Parents encounter a dizzying array of choices when they shop for fruit drinks in the supermarket aisle. Many packages sport bright images of fresh fruit and tout a day’s worth of vitamin C in a serving.
But look closer. Many popular drinks, especially those geared toward children, can harbor up to six teaspoons of sugar per serving — about half the amount a child should consume in a whole day — said Aviva Musicus, a postdoctoral nutrition research fellow at Harvard’s T.H. Chan School of Public Health.
Musicus lead a recent study of parents’ beverage choices for their young children and found that many were swayed by pictures of fruit on the front label or claims of 100 percent of a daily dose of vitamin C.
“Our research has shown that parents buy these drinks because of the packaging,” Musicus said.
Her team found that explicit sugar warnings — illustrations on the front label showing several teaspoons of sugar contained in the juice drink — reduced parents’ purchases of high–added sugar beverages for their young children.
But they also found parents apparently weren’t swayed by labels that disclosed the drink contained relatively small amounts of actual juice.
“I don’t think that people make the leap,” she said. “Knowing that a product has a low percentage of juice doesn’t really tell you how much sugar is in it.”
Other researchers have also found that the nation’s food packaging rules, particularly for juice drinks, do little to help consumers make healthier choices.
“It’s really difficult for even a very educated consumer to be able to tell the differences [from front package labels] between juices and juice drinks and flavored drinks,” said Jennifer Pomeranz, an assistant professor in public health policy and management at New York University, who was not involved in the recent research.
Musicus’ study noted that most young children in the United States consume sugar-sweetened beverages, predisposing them to tooth decay, obesity, type 2 diabetes, and other chronic diseases. The most frequently consumed sugar-sweetened beverage among children 8 years old and younger, it said, are fruit-flavored drinks that are less than 100 percent fruit and account for 11 percent of added sugars consumed by children ages 2 to 8.
The Centers for Disease Control and Prevention recommends that individuals 2 years and older limit intake of added sugars to less than 10 percent of their total daily calories. For example, in a 2,000 calorie diet, no more than 200 calories should come from added sugars, or about 12 teaspoons. Children younger than 2 shouldn’t consume any added sugar.
But many youngsters greatly exceed that. The CDC found the average daily intake of added sugars was 17 teaspoons for children and young adults 2 to 19.
The American Beverage Association, which represents several companies that manufacture fruit drinks, said in a statement it has taken steps to help consumers reduce their sugar consumption.
“America’s leading beverage companies are offering more than 400 different beverages with low or zero sugar, including reduced-calorie juice drinks, and we are voluntarily placing easy to see calorie count labels on the front of every bottle we sell so families know exactly how many calories are in their drink before they buy it,” it said in a statement.
“As a result,” it concluded, “nearly 60% of all beverages sold today are zero sugar.”
The statement did not say whether the industry would consider adding explicit sugar content information to the front package labeling of fruit drinks.
Musicus’ study recruited about 5,000 parents of children 5 years old and younger for an online survey that explored their choices and knowledge about fruit drinks.
In one task, participants viewed 12 commonly purchased multipacks of real beverages in a random order and were instructed to “click on the drink you would like to purchase for your oldest child aged 0-5.” In another task, parents were shown commonly purchased drinks and asked to describe how much juice and sugar each product contained.
The researchers found that when they removed images of fruit on the products’ front labels, as well as the claims of 100 percent vitamin C, roughly 18 percent fewer parents selected the high–added sugar beverages.
But for busy parents who may not have the time to scrutinize labels, and are just trying to keep their finicky children hydrated, Pomeranz, the NYU professor, suggests parents buy beverages that say 100 percent juice on the label, which are unlikely to have added sweeteners, and water them down.
“The best thing is, give your kid flavored seltzer,” she said. “Why even start them on sugary beverages?”
Pomeranz has analyzed government rules for food packaging and has found requirements for drinks typically consumed by children lacking transparency.
For instance, products that are 100 percent juice, if nonjuice ingredients are added such as sweeteners or vitamins, it must include a disclosure identifying the added product near the 100 percent juice statement on the front label. Yet these products rarely add sugar.
Conversely, for drinks that contain less than 100 percent juice or no juice, such a statement is not required.
“Such transparency exists for regular and diet soda, but not for similarly unhealthy drinks directly marketed for children,” she concluded in a 2020 study.
Sean Cash, Bergstrom Foundation professor in global nutrition at Tufts University, said some other countries require much more clear information on the front labels of food products.
US rules require manufacturers to detail the nutritional content of food products, but that information is usually found on the back or side labels, and it’s often in tiny print.
Cash has been studying the system in Chili, which requires prominent stop sign-shaped icons on front labels across many food products that warn of high sugar, saturated fat, and calories. That means the government decides the cut-off points for what constitutes levels that are too high.
“To do this, you are giving that control to government agencies, and there is an element of paternalism in that,” Cash said.
“In countries that value individual freedom, like the US, that could be a problem,” he said. “It could undermine trust, or some people’s trust.”
Another approach to such labeling, he said, is the way US regulators handled the disclosure of trans fats, which raise the level of “bad” cholesterol in a person’s blood. Instead of limiting the ingredient, regulators in 2006 started requiring nutrition labels to disclose the number of grams of trans fat, per serving.
But if a serving contains less than 0.5 gram of trans fats, it can be declared as zero.
That disclosure requirement prompted manufacturers to reformulate products so they included lower levels of trans fats, Cash said.
“There are products out there now that are healthier than they used to be.” he said.
“Even these geeky, dry product disclosures,” he said, “can make a difference.”