A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

By C. Ebbeling, H. Feldman, V. Chomitz, T. A. Antonelli, S. Gortmaker, S. Osganian, D. Ludwig. New England Journal of Medicine, 2012

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BACKGROUND Consumption of sugar-sweetened beverages may cause excessive weight gain. We aimed to assess the effect on weight gain of an intervention that included the provision of noncaloric beverages at home for overweight and obese adolescents. METHODS We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention. We hypothesized that the experimental group would gain weight at a slower rate than the control group. RESULTS Retention rates were 97% at 1 year and 93% at 2 years. Reported consumption of sugar-sweetened beverages was similar at baseline in the experimental and control groups (1.7 servings per day), declined to nearly 0 in the experimental group at 1 year, and remained lower in the experimental group than in the control group at 2 years. The primary outcome, the change in mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) at 2 years, did not differ significantly between the two groups (change in experimental group minus change in control group, −0.3; P = 0.46). At 1 year, however, there were significant between-group differences for changes in BMI (−0.57, P = 0.045) and weight (−1.9 kg, P = 0.04). We found evidence of effect modification according to ethnic group at 1 year (P = 0.04) and 2 years (P = 0.01). In a prespecified analysis according to ethnic group, among Hispanic participants (27 in the experimental group and 19 in the control group), there was a significant between-group difference in the change in BMI at 1 year (−1.79, P = 0.007) and 2 years (−2.35, P = 0.01), but not among non-Hispanic participants (P>0.35 at years 1 and 2). The change in body fat as a percentage of total weight did not differ significantly between groups at 2 years (−0.5%, P = 0.40). There were no adverse events related to study participation. CONCLUSIONS Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up (the prespecified primary outcome). (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; ClinicalTrials.gov number, NCT00381160.)

Subfields: Endocrinology, Diabetes and Metabolism, Physiology, Public Health, Environmental and Occupational Health

View Paper: https://www.semanticscholar.org/paper/d172656e4f674c9bfb84a312310009be49fda634

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Citations in the corpus

Should We Tax Sugar-Sweetened Beverages? An Overview of Theory and Evidence (2019, background): “Randomized trials with children and adolescents find that substituting diet drinks for sugar-sweetened beverages for 12 to 18 months reduces weight by 2 to 4 pounds (de Ruyter et al. 2012; Ebbeling et al. 2012).”
Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. (2017, positive): “This lack of compensation may partly explain the reduced weight gain associated with nonsweetened drinks (115, 167).”
Role of Dietary Fructose and Hepatic de novo Lipogenesis in Fatty Liver Disease (2016, background): “Increased consumption of sugar-sweetened beverages is linked with development and progression of NAFLD, but also it is associated with development of obesity [15], type 2 diabetes mellitus [16, 17], dyslipidemia [18], and cardiovascular disease [19].”
Pro v Con Debate: Role of sugar sweetened beverages in obesity Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases (2013, neutral): “(33) randomly assigned 224 overweight and obese adolescents who regularly consumed SSBs to intervention and control groups.”
Propensity Score Weighting for Causal Inference with Clustered Data (2017, background): “Early studies have shown that SBMIS has been associated with increased parental awareness of child weight [66, 67].”
A Framework for Assessing Effects of the Food System (2015, background): “For example, individual studies and systematic analysis have found strong associations between eating an excess amount of sugar and weight gain (de Ruyter et al., 2012; Ebbeling et al., 2012; Malik et al., 2013; Perez-Morales et al., 2013; USDA and HHS, 2010b).”
Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. (2013, methodology): “This study (48), along with the recent RCT by Ebbeling et al (64), examined the sustained effects of their interventions on body weight at 2 and 1 y postintervention, respectively.”