The obesity epidemic

Terming the gradual increase in the number of overweight people as the Obesity Epidemic is more an emotional phrase than an accurate one say Canadian academics in an editorial in the European Journal of Public Health. An epidemic usually refers to a disease that has a sudden onset with a temporary high prevalence in a population. Although over half of western populations are overweight, it has hardly been a sudden onset.

Is excess body fat a disease?

The other aspect to calling obesity an epidemic is that it then becomes a disease. Is obesity really a disease or just a mis-management of energy in and energy out in a society with abundant food and energy saving devices? Labeling obesity as a disease can help generate research funding to find a “cure” for the disease. It also suggests that people had little say in becoming overweight because, well, it’s a disease, and diseases are something that you catch, possibly from another person!

Disaster on the horizon?

In my view, the use of the terms “disease” and “epidemic” helps cement the idea that a disaster is pending and many people are about to die, and, without a skerrick of justification, people can say that “our children will be the first generation to have a shorter life span than their parents.” Rest assured, that claim has been pure fabrication to generate headlines. Right now, average life spans continue to increase, with no hint of dropping.

The good news

The authors point out that while overweight has increased, high blood pressure and heart disease have been on the decline. They say that: “further, since the early 1980s, coronary heart disease mortality rates have halved and life expectancy has increased steadily in several developed countries.”

In Australia, high blood pressure has halved in adults dropping from 40% in 1980 to 18% in adults aged 25 to 64 years at the beginning of this century. Coronary heart disease death rates have fallen rapidly since the 1970s. In the decade 1996 to 2005 the heart disease death rate dropped by 42% due to a reduction in the number of heart attacks and a better survival rate.

However, the authors do add that the increase in obesity may well have slowed down these favourable trends, and that it is very unlikely that heart disease rates will ever return to those of the 1970s.

Not for a moment are the authors downplaying the health consequences of being overweight as it is associated with a number of chronic disabilities such as diabetes and osteoarthritis, and the fact that such people are unlikely to be enjoying life to the fullest.

What does it all mean?

The authors do warn that classifying obesity as a disease rather than a risk factor does not help us understand obesity as a public health problem. For example, you cannot guess somebody’s weight if you only look at a series of tests such as blood cholesterol or blood pressure. In NI 36 I mentioned that that about half of overweight people are metabolically fit and around one quarter of lean people are quite unhealthy. There is no specific cut off weight that determines whether you are going to be unhealthy or healthy in the future.

Although the authors didn’t state it in blunt language, if they think that labeling obesity as a disease is more about creating fear in the public in the potential hope that researchers will attract government attention and possibly funding for research, then I can only agree.

Reference: European Journal of Public Health 2009; 19 (6): 568-571

Juice Plus revisited

You may recall that in an earlier blog I asked about this fruit and vegetable extract supplement. To refresh your memory I said: “Juice Plus has been around for some time. Nutrition professionals are not that excited by it, as it is very difficult to get much dehydrated vegetable or fruit into a tablet. There is research to show that the tablets do increase antioxidant levels in the blood. You would have to eat at least 10 tablets to get even close to a single serve of a vegetable and even then, many nutrients will be lost through processing.”

Since then, there has been a short article in the American Journal of Medicine late last year. A 51 year old woman with endometrial cancer began to take Juice Plus as a supplement. It is very common for people with cancer to start taking what is perceived as natural supplements in the hope that this will reverse the cancer or halt its progression. In this case, the Juice Plus began to adversely affect her liver function. Stopping the Juice Plus returned the liver to normal after four weeks.

The authors from the University of Texas said it was important that doctors know of all the supplements being taken by patients and, conversely, that patients were open about what they took in addition to any prescribed medication. That way they can be alerted to potential side-effects of the supplement. Natural does not always equal safe or healthy.

Comfort Foods

Down in the dumps? Life not too flash? Or simply just want to enjoy a feel good food? What would be your comfort food? No doubt many would turn to chocolate, bit I’m certain there are other choices too. Camembert on thick fruit toast, creamy pumpkin soup, mushroom and egg on a wholemeal bun, super premium ice cream with chocolate coated almonds. I best stop there before I give away too many personal secrets. So what’s yours?

Psychology link

There is often a psychological component to a food you like (and those you dislike). Chocolate pudding could bring back memories of Sunday lunch at Grandmas, or fish and chips might have been the Friday night special when you were a kid and you were allowed to stay up and watch the late movie.

Brian Wansink’s research group at Cornell University in the US have taken an interest in comfort foods (see __Mindless Eating__, Bantam Books 2006) and found men and women were different. Golleee! Yep, the ladies preferred sweet foods and the blokes generally went for savoury comfort foods, except when they were offered super-premium ice cream with chocolate coated almonds. Everyone loves their ice cream.

Boys vs girls

The guys said they preferred pasta, pizza and soup because they felt spoiled or pampered and being the focus of attention when given these foods. Comfort foods did their magic especially when they were prepared “just like mama used to make”, and lost some of their comforting effect when they deviated from expectation in look and taste.

The women didn’t rate such savoury foods as highly because they generally reminded them of the time spent in preparing the dishes. For the women, cake and chocolate were preferred because they required no effort, no prep, no cleaning, just pop out and buy your favourite.

The mood made a difference too. A happy mood often led to more healthier choices, such as a pizza instead of a bag of potato chips/crisps.

Change begets change

Anyway, that has been our common understanding of comfort foods. When life throws out a challenge we tend to towards familiar foods that make us feel good. Stacy Wood who is a professor of marketing at the University of South Carolina has put her spin on comfort foods. She found that when people were subjected to a changing environment (eg move house, go on a trip, traumatic event) they chose different, unfamiliar foods, not the stabilizing comfort foods. Paradoxically, people predicted that if they had to move town they would much prefer comfort foods over foods they had never experienced before. So, what they predicted would happen was different to what they eventually did.

What does it all mean?

It all depends on the circumstances. If you have scored some winners at work and then choose a pizza or ice cream, there is synergistic effect of boosting your mood. If you have moved to a different address, some distance from your previous home, along with the hassle of packing, it makes sense that many people will check out new supermarkets and restaurants and experiment with new foods in a new place. What I think Stacy Wood is trying to demonstrate is humans adapt in different ways and an upheaval in life doesn’t send everyone in search of a comfort food.

Ever travelled to a very different country? Did you decide to eat like the locals or did you ask the concierge if they knew if Pizza Hut had a franchise close by? The answer to that question might give you an insight into your relationship with comfort foods.

Reference: Journal of Consumer research 2010; 36: doi 10.1086/644749

Why does a mushroom have that shape?

I bet you haven’t, for one moment, thought about the shape of a mushroom. Why does it look like it does? Because it is a clever example of natural engineering according to the boffins at Miami University. The gills on the underside are designed to carry the maximum number of spores, about 20 times more than would fit on a flat surface.

“Spores are catapulted from the gill surface, travel a short distance horizontally, then fall vertically to be swept away by air currents. The spores then go off to start new mushroom colonies,” explains Professor Nicholas Money. (Yes. Real name. I bet he is called “Thief” behind his back. You know, Nick Money. I don’t think it is funny either).

Nick and his colleagues have placed mushrooms in wind tunnels and found that the leading edge of the mushroom causes a rapid slowing of air movement close to the underside, allowing spores to successfully leave the gills and drop into fasting moving air to be dispersed. If the air movement wasn’t slowed near the gills there is a good chance that the spores will be blown back into the gill structure and not travel anywhere. That’s a clever mushroom.

For weight loss, carbs in or out?

Anyone who has lost significant weight by design will happily tell you how it was done and what they believe is the perfect diet for successful weight loss. It will always be a low calorie diet, no matter how they dress it up, although the composition of that diet is the stuff of discussion and argument.

Weight loss significant

An Australian study put 141 overweight subjects on a low kilojoule meal replacement diet (eg milkshake) for three months providing 210 kJ (500 Cals) a day. That then followed with 12 months of either a high protein or a high carbohydrate individually tailored diet. So, everyone was followed for a total of 15 months. Each diet provided the same amount of kilojoules/calories. Both groups lost an average of 16.5 kg (36 lb) in the first three months and maintained a weight loss of 14.5 kg (32 lb) twelve months later.

Heart benefits

The high protein diet provided about twice the protein of most free-living westerners, so being a low energy diet, it still meant modest servings of meat and fish. The high carb diet was closer to what most people eat when “watching their weight” (it wasn’t really high in carbs). It wasn’t just weight that changed. Bad cholesterol came down, good cholesterol went up and triglycerides came down. Blood pressure remained pretty much the same.

Calorie amnesia

The study also revealed a common phenomenon, that of under-reporting. It has been well documented that people frequently get “calorie amnesia” and forget to report exactly what they have eaten. Published data on under-reporting shows we forget 12-54% of what we eat, making it difficult to identify why weight creeps on because all you remember is the salad and fruit you eat. In this study the ladies under-reported by about one-third.

Surprisingly, the guys had much better recall with an accuracy of 99%. I say, surprisingly because under-reporting of 1% is the lowest recorded. I’m too frightened to make a gender related comment here, but you can bet that had this study been about beer, that 1% figure would have been different.

What does it all mean?

Success is only ever likely if you follow a style of eating that you are going to enjoy for the rest of your life. That might be with bread or without it. Over time, both groups began to eat more and more similarly to each other, which may partly explain why the researchers didn’t see any difference in weight loss between the two diet groups.

Those that are involved in research like this are selected because they are more motivated than the average. They also got free monthly counseling, which is not within every person’s budget. Even so, 40% of those in the study dropped out before the end of the 15 months. As you have heard me say before, losing weight is quite easy. So is gaining weight. Maintaining the weight loss is the really tough part, way beyond what most people can cope with. This study showed that it’s possible to maintain weight loss over 12 months – the type of diet didn’t make any difference.

Reference: American Journal of Clinical Nutrition 2009; 90: 1203-1214

Don't be fooled by weight loss ad

In my local paper there was an ad for a half price fat and cellulite-losing program. The moment the word “cellulite” appears the red warning light was illuminated. Reading further, I saw the word “detox”, which triggered the scam alert siren. Then the ad said that on this program you will “burn 1200 Calories in 50 minutes whilst you relax fully clothed”.

First, let me say never, ever use the word “whilst” in print. Well, when have you ever said “whilst” in your life? Imagine saying “Would you please hold my jacket whilst I go to the bathroom?” People will think you are a right twit. And they are fully justified.

Second, do you know who has ever come close to burning 1200 Calories in 50 minutes clothed? I mean properly measured, not guesswork? Tour de France cyclists climbing the Alps. They have their backside out of the saddle, legs pumping, sucking in huge volumes of air, eyes bulging, aching for the finish line. Do they look relaxed to you? During an Alps sector they can burn 7740 Cals (32,400 kJ) over six hours.

Another example. Mike Stroud once burned 11,630 Cals (48,700 kJs) in a day, about 500 Cals an hour. This is the biggest daily calorie burn ever measured in the world. Want to know how he did it? By crossing Antartica pulling a 222 kg (480 lb) sled. I met Mike in Southampton, England for a chat. I now regret not asking him how relaxing he found the three month trekking experience. He did lose 25% of his body weight and he was fully clothed, so if you answer the ad and they rug you up and check your passport before putting you on a plane heading south, well, you were warned.

Mental Calorie Budget

How do you control how much you eat in a world of relatively cheap food that’s easy to buy anytime of the day? You might be one of the rare folk who eat well until hunger departs, allowing your appetite to keep your weight healthy. Well done you. Most people today look at food and go through the “should I or should I not?” mental routine. Should I choose dessert or not? Have I deserved a treat? It’s a common self-justifying system employed by many.

Putting on the calorie brakes

Does giving yourself a Mental Calorie Budget (MCB) help you to control your eating when surrounded by abundant food? In theory, yes, according to research done by scientists in the US and France. They convinced one group of adults to keep a MCB on the amount of treats they would consume when offered plenty of treat opportunities over a day. As they were offered treats, they had the option to accept or reject each one.

If they had a MCB they ate much fewer treats than the control group who were not asked to have a MCB. Well it worked when done as an online exercise and only if the MCB was specific, such as “I won’t eat any treat over 100 Calories (420 kJ)”, not, for example, “I’ll try and avoid high calorie treats”.

The power of the outside voice

So, would the theory work in real life too? Let’s face it, it is easy to reject a treat that you just get to see on the computer screen. It’s a whole different story if the treat is edible and within reach. The researchers found that the MCB worked well in real life too. What was interesting was that when limits were made by an external voice (such as by a health professional) they were more effective that an internally voiced limit as you might tell yourself. This reinforces the potential benefits of advice from your doctor or dietitian. Well, for a short while at least.

Frequently stated message

If you know that you have a weakness for chocolate, biscuits or anything ending in –ccino then setting a MCB each morning as you clean your teeth may be a helpful way of restricting those foods or drinks. I suspect the message to self would have to be made every day as I can’t see a Monday message getting you through to the weekend. And, to be honest, it will only have a limited effect if you are trying to lose weight. You will need to employ other mind games (eat slowly, not buying treats in the first place etc) for the MCB to be helpful. Just remember that chocolate biscuits only have the power you give them in the first place.

What does it all mean?

When food was scarce or unpredictable, as it has been for most of human evolution, the choice was simple: eat or starve. It is no surprise that we haven’t adapted well to having an abundance of food choices close at hand. It is so easy to eat “just one more” to be sociable or get another squeeze of endorphins running around the brain sending off “oooh, yummy” feelings.

One useful message you could implant in your brain each morning is the MCB. “Yes, today I shall have only one hot chocolate (or one biscuit or one beer)”, or even telling yourself that you will eat two pieces of fresh fruit that day. A message to your brain on arising each morning could be a neat way to help control your shapeliness.

Reference: Journal of Consumer Research 2010; 37 (doi: 10.1086/6496.50)