Obesity affects nearly 40% of US adults and may contribute to a gamut of other medical issues like cardiovascular disease, type 2 diabetes, and cancer. One of the most significant contributors to the obesity epidemic is the consumption of sugar-sweetened beverages (SSBs) at higher than recommended levels. These levels are especially high among non-Hispanic black and Hispanic populations, as well as among those with lower educational attainment and income. As part of national efforts to reduce the incidence of obesity, policymakers have proposed including health warnings on SSBs like those used on cigarette packaging. A recent study published in the American Journal of Preventive Medicine used a simulation model to project possible effects of such a policy on the body weight and dietary behaviors of US adults.

The researchers used a stochastic microsimulation model to represent individuals and assessed obesity outcomes for 5 years. The model simulated the varying demographic characteristics of US adults. Each simulated individual was assigned an age group, race/ethnicity, educational background, and income level. Each was also assigned a baseline height, weight, and SSB intake using data from the National Health and Nutrition Examination Survey Cycles from 2005 to 2014. The SSBs themselves were defined as nondiet, nonalcoholic beverages with added sugars at a level ≤5 calories/100 grams.

During the study, the model represented 2 scenarios: a “policy” scenario where simulated individuals experienced a national health warning for SSBs and a “status quo” scenario, assuming that no such warning policy was experienced by the individuals. The model used the National Institutes of Health validated model of weight change dynamics, and individuals’ body mass index and obesity status were calculated using baseline height. During statistical analysis of the data, sensitivity analyses examined 3 main parameters of the model: warning efficacy over time, magnitude of warnings’ impact on SSB intake, and caloric compensation.

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Analysis of the simulated data showed that by implementing a national policy for health warnings on SSBs, energy intake would be reduced by 25.3 calories per day, for a total energy intake reduction of 31.2 calories per day. Assuming this reduction continues over time, the average body mass index at the end of a 5-year period would be 0.64 kg/m2 lower for policy model individuals. Overall, there would be a 3.1% reduction in obesity prevalence in US adults. These reductions were seen across all demographic groups, with obesity prevalence reduction most apparent in black adults and Hispanic adults when compared with white adults. Adults with lower income and a lower education level also displayed larger reductions in obesity prevalence. Results when assuming that warnings would reduce SSB intake by 14.8% decreased obesity prevalence further, and a 22.4% intake reduction showed an even greater decrease.

The researchers acknowledge that the study was limited by the simplifier nature of microsimulations, as well as by the use of one-way sensitivity analyses. Additionally, the model was unable to incorporate data on the impact of the warning on social behaviors and interactions with other policies or on the creation of tandem policies like taxes on SSBs.

The need for policies addressing SSB overconsumption has grown in concordance with increased rates of obesity and obesity-related conditions among US adults. Implementing warning labels is a possible strategy for addressing this issue. Through the use of large and prominent warning labels, the researchers argue that SSB consumption rates could decrease and lead to an overall reduction in rates of obesity and obesity-related conditions among US adults.


Grummon A, Smith NR, Golden SD, Frerichs L, Tallie LS, Brewer NT. Health warnings on sugar-sweetened beverages: simulation of impacts on diet and obesity among US adults [published online October 15, 2019]. Am J Prev Med. doi:10.1016/j.amepre.2019.06.022.