June 12, 2019

expert reaction to new cochrane review assessing evidence on ways to reduce sugary drinks consumption

Reactions to a review published in the Cochrane Database of Systematic Reviews that summarizes evidence from research studies testing different ways of reducing consumption of sugary drinks at a population level.

Dr Amelia Lake, Reader in Public Health Nutrition, Teesside University, said:

“This is a high quality review of the available evidence (from peer review published studies) around different ways to reduce consumption of sugar sweetened beverages – but it excludes taxation (e.g. UK sugar sweetened beverages (SSB) levy).  The authors, through a rigorous method found 58 peer reviewed publications which they use to synthesis their recommendations.  However it’s important to remember than this is reviewing the existing published evidence.  It’s limited by the studies that have been carried out and those that have been published.

“Why are we so interested in Sugar Sweetened Beverages (SSB)?  Drinking SSB is a risk  factor for obesity, type 2 diabetes, cardiovascular disease and dental caries.  At population level, we need to make changes to help decrease the risk of these chronic conditions which affect the quality of our lives and also place a heavy burden on our health system.

“This review explores the environmental factors which may influence consumption of these drinks (e.g. traffic light labelling).  They have produced a list of interventions – for which there is some evidence – that will help reduce consumption of these drinks.  However they acknowledge some of the studies are considered lower quality – perhaps they don’t have a control or it was a poorly reported study.  The take home message from this review is that there are methods – in addition to the sugar levy – to change the environment to reduce our consumption of these SSB.  The interventions that the review found evidence to support included:

Comprehensive labels e.g. traffic light labelling.

Reducing the availability of SSB in schools (e.g. replacing SSBs with water in school canteens).

Price increases on SSBs in restaurants, shops and leisure centres.

Children’s menus in chain restaurants which include healthier beverages as their standard beverage (changing the default).

Promotion of healthier beverages in supermarkets.

Government food benefits (e.g. food stamps) which cannot be used to buy SSBs.

Community campaigns focused on SSBs.

Measures that improve the availability of low-calorie beverages at home, e.g. through home deliveries of bottled water and diet beverages.

“An obvious intervention that you might expect is what about advertising and marketing regulation of these drinks?  The authors state that there were no studies that met their inclusion criteria for this topic.  It points to the need for research, particularly evaluation of interventions that restrict the marketing and advertising of these drinks which we know happens on many platforms including social media.

“This review gives further tools to policy to implement environmental changes that shape our food environment into a healthier one and will help contribute to better health for the whole population.”

Dr Anna Macready, Lecturer in Consumer Behaviour and Marketing, University of Reading, said:

“Evidence suggests that effective, consistent and long term healthy behaviour change can best be achieved when environmental measures fully support those changes.  Whilst highlighting the challenges facing policy-makers and stakeholders in achieving key societal health benefits through a variety of means, this high quality review provides some evidence that environmental measures can be effective in a range of environmental settings and population groups, particularly those most at risk of developing non-communicable diseases as a result of high sugar intake.  However, as the authors point out, evaluation of the evidence is hampered by a lack of consistency in the context, design, reporting, follow-up and quality of the research carried out to date, particularly with respect to bias.  The key value of this review, therefore, is that it provides an excellent framework and consensus for the design, planning, reporting and evaluation of future research in this area.”

Dr James Doidge, Senior Research Associate, UCL, said:

“Cochrane reviews provide some of the most valuable, fair and transparent summaries of the available evidence on many health interventions.  While this review provides useful insights into environmental measures that could be implemented to reduce consumption of sugary drinks, one really interesting question is how these measures stack up against the taxes that are currently being implemented or considered by many governments.  Unfortunately, taxation measures are to be covered by a separate review.  Nor does this review compare the effectiveness of methods targeting consumption of sugary drinks with other ways of tackling obesity, for which sugary drinks are only part of the story.

“One thing the review does highlight is the paucity of research in this area, with available studies constituting only “low” or “moderate” certainty of evidence.  From this, the authors rightly conclude that further implementation of interventions should be accompanied by further evaluation of their effectiveness.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“This is a substantial and well considered body of work on a topic that is important and non-controversial as there is little need to consume sugar sweetened beverages in the modern day of abundant calorie-rich temptations in many forms.  Whilst the evidence base is not complete for all key suggestions to reduce consumption of sugary drinks, it is sufficiently strong to move ahead and push governments and other agencies to implement as many as possible and then monitor the changes.  The public has little to lose from these changes and much to gain.  Most people’s palates can be retrained to enjoy low calories drinks or water and so lessening the availability of sugar rich drinks makes complete sense.”

‘Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health (Review)’ by P von Philipsborn et al. was published by Cochrane at 11.00am UK time on Wednesday 12 June 2019.

Declared interests

Dr Amelia Lake: “Amelia is a dietitian and public health nutritionist.  She works as a Reader at Teesside University and is Associate Director for Fuse, The Centre for Translational Research.  I have no conflicts of interest.”

Dr James Doidge: “Nothing to declare.”

Prof Naveed Sattar: “No COI.”

None others received.