Bradley Waggoner, MD

Carbohydrate Claims Can Mislead Consumers, Study Finds

Food manufacturers advertise a variety of foods on grocery store shelves by using nutrient claims on the front of packaging. A study in the September/October issue of the Journal of Nutrition Education and Behavior evaluates how consumers are interpreting certain carbohydrate-related content claims and the effects of claims on consumer perceptions of food products. Findings from this study reveal that consumers misinterpret low carbohydrate claims to have health benefits and weight loss qualities beyond their nutrition facts.

In the early 2000s, low-carbohydrate claims gained huge popularity in response to such books as Dr. Atkin's New Diet Revolution and The South Beach Diet. In a study published in AC Nielsen Consumer Insights, it was noted that there was a 516% sales increase in low-carbohydrate food products from 2001 to 2005 showing that front of package claims can play a large part in consumer decisions.

Existing research suggests that consumers are less likely to turn to the back of a package to look at the Nutrition Facts panel when there is a claim on the front of the package. In the new study, researchers at the United States Food and Drug Administration, Center for Food Safety and Applied Nutrition sought to determine whether low-carbohydrate claims might lead consumers to perceive products to have benefits that are not necessarily related to being low in carbohydrate. Using an online questionnaire, 4,320 consumer panelists rated products for their perceived healthfulness, helpfulness for weight management, and caloric content based on front-of-package-only conditions (nutrition claims versus no nutrition claims) and availability of Nutrition Facts panels.

This study documents that in the absence of Nutrition Facts panels, "low-carbohydrate claims led to more favorable perceptions about products' helpfulness for weight management, healthfulness, and caloric content. Because an individual packaged food product's usefulness for weight management as part of an overall diet, its healthfulness, and total calorie content are not dependent solely on the amount of total carbohydrate it contains, the study demonstrated that consumers could misattribute benefits to products that claim to be low in carbohydrate."

However, the researchers found that when the Nutrition Facts panels are available "participants' perceptions became more consistent with the nutrition profile of the products…By showing the claims and the NF [nutrition facts] side-by-side, both pieces of information were equally accessible to participants as they answered the study questions. The presence of the NF, however, allowed participants to use this more diagnostic information to judge the product."

One limitation mentioned in this study by Dr. Judith Labiner-Wolfe, former consumer science specialist at the United States Food and Drug Administration (now an evaluation specialist at the United States Department of Health and Human Services' Office on Women's Health) and colleagues is that "the online venue for viewing the stimuli and answering the study questions may have fewer distractions than situations in which consumers make real product judgments, such as in a busy grocery store. Therefore, this study may overestimate the effect of the Nutrition Facts panel. Findings from this research are consistent with previous experimental studies that found participants misattribute health benefits to products with claims and that nutrition information has an independent effect on perceptions." The authors' state, "although exposure to the Nutrition Facts has the potential for mitigating inappropriate benefits attributed to products claiming to be low carbohydrate, previous consumer research suggests that when a food product carries a front-of-package claim, consumers are less likely to turn the package over to look at the Nutrition Facts panel."

Within the article, the researchers emphasize the important role nutrition educators have in helping consumers better understand the limited meaning of front- of- package claims and to further emphasize the importance of using the Nutrition Facts panel when making food choices.

The article is "Effect of Low-carbohydrate Claims on Consumer Perceptions about Food Products' Healthfulness and Helpfulness for Weight Management" by Judith Labiner-Wolfe, PhD; Chung-Tung Jordan Lin, PhD; and Linda Verrill, PhD. It appears in the Journal of Nutrition Education and Behavior, Volume 42, Issue 5 (September/October 2010) published by Elsevier.

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Elsevier Health Sciences (2010, October 11). Carbohydrate claims can mislead consumers, study finds. ScienceDaily. Retrieved November 7, 2010, from ScienceDaily.com.

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Focusing on Immediate Health Effects May Improve Weight Loss Success

Most weight loss programs try to motivate individuals with warnings of the long-term health consequences of obesity: increased risk for cancer, diabetes, hypertension, heart disease and asthma.  New research suggests the immediate health benefits—such as reduced pain—may be the most effective motivator for helping obese individuals shed extra weight and commit to keeping it off.

 

In a pilot research study, University of Cincinnati (UC) researchers found that 21 percent of participants in a local dietary weight loss program reported significantly less pain in the lower extremities and back after losing an average of 10 pounds. Additionally, study participants reported a 20 to 30 percent reduction in overall bodily pain after weight loss.

 

Researchers say their results indicate that even small weight loss can relieve pain and reduce the burden excessive weight puts on the musculoskeletal system.

 

"By focusing on an immediate benefit that can be felt—like pain reduction—instead of the future health impact of obesity, weight loss programs may be able to inspire overweight individuals to lose weight,” says Susan Kotowski, PhD, study collaborator and director of the Gait and Movement Analysis Laboratory in the UC College of Allied Health Sciences.

 

Kotowski and colleague Kermit DAvis, PhD, report their findings in the August 2010 issue of the journal Work.

 

According to the Centers for Disease Control and Prevention (CDC), 44 million Americans are considered clinically obese. Since 1975, the number of obese Americans has risen from 47 percent to 66.3 percent. Previous studies have estimated obesity-attributable medical expenditures in the United States at $75 billion, with half of these costs financed by Medicare or Medicaid.

 

"Obesity has become a national health crisis, but compliance for weight loss programs is notoriously poor. One potential reason for this is that current programs target long-term diseases, with little direct relevance to the person’s current health status,” adds Davis, senior author of the study and director of the Low Back Biomechanics and Workplace Stress Laboratory at the UC College of Medicine’s environmental health department. "Our study results challenge people to rethink the way they structure weight loss programs.”

 

For this pilot study, UC researchers partnered with a Cincinnati-based weight loss clinic to recruit study volunteers. Thirty two women between the ages of 22 and 76 participated in the study and data was collected over the course of a 12-week dietary weight loss regimen.

 

Researchers collected baseline individual weight and musculoskeletal pain data related to nine body regions: neck, shoulders, elbows, hands and wrists, upper back, lower back, hips, knees and lower legs and feet. Participants were then tracked each week to record any weight loss and asked to rate their pain on a scale of zero to 10 every other week.

 

Significant associations were found between weight loss and overall pain reduction, as well as pain reduction in the elbow, hip region and upper and lower back.

 

Researchers say these preliminary results could have ramifications for companies with a high prevalence of overweight workers with musculoskeletal problems—particularly in industries that require manual or repetitive weight-bearing labor.

 

"From an ergonomics perspective, we can only do so much to alter the work environment to remove body stressors,” explains Kotowski. "Excess weight adds additional stress to the musculoskeletal system and that can only be relieved through weight loss.”

 

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Source: University of Cincinnati . http://www.healthnews.uc.edu/news/

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One High Fat Diet, Two Different Outcomes: The Path To Obesity Becomes Clearer

Why is it that two people can consume the same high fat, high-calorie Western diet and one becomes obese and prone to diabetes while the other maintains a slim frame? This question has long baffled scientists, but a study by Yale School of Medicine researchers provides a simple explanation: weight is set before birth in the developing brain.

The results were reported online the week of August 2 in the Proceedings of the National Academy of Sciences.

Led by Tamas Horvath, chair and professor of comparative medicine and professor of neurobiology and obstetrics & gynecology at Yale School of Medicine, the research team analyzed the same question in specific groups of rats. These animals have been bred so that their vulnerability to diet-induced obesity is known before they would be put on high-fat, high-calorie diet diets.

Horvath said animals that become obese already had a significant difference in the feeding center of the brain. Neurons that are supposed to signal when you’ve eaten enough and when to burn calories, are much more sluggish in these animals because they are inhibited by other cells. In animals resistant to obesity, these satiety signaling neurons are much more active and ready to signal to the rest of the brain and peripheral tissues when enough food has been consumed.

“It appears that this base wiring of the brain is a determinant of one’s vulnerability to develop obesity,” said Horvath, who is also co-director of the Yale Program in Integrative Cell Signaling and Neurobiology of Metabolism. “These observations add to the argument that it is less about personal will that makes a difference in becoming obese, and, it is more related to the connections that emerge in our brain during development.”

Horvath points to other unwanted consequences of these brain mechanisms. “Those who are vulnerable to diet-induced obesity also develop a brain inflammation, while those who are resistant, do not,” he said. “This emerging inflammatory response in the brain may also explain why those who once developed obesity have a harder time losing weight.”

Diet-induced obesity has become one of the most critical medical problems in the United States. In particular, the incidence of childhood obesity has reached unprecedented levels. Since genetics alone cannot explain the surge of obesity in society, investigators have been trying to determine the primary underpinnings of the vulnerability to develop obesity on a Western diet.

“What genetic, epigenetic and environmental factor determines this base wiring in the brain is a very important issue to address,” said Horvath. “Specifically, the emerging view is that besides genetics, maternal impact on the developing brain is likely to be critical to imprint these feeding circuits thereby determining one’s vulnerability or resistance to obesity.”

The study was supported by the National Institutes of Health and the American Diabetes Association.

Other Yale authors include Beatrix Sarman, Peter Sotonyi, Marya Shanabrough, Erzsebet Borok and Sabrina Diano. The study also included authors from the following institutions: Monash University, University of Cincinnati, German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Veterans Affairs New Jersey Health Care System and University of Medicine and Dentistry New Jersey.

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Source: Reprinted with editorial adaptations from materials provided by Yale University. http://opa.yale.edu/health-medicine

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TV Food Advertisements Promote Imbalanced Diets

Making food choices based on television advertising results in a very imbalanced diet according to a new study comparing the nutritional content of food choices influenced by television to nutritional guidelines published in the June issue of the Journal of the American Dietetic Association¹.

Investigators found that a 2,000-calorie diet consisting entirely of advertised foods would contain 25 times the recommended servings of sugars and 20 times the recommended servings of fat, but less than half of the recommended servings of vegetables, dairy, and fruits. In fact, the excess of servings in sugars and fat is so large that, on average, eating just one of the observed food items would provide more than three times the recommended daily servings (RDS) for sugars and two and a half times the RDS for fat for the entire day.

"The results of this study suggest the foods advertised on television tend to oversupply nutrients associated with chronic illness (eg, saturated fat, cholesterol, and sodium) and under supply nutrients that help protect against illness (eg, fiber, vitamins A, E, and D, calcium, and potassium)," according to lead investigator Michael Mink, PhD, Assistant Professor and MPH Program Coordinator, Armstrong Atlantic State University, Savannah, GA.

Researchers analyzed 84 hours of prime time and 12 hours of Saturday morning broadcast television over a 28-day period in 2004. ABC, CBS, Fox and NBC were sampled on a rotating basis to develop a complete profile of each network. The Saturday-morning cartoon segment (from 8:00 am to 11:00 am) was included to capture food advertisements marketed primarily to children.

All 96 hours of observations were videotaped and reviewed later to identify food advertisements and specific food items being promoted. Only food items that were clearly promoted for sale during an advertisement were recorded. Each food item was then analyzed for nutritional content. Observed portion sizes were converted to the number of servings.

The article indicates that the observed food items fail to comply with Food Guide Pyramid recommendations in every food group except grains. The average observed food item contained excessive servings of sugars, fat, and meat and inadequate servings of dairy, fruit and vegetables. The situation was similar for essential nutrients, with the observed foods oversupplying eight nutrients: protein, selenium, sodium, niacin, total fat, saturated fat, thiamin and cholesterol. These same foods undersupplied 12 nutrients: iron, phosphorus, vitamin A, carbohydrates, calcium, vitamin E, magnesium, copper, potassium, pantothenic acid, fiber, and vitamin D.

The authors advocate nutritional warnings for imbalanced foods similar to those mandated on direct-to-consumer drug advertisements. They recommend investigating health promotion strategies that target consumers, the food industry, public media, and regulation focusing on a three-pronged approach.

"First, the public should be informed about the nature and extent of the bias in televised food advertisements. Educational efforts should identify the specific nutrients that tend to be oversupplied and undersupplied in advertised foods and should specify the single food items that surpass an entire day's worth of sugar and fat servings. Second, educational efforts should also provide consumers with skills for distinguishing balanced food selections from imbalanced food selections.

For example, interactive websites could be developed that test a participant's ability to identify imbalanced food selections from a list of options. This type of game-based approach would likely appeal to youth and adults. Third, the public should be directed to established nutritional guidelines and other credible resources for making healthful food choices."

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¹Reprinted from materials provided by Elsevier Health Sciences , via EurekAlert!, a service of AAAS.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Managing the Emotions Behind Eating

How many times have you, after a particularly hard day, reached for some chocolate or ice cream? It's common for many people, but for those trying to lose weight, it can be detrimental to their long term success, and most weight-loss programs never even address it.

They focus on choosing healthier foods and exercising more, but they never answer a key question: how can people who have eaten to cope with emotions change their eating habits, when they haven't learned other ways of coping with emotions?

Researchers at Temple's Center for Obesity Research¹ are trying to figure out the answer as part of a new, NIH-funded weight loss study. The new treatment incorporates skills that directly address the emotional eating, and essentially adds those skills to a state-of-the art behavioral weight loss treatment.

"The problem that we're trying to address is that the success rates for long-term weight loss are not as good as we would like them to be," said Edie Goldbacher, a postdoctoral fellow at CORE. "Emotional eating may be one reason why people don't do as well in behavioral weight loss groups, because these groups don't address emotional eating or any of its contributing factors."

The study has already had one wave of participants come through, and many participants have seen some success in the short term, but have also learned the skills to help them achieve long term success.

Janet Williams, part of that first cohort, said she lost about 17 pounds over 22 weeks, and still uses some of the techniques she learned in the study to help maintain her weight, which has not fluctuated.

"The program doesn't just help you identify when you eat," said Williams. "It helps you recognize triggers that make you eat, to help you break that cycle of reaching for food every time you feel bored, or frustrated, or sad."

Williams said that the program teaches various techniques to help break that cycle, such as the "conveyor belt," in which participants, when overcome with a specific emotion, can recognize it and take a step back, before reaching for chips or cookies, and put those feelings on their mental "conveyor belt" and watch them go away.

"I still use the skills I learned in the study," she said. "I've learned to say, 'I will not allow this emotional episode to control my eating habits.'"

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¹Temple University. http://www.temple.edu/

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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Phosphorous in Sodas and Processed Foods Accelerates Signs of Aging Say Harvard Scientists

Here's another reason to kick the soda habit. New research published online in the FASEB Journal¹ shows that high levels of phosphates may add more "pop" to sodas and processed foods than once thought. That's because researchers found that the high levels of phosphates accelerate signs of aging. High phosphate levels may also increase the prevalence and severity of age-related complications, such as chronic kidney disease and cardiovascular calcification, and can also induce severe muscle and skin atrophy.

"Humans need a healthy diet and keeping the balance of phosphate in the diet may be important for a healthy life and longevity," said M. Shawkat Razzaque, M.D., Ph.D., from the Department of Medicine, Infection and Immunity at the Harvard School of Dental Medicine. "Avoid phosphate toxicity and enjoy a healthy life."

To make this discovery, Razzaque and colleague examined the effects of high phosphate levels in three groups of mice. The first group of mice was missing a gene (klotho), which when absent, causes mice to have toxic levels of phosphate in their bodies. These mice lived 8 to 15 weeks. The second group of mice was missing the klotho gene and a second gene (NaPi2a), which when absent at the same time, substantially lowered the amount of phosphate in their bodies. These mice lived to 20 weeks. The third group of mice was like the second group (missing both the klotho and NaPi2a genes), except they were fed a high-phosphate diet. All of these mice died by 15 weeks, like those in the first group. This suggests that phosphate has toxic effects in mice, and may have a similar effect in other mammals, including humans.

"Soda is the caffeine delivery vehicle of choice for millions of people worldwide, but comes with phosphorous as a passenger" said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal. "This research suggests that our phosphorous balance influences the aging process, so don't tip it."

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¹FASEB Journal. http://www.fasebj.org

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New Eating Device Retrains Dietary Habits and Helps Children Lose Weight

A new computerized device that tracks portion size and how fast people eat is more successful in helping obese children and adolescents lose weight than standard treatments, according to research published on bmj.com¹.

The Mandometer device, a portable computerized weighing scale, was developed at the Karolinska Institutet in Stockholm. It helps to retrain individuals to eat less and more slowly by providing real-time feedback during meal times. The device plots a graph showing the rate at which food actually disappears from the plate, compared to the ideal graph programmed in by a food therapist.

Childhood obesity is an increasing global problem and there is little evidence to support one specific treatment program. While it is unknown whether specific eating patterns are common in all obese people, in this study the patients ate large portions very quickly.

Researchers at Bristol Royal Hospital for Children and the University of Bristol, led by Professor Julian Hamilton-Shield, carried out a randomized controlled trial of 106 obese patients aged between 9-17 years.

One group of participants received Mandometer therapy to lose weight and the other were provided with standard care. Both groups were encouraged to increase their levels of physical activity to 60 minutes of exercise a day and to eat a balanced diet based on the Food Standards Agency "eatwell plate."

Participants were assessed after 12 months and followed up at 18 months. During the research period they were also regularly monitored and offered telephone support and encouragement.

After 12 months, the Mandometer group not only had a significantly lower average body mass index and body fat score than the standard care group, but their portion size was smaller and their speed of eating was reduced by 11% compared with a gain of 4% in the other group. Levels of 'good cholesterol' were also significantly higher in the Mandometer group.

The improvement in body mass index was maintained six months after the end of treatment, suggesting an element of longer term behavioral change, add the authors.

"Mandometer therapy, focusing on eating speed and meal size, seems to be a useful addition to the rather sparse options available for treating adolescent obesity effectively without recourse to pharmacotherapy," say the authors.

They acknowledge that the Mandometer requires further evaluation in other settings and with different groups of patients, but conclude that "Retraining eating behavior and reinforcing feelings of satiety, however, does seem to improve weight loss in obese adolescents."

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¹ http://www.bmj.com. Full text of this study can be found at the BMJ Journal's website.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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What You Eat After Exercise Matters

Many of the health benefits of aerobic exercise are due to the most recent exercise session (rather than weeks, months and even years of exercise training), and the nature of these benefits can be greatly affected by the food we eat afterwards, according to a study published in the Journal of Applied Physiology

“Differences in what you eat after exercise produce different effects on the body’s metabolism,” said the study’s senior author, Jeffrey F. Horowitz of the University of Michigan. This study follows up on several previous studies that demonstrate that many health benefits of exercise are transient: one exercise session produces benefits to the body that taper off, generally within hours or a few days.

“Many of the improvements in metabolic health associated with exercise stem largely from the most recent session of exercise, rather than from an increase in ‘fitness’ per se,” Dr. Horowitz said. “But exercise doesn’t occur in a vacuum, and it is very important to look at both the effects of exercise and what you’re eating after exercise.”

Specifically, the study found that exercise enhanced insulin sensitivity, particularly when meals eaten after the exercise session contained relatively low carbohydrate content. Enhanced insulin sensitivity means that it is easier for the body to take up sugar from the blood stream into tissues like muscles, where it can be stored or used as fuel. Impaired insulin sensitivity (i.e., “insulin resistance”) is a hallmark of Type II diabetes, as well as being a major risk factor for other chronic diseases, such as heart disease.

Interestingly, when the research subjects in this study ate relatively low-calorie meals after exercise, this did not improve insulin sensitivity any more than when they ate enough calories to match what they expended during exercise. This suggests that you don’t have to starve yourself after exercise to still reap some of the important health benefits.

The paper, “Energy deficit after exercise augments lipid mobilization but does not contribute to the exercise-induced increase in insulin sensitivity,” appears in the online edition of the journal. The authors are Sean A. Newsom, Simon Schenk, Kristin M. Thomas, Matthew P. Harber, Nicolas D. Knuth, Haila Goldenberg and Dr. Horowitz. All are at the University of Michigan. The American Physiological Society published the research.

The study included nine healthy sedentary men, all around 28-30 years old. They spent four separate sessions in the Michigan Clinical Research Unit in the University of Michigan Hospital. Each session lasted for approximately 29 hours. They fasted overnight before attending each session, which began in the morning.

The four hospital visits differed primarily by the meals eaten after exercise. The following describes the four different visits:

• They did not exercise and ate meals to match their daily calorie expenditure. This was the control trial.

• They exercised for approximately 90 min at moderate intensity, and then ate meals that matched their caloric expenditure. The carbohydrate, fat, and protein content of these meals were also appropriately balanced to match their expenditure.

• They exercised for approximately 90 min at moderate intensity and then ate meals with relatively low carbohydrate content, but they ate enough total calories to match their calorie expenditure. This reduced-carbohydrate meal contained about 200 grams of carbohydrate, less than half the carbohydrate content of the balanced meal.

• They exercised for approximately 90 min at moderate intensity and then ate relatively low-calorie meals, that is, meals that provided less energy than was expended (about one-third fewer calories than the meals in the other two exercise trials). These meals contained a relatively high carbohydrate content to replace the carbohydrate “burned” during exercise.

The exercise was performed on a stationary bicycle and a treadmill. The order in which the participants did the trials was randomized.

In the three exercise trials, there was a trend for an increase in insulin sensitivity. However, when participants ate less carbohydrate after exercise, this enhanced insulin sensitivity significantly more. Although weight loss is important for improving metabolic health in overweight and obese people, these results suggests that people can still reap some important health benefits from exercise without undereating or losing weight, Dr. Horowitz said.

The study also reinforces the growing body of evidence that each exercise session can affect the body’s physiology and also that differences in what you eat after exercise can produce different physiological changes.

The research team is now performing experiments with obese people, aimed at better identifying the minimum amount of exercise that will still improve insulin sensitivity at least into the next day.

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Story Source: Adapted from materials provided by  The American Physiological Society.

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If you are considering weight loss surgery, you owe it to yourself to choose a physician who is not only highly skilled, but caring and compassionate as well. Many physicians out there will treat your obesity. Dr. Waggoner will treat you!

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• If you are ready to set-up an appoint to discuss your weight loss options.
• Reserve your seat at the next free informational seminar outlining your obesity surgery options (including lap-band system procedures) and meet Bradley Waggoner in person.

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