Resolved: there is sufficient scientific evidence that decreasing sugar‐sweetened beverage consumption will reduce the prevalence of obesity and obesity‐related diseases

Summary Sugar‐sweetened beverages ( SSB s) are the single largest source of added sugar and the top source of energy intake in the U.S. diet. In this review, we evaluate whether there is sufficient scientific evidence that decreasing SSB consumption will reduce the prevalence of obesity and its related diseases. Because prospective cohort studies address dietary determinants of long‐term weight gain and chronic diseases, whereas randomized clinical trials ( RCT s) typically evaluate short‐term effects of specific interventions on weight change, both types of evidence are critical in evaluating causality. Findings from well‐powered prospective cohorts have consistently shown a significant association, established temporality and demonstrated a direct dose–response relationship between SSB consumption and long‐term weight gain and risk of type 2 diabetes ( T 2 D ). A recently published meta‐analysis of RCT s commissioned by the W orld H ealth O rganization found that decreased intake of added sugars significantly reduced body weight (0.80 kg, 95% confidence interval CI 0.39–1.21; P < 0.001), whereas increased sugar intake led to a comparable weight increase (0.75 kg, 0.30–1.19; P = 0.001). A parallel meta‐analysis of cohort studies also found that higher intake of SSB s among children was associated with 55% (95% CI 32–82%) higher risk of being overweight or obese compared with those with lower intake. Another meta‐analysis of eight prospective cohort studies found that one to two servings per day of SSB intake was associated with a 26% (95% CI 12–41%) greater risk of developing T 2 D compared with occasional intake (less than one serving per month). Recently, two large RCT s with a high degree of compliance provided convincing data that reducing consumption of SSB s significantly decreases weight gain and adiposity in children and adolescents. Taken together, the evidence that decreasing SSB s will decrease the risk of obesity and related diseases such as T 2 D is compelling. Several additional issues warrant further discussion. First, prevention of long‐term weight gain through dietary changes such as limiting consumption of SSB s is more important than short‐term weight loss in reducing the prevalence of obesity in the population. This is due to the fact that once an individual becomes obese, it is difficult to lose weight and keep it off. Second, we should consider the totality of evidence rather than selective pieces of evidence (e.g. from short‐term RCT s only). Finally, while recognizing that the evidence of harm on health against SSB s is strong, we should avoid the trap of waiting for absolute proof before allowing public health action to be taken.