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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 obesity is a problem in this country. Sometimes we can be in denial about what a huge problem it is, but once you pay attention and look around you realize that we have an epidemic on our hands. This will cripple our nation in terms of rising health care costs, inability to work, and general lack of joy and vitality in one’s life. It’s not only expensive, it’s just sad.

The even more terrifying situation on the horizon is the thousands of children who now face this terrible scenario at such a young age. Children are now being diagnosed with pre-diabetes, high blood pressure and high cholesterol. This is often in direct correlation with their weight. It’s not just the older children either. Children as young as 3 or 4 see these elevated numbers on their lab results. The question is: what do we do about it?

I worked in the WIC (Women, Infant, and Children) clinic for a while after I graduated from grad school. My job was to advise parents with their young children, as well as high-risk pregnant women about healthy nutrition. For some, this was the only time they would ever receive such one-on-one education. It was a rewarding experience. Unfortunately, we often saw young children climbing quickly on their growth charts. The system would flag these individuals and we would be reminded at each visit to discuss ways to reduce calorie intake. Often it was a recommendation to switch to low-fat milk, or cut down on portion sizes, or drink less juice. Sometimes these answers worked, and sometimes they didn’t. Honestly, we didn’t always know what the right solution was. The main goal was to somehow get these parents through that something had to change. A simple guideline like “eat healthy” wouldn’t cut it.

That’s why this new study that came out recently 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 knew a more direct and positive recommendation to make with known health outcomes. You see, people often forget that when you work in public health, the recommendations should be simple and easy to remember. I’m not saying people are dumb or don’t care, but they aren’t necessarily in my office out of their own free will. They must be there, and so I captured them for a few short minutes. If we can simply and firmly convince them with solutions that work, that’s a message they can take home.

So back to the study. The starting point was to see if changes in the types of sugars that are consumed, without a change in the overall macronutrient or caloric composition of the diet, can affect basic biochemical markers of health. Some of the markers they looked at pre- and post-diet included fasting blood glucose levels, fasting insulin levels, cholesterol levels, and the liver enzymes AST and ALT.

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

Fasting blood samples and an Oral Glucose Tolerance Test were administered on day 1 of the study. Afterwards, they would start a diet of food provided only by the clinic. These foods, as stated earlier, matched their exact macronutrient intake. The only change was swapping added sugars, especially fructose, and substituting other types of carbohydrates from things like bagels, cereals, fruit, pasta and bread. Total dietary sugar and fructose were reduced to 10% and 4% of total calories, respectively. Would this be enough to see changes in overall health?

As I’m sure you can guess, there was a significant impact. Not in 3 months, not in 1 month – but in 10 short days. That was the reason why this study caught my attention so quickly. If this is true, as I assume it likely is (hopefully follow-up studies will continue to confirm this), this is a direct and easy take-home message that we can give to parents and to older children themselves. Cut back on added sugars, eat other types of carbohydrates instead (with colorful handouts included, of course), and see improvement in your risk for diabetes and cardiovascular disease.

In addition, I found it interesting that the researchers had a hard time keeping the weights of the study participants perfectly stable, namely that they lost a small percentage of weight overall, which the researchers noted that the final results ever so have a little skewed. You then have to wonder in a real world environment, with the implementation of the diet, but not telling them to monitor so closely for identical macronutrient intake, if weight loss would not be a natural byproduct of simply changing the types of carbohydrates that you consume.

I won’t dive into all the exact numerical findings here, but feel free to check them out and the entire study for yourself via the link at the beginning of this article. It is worth reading.

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 sugars 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 diet and especially in foods and products promoted 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 make a difference in someone’s health. You may not be able to solve every problem, but you can inform a client to get on the path to better health.

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