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Children

Study Finds Giving Prebiotics To Kids Doesn’t Change Their Energy Intake And Ups A Major Hunger Hormone Yet Still Concludes Prebiotics Have Potential To Help With Childhood Obesity?

Posted August 14, 2018 by Yoni Freedhoff

Today will be discussing a study that had kids randomly assigned to taking either 8g oligofructose enriched inulin (prebiotic) per day or placebo (maltodextrin) for 16 weeks.

The study’s pre-registered primary outcome measure, as recorded in ClinicalTrials.gov, was change in baseline fat mass at 16 weeks.

Secondary outcome measures (as recorded) were changes in baseline appetite at 16 weeks (assessed with visual analog scales and an eating behavior questionnaire), and objective appetite measures including a weighed breakfast buffet, weighted 3-day food records, and serum satiety hormone levels.

(Not preregistered as an outcome of interest? Body weight change or BMIz score.)

Outcome wise, here’s a snapshot of the study’s abstract:

Reading through the study, here’s what I found as outcomes:

  • According to their 3 day food diaries (but be aware, food diaries are notoriously inaccurate), there was no difference in 3 day energy intake between the prebiotic and placebo arms.
  • When all ages were included in the analysis, there was no difference in all-you-can-eat breakfast buffet energy intake between the probiotic and placebo arms, BUT, by dividing the kids into those between the ages of 7-10 and 11-12, suddenly, but only in the older group, kids ate less breakfast in the prebiotic arm, while in the younger group, they ate more.
  • The hunger hormone ghrelin was found to be significantly elevated in those taking the prebiotic (an increase of 28%) from baseline, whereas placebo was not demonstrably different from baseline (an increase of 8%).
  • There was no difference reported in subjective post-breakfast buffet hunger in either group
  • There was no difference reported in subjective eating behavior questionnaires between groups, but parents reported improvements in fullness, but equally in both prebiotic and placebo groups.
  • The primary outcome of change in baseline fat mass was not mentioned anywhere in the study.

The authors’ conclusions about a prebiotic supplement that was shown to markedly increase hunger hormone levels, that didn’t decrease 3 day food diary energy intake, that didn’t change all-you-can-eat breakfast buffet energy intake (unless you arbitrarily after the fact divided up the kids into those aged 7-10 and 11-12), and where the study’s registered primary outcome wasn’t mentioned in the study itself sure look differently than what you might expect, with their concluding sentence being,

This simple dietary change has the potential to help with appetite regulation in children with obesity

I also found it surprising that the study was free to read, and given the incredibly unexciting findings, it’s more difficult to imagine the authors paying for its open access. Easier to imagine the company that makes the prebiotic that a randomized controlled trial published in an impactful journal explicitly concluded, “has the potential to help with appetite regulation in children with obesity” (even though it didn’t), paying the extra fees as open access articles generally gather more citations.

As to what Beneo, the manufacturer of the prebiotic used in this study had to say, I found these quotes in an article published on the trade-zine Nutraingredients at the time of the study’s publication,

Beneo regards this research of highest importance“,

and despite the study not even remotely coming to this conclusion also added,

The intake of 8g of prebiotic inulin (Orafti Synergy 1) in a glass of water prior to dinner is a simple dietary intervention that supports children in their weight management efforts. The results show that they were naturally eating less (YF: no they didn’t) than the control group having maltodextrin

Beneo also put out an excited press release to publicize the study.

And you can bet your bottom dollar, it’s studies and conclusions like this one that supplement companies use to suggest great benefits to their products, and it’s also studies like this one where I wish the journal employed open peer review as I can’t fathom how this one got through as is.

Lastly, while the authors didn’t report any conflicts of interest with this particular study, the supplements and placebos were provided by Beneo, and it was noted that one of the authors had previously enjoyed funding from Beneo. Unfortunately there is no mention as to who paid for this study’s open access.

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Children

Apparently Some Parents Are Hiring Fortnite (A Video Game) Coaches For Their Kids. Wish They’d Hire Them Cooking, Budgeting, And Critical Appraisal Coaches Instead

Posted August 2, 2018 by Yoni Freedhoff

Now I can’t imagine it’s a commonplace practice, but yesterday the Wall Street Journal published a piece about parents hiring coaches to help their children gain skills and level up in Fortnite, a first person shooter video game.

The mind boggles.

Dare to dream of a alternate universe, where instead of hiring their children video game tutors, parents hired coaches to help teach their kids life skills like cooking, making and keeping a budget, or critical appraisal. Or better yet dream of parents going out of their way to do so themselves, and of a school system that weaves those sorts of actual life skills throughout their curricula from K-12.

We can dare to dream, can’t we?

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Children

No Parents, Your Children Aren’t “Stealing Food” (And Some Thoughts On How To Silently Cultivate Better Choices)

Posted July 30, 2018 by Yoni Freedhoff

It’s a concern I hear not infrequently when meeting with parents of children with obesity – that their son or daughter is “stealing” food.

I have no doubt too, that in some cases, those kids received some perhaps well-intentioned, but I think very misplaced, ire about it.

The stories are all pretty similar, and often occur on weekends or after school whereby parents come home and find evidence that their child has raided the fridge, cupboard, or freezer by way of wrappers, cans, dirty dishes, or a much emptier than before container.

As to what’s happening, some thoughts.

First off, we all did it. I remember “stealing” Voortman Strawberry-Turnovers pretty much every Saturday morning while my parents were sleeping and I was watching cartoons. Some mornings I’d put away 6 of them.

And why did I do it?

Because they’re were delicious, and I was hungry, and I was a kid, and they were there, and because I could.

Secondly, we all still do it. Who doesn’t grab a handful of this, or a package of that, multiple times a week or even daily?

Plainly put, grabbing yummy, readily available, oftentimes calorie dense and unhealthy foods is part of the human condition.

And though I appreciate that parents who may be concerned about their children’s weights and/or eating patterns find this behaviour alarming, believing there to be something wrong with their children, or that their children lack “willpower“, is unwise and unfair.

If you’re worried about your children’s (or your own) grazing habits, here are a few things for you to consider.

  • Take an inventory of the “stolen” foods in your home. Are they cookies, candy granola bars, drinkable ice-creams yogurts,  soda, flat-soda juice, etc.? If so, could you buy them less frequently? And eventually not at all?
  • Are your children’s other meals and snacks designed to be filling? Are they large enough? Do they include protein? Are they eating them or do they skip meals? Ensuring you’re providing your children with filling, regular meals and snacks may lead them to come home less driven to raid the cupboards. And if they’re skipping meals and snacks, are they doing so consequent to your own example?
  • Are your children worried they’ll simply never get anything “good“? If your home is highly restrictive around treats, and your children don’t know when they’ll next be offered one, grabbing one when you’re not there is not a surprising outcome. To combat snack and treat based food insecurity, plan them into your child’s week and ensure they’re made aware that they’ll be getting them – and this too may provide you with a great opportunity to work on weekly treat-inclusive menu planning with your family which in turn is an important life skill.
  • Make the stuff you want them to eat more of more readily accessible and inviting. Wash all fruits and vegetables when you get home from the grocery store and leave them in visible, easy to reach, inviting bowls while relocated the stuff you’d prefer they eat less of to cupboards and drawers that require more effort to see. And note, I’m not recommending hiding anything or locking it away, just ensuring that the easiest things to see and eat and the foods you’d prefer that they grab.

So, if your kids are grabbing stuff, instead of approaching them with anger or overt concern, instead try to approach them with genuine curiosity to find out what’s going on, and then turn back to that list up above. If they just really like those things they’re grabbing, then planning them into the menu may help. If they report they’re starving, exploring their daytime eating patterns and choices to look for ways to ensure they get enough to eat so as to not arrive home famished. If they report there wasn’t anything good to grab, brainstorm other options and make sure they’re readily available and visible.

And lastly don’t forget who we’re talking about. If the expectation of regularly making healthy choices just because they’re healthy isn’t a fair expectation for all of us fully grown adults (and it’s not), why would it be fair to expect that of your children?

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