Research in context
Evidence before this study
We searched PubMed, Embase, and Google Scholar for scientific literature published up to Oct 1, 2015, with no language restrictions, using the following terms: (“carbonated beverages” OR “SSB” OR “sugar sweetened beverages” OR “soft drinks” OR “sweet drinks” OR “soda” OR “sugary drinks” OR “fruit drinks” OR “sport drinks” OR “cold drinks” OR “non-alcoholic drinks”) AND (reduc* OR limit* OR decrea*) AND (“energy” OR “weight” OR “calorie” OR obes*) AND (“strategy” OR “intervention” OR “policy” OR “way” OR “approach”). Among these terms, “carbonated beverages” was used as a MeSH term in PubMed. We screened the retrieved results for research articles, reviews, commentaries, and reports of public health strategies related to sugar-sweetened beverages. Based on existing evidence, several countries have worked to develop and implement strategies that focus on reducing the consumption of sugar-sweetened beverages through increasing marketing price, limiting its availability, and raising public awareness. These strategies included tax policies, public education through media and school, restricting the portion size and availability of sugar-sweetened beverages, and clear labelling. A meta-analysis of all quantitative studies showed that a 10% increase in the price of sugar-sweetened beverages would lead to reduction of about 13% in sugar-sweetened beverage demand, based on the experience of several countries including France, several US states, and Mexico. Other studies have modelled the risks and benefits of substituting sugars added to sugar-sweetened beverages with non-caloric sweeteners. However, we did not identify any studies in which a strategy to gradually reduce sugars added to sugar-sweetened beverages was proposed and systematically assessed with respect to its effect on weight status.
Added value of this study
To our knowledge, our study is the first to propose and assess an innovative strategy for the gradual and stepwise reduction of free sugars added to sugar-sweetened beverages. Our findings suggest that this approach could potentially lead to an effective and sustainable reduction in population energy intake and bodyweight, which would in turn reduce the prevalence of obesity and obesity-related diseases nationwide and lead to cost savings. The previous success of a similar strategy to reduce salt intake suggests that this approach should be both feasible and effective.
Implications of all the available evidence
A systematic and gradual reduction in free sugars added to sugar-sweetened beverages by 40% over 5 years is a feasible and potentially important public health strategy, which could be implemented immediately. The proposed strategy could be used in combination with other approaches for the reduction of sugar-sweetened beverage consumption, such as tax policies, to produce a more powerful effect.