Pediatric Weight Management (PWM) Reduced Glycemic Load Diet
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
PWM: Reduced Glycemic Load Diet - Children Six to 12 Years
If an ad libitum, reduced glycemic load diet is selected for use in children (ages six to 12), then this diet could be used to produce modest short-term improvement in weight status. Limited research shows that an ad libitum reduced glycemic load diet results in short-term improvement in weight status in this age group.
PWM: Reduced Glycemic Load Diet - Adolescents
If an ad libitum reduced glycemic load diet is selected for use in adolescents (ages 13 to 18), then this diet could be used to produce modest short-term and longer-term improvement in weight status and body composition. Limited research shows that an ad libitum reduced glycemic load diet results in short-term improvement in weight status and body composition in this age group. One study shows weight status improvement at one year.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Parents or caregivers of obese children need to participate in the counseling process.
Potential Costs Associated with Application
- The use of specialized commercial food products to implement this diet could be an additional cost
- If organizational and program costs are passed on to participants, this could limit program access. Additionally, parent commitment to program participation is required.
- The absence of health insurance coverage for weight management could limit program access.
Three studies were identified that met inclusion criteria for treatment of childhood obesity using a low glycemic load diet. In all three studies (Ebbeling CB, Leidig MM et al, 2003; Spieth L, Harnish J et al, 2000; Young, West et al, 2004), results showed an improvement in anthropometric outcomes measured by BMI. However, only Ebbeling et al showed long-term improvement, in one-year follow-up data, of anthropometric outcomes.
In the analysis of six studies (Ludwig DS, Majzoob et al, 1999; Ball SD, Keller KR et al, 2003; Ebbeling CB, Leidig MM et al, 2003; Warren, Henry et al, 2003; Young, West et al, 2004; Spieth L, Harnish J et al, 2000), which prescribed an ad libitum low glycemic diet or meal to their subjects, all studies that reported the actual intake showed a reduction in caloric intake (compared to either baseline calorie intake or higher glycemic load diet).
Thus, it is likely that one of the reasons low glycemic diets may bring about weight loss is simply that this type of diet brings about a reduced caloric intake. In the Ebbeling et al study, both groups, the low-fat hypocaloric diet and the ad libitum low glycemic diet, demonstrated a reduction in energy intake from baseline to follow-up. However, the low glycemic diet group was able to demonstrate long-term weight loss, while the low-fat hypocaloric group regained the lost weight.
Recommendation Strength Rationale
- Both conclusion statements are given Grade III
- All studies had small numbers of participants (seven to 64 participants). Only one study (Ebbeling CB, Leidig MM et al, 2003) included a follow-up at one year. Of the three intervention studies, two were given a neutral rating and one a positive rating. However, the results of these studies were consistent supporting the recommendations.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, and Ludwig DS. A Reduced–Glycemic Load Diet in the Treatment of Adolescent Obesity. Arch Pediatr Adolesc Med 2003;157:773-779.
Spieth L, Harnish J, Lenders C, Raezer L, Pereira M, Hangen SJ, Ludwig D. A Low-Glycemic Index Diet in the Treatment of Pediatric Obesity Arch Pediatr Adolesc Med 2000;154:947-951
Young P, West S, Ortiz K, Carlson J. A pilot study to determine the feasibility of the low glycemic diet as a treatment for overweight children in primary care practice. Ambulatory Pediatrics 2004;4:28-33.
Ball SD, Keller KR, Moyer-Mileur LJ, Ding Y-W, Donaldson D, Jackson WD. Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents. Pediatrics 2003;111:488-494.
Ludwig DS, Majzoub JA, Al-Zahrani A, Dallal GE, Blanco I, Roberts SB. High glycemic index foods, overeating, and obesity. Pediatrics 1999;103:e26
Warren JM, Henry JK, Simonite Y. Low glycemic index breakfasts and reduced food intake in preadolescent children. Pediatrics 2003;112:e414-e418.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process