Marc Joseph Nutrition - Blog

5 billion pounds.

That’s the estimated collective amount Americans are overweight.

Recently, there was an interesting Time magazine cover story that discussed the science of appetite and asked:

Just why is our appetite so powerful a driver of our behavior, and, more important, how can we bring it to heel?

These are difficult questions to answer, as there are many factors that can influence appetite, including “taste, smell, sight, texture, brain chemistry, gut chemistry, metabolism and, most confounding of all, psychology.”

The article discusses several of these factors in more depth, including how:

We’re programmed to eat to excess to store energy.

“We were hardwired to eat and eat—and particularly eat fatty foods because we didn’t get them often,” says Sharman Apt Russell, author of Hunger: An Unnatural History. We’re programmed not only to overeat but also to fail to recognize immediately just when we’ve reached that point. Mothers tell kids not to wolf their food because it’s harder to enjoy it that way and also because even after you’ve had enough, it can take a while for your brain to get the message. By the time it does, you’re not just full; you’re stuffed. “The people who didn’t immediately lose their appetites, who could gorge themselves and keep going, those people would survive longer during the next famine,” says Dr. Jeffrey Flier, obesity scientist and professor at Harvard Medical School.

The wide availability of inexpensive, high-calorie foods feeds directly into this historical tendency and contributes to a greater risk for obesity.

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In a study published in the journal Diabetes, researchers found that increased belly fat led to the production by fat cells of higher levels of inflammatory molecules that may directly promote systemic (whole body) inflammation. This increase in systemic inflammation may, in turn, raise the risk for several diseases, such as heart disease, diabetes, cancer, and cognitive decline.

There are two types of abdominal fat:

1. Subcutaneous fat - found just beneath the surface of the skin (the fat you can “pinch”)
2. Visceral fat - found in the spaces between internal organs

(Image: LA Times)

Visceral fat appears to be the primary source of the problem:

[T]he research team says visceral fat likely contributes to increases in systemic inflammation and insulin resistance. They sampled blood from the portal vein [which routes blood to the liver from the gastrointestinal tract] in obese patients undergoing gastric bypass surgery and found that visceral fat in the abdomen was secreting high levels of an important inflammatory molecule called interleukin-6 (IL-6) into portal vein blood.

“The portal vein is filled with blood that drains visceral fat,” says first author Luigi Fontana, M.D., Ph.D., assistant professor of medicine at Washington University in St. Louis and an investigator at the Istituto Superiore di Sanita, Rome, Italy. “Portal vein blood had levels of IL-6 that were 50 percent higher than blood from the periphery.”

Increased IL-6 levels in the portal vein correlated with concentrations of an inflammatory substance called C-reactive protein (CRP) in the body. High CRP levels are related to inflammation, and chronic inflammation is associated with insulin resistance, hypertension, type 2 diabetes and atherosclerosis, among other things …

… “Many years ago, atherosclerosis was thought to be related to lipids and to the excessive deposit of cholesterol in the arteries,” Fontana says. “Nowadays, it’s clear that atherosclerosis is an inflammatory disease. There also is evidence that inflammation plays a role in cancer, and there is even evidence that it plays a role in aging. Someday we may learn that visceral fat is involved in those things, too.”

Evidence Building

This latest study is one of many to highlight the influence of excess fat on systemic inflammation and disease risk. Here are links to a few other studies:

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Last week, I wrote about the potential risks of exposure to the estrogenic chemical, bisphenol-A.

Another class of chemicals that may have negative health effects is phthalates, which are used in plastic packaging, cosmetics, shampoos, soaps, lotions, lubricants, paints, and pesticides. Phthalates are also commonly used as a softener for products made using PVC (polyvinylchloride) and as a key ingredient in fragrances. One kind of phthalate helps prevent the fragrance in perfumes, lotions, shampoos, make-up, nail polish and hair sprays from degrading.

Research has shown that phthalates impair testicular function in rats and are linked to abnormal sperm counts and anti-androgenic effects in humans, such as decreased testosterone levels. In recent years, a significant population-wide decline in testosterone levels has been observed in American men. More than 75% of the US population has measureable levels of several phthalates in the blood.

Latest Research

A study (full-text PDF) published in the latest issue of Environmental Health Perspectives further explored the potential negative effects of phthalates. Researchers found that adult males with the highest urinary levels of several different phthalates were more likely to be insulin resistant and obese.

Study Limitations

The study’s authors note that:

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Couple of new studies out that highlight what many likely intuitively know: Many Americans want to eat better and be more healthy, but they want it to be easier and more convenient to do so.

ACNielsen - LifeChoices

NPD Group - Eating Patterns in America

The AC Nielsen study notes that most people (82%) acknowledge that the responsibility for weight gain lies with the individual. And yet, despite the fact that approximately 6 out of 10 people perceive as effective some of the important steps they can take to control weight, such as:

• Reducing frequency of eating junk food
• Taking up a sport, hobby, or exercise program
• Substituting water for sugary drinks
• Reducing meal sizes
• Increasing exercise intensity or amount of exercise

even smaller percentages of people actually take action.

(The fact that approximately 4 out of 10 people don’t perceive the steps above as potentially helpful is a separate, slightly scary issue. But let’s focus on the other 6 out of 10 first.)

For example, 65% of people perceive reducing junk food consumption as effective in losing weight. Yet, only 64% of those people have actually tried that. And what’s really interesting is that 86% of those who tried it found it to be effective.

Likewise, 62% of people thought taking up a sport or exercise program would be effective, but only 32% of them actually tried it. Of those who tried it, 88% found it to be effective!

Easier, But Better?

Clearly, something is holding people back. And that ‘thing’ seems to be convenience. When asked why consumers don’t follow through on healthy lifestyle changes, the top three responses were lack of exercise (29%), easy availability of junk food (19%), and the ease of modern life (18%).

According to the NPD study,

“The driving force in our eating habits has always been convenience. The only surprise is how that will manifest in our behavior.”

For example: The top 5 reasons people chose a dish for dinner

1. Required little effort or easy to make = 53%
2. Took little/no planning = 50%
3. Made with foods that are on-hand = 39%
4. Everyone would like = 35%
5. Easily cleaned up = 34%

It’s true a healthy lifestyle can require more effort. Exercise take time. Healthy food alternatives aren’t always easily available, especially when eating out. Nor are fresh foods as quick and easy to prepare as packaged foods.

Life is busy for many Americans. It’s often just easier to go for the convenient alternatives.

Yet, the health of many Americans continues to decline, in large part because of their own dietary and lifestyle choices. My guess is that behavior changes won’t really take hold until the health care costs resulting from these dietary and lifestyle choices are more directly borne by the individuals making the decisions. That’s certainly beginning to happen today and will only accelerate going forward as the health care system changes. It’s a topic that we’ll revisit often.

Interesting article in the San Francisco Chronicle discussing the disillusionment with dieting:

Eighty percent of the people who responded to a recent survey by Mintel International, a marketing research firm that specializes in food, said they are making up their own diet plans by trying to eat less fat and cut calories. Only 6 percent said they are on commercial diets such as Jenny Craig, Weight Watchers and NutriSystem. Nearly 70 percent said they aren’t interested in the diets of celebrities…

…nutritionists and doctors are finding that many dieters prefer to go it alone. People are fed up with taking off the weight only to regain it, others are frustrated by the strictures of popular plans on the market, and then there are those who are just plain confused by the sheer volume of food do’s and don’ts.

Given both the proliferation of diet hype and the tripling of the obesity rate in recent years, it’s no wonder many people have said, “Enough!”

Steven Blair, a professor at the Arnold School of Public Health at the University of South Carolina, is on the right track:

“People need to stop obsessing on the weight and start focusing on health…We’re not all going to look like models and movie stars. Get over it and get a life.”

That’s not to say people shouldn’t target a healthy body weight for their height and build, but the focus really does need to be on health and not just weight. There are many things that one can do to benefit health without obsessing about every calorie, including:

• Selecting healthier food choices when available, e.g.:
  • Whole grains instead of refined grains
  • Foods and drinks without added sugars
  • Lots of vegetables, organic if possible
  • Freshly prepared foods, rather than processed foods
  • Foods low in saturated animal fats and without trans fats
• Moderating portion sizes
• Eating smaller meals, each with some protein, spaced throughout the day to control blood sugar and appetite swings
• Getting adequate fiber and filtered water in the diet to help ensure the excretion of waste and toxins
• Getting regular, moderate exercise
• Supplementing with a core set of essential nutrients to ensure that your body’s cells have the raw materials to function well

Nutrition can seem complex and confusing, but it doesn’t have to be. Taken incrementally, simple changes like those above can make a difference and help you to be healthier and feel better.

A large recent study by the National Cancer Institute of people aged 50-71 found, not surprisingly, that obese and underweight people had greater risk of premature death than people of a healthy weight.

But the study also found that non-smokers who were just overweight (Body Mass Index* of 25 to 30) were 20 to 40 percent more likely to die prematurely than normal-weight people.

More evidence for the importance of maintaining a healthy weight.

* Here’s a Body Mass Index (BMI) calculator.

A really interesting article discussing the dynamics of diabetes in India:

. . .Throughout the world, Type 2 diabetes, once predominantly a disease of the old, has been striking younger people. But because Indians have such a pronounced genetic vulnerability to the disease, they tend to contract it 10 years earlier than people in developed countries. It is because India is so youthful — half the population is under 25 — that the future of diabetes here is so chilling.

. . .In perverse fashion, obesity and diabetes stand almost as joint totems of success.

Last year, for instance, the MW fast-food and ice cream restaurant in this city proclaimed a special promotion: “Overweight? Congratulations.” The limited-time deal afforded diners savings equal to 50 percent of their weight (in kilograms). The heaviest arrival lugged in 135 kilograms (297 pounds) and ate lustily at 67.5 percent off. . .

. . .In the United States, an inverse correlation persists between income and diabetes. Since fattening food is cheap, the poor become heavier than the rich, and they exercise less and receive inferior health care. In India, the disease tends to directly track income. . .

It’s a scary unfolding of events. The rise in infections, amputations, and heart and kidney disease as a result of the disease is bankrupting people physically, financially, and emotionally. Few people in India have health insurance, and policies often don’t cover diabetes. Divorce rates are increasing as people become disabled.

As mentioned above, East Indians, like other ethnic cultures such as American Indians and Hispanics, are especially susceptible to diabetes, possibly because their bodies are genetically programmed to better store fat when food is in ample supply.

Whatever the genetics, type 2 diabetes is preventable (and, in some cases, reversible) with good dietary habits and supplementation. The question is, as it is around the world, will people take the necessary steps?

An interesting study published in a recent issue of the Intl Journal of Obesity discussed several of the less covered potential contributing factors to obesity, including:

1. Sleep debt - deprivation increases hunger
2. Environmental toxins - hormone disrupters may affect signals to the brain that help to control appetite
3. Temperature regulation - when hot, people eat less; greater use of air conditioning offsets this effect
4. Decreased smoking - smokers tend to weigh less
5. Prescription drugs - some may promote weight gain
6. Societal changes in age and ethnicity - more people between ages 35-54 and also of Hispanic and black ethnicity have greater rates of obesity
7. Women having children later - children born to older mothers more likely to be overweight
8. Genetics - e.g., children of diabetics more likely to be diabetic
9. Natural selection - body fat may be related to reproductive ability
10. Partner choice - people tend to mate with people of similar body type

Poor food selection, oversized portions, and inactivity are still the primary causes of obesity, but it’s also worth looking at the factors above to see what role they may be playing.

A recent University of Michigan study projected the cost of strokes in the U.S. to be $2.2 trillion over the next 45 years. The study factored in everything from hospital care to medications to home health care.

And that’s a conservative estimate, as it’s based on the current rates of primary risk factors such as diabetes, heart disease , obesity, and high blood pressure. With rates of obesity and Type 2 diabetes rapidly increasing in younger populations, the eventual costs could be much greater.

Fortunately, these risk factor conditions are largely preventable, with nutrition playing a significant role.

A worldwide problem — and growing fast:

About one fifth of the one billion overweight or obese people in the world are Chinese. China was once considered to have one of the leanest populations, but it is fast catching up with the West in terms of the prevalence of overweight and obesity; disturbingly, this transition has occurred in a remarkably short time.

Data from the 2002 national nutrition and health survey showed that 14.7% of Chinese were overweight (body mass index (BMI; kg/m2) > 25) and another 2.6% were obese (BMI > 30), such that there are currently (2002) 184 million overweight people, and a further 31 million obese people, in China, out of a total population of 1.3 billion. Although the prevalence of obesity in China is relatively low compared with Western countries such as the United States, where over half of adults are either overweight or obese, it is the rapid increase of the condition, especially among children, that is particularly alarming. Data from the China national surveys on the constitution and health in school children showed that the prevalence of overweight and obesity in children aged 7-18 years increased 28 times and obesity increased four times between 1985 and 2000, a trend that was particularly marked in boys.

The common culprits are cited: changes to the traditional diet, reduced levels of physical activity, and increased sedentary lifestyles.