Obesity is affecting increasing numbers of children throughout the United States. According to the 2011 National Survey of Children’s Health, 31% of children ages 10-17 are overweight or obese. In Texas, the number is 36.6%. Pediatricians have an important role in not only educating patients and their families regarding childhood obesity but also advocating for measures that allow our patients to make healthy choices.
This has serious implications for our children. Children who are obese are more likely to develop metabolic syndrome, increased risk for heart disease, high blood pressure, type 2 diabetes, and stroke. These complications are not distant prospects: they are affecting children now. For example, type 2 diabetes, known colloquially as “adult onset diabetes,” is becoming increasingly more common in our pediatric population. The total staggering effects of this trend will not be seen for decades, but economists now estimate obesity-related medical costs alone could rise to $50 billion per year by 2030. That does not capture the societal impacts of a sicker population.
The rising obesity epidemic has been a multifactorial phenomenon, so multi-pronged approaches have tried to address it. One strategy has been to focus on reducing access to sugar-sweetened beverages (SSB) through limiting sales of soda vending machines at school. Sugar-sweetened beverages deliver high levels of sugar to children which make it very easy to surpass the daily recommended amount of added sugar. The American Heart Association’s dietary recommendations for sugar are a maximum is 12 grams for children and 25 grams for teens. Consider that a single 12 oz can of typical soda has 39 grams of sugar, about 1.5 times the recommended amount for teens. Furthermore, a study of teenage drinking habits showed that teenage boys who drink SSB consume on average three 12 oz cans per day, and teenage girls more than 2 cans.
In 2004, Texas banned carbonated beverages in vending machines accessible to students in high school. However, the Texas Department of Agriculture removed the ban of carbonated beverages in 2015 (as well as the ban on deep fryers) in schools.
In 2014, updated federal guidelines for the National School Lunch and Breakfast programs were issued which restrict the calories on non-milk and juice beverages. Unfortunately, SSB are still sold at schools through fundraising activities, and the federal guidelines have led a shift in stocking vending machines with more no/low-calorie “diet beverages”. Yet even no/low-calorie beverages have been linked with changes in dietary behaviors that lead to a total increased caloric intake. Studies show that overweight and obese individuals who drink diet beverages consume significantly more solid-food calories.
In light of all this, what can pediatricians do?
– Talk directly with patients and families about proper nutrition. Explain that one sugar-sweetened beverages often contains more than the daily recommended amount of sugar. Explain what metabolic syndrome is and what it can do to the child. Point out that no/low-calorie beverages can lead to increased total caloric intake. Prepare families to make good decisions on the food they eat.
– Engage in the public debate. Soda in public high schools may seem like a drop in the ocean of obesity epidemic. However, education in school extends beyond the classroom. We have the opportunity to teach our children what a healthy diet looks like by the options we provide. Here in Texas, the Department of Agriculture allows local school districts to make these decisions, so participate with your local schools to provide healthier options. If you live in another state, find out which authority makes decisions on school nutrition Your position as a pediatrician has long-reaching influence, and your input can make a difference.
Timothy Chow MD