Author: cmv69311

Everyone is familiar with the frequent promotions of new fad diets, cleanses, and detox teas that supposedly claim to help one lose weight instantaneously. Even if some of these claims are true, is the rapid weight loss safe? What is actually being lost (i.e. fat, water, lean muscle mass)? Does the weight stay off long-term? Those are the questions these promotions typically neglect to address. Dietician Lauren Harris-Pincus promotes a healthier and safer way to lose weight. With supporting research from the Center for Disease Control, Harris-Pincus recommends a “slow and steady slim-down approach that vaporizes one to two pounds per week.”^1,2 Additionally, unlike all of the quick-slim crash diets, she recognizes the other lifestyle factors that play a role in maintaining a healthy goal weight, such as behavioral changes in eating, sleeping and physical activity habits.²

Harris-Pincus and New York Post article author Molly Triffin very accurately reiterate what the Center for Disease Control and Prevention research found, that long-term changes in daily eating and exercise habits strongly affect the maintenance of any type of weight loss.^1,2 Not only does a slow and steady weight loss necessitate reducing caloric intake by about 500-1000 calories per day, but also in order to maintain this loss, an individual must participate in about 60-90 minutes of physical activity 3-4 days per week.¹ Triffin also discusses some unwanted side effects of crash diets and attempts to rapidly lose weight, such as increased levels of stress, slower metabolism, loss of muscle tone, and dehydration.²

Clinicians can utilize this easy to read informational article as well as the Center for Disease Control recommendations, to give healthy weight loss advice to clients, patients, athletes, and others. Particularly, explaining the unwanted side effects of crash diets versus the longer-lasting health benefits of a slow and steady weight loss approach support the latter route to attaining one’s goal size. I particularly like Triffin’s quote near the end of the article, as I feel it sums up the major components of a healthy lifestyle: “I encourage my clients to forget about the scale and focus on eating right, exercising, reducing stress, and getting adequate rest.”² Slow and steady wins the race!

¹Healthy Weight. (15 May 2015). Center for Disease Control and Prevention. Retrieved November 4, 2016 from http://www.cdc.gov/healthyweight/losing_weight/.

²Triffin, M. (13 September 2016). What you need to know about losing weight quickly. New York Post. Retrieved November 4, 2016 from http://nypost.com/2016/09/13/what-you-need-to-know-about-losing-weight-quickly/.

In a well-timed article in the New York Times last month, Aaron Carroll discusses the implications SNAP restrictions can have on the obesity levels of its participants. Whether due to the higher costs of nutrient-dense food or other factors, obesity has been linked to food insecurity.² This relates back to SNAP, as much of the concern surrounding restrictions for SNAP participants involves the stigma and embarrassment such a policy could cause. However, a strategy to encourage SNAP participants to eat healthier must be implemented in some way or another. Carroll looks at a recent study in which Harnack et al. evaluated the effects of incentive and restrictions on the obesity levels of SNAP participants. 279 low-income participants, who were not currently enrolled in SNAP, were utilized in this randomized control trial and placed into one of four different study groups. The first group, incentives, provided a 30% financial incentive for participants who purchased fruits and vegetables. The second group, restrictions, did not receive any incentives and were not allowed to purchase SSB’s, baked goods, or candy using their food benefits. The third group, incentives plus restrictions, were given the 30% financial incentive for fruits and vegetables but also had the same purchasing restriction as group two. Finally, group four was the control group, on which no incentives or restrictions were placed.³

With outcome measurements of energy intake, discretionary calories, and overall quality of diet, the researchers found that the third group (incentives plus restrictions) was significantly improved compared to the control group.³ However, although group three had reduced energy, discretionary calorie, and sugared food intake as well as increased fruit intake, the study did not have obesity as an outcome measurement. Carroll concludes that Harnack et al.’s study has found a solution to the link between obesity and SNAP participants; yet the study does not itself conclude that incentives and restrictions for a SNAP program will lead to a reduction in overall obesity.¹ Yes, the participants eating habits became healthier, but this is only one contributing factor to obesity. Carroll does make a valid point however that although this study seems to demonstrate a strategy to improve the healthful diets of SNAP participants, actually instituting these polices is a long ways away.¹ I also agree that Carroll makes a valid point by referencing the restrictions placed on other federal food benefit programs, such as WIC and the national school lunch program. If restrictions for healthy eating can be implemented with these programs, finding an agreeable solution for SNAP hopefully shouldn’t be so far off.

¹Carroll, A. (2016, September 22). How Restricting Food Stamp Choices Can Fight Obesity. Retrieved October 23, 2016 from http://www.nytimes.com/2016/09/23/upshot/restrictions-on-food-stamp-purchases-can-improve-diets.html?_r=0.

²Dinour, L., Bergen, D., & Yeh, M. (2007, November). The Food Insecurity–Obesity Paradox: A Review of the … Retrieved October 23, 2016, from http://www.andjrnl.org/article/S0002-8223(07)01616-1/fulltext.

³Harnack, L., Oakes, JM., Elbel, B., et al. (2016, September 19). Effects of subsidies and prohibitions on nutrition in a food benefit program. JAMA Internal Medicine. Retrieved October 23, 2016 from http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2553293

Once the clock strikes midnight (or in this case 6pm), all calories go straight to the waist, hips and thighs, right? Everyone has heard the mantra that eating after a certain time at night leads to greater weight gain, but is 6pm really a hard and fast rule? Danna Hunnes, Ronald Reagan UCLA Medical Center, and The New York Post think not. However, there is agreement that eating at night can lead to greater weight gain, particularly when the late night munchies chooses junk foods as its snack of choice. James LeCheminant and others looked at the differences in weight among 29 male participants under two difference circumstances.⁴ The first involved a nighttime eating restriction, where no food was consumed between the hours of 7pm and 6am for two weeks.⁴ The participants lost about one pound each.⁴ However, when this restriction was lifted, the participants gained an average of 1.3 pounds back.⁴ Researchers concluded that this difference was mostly due to the fact that eating at night increased daily energy intake, rather than because the food was specifically consumed at night instead of during the day.³

The New York Post article also references an article in Women’s Health that discusses Eckel et al.’s research concerning the effects of evening eating on insulin levels, in which “ad libitum food intake [during the biological night] resulted in ∼20% reduced oral and intravenous insulin sensitivity.”² Eating in the evenings, when your body is more resistant to insulin’s effects, causes blood sugar to increase as well as excess sugar to be store as fat, both of which are unfavorable health effects.

Dietician Danna Hunnes suggests that adequately fueling oneself throughout the day should help to reduce nighttime hunger and thus lessen the weight gain effects that do result from eating unhealthy snacks late at night. Practitioners can utilize this information to help disseminate information to patients on what composes a healthy meal (i.e. a breakfast with enough protein, proper portions throughout the day, etc.) and thus help decrease individual’s need to snack after dinnertime.

¹Arnold, C. How to Cut Out Late-Night Snacking. (December 31, 2013). Women’s Health. Retrieved on October 16, 2016 from http://www.womenshealthmag.com/weight-loss/night-snacks. 

²Eckel, R. et al. Morning Circadian Misalignment during Short Sleep Duration Impacts Insulin Sensitivity. (November 5, 2015). Current Biology. Retrieved October 16, 2016 from http://www.cell.com/current-biology/fulltext/S0960-9822(15)01239-7.

³Fetters, K. Just how serious is that ‘no eating after 6’ rule? (August 29, 2016). New York Post. Retrieved October 16, 2016 from http://nypost.com/2016/08/29/just-how-serious-is-that-no-eating-after-6-rule/.

⁴LeCheminant, J., Christenson, E., Bailey, B., & Tucker, L. Restricting night-time eating reduces daily energy intake in healthy young men: a short-term cross-over study. (December 2013). British Journal of Nutrition. Retrieved October 16, 2016 from https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/restricting-night-time-eating-reduces-daily-energy-intake-in-healthy-young-men-a-short-term-cross-over-study/3627087601F148E8D16163468FCB3F05.

The familiar phrases “out of sight out of mind” and “why fight an uphill battle” can apply well to whether the layout of one’s fridge and kitchen will affect one’s eating habits. The Times Free Press takes a look at behavioral and nutritional science professor Brian Wansink’s book Slim by Design, in which various studies on the design of kitchens, restaurants and school lunchrooms are compiled to determine their effect on eating habits. We already had a sneak peek at a portion of Wansink’s ideas in the Lunch’d Project. However, this article focused specifically on kitchen design and whether it works for or against healthy eating habits. Wansink’s ideas focus on working with human nature to make healthy eating choices easier and simpler for individuals to actually make.

One such study, “Slim by Design: Kitchen Counter Correlates of Obesity,” documented the state of 210 households in Syracuse, NY and compared BMI with the state of the kitchen counters in each household, i.e. clutter and presence of fruit or various unhealthy foods sitting on the counter.² The Times Free Press slightly exaggerated the results, claiming a difference of 21 pounds between those who had a box of cereal visible on the counter and those who didn’t.¹ Wansink et al. actually found that weights ranged from 20 pounds to 31 pounds when the kitchen had a presence of “candy, cereal, soft drinks, and dried fruits”.² They also found lower BMI was associated with households who had fruits sitting out on the counters.

This returns back to those phrases mentioned earlier. If unhealthy foods are out of sight (not sitting in plain view on the counter), are individuals more likely to avoid them and grab an apple or banana as a snack instead? Wansink thinks yes. The Times Free Press also mentions Wansink’s studies that show individuals are more likely to reach for the first foods they see (a theory he tested out in Lunch’d as well), and thus will take the less cumbersome task of grabbing the healthier foods positioned in the front of the fridge rather than reaching towards the back for the leftover chinese or sodas. Practitioners can use these ideas (whether in lunchrooms, fueling stations for sports teams, snack stands in the workplace, etc.) to their advantage by making access to healthier foods more compatible with human nature, thus increasing the likelihood than individuals will make healthier food selections simply because those selections are within closer reach.

¹Pierce, S. Is your kitchen making you fat? Author says design, setup of kitchen can work for or against you (January 10, 2015). Times Free Press. Retrieved October 16, 2016 from http://www.timesfreepress.com/news/life/entertainment/story/2015/jan/10/your-kitchen-making-you-fat/281726/.

²Wansink, B., Andrew, S., and Kaipainen, K. Slim by Design: Kitchen Counter Correlates of Obesity (August 12, 2015). Health Education & Behavior, Forthcoming. Retrieved October 16, 2016 from https://ssrn.com/abstract=2643023.

Most individuals would assume that due to the low number of calories and artificial additives, sparkling water and seltzer water are considerably healthier alternatives to soda. The low sugar content pushes it above many juices and recovery drinks such as Gatorade or Powerade. However, Sophie Egan’s article in the New York Times, Does Sparkling Water Have a Downside, questions this healthy alternative¹. The first question posed is the risks of sparkling water contributing to low bone mineral density (BMD) and osteoporosis. In Tucker et al.’s study on the effects of coca cola and other carbonated beverages on low BMD, results showed only coca cola – regular, diet and non-caffeinated (albeit lower for the latter two types) – was associated with a decrease BMD in men and women who consumed more than one coca cola per month³. Other carbonated beverages, such as the essentially carbonated water that is seltzer and sparkling, showed no effects on bone mineral density or association with osteoporosis development³.

However, this leads to the second question. Sparkling water may not be correlated with detrimental effects on bone, but does its low pH (acidity) lead to a degradation of tooth enamel? Reddy et al., in a study on 379 United States beverages and their pH levels, established three classifications for beverage acidity (extremely erosive, erosive, and minimally erosive)². Sparkling water, plain without any additions, has a pH level of 5, which classifies it as minimally erosive, and hence not a danger to tooth enamel erosion¹. Yet, where individuals need to be careful is with adding citric flavors, such as lemon or lime, to their sparkling water. The natural acidity in these fruits can increase the pH levels and consequently decrease the healthy benefits of drinking a sparkling water over a carbonated soda.

Two additional comments Egan makes on the downside of sparkling water involve essential minerals. Drinking bottled sparkling water eliminates the benefits of the fluoridation process of tap water. Also, avoid making the mistake of confusing seltzer and sparkling water with club soda. These are not the same, as the latter includes a large amount of added sodium, which is already consumed in a larger than healthy amount among most Americans.

All in all, Egan utilizes two decently coordinated studies to effectively, and accurately, provide a better-rounded view on the health benefits, and risks, of consuming sparkling water. This media piece provides useful information that many individuals may have been unaware of, as they chose sparkling water with fruit flavorings over sodas in an attempt to make a healthier beverage selection.

¹Egan, S. (16 September 2016). Does Sparkling Water Have a Downside? New York Times. Retrieved September 18, 2016 from http://well.blogs.nytimes.com/2016/09/16/does-sparkling-water-have-a-downside/?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=9&pgtype=sectionfront.

²Reddy, A., et al. (2016). The pH of Beverages in the United States. American Dental Association. Retrieved September 18, 2016 from http://www.ada.org/en/~/media/ADA/Public%20Programs/Files/JADA_The%20pH%20of%20beverages%20in%20the%20United%20States.

³Tucker, K., et al. (2006). Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. American Society for Clinical Nutrition. Retrieved September 18, 2016 from http://ajcn.nutrition.org/content/84/4/936.

It’s raining outside. I do not have the time in my day. Walking is not vigorous enough to actually benefit my health. These are only a few of the excuses individuals use on a regular basis to justify a lack of daily physical activity. So how can practitioners reach communities regarding the importance of walking and staying active? Dr. Gregory Heath discusses some of the approaches and strategies as well as keys to success of implementing community and school level walking programs to increase individuals’ overall health and lower risk of chronic disease.

A large barrier to the success of walking programs is a lack of knowledge on the part of the community. The national physical activity guidelines suggest a minimum dosage of 150 minutes of moderate to vigorous physical activity each week to receive any health benefits. This could be spread into a short ten-minute brisk walk each morning and evening throughout every day of the week, or condensed into more vigorous activities on fewer days of the week, but either way physical activity promotes many health benefits. Dr. Heath discusses the importance of increasing this awareness using broad, multicomponent strategi
es that reach across many sectors. Implementing walking programs requires partnership among not only the local community health department, but also the schools, parks and recreation department, neighborhoods and citizens themselves. For example, many walking school bus interventions or Kids Walk-To-School programs require organization and advocacy at the school level via teacher support as well as parental
involvement.

Another important key to success is implementation of a social support network, a behavioral approach to walking interventions. Providing social support and groups can dispel many of the previously mentioned excuses. Exercise Honolulu, an initiative that aimed to improve walkability by implementing walking events at a central location, provided both a measure of accountability and a social environment in which to engage by establishing 6 Sunday walks throughout 25 neighborhoods. This campaign involved an informational approach in addition to the initiative being promoted via media press releases and radio advertisements to disseminate the benefits of the event.

Practitioners can utilize this overview of approaches and keys to success to help implement walking programs within their own communities. Ensuring a successful program requires multi-sector cooperation and coordination, appropriate use of promotional techniques, and provision of a social support to ensure an enjoyable environment.

“Effective Walking and Walkability Interventions” Webinar (August 3, 2016)