Michael Macknin, M.D., an emeritus professor at Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Children’s, talks about how obesity in children can lead to high blood pressure, high cholesterol, and cardiovascular diseases.
Interview conducted by Ivanhoe Broadcast News in December 2021
Can you provide us with background regarding the study in obesity and how it’s measured?
Dr. Macknin: Over 20% of the children in the United States are considered obese. If you took what would be an ideal body weight, a body mass index of greater than 95% means that you’d be heavier than 95% of the total number of children, but because so many children are over the ideal body weight, there’s 20% over the ideal body weight, which you’d expect only 5% to be.
What are obese kids at risk of developing, and how significant is that risk?
Dr. Macknin: Obese children are the same risk for problems that adults are. It’s not generally known that cardiovascular disease, things like heart attacks and strokes, had their beginnings in very early childhood, and even in the first 10 years of life. Children are developing these risks as obese children at a very, very, very young age. And we have a chance to help prevent these illnesses in adults if we could help the children attain ideal body weight. There’s also increased risk of things like diabetes and a whole variety of cancers are much more common in people who are obese than people who are of normal body mass index. If kids have been under stress in utero, you can measure the carotid artery inimal thickness of newborns, and you can see that they’re at risk starting as soon as they pop out of the womb.
Can you outline this study and how many children were enrolled over what period of time?
Dr. Macknin: We enrolled a total of 96 parent-child pairs, we started off with 1,200 eligible patients and only eight percent volunteered. The major reason they didn’t volunteer was they said that they didn’t have the time to participate in the study, which is unfortunate because all these parents knew that these children had significant risk for future illnesses, but they just didn’t have the time to take care of it.
What was that period of time? How long was it?
Dr. Macknin: We enrolled everyone at the very beginning of this study, and then we started at the same time and then we followed them for a total of 52 weeks, one year.
Could you describe the three different eating patterns that were involved and then the significance of studying each of those three?
Dr. Macknin: We studied three major dietary types, and we chose those because those are the dietary types that are emphasized in the healthy eating pattern suggested by the United States Department of Agriculture, the Dietary Guidelines for the United States. Those three diets that we studied were a plant-based diet, the American Heart Association diet and we also studied the Mediterranean diet. And a plant-based was totally whole foods. It was based primarily on eating a lot of vegetables and fruits and whole grains and eating healthy proteins, particularly things like legumes, which include beans, chickpeas, lentils, as a very good source of protein. Then the American Heart Association diet also emphasized eating fruits and vegetables, whole grains and having a healthy source of protein, but they also allowed some dairy products and some low-fat meats. And then the Mediterranean diet is similar to the American Heart Association diet, except it emphasizes primarily, again, fruits and vegetables, whole grains, and healthy proteins, but they emphasize eating nuts and or fish as a major source of protein, and also consuming olive oil.
How do you measure the impact of the eating patterns on children in the study?
Dr. Macknin: We tried to see if we could impact their cardiovascular risk. There are certain markers that you can look at that we know help predict future cardiovascular disease. We looked at things like weight, we looked at blood pressure, we looked at total cholesterol, bad cholesterol, or LDL cholesterol. We looked at something called C-RP, that’s a C-reactive protein, which is a measure of inflammation, which is also a measure of body risk. We looked at something that’s called trimethylamine n-oxide, which is an unusual marker that is used a lot in research, and I think will be used in clinical use more in the future, and that also measures cardiovascular risk. It’s a breakdown primarily of some of the things in meats, primarily things like carnitine, also lecithin.
What was the impact of following these eating patterns?
Dr. Macknin: What we saw was an amazing improvement in almost all the things that we measured on all the diets. They were extraordinarily similar results between the groups. We saw that there were decreases in body weight, which unfortunately was not sustained. It was very great at about four weeks, and they were unable to sustain that over the 52 weeks of this study, but all the other markers improved significantly and remained improved for the entire study. Things like blood pressure, both systolic and diastolic blood pressure went down, total cholesterol decreased, LDL cholesterol, the bad cholesterol went down, the C-reactive protein went down. And we were also measuring glucose even though these children did not have diabetes. The fasting blood sugars in 52 weeks were lower in all three groups.
What are the implications of this research?
Dr. Macknin: We started out trying to figure out which diet was best, and we may have been asking the wrong question. What we should have asked, what are the similarities between these diets? Because the results were so wonderful with all three diets, I think it’s important to see what they all had in common. And what they had in common was they emphasized eating a lot of vegetables, eating a lot of fruits, eating a lot of whole grains, and having a healthy protein source. And they also suggested that you stay away from added sugars, salts, saturated fats, stay away as much as you can from red meats, don’t eat processed meats or other processed foods. One of the extraordinary facts about the study was that we had these great results and the children didn’t comply very well. They stuck to their diets maybe 55, 60% of the time by the end of the study, and yet they had these wonderful results. The point is that you need to know what healthy eating patterns are and do your best to follow them and pick a diet that you think you can stick with and just do the best you can. You don’t have to be perfect to make wonderful changes.
They say it takes 60 days, you said they needed four weeks. I wish you could have gotten one more month in to see if there were more changes.
Dr. Macknin: No, what we did, as I said we did, we did 52 weeks, and the changes were dramatic at four weeks. And everything was maintained except the weight. They had trouble keeping the weight off.
Is there a follow-up study that you have in the works?
Dr. Macknin: Unfortunately, we don’t have a follow-up study in the works. I think what we’ve learned from this study is if we can just make it easier for children and their families to eat healthy, and we know what eating healthy is. I keep on coming back to the same things. Eat a lot of vegetables, eat a lot of fruits, eat whole grains, and eat a healthy source of protein and watch out for salts, sugars, saturated fats and watch out for red meats, processed meats, and any processed food. If you can read a label and you understand everything that’s on the label, and there aren’t too many things in the label, you’re probably eating something wonderful for you.
Were there other interventions that were suggested besides cardiovascular risks?
Dr. Macknin: We suggested that everybody get more exercise, unfortunately measured exercise, and that didn’t change significantly in any of the groups. Some of the things we learned were that the children were a whole lot more open to making change than the adults were. We asked about diet acceptability, and the parents found lots of things wrong with all the diets, and the children really didn’t notice that anything was that bad; they just went along with the flow. Particularly, younger children were more likely to volunteer for the study than older children. The message there is, if we can start early, we can make a huge impact on cardiovascular disease throughout our country and throughout the world.
In what ways were parents involved, and how important was that family support?
Dr. Macknin: Family support was critical. And there have been previous studies that show, particularly in younger children, if you have a family working together on improving eating patterns, they do much, much better. We insisted that one of the parents do the diet with the child, so they weren’t doing it by themselves. We measured effects in parents, and the parents also had wonderful improvements. But they weren’t nearly as profound as the improvements we saw in the children, and they weren’t nearly as sustained. So again, if you can start early, that will make the huge difference.
Is there anything you want to have a final thought or something that they didn’t touch on?
Dr. Macknin: If we can do things that will make it easier for people to know what healthy food is and if we can make that food more accessible for more people, that’s what would be a nice thing to take away from this study.
END OF INTERVIEW
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