Eating for the 'wrong' reasons and important links

Even though I don’t have time to maintain my blog, I am reluctant to shut it down. So today I am writing for two reasons. The first is to remind readers about the danger of eating when you aren’t hungry and the second is to share a couple of health news sources. These news sources will be of particular interest to those who have enjoyed my blog topics, and I will share the links at the end. The sources have free email subscriptions and I believe they are two of the best (i.e., credible, relevant, current) out there.

As I thought about writing (my posts often percolate in my head a few days), I remembered that I started my blog as a newsletter back in 2004 (approximately) when I was working at a hospital and taking classes to earn my Master’s in Public Health. Many readers followed my journey from that point (i.e., to Florida as a Tobacco Treatment Specialist, to UNCG for more graduate studies in Public Health, to Beasley School of Law to complete a post doc in Public Health Law Research) to now – 13 years later.

Today, I am an Assistant Professor at Temple University in the Department of Social and Behavioral Sciences. My teaching responsibilities include a course about substance use disorders and addiction (that should make sense if you’ve read the blog over the years) and a course on nutrition as it relates to the health of populations (i.e., I am still not a registered dietician and do not give individual diet advice). I teach additional courses and conduct research/program evaluations, but this blog has foremost been about behaviors that impact our health and the laws that make those behaviors harder or easier to accomplish (e.g., that darn national menu labeling law that can’t seem to be implemented, soda taxes, new food labels). 

Dietary intake and health status (including obesity) has probably been of most interest to my readers, and to me. So, I want to talk about a specific area of risk regarding dietary intake. Eating for non-hunger reasons. It is often when we eat for the ‘wrong’ reasons that we gain weight. I think what sets me apart from a lot of people is that I don’t do that. I primarily eat to fuel my body when I am hungry. Or better put: I do not eat to socialize. I do not eat because I am bored. I do not eat because I am sad. I do not eat because I am high (haha, just kidding – bc I don’t get high). I do not eat just because everybody else is eating or to be polite. To be clear, I LIKE food, and enjoy meals and snacks and alcoholic beverages, but I don’t respond to social (including work meetings) or familial pressure to eat for the sake of fitting in.

Now that I think about it, I did blog about this many years ago – about how to eat in a social context without gaining weight. I suggested that when you are going to an event (family traditions included) where it is expected that you ‘eat to be social,’ or you know your favorite foods will be available, you plan it so that the food you eat at the event is part of your daily intake (and if its occasional, maybe it’s a little more than your daily intake). But eating when you are sad, bored, or unexpectedly confronted with someone’s ‘oh I had to get these out of my house, please have some’ cookies is a sure path to over consumption/excess calories. This over consumption is especially likely because the food associated with those ‘eating but not for hunger’ reasons are usually high in sugar, saturated fat, salt and calories. So, just think about that – and decide how you want to handle it.

That’s all I have for you on diet and health today. Most importantly are the links I promised you at the start of this post. Here they are:

STAT News Morning Rounds

ConscienHealth blog   (the subscribe option is on the top right of the page)

Calorie Stealth

Calories, calories, calories. That is all this girl talks about… well, mostly true. I also talk about making sure that you are as physically active as possible (that means sit less) and that you try to exercise every day. And a few other things, like not smoking or tanning… and, well by now, you can fill in the rest yourselves.

So YES, calories.  First, restaurant (and similar venue) menu labeling is coming and I have noticed an increasing number of commercials that include a calorie count within the TV (or internet) ad.  Here is the most recent:

Second, I want to pass along a ‘be on the lookout’ note:

Little Bites and mini donuts are not low calorie options, but calling something little bites sure makes you think so. Right? Actually, a serving of Little Bites muffins has 180 calories, a regular muffin 190 and a 'mini' cake 260.  All of these are made by Entenmann’s. TastyKake sells mini-donuts with over 200 cals per serving. Take home message: read the calorie AND serving size information regardless of the words, light, little, diet, mini, good for you, all natural, organic...etc.

And back to the lemonade: 240 calories for a beverage is a bit much… more than half those calories are from sugar - 39 grams or about 10 teaspoons. The rest is from protein and fat, which comes from the milk. Below is the ingredients list from ChickfilA. The ingredients in the “Icedream” read like a chemistry book.

Frosted Lemonade: Icedream (whole milk, sugar, nonfat dry milk, artificial flavor, corn starch, mono & diglycerides, microcrystalline cellulose, carrageenan, guar gum, Yellow 5 & 6), water, freshly-squeezed lemon juice, sugar.

Diet Frosted Lemonade: Icedream (whole milk, sugar, nonfat dry milk, artificial flavor, corn starch, mono & diglycerides, microcrystalline cellulose, carrageenan, guar gum, Yellow 5 & 6), water, freshly-squeezed lemon juice, Splenda® (dextrose, maltodextrin, sucralose).

SO – the picture above, with the 240 calories, that is the diet one…. the regular lemonade has 330 calories and 63g of sugar (16 teaspoons). Sigh…and by sigh, I mean that's crazy! (PS I didn't see the fine print in the picture at first, “starting at…. 240 cals.”)

McDonalds?

Okay, yes.  I am going to come out and say that this is a good thing.
McDonalds is going to allow people to choose a salad or a vegetable in place of french fries in the value meals.
It is also going to stop promoting soda as a drink option in its happy meals (I wonder about other sugar sweetened beverages like juice and if they will only offer low fat milk, but its a start)

Is McDonalds the right place to do this?  Well, heck yeah.... its THE place to do it.  BTW, if McDonalds can let us substitute salad for fries, I hope the more 'upscale' restaurants will join in.  Actually, didn't I talk about this a year ago?

I am excited.  It has to start somewhere - and since the USA has the highest ratio of McDonalds restaurants per 1 million people in the WORLD - and the near highest obesity rate (I think USA is second) - McDonalds it is.  

I find this change more important than the one over at Burger King.  It is good that BK is thinking of ways to reduce calories in their items, but 270 calories is still a lot more than an 80 calorie salad (minus the high cal/high fat dressing of course)  

In my last blog, I wrote about a french fry burger and a bottomless bowl of pasta so I am calling this progress and leaving it at that.

Fat in food vs Fat on your body

    I was frustrated by the research study on M&Ms. I was frustrated because it is 2013 and I thought we had learned that low fat is not the answer to our collective weight problem.
   Studies that continue to focus on promoting low fat choices add to the confusion.
As someone who has expertise in public health nutrition, health education and health promotion, I must try to clear this up. 
   Fat in food does not equal fat on your body.
   Too many calories from any source does. When a person regularly consumes more calories than their body needs, the extra is stored as body fat.  (Note: Over indulging every weekend is regularly consuming too much.)  There are ways to increase your intake to build lean body mass but that is not the focus here.

YES it is true that there are more calories in a gram of fat than there are in a gram of carbohydrate, protein or alcohol.   (9,4,4,7)  
YES it is true that some foods are more nutritious than other foods.  It is recommended that we fill our plates with nutrient dense, not energy dense, foods 
    Foods that are especially important are complex carbohydrates (vegetables and many fruits), whole grains and so called 'healthy' oils or fats (like those in olive oils and salmon).
Complex carbohydrates contain phytochemicals, flavinoids, and antioxidants.  These substances have been associated with reduced risk of many chronic diseases.
And YES it is true that refined or simple carbs, like sugar, white flour (rice, pasta, bread) baked goods, sugary or starchy fruits with little fiber, and all sugar sweetened beverages have more calories than they do nutrients.
AND Yes, it is true that some sources of fat just like some sources of carbs are believed to be harmful. (e.g., red and processed meats are associated with colon cancer).
   The reason some foods are calorically (energy) dense is because they are full of sugar or fried in grease.  
   Too many calories from either  = fat storage. 
********************
    And because its politically palatable to promote, physical activity as a solution to the country's obesity 'problem,'  I have to address that too.  Initiatives to build more parks and alert people to "take the stairs" are only going to work (for weight control) if two things happen.  TWO things.

1) people actually start using the stairs and parks, and
2) they stop eating too much

It does not matter how many stairs a person climbs (Mayor Bloomberg), if he or she eats more calories than needed - weight loss will not occur if 'we' keep eating too much.

There are people (fewer than the drug/genetic companies would have us think) who fall outside these generalities.  In other words, some people do not gain weight no matter how much they eat and others do not lose weight not matter how much they restrict.  These are very unusual people and I suspect you are not one of them. 

Disclaimer: I am not a nutritionist or a dietitian who can give individual diet advice.   I share information based on research and public health recommendations.

Which of these three things made us fat?

   I recently read an article by Duffey and Popkin (2013) published in the American Journal of Preventive Medicine.  The researchers attempted to quantify the effects of three suspected causes of the rise of obesity in children and adolescents.  They did a similar study in 2007 on adults.  The results are not definitive, but the three    factors are worth noting.  
   Duffey and Popkin looked at changes in 1) the number of eating occasions (meals+snacks) per day, 2) the energy density of foods and beverages in those meals, and 3) the portion size of each item.  My immediate reaction to their expectation that increases in portion size and number of times people eat would explain the rise in obesity was, "not necessarily."  
   A person might not gain weight under those conditions if they applied the concept of Volumetrics (B. Rolls) or chose foods low in energy density as the Dietary Guidelines advise.  In the thirty years that were studied, portion sizes and number of eating occasions did rise (and sometimes fall).  The energy density of the meals did not show a clear pattern of increase or decrease. 
   In the past 13 years, my number of eating occasions and portion size also increased, but my weight did not. That is because I have strictly adopted the low energy density concept.  I was able to increase the size of my meals because I reduced the calories per gram in each of them.  (I also eat no less than 8 times a day)
   What the researchers did find when studying adults was that in the past 30 years, the change in total energy intake that is associated with the rise in obesity, has involved all three.  More of the change is explained by portion size and an increase in number of meals eaten.  In the last five or more years, portion sizes have begun to decrease.    
   You can review the abstract (a summary of what they did and what they found) by clicking here.
   

Why Exercise is Essential

  Here is the most important thing that you need to know about exercise – and it applies to either weight loss or weight gain.  Exercise matters because it has an impact on body weight; specifically, body weight ratio.  Most basically, our body weight is composed of fat mass and fat free mass (sometimes referred to as lean body mass).  Fat free mass involves several components, including, bones, muscles and water.  When you change your body weight, it is essential for good health and calorie expenditure that you increase your fat free mass and/or preserve your fat free mass.            

   Exercise helps you to do so because it builds muscle.  Muscle where most energy is burned.   If you lose lean body mass you may weigh less but have a higher ratio of body fat and this is not good.

   A person can be overweight and not have metabolic disturbance if they exercise and keep up their fat free mass (they may still have joint problems though).  A person can be thin and have metabolic dysfunction because they have a higher proportion of fat mass.

   Cardio exercise can certainly keep you toned, but to build muscle I recommend that you consider strength training (resistance or weight lifting) at least twice a week (as the PGA suggest.)

   I also want to share with you this sentence from the recently released report U.S. Health in International Perspective: Shorter Lives, Poorer Health from the Institute of Medicine and the National Research Council (2012).

[D]ecades of research suggest that avoiding sedentary behavior and engaging in regular physical activity (independent of body weight, body mass index, and dietary habits) exerts its own protective effect on the risk of heart disease and stroke and possibly other conditions, including cancer, depression, and dementia (Lee et al., 2012; U.S. Department of Health and Human Services, 2008a).

   As the sometimes controversial Robert Lustig, MD says, “exercise is the anecdote for anything that is wrong.”  I agree – and you know that I do.  He also thinks fructose is the root of all evil and that foods that cause the release of insulin are the culprit for our obesity epidemic or the diseases that accompany it.  I am not sure – but he has a new book out that you might like to search for if you are interested.  I agree with him 85% of the time, somewhat less than I agree with Walter Willett (90+%) and a lot more than I agree with that Dr. Oz fellow.  

Interested in the full report regarding the poor health of Americans compared to similar countries... click here.

AstraZeneca Wins!

Astrazeneca is the company responsible for Seroquel which is an antipsychotic medication. This medicine is in the same category as Zyprexa and has some of the same risk profile. These are new medications meant to treat mental illness - most often schizophrenia. In the past, the medications used to treat this condition would cause Tardive Dyskinesia which is a very noticable movement disorder (think lip smacking).

The new drugs do not seem to cause TD, but they have been associated with significant weight gain and subsequently, diabetes. The concern about blood sugar and insulin resistance is not new and is listed as a side effect on the medication labels. It is something that psychiatrists are encouraged to consider when choosing a medication.

There are active court cases for which both Zyprexa and Seroquel are alleged to have caused plaintiff specific cases of diabetes. In the most recent finding, AtraZeneca was NOT found at fault. Though I am not a fan of medication, nor drug companies, this finding would be acceptable to me, in that, I do not believe drugs make people fat - which is the number one risk factor for the type of diabetes of which these persons are susceptible - but that food does.

There is a chance that these new medications (not so new anymore) do independently cause some amount of insulin resistance - but I expect if that were proven, AstraZeneca would have lost their case. What I do know, because I SAW it with my own eyes, is that people who are put on these medications gain a LOT of weight.

When I worked in the hospital with people who suffered mental illness, I did so as a social worker, not a health education specialist, but I WAS going to graduate school for my MPH at the time. I kept thinking to myself that these patients whom I would see when they returned to the hospital, as they always did, they needed to be TOLD that the medication either slowed their metabolism or increased their hunger, or maybe even turned off the hormone that told them they were full - what ever was happening, the patient HAD to be mindful and change the way that they ate. I don't remember any patient education about this possible side effect.

If nothing else comes from these lawsuits, maybe someone will have the foresight to make educating the patients about calories, physical activity and how attending to both can prevent both weight gain and diabetes a mandatory part of prescribing the medication.