A recent study titled “Incidence of Childhood Obesity in the United States” recently published in the NEJM has sent obesity experts around the world scrambling. The study took a longitudinal view of over 7,000 kindergarten children and followed their weight and height for almost a decade. They used standard criteria to define “overweight” and “obesity” based on body mass index (BMI). Their most startling finding was that a third of children who were overweight at age of five had progressed to full-blown obesity nine years later and those who were obese tended to stay that way. Some of those who were overweight or obese managed to move into the normal range during the study and some normal kids transitioned to being overweight or obese, but as the study progressed fewer and fewer kids made these transitions. Time seemed to seal their fate.

Fat Chance of Overcoming Obesity
Previous studies have documented how many children were overweight or obese at any given age, but until this study we really didn’t know what happened to these children over time. Thus obesity seems to become firmly established relatively early in life, suggesting that interventions in older children are less likely to be effective. Most of our current efforts at reversing obesity are targeted to older children and adults, so this study suggests that we may need to realign our efforts. The good news is that if you can make it to age 5 with a normal BMI, you are much less likely to transition to obesity in later years. In other words the dye is cast at a very early age. Although they didn’t track the children before the age of 5, they did have access to their birth weight and larger babies were at increased risk of developing obesity. This suggests that for many children, obesity starts in utero.

Previous studies that have attempted to reverse childhood obesity in schoolchildren have mostly failed. A few intense studies have shown some positive results but these approaches tend to be very expensive and they usually aren’t covered by insurance. On the surface this study presents a rather dismal picture and prognosis. Perhaps we should just throw up our hands and give up in despair! In my opinion this would be a big mistake. Perhaps we have been barking up the wrong tree when it comes to obesity. Although this study doesn’t address the causes of childhood obesity, most of the efforts to combat it have focused on the usual villains—too much food and not enough exercise. In my opinion this approach is doomed to failure from the start.

Body Mass Index—A Trip Down the Wrong Road
Years ago when the obesity epidemic really started to take off I learned a thing or two about obesity when I was working as a Family Physician in a small town in Northern Minnesota. I decided to study the topic in detail and immediately recognized that obesity is defined as excessive body fat. At the time most clinicians were using weight as a measure of obesity. Although BMI had been first described by Belgian Adolphe Quetelet in the early 1800’s, it really didn’t enter the medical consciousness until it was described in a paper published by Ancel Keys at the University of Minnesota in 1972. BMI was thought to be a more accurate measure of obesity because it takes into account both height and weight. BMI is essentially a measure of your relative size.

At the time it occurred to me that BMI really doesn’t tell me what I want to know—how much fat is in a patient’s body. The most accurate way to find out if someone is obese is to measure their body composition. I purchased some equipment to do so and over the years I took over 18,000 body composition readings. Almost immediately I noticed an interesting trend. Those who were the most successful dieters and lost the most weight often still had significant excess body fat, because they were losing more lean body mass than fat. In other words many of these champion under-eaters remained obese even as they lost weight.

At the time there was emerging evidence that diet composition might play a key role in obesity. This trend was ushered in by the Atkins Diet and was soon followed by other similar diets that downplayed the calorie issue. Gary Taubes was the champion of this perspective in his books “Good Calories, Bad Calories” and “Why We Get Fat”.  I soon noticed that people who followed this approach tended to slowly lose fat without losing lean body mass. In other words they became less obese even when they didn’t lose much weight. I also noticed that some folks with a normal body composition or even some thin people had excessive body fat. These patients were usually eating highly processed food like their larger cohorts, but they were simply eating less of it. The issue concerning body composition might seem like a minor point, but over the years I learned that food composition seems to play a key role in fat storage. Grandma was right—you are what you eat.

This is Your Brain on Processed Food
Another key thing I learned by measuring body composition is that many people with excessive body fat seem to have problems with their brain function. Over time they develop certain brain dysfunction symptoms that not only interfere with their ability to function, but also pushes them down a road of poor dietary choices. Over the years I noticed that these brain and metabolic problems seem to travel together in a predictable manner, suggesting that we are dealing with a distinct disease. I now call this condition Carbohydrate Associated Reversible Brain syndrome or CARB syndrome. Some of the typical symptoms of CARB syndrome are physical and mental fatigue, minor memory problems, poor impulse control and constantly thinking about food and eating. The lead symptom of CARB syndrome is experiencing intense cravings for sweet and starchy foods. Over the years I noticed that not all obese children fit the CARB syndrome pattern, many of them do.

Vanish the Cravings
I also learned that unless I could somehow suppress these brain dysfunction symptoms in adults, patients really couldn’t comply with any type of treatment program. The best nutritional information in the world was no match for intense carbohydrate cravings. Over the years I learned how to suppress these symptoms by focusing on improving brain function. The same principles apply to obese children who fit the CARB syndrome pattern. If they have physical and mental fatigue and strong cravings for sweet and starchy foods, it is highly unlikely they will benefit from traditional programs focused on eating less and exercising more.

Obesity is Linked to the Past
As this study suggests, obesity may even start in utero based on a pregnant mother’s eating habits. In my experience many pregnant mothers fit the CARB syndrome pattern and the type of food they are eating likely sets their infant up for the same disease process. Infants who are likely born with CARB syndrome do reasonably well when fed breast milk or formula because these foods lack the primary triggers of CARB syndrome—excessive fructose mainly from sugar and HFCS, high glycemic carbohydrates especially from grains and excessive omega 6 fatty acids from vegetable oils. Of course this describes typical processed food. When they start to consume finger foods and solids, the disease takes off.

This combination of obesity and brain dysfunction in children not only sets up a future loaded with common chronic diseases like obesity and type II diabetes but also dooms children to less than optimal functioning in school settings. Many of these children are then diagnosed with ADHD, oppositional defiance disorder (ODD), bipolar II, learning disabilities and similar conditions. Thus the health picture for our children may be much worse that described in this article. These children become victims of what I call “labelitis”—a long list of questionable diagnoses.

The study also shows that Hispanics, blacks and poor children below the age of five are more prone to developing obesity, but after the age of five these factors become less important. Of course once a child is obese at the age of five, they will likely stay that way, so these factors do seem to have some relevance. If obesity is caused by over-eating and lack of exercise, then this study implies that Hispanics, blacks and poor people are too dumb, stupid and lazy to figure out how much to eat and how much to exercise. It is obvious that nobody is going to openly discuss these statistics in this manner, so they are often presented with little explanation or comment.

If you use the CARB syndrome disease model, then these statistics make perfect sense. The tendency for any given race to develop CARB syndrome is inversely associated with the length of time a given race has been eating highly processed food. Whites have been doing so for much longer than Hispanics or Blacks, so they tolerate processed food somewhat better than other racial groups. Poor people often cannot afford healthy whole foods or they are not available in their neighborhoods, so they end up eating cheap processed foods.

Is it Hopeless?
So where do we go from here? Are many of our children simply doomed to a lifetime or poor metabolic health and brain function? If we learn to focus like a laser on the right efforts, we have a chance to turn things around. If CARB syndrome is already established in a pregnant mother, then keeping the child healthy will be a challenge. That means that we need to improve the health of women before they get pregnant. In my experience the most effective way to do so is to focus on diet composition rather than quantity of food. Processed food should be drastically reduced or eliminated. Carbohydrates should mainly come from vegetables and some fruits rather sugar and grains. Healthy fats like olive oil, coconut oil, avocados and nuts should always be included in the diet. Some people do well with a limited carbohydrate, high fat ketogenic diet.

It’s also critical to focus on the cravings. Knowing the best way to eat won’t do much if your brain is constantly craving sweet and starchy food. The amino acid L-glutamine can help to suppress these cravings. I recommend taking at least 1,000 mg 3x daily between meals.  A precursor supplement like CARB-22 can also suppress these cravings and the other symptoms of CARB syndrome by helping to maintain healthy levels of neurotransmitters like serotonin, norepinephrine and dopamine. If a woman is trying to get pregnant or becomes pregnant, I don’t recommend taking these supplements because very few supplements have been studied for safety in pregnancy. Thus during pregnancy focusing on food composition is the best way to maintain healthy metabolism and brain function.

It’s Never Too Late To Start
This same approach is appropriate for infants and young children. Once infants come off breast milk or formula, it is extremely important to transition them to healthy whole foods in a form that is appropriate for their age. Whatever you do, please refrain from the common practice of giving them finger foods like Cheerios. It’s best to make your own baby food by grinding up the whole foods you are eating. It’s critical for the whole family to adopt a lifestyle and diet that is compatible with a healthy metabolism and brain function. For many people I recommend following a Paleo style diet as outline in Loren Cordain in his book “The Paleo Answer” or Robb Wolf in his book “The Paleo Solution”. If you do so, it’s much more likely that mom will be in good place if she becomes pregnant again, providing a great deal of protection for the next generation when it comes to obesity and brain function. David Perlmutter also outlines the many of the adverse affects of processed food on brain function in his book “Grain Brain”.

For children with significant obesity associated with CARB syndrome symptoms, consider placing the child on a ketogenic diet. This diet was originally developed to treat seizures in children and it is safe and well tolerated in this age group. It has been shown to be very helpful at reversing metabolic problems and improving brain function. Jimmy Moore will be coming out with his new book “Keto Clarity” sometime this spring and I know it will be a good read. If you want to protect the metabolism and brain function of your children, it is extremely important to institute these recommendations at an early age.

Even if your child has already become overweight or obese, it’s never too late to reserve this process but you can’t afford to wait. If you child demonstrates any of the 22 symptoms of CARB syndrome, then it’s critical to focus on improving your child’s metabolism and brain function today by following these basic principles:

1. Focus on food composition rather than calories. The most critical step is to restrict processed food loaded with sugar, processed grains and vegetable oils.
2. For children over the age of two, use targeted supplements to suppress cravings for sweet and starchy foods. Powdered L-glutamine can be added to milk and CARB-22 capsules can be pulled apart and the powder can also be added to milk or water at a reduced dose.
3. Be sure the child receives an omega 3 supplement. I recommend visiting Barry Sear’s web site for more information on this important topic.
4. Use exercise to improve brain function rather than as a measure to burn calories.
5. For those with significant obesity associated with CARB syndrome symptoms, consider placing the child on a ketogenic diet. Jimmy Moore is the master of ketogenic diets.
6. Never give up! It’s never too late to improve the metabolism and brain function of any given child.

How do you know if this approach is working? I recommend paying attention to two parameters: improvement in brain dysfunction symptoms and body shrinkage. If the child’s symptoms are subsiding–especially carbohydrate cravings, and the child seems to be shrinking, then the approach is working. Body shrinkage can be assessed by paying attention to how the child’s clothes fit or you can take body measurements. When you lose fat rather than lean body mass, then there is noticeable body shrinkage even if there isn’t much weight loss.

Even though this study seems to outline a dismal future for many of our children, it doesn’t have to be this way. We can move these statistics in the right direction one child at a time. Let’s work together to ensure the health and wellbeing of the generations to come.