Pictured here is the logo for the University of California San Francisco (UCSF) medical center ... [+] embedded into the wall of a building in the Mission Bay neighborhood of San Francisco, California, July 11, 2018. (Photo by Smith Collection/Gado/Getty Images)

Imagine that you are at work and thirsty. How easy is it to get a soda or some other sugary drink? Not too easy? Easy? Very easy? Open-your-eyes-and-it-will-be-in front-of-you-easy?

How then might this affect your chances of drinking a sugary drink rather than water and how might this affect your health?

Well, a study just published in JAMA Internal Medicine showed what happened after a big employer banned the sales of sugar-sweetened beverages. Significant changes occurred and, spoiler alert, things didnt go to waist.

The big employer was the University of California, San Francisco (UCSF), which is the second-largest employer in San Francisco and the fourth-largest in the Bay Area with over 24,000 employees, according to UCSF. As part of the UCSF Healthy Beverage Initiative, the mega-medical center has banned the sales of all sugary drinks across all of their venues since November 1, 2015. After that date, no cafeteria, no vending machine, no food truck, no restaurant, and no store on a UCSF campus could sell sodas or any other drink with added sugar. Not in a box, not with a fox, not with a mouse, there was no such drinks sold in the house.

It can be common to find cans of soda being sold at healthcare facilities. Photographer: Carla ... [+] Gottgens/Bloomberg

Now this didnt mean that UCSF employees had to smuggle sodas in brown paper bags into their workplaces and pretend that they were drinking very brownish water. People could still bring whatever non-alcoholic drinks they wanted onto the UCSF campus. They could also step out of their immediate workplaces into the surrounding neighborhoods to buy sugary beverages. Because, after all, how many times have you heard a person complain about not being able to find soda in a major American city?

Therefore, before this sales ban went into effect, a research team at UCSF (Elissa S. Epel, PhD, Alison Hartman, Laurie M. Jacobs, PhD, Cindy Leung, ScD, MPH, Michael A. Cohn, PhD, Leeane Jensen, MPH, Laura Ishkanian, MPH, Janet Wojcicki, PhD, MPH, Ashley E. Mason, PhD, Robert H. Lustig, MD, MSL, Kimber L. Stanhope, PhD,MS, RD, and Laura A. Schmidt, PhD, MSW, MPH) thought that this would be a great opportunity to measure the impact of such a workplace ban. As Epel, first author of the study, a health psychologist, and Professor in the UCSF Department of Psychiatry said, Many hospitals have recently been implementing bans on selling sugar-sweetened beverages, but no one had really evaluated the effects on consumption and health.

The research team recruited 214 UCSF employees for the study that began on July 28, 2015, about three months before the ban had gone into effect. All of the study participants had to be regular sugar-sweetened beverage drinkers, consuming at least 360 mL or 12 fluid ounces a day. Thats the size of an average aluminum beverage can.

At the start of the study, the research team interviewed and examined each participant, taking a bunch of measurements. Physical measurements included each participants height, weight, waist-to-hip ratio, waist circumference, and sagittal diameter. Your sagittal abdominal diameter (SAD) has nothing to do with how much of a Sagittarius you are or how sad you happen to be. It is the distance from the small of your back to your upper abdomen, which gives a sense of how much fat that you may have in your gut.

The team also asked each participant how many sugar-sweetened beverages he or she consumed each day and did blood tests to assess each participants level of insulin sensitivity. Insulin is the hormone normally secreted by your pancreas that helps regulate sugar in your body and sugar move from your bloodstream into the your cells.

Additionally, the researchers randomly chose half of the participants to undergo a motivational intervention. This motivational intervention wasnt quite like the live in a van down the river Chris Farley as Matt Foley speech from Saturday Night Live. Instead, health educators interviewed each selected participant at the beginning of the study. During this fifteen-minute encounter, the educator quantified the amount of sugar that the participant was drinking each day and provided guidance and educational materials on how to reduce sugar intake. The intervention also included five minute follow-up phones calls one week after the initial interview and one month and six months following the beginning of the sales ban. The motivational intervention was similar to the interventions used to make people aware of the dangers of alcohol dependence.

By the way, this Kasier Permanente video, which was not part of the study, shows how much sugar sugary drinks can have:

How sweet then were the results of the study? Well, just ten months after the ban had started, the average daily consumption of sugar-sweetened beverages had gone down from 1050 mL (or 35 fluid ounces) to 540 mL (or 18 fluid ounces) per participant. That was a 510-mL (or 17 fluid ounces or almost a can-and-a-half) drop, which amounted to a 48.6% decrease. The participants who had received the motivational intervention experienced on average a greater drop (762 mL, 25.4 fluid ounces, or two cans worth) than those who had not (246.0 mL or 8.2 fluid ounces).

Thats not all folks. Those who had decreases in daily sugar-sweetened beverage consumption also tended to have decreases in their insulin resistance as measured by lab tests. Insulin resistance is not a political movement but is a situation in which the cells in your body begin ignoring what insulin is trying to do. With insulin resistance, the cells in your muscles, fat, and liver essentially say, bye Felicia, when insulin says take up some sugar from the blood. As a result, your blood sugar levels begin creeping upwards, which can be a major step towards badness such as developing fatty liver disease or diabetes.

Then theres the waist from this study or rather waists. The average waistline measurements decreased by 2.1 cm. Again, just 10 months after the ban had started, noticeable loosening of pants or similar garments occurred in a number of participants. Thats big, or rather less big.

Epel explained that the study period was too short to see significant changes in weight but abdominal fat is sensitive to sugar intake, and we saw significantly reduced waist lines.

Of note, significant decreases in waist sizes occurred among not only those who were in the obesity or overweight categories but also those who fell into the lean category, which was having a body mass index (BMI) less than 25. This was a reminder that even though you may appear lean or skinny, looks can be deceiving. It also matters how much fat you may have sitting in your abdomen.

Ten months is significant because it was long enough for each participant to go through different seasons, as much as seasons exist in San Francisco. The research team wanted to make sure that any observed changes were sustained and not just typical fluctuations that may occur throughout the year. In fact, the observed changes persisted through not just 10 months but 12 months after the ban had begun.

Of course, 12 months is not 15 months, which is not two years, which is not a decade. So, yes, the study did have its limitations and could not tell you if the changes were sustainable over several years. The study also did not track what concurrently happened with other habits such as eating and exercise. Moreover, different workplaces can be quite different, so the question remains: would such a ban have the same effects elsewhere.

Schmidt, the senior author of the study and a Professor of Health Policy at UCSF, did say that their team has started a controlled study in Sutter Health, a large health care system in the Bay Area, that will address some of these limitations and help better nail down the mechanisms involved. So stay tuned.

Nonetheless, this is yet more evidence that your work environment really matters. This is not surprising, since you do spend on average a third of your time at work, maybe more if you are a doctor or a doctor going through training. What you are exposed to at work can really affect what you eat and drink. After all, you are still like a baby in that you tend to put whats close to you into your mouth. The food and beverages that are around you comprise whats called your food and beverage environment.

In fact, changing the beverage environment at work could have a spill-over effect as well, so to speak. People in the study really drank less sugar-sweetened beverages, not just at work, said Epel. They were making equal reductions at home and at work.

Schmidt likened removing soda from workplaces to taking cigarettes out of workplace vending machines. Schmidt is certainly not the first person to find similarities between sugary beverages and tobacco. A number of people have called sugar the new tobacco, including the authors of aCMAJ (Canadian Medical Association Journal) commentary. As I have written previously for Forbes, a report from Vital Strategiesraised concerns that soda companies are using the same marketing strategies that Big Tobacco companies have used.

Sugar does have at least one thing in common with nicotine, it can be addictive. Epel included the following video on food addiction on her UCSF Aging, Metabolism, and Emotion Research website:

Addiction is one reason why sugar exposure at work can affect what you consume at home. As Epel explained, there is deeply ingrained moral ethic of personal responsibility. While theoretically that sounds good, the reality is our brain is vulnerable to addiction. We need to help people be well by creating the right environments. In other words, you are what you are exposed to every day.

Speaking of exposure, marketing is another possible cause of such spill-over effects. If you are exposed to soda is great messages at work, that could potentially influence what you buy elsewhere. No matter how hard you try to separate work life from home life, influences invariably will bubble over in both directions.

While some other healthcare institutions, such as the Cleveland Clinic, the University of Michigan Health System, the Baylor Health Care System, and the Geisinger Clinic, have instituted sugar-sweetened beverage sales bans as well, there are still many healthcare institutions that continue to pour some sugar on their employees. Schmidt pointed out that institutions arrange pouring rights with soda companies. The institutions will then co-brand and market sugar-sweetened beverages. This could be money-makers for institutions, making them more likely to continue to go with the flow.

To re-purpose the words of Alanis Morissette, isnt it ironic for healthcare institutions to help sell sugar-sweetened beverages? After all, many such beverages have no demonstrated nutritional value over water and are in essence liquid sugar, in the words of Epel. As Epel related, you have institutions that are training people to be health professionals and employing people to treat patients but at the same time are serving them sugary beverages.

Its not as if employees at UCSF resisted the ban. Rather, UCSF employees appreciated the care for their health. They were very positive about the ban. In fact, the only people who expressed any concerns were some visitors who didnt understand the culture and wanted to buy sugar-sweetened beverages during their visit, according to Epel.

Of course, healthcare employers arent the only employers that could institute such a ban. Schmidt referred to such bans as low-hanging fruit, as opposed to low-hanging sugar-sweetened fruit drinks. Policy changes such as soda taxes have run into political obstacles. Having employers change their food and beverage environments is a way of getting around such obstacles.

Indeed, employers could have lots of incentive to make such changes. Studies such as one published in a 2014 issue of JAMA Internal Medicine have linked excess sugar consumption to a variety of health problems including obesity, diabetes, cardiovascular disease, cancer, and early death, even for those who fall into the normal weight category. What employers then would want their employees to be as sick as possible? Schmidt pointed out that if you can avert new cases of illness, you can save a lot of money.

The fact that UCSF not only instituted the ban but also provided financial support for the study suggests that employers could help lead the way in curbing sugar-sweetened beverage consumption. Employers may want to pore through this UCSF study before they decide about pouring rights and what to essentially pour on their employees.

Continue reading here:
UCSF Banned Sugary Drink Sales, Here Is What Happened Next - Forbes

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