Where Do We Go Now?

December 13, 2007 at 3:55 pm Leave a comment

Not a day goes by without some mention in the media about the epidemic of childhood obesity. We’re reminded that there is a growing prevalence of overweight and obesity amongst our children and that we must do something to avert a health crisis in the future – overweight and obese children are at a higher risk for heart disease, type II diabetes and a host of other ailments. All of this is true.

We read and hear about all sorts of solutions – improve the diet of children, eliminate vending machines in schools and advertising to children on television, limit screen time for television, computers and video games, encourage more physicial activity, build more sidewalks so children can walk to school, increase physical education classes in schools, enroll children in programs that promote physicial activity, cook meals at home, eat with your children, eat fewer meals prepared outside the home, decrease juice consumption, eliminate sugary sodas, provide more fruits and vegetables each day, limit saturated fat and cholesterol, go for low-fat or skim milk and dairy, eat less fast food – the list goes on and on, boling down to the same tired advice for adults who are overweight or obese – eat less and move more.

Here’s a startling finding – data from various studies suggest that the cause of childhood obesity is not calories per se, nor is it inactivity.

In fact a large number of studies find that despite differences in weight, children of similar age consume similar calorie loads each day; and even that children engage is similar levels of activity. Simply put, the data suggests children who are overweight or obese do not overeat, nor are they sedentary when compared with their peers who are normal weight.

Other data finds that the numerous proposed interventions – actually tested in clincial trials to see what happens – do little over the long-term for children who are enrolled in various interventions. Yet we continue along the same path of hope, that modifying diet and increasing physical activity might work in the future.

What’s the problem?

The first problem is our focus.

In an ABC News article we find it articulated by Dr. Keith-Thomas Ayoob, associate professor of pediatrics at the Albert Einstein College of Medicine in New York, “Children who have been obese for much of their childhood will enter adulthood with chronic health problems that will only continue if their BMI remains high.”

So of course the solution is to reduce BMI and/or prevent it from ever reaching the threshold of being classified overweight or obese. No brainer, right?

Wee little problem – it’s a flawed solution that fails to address the underlying cause of the weight gain.

Which brings us to the second problem – seeing the weight as the problem, not the symptom it is.

We’ve reached the point where our list of potential solutions are all directly tied to the belief that obese children are fat, lazy and just eat too damn much, because that is the only place you can go when you believe that weight gain is simply a matter of calories in and calories out.

Taking that belief to the next step, you reach the idea that if you modify the calories in and increase the calories out, children will slim down and realize the health benefits long-term.

Yet there is no strong evidence that finds this works for the long-term – not in adults and not in children. But the lack of evidence has not caused us to pause in the past, so why should it in the present and future?

We absolutely need to step-back and take a critical look at what is really happening today. We’re telling our children that they’re too fat, lazy and going to die before their parents; we’re telling them that they’re going to have major health issues when they are adults; and we’re actively promoting the idea that their parents are failing them.

I cringe when I read most of the articles about childhood obesity today because what we’re setting up for the future of our children is pretty darn scary!

To me it’s not scary that the future is bleak for these children because they’re overweight or obese – no, it’s because we’re on the path to destruction because we’re focused on weight and BMI rather than the true underlying cause of weight gain in children, and even adults – insulin resistance, a nutritionally bankrupt diet and the cascade of metabolic derrangement from both.

Rather than address that, the powers that be focus on the overt symptom – weight gain – and design solutions based on assumptions that reducing calories and increasing activity will solve the problem.

But, we know from other studies, that body weight and BMI in children is a poor indicator of health and well-being.

A number of studies have found that even slim children can be insulin resistant and fat despite having a normal body weight and BMI.

In very young children, a study out of Sweden found that children with a higher BMI head a higher incidence of insulin resistance, yet consumed less fat but more sugar, despite consuming consuming similar calories each day as their healthier peers.

As I noted in my review of that study, “The summary says it all “A lower fat intake was associated with higher BMI and higher HOMA ß-cell function. fS-insulin and insulin resistance were associated to increased growth rate from birth to the age of 4 (upward centile crossing). Risk factors for the metabolic syndrome can be identified already in healthy 4-year olds, especially in girls.”

We ignore data, like that published in February 1998 – Diabetes Care; U-shaped and J-shaped relationships between serum insulin and coronary heart disease in the general population. The Bruneck Study, where researchers concluded, “Results of the present study suggest that both hyperinsulinemia and “hypoinsulinemia” are independent indicators of CHD. Furthermore, it is proposed that the relationship between CHD and fasting insulin is U-shaped, whereas that between CHD and postglucose insulin may be J-shaped.”

In June 2003 – Obesity Research; Fasting plasma insulin modulates lipid levels and particle sizes in 2- to 3-year-old children reported “Fasting insulin level was positively correlated with triglyceride levels and inversely correlated with HDL-cholesterol level in boys. Higher fasting insulin level was also correlated with smaller mean HDL particle size in both boys and girls and smaller mean LDL particle size in boys. The associations of fasting insulin level with triglyceride and HDL-cholesterol levels and HDL and LDL particle size remained significant after multivariate regression adjustment for age, sex, and BMI or ponderal index. Fasting insulin level is associated with relative dyslipidemia in healthy 2- and 3-year-old Hispanic children.”

Two and three year old children, already experiencing the health damaging effects of high insulin and high triglycerides!

But it’s the calories driving the overweight driving the long-term risk of heart disease.

Yeah, right.

I wrote, back in November 2005, about a study published that found the incidence of pre-diabetes in teens alarming. In that article I wrote, “What is fueling this disfunction is not a metabolism gone awry, but years of eating a poor diet and consuming what can only be described as excessive carbohydrate in a state of malnutrition. This excess of carbohydrate and a chronic failure to meet nutrient requirements is exhausting the metabolism – exhausting the body’s ability to produce and effectively use insulin.

It is time we change our perspective to one that addresses the underlying problem – poor diet – and stop pretending it isn’t the increase in carbohydrate, to excessive levels, in our diet that is causing the numbers of children, adolescents and adults that become obese to continue climb and the numbers being diagnoised with pre-diabetes and diabetes to skyrocket along with other symptoms like dyslipidemia and high blood pressure.

What was once a long-term “wear-and-tear” disease seen in older people is now, with increasing and alarming frequency, afflicting our children. When are we going to stand up and say “enough is enough” – how many millions of children must be diagnoised before we finally step up and truthfully state the problem and give parents the solution to try to prevent this in their children?

This isn’t rocket science.”

Two years later, we still aren’t addressing the real problem – we just continue to beat the drum that children are growing fatter because they’re eating too much and moving too little.

If we are going to have a real impact on the health of our children, we MUST step-back from the dogma based on failed ideas and interventions with adults, and begin to tackle the real issue here – our nutritionally bankrupt diet that contains exessive carbohydrate day-in and day-out.

Our children gaining weight is the symptom of this excess – an excess not of calories, but an excess of carbohydrate leading to an excess of insulin and blood glucose, leading to insulin resistance in younger and younger ages, and leading to existing health problems as they enter adulthood.


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Low-Carb, Too Much Stress on the Body? Say It Isn’t So! Glycemic Index Doesn’t Matter Much in Overall High-Carb Diet

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