Healthy Food & Healthy Living by Dr. Ayala

Can we blame our habits for making us fat?

We’d like to think we’re free to make choices about our everyday life.

But studies show that almost half of the actions people take each day aren’t actually a result of decisions – they’re driven by habit alone.

Habits are so strong and so ingrained that they override many other thought processes. It seems like our human brain, trying to save on energy, goes into autopilot for every process it can use old routines for, and will fight any proposed change. The positive side of habit is that once you’ve mastered dressing up in the morning and backing out of your garage, your mind can wander free while you’re performing a rather complicated task. The negatives are quite clear to anyone trying to lose weight or stop smoking.

Charles Duhigg’s "The Power of Habit" is a fascinating exploration of the research of habits, and is packed with absorbing stories about how habits influence every aspect of our lives – the way we shop, listen to music, drive, and of course eat is driven mostly by habit. Understanding habits is the key to creating change.

The habit loop

A habit is a three-step loop, written in our brain’s pathways. First comes a cue: a trigger that tells our brain to go into the automatic mode of the habit. Then comes the routine, which is the physical, emotional or mental action we take. What follows is the reward: the prize at the end of the routine is what reminds our brain why this habit is worth keeping. When a habit is fully formed the reward’s rush of excitement appears well before it actually happens – brain scans show that we expect the reward and get excited as soon as the cue appears, and this anticipation creates cravings.

Food habits start innocently: Feeling tired or bored an hour after lunch can become a cue to walk to the vending machine and select a high calorie snack that hits all the right spots and gives you the instant reward of yumminess and energy. After repeating this routine several times it becomes habit, and your brain craves to finish the loop whenever the faintest prompt shows up. 

Watching TV acts as a cue for many people to munch: the cue is the TV or the couch, the routine is going through a bowl of chips, and the reward is that physical sensation of this delightful combo experience. The loop becomes so automatic, that watching TV without a bowl of munchies makes you feel robbed (and in case you forget it there’s always an ad to remind you that watching is better with eating).

Advertisers are well aware of the psychology of habit, and if you examine carefully, many ads and marketing campaigns build a habit loop in which they tie a certain cue – be it a place, an emotion, a time of day, a thought or a situation – to the action of consuming their product and feeling its reward. Duhigg uses McDonald’s as an example of habit building strategy:

“Every McDonald’s looks the same – the company deliberately tries to standardize stores’ architecture and what employees say to customers, so everything is a consistent cue to trigger eating routines. The foods at some chains are specifically engineered to deliver immediate rewards – the fries, for instance, are designed to begin disintegrating the moment they hit your tongue, in order to deliver a hit of salt and grease as fast as possible, causing your pleasure centers to light up and your brain to lock in the pattern. All the better for tightening the habit loop.”

Keystone habits

Some habits are more important than others, because they spill over to other parts of life, causing a ripple effect. These habits are called keystone habits and identifying them can often trigger widespread change.

Take exercise: Studies show that introducing exercise – even infrequently – changes other daily routines. Unknowingly, people who start to exercise start eating better, are less stressed, and become more productive at work. Duhigg lists eating dinner as a family as a keystone habit, which seems to go with better homework skills, higher grades, better self-control and more confidence.

I’d argue that sugary drinks are a keystone habit that initiates an array of associated poor nutrition habits. That’s one of the reasons most serious diet programs target the sugary drink habit first – winning the soda habit change leads to several other wins that follow.

Is habit destiny?

Once a fresh sheet of paper has been folded it will tend to fold into the same crease, and once water carved a path in the soft soil water will naturally flow in the same route, but our habits are malleable, and as Duhigg concludes:

"Once you know a habit exists, you have the responsibility to change it...others have done so...That, in some ways, is the point of this book...how we eat and sleep and talk to our kids, how we unthinkingly spend our time, attention and money — those are habits that we know exist. And once you understand that habits can change, you have the freedom and the responsibility to remake them. Once you understand that habits can be rebuilt, the power of habit becomes easier to grasp and the only option left is to get to work."

Changing habits is very hard work, and thinking about the power of established habit should remind us to be aware of habit acquisition, especially as parents.

We can do our kids a favor by helping them acquire good habits – habits that ensure that their automatic, default routines are healthy and beneficial. If kids brush their teeth every night before bedtime, get used to healthy eating habits, learn how to cook and are active when young they’re likely to continue doing these things throughout life.

We should also do our best to help them avoid habits that will be difficult to fight later on. Highly processed, densely caloric salty sweet and fatty foods are addictive and habit forming – ads make them even more so. Eating while multitasking, constant snacking and eating in the back seat of a car are learned routines that will not serve them well.

Dr. Ayala

“It is easier to prevent bad habits than to break them” ~Benjamin Franklin 

Reposted as part of Food Renegade's Fight back Fridays. 

Flat Belly Tip: Eat More Fiber

Not all body fat is created equal.  Some people accumulate fat predominantly in the belly, while in others fat deposits are spread all around, and it does matter, because belly fat presents a higher risk for chronic diseases.  Think of belly fat as a big, active endocrine gland secreting risky substances — abdominal or visceral fat is especially active metabolically and plays a part in insulin resistance and diabetes, lipid abnormalities, hypertension and cardiovascular disease. 

And here’s another piece of worrying news: The majority of Americans are now overweight or obese, and the extra padding we’ve added as a population has accumulated preferentially in the worst location for our health — our belly — and even people with normal weight seem to be getting wider waistlines.

Why are bellies getting disproportionately bigger? Some ethnic groups — such as Asians, Indians and Hispanics — have a higher tendency to accumulate abdominal fat. Other factors suggested to affect belly fat buildup include lack of exercise.

But does our diet affect where we deposit our fat stores?  Does the kind of food we eat determine body shape?

Lifestyle and belly fat

Several studies suggest that sugary drinks and fructose increase fat accumulation in the worst possible locations of our anatomy.

A new study in the journal Obesity followed 1,114 people over 5 years, looking to see if lifestyle factors directed fat preferentially to the belly.

The study population included 339 African Americans (African Americans tend to have lower belly fat than whites or Hispanics) and 775 Hispanic Americans, aged 18-81 years.   Participants were asked about their dietary and exercise habits, weight and height were measured at baseline and follow-up visits, and belly fat was measured with an abdominal CT scan.  A CT scan is a rather invasive way to measure belly fat, but a very accurate one.

Of all the foods and nutrients considered in the study one single nutrient was most significantly associated with belly fat: Fiber.  For every 10 grams of soluble fiber eaten per day, belly fat was reduced by about 4 percent after 5 years -- irrespective of total weight or BMI. 

Other studies have shown that reduced fiber diets are associated with weight gain, but this study actually showed that soluble fiber makes fat “choose” a depot that’s healthier for us — if you overeat, but eat more soluble fiber, the fat will go under the skin, rather than into the belly.

Oh, and here’s one more important finding: Vigorous exercise was also associated with less belly fat. 

Fiber: soluble, insoluble, and where to find it

Dietary fiber is a part of plant food that we humans cannot digest, but it nevertheless has many health benefits.

Soluble fiber is fermented by bacteria in the gut and has physiologically active byproducts; insoluble fiber is metabolically inactive, and just absorbs water and creates bulk as it moves through the gut, thus speeding food’s passage in the gut and preventing constipation.

Both soluble and insoluble fiber may help in making us feel full on less food, because they add to food bulk while adding no calories.  Soluble fiber has shown promise in lowering LDL (bad) cholesterol, regulating blood sugar and prevention of heart disease.  Insoluble fiber aids regular bowel movement.

Good sources for soluble fiber include fruits such as apples, bananas, plums, and berries, vegetables such as broccoli and carrots, sweet potatoes and onions, legumes such as soy, peas and other beans, and grains such as oats and barley.

Good sources of insoluble fiber include whole grain foods, bran, nuts and seeds, vegetables such as celery and zucchini, and the skins of many fruits and veggies.

Most Americans get only about 15 grams of fiber per day in their diet, which is half the minimum 25-30 grams recommended.

What about fiber supplements and foods with fiber added to them? It’s unclear if added fiber provides the benefits of naturally occurring fiber and the benefits of supplements have not been studied as extensively as those of dietary fibers – the food plant as a whole is usually more than the sum of its known parts.

Fiber for a flat belly

All fruits, veggies whole grains and nuts contribute fiber to our diet.  I don’t participate in the fiber wars, and wouldn’t favor one fruit over another for its fiber quantity or quality.  If you eat your fruits and veggies you’ll get plenty of fiber – but do try to leave the peel on where appropriate.

Eating fruits and veggies reduces the risk of obesity, but this new study suggests that eating them also enables us to direct where were we deposit our fat even if we do gain weight — dietary fiber may funnel that fat to a more favorable storage area.

Dr. Ayala 

 

Three healthy habits to help fight childhood obesity

I'll be taking some time off to spend time with my family and travel, and I'm be reposting a few popular posts I’ve written over the past years so that new readers have a chance to catch up. 

One in three American kids is overweight or obese. Many of our kids start accumulating extra weight—or develop the habits that will lead to weight gain later on—in very early childhood, setting them up for a lifelong struggle with both weight and a multitude of chronic diseases.

But many parents don’t pay much attention to obesity prevention advice; they don’t believe it’s relevant to their kids. They’re more focused on making sure their kids develop well, and they’re the last to notice when their kid puts on the pounds. And of course everybody hates “eat less” type of advice.

That’s why obesity-fighting tactics that aren’t directly related to what to put on kids’ plates have the potential of being successful.

A recent study in Pediatrics examined the association between childhood obesity and three household routines—regularly eating dinner as a family, getting enough sleep, and limiting TV-time—and found that 4-year-olds exposed all three routines had about a 40 percent lower prevalence of obesity than those exposed to none of these routines.

The study involved 8,550 nationally representative four-year-old American kids, and included measurements of height and weight as well as collection of background data, including ethnicity, maternal weight and education, and household income.

Eating dinner together regularly was defined as having the meal with at least some family members six or seven times a week. Adequate sleep for a four-year-old was categorized as 10.5 hours or more a night. Limited TV time was anything less than two hours a day during weekdays.

Here are the main findings:

• More than 18 percent (!) of the four-year-olds were obese.

• About half the families had a family dinner routinely.

• A little over a half of the four-year-olds got what the study considers enough sleep.

• 40 percent of four-year-olds had their TV time limited to less than two hours a day on weekdays.

• One in seven kids had all three household routines (family meals, enough sleep and limited TV time) and one in eight kids had none of these routines in place.

• Each of the routines was associated with significantly lower obesity rates. Kids who had all three routines had 40 percent less prevalence of obesity even after adjusting for maternal obesity and other socioeconomic characteristics.

Anything surprising in this data?

Unfortunately we’re getting used to seeing 18 percent obesity—yes, obesity, defined as a Body Mass Index (BMI) above the 95 percentile—not merely overweight in four-year-olds. That’s nearly one in five young kids!

Yet I still cringe whenever I see these numbers.

The finding that 60 percent of four-year-olds log more than two hours a day in front of the TV on weekdays is especially troubling to me. And I suspect these TV viewing times are an underestimate since parents tend to give socially desirable responses when asked about their habits, and only TV viewing athome and on weekdays was figured-in into this study.

Most large studies show that the more TV kids watch, the more likely they are to be overweight. How does TV contribute to obesity? Although common sense would say that TV displaces more active pursuits, that point isn’t well proven, as of yet.

What is very clear is that when our kids watch TV they are exposed to billions of dollars’ worth of well-crafted food ads, most of them for junk-foods: fast-food, sugary cereals and candy. These ads are so slick, and the marketing is so clever and entertaining that some toddlers have been known to sing the tunes and repeat the message after being exposed to some ads just once.

Most toddlers can’t tell programming and advertising apart—furry, cuddly friends and super-heroes abound in both—and it takes maturity and training to teach kids how to counteract the impact or to even notice the persuasive intent of advertising.

That’s why marketers want to get kids while they’re young; it’s like shooting fish in a barrel, and they’ll be loyal to the brand forever. That’s also why we parents should want to keep marketers away from our kids, especially when they’re very young and impressionable.

These days some food companies participate in a self-regulatory program butself-regulation doesn’t seem to be doing much to ensure responsible advertising to children. I actually don’t think there is such a thing as fair and responsible advertising to toddlers.

The American Academy of Pediatrics recommends limiting “children's total media time (with entertainment media) to no more than 1 to 2 hours of quality programming per day” and “discourage television viewing for children younger than 2 years”. TV is a babysitter every parent might want resort to every once in a while (we all need a break!) but common sense suggests that the upper limit should be lower than the Academy’s guide, and unfortunately, even quality programming is often flanked by ads. 

Should we adopt these three habits?

This study is cross-sectional and observational, meaning it looks at a population at a certain point in time and proves an association between family meals, good sleep and limited TV and lower rates of childhood obesity. It cannot prove causality, nor did the study examine the key influencers of obesity—diet and physical activity levels. It very well may be that these three habits are the habits of families who eat better and move more.

Yet even without further proof that these three habits curb obesity, I would absolutely recommend them to families, mainly because family meals, good sleep and limited TV-time make so much sense. There are other reasons to adopt these habits (for example, eating together is simply a good way to keep family ties strong), and there’s very little downside to embracing them.

But there are possible drawbacks. Your kids may suffer some arguments over the dinner table, have occasional bad dreams while they sleep, and miss some educational and entertaining stuff on TV.

On the other hand, they’ll be learning the pleasures and skills of dining in company rather than gulping down food, they’ll get enough sleep to sustain growth and health, and I’m pretty sure that most alternatives to TV (playing, reading or even being bored) offer better stimulation and sustenance to a child’s developing brain. If these three habits also protect young children from obesity, that’ll be a nice added bonus.

I’d take the risk.

Dr. Ayala

 

Moms oversharing their kids’ most personal stories

The mommysphere was abuzz over Dara-Lynn Weiss's Vogue article that detailed her effort to get her 7-year-old daughter to lose weight.

Criticism of Weiss spread like wildfire, especially after Katie J. M. Baker posted her scorn in Jezebel and described Weiss’ self-reported intense regimen of calorie restriction and public shaming as “abrasive, often irrational weight-loss strategies” and accused Weiss of projecting her hatred of her own body onto her child, and of writing the “worst Vogue article ever”.

Was Weiss wrong to put her daughter on a diet? Was the diet regimen inappropriate? Was its message misguided? Is being tough on your kid a parenting mistake?

There are situations in which action needs to be taken to prevent kids from further weight gain, and it’s definitely a parent’s job to educate kids about healthy eating and active lifestyle, and to provide for healthy food. There’s more than one way to obesity prevention and treatment in kids, and the discussion about what to do when a kid is diagnosed with overweight or obesity is an important one.

But here’s why I’m absolutely appalled by Dara-Lynn Weiss's piece: the Vogue article not only gave the child’s full name, it also displayed her photos.

A few days after witnessing the media party around the 7-year-old-on-a-diet, I read Elizabeth Weil’s Puberty Before Age 10: A New ‘Normal’? in the New York Times. This article opens with a story told by another mother, Tracee Sioux, whose daughter started growing pubic hair at the age of 6. Again, full name of the child, hometown and picture all included.

Outing kids

Reality TV seems to have dampened our instinct for privacy.

Adults willing to share tears and fears and humiliation with strangers are one thing, but dragging your kids exposed into the village square is an entirely different story.

Could anyone really imagine that a girl could benefit from the world knowing when her breasts budded?

So here’s an easy trick for moms with oversharing tendencies: Ask yourself this: if someone else revealed the information about your kid, would you feel comfortable? If your kid wanted to expose the information on the Internet, would you advise him to go ahead?

I’m sure most parents would be outraged if their kid's weight struggles, breast budding or pubic hair appearance were exposed by a reporter or a friend. They’d sue them!

Why did these moms do it? Weiss’ diet might have been designed to help her kid. Sioux might be thinking that she has an important story to tell.

But revealing the names and images served only mom’s interest – and was done for publicity and financial gain. Apparently, Weiss scored a book contract with Random House following her article. Sioux got to plug her “No Craptastic Ingredients” cosmetic line in the Times article as the solution to early puberty.

Every parent will make mistakes. I believe that kids are pretty resilient, and usually turn out fine despite the fact that perfect parents don’t exist. Our kids might be angry with us over what they see as our wrongdoing, but will forgive us – because most kids realize their parents do the best they can, and mean well.

I really can’t see exposing your kids’ private life for financial or any other gain as an act done in the kids’ best interest.

Dr. Ayala