Modeling the Effect of Replacing Sugar-Sweetened Beverage Consumption with Water on Energy Intake, HBI Score, and Obesity Prevalence

Abstract

Sugar-sweetened beverages (SSB) contribute to excessive weight gain through added energy intake. Replacing SSB with water is one strategy that has shown promise in helping lower excessive energy intake. Using nationally representative data from US adults (n = 19,718) from NHANES 2007-2012 we examine the impact of replacing SSB with water on Healthy Beverage Index (HBI) scores and obesity prevalence. Replacing an 8-ounce serving of SSB with water lowered the percent of energy from beverages from 17% to 11% (among those consuming 1 serving SSB/day). Reductions in the percent energy from beverages were observed across all SSB consumption groups (1-2 servings/day and >2 servings/day). Among adults there was a 9% to 21% improvement in HBI score when one serving of water replaced one serving of SSB. Using previously published randomized controlled trials (RCT) and meta-analyses of measured weight loss we also predicted a reduction in the prevalence of obesity (observed: 35.2%; predicted 33.5%-34.9%, p < 0.05) and increase in the prevalence of normal weight (observed: 29.7%; high weight loss: 31.3%, p < 0.05). Our findings provide further epidemiologic evidence that water in the place of SSB can be used as a strategy to limit energy intake and help individuals meet beverage intake recommendations.

Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies

“…A recent study modeled the effect of replacing one serving of SSB (∼0.25 l) with one serving of water and estimated a decrease of energy intake from beverages from 17 to 11%. Authors also predicted a reduction in the prevalence of obesity and an increase in the prevalence of normal weight [51], similar to those results found in the SUN cohort [52]. …”

Intakes and sources of total and added sugars among 4 to 13‐year‐old children in China, Mexico and the United States

“…The data presented in this paper highlight the heterogeneity of food patterns worldwide, and the need for adapted country‐specific public health recommendations. One example is to encourage caregivers and children to limit consumption of SSBs and to make water and low‐fat milk the preferred beverage choices . Our data suggest that while such measure is of prime importance in the United States and Mexico, its impact may be more moderate in countries such as China, where SSBs contribute to only a minor proportion of sugar intakes.…”

Change in drink purchases in 16 Australian recreation centres following a sugar-sweetened beverage reduction initiative: an observational study

“…Replacing just one can of SSB a day with water can significantly improve health and has been modelled to result in a modest but significant reduction in obesity rates 38. Extrapolation of the response to this policy to all sports and recreation facilities across Australia would lead to over 3.5 million fewer cans of SSB purchased per year.…”