ROCHESTER, Minn. — Ten months after a company-wide ban on the sale of sweet drinks in the workplace, employees for a large hospital system in California cut nearly an inch off their waistlines on average, according to new research.
The first-of-its-kind study, published this week in the journal JAMA Internal Medicine, tracked outcomes for over 200 employees at the five campuses of the University of California, San Francisco after it banned the sale of sweet drinks on hospital property.
Currently, the Cleveland Clinic, Fairview Hospitals and Allina Health are among health systems nationally with similar bans. While some regional health systems have shifted the balance of drinks in their machines, and HealthPartners and Essentia have removed the drinks in some hospitals, Mayo Clinic, Sanford Health, Health Partners and Essentia Health have not removed sugar-sweetened beverages from their premises entirely.
"Many hospitals including the UK health system have seen the science and instituted a sales ban on sugary drinks," says lead author Elissa Epel. "But this is the first site evaluation to ask whether it makes a difference. We found, to our surprise and delight, there were large effects on people's behavior. We found that by six months people had reduced the amount of sweetened beverages they were drinking by almost 50%, and that the change held when we assessed them again at 12 months."
The study recruited employees who reported consuming sugar sweetened beverages daily. Removing the products cut their consumption of the drinks from a daily average of nearly 36 ounces, to just 18 ounces. The participants also improved on a measure of insulin resistance known as HOMA-IR, and 70% of them saw their waistline drop an average of 2.1 centimeters.
Abdominal adiposity is considered a key risk factor for metabolic dysregulation behind the epidemic of chronic disease driving up costs and sickness within the U.S. health care system.
"There are five things that go into metabolic syndrome," says senior author Laura Schmidt, "and you need a doctor to test for all of them except large waist circumference. So to be able to lower people's waist circumference, that's a hopeful sign that we may be tying into some of the underlying chronic risk factors that comprise metabolic syndrome."
In a separate arm of the study, those receiving a brief motivational interview about the rationale behind the ban, including a demonstration of the sugar cubes in a glass for each calorically-sweetened soda, caused employees to drink even less high-sugar teas, sodas, coffees and sports drinks over the study period. Their consumption dropped to less than a can of soda a day.
'We told people we are going to change your beverage options for these reasons," says Epel. 'We said there is science that shows liquid sugar affects the health of everyone. That it can cause hidden metabolic disease, even in lean people, by creating fatty liver. We explained that this is a common pathway to all the diseases of aging — not just diabetes, but heart disease, stroke, many cancers and dementia."
Critics counter that removing sugar-sweetened beverages from hospitals can be unpopular. Near the end of the experiment, the health news website STAT found two unhappy medical employees in a UCSF cafeteria, including one anesthesia tech who asked of the ban on the drinks: “why did we throw the tea into the harbor for freedom?” But this viewpoint may have been in the minority.
"It sounds right," says Epel. "It sounds really good, like people should always have a choice of what they want to drink no matter what. But the data speak clearly that people find it hard to stop on their own, and cannot resist highly palatable, highly sugared food when it's in front of them."
"Anybody is free to bring sugary sodas into our campuses," says Schmidt. "It's just that we don't sell them."
"This is a pretty simple thing that any employer can do," Schmidt adds. "Right now employers are facing dramatic increases in spending on diabetes. You're looking at a condition that is a big loser for employees and employers. If there is something simple and not expensive to prevent cases from getting worse, then that's a low-hanging fruit."
Among its limitations, the study had no control group. UCSF is the home of the SugarScience metabolic disorders research project directed by Schmidt. SugarScience is currently conducting a large, multi-center controlled trial California health system Sutter Health.