In middle class India, sugar accounts for approximately 13 percent of the daily calorie intake of children aged 4-10, and 15 percent for children aged 11-18. This far exceeds the World Health Organisation’s recommended cap of 5 percent – Kiran Balimane & Cynthia John. 

Prime minister Narendra Modi and the BJP/NDA government at the Centre have set ambitious goals of a Viksit (developed, middle class) Bharat and a $30 trillion economy (cf. $4 trillion currently) for 2047 when India will celebrate its first centenary of freedom from almost two centuries of debilitating British rule over the sub-continent. However, the reality that high-quality education and good health of the world’s largest child and youth population (estimated at 600 million) is an essential precondition of achieving these goals is not being given sufficient attention. 

Several authoritative studies of the Unicef, UNDP and WHO report that 19 percent of the country’s 130 million children under age five are severely malnourished with 35.5 percent of them in danger of stunting and brain damage because of poor nutrition. Simultaneously, learning outcomes in the country’s 1.1 million government schools are rock-bottom. According to the Annual Status of Education Report (ASER) 2024 published by the highly respected Pratham Education Foundation, over 50 percent of class V children can’t read class II texts and 70 percent can’t do simple subtraction and division sums.

Confronted with alarming reports about the deteriorating learning outcomes of children and poor health, the Central and state governments are responding with several overdue initiatives. The National Education Policy (NEP) 2020 which accords high importance to Foundational Literacy and Numeracy (FLN), i.e, early childhood and primary education, is being rolled out urgently. Simultaneously, the mid-day meal scheme (MMS) — the world’s largest compulsory children’s lunch programme — provides cooked lunch to 150 million children in 1.10 million government schools countrywide. Coterminously to ensure that children are provided with minimal nutrition at home, 40 million EWS (economically weaker section) households receive free/subsidized rations through the PDS (public distribution system) network.

Paradoxically even as children in bottom-of-pyramid EWS households are confronted with the challenge of inadequate nutrition, India’s sizeable (430 million) and fast-expanding middle class is confronted with the challenge of rising child obesity. In middle class India, sugar accounts for approximately 13 percent of the daily calorie intake of children aged 4-10, and 15 percent for children aged 11-18. This far exceeds the World Health Organisation’s recommended cap of 5 percent. The latest Dietary Guidelines for Indians (2024) of ICMR-NIN prohibits added sugar for children under two, and less than 5 percent sugar intake for all other age groups. A recent (2023) study of the Department of Community Medicine and School of Public Health at PGIMER, Chandigarh, indicates that 15.35 percent of Indian schoolchildren are in a pre-diabetic condition, and nearly 1 percent already have diabetes.

This alarming condition of middle class children has prompted the Central Board of Secondary Education (CBSE) — India’s largest national school examination board with 30,700 high-ranked affiliated primary-secondary schools — to issue a directive to all affiliated schools to establish ‘sugar boards’ to reduce children’s sugar consumption nationwide. In a circular dated May 16, CBSE directs affiliated schools to educate children about the sugar content in junk foods and beverages, health risks associated with high sugar consumption and recommend healthy dietary alternatives.

“Establish ‘sugar boards’ where information is displayed for educating the students about the risks of excessive sugar intake. These boards should provide essential information, including the recommended daily intake, sugar content in commonly consumed foods (unhealthy meals such as junk food, cold drinks, etc), health risks associated with high sugar consumption, and health dietary alternatives. This will educate students about informed choices and promote long-term health benefits among students. Affiliated schools have been asked to organise seminars and workshops in this regard and by July 15 submit a brief report along with photographs of these activities on https://shorturl.at/E3kKc,” says the circular.

Likewise, the Council for Indian School Certificate Examinations (CISCE) — India’s second largest national exam board with 3,100 affiliated schools — has also directed school managements to monitor children’s sugar consumption. In a circular dated June 10, CISCE cautions them about the rise of Type 2 diabetes among children and urges them to create awareness among parents.

Proliferation of sugar snacks, beverages and processed foods, often easily available in school and contiguous environments, contributes significantly to excessive sugar intake. NCPCR (National Commission for Protection of Child Rights) in recent consultative meetings with various stakeholders in K-12 education, has supported the CBSE/CISCE initiative.

“The circulars of these two pan-India school boards that set standards in K-12 education for state boards to follow, are most welcome. Most children consume sugar way more than the 5 percent cap — almost 15 percent of their daily calorie intake. That’s because sugar is chidden in most children’s foods such as packaged breakfast cereals, flavoured milk, snacks and desserts. The result is that children as young as six or seven are being diagnosed with diabetes and showing early signs of insulin resistance. Not only diabetes, excessive sugar intake results in children experiencing persistent fatigue, weight gain, and puts them at risk of cognitive decline and fatty liver disease. It’s become an urgent national necessity for parents to reset children’s diets to reduce sugar consumption and to also educate them about the dangers it poses to their health and well-being,” says Dr. Jaison Paul Sharma, a well-known diabetologist of the Sharma Hospital, Hoshiarpur, Punjab.

In the pages following, PW presents curated advice from well-known diabetologists and nutritionists on ways and means to identify refined sugar hidden in everyday foods, understand food labels, switch to healthier alternatives, and build lifelong dietary habits in children.

Silent sugar bombs

According to Dr. Sharma, many packaged foods advertised as healthy contain ‘hidden’ refined sugar. This is a major cause of rising blood sugar of children. “Too many busy parents don’t bother about providing home-cooked meals and instead, offer children convenience and packaged foods. This may be the easy way out, but in the long run, it causes irreparable damage to children’s health. Packaged foods and beverages should be given to children as occasional treats, not everyday meals,” warns Dr. Sharma.

According to Sharma, six processed foods routinely included in children’s diets that have high sugar content:

Flavoured yoghurts & health drinks. Often marketed as ‘fortified’‘healthy,’ processed yogurts and health drinks contain 3-4 teaspoons of sugar per serving (nearly the entire daily recommended limit of 3 teaspoons for children).

Breakfast cereals. Packaged breakfast cereals marketed to children usually have high sugar content, including cereals labeled ‘multi-grain’ and ‘low-fat’. The average sugar content per 100 gm of packaged breakfast cereal is about 19.9 gm i.e, 4-5 teaspoons of sugar.

Packaged fruit juices. A standard 200 ml tetra-pack of packaged fruit juice contains 20-25 gm of sugar, i.e, around 5-6 teaspoons — almost equivalent to aerated cola.

Energy/protein bars. Often marketed to children as healthy alternatives, these are candy bars in disguise. They contain 20-40 gm of sugar (5-10 teaspoons) per 30-50 gm bar.

Biscuits and bakery foods. These contain refined flour, sugar, and unhealthy fats. One biscuit/cookie contains over 2 teaspoons of sugar.

Sauces and ketchup. One tablespoon contains a teaspoon of sugar.

 

Importance of reading food labels

Processed foods are usually high in refined sugar content, hidden away in the micro-fine print of product labels. Detailed information by way of labels or printed on packaging, is mandatory under the Food Safety and Standards Act, 2006 (FSS Act) and the Food Safety and Standards (Labelling and Display) Regulations, 2020. The information required is notified by the Food Safety and Standards Authority of India (FSSAI). It says that all packaged food products must display information such as generic name of the food; ingredients; nutritional content; vegetarian/non-vegetarian symbol; manufacturer details and date of manufacture and expiry.

Despite this, marketing wizards, especially of multinational consumer goods corporations, have devised highly effective strategies and clever use of synonyms, colours, blurbs etc to prompt purchases.

Therefore, Dr. Priyanka Marakini, a Bengaluru-based nutritionist and naturopathy/yoga expert, stresses that it’s vital for parents to read food labels carefully to identify and avoid foods with high sugar. She shares a valuable labels-reading guide for parents to reduce children’s sugar consumption:

Sugar synonyms. When reading food labels, don’t merely look for the word ‘sugar’. It hides behind many names — glucose, fructose, sucrose, corn syrup or high-fructose corn syrup, agave nectar, honey, maple syrup, brown rice syrup, fruit juice concentrate. If you see multiple sugar synonyms printed — especially among the first few ingredients — the product is best avoided.

Added sugars. Nutrition facts label on food products mandated by FSSAI separates natural and added sugars. Parents should note:

• Children aged 2-18 years should consume less than 25 gm (six teaspoons) of added sugar per day.
• For snacks, under 5 gm of added sugar per day is ideal. Packaged cereals and flavoured milk exceed this limit in single servings.

Pay attention to prescribed servings. Always check the prescribed serving, it may be smaller than what your child typically eats. For example, if a cereal lists 7 gm of sugar per 30 gm serving, and your child eats 60 gm, she is consuming 14 gm of sugar.

Scepticism about health claims. Packaged foods labelled ‘natural,’ ‘organic,’ ‘made with fruit’ may nevertheless have high sugar content. Ditto, low-fat or fat-free food — they often contain sugar to improve taste. Watch out for fruit-flavoured yogurts, packaged juices, granola bars, health drinks and smoothies. Even if they are healthy, their sugar content often rivals desserts.

Order of listed ingredients. Ingredients are obliged to be listed by weight on labels and packaging. If sugar synonyms are listed in the first three ingredients, that’s a red flag.

Although preventing excessive sugar consumption by children is important for their health and well-being, this is not to say that popular aerated drinks and packaged food and snacks should be totally proscribed.

Contrary to woke opinion, bottled and packaged food manufacturers serve a useful socio-economic purpose inasmuch as they process, transform and package perishable fruit, vegetable and foodgrain surpluses into durable packaged products which serve nutritional and convenience needs of consumers. Moreover, they guarantee remunerative and stable prices for farmers and food growers. Therefore, all processed foods are not poison. However, parents should advise their consumption in moderation and on special occasions.

Smarter options. Moreover, parents also have the option to choose alternatives to packaged foods. For instance, plain yogurt with fresh fruit instead of sweetened versions; whole fruits over packaged juice, and unsweetened packaged cereals with nuts and seeds. “In summer and other times, water is the best thirst-quencher. Encourage children to drink water when thirsty. The other alternative to packaged juice is freshly made fruit juice without added sugar or lime juice with honey. Moreover, provide home-cooked meals and involve children in the culinary process, while educating them about healthy ingredients and eating. Also build a family culture of sports and physical exercise to encourage good digestion and metabolism,” advises Dr. Marakini.

 

Sugar substitutes

Although agony aunts and woke liberals advise strict prohibition of sweets and ‘junk food’, it’s impractical to completely deny them to growing children. Hence, moderation rather than proscription is advised in the interests of family peace and harmony. Moreover, parents also have the option to get children accustomed to healthy sugar substitutes.

“Natural alternatives such as fruits and honey retain nutrients like vitamins, fibre, minerals, and antioxidants. They slow down the absorption of glucose into the bloodstream and prevent blood sugar spikes and drops. Parents should gradually substitute refined sugar with natural sugar in family meals,” advises Deepalakshmi Sriram, pediatric and neonatal nutritionist at the Cleft & Craniofacial Centre, Sree Balaji Medical College & Hospital, Chennai. According to Dr. Sriram, there are several sugar substitutes suitable for children. Among them:

Jaggery. An unrefined sweetener derived from sugarcane or palm sap, jaggery is routinely used as a substitute for refined white sugar in many cultures. Jaggery retains essential micronutrients such as iron, magnesium, potassium, and calcium. Its complex carbohydrate structure results in slower digestion, leading to gradual release of glucose into the bloodstream. It can be used in desserts and beverages. However, moderate consumption is advised given its caloric density.

Dates. Dates are also an excellent natural alternative to refined sugar. They are rich in fructose, which provides sweetness, and also in other nutrients such as dietary fibre, potassium, magnesium, and antioxidants, which support digestive health, electrolyte balance, and overall immunity. Fibre content in dates slows down sugar absorption and regulates blood glucose levels. But, as with all sweeteners, moderation is advised. Date paste or finely chopped dates are often used to make desserts, smoothies, and snacks.

Honey. Honey, especially raw or minimally processed, is a rich source of antioxidants, enzymes, and trace vitamins. It contains antibacterial properties and has been traditionally used to soothe respiratory ailments and aid digestion.

While honey is a beneficial sugar alternative in children’s diets, it should never be fed to infants under one year of age due to the risk of botulism. For older children, honey can be used to sweeten yogurts, smoothies, and drinks.

Fruit purees and whole fruits. Replacing refined sugar with whole fruit or fruit purees such as mashed bananas, applesauce, or date paste is an effective way to add taste to snacks and baked foods. Fresh fruits — especially organically grown — are rich in dietary fibre, vitamins, and antioxidants that improve metabolic health and regulate blood sugar levels. Incorporating fruit-based sweeteners encourages children to develop healthy eating habits aligned with pediatric nutrition recommendations.

Coconut sugar. Drawn from the sap of coconut palm trees, coconut sugar has lower glycemic properties than refined sugar. It contains trace minerals including zinc, iron, and potassium and can be used in desserts and baked foods.

“Diabetes as other ailments linked with excessive sugar intake, is preventable. To safeguard children’s long-term health, parents should substitute refined sugar with natural alternatives in family diets. Sugar is a sweet but silent killer. Moderating its consumption will lead to children leading healthy and happy lives,” says Deepalakshmi Sriram.

3 dangerous snacks

They are the easiest snacks to serve. Available in a wide variety and enticingly advertised, dangerous snacks are regularly stocked in most middle class homes. Consumed in excess, they can be dangerous because they provide empty calories. Normatively they contain high levels of sugar and salt.

Carbonated drinks. Carbonated drinks are at the top of every nutritionist’s list of dangerous products. It’s common knowledge that they contain unhealthy amounts of sugar, as also phosphoric acid and fructose corn syrup. Consumed in excess they cause liver damage, diabetes, and calcium depletion in bones (and therefore osteoporosis). Other substances such as caffeine and aspartame (in sugar-free versions) could induce jitters, brain damage and cancer.

Sugar-free products. Opting for sugar-free snacks is the latest fad. But they don’t guarantee freedom from adverse effects. Non-natural, especially acidic sugar products can damage the teeth. Aspartame, a commonly used sweetener, can adversely affect cognition and prompt nausea and seizures. It is commonly included in sugar-free bubble gum, colas and sugar-free biscuits.

Processed potato products. High calorific content apart, fat and sodium in potato chips and French fries are highly detrimental. Eating processed potato products can send a child’s sodium levels soaring, prompting hypertension, obesity, diabetes and peripheral artery diseases in adulthood.

The process of frying, especially when oils are reused, generates carcinogenic substances, which cause cancer. Packaged chips also contain a variety of unhealthy chemicals in the form of flavouring substances and preservatives. If children insist on French fries, make them at home.

Also Read: CBSE Sugar Boards to help students, parents make informed choices on sugar intake: Experts