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Dieting may produce weight gains in youths

Research suggests physicians have to be careful about weight-control recommendations for young patients.

By Victoria Stagg Elliott, amednews staff. Nov. 10, 2003.

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Repeated dieting by children and adolescents may lead to weight gain rather than loss, according to a study in the October Pediatrics. The study also found more than a quarter of girls and more than 15% of boys reported dieting at least periodically.

"It's important for clinicians to realize that many adolescent and pre-adolescent patients will be dieting, and it may not be warranted, so it's probably a good discussion to have with the patient about healthy and unhealthy nutrition and ways to control their weight," said Alison E. Field, ScD, lead author and assistant professor of pediatrics at Children's Hospital in Boston.

Dr. Field and her co-authors surveyed children whose parents were participants in the Nurses Health Study II. More than 15,000 9- to 14-year-olds completed two annual questionnaires over a three-year period, answering questions about food intake, binge eating, and body mass index. Dieting was associated with weight gain, whether the child was overweight or not.

The study adds to the growing body of literature suggesting that dieting may not be healthy for children. Researchers commented that this does not indicate that medically supervised diets for children who are overweight or obese are inappropriate. Rather the study's message is that calorie restriction without medical supervision for children who are of normal weight or slightly above it may not be the healthiest idea.

Critics said the study did not go far enough to show what was at the root of the association between diet and weight gain. They questioned the mechanism of increased poundage. Could these be kids genetically predisposed to add pounds easily and therefore more likely to diet? Did the diets reset their metabolism to a low point? The study also detected a correlation between binge eating and dieting, and experts questioned whether that, rather than the actual diets, was key to added girth.

"It may have been that in these families there were things going on that made them diet more, and there may be some underlying metabolic differences that make it easy to gain weight," said Diane Elliot, MD, professor of medicine at Oregon Health Sciences University in Portland.

But some maintained the study reinforced the message that dieting is not the cure-all for the growing number of overweight and obese children.

"We really need to get more education in the school system on proper nutrition and diet because our children are trying to improve their weight but they may be doing it in ways that are unhealthy," said Wendy Miller, MD, medical director of the pediatric weight-loss program at Beaumont Hospital in Royal Oak, Mich. "We really can't rely on parents and caregivers to give this education because more than 60% of adults in this country are overweight."

Many primary care physicians who see their young patients become ever larger still find themselves with few structured options to recommend.

"We're between a rock and a hard place," said Robert Hopkins, MD, associate professor of internal medicine and pediatrics at the University of Arkansas for Medical Sciences in Little Rock. "On the one hand, you're worried about the children with body image problems and extreme dieting. On the other side, there are the free-eaters who are super-sizing and not getting the healthy stuff."

Diets have gone out of vogue for this age group, and most physicians opt to recommend eating healthier and exercising more. Specifics may include cutting out sodas and reducing television viewing time.

"Not many doctors these days would hand out a menu plan," said Nancy Krebs, MD, associate professor of pediatrics, University of Colorado Health Sciences Center in Denver. "We don't want to be promoting kids counting calories or points or whatever in general, except in specific situations where it might be appropriate."

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