In my second post on good things individual parents can do in the absence of pro-kid policy reforms, I want to focus on child nutrition. In particular I’ll discuss an extraordinary recent study measuring the long-term impacts of giving kids more sugar.
I’m not gonna lie – I found the article stressful to read. Fun, useful, fascinating – but stressful. It made me reflect on my own history with sugar, the origins of my own identity, and bigger issues of what it means for parents to share what they love in life with their kids. It got me thinking about trade-offs between pleasure and health and life and death.
Before I dive into the details of what the study found and what it means for parents, I want to share a little about my own relationship with sugar.
I LOVE sugar.
I especially love ice cream. I love fancy ice cream and regular ice cream. I love Salt & Straw and Haagen Dazs. I love Tillamook, Breyers, Blue Bell. I love the ice cream sandwiches they sell at gas stations. In a perfect world, I would drink an extra-thick malted vanilla or chocolate shake for breakfast and eat 3-4 scoops of ice cream every night, with maybe a couple scoops of coffee ice cream after lunch on the pretense of waking myself up.
I have a close friend who also loves ice cream. He’s from Texas and he once got me Blue Bell’s 4-pack of half-gallons for my birthday and we found ourselves with a lot of ice cream. So we did an experiment where we sat down together and ate as much ice cream as we wanted. We weren’t competing or trying to make ourselves sick. We were just curious. My friend ate 7 or 8 scoops. I ate 9. I didn’t feel gross. I felt satisfied.
For me ice cream is delicious, and also an emotional safe harbor. In my 20s, I spent a lot of nights by myself, wishing I had a partner or a party to go to or a “crew” that wanted me to swing by last minute and live the kind of fantasy friend life they show on TV beer commercials. On many of those nights I would eat a whole pint of ice cream and watch The Daily Show and dive down research rabbit holes, and I’d feel less alone. In a weird way, knowing it was a little bad for me was part of the fun — I was free, I had a lot of options, life could never get that crummy.
I once read a moving article by Atul Gawande about the importance of telling loved ones exactly how far you’d want the medical system to go with elaborate end-of-life care. One woman told Gawande about having “the conversation” with her dad:
She told him, “ ‘I need to understand how much you’re willing to go through to have a shot at being alive and what level of being alive is tolerable to you.’ We had this quite agonizing conversation where he said—and this totally shocked me—‘Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that.’
When I read that I thought, “I love you!”
I also love cookies, and cake, and pie, and gooey baked goods with cinnamon, and nutty chocolate things. And sugar cereal. Growing up, a favorite birthday treat every year was to go to the supermarket and pick out one box of the junkiest, most sugary cereal I could get my grubby little birthday hands on. Apple Jacks, Fruit Loops, Cinnamon Toast Crunch … all these cereals have a kind of aura around them in my imagination, like Christmas trees and Chanukah candles. I also have the fondest memories of dropping by See’s Candies with my mom to get free samples of random chocolate truffles, along with a few hard butterscotch lollipops and chocolate-covered raisins and maybe some Scotch Kisses and Milk Molasses Chips.
I find it easier to form close friendships with people who have trouble managing their sweet tooth. It’s not a simple thing about feeling better about my own problem. At least I don’t think it is. It’s more a way to feel reassured that someone has remained in touch with basic human pleasures untethered to success or health or any other more rarefied aspiration, and in a way I can access and relate to. I don’t have the constitution for heavy drinking or drugs or cigarettes. I’m not masochistic or decisive enough to get big tattoos, or brave enough to do extreme sports. For me, sugar is the vice that binds.
Now, let me tell you about this amazing article measuring the impacts of sugar on children’s long-term health and well-being.
Sugar Bomb
During World War 2, England worried about many things, including running out of food. So it put its entire population on a diet.
It turned out the diet didn’t change people’s nutritional intake all that much, with one exception: sugar. Sugar was heavily rationed and people ate a lot less of it than they had before the war.
Writer Anne Addison recalled this time in the UK:
Sweets were devised from a mixture of dried milk and peppermint essence with a little sugar or icing sugar if available. Grated carrots replaced fruit in a Christmas or birthday cake… Dried egg powder was used as a raising agent, and this same dried egg could be reconstituted and fried, yielding a dull, yellow, rubbery-like apology for the light and fluffy real thing – but there was nothing else, so we ate it.”
Then, in 1953, England removed all wartime limitations on sweets. Right away sugar consumption shot back up to prewar levels. As a result some cohorts of kids born in the years after 1953 grew up randomly eating a LOT more sugar than cohorts of kids born in the years before 1953.
Researchers knew about this. The big new contribution (still under peer review), by economists Paul Gertler and Tadeja Gračner, is to link these cohorts to longer-term data on their adult nutrition, health, and economic success.
The paper interprets the sudden end of wartime rationing as a natural experiment to measure the causal impacts of sugar-rich diets early in life. This by itself caught my attention because there is very little good causal evidence on the impacts of different diets. Large, extended, randomized controlled trials are almost impossible because, as Richard Kahn puts it, “people do not want to participate. They don’t want to alter their diet patterns for a long time and they don’t comply with the regimen of the instructions in the randomized trial.” So this paper nudges nutrition science in a good direction and I’m sure researchers will discover many more such episodes altering other aspects of childhood diet if they really start to look at history with this forensic mindset.
How did rationing change kids sugar intake? After rationing ended, kids age 6-12 upped their daily sugar consumption from 16 to 32+ grams (the authors vaguely state that it “more than doubled”). That’s an additional 7+ Hershey Kisses per day. Keep in mind that even these higher rates of sugar consumption barely approach the 70 grams of sugar per day consumed by US children in the same age group on average today.
Growing up with a lot more sugar increased these kids’ future sugar consumption in adulthood by about 20% or 5 Hershey Kisses per day. These adults didn’t eat more total calories. Instead, they replaced fruit with sweets. They ate strawberry ice cream instead of strawberries. And all that sugar had consequences. The kids wound up 20-50% more likely to experience chronic inflammation, high cholesterol, diabetes, and arthritis – an additional one in every ten of these kids wound up with multiple chronic metabolic conditions. Either due to worse health or reduced ability to concentrate or some other channel, an additional one in every ten of the affected kids also didn’t complete any college, work in a skilled occupation, or surpass median wealth.
I do like ice cream, a lot. But I also like all the additional freedom associated with higher education and skilled work, a lot. And I like not experiencing awful health problems even more. Especially now that I’m over 40 and I’ve started to experience just how badly health problems can chip away at life’s many pleasures. One in ten is a huge impact. And today’s kids on average get three times the additional sugar at play in this study.
Hence the stress I felt reading this article. Both for myself, and for my kids. If sharing my love of sweets with my family instills the same kinds of craving I experience, and the result is a one in ten higher chance of severe health problems and a less lucrative and fulfilling career … I don’t know. Is it worth it?
What Individual Parents Can Do
The upshot of all this is that parents can improve their kids’ long-term health and success by moderating their sugar intake. And if sugar affects long-term outcomes as much as Gertler and Gračner’s study suggests, then other aspects of diet also probably matter a lot and are worth taking seriously as well. Related research bears out this intuition. Just improving school lunch quality during primary school (a tiny share of all childhood meals) raised Swedish kids’ future income by 3%.
Parents can try to think about sugar and diet a little more like they think about smoking. Kids absolutely cannot eat all the sweets and junk food they want, just as they cannot dabble in smoking. It’s hard to say no, but the stakes are (annoyingly) high.
At this point, it seems worth noting that the only way to really save an entire generation of kids from sugar overload has been, apparently, to threaten their parents with annihilation by Nazi warlords. But hey — we can totally DIY it, too! We just have to try really, really hard.
It’s 6:23pm. You’re fried after work. Your toddler is tired. She just finished her mac and cheese and maybe, if you’re lucky, a couple string beans. Now she wants a creamsicle.
You’re trying to break this creamsicle habit. It’s gotten out of hand. But saying “no” guarantees a meltdown. Is now the time to fight? No, not tonight. Another night. Weeks pass. Months. Years. An extra couple cookies after school, an extra slice of birthday cake at parties, an extra bag of M&Ms at the supermarket checkout lane.
But also – the ketchup on chicken nuggets, the blueberry yogurt, the Wheat Thins and honey pretzel sticks, the frosted mini-wheats, the apple juice … it’s hard to escape in normal life, even when you’re making decisions that food companies choreograph to feel wholesome.
A society with cheap sugar permeating all its mainstream food is kind of like a society with heavy air pollution. Sure, families can insist their kids wear gas masks. They can install air purifiers in every room of their house. They’ll be eccentric and beleaguered, but they can handle it on their own if they really want to.
But of course, they won’t. None of us will. The best option is to clean up the air we all breathe, so that healthy air is the easy, default choice for everyone. With food, this might mean making certain forms of sugar more expensive. It might mean packaging regulations that help parents avoid unhealthy food more easily. It should definitely mean making school meals healthy (rather than, say, unhealthy) from very early in childhood, ideally as a part of a much more subsidized and high-quality child care ecosystem, so that a healthier diet becomes the easier, cheaper, default option and more people grow up free of the fiendish cravings that sugarheads like me spend our time indulging and resisting.
But until all that happens it’s up to parents to simulate the dietary constraints of World War 2.
We can try to teach our kids to expect sweets only occasionally, in moderation, as a treat. We can try to stand up to kids’ demands and reset their expectations around a rule that makes sense, say 1-2 treats per week. As best we can, we can steer kids away from foods with high added sugar and toward whole fruits, vegetables, grains, and proteins. We can buy Triscuits, not Wheat Thins (our kid hates Triscuits). Apples and nuts, not apple pie (our kid LOVES pie). And yes, as much as it pains me to say it – strawberries, not strawberry ice cream (our kid LOOOOVES strawberry ice cream).
Impeccable research, nice work!
Lots of foods were rationed in Britain during WW2, not just sugar. Obviously, too much sugar is bad for you. But the positive effects of rationing could have resulted from forced reductions of other foods.
When World War II began in September 1939, petrol was the first commodity to be controlled. On 8 January 1940, bacon, butter, and sugar were rationed. Meat, tea, jam, biscuits, breakfast cereals, cheese, eggs, lard, milk, canned and dried fruit were rationed subsequently, though not all at once. In June 1942, the Combined Food Board was set up by the United Kingdom and the United States to coordinate the world supply of food to the Allies, with special attention to flows from the U.S. and Canada to Britain. Almost all foods apart from vegetables and bread were rationed by August 1942.
https://en.wikipedia.org/wiki/Rationing_in_the_United_Kingdom