Reflections on Obesity and the Weight of the Nation

This post was originally written during my 2 1/2 year tenure as a blogger for Health Goes Strong. The site was deactivated on July 1, 2013, so the post has been reproduced here.

A REGISTERED DIETITIAN’S VIEW OF OBESITY CONTRASTS WITH HBO’S WEIGHT OF THE NATION

While awaiting the heavily promoted premier of the HBO documentary, Weight of the Nation, I took the time to reflect on what I have learned about obesity in my 35 years of experience treating people who are overweight or obese. It just so happens my career spans the same trajectory as the epidemic, but I’m pretty sure I am not to blame!

Much has changed in this country since the mid-1970’s when obesity rates began to soar, and it all matters. But it is also true that no one thing is more important than any other in bringing about this unprecedented weight gain among Americans of every race, class and region.

I cannot offer all the mind-numbing statistics, frightening graphics, and challenging expert opinions of a high-tech television production, but I can tell you some things that need to be said.

What Obesity Is Not

All obesity is not same. Every person who reaches the benchmark to be classified as obese got there in his or her own way. It’s the result of a complex interplay of personal biology, environment, and lifestyle, where no two situations are exactly the same because no two people are exactly the same. This becomes even more apparent as the epidemic spreads around the world.

Obesity is not curable. There are many different factors that play a causal role in developing obesity and there no cure for it. Once you become obese, you must spend the rest of your life treating it or risk becoming even fatter or dying of the chronic diseases that accompany it.

 

Obesity is not easy to diagnose. Weighing a person and measuring their height is easy. Using those figures to calculate body mass index (BMI) is also easy. But deciding if someone is obese based on their BMI is not. More sophisticated measurements are needed to determine what the percentage of fat is in the body and where it is located to fully understand whether someone is at risk due to their body size and composition.

 

Obesity is not easy to prevent or treat. The best advice medical science has to offer as a means to prevent obesity is to maintain a state of “energy balance.” That advice is difficult to follow. It requires knowing precisely how many calories you consume every day (over a lifetime) and how much energy you expend every day to offset them. These are intangible values. Once you become obese, you are expected to create an energy imbalance by expending more calories than you take in. Only at this point, your body has a whole new way of dealing with energy that defies the mathematics of using calorie control to achieve weight control.

Obesity is not a plague. Obesity spread very quickly in the last three decades, but it is not a scourge that must be routed out by any means possible. Drastic measures have been proposed to “fix” the way we grow, distribute, and sell food in this country, while the obese have been scrutinized, marginalized, and penalized for their weight. In the panic to find a solution we have lost sight of the fact individuals become obese and it is individuals who need help dealing with it.

I hope I can look back 35 years from now and reflect on all that we learned about obesity to lift this weight from our nation.

 

The simple truths about good nutrition are lost in the hype and sensationalism

Why Are Consumers Confused by Food, Nutrition & Diet Information?

This blog was written as a guest post for Yahoo! Shine. You can read the original here.

In my 30 years of practice as a registered dietitian I have never been discouraged by the challenge of educating people on how to make healthier food choices. It has been a rewarding process for me, whether done individually, in a classroom or over the airwaves.

The bigger challenge has been countering the effort by some health professionals and journalists to reduce important food and nutrition information to simple sound bites or catchy headlines. I have found that these proponents often infuse their messages with emotional language and unsupportable claims that leave consumers ill-equipped to make appropriate decisions in the rapidly expanding food and nutrition marketplace.

I choose not to contribute to this debilitating process. Instead, I want to empower people to make sensible choices for themselves. To support that effort I have prepared a list of New Year’s Resolutions for Better Food and Nutrition Communications in 2012. I hope others will join me and take the pledge to help Americans become better consumers by giving them all of the food and nutrition information they need – not just what fits a sexy headline.

I pledge to:

1. Never propose that a single “diet” – or combination of foods – is best for everyone. I will always ask you what you currently eat and what your food preferences are, then tailor a diet to suit you.

2. Never use the length of a food’s ingredient list as a simple measure of its nutritional value, or lack thereof. I will explain what the key ingredients are in different foods and how they can be enriched or fortified by other ingredients.

3. Never agree with banning or taxing foods or drinks as a way to change what people eat. Advocates say efforts like these will curb obesity, but research shows taxing sugary drinks like soda does not affect body mass index. Instead, I will show you how any food or drink can fit into your diet when you control the frequency and portion size.

4. Never dismiss foods that contain multisyllabic ingredients, words with scientific origins or words that are difficult to pronounce. Instead, I will teach you what those words mean and what their function is so you can make more informed decisions.

5. Never suggest that foods labeled as “all natural,” “organically grown” or “locally sourced” are superior to foods that do not carry these labels. I will show you how to use the Nutrition Facts on food labels so you can make appropriate comparisons based on nutrient content, cost and availability.

6. Never use inflammatory or provocative language when talking about food, such as “junk,” “garbage” or “toxic.” I will remain objective in my discourse so you can make objective decisions rather than emotional ones.

7. Never assume that most people can evaluate the integrity of scientific research studies or interpret their findings. I will assist you in your understanding of the scientific process by providing an explanation of how the new information fits in with the current body of knowledge on the subject.

8. Never support the notion that to “binge,” “splurge” or “cheat” when eating is compatible with good health. I will evaluate the underlying reasons for these potentially abusive eating behaviors and attitudes and help you establish a more balanced approach to making your food choices.

9. Never imply that losing weight can be quick, simple or effortless. I will remind you that eating is a complex behavior and we don’t understand all of the factors that influence it. Changing your eating habits and level of physical activity is a slow and difficult process, but with help it is possible to establish a healthier lifestyle.

10. Never profess that we know everything about our nutritional needs and how to best meet them. I will acknowledge that the science of human nutrition is young and still evolving and I remain open to new discoveries.

Please sign up below if you want to take the Pledge:

Goals for Food Day matter every day of the year

Registered Dietitian’s Food Day Pledge Takes Aim at What’s Wrong With Most Advice

Food Day Pledge from registered dietitian lists 10 Things she will not do when giving food advice

Today is Food Day, a day to promote “healthy, affordable food produced in a sustainable, humane way.” This I support. But some of the lofty ideas, biased language and unsupportable premises offered by the promoters I do not.

For example, the 6 Food Day Principles strive to both limit subsidies to agribusiness and alleviate hunger, even though you need the first to first to accomplish the second. The official Food Day cookbook, Eat Real, is described as a collection of delicious, healthful, easy-to-prepare recipes, yet includes “Braised Kohlrabi with Fennel & Leeks” and “Yogurt Panna Cotta with Cranberry Pear Sauce,” which just don’t sound real enough for most people I know.

Therefore I am taking a different approach. As a registered dietitian and cultural anthropologist, I have prepared a pledge of the ten things I will not do on Food Day, or any other day of the year, because I believe they are contrary to health promotion and a sense of fairness to all of the people in America who need to hear messages about good nutrition.

Food Day Pledge From a Registered Dietitian

I hereby pledge not to:

  1. Blame any single food, beverage or ingredient for obesity. It’s a complex issue with many biological, environmental, behavioral and social implications. We don’t have all the answers but the shot-gun approach of targeting one thing as the cause doesn’t help.
  2. Use toxic language to describe otherwise edible food. Terms like “toxic,” “garbage” and “junk,” have no place in the conversation when a food is not spoiled or is otherwise safe to eat.
  3. Hide vegetables in other foods in order to get kids – or anyone else – to eat them. Only in America could such an idea flourish.
  4. Presume that the food supply and/or diets of Americans were actually better at some other time in history than they are right now. We simply weren’t micromanaging everything we ate in the past as we are today since most of history was dominated by a need to stay one step ahead of starvation.
  5. Submit to the idea that food advertising and brand marketing are more powerful than individual choice. They may lead us to the product, but we buy based on education, income and circumstances.
  6. Profess that we know all that there is to know about our nutritional needs and how to meet them. The science of human nutrition is young and still evolving, so I will always be ready for more breakthroughs.
  7. Let the rapid rate at which news travels via the Internet undermine the slow and methodical pace of scientific discovery. Changes in dietary guidance are not based on single studies or viral videos.
  8. Forget that most Americans do not live near a farmer’s market or other local source for year round produce. Frozen and canned vegetables are two of the best values in the grocery store.
  9. Ignore the fact that there is no such thing as “The American Diet.” Food consumption survey data is at best a fuzzy snapshot of what some people ate for a few days of the year, as best as they could remember and describe it. That does not tell the whole story.
  10. Overlook the uniqueness of each person’s diet as a reflection of his or her cultural, ethnic, religious and socio-economic heritage and, most importantly, personal tastes.

 

 

 

 

 

 

 

 

Lessons learned during weight loss hold key to success

Changing Lifestyle is Key to Successful Weight Control

Research shows losing weight and keeping it off requires changes in lifestyle

Losing weight is difficult, very difficult. No matter what diet program, product or procedure is used to shed excess pounds, people have tremendous resistance to changing their routines and doing something different. I could argue that no matter what the reasons are that people have gained weight, they all share the same reason for having trouble losing it. People hate change.

Eating is a habit, which is one reason it’s so hard to change, but another is that it’s part of a lifestyle. And your lifestyle is shaped by where you live and work, how much money you have, who you spend your time with, and what you know, like, believe. If you want to change what and how much you eat and how often you exercise, it is going to require major changes in your lifestyle.

Knowing what needs to be done to lose weight is rarely the problem. All of my clients are able to tell me what they need to do differently. They say they know they should eat breakfast, take smaller portions, limit their snacks, exercise more, double-up on vegetables and switch to low fat, but they have a hard time sticking to those suggestions. Even just one.

That is because, for example, to eat breakfast every day you have to shop regularly to be sure you have food in the house, get up a little earlier, be able to prepare something you like and is good for you, make your own coffee, and clean up after yourself. Getting up earlier is a big enough hurdle for most people; making sure you have cereal, milk and a banana can be insurmountable!

Why, then, is it possible for some people to change their lifestyle and lose weight? The answers can be found in the National Weight Control Registry (NWCR).

First a few words about the Registry, my favorite source of inspiration. It is a voluntary group made up of over 5000 people who have lost anywhere from 30 -300 pounds and kept it off for five years or more. That’s all it takes to be a member.

Several common traits have been identified among the NWCR participants to help us understand what has worked for them and might help others. They are listed below.

The one thing you won’t find on the list is what made them do it. Cultural anthropologist Inga Treitler, Ph.D. conducted extensive interviews with ten of the registrants to see if she could figure that out. What she found is they all experienced an inner transformation which resulted in their abandoning their former lifestyles and being “reborn” into a new one. In essence, they found a reason to change that made living in their new lifestyle easier than the old.

It all begins with the right reason.

TOP TEN TRAITS FROM WEIGHT CONTROL REGISTRY45% lost the weight on their own

10. 55% lost the weight with the help of a program

9. 62% watch less than 10 hours of TV per week

8. 74% weigh themselves at least once a week

7. 78% eat breakfast every day

6. 80% are women, 20% are men

5. 90% exercise an average of 1 hour a day

4. 94% increased their physical activity, walking was the most common activity

2. 98% modified their food intake in some way, most by controlling calories and fat

1. 100% found a reason to change their lifestyle

Here’s what has helped me keep my weight in control for the past 40 years.

Getting Motivated to Eat Right

Junk food not the problem, imbalanced food choices are.

Guess What? There Are No Junk Foods!

5 Simple Truths help avoid the junk food mindset

It’s the catch-all phrase used to describe anything edible that’s blamed for the rising rates of chronic disease and obesity in this country, but what exactly is junk food? Given the frequency the term is used, I’ve never heard a satisfactory definition of junk food, or the criteria for labeling a food or beverage as such, that can help people make eating decisions.

Maybe we need a food group for junk foods to know which ones they are and how many servings a day we can have?

Some people say junk foods provide empty calories, or ingredients that are unhealthy, or are overly processed. Well that implies everything we eat is supposed to be full of nutrients. Ever look at the nutrition facts for iceberg lettuce? It’s pretty empty. And what about nutritious foods, like eggs, that also happen to have a lot of something in them that isn’t so good for us, like cholesterol. Are eggs a junk food? What if we eat something just because it tastes good. Should chocolate chip cookies be banned?

Blaming individual foods, beverages and ingredients for what’s wrong with our health and trying to ban certain foods as a way to fix the problem just doesn’t make sense. And it doesn’t work, either. First, there is simply no way we could ever make a definitive list of all “junk foods”, and even if we did, thousands of new food items enter the marketplace every year making “the list” obsolete very quickly. Second, people eat for many reasons, not just to meet their nutritional needs. Celebrations, rituals and traditions of all sorts are based on eating certain foods, and that is an important part of every culture.

So if you’re still trying to figure out if something belongs on the junk food list du jour, here are 5 Simple Truths to help you put it all into perspective:

  1. No food is bad for you unless the food is bad – as in unfit to eat. It’s the quality of your total diet – everything you eat and drink throughout the days, weeks, months and years of your life – that determines your nutritional well-being. (Exceptions apply for those with diseases or allergies for which special foods must be consumed or avoided.)
  2. There are no fattening foods or foods that make you gain weight. The calories in everything we eat are all equally available to be used as energy or stored as fat if not used. Some calories come packaged in foods with many other nutrients, but if we eat more of them than we need, the nutrients will not make us healthier, but the calories will make us fatter.
  3. There is no perfect diet, or diet plan. Instead of shopping around for the next best diet, start paying attention to what you now eat and how that stacks up against the Dietary Guidelines for Americans. Then you can begin to fix your diet one food group at a time using ChooseMyPlate.gov.
  4. People come in different sizes and so should their food. There is no one serving size that’s right for all of us, so don’t count on that food label to tell you how much you should eat. The serving size listed on packages is just a reference amount for the rest of the nutrition information found on the label. Eating too much of something that’s good for you is a much bigger problem than eating a little bit of something that isn’t.
  5. Hypocrisy is the worst nutrition message parents and other care-givers can deliver to children. It sounds like this: “No you can’t have that junk food, it’s not good for you,” one day and then, “You can have that junk food because it’s your birthday, a holiday, we’re on vacation…” on another. It’s far better to teach them how to enjoy all foods in moderation and set a good example for how to do it, one chocolate chip cookie at a time.
Remove the distractions that lead to mindless eating to stop overeating and lose weight

Research on Mindless Eating Offers New Insight into Obesity

Eating while distracted can lead to overeating and weight gain

Research presented by Dr. Marion Hetherington at the 2011 Food & Nutrition Conference & Expo about multitasking and mindless eating provided proof that weight gain isn’t just about what you eat, but how you eat.

Dr. Hetherington explained that “satiation” is the sensation that lets us know when to end a meal or stop eating. “Satiety” describes what we feel after eating that tells us we’re satisfied, but not stuffed. Hunger is the signal that it’s time to eat again. Being able to detect each of these physical conditions has strong cognitive component.

Or simply put, we must pay attention when eating so our mind can process all of the signals that our body receives through sight, smell, taste and touch, in addition to the barrage of gastrointestinal signals transmitted with each bite.

According to Dr. Hetherington, several studies show that if you eat while doing other things, such as watching TV, reading or even talking, you can end up overeating. Appetite regulation is also affected by the amount of food available, such as large servings or buffets, even if the food doesn’t taste that good.

Based on this emerging research, a new direction for treating weight gain and obesity has evolved that focuses on the act of eating. Evelyn Tribole, MS, RD explained how Intuitive Eating, an approach she helped pioneer, allows people develop a healthy relationship with food and their own body.

Intuitive Eating is based on 10 principles which begin with rejecting the diet mentality and all the externalized rules for “dieting” that go with it. In this way the physical cues of hunger and satiety can begin to guide eating.

Ms. Tribole described “eating amnesia” as what occurs when you eat while distracted. She went on to explain that eating intuitively requires being aware of the food in front of you, as well as your emotions and body sensations.

The benefits of overcoming mindless eating and eating more intuitively go far beyond weight control according to both speakers. Practitioners gain a whole new appreciation for how to live in their own bodies and more accurately interpret their other needs, feelings and thoughts unrelated to food.

Given the abysmal results of most weight loss diets and the constantly changing food landscape, it makes sense to redirect your attention to how you eat, instead of what, if you want to lose weight. Why not shut down all the electronics and other distractions at your next meal and see how it feels?