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Added Sugar

American Academy of Pediatrics Weighs In on Added Sugar and Sugar Substitutes

April 28, 2015

I have been compensated for my time by McNeil Nutritionals, LLC, the maker of SPLENDA® Sweetener Products. All statements and opinions are my own. I have pledged to Blog With Integrity, asserting that the trust of my readers and the blogging community is vitally important to me.

According to the Centers of Disease Control and Prevention (CDC) more than one third of children and adolescents are overweight or obese. Out of concern over childhood obesity the American Academy of Pediatrics (AAP) weighed in again on the issue in a recently published policy statement titled Snacks, Sweetened Beverages, Added Sugars, and Schools. This statement details recent progress with school food and nutrition programs and changes in regulations and policies at the federal, state and local school level. The paper concludes with recommendations that pediatricians and others concerned about the health of children have for further improvement.

You may wonder why the AAP statement focused so much on the foods and beverages consumed in schools. When we think about schools and food we focus on lunch; however, some students eat both lunch and breakfast in school through federally-sponsored programs. In addition, students may purchase other foods and beverages in school from a la carte items in the cafeteria line, vending machines or a school store. A third source of foods and beverages are at bake sales, sporting events, classroom parties and other celebrations.

Add up all these sources of foods and beverages consumed in school and it’s no surprise that, as the AAP policy statement cites, students get 35 to 40 percent of their calories in school. The AAP paper also cites research noting that most of the calorie-dense and nutrient-poor foods and beverages are consumed by students away from school.

During the last decade myriad regulations from federal guidelines to local wellness policies have been put into place to improve the nutrition quality of foods served to children in schools. These guidelines and policies are aimed at making sure the foods and beverages available to students in the cafeteria, classroom or at celebrations are all more closely aligned with the 2010 Dietary Guidelines for Americans. The AAP policy statement cites newer research showing that children who eat school meals have improved nutrition.

But, with the rates of overweight among children staying fairly steady, according to a recent report from CDC, the AAP has suggestions for further improvement:

  • Use a minimum amount of added sugar with a practical approach that achieves a balance between avoidance and overindulgence.
  • Use sweetness in foods to encourage children to eat foods with lots of nutrition.
  • Foods and meals served in school should align with the 2010 Dietary Guidelines for Americans and present them mainly with foods from the five key food groups: vegetables, fruits, grains and whole grains, low-fat milk and dairy, and quality protein sources.
  • Expose children to a broad variety of foods and food experiences.
  • Avoid foods that are highly processed and high in calories with few nutrients.
  • Serve foods in age-appropriate portions based on the federal nutrition standards in the school meal programs and the standards for foods sold outside of the school meal program.

American Academy of Pediatrics’ Policy Statement Regarding Low Calorie Sweeteners

Of interest to readers of this blog, the AAP policy also includes a statement about the safety and use of low calorie sweeteners for children. The statement notes that low calorie sweeteners and sugar substitutes, such as SPLENDA® Sweeteners, are a tool to replace added sugar and lower the calories of some foods. AAP specifically states, “Additional improvements in nutrient density of sweet-tasting products could be obtained if nonnutritive sweeteners [also known as low calorie sweeteners] are used as a tool to replace added sugar and help lower caloric intake.”

The AAP paper points out that several low calorie sweeteners are deemed safe by the US Food and Drug Administration (FDA) and have, over time, been shown to have a good safety record.

Regarding how effective low calorie sweeteners are for long term weight control in young people, the AAP paper states that there have not been enough studies and more research is needed.

While it’s true that not many studies have been done in this area, a few recent studies are available and worth detailing. These studies have begun to show that, just as in adults, using low calorie sweeteners and foods and beverages sweetened with them as part of an otherwise healthy eating plan can help children and adolescents slow their rate of weight gain and not cause a weight increase, or produce a modest reduction in weight. It’s also worth noting that in children who are still growing and developing the preferred approach for weight control is to focus on slowing weight gain or holding weight steady as height catches up.

Feeding children and adolescents healthfully and raising them with healthy eating habits to keep them healthy over their lifetimes requires a balanced approach to food choices and consistent messages from all of the adults who surround them. This includes parents, grandparents, other caretakers, and teachers and healthcare providers.

Hope Warshaw, MMSc, RD, CDE, BC-ADM, is a nationally recognized dietitian and diabetes educator who applies more than 35 years of expertise as an author, freelance writer, media spokesperson, consultant and diabetes educator. Hope notes: “Healthy eating today is one tough job! The good news is that simple tweaks in your food choices and how you prepare foods can often set you on a path to healthier eating. Each positive step is a step in the right direction along the path to a long and healthy life.”


  • Childhood Obesity Facts. Centers for Disease Control and Prevention (CDC).
  • American Academy of Pediatrics Policy Statement. Snacks, Sweetened Beverages, Added Sugars, and Schools. Pediatrics. 2015;135(3) (e-pub).
  • US Department of Agriculture and US Department of Health and Human Services. Dietary Guidelines for Americans, 2010.
  • Odgen CL, et al.: Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. Journal American Medical Association. 2014;311(8):806-814. 
  • Scientific statement from the American Diabetes Association and American Heart Association: Nonnutritive Sweeteners: Current Use and Health Perspectives. (Published simultaneously: Diabetes Care. 2012;35(8):1798-1808 and Circulation: 2012;126:509-519.
  • Rodearmel SJ, et al.: Small changes in dietary sugar and physical activity as an approach to preventing excessive weight gain: the America on the move family study. Pediatrics. 2007;120:e869–79.
  • Foreyt J, et al.: The use of low-calorie sweeteners by children: implications for weight management. J Nutr. 2012;142(6): 1155S–1162S.
  • de Ruyter, et al.: A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Eng J Med. 2012;367(15):1397-1406.
April 28, 2015  |  POSTED BY: Hope Warshaw, MMSc, RD, CDE, BC-ADM  |  IN: Sugar Substitutes


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