Skip to main content
Top

06-05-2024 | Obesity | REVIEW

Beyond Obesity and Overweight: the Clinical Assessment and Treatment of Excess Body Fat In Children

Part 2 — the Prescription of Low-Carbohydrate Eating as the First Approach

Authors: Mark Cucuzzella, James Bailes, Jenny Favret, Nina Paddu, Anna Beth Bradley

Published in: Current Obesity Reports

Login to get access

Abstract

Purpose of Review

Pediatric obesity and comorbidities related to insulin resistance continue to be a growing public health crisis. If lifestyle measures are unsuccessful, pharmacological and surgical interventions are offered. In this paper, we describe the driving force of the obesity crisis: hyperinsulinemia and the development of insulin resistance. We give historical background of key policy issues which have contributed to this pandemic as well as the physiologic mechanisms of insulin resistance. The prevalence of obesity will continue to rise unless the root cause of hyperinsulinemia is addressed.

Recent Findings

Current research on insulin resistance demonstrates that a decreased consumption of carbohydrates is an effective first-line dietary intervention for the treatment of obesity and related metabolic diseases. Evidence shows it is safe and beneficial.

Summary

A low-carbohydrate eating pattern can be helpful to address pediatric obesity. However, there must be policy guardrails in place to ensure that this is a sustainable and viable option for children and their families. There must be a change in the nutritional environment to help individuals battle the chronic disease of obesity.
Literature
3.
go back to reference •• Chacón V, Cara KC, Chung M, Wallace TC. Defining “low-carb” in the scientific literature: a scoping review of clinical studies. Crit Rev Food Sci Nutr. 2024. https://doi.org/10.1080/10408398.2023.2300705. There remains a lack of scientific consensus on what level of carbohydrate intake constitutes low-carbohydrate diets. The scoping review helps us understand how low-carbohydrate diets were defined in the peer-reviewed literature.CrossRefPubMed •• Chacón V, Cara KC, Chung M, Wallace TC. Defining “low-carb” in the scientific literature: a scoping review of clinical studies. Crit Rev Food Sci Nutr. 2024. https://​doi.​org/​10.​1080/​10408398.​2023.​2300705There remains a lack of scientific consensus on what level of carbohydrate intake constitutes low-carbohydrate diets. The scoping review helps us understand how low-carbohydrate diets were defined in the peer-reviewed literature.CrossRefPubMed
5.
go back to reference •• Volek JS, Phinney SD, Krauss RM, Johnson RJ, Saslow LR, Gower B, Yancy WS Jr, King JC, Hecht FM, Teicholz N, et al. Alternative dietary patterns for Americans: low-carbohydrate diets. Nutrients. 2021;13(10):3299. https://doi.org/10.3390/nu13103299. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling.CrossRefPubMedPubMedCentral •• Volek JS, Phinney SD, Krauss RM, Johnson RJ, Saslow LR, Gower B, Yancy WS Jr, King JC, Hecht FM, Teicholz N, et al. Alternative dietary patterns for Americans: low-carbohydrate diets. Nutrients. 2021;13(10):3299. https://​doi.​org/​10.​3390/​nu13103299. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling.CrossRefPubMedPubMedCentral
6.
go back to reference •• Zinn C, Lenferna De La Motte KA, Rush A, Johnson R. Assessing the nutrient status of low carbohydrate, high-fat (LCHF) meal plans in children: a hypothetical case study design. Nutrients. 2022;12;14(8):1598. https://doi.org/10.3390/nu14081598. PMID: 35458160; PMCID: PMC9032080. This study demonstrates that LCHF meal plans can be energy-, protein-, and micronutrient-replete for children and adolescents. •• Zinn C, Lenferna De La Motte KA, Rush A, Johnson R. Assessing the nutrient status of low carbohydrate, high-fat (LCHF) meal plans in children: a hypothetical case study design. Nutrients. 2022;12;14(8):1598. https://​doi.​org/​10.​3390/​nu14081598. PMID: 35458160; PMCID: PMC9032080. This study demonstrates that LCHF meal plans can be energy-, protein-, and micronutrient-replete for children and adolescents.
7.
go back to reference Desmond MA, Sobiecki JG, Jaworski M, Płudowski P, Antoniewicz J, Shirley MK, Eaton S, Książyk J, Cortina-Borja M, De Stavola B, Fewtrell M, Wells JCK. Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021;113(6):1565–77. https://doi.org/10.1093/ajcn/nqaa445. PMID: 33740036; PMCID: PMC8176147.CrossRefPubMedPubMedCentral Desmond MA, Sobiecki JG, Jaworski M, Płudowski P, Antoniewicz J, Shirley MK, Eaton S, Książyk J, Cortina-Borja M, De Stavola B, Fewtrell M, Wells JCK. Growth, body composition, and cardiovascular and nutritional risk of 5- to 10-y-old children consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021;113(6):1565–77. https://​doi.​org/​10.​1093/​ajcn/​nqaa445. PMID: 33740036; PMCID: PMC8176147.CrossRefPubMedPubMedCentral
18.
go back to reference •• Ludwig DS, Holst JJ. Childhood obesity at the crossroads of science and social justice. JAMA. 2023;329(22):1909–10. https://doi.org/10.1001/jama.2023.7592. Treatment focused on the root cause of disease generally achieves the best outcomes for efficacy and safety, a precept that has guided medical research and clinical practice for centuries. The American Academy of Pediatrics (AAP) published a clinical practice guideline for the evaluation and treatment of children with obesity emphasizes weight loss drugs and bariatric surgery even though the prevalence of childhood obesity has increased far too fast to be attributable to otherwise untreatable genetic predisposition.CrossRefPubMed •• Ludwig DS, Holst JJ. Childhood obesity at the crossroads of science and social justice. JAMA. 2023;329(22):1909–10. https://​doi.​org/​10.​1001/​jama.​2023.​7592. Treatment focused on the root cause of disease generally achieves the best outcomes for efficacy and safety, a precept that has guided medical research and clinical practice for centuries. The American Academy of Pediatrics (AAP) published a clinical practice guideline for the evaluation and treatment of children with obesity emphasizes weight loss drugs and bariatric surgery even though the prevalence of childhood obesity has increased far too fast to be attributable to otherwise untreatable genetic predisposition.CrossRefPubMed
20.
go back to reference Cucuzzella M, Sullivan K. "Low Carb on Any Budget". ebook supported by educational grant from Claude Worthington Benedum Foundation 2022. Cucuzzella M, Sullivan K. "Low Carb on Any Budget". ebook supported by educational grant from Claude Worthington Benedum Foundation 2022.
21.
go back to reference Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R, et al. Charlie Foundation; Matthew’s Friends; Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;21;3(2):175–92. https://doi.org/10.1002/epi4.12225. PMID: 29881797; PMCID: PMC5983110. Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R, et al. Charlie Foundation; Matthew’s Friends; Practice Committee of the Child Neurology Society. Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;21;3(2):175–92. https://​doi.​org/​10.​1002/​epi4.​12225. PMID: 29881797; PMCID: PMC5983110.
22.
go back to reference Sidbury JB Jr, Schwartz RP. A program for weight reduction in children”. In Childhood Obesity, edited by Collip PJ. 1975;65– 74. Acton, Mass. Publishing Sciences Group. Sidbury JB Jr, Schwartz RP. A program for weight reduction in children”. In Childhood Obesity, edited by Collip PJ. 1975;65– 74. Acton, Mass. Publishing Sciences Group.
24.
go back to reference •• Pauley M, Mays C, Bailes JR Jr, Schwartzman ML, Castle M, McCoy M, Patick C, Preston D, Nudelman MJR, Denning KL, Bellner L, Werthammer J. Carbohydrate-restricted diet: a successful strategy for short-term management in youth with severe obesity—an observational study. Metab Syndr Relat Disord. 2021;19(5):281–87. https://doi.org/10.1089/met.2020.0078. Epub 2021 Feb 9. PMID: 33566732; PMCID: PMC8823673. This study demonstrated a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office. •• Pauley M, Mays C, Bailes JR Jr, Schwartzman ML, Castle M, McCoy M, Patick C, Preston D, Nudelman MJR, Denning KL, Bellner L, Werthammer J. Carbohydrate-restricted diet: a successful strategy for short-term management in youth with severe obesity—an observational study. Metab Syndr Relat Disord. 2021;19(5):281–87. https://​doi.​org/​10.​1089/​met.​2020.​0078. Epub 2021 Feb 9. PMID: 33566732; PMCID: PMC8823673. This study demonstrated a carbohydrate-restricted diet, utilized short term, effectively reduced weight in a large percentage of severely obese youth, and can be replicated in a busy primary care office.
27.
go back to reference Schiavo L, Pilone V, Rossetti G, Barbarisi A, Cesaretti M, Iannelli A. A 4-week preoperative ketogenic micronutrient-enriched diet is effective in reducing body weight, left hepatic lobe volume, and micronutrient deficiencies in patients undergoing bariatric surgery: a prospective pilot study. Obes Surg. 2018;28(8):2215–24. https://doi.org/10.1007/s11695-018-3145-8. PMID: 29502279.CrossRefPubMed Schiavo L, Pilone V, Rossetti G, Barbarisi A, Cesaretti M, Iannelli A. A 4-week preoperative ketogenic micronutrient-enriched diet is effective in reducing body weight, left hepatic lobe volume, and micronutrient deficiencies in patients undergoing bariatric surgery: a prospective pilot study. Obes Surg. 2018;28(8):2215–24. https://​doi.​org/​10.​1007/​s11695-018-3145-8. PMID: 29502279.CrossRefPubMed
28.
go back to reference •• Favret J, Wood CT, Maradiaga Panayotti GM. Ketogenic diet as an advanced option for the management of pediatric obesity. Curr Opin Endocrinol Diabetes Obes. 2021;28(5):488–95. https://doi.org/10.1097/MED.0000000000000661. STEP, the Duke Healthy Lifestyles Program version of low carbohydrate high fat eating, is a safe dietary intervention for a carefully selected subset of pediatric patients with obesity who are trying to lose weight.CrossRefPubMed •• Favret J, Wood CT, Maradiaga Panayotti GM. Ketogenic diet as an advanced option for the management of pediatric obesity. Curr Opin Endocrinol Diabetes Obes. 2021;28(5):488–95. https://​doi.​org/​10.​1097/​MED.​0000000000000661​. STEP, the Duke Healthy Lifestyles Program version of low carbohydrate high fat eating, is a safe dietary intervention for a carefully selected subset of pediatric patients with obesity who are trying to lose weight.CrossRefPubMed
Metadata
Title
Beyond Obesity and Overweight: the Clinical Assessment and Treatment of Excess Body Fat In Children
Part 2 — the Prescription of Low-Carbohydrate Eating as the First Approach
Authors
Mark Cucuzzella
James Bailes
Jenny Favret
Nina Paddu
Anna Beth Bradley
Publication date
06-05-2024
Publisher
Springer US
Published in
Current Obesity Reports
Electronic ISSN: 2162-4968
DOI
https://doi.org/10.1007/s13679-024-00564-1
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.