We Know How to Reverse the Childhood Disease Epidemic -- but We're Not Doing It

The American Academy of Pediatrics recently updated its guidelines to recommend weight-loss drugs to kids as young as 12 and offer bariatric surgery to kids as young as 13.

These treatments are drastic, expensive, and for most kids, unnecessary. A proper diet is often enough to improve children's metabolic health and help their bodies shed excess weight. In fact, a mounting body of nutritional science suggests that kids can prevent or even reverse many common chronic diseases -- by cutting down on the vast quantity of sugars and starches we've come to think is normal in the human diet.

Since 1980, our government's official nutrition recommendations, enshrined in the U.S. Dietary Guidelines for Americans, have told us to eat more grains. Today, the guidelines advise six servings of grains per day -- including three servings of refined grains -- and up to 10% of calories as sugar.

Natural fats found in milk, cheese, and other animal products are still actively discouraged, and although the guidelines no longer recommend a "low-fat" diet, most people still think that's the healthiest approach.

On the whole, Americans have complied with the government's advice. We eat 28% more grains than we did in 1970, according to the government's most recent food availability report, and 30% more carbohydrates as a portion of total energy since 2011.

These changes in eating habits have coincided with a rise in obesity and other chronic conditions. In 1980, just 5% of American kids were obese. Today, about 20% are.

As a general pediatrician and pediatric endocrinologist who has practiced in eastern West Virginia and southern Ohio for 30 years, I have seen firsthand the effect of these guidelines.

In my first five years of practice, I was a victim of this high-carbohydrate fallacy. I routinely recommended that overweight children follow the government's guidelines, along with those from the American Academy of Pediatrics, which were virtually identical. I also counseled my patients to exercise daily and limit screen time.  

Unfortunately, none of my patients lost weight. In fact, most continued to gain weight at the same rate or even faster.

A turning point came when a third-year medical student asked me about carbohydrate restriction. I began researching the physiology of a low-carbohydrate diet, and it made sense. When carbohydrates such as sugar or starch are eaten, the pancreas secretes insulin, which is the body's main hormone for stimulating fat storage.

I figured that if we could limit insulin secretion by minimizing carbohydrate intake, children could lose weight. I started suggesting a low-carbohydrate diet for the overweight children in my practice.

My first patient was a 10-year-old girl who lost 14 pounds in two months. My second patient was a teenager who lost 12 pounds in six weeks.

Over the last 23 years, I have treated hundreds of overweight children with this diet. Several teenagers lost over 100 pounds. Other children witnessed their type 2 diabetes disappear. Every single one told me that they felt better, had more energy, and were less hungry than before.

There is a large body of rigorous science now supporting this diet and its ability to reverse obesity and type 2 diabetes. Colleagues and I have published journal articles on a small clinical trial we undertook, showing the success of our approach on weight loss and heart disease risk factors. Our larger, follow-up study confirmed these results. I've also testified before the 2020 U.S. Dietary Guidelines Advisory Committee, presenting evidence for carbohydrate restriction as an alternative to the current one-size-fits-all high-carbohydrate advice.

Yet the guidelines have not caught up. Despite at least one hundred clinical trials examining these diets -- including one conducted by a member of the advisory committee herself --, the committee's most recent report in 2020 claimed it could not find a single study on this topic.

Unfortunately, I have witnessed many children regain their weight when they resume eating the high-carbohydrate diets that the government still recommends. Many parents don't know how to make low-carb diets affordable, even though eggs and ground beef can fit into most household budgets. But the biggest challenge for my patients is the sugar-and-grain loaded food they're fed in schools: for breakfast, lunch, and even after-school snacks. Added sugars exceed 10% of total energy in more than 90% of breakfasts provided in public schools and 69% of lunches, according to a government report. These meals are a highway to obesity. Even my motivated patients find school food to be the most difficult obstacle to sustainable weight loss.

We urgently require a new standard of care for children with metabolic disease. And we need school cafeterias across the country to reduce carbohydrate consumption.

Congress and the USDA have the power to improve life for future generations of children. By not revising nutrition policy to reflect the most current scientific research, they are condemning millions of American kids to poor health -- and even early graves.

James R. Bailes, Jr., MD, is a pediatrician in West Virginia specializing in childhood obesity.