Health Education: Obesity

Showing posts with label Obesity. Show all posts

Using Advertising to Improve Diet

The post for today was written, by me, as an exercise for a class I am taking to improve my writing.  I chose the study for blog relevance and personal interest, but it may seem more formal than my usual, opinion- infused posts.  Now you know why :) <div class="MsoNormal"> In the United States, obesity rates have risen over the past 40 years (Ogden & Carroll, 2010), and many health professionals consider the disease to be epidemic.  The suggested causes of obesity are numerous, interconnected and multi-level.  Because individual level prevention programs are expensive and generally ineffective, researchers have begun testing environmental or societal level strategies that can affect whole populations (Swinburn, Egger, & Raza, 1999).  For example, Rusmevichientong, Streletskaya, Amatyakul and Kaiser (2014)recently conducted a laboratory experiment to compare the effect of 4 types of food advertising on lunch purchases.  The researchers expected that limiting unhealthy food advertising, increasing healthy food advertising and airing anti-obesity messages would each lead to the purchase of items with less calories, fat, sugar and sodium. </div> <div class="MsoNormal">If advertisement manipulation is effective in reducing over consumption in the short term, public health advocates will have evidence to promote advertising interventions or policies, which may lead to a reduction in obesity rates over the long term.  Rusmevichientong and colleagues offer some evidence in this regard. </div> <div class="MsoNormal"> Rusmevichientong and colleagues randomly assigned 182 adult college students into one of 4 treatment conditions.  All participants watched TV for about 16 minutes. In all but one group (the control), the participants viewed four, five or six, 30 to 60 second advertisements in one of the following categories: unhealthy food advertisements (unhealthy foods were defined as items high in sugar, fat and sodium), healthy food advertisements (ones promoting the consumption of fruits and vegetables), anti-obesity messages, and a mixture of all three types. Before and after the TV viewing, each participant chose a lunch meal from a computerized menu.  The researchers provided $10 meal vouchers, but participants had to pay the difference if their order was more than $10.  The researchers compared the food orders before and after the TV viewing (within participants) and the changes between the groups, including the control. The research design (different in difference) allowed the researchers to compare the magnitude of difference between ad types. </div> <div class="MsoNormal">In this laboratory experiment; exposure to the healthy food messages, anti-obesity messages and a mixture of unhealthy, healthy, and anti-obesity messages, led to an increase in healthy food purchases and a decrease in number of calories purchased. The healthy food messages produced the greatest decrease in calories purchased (134) compared to anti-obesity messages (93) or mixed messages (90). There was also some reduction in the fat and sodium content in the meals purchased.  In addition, Rusmevichientong and colleagues found a positive association between these 3 advertisement conditions and ‘becoming healthier,’ which they defined as purchasing a greater number of healthy foods at time 2.  The researchers suggest using anti-obesity ads judiciously and thoughtfully (i.e., ones that are not stigmatizing or fear producing) and healthy food advertising to reduce the over consumption of calories in the US adult population. </div><div class="MsoNormal">Rusmevichientong and colleagues results are important because most research suggesting a relationship between both anti-obesity messages and reduced caloric consumption, and healthy food ads and reduced caloric consumption is based on cross sectional surveys.  Experimental studies allow researchers to claim causal inference, e.g., healthy food ads change behavior. However, this particular study was small, took place outside of a natural setting and used a homogenous set of participants.  Policy advocates may present this evidence along with evidence produced from representative, field based, cross-sectional or longitudinal studies to make a case for new advertising polices. Citations </div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 0.5in; text-indent: -0.5in;">Ogden, C. L., & Carroll, M. D. (2010). Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960–1962 through 2007–2008. NCHS Health and Stats. </div><div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0in 0.5in; text-indent: -0.5in;">Rusmevichientong, P., Streletskaya, N. A., Amatyakul, W., & Kaiser, H. M. (2014). The impact of food advertisements on changing eating behaviors: An experimental study. Food Policy, 44(0), 59-67. doi: <a href="http://dx.doi.org/10.1016/j.foodpol.2013.10.011">http://dx.doi.org/10.1016/j.foodpol.2013.10.011</a></div><div class="MsoNormal" style="line-height: normal; margin-left: 0.5in; text-indent: -0.5in;">Swinburn, B., Egger, G., & Raza, F. (1999). Dissecting obesogenic environments: The development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine, 29(6), 563 - 570. doi: 10.1006/pmed.1999.0585</div><div class="MsoNormal"> </div>

Using Advertising to Improve Diet

The post for today was written, by me, as an exercise for a class I am taking to improve my writing. I chose the study for blog relevance a...

5:45 PM

Labeling Rules ~ The FDA has us all in limbo

Any day now, or more likely, sometime in 2014, the FDA will release the final rule for the national nutrition/menu labeling law officially meant to apply to restaurants (sit down and counter chains), vending companies, and similar retail establishments. As of today, the consumer (you and I),  health advocates (myself,  CSPI, the RUDD Center,  many others), the National Restaurant Association, the National Grocers Association, the Association for Convenience and Fuel Retailing, pizza restaurants and other food selling/entertainment venues (e.g., bowling alleys, cinemas) remain unawares and unprepared for what will be required. Of those listed above, the consumer interest groups (and thus a majority of the general public), public health folks and the National Restaurant Association supported the menu labeling law, but the others did not nor did they expect to get caught up in it.  My personal belief is that anyone selling ready to eat, unpackaged food has an obligation to share with the buyer of that food, pertinent nutrition information.  I would include food sold from steam tables in grocery stores, hot dogs and the like sold in convenience stores and items sold from concession stands at bowling alleys, sports arenas and movie theaters. I do think that pizza joints should get some leeway in how they present the information due to the individual, made to order nature of pizza. Once the FDA makes its announcement, retailers will have 6 mos to 1 year to comply.  Then the next battle begins.  Updating the nutrition facts panels on packaged foods. In this case, the concern  (of food companies) is whether the update is going to mandate  labels that imply a foods goodness, e.g., star ratings or multiple traffic lights.

Labeling Rules ~ The FDA has us all in limbo

Any day now, or more likely, sometime in 2014, the FDA will release the final rule for the national nutrition/menu labeling law officially m...

7:49 PM

What does it mean to be metabolically healthy obese?

Over the past weekend, I read a summary statement for a research study by Camhi and Katzmarzyk, 2013.  I was intrigued because the exercise and health scientists explored the differences in body composition (e.g., % lean mass, fat mass, bone density, central fat tissue) between two groups of obese people. The people in the study were classified as metabolically healthy obese or abnormal obese. The summary statement did not indicate if obesity was determined by BMI, waist to hip ratio, waist circumference or some other measure.  It did say how the determination of healthy vs unhealthy (metabolically speaking) was made, and I thought this a teaching point.  (FYI: Simply put, metabolic refers to under the skin - cellular processes. So the researchers were not looking at whether or not there were mental health issues, or physical conditions like arthritis, in this group of obese persons.)  I also do not know why the researchers chose the criteria listed below to determine metabolic health, but each has been independently associated with poor health outcomes, like heart disease, in other studies.  Of the following measures, an obese person in the study who had 1 or less of them was considered metabolically healthy, and an obese person in the study who had 2 or more was considered metabolically abnormal.   The measures were: <ol><li>a blood pressure reading higher than 130/85 mm/Hg</li><li>a fasting glucose level greater than 100 mg/dl</li><li>a waist circumference greater than 102 cm men, 88 cm women (click <a href="http://www.metric-conversions.org/length/centimeters-to-inches.htm" target="_blank">here</a> to convert to inches) </li><li>triglyceride level (blood fats) higher than 150 mg/dl</li><li>hdl (good) cholesterol less than 40 mg/dl men, 50 mg/dl women</li></ol>     I noticed that they did not use total cholesterol levels or LDL levels.       The aim of the study was to see if something about body composition was different between the two groups (could this difference explain the accumulating risk factors).  The researchers did find differences, which were specific to gender.  For most of the body composition measures they assessed(not described here), the metabolically healthy obese had lower values.  For example, both metabolically healthy men and women had lower fat mass and less stomach or trunk fat.  Most every measure was related to a type of adipose(fat) tissue, such that the more fat one had on their body, and in specific places, the more likely they were to have more than 2 of the risk factors and thus be metabolically unhealthy.      Take home point.  Your absolute weight is not as important as your body composition and the 5 measures listed here are numbers you might want to pay attention to at your doctor's visits.

What does it mean to be metabolically healthy obese?

Over the past weekend, I read a summary statement for a research study by Camhi and Katzmarzyk, 2013. I was intrigued because the exer...

7:34 PM

Future Self-Control

I am 100% in favor of mandatory nutrition information at the point of purchase for ready to eat foods at all places where they can be purchased (e.g., restaurant, vending machine, movie theater, bowling alley).  I believe that an interpretive system, like the multiple traffic light (red for high in a nutrient, amber for moderate and green for low), is crucial, but I understand that nutrition labeling as a means to change behavior will always be less effective than other strategies, like zoning laws and taxes.     The provision of nutrition information, even with a color code or star rating system, leaves individuals free to make an informed choice.  Unfortunately, choosing food isn't the same as choosing a dishwasher (which also comes with content info and a rating system).      There are many things that influence a food choice.  One of my favorite theories or frames which addresses these nuances is behavioral economics.   <a href="http://aepp.oxfordjournals.org/content/early/2013/10/02/aepp.ppt027.short" target="_blank">READ THIS GREAT ARTICLE</a>, by Liu, Wisdom, Roberto, and Liu (2013).     The reason I think the traffic light labels are crucial is two fold.  First, most people do not have awareness of dietary guidelines or the nutrition knowledge that allows them to determine if a food is high or low in items that are best limited (e.g., saturated fat, sugar, salt, calories).  Second, many people are present biased in their (food) decision making. In other words, the desire for the taste or the happy memory associated with a certain food, is first and foremost in a present biased persons mind.  The needs of  'here and now' trump any consequences (weight gain, ill health) that might occur sometime in the future.    There is another factor (noted in the article I linked earlier) that I wanted to share.  I think you will go "oh my gosh, that is so true!" just like I did.  This is the belief or confidence we have in the self-control of our future selves.  For example, on a certain day of the week, you know that you should skip dessert.  You are full and can't afford the extra calories.  But it is someone's birthday so you just have to have some, and you'll do better next time or the next day.  Then someone brings cookies to the office and you really shouldn't have any, but everyone else is having them, and they really taste good, so you eat the cookies and promise yourself that tomorrow you will have dinner with out bread.  Oh, but tomorrow comes and the waitress served bread so you have to eat it, right? etc.....

Future Self-Control

I am 100% in favor of mandatory nutrition information at the point of purchase for ready to eat foods at all places where they can be pu...

8:13 PM

Does vegetarian = low calorie?

If you are considering a meat free diet specifically to reduce the number of calories you consume, this post is for you.    There are several reasons why national dietary guidelines, the American Cancer Society and the American Heart Association recommend that  <ol><li>red meat be limited(this includes pork no matter what you tell yourself), </li><li>processed meat be avoided or extremely restricted (this includes all lunch meats, bacon, sausage) and </li><li>a plant based diet be chosen (lots of vegetables, fruits and whole grains).</li></ol>    Two words in the start of that sentence explain the dietary advice, heart and cancer.  Evidence suggests that saturated fat in red meats may lead to high blood cholesterol and thickening or hardening of the arteries, and that processed meat increases the risk of colon cancer.  Fruits, vegetables and the fiber from whole grains has been shown to reduce the same problems or diseases.   Meats also have more calories per gram than plant based items and limiting them can make it easier to consume fewer calories. However, this is only true when all things are equal- (and they never are - equal). Look at the table below, which I created using Jimmy John's gourmet sandwiches - this is a list of the seven 8" sub sandwiches on their menu.  I put them in order from least to most calories per sandwich. <table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicLdiZkwXiApn9fhmd6ICK1cuFhmlEd0_C9MGGbs8lZg_O6ZHb7IKLbYtz6OE7gRtquzN1HvA-si4eAAEpl-RlBbooeBiPIcuM_ivN6ggioPL6rfkdBdK0C8hi-K9-q4W_Je57ZRkIqWDL/s1600/JJs.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="208" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicLdiZkwXiApn9fhmd6ICK1cuFhmlEd0_C9MGGbs8lZg_O6ZHb7IKLbYtz6OE7gRtquzN1HvA-si4eAAEpl-RlBbooeBiPIcuM_ivN6ggioPL6rfkdBdK0C8hi-K9-q4W_Je57ZRkIqWDL/s400/JJs.JPG" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="https://www.jimmyjohns.com/menu/#/subs/" target="_blank">JJs 8" sub sandwiches </a></td></tr></tbody></table> As you can see, the vegetarian sandwich has the most saturated fat and nearly the most calories.  All of the sandwiches, with the exception of the Vito, which is made with Italian lunch meats and an oil and vinegar, contain MAYONNAISE.  I can tell you how the vegetarian sandwich ended up to be so high in calories, but first note that all the sandwiches are a significant source of calories because of the bread - a salad would be a better choice (if not loaded with a mayonnaise based dressing).  The vegetarian option is described on the menu as having 'layers of provolone cheese and an avocado spread,' plus the mayonnaise and a few veggies for a grand total of 640 calories! The cheese, avocado and mayonnaise are the main source of calories, followed by the bread - I suspect.  A more reasonable lunch would have 400 calories, and mine usually have 100 or 200 because I eat small meals often. All food has the potential to be high in calories and nutrients that are harmful in excess (i.e., saturated fat, sugar, sodium). In order to make sure that when you intend to eat a low calorie meal you actually do, read the menu labels, ask the restaurant staff to hold things like mayo, ask if butter is used on the 'steamed' vegetables and consider skipping butters, breading and sauces when preparing food for yourself. BTW, this post was inspired by a meeting I am going to next week.  We were given these 7 options to choose from for our lunch.  I replied to the host that I would be bringing my own lunch.   (That's right.  It doesn't matter that the lunch is free - it doesn't matter if everyone else is going to order from that menu - what matters it what I need for my body and my health.  Surely you feel as interested in your health as I do mine.  Be brave and remember not to eat to please others but to fuel your body - while enjoying the choices you make.)

Does vegetarian = low calorie?

If you are considering a meat free diet specifically to reduce the number of calories you consume, this post is for you. There are sev...

7:34 PM

Eating to Please... the Slippery Slope

No matter where you live in the world, society has certain norms about food.  In addition, your family or church culture might have traditions or customs about food. Some things are easy.  If you are going to a function where food is to be served, whether its an official party, or just a visit to your Auntie's house where food is not to be refused! - go hungry (go to the event hungry).  In other words, don't add to the days calories, include what you eat or drink there as part of your day's total intake. But what about the social norms that you can't prepare for?  What if someone bakes a cake and brings it in to work?  Or you just drop by a friends house and he or she brings out cookies?  Is it right to eat just to please someone else?  Is it right (smart) to eat just because 'everyone else is'?   I say no.  I think we are on a slippery slope when we start eating to give other people pleasure.  Consistently eating for reasons that are far removed from the main purpose which is to fuel our bodies and brains is dangerous. To be absolutely 100% clear, food is to be enjoyed!  Tasted, savored, shared - I always enjoy eating but I do not eat to feel enjoyment.  Does that make sense? Eating to feel good is a very dangerous habit to get into and eating just because someone suggests it, or you are bored, or you want to celebrate.. when you are really not hungry.. that is risky.  It can condition the brain to use food as a crutch or as a feel good medicine.. food should not be used as a security blanket. It is okay to tell someone that you are too full to try their cake, or heck, that you have allergies, or that you are fasting for religious purposes, tell them anything you want..you do not have to eat to please someone else. But if you know a food event is coming, it makes more sense to go there hungry or to bring a low calorie item to share rather than offend your host. Please give this post some thought.  One of the reasons - and there are many - that a majority of people weigh more than is healthy for them (70% of US adults), is because they consume more calories than they need, and that is sometimes because they eat for the wrong reasons. (sometimes they eat too many calories by accident, but that is related to food labeling)

Eating to Please... the Slippery Slope

No matter where you live in the world, society has certain norms about food. In addition, your family or church culture might have traditio...

7:04 PM

McDonalds?

Okay, yes.  I am going to come out and say that this is a good thing. McDonalds is going to allow people to choose a salad or a vegetable in place of french fries in the value meals. It is also going to stop promoting soda as a drink option in its happy meals (I wonder about other sugar sweetened beverages like juice and if they will only offer low fat milk, but its a start) Is McDonalds the right place to do this?  Well, heck yeah.... its THE place to do it.  BTW, if McDonalds can let us substitute salad for fries, I hope the more 'upscale' restaurants will join in.  Actually, didn't I talk about this a year ago? I am excited.  It has to start somewhere - and since the USA has the highest ratio of McDonalds restaurants per 1 million people in the WORLD - and the near highest obesity rate (I think USA is second) - McDonalds it is.   I find this change more important than the one over at Burger King.  It is good that BK is thinking of ways to reduce calories in their items, but 270 calories is still a lot more than an 80 calorie salad (minus the high cal/high fat dressing of course)   In my last blog, I wrote about a french fry burger and a bottomless bowl of pasta so I am calling this progress and leaving it at that.

McDonalds?

Okay, yes. I am going to come out and say that this is a good thing. McDonalds is going to allow people to choose a salad or a vegetable in...

8:25 PM

Is the Food Industry Promoting Obesity?

The US population has a high rate of obesity, perhaps the highest in the world (see the WHO and CDC obesity websites for the numbers).  The simplest explanation, the one without nuance, is that people are eating more calories than they need. The nuanced explanation involves all the reasons why we are consuming too many calories.  For example, one reason is that we don't know how many calories we need.  Another is that, even those who know their caloric needs, cannot reasonably (or accurately) estimate the amount of calories in the food and beverages available to them.  Still another, the food and beverages most readily available and heavily promoted are (ridiculously) high in calories. So is the food industry a culprit? I give you three reasons why I think the answer is yes, but note, I said a culprit not the culprit.  They are: <ol><li>The french fry burger</li><li>Endless bowls of pasta</li><li>And the Bacon Pepperoni pizza burger</li></ol>  There are many factors that promote an over consumption of calories.  The cause will always involve an interaction between the person and his or her environment.  But really, does the environment have to be this over the top?  Cheap, calorically- dense, nutrient-poor food is much easier to access than it is to avoid.  That's a problem, but its one we CAN address.

Is the Food Industry Promoting Obesity?

The US population has a high rate of obesity, perhaps the highest in the world (see the WHO and CDC obesity websites for the numbers). The ...

8:13 PM

Does Information Make It Easy?

This past Monday, the Huffington Post ran an article on menu labeling that was written by two former USDA secretaries.  They were writing in support of the mandate found in the Affordable Care Act that requires restaurant chains and similar establishments to post the calorie contents of their items on menus and menu board.      The secretaries, Dan Glickman and Ann Veneman were specifically speaking to the debate over similar establishments, and as I have suggested here, they urged the FDA to include movie theaters in the mandate.  They also called for supermarket inclusion and alluded to sports arenas, but did not mention bowling alleys.  They appeared to be in support of having all of the venues included because they spoke of consumers being able to compare items no matter where they were choosing them.  They said that the regulations should be "inclusive."  They also said, and here is where I disagree, that having information available at all locations will make the healthy choice the easy choice.     Though it is necessary to have information to make an informed choice and information is necessary to make one that meets your values, having it does not make the healthy choice easy.  Why not? Because information is only one factor that goes into food decisions and if survey research is correct, it is not the number one or even number two factor in this choice.  Along side those lower calorie items (on that menu) are the cheaper ones and the more palatable ones(high sat fat and sugar).  In order for the healthy choice to truly be easy, we have to do something about the unhealthy choice.  We have to find a way to make it LESS desirable.  (raise the price or limit the advertising for instance)

Does Information Make It Easy?

This past Mond ay, the Huffington Post ran an article on menu labeli ng that w as writ ten by two former USDA secretaries. The y were wr...

8:00 PM

Is Being Overweight Healthy?

In a word....NO.   <div class="MsoNormal">A researcher is making news for her findings – and some of it might not be the kind of news she would like to make.  Dr. K.  Flegal has completed a study that she says shows being somewhat overweight is better than being low weight.    Her study supports the present belief that obesity is related to heart disease, diabetes, some cancers and all-cause mortality, but challenges the belief that overweight does the same thing.  The problem with her study, some say, is that she is including people who are thin not because they are fit, but because they are unhealthy – having terminal illnesses and or being smokers.</div> <div class="MsoNormal">Her work stands in stark contrast to most studies and in and of itself does not merit a reversal of public health recommendations.  It certainly is not an excuse for YOU to accept a weight that is high for yourself.  </div> <div class="MsoNormal">Here I will requote Dr. Walter Willett – an epidemiologist with Harvard School of Public Health who was interviewed by Allison Aubrey.  Please see her article <a href="http://www.npr.org/blogs/health/2013/01/02/168437030/research-a-little-extra-fat-may-help-you-live-longer">here.</a>  These quotes come directly from her story:</div> <div class="MsoNormal" style="margin-left: 0.5in;">"This study is really a pile of rubbish and no one should waste their time reading it," he says.</div> <div class="MsoNormal" style="margin-left: 0.5in;">Also, he says the analysis doesn't address the bigger, more important issues of quality of life. If an overweight person does live longer — is he or she living with chronic diseases?</div> <div class="MsoNormal" style="margin-left: 0.5in;">"We have a huge amount of other literature showing that people who gain weight or are overweight, have increased risk of diabetes, heart disease, stroke, many cancers and many other conditions," Willett says.</div> <div class="MsoNormal" style="margin-left: 0.5in;"> </div>

Is Being Overweight Healthy?

In a word....NO. A researcher is making news for her findings – and some of it might not be the kind of news she would like to make. Dr. ...

6:47 PM

When the average is a bad thing.

A friend shared a smart phone app with me yesterday.  It is called Fooducate.  You can visit the webpage by clicking <a href="http://www.fooducate.com/" target="_blank">here</a>.  If you have a smart phone (iphone or android) you can download the free application.  The link was shared with me because I am studying the use of nutrition information in college students and my colleague thought that menu labeling wasn't going to cut it with this age group. (I plan to find out) I went ahead and downloaded the app to test it out. You can hold your phone's camera lens near the barcode of the food item and it will read it.  Then you are taken to a webpage that gives you information about that product - including calories, saturated fat and even if it has GMOs. To set up the application on your phone, you enter 6 pieces of information.  One of them is your weight.  When I got to that screen, there was this message "the average woman weighs 160 pounds and the average man weighs 190 pounds."  I am pretty sure it said the average American....  Let me make something very clear - the average weight is overweight or obese - greater than 60% of the US Population falls into this category.  In fact, the NHIS released data reports today that show the obesity rate is at about 30% currently.  Many women who weigh 160 pounds are not at a healthy weight.  Do NOT be comforted or fooled into thinking that  a 'normal' or 'average' weight is good. (I am not speaking to anyone individually here - a healthy weight is determined by your blood work (glucose, cholesterol etc) and blood pressure, physical stamina, physical and mental comfort, etc) I read the statement re: 160 pounds yesterday and today the NHIS brief was in my mailbox.  I thought that was a neat coincidence. Here is the latest data - in graph form.  This comes from the CDC.  <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmfPK-o1KkxbtmnvufoaqmvY8AUTf-Aa-W3_R_Qb0PrjBapi9YKUK2QtnxW9yd316VqVq8WNjgysnuDbcDbd4BYMYW0WbvthDJlU-rX_Id0oNnAWsWZIFOFTA9leyl2aopKz5OPOesnH10/s1600/obesity+2012.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="477" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmfPK-o1KkxbtmnvufoaqmvY8AUTf-Aa-W3_R_Qb0PrjBapi9YKUK2QtnxW9yd316VqVq8WNjgysnuDbcDbd4BYMYW0WbvthDJlU-rX_Id0oNnAWsWZIFOFTA9leyl2aopKz5OPOesnH10/s640/obesity+2012.JPG" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">NOTE: this is one of our Health Indicators... The goal is that white line... we want to be UNDER it.</td><td class="tr-caption" style="text-align: center;"> </td></tr></tbody></table>  Remember that excess weight is associated with metabolic dysfuntion.  This puts a person at risk for diabetes and heart disease.  The state of obesity in this country affects children and adults.  It is not okay for our normal to be unhealthy.  Adults are living longer sicker and our youth are expected to have shorter life expectancies than their parents.  Its a serious problem.

When the average is a bad thing.

A frien d shared a smart phone app with me yester day. It is called Fooducate. You can visit the webpage by cli cking here . If yo u hav...

7:13 PM

Weight Watchers Australia & Access

Weight Watchers International has asked the Australian government to subsidize its program so that more overweight and obese persons can benefit from its evidence based community weight loss program. They are asking for tax dollars to cover most of the 12 week cost  ($202) - the attendee would pay 30 dollars out of pocket.  I certainly support efforts to make this program accessible to more people, but I have an issue.  As is often the case, after we find evidence of an effect (efficacy), an intervention is given to the public under another condition or in a different dose. The real intervention is not replicated, the results are not replicated, and the program itself is found to be ineffective.   That could happen here because the research study which found that Weight Watchers participants lost twice as much weight as similar persons who received assistance from their physician lasted 12 MONTHS not 12 weeks. In addition, I agree with the Obesity Policy Coalition spokesperson, Craig Sinclair, who said that an environmental approach was needed.  The government should consider nutrition labeling laws, limits on junk food advertising and cost supports for healthy foods or increased taxes on junk foods.  YES!

Weight Watchers Australia & Access

W eight Watchers I nternational has asked the Australian g overn ment to subsidi z e its program so that m ore overweight and obese perso n...

6:58 PM

Overweight and Military Service

I am certain that soda has a lot to do with this problem, as does the increasing portion size and energy density of foods at home and restaurants.  I am certain we have a problem. <blockquote class="tr_bq">Currently, about 25 percent of 17- to 24-year-olds are too overweight for military service. Also, the Department of Defense spends an estimated $1 billion per year on medical care for weight-related health problems.</blockquote>Mission: Readiness is the nonprofit, nonpartisan national security organization of senior retired military leaders calling for smart investments in America's children. It operates under the umbrella nonprofit Council for a Strong America. Read their recently released report, Still Too Fat to Fight - <a href="http://www.rwjf.org/content/dam/farm/reports/reports/2012/rwjf401381" target="_blank">HERE</a>

Overweight and Military Service

I am certain that soda has a lot to do with this problem, as does the increasing portion size and energy density of foods at home and restau...

7:38 PM

A Billion Dollar Disease

A couple of weeks ago, I read a post by Cris Frangold.  Cris pronounces a love for investing and writing about it.  I would consider him or her a financial blogger, with a  focus on medical services and the health sector.    The piece that I read in Seeking Alpha regarded the value of Merck and purchasing its stock.  One reason offered to invest in the company was its drug Januvia.  Januvia is meant to treat the symptoms of type 2 diabetes.  Cris noted that 2012 Q2 sales of the drug were over 1billion dollars. Then he or she said: <blockquote class="tr_bq">Januvia has a potential to be a real moneymaker because the American Diabetes Association estimates that 25.8 Americans, or 8.3% of the population have Type 1 and Type 2 diabetes - the majority are Type 2.</blockquote>   Type 2 diabetes in adults and children is related to diet - diet as it produces obesity.  It appears that excess body fat leads to metabolic dysfunction or disregulation so that blood sugar, blood pressure, and cholesterol irregularities follow.   Our diabetes rates have doubled in the past 30 years in tandem with our increase in obesity.  The 30 year trend of rising weights has been attributed to an increase in availability and consumption of high calorie, nutrient poor foods and beverages.    Sure we can make billions on treatment and millions investing in those treatment options, but isn't there a better response?  I suggest that there is.  Investing in a diabetes drug means counting on a disease to continue, needing it to continue in order to enhance a portfolio or fund a retirement account.  That seems to be a good example of maleficence.        What of the better good?  I say the noble thing to do is invest in the food environment so that meals and drinks contain reasonable amounts of sat fat, sugar and calories.  And yes - sometimes that takes a mandate. <a href="http://www.diabetes.org/" target="_blank"> American Diabetic Association</a> <a href="http://diabetes.niddk.nih.gov/" target="_blank">National Diabetes Information Clearinghouse</a>.  Program of the National Institutes of Health

A Billion Dollar Disease

A couple of weeks ago, I read a post by Cris Frangold. Cris pronounces a love for investing and writing about it. I would consider him ...

7:19 PM

Did we become overweight on purpose?

In the September 2012 issue of the American Journal of Public Health, Mary T Bassett, MD MPH, discusses the role of government in "leveling the playing field" so that consumers have a real choice when choosing a food item.  A level playing field could increase consumption of higher quality foods.    This statement, her article and my own studies lead to the same conclusion.  Most of us make food choices based on taste, cost, marketing shaped preferences, availability and convenience.  Healthiness comes in last - after these attributes have been considered - by us or for us.    Dr. Bassett made mention of the food industry's support for initiatives that encourage physical activity as a strategy to reduce obesity.  This is clear by the placement of actual exercise icons on some food packages.      Here is a sad truth.  Exercise is not a popular way to spend leisure time.  Two hundred years ago that didn't really matter, we moved for sustenance and survival.  In the more recent past, our physical activity levels during work and non work hours has decreased.  We have become sedentary and for that reason alone need to exercise.          Both of these energy expenditure issues play a role in our obesity (over fatness) epidemic, but a much smaller one than you'd expect.  Trends of weight status in the US and similar countries show a steady and sharp rise beginning in 1970 and continuing to this date.  It has occurred in every age group - infants included.    Certainly, the entire country did not have a sudden cellular shift  that made us ALL genetically predisposed to gain weight.  And with regard to burning less calories from work and travel, the best estimates from scientific studies suggest at most a decrease in 100 calories expended.    Could it be then, that the entire country made a conscious and deliberate decision to gain weight?  Even before we learned of the connection between fat and disease, we knew that being too large for our bones was uncomfortable and stigmatizing.  Few of us would invite those things. So I say NO, we did not seek out calorically dense, nutrient poor, portion inappropriate foods. They came to us.    Sure, our changing culture had us looking for convenience and increased the number of meals we purchase away from home.  We did not however, know that our 200 calorie meal had doubled into a 400 calorie one- before adding the super sized sized milk, juice or soda.     Today, we find ourselves in need of a few less calories (compared to 1970) but consuming a WHOLE lot more - often passively.  Calorically dense foods are what the food industry offers  - at a price we can't refuse.    Our environment changed around us, we got fat, our heart disease, diabetes, cancer and stroke risk went up.  Indeed the playing field from which we make our choices became leveled against us. The article referenced in the opening paragraph : Mary T. Bassett.  Of Personal Choice and Level Playing Fields: Why We Need Government Policies on Food Content. American Journal of Public Health: September 2012, Vol. 102, No. 9, pp. 1624-1624.

Did we become overweight on purpose?

In the September 2012 issue of the American Journal of Public Health, Mary T Bassett, MD MPH, discusses the role of government in "l...

7:06 PM

Does a BMI number cause Breast Cancer Death?

The headlines read that obesity increases the risk of cancer recurrence and death in women who are diagnosed with breast cancer.  The actual study involved an evaluation of several groups of women who had stage 1, 2 or 3 breast cancer and were themselves enrolled in clinical research trails.  The purpose of those research trials was not to determine if weight impacted recurrence or mortality, but to evaluate the efficacy of new chemotherapy drugs.  This is important.  Who were the women in the sample, how much are you like them, and how much are other breast cancer patients like them?     The women who were studied all received chemotherapy and had operable cancers (I do not know if they had surgery, only that they had operable tumors and received chemotherapy).  A consideration to make is whether or not the people who chose to enroll in the study are different from people who did not enroll.  Also, only certain types of people were allowed to participate.  Usually, and it is true here, the people in drug studies have the condition the drug is trying to treat, but are usually otherwise healthy.  This study left out people with "significant" co-morbidities (other diseases occurring at the same time), but I do not know what 'significant' includes.    The headlines refer to BMI as the risk factor, but having a BMI of 30 or higher isn't the problem.  What that number might reflect is the problem.  For most people BMI mirrors waist circumference (WC) - they mean the same thing.  However, in some people the BMI does not reflect their weight status well.  Waist circumference over 35 inches or higher is a very good indicator that a person also has insulin resistance, high triglycerides and high blood pressure.  It is those issues - collectively called 'metabolic dysfunction', that puts people at greater risk of disease and death.  Consider that those conditions; high blood pressure, trouble with sugar, high blood fats,  make the body less robust, less able to fight off infection, less able to rebound from injury and disease.  Metabolic dysfunction is deconditioning and a person with these conditions (including a WC 35+ and a high BMI) is at a disadvantage before treatment for cancer ever begins.    This way, obesity and smoking are similar - both increase the risk of disease and death from any disease - just know that BMI and obesity are not the cause - it is the metabolic dysfunction.  Maybe they are the cause of the cause.     Here is a <a href="http://onlinelibrary.wiley.com/doi/10.1002/cncr.27527/abstract" target="_blank">link</a> to the study regarding the outcomes of the 3 drug trials that were used for the headline making stories. Study reference:  Sparano, J. A., Wang, M., Zhao, F., Stearns, V., Martino, S., Ligibel, J. A., Perez, E. A., Saphner, T., Wolff, A. C., Sledge, G. W., Wood, W. C., Fetting, J. and Davidson, N. E. (2012), Obesity at diagnosis is associated with inferior outcomes in hormone receptor-positive operable breast cancer. Cancer.

Does a BMI number cause Breast Cancer Death?

The headlines read that obesity increases the risk of cancer recurrence and death in women who are diagnosed with breast cancer. The act...

7:46 PM

North Carolina Education Lottery and Obesity

North Carolina, like many states with soaring obesity rates, has a statewide obesity prevention program.  It is called Eat Smart Move More NC.  I am a naive optimist, but I like to think that when a state has such an initiative, all its departments, agencies, forms of government - etc - will work together.  At the very least they would not work against each other.    So how does the Lottery system play into this?  It's rather bizarre actually and of course, I would be the one to hear the commercial and scratch my head.  Here it goes.    Full disclosure, I didn't hear the whole commercial.  I missed the beginning. It seems like the narrator was asking people to define what "LUCKY" meant to them.  I heard the last person say, "when I circle around the parking lot for ten minutes and then find a space up front, 'I feel lucky.'"  The narrator then summed up the other responses (the ones I missed).  He said, something like, "If you get the last cookie in the break room cookie jar, or find the prize in your french fries, or get to park close to the store - you are LUCKY."  People who are having this kind of good luck, should "buy a lottery ticket.'   I was thinking, REALLY?! People who think cookies, french fries and limited physical activity are things to strive for - ought to spend their money on a good health insurance plan.    Myself - I feel damn lucky that I do not NEED to park close to a building.  I am ever grateful to have full use of my body in order to walk a few steps.

North Carolina Education Lottery and Obesity

North Carolina, like many states with soaring obesity rates, has a statewide obesity prevention program. It is called Eat Smart Move Mor...

7:08 PM

Odds and Ends

F as in Fat The 2012 report from RWJF and the Trust for America's Health will be released soon.  This week a press update offered news on disappointing and compelling trends.  The majority of states have an adult obesity rate of 25% or higher.  Twelve states have rates of 30% or higher and when rank ordered, the 30 heaviest states include 7 from the South.  This speaks to regional food norms.  In the South one can expect foods to be deep fried, rich, sweet and salty (maybe not all at once!).  It is also custom in the South to eat what you are offered and for those offerings to be generous.  The pending report form TFAH and RWJF will offer suggestions on curbing the obesity epidemic and the benefits that we can expect from certain strategies.   We're # 1 I passed a billboard that proclaimed hospital X to be number one in heart surgery. I considered this to be evidence that hospitals are competing for customers.  There must be a significant number of them (or why advertise on a billboard).  A great many Americans have or will have heart disease - in fact, the odds of dieing from it are pretty high.  It is the number one cause of death here.  The hospitals know this and can profit from it.  They must - billboards are not cheap.  Incidentally, the current HSPH newsletter has a link to a blog post by one of their esteemed staff on the topic of hospital ratings.  The blogger discusses how a hospital can be scored differently by 3 credible sources. It is a great, MUST read.  Click <a href="http://blogs.sph.harvard.edu/ashish-jha/" target="_blank">HERE</a>. MCR (medicare)  Not to be political but to acknowledge a topic that has become political.  I have been listening to the public discourse and in the interest of full disclosure, I support the Affordable Care Act.  The ACA has benefited Medicare recipients that I know personally.  Still, there may be a future where persons over the age of 67 are seeking health care coverage as primary payers of that coverage.  Perhaps they will have vouchers.  In order for such a person to find the best coverage for the least amount of money (premium, copay, deductible) they will need to be healthy and not smoke.  The insurance companies will probably SEEK out healthy active seniors in order to reduce losses related to costs of covering non healthy older adults.  The majority of older adults are currently and will continue to be unhealthy.  Half of all adults now suffer from at least one chronic disease associated with being inactive and or overweight.  (increasingly adults have more than one disease, i.e arthritis and diabetes)      You won't be able to change your past, but you have some control over your future. Get some amount of exercise every single day, always be aware of the foods you are consuming - aim for quality in the proper quantity, avoid all cigarette smoke.

Odds and Ends

F as in Fat The 2012 report from RWJF and the Trust for America's Health will be released soon. This week a press update offered news ...

7:48 PM

The Calories You Burn

Part Two    Here is a way to get a (very) rough estimate of the amount of calories you are burning in a day.  This is for people who have been weight stable for at least a year.  If you are currently at a steady weight,  write down everything (remember the Micky Mantra - every bite, lick and taste) you ate yesterday and the day before.  Write down everything for today and do the same thing tomorrow.  That should give you four days to average.  Do NOT change your normal behavior - this includes eating out. If you usually eat out, then you need to capture those meals in your average.    There are many tools available on line (and perhaps in print) that can help you determine the calorie amounts for all of the foods on your list, if you have the serving sizes.  [You might have to go four days forward instead of two days backwards for accuracy.  The reason I suggested that you start with past days (even though you may forget something) is so you won't change your pattern because you are thinking about it.]    If you purchase foods away from home, you can usually get calorie information from the restaurant's website, but it may be slightly or largely inaccurate.  If you prepare your own meals, you can get info on the ingredients from the<a href="http://ndb.nal.usda.gov/" target="_blank"> USDA </a>website.  When you feel pretty confident that you have the four days individual totals, add them together, divide by four and that is your average.  Remember this is only going to work if you are tracking what you normally eat.   If you are stable, the number you came up with should be the same number that you burn.  TEI total energy intake = TEE total energy expenditure in weight stable people.      I will tell you that this type of estimate is closer than any you can get by trying to track your energy burn, outside of a clinical, laboratory setting.  The machines at your gym are NOT accurate.  Your GPS systems and sports watches are not either (but they are a good measure of consistency and changes - in other words they are reliable even if they are not valid)   I want to be very clear that what I just told you is offered as a way for you to assess in general terms, the amount of energy you use in a day.  It is not meant to suggest how many calories you need to maintain or lose weight.  The only qualified nutrition guidance that applies to individuals is provided by licensed/registered dieticians.  Remember that even if you forget everything else you read.  Your personal trainer at the gym is NOT qualified to give you diet advice, unless of course, he or she is an RD.     Nutritional science continues to grow and to challenge our  assumptions about food and weight.  We are learning that a calorie is not a calorie. What you eat can have an impact on your metabolic processes.  Again, that is a discussion to have with a nutrition expert.    Ah, but let me get back to the conversation started with the Lowe article.  We will use me as an example.  I am very confident that my calorie intake varies from 1600 to 1680 calories a day (higher if I am running more).  This keeps me, a very active person who is short and thin, at a stable weight.  If I shift that range by even 70 calories, to between 1750 and 1830 a day, I will gain several pounds in a year.  Seems like nothing, but of course, we have shifted our normal calorie intake by as many as 300 calories a day and gained many pounds.  This can be reversed, in general and at the population level, by a 500 calorie reduction (some say).   Sounds like a lot, but if you are one of the people eating 3000 calories a day  and switch to low energy dense foods, its a piece of ......... its not that hard.

The Calories You Burn

Part Two Here is a way to get a (very) rough estimate of the amount of calories you are burning in a day. This is for people who have ...

7:02 PM

Food Supply and Weight (part one)

Part One      Continuing from yesterday, here are observations regarding the food industry.  This post is related to information in an article by Tillotson which is referenced below.  Something to consider on an individual level (with regard to energy balance) will be noted tomorrow.     The U.S has created a phenomenal food system based on the exceptional work of our agricultural industry.  Less than two hundred years ago, the US began its investment in agriculture.  The goal was to provide Americans with a food supply adequate to prevent (or reverse) nutritional deficiency. The government invested in farmers and land, in Universities, technology and research.  The efforts were hugely successful and continue today.  We can feed our people and much of the world.  The agricultural industry is responsible for supplying food makers with cheap commodities; beef, dairy, grains, sugar, etc and the food industry....Well they too are an American (business) success story.      We forget that in the late 1800s a shift occurred in our relationship with food.  We went from growing our own food or working to earn food to paying money for food.  This inspired entrepreneurs to create and sell a product (with substantial backing from investors), but it also meant we weren't working as hard in general or doing any physical work to obtain our food.    In the 21st century, NOW, we have the least active population that has ever existed and the most abundant food supply.  We don't just eat to stay alive - we eat because its the social thing to do and because it brings us pleasure.  The food industry is happy to keep oversupplying.  Food companies work hard to shape our preferences and to earn our loyalty.  Any time, any where, tasty and cheap.    So that's a problem.  Two systems working remarkably well and a population that (as we discussed yesterday) is unable to regulate its intake.  The same population that is quite disinterested in exercise.    There are a number of ways to regulate the supply and the demand side, but what about regulating or restricting what an individual consumes?    At the end of the day, the amount of regulation or limiting a person needs is based on energy expenditure.  If a person does not want to exercise, then the amount of calories they burn in a day and thus need, is going to be low.  There may come a point where the amount needed is too low to be reasonably regulated.  That is hard to explain.  It means that we need a certain amount of calories - even if that need is psychological and our limiting has limits.    Clearly we cannot go on eating all the food that is available to us.  By doing so, we become a nation of unhealthy people.  The food supply allows over 3000 calories a day for every person.  Not everyone consumes 3000 calories a day, but it can easily be done.    More about energy balance in a food heavy society, tomorrow.   <div style="margin-left: .5in; text-indent: -.5in;">Tillotson, J.  (2004). America's obesity: conflicting public policies, industrial economic development, and unintended human consequences. Annu. Rev. Nutr., 24, 617-643.</div>

Food Supply and Weight (part one)

Part One Continuing from yesterday, here are observations regarding the food industry. This post is related to information in an artic...

7:36 PM

Health Education