Advocates for health dumped 9.6 tons of white sand outside an Ellicott City middle school four years ago to launch Howard County Unsweetened, a campaign to ease sugary sodas and fruit drinks out of local diets.
On Sunday, they announced the results of their campaign: Sales of soda at 15 grocery stores in Howard County dropped nearly 20 percent, according to Marlene Schwartz, director of the Rudd Center for Obesity & Food Policy at the University of Connecticut. That exceeded the annual decrease of between 1 percent and 2 percent reported nationally.
Researchers presented the results in a study to the American Heart Association.
"We're making a huge amount of progress," said Nikki Highsmith Vernick, president of the Horizon Foundation, the local health advocacy nonprofit behind the campaign. "The study shows education and the media campaign and public policy changes can lead to great gains in public health."
The mound of sand dumped outside Burleigh Manor Middle School in December 2012 represented the amount of sugar the students would consume in one year if they each drank a can of soda every day. A nondiet soda has more than 8 teaspoons of added sugar, greater than the 6-teaspoon limit recommended for children and women by the American Heart Association. Men are advised to consume no more than 9 teaspoons.
The sugary drinks contribute to obesity, diabetes and heart disease — leading causes of death in Howard County, Highsmith Vernick said.
The county has been at the vanguard of a national movement to limit the consumption of sodas and sugary fruit drinks.
Voters in San Francisco, Oakland and Albany, Calif., and Cook County, Ill., approved new taxes of a penny per ounce on such drinks last week. Boulder, Colo., passed a two-cent tax.
In Howard County, legislation to restrict the sugary drinks stirred debate in 2012. Then-County Executive Ken Ulman issued an executive order to restrict the sale of sugary drinks and high-calorie snacks on county property and during county events.
County Executive Allan H. Kittleman rescinded the ban when he took office in December 2014. He said the ban overstepped the role of government. His action drew praise from local vendors and criticism from public health advocates, including the Horizon Foundation.
Kittleman said the study proves consumers can make healthy decisions without government interference.
"Clearly the private individuals and organizations are using their ability to sway people," he said. "It's not the government telling them what they can and can't drink."
But Highsmith Vernick said the county government should be involved.
"The government has a role to create a healthy environment for its citizens to thrive," she said. "I see this as government creating the right environment for people to make healthy choices."
The study of Howard County, presented Sunday at an American Heart Association conference in New Orleans, found sales of sugary fruit-flavored beverages and 100 percent fruit juice decreased by 15 percent. Over the years, the serving sizes have grown beyond, say, a small, healthful glass of orange juice at breakfast.
The study tracked sales at 15 stores from 2012 to 2015.
The "Howard County Unsweetened" campaign included TV advertisements and social media postings. Howard County Schools phased in nutrition guidelines for lunches and vending machines during the campaign. And the General Assembly approved legislation in 2014 requiring child care centers licensed in Maryland to meet federal health standards for beverages served to children.
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Schwartz said these measures combined to change buying habits at the grocery stores in Howard County.
"It sort of reinforced this message that people should think twice before purchasing," she said.
Beverage companies have taken steps on their own to change behaviors that lead to obesity, said Lauren Kane, spokeswoman for the American Beverage Association. Companies have voluntarily removed full-calorie soft drinks from schools across the country, she said. Also labels are placed on the front of every can so consumers know what they're drinking.
"America's beverage companies are committed to helping people cut the calories and sugar they get from beverages because we too want a healthy America," Kane said. "But tackling obesity requires a holistic approach that looks at the entire diet, not just the 6 percent of calories that comes from beverages."
This article has been updated to include comment from the American Beverage Association.