Childhood Obesity and Carbohydrate Intake: Review of the Recent Study “Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome.”

I think it’s safe to say that we all know obesity is a problem in this country. Sometimes we might be in denial about what an enormous problem it is, but once you pay attention and look around, you realize we have an epidemic on our hands. This is going to 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 just costly, it’s just sad.

The even scarier situation on the horizon is the thousands of kids who are now facing 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 to their weight. It’s not just the older children either. Kids as young as 3 or 4 are seeing these elevated numbers on their lab results. The question is: what do we do about it?

I worked in WIC (Women, Infant, and Children) clinic for some time after graduating from grad school. My job was to counsel 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 did often see 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 caloric intake. Often it was a recommendation to switch to lower 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 through to these parents that something had to change. A simple directive such as “eat healthy” wasn’t going to cut it.

That is why this new study that recently came out 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 to make 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 am not saying people are dumb or don’t care, but they aren’t necessarily in my office out of their own will and volition. They have to be there, and so I have them captive for a few brief minutes. If we can convince them simply and firmly with solutions that will work, that is a take-home message they might employ.

So back to the study. The premise was to see if changes in the types of sugars being ingested, with no change in overall macronutrient or caloric composition of the diet, could affect basic biochemical markers on 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 study design was this. They took a group of kids, ages 6-18, with high BMI, and at least one other co-morbidity (hypertension, hypertriglyceridemia, impaired 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 their weight, stable throughout the study.

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

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

Additionally I found it interesting that the researchers had a hard time keeping the study participant’s weights perfectly stable, namely they did lose a small percentage of weight overall, which the researchers noted may have skewed the final results ever so slightly. You have to wonder in a real world setting then, with implementing the diet but not being told they had to so closely control for identical macronutrient intake, if weight loss would not be a natural byproduct of simply altering the types of carbs one consumes.

I won’t dive into all the precise numerical findings here, but do feel free to peruse them and the entire study yourself via the link provided at the beginning of this article. It is worth the read.

I think the take home message is this. The types of carbs we consume do matter, and they definitely matter in our young children. We have got to get the added sugars out of our diets. I am not saying bagels and cereal are the answer, but we cannot ignore what a problem refined sugar has become in our diets and especially in the 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 solve every problem, but you might empower a client to get on the path to better health.