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To the Editor: In their Commentary questioning the relationship between sugar-sweetened beverages and obesity, Drs Allison and Mattes¹ cited our randomized controlled pilot study.² We would like to clarify 2 points regarding this study: the nature of the counseling provided as part of the intervention and the relevance of effect modification by baseline body mass index (BMI).

First, the intervention involved delivery of noncaloric beverages to the homes of adolescents who reported consuming at least 1 serving per day of sugar-sweetened beverage as a strategy to decrease consumption. In addition, we contacted adolescents in the treatment group by telephone on a monthly basis throughout the 25-week intervention period to encourage adherence. We disagree with Allison and Mattes that this "extra counseling . . . most likely confounded the study" because the telephone calls focused strictly on beverage consumption, without conveying other dietary or lifestyle messages, thereby serving to enhance rather than compromise treatment fidelity. . . . [Full Text of this Article]

Cara B. Ebbeling, PhD; David S. Ludwig, MD, PhD
david.ludwig@childrens.harvard.edu
Children's Hospital
Boston, Massachusetts

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