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Hidden Sugars: How to Take the Mystery Out of Making Healthier Choices for You and Your Child

Posted on Aug 30, 2021

Childhood obesity is associated with excess sugar intake. Currently, nearly one in three children meet criteria for overweight or obesity so reducing excess sugar intake is an important tactic to reduce your child’s risk for these health issues. The American Academy of Pediatrics recommends that children less than 2 years old have no sugar in their diet.

On this week’s On Call for All Kids, Raquel Hernandez, M.D., M.P.H., assistant professor of pediatrics at the Johns Hopkins University School of Medicine and medical director of the Johns Hopkins All Children’s Healthy Weight Initiative, helps us find those hidden sugars and reduce the risk of excess calories and sugar intake in our children’s diets.

Why do you think it’s so difficult for us to know how much sugar we really take in on a daily basis?

So many reasons. First is that we often expect for sugar to look the way it looks when we sweeten our tea or coffee — a powder. That’s often not the case. In fact, the majority of foods that we purchase or make are fortified or supplemented with sugar and you would only know if it was supplemented by reading a food label.

So how much sugar should kids really be having on a daily basis? 

Six teaspoons is a very small amount of sugar. If you consider that one can (8-10 ounces) of soft drink or orange juice can have anywhere from 35 to 40 grams, you can see how quickly we start to add on more sugar and, unfortunately, more pounds than are needed.

What would you say are some of the most common foods to avoid that have hidden sugars?

There are so many foods that are often marketed as “healthy” for kids and families that are unfortunately not great for maintaining a healthy weight or for overall health.

Top Foods with Hidden Sugars:

  • Sports drinks and energy drinks
  • 100% juice drinks 
  • Breads and cereals
  • Yogurts and flavored milks
  • Most breakfast foods (pancakes, waffles, croissants)

What can parents and kids do to be more aware of and to reduce how many hidden sugars they eat?

  1. If you’re going to have a beverage (juice, soda, sports drink) consider watering it down/diluting it with water. Using flavored water options or sparkling water options can be very helpful.
  2. When it comes to breads and cereals, look for whole wheat options. The more fiber the food has, the better it is for you and the less health effect of the sugar it contains.
  3. For yogurts, we recommend looking for the plain yogurt options and adding fresh fruit or small amounts of honey to the portion. Remember that a healthy portion for most children is often about the amount of yogurt that fits in their hand, so make sure you’re not giving them too large of a portion. Also, milk is already sweet and adding more sweeteners or flavor is really just unnecessary calories.
  4. For breakfast, think about options that include unprocessed foods: Eggs, fruit, vegetables and lean meats (turkey bacon) can really fill you up in a healthy way. If you’re going to choose pancakes or waffles, think about your portions and think about it as “extra” vs. the central part of your meal.

Many parents have questions about sugar substitutes or zero sugar options. Are these healthy?

Sugar substitutes have both advantages and disadvantages when introduced into our diets. Interestingly, they have been hard to study because each of these substitutes whether they are synthetic (saccharides) or natural (stevia) are metabolized in different ways so it has been hard to compare “apples to apples” in most clinical trials. In general, the more we avoid synthetic substances the healthier we are. In addition, there have been studies to suggest that artificial sweeteners can cause increased appetite, increased insulin response (and therefore increase risk for diabetes) and in some cases increased risk for cancer.

Having said that, I have had several patients in which a transition to artificial sweeteners has led to improved health in reducing their intake of high-fructose corn syrup which had a much more detrimental effect of health and therefore, may be a way of gradually improving how much overall sugar someone is taking in.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children's Hospital experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report. You also can download our free Pocket Doc app, which features a symptom checker, parenting advice and other tools for staying in touch with us.


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