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Childhood obesity: Do Merced schools provide too much fruit juice, chocolate milk?

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Childhood obesity: Do Merced schools provide too much fruit juice, chocolate milk?

Picture of Vikaas Shanker

This story was produced as part of a larger project led by Vikaas Shanker, a participant in the USC Center for Health Journalism's 2018 Data Fellowship.

Other stories in this series include:

One of the worst in state. Merced County’s childhood obesity crisis

Childhood obesity: Here’s what’s being done in Merced County

A student eats an orange during lunch at Don Stowell Elementary School in Merced, Calif., on Tuesday, May 14, 2019.
A student eats an orange during lunch at Don Stowell Elementary School in Merced, Calif., on Tuesday, May 14, 2019.
ANDREW KUHN
Merced Sun-Star
Friday, May 31, 2019

The Gutierrez brothers all have concerns about their body image.

Mario, 10, and his brother, 11-year-old Manuel, go to Gracey Elementary School in South Merced and often feel the effects of being overweight.

“I know I eat too much at school and at the house,” Mario said. “When I run the mile (in school) I get tired fast. I sometimes see friends who are skinny, and I sometimes feel sad and overweight.”

Manuel said he felt the same and he wasn’t happy with the way he looked.

Jesus, a 14-year-old student at Tenaya Middle School, was in his younger brothers’ shoes a couple years ago until a doctor told him and his mother about the higher risks he had of getting Type 2 Diabetes due to his weight.

The three brothers’ names have been changed to protect their identity.

“I started running more and I just started eating the food cooked at home,” Jesus said, adding that he skipped free meals at school in favor of breakfast and dinner at home because he thought many school meals were greasy, filled with too much sugar and generally unhealthy enough to work against his goals to lose body fat.

“It’s like everyone drinks the chocolate milk and juice,” Mario said, adding that he wished the schools in the Merced City School District served water instead. “They’re so sweet, it just doesn’t seem healthy.”

Mario is right, according to the latest research and experts on obesity and the effects of sugar in kids’ diets.

In addition to naturally occurring sugars found in milk, a breakfast or lunch serving of chocolate milk has about 7 grams of added sugars. And while one serving of 100 percent fruit juice during a school breakfast contains a little over 14 grams of sugar derived from natural fruit, experts, including leading childhood obesity researcher Dr. Robert Lustig of UCSF, say those sugars are as bad, if not worse, than the sugar in soda.

Chocolate milk and fruit juice accounts for about half of sugar consumed by district students, according to a Sun-Star analysis of breakfast and lunch nutritional data.

And with students consuming an average of 68 grams, or about 18 teaspoons, of total sugar per day just at Merced city school, experts say these sugary drinks could be contributing to the childhood obesity epidemic.

BREAKFAST, LUNCH AND SUGAR

According to the U.S. Census, one out of every three people under 18 years old in Merced County lives below the poverty line, the third highest rate in California behind Fresno and Tulare counties.

For lower income families like the Gutierrez’s who qualify for free and reduced price meals, or FRPM, through the Merced City School District, the school meals can be a blessing.

Through the U.S. Department of Agriculture, the Merced City School District is reimbursed for providing breakfast, lunch and snacks to students from low income families as an effort to curb child hunger. In areas with very high poverty rates like Merced County, a majority of schools offer the free meals to every student under what’s called the “Community Eligibility Provision.”

A Sun-Star data analysis found the Merced City School District complies with and even goes beyond federal requirements, which include serving fruits, vegetables and whole grains. But the total sugar and fiber content in the meals — key to how our bodies store fat — may be contributing to childhood obesity, based on the latest scientific research and recommendations on children’s diets.

Sugars, specifically fructose, are a major cause of Type 2 Diabetes and other life-altering metabolic conditions related to obesity, according to Robert Lustig, a pediatric endocrinologist whose video lecture “Sugar: The Bitter Truth” went viral in 2009.

Sugar, Lustig said, is a major culprit not just for obesity, but for Type 2 Diabetes, challenging longstanding notions that obesity is simply a matter of calories.

Some studies have also shown sugar has addictive properties, Lustig said.

The typical school lunch and breakfast in the Merced City School District each contains almost 34 grams of total sugar, according to the data analysis. That’s almost nine teaspoons of sugar for each meal.

While there aren’t recommendations from health organizations for how many total sugars kids should take per day, the American Heart Association and World Health Organization advise children shouldn’t eat more than six teaspoons of added sugar per day on a 2,000-calorie per day diet.

The Merced City School District doesn’t track or have data on how much added sugar is in each meal item. So it’s hard to say how much of the 18 teaspoons of total sugar per day is added sugars.

But taking out the natural sugars in milk and whole fruits, nuts, legumes and vegetables served by the school district reveals about 9.3 teaspoons of natural or added sugars in meal items such as pancakes with syrup, yogurt, pizza, salads and french toast sticks.

Chocolate milk served in schools contains about 12 grams of natural lactose and 7 grams of added sugar, according to the district’s nutritional information and the added sugar ratio of chocolate milk by the Dairy Council of California. But the chocolate milk contains no fiber.

And while the 100 percent fruit juice served by the district has the nutrients fruit provides, qualifying it as a serving of fruit under USDA guidelines, it also doesn’t have any added fiber. That becomes a problem when half the items served at breakfast, and almost one of every five items kids take at lunch, are either chocolate milk or fruit juice.

NOT ENOUGH FIBER

Any grain product school district serves is whole grain, nutrition officials said. But it’s not enough, according to the nutrition analysis.

Fiber, opposite of sugar, isn’t digested by the body but can protect against obesity and heart disease, Lustig said.

The average school lunch at a Merced elementary school contains seven grams of fiber. Breakfast gives almost 3 grams, making a total of about 10 grams per day.

“That’s actually pretty good” compared to other schools’ lunches, Lustig said. “But it’s not good enough.”

The American Heart Association and other health organizations recommend anywhere between a 10-1 to 5-1 ratio of carbohydrates to fiber.

The average student eating lunch and breakfast at school consumes a total of 142 grams of carbohydrates per day with those meals. That means they should be eating between 14 and 28 grams of fiber at school, according to health recommendations.

While USDA standards encourage whole grains, they don’t specify the way whole grains should be incorporated, Lustig notes.

For example, schools and food producers in California can use 51 percent whole grain flour to fill federal requirements after President Donald Trump’s administration’s rollback of grain standards in school meals.

While that does have more fiber than other flours, it provides minimal gains because the fiber is pulverized with the starches and sugars in the grains. That severely limits the ability of the fiber to slow down absorption of carbohydrates, Lustig said.

“It’s not really a whole grain because the grain isn’t whole,” he said, adding that the best whole grains items are dense and include the fibrous outer layer the grain’s original form has.

WHAT TO DO?

Making healthier meal options isn’t as easy as switching out meals, MCSD school administrators say. If they deviate too much from the standards set by the USDA, they could be at risk of losing millions of dollars in funding.

“We have little flexibility as far as basic nutrients go,” said Patty Morado, director of nutrition services. “We have to fit the meals into the minimum and maximum calorie ranges based on grade level.”

And then there’s the conundrum of whether students will actually eat the meals. Instead of overhauling the meals, the school district has tried to make popular foods healthier, and healthy foods popular.

Lunchroom pizza, for example, has a whole grain crust. The fried rice and eggroll meal contains whole grain brown rice.

Last year, the school district added “flavor stations” to the lunchrooms. The station contains various seasonings students can put on their meals.

“We’ve noticed our students are eating more vegetables since we introduced them,” said nutrition services Supervisor Mary Williams. “The kids especially love the Tajin.”

Soda isn’t seen anywhere on campus, a change many of the district’s schools made before an evolving discussion on childhood obesity and Michelle Obama’s sweeping Healthy Lunch Program put soda at the top of the list of causes.

The only time the sugar-filled aluminum can or plastic bottle could surface in the lunchroom would be if a parent sends the soda with the student’s lunchbox.

“We try to let the parents know that it’s not healthy, but we can’t force the parent,” said Morado.

Breakfast and lunch workers also try to make sure students are taking the right amounts of fruits, vegetables and grains, said Susan Tingey, nutrition manager at Reyes Elementary School.

“They all know the rules about fruits and vegetables,” said Tingey, who sits at the cashier spot punching in student IDs as they choose meal tray items. “We’ll ask them what’s missing. And they’ll look and realize it. ... It’s an educational process too.”

Due to the high poverty rates, school lunches may be the healthiest meal — or the only meal — some MCSD students get, researchers and school officials said. That’s why school administrators try to provide healthy meals within the standards set by the USDA.

The USDA’s dietary guidelines were revised in 2015, focusing on calories, carbohydrates and fat content.

“To get reimbursed by the USDA for the meals, we have to follow their meal pattern,” Morado said.

A healthy kid’s diet, according to the USDA, includes a plate filled half with vegetables and fruits, and the other half with grains and protein, favoring grains. At least half the grains should be whole grains, such as whole wheat, brown rice, and floured grains that include all parts of the grain.

USDA guidelines state federally funded breakfasts should contain two grains, a full cup serving of fruit or half fruit and half vegetables, a choice of two different varieties of milk and minimum and maximum calories, Morado said.

School lunch meals should contain a minimum of one grain, at least one ounce of a protein or meat substitutes like soy, cheese or nuts, a half cup serving of fruit, half cup serving of vegetables, option of two different kinds of milk and minimum and maximum calories.

Also, FRPM lunches should contain a total of nine grain servings and nine ounces of protein over a week, Morado said.

But if the school district is following federal health guidelines, why are there disparities between the food served and the nutritional recommendations from leading health organizations like the American Heart Association?

The USDA’s guidelines aren’t always aligned with the latest research and evidence about the causes of childhood obesity. One example is dietary fat.

“We now know (dietary) fat is not the problem,” Lustig said. “(The USDA) is still running on an old paradigm that fat is bad, despite the fact there has been a complete nutrition revolution to understand it’s the processed foods that are not good.”

The MCSD’s dietary fat per day is about seven grams per day for breakfast, and 16 grams per day for lunch. That’s about 22.5 percent of calories served.

Long considered the culprit of obesity, sparking a low-fat craze from the 1970s to the present day, dietary fat should be about 25 to 35 percent of calories consumed per meal for kids, according to the American Heart Association.

The USDA responded to requests for comment with a statement claiming its standards are consistent with their Dietary Guidelines for Americans and formed on recommendations of the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine.

The guidelines, according to the statement, are formed with the Dietary Guidelines Advisory Committee, a group of members who are appointed as “special government employees” and are subject to federal ethics laws and regulations, and an annual review of financial disclosures to reveal potential conflicts of interest.

“The 2015 Dietary Guidelines recommend that persons over two years of age consume fat-free or low-fat (1%) fluid milk,” the statement reads. “The current meal patterns and nutrition standards have average daily calorie, saturated fat, and sodium maximums and place a strong emphasis on fruits, vegetables, and whole grains — which leaves little room for discretionary calories such as calories from added sugars and solid fats.”

The statement also said meals complying with USDA standards are designed to keep children healthy and strong while allowing menu planners enough flexibility to serve foods kids will eat.

But skeptics of the USDA question the ability of an organization designed to serve the agriculture industry to also construct dietary guidelines.

“The USDA is in charge of selling food and feeding our kids nutritiously,” Lustig said. “They can’t do both.”

And while Lustig’s position on dietary fat as it relates to obesity is a popular but challenged one in the global dietary health conversation, the added sugar conversation is much more settled.

If the school district cut its chocolate milk and fruit juice consumption in half, it could reduce a student’s overall discretionary sugar intake by 10 grams, or 2.5 teaspoons, per day, according to the nutritional analysis.

But adjusting that is not the easiest thing to do, school officials said.

“If we were to eliminate the fruit juice completely, the concern is that students who do not like fresh fruit would stop getting any of that nutrition,” according to a statement by the school district. “Some may even stop participating in breakfast altogether since juice is a popular item that they look forward to having.

“We know that it’s extremely important for students to have some nutrition in their system to start the day so the concern about eliminating juice is that it could do more harm than good,” the statement reads. “However, it is something we can look into further.”

When it comes to fiber, school district meals offer more in the form of whole grains, vegetables, fruits and other high fiber options than those who bring lunch from home, according to the statement.

“Still, there is always room for improvement,” the statement reads. “And we will continue to keep an eye on fiber content when selecting meals in the future.”

[This story was originally published by Merced Sun-Star.]