The Obesity Society Recommends Reduced Consumption of SSBs as a Strategy to Reduce Total Daily Caloric Intake
The Obesity Society recognizes that weight gain is a multi-determined phenomenon that rises beyond both calories consumed and any single calorie source. We encourage policy makers, scientists, clinicians and the public to look at overall caloric density of a wide range of food sources in seeking solutions to reduce total calories consumed by individuals and across the population. However, we also recognize, based on the available evidence, that SSBs may be a significant contributor to total energy consumption for some individuals. We further note that these are a topic of policy discussion. As such we offer the following guidance based on the available evidence regarding SSBs.
Statement of the Problem
Sugar-sweetened beverages (SSBs), including soda, sports drinks, and other types of beverages, are made up primarily of water and added sugar.1 Americans report that SSBs comprise 6-7% of overall calorie intake.1 Policy efforts to reduce consumption of SSBs, such as the effort by the New York City Health Department to limit portion sizes of SSBs, are controversial because of the role of government in shaping dietary choices and also because scientists debate over how much SSBs contribute to the epidemic of obesity in the U.S.
What is the Evidence?
There is good evidence from population-based studies for the hypothesis that increasing SSB consumption increases body weight.2 The strongest evidence characterizing the relationship between SSB consumption and body weight comes from randomized trials, where two groups of people with the same baseline characteristics are randomly assigned to one treatment or another, or in which the same participants are exposed to different test conditions in random order.3
In children, the largest randomized trial (641 participants) observed that children who drank one sweetened drink per day for 18 months gained more weight than children who drank one unsweetened drink per day, with both groups blinded to what they were drinking.4 Two other randomized trials in children and adolescents found that reducing SSB consumption reduced weight during the one-year intervention but not after two years (1 year after the intervention ended).
In adults, several randomized trials show that increasing consumption of SSBs does increase weight. Results involving reduction of SSB consumption and body weight in adults are mixed and to date inconclusive. Overall, the effect of SSB consumption on body weight is small, even though it is statistically significant in many studies. This is likely because most individuals who consume SSBs do not consume enough calories per day from SSBs alone to cause weight gain (or to cause weight loss if the only change they make in their diet is to stop drinking SSBs). Several studies suggest that unhealthy lifestyle behaviors tend to cluster (such as consuming high calorie foods, smoking, and physical inactivity), making it difficult to identify the effect of a single component.2
In adults, short-term trials done in laboratory settings suggest that calories from liquids may predispose to weight gain more than calories from solid food. Individuals might not decrease their usual energy consumption to counter the effect of increasing calories from liquids. In one small trial (15 participants), participants consumed 450 extra calories per day from either solid sugar (jelly beans) or a liquid sugar load (SSB) for 4 weeks and then, after a 4 week “washout” period, they consumed the other form for 4 weeks.5 The study reported that participants ate more calories during the period where they consumed liquid sugar than during the period that they consumed solid sugar. However, there was no significant difference in body weight between the two conditions, suggesting that the difference in calorie intake was small.
- The scientific evidence is suggestive, but not definitive, that SSBs contribute to the epidemic of obesity in the U.S. The effects seem strongest in children. In general, weight gain occurs when total energy intake exceeds energy expenditure for extended periods of time. The Obesity Society recommends that individuals affected by obesity or overweight reduce consumption of SSBs as part of a more general effort to reduce total daily calorie intake and increase physical activity to help control weight.
- The Obesity Society joins with the American Medical Association, American Association of Pediatrics, Centers for Disease Control, and Institute of Medicine in recommending that individuals decrease consumption of, or avoid, SSBs.
- The Obesity Society supports national efforts to increase the consumption of water, a readily accessible, calorie free and healthy alternative to SSBs that also contains fluoride needed for oral health.
- The Obesity Society recommends that children minimize SSB intake.
- Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States. Am J Clin Nutr. Sep 2011;94(3):726-734.
- Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. Aug 21 2013.
- Kaiser KA, Shikany JM, Keating KD, Allison DB. Will reducing sugar-sweetened beverage consumption reduce obesity? Evidence supporting conjecture is strong, but evidence when testing effect is weak. Obes Rev. 2013;14(8):620-633.
- de Ruyter JC, Olthof MR, Seidell JC, Katan MB. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012;367(15):1397-1406.
- DiMeglio DP, Mattes RD. Liquid versus solid carbohydrate: effects on food intake and body weight. Int J Obes Relat Metab Disord. 2000;24(6):794-800.