The frequent consumption of sugary beverages, such as sodas, sports drinks, energy drinks, fruit punches and sweetened waters, teas and coffee, is considered a major factor behind the obesity epidemic, both globally and here in the United States. It has also been linked to an increased risk of heart disease and type 2 diabetes.
Public health officials have encouraged governments, schools, businesses and other institutions to try a variety of environmental interventions — ones that change the social or physical environment in which individuals buy or drink beverages — to discourage people from consuming sugar-sweetened drinks.
But how effective are those interventions?
To help answer that question, a team of British and German researchers conducted a Cochrane review of 58 studies that have tested various ways of reducing the consumption of sugary beverages at the population level (among large groups of people).
Their findings, published Wednesday, found that some strategies appear more effective than others.
Strategies that work
The studies included in the review involved more than 1 million adults, teens and children. They lasted for a median of 10 months and were done in a variety of real-world settings, including schools, stores and restaurants.
Many different strategies were tested in the studies, including pricing, labeling and making healthy alternatives more easily available to consumers. Some of the studies looked at broad approaches, such as public awareness campaigns that encourage healthier beverage choices.
The reviewers found that not all of the studies were rigorously designed. “Some studies used methods that are not very reliable,” they write. “For example, in some studies participants were simply asked how much SSB they drank, which is not very reliable, as people sometimes forget how much SSB they drank. Some of the findings of our review may therefore change when more and better studies become available.”
Despite that limitation, the reviewers concluded that the evidence shows a number of approaches for reducing the consumption of sugary beverages can be successful. These measures include the following:
- Putting easy-to-understand labels on beverages, “such as ‘traffic-light’ labels, and labels that rate the healthfulness of beverages with stars or numbers.”
- Limiting the availability of sugary beverages in schools.
- Increasing the price of sugary drinks in restaurants, stores and recreational centers.
- Having healthier beverages be the standard drinks offered on children’s menus in restaurants.
- Promoting healthier beverages in grocery stores.
- Eliminating sugary beverages from the list of food products that can be purchased with government food benefits.
- Launching community awareness campaigns that focus on the health risks associated with sugar-sweetened beverages.
- Implementing programs that improve the availability of low-calorie beverages at home, such as the delivery of bottled water and diet drinks.
Some negatives, too
The reviewers note that these measures, while appearing to be effective in reducing the consumption of sugar-sweetened beverages, can also produce some unintended effects, including potentially negative ones.
“Some studies reported that profits of stores and restaurants decreased when the measures were implemented, but other studies showed that profits increased or stayed the same,” they explain. “Children who get free drinking water in schools may drink less milk. Some studies reported that people were unhappy with the measures.”
“We also looked at studies on sugar-sweetened milk,” they add. “We found that small prizes for children who chose plain milk in their school cafeteria, as well as emoticon labels, may help children drink less sugar-sweetened milk. However, this may also drive up the share of milk which is wasted because children choose but do not drink it.”
Overall, however, the positive effects of these strategies appear to outweigh any negative ones.
“Based on our findings we suggest that such measures may be used more widely,” the Cochrane reviewers conclude. “Government officials, business people and health professionals should work together with researchers to find out more about their effects in the short and long term.”
“Rates of obesity and diabetes are rising globally, and this trend will not be reversed without broad and effective action,” adds Hans Hauner, one of the authors of the review and a professor of nutritional medicine at the Technical University Munich, in a released statement. “Governments and industry in particular must do their part to make the healthy choice the easy choice for consumers. This review highlights key measures that can help accomplish this.”
FMI: You can read the review on the Cochrane Database of Systematic Reviews. Cochrane is a nonprofit global organization of independent scientific investigators.