Collectively, SSBs are the largest source of added sugar in the diet a typical 12 fl oz (355 ml) serving of soda delivers 35.0–37.5 g of sugar and 140–150 calories (Box 1). Among these factors, sugar-sweetened beverages (SSBs) have emerged as an important risk factor, with a robust body of evidence linking SSBs to weight gain and risk of T2DM, cardiovascular disease (CVD) and certain cancers 6. Maintaining a healthy weight is in large part a function of modifiable lifestyle choices 4 that are shaped by the broader food environment, including availability, price and marketing 5. Obesity is a complex condition that results from various physiological, environmental, behavioural and sociopolitical factors, which all contribute to a positive energy balance. The global economic effect of obesity is estimated to be ~2 trillion US dollars, or 2.8% of global gross domestic product, which is roughly equivalent to the global economic effect of smoking or armed conflict 3. Excess weight is the leading risk factor for type 2 diabetes mellitus (T2DM) and can also lead to a number of related chronic conditions, including coronary heart disease (CHD), stroke and many cancers. Over 2.1 billion people, or nearly 30% of the global population, have overweight or obesity, giving rise to substantial health, social and economic costs 2. Pooled estimates from population-based studies from across the globe show that the prevalence of obesity increased between 19, from 11% among men and from 6% to 15% among women 1. The worldwide prevalence of overweight and obesity has nearly tripled over the past four decades, and represents one of the most serious unmet public health challenges of the 21st century. As such, more intensified policy efforts are needed to reduce intake of SSBs and the global burden of obesity and chronic diseases. Many populations show high levels of SSB consumption and in low-income and middle-income countries, increased consumption patterns are associated with urbanization and economic growth. Strong evidence from cohort studies on clinical outcomes and clinical trials assessing cardiometabolic risk factors supports an aetiological role of SSBs in relation to weight gain and cardiometabolic diseases. We also consider global trends in intake, alternative beverages (including artificially-sweetened beverages) and policy strategies targeting SSBs that have been implemented in different settings. We discuss potential biological mechanisms by which constituent sugars can contribute to these outcomes. This Review provides an update on the evidence linking SSBs to obesity, cardiometabolic outcomes and related cancers, as well as methods to grade the strength of nutritional research. A robust body of evidence has linked habitual intake of SSBs with weight gain and a higher risk (compared with infrequent SSB consumption) of type 2 diabetes mellitus, cardiovascular diseases and some cancers, which makes these beverages a clear target for policy and regulatory actions. Sugar-sweetened beverages (SSBs) are a major source of added sugars in the diet.
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