November 14, 2019

UCSF banned soda on campus 4 years ago. Did it work?

Daily Briefing

    A ban on sugary drink sales at the University of California, San Francisco (UCSF) was associated with a nearly 50% reduction in soda consumption among a select group of employees, according to a study by UCSF researchers published recently in JAMA.

    Cheat sheets: Evidence-based medicine 101

    The problem with sugary drinks

    Health experts say a variety of factors have contributed to the rise of obesity in the United States, but some have pointed to the country's 30% increase in added sugar consumption between 1977 and 2010 as a key driver. 

    According to researchers, much of this added sugar is consumed in the form of sugar-sweetened beverages.

    Now, employers, including 30 medical centers across the United States, are considering banning the sale of the beverages to improve employees' health. One of those employers is UCSF.

    Study details

    In 2015, UCSF banned the sale of sugary beverages on its campus, and a group of researchers set out to measure the impact of the ban.

    The study was funded by the University of California, UCSF, and philanthropic groups, including at least one that has donated to efforts to impose taxes on sugary beverages, according to the New York Times. Several localities across the United States—including Berkeley, California, and Philadelphia—have implemented taxes on sugar-sweetened beverages.

    For the ban, UCSF removed sugar-sweetened beverages from cafeterias, food trucks, and vending machines across all campus sites and medical facilities. Fast food chains on campus also stopped selling the sugary drinks. The only exception to the ban was 100% fruit juices, which have no added sugar. In addition, UCSF installed more water stations to encourage more water consumption during the ban.

    To observe the impact of the ban on employees, the researchers followed 214 employees who drank what amounted to be three cans of soda per day before the ban took effect. The researchers originally focused on enrolling lower-income service workers because they drank the most sugar-sweetened beverages. Cafeteria workers had a particularly high sugar intake, mostly due to an "open tap" policy, which allowed them to drink from the cafeteria soda machines for free. According to Elissa Epel, an author of the study and director of the Aging, Metabolism, and Emotions Center at UCSF, this population tended to have a higher body mass index (BMI).

    The researchers then split the workers into two groups. One group participated in a motivational intervention where health educators discussed their daily sugar intake and demonstrated the adverse health effects of sugar. The health educator also helped the participants set intake goals. The other group had no intervention to keep them from drinking sugary beverages.

    The researchers then took participants' blood samples and measured their soda intake, weight, BMI, and waist sizes throughout the study.

    Do soda bans work?

    Ten months after the sales ban went into effect, across both groups, employees had cut their daily intake of sugar-sweetened beverages by almost in half, from 35 ounces per day to 18 ounces per day. The group that received the intervention reduced their daily sugary drink intake by an average of 25.4 ounces, while the control group reduced daily intake by 8.2 ounces.

    At the conclusion of the study, the researchers found that about 70% of participants overall had a smaller waist size. Overall, participants' waist size decreased by an average of 2.1 cm. The researchers did not observe any changes in BMI.

    Implications

    The study is the first peer-reviewed study to observe whether workplace sales bans on sugar-sweetened beverages could result in reduced consumption of the drinks and improve employees' health, according to the Times.

    Laura Schmidt, a professor at UCSF medical school and senior author of the study, said results demonstrate that the bans could be a simple and low-cost way to improve employee health.

    Epel said, "This was an intervention that was easy to implement." He continued, "[The results are] promising because it shows that an environmental change can help people over the long run, particularly those who are consuming large-amounts of sugary beverages."

    In fact, following the success of the ban at UCSF, about nine other University of California schools plan to adopt a similar sales ban, according to the Times.

    However, critics of the sales bans have pointed out that, while consumption of sugar-sweetened beverages in America has decreased in the last 16 years, obesity is still on the rise.

    William Dermody, a spokesperson for the American Beverage Association, which represents the soda industry, noted that companies like Coca-Cola and Pepsi are already offering beverages that have fewer calories and contain no sugar. "We believe that the actions America’s leading beverage companies are taking to reduce sugar across their broad portfolio of products is a better and more effective way to help reduce the amount of sugar people get from beverages than unpopular bans," he said (UCSF release, 10/28; O'Connor, New York Times, 10/28; Espel et al., JAMA Internal Medicine, 10/28).

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