How to Reduce Sugar in Your Child’s Diet Without Them Noticing

Increased Sugar Consumption among children

Various factors like westernization, urbanization, increased marketing and accessibility to marketplaces, increased purchasing power, and lack of time to cook have brought about a nutrition transition in India. There has been a shift in what we eat. This transition has led to increased consumption of processed and packaged foods which are high in fat, sugar, and salt. There are a plethora of sugary foods and beverages available in the market viz., carbonated beverages, instant health drinks, packaged cold coffees, instant fruit drink mixes, fruit juices, cakes, biscuits, jams, jellies, and so on.

Even children’s diets have observed this shift, and many studies have confirmed increased sugar consumption among children. A recent survey conducted in 2021 on Indian children aged 9–14 years reported that 68% of children drank sugary beverages every week¹. Another study conducted in Mumbai among children aged 6 months to 6 years of age showed that 60% of children consumed milk, tea with sugar, sweet snacks, and biscuits daily².  In a clinical trial, it was seen that 89.53% of children who participated in the study consumed sugar beverages in one form or another³. 

Why is there a concern with increased sugar intake in children?

Dietary habits and preferences formed in childhood may last a lifetime. Hence, it is important to build good dietary habits early in life, starting from childhood. The National Institute of Nutrition (NIN) recommends eating less sugar and reducing sugar in the diet to less than 5% of total energy/day i.e., 25g/day basis 2000 kcal-diet⁴. Moreover, added sugar consumption is not advised for children less than 2 years of age⁴.

Increased sugar consumption is associated with various health problems like dental caries and Attention-deficit Hyperactivity Disorder (ADHD). Since foods high in sugar have a high Glycaemic Index (GI), it leads to sugar spikes in the blood which predisposes the risk of obesity and obesity-related health problems like type 2 diabetes, cardiovascular diseases, and metabolic syndrome in adulthood⁵. Moreover, foods high in sugar are calories-dense and low on micronutrients (vitamins and minerals) which leads to a triple burden of malnutrition i.e., undernutrition, overnutrition (overweight and obesity), and micronutrient deficiencies (also known as hidden hunger)⁸. 

Reading Labels for Sugar

Before we understand how to reduce sugar intake, it is important to understand the terms ‘total sugars’ and ‘added sugars’. You will also come across these terms while reading labels for sugar. ‘Total sugars’ contains both naturally occurring sugar in food (for example- fructose in fruits, lactose in milk, etc.) and ‘added sugars’. ‘Added sugars’ refers to sugar added to foods and drinks during processing e.g., sucrose (table sugar), glucose, fructose, dextrose, jaggery, honey, etc.

How to reduce sugar intake?
 

1.       Healthy sugar replacements:

· To cut sugar from your diet, replace sugar-sweetened beverages with natural beverages like tender coconut water, buttermilk, fresh lemon juice, whole fruit juices (without added sugar), etc⁴. Carbonated beverages or soft drinks are very popular among children and teenagers. These are high in phosphoric acid which depletes the enamel of teeth and leads to dental caries if consumed in excessive quantity. Hence, it should be totally avoided. Instead, whole fruit juices should be consumed which is a healthier option because not only it doesn’t contain harmful ingredients and sugar but also provides vitamins (like beta-carotenes and vitamin C) and minerals (potassium, calcium, etc.).

· Replace sugar with sweet herbs and spices such as cinnamon, nutmeg, cardamom, basil, and rosemary⁷.

· Replace jams with peanut butter and ketchup with homemade salsa to cut sugar from your diet.

2.       Gradually reduce sugar intake:

Gradual sugar reduction has been shown to be more effective than abrupt sugar reduction⁶, as children will not notice the change in sweetness and will slowly become accustomed to lower sugar concentration.

· Choose homemade foods and beverages over packaged foods as the quantity of added sugar can be controlled if the food is prepared at home.

· In homemade food and beverages, gradually reduce the quantity of added sugar and/or replace sugar with dates and dried fruits like raisins, figs, apricots, etc.

· Packaged fruit juices can be watered down to reduce sugar quantity while enjoying the same amount of beverage.

3.       Portion control:

Serve smaller quantities of sugary foods and beverages. 

4.       Stop keeping stock at home:

Avoid bringing new sugar products into the home. Create an environment where healthier food choices are more available than unhealthy options. Keep sugar out of reach of your children. If it is easily accessible to them, they would be more likely to consume it. Instead, stock on healthy snacks like nuts, roasted chana, makhanas, fruits, and vegetable sticks for munching.

5.       Control sugar cravings:

To prevent sugar cravings, one should focus on increased amounts of protein, fiber, and fat in the diet. Protein and fibre provide satiety i.e., it will help them feel fuller for a longer time thus reducing sugar cravings between meals.

6.       Distract your child from sugar:

If your child eats foods high in sugar during a particular activity (i.e., watching the TV at the same time every day) or a particular time of the day, then engage your child in something physically active to do at that time like going out to play⁷.

7.       Be a role model:

As the saying goes, ‘monkey see, monkey do’, children pick up those habits which they see around them. If you reduce sugar in your own diet, your child is also likely to eat less sugar.

8.       Read Food Labels:

If you must give packaged food to your child, read the sugar labels on the back of the pack to make an informed choice. Please note that some products claim, ‘no added sugar’ or ‘low sugar’ and add artificial sweeteners to provide sweetness. Artificial sweeteners may provide fewer calories and do not cause sugar spikes but is still harmful to consume as it has been shown to affect health negatively.

9.       Sugar and emotions:

There lies a relationship between sugar and emotions. Children may be more inclined towards sugary foods to feel emotionally better. Thus, emotion-regulation practices like breathing exercises can be taught to children. This will help children to regulate their emotions and avoid emotion-induced eating.

References:

1.       Singh SA, Dhanasekaran D, Ganamurali NLP, Sabarathinam S. Junk foodinduced obesity- a growing threat to YOUNGSTERS during the pandemic. Obes Med. 2021. https://doi.org/10.1016/j.obmed.2021.100364

2.       Kumar, A., Kulchar, R. J., Khadka, N., Smith, C., Mukherjee, P., Rizal, E., & Sokal-Gutierrez, K. (2023). Maternal–child consumption of ultra-processed foods and sugar-sweetened beverages in informal settlements in Mumbai, India. Journal of Health, Population and Nutrition, 42(1), 142.

3.       Raj, A., Kashyap, S., Kundra, K., Kandari, S., Rela, R., & Naz, F. (2022). Correlation Between BMI, Caries Prevalence, and Sugar-containing Beverage Intake in 6-10 Year Old Children. Journal of Pharmacy and Bioallied Sciences, 14(Suppl 1), S991-S994.

4.       ICMR-NIN Expert Committee, Dietary Guidelines for Indians-2024

5.       Arshad, S., Rehman, T., Saif, S., Rajoka, M. S. R., Ranjha, M. M. A. N., Hassoun, A., ... & Aadil, R. M. (2022). Replacement of refined sugar by natural sweeteners: focus on potential health benefits. Heliyon, 8(9).

6.       MacGregor, G. A., & Hashem, K. M. (2014). Action on sugar—Lessons from UK salt reduction programme. Lancet, 383, 929–931

7.       Rodda, S. N., Booth, N., Brittain, M., McKean, J., & Thornley, S. (2020). I was truly addicted to sugar: A consumer-focused classification system of behaviour change strategies for sugar reduction. Appetite, 144, 104456.

8.       Prentice A. M. (2023). The Triple Burden of Malnutrition in the Era of Globalization. Nestle Nutrition Institute workshop series, 97, 51–61. https://doi.org/10.1159/000529005