Speaking With...: Brian Wansink

This past Friday, Cornell University John Dyson Professor of Consumer Behavior and director of the Cornell Food and Brand Laboratory Dr. Brian Wansink stopped by New York University after being tapped as the second featured speaker of a new lecture series on nutrition and chronic disease.

Taking off from his bestseller Mindless Eating, his talk was appropriately titled, "How To Turn Mindless Eating Into Healthy Eating."

With those prevously mentioned credentials, you might picture a stiff, "all business" type who solves complex equations in his head while half-listening to you.

Dr. Wansink, however, is reminiscent of the cool high school math teacher who wanted you to learn -- and have fun while doing so. His research explanations are peppered with personal anecdotes, comedy, and facial expressions that sometimes rival those of Jim Carrey.

A few hours before his afternoon presentation, I sat down with Dr. Wansink for a one-on-one interview.

If you are unfamiliar with Dr. Wansink's work, please click here to familiarize yourself with his research before reading the interview.

I get such a kick out of all your publicity shots for Mindless Eating [NOTE: see accompanying picture]. They're great! Have they all been photographers' ideas?

Ha! Thanks. Yeah, I've had some really creative photographers who set up these elaborate shoots. Some of those popcorn shots literally took twelve hours, from setup to cleanup. There was a LOT of popcorn all over the floor at the end that had to be cleaned up (laughs).

So, I recently read that all of this research started as a result of you wanting people in the United States to eat more vegetables.

That's right.

How did you go from that to your current line of research?

Yeah, before I started my dissertation [in the late 80s], I wanted to know: "why do you finish your vegetables sometimes and other times you leave them on your plate?". "Why are you hungry for them one night and not the next?" That then evolved into the idea of environmental factors that affect our overall eating patterns. It's a lot more complex than people think because so many of our eating behaviors are automatic. This is all about getting below that surface. One of my first research studies had to do with family serving behavior. We had people come in, eat, and then answer questions about what they ate.

Then, we showed them video footage of their meal. It is amazing how many people flat out deny, or are not aware of, their eating behavior. You'll say to someone, "you had three servings of peas." They'll tell you, "No, I only had one!" You feel like saying, "Well, unless you have an evil twin..."

It's not until you show them the videotape that they change their mind. I once had a woman cry when she saw herself eating on camera! My research considers three angles. Not only what people are eating and how much of it, but also with what frequency.

How did all that research turn into Mindless Eating?

In 2004, I was in France and thought to myself, "I'd like to write a book, but I don't know if I want it to be academic or pop."

That year, Bonnie Liebman of the Center for Science in the Public Interest interviewed me for their Nutrition Action newsletter, and suddenly a lot of requests for book deal started coming in. Most of them were e-mails and, I don't know, nothing really stood out. Then I got a letter -- an actual letter! -- from Bantam Dell Books. One of the things I liked about them is that, as they told me, they are in the business of creating "real books that people read."

Interesting you say that, because I think that's definitely one of the factors behind the popularity of Mindless Eating. It is relatable for and interesting to the average consumer.

So at this point, it's been a few years since the book came out. I was wondering about recent developments. For example, have you conducted any research on the effects of calorie postings in fast food restaurants?

Oh yeah, I was involved in a VERY well-done study with Carnegie Mellon in regards to calorie labeling. We looked at McDonald's, Subway, and Starbucks in terms of what consumers were buying before and after calories went up. And, you know what? The results were indeterminant. They were all over the board. Some people consumed fewer calories, others didn't. I would actually be suspicious of anyone who told you they have seen a dramatic effect as a result of calorie labeling.

That strikes me as really odd. What are your theories regarding the results of that study?

There's a few things to consider. First of all, when it comes to weight loss, a lot of people think: Yeah, I wouldn't mind losing ten pounds, but I don't want to change a thing." Then there's reactance, which is a psychological term. It's basically resistance. Reactance is at play when you're in your car and the person behind you honks so you pull away more slowly than you would otherwise.

(Laughs) Or when you know someone at a restaurant is waiting for your table, so you sit there and take a little longer.

Yeah. So I think, in a way, some people are seeing these calories and thinking, "Oh yeah? Well, you're not going to tell ME what to eat!" Something similar happened in a study I did with Cornell. So, Cornell has a huge dining hall that services about 1100 people at one time. I wanted to see what effect going tray-less would have. I thought it would have two positive effects -- it would result in reduced waste and reduced calories.

The idea being that people couldn't pile everything on at once but instead had to get up from their table each time they wanted more food?

Yeah, exactly. Well, the results came in, and that night there was roughly 30 percent MORE plate waste! I think it comes back to that idea of reactance, where people saw this and thought, "Fine, I won't use a tray, but I'm not going to eat less." But that's not to say that I think calorie labeling isn't useful. Let me tell you something. The other day I went to Sbarro and saw that the slice of pizza I wanted was 787 calories. Aaaaaaaah!! So I think these calorie postings are going to serve as incentives for these food companies to say, "Alright, wait a minute, I want to turn that 787 into 690." I think it's going to nudge companies to drop the numbers, and that's what will, in turn, affect consumers.

Speaking of consumers, you recently finished your one-year post with the United States Department of Agriculture’s Center for Nutrition Policy and Promotion working on the Dietary Gudelines. How did that go?

Oh, it was great! I thought I was on a mission from God! My last day was January 20, when the new president took office. I was literally sending e-mails at 11:59 PM on January 19. I was still e-mailing at 12:05 AM on January 20, and I remember thinking "Wow, they didn't shut off my inbox!" Then I got up to grab something to eat, and about ten minutes later I came back and I no longer had access.

Any sneak peeks as to possible changes we may expect in the next round of Dietary Guidelines?

I was involved with the selection of the 13 Dietary Guidelines committee members, and 11 of them have a behavioral focus. They operate where the rubber meets the road. That's important, because they take pages upon pages of data and transform it into information for the masses that can be summarized in just a few sentences.

So to wrap up, I'm interested in hearing about research you are in the process of conducting now.

Oh yeah, sure. Well, we're looking at what happens to people's eating behaviors when they sit next to someone who has a much higher BMI than they do. We are also doing a study where we have someone wearing a fat suit and going through one side of a buffet very slowly, serving themselves a lot of food. Everyone on the other side of the salad bar takes a much lower amount of food compared to when that person is going through the salad bar without the fat suit on. It's the whole concept of mimicking the attractive person. It's terrible, because weight is the last acceptable prejudice in our society and it can really be crippling to a person's self-esteem.

Lately, the concept of "nature vs. nurture" has become central to the issue of childhood obesity. Do you have any thoughts on that from a behavioral standpoint?

Well, we conducted a study with 4 year olds. We gave all the kids a questionnaire to take home. The point of the questionnaire was to determine to what extent parents forced their kids to eat everything that was on their plate. Of course, we disguised those questions among lots of filler like "what is your favorite TV show?"

"What color are your curtains?", etc.

(Laughs) Exactly. So the parents, on a scale of one to nine, had to rate just how heavily they enforced "the clean plate club" at home. So, you know, nine was "my kids HAVE to finish everything on their plate or there is some kind of consequence" and one was "Ah, if they eat, they eat. If they don't, they don't." We discovered that the children whose parents insisted they finish everything on their plate served themselves approximately 40 percent more cereal in our study.

Wow! And based on what you talk about in Mindless Eating... the idea that, once food is in front of us, it is very easy to eat it all, that's a significant finding.

Yeah, the thinking is that children who are forced to clean their plate feel like the have no control when it comes to food, so they find ways to reassert their control and independence.

Well, it looks like we've actually gone over time, but this has been fascinating. It's been a pleasure speaking with you. Thank you!

Oh, absolutely. Thank you and best of luck with everything.

Many thanks to Dr. Wansink for his time!

So Much for Moderation

I don't know what the weather is like in your corner of the world right now, but New York City's is currently grey and rainy.

Alas, here is a perfect website for such a day -- This Is Why You're Fat.

Crass name aside, it's a grotesquely fascinating photo gallery of real, gasp-worthy, "you've GOT to be kidding me!" dishes (many of them served at restaurants).

Take, for instance, "the Thunderdome's three stacks of bacon, sausage, elk meat, onions and cheese between tortillas all topped with sour cream, two fried eggs and scallions."

Then there's the blasphemous "Snack Pizza Bomb: pizza topped with french fries, sliced corn dogs, popcorn chicken and Doritos" pictured alongside this post.

Anyone up for figuring out calorie totals?

In The News: In The Zone

Today's New York Times reports the conclusion of an eight-year-long study of millions of schoolchildren completed by economists at the University of California and Columbia University: "ninth graders whose schools are within a block of a fast-food outlet are more likely to be obese than students whose schools are a quarter of a mile or more away."

This study is particularly significant since it adjusted for variables like income, education, and race, thereby making it easier to accurately pinpoint the effect of fast food restaurant proximity to weight.

More specifically, "obesity rates were 5 percent higher among the ninth graders whose schools were within one-tenth of a mile of a pizza, burger or other popular fast-food outlet, compared with students attending schools farther away from fast-food stores."

In a not-at-all surprising move, the National Restaurant Association is shrugging this off since "it did not take individual diet and exercise into account." The argument falls rather flat when you consider that the location of these fast food restaurants clearly had an effect on students' diets.

I have long been a supporter of zoning laws regarding fast food restaurants and schools, and this only strengthens my belief.

In The News: "Second Hand" Obesity

Today's New York Times reports on a new pooled analysis study published in the Journal of the American Medical Association which concluded that "obese women are more likely to have babies with rare but serious birth defects, including spina bifida and other neural tube defects."

Although spina bifida is generally associated with insufficient maternal intake of folic acid, lead study author Dr. Judith Rankin theorizes that in the case of obese women, "insulin resistance and undiagnosed diabetes may be playing a causative role in birth defects... though the precise mechanism is not known."

This new study gives further credence to weight-loss recommendations given to obese women planning to start a family.

Numbers Game: Answer

The world renowned Framingham study concluded that a 2 point decrease in BMI reduces the risk of developing osteoarthritis (a loss of cartilage) in the knee by approximately 50 percent.

(NOTE: Using a 5 foot, 10 inch tall man weighing 190 pounds as an example, a 2 point decrease in BMI is achieved by losing 10 pounds.)

According to World Health Organization statistics, osteoarthritis is the fourth leading cause of disability in the world.

The research literature clearly identifies obesity as the most influential factor in the development -- and subsequent progression -- of this condition.

One of the more problematic aspects of osteoarthritis is that it makes implementation of most sorts of physical activity and movement significantly challenging, thereby adding more difficulty to weight loss efforts.

Numbers Game: Answer

A University of North Carolina at Chapel Hill School of Public Health study published in the November 2007 issue of Obesity Research found that per capita total daily intake of liquid calories in the United States increased 94 percent from 1965 to 2002.

This means the average American is now getting a hefty 21 percent of his or her total calories exclusively from beverages.

Since we are talking about mostly caloric beverages (particularly sodas and fruit juices), this makes the 2002 figures 222 calories higher than those from 1965!

Add to that the fact that these 222 calories are not balanced out by a reduction in food intake (if anything, they are accompanied by an increase in calories from food!) and it becomes rather clear why rates of overweight and obesity have increased.

Let the accompanying photo also serve as a reminder that 7-11's 44 ounce Super Big Gulp and 64 ounce Double Gulp cups did not exist in 1965!

In The News: Get In Shape! Yes, Sir!

Here's one example of childhood and adolescent obesity having consequences one might not initially think of: "the Army has been dismissing so many overweight applicants that its top recruiter, trying to keep troop numbers up in wartime, is considering starting a program to transform chubby trainees into svelte soldier,"reports The Washington Post.

Obesity tops the list of reasons preventing applicants from entering the military -- more so than "a lack of a GED or high school diploma, misconduct or criminal behavior, and other health issues such as eye or ear problems."

Recruiters estimate that 30 percent of all applicants are considered, pardon the pun, "unfit" as a result of their overweight or obese status.

And it's not just the military feeling this crunch -- firefighting department across the country are finding themselves with an increasingly larger number of young, overweight applicants unable to pass the necessary fitness tests.

And so come to the usual question: how do we remedy this situation?

We know that obesity is a multi-layered issue that calls, among other things, targeted public policy, education, and access to healthy foods.

In the meantime, how about mandatory physical education through twelfth grade?

The "stay active" part of the formula appears to be missing in too many places.

Speaking With...: Ian Smith

Most of you know him simply as "Doctor Ian," nutrition expert on Vh1's Celebrity Fit Club, creator of the 50 Million Pound Challenge, host of the nationally syndicated radio show HealthWatch on American Urban Radio Networks, and author of #1 New York Times Bestsellers like The Fat Smash Diet.

Yesterday, Dr. Smith -- a graduate of the University of Chicago Pritzker School of Medicine -- launched his latest work, The 4 Day Diet, which is composed of a variety of 4-day modules.

My e-mail interview with him, transcribed below, covers the new book (I received an advance copy last month in preparation for our correspondence) as well as other current issues of interest in the fields of nutrition and public health.

The concept of motivation plays a significant role in this book. What motivated you to pen The 4 Day Diet?

So many people who I've worked with over the years have always talked about a lack of motivation or the inability to stay motivated. They wanted to know how to figure out a solution to this deficit.

I looked at all of the best diet books and none of them really gave the topic of motivation any real coverage. I know as a fact that the mental part of dieting is the most critical, because if your mind isn't in the right place, then regardless of how good the plan might be, you're not going to succeed.

The 4 Day Diet is my rendition of a COMPLETE program. There's the mental plan, diet plan, and exercise plan. The people who I worked with while creating this program not only lost a lot of weight, they lost it consistently and they constantly told me how "doable" the program was compared to others they had followed.

I also wrote the 4 Day Diet so that if parents want to put the entire family on a program, this could be that program. Most diet plans are not kid-friendly, but the 4 Day Diet is one that everyone can enjoy and see results.

The psychological and emotional factors behind weight loss are thoroughly explored in The 4 Day Diet. Do you recommend that, if financially possible, people simultaneously seek psychological counseling before/while trying to achieve significant weight loss?

In the best of worlds, people who need to lose a serious amount of weight or who have some psychological component to their cause(s) for being overweight would seek some type of psychological consultation. It's not because they're crazy or not smart. It's because sometimes we have anxiety or stress-related problems and don't even know it, and a professional might help tease these problems out.

I know that everyone can't afford to go to a psychiatrist/psychologist or doesn't want to go, so that's why I've included this material in the 4 Day Diet.

A lot of people will learn more about the cause of their problems and the strategies they can employ to solve them as they go on and lose the weight while regaining their health.

On a similar note, do you think periods of high stress are not a good time to begin implementing dietary changes?

One of the worst times to start a diet program is during a period of high stress. I tell people all the time, if you have some type of major life disruption such as relationship problems, job problems, financial crisis, loss of a loved one, medical crisis--these are not the times to undertake a diet program.

Unfortunately, too many people start a program simply because they believe it's the right time on the calendar to do so and they don't make sure it's the right time in their life. Success is more attainable if one begins this journey at the most appropriate time.

That being said, one must also guard against coming up with every excuse in the book as to why they shouldn't lose weight. Major stress-inducing situations are the only things that should stand in the way, not the small stuff.

Are you at all concerned the "Be Thinner by Friday!" label on the cover of the book can set up unrealistic expectations in readers or make this look like a gimmick?

There is that risk and to be honest I wrestled with the idea of putting it on the cover. I had those exact concerns, but the publishing team felt as though given my history of creating medically sound programs and being honest with people, that they would not interpret it as a gimmick.

The truth of the matter is that with the 4 day detox that's at the beginning of the program, people will lose weight right away. Will they lose all of their weight? NO WAY! That's not what I'm saying. They will lose weight and they will think differently.

One of the chapters talks about "thinking thin." That is as important as the physical part of looking thin. So, people will be thinner by Friday not just physically but mentally, and they will be on the road to significant changes if they stick to the plan.

Is there a particular reason why the modules [in the diet plan] only allow one teaspoon of milk (even skim or low fat) in coffee?

Great question. The honest answer is that people tend to go overboard. If the limit is 1 teaspoon, then most people are going to have 2. If I said 2 teaspoons were allowed, then they would rationalize having 3. Sometimes you can't win.

The major point with this is that you must try to cut calories wherever possible, even a small amount. If you get into the behavior of cutting calories with drinking coffee, then you're also likely to do the same when there are bigger calories at stake such as eating an entree or dessert.

It's all about learning how to make lifestyle changes that will lead to permanent good health.

What is your approach to people who "excuse themselves" from ever attempting to lose weight by saying "it's just how they are built" because they come from "large families"?

This is one of the most frustrating excuses I hear when people talk about reasons they don't try or can't lose weight. The truth of the matter is that unless one has a genetic medical condition that has been inherited from their family, there really is no such thing as "coming from a large family, therefore it's inevitable that they are large."

Can you come from a tall family? Yes. But that's genetic. Weight is rarely genetic. Families tend to be large because the choices they make from a dietary and exercise perspective make them large. There are no genetic plans that say everyone in a family is going to be 50 pounds overweight.

But if there's a medical condition that's inherited, then that's a different story. The truth is that you have a better chance of winning the lottery than truly being large "because your family is large."

Only 40 percent of medical schools in the United States offer a nutrition course. Of that 40 percent, very few actually require it as part of their curriculum. What are your thoughts on the apparent dismissal of nutrition that appears to be prevalent in the medical field (i.e.: "to lower blood pressure, take this pill, rather than be mindful of sodium and potassium intake.")

I think the lack of nutritional education is medical schools is a tremendous oversight and we are now seeing the manifestation of it with the obesity crisis we're now facing. More doctors and nurses need to know a lot more about nutrition and supplements and non-medicinal ways to control weight.

Obesity is a medical epidemic just like the plague was an epidemic. The front line fighters against this epidemic should be the doctors and nurses and other healthcare professionals. But there's not enough nutritional and related training, thus they are not effective at fighting on the front lines.

Are doctors entirely to blame for the obesity crisis? Absolutely not. Do doctors share some of the blame? Absolutely. I hope in the coming years that medical schools will see the need to take nutrition as serious as they take pharmacology and physiology and help train a new generation of obesity fighters.

Mandatory calorie labeling has proven to be a successful policy in New York City. What are some other public health nutrition policies you would like to see implemented in the coming years to help people achieve their health goals?

I think NYC has gotten off to a good start and I hope it proves successful and others will follow this lead. There are lots of health nutrition policies that should be implemented over the coming years to help cut into our obesity problem.

I think that schools across the country are getting an F grade when it comes to providing healthy food for our children. This is an embarrassment for the US, a country so rich and so full of resources and intellectual capital. Our children need to be served healthier food and mandated to participate in regular physical activity. At a time when we need children to be more active, we're dramatically cutting funding to programs and classes that would help our children get moving and lose some of this weight that will only harm them in their adult years.

I also believe that the government needs to be more instrumental in helping lower-income areas attract healthier grocery stores. Too many neighborhoods have nowhere to shop but stores that sell unhealthy, calorie-rich, sweet, processed foods and not enough natural, fresh food.

Yes, the communities must first want and then work to get these stores in their communities, but the government at some level should step in and play some role in incentivizing businesses to set up shop in these very needy communities. Remember, the healthier our fellow citizens, the healthier we all are!

Many thanks to Dr. Smith for taking time to participate in Small Bites' "Speaking With" section!

You Ask, I Answer: PolyCystic Ovary Syndrome, Milk

I have a condition known as PolyCystic Ovary Syndrome, which results in my hormones being all out of whack.

I'm befuddled as to which would further alter my hormone levels more (and which hormones that would be): cow's milk or soy milk?

I have read that bodybuilders [try to avoid] soy-based protein powders because they increase estrogen [levels], but I have also read reports that the hormones in cow's milk can cause girls to [begin] puberty at a younger age.

Would drinking organic milk be the solution?

-- Rachael (last name unknown)
(city unknown), NJ

Let's first begin by touching upon some nutrition-related specifics regarding PolyCystic Ovary Syndrome (POS).

The hormones found at high levels in affected individuals are a group of male hormones known as androgens.

One interesting theory that has emerged about risk factors for POS (other than being overweight or obese) surrounds the body's inability to use up insulin efficiently.

Since high levels of free-floating insulin building up in the blood can increase the amount of androgens produced, it is believed this could be a factor behind the development of this syndrome.

This is also why POS in itself is a risk factor for Type-2 diabetes.

From a nutritional standpoint, the best recommendation is to lose excess weight, as this often results in more efficient use of insulin by the body and, consequently, lower production of androgens.

The catch-22 is that, for many individuals, it is precisely this hormonal imbalance that can add a degree of difficulty to achieving weight loss.

Consequently, I highly recommend that you speak to a Registered Dietitian (as opposed to picking out a diet plan from a book or magazine, even if it is from a highly reputable source.)

With POS, you need a customized plan based on your individual situation.

It really doesn't make a difference to your condition whether you include dairy or soy milk in your diet, as neither of these have a particular effect on androgen levels.

As for the link between hormones in milk and early puberty -- I don't buy it.

After all, milk consumption has been on a steady decline over the past two decades. It's children's intake of soda -- not milk -- that has skyrocketed since the 1980s!

A much more realistic explanation for the recent trend of earlier puberty initiation? Increasing obesity rates among children.

Highly respected endocrinology journals have published a handful of studies over the past few years -- such as this one -- making interesting physiological connections between high BMI levels and earlier sexual maturation in girls.

In The News: Milk Madness

The Chicago Tribune is profiling the battle over milk that has ignited in several of the Windy City's school districts.

On the one hand, you have administrators and parents supporting the inclusion of milk in school cafeterias, "amid concerns that dairy consumption is waning among older children who have more beverage choices, from flavored water to energy drinks. Nine of every 10 preteen girls fall short of the federally recommended three calcium servings a day... for boys, the estimate is 7 of 10."

Then there are those concerned with flavored non-skim milks contributing to childhood obesity. Huh??

"A half-pint of low-fat chocolate milk has 3 teaspoons of added sugar... [and] those extra 75 calories raise a concern, given that surveys compiled by the Centers for Disease Control and Prevention have found that 17 percent of school-age children are obese."

Whoever is concerned about those additional 75 calories seriously needs to reevaluate their priorities.

Childhood obesity is not caused by opting for low-fat chocolate milk over non-flavored skim milk at lunchtime.

All you need to do is look at the numbers. As childhood obesity rates have skyrocketed, milk consumption has decreased.

What has increased? Soda consumption -- overwhelmingly so!

It is those beverages, plus chips, breakfast toaster pastries, and supersize fast food portions -- staples of so many American teenagers' diets -- that should truly be "of concern."

It's also rather laughable to think that some schools are concerned with milk but apparently don't take issue with their almost daily offerings of meatloaf, chicken nuggets, and fruit canned in heavy syrup.

A glass of low-fat chocolate milk with a healthy lunch is harmless. This apparent phobia of 1% (reduced-fat) milk is beyond my comprehension.

We are talking about 2.5 grams of total fat, of which 1.5 gram are saturated, per cup. Perfectly reasonable numbers, as far as I'm concerned.

In The News: An Odd Solution

The San Francisco Chronicle reports that skyrocketing obesity and diabetes rates in India are leaving citizens looking for healthier alternatives to mithai -- "sweet, fudgy goodies rich with cardamom, pistachio and saffron... eagerly eaten, given as gifts, [or] offered to the gods]" during annual Diwali celebrations.

Partially due to an improved economy, many Hindus are opting to replace the sugary treats with clothes, electronics, and jewelry.

Two interesting points stand out here.

Number one: sales of sugar-free mithai are improving.

Number two: the government has taken action by releasing "millions of tons of sugar into the markets... in a bid to drive down prices."

As you may imagine, both of these developments leave me shaking my head.

First of all, sugar-free varieties of candies are not necessarily lower in calories.

The overwhelming majority of sugar-free candies contain higher amounts of fat than their standard counterparts, often times resulting in mere 10 or 20 calorie differences.

Remember, whereas sugar adds 4 calories per gram, fat contribues 9 calories per gram.

Of course, the average consumer is not aware of this, and often finds themselves thinking they can eat more simply because sugar is absent. Not quite.

And lastly, why on Earth is the government's solution providing more sugar at lower prices?

If a large percentage of the country is concerned about obesity and diabetes, cheapening sugary food is not the optimal solution!

Why not look into long-term policy that can begin to address some of the population's needs (for instance, calorie labeling)?

In The News: Is Fat Acceptance Acceptable?

Yesterday's New York Times Magazine ran a short piece on the "growing" fat-acceptance movement (although it's been around for approximately three decades and has yet to catch on, but I digress.)

"Fat-acceptance activists insist you can’t assume someone is unhealthy just because he’s fat, any more than you can assume someone is healthy just because he’s slim. "

In fact, this movement firmly believes that "it is possible to be healthy no matter how fat you are."

No matter how fat? Really?

So how do they explain, then, the countless research studies that have observed reductions in LDL ("bad") cholesterol, type 2 diabetes risk, and blood pressure in overweight and obese individuals who lose weight, even just five pounds?

Well, they point to a report published in The Archives of Internal Medicine this past August, which "reported that fully half of overweight adults and one-third of the obese had normal blood pressure, cholesterol, triglycerides and blood sugar — indicating a normal risk for heart disease and diabetes, conditions supposedly caused by being fat."

Too bad that study didn't examine levels of C-reactive protein, a marker of inflammation.

Remember, most diseases -- especially cardiovascular ones -- have cellular inflammation as a precursor.

And guess one of the factors that increases C-reactive protein levels? Overweight and obesity!

Additionally, one of those study's co-authors was quoted as saying that "among people of healthy weight in the study, elevated blood pressure, cholesterol and other factors were more common for people with larger waists or potbellies" and that "among overweight and obese adults, those in the “healthy” category tended to have smaller waists than those with at least two risk factors.

Need I say more?

The problem with this entire "movement" is that it attempts to kill two very different birds (social acceptance of overweight/obese physiques and the health consequences of being overweight/obese) with one stone.

It is one thing to denounce the media's obsession on borderline unhealthy bodies, but how anyone can believe weight has nothing to do with health status is beyond me.

All you have to do is speak to formerly obese people.

Ask them how they feel walking up a flight of stairs now as opposed to when they were carrying an additional 60 or 70 pounds on them.

Ask them how their lipid profiles have changed.

Ask them, very simply, if they miss carrying that excess weight.

Similarly, people who are extremely underweight (purposefully or not) are also at increased risk of mortality.

I point that out to show that nutrition and weight management are not inherently "anti fat," it's just that with the obesity rate doubling in the past 30 years in this country, it is not surprising that most public health nutrition efforts are concentrated on that particular problem.

Back to the Times article, I can't help but roll my eyes at the mention of "a new book out this fall, Health at Every Size, by Linda Bacon, a nutritionist and physiologist at the University of California at Davis, which is less about dieting than a lifestyle change that emphasizes “intuitive eating”: listening to hunger signals, eating when you’re hungry, choosing nutritious food over junk."

What exactly is so revolutionary? The guidelines mentioned above are precisely the same ones advocated for permanent weight loss and increased health awareness by many Registered Dietitians.

In fact, if any of you have ever been to a Registered Dietitian, you know the focus is on establishing healthy dietary patterns. It's not about six packs, fitting into size 0 clothes, or looking like the cast of the new Beverly Hills 90210.

To place the nutrition field on the same level as a celebrity diets segment on The Insider is preposterous and extremely reductive.

I don't see the damage in advocating for a healthy medium, where the end goal is to not be underweight or overweight.

In The News: Just How Splendid Is Splenda?

Not very, according to some Duke University researchers who point the finger at the artificial sweetener, accusing it of "contribut[ing] to obesity, destroy[ing] “good” intestinal bacteria and prevent[ing] prescription drugs from being absorbed."

Interestingly, the study is financed by the Sugar Association.

Perhaps more ironically, the first two statements could also apply to sugar.

In fact, many foods and ingredients can feasibly be labeled as "obesity contributors" depending on consumed quantities.

Someone could very well point to olive oil as an "obesity contributor," which it can be if it is liberally poured over every meal you eat.

As you can see, such statements completely distract everybody from more relevant issues.

In the case of sugar and Splenda, these accusations are misleading.

After all, obesity rates were much lower 400 years ago (when sugar was consumed), and it's not as if a surge in obesity occurred when Splenda was unleashed to the public.

Here are my thoughts on the real issues at stake here:

1) Is Splenda safe?

A packet of Splenda in your morning coffee or enjoying a Splenda-sweetened beverage a few times a week with your lunch isn't a huge concern.

However, there are no long-term human studies -- Splenda is less than ten years old.

We truly do not know what, say, 40 or 50 years of consuming Splenda on a daily basis does to the human body. A little tidbit to keep in your back pocket...

2) Does Splenda contribute to obesity? What about sugar?

Well, sugar is the epitome of empty calories (you can down 500 calories of sugar water and not feel the least bit full.)

And, since most sugary treats are also high in fat and overall calories, I suppose there is a "two degrees of separation" concept going on here. However, sugar was consumed long before obesity rates skyrocketed, so branding it a culprit seems wrong to me.

As far as Splenda "contributing to obesity," I don't buy it.

What I will say is that it can certainly provide a false sense of security.

A slice of sugar-free cake (made with Splenda) is NOT calorie-free, although many people may inaccurately think so.

The fact remains that sweetener consumption in the United States has grown exponentially over the past 20 years.

Consequently, additional calories are being consumed from sucrose (table sugar) and high fructose corn syrup.

Sugar as a sole ingredient does not make anyone fat. Having endless grams (and calories) of sugar on cereals, cookies, frozen desserts, yogurts, and salad dressings, however, gets very problematic very quickly.

Artificial sweeteners, meanwhile, continue to become more available in a wide variety of calorie-free foods.

Completely absent from everyone's diet fifty years ago, they are a relatively new piece to the public health nutrition puzzle.

My suggestion? Scale back a little on both. You can't go wrong reducing your intake of empty calories and artificial chemicals.

You Ask, I Answer: Friend's Weight Loss

I have a question concerning my friend's health.

He is an obese 34 year-old man with a thyroid problem (which slows down his metabolism).

As far as I know, he eats very little throughout the day, and what he eats consists mainly of hamburgers, beef, pizza, etc. He does not -- and will not -- eat vegetables, and his taste for fruits is very limited.

He does not eat chicken or seafood either. He also skips breakfast every morning, and does not take vitamin supplements.

I'm really concerned about his healthy but can't seem to sway him to eat better.

What are the risks he's up against with his health if he continues to eat like this?

What kind of eating plan would you advise he go on? Should he be eating more food in a day, but with fewer calories and in smaller quantities?

I feel like the food he is eating isn't getting properly broken down because of the lack of other foods in his diet. Is that true?

-- Kara (last name withheld)
St, Louis, MO

There are many things worth covering here, so let's take everything in order.

Your friend is certainly in a fragile situation.

The few statistics you provide (thyroid issues, obesity) as well as your observations of his eating habits (a diet lacking fruits, vegetables, and, I'm assuming, whole grains) paint quite a bleak picture.

I do find it interesting that you are curious to know what negative health effects this may have on him, because I have a feeling he is already experiencing some of them.

I am sure he feels short of breath when exerting the slightest bit of physical activity, experiences pain in his knees, and may even have sleep apnea (a potentially fatal condition in which people stop breathing for short periods of time in their sleep.)

The examples mentioned above give us a clue of what is happening to some of your friend's organs (i.e.: the heart may be working overtime, and joints can have too much pressure put on them.)

Although the human body is very resistant, years and decades of these conditions really run it ragged, and "system malfunctions" (or meltdowns) can begin to happen.

A heart that is put through the wringer every day for 10 or 15 years is not a healthy heart. Although your friend may be 34 years old chronologically, his organs very likely resemble that of an older person (depending on how long he has been obese.)

You mention not being able to sway him to eat better, and it appears you aren't too sure why.

I'd like you to go back and re-read the questions you sent me. Pay attention to the feelings they conjure up.

Perhaps you feel overwhelmed, not knowing where to start with your friend. Or hopeless that it will be hard to break this behavioral mold. You might even feel like whatever the "solution" is, it will be one that will take a lot of time, effort, and patience.

I ask you to think about this because the thoughts and feelings that come to your mind will very likely reflect what your friend is feeling about all of this.

A lot of tweaking needs to happen here -- eating more small frequent meals, consuming more fruits and vegetables, cutting back on calories, increasing physical activity... I could go on.

Believe it or not, though, that isn't really the issue right now.

Why? Because, most likely, your friend is already aware that some changes need to happen.

The issue here is what is keeping your friend repeating behavioral eating patterns that keep him at an unhealthy weight.

I am willing to bet that he either doesn't know where to start, or the entire concept of eating healthy and losing weight is so overwhelming that the mere thought of it makes him want to forget the whole thing.

It isn't uncommon to contemplate a "can of worms" scenario like this one and be at a complete loss as to which particular worm to untangle first.

All change, no matter how small, is difficult.

I can't provide an eating plan without knowing his medical history, food preferences, and bloodwork numbers, but here is what I suggest you do:

Once, and only once, sit down with your friend and thoroughly explain your concerns to him.

Let him know you are concerned about his weight from a health perspective, and ask him what his feelings and thoughts are on the matter.

Be mindful, though, to stay away from tips, suggestions, or recommendations about what he should or should not eat. The point of this conversation is not to tell him what saturated fat does to the body or which diet book he should read.

Simply recommend to him that, if his insurance covers it, he has the option of meeting with a Registered Dietitian, a trained professional who will work WITH him one-on-one to achieve whatever his goal may be.

Once this conversation is done, you have to make a promise to yourself to let the issue go.

That, my dear Kara, is really all you can do. Until your friend is ready to make a change, there is very little you can do.

Lastly, your question about whether the food he is eating is being broken down properly even though his diet isn't balanced? The answer is yes.

The human digestive system breaks down all foods, regardless of how healthy -- or unhealthy -- they are.

In The News: Genetics? Environment? Why Not A Little Bit Of Both?

Much like certain areas of sociology and psychology, the question of “nature versus nurture” permeates nutrition – or at least the consistently hot button issue of obesity.

A new study published in the Archives of Internal Medicine gives both factors the attention they equally deserve.

The end result?

“Vigorous physical activity can help even people genetically prone to obesity keep the weight off.”

A team of researchers led by Dr. Soren Snitker of the University of Maryland and Dr. Evadnie Rampersaud of the University of Miami “focused their study on a group of 704 Old Order Amish men and women in Lancaster County, Pennsylvania.”

Okay, not the largest sample size, but that doesn't mean we can't extract some juice -- and talking points.

As it turns out, participants who had the obesity (FTO) gene and engaged in the least amount of physical activity were, not surprisingly, "significantly more likely" to be overweight or obese.

However, those participants genetically predisposed to obesity but physically active were not heavier than participants without said predisposition partaking in similar amounts of physical activity.

It’s worth pointing out that the most physically active genetically predisposed group was burning an additional 900 calories than their satient counterparts.

That’s another point for the “calories count” camp!

By the way, the physical activity did not involve treadmills, Stairmasters, Swiss medicine balls, or pullup bars -- just old-fashioned chores (i.e.: gardening, farming, and even working the land with horses and plough!).

Do you think this study can be considered relevant for us non-Amish folks?

You Ask, I Answer: Stress & Weight Gain

Can stress alone cause weight gain?

I've been dieting and exercising great but I actually gained weight and I think it could be because I've been under a lot of stress lately.

-- "Chai"
Via the blog

I can't provide as detailed of an answer as I would like since I do not know what you classify as "dieting and exercising great."

Healthier eating does not necessarily lead to weight loss.

Some people, for instance, think that substituting soda for fruit juice is a great switch, not realizing that the fruit juice delivers just as many calories -- if not more -- than the soda!

Similarly, replacing French fries with stir fried garlic broccoli drenched in three tablespoons of olive oil provides healthier fats, but not less calories.

Anyhow, the issue of stress and weight gain is a little tricky.

For starters, stress affects people differently.

In the same way that some individuals can develop insomnia while others would rather sleep all day, some completely lose their appetite, and others want to eat an entire sleeve of Oreos in one sitting.

I am sure you have heard of the product CortiSlim, which promises to get rid of "stubborn belly fat" that is a result of a hormone known as cortisol.

The belief is that cortisol -- which the body releases in response to stress in order to get you moving (say, if you are riding your bike and about to get hit by a moving car) -- is overproduced during long periods of stress, in turn stimulating appetite and promoting adipose tissue storage in the abdominal area.

It's worth pointing out that CortiSlim was initially in hot water with the Federal Trade Commission for making unsubstantiated claims.

I personally don't think stress as an individual factor universally leads to weight gain.

Cortisol production varies between people; not everyone undergoing stress produces an abundance of cortisol.

I am sure you know many people who, when undergoing long periods of stress (i.e.: a turbulent breakup or the death of a family member,) can lose significant amounts of weight.

Additionally, a study conducted by New England Research Institutes and published in the April 2007 issue of the Journal of Endocrinology did not find a strong link between cortisol production and obesity.

"Circulating cortisol concentrations are somewhat lower in obese than in nonobese community-dwelling men," the study concludes.

Another interesting observation? "Age-related weight loss - and not gain - was associated with simultaneous increases in serum cortisol concentrations."

Where I do think stress plays a role is in making some people more vulnerable to reaching for high-calorie comfort foods.

I know that, in my experience, an ice cream cone is a lot more appealing than a cup of Greek yogurt on a sad day.

Ultimately, though, we come back to the concept of choice. Of course, some people can have a harder time resisting high-calorie foods when they are stressed, but it is ultimately the consumption of these foods -- as opposed to stress itself -- that can lead to weight gain.

Numbers Game: Answer

According to recent estimates, 30.6 percent of adults in the United States are classified as obese (Body Mass Index of 30 or higher,) while only 3.2 percent of the adult population in Japan falls into that category.

With that in mind, here's an interesting fact:

Average caloric consumption in the US clocks in at 3,770 calories a day, whereas the average Japanese citizen takes in 2,770 calories a day.

Quite a striking difference, wouldn't you say?

By the way, I have seen lots of sloppy reporting in regards to Japan's obesity rate.

Many articles point out that Japan's reputation as a healthy nation is undeserved, since one third of their adults are obese.

Not quite.

It just so happens that Japan and The United States use different parameters to define obesity.

In the USA, one is categorized as obese if their Body Mass Index totals 30 or more.

"Overweight," meanwhile, is used to describe BMIs ranging from 25.0 to 29.9

Japan, however, considers a BMI of 25 to mark the onset of obesity.

To fall into the "overweight" category in the land of the rising sun, one's BMI needs to be between 23.0 and 24.9.

Theories of the Japanese having a distinct genetic makeup that makes them less likely to be obese are flimsy, since adopting the typical US diet -- with its excessive caloric load -- leads to weight gain in this population as well.

In The News: Obesity & Genetics

I’m slightly weary of how the mainstream media will present the latest findings in the Journal of Clinical Endocrinoloy & Metabolism.

To summarize, researchers at University College in London and the Institute of Psychiatry, King’s College London, discovered that children with the FTO gene – a gene associated with obesity -- “are less likely to have their appetite ‘switched off’ by eating.”

Furthermore, “previous studies have shown that adults with two copies of the FTO gene are on average 3kg [6.6 lbs] heavier, and individuals with a single copy are on average 1.5kg [3.3 lbs] heavier, than those without the gene.”

What is important to keep in mind with this study and others similar to it is that the presence of this gene simply indicates “susceptability to overeating.”

In other words, making smart food choices is crucial, no matter what your genetic makeup. A predisposition should not be turned into a self-fulfilling life sentence.

I hope you are starting to see how a lot of the topics discussed on this blog feed into each other (pardon the pun.)

Think about the following.

It’s a known fact that when supersize portions are placed in front of us, we are likely to eat until the last bite simply because the food is there, inches away from our hands, eyes, and mouth.

Restaurant entrées containing upwards of 2,000 calories are not unheard of these days.

Place that factor within the framework of someone with an altered hunger mechanism and I'm sure you see the problem: they are even more likely to finish their plate, whether it packs in 800 or 3,000 calories.

Individual choices do play an important role, though. Regardless of their genetic predisposition, anyone can choose to accompany their meal with a 150 calorie side dish of brown rice or a 400 calorie side dish of onion rings.

Genes in and of themselves do not make anyone obese. It is the combination of dietary patterns and behaviors along with these genetic conditions that ultimately determine the outcome.

After all, our genes are the same now as 50 years ago, when obesity rates in the United States were approximately 65% lower than they are today.

Here's hoping an overeager newscaster won't soon be stating, "Why some people just can't help being obese! All that and more tonight at eleven."

In The News: LA Lays Down The Law

Controversy is cooking in California, where a new law was passed that "prevents fast-food chains from opening new restaurants in a 32-square-mile area [of South Los Angeles] for one year, with the possibility of two six-month extensions."

This particular area of Los Angeles -- formerly, and commonly, known as South-Central Los Angeles -- has the highest obese rates in its county.

In fact, the latest figures place 30% of adults in South Los Angeles as obese, whereas 20.9% of adults in that respective county fall into that same category.

Diabetes figure are also higher in Southern LA (11.7%) than the rest of the county (8.1%).

It's worth nothing that this particular piece of policy defines a fast-food restaurant as "any establishment which dispenses food for consumption on or off the premises, and which has the following characteristics: a limited menu, items prepared in advance or prepared or heated quickly, no table orders and food served in disposable wrapping or containers."

A few points of interest:

Some lawmakers have called into question the "limited menu" aspect of the definition, explaining that many fast food restaurants expand their menus as time goes on.

Additionally, "fast-food casual" restaurants, such as Subway or Pastagina, that do not have heat lamps or drive-through windows and prepare fresh food to order" are exempt.

While I think this is a step in the right direction, I am interested in seeing how effective this will be towards improving the health of residents.

There are still literally hundreds of fast food chains in the area, and, perhaps more disturbingly, "the area has far fewer grocery stores than other parts of town."

This is always a dilemma in the public health and nutrition fields -- how do you encourage people to improve their eating habits when they are so used to -- and dependent on -- a quick fix?

My proposal?

First, strike a deal with these fast-food restaurants that would entail them offering their healthier items at a reduced cost for a week, so as to encourage consumers to try them out.

Then, offer free nutrition workshops at local community centers with an emphasis on healthy, low-cost, quick recipes.

A lot of this dependence on fast food stems from convenience, a lack of nutrition education, affordability, and lack of alternative options.

That is not some armchair theory, it is what I can recall from my own experience.

Upon completing my undergraduate degree a few years ago, I lived in Washington Heights, a New York City neighborhood that has a high percent of low-income residents.

The local supermarkets had terrible produce, and healthier convenience foods were nowhere to be found (i.e.: low-sodium varieties of canned foods, whole wheat crackers, baby carrots, etc.)

The restaurants within a half mile radius of my building? All fast food.

If I was ever not in the mood to cook, my only options were fried chicken, Chinese takeout, or McDonald's.

The situation in South Los Angeles is the same.

Hopefully this community will be given resources -- specifically nutrition education, healthier restaurants, and supermarkets with decent offerings.

Thank you to Sandy R. for bringing this article to my attention.

You "Ask", I Answer: Jared's Subway Diet

It's important to note that when Jared went on his Subway diet, his overall consumption of carbohydrates dropped way down, despite the fact that the relative amount may have been 60% of total calories.

Jared's weight loss is consistent with [Gary] Taubes' ["obesity is caused by high carbohydrate intake"] views.

-- Anonymous
(Via the blog)

I do not intend for Small Bites to turn into a "low carb vs. calorie cutting" blog (that would have been "hot" five years ago).

Alas, many low-carb advocates and Gary Taubes worshippers have found this blog and love to leave, what else, anonymous comments.

I initially thought it made for great discussion, but the postings -- and my subsequent answers -- are starting to rehash previous Small Bites content.

The last thing I want to do is repeat myself, especially when archives of all previous posts are available.

So, unless there is a major development or news story relating to low-carbohydrate diets, this will be my last post actively refuting low-carb claims.

Although readers are more than welcome to leave comments and debate amongst themselves, consider this a closing statement of sorts from my end.

Jared's carbohydrate consumption decreased, but, more importantly, so did his calories.

Had he dropped his carbs to roughly 130 grams a day (as he did when he went on the Subway diet) but still consumed 10,000 calories, he would not have lost weight.

Based on the comments I have received, it seems like the Taubes supporters aren't too sure of their own views.

On the one hand, you say Jared would have lose weight while eating 130 grams of carbs since these 130 grams were lower than what he normally consumed.

However, a large number of Taubes fans have harshly criticized research studies showing low-carb dieting isn't effective because the carb amount used in these studies (45 or so grams) is "too high."

According to these people, true low carb diets consist of no more than 30 grams of carbs a day (anything else, they say, is "not low carb" and therefore does not have much of an impact on weight loss).

So, which is it?

Like I have said before, this is a case of flawed logic.

It's equivalent to somebody saying, "It rains because the sky turns gray."

No, it rains when air rises, expands, and cools (as air cools, it is unable to hold much water; this water often condenses and becomes rain).

Gray clouds themselves do not cause rain.

In that analogy, cutting calories is the equivalent to air rising, expanding, and cooling (the real cause of something), while cutting carbohydrates is parallel to gray clouds (a consequence that people erroneously attribute as a cause).

Jared's case is very simple: calories decreased, and, consequently, so did his weight.

You can attempt to make the "his carbs also decreased" argument, but don't you see that an advocate of a low fat or even a low protein diet could say the same thing? After all, almost every single nutrient decreased.

Someone could even attempt to make the argument that Jared lost weight "because he didn't eat fruits" or "only ate at restaurants starting with the letter S".

So, no, Jared's case (a hundred grams of carbohydrates a day for someone with a propensity to be obese resulting in weight loss) is not consistent with Taubes' views.