A digital behavioral intervention to reduce sugar-sweetened beverage consumption: a randomized, controlled trial.

Background: Reducing sugar-sweetened beverages (SSB) is a worldwide public health priority. There are United States regions with notable SSB consumption pattern disparities, including Appalachia.

Objectives: We aimed to measure the efficacy of a digital behavioral intervention in reducing SSB consumption. Weight and quality of life (QOL) were also explored.

Methods: In this 2-group randomized-controlled trial targeting adults living in Appalachia, participants were randomly assigned to either an interactive, structured, digital intervention comprised of 6 cores, behavioral tracking, and personalized action planning, or a static patient education website. At baseline and at 9-wk and 6-mo postintervention, validated measures were used to assess SSB intake and QOL. Weight was captured using cellular-enabled scales.

Results: Participants (n = 249) were 88% Caucasian, 83% female, 52% with income <$55,000/y, 86% from more rural counties, and 84% with overweight or obesity. In the digital intervention group, the mean core completion was 5.2 [standard deviation (SD) = 1.6] of 6 cores, and participants tracked a mean of 76% (SD = 29%) of daily SSB diaries and 57% (SD = 31%) of daily weights. At 9-wk, digital intervention participants [-896.1 mL/d; 95% confidence interval (CI): -1043.9, -748.2 mL/d] consumed 289.8 (95% CI: -493.9, -88.7) less SSB mL/d than comparison participants (-606.3 mL/d; 95% CI: -745.3, -467.9 mL/d) [effect size (ES) = 0.37; P = 0.005]. The 6-mo assessment was similar, with digital intervention participants consuming an average of 280.9 (95% CI: -490.9, -68.0) less SSB mL/d than comparison participants (ES = 0.35; P = 0.009). There was no significant between-condition QOL effects, yet QOL improved within both conditions (P < 0.001). At 6-mo, body weight was significantly reduced for digital intervention relative to comparison participants (ES = 0.23; P = 0.046).

Conclusions: A digital behavioral intervention was efficacious in reducing SSB consumption among Appalachian adults and yielded high engagement and retention rates. This intervention should be evaluated in other populations with excessive SSB consumption. This trial was registered at clincialtrials.gov as NCT05030753.