Research Profile

One if five teenagers in the United States is living in a larger body. For many teenagers, living in larger body increases their risk of having multiple chronic disease, such as high blood pressure, cholesterol, and diabetes, and may limit their lives. We currently treat obesity by recommending that youth change the type of food they eat, the quantity of food they eat, and increase their daily exercise. Unfortunately, although these skills are very important to lead a healthy life, they often do not result in weight loss for many teenagers. One of the reasons these recommendations are challenging for teenagers, is that they require continuous, daily, behavior change, calorie counting, and changes to the types of food teens eat. The effectiveness of these interventions relies on doing them every day over a long period of time which is very difficult for many young people who have busy lives full of many commitments and responsibilities. Interestingly, in infants and babies many pediatricians recommend that parents focus their eating on what times they are eating, which we call a time-based approach. This technique is not utilized in teenagers very often, where the focus is on quality and quantity of calories instead. In adults, over the last decade many scientists have started to study if adjusting the time of day in which a person eats and the over how many hours, they eat make them healthier. For many adults, limiting the hours of the day in which they eat helps them lose weight, control their diabetes, high blood pressure, and high cholesterol. Adults that have participated in these studies also report that only thinking about the time of day in which they are eating, opposed to constantly counting calories is easier and less disruptive to their lives. However, what we don’t know yet is whether they should have their eating window in the morning, afternoon, or evening. It seems that the time of day in which they eat changes whether this approach results in weight loss and improved health. Several studies conducted in both animals and humans have suggested that eating early in the day may be the best approach to improve health. However, many teenagers prefer to not eat breakfast or lunch and are most hungry later in the day. This may be due to growth and puberty or simply because they prefer to eat with friends and family after school. Either way, recommending teenagers should start eating early in the morning many not be something they are interested in and therefore hard for them to follow consistently. Although studies in adults have suggested that eating early in the day is best for health, very few of those same studies have been done in teenagers, so we don’t really understand how time of day in which you eat may affect health in teens. To better understand that we are going recruit 100 teenagers, living in larger bodies, at risk for diabetes, to be a part of a 6-month study. In this study, teenagers are going to wear a continuous glucose monitor daily and either be assigned to eat all their food for the day early (between 8 AM and 4 PM) and later in the day (between 12 PM and 8 PM). We are going to see what happens to their blood sugar and other hormones and proteins in response to eating at different times of day.

We predict that due to puberty and growth teenagers living in larger bodies may have a healthier response to food later in the day than early in the morning. If that is true, then it may help us argue that time-based approaches in teenagers should recommend the eating window in the afternoon and evening. This is important because we must do something to try and prevent teenagers living in larger bodies from getting diabetes. If the simple act of changing the time of day that you eat could prevent diabetes and help teenagers living in larger bodies live longer healthier lives, we want to know so we can teach pediatricians and have them prescribe that to their patients.

I believe pediatric obesity is one of the greatest risk to the longevity and health of the next generation. My work is committed to finding innovative, simple, and effective strategies to help youth living in larger bodies thrive and avoid life-limiting complications such as youth onset type 2 diabetes. My long-term goal is to determine whether time based nutrition is beneficial as part of the medical regimen in youth living in larger bodies, at risk for type 2 diabetes, and if so, to identify: 1) youth characteristics associated with positive response, 2) mechanisms by which time-based eating works, 3) optimal timing of the eating window, and 4) the best methods to administer time-based eating to maximally harness its effects across all communities. The data collected in this project will form the basis to complete a large, multi-center trial of time-restricted eating in teenagers with both pre-diabetes and type 2 diabetes to determine how this approach can impact disease onset, progression, and severity over the longer-term.

There is an urgent need to identify successful nutrition strategies that can delay or prevent youth from getting type 2 diabetes. I believe time-based approaches may be a simple, straightforward, and effective nutrition strategy that is impactful, sustainable, and cost effective across all communities and all age groups.