A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity

Ebbeling, Cara B.; Leidig, Michael; Sinclair, Kelly B.; Hangen, Jan P.; Ludwig, David S.

doi:10.1001/archpedi.157.8.773

Cited by 385 publications

(255 citation statements)

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“…The common or shared aetiologies of obesity and MS may also impact on who is targeted for obesity treatment and the management approach chosen. 33 The strengths of this study are recent data collection allowing assessment of MS prevalence within a background of high obesity prevalence and the narrow age range, which limits the effect of age-related differences, including the possible confounding of puberty on insulin resistance. The limitations of the study are the lack of a (non-overweight) control group to enable comparison and that the cut points used for MS definitions were not derived from local data.…”

Section: Discussionmentioning

confidence: 99%

Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study

et al. 2006

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Objectives: To assess the implications of variation in Metabolic Syndrome (MS) definition (biochemical and anthropometric indicators) on MS prevalence estimates in a population of overweight and mildly obese children. Design: Cross-sectional study. Subjects: Ninety-nine (64 girls) overweight or mildly obese, but otherwise healthy, pre-pubertal 6-9-year olds recruited for a randomized controlled trial of weight management. Measures: Height, weight and waist circumference were measured with BMI and waist z-scores calculated. Fasting cholesterol and fractions, glucose and insulin were measured, together with systolic and diastolic blood pressure (BP). Anthropometric and metabolic indicators were classified as normal or elevated using adult-or child-specific cut points with clustering of MS indicators also assessed using two adult and three child-specific definitions. Results: A total of 0-4% of subjects were classified with MS when adult definitions were applied. This increased to between 39 and 60% using child-specific definitions, varying according to whether hyperinsulinaemia was central to the MS classification. Systolic BP, triglycerides, total cholesterol, high-density lipoprotein cholesterol and waist z-score increased across insulin quartiles (Po0.05). The use of body mass index and waist circumference in the MS definition classified the same subjects. Conclusions: The classification of MS in children depends strongly on the definition chosen, with MS prevalence estimates higher if insulin is part of the definition and child-specific cut points for metabolic indicators are used. Hyperinsulinaemia and MS are common consequences of childhood obesity but they are not commonly part of the assessment or management plan for weight management in children. There is a need for the establishment of normal insulin ranges and consistent definition of MS in childhood and adolescence.

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Section: Discussionmentioning

confidence: 99%

Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study

et al. 2006

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“…There have been previous studies of low-GI diet in obese children (9-12) who had significant changes in body composition when they received instruction about this diet. A study of 14 obese children divided into two groups receiving a reduced-GL vs. reduced-fat diet by Ebbeling et al (12) found BMI and FM decreased more in the low-GL group at 12 mo. Intensive intervention by 12 dietary behavioral therapy counseling sessions for 6 mo followed by two dietary counseling sessions for 6 mo afterward may have caused this reduction in FM, not observed in our study.…”

Section: Articlesmentioning

confidence: 99%

“…However, the effectiveness of a low-GI diet in the treatment of pediatric obesity has not been well evaluated. There are few studies in obese children on BMI reduction (6)(7)(8) and fat mass reduction (9)(10)(11)(12), and some of these studies showed an improvement in insulin sensitivity (9,12); however, their sample sizes were quite small, and most of the studies were conducted in western countries and may not be applicable to Thai cuisine. In Thailand, the staple food is rice which has several varieties.…”

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confidence: 99%

Low-glycemic index diet may improve insulin sensitivity in obese children

et al. 2015

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ArticlesClinical Investigation nature publishing group BACKGROUND: A low-glycemic index (GI) diet may be beneficial for weight management due to its effect on insulin metabolism and satiety. METHODS: Obese children aged 9-16 y were randomly assigned either a low-GI diet or a low-fat diet (control group) for 6 mo. Body composition changes were measured by dualenergy X-ray absorptiometry and bioelectrical impedance analysis. Insulin sensitivity was measured by fasting plasma glucose and insulin. RESULTS: Fifty-two participants completed the study (mean age: 12.0 ± 2.0 y, 35 boys); both groups showed significantly decreased BMI z-score but similar changes in fat and fat-free mass. The low-GI group demonstrated a significant decline in fasting plasma insulin (22.2 ± 14.3 to 13.7 ± 10.9 mU/l; P = 0.004) and homeostatic model of assessment-insulin resistance (4.8 ± 3.3 to 2.9 ± 2.3; P = 0.007), whereas the control group did not. However, general linear model showed no significant difference in insulin resistance between groups after adjusting for baseline levels, suggesting that the greater reduction in insulin resistance in the low-GI group may be explained by higher baseline values. CONCLUSION: Despite subtle effects on body composition, a low-GI diet may improve insulin sensitivity in obese children with high baseline insulin. A bigger study in obese children with insulin resistance could be worthwhile to confirm our findings.C urrently, the prevalence of childhood obesity has been increasing worldwide (1). The Centers for Disease Control and Prevention reported that about 17% of children and adolescents in the United States aged 2-19 y were obese (2). Furthermore, the prevalence of the metabolic syndrome has been rapidly rising in obese children, and with it, the risk of cardiovascular disease (3). About 60% of overweight children have at least one cardiovascular disease risk factors such as hypertension, dyslipidemia, and insulin resistance. In addition, more than 25% of them have more than one type of cardiovascular disease risk factors (1). The common complications of childhood obesity are the metabolic syndrome (hypertension, dyslipidemia, insulin resistance, and type 2 diabetes), obstructive sleep apnea, nonalcoholic steatohepatitis, polycystic ovary syndrome, orthopedic complications, and premature atherosclerosis (4).At present, we are unable to describe the exact etiology of obesity, but one of the most common causes is an imbalance between energy intake and physical activity. Treatment of obesity is difficult and can be done by several approaches, including dietary control (such as low-fat, low-energy diet), physical activity program, behavioral modification (such as generating weight reduction goal, self-monitoring, as well as positive reinforcement by parents), and medical treatment. There are many pediatric patients seeking hospital-based obesity treatment. Most of them have one or more of the complications of obesity mentioned above as well as a loss of their self-esteem and social lives. In general, ...

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“…Figure 4 models the short-term (1-year) results from these types of studies, translated to BMI percentiles. Figure 5 demonstrates results from all behavioral counseling studies among adolescents 86,88,104,105,107,108 that reported, or could be translated into, BMI percentiles. Most studies addressed extremely overweight patients, with short-term results showing modest to no change in BMI percentiles.…”

Section: Behavioral Counseling Interventionsmentioning

confidence: 99%

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

et al. 2005

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ABSTRACT. Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.Methods. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched Results. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m 2 ) is >50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.Conclusions.

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A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity

Cited by 385 publications

References 40 publications

Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study

Comparison of metabolic syndrome prevalence using six different definitions in overweight pre-pubertal children enrolled in a weight management study

Low-glycemic index diet may improve insulin sensitivity in obese children

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

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