2) Avoiding added sugars is smart — but may be tricky with school-aged kids
The new guidelines recommend kids consume no added sugars until age 10, whereas the prior guidelines suggested kids not eat anything with added sugar until age 2.
There’s plenty of evidence that consuming added sugars can be harmful, especially for children, and especially while forming their dietary preferences, Patel said, adding that she appreciates the recommendation.
“Much of my research has focused on getting kids to drink water instead of sugar-sweetened beverages, which are a major source of added sugars in children’s diets,” Patel said. “We’ve done educational campaigns in several California school districts to encourage students to drink water, while also working with schools to make sure campuses have appealing water bottle filling stations.”
But Patel thinks there will be challenges with implementing the recommendation to completely avoid added sugars for kids up to age 10. How, she asks, will it be put it into action and how will experts provide supportive environments for families so they can follow this advice?
One big concern is that older kids enter the school environment, so there will need to be efforts to change that system’s food supply. The food industry has a whole host of products that they sell to schools, and they are good at reformulating products, she said. “For instance, if new regulations say there is to be no added sugar in yogurt, they might add fruit syrup concentrate instead, which is a different name for what is basically added sugar,” Patel said. “Or they may add non-nutritive sweeteners — also not recommended for children.”
The new dietary guidelines don’t offer guidance on concerns like these, she said, whereas the prior version of the guidelines had much more information about policy and implementation.
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3) ‘More protein’ advice could have unintended consequences
The new dietary guidelines emphasize eating more protein, particularly from meat and other animal products. But Americans generally have sufficient protein intake — and that’s true for most children, too.
“We’re seeing that adolescents may now think they need to increase their protein intake, which is not necessarily true, and that they may add protein in less-healthy ways,” Patel said. “Some teens are consuming protein supplements, including products that are not FDA-approved, or are eating processed foods with added protein.” If someone eats more protein than they need to maintain healthy body structures and grow, it either gets burned for energy or converted into fat.
The emphasis in the new guidelines on protein from animal sources is also concerning, Patel said. Meat and other animal products are higher in saturated fat and are less sustainable for the planet than high-protein plant foods, such as beans. Many people do not eat animal protein due to personal preferences or cultural or religious traditions. Animal products are also more expensive. It worries Patel that individuals living in poverty may have less access to recommended foods under the new guidelines.
“In addition, while kids typically get plenty of protein, many children don’t consume enough fiber,” she said. “This can contribute to constipation, a very common childhood problem. Plant foods — including many that are high in protein — provide fiber that kids need in their diets, while high-protein animal foods do not.”
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4) Advice on full-fat dairy conflicts with messages about saturated fat
The new guidelines say to consume no more than 10% of daily calories from saturated fat — which has been the recommended limit on saturated fat for decades. Eating too much saturated fat, which comes mostly from animal products, has long been linked to higher levels of LDL, the “bad” cholesterol, as well as higher risk for heart disease.
However, the guidelines also encourage people to consume more full-fat dairy products, such as whole milk and full-fat yogurt. It would be difficult to do that and not exceed the saturated fat limit, Patel said.
“I co-chaired an expert panel that worked with four leading national health and nutrition organizations to develop healthy beverage guidelines for school-aged children,” she said. “The panel decided that even though the evidence suggests possible benefits to consuming whole-fat dairy, including lower obesity rates, there weren’t enough rigorous studies to change the recommendation away from low-fat products.”
Patel’s team, along with Lorrene Ritchie, PhD, of the University of California Nutrition Policy Institute, is currently conducting an NIH-funded study looking at the impact of whole milk versus lower fat milk in toddlers. Families who participate are being randomized to consume one of the two types of milk. The scientists are tracking kids’ growth, development, microbiome and cardiovascular outcomes.
“We think it’s really important to do this research because prior studies associating whole fat milk consumption with lower obesity risk haven’t been randomized controlled trials that are able to definitively show that whole milk is actually responsible for lowering obesity,” Patel said.
“We need more rigorous research in this space. I don’t think the evidence is strong enough to support this shift in dietary guidelines yet.”
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5) Pediatricians and dietitians can help with individualized advice
The guidelines are brief and they hit some key points — they support breastfeeding for infants, for instance — but there are many situations they don’t cover, Patel said. Even for a simple question, such as when to switch from whole milk to low-fat milk, which has typically been recommended when a child turns 2, many families need individualized advice.
“Right now, I look at each patient and determine ‘Does this make sense for them personally, based on family history and their current growth trajectory?’” she said. “And that’s not a simple issue. Kids’ food needs and preferences change a lot as they grow. They often go through a picky phase as preschoolers. They need more nutrition when they hit their growth spurt during puberty. They might take up a new sport and suddenly their calorie needs go way up.”
In addition, she points out, lots of children and teens face more complex nutritional challenges because of a chronic condition such as diabetes, a food allergy or an eating disorder. And many families experience food insecurity and need help from their healthcare team in getting connected to programs that can help them make sure they have enough food for their kids.
“So, one size doesn’t fit all in terms of the dietary guidelines, especially not for kids,” Patel said. “I recommend that families ask their pediatrician for help or consult with a registered dietitian. We have lots of experts who can work with parents and children one-on-one and help them make dietary choices that will work well for them.”
