Healthy Food & Healthy Living by Dr. Ayala

How do you know if you have a healthy weight?

Mirror, mirror on the wall, am I fat? Just right? Too thin? (Is there such a thing?)

It should be quite easy to tell, shouldn’t it? One look in the mirror should tell all, right?

Apparently not! Self assessment often isn’t correct, and many people’s perception of where they stand in the weight spectrum is just wrong!

A recent article in the journal Obesity shows that weight misperception is highly prevalent among all US adults: more than 20% of healthy weight adults considered themselves overweight, and close to 40% of overweight adults and about 8% of obese adults considered themselves to be "about the right weight."

The study sample consisted of more than 17,000 adults. Subjects reported self-perception of their weight status, and their assessment was compared to a calculated Body Mass Index, or BMI, which is the measured weight in kilograms divided by measured height in meters squared.

As you’d probably guess, there was a big difference between individual’s body image perception between men and women.

Underestimation of body fat by overweight and obese subjects was more common in men than it was for women:

• 49% of overweight men misdiagnosed themselves as underweight or healthy weight, compared to 22% of overweight women.
• 12% of overweight men misdiagnosed themselves as underweight or healthy weight, compared to 4.5% of women.

Overestimation of body fat went the other way:

• 32% of women with healthy weight perceived themselves as overweight, compared with 8% of healthy weight men reporting they were overweight.

What I found quite interesting was weight misperception was more common among racial/ethnic minorities and people with lower education. The study found that, although overweight and obesity was more common among ethnic minorities, so was the misperception of these conditions. For example:

• Overall 12% of obese men misclassified themselves as healthy weight; the prevalence of misperception was 9% for non-Hispanic whites, 25% for non-Hispanic blacks and 17% for Mexican Americans.

The study limited itself to the self-reported ethnic classification mentioned above due to the limited sample size of other ethnic groups.

The authors, lead by Rashinda R. Dorsey, conclude:

“Misperception, that is incorrect self-assessment of measured weight, was common among healthy weight, overweight and obese adults in the United States. Minorities were more likely to have a weight misperception, as well as men and persons with lower educational levels. Addressing the issue of weight misperception may help address the problem of obesity in the United States by increasing awareness of healthy weight levels, which may subsequently have an impact on weight-related behavior change. Additionally, targeting weight management interventions at groups disproportionately reporting weight misperception may be beneficial.”

I wasn’t at all surprised by the study’s findings because I’ve seen many studies showing the same results. The current issue of Pediatrics includes a study that shows that a large percentage of overweight and obese patients remain undiagnosed even by their pediatrician. There are several studies showing that parents fail to notice their kids are overweight.

Bottom line: Body fat status needs to be objectively assessed. Calculating the BMI (after measuring weight and height) is one important tool, but BMI doesn’t distinguish between fat tissue and muscle, and can misclassify people with muscular builds as overweight. The other important measure is waist circumference or waist-to-hip ratio.

As I discussed in a previous post, extra belly fat carries an extra health risk for chronic diseases, such as diabetes and heart disease, and there are people with normal BMIs who are generally thin, but have big bellies.

Another important, practical tool that doesn’t require a visit to the physician’s office, is to simply examine your own trend. If you’re gradually gaining a few pounds over the months or years, or can’t fit into clothes you wore last season, it’s time to take a look at what you eat and how much you exercise, and consider a few adjustments. Weight is usually accumulated very slowly, and it’s best to “catch” this risk factor early, when it’s less painful to overcome. After all, it’s much easier to stop gaining further weight or to lose 10 pounds than it is to face a goal of losing 40 pounds.

It’s also worth paying attention to the significant percentage of people (mostly women) in this study who are plagued by a negative self image, and view themselves as overweight despite not being unhealthfully so. While in some societies large body size is both acceptable and the statistical norm, and leads overweight people to complacency and inaction, in other societies the pursuit of incredible thinness leads people (usually women) of perfectly healthy weights to continuously pursue unattainable and unnecessary goals.

People usually face high blood pressure or high cholesterol in a matter-of-fact way, and find ways to deal with it without great injury to their self esteem. Don’t you wish weight were just like any other health risk?

I believe we should accept and love ourselves at any weight, but still pursue a healthy weight (and not perhaps the most fashionable one) for health’s sake.

Easier said than done.

Would love to hear your thoughts!

Dr. Ayala

I'm guest blogging today

I have a guest post today at www.littlestomaks.com, a great blog about toddler nutrition. It's called: "Help! My Kids Don’t Eat Enough Fruits and Veggies!"

Take a look!
Leave a comment.

Ayala

Let the Obamas eat what they want!

I’m super excited about Barack Obama’s inauguration this week. Just like everyone else, I’m expecting a new era to start this Tuesday, and I’m hopeful for positive change.

Obama is greatly admired, and expectations from a president have never been so high. President Obama is expected not only to rescue the global economy, fix the environment, solve health care and bring peace to the Middle East, but seemingly, to be our role model for everything—model parent, model spouse, a fitness guru, a fashion icon—you name it.

The food world has joined in with their total obsession around Obama’s food habits. They (we) would love to embrace him as a model of healthy, ethical, sophisticated eating, and one of their (our) own. But is Obama a dedicated healthy, organic eater?

The New York Times Kim Severson says:

“… no one is sure just how serious Mr. Obama really is about the politics of food. So like mystery buffs studying the book jacket of “The Da Vinci Code,” interested eaters dissect every aspect of his life as it relates to the plate.”

Severson’s article refers to Obamafoodorama.com—an incredibly entertaining and informative website, that’s dedicated to the Obama foodscape.

To judge by the feverish speculation in blogs about the selection of White House chef, one might think the position is as important as Secretary of State. (In the end, Michelle Obama announced she’s keeping Cristeta Comerford, the current White house chef.)

I enjoy Obamafoodorama.com. I’ll also admit that I did put my name on the petition urging the Obamas to replant a large organic Victory Garden on the First Lawn (the symbolic idea of growing food in the White House is just too good to ignore).
But I really think that by looking too carefully at what the First Family puts in their mouths we’re really missing the point.

What we need and what I’d like to see is President Obama enacting wise food policies.

I’d like to see the new government making the fight against obesity a very high priority. I’d like to see more oversight on food safety. I think that it’s high time we addressed the issue of sustainable agriculture. Food is important, and it should be put high on the agenda; I hope, and believe, that the new administration will do so.

But just as a good psychiatrist doesn’t need firsthand experience of mental illness, and a male doctor can be an excellent ob/gyn, Obama can eat junk food, even have an occasional cigarette and still enact wise food and health policies.

No one likes their picture taken with food in their mouth; eating is quite a private matter. The level of scrutiny given to each food morsel Barack Obama (or his family) eats has reached the point of silliness. Does our new president need to be careful not only about what comes out of his mouth, but also what the world sees going in?

Food has become quite a sport in recent years, with more people watching cooking shows and surfing food websites. The irony is that many of these spectators aren’t actually cooking more and eating more family meals. Perhaps it’s time to stop looking at food as a spectacle, and just eat together a little better.

I wish our new president the best of health and many happy meals with his family in the White House. I, for one, will not to be disappointed by what he eats—it's entirely his call, and completely none of my business.
Ayala

The power of the health journalist’s pen

Where do you get your health and medical news? How do you know whom to trust? Should you act on news you read about health and nutrition?

The Health Correspondent Susan Dentzer recently wrote a perspective piece in the New England Journal of Medicine in which she argues that when journalists ignore complexities, or fail to provide context, the public health messages they convey are inevitably inadequate or distorted. While many seasoned reporters do a responsible, thoughtful job, she says, others—due to ignorance, an inability to interpret and convey the nuanced results of clinical studies, or a desire to hype a story to draw attention to it—deliver misleading or wrong information.

Dentzer writes:

“In my view, we in the news media have a responsibility to hold ourselves to higher standards if there is any chance that doctors and patients will act on the basis of our reporting. We are not clinicians, but we must be more than carnival barkers; we must be credible health communicators more interested in conveying clear, actionable health information to the public than carrying out our other agendas. There is strong evidence that many journalists agree—and in particular, consider themselves poorly trained to understand medical studies and statistics. But not only should our profession demand better training of health journalists, it should also require that health stories, rather than being rendered in black and white, use all the grays on the palette to paint a comprehensive picture of inevitably complex realties. Journalists could start by imposing on their work a ‘prudent reader or viewer’ test: On the basis of my news account, what would a prudent person do or assume about a given medical intervention, and did I therefore succeed in delivering the best public health message possible? “

I think that there’s no field as prone to misinformation and misinterpretation as nutrition science.

Nutrition study is inherently hard. Isolating the effect of diet on health is difficult, and in the end gives a statistical answer, telling us what’s likely. The fact is there are no certainties.

People differ from each other, eat all sorts of different foods over a lifetime, and live in different types of environments. Testing a specific food or nutrient—as opposed to testing a highly purified new drug—is impossible, as people eat in a social context, with food, lifestyle and other health influencers interacting and complicating interpretations. Many nutrition studies use study models that are not the ideal methods for obtaining proof, as there are technical and financial restraints that would make the ideal trial unattainable. Nevertheless, when the evidence of these trials is weighed together, and further, better studies are preformed, scientists can arrive at a consensus, which is the best advice that can be given at this time.

As difficult as nutrition science is, most people are very interested in learning about new developments. We all eat, and we’d all like to know how to eat best for optimal health. Therefore many scientific studies are reported in the general media.

Now, don’t get me wrong: every study has value, and publishing study results in scientific papers is the way science—eventually—gets to the truth. But publishing a surprising study result using a catchy title in a popular media outlet can lead to misinterpretation and the false belief that what a study shows is the “truth.”

I’ll give you one recent example that really upset me.

A paper titled: “Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age?” was published in International Journal of Epidemiology. It was a prospective study whose results indicated that at age 3 years children born to mothers who drank up to 1–2 drinks a week during pregnancy did not seem to have clinically relevant behavioral difficulties or cognitive deficits compared with children of abstinent mothers. The authors of the study concluded:

“There is no increased risk of behavioural problems or cognitive deficits at age 3 years for children whose mother drank not more than 1 or 2 units of alcohol per week or on any given occasion. It is important to acknowledge that problem behaviours or cognitive deficits may become apparent in these children at older ages, and the evidence presented should be used to guide future research and inform policy.”

Because alcohol consumption during pregnancy is a big health problem, such a study—if reported in lay media at all—must be interpreted with extreme caution.

Alcohol is a known teratogen (a chemical that can cause birth defects). Prenatal exposure to alcohol is widely accepted to be a risk factor in child development. Since it’s unclear what amount, frequency and timing of alcohol consumption during pregnancy causes damage to the fetus, the current recommendation of the U.S. Surgeon General is to not drink at all during pregnancy.

However, here are a few examples of popular media headlines in stories that presented this study:

“Light Drinking During Pregnancy May Benefit Baby”

“Pregnancy: Odd Drink May Not Hurt”

“Light drinking in pregnancy may be good for baby boys, says study”

If readers got to the end of these articles, they might have learned that experts don’t actually suggest an expectant mother should drink, but did anyone actually read the whole story? And did the same news reporters balance this catchy piece with all the bland but plentiful studies showing again and again that alcohol is dangerous to the fetus? I suspect not.

Unfortunately, there are many cases of this type of irresponsible reporting, in which the reader is drawn in with sexy headlines to seemingly relevant, applicable nutrition “news.” Studies are interpreted with great liberty while the related scientific article may be about an animal model or a cell-culture model, and be hardly relevant to anyone but the scientific community.

Study results should never be taken as guidelines for behavior. An interesting study, especially one showing new or contradictory results, will be followed by repeated and more methodological ones, and in the end, all evidence will be weighed by experts and only then might a recommendation be made.

I’m all for good health and nutrition reporting. But people are influenced by what they read in print and watch on TV, and many will act on media stories. I therefore agree with Susan Dentzer, and hope reporters take their position as influencers very seriously. There are many excellent health reporters who do and never fail to put new studies in a bigger context, examples of great health reporting would be the New York Times Health section and Tara Parker-Pope’s Well blog, and NPR’s science and health programming.

What do you think of the reporting of nutrition news? Who do you trust?

Ayala

Small changes for the New Year to curb obesity

As the New Year sets in, consider a small adjustment—a rather easy lifestyle change—for your New Year’s resolution.

Change is hard, and quick and big changes are even tougher. Most people find it hard to stick to their resolutions, and eventually fall back on old habits. So while taking on big changes, not small ones, is a strategy likely to yield immediate gratification, noticeable benefits and inspire further positive change, perhaps in the long term small, slow and steady is a better strategy when it comes to food, as eating is such an ingrained habit.

Are small steps the way to go as a society too?

We all know something needs to be done about the growing waistline of most Americans. Intuitively, we’d all hope that something big could change, but in reality, it seems like the small change idea is gaining ground as the most practical approach to fighting the obesity epidemic.

Looking at obesity from the population point of view—as opposed to the personal one—paints a rather bleak picture. There are many factors acting together to create an environment that promotes obesity, and indeed obesity rates are still climbing up. Two-thirds of Americans are overweight or obese, and it’s predicted that if trends don’t reverse, the majority of the world population will become obese, with enormous health and economic consequences.

The small-changes approach—embraced by many groups—focuses on promoting a small, widespread lifestyle change, such as replacing one sugary drink a day with a non-caloric one, or walking an additional 20 minutes a day. These small changes won’t drive overall weight loss in a society, but will help eliminate further weight gain. Over time, such a measure could lead to reductions in obesity rates.

A recent report in The American Journal of Clinical Nutrition by James O. Hill, representing the 17-member task force consisting of members of the American Society for Nutrition, the Institute of Food Technologists and the International Food Information Council, considers whether a small-changes approach could be useful in addressing obesity.

There are some interesting points in this report that explain the rational for this plan. I’ll focus on just a few:

• The energy gap. This measure the daily discrepancy between energy intake and energy expenditure. For the American population, the energy gap is estimated at about 100 extra calories a day, which explains the gradual weight gain of the population.

Eliminating 100 calories a day from a population would prevent further weight gain.

On the other hand, the energy gap required to produce and maintain weight loss is very much higher, says Hill. The estimate is that the energy gap to maintain a 9-14 kg (20-30 pounds) weight loss in obese people would be 175-250 calories per day, and the energy gap to maintain a 18-27 kg (40-60 pounds) weight loss in obese people would be 325-480 calories per day. This explains why obese people find it so very hard not to regain the weight they lost.

• Small changes are easier to achieve and maintain. It’s very hard to sustain large behavioral changes, and small changes could be the start of a process that ultimately leads to larger changes.

• The small change approach has been shown to work successfully in reducing obesity in several studies that intervened by promoting a small reduction in energy intake (of around 100 calories) and a small increase in exercise (such as 2,000 steps over baseline). I reported about one such successful small step approach in a previous blog post.

Hill suggests that these studies demonstrate that small changes reduce further weight gain, and that attempts at large changes in the American diet have not been widely successful, unless they’ve been undertaken by the food industry. One example of this is the sharp decline in consumption of trans-fatty acids, which did not require behavioral change from consumers but rather change mostly from the food manufacturers.

Hill concludes:

“This task force believes that a small-changes framework aimed at helping people make conscious small changes in lifestyle behaviors in combination with efforts by the private sector to gradually ’ratchet down’ some of the environmental factors that have contributed to excessive energy intake and to the declining rates in physical activity could be successful in reducing obesity rates. This initiative could be supported by educational and social marketing campaigns driven by or influenced by the many government agencies addressing this problem.”

I think we shouldn’t give up on ambitious big changes, especially since some big changes can be driven by policy decisions (one example would be removing fast food from school cafeterias) and therefore not require self-discipline from individuals.

But I do think that taking on small and easy goals is a good idea. Given the difficulty of weight loss, and the discouraging overall results of endless weight loss regimens, it’s perhaps very sensible to focus efforts on overweight prevention, rather than weight loss.

For those of us who don’t carry unhealthy amounts of extra weight, resolving to a healthy lifestyle that prevents further weight gain is really all that’s needed.

If you’re a parent of young kids like me, you’re in a unique position to play an important role in helping them avoid extra weight in childhood and adolescence by teaching them the skills of how and what to eat. An overweight condition, once established, is very hard to overcome permanently.

A recent poll shows this year--just like many before it--the top New Year resolution was to lose weight with resolutions to exercise more, eat a healthier diet, and improve one's health at fourth, fifth and sixth places.

I would love to hear about small changes (or big ones) you’ve pledged to make this year, if any.

Happy New Year!
Ayala