New Clinical Decisions: Regulation of Sugar-Sweetened Beverages

Posted by Karen Buckley • September 24th, 2012

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Our latest Clinical Decisions presents the brief fictional vignette of a 12-year-old girl named Meredith, who has no history of medical illness and does not engage in regular physical activity, other than her school gym class, which lasts 30 minutes twice a week.  She is in the 87th percentile for body mass index (BMI) for her age group, and is therefore overweight.

Two experts in the field consider patients like Meredith when making arguments for and against the broader issue at hand, which has been a regular topic in the news recently, and the subject of three new studies presented at The Obesity Society meeting and published on Friday on NEJM.org.   Should we regulate sugar-sweetened beverages (SSBs)?

Dr. Thomas Farley from the New York City Department of Health and Hygiene supports regulation, saying we need a “food environment” that does not entice children into drinking sugary drinks in school or on the way home.  Drs. David Just and Brian Wansink from Cornell University argue against regulation, citing three potential pitfalls, and making suggestions for other ways to curb childhood obesity.

Which approach do you support? Base your choice on the experts’ essays, published literature, your own experience, recent guidelines, and other sources of information.  Vote and comment on your choice on NEJM.org.

The recently-published research includes a study from Qi et al. that examined the influence of SSB  intake on BMI and obesity risk. A genetic predisposition to adiposity appeared more pronounced with greater consumption of SSBs.  De Ruyter et al. conducted a randomized trial in normal-weight children in which they provided a daily sugar-free artificially sweetened drink, or a similar tasting sugar-containing drink.  The sugar-free group had less weight gain and fat accumulation over the 18-month study period.  And, a randomized trial from Ebbeling et al. assigned overweight and obese adolescents to a one-year intervention designed to decrease consumption of SSBs or routine care, with follow-up for an additional year. BMI increased less in the intervention group after a one-year intervention, but not at the two-year follow-up.

An editorial from Dr. Sonia Caprio at Yale School of Medicine comments on all three studies.

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