Organic Consumers Association

Pediatricians Say Ban Sodas in Schools

Commercial Alert, January 5, 2004
Today, the American Academy of Pediatrics (AAP) issued a statement in favor
of a ban on the sale of soda pop and sweetened drinks to schoolchildren, to
help stop the childhood obesity epidemic. "Pediatricians should work to
eliminate sweetened drinks in schools," the AAP statement says.

The AAP statement says that "advertising of sweetened soft drinks within the
classroom should be eliminated." Channel One, an in-school marketing
program, regularly advertises soda pop to its captive audience of 8 million
children in 12,000 schools across the country.

1) If your local schools sell or advertise soda or sweetened drinks to
children, send a copy of the American Academy of Pediatrics policy (below)
to the members of your local school board, and ask them to ban the sale and
advertising of soda and other sweetened drinks in your school district.

2) Please send the new AAP statement to your Members of Congress, and ask
them to introduce and support legislation to ban the sale or advertising of
soda and other sweetened drinks in schools.

Following is today's Associated Press article about the new AAP policy on
soft drinks in school.
Pediatrics Group: No Sodas in Schools
CHICAGO, Illinois (AP) --Soft drinks should be eliminated from schools to
help tackle the nation's obesity epidemic and pediatricians should work with
their local schools to ensure that children are offered healthful
alternatives, the American Academy of Pediatrics says.

In a new policy statement, the academy says doctors should contact
superintendents and school board members and "emphasize the notion that
every school in every district shares a responsibility for the nutritional
health of its students."

Some schools already limit contracts with vendors of soft drinks and fast
foods, though the soft drink industry has fought efforts by some states to
mandate such restrictions.

While some schools rely on funds from vending machines to pay for student
activities, the new policy says elementary and high schools should avoid
such contracts, and that those with existing contracts should impose
restrictions to avoid promoting overconsumption by kids.

The policy appears in the January issue of Pediatrics, being published

"The purpose of the statement is to give parents and superintendents and
school board members and teachers, too, an awareness of the fact that
they're playing a role in the current obesity crisis, and that they have
measures at their disposal" to address it, said Dr. Robert D. Murray, the
policy's lead author.

About 15 percent of U.S. youngsters aged 6 to 19 are seriously overweight.
That is nearly 9 million youths and triple the number in a similar
assessment from 1980.

Soft drinks are a common source of excess calories that can contribute to
weight gain, and soft drink consumers at all ages have a higher daily
calorie intake than nonconsumers, the academy's policy said. It cites data
showing that 56 percent to 85 percent of school-age children consume at
least one soft drink daily, most often sugared rather than diet sodas.

The National Soft Drink Association, which represents most soft drink makers
nationwide, said the new policy is misguided and goes too far.

"Soft drinks can be a part of a balanced lifestyle and are a nice treat,"
said Jim Finkelstein, the association's executive director.

<-----article ends here----->

Following is today's American Academy of Pediatrics statement.

Soft Drinks in Schools


Policy Statement

Organizational Principles to Guide and Define the Child Health Care System
and/or Improve the Health of All Children

Committee on School Health

ABSTRACT. This statement is intended to inform pediatricians and other
health care professionals, parents, superintendents, and school board
members about nutritional concerns regarding soft drink consumption in
schools. Potential health problems associated with high intake of sweetened
drinks are 1) overweight or obesity attributable to additional calories in
the diet; 2) displacement of milk consumption, resulting in calcium
deficiency with an attendant risk of osteoporosis and fractures; and 3)
dental caries and potential enamel erosion. Contracts with school districts
for exclusive soft drink rights encourage consumption directly and
indirectly. School officials and parents need to become well informed about
the health implications of vended drinks in school before making a decision
about student access to them. A clearly defined, district-wide policy that
restricts the sale of soft drinks will safeguard against health problems as
a result of overconsumption.


Overweight is now the most common medical condition of childhood, with the
prevalence having doubled over the past 20 years. Nearly 1 of every 3
children is at risk of overweight (defined as body mass index [BMI] between
the 85th and 95th percentiles for age and sex), and 1 of every 6 is
overweight (defined as BMI at or above the 95th percentile).1 Complications
of the obesity epidemic include high cholesterol, high blood pressure, type
2 diabetes mellitus, coronary plaque formation, and serious psychosocial
implications.2-6 Annually, obesity-related diseases in adults and children
account for more than 300 000 deaths and more than $100 billion per year in
treatment costs.7-9

Soft Drinks and Fruit Drinks

In the United States, children's daily food selections are excessively high
in discretionary, or added, fat and sugar.10-15 This category of fats and
sugars accounts for 40% of children's daily energy intake.10 Soft drink
consumers have a higher daily energy intake than nonconsumers at all ages.16
Sweetened drinks (fruitades, fruit drinks, soft drinks, etc) constitute the
primary source of added sugar in the daily diet of children.17 High-fructose
corn syrup, the principle nutrient in sweetened drinks, is not a problem
food when consumed in smaller amounts, but each 12-oz serving of a
carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of
sugar and 150 kcal. Soft drink consumption increased by 300% in 20 years,12
and serving sizes have increased from 6.5 oz in the 1950s to 12 oz in the
1960s and 20 oz by the late 1990s. Between 56% and 85% of children in school
consume at least 1 soft drink daily, with the highest amounts ingested by
adolescent males. Of this group, 20% consume 4 or more servings daily.16

Each 12-oz sugared soft drink consumed daily has been associated with a
0.18-point increase in a child's BMI and a 60% increase in risk of obesity,
associations not found with "diet" (sugar-free) soft drinks.18 Sugar-free
soft drinks constitute only 14% of the adolescent soft drink market.19
Sweetened drinks are associated with obesity, probably because
overconsumption is a particular problem when energy is ingested in liquid
form20 and because these drinks represent energy added to, not displacing,
other dietary intake.21-23 In addition to the caloric load, soft drinks pose
a risk of dental caries because of their high sugar content and enamel
erosion because of their acidity.24


Milk consumption decreases as soft drinks become a favorite choice for
children, a transition that occurs between the third and eighth grades.12,15
Milk is the principle source of calcium in the typical American diet.11
Dairy products contain substantial amounts of several nutrients, including
72% of calcium, 32% of phosphorus, 26% of riboflavin, 22% of vitamin B12,
19% of protein, and 15% of vitamin A in the US food supply.25 The percent
daily value for milk is considered either "good" or "excellent" for 9
essential nutrients depending on age and gender. Intake of protein and
micronutrients is decreased in diets low in dairy products.19,26 The
resulting diminished calcium intake jeopardizes the accrual of maximal peak
bone mass at a critical time in life, adolescence.27 Nearly 100% of the
calcium in the body resides in bone.27 Nearly 40% of peak bone mass is
accumulated during adolescence. Studies suggest that a 5% to 10% deficit in
peak bone mass may result in a 50% greater lifetime prevalence of hip
fracture,28 a problem certain to worsen if steps are not taken to improve
calcium intake among adolescents.29


Soft drinks and fruit drinks are sold in vending machines, in school stores,
at school sporting events, and at school fund drives. "Exclusive pouring
rights" contracts, in which the school agrees to promote one brand
exclusively in exchange for money, are being signed in an increasing number
of school districts across the country,30 often with bonus incentives tied
to sales.31 Although they are a new phenomenon, such contracts already have
provided schools with more than $200 million in unrestricted revenue.

Some superintendents, school board members, and principals claim that the
financial gain from soft drink contracts is an unquestioned "win" for
students, schools, communities, and taxpayers.31,32 Parents and school
authorities generally are uninformed about the potential risk to the health
of their children that may be associated with the unrestricted consumption
of soft drinks. The decision regarding which foods will be sold in schools
more often is made by school district business officers alone rather than
with input from local health care professionals.

Subsidized school lunch programs are associated with a high intake of
dietary protein, complex carbohydrates, dairy products, fruits, and
vegetables.16 The US Department of Agriculture, which oversees the National
School Lunch Program, is concerned that foods with high sugar content
(especially foods of minimal nutritional value, such as soft drinks) are
displacing nutrients within the school lunch program, and there is evidence
to support this.26

There are precedents for using optimal nutrition standards to create a model
district-wide school nutrition policy,33 but this is not yet a routine
practice in most states. The discussion engendered by the creation of such a
policy would be an important first step in establishing an ideal nutritional
environment for students.

1. Pediatricians should work to eliminatesweetened drinks in schools. This
entails educating school authorities,patients, and patients' parents about
the health ramifications of softdrink consumption. Offerings such as real
fruit and vegetable juices,water, and low-fat white or flavored milk provide
students at all gradelevels with healthful alternatives. Pediatricians
should emphasize thenotion that every school in every district shares a
responsibility forthe nutritional health of its student body.
2. Pediatricians should advocate for thecreation of a school nutrition
advisory council comprising parents,community and school officials, food
service representatives,physicians, school nurses, dietitians, dentists, and
other health careprofessionals. This group could be one component of a
school district'shealth advisory council. Pediatricians should ensure that
the healthand nutritional interests of students form the foundation
ofnutritional policies in schools.
3. School districts should invite publicdiscussion before making any
decision to create a vended food or drinkcontract.
4. If a school district already has asoft drink contract in place, it should
be tempered such that it doesnot promote overconsumption by students.
* Soft drinks should not be sold aspart of or in competition with the school
lunch program, as stated inregulations of the US Department of Agriculture.34
* Vending machines should not beplaced within the cafeteria space where lunch
is sold. Their locationin the school should be chosen by the school district,
not the vendingcompany.
* Vending machines with foods ofminimal nutritional value, including soft
drinks, should be turned offduring lunch hours and ideally during school
* Vended soft drinks andfruit-flavored drinks should be eliminated in all
elementary schools.
* Incentives based on the amount ofsoft drinks sold per student should not be
included as part ofexclusive contracts.
* Within the contract, the number ofmachines vending sweetened drinks should
be limited. Schools shouldinsist that the alternative beverages listed in
recommendation 1 beprovided in preference over sweetened drinks in school
* Schools should preferentially venddrinks that are sugar-free or low in sugar
to lessen the risk ofoverweight.
5. Consumption or advertising ofsweetened soft drinks within the classroom
should be eliminated.


Howard L. Taras, MD, Chairperson
Barbara L. Frankowski, MD, MPH
Jane W. McGrath, MD
Cynthia J. Mears, DO
*Robert D. Murray, MD
Thomas L. Young, MD
Janis Hootman, RN, PhD, National Association of School Nurses
Janet Long, MEd, American School Health Association
Jerald L. Newberry, MEd, National Education Association, Health Information
Mary Vernon-Smiley, MD, MPH, Centers for Disease Control and Prevention
Su Li, MPA
*Lead author
1. American Academy of Pediatrics,Committee on Nutrition. Prevention of
pediatric overweight and obesity. Pediatrics. 2003;112:424-430
2. Freedman DS, Dietz WH, Srinivasan SR,Berenson GS. The relation of
overweight to cardiovascular risk factorsamong children and adolescents: the
Bogalusa Heart Study. Pediatrics. 1999;103:1175-1182
3. Pinhas-Hamiel O, Dolan LM, Daniels SR,Standiford D, Khoury PR, Zeitler P.
Increased incidence ofnon-insulin-dependent diabetes mellitus among
adolescents. J Pediatr. 1996;128:608-615
4. Ludwig DS, Ebbeling CB. Type 2diabetes mellitus in children: primary care
and public healthconsiderations. JAMA. 2001;286:1427-1430
5. Dietz W. Health consequences ofobesity in youth: childhood predictors of
adult disease. Pediatrics. 1998;101:518-525
6. Davison KK, Birch LL. Weight status,parent reaction, and self-concept in
five-year-old girls. Pediatrics. 2001;107:46-53
7. Allison DB, Fontaine KR, Manson JE,Stevens J, VanItallie TB. Annual
deaths attributable to obesity in the UnitedStates. JAMA. 1999;282:1530-1538
8. Must A, Spadano J, Coakley EH, FieldAE, Colditz G, Dietz WH. The disease
burden associated with overweightand obesity. JAMA. 1999;282:1523-1529
9. Blumenthal D. Controlling health careexpenditures. N Engl J Med.
10. Muñoz KA, Krebs-Smith SM,Ballard-Barbash R, ClevelandLE. Food intakes of
US children and adolescents compared withrecommendations. Pediatrics.
11. Subar AF, Krebs-Smith SM, Cook A,Kahle LL. Dietary sources of nutrients
among US children, 1989-1991. Pediatrics. 1998;102:913-923
12. Calvadini C, Siega-Riz AM, Popkin BM.US adolescent food intake trends
from 1965 to 1996. ArchDis Child. 2000;83:18-24
13. Borrud LG, Enns CW, Mickle S. What weeat in America:USDA surveys food
consumption changes. Food Rev. 1996;19:14-19. Available at:
Accessed February 12, 2003
14. Borrud LG, Mickle S, Nowverl A,Tippett K. Eating Out in America: Impact
on FoodChoices and Nutrient Profiles. Beltsville, MD: Food Surveys Research
Group, US Department of Agriculture; 1998. Available at: Accessed February
12, 2003
15. Lytle LA, Seifert S, Greenstein J,McGovern P. How do children's eating
patterns and food choices changeover time? Results from a cohort study. Am J
HealthPromot. 2000;14:222-228
16. Gleason P, Suitor C. Children'sDiets in the Mid-1990s: Dietary Intake
and Its Relationship with SchoolMeal Participation. Alexandria, VA: US
Department of Agriculture, Food and Nutrition Service, Office of Analysis,
Nutrition and Evaluation; 2001. Available at: Accessed
February 12, 2003
17. Guthrie JF, Morton JF. Food sources ofadded sweeteners in the diets of
Americans. J Am DietAssoc. 2000;100:43-51
18. Ludwig DS, Peterson KE, Gortmaker SL.Relation between consumption of
sugar-sweetened drinks and childhoodobesity: a prospective observational
analysis. Lancet. 2001;357:505-508
19. Harnack L, Stang J, Story M. Softdrink consumption among US children and
adolescents: nutritionalconsequences. J Am Diet Assoc. 1999;99:436-441
20. Mattes RD. Dietary compensation byhumans for supplemental energy
provided as ethanol or carbohydrates influids. Physiol Behav.
21. Bellisle F, Rolland-Cachera M-F. Howsugar-containing drinks might
increase adiposity in children. Lancet. 2001;357:490-491
22. Tordoff MG, Alleva AM. Effect ofdrinking soda sweetened with aspartame
or high-fructose corn syrup onfood intake and body weight. Am J Clin Nutr.
23. De Castro JM, Orozco S. Moderatealcohol intake and spontaneous eating
patterns of humans: evidence ofunregulated supplementation. Am J Clin Nutr.
24. Heller K, Burt BA, Eklund SA. Sugaredsoda consumption and dental caries
in the UnitedStates. J Dent Res. 2001;80:1949-1953
25. Gerrior S, Bente L. NutrientContent of the US Food Supply, 1909-97. Home
Economics Research Report No. 54. Washington, DC: Center for Nutrition
Policy and Promotion, US Department of Agriculture; 2001. Available at: Accessed
February 12, 2003
26. Johnson RK, Panely C, Wang MQ. Theassociation between noon beverage
consumption and the diet quality ofschool-age children. J Child Nutr Manage.
27. American Academy of Pediatrics,Committee on Nutrition. Calcium
requirements of infants, children, andadolescents. Pediatrics.
28. Wyshak G. Teenaged girls, carbonatedbeverage consumption, and bone
fractures. Arch PediatrAdolesc Med. 2000;154:610-613
29. NIH Consensus Development Panel onOsteoporosis Prevention, Diagnosis,
and Therapy. Osteoporosis:prevention, diagnosis, and therapy. JAMA.
30. Henry T. Coca-cola rethinks schoolcontracts. Bottlers asked to fall in
line. USA Today. March 14, 2001:A01
31. Nestle M. Soft drink "pouring rights":marketing empty calories to
children. Public Health Rep. 2000;115:308-319
32. Zorn RL. The great cola wars: how onedistrict profits from the
competition for vending machines. Am Sch Board J. 1999;186:31-33
33. Stuhldreher WL, Koehler AN, HarrisonMK, Deel H. The West Virginia
Standards for School Nutrition. J Child Nutr Manage. 1998;22:79-86
34. National School Lunch ProgramRegulations. 7 CFR §210.11 (2002).
Competitive food services
<-----AAP policy statement ends here ----->
For more information about the marketing of soda pop and junk food to
schoolchildren, see Commercial Alert¹s web pages on:
* Junk food in schools:
* Coke and Pepsi:
* Channel One:
* Childhood obesity:

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keep the commercial culture within its proper sphere, and to prevent it from
exploiting children and subverting the higher values of family, community,
environmental integrity and democracy.

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Congressional Accountability Project |
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