PORTLAND, OR — After a multipronged, 3-year community campaign to reduce the consumption of sugary drinks in Howard County, Maryland, supermarket sales of sodas dropped 20%, whereas sales remained flat in "control" supermarkets elsewhere, researchers report[1].

The Howard County Unsweetened campaign included television ads, social-media posts, projects by more than 50 community groups, and lobbying that led to passing state laws—all aimed at getting people, especially children and teenagers, to switch from sugary drinks to "better beverages."

"These findings support the hypothesis that community-based interventions aimed at changing attitudes and access to sugary drinks through policies can meaningfully influence purchasing behavior at the supermarket," Dr Marlene B Schwartz (University of Connecticut, Hartford) and colleagues report in their study published online March 6, 2017 in JAMA Internal Medicine.

This type of community effort is needed to change health policies and reduce the consumption of sugary drinks, especially by adolescents, Dr Lawrence J Appel (Johns Hopkins Medical Institutions, Baltimore, Maryland) told heartwire from Medscape after he presented the study findings in a "hot-off-the-press" session March 9, 2017 at the EPI|LIFESTYLE 2017 Scientific Sessions.

"The point at which the obesity epidemic takes off, particularly in girls," is in adolescence, and, on average, adolescents in the US obtain 200 to 300 calories a day from sugar-sweetened beverages, he noted. "Given the scale of the obesity epidemic . . . I think this [public-health] effort—I'm not saying ours is perfect; it's more expensive than a taxation approach—is the way to go," he said.

"The consumption of sugary beverages is a serious problem in the United States that is associated with obesity, diabetes, and cardiovascular disease," JAMA Internal Medicine deputy editor Dr Mitchell H Katz (Los Angeles County Department of Health Services, California) writes in an editorial note that accompanies the study[2].

"These authors demonstrate the value of a well-performed evaluation of an important public-health intervention."

"It's a formal intervention and it gets further away from some of the [less rigorous] observational interventions and shows that a multifaceted aggressive intervention can reduce sales of sugar-sweetened beverages." session comoderator Dr Elizabeth Selvin (Johns Hopkins University, Baltimore, Maryland), who was not involved with the study, echoed in a comment to heartwire .

Session comoderator Dr Pamela Lutsey (University of Minnesota, Minneapolis) agreed that the 20% drop in the consumption of sugary drinks was "impressive."

Complex Campaign to Get People to Switch to "Better Beverages"

In 2012, the Horizon Foundation and several community partners planned this multicomponent Howard County Unsweetened campaign to encourage people to move away from sugary drinks—notably soda, sports drinks, and fruit drinks—although sweetened flavored waters, iced or hot tea, and coffee were mentioned in some publicity materials.

Instead, people were encouraged to switch to "better beverages" such as bottled water, tap water, spa water (tap water flavored with fruit or vegetable slices), or possibly unsweetened tea or small portions of 100% fruit juice. Diet soda was not part of the campaign but was listed as a better beverage in the online tool.

The 3-year campaign (in 2013 through 2015) included the following components, among others:

  • The educational component included television ads, outdoor billboards, direct mail, and Twitter, Facebook, and YouTube posts, and a Better Beverage Finder online tool that lists hundreds of brands of unsweetened beverages.

  • Forty providers (in 13 practices) participated in an American Academy of Pediatrics collaborative to improve practice behaviors related to childhood obesity.

  • Professional marketers set up booths at community events such as sporting events and distributed healthy drinks.

  • The Better Choices Coalition of 50 community organizations collaborated in diverse efforts such as improving vending-machine choices and educating their members.

  • A contest was held for youths to produce the best documentary about sugary drinks.

  • Campaign members were successful in getting laws passed that removed student-accessible vending machines in middle schools; required that food sold in schools meet national nutrition standards; and required that childcare facilities serve beverages such as water, plain or low-fat milk, or small sizes of 100% fruit juice.

Schwartz and colleagues then examined sales of 13 brands of regular soda, two brands of sports drink, seven brands of diet soda, four brands of 100% fruit juice, and six brands of fruit drinks (all top-selling brands), in total fluid ounces sold per product, per week, in 15 supermarkets in Howard county vs 17 supermarkets in Pennsylvania—in 2012 and in 2015.

The intervention resulted in a significant decrease in sales of regular soda and fruit drinks. Sales of sports drinks decreased but this was not significant. Sales of 100% juice also dropped significantly, possibly due to choosing smaller drink sizes. Sales of diet soda did not increase, suggesting that people were not switching from regular soda to diet soda.

Changes in Sales of Beverages From 2012 to 2015

Beverage % Change in Volume Sold in Intervention Supermarkets % Change in Volume sold in Comparison Supermarkets Difference in Volume P
Regular soda* -19.7 0.8 -369 <0.001
Sports drinks* -25.1 -7.9 -86.3 0.51
Fruit drinks* -15.3 -0.6 -343.2 <0.001
Diet soda -17.8 -11.3 -78.9 NS
100% fruit juice -15.0 -2.1 -575.6 <0.001
*Sugary drinks=regular soda, sports drinks, or fruit drinks
Volume=Fluid ounces per beverage type per store per week

Study limitations include that it looked only at supermarket sales of sugary drinks, which account for only half of these sales, and missed sales at fast-food or other restaurants, vending machines, convenience stores, or retailers such as Walmart.

The studied county is also wealthier, more ethnically diverse, and more highly educated than the comparison counties.

Nevertheless, this intervention can be used as a "road map for other communities to reduce consumption of sugary drinks," Schwartz and colleagues conclude.

"Other communities should implement similar programs," Katz agrees.

The legislative changes that resulted from the work of community coalitions and an especially active public-health policy advocate probably had the most impact out of the many aspects of this campaign, Appel speculated to heartwire .

The study was supported by grants from the Horizon Foundation, the Robert Wood Johnson Foundation, and the Rudd Foundation. Appel reports serving on the board of directors of the Horizon Foundation. The disclosures of the other authors are listed with the article.

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