# Impact of policies restricting advertising, promotion, and sponsorship of sugar-sweetened beverages: A systematic review

## TL;DR

This paper reviews how policies banning sugar-sweetened beverage advertising can reduce consumption and improve health outcomes, especially in children.

## Contribution

The study provides a systematic review of policies restricting sugar-sweetened beverage advertising and their health and economic impacts.

## Key findings

- Policies restricting sugar-sweetened beverage advertising were linked to reduced consumption and improved health outcomes.
- Most studies showed decreased economic and clinical measures following the implementation of these policies.
- Restrictions on TV, school, and point-of-sale advertising were associated with lower exposure and consumption.

## Abstract

To summarize the evidence on the impact of the implementation of the ban on the advertising, promotion and sponsorship (APS) of sugar-sweetened beverages (SSBs) in terms of decreased consumption, advertising exposure and relevant clinical outcomes.

Systematic review of articles published between 2001-2021 in the PubMed, Embase, Global Health, CINAHL and LILACS databases written in English, Portuguese or Spanish. We included experimental, observational and economic model studies. Risk of bias was assessed using RoB2, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group and Consolidated Health Economic Evaluation Reporting Standards 2022. We carried out a descriptive synthesis of the studies.

We selected 11 out of 1146 identified studies. Due to the heterogeneity of the outcomes, it was not possible to conduct a meta-analysis. The interventions corresponded to a comprehensive policy; restrictions on television advertising, promotions, point-of-sale advertising and advertising in schools. We found changes in clinical outcomes (obesity, cardiovascular disease, diabetes, cancer), economic outcomes (purchase, sale, cost-effectiveness, other economic outcomes), exposure and consumption. Most of the effect measures decreased as a result of the interventions. More studies on effectively implemented policies are still needed. The results of the included studies should be interpreted taking into account their methodological limitations.

Policies to restrict the APS of SSBs may be effective, particularly in reducing their consumption in children and adolescents, with a positive impact on their health.

Sintetizar la evidencia sobre el impacto de la implementación de la prohibición de publicidad, promoción y patrocinio (PPP) de bebidas azucaradas (BA) en términos de disminución de consumo, exposición publicitaria y desenlaces clínicos relevantes.

Revisión sistemática de estudios publicados entre 2001-2021 en las bases de datos PubMed, Embase, Global Health, CINAHL y LILACS escritos en inglés, portugués o español. Se incluyeron estudios experimentales, observacionales y modelos económicos. Se evaluó el riesgo de sesgo mediante RoB2, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group y Consolidated Health Economic Evaluation Reporting Standards 2022. Se realizó una síntesis descriptiva de los estudios.

Se seleccionaron 11 de 1146 estudios identificados. Debido a la heterogeneidad en los desenlaces no fue posible realizar un meta-análisis. Las intervenciones incluidas correspondieron a una política integral; restricciones de publicidad televisiva, de promociones, en punto de venta y en escuelas. Se hallaron cambios en desenlaces clínicos (obesidad, enfermedad cardiovascular, diabetes, cáncer), de índole económica (compra, venta, costo-efectividad, otros desenlaces económicos), en exposición y en consumo. La mayoría de las medidas de efecto evaluadas registraron disminuciones a partir de las intervenciones. Aún hacen falta más estudios sobre políticas efectivamente implementadas. Los resultados de los trabajos incluidos deben ser interpretados contemplando sus limitaciones metodológicas.

Las políticas de restricción de la PPP de las BA pueden resultar efectivas, sobre todo para disminuir su consumo en niños, niñas y adolescentes, impactando positivamente en su salud.