We did not assess the degree of heterogeneity for secondary outcomes (nutrition and health) because there were relatively few studies in these domains. Initially, for each primary outcome (energy intake, body weight, milk intake, and calcium intake), we assessed the degree of heterogeneity of effect sizes by testing the significance of the Q statistic, which is the sum of the squared deviations of each effect size from the overall weighted mean effect size. Because such heterogeneity of research methods is likely to produce heterogeneity of effect sizes across studies (an effect size represents the magnitude of the relationship between 2 variables), we took 2 steps to assess the impact of research method on outcome. Studies vary in their design (i.e., cross-sectional, longitudinal, or experimental studies), sample characteristics (e.g., male vs female, adults vs children), and operational definitions of independent and dependent variables. There is a great deal of variability in research methods in this literature. Our searches yielded a total of 88 articles that were included in the present analysis. Finally, we contacted the authors of each included article with a request for unpublished or in-press work, and we asked each author to forward our request to other researchers who might have relevant work. We identified additional articles by searching each article’s reference section and the Web of Science database. We conducted a computer search through MEDLINE and PsycINFO using the key terms “soft drink,” “soda,” and “sweetened beverage.” We identified articles that assessed the association of soft drink consumption with 4 primary outcomes (energy intake, body weight, milk intake, and calcium intake) and 2 secondary outcomes (nutrition and health). We focused on research investigating the effects of sugar-sweetened beverages diet and artificially sweetened beverages are noted only in certain cases for comparison purposes. Our objectives were to review the available science, examine studies that involved the use of a variety of methods, and address whether soft drink consumption is associated with increased energy intake, increased body weight, displacement of nutrients, and increased risk of chronic diseases. Legislative and legal discussions focusing on soft drink sales often take place on political and philosophical grounds with scant attention to existing science. Similar positions have been taken by other trade associations such as the British Soft Drinks Association and the Australian Beverages Council. The industry trade association in the United States (the American Beverage Association, formerly the National Soft Drink Association) counters nutrition concerns with several key points: (1) the science linking soft drink consumption to negative health outcomes is flawed or insufficient, (2) soft drinks are a good source of hydration, (3) soft drink sales in schools help education by providing needed funding, (4) physical activity is more important than food intake, and (5) it is unfair to “pick on” soft drinks because there are many causes of obesity and there are no “good” or “bad” foods. 2 In the intervening years, controversy arose over several fundamental concerns: whether these beverages lead to energy overconsumption whether they displace other foods and beverages and, hence, nutrients whether they contribute to diseases such as obesity and diabetes and whether soft drink marketing practices represent commercial exploitation of children. 1 At that time, annual US production of carbonated soft drinks was 90 8-oz (240-mL) servings per person by 2000 this number had risen to more than 600 servings. In 1942 the American Medical Association mentioned soft drinks specifically in a strong recommendation to limit intake of added sugar. A key question is whether actions taken to decrease soft drink consumption are warranted given the available science and whether decreasing population consumption of soft drinks would benefit public health.
Many US states have considered statewide bans or limits on soft drink sales in schools, with California passing such legislation in 2005. Soft drinks have been banned from schools in Britain and France, and in the United States, school systems as large as those in Los Angeles, Philadelphia, and Miami have banned or severely limited soft drink sales. Soft drinks are viewed by many as a major contributor to obesity and related health problems and have consequently been targeted as a means to help curtail the rising prevalence of obesity, particularly among children. Soft drink consumption has become a highly visible and controversial public health and public policy issue.
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