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Confessions Of A Physician Sugar Addict

(Mel B via Compfight)

(Mel B via Compfight)

By Terry L. Schraeder, M.D.
Guest contributor

In medical research, the “n” value is the number of people in a study. If n = 1, it is not generally considered a very powerful study. But when you are the “1” in “n = 1,” it somehow becomes more significant.

It all started with a can of soda disguised as sparkling orange juice. It had become my “go to” treat. My pick-me-up when I was low. In fact, it gave me a rush of energy every time I drank it. One day, I looked at the label to see if it contained caffeine. No caffeine, just added sugar. In fact, it contained 32 grams of sugar — eight teaspoons per can — with sugar second only to water as the largest ingredient. The World Health Organization recommends women not consume more than six teaspoons of added sugar per day — or about 5 percent of total calories as added sugar. Men can have up to nine teaspoons.

How much sugar was I consuming a day? I was also adding honey to my coffee, maple syrup to my oatmeal, consuming corn syrup in my “healthy” flavored yogurt (some brands add as much as 30 grams per serving) and enjoying muffins as a snack and dessert many evenings. Along with my routine stop for a drive-through flavored coffee drink, and occasional cookies or candy, I had officially joined our nation of fellow sugar addicts.

In the US, we are consuming on average 88 grams or 22 teaspoons of added sugar a day. (There are four grams of sugar per teaspoon.) My guess is that I was eating even more. Like many, I needed my fix of high fructose corn syrup or other sugar source every few hours.

For the last several years, there has been an increasing drumbeat of warnings linking sugar to obesity, diabetes, heart disease, cancer and nonalcoholic fatty liver disease from experts such as endocrinologist Dr. Robert H. Lustig at the University of California at San Francisco and media doctor Dr. Sanjay Gupta at CNN. But somehow the message had missed me. I did not think of myself, especially as a physician, as a high sugar consumer.

I have tried to stop the hourly IV drip of added sugar I was consuming throughout the day.

I have passed my 50th birthday and have a normal body weight and exercise regularly. I am not on any medication. My blood pressure and fasting blood glucose are normal. But last year, my triglyceride level was high. One reason might be that the high fructose corn syrup I was consuming is converted to triglycerides in the liver – hence the high level.

There were other concerns. I noticed that I felt shaky and had food cravings two hours after eating. I also noticed an afternoon slump of low energy, a growing bulge of belly fat, and plaque that needed to be vigorously scraped from my teeth every six months. How long had my sugar intake been so high?

Sugar consumption in the US has climbed into the stratosphere in the past three decades. Our added sugar consumption increased by 30 percent from 1977 to 2010, according to a study presented last week at ObesityWeek, a major obesity conference, in Boston. It seems we are slurping, sucking and chewing 300 calories of added sugar daily (up from 228) and far more than the recommended limit of 100 calories of added sugar per day. Continue reading

Studies: It May Be Better For Kids Who Are Overweight Not To Know It

feetonscale

According to the scale, the 18-year-old girl is severely obese. But she doesn’t think so.

“I know I’m big, but I’m not obese,” she says. “I don’t take up three seats. My weight is high, but no higher than lots of people’s. It’s no problem.”

If you’re her doctor or school nurse or parent, what do you do? Do you bombard her with Body Mass Index charts and warnings of the health risks she faces? Knowledge is power, right? Certainly, that’s the principle behind the “BMI report cards” — colloquially known as “fat letters” — that schools send home in some states.

But research just presented at ObesityWeek, a major conference on obesity, suggests that it may not be wise to persuade that young woman that she has a problem.

One study found that overweight teens who “misperceive” their weight as normal end up gaining less weight over the next decade or so than teens who are overweight and know it. Another study found that those “misperceivers” blind to their extra pounds were also less likely to become depressed in later years.

The findings are at odds with the basic assumption behind BMI report cards, that it is helpful to inform kids and their families of their weight status, says researcher Kendrin Sonneville, an assistant professor at the University of Michigan School of Public Health who is also affiliated with Harvard and the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital.

Kendrin and IdiaXXX

Dr. Kendrin Sonneville and Dr. Idia Thurston at the Obesity Week conference, where they presented studies that found that weight “report cards” may backfire. (Carey Goldberg/WBUR)

“I think we can say the jury is still out,” she says. “Weight misperception is not something we should assume is harmful, and in the spirit of doing no harm, I think we need to proceed with caution on any type of programming that involves correcting weight misperception.”

The study she led, which followed more than 2700 young people beginning in high school, found that after about a decade, the overweight teens who had perceived their weight accurately gained more than one BMI unit — very roughly about 10 pounds — more than those overweight teens who had falsely believed their weight to be normal.

Why might this be? That’s one of the next avenues of research that need to be explored, but clinical psychologist Idia Thurston, an assistant professor at the University of Memphis, says the key could be the emotional baggage that comes with being told you’re overweight or obese.

More accurate weight perception may translate into more feelings of stigma and lower satisfaction with your own body, she says, “and that could affect your ability to cope — hence, depressive symptoms or hence, engaging in harmful eating behaviors.”

“So when we think about weight report cards and telling kids, ‘This is what your weight status is,’ you really need to think about how that information is being disseminated, and what kinds of protections are put into place, rather than just sending report cards home to kids and not knowing how kids will act on that information.”

Dr. Thurston’s study, also presented at ObesityWeek, found that overweight high-school-aged boys who accurately perceived their own weight as high were significantly more likely to develop depressive symptoms over the next decade or so. (The findings in girls were not statistically significant.) Once again, a false sense of being a normal weight appeared to be protective for overweight young people.

The idea of having schools screen kids for obesity began in 2003 in Arkansas during then-Gov. Mike Huckabee’s anti-obesity efforts, Dr. Sonneville says, and spread around the country without ever having a solid research base on what its effects might actually be.

About one-fourth of states track schoolchildren’s height and weight, and last year U.S. News reported that nine sent weight “report cards” home, including Massachusetts. But last October, facing pushback from nurses, parents and others, the state’s Public Health Council voted to stop sending the letters home, though the schools still gather the information. U.S. News reported that decision under the headline “Massachusetts Schools To Stop Sending ‘Fat Letters:'” Continue reading

Fat Stigma Fading? Fewer See Obesity As Problem Of Bad Personal Choices, Survey Says

Are public perceptions and stereotypes around obesity beginning to shift?

Maybe.

New research presented this week in Boston suggests that the general public and health care providers are starting to view obesity more as a “community problem of shared risks” as opposed to a personal problem stemming from “bad choices.”

These findings were presented as part of The Obesity Society’s Annual Meeting.

Americans’ view on fat has been evolving for some time, spurred by a robust “fat acceptance movement” and a decision last year by the American Medical Association to officially recognize obesity as a disease.  Also, a wave of media and advocacy revolving around healthier eating and lifestyles, from Michelle Obama’s Let’s Move campaign to the film Fed Up, has focused the national attention on the nitty gritty of food and weight.

The Obesity Society

The Obesity Society

The latest research shows that bias against fat people may also be evolving.

Here’s more from the Obesity Society news release:

…For adults in the United States, perception has moved away from seeing obesity as a personal problem resulting from bad choices. Healthcare professionals were already less likely than the public to view obesity as a personal problem of bad choices.

“Despite the high prevalence of obesity in the U.S. and worldwide, weight bias and stigma continue to complicate clinical and policy approaches to obesity treatment,” said study author Ted Kyle, RPh, MBA, of ConscienHealth in Pittsburgh, PA. “The goal of our study was to measure any shifts that might affect or result from public policy changes.” Continue reading

Berkeley ‘Says No To Big Soda,’ First To Pass Tax On Sugary Drinks

sodabottles

In the flurry of election results, don’t miss this milestone with potential public health significance from Caifornia: Berkeley has voted to tax sugary drinks one penny per ounce, and a majority of San Franciscans voted for a similar measure, though it fell short of the two-thirds it needed to pass.

From the Los Angeles Times, which reports that Berkeley is “the first electorate in the nation to approve a tax on sodas and other sugary beverages”:

The [Berkeley] measure was backed by public health advocates and the city’s elected leaders, who said the tax would reduce consumption of sugary drinks and raise awareness of the link between sugary drinks and diabetes and other diseases. The measure’s backers say a national soda tax in Mexico has caused people there to consume fewer sugary drinks.

The American Beverage Association spent $2.4 million to defeat Measure D, and an additional $9.1 million to fight San Francisco’s Proposition E, which would have imposed a 2-cents-an-ounce tax on sodas and other sugar-sweetened drinks.

Though 54.5% of San Francisco voters backed the sugary-drink tax, a tally of 66.67% was needed to pass the measure. The two-thirds threshold was required because the tax revenue would have gone to a special fund for recreation and nutrition programs in schools and parks. The Berkeley measure needed only a majority to pass because that revenue went into the city’s general fund.

“We’re saying no to Big Soda,” Berkeley Mayor Tom Bates said, according to the Associated Press. “We’re saying that Berkeley and the rest of the country need to pay attention that soda is such a destructive product.”

Proposals for a similar tax in Massachusetts have been floated for years now. A few examples:

• In 2009, a group of economists and public health experts, including those from Harvard Medical School and the Harvard School of Public Health, called for a tax on sugar-sweetened beverages to fight obesity and fund health care costs.

• In 2011, Massachusetts pediatricians and other health-promoters concerned about obesity officially launched a concerted campaign against sugary drinks and candy, pushing a bill to remove the sales tax exemption on soda.

• In 2013, Gov. Deval Patrick pushed the idea of removing the tax exemption in the legislature, saying candy and soda should not be considered food and thus exempt from the state’s 6.25 percent sales tax.

Thus far, the Mass. attempts to tax soda have failed. But meanwhile, evidence has been mounting that such efforts have an effect against obesity, and the Berkeley vote translates the data into political impact.

The Center For Science in the Public Interest hailed the vote as “a historic victory for public health,” saying Berkeley has “shown it can be done.”

On the other hand, the Associated Press quotes American Beverage Association spokesman Roger Salazar as unworried that Berkeley is a harbinger of sweeping change. Berkeley “doesn’t look like Anytown USA,” he says.

Readers? Do you think these California votes will have any effect elsewhere?

Study: Aerobics Plus Resistance Training May Be Best Against Teen Obesity

obese kid

A new study published online in JAMA Pediatrics finds that a combination of aerobic workouts plus resistance training offers the best hope for teenagers battling obesity.

From the abstract:

Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.

Here’s more from The New York Times coverage of the study, which found that “diet without exercise accomplishes little:”

Canadian researchers put 304 obese teenagers on a diet with a daily energy deficit of 250 calories (measured from their resting energy expenditure). Then they assigned them randomly to one of four groups for 22 weeks: aerobic training on exercise machines like treadmills, resistance exercise using weight machines and free weights, combined aerobic and resistance training, and a diet-only group with no exercise… Continue reading

If You Build A Crew Program For Overweight Kids, They Will Row — And Get Fitter

There was no comfortable place for 17-year-old Alexus Burkett in her school’s typical sports program of soccer and lacrosse and basketball.

“They don’t let heavyset girls in,” she says.

Alexus was “bullied so bad about her weight,” says her mother, Angelica Dyer, “and there was no gym that would take her when she was 14, 15 years old. There was no outlet.”

But Alexus has found a sports home that is helping her bloom as an athlete: an innovative program called “OWL On The Water” that offers rowing on the Charles River specifically for kids with weight issues.

She has lost more than 50 pounds over half a year, but more importantly, says her mother, “They’ve given me my daughter’s smile back.”

Alexus Dwyer during warm-ups before instruction time. (Jesse Costa/WBUR)

Alexus Burkett stretches during warm-ups before “OWL On The Water” instruction time. (Jesse Costa/WBUR)

“It’s given me a lot of good strength and it’s making me more outgoing,” Alexus says. “We’re all best friends and we’re all suffering with the same problem — weight loss — so we’re more inspiring each other than we are competing against each other.”

OWL On The Water offers a small solution to a major national problem: According to the latest numbers, 23 million American kids are overweight or obese, and only about one quarter of 12-to-15-year-olds get the recommended one hour a day of moderate to vigorous physical activity. Heavier kids are even less likely to be active, and only about one-fifth of obese teens get the exercise they need, the CDC finds.

“I know I need to be active, but please don’t make me play school sports!” That’s what exercise physiologist Sarah Picard often hears from her young clients at the OWL — Optimal Weight for Life — program at Boston Children’s Hospital that sponsors OWL On The Water.

Many gym classes still involve picking teams, “and my patients are the ones that are always picked last,” she says. “You’re the biggest one, you’re the last one, you’re picked last, and you’re uncomfortable.”

They are strong, powerful people.
– Sarah Picard

School fitness testing is important, Picard says, but it, too, can be an ordeal: “I have kids who sit in my office and tell me that they didn’t go to school for a week because they wanted to miss the fitness testing,” she says.

While many a coach might see bigger bodies as poorly suited to typical team sports, Picard sees them as having different strengths. Particularly muscular strength.

“What I’ve observed is that these kids are much better at strength and power-based activities,” she says. And rowing is particularly good for them, she says, because though it is strenuous, it is not weight-bearing, and thus more comfortable for heavier bodies — yet a heavier, strong body can pull an oar much harder than a smaller person’s body. The program begins by building on that muscular strength, she says, and then works on aerobic fitness. Continue reading

Study: Could Bro Or Sis Affect Weight More Than Mom Or Dad?

sisters

Veronica Thomas
CommonHealth Intern

My adolescence was a blur of rushing from school to dance classes with my older sister. After hours of practice, we couldn’t wait to get home and make berry smoothies that we’d slurp from the blender. My sister and I did almost everything together.

A new study suggests this relationship may have played a key role in keeping me healthy and fit.

The study, released online by the Journal of Preventive Medicine, found that siblings may have a greater influence on a child’s risk of obesity than parents do. Specifically, having an obese older sibling is associated with more than double the risk of being obese compared to having an obese parent. The association is even greater among siblings of the same gender.

It may seem obvious that family members influence a child’s chances of being obese, but the importance of the type of family relationship has been less clear. This new study, led by Dr. Mark Pachucki at the Mongan Institute for Health Policy at Massachusetts General Hospital, is the first to compare the influence of sibling obesity and parent obesity on a child’s obesity risk.

Dr. Pachucki and his team surveyed almost 2,000 only-child and two-child families from the larger Family Health Habits Survey. One parent from each family reported on the food environment, physical activity, weight and height for themselves and their children. The researchers also considered and analyzed the parents’ socioeconomic status, demographic background and overall health. Continue reading

Tracking The Rising Backlash Against Sugar

Years ago, on my daughter’s first birthday, my mother-law, an avid cook, baked her a cake. I don’t remember if it was chocolate or layered. What I do remember is forbidding my baby from eating it — not even a nibble. Why, I thought, would I introduce processed sugar into a one-year-old’s diet when she’d been perfectly content with avocados and bananas? “Don’t you want to see pure joy on her face?” asked one friend. Yeah, sure, but not from frosting.

Needless to say, the birthday cake prohibition triggered a bit of a backlash among some family members, and earned me labels like “rigid” and “crazy.”

But these days, with the huge national backlash against sugar — from the new film “Fed Up” and Eve Schaub’s popular family memoir, “Year Of No Sugar,” to Mark Bittman’s regular columns hammering on the message of sugar’s toxicity — I feel somewhat vindicated.

Here’s a snippet from Bittman’s latest, “An Inconvenient Truth About Our Food” on why “Fed Up” is such an important film:

The experts carry the ball. The journalist Gary Taubes calls the “energy balance” theory — the notion that all calories are the same, and that as long as you exercise enough, you’ll avoid gaining or even lose weight no matter what you eat — “nonsense.” One Coke, we learn, will take more than an hour to burn off. The pediatrician Rob Lustig, a leading anti-sugar campaigner, notes that “we have obese 6-month-olds. You wanna tell me that they’re supposed to diet and exercise?” David Ludwig, another M.D., notes that there is no difference between many processed foods and sugar itself, saying you can eat a bowl of cornflakes with no added sugar or a bowl of sugar with no added cornflakes and “below the neck they’re the same thing.” Lustig reminds us that anyone can develop metabolic syndrome: “You can be sick without being fat; this is not just a problem of the obese.”

And so on. Senator Tom Harkin says, “I don’t know how they (the food industry) live with themselves,” comparing them to the tobacco industry. Bill Clinton says, effectively, “We blew it,” when it came to this struggle.

The movie has some splendid moments: A mother cries at the difficulty of the choice she must make between giving her child what she wants and giving her what’s best. Her struggle is common, and she’s fighting against an almost overwhelming tide of marketing and, yes, even addiction. A school lunch worker, speaking of the fact that few kids choose the healthy option at lunch, says, “You can’t choose for them.” But they are children; we must choose for them. Not only are their parents not present, but their parents often don’t know what’s best.

Just to be clear, this isn’t simply rationalizing my own personal food obsessions (though there’s some of that) or about our cultural sickness around achieving “thigh gap” thinness. It’s about overall health — for instance, heart disease. Continue reading

Eat Fat But Stay Thin: Mice Can Do It, Maybe Someday We Can Too

Generic lab mice

Generic lab mice

The journal Nature reports that some lab mice have lived out my food fantasy: Even though they ate a heavy, high-fat diet — my particular dream is unlimited Ben & Jerry’s — they did not become obese, because researchers found a novel way to tweak their metabolism.

Sigh. The caveats first: What works in mice might not in humans. It might not be safe. Clinical trials are not on the immediate horizon. This is no reason to stop eating healthy food and exercising.

But we can dream, right? And we can savor the explanations from Dr. Barbara Kahn of Beth Israel Deaconess Medical Center and Harvard Medical School, senior author on the Nature paper. She sums up: “We found an enzyme in fat that appears to be elevated in people with obesity and diabetes. And if we inhibit it in mice, we can increase the amount of energy that the animal burns, and thereby decrease the amount of calories that are stored as fat.”

It’s something like the extra energy you burn when you exercise, she said — except without the exercise.

Dr. Kahn’s team found a gene that, when suppressed, makes metabolism less efficient — which is actually a good thing if you’re trying to avoid obesity.

“Generally, in our lives, we think it’s good to be efficient — and it certainly is good to be efficient in time management,” she said. “But if your metabolism is efficient, it means you need fewer calories to generate the energy that cells need for their basic metabolism, and therefore, if you eat too many calories, you will put on weight. But if the cells are inefficient, they’ll burn up those extra calories and you won’t put on weight.”

So do these findings — centering on an enzyme known as nicotinamide N-methyltransferase or NNMT — indeed hold the promise of some sort of drug to prevent or treat obesity?

“The approach we used in the mice was mainly prevention,” Dr. Kahn said, “but the same idea should work for treatment of obesity. I have to caution, of course: one has to look into all the safety aspects if one considers such a treatment in humans. But all the cellular machinery is there, so it should work.” Continue reading

Obesity: A Disease By Any Other Name

(Photo: Yale Rudd Center for Food Policy and Obesity)

(Photo: Yale Rudd Center for Food Policy and Obesity)

By Melinda J. Watman
Guest contributor

When the American Medical Association declared obesity a disease last year, most of us — advocates who work to help those with obesity — were thrilled.

We saw the new definition’s potential to change how medical professionals regard people with obesity, increase society’s focus on obesity, push insurance companies to cover obesity treatments, reduce social stigma and moderate the anxiety and depression often afflicting those with obesity.

Already, we see some of those hopes being realized. Just last week, the federal government’s Office of Personnel Management issued a ruling that health insurers who cover federal employees may no longer exclude coverage of weight loss drugs on the basis that obesity is a “lifestyle” condition or that obesity treatment is “cosmetic.” This is one more significant step in the recognition and treatment of obesity as a disease.

But nothing is that simple or easy.

The high-fiving was barely over when the first study came out saying “not so fast.” It would seem, according to an article published in the New York Times, no good deed goes unpunished. The article presented a summary of a research paper titled “‘Obesity Is a Disease': Examining the Self-Regulatory Impact of this Public-Health Message.

Melinda Joy Watman (Courtesy)

Melinda Joy Watman (Courtesy)

The three authors concluded that labeling obesity a disease led their subjects to want to eat more, eat worse and care less about their weight. They suggested that labeling obesity a disease leads to the belief that it is futile to try to manage one’s weight.

Whether one agrees with the study’s findings and conclusions or not, the underlying question of whether obesity should be accepted as a disease is the critical point. The authors certainly question its validity based on the findings that their subjects suffered an “undermining of beneficial self-regulatory processes.”

What is interesting is that if it were any other chronic illness with comparable results, we would not be questioning whether the illness should be classified as a disease. Rather, we would be trying to find better ways to engage, educate, support and treat those patients as we continued to work on new therapeutics to manage the disease.

As is often the case with obesity, it would appear this line of thinking and research has the potential to further marginalize the problem and those affected by it. This is completely counter to what the AMA policy strives for – the same medically accepted framework to diagnose, treat and support patients as exists with any other chronic illness. Continue reading