Background

Many parents will be familiar with the constant struggle of managing their children’s eating habits to ensure they are consuming a balanced diet while also not invoking the ire of their children by forbidding them of any sweet treats. This problem has been made all the more difficult by the countless sugary options available to children, many of which are directly marketed to them by food and drink companies.^1,2 This has led scientists to label childhood obesity - ‘a growing pandemic’, with rates on the rise in both high-income and low- and middle-income countries.³ Others have gone as far as to describe sugar as the ‘new tobacco’, with increases in tooth brushing practices masking the severe effects added sugar is having on the overall oral health of children globally.⁴

Considering the growing concern surrounding childhood obesity and oral health; and the contribution sugar makes to both problems, this article seeks to explore effective strategies for reducing added sugar in children’s diets.⁵

What is added sugar?

When discussing the role of sugar within a diet, it is important to make the distinction between naturally occurring sugar and added sugar. Naturally occurring sugar can be found in staple foods of a healthy diet, such as fruit, vegetables and milk, which are all rich in nutrients.⁶ However, added sugar refers to the sugar found in food and drink that is added in a discretionary way to alter the taste of the food; frequently, these foods themselves are poor in nutrients and cheaply made, but appeal to people based on their added sugar content.⁷ Evidence in children demonstrates that increased added sugar consumption correlates to poorer nutrient intake, suggesting that children replace nutrient-rich foods in their diets with food that has less nutrients but more added sugar.⁸ This is especially concerning given the importance of a healthy and balanced diet during a child’s development. It has been shown that poor dietary choices not only affect metabolism and growth but also behaviour and cognition, for example, high levels of glucose in the blood of children have been shown to affect mental performance, particularly in long-duration tasks.⁹

Sugar guidelines

While it may be helpful to know, in theory, which foods are nutrient-rich and free of added sugar and which are nutrient-poor and contain lots of added sugar, in practice, it is next to impossible to completely eliminate all added sugar from a child’s diet, no matter how good the intention. Thus it is a lot more reasonable to expect children to consume added sugar, but parents, teachers and carers to look for ways to manage this consumption, cutting down on added sugar at each stage possible. 

For this to work, however, it is useful to know how much-added sugar is too much, and to provide clarity on this, the World Health Organisation, in 2015, released the guidelines for sugar intake in both children and adults.¹⁰ These guidelines strongly recommend that added sugar intake should be less than 10% of total energy intake and preferably beneath 5% of total energy intake.¹¹ While this kind of information may be helpful on a scientific level, on an everyday level, describing nutrition in these terms can make it harder to manage and comprehend. This is especially true for children, as even the most attentive parent will struggle to keep track of everything their child eats, given their time spent at school and their own snack habits (which they may keep a secret). 

Therefore, it is more useful to think about nutritional choices in a more holistic and pragmatic manner, where thought and consideration are given to the everyday choices that shape children’s eating habits rather than calorie counting from birth. As such, this article aims to illustrate a range of strategies for reducing added sugar in children’s diets. These simple steps towards a positive change are listed below and explained in greater detail in the rest of the article:

• Identify sources of added sugar
• Swap out sugary drinks and snacksEmpower children to take an active role in their health

Identify sources of added sugar

As previously mentioned, it can be difficult to constantly monitor the nutritional intake of children to ensure that their added sugar consumption is low. However, what is a more manageable, proactive step that can be taken to curb unhealthy eating habits is to identify what foods and drinks are high in added sugar to minimise/eliminate their consumption. While it may be known to everyone that doughnuts and fizzy drinks contain added sugars, other, more commonplace snacks and beverages can be equally as harmful, especially when people view them as less damaging, leading them to consume them more as part of a staple diet, compared to viewing them as a ‘treat’ for special occasions. 

One such example of a food that flies under the radar comparatively to the easier-to-identify high-added sugar sources is ready-to-eat cereal. A study of over 2000 U.S. children, aged between 2-8 years old, found that amongst all the different types of food they consumed, cereals contributed to the highest percentage of their added sugar intake (14.8%).¹² This speaks to the need for identification of unexpected sources of added sugar, which is often a result of misleading marketing, which is particularly true of cereal, which has been found to market less-nutritious types of cereal to children using graphics and toys that appeal to a younger audience.¹³

Swap out sugary drinks and snacks

Once the sources of added sugar have been identified in a child’s diet, it is not enough to merely remove them and move on. It is equally as important to replace them with healthier, lower-added sugar alternatives, not only to ensure that their nutritional intake is improved but also to build better habits and choices within their diet so that the change is permanent.

One such simple swap is to offer children snacks in the form of fruit, nuts or other low-sugar options instead of allowing them to snack on sweets and chocolate. This involves taking an active approach to a child’s eating habits to understand what appeals to them so that they feel they are making a positive change to their diet rather than sacrificing something in favour of something they dislike. With better insight into a child’s snacking habits, more personalised substitutions can be made, which are more likely to be sustained in the long term.¹⁴

Empower children to take an active role in their health

Though many parents may wish that their children shared the same level of concern surrounding their health choices as they do, the reality is they often do not. Whether that is because of a lack of perspective on the long-term effects of a poor diet or a lack of knowledge of what constitutes a healthy lifestyle, the outcome, frustratingly, is often the same. Therefore, as outlined in the previous strategy of swapping out sugary snacks and drinks, it is vital that all strategies aimed at building better health habits in children empower them to feel that the change is necessary and that they are capable of it. 

Beginning with changing behaviour around snacking, it is almost as important to establish why children snack as it is to establish what they snack on. The rationale behind this is that children are growing, and so snacking is a greater part of their everyday life than it is for adults, as in the U.S., one-third of a child’s daily energy intake is consumed in the form of snacks.¹⁵ Therefore, snacking as a habit is unlikely to be completely removed, however, if children are involved in the snack-choosing process alongside their parents, teachers and carers, a more fruitful decision can be agreed upon. 

One such concept that can be adopted to empower children is having them set a ‘sugar budget’. This initiative works by allowing children to consume added sugar in whatever form they please, as long as their daily/weekly intake is below an agreed-upon ‘budget’.¹⁶ This may sound like a risky strategy to begin with however, it relies upon the child keeping a record of their sugar consumption so that it can be checked by an adult, It is hoped that this method will prompt children to reflect on which foods and drinks are higher in added sugar relative to others, and thus change their behaviours so that they can maintain their snacking habits, without exceeding their limit, thereby reducing added sugar consumption overall.

Summary

Added sugar constitutes any sugar that is added to food and the maker/manufacturer's discretion. This does not apply to sugars that are naturally occurring in fruits, vegetables and other food compounds. These added sugars are harmful in a number of ways, contributing to the ongoing problem of obesity and tooth decay in children globally. Therefore it is vital that added sugar consumption is reduced at all possible avenues. Steps to be taken to ensure this occurs, begin with identifying the sources of added sugar within a child’s diet, swapping out these snacks and beverages for healthier alternatives and empowering children to make conscious, healthy choices in the long term.