In Fight Against Obesity, Drink Sizes Matter

I recently met a slender, health-conscious young woman who insisted that the size of sugar-sweetened drinks should not be legislated. “Getting people to drink less of them should be done through education,” she said.

via nytimes.com

 

It is an opinion shared by many others. Some may be unaware of the role that these beverages are playing in the nation’s burgeoning epidemics ofobesity and Type 2 diabetes. Few know the disappointing history of efforts to change human behavior solely through education.

The young woman was reacting to a New York City regulation, to take effect on March 12, limiting to 16 ounces the size of sugar-sweetened soft drinks available for purchase at restaurants, street carts, movie theaters and sporting events. The Barclays Center in Brooklyn, the new home of the Nets, has already imposed this limit. Convenience stores, vending machines and some newsstands are exempted from the regulation.

Several new studies underscore the public health potential of the restriction. If it succeeds in curbing the consumption of sweet liquidcalories, it is likely to be copied elsewhere, because the nation’s love affair with super-size sugary soft drinks is costing cities and states billions of dollars annually in medical care.

Sweet Tooth Run Amok

We are all born with a natural preference for sweetness, which through evolution enabled us to know when fruits and berries were ripe and ready to eat. But as Gary K. Beauchamp, a biopsychologist and director of the Monell Chemical Senses Center in Philadelphia, has put it, “We’ve separated the good taste from the good food.” Our sweet tooth is no longer working to our advantage.

No one is claiming that sugar-sweetened drinks are the only reason Americans have gotten fatter and developed high rates of Type 2 diabetes. But at no time in history have we eaten more caloric sweeteners than we do today, and soft drinks are the main culprit.

Sugar-sweetened drinks, the single largest source of calories in our diet, account for nearly half of the total added sugars we consume and 7 percent of our total calories — nearly 15 percent in some groups, including adolescent boys. University of Wisconsin researchers reported in 2005 that the average student consumes 31 pounds of sugar in sweetened beverages annually.

Coca-Cola once came in eight-ounce bottles with 97 calories. Today people buy 12-ounce cans with 145 calories (the equivalent of 10 teaspoons of table sugar); 20-ounce bottles with 242 calories; 32-ounce Big Gulps with 388 calories; 44-ounce Super Big Gulps with 533 calories; and 64-ounce Double Gulps with 776 calories. There are but small differences in price among these choices.

These calories are nutritionally empty, unlike those from fruits, vegetables, meat, poultry, fish and dairy products, all of which are life-sustaining sources of essential nutrients.

Barbara J. Rolls, professor of nutritional sciences at Penn State, has shown that liquid calories lack a sufficient “satiety factor.” When people consume soft drinks, they don’t compensate adequately by eating fewer calories from solid foods.

Brian Wansink, director of the Food and Brand Laboratory at Cornell University, explained that beverages aren’t as filling as solid food because they lack texture and “mouth feel,” and we “tend to consume them so fast they don’t register.”

Many observational studies have linked consumption of sugar-sweetened beverages to weight gain in children, and to weight gain and Type 2 diabetes in adults. But the new research goes well beyond those findings.

In one study among women followed for four years, consuming one or more of these drinks per day nearly doubled the risk of developing Type 2 diabetes, compared with women who drank fewer than one a month. And the authors concluded that those who increased their consumption of sugary drinks also “increased energy intake” — calories, that is — “from other foods, indicating that these beverages may even induce hunger and food intake.”

Two recent studies, published in The New England Journal of Medicine, looked at the effects on weight in children and adolescents when sugar-free beverages were substituted for those with caloric sweeteners. In both cases, limiting sweet liquid calories curtailed weight gain in children, compared with those who continued to consume sugared drinks.

The authors of one of the studies, conducted in the Netherlands, noted, “Children in the United States consume on average almost three times as many calories from sugar-sweetened beverages,” compared with Dutch children.

As you might expect, soon after the end of the other study, conducted among adolescents in the Boston area, the youngsters reverted to consuming readily available sugary drinks, which speaks to the importance of both education and regulation. Dr. David S. Ludwig, an expert in childhood obesity and the study’s senior author, said the findings emphasized the need for public policy changes.

“It suggests that if we want long-term changes in body weight, we will need to make long-term, permanent changes in the environment for children,” he told The New York Times when the report was published.

A third study, published with the first two, found an important link between genetics and the effects of sugary drinks on weight. Men and women with a genetic predisposition to gain weight experienced a more pronounced effect from sugar-sweetened beverages than did people lacking 32 genes associated with greater body mass index.

Improving Health Habits

Education matters. If I didn’t believe that, I would have long since abandoned my role as a public health educator. But history has clearly shown that teaching people what is good for them is not enough. It must be accompanied by restrictions that curb unhealthy habits and environmental changes that foster healthier ones.

Cigarette smoking is a classic example. Myriad well-publicized reports documenting its hazards — even warnings on cigarette packs — did relatively little to get people to quit smoking and keep others from taking it up. It was not until smoking was banned in workplaces, restaurants, public buildings and transportation that smokers became social pariahs and millions gave it up. Today only about one American man in five smokes, down from nearly one in two 40 years ago.

Just as the tobacco industry disputed the link between smoking and lungcancer for many years, claiming the evidence was circumstantial and did not prove cause and effect, the American Beverage Association says that there is no proof that sugary beverages are major players in obesity anddiabetes.

But why wait decades for conclusive evidence, by which time millions will have been sickened or died from obesity? If there were an environmental threat with even a fraction of the health risk posed by sugary drinks, there would surely be a large public protest.

It is not as if there are no readily available alternatives to sugar-sweetened drinks, including ones with noncaloric sweeteners and waters with and without carbonation, flavored or plain. If such beverages were less expensive and prominently displayed, and more venues limited the size and availability of sugared drinks, we could start on the path so well trod during our antismoking efforts.

Running a marathon: How green are our two legs?

About 30,000 runners will invade Washington Oct. 28 for the 2012 Marine Corps Marathon. The race’s popularity has skyrocketed since its inception in 1976, when 1,175 participants undertook the lung-busting challenge.

via washingtonpost.com

Nationwide, people are flocking to marathons: Between 2000 and 2009, the number of participants has increased 58 percent. This growing obsession with covering vast distances by foot has me thinking about its environmental efficiency compared to other modes of transit. How green are our two legs?

 

Calculating the average runner’s greenhouse gas emissions for a 26.2-mile distance is a fairly straightforward task.

The first step is to determine how much energy is burned by the typical marathoner. Exercise physiologists estimate that an ordinary runner weighing 150 pounds uses approximately 3,000 calories on the marathon course. The next step is to determine how many carbon dioxide equivalents are released into the atmosphere in the creation of those calories.

You see, the carbon dioxide that a runner exhales does not directly contribute to climate change, because it’s a part of a natural carbon cycle. Humans exhale carbon, plants inhale it, humans eat it and exhale it some more. However, our agricultural system uses fossil fuels to produce food, which means that carbon that had been safely stored in the ground is extracted and added to the atmosphere. Growing food on an American farm emitssomething like 0.0064 pounds of carbon dioxide equivalents for every calorie produced. (A carbon dioxide equivalent includes emission of both carbon dioxide and other greenhouse gases, such as methane and nitrous oxide.) That means a runner eating a standard American diet is responsible for the emission of 19.2 pounds of carbon dioxide during a marathon.

A few footnotes are in order. Statisticians include all the food that farmers produce when calculating greenhouse gas emissions per calorie. If we didn’t throw away as much food as we do, exercising would be less carbon-intensive by this standard.

The efficiency of food distribution and production is out of your control, but you can change such things as your diet.A calorie from fruit and vegetables is responsible for about 40 percent less greenhouse gas than a meat or dairy calorie, so vegan runners do substantially better in this department than omnivores.

You could also slow down. While slower runners get less glory, the tortoises are a little bit greener than the hares. Running a marathon at a pace of 10 minutes per mile releases about 5 percent fewer carbon dioxide equivalents than running at six minutes per mile.

What if you ditched your running sneakers and hopped on a bicycle? Just like running, it depends somewhat on how fast you go, but overall, cyclists produce far less greenhouse gas than runners over the same distance. Pedaling at a moderate 13 mph, a 150-pound bicyclist would burn around 1,150 calories over 26.2 miles. Eating a standard American diet, he would be responsible for 7.4 pounds of carbon dioxide — 60 percent less than the runner generated.

More evidence commercial weight loss plans can work

NEW YORK (Reuters Health) - People who take part in a commercial weight-loss program may indeed shed some pounds - especially if they substantially cut calories, a new study from Sweden finds.

via  reuters.com

 

Worldwide, around 1.5 billion adults are overweight and another half billion are obese. In the U.S., two-thirds of adults are overweight or obese. That's a huge market for commercial weight-loss programs, but few studies have looked at whether they really work.

The popular Weight Watchers and Jenny Craig programs are among the few that have been tested in clinical trials, with promising results: People in the programs lost more weight over two years than people assigned to "usual care" - generally advice from a doctor or dietitian. (See Reuters stories of September 8, 2011 and November 4, 2011).

The newest study followed over 9,000 adults who enrolled themselves in Itrim, a popular chain of weight-loss and exercise centers in Sweden. The company just recently expanded to the U.S., opening a center in San Francisco .

Over a year, program clients lost an average of 11 to 25 pounds, depending on how strict they were willing to get with calories.

On the other hand, up to one-quarter dropped out, according to results published in the American Journal of Clinical Nutrition.

The Itrim program is different from its better-known competitors, according to Erik Hemmingsson, a researcher at the Karolinska Institute in Stockholm who led the study.

Weight Watchers promotes eating "normal food" and trimming calories, while Jenny Craig typically provides prepackaged lower-calorie meals, then has people gradually go back to regular meals.

People in the Itrim program choose an eating plan, with the help of a "health coach," and take up an exercise regimen. The strictest diet plan involves downing liquid meals of just 500 calories a day for six to 10 weeks, then gradually reintroducing normal food.

If that sounds too daunting, people can combine liquid meals and lower-calorie regular meals for a total of 1,200 to 1,500 calories per day, or stick with normal food but trim calories to 1,500 to 1,800 per day.

In their study, Hemmingsson and his colleagues found that the strictest diet worked best. Among nearly 3,800 clients who chose it, the average weight loss over one year was 25 pounds.

Almost 4,600 people who opted for the liquid meal/real food combo came in second. They shed 15 pounds, on average. Meanwhile, the group that stuck with normal food - 676 clients in all - trimmed an average of 11 pounds.

It remains to be seen how widely appealing the program could become, according to Hemmingsson, who was once employed by Itrim and has received consultancy fees from the company. (Itrim also funded the current study.)

This study was not a clinical trial, wherein people were randomly assigned to the Itrim program or to routine healthcare: Everyone in the study chose to enroll, put their own money up and were motivated to shed pounds.

Even so, clients dropped out: anywhere from 18 percent to 26 percent, depending on the plan. (The strictest, liquid-meal plan had the lowest dropout rate.)

And of course, they paid a price. The cost of Itrim over one year, excluding the liquid meals, is equivalent to $1,300.

But the findings do underscore the importance of old-fashioned calorie-cutting, Hemmingsson said.

"Calories are still what counts and makes a difference regardless of the setting - clinical or commercial," Hemmingsson said.

Yet that simple principle - burn more calories than you take in - is often forgotten when people try to shed weight, he noted. "It's not rocket science, but it works," Hemmingsson said.

Commercial diet programs might help when people have trouble making those changes themselves, or staying motivated over time, according to Hemmingsson.

He said he thinks the support in the Itrim program is "absolutely crucial."

When people enter the program, they discuss their diet strategy with a health coach. And after the first three months - the "weight loss phase" - they start going to their local Itrim center for a workout two or three times a week. They also continue to get diet and lifestyle advice.

Researchers still have a lot to learn about commercial weight loss programs, including whether people maintain their initial success over the long haul.

"We generally need to raise the bar by designing studies with a much longer follow-up, say three to five years," Hemmingsson said.

For now, he suggested that people zero in on calories if they want to win the battle of the bulge.

"If you are serious about losing weight," Hemmingsson said, "then you should focus on calorie cutting - for example, by using meal replacements - and adopt a more physically active lifestyle."

If that's too difficult on your own, he added, a commercial program might help. But he advised choosing one that has actually been held up to some scientific scrutiny.

SOURCE: American Journal of Clinical Nutrition, online September 18, 2012.

Can Swimming Twice A Week Really Shed Those Pounds – Follow Gabby

Can Swimming Twice A Week Really Shed Those Pounds – Follow Gabby (via 21C Woman)

For many people, jogging and running are the definitive way to burn calories and shed the pounds. However, these forms of exercise simply aren’t for everybody, and some people just don’t get bitten by the jogging bug. Many women feel discouraged at the start of their fitness journey when they find…

Short Bursts Of Exercise Can Burn Calories Throughout The Day

Although we all need it—maintaining a regular exercise regimen can be difficult with the demands of everyday life pulling at us from every direction.

   via redorbit.com

However, some exercise is better than none at all and a new study from a group of Colorado researchers supports that notion by demonstrating a few short bursts of intense exercise can burn to up 200 more calories throughout the day.

The researchers, from the University of Colorado and Colorado State University, will present their findings in a presentation entitled, “A Single Session of Sprint Interval Training Increases Total Daily Energy Expenditure,” at The Integrative Biology of Exercise VI meeting this week in Westminster, CO.

“Research shows that many people start an exercise program but just can’t keep it up,” said the study lead author Kyle Sevits of CSU. “The biggest factor people quote is that they don’t have the time to fit in exercise. We hope if exercise can be fit into a smaller period of time, then they may give exercise a go and stick with it.”

Previous studies have shown that an exercise program known as sprint interval training can improve overall fitness and athletic performance. The team decided to investigate how this exercise regimen affects caloric expenditure, a factor that motivates many people to exercise.

In their study, Sevits and colleagues enlisted five healthy male volunteers between the ages of 25 and 31 years old. The participants began the study by undergoing an exercise stress test to make sure they were fit enough to participate in the sprint training. The researchers also recorded the participants’ body compositions and metabolic rates while at rest.

After they were deemed healthy enough to participate, the volunteers ate a specific diet over three days that was designed to meet their metabolic needs and establish an “energy balance,” with just enough calories for their bodies, Sevits explained.

The men then checked into hospital-type rooms at the University of Colorado research facility that were outfitted with a ventilation system designed to analyze oxygen, carbon dioxide and water content. The system allowed researchers to determine how many calories were burned by each volunteer.

For two days, each volunteer continued to eat the balanced diet. They spent the majority of their time doing sedentary activities, but on one of the days, they engaged in the sprint interval workout.

During the workout, each participant would pedal as fast as possible on a stationary bicycle on a high-resistance setting for five 30-second periods, separated by four-minute recovery periods in which they pedaled slowly at a low-resistance setting. The researchers also coached the volunteers over an intercom system during their sprints so that they would give maximum effort.

The ventilation analysis showed that the participants burned an extra 200 calories on the day of their 2.5-minute sprint workout. Researchers were unsure of the mechanism behind the burn, but noted that the results were promising for people trying to squeeze a few minutes of exercise into their schedule.

“Burning an extra 200 calories from these exercises a couple of times a week can help keep away that pound or two that many Americans gain each year,” Sevits noted.

The American government currently recommends 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week.