Starting in the early 1980s, sugar was erroneously promoted as a healthy alternative to fat. At the time, many people believed that fat was the enemy, and that if you wanted to lose weight and prevent heart disease, you should consume a diet low in fat. This philosophy has merit, except that we replaced fat (both healthy and unhealthy types) with mostly unhealthy carbohydrates (simple sugars and low-fiber starches). Along the way, we were told that both adults and children should eat complex, rather than simple, carbohydrates—but even that message was skewed.

 We now know that the body does not process all carbohydrate equally; that is, some promote optimal blood sugar and insulin levels better than others. Further, we have learned that fat is not—nor was it ever—the enemy.

 Documentaries such as That Sugar Film and Fed Up have highlighted the misconceptions about the roles of fat and sugar in our diets and their implications on our health. Alarmingly, we became heavier and less healthy when we replaced fat with sugar. Adults and adolescent obesity and diabetes rates are higher today than ever.

So how do we combat misinformation to choose healthy foods that our children will actually eat? This is a challenge because three components of food taste good: fat, sugar and salt. Typically, any time you remove one of those, you have to add one of the others (or an artificial ingredient) to keep the food palatable. The fat-free cookies, crackers and snacks that were so popular in the 1990s were loaded with sugar and artificial flavors.

Children need a variety of nutrients to grow and thrive, including fats, protein and carbohydrates. The first step is to not completely eliminate any single food group. And yes, some sugar is beneficial—it just depends on the source.

Rather than focusing on simple vs. complex carbohydrates, consider natural vs. processed food choices. The reasoning for this is that not all simple carbohydrates are low in fiber or unhealthy. Likewise, not all complex carbohydrates are high in fiber or healthy. Fruit, for example, is a simple carbohydrate, but granola is considered a complex carbohydrate. An apple, however, has a single ingredient “apple” (zero added sugars or preservatives). Popular-brand granolas list more than 10 ingredients with at least two different types of added sugars.

The current Dietary Guidelines state that no more than 10% of total daily calories should come from added sugars. The amount we “need” is less than that, but exceeding that amount can contribute to weight gain, diabetes, heart disease and poor dental health (among others). And yes, it is possible for heart disease to start developing during adolescence.

Assuming that children need 1,300-1,800 calories per day, this recommendation equates to 130-180 calories from added sugar, or 32-45 grams daily (carbohydrates contain 4 calories per gram). That is roughly one can of soda (35-45 grams, depending on the variety). According to the Dietary Guidelines, soda and other sweetened drinks are by far the largest contributors to children’s intake of added sugars (45% of the total amount).

Most parents understand that soda, along with candy and sugary breakfast cereals, should be considered rare treats. But even seemingly “healthy foods” contain added sugar, which can easily tally up throughout the day. Currently, added sugar is not listed on the Nutrition Facts label—only total sugar is identified. The new Nutrition Facts Labels (released by 2018) will, however, list added sugars on the food label.

To figure out which foods in your kitchen cabinet contain added sugar, read the Ingredients List. Added sugars include any type of “syrup” or any word ending with “ose.” Common added/hidden sugars include: brown rice syrup, corn syrup (solids), high-fructose corn syrup, dextrose, agave nectar, honey, brown sugar, malt/malt syrup, (evaporated) cane juice, fructose, glucose, invert sugar and molasses.

A teaspoon contains 4 grams of sugar; thus a child’s daily added sugar should be well under 10 teaspoons (40 grams) per day. The following “healthy” foods each likely contain 1 to 2 teaspoons of added sugar per serving:

• Dried blueberries, cranberries, cherries
• Turkey jerky
• Gummy vitamins
• Energy/Protein bars
• Organic ketchup
• Spaghetti sauce
• Greek yogurt
• Flavored apple sauce
• Granola
• Infant formulas; most of which list a form of sugar as the first ingredient

Thus, a single serving of each of these could easily exceed the recommended limits. The take-home message is to read ingredient lists on labels and shift away from counting calories, fat, carbs and protein. The types of fat/carbs/protein and the sources of sugar (naturally-occurring vs. added) are what matter most. Ideally, select unprocessed foods that have no added sugar or have added sugar very far down the ingredient list.

Emphasize whole, natural foods in your children’s diet, just as you should in yours. Essentially, the perfect kids’ diet is smaller portions of the perfect adult diet, which includes high-fiber carbohydrates, lean proteins and healthy fats with a lot of color and few preservatives and artificial ingredients, and little sugar.