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Am J Public Health. 2014 May;104(5):787-95. doi: 10.2105/AJPH.2013.301708. Epub 2014 Mar 13.

Ethics and obesity prevention: ethical considerations in 3 approaches to reducing consumption of sugar-sweetened beverages.

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Nancy Kass is with the Johns Hopkins Berman Institute of Bioethics and the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. At the time of the study, Kenneth Hecht was with California Food Policy Advocates, Oakland, CA. Amy Paul is with the Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Berman Institute of Bioethics. Kerry Birnbach is with California Food Policy Advocates, Oakland, CA.


Obesity and overweight prevalence soared to unprecedented levels in the United States, with 1 in 3 adults and 1 in 6 children currently categorized as obese. Although many approaches have been taken to encourage individual behavior change, policies increasingly attempt to modify environments to have a more positive influence on individuals' food and drink choices. Several policy proposals target sugar-sweetened beverages (SSBs), consumption of which has become the largest contributor to Americans' caloric intake. Yet proposals have been criticized for unduly inhibiting choice, being overly paternalistic, and stigmatizing low-income populations. We explored the ethical acceptability of 3 approaches to reduce SSB consumption: restricting sale of SSBs in public schools, levying significant taxes on SSBs, and prohibiting the use of Supplemental Nutrition and Assistance Program (formerly food stamps) benefits for SSB purchases.

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