Tim Radak, DrPH, RD
The current state of obesity or overweight in children has reached a level to where it is a serious public health concern. Risk factors for diseases such as diabetes and heart disease were previously were thought to occur in adulthood but are occurring in youth and are associated with obesity, poor diet and physical inactivity.
It is well documented that children who are obese or overweight strongly tend to continue that characteristic into adulthood. Most weight loss treatments have not shown success over the long term. Clearly new approaches are needed.
While the cause of childhood obesity is certainly multifaceted, some researchers have proposed that adopting and following a vegetarian diet would help address this issue.1,2 Adult vegetarians tend to weigh less than omnivores and a number of studies in vegetarian youth suggest they are at decreased risk for overweight and obesity.1,3 Well planned vegetarian diets are plentiful in grains, legumes, fruits and vegetables, which can be high in fiber and low in fat, making one feel full sooner, and may result in less caloric intake. A recent large study using National Health and Nutrition Examination Survey 1999-2004 data found that vegetarians had many nutrients that were higher in intake as compared to the non-vegetarian population.2
Additionally, vegetarians who were dieting were also found to have nutrient intakes that were generally higher, as well as lower intakes of cholesterol and total fat.2 Of note, fiber intake is a nutrient of concern for Americans, and was a whopping 24% higher in the vegetarian group of this study. Fiber is one of nature’s secret weapons in tackling obesity, and produces a feeling of fullness or satiety sooner, and may make us less likely to continue eating. Vegetarians also have been shown to reduce risk for many chronic diseases including heart disease and type 2 diabetes.
Vegetarians also tend to adopt other healthy lifestyle behaviors and this could have a positive effect on reducing risk for obesity over the long term. These reasons taken together could present a strong case for having children adopt a vegetarian diet as a practical step in reducing risk for becoming obese or overweight or reducing weight for those already obese or overweight.
As a registered dietitian, while any new change has its set of challenges, I have found the promotion of vegetarian or plant based diets to be beneficial and a great strategy for those willing to consider this strategy over traditional caloric restriction diet prescriptions. One pediatric patient, in conjunction with his mother, was provided with dietary advice and counseling to address overweight status by incorporating more fruits, vegetables, and whole grains as part of a vegetarian diet plan.
Before the counseling session, the patients BMI for age was approaching the 90th percentile and the diet was significant in processed meat products, both from at home and away, in particular from fast food restaurants and the patients school cafeteria. Focused efforts to provide healthy vegetarian meals at home, choose vegetarian options at the school cafeteria, and reduce fast food restaurant visits, resulted in significant weight loss over an 8 week period. An additional benefit was the mother also lost weight as part of the dietary changes to a vegetarian diet.
Adults can benefit just as much as children in achieving weight loss success by following a vegetarian dietary plan. Another patient was encouraged to consider a plant based diet for her obesity after reading a weight loss book from Dr. John McDougall (The McDougall Program for Maximum Weight Loss), an entirely plant based weight loss plan. Support and guidance was provided as her dietitian and impressive results were obtained within a three month time and in some case better than from traditional caloric restriction weight loss approaches. Of particular note was that the patient considered this more of a lifestyle change than a diet prescription which was an encouragement to continue the program as part of a daily eating pattern.
Other researchers have critically reviewed the idea of plant-based diets for addressing childhood obesity and expressed concerns over whether this recommendation is ethical given the perceived cost constraints of a plant-based diet.3 The author points out that fruits, vegetables and dairy products can be costly. However, plant-based proteins such as beans, legumes and grains generally cost less than animal protein sources and a recent study reviewing the cost from adopting a plant-based diet was minimal.4 Another large review assessing the impact on health from not consuming adequate fruits and vegetables suggest that independent of anything else, consumption of more fruits and vegetables could play a role in reducing incidence and death from most of the chronic diseases affecting us today.5 The author suggests that these diseases add extraordinary costs for healthcare, and should prompt national strategies to promote population based programs to increase fruit and vegetable intake.5
For populations that are at or near the poverty line, recommendations to eat adequate amounts of fruits and vegetables may result in an extra economic burden. However, some research suggests, that at least with regard to the Food Pyramid, it is possible to meet fruit and vegetables recommendations for low income individuals or families.6-7
Ideas and suggestions for meal plans, food choices, resources and starter kits. Consider:
the Academy of Nutrition and Dietetics Vegetarian Nutrition Dietetic Practice Site: http://vegetariannutrition.net/
The USDA page on Vegetarianism and Children:https://www.nal.usda.gov/fnic/vegetarianism-and-children
The Vegetarian Resource Group: http://www.vrg.org/
Recommending a vegetarian diet for weight loss may not appeal to all patients, but the time might be ripe for it to be a strategy to be considered for incorporation as part of weight loss options and approaches for patients who present with obesity or overweight. The potential increase in consumption of whole grains, fruits, vegetables, and legumes, all with well documented health benefits could help your patient not only achieve weight loss goals, but reap the additional disease risk reducing benefits from what constitutes or makes up a vegetarian diet.
Dr. Radak graduated with a masters and doctorate in public health nutrition with a specialty in vegetarian nutrition and has been a Registered Dietitian for over 20 years. He currently teaches masters and doctorate public health courses, is a program coordinator in the College of Health Sciences at Walden University, and practices as a dietary and nutritional consultant.
Sabaté J, Wien M. Vegetarian diets and childhood obesity prevention. Am J Clin Nutr. May 2010;91(5):1525S-1529S.
Farmer B, Larson BT, Fulgoni VL 3rd, Rainville AJ, Liepa GU. A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the national health and nutrition examination survey 1999-2004. J Am Diet Assoc. 2011 Jun;111(6):819-27.
Robinson-O’Brien R, Perry CL, Wall MM, Story M, Neumark-Sztainer D. Adolescent and young adult vegetarianism: Better dietary intake and weight outcomes but increased risk of disordered eating behaviors. J Am Diet Assoc. 2009;109:648-655.
Newby PK. Plant foods and plant-based diets: protective against childhood obesity? Am J Clin Nutr. May 2009;89(5):1572S-1587S.
Hyder JA, Thomson CA, Natarajan L, et al. Adopting a plant-based diet minimally increased food costs in WHEL Study. Am J Health Behav. Sep-Oct 2009;33(5):530-9.
Bazzano LA. The high cost of not consuming fruits and vegetables. J Am Diet Assoc. 2006 Sep;106(9):1364-8.
Stewart H, Hyman J, Frazão E, Buzby JC, Carlson A. Can low-income Americans afford to satisfy MyPyramid fruit and vegetable guidelines? J Nutr Educ Behav. 2011 May-Jun;43(3):173-9.
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