The nutrition community offers 2 different approaches to better health through dietary change: first, eliminate “bad nutrients”; and second, build a strong dietary pattern. These approaches seem complementary but in practice are often adversarial. The comments by Drs Dooley, Patel, and Schmidt illustrate the problem.1
Children consume excess “empty” calories from added sugars that must be curtailed. More than 70% of these calories come from candy, soft drinks, fruit drinks, and grain deserts, which are all excellent targets. But when we urge total prohibition, regardless of the consequences on a child’s total diet, we then do harm.
What are we trying to accomplish by removing flavored milk from schools? A reduction in obesity? Shouldn’t we show that elimination of flavored milk accomplishes that goal or, at the very least, cuts daily calories or added sugars? The data we have show no increase in obesity or intake of added sugars.1 More accurately, studies by Nicklas et al2 found that drinkers of flavored milk have a higher quality of diet. Would adults consume equal amounts of yogurt if it was strictly unflavored or oatmeal if it was only unsweetened? Four studies have reported on consumption patterns after removal of flavored milk, and each showed a significant decrease in milk consumption. Harm was done with no discernible benefit (ie, a policy based on assumptions).
Dairy’s declining consumption may have as much to do with cardiometabolic disease as it does with the increased use of added sugar. Dairy lowers the risk of cardiovascular disease, hypertension, and type 2 diabetes.3 It is the primary source for 3 of 4 nutrients of concern (calcium, vitamin D, and potassium) cited in the Dietary Guidelines. Sufficient bone mass must be accrued during childhood and adolescence to ensure bone health for life.4 If intake falls as a result of our policy to remove flavored milk, how will those nutrients be replaced within the strict economics of school meals? We can’t just shrug. Failure to achieve dairy recommendations is already a major contributor to serious health disparities in the United States.
The intersection of fat deposition, genetics, diet, and activity is extraordinarily complex, confounding a one-size-fits-all obesity narrative. Added sugars have certainly contributed to increased consumption of calories. Intake of added sugar in the United States throughout the 20th century was always high but rose by 20% between 1980 and 2000 to >75 lb per person per year as obesity took hold. However, producer countries such as Cuba and Brazil far exceed the United States, at 134 and 123 lb per person per year, respectively. Although China has the lowest per capita consumption (15 lb per person per year), it still has rapidly rising obesity and strikingly high levels of type 2 diabetes.5 There are many pathways to obesity.
In the realm of consumer education, simple guidance can be helpful, but simplistic messages sow frustration, confusion, and distrust. Nutrition is particularly prone to “white hat bias”; that is, strongly held positions staked on moral certainty and proof not needed. Campaigns against cholesterol, fat, and high-fructose corn syrup all shared the same righteous surety as that against added sugar. But we were wrong and did more harm than good.
Conflict of Interest:
Dr Murray receives support from the National Dairy Council and the American Dairy Association for serving on speakers’ bureaus. Dr Bhatia receives support from the Nestle Nutrition Institute for serving as workshop faculty and an advisor. Dr Corkins has indicated he has no potential conflicts of interest to disclose.
- Kratz M,
- Baars T,
- Guyenet S
- Golden NH,
- Abrams SA
- Koo WW,
- Taylor RD
- Copyright © 2015 by the American Academy of Pediatrics