Banning the sale of sugar-sweetened beverages (SSBs) at the University of California at San Francisco was associated with an overall reduction in the intake of sweetened beverages as well as significant reductions in waist circumferences of university employees who regularly drink beverages with added sugar, a study in JAMA Internal Medicine reports.1
Employees at risk for obesity also had improvements in waist circumference when a brief motivational intervention was employed, suggesting the combination of motivational interventions and restricting access to SSBs could be helpful in improving health outcomes.
SSBs contribute to approximately 34% of added sugar in the American diet.2 Some experts believe legislation restricting access to SSBs may curtail this high and increasing “empty” energy intake, thereby reducing rates of obesity and the burden that the disease places on the healthcare system in the United States.
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The study examined 214 full-time university employees who reported high intake of SSBs (ie, ≥360 mL [≥12 fl oz] per day) before and after the ban of SSBs in their workplace. Of these employees, 109 were randomly assigned to a brief motivational intervention designed to target SSB intake. Investigators assessed changes in the intake of SSBs as well as changes in waist circumference. At baseline, the mean body mass index (BMI) in the overall cohort was 29.4. Additionally, participants reported a mean daily intake of 1050 mL (35 fl oz) of SSBs.
Six months after the sales ban, participants reported a 48.6% reduction in SSB intake (1050 mL to 540 mL, respectively; P <.001). This reduction was similar at 12 months. The changes in beverage intake were also associated with improvements in the Homeostatic Model Assessment of Insulin Resistance (r = 0.16; P =.03) and insulin (r = 0.16; P =.04). Participants in the high BMI group (BMI >25) had the greatest improvements in Homeostatic Model Assessment of Insulin Resistance (r = 0.24; P =.01) and insulin (r = 0.21; P =.03).
During the study period, there was also a 2.1-cm (t = 5.61; P <.001) decrease in mean waist circumference and a 0.4-cm (t = 2.36; P =.01) decrease in sagittal diameter. Participants exposed to the sales ban as well as the brief motivational intervention had an additional 369.0-mL (12.3 fl oz) reduction in daily SSB intake (F4,177 =71.37; P <.001). A greater reduction in SSB intake was observed in employees exposed to the sales ban and intervention program vs those exposed to the sales ban alone (reduction of 762.0 mL vs 246.0 mL, respectively; t = −4.37; P <.001).
Limitations of the study include the lack of an external control institution without a sales ban as well as the reliance on self-reported intakes of SSBs.
While enacting sales bans in the workplace appears effective for reducing the intake of sugar and improving specific health parameters, “contractual arrangements with beverage companies may pose obstacles to implementing workplace [SSB] sales bans.”
References
1. Epel ES, Hartman A, Jacobs LM, et al. Association of a workplace sales ban on sugar-sweetened beverages with employee consumption of sugar-sweetened beverages and health [published online October 28, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.4434.
2. Drewnowski A, Rehm CD. Consumption of added sugars among US children and adults by food purchase location and food source. Am J Clin Nutr. 2014;100(3):901-907.
