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• W2034700352 abstract "See related article, p 604 .The prevalence of children who are overweight doubled in the last two decades and has tripled among adolescents. In 1999 and 2000, the national prevalence of overweight (body mass index ≥95th percentile for age) was 10.4% for children 2 to 4 years of age, 15.3% for children 6 to 11 years of age, and 15.5% for children 12 to 19 years of age. The percentage of overweight is higher for certain ethnic groups. More than 23% of African American and Mexican American adolescents are overweight.1Ogden CL Flegal KM Carroll MD Johnson CL Prevalence and trends in overweight among US children and adolescents, 1999-2000.JAMA. 2002; 288: 1728-1732Crossref PubMed Scopus (3253) Google Scholar Unfortunately, many overweight children become overweight adults. A report from the Bogalusa Heart Study found that 87% of children who are overweight at younger than eight years become obese adults.2Freedman DS Dietz WH Srinivasan SR Berenson GS The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study.Pediatrics. 1999; 103: 1175-1182Crossref PubMed Scopus (1814) Google ScholarObesity is a disease with devastating consequences; 65% of obese children 5 to 10 years of age have at least one cardiovascular risk factor, and 25% have two or more risk factors.3Dietz WH Barriers to the treatment of childhood obesity: a call to action.J Pediatr. 1999; 134: 535-536Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Type 2 diabetes, which before 1992 made up 3% to 10% of new cases of diabetes among children 10 to 19 years of age, accounted for 33% of new cases of diabetes in this age group in 1994. All of the patients were obese.4Pinhas-Hamiel O Dolan LM Daniels SR Standiford D Khoury PR Zeitler P Increased incidence of non-insulin-dependent diabetes mellitus among adolescents.J Pediatr. 1996; 128: 608-615Abstract Full Text PDF PubMed Scopus (938) Google Scholar A recent report found that 25% of obese children and 21% of obese adolescents had impaired glucose tolerance.5Sinha R Fisch G Teague B Tamborlane WV Banyas B Allen K et al.Prevalence of impaired glucose tolerance among children and adolescents with marked obesity.N Engl J Med. 2002; 346: 802-810Crossref PubMed Scopus (1391) Google Scholar Other complications of obesity include hypertension, hyperlipidemia, liver disease (nonalcoholic steatohepatitis), kidney disease, sleep apnea, hirsutism (elevated androgens), and psychological disorders (depression, low self-esteem).Why is there an obesity epidemic?Obesity is frequently called a genetic problem. Genes do influence our susceptibility to obesity, but our gene pool has not changed. What has changed is our environment. Weight gain occurs when energy intake exceeds energy expenditure. Physical activity has decreased and inactivity (watching television, playing video/computer games) has increased. Our diets have also changed, and we now consume large quantities of high-calorie, high-fat foods and sugar-sweetened drinks. Only 20% of children consume the recommended five or more servings of fruits and vegetables per day, and 30% of the vegetables are French fries.6Krebs-Smith SM Cook A Subar AF Cleveland L Friday J Kahle LL Fruit and vegetable intakes of children and adolescents in the United States.Arch Pediatr Adolesc Med. 1996; 150: 81-86Crossref PubMed Scopus (294) Google Scholar High-energy snacks make up more than 25% of children's caloric intake.7Jahns L Siega-Riz AM Popkin BM The increasing prevalence of snacking among US children from 1997-1996.J Pediatr. 2001; 138: 493-498Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar Portion sizes have expanded so that a large cheeseburger, super-size French fries, and super-size drink at a fast food restaurant contain more than 1800 calories.Soft drinks and obesityOne of the major changes in children's diets over the past two decades has been an increase in soft drink consumption. Soft drinks include soda, fruit-flavored drinks, and sport drinks. Between 1989 and 1991, and 1994 and 1995, daily soft drink intake increased from 11.5 ounces to 19 ounces among adolescent boys; 65% of adolescent girls and 74% of boys consume soft drinks daily.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar One third of teenage boys consume three or more cans of soda per day.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Soft drinks constitute the leading source of added sugar in the diet.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar A 12-ounce can of soda contains 10 teaspoons of sugar and a 20-ounce serving contains 17 teaspoons.A study of 548 sixth and seventh grade children in Boston found a 60% increase in overweight (body mass index ≥85th percentile for age) for each 12-ounce can of sugar-sweetened drink consumed daily.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar Portion size for beverages has also increased. A soda in the 1950s contained 6.5 ounces (75 calories); this increased to 12 ounces (150 calories) in the 1960s, and 20 ounces (250 calories) in the late 1990s. Even worse, the super-size drink at some fast food restaurants contains 40 ounces (410 calories) with a free refill.In this issue of The Journal, Mrdjenovic and Levitsky describe a longitudinal study of sweetened drink consumption in 30 children over a 4- to 8-week summer day camp session. Sweetened drinks included carbonated or noncarbonated fruit-flavored drinks, fruit punch, soda, or tea. During the week all meals were prepared by the camp, but on weekends food was prepared at home. Parents recorded the child's food consumption at home. Milk, juice, and juice drinks (but not sodas) were available at camp. Presumably all beverages (including sodas) were available at home. The children (n = 30) were weighed at the beginning of camp, and a second weight was recorded for 21 of those children during the last week of camp. The authors found that increased consumption of sweetened drinks was associated with greater total daily energy intake. Children who had the highest level of sweetened drink consumption (>16 oz/day) had the highest energy intake and gained the most weight during the study, although the sample size was not large enough to reach statistical significance.10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar A 1994 survey of 1810 children ages 2 to 18 years found that children who consumed >9 ounces of soft drinks per day had 190 kcal higher energy intake compared with nonconsumers.11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar The increase in energy intake occurred because the children failed to reduce consumption of solid foods to adjust for the additional energy of the sweetened drinks.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar, 10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar, 11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google ScholarOther risks of excessive soft drink consumptionThe authors of the current study also found a decrease in milk consumption associated with excess intake of sweetened drinks. They concluded that milk was being displaced from the diet by the sweetened drinks.10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar This was noted in another study where children in the highest soft drink consumption category consumed the least amount of milk.11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar As adolescents have doubled and tripled their consumption of soft drinks, they have decreased milk consumption by more than 40%.13Wyshak G Teenaged girls, carbonated beverage consumption, and bone fractures.Arch Pediatr Adolesc Med. 2000; 154: 610-613Crossref PubMed Scopus (218) Google Scholar Inadequate calcium and vitamin D intake during these critical years may contribute to an increased risk of osteoporosis later in life.Another adverse effect of soft drink consumption is a disruption of sleep related to caffeine intake. Higher caffeine intake among seventh to ninth grade students, mostly from carbonated beverages, was associated with shorter nocturnal sleep duration, increased wake time after sleep onset, and increased daytime sleep.14Pollack C Bright D Caffeine consumption and weekly sleep patterns in US seventh, eighth, and ninth graders.Pediatrics. 2003; 111: 42-46Crossref PubMed Scopus (135) Google Scholar Soft drink companies have recently started marketing drinks with more caffeine than regular soft drinks.The role of soda consumption contributing to dental caries is less clear, because tooth decay in the United States has declined as soft drink intake has increased.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google ScholarAdvertising, vending machines, and schoolsThe soft drink industry spends more than $600 million for advertising in the United States each year.15Jacobson MF Brownell KD Small taxes on soft drinks and snack foods to promote health.Am J Public Health. 2000; 90: 854-857Crossref PubMed Scopus (244) Google Scholar Marketing directed to school children can be profitable for soft drink manufacturers. Soft drinks are now sold in 60% of public and private middle schools and high schools nationwide.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Schools in need of additional revenue are turning to “pouring contracts,” which give soft drink companies the exclusive rights to sell and advertise their products at the schools. County school districts receive millions of dollars from these contracts, which may include financial incentives for increased sales of soft drinks. In a school district in Colorado, where soft drink sales were not meeting projections, the students were allowed to bring sodas into the classroom, and vending machines were moved to locations where they would be more accessible to the students.16Schlosser E Fast food nation.in: Houghton Mifflin, New York2001: 57Google ScholarBeverage companies may blame the obesity epidemic on a decline in physical activity. In part they are correct; time spent in physical activity has decreased at school and at home, and sedentary activities have increased. However, because it takes about 30 minutes of moderate physical activity to burn 200 calories, one would have to exercise for almost 45 minutes just to break even after a 20-ounce soda.What can we do to reduce soft drink consumption in children and adolescents?•Reduce the availability and limit portion sizes of sugar-sweetened drinks sold at school and provided at home•Teach children that water is the best thirst quencher•Advocate for healthier choices in beverage vending machines in schools and communities (bottled water, low-fat milk, and 100% fruit and vegetable juice products)•Prohibit advertising of sugar-sweetened beverages at school and daycare centers•Parents should model healthy behavior by limiting their own soft drink consumption•Provide schools with adequate funding for educational and extra-curricular programs•Advocate for small taxes on soft drinks and snack foods with the revenues applied to school health programs, or subsidization of healthful foods such as fruits and vegetables15Jacobson MF Brownell KD Small taxes on soft drinks and snack foods to promote health.Am J Public Health. 2000; 90: 854-857Crossref PubMed Scopus (244) Google Scholar, 17Jacobson MF. Liquid candy: how soft drinks are harming Americans' health. Available at: http://www.cspinet.org . Last accessed 3/03.Google ScholarWe should not auction our children's health to the highest bidder. There have been recent signs of hope. Starting in 2004, soft drink sales will be banned from all schools in the Los Angeles School District, and vending machines will be stocked with healthier options such as bottled water, milk, 100% fruit juice, and sports drinks that meet the requirements for glucose content. In Gastonia, North Carolina, a school principal removed all soda and snack vending machines except two that dispense water. Other schools and communities would do well to follow these courageous examples. See related article, p 604 . The prevalence of children who are overweight doubled in the last two decades and has tripled among adolescents. In 1999 and 2000, the national prevalence of overweight (body mass index ≥95th percentile for age) was 10.4% for children 2 to 4 years of age, 15.3% for children 6 to 11 years of age, and 15.5% for children 12 to 19 years of age. The percentage of overweight is higher for certain ethnic groups. More than 23% of African American and Mexican American adolescents are overweight.1Ogden CL Flegal KM Carroll MD Johnson CL Prevalence and trends in overweight among US children and adolescents, 1999-2000.JAMA. 2002; 288: 1728-1732Crossref PubMed Scopus (3253) Google Scholar Unfortunately, many overweight children become overweight adults. A report from the Bogalusa Heart Study found that 87% of children who are overweight at younger than eight years become obese adults.2Freedman DS Dietz WH Srinivasan SR Berenson GS The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study.Pediatrics. 1999; 103: 1175-1182Crossref PubMed Scopus (1814) Google Scholar Obesity is a disease with devastating consequences; 65% of obese children 5 to 10 years of age have at least one cardiovascular risk factor, and 25% have two or more risk factors.3Dietz WH Barriers to the treatment of childhood obesity: a call to action.J Pediatr. 1999; 134: 535-536Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Type 2 diabetes, which before 1992 made up 3% to 10% of new cases of diabetes among children 10 to 19 years of age, accounted for 33% of new cases of diabetes in this age group in 1994. All of the patients were obese.4Pinhas-Hamiel O Dolan LM Daniels SR Standiford D Khoury PR Zeitler P Increased incidence of non-insulin-dependent diabetes mellitus among adolescents.J Pediatr. 1996; 128: 608-615Abstract Full Text PDF PubMed Scopus (938) Google Scholar A recent report found that 25% of obese children and 21% of obese adolescents had impaired glucose tolerance.5Sinha R Fisch G Teague B Tamborlane WV Banyas B Allen K et al.Prevalence of impaired glucose tolerance among children and adolescents with marked obesity.N Engl J Med. 2002; 346: 802-810Crossref PubMed Scopus (1391) Google Scholar Other complications of obesity include hypertension, hyperlipidemia, liver disease (nonalcoholic steatohepatitis), kidney disease, sleep apnea, hirsutism (elevated androgens), and psychological disorders (depression, low self-esteem). Why is there an obesity epidemic?Obesity is frequently called a genetic problem. Genes do influence our susceptibility to obesity, but our gene pool has not changed. What has changed is our environment. Weight gain occurs when energy intake exceeds energy expenditure. Physical activity has decreased and inactivity (watching television, playing video/computer games) has increased. Our diets have also changed, and we now consume large quantities of high-calorie, high-fat foods and sugar-sweetened drinks. Only 20% of children consume the recommended five or more servings of fruits and vegetables per day, and 30% of the vegetables are French fries.6Krebs-Smith SM Cook A Subar AF Cleveland L Friday J Kahle LL Fruit and vegetable intakes of children and adolescents in the United States.Arch Pediatr Adolesc Med. 1996; 150: 81-86Crossref PubMed Scopus (294) Google Scholar High-energy snacks make up more than 25% of children's caloric intake.7Jahns L Siega-Riz AM Popkin BM The increasing prevalence of snacking among US children from 1997-1996.J Pediatr. 2001; 138: 493-498Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar Portion sizes have expanded so that a large cheeseburger, super-size French fries, and super-size drink at a fast food restaurant contain more than 1800 calories. Obesity is frequently called a genetic problem. Genes do influence our susceptibility to obesity, but our gene pool has not changed. What has changed is our environment. Weight gain occurs when energy intake exceeds energy expenditure. Physical activity has decreased and inactivity (watching television, playing video/computer games) has increased. Our diets have also changed, and we now consume large quantities of high-calorie, high-fat foods and sugar-sweetened drinks. Only 20% of children consume the recommended five or more servings of fruits and vegetables per day, and 30% of the vegetables are French fries.6Krebs-Smith SM Cook A Subar AF Cleveland L Friday J Kahle LL Fruit and vegetable intakes of children and adolescents in the United States.Arch Pediatr Adolesc Med. 1996; 150: 81-86Crossref PubMed Scopus (294) Google Scholar High-energy snacks make up more than 25% of children's caloric intake.7Jahns L Siega-Riz AM Popkin BM The increasing prevalence of snacking among US children from 1997-1996.J Pediatr. 2001; 138: 493-498Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar Portion sizes have expanded so that a large cheeseburger, super-size French fries, and super-size drink at a fast food restaurant contain more than 1800 calories. Soft drinks and obesityOne of the major changes in children's diets over the past two decades has been an increase in soft drink consumption. Soft drinks include soda, fruit-flavored drinks, and sport drinks. Between 1989 and 1991, and 1994 and 1995, daily soft drink intake increased from 11.5 ounces to 19 ounces among adolescent boys; 65% of adolescent girls and 74% of boys consume soft drinks daily.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar One third of teenage boys consume three or more cans of soda per day.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Soft drinks constitute the leading source of added sugar in the diet.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar A 12-ounce can of soda contains 10 teaspoons of sugar and a 20-ounce serving contains 17 teaspoons.A study of 548 sixth and seventh grade children in Boston found a 60% increase in overweight (body mass index ≥85th percentile for age) for each 12-ounce can of sugar-sweetened drink consumed daily.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar Portion size for beverages has also increased. A soda in the 1950s contained 6.5 ounces (75 calories); this increased to 12 ounces (150 calories) in the 1960s, and 20 ounces (250 calories) in the late 1990s. Even worse, the super-size drink at some fast food restaurants contains 40 ounces (410 calories) with a free refill.In this issue of The Journal, Mrdjenovic and Levitsky describe a longitudinal study of sweetened drink consumption in 30 children over a 4- to 8-week summer day camp session. Sweetened drinks included carbonated or noncarbonated fruit-flavored drinks, fruit punch, soda, or tea. During the week all meals were prepared by the camp, but on weekends food was prepared at home. Parents recorded the child's food consumption at home. Milk, juice, and juice drinks (but not sodas) were available at camp. Presumably all beverages (including sodas) were available at home. The children (n = 30) were weighed at the beginning of camp, and a second weight was recorded for 21 of those children during the last week of camp. The authors found that increased consumption of sweetened drinks was associated with greater total daily energy intake. Children who had the highest level of sweetened drink consumption (>16 oz/day) had the highest energy intake and gained the most weight during the study, although the sample size was not large enough to reach statistical significance.10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar A 1994 survey of 1810 children ages 2 to 18 years found that children who consumed >9 ounces of soft drinks per day had 190 kcal higher energy intake compared with nonconsumers.11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar The increase in energy intake occurred because the children failed to reduce consumption of solid foods to adjust for the additional energy of the sweetened drinks.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar, 10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar, 11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar One of the major changes in children's diets over the past two decades has been an increase in soft drink consumption. Soft drinks include soda, fruit-flavored drinks, and sport drinks. Between 1989 and 1991, and 1994 and 1995, daily soft drink intake increased from 11.5 ounces to 19 ounces among adolescent boys; 65% of adolescent girls and 74% of boys consume soft drinks daily.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar One third of teenage boys consume three or more cans of soda per day.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Soft drinks constitute the leading source of added sugar in the diet.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar A 12-ounce can of soda contains 10 teaspoons of sugar and a 20-ounce serving contains 17 teaspoons. A study of 548 sixth and seventh grade children in Boston found a 60% increase in overweight (body mass index ≥85th percentile for age) for each 12-ounce can of sugar-sweetened drink consumed daily.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar Portion size for beverages has also increased. A soda in the 1950s contained 6.5 ounces (75 calories); this increased to 12 ounces (150 calories) in the 1960s, and 20 ounces (250 calories) in the late 1990s. Even worse, the super-size drink at some fast food restaurants contains 40 ounces (410 calories) with a free refill. In this issue of The Journal, Mrdjenovic and Levitsky describe a longitudinal study of sweetened drink consumption in 30 children over a 4- to 8-week summer day camp session. Sweetened drinks included carbonated or noncarbonated fruit-flavored drinks, fruit punch, soda, or tea. During the week all meals were prepared by the camp, but on weekends food was prepared at home. Parents recorded the child's food consumption at home. Milk, juice, and juice drinks (but not sodas) were available at camp. Presumably all beverages (including sodas) were available at home. The children (n = 30) were weighed at the beginning of camp, and a second weight was recorded for 21 of those children during the last week of camp. The authors found that increased consumption of sweetened drinks was associated with greater total daily energy intake. Children who had the highest level of sweetened drink consumption (>16 oz/day) had the highest energy intake and gained the most weight during the study, although the sample size was not large enough to reach statistical significance.10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar A 1994 survey of 1810 children ages 2 to 18 years found that children who consumed >9 ounces of soft drinks per day had 190 kcal higher energy intake compared with nonconsumers.11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar The increase in energy intake occurred because the children failed to reduce consumption of solid foods to adjust for the additional energy of the sweetened drinks.8Ludwig DS Peterson KE Gortmaker SL Relation between consumption of sugar-sweetened drinks and childhood obesity. A prospective, observational analysis.Lancet. 2001; 357: 505-508Abstract Full Text Full Text PDF PubMed Scopus (1756) Google Scholar, 10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar, 11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar Other risks of excessive soft drink consumptionThe authors of the current study also found a decrease in milk consumption associated with excess intake of sweetened drinks. They concluded that milk was being displaced from the diet by the sweetened drinks.10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar This was noted in another study where children in the highest soft drink consumption category consumed the least amount of milk.11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar As adolescents have doubled and tripled their consumption of soft drinks, they have decreased milk consumption by more than 40%.13Wyshak G Teenaged girls, carbonated beverage consumption, and bone fractures.Arch Pediatr Adolesc Med. 2000; 154: 610-613Crossref PubMed Scopus (218) Google Scholar Inadequate calcium and vitamin D intake during these critical years may contribute to an increased risk of osteoporosis later in life.Another adverse effect of soft drink consumption is a disruption of sleep related to caffeine intake. Higher caffeine intake among seventh to ninth grade students, mostly from carbonated beverages, was associated with shorter nocturnal sleep duration, increased wake time after sleep onset, and increased daytime sleep.14Pollack C Bright D Caffeine consumption and weekly sleep patterns in US seventh, eighth, and ninth graders.Pediatrics. 2003; 111: 42-46Crossref PubMed Scopus (135) Google Scholar Soft drink companies have recently started marketing drinks with more caffeine than regular soft drinks.The role of soda consumption contributing to dental caries is less clear, because tooth decay in the United States has declined as soft drink intake has increased.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar The authors of the current study also found a decrease in milk consumption associated with excess intake of sweetened drinks. They concluded that milk was being displaced from the diet by the sweetened drinks.10Mrdjenovic Levitsky D Nutritional and energetic consequences of sweetened drinks consumption in 6- to 13-year-old children.J Pediatr. 2003; 142: 604-610Abstract Full Text Full Text PDF PubMed Scopus (182) Google Scholar This was noted in another study where children in the highest soft drink consumption category consumed the least amount of milk.11Harnack L Stang J Story M Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc. 1999; 99: 436-441Abstract Full Text Full Text PDF PubMed Scopus (581) Google Scholar As adolescents have doubled and tripled their consumption of soft drinks, they have decreased milk consumption by more than 40%.13Wyshak G Teenaged girls, carbonated beverage consumption, and bone fractures.Arch Pediatr Adolesc Med. 2000; 154: 610-613Crossref PubMed Scopus (218) Google Scholar Inadequate calcium and vitamin D intake during these critical years may contribute to an increased risk of osteoporosis later in life. Another adverse effect of soft drink consumption is a disruption of sleep related to caffeine intake. Higher caffeine intake among seventh to ninth grade students, mostly from carbonated beverages, was associated with shorter nocturnal sleep duration, increased wake time after sleep onset, and increased daytime sleep.14Pollack C Bright D Caffeine consumption and weekly sleep patterns in US seventh, eighth, and ninth graders.Pediatrics. 2003; 111: 42-46Crossref PubMed Scopus (135) Google Scholar Soft drink companies have recently started marketing drinks with more caffeine than regular soft drinks. The role of soda consumption contributing to dental caries is less clear, because tooth decay in the United States has declined as soft drink intake has increased.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Advertising, vending machines, and schoolsThe soft drink industry spends more than $600 million for advertising in the United States each year.15Jacobson MF Brownell KD Small taxes on soft drinks and snack foods to promote health.Am J Public Health. 2000; 90: 854-857Crossref PubMed Scopus (244) Google Scholar Marketing directed to school children can be profitable for soft drink manufacturers. Soft drinks are now sold in 60% of public and private middle schools and high schools nationwide.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Schools in need of additional revenue are turning to “pouring contracts,” which give soft drink companies the exclusive rights to sell and advertise their products at the schools. County school districts receive millions of dollars from these contracts, which may include financial incentives for increased sales of soft drinks. In a school district in Colorado, where soft drink sales were not meeting projections, the students were allowed to bring sodas into the classroom, and vending machines were moved to locations where they would be more accessible to the students.16Schlosser E Fast food nation.in: Houghton Mifflin, New York2001: 57Google ScholarBeverage companies may blame the obesity epidemic on a decline in physical activity. In part they are correct; time spent in physical activity has decreased at school and at home, and sedentary activities have increased. However, because it takes about 30 minutes of moderate physical activity to burn 200 calories, one would have to exercise for almost 45 minutes just to break even after a 20-ounce soda. The soft drink industry spends more than $600 million for advertising in the United States each year.15Jacobson MF Brownell KD Small taxes on soft drinks and snack foods to promote health.Am J Public Health. 2000; 90: 854-857Crossref PubMed Scopus (244) Google Scholar Marketing directed to school children can be profitable for soft drink manufacturers. Soft drinks are now sold in 60% of public and private middle schools and high schools nationwide.9S Squires, Soft drinks, hard facts (2/27/01 Washington Post, HE10).Google Scholar Schools in need of additional revenue are turning to “pouring contracts,” which give soft drink companies the exclusive rights to sell and advertise their products at the schools. County school districts receive millions of dollars from these contracts, which may include financial incentives for increased sales of soft drinks. In a school district in Colorado, where soft drink sales were not meeting projections, the students were allowed to bring sodas into the classroom, and vending machines were moved to locations where they would be more accessible to the students.16Schlosser E Fast food nation.in: Houghton Mifflin, New York2001: 57Google Scholar Beverage companies may blame the obesity epidemic on a decline in physical activity. In part they are correct; time spent in physical activity has decreased at school and at home, and sedentary activities have increased. However, because it takes about 30 minutes of moderate physical activity to burn 200 calories, one would have to exercise for almost 45 minutes just to break even after a 20-ounce soda. What can we do to reduce soft drink consumption in children and adolescents?•Reduce the availability and limit portion sizes of sugar-sweetened drinks sold at school and provided at home•Teach children that water is the best thirst quencher•Advocate for healthier choices in beverage vending machines in schools and communities (bottled water, low-fat milk, and 100% fruit and vegetable juice products)•Prohibit advertising of sugar-sweetened beverages at school and daycare centers•Parents should model healthy behavior by limiting their own soft drink consumption•Provide schools with adequate funding for educational and extra-curricular programs•Advocate for small taxes on soft drinks and snack foods with the revenues applied to school health programs, or subsidization of healthful foods such as fruits and vegetables15Jacobson MF Brownell KD Small taxes on soft drinks and snack foods to promote health.Am J Public Health. 2000; 90: 854-857Crossref PubMed Scopus (244) Google Scholar, 17Jacobson MF. Liquid candy: how soft drinks are harming Americans' health. Available at: http://www.cspinet.org . Last accessed 3/03.Google ScholarWe should not auction our children's health to the highest bidder. There have been recent signs of hope. Starting in 2004, soft drink sales will be banned from all schools in the Los Angeles School District, and vending machines will be stocked with healthier options such as bottled water, milk, 100% fruit juice, and sports drinks that meet the requirements for glucose content. In Gastonia, North Carolina, a school principal removed all soda and snack vending machines except two that dispense water. Other schools and communities would do well to follow these courageous examples. •Reduce the availability and limit portion sizes of sugar-sweetened drinks sold at school and provided at home•Teach children that water is the best thirst quencher•Advocate for healthier choices in beverage vending machines in schools and communities (bottled water, low-fat milk, and 100% fruit and vegetable juice products)•Prohibit advertising of sugar-sweetened beverages at school and daycare centers•Parents should model healthy behavior by limiting their own soft drink consumption•Provide schools with adequate funding for educational and extra-curricular programs•Advocate for small taxes on soft drinks and snack foods with the revenues applied to school health programs, or subsidization of healthful foods such as fruits and vegetables15Jacobson MF Brownell KD Small taxes on soft drinks and snack foods to promote health.Am J Public Health. 2000; 90: 854-857Crossref PubMed Scopus (244) Google Scholar, 17Jacobson MF. Liquid candy: how soft drinks are harming Americans' health. Available at: http://www.cspinet.org . Last accessed 3/03.Google Scholar We should not auction our children's health to the highest bidder. There have been recent signs of hope. Starting in 2004, soft drink sales will be banned from all schools in the Los Angeles School District, and vending machines will be stocked with healthier options such as bottled water, milk, 100% fruit juice, and sports drinks that meet the requirements for glucose content. In Gastonia, North Carolina, a school principal removed all soda and snack vending machines except two that dispense water. Other schools and communities would do well to follow these courageous examples. Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old childrenThe Journal of PediatricsVol. 142Issue 6PreviewObjective To study the effects of excessive sweetened drink consumption on daily energy balance and nutrient intake in a longitudinal study of children. Subjects and methods Daily dietary intakes of 30 children aged 6 to 13 years old were collected over 4 to 8 weeks. Weights and heights of children were measured at the beginning and end of the study in 21 children. Data were analyzed by analysis of variance (ANOVA) (PROC MIXED in SAS) and multiple regression. Results Excessive sweetened drink consumption (>12 oz/day) displaced milk from children's diets (122-147 g/day less milk drank, P < .0001) because caregivers served less milk and the children consumed smaller amounts of milk. Full-Text PDF" @default.
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