If You Serve It, We Will Drink It (Medical Resident Edition)

12oz can of Coca-Cola = 39g of free sugar (9.75tsp) offered to residents at recent CaRMS event

Today's guest post comes from first year medical resident Jen Crichton (who you can follow on Twitter). After she came back from a recent CaRMS event and told me what was being served (she's spending a month with us at our office), it reminded me that people consume what they're given, and that of all people, physicians ought to be considering that in their offerings.

Canada’s 2019 Food Guide was released in January. One of many welcome changes is the recommendation for water as the beverage of choice. The new Guide also recommends that sugary drinks (100% fruit juice, milk or milk substitutes with added sugars, soda pop, sports and energy drinks, etc.) not be consumed regularly. Section 2 of the Guide states that:

"Foods and beverages offered in publicly funded institutions should align with Canada's Dietary Guidelines.”

Many universities have previously banned the sale of bottled water on campus (to name just a few: McGill, Ottawa, Queen’s, York). These initiatives are motivated by obvious and warranted sustainability concerns about plastics. However, by continuing the sale of other sugary drinks in plastic bottles we are ignoring the elephant in the room. Why do we vilify bottled water but not bottled water with added sugar? A 2016 guest post by Sean Bawden explored this idea:

“Bottled water is seen as wasteful and unnecessary (See this video as an example); a stigma that did not seem to attach to a similar disposable bottle if filled with something other than water […] A plastic bottle is a plastic bottle; any environmental concerns and any objections to the use of such containers should apply equally, regardless of the container’s contents.”

It’s no secret that food environments shape our choices. Anecdotally, I was a part of one undergraduate medical event where organizers made the effort to purchase still and sparkling water off campus and bring it back on-site themselves. Many students had a relieved and refreshed reaction at the less common option of sparkling water.

Conversely, having just completed the CaRMS tour a year ago, I remember the challenges of making healthy choices amid the constant travel, social events, and interview day breakfasts and lunches. This year I empathized with the candidates who were on just one of many stops on a cross-country journey. Each interview day is high stakes; all are hoping to match to a residency program in order to complete their medical training. Do they really need the added decision of choosing water over freely available orange juice or soda pop? Or perhaps it’s not even a conscious decision because of the social stigma associated with bottled water compared to other beverages? Or the stress and vulnerability of the day leads them to choose a sugary option that they would not otherwise consider? Similar to at other medical events:

“All of the [people] here are human, when faced with indulgent dietary choices, they choose them.”

As residents, we are the next generation of physicians in training. Across many different medical specialties, we counsel patients to avoid sugar-sweetened beverages for their own health. We lament with our patients that the food environment around us can be challenging to always make healthier choices. And then on a personal level, residency can be a time of sleep deprivation and limited self-care activities such as cooking and exercise. In medicine, and really in any field where one has public influence, we need to stop shying away from opportunities to be leaders in the promotion of water as the beverage of choice for health.

Sure, it can be hard to please everyone at events. However, in an area where there’s really no longer any debate in terms of health impacts and recommendations, let’s choose to be better role models with respect to excessive sugar consumption and its role in obesity and other chronic diseases. I’m not suggesting that we embrace the disposable plastic water bottle wholeheartedly but rather that we should re-think our indifference (or even preference) towards other sugary drinks delivered in plastic bottles or otherwise.

The challenge is ours in how to create supportive environments that remind us to bring a reusable bottle or cup, that make access to safe drinking water readily available, and that do not punish our health by offering sugary drink choices.

It does not need to be complicated. It just needs to be the default.

Proposed simple guidelines for colleges, universities, hospitals, and other publicly funded institutions to follow:

1. Water’s number one: Always offer water as the beverage of choice.
2. Sustainability whenever possible: Water delivered in an environmentally-friendly cup or bottle is optimal.
3. Avoid sugary drinks: Do not forego bottled water in favour of 100% fruit juices, sodas, sports or energy drinks, or other sugar-sweetened beverages.

Jen Crichton is a Family Medicine resident doctor in training at the University of Ottawa with interests in nutrition and exercise as they intersect with all aspects of primary care. She loves all things active: CrossFit, running, and puppies.