The Most Obese States List

U.S. News and World Report has made a living off of ranking things, although recently it’s gotten some significant pushback from law schools and colleges about the choice of the data used to compile the rankings. Rankings seem to sell a lot of magazines. So, it’s not surprising that the publication would continue to focus on ranking, but this time with a new, and potentially less controversial, subject: obesity of adults in the 50 states.

The obesity ranking is taken from the public health evaluation that was part of a broader ranking of the 50 states by U.S. News and World Report. To do its public health analysis, U.S. News looked at CDC state-by-state data in six areas: mortality rate, obesity rate, suicide rate, smoking rate, mental health, and infant mortality rate. The obesity rate uses the body mass index (BMI) measurement of obesity, which is calculated by taking weight in kilograms and dividing it by the square of height in meters. It should be pointed out that the BMI is a rough measurement of obesity, and some strongly question its value.

Obviously, the list of the most obese states is not one you want to be on. I’m happy to report that Ohio doesn’t make the top five. Our neighboring state, West Virginia, has the highest adult obesity rate, coming in at a staggering 40.7 percent. It is followed in the top five by Alabama, Kentucky, Oklahoma, and Mississippi. Regrettably, Ohio comes in at no. 9 on the list, with an adult obesity rate of 37.5 percent.

Is there significant value in ranking states based on the amount of adult obesity, using a debatable measurement like the BMI? No doubt some people will argue that such a ranking is a form of improper body shaming, and people’s weight and appearance is nobody’s business but their own. There is no doubt, however, that obesity has significant health consequences. If you are about public health, you have to care about obesity. If the U.S. News rankings get people to focus on that, it is performing a public service.

Don’t Let Them Eat Cake

In Great Britain, the chairwoman of the Food Standards Agency, Professor Susan Jebb of the University of Oxford, is mightily concerned about the nation’s health and the obesity epidemic affecting many Brits. Among the targets of her ire are people who bring cake into the office–something she considers to be harmful as exposing your co-workers to secondhand smoke.

Professor Jebb’s basic point is that you simply can’t rely on the personal willpower of people who are exposed to the tantalizing prospect of free cake. The Times article linked above quotes her as follows: “’We all like to think we’re rational, intelligent, educated people who make informed choices the whole time and we undervalue the impact of the environment,’ she said. ‘If nobody brought in cakes into the office, I would not eat cakes in the day, but because people do bring cakes in, I eat them. Now, OK, I have made a choice, but people were making a choice to go into a smoky pub.’” She raised the smoking issue because passive smoking harms others, and “exactly the same is true of food.” The upshot, in her view, is that Great Britain needs to provide a “supportive environment” to help individuals avoid bad choices that lead to weight gain.

Although Professor Jebb specifically singled out cake at the office as an example of the prevalence of bad food options at every turn, the bottom line for her is that Great Britain needs to regulate food advertising. She notes: “At the moment we allow advertising for commercial gain with no health controls on it whatsoever and we’ve ended up with a complete market failure because what you get advertised is chocolate and not cauliflower.”

If Professor Jebb is hoping to get to a a society where cauliflower is vigorously advertised, I predict her efforts are doomed to failure. I also predict that her fellow Brits won’t look kindly on any potential restrictions on a co-worker’s ability to bring cake into the office.

Putting aside time-honored employee birthday cake events, people who bring leftover cake to the office want to get it out of their homes so they won’t be tempted by it, and people who eat cake at the office like to have a treat now and then. I’m not sure that trying to regulate cake offerings is going to prevent obesity, if that cake is then consumed at home rather than at the office. I don’t think regulating TV or billboard or radio advertising is going to get there, either, so long as cake mix is sold in stores and candy and snacks are available at the point of purchase to tempt people into taking the road to perdition.

The bottom line on obesity is that we need to build up the willpower of individuals, and incentivize them to watch their weight. Restricting cake at the office isn’t really getting at the root cause.

“Please Don’t Weigh Me” Cards

I happened to see a news article about these “please don’t weigh me” cards that some people apparently are using with their doctors. One of the cards is pictured above.

The cards are being offered by a group called more-love.org. Its website indicates that it has sent out thousands of the cards. The website explains the cards as follows:

“Because we live in a fatphobic society, being weighed and talking about weight causes feelings of stress and shame for many people. Many people feel anxious about seeing the doctor, and will avoid going to the doctor in order to avoid the scale.

We want to support you in requesting healthcare that is free of weight bias. Getting weighed is an informed choice that we get to make with our doctor. We don’t have to automatically step on the scale just because someone asks us to.

Our “Don’t Weigh Me” cards are a polite and respectful way to assert your preference at the doctor’s office and seek informed consent if weight is deemed necessary for care and treatment. It’s OK to not automatically step on the scale when asked.”

Perhaps I’m insensitive and “fatphobic,” but this concept seems strange to me. First, there’s a passive-aggressive element to it that doesn’t seem particularly well-suited to a positive doctor-patient relationship. Why do you need pre-printed cards, rather than having an honest conversation with your doctor, and his staff, about your feelings? If you can’t have candid communications with your doctor about your issues, you’re probably not going to get the best health care.

Second, what is this about “healthcare that is free of weight bias”? Numerous studies have shown that weight is directly related to health care, in that obesity increases the risk of conditions like diabetes, heart disease, joint problems, respiratory problems, and other significant health issues. Even if you don’t currently have one of these conditions, excessive weight is likely to cause you to develop such problems in the future–which means weight logically is a focus of any doctor who is interested in preventive health care. Asking your doctor not to weigh you is like asking him to not take your pulse, conduct a blood test, or perform a physical examination. You are depriving him of information that he can use in prescribing appropriate medication, treatment, or other activities that can produce better health and avoid future problems.

Third, isn’t it odd that people are concerned about living in a “fatphobic” society, and what really worries them is getting a metric from a scale, rather than how they look, or how they feel, or how their clothes fit? What is it about the act of getting on a scale that makes it, specifically, the focus of a pre-printed card?

These cards seem to be a new development, and it isn’t clearly how common their use is. It would be interesting to know how doctors are reacting to being handed one of these cards.

The Wearable Chair

In the new product development department, the other day I ran across a news story on the “wearable chair.”  It’s a contraption of bands and extendable aluminum legs;  you strap it to your keister and it allows you to sit wherever and whenever you want to do so.

It’s an ungainly looking device, to be sure, and it gives the people sitting on it a distinctly bionic, quasi-insectoid appearance.  It seems like a pretty clumsy thing to wear around, and if you’re in a crowd it looks like it would take up space that might not be appreciated by the other people on, say, the subway train.  Presumably there are rigorous weight limits for the wearable chair, too.  It’s supposed to help with your posture, though — which doesn’t surprise me, because the photos of the product make it look like you need to sit in a particular, erect way or weight distribution issues would otherwise cause you to go tumbling to the ground.  No slouching when you are strapped into the wearable chair!

I guess we’ll find out whether there’s a market for the wearable chair.  It seems hard to believe that there are enough people who become so fatigued at the spur of the moment that they can’t find a chair or bench — or even spot on the grass — where they can sit, and would rather extend limbs from an exoskeleton on their butt and draw curious attention to themselves.  Maybe modern people have become so lazy and in need of instant comfort that the wearable chair will be a big success.  In a world struggling with obesity, however, it seems like we’d all be better off if people had to actually stand while waiting for a bus or train rather than plopping down wherever they wanted.

How long do you suppose it will be before somebody decides to combine a wearable chair with a standing desk?

Caught Between Two Donuts

I thought it was a sign of the apocalypse when McDonald’s started serving breakfast sandwiches between two griddle cakes several years ago — but in our modern culture, the envelope is always being pushed farther and farther.

So I suppose I shouldn’t be surprised to read that KFC is now offering various chicken and donut combinations at selected locations in Pittsburgh, Pennsylvania and Norfolk and Richmond, Virginia.  At those test locations, you can get a basket of chicken on the bone or chicken tenders served with one or two doughnuts, or you can order a sandwich made of a boneless piece of Kentucky Fried Chicken positioned between two glazed donuts, all of which is then served hot.  The donuts apparently will be delivered to the test KFC stores already cooked, and when a customer orders them, they will be dipped into fryers and glazed with vanilla icing so they are served hot.

KFC has explained that it is conducting the test to determine whether customers are craving chicken and donuts on a national scale.  I don’t think any kind of test of that sort truly is needed.  When you combine the statistics on the growing American obesity epidemic (no pun intended) with the known fact that most people are powerless to resist donuts that are made available to them, it seems very likely that the KFC chicken-and-donut sandwich will be a smashing, calorie- and carbohydrate-laden success.  Fortunately, I’m not going to be going near Pittsburgh or Virginia in the near future, so I won’t be tempted to give the sandwiches a try.

If the sandwiches are adopted on a national scale — and I have no doubt they will be — KFC or a competitor will have to figure out a way to push the culinary/calorie/carb envelope still farther.  I’m guessing we’ll see bacon, cheese, and honey drizzle added to the combination next.

Plus-Sizing America

People come in all sizes, large and small.  And in these days of increasing obesity among Americans, the range seems to be shifting toward the “plus-sized” end of the spectrum.

So, what’s a business that deals with seating any customers who might walk in — like a restaurant — to do to account for that fact?

This year the New York Times ran an interesting article about the challenges that “plus-sized” diners face when they go out to eat.  They not only feel judged by restaurant staff and other patrons about what they are ordering in view of their weight, they also struggle to find places where they can comfortably sit for a meal.  Depending upon a diner’s size, booths may be impossible for them to squeeze into, and bar stools may be too narrow and shallow to provide a viable seating option.  And places where the tables are positioned closely together may put larger diners in the position of intruding into the personal space of a neighboring table.

Those of us who aren’t in the plus-sized category don’t pay attention to such issues, because standard seating options are perfectly suitable for us.  But for the large people among us, such options may be so painfully confining that they interfere with the enjoyment of the meal — and some options may be physically impossible to use, period.

It’s an example of the challenges that are arising from the plus-sizing of a significant chunk of America’s population.  People who are XXXLers are going to want to go out to eat like everybody else, and they are going to want to find places that can appropriately seat diners their size.  If restaurants want their paying business, they are going to need to come up with ways to comfortably accommodate such patrons — without calling undue attention to the effort.

Overweight Ohio

Some entity I’ve never heard of came out with their list of the fattest states in America.  Of course, I checked to see where Ohio ranked, and found that we’re at number 12 on the portly parade — not quite cracking the Top Ten of Tubbiness, but definitely up there farther than we want to be.

An outfit called WalletHub (has anybody heard of these guys?) supposedly looked at three factors — “obesity and overweight prevalence, health consequences and food and fitness” — to determine their rankings.  By their analysis, Mississippi, West Virginia, and Arkansas rank 1, 2, and 3 in overall corpulence, whereas Colorado, Utah, and Hawaii, respectively, are the top three at the slender end of the spectrum.  And notwithstanding all of the lobbying fat cats who prowl the halls of Congress, the District of Columbia is found to be one of the slimmest jurisdictions in the U.S.

I’m always skeptical of these kinds of rankings of states, but the news stories never get into the details of how they are developed that would allow proper analysis.  Precisely how was the “obesity and overweight prevalence” factor in this study determined?  Is there some kind of secret federal blubber database that was consulted?  And does food and fitness just look at the availability of food and workout facilities, or the kind of food that is consumed, or the use of restaurants and fitness outlets, or something else?  How in the world would you determine, for example, that Ohio is marginally fatter than That State Up North?

All that said, it’s clear that Ohio has work to do.  We don’t want to crack the Top Ten on the State Stoutness Scale and be known as Obese Ohio.  It’s time to put down those delectable Buckeye candies, push back from the kitchen table, hop on the elliptical or the bike, break out the weights, and start turning blubbery Buckeyes into buff Buckeyes.

Coffee As Candy

On our drive up to Maine, Kish wanted to grab a cup of coffee, so we stopped at your basic 7-Eleven in a small town in western Massachusetts.  It’s the first time I’ve been in a 7-Eleven in years.

It’s safe to say that the current 7-Eleven coffee station, even in your basic 7-Eleven in small town America, is . . . elaborate.  In fact, incredibly elaborate would not be an exaggeration.  Whereas there used to be one little area with a few coffee pots where you could pour yourself a generic regular coffee or decaf coffee and add your standard creamer, sugar, or non-sugar sweetener, now there is a long row of different coffee options, depending on your preference in strength and flavoring, and then an extensive choice of creamers and additives that apparently is offered to allow you get your 7-Eleven cup of coffee as close to what a high-end coffee house barista might serve you.

My mind reeled at some of the flavoring options.  There’s hazelnut, of course, but cinnamon?  Marshmallow?  There had to be more than a dozen different creamer flavors, and that doesn’t even account for the dry materials you could add to your cup.  The standard creamer bin was totally outnumbered by a host of sweetening alternatives.

Coffee is increasingly becoming less like coffee, and more like candy or ice cream or dessert.  Americans apparently have such a sweet tooth that even the old cup of joe from a 7-Eleven store needs to be gussied up into some frothy, hyper-sweet concoction.  Is it any wonder that we’ve got an obesity problem in this country?

A Blunt Instrument

As of January 1, 2018, Seattle has placed a tax — it’s officially called a “sweetened beverage recovery fee” — on sugary sodas and “sports drinks” like Gatorade.  Costco, the big box membership club retailer, has responded by placing signs showing consumers the specific impact of the tax on the Costco price for the product — and it’s a whopper.

The Costco signs show that the Seattle tax adds $10.34 to a Gatorade 35-bottle variety pack — the kind you might buy if you were responsible for buying refreshments for your kid’s sports team to consume after a practice.  The price of the product was $15.99, but with the new tax the price is now $26.33.  The tax added $7.56 to a 36-can case of Dr. Pepper, bringing the price from $9.99 to $17.55.  Costco also helpfully added signage to explain the tax-related increase to its customers and remind them that they can avoid paying the additional cost simply by going to a nearby Costco located out of the city limits.  Some customers have told local TV stations they plan on doing just that.  There’s also been lots of social media chatter about the Costco signs and the impact of the tax on prices.

What’s the point of the tax?  Seattle evidently is concerned about obesity, which some studies have linked, at least in part, to the consumption of sugary soft drinks.  Seattle hopes that by imposing a substantial tax on soft drinks and “sports drinks,” it will incentivize people to make healthier choices.  But get this:  the tax exempts sweetened products from certified manufacturers with annual worldwide gross revenue of $2 million or less, and products from certified manufacturers with gross revenue of more than $2 million but less than $5 million pay a much smaller tax.  That exemption is a purely political decision that doesn’t make sense as a public health issue, because the size of the producer obviously doesn’t change whatever the impact of the product might be.  Seattle’s approach also focuses only on sweetened drinks, and doesn’t address products like ice cream, candy bars, “snack foods,” or frozen pizza that might also be said to contribute to “unhealthy lifestyles.”  And, of course, it doesn’t begin to address other issues that contribute directly to obesity, such as lack of exercise.

Other cities, like Chicago, have tried soft drink taxes and dumped them in the face of business opposition.  Costco is providing a salutary service by alerting its customers to the specific cost impact of the tax so they can factor it into their decision-making.  The Seattle experiment, as illuminated by the Costco signs, reminds us, yet again, that taxes are a pretty blunt instrument when it comes to trying to change behavior and achieve broader policies — and that taxes are always going to be affected by political considerations, too.

Seat Grab

I was sitting in my seat on my flight to Denver, doing some reading for work and minding my own business, when suddenly my seat lurched backward.

I momentarily wondered what had happened,, then I realized the truth:  the person who was sitting in the seat behind me was getting up and had to grab the back of my seat with both hands to help themselves up — and from the amount of the backward movement of my seat, I figured it was a big person.  When I looked behind me, sure enough I saw a heavyset guy struggling to rise from his seat and head off to the bathroom.

How often has this happened to you?  For me, it’s become commonplace.  We’ve got such an obesity problem in this country that people can’t get up from their seats without help.  Even the armrests that allow you to balance yourself as you rise from your seat on the airplane aren’t sufficient, so the obese travelers have to hang on to the back to the seat in front of them and pull themselves to their feet.  Never mind that there’s somebody sitting in that seat they’re grabbing, and that the seat grab is going to cause that unlucky person to move backward unexpectedly, interrupting whatever they might be doing.  There’s never an apology, either.  It’s as if the seat you are sitting in was intended solely to help tubby passengers stand up, giving them every right to wrestle with your seat and maneuver it as they see fit so they can get on their feet.

It’s a minor annoyance, to be sure, but it’s just another little reminder of how extensive the obesity epidemic is in this country.  When people can’t even get to their feet on a plane without putting both hands on the seat in front of them and pulling with all of their might, it’s obviously a problem.

Politicized Diets

Recently I ran across an interesting article dealing with governmental diet instructions.  It noted that much of the nutrition advice that Americans have received from their government over recent decades has turned out to be dead wrong — and in fact may have contributed to the obesity epidemic that you see whenever you go out in public.

The article focuses on the national dietary guidelines released in 1980 by the U.S. Department of Agriculture and the forerunner to the current Department of Health and Human Services.  The guidelines targeted fat, saturated fat, and cholesterol as villainous substances to be avoided and drummed into American heads that low-cholesterol, low-fat foods were better for your heart and your health generally.  As a result, the article posits, food manufacturers started churning out “low-fat” and low-calorie offerings that Americans bought, thinking they were eating healthy.

But the government’s conclusions about our eating habits and their effect on health turned out to be erroneous. Research has determined that fat and cholesterol are not, in fact, harmful, and the “low-fat,” high in carbohydrates foods that Americans have been munching on may instead have helped to produce vast problems with obesity and diabetes — problems that did not exist in 1980, when the government report that triggered it all was released.  One British cardiologist contends:  “The change in dietary advice to promote low-fat foods is perhaps the biggest mistake in modern medical history.”  And other results have indicated that diets that go in the opposite direction from the government’s instruction, with dieters looking to eat meats and eggs and limit carbs instead, are effective in reducing weight.

How did the government turn out to be so wrong?  Some researchers believe that it was because, back in the ’60s, sugar industry lobbyists funded dubious research that linked fat and cholesterol to heart disease and downplayed the adverse health effects of sugar and carbohydrates.  With the nudging from the lobbyists, the government bought the sketchy results, issued its report, and started the country on the road to flabbiness.  In short, politics helped to put us on the wrong dietary road.

If you’ve lived long enough, you begin to reach a critical mass of alarming governmental declarations that have turned out to be wrong.  It’s one of the reasons why the credibility of our governmental institutions among the American public has dropped to an all-time low.  The conclusion that modern America’s obesity epidemic is a self-inflicted problem caused in part by really bad governmental advice isn’t going to help.

Obesity On The Interstate

On Saturday and Sunday, Kish and I drove home from Maine.  It was a long trip, so we broke it up into two days.  The distance wasn’t a problem for me, though, because I just enjoy driving, listening to the radio, and seeing the countryside pass by.

We rolled along interstate highways in Massachusetts, upstate New York (where we got ridiculously gouged paying tolls on the New York Turnpike), and then Pennsylvania and Ohio.  Because we were on the NY Turnpike, we used the service plazas to fill up, and we visited rest areas on the non-toll roads.  As we stopped from time to time and I passed fellow travelers, I slowly realized something:

My God!  We are a country of porkers!

Look, I recognize that the crowd you see on the interstate highway system in the Eastern time zone isn’t a random statistical sample of the United States as a whole.  I know you can’t extrapolate from the people I happened to see, by chance, as I stopped to fill up or hit the men’s restroom.  But after a while the number of seriously obese people I was seeing at every stop became so obvious that it just couldn’t be ignored.  And I’m not talking about people who are a few pounds above their ideal, either.  I’m talking about people that move with the slow waddle characteristic of the grossly overweight, men with colossal beer guts, women who are huffing and puffing just walking from their cars to a roadside restroom, and people who look like they are ready to burst out of their clothes.

I’m not saying this to be funny, or provocative.  It really was disturbing, and depressing.  There obviously are a lot of morbidly obese people in this country, and if you want to see them just drive a while on the interstate highway system.  When you think about the back problems, and diabetes, and joint problems, and heart disease, and high blood pressure, and other health conditions associated with obesity, you realize that the weight problems of so many people have to be a large contributor to the exploding health care costs in the United States.  Is it any wonder that we can’t control health care costs, when so many people can’t control their own urges and their own weight?

Garbage In

What are the costs of eating fast food?  Of course, one cost is the simple consumption of an unsatisfying, typically over-salted meal in either a car seat or a sticky and garish fast-food environment, rather than sitting down to a leisurely meal with family or friends.  That’s a given.  Then there’s the weight gain that tends to result from slamming down high-calorie processed foods.  But now research is indicating there’s even more to it.

The Washington Post recently published an article about the curious association between fast-food consumption and phthalates.  (Yes, “phthalate” is a real word, and no, I have no idea how it is pronounced.)  The study tracked fast-food intake by 9,000 research subjects — fast-food was defined as any food served at a restaurant without waiters or waitresses — and took urine samples from them.  Analysis of the urine samples showed that people who had eaten any fast food in the last 24 hours had higher phthalate levels than people who had not eaten any fast food during that same period, and the larger your fast food intake, the higher your phthalate levels tended to be.

The results are troubling because phthalates are industrial chemicals used to soften plastic and vinyl and make it more flexible, and the Post reports that they have been associated with a number of adverse health effects.  Male infertility is one of them, and another is diabetes.  Why do people who consume fast food have higher phthalate levels?  Researchers don’t know for sure, but they suspect it is because the processed nature of fast food means that the food tends to touch a lot more machines, conveyor belts, plastic wrapping, other packaging materials, and other potential sources of phthalates before it gets onto your plate — I mean, your cheap cardboard box, paper bag or foam container.

But here’s the most troubling part of the Post story from my standpoint: the research revealed, and other government studies confirm, that one-third of the participants eat some form of fast food every day.  That includes one-third of kids and adolescents.

A diet that includes fast food every day.  Just the thought of it makes my mouth feel dry and briny from anticipation of the salt intake.  It’s no wonder that we’ve got some serious health and obesity problems in the U.S. of A.  We’ve got to start taking better care of ourselves, and it starts with eating better food.

Happiness And Health

Studies show that happy people — or, at least, people who self-identify as happy — are likely to live longer.  So, does that mean being happy is the key to living to a ripe old age?

Scientists now say . . . not so fast.  They found that although the happy people in the studied population of a million women were less likely to die during the ten-year study period than people who described themselves as unhappy, when researchers looked into the health of those groups they found that happy people also tended to be objectively healthier than the sad contingent — and healthier people by definition are likely to live longer.  In short, happiness might be correlated with longevity, but being happy, by itself, doesn’t cause long life. The study bluntly concluded:  “Our large prospective study shows no robust evidence that happiness itself reduces cardiac, cancer, or overall mortality.”

No surprise there, really.  Only the most ardent happiness advocate might think that the simple act of being happy could, say, prevent the formation and spread of cancerous cells in your body or allow you to escape a genetic predisposition to heart attack.  But that obvious conclusion still begs a significant question — why does the correlation exist in the first place?  Why do happy people tend to be healthier than unhappy people?

I think the answer is clear — and the key is not happiness, but the state of unhappiness.  If you are in pain or feeling sick or otherwise are suffering from poor health, it’s difficult to maintain a happy attitude.  On the flip side, if you’re down in the dumps, it’s harder to get motivated to do the things that help to keep you healthy, like getting a decent amount of exercise and watching your diet and your weight.  How many unhappy people overeat to compensate for their depression, for example, and end up dealing with obesity, the health problems associated with it, and the poor self-image issues that tend to accompany it?

Happiness therefore might not be the cause of good health, but unhappiness and poor health seem to be part of a cycle, with one reinforcing and contributing to the other.  Happiness therefore might not be the cause of a long life, strictly speaking, but if you can develop and keep a positive attitude it sure seems to help.

Unfizzed And Unfazed

I can’t even remember the last time I had a full-calorie soda.  It’s a time period that can be measured in decades, and it might stretch back into the mid-1980s.  At some point I switched to diet sodas and then I pretty much stopped drinking sodas altogether.

Apparently I’m not alone.  America is in the midst of a long and significant decline in the consumption of soda generally, and full-calorie soda specifically.  The drop in consumption is having the incidental effect of reducing calorie consumption by kids — but we’ve nevertheless still got a serious obesity problem.  The decline in people guzzling fizzy soft drinks, without a commensurate decline in obesity issues, suggests that sodas can’t bear the entire blame for our country’s tubbiness troubles.

What are Americans drinking instead of sodas?  The article linked above says bottled water sales are jumping, and based on my personal observations I’m guessing that consumption of coffee also has increased.  In fact, Americans who used to satisfy their sweet tooth with a Coke may simply have switched to some high-end, caramel-flavored, whipped-cream-topped coffee concoction — which may also explain why obesity rates haven’t tracked the downward path of soda drinking.

I don’t drink either bottled water or high end coffees.  I long ago decided that some tap water over ice, with a lemon slice, would do me just fine.  It quenches my thirst, cools me down, and has a nice light tartness to it — as well as being cheaper, less fattening, and more environmentally friendly.