The Sugar Dilemma: Building Healthy Eating Habits for Kids

• Consuming too many foods rich in sugar can contribute to health problems like weight gain and obesity, type 2 diabetes mellitus, liver diseases, and heart diseases. ⁽¹⁾

• Consumption of sugar-sweetened beverages in children is known to be associated with obesity and weight gain. ⁽¹⁾

A high consumption of foods and drinks rich in sugar, by children, has several health implications which are manifested in adulthood. Sugar contributes to the daily energy intake, with no additional nutritional values. Sugar consumed in the form of added sugars in processed foods is the main source of sugar in children’s diets.

Sugars are the term used to include all the sweet carbohydrates. It is a source of energy with no nutritional value. Sugars are found in natural foods like milk and yogurt, fruits, and some vegetables. Sugars are found in foods like sweets, cakes and pastries, cookies, confectionary products, bakery food, candies and chocolates, flavored yogurt, and milk. Sugars are added to processed foods to enhance their palatability, color, and texture, and to make them visually appealing.

Sugars consumed through fruits, vegetables, or processed foods are converted into glucose by the liver. The glucose is stored as energy to perform many functions. The excess sugar is stored in the adipose tissue as fat.

Thus the excess consumption of sugar may result in weight gain, obesity, cardiovascular diseases, and type 2 diabetes mellitus.

The Dietary Guidelines for Americans 2020-2025, recommends that people of age 2 years or older limit added sugars intake to less than 10% of their total daily calories. Children younger than 2 years should not be given any foods or beverages with added sugars. ⁽²⁾

Early Childhood Caries

Children who consume foods rich in high sugar content are known to have early childhood caries which is a condition resulting from demineralisation of teeth.

Type 2 Diabetes Mellitus, Cardiovascular Diseases, and Liver Diseases

A diet rich in high glycemic index results in inflammation and insulin resistance which will manifest in type 2 diabetes in adulthood. ⁽⁴⁾

Excess consumption of foods and drinks rich in sugar can contribute to health problems such as weight gain, obesity, type 2 diabetes, heart disease, depression, and other psychological disorders. ⁽³⁾

The new WHO guideline recommends adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits. ⁽²⁾

There are two forms of sugar. 

Natural sugars: These are the sugars that are found naturally in foods like fruits and milk.

Added sugars:  These are the sugars that are added to processed foods by the manufacturer or the cook, in the form of syrups, honey, white or brown sugar.

The WHO guideline does not refer to the sugars in fresh fruits and vegetables, and sugars naturally present in milk, because there is no reported evidence of adverse effects of consuming these sugars. ⁽²⁾

DO’s and DON'Ts

DOs: To raise a healthy kid!

1. Limit the foods rich in added sugars such as breakfast cereals, cookies, cakes, flavored milk, yogurt, candies, and sweets; sugar-sweetened beverages like fruit juices and soda.

2. Schedule the sweet treats.

   Don’t be too strict on the kids. This will only push them to try harder to get what they like. Instead, plan a schedule to enjoy sweet treats like on a birthday or weekend. 

3. Explore substitutes

   Explore the alternatives for refined sugars like fruit yogurts, frozen fruit pops, and foods that are naturally sweetened with fruit sauces like bananas and apples. Look out for the ‘sugar-free ‘  and ‘naturally sweetened ‘labels on the product.

4. Be a role model

   Kids learn by seeing the adults practicing rather than listening. Practice what you preach. Practice moderate consumption of sugar and avoid ultra-rich processed foods.

5. Cultivate good eating habits in their lifestyle. Include vegetables, green leafy vegetables, fiber-rich fruits, and dairy and calcium-rich foods. Adding little sugar to healthy grains, like cereals and wholegrain bread, may encourage kids to opt for healthy foods.

6. Encourage exercising as part of their daily routine. 

7. Nutrition facts label

   Check for the nutrition facts label before buying any food. Look for the values of total sugars and added sugars on the label so that you can make informed choices based on your health needs and preferences.

Check the label to see if foods are LOW or HIGH in added sugars.

• 5% DV or less is a LOW source of added sugars

• 20% DV or more is a HIGH source of added sugars.⁵

• DV represents daily value.

• Involve them in meal planning: Allow them to choose the healthy versions of the sugary foods. Let them make informed decisions about their eating habits.

DON’Ts: To raise a healthy kid!

1. Babies and children less than 2 years old should never have sugary foods or sugar substitutes. This is attributed to the increased risk of obesity and type 2 diabetes mellitus in adulthood.

2. Sugar is neither the best friend nor the enemy.

   Teach them to enjoy the sugar treats without any guilt or fear.

3. Don't encourage giving sugar as a reward. This will make the kids crave sugar even more.

4. Don't be too strict with the kids when it comes to candies. Be flexible with them with little limitations. Discuss beforehand with the kids before going out to birthday parties or outings with friends and family.

5. Never skip meals. This may result in sugar cravings.

Summary

Kids seek inherent joy in indulging in sugary treats. A moderate intake of sugar, thus, in any form, does not hurt. 

The growing demand for the rich, ultra-processed sugary foods in the market and the increased occurrence of chronic diseases like obesity and weight gain, cardiovascular diseases and heart diseases, and early childhood caries - are parallel with each other. 

A mindful and comprehensive approach drafted towards the dietary habits of children, could address the problem of overindulgence in sweet treats and drive the kids towards making mindful choices preferred over choices linked with pleasure.

Reference:

1. CDC. Get the Facts: Added Sugars [Internet]. Nutrition. 2024. Available from: https://www.cdc.gov/nutrition/php/data-research/added-sugars.html

2. World Health Organization. WHO calls on countries to reduce sugars intake among adults and children [Internet]. www.who.int. WHO; 2015. Available from: https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children

3. Velázquez AL, Vidal L, Varela P, Ares G. Sugar reduction in products targeted at children: Why are we not there yet? J Sens Stud. 2021 May 20;36(4).

4. Bestle SMS, Christensen BJ, Trolle E, Biltoft-Jensen AP, Matthiessen J, Gibbons SJ, et al. Reducing Young Schoolchildren’s Intake of Sugar-Rich Food and Drinks: Study Protocol and Intervention Design for “Are You Too Sweet?” A Multicomponent 3.5-Month Cluster Randomised Family-Based Intervention Study. Int J Environ Res Public Health. 2020 Dec 21;17(24):9580.

5. Added Sugars on the Nutrition Facts Label. FDA [Internet]. 2023 Sep 27; Available from: https://www.fda.gov/food/nutrition-facts-label/added-sugars-nutrition-facts-label

(Input from various sources)

(Rehash/Yagna Prasanna Kondadadi/MSM)