KIDS
June 17, 2009

Let Them Drink Water

When kids switch from sugar-sweetened beverages to water, this simple change can result in a reduction of 200+ the calories a day.

Everyone knows about the national epidemic of overweight children and teens. It is both well−documented and a cause of short− and long−term physical and emotional health problems. Between the 1970s and the early 2000s, the rates of obesity in children ages 2−11 years nearly doubled; and they tripled in adolescents ages 12−19 years old. While there is no quick fix, there are changes that can be made in the nation's eating habits that can be effective. A study reported in the April issue of The Archives of Pediatric and Adolescent Health addressed one such remedy.

Parents can use this information from early childhood, giving toddlers water rather than sugary drinks to accustom them to the taste of water.

Previous studies have shown that much of the obesity epidemic is the result of an 135% increase in consumption of sugar−sweetened beverages (SSBs) by children and adolescents from 1970 to 2001. Recent data suggests that SSBs alone can contribute more than 10% of the total calories consumed by US children per day.

When children and adolescents drink sugar−sweetened beverages, they do not reduce their caloric intake from other sources. Additionally, the commercial trend toward super−sized drinks has lead to inappropriate portion sizes of high calorie sugared beverages. This led the authors of this study to investigate the drinking habits of children and to predict the impact on their daily calorie consumption when sugar−sweetened beverages were replaced with water. For this study, one serving of a beverage was defined as 8 ounces.

The 3098 participants who participated in the study were divided into three groups, preschool ages 2−5, primary school, ages 6−11, and middle school or higher ages 12−19. Different age groups have different access to SSBs. Older more independent children are less likely to have their beverage choices monitored by their parents. Parents of younger children may believe that fruit juices are important sources of nutrition, and are unaware of the excessive sugar load and minimal nutritional value of these highly advertised drinks.

The study used data from a 24−hour dietary recall questionnaire obtained in 2003−2004 by the National Health and Nutrition Examination Survey, one of many ongoing surveys about the US population conducted by the National Institute for Health. The questionnaire asked about a variety of SSBs such as soda, sports drinks, fruit drinks etc. Two such questionnaires completed on non−consecutive days were used for each participant. The caloric content from the consumed drinks was calculated along with the daily caloric intake from non−beverage items. Weight and height were measured and the National Centers for Disease Control control definition of "overweight" was used.

Results showed that caloric consumption via sugar−sweetened beverages did not vary by sex, race, income, or weight, but found that older age groups tended to consume more SSBs. This is consistent with their independence, and interest in fast food. The study showed that each serving of an SSB was associated with an additional 106 calories per day, which were not compensated for by a decrease in caloric intake from non−beverage foods.

The researchers then created a computer model in which the SSBs for each individual would be replaced by water. They found a substantial reduction in caloric intake in all age groups. Further they found that each 1% replacement of SSBs with water resulted in a decrease in consumption of 6.6 calories. This decrease in calories was not offset by an increase in other food or beverages. If all daily SSBs were replaced with water, the model predicted an average reduction of 235 calories per day per child.

Diet drinks don't seem to help. The researchers did not find a statistically significant decrease in daily calorie consumption when respondents reported drinking diet drinks. They attributed this to the fact that a relatively small number of children and adolescents actually drink diet products. They further note that although non− nutritive sweeteners such as aspartame and sucralose has been labeled safe for children by the FDA, studies have shown that paradoxically, these diet drinks increase appetite and food intake. The lack of information on the long−term health effects of non−nutritive sweeteners, along with this reported paradoxical effect on appetite, lead the researchers to warn parents to be careful in use of diet drinks for children.

This study strongly concludes that replacing sugar−sweetened beverages with water can contribute to the health of children and adolescents by significantly decreasing their total calorie load. Parents can use this information from early childhood, giving toddlers water rather than sugary drinks to accustom them to the taste of water. Decreasing the availability of SSBs in the home, for snacks or mealtime demonstrates good nutritional habits, and develops healthier choices for children. Buying smaller drinks at fast food restaurants to decrease quantity of SSBs consumed and encouraging water consumption by teens and providing weight conscious teens with accurate information about the caloric difference a change of beverage choice can make will also have an impact. Children and adolescents should still drink adequate amounts of milk, and the daily amount and the choice of low fat or skim should be discussed with the children's doctors.

Parents may also wish to get involved in their children's school and after school programs' nutrition decisions, requesting that water be provided as a replacement or an option to SSBs. A report in the journal, Pediatrics in April 2009 described an intervention study in which water fountains and water bottles were provided to a study group of second and third graders in a German elementary school, along with a series of classroom lessons on the body's needs for water. The teachers encouraged morning filling of the water bottles and each individual student's water consumption was monitored as was the daily water fountain flow. The results included an increase in water consumption in the group that had received the educational and environmental (water fountain and water bottles) interventions and noted a 31% decrease in the risk of overweight in the intervention group during the one−year study period.

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