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    The Skinny On Soft Drinks In Schools
    By Becky Jungbauer | March 8th 2010 03:45 PM | 10 comments | Print | E-mail | Track Comments
    About Becky

    A scientist and journalist by training, I enjoy all things science, especially science-related humor. My column title is a throwback to Jane

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    Imagine a child, standing in a school cafeteria. We'll assume that this child has reached or surpassed the age of reason (7 years old, for non-Catholics out there), meaning they can understand their choices and therefore can make the wrong choice along with the right one.

    In front of this lovely child is a vending machine filled with tempting soda1 and sports drinks and other such calorie-laden, battery-acid-by-another-name, neatly packaged consumables.

    The child raises an arm to deposit the GDP of a third world country into the coin slot to obtain one of the aforementioned beverages, when ZAP! The vending machine zips away into the ether and is replaced, a la the phone booth in Bill&Ted's Excellent Adventure, with another vending machine filled with water (regular, flavored, and fortified), diet sodas, sports drinks, unsweetened juices, and milk products.

    At this particular moment in time, when the vending machine contents have been replaced with more "healthy" alternatives, has the child's knowledge about calorie consumption increased? Has the new vending machine reinforced with the child the importance of balancing calories consumed with calories burned? Has it taught the child how to consume foods and beverages as part of a balanced diet and be more active?

    If you are the American Beverage Association, your answer to the above questions is a resounding YES!

    I, however, am not an ABA member, and I would skew toward the "no" end of the spectrum. In this situation, all you've done is take away an option, not educated the child or allowed the child to apply that education in making the healthier choice. If you take away candy from kids and instead only allow them to eat carrots, are you teaching the kid that carrots are more healthy, why they're more healthy, and how a healthy diet can help the kids stay fit and healthy in the long term? No. So, while I applaud the ABA sincerely for their voluntary efforts - more on that in a moment - I don't think you can use the removal of an option as a means to cognizant behavior modification.

    The ABA - not the lawyer one

    My hypothetical example above is less hypothetical than you might think, although without the cool sound effects and sci-fi tricks. Back in 2006, the American Beverage Association teamed up with the Alliance for a Healthier Generation (a joint initiative of the William J. Clinton Foundation and the American Heart Association) to provide School Beverage Guidelines "that limit the number of calories available in beverages by providing students with even more low-calorie, nutritious, smaller-portion choices. These guidelines built upon the school vending policy adopted by the beverage industry in 2005."

    The ABA worked on guidelines and encouraged their bottlers "to work with schools and school districts to amend existing contracts to change the product mix to include only beverages outlined in the guidelines," and adopt the guidelines within three years (ending during the 2009-2010 school year).

    The School Beverage Guidelines - which are voluntary - detail drink options by age (elementary, middle and high school) and times of day (before and after school).

    Three years later, the results are pretty clear - the final progress report stated that there has been an 88 percent decrease in total calories contained in all beverages shipped to schools; there has been a 95 percent reduction in shipments of full-calorie soft drinks to schools; and at the beginning of this school year 98.8 percent of schools and school districts measured were in compliance with the guidelines.

    I want to mention two caveats to temper these results: one, while the voluntary guidelines certainly did their part, state and local restrictions on sales of sweetened beverages in
    schools are also responsible for some of the decline, according to the story on this report in the Wall Street Journal. Two, these results really are great - I'm all for reducing caloric consumption in children, especially via sugary drinks - but how does a decrease in calories shipped to schools correlate with the outcomes the ABA touted?

    In the ABA's Q&A section on the guidelines, they say the following:
    "The School Beverage Guidelines reinforces with children the importance of balancing calories consumed with calories burned. We believe achieving this balance is the most meaningful way to have an impact on the health and wellness of our children."

    "We particularly like this relationship [among parents, children and the schools] because it focuses on calories consumed and calories burned. We need to start doing the hard work of teaching our children how to consume foods and beverages as part of a balanced diet and active lifestyle. And we share the Alliance's desire to get more physical activity into schools and the lives of our students.

    By shifting the focus to calories, we hope schools will begin teaching students how to consume foods and beverages as part of a balanced diet and be more active."

    I don't agree that simply removing options equals shifting a focus to calories in the minds of children, nor does it help schools teach students how to consume a balanced diet. It is certainly a component of that, but the education step and self-efficacy step (the child's confidence in his/her ability to successfully perform an action, like making a healthy choice) are missing. The ABA can't do it all, and I get that. But where I really start to t'd off is the next set of statements.

    The School Beverage Guidelines focus on calories and helping to control calorie consumption. Students enjoy variety in their beverage choices and diet soft drinks are an appropriate refreshment for high school students. The fact that these drinks are low-calorie and refreshing helps to reinforce the focus on calories for students as part of maintaining a healthy weight and lifestyle.

    Not to sound like Bill Clinton, but define appropriate for me. And also refreshing. I beg to differ on the refreshing part - if you define refreshing in this context as thirst-quenching, then soda is actually the exact opposite. Let's take two ingredients in diet Coke, for example. First, you have caffeine (unless you're drinking caffeine-free), which is a diuretic - it increases the rate of urination, so you LOSE more water. Then you have Splenda, or aspertame, or NutraSweet - and artificial sweeteners, while avoiding the calories of real sugar, may actually make you crave MORE sugar because you aren't consuming the real thing. Sure, it says zero- or low-calorie. But you're still getting some sodium (even in flavored waters, like Sobe Life water), which is also a diuretic. Anyway, on to the next statement.

    Sports drinks clearly have a functional place in schools. Studies show that 53% of high school students participate in interscholastic sports before, during and after school, and sports drinks provide a functional benefit necessary for students to add energy and absorb fluids efficiently. This makes sports drinks an effective beverage for prehydrating and rehydrating students active in team sports, recreational activities and rigorous physical education activity. In short, the calories contained in sports drinks, largely through carbohydrates, are needed to fuel working muscles of active students.

    So, before the introduction of Gatorade, student athletes were just poor schmucks that couldn't compete up to their full potential? How is a performance-enhancing sports drink any different from steroids, then?

    Did it work?

    Another problem I have with this report is that the measurements were somewhat out of sync with what the goals are - yes, you reduced shipping of high-caloric drinks. But how do you know what kids drank outside of school? Did they consume even more soda to make up for the lack of it during school? Did they bring it in from outside to drink at lunch? And because the ABA didn't set up measurements to correlate fewer shipments with awareness of calories consumed versus burned and drinking soda as part of a "healthy, balanced" diet, we can't know what the outcomes are from these actions.

    An article from Scientific Blogging suggests that getting rid of sugary snacks and drinks actually does have some impact on weight, but not across the board.

    Drinking water and 100% juice is still the best alternative to soda and high-sugar fruit juices and sports drinks. And giving kids the option for healthier choices is great. But is it a choice when it's the only item available? And how are kids going to know how to eat better if we don't teach them and enable them to make healthy decisions?

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    1 Or pop, if you're from the Midwest. Or Coke, if you're from the South.

    Comments

    Gerhard Adam
    But is it a choice when it's the only item available? And how are kids going to know how to eat better if we don't teach them and enable them to make healthy decisions?
    Teaching is a great idea and it's necessary, however it doesn't work very well.  All one has to do is examine the statistics regarding teen pregnancy and STD's to see that despite having access to more information than any time in history, teens are still fundamentally ignorant regarding sex.  In addition, it can hardly come as a shock to anyone that excessive alcohol consumption is bad (especially when coupled with driving) and that hard drugs can ruin your life or kill you.

    We don't sell alcohol and cigarettes to teens because we don't presume that it's education that is the deciding factor (we've already seen decades of that approach).  Instead we deny them access until they are adults and at least, defer the problem to a less volatile time in their lives.

    I would be shocked if anyone today didn't know the relationship of sex to pregnancy or hard drugs to addiction, or drunk driving to fatalities and yet they persist.  So while I agree with the need for education, the simple reality is that sometimes what works is eliminating choices.
    Mundus vult decipi
    Becky Jungbauer
    I agree, which is why I say that students need self-efficacy as well. They need to know what to choose but also have confidence in themselves to make that choice. Education alone doesn't work, as public health has shown over and over.
    Gerhard Adam
    ...which is why I say that students need self-efficacy as well.
    I would agree, but what does that mean in this context?  I know people well into their twenties that don't have the confidence to make appropriate decisions, so I'm not clear on what your criteria or definition is for achieving this. 

    I'm not trying to put words into your mouth or suggest that you're implying something that you aren't, so that's why I"m asking it like this.  In particular, my concern is that we are already placing far too many choices in kid's hands and (in some cases) effectively absolving parents of the responsibility of being parents. 
    Mundus vult decipi
    Becky Jungbauer
    The public health model says education/information isn't enough, people need self-efficacy as well in order to actually make a behavior change. This applies to any age, not just kids. And I don't at all absolve parents of their responsibility. I think some of the self-efficacy comes from parents, and as Mike says, eating habits are definitely learned at home. Anyway, my point was that I agreed, just passively learning something isn't enough to change behavior, no matter what age.
    adaptivecomplexity
    I'm not sure what schools make available makes that much of a differences, because so many bad eating habits are reinforced at home. If your kid is drinking a lot of Coke at home, she'll buy it at school. If she doesn't get it at home, she either won't buy it at school, or it will be her one soft drink of the day.
    The reality is that so many kids are fed junk at home.
    Mike
    Gerhard Adam
    You're certainly correct in terms of what gets reinforced at home and the origin of many such bad habits.  However, I suspect you wouldn't say the same thing if we were talking about cigarettes and alcohol which would have similar reinforcement patterns.

    I can't imagine you saying, that it would be her one cigarette of the day.
    Mundus vult decipi
    CJE
    How are those even remotely related, Gerhard? A can of soda is not a cigarette.
    Gerhard Adam
    Considering that new studies are suggesting that diabetes and obesity in kids is becoming a bigger problem than cigarette smoking, then the point remains.
    Mundus vult decipi
    CJE
    But the very flawed assumption in that statement is that soda consumption is the primary cause of obesity. For all the hype, there's a surprisingly limited amount of clinical evidence that soda, or any one food, deserves the blame for our overweight children.
    Gerhard Adam
    I'm not suggesting any ONE food, but certainly a single soda at school isn't the issue either where other less healthy meals are also available.  There's no question that this is a problem that has multiple components, but my point is simply that if food is considered a problem, then why parse it like this?  You could hardly argue that a single beer is bad either, or even a single cigarette. 

    However we all know that this isn't a singular event and that the availability of such foods/drinks in schools creates an environment where repeated encounters occur.  While I don't think that the schools are responsible for obesity, there is also no reason why they should contribute to it in small ways either.  My example of smoking and drinking is to demonstrate that we have no problem in restricting access for kids and teens, so why do we suddenly think that food should be strictly a matter of personal choice?  Aren't these other things personal choices as well?  It isn't about whether they are good or bad, but rather whether kids/teens are mature enough to be making these choices (especially when to eliminate them isn't a hardship on the schools).
    Mundus vult decipi