Have Pediatricians Sold Out to Big Dairy?

Does your doc recommend chocolate milk?

The Dairy Industry widely touts the nation’s pediatricians as supporting sugary chocolate milk for children. But when I went looking for the American Academy of Pediatrics’ policy on flavored milk in school, what I found was hardly a sweeping endorsement.

Instead, the group representing some 60,000 of the nation's pediatricians cites flavored milk along with plain milk, water, fruit and vegetable juices as “healthful alternatives” to the problem of sodas in school. But sodas aren’t served in most elementary schools, and are on the way out in many middle and high schools as well.

A 2010 report by the Institute for Health Research and Policy, University of Illinois, Chicago, found that only 17 percent of public elementary schools offer sugar-sweetened beverages such as sodas or sports drinks. The percentage of middle schools that offered sodas with meals shrank from 35 percent to 26 percent between 2007 and 2008. In high schools the decrease was from 46 percent to 36 percent.

When I pressed the head of the AAP’s nutrition committee to explain how pediatricians might continue to support chocolate milk if there were no sodas offered in schools, he abruptly ended our interview.

“I think we are belaboring the issues and I do not have any answers to address your concerns,” said Jatinder Bhatia, chief of neonatology at the Medical College of Georgia in Augusta.

So what explains the cozy relationship between the American Academy of Pediatrics and Big Dairy.

Bhatia acknowledged that he serves as an “unpaid advisor” to the National Dairy Council. And as I would later learn, the American Academy of Pediatrics receives funding from dairy interests, although it refuses to say how much.

The AAP issued a statement saying: “The American Academy of Pediatrics receives grants and contributions from the federal government and foundations as well as from a number of corporations. These contributions help support the AAP's mission to promote the health and wellbeing of all children. In the 2009-10 fiscal year, just 7 percent of the AAP’s income came from corporate support. This includes contributions from the National Dairy Council and MilkPEP. “

(MilkPEP--or Milk Processors Education Program--is an industry group funded through a congressional mandate that promotes dairy with media campaigns such as “Got Milk?” and “Raise Your Hand for Chocolate Milk!”)

The AAP statement goes on to say: “Safeguards and disclosure procedures are in place to protect against conflict of interest by either the AAP or its physician members who develop policy for review and approval by the AAP. The AAP conforms with all industry standards for disclosure of financial relationships…Outside funding has no effect on the AAP's policies, guidelines or messaging on any aspect of child health.”

If dairy money has no influence on AAP policy, it may help grease the wheels for what the pediatric group describes as “partnerships” with dairy interests to promote its products—including flavored milk.

For instance, the AAP last year joined a MilkPEP Halloween blitz that advised parents, “If you’re hosting a Halloween Party, serve low-fat chocolate milk as a nutritious treat in disguise.”

The AAP has also signed on to the National Dairy Council’s “3 Every Day of Dairy,” campaign, urging everyone to consume at least three servings of dairy on a daily basis. The AAP participates along with prominent sports figures in the dairy council’s “Fuel Up to Play 60,” promoting dairy and an hour of exercise in schools.

What’s more, the AAP appoints prominent members such as Jatinder Bhatia to “advise” the dairy industry.

When I asked to see a copy of the AAP’s partnership agreement with the National Dairy Council and MilkPEP, I was told, “We do not have agreements available for public inspection.”

This is the second in an occasional series of reports responding to an Associated Press article published in May that falsely asserted that several professional groups—including the American Academy of Pediatrics—had issued a “joint statement” supporting chocolate milk in schools.

My reporting reveals that most of the groups cited receive money from dairy interests as part of a carefully crafted public relations campaign designed to boost sales of flavored milk in the face of plummeting sales of plain milk. Schools account for only 7 percent of all milk sales, but more than half of all flavored milk. The American Dietetic Association and the School Nutrition Association also receive dairy industry money and enthusiastically support the chocolate milk campaign.

Dairy interests also pay for “research” to bolster their claim that children will lack the calcium they need for healthy bones if they are not offered flavored milk with added sugar.

Dairy groups trumpet the participation of individual physicians such as Jatinder Bhatia, publishing long lists of "advisors" that help create an aura of medical approval around the industry’s chocolate milk promotions.

In fact, the American Academy of Pediatrics does not have a formal policy explicitly focused on flavored milk. The AAP's 2006 statement on optimizing children's bone health and calcium intake states that flavored milk, cheese and yogurt containing "modest amounts of added sweeteners" are "generally recommended." In the absence of more specific guidance, the dairy industry has created the illusion that it exists: Drink chocolate milk!

Pediatricians are hardly unanimous on the question. Robert Lustig, a prominent specialist in childhood obesity at the University of California, San Francisco, has called the sugar (meaning fructose) in chocolate milk “poison” because of its metabolic links with obesity, diabetes, hypertension, cardio-vascular disease and fatty liver disorder in children.

Lustig was prominently featured in a recent New York Times Magazine article on the perceived dangers of fructose. But he declined to comment on the findings in this article, saying the American Academy of Pediatrics has, in fact, “embraced the issue of sugar in obesity.” He cited a recorded panel discussion the AAP recently sent its members in which Lustig and other specialists discuss the hazards posed by sugar in children’s diets.

“The issue of flavored milk is a complex one,” said Lustig in an e-mail, “and my opinion and comments are not for distribution.”

(When I interviewed Lustig in January and asked, "Do you think it's wrong for schools to be serving milk with added sugar?" he replied: "Short answer, of course. But it won't get fixed any time soon. The Dairy Industry is very tight with the USDA.")

The chocolate milk AAP policy suggests as an alternative to the sodas and sports drinks offered in schools typically contaings 3.5 teaspoons of added sugar in an 8-ounce serving. But Jatinder Bhatia was vague on the question of how much of it children should drink, saying, "AAP does not have policy on the number of servings of flavored milk per day."

Bhatia recommended “two glasses a day in younger children and three a day in older children,” adding that “moderation is key.”

“Although I personally am a proponent that we need to reduce sugar in the American diet in general and in children in particular, I also believe that it is not the flavored milk rather than the number of times the flavored milk is consumed.”

Bhatia continued: “We need to start in infancy when we start weaning infants from breast feeding or formula feeding and not offer them high sweet drinks and foods so as to not let them acquire a ‘sweet tooth.’ That way, we would not have to resort to flavored or other milks since children would have not acquired a sweeter taste.”

In its online publications, meanwhile, the dairy industry prominently quotes Bhatia as saying that “flavored milk could be a nice alternative [to plain milk] since the contribution of added sugars to the overall diet of young children is minimal.”

When Bhatia balked at the question of whether schools should serve flavored milk in the absence of sodas, I was told that this particular AAP policy, first approved in 2004 and “affirmed” without change in 2009, is likely to be revised soon.

I was then referred to Dr. Robert Murray, a professor and child nutrition specialist at Ohio State University, and until recently chairman of the AAP’s council on school health. “The policies of the AAP,” Murray said, “have been unwilling to sacrifice the nutrients in milk just to avoid a couple teaspoons of sugar.”

“Your question reflects a common misperception: that our directive to the public to limit sugar-sweetened beverages is based on the fact that sugars are ‘bad’. This is not the case,” Murray said. “Sugars, even simple sugars, can be a part of a total diet, just like any other component.”

According to Murray, “We did not write the soft drinks policy because of a concern about sugar itself, as much as a concern about energy-dense and nutrient-poor drinks being promoted by schools through industry contracts. The implications of that on increasing added sugars and lowering diet quality was the focus.”

School food advocates such as Ann Cooper contend that routinely serving flavored milk as part of the federally-funded meals program teaches kids to expect sugar in their food. But Murray says chocolate milk has become “a whipping boy” in the school food debate.

“Removing flavored milk is detrimental to overall pediatric nutrition and unlikely to affect overall added sugar consumption in any meaningful way,” he said.

Murray, who also served a term as a National Dairy Council advisor, said “neither the AAP Committee on Nutrition nor any other national nutrition organization has proposed a specified limit on flavored milk.”

But an advisory published by the American Academy of Family Physicians at its website lists drinking flavored milk as a “key unhealthy eating habit.” It says children should drink no more than 12 ounces of flavored milk per day.

The American Heart Association, meanwhile, recently set guidelines that would have children consume no more than half of their “discretionary calories” in the form of sugar. Millions of children may already be exceeding that standard because of the chocolate milk they drink at school with their federally-sponsored breakfast and lunch. Many are drinking even more in snack and supper programs.