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The results of a very large European cohort study based at Imperial College London showed a strong link between developing type 2 diabetes and sugar sweetened drinks such as cola. Even one glass had a substantial effect. However artificially sweetened drinks such as diet coke and fruit juices did not lead to an increase. This was a large, well designed study of over 300,000 people for 16 years. Participants also completed questionnaires on other factors that could influence results including smoking, alcohol, physical activity and educational level and BMIs.The researchers used standard statistical methods to analyse the association between soft drink consumption and diabetes. They then adjusted their results for confounders such as lifestyle factors and BMI.

Consumption of sugar-sweetened drinks may lead to type 2 diabetes because they lead to weight gain. They also have a ‘glycaemic effect‘ that can lead to rapid spikes in blood glucose and subsequent insulin secretion. This is the first major study of the effects of sugary drinks in Europe. Other studies have shown links between diabetes and sugary drinks in the USA where soaring obesity levels have caused such concern that the Mayor of New York banned soda/sugary drink portions larger than 16oz.

Mayor Bloombergs acceptable soda chart

10% of New Yorkers are now diabetic and America is leading the way in anti-obesity adverts [see below]. However the Supreme Court overturned Mayor Blomberg’s new law as it did not ‘respect the autonomy’ of the individual to make choices.

diabetes ad

The argument of upholding the autonomy of the individual against those encouraging healthier habits is centuries old as can be seen from an editorial in the Times 1854 [below]. The first Public Health board had just been dismissed, cholera was rife, the ‘Great Stink’ had forced the abandonment of the Houses of Parliament. However The Times rejoiced when sanitary reformers were defeated in their attempts to clean up cities and have human excrement removed as this extract shows.

The Board of Health has fallen. We prefer to take our chance of cholera than be bullied into health. ……There is nothing a man hates as much as being cleaned against his will, or having his floors swept, his walls white washed, his pet dung heaps cleared away, all at the command of a sanitary bumbaliff’

 The Times 1st Aug 1854

It was thought then that people had the ‘right to be unsanitary’ but the germ theory of disease and the cholera epidemics convinced doctors that their autonomy had to be overruled because of the public health consequences.  Perhaps in another hundred years or so people will be just as incredulous at the idea that cancer causing cigarettes were sold and sugar sweetened drinks were promoted and marketed as we are now at the thought that people opposed the removal of human sewage in 1854.

‘Rights versus Responsibility’ is still an issue debated frequently today. It is a common ethical scenario, the unhealthy habits of other people affect us all – from second hand smoke, consequences of alcoholism to the costs of obesity for the NHS.

obesity cartoon

obesity and ethics