Fat moms make fat babies; and thin, high-carb eating moms might make fat kids too…

Juliana is the oldest of three kids, and the only one of my three kids who was ever overweight.  Indeed, at the moment, my son Teddy is technically underweight, with a BMI in the 3rd percentile.

When I was pregnant with and nursing Juliana, I ate a vegetarian diet.  When I was pregnant with her sister Molly, I had an overwhelming desire for chicken, and abruptly stopped eating vegetarian after 18 years.  So I got to wondering whether there might be a relationship between what I ate while pregnant and nursing and Juliana’s metabolism and ability to handle carbohydrates versus her siblings.

And there could be.  Fat mothers produce fatter babies; diabetic mothers (whose blood sugar is on average higher than non-diabetic mothers) produce fatter babies.  And the incidence of fat babies is increasingly dramatically, in step with the increase in obese and diabetic adults.

“The probable explanation is that as women of childbearing age get heavier and more of them become diabetic, they pass the metabolic consequences on to their children through what is known technically as the intrauterine environment. The nutrient supply from mother to developing child passes across the placenta in proportion to the nutrient concentration in the mother’s bloodstream. If the mother has high blood sugar, then the developing pancreas in the fetus will respond to this stimulus by overproducing insulin-secreting cells. “The baby is not diabetic,” explains Boyd Metzger, who studies diabetes and pregnancy at Northwestern University, “but the insulin-producing cells in the pancreas are stimulated to function and grow in size and number by the environment they’re in. So they start over functioning. That in turn leads to a baby laying down more fat, which is why the baby of a diabetic mother is typified by being a fat baby.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 8167-8174). Random House, Inc.. Kindle Edition.

Juliana wasn’t actually a fat baby.  But her intrauterine environment was with me eating a vegetarian diet, which was necessarily higher carb than when I switched to being an omnivore with Molly and Teddy’s pregnancies.  She was also nursed for several years with me eating a vegetarian diet.  I’m not diabetic, but that doesn’t mean Juliana didn’t suffer the consequences of my high-carb eating style:

“There’s no reason to think that the hormonal and metabolic consequences of high blood sugar—from what James Neel in 1982 called the “excessive glucose pulses that result from the refined carbohydrates/ over-alimentation of many civilized diets”—do not pass from mother to child through the intrauterine environment, whether the mother is clinically diabetic or not.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 8189-8192). Random House, Inc.. Kindle Edition.

I can’t prove that my eating style contributed to Juliana’s carb sensitivity and subsequent overweight–but it’s an interesting association that she is the only one of three kids who experienced my high-carb eating style and she’s the only one with excess weight.

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.

They probably won’t “grow into it.”

If you buy into the idea that your overweight child may grow into his or her weight, you have to wait until adolescence–possibly until the age of 16 or so for boys–to see if the slimming growth spurt appears before taking action. Your child will go through middle school and high school overweight or obese. They may experience teasing, social isolation, and will certainly find it harder to participate in sports because of their weight.

So what does the research science actually show?   It shows clearly that overweight and obesity among children is more and more common, and that most overweight children will become overweight adults. Time article. CDC Page. About.com.  So the odds are that even if some kids will grow into their weight, yours won’t.

And if they don’t, then they are at risk for all the chronic diseases associated with overweight and obesity.

Don’t let the small possibility that growth will outpace weight gain for your child prevent you from taking action now.

What is Body Mass Index?

Body Mass Index (BMI) is a ratio of weight to height. It is a screening tool for spotting people who are more likely to develop various health problems from over or underweight, and for tracking that development in children is progressing appropriately. In adults, a BMI Between 18.5 and 25 is considered healthy. Below 18.5 is underweight. Higher than 25 is overweight; higher than 30 is obese.

In children, the BMI is expressed not only as a number, but as a percentile rank. The child or teen is plotted against other kids of the same age. A child who has a BMI greater than 85 percent of children her age is considered overweight; greater than 95 percent is considered obese. A BMI of less than 5 percent is considered underweight.

There is a very wide range of weights that are considered healthy for a given height in children and adults. Juliana’s healthy weight range is between 93 and 136 pounds. My healthy weight range is between 121 and 171 pounds.

Healthy doesn’t mean ideal for the individual. Although a BMI of 24 is considered healthy, most adults will feel better at a much lower BMI. The same is true for children–although a BMI in the 84th percentile will not technically indicate a child is overweight, that child will likely feel better at a lower BMI.

I have 3 kids but only 1 is overweight

Taubes‘ books also explained why, although I had 3 children who were offered the same food, only one of them was overweight.  They explained why a child could be overweight even while eating the recommended 5 to 9 servings of vegetables and fruit a day.  While not drinking soda, juice, or even milk–just water.  While not eating fast food.  While virtually never eating out at all.  While rarely eating dessert. While being physically active.

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 Taubesargues 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.

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.

Maybe if I cook healthier food?

I went to elaborate lengths to prepare healthy food. I cooked breakfast every morning–no cold cereal. Whole wheat French toast, whole wheat pancakes, oatmeal, broccoli omelets. I packed healthy lunches every day. Juliana’s staple lunch was whole wheat pasta with carrots and chicken sausage. She would have a sweet potato, or a banana or beets for a snack. Sometimes with popcorn or applesauce. I tried the Jessica Seinfeld method of reducing calories by mixing starches like whole wheat couscous or quinoa with puréed yellow squash or cauliflower. I made pizza from scratch, with whole wheat dough and minimal cheese.

I packed, and packed, and packed, food on the go.  We have a busy life, and the kids have lots of activities.  My kids regularly eat in the car.  Packing food is a lot of work, and I would have loved to have “healthy” choices to pick up on the road–but there weren’t any.  Nonetheless, Juliana remained overweight.

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.