nutrition

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A Weight Watching Life, And (Maybe) A Post-Diet Era

The diets in my life have come and gone: the grapefruit diet, no-fat diet, juice cleanses and Atkins. But through it all, there’s always been Weight Watchers. With its point system and lo-cal dinners, weigh-ins and group therapy vibe, Weight Watchers offered an all-encompassing road map to controlled eating. I tried it, Betty Draper of “Mad Men” tried it, you probably know someone who’s been there. It was a diet, yes, but also more: a structure to control the chaos of disordered eating.

Sadly, as many of us know, no single “diet” really works. Without a wholesale lifestyle shift, and replacing old, destructive patterns with healthier habits — a much slower and sometimes painstaking process — one failed diet begets another and another.

Reading the obituary of Jean Nidetch, a founder of Weight Watchers who died this week at 91, made me realize, yet again, the obsessive and punishing ways we compel ourselves to diet, and how, deep down, food and weight are as much about emotion as physiology. The New York Times described Nidetch as “pumpkin-shaped all her young life” and “raised in a family that ate as a consolation for disappointment.” Here’s more:

She was born Jean Evelyn Slutsky in Brooklyn on Oct. 12, 1923, the daughter of David and Mae Rodin Slutsky. Her father was a cabdriver and her mother a manicurist. Her compulsive eating habits began as a child, she recalled in a memoir…

“I don’t really remember, but I’m positive that whenever I cried, my mother gave me something to eat,” she wrote. “I’m sure that whenever I had a fight with the little girl next door, or it was raining and I couldn’t go out, or I wasn’t invited to a birthday party, my mother gave me a piece of candy to make me feel better.”

And that launched a life of binge eating and yo-yo dieting. Eventually, though, it pushed Nidetch to seek an escape: through tough-love control and, well, vigilant weight watching.

But we’re not in Brooklyn with the Slutskys anymore. Diets have evolved. Lifestyle Medicine is all the rage, and a far more holistic, Pollan-esque approach to food is taking hold. (“Eat food. Not too much. Mostly plants.”) Also, it turns out, not all calories are alike.

Are we then, at long last, in a post-diet era? Can we all just agree that diets do not work in the long term? I asked Jean Fain, a Harvard Medical School-affiliated psychotherapist and the author of “The Self-Compassion Diet” for her thoughts on the passing of a diet icon and where Weight Watchers stands today. Here’s what she wrote:

As the embodiment of Weight Watchers, Jean Nidetch did a lot of good. Her success (she lost 72 pounds and kept it off) inspired waist watchers to stop looking to medical professionals to solve their eating issues and to start finding inspiration, strength and direction from those who understand the problem far better – other successful dieters.

With a little support from fellow Weight Watchers, members not only learn that yes, they can lose weight, they find out they can have a lot more fun as group, rather than try to go it alone.

Inadvertently, Nidetch also did real harm with her eating system and the conditional support that goes with it. (Members get applause and other positive reinforcements for losing weight, for instance, but little or nothing for gaining weight.)

While Weight Watchers insiders claim their program is more successful than other diets, studies that compare various diets to each other do not support that. Whether or not the international slimming organization actually has a 16% success rate, (a number quoted in the book “Secrets from the Eating Lab” by Traci Mann) truth be told, the overwhelming majority regain what they lose and sometimes more. Diets like the one the organization promotes can exacerbate the very eating problems they were hoping to resolve. When that happens, those who most need support are least likely to get it because they’re too ashamed to go to meetings, let alone get weighed in.

More than a Weight Watchers ice cream bar, a lo-cal recipe or the conditional support of a group that fails to acknowledge the shame that members carry, what waist watchers need more than anything is a heaping helping of self-compassion.

Compassion for yourself is the missing ingredient, the antidote to this and most other weight-loss programs because most plans revolve around self-discipline, deprivation and neglect. You’re supposed to stick to the plan no matter what. If you’re starving, keep eating tiny portions. If you’re exhausted, keep moving – no pain, no gain. Going on vacation? Keep counting points, calories or carbs. It’s not a very compassionate (or realistic) approach; it’s not very effective. And it’s no fun. Continue reading

One Doc’s Oreos-And-Batman Perspective: TV Doesn’t (Necessarily) Make Kids Fat

(Donnie Ray Jones/Flickr)

(Donnie Ray Jones/Flickr)

By Steve Schlozman, MD

Here are three recent headlines that got me thinking about kids and fat:

“Watching one hour of TV per day increases risk for obesity by 50%”

“Watching TV for Just an Hour a Day Can Make Children Obese”

“Study makes surprising link between TV time and childhood obesity”

Oversimplifications? Um, yes. Each of these headlines greatly simplifies (dare I say, incorrectly simplifies) a critical social and health issue. Personally, I don’t think TV is the sole evil culprit here. It’s far more complicated.

The medical community has long known that the amount of TV that a child watches correlates with obesity. We can even make some leaps from these data towards implicating causality. Unless your little ones happen to be doing aerobic exercises while they tune in to their cartoons, it’s easy to see how passive watching can equal active weight gain.

However, be wary of oversimplification and especially of the “one-size-fits-all” policy statements that these headlines often generate. The study authors here do, in fact, suggest further limiting TV exposure based on the existing American Academy of Pediatrics guidelines for young children as a means of controlling the rate of obesity in this country. (Currently, the AAP recommends limiting screen time to one to two hours or less for children over the age of 2, and discouraging screen time altogether for those who are younger.)

So, here’s the big question: Is the recommendation that TV time be further limited an entirely appropriate conclusion?

Beyond The Headlines

The answer, like many answers to social policy questions, is both yes and no.

What we know for certain is that we can’t really discern from the headlines what we ought to do, though there is ample reason to believe that most American rarely go beyond the headlines. Thus, we run the risk of jumping to more draconian conclusions than might be appropriate simply because we don’t have or take sufficient time to examine the flood of information.

How do we guard against this leap to oversimplification?

Here are a few key questions:

•Was there a large and diverse population studied?

There have been solid links between lower socioeconomic groups and some ethnic minorities and increased television time, as well as between lower socioeconomic groups and obesity.

The causes for both of these issues are of course multi-factorial. Fatty foods and higher calorie foods are cheaper. TV can function as a babysitter in households where parents are busy working and living paycheck to paycheck. However, the study in the headlines above, conducted by the Department of Education in conjunction with physicians at the University of Virginia, was indeed both large and diverse.

Over 12,000 children starting kindergarten were enrolled in the investigation, and a year later follow-up data was available for more than 10,000 of these children. These data included height and weight, as well as statistical analyses to account for differences in race, gender and socioeconomic effects. In other words, the numbers here are sufficiently large and diverse for us to feel comfortable drawing at least preliminary conclusions.

Causality, Really?

But beware, always beware, of flashy headlines. A Google search yielded all of the headlines above with equal weight, and yet one of the headlines clearly implicates causality. “Watching TV for just an hour a day can make a child obese.” (My italics.)

However, this study does not in any way suggest causality. There are a number of potentially unrelated factors that also happen everyday that might be associated with obesity, but not function as a cause of obesity. These could include behaviors like longer baths to cool down. We don’t know until we do the study whether longer baths would be associated with obesity. In other words, always be wary of blanket statements of causality with regard to the complexity of human behavior.

•What about the ample availability of screen-based material on demand? Perhaps the fact that children can often watch both what they want and when they want it affects their activity patterns in negative ways. We could ponder the fact that TV content, even for kids, has arguably (though not in all spheres) gotten better and of higher quality. There is even evidence that TV watching can improve behavior among kids, and this evidence also comes from the American Academy of Pediatrics. Does that mean we ought to make a policy statement advocating that TV should be less compelling?

Confessing My Bias

Things get even messier when we take the necessary step of examining our own personal biases. In my case, that examination includes a shameless confession regarding the ways my own penchants might complicate my interpretation of these data. Continue reading

You Are When You Eat: Study Explores Body Clock Effects On Blood Sugar

(Macro Mondays/Flickr Creative Commons)

(Macro Mondays/Flickr Creative Commons)

You know the old saying (or maybe you should): “Eat breakfast like a king, lunch like a prince and dinner like a pauper.”

A new study in the journal PNAS looks into some of the underlying biology: that our bodies tend to regulate blood sugar better after breakfast than after dinner.

Led by researchers at Brigham and Women’s Hospital, it also helps explain why night shift workers tend to be at heightened risk for Type 2 diabetes.

Says the study’s senior author, Frank A. J. L. Scheer of the Brigham, on Radio Boston today: “What we wanted to explore was whether the biological clock — the internal clock — is playing an important part in this day/night variation, or that it might just be due to the sleep/wake and feeding/fasting cycle.”

The study pinpoints two separate mechanisms at work:

• Our basic body clocks, also known as circadian rhythm, have major influence on our blood sugar regulation: our glucose tolerance is naturally higher in the morning than the evening.

• And, independently, when our clocks are misaligned — when we’re forced to flip our days and nights — that, too, lowers our glucose tolerance.

Bottom line, for those of us who are not shift workers: The same exact meal can lead to more of an increase in blood sugar when eaten at night than when eaten in the morning (and higher blood sugar is considered a risk factor for developing diabetes.) Chalk one up for the writers of old sayings.

On the study: Continue reading

Forbidden Fruit: Pesticide-Laden Produce Linked To Lower Semen Quality, Study Finds

(Robert S. Donovon/Flickr)

(Robert S. Donovon/Flickr)

That apple a day? Consider choosing it wisely: If it’s laden with pesticide residues, it could mess with your sperm.

That’s the analysis from researchers at the Harvard School of Public Health in a study published online this week in the journal Human Reproduction.

The study found that men who ate a range of fruits and vegetables, including strawberries, peppers, spinach and apples, with higher levels of pesticide residues had a lower sperm count and a lower percentage of normally-shaped sperm compared to men who ate produce with less pesticide residue. (This finding was true even after fruit was washed before eating.) Researchers said it’s the first study to examine exposure to pesticides and semen quality.

Senior study author Jorge Chavarro, assistant professor of nutrition and epidemiology at the Harvard School of Public Health, said the research doesn’t mean people should eliminate fruits and vegetables from their diet — on the contrary; rather consumers should simply choose more carefully. In an email, he wrote:

I think there are two main takeaways from this work. The first one is that, as interesting and potentially alarming these findings may be, this is the first time that pesticide residues in foods have been linked to an adverse reproductive health outcome in humans. It is therefore very important that these results are replicated in other studies, and ideally in randomized trials, before firm conclusions can be made one way or the other.

On the more practical end, the other important point is that our results point to a very specific role of high pesticide residue produce, rather than to intake of fruits and vegetables in general which means that strategies specifically aimed at avoiding high residue produces, such as consuming organic produce if budget allows or selecting fruits and vegetables known to have low levels of pesticide residues may be the preferred way to address this issue…

Chavarro said the easiest way to determine produce safety is to check the dirty dozen/clean fifteen list that the Environmental Working Group releases each year. Continue reading

Conflicts Abound In Research Studies On Food, Nutrition, Expert Notes

Marion Nestle, a professor in the Department of Nutrition, Food Studies, and Public Health at New York University, has been called one of the most powerful foodies in America. (Michael Pollan deemed her No. 2, right after Michelle Obama.)  Ranking aside, Nestle (no relation) knows her Big Food.

(david_pics/Flickr)

(david_pics/Flickr)

In a recent post on her blog Food Politics, Nestle makes a clear case that food and nutrition “research” is riddled with conflicts of interests — chocolate makers sponsoring a study on the cognitive benefits of cocoa, for instance.

Nestle notes that some studies paid for by food companies or trade groups “almost invariably promote the financial interests of the sponsor.” Here are just a few examples she collected in a week or so: Continue reading

Sip Of Latte With Binky? Study Finds Coffee Drinking ‘Not Uncommon’ Among Boston Toddlers

When Boston researchers asked mothers what types of fluids they were feeding their babies, they expected typical answers: breast milk, formula, water, juice.

But what they heard was surprising: a number of moms were giving their 1- and 2-year-olds coffee to drink. Not much, but still.

According to a new study on the links between early feeding and childhood obesity, researchers report approximately 15 percent of 2-year-olds were receiving up to 4 ounces of coffee every day (though the average was just over an ounce). Among the 1-year-olds in the Boston-based study, the rate of coffee consumption was 2.5 percent of children.

“We didn’t ask if it was decaf,” says the study’s principal investigator, Anne Merewood, PhD, MPH, director of the Breastfeeding Center at Boston Medical Center and associate professor of pediatrics at Boston University School of Medicine. The majority of the coffee-drinking children had Hispanic mothers who were born outside the U.S., the researchers wrote; and female infants and toddlers were more likely than males to drink coffee.

Merewood said while she was surprised by the findings, the practice does make cultural sense. “I’m English and I’ve been drinking tea since I was a very small child,” she said. “It’s a cultural thing, they just feed the baby what everyone else is eating.”

The researchers did not ask whether the children’s minimal coffee consumption impacted behavior, or whether the kids got hyper with the additional caffeine. Still, Merewood said: “It’s probably not a great idea to give caffeine to young children. We we need to investigate more.”

(Soul 2 Amor/Flickr)

(Soul 2 Amor/Flickr)

The study of 314 pairs of mothers and babies specifically looked at breast feeding and other eating habits of children at age 1 and 2 years. The findings, published in the Journal of Human Lactation, which is edited by Merewood, cites some earlier research on the downside of coffee drinking by young children:

Although coffee consumption in the first years of life has not been well documented, several risks of coffee and caffeine consumption in older children and adolescents have been identified. Research suggests an association between coffee consumption and higher rates of type 1 diabetes in children. Caffeine use among children and adolescents has been associated with depression, sleep difficulties, substance use, and concerning physiological, behavioral, and psychological effects…

It is unknown if these same risks apply to very young children and coffee. One study that did explore the risks of coffee consumption among toddlers found that 2-year-olds who consume coffee or tea between meals or at bedtime had “triple the odds of severe kindergarten obesity.”

The researchers also point out that: “In a recent statement, the US Food and Drug Administration expressed an intent to establish an acceptable limit for caffeine use by children, recognizing that the AAP discourages this practice.”
Continue reading

Nutrition Panel: Cut Down On Sugar To Combat Obesity, Chronic Disease

(Mel B via Compfight)

(Mel B via Compfight)

A U.S. advisory panel on nutrition has issued a sweeping report on the American diet that many of us won’t find earth shattering. One key conclusion: we should eat less sugar.

The 2015 Dietary Guidelines Advisory Committee offered its recommendations to the U.S. Department of Health and Human Services and the Department of Agriculture today as part of a process to develop new national dietary guidelines, which are updated every five years. Public comments are currently being accepted.

As far as sugar goes, the report states that: “Higher consumption of sugar-sweetened foods and beverages as well as refined grains was identified as detrimental in almost all conclusion statements with moderate to strong evidence.”

The report’s authors said they were guided by “two fundamental realities”:

“First, about half of all American adults — 117 million individuals — have one or more preventable, chronic diseases, and about two-thirds of U.S. adults — nearly 155 million individuals — are overweight or obese. These conditions have been highly prevalent for more than two decades. Poor dietary patterns, overconsumption of calories, and physical inactivity directly contribute to these disorders. Second, individual nutrition and physical activity behaviors and other health-related lifestyle behaviors are strongly influenced by personal, social, organizational, and environmental contexts and systems. Positive changes in individual diet and physical activity behaviors, and in the environmental contexts and systems that affect them, could substantially improve health outcomes.

Here’s more about the dietary recommendations:

The overall body of evidence examined by the 2015 DGAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low-or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat;i and low in sugar-sweetened foods and drinks and refined grains. Vegetables and fruit are the only characteristics of the diet that were consistently identified in every conclusion statement across the health outcomes. Whole grains were identified slightly less consistently compared to vegetables and fruits, but were identified in every conclusion with moderate to strong evidence. For studies with limited evidence, grains were not as consistently defined and/or they were not identified as a key characteristic. Low- or non-fat dairy, seafood, legumes, nuts, and alcohol were identified as beneficial characteristics of the diet for some, but not all, outcomes. For conclusions with moderate to strong evidence, higher intake of red and processed meats was identified as detrimental compared to lower intake….

Continue reading

That Extra Slice: Study Finds When Kids Eat Pizza, They Eat More Calories

Pizza birthday party (Flickr Creative Commons)

Pizza birthday party (Flickr Creative Commons)

By Alvin Tran
Guest contributor

Parents, if you want to prevent your kids from eating too many extra calories, you might want to think twice about letting them have that “just one more” slice of chewy dough, tangy tomato sauce and glistening melted cheese.

In a new study, published Monday in the journal Pediatrics, researchers found that pizza contributed to children and adolescents consuming more calories, saturated fat, and sodium in their usual diet.

“They’re taking in substantially more nutrients we really want to be thinking about limiting,” said Lisa Powell, PhD, a University of Illinois at Chicago professor of health policy and administration and the study’s lead author.

Powell’s study, which analyzed 24-hour dietary recalls of more than 12,000 kids over a 7-year period, found that children between the ages of 2 and 11 consumed an extra 84 calories on the days they ate pizza, while adolescents consumed an extra 230 calories.

It’s not a good idea to eat pizza as a snack.

– Lisa Powell, PhD

They also consumed significantly more sodium and saturated fat, which nutrition and health experts often dub the “bad fat.”

There is a silver lining, however. Children’s overall caloric intake from pizza declined by 25 percent over the course of the study. The study’s adolescent population, which ranged from ages 12 and 19, also demonstrated similar trends: its caloric intake from pizza fell by 22 percent.

But while the number of calories that adolescents consumed dropped, their overall consumption, on average, did not significantly change over the course of the study. According to Powell and her co-authors, this may be due to a slight increase in pizza consumption.

“The average adolescent takes in 620 calories of pizza. By showing that they consume this extra 230 calories, that means that on days they consume pizza, they’re not adequately adjusting the caloric intake and other things they take in that day,” Powell said. “They may be eating pizza but they’re having this additional 230 calories that they’re taking in.”


Overall, pizza consumption remained highly prevalent across both groups. In 2009 to 2010, 20 percent of children and 23 percent of adolescents consumed pizza on a given day.

Powell and her colleagues also found that consuming pizza as a snack or from fast-food restaurants were the two greatest culprits influencing both children and adolescents’ overall daily calorie intake.

“It’s not a good idea to eat pizza as a snack. That’s one thing that teens and parents should keep in mind,” Powell said. Continue reading

Project Louise: The Project Ends Now … But It Lasts A Lifetime

baby steps, will 668/flickr

baby steps, will 668/flickr

With the end of 2014 comes the end of Project Louise. The official end, that is. My excellent CommonHealth hosts gave me a year of coaching and support to see how much I could improve my health, and that year is now over. But my efforts to keep improving my health will continue, I hope and believe, for the rest of my life.

In part that’s because I haven’t reached all the goals I set for myself a year ago. I lost some weight, but not as much as I hoped; I exercised more, but I still haven’t developed the consistent exercise habit that I know I’ll need in order to make fitness a real and permanent part of my life.

On the other hand, I have made some real changes that I know will last. My diet is much better than it was a year ago – more vegetables, less junk – and, maybe even more important, my relationship with food is less complicated and neurotic. I still sometimes eat “bad” foods, but I don’t hate myself when I do – and that means I don’t go off on a binge.

That change is part of a larger one, one that Coach Allison Rimm urged me to undertake – and one that, frankly, didn’t immediately strike me as relevant to this project. Gently, consistently and with remarkable success, she has encouraged me to speak more kindly to myself, to focus on what I’m doing right rather than what I’m doing wrong.

Gentle Nudging

It turns out that gentle encouragement works much better than relentless criticism – something I knew and practiced in raising my children, yet somehow needed to learn in “raising” myself. In teaching me this lesson, Coach Allison has given me a priceless and lasting gift.

And that newfound sense of patience with myself is connected to the main reason I’ll keep working on this “project,” the single most important thing it has taught me. More than better nutrition, more than motivation for exercise, what Project Louise has shown me is that nothing lasting happens overnight. Change is a continuous process, not an isolated event.

No Overnight Success

We all fantasize about the life-changing moment, the day that divides our imperfect past from our glorious future – isn’t that what New Year’s Eve is all about? But in fact most days are pretty much like most other days; the calendar may change tomorrow, but we all know that Jan. 1 won’t feel much different from Dec. 31. Continue reading

Embrace The Eggnog, And Other Tips To Curb Holiday Eating (And Guilt)

(Theen Moy/Flickr)

(Theen Moy/Flickr)

It’s peak season for overeating — and then beating yourself up for doing it.

Clearly, you’re not the only one treating yourself to pumpkin and pecan pie, egg nog and, yes, fruitcake. Yet it’s no comfort that everyone else and their Weight Watchers’ leader is also riddled with guilt and enduring a personal thrashing for the extra calories and potential weight gain. While this self-flagellation goes on, you’re missing out on enjoying the holidays.

If only there were a better approach to holiday eating, maybe then you’d be able to stop beating yourself up, enjoy eating what you love and savor everything else you really do love about this season.

Happily, you don’t need an emergency gastric bypass to stop the vicious cycle: putting an end to both overeating and self-criticism might be easier than you think. It might be as easy as reviewing some research-based strategies honed from a group training I lead for people with eating issues. It revolves around practicing a variety of mindful eating and self-compassion meditations.

Here are five proven tips for happier, healthier holiday eating:

1. Redefine Holiday Eating

You’ll need a better working definition of “normal holiday eating” if your definition sounds anything like my esteemed colleague and family eating expert Ellyn Satter’s:

Most people get caught up in what they should and shouldn’t eat. They’re anxious and ambivalent about eating. They might try to resist at holiday parties, but the table is laden with ‘forbidden food,’ and they throw away all control and overdo it. Many times they’re over-hungry because they’re trying to restrict themselves and lose weight. So the standard definition of holiday eating becomes eating way too much.

If you’d prefer to take fewer bites and ease the anxiety and ambivalence, now’s the time to do the exact the opposite, starting with eating regular meals and snacks. Then, come party-time, permit yourself to eat the foods you enjoy. You’re probably going to eat them anyway, so you might as well as enjoy them, without the guilt and other uncomfortable emotions that predictably fuel emotional eating.

2. Go Easier On Yourself

If, like most dieters, you’re hoping that feeding yourself a steady diet of self-criticism will inspire you to rein in your eating, think again. You’ve actually got it backward. Self-criticism — calling yourself fat, disgusting and other mean, nasty names — is really a recipe for emotional overeating and holiday weight gain. Continue reading