Healthy Futures: Engaging the Oral Health Community in Childhood Obesity Prevention


Oral Health- and Nutrition-Related Guidelines, Policies, Positions, and Resolutions
by Federal Agencies and National Organizations

Federal Agencies

Source Publication Key Statements
U.S. Department of Health and Human Services (DHHS) and U.S. Department of Agriculture (USDA)
Dietary Guidelines for Americans 2015-2020, 8th edition (2015)
"When juices are consumed, they should be 100% juice, without added sugars." (p. 44)

"Fruits with small amounts of added sugars can be accommodates in the diet as long as calories from added sugars do no exceed 10 percent per day and total caloric intake remains within limits." (p. 45)

"Sugar-sweetened beverages, such as soft drinks, sports drinks, and fruit drinks that are less than 100% juice, can contribute excess calories while providing few or no key nutrients." (p. 111)

"Individuals have many potential options for reducing the intake of added sugars. Strategies include choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages, reducing portions of sugar-sweetened beverages, drinking these beverages less often, and selecting beverages low in added sugars." (p. 101)
Diet Quality of Children Age 2-17 as Measured by the Healthy Eating Index-2010 (2013) "The diet quality scores of children and adolescents would be improved by … decreasing the intake of sodium (salt) and empty calories from solid fats and added sugars." (p. 3)
Smart Snacks in School, USDA's "All Foods Sold in Schools" Standards Note: Standards, required by Healthy, Hunger-Free Kids Act of 2010
"Nutrition Standards for Beverages

All school may sell:

  • Plain Water (with or without carbonation)
  • Unflavored low fat milk
  • Unflavored or flavored fat free milk and milk alternatives permitted by NSLP/NBP
  • 100% fruit or vegetable juice
  • 100% fruit or vegetable juice distilled with water (with or without carbonation), and no added sweeteners" (p. 2)
Update of the Health Eating Index: HEI-2010 (2013)
"Key features of the Health Eating Index and guiding principles for the 2010 update

Key recommendations

  • Reduce the intake of calories from solid fats and added sugar." (p. 14)
Child and Adult Care Food Program: Meal Pattern Revision Related to Healthy Hunger-Free Kids Act of 2010 (2016)
"Fruit and vegetable juices must not be served [for infants 6 through 11 months]." (p. 24366)

"Fluid milk must be unflavored whole milk for children age one. Must be unflavored low-fat (1 percent) or unflavored fat-free (skim) milk for children two through five years old. Must be unflavored low-fat (1 percent), unflavored fat-free (skim), or flavored fat-free (skim) milk for children six years old and older." (pp. 24366-24369)

"Pasteurized full-strength juice may only be used to meet the vegetable or fruit requirement at one meal, including snack, per day [for children ages 1 through 18]." (p. 24366-24369)

National and International Organizations

Source Publication Key Statements
Academy of Nutrition and Dietetics
Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition (2014)
"Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease." (p. 693)

"Dental caries can be prevented by healthful dietary and good oral hygiene behaviors and exposure to fluoridated water and use of topical fluoride (i.e., fluoridated toothpaste and fluoride varnish) along with routine preventive oral health care." (p. 694)

American Academy of Pediatric Dentistry
Policy on Dietary Recommendations for Infants, Children, and Adolescents (2012)
"AAPD encourages . . . educating the public about the association between frequent consumption of carbohydrates and caries is encouraged." (p. 57)
American Academy of Pediatrics
Preventive Oral Health intervention for Pediatricians (2008)
"Parents and caregivers should be counseled on the importance of reducing exposure to sugars in foods and drinks. To decrease the risk of dental caries and ensure the best possible health and developmental outcomes, it is recommended that parents do the following:
  • Limit sugary foods and drinks to mealtimes.
  • Avoid carbonated beverages and juice drinks (juice drinks contain high-fructose corn syrup and 100% natural juice).
  • Encourage children to drink only water and milk between meals.
  • Limit the intake of 100 fruit juice to no more than 4 oz per day. (p. 1389)
American Dental Association
Report 10 of the Board of Trustees to the House of Delegates: Reducing Added Sugar Consumption as a Means to Reduce Dental Caries Risk (2015)
"ADA encourages continued research on the deleterious oral health effects of the increasing consumption of sugar sweetened beverages and opposes pouring rights contracts that influences increased access and consumption of soft drinks." (p. 5046)

"ADA policy encourages dentists to maintain current knowledge of nutrition recommendations such as the Dietary Guidelines for Americans and effectively educate and counsel their patients about proper nutrition and oral health." (p. 5047)

"Recommendations: Based on deliberation of the topic of reducing sugar consumption as a means of reducing caries risk, the Board recommends the following resolutions and directives for the House's consideration:

49. Resolved, that the ADA acknowledges it is beneficial for consumers to avoid a steady diet of foods containing natural and added sugars, processed starches, and low pH-level acids as way to help maintain optimal oral health.

50. Resolved, that the ADA supports public information campaigns to reduce the amount of added sugars consumed in American diets.

51. Resolved, that the ADA supports legislative and regulatory actions, as appropriate and feasible, to increase consumer awareness about the role dietary sugar consumption may play in maintaining optimal oral health, and the potential benefits of limiting added sugar consumption in relation to general and oral health.

52. Resolved, that the ADA encourages federal research agencies to further investigate the relationship between diet, nutrition, and oral health, particularly the extent to which dental caries incidence may fluctuate with changes in overall added sugar consumption." (p. 5049)

Note: Public copy of document not available
American Dental Hygienists' Association Policy Manual "The American Dental Hygienists' Association supports nutritional guidelines and programs that promote total health and encourages media advertising and public education that promote healthy eating habits and wellness.
Nutrition 13-94/29-74"

"The American Dental Hygienists' Association supports consumer awareness by requiring labeling of all products that have potential adverse effects on oral health.
Product Labeling 13S-10/57-82"

"The American Dental Hygienists' Association advocates arrangements between school districts and vendors to promote the consumption of healthy foods and beverages.
Nutrition 1-12/14-0" (p. 29)
American Heart Association Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement from the American Heart Association (2016)

"A preponderance of relevant literature supports a relationship between dietary sugars, specifically those found in SSBs, and increased adiposity in children." (p. 7)

"Committee Recommendations:

On the basis of the existing literature and in combination with expert opinion, the following recommendations are made (excerpts):

  • Children and adolescents limit their intake of sugar-sweetened beverages to 1 or fewer 8-oz beverages per week.
  • Children and adolescents consume ≤ 25 gram (100 calorie or ≈ 6 teaspoons) of added sugars per day
  • Added sugars should be avoided in the diet of children < 2 years of age" (p.12)
American Heart Association
Policy Recommendations for Obesity Prevention in Early Care and Education Settings (2015)
"To support the development of healthy early childhood habits surrounding diet and physical activity, the American Heart Association makes the following recommendations: (excerpts)
Child care providers should meet minimum, uniform standards in nutrition, physical activity, screen time limitations, breastfeeding, and professional development, such as the Healthy Way to Grow best practices..." (p. 3)

"Healthy Way to Grow Best Practices (excerpts)
  • 100% juice (even if diluted with water) is not provided until age 1.
  • No more than 4-6 ounces of 100% juice is provided to toddlers and preschoolers in a day; including the amount of juice served at home.
  • Sugar-sweetened beverages are not served to children." (p. 4)
Association of State and Territorial Dental Directors Nutrition Education and Healthy Eating in School Settings
"ASTDD fully supports and endorses the inclusion and expansion of oral health in school nutrition curricula and the promotion of healthy foods served on campus following evidence-based practices to reduce the risk of dental caries and to promote health and well-being." (p. 2)
Obesity Society
Reduced Consumption of Sugar-Sweetened Beverages Can Reduce Total Caloric Intake (2014)
"The Obesity Society joins with the American Medical Association, American Association of Pediatrics, Centers for Disease Control, and Institute of Medicine in recommending that individuals decrease consumption of, or avoid, SSBs." (p. 1)

"The Obesity Society supports national efforts to increase the consumption of water, a readily accessible, calorie free and healthy alternative to SSBs that also contains fluoride needed for oral health." (pp. 1-2)

The Obesity Society recommends that children minimize SSB intake." (p. 2)

World Health Organization
Report of the Commission on Ending Childhood Obesity (2016)
"Implement comprehensive programmes that promote the intake of healthy foods and reduce the intake of unhealthy foods and sugar-sweetened beverages by children and adolescents." (p. viii)

"Implement an effective tax on sugar-sweetened beverages." (pp. viii, 18)

"Eliminate the provision or sale of unhealthy foods, such as sugar-sweetened beverages and energy-dense, nutrient-poor foods, in the school environment." (pp. xi, 31)

"Motivate consumers to demand that governments support healthy lifestyles and that the food and non-alcoholic beverage industry provide healthy products, and do not market unhealthy foods and sugar-sweetened beverages to children." (p. xiii)