Healthy Food & Healthy Living by Dr. Ayala

Study: Sixty percent of teens notice calorie postings

Chain restaurants are required to post the calorie content of their offerings on menu boards in a prominent way in some major American cities (including my fair but fat city of Philadelphia). The new health care reform law, signed last year, will enforce such labeling nationally. Many health experts support this public policy, saying it will help consumers make better informed food choices.

There are already efforts to evaluate if calorie labels make a difference. Some studies showed reductions in intake, some showed no measurable effect.

A new study, led by Brian Ebel, and published in the International Journal of Obesity, compared kids’ fast-food choices in two low-income communities: in New York City, where calorie labeling became mandatory in 2008, an in Newark NJ, were calories are not posted.

Here are the main findings:

• 349 kids, aged 1 to 17 years, were included in the study. The vast majority of these kids (90 percent) were from ethnic or minority groups

• Many of the NYC adolescents (57 percent) reported noticing the calorie labels. 9 percent of participants said they took calorie posting into consideration (so of those that noticed the calorie postings, 16 percent said it played a role in food choices)

• Customers’ receipts, show no effect on food purchases -- kids in the study ate on average 645 calories per meal at the participating fast-food joints (McDonald’s, Burger King, Wendy’s and KFC) before and after the labeling rules took effect

• 35 percent of teens in the study reported they ate fast food six or more times a week

• Asked about what influenced restaurant choice, the most important factors were ease, followed by location

• When making food choices, the most important factor was taste (72 percent), followed by price (46 percent). Only about a quarter of the kids said they were concerned with their weight and tried to eat fewer calories

• Three fourths of the kids had no clue about the daily caloric requirements of adults.

The titles of most of the many reports on this study announced the ineffectiveness of calorie labeling on kids’ choices (CBS: Calorie Labels Don't Affect Kids' Fast Food Choices, Time: Calorie Counts on Menus: Apparently, Nobody Cares, Business Week: Calorie Labels Don't Affect Kids' Fast-Food Choices). But please do not despair, and bear with me while we try to look at this issue a little more deeply.

What does it take to change a habit?

Habits are hard to break. What does it take to get people to exercise more? I think that very few people get serious about exercise because their physician told them so during a checkup. Does that mean the doctor should stop advocating exercise? Absolutely not! Well-being promotion should be voiced from many sources. The accumulated message, at some point, hopefully, will sink in. Maybe only after a really alarming health scare.

Advertisers know that a consumer needs to see a message more than a dozen times, in different ways, preferably on different sources of media, before it makes any impression at all.

So did anyone think that the unpleasant message of “this stuff you love to eat, and is so convenient and affordable is not very good for you” is going to change what people do with a just few large numbers posted on a menu board?

We have the right to know

Only a small percentage of the population suffers food allergies. Even fewer have celiac disease, or phenylketonuria (PKU). Yet the information about allergens, we all agree, needs to be listed for their benefit.

There are those among us counting calories and watching their weight. 50% of American women and 25% of American men are currently on a diet. Since the calorie information already exists for chain restaurants, isn’t it just common sense that it be posted prominently for the benefit of those of us who care about such things?

Should teens really be counting calories?

My general advice to kids, including my own, is to eat real, healthy food, seated at a table, eat when hungry, only until they’re no longer hungry, and minimize the junk. Although I think kids should learn about nutrition, and learn as much as possible about food, I think that counting calories should not be part of a kids’ routine. Since most kids have no idea how many calories they should consume in a day, putting the menu board calorie numbers in context is quite impossible.

Nevertheless, a casual glimpse on a calorie board leaves an impression—it tells the viewer, which are the calorie-dense foods, and which are lighter. Over long periods of time a general picture emerges, that helps an informed decision. I was shocked when I first saw the nutrition label of Ben and Jerry’s New York Super Fudge Chunk, but I still buy it. Does that mean the information had no effect? Absolutely not! I used that information to make the decision to reduce the frequency and serving size of this treat. In much the same way, the item selection at a fast food chain may look the same, but the frequency in which a teen visits the chain may change because he learned something from the calorie board, and that calorie count, combined with the talk he had with the school nurse about his rising BMI, led him to decide six fast-food meals a week are a tad too much. This habit change can’t be captured in the kind of studies done so far on the effect of calorie postings.

Kids’ life, contrary to what some may think, is not worry-free, but health and safety are rarely a concern that engages young people. I’m pretty impressed by the finding that 57 percent of adolescents in this study noticed calorie labels — so it’s not just sports, music and girls that are on a boy’s mind. At some point this knowledge may translate into action. For now, these kids are choosing restaurants by location and convenience – and that’s why McDonald situates its joints near schools.

Have calorie posting shocked you? Did they change your eating habits?

Dr. Ayala

Related posts:
Calorie posting laws spread—healthier choices follow
Counting calories to make healthy choices in fast-food restaurants

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Are you too busy to cook?

A version of this post first appeared in Maria Rodale’s blog Maria’s Farm Country Kitchen.

Parents today are busier than ever, and lack of time is the reason many people give when asked why they don’t cook more often and resort to prepared foods.

But I don’t believe it. My feeling is that although it’s true that our lives may be fast and hectic, time scarcity isn’t the main reason families aren’t enjoying a home-cooked meal together.

There are plenty of time-consuming house chores we still perform diligently, either ourselves or through surrogates – we still do laundry, clean, tidy-up and shop. Most of us find time for all the things that we see as important, and also some time for watching TV. I’m also sure you know plenty of super busy people who cook a decent meal most days (I’ll let you in on their secret before this post is done). No, I think lack of time hardly explains this trend.

Why is cooking the chore we so often outsource?

I was intrigued by a new study in the journal Appetite that looked at 120 working mothers’ perceived and factual time-pressure, to see whether time constraints affected the healthfulness of their evening meal preparation.

The researchers led by Monica Beshara, recruited 120 moms to at least one school-aged kid, who identified themselves as the primary meal preparers in the household. The mothers were asked how many hours they worked, and using a specialized questionnaire, also how time-pressured they felt.

Healthfulness of a weeks’ worth of meals was assessed comparing the meals mothers reported serving to the dietary guidelines.

The researchers hypothesized that time pressure would be the main obstacle to healthy meals, but they also assessed many other variables. Among the most important were the mother’s self-report of how self-efficient and confident she was in her ability to make a healthy meal, and how much she valued convenience and time-saving strategies in food preparation.

To the researchers’ surprise they found that time, or lack of it, had no direct impact on the meal quality. The busiest of moms were as likely to produce healthy meals as those with more time on their hands. The most important determinant of meal quality was the mother’s confidence in her ability to make it happen — mothers who believed in their culinary skills and had an expectation of a good result produced healthy meals.

So here’s, I think, our main culprit for the disappearing home-cooked meal: lack of culinary skills. Many parents today are second-generation non-cooks. They have very few kitchen skills to build upon, and cooking and food preparation is therefore alien and dreaded.

The double edged sword of convenience

Many kids leave home without a clue on how to do laundry, or balance a check-book. They learn fast enough, because they have to. Not so with cooking, many are proudly ignorant, believing they can live happily ever after without even the most basic food skills.

And the reason so many think they can get away with not cooking is very obvious. Prepared meals, fast-food and take-away have provided a cheap, palatable, highly advertized alternative. Cleverly, these foods are promoted to kids for taste and fun and to moms for convenience. Who doesn’t love convenience, ease and saving time? Decades-long of promotion established in our collective mind that cooking takes too much time and skill. Convenience food was the solution to everything: The kids are happy to eat brightly packaged as-seen-on-TV food and mom saves precious time.

Except this solution is now blamed, in large part, for our expanding waists and poor health. Because there is no substitute to simple, nutritious home-made meals, and most bought foods add a lot of calories and unhealthy ingredients to our diets. The most convenient, time-efficient (and inexpensive) way to eat healthfully is to cook simple meals at home.

Time to go back to cooking

A recent editorial in the Journal of the American Medical Association calls for restoring a modernized form of home economics class in schools, with a curriculum that would teach kids how to prepare healthful meals and make better food choices. Many kids today, the authors say, aren’t likely to receive such instruction at home, because the skills have been lost for more than a generation. I think it’s an idea worth exploring. Many trends start with kids, with grown-ups following suit.

Here’s the secret I’m sure all cooking moms and dads know: Cooking isn’t hard, nor is it necessarily time consuming. It’s quite rewarding, and when cooking at home, for family or friends, most people are so happy to be fed a home-cooked meal they are just thankful, and completely non-judgmental.

And here’s another secret: You can recruit help. Kids are very happy to have important jobs, and very proud to be working in the kitchen.

If you’re new to ways of the kitchen buy good ingredients, cook them simply, and build on your successes. Like any other skill, practice and gradual learning will make it better and better.

No one is too busy to cook, and anyone can cook.

Dr. Ayala

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

Dinner in New York

One of the pleasures of being a blogger is the occasional pleasant surprise in your mailbox. No, I don’t mean the goodies sent your way for review (I don’t review products on my blog), what I’m referring to is the bloggers, colleagues, friends and like-minded people who reach out over the web, react to my work, and introduce me to theirs.

That’s exactly how I met Miho Aikawa, a Japanese born documentary and fine art photographer now living in Brooklyn, NY. Miho is currently working on a photo project called "DINNER in NY" which portrays New Yorkers by capturing one moment in their day: Dinner time.

When Miho looked through her photographs, she found that many people ate dinner with a computer screen, phone or TV in their sight, and that got her thinking: Is it that people are too busy? Do they not care about dinner enough to give it their full attention? What is a quality dinner?

Looking for some background data Miho came across my post “Americans spend more time eating, mostly while distracted”, in which I cite a study in Public Health Nutrition that shows that eating as a primary activity declined in the past 30 years. On the other hand, eating as a secondary activity rose dramatically in the past 30 years. When combining the primary and secondary eating time we see that overall we’re spending, on average, 25 more minutes daily eating than we did 30 years ago, and we now do almost 50 percent of our eating while concentrating on something else.

I will be writing a foreword to Miho’s exhibition and Miho kindly let me share a few of her photos with you (go see the entire collection on Miho’s website). The pictures speak for themselves, and tell a compelling story. What do you read into them? What’s your dinner time like?

Dr. Ayala

Related post: The Family Dinner: A healthy ritual to look forward to every day

Reposted as part of Food Renegate's Fight Back Fridays--go join the food fight!

The New Dietary Guidelines: Eat Less for Better Health!

The 2010 Dietary Guidelines for Americans are finally out. Yeah, I know, not everyone suspended eating awaiting their debut. Nevertheless, the guidelines are an excellent source on what scientific evidence suggests we eat, and it seems this seventh edition of the guidelines is moving towards more clarity on several key nutrition issues.

I was listening in on the press conference in which agriculture Secretary Tom Vilsack and Secretary of the Department of Health and Human Services Kathleen Sebelius unveiled the new guidelines this Monday morning, and it was refreshing and sobering to hear the not great and not-really-news: Our population faces an epidemic of overweight and obesity, and therefore the main theme of the new guidelines is eat less!

Here are the main messages:

Eat more of:

What’s really lacking in the American diet? Not protein, certainly not fat, and vitamin deficiencies are not an issue either. What we need more of is fruits and veggies. The guidelines have a practical message for consumers:

“Make half your plate fruits and vegetables”

Other key recommendations: Eat at least half your grains as whole-grain, increase intake of low-fat or fat-free milk and its products, replace high fat meats with low fat ones.

Eat less of:

Salt: although an essential nutrient, virtually all Americans consume more sodium than they need – we take in approximately 3,400 mg per day, when the upper limit should be 2.300 mg. The upper suggested limit is actually 1,500 for African-Americans, people over the age of 50, and those of us with hypertension, diabetes, heart disease or kidney disease – these subgroups together add up to more than half the population.

Most of the sodium in the American diet comes from prepared and processed foods, therefore the only way to reduce sodium in a meaningful way right now is to eat less processed foods and cook at home. Beyond that, it’s up to food manufacturers: “An immediate, deliberate reduction in the sodium content of foods in the marketplace is necessary to allow consumers to reduce sodium intake to less than 2,300 mg or 1,500 mg per day now”, says the report.

Sugar: Added sugars make up about 16 percent of the total calories in American diets, and in an obese society the first thing to cut should be these empty calories. The guidelines state that “the major sources of added sugars in the diets of Americans are soda, energy drinks, and sports drinks”, and therefore one of the key messages of the report is:

“Drink water instead of sugary drinks”

Other foods to reduce: saturated (solid) fats (to less than 10 percent of total calories), trans fats, cholesterol, refined grains and alcohol.

Here’s an interesting piece of advice: “Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.” Can you name the food to be limited? Perhaps the image prefacing the chapter (see below) can help name that-which-should-not-be-named.

Enjoy your food

The selected messages for consumers one-page contains a sentence that is quite intriguing:

“Enjoy your food. But eat less.”

What do the authors mean? Are they consoling us with the reassurance that moderation and living with less (calories) can still be enjoyable? I actually read something completely different into this piece of advice: Make your meals really enjoyable – buy good ingredients, eat in company, have a nicely set table and good conversation around it, eat mindfully – and you’ll find you need less food.

Secretary Vilsack admitted that he didn’t use to read the guidelines or pay much heed to their advice in the past, but nowadays many more Americans – Including Vilsack himself – care a lot more about what they eat, and many more accept the fact that a poor diet is linked to many illnesses and shorter lives. These guidelines are the basis of educational materials (including a new food pyramid that will be published later this year) and policies, such as the federal nutrition assistance and school lunch programs. So these guidelines do matter.

Do you pay attention to the guidelines? What advice would you like to see in them?

Dr. Ayala

Full disclosure: I’m vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.