Sugar sweetened beverage (SSB) consumption is associated with increased risk for chronic health conditions. There are many factors that influence consumers’ purchase of SSB, marketing and choice-architecture are among them (MMCA).  MMCA is a framework that combines marketing and behavioral economic principles to describe strategies used to sell food and beverages. The purpose of this review was to understand and characterize MMCA used to sell SSB in the U.S to inform public health research, practice, and policy approaches. Guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, as well as a protocol published by the World Health Organization were followed. Key terms to search six databases and Google Scholar were used to identify literature relevant to stocking and marketing practices. Inclusion criteria included original, peer-reviewed research published during or after 2013 about SSB stocking and marketing practices in the US. Data about SSB stocking and marketing practices were categorized into seven categories: place, profile, portion, pricing, promotion, priming, and proximity. Twenty-nine articles were chosen for inclusion. Results focused on SSB availability (n=13), pricing (n=13), and promotion (priming) strategies (n=7). Results for availability indicated that in general, SSB were highly available. Of note, one study found increased SSB product placement during monthly SNAP benefit periods. Pricing results showed that SSB contributed largely to stores’ profits. One study mentioned SSB contributing to 13% of total profits. Results on priming showed that SSB promotional displays are more common in the southeastern part of the country. Another study reported displays promoting SSB are common, especially child focused SSB products. In summary, there is evidence that MMCA is being used to sell SSB to  at- risk consumers (i.e., SNAP participants; children).

Study strengths: This review provides evidence to inform future public health research, practice and policy approaches to reduce the prominence of SSB. This study also highlighted evidence of MMCA strategies among stores with at-risk customers, emphasizing the need for future research in this area.

Study limitations: Most of the studies included are observational (83%) and therefore cannot demonstrate causation. Additionally, studies citing MMCA targeting at risk consumers to purchase SSB did not account for community factors such as income, location, and race; more research is needed on this topic.

What this means for your practice: This review highlights the need for comprehensive strategies to reduce the intake of SSB, especially among those with health disparities. As a trusted healthcare professional, you are in a unique position to educate and influence your patients and their parents/guardians about the benefits of limiting sugary drinks. Refer your families to for more about how limiting sugary drinks can help kids stay healthy.

Original citation: Houghtaling, B., Holston, D., Szocs, C., Penn, J., Qi, D., & Hedrick, V. (2021). A rapid review of stocking and marketing practices used to sell sugar‐sweetened beverages in US food stores. Obesity Reviews, 22(4), e13179.

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