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Survey Uses Parent Data To Draw Wide Conclusions About Sugar and Sweetener Labeling

April 22, 2021

Keith Ayoob, EdD, RDN, FAND

This study looks at parents’ ability to identify added sugar, low-and no-calorie sweeteners (LNCS), and juice in children’s beverages.

Parents were randomly assigned to view one of the following:

  1. The front of the package by itself, or
  2. The front and back/side of the package, (whichever included the nutrition facts panel (NFP) and the ingredients list, and the percentage of juice). 

The parents were offered a “Yes or No” response to indicate whether they thought the beverage contained added sugar or LNCS. They were also asked to use a sliding scale (0%-100%) in order to indicate their understanding of the beverage’s percentage of juice.

Parents were then asked to indicate whether products with names identifying the type of beverage (i.e. “juice drink” or “100% juice”, etc.) contained added sugar or LNCS. Finally, they were asked to indicate the percentage of juice the beverage contained. 

Among the findings:

  • The majority of parents, up to 90%, depending on the product, were competent in identifying beverages with added sugar.  When shown the ingredient list, their accuracy improved further. 
  • Fewer than half of the parents correctly determined that drinks did not contain added sugar, based on the beverages’ statements of identity (legal definitions).  This suggests that parents may be unfamiliar with the formal distinctions between the various beverages.

How informative is this study?  Perhaps less so than the authors had hoped, for several reasons.  First, the authors admitted the survey tool hadn’t been validated.  How should we interpret the results of a study that used an unvalidated tool?  Some in the scientific community might have difficulty taking these results seriously. 

Further, the authors’ conclusion that, “The present findings support the need for revised regulations that clearly and consistently convey drink ingredients, including added sugar, LNCS and type and percentage of juice,” is troubling.  It could also be argued that many physicians and healthcare professionals are similarly unfamiliar with legal beverage descriptions.  The authors’ conclusion stops short of suggesting that if consumers were simply more knowledgeable, then they would choose water that is unflavored, flavored water that is not sweetened with sugar or LNCS, or 100% juice, as opposed to beverages with added sugar or LNCS.  

The assumption that consumers would make different choices if more information were ‎available is baseless. Merely providing additional product ingredient information won’t necessarily alter behavior. This information may help inform choices, but it won’t necessarily change them. To suggest otherwise dismisses the consumer’s power of free choice.  Providing caloric information on menu boards at fast food restaurants, for example, doesn’t necessarily prompt consumers to order differently.  Their menu decisions, however, may be more informed.  

Moreover, in addition to 100% juice, beverages that include LNCS may be very useful options when reducing added sugars is a goal.  The 2019 policy statement of the American Academy of Pediatrics aligns, as it states: “Individuals affected by certain conditions (e.g., obesity and type 1 or 2 diabetes mellitus) may benefit from the use of LNCS if substituted for caloric sweeteners.” 

The authors also discount the possibility that the more consumers know about LNCS, the more they will realize they have no reason to fear them.  These ingredients are simply tools for reducing sugar intake.  As with all tools, they should be used wisely.  LNCS are not a “cure” for obesity, type 2 diabetes or any condition, nor should they be given the burden of being such.   

Finally, it’s doubtful that consumers are familiar with the mountain of research documenting the safety of LNCS across all populations, including children.  Although LNCS are not recommended for children under age two years, this is not due to issues of safety.  Rather, the goal in infants and toddlers is to provide a diet that doesn’t displace valuable nutrients in the often-modest volume of food and fluids this age group consumes.  Proper labeling should inform consumers about food and beverage products and their ingredients by providing accurate information that assist them in making choices that fit the needs of their children and themselves. 

Harris JL, Pomeranz JL. Misperceptions about added sugar, non-nutritive sweeteners and juice in popular children’s drinks: Experimental and cross-sectional study with U.S. parents of young children (1-5 years). Pediatr Obes. 2021 Apr 7:e12791. doi: 10.1111/ijpo.12791.

Keith Ayoob, EdD, RDN, FADN, is an Associate Clinical Professor Emeritus at the Albert Einstein College of Medicine. As a pediatric nutritionist and registered dietitian, Dr. Ayoob is also a past national spokesperson for the Academy of Nutrition and Dietetics. Dr. Ayoob is a consultant with the Calorie Control Council Advisory Board and the Global Stevia Institute (GSI), GSI is supported by PureCircle Ltd, a global leader in purified stevia leaf extract production.

faq2Do you have questions about low-calorie sweeteners? Want to learn more about maintaining a healthy lifestyle? You asked and we listened. Our resident Registered Dietitians answered the most popular questions about low-calorie sweeteners.