obesity

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50 Years Of American Health Choices: Smoking Gains Offset By Getting Fatter

(Lucia Sofo via Wikimedia Commons)

(Lucia Sofo via Wikimedia Commons)

Feeling optimistic? Then you may see the moral of this story as, “Yay, public health efforts! They can wield amazing power and save many lives.”

In more of a glass-half-empty mood? Then your takeaway may be, “If it’s not one thing, it’s another.” Or perhaps, that public health must play an eternal game of Whack-a-Mole.

The story itself: The National Bureau of Economic Research just sent over word of a new working paper that looks at American health behaviors and their effects over 50 years, from 1960 to 2010. It examined six behaviors: obesity, smoking, heavy drinking, unsafe driving, firearms, and poison or overdoses. What most struck me: Though we’re generally living longer, our health gains from shunning cigarettes and safer driving are all but erased by the rise in obesity and drug overdoses. Sigh. From the summary:

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

…The authors find that the gains associated with declines in smoking, motor vehicle fatalities, and heavy drinking are essentially offset by the losses arising from rising obesity and misuse of firearms and poisonous substances. Valued in dollar terms, there is a near zero net gain in health from public health and behavioral changes over the past fifty years. However, the analysis includes a mix of some risk factors that have been aggressively addressed through public health and behavioral changes over a long period (smoking, unsafe driving), and others that are in the earlier stages of being addressed and have proven challenging (obesity, prescription drug addiction).

The authors conclude “our study demonstrates the enormous benefits of public health and behavioral change in improving population health, underscoring the importance of continued advances in these areas of research and practice.”

I asked Harvard health economist David Cutler, who co-authored the report, what he’d want the public’s takeaway to be (and included a plea to help me beat down my own cynicism.) His e-mailed response:

There are some who see this as ‘glass mostly empty’ – i.e., if it’s not one thing, it’s another. But remember how hard these changes are. Quitting smoking is very difficult, and yet millions of people have done it. Reducing caloric intake is very difficult, though weights finally seem to be stabilizing. The difficulty of these interventions makes the successes particularly notable.

Readers, your own thoughts? Read the full paper here and the summary here.

The Buffet Phenomenon: Researchers Find More Food Choices Linked To Fatter Mice

(Alpha/Flickr)

(Alpha/Flickr)

This is why I hate buffets: Too many food choices make my head spin. For weight control, I prefer the out-of-sight, out-of-mind approach — keep the oversized muffins and pepperoni pizzas out of the house altogether. Call me rigid, but it seems to work.

Apparently, mice have similar issues, according to a study published in the journal Endocrinology.

The study tried to tease out the relative importance of genetics vs. environment when it comes to obesity risk. So, baby mice born to mothers with a defined high-fat or low-fat diet were randomly assigned to one of three diet groups: either a high-fat diet, a low-fat diet or to an “eat what you want” diet in which they got to pick and choose among the various options.

Researchers from Virginia Tech College of Agriculture and Life Sciences and the Edward Via College of Osteopathic Medicine report that:  “Offspring displayed negative outcomes of increased body weight, body fat, serum leptin, and blood glucose levels when given the choice diet compared with offspring on the [low-fat diet].”

This begs the question whether a child’s environment can indeed trump genetics when it comes to obesity.

The Virginia Tech news release quotes one of the study authors who wraps up the findings simply:

“We like variety,” said Deborah Good, an associate professor of human nutrition, foods, and exercise at Virginia Tech. “But when there is a choice, we eat more than when there is not any variety.”

Though the study was done using mice, it can help inform researchers of how human’s natural environment can affect food choices and ultimately a person’s weight. In a country where one-third of adults and 17 percent of children are obese, understanding the root causes of the problem is imperative.

One apparent upside found among mice in the choice group, according to the report: they had “improved energy expenditure” compared to the low-or high-fat diet groups. “Essentially,” the news release says, “the mice burned more energy as they wandered around and evaluated which food they were going to eat.”

This recalls the food and environment research of Brian Wansink, a professor of consumer behavior at Cornell University in Ithaca, New York. A recent Psychology Today article on how we eat (and overeat) called, “Why Out of Sight is Really Out Of Mind,” discusses how we can slip into mindless eating in a world where food is everywhere. But there are ways to eat smarter, if you think about what you’re doing:

Wansink found that slim people approach an “all you can eat” buffet by “scouting out” what is available — “getting the lay of the land,” as it were — before they grab their plates and pile on food. They are also more likely to sit facing away from, and to choose a table farther away from a buffet; more likely to choose small plates; and, if eating Chinese food, eat with chopsticks.

Jean Fain, a Harvard Medical School-affiliated psychotherapist who runs “mindful eating” training sessions, has offered some tips on how to curb excessive eating, particularly during the holidays, when tables are brimming with tempting sweets and heavy dishes loaded with nostalgia. In a December post, she wrote:

If you find yourself automatically reaching for another piece of pumpkin cheesecake, step back from the dessert table and ask yourself: “How do I feel? What do I need? Do I really want another piece of cheesecake?” If you do, by all means, enjoy. But if you feel full, better to interrupt the automatic urge for more. It’ll taste better when you’re hungry. What’s more, a short interruption can give you back control.

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

Biggest Gene Study Finds New Clues To Obesity, Apple Vs. Pear Shapes

(Wikimedia Commons)

(Wikimedia Commons)

You might think the link between genes and weight is simple: Fat tends to run in families, right? But as researchers tease apart the underlying genetics of body weight, it becomes ever clearer that it is a complex trait. Very complex, with ultimately perhaps hundreds of genes involved in what you see when you step on the scale.

Today, the biggest-ever study of the genetics of obesity, involving genetic samples from nearly 350,000 people, reveals dozens of new spots on the human genome that are involved with body weight and body shape, according to two papers (here and here) published in the journal Nature.

My dominant impression: The data tend to implicate the brain as a powerful influence on overall body weight, but point more towards hormones and the fat cells themselves as strong determinants of whether we’re shaped like “apples” — with more upper body fat — or “pears,” with more fat concentrated below the waist.

Dr. Joel Hirschhorn, of Boston Children’s Hospital, the Broad Institute and Harvard Medical School, leads the Genetic Investigation of Anthropometric Traits consortium, or GIANT, the friendly collaborative of hundreds of researchers around the world who contributed to the studies. Our conversation, lightly edited:

How would you sum up the findings that come out in “Nature” today?

We did a very large genetic study looking at two different kinds of obesity: Overall obesity measured by body mass index and central obesity — fat around the belly — measured by waist circumference and hip circumference. And what we found was that there are a lot of genes that influence both types of obesity, but, really interestingly, the types of genes that influence overall obesity are actually quite different than the types of genes that influence where the fat goes on the body.

Interesting. So what does that tell us?

That tells us that even though both types of obesity are bad for your health, that it may be very important to understand what kind of obesity you have, because if the biology is different, that means the way we can treat that obesity, or prevent it effectively, is probably going to be different for the two kinds of obesity.

So it may matter even more than we thought whether you’re shaped like an ‘apple or a ‘pear’?

That’s right. It matters both whether you’re an apple or a pear and it matters just how big you are in general. But the way you get to be big in general is probably different than the way you get to be an apple or a pear.

So it’s different pathways? Perhaps whole different mechanisms at work?

That’s right. The overall obesity seems to have more to do with what’s going on in the brain, maybe controlling appetite or whether you get full or how quickly you get full. And the apple vs. pear seems to have more to do with your fat cells and hormones that your body makes, things like insulin.

So does all this translate into any action points for the general public? Continue reading

Sugar On The Brain Circuit: Mice Seeking Sweets May Hold Key To Compulsive Overeating

You know the feeling: you’re tired, cranky, low or just have a serious, relentless desire for something sweet. Part of your brain cries out, “No, don’t do it, this will end badly.” But another (louder) part wants what it wants and won’t let up until that pint of Cherry Garcia, or red velvet cupcake or Caramel Macchiato is in plain sight. It’s an itch that must be scratched.

Now, brain scientists at MIT say they’ve identified a specific neural circuit in mice that can increase that compulsive overeating of sweets, but doesn’t interfere with normal eating patterns necessary for survival. More specifically, turning on this set of neurons drove mice to seek the reward of a sugary drink even in the face of punishment (a shock to the foot); and compelled them to eat voraciously even when full.  When the researchers shut down this pathway, however, the compulsive sucrose-seeking decreased.

Why does this matter? The new research, published in the journal Cell, may ultimately provide a target for the treatment of compulsive overeating and sugar addiction in humans, without undermining the clearly critical drive of eating to live, the scientists say.

“Imagine if I told you that in the future, we could change the way our neural circuits communicate in a way that I did not want to binge on sweets, but still allowed me to eat healthy foods when I’m hungry?” says Kay Tye, the study’s senior author and an assistant professor in the Department of Brain & Cognitive Sciences at MIT. “Obviously there is a ton of work that needs to be done to make this vision a reality, but our study suggests that it is possible.”

A Binge-Free Future?

As obesity rates have spiked in recent decades, experts say that overeating in general and consuming too much sugar in particular are major threats to human health.

But Tye says “the real underlying problems are the cravings that lead to compulsive eating, and the behavior of compulsive overeating itself.”

To tease out what might be driving that compulsion, Tye looked to a particular set of neurons in the mouse brain.

She and her colleagues showed that when mice perform reward-seeking actions enough that they become habits, that activates neurons connecting two key areas: a brain region called the lateral hypothalamus (an area important for hunger, feeding and homeostasis) and the ventral tegmental area (a brain region important for motivation and reward).

“If we want to understand how the brain gives rise to these feelings, thoughts and actions, we need to know more than what they are saying, we need to know who they are talking to,” Tye said. The team used so-called “optogenetic projection-defined phototagging” [essentially using laser light to activate or silence neurons] to see “which neurons…were saying what…and who they were talking to…”

These neural communications are quite distinct, Tye said; for instance, it’s important to distinguish between two types of reward-seeking behavior: binge-eating and drug addiction: “You don’t need cocaine to survive, you need food to survive,” she said.

The “Wanting” Neurons

Tye says that one of the biggest challenges with treating the obesity that comes from compulsive overeating disorders is that “most treatments are just a band-aid — treating the symptoms instead of the core problems.  Gastric bypass for example, is something that just makes it harder to eat, it doesn’t always change a person’s habits and eventually many people relapse and regain the weight.” Again, she theorizes that it’s the craving embedded in the brain that drives the compulsive behavior. She says there may be a distinctive set of  “wanting neurons” as opposed to “liking neurons.” 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

Why To Exercise Today (Even A Short Walk): Avoiding A Premature Death

I’ve been having such a hard time dragging myself out in the frigid, icy cold to run or get to a gym lately: there are so many excellent reasons not to do it. But here’s the best I could come up with today for why I shouldn’t listen to that “stay-warm-and-slip-into-bed-with-a-laptop little voice in my head: exercise is truly the “best way to avoid an early death,” according to U.K researchers, who report that even small chunks of exercise — a brisk 20-minute walk, for instance — can provide benefits.

Steve Koukoulas/flickr

Steve Koukoulas/flickr

The U.K. Telegraph headline sums up the new study tidily: “Lack of exercise is twice as deadly as obesity, Cambridge University finds.”

Indeed, this cohort study of 334,161 European men and women over 12 years, published in the American Journal of Clinical Nutrition found that “physical inactivity may theoretically be responsible for twice as many total deaths as high BMI” and concludes: “The greatest reductions in all-cause mortality risk were observed between the inactive and the moderately inactive groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be of public health benefit.”

Here’s more from The Telegraph report:

Using the most recent available public data, the researchers calculated that 337,000 of the 9.2 million deaths that occurred in Europe in 2008 could be attributed to obesity.

But physical inactivity was thought to be responsible for almost double this number – 676,000 deaths. Continue reading

Hey, Guys: Post-Holiday Belly Fat? Better Start Lifting

(Mr.TGT/Flickr via Compfight)

(Mr.TGT/Flickr via Compfight)

If your resolutions included a re-energized commitment to cardio, you might want to reconsider your program.

A recent study by researchers at the Harvard School of Public Health reports that for men over 40, aerobic exercise alone may not be enough to rid you of your ring around the middle.

The study, published in the journal Obesity, found that men who did 20 minutes of daily weight training gained less abdominal fat than men who did 20 minutes of daily aerobic activity. A combination of cardio and weight training led to optimal results. Continue reading

Weight Loss 2015: How To Get A Little Help From Your (New) Friends

feetonscale
If you made your resolution to lose weight in 2015 on New Year’s Eve, chances are you’re already feeling your initial determination start to flag. The dreary winter dusk calls for comfort food, and there’s slush between you and the gym.

So it’s time for a little help from your friends — only, maybe they should include new friends, not just the usual posse. Not the network that may have influenced you to over-indulge in the first place.

Dr. Sherry Pagoto, an associate professor of medicine at the University of Massachusetts Medical School and an obesity researcher, says studies show that social support is important for making lifestyle changes. “But just because you’ve decided to make a change, that doesn’t mean your friends or family members have. So what do you do? The best support comes from people who are on the same journey.” Social media lets you find people who are “exactly where you’re at, have the same interests and can support each other.”

“Maybe you don’t need everyone in your family to be as dedicated about the gym as you are,” she adds. “But if you can post to your online community — ‘I’m headed to the gym’ or ‘I just got back from the gym’ or ‘I’m on day 5 of my couch-to-5K’ — you’ll have someone who says, ‘Yay!'”

Here, Dr. Pagoto offers five top tips for using social media to help with weight loss:

1. Create a private Facebook group for friends interested in losing weight.

How? It’s easy: Post on Facebook asking if anyone wants to join a private weight loss group. Then create a group page (private, not public) and send invites to those interested. Identify a day when people report weight change from the last week, and a day to post goals for the coming week. Ask people to post helpful content, recipes, their exercise plans, questions, struggles and more throughout the week.

2. Find an existing weight loss community, such as those on Sparkpeople, Weight Watchers or MyFitnessPal websites.

Many are free. Just be sure they are promoting healthy lifestyle change, not a particular specialized diet.

3. Most commercial weight loss apps allow you to ‘friend’ other users. Connect with other serious users to increase your social support and motivation. Continue reading

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