Sweet Surrender? Trimming Sweetness from Sugary Drinks May Cut Obesity-Related Diseases

Gradually removing sugar from sweetened beverages and allowing people’s taste perception to change accordingly over several years could help with weight loss on a large scale and stave off hundreds of thousands of type 2 diabetes cases in the decades following the effort, according to estimates from a UK modeling study.

Pointing to the success of a similar program aimed at reducing salt content in foods in the United Kingdom, study author Graham MacGregor, MD, of Queen Mary University of London, told TCTMD that the sugar initiative is “very practical and could be done quite easily.”

Although other efforts, such as taxing sugar-sweetened beverages, cutting sugar content in other foods, and placing restrictions on marketing, are needed to combat obesity, “the reformulation as exemplified in this paper is one of the most important strategies,” said MacGregor, who is chairman of the nongovernmental organizations Action on Sugar and World Action on Salt & Health.

Consumption of sugar-sweetened beverages, which has been tied to obesity and related diseases like type 2 diabetes, is a growing problem in most of the world. To combat the health effects, Action on Sugar has proposed a plan that would gradually reduce the amount of free sugar in sugar-sweetened beverages by 40% by 2020, without replacing it with artificial sweeteners. That would be accompanied by a parallel reduction in artificial sweeteners in other drinks.

As reported online this week in The Lancet Diabetes and Endocrinology, MacGregor and colleagues used nationally representative data from the National Diet and Nutrition Survey rolling program and information from British Soft Drinks Association annual reports to calculate sugar-sweetened beverage consumption in the UK population and then estimated the effects of the sugar reduction strategy.

They calculated that a 40% reduction in free sugar in sugar-sweetened beverages over 5 years would lower daily energy intake by an average of 38.4 kcal and steady-state body weight by 1.2 kg (2.65 lbs) among adults. That would translate into 500,000 fewer adults being overweight and 1 million fewer being obese and the prevention of 274,000 to 309,000 incident cases of obesity-related type 2 diabetes over the course of 2 decades.

The predicted effects were greater in adolescents, young adults, and individuals from low-income households, who typically consume higher amounts of sugar-sweetened beverages.

“These findings provide strong support for the implementation of the proposed strategy,” the authors write. “Individuals should also reduce their consumption of sugar-sweetened beverages in the long term, but this can be difficult because of the advertising power of industry.”

Why This Could Work

The proposed reduction in sugar content has several advantages, according to the authors.

First, sugar taste preference has been shown to be modifiable over a short period of time, so removing sugar from beverages is not likely to influence consumers’ choices, they say. Second, cutting calories from sugar will not likely increase energy intake from other sources, which is “supported by the fact that reducing salt in processed food did not increase the use of table salt.”

“Third, a reduction of sugar added to sugar-sweetened beverages will have little effect on the cost and price of the product and therefore is unlikely to affect sales and profits for the soft drink industry, meaning it could be seen as an attractive prospect politically,” the authors argue. And finally, they say, the strategy “would change the environmental determinants of obesity and will benefit all consumers of sugar-sweetened soft drinks….”

To be successful, the initiative should provide clear targets to ensure a level playing field for all manufacturers, should be overseen by an independent agency charged with guaranteeing compliance, and should involve close collaboration between industry, the government, nongovernmental organizations, and health professionals,” they say.

The proposal seems to offer the “perfect combination” of having an effect on population groups most at risk without having a major effect on commercial activity, Tim Lobstein, PhD, of the World Obesity Federation in London and Curtin University (Perth, Australia), writes in an accompanying comment.

“A gradual reduction in the sugar content of soft drinks, without replacing them with artificial sweeteners, should have a small but important effect on the prevalence of obesity, especially if there is no compensatory increase in calories consumed from other sources,” he says. “Soft drinks are consumed in the greatest quantities by population groups with a higher prevalence of obesity and diabetes. And reducing the sugar content gradually should have little effect on soft drinks sales, and indeed might save the producers some of their ingredient costs.”

He notes that there are some caveats to the study’s findings, including the fact that the models were based on the assumption that the same quantities of beverages would be consumed with other dietary changes to compensate after the sugar reduction, as well as the use of a survey that is known to have problems with underreporting consumption.

Nevertheless, he adds, “such modeling is probably the best we can expect for the available data, and it brings a very positive message to policy makers.”

He concludes by saying that combining a reduction in sugar in beverages with taxation and marketing restrictions “could have a substantially greater effect on sugar consumption than in isolation, bringing even greater relief to the over-stretched budgets of the UK’s health services.”

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Sources: 
1. Ma Y, He FJ, Yin Y, et al. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study. Lancet Diabetes Endocrinol. 2016;Epub ahead of print.
2. Lobstein T. Sugar: a shove to industry rather than a nudge to consumers [comment]? Lancet Diabetes Endocrinol. 2016;Epub ahead of print.

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