Posts Tagged ‘Obesity’

Diet advice for 2012 – from Cleveland Clinic

January 5, 2012

It’s  a new year and I resolve to write more blog posts this year than last. So, I’ll start with what is on many people’s minds now: which diet should I choose? Here is the latest from a respected source – Cleveland Clinic.

This New Year’s, losing weight will undoubtedly top many Americans’ list of resolutions – and it’s an important one. One reason? Heart disease is the main health threat caused by obesity. Make your efforts to slim down more successful this year by becoming wise to the “secret of calories!”  …

Just follow these 5 rules:

1. Understand the basic principal of dieting for weight loss. With all of the opposing diet plans forbidding carbohydrates or preaching against fat, it’s easy to see why confusion prevails. But, Cleveland Clinic experts say, recent studies comparing these different diets have found that the proportion of carbohydrates, proteins and fats in your diet do not influence weight loss. 

This means, in a nutshell, you can lose weight with any diet as long as you burn more calories than you take in. That’s the secret.

2. Know how many calories you need. Would you believe that of the half of Americans who are dieting at any given time, only 12 percent know how many calories they should consume daily? This number, which for adults ranges from 1,600 to 3,000 a day, depends on your age, gender and activity level. [Here is a useful daily calorie calculator]

3. Change your calorie intake to lose weight. If you want to lose weight, eat fewer calories than you burn. Eat 500 to 1,000 fewer calories per day and you will lose weight, often one to two pounds per week. But don’t be discouraged when weight loss begins to slow after a few weeks of dieting – this is a normal event as your body adjusts to your new diet. Keep watching calories and exercising and you will keep heading toward your weight loss goal!

4. Don’t be fooled by fad diets. More isn’t always better. In fact, it can be harmful. Any loss of more than two pounds a week is usually just water weight. Studies also show that the faster weight comes off, the quicker it is regained. Stick to a diet that has a goal of only one to two pounds weight loss a week [even better, in the long run, would be one pound per month].

5. Choose a diet you can live with. For your weight loss and weight maintenance efforts to succeed, you must continually manage your calories. No one diet is better than another. Studies show dieters tend to lose five to 10 pounds over the course of a year, regardless which diet they pick. What’s important is to pick a diet that works for you and that you can stick with. And if you’re not successful, pick a different diet next time.

Do you know a fat person?

July 20, 2010

Call them obese, huge or fat — the stigma won’t go away. And I’m not sure it should.  Obesity is bad for a person’s health, bad for the planet, bad for fellow airline passengers, and even bad for babies born to obese mothers (which, in turn, is bad for the economy; see NYTimes article).  When something causes this many personal and social problems we usually assume it is not a good thing to have or be.

“But,” some say, “we mustn’t blame the victim.  Obesity isn’t a weakness or a fault; it’s genetic. When we stigmatize people, they suffer even more, and may even avoid seeking help.” There is a kernel of truth to this concern, but it distracts us from the main point: obesity can and should be eliminated over time, through more research, and through attacking many known contributing factors (factors such as the  marketing and subsidizing of unhealthy foods).

The most active researchers who advocate against “weight bias” and “weight stigma” (Kelly Brownell and Rebecca Puhl at Yale, for example) also tell us that the obesity epidemic is growing and the health consequences are horrible.  They do not claim the problem is due to a change in genetics.  People can do a lot to prevent and even treat obesity, without altering genes (see many of my posts in this blog).

An anti-obesity program in Singapore that targeted overweight children was discontinued because of concern about stigma, even though the program was effective (reducing the percentage of overweight children from 14% to 9.5% in fourteen years — 1992 – 2006; click here for more information). I don’t know what should have been done in this case; there are no easy answers.

Outright discrimination against people based on appearance is generally wrong, and fat people should be treated sensitively and humanely, no matter what caused their affliction.  (Many equate stigma with discrimination, but I see a difference between the two concepts.)

Whether or not it reduces stigma, television has recently upped its focus on obesity by producing such shows as “Drop Dead Diva,” “Huge,” “Mike and Molly,” and, of course, “The Biggest Loser.”  A new series starts next month, “Too Fat for Fifteen: Fighting Back,” and at least one other obesity-related series is in the works. See this article for a discussion of how obesity is being addressed on TV.

[The photo at the top of this post is from ABC Family’s series “Huge”]

Why “Eat only when you’re hungry” won’t work

May 15, 2010

During a recent social event, the conversation turned to weight loss and dieting. One of the women said she read a new book and it had “the answer” to her problem of weight gain: eat only when you’re hungry.  Many books and weight loss plans, in fact, emphasize this point, offering various tips and methods to define “hungry” and help the reader learn what kind of hunger, exactly, they should satisfy and what kinds they should ignore.  The worst books (in my opinion) give the message that people gain weight because of various psychological or “spiritual” hungers that we try to assuage with food.  There is little to no consistent science to back up these claims, and I believe the message does much harm, because it implies an almost magical answer to the problem  of overeating.  When it inevitably fails to work, the victim of this propaganda is left with yet another cycle of failed dieting and increased weight.

As recently as hundreds of years ago, most people did need hunger as a cue to begin eating, because their days were full of physical labor and food was not always readily available.  But, in recent decades, this situation has changed dramatically.  Now, most have relatively low levels of physical activity and the availability of food has increased exponentially — to the point where there is a glut of high calorie, low cost “food” in our faces continually.  We rarely get hungry in the old sense of the word, because these cleverly marketed and subsidized foods (high in sugar, salt and/or fat) overwhelm our biological regulatory systems.  Instead, we develop cravings and hungers triggered by environmental cues and implanted “beliefs” from our culture, no longer based on biological requirements.  In a sense, we get “addicted” to unhealthy foods and lose our ability to trust our hunger.

So, what can we do?  Easy — and difficult.  Train ourselves to ignore these contrived temptations; limit our exposure to them (most importantly, protect our children from them!).  Learn what a healthy lifestyle looks like and adopt it.  Avoid frequently eating “addictive” foods containing large amounts of  sugar, salt and fat.  And advocate, loudly and often, for changes in our culture so that fruits, vegetables and other unprocessed foods are cheaper and more available than the junk food that now receives so many economic advantages.

For more information and tips, check out these links:

Food Industry Pursues the Strategy of Big Tobacco

Coping with the obesity epidemic

Ending overeating

Overeating leads to more overeating

What does 200 calories look like?

Do not — DO NOT — deprive yourself

Mindful eating vs. mindless munching

Weight Management for Your Life: Ten Steps to Prepare You for Adopting a Healthy Lifestyle

I recommend Nutrition Action Health Letter, available by subscription from the non-profit CSPI (regarding today’s post: see the May, 2010, cover story “How the Food Industry Drives Us to Eat” featuring an interview with Yale’s Dr. Kelly Brownell).

P.S.  I have not posted in the last 3 months for several reasons, one of which is having surgery and recovering.  I’m fine now, though.

Ending overeating

July 7, 2009

Kessler overeating

A very important new book (The End of Overeating: Taking Control of the Insatiable American Appetite by David Kessler) accurately describes major factors contributing to the obesity epidemic: cleverly formulated manufactured food designed to seduce us into overeating, addictive ingredients (salt, sugar and fat) which act like nicotine in cigarettes to keep us coming back for more, a profit driven system of marketing and government subsidies which works against our best interests, and the loss of boundaries limiting when and how much we eat. It is indeed frightening to think that a 2-year-old’s appetite “knows” to shut down when enough calories have been consumed, but by the time that child is four (in our culture) there is often a loss of that self-control mechanism.

Kessler’s solutions include re-training our minds to devalue unhealthy processed foods loaded with the Big Three (salt, sugar, fat); reforming our policies and practices which encourage this vicious cycle; and doing much more to educate people as to what they are consuming (such as requiring nutritional information in restaurants).

I agree with all this, but take issue with some of the concepts Kessler promotes. My main complaint is he oversimplifies the issue of food containing salt, sugar and fat by using an addiction model. Too much of these ingredients is indeed unhealthy, but a simple addiction model will not work.

Another problem is his use of the term “real food” (see NPR interview) which is a vague concept, at best. Many seemingly real foods contain salt, sugar and fat (either naturally, or because of the way they are produced), and not all “manufactured” foods are bad (e.g., some fish farmed in a sustainable way are better for us than some “wild-caught” fish). I can buy a chicken that has been doctored with added salt and fat, or I can buy one (usually smaller and more expensive) which has been grown almost organically. To the average consumer, both seem “real.” Also, I can buy “sea salt” and “unrefined real sugar” and think I am getting something healthier than standard table salt and corn syrup, but the bottom line (sodium and calories) may be exactly the same.

Finally, he promotes a black vs. white dichotomy between a disease-like state we cannot directly control (“conditioned hypereating”) and old fashioned willpower, telling us “it is not our fault” that we overeat. Fault, per se, may not be the issue; rather, we should learn ways to increase our resistance to external cues and marketing, educate ourselves about nutrition and portion size, and practice coping skills to enhance self-regulation. I have written about this at length elsewhere.

It takes a village to impact obesity epidemic

February 27, 2009

french-village

The results of the latest (and so far best) research on diets are in:  most people won’t stick to them. The New England Journal of Medicine (2/26/09) published the study which has now been widely reported in the news.  Over 800 men and women were followed on various diets for 2 years; the average weight loss was modest (about 9 pounds) and those who attended counseling sessions (an indirect measure of motivation) lost the most.  No one adhered to the diet closely, despite frequent monitoring and much support.  The conclusion is that eating less (calories) is what matters, not the specific content of the diet (in terms of low fat, high protein, low carbohydrate, etc).

These findings are not surprising, but what is most interesting is the accompanying editorial which describes a study in France where entire villages were used to counteract the obesity epidemic.  Here is the summary from the NEJM editorial:

A community-based effort to prevent overweight in schoolchildren began in two small towns in France in 2000. Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling.

Though this was not a formal randomized trial, the results were remarkable. By 2005 the prevalence of overweight in children had fallen to 8.8%, whereas it had risen to 17.8% in the neighboring comparison towns, in line with the national trend.11 This total-community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l’obésité des enfants [Together, let’s prevent obesity in children]).12

Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action. Evidence for the efficacy of the EPODE12 approach is only tentative,11 and what works for small towns in France may not work for Mexico City or rural Louisiana. However, the apparent success of such community interventions suggests that we may need a new approach to preventing and to treating obesity and that it must be a total-environment approach that involves and activates entire neighborhoods and communities. It is an approach that deserves serious investigation, because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery.

The NEJM research article is here: http://content.nejm.org/cgi/content/full/360/9/859.

The editorial is here: http://content.nejm.org/cgi/content/full/360/9/923.

Coping with the obesity misinformation epidemic

October 2, 2008

There has been much talk lately about the obesity epidemic which is sweeping the world, and the ensuing panic has resulted in an avalanche of books and articles packed with ideas about why we are growing larger and what we can do about it. The sheer quantity of information is overwhelming and would be hard to digest even if most of it were helpful. But much of it is unhelpful and misleading, so that the consumers of all this misinformation are left to throw up their hands in frustration, and down another cheeseburger.

As a physician struggling with making sense of all this over many years, I have come up with a few areas to consider when evaluating the constant stream of data about diet, weight loss and lifestyle. Hopefully, these suggestions will be helpful for therapists and other health professionals as well. Here is what I look for:

  • Bias. If the author of an article stands to profit from what s/he is promoting, there may be a conflict of interest leading to bias. Some magazines, journals and websites now require authors to disclose any significant income from a product (or competing product) s/he is reviewing. Be suspicious of an overly dramatic or sales-oriented tone, an extreme position, or a statement that seems “too good to be true.” In research reports, the author should point out weaknesses and limitations of the study.

  • Balance. Obesity and weight management are complicated. Articles and books on these topics should acknowledge this and indicate which part of the problem the author is addressing. In general, there are at least three components to the problem and its solution: biological, psychological, and social. For example: complex genetic and hormonal systems interact with the brain and environment to affect how much we weigh, our fat composition, our body shape and even our cravings and appetites; stress, coping patterns, how we think, and how we react emotionally affect our eating and metabolism; and our culture and social relationships affect our lifestyle choices and our ability to adhere to a plan.

  • Timeframe. Changing how we eat, move, and what we weigh should be a lifelong project. Time-limited diets and programs may help for a while, but much research indicates that we will not put up with boredom, difficult tasks, and self-deprivation for long, and that once we stop a short-term program we are very likely to regain any weight we may have lost, and then some. The good news is that the more we practice healthy habits of eating, moving, and thinking, the easier and more natural the new behaviors become.

  • Reality check. There is no quick and easy substitute for following a sensible diet, controlling serving size (we all suffer from “portion distortion” and underestimate how much we actually eat), and increasing energy expenditure through both “spontaneous” activity and planned exercise. Realistic weight loss should be a gradual process; otherwise, our body “thinks” it is starving, and powerful biological systems take over to prevent further weight loss. We must choose a realistic weight maintenance goal. For example, if my natural weight range (some call it “set point”) is between 170 and 200 pounds, my ability to maintain a desired weight may be practically limited to keeping it between 175 and 180 pounds. Efforts toward maintaining a desired weight range, even if still overweight according to standard weight tables, do pay off in terms of better health outcomes (for example, preventing type 2 diabetes and lowering blood pressure). Also, alcohol intake (and taking certain drugs) affects weight; any diet which ignores this fact is unrealistic.

  • Impact on the planet. This criterion is “optional,” but I think very important. Is the proposed diet or program good for the planet? For example, one of the biggest threats to our global climate and resources is meat farming. So, any diet or lifestyle which advocates eating more meat (especially beef) is harmful to the planet. Cutting down the meat portions in our diet, or eating meat less frequently, can benefit the planet.

Considering these five categories has helped me cope with information overload. If you follow these simple guidelines, I predict you will feel less overwhelmed and will then be better able to help yourself and/or your clients address issues with weight and health.

More on “Who needs exercise?”

June 8, 2008

After writing my last post on exercise, I came across this article, which has some very important implications for young people. Again, it shows how complex the question “who needs exercise?” is and how important it is to specify “for whom?” and “exactly what do you mean by exercise?”

Preventing Childhood Obesity: Vigorous Physical Activity—YES, Restricting Calories—NO*

by Bernard Gutin, PhD

My colleagues and I at the Medical College of Georgia investigated the relationship among diet, physical activity and body composition in 661 African American and white adolescents ages 14 to 18.1 We hypothesized that fatter youths would have higher levels of energy intake and lower levels of both moderate and vigorous physical activity.

To our surprise, we found that higher levels of percent body fat were associated with lower levels of energy intake and lower levels of vigorous (but not moderate) physical activity. Youths who did the most vigorous physical activity and consumed the most calories were the leanest. Those who did no vigorous physical activity had a percent body fat of 28.6 and consumed 1744 calories a day, while those who did at least 1 hour of vigorous physical activity each day had a percent body fat of 19.4 and consumed 2203 calories a day. See Relationship of Vigorous Physical Activity, Caloric Intake and Percent Body Fat.

Although moderate physical activity, such as brisk walking, burns calories, we found that lower percent body fat was linked to greater amounts of vigorous, but not to moderate, physical activity. Vigorous activity includes sports, games and dance activities such as running, swimming, soccer and aerobic dancing. These activities impart a significant “mechanical load,” which means they work your body’s muscles and bones. This type of activity stimulates stem cells to differentiate into bone and muscle rather than fat.2 A healthy body composition in youths requires both a large amount of vigorous physical activity and ingestion of sufficient calories and nutrients to support this tissue-building process.

This idea is further supported by experimental studies that looked at the effect of mostly vigorous physical activity, without restriction of calories, on body composition. Research on youths with varying levels of fatness and fitness found moderate physical activity to be ineffective in preventing obesity, so we conducted studies using 300 to 400 minutes a week of mostly vigorous physical activity and found positive effects on body composition, including reduction of visceral adipose tissue (the fat around abdominal organs). Within the intervention groups, those youths who participated regularly and maintained the highest heart rates during the physical activity sessions showed the greatest decreases in percent body fat and the greatest increases in bone density.3,4

Youths who are obese and unfit can benefit from exercise of relatively low intensity and duration. For example, in obese youths, studies using 155 to 180 minutes per week of physical activity at moderate to high intensity produced favorable reductions of percent body fat and visceral adipose tissue and increases in bone density and aerobic fitness.5 As children improve in fitness, they should be encouraged to progress to higher amounts and intensities of physical activity.

An expert consensus panel has suggested that youths engage in at least 420 minutes a week (about 60 minutes a day) of moderate to vigorous physical activity.6 The research reviewed here suggests that greater emphasis should be given to vigorous rather than moderate physical activity.

Taken together, these findings suggest that a paradigm shift is needed to improve the effectiveness of pediatric obesity prevention interventions. It is well known that eating a nutritious diet supports the development of muscles and bone and other aspects of proper growth and development, as well as good health. However, limiting energy intake runs counter to the biologic demands of growth, which require adequate calories and nutrients. When youths engage in adequate amounts of vigorous physical activity, calories and nutrients are preferentially directed to the production of lean tissue (muscle and bone) rather than fat. So, insuring a high quality diet and plenty of exercise, rather than calorie restriction, is the model to pursue to prevent obesity and improve body composition.

References

* A longer version of this editorial will soon appear as a Perspective article in the journal Obesity.


Bernard (Bob) Gutin, PhD, is Adjunct Professor of Nutrition at University of North Carolina in Chapel Hill and Professor Emeritus at Teachers College of Columbia University and the Medical College of Georgia.

The power of social networks to improve health

May 22, 2008

Quitting smoking and losing weight (if you are overweight) are perhaps the two most important behavior changes you can make to improve your health. A new article in today’s New England Journal of Medicine confirms what a previous article has shown: people we interact with in our social network (friends, spouse, co-workers, etc.) strongly affect our behavior when it comes to smoking and weight gain or loss. We also affect the other people in our network. Today’s article is titled “The Collective Dynamics of Smoking in a Large Social Network” by Christakis NA, Fowler JH (NEJM, Volume 358:2249-2258). The earlier article, and similar research, is described in Weight Management for Your Life (p. 79):

In 2007, an article appeared in the New England Journal of Medicine with the title “The Spread of Obesity in a Large Social Network over 32 Years” [N Engl J Med. 2007 Jul 26;357(4):370-9] The same day the article was published it made front page news. No previous research had focused so intensively on “the obesity epidemic” as a social network phenomenon. The main finding of this elaborate study was that friends have a highly significant influence on our weight, specifically whether we become obese. The effect of friendship was surprisingly large and exceeded the influence of siblings and spouse (whose influence was also significant). … The editorial in the NEJM accompanying the article put it this way: “As the article by Christakis and Fowler [the researchers] shows, … networks, in this case those that pertain to social influence, may have just as strong an impact on the development of obesity as the otherwise strong genetic effects.”

These studies provide exciting and compelling evidence in favor of the bio-psycho-social model for disease and wellness, meaning that biological (e.g., genetic), psychological (e.g., coping) and social (e.g., interpersonal and cultural) factors interact to produce health problems and all must be addressed in reversing or treating these problems.