Our post last week (“Taste Buds — Got Milk?”) highlighting research showing that milk consumption in adults does not prevent bone fractures and may even increase the risk of heart disease generated some interesting reader comments, including this question:

If a person likes the taste of milk, particularly with cereal or cookies (my 20 year old still loves cookies and milk!), which is the best and/or safest? Skim, 1%, 2% or whole. I know I do not like the taste of whole or 2%, and thought skim or non-fat was best, but I’ve read recently that the opposite is true. I’ve read there’s more sugar and less nutritional value in skim vs. whole or 2% milk.


The significant difference between whole milk, low-fat milk (2% or 1%) or skim milk (0% milk fat) lies in the amount of saturated fat.  Following AAP nutritional guidelines has meant encouraging mothers to breastfeed until at least one year of age, giving whole milk in a cup between 1-2 years old, moving to low-fat milk at 2 years old, and then onto skim at 4 years.  These guidelines have been reinforced over the last few years with the realization that we have an obesity epidemic in this country.  Furthermore, most pediatricians feel that a lot of adult heart disease can be prevented with attention to nutrition in childhood — specifically diets low in saturated fat.  But a study published in Archives of Disease in Children challenges those assumptions, suggesting more scientific evidence is needed to support such guidelines. Alexandra Sifferlin spoke with one of the study’s authors:

“Our original hypothesis was that children who drank high-fat milk, either whole milk or 2% would be heavier because they were consuming more saturated-fat calories. We were really surprised when we looked at the data and it was very clear that within every ethnicity and every socioeconomic strata, that it was actually the opposite, that children who drank skim milk and 1% were heavier than those who drank 2% and whole…”


One reason often cited for recommending skim milk to children (four and over) and adults is that milk fat binds calcium in the intestine, allowing less of it to be absorbed.  Since skim milk has no fat, there is more calcium available to be absorbed from the intestine into the bloodstream and from there into bones.  The study we looked at last week questioned the importance of milk in regard to bone health.

Low-fat and fat-free (skim) milk are lower in calories than whole milk.  But the difference is probably not very significant unless you are drinking a lot of milk.  Allison Aubrey explains why whole milk might actually be better for people trying to lose weight:

It’s not clear what might explain this phenomenon. Lots of folks point to the satiety factor. The higher levels of fat in whole milk products may make us feel fuller, faster. And as a result, the thinking goes, we may end up eating less.


Which brings us back to our understanding of what makes us overweight and obese.  Blaming the amount of fat in milk isn’t going to do.  The fact is that when a person takes in (by eating and drinking) more calories than he or she burns off (by being active and exercising), the balance of calories in American culture favors weight gain.  When that imbalance of calories in vs. calories out persists over time, we become overweight and obese.

The solution seems pretty simple: Eat less quantity, eat greater quality (real food like fruits and vegetables vs. processed foods like sugar, processed wheat, and packaged “foods”), and be active.

Our goal as pediatricians is to help parents get this simple energy equation right for their children from the beginning.  For many reasons, it’s a lot harder to get the right balance in adulthood.