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Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Cutting back on sugar is a good first step to preventing childhood obesity, but a new study cautions parents and providers to think twice about sugar substitutes.
As parents and healthcare providers struggle to fight childhood obesity, cutting back on sugar is often the first weapon of choice. New research suggests, however, that artificial sweeteners often are substituted for sugar-a move that isn’t always helpful.
The report, published in Clinical Advisor, found that artificial sweeteners-previously linked to weight gain in children-may actually be stimulating children’s appetites and leading to overconsumption.1
“Obesity rates have tripled in some pediatric age groups. As providers and parents search for alternatives that will allow children to consume healthier choices, the use of artificial sweeteners is not a ‘healthy’ alternative to sugar-dense beverages,” says Susan Eley, PhD, MS, RN, FNP-BC, one of the study authors and professor, College of Health and Human Services, School of Nursing, Indiana State University, Terre Haute. “Children’s diet should not include carbonated beverages or those with artificial sweeteners. Parents should be questioned during the patient visit regarding the diet including beverages that their child consumes.”
The report cites a study from the Harvard School of Public Health that identified a 45% increase in body mass index (BMI) among children consuming artificially sweetened beverages over an 8-year period compared with those who did not consume sugar substitutes.
To extrapolate on this study, researchers in the new report examined numerous studies investigating the effects of zero-calorie beverages and artificial sweeteners on weight in children. Several investigated the effect of increasing water intake, thereby reducing the consumption of artificially sweetened beverages. In several of the studies, increased water consumption was associated with a lower BMI and other measurements of obesity, while continued or increased consumption of artificially sweetened beverages led to increases in weight and BMI. Overall, however, the research team notes that a link between artificially sweetened beverages and weight gain are inconclusive, with most studies showing mixed results.
“In the pediatric population, there are limited data about artificially sweetened beverage consumption and its influence on weight. Most of the studies conducted on artificially sweetened beverages and the pediatric population are prior to a current report by Harvard School of Public Health that suggests avoidance of artificially sweetened beverages for the pediatric population,” the report notes. “Although studies report that parents are concerned about allowing their children to consume artificially sweetened beverages, the consumption of artificially sweetened beverages is growing in the pediatric population as a dietary tool to reduce caloric intake. . . . Water appears to have become the forgotten zero-calorie beverage that does not increase weight or BMI. Sugar-sweetened beverages and artificially sweetened beverages can easily be replaced with readily available water to increase hydration, decrease the risk of weight gain, and promote healthier dietary choices for all populations.”
Eley says that although the report is not an original study, it is a review of current literature that supports the position that substituting foods or beverages with artificial sweeteners will not lead to weight loss in children but may actually stimulate their appetite and cause weight gain.
“It should be remembered that children are not part of random control trials when artificial sweeteners are in research and development. They are not tiny adults and their metabolic process is not the same as adults,” Eley says. “Use of artificial sweeteners as a means to reduce calorie consumption and cause weight loss is not supported by the research.”
Healthy choices have far-reaching effects
Obesity affects 1 of every 3 children aged 2 to 19 years, the study notes, and costs about $14 billion annually in direct medical costs. Prevalence of this issue, coupled with cost and implications for lifelong, chronic health conditions make this not only an issue for parents, but also for pediatricians, communities, and the government, the report notes. The authors suggest that, although results from the literature review are mixed, eliminating sugary drinks and sports drinks from schools and community programs, as well as increasing the availability of fresh water, would encourage better beverage choices among children.
“Education on healthy beverage choices is a crucial element in reducing pediatric obesity. Healthcare providers need to be willing to converse with all children and families about healthy diets, exercise, and making better food and beverage choices,” the report notes. “Weight loss is seldom recommended in the pediatric population; therefore, empowering children to make healthier food and beverage choices will require education and awareness for the entire family.”
Parents are a big part of this effort, but Eley says they often need education and guidance, and the pediatrician is a natural choice.
“Parents or guardians control foods that are purchased for the home and can influence healthier choices available to all family members. Parents must be part of the change to a healthier lifestyle. Children eat what their parents eat,” Eley says.
Pediatricians can encourage parents to make healthy snacks and beverages readily available in the home, conditioning children to let the natural sweetness of whole foods satisfy their “sweet tooth.”
“Look for cost effective resources you can direct your patient and families to. Work with a registered dietician if possible,” Eley suggests. “Many private insurances will cover a consultation with a registered dietician. Public health offices have many excellent resources. Colleges in the area that have dietetics programs may provide reduced or free services when working with dietetic students.”
Eley says she hopes the report inspires pediatricians to tackle obesity from a nutrition standpoint.
“As providers we must have greater focus on nutrition and health and explore with our parents/patients what tools they need to make healthy changes in their own and their families’ diet,” Eley says. “Time is short in the exam room and using handouts, flyers, and perhaps group medical appointments focused on nutrition will assist in translating information to action. It is shocking that we will prescribe medication for conditions such as hypertension, diabetes, and elevated lipids for our adults without addressing the underlying issue of obesity that is preventable and is on the rise in the children that we see in the patient setting. Shaping our health starts when children are young.”
1. Noblitt M, Shepard KL, Eley S. Effect of artificial sweeteners on obesity risk in children. Clinical Advisor website. Available at: https://www.clinicaladvisor.com/pediatrics-information-center/use-of-artificial-sweeteners-and-risk-of-obesity-in-the-pediatric-population/article/811301/. Published November 1, 2018. Accessed December 6, 2018.