It has been eight years, but the National Restaurant Menu Labeling Law (part of the Patient Protection and Affordable Care Act) will be in effect on Monday. Restaurant chains with over 20 locations will be required to post the calorie content of their standard offering on menu boards and print menus. The goal is to raise awareness of the amount of calories in the items we choose - and to do so before we make that choice. This law has the potential to change our behavior as consumers as well as the behavior of those providing us with food and beverages. Will the calories available to purchase decline? Will we purchase AND consumer fewer calories? If the answers are yes, will the country's obesity rate plateau or decline? I sure hope so - but that's a lot of ifs.
Meanwhile, the recommended changes to the Nutrition Facts Panel have been delayed to 2020 - here we go again. The main change on those labels is an emphasis on total calories and added sugar and a de-emphasis on total fat.
On a personal note, sorry I don't post much anymore, but my students require a substantial amount of my time!
Showing posts with label overweight. Show all posts
Showing posts with label overweight. Show all posts
Friday, May 4, 2018
Tuesday, May 3, 2016
Why we focus on food deserts and not food swamps
Most people have heard the term food desert. A food desert is a place where people live and do not have reasonable access to whole foods, or fresh produce. Often this is measured by some distance to a grocery store. For example, in some places people live close to convenience stores and fast food restaurants, but would have to travel several miles, sometimes 10 or 20, to get to a grocery store. In these same areas, there may be high rates of obesity - however, there are high rates of overweight and obesity across the USA. Some speculate that not living close to a grocery store where one can access produce is a 'cause' of obesity (i.e., they associate food deserts with obesity). And it is not just availability, it's affordability, too. If the fresh produce costs more than processed foods, they are less accessible. If children have to try foods several times to like them, and a parent is on budget, it makes it hard to buy more expensive items that might not be eaten.
Access and affordability are things that public health advocates work to change AND that the electorate/society supports. Right? Of course we should make sure everyone has access to nutritious foods that are often low in calories. YAY! Let's do it.
Research has not always supported the intuitive, however, and sometimes people who have access to fruits and vegetables still don't purchase or consume them. Why not? Well, my educated/informed opinion is because a good many people live in food swamps. I am not sure where I first heard or read the phrase, but I describe a food swamp as an area where high calorie foods - often low in nutrients - are in abundance, are cheap, easy to locate, highly advertised, branded (e.g., KFC, Doritos, Pepsi) and popular among children, adolescents and adults. Actually, these foods and their promotions (e.g., all you can eat buffets, $1 hamburgers, 3 for 1 honeybuns, 32 ounce sodas) are hard to avoid.
As noted above, the popular strategy for dealing with a food desert is to bring more fresh foods in - build a grocery store or a farmers market, add produce to the convenience store checkout, send in a mobile produce truck - and hope people will purchase, prepare wisely and eat more nutritious foods. Oh and here is the most important part... eat them instead of the high calorie non-nutritious foods they have been eating. Every one agrees, yes - those are all good strategies... yay, lets fund them! [They don't work so well, but they seem smart and non-paternalistic, therefore, it must be right.]
The strategy for food swamps (which is as unpopular as the food desert strategy is popular) is policy and regulation. I believe that food swamps are the bigger problem and that regulation and policy are our best bet at trying to reduce over consumption of calories (often occurring passively, i.e., not intentionally eating extra calories). Examples include, limiting the number of fast food/quick casual restaurants that can surround neighborhoods, schools, and worksites (zoning laws), putting a sales tax on high calorie, low nutrient items, like sugar sweetened beverages (specifically I say a sales tax because consumers are more likely to notice a sales tax than an excise tax and sales taxes cannot be 'eaten' by the manufacturer unless they literally lower the prices of their products), putting calorie counts out in front on everything, everywhere (menu boards, front of packages, sodas) and educating people on what is considered a 'high' amount of calories (e.g, a dinner entree over 500 calories is high, if it is part of a days worth of meals), portion caps - like suggested in NYC might work, and limiting ads for high calorie foods or ad space (e.g., TV, public transit, magazines, websites, social media). I think our grocery stores should have makeovers as well. The cheap, high calorie foods should not get prominence and promotion. This is one of the main reasons I believe that strategies to add fruits and vegetables to neighborhood stores or whole grocery stores to neighborhoods, fail. It is hard to get through the mire of junk - physically, emotionally, socially, parentally - to the better for you items.
And before anyone points out that the food swamp policies I mentioned are regressive (i.e., they will have a bigger impact on persons of lower income) I say YES, and obesity and its related disease conditions is also regressive and has a greater impact on persons of lower income.
My point is, that though it might sound good (especially politically) to make fruits and vegetables and other nutritious foods available and accessible, what we really need is to make low nutrient (junk) foods and drinks LESS available and accessible (less cheap, less popular, less in our face). And as that annoying prince on the TV show Outlander says, "mark me" I am right about this.
Access and affordability are things that public health advocates work to change AND that the electorate/society supports. Right? Of course we should make sure everyone has access to nutritious foods that are often low in calories. YAY! Let's do it.
Research has not always supported the intuitive, however, and sometimes people who have access to fruits and vegetables still don't purchase or consume them. Why not? Well, my educated/informed opinion is because a good many people live in food swamps. I am not sure where I first heard or read the phrase, but I describe a food swamp as an area where high calorie foods - often low in nutrients - are in abundance, are cheap, easy to locate, highly advertised, branded (e.g., KFC, Doritos, Pepsi) and popular among children, adolescents and adults. Actually, these foods and their promotions (e.g., all you can eat buffets, $1 hamburgers, 3 for 1 honeybuns, 32 ounce sodas) are hard to avoid.
As noted above, the popular strategy for dealing with a food desert is to bring more fresh foods in - build a grocery store or a farmers market, add produce to the convenience store checkout, send in a mobile produce truck - and hope people will purchase, prepare wisely and eat more nutritious foods. Oh and here is the most important part... eat them instead of the high calorie non-nutritious foods they have been eating. Every one agrees, yes - those are all good strategies... yay, lets fund them! [They don't work so well, but they seem smart and non-paternalistic, therefore, it must be right.]
The strategy for food swamps (which is as unpopular as the food desert strategy is popular) is policy and regulation. I believe that food swamps are the bigger problem and that regulation and policy are our best bet at trying to reduce over consumption of calories (often occurring passively, i.e., not intentionally eating extra calories). Examples include, limiting the number of fast food/quick casual restaurants that can surround neighborhoods, schools, and worksites (zoning laws), putting a sales tax on high calorie, low nutrient items, like sugar sweetened beverages (specifically I say a sales tax because consumers are more likely to notice a sales tax than an excise tax and sales taxes cannot be 'eaten' by the manufacturer unless they literally lower the prices of their products), putting calorie counts out in front on everything, everywhere (menu boards, front of packages, sodas) and educating people on what is considered a 'high' amount of calories (e.g, a dinner entree over 500 calories is high, if it is part of a days worth of meals), portion caps - like suggested in NYC might work, and limiting ads for high calorie foods or ad space (e.g., TV, public transit, magazines, websites, social media). I think our grocery stores should have makeovers as well. The cheap, high calorie foods should not get prominence and promotion. This is one of the main reasons I believe that strategies to add fruits and vegetables to neighborhood stores or whole grocery stores to neighborhoods, fail. It is hard to get through the mire of junk - physically, emotionally, socially, parentally - to the better for you items.
And before anyone points out that the food swamp policies I mentioned are regressive (i.e., they will have a bigger impact on persons of lower income) I say YES, and obesity and its related disease conditions is also regressive and has a greater impact on persons of lower income.
My point is, that though it might sound good (especially politically) to make fruits and vegetables and other nutritious foods available and accessible, what we really need is to make low nutrient (junk) foods and drinks LESS available and accessible (less cheap, less popular, less in our face). And as that annoying prince on the TV show Outlander says, "mark me" I am right about this.
Friday, April 1, 2016
Exercise for Weight Loss?
No.
Exercise for exercise. Exercise for a long, healthy, active live.
Exercise for functional capacity, mood stability, improved attention and learning.
Exercise to prevent disease. Exercise to improve your quality of life.
Exercise because not exercising increases your risk of all causes of death and all disease states.
If you exercise only because you think it will help you lose weight, and exercise is your only weight loss strategy, chances are you won't lose weight. And then you will think exercise failed you. You will be wrong. Exercise is the sine qua non of health; it will never fail you. if you do it for the right reasons. There are many reasons, see the first paragraph and the research studies below.
If you want to lose weight, change your eating patterns. Many people need to lose weight.
If you want to be healthy, exercise - daily.. Everyone, regardless of their weight status, needs to do this.
(NB. this was posted a few weeks later http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories)
Exercise for exercise. Exercise for a long, healthy, active live.
Exercise for functional capacity, mood stability, improved attention and learning.
Exercise to prevent disease. Exercise to improve your quality of life.
Exercise because not exercising increases your risk of all causes of death and all disease states.
If you exercise only because you think it will help you lose weight, and exercise is your only weight loss strategy, chances are you won't lose weight. And then you will think exercise failed you. You will be wrong. Exercise is the sine qua non of health; it will never fail you. if you do it for the right reasons. There are many reasons, see the first paragraph and the research studies below.
If you want to lose weight, change your eating patterns. Many people need to lose weight.
If you want to be healthy, exercise - daily.. Everyone, regardless of their weight status, needs to do this.
(NB. this was posted a few weeks later http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories)
Janssen, I., & LeBlanc, A. G. (2010). Review Systematic review of
the health benefits of physical activity and fitness in school-aged
children and youth. International Journal of Behavioral nutrition and physical activity, 7(40), 1-16.
Nocon, M., Hiemann, T., Müller-Riemenschneider, F., Thalau, F., Roll,
S., & Willich, S. N. (2008). Association of physical activity with
all-cause and cardiovascular mortality: a systematic review and
meta-analysis. European Journal of Cardiovascular Prevention & Rehabilitation, 15(3), 239-246.
Penedo, F. J., & Dahn, J. R. (2005a). Exercise and well-being: a
review of mental and physical health benefits associated with physical
activity. Current opinion in psychiatry, 18(2), 189-193.
Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.
Monday, July 13, 2015
The delay is NOT the demise of menu labeling
The FDA has granted restaurants and similar retail establishments a delay in posting calorie amounts - how that delay actually came about and why, warrants some clarification.
The National Restaurant Industry, like the National Automatic Merchandising Association for vending machines, supports calorie disclosures on menus and menu boards as mandated for large (20 or more) chain restaurants. Large chain restaurants are probably ready to roll with the disclosures - several cities and at least 1 state already have calorie (+) disclosure laws in place (though they are preempted by the federal law). It is not likely that restaurants need or even want the delay, after all, the industry(through its trade group) supported the federal law; a nationwide, preemptive law is good for them.
What is really going on is that the 'similar retail establishments,' ones that sell ready to eat food as a major part of their enterprise, for example, grocery stores, movie theatres, bowling alleys, convenience stores, tried to get out of the mandate. Once they realized the law did indeed apply to them, they asked for and received more time to get their act together.
I do not see the delay as a bad thing and I do not read it as the demise of the legislation. Too many big players AND consumers want calorie displays across the many places where food choices are made.
Including the similar retail establishments (and vending machines) in the law makes it 1) fair to the sellers of the food - why should some have to disclose and other not? and 2) easier - possible - for us to monitor our calorie intake if we so choose. Whether we will choose to do it or understand how to do it, is a separate discussion.
Researchers and proponents of the law do not know if calorie disclosure by itself is going to change the behavior of people most in need of changing their behavior (i.e., people who exceed their average daily calorie needs), but it makes it possible and before we can do anything else (e.g., tell people how many calories, from which types of foods, are too many), we have to put the information out there. The early positive change that I, and many others envision, is that the retailers are going to reformulate recipes or reduce serving sizes in order to 'present' calorie counts that are more reasonable. Hey, there is a thought, maybe one of the things that 'similar retail establishments' will do with their extra year is reduce calories - say in that bucket of popcorn!
Anyway, I am not disheartened and as a researcher, I hope to take advantage of the extra time to conceptualize some new evaluation studies!
The National Restaurant Industry, like the National Automatic Merchandising Association for vending machines, supports calorie disclosures on menus and menu boards as mandated for large (20 or more) chain restaurants. Large chain restaurants are probably ready to roll with the disclosures - several cities and at least 1 state already have calorie (+) disclosure laws in place (though they are preempted by the federal law). It is not likely that restaurants need or even want the delay, after all, the industry(through its trade group) supported the federal law; a nationwide, preemptive law is good for them.
What is really going on is that the 'similar retail establishments,' ones that sell ready to eat food as a major part of their enterprise, for example, grocery stores, movie theatres, bowling alleys, convenience stores, tried to get out of the mandate. Once they realized the law did indeed apply to them, they asked for and received more time to get their act together.
I do not see the delay as a bad thing and I do not read it as the demise of the legislation. Too many big players AND consumers want calorie displays across the many places where food choices are made.
Including the similar retail establishments (and vending machines) in the law makes it 1) fair to the sellers of the food - why should some have to disclose and other not? and 2) easier - possible - for us to monitor our calorie intake if we so choose. Whether we will choose to do it or understand how to do it, is a separate discussion.
Researchers and proponents of the law do not know if calorie disclosure by itself is going to change the behavior of people most in need of changing their behavior (i.e., people who exceed their average daily calorie needs), but it makes it possible and before we can do anything else (e.g., tell people how many calories, from which types of foods, are too many), we have to put the information out there. The early positive change that I, and many others envision, is that the retailers are going to reformulate recipes or reduce serving sizes in order to 'present' calorie counts that are more reasonable. Hey, there is a thought, maybe one of the things that 'similar retail establishments' will do with their extra year is reduce calories - say in that bucket of popcorn!
Anyway, I am not disheartened and as a researcher, I hope to take advantage of the extra time to conceptualize some new evaluation studies!
Thursday, October 10, 2013
The Power of Oatmeal
No not as a miracle cure for weight loss... surely by now you know that I don't endorse such nonsense.
I mean the power of oatmeal (oat bran for me) to satiate. To leave you with a feeling of fullness which lasts for hours.
I knew that my oat bran with almond milk breakfast was very filling, but now there is research to support this personal experience and to explain why it occurs.
The researchers in this study collected information on how the participants were feeling, e.g., if they 'felt full,' 'were hungry' and what was happening to the oatmeal and the comparison food - ready to eat cold cereal - in the body, i.e., how it was being digested. The participants reported their feelings at several different time points up to four hours after they ate their assigned breakfast.
It is important to note that the participants each ate both meals, but in random order and about a week apart. The meals were 1) Quaker oatmeal and 2) Honey Nut Cheerios. The meals were served with the same amounts of skim milk and had the same amount of total calories. I do not eat Quaker Oatmeal - but I think they used the kind that you cook with hot water. I use oat bran which I cook with water and eat with low cal almond milk (+aspartame). I can say with certainty that if I had equal calories of cheerios and oat bran the cheerios would be half the volume of my oat bran. And I believe that what you see has an effect on your feelings of satisfaction and fullness.
Anyway, the study was well done. The lead author/researcher is Candida Rebello - a nutritionist. You can read the summary abstract here.
Putting the reports from the participants together with the lab results, the researchers could assert that the oatmeal breaks down more slowly, is thicker going through the small intestine, among other things and is more satiating than the cereal. There are a lot of details in the article that I am not taking the time to explain, and some I could not explain even if I had the time. But I think I have shared enough to give you the evidenced based take home message. Choose oatmeal over cold cereal.
As for myself, I never eat cold cereal as a breakfast. I believe that it offers too many calories per ounce (it is energy dense) and as this research suggests, doesn't stay with you very long. I do sometimes have a taste of it as part of my discretionary (treat) calories.
I mean the power of oatmeal (oat bran for me) to satiate. To leave you with a feeling of fullness which lasts for hours.
I knew that my oat bran with almond milk breakfast was very filling, but now there is research to support this personal experience and to explain why it occurs.
The researchers in this study collected information on how the participants were feeling, e.g., if they 'felt full,' 'were hungry' and what was happening to the oatmeal and the comparison food - ready to eat cold cereal - in the body, i.e., how it was being digested. The participants reported their feelings at several different time points up to four hours after they ate their assigned breakfast.
It is important to note that the participants each ate both meals, but in random order and about a week apart. The meals were 1) Quaker oatmeal and 2) Honey Nut Cheerios. The meals were served with the same amounts of skim milk and had the same amount of total calories. I do not eat Quaker Oatmeal - but I think they used the kind that you cook with hot water. I use oat bran which I cook with water and eat with low cal almond milk (+aspartame). I can say with certainty that if I had equal calories of cheerios and oat bran the cheerios would be half the volume of my oat bran. And I believe that what you see has an effect on your feelings of satisfaction and fullness.
Anyway, the study was well done. The lead author/researcher is Candida Rebello - a nutritionist. You can read the summary abstract here.
Putting the reports from the participants together with the lab results, the researchers could assert that the oatmeal breaks down more slowly, is thicker going through the small intestine, among other things and is more satiating than the cereal. There are a lot of details in the article that I am not taking the time to explain, and some I could not explain even if I had the time. But I think I have shared enough to give you the evidenced based take home message. Choose oatmeal over cold cereal.
As for myself, I never eat cold cereal as a breakfast. I believe that it offers too many calories per ounce (it is energy dense) and as this research suggests, doesn't stay with you very long. I do sometimes have a taste of it as part of my discretionary (treat) calories.
Thursday, March 14, 2013
Obesity Studies... What is a Cause?
It isn't often that I refer you to an article in full that has been written by someone else, or in this case, a couple of someones. You can trust that I am doing it for a good reason. The article published in the NY Times addresses a point often made here. Headlines and research should be interpreted carefully.
I believe that these two journalists get it exactly right (one hails from Union College - yay). I only have one or two things to add, but I really think you should read the article first... click HERE.
Okay - I feel like you didn't listen to me. The article is about junk food advertising and soda sizes causing obesity. Read it HERE.
OK.
The only big problem I had was with the journalists' assertion that we do not know what causes obesity. Of course we do. A lot of people eating more calories than they need (and the number they need is personal). There are reasons that people eat more calories than they need and some of those reasons are ones that I want to study. I want to use the exact type of research design that the journalists advocate. But, I do not think randomization into conditions will always (or ever) be possible. Lagged interventions, or lagged policies may allow me to make good inferences. By this I mean, if one state adopts a public health policy before a similar state does, I can compare the two states on the outcome (calories purchased, BMI, etc). Most of the time, my work will speak to associations, relationships, correlations and that is ok. I hope I can get to cause, but I won't pretend that I did when I did not.
I would reword some of the journalists language about the studies they referenced. It is true that advertisements do not cause weight gain - but they may entice people. Ads may lead people to establishments where they over consume. Once inside the restaurant, is there any hope? Maybe. It is possible that putting the number of calories per item on a menu might encourage people to chose an item with fewer calories. Having to put calorie numbers on a menu might encourage the restaurant owner to offer more low calorie items.
Having less billboards, less fast food places, higher prices on nutrient poor foods, removing sodas from WIC and SNAP benefits...Polices like these might reduce consumption of foods that are very high in calories... but at the end of the day.. it will always be about a choice that a person makes. If that choice includes too many calories.. weight gain is likely to follow.
(ps if you think that the government wants to manipulate you and the food industry doesn't, you are woefully naive)
I believe that these two journalists get it exactly right (one hails from Union College - yay). I only have one or two things to add, but I really think you should read the article first... click HERE.
Okay - I feel like you didn't listen to me. The article is about junk food advertising and soda sizes causing obesity. Read it HERE.
OK.
The only big problem I had was with the journalists' assertion that we do not know what causes obesity. Of course we do. A lot of people eating more calories than they need (and the number they need is personal). There are reasons that people eat more calories than they need and some of those reasons are ones that I want to study. I want to use the exact type of research design that the journalists advocate. But, I do not think randomization into conditions will always (or ever) be possible. Lagged interventions, or lagged policies may allow me to make good inferences. By this I mean, if one state adopts a public health policy before a similar state does, I can compare the two states on the outcome (calories purchased, BMI, etc). Most of the time, my work will speak to associations, relationships, correlations and that is ok. I hope I can get to cause, but I won't pretend that I did when I did not.
I would reword some of the journalists language about the studies they referenced. It is true that advertisements do not cause weight gain - but they may entice people. Ads may lead people to establishments where they over consume. Once inside the restaurant, is there any hope? Maybe. It is possible that putting the number of calories per item on a menu might encourage people to chose an item with fewer calories. Having to put calorie numbers on a menu might encourage the restaurant owner to offer more low calorie items.
Having less billboards, less fast food places, higher prices on nutrient poor foods, removing sodas from WIC and SNAP benefits...Polices like these might reduce consumption of foods that are very high in calories... but at the end of the day.. it will always be about a choice that a person makes. If that choice includes too many calories.. weight gain is likely to follow.
(ps if you think that the government wants to manipulate you and the food industry doesn't, you are woefully naive)
Thursday, September 27, 2012
Overweight and Military Service
I am certain that soda has a lot to do with this problem, as does the increasing portion size and energy density of foods at home and restaurants. I am certain we have a problem.
Read their recently released report, Still Too Fat to Fight - HERE
Currently, about 25 percent of 17- to 24-year-olds are too overweight for military service. Also, the Department of Defense spends an estimated $1 billion per year on medical care for weight-related health problems.Mission: Readiness is the nonprofit, nonpartisan national security organization of senior retired military leaders calling for smart investments in America's children. It operates under the umbrella nonprofit Council for a Strong America.
Read their recently released report, Still Too Fat to Fight - HERE
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