Crystal Smit

Chapter 1 12 BACKGROUND The rising rate of childhood overweight and obesity has been a major public health concern for over the past three decades (WHO, 2020). Recent estimates suggest that in 2016 over 340 million children and adolescents between the ages of 5 and 19 years were overweight or obese worldwide (WHO, 2020). In the Netherlands specifically, 13.9% of the children and adolescents between the ages of 4 and 20 years were overweight in 2019, with 2.2% being obese (CBS, 2020a). This corresponds to 1 in 7 Dutch children being overweight or obese. Overweight and obese children have a higher risk of obesity later in life, disability in adulthood, an increased risk of developing cardiovascular diseases and insulin resistance at a younger age, and premature death (WHO, 2020). Overweight and obesity, as well as its health consequences, are largely preventable and therefore their prevention remains a high priority for public health (WHO, 2020). There is an extensive body of research indicating that the consumption of sugar- sweetened beverages (SSBs; such as soda, sweetened juice drinks, and energy drinks) is positively associated with overweight and obesity in children (e.g., Garduño-Alanís et al., 2020; Luger et al., 2017; Marshall, Curtis, Cavanaugh, Warren, & Levy, 2019). The calories from SSBs have little nutritional value and do not lead to a sense of satiety; therefore, SSBs are assumed to cause an increase in total energy intake and ultimately in weight gain (Mattes, 2006). Research has shown that consuming at least one SSB per day can lead to an additional weight gain of 6.75kg in one year (Apovian, 2004). Although the consumption of SSBs has started to decline in recent years; children still consume more than the recommended amount of SSBs (Marriott, Hunt, Malek, & Newman, 2019). On any given day, about half of the children (54%) consume at least one SSB with an estimated daily contribution of 94 kilocalories. The consumption of SSBs is currently one of the largest single caloric food source of children’s energy intake (Marriott et al., 2019). As a result, there is an increasing focus among policymakers to reduce the consumption of SSBs among children to prevent and reduce overweight and obesity at a young age (Muth et al., 2019). Encouraging healthier alternatives,