Shaping choices: Healthy beverage options

Creating healthy beverage environments for children and adolescents is one of the most promising strategies for preventing obesity.

Overview

Children and adolescents encounter many beverage environments in their daily lives. Soda, juice, milk, water, sports drinks; the choices are numerous. According to the research, choice of beverage appears to be related to calorie and nutrient intake, body weight and the overall diet quality of Americans. Excessive consumption of sugar-sweetened beverages, sports drinks and fruit juices can negatively impact bone health, oral health and lead to obesity in young people.

Reducing soda consumption is an important element in creating healthy beverage environments for children. Soft drink consumption has more than doubled since 1971 and those drinks now account for more than one out of every four beverages consumed in America. These beverages comprise the leading source of added sugar in the American diet. According to dietary surveys, soft drinks provide the average American with 7 teaspoons of sugars per day, out of a total of about 20 teaspoons. Specifically, teenage boys get 44 percent of their 34 teaspoons of refined sugars a day from soft drinks while teenage girls get 40 percent of their 24 teaspoons of sugars from soft drinks. Studies have shown that more soda leads to childhood obesity, more diabetes, less calcium and more osteoporosis, and more cavities.

Minnesota data

The 2004 Minnesota Student Survey found the following statistics:

42 percent of boys and 34 percent of 6th grade girls reported drinking three or more glasses of milk. In 12th graders these numbers decrease to 35 percent of boys and 18 percent of girls.
64 percent of boys and 55 percent of 6th grade girls reported drinking one or more glasses of pop or soda. In 12th graders these numbers increased to 71 percent of boys and 55 percent of girls.
Consumption of one or more glasses of 100 percent fruit juice were relatively consistent from 6th to 12th grade boys (60 percent), but juice intake decreased significantly from 6th to 12th grade girls (60 percent to 41 percent).
Water intake decreased from 6th to 12th grade with 34 percent of boys and 31 percent of girls drinking five or more glass of water per day.

National data

The National Health and Nutrition Examination Survey (NHANES) from 2001-2002 found the following beverage statistics for Americans age 4 and older:

Nearly 50 percent consumed regular soft drinks on any given day. The contributions of soft drinks to total added sugar intakes were highest among teenagers.
Nearly 20 percent consumed fruit drinks (fruit-flavored beverages containing less than 100 percent fruit juice).
45 percent reported drinking plain milk on any given day.
Nearly 90 percent said they drank plain drinking water (tap or non-carbonated bottled water).

Know your numbers

Preferred beverages for children and adolescents include water, 100 percent fruit juice, and milk. Sugar-sweetened beverages should be limited.

Institute of Medicine recommendations

A recent report from the Institute of Medicine, Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth, provides the following recommendations for beverages in schools:

Schools should make plain, unflavored water available for free throughout the school day, either in the form of bottled water or from water fountains.
In elementary and middle schools, beverages should be limited to plain water, skim or 1 percent milk, soy beverages and 100 percent fruit or vegetable juice.
Juice should be limited to 4 ounce servings for elementary and middle school students, and 8 ounce portions for high school students.
High school students should only have sports drinks available to students who've engaged in an hour or more of vigorous physical activity, at the discretion of coaches.

Juice

The American Academy of Pediatrics recommendation for juice intake:

Fruit juice should not be given to infants before 6 months of age
For children ages 1-6, limit juice to 4-6 ounces per day
For children ages 7-18, limit juice to 8-12 ounces per day

Milk

The American Heart Association Pediatric Dietary Strategies for Individuals Aged >2 Years suggests:

Use nonfat (skim) or low-fat milk and dairy products daily
Reduce the intake of sugar-sweetened beverages

Daily estimated calories and recommended servings for milk/dairy by age and gender

1 year - 2 cups*
2 to 3 years - 2 cups
4 to 8 years - 2 cups
9 to 13 years - 3 cups
14 to 18 years - 3 cups

* Milk listed is fat-free, except for children under the age of 2 years.

Key strategies

Children's beverage habits are greatly influenced by their environment. Strategies for creating healthy beverage options for children and adolescents should be explored in every setting in which they reside. Examples of promising strategies include:

Individuals and families should consider which beverages their children are drinking and choose/stock healthful beverages that family members enjoy.
Physicians, nurses, dentists, nutritionists should routinely ask patients about their beverage choices and advise them accordingly.
One of the most important and often overlooked beverages that children should consume is water. Any environments in which children reside should serve water to drink, have clean sources of tap water, and/or working water fountains.
Wellness policies in school systems and other organizations catering to children and adolescents should cover beverages sold in hallways, the cafeteria, beverages served at classroom parties, and beverage advertising.
Review your organizations vending sales contracts and replace sugar-sweetened beverages with healthier options. A report from the Center for Science in the Public Interest (CSPI) found that in most cases, the revenue generated from these beverages is modest and can be replaced by the sale of healthier beverages or by alternative fundraisers that do not undermine children's diets or health. In fact, many of the nation's largest school districts (e.g. Boston, Chicago, District of Columbia, Las Vegas, Miami, New York City, Philadelphia, San Francisco, and Seattle) prohibit the sales of soft drinks in schools.

Resources

Looking for more information on Alliance for a Healthier Generation and their vending guidelines? The Strategic Alliance focuses on healthy eating environments for a variety of settings. Check out their quick facts, model programs and success stories, tools, policies in action, and organizations and coalitions for many setting in which children and adolescents reside.

Would you like more details and information on milk? Visit the Midwest Dairy Council.

For more information on the recent report, read Institute of Medicine.

For information on dietary guidelines for children, read American Heart Associations Dietary Guidelines for Children.