Tracy Roberson thought her 8-year-old daughter would grow out of it, that she would trim down with all her activities, like Girl Scouts, volleyball and track. But her weight kept climbing.
"I could never figure out what was the problem," said Roberson of St. Ann. When her daughter Brianna turned 16, the 5-foot-2-inch teen checked into a weight management program at 235 pounds.
Roberson said she was surprised to learn drinks she thought were healthy — sports drinks and 100 percent fruit juice — were the main culprits. "Especially apple juice," Roberson said. "Apple juice was one of her downfalls. She loves apple juice."
Fruit juice has a wholesome image. It's natural. It provides vitamins and minerals. It's increasingly offered in kids' restaurant meals and vending machines as a healthy option. The portable juice box is a brown-bag staple.
But with more than one-third of children and more than two-thirds of adults in the United States classified as overweight or obese, some health experts argue that even 100 percent fruit juice should have no place in our diets.
"I try to encourage all pediatricians and (medical school) residents to counsel parents to never introduce fruit juice to their children," said Dr. Nadim Kanafani, an endocrinologist at Cardinal Glennon Children's Medical Center who treats children in the hospital's weight loss program.
While soda and other sugary drinks have been vilified for growing waistlines, Kanafani and other health experts include fruit juice in the same category.
"Calorie for calorie, gram for gram, ounce for ounce, juice is actually worse than soda," said Dr. Robert Lustig, a pediatric endocrinologist at the University of California at San Francisco and one of the leading researchers on the causes of obesity.
The sucrose in fruit juice and the high fructose corn syrup added to sweeten drinks, like soda, are both broken down by the body exactly the same — into a one-to-one mixture of glucose and fructose, Lustig said. But juice has more of the sweet stuff per ounce. An 8 ounce glass of juice has about 120 calories, while the same size soda has 100.
Our bodies are not equipped to consume lots of fructose, Lustig said. Glucose, which is found in bread, pasta, rice and potatoes, can by metabolized by all the body's digestive organs. Fructose can only be metabolized by the liver. If you overwhelm the body with fructose, the liver can't convert it to energy fast enough. The liver converts it to fat.
"Liver fat makes you insulin resistant, and that is the primary phenomenon that causes all of the downstream metabolic diseases," such as type 2 diabetes, obesity and heart disease, Lustig said. Some early research even shows links to cancer and dementia. "The goal is to not over-fructosify your liver," he said, "but fruit juice does that."
Nature offers protection by including soluble and insoluble fiber in fruit. Both types reduce the absorption rate of fructose, so the liver isn't bombarded by the caloric onslaught.
A glass of juice, on the other hand, contains the amount of fructose from several pieces of fruit and no fiber. "God made fructose with fiber on purpose," Lustig said, "and we have undone it." Even in blended fruit smoothies, the insoluble fiber gets destroyed, he said.
'PERFECT STORM' FOR OVERUSE
But the idea that a glass of orange juice is just as bad as a can of Coke is hard for many to swallow.
For decades, pediatricians have recommended 100 percent fruit juice as a source of vitamin C and water for healthy infants and children. Federal dietary guidelines allow a 6 ounce glass to count as a serving of fruit. The federal Special Supplemental Nutrition Program for Women, Infants and Children known as WIC — which provides food assistance to over half of all U.S. infants and a quarter of children ages 1 to 5 — provided high amounts of fruit juice up until just two years ago.
Kanafani said these policies have created a "perfect storm" for overuse. The latest government report shows children and young adults consume more than half of their fruit intake as juice, and they lack fiber and other disease-fighting phytochemicals abundant in whole fruit.
With the abundance of sugar in the American diet (our consumption of fructose has gone from less than half a pound per year in 1970 to 56 pounds per year in 2003), the health benefits in juice aren't worth the calories, Lustig said. "True, juice has vitamin C, But, you know what? Take a pill, we don't need that much vitamin C," Lustig said.
Noting children's increasing consumption of juice and problems such as diarrhea, abdominal pain and early tooth decay, the American Academy of Pediatrics in 2001 recommended that fruit juice should be limited to 4 to 6 ounces a day for children 1 to 6 years old, and no more than 12 ounces for older children and teens.
"Because juice is viewed as nutritious, limits on consumption are not usually set by parents," the report stated. "Like soda, it can contribute to energy imbalance."
CHILDREN ARE CULPRITS
More children than ever are drinking fruit juice, and each young consumer is drinking more, studies show. The average daily consumption went from 11.2 ounces between 1988 and 1994, to 12.4 ounces between 1999 and 2004, according to a study led by Dr. Claire Wang, assistant professor of health policy and management at Columbia University. The largest increased occurred among black children ages 2 to 5 who drink fruit juice — consumption went from 9.5 to 11.9 ounces a day — twice the recommended amount.
Wang said the problem with calories in beverages is that they don't satisfy hunger. They are considered "extra" because we don't make up for them by exercise or eating less.
"If we increase the french fries, we cut back on say, the apple pie," Wang said. "But we don't feel that way with beverages." Just one glass a day equates to about 15 pounds of weight gain a year.
Roberson, whose daughter is in the weight management program, said after stocking up at the grocery, Brianna would drink a 64 ounce container of apple juice in two days. "She was addicted, in a way, to the sweet taste," Roberson said.
Kanafani said while juice is not addictive like a drug, drinking it produces the same affect. "The brain's rewards system goes haywire. You love it, and it's awesome," which causes you to crave it, he said. "Fruit juice is a substance that can change the brain's biochemistry."
U.S. CHANGES RECOMMENDATIONS
The government has taken notice and has limited the amount of juice provided by federal school lunch programs and drastically reduced the amount provided by WIC.
Up until two years ago, WIC provided 96 ounces a month for infants 4 months to 1 year, and 288 ounces (about 9 ounces a day) for preschoolers. Now, juice is not included for infants; and only 128 ounces (about 4 ounces a day) is provided for young children.
Instead, the assistance program provides jarred fruits and vegetables for babies and $6 monthly vouchers for fresh fruits and vegetables for young children.
The changes were based on recommendations by experts at the Institute of Medicine, which at one point considered eliminating juice from the program to allow for more fresh fruit and contain costs. But many considered the reductions drastic enough.
"It's a start, because they don't really eat fruits and vegetables. If they do, it's really sporadic," said Kristin Gore, who manages the WIC program for Grace Hill Health Centers in St. Louis.
Gore said many families she sees are drinking too much juice as well as soda and fruit punch. "Whatever they are drinking, they don't realize the calories are adding up," she said.
Stephanie Bess, WIC nutrition services coordinator for the state of Illinois, says the program's education component is key. Educators instruct participants to only drink fruit juice with meals and drink water when thirsty. While money spent on juice could go toward buying produce, Bess said, "WIC not providing juice any more is not going to solve the obesity problem."
While some studies have linked fruit juice to increased weight gain, other studies have not. Kanafani says it's time, however, to consider the effects of government policies and marketing.
A national poll taken in September by the University of Michigan shows children in low-income families drink too much juice. In households earning less than $30,000, 49 percent of children drink 16 ounces of juice or more a day, the results show. As incomes rise, the percentage drops. More parents in the lowest-income group also reported their children's doctor recommends juice.
"A little bit of fruit juice is OK," Kanafani said, "but when you have an epidemic of obesity, we have to start answering these questions."
Juice can no longer be found in Roberson's refrigerator. Her daughter packs two water bottles for school and drinks skim milk with dinner. Roberson said she won't even give juice to her 1-year-old granddaughter she often cares for, "because that's all they'll want."