search text   Advanced Search

This Article Abstract Full Text (PDF) P3Rs: Submit a response P3Rs: View responses Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Search for Related Content PubMed PubMed Citation Related Collections Nutrition & Metabolism

Soft Drinks in Schools

	ABSTRACT

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 
This statement is intended to inform pediatricians and other health care professionals, parents, superintendents, and school board members about nutritional concerns regarding soft drink consumption in schools. Potential health problems associated with high intake of sweetened drinks are 1) overweight or obesity attributable to additional calories in the diet; 2) displacement of milk consumption, resulting in calcium deficiency with an attendant risk of osteoporosis and fractures; and 3) dental caries and potential enamel erosion. Contracts with school districts for exclusive soft drink rights encourage consumption directly and indirectly. School officials and parents need to become well informed about the health implications of vended drinks in school before making a decision about student access to them. A clearly defined, district-wide policy that restricts the sale of soft drinks will safeguard against health problems as a result of overconsumption.

	BACKGROUND AND INFORMATION

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

Soft Drinks and Fruit Drinks
In the United States, children’s daily food selections are excessively high in discretionary, or added, fat and sugar.^10–15 This category of fats and sugars accounts for 40% of children’s daily energy intake.¹⁰ Soft drink consumers have a higher daily energy intake than nonconsumers at all ages.¹⁶ Sweetened drinks (fruitades, fruit drinks, soft drinks, etc) constitute the primary source of added sugar in the daily diet of children.¹⁷ High-fructose corn syrup, the principle nutrient in sweetened drinks, is not a problem food when consumed in smaller amounts, but each 12-oz serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar and 150 kcal. Soft drink consumption increased by 300% in 20 years,¹² and serving sizes have increased from 6.5 oz in the 1950s to 12 oz in the 1960s and 20 oz by the late 1990s. Between 56% and 85% of children in school consume at least 1 soft drink daily, with the highest amounts ingested by adolescent males. Of this group, 20% consume 4 or more servings daily.¹⁶

Each 12-oz sugared soft drink consumed daily has been associated with a 0.18-point increase in a child’s BMI and a 60% increase in risk of obesity, associations not found with "diet" (sugar-free) soft drinks.¹⁸ Sugar-free soft drinks constitute only 14% of the adolescent soft drink market.¹⁹ Sweetened drinks are associated with obesity, probably because overconsumption is a particular problem when energy is ingested in liquid form²⁰ and because these drinks represent energy added to, not displacing, other dietary intake.^21–23 In addition to the caloric load, soft drinks pose a risk of dental caries because of their high sugar content and enamel erosion because of their acidity.²⁴

Calcium
Milk consumption decreases as soft drinks become a favorite choice for children, a transition that occurs between the third and eighth grades.^12,15 Milk is the principle source of calcium in the typical American diet.¹¹ Dairy products contain substantial amounts of several nutrients, including 72% of calcium, 32% of phosphorus, 26% of riboflavin, 22% of vitamin B₁₂, 19% of protein, and 15% of vitamin A in the US food supply.²⁵ The percent daily value for milk is considered either "good" or "excellent" for 9 essential nutrients depending on age and gender. Intake of protein and micronutrients is decreased in diets low in dairy products.^19,26 The resulting diminished calcium intake jeopardizes the accrual of maximal peak bone mass at a critical time in life, adolescence.²⁷ Nearly 100% of the calcium in the body resides in bone.²⁷ Nearly 40% of peak bone mass is accumulated during adolescence. Studies suggest that a 5% to 10% deficit in peak bone mass may result in a 50% greater lifetime prevalence of hip fracture,²⁸ a problem certain to worsen if steps are not taken to improve calcium intake among adolescents.²⁹

	STATEMENT OF PROBLEM

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 
Soft drinks and fruit drinks are sold in vending machines, in school stores, at school sporting events, and at school fund drives. "Exclusive pouring rights" contracts, in which the school agrees to promote one brand exclusively in exchange for money, are being signed in an increasing number of school districts across the country,³⁰ often with bonus incentives tied to sales.³¹ Although they are a new phenomenon, such contracts already have provided schools with more than $200 million in unrestricted revenue.

Some superintendents, school board members, and principals claim that the financial gain from soft drink contracts is an unquestioned "win" for students, schools, communities, and taxpayers.^31,32 Parents and school authorities generally are uninformed about the potential risk to the health of their children that may be associated with the unrestricted consumption of soft drinks. The decision regarding which foods will be sold in schools more often is made by school district business officers alone rather than with input from local health care professionals.

Subsidized school lunch programs are associated with a high intake of dietary protein, complex carbohydrates, dairy products, fruits, and vegetables.¹⁶ The US Department of Agriculture, which oversees the National School Lunch Program, is concerned that foods with high sugar content (especially foods of minimal nutritional value, such as soft drinks) are displacing nutrients within the school lunch program, and there is evidence to support this.²⁶

There are precedents for using optimal nutrition standards to create a model district-wide school nutrition policy,³³ but this is not yet a routine practice in most states. The discussion engendered by the creation of such a policy would be an important first step in establishing an ideal nutritional environment for students.

	RECOMMENDATIONS

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 

1. Pediatricians should work to eliminate sweetened drinks in schools. This entails educating school authorities, patients, and patients’ parents about the health ramifications of soft drink consumption. Offerings such as real fruit and vegetable juices, water, and low-fat white or flavored milk provide students at all grade levels with healthful alternatives. Pediatricians should emphasize the notion that every school in every district shares a responsibility for the nutritional health of its student body.
   
2. Pediatricians should advocate for the creation of a school nutrition advisory council comprising parents, community and school officials, food service representatives, physicians, school nurses, dietitians, dentists, and other health care professionals. This group could be one component of a school district’s health advisory council. Pediatricians should ensure that the health and nutritional interests of students form the foundation of nutritional policies in schools.
   
3. School districts should invite public discussion before making any decision to create a vended food or drink contract.
   
4. If a school district already has a soft drink contract in place, it should be tempered such that it does not promote overconsumption by students.
   • Soft drinks should not be sold as part of or in competition with the school lunch program, as stated in regulations of the US Department of Agriculture.³⁴
     
   • Vending machines should not be placed within the cafeteria space where lunch is sold. Their location in the school should be chosen by the school district, not the vending company.
     
   • Vending machines with foods of minimal nutritional value, including soft drinks, should be turned off during lunch hours and ideally during school hours.
     
   • Vended soft drinks and fruit-flavored drinks should be eliminated in all elementary schools.
     
   • Incentives based on the amount of soft drinks sold per student should not be included as part of exclusive contracts.
     
   • Within the contract, the number of machines vending sweetened drinks should be limited. Schools should insist that the alternative beverages listed in recommendation 1 be provided in preference over sweetened drinks in school vending machines.
     
   • Schools should preferentially vend drinks that are sugar-free or low in sugar to lessen the risk of overweight.
     
   
   
5. Consumption or advertising of sweetened soft drinks within the classroom should be eliminated.
   

	Committee on School Health, 2002–2003

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 
Howard L. Taras, MD, Chairperson

Barbara L. Frankowski, MD, MPH

Jane W. McGrath, MD

Cynthia J. Mears, DO

^*Robert D. Murray, MD

Thomas L. Young, MD

	Liaisons

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 
Janis Hootman, RN, PhD National Association of School Nurses

Janet Long, MEd American School Health Association

Jerald L. Newberry, MEd National Education Association, Health Information

Mary Vernon-Smiley, MD, MPH Centers for Disease Control and Prevention

	Staff

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 
Su Li, MPA

	FOOTNOTES

 
^* Lead author

	REFERENCES

TOP ABSTRACT BACKGROUND AND INFORMATION STATEMENT OF PROBLEM RECOMMENDATIONS Committee on School Health,... Liaisons Staff REFERENCES

 

1. American Academy of Pediatrics, Committee on Nutrition. Prevention of pediatric overweight and obesity. Pediatrics.2003; 112 :424 –430[Abstract/Free Full Text]
2. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics.1999; 103 :1175 –1182[Abstract/Free Full Text]
3. Pinhas-Hamiel O, Dolan LM, Daniels SR, Standiford D, Khoury PR, Zeitler P. Increased incidence of non-insulin-dependent diabetes mellitus among adolescents. J Pediatr.1996; 128 :608 –615[CrossRef][ISI][Medline]
4. Ludwig DS, Ebbeling CB. Type 2 diabetes mellitus in children: primary care and public health considerations. JAMA.2001; 286 :1427 –1430[Free Full Text]
5. Dietz W. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics.1998; 101 :518 –525[Abstract/Free Full Text]
6. Davison KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics.2001; 107 :46 –53[Abstract/Free Full Text]
7. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the United States. JAMA.1999; 282 :1530 –1538[Abstract/Free Full Text]
8. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA.1999; 282 :1523 –1529[Abstract/Free Full Text]
9. Blumenthal D. Controlling health care expenditures. N Engl J Med.2001; 344 :766 –769[Free Full Text]
10. Muñoz KA, Krebs-Smith SM, Ballard-Barbash R, Cleveland LE. Food intakes of US children and adolescents compared with recommendations. Pediatrics.1997; 100 :323 –329[Abstract/Free Full Text]
11. Subar AF, Krebs-Smith SM, Cook A, Kahle LL. Dietary sources of nutrients among US children, 1989–1991. Pediatrics.1998; 102 :913 –923[Abstract/Free Full Text]
12. Calvadini C, Siega-Riz AM, Popkin BM. US adolescent food intake trends from 1965 to 1996. Arch Dis Child.2000; 83 :18 –24[Abstract/Free Full Text]
13. Borrud LG, Enns CW, Mickle S. What we eat in America: USDA surveys food consumption changes. Food Rev.1996; 19 :14 –19. Available at: http://www.ers.usda.gov/publications/foodreview/sep1996/sept96d.pdf. Accessed February 12, 2003
14. Borrud LG, Mickle S, Nowverl A, Tippett K. Eating Out in America: Impact on Food Choices and Nutrient Profiles. Beltsville, MD: Food Surveys Research Group, US Department of Agriculture;1998 . Available at: http://www.barc.usda.gov/bhnrc/foodsurvey/Eatout95.html. Accessed February 12, 2003
15. Lytle LA, Seifert S, Greenstein J, McGovern P. How do children’s eating patterns and food choices change over time? Results from a cohort study. Am J Health Promot.2000; 14 :222 –228[ISI][Medline]
16. Gleason P, Suitor C. Children’s Diets in the Mid-1990s: Dietary Intake and Its Relationship with School Meal Participation. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation;2001 . Available at: http://www.fns.usda.gov/oane/menu/published/cnp/files/childiet.pdf. Accessed February 12, 2003
17. Guthrie JF, Morton JF. Food sources of added sweeteners in the diets of Americans. J Am Diet Assoc.2000; 100 :43 –51[CrossRef][ISI][Medline]
18. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective observational analysis. Lancet.2001; 357 :505 –508[CrossRef][ISI][Medline]
19. Harnack L, Stang J, Story M. Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc.1999; 99 :436 –441[CrossRef][ISI][Medline]
20. Mattes RD. Dietary compensation by humans for supplemental energy provided as ethanol or carbohydrates in fluids. Physiol Behav.1996; 59 :179 –187[CrossRef][Medline]
21. Bellisle F, Rolland-Cachera M-F. How sugar-containing drinks might increase adiposity in children. Lancet.2001; 357 :490 –491[CrossRef][ISI][Medline]
22. Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr.1990; 51 :963 –969[Abstract/Free Full Text]
23. De Castro JM, Orozco S. Moderate alcohol intake and spontaneous eating patterns of humans: evidence of unregulated supplementation. Am J Clin Nutr.1990; 52 :246 –253[Abstract/Free Full Text]
24. Heller K, Burt BA, Eklund SA. Sugared soda consumption and dental caries in the United States. J Dent Res.2001; 80 :1949 –1953[Abstract/Free Full Text]
25. Gerrior S, Bente L. Nutrient Content of the US Food Supply, 1909–97. Home Economics Research Report No. 54. Washington, DC: Center for Nutrition Policy and Promotion, US Department of Agriculture;2001 . Available at: http://www.usda.gov/cnpp/Pubs/Food%20Supply/foodsupplyrpt.pdf. Accessed February 12, 2003
26. Johnson RK, Panely C, Wang MQ. The association between noon beverage consumption and the diet quality of school-age children. J Child Nutr Manage.1998; 22 :95 –100
27. American Academy of Pediatrics, Committee on Nutrition. Calcium requirements of infants, children, and adolescents. Pediatrics.1999; 104 :1152 –1157[Abstract/Free Full Text]
28. Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med.2000; 154 :610 –613[Abstract/Free Full Text]
29. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis: prevention, diagnosis, and therapy. JAMA.2001; 285 :785 –795[Abstract/Free Full Text]
30. Henry T. Coca-cola rethinks school contracts. Bottlers asked to fall in line. USA Today. March 14,2001 :A01
31. Nestle M. Soft drink "pouring rights": marketing empty calories to children. Public Health Rep.2000; 115 :308 –319[CrossRef][ISI][Medline]
32. Zorn RL. The great cola wars: how one district profits from the competition for vending machines. Am Sch Board J.1999; 186 :31 –33
33. Stuhldreher WL, Koehler AN, Harrison MK, Deel H. The West Virginia Standards for School Nutrition. J Child Nutr Manage.1998; 22 :79 –86
34. National School Lunch Program Regulations. 7 CFR 210.11 (2002). Competitive food services

This article has been cited by other articles:

				M. M. Mello, J. Pomeranz, and P. Moran The Interplay of Public Health Law and Industry Self-Regulation: The Case of Sugar-Sweetened Beverage Sales in Schools Am J Public Health, April 1, 2008; 98(4): 595 - 604. [Abstract] [Full Text] [PDF]

				M. M. Davis, B. Gance-Cleveland, S. Hassink, R. Johnson, G. Paradis, and K. Resnicow Recommendations for Prevention of Childhood Obesity Pediatrics, December 1, 2007; 120(Supplement_4): S229 - S253. [Abstract] [Full Text] [PDF]

				A. Pinto, S. Kim, R. Wadenya, and H. Rosenberg Is There an Association Between Weight and Dental Caries Among Pediatric Patients in an Urban Dental School? A Correlation Study J Dent Educ., November 1, 2007; 71(11): 1435 - 1440. [Abstract] [Full Text] [PDF]

				A. Cohn and C. Ramesh Mixed messages Arch. Dis. Child., October 1, 2007; 92(10): 860 - 860. [Full Text] [PDF]

				F. Manz Hydration in Children J. Am. Coll. Nutr., October 1, 2007; 26(suppl_5): 562S - 569S. [Abstract] [Full Text] [PDF]

				W. W. K. Koo Bone Deficit and Bone Health Nutr Clin Pract, June 1, 2007; 22(3): 259 - 260. [Full Text] [PDF]

				D. A. Straub Calcium Supplementation in Clinical Practice: A Review of Forms, Doses, and Indications Nutr Clin Pract, June 1, 2007; 22(3): 286 - 296. [Abstract] [Full Text] [PDF]

				P. T. von Hippel, B. Powell, D. B. Downey, and N. J. Rowland The Effect of School on Overweight in Childhood: Gain in Body Mass Index During the School Year and During Summer Vacation Am J Public Health, April 1, 2007; 97(4): 696 - 702. [Abstract] [Full Text] [PDF]

				H. B. Sahud, H. J. Binns, W. L. Meadow, and R. R. Tanz Marketing Fast Food: Impact of Fast Food Restaurants in Children's Hospitals Pediatrics, December 1, 2006; 118(6): 2290 - 2297. [Abstract] [Full Text] [PDF]

				Council on Sports Medicine and Fitness and Council Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity Pediatrics, May 1, 2006; 117(5): 1834 - 1842. [Abstract] [Full Text] [PDF]

				C. B. Ebbeling, H. A. Feldman, S. K. Osganian, V. R. Chomitz, S. J. Ellenbogen, and D. S. Ludwig Effects of Decreasing Sugar-Sweetened Beverage Consumption on Body Weight in Adolescents: A Randomized, Controlled Pilot Study Pediatrics, March 1, 2006; 117(3): 673 - 680. [Abstract] [Full Text] [PDF]

				B. A. Burt The use of sorbitol- and xylitol-sweetened chewing gum in caries control J Am Dent Assoc, February 1, 2006; 137(2): 190 - 196. [Abstract] [Full Text] [PDF]

				T. Korioth Councils formed from merged AAP committees, sections: New structure will facilitate policy development, communication, education and advocacy AAP News, June 1, 2005; 26(6): 7 - 7. [Full Text]

				S. Bawa The role of the consumption of beverages in the obesity epidemic The Journal of the Royal Society for the Promotion of Health, May 1, 2005; 125(3): 124 - 128. [Abstract] [PDF]

				A. Jessup and J. S. Harrell The Metabolic Syndrome: Look for It in Children and Adolescents, Too! Clin. Diabetes, January 1, 2005; 23(1): 26 - 32. [Full Text] [PDF]

				D. R. Neuspiel School Program Targeting Carbonated Drinks Helps Curb Obesity AAP Grand Rounds, September 1, 2004; 12(3): 25 - 26. [Full Text] [PDF]

				S. A French, P. J Hannan, and M. Story School soft drink intervention study BMJ, August 14, 2004; 329(7462): E315 - E316. [Full Text] [PDF]

				L. M. Grant School Snack Bars Hamper Nutritional Health AAP Grand Rounds, June 1, 2004; 11(6): 62 - 63. [Full Text] [PDF]

				AAP News, March 1, 2004; 24(3): 145 - 145. [Full Text]

				L. O'Keefe Policy: Students and soft drinks not a good mix AAP News, February 1, 2004; 24(2): 51 - 58. [Full Text] [PDF]

P³Rs:

This Article Abstract Full Text (PDF) P3Rs: Submit a response P3Rs: View responses Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Search for Related Content PubMed PubMed Citation Related Collections Nutrition & Metabolism

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2004 American Academy of Pediatrics. All rights reserved.