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. 2023 Jul 3;6(7):e2325158.
doi: 10.1001/jamanetworkopen.2023.25158.

Consumption of Soft Drinks and Overweight and Obesity Among Adolescents in 107 Countries and Regions

Huan Hu  1 , Jing Song  2 , Graham A MacGregor  2 , Feng J He  2
Affiliations

Consumption of Soft Drinks and Overweight and Obesity Among Adolescents in 107 Countries and Regions

Huan Hu et al. JAMA Netw Open. .

Abstract

Importance: Soft drink consumption is associated with weight gain in children and adolescents, but little is known about the association between soft drink consumption and prevalence of the overweight and obesity in adolescents.

Objective: To investigate the association of soft drink consumption with overweight and obesity in adolescents enrolled in school (hereafter, school-going adolescents) using country-level and individual-level data.

Design, setting, and participants: This cross-sectional study used data from 3 cross-sectional studies including 107 countries and regions that participated in the Global School-Based Student Health Survey (2009-2017), the European Health Behavior in School-Aged Children study (2017-2018), and the US Youth Risk Behavior Survey (2019).

Exposure: Daily soft drink consumption (consuming soft drinks 1 or more times per day or not).

Main outcome and measure: Overweight and obesity defined by the World Health Organization Growth Reference Data.

Results: Among the 107 countries and regions, 65 were low- and middle-income, and 42 were high-income countries and regions, with a total of 405 528 school-going adolescents (mean [SD] age, 14.2 [1.7] years; 196 147 [48.4%] males). The prevalence of overweight and obesity among adolescent students varied from 3.3% (95% CI, 2.6 to 4.1) in Cambodia to 64.0% (95% CI, 57.0 to 71.6) in Niue, and the prevalence of adolescent students consuming soft drinks 1 or more times per day varied from 3.3% (95% CI, 2.9 to 3.7) in Iceland to 79.6% (95% CI, 74.0 to 85.3) in Niue. There was a positive correlation between the prevalence of daily soft drink consumption and the prevalence of overweight and obesity (R, 0.44; P < .001). The pooled analysis using individual-level data also showed a statistically significant association between daily soft drink consumption and overweight and obesity (daily soft drink consumption vs nondaily soft drink consumption), with an odds ratio of 1.14 (95% CI, 1.08 to 1.21) among school-going adolescents.

Conclusions and relevance: In this study of 107 countries and regions, the prevalence of daily consumption of soft drinks was associated with the prevalence of overweight and obesity among adolescent students. Our results, in conjunction with other evidence, suggest that reducing soft drink consumption should be a priority in combating adolescent overweight and obesity.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr MacGregor reported being the chairman of Blood Pressure UK (BPUK), Action on Salt, World Action on Salt, Sugar, and Health, and Action on Sugar outside the submitted work. Dr He reported being a member of the Action on Salt and World Action on Salt, Sugar, and Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Prevalence of Overweight and Obesity by Soft Drink Consumption Across 107 Countries and Regions in the 2009-2017 Global School-Based Student Health Survey, 2017-2018 European Health Behavior in School-Aged Children, and 2019 US National Youth Risk Behavior Surveys
Data are from the Global School-Based Student Health Survey (2009-2017), the European Health Behavior in School-Aged Children study (2017-2018), and the US Youth Risk Behavior Survey (2019). Consumption is the prevalence of daily soft drink consumption (1 or more times per day) among school-going adolescents. The partial correlation coefficient (each country has the same weight) is 0.44 (P < .001) for all students, 0.36 (P < .001) for males, and 0.50 (P < .001) for females, controlling for the mean age, percentage of female students (for the overall analysis), prevalence of daily fruit consumption, prevalence of daily vegetable consumption, percentage of physical activity, implementation of soft drink taxes, country income groups, and year of data collection.
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