You Tube and the Dietary Guidelines for Americans

I am attempting to embed a power point presentation into my blog.  Consider this a test.  I am using a hosting site call Scribd.  Using the blog or the host site means that you do not have to download the presentation or have any special program to view it.
The power point itself - the slide show - has links to the internet that you can click on while viewing. 

 [I do not think the presentation will show up in an email message so if you receive this blog in email format, you will have to come to the Your Health Educator website just click on the hyperlink in your mail message].

Below is the presentation I entered in the Graduate Student Creativity Expo at my university .  If the slide show is not here - or fully operating (there are over 20 slides) then click on the You Tube for Weight Control link above it and that should take you to the hosting site.  That is If you want to see the presentation.  IF you don't care to see it just come back tomorrow and I will have found something else to talk about :)

You Tube for Weight Control

How Healthy Is Your State/County?

I can't believe it has been another year - but it has and the results are out.  You can look up your state and the county where you live.  You can compare the county rankings on overall health or particular factors.  For example, Sarasota Co is the 3rd healthiest of 66 counties in Florida.  You can look at disease, early death, low birth weight. You can also look at things like obesity and physical activity.  You can even see which county has the most access to healthy foods!  A table lists the number of zip codes in the area and the number of zip codes with access to healthy foods and creates a ratio.  Pretty awesome.

Explore it yourself by clicking here.

(BTW - I heard today that the BMI is not capturing the true extent of the countries obesity rates and we are actually fatter than we thought - great)

Raisins and Blood Pressure

Several news outlets have reported on findings that were discussed this past weekend at the American College of Cardiology Annual Conference, but I have not been able to track down the actual published research.  It may not be published yet. 


There were actually two stories making the headlines - one involves raisins and the other soy products.  Both are said to be associated with a lowering of blood pressure in the people studied.

The raisin research (for which I have no rich details) involved at least two groups of people.  One group had a snack of about a handful of raisins three times a day and the other group had a different snack, like cookies.  The results are that the raisin group lowered its blood pressure numbers and the mechanism is thought to be the potassium in the raisins.  Potassium has been found to lower blood pressure.
I want to look at the study to see 1) what else was going on 2) how much the blood pressure changed, and 3) if the snacks were equivalent calorie wise.  The raisins would have about 85 calories times 3 servings.  Over 250 calories of snack food every day.  Raisins are not a low energy dense food so those 85 calories are not that many raisins.

Just some things to think about - perhaps another place to get potassium is in bell peppers!

Weight Based Terminology

Puhl RM, Peterson JL, Luedicke J. Parental perceptions of weight terminology that providers use with youth. Pediatrics. 2011;128:e786-e793

I came across an article from Medscape that had to do with doctors addressing obesity or overweight with their young(child) patients.  I had just posted my comments about kids and calories when the Medscape Week In Review landed in my inbox, so I saved it.

I took a break from my studies today, just to give it a quick read for the purpose of summarizing it here.  Well, of course, the advice to physicians comes from the results of a research study.  A survey based one at that (my favorite).  So you know I had to track it down and read about the sample, methods and data analysis.  I am a nerd that way.

These tangents were fine when I was in Florida, but are an indulgence with a price these days.  

So bottom line:

• docs need to address the issue because overweight/obesity lead to adverse  psychological and physical outcomes (teasing, alienation, disease)
• parents respond differently to the language doctors use
• the least stigmatizing or blaming terminology should be used - suggestions are based on the survey responses of nearly 500 parents  (70% of the sample was white and the majority had more than a HS education) 
• the words used (along with some personal traits of the parents) has an impact on the parents response to the physician's assessment
• even when the doctors used the words that the parents found the most blaming or stigmatizing the majority (71%) still said that they would encourage their children to lose weight
• the researcher is concerned that other parents will either find another doctor, not follow up with health care, or worse - put their child on an extreme diet

The survey results found that the terms the parents found most motivating (for weight loss) and least blaming were "weight problem", "unhealthy weight" or just "weight."

The words that were most stigmatizing and least helpful were "obese", "fat" and "extremely obese."
My favorite way to say it is "unhealthy weight."  I think that parents need to hear the connection between weight and health.  

The responses or answers were compared by some demographics and other traits (called psychographics).  For example, did the choice of most helpful response (unhealthy weight) change based on a persons race, gender, income, education level, own weight status, history of personal victimization or child's victimization, or the parents score on the fat phobic scale.  Yeah, thought that last one might get you.  I looked it up and it is attached below.  

The answers were pretty consistent by all traits with only subtle differences noted.

Here is a link to the Fat Phobia Scale (I would call it the fat negativity scale myself)

Here is the summary for the research article by Dr. Puhl.

Odds and Ends

Label Policy : First, a great thanks to Jennifer Pomeranz at the RUDD Center for getting back to me so fast on the labeling law update.  She gave me some information that comes from the Center for Science in the Public Interest, or CSPI.  I have mentioned them before and am a fan.  Here is the email content from Hannah Jones, Nutrition Policy Project Assistant:

As you may know, a number of policy issues are holding up the final rule for national menu labeling.  
The key policy issues to address are:

 
Definition of Retail Food Establishments

• The final rule should cover all retail food establishments that sell restaurant-type food, including movie Theaters, supermarkets, and convenience stores.

Alcohol labeling

• Alcohol should be required to be labeled in the final rule.  According to the Dietary Guidelines, alcoholic beverages are the fifth largest source of calories in American adults’ diets.

Vending Labeling

• Vendors should not be allowed to post a sign next to a vending machine instead of posting calories beside each individual item or the selection button.  Nutrition information needs to be easy to see, find, and use.

Colace: At some point this week, I heard a commercial for the OTC product Colace.  I don't even remember what was said, only that I thought - No No - these pills are just not the best way to maintain regularity.  So I wrote down Colace on my O&E list and today I looked it up.  I found  information on a PubMed website.  Colace is a type of stool softener that should be taken on a temporary basis by people who need to avoid "straining" to have a bowel movement.  Oh, let us all avoid straining - don't you think?  Whole grains and fiber - unless you are unable to eat actual foods (and some people really can't) - are a much better way to maintain your constitution.  Food is so much better than pills, powders and enemas! 

Heinz/TGIF -REALLY?:  Heinz Co has a business relationship with TGIF - at least the TGIF frozen food items that you can buy at a grocer.  This week a business wire story proclaimed the benefit of this relationship ($250 million for Heinz) and highlighted a new product.  I had a bit of a jaw drop over the product - macaroni and cheese wedges.  (Who is it that thinks the food manufacturing industry cares about obesity?)
The snack is pasta and cheese that is made into a wedge, breaded and then baked? fried? - who knows.  A 3 wedge serving, just 81grams, has 240 calories and 3.5 g of saturated fat.  The ingredient list is HUGE and certainly would not qualify as minimally processed!
Here is a paragraph from the Business Wire article published 3-7-2012.

T.G.I. Friday’s frozen Mac & Cheese Wedges combine macaroni pasta with a creamy cheddar, Parmesan and Romano cheese sauce and are coated in a crispy breading. This innovative new product that embodies the fun and flavor of the T.G.I. Friday’s brand begins shipping this month and will be available at major retailers in a 15.5 oz box for a suggested retail price of $5.99.

Grown Ups and Milk: I will attach the story that caught my eye, especially because Marion Nestle is quoted there in and she says some things that I have said.  (I always like that!) The gist of it is that schools are under order to limit the amount of sugary sweetened beverages students have access to, and the percent of fat in the milk served(good changes based on efforts to reduce overweight and obesity in our children).  This however, leads to a reduction in sales for the milk industry and so  - adults are the new target for chocolate milk.  And make no mistake, those Milk - It Does a Body Good campaigns are NOT from a health organization - they are from a retail organization. And because they are coming after you, you might want to read the story here. 
I will leave you with some great words of wisdom from  Marion Nestle (from the attached article).

"As the pressure on schools has grown to get chocolate milk out, they're looking for any new marketing," says Marion Nestle, nutrition professor at New York University. "I'd never recommend drinking a sweetened drink. People shouldn't drink their calories."

Funny that she also advises that after a workout one should eat a sandwich.  I was just telling my friend today that I don’t drink sports drinks (w/ sugar – or calories) and that I actually have gone on long runs with peanut butter sandwiches in my running belt!  

 

The Powerlessness of Obesity "Treatment"

I would like you to take a look at this two-page editorial which was published in the New England Journal of Medicine - NEJM - in 2009.  It is in response to a research study, which we probably discussed at some point, which reviewed the impact of different macro nutrient combinations on weight loss in  a reduced calorie situation. 

I have always contented and made arguments regarding, the futility of diets.

Here are two specific points in the article by Dr. Martijn Katan that I want to bring to your attention:

Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices (p924)

AND

 ...we may need a new approach to preventing and to treating obesity and it must be a total-environment approach that involves and activates entire neighborhoods and communities. ... because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery(p924)   (YIKES!!)

 In the article, Dr. Katan gives an example of an intervention in France where one of the strategies used was "cooking workshops."  To which I say, "Volumetrics anyone?"  My You Tube channel is ready to hit the road :)

Referenced Editorial by:

Martijn B. Katan, Ph.D.

Published here:

N Engl J Med 2009; 360:923-925

 February 26, 2009

How's Your Fresh Food Access?

Do you live in a food desert ? - defined by the US Farm Bill 2008 as an area in the United States with limited access to affordable and nutritious food, particularly such an area composed of predominantly lower income neighborhoods and communities.

Last night I attended a sustainability meeting for a 12 county region.  There were many display boards in the room, but one caught my attention.  It was a map of the area food deserts, showing that 17% of residents lived in one.

If you would like to see if you live in a food desert - enter your zip code in this locator.  IF your dot is in a pink area, then you live in a food desert. I entered my last zip code in Florida and there was no pink to be found.

But when I put in my current zip code, I was surrounded by food deserts.

Comparative Fatness

My title is a word play on a concept that was addressed in a recent news paper article or series of articles.  A journalist, Marni Jameson, interviewed several health experts for her four part series "Why We're Fat." 
I was most interested in the last piece and you can read it in its entirety here.  Part 4 focuses on the environment and governmental policies, which are also my areas of research and career interest.  I particularly would suggest that you look at numbers, 1,2, 4 and 8-10 if you are curious about my leanings. 

Item 8 is the one that inspired my title, but in Jameson's article, Steve Smith, PhD is credited with saying "Fat is the new normal" and Ms. Jameson's header is "Fat is Relative."  Sadly, both have a legitimate point.  If everyone around you is overweight, then your obesity does not stand out with  the importance that it should.  Not only is fat prevelant, so is chronic disease - i.e. diabetes and hypertension.  These conditions might then be normal, if you take normal to mean "majority," but they are not 'healthy' states of being.  Also, in this particular section of the article - vanity sizing is noted.  In other words, the clothing industry has responded to our vanity - not wanting to wear a size 12 or 14 because those are fat sizes - and takes those SAME patterns and calls them a 10.  This is a grand form of denial - not of attractiveness or unattractiveness - that is size neutral and really IS a matter of opinion - but of disease.  Disease states are measureable and objectively defined - overweight> diabetic>hypertensive.... >disability>unsuccessful aging> premature death or disability adjusted life years (living as long but in poor health).

Read the entire article and see if you can guess why I do NOT like the way it ends - (hint (ok answer) - the article explores reasons why people are fat as related to government subsidies, marketing ploys, food availability, food content, etc... and then tells the individual to do something different)

What Physical Activity Can Do

I had the opportunity to attend a lecture  conducted by a scientist from the University of Pittsburgh today.  He studies the impact of physical activity/exercise on weight loss and conditions related to obesity (diabetes, inflammation, HTN, heart disease).  His name is Dr. John Jakicic and he has had numerous studies published in peer reviewed science journals.  IN fact, I recall having read some of the studies that he referenced today.

I went to the lecture to see if he would present anything to support or challenge my assertions.  In case you have forgotten my stance (which developed from reading a lot of research), it is this:
Physical activity is very important and effective in reducing disease occurrence, in preventing adverse outcomes due to a disease, in promoting successful or active aging and for managing moods - or mental health.  It assists in weight loss and weight maintenance, but is not the best strategy for weight loss on its own.  Physical activity is associated with significant weight loss only in the presence of caloric reduction or restriction.  I.e. eating less.  

Before we get into that - let me be very clear that exercise can improve health even in the absence of weight loss and even in persons who are obese.  Obese persons who exercise are healthier than obese persons who do not.  Obese persons who exercise can have some improvement in risk factors even if they do not lose weight. Let me break that down.  An obese diabetic person who only exercises may not lose weight, but research supports that exercise alone can improve their blood sugar (or hemoglobin A1C).  Exercise can moderate blood pressure numbers and reduce inflammation (CRP) that increases the risk for heart attacks.  Exercise alone is helpful. 
Exercise AND weight loss are the best treatments for obesity and overweight.

Dr. Jakicic showed that exercising more than 300 minutes a week (w/out changing the amount of food eaten) led to a 3% weight loss - or about 5 pounds. [that is equal to about ten 30 minute walks a week] He told us that we (exercise and public health professionals) needed to be careful about what we said to people regarding exercise.  We needed to make sure that people maintained realistic expectations. He gave the example of the beginning of a new year when everyone heads to the gym and works out every day but the weight does not come off because they do not also change their eating.  The people have gone to the gym because they think they just have to exercise more and the weight will come off.  When that does not work, they quit the gym.

He actually showed a great chart during his presentation.  The chart had several lines that went from left to right.  The lines represented time one (baseline) and time two and the further the line dropped at time two the more weight the person lost.  Each line represented a different condition.  1)  for just calorie reduction, 2) a line for  exercise > 300 min a week, 3) a line for exercise at ~ 150 min a week, and 4) a line for a combination.  The diet alone line and the combo line were close together (low on the graph) - the others were up high, indicating no or few pounds lost. 
Therefore, as I have said, diet alone is far more powerful than exercise alone for ONE specific thing- losing weight.  Together they are better and best, but singularly they both have a powerful impact on health in general.

Public Health

A newscaster was discussing what appears to be a growing trend where parents are choosing not to have their children receive any or all of the recommended (even mandatory) vaccines.  The change may be related to fears that are unsubstantiated, but I am not venturing into this argument - well, I would say that if you are contemplating not having your children vaccinated that you make sure your reasons are supported by reputable scientific sources.

The statement that caught my attention the other night was, to paraphrase:

That is why they call it Public Health.  The actions or inactions of an individual can have an impact on the health of others. 

A person's family, friends, community - the country can become sick or pay a cost because of one or more individuals behavior.

I, and many others, consider obesity to be a public health concern, but there are those that don't.  Some will say that being overweight or obese, to whatever degree that it is a choice, is a personal decision and thus, one's personal business.  Even if I believed that obesity was (always) solely the responsibility of an individual (I don't), I would still think that a high  population rate of obesity is  a Public Health issue.  

Obesity relates to a loss of productivity, mobility, mental health, physical health and independence.  Those losses can be devastating to one person, but we have about 75 million obese people in this country. The CDC estimates over 147 billion in medical costs for treating them in 2008 alone.  The mental and economical costs are not included

It is a good thing then that Medicare is going to start paying for some preventative services, but that's another story.  Point for today - Obesity IS a public health issue, if not crisis.

Degree Not Needed, Sugar Pooh

I purposefully left my Monday blog up for two days.  I felt that the issue was important enough for us to dwell on.  Yesterday the Diane Rehm show discussed diabetes and its association with weight, the importance of choosing better foods and the benefit of adding exercise to every day.  A caller to the show talked about his diagnosis of diabetes and how hard it was to eat well outside of his own home.  He had gone to an event to support one of his children and  he recalled the breakfast they served; toast, hashbrowns, bacon, eggs, and so on .  He said it was as if the culture we live in was set up to create a diabetes epidemic.  Some public health experts would agree.  Diane added some comments about how hard it was to find anything of quality to eat when traveling by plane.  I think that is changing a little, but you really have to know what you are doing in order to make healthy choices.  I linked her show in case you want to listen.  She had several experts on as guests.

I had to mention the show because it was important, but my post today really centers on something that I observed in one of my classes last night.  The student sitting next to me had a canned drink that at first appeared to be an energy drink because of its size.  I think it was just a smaller can of coca cola.  I could see the back and the label.  I noticed that it had 25 grams of sugar and 90 calories.  I thought, well, if she would have had a 150 to 200 calorie drink, that is better.  At class break, she came back with a pack of nabs and a 12 ounce bottle of regular Dr. Pepper.  Meanwhile, I had a diet Mt Dew and half a peanut butter sandwich.  My classmate weighs significantly more than me, possibly 100 pounds more.  
On the one hand, we could say, "Well this isn't rocket science then.  One of us was monitoring or moderating our intake and the other was not."  Of course, what an observer doesn't know and I don't know, is what goes into the decisions people make.  Food decisions tend to be much more nuanced than they appear to be.  I would, however, like to show people how they can eat and drink more without taking in extra calories (extra meaning more than they need to maintain a healthy weight). 

But especially after the last post on sugar sweetened beverages, I found last nights observation troubling.

Why the NSLP Matters to Everyone

NSLP is the National School Lunch Program.  Earlier this year I blogged about the 2010 Dietary Guidelines for Americans and the alignment mandate that has long existed between the two.  I mean that the meals that are fed to the children are supposed to meet these guidelines.  If you recall, the DGAs call for the increase of fruits and vegetables, whole grains, good fats(oils) and the limit of calories, salt, saturated fat and added sugar.  For the first time, the DGAs discuss the difference in quality amongst vegetables.  This is something that was evident in the food pyramid from Walter Willett and Harvard that I posted many years ago and several times.  The problem is potatoes and starchy vegetables such as corn and peas.  Because of their lesser status, the school lunch program has to limit them.

There is a great post about this on the Harvard School of Public Health's website.  I receive their newsletter and became aware of this post today.  It makes far more sense for me to share the page with you then to try and restate it here.  

The point of my title today is that what is being done with the school lunch program is something we should all be doing -limiting foods that are higher in calories and which have a composition that is not the best for our metabolic system (insulin and such)

PLEASE read more here.

Self-Monitoring and Weight Loss

I have reviewed the following three research articles, one of which I have read several times because I am critiquing the study for a class assignment.  One of the articles refers to a main clinical weight loss trial that is called PREFER, another refers to a specific study on self monitoring as part of that trial and a third used interviews with select participants after the first two parts were complete.  It is the last one that I am reviewing for class.  Both ancillary studies are of interest to many of you, I would suspect.  They are also entwined.

The rationale for self monitoring of meals,(calories and fat content) and of exercise is provided in the studies. The major study used education, monitoring and group support as the factors involved in weight loss.  The smaller study involved reflections of keeping a food diary.
The main points to share, with the limited time that I have, follow:
There are certain characteristics that people who adhere to self monitoring share.  
When self-monitoring is consistent, complete and timely it usually correlates to weight loss.  This reminds me of my sister's friend who I mentioned before - every bite, lick and taste.  It is important to get everything but also to record the meals in real time.  Successful losers record on the same day that the intake occurs and within minutes of consumption.  It makes sense.  If you wait until the end of the day, the ability to see and attend to over consumption will be lost. 
Persons who keep their record and make the connections between too many calories and weight gain are also more likely to be successful weight losers. In the article, there were quotations of persons who were astonished about the amount of calories they had been consuming.  I think that this is very important and is related to the passive over consumption that I have mentioned lately.
Persons who self monitor, make connections and lose weight are rewarded with increased self-efficacy.  This self-efficacy is empowering and leads to long term monitoring adherence. 
Successful loser/maintainers may not continue to keep food diaries into perpetuity, though some do, but, they employ the strategy at times, or as needed.  
Successful self-monitors also use the information to plan ahead.  They aim to eat a certain amount of calories a day and if they are like me, they like to eat many times a day.   It is this planning that leads the weight loser to decline more caloric foods that they might be offered throughout the day (you know from the food pushers :)).  
Other identified components of success included group support, support from spouses (which was hard to come by) and not having been in numerous weight loss programs prior to the study.

Burke, L. E., Choo, J., Music, E., Warziski, M., Styn, M. A., Kim, Y., & Sevick, M. A. (2006). PREFER study: a randomized clinical trial testing treatment preference and two dietary options in behavioral weight management--rationale, design and baseline characteristics Contemp Clin Trials (Vol. 27, pp. 34-48). United States.

Burke, L. E., Sereika, S. M., Music, E., Warziski, M., Styn, M. A., & Stone, A. (2008). Using instrumented paper diaries to document self-monitoring patterns in weight loss. Contemporary Clinical Trials, 29(2), 182-193. doi: 10.1016/j.cct.2007.07.004

Burke, L. E., Swigart, V., Warziski Turk, M., Derro, N., & Ewing, L. J. (2009). Experiences of Self-Monitoring: Successes and Struggles During Treatment for Weight Loss. Qualitative Health Research, 19(6), 815-828. doi: 10.1177/1049732309335395

The Denmark Tax

At the end of September, Denmark became the first country to levy a tax on fat.  Saturated fat that is - in foods.  I mentioned it here at the time, but was just able to explore it  today.
The tax is a "certain amount of money on a certain measure of weight".  In Denmark this means that they are adding 16 kroner per kilo.  If this were in American money and weight, it would be about a dollar a pound.  OF course, most products don't have a pound of saturated fat (except maybe Blooming Onions and butter), so the tax is really ten or twenty cents more for whatever the product is.   

It might have seemed a good idea at the time - imposed by the exiting government (imagine that) - but it is VERY complicated.  It applies to local and imported foods and requires importers to declare the amount of Sat Fat in their foods (which I thought ALL labels had to declare in the first place).  I suppose if someone is bringing in a truck of goods it could be tricky.
Worse - unless they have a provision in the law that I am unaware of - healthy, heart protective, foods and oils like olive oil and (Smucker's all natural) peanut butter will ALSO go up in price.  For those two specific products the amount of monounsaturated or GOOD fat is six or seven times higher than the 2 gs of sat fat they contain, but they would cost more (now) in Denmark.  That would go directly against one of the goals of the DGAs (Dietary Guidelines for Americans). 


I think that price differentials are very important but this wouldn't be the way I would go about it.  If I were to raise taxes - I would do it by class of food.  Really, I would prefer that we suspend or lower taxes on fresh fruits and vegetables as well as whole grain products - for a start.

The Potato Wars

 Please review this past post on changes that are proposed for our National School Lunch Program.  The statement below comes from that post.

The lunch will have more whole fruit and vegetables, with LIMITS on starchy vegetables and specific amounts of green, orange and legumes is mandatory.

One of the starchy vegetables that is to be limited is the potato.  Several studies, including one released this summer and discussed in this blog, have noted that in any form, but especially as fries and chips, the potato is associated with weight gain.  Even the baked potato with or without its accompaniments (butter and sour cream) continues to be a problem.

Today the potato farmers, lobbyists and their congresspersons are fighting to have this part of the NSLP revisions (in line with the DGA 2010) eliminated.  One of the arguments being made is that by replacing the starchy peas, corn and potatoes with higher quality vegetables the cost of meeting the school lunch standard will increase.  The increase in price was considered unacceptable.

This dialogue and the very real chance that the politicians will win the fight is incredibly disheartening to me.  It is as though the idea of obese children turning into obese adults who have long term, debilitating, chronic diseases and lowered life expectancy means NOTHING and food politics means everything. 
Lastly, the recommendation is not to remove potatoes and starchy foods but to limit them.  Why is it so hard for people to accept limits??? 

Research and Policy Intersect with Public Media

Boyd Swinburn is the Alfred Deakin Professor of Population Health and Director of the World Health
Organization (WHO) Collaborating Centre for Obesity Prevention at Deakin University in Melbourne.  You have seen his name many times in my blog and I have read at least 20 articles which either discuss policy issues or examine research that he himself has conducted. 

Recently I talked about the 4 articles that are published in the medical journal the Lancet.  I also mentioned that Dr. Swinburn was to attend a UN General Assembly Meeting in NYC this month.  

His work as a researcher and as director of the WHO Collaborating Center for Obesity Prevention is getting him a lot of press these days.  His studies often include the USA, UK and Australia.  Today I am linking you to a popular press story which does his research justice.  Remember, I have read the work of both Swinburn and the other scientist noted in the report, Gortmaker.  I have blogged about Swinburn's work which shows that the weight gain in the last 30 years is much more about calories in then out.  In this article it is said again.  Our change in physical activity occurred decades before our weights began to rise.  Our bodies had adjusted to the change in activity and as individuals we WERE eating less to compensate for doing less- until the "tipping point" happened.  The calorie content of our food doubled and tripled. The journalist quotes the studies of Swinburn et al - and this is my favorite line "Energy intake rose because of environmental push factors, i.e., increasingly available, cheap, tasty, highly promoted obesogenic foods.” 

This is not a research article but a newspaper story written by Jane Brody - do take a minute to read it for yourself.  This is the type of policy work I hope to engage in myself.

France

As I was getting ready to meet my friend for our Saturday walk, I listened to a radio show and the topic at the time was the growing rate of obesity in France.  
Though their adult rate of obesity is far lower than the USA, Australia and Mexico, it is almost double what it was ten years ago.  Today it stands at 14%.
France blames its rise of obesity on immigration and the influence of American TV and culture.  I did catch these few things and cannot deny them.

Americans -
always have something in their hands
open the fridge as soon as they walk into their homes
do not have as many home cooked meals or fresh ingredients in their meals, and
are less likely to teach children the value of sit down meals

I would think that if they eat less processed foods there is a good chance that their meals are also less calorically dense.

I do understand their fear of having the same obesity rates and adverse health outcomes as Americans.  They have several strategies ready to implement and we might want to take notice!

I think you may enjoy listening to the story as I did not have the opportunity to hear it all myself.  Just click here and you should be directed to the audio link.  

If you are interested in exploring the obesity (BMI greater than 30)  in other countries, this table at the World Health Organization's website will help you.  It is many pages long, so you would have to click next page at the bottom of the table to see more countries.  Of course, there could be some measurement errors and certain countries may or may not have made the information available.