By Keith Ayoob, EdD, RD Global Stevia Institute Advisor, internationally known nutritionist, and Associate Clinical Professor of PediatricsThe overconsumption of added sugar by children is debated by everyone from parents to policymakers around the world. Further fueling the debate, the United States Centers for Disease Control and Prevention (CDC) issued a report on the consumption of added sugars by children and adolescents in the U.S.1 The report summarized data from the National Health and Nutrition Examination Survey (NHANES) from 2005-2008.The good news is that between 1999-2000 and 2005-2008, there was a decline in the percentage of daily calories derived from added sugars. However, children still consume many calories from added sugar, more than is generally recommended.On average, boys consume about 360 calories from added sugars, compared to 280 calories consumed by girls. Teen boys consume about 440 calories from added sugar, nearly ½ a cup each day, and teen girls get 314 calories from sugar.Of course, boys typically eat more calories than girls anyway, so they’d eat more sugar, too. Put into percentages, boys consume 16.3% of their daily calories from added sugars, and girls get 15.5%. The 2010 US Dietary Guidelines for Americans recommend between 5-15% of calories from added sugars and fats combined. That would suggest a maximum of about 7 or 8% of calories from adde d sugars – about half what children are consuming now.Interestingly, food supplied about 20% more added sugar to the diet than beverages. Nearly six in ten added sugar calories came from food, with the rest of the calories coming from beverages.Home Sweet HomeThe report found that most of the added sugars children consume comes from food and drinks in their own homes, not at places like schools and fast food. So it is especially important for parents to be an active part of their children’s diets.There’s hope The question at hand remains, is stevia safe for kids? Stevia, a naturally-sourced zero calorie sweetener, can be used by the whole family to enjoy the taste of sweet with no added calories.High purity stevia leaf extract has been approved for use in foods and beverages around the world. And these approvals include that high purity stevia extract is safe for use by children, as well as pregnant women and people with diabetes. Stevia, as found in tabletop sweeteners, can be used in place of table sugar in hot and cold drinks, cereals, and even as partial replacement for sugar in baking. Foods and beverages sweetened either with 100% stevia or a blend with other naturally sourced sweeteners like sugar can help reduce calories from added sugars without sacrificing taste.Coming from the stevia leaf, native to Paraguay, the high purity extract of the stevia leaf gives us a natural, sweet taste we can feel good about giving to our kids, but without the added sugar calories they don’t need.It’s how Mother Nature does a zero-calorie sweetener, and it’s time to bring it home to your family.To learn if stevia is safe for kids, see our Stevia Safety page.
1. Ervin RB, Kit BK, Carroll MD, Ogden CL. Consumption of added sugar among U.S. children and adolescents, 2005–2008. NCHS data brief no 87. Hyattsville, MD: National Center for Health Statistics. 2012.
The Rise of Adolescent Obesity
Global Stevia Institute Advisory Board Member, Mauro Fisberg MD PhD, addresses the significance of adolescent obesity, its prevention and challenging treatment. He also provides general dietary recommendations and practical suggestions for establishing healthy habits. Dr. Mauro Fisberg is a pediatrician and nutritionist, specializing in adolescent nutrition and has recently published an in-depth article on adolescent obesity and treatment in The Pediatrics Society of Brazil Nutrition Manual with his expert fellows.1
In every generation, adolescence seems to earn its reputation as one of the most difficult stages of life for both teens and their families. During this age, we think we’re different, that our parents do not understand us, and that we are in fact, much more mature than we are. We try to make statements to define who we are and most importantly, assert our independence in each choice that we make, all while developing mentally, emotionally, and physically. As such, food during this stage of life is full of different meanings. A growing teenage r needs a healthy balanced diet that is high in nutrients to support normal growth and development. Yet, he or she often seeks fast food or too many unhealthy snacks instead of balanced meals. In excess, these foods and beverages can further dietary imbalance, which combined with physical inactivity can lead to overweight or obesity at a young age.Globally, the prevalence of adolescent obesity has increased over the past decade in both developing and developed countries. It is estimated that up to 200 million school aged children are either overweight or obese, and of those 40-50 million are classified as obese.2 In the US, the growth of obesity has slowed slightly over the past few years, however, the prevalence among children and adolescents is still significantly high at 16.9%.3 As in other regions, some recent surveys show that at least 30% of Brazilian adolescents are overweight and up to 11-15% are obese, which represents a significant increase in a short period of time.4 Weight can fluctuate normally in this growth stage, but children and adolescents who are overweight are more likely to become obese adults with comorbidities such as diabetes mellitus and hypertension, occurring earlier in life. These data were established in the 1980s and remain conclusive.5 Studies also show that comorbidities of obesity are more severe in adults with excess weight early in life.6, 7Obesity Prevention & Treatment in AdolescentsIn my experience, the key element to promoting a healthful diet and lifestyle in adolescence is through positive examples at home and strong family support. Preventive and therapeutic measures to combat overweight/obesity must begin early and require a balanced healthful diet, regular physical activity, reduced sedentary activity, and positive support of these efforts by the whole family.Treatment of obesity in adolescents is challenging. It will vary by age and health condition, and requires a multidisciplinary approach. Overall, a balanced and varied diet, with increased intake of fruits and vegetables, low saturated and trans fat content, and reduced sodium and added sugars is recommended. Non-caloric sweeteners, like natural origin stevia can be used to reduce added sugars and calorie levels in foods and beverages. Nutrition education about essential nutrients, proportion, and the food pyramid must support these dietary changes. The degree to which calories should be restricted in adolescents should be individualized and monitored by a nutritionist and a pediatrician to ensure adequate nutrients and energy for normal growth.Dietary intervention is the primary method for obesity treatment in adolescents; however, physical activity in combination with dietary treatment is more effective than diet alone for sustained weight loss and management. Exercise helps preserve lean mass during a dietary intervention, and may decrease the reduction of metabolic rate associated with weight loss. Exercise has also been associated with improved mood and improved food choice. Sports participation and opportunities for physical exercise can be limited by environment or familial culture, but efforts to reduce downtime throughout the day, i.e. watching less television, performing regular chores, etc. are also effective for increasing physical activity.8Promoting a positive self-image and improving self-esteem are especially important during obesity treatment. Affirming positive changes, acceptance of failures prior to success and the ability to deal with the negative attitudes or attention from peers is crucial. Positive reinforcement and incentives can help and adolescent to achieve their desired goals and should be encouraged among families.ChallengesMany factors contribute to the difficulty of obesity treatment in adolescents, including lack of family involvement, associated depression and low self-esteem, and low adherence to a difficult and long treatment. Adolescents and parents (and sometimes doctors) often believe that the treatment results are immediate with massive loss of weight. When this rapid result does not occur, an adolescent can experience frustration and anguish. Successful treatment requires time, a long-term commitment, and consistent family support.Tips for Promoting Positive HabitsThese simple and practical suggestions can help to promote healthy behaviors at home:
Eat slowly and consciously— while eating, do not divert attention to TV or magazines
Proportion your plate and avoid second helpings
Shave calories throughout the day easily with simple substitutions that add up over time, i.e. substitute stevia sweetener for 1 teaspoon of sugar, to save up to 15 calories in beverage or when sprinkled on top of foods; and skim off excess butters or jams on bread with flat edge of a butter knife to help save calories while still enjoying the food
Eat at regular times throughout the day, with low-calorie, nutritious snacking in between meals with fruits, vegetables, light yoghurts, vegetable dips or hummus. Consume sweet foods and beverages in moderation, and reduce calorie intake by choosing reduced-sugar versions sweetened with zero-calorie, natural origin stevia
Reduce down time— spend less time watching television and playing computer games, make it a habit to climb stairs instead of using escalators/elevators, and encourage walking and more physical movement through household and yard chores
For food, as in life, balance is the secret. Eating well and being physically active are some of the most important factors for healthy growth. In adolescence, the diet should not be overly restricted and can be made more healthful with great tasting foods that adolescents choose to eat, not just endure. Reducing calories with moderate portions and smart substitutions like stevia can help support dietary improvements for overweight/obesity interventions. Families and groups must be models for the young in their commitment to active life style and healthy eating. Today, many adolescents and their families may face the challenging treatment of obesity, but a long-term commitment to health with the guidance of supportive health professionals, can improve wellbeing and health into adulthood.REFERENCES
6. Braddon et al “Onset of obesity in a 36 year birth cohort study” British Medical Journal, 291:1534-8, 1986. http://www.ncbi.nlm.nih.gov. Accessed on May 3, 2012
7. Lonstein T, Baur L, et al Obesity in children and young people: a crisis in public health. Obesity Reviews an Volume: 5 Suppl 1, Issue 1, 2004. http://www.mendeley.com. Accessed May 4 2012
8. Fisberg M, Baur L, et al. Obesity in children and adolescents: Working Group report of the second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2004; 39 (Suppl 2):S678-S687 ). http://www.ncbi.nlm.nih.gov Accessed May 4, 2012