Chocolate Milk in Schools

As pediatricians and professors dedicated to the prevention of childhood obesity, we were disappointed by the March 2015 American Academy of Pediatrics’ Policy Statement on “Snacks, Sweetened Beverages, Added Sugars, and Schools.”¹ The American Academy of Pediatrics’ Committee on Nutrition and Council on School Health endorsed this statement, which seems to accept the trend that 70% of milk consumed in schools is “flavored” and minimizes the detrimental health effects of flavored milk because children consume “nutrient-rich nonfat milk” with added sugar and chocolate.

The committees’ endorsement of adding sugar to the milk of millions of schoolchildren conflicts with the majority of leading health organizations’ recommendations, such as the American Heart Association, which recommends that children consume only 3 to 4 teaspoons of added sugar per day.² If a child drinks a single 8-oz carton of flavored milk at school, he or she will consume the recommended daily amount of added sugar in 1 sitting. Interestingly, this endorsement also contradicts the Committee on Nutrition’s own 2011 clinical report on sports drinks and energy drinks, which stated, “In general, there is little need for carbohydrate-containing beverages other than the recommended daily intake of fruit juice and low-fat milk.”³ The authors of the recent policy statement cite references which report that “flavored milk [sic] consumption is not associated with weight gain or even a higher total daily sugar intake in children.” However, the cited studies stand in conflict with a large body of evidence showing that avoidance of sugar-sweetened beverages is a major strategy for the prevention of childhood obesity.⁴

In their endorsement of flavored milk offerings in schools, the authors should have noted the limitations of the studies cited in the policy statement.¹ The study citing flavored milk’s lack of an adverse impact on weight had relatively low rates of flavored milk consumption, and it calculated whether the mean BMI was changed, rather than rates of obesity.⁵ The studies citing increased “milk wastage” were limited in that they were quasi-experimental, had short follow-up periods, and did not comprehensively assess the impact that removal of flavored milk in schools would have on students’ daily nutrient and caloric intake.

As pediatricians, we have the trust of the public and the obligation to “primum, non nocere” (first, do no harm). It seems important that an endorsement of sugar-flavored milk in schools, an admittedly “controversial” issue according to the authors,¹ should reflect a sound body of evidence. The evidence shows that sugar-sweetened beverages are a major source of excessive sugar intake for children and that excessive energy and sugar consumption can lead to obesity and dental caries. In light of these findings, we encourage these committees to critically review their statement and reconsider how flavored milk offerings in schools may affect children’s health and well-being.

• Copyright © 2015 by the American Academy of Pediatrics