Consumption of sugary drinks is considered to be a key driver behind the global obesity epidemic, and is linked with tooth decay, diabetes and heart disease. Many public health bodies including the World Health Organization (WHO) have called upon governments, the food and drink industry, educational institutions, places of work and civil society to support healthier beverage choices.
This new Cochrane Review summarizes evidence from research studies testing different ways of reducing consumption of sugary drinks at a population level. A team of researchers from Germany and the UK looked at the results from 58 studies that assessed a range of approaches and strategies aimed at changing the physical or social environment where people consume or buy sugary drinks. The studies were done in a variety of settings, including schools, cafes, restaurants, homes, and retail outlets. The studies assessed a wide range of different approaches to reduce consumption such as labelling and pricing of sugar sweetened drinks and healthy alternatives. They also looked at broader policy initiatives such as community-based campaigns to encourage healthier choices. The studies were conducted in 19 different countries from North and South America, Australasia and Europe and South East Asia.
Within the broad categories of interventions studied, (labelling, nutrition standards, price increases and subsidies, home-based interventions, interventions aimed at the whole food supply, retail and food services, and intersectoral approaches such as food benefit programs and trade and investment policies), the certainty of the evidence for specific measures ranged from very low to moderate.
The review authors identified a number of measures which the available scientific evidence indicates reduces the amount of sugary drinks people drink. These measures included:
- Labels that are easy to understand, such as 'traffic-light' labels, and labels that rate the healthiness of beverages with stars or numbers.
- Limits to the availability of sugary drinks in schools.
- Price increases on sugary drinks in restaurants, stores and leisure centres.
- Children's menus in chain restaurants which include healthier beverages instead of sugary drinks as the default.
- Promotion and better placement of healthier beverages in supermarkets.
- Government food benefits (e.g. food stamps) which cannot be used to purchase sugary drinks.
- Community campaigns focused on supporting healthy beverage choices.
- Measures that improve the availability of low-calorie beverages at home, e.g. through home deliveries of bottled water and diet beverages.
The Cochrane authors also found evidence that improved availability of drinking water and diet beverages at home can help people lose weight. There are also other measures which may influence how much sugary drinks people drink, but for these the available evidence is less certain.
Past research has shown that health education and taxation of sugar-sweetened beverages can also help to reduce their consumption, but these approaches were not examined in the current review. Taxation of sugary drinks, unprocessed sugar and sugar-added foods will be examined in two future Cochrane Reviews.
Review author Hans Hauner, Professor of Nutritional Medicine at Technical University Munich, Germany, and a world-leading expert in the field, commented: "Rates of obesity and diabetes are rising globally, and this trend will not be reversed without broad and effective action. 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 to accomplish this."
Review author Eva Rehfuess, Professor of Public Health and Health Services Research at LMU Munich, Germany, adds: "This review highlights essential building blocks for a comprehensive strategy to support healthy beverage choices for the whole population. However, we need to do more work to understand what works best in specific settings, such as schools and workplaces, for people of different socio-economic and cultural backgrounds, and in countries at different levels of economic development. This would help us to improve existing approaches further. Policy-makers and practitioners who implement such measures should therefore cooperate with researchers to allow for high-quality evaluations."
Review lead author Peter von Philipsborn, Research Associate at LMU Munich, Germany, said: "Sugary drinks are a global problem, and middle-income countries such as South Africa, Mexico and Brazil are particularly affected. The measures highlighted in this review should be considered by policy-makers worldwide."
This Cochrane Review from Cochrane Public Health was conducted by researchers affiliated with the Institute of Medical Information Processing, Biometry and Epidemiology at the Pettenkofer School of Public Health at the LMU Munich, the Technical University Munich, and University College London.
Full Citation: Von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD012292. https:/
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