Nutritively Sweetened Beverage Consumption and Obesity

Abstract

The prevalence of obesity has increased substantially in the past several decades, and clinicians, policy makers, and others seek tools to abate this epidemic. One tantalizingly simple solution is to identify a single class of foods for which the elimination or radical reduction would meaningfully decrease the energy intake/expenditure ratio and obesity prevalence. Nutritively sweetened beverages (NSBs) (eg, sugar-sweetened beverages, soft drinks) seem to have become a leading contender, and the surrounding dialogue has become contentious, evoking scientific, clinical, and sociopolitical questions.The key question is whether reducing NSB consumption will help prevent the onset, reduce the prevalence, or contribute to the management of obesity. The controversy hinges on the strength of the current evidence. Clearly there are other important issues, such as potential NSB effects on overall diet quality, dental and bone health, glucose tolerance, hydration, quality of life, the economy, and the environment. In this Commentary, we address only the obesity question. Plausibility That Reducing NSB Consumption Will Reduce ObesitySome epidemiological studies support an association between NSB consumption and obesity, 1 some animal studies have shown that ad libitum NSB consumption increases body weight, 2 and some short-term food intake studies suggest that NSB consumption may be poorly compensated (compensation here refers to the adjustment of subsequent energy intake or expenditure downward or upward in response to NSB ingestion; hence, its influence on overall energy balance). 3 However, other epidemiological, 4 animal, 5 and shortterm behavioral studies 6 do not show such results. The stage for evidence that can provide clearer answers has been set.For some questions, such as whether smoking causes lung cancer, it is impractical or unethical to randomize study participants to receive or not receive the putatively influential agent and observe its effects. In such situations, consideration of the totality of evidence is

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