Rethinking beverage choices of family members may be one strategy to lower calories and prevent obesity. Many parents are not only concerned about their own weight, but also concerned about the weight of their children. Parental beverage preference influences what children drink and may dominate the actual choices of young children adding extra calories and excess body weight.
How do these beverage preferences develop? In infancy, milk is the primary liquid up to a child’s second birthday. During childhood juice becomes more popular contributing about 40% of total beverage calories. To evaluate if parental beverage choice dominates a child’s, one study placed children, 2-6 years old, in a mock grocery store to buy whatever they wanted without parent guidance. Children purchased regular soda 1.5 times more often than milk modeling their parents’ preference for regular soda over milk.
Beverage pattern was analyzed for 3,583 U.S. children, 6-11 years old between 1989 and 2008. Sugar-sweetened beverages increased and nutrient-rich beverages decreased in similar magnitude generally for the first few years and then remained constant the latter years. This strongly suggested that a beverage pattern is defined when a child is young.
Then in adolescence, regular sodas and sweetened teas/coffee/waters increase while fruit juice and milk decline. In fact, girls’ early soda intake was very predictable. For 170 non-Hispanic white girls, 5-15 years old, soda intake was monitored as they aged. If girls were soda consumers at the beginning of the study, no matter if they were 5 or 10 years old at that time, they had higher intake of regular soda and other beverages with added sugars as they aged. The proportion of regular soda compared to total beverage intake remained the same. If girls were soda drinkers in the younger years, then they had lower intake of milk yielding less calcium and protein, and important vitamins and minerals for their growth and development.
For boys, as they age from 13-18 years, studies show a significant increase in the number of sweetened beverages they drink each day. By high school graduation, beverage intake plateaus for both boys and girls, suggesting a beverage pattern and a taste preference.
These research findings drive the argument to reduce sugar-sweetened beverage intake early in the life to reduce total calories. By so doing, a child’s nutrient intake from beverages can increase. An added benefit would be a reduction in weight gain and obesity, but would that really work?
Researchers analyzed how a reduction in liquid calories would equate to weight loss in adults. Not only did the adults have a significant weight loss from reducing liquid calories, but the reduction in calories from beverages was greater than the changes they made to reduce calories from foods. It appears that adults were more willing to change their beverage choice than change their solid foods to lower calories. Children and youth may model this behavior as well. These same researchers found that no other type of beverage was associated more dramatically with a weight change than the sugar-sweetened beverage intake.
Eight of nine studies reported in the literature between 2001-2009, found that as sweetened beverage intake decreased, children’s BMIs declined. Among overweight African-American preschool children, investigators evaluated the association between sugar-sweetened beverage and their weight. Dietary data was collected once between 2002-2003 and again two years later to evaluate if additional fruit juice and sugar-sweetened beverages affected body weight. The result was that the probability of a child becoming overweight two years later was significantly greater when the children had additional sugar-sweetened beverages and juice intake at a younger age.
A longitudinal sample of 7,445 children was observed for their beverage choices from their 5th to 8th grade years. Published in the September 2012 issue of the Journal of the Academy of Nutrition and Dietetics, researchers concluded that decreases in average milk intake were not related to increases in sweetened beverage intake. Milk frequency mirrored fruit juice intake over a 3-year period. If milk went up, then juice went up and vice versa, but the changes did not associate with changes in sweetened beverages. What is important to note is that the authors were only looking at the number of times the beverages (milk, juice and regular soda) were drunk and not at the quantity or total calories. Their methods were quite limited and open to error. In addition, had they included diet drinks as an option, the impact of replacing sweetened soda with diet soda could have been determined. This is important because even if milk and juice increased or decreased in parallel, an independent calorie reduction could occur if regular soda intake was changed to diet or simply eliminated producing a calorie reduction.
This point is supported by two research studies in the October 2012 issue of the New England Journal of Medicine. J.C. deRuyter et al. conducted a double-blind, randomized 18-month intervention. The 641 normal weight children, between 4 and 11 years of age who commonly drank sugar-sweetened beverages, were assigned to either 8 fl. oz. of a diet beverage or 8 fl. oz. of a sugar-sweetened beverage at school. Urinary sucralose levels were monitored to validate adherence. A significant reduction in weight gain and body fat gain was observed for children drinking the sugar-free beverage.
Ebbeling et al. randomly assigned 224 overweight and obese adolescents to either an intervention consisting of home-delivered bottled water and ‘diet’ beverages every two weeks or to a control condition. The adolescents drank at least 12 fl. oz. of sugar-sweetened beverage or 100% fruit juice daily to be eligible for participation. The 12-month intervention had two follow-up points, i.e., 12 months and 24 months. At 12 months, a significant difference was found between groups for change in BMI (-0.57, P= 0.045) and weight (-1.9 kg, P=0.04). A significant difference was noted among Hispanic adolescents at both 12 and 24 months.
In summary, it is important to present parents with accurate data about beverage research, especially if they are concerned about their children’s weight. The Dietary Guidelines for Americans (DGAs) report that adults drink about 400 calories daily from beverages. Adult preferences in order of choice are regular soda, energy/sports drinks, alcoholic beverages, milk of all different fat levels, 100% fruit juice and fruit drinks. Children from 2 to 18 years average 400 calories each day from beverages. Their choices, if ranked, are milk of any type, regular soda, energy/sports drinks, fruit drinks and 100% fruit juice. The DGAs acknowledge that milk and 100% fruit juice provide the most calories for younger children, and regular soda provides more calories for adolescents.
Parental beverage choice reflects their personal pattern and children will model that pattern as they define their own. Although some research shows no association between sugar-sweetened beverages and body weight or BMI, some studies provide strong evidence that weight increases when preschoolers and young children have more sugar-sweetened beverages. Further, a beverage pattern actually appears defined during the pre-teen and teenage years. This pattern reflects a taste preference which may be very difficult to change because it is driven by a preference for a sweet taste.
Since there is a good chance that what parents drink ultimately influences their children’s weight, if the taste for sweet is set early, then beverage choices which are sweet, but low in calories like water, low-fat milk and diet sodas, may be powerful substitutes to fight the obesity epidemic. Sugar-sweetened beverages give excess calories and few essential nutrients for growing children. No and low-calorie alternatives should be the choice so daily calories are not exceeded and weight gain is kept in check.
Gail Frank Dr PH, RD, CHES is Professor of Nutrition at the Department of Family and Consumer Science of California State University.
Chen, L.W., Appel, L. J., Loria, C., Lin, P. H., Champagne, C.M., Elmer, P. J., Caballero,
B. (2009). Reduction in consumption of sugar-sweetened beverages is associated with weight loss: The PREMIER trial. AJCN, 89(5), 1299-1306. doi:10.3945/ajcn. 2008. 27240
Clabaugh, K. & Neuberger, G. B. (2011). Research evidence for reducing sugar sweetened beverages in children. Issues in Comprehensive Pediatric Nursing, 34(3), 119-130.
Ebbeling, C.B., Feldman, H.A., Chomitz, V.R., Antonelli, T.A., Gortmaker, S.L., Osganian, S.K., & Ludwig, D.S (2012). A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight. N Engl J Med. September 21. NEJM.org
Fiorito, L. M., Marini, M., Mitchell, D. C., Smicklas-Wright, H., & Birch, L. L. (2010). Girls’ early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence. J Am Diet Assoc, 110, 543-550.
Frank GC. Where Do Beverages Fit? – Limiting Calories in Restaurant Meals. Nutrition Education of the Public. Fall, 2011.
Frank GC. (2011). Beverage of children—It’s role across the lifecycle. California Dietetic Association Annual Meeting. Platform presentation. Ontario, CA.
Lasater, G., Piernas, C., & Popkin, B. M. (2011). Beverage patterns and trends among school-aged children in the US, 1989-2008. Nutrition Journal, 10:103.
Lim, S., Zoellner, J. M., Lee, J. M., Burt, B. A., Sandretto, A. M., Sohn, W., et al. (2009). Obesity and sugar-sweetened beverages in African-American preschool children: a longitudinal study. Obesity, 17(6), 1262-1268.
Oza-Frank, R., Zavodny M., & Cunningham S.A. (2012). Beverage displacement between elementary and middle school, 2004-2007. J Acad Nutr Diet, 112 (9), 1390-1396.
Rutyer, J.C., Olthof, M.R., Seidell, J.C., & Katan M.B. (2012). A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children. N Engl J Med. September 21. NEJM.org
U.S. Department of Health and Human Services and U.S. Department of Agriculture. Report of the Dietary Guidelines for Americans, 2010. http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm. Published January 31, 2011. Accessed October 11, 2012.