Discussion
obesity, cardiometabolic disease
OBESITY, ADIPOSITY
Employers have begun to experiment with workplace SSB sales bans as a strategy for preventing obesity and cardiometabolic disease. All prior studies of the effectiveness of this non-governmental policy approach to SSB reduction have been small-scale and uncontrolled, limiting the conclusions that could be drawn. Results from this controlled trial, conducted across eight large workplace sites, suggest that the sales ban is a promising public health strategy for employees who consume SSB heavily. Study participants in both the intervention and control groups experienced secular declines in SSB consumption, a finding consistent with other studies conducted in California during a similar time frameEvidence from this trial suggests that workplace sales bans are likely to be most effective by discouraging workplace consumption, with limited spillover on consumption outside the workplace. On average, employees in the sales ban condition reduced their daily SSB consumption outside the workplace by 1·2 oz. per d more than controls, but this effect was not statistically significant. Our analyses ruled out the possibility that employees might compensate for the sales ban at work by increasing their SSB and/or sugar consumption outside the workplace. Although at least one prior study of a school-based SSB sales ban documented higher sugar compensation at homeBaseline characteristics of the sample lend confidence to the conclusion that sales bans can be effective for a wide range of people, including at-risk populations. Employees recruited for this study were ethnically diverse (66·1 % non-White). At baseline, a majority of the sample had an elevated BMI (mean = 29·5) and/or waist circumference (mean = 98·7 cm). Average baseline SSB consumption in this sample was 34·7 oz. or approximately 1·0 litres per d. We also found associations between the baseline level of SSB consumption and measures of adiposity: those consuming the most SSB (36+ oz. per d) had the highest average BMI and waist circumference (This trial was statistically powered to explore the sales ban’s differential effects on high-risk subgroups, including those with an elevated BMI and elevated waist circumference at baseline. This is important because sales bans, by necessity, impact the whole employee population, even though those already at risk are a top public health priority. One prior study of a sales ban found disproportionate benefits in employees with obesity but also examined the impact of a brief motivational intervention and did not have a control group