Healthy Beverage Strategy Document
Johns Hopkins Institutions
Introduction
The Johns Hopkins Institutions present an image of excellence and integrity in health care. It is our
responsibility as a respectable health care organization to promote health to our staff, visitors, and the
surrounding community. In fact, a component of the Johns Hopkins Medicine’s five year strategic plan,
People Pillar, is to “actively support a healthy workforce.” As part of this plan, participating Hopkins
entities will increase the offerings of healthy beverages and decrease the availability of unhealthy sugarsweetened drinks with the goal of making it easier for our employees to make healthier beverage
choices.
Rationale
Consumption of sugary drinks has increased substantially across the United States over the past 30
years. The largest single source of excess non-nutritional calories in America comes from sodas and
other sugar-sweetened beverages. Scientific evidence consistently supports the association between
sugar-sweetened beverage consumption and an increased risk of weight gain, obesity, diabetes and a
variety of other health consequences. Since the consumption of sugary drinks is a modifiable behavior,
strategies to reduce intake can make an important impact on overall health.
SSB Definition
A sugar-sweetened beverage (SSB) is any beverage that contains added sugar or other caloric
sweetener. These beverages include soft drinks, sport drinks, energy drinks, juice drinks (drinks that are
not made with 100% juice), sweetened tea and coffee drinks, and sweetened milk or milk alternatives.
Implementation Plan
All beverages will be classified into a color categorization system, adapted from the labeling system at
Massachusetts General Hospital.1 Specifically, we base our labeling on density of calories per ounce
and the volume of each beverage container. The positive results from using a color coded system and
choice architecture intervention at Massachusetts General Hospital were sustained over a two year
period.2 In addition, we will apply price differentials, which have been shown to decrease purchasing
practices of sugar sweetened beverages.3
 Green: Beverages 0 to 25 kcal per 12 oz. serving and non-fat/low-fat milk. Examples: water,
diet beverages (with artificial sweeteners), unsweetened tea, unsweetened coffee and seltzer
water
 Yellow: Beverages 26 to 100 kcal per 12 oz. serving and 100% fruit/vegetable juice (limit of 12
oz. container and low or no sodium added). Examples: low calorie fruit drinks, low calorie sports
drinks
 Red: Beverages > 100 kcal per 12 oz. serving (limit of 12 oz. container). Examples: fruit drinks,
soda, sports drinks, coffee drinks, and whole milk with > 100 calories and ≥5 grams saturated fat
per container.
Page 1 of 3
Components
Hopkins sponsored
meetings/events
Vending machines
Cafeterias
Retail Vendors
SSB Reduction Strategies
Red beverage availability: 0% of total offerings
Implementation Date
September 2014
Red beverage availability: ≤20% of total offerings
Green beverage availability: ≥60%4 of total offerings
Size limitation: ≤12oz./container of red beverages
Price differential: Red beverages $.25 higher than
yellow/green beverages
Product placement: place green beverages at eye level
Red beverage availability: ≤20% of total offerings
Green beverage availability: ≥60% of total offerings
Size limitation: ≤12oz./container of red beverages
Price differential: Red beverages $.25 higher than
yellow/green beverages
Product placement: place green beverages at eye level
Red beverage availability: ≤20% of total offerings
Green beverage availability: ≥60% of total offerings
Size limitation: ≤12oz./container
Price differential: Red beverages $.25 higher than
yellow/green beverages
Product placement: place green beverages at eye level
Partial conversion:
September 2014
Note: Contract bid
occurring July 2014 with
5-6 month timeframe to
replace all machines.
September 2014
September 2014
Participating Entities
Johns Hopkins Hospital
Johns Hopkins Bayview Medical Campus
Johns Hopkins HealthCare, LLC*
Johns Hopkins Home Care Group*
Subject Matter Experts
The following faculty members have been consulted during the process of addressing SSB availability
within the Johns Hopkins Institution.
 Lawrence Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health
(Human Nutrition); Director, Welch Center for Prevention, Epidemiology and Clinical Research,
School of Medicine
 Sara Bleich, PhD, Associate Professor, Department of Health Policy and Management, Johns
Hopkins Bloomberg School of Public Health
 Roger Blumenthal, MD, Professor , Department of Medicine / Cardiology, Director of the
Ciccarone Preventive Cardiology Center, School of Medicine
 Benjamin Caballero, M.D., M.Sc., Ph.D., Professor of International Health, School of Public
Health and Professor of Pediatrics, School of Medicine
 Thomas Donner, MD, Associate Professor Medicine / Endocrinology; Director, Johns Hopkins
Diabetes Center, School of Medicine
Page 2 of 3
Marketing/Education Plan
The focus of the healthy beverage campaign centers on creating a healthy environment for employees,
which includes increasing access to healthy beverages. Since water is the healthiest beverage for human
consumption, the campaign will promote water as the optimal beverage of choice. In addition, the
traffic light categorization system will be used as a tool to help consumers make a healthy choice at the
point of purchase. Color coding labeling interventions have been successfully implemented in hospitals
around the country to increase the consumption of healthier beverages. The categorization system will
be utilized as a means to promote the healthiest beverages. In addition to addressing our own
marketing and education tactics, we will pursue the avenue of not allowing promotional marketing of
SSBs within our physical workplace. For example, vending machines will not have pictures or names of
SSBs on the sides. Any advertisements of beverages will need to promote those in the ‘Green’ category.
Evaluation Plan
 Pre/post sales data analysis
* These entities have made a comprehensive change in beverage exposure on their campuses that
slightly deviates from the plan laid out in this document.
1
Thorndike AN, Sonnenberg L, Riss J, et al. A 2-phase labeling and choice architecture intervention to
improve healthy food and beverage choices. American Journal of Public Health 2012; 102(3): 527-533.
2
Thorndike AN, Riis J, Sonnenberg LM, et al. Traffic-light labels and choice architecture promoting
healthy food choices. American Journal of Preventive Medicine 2014; 46(2): 143-149.
3
Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review
of research on price elasticity of demand for food. American Journal of Public Health 2010; 100: 216-222.
4
Recommendation according to Nemours Health and Prevention Services
Page 3 of 3