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Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health

28 / 08 / 19

Finding: There are effective, scalable interventions addressing population sugar sweetened beverages (SSB) consumption.

Summary: This intervention review aimed to assess the effects of environmental interventions (not taxation) on the consumption of sugar sweetened beverages (SSB) and sugar-sweetened milk. Researchers identified 58 studies and they included children, teenagers and adults and in a variety of settings including schools, retail and food service. Most studies were judged to be at high or unclear risk of bias in at least one domain and most were non-randomised. Results were as follows:

Labelling interventions (8 studies). For decreased SSB sales, Traffic Light Labelling has moderate certainty evidence, nutritional rating score has low-certainty evidence, and menu-board labelling has variable effects.

Nutrition standards in public institutions (16 studies). There is low-certainty evidence that: reduced availability in schools is associated with decreased consumption; improved availability of drinking water and fruit programs in schools is associated with decreased SSB consumption; and variable results of increasing availability of school drinking water and body weight.

Economic tools (7 studies). Moderate certainty evidence that price increases on SSBs are associated with decreased consumption of SSBs. Discounts on low-calorie beverages has varied results on sales.

Whole food supply interventions (3 studies). Associations between voluntary industry initiatives to improve whole supply and SSB sales varied.

Retail and food service interventions (7 studies). There was low certainty evidence that healthier beverages with children’s meals in chain restaurants is associated with decreasing SSB sales, and low-certainty evidence that and urban planning restrictions on fast food restaurants and restricted sales of SSB in remote stores is associated with decreasing sales. There was moderate certainty evidence that promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. Vending machine promotion of healthier beverages had varied effects on SSB sales.

Intersectoral approaches (8 studies) There was moderate certainty evidence that government food programs with SSB purchasing restrictions are associated with decreased SSB intake. Evidence was also moderate certainty that multicomponent community campaigns to reduce SSB are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.

Home-based interventions (7 studies): there is moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity with a high baseline consumption of SSBs.

Adverse outcomes reported included: decreased revenue, compensatory consumption of SSBs outside school, reduced milk intake, stakeholder discontent, and increased total energy content of food purchases when low-calorie drinks were discounted. There was low-certainty evidence that improved placement of plain milk is not associated with decreasing sugar sweetened milk consumption.

Citation: von Philipsborn P, Stratil JM, Burns J et al. 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. DOI: 10.1002/14651858.CD012292.pub2. (free to view)