En ese vecindario de bajos ingresos, predominantemente latino, es bastante difícil para un niño evitar el azúcar. El año pasado, los médicos del , una clínica comunitaria sin fines de lucro a siete cuadras de distancia, se alarmaron por el aumento de peso de Adrián Mejía, el hijo de Díaz. Lo convencieron para que participara de un dirigido por la Universidad del Sur de California y el Hospital Infantil de Los Ángeles (CHLA) que elimina el azúcar de la dieta de los participantes en un esfuerzo por reducir la tasa de obesidad y diabetes en niños.

Y también apunta a una tercera condición de la que pocos han oído hablar: enfermedad del hígado graso.

Vinculada tanto a la genética como a las dietas altas en azúcar y grasa, “la enfermedad del hígado graso está afectando a la comunidad latina como un tsunami silencioso, que impacta especialmente a los niños”, dijo el doctor Rohit Kohli, jefe de gastroenterología, hepatología y nutrición de CHLA.

Investigaciones recientes muestran que aproximadamente 1 de cada 4 personas en los Estados Unidos sufre la enfermedad del hígado graso. Pero entre los latinos, especialmente de ascendencia mexicana y centroamericana, la tasa es significativamente más alta. Un en Dallas encontró que el 45% de los latinos tenía hígado graso.

La enfermedad, que se diagnostica cuando más del 5% del peso del hígado es grasa, no causa problemas graves en la mayoría de las personas. Pero puede progresar a una afección más grave llamada , que está relacionada con la cirrosis, el cáncer de hígado y la insuficiencia hepática. Esta forma progresiva de la enfermedad del hígado graso es la causa de más rápido crecimiento de los .

El año pasado, el estudio de USC-CHLA, que lidera Michael Goran, director del Programa de Diabetes y Obesidad de CHLA, hizo un : el azúcar de las bebidas endulzadas puede pasar de la leche materna a los bebés, lo que podría predisponerlos a la obesidad. Y a sufrir de hígado graso.

El programa, llamado HEROES (Healthy Eating Through Reduction of Excess Sugar), está diseñado para ayudar a los niños como Adrián, quien solía tomar cuatro o más bebidas azucaradas al día, a desterrar hábitos poco saludables que pueden provocar hígado graso y otras enfermedades.

La enfermedad del hígado graso está ganando más atención en la comunidad médica a medida que los legisladores aumentan la presión para desalentar el consumo de bebidas llenas de azúcar. Representantes en Sacramento, California, están considerando propuestas para imponer un impuesto estatal a las gaseosas, poner etiquetas de advertencia en las bebidas azucaradas y prohibir que las empresas que producen estas bebidas ofrezcan cupones de descuento para comprarlas a menos precio.

“Apoyo los impuestos sobre el azúcar y las etiquetas de advertencia como una forma de desalentar el consumo, pero no creo que eso solo logre resultados”, dijo Goran. “También necesitamos estrategias de salud pública que limiten la comercialización de bebidas azucaradas, bocadillos y cereales para bebés y niños”.

William Dermody, vocero de la American Beverage Association dijo: “Entendemos que tenemos un papel que desempeñar para ayudar a los estadounidenses a controlar el consumo de azúcares agregadas, por lo que estamos creando más bebidas con menos o nada de azúcar”.

En 2016, 45 muertes en el condado de Los Ángeles se atribuyeron a la enfermedad del hígado graso. Pero eso es una “gran subestimación”, porque cuando las personas con la enfermedad mueren, a menudo tienen cirrosis y eso es lo que aparece en el certificado de defunción, dijo el doctor Paul Simon, director científico del Departamento de Salud Pública del condado.

Simon dijo que, aun así, fue sorprendente que el 53% de las muertes en 2016 atribuidas a la enfermedad del hígado graso fueran entre latinos, casi el doble de la proporción del total de muertes en el condado.

Investigadores consideran que la enfermedad del hígado graso es una manifestación de algo llamado síndrome metabólico, un conjunto de afecciones que incluyen exceso de grasa abdominal y presión arterial elevada, azúcar en la sangre y colesterol, que pueden aumentar el riesgo de enfermedad cardíaca, accidente cerebrovascular y diabetes.

Hasta 2006, pocos médicos sabían que los niños podían desarrollar la enfermedad del hígado graso. Ese año, el doctor Jeffrey Schwimmer, profesor de pediatría en la Universidad de California-San Diego, , de 2 a 19 años, quienes habían muerto en accidentes automovilísticos o por otras causas, y descubrió que 13% tenía enfermedad del hígado graso. Entre los niños obesos, el 38% lo padecía.

Después que se publicó el estudio de Schwimmer, Goran comenzó a usar resonancias magnéticas para diagnosticar el hígado graso en niños vivos.

Un realizado en 2008 por otro grupo de investigadores impulsó a Goran más allá. Mostró que una variante de un gen llamado PNPLA3 aumentaba significativamente el riesgo de la enfermedad. Según Goran, alrededor de la mitad de los latinos tienen una copia de ese gen de alto riesgo, y una cuarta parte tiene dos copias.

Goran comenzó , que mostró que, entre los niños de tan solo 8 años, los que tenían dos copias del gen de riesgo y consumían altas cantidades de azúcar tenían tres veces más grasa en sus hígados que los niños sin copia del gen. Ahora, en el estudio de USC-CHLA, se está evaluando si la reducción en el consumo de azúcar disminuye el riesgo de hígado graso en niños que tienen la variante del gen PNPLA3.

Al comienzo del estudio, se examina a los niños para ver si tienen el gen PNPLA3, se usa una MRI para medir su grasa hepática y se cataloga su consumo de azúcar. Un dietista del equipo educa a la familia sobre el impacto del azúcar. Luego, después de cuatro meses, vuelven a medir la grasa del hígado para evaluar el impacto de la intervención. Goran espera tener resultados del estudio en aproximadamente un año.

Más recientemente, Goran ha estado investigando la transmisión de azúcar de las madres a sus bebés. El año pasado demostró que en madres lactantes que bebían bebidas endulzadas con jarabe de maíz con alto contenido de fructosa, el edulcorante principal en formulaciones estándar de , y otras sodas, el nivel de fructosa en la leche materna aumentaba y se mantenía elevado durante varias horas, asegurándose que el bebé lo ingiera.

Esta exposición temprana al azúcar podría estar contribuyendo a la obesidad, la diabetes y el hígado graso, según que demostraron que la fructosa puede mejorar la capacidad de almacenamiento de grasa de las células, explicó Goran.

En barrios como el sur de Los Ángeles, donde viven Saira Díaz y Adrián Mejía, la falta de supermercados y productos frescos hace que sea más difícil comer sano. “El acceso a opciones de alimentos poco saludables, que generalmente son más baratos, es muy alto en esta ciudad”, dijo a Kaiser Health News Derek Steele, director de programas de equidad en salud en el Social Justice Learning Institute, en Inglewood, California.

El instituto comenzó con mercados de granjeros, ayudó a convertir dos tiendas en mercados con opciones de alimentos más saludables y creó 109 huertas comunitarias en terrenos públicos y privados en el sur de Los Ángeles y el vecino Inglewood, que cuenta con 125 tiendas de licores y pequeños comercios, y 150 establecimientos de comida rápida.

En Torrance Memorial Medical Center, a 10 millas de distancia, el doctor Karl Fukunaga, gastroenterólogo con Digestive Care Consultants, dijo que él y sus colegas ven a tantos pacientes con enfermedad del hígado graso que planean comenzar con una clínica específicamente para abordar el problema. Fukunaga insta a sus pacientes a evitar el azúcar y reducir los carbohidratos.

Adrián Mejía y su madre recibieron consejos similares de un nutricionista en el programa HEROES. Adrián dejó de tomar bebidas azucaradas, y su grasa hepática se redujo en un 43%. Hace dos meses, comenzó a jugar en un equipo de fútbol.

“Antes, pesaba mucho y era difícil correr”, dijo. “Si continuara al ritmo al que iba, probablemente más tarde en mi vida sería como mi abuela [diabética]. No quiero que pase eso”.

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In that low-income, predominantly Latino neighborhood, it’s pretty hard for a kid to avoid sugar. Last year, doctors at , a nonprofit community clinic seven blocks away, became alarmed by the rising weight of Diaz’s son, Adrian Mejia. They persuaded him to join an run by the University of Southern California and Children’s Hospital Los Angeles (CHLA) that weans participants off sugar in an effort to reduce the rate of obesity and diabetes among children.

It also targets a third condition fewer people have heard of: fatty liver disease.

Linked both to genetics and diets high in sugar and fat, “fatty liver disease is ripping through the Latino community like a silent tsunami and especially affecting children,” said Dr. Rohit Kohli, chief of gastroenterology, hepatology and nutrition at CHLA.

Recent research shows about 1 in 4 people in the U.S. have fatty liver disease. But among Latinos, especially of Mexican and Central American descent, the rate is significantly higher. in Dallas found that 45% of Latinos had fatty livers.

The illness, diagnosed when more than 5% of the liver’s weight is fat, does not cause serious problems in most people. But it can progress to a more severe condition called nonalcoholic steatohepatitis, or NASH, which is linked to . This progressive form of fatty liver disease is the .

The USC-CHLA study is led by Michael Goran, director of the Diabetes and Obesity Program at CHLA, who last year made : Sugar from sweetened beverages can be passed in breast milk from mothers to their babies, potentially predisposing infants to obesity and fatty livers.

Called HEROES, for Healthy Eating Through Reduction of Excess Sugar, his program is designed to help children like Adrian, who used to drink four or more sugary drinks a day, shed unhealthy habits that can lead to fatty liver and other diseases.

Fatty liver disease is gaining more attention in the medical community as lawmakers ratchet up pressure to discourage the consumption of sugar-laden drinks. Legislators in Sacramento are mulling proposals to impose a statewide soda tax, put warning labels on sugary drinks and bar beverage companies from offering discount coupons on sweetened drinks.

“I support sugar taxes and warning labels as a way to discourage consumption, but I don’t think that alone will do the trick,” Goran said. “We also need public health strategies that limit marketing of sugary beverages, snacks and cereals to infants and children.”

William Dermody, a spokesman for the American Beverage Association said: “We understand that we have a role to play in helping Americans manage consumption of added sugars, which is why we are creating more drinks with less or no sugar.”

In 2016, 45 deaths in Los Angeles County were attributed to fatty liver disease. But that’s a “gross underestimate,” because by the time people with the illness die, they often have cirrhosis, and that’s what appears on the death certificate, said Dr. Paul Simon, chief science officer at the L.A. County Department of Public Health.

Still, Simon said, it was striking that 53% of the 2016 deaths attributed to fatty liver disease were among Latinos — nearly double their proportion of total deaths in the county.

Medical researchers consider fatty liver disease a manifestation of something called metabolic syndrome — a cluster of conditions that include excess belly fat and elevated blood pressure, blood sugar and cholesterol that can increase the risk of heart disease, stroke and diabetes.

Until 2006, few doctors knew that children could get fatty liver disease. That year Dr. Jeffrey Schwimmer, a professor of pediatrics at the University of California-San Diego, of 742 children and teenagers, ages 2 to 19, who had died in car crashes or from other causes, and he found that 13% of them had fatty liver disease. Among obese kids, 38% had fatty livers.

After Schwimmer’s study was released, Goran began using MRIs to diagnose fatty liver in living children.

A 2008 by another group of researchers nudged Goran further. It showed that a variant of a gene called PNPLA3 significantly increased the risk of the disease. About half of Latinos have one copy of that high-risk gene, and a quarter have two copies, according to Goran.

He began a new study, which that among children as young as 8, those who had two copies of the risky gene and consumed high amounts of sugar had three times as much fat in their livers as kids with no copy of the gene. Now, in the USC-CHLA study, he is testing whether reduced consumption of sugar decreases the fatty liver risk in children who have the PNPLA3 gene variant.

At the start of the study, he tests kids to see if they have the PNPLA3 gene, uses an MRI to measure their liver fat and catalogs their sugar intake. A dietitian on his team educates the family about the impact of sugar. Then, after four months, they measure liver fat again to assess the impact of the intervention. Goran expects to have results from the study in about a year.

More recently, Goran has been investigating the transmission of sugar from mothers to their babies. He that in nursing mothers who drank beverages sweetened with high-fructose corn syrup — the primary sweetener in standard formulations of , and other sodas — the fructose level in their breast milk rose and stayed elevated for several hours, ensuring that the baby ingested it.

This early exposure to sugar could be contributing to obesity, diabetes and fatty livers, based on that showed fructose can enhance the fat storage capacity of cells, Goran said.

In neighborhoods like South Los Angeles, where Saira Diaz and Adrian Mejia live, a lack of full-service markets and fresh produce makes it harder to eat healthily. “Access to unhealthy food options — which are usually cheaper — is very high in this city,” Derek Steele, director of health equity programs at the Social Justice Learning Institute in Inglewood, Calif., told Kaiser Health News.

The institute has started farmers markets, helped convert two corner stores into markets with healthier food options and created 109 community gardens on public and private lands in South L.A. and neighboring Inglewood, which has 125 liquor and convenience stores and 150 fast-food outlets.

At Torrance Memorial Medical Center, 10 miles down the road, Dr. Karl Fukunaga, a gastroenterologist with Digestive Care Consultants, said he and his colleagues are seeing so many patients with fatty liver disease that they plan to start a clinic to address it. He urges his patients to avoid sugar and cut down on carbohydrates.

Adrian Mejia and his mother received similar advice from a dietitian in the HEROES program. Adrian gave up sugary beverages, and his liver fat dropped 43%. Two months ago, he joined a soccer league.

“Before, I weighed a lot and it was hard to run,” he said. “If I kept going at the pace I was going, probably later in my life I would be like my [diabetic] grandma. I don’t want that to happen.”

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That’s just a sampling of the $11.8 million that soft drink companies and their lobbyists spent at the state and local levels in the past two years in California to block proposals such as taxing sugary beverages and slapping health warnings on their drinks, a California Healthline analysis found.

“They exercise extraordinary influence in this building,” state Sen. Bill Monning (D-Carmel) said of the industry. “We don’t underestimate the power of the opposition.”

Monning doesn’t accept soda industry money — and has tried repeatedly to tax sugary beverages in California and place warning labels on packaging. He was one of the most vocal critics last year when the industry blocked cities and counties from levying soda taxes — a maneuver some lawmakers described as “.”

Angered by the industry’s tactics, Monning and other lawmakers now are pushing a package of to clamp down on drinks they say contribute to rising rates of obesity and diabetes. Several of the measures are scheduled for a committee hearing Tuesday, that would tax distributors of sugary drinks at 2 cents an ounce.

, , , and also are considering statewide taxes on sugar-sweetened beverages. states, including Arkansas and West Virginia, already impose taxes on sodas, either by the fluid ounce or on gross receipts, according to the National Conference of State Legislatures.

Although it’s anybody’s guess how much the industry will spend to sway California lawmakers this year, its previous largesse indicates money will flow to nearly every Capitol officeholder.

A California Healthline analysis found that 9 in 10 state senators and members of the Assembly, or a member of their staff, accepted a campaign contribution, gift or charitable donation in 2017 and 2018 from the American Beverage Association (or its political action committee), the Coca-Cola Co. or PepsiCo — the three largest givers in the industry.

The beverage industry, like other interest groups, spends money to influence lawmakers in several ways: It makes financial contributions to their campaigns and lobbies them and their staffs, sometimes plying them with meals, events and travel. It also donates to charities in lawmakers’ names.

“They follow the playbook of the tobacco industry in protecting their products from criticism, casting doubt on the science, lobbying, working behind the scenes, funding front groups, doing all the things that industries that make potential harmful products do,” said , author of “Soda Politics” and a professor emerita of food nutrition at New York University.

The beverage association and Coca-Coca did not respond to specific questions about their political giving, and PepsiCo didn’t respond at all. William Dermody Jr., an ABA vice president, argued “excessive” taxes on drinks would harm the economy.

“It’s important to inform lawmakers about the contributions that our products make to the local economy, not only the millions in tax revenues we generate for the state but the wages we bolster for hundreds of thousands of California workers,” Dermody said in an email.

Big Soda is not alone in trying to influence lawmakers on the issue of sugary drinks.

The California Medical Association and the California Dental Association, which represent doctors and dentists, are planning a ballot initiative to tax sugary drinks. Together they spent about $10.6 million in lobbying and campaign contributions to influence a broad range of health-related legislation over the past two years.

For the soda industry, 2017-18 was particularly expensive.

Why? As more California cities passed and proposed local taxes on sugary beverages, soda companies last year poured $8.9 million into a statewide ballot measure that would have made it more difficult for cities to levy any new tax, not just those on beverages. The money came from the American Beverage Association PAC, primarily funded by Coca-Cola, Pepsi and Dr Pepper Snapple Group.

Concerned that California voters would approve a higher voting threshold for all local taxes, lawmakers reluctantly banned local soda taxes until Jan. 1, 2031, if the industry dropped its ballot proposal.

“I don’t think they won any friends in the legislature,” said Assemblywoman Lorena Gonzalez (D-San Diego). She received $11,000 in campaign contributions from the industry in the past two years, and has voted on its side against bills to label and tax sugary drinks, citing concerns that a soda tax is regressive and would harm poor, minority communities.

Entertaining Lawmakers And Their Staffs

In 2017 and 2018, the spent just over $1 million lobbying California policymakers, while spent $371,482 and spent $352,469, according to forms filed with the California Secretary of State’s office. That’s nearly 70 percent more than they spent in the previous two years.

The bulk of the money went to lobbying firms staffed by former government employees — people with connections at the Capitol who know how to influence legislation.

The ABA spent $379 on food for eight lawmakers in November 2017 as part of an $813 dinner tab at the upscale Humble Market Kitchin Restaurant in Maui — a steak might go for $65 and a whole fried fish for $57. The legislators were attending a legislative retreat.

The association gave 11 legislative staffers tickets to Sacramento Kings basketball games and paid for their food and drinks, at a cost ranging from $163 to $326 per staffer. It also shelled out at least $3,747 for at least 92 lawmakers, staff members and their guests to attend a showing of “Black Panther” in March 2018.

Asked why Assemblywoman Sabrina Cervantes (D-Riverside) attended the movie, her spokeswoman said she is “supportive of the arts and celebrates diversity in cinema.”

The ABA’s biggest lobbying expense was a $250,000 payment to the California State Protocol Foundation, which while he was governor.

In The Name Of Charity

While there are limits on how much lawmakers can accept in gifts, companies also seek to gain influence by making unlimited charitable donations on a lawmaker’s behalf. These donations are known as “ payments,” and the industry made nearly $100,000 of them in 2017 and 2018.

Last year, a Coca-Cola distributor in Gonzalez’s district donated $10,000 to the San Diego Food Bank in her name — a contribution she said she was unaware of until contacted for this article.

Sometimes, lawmakers seek out contributions. When state Assemblyman Adam Gray (D-Merced) asked the beverage association to sponsor the annual meeting of the National Conference of State Legislatures, the association gave $25,000 in his name. Gray, who served as California’s representative to the meeting, said it was his responsibility to secure sponsors, and that he asked several corporations to contribute.

Those contributions, he said, don’t influence his vote. For example, he said Google gave $100,000 but he voted for privacy legislation the company opposed.

“If you want to support my agenda, my voting record and the things I stand for, I’m happy to take that support,” Gray said. “But it has zero role in how I represent my district or how I make decisions on public policy.”

Funding Lawmakers’ Campaigns

that interest groups use to influence the political process is by giving money to campaigns, political parties and legislative caucuses.

Along with spending $8.9 million on the statewide ballot measure, the American Beverage Association PAC, PepsiCo and Coca-Cola gave about $1.1 million to other statewide and local political efforts in the past two years.

The majority of legislators received campaign cash from the beverage association, Coke or Pepsi — if not all three.

A spokesman for Coca-Cola said the company selects recipients committee assignments, caucus memberships, leadership positions and whether they represent regions with Coca-Cola facilities.

“There is no one-size-fits-all approach,” said company spokesman Max Davis. “At times, the individual views of candidates we support may vary from our own.”

Monning said the soft drink industry is a formidable adversary. Many colleagues tell him they can’t vote for legislation that would cut sales because they have a distributor in their district.

In addition to a statewide soda tax, the bills under consideration this year would require about sugar and prevent soda companies from offering retailers to sell their drinks. They also retailers from selling supersize sodas and prohibit sales in .

As lawmakers consider these bills, Monning said, his question to his colleagues will be simple:

“Do you represent the soda industry?” he said. “Or do you represent those children in your district showing a steady increase in poor health?”

California Healthline digital reporter Harriet Blair Rowan contributed to this report.

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Soda makers have campaigned against sugary drink taxes in dozens of cities in recent years, mostly successfully. But after a string of recent defeats, the industry is now pushing statewide measures billed as grocery tax bans that strip cities and towns of their ability to tax soda. Two of these state initiatives are on the ballot Tuesday in and

and already ban localities from enacting soda taxes. In California, where four cities have soda taxes, the beverage industry pressured lawmakers this summer into accepting on local taxes on sugar-sweetened drinks. Some California lawmakers said they felt they were by the soda industry, which spent on a ballot initiative that would have made it much harder for cities to raise taxes of any kind. The beverage industry dropped the initiative after lawmakers agreed to the moratorium.

Soda makers also have cultivated close relationships with doctors, scientists and professional societies, including the Obesity Society and the Academy of Nutrition and Dietetics. Both groups say there’s not enough evidence to know if sugar taxes are effective.

Public health advocates say Big Soda is following a script perfected by the , which denied that their products were harmful and funded research that cast doubt on scientific studies while forcefully resisting taxes and regulations. Tobacco companies used their lobbying clout to persuade state lawmakers to prevent cities and counties from passing smoke-free ordinances. In 2006, 21 states pre-empted local smoke-free laws, according to Americans for Nonsmokers’ Rights. Even today, 13 states have some sort of ban on local smoke-free laws.

“There are definitely parallels with the tobacco industry,” said Betsy Janes, an activist with the American Cancer Society Cancer Action Network. Soda makers “are happy to take a page from their playbook.”

Following recommendations from the , more than and — including Seattle, San Francisco and Boulder, Colo. — now tax sugary drinks. These laws usually exempt diet soda, pure fruit juice and bottled water.

Most public health advocates describe soda taxes as a to reduce Americans’ consumption of added sugars, which have been linked to from heart disease every year. A study published last year in projects that Mexico’s soda tax will prevent up to 134,000 cases of diabetes by 2030. In Philadelphia, sales of sweetened beverages fell 57 percent after a city tax of 1.5 cents per ounce took effect, .

Soda companies used their war chests to fund the Washington and Oregon ballot measures. Coca-Cola has contributed nearly half the raised in support of the Washington initiative, while the has contributed about half the behind the Oregon measure.

PepsiCo, one of the largest soda companies, did not respond to calls or emails. Coca-Cola declined to comment on the issue, referring all questions to the American Beverage Association, which represents the soda industry. William Dermody, a spokesman for the beverage association, declined to comment on the comparison with Big Tobacco. But Dermody said the soda industry supports “keeping food and beverages affordable” and is “standing up for small business and working families” by supporting the ballot measures. Taxes on soda and other groceries “are harmful; they raise prices and they cost jobs,” he said.

Health advocates say the ballot measures aren’t really about groceries. The beverage industry’s strong support suggests the measures are really about protecting soda profits, said Hillary Caron, senior policy associate at the Center for Science in the Public Interest.

In Washington, basic groceries are exempt from sales taxes, said state Sen. Reuven Carlyle, a Seattle Democrat opposed to the initiative. “In 41 years, there hasn’t been one bill to tax groceries,” Carlyle said. The beverage industry “is retaliating against our state” because of Seattle’s soda tax.

Matthew Myers, of the Campaign for Tobacco-Free Kids, said the tobacco industry has long allied itself with anti-tax and pro-business groups, which have helped it fend off cigarette taxes. The tobacco industry fought smoke-free laws by warning that they would drive customers away from restaurants and bars. In fact, the reports that smoking bans increase business at bars and restaurants because customers enjoy clean air. Similarly, research shows that Philadelphia’s sugary drink tax hasn’t hurt business, Myers said. Although sales of sugary drinks have fallen, overall business at chain stores hasn’t suffered, . A , found similar results, with residents buying less soda but more bottled water.

Public health groups said they aren’t giving up on soda taxes. In California, the have filed a ballot measure for 2020 to create a statewide tax on sugary drinks.

A Show Of Force

Soda makers have plenty of money for a fight. The food and beverage industry spends a year on lobbying, including $5.4 million by Coca-Cola. That’s more than the tobacco industry, which spends on lobbying, according to OpenSecrets.org.

The tobacco industry spent decades funneling money into research that made cigarettes look less harmful than they really were, Myers said. Beverage companies also have tried to win over scientists and medical societies by funding research, said an emeritus professor of nutrition, food studies and public health at New York University and author of “Unsavory Truth: How Food Companies Skew the Science of What We Eat.”

Soda industry funding of medical meetings, journals and researchers is ubiquitous. acknowledges spending $146 million on “well-being related scientific research, partnership and health professional activities” from 2010 through 2017. A found that Coca-Cola and PepsiCo funded 95 national medical organizations from 2011 to 2015, while lobbying against 29 public health bills that aimed to reduce soda consumption or improve diet. Coca-Cola funded the publication of 389 articles in 169 journals from 2008 to 2016, according to a study published this year in

Nestle said no one should be surprised that tends to absolve soda from any role in causing obesity. Beverage industry research typically shifts the blame for obesity onto inactivity and “energy balance,” suggesting that exercise is far more important to weight loss than cutting back on sugar and calories, she said.

Yet independent researchers have found “quite compelling” evidence linking sugary drinks to , said Dr. Frank Hu, chair of the nutrition department at the Harvard T.H. Chan School of Public Health. The notes that sodas are among the largest sources of added sugar in the American diet. A 12-ounce can of Coke contains 9 1/3 teaspoons of sugar; the  that women consume no more than six teaspoons of sugar a day, and that men limit themselves to nine.

Dermody questioned the link between sugary drinks and obesity. Obesity has increased steadily over the past three decades. Yet in 2015, sales of carbonated soft drinks fell to their , suggesting the obesity epidemic is being driven by something other than soda, Dermody said. He noted that half the soft drinks sold today have no calories. That shows that voluntary industry efforts to reduce sugar and calories in soft drinks are working, and that taxes aren’t needed.

A number of medical groups and universities stopped accepting soda industry funding in 2015, after extensive publicity of Coca-Cola’s attempts to influence science. Most — including the American Heart Association, American Cancer Society and American Diabetes Association — now support soda taxes.

Two medical groups have defied this trend.

In July, just after California lawmakers approved the moratorium on soda taxes, the Obesity Society, which represents doctors who treat overweight patients, issued a saying there’s no proof that such measures will save lives. The Academy of Nutrition and Dietetics, which includes dietitians, has taken a “neutral” stand on soda taxes, noting that “scientific evidence is insufficiently clear.” In a statement similar to positions taken by the beverage industry, the nutrition academy said, “No single food or beverage leads to overweight or obesity when consumed in moderate amounts and within the context of the total diet.”

Both the obesity and nutrition groups have had close relationships with the soda industry. Coca-Cola and PepsiCo were of the nutrition academy in 2016, according to the group’s annual report. PepsiCo and Ocean Spray paid for at the nutrition academy’s national conference in October. Booths that size were priced at nearly each.

In October, PepsiCo underwrote a special issue of the , which was devoted entirely to the science of artificial sweeteners, at a cost of $26,880. Although PepsiCo paid the journal’s publisher for the special issue, part of the money also went to the Obesity Society, said Dr. Steven Heymsfield, the group’s president-elect. The Obesity Society also has nurtured close ties with soda makers through a “.” Past meetings were chaired by executives of PepsiCo and attended by employees of the Dr Pepper Snapple Group, now known as Keurig Dr Pepper.

Anthony Comuzzie, the Obesity Society’s executive director, said the society has disbanded the food industry council. In an email, Comuzzie denied that the society’s ties to industry have influenced its position on soda taxes. “To imply that the group or society collectively is biased by food companies has no basis in reality,” he said in an email.

The nutrition academy notes that sponsorships make up less than 5 percent of its budget. “Revenue generated from sponsorships has no impact on the Academy’s policymaking or any stance on issues,” the group said in a statement.

Nestle said that the soda industry appears to have bought the nutrition academy’s silence.

“It is shameful that the academy is not strongly supporting public health measures to prevent obesity,” Nestle said. “The academy’s position puts it squarely on the side of the food industry and against public health.”

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On Thursday, the state legislature rushed to approve the last-minute, quid pro quo deal between one of the state’s largest labor unions and the American Beverage Association. Democratic Gov. Jerry Brown signed the measure shortly after the vote.

The gives the industry a reprieve in California from any future local soda taxes until Jan. 1, 2031. In return, cities and counties will avoid a costly fight at the ballot box on a broader proposal that could have made it more difficult for them to raise general taxes and fees.

It was a vote that several frustrated lawmakers described as a reluctant but necessary choice that will safeguard city and county revenues.

“The industry is aiming basically a nuclear weapon at government in California and saying, ‘If you don’t do what we want, we’re going to pull the trigger and you’re not going to be able to fund basic government services,'” said state Sen. Scott Wiener (D-San Francisco). “This is a ‘pick your poison’ kind of a situation.”

Backers of the which would have made it harder for local governments to raise taxes, had until Thursday to pull their measure off the November ballot, an election-year deadline that required lawmakers to act quickly and rush a deal crafted over the weekend to votes this week.

In a message he sent after signing the bill, Brown called the barely averted ballot initiative “an abomination.” He said he had heard from the mayors of “countless cities,” who had called “to voice their alarm and to strongly support the compromise which this bill represents.”

The initiative, called the of 2018, was sponsored by the American Beverage Association. It sought to increase the voter threshold for cities and counties to levy taxes and fees from a simple majority to a two-thirds vote. It also would have required a two-thirds majority for tax and fee votes by local governing bodies, such as city councils and county boards.

It was a tactic intended to make it harder for cities to get the votes for new taxes on soda, which has been a growing target of public health advocates and local governments across the country. But the initiative also would have affected new taxes and fees for libraries, public safety and other government services, triggering fears among local governments and unions that they might not be able to raise the revenue they need in the future.

In a statement, the American Beverage Association said the legislature’s decision would “provide protections for working families, our customers and our consumers” and keep the cost of beverages and other groceries affordable in California.

In the past few years, voters in Albany, Berkeley, Oakland and San Francisco have passed local soda taxes, steering new tax revenues to public health programs and denting soda revenues. In Berkeley, for example, sales of sugary beverages fell by 9.6 percent in one year, according to one . But the industry so far has thwarted legislative efforts to pass statewide soda taxes and require health warning labels.

have found that sugary drinks can increase the risk of Type 2 diabetes, heart disease and other chronic health conditions, with the recommending people avoid soda, fruit and energy drinks, and sweet tea.

Soda taxes “are one of the most effective tools communities have to reduce the consumption of sweet and sugary beverages,” said Juliet Sims, program manager at the Prevention Institute, a nonprofit based in Oakland that promotes community health solutions. “When soda taxes are proposed, the industry will spend tens of millions to oppose them.”

The beverage association said it understands that obesity is a serious health issue and is “committed to working with government, public health and others to find better ways to help consumers reduce sugar consumption.”

Under the terms of the Capitol deal, existing soda taxes will remain in place if they were adopted before January 2018.

The American Beverage Association had poured $7 million into the “tax fairness” initiative since January, according to filings with the secretary of state. By comparison, opponents including the Service Employees International Union California and the California League of Cities gave just slightly more than half a million dollars to defeat it. SEIU California Executive Director Alma Hernandez said the initiative would have compromised local emergency services, parks, libraries and other crucial community investments.

“A temporary pause on further local soda taxes gives California the opportunity to work on a statewide approach to the public health crisis of diabetes,” Hernandez said in a written statement.

A January by the Legislative Analyst’s Office found that roughly half of the tax measures enacted by local voters since 2012 would not have passed if they had required a two-thirds vote under the initiative.

“This would make it harder for local governments to raise revenue. Their finances would be more constrained if the measure were to pass,” Ryan Miller, a fiscal and policy analyst at the LAO, said before the vote. “The effect on local governments could be substantial.”

Some Republican lawmakers, however, voted against the deal because they viewed the initiative and its two-thirds voting requirement as a welcome proposal. They decried its removal from the ballot as a “backroom deal” that favors one industry.

“The higher vote threshold means members of your community are in agreement and they see [taxes] as a priority,” Sen. Joel Anderson (R-Alpine) argued during Thursday’s floor debate.

The deal was a classic, election-year political maneuver often used to force the legislature to act, prompting state Sen. Bill Monning (D-Carmel) to complain during a committee hearing earlier in the week that the ballot process had been “abused by one special interest” that had now insulated itself from future taxes.

“I’m referring to big soda, the big soda industry that … uses that extraordinary monetary and economic influence to hold the citizens of California hostage,” Monning said.

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The study, the largest to date of Berkeley’s soda tax, comes as California lawmakers this week again consider legislation to put a warning label on sweetened beverages — a bill that died in committee three times in three years.

The study,  in the journal PLOS Medicine, shows that a year after Berkeley’s soda tax took effect in 2015, the city saw a nearly 10 percent drop in purchases of sugary drinks and a nearly 16 percent increase in sales of bottled water.

The study looked at 15.5 million supermarket checkouts in the city, evaluated prices in 26 stores and surveyed 957 adult residents by phone.

Dr. Lynn Silver, the lead author of the study and a senior adviser with the Public Health Institute in Oakland, Calif., said that researchers were pleasantly surprised to see the significant increase in the sale of water.

Silver said that before voters passed the 1-cent-per-fluid-ounce tax in 2014, researchers were not sure if the small additional cost to buy soda would be enough to make a difference in a prosperous city like Berkeley. But the study’s findings show that it’s “been a home run,” she said.

However, while purchases of sugary drinks dropped in Berkeley, they rose in surrounding Bay Area cities by 6 percent — prompting the question of whether residents simply shifted their soda buying to other cities without a soda tax. Silver said that residents surveyed did not report significant changes in where they purchased their beverages after the tax took effect.

The study, Silver said, also showed that overall beverage sales went up in Berkeley. If people were buying beverages elsewhere, that overall number would have most likely dropped, she explained.

Last year, voters approved a similar soda tax in San Francisco, Oakland and Albany, Calif., as well as in Boulder, Colo., Cook County, Ill., and Philadelphia. Santa Fe, N.M., and Seattle are considering soda taxes.

Researchers believe soda taxes in those communities could have a greater impact than in Berkeley because per capita consumption of sweetened beverages is about three times lower in Berkeley than the country as a whole, Silver said.

Meanwhile, in the California Legislature, a  reintroduced by Sen. Bill Monning (D-Carmel) would require that sugar-sweetened drinks of 75 calories or more per 12 ounces be labeled with the following message:

STATE OF CALIFORNIA SAFETY WARNING: Drinking beverages with added sugar(s) contributes to obesity, type 2 diabetes, and tooth decay.

“Consumers have the right to know about these potential harmful health impacts, and [this bill] will empower Californians to make healthy beverage choices,” Monning said in a press statement.

The bill also would require owners of vending machines selling sugary drinks to place a safety warning on the machines’ exteriors.

A spokeswoman for the American Beverage Association, an industry group, said in an emailed statement that consumers have more information than ever before to make informed food and beverage choices.

“Singling out one common grocery item for a misleading warning label will do nothing for real public health challenges like obesity and diabetes, which have multiple risk factors,” the spokeswoman wrote.

If the bill passes, labeling would be required starting July 1, 2018. The legislation is scheduled for a hearing on Wednesday in the Senate Health Committee.

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