Fat kids eat less.

Great Debates
1

Really. Apparently fat kids, at least from 7 years old on, really eat less. I put this here because I know it will be of interest to many and that some will debate it as it seems so counter-intuitive.

There are many possible speculative explanations for this data. Fat kids may move less, perhaps as part of their nature or perhaps or as a consequence of their obesity; fat kids may actually be fat because they really do have a slower metabolism; obesity may secondarily result in hormonal or other changes that slow BMR and feed-forward a tendency to gain more weight; and others.

But what seems to be clear is that just stating that a fat kid eats too much, is not completely fair. (S)he really does likely eat no more and on average a bit *less than *his/her school-aged peers.

2

2000 calories is an obscene amount for an 11 year old to be eating. Therefore the main problem is obviously in the diet; it just happens that the thin ones are doing a huge amount of exercise, from the looks of things.

3

I am convinced obesity is not a willpower issue, but result of a unmet need i n one’s life.

There are many causes for obesity, which IMHO stems from other issues, like what is the root cause of, for instance, inactivity? This could be things like not being accepted by his/her peers, so not being able to play (be active), which would stem from another root.

OTOH We see the term comfort foods, people take comfort in them making up for a lack of comfort may have been denied, setting a pattern of eating when they feel lonely.

4

I have 2 boys, ages 12 and 10, who eat an INSANE amount of food, and neither of them has an ounce of fat. They are active, but not unusually so.

Last night after a regular dinner of fish, corn and veggies, my son had 2 containers of yogurt, a bowl of cereal, goldfish, a Popsicle, and 2 tortillas with ham, cheese and salsa. And when he went to bed he was mumbling, “But I’m still hungry!”

I don’t pretend to understand what causes the obesity in any detail, but some people can just eat more than others. The hollow leg theory.

5

Don’t forget that 11-year-olds are doing something no normal adult is spending calories on: growing taller, which at that age can be at a ridiculously fast rate for some.

6

Actually that is pretty average for an average activity 11 year old boy. As noted the anabolic demands of growth have a lot to do with it. The mere fact that healthy weight kids (not all of whom are all that physically active) eat that much or more on average proves that it is not “an obscene amount”.

One interesting note about anabolic demands - it is known that obesity blunts the body’s secretion of Growth Hormone, which in turn makes the body less effective at building lean body mass (a key anabolic activity and that which additionally, once built, is a key contributor to the basal metabolic rate - burning calories at rest). The lesson here seems to be that being fat by early school age makes one a physiologic set up for becoming more fat as time goes on, even as the individual’s calorie intake decreases: less likely to engage in sports or even active recess because of poorer baseline fitness, less Growth Hormone so less likely to get as much muscle mass with exercise (at least until some weight drops), less muscle mass burning calories at rest, less growth of muscle mass using up calories.

We need to come up with effective interventions to implement by 5 to 7 years old if we want to hit this issue effectively.

7

No, it’s not. America’s obsession with extremes really hurts us here: just as we tend to assume that if some food is good, more is better, we then turn around and assume that if some calorie restriction is good, more must be better.

Not only is a kid that age growing, reasonable exercise at that age is a couple hours a day up and moving.

8

My WAG for an explanation is that up to age 9, some kids eat more, and get fatter. Then the pattern “flips” for 9 - 11 year olds, because the ones that are already fat do not do any exercise. These fat kids can remain fat while consuming fewer calories because they are sitting on the couch watching TV all day.

9

Another root cause could be a simple dislike of exercise. As long as I can remember, I have not enjoyed prolonged exercise. I don’t get a “rush” out of it, it isn’t fun, and it doesn’t relieve stress. In fact, I associate exercise with increased stress, since it makes me feel hot and sweaty (which I hate). I exercise now only because I know I need to; I force myself to go to the gym three times a week for an hour.

I think it would be interesting to study how exercise affects brain chemistry in more detail. I’ll bet there are already some studies out there showing a positive correlation between exercise frequency/intensity and levels of “feel-good” brain chemicals. But I know for a fact that I’m not the only one who feels no “high” or “relief” after exercise.

10

Eh? When I say that somebody is eating too much, it wouldn’t make any sense for me to be comparing them to their peers. They’re eating too much for themselves. Their peers have nothing to do with it.

11

That’s a subscription-only link. I’d like to see the methods. 2:1 they just asked the kids (or their parents) what they were eating.

12

Wouldn’t be surprised if the overweight kids are eating foods that are more insulinegenic, so their bodies are prone to storing their calories as fat.

13

Didn’t realize. More detail but still hopefully within the fair use limits:

14

Exactly what I thought. Self-reported. And 6 year olds were supposed to accurately count their calories? I don’t think so. The average 30 year old probably couldn’t do that. I’d also like to see the data compiled with a more resistant measure of the center.

Then of course calories as a raw number don’t mean much. Twenty-two hundred calories of vegetables, olive oil, whole-grain bread, fresh dairy products and wine is radically different than 2,200 calories off the value menu at BurgerWorld. I’m not saying the average kid was sticking to either one of those diets, but I’d be interested to know what their goals were in isolating calories. It seems a little like studying kerosene to figure out the difference between my old space heater and a fighter jet.

Calling the results of one study a definitive statement of anything is bad enough, without even considering all of these factors.

15

I doubt the kids were supplying the calorie counts, it was more like I had 6 chicken nuggets with bbq sauce, a small fries and a milk, and then i had 5 cookies, and for dinner i had a piece of chicken, some beans and an apple …

16

Again, for clarity.

This is a large study, not an n of 10. The method used is the state of the art for documenting energy intake in real world settings. No, 6 year olds were not counting calories. No, they have not yet parsed out (or at least reported) whether the quality of the calories were significantly different between the overweight/obese and healthy weight children. It is certainly valid to speculate that there may be a difference there. (Although 2200 calories of “vegetables, olive oil, whole-grain bread, fresh dairy products and wine” (wine!?) is a lot more food than 2200 calories off of “the value menu at BurgerWorld” - you’d be hypothesizing that fat kids consume way less volume than do healthy weight kids. Still could be. But the commonly held hypothesis that fat kids are fat because they eat more than other children (“like pigs” is how it often said) is pretty well falsified.

17

I would say heavily challenged rather than falsified.

From some brief checking it seems with this measurement instrument “When subjects of diverse behavioural characteristics are studied, correlations between factors such as social desirability or body dissatisfaction and dietary self-reporting accuracy are seen”

As children get older they’re going to be more obviously overweight or obese, and minimisation due to social desirability could be increasing with both children and parents. Id be interested to see how they controlled for these potential issues, particularly given it seems to be a reanalysis of previously collected data.

It would be interesting to see how the relevant professions are responding to these findings, rather than the study alone. Is it generally being viewed as a slam dunk, or is it being contested a bit?

Otara

18

Yeah, and I’m pretty sure still others have found that it’s not accurate at all. I’ll look for a reference on that tomorrow.

So the study’s authors were guessing, or what?

Which isn’t a revelation. We all already knew that a salad is greater in volume than a slice of oreo cheesecake. One extra sip of water is greater in volume than an otherwise equal amount of Mountain Dew.

No it’s not. It’s being challenged. Do you understand how science works?

19

Otara, this report on Medscape was in advance of its full publication and was based on its poster presentation at the 2010 Pediatric Academic Society Meeting May 11th in Vancouver. It has been the first I had read of it.

I am open to the possibility that obese subjects may be more prone to underreporting energy intake than normal subjects, or even more prone to altering their energy intake during a period that they know is being recorded (see below for more detail). So “challenged” is indeed perhaps a more precise term to use. Certainly it makes the hypothesis that obese school aged children consume significantly more calories per day than their normal weight peers to be somewhat unlikely.

Cisco, are you intentionally being denser than an Oreo cheesecake? No they did not “guess”. The method is a process by which food intake is recalled and then a series of prompts is undertaken which includes visual cues for serving sizes to foster further recall. For six year olds both the parent and the child were interviewed. The researchers then count the calories.

As for the potential limits of the instrument, it is a reasonable concern - I’ve tried my best to find the most critical analysis I could and here it is.

In the data tables this study demonstrates that overweight and obese subjects under reported by 14-20% compared to <3% for normal weight subjects.

So indeed the study’s method, even though it is the state of the art, may have some limitations. If what I just cited is accurate when translated to the NHANES dataset then it is possible that the obese subjects were in fact consuming 100 or more calories per day more than normal weight subjects.

20

Ok, so they guessed, and obese people are known to underreport caloric intake. Why are you calling me dense and then supporting what I’ve been saying?