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Childhood Obesity and Carbohydrate Intake: Review of a Recent Study

I think it’s safe to say that we all know that obesity is a problem in this country. Sometimes we might deny what a huge problem this is, but once you pay attention and look around you realize we have an epidemic. This will cripple our nation in terms of rising healthcare costs, disability and general lack of joy and vitality in life. Not only is it expensive, it’s just sad.

The even more frightening situation on the horizon is the thousands of children who are now facing this horrifying scenario at such young ages. Children are now being diagnosed with prediabetes, high blood pressure and high cholesterol. This is often directly related to their weight. It’s not just the older kids either. Children as young as 3 or 4 years old will see these elevated numbers on their lab results. The question is: what do we do about it?

After graduating from high school, I worked for some time at the WIC Clinic (Women, Infant, and Children). It was my job to advise parents with their small children and pregnant women at risk about healthy eating. For some, this was the only time they would ever receive such one-on-one training. It was a rewarding experience. Unfortunately, we have often seen young children quickly climb their growth charts. The system would tag these people and we would be reminded at each visit to discuss ways to reduce calorie intake. It was often recommended to switch to lower-fat milk, reduce portion size or drink less juice. Sometimes these answers worked and sometimes they didn’t. To be honest, we didn’t always know what the right solution was. The main goal was to somehow convey to these parents that something had to change. A simple instruction like “eat healthy” would not do it.

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That’s why this recent study caught my eye. It brought me back to those WIC days and made me think about how I would approach these clients differently if I had known a more direct and positive recommendation with known health outcomes. You see, people often forget that when you work in public health, the recommendations need to be simple and easy to remember. I’m not saying people are stupid or don’t care, but they’re not necessarily in my office of their own free will and will. They have to be there, so I caught them for a few short minutes. If we can simply and firmly convince them with solutions that work, that’s a take-home message they could use.

So back to study. The premise was to see if changes in the types of sugars ingested could affect basic biochemical markers of health without changing the overall macronutrient or caloric composition of the diet. The markers they looked at before and after the diet included fasting blood sugar levels, fasting insulin levels, cholesterol levels, and the liver enzymes AST and ALT.

The study design was as follows. They took a group of children aged 6 to 18 years with high BMI and at least one other comorbidity (hypertension, hypertriglyceridemia, impaired fasting blood sugar, hyperinsulinemia, elevated alanine aminotransferase, or severe acanthosis negricans) and assessed their typical macronutrient and caloric intake. The goal was to keep this, along with their weight, stable throughout the study.

Fasting blood samples and an oral glucose tolerance test were administered on day 1 of the study. After that, they should start a diet provided exclusively by the clinic. These foods, as previously mentioned, matched their exact intake of macronutrients. The only change was swapping out added sugars, mostly fructose, and substituting other types of carbs from things like bagels, cereal, fruit, pasta, and bread. Total dietary sugar and fructose were reduced to 10% and 4% of total calories, respectively. Would this be enough to detect changes in general health?

As you can safely guess, there was a significant impact. Not in 3 months, not in 1 month – but in 10 short days. That’s why this study caught my attention so quickly. If this is true, which I think is likely (hopefully follow-up studies will continue to confirm this), it is immediate and simple news for us parents and older children to take home with us. Cut down on added sugars, eat other types of carbs instead (with colorful handouts, of course), and see an improvement in your risk of diabetes and cardiovascular disease.

I also found it interesting that the researchers had a hard time keeping the study participants’ weight completely stable, namely that they lost a small percentage of weight overall, which the researchers noted may have skewed the final results a bit. You then have to ask yourself, in a real-world setting, if weight loss wouldn’t be a natural by-product of simply changing the type of carbs you’re consuming when you’re on the diet, but aren’t told to watch so closely for identical macronutrient intake .

I won’t go into all the exact numerical results here, but you can read them and the entire study for yourself via the link at the top of this article. It’s worth reading.

I think the take home message is this. The types of carbohydrates we consume are important, and they definitely play a role in our young children. We need to remove added sugar from our diet. I’m not saying that bagels and cereal are the answer, but we cannot ignore the problem refined sugar has become in our diets and particularly in the foods and products that are touted to our youth. For those of us who work in public health, we can use this study as a clear example of a simple, tangible way to improve someone’s health. You may not solve every problem, but you can empower a client on the path to better health.

Thanks to Danielle VenHuizen

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