Introduction
Obesity in children has reached epidemic proportions.1
Ultimately energy imbalance is the reason for excessive weight
gain, whether the main cause is genetic, endocrinal, or
idiopathic.2 A contributory factor seems to be the consumption
of carbonated drinks sweetened with sugar.3 These have a high
glycaemic index and are energy dense. Children who drink one
regular carbonated drink a day have an average 10% more total
energy intake than non-consumers.4 In the United Kingdom
more than 70% of adolescents consume carbonated drinks on a
regular basis.5
Although school or family based programmes that promote
physical activity, modification of dietary intake, and reduction of
sedentary behaviours may help reduce obesity in children, few
have been effective.6 Recently the United Kingdom based active
programme prompting lifestyle in schools (APPLES) reported
the effects of multiple interventions on obesity in children.7 The
programme included teacher training, modification of school
meals, action plans within the curriculum, changes to the tuck
shop, physical education, and playground activities. Despite these
initiatives there was only a modest increase in consumption of
healthy foods such as vegetables without any change in obesity
rates. In contrast, there is a paucity of studies on single factors
Introduction
Obesity in children has reached epidemic proportions.1
Ultimately energy imbalance is the reason for excessive weight
gain, whether the main cause is genetic, endocrinal, or
idiopathic.2 A contributory factor seems to be the consumption
of carbonated drinks sweetened with sugar.3 These have a high
glycaemic index and are energy dense. Children who drink one
regular carbonated drink a day have an average 10% more total
energy intake than non-consumers.4 In the United Kingdom
more than 70% of adolescents consume carbonated drinks on a
regular basis.5
Although school or family based programmes that promote
physical activity, modification of dietary intake, and reduction of
sedentary behaviours may help reduce obesity in children, few
have been effective.6 Recently the United Kingdom based active
programme prompting lifestyle in schools (APPLES) reported
the effects of multiple interventions on obesity in children.7 The
programme included teacher training, modification of school
meals, action plans within the curriculum, changes to the tuck
shop, physical education, and playground activities. Despite these
initiatives there was only a modest increase in consumption of
healthy foods such as vegetables without any change in obesity
rates. In contrast, there is a paucity of studies on single factors
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