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.

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].

47 Comments

  1. Supriya

    Very educative post!

    Reply
    • Ophira

      Thankyou Supriya!

      Reply
  2. Nancy

    This is a great post!! Very helpful to all mom’s but especially new ones. As I start to give my child solid foods more often, I am trying to be aware of how much sugar I feed him- especially the hidden ones. Your list of terms is useful. Thank you!

    Reply
    • Ophira

      I am glad it helped you Nancy! that is the intention of this post 🙂

      Reply
  3. Hayley

    Really interesting post. The amount of sugar my child eats is a real concern of mine. And sometimes it’s out of my hands. Grandparents bestow with her sweets, she goes to parties & gets given sweets, ice cream & cake, she goes the friends’ houses & gets given sweets, sweets are handed out at school, then it’s Halloween, Christmas, Easter, her Birthday. It never ends. I try and ration everything. Everything in moderation is fine, but as a general rule this world consumes too much sugar.

    Reply
    • Ophira

      Oh I agree Hayley, as parents we can police all we can but cannot control when sweets are given to the child literally everywhere they go. This is going to be one of my main concerns going ahead too. So far we have managed to keep it all natural and homemade food for our 16 month old, but I too worry about when he goes to school. That is why I stress so much about parents being good examples to their kids. As kids we got our share of sweets but generally the entire house was on minimal junk so we didnt have as much appeal for the sweets. I guess I looked up to my parents and grandparents as my role models. I hope this works once more now with my family too!

      Reply
  4. Fancy

    It is so frightening how much sugar is in our foods. How did it get so far? Scary.

    Reply
    • Ophira

      I know Fancy, it no longer is in just sweets and pastries, its everywhere!!

      Reply
  5. Ritu

    It is scary how people don’t understand the problems they are giving to their children for the future!

    Reply
    • Ophira

      I hope this post helps educate more parents into making better food choices when they can. It all starts with simple switches to more whole foods.

      Reply
  6. Lisa Orchard

    Awesome post! I wrote a post about this about 9 months ago. I titled it “Is our Food Industry Making Us Fat?” Here’s the link: https://wordpress.com/posts/lisaorchard.wordpress.com?s=is+our+food+industry+making+us+fat

    I wrote on this same subject and I’m glad to see other people are seeing the problem here. I’ve taught my boys to look for the sugar content in everything they eat or drink. There’s even added sugar in many sport drinks. My youngest is very diligent about it, but my oldest isn’t quite as concerned. Sigh. I’ll keep working on him, though. Again, great post and thanks for getting the word out there!

    Reply
    • Ophira

      Yes Lisa, we have to try our best to educate our kids. I am glad that there are moms like you who do care about this subject. We need to spread awareness on this topic 🙂

      Reply
  7. Gary Jefferies

    Sad to see the trail of retail spreading far and wide. They talk about it here all the time and yet everywhere is stocked knee deep in confectionary (multi-buys), fizzy drinks, microwave food packed with sweeteners, the list goes on. Back in the day accessibility was much less and so average health was better in terms of obesity and all the biochemical issues that spawn from that. Somewhere along the line social conscience has missed the boat and been sucked into the commercial enterprises that don’t really care as long as you buy their products.

    Labelling, if its the first time you pay attention to it, is scary reading once you know what is what. My advice is always take of fast re-heat meals, halve the fizzy drinks in the fridge (a case of yes, drink it all at once, but that’s all there is until I go shopping again next week), if they have 2 sugars in hot drinks, drop it to one, then half a spoon until none – mine never noticed 2 to 1 at all.

    As a biochemist this is a pet peeve and shame on the industries too; bit like alcohol really. Available 24/7 and cheap… throwback time and supermarkets were prohibited from off sales in favour of Off Licences which had strict trading hours and pubs weren’t open all day. Worked fine and dandy until someone said open all day and let supermarkets sell it…now we have alcohol consumption on the rise…hello, the world needs more rocket scientists (play on “It’s not rocket science” for the uninitiated; I say this as not so long ago I said “Seen that bought the T-Shirt;” the reply was “But I don’t sell T-shirts,” no but probably stocks up on beer and sugar…#glibtalk). Where was I, oh yes marketing, run by people who have no dietary or moral standing. Cash is King.

    I guess this is why, as Lisa said above, parents have to pick up the pace more and make good choices, do not fall for the easy fast option and the educational word needs shouting out more.

    Great post and apologies for soap boxing 🙂

    Reply
    • Ophira

      I think you hit the nail on the head there. It is my intention with this post to create as much awareness as possible. India is aping the West in many spheres and unfortunately fast food and packed food have now become a mainstay in our diets. Many Indian mothers consider any packaged food as good rather than sticking to traditional meals. Advertising and big companies know well how to get their customers hooked. At this stage, all we can do is be more aware of what we are putting in our mouths and as you said start by making smaller changes until there is minimal sugar consumption. Its hard, but definitely not difficult. Thank you for adding some valuable points here Gary.

      Reply
  8. Cook & Enjoy

    A very informative and well written post. Yes we need to guard again this evil “sugar”

    Reply
    • Ophira

      Thankyou 🙂

      Reply
  9. Cindy

    Great post! This is a big concern to me. Once a child or adult becomes addicted to sugar, it is so hard to break the cycle. I am trying to limit added sugar in my daughter’s diet, but it is difficult when other family members want to give treats constantly. Thanks for a very informative and important article.

    Reply
    • Ophira

      I am glad it helps Cindy! Its all about being aware.

      Reply
  10. arv!

    Indian food is not the healthiest. It’s laden with sugar and fats. We certainly need to watch we give kids to eat

    Reply
    • Ophira

      We have lost our way. I don’t see families practicing moderation anymore. It is quite unfortunate.

      Reply
  11. Shirin

    Hey hi Ophira, hope you’re doing good 😊. Needless to say the blog is awesome and I am so happy to read this as I am into healthy nutrition for my Lo. I wanted your help in applying gentle parenting as my Lo is very stubborn these days.

    Reply
    • Ophira

      Hi Shirin, I am so glad you found the blog helpful. There are some great resources for applying Gentle parenting and I would love to share these with you. You can personally write to me at contact@easymommylife.com so we can take this discussion further. Also do subscribe! As I plan to write on this topic soon. I am applying these strategies with my little one and will do a series on our successes with gentle parenting. Would love to hear from you. Keep reading!

      Reply
  12. Niki @ Toot's Mom is Tired

    Great info! I always try to find food labeled “no sugar added” especially fruit cups. There’s already sugar in fruit, why do we need to add more?

    Reply
    • Ophira

      Thankyou Niki 🙂 I know how frustrating it is figuring out labels. We dont have much variety in natural no sugar snacks here in India, I have to stick to home cooked snacks on the go too.

      Reply
  13. Preetjyot

    That’s a great piece of information that you have shared. I’m sure it will help many parents

    Reply
    • Ophira

      Thankyou Preetjyot!

      Reply
  14. Sanjivini

    Very informative post. We ourselves refrain from using packaged food as much as we can

    Reply
    • Ophira

      That is great Snajivini, I hope my post helps.

      Reply
  15. Deepali

    Super Informative post. I keep a check on my ToT’s sugar intake.

    Reply
    • Ophira

      Great Deepali, nice to know other moms are also aware about sugar intake and actively looking after for their kids nutritional needs.

      Reply
  16. Aya

    Informative post!

    The only thing I could remember is as long as there’s an -ose, it’s sugar. But then again, I don’t even bother reading the ingredients. Haha. Next time I’ll be sure to check.

    Reply
    • Ophira