Monday, December 29, 2008

A story you won't read in 2009

A story you won’t read in 2009
No-one thought it was possible, except Craig Middlemass himself. Throughout 2008 Craig’s weight didn’t deviate more than half a kilogram from his ideal weight of 82kg. This was the second year in a row that his weight remained stable, making him eligible to enter Channel 7’s new season program “Stable Weight, Stable Mind” where 10 contestants, five men and five women, maintain a steady weight for six months without displaying a single high five or breaking down in tears.

“People just don’t understand us”, bemoaned Craig during a telephone interview. “We generally exercise 5-6 days a week and eat plenty of fruit and vegetables. Everyone just assumes that I’m on a diet of cabbage heads and Himalayan goats’ milk, and can’t see that I get most of my food from Coles and the farmers market”.

Middlemass doesn’t always comprehend the strange world in which he lives. What feels quite normal to him is seen as seriously weird by his colleagues at work. Only last week he was seen to eat some chocolate cake without a shred of guilt. One girl followed him everywhere for the remainder of the day expecting him to drop to his knees and repent.

“I get reminded of being different every time I go to the gym. The staff say I’m a freak because I bought a 12 month gym membership and went at least once a week for the 12 months. Apparently I was meant to stop after five weeks, but hey, I actually enjoyed going there”.

“Anyway, I’m looking forward to being on the program. I reckon I can win Stable Weight, Stable Mind and promote the concept that us stable-weighters are humans too and deserve acknowledgement and respect from the weight-extremists who get all the kudos and publicity”, were the parting words from MIddlemass.

Hippy hippy shake - bigger hips, smarter babies

What shape is your Mum in?

Part of nature’s grand design was for women to have curves, no matter what fashion promotes or Photoshop can change. Hips are for shaking and for placing infants so they don’t slide down your leg. A recent study suggest that hips are also for making that very same child smarter.

First you take the waist, then you take the hip
A study sample of over 16,000 women correlated their children’s mental development against their own “curvature” expressed as the Waist-Hip Ratio (WHR). The WHR is a simple measure of the waist circumference at the navel compared to the circumference at the widest part of the hips. A low WHR means that a person has less fat around the abdomen and more fat in the buttock, hip and thigh area – this is the preferred ratio.

It was clear that the lower the WHR in the mum, the smarter the child, and the more mature the mother, the smarter the child. In fact, the lower the WHR in the mum, the smarter the mum! Now, you will immediately twig to the notion that this is just a case of smart mums having smart kids. Well, the researchers were awake to that and determined that even when they took mum’s IQ out of the equation, the lower her WHR the smarter her child was likely to be.

Women have more body fat than men (under normal circumstances) and that fat is mainly distributed around the hips, thighs and buttocks. During puberty, women gain 10-20kg of body fat, most of it in the lower body, and it is fiercely protected by the body, being lost only during starvation. The lower body fat is the main source of long-chain polyunsaturated fats (LCPUFAs) such as docosahexaenoic acid, an omega-3 fat better known as one the main fats in fish. These fats are critical in foetal and infant brain development.

There are much more LCPUFAs in lower body fat than found in abdominal fat. About 60-80% of the LCPUFAs in breast milk come from the mother’s lower body fat stores, with the remainder coming from the diet. It is thought that Mum’s diet would not be able to provide enough for the rapid brain development soon after birth (20% of the brain is LCPUFAs). Women with extra abdominal fat lower the level of an enzyme that helps the manufacture of LCPUFAs, so chubbier tummies meant less LCPUFAs getting around the body.

Under ideal situations, there is a sufficient gap between children to allow for replacement fat stores to be generated. This does not occur in poorly nourished women suffering famine and food shortages, or very young women who are still growing and developing themselves during their pregnancy.

What does it all mean?
Lower body fat in women is released later in pregnancy and during her infants first year to provide essential LCPUFAS for brain development. For years, musicians have been asking women to shake their hips. Clearly it was a ploy to allow quick determination of a lady’s IQ, and the likely IQ of her progeny. The curvature of the silhouette demonstrated nature at its smartest.

Wednesday, December 10, 2008

Sound bites

The sound of the first bite
You know the sound of biting into a potato crisp (or potato chip). Being a good dietitian, I don’t of course. OK, once back in the 1980s I ate some. Maybe twice. Anyway, you know the sound that you are expecting. No crunch means that the crisp is stale or you have an ear wax problem.

A couple of researchers from the University of Oxford, in the land where they love their crisps, placed headphones on subjects, got them to bite into a crisp and instantly played the sound back through the headphones, surreptitiously changing the sound the subjects heard.

Turning the volume up to 11
When the volume was increased, or when the higher frequency of the crunch was amplified, people believed the crisp to be fresher. A decrease in volume was perceived to mean a staler crisp. Now, this is pretty much what is to be expected. What this is likely to mean in the future is that for certain foods, the technologists will pay a bit more attention to the sound of that first bite, in addition to the flavour and aroma of a food.

When people discuss food, they rarely mention the importance of sound in preparing your mind for an eating experience – the sound of a barbeque cooking, the pop of the champagne bottle, the snap of a chocolate bar. You could argue that nature knew about the importance of sound all along when it gave you the apple.

Reference: Journal of Sensory Studies 2004; 19: 347-363

Portion sizes

The unexpected result of food in smaller portion sizes

One common suggestion to slow down the inexorable increase in human plumpness is to make sure we are offered snack foods in small packets. No doubt it stops some people overeating. For me, if I want chocolate, my taste buds demand 50g and is not satisfied by something prettily packed in 20g units. All the same, will creating snacks in small packets reduce the amount people eat?

The 100 Calorie packet
The 100 Calorie packet (420 kJ) has become popular internationally and has crept onto the Australian market. To see the response to food in smaller packs, researchers from the University of Kentucky and Arizona State University gave either small or large packets of M&Ms to people who were classified as either “restrained” or “unrestrained” eaters. In simple language, a restrained eater is one who is likely to have followed weight loss diets and be watchful, and probably concerned, about what and how much they eat in order to control their weight. In contrast, unrestrained eaters generally don’t get too fussed about kilojoules or fat content (this is not to suggest they eat poorly or overeat; food is just not a source of emotional concern).

The subjects were given four packets of either regular M&Ms or mini-M&Ms with 50 Cals (210 kJs) each or one packet with 200 Cals (840 kJ). When the snack was presented in small packets, people presumed that they were getting a ‘calorie controlled’ food, especially with the mini-M&Ms, yet also estimated the 4-pack of M&Ms Calorie content to be much higher than regular M&Ms in the single large packet (285 Cals v 205 Cals; 1200 kJ v 860 kJ).

Then it gets interesting
So, are you with me? Basically, the consumers thought that small foods in small packets were higher in kJs, but being in small packets meant that they were also seen as "calorie controlled" portions by the consumer. What I found interesting is that, not being aware that their snacking was being monitored, the restrained eaters ate 20% more M&Ms when they were in small packets than when they were given the large packet!

The researchers reckon that restrained eaters freak out when their brain sees something that is saying “We are small in size, and we are in a small diet packet because that means we are calorific and taste yummy”. The small packet makes the restrained eater stressful knowing that, on one hand the packet is small, yet on the other hand, the snack is high kilojoule, weight for weight. The attendant stress leads to uncontrolled eating and a greater consumption of the snack.

Naturally, the unrestrained eater is more likely to rely on internal appetite cues to tell them when enough is enough, so being given small packets meant they ate less than restrained eaters. However, it is not as simple as all that because unrestrained eaters ate more, comparatively, when given the large packet. Maybe they will benefit more from the smaller packs on the market.

What does it all mean?
Frankly, I don’t know. Why I tell you about the study is because it alerts us to the less tangible fact that how much we eat under different circumstances relates more to our relationship with food rather the food itself. The constant blabbering about being overweight, snack food fears, follow our latest diet, worry about the size of your bum style dialogue can only be creating more and more restrained eaters and that is just plain not healthy. The portion-controlled snack food may not help the restrained eater to control their eating at all and may, inadvertently, cause more stress than they need.

Reference: Journal of Consumer Research 2008; 35 (October): 391-405

Thursday, November 27, 2008

Is it smart to lose weight?

This seems a frivolous question with an obvious answer. But not so fast with your response. Let’s first clarify the question. If you find yourself losing weight without any planning by you, then your weight loss could be a sign of a medical condition. Off to your GP please. Then there are those that really don’t need to lose weight; a distorted view of a normal body shape has probably sent them into the world of eating disorders and weight loss. They too need some outside help.

Intentional weight loss
Let’s just say that your mirror has spoken in a frank manner: “Hey chunky! What’s with the extra curve?” You both then agree that a few kilos could be safely left behind and you join the masses that are “watching their weight”.

Every health authority urges you towards a healthy weight. It makes sense. An overweight person will likely experience a drop in blood cholesterol and blood pressure, while their insulin sensitivity improves. Perfect.

But there is another important question. Will this weight loss make you live longer? A Danish research group says: “Maybe, maybe not”.

Weight loss may not be healthy
At the Institute of Preventive Medicine, Copenhagen, five scientists checked out the research on weight loss and mortality and found that, out of nine studies, only two found a decreased mortality with intentional weight loss in healthy folk. Four found no difference in life span and, disturbingly, three studies found an increased risk of early death in healthy adults over a follow-up period of 13-22 years.

We have to be careful how we interpret these results. It may be that those who lost weight quickly are at a greater risk of early death because they tend to lose more muscle than those that lose weight gradually. There was a hint that mortality rate was higher in people under 60 years of age so they may have already had a pre-existing disease that was not obvious at the start of the study.

So, should you lose weight?
That is your choice. In some cases, it may be a necessity with extra body fat causing joint pain or uncontrolled diabetes. If you are less than 5kg (11lb) overweight, intentional weight loss may be more a cosmetic decision, rather than a health decision.

This review study raises many questions. For example,are those that have ‘dieted’ many times at greater risk than those that have intentionally lost weight 1-2 times? There are some pretty unhealthy ways to lose weight (purging, fad diets etc) that may have reduced life span too. Anyway, I think I’ll play it safe and make sure I don’t lose weight this Christmas.

Reference: Nutrition Reviews 2008; 66(7): 375-386

Sunday, November 9, 2008

What else can make you fat?

Eat less food; do more exercise. Boring as it sounds, we are told that is the key to weight loss. Who willingly enjoys eating less food? History tells us that humans really don’t like to change their eating habits, or any habit really. Which means they prefer not to increase their energy expenditure either, as that means more walking, going to the gym, and even possibly sweating.

Climate change is good for you
Twenty scientists pooled their expertise and the results from around the world to present an argument that if we focus solely on food and exercise in weight control, we have missed other aspects of life that can make us fat.

Climate change may be bad for the environment, but it is great for the waistline. What is the temperature of your house, your vehicle and your office? Many people live at 25ºC (77ºF) all year round. You only need a jacket to wear to get from one climate-controlled venue to another. At 25ºC you will feel very comfortable. Experiencing cold or hot makes your body work and burn energy (kilojoules/Calories). Shivering and sweating both require “work” from the body. There is suggestive evidence that when you feel hot, you also eat less food.

The study in the International Journal of Obesity reports that the average temperature in an UK home rose from 13ºC/55ºF in 1970 to 18ºC/64ºF in 2000. Some Australians will remember having four-eighty air-conditioning in your car in the 60s and 70s. Now every car has “air”. (Four-eighty air-con? Wind down four windows and drive at 80 km/h for a cooling effect).

Quit campaign fattens you up
It is well known that smokers can gain a few kilos when they quit. Conversely, some young women are known to smoke to dampen their appetite. US scientists have estimated that smoking cessation is responsible for 25% of the increase in chubby men and 17% of the extra plump ladies out there. One wonders if some people have a brutal choice: smoke or be fat.

Sleep it off
In 1908, it is estimated that the average adult got nine hours of snooze each night. Now that figure is believed to be closer to seven hours, meaning that we have gone from 40 winks down to 31.1 winks. The authors refer to studies revealing that the less sleep you get, the larger your girth, and this goes for both kids and adults. Sleep deprivation appears to influence hormonal levels involved in weight control, such as higher levels of the hormone ghrelin, which increases appetite. So, next time your partner calls out “Hey, lazy, gedowdabed”, you could remind them of your weight control program.

Wait, there’s more…
The authors offer many other reasons for increased body mass over the years, including Mum’s age. Women are delaying having children until their late 20s or early 30s. Every 5 years later in Mum’s life means a 14% increased chance of having a child who becomes obese.

Even if any of these factors has only a very small effect then, coupled with those two choccy biscuits for morning tea, they could be making a big difference to whether you accumulate fat cells or reduce their size.

Reference: International Journal of Obesity 2006; 30: 1585-1594

Thursday, October 16, 2008

Fat & Healthy

Fat & Healthy

OK, be honest, if you see a chubby person do you think “hey, you look sensational” or “don’t collapse near me please, I ain’t done CPR training in years”? It is difficult not to think that a person with a greater width than you dines on pastries and wouldn’t be wise to plan past the weekend.

There are two (unexpected) types of people
A US report on 5440 adults found there are two types of people we do not normally acknowledge. One group of adults (or phenotype) were healthy, overweight people who did not have the cluster of expected risk factors for early demise, such as high blood pressure, blood glucose and blood cholesterol. Another phenotype is the physically lean person who did have a cluster of risk factors for heart disease and early death.

The study revealed that one in four lean adults were just around the corner from their first heart attack, while a half of overweight adults (yes, half) were healthy on the inside, or “metabolically healthy” in their words. That is, all things being equal, they would live a long and healthy life. Even one in three obese adults were metabolically healthy.

Are thin health professionals too smug?
We are frequently told of the prevalence of overweight and obesity (67% men; 52% women), with the implied assumption that all of these people are going to die young unless they see the error of their habits and start taking better care of themselves. That some people classed as overweight could be healthy will not suit the socially-sanctioned and health professional-endorsed view that all overweight people are, or likely to be, a health burden. And it is easier to make every fat person feel guilty rather than admit that some of them are pretty fit and healthy.

Why is it that we assume that a lean person is a healthy person? It seems that plenty of trim folk have high cholesterol and blood pressure, although they are not publicly admonished as they look healthy. Go to the gym and see the people aiming to get the right look, the “approved look”. Is this self-obsession healthy? When a solid looking guy tells you that he hates Good Friday and Christmas Day because the gyms are closed, you wonder if we haven’t missed something in our list of risk factors for health. I recall a conversation with one 25 year old lady who had decided not to have children. Why? Because she would look fat for five months or so!

Is health just based on measurements?
I wonder whether health is measured solely by what is measurable? We can measure your blood pressure, but there isn’t a simple test for happiness. You won’t find it in the textbooks, but I think that health includes an appreciation of a normal body; for example, pregnancy is normal, being able to bench press 150kg (330lb) is not. Healthy habits also include volunteering, mentoring, giving to charity, hugging your kids, and buying Girl Guide biscuits even if they go to the dog.

The salient point
That point is that you cannot assume that every fat person is a walking heart attack and that every lean person should plan for a long life. A better measure of your health will come from a knowledge of what is happening on the inside, such as blood cholesterol, blood pressure, fitness levels and Prostate Specific Antigen in men. On a different level, it would be wise to meet with your friends each time assuming it could be the last, independent of their size. Morbid, I know, but that thought could get you to appreciate them more each time you do see them.

Reference: Archives of Internal Medicine 2008; 168 (15): 1617-1624

Tuesday, October 14, 2008

Nutrition Impact #1

Can you believe it? Only 3% of people follow a healthy lifestyle. If there was you, me and your mother then the next 97 people would be unhealthy. And where did we get the word vitamin from? All this in five minutes.

Wednesday, October 1, 2008

Junk Food Tax

Junk Food Tax

It is socially sanctioned, media attractive, and loved by just about every health authority (and self-proclaimed health authority) in the land. The “junk food” tax is seen as a means of generating revenue and a way to get people to stop eating their favourite treat.

Community support
Many people for a long time have requested a food/fat tax of sorts. A survey in the US last year found that three quarters supported a tax, yet two out of five said that a tax wouldn’t change their eating habits. A report from the Economic Research Service of the United States Department of Agriculture in 2004 concluded that a small tax “is unlikely to have much influence on consumer diet quality or health”. Of all the groups suggesting a fat tax in the US, the report found that none had specified how they would use the extra funds to improve eating habits or food choice.

Here in Australia, Access Economics produced a 2006 report that estimated the direct cost of obesity to be $3.8 billion, with nearly half of this due to lost productivity. In the report, they claim that the idea of a “fat tax” is flawed. A broad tax on certain foods doesn’t target obese people and assumes that obese people overeat only taxed foods. The tax also assumes that a higher cost will shift consumption away from certain foods towards healthier foods. Access Economics use the example that having virtually free tap water has not shifted consumption away from soft drinks and fruit juices.

What to tax?
Even if you did tax certain foods, on what would you base the tax? Fat? Saturated fat? Salt? Sugar? Or combinations of these components? If it was a fat tax, then it may include oils (100% fat) and nuts (50-80% fat). But hang on, you say, they aren’t junk foods. So how do define a junk food? One that is high in saturated fat and salt may be your answer. If so, then cheese is a junk food. OK, you didn’t mean cheese, you meant potato chips. What about high sugar drinks like soft drinks? Well, they have the same sugar content as pure fruit juice. Should we tax juice? You will notice that anyone proposing a food tax never, ever defines what to tax, most likely because their thinking is based on an emotional argument and not a practical argument.

What level of tax?
If you wanted to enforce an additional tax on a food, what level should it be at? On this next comment, I am speculating. What if a $3 serve of fries attracted a 50% tax to take it to $4.50? If that did change sales, and I doubt it, the fast food outlet might just decide to use a poorer quality cooking oil and take a revenue-neutral or small-loss stance and sell them for $2.00 instead. Add the 50% tax and you have a $3.00 serve, the same price as before, only now with more cholesterol-raising potential. Who is the winner here? As I said, I am only speculating, but it is a definite possibility. McDonalds has twice changed its cooking oil in the last four years to reduce saturated fat levels. Love them or hate them, it is the right direction to head.

Another option
Rather than taxing foods, in may be more productive to offer tax incentives to food companies to encourage changes to their recipe formulations. Food companies in Australia and New Zealand have made concerted efforts to reduce sodium, saturated fat and trans fats in the food supply. The Heart Foundation tick program each year has removed 235 tonnes of salt from the Australian food chain and over 35 tonnes from the NZ food supply, compared to pre-2002. Margarine manufacturers virtually deleted trans fatty acids from table margarine around a decade ago. Maybe food companies are a lot like children – they respond better to encouragement than regular beltings.

Thursday, June 5, 2008

Alcohol benefits the wallet

On one hand health authorities bemoan the abuse of alcohol, while on the other hand there are those promoting the potential health benefits of moderate alcohol drinking. The former causes car accidents, domestic violence and liver disease; the latter may be due to the alcohol reducing blood clots that cause heart attacks or possibly the antioxidants helping to protect heart and brain damage.

Yet, no-one tells you about another potential benefit of alcohol - a bigger pay packet. Economists over the last 20 years have noted that alcohol consumers earn more money than teetotallers, usually between 7-10% more. A recent study showed that full-time female workers earned 23% more than female abstainers, and full-time male workers earned 19% more than male abstainers. All those government health programs promoting the avoidance of alcohol may not be good for the economy.