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.

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.”

Low fat, high carb eating has made us fat.

The low fat, high carb diet that public health authorities began recommending in the 1980s was supposed to be relatively low in calories, and therefore help people achieve or maintain a healthy weight.  Carbohydrates have fewer calories per gram of weight (4) than fat (9) and the same as protein (4).  Consuming more carbohydrates than protein or fat was supposed to supply fewer overall calories in the diet and result in a healthy weight.  But that’s not what happened.  Instead, people have gotten fatter and fatter.

Public health authorities now blame the obesity epidemic on the public not following their advice.  Gary Taubes argues that they have followed the advice, and cites food consumption statistics to back this up:

“Consider, for instance, that most reliable evidence suggests that Americans have indeed made a conscious effort to eat less fat, and particularly less saturated fat, since the 1960s. According to the USDA, we have been eating less red meat, fewer eggs, and more poultry and fish; our average fat intake has dropped from 45 percent of total calories to less than 35 percent”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 219-222). Random House, Inc.. Kindle Edition.

Yet people, including children, have become fatter than ever:

“The prevalence of overweight in children six to eleven years old more than doubled between 1980 and 2000; it tripled in children aged eleven to nineteen.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 4765-4766). Random House, Inc.. Kindle Edition.

Why is the high carb, low fat dietary advice just plain wrong?  Because it ignores what different types of foods do in the human body.  Carbohydrates produce a different biological response than do fats or proteins.  Specifically, they produce a response that stores food energy as fat.  Fat and protein do not.  However, the energy from fat and protein, if eaten in conjunction with carbohydrate, will be swept up in the same process and stored as fat.  Eating fat and protein with too much carbohydrate (and for many individuals, “too much” is a very small amount), will make you fat.

My daughter’s weight explosion

My daughter went from a low normal Body Mass Index of 25th percentile to above the 95th percentile (considered clinically obese) in about one year from the age of 3 and a half to 4 and a half.  I spent more and more time and energy over the next eight and a half years trying to help her slim down, ultimately enrolling us both in a pediatric weight control program at the Lucile Packard Children’s Hospital at Stanford.  Our experience in that program convinced me there had to be something else going on with Juliana than just that she ate more calories than she burned.  And I was right.