Childhood obesity and carbohydrate intake: Review of a recent study

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 may deny what a huge problem it is, but once you pay attention and look around, you realize we have an epidemic on our hands. This will cripple our nation in terms of rising healthcare costs, inability to work, and general lack of joy and vitality in one's life. Not only is it expensive, it's just sad.

The even scarier situation on the horizon is the thousands of children facing this horrific scenario at such a young age. Children are now diagnosed with pre-diabetes, high blood pressure and high cholesterol. This is often directly related to their weight. It's not just the older children. Children as young as 3 or 4 years old see these elevated numbers in their lab results. The question is: what do we do about it?

After graduating from school, I worked for some time in the WIC (Women, Infant and Children) clinic. My job was to advise parents with their young children and high-risk pregnant women about healthy eating. For some, this was the only time they ever received such individual training. It was a rewarding experience. Unfortunately, we have often seen young children quickly climb their growth charts. The system would flag these individuals and we would be reminded at each visit to discuss ways to reduce calorie intake. It was often recommended to switch to low-fat milk, reduce portion sizes 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” wouldn’t change it.

That's why I noticed this new study that was recently published. 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 working 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 aren't necessarily in my office of their own free will and will. They must be there, and 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 that they might use.

So back to the study. The premise was to test whether changes in the types of sugars consumed, without changing the total macronutrient or calorie composition of the diet, could influence basic biochemical markers of health. Some of the markers they examined before and after the diet included fasting blood glucose levels, fasting insulin levels, cholesterol levels, and the liver enzymes AST and ALT.

The study design was this. They took a group of children aged 6 to 18 years with high BMI and at least one other comorbidity (hypertension, hypertriglyceridemia, impaired fasting glucose, hyperinsulinemia, elevated alanine aminotransferase, or severe acanthosis negricans) and assessed their typical macronutrient and calorie 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 the first day of the study. After that, they should start a diet of foods provided exclusively by the clinic. These foods, as previously mentioned, were consistent with their exact macronutrient intake. The only change was swapping out added sugars, primarily fructose, and replacing other types of carbohydrates with 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 sufficient to detect changes in general health?

As you can probably 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, as I think it probably is (hopefully follow-up studies will continue to confirm this), this is an immediate and simple take-home message that we can give to parents and older children ourselves. Cut down on added sugar, eat other types of carbohydrates 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 found it difficult to keep the weights of the study participants perfectly stable, namely that they lost a small percentage of weight overall, which the researchers believe may have only slightly skewed the final results. In a real-world setting, one then has to ask oneself whether, in implementing the diet, but without being told that they need to control identical macronutrient intake so closely, whether weight loss would not be a natural byproduct of simply changing the type of carbohydrates one consumes.

I won't go into all the exact numerical results here, but you're welcome to read them and the entire study for yourself using the link provided at the beginning of this article. It's worth the read.

I think the take home message is this. The types of carbohydrates we consume matter, and they definitely matter in our young children. We need to get the added sugar out of our diet. I'm not saying bagels and cereal are the answer, but we can't ignore what a problem refined sugar has become in our diets and especially in the foods and products marketed to our youth. For those of us 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 be able to solve every problem, but you can empower a client to get on the path to better health.