Sugar And Childhood Obesity

A recent study published in the New England Journal of Medicine, highlighted that in 2015 India had the second highest obese children in the world. What has led to this increase in obesity in young children in India? Where have we gone wrong? Are our cultural notions that obese kids are healthy to blame or the growing urbanization and adoption of western diets to blame? Scientists think it’s both.
Sugar has a considerable cultural relevance in India. In the land of festivals, sugary sweets are everywhere. How aware are we as parents about the effects of sugar consumption on our kids?

Let’s dive into this topic and look at some important points to be considered.

What is sugar?

Sugar is a carbohydrate found naturally in most plants, but mainly in sugar cane and sugar beets.

Simple sugars or monosaccharides are glucose, galactose and fructose. Whereas disaccharides are combinations of two sugar molecules. Examples of disaccharides are lactose, maltose and sucrose.

Many of the foods we eat contain naturally occurring amounts of sugars; especially dairy, fruits and some vegetables. When experts talk about reducing sugar content, they don’t mean the naturally occurring ones.  They’re referring to added sugars.

What is added sugar?

The words added sugars and free sugars are used interchangeably, but there are slight differences in their definitions.

• Added sugars are sugars and syrups put in foods during preparation or processing or added at the table.

• As per the World Health Organization (WHO) Guidelines: “Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.”

Point to note here is that, the definition for added sugars does not include honey, fruit juices or fruit juice concentrates. The definition for free sugars is therefore more apt, encompassing all known sugars.

Recommendations for sugar

The WHO recommends reducing the intake of these free sugars to less than 10% of total energy intake in both adults and children.

In fact recently in view of the rising obesity levels and related disorders globally, WHO’s expert panel recommended decreasing sugar intake to 5% of total calorie intake to combat obesity. [1]

The American Heart Association (AHA) recommends no more than six teaspoons of added sugar to be consumed by children 2 to 18 years of age. [2]

The AHA also recommends that added sugars should not be included at all in the diet of children under the age of 2 years.

Where are these added sugars?

Well most parents think sugars are only found in sweets and pastries. But that is not the case, with rapidly changing diets and dependence on heavily processed foods, hidden sugars are everywhere.

You can find sugars in everything from baby cereals, purees, granola bars, ketchup, mayonnaise, pasta sauces, cheese spreads, nut bars, peanut butter, yogurts, breads, cured meats and healthier looking versions of toddler snacks labelled from fruit concentrate.

As mothers it becomes important to learn to read labels. Look for the following words on packaging:

• Sucrose
• Maltose
• Lactose
• Dextrose
• Fructose
• Mannitol
• Sorbitol
• Xylitol
• Glucose Syrup
• Corn Syrup
• High Fructose Corn Syrup
• Disaccharides
• Molasses
• Invert sugar
• Honey
• Jaggery

These are all names for SUGAR!!

How do sugars affect my child?

Sugar intake contributes to accumulation of body fat, hypertriglyceridemia, insulin resistance, metabolic syndrome, diabetes, fatty liver, high level free fatty acids. [3]

It is important to mention here that Indians already have higher NEFAs (Non-Esterified Fatty Acid), insulin resistance, hepatic steatosis and dysglycemia compared to Caucasians. [4]

To add to this, Indians are increasingly consuming traditional Indian sweets along with sugar sweetened beverages, and westernized sugar-loaded food items, which are now easily available due to globalization.

Children are not far behind, the consumption patterns of sweets and beverages are rapidly changing among the children in our country. Sugar sweetened beverages and sugar containing high calorie foods are easily available around school premises.

A study conducted on 1800 school children aged 9-18 years and their mothers from four cities in India: Delhi, Bangalore, Pune and Agra in 2013 showed a high consumption pattern of sweetened food items among children and their mothers.

The study highlighted the role of mothers in deciding the food choices of children and reported a strong association between the dietary intake of children and their mothers for all the studied sweetened food items [5]. The study also showed that any food or food preparation was considered “healthy” if it was “hygienically” prepared. Furthermore, the results showed that the consumption of food among children is influenced by television advertisements, peer pressure and the fashion for consuming westernized foods.

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Think about this

Nutritionally sugar provides only “empty” calories (1 gm of sugar gives 4 calories). It lacks the natural minerals which are present in the beet root or sugarcane.

When we say it’s okay to consume 6 teaspoons or 24 grams of sugar per day, we have to consider the following:

• 1 tablespoon of ketchup contains 4 grams of sugar
• 1 small 100gm/3.5 oz container of flavored yogurt contains upto 13 grams of sugar.

These make up just the sides of a single meal. This is where our role as parents really kicks in.

How to avoid too much sugar consumption?

• Many Indian mothers add sugar even to savory dishes like poha, upma, sabzis and curries. This can be avoided.
• Enjoy foods with natural sweeteners like jaggery and honey in moderation.
• Always leave the house prepared. You don’t want a last minute hunger tantrum on your trip where you give in and provide your child with biscuits and sweets. Carry theplas, parathas, boiled sweet potato, vegetable/non-vegetarian patties, wraps, chappatis, fruits or your child’s favourite snacks.
• Many times mothers prefer packaged foods including bottled beverages at restaurants as they are concerned about hygiene. Again offering coconut water or bottled water instead of sugary drinks can suffice.
• Always stick to whole foods instead of packaged foods. Labels can be deceiving, not all products may have complete breakdown of added sugars. Look for the “Carbohydrates (of which sugars)” figure in the nutrition label to see how much sugar the product contains for every 100g: Less than 5 gram of sugar per 100 gram of product is considered low in sugar.
• Offer your child fruit over fruit juice, fruit rollups and fruit pouches.
• Food pouches for kids are a new trend. But many experts suggest limiting the use after first year of baby’s life. They contain high amounts of sugar, don’t teach the child about the real texture of foods and may lead to tooth decay. These are okay for travel or occasional consumption but definitely not as a replacement for everyday meals.
• Lastly, it is important to educate our kids on nutrition. What is good food? Why is it important for the body? Also to lead by example, kids learn everything from their parents. It’s best when we model good eating and healthier lifestyle to them.

In conclusion

The intention of this post is not to showcase sugar as the devil that needs to be avoided at all costs instead it is to educate and increase awareness about our knowledge of sugar. Many of us know too much sugar is bad for our health but how many of us are truly aware how much we end up consuming in a day through a seemingly healthy diet.

We owe our children knowledge of good nutrition so we can raise a healthier generation for tomorrow. Stick to home cooked whole foods and leave processed packaged foods for rare occasions. Let’s teach our children how real food looks and tastes like. These minor changes in our perspectives and daily eating habits will impact our children in a great way. My own love for nutrition and good home cooked food was instilled in me by my grandfather. There is no greater gift you can give your child than the gift of good health.

Resources:

1] World Health Organization. WHO Opens Public Consultation on Draft Sugars Guideline. (2014). [online] Available at: http://www.who.int/mediacentre/news/notes/2014/consultation-sugar-guideline/ en/ [Accessed on 06 Jul. 2017].

2] Children should eat less than 25 grams of added sugars daily. (2016). [online] Available at: http://newsroom.heart.org/news/children-should-eat-less-than-25-grams-of-added-sugars-daily [Accessed 6 Jul. 2017].

3] Gulati, S. and Misra, A. (2014). Sugar Intake, Obesity, and Diabetes in India. Nutrients, 6(12), pp. 5955-5974.

4] Misra, A., Ramchandran, A., Jayawardena, R., Shrivastava, U. and Snehalatha, C. (2014). Diabetes in South Asians. Diabet. Med, 31(10), pp. 1153-62.

5] Gulati, S., Misra, A., Colles, S.L., Kondal, D., Gupta, N., Goel, K., Bansal, S., Mishra, M., Madkaikar, V., Bhardwaj, S.(2013). Dietary intakes and familial correlates of overweight/obesity: A four-city study in India. Ann. Nutr. Metab, 62, pp. 279–290.

6] Hubbard, M.D, S. (2013). The Kid’s Doctor: Pass on those fruit and veggies in a pouch. Chicago Tribune. [online] Available at: http://articles.chicagotribune.com/2013-07-03/lifestyle/sns-201307021400–tms–premhnstr–k-n20130703-20130703_1_pureed-baby-food-fruit-and-veggies-apples [Accessed 6 Jul. 2017].

7] The Indian Express (2017). India has second highest obese children in world: Study. [online] Available at: http://indianexpress.com/article/lifestyle/health/india-has-second-highest-obese-children-in-world-study-4702274/ [Accessed 6 Jul. 2017].