Experts support screening for sugar-sweetened beverage (SSB) consumption, but no standardized method for doing this in a clinical setting has been established. The authors of this research study implemented an electronic health record (EHR)- based screening question for SSB and 100% fruit juice consumption among children of all ages. It should be noted that the question grouped 100% fruit juice and all SSB as “sugary drinks”.

Using the EHR data that resulted from this question, the authors measured the association between sugary drink consumption and child weight status. Body weight was measured using baseline body mass index z-scores (BMIz), which is a measure of relative body weight for a child’s age, height, and sex, compared to the general population. The sample included data from 22,291 children ages 6 months to 17 years who visited participating practices in North Carolina from March 2017 to March 2018.

In their cross-sectional analysis, they found a positive association between high sugary drink consumption and BMIz for 6-11 year olds and 12-17 year olds. For those children who had multiples visits to their clinic (n=15,373) over the year of the study, change in BMIz was analyzed. Children ages 2-5 years in the highest consumption category (>3 sugary drink) had a greater increase in annualized change in BMI than those reporting less than one SSB a week. For children 6 years and older who consumed one or more sugary drinks daily, higher consumption at baseline was associated with higher increase in BMIz.

Study strengths: This study used the novel approach of utilizing EHR data gathered primarily from well-child visits. In addition, this study included a large and diverse sample of children.

Study limitations: Due to the wide range of ages of children in the study, the authors used BMIz to measure weight status. Since this measurement is not as commonly used in the literature, it may be difficult to compare the results of this study to other previous studies. In addition, the study relied on self-reports of sugary drink consumption, which may not be accurate due to recall issues and social desirability biases. Finally, the EHR screener tool did not differentiate between SSB and 100% fruit juice.

What this means for your practice: This study used EHR data from well-child visits to measure the association between sugary drink consumption and weight status among children. Their results confirmed what has been documented previously regarding the health risks associated with excessive sugary drinks. Counseling your young patients and their parents about the importance of healthy beverage choices and the need to limit SSB and 100% fruit juice is important to ensure maintenance of a healthy weight. Resources to encourage healthy drink choices for both parents and children can be found at

Original citation: Lewis KH, Skelton J , Hsu F, Ezouah P, Taveras EM, Block JP. Use of Electronic Health Record Data to Study the Association of Sugary Drink Consumption with Child Weight Status. Academic Pediatrics (2019). doi:

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