Buoyed by science, pediatricians and cities seek to lower children’s sugar intake

Sugar consumption among the youngest Americans recently made headlines when the American Academy of Pediatrics took a tougher stance on fruit juice, stating that excess consumption can lead to “weight gain and tooth decay.”

The new recommendation — the Academy advised the fruit juice should not be given to children under age 1 and that fresh fruit is preferable for older kids — adds to a growing movement to reduce added sugar consumption for Americans of all ages.

“You’re seeing more and more interest by scientific bodies as well as the media in how to reduce sugar intake and sugar-sweetened beverages,” said Dr. Anisha Patel, a pediatrician and part of University of California San Francisco’s team of SugarScience experts.

The AAP’s new policy coincides with the American Medical Association’s announcement last month in support of “evidence-based” strategies to reduce the consumption of sugar-sweetened beverages. The AMA cited evidence such drinks with an increase in type 2 diabetes and coronary heart disease. The Association also pointed to policies such as taxes, keeping these drinks out of schools, adding warning labels, and reducing marketing to children.

The science behind the shift

Drinking fruit juice isn’t the same as eating a whole fruit, said William McCarthy, adjunct professor in the UCLA Fielding School of Public Health, in a recent seminar on reducing added sugar.

“They are not metabolically equivalent and that’s why the American Academy of Pediatrics took the motion it did,” McCarthy said.

When sugars occur naturally in fruits, they’re combined with fiber — something that has historically been ignored by nutrition researchers, he said. But emerging science is increasing highlighting the role soluble fiber plays in nourishing gut microbes, which in turn “play an underappreciated role in glucose metabolism, glucose control and satiety signaling,” he said.

Juice is also problematic because the amount of fruit in a cup of juice is much more than a child would typically consume as a whole food, said UCSF’s Patel.

High-sugar drinks can also have an effect on children’s developing taste buds. When introduced early, they may get accustomed to the sweet taste and “want it more and more,” Patel said.

Taxing added sugars

Along with these medical groups’ policy shifts, more and more communities are tackling added sugar — and its link to obesity — through sugar taxes. While they’re still in their infancy, early studies are showing promising results in reducing sugar consumption and generating revenue that can be used for health programs.

The first sugar tax in the United States was introduced in Berkeley. That tax, which was introduced in 2015, cut sales by nearly 10 percent and increased water sales in its first year, The Guardian reported.

Internationally, Mexico’s sugar tax also has led to a dramatic drop in consumption. In 2014, the country implemented a nationwide tax of about 10 percent on sugar-sweetened beverages, which could lead to a drop in type 2 diabetes cases, strokes, heart attacks and deaths, according to mathematical projections published in the journal PLOS.

In the United States, the few communities that have enacted sugar taxes did so only after hard-won battles against intense industry lobbying and court challenges.  Still, momentum is growing throughout the country. This summer, Seattle joined the growing list of communities with sugar-beverage taxes that now includes Boulder, Colorado; Philadelphia; Cook County in Illinois; and three additional California cities — San Francisco, Oakland and Albany.  

Truth in labeling

Better nutritional labeling could be another vehicle to help consumers to understand how much sugar they’re actually consuming, UCSF’s Patel said.

While it’s tough to eliminate sugar completely, trying to limit it to six teaspoons a day is advisable for children, she said. The tough part it that it’s often hidden in unexpected places — like peanut butter or pasta sauce. “If you look over the course of the day, the sugar adds up,” she said. “You’re not eating a pizza thinking it’s a sugary treat.”

One way to help people keep track of their sugar intake would be through labels that clearly show how much sugar is in a product rather than force consumers to convert grams into teaspoons. And current labeling makes it tough to tell what’s added sugar versus natural sugar. For example, some sugar in yogurt may come naturally from lactose while others might be added to sweeten it more.

Patel would also like to see more consumer information on different types of sugar. Many consumers think that coconut sugars, honeys and other “naturally derived” sugars are healthier, but that doesn’t change how your body processes it. In other words, while honey might have some great properties, it still counts as sugar.

In her own pediatric practice, Patel urges moderation.

“I don’t feel it’s fair to say zero sugar — it’s not sustainable for most of the public,” she said. “What I tell families is: ‘Make it a special treat’ and ‘Look out for hidden sugar.’”

[Cropped photo originally by Kim Love via Flickr.]