Nothing beats the refreshing taste of a chilled bottle of Coca Cola on a hot summer’s day. However, a new study published in JAMA Internal Medicine might make you think twice before twisting the cap off of your favourite sweet beverage.
According to the 2012 report by the Institute of Medicine, a recommended strategy to prevent childhood obesity is for communities to “adopt policies and implement practices to reduce overconsumption of sugar-sweetened beverages”. Public health departments and nutrition advocates are devoting specific attention to the consumption of sugary drinks – any type of beverage that contains added sugar or nutritive sweetener – and correlations with obesity, type 2 diabetes, and cardiovascular risk.
The Centers for Disease Control and Prevention issued a guideline of strategies for communities to employ to promote the decline of sugary drink consumption, with an emphasis on the roles of policy and environmental changes in reducing access to sugary drinks and promoting water consumption. The guideline also recommends educating healthcare professionals about the harms associated with sugary drink consumption and how to screen patients for consumption. Communities have since responded to these recommendations by implanting campaigns to educate consumers and pass policies to limit access to sugary beverages in schools, child care centres, and government-owned properties; to place warning labels on packages; and to tax sugary beverages.
In Howard County, Maryland, a campaign to reduce the consumption of all sugary drinks through television advertising, digital marketing, direct mail, outdoor advertising, social media, and earned media during a 3-year period created 17 million impressions (views) and reached over 576,000 residents. The campaign specifically targeted drinks with any type of added sugar, and demonstrated a vivid contrast to the promoted “better beverages” (those lower in sugar and calories). In order to address all levels of the social ecological model, the promotion of healthy beverage consumption was also advocated at the interpersonal, organizational, community, and policy levels. Faith-based groups, businesses, the county school board, child care facilities, local government agencies, paediatricians, and the health care system were engaged via extensive community outreach.
To evaluate these community interventions, supermarket beverage sales data in Howard County was compared with sales from “comparison stores” in neighbouring American states before and during the 3-year campaign. 15 Howard County supermarkets were compared with 17 “control group” supermarkets in this observational experiment, which analyzed the weekly beverage sales data at baseline and from campaign years 1 to 3. The tracked sales included regular soda, sports drinks, fruit drinks, diet soda, sweetened flavour waters, sweetened teas, sweet hot beverages, and 100% juice. Statistical analysis compared the volume sales per product per week in both groups of stores, and controlled for mean product price, competitor’s product price, product size, weekly local temperature, and manufacturer.
The study revealed that regular supermarket soda sales of the top-selling 13 brands decreased by 19.7%, and fruit drink sales decreased by 15.3%, differing significantly from the relatively stable sales observed in the comparison stores. Similarly, juice sales decreased by 15.0%, a change significantly larger than control stores. Sales of sports drinks and diet soda decreased in both communities; however, the decreases were not significantly different between the Howard Country and the comparison groups.
The study’s results suggest that local, community-based efforts to decrease the consumption of sugar drinks are indeed a worthwhile investment of both time and money. The data also demonstrates that conducting statistical analyses of community interventions is feasible, and further research will facilitate the identification of the most cost-efficient policies to pursue. Conducting future studies in demographically diverse communities can help evaluate the disproportional changes that may occur among different socio-economic populations, which would have significant implications related to health equity.
This study highlights the importance of powerful community-based campaigns and media exposure to produce meaningful changes in the retail sales of soda and other beverages. It is important to also acknowledge the significant collaborative roles local organizations and government play in the establishment of strong policies to promote healthy beverage consumption. Locally-designed community-based education that focuses on harm reduction proves to have measurable effects on behaviour modification related to healthy beverage choices.
Written By: Jordyn Posluns, B.Sc. (Hons)