Unhealthy? Got it! ... but ... How Much?

Obesity affects 40 percent of adults and 19 percent of children in the United States and accounts for more than $168 billion in health care spending each year. Sugary beverages are thought to be one of the major drivers of the obesity epidemic. These drinks (think soda and sports drinks) are the largest single source of added sugars for Americans and contribute, on average, 145 added calories a day to our diets. For these reasons, reducing sugary beverage consumption has been a significant focus of public health intervention. Most efforts have focused on sodas.

(NYTimes. By Erika R. Cheng, Lauren G. Fiechtner, Aaron E. Carroll)

But not juice. Juice, for some reason, gets a pass. It’s not clear why.

Americans drink a lot of juice. The average adult drinks 6.6 gallons per year. More than half of preschool-age children (ages 2 to 5) drink juice regularly, a proportion that, unlike for sodas, has not budged in recent decades. These children consume on average 10 ounces per day, more than twice the amount recommended by the American Academy of Pediatrics.

Parents tend to associate juice with healthfulness, are unaware of its relationship to weight gain and are reluctant to restrict it in their child’s diet. After all, 100 percent fruit juice — sold in handy individual servings — has been marketed as a natural source of vitamins and calcium. Department of Agriculture guidelines state that up to half of fruit servings can be provided in the form of 100 percent juice and recommend drinking fortified orange juice for the vitamin D. Some brands of juice are even marketed to infants.

Government programs designed to provide healthy food for children, such as the Special Supplemental Nutrition Program for Women, Infants, and Children, offer juice for kids. Researchers have found that children in the program are more likely to exceed the recommended daily fruit juice limit than those who are similarly poor but not enrolled.

Despite all the marketing and government support, fruit juices contain limited nutrients and tons of sugar. In fact, one 12-ounce glass of orange juice contains 10 teaspoons of sugar, which is roughly what’s in a can of Coke.

Drinking fruit juice is not the same as eating whole fruit. While eating certain fruits like apples and grapes is associated with a reduced risk of diabetes, drinking fruit juice is associated with the opposite. Juices contain more concentrated sugar and calories. They also have less fiber, which makes you feel full. Because juice can be consumed quickly, it is more likely than whole fruit to contribute to excess carbohydrate intake. For example, research has found that adults who drank apple juice before a meal felt hungrier and ate more calories than those who started with an apple instead. Children who drink juice instead of eating fruit may similarly feel less full and may be more likely to snack throughout the day.

Juice may also be a “gateway beverage” — 1-year-olds who drank more juice also drank more sugary beverages, including more soda, in their school-age years. Children’s excessive consumption of juice has been linked to an increased risk of weight gain, shorter stature and cavities. Even in the absence of weight gain, sugar consumption worsens blood pressure and increases cholesterol.

It’s tempting to minimize the negative contributions of juice to our diets because it’s “natural” or because it contains “vitamins.” Studies that support this view exist, but many are biased and have been questioned.

There is no evidence that juice improves health. It should be treated like other sugary beverages, which are fine to have periodically if you want them, but not because you need them. Parents should instead serve water and focus on trying to increase children’s intake of whole fruit. Juice should no longer be served regularly in day care centers and schools. Public health efforts should challenge government guidelines that equate fruit juice with whole fruit, because these guidelines most likely fuel the false perception that drinking fruit juice is good for health.

It’s much easier to prevent obesity than it is to reverse it. We need to teach kids how to eat healthier when they’re young so that they develop good habits to carry on for the rest of their lives. In the past decade or so, we have succeeded in recognizing the harms of sugary beverages like soda. We can’t keep pretending that juice is different.