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New Diet Approach May Fight Child Obesity

Reduced-Glycemic-Load Diet Sheds Pounds, Lowers Diabetes Risk

By Jennifer Warner
WebMD Medical News Reviewed By Michael Smith, MD
on Tuesday, August 12, 2003

Aug. 12, 2003 -- A diet that focuses on changing how and what a child eats rather than just counting calories and fat grams may help obese children and adolescents lose weight and lower their risk of developing type 2 diabetes.


New research shows a reduced-glycemic-load diet that emphasizes foods with a low to moderate glycemic index and allows children to eat until they're full was more effective than a traditional low-fat, calorie-restricted diet in helping obese children shed pounds and slow the progression of insulin resistance, a risk factor for diabetes.


Foods with a high glycemic index include simple carbohydrates, such as white bread, white rice, sweet cereals, and sugary foods. Researchers say these foods cause blood sugar levels to surge after eating, which places additional stress on the cells in the pancreas that produce the insulin needed to process sugar in the body.


Complex carbohydrates, such as whole-grain bread and cereals, brown rice, and vegetables, are foods with a low to moderate glycemic index.


By preventing this surge in blood sugar associated with eating foods with a high glycemic index, previous research suggests that people can curb their carbohydrate cravings and reduce their risk of diabetes.


Researchers say it's the first time the benefits of targeting the composition of a child's diet rather than just the total calorie intake have been shown in a major scientific study. The results appear in the current issue of Archives of Pediatric & Adolescent Medicine


"I think it is the first well-controlled study to show that we need to look at the composition [of the diet]. It's not a calorie is a calorie is a calorie," says Melinda Sothern, PhD, director of the Prevention of Childhood Obesity Laboratory at Louisiana State University's Pennington Biomedical Research Center. "It's echoing what we're seeing in the adult literature."


Counting Carbs vs. Calories


In this study, researchers compared the effects of the following two diets in a group of 14 obese adolescents between the ages of 13 and 21:


A reduced-glycemic-load diet that emphasized eating foods with a low to moderate glycemic index and getting 45% to 50% of their daily calories from complex carbohydrates, such as whole grains, fruits, and vegetables, and 30% to 35% from fat
A conventional reduced-fat diet that emphasized eating foods low in fat with 55% to 60% of daily calories from carbohydrates and 25% to 30% from fat

After one year, adolescents who followed the reduced-glycemic-load diet lost an average of 11 pounds more than those on the conventional low-fat diet and lowered their body mass index (BMI, a measure of weight in relation to height used to indicate obesity) by an average of two units.


By comparison, the group that followed the traditional low-fat diet generally remained the same and didn't lose or gain any significant amount of weight.


In addition, researchers found that those adolescents on the reduced-glycemic-load diet had improvements in insulin resistance -- an indicator of how well the body is handling blood sugar -- that were above and beyond those attributable to weight loss alone.


Together with obesity, insulin resistance significantly increases the risk of developing type 2 diabetes. Researchers say the current epidemic of childhood obesity has spurred a dramatic increase in type 2 diabetes among adolescents, which poses significant long-term health risks.



A New Approach for Obese Children?


"Unfortunately, conventional approaches to dietary treatments for obesity have had poor long-term effectiveness in any population, let alone children," says researcher David Ludwig, MD, PhD, director of the obesity program at Children's Hospital Boston.


Ludwig says obese children and adolescents are one of the toughest groups to treat because they are at a time in life when many other emotional, psychological, and developmental changes are already under way. That makes finding teens that are motivated to lose weight or adopt dietary habits that are different from their peers especially problematic.


But adolescents in this study actually preferred the low-glycemic-index diet to the more traditional diet.


Experts say that by taking the pressure off counting calories and putting the emphasis on eating until they become full may make it easier for young people to stick to a diet as well as develop healthy eating habits.


"Unlike in most long-term weight-loss studies where maximum weight loss is seen at six months and substantial weight regain occurs at 12 months, in our study we found no weight regain between six and 12 months, providing encouraging signs that this diet might be sustainable in the long term," says Ludwig.


Ludwig describes the reduced-glycemic-load diet as a middle ground between the high-fat, low-carbohydrate diets, such as the Atkins diet, and low-fat diets that tend to be high in carbohydrates.


"It may be a very nice compromise -- more effective than a low-fat diet but not as extreme and restrictive as an Atkins diet," says Ludwig.


Ludwig says ultimately the goal of any diet is to reduce calorie intake to stimulate and sustain weight loss.


"The question is, 'How do you get there?'" Ludwig tells WebMD. "If you get there with an external calorie restriction as with a typical diet that leaves the individual or especially the child feeling excessively hungry or psychologically deprived, then that individual would be unlikely to follow that diet for the long term, causing a big risk for weight regain."


Sothern agrees with the emphasis on quality carbohydrates and lowering sugar intake that are hallmarks of the reduced-glycemic-load diet, but she says diet is only half of the story in fighting childhood obesity and reducing the risk of diabetes among adolescents.


"The diet is only as good as the physical activity it's paired with," says Sothern. "You can put people on a low-glycemic diet all you want, but if they're not physically active, it's only going to have half the effect it could have if it was combined with exercise."



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SOURCES: Archives of Pediatric & Adolescent Medicine, August 2003. David Ludwig, MD, PhD, director of the obesity program, Children's Hospital Boston. Melinda Sothern, PhD, director, Prevention of Childhood Obesity Laboratory, Louisiana State University, Pennington Biomedical Research Center.





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At last a good study. But must they always find a way to jab at the good Dr. Atkins? I think this is pretty much what Atkins for life is all about... people confuse the induction part of Atkins with the LC lifestyle.

bvtaylor...I agree. This sounds an awful lot like Atkins For Life or lifetime maintainance.

My reservation about it is, they're still singing the praises of so-called "complex carbohydrates." Really, if you look at the GI, there's only a piffling difference between brown rice and white rice - they're both disastrous to my diabetic system and therefore probably equally bad for IR type people. Or anyone, for that matter. And "whole grain" bread? same story, GI only marginally different for wholewheat vs baloon bread. And in fact, lots of the "crafty" multi grain breads are loaded with molasses, honey, stuff like that. The only really low GI foods are things like broccoli, cauliflower, lettuce, stuff like that. I think they're just trying to salvage the pyramid, by telling us to eat the mythical "whole grain" starches. As Dr Bernstein says "Sugar?You may ask, holding up a slice of coarse-ground, seven grain bread. This is sugar? In a word, YES, at least after you digest it." Really, once they accept the concept of GI, they're conceding to dr A's premises, and may as well give up. Bill

The reason for this is simple: The amount of Fibrous Bran/Germ in a Wheat Kernel is almost none. A Wheat Kernel is almost all Endosperm. I believe White Bread is made from the Endosperm. Whole Wheat is made from the Whole Kernel. But, the Kernel [in nature] only has a token/trace amount of Bran/Germ. So, in reality...there is not much nutritional difference between the two.

Think about it this way...If you take White Flour, sprinkle it with a few Bran Flakes and a few Germ Seeds, then grind it down and mix it together, you basically have Whole Wheat. Whole Grains [for the most part] are a joke, because there is so little Bran and/or Germ in the Kernel anyways.

I think the difference comes in when the grain is not ground up. Our bodies are inefficient in breaking down the coverings on whole grains and unless they are ground up or chewed (which still doesn't get all the grains, some are left whole), the glycemic index would be lower for the whole grains. Glycemic index also takes into account the amount of fiber in a substance which does slow down the absorption and subsequent blood sugar rise. Proteins and fats also aid in slowing down this process as well which is why you can moderate the impact of carbs by eating fats and proteins with them. Having said that, you still can't eat a Krispy Kreme with a stick of butter and hope that you won't have a blood sugar spike.

The benefit of whole grains is of course the fiber which tends to slow the glycemic load (studies have shown that fiber is extremely important in a diabetic's diet) but I think as well the criticism of refined grains is in part that the process that breaks down a whole grain also corrupts myriad of beneficial nutrients inherent in the food (nutrients which are usually best absorbed in their natural state by our bodies).

These vita-nutrients are critical in protecting and keeping our bodies healthy inside and out. They may also help stave off cravings that lead to overeating.

That's why white flour is often fortified to make up for the loss of nutrients. In fact a bleaching process is used to make flour white. It doesn't mean, however, that those nutrients are as well received by our bodies as they would have been in the natural state.

A normal healthy diet should allow whole grain foods in moderation, blended of course, with good natural sources of fat and protein.

A good diet has variety and leans towards whole, less-processed foods in general. It's the processed foods that are high in trans-fats, those partially hydrogenated monsters that improve food texture and shelf-life but are murder to our cardiovascular system--found typically in frozen dinners and other frozen prepped foods, baked goods, and pre-packaged desserts.

Just look at a simple can of mushrooms, and you will be appalled at how there are little or no nutrients in comparison to their fresh comrades. In a society that does not have much time for food prep, we rely heavily on these empty canned foods.

Ever looked at a jar of applesauce? It's basically all sugar carbs unless fortified with Vitamin C. I'm sure a raw apple with all it's fiber and a-peel is a lot more beneficial both for the glycemic load and for nutrients.