Knowing the risks, Americans still sip sugary beverages daily

Despite widespread awareness of the health risks linked to sugary drinks, consumption remains high, revealing the stronger pull of taste, habits, and marketing over knowledge alone.

Background

High intake persists: Nearly 30% of U.S. adults consume sugar-sweetened beverages (SSBs) twice or more per day, despite widespread awareness of certain health risks like weight gain and diabetes.

Health experts have warned that excessive added sugars, particularly from SSBs, are becoming a significant public health challenge in the United States. Frequent consumption of SSBs has been linked to health issues, including cardiovascular disease, some cancers, high cholesterol and blood pressure, type 2 diabetes, cavities, and weight gain.

American dietary guidelines recommend limiting added sugars to less than 10% of daily caloric consumption. However, estimates from 2015 to 2018 suggest that the average intake in the United States is higher, at approximately 12.2%.

SSB intake is prevalent across the country, with nearly 78% of non-Hispanic Black and Hispanic adults consuming SSBs compared to 65% of non-Hispanic White individuals. While health knowledge can lead to healthier behavior, studies show inconclusive results regarding whether an understanding of the health risks of SSBs influences their consumption.

About the Study

Researchers applied a cross-sectional research design using survey data evaluating health-related behaviors, attitudes, and knowledge among American adults. After excluding those with incomplete information, the sample included 4,022 individuals.

SSB consumption was measured as the daily intake of five kinds of SSBs: sweetened fruit, energy, sports, sweetened tea or coffee, and regular soda. The frequency of consumption was noted, with more than twice a day being the upper limit and no consumption being the lower limit.

The survey also asked participants questions to gauge their knowledge of health conditions associated with SSB consumption. It collected sociodemographic characteristics, including geographic region, weight status, income, marital status, education, ethnicity or race, sex, and age.

Researchers analyzed the data using statistical tests that examined the relationships between health knowledge, sociodemographic characteristics, and SSB consumption.

Findings

Decline in consumption: Between 2014 and 2021, daily SSB consumption dropped from 68% to 50%, reflecting a modest but positive trend likely influenced by labeling reforms and public health campaigns.

The results on patterns of SSB consumption showed that nearly 30% of sampled participants reported consuming SSBs twice or more a day in the month preceding the survey. High SSB consumption was most common among those living in the Northeast, people with an annual income of less than $35,000, those without college educations, non-Hispanic White individuals, males, and people between 45 and 64.

84% of respondents knew that SSB consumption could lead to weight gain, while more than 78% knew about its links to diabetes, and 74% knew it could cause cavities. However, fewer than 40% were aware that some cancers, high cholesterol and blood pressure, and heart disease have also been linked to SSB consumption.

Knowledge of these effects differed significantly across different sociodemographic groups, including income, ethnicity or race, sex, and age. Bivariate analyses suggested that SSB consumption differed significantly with knowledge of associations with diabetes and weight gain.

Notably, after researchers adjusted for sociodemographic characteristics, knowledge of health conditions did not appear to be significantly associated with consuming SSBs twice or more per day compared to not consuming any SSBs. This suggests that behavior change may be driven more by taste preferences, marketing influences, and the habitual nature of SSB consumption rather than health knowledge alone.

Conclusions

Researchers found that while the links between SSB consumption and cavities, diabetes, and weight gain were well-known, awareness of other risks was lower. Between 2014 and 2021, there were slight increases in awareness of health risks related to SSB consumption. Consumption rates also declined; while approximately 68% of American adults consumed SSBs daily in 2014, this statistic fell to about 50% in 2021.

The decline in SSB consumption may reflect the impact of updated food labeling, increased consumer awareness, and public health education campaigns during this period.

The analysis found no indication that knowledge of health risks influences high SSB consumption after adjusting for sociodemographic factors, suggesting that behavior may be affected more by perceived healthfulness, marketing, and taste. Public health policies seeking to reduce SSB consumption could include interventions such as front-of-package warning labels that prominently display health risks and updated warning labels that are easily visible.

Successful past initiatives have included education campaigns that raise awareness and introduce and promote alternatives. Challenges to effective interventions include misconceptions about risks, specific preferences for some SSBs, the high accessibility of these products, and habitual consumption.

The study also highlights limitations, such as its cross-sectional design, which precludes causal conclusions. Additionally, the self-reported data may be subject to recall or social desirability bias.

Future surveys should also focus on drawing nationally representative samples for more generalizable results.

Journal reference:

• Associations between knowledge of health conditions and sugar-sweetened beverage intake among US adults, 2021. Hunter, J.R., Oza-Frank, R., Park, S., Sauer, A.G., Gunn, J.P. Nutrients (2024). DOI: 10.3390/nu16244317, https://www.mdpi.com/2072-6643/16/24/4317