Nutrition Notes #3 - Hot Topics: Nutrition wars, More sobering childhood obesity news, Sodium limits

What you need to know -- and my 2 cents

This was a big week on the nutrition front. This week I want to dig deeper into 3 hot topics:

  • the energy balance vs carbohydrate-insulin theories of weight management

  • the 2021 RWJF childhood obesity report, and

  • new FDA voluntary sodium recommendations.

I’ll start each with as unbiased of a recap of the issue as possible. Then, I will share my 2 cents.

Nutrition Wars - The Energy Balance vs Carbohydrate-Insulin Theories of Weight Management

Classic teaching around weight management relies on the concept of energy balance. That is, eat fewer calories than you expend and you lose weight. Consume more calories than you expend and you gain weight. There are complex metabolic factors that play into the energy expenditure part of the equation but, according to the energy balance model, overall the principle holds. Researchers at NIH have developed a science-based tool the NIH Body Weight Planner that helps to figure just how many calories to consume in a day to achieve a given weight based on all of these factors. According to this model, a calorie is a calorie whether obtained from highly-palatable processed food or from a vegetable or piece of fruit, although people are more likely to overconsume calories from high-sugar processed foods than they are from whole foods with fiber like fruits or vegetables.

A perspective piece by Dr. David Ludwig of Boston Children and colleagues published in the American Journal of Clinical Nutrition argued that it is not energy imbalance that causes weight gain but rather the type of food consumed — in particular that high-glycemic carbohydrate intake triggers an insulin spike that causes fat deposition, increased hunger, and weight gain. It is the type of food that triggers a cascade that ultimately leads excess intake and weight gain. Their conclusion - for weight management, we should advise patients to follow a low-glycemic load diet.

My 2 Cents

These theories are not mutually exclusive, and, ultimately, a person’s weight is dependent on many factors. Overconsumption of calories beyond that which the body needs is likely to lead to weight gain. Likewise, consumption of highly-processed foods, many of which are of high glycemic-index refined grains and sugary drinks, probably derail hunger and satiety cues, leading to caloric overconsumption and metabolic dysregulation. Once weight is gained, there are complicated metabolic factors at play that resist permanent weight loss through nutrition and activity changes alone (I’ll talk more about this in a future Nutrition Notes on set point weight).

The ‘solution’ is not dieting or eliminating whole food groups or even not-so-healthy favorite foods, as this is likely to contribute to feelings of deprivation and low likelihood of long-term maintenance to the eating plan.

Rather, for optimal health, we need to focus less on weight and more on helping people adopt eating plans that high in foods we know are good for health — vegetables, fruits, nuts and seeds, whole grains. We need to help people enjoy these foods because they taste good and are good for us (check out last week’s Nutrition Notes post for more on this). And we need to make the stuff we all agree are not beneficial to health such as sugary drinks, ultra processed refined grains less ubiquitious.

This sounds simple and of course isn’t. But neither preaching “eat less, move more” nor a one-size-fits-all diet approach is likely to get us any further along in helping people improve nutritional status or overall health. Rather, we need to meet people where they are to help take small sustainable steps towards better health — while simultaneously advocating for environmental changes that make healthy foods and ample physical activity opportunities readily available for everyone.

The State of Childhood Obesity

The 2021 State of Childhood Obesity, a project of the Robert Wood Johnson Foundation, reports that 1 in 6 children in the United States has childhood obesity.

As I discussed previously, the COVID 19 pandemic has played a heavy role in the rising rates of childhood obesity. The report highlights that food insecurity and structural racism are also to blame.

The report advises the following priority policy recommendations:

  • make universal school meals permanent

  • extend eligibility for WIC to postpartum mothers through 2 years after birth of a child and to children through age 6.

  • expand programs that help pull families out of poverty and reduce food insecurity such as the expanded Child Tax Credit.

  • close the Medicaid coverage gap

My 2 Cents

The continued sobering news of persistently worsening childhood obesity should send alarm bells (and inspire action) for all of us, but most especially policy makers who need to make or expand policy level changes such as those outlined in the report as policy priorities to support child health.

Sodium Limits

The FDA issued food industry guidance for voluntarily lowering sodium in processed and packaged foods. Excess sodium contributes to hypertension which is a cause of heart attack and stroke, the 1st and 5th leading causes of death in the United States, respectively. More than 70 percent of total sodium intake is from sodium added to foods during manufacturing and commercial food preparation. The recommended target is to decrease sodium intake from 3400mg per day to 3000mg per day on average over the next 2.5 years.

The Dietary Guidelines recommend no more than 2300mg of sodium per age for those ages 14 and older, 1800mg for ages 9-13, 1500mg for ages 4-8, and 1200mg for ages 1-3. Americans across all age groups consume far more sodium than recommended.

My 2 Cents

Lowering sodium in the food supply is an excellent target to improve health. The recommendations are voluntary, so whether or not food manufacturers will actually achieve the target remains to be seen.

That’s a wrap for this week’s Nutrition Notes. If you found it to be useful, please share!

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