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3.2: Think Before I Drink

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    National Health Education Standards (NHES)

    • 1.12.7: Compare and contrast the benefits and barriers to practicing healthy behaviors, such as making healthier beverage choices.
    • 5.12.1-7: Practice decision-making steps enhance health, such as establishing healthy beverage choices.

    Wellness Guidelines

    • Decrease sugary beverage consumption


    • Instruction: In a group or think-pair-share format, have participants discuss the following questions. Acknowledge those who have progressed toward their goal(s) and encourage anyone who wants to change or modify their goal to get 1:1 support.
    • Share: Let’s discuss our SMART Goals.
      • How is it going with your current SMART goal?
      • What are some ways you can improve progress towards your goal? (Grows)
      • What are some ways you are doing well with progress towards your goal? (Glows)

    GUIDELINE: Decrease Consumption of Sugary Drinks

    • Share: What guideline do you think is related to today’s lesson? Who has a SMART Goal related to this guideline?
    • Instruction: Select one activity.
    1. Guideline Popcorn: The group lists all 8 guidelines rapidly in popcorn format.
    2. Guideline Charades: Divide participants into groups and assign each a guideline. Each group has to silently act out the guideline for the rest to guess.
    3. Two Truths and One Lie:
      • Truth 1: Nearly half of the adolescents see or hear advertisements for sugar-sweetened beverages one or more times a day.
      • Truth 2: The sugar in one can of soda is usually more than in a standard-sized candy bar.
      • Lie: Diet soda is the healthiest alternative to regular soda.
      • Share: Research on sugar is conflicting and not conclusive. Remember moderation is key and drinking water is a healthier choice.

      4. Questions to discuss and/or journal:

      • How often do you drink soda? Where?

      • How often do you see/hear a soda advertisement? How does it affect you?

      • Why do you think people like drinking soda?

      • How do you feel when you are drinking soda? After drinking?


    • How much sugar is in sugary beverages and why it is important to drink water.


    • Worksheets
    • Slide presentation
    • Teaspoons
    • Large bag of sugar
    • 5-10 assorted drink choices
    • Clear cups


    [As defined by USDA & HHS, 2015; WHO, 2017; Michigan State University, 2013; Merriam-Webster Learner’s Dictionary, n.d.]

    • Added Sugar: Syrups and other caloric sweeteners used as a sweetener in other food products.
    • Sugar-Sweetened Beverages: Liquids that are sweetened with various forms of sugars that add calories including soda, fruitades and fruit drinks, and sports and energy drinks.
    • Dehydration: A condition that results from excessive loss of body water.
    • Evaluate: Determine the significance or worth of something.
    • Benefit: A good or helpful result or effect.
    • Barrier: A problem that makes something difficult or impossible.


    • Do Now
    • Secret Sugar
    • Sugar Size Up
    • Why Make A Choice?
    • Exit Ticket


    Do Now:

    • Set Up:
      • Display 5-10 beverages and/or print nutritional labels of beverages such as soda, sports drink, energy drink, juice drink, fruit-flavored soda, vitamin-added water, sweetened tea, coffee, and water.
    • Instruction:
      • Ask everyone to observe the beverages on display and answer the following questions out loud or on their worksheet.
        • What’s your favorite drink?
        • Which drink do you think has the most sugar?
          − Soda
          − Juice
          − Sweetened tea
        • Which drink do you think has the least sugar?
          − Water
          − Unsweetened tea
          − Coffee
      • After everyone has made a guess, reveal which drink has the most sugar and which has the least sugar. To determine how much sugar a drink has, read how many grams of sugar there are on the drink’s nutrition label.

    Good to Know: Secret Sugar

    • Share:
      • People are now getting more calories from what they drink instead of what they eat. Americans consume on average of 150-170 pounds of refined sugar every year!
      • Added sugars account on average for almost 270 calories, or more than 13 percent of calories per day, particularly high among children, adolescents, and young adults.
      • Added sugars are syrups and other caloric sweeteners used as a sweetener in other food products. Naturally occurring sugars such as those in fruit or milk are not added sugars. Specific examples of added sugars that can be listed as an ingredient include brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, raw sugar, sucrose, trehalose, and turbinado sugar.
      • “Sugar” on the nutrition label is the total sugar, including natural and added. If a product does not include milk or fruit (lactose/fructose/natural sucrose), then you can assume the amount listed reflects added sugars.
      • The major source of added sugars in beverages, which include soft drinks, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic beverages, and flavored waters.
      • Sugar-sweetened (sugary) beverages are liquids that are sweetened with various forms of sugars that add calories including soda, fruitades and fruit drinks, and sports and energy drinks.
      • In fact, sugary beverages account for almost half (47%) of all added sugars consumed by the U.S. population.
      • The other major source of added sugars is snacks and sweets, which includes grain-based desserts such as cakes, pies, cookies, brownies, doughnuts, sweet rolls, and pastries; dairy desserts such as ice cream, other frozen desserts, and puddings; candies; sugars; jams; syrups; and sweet toppings.
      • Together, these food categories make up more than 75 percent of intake of all added sugars.
      • What makes us choose sugary beverages? Maybe because they taste good, satisfy a craving, or fill you up (USDA & HHS, 2015).
    • Share:
      • Why decrease sugar? When sugars are added to foods and beverages to sweeten them, they add calories without contributing essential nutrients. Consumption of added sugars can make it difficult for individuals to meet their nutrient needs while staying within calorie limits (USDA & HHS, 2015).
      • Extra calories from added sugar can cause unwanted weight gain or obesity and increase your risk for Type 2 Diabetes and heart disease. It can also cause cavities (California Department of Public Health, 2014).
      • How much added sugar should we allow ourselves per day? Your body does not need added sugar, so women should limit their consumption to 25 grams per day and men no more than 36 grams per day.
      • Often sugar is recorded in grams. A gram of sugar is equal to about 1/4 tsp by volume (Michigan State University, 2013).
      • In other words, if you take grams of sugar and divide by four (4), you’ll get the teaspoons equivalent. So what is 25 divided by four (4)? About 6. What is 36 divided by four (4)? It is nine (9).
      • Therefore, women should limit added sugar intake to 6 teaspoons per day and men to nine (9) teaspoons per day (American Heart Association, 2017).
      • Also, USDA recommends limiting added sugars to less than 10 percent of calories per day (USDA & HHS, 2015).

    Hands-On: Sugar Size Up

    • Instruction:
      • Select one beverage as an example, and calculate the teaspoons for sugar together as a group.
      • Ask for or select a volunteer to come up and measure out the teaspoons of sugar.
      • Note: Use a clear cup so that the sugar content is easily visible.
        • Soda: ~ 14 tsp sugar
        • Sports Drink: ~ 9 tsp sugar
        • Energy Drink: ~ 15 tsp sugar
        • Juice Drink: ~ 17 tsp sugar
        • Sweetened Tea: ~ 14 tsp sugar
        • Water: 0 tsp sugar
    • Share:
      • Now we are going to practice calculating the teaspoons of sugar in beverages. Participants will answer the following questions:
    • Instruction:
      • Divide participants into groups and assign each a different beverage.
      • Have each group calculate the equivalent teaspoons of sugar. To calculate the teaspoon-equivalent, take the number of grams and divide by four (4) to get the number of teaspoons. In other words, one teaspoon of sugar equals four (4) grams (Michigan State University, 2013).
      • Have one person from each group share the answers to each of the following questions:
        • What is the serving size?
        • What are the servings per container?
        • How many grams of sugar per serving?
        • How many grams of sugar total? Multiply grams of sugar by the servings per container.
        • How many teaspoons of sugar? Divide the total grams of sugar by 4.
    • Share:
      • What are some other drinks we could choose instead that have less or no sugar (California Department of Public Health, 2014)?
        • Water – plain or flavored with added fruit, vegetables, and herbs
        • Unsweetened seltzer water or unflavored sparkling water
        • Unsweetened tea (iced or hot)
        • Unsweetened coffee (iced or hot)
        • Milk
    • Share:
      • Let’s cover some frequently asked questions.
      • What about juice? 100% fruit juices have a lot of natural sugar so it is recommended to limit consumption to less than eight ounces (or one cup) per day.
        • Make sure to check the nutrition label to see if it’s 100% juice. If you’re craving fruit, though, there’s an even better choice. The whole fruit! It has more fiber, which will keep you fuller, longer.
      • What about diet soda? These can contain non-caloric sweeteners, which may seem like the smart choice.
        • However, some research shows that these no-calorie sweeteners can actually increase weight (Azad et al., 2017).
        • If you like the fizziness, choose a seltzer water or unflavored sparkling water instead (California Department of Public Health, 2014).

    Real World Relevance: Why Make a Choice?

    • Share:
      • Now we are going to evaluate drinking sugary beverages. But first, let’s review a few terms.
      • What does evaluate mean? To determine the significance or worth of something.
      • What does benefit mean? A good or helpful result or effect.
      • What does barrier mean? A problem that makes something difficult or impossible.
    • Instruction:
      • Instruct participants to take a moment and reflect on the benefits and barriers to limiting sugar content.
      • Then, have participants share with the entire group. Record answers on a projector, board or flip chart paper.
      • What are the benefits of choosing a non-sugary beverage? Answers could include: help you stay hydrated, manage weight, perform better in school, keep the brain working, regulate blood sugar levels.
      • What are the barriers to choosing a non-sugary beverage? Answers could include: not as tasty, access to less sugary options
      • How can we overcome those barriers? Answers could include: carry a water bottle, add flavor to water (such as cucumbers, lemon, berries, and mint), and add seltzer water to 100% juice if you like fizzy drinks.
    • Share:
      • Why is it important to drink water?
      • Dehydration is a condition that results from excessive loss of body water (WHO, 2017). It can cause tiredness, headaches, lack of concentration, reduced mental performance, and dry skin.
      • So does it make sense to drink a sugary sports drink after working out over water? No!
      • You should choose water because it is one of the few fluids that hydrates without sugar.


    Exit Ticket:

    • Instruction:
      • Have participants write on their worksheet or share out loud the following question(s).
        • What did you learn?
        • Why is it important?
        • What change(s) are you going to make about the way you stay hydrated?
          • Carry around a water bottle
          • Drink water instead of soda during meals (water instead of sports drink after exercising, etc.)
          • Set reminders to drink water
          • Buy less sugary beverages and drink water instead

    Special thank you to our partners at Atkins for supporting the content of this lesson:

    Atkins Nutritionals, Inc. (Atkins) is a consumer lifestyle and packaged goods brand with a 50-year legacy of helping individuals reach their weight management goals by making better choices about the best foods to eat. With a well-balanced approach to nutrition emphasizing a wide array of vegetables, proteins, healthy fats and fiber-rich carbohydrates, Atkins is committed to educating and empowering people on living healthier lives with an increased awareness about controlling carbohydrates, leading to balanced blood sugar, sustained energy, and improved health markers in the long term.



    • Optional Good to Know: Four Grams
      • Share: The body produces insulin to reduce and regulate the blood sugar, but sometimes it can go too low and you feel these effects within your body as well as your brain. There have also been studies suggesting that too much sugar consumption can result in a decline in memory function by harming the hippocampus (which is responsible for a variety of functions such as forming memories, organizing thoughts, and storing information). It is important to look at the sugar content of a beverage. Point out that there is an approximate amount (4 grams) of sugar that the human body is built to circulate at a given time. Drinking beverages repeatedly with much more than 4 grams of sugar (e.g. soda or other sugary drinks) is taxing to the body; it’s not designed for this (Wasserman, 2009).
    • Optional Real World Relevance Activity: Water Is Life
      • Instruction: Participants complete the fill-in-the-blank section on their worksheet by selecting words from the word bank. And review the correct answers.
        • Starting in the morning with breakfast, aim to have 6-8 drinks per day.
        • When we are born water makes up about 75% of our body weight.
        • Water makes up about 60% of the body weight of older children and adults.
        • Water is constantly being lost in our body (when we go to the toilet when we breathe when we sweat) so if we don’t drink enough, we become dehydrated.
        • Water helps our body in many ways. It carries nutrients to cells, helps to remove waste products from our major organs and helps us to control our body temperature.
        • People can survive for up to 50 days without food but only a few days without drinking water.
      • Share: Based upon our discussion and your analysis, do you think the benefits outweigh the barriers when choosing a non-soda beverage? Yes.

    This lesson was created in partnership with Albert Einstein College of Medicine Department of Epidemiology and Population Health with funding support by the National Institutes of Health NIDDK Grant R01DK097096.

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