February 2013 Summary

Sugar and sugar substitutes are hot topics that have flooded both media and academia with research and confusion.   There are a lot controversial studies that some say sugar has no negative effects, some say certain sugars are to blame.  Other studies say that artificial sweeteners are the answer to lowering calorie intake in America, while other studies say they increase obesity and cause cancer despite being generally recognized as safe by the government.  It is no wonder that the public and professionals alike are confused at what all of this means.

                While it is known that both the use of sugar sweetened beverages is increasing in America and the use of artificial sweeteners is increasing as well in order for people to try and obtain a healthy body weight.  While these studies show that increased consumption of sugary beverages can increase the risk of heart disease in children and that sugar sweetened beverages may not help in preventing weight gain or help to aid weight loss.  What is known is that sugar sweetened beverage intake has been associated with adverse health effects and that artificial sweeteners may not be a viable answer to help reverse their effects after the damage is already done. This discussion is to see how RDs would be able to rationalize their decisions in counseling in these areas to maximize their recommendations to future clients.

Question 1: After reading the second article do you feel like switching children to diet soda is a good way to avoid negative effects of SSB?  Why? How can you use this information with future clients?

Everyone agrees with the idea that SSB are not a good part of a child’s diet and should be limited or removed.  Some of the interns seemed to believe that AS would be a good alternative to SSB only if the parents/children were unwilling to avoid soda all together.  Also, Amy pointed out that she believes that it depends on the degree that children are drinking the SSB.  If the child is drinking 6 pops a day then switching them to diet pop she believes would still be beneficial despite what the article indicates and several other interns agree with this statement.

Many of the interns feel like though that neither SSB or AS beverages should be consumed by children and that they should be replaces by water, milk, or 100% fruit juice.  Teju made the point that for children that are very resistant to wanting to give up pop all together the parents could try making milk shakes or smoothies with real fruit to give the children the sweetness but in a natural form.  Molly made the point that she agrees that SSB intake needs to be decreased but cautions against an all or nothing approach for fear that children will rebel and find a way to drink extra amounts of the SSB when the parents have less control over their intake.  Many of the interns agreed with this point of view and feel it is valid.

Another theme that seemed to be discussed during this question was that many of the responses state that for a child to be taken off of both SSB and AS they would need the parents cooperation.  The claims were that if a parent starts the child off at birth with not ever having SSB, then the child will never have a craving for them and will grow up with better nutritional habits.  Some interns quote their own life experiences with only being allowed milk at dinner as children and how themselves and their family members still practice this today.  A point that went along with this is the fact that interns would counsel the parents of the children to set a good model for the children and avoid both regular and diet drinks in the home.  By setting this good model then it would be easier to adopt water, milk, and 100% juice for the child.

Finally, some interns brought up the safety and efficacy of the use of certain AS.  Aria reports research that she has done on aspartame and high temperatures normally found in warehouses causing formaldehyde in the body which had negative effects. Also, she reports sucralose and how they can also have negative side effects such as headaches, tingling, and dizziness.  Her stance was that since there is so much unknown about the effects of these chemicals in the human body it would be risky to allow children to have them.  Angela also agreed with these statements.  Angela also stated, and several interns agreed, that there is a problem currently with kids being addicted to sweeteners and they are taking the place of nutritious foods/drinks and therefore need to be regulated.

                Many responses claim that they can use the information in the articles about the cardiometabolic effects of SSB on children and the unknown and possible negative effects of SSB with future clients.

               

Question 2: As this study states Sugar sweetened beverages are related to several cardiovascular risk factors.  If you had a client come in with a child who was not overweight yet but after talking with the parent you find that the child consumes several 8 oz glasses a day of SSB in the form of sweetened fruit juice, chocolate milk, and pop.  The client reports that the child is not a “a very good eater” and therefore they let the child drink more of their calories.  How would you approach this situation knowing that SSB increase the risk of high waist circumference and future heart disease?  What are some techniques that could be used to reduce SSB? How could you motivate the child/parent to make a change with something like future obesity or heart disease being so abstract?

Many of the responses varied in approach and techniques.  Most of the responses reported that to motivate with the idea of obesity/heart disease would not be effective and therefore most would not mention it.  Some interns did respond they would mention it or as Angela said use a different more “shocking” statistic like this generation of kids will be the first generation to not outlive their parents.  Overall, most of the interns felt like a more informational approach based on short term growth/health would be the best approach at motivating parents/children to make a change from a highly concentrated diet of SSB.

The responses on different techniques to get children to decrease SSB were varied and interesting.  Many of the interns that have had rotations at WIC reported having similar clients at WIC and would report having the children and parent agree on appropriate amounts of SSB per week and then substituting in other more nutritious items with SSB as an occasional treat.  Many of the interns also said that they would do a food recall with the parents/children in order to determine what is a “poor eater” to them and then work from that starting point. Once they determined this information they would then make suggestions on fruits/vegetables/highly nutritious items that the child does like and help to work them in as they decrease their amount of SSB.

Alana pointed out, and most everyone agreed with her, that a techniques that could work is slowly diluting SSB beverages with water over time until it basically becomes flavored water is a good way to transition a child from heavy SSB to a more manageable level. Kelsey quoted recommendations from Ellyn Satter that many of the interns also felt was a good method of transitioning a child off of SSB and onto whole natural foods.  This included fairing unfamiliar with familiar food, don’t make special food for the child, be sure to put one or two foods on the menu that they ordinarily eat, let them pick and choose from what you put on the table, do not limit the menu to food your child readily accepts, do not talk about the food the child likes or dislikes, and do not let the child graze in between meals.

Carly and several other interns also reported that since the child likes juice so much that the parent could nurture this with buying a juicer for home.  Other suggestions based on this included having the child help make the juice in order to have them have a place in their nutrient selection.  Also, suggestions included pairing fruit with vegetables to get the child a variety of nutrients while not having excess added sugar.  Aria also suggested adding PediaSure into the diet would be better than most SSB due to adding other nutrients that the SSB are lacking. Finally, many agree that since the child is a picky eater to allow them to have several choices of nutrient rich foods frequently and trying to educate both the parents/child on the need for solid food and the benefits long term and short term it will bring to their health and wellbeing.

Question 3:        With information from studies like the SSB article that show deleterious effects of sugar beverages.  How do you feel about states having “soda” taxes and removing pop and sugary drinks from school ground? Do you think this helps to curve some of the behaviors long term or not?  If you do not agree what are some things you would suggest to get populations off of sugary drinks from a government, society or professional standpoint?

By far in large almost every responder to this question believes that the “soda” tax would not make a significant difference and that it may promote people to drink it as a forbidden fruit paradox.   However, almost everyone agrees that SSB machines (and other high sugar snacks) should be removed from school grounds.  While it was stated that this is only 1/3 of the student’s intake it does show them disapproval and could prevent the exposure/bad habits from developing.  There was also a concern that over regulation of the government would be a problem and be taking away more rights of the person.

Since most of the interns agreed that the tax wouldn’t help they sited previously legislature that has failed to produce long term effects, such as alcohol/cigarette tax.  Most agree that education of the person and finding new and interesting ways to motivate them is going to be the answer and that the tax would not be able to be significant enough to make a real difference but more an inconvenience.

Teju and Amy made a point that some of the responders got behind.  They claim that studies and their own experience have shown that increasing the tax on unhealthy things does decrease the intake of these items.  This started a debate that many people claim they do not want to buy healthy because it is more expensive that the unhealthy stuff.  Increasing the tax to make unhealthy and healthy choices the same amount may be a motivational tactic that could work according the predictions of the students.

Recommendations for practice:

While this is a hot issue right now it seems that there is no clear cut answer.  From the response reviews it seems that my fellow interns feel that education of kids about cardiovascular and obesity will fail to motivate children to avoid SSB or AS in the future.  Also, many fail to believe that a tax on bad food would bring about any significant change.  Perhaps what we could do in practice is lobby for the government to make stricter regulations on labeling or acceptable quantities of ingredients that they can put into products.  Also, perhaps encourage government to reward making healthy decisions as opposed to punishing poor decisions with taxes.  Perhaps subsidizing healthier food options to make them cheaper you be more effective tactic.  As far as getting kids off of SSB and AS it appears to be a far off goal right now and making small choices now and encouraging parents to model good behavior is the best bet.  Also, working with schools to promote healthy choices and advocating coaches and other health role models to promote the best fuel for our youth could be a potential avenue a future RD could use to help achieve a more healthful diet for children today.