Cross Fit Gyms–A low carb community

One of the first things I did after I discovered how much better Juliana felt eating low carb was to go looking for a community for her.  The path was circuitous–Jimmy Moore’s livinlavidalowcarb blog had a list of “low-carb friendly” health practitioners, and Susan Jimenez was on it.  Turns out she is a nurse practitioner, but now she’s become a cross-fit trainer at the gym she runs with her husband Saul, Mad Dawg School of Fitness.  Cross-fit gyms recommend a Paleo, or Primal eating style–basically what we would have eaten before the advent of agriculture.  In other words, no grains, sugar, dairy, and limited fruit.  The eating plan consists mostly of animal protein in various forms and vegetables.  Paleo isn’t designed to be low carb, but it ends up being low carb.

A low carb gym sounded good to me, and we went to meet them.  Susan did a functional movement screen with Juliana, something they do at Cross Fit gyms to establish baseline mobility.  Then I joined them and poured out my questions–why hadn’t anyone ever told me carbs could be the problem for Juliana?  Was there a health care practitioner who could help me navigate this new environment?  Susan said it was unlikely we would find support for a low carb eating style amongst the health care establishment.  I knew from experience that my somewhat alternative family practice–they were willing to discuss the benefits and risks of commonly administered vaccines, unlike the pediatric practice I had left when Juliana was 2–would not know anything about it.

Juliana started training with Susan.  Even though she was a teenager in a gym for adults, she felt welcome and really enjoyed it.  She had to take a break over the summer and then for soccer season.  I started training there in September, and although I have historically disliked group exercise classes, cross-fit is totally different.  It’s the exercise equivalent of low carb eating–it does not recommend exhausting cardio sessions to control weight, as most other gyms do–rather cross-fit, generally speaking, recommends duplicating the likely physical feats of our ancient ancestors.

Lengthy cardio sessions leave you depleted and a tasty target for predators.  In cross-fit you do a lot of work on mobility, everywhere (hips, shoulders, wrists, ankles etc.) so that you become more agile and less prone to injury; you sometimes lift really heavy things; and you sometimes sprint really fast.  Cross fit may make it possible for me to succeed in my life-long project to get my shoulders to stay back instead of hunch forward.

Excellent resources to learn about Paleo/Primal eating and exercise are The Primal Blueprint, by Mark Sisson, and Mark’s blog:  Mark’s Daily Apple.

 

Most doctors won’t be able to help an overweight child

I asked many doctors over the years to help me with Juliana’s weight.  What was going on?  What do I do?  I got no help.  Her family practice doctor, whom I loved, told me frankly that doctors had no idea what was causing the obesity epidemic among children.  She asked Juliana what her favorite vegetable was.  Juliana replied “broccoli.”  That was the extent of our nutritional counseling.  All of the doctors I consulted prescribed “watchful waiting,” what I now think of as the hope that she would “grow into her weight.”

Why does the “grow into their weight idea” persist in the face of the evidence that most overweight children will become overweight adults?  In part because it’s almost impossible to lose weight and keep it off on the Standard American Diet if you are sensitive to carbohydrates (and all of us become more sensitive over time if we continue to eat carbohydrates–this is one of the reasons people tend to gain weight as they age).  Your doctor knows how little success he or she has counseling patients to lose weight–almost none of them do.  The myth allows everyone to postpone the day of reckoning for overweight or obese children.

A friend of mine provided a perfect example of this phenomenon recently.  She took her 14 year old to the doctor for a yearly physical, and wanted the doctor to help her discuss weight management with the teen.  The teen had recently gained a lot of weight without growing taller, and was clearly becoming uncomfortable with her appearance.  But the doctor didn’t.  Instead, she said that since the teen was “only” in the 80th percentile for Body Mass Index, she wasn’t overweight, and not to worry about it.  The doctor didn’t advise doing anything, even though the teen had gone from the 42nd percentile BMI at her last checkup a year prior to 80th percentile at this checkup.  I bet the doctor was relieved that the teen hadn’t crossed the 85 percent threshold, where she would technically be considered overweight, because the doctor knows she doesn’t have any effective information to offer on how the teen can slim down.

We check in with the Packard Program

Juliana and I visited with the staff from the Packard Program yesterday.  They are doing great good in the world trying to help obese kids achieve a healthy weight, and they have good success.  Nonetheless, I believe that the calories in/calories out model that underlies the program is wrong.  So why does it work as well it as it does?

The Packard Program teaches kids to substitute lower-calorie yellow or green foods for higher-calorie red foods.  In many cases, those substitutions are from super-high-carb foods to less-high-carb foods.

From a glass of apple juice, for example, to an apple.  8 ounces of apple juice has about 29 grams of carbs; one medium apple has about 16 grams of carbs and it also has 4 grams of fiber, for only 12 grams of “net carbs.”  (When counting carbs, you subtract the fiber grams from the total carbohydrate grams, because fiber does not provoke the same insulin response).

Or from a high-sugar cereal to a low-sugar cereal.   Changing from raisin bran (36 grams of net carbs per cup) to cheerios (19 grams of net carbs per cup) cuts the carb load almost in half.

Both those substitutions are lower calorie changes, but they are also lower-carb changes.  So is it the carbs, or the calories?   I think it’s the carbs.  See chapters 19 and 20 of Gary Taubes‘ “Good Calories, Bad Calories” for a full discussion of this point.

The real power of the realization that carbohydrate restriction is the most important part of the eating plan is that your child will not be constantly hungry on a low carb plan, as they will be on a low calorie “balanced” plan.  At Packard yesterday I really emphasized this point:  Juliana complied perfectly with the program and did lose 6 pounds in 10 weeks.  But she was hungry all the time and I didn’t see how she could possibly keep it up.

A low carb eating plan doesn’t require superhuman restraint to follow.  That makes it a lot easier to coach your child on a low carb eating plan than a low calorie eating plan.

After losing a lot of weight in the beginning, Juliana’s weight loss rate has slowed on the low carb eating plan.  But even if she only loses an average of a 1/2 pound a week, as she did on the Packard Program, she will eventually get to her goal weight WITHOUT suffering constant hunger.  And in the meanwhile, her energy level is high, she has a completely new level of physical stamina, and her mood is consistently good.

We enroll in a kids weight control program

After Juliana hit 168 pounds at a height of 5′ 4″, I went looking for a kids weight control program. I found one at Lucile Packard Children’s Hospital at Stanford University. It was near my house, and started at the end of January. It was expensive and not covered by insurance, but I wanted help. Juliana was in the habit of asking my permission to eat things–usually sweets or seconds. I never said no, but would try to guide her choices–”I wouldnt have the cookie because we are going to a party later and you’ll probably want something there.” I wanted to cut myself out as the middleman. I wanted her to be in charge and empowered to control her own intake. The Packard program is designed to do that. Juliana met with the Packard staff, learned about the program, and we both agreed to try it together.

The Packard program is based on the standard calories in/ calories out model.  Kids are taught to switch to lower calorie foods, control their portion sizes, and increase their physical activity level.  Children are thereby supposed to burn more calories than they consume and lose weight.  The Packard program first ramps down on higher calorie foods. Then it ramps up on physical activity.

Foods are evaluated for their caloric density, that is calories over grams of weight: c/g. Foods with caloric density over a certain threshold are red. Below a lower threshold are yellow, and below the lowest threshold are green.

Green foods are things you may eat in virtually unlimited quantities. It’s a short list, and includes things like broccoli, romaine lettuce, and spinach. Yellow foods are go-slow foods–usually still healthy, but watch your portion size. Whole wheat bread, pasta, chicken, starchy vegetables like sweet potatoes, eggs. Red foods are junk foods, like soda or candy, or fast food, but also meats if they aren’t low in fat, full fat cheese, and nut butters.

Eating more than two servings per meal of a yellow food also makes the third portion into a red, to try to control for meal size. The kids were taught the visual cue of a serving being equal to what would fit in the palm your hand.

Some of the kids started out eating 100 or more red foods per week. They had fast food, soda, and juice regularly. Juliana topped out at 35, the week she was on a trip with her school and had no control over her food. Even so, we reduced the number of reds she ate. We eliminated maple syrup on her whole wheat French toast, substituting applesauce. She cut out the 100 calorie fudge bars she liked for dessert. I started cooking with almost no oil–a teaspoon for six servings was a “yellow”, more than that a red. I started making mostly vegetarian bean soups and stews, carefully using my teaspoon of oil to sauté garlic and onion. In a few weeks, she was down to eating only 4 or 5 reds a week.  (The Packard program didn’t recommend even trying to go below 18 reds per week, because they wanted goals to be challenging but doable—they didn’t think 18 reds or fewer was doable enough).

After six weeks, the Packard program starts to ramp up on exercise. Different activities have different point values, and you try to increase your exercise points while you decrease your red foods. Juliana had always exercised, but she began to do even more.

Did she lose weight? Yes, she lost 6 pounds in 10 weeks.   I didn’t find that rate of weight loss very impressive, considering how few reds she was eating and how much she exercised.  Then she stalled, gaining back half a pound at the weekly weigh-in. And meanwhile, she was almost always hungry, despite eating every few hours. I would pick her up from school, and before she said hello, she would gasp, “do you have a snack?”

The Packard program confirmed for me what I had been saying to anyone I thought could help–compared to the other overweight and obese kids in the program, her eating habits had been super healthy, and now were even healthier, and she exercised. If the Packard program was going to work for her, shouldn’t she be steadily dropping weight eating only 4 reds a week and exercising a minimum of 30 minutes a day at a medium intensity? But she wasn’t. She was also having a hard time because she was frequently hungry.   I went looking for something better.

She won’t grow into it.

Wait for them to “grow into their weight.” This is one of the more misleading ideas out there. As Juliana grew older, I kept hoping this magic was starting to happen, or looked like it was going to start happening. I had been a bit pudgy as a child, and had a growth spurt and slimmed down when I was about eleven. I thought it was worth waiting to see if Juliana had a slimming growth spurt before trying something else, because I was worried about creating an eating disorder.  

As a result, we spent years on the wrong track. I only went looking for a structured weight loss program when Juliana’s weight at age 13 exceeded even a healthy adult weight. I realized that even if she grew to my height, she would still be overweight. Looking back, I realized that I had probably never been overweight, and certainly not obese as a child, as Juliana has been.