' the nutritional content at the back in a small square with small print and cleverly listed just calorie content per serving," said Dr. Jessica Bartfield, part of a physician-led team with Loyola University Health System that is trying to help people change behaviors that lead to them being overweight. "Unbeknownst to those who are happily guzzling their favorite cola or fruit drink, most packaged beverages contain multiple servings, and most Americans fail to do the math on the total calorie count."

In terms of caloric consumption when it comes to fruit and soft drinks, Bartfield shared some troubling statistics, which research research-reporting service Newswise listed:

• The average American consumes 22.5 teaspoons of added sugar each day. Half of that amount comes from soda and drinks, the National Health and Nutrition Examination Survey (1999-2004) showed.

• One in 10 overweight adults "consume 450 calories of sugar sweetened beverages per day, which is three times that of an average American. Cutting 450 calories per day would lead to about a 1 pound per week weight loss, close to 50 pounds in one year," Bartfield said. (Read more)