Reflect

I didn’t really know what he meant. Why wouldn’t they have any left? It’s just a drink. Little did I know! After a hunt around, he asked a sales assistant whether this much desired product was in stock. Predictably, the answer was, “No” - it had sold out and she didn’t know when they’d get any more. Judging by her weary and slightly irritated response, she’d already been asked this question numerous times that day by teens, keen to get their hands on a bottle.

Prime was created and launched in 2022 by influencers and former boxers, Logan Paul and KSI, both of whom have many millions of followers on YouTube. Word about this drink, with its brightly coloured bottles and cans, vibrant branding, mysterious ingredients, and saccharine sweet flavours (ice pop, orange mango and strawberry watermelon) spread quickly among their captivated audience. Initially, Prime was a ‘hydration drink’, but the range has since expanded to include an energy drink containing caffeine. Riding the wave of huge social media hype, Prime became a sales phenomenon, with both products becoming so popular among teens (especially boys) that schools banned it and bottles were spotted selling for £18 in some shops (and more on resale sites), despite the recommended retail price being only £2.99.

Like many things, Prime may well be a passing fad. My son certainly hasn’t asked for a bottle since. However, some brand new research published on Monday evening, a podcast interview last week with lead author (and Tooled Up’s new researcher of the month), Professor Amelia Lake, and some work with a fantastic drugs education charity, the DSM Foundation, has taught me that energy drinks are going nowhere. In fact, these products, which tend to be packed with caffeine, sugar, and other lesser-known ingredients with stimulant properties, form the fastest growing sector of the soft drink industry, and they are particularly popular amongst the young. In 2020, the energy drinks market was worth $45.8 billion globally. It is projected to grow at an annual rate of 8.2% and reach a whopping $108.40 billion by 2031. Research has found that, despite warning labels stating that energy drinks are ‘not recommended for children’, up to a third of UK children say that they regularly consume energy drinks and, on average, young people in the UK consume more energy drinks than those in other European countries.

Energy drinks are accessible and cheap. They are often promoted on gaming sites, are frequently linked to sports (especially extreme sports) and an athletic lifestyle, and are particularly aimed at boys. In qualitative research which asked young people why they drink energy drinks, taste, price (they were easily available in local shops; sold for as little as 25p on ‘four for £1’ offers), advertising, ease of access and peer influences were all identified as key factors. Whilst the manufacturers would argue that they are not targeting young people, the packaging, flavours and advertising choices might suggest otherwise.

Motivate

It is not uncommon for a 500ml can of energy drink to contain 20 teaspoons of sugar and the same amount of caffeine as two cups of coffee. Research on the safety of caffeine has led to recommendations that children should only consume caffeine in moderation and have no more than 3mg/kg body weight per day. As an example, a child weighing 30kg should have no more than 90mg caffeine, and a small can of energy drink may contain more than this. In fact, the UK Food Standards Agency states that caffeine levels in a can of energy drink can vary between 80mg (equivalent to two cans of cola or a mug of instant coffee) and 200mg (equivalent to five cans of cola).

Professor Lake and her colleagues at Fuse, The Centre for Translational Research in Public Health, have been exploring the topic of energy drinks with young people, schools, teachers, parents, and policy makers since 2014. Their earlier research produced an evidence review which showed that consumption of these drinks is associated with common health complaints, such as headaches and stomach aches, and risky behaviours.

The Fuse team’s initial study received international media coverage, helped along by a Jamie Oliver national campaign, #notforchildren. At that time, many large UK supermarkets voluntarily banned the sale of energy drinks to children, but they are still widely and easily available. Acknowledging the study, a UK Government inquiry was launched, and the research team gave evidence to the Science and Technology Committee on the effects of energy drinks on young people’s health in June 2018. A public consultation resulted in 93% of respondents supporting the restriction of sales to under 16s and, in July 2019, the government suggested a ban in their green paper, Advancing our Health: Prevention in the 2020s. But there has been no further action. In 2022, the devolved government in Wales launched its own consultation to ban the sales of energy drinks to under 16s. A ban is not without precedent. A number of countries have attempted to regulate energy drinks, including bans on sales to under 18s in Lithuania and Latvia.

On Monday, the team from Fuse released an updated review of the evidence which has revealed some worrying associations. Evidence was collected from 57 studies conducted in more than 21 countries, involving 1.2 million children. In addition to newly noted physical health harms including tooth decay and insulin resistance, they also found that drinking these products is associated with an increased risk of suicidal thoughts, psychological distress, anxiety, depression, stress and panic behaviours. Alongside these physical and mental health outcomes, they also identified issues around sleep quality and quantity, poor academic performance, and unhealthy dietary habits. There is also a clustering of unhealthy behaviours around energy drink consumers including other substance use (alcohol, smoking, and vaping), risk taking and violent behaviours.

Professor Lake is keen to stress that the evidence reviewed is mostly cross-sectional (where data is collected at a single point in time), and so doesn’t prove that energy drinks are causing these negative outcomes. However, the research team, along with 41 other health related organisations, are calling on policy makers to adopt a ‘precautionary principle’ by banning sales of energy drinks to children and young people under the age of 16, to prevent further harm. As Professor Lake told me last week, “I hope this is the last evidence review on energy drinks. There is enough evidence now for our policy makers to look after not just the heath, but the wellbeing and mental health of our children and young people, and to make it clear to parents, to guardians, to shop owners, that these products are not for children. Alongside other policies that are looking to create a healthier environment and space to make choices, this could be a change that could have a far-reaching impact on health, mental health and educational attainment. Banning sales would send a clear message that these drinks are harmful to children and young people. It is there on the label – so why do we continue to allow them to be sold?”

Meanwhile, sales of these drinks continue to grow, marketing becomes more prevalent and sophisticated, and, as parents, we all know that they continue to be part of youth culture.

Support

It’s probably not effective to ban these products or say they are ‘bad’ without giving a reason and making time for discussion. Instead, strive to have open, inquisitive, truthful conversations, perhaps at dinnertime, in the car, or the next time you are out shopping, which encourage critical thinking about product marketing. Be clear about how products can target children, and encourage curiosity about why companies might choose this strategy to sell their products. Energy drinks are often promoted online on social media and gaming sites and are associated with sports sponsorship and an athletic lifestyle – no wonder they are attractive to young people. Things to consider might be: why does packaging look a certain way? Why are energy drink brands sponsoring sporting events? Why might a particular influencer consume a certain drink on their feed? What’s the point of an energy drink having its branding on a school bag or pencil case? What are they trying to achieve?

Look at ingredients together. Shining a light on sugar and caffeine content can be eye-opening. Caffeine is ever-present, so it’s worth considering our own habits. If we drink a lot of coffee, how might this influence our children’s decision-making? Tolerance to caffeine can develop, as can dependence, so it is worth being open with children about any issues we’ve experienced along these lines. We could even use this as a jumping off point into a wider conversation about coping strategies or even addiction. With older teens, it’s also worth being alert for accumulation and mixing. Caffeine is an extremely common ingredient, and it is easy to inadvertently double up on the recommended allowances (perhaps by having an energy drink plus a caffeine-containing cold remedy, for example). It is also a common, and potentially problematic, mixer for alcohol for many young people.

Finally, something that we often come back to at Tooled Up; it's important to focus on children’s sleep, even during the teen years. The most concerning finding in this new study is an association between energy drinks and mental health issues. There may be many reasons for this, but one factor might be the impact that caffeine has on our shut-eye. Getting enough good quality sleep is vital for our health and wellbeing. We know that sleep problems are a factor in many mental health conditions and that the relationship between sleep and mental health is, at the least, bi-directional. Caffeine-filled energy drinks can be the thief of sleep and, if this interference happens regularly, it can undoubtedly impact detrimentally on physical and mental health. Promoting a good understanding and appreciation of sleep hygiene (including an awareness about not drinking caffeine in the evening or late at night) is vital.

Any school or parent looking for some information to share with children should download a fact-filled leaflet which the Fuse team has co-produced with young people. Professor Lake also recommends checking out the Bite Back 2030 campaign, which features children and young people eloquently talking about the ways in which they are targeted marketing campaigns by companies through cute, colourful, clever packaging. We also love Humankind's little animated video of the Tortoise and the Hare, who thinks he will win the race by drinking an energy drink.