Modeling the Impact of Restricting Sugar‐Sweetened Beverages from SNAP Purchases on Children's Consumption and Risk of Dental Caries and Obesity
Authors: Choi S.E. , Wright D. , Bleich S. 
Published: August 2020

To evaluate the theoretical impact of restricting sugar‐sweetened beverage (SSB) purchases in the Supplemental Nutrition Assistance Program (SNAP) on calorie intake, dental caries, and obesity risk in children.

Using SNAP participation and dietary consumption data from a nationally representative sample of children (ages 0 to 19) completing the National Health and Nutrition Examination Survey (2009‐2014, N = 9,753), we constructed a stochastic microsimulation model to evaluate the effectiveness of restricting SSB purchases in SNAP on childhood obesity and dental caries among children enrolled in the SNAP. We simulated the population over a 10‐year period to be consistent with policy planning horizons, and to minimize longitudinal uncertainty in our estimates. From the simulation, we assessed changes in SSB consumption, total daily calorie intake, body mass index (BMI), prevalence of obesity, and the incidence of dental caries given observed SSB consumption rates and differences in disease risks within the SNAP population as compared to the general US population. Sensitivity analyses were conducted to assess whether variations in food substitution patterns and SNAP enrollment rates could alter the benefits of the proposed program.

Hypothetical cohort of US children aged less than 19 years, stratified by age, gender, race/ethnicity, income, and SNAP enrollment status.

SSB consumption among the target SNAP participants was 105.2 grams/person/day (95% CI: 64.8, 145.6) higher than non‐SNAP participants, and restricting SSB purchases in SNAP would result in an estimated 108.3 grams lower SSB consumption per day (95% CI: −150.6, −66.0). The most SSB consumption reduction was observed among non‐Hispanic Black male population given higher baseline SSB consumption level. If SSB was substituted for 100% fruit juice and milk based on a recent review, a restriction on SSB purchases would be expected to reduce calorie intake by a net average of 16.9 kcal/person/day (95% CI: −18.4, −14.3) among SNAP participants, resulting in a 1.2 kg/m‐ (95% CI: −1.5, −0.8) decrease in BMI. Obesity prevalence would not be expected to decrease significantly based on this change in BMI, −4.7 percentage point (95% CI: −14.1, 4.7). The anticipated decrease in dental caries incidence averaged 49.0 per 10,000 (95% CI: −52.2, −45.8), 0.9% decline from baseline. When SSB was substituted for other most typically purchased food items by the SNAP participants, such as meat, vegetables, and frozen prepared foods, the participants consumed 5.1 more kcals/person/day (95% CI: 4.70, 5.54), but BMI or obesity prevalence among the participants was not significantly impacted by this change.

Restricting SSB purchases in SNAP would be expected to significantly lower the risk of dental caries and BMI among children. However, it would not be expected to have a significant effect on obesity due to food substitutions.

Children enrolled in the SNAP are at a higher risk of poor diet, including higher SSB consumption compared with non‐SNAP participants. Restricting SSB purchases in SNAP could potentially promote healthier diet, and significantly reduce dental caries—one of the most common chronic diseases of childhood in the United States.