I think it’s safe to say that we all know obesity is a problem in this country. Sometimes we can deny what a huge problem it is, but once you pay attention and look around you, you realize that we have an epidemic on our hands. This will cripple our nation in terms of rising health care costs, the inability to work, and a general lack of joy and vitality in life. Not only is it expensive, it’s just sad.
The even scarier situation on the horizon are the thousands of children now facing this dire scenario at such a young age. Children are now diagnosed with prediabetes, high blood pressure, and high cholesterol. This often has a direct correlation with your weight. It’s not just the older kids, either. Children as young as 3 or 4 years old see these high numbers in their lab results. The question is: what do we do about it?
I worked at the WIC (Women, Infants and Children) clinic for some time after graduating from graduate school. My job was to counsel the parents of their young children, as well as high-risk pregnant women, on healthy nutrition. For some, this was the only time they would receive such a personalized education. It was a rewarding experience. Unfortunately, we often saw young children climb quickly on their growth charts. The system would flag these people and we would be reminded at each visit to discuss ways to reduce caloric intake. Often times, it was a recommendation to switch to low-fat milk, reduce portion sizes, or drink less juice. Sometimes these answers worked and sometimes they didn’t. Honestly, we didn’t always know what the correct solution was. The main objective was to communicate in some way to these parents that something had to change. A simple directive like “eat healthy” was not going to be enough.
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 had known to make a more direct and positive recommendation with known health outcomes. You see, people often forget that when working in public health, the recommendations should be simple and easy to remember. I’m not saying that people are dumb or don’t care, but they aren’t necessarily in my office of their own free will. They have to be there, so I hold them captive for a few minutes. If we can simply and firmly convince them with solutions that work, that’s a take-home message they could employ.
So let’s get back to the study. The premise was to see if changes in the types of sugars ingested, without changes in the overall composition of macronutrients or calories in the diet, could affect basic biochemical health markers. Some of the markers they observed 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 as follows. They took a group of children, aged between 6 and 18 years, with a high BMI and at least one other comorbidity (hypertension, hypertriglyceridemia, impaired fasting blood glucose, hyperinsulinemia, elevated alanine aminotransferase, or severe black acanthosis) and evaluated its 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. Subsequently, they had to start on a diet of foods provided solely by the clinic. These foods matched, as mentioned above, their precise macronutrient intake. The only change was switching to added sugars, mainly fructose, and substituting other types of carbohydrates from things like bagels, cereals, fruits, 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 is why this study caught my attention so quickly. If this is true, as I suppose it is likely (hopefully follow-up studies will continue to confirm this), this is an immediate and easy-to-take-home message that we can pass on to parents and older children themselves. Cut back on added sugars, eat other types of carbohydrates instead (with colorful brochures included, of course), and see an improvement in your risk for diabetes and cardiovascular disease.
Also, I found it interesting that the researchers had a hard time keeping the study participants’ weights perfectly stable – that is, they lost a small percentage of weight overall, which the researchers observed may have skewed the final results slightly. So you have to ask yourself in a real world setting, with the diet in place but not being told that they have to monitor the identical macronutrient intake so closely, if weight loss would not be a natural by-product of simply altering the types of carbohydrates consumed.
I will not delve into all the precise numerical findings here, but feel free to read them and read the entire study yourself via the link provided at the beginning of this article. It is worth reading.
I think the take home message is this. The types of carbohydrates we eat are important, and they definitely matter in our young children. We have to eliminate added sugars from our diet. I am not saying that bagels and cereals are the answer, but we cannot ignore what a problem refined sugar has become in our diets and especially in foods and products that are promoted to young people. 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. It may not solve all problems, but it can empower a client to move toward better health.