Popular eating program for kids sparks controversy

According to the most recent data from the National Health and Nutrition Examination Survey published by the Centers for Disease Control and Prevention,¹ 39.8% of all U.S. adults are obese. The same data show the obesity prevalence in children ages 2 to 19 years is 18.5%, and is expected to rise to 20.6% in adolescents from 12 to 19 years.²

According to the National Institute of Diabetes and Digestive and Kidney Diseases,³ an individual who weighs more than what's considered normal for their height is described as overweight or obese. According to the CDC, the percentage of youth who are overweight or obese has more than tripled since the 1970s.⁴

There are several factors contributing to these rising percentages, including shorter sleep duration, metabolic inefficiency, poor eating and low levels of physical activity.⁵ Children who are obese are also more likely to develop health conditions such as metabolic syndrome, musculoskeletal disorders, cardiovascular disease and disability.⁶

The growing number of those who are overweight and obese directly feeds the weight loss industry, which market researchers anticipated would grow in 2018 to a value of $70.3 billion.⁷

While the final reports are not yet out on whether those numbers were actually reached, a summary of Marketdata’s research⁸ showed the greatest gains were expected in the commercial chains and meal replacement programs, with a trend toward ketogenic diets as well as diets high in protein. One market that was identified as untapped and underserved included overweight adolescents.

WW losing consumer base opens up to teens

However, even as researchers anticipated strong growth in the weight loss industry, one iconic company has been posting losses. WW, the company formerly known as Weight Watchers, rebranded their company in September 2018 in an effort to become the world's partner in wellness. According to Mindy Grossman, president and chief executive officer:⁹

“No matter what your goal is — to lose weight, eat healthier, move more, develop a positive mind-set, or all of the above — we will deliver science-based solutions that fit into people's lives. This is just the beginning of our journey to become the world's partner in wellness, and I am inspired by the potential for our impact."

The company posted a poor fourth quarter 2018 performance with declining memberships for 2019. One marketing analyst believes this might be in part due to their rebranding, as well as the declining popularity of “dieting.”¹⁰ Early in 2018, the company offered free membership to teens between ages 13 to 17.

While the company said they were aiming at helping children develop good habits at a critical age, CNN¹¹ reported Weight Watchers expected the tactic to engage young customers who could become loyal for years. The company's goal was to impact 10 million lives with 5 million people in the program by the end of 2020 and another 5 million using other company content.¹²

The announcement angered many parents who felt counting calories and engaging in a weight loss program may give rise to unhealthy eating behaviors. However, Time magazine reports WW CEO Mindy Grossman responded by saying,¹³ “It actually strengthened our resolve and made us offensive.”

The answer didn’t go down well with Lori Ciotti, regional assistant vice president of the Renfrew Center, an organization that bills itself as having treated more than 75,000 adolescents for eating disorders.¹⁴ Ciotti spoke to Today, saying:¹⁵

"Dieting is a slippery slope into an eating disorder. It sends a message that one should not listen to their body's hunger or fullness cues, so it's really concerning from that perspective.

I think what (Weight Watchers) is doing here is offering a sanctioned method of counting calories or points or whatever they want to call it. It's not teaching teens anything about self-care or self-worth. Instead it teaches them that their worth is about a number on a scale or the back of their jeans."

Appearing to aim at childhood obesity, WW lowers the bar

As the company appears to take aim at childhood obesity in their well-publicized “wellness” campaigns, they have now announced the release of a smartphone app for children as young as 8.¹⁶ In their notice, Gary Foster, Ph.D., chief scientific officer at WW said:¹⁷

"At WW, we have decades of expertise in scaling science-backed behavior change programs, uniquely positioning us to be a part of the solution to address the prevalent public health problem of childhood obesity.

Alongside a distinguished group of leaders in pediatric health and nutrition, we've carefully developed this platform to be holistic, rewarding and inspirational so kids, teens and families get the tools and guidance they need to manage their environment and build and sustain healthy habits."

The “distinguished group” to which Foster is likely referring are the scientists at Stanford Pediatric Weight Control Program.¹⁸ The Stanford program was licensed by the app’s founder, Joanna Strober, who helped develop the original app, Kurbo.¹⁹

That app was designed to help children learn healthier eating patterns without parental involvement. This app did not produce metrics like calories, carbs and sugar, but rewarded children for their food choices with a red, yellow or green light. After WW purchased the product, they made a few changes.²⁰

With the WW version, parents have greater involvement, and for an optional monthly subscription, children may work with coaches. Parents also have the option of joining the sessions. WW also added options children can track, such as weight loss, body measurements and Snapchat-style tracking streaks.²¹ Children enter their height, weight, age and goals, and then log what they eat.²²

In an earlier free progra, WW targeted teens aged 13 to 17. But in an effort to take advantage of smartphone applications, children's affinity for using smartphones and the childhood obesity epidemic, WW aimed the Kurbo app at children as young as 8. In their press release, the company says the program:²³

“ … builds on Kurbo's evidence-based mobile platform to help children and teenagers, with support from their families, make lifestyle changes while receiving guidance around sustainable healthy eating, physical activity and mindfulness habits. Kurbo by WW is currently available in the U.S., and the free Kurbo app can be accessed through iOS Apple Store and Google Play.”

Dieting may have the opposite effect

Despite the company's assertion that this is a program that teaches healthy eating choices, critics counter that it’s nothing more than a weight loss program for children, which they believe will contribute to children’s eating disorders. The backlash has gained a substantial following of people filing a Change.org petition calling for WW to remove the app.²⁴

In explaining why she thinks WW’s app is counterintuitive to WW’s stated goals for it, Tomi Akanbi, clinical nutrition coordinator at Mount Sinai Adolescent Health Center, warns that encouraging children and teenagers to count calories like many adults do is dangerous.²⁵ She routinely counsels patients who have adopted weight loss programs used by their parents without realizing that the nutritional needs of teens are different from those in other age groups.

By focusing on calories, many teenagers tend to skip meals or replace foods with empty calories from junk foods. Akanbi goes on to say focusing on weight can also lead to eating disorders, especially in teenage girls who feel pushed by media images to conform to a specific image. Following the announcement of the free summer program for teens, she said to CNBC

“Weight Watchers really is dieting and focusing on just weight, and research has shown when the focus is on weight and dieting in teens, that is not an effective way to promote and sustain weight loss. It’s not even helpful to promote overall wellness because we’re also talking about body image and how these kids are experiencing themselves and food and their bodies, and dieting does not help with that.”

In support of this line of thinking, some experts have suggested weight loss efforts in childhood may result in body image dissatisfaction and unhealthy weight control behaviors, including disordered eating, if the behavior is not severe enough to warrant diagnosis of an eating disorder.²⁶

A small study using a survey and two workshops delved into it deeper, with researchers gathering data about how young people interact with fitness mobile apps. The aim was to identify risks and negative experiences about how current fitness apps may or may not exacerbate risky eating behaviors.²⁷

The researchers concluded there was a need for consideration around the design of these apps when used for teenagers who are vulnerable to poor body image and maladaptive eating behaviors.²⁸ Additionally, the American Academy of Pediatrics (AAP) has advised doctors and families to avoid the use of “weight” in their talks with teens and instead focus on healthy lifestyles.²⁹

Calorie counting is not the answer

The AAP stresses families focus on eating a healthy diet and get plenty of physical activity rather than focusing on weight loss, if they want to reduce the risk of their teens developing an eating disorder:³⁰

“Family involvement in treatment of teen obesity and EDs [eating disorders] has been determined to be more effective than an adolescent-only focus. An integrated approach to the prevention of obesity and EDs focuses less on weight and more on healthy family-based lifestyle modifications that can be sustained …

… AAP recommendations include discouraging dieting, skipping of meals or the use of diet pills; promoting a positive body image; encouraging more frequent family meals; and suggesting that families avoid talking about weight.”

The AAP also stressed that making healthy foods such as fruits and vegetables more accessible while limiting sugars and refined carbohydrates is one way to positively address weight without directly talking about it. The pediatricians also suggest working on helping children make lifestyle changes, such as limiting TV and screen time and promoting physical activity — and I agree.

In addition to the possibility that counting calories or counting points may promote an unhealthy relationship with food³¹ and increase a teen’s risk of developing an eating disorder, the act of counting calories is not the answer to maintaining a healthy weight or overall health.

The fatal flaw in counting calories is you don't pay attention to the nutrition you're eating. The calorie-counting theory is that whatever calories you take in, as long as you burn them off, you will either maintain your weight or lose weight. But that way of thinking is simply wrong: All calories are not alike — while you may like to believe 100 calories in an apple and 100 calories in a cookie are identical, they are not.

The real science says that calories you get from whole, unprocessed foods feed your cells and reduce your risk of disease, including obesity. Foods from processed meals include high amounts of sugar or fructose as well as chemicals that may trigger weight gain.³²

Cyclical ketosis supports balanced weight and health

Like the AAP states, more important than counting calories is focusing on bringing home healthy foods and watching where your teens are spending their lunch money. While Grossman has attributed part of the problem with WW’s poor earnings in late 2018 to the keto diet,³³ she’s failed to realize that one reason the keto “diet” — which is aimed at adults — is working is because you don’t count calories. Instead, you focus on eating healthy, which is just what the AAP prescribes.

The good news is that keto also aligns with the AAP’s guidance in that you don’t eat processed foods or refined sugars when you “go keto.” The truth is children need protection from the junk food industry and you can help your children eat healthy and learn to make healthy food choices by simply refusing to buy processed foods, and concentrating on stocking your pantry with organic, fresh fruits and vegetables.

Go the extra step and skip fast food restaurants and cook and eat at home, and you’ll be well on your way to teaching them healthy eating.

You can also help by getting your kids moving. Overweight and obese children need at least 30 minutes of exercise each day, and may benefit from closer to 60 minutes. But, even if your child is not overweight, you should encourage him or her to take part in physically engaging activities after school and on the weekends.

For older teens and young adults who are motivated to try the keto way to health on their own, it’s crucial to understand which fats are good for you and which are not. Most Americans consume harmful fats like processed vegetable oils, which will invariably worsen your health.

So when we're talking about boosting consumption of dietary fats, we're referring to natural, unprocessed fat, found in real foods such as seeds, nuts, butter, olives, avocado and coconut oil. A more extensive list of examples can be found in “Basic Introduction to Metabolic Mitochondrial Therapy.”

If they want to go the next step and consider ketofasting, it’s even more important to remember that this isn’t about skipping meals, but of understanding that cyclical ketosis lies in the metabolic flexibility your body achieves as it is able to burn glucose and ketones for fuel.

Unfortunately, eating over a 12-hour period or more during the day radically increases your risk for obesity as your body is only adapted to burning glucose and it's not flexible enough to burn ketones or fat for fuel.

In addition to metabolic flexibility and the reduction in the risk for metabolic syndrome, cyclical ketosis accelerates autophagy³⁴ during which your body eliminates damaged organelles and intracellular pathogens.³⁵

This essential cleaning process encourages the growth of healthy cells and is a foundation for longevity. Intermittent fasting may be one of the most profound interventions you can do to radically improve your health, increase your body’s ability to preferentially burn visceral fat³⁶ and help you shed excess weight³⁷ all while extending your lifespan.

Instead of picking up the newest smartphone app, consider going on a journey of discovery with your teenagers, seeking out some of your locally grown produce, eliminating the processed foods and incorporating intermittent fasting. Each of these nutritional strategies helps support your overall health and weight control.