It is important for pediatricians to show parents how to recognize added sugars in their children’s diet and stress the importance of limiting them. New and improved food labels could facilitate this kind of nutrition counseling. In May 2016, the FDA issued a rule changing what needed to be included in nutrition food labels. Originally, companies were expected to be in compliance by July 2018, just last month.¹ However, many groups rallied against the new food labels, including the Sugar Association, the American Beverage Association, the Corn Refiners Association, and the American Bakers Association, to name a few.² One part of the nutrition label that was criticized by these groups was a new section underneath “Total Carbohydrates.” This section will inform consumers about the quantity of added sugars in each product. However, the deadline has now been pushed back until January 2020 for food companies with revenue greater than 10 million dollars in food sales and until January 2021 for those with revenue less than 10 million dollars in food sales. Many of the public comments under the bill proposing the new food label came from industry groups who pointed to a lack of scientific research demonstrating intrinsically harmful effects of sugar.³

It is important to note that when an individual consumes too much sugar, they are not able to consume enough foods to meet other vitamin and nutritional requirements and still stay within a reasonable calorie limit. Consequently, the 2015-2020 Dietary Guidelines for Americans advises that only 10 percent of calories should be from added sugars.⁴ Thus, it is important for physicians to provide advice when patients’ diets include too much. From 2009-2012, kids 2 to 8 years old received 14.3 percent of their calories from added sugars. Among kids 9-18, the percentage was even higher at 16.2 percent. Kids’ added sugars tend to originate from sugar sweetened beverages, candy, and desserts.⁵

The new food labels will help pediatricians and all doctors advise patients regarding intake of added sugars, along with other nutrients, which would dovetail the Dietary Guidelines for America 2015-2020. Consistency between physicians’ counseling and what patients see in the grocery will likely help them more easily carry out these practices.

However, in the meantime, there are a few pointers that we can give to families so that they can recognize and reduce their sugar intake. First, parents can be informed that added sugars can take many forms other than just “sugar” on the ingredients list of a food label. These include: brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose molasses, raw sugar, sucrose, trehalose, and turbinado sugar.⁵ Also, the more ingredients are listed on the food label, the more processed that food is and the less nutritional value it will have; consequently, these are foods to be enjoyed occasionally as treats, if at all. Second, ask patients about their intake of sugar sweetened beverages, snacks and desserts as these tend to be where kids find their added sugars. The daily recommended limit for children ages 2-18 according to the American Heart Association is 25 grams of sugar, or 6 teaspoons (the limit for adults is two times as much).⁶ A 12 ounce can of coke has 36 grams of sugar, or more than 140% of what is recommended in an entire day. Thus, eliminating or even reducing intake of these beverages can be helpful. Children under two should not consume any added sugar as their preferences for different types of food are developing, and they need a diet rich in other nutrients.⁶

Improved food labels will help families better understand how to feed their children and themselves. Until then, pediatricians ought to address these issues regularly with patients and their caregivers.

Hali Nguyen, MD

References

1. https://www.federalregister.gov/documents/2018/05/04/2018-09476/food-labeling-revision-of-the-nutrition-and-supplement-facts-labels-and-serving-sizes-of-foods-that
2. https://www.washingtonpost.com/news/wonk/wp/2016/05/20/why-the-sugar-industry-hates-the-fdas-new-nutrition-facts-label/?noredirect=on
3. https://www.regulations.gov/document?D=FDA-2011-F-0172-0621
4. https://health.gov/dietaryguidelines/2015/guidelines/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793330/
6. http://www.aappublications.org/news/2016/08/23/Sugar082316
7. Photo: https://www.foodbusinessnews.net/articles/11761-fda-officially-moves-back-nutrition-facts-label-compliance-date