Reducing consumption of sugar-sweetened beverages to reduce the risk of childhood overweight and obesity Biological, behavioural and contextual rationale Tim Lobstein Director of Policy, World Obesity Federation, London UK September The consumption of sugar-sweetened beverages has been suggested as a contributory factor to the rising levels of childhood obesity being recorded in many countries worldwide. Recent systematic reviews of the literature confirm the link between consumption of free sugars, particularly in the form of sugar-sweetened beverages and weight gain in both children and adults 1,2while reducing intake of sugar-sweetened beverages has been shown to reduce weight gain in children, particularly in those who are already overweight
Abstract In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes.
We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with Obesity nutrition and larger soft drink increased risk of several medical problems e.
Study design significantly influenced results: Several other factors also moderated effect sizes e. Finally, studies funded by the food industry reported significantly smaller effects than did non—industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.
Soft drink consumption has become a highly visible and controversial public health and public policy issue. Soft drinks are viewed by many as a major contributor to obesity and related health problems and have consequently been targeted as a means to help curtail the rising prevalence of obesity, particularly among children.
Soft drinks have been banned from schools in Britain and France, and in the United States, school systems as large as those in Los Angeles, Philadelphia, and Miami have banned or severely limited soft drink sales.
Many US states have considered statewide bans or limits on soft drink sales in schools, with California passing such legislation in A key question is whether actions taken to decrease soft drink consumption are warranted given the available science and whether decreasing population consumption of soft drinks would benefit public health.
The issue is not new. In the American Medical Association mentioned soft drinks specifically in a strong recommendation to limit intake of added sugar. Similar positions have been taken by other trade associations such as the British Soft Drinks Association and the Australian Beverages Council.
Legislative and legal discussions focusing on soft drink sales often take place on political and philosophical grounds with scant attention to existing science. Our objectives were to review the available science, examine studies that involved the use of a variety of methods, and address whether soft drink consumption is associated with increased energy intake, increased body weight, displacement of nutrients, and increased risk of chronic diseases.
METHODS We focused on research investigating the effects of sugar-sweetened beverages; diet and artificially sweetened beverages are noted only in certain cases for comparison purposes.
Finally, we contacted the authors of each included article with a request for unpublished or in-press work, and we asked each author to forward our request to other researchers who might have relevant work.
Our searches yielded a total of 88 articles that were included in the present analysis. There is a great deal of variability in research methods in this literature. Studies vary in their design i.
Because such heterogeneity of research methods is likely to produce heterogeneity of effect sizes across studies an effect size represents the magnitude of the relationship between 2 variableswe took 2 steps to assess the impact of research method on outcome.
Initially, for each primary outcome energy intake, body weight, milk intake, and calcium intakewe assessed the degree of heterogeneity of effect sizes by testing the significance of the Q statistic, which is the sum of the squared deviations of each effect size from the overall weighted mean effect size.
We did not assess the degree of heterogeneity for secondary outcomes nutrition and health because there were relatively few studies in these domains. Our analysis of primary outcomes revealed a significant degree of heterogeneity of effect sizes in each case, and thus we separated the studies according to research design.
This procedure reduces the likelihood of aggregating effect-size estimates across heterogeneous studies. Moreover, some research designs are viewed as more powerful than others.
Cross-sectional studies represent the weakest design, because such studies cannot determine causality. Longitudinal designs are considered stronger, but experimental designs are the strongest test of causal relationships. Thus, separating studies according to type of design allowed us to examine effect magnitudes as a function of strength of research design.
We further explored variability in effect sizes by examining a number of potential moderator variables, including 1 population studied children and adolescents vs adults2 gender of participants only male, only female, or male and female combined3 type of beverage sugar-sweetened carbonated soft drinks vs a mix of sugar-sweetened and diet beverages4 whether the reported results were adjusted for covariates e.
Articles that did not report a funding source or cited support from other sources e.
In most cases, we entered data in the form in which they appeared in each individual study, including group means and standard deviations, correlation coefficients, t values, P values, and odds ratios and confidence intervals.
In certain cases, it was necessary to manually calculate effect sizes. For example, when means for more than 2 groups were presented e. In the case of studies that reported multiple measures of a particular construct e. When there was extraordinary variability in sample sizes across studies, we employed the conservative approach of limiting the sample size of the largest study in a particular domain e.
This approach ensured that the calculated average effect size would not be dominated by a single study. We considered an effect size of 0. Because there was a significant degree of heterogeneity among the effect sizes, we separated studies according to type of research design.The consumption of sugar-sweetened beverages has been suggested as a contributory factor to the rising levels of childhood obesity being recorded in many countries worldwide.
Recent systematic reviews of the literature confirm the link between consumption of free sugars, particularly in the form of. While the term "soft drink" is commonly used in product labeling and on restaurant menus, in many countries these drinks are more commonly referred to by regional names, including carbonated drink, cool drink, cold drink, fizzy drink, fizzy juice, lolly water, .
Consumption of sugar-sweetened beverages (SSBs), particularly carbonated soft drinks, may be a key contributor to the epidemic of overweight and obesity, by virtue of these beverages’ high added sugar content, low satiety, and incomplete compensation for total energy. Sweet Drinks and Obesity The consumption of sweetened drinks, such as soda, juice, Kool-Aid and sports drinks, has been on the rise in past decades.
At the same time, the prevalence of obesity in children has also risen. Sugary drink portion sizes have risen dramatically over the past 40 years, and children and adults are drinking more soft drinks than ever.
In the s, sugary drinks made up about 4% of US daily calorie intake; by , that had risen to about 9%. (14) Children and youth in the US averaged Soft drink intake has been associated with the epidemic of obesity and type II diabetes among children. While it is possible that drinking soda instead of milk would result in higher intake of total energy, it cannot be concluded definitively that sugar containing soft drinks .