March 2019
Happy National Nutrition Month!
This month's continuing education article is titled "Child and Adolescent Sugar-Sweetened Beverage Intakes Are Longitudinally Associated with Higher Body Mass Index z Scores in a Birth Cohort Followed 17 Years". This research article explores the association between sugar-sweetened beverage intake and BMI in children and adolescents. Although BMI is a questionable measure, I think we could all agree that sugar-sweetened beverage intake, especially in this population, is a pertinent issue.
Link to the article: https://jandonline.org/article/S2212-2672(18)30858-X/fulltext
Aside from your general thoughts and reflections on this study, here are some questions to stimulate your response:
1. This study found that sugar-sweetened beverages were significantly associated with an increase in BMI throughout childhood and adolescence, but 100% juice and milk were not. What are your thoughts on this finding?
2. In this study, 100% juice was not considered a sugar-sweetened beverage by definition, but has lately been receiving a bad reputation for its high total sugar content. Do you think that 100% juice should be in the category of beverages to limit in young children or adolescents?
3. Why do you think this study looked at the socioeconomic status of the participants? Do you think there are any other categorical independent variables that could contribute to SSB intake in children?
4. What are some weaknesses of this study and how could they have been improved?
5. As future dietitians, how can we can reduce the intake of sugar-sweetened beverages in the child and adolescent populations? What are some barriers?
1. This study found that sugar-sweetened beverages were significantly associated with an increase in BMI throughout childhood and adolescence, but 100% juice and milk were not. What are your thoughts on this finding?
Abstract
Background: Sugar-sweetened beverages (SSB) are considered a
risk factor for obesity.
Objective: The objective of the current study was to
investigate associations between the predictors of beverage and energy intakes and mean
adequacy ratios (MARs), and the outcome of body mass index (BMI) z scores, in a birth
cohort using longitudinal models.
Design: This was a longitudinal analysis of secondary data.
Participants/setting: Participants in the Iowa Fluoride and
Iowa Bone Development Studies with two beverage intake questionnaires completed
between ages 2 and 4.7 years or 5 and 8.5 years or one questionnaire between ages 9
and 10.5, 11 and 12.5, 13 and 14.5, or 15 and 17 years (n¼720); two food and beverage
diaries completed between ages 2 and 4.7 years or 5 and 8.5 years or completion of the
Block’s Kids’ Food Frequency Questionnaires at age 11, 13, 15, or 17 years (n¼623); and
anthropometric measures at the corresponding age 5-, 9-, 11-, 13-, 15-, or 17-year
examination(s).
Predictors: Mean daily 100% juice, milk, SSB,
water/sugar-free beverage, and energy intakes and MARs averaged over ages 2 to 4.7, 5 to 8.5, 9 to
10.5, 11 to 12.5, 13 to 14.5, or 15 to 17 years were predictors.
Outcome: BMI z score was the outcome.
Statistical analyses: Linear mixed models were fit for each
beverage, energy, and MAR variable, with the beverage, energy, or MAR variable as the
predictor and BMI z score as the outcome. Beverage models were adjusted for energy and
MAR and baseline socioeconomic status.
Results: SSB intake adjusted for energy intake, MAR, and
baseline socioeconomic status was associated with BMI z score; each additional 8 oz SSB
consumed/day throughout childhood and adolescence increased the BMI z score an
average 0.050 units (95% CI 0.022 to 0.079; P¼0.001). Adjusted water/sugar-free beverage
intake (0.026 units; 95% CI 0.006 to 0.046; P¼0.013) was modestly associated with BMI
z score, while 100% juice (e0.001 units; 95% CI e0.059 to 0.057; P¼0.97) and milk
(0.022 units; 95% CI e0.007 to 0.052; P¼0.13) intakes were not associated with BMI z
scores.
Conclusions: Higher SSB intakes were associated with
increased BMI z scores throughout childhood and adolescence in Iowa Fluoride Study
participants. Public health initiatives targeting SSB consumption during
childhood and adolescence remain relevant
posted by Jaime @ 3:46 PM
48 comments
48 Comments:
The fact that the study found a positive correlation between sugar-sweetened beverages but not 100% juice and milk is an interesting finding. It is more shocking to me that there was no significance found in the correlation of 100% juice and BMI, because it contains a higher amount of sugar than milk. Although milk and juice contain decent amounts of sugar, maybe the data was not significant because they do not contain as much sugar as other sweetened beverages. For example, one cup of milk is about 12 grams of sugar, whereas a can of soda contains close to 40 grams of sugar. Although 100% juice is not considered a sugar-sweetened beverage by definition, it does contain a higher amount of sugar than other drink options. I believe it’s good that people are being made aware of the amount of sugar in juice, because many people believe that because it is 100% juice they can give as much as they want to their children. I think it would be wise to limit fruit juices among children, not to such an extent to where they can never have it, because many juices have beneficial vitamins and minerals. It would be a better choice than soda but not beneficial to give to children all the time because of the sugar content.
The socioeconomic status of study participants could have an affect on the amount of sugar-sweetened beverages the children drink. Participants of lower socio-economic status could have less knowledge on health-related topics, which could lead to them giving their children fruit juice more often than participants of higher socio-economic status. I believe other variables that could affect the study are the amount of physical activity a child gets, their overall nutrition (what the family feeds them), and the location in which they live. All of these variables could have an effect on the child’s BMI. A weakness of the study is that the beverage and dietary intakes were self-reported, so the data could not be accurate due to human error. Also, the study sample was similar in the fact that they were all mostly of the same race, socio-economic status and other demographics. This does not depict a big picture of the general population.
As a dietitian, I think one of the main things we can do is educate people and help them understand the amount of the sugar in 100% fruit juice and what the risks are of continually consuming too much sugar. If a parent was aware of the potential health dangers for their child from continually consuming high amounts of sugar, it might lead to a reduction in the consumption of these sugar sweetened beverages. The knowledge we have is a powerful tool we can use as future dietitians, so sharing what we know in an understanding and non-judgmental way could be beneficial in this situation. A barrier to this would be trying to educate people who are unwilling to change their ways or uninterested in listening to the advice we are giving them.
I enjoyed reading this article as it had an interesting result. It was shocking to me that 100% fruit juice was not included in sugar-sweetened beverages and was not significantly associated with BMI scores in either age range. However, I still believe juice should be in the category of beverages to limit in children’s diets. Currently I am taking an Childhood nutrition education class, and I have learned that it is imperative to completely eliminate juice consumption up until the age of two. If juice is introduced to the child before that age, the child is more likely to not drink enough water and prefer sugary food items which can increase the risk of developing obesity later. In addition, consuming to much fruit juice can cause development of dental caries in young children which is important to avoid. As a child progresses into adolescence it is okay to introduce juice, but it still should be limited as fruit juice is not a better source than natural fruits to receive essential vitamins and minerals.
One reason the study looked at socioeconomic status could be to assess the access to certain types of foods. Lower income families tend to buy cheaper groceries which include sugar-sweetened beverages and prepackaged meals compared to higher income families who have more financial access to purchase fresh produce and healthier beverage options. Al though, higher income families still may choose to buy sugar sweetened beverages just depending on the family’s eating habits. In addition to socioeconomic status, I believe lack of nutrition education could lead to sugar-sweetened beverages consumption. Parents who are not educated on the sugar content in beverages will continuously offer them to their child without being aware of how they are effecting their child’s health.
With that being said, Registered Dietitians are responsible for providing information to clients to improve their eating habits. In order to reduce the sugar-sweetened beverage intake, Registered Dietitians can approach the subject relating it to the oral health, especially in young children. Educating parents and children on that subject could persuade them to limit the consumption. However, some families may no listen to this information especially if their child(ren) do not have a history of poor dental health. Also, dietitians can promote more water intake infused with fruit or offer a few alternative non-water beverages, so the child is not completely restricted from drinking flavored drinks. A barrier in encouraging children to drink alternative beverages is simply the fact that most children do not like to try new things and have a hard time changing their normal habits.
1. I think that it's interesting that SSB were the only category of beverage to have a significant effect on weight. While I do think that SSB definitely contribute to weight gain in both children and adults, it may also be due to the overall diet that these beverages are a part of. Children don't tend to meet the recommendations for milk, so if they are consuming more dairy beverages it may mean that their parents/guardians are being more conscious of or more educated about their children's diets and trying provide a generally healthy diet, which includes milk. The same could go for 100% fruit juice, which although not recommended for young children, is generally recommended and perceived as a healthier option than SSB. It's important to note that the reported results in the article were controlled for energy intake; however, the make-up of those calories could vary greatly and support my speculation that the children who consume milk or other beverages more frequently may have overall healthier diets even if energy intake was accounted for.
2. In this study they were technically correct to not include 100% fruit juice in the SSB category. The glycemic index for fruit juice is lower than soda, and it may have a bit more micronutrient content than soda does. However, should it be given to small children? I'm going to have to say no. Even if it isn't a sugar-sweetened beverage, it's still a sweet beverage. This is speculation, but by learning to drink their calories, it would make it much easier to get in the habit of sweet beverages and easier to switch to other SSBs. Not to mention that they are missing out on fiber and the satiety that provides, and I'm sure nutrients are lost in processing. For children, I would avoid 100% fruit juice as long as it's being replaced by something more nutrient dense.
3. I'm glad they accounted for socioeconomic status, because that can have an impact on what foods are affordable and accessible. Socioeconomic status can also be correlated with education, and if the parents/guardians are not aware of the detrimental effects of SSB on weight status, they may not avoid them, so education level of the parents/guardians is definitely a factor I'd like to see. Also whether or not they participate in school breakfast/lunch programs and ethnicity would be helpful. In a larger study, I'd be curious to see the overall diet patterns of those who consume more SSBs as compared to those who consume more milk, 100% fruit juice, or water, to see if there's a difference in composition or types of food typically consumed with the different categories of beverages.
1. It is understandable as to why a SSB would have a greater influence on BMI in the subjects, but what is challenging to understand is why 100% juice and milk were not. 8 oz of 100% apple juice contains about 27 g of sugar compared to 8 oz. of coke which contains about 28 g. What I believe we're ultimately getting back to here is the difference of table sugar, fructose, and lactose and how they are processed differently in the body. So while there may be comparable amounts of sugar present in these types of drinks, how they are processed is different. Additionally, I figured that milk would have a similar influence on BMI as SSB but more so because of a gain in lean body mass due to milk's high protein and calcium content.
2. This is question has many facets to consider. In general, I do not believe that we should be discouraging parents from having their children have 100% juice. But I think it is important to consider that while it may be a better choice compared to a SSB, 100% juice is till quite sweet when consumed. In a way, I feel this is conditioning kids to crave and consume more sugar dense products because they are so used to the sweet taste. A better option would be to water down the 100% juice to save money in groceries, dental fees, and prevent children from becoming too accustomed to highly sweet beverages.
3. Lower SES has been tied with higher intake of SSB, junk-type food items, and fast foods as well. This would be difficult to measure, but if the children and adolescents had ever been exposed to a nutrition education or health course would be an interesting variable to observe and see its influence on SSB intake.
4. It is understandable as to why BMI is used in studies, however I still dislike using it at times. What if a portion on the children or adolescents were participating in sports that support increases in lean body mass? Can we assume that SSB intake influenced their BMI, or is their increase in BMI because of increases in LBM? Additionally, I would have liked to see the researchers touch on differences between the sexes. For example, adolescent females tend to have greater increases in fat mass during adolescence just due to puberty. Seeing each sex independently analyzed and discussed would have provided some more insight.
5. Starting with the parents is the first and foremost way to do influence a child and adolescent's SSB intake. We are not here to demonize sugar sweetened beverages, that is not our job. Our job is to discuss the implications for consuming high amounts of SSBs and its effect on health. If we encourage parents to think about soda as more of a special treat, and less of grocery staple they buy weekly, then we can better control the youth of America's intake. Another point of interest is in at the public sector on what types of foods should be served during school lunches and throughout the day. An example, in my high school soda machines were only turned on during lunch hours of the day. While as a student I despised this, it certainly was a simple way to control how much soda was being drank throughout the day by students.
Liz,
I really liked your first point in investigating what other types of foods are being consumed. While this would be challenging to do in a sample this size, I feel it is in important thing to bring up. If you think about what kind of food you had access to as a child, it almost disgusts you as to what passes for a healthful diet in our schools. Additionally, many children have full control over what they can get from a hot lunch. In my high school, students commonly ate a burger or chicken patty with a large side of fries. Then many of the students would go back and get a straw hat (frito's, beef, melted cheese). Well over 1,000 kcal right in that meal.
Your second point brings up excellent topics about glycemic index of soda vs. juice and the lack of fiber or the satiety component when consuming foods in the form of liquid. Glycemic index is losing some of its reputation as of lately, but ultimately we know the importance of presence of fiber and proteins on glycemic control when consuming foods.
Amy,
I agree with your first point almost entirely. The things I agree on is the influence of fruit juice on dental carries and its influence on obesity, especially in early life. You are correct when saying that children will become very dependent on the sugary taste of juice. But to say that we should completely eliminate it is a tougher pill to swallow. My issue with this is that by completely eliminating juices children and adolescents will then think of anything that is sweet as taboo, and that they should break the rules. I commonly conduct nutrition consultations where someone will say "isn't fruit bad because of the sugar content"? Which we of course know is not true. A better method in this case would be to educate about what fruit juices are, and how over consumption of too much of them can decrease your health. Do I drink soda everyday, no. Will I on occasion, sure. It all gets back to improving the relationship with food, and helping to educate the consumer about how too much of anything is going to have negative results. I fully understand and agree on the position of the childhood nutrition education class on consumption of fruit juices. I just think there is a lot more to this question besides what effects it has on health.
1. This article dove into one of the hot topics of this time, childhood obesity. With many compounding factors, the change in diet composition and lifestyle of children has become apparent. This study particularly looked at SSB which are very common in homes, schools, and restaurants. It is not confusing why 100% juice was not counted (being that it doesn't have the artificial sweeteners added) but milk on the other hand is a very popular drink for children. Served at essentially all schools, milk and chocolate milk are beverages that many children consume quite frequently. I don't believe the researchers included it because of the higher nutrient/protein content that may attribute to lean body mass. However, it would be interesting to see if there was a correlation between either plain milk/chocolate milk and BMI of children since it is such a common beverage, offered to them almost daily.
2. I do believe 100% juice should be limited because of the high sugar content. However, it is definitely preferred to juice concentrates, sodas, Kool-aid, and other SSB. The difference in sugar type, being natural vs. artificial, between 100% and other juices must have some impact on the way it is processed and stored in the body. My actual concern with 100% juice is that most people don't have just a serving but rather a couple either in one sitting or throughout the day. This would lead to very high simple sugar intake and increased BMI in children, especially those who do not have an active lifestyle.
3. The SES would be a very important variable to consider. Research regarding lower SES and food desserts show how difficult it is to have a healthy diet when all that is available or affordable is not good for people, especially children in developmental stages. A few other variables that may impact or alter the intake of SSB could be who the primary caregiver is or who watches the children the majority of the time (siblings, nanny, grandparents, etc.), where the study takes place (northern vs. southern regions), or perhaps ethnicity as well since some cultures consume more SSB than others.
1. I have a few thoughts regarding the finding that SSBs are associated with BMI, while 100% juice and milk are not. My first thought is that maybe children enjoy SSBs more, so they drink them more often than juice and milk. As seen in Table 1, you can see that there is an increase in SSB consumption over the years, while there is a decrease in 100% juice and about a consistent intake of milk. Since there is a higher intake of these SSBs, there is a greater association with BMI. Consuming lots of SSBs is more concerning in my eyes than consuming lots 100% juice or milk. My second thought is that maybe since the SSBs are sweetened with added sugars, but 100% juice and milk have naturally occurring sugars, that could affect the child’s BMI. Added sugars have been shown in the past to have a negative effect on health outcomes, so the high consumption of added sugars in the sugar-sweetened beverages makes sense to lead to increased BMI.
2. While I think 100% juice can be both good and bad, I do think that it should be limited in children. It can be good to drink 100% juice for individuals who do not have consistent access to fresh fruit. I don’t think it needs to be in the SSB category, but should be limited due to the high total sugar content.
3. I think noting the SES of the participants is important because their BMI and overall weight status could be affected by many other factors. Other studies have noted that individuals with a lower SES and less education tend to consume less healthy foods in general. Taking note of the participants’ food intake, beyond the beverage intake, as well as physical activity levels would be important to determine how much the beverage intake is associated with BMI.
4. One weakness is the self-reported intakes. This allows for the participants to lie or misreport their intakes, leading to flawed results. There isn’t a very good way to improve this, other than to continue encouraging the participants to be as accurate as possible. Another weakness of this study is the fact that one questionnaire included both 100% juice with juice drinks. This could have adjusted the results and caused the inability to identify between the two drinks. One way to improve this is to have a different drink on each questionnaire, so that non are combined. Finally, a third weakness, is the sample size. As discussed, 94% of the participants are non-Hispanic white. This could be a weakness because there is a more diverse population of individuals in the United States, and around the world, so these results may not be generalized to the larger population. One way to fix this is to include an equal number of participants from each race and make note of that.
5. As future dietitians, we need to do our best to reduce the consumption of sugar-sweetened beverages in children and adolescents. One way we could work to do this is by suggesting the consumption of fruit in water. Many people do not like drinking water because it “tastes bad”, but this can be adjusted in healthier ways than adding a bunch of sugar. The children could add things such as lemons, cinnamon sticks, sliced apples, or other fruits to their water to make it taste sweeter. One barrier to this option is the availability of fresh fruit. Individuals that do not have access to fresh fruit will not have the ability to use fresh fruit in their water.
Rachel,
I agree that it would be interesting to see the results of this study using milk/chocolate milk. I didn't think about the fact that milk is often offered in schools during lunchtime. While reading this article and writing my responses, I was mostly thinking about home life and what children drink at home. What I've seen most often (from babysitting) is that children like drinking things like apple juice, sodas, and sometimes milk. From these thoughts, I concluded that children drink SSBs more often than milk. I also like your thoughts from the second question. It is so easy to drink multiple big glasses of juice throughout the day, that it definitely is something that needs to be limited. Drinking one 8-oz glass per day would be a good starting point at attempting to reduce intake in children.
Zak,
I like in the third question how you brought up the idea of looking at individuals who had received a nutrition course and see how that affects their SSB intake and BMI. This would be interesting because even though I do believe SES affects these variables, a nutrition course would affect them differently. We would think that individuals who receive a nutrition education course would end up having a lower intake of SSBs, but that may not be true. This type of study could be very beneficial. I also liked your thoughts in question 5. If parents don't see a problem with providing unlimited sodas and other SSBs to their children, the children won't know any difference and will most likely drink a lot of it because it tastes good. Targeting the parents to limit their child's SSB intake and to educate their child is a good way to go about it. Mentioning the school's availability of these SSB is important too. If the school cafeteria offers a bunch of sodas, then the students' eyes will likely be drawn to those and choose those as their beverage. Putting more water in the fridges and vending machines and only a few SSB options could help reduce SSB intake in schools.
This article was interesting because the first thing that came to my mind after reading it was health and wellness marketing. This study looked at sugar sweetened beverages, but I wonder what the labeling looked like on the drinks they chose. The BMI of the children were higher on the sugar-sweetened beverages, which would be artificial, versus the 100% fruit juice. If the 100% fruit juice had no added sugars then the children' BMI should be lower because they are consuming less added, artificial sugars. This study proves what we learn in class, however, the majority of the population see fruit juice and automatically think it is healthy. It would be interesting to do a similar study that compared 100% fruit juice with added sugars versus 100% natural fruit juice. I wonder what the parents would choose to give their children or if the children would know the difference. Some 100% fruit juice has just as many added sugars as soda or "unhealthy" drinks. Nutrition marketing has become creative on wording to make consumers believe it is healthy.
Looking at socioeconomic status is important in a study like this because it may show trends in choices of the drinks. Low socioeconomic populations tend to have lower education levels which could lead to uneducated food or product choices. If the label say fruit juice they could think it is a healthier option. Also, if money is an issue for a family, they will choose cheaper choices which tend to be sodas and juices. As a dietitian, we have to be understanding off all economic situations.
One weakness of this study is the self reporting aspect. Any nutrition intake study has the opportunity to be skewed because the researcher has to trust that the participants are going to be 100% honest. This will not always be the case in research especially if it is focusing on healthy versus unhealthy food choices. Another weakness of this study is the differentiation of fruit juices. As nutrition majors, we understand how to read a nutrition label and know what 100% true fruit juice versus "fruit juices" are. The participants may have had different ideas of what the sugary sweet beverages and fruit juices are. This aspect could also give skewed answers from the participants. Having education on the different beverages and also a guide that the participants could follow to get the most accurate answers could be beneficial for this study.
Parents' opinions and what they think is best for their child will always be a barrier as a dietitian. It is difficult to tell a parent that their child may be going down an unhealthy path and it is due to behaviors that are practiced at home. I think educating the family together could be beneficial for a situation like this. Educating on how to read a nutrition label and keeping the mood positive showing how important it is to know the ingredients instead of saying they cannot have sugary beverages. Also, being creative as a dietitian is important especially when working with children. The child may already be addicted to soda, so showing them there are other fun drinks with less added sugar could be useful.
1.
I understand why the sugar-sweetened beverages were significantly associated with an increase in the BMI of children and adolescents but I do not see why milk and 100% fruit juice were not considered in the same category as such. These have similar sugar contents but I believe it has to do with society’s views on the drinks. Milk is fortified with vitamin D and calcium and the 100% fruit juice counts as a serving of fruit so these are beneficial to children and adolescence. Another thing that could be looked at is the consistency of the consumption of these drinks. The sugar sweetened beverages in the study are more often consumed and also contain different sugars from those in milk and 100% fruit juice.
2.
I do believe 100% fruit juice should be in the category of limited consumption in children and adolescents. The high sugar content of these drinks can contribute to dental carries in children. I also do not believe it is very practical to limit these types of beverages because they are substitutes to the sugar-sweetened beverages such as soda and Kool-Aid. Some families also cannot afford a lot of fresh fruit so it is also a good way for these children to get in their daily servings of fruits.
3.
I believe it looked at the socioeconomic status of the participants because this can contribute to the types of beverages they can afford or that are in the stores around them. For instance if a family lives in a food desert, then sugar sweetened beverages will be more prominent. Some independent categories could be what is given to them at school and whether they got o public or private schools. Another thing that can be looked at is who is the primary caregiver and the education level of the caregiver. Another thing could be the activity level of the child. If they are in sports then their BMI could be lower than those who are not in sports or who do physical activity.
4.
Some weaknesses of the study are that the dietary intake and beverages consumed were self-reported. This can always lead to error in studies because of dishonesty. It also would have been beneficial to include a more diverse population of the participants. This could better show how economic status plays a role in the intake of SSB and BMI.
5.
As future dietitians, we can always push education with parents and with teachers. It is important to educate people on the foods and beverages they are giving their children. When people are aware of how these beverages affects their children’s health, then they may rethink about giving it to them. Some barriers would be that some people cannot afford to give their child any other beverages. Also you will always get the people who do not see anything wrong with it because they may have consumed them when they were children and adolescents so they think it will not affect their child.
Zak,
I agree with your response to the fifth question. I also believe that educating the parents plays a major factor in the consumption of these beverages. Instead of shaming them and the drinks, I like how you suggested using them as a "treat" for maybe special occasions. This could definitely help with moderation and show that these beverages do not have to be completely cut out. I think it would be a good thing to implement what your school did in all schools. Turning off the machines when lunch is not in session could decrease their consumption. I think that even only allowing certain SSB beverages in the machines would be beneficial as well. It would be nice to also see education posters in schools educating the children about these beverages as well.
1. This result does not surprise me. These sugar sweetened beverages are adding extra calories to a daily intake that a child may not be using. In addition, these processed sugars could be affecting a child’s appetite for a healthier meal. The milk does not surprise me. Milk has essential nutrients in it, giving it more nutritional value that just milk sugar. The juice did surprised me. Even though 100% juice is less processed than other sugars, it is still sugar. Juice still adds additional calories than an individual may not be using. Table 1 shows an increased consumption of sugar sweetened beverages over the years. Encouraging lower sugar options earlier on may cause children to gravitate towards those options instead. However, it is important to observe the other factors that could lead to and cause childhood obesity considering lifestyle habits as a whole.
2. I think that 100% juice is a better option than say, a can of pepsi, lemonade, Kool-Aid, etc. However, there is still sugar in it, with very little other nutritional benefit. I think 100% juice should not be totally eliminated, but it should be limited. I would try to encourage whole fruit more because it is less processed and it has more fiber content.
3. Socioeconomic status is always something to consider when it comes to testing BMI measure from a population. Generally speaking, sugar sweetened beverages are cheap. They can give you calories and a small price. An individual who is from a lower socioeconomic status may not be able to afford the price of eating healthy. This factor may affect an individual’s BMI. However, it is important to consider all other factors that may cause obesity.
4. For me, I am not the biggest fan of using BMI measures. Yes, they are helpful and can be used at times. However, I don’t think it always is the best indicator of health. You could have an individual with a higher muscle mass that is considered “overweight” by BMI standards. In addition, you could have a healthy individual who may be slightly overweight due to genetic diseases and/or disorders. Lab values such as blood glucose, cholesterol, triglycerides, heart rate, blood pressure, etc would be the best form to determine health status. However, BMI is the most feasible so it is understood why someone may use this measure over lab values.
5. As future dietitians, I think it is important to encourage the reduction of sugar sweetened beverages. This has been shown in several studies and research that this causes individuals to be overweight and obese. Encouraging children to drink more water is a good start. If children don’t like the taste, I would encourage to add fruit or flavored sparkling water. Another option would to be a sugar free flavor enhancer like Mio. Even though those contain artificial sweeteners and flavors and may not be ideal for ALL water consumption, it could be a start to help ween an individual off of sugar sweetened beverages.
Lacey,
I like your comment about educating the family together as a way to decrease the consumption of sugar-sweetened beverages. Getting the child involved can help implement healthy habits early on so that they may use them all throughout their lives. Teaching them how to read nutrition labels can help them understand some key nutrition aspects without going too in depth to a level they may not completely understand. I also agree that parents can be a big barrier when trying to share nutritional knowledge. Many people have their own opinions even when they are not educated on the topic.
1)I'm genuinely not surprised about the findings. I don't think many people would be. However, the new hot topic is that human adults shouldn't be drinking milk, but I won't even get started on that. There is a lot of research on the effects of added sugar, which is pretty much what is added to the SSB.
2) I mentioned added sugar above. There's a big difference between sugar content and added sugar content. Natural sugars from fruit do not have nearly the same amount of negative connotation as the added sugars do. I think that it is okay to have children consume 100% juice, if it is ACTUALLY 100% juice. However, it shouldn't be the only thing they're drinking. Moderate intake, maybe a serving or two per day would be fine. I'm a firm believer in getting kids comfortable drinking water regularly when they're young so they have developed that habit for the rest of their lives.
3) Socioeconomic status plays a role in what foods and beverages are purchased. Some healthier options are often more expensive. Including the socioeconomic status helps control for another factor and can provide some valuable information. It could show that those with a lower income can or can't purchase healthier options. Since these are children, growth charts should be involved instead of just BMI.
4) As I mentioned in the previous paragraph: growth charts need to be involved. I had a professor in school once threaten to rip up my degree if they ever found out I was using BMI to classify children. Growth charts have a lot of research to support them and use percentiles. This information is more valuable to research as opposed to BMI.
5) Provide options! There are a lot of low-calorie ways to keep water flavorful and interesting for children. I even use them myself to ensure I am drinking more water. Providing people with the information on these products can help promote water consumption. I would emphasize the importance of regular water consumption. I would also discuss which juices should be chosen (better options instead of completely removing). The largest barrier would combating how much people love the taste of SSB. People love the taste of them and it can be difficult to convince people to give them up.
I think this article is super important as RDs because it emphasizes a specific way we can educate parents and children to prevent childhood obesity. We are very educated on the impact of sugar-sweetened beverages, but for many it is not common knowledge that they are packed full of added calories and sugar. I met with a 9 year old child that weighed over 250lbs and was only drinking capri suns. His mom was shocked to hear that that wasn’t even juice and that it was a huge contributor to his obesity. The most interesting part of this study to me is that the associations between SSB and BMI were not due to the energy content because associations were not found with milk or juice. That means that there are other effects of SSB on weight gain beyond just empty calories. I think it could be related to a hormone insulin resistance response to simple sugars. That is why I think it was interesting that 100% juice did not have the same association. I think it would be interesting to see the study done again with 100% juice in a separate category. I am curious to see how the National School Lunch Program and other government run nutrition programs will modify in the coming years as more research is done on juice and the effects on weight, obesity, and metabolic response.
1. It makes sense for the SSB’s to be associated with increased BMI throughout childhood but it does surprise me that juice didn’t also contribute to this. I think this might be due to the fact that many parents water down juices when giving them to children in order to cut the sugar content and that might help with this. I see the milk finding making sense since most children stop drinking milk after leaving early childhood.
2. I think we should limit consumption of 100% juice because despite not being sweetened, it’s still very high in sugar and has zero fiber to counteract the sugar content in the juice. This can still cause blood glucose issues in children and the high sugar content can also cause dental carries early in childhood that leads to painful procedures that can be prevented.
3. It’s important to look at SES of a person when observing diet since many sugar-sweetened beverages are low cost and served alongside many fast food meals. I think we should also look at the food availability of the participants as well. Many people don’t realize that food deserts can still occur even in very populated areas, leading people to have to resort to convenience foods for energy, which often lead to consuming sugar-sweetened beverages. It should be observed the areas in which the participants lived and how close they were to the nearest grocery store.
4. Not necessarily a weakness of the study, but I personally didn’t care for how they cited the sources. It was confusing to have to read 10 different last names within a single paragraph at the beginning of every single sentence. They could’ve easily left the citation for the end of the sentence but that’s my personal preference. I also think they should’ve tried to diversify the findings since 94% of the participants were non-Hispanic white. It’s important to include all races in research that is going to be applied to the general public. The US isn’t 94% non-Hispanic white so why should we apply these results from a 94% white study sample to our population?
5. It really starts with the parents and adult caregivers when it comes to the introduction and incorporation of sugar-sweetened beverages in a child’s diet. We as dietitians need to start recommending that parents stop consumption of these beverages altogether, or at least around their children because children observe and learn from their parents first. I feel that if we were better able to convince parents that their unhealthy habits affect more than just themselves then we can prevent the introduction and initial interest in the beverages when children are exploring different foods.
1) I believe it all comes down to the content of these drinks. The 100% fruit juice contains natural sugars, meaning that the sugars did not have to be added. It can also be a great source of specific nutrients. As for milk, it contains appropriate amounts of both carbohydrates and proteins. While on the other end, sugar-sweetened beverages contain very little actual nutrients that are beneficial to health. By adding extra sugar to these beverages, people are essentially dehydrating their bodies, causing them to consume a higher amount.
3) I believe that they looked at socioeconomic status because those who are on the lower end of that spectrum are more likely to being buying sugar sweetened beverages due to the perceived higher cost of milk, 100% fruit juice, and so on. Those who are of lower socioeconomic status also usually have little education on nutrition, and do not know any better. I think another variable that could be important for researchers to look at is the location of where these people live, as living in a rural versus urban area could have a major impact on the nutrition decisions made.
5) I believe that it is important to educate these ages groups on the possible consequences of the overconsumption of sugar-sweetened beverages. A good strategy for this would be to use a lot of visual aids (such as showing how much sugar is in a can of pop, sweet tea, etc.). It would also be beneficial to help them be able to differentiate between the different types of milks, juices, and so on, so that they are able to make better decisions on their own. A barrier that we, as future RDs, could expect is that this age group will not be willing to listen to our advice. This is why we need to make sure that we highlight the importance of avoiding sugar sweetened beverages.
Jonathan, I also answered 3) and I didn’t even think about the use of growth charts. You have a great point there because BMI is certainly not the most ideal marker to measure growth in children. I also agree with you that it’s very important to make drinking water “fun.” I have many friends my age or even older than me that dislike drinking plain water. I also know many people who are very unwilling to give up give up certain beverages (pop is a huge one), so maybe a great first step would at least be to get these people to start cutting down on the amount they consume.
Rachel, I also agree that 100% fruit juice is better than juice cocktails, but it is still something that should be consumed in moderation. It is also very true that many people usually have more than one serving. Most people are shocked when they see how little one serving size is. Although a mother might think she is doing her child good by giving 100% fruit juice, too much can have negative consequences. You also have a very good point that the caregiver who is regularly watching the child is a variable to consider. For example, a younger, less educated babysitter may see no problem with giving children multiple sugar-sweetened beverages throughout the day.
1. These findings are very surprising to me. 100% juice and milk are pretty high in sugar, and depending on the amount of consumption, it would make sense that it would increase BMI throughout childhood and adolescence. However, when comparing the sugar content in milk and in juice, sugar-sweetened beverages usually have a higher amount of sugar in them. Therefore, this can explain why only sugar-sweetened beverages significantly increased BMI compared to milk and juice.
2. Although the amount of sugar in 100% juice is not as high as some sugar-sweetened beverages, I do think it should be categorized as a beverage that should be limited in young children. The reason I believe this is because once parents think the juice is healthy, the more they will give their children. If a child has juice for both lunch and dinner, they would have consumed more sugar than one can of soda. If they did this every day, then a child would have consumed more sugar than in a soda every day.
3. I believe they observed socioeconomic status of participants because it could reveal the knowledge families have on nutrition and on what they can afford when it comes to beverages and food. I believe the biggest factor that contributes to SSB intake in children is nutrition knowledge and what they can afford. Recent trends show that the lower socioeconomic usually means that they are less knowledgeable about education. Some other variables that could contribute to SSB intake in children, is how lenient parents are. Some parents have a hard time saying no to children, so if the child consistently demands juice, the parents might be reluctant to say no.
4. A weakness I noticed was that the sample of this study mostly consisted of the same race. To get more accurate findings, I think they need a more of a variety in their sample. I also noticed that the dietary reports of the sample were reported by the participants. This could lead to skew results if the participants were not honest about their intake.
5. As I work in corporate nutrition, I found what has been most successful in reducing the intake of sugar-sweetened beverages is the combination of nutrition education and teaching people how to make infused waters. It is delicious, refreshing, and healthier! However, there will be many barriers. So many drinks are sweetened, sometimes it is hard to find delicious drinks that are not sweetened. Sweetened beverages are often addicting and found everywhere. Therefore, helping people reduce their intake can only be successful if they are willing to change their intake.
1. As mentioned, the idea that BMI and consumption of sugar-sweetened beverages (SSB) being positively correlated is no new news. However, it is an interesting thought to know that in this study, the consumption of 100% juice was not positively associated with BMI. My first thought is that even though 100% juice is still high in sugar, it is nearly half of that in SSB. One cup of apple juice has approximately 20-30 grams of sugar, while one can of soda-pop contains around 40 - 50 grams of sugar. My other thought is that, in my opinion, more SSB are consumed in a day, or in one sitting, than 100% juice or milk servings. These combined are reasons why I do not think this is a ground-breaking idea, but still one worth mentioning and understanding.
2. I do not believe it should be considered a SSB if sugar is not added, but it does have a high sugar content as many fruits do. As with the majority of our food groups, it is always smart to consume with moderation. I believe that 100% juice is not an exception to this rule. Its high sugar and calorie content should be limited in all populations, and if possible, should be replaced with the actual fruit. This will be of greater nutritional benefit, with one of the main ones being the fiber content.
3. It is also fairly well accepted that nutrition intake and its quality varies among socioeconomic classes. Those in a lower socioeconomic class tend to consume less-healthy options, including SSB, than those of a higher socioeconomic status. There are several reasons for this, with one being the availability. Unhealthy food options such as SSB are easily accessible in low socioeconomic neighborhoods. In addition, these areas also tend to lack healthy alternatives. I have also seen first hand the difference in buying habits from individuals from different economic backgrounds during my eight years working in a grocery store. Individuals using WIC check out with a much higher amount of SSB than others. Many may buy several cases and two-liters during one trip, while those of higher socioeconomic status rarely buy any. SSB are cheap and the educational level tends to be low, which contributes to why SSB may be more appealing to these populations.
5. As dietitians, the first thought on how we can reduce the intake of SSB is education. Making education effective, making sure the message is heard, and conveying the importance behind limiting SSB in the diet and its impact on future health is key. Some barriers are also obvious. We have to go up against companies that have an insane amount of money to use for advertising using several different media, we have to break old habits, we have to encourage parents to set an example for their children, and we have to go against the high accessibility and low cost of these products. All of these make it difficult to reduce the SSB intake of children and adolescents.
This comment has been removed by the author.
I was not surprised by the strong association between the SSB and increased BMI found in this study. The fact that 100% juice and milk consumption were not implies an effect of artificial sweeteners beyond the caloric content.
Juices and SSB are generally more affordable and easier to access than 100% juices. They are also self-stable and more convenient than fresh, frozen, and canned fruits. All factors that are important to individuals of lower socioeconomic status and serve as barriers to reducing consumption in this population. However, I think a lack of parent/provider education across all socioeconomic status’ contributes to the current consumption of SSB. Educating these communities and caregivers will have the largest impact on reducing SSB intake.
Ashley,
You made a great argument that it is interesting that the children who consumed 100% fruit juice did not have a higher BMI correlation. Juices usually have higher sugar content as well. I wonder if the idea that the SSB were "added" into the drink instead of the natural sugars that occur in 100% fruit juice had any effect on the BMI results. I do agree with you when you said that drinks should not be considered SSB if there is no added sugars (not naturally occurring). That may have had an effect on the study. That would be a great education piece for dietitians to touch on with families. The difference of where the sugars are coming from could have a large effect on BMI.
Cecily,
We had similar opinions on why the study looked at socioeconomic status of the families within the study. Education level of the parents would have a large effect on the outcome of the study. This research is looking at the drinks children consume and their BMI status to see if there is a correlation. If the parents are at a lower education level, they may not know the difference between 100% fruit juice and SSB. Not only could this skew the results that the study found it could also mean there is an education piece missing that dietitians could help with. What if the parents are unknowingly giving these SSB to their children thinking they are a healthy and cheap option? It would be interesting to give the same families in this study education and reevaluate the study to see if the choice of drink behavior made improvements.
I’ve been finishing up my rotation at WIC, so this article was definitely interesting to me considering I’ve seen a wide range of children consuming a variety of different beverages. At WIC, our response to these parents who provide their children with SSB & 100% juice is to be completely nonjudgmental while also educating families on alternative options. For example, we might suggest the family try incorporating more water into the child’s diet rather than always giving SSB or even diluting juice (both 100% and others). I think it’s unrealistic to think that families (or kids) will never have these drinks so above all else, we need to educate the parents, and even the little ones if appropriate, so they can make informed decisions on their own. In regard to 100% juice, I think that it should be limited in the diet, but I also don’t think it’s the worst thing a child can have. Again, I think it’s most important to educate the parents, so they know the facts (negatives, positives, benefits, etc.) about these beverages so they can make the best choices for their children rather than simply telling them what they can and can’t have.
Like Jonathan brought up, a major weakness of this study is the use of BMI rather than growth charts considering the study’s population is children. From my understanding, this isn’t really an appropriate measure when we are looking at a child’s weight and height, so I find it pretty interesting that the researchers chose to use it. Lastly, when reading a study like this, I think it’s important to remember that childhood obesity (and obesity in general) is much more complex and involves many more factors than simply the consumption of a specific type of food or beverage. I personally feel we get much further with individuals when we are clear that we don’t have to completely rid our lives of these things and that moderation and healthy lifestyle factors are key.
Brandi,
I also believe the 100% fruit juice should be limited, especially in children younger than two years old. For older children, whole fruits should be offered more often than fruit juice. Of course, it is important to consider the SES of families since some may not afford or have consistent access to fresh fruits. However, there are other options parents can try instead of automatically relying on fruit juice for the children's fruit consumption. That is where our role as a Registered Dietitian comes into play. I concur with your alternative suggestions to limit fruit juice intake, but we also need to include a brief education of SSB and children's health to the parents.
I agree with you that BMI is not always the best method to measure weight status. Most people are built differently as some have more muscle mass than others. As many other people mentioned in the comments, growth charts may have been a better method to measure weight status since children were the subjects. With that being said, it would be interesting to see how the results would change.
Ashley,
I had a similar opinion about fruit juice intake in children. I appreciated that you pointed out the sugar content of fruit juice compared to a can of soda. Those values put into perspective of how much sugar is actually in fruit juice. Drinking juice is way easier and more enjoyable than eating a whole fruit. Thus,children are more likely to over consume on juice and sugar than eat fruit because the juice tastes better than the actual fruit. My point is that juice should be limited and fruits should be offered more than juice which you mentioned. Rather, more water should be offered to children to prevent dehydration from occurring.
I agree with you that Registered Dietitians just need to provide education for parents and children. As I mentioned, including information about oral health can be beneficial in persuading parents to reduce the amount of juice they offer to children. Also, although it is obvious, providing evidenced based education about the association of SSB and weight is key to encourage parents to help their children be healthy individuals.
Rachel,
I agree with your response to question three that SES is a variable that could strongly influence the results. We know that people who have a lower SES are more likely to live in food deserts just because it's not as profitable for supermarkets and grocery stores to have locations in these areas. Thus a child in a low SES family would probably have more access to 100% fruit juice than whole, fresh fruit. Even if they do have access and transportation, they may not have the proper equipment to store and prepare these foods. Now obviously this would vary greatly between households depending on their environment and situation, so I think that's why it'd be important to include SES as a factor in future research studies of this nature.
Ashley,
I agree with your response to question five even if it's not very encouraging. Yes, there are several environmental influences that make SSBs a popular choice, and especially in vulnerable populations. Like you said, the influence that companies like Coca-Cola and Pepsi have is insane - it seems like they sponsor just about everything, and their ads are everywhere. SSBs are also very affordable and they don't require any special equipment for storage or preparation. They're available in pretty much every restaurant and convenience store. It's already a huge part of our culture, so we have to work against the norm to get our patients and clients to reduce their intake. Really, it just comes down to education like you said - if we can inform and remind people of the negatives of SSBs, especially for young children who are growing up in this environment, we can help guide them towards better choices for them and their children.
Brandi,
I like that you critiqued the use of BMI in the study as the sole indicator of health status. There are hundreds of people who are at an overweight BMI but also don't show signs of anything metabolically wrong with them such as increased blood pressure and cholesterol. At the same time, I have seen plenty of cases of people within the healthy BMI range that have a laundry list of metabolic syndrome-related ailments like blood sugar imbalances and cardiovascular issues. But it is a cheap and easy way of assessing a general idea of health so I can also see why it was used.
Kriston,
I'm glad you mentioned the point that many parents might not be able to afford other drinks for their children and also have the common belief that if they drank sugar sweetened beverages as kids, why can't their children? It's vital to emphasize that just because they were able to drink juice and pop as a kid, they might not have had the same diet or activity level as their children. Parents also probably didn't drink to the amounts that many children do nowadays since its more easily accessible now.
Jessie,
I mentioned something similar to what you said in number 5. I recommended infused waters as a great alternative. However, you brought up a good point that not everyone might not have access to fruits and herbs normally used in infused waters. If parents do not have access to these foods, I would recommend ways to budget to afford these foods, educate them the benefits of them, and how to make the herbs and produce longer lasting.Some children might not even like the taste in infused waters. This can definitely be a barrier for children. What I most commonly learned when counseling children, is that consistent exposure to the food increases their chances to give it a try and increase their chances for liking to it. Therefore, I would recommend for parents to continue exposing the children to the infused waters in hopes they can overcome the barrier of disliking infused waters.
Jonathan,
I really like when you said growth charts need to be involved in the study and that BMI should not be used to classify children. I do agree that growth charts give us more information than a BMI does. Especially when it comes to growing children. When I worked at a hospital, the doctors did look at the BMI when it came to obese children but also compared it to the growth chart. So perhaps the BMI should not be disclosed completely but rather looked at it while looking at the growth chart. This will provide a better picture of the child's health. I wonder why the researchers did not think to include a growth chart. I do believe people have become obsessed with BMI and the weight on scale and forget there is better ways to asses health. However, BMI is more cost and time efficient.
Ashley,
I thought it was very interesting that you have worked at a grocery store for eight years and have noticed a difference in individuals that check out using WIC benefits than without. You noticed that those using the benefits check out with higher amounts of SSB than those who do not. I thought that this would be a common trend due to those at lower socioeconomic status not receiving as many years of education and being drawn to a cheaper beverage option. I also like how you included the barriers in educating these people on SSB. I also mentioned how education in this area would be important and the most effective as a dietitian. However, like you said there are so many barriers that we are going up against. The advertising of SSB is everywhere, their cost is low, and they taste better due to the high sugar content, so people are drawn to them for these reasons.
Cecily,
I agree with you in that parents should limit the amount of 100% fruit juice they give to their children. You made a good point, that if parents think this juice is healthy for their children then they are going to give them however much they want. Just two servings of juice would be as much if not more than one can of soda. So giving 100% fruit juice to children in moderation would help lower their sugar intake. I also enjoyed another point you brought up about your corporate nutrition job. Not only do we need to educate people on SSB and the consequences of consistently consuming too much sugar, but we need to recommend other options for them! Many people get sick of drinking water all of the time, so they want someone else to quench their thirst but also tastes good. I think infused water is a great recommendation for this.
Jessie,
Your suggestion for naturally flavoring water instead is very interesting. Many people over look simple fixes such as this. It is very important as dietitians to keep our minds open to the myriad of options and simple substitutions that could potentially make larger impacts on healthy living. More often than not, people are told to exclude X or Y but not how to replace those things, making it seem like a punishment. Adding various fruits to water may be something fun for the kids too with the different colors. Great idea!
Jonathan,
Thank you for pointing out the use of growth charts as opposed to the use of BMI. The BMI measurement is really an outdated way to measure health status, especially in children. I know from personal experience that doctors used to criticize my BMI as a child but never took into account that I was a year round athlete, even at younger ages of 7 or 8. The growth chart is more accurate when assessing children and it is definitely a weakness of the study that they used BMI.
Jonathan,
I liked that you pointed out the difference between natural verses added sugar. I would agree that if it is ACTUALLY 100% juice, we have a different story. I agree in that I think it a serving or two a day in conjunction with other drinks would be okay. In addition, I LOVE that you mentioned growth charts with kids. They are more useful than BMI. BMI is not the best indicator of health in general, but with kids that is even more true. Growth charts are also easy to use and would be just as simple as BMI measures.
Cecily,
I like that you pointed out that once parents think juice is healthy, they will give it to their kids more. Now, you see parents giving their kids large amounts of apple juice. This adds up to large amounts of sugar, like you said. I appreciate the parents that mix the juice with water to increase their water intake. This is always a good idea for kids that don’t like anything but juice. I also liked that you pointed out that the dietary reports were reported by the participants. That was something I did not catch at first. Lastly, I understand the struggle in finding delicious drinks that are not sweetened. Sparkling water can be an acquired taste and sometimes adding fruit to water can be just flat out boring for people that are used to SSB. If a patient wants sweetened beverages only, I think adding Mio or crystal light is a good idea for them.
I think that sports drinks and coffee drinks should have been included in the questionnaire for ages under 9 as well, especially sports drinks are served to children under the age of 9 frequently at sporting or group events, that could have led to more information. Also I would like to see this study re-done in a lower SES area, of course with some of the weaknesses the study itself mentioned changed. Maybe this was a part of the study and I missed it, but it would be interesting to collect data on WHERE the drink is coming from, like was it a drink at home, purchased at a grocery store, from a restaurant, school, or from an event.
100% juice is starting to be used in schools as a substitute for fruit which is required to be served if they want reimbursements for meals. So for the next similar study it would be interesting to see if this statistic changes or not with this change in schools serving requirements. Though I do agree with categorizing it apart from other sugar-sweetened beverages because if facing a choice between soda and 100% juice, juice (not juice-flavored drink) would be the better option. Especially if education parents like Paige said and diluting the juice or just serving sweeter tasting beverage less frequently overall and increasing plain water intake. I agree with Paige's point on education and non-judgement education as RDs is most important when foods and beverage choices, especially when discussing with a parent choices they have made for their child.
Lacey,
Although I do agree that the different sources of sugars may be playing a role (however I think it is more quantity based than source-based), I also believe that the family may be the true influencer as to why the children drinking more juice had a lower BMI than those drinking more soda. I feel that the parents are likely the ones either providing the beverages or have influenced the choices made by the children. If a child is drinking juice over soda, I feel that there is a high chance that their family also consumes more healthy meals and the parent has chosen juice over soda. Versus a family consuming/providing soda to their child in which case it is likely that they are consuming less healthy meals. This is all speculation of course, so I agree with Abby. I wish they would have also asked WHERE the beverages were being consumed by the children.
Jonathan,
I definitely agree that growth charts should be taken into consideration. However, I also listened to a professor, very recently, say that growth charts can be misleading in children if not used correctly. When using growth charts to determine if a child is overweight or obese, it is very important that the biological age of the child, as opposed to the chronological age of the child, is used. For instance, if the child in question was an early maturer, and was biologically 14 (instead of chronologically 9 - by birth date) then we may incorrectly assume that the child is overweight for their age when in reality they are fine. So instead of being placed on a growth chart with 9-year-olds, this child should be on a growth chart with 14-year-olds. Biologically aging children can be difficult though. Paying a researcher to accurately age children biologically may be expensive and can be awkward for the children, which is why this study probably opted to just use BMI.
Rachel,
It was interesting what you said about the amount of consumption at one time with SSB as compared to a beverage such as milk or water. I think you are absolutely right that more than one serving at a time of juice is being consumed. However, do you think this could be addressed through education on serving sizes and appropriate consumption rather than a restriction?
Sydney,
Your point on educating the individuals is HUGE. It's the whole "Give a man a fish he'll eat for a day. Teach a man to fish he'll eat for life" philosophy. You can provide people with specific drinks, foods, meal plans, everything, but if they don't have the autonomy or means to learn and do it on their own it can become very difficult. For example: if someone goes to the store and they are out of the product you told them to buy, but they don't know WHY they were told to buy it. They could revert back to what they originally get. However, if they are told why they're supposed to avoid that product, they can make a better informed decision on another product.
Amy,
I thought about this while reading your post. Those of lower socioeconomic status may purchase prepackaged meals and sugar sweetened beverages due to financial restrictions. Those of higher socioeconomic status may purchase those same things by choice. In the end, the result is the same and those products are still being regularly consumed by many people, contributing the the potential health problems. If those of lower socioeconomic status are able to make it to a better financial situation in the future, them and their children are already accustomed to that style of food and purchasing. Then it turns into a vicious cycle of being stuck there. It's an interest way of looking at it. Those in the high socioeconomic status may have come from further down the chain and are still in those same habits they developed.
Post a Comment
<< Home