The causes of obesity are complex and reflect food and lifestyle choices that ultimately result in an energy intake that exceeds expenditure. In 1997, American children obtained 50% of their calories from added fat and sugar (35% and 15%, respectively); only 1% regularly ate diets conforming to the recommendations of the Food Guide Pyramid, and 45% failed to achieve any of the Pyramid recommendations.1 Although parental influence remains a critical determinant of children's dietary intake, environmental factors outside parental control also influence what children eat. These factors include the marketing of high-calorie, low-nutrient soft drinks and other snack foods to children in schools.
In 2001, the advertising budgets of Coca-Cola and PepsiCo approached $3 billion in the United States alone.2 Soft drink companies aim advertising campaigns at children in efforts to develop lifetime brand loyalties and capture market shares.3 Entire conferences are devoted to marketing to children, offering sessions on effective promotional campaigns and "emotional branding for kids."4 That these advertising and marketing techniques affect children's recognition of brand names, requests for food purchases, food choices, and levels of consumption is well established.5
The consumption of soft drinks is of special concern because many contain sugars and corn sweeteners but few essential nutrients, and because soft drinks are currently the leading source of added sugars in the adolescent diet. Nearly one fourth of adolescents drink more than 26 oz/day, which provides at least 300 kcal, approximately 12% to 15% of their daily caloric need. Children who habitually consume sodas take in fewer nutrients but more calories; they are more likely to be overweight or obese after adjustment for anthropometric, demographic, dietary, and lifestyle variables.6 Furthermore, students in schools that provide access to soft drinks and snack foods are less likely to consume fruits, juice, milk, and vegetables than students who do not have such access.7
Nevertheless, about 60% of US middle and high schools sell soft drinks in vending machines.8 In 2002 an estimated 240 US school districts had entered into exclusive "pouring rights" contracts with soft drink companies.9 Typically, the companies give the schools cash and other incentives in return for the right to sell sodas in vending machines, and to advertise on scoreboards, in hallways, on book covers, and other places. These contracts reward schools for selling more soda to students, and some even directly link the school's revenues to the amount of soda sold.10
School nutrition has become an important focus of political and legislative initiatives targeting the causes of obesity. Recently, several school districts across the country have refused to enter into deals with soft drink companies after protests by parents, students and school officials.11 In February 2002, the Oakland school district banned all sales of soda and candy. In August, the Los Angeles school board voted to take soft drinks off cafeteria menus and end the sale of soft drinks in vending machines by 2004. This action is especially significant since the Los Angeles district is so large (677 schools and 736 000 students) and its schools sell $4.5 million worth of sodas annually.12 These actions signal a growing movement to oust soft drinks from schools. These actions will most likely decrease soft drink companies' support for schools, but for many schools, contracts with soda companies are a significant source of revenue. Strong public advocacy is critical to ensure that schools are adequately funded from noncommercial sources.
Voicing opposition to a ban on school soda sales, a spokesman for the National Soft Drink Association implied that the problem is lack of activity rather than too many calories. He said that obesity is "about the couch and not the can."12 To prevent childhood obesity, it is necessary to promote greater activity but also to eliminate environmental factors that foster excess caloric intake. As political initiatives increasingly eliminate soft drink vending machines and advertising from schools, it will be important to assess whether doing so significantly decreases calorie consumption and obesity among children.
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