Childhood obesity is associated with excess sugar intake. Currently, nearly one in three children meet criteria for overweight or obesity so reducing excess sugar intake is an important tactic to reduce your child’s risk for these health issues. The American Academy of Pediatrics recommends that children less than 2 years old have no sugar in their diet.

Watch: Childhood Obesity and Hidden Sugars

Ashley: Thanks for watching On Call for All Kids today we're talking about the effects of hidden sugars in your child's diet. We'll dive into how pediatric obesity is related to excess sugar intake, why it's so easy to overlook the amount of sugar that your child is consuming, and how to make healthier choices for your family. I am joined by Dr. Raquel Hernandez. She's the medical director of the Healthy Weight Initiative here at Johns Hopkins All Children's Hospital and what a great time, Dr Hernandez, because September is actually childhood obesity awareness month so its great having you here.
 
Dr. Hernandez: Thanks Ashley for having me and thanks for highlighting this really important topic.
 
Ashley: We know that according to the American Academy of Pediatrics, one in three children are either obese or overweight. That's just an astounding statistic, really,
 
Dr. Hernandez: Absolutely it really is something that we consider an epidemic within our country and that so many kids are affected, and really the concept of hidden sugars is so important in preventing obesity which is why we really want to let parents and kids know about it.
 
Ashley: Let's talk about that. Why do you think it's so difficult for us as parents and in our families to really identify how much sugar is in these foods that we're eating?
 
Dr. Hernandez: It's such a great question Ashley, and yeah, it's actually really hard for parents and kids to know how much sugar is in what they eat. Most commonly, the reason is because we think that sugar should look like a powder what we put in our coffee or what we put in our tea, and oftentimes it's not the case. Oftentimes, it's already processed within the food that you're buying or eating and only reading a food label will let you know that there's actually sugar in what you're eating.
 
Ashley: Well how much sugar should we actually be consuming on a daily basis?
 
Dr. Hernandez: Great question, so the American Academy of Pediatrics recommends that for children zero to two
that they consume zero to no sugar at all and actually the American Heart Association recommends that at a maximum, children should have about 25 grams or six teaspoons of sugar per day at a maximum.
 
Ashley: What would you say are some of the most common foods that have those hidden sugars in them that we should probably avoid?
 
Dr. Hernandez: Absolutely, so I’d love to share with you actually some of the most common foods that I’ve seen children and families get a little bit tripped up on in thinking that they're healthy, but they actually have a lot of sugar in them. So, let's for example take a very common breakfast food like your common yogurt with fruit on the bottom or even maybe accompanied by a little bit of chocolate milk. So, you'd be really surprised to know that both of those items individually have about three and a half teaspoons of sugar which is what's in this little plastic bag and that theoretically, is half what children should have the whole day, so, imagine in just one breakfast meal you might already have exceeded what your child should have on a day to day basis in terms of sugar.
Another quick example, many kids love their cereal so here's a very common cereal and a typical serving size for what most families think is appropriate for their child and you would probably be pretty shocked to know that this is actually 16 grams of sugar about four teaspoons in just that bowl not including the milk.
 
Similarly, when you go down the yogurt aisle you might find these kind of new fancy yogurt drink mixes and they actually have just about the same amount of sugar as that bowl of cereal. So pretty shocking when you think about how these are marketed as really healthy foods and how commonly we put them in our grocery cart. One of the ones that might even surprise you all is also thinking about healthy quote unquote bran muffin. So the bran muffin is interesting because it does have a little bit of fiber but what happens is that there is excess sugar added to make this even tastier so this is about 29 grams of sugar so you've already exceeded your child's daily intake with just this muffin.
 
Ashley: Just this little muffin, that is incredible!
 
Dr. Hernandez: Isn't that incredible? And then I think another example which we probably have hopefully heard a little about in terms of the risks of sugary beverages so here's your typical most common you know kind of soda can and then think about just that one drink has actually 40 grams of sugar which is what's in this bag, so simply in one beverage, you've actually almost doubled what your child should be taking on a day-to-day basis and then one that I think is particularly shocking to many parents who know that their kids love these little cheesy snacks these little cheesy snacks actually have the same amount of sugar as that one can of soda and i wouldn't have even thought that there's any sugar in those type of crackers.
Dr. Hernandez: you're not alone Ashley I mean it's really surprising to a lot of parents when I show that item, given that it's so popular, it's so common.
 
Ashley: Well all these visuals really help to put this into perspective to really understand how much sugar are in these types of foods but what else can we do as parents to be a little bit more cognizant and aware of what we're feeding our children and these hidden sugars that are in them?
 
Ashley: It's a great question Ashley. I think you know in the end I really hope that parents become really smart consumers of what they're bringing home for their kids and the only way to do that is to really start paying attention to those food labels and specifically paying attention to what a portion is and as it's labeled within the product so for example sometimes even a bottle like this will actually be considered two servings and if you have the whole bottle you've already doubled the intake that's recommended in addition I would also advocate for parents looking at the term on the food label called total carbohydrates and added sugars. those are the two terms that oftentimes go sort of unknown as a hidden sugar and so when you're seeing those numbers remember what we talked about in the sense that we shouldn't have, kids should not have more than 25 grams of sugar per day and that hopefully will help you make some better decisions in looking at those areas on the food label.
 
Ashley: And lastly, I know a lot of parents ask you about zero sugar options or sugar substitute options, what do we need to know about those?
 
Dr. Hernandez: So another great question Ashley and it is it's kind it's a very sort of tricky topic in the sense that there's a lot of studies to demonstrate that artificial sugars are a health risk and specifically what's been found is that
they can actually sometimes increase appetite and actually increase the total amount of intake that you have of that
particular artificial sweetener and so in the end I think the message is always trying to have foods that are natural. Naturally sweetened, without additives that's always going to be our recommendation I will say that there are indications sometimes when for example we're trying to kind of slowly have a child or a parent reduce the amount of total sugar they're taking in I will sometimes advocate at least looking for the zero sugar options such that it's almost kind of a stepping stone to really eliminating sugar overall. So, there are sort of advantages and disadvantages but again reading labels and going for the most natural food that you can is always the healthiest.
Ashley: All right Dr Hernandez great advice, and we really appreciate you joining us today.
 
Dr. Hernandez: Thanks so much Ashley for having me.
 
Ashley: Thank you all for watching don't forget you can also visit our website it's hopkinsallchildrens.org newsroom you'll find a lot of other great timely topics in pediatric healthcare and other great resources for your family, we'll see you next week!

How much sugar should kids have daily? 

The American Academy of Pediatrics (AAP) currently recommends that children 2-18 years of age have a maximum of 6 teaspoons, or 25 grams of sugar per day. This often surprises parents and families as it is a very small amount of sugar overall. If you consider that one can (8-10 ounces) of soft drink or orange juice can have anywhere from 35 to 40 grams, you can see how quickly we start to add on more sugar and, unfortunately, more pounds than are needed. To see how quickly sugar adds up, look below to see how many teaspoons of sugar are in most beverages.

Sugar amounts in popular beverages

Adapted from https://www.cdc.gov/healthyweight/healthy_eating/drinks.html

Why do you think it’s so difficult for us to know how much sugar we really eat daily?

There are many reasons why it is difficult to know how much sugar we eat per day. First, is that we often expect for sugar to look the way it looks when we sweeten our tea or coffee—a powder or granule. That’s often not the case. In fact, the majority of foods that we purchase or make are fortified or supplemented with sugar, and you would only know by reading a food label.

What are some of the most common foods to avoid that have hidden sugars?

There are so many foods that are often marketed as “healthy” for kids and families that are unfortunately not great for maintaining a healthy weight or for overall health.

Top Foods with Hidden Sugars:

1. Sports drinks and energy drinks

2. 100% juice drinks 

3. Breads and cereals

4. Yogurts and flavored milks

5. Most breakfast foods (cereals, pancakes, waffles, croissants)

What can parents and kids do to be more aware of and reduce how many hidden sugars they eat?

1. If you’re going to have a beverage (juice, soda, sports drink), “Rethink your Drink!” by watering it down/diluting it with water. Using flavored water options or sparkling water options can be very helpful.

2. When it comes to breads and cereals, look for whole wheat options. The more fiber the food has, the better it is for you and the less health effect of the sugar it contains.

3. For yogurts, we recommend looking for the plain yogurt options and adding fresh fruit or small amounts of honey to the portion. Remember that a healthy portion for most children is often about the amount of yogurt that fits in their hand, so make sure you’re not giving them too large of a portion. Also, milk is already sweet and adding more sweeteners or flavor is really just unnecessary calories.

4. For breakfast, think about options that include unprocessed foods: Eggs, fruit, vegetables and lean meats (turkey bacon) can really fill you up in a healthy way. If you’re going to choose pancakes or waffles, think about your portions and think about it as “extra” vs. the central part of your meal.

Many parents have questions about sugar substitutes or zero sugar options. Are these healthy?

Sugar substitutes have both advantages and disadvantages when introduced into our diets. Interestingly, they have been hard to study because each of these substitutes whether they are synthetic (saccharides) or natural (stevia) are metabolized in different ways, so it has been hard to compare “apples to apples” in most clinical trials. In general, the more we avoid synthetic substances, the healthier we are. In addition, there have been studies to suggest that artificial sweeteners can cause increased appetite, increased insulin response (and therefore increase risk for diabetes) and in some cases, increased risk for cancer. Having said that, I have had several patients in which a transition to artificial sweeteners has led to improved health in reducing their intake of high-fructose corn syrup, which had a much more detrimental effect on health and therefore, may be a way of gradually improving how much overall sugar someone is taking in.

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Sugar in a child's diet: how much, what is useful and what to do with food in the kindergarten

Nutritionists believe that 5 teaspoons of sugar for a child a day is the maximum allowable rate. But they remind you that sugar can be found in sauces, ketchup, cereals, instant cereals, tomato juice, muesli bars. Therefore, it is also important to read the composition and control the nutrition of the whole family.

“If your child is already used to drinking tea with sweets at night, and you want to change this tradition, start with yourself,” advises Natalia Nefyodova. - Set new rules, set an example and change the habits of the child and the whole family step by step. It is important to do this without edification. You can even talk in a playful way about the benefits of certain products, cook together, tell what happens in the body, in terms accessible to the child.

Of course, all the efforts of parents to reduce the amount of sugar they consume can be nullified by meals in kindergartens and schools. If a child tells that he drank sweet tea with sugar cookies and ate sweet porridge, this completely changes the picture. And if the school can still operate parental committees to control school meals, then kindergartens remain “abandoned” in matters of nutrition control. On the website of the Russian Public Initiative, a petition was published by specialists from the DocDeti clinic and a nutritionist, UNICEF-certified child nutrition specialist Victoria Vishnyakova. The essence of the proposal is to make the nutrition of children in kindergartens healthy and balanced, to reduce the amount of sugar consumed.

The authors of the petition propose fairly simple measures that can really improve the nutrition of preschool children and preserve their health. Here is what is enough to change in the norms according to which the kindergarten menu is built:

1. Set the upper limit of free sugars to 15 g / day.

2. Remove all drinks with added sugars from the menu. The best drink for children is water.

3. Reduce the amount of salt to 2-3 g/day.

4. Do not replace fruits and vegetables in the diet with juices.

5. Achieve the recommended amount of fiber per day. To do this, enter the breakdown of carbohydrates into free sugars and fiber in the menu and indicate it on the menu along with calories, proteins and fats.

6. Enter the required minimum of vegetable protein sources.

7. Exclude industrial sweets and ultra-processed foods from the menu of kindergartens.

8. Increase the amount of fish - at least 2 servings of 30 g per week.

9. Reconsider the allowance for orphans - keep the amount of sugar at an acceptable level, and increase the calorie content through foods with high nutritional value.

If you doubt that the petition can affect the organization of food in kindergartens, we hasten to object: not everything is so simple. Thanks to one of these petitions, it was possible to solve the problem of nutrition of children with allergies. Tatyana Zvereva, director of the Russian Association of Allergy and Atopic People, shared her experience with us.

“We are working to ensure that children with allergies and other food intolerances can eat fully in schools and kindergartens and, in principle, attend them,” says Tatyana Zvereva. “I can’t say that all officials are open to dialogue, but in the last few years they have been ready to hear us. I express my deep gratitude to Rospotrebnadzor and subordinate institutions that heard us, whose specialists come to round tables and try to understand our problems. They made a very important point in the SanPin norms that you can carry food with you. Previously, this was not possible. I am sure that gradually these departments will meet halfway in matters of the composition of preschool and school meals, including the amount of sugar.

If you would like to sign a petition to reduce sugar in preschool meals, please click here.

How much sugar can be eaten per day for children at different ages

About nutrition

Despite the fact that nutritionists call for limiting the consumption of sweets, they admit that the body still needs natural sugar for energy.

Photo

Getty Images

However, nutrition experts still recommend avoiding refined sugar. The kid should get everything his body needs from fruits, vegetables, honey and molasses.

According to recent research, children need at least as much sugar as adult women (more for men).

“Sugar gives a boost of energy, which can be good for a child, especially when he is learning something new. Plus, for small children, sugar makes many dishes more enjoyable and stimulates the appetite, ”the doctors say.

It is better to eat sugary foods during the daytime. Because in the evening it can provoke a surge of energy and it will be difficult for the child to fall asleep.

Photo

Getty Images

At the same time, sugar is a source of "empty" calories, without any nutritional properties. Therefore, children who consume more than the recommended daily allowance are at risk of getting nutritional deficiencies and gaining excess weight - and this is already a serious problem, more and more obese children in the world are on the rise.

In addition, sugar in large quantities provokes inflammation and causes negative gastrointestinal side effects. Therefore, you need to make sure that the child does not eat more sweets than doctors recommend. And do not introduce sweets into the diet too early - before two years.

Early introduction of sweets may incorrectly shape the child's taste preferences. Then it will be difficult to accustom him to a balanced diet.

• Babies under five should either avoid sugar entirely or consume less than 10 grams per day .

• Children between the ages of 5 and 10 should be limited to no more than 20-25 grams of sugar per day .

• Children between 10 and 15 years of age may be allowed to increase the amount of sugar to 25-30 grams per day .

• Children over 15 years of age can eat no more than 30 grams of sugar per day .

Endocrinologist, dietitian at the clinic for children and adolescents "SM-Doctor" on Cosmonaut Volkov, Candidate of Medical Sciences

“It is very important to maintain a safe daily sugar intake for children. And it is also important not to forget that we mean all sugar - both obtained from products, for example, fruits and juices, and added - from cookies, sweets, etc. We recommend giving fruits and dried fruits to children first, but other sweets - only one or two items a day, depending on the age of the child.

Healthy sweets also have contraindications - these are food intolerances and allergies. For honey and products in which sugar or fructose are added - diabetes mellitus.

Pediatric cardiologist

“Modern children eat a lot of sugar, and parents often do not even realize how much. For example, 200 ml of cola contains 10 teaspoons of sugar, which is one and a half times the daily requirement for a child from 10 to 18 years old. Just one can of soda with a volume of 0.33 liters - and the daily sugar limit has already been exceeded. Add to this another candy, a chocolate bar - and the sugar level is already going through the roof.

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