How much do families underestimate sugar content?

Rachel Shaffer, MPH

Sugar is in nearly every food we consume, and the amounts of sugar in some presumably healthy foods are astounding. A new study now shows that parents are having a difficult time estimating how much sugar they are actually feeding their children, with “healthy foods” containing far more sugar than families realize.¹

Rachel Shaffer, MPH, a PhD student at the University of Washington School of Public Health, Seattle, Washington, and a co-author of the study, says she hopes that the study will help clinicians realize that parents need more guidance on sugar consumption.

“We hope that clinicians will incorporate this guidance into their patient visits, so that families can make informed decisions to minimize their exposures to food additive chemicals,” Shaffer says. “In addition, we hope that clinicians will join in advocating for policy changes, so the burden does not rest upon individuals to avoid these chemicals.”

The study, published in the International Journal of Obesity, revealed that most parents underestimate the amount of sugar they are feeding their children. High sugar intake is associated with an increased risk for obesity, but little has been known until now about how well parents estimate the sugar content of their child’s foods, and how well they manage consumption.

“Evidence about the harmful effects of common chemicals has been growing for decades, and we took this opportunity to review and synthesize the data for the public, clinicians, and policymakers,” Shaffer says. “Chemicals in food additives have been linked to hormone disruption, obesity, reproductive development, and neurodevelopment.”

The study was conducted through the Max Planck Institute for Human Development in Berlin, Germany. Researchers collected data from 305 German families with at least 1 child aged between 6 and 12 years. Body mass indexes (BMIs) were calculated for each child, and the parents who most often made the family food choices completed a computerized quiz assessing their knowledge about the sugar content in various foods common to a child’s diet. The parents were not presented food labels, but rather asked to estimate sugar content in terms of sugar cubes, with each cube containing about 3 grams of sugar.

The study reveals that parents “considerably underestimated” the sugar content in most foods and beverages, with 92% of parents underestimating the sugar content of yogurt by an average of 7 sugar cubes. That equates to roughly 7 teaspoons of sugar or 21 grams of sugar more than parents thought.

These miscalculations aren’t harmless, either, notes the report. Researchers found that after controlling for parental education and BMI, underestimating sugar content in food was significantly associated with a higher risk of a child being overweight or obese.

“These findings suggest that providing easily accessible and practicable knowledge about sugar content through, for instance, nutritional labeling may improve parents’ intuition about sugar,” the report says. “This could help curtail sugar intake in children and thus be a preventive measure for overweight.”

Clinicians may ask, however, with sugar amounts already clearly labeled on foods here in United States, what more can a physician do to educate families?

“We suggest that clinicians work with patients and their families to develop a realistic plan for minimizing exposure to food additive chemicals. Some of our suggestions overlap with other public health aims,” Shaffer says. “For example, prioritizing fresh or frozen fruits and vegetables instead of fast food and processed food, which is one of our recommendations, can also help families reach nutritional goals. If cost presents a burden, clinicians can help families search for assistance programs, such as the WIC Farmer's Market Nutrition Program.”

The study also suggests that more visual systems be created, such as a “traffic light” type of system where a red dot on a label would indicate high sugar content, and a green dot would indicate minimal sugar content. 

References:

1. Dallacker M, Hertwig R, Mala J. Parents’ considerable underestimation of sugar and their child’s risk of overweight. Int J Obes (Lond). 2018;42(5):1097-1100.