Getting Hard on Soft Drinks in Schools

  • Medical Editor: John Mersch, MD, FAAP
    John Mersch, MD, FAAP

    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

Soft drinks and soda are the biggest source of sugar in kids' food

Sweet soft drinks constitute the primary source of added sugar in the daily diet of children. Each 12-ounce serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar! The majority of school-age children consume at least one soft drink daily.

In 2004, the AAP published a policy statement ("Soft Drinks in Schools") in response to a growing trend toward contracts for exclusive right of sale between school districts and their beverage distributors. The voice of the American Academy of Pediatrics (AAP) was just one in a chorus of concern about poor nutrition and child health. The Alliance for a Healthier Generation was formed as a collaborative effort to help address childhood obesity. "School Beverage Guidelines" published in 2007 urged the beverage industry to alter the availability and mix of beverages offered in schools. Of greatest concern was the likelihood that innovations by the industry would usher in new but similar alternatives. To some extent, this prediction has been borne out. Fruit drinks, sports rehydration drinks, energy drinks, sweetened teas, and coffees have joined water, milks, and fruit juice as replacements for more traditional soft drinks.

Substantial progress was made after the voluntary Alliance for a Healthier Generation agreement. A report from the alliance issued in 2010 cited an 88% decrease in total calories shipped to schools, a 95% decrease (in ounces) of full-calorie carbonated soft drinks, and a corresponding increase in more acceptable alternatives, such as water, 100% fruit juice, and rehydration drinks in smaller portion sizes.

Other forms of sweetened drinks have become popular in schools, as well, replacing carbonated soft drinks. The AAP policy statement that was issued in 2011, on the role of rehydration drinks among children and adolescents, warns that their use outside of prolonged, vigorous-intensity physical activity involving fluid and electrolyte depletion delivered unwarranted energy and added sugar. Water is the appropriate source of hydration for nearly all types of less vigorous activities. The statement also raised concerns about caffeine and other additives in popular energy drinks.

Overweight and other health problems

The consumption of sweetened soft drinks has been associated with the increased risk of overweight and obesity, currently the most common health problems in childhood.

Aside from overweight and obesity, sweet soft drinks promote dental caries (cavities) and potential enamel erosion.

Soft drinks also displace milk consumption, resulting in calcium deficiency with an attendant risk of osteoporosis and fractures. As soft drink consumption increases, milk consumption decreases, and milk is the principal source of calcium in the typical American diet

Recommendations for healthy diets for children

The American Academy of Pediatrics has the following recommendations:

  1. Pediatricians should offer a clear perspective for students, parents, and school officials, based on national nutrition goals, the evidence review of the 2010 Dietary Guidelines for Americans, and the recent nutrition guidelines for schools. The primary objective should be to maximize nutrient density (nutrients consumed per kilocalorie) within recommended calorie ranges, which represents a balance between reducing excess calories, solid fats, added sugars, and sodium while using available discretionary calories to encourage greater consumption of nutrient-rich foods and beverages.
  2. Particularly at the local level, pediatricians should acknowledge the substantial gains made by the school nutrition staff on school meals while supporting the full implementation of the recent USDA guidelines both for school meals and for competitive foods sold in schools.
  3. Pediatricians should focus particular attention on counseling families and local school staff about improving the quality of selections brought into schools for packed lunches and snacks, fundraisers, sporting events, in-class parties, and school celebrations. By identifying the attributes of nutrient-rich foods, pediatricians can influence food choices and, at the same time, offer families and schools a practical, holistic perspective on child nutrition.
  4. In schools, pediatricians should consider wellness councils or school health advisory councils as a unique opportunity for influencing student nutrition through collaboration with other professionals invested in child nutrition, especially registered dietitians, school nurses, and school food service directors. Development of policies and practices with the involvement of students and staff can be a potent form of education about quality nutrition.
  5. Advocacy efforts of the AAP and its member pediatricians within their state chapters and local school districts should continue to support the efforts of the USDA to improve the school nutrition environment as the best means to ensure the nutritional adequacy of all school-aged children and adolescents.

Medically reviewed by Margaret Walsh, MD, American Board of Pediatrics

REFERENCE:

American Academy of Pediatrics. "Policy Statement: Snacks, Sweetened Beverages, Added Sugars, and Schools COUNCIL ON SCHOOL HEALTH and COMMITTEE ON NUTRITION." Pediatrics 135.3 (2015): 575-583.

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