Understanding the Consequences of Sugar-Sweetened Drinks

By: Saisha Sikka

BMJ2024;386:e079234 http://dx.doi.org/10.1136/ bmj-2024-079234

This study extensively examines global trends in the consumption of sugar-sweetened beverages (SSBs) among children and adolescents. Given the growing concerns around childhood obesity and related health issues, understanding the trends in SSB consumption is critical for informing public health strategies.

In 2018, the average global intake of SSBs among children and adolescents was 3.6 servings per week. However, this average masks significant regional variations. For instance, the lowest consumption was recorded in South Asia, where the average intake was just 1.3 servings per week. In contrast, Latin America and the Caribbean had the highest consumption, with an average of 9.1 servings per week.Given that our SSBs definition excluded sweetened milk, this could partially explain the low intakes observed in our study among the youngest age categories. 

The study found that SSB consumption generally increased with age, with adolescents (15-19 years old) consuming more than younger children. Additionally, SSB intake was typically higher in urban areas compared to rural areas and was more prevalent among children whose parents had higher levels of education. Thus, in Latin America and the Caribbean, south Asia, and sub-Saharan Africa, the largest intakes of SSBs in children and adolescents of parents with high and medium education in urban and rural areas in Latin America and the Caribbean (≥9 servings/week each). 

However, Intakes of SSBs by area of residence and education were inverted in the Middle East and North Africa, with larger intakes among children and adolescents from rural areas and of parents with lower parental education, and little variation was observed in other world regions. Between 1990 and 2005, increases in SSB intakes were observed in most regions, with the largest increase in high-income countries, except for South Asia, where little change was evident.  Over the nearly three decades covered by the study, there was a 23% increase in global SSB consumption. The most dramatic rise was seen in sub-Saharan Africa, where the intake more than doubled, showing a 106% increase.

In many high-income countries, SSB consumption had plateaued or even declined in some cases, reflecting the impact of public health campaigns and policy interventions. In contrast, low- and middle-income countries, particularly in Africa and Asia, saw significant increases, likely driven by economic development, urbanisation, and the aggressive marketing of SSBs.

The rising intake of SSBs is a major public health concern because of its strong association with obesity, type 2 diabetes, dental caries (tooth decay), and other chronic health conditions. There is an urgent need for effective public health policies to curb SSB consumption among young people. Potential strategies include implementing taxes on SSBs, restricting marketing targeted at children, mandating clearer labelling of sugar content, and promoting healthier beverage alternatives. The findings suggest that without intervention, the continued rise in SSB consumption, particularly in developing regions, could exacerbate the global burden of obesity and related diseases. Public health strategies must be tailored to specific regions and demographic groups, given the significant variations in consumption patterns.

In conclusion, this study provides a comprehensive overview of global SSB consumption trends among children and adolescents, revealing a worrying upward trend in many regions, especially in low- and middle-income countries. The data collected over nearly three decades show that while some high-income countries have managed to stabilize or reduce SSB intake through various public health measures, the global average continues to rise, driven by increasing consumption in developing regions.