I think of myself as Juliana’s coach

There’s a bit of a fad now about parents who have been successful at forcing their children to lose weight with “strict and punishing” methods.  While the daughter in the article, now 8, is a healthy weight, you have to wonder if the mother’s methods are going to come back to haunt her later.

To me, it makes more sense to think of yourself as a coach.  No child or teen wants to be overweight.  If you provide them a path to a healthy weight that doesn’t require semi-starvation, they will embrace it.  The key is low carb eating–but there are many other things you may need to tweak.  Juliana’s weight loss was abruptly halted by allergy medications.  It took me 6 weeks to figure out that they were a problem.  Another time we decided she needed to drink much more water, and that got her weight loss going again.  In the Calories In/Calories Out model, these sort of hidden obstacles to weight loss do not get much attention.

Before she started eating low carb, I used to worry about everything she ate, and hope she would eat smaller portions.  Now, we think of weight loss as a big puzzle.  We need to continuously work on the the puzzle to get her to a healthy weight.  I keep reading, and make suggestions of new things to try.

The mother in the above article, Dara-Lynn Weiss, reportedly once tried the Atkins eating plan.  I’m willing to bet she didn’t do it correctly, or she would have finally understood what she had gone through with all the different diets she had tried, and what was going on with her daughter’s huge appetite.

Your child isn’t going to become an expert on low carb eating without your help.  As the coach, you need to learn everything you can to help your child work out his or her own weight loss puzzle.

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.

The scale is a tool

What about the scale? Throughout her childhood, I had been afraid to put Juliana on a scale. I looked for “innocent” opportunities to check her weight. Doctor’s visits, obviously, but also the scales in the dressing room at the pool–I’d check my weight and ask all my kids if they wanted to check theirs. If I took in one kid to urgent care for an earache or something like that, all 3 of them came with me and we’d kill time by checking our height and weight while waiting for the doctor. But Juliana usually declined.

Since I didn’t check her weight regularly, I am guessing that she gained about 30 pounds in a year from the age of 12 to 13. By not checking her weight regularly, I also missed this steep weight gain as it was happening–more than half a pound a week.

Why was I afraid to put her on a scale? Eating disorders and self-esteem issues. I didn’t want her to tie her self-worth to a number on a scale. I didn’t want to create the impression that food was bad because it was making the number on the scale go up, or that it might be a good idea to starve herself to get to a lower number. When Juliana was 9, her BMI had spiked up again. I asked a family therapist about using a scale with a 9 year old, and she was emphatically against it, for the same sorts of reasons.

For some kids and teens not using a scale might be the right answer. But, the scale is a very valuable tool. Information from the scale allows you, as your child’s coach, to continually tweak what you are doing to help your child achieve a healthy weight. If your eating plan is effective, the numbers on the scale will demonstrate that by going down. If it isn’t, they won’t.

Yes, I know, muscle weighs more than fat and takes up less space. Your child could be adding muscle, staying the same weight, but slimming down. Could be. But unless he or she is on an exercise program that would justify a belief in added muscle, I would be wary of hoping that is happening, simply because the hope delays making tweaks to your eating plan to improve its effectiveness.

What about body composition measurements? We tried a home body fat monitor, but the numbers varied too much day to day to give useful information about the effectiveness of the eating plan. Unlike with a scale, there is far too much variation in the measurements of the body fat monitor from day to day to know if you are losing body fat. Juliana’s measurements bounced up and down between 25% and 35% from day to day.

We started with weekly weigh-ins, which was the procedure on the Packard pediatric weight control program. But now we weigh in daily, because we don’t want to waste time on a losing strategy. She feels great eating low carb, and she’ll eat this way the rest of her life, and yes, eventually she’ll reach her goal weight one way or the other; but she still wants to slim down without wasting time. I think everyone does. So if you can use the scale as a tool, and not obsess over the number, you should.  Juliana is doing well with the information from a daily weigh-in.  You have to judge for yourself whether using the scale is going to do more harm than good for your child.

Low carb eating plans are not calorie- or nutrient-restricted

Mainstream advice generally is against children or teenagers going on diets. The worry seems to be that calorie or nutrient restriction can interfere with healthy development.  You will frequently see the advice to try to stabilize weight first, because it is assumed that doing so will require less calorie restriction than actually trying to lose weight.  By preventing more weight gain, children can “grow into their weight.”  This recommendation makes no sense on its face for children who already weigh more than a healthy adult weight, of which there are many, including Juliana when she started her low carb eating plan.

The unspoken assumption is that a weight-reducing diet must be calorie restricted and therefore nutrient restricted. But a low carb diet is neither. Children can and should eat until they are satisfied. It is better to call it a low carb eating plan, since diet seems to be synonymous with calorie restriction in most people’s minds.

Our eating plan consists of high quality meats, organic eggs, a little cheese, tree nuts, and vegetables. It is not calorie-restricted. It is not nutrient-restricted. There are no essential nutrients available in grains that are not available from other sources.  See Epilogue of : Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 9085-9089). Random House, Inc.. Kindle Edition, for a review of the evidence demonstrating that 1) the brain does not need ingested carbohydrate for fuel, but can manufacture what it needs from ingested fat and protein and 2) there are no essential vitamins and minerals in carbohydrate that are not available from meat and fat.

Moreover, we usually eat more than the recommended 5-9 servings of vegetables (not fruit) per day, unlike the vast majority of Americans.

BMI curves for children and teens may be moving out.

The 1977 BMI charts developed by the National Center for Health Statistics were revised, using new empirical data from five national health examination surveys, by the Center for Disease Control in 2000.

In comparing the 2000 to the 1977 charts, the CDC notes:

“For matching statures within the range shown, weights in the 2000 charts tend to be higher than weights in the 1977 charts, especially at larger statures and for girls.”  This may or may not be the result of the underlying population becoming heavier, since the data sets and statistical procedures used to develop the two sets of charts were not the same.  Jump to report.

While the stature for age charts match very closely, the weight for stature charts diverge.  The biggest difference is for girls–the 95th percentile of weight for stature in 1977 is almost the same at heights above 110 cm as the 90th percentile of weight for stature in 2000 (Figure 104).  Almost every percentile curve has moved out for girls (except the 5th percentile).  The difference is less pronounced for boys, with the lower percentiles tracking closely, and only the 90th and 95th percentiles moving out in the 2000 tables (Figure 103).

So a girl that was “obese,” above the 95th percentile in 1977, would now be classified as only “overweight.”  If the underlying population is becoming heavier, then heavier weights will fall in the range of “normal.”