By Sreya Deb
In 2022, around 95,600 children below the age of 14 years in India were reported to have type-1 diabetes, as per the Indian Council of Medical Research (ICMR). This placed India at the top with the highest number of children with the chronic autoimmune disease in southeast Asia. A year later, things were no different. According to a study published in the American medical journal JAMA Network Open in 2023, India witnessed 227,580 cases of childhood diabetes and 5,390 deaths that year, suggesting a 39.4% increase in cases since 1990.
India is facing a public health crisis of gargantuan proportions, with rising cases of diabetes—a chronic disease traditionally associated with adults—now affecting children. Yet awareness and resources remain low. “We’re not just seeing more cases—we’re facing a potential health crisis that could affect an entire generation,” says Dr Saptarshi Bhattacharya, senior consultant, endocrinology, Indraprastha Apollo Hospitals, New Delhi. “If we don’t act now, the impact on families, healthcare systems, and the future health of our youth could be severe,” he adds.
Dr Akanksha Parikh, consultant, paediatric endocrinology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, attests to this fact. “A growing number of children are showing signs of insulin resistance and metabolic syndrome, which are precursors to diabetes,” she adds.
Despite the growing prevalence of diabetes and childhood obesity in the country, Dr Parikh believes awareness remains low among the general public, even among urban populations. “Most parents associate diabetes with ageing or genetics and rarely link it with lifestyle in children,” he explains.
How much is too much
While the recommended daily sugar limit for a child aged 2-7 years is around 20 gm or 5 teaspoons, paediatricians agree that children are usually consuming more than two times of that, to the tune of 50 gm of sugar or more on most weekdays.
In fact, according to the guidelines of the Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN), pregnant, lactating women and children should avoid sugar and sugar substitutes altogether. The American Heart Association also holds that children below the age of 2 years should not consume sugar at all.
The European Nutrition committee recommends that intake of free sugar should be less than 5% of the energy intake for children and adolescents. The recommended intake of sugar for kids between 2 and 7 years is 15 to 20 gm, 7-13 years is 22-27 gm and 13-19 years is 27-37 gm.
“Encouraging children to eat whole, minimally processed foods is key to breaking sugar addiction patterns,” says Dr Parikh.
According to pediatrician and nutrition expert Dr Sanjiv Verma of King George’s Medical University, Lucknow, “Nutrition from every one grain of unprocessed rice consumed will be equal to four grains of processed rice— the overconsumption is inevitable which leads to uncontrolled weight gain and complications later,” he adds.
Dr Verma expounds, “One small bottle of cold drink will equal 50 teaspoons of sugar, and children consume so many of these products in a day. Moreover, Indian mithais have been replaced with chocolates and various types of candies, the tastes and textures of which can become addictive for children.”
Dr Bhattacharya offers, “The metabolic clock is speeding up—what used to take decades to develop is now happening over a handful of years. We’re compressing a lifetime of metabolic damage into childhood and adolescence. High sugar intake early in life changes a child’s taste preferences and how their metabolism responds.”
Those diagnosed with diabetes and high body mass index (BMI) may also be at risk of a reduced lifespan, says Dr Bhattacharya. “If someone has a high BMI, especially along with diabetes or related conditions, it can reduce their life expectancy by anywhere between 5 and 20 years—depending on how early it begins and how severe it is,” he adds.
Awareness is the key
A global report by Innova Market Insights released last year, titled Now and Next in Global Sugar Reduction, shows that consumers understand that healthy products should have reduced amounts of unhealthy ingredients, such as reduced sugar. “According to global consumer trends, consumers become more conscious about sugar as they get older,” the report adds.
While consumer awareness may be increasing, a reflective impact on children’s diets is a dire need at this juncture. Paediatricians opine that it is often more difficult to monitor the diet of a school-going child as they spend a large amount of time out of home and surrounded by peers. Attractive yet unhealthy snacking options are available around school campuses in the dozens—and unless these stores and school canteens begin stocking healthy snacks, dietary changes in children may be slower to achieve. Consumer consciousness regarding sugar intake is only the first step in addressing the health crisis of childhood diabetes looming in India.
Notably, a report titled How India Consumes Sweets compiled by Local Circles, a community platform and citizen pulse agg-regator, last year revealed that 55% of urban Indians would prefer their sweets to contain 25-75% less sugar. Among those consuming traditional Indian sweets, 10% reported consuming them daily, while 18% reported consuming packaged bakery sweets like cakes and biscuits daily. The report was collated from 36,000 responses across 311 districts in the country.
Aside from mithais, chocolates, and other sweet treats that are obvious sources of sugar, there are other food items and beverages which contain hidden sugars that escape the unaware consumer’s notice. Consumers are often surprised that food items like fruit juices, flavoured and packaged yoghurts, are among those few. Breakfast cereals like muesli, which is considered healthy due to its nuts and dry fruits, also have hidden sugars, along with protein bars and paediatric powders. The sugar content listed on the packaging is hidden in terms like sucrose, glucose syrup, maltose, dextrose, corn syrup, even things like honey and jaggery.
“Sugar isn’t always just called sugar on a label. It often hides behind fancy names like sucrose, glucose syrup, maltose, dextrose, corn syrup, even things like honey and jaggery,” says Dr Bhattacharya, warning against labels that claim ‘low-fat’ or ‘no-sugar’ and advising that sugar in any form listed among the top ingredients should be avoided. Dr Verma echoes the same, saying that packaged foods often list ingredients with sugar content under carbs and raw materials as well.
According to a research done by the ICMR last year, those who consume ultra-processed foods have a 12% higher chance of developing Type 2 diabetes than someone who does not, and an exponentially higher risk of obesity.
Step in the right direction
On May 14, the Central Board of Secondary Education (CBSE) issued a directive for all affiliated schools in India to put up ‘sugar boards’ on campus to push for nationwide awareness to reduce excessive sugar consumption among school-going children. When announcing the directive,
the CBSE also shared that children in the age group of 4-10 years are getting 13% of their calorie intake
from sugar, while those aged 11-18 years get 15%.
These sugar boards are meant to contain information on the recommended daily sugar intake for children, sugar content in commonly preferred foods and beverages, health implications of excessive sugar consumption, and healthier food alternatives.
“This is a positive and much-needed step,” says Dr Parikh, adding: “Visual awareness campaigns in schools can prompt
curiosity among students, and support teaching staff in inculcating healthy eating and diet consciousness in the students.
WHAT PARENTS CAN DO
- Keep sugary snacks and drinks out of house, limit use of sugary rewards
- Have set meal and snack times to reduce grazing, encourage mindful eating
- If you avoid sugary drinks and prefer fruits, kids are likely to follow
- Encourage reading food labels together and understanding what’s in their snacks
- Focus on balanced meals with mix of proteins, whole grains, vegetables
LONG-TERM IMPLICATIONS
- Higher risk of early heart disease and strokes, fatty liver, hormonal disturbances, PCOS
- Chronic illness in childhood can lead to long-term medication costs and more
HIDDEN SUGARS IN DIETS
- Fruit juices
- Flavoured yoghurts
- Breakfast cereals like cornflakes and muesli
- Snack and protein bars
- Commercial paediatric protein powders
- Nutritional supplements
- Sweetened beverages, bakery items, frozen foods, instant snacks