Healthy Eating Consumption of Sports Drinks Research by Children and Adolescents Building evidence to prevent childhood obesity A Research Review, June 2012 Abstract Children’s and adolescents’ consumption of sports drinks is increasing. Amidst a national obesity epidemic, many sports drinks sold in the United States contain high amounts of sugar, adding more calories to youths’ diets. In limited quantities, sports drinks are recommended only for individuals engaged in prolonged vigorous physical activity for more than one hour. For most children and adolescents, consuming water before, during, and after physical activity provides the necessary hydration. This research review examines the evidence about children’s and adolescents’ consumption of sports drinks and the related health implications. Parents, teachers, coaches, and children and adolescents need to know that sports drinks are not recommended for the vast majority of youths engaged in normal physical activity. Government agencies also need to monitor the effects of marketing sports drinks to children. Introduction Over the past three decades, U.S. children and adolescents have significantly increased their consumption of sugar-sweetened beverages (SSBs).1 The per-capita caloric contribution of SSBs to children’s and adolescents’ diets increased from 204 calories per day in 1988–1994 to 224 calories per day in 1999–2004.1 Adolescents now obtain 10 percent to 15 percent of their caloric intake from SSBs.1 Consumption of SSBs performed in high temperatures and humidity. Although is associated with excess weight gain, poor nutrition, individual brands and products might vary, sports drinks displacement of healthful beverages, and a higher risk for typically contain nutrients such as water, electrolytes obesity and diabetes.2 (primarily sodium and potassium), and carbohydrates.4 Carbohydrate options found in a number of popular The term sugar-sweetened beverages is often associated sports drinks include high fructose corn syrup, fructose, with traditional carbonated beverages, such as sodas. sucrose, sucrose syrup, brown rice syrup, cane juice, and However, this category of beverages also includes sports maltodextrin.5 Depending on the brand, some sports drinks or electrolyte drinks, sweetened tea, fruit-flavored drinks contain as much as 19 grams of added sugar, 200 drinks and punches, and other beverages that contain milligrams of sodium, and 80 calories per 8 ounces.6 large amounts of added sugar. While sports drinks were designed for athletes or Sports drinks were created in 1965 in the United States individuals participating in prolonged vigorous physical as dietary supplements for athletes in an effort to address activity, they are now commonly consumed by youths in certain sports-related physiological and nutritional issues.3 These beverages were designed for athletes or individuals needing replenishment of water as well as carbohydrates and electrolytes lost or utilized during prolonged vigorous physical activity, including activities Healthy Eating Research A National Program of the Robert Wood Johnson Foundation the United States. Based on data from the 2010 National ■ The benefits of sports drinks are appropriate only for Youth Physical Activity and Nutrition Study, 16.1 percent athletes or individuals engaging in prolonged vigorous of high school students drank one or more servings of physical activity, and/or those activities performed in a sports drink during the seven days before the survey, high temperatures and humidity. and 9.2 percent drank sports drinks two or more times ■ The average American child or adolescent does 7 per day during the same timeframe. Adolescents who not engage in enough physical activity to warrant consume sports drinks more than once a day are more consumption of sports drinks. likely to be male, Black or Hispanic, eat at fast-food restaurants more than once a week, and be physically ■ Water and a balanced diet are recommended and inactive.8 One study examined why adolescents drank optimal for children and adolescents who do not sports drinks. Adolescents’ main reasons for drinking participate in high-intensity physical activity lasting sports drinks included quenching their thirst, seeking more than one hour. a soda substitute, increasing their energy, and boosting ■ Sports drinks are a source of added sugars and their sports performance.9 None identified the exercise- contribute to excess energy intake. related rehydrating properties as the reason for their ■ Consumption of sports drinks may increase risk for consumption.9 Increasingly, sports drinks also are being poor dental health. consumed by non-athletes—those who simply like the taste of sports drinks or who are looking for a different ■ Sports drinks are a source of sodium and contribute to kind of beverage.10 increasing sodium intakes among American youths. ■ Sports drinks may displace necessary nutrients for Summary of Methodology Used in growing youths. Gathering Evidence Studies Backing Key Research Results This research review summarizes the current literature on sports drinks trends, marketing of sports drinks to Sports drink consumption is increasing. children and adolescents, and the health implications ■ Between 1985 and 2005, the overall availability of SSBs associated with sports drink consumption. Keyword in the United States increased by 8.5 gallons per capita searches were conducted in PubMed, Web of Science, per year; 40 percent of this increase was due to sports Business Source Premier, and Google Scholar. Searches drinks and fruit-flavored drinks.11 were carried out with a combination of terms and words ■ While the number of people buying regular sodas fell in the title or text. Databases were searched with key by 16.5 million from 2003 to 2008, other non-alcoholic terms such as: “sugar-sweetened beverages AND child beverage segments, including sports drinks, grew during health,” “sports drinks AND health,” “sports drinks AND the same timeframe.12 physical activity,” and “sports drinks AND marketing.” Article titles and abstracts were examined, and relevant ■ From 1989–2008, the percentage of American children articles were retrieved. Additional articles were identified ages 6 to 11 consuming sports drinks increased through searches of the references of the initial set of significantly, from 2 percent to 12 percent.13 The publications found through keyword searches. Position amount of sports drinks consumed by these children papers from organizations, such as the American College also increased, from 255 milliliters per day to 289 of Sports Medicine and the Academy of Nutrition and milliliters per day during the same timeframe.13 Dietetics also were reviewed. Additional electronic ■ In 2006, sports drinks were the third-fastest growing database searches were performed to identify research beverage category in the United States.6 In 2008, sports specific to dental health and hydration. Search limits drinks sales were $7.5 billion, increasing in volume by were confined to the English language. Searches were not 17 percent between 2004 and 2008.14 restricted by date or study design. Sports drink manufacturers are targeting children and adolescents. Key Research Results ■ Coca Cola developed a reduced-calorie, smaller-sized ■ Sports drink consumption is increasing. variety of Powerade sports drinks (Powerade Play) for ■ Sports drink manufacturers are targeting children and younger children.15 Powerade Play is advertised with the adolescents. tagline, “The sports drink for the young athlete.”15 ■ Sports drinks are marketed as a healthy alternative ■ The re-branding of “Gatorade” as “G” in 2008 was meant to soda. to grab teenagers’ attention, as they had moved away 2 Consumption of Sports Drinks by Children and Adolescents | Research Review | June 2012 from the brand thinking it was outdated.14 Recently, The benefits of sports drinks are appropriate only for Gatorade has been working with adolescents to test and athletes or individuals engaging in prolonged vigorous promote new products, and in 2010 a “mobile locker physical activity, and/or those activities performed in room” featuring “G Series” products was marketed to high temperatures and humidity. high schools throughout the United States.14 ■ The American College of Sports Medicine reports that ■ In 2010, Gatorade television ads were ranked among the electrolytes and carbohydrates in sports drinks are the top five most-advertised products seen by children beneficial for individuals who engage in prolonged and adolescents.15 Powerade television ads were ranked vigorous physical activity, particularly in warm to hot twenty-sixth.15 temperatures.17 Common examples of high-intensity physical activities include: football training during ■ The sports drink industry has employed a number of social media strategies to target young consumers. the summer months, marathon training and races, Gatorade’s “Mission Control,” which launched in competitive soccer and tennis matches, and long 17 April 2009, represents an unusually extensive effort by cycling races. Dehydration by 2 percent of body a company to track social media.16 “Mission Control” weight during extended periods of vigorous exercise in monitors popular social media elements, such as a warm to hot environment weakens stamina among 18, 19 Facebook and Twitter, around the clock in order to athletes. Sports drinks have been shown to decrease monitor consumer behavior and to interact directly fatigue and replace electrolytes lost in sweat under 17,