Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses
Open accessAbstract
Evidence suggests that excessive intake of added sugars has adverse effects on cardiometabolic health, which is consistent with many reviews and consensus reports from WHO and other unbiased sources. 74% of products in the US food supply contain caloric or low-calorie sweeteners, or both. Of all packaged foods and beverages purchased by a nationally representative sample of US households in 2013, 68% (by proportion of calories) contain caloric sweeteners and 2% contain low-calorie sweeteners. We believe that in the absence of intervention, the rest of the world will move towards this pervasiveness of added sugars in the food supply. Our analysis of trends in sales of sugar-sweetened beverages around the world, in terms of calories sold per person per day and volume sold per person per day, shows that the four regions with the highest consumption are North America, Latin America, Australasia, and western Europe. The fastest absolute growth in sales of sugar-sweetened beverages by country in 2009-14 was seen in Chile. We believe that action is needed to tackle the high levels and continuing growth in sales of such beverages worldwide. Many governments have initiated actions to reduce consumption of sugar-sweetened beverages in the past few years, including taxation (eg, in Mexico); reduction of their availability in schools; restrictions on marketing of sugary foods to children; public awareness campaigns; and positive and negative front-of-pack labelling. In our opinion, evidence of the effectiveness of these actions shows that they are moving in the right direction, but governments should view them as a learning process and improve their design over time. A key challenge for policy makers and researchers is the absence of a consensus on the relation of beverages containing low-calorie sweeteners and fruit juices with cardiometabolic outcomes, since decisions about whether these are healthy substitutes for sugar-sweetened beverages are an integral part of policy design.
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- Authors
- Popkin, B. M., & Hawkes, C.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- City, University of London (GB)
- Corresponding author
- Popkin, Barry M
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2016-02
- Volume
- 4
- Issue
- 2
- Pages
- 174-186
- ISSN
- 2213-8587 (ISSN-L)
- PMC
- PMC4733620
- OpenAlex
- W2183519426
- Cited by
- 737
- References
- 117
- Citations by year
- 2026: 40 · 2025: 56 · 2024: 59 · 2023: 56 · 2022: 79 · 2021: 93 · 2020: 104 · 2019: 84 · 2018: 81 · 2017: 57 · 2016: 27 · 2013: 1
- FWCI
- 11.12
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- Robert Wood Johnson Foundation (68793, 67506, 67506, 68793, 70017, 70017, R01DK098072, 71837)
- World Cancer Research Fund International
- Universidad de Chile
- National Institutes of Health (2r24hd050924-06, 70017, 68793, 71837, 67506, R24 HD‐050924, #HD050924, CPC 5 R24 HD050924, 5 R24 HD050924)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK098072)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924, 5R24 HD050924, P2CHD050924)
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Consumer Attitudes and Food Labeling
- Keywords
- added sugars, sugar-sweetened beverages, artificial sweeteners, caloric sweeteners, cardiometabolic health, sugar-sweetened beverage tax, front-of-pack labeling, public awareness campaigns, fruit juice, food policy
- MeSH terms
- Beverages, Diet, Humans, Nutrition Policy, Dietary Sucrose, Internationality
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