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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Weight Loss Misconceptions Still Persist

McNeil Nutritionals, LLC, a marketer of nutritional products, recently revealed some of the results of a recent survey they conducted regarding what American women believe about weight loss and healthy eating.  While the full survey does not appear to be available, a press release discusses some of the results.  Some of the results of this survey are outlined below.

Body Image Perceptions:

• More than 33% of American women think about their body weight at least 3 times each day.
• 81% of the women surveyed do not believe that they are at their ideal body weight.
• Nearly half feel that they will reach their ideal body weight this year.
• However, many American women believe that drastic, overly-strict lifestyle changes are needed to reach and maintain their ideal body weight.

 Dieting:

• 91% of the American women surveyed did not realize that they had to burn 3,500 calories to lose 1 pound of body weight.
• 35% of women surveyed believed that they would need to cut something like sweets or snacks out of their diet completely.
• 39% were under the impression that they would need to reduce their food consumption to below 1,000 calories per day.
• Difficulty in losing weight was frequently attributed to family obligations, finances, stress, and other demands on time.

Healthy Eating:

• Only 17% of the women surveyed ranked the nutritional value of foods as the most important factor when making a purchase decision.
• Price, taste, and quality of foods purchased were more important than the foods' nutritional value in most cases.
• 70% of women added sugars to their foods and beverages.

Among these results were some interesting observations.  If these results are representative of the population in general, it would suggest that the vast majority of us do not give the nutritional value of our foods enough consideration.  Additionally, we appear to hold the opinion that weight loss through dieting has to be a grueling, unpleasant endeavor that might require a severe restriction in the amounts and types of foods we eat.  Overall, it appears that the health professional community still needs to work on getting the appropriate messages out about healthy ways to lose weight.  For example, while restricting the amount of calories we consume is an important part of losing weight, the amount shouldn't be so much that it drops you below 1,000 daily calories.  Also, losing weight does not have entail dramatic lifestyle changes.  In fact, making a number of small changes in our eating habits can go a long way towards reaching one's weight loss goals.  A good example from the results of this survey would be to simply decrease the amount of sugars one adds to their foods and drinks or start reading nutrition labels.  Both these simple changes could improve a person's eating habits dramatically.  Reading blogs like this one and others is a great way to become more informed about healthy weight loss and good nutrition.

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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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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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Childhood Obesity Linked to Adult Health

As we have discussed in several previous blogs, childhood obesity is a major concern both in the U.S. and worldwide.  According to the most recent data, over 30% of U.S. children 2-19 years of age are overweight, while 17% of U.S. children are obese.  Research has clearly shown that childhood obesity has a number of negative health effects on children; however, the impact of childhood obesity on later adult health has been a subject of some debate.

A new systematic review paper published online in the International Journal of Obesity summarized the long-term impact of childhood obesity on adult health and mortality.  The study authors searched the scientific literature published between 2002 and 2010.  Analysis of these papers revealed:

• 4 of the 5 studies that examined lifespan found that childhood overweight or obesity was linked to a substantially higher risk of early death in adulthood.
• All of the studies that reported on heart health showed that childhood overweight and obesity was linked to poorer heart health in adulthood.
• Nine studies reported that childhood obesity was linked to a variety of chronic health conditions and disability in adulthood.

Around the same time that this first paper was published, a second review paper on the same topic was also published.  Unlike the first paper, this second review paper is free to download.  The authors of this second review do a wonderful job of both describing the immediate health impact of childhood obesity and detailing the effect of childhood obesity on future adult health and lifespan.  This review paper clearly shows that many research efforts to date have reported that childhood obesity can have a major impact on adult health.  The study authors even indicated that if some of the science on childhood obesity is correct, then there is likely to be a dramatic increase in healthcare costs and possibly a decline in life expectancy in the U.S.

Together, these two review papers paint a rather bleak picture of our future health as a nation.  While most of understand the huge negative health impact obesity can have on our children, many of us probably do not realize the impact childhood obesity will have on a child's future health and quality of life as an adult.  Many of us like to believe that while a child might be overweight, he or she will grow into their weight as they become older.  Research suggests that this is probably not the case.  These two studies clearly point out the need for focusing on maintaining a healthy body weight throughout life, starting at early childhood.

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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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Calcium and Vitamin D in Childhood Obesity

In a previous blog, we discussed the beneficial impact of higher calcium intakes and higher vitamin D blood levels on successful weight loss in adults.  New research studies also suggest that vitamin D and calcium might reduce the risk of obesity for some children.

In one childhood obesity research study, investigators examined the relationship between calcium intake and body composition in African-American children (free to download).  In this study, 186 African-American children at risk for being overweight were asked with the help of their elders to record food intake for 3 days.  Body composition and body weight measures were taken and analyzed in respect to nutrient intake.  The investigators reported:

• Less than half of the children met the dietary recommended intake of any of the vitamins and minerals measured with only about 1% meeting calcium recommendations and about 4% meeting vitamin D recommendations.
• When the study volunteers were examined as a whole group, no links were evident between calcium intake and body composition or body mass index.
• However, when looking at differences between boys and girls, it was clear that girls who consumed less than 314 milligrams of calcium per day had a higher percent of fat mass than girls who consumed more than 634 milligrams of calcium per day.

In the second childhood obesity research study, investigators assessed the link between vitamin D blood levels and changes in body mass index and waist size in more than 450 5-12 year old children.  For this study, blood levels of vitamin D were measured at baseline and classified as deficient (less than 50 nmol/L), insufficient (more than 50 nmol/L, but less than 75 nmol/L) or sufficient (more than 75 nmol/L).  Body changes were assessed yearly for approximately 3 years.  In this study, children deficient in vitamin D were shown to have greater increases in body mass index, skin-fold thickness, and waist size over the 3-year follow-up period than children with sufficient blood levels of vitamin D.  Additionally, a lack of vitamin D was linked to slower growth rates in girls.

These two studies both show that deficiencies in calcium and vitamin D might be linked to some children having an increased risk for becoming overweight or obese.  The reason for the difference between African-American boys and girls in regards to calcium's impact on body fat is uncertain; however, the study researchers point out that their analysis was negatively effected by the very low percent of children consuming adequate levels of calcium (1%).  In truth, the insufficient intake of most vitamins and minerals in this group of children is one of the most disturbing results of this first study.  In this study, less than 10% of the children consumed adequate amounts of calcium, magnesium, phosphorus, potassium, folate, vitamin D, vitamin A, and vitamin K based on food intake records!  Ensuring that children get adequate nutrition is an important step to both maintaining overall health as well as possibly reducing their risk for both childhood and adult obesity.

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Individual Costs of Being Overweight

We have all heard that being overweight or obese puts a heavy burden on the health care industry resulting in substantial increases in medical costs for heavier individuals.  However, medical costs are only part of the additional costs paid by overweight or obese individuals.  Until recently, it was unclear how much being obese costs on an annual basis for individuals.

A new report from the George Washington University School of Public Health and Health Services Department of Healthy Policy outlines some of the individual costs linked to being overweight and obese.  While the full report is free to download and read, some of the most important revelations are briefly discussed below.

Direct Medical Costs.  Being obese costs an individual person $1,474 dollars a year in direct medical costs.  This includes $433/year inpatient costs, $458/year non-inpatient costs, and $586/year in prescription drug costs.  One study reported that costs increase with higher body weights; a moderately obese person (BMI 30 to 34.9) pays about $800 more per year than a normal weight person, while a morbidly obese person (BMI >40) pays about $2,800 more per year than a normal weight person.

Income.  Results of the analysis conducted for this new report indicated that obese female full time employees make $1,855 less per year compared to normal weight women.  Annual lost wages was only $75 for obese men compared to normal weight men.

Productivity.  According to this report, studies have shown that on average obesity causes a reduction in productivity at work.  The loss of productivity linked to obesity equaled $358 per obese employee.

Short-term Disability.  Several studies have indicated that obese workers are more likely to suffer a short-term disability than normal weight workers.  These studies suggest that an overweight employee is at a 26% increased risk for a short-disability event and that an obese worker is at a 76% increased risk for such an event.  These increased risks translated to increased costs.  The number of days lost due to illness cost an additional $55 per year for the average overweight individual and an additional $349 per year for an obese individual.  Annual costs for disability pension insurance was approximately $70 higher for obese individuals.

Personal Costs.  This new report examined two personal costs, gasoline cost and life insurance cost.  Morbidly obese individuals spent $30/year (men) and $36/year (women) more in gasoline costs than normal weight individuals.  In regards to life insurance costs, overweight individuals typically pay an additional $14/year, while obese individuals will generally pay an additional $111/year. 

Life Expectancy.  Obesity reduces life expectancy in men more so than it does in women.  In Caucasian men life expectancy is reduced by about 5 years, whereas life expectancy is reduced by 4 years in morbidly obese Caucasian women.  The value of life lost due to obesity was reported to be $3,486/year for men and $3872/year for women.

Total Costs.

1. The total reported costs for being overweight is $524 per year for women and $432 per year for men.
2. The yearly costs associated with being obese is $4,879 for women and $2,646 for men.
3. If the loss in life expectancy is included, the cost of being obese is $8365 per year for women and $6,518 per year for men.

It is clear from this new report, that being overweight or obese can have a major impact on an individuals finances.  Not counting the value associated with life span, it costs about $3,000 - $5,000 per year more to be obese compared to having a normal body weight.  While some of the costs outlined in this report are shared with employers and government institutions a number of costs come directly out of a person's pocket.  The study investigators indicated that these costs are likely to be underestimated because many other consumer-related costs like travel costs, clothing costs, automobile size, and other goods and services have not been studied.  Reducing one's body weight and maintaining a healthy body weight not only has numerous health benefits, but apparently can impact personal finances.

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Improving School Vending Machine Choices

Many individuals and organizations point to vending machines and other 'competitive food/beverages' (i.e. school stores, snack bars, a la carte items, etc) in schools as a major contributor to childhood obesity and poor diet quality among American children.  Two recent research studies continue to reinforce this theory.

A recent study (free to download) published in the September issue of the Journal of School Health examined the use of 'competitive foods/beverages' by over 2,300 school children in grades 1 - 12.  A questionnaire was used to collect information on food consumption over a 24-hour period, which was then used to assess the children's diet quality and nutrient intake.  The results of this survey showed that 22% of school children purchased and consumed foods from competitive venues during the school day and usage was highest in high school students.  The results of this study also showed that consumption of these 'competitive foods/beverages' resulted in poorer diet quality.  School children consuming these foods typically consumed over 200 calories more than school children who did not purchase these foods.  Additionally, consumption of these 'competitive foods/beverages' resulted in increased intake of sugar and decreased intake of fiber, B vitamins, and iron.

A second study investigated how common it was for middle school students (grades 6 - 8) to buy snacks and beverages from vending machines instead of buying the school lunch.  For this study, data was collected from over 4,300 middle school students using the 2003 Florida Youth Physical Activity and Nutrition Survey.  The results of this survey analysis showed that 18% of middle school students purchased a snack or beverage from vending machines 2 or more days during the previous 5 days of school.  The most commonly purchased food items were chips, pretzels/crackers, candy bars, soda, and sport drinks.

It is clear from these two studies, that vending machines are commonly utilized by school children of all ages, though high school students appear to be the most active users.  While many vending machines provide healthier options in addition to the standard fare to which we have grown accustomed, school children still typically choose the less healthy options.  These and previous studies show us that the presence of vending machines in schools, the choices they provide, and the choices the school children make lead to a poorer diet quality and increased energy intake in school children.

Clearly, we need to make improvements in what we are offering school children through these 'competitive food/beverage' options.  Fortunately, it appears that we are slowly making progress in this direction.  An article published in the Chicago Tribune (May 16, 2010) reports that future vending machines will offer more fresh fruits/vegetables, more appropriate portion sizes, and lower calorie options due to tighter state and federal nutrition standards.  While we still have a long way to go, progress is slowly being made.

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New World Report - Americans Among The Fattest

A new obesity report, Obesity and the Economics of Prevention: Fit Not Fat, published yesterday from the Organization of Economic Cooperation and Development (OECD) indicates that the population of many of the world's leading economies are continuing to become more overweight and obese and that Americans are leading the charge.  While this organization is better known for economic-related forecasts, the impact of obesity on country economics prompted the development of this new obesity report.  While the full report is available only through purchase, parts of the report like the executive summary and some of the country data are available to read at no cost.  Some of the key facts from this new obesity report are listed below.

Key Facts from the 33 OECD Countries:

• 50% of the population in nearly half of the OECD countries is overweight or obese.
• Children with at least one obese parent are 3-4 times more likely to become obese
• Obesity results in a 25% higher cost of healthcare expenses.  In fact, according to this study, obesity is responsible for 1-3% of total healthcare costs in most OECD countries (5-10% in the U.S.)
• Obesity decreases life expectancy by 8-10 years.
• Poorly educated women are 2-3 times more likely to be obese than women with a high level of education.
• Japan and Korea have the lowest prevalence of overweight (~25%) and obese (3%) individuals.
• The United States and Mexico have the highest rates of overweight (nearly 70%) and obese (~33%) people.
• The United States and Scotland have the highest rates of childhood obesity (35%).

Key Facts from the United States:

• 75% of the U.S. population is predicted to be overweight or obese by the year 2020.
• While women with poor education are 1.3 times more likely to be overweight compared to women with a higher level of education, this disparity does not exist in men.
• Obesity rates are 17% higher in African-American women and 6% higher in Mexican-American women compared to Caucasian women.
• Childhood obesity overall, currently at about 35%, appears to have become relatively stable and is not expected to increase.
• The highest rates of childhood obesity in the U.S. are in Hispanic boys (23%) and African-American girls (21%)
• Children from poorer families are more than 1.5 times more likely to become obese compared to children from higher income families.

The authors of this new obesity report blame the increasing rates of obesity around the world to the usual things... availability of inexpensive, nutrient poor foods, increased rates of dining out, poor dietary habits, and lack of exercise.  To battle these rising rates of overweight and obese individuals, the authors of this report suggest that improving dietary habits and increasing physical activity through various means (health education, regulatory measures, and counseling by healthcare professionals) are all effective, cost efficient strategies that need to be reinforced.  This and previous obesity-related reports clearly indicate that we have a serious weight problem, particularly here in the U.S., and that we have a lot of work ahead of us to reverse this dangerous trend.

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Perceiving Our True Body Size

A large part of the fight against obesity revolves around obesity education and obesity awareness.  This involves making us aware of our body weight, exercise habits, eating habits and more and teaching us how to make appropriate changes that will hopefully lead to each of us adopting a healthier lifestyle.

Despite progress in obesity awareness and education, the results of a recent Harris Interactive poll suggests that as a whole, we still do not recognize when we are overweight or obese nor the extent of our body size.  Harris Interactive conducted an online survey between August 17-19, 2010 in which more than 2,400 volunteers answered questions about their body size image and more.  The results of this survey indicated that:

• 30% of overweight individuals think that they are within a normal body size range.
• 70% of obese people believe that they are simply overweight.
• 39% of morbidly obese people believe that they are overweight, but not obese.
• For those individuals who recognized themselves as being overweight, most of them (52% of overweight people and 75% of obese and morbidly obese people) blamed a lack of exercise on being heavy.
• Only 36% of overweight individuals, 48% of obese individuals, and 27% of morbidly obese people felt they ate more food than they should.
• Survey responders believed that weight loss surgery is the most effective weight loss method.

These are rather disturbing survey results that indicate the healthcare industry still has a lot of work to do in regards to educating us about obesity and appropriate body size.  Based on this poll, there is a large population of Americans that do not recognize they have a weight problem or do not recognize the extent of their weight problem.  Without this recognition, it is difficult for any of us to make necessary changes.  The authors of the poll suggest that fat has become the new norm, which if true, is a very unsettling situation.  Knowing your body weight and body mass index is an important part of developing and maintaining a healthy lifestyle.  You can calculate your body mass index for free at many websites, including the National Heart Lung and Blood Institute's website.  What's your BMI?

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Exercise Reduces Genetic Likelihood Of Obesity

While it is clear that being overweight or obese can be the result of too many calories consumed and not enough exercise, it is just as clear that genetic factors can play a major role in a person's risk for becoming obese.  In fact, research has shown that at least 12 different gene locations are involved in increased body mass index (BMI) and that these 12 different gene locations can be used to determine a person's chances of becoming obese by calculating a genetic predisposition score.  What is less clear is whether exercise can overcome a person's genetic likelihood of becoming obese.

Investigators collected data from over 20,000 men and women who took part in the European Prospective Investigation of Cancer - Norfolk (EPIC-Norfolk) study in an attempt to examine the possible relationship between physical activity and the genetic risk for obesity (free to download).  Physical activity was determined with a questionnaire and categorized as inactive, moderately inactive, moderately active, and active.  A genetic predisposition score was calculated for each study subject by adding up the changes at the 12 different gene locations linked to increasing BMI.  Analysis of the interaction between genetics and physical activity showed that:

• When all study subjects were examined together, each additional BMI-increasing gene was linked to a 0.154 increase in BMI.
• This was even greater in the inactive volunteers where each BMI-increasing gene was linked to a 0.205 increase in BMI.
• In contrast, each additional BMI-increasing gene was only linked to a 0.126 increase in BMI in active individuals, indicating that exercise suppressed the genetic effects on body mass.
• Moderately active and moderately inactive individuals showed an intermediate effect on BMI-increasing genes, suggesting that even small amounts of activity can help fight against the genetic likelihood of becoming obese.
• When looking at obesity risk instead of body mass index, taking part in regular physical activity suppressed the genetic predisposition for obesity by about 40%.

These are both fascinating and important results.  Overall, this study shows us that while genetics certainly play a role in obesity risk and weight gain, exercise can dampen the effects of genetics.  Interestingly, the study investigators report that even exercising less than 30 minutes per day can have a positive effect on one's genetic likelihood of becoming overweight or obese.  While getting enough exercise is an important part of a healthy lifestyle for everyone, individuals who are genetically predisposed towards becoming overweight might gain additional benefit from a regular exercise routine.  So rather than believing that one's genetics doom us to being overweight, it is important to remember that exercise can fight back against one's genetic risk for obesity.

In addition to making exercise an important part of our fight against obesity, following a healthy eating plan can also be critical.  My easy diet plan is a great way develop better eating habits and lose weight while still enjoying delicious tasting foods.  Visit us at www.drtabor.com to learn more or tune in to watch me on QVC September 12th from 1 AM - 2 AM EST!

Exercise & Eat Right To Reduce Menopausal Weight Gain

While many women can probably attest to the fact that they gain weight after menopause, there has been some scientific debate about whether the weight gain and changes in body composition that take place during this time of life are related strictly to menopause or are just another unwanted part of aging in general.

A new research study in Chinese perimenopausal women attempted to clarify this debate.  For this menopausal body composition study, researchers collected data from 438 perimenopausal women between the ages of 44-55 years who took part in a large bone health study.  Body composition information was collected at the beginning of the study and after 9, 18, and 30 months.  Changes in body fat and lean muscle mass were compared between women who remained premenopausal, those who transitioned through menopause and women who were already in menopause at the start of the study.  The study investigators reported that:

• A decrease in lean muscle mass and an increase in total fat mass and trunk fat mass were observed overall during the 30-month follow-up period.
• Age was negatively linked to central obesity (belly fat), such that belly fat increased as the women got older.
• When the information was adjusted for age, menopause was specifically shown to be linked to a decrease in lean muscle and an increase in percent body fat and trunk fat mass.

Overall, this new body composition study showed that though aging in general is related to weight gain, the transition to menopause itself is linked to an increase in body fat, particularly belly fat.  Like many other aspects of the menopausal transition, these changes in body fat distribution have been reported to be due to the loss of estrogen during the menopausal transition.  While hormone therapy has been reported in some studies to decrease obesity in postmenopausal women, hormone therapy comes with its own set of risks.  Developing healthy diet and lifestyle habits remains the best approach to preventing or reducing the impact of menopause on body weight gain and body composition.  Eating healthy foods in appropriate portions and getting plenty of exercise are core to preventing menopausal weight gain.  Starting during the premenopausal years and developing life-long healthy habits is the best approach to maintaining a healthy body weight throughout life.

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Fighting The 'Freshman Fifteen'

It's the time of year when many recent high school graduates start heading off to begin their college careers.  One of the many challenges these aspiring young adults will face is avoiding what has been called the "freshman fifteen", the typical weight gain experienced by young adults during their first year at college.  The change in lifestyle experienced when starting college and the freedom of choice that goes with it can lead to unhealthy eating habits and subsequent weight gain, though the actual average weight gain has been reported to be less than the name suggests.

While a number of factors impact weight gain during this transitional phase, less is known about some of the environmental factors that influence a person's body weight during their first year of college.  A recent health and nutrition study examined the impact of some environmental factors on college freshman weight gain.  For this study, obesity researchers investigated the impact of college dormitory characteristics on freshman weight gain, eating habits, and physical activity.  The results of this study showed that:

• Freshman students assigned to dorms with on-site dining halls gained more weight than students assigned to dorms without on-site dining halls.
• Female freshman residing at dorms with on-site dining halls weight more and exercised nearly 1.5 times less than female freshman living at dorms that did not have on-site dining halls.
• Living in dorms with on-site dining halls was linked to male freshman consuming more meals and more snacks each day.
• Dormitories located near a campus gym led to increased physical activity by female freshman compared to dorms located near the center of the campus.

This nutrition study indicates that living conditions and physical environment can influence a college freshman's eating habits, exercise habits, and body weight.  While on-site dining halls can be wonderfully convenient, it appears that this convenience might come at an unexpected price.  These environmental factors can be important for new college students to keep in mind when trying to maintain a healthy lifestyle.  Developing and maintaining healthy eating and exercise habits can not only help fight off the 'freshman fifteen', but can help develop healthy habits for life.  According to the American Institute for Cancer Research (AICR), unhealthy habits developed during this transitional period can turn into lifelong habits that can negatively impact a person's health in the long term.  The AICR recommends the following five strategies to help college freshman stay fit:

1. Aim for proper portions with plenty of fruits, vegetables, and whole grains.
2. Plan meals in advance
3. Limit the amount of alcohol consumed, particularly since these contain non-nutritive calories
4. Remain or become physically active
5. Become more aware of the nutritional value of foods

Avoiding the 'freshman fifteen' can be tough, but by being aware of the risk, planning ahead, and developing healthy lifestyle habits, it is possible for any new college student to successfully fight the 'freshman fifteen'.

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Obesity Linked To Poor Omega-6 to Omega-3 Ratio

Dietary fats are often misunderstood and as a result are often grouped together as a bad part of our regular diets.  For years we were told that limiting the amount of fat in the diet was the right way to eat for both weight management and heart health.  While this is still correct to a point (eating too much fat is still not good for us), we have learned that eating healthy consists of choosing the right fats in the correct amounts.  Fats are an essential part of a healthy diet.  They supply energy and are vital for the absorption of the fat-soluble vitamins A, D, E, and K.  Fats also are important for the normal operation of many of our body's functions.  Unhealthy fats consist of the saturated fats and trans fats, which have been linked to poor heart health.  In contrast, the monounsaturated and polyunsaturated fats are considered healthier fats.  Interestingly, research over the last several years suggests that even the healthy fats need to be consumed in appropriate proportions.

A new obesity research paper explored the impact of a Western diet, which typically has an unhealthy ratio of omega-6 to omega-3 polyunsaturated fats, on obesity over several generations of mice.  For this study, the obesity researchers fed male and female mice a high fat diet (35% of total calories).  This high fat diet  consisted of a high ratio (28:1) of omega-6 fat (linoleic acid) to omega-3 fat (alpha-linolenic acid) and was fed over four subsequent generations.  Consumption of this unbalanced, Western diet resulted in an increase in fat mass over the four generations.  Additionally, changes in fat tissue genes and protein production, particularly those involved in inflammation, were observed throughout the generations of mice consuming this unbalanced diet.  These researchers concluded that even in a population with genetic stability and an unchanging routine, consumption of an unbalanced, high fat diet leads to greater incidence of obesity.

The results of this study appear to reflect the unbalanced diets we typically consume and the rise in obesity seen over the last 20 years or more.  According to some researchers, human beings originally consumed a diet with a 1:1 ratio of omega-6 to omega-3 fats.  Unfortunately, a typical Western diet now contains a ratio of approximately 20:1 omega-6 to omega-3 fats.  This unhealthy ratio of omega-6 to omega-3 fats has arisen through both the excessive consumption of omega-6 fats and insufficient consumption of omega-3 fats.  Current research efforts suggest that dropping back down to a ratio of less than 4 parts omega-6 to 1 part omega-3 has many healthy benefits and that increasing omega-3 consumption is a critical part of re-balancing our dietary fat intakes.  This new obesity research study explored the omega-3 fatty acid alpha-linolenic acid.  The current recommendation for alpha-linolenic acid consumption is between 1.1 - 1.6 grams per day and can be obtained from a variety of plant sources including flaxseed, soybeans, walnuts, and olive oil.  When designing your healthy eating plan, remember to not only aim for healthy fats but for the right balance of healthy fats.

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Reduce Children's Obesity Risk - Control Pregnancy Weight Gain

Numerous obesity research studies have reported that weight gain during pregnancy and birth weight are both linked to one's risk for becoming overweight or obese during both childhood and as an adult.  However, it has been unclear if these links between obesity risk and pregnancy weight gain and birth weight are confounded by genetic factors.

In an attempt to clarify the associations between future obesity risk, birth weight, and weight gain during pregnancy, researchers from the Children's Hospital Boston and Columbia University teamed together to conduct a population-based study of pregnancy weight gain and birth weight.  For this study, obesity researchers analyzed vital statistics birth records from over 500,000 women and over 1 million births. Analysis of the information in these records showed:

• A consistent relationship between greater weight gains during pregnancy and greater birth weights
• Women who gained more than about 53 lbs during their pregnancy had heavier babies than women who gained only 18-22 lbs.
• Gaining more than 53 lbs during pregnancy more than doubled a woman's chances of giving birth to a baby weighing more than 8 lbs 13 oz.

By using such a large population, the researchers were able to omit factors that might have altered the impact of pregnancy weight gain on birth weight like short or long pregnancy lengths, maternal diabetes, and more.  By reducing these potentially interfering factors, these researchers showed that excessive weight gain during pregnancy directly effects birth weight.  This is important because previous research has shown that a large birth weight substantially increases a person's risk for obesity both as a child and later in life as an adult.  In fact, some studies have reported that a birth weight of more than 8 lbs increases a person's risk for obesity by about 50-70%!

Therefore, it is important to eat healthy and maintain a healthy weight gain during pregnancy.  The following tips from the Weight-Control Information Network might help prevent excessive weight gain during pregnancy:

• Consume only about 300 more calories per day than normal during the last 6 months of pregnancy.  For normal weight women, this would equal about 1,900 - 2,500 total calories per day
• Eat breakfast every day
• Be sure to include high fiber foods
• Keep healthy snacks handy
• Consider cutting back on large amounts of caffeine
• Exercise at a moderate intensity on a regular basis.

Keeping weight gain during pregnancy to a healthy level is an important step for reducing childhood and adult obesity.

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All-You-Can-Eat Ballparks!

Have you read the recent article on the Sports Illustrated website about the relatively new trend in ballparks?  It appears that despite the fact that two-thirds of Americans are overweight or obese, ballparks have been opening all-you-can-eat sections in order to boost sales, and it is working.

According to this article, this trend started off with the development of premium all-inclusive packages, but has progressed to include other stadium sections.  In fact, many of these all-you-can-eat sections are sections of stadiums that typically do not sell out. By selling seats that include all the food and drink that you can consume, ballparks have now been selling out sections that were nearly empty before including the all-you-can-eat promotion.  For sports fans it's a great deal.  One park is selling seats in its all-you-can-eat section for $40 per person.  Most sports fans would end up spending quite a bit more than $40 for tickets, food, and drink if they had to pay for the items separately.  Because ticket sales have increased, so has the number of teams using similar promotions.  Currently, over half of the major league baseball teams have all-you-can-eat seats, up from only a handful of teams in 2007.

It is clear that these all-you-can-eat promotions are helping the ballparks and also helping the wallets and pocketbooks of customers who choose to attend a game, but is it helping these customers' waistlines?  Most likely not!  While some ballparks apparently offer salads, fruits and other healthy options, the majority of foods offered are what we consider typical ballpark fare... hot dogs, nachos, peanuts, soda, ice cream, and more.  Not exactly the healthiest of choices.  Even when healthy options are offered, customers reportedly opt for the less healthy choices because it is part of the ballpark culture.  In addition to being offered less than healthy food choices in most cases, the all-you-can-eat ballpark atmosphere leads to some serious overeating.  One customer mentioned in the article apparently eats double or triple what he would normally eat in another section of the stadium, stating "I figure I might as well take advantage of it".  This is the same attitude many of us take at any buffet, whether at a ballpark or our favorite restaurant.

Eating healthy is a challenge for most of us in the best of situations.  Putting ourselves in all-you-can-eat situations makes it even more difficult to eat healthy.  While I would never tell anyone to stay away from a ballpark, I would suggest that you practice restraint if do you have the opportunity to watch a game from an all-you-can-eat section.  Some of the tips below might help:

• Eat a healthy snack of fruits and/or vegetables before going to the game.  This will curb your appetite so that you can resist the buffet longer and decrease your chances of overeating.
• Try to avoid repeated trips to the all-you-can-eat buffet.
• If you order nachos, only get one and share it with a friend.
• If they offer grilled chicken, choose it over less healthy options.
• If a salad bar is available, include a salad as part of your meal.  It is a healthier option and will reduce the amount you eat of less healthy options.  
• Choose healthier dessert options if available (e.g. frozen yogurt over ice cream)
• Choose calorie-free drinks when possible.

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Obesity Rates Continue To Rise!

The newest national obesity report, "F as in Fat: How Obesity Threatens America's Future 2010" was recently made available to the public and indicates that obesity levels continue to increase.  While the full report is free to read, some of the major finding are briefly outlined below:

• Adult obesity rates rose in 28 states.
• 38 states have an obesity rate more than 25% with 8 of those states having obesity rates greater than 30%.
• Of the 11 states with the highest obesity rates, 10 are Southern states with Mississippi having the highest rate of obesity (33.8%).
• Adult obesity rose for a third year in a row in 11 states and for a second year in a row for 15 states.
• Obesity rates were highest in individuals with an income below $15,000/year and lowest in individuals with an income above $50,000/year, suggesting the cost of healthy foods is a barrier to healthy eating.
• Physical inactivity rose in 12 states with 6 states reporting that more than 30% of adults did not exercise.
• 8 of the 10 states with the highest rates of obesity also had the lowest rates of fruit and vegetable consumption.

The report indicates that obesity reached 'epidemic proportions' in 2001, after which steps were taken nation wide to slow or prevent the increase in obesity rates.  Unfortunately, these steps were often too slow to develop and were not always well-accepted.  According to this new report, programs to prevent obesity have grown tremendously in the last couple of years and research suggests that 80% of Americans recognize obesity as a national problem.  Some of the programs being widely adopted include raising nutritional standards for school lunches and foods sold in vending machines (over 20 states), requirements for body mass index screening of children and teens (20 states), linking local farms to schools (23 states), imposing soda taxes (33 states), and improving safe access to community streets for pedestrians and bicyclists (13 states).  Hopefully, this growing obesity awareness and improved obesity education will lead to a reversal of the obesity trends being reported.

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Our Neighborhood Effects Our Obesity Risk

Obesity is a very complex health condition that can be effected by many factors.  While obesity is still considered the result of too many calories consumed and to little exercise, many things influence our eating and exercise habits.  One such factor to which most of us give very little thought is our physical environment.  Yet studies are starting to show that the neighborhoods in which we live might effect our obesity risk.

In one new obesity research study, investigators examined volunteers' perceptions of their environment in relation to body mass and exercise levels.  The researchers also investigated the effect of a light rail transit system on body weight and physical activity.  Information on body mass, obesity, and physical activity was collected both before and after the completion of a new commuter light rail transit system.  The results of this study showed that:

• A positive feeling about one's neighborhood was linked with a lower body mass index, a 15% decreased risk for obesity, and a greater likelihood of getting regular exercise.
• Use of the light rail transit commuter system was associated with a reduction in body mass index and an 81% decreased risk of becoming obese.

A second obesity study examined the effect of a person's food environment (closeness of restaurants, grocers, convenience stores, etc.) on body mass.   The study investigators reported that a higher number of restaurants within a 5-minute walk of one's house was associated with a higher body mass index.  Also, living close to supermarkets and grocery stores was linked to a lower body mass index when compared to living near a convenience store.

The results of these two new studies clearly suggest that our neighborhood environment can have a real impact on our body weight and risk for becoming obese.  Environments that encourage physical activity (e.g. walking to commuter systems, well lit, etc.) and provide availability of healthy food options appear to decrease obesity risk.  Improving neighborhood environments might be an important public policy approach to providing better health and well-being.

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Learn to Estimate Correct Portion Sizes

Consuming the appropriate portion size of the foods we eat is a vital part of eating healthy.  However, it has become one of the things with which we have the greatest amount of difficulty.  Part of this is likely due to the way portion sizes have changed over the years.  A hamburger 20 years ago was much smaller than a typical fast food hamburger we consume now.  This change in portion sizes over time has distorted our concept of correct portion sizes.

A new nutrition study used computerized tool to determine how accurately adolescents estimate portion sizes.  For this study, adolescents between the ages 11-17 years were asked to estimate portion sizes in two ways.  In a short-term recall test, the children served themselves their usual amounts of 10 foods and later in the day were asked to estimate the amount they ate.  In a real-time perception test, the children were asked to estimate pre-weighed portions.  On average, the children in the study underestimated their self-served portions by 8% with substantial underestimations for breakfast cereals and french fries among others.  The results of the real-time perception test were even worse with children underestimating portion sizes by 15% on average.  Substantial underestimations in this test were found in 14 of the 20 portions.

These results make it pretty clear that not only us adults underestimate portion sizes.  By underestimating portion sizes, we put ourselves into situations where we are eating more that we realize.  The size of food items presented to us at stores and restaurants is typically much more than a single serving.  For example, the 12 oz. steak we might be intent on grilling over the weekend is not one serving; it is actually 4 servings of meat.  By assuming that one 12 oz. steak is one serving size, we find ourselves eating a lot more than planned throughout the course of a day.  Learning how to estimate correct portion sizes is an important part of designing a healthy eating plan.  In addition to actually weighing or measuring your food as you prepare it, you can visualize appropriate portion sizes:  For example:

• 3 oz. of meat (beef, poultry, and fish) equals a deck of cards
• 1/2 cup of cooked pasta is about the size of a golf ball
• 1 bagel should be about the size of a hockey puck
• 1/2 cup of cooked vegetables is about the size of half a baseball
• 1 teaspoon of butter is about the same size as the tip of your thumb
• 1 cup of cereal is about the size of a baseball
• 1 cup of fruit equals a tennis ball

If you want to test your knowledge, take the Portion Distortion Quiz!

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