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Soda bans in school lead to increase in other sugar-sweetened beverages
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High school students consumed more servings of sports drinks, energy drinks, coffee/tea and other sugar-sweetened beverages if they resided in a state that banned soda but attended a school with vending machines that sold other sugar-sweetened beverages, according to recent study data.
In 2005 and 2006, soda accounted for more energy intake compared with any other food or beverage among high school students in the United States, according to researchers. In response to unhealthy diet trends, legislators began to ban the purchase of soda in schools, particularly in districts that participated in federal meal programs. By 2011, the proportion of high school students that had access to soda in school decreased from 53.6% to 25.3%.
“Throughout the United States, schools and policymakers have made progress to remove regular soda from schools; however, evidence suggests that schools and students may be substituting soda with other sugar-sweetened beverages instead,” Daniel R. Taber, PhD, MPH, from the Institute for Health Research and Policy at the University of Illinois, told Infectious Diseases in Children.
To determine whether anti-soda policies were associated with higher consumption of other sugar-sweetened beverages, Taber and colleagues performed a cross-sectional analysis using data collected by the National Youth Physical Activity and Nutrition Study in 2010. The researchers analyzed data on 8,696 high school students in 27 states who responded to a questionnaire assessing weekly consumption of sugar-sweetened beverages. Students also reported whether their school had vending machines that sold soda, sports drinks or fruit drinks that contained less than 100% juice.
Based on the responses, a large proportion of participants did not consume any sugar-sweetened beverages and a small proportion of participants consumed large quantities of sugar-sweetened beverages. On average, participants consumed 5.4 servings of soda, 4.1 servings of juice (< 100% fruit) and 3.5 servings of sports drinks.
Students who had access to vending machines but attended schools that banned soda (n = 2,229) reported drinking more sports drinks (RR = 1.25; 95% CI, 1.11-1.42), energy drinks (RR = 1.29; 95% CI, 1.03-1.62), coffee/tea (RR = 1.18; 95% CI, 1.01-1.36) and other sugar-sweetened beverages (RR = 1.16; 95% CI, 1.02-1.32) compared with students who had access to both soda and other sugar-sweetened beverages (n = 4,452). Similarly, students with access to soda but not vending machines (n = 969) also reported more servings of diet soda (RR = 1.4; 95% CI, 1-1.97), sports drinks (RR = 1.22; 95% CI, 1.03-1.45), energy drinks (RR = 1.33; 95% CI, 1.03-1.71) and coffee/tea (RR = 1.27; 95% CI, 1.03-1.56).
“This echoes national trends, as teenagers have been drinking lower quantities of soda but higher quantities of sports drinks and energy drinks,” Taber said.
However, intake was generally not elevated in students who attended a school that banned soda and did not have vending machines (n = 1,046).
“In other words, [sugar-sweetened beverage] consumption tended to be higher if individual state or school restrictions on [sugar-sweetened beverage] access were in place, but usually not if both state and school restrictions were in place,” Taber and colleagues wrote.
The researchers concluded that school and state policies should extend their restrictions to other sugar-sweetened beverages to ensure students have access to healthier alternatives.
Aside from soda bans, the researchers wrote that higher consumption may also be attributed to a shift in industry marketing practices that target adolescent audiences, especially when promoting energy drinks.
“Students and parents often perceive other sweetened beverages as “healthy” because the beverages are marketed as being healthy,” Taber told Infectious Diseases in Children. “For that reason, I think the biggest take-away message is that we need to recognize how the sweetened beverage market has evolved and expanded, and that kids and parents may not know what beverages are truly healthy. We need to actively promote alternatives that are healthier (eg, water, 100% fruit juice) so that kids and parents are not simply swapping one sugary beverage (soda) for another (sports drinks).”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Aneesh Tosh, MD
It is well known that one-third of children and adolescents in the United States are overweight or obese, leading to a higher risk of developing diabetes and other significant health problems than healthy-weight peers. Several recent studies have concluded, and I have witnessed with my own patients, that the most significant lifestyle change that can be made by children and adolescents needing to lose weight is the elimination of sugar-sweetened beverages in the diet.
As children progress through adolescence towards adulthood, they become more responsible for their own choices, including what they decide to drink. Unfortunately, many of the beverage options that adolescents have available to them at school, home, and their social gatherings contain significant amounts of sugar. While soda is the most commonly considered sugar-sweetened beverage, typically containing 100 to 200 calories per 12-ounce serving, many of our patients and families are unaware that fruit juice, sweet tea, sports drinks, coffee drinks, and energy drinks contain the same amount calories as soda, if not more. Among adolescents, the consumption of energy drinks has risen in popularity, which not only contain sugar but also caffeine, which can lead to other health effects such as poor sleep, headaches, and heart irregularity.
During our consultations with patients and their families in our weight-management clinic, we regularly screen for sugared-beverage consumption and work hard to educate on the importance of eliminating them from the daily diet and limiting beverages to plain water and milk. We encourage parents and other caregivers to demonstrate positive role-modeling by also reducing their own sugared-beverage consumption. We realize that sugared-beverages are fun and are common during social gatherings, but limiting their consumption to once a week for special events rather than daily can be a significant first step towards healthy weight loss for many of our children and adolescents.
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Tiffani Hays
A growing body of evidence has suggested that marketing healthier food choices – whether in vending machines or in school cafeterias – has led to higher intake of fruits and vegetables among children despite the availability of other foods with poorer nutritional quality. Increasing access to and positive perception of healthy foods may result in a greater consumption of these foods and beverages vs. policies of restriction.
In the fight against childhood and adolescent obesity, there is no easy answer. Weight gain results when energy intake exceeds energy expenditure. However, to achieve optimal health benefits as well as a healthy weight, interventions should target both sides of the equation. Strategies that target only one side, like the high consumption of SSBs, will not curb nor reverse the obesity epidemic. On the other hand, neither will promoting exercise without addressing the intake of non-nutritive, high-calorie foods and beverages such as SSBs. Consumers should be wary of one-sided claims in the media.
As an example, recent claims from the Global Energy Balance Network, an industry-sponsored, physician-led non-profit, propose that increasing exercise has a greater impact on weight loss than decreasing caloric intake. However, the scientific evidence to support this claim is weak. Much stronger evidence exists to show that the effects of increased physical activity on weight loss plateau as the energy burned decreases over time and rarely equals the amount of calories ingested. So, the age-old adage, “calories in, less than calories out,” remains the key to weight loss and we would all be wise to keep our kids on the playground instead of on the couch with any SSB in their hand, and schools would be wise to promote healthy choices and reasonable portion sizes instead of imposing bans.
Tiffani Hays, MS, RD, LDN
Director of Pediatric Clinical Nutrition Education and Practice
Johns Hopkins Hospital
Christie Williams, MS, RD, LDN
Clinical dietitian specialist
Johns Hopkins Hospital
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