Of Dreams and Reality

Obesity simplex: Childhood Obesity Management Without Food Intake Reduction.

The management of childhood obesity (once established) should not involve a reduction of food intake (as a means for reducing the body weight).

Children (obese or not) require a balanced diet which can support the growth and maturation processes.
Restricting the food intake can introduce the risk of a lack of one or more essential nutrients.

Instead the aim should be to maintain the weight constant whilst the child grows in height. By so doing the weight and height should ultimately be compatible with each other.

Thus the RELIED 500 Cal Plan (in its entirety) is not recommended for the management of Obesity simplex in children.

However, introducing in the child’s daily routine, one or more activities aimed at producing a raised expenditure (RE) of energy is to be encouraged.

It is worth noting that in 1994, E. Obarzanek and his associates showed that both obesity and blood cholesterol levels correlate with hours of television viewing (Volume 60 of American Journal of Clinical Nutrition, pages 15 to 22).

[Note: Children also spend a lot of time working at computers and playing video games].

TV viewing may have the added effect of fostering snacking, often on foods that are rich in calories (chocolates, sweets, peanuts, potato crisps/chips, etc.).

[Note: TV advertising of the above foods can play a significant part in this]

Someone unfamiliar with the RELIED 500 Cal Plan may mistakenly believe that it recommends a daily intake of 500 Calories (which a 500 Cal plan, if it existed, would recommend).
In fact:
1) The RELIED 500 Cal is based on the production of a deficit of 500 Calories per day as suggested by Mark Bricklin (1979) in his book “Lose Weight Naturally” published by Rodale Press, Emmaus, Pennsylvania.
2) The deficit should be arrived at by the production of:
a) A Raised expenditure (RE) of energy of 200 Calories and
b) A Lowered intake of energy (LI) of 300 Calories
[Note: This quantity of energy represents the 300 in Mark Bricklin’s “Natural 300 Plan”]

Mark Bricklin’s quantities (figures) are a good reference/starting point.
However, as stated in earlier entries of the present series, the RELIED 500 Cal Plan allows for flexibility with regards to actual quantities concerning raised energy expenditure (RE) and lowered energy intake (LI).
[Please see previous entries, more especially “Obesity simplex (primary obesity): Facing up to its reality” and “Practical aspects of the RELIED 500 Cal Plan (A concise user’s manual)”].

Moreover, as the body weight changes more adjustments can and need be made but it is recommended that the RE (raised expenditure) remains a permanent feature.
This is essential for general health reasons, and more especially, if one wanted to maintain the newly acquired ‘desired’ weight over a significant (meaningful) period of time (if not on a permanent basis).
[Note: The RE should be quantified on an individual (personalised) basis (please read previous entries, more especially: “Walking as a means of producing a net expenditure of 200 Calories].

Thus one difference between the RELIED 500 Cal Plan and the ‘Natural 300 Plan’ relates to methodology (and also, possibly emphasis).
Everyone can quantify their lowered energy intake (LI) by simply referring to the energy contents of foods left out (not taken in).
However, to quantify raised energy expenditure (RE) one needs to take a personalised (individual) approach.
[Note: RE is deemed to be more important than LI, although both are required].

Ultimately and ideally the activity or activities producing the RE (raised expenditure) should be geared (adapted) to:
3) Improving physical fitness (cardio-respiratory endurance, muscle strength and endurance, and flexibility)
4) Maintaining lean body tissue (skeletal muscle).

500 Cal Plan
Either the plan does not exist or no one should be on it.

Satiety and Criteria for Nutritional Adequacy in Infants
A. Satiety

Looking for signs of satiety in infants (defined in ‘Nutrition in Health & Disease’ in 1968 by H. Mitchell and her colleagues as “the mechanism by which the infant is made aware that he has had enough”) is important because overfeeding in infancy may establish an undesirable feeding pattern in later life.

Unfortunately satiety (‘its expression’) varies widely among infants.
For example:
1) In some, it is sharp and is accompanied by an active resistance to further feeding attempts.

2) In some, it is less sharply defined and interest in feeding wanes gradually (after a period of playfulness).

3) Others appear not to know they have had enough and will vomit the ‘excess’.

[Note:
a) Parents, nurses, carers, etc. should be able to assess after a period of observation which category the infant they are responsible for falls under and take appropriate action.

b) In all cases feeding which includes some degree of force (compulsion, 'persuasion') should be avoided.

c) It is better to rely on the Criteria of Nutritional Adequacy (B, below) to assess that the infant is being properly fed].

B. Criteria for Nutritional Adequacy in Infants

In the publication mentioned above the following criteria for assessing adequate nutrition are mentioned:
1) A steady gain in weight
2) A moderate increase in subcutaneous (‘under the skin’) fat
3) Development of firm muscles
4) Good elimination
5) A happy infant
6) Sleeps well
7) Shows normal curiosity about surroundings

Infant Feeding (1)
Milk-related data (quantitative)

1) Human milk
a) 100 millilitres (ml) = 64 Calories (kcal) or 268 kilojoules (kJ)
b) 1 fluid ounce (28.4 millilitres) = 18.2 Calories (kcal) or 76.1 kilojoules

2) Infant formula (normal dilution)
a) 100 ml = 67 Calories (kcal) or 280 kJ
b) 1 fluid ounce = 19 Calories (kcal) or 79.5 kJ

3) Cow’s milk
a) 100 ml = 66 Calories (kcal) or 276 kJ
b) 1 fluid ounce = 18.7 Calories (kcal) or 78.2 kJ

4) Working average for (1), (2) and (3)
a) 100 millilitres = 65 Calories (kcal) or 272 kilojoules (kJ)
b) 1 fluid ounce = 18 Calories or 75 kilojoules (kJ)

5) Consumption of human milk [per pound] and {per kilogram} of body weight
respectively =
a) [2.5 ounces]-----{5.5 ounces}
b) [70 millilitres]-----{154 millilitres}
c) [45 Calories or kcal]-----{99 Calories or kcal}
d) [188 kilojoules or kJ ]-----{413 kJ}

6) Human milk production per day is about =
a) 25 ounces per day
b) 700 millilitres
c) 455 Calories (kcal)
d) 1904 kilojoules (kJ)

[Note:
a) There is considerable variation among women
b) Variation occurs also in the same woman from time to time depending primarily on the infant’s feeding rate].

7) 1 litre =
a) 1000 millilitres
b) 1.76 pints (pt) [roughly 1 and three quarter pint]
c) 35.2 fluid ounces

8. 1 pint=
a) 20 fluid ounces
b) 568 millilitres

9) 1 fluid ounce =
a) 28.4 millilitres

Recommended energy allowance (REA).

INTRODUCTION

In infancy, Obesity simplex [see definition and introduction in: “Obesity simplex (primary obesity)” posted on 7/11/ 2007] is (as it is in all other age groups) linked to a surplus of energy (unused energy that is).

It is difficult if not impossible for the carer/minder (parents, nurses, etc) to get the balance right (i.e. between energy taken in and energy expended) in the early days of an infant’s life because many factors (rapid rate of growth, activity, sleep pattern, hunger, satiety, etc.) are involved.

[Note:
1) An obese infant may be either overfed or under-active or both.

2) Overfeeding can occur because the carer (‘feeder’) cannot distinguish between a hunger cry from other crying].

3) Appropriate levels of stimulation of the infant that results in energy expenditure should be explored and encouraged].

RECOMMENDED ENERGY ALLOWANCE (REA) for INFANTS

In the 1989 publication of the National Academy of Sciences ‘Recommended Dietary Allowances’ the following figures are quoted:

a) First 6 months = 108 Calories (kcal) per kilogram (2.2 pounds) of body weight

b) Second 6 months = 98 Calories (kcal) per kilogram (2.2 pounds) of body weight

[Note:

1) A healthy infant’s birth weight:

a) Doubles after around 4 months

b) Triples after around 12 months]

Wherever and whenever possible the REA should be followed because it is linked to the body weight and therefore ‘mirrors’ or ‘shadows’ the development/growth of the infant.

EXAMPLE:

REA for James (aged 3 months and weighing 12 pounds)

Weight in kilograms = 12 pounds divided by 2.2 = 5.4545

REA = 5.4545 x 108 = 589 Calories (kcal)

Spotting the obese infant

1. To date there is no generally accepted ‘means for the quantitative characterisation’ (for want of a better expression) for an obese infant.

A gain in weight by a six months old infant that exceeds 5.34 kilograms (11.748 pounds) was proposed by P.B.Crawford and his associates (Am.J.Clin.Nutr.27:706, 1974) to be the best index for obesity at that age.

[Note: The limitations of such an index in the context of obesity prevention {see Obesity simplex: Infant obesity (1)} are obvious].

2. Perhaps a significant discrepancy between length (height) and weight (as compared with established growth charts) is of more practical use.

The following figures for boys read from one such chart (Am.J.Clin.Nutr. 32: 607-629, 1979) will be used to illustrate this:
a) Age: 3 months
b) Length (height) range: 57 to 65 centimetres (22.44 to 25.59 inches).
c) Weight range: 4.318 to 7.27 kilograms (9.5 to 16 pounds)

Example1.
Assessing weight status for a 3 months old boy (George)
d) Age: 3 months
e) Length (height) = 58 centimetres
[Note: This is near the bottom of the range]
f) Weight = 7 kilograms
[Note: This is near the top of the range]
Conclusion:
George may be considered obese.

Example2.
Assessing weight status for a 3 months old boy (James)
g) Age: 3 months
h) Length (height) = 64 centimetres
[Note: This is near the top of the range]
i) Weight = 7.25 kilograms
[Note: This is near the top of the range]
Conclusion:
James may be considered not to be obese.

[Note:
a) There are many growth charts and there are slight differences here and there.
b) When used as illustrated in the examples above they are just as good as each other].

Obesity simplex: ‘Infant obesity’ (1).
Early infancy: When the foundation of obesity is laid down.

Introductory remarks
Much adult obesity has its origins in infancy, childhood and adolescence. Therefore the prevention of obesity begins in infancy.

A. In two papers published independently in 1970 by:
(1) J.Hirsch and J.L.Knittle (Fed.Proc.29:1516) and
(2) E.E.Eid (Brit.Med.J.2:74)

(a) It was concluded that:

Infants who are over-nourished (i.e. their rate of growth is higher than usual) at the stage when adipose tissue (‘body fat’) cells are rapidly increasing accumulate more fat cells than infants whose rate of growth is more carefully controlled.

[Note:
1) The rate of growth generally is highest in the first few months of life.
2) It would not be unreasonable to suggest that the rapid formation of adipose tissue cells could occur at that time].

(b) It was suggested that:

This surplus of adipose tissue cells persists throughout life carrying with it persistent problems (‘potential for the problem’) of obesity (overweight).

B. Science Daily (Nov. 14, 2001) has reported that a research team (N.Settler, B.Zemel, S. Kumanyika and V. Stallings) at The Children’s Hospital of Philadelphia have suggested that:

(a) The first four to six months may be a period for the establishment of weight regulation.

(b) Rapid weight gains during infancy could lead to childhood obesity, more specifically:

(c) Rapid weight gain during the first 4 months of life is linked to an increased risk of being overweight at age 7 (regardless of birth weight and weight at 1 year) and:

(d) An increase in weight gain of 100 extra grams per month increases the risk of being overweight at age 7 by more than 25%.

[Note:
The first 4 to 6 months are thus critical both:
1) In the context of rapid formation of adipose (fat) cells and
2) Establishment of weight regulation].

OPENING REMARKS
Getting the body weight to its health promoting weight range or HPWR (see Archives of Obesity simplex series) is hard for many. It is harder still to keep it there over a meaningful length of time.
However to slim down (by reducing fat depot size of) specific parts is impossible.
The following two topics are introduced here to illustrate that fact.

PASSIVE EXERCISE (PE)
The term PE is in itself problematic. It refers to the body’s activity (mostly in the form of localised muscular contractions) induced by an electric stimulator (generator of short bursts / ‘pulses’ of electric current).
The passive (‘involuntary’) aspect of PE refers to the fact that the command (stimulus) for the contraction comes not from the brain of the individual connected to the stimulator but from the latter (in the form of an electric current).
However, of greater significance (and more especially in the context of weight management) is the amount of energy expended during PE.
In the Wellness Encyclopedia (University of California, Berkley) it is quoted that a research team at Northeastern University (Boston) recorded an expenditure of no more than six Calories during 35 minutes of PE of such areas as the abdomen, buttocks and thighs (popular sites for such treatment among women).
[Note: The 6 Calories are additional to the amount of energy the body expends whilst in the resting state].
It can only be concluded PE cannot make any serious contribution in the fight against obesity simplex.
Perhaps if pushed one could make a case for PE as a reward (or a form of pampering) after a proper bout of active / normal (true) exercise.
However, a massage would serve that purpose much better (but would obviously require more work from the masseur or masseuse).

SPOT REDUCTION (SR)
SR is a problematic aim (more of a dream than reality). It refers to (which is impossible) a reduction in fat depot size by exercising specifically (by natural or artificial means) the muscles that are located nearby (the abdominals for example).
Moreover it should be noted that in women certain fat depots (those on the thighs and buttocks) are ear marked for milk production.
Consequently they may remain (largely untouched) whilst other depots are used up (to varying degrees depending on the extent of the energy deficit produced and its duration) through a combination of raised energy expenditure and lowered energy intake (to be recommended) or by dieting alone (not to be recommended).

RAPID WEIGHT LOSS (RWL)
A weekly loss achieved purely from dieting (i.e. by reducing energy/food intake) of more than 1.5 to 2 pounds is regarded as excessive (here to be referred to as rapid weight loss i.e. RWL).
Adverse reactions of RWL range from dizziness, headaches, nausea (and their complications). They become more problematic when the energy intake is less than 1200 Calories and the diet/s nutritionally unbalanced (i.e. deficient in essential constituents).
In addition (and possibly more relevant to the management of body weight on a long-term basis) RWL is invariably linked to the so-called yo-yo effect of dieting.
[Note:
1) The RELIED 500 Cal Plan aims for a weekly loss of 1 pound through a combination of lowered intake (LI) and raised expenditure (RE) of energy (calories).
2) As explained in earlier parts of the Obesity simplex series (to access these, see Archives at the bottom right of this page) this approach is more likely to avoid the yo-yo effect than most].
RESPONSES TO RWL PRODUCED BY CRASH DIETING
1) The body adapts/adjusts to the lowered food intake by lowering its metabolic rate (rate at which the chemical reactions that underpin all life processes take place) thereby lowering its fat usage (“burning”).
[Note: Fat is one source of energy for the body’s activities].
2) This adjustment / adaptation can have disastrous effects best outlined as follows:
a) Imagine someone losing 10 pounds in a relatively short time by going on a diet of quite low energy content (“crash” diet).
[Note: RWL recorded in the early stages of a calorie-restricted diet is to a large extent due to water loss].
b) If food intake is now increased (providing more energy than is required because of the lowered metabolic rate) but is less than before the start of the diet, the body will store the unused (surplus) energy as fat and the weight goes up (“rebound effect”).
[Note: After achieving the initial loss of 10 pounds (achieved by crash dieting for instance) the dieter can now justify increasing their food intake (by what seems to them a reasonable amount)].
The “rebound effect” explains why many dieters try one diet after another and lose weight only to regain it (usually with interest) thereby becoming trapped in weight cycling (the yo-yo effect of dieting).
Perhaps the hardest aspect of the yo-yo effect to ‘swallow’ is that it takes the dieter progressively longer each time to lose weight and progressively faster to regain it (and usually more of it).
From a health point of view there is evidence to suggest (K. van der Kooy and co-workers, 1993) that weight cycling (repeated loss and gain of weight) can increase the risks of diabetes, hypertension, high blood lipids and death.
[Note: The increased risks are no deterrent to genuine attempts at lowering one’s body weight at a sensible rate as mentioned above and throughout the Obesity simplex series].

Homo sapiens sapiens vs “Homo sapiens tabellarius”.

Modern humans are classified within the animal kingdom as Homo sapiens sapiens.
Bearing in mind that in Latin (Homo = human) and (sapiens = wise/knowing) cynics may wonder how many of us truly qualify as members of the human race.

Perhaps a better term (albeit marginally) that covers all of us could be Homo sapiens tabellarius (tabellarius = letter carrier or messenger).

There are two main reasons for this:
(1) Like the rest of the living things we are carriers of genetic information (genes) obtained from our ancestors which is to be imparted to our offspring/s.
Whether (as individuals) we succeed or not in this (by design or otherwise) depends on many factors (chance or luck included) which we need not go into.

(2) Through communication (spoken, written, pictorial, etc.) we pass on information
(knowledge, ‘wisdom’) we have gathered by countless means (including legends, myths, education, training, personal experiences, etc.).
Many factors (which we need not go into) determine the extent to which we do this appropriately (wisely: possible sapiens connection)) or otherwise.

Moreover, it would appear that the continued existence (see note below) of the human species (as we know it to-day and irrespective of classification) may well depend (and increasingly so as pollution and climate change really bite in and inter-national/racial/religious conflict/ tension mounts up) on the:

(a) ‘Matter’ (information, knowledge, ‘wisdom’) men will have accumulated that he may choose to communicate (or perhaps in some cases not communicate) and

(b) ‘Manner’ (advertising, bargaining, blackmail, bribery, coercion, indoctrination, and the likes not necessarily excluded) in which this will be done.

[Note: E. Mayr (1995) has estimated that the life expectancy of a species is about 100,000 years (Biastronomy News 7, no.3].

As for the genes they will do mostly as they please (within the confines of the modern human species) unless we start engineering them beyond recognition or we modify the environment (theirs and ours) recklessly and drastically.

[Note: Genes hitherto ‘silent/dormant’ can express themselves when the conditions are right for them to do so. Those expressions might not all (if any) be what we (as we are to-day) would/might like!].