Eat A Good Breakfast, But Don't Overdo It

In regards to obesity prevention and weight loss, breakfast is probably the most studied meal of the day.  Some research studies suggest that eating a large breakfast can aid in weight loss and that skipping breakfast can increase our risk for becoming overweight or obese.  In contrast, some studies have suggested that a high-calorie breakfast does not lead to smaller meals later in the day, leading to excess caloric intake.  The inconsistency in these study results appears to be due, at least in part, to differences in how the information is analyzed and how the studies are run.

A new dietary research study (free to download) has attempted to resolve this confusion by conducting a study on daily food consumption using the two main methods of analysis.  The study investigators asked 280 obese individuals and 100  normal weight individuals to complete a very detailed food diary of their normal eating habits over 10 straight days.  The amount of food in calories was determined for breakfast, lunch, dinner, morning snack, afternoon snack, and evening snack.  The relationships between breakfast consumption and total daily food consumption were analyzed based on (1) each day's absolute breakfast calories and (2) breakfast calories as a percent of each day's total food consumption.  The study researchers reported:

• In obese and normal weight study volunteers, an increasingly large breakfast resulted in an increasing amount of total calories consumed throughout the day.
• There appeared to be little or no compensation for consuming a large breakfast.  No matter how large the breakfast was, study volunteers consistently consumed around 550 calories at lunch and dinner.  
• Snacking was not affected by breakfast size with the exception of the morning snack, which was reduced only on the two days of largest breakfast consumption by obese volunteers.
• When the data was examined based on breakfast calories as a ratio of total daily calories, a high ratio of breakfast-to-total calories was linked to a reduction in total daily food consumption only on those days when lunch and dinner sizes were reduced. 

The study investigators went on to state that the absolute breakfast calories appears to be more strongly linked to total daily food consumption than the ratio of breakfast-to-total calories.  This is apparently due to the fact that the ratio of breakfast-to-total calories can be influenced by breakfast size, other meals sizes or a combination.

In essence this study suggests that in situations where individuals follow their regular eating habits, consuming a large breakfast results in excess food consumption throughout the day.  This could lead to an increased risk for becoming overweight or obese.  This is important information of which we should all be aware.  Consuming a healthy breakfast is an important part of a healthy diet and helps prepare us for a full and busy day; however, if we choose to eat an overly large breakfast we might want to consider eating a little less at lunch and dinner in order to stay at an appropriate daily calorie intake.  So, be sure to eat a good breakfast, but don't go overboard!

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Plant Proteins Support A Healthy Body Weight

Previous research has suggested that meat consumption is linked to weight gain, though this remains a topic of fairly intense debate.  While meat is a good source of protein, many meats, particularly red meats, are also a high source of total fat and unsaturated fat.  Additionally, we typically eat way too much meat rather than consuming the recommended 3-ounce serving size.

A recent nutrition research study continues to add fuel to this debate on meat consumption and weight gain.  This new study examined the relationship between protein intake and body mass index and compared animal protein to plant protein intakes in volunteers enrolled in the Belgian National Food Consumption Survey.  Eating habits were determined by 24-hour dietary recalls from over 3,000 men and women.  In this group of volunteers, animal protein consumption was nearly twice as high as plant protein consumption. Meat and meat products made up the majority of the animal protein consumption, while cereals and cereal products made up the majority of plant protein intake.  A look at the relationship between different protein intakes and body mass index revealed:

• As animal protein intake increased, body mass index became greater in men.
• Also in men, eating greater amounts of animal protein resulted in greater waist sizes.
• In men and women, an increasing level of plant protein consumption was linked to both a lower body mass index and a smaller waist size.

This new research study continues to suggest that the consumption of animal protein is linked to an increase in body mass index and waist size, putting individuals at risk for becoming overweight or obese.  In contrast, altering our eating habits to include greater amounts of plant proteins might help support a healthier body weight and reduce our risk of becoming overweight.  Unfortunately, this study's summary does not indicate whether this analysis was done such that it adjusted for caloric content of these foods, as this could impact the final conclusions.  Nonetheless, previous research that did make this adjustment still suggested that red meat consumption was linked to weight gain.  Reducing the amount of animal protein we consume or making healthier choices in the animal proteins we choose to consume can be an important part of our fight against obesity.  Fortunately, the U.S. Department of Agriculture (USDA) recently announced that the 40 most popular meat products will be required to carry a nutrition facts panel.  The nutrition facts panel will include the total calories and grams of total fat and saturated fat the product contains and any product that lists a lean percentage statement (e.g. "80% lean") on its label also must list its fat percentage.  This information will make it easier for all of us to choose meat products that fit into a healthy diet.

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FDA Warns Consumers About Fruta Planta Diet Pills

Another 'miracle' weight loss pill has been found to contain the drug sibutramine, which was marketed as the prescription weight loss pill Meridia before being pulled from the market.

The U.S. Food & Drug Administration (FDA) issued a press release on December 31st warning consumers not to use Fruta Planta weight loss products because FDA testing has revealed that they are contaminated with sibutramine, a drug withdrawn from the market earlier in December for safety reasons.  Sibutramine is known to cause an increase in blood pressure and/or heart rate in some individuals, thereby posing a potentially serious risk for individuals with poor heart health.  The FDA reports that they have received several reports of adverse events associated with Fruta Planta.

According to the Fruta Planta website, Reduce Weight Fruta Planta is an all natural weight loss pill with the active ingredients lemon, bitter melon, papaya, Benefit fruit, and spirulina maxima.  This diet pill is marketed to help individuals lose weight by reducing their appetite and helping them fight daily hunger cravings WITHOUT diet and WITHOUT exercise.  The manufacturers of Reduce Weight Fruta Planta, PRock Marketing LLC, has voluntarily issued a recall of all lots of their weight loss products in response to the FDA's discovery of sibutramine in them.  According to the FDA, consumers should stop using this product immediately, while the recall notice recommends that consumers should discard the product in a sealed container out of the reach of children and animals or return it to the company.

This is not the first dietary supplement weight loss product found to be contaminated with sibutramine.  Back in July 2010, the FDA warned consumers that the weight loss supplements "Slimming Factor Capsule" and "Slim-30 Herb Supplement" were adulterated with sibutramine.  Both of these products were also marketed as 'all natural' weight loss pills that provide great results, apparently without the need for dieting.

Remember, the best weight loss plans still focus on diet and exercise.  While, weight loss pills can have a place in a healthy weight loss plan, it is important to be careful about the diet pills we choose.  If you are starting a weight loss plan, be sure to discuss your plan with your physician and include a discussion of any diet pills you might be considering.

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Food Prices Impact Healthy Eating

There remains a lot of debate over whether various food pricing strategies can help individuals develop better eating habits and reduce their risk of becoming overweight or obese.  While studies have suggested that increasing the price of unhealthy foods can improve diet quality, other studies have reported that consumers prefer that healthy foods get discounted rather than see an increase in the cost of unhealthy foods. 

A recent nutrition research study published online ahead of print in the Journal of Nutrition explored the relationship between food prices, fast food consumption, and diet quality among U.S. children.  Fast food prices and fruit and vegetable prices were examined in relationship to their dietary consumption by over 6,500 young children and over 1,500 teens who took part in the Continuing Survey of Food Intakes by Individuals.  While relationships in teens were inconsistent according to the researchers, observations in young children showed that:

• Higher fast food prices were linked to lower consumption of fast foods, higher intakes of dietary fiber, higher calcium consumption, higher dairy consumption, higher intakes of fruits and vegetables, and an improved overall healthy eating index.
• Lower costs of fruits and vegetables were linked to greater fiber consumption and reduced body mass index.

Overall, this newest study continues to suggest that food prices can impact diet quality and childhood obesity.  This particular study suggests that increasing the cost of fast foods reduces the consumption of these foods and increases dietary quality of U.S. children.  This study also points out that the high cost of healthy foods like fruits and vegetables is linked to a higher body mass index.  Unfortunately, the cost of healthy foods appears to still be increasing.  A recent Australian study reported that while healthy eating still requires about 30% of a family's income, the cost of healthy foods continues to rise.   In fact, from 2000 - 2009 the cost of vegetables rose by about 40% and the cost of fruit rose by 64% in Australia. Another study reports that the cost of nutrient dense foods (more healthy) in Seattle, Washington increased by 29% between 2004 - 2008, while the cost of foods with a low nutrient density (less healthy) only increased by 16% over the same time span with the cost of the most nutritious foods being about 9 times greater than the least nutritious foods. 

These studies make it clear that in general healthier foods cost quite a bit more than less nutritious foods and that various pricing strategies like increasing the cost of less nutritious foods and decreasing the cost of healthy foods can impact dietary quality.  While taking both approaches might have the best overall effect of improving our eating habits and reducing our risk for becoming overweight or obese, any increase in food prices will probably not be well received by any of us.  Finding the best and least costly approach to improving the quality of our diets will take a lot of work and almost certainly won't happen right away.  In the meantime, look for nutrient dense foods that fit your budget and try to minimize the amount of energy dense foods in your diet.

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Make Exercise A Lifetime Habit!

Numerous research studies have shown us the importance of regular exercise for both weight loss and the maintenance of a healthy body weight.  However the vast majority of these studies have typically been relatively short-term, running anywhere from 3 months to 3 years.  From these studies, we typically infer that maintaining a lifelong habit of regular exercise is important for the maintenance of a healthy body weight; however, few studies have actually tested this.

A new research study published a couple of weeks ago in the Journal of the American Medical Association tested the impact of long-term exercise on long-term weight maintenance.  For this study, researchers collected information from more than 3,500 men and women who took part in the Coronary Artery Risk Development in Young Adults and who were 18 - 30 years of age at the start of the study.  Study volunteers were classified as maintaining either a high, moderate, or low level of physical activity based on activity scores at the start of the study.  The study investigators collected information on body weight, waist size, and physical activity at regular intervals during a 20-year follow-up period.  The results of this study showed that:

• Men who maintained a high level of physical activity during the 20-year follow-up period gained nearly 6 fewer pounds on average than men who maintained only a low level of physical activity.
• On average, men maintaining a high level of regular exercise also gained about 1 inch less around their waist than men with a low physical activity level.
• Women with a high level of physical activity over the 20-year period gained about 13 fewer pounds than women who did not exercise at a high level.
• Women who maintained a high level of regular exercise also gained about 1.5 fewer inches compared to women with a low level of physical activity.

While not unexpected, the results of this new study confirm the importance of maintaining a high level of physical activity throughout our lives.  This particular study shows that starting a regular exercise program as a young adult and maintaining it for 20 years helps reduce weight gain, reducing their risk of becoming overweight during their middle-aged years, a time where many of us tend to start gaining unwanted pounds.  However, this does not mean that it is too late to start exercising if you are already in your middle-age years or older.  It is never to late to start exercising and receiving the benefits of that exercise.  So, no matter how old you are, develop a healthy exercise plan, make it something you enjoy so that you can stick to it long-term, and get moving!

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Eat Three Meals Per Day

Many diet plans suggest eating small meals every 2-3 hours throughout the day instead of simply eating the three 'big' meals, breakfast, lunch, and dinner.  Eating like this can mean eating as many as 5-6 total meals per day, though the meals are smaller.  The concept behind this eating pattern is that it will assist in our weight loss efforts by boosting our metabolism, reducing our appetite, and helping to support normal blood sugar health.  Although this approach is well accepted by many, the science behind the theory remains open for debate.  Additionally, the impact of eating frequency on the amount of total calories consumed and appetite control remain unclear.

A review of the science behind this issue was recently published in the Journal of Nutrition.  The review primarily examined published feeding studies that focused on the effect of eating frequency on appetite and food intake with the 3 meals/day eating pattern used for comparison.  The study investigators reported that...

Eating more than 3 meals per day:

• Reduced the highest level of feelings of hunger,
• Suppressed the highest level of feelings of fullness, 
• Reduced peak levels of some appetite-related hormones, but
• Had no effects on feelings of hunger or fullness when measured throughout the course of the day.

Eating less than 3 meals per day:

• Increased subjects perceptions of appetite (felt hungrier) and
• Reduced their feelings of fullness.

Overall, this review suggests that eating more than 3 meals per day has only a minimal impact on hunger and hunger-linked hormones.  This suggests that eating smaller amounts of food more frequently probably has little impact on appetite control and probably does not reduce the overall amount of food one eats.  Nonetheless, the study investigators did report that actual studies on eating frequency and food intake are inconsistent and conflicting to date, so additional research is needed to determine if eating more than 3 meals per day has any real benefit on reducing overall caloric intake.  In contrast, this current review of the science clearly indicates that eating fewer than 3 meals per day has a negative impact on feelings of hunger and fullness, suggesting that over time we might lose control over our appetite if we try to stick to a diet plan that recommends eating fewer than 3 meals per day.   In general, this study appears to suggest that eating 3 meals per day remains the preferred eating pattern in regards to its effect on our appetite and food intake.  If we choose to eat smaller meals more closely together over the course of the day, it is important for us to keep close track of our total food intake.  Following an eating pattern that includes fewer than 3 meals per day appears to be a poor choice and likely should be avoided.

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Plan Your Weight Loss

Most of us that need to lose weight, no matter how much, realize it and have every intention to lose those unwanted pounds.  For many of us those intentions are expressed most loudly at the beginning of each year when we make our New Year's resolutions.  Each and every year, weight loss is listed as one of our most common and popular resolutions.  While our intentions are great, we often fail to follow those intentions with actions.

Researchers at the Teagasc Food Research Centre, the Irish Agriculture & Food Development Authority, have been exploring what we need to do in order to realize our good intentions when it comes to developing healthier eating habits. According to their Winter TResearch newsletter, 80 adults who took part in the National Adult Nutrition Survey were further interviewed regarding their food choice strategies and goals and their successful/failed attempts to make changes.  Based on these interviews, the nutrition researchers identified three factors that effect our ability to turn intentions into actual behaviors.  These factors are:

Planning - making actual, specific plans on how a person was going to begin and follow a healthier eating plan was considered to be extremely important in achieving the goal of eating healthier.

Monitoring - keeping track of one's progress helped individuals become more aware of positive progress, which reinforced motivation and resulted in additional progress.

Coping/Control - It was clear that obstacles get in the way of developing healthier eating habits and can result in failure.  However, deciding how one was going to cope with those obstacles or correct those failures helped individuals realize they were able to maintain their commitment and achieve final success.

Overall, this research showed that individuals who planned ahead had greater success at turning their good intentions into improved behaviors.  Planning ahead not only has to do with planning meals in advance, but also things like shopping for those planned meals and planning in advance how you intend to cope with obstacles.  It is also important to plan how you intend to monitor your progress and make sure you continue the monitoring process.  Good examples of this is keeping a food record, keeping a physical activity log, or monitoring your weight on a specific day each week.  Previous research has also reported that individuals who monitor their dietary habits and track their overall progress have greater weight loss success.  Therefore, it appears clear that forming a plan before diving into a new weight loss plan or healthier eating plan will go a long way towards ensuring long-term success.  While planning your weight loss strategy is of great importance, don't forget to put your plan into action.  Like the cartoonist Walt Kelly once said "It is not good enough for things to be planned - they still have to be done; for the intention to become a reality, energy has to be launched into operation".

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Healthy, Hunger-Free Kids Act Signed!

As I have mentioned in several previous blogs, childhood nutrition is in need of some major improvements.  This is particularly true in regards to the foods provided to children as part of their lunch, vending machine, and a la carte options offered at schools and daycare facilities.  On Monday, the Healthy, Hunger-Free Kids Act of 2010 was officially approved and signed.  Hopefully, this will be a major step in the right direction towards improving childhood nutrition and decreasing childhood obesity.

The Healthy, Hunger-Free Kids Act sets forth a number of goals and guidelines, some of which include:

• Giving the U.S. Dept. of Agriculture (USDA) the authority to set nutritional standards for all foods sold in schools during the day.  This includes school meals, vending machine options, and a la carte options.
• Aids in the establishment of local 'farm-to-school' networks and school gardens in an attempt to focus on fresh, locally grown foods.
• Sets basic standards for school wellness programs that include nutrition education and physical activity.
• Requires school districts to be reviewed every three years to see if they have met new nutritional standards.
• Requires schools to make nutritional information on school meals more available to parents.
• Provides additional funding to schools that meet the updated nutritional standards.

While updated nutritional standards do not appear to have been developed or released yet, a sample menu suggests that healthier options like more fruits and vegetables, more whole grain foods (whole wheat spaghetti, whole wheat dinner rolls, etc.), more low-fat replacements (low-fat salad dressing rather than regular salad dressings), and leaner protein products (turkey, fish, etc) will be emphasized. Although changes will not appear overnight, this new piece of legislation has the potential to make real improvements in childhood nutrition and wellness that will hopefully lead to reductions in childhood obesity.  You can download a fact sheet that provides more information as well as a sample menu at Let's Move.

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Avoid Distractions During Meals

There are many things we can do to improve our eating habits that can help us improve the nutritional quality of our meals while reducing the amount we eat to a healthier level.  Making fruits and vegetables a much bigger part of our meals, choosing foods that keep us feeling fuller longer, and eating at a slower pace are all things each of us can do that will help us develop better eating habits.

According to a new study published online ahead of print in the American Journal of Clinical Nutrition, removing distractions during our meal times might also improve our eating habits.  While previous studies have shown that mealtime distractions can lead to greater amounts of food consumed during one's meal, this new study examined the impact of mealtime distraction on later appetite and food memory.  For this eating study, investigators instructed 44 volunteers to consume a fixed lunch within a specified amount of time while playing computer solitaire or without any distraction.  30 minutes after the meal, study subjects took part in taste test.  Interestingly, the study investigators reported:

• Distracted volunteers, those playing solitaire, reported being less full after lunch compared to non-distracted volunteers.
• Volunteers that played computer solitaire during their lunch ate nearly 2 times as much during the post-meal taste test.
• Recall of the 9 food items provided during lunch was less accurate in the game-playing group compared to the non-distracted study volunteers.

Although small, this is an interesting study that further supports the concept that mealtime distractions can affect our food consumption.  While previous studies indicated that mealtime distractions cause us to eat larger meals, this current study suggests distractions during meals can results in greater post-meal appetite and greater post-meal snacking.  This has the potential to result in overall greater food consumption throughout the day.  Considering our tendencies for eating on the run, watching television while eating, or sitting in front of a computer while eating, the effect of mealtime distractions on eating habits is important to keep in mind.  Minimizing mealtime distractions is one easy step we can all take towards developing better eating habits and fighting obesity.

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New Diet Pill Gets Lukewarm Backing

On Wednesday, it was reported in numerous media outlets that an FDA advisory panel recommended the new weight loss pill, Contrave, for approval.  According to the FDA Advisory Committee briefing document, Contrave is a combination weight loss drug that includes both bupropion, a drug used to treat depression and reduce nicotine cravings, and naltrexone, a drug used to treat some addictive behaviors.  The lukewarm backing of the FDA Advisory Committee was clearly represented by the 13-7 vote to back Contrave’s approval.  This unenthusiastic appearing recommendation seems to partly be based upon Contrave’s modest weight loss benefits.

In the two primary weight loss studies described in the briefing documents and one published research article, obese men and women were asked to follow a reduced-calorie diet (reduced by 500 Calories/day), were given advice on lifestyle changes that included physical activity, and were asked to take Contrave or a placebo pill daily for slightly more than one year (56 weeks).  Individuals taking Contrave were divided into two groups, one group taking a low dose (16 mg naltrexone + 360 mg bupropion) and one group taking a higher dose (32 mg naltrexone + 360 mg bupropion). In these studies, individuals lost approximately 6% of their initial body weight after 56 weeks when taking the 32 mg version of Contrave and about 5% of their initial body weight after taking the 16 mg version of Contrave for 56 weeks.  According to the published research article, this amounted to a weight loss of about 11 pounds in the lose-dose group and 13 pounds in the high-dose group after 56 weeks in study volunteers who weighed about 220 pounds on average at the start of the study.  Additionally, only about half (48% in one study and 50% in the second study) successfully lost more than 5% of their starting body weight.  According to some of the news stories, some members of the FDA Advisory Committee apparently supported approval for Contrave, despite the modest weight loss benefits, due to concerns about suppressing the development of future weight loss pills during a time when about two-thirds of Americans are overweight or obese.

Unlike weight loss pills that appear to provide only modest weight loss benefits, a well-structured weight loss plan that is easy to follow and includes adequate amounts of regular exercise can help nearly anyone lose the weight they want.  During a 16-week study, dieters lost about two times more weight on my diet eating and physical activity plan when compared to the dieters in the two main Contrave studies. Dieters in my diet study consumed approximately 1,200 calories per day, and participated in physical activity six days per week, while dieters in the weight loss pill study were instructed to consume a 500-calorie per day deficit diet. Dieters lost an average of 26 to 29 pounds on my plan compared to only about 11 pounds on the diet pill plan after 16 weeks. Average starting weight of study participants on my diet plan was 210 pounds, which was similar to the average starting weight of about 220 pounds in the Contrave weight loss pill studies.

Overall, it appears that dieters lost about 200% more weight on my diet and physical activity plan when compared to dieters using the Contrave weight loss diet pill. Therefore, you can lose more weight in less time on my diet plan...without diet pills.

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Is There An "Ideal" Body Mass Index?

Despite its limitations, the Body Mass Index (BMI) is still one of the easiest and must utilized tools for determing an individual's healthy body weight range.  Currently, a BMI ranging from 18.5 - 24.9 is considered normal or healthy.  A person with a BMI below 18.5 is considered to be underweight while a BMI of 25 - 29.9 is considered overweight and a BMI of 30 or more is defined as obese.  Numerous research studies have clearly shown us that a high BMI, particularly an obese BMI, is linked to poor health and increased risk of death from certain conditions.  However, the full relationship between BMI and overall mortality have remained unclear.

A group of investigators from around the world, including the National Institutes of Health, recently published the results of their examination of the link between BMI and death due to any cause.  In order to analyze this relationship, the researchers pooled data from 19 studies that included a total of 1.46 million adults.  During an average follow-up period of 10 years (ranging from 5 to 28 years), slightly more than 160,000 deaths were recorded.  After adjusting for multiple factors (age, exercise, alcohol consumption, etc.) and using a reference BMI of 22.5 - 24.9, the researchers revealed that among healthy, non-smoking women there were specific relationships between BMI and risk of overall death as outlined below:

• BMI of 15 - 18.4...  risk of death increased by 47%
• BMI of 18.5 - 19.9... risk of death increased by 14%
• BMI of 20 - 22.4... no increased risk of death was observed
• BMI of 25 - 29.9... risk of death increased by 13%
• BMI of 30 - 34.9... risk of death increased by 44%
• BMI of 35 - 39.9... risk of death increased by 88%
• BMI of 40 - 49.9... risk of death increased by 251%

The study investigators further reported that these relationships were also similar for the men in the study.  According to a related NIH press release, this study also showed that for all participants, every 5-unit increase in BMI was linked to a 31% increased risk of death due to any cause and that while a BMI of 25 or more was linked to an increase risk of death in all age groups, the risk was greatest for those who were overweight or obese before 50 years of age.

This is a truly fascinating and important study.  While it was probably not unexpected to see an increased risk of death for BMI levels over 30, the dramatic increase observed is astonishing.  The relatively high risk of death linked to being underweight is also an important observation.  Due to a variety of pressures (media, peers, etc.), many individuals strive for a body weight that is an unhealthy, excessively low body weight.  Hopefully, this observation will help these individuals realize the importance of staying within a healthy body weight range.

Interestingly, the risk of death is actually increased within the low part of what is currently considered a healthy BMI.  According to this study, individuals with a BMI between 18.5 - 19.9, while within the normal BMI range, are at a 14% increased risk of dying due to any cause.  While this level of risk is not on par with the risk observed with being obese, it clearly suggests that even within a normal BMI range, there appears to be an 'ideal' BMI range.  Based on these analyses, the risk of death is lowest for those with a BMI ranging from 20 - 24.9, which encompasses the mid- to high-range of the normal BMI range.  This is potentially important information for individuals looking to set weight loss goals or optimize their overall health.

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Lose Weight Successfully With High Protein, Low Glycemic Foods

Diets come and go through the years, each of them generally suggesting a specific amount of macronutrients.  These include low carb diets, low fat diets, high protein diets, and more.  While each of these diets have been reported to support weight loss in the short term, most of us find it difficult to maintain our weight loss for longer than 1 year.  Therefore, the overall success of many of these diets, particularly in comparison to each other, is often debated.

The Diogenes Study, a large, multicentered, pan-European weight loss study, has attempted to determine which type of diet is best in regards to successfully maintaining weight loss.  For this study, 773 adult men and women who successfully completed an 8-week weight loss phase were randomly assigned to one of five weight maintenance diets:

1. Low protein (13%) + low glycemic index
2. Low protein + high glycemic index
3. High protein (25%) + low glycemic index
4. High protein + high glycemic index
5. Control diet that followed each country's dietary guidelines

Each diet was moderate in fat content (25-30%) and study volunteers were directed to eat as much as they wanted while aiming to maintain their current body weight during the 26-week weight maintenance phase.  The results of this weight loss study, which were recently published online ahead of print in the New England Journal of Medicine, showed that:

• The high protein, low glycemic index diet was easier to stick to than the low protein, high glycemic index diet.
• Consumption of the low protein, high glycemic index diet resulted in a significant increase in body weight by about 3 - 4 pounds on average.  Weight re-gain was not observed on average in the other diet groups.
• Diet groups high in protein, regardless of glycemic index status, re-gained 2 lbs less than diet groups low in protein.
• Use of low glycemic index diet plans, regardless of protein level, resulted in about 2 lbs less weight re-gain than diets with a high glycemic index.
• The high protein groups and the low glycemic index groups were more likely to continue losing weight compared to the low protein and high glycemic index groups.  This was particularly true for the high protein, low glycemic index group.

This is an excellent study that shows us what might be the most effective way at maintaining weight loss for the long-term.  In this new weight maintenance study, a small increase in dietary protein intake and a small reduction in the glycemic index of foods consumed were of substantial help in either continuing modest weight loss or maintaining the weight volunteers lost in the weight loss phase of the study.  This study was also conducted in the children of the adult volunteers.  The childhood arm of the study reported similar benefits with the high protein, low glycemic index group showing a substantial decrease in the percent of overweight/obese children.  In contrast, children consuming the low protein, high glycemic index diet showed an increase in body fat.

The benefits of increasing dietary protein and decreasing the glycemic index are likely due to their effects on appetite and blood sugar metabolism.  Protein has been reported to increase our feelings of fullness and help maintain that feeling longer.  Foods with a low glycemic index have been shown to have little impact on blood sugar, helping us to avoid cravings and spikes in hunger.  These aspects of protein and low glycemic foods might be why individuals found it easier to stay on the high protein, low glycemic index diet plan compared to the other diet plans.

My Slim & Beautiful Diet bars and shakes are high in protein (20 grams each) and have a low glycemic index, making them an excellent and delicious addition to any high protein, low glycemic weight loss program you might choose to follow.

Start losing pounds now with my easy diet plan using delicious, low glycemic, protein-packed bars and shakes to satisfy your hunger. Please recommend to anyone who wants to lose weight using a clinically tested diet plan and weight loss program.

Choose Foods That Are Eaten Slowly

Enhancing satiety, or our feeling of fullness, is a major target many weight loss strategies.  One aspect of this concept is that eating foods that make us feel full after consuming only relatively small amounts will cause us to eat less throughout the day.  Another approach is to eat more slowly, which has been reported to allow our brains to send fullness signals to our stomach and result in us consuming less calories.  One study has even reported that the earlier feelings of fullness associated with eating slowly are due to the release of aromas from the food during chewing.

Because some foods can be eaten more rapidly than other foods, a new nutrition study has examined the possible link between the eating rates of foods (how fast a food item can be eaten) and the amount of food we eat and the impact on the nutritional quality of our diets.  For this study, nutrition researchers asked 37 study volunteers to consume 50 grams of 7 different foods.  A total of 45 different foods were tested.  The researchers measured how long it took to consume each food item, subsequent food intake, and nutritional quality of the overall diets.  The results of this study showed:

• The length of time it took to consume the food items ranged from 4.2 grams per minute (slow) to 631 grams per minute (fast).
• Consumption of foods that could be rapidly eaten was linked to an increase in overall food consumption and calorie intake.
• Intake of carbohydrates, protein, and fiber were reduced by consumption of rapidly eaten foods.
• Fat consumption was not reduced by consumption of rapidly eaten foods.

This is a unique and interesting study that shows a link between how quickly a food can be eaten and diet quality.  Overall, this study suggests that consuming rapidly eaten foods can lead to an unrealized over-consumption of food, which can lead to an increased risk for becoming overweight or obese.  Additionally, choosing foods that can be eaten quickly puts us at risk of consuming a nutritionally-poor diet.  The results of this study emphasize the importance of our food choices and eating habits.  Choosing foods that naturally lend themselves to being consumed slowly and then consciously forcing ourselves to consume our food at a more leisurely pace can be important and easy steps to developing healthier eating habits.  

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Honest Body Size Perceptions Are Important

One of the largest obstacles to losing weight that many of us have is developing a realistic perception of our true body size.  In a previous blog, I discussed a Harris Interactive poll of 2,400 survey respondents that reported 30% of overweight individuals believe they are within a normal body size and that 70% of obese individuals believe they are simply overweight.  This study clearly shows that as a population we need to develop a truer perception of our body size.

A new, larger obesity research study examined our perceptions of body size, what we choose to do about it, and the potential role of health care professionals in improving our perceptions. For this study, obesity researchers analyzed data from nearly 17,000 adults who took part in the National Health and Nutrition Examination Survey from 2003 - 2008.  The study investigators reported that:

• 73% of women and 55% of men reported a desire to lose weight; however, only 57% of women and 40% of mean actually reported trying to control their weight. 
• 48% of overweight men and 23% of overweight women perceived themselves as being at their correct body weight.
• The vast majority of overweight individuals (74%) and nearly one-third (29%) of obese individuals have never been diagnosed as overweight or obese by their health care provider.
• Most overweight or obese survey respondents (74% of women and 60% of men) reported trying at least one weight loss strategy.
• Only about one-third of overweight or obese individuals reported using both diet AND exercise to lose weight.
• Obese or overweight individuals diagnosed as such by their health care provider were more likely to diet, exercise, or do both compared to individuals not diagnosed as overweight by their health care provider.

This study is a fascinating look into our perceptions of body size, what we chose to do about it, and the important role health care providers can play.  It is clear from this large population-based study that nearly two-thirds of us profess a desire to lose weight; unfortunately, only about a third of us actually take steps to lose the weight we desire to lose.  Part of this is apparently because many overweight individuals, men in particular, perceive themselves to be at a normal, healthy body weight.  Developing a more realistic and accurate perception of our body size is clearly an important step towards losing weight.  Developing a more realistic perception of our true body size can be aided by our health care providers.  Considering that the data from this study suggests that a proper body weight diagnosis by a health care professional can motivate many of us to lose weight, it is very disturbing to read that nearly 75% of overweight individuals are never diagnosed as such by their health care providers.  This clearly shows that health care providers can play an important part in our weight loss efforts.  The results of this study indicate the importance of an honest, straight-forward discussion of body size and weight control strategies with our health care providers as a first step to obtaining and maintaining a healthy body weight throughout life.

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Be Careful When Interpreting Size 'Labels'!

Because many of us find it difficult to estimate correct portion sizes and many food providers throughout the world use slightly different portion sizes, we have found it easy to rely on size labels like 'small', 'medium', 'large', or 'extra large' when purchasing and consuming food.  Unfortunately, recent research from the University of Michigan indicates that we as consumers easily misinterpret these size labels.

In a series of 5 studies, nutrition researchers tested consumer's ability to differentiate sizes based on how they were labeled and to determine if the size labeling had an impact on consumption habits.  Some of the observations recorded by these researchers included:

• Labeling a large size as 'small' or 'medium' caused study subjects to perceive them as 'small' or 'medium' rather then recognizing the true size.
• Subjects consumed more food when they perceived large portion sizes to be small or medium based on the size label used.
• Subjects found it difficult to believe that an item labeled 'medium' or 'large' was in fact the size labeled if the item appeared visually small.
• Switching 'small' and 'large' labels caused some subjects to perceive a small item as larger than a large item.
• Individuals less likely to be deceived by the size labels placed on the food were those who were very nutrition conscious.

Overall, the researchers noted that consumers typically underestimate how much they eat and the underestimation becomes larger when the meal size increases.  This can clearly lead to over consumption of food on a daily basis.  Unfortunately, this happens without us realizing it.  Since we generally believe the size label, we tend to believe that we have not consumed too much and feel less guilty about what we are eating.

This is interesting information in the wake of the fast food marketing report, which indicated that some fast food restaurants are simply re-naming their portion sizes to give a smaller appearance rather than actually serving smaller sizes.  For those of us that noticed 'smaller' portion sizes at our favorite fast food restaurant, we might not actually be eating less like we thought because of our tendency to believe the size label.  Becoming more nutritionally aware, particularly about portion sizes, is an important step in our ability to choose foods wisely and fight obesity.

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High Cortisol Levels Increase Calorie Intake

Cortisol is an important hormone produced by our adrenal glands.  Under normal circumstances, cortisol plays an important role in blood sugar health, maintenance of healthy immune function, and much more. However, stress can cause a chronic elevation of cortisol, which then can have a variety of negative health effects.  Chronic stress has also been implicated in the risk for obesity. 

A recent nutrition study explored the relationship between cortisol levels and dietary habits in overweight and normal weight women.  In this study, 127 overweight women and 21 normal weight women had their cortisol excretion rate measured over a 24-hour period.  The relationship between the cortisol levels and information collected on dietary intakes were then analyzed.  The researchers reported that:

• Obese women excreted substantially higher levels of cortisol than women maintaining a normal body weight.
• Regardless of the volunteers' body mass index, higher levels of cortisol were linked to larger waist sizes. 
• Higher consumption of carbohydrates, fats, and overall calories was linked to higher cortisol levels in obese women.

These research results continue to suggest a possible link between chronic stress and obesity.  Because the study summary did not discuss stress, it is unclear whether stress might have been involved in the poor dietary choices of the overweight women.  Since long-term elevations in cortisol can be a sign of stress, it is possible stress might be one of the factors related to the study observations.  Nonetheless, this study indicates that elevated cortisol levels, whether from stress or some other reason, might have a major impact on our dietary habits such that we tend to eat more foods high in calories, high in fats, and high in carbs.  These foods, particularly those high in fats and calories, can have a major negative impact on our efforts to maintain a healthy body weight.  Keeping cortisol levels within a normal range, perhaps be reducing stress, might be one way to help maintain a healthy body weight. 

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Fitness Is Declining In College Students

Most of the time when we think about diet, lifestyle, exercise, and obesity, we think about body weight and weight loss.  While these factors are an important component of being physically fit, we often don't give as much thought to how physically fit we are as a population.

A new obesity and wellness research study (free to download) was conducted to determine if the physical fitness of college students changed over time and, if so, how those changes effected measures of obesity like body mass index (BMI) and body fat.  Nutrition researchers analyzed the results of MicroFit tests from over 5,000 students attending a private Seventh-Day Adventist college where each student enrolled in a physical activity class was required to take the MicroFit test.  Information collected on body weight, body fat, muscle strength, aerobic fitness and more from 1996 to 2008 was analyzed.  Fitness was measured by estimating VO2max, which is a measure of the maximum oxygen uptake during a graded exercise and is considered to be one of the most accurate measures of physical fitness.

The results of this data analysis showed that:

• While there was some yearly fluctuation, physical fitness, as measured by VO2max, declined overall during the 13 years examined.
• Physical fitness declined at a faster rate for male college students (0.812 mL/kg/min) than female college students (0.414 mL/kg/min).
• During the 13 year study period, percent body fat increased in both males (0.513% per year) and females (0.654% per year).
• The proportion of male college students classified as having poor physical fitness increased dramatically, while the number of male students classified as excellent, fit, or fair declined steadily.  Similar, but less dramatic, changes were observed in college females.

Overall, this study showed that both male and female college students are apparently becoming less physically fit and gaining more body fat over time.  One of the most interesting aspects of this study is the study population.  Seventh-Day Adventists are a religious group that stresses a very healthy lifestyle that includes eating a healthy vegetarian diet and getting plenty of exercise.  It has been reported that their lifestyle choices have resulted in a lifespan that is typically about 10 years longer than the average American.  This is reflected in this new study by the fact that the average body mass index of the students was about 24, which falls within the accepted healthy range, while average body fat was only about 12% in male college students and 22% in female college students.

While it is not completely unexpected to see a decrease in physical fitness during the college years due to the college lifestyle of little sleep, skipping meals, too much snacking and too much fast foods, one has to wonder how rapidly physical fitness is declining in the general population where healthy diet and lifestyle habits are not as frequently stressed.  Finding ways to increase physical activity, improve eating habits, and improve overall physical fitness during the college years should be an important part of our fight to reduce obesity.

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Body Volume Index To Replace BMI?

BVI (or Body Volume Index) was recently launched as a new measurement of body size/shape designed to eventually replace BMI (Body Mass Index) as a way to assess obesity and heart health risk factors. 

For decades BMI has been the industry standard for determining if a person is at a healthy body weight.  BMI categorizes each of us as underweight, normal weight, overweight, obese, or morbidly obese based on whether our weight is appropriate for their height.  While this has been a healthcare standard, BMI has many detractors due to its limitations.  Although BMI provides an easy-to-use tool, it is unable to account for weight distribution and body composition.  This can lead to many people, especially athletes being categorized as overweight or obese due to their level of muscle mass.  Other measures of obesity have been proposed such as waist-to-hip ratio, which many healthcare professionals believed offered a more accurate assessment of body composition than BMI.  However, it appears that BVI has come to the forefront of new body size assessment tools.

BVI is measured using a 7-foot white light scanner into which a person walks to be measured.  A person's body image is scanned using a 3-D camera system with data from the scan being generated and saved into a computer system, which can calculate body volume as well as hundreds of other measurements including BMI, waist size, and waist-to-hip ratio.  According to the BVI website, the scan takes approximately 6 seconds and does not use radiation or lasers.

For validation of the BVI system, a major research collaboration, the Body Benchmark Study, was conducted at several research centers in the UK, Europe and the U.S. with the U.S. tests being conducted at the Mayo Clinic.  Results of these clinical trials indicated that:

• BVI can accurately measure abdominal volume as a proportion of the whole body, giving an accurate assessment of central obesity, a major risk factor for a number of chronic health conditions.
• BVI is able to detect differences in body shape and weight distribution in individuals with the same body mass index.
• BVI measurements were shown to strongly correlate to heart health markers, suggesting that BVI might prove to be an accurate way to determine a person's risk for poor heart health.
• BVI is an accurate and reliable tool to measure a person's obesity-related body characteristics such as waist size and hip size.

Based on these research studies, the BVI can be used to objectively track a person's body changes over time, reduces time and error inherent in manual measurements, and by using person-specific medical data can generate a health risk indicator.

This is a fascinating and important new development in obesity-related healthcare.  This new system, should it become accepted by the medical community, has the possibility to provide new, more accurate ways to assess body shape, size, and obesity and associated health risks.  This allows a very personalized approach to healthcare and intervention strategies to reduce one's risk for numerous chronic health conditions.  While BVI appears to have many benefits, it is system that has to be used in a physician's office and it is unclear how quickly it will appear in hospitals and private practices.  In the meantime, simple measurements we can all do, like BMI (18.5 - 24.9 is a healthy BMI range) and waist-to-hip ratio (0.8 or below for women and 0.95 or below for men), can help us aim for healthy body weight goals.

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Plant Compounds Suppress Inflammation Markers

Obesity has been linked to a low level of chronic inflammation due to the production inflammation-related chemicals by fat cells.  Research has suggested that many of the chronic human health conditions linked to obesity are due to this low-grade chronic inflammation.  Therefore, the concept that reducing the chronic inflammation associated with obesity might help support normal health is receiving a good deal of attention from the scientific and medical communities.  Two recent research studies explored the possibility that natural plant compounds with anti-oxidant and anti-inflammatory properties might help suppress obesity-related chronic inflammation.

In the first obesity research study, investigators examined the effect of resveratrol on the production of inflammation-related chemicals from fat tissue.  Resveratrol is one of the main anti-oxidant and anti-inflammatory polyphenol compounds found in red grapes.  For this study, obesity researchers treated human fat tissue in order to produce an inflammatory response and then treated the fat tissue with resveratrol to determine if it could suppress this artificially induced inflammation.  The study investigators reported that treating human fat tissue with resveratrol suppressed both the induced secretion of several inflammatory chemicals and the gene expression of these inflammatory chemicals.

A second obesity research study examined the impact of lycopene on the production of inflammation-related chemicals from fat tissue.  Lycopene is the chemical responsible for the red/orange color of many fruits and vegetables, including tomatoes.  To evaluate this possible relationship, investigators cultured fat tissue collected from mice fed a high-fat diet as well as human fat cells.  The obesity researchers reported that treatment of fat cells, both mice and human, with lycopene suppressed both the normal production of chemicals involved with inflammation and the artificially stimulated production of these inflammation chemicals. 

Both of these cell culture studies suggest that natural plant chemicals with anti-oxidant and anti-inflammatory properties might be able to suppress the chronic inflammation associated with obesity.  With the high rate of obesity and the link between obesity, inflammation, and human health, methods to reduce obesity-related inflammation could be very beneficial.  Additional studies will be needed to determine if natural plant chemicals like resveratrol and lycopene can have the same anti-inflammatory benefits when consumed and how much is needed in the diet to obtain these possible benefits.  Fortunately, many of these natural chemicals are found in fruits and vegetables, giving us additional reasons to eat plenty of fruits and vegetables.  In addition to being sources of some of these anti-inflammatory chemicals, fruits and vegetables are nutrient rich and low in calories, making them and essential part of a healthy, well balanced diet.

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De-Stress To Fight Body Fat

Stress... we are all subject to it.  We live in a fast-paced world that includes many daily stressors such as traffic snarls, discord in families, financial problems, illness, employment worries and more.  Unfortunately, stress can potentially lead to all kinds of health-related issues.  Stress has also been implicated in weight gain.  While we each handle our daily stress in our own particular way, some individuals find comfort in food, particularly high-fat foods.  Research suggests that chronic stress can alter metabolism and appetite hormones, which can lead to altered eating behaviors.

A new obesity research study explored this phenomenon further.  For this study, adult female rats were fed either a regular chow diet or a high-fat diet and exposed to either their stress-free home environment or exposed to chronic variable stress for 4 weeks.  The results of this study showed that:

• Animals fed a high-fat diet, regardless of their environment, gained weight, total body fat, and abdominal body fat.
• Body weight gain in stressed rats eating either the chow or high-fat diet was similar to unstressed rats fed the chow diet.
• Rats exposed to chronic stress and fed a high-fat diet became more fat, despite not having a different body weight compared to control rats.

These are interesting study results due to discrete differences in how the animals responded to high-fat diets and chronic stress.  First, a high-fat diet on its own, as one might expect, led to a gain in body weight and a gain in body fat.  In comparison, stressed rats fed a high-fat diet did not gain any more body weight than control rats, but became fatter.  The authors of this study suggest that chronic stress appears to increase the number of calories burned, keeping body weight gain similar to the control rats.  Despite this, stressed animals had altered levels of some hormones and a preferential increase in body fat.  Therefore, while stress might not always cause us to gain weight, it might cause us to gain body fat.

Minimizing the amount of daily stress to which we are exposed might be one way we can reduce our risk for overeating and obesity.  While there are probably hundreds of ways to combat stress, I've outlined a few ideas below:

• Focus on the positive - focusing on the negative can lead to constant worrying and additional stress.
• Exercise – exercise helps you get your mind off whatever is stressing you, making it a great stress reliever.
• Find ways to relax – enjoy nature in a quiet spot, work on a hobby you like, talk and laugh with trusted family members and friends, listen to your favorite music, or read a good book.
• Add a few “I want to’s” into your daily or weekly routine.  It’s ok to treat yourself every once in a while.
• Learn to say “no” - saying “yes” to all requests might make you feel that others are taking advantage of you, causing undue stress.
• Laugh out loud - laughter can relieve stress and lighten one's mood.
• Take a day or a half day and do something for yourself.
• Take a nap - naps may help reduce stress and increase alertness and productivity

Stress can come from many sources and can sneak up on us before we realize it.  So, be proactive and incorporate some stress-relieving activities into your daily routine. 

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