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    Archive for the ‘obesity’ Category

    2011: A Year to Remember (and Forget!)

    It wasn’t until I started compiling stories for this post that I realized just how much had taken place this year on issues of food, agriculture, and nutrition. While by no means a definitive list, I think it covers the most substantial events.

    So, if you’ve been spelunking in Antarctica for the past twelve months — or just want a short trip down memory lane — let’s review 2011, the year where:
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    Call Off the War on Obesity

    “The war on obesity” has become a familiar battle cry.

    It serves as the basis for professional health conferences or exploitative “motivational” extreme-weight-loss shows like The Biggest Loser, and is referenced almost daily. Despite the intent to increase awareness of a public health issue, it is plagued with problems that severely impede progress.

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    Don’t Blame Obesity on Carbohydrates

    Ever since the second-coming of the Atkins Diet in 2003, carbohydrates have taken the blame for rising obesity rates.  Before I go any further, let me make it clear that this country’s steadily rising intake of added sugars (which increased by 23 percent from 1985 to 1999, and currently clocks in at 156 pounds per year per person) has undoubtedly played a major role in the contribution of empty, and mostly liquid, calories that do not satiate and therefore do not discourage the consumption of additional calories.

    However, the dangerous and inaccurate carb-phobia out there goes far beyond added sugars, vilifying all carbohydrates, essentially equalizing oatmeal with soda, chickpeas with donuts,  and brown rice with Froot Loops.

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    “Food Politics: Advocacy for Social Change” — A Wonderful Talk by Marion Nestle

    nestleLast night I was grateful and honored to have a reserved seat for a talk given by Dr. Marion Nestle at The University of Washington to a sold-out audience of over 400 students, faculty members, and food policy buffs (the lecture was open to the general public).

    What follows is a bullet-point, Cliffs Notes style recap of Dr. Nestle’s presentation; consider it a crash course in food politics 101!

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    Guest Post: Why Is McDonald’s Listed As a Resource For Childhood Obesity Awareness Month?

    RonaldI am not a fan of any sort of “awareness” month as I find the concept trivializes important health issues. Are we only supposed to care about heart disease, diabetes, etc, during that one month of the year? And I rarely see anything of substance come from the month-long activities, just the usual ineffective educational campaigns, instead of meaningful public policy reforms. Plus many issues tend to crowd themselves into certain months, so it all becomes background noise. September is one such month. Among other causes (e.g., “cholesterol education“), September has been proclaimed “Childhood Obesity Awareness Month” by Congress and President Obama.

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    Guest Post: Eat Less vs. Move More

    Slide1In her August 21 New York Times Slipstream column Natasha Singer opens by asking:

    “WHY are Americans getting fatter and fatter?  The simple explanation is that we eat too much junk food and spend too much time in front of screens — be they television, phone or computer — to burn off all those empty calories.”

    I agree that, as a population, we are eating too much, but is exercise really the solution to America’s growing obesity epidemic?

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    I Didn’t Know PepsiCo’s CEO Did Standup!

    14273237_indra-nooyi_01I just came across this CNN interview from late April with PepsiCo CEO Indra Nooyi.  Apparently, she’s quite the comedienne.  Move over, Kathy Griffin!

    “If all consumers exercised, did what they had to do, the problem of obesity wouldn’t exist.”

    Really?  Obesity levels have exponentially increased over the past three decades, but gym memberships haven’t taken a sudden plunge.  Similarly, surveys and polls don’t show that Americans are exercising any less today than they were in the ’80s or ’90s; quite the opposite, actually!

    This is the basic “personal responsibility” argument on steroids.  It surpasses the usual “well, our foods aren’t meant to be eaten all the time” message to now completely discredit nutritional approaches to obesity.  Apparently, chips and soda every day are a-okay as long as you hit the treadmill (for, what, six hours?).

    Ms. Nooyi also falls prey to the fallacy that health is only about weight.  One can be at a healthy weight but subsist on highly-processed, minimally-nutritious junk that increases blood pressure and heart disease risk, to name a few conditions.

    “If I look at our portfolio, I think you can classify them into three groups: “fun-for-you foods” like Pepsi, Doritos, Lays, and Mountain Dew, “better-for-you” products like Diet Pepsi, PepsiMax, Baked Lays, Sobi Life Water, Propel, all of these products, and “good-for-you” products like Quaker, Tropicana, Naked Juice, Gatorade.”

    “Fun-for-you foods”?  I understand she’s not going to bash her own product line, but why not call a spade a “kinda-sorta” spade and at the very least classify those foods as “occasional treats”?  Besides, we all know there is nothing “fun” about your breath after you eat a few Cool Ranch Doritos.

    Diet soda a “better-for-you” product?  News to me!  An absence of calories and sugar does not automatically make a food healthier, especially when the calories and sugar are replaced with a long list of chemicals (most of which have no studies demonstrating that long-term consumption is safe).

    Referring to Quaker and Gatorade as “good-for-you” is also a stretch.  Gatorade is essentially sugar water (its electrolyte values are a joke), and while the Quaker line does include straight-up, unsweetened oatmeal, many of their products contain a hefty amount of added sugars.  The mere presence of oats does not make a product healthy, especially if the oats are accompanied by sweeteners and/or oils loaded with omega-6 fatty acids.

    “The longevity in parts of China is very, very high because there’s a lot of traditional Chinese medicine that is based on herbs that really help lifestyle management, that really help body mass index down, that really help the longevity of the person.”

    You know why else longevity in certain parts of China is very high?  Residents eat whole, unprocessed foods.  They aren’t munching on “fun-for-you” foods like Doritos or chugging 20-ounce bottles of sugar water with a pinch of potassium Gatorade.

    Herbs that help keep body mass index down?  Wait a minute, didn’t she just say that the only way to not be obese was by exercising?

    I’m also surprised — and disappointed — that someone of Asian heritage would play into the stereotypical exoticization of East Asian cultures (“they don’t stay healthy just by watching what they eat, they also ingest magic and secret herbs!”)

    “Now, I’m not talking about “pixie dust.” I’m talking about real science-based stuff.”

    Ah, of course, the ever-popular “herbs aren’t REAL science” argument.  Long live narrow-mindedness!  You would think that if Ms. Nooyi was such a “real science” buff, she would have some appreciation for nutrition science and acknowledge its importance in weight management.

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    You Ask, I Answer: Endocrine Disruptors & Obesity

    Keep-the-Weight-Off-After-You-ve-Lost-It-Weigh-Yourself-Daily-or-Weekly_slideshow_imageWhat do you think of articles (like this one) that link chemicals known as endocrine disruptors with obesity?

    — Various Readers

    While on vacation last week, I received over a dozen e-mails inquiring about endocrine disrupting chemicals (EDCs) and their potential role in “making Americans fat”. 

    Also known as “obesogens”, these chemicals are present in pesticides, plastic containers, and unfiltered tap water.

    According to the article linked to in this post, EDCs explain why “traditional diet advice — choose chicken over beef, eat more fish, load up on fruits and vegetables — may not work anymore.”

    Hold up.  Do you see the problem with that description of supposed “traditional advice”?  None of it is about eating fewer calories!   “Choose chicken over beef”, for example, has very little to do with caloric intake (that advice has more to do with lowering saturated fat intake).

    While I am not denying that EDCs exist, and can pose health consequences to us, I really dislike the notion that they are the reason “why you can’t lose those last ten pounds.”

    EDCs may very well be a tiny factor in rising obesity rates, but we can’t ignore the main one — excessive caloric intake.

    By “excessive caloric intake”, I don’t simply mean “we are eating more”.  To me, “excessive caloric intake” encompasses crop subsidies (which make heavily processed, not-at-all filling ingredients cheap), exploding portion sizes (a direct result of crop subsidies), food deserts, and other social factors. 

    Imagine, if you will, that you light a match and start a fire outdoors.  A gust of wind will strengthen it, but it did not start the fire.  The same can be said about EDCs and obesity.  They very well could be the wind that provides some extra fuel to the obesity flame, but they are certainly not the match that started it all.

    I am not downplaying the benefits (both personal and environmental) of eating organic produce and avoiding BPA, but keep in mind that many people have successfully lost weight while strill drinking unfiltered tap water, eating conventional produce, and eating/drinking items from plastic containers. 

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    You Ask, I Answer: Agave Is The New Enemy?

    Before reading my response below, I recommend you read his article first.

    One more thing before we get started.  Look back at previous posts on this blog and you will see I am by no means an agave enthusiast.

    From the inception of Small Bites, I have always said that, in my world, “sugar is sugar is sugar”.  All sweeteners offer 4 grams of sugar (16 calories) per teaspoon.  The best thing you can do is limit all added sugars — whether it’s white sugar, brown sugar, maple syrup, honey, or agave.

    That said, I don’t see the need to demonize agave, which brings us to this post.

    Dr. Mercola’s statements are in red.  My responses are in black.

    “We have an epidemic of obesity in the US and it wasn’t until recently that my eyes opened up to the primary cause – – fructose.”

    Here we have one of the most basic (yet very prevalent) erroneous statements about obesity rates — that a certain component in food “causes” obesity.

    Rising obesity rates are clearly linked to increases in caloric consumption.  Technically — though very misleadingly — one could argue that carbohydrates are behind rising obesity rates in the sense that some of the additional calories consumed over the past thirty years come from carbohydrates.

    Protein intake has also increased in the past forty years, so one could also technically claim protein is behind rising obesity rates.  Of course, those sorts of statements are ultimately untrue and distract from any sort of serious conversation on the matter.

    The issue with sweeteners — ALL of them — is that they provide empty calories.  Empty calories do not satiate.  That is why we can easily drink 600 calories of soda (whether it is sweetened with high-fructose corn syrup, brown sugar, or agave nectar) and still feel hungry.  Eat 600 calories of a whole food that offers fat, protein, and fiber and I guarantee you will be full for hours.

    “Depending on the source and processing method used, agave syrup can, therefore, contain as little as 55% fructose, the same amount found in high-fructose corn syrup — in which case the syrup would offer no advantage.”

    Except that no one who consumes agave seeks it out because of lower fructose levels. Some reasons why individuals prefer agave over high fructose corn syrup (HFCS) include:

    • Avoidance of genetically modified organisms
    • Flavor/texture preferences
    • Veganism (the filtration of white table sugar often utilizes bone char from animals, thereby making it unsuitable for vegans)
    • Practical use (you can purchase agave nectar and bake with it, add it to beverages, or pour some over yogurt)

    “Most commercially available agave is converted into fructose-rich syrup using genetically modified enzymes and a chemically intensive process involving caustic acids, clarifiers, and filtration chemicals.”

    Okay, and most yogurts contain excessive amounts of sugar.  That doesn’t mean all yogurt should be avoided.  Similarly, a lot of salmon is farmed and offer less omega-3s than wild salmon.  The key isn’t to completely shun salmon, but to know which types to pick.  That said, though, the processing of agave only requires one step.

    As Marion Nestle explained on her Food Politics blog earlier this year, “agave contains inulin, a polymer of fructose, which must be hydrolyzed (broken down by heat or enzymes) to fructose to make the sweetener.  It’s a processed sweetener requiring one hydrolysis step, requiring more processing than honey and less than high fructose corn syrup.”

    Raw agave nectar achieves this process through enzymes, while other varieties utilize heat.  I don’t know where the “caustic acid” notion comes from.

    “While agave syrup does have a low-glycemic index, so does antifreeze — that doesn’t mean it’s good for you.”

    A pretty terrible comparison.  I am not a fan of labeling foods as “good” or “bad” based solely on their glycemic index.  After all, ice cream has a ‘better’ score than watermelon.

    “There are also concerns that some distributors are cutting agave syrup with corn syrup — how often and to what extent is anyone’s guess.”

    Concerns that have never been substantiated, to the best of my knowledge.  Again, they key is to look for reputable sources.  Look for the USDA Organic seal on bottles of agave nectar, and make sure the ingredient list only lists agave nectar.

    “Agave is known to contain large amounts of saponins. Saponins are toxic steroid derivatives, capable of disrupting red blood cells and producing diarrhea and vomiting. There is also a possible link between saponins and miscarriage by stimulating blood flow to the uterus, so if you’re pregnant, you should definitely avoid agave products.”

    Saponins are found in a variety of foods, mainly legumes and beans.  They actually have health-promoting effects, including the lowering of LDL cholesterol.  When consumed in extremely high amounts, they can cause gastrointestinal distress.  Look at the data, though. and the amount of saponins needed to experience those symptoms is ridiculously high.  Dr. Mercola’s hyperbolic statements would be akin to a warning not to drink wine because it contains alcohol, which is capable of causing alcoholic poisoning.

    “Fructose only becomes a metabolic poison when you consume it in quantities greater than 25 grams a day. If you consume one of the typical agave preparations, that is one tablespoon.”

    I don’t know where the “25 grams a day” figure comes from.  It is not referenced and I certainly have not seen it in any reputable journal or publication.  What is most ridiculous about this quote is that it literally doesn’t add up.

    One tablespoon of agave nectar contains 12 grams of sugar.

    Let’s assume we are talking about one of these “super high in fructose varieties”.  Fine, if ninety percent of that sugar is fructose, that leaves us with 10.8 grams of fructose.

    How Dr. Mercola concludes that a tablespoon (12 grams) of agave equal 25 grams of fructose beats me — and scientific reasoning.

    For the record, a medium mango contains more than 25 grams of fructose, so does a medium pear and half a mango.  Would you consider that “metabolically poisonous”?

    As for pesticide claims: if this is a concern for you, look for certified-organic agave.

    Is agave addictive?  I have yet to see any evidence of that.  The very preliminary — and very controversial — research on sugar addiction only places the spotlight on sucrose, not fructose.

    As I have stated before, I never considered agave a “wonder” food.  I never advocated liberal consumption, nor did I classify it as “healthy”.  While I take issue with anyone who classifies agave as a health-promoting “super food”, I also will not stand for absurd demonizations of it.

    As one distributor or raw, organic agave put it, “[Agave] is not going to solve world peace, cure cancer or do your laundry, but it will provide a delicious alternative to highly refined sweeteners, poor tasting nutritive sweeteners, and high glycemic natural sweeteners.”

    One last point — what is it about the word “doctor” that inspires blind trust in so many?  For years now, I have heard people parrot absurd nutrition “facts” with the assumption that said information must be true because “a doctor” said it.

    Don’t get me wrong.  There are many intelligent, well-informed doctors with extensive nutrition knowledge.  There are also those who, for whatever reason, believe that having ‘MD’ after their name automatically makes them THE authority on every topic under the umbrella of health.

    The word “doctor” before someone’s name simply means they were granted an MD or PHD.  It tells us absolutely nothing about someone’s character, motivations, or extent of knowledge.

    So, no, Edrie, please do not forward that inflammatory article to your girlfriend.  Allow her to enjoy a small amount of agave nectar in her coffee.

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    In The News: Food Addiction, Redux

    fast food collection on on white backgroundWhen it comes to food addiction, I firmly stand in Marion Nestle’s “mostly skeptical” camp.

    Alas, CNN.com (via Health.com) is sharing the conclusions of a rat study conducted at the Scripps Research Institute which found that “bacon, cheesecake, and other delicious yet fattening foods may be addictive.”

    More specifically, “[the] new study suggests that high-fat, high-calorie foods affect the brain in much the same way as cocaine and heroin. When rats consume these foods in great enough quantities, it leads to compulsive eating habits that resemble drug addiction, the study found.”

    One of the most eye-rolling components of these articles is that the foods referred to as “high-fat and high-calorie” are your usual suspects: cheesecake, frosting, sausage, bacon, etc.

    Let’s not forget, though, that there are plenty of healthy and nutritious high-fat, high-calorie foods: coconut, almonds, cashews, pecans, walnuts, salmon, avocado, etc.

    I have yet to hear someone who claims bacon is addictive also tell me they have a hard time saying no to an extra ounce of pecans, or that they find themselves gorging on salmon steaks.

    Many of these foods, by the way, are not simply high in fat — they are also high in added sugars.  So, why is fat being singled out as the “addictive” nutrient?

    Some more details on the study:

    “[Researchers] studied three groups of lab rats for 40 days. One of the groups was fed regular rat food. A second was fed bacon, sausage, cheesecake, frosting, and other fattening, high-calorie foods–but only for one hour each day. The third group was allowed to pig out on the unhealthy foods for up to 23 hours a day.

    The rats in the third group gradually developed a tolerance to the pleasure the food gave them and had to eat more to experience a high.  They began to eat compulsively, to the point where they continued to do so in the face of pain.

    When the researchers applied an electric shock to the rats’ feet in the presence of the food, the rats in the first two groups were frightened away from eating.  But the obese rats were not.

    My main issue with these studies is that they truly leave me with a “so what?” feeling.  I have a very difficult time making parallels to human behavior.

    Am I supposed to believe that an obese individual who is physically addicted (which is very different from emotionally addicted, which, to me, is significantly more credible) to junk food will continue to wolf down bags of Doritos while bleeding from a shotgun wound?

    Additionally, if the group of rats that developed this food addiction were able to binge up to 23 hours a day on a very small number of foods, how is that applicable to the human experience?

    Another frustrating thing for me about these studies — it lets food companies off the hook.  Can’t you just see it now?  “Oh, no, it’s not our 64 ounce sodas that contribute to obesity; it’s you addicts that can’t stop yourselves!”

    Something else to ponder: all of these foods existed — and were consumed — long before obesity rates skyrocketed.

    Thank you to Claudia Zapata, MS, RD, for tweeting the CNN article. You can follow her at @ClaudiaZapata.

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    Framing the Obesity Issue

    obesity-advertisingEarlier this week, I received an e-mail from Small Bites reader Sara Zuba. With her permission, I am pasting it below because what she shared with me was simultaneously frustrating and eye-opening:

    I am a recreational therapist and currently in school to be a personal trainer. Last week, I attended the ATRA (American Therapeutic Recreation Association) mid year conference down in Mississippi.

    The opening keynote speaker of our conference was an MD, and addressed the obesity epidemic. This is a hot topic in our profession and it came up many times throughout the conference. Being that Mississippi is the fattest and least healthy state, I was shocked at their approach to combating this disease. No one mentioned the lack of exercise or school lunch programs. It seemed like they were looking for a scapegoat. One of the MDs stated, “My kids exercise all the time and they are still overweight. They must be putting something in the water.”

    I mentioned to a few of my fellow therapists that as someone coming from the northeast, I had never been to Mississippi and I had also never seen so many Waffle Houses and other fast food chains in such a short proximity. I never once saw a gym or a grocery store (other than Super Wal-mart). There were also miles of beaches with nice sidewalks and no one utilizing them on a sunny weekend day.

    As much as the general public likes the notion of having one factor singled out as causing rising obesity rates, that kind of thinking is reductionist, inaccurate, and misguided.

    Unfortunately, the players with the loudest voices stand on completely opposite ends of the spectrum.

    Most food companies and restaurant chains love to regurgitate the “personal responsibility” angle, placing the entire burden on consumers’ shoulders.

    On the other hand, you have groups of activists — and class-action lawyers — who approach the obesity debate with the assumption that consumers are completely ruled by advertising and external influences, and have no power of choice.

    I stand firmly in the middle.

    Consumers always have a choice.  Even in situations where the only options for a meal are fast food restaurants, choices are abundant (ranging from size of sodas and side items to whether or not to have dessert).  Similarly, it is up to each individual whether or not they join a gym, take the stairs instead of the elevator, or sign up for weekly kickboxing lessons.

    We can not, however, ignore environmental and societal factors.

    Consider portion sizes.  I find it very disturbing when a sundae at an average restaurant is a 1,500 calorie monstrocity.  As Brian Wansink’s research has clearly shown, when food is in front of us, it takes tremendous awareness and self-restraint to only eat a small portion.

    Similarly, it seems silly to talk about rising obesity rates and increasing portion sizes without taking into account crop subsidies that not make it possible to buy 64 ounces (500 calories) of a soft drink for a mere two dollars, but also explain why school lunches across the country are trays full of overly refined ad highly-processed foods.

    As this article explains, geographical location and urban “food deserts” greatly affect eating habits in certain neighborhoods.

    We can’t ever attempt to start working on a solution if we can’t even identify the real problem.

    Thank you to Nilsa Duran for forwarding me the linked article.

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    In The News: Good Riddance, Naughties!

    HP2010_webTechnicalities of when a decade truly begins aside, I say good riddance to the ’00s (or “naughties”, as they are commonly known).

    As far as I’m concerned, the past decade was akin to a really bad dress rehearsal starring a mostly repulsive cast of characters.

    Adding one more drop to that big bucket of failure, and much to the delight of Debbie Downers everywhere, The San Francisco Chronicle reports that the nation’s health goals outlined in Healthy People 2010 were not met.  And by “not met” they mean “wow, that wasn’t even close!”

    In case you are unfamiliar with Healthy People 2010, they are a list of “objectives… first created in the late 1970s [by the Department of Health and Human Services] to set an agenda for getting Americans to live longer, healthier lives.”

    You can see the full list of Healthy People 2010 goals — as well as proposed objectives for Healthy People 2020 — here.

    Although workplace injuries have decreased (golf clap) and vaccination rates have increased, “there are more obese Americans than a decade ago, not fewer. We eat more salt and fat, not less. More of us have high blood pressure. More of our children have untreated tooth decay.”

    Ready for more bad news?  While 41 percent of goals outlined in Healthy People 1990 were met, that number tumbled to 24 percent for Healthy People 2000.

    Data on Healthy People 2010 is still being tabulated, but it appears the success rate will fall somewhere between 18 and 20 percent.

    Granted, it would help if the general population was aware of the existence of Healthy People.  Or, even better, if Healthy People did more than state goals.  How about raising funds to tackle a few of the more pressing issues?

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    Numbers Game: This is What Is Meant By “Healthy Weight”

    broken_heart_by_starry_eyedkid-1Excess weight  (and its health consequences) is believed to be the main factor in _____ percent of heart disease cases and _____ percent of strokes.

    a) 64/68
    b) 79/52
    c) 41/80
    d) 53/74

    Leave your guess in the “comments” section and come back on Friday for the answer.

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    In The News: Behind the Scenes of “The Biggest Loser”

    biggest-loserI never understood the popularity of NBC’s weight-loss reality show The Biggest Loser.

    Actually, let me backtrack.  I get why The Biggest Loser is a hit — it appeals to our interest in makeovers, weight-loss, and cheering for the underdog.

    What I don’t understand is how a show that humiliates obese people (the sight of publicity-obsessed Jillian Michaels berating an obese person panting on a treadmill doesn’t scream “empowering” to me) and condones unhealthy weight-loss practices (i.e.: six hours of a day of exercise, extreme caloric restriction) was so welcomed by millions of television viewers.

    Today’s New York Times features a much-needed article on just how dangerous this show’s diet and exercise guidelines can be.

    Of course, the show’s producers attempt to justify their reality circus by giving lip service to America’s “obesity crisis” and inspiring people to be the best they can.  Blah, blah, blah.

    Not surprisingly, medical and nutrition consultants to the show have nothing but praise and positive comments for the show they are employed by!

    I wholeheartedly agree with many of the statements made by Dr. Charles Burant, a professor of internal medicine at the University of Michigan Health System director of the Michigan Metabolomics and Obesity Center:

    “I’m waiting for the first person to have a heart attack.  I think the show is so exploitative. They are taking poor people who have severe weight problems whose real focus is trying to win the quarter-million dollar [grand prize].”

    Meanwhile, how much longer do I have to put up with those heinous commercials for Jillian Michaels’ various pills, supplements, and “fat burners”?  Enough is enough.

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    Numbers Game: Answer

    cataract_lRecent research from the Nurses’ Health Study and the Health Professionals’ Follow-Up Study indicates that, diabetes aside, obese individuals (BMI > 30) have a 36 percent higher risk of developing cataracts than individuals with BMIs between 18 and 23.

    Researchers attribute this heightened risk to the increased glucose intolerance — and insulin resistance — caused by excess weight.

    Other studies have also concluded that obesity concentrated in the abdominal area (seen more commonly among men) is a higher risk factor for cataract development than excess weight that is mainly distributed in the hips and thighs.

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