RAMESH KILLARI PHYSICALTHERAPIST/KINESIOTHERAPIST

1. Effects of Sugar- Sweetened Beverages 1
Running Head: EFFECTS OF SUGAR-SWEETENED BEVERAGES
Effects of Sugar-Sweetened Beverages on Childhood Obesity
Ramesh Killari
University of Central Arkansas

2. Effects of Sugar- Sweetened Beverages 2
The purpose of this study is to demonstrate the effect of sugar-sweetened beverages on
children. Children who consume sugar-sweetened beverages will be at higher risk for obesity;
therefore, sugar-sweetened beverages have a direct effect on childhood obesity.
Children are categorized from 4 to 10 years of age. The term overweight is used to
describe children with Basal Metabolic Index (BMIs) in the 85-95%, while obese describes
children in the > 95%. The BMI refers to the Body Mass index-for-age percentiles: boys and
girls 2 to 20 years of age, which was developed by the National Center for Health Statistics in
collaboration with the National Center for Chronic Disease Prevention and Health Promotion.
Sugar sweetened beverages include those that contain 20-40 grams of sugar per 8 ounces.
Significance of the Problem
The prevalence of soft drink consumption has risen 500% over the past years (Ludwig,
Gortmaker, & Peterson, 2001). Due to the increasing prevalence of both childhood obesity and
consumption of sugar sweetened beverages among children, this study is needed to determine if
a correlation exists between the two.
It is estimated that 21% of American children and adolescents ages 12 to 19 are obese.
According to the 1995 study quot;Childhood Obesity: Pathophysiology and Treatment” by the
Baylor College of Medicine, adolescent obesity is associated with myriad factors, such as obese
parents, a sedentary lifestyle, and young children's tendency to eat away from home at a
childcare center, a friend's house and/or fast food restaurants.
Review of Literature
The literature related to sugar-sweetened beverage consumption and its connection to
weight gain/obesity is reported in this review. For organizational purposes, the literature is
presented according to the following topics: themes and trends within beverage consumption and

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obesity studies, methodologies used to connect sugar-sweetened beverage consumption to
obesity, results of the reviewed studies, and a summary.
The studies reviewed fell within the time frame of 1998-2007. A prevalent theme within
the studies was the idea that sugar-sweetened beverages were connected to weight gain/obesity,
whether they were being consumed by preschool aged children or French men. Welsh & Dietz
(2005) as well as Schulze, et al. (2004) shared a common theme in that both studies associated
the risk of weight gain in connection with sugar-sweetened beverage consumption to Type II
Diabetes. Schulze, et al. (2004) took the study a bit further, looking at the associations between
young and middle-aged women and Type II Diabetes. Although the proposal at hand is not
considering an association with this disease, these studies were nonetheless relevant including a
study completed by French, Lin, & Guthrie (2003) which examined the trend in the prevalence,
amount, and source of soft drink consumption in children ages 6-17 years old in the years
between 1977-78 and 1994-98. Very closely related in theme to this article is a study conducted
by Dubois, et al. (2007) which examined the relationship between consumption of sugar-
sweetened beverages and the prevalence of being over-weight among preschool-aged children
living in Canada. The target audience of this study directly related to the proposal at hand.
Although several of the studies related to audiences that did not fall within the proposed age
range, they were great assets due to their methodological proceedings.
Somewhat off the topic but reviewed for its methodologies was the study conducted by
Dallongeville, et al. (1998) which serves as a model or tool for setting up a similar study. The
researchers used trained nurses that tested various body weights according to the BMI scale as
well as measuring waist-to-hip ratios and waist girth. The only other study that actually included
any type of measurement was Dubois, et al. (2007) which included measurements of weight and

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height that were taken at home by trained, registered dietitians. Their measurements were
analyzed using the BMI scale, with overweight being defined as having a BMI at or above the
95th percentile.
Both of the aforementioned studies as well as the others reviewed included questionnaires
and this creates a great relevance to the proposal at hand. Dubois, et al. (2007) delivered self-
administered food frequency questionnaires (FFQs) as part of their nutritional assessment which
were addressed to the children’s mothers and fathers. They were answered by the person most
knowledgeable about the child, which was generally the mother. The information retrieved from
the FFQ was used to categorize the children studied by frequency of sugar-sweetened beverage
consumption, focusing on the consumption taking place between meals. Children were then
defined as non-consumers, daily consumers, or regular consumers based upon their responses. A
similar method was used by Welsh & Dietz (2005) in which women were mailed a questionnaire
every two years to determine weight and morbidity from 1991-1999. A FFQ was mailed every
four years, including questions regarding how often the participants consumed sugar-sweetened
beverages over the past year. The mean weight change in the women, grouped by beverage
consumption, was categorized by consistently low (<1 per week), consistently high (>/=1 per
day), increased from low to high, and decreased from high to low. Schulze, et al. (2004) also
administered a biannual questionnaire to women ages 24-44 regarding the specifics of beverages
that they consumed, including type, portion sizes, and consumption frequency.
Each study reviewed held very important information for the outcome of this proposal in
their results. Results from four of the relevant studies, excluding Dallongeville, et al. (1998)
indicated that there is a relationship between sugar-sweetened beverage consumption and the
state of being overweight. An excellent view of trend rates comes from French, Lin, and Guthrie

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(2003) which finds that the overall prevalence of soft drink consumption for children ages 6 to
17 years was 48% higher in 1994-98 as in 1977-78. The quantity of soft drinks consumed was
increased 51% during these same years. Results from both Welsh &Dietz (2005) and Schulze, et
al. (2004) indicate that there is a positive association with sugar-sweetened beverages and weight
gain. These studies also examined that as consumption rates rose from low to high in
participants, their total energy consumption followed suit. For Schulze, et al. (2004) the study led
to an additional question of whether or not these drinks can cause an increase in hunger. On the
reverse, women who decreased their consumption from high to low in this study did not gain
significant weight and had decreased total energy consumption. Welsh & Dietz (2005) saw this
pattern of caloric intake as well, in women whose consumption rose from low to high from 1991
– 1995. There was an average increase of total caloric intake of 358 calories per day. This is a
unique aspect to consider.
The study conducted by Dubois, et al. (2007) had the most relevance to this proposal with
their results, which indicated that 17.2% of children consumed sugar-sweetened beverages daily
at the age of 4.5 years. In comparison with children who were non-consumers, more than twice
the children who were regular consumers were overweight at 4.5 years. The proposal at hand
relates to the connection between sugar-sweetened beverage consumption and obesity in children
ages 4-10, but the results of the reviewed studies gives great indication as to what we can expect
from this study.
In summary, the themes, methods, and results found by the research that we reviewed
will all contribute as models for this proposal. Some of the articles reviewed, such as
Dallongeville, et al. (1998) were off topic in the aspect of type of beverage consumption studied

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and the addition of factors such as Type II diabetes but offer much relevance and specific ideas
for how to organize future, similar studies.
The incidences of overweight children and sugar-sweetened beverage consumption have
both been on the rise for several decades. In the study regarding sugar-sweetened beverage
consumption between meals (Dubois et. al, 2007), researchers were unable to examine the effects
of subcategories of sugar-sweetened beverages because they were combined into a single
question on the applied food frequency questionnaire. Also, studies have been limited to pre-
school aged children, teenagers, and women. It is necessary to examine the subcategories of
sugar-sweetened beverages as well as obtain an overview of children ages 4 to 10. This is a vital
period in child development when personal choices become lifestyle factors.
Children are categorized from 4 to 10 years of age. The term overweight is used to
describe children with BMIs in the 85-95% percentile, while obese describes children in the >
95% percentile. The BMI refers to the Body Mass index-for-age percentiles: boys 2 to 20 years
of age and girls 2 to 20 years of age, which was developed by the National Center for Health
Statistics in collaboration with the National Center for Chronic Disease Prevention and Health
Promotion. Sugar sweetened beverages include those that contain 20-40 grams of sugar per 8
ounces. The questionnaire utilized in this study consists of a series of questions and other
prompts that will gather information about the participants regarding their food frequency habits
and will ultimately determine their overall sugar-sweetened beverage consumption. All 210
participants will have their weight and height determined by students at the University of Central
Arkansas who have completed at least one year of the nursing program and have clinical
experience obtaining these measures. These measurements will be taken from January 7-11,
2008. The Head Start children will have their measurements taken from 3:00 - 4:00 pm. The

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children from the Boys and Girls Club will have their measurements taken from 4:30 – 6:30 pm.
Their height will be measured using a standard tape measure and their weight will be taken using
a scale. From this information, the nursing students will calculate the participants’ BMI.
Guardians will then be asked to complete a self-administered food frequency questionnaire
(FFQ) regarding their participant’s consumption habits. A table will be set up for guardians to fill
out the FFQ when they pick up their children. The information retrieved from the FFQ will be
used to classify children based on overall frequency of sugar-sweetened beverage consumption.
Analysis
The criterion for accepting or rejecting the hypothesis will be the 0.05 level of
significance. Data will be analyzed by computer at the Data Processing Center at the University
of Central Arkansas to determine the correlation between amount of sugar-sweetened beverage
consumption and BMI.

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References
Dubois, L., Farmer, A., Girard, M., & Peterson, K. (2007). Regular sugar-sweetened beverage
consumption between meals increases risk of overweight among preschool-aged children.
Journal of the American Dietetic Association, 107, 924-934.
Dallongeville, J., Marecaux, N., Ducemeteire, P., Ferreires, J., Arveiler, D., Bingham, A., et al.
(1998). Influence of alcohol consumption and various beverages on waist girth and waist-
to-hip ration in a sample of French men and women. International Journal of Obesity, 22,
1178-1183.
Escott-Stump, S. & Mahan, L. K. (Eds.) (2004). Drause’s Food, Nutrition, & Diet Therapy (11th
ed.) (pp. 275- 277). (Alexopoulos, Y.) Philadelphia: The Curtis Center.
French, S., Lin, B., & Guthrie, J. (2003). National trends in soft drink consumption among
children and adolescents age 6 to 17 years: Prevalence, amounts, and sources, 1977/1978
to 1994/1998. Journal of the American Dietetic Association, 103, 1326-1331.
Ludwig, D., Gortmaker, S., & Peterson, K. (2001). Relation between consumption of sugar-
sweetened drinks and childhood obesity: a prospective, observational analysis. The
Lancet, 357, 505-509.
Schulze, M., Manson, J., Ludwig, D., Colditz, G., Stampfer, M., Willett, W., et al. (2004) Sugar-
sweetened beverages, weight gain, and incidence of Type 2 Diabetes in young and
middle-aged women. The Journal of the American Medical Association, 292, 927-934.
Welsh, J. & Dietz, W. (2005). Sugar-sweetened beverage consumption is associated with weight
gain and incidence of Type 2 Diabetes. Clinical Diabetes, 23, 150-152.

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