Healthy Food & Healthy Living by Dr. Ayala

Distracted eating doesn’t necessarily mean you'll eat more

Multitasking, it’s what we do to get more done.

Eating is one of those things that are so instinctive and that we’re so proficient at, that doing it while doing something else is very easy. And it’s not just a time saving ploy: I derive great pleasure from reading a novel while munching on an apple (ok, I’ll admit it, chocolate is what I really want), and we all know how movies are better with popcorn.

Since eating while doing something else is totally acceptable, we’re now doing it while driving, working and walking down the street. A larger portion of our day is spent eating and snacking. A study found that Americans spend, on average, 25 extra minutes daily eating than we did 30 years ago; most of that eating is done, however, while concentrating on something else. The time spent eating as a primary activity has declined, as did the time spent preparing food.

Does distracted eating play a part in our pattern of overconsumption and in the spread of obesity?

A new study in the Journal of Nutrition tests how 119 healthy, non-dieting student volunteers eat when they’re distracted. In the distracted setting students were taken to private booths in food sensory lab, and were given a computer based 10 minute cognitive task – they were asked to identify and series of consecutive odd or even numbers. A plate of 10 small spinach and cheese quiches was served during the task, the students were told to eat as much as they wanted, and the leftovers were measured after the task was completed. The control condition was much the same, except without the cognitive task. Volunteers acted as their own controls, experiencing the alternative condition a week later.

After the task, all participants were rested for 30 minutes, and then taken again to private booths, where mini chocolate chip cookies and grapes were waiting for them, and they were instructed to help themselves, while they waited for the exit survey.

In the exit survey the participants were asked to assess how much quiche they ate, and were also asked about feelings of hunger, fullness and enjoyment of the food they received.

And the results:

To the surprise of the researchers the distracted volunteers ate significantly less quiche than when they were not distracted, and in the subsequent snacking there were no significant differences in grape or cookie choices and consumption among the groups.

As the researchers hypothesized, in the distracted state the volunteers’ memory of what and how much they ate was diminished.

Distracted or mindless?

This study’s findings are contrary to what was expected. A review of 24 studies of distracted eating in the American Journal of Clinical Nutrition concluded that eating while distracted produced a moderate increase in immediate intake, and an even greater increase in what people ate later (as they hardly remembered the food eaten while distracted.

The authors point out an important point: “distracted” and “mindless” are used interchangeably. They are not the same, though.

In both distracted and mindless eating people are eating while doing something else, and the food is secondary. In distracted eating people consciously decide to eat – they bring a sandwich for lunch and eat it while corresponding on their computer. In mindless eating people never made a conscious choice to eat; they eat the food that’s there, already in their vicinity, as in snacks laid out next to the TV, or on the table in a conference room.

Keeping the “distracted” and the “mindless” apart might help clarify how each affects out choices, intake and satisfaction from food. 

And while both are not optimal, it makes sense that mindless eating can be a more powerful trigger for overeating.

Mindful eating

There’s much to be said for eating mindfully, for celebrating food and for giving it your full attention. Food is a pleasure you can indulge in daily. Taking the time to truly enjoy it, to savor the taste and beauty of good food also makes overeating less likely.

Nevertheless, desktop dining is a habit that’s already deeply ingrained in many of us.

If you can’t eat mindfully at all times – and I certainly can’t – I suggest setting some ground rules:

• Protect family dinners with everything you’ve got. Aim for a daily unrushed meal with the people in your life, with no electronic distractions at the table.
• Limit eating-while-distracted foods to low caloric density, highly nutritious ones, such as fruits and vegetables.
• Munching while watching TV is the worst of mindless eating. This is one habit that you don’t want to have, and don’t want your kids to adopt. If the pattern is already set, you may need to break it with eliminating the trigger – TV watching ­– for a bit. Or at least try to switch the snack to something healthy and less calorically dense: swap chips with carrots and fruit, soda with herbal tea.

Dr. Ayala

The Biggest Loser’s biggest disappointment

What happens after the happily-ever-after of a show’s finale? Researchers followed 14 of the original 16 The Biggest Loser Season 8 contestants for 6 years to find out, and their findings made quite a splash.

It was disappointing but hardly surprising to find that after 6 years most of these very successful dieters regained a significant amount of what they lost, and 5 of the 14 in the study were right were they started, or even above their initial pre-show weight. Nevertheless, about 60 percent of Biggest Loser contestants in the study maintained at least 10 percent of their weight loss. As dismal as this sounds, these results, published in the journal Obesity, are better than the incorrect belief that no one -- ever --achieves permanent weight loss, and better than results usually seen in other diet programs: It’s estimated that 20 percent of dieters maintain 10 percent of the weight loss a year after the diet ended.

What was unforeseen was that even after 6 years, even after the participants regained weight, their metabolic rate was significantly lower than expected – hundreds of calories lower than the caloric expenditure of people of the same size and activity level. It’s well known that the body adapts to weight loss in a way that makes weight gain really easy – the body becomes very efficient with energy, and starts doing more with less, practically needing fewer calories for its usual maintenance. That even 6 years and after losing weight, and even after weight regain this metabolic adaptation was still in action was a new, quite shocking finding.

And the metabolic rate issue is, of course, only one aspect of the fight to keep weight off after weight-loss diet. There are also psychological, hormonal and social factors that might be even more important determinants of weight regain.

The reality of weight loss and weight stigma 

Overweight people face bias and discrimination every day – despite being the majority in the US and many other countries. The gigantic, ever-present weight loss industry makes it seem that weight loss is totally controllable and that it’s within each individual’s power to change. The Biggest Loser shows that with enough willpower and hard work one can reach weight loss extreme makeovers.

This kind of portrayal is not only unrealistic; it might also fuel greater negative attitudes and bias toward obese people.

Another study in Obesity examined how a 40-minute episode of The Biggest Loser affected viewers' anti-fat attitudes. Undergraduate students were randomly assigned to watch an episode of The Biggest Loser or a nature film, while being told that the purpose of the study is to test the effect of media consumption on processing speed. Watching The Biggest Loser did not improve attitudes towards obese people. It made them worse. The participants who watched The Biggest Loser reported greater dislike of obese people and greater belief that weight is controllable.

Despite the attention this recent study got, I doubt any network is proposing a reality show about the trials and tribulation of keeping lost weight off – it just doesn’t make for good TV.

And neither, I’m afraid, does the message of prevention.

Curing grave illness, last-minute rescues and extreme weight loss inspire the imagination. Preventing disease, avoiding risk and evading weight gain have no compelling visuals to attract our short attention spans.

Yet when one looks at what weight loss really looks like it is clear that the best strategy, as a society, is to avoid weight gain. We, as a society, have not changed genetically in the last 30 years. Our food has. Unless we move towards a culture that makes eating sensibly easier, many of us who want a healthy weight will have to continue to struggle with losing weight and then – forever -- with keeping it off.

It’s becoming clear that the keeping-lost-weight-off part is at least just as hard as shedding those pounds.

Dr. Ayala

The food ads that teens make

Millennials are both credited and accused of being obsessed with food. The younger generation is recognized as a driver of healthy eating trends, as the generation that photographs its food until it’s cold, that spends its discretionary money on eating out, and one that admires celebrity chefs.

Social media is where this preoccupation manifests most vividly.

A new study led by Christopher Holmberg in the journal Appetite set out to see what kinds of foods teens share with their friends. The Swedish research team picked Instagram because of its popularity.

A sample of more than 1000 Instagram accounts belonging to teens aged 14 year-old was analyzed.

High calorie low nutrient foods dominate

Food photos were found in about 85 percent of teen accounts, and food was the central feature in 96 percent of these uploaded images (it was placed in the center of the photo, and featured in the description).

The most common foods were cookies and pastry (20 percent of images), soda and lemonade came second (18 percent), followed by chocolate (16 percent), ice cream (11 percent), and candy (11 percent). Fruits occupied 9 percent of images, as did veggies. Overall, two thirds of food photos were of food the researchers categorize as high calorie low nutrient food.

Almost 40 percent of food images prominently displayed a brand name – much like an ad. Food brands that received lots of images were sodas, with Coca Cola in the lead, followed by Ben and Jerry’s and Starbucks.

Teens promote sugary drinks to their friends

The authors note that many of the photos that contained brands mimicked the existing ads the brands themselves produce.

It might be that teens agree with the brands, or, perhaps more likely, that they’re not aware that they’re participating in what becomes an ad. As mentioned above, several brands received a lot of uploads, and this was not by chance, the researchers found out: Many of these uploads were in response to campaigns such as Coca-Cola’s “Share a Coke”; Starbucks and Ben and Jerry’s had similar hashtag related campaigns.

The authors suggest that food photos are part of the teen's identity profile on Instagram. Association with food brands plays this role, but then, so does sharing a photo depicting healthy foods such as freshly picked berries

According to a recent report from the University of Connecticut Rudd Center for Food Policy kids are seeing more unhealthy snack ads than ever before as food brands increased their ad spend on TV and on social media. The report says that companies are moving to newer forms of digital marketing: “As social media sites enlist teens to market unhealthy products virally to their friends this form of marketing raises additional concerns among health experts.”

Social media spreads ideas, behaviors and habits. Brands are already paying attention and capitalizing on the word-of-mouth or, more accurately, the selfies, emojis and hashtags by teens as brand ambassadors.

Not all food is equally photogenic, but fruits, veggies, and many other plant-based ingredients and preparations of healthy foods certainly are – and they need all the free advertising they can get.

Dr. Ayala

Downton Abbey finale has a lesson in nutrition

I’m going to miss Downton Abbey. Escaping into the lives of the Crawleys was a wonderful Sunday night treat – that always left me grateful to be living in our era, especially as a woman.

For those of us nostalgic for old times, and especially those who claim nutrition science is useless, there was a small lesson to be learnt from the drama-packed finale.

(If you haven’t been following the series it really doesn’t matter; read on. Spoiler alert for those who haven't watched the chapter yet, although I'm not giving away much.)

Lord Merton, Isobel’s onetime fiancé discloses that he has a terrible diagnosis. He was feeling weak, and visited the best doctors in London, who ran all the tests and diagnosed anemia. Isobel’s worried face lightens up hearing this, but Lord Merton quickly brings her hopes down. At this point I thought he was going to say he has leukemia, but what he has is pernicious anemia – and Isobel realizes his end is near.

Pernicious means dangerous, destructive, deadly.

So what’s Lord Merton malignant condition? Are Isobel’s gloomy tears justified?

Pernicious anemia was described by English researchers in the mid nineteenth century. Patients had anemia with all its symptoms (fatigue, pallor, rapid heart beat), and also mental slowness, memory loss, numbness and tingling of hands and feet, walking difficulties and mild dementia. In the lab, a blood smear would show megaloblasts: abnormally large immature blood cells. It was an invariably fatal, rapidly progressive disease.

Nowadays, pernicious anemia’s death sentence is overturned within 1-2 days – with one injection.

What causes this mystery fatal illness?

Pernicious anemia is B12 deficiency. This vitamin was finally discovered and isolated in 1948 – many decades after the disease was first described and 23 years after the time described in this Downton Abbey chapter. B12 deficiency is usually a result of inability to absorb the vitamin, but can also develop in cases where intake of the vitamin is very low – such as in vegans who don’t take B12 supplements and their exclusively breast-fed infants. Only animal-origin foods have B12: dairy, eggs fish and meat and shellfish are all good sources.

There might be pieces of the past we wish we could have held on to, but with all the criticism we rightfully have of modern medicine let’s be thankful for all the suffering it has helped us avoid. It’s because we now know so much more about nutrition that the classic nutritional diseases (such as scurvy, beriberi, pellagra and rickets) are rare and easily treated.

People often say nutrition science is confused, that advice changes every other week. Well, nutrition science is a young science, and like all science it is moving towards the discovery of truth – sometimes taking an unfortunate detour on a path that leads nowhere before correcting course. The main problem is the abuse and hype nutrition science suffers by the hands of weight-loss and food marketers. Diet and exercise programs sometimes latch onto flimsy evidence, twisting and exaggerating findings, and creating an enormous amount of hype – to their gain and the general public’s confusion.

Science is complex and slow moving. Nutrition science it especially difficult, because it deals with people eating – at their own will – diverse foods throughout a lifetime. We are moving towards answers and consensus at a much faster rate than we did in Downton’s time, and with some patience and perspective – and less distractions – we will know much more.

I’m going to miss Downton Abbey, and its reminders of how far we’ve come.

Dr. Ayala

Where not to get your nutrition advice

The new year is a chance for new beginnings, an opportunity to eat better, to take better care of ourselves; many look to popular media for ideas on how to best achieve these goals.

Dr. Oz dispenses such advice regularly on his TV show and many health related resolutions start with “I heard it on Dr. Oz”, but how sound are his recommendations?

A new study in the BMJ randomly selected 40 episodes of the Dr. Oz Show and The Doctors – the most popular medical talk shows on TV -- and looked at the quality of their recommendations.

If this sample is representative, Dr. Oz is the program for those asking what they should eat. Dietary advice was 4 times more common on Dr. Oz compared to The Doctors and of the 479 recommendations (about 12 per show) 40 percent were nutritional in nature. 

Now came the arduous task of checking out the recommendations. The researchers looked to see if there was evidence to back the advice, if the advice was believable, and if the recommendation was given in a way in which it could be properly weighed:  were both benefits, including their magnitude, and the treatment’s risk and costs mentioned.

The programs, rich in entertainment value and in dietary suggestions, fell short on proof and precision, the researchers found. Of the many recommendations, only a third were based on some believable evidence. On the other hand there was proof that the treatment didn’t work for about 1 in 10 recommendations. For a third of Oz’s recommendations no evidence at all could be found in the medical and scientific literature. As far as the advice goes, it was generally non-specific, the extent of the benefit (does vitamin E help brainpower a lot or a little?), the potential harm and the costs where rarely mentioned. 

Last summer, Senator Claire McCaskill grilled Dr. Oz on Capitol Hill regarding false and misleading weight loss miracles endorsed on his program. In a written testimony to the US Senate Committee Dr. Oz explains:

“To make the Dr. Oz Show succeed in its mission, we have to overcome certain obstacles I learned in years of conversations with patients. We have to simplify complicated information. We have to make the material seem interesting and focus on the “wow” factor.”

And indeed, if you’re looking for “wow”, over-the-top enthusiasm, for inspiration and endless hope, TV shows such as those studied will supply you with plenty.

If you’re looking for practical, tested, realistic nutrition advice, look elsewhere, and unfortunately, that kind doesn't usually "wow". 

Dr. Ayala

Two small changes that can improve your health

I'll be taking a few weeks off to travel with my family, and will write infrequently during this time. This is a favorite repost -- in case you missed it. Have a good, safe summer!

Habits tend to cluster.  People who exercise will often also watch their weight, consider the nutrition label, avoid smoking and get enough sleep. On the other end, unhealthy behaviors bunch together, too, and many of us have a long list of practices their doctor would like them to change in order to lower their risk of disease.

But who wants a long shopping list of to-dos and not-to-dos? 

The ideal plan would involve one or two guidelines that could drag with them other positive behavior changes.

Oh, and what if we could also achieve that remotely, with something as simple as a phone app? Wouldn’t that be useful?

Eat your veggies and turn the TV off

A  study, published in the Archives of Internal Medicine studied about 200 people who skimped on fruits and veggies, ate plenty of saturated fats, didn’t exercise much and had a sedentary lifestyle, (sounds like someone you know?) trying out a mobile technology aimed at behavioral change.

The participants each got one dietary behavior to change – either eat more fruits and veggies or lower your saturated fats intake -- and one activity behavior goal – either decrease sedentary leisure (less TV) or increase exercise. That made 4 treatment groups.

The participants got a personal digital assistant, and were asked to report on their diet and activity. The treatment phase lasted 3 weeks, with 20 weeks of follow-up during which the researchers tracked how much of the behavior change persisted.

This was a compliant group – perhaps because participants were rewarded $175 for achieving the 3-week target. All but 1 participant were able to adhere to both the dietary and activity goals within 3 weeks. 

But here’s the interesting part: the group that was instructed to eat the 5-a-day fruits and veggies and reduce screen time achieved not just these goals, but also, without being told, decreased saturated fat intake. 

And those benefits persisted to some degree after the treatment phase was completed, and the participants were no longer paid for adherence or even asked to keep up the positive change. In the 5 months of follow-up this group was still eating more than double the fruits and veggies compared to what they ate before the experiment started, watching an hour and a half less TV, and eating significantly less saturated fat. 

On the other hand, the group that got the more traditional diet regimen of eat less fat and exercise more achieved less healthy change: The participants didn’t eat more fruits and veggies, and lounging in front of the screen was unaltered. 

Healthy chain reaction

As Charles Duhigg discusses in The Power of Habit some habits are keystone ones. Changing one thing, such as starting to exercise, may have a beneficial domino effect, improving diet, stress and productivity unintentionally.

This study suggests that reducing screen time not only offers the advantage of reducing inactive time, but also automatically reduces high-fat intake. There are plenty of studies showing that more TV is linked with higher energy intake and high-fat snacking. I can’t think one good outcome arising from hours in front of the TV.

Mind you, the eat-your-veggies-&-limit-TV advice didn’t get people in this study exercising. Exercise needs its own nudge.

The 5, 2, 1, 0 advice for healthy active families from the American Academy of Pediatrics captures all the important recommendations very simply:

• 5 fruits and vegetables a day,
• 2 hours or less of screen time (TV, computer, video games) per day,
• 1 hour of physical activity a day, and
• 0 limit sugar-sweetened drinks.

These are small changes that can bring about bigger ones!

Dr. Ayala

 

Can adding sleep subtract pounds?

Many studies have shown that kids and adults who sleep less are more likely to be overweight or obese. This correlation doesn’t prove that sleeplessness causes obesity: Obesity can lead to sleep problems, and lack of sleep might be associated with socioeconomic factors, less organized homes and other factors that affect weight gain.

But a new experimental sleep study, reported in Pediatrics, actually looked at what adding and subtracting sleep did to weight and caloric intake in kids, and its findings suggest that just changing sleep duration may impact kids’ waistlines.

The less you sleep, the more you eat

The researchers asked 37 kids, aged 8-11 years, 27 percent of them overweight or obese, to sleep as usual for the first week of the study. During the second and third weeks the kids alternated between sleeping 1½ hour more and 1½ hour less per night for an entire week. Sleep duration was verified by an actigraph – a device that is placed on the wrist and monitors activity level. On average, the actual sleep difference between the week with increased and decreased sleep was about 2½ hours.

So what can 2½ hours do?  During the week the kids slept more they reported eating 134 fewer calories per day compared to their intake during the reduced sleep condition, and their measured weight was about half a pound less.

While you may frown upon the 134-calorie decrease, if such a reduction is maintained over a long period of time – something further studies that last longer than 3 weeks will need to prove – this would be enormous. Weight is usually gained slowly, by eating just a little more than necessary over long periods of time. The energy gap is the daily discrepancy between energy intake and energy expenditure, and for American kids, the average energy gap estimate is just 64 calories a day. Eliminating calories in just the double digits daily could prevent further weight gain and doing that in your sleep could be sweet!

The exact mechanism in which sleep affects weight is unclear. After a good night’s sleep we might be more active and burn more calories, we might have reduced appetites, and craving for high-calorie foods might be curbed.

Getting a good night’s sleep

Getting enough sleep helps kids grow, concentrate in school, feel good, and – as this study further confirms -- keep a healthy weight.

And while getting enough sleep isn’t always easy, one of the factors that affect sleep is in our hands. TV before bed has been shown time and time again to result in kids sleeping later, and having a screen in the bedroom not only reduces sleep – it is correlates independently with overweight. 

Dr. Ayala

Cities Fighting Soda

Several city health departments are stepping up their anti-soda efforts in an attempt to curtail obesity and diabetes. Philly is now airing its own TV spot, which my kids had noticed and brought to my attention over the dinner table.

There's quite a wide range in the messaging tactics each city takes.  NYC's campaign certainly caused a stir, especially the "Are You Pouring On The Pounds" video, which was deemed too disgusting by some. Take a look at these different approaces.  Which works best in your opinion?

Philly:

 

New York: 

 

 

Boston:

 

See LA's media campaign here and Santa Clara's here.

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.

Does The Biggest Loser Fuel Weight Stigma?

Overweight people are the majority in the US; a third of Americans are obese, so obese people can hardly be viewed as a small minority.

Nevertheless, overweight people face bias and discrimination every day.

Does the portrayal of obese people in the media reinforce weight bias?  Is the swelling roster of popular weight-loss reality TV shows supporting anti-fat attitudes? Or do these shows actually introduce viewers to the trials and tribulations of obese people, thus promoting sympathy and reducing prejudice? 

NBC’s The Biggest Loser is now in its 13th season and is a huge hit, with millions of viewers weekly, an online weight loss program, a line of diet and nutritional supplements, and two weight loss resorts.

The Biggest Loser clearly promotes weight loss, but some suggest that the show presents the unrealistic view that enormous weight loss can be achieved by willpower and very hard work – suggesting obesity is totally controllable. 

A new study in the journal Obesity examined how a 40-minute episode of The Biggest Loser affected viewers' anti-fat attitudes.

About 60 undergraduate students participated in the study, in which they were randomly assigned to watch an episode of The Biggest Loser or a nature film, while being told that the purpose of the study is to test the effect of media consumption on processing speed.  The participants’ attitude was gauged before and after the reality TV show by several established tests, developed to check for anti-fat sentiment, stereotypical attribution traits and bias.

Increased negative attitude

Watching The Biggest Loser (sans ads) did not improve attitudes towards obese people.  It made them worse.

The participants who watched The Biggest Loser reported greater dislike of obese people and greater belief that weight is controllable.

Since The Biggest Loser’s contestants show enormous commitment, hard work and perseverance, the researchers expected to see a change in anti-obese attitudes, and a shift in the positive traits attributed to obese people.  This did not happen. 

Does controllability translate to blame?

We tend to have greater compassion for conditions that are beyond human control, and spare less sympathy for what we believe are troubles that are entirely under the individual’s power to change. If the take home message from The Biggest Loser is that weight loss is entirely a matter of hard work and overcoming obstacles, we can see how internalizing that idea would increase weight bias.  This study’s incendiary findings should be taken with a grain of salt though, due to the small study group composed of all young students – its authors advise as much. 

The reality of weight loss doesn’t make for compelling reality TV, I’m afraid.  Tara Parker-Pope’s recent article “The Fat Trap” tells the stories and the science behind why losing weight -- and especially keeping it off -- are beyond what most people are able to do. Although Parker-Pope’s article was widely spread I wonder how many TV viewers would tune in weekly for that kind of pessimistic analysis.

It’s complicated, but although we ultimately decide what and how much we put into our mouths obesity and overweight aren’t completely under most people’s control. Most people don’t want to be fat and are indeed spending lots of energy, time and money to get thinner. The fact that we have an obesity epidemic that is evident even among preschoolers indicates that gluttony and laziness don’t explain what's going on.

That’s not to say that weight loss is something we should give up on, but clearly, the only true, far-reaching solution to overweight is unsexy prevention – which of course doesn’t tell a compelling story, since averted trouble creates no drama at all.

Dr. Ayala

 

Does electronic media make kids fat?

Why are today’s kids so much heavier than kids of previous generations?

The classic answer is that kids today are taking in more calories and spending less energy: They spend less time playing outdoors and have stopped working on the farm and doing chores – but hey, haven’t they stopped doing that a long time ago?

The energy expenditure side of the equation is the pet project of fast-food and junk-food makers.  Oh, if we could only give kids another hour of gym! If only kids could balance their ravenous appetite for snacks with a little more outdoor play we wouldn’t have to voice the unthinkable “eat less” advice.

But the numbers just don’t add up.  In order to eat like the TV ads suggest kids would have to increase physical activity to what amounts to no time left for homework or sleep.

I’d like to take an honest look at how sedentary activities really affect kids’ waistlines. 

An article in Obesity Reviews looked at the current trends of childhood pastimes, and how those affect not only energy expenditure, but also energy consumption.  Let’s take a look:

TV viewing

Kids watch many hours of TV and high rates of TV viewing are correlated with obesity.  While sitting on a comfy couch is super sedentary, watching TV has many other effects on energy balance. 

20-25 percent of daily calories are consumed in front of the TV.  This distracted eating increases intake of calorie-dense food (i.e. highly processed foods with lots of calories).

A study showed that 36 percent more pizza and 71 percent more mac&cheese were consumed when eaten in front of the TV, compared to meals eaten without the TV on.

For many people TV watching is associated with snacking.  They’ll munch while watching whether hungry or not, and if they ever forget to bring the munchies, an ad – so many of the TV ads are for junk-food -- will no doubt remind them that something is amiss.

Video games

Video and computer games fill many hours in the average kid’s day.   Video games are relatively new, and their effect on obesity has been studied less extensively than that of TV's, but observational studies show a connection, and a recent study showed obesity and overweight doubling for every extra hour spent playing electronic games.

Again we can argue that (non-active) video games are pretty sedentary, but the studies show that playing video games makes kids eat more.  Just like TV, video gaming leads to eating, the reflexive non-hunger kind of eating.

And don’t forget advertisers target video gamers on these platforms, too.

A single session of video game play in healthy male adolescents is associated with an increased food intake, regardless of appetite sensations.

Sleep

Who wants to sleep when there’s so much to do?  The presence of electronic devices such as a computer, TV or smart phone in the bedroom has been shown to delay sleep.

It seems counterintuitive, but shorter sleep duration is associated with increased risk of obesity.  It might be that being awake at night gives opportunity for late-night snacking; it might be that fatigue leads to inactivity the next day; and maybe lack of sleep messes up our hunger and appetite regulation.

We’re sleeping less – studies show that sleep has gone down by more than an hour over the past decades – and since sleep isn’t a waste of time, the barriers to sleep (many of them electronic) are hurting our health.

Media consumption begets food consumption

A recent Kaiser Family Foundation study showed that 8-18 year-olds devote an average of 7½ hours (!) to using entertainment media in a typical day.  Much of that time is spent media multitasking -- using more than one medium at a time. From what we learn from other studies we know that much of our kids’ multitasked media time also involves another added and almost automatic activity: snacking. 

Much more significant than the low energy expenditure toll of media consumption is its pairing with distracted eating.

Victorian ladies weren’t known for their workouts.  But they didn’t snack while embroidering.  Eating used to be prompted by hunger and traditional mealtimes.  Now, it’s prompted by an ad and constant availability of highly processed high-calorie food.

Uncoupling the TV, computer and video from it’s by now natural companion – sugary drinks, snacks and ready to eat meals – is a tall task.

Any ideas on where to start?

Dr. Ayala

 

Are women more susceptible to food ads than men?

Kids are very responsive to the messages in ads, often not even aware of their persuasive intent. We’d like to think that we adults know better, and are somewhat immune to the power of commercials.

But the mere presence of ads -- and knowing how much money is invested in them -- is probably proof enough that these ads do work. Research also supports the notion that seeing certain foods in ads, and seeing eating these foods as a highly rewarding act – which is how it’s invariably presented in ads – increases desire for and consumption of the advertised foods.

A study in this month’s Appetite looked at the direct effect food ads had on snacking. The studied group of 82 young students consisted of an equal number of men and women, all of normal weight, all unaware of the purpose of the study.

The students watched a 30 minute nature movie, seated on a comfortable couch, next to which, on a side table, snacks (chips and peanut M&Ms) were freely available. The movie was interrupted by two commercial breaks, in which half the study group was exposed to three ads for energy dense foods and five non-food ads, and the other half was exposed to eight non-food ads. The amount of snacks consumed during the viewing was measured, and the students completed several questionnaires and had their height and weight measured.

The women in the group snacked more when they were exposed to the food commercials. In fact, the women who watched food ads ate, on average, an extra 65 grams of the snacks (I’d estimate that as an extra 300-350 calories) in the short 30 minute of viewing.

The men didn’t seem to be affected in the same way. The men actually snacked more when shown the non-food ads.

Why would women be more susceptible to food ads?

Is it that women see ads for junk-food as permission to eat – because, hey, that’s what everyone’s doing? Advertisers are genius at presenting the product they’re selling as the social norm.

Or is it that the ad puts women in a good mood? Elated and free from concern, they indulge in some snacking.

Or do women identify with the happy, pretty (usually thin) mom in the ad and want to adopt whatever it is she’s doing?

Or is it that women are more likely to restrict snacking? Getting women to lose their guard by distraction perhaps opens the floodgates to uncontrolled eating.

The authors, led by Doeschka Anschutz, consider these possible explanations. Advertisers usually target women when designing food ads, as women are considered the gatekeepers to the pantry and do most of the food shopping. That might explain why the food ads worked on women. It would be interesting to see if beer ads – directed mostly at men – would affect men’s snacking habits. Indeed, maybe men in this study ate more when viewing the non-food ads because the non-food ads were for a car, a camera and a bank – ads typically targeted mainly at a male audience – and these ads grabbed their attention and therefore increased their snacking.

The TV obesity link

Several studies have shown that concentrating on something else makes over-eating more likely. Therefore blending TV viewing with high calorie snack foods is a recipe for weight gain. The food commercial breaks probably just add to the food craving.

Food commercials work. They work especially well on kids, and this study suggests they work their wonders on women, too. If we want to encourage healthier eating we’d be wise to keep junk-food ads away as much we can.

Do you feel that food ads affect you?

Dr. Ayala

Can video games be a tool for better nutrition and more exercise?

I’m very old fashioned when it comes to video, computer and all other electronic games. OK, I’ll admit it: I don’t even fully understand why playing them is fun, or as my kids say, I just don’t get it. My imaginary migraine-inducing chamber-of-torture is a video arcade – but that’s just my personal inclination, and I’m in the minority. According to the Kaiser Family Foundation’s recent survey kids spend an average 7 hours 38 minutes a day in front of a screen. A typical kid spends 65 minutes a day playing video games, and the majority of kids have a game console in their bedroom. So I guess video games are entertaining.

But spending hours in front of a screen is one of the least desirable uses of a kids’ time, and there’s plenty of evidence to back this assertion. The American Academy of Pediatrics recommends limiting screen time to less than two hours a day, and keeping screens out of the bedroom. That’s because screen time’s usually sedentary, and is linked with obesity and metabolic risk factors. Prolonged screen time is also associated with inferior academic performance.

Hours of inactivity are only one harmful outcome of sitting in front of a screen. Here’s another reason why screen time can make kids fat: Advertisers look for eyeballs wherever they can find them, and screen time, whether it’s TV, video, hand-held or computer, is soaked with ads. Guess who’s willing to pay top dollar to get your kid as a loyal customer for life? Fast-food and junk-food makers top the chart of kid oriented ads in electronic media.

There’s another really sad outcome of electronic games: Kids aren’t playing the way they used to. Kids’ play is the unstructured, messy, imaginative way in which kids create an inner world, interact with the real world, interrelate with friends, negotiate, solve problems, and work as a team. An old bed sheet becomes a toga, which turns into a sultan’s turban, which doubles as a magic carpet that can transport the princess to the castle (the castle’s roof made of the same cloth). A vivid example of child play is depicted in Toy Story 3 (one of the best movies I’ve seen this year). Kids’ play is a healthy way for kids to learn so much of the skills they’ll need, while having serious fun, and often while breaking a sweat.

Video games to the rescue?

Active video games debuted a few years ago, and my kids were excited to inform me that the Wii gets you moving and that “everyone has them” (to which I said: That’s great! you’ll be able to play them at your friends’ house).

Exergames indeed get you moving. Somewhat moving. A recent review in the Archives of Pediatric and Adolescent Medicine looked at these games and concluded that they enable light to moderate physical activity. To put it in other words, the Wii is better than sitting on the couch, but won’t improve aerobic fitness — to improve fitness kids need intense exercise and real sports, the kind that gets them sweating and their heart racing. Perhaps the groups that can benefit most from these exergames are patients undergoing physical rehabilitation and the elderly.

I asked my kids recently if the Wii’s still popular among their friends, and their conclusion was that the Wii gets rather boring after a while — and once a kid has a gaming console he’ll find something more exciting to play.

Here’s another attempt to make gaming healthy. A new study published in this months’ issue of the American Journal of Preventive Medicine examined the effect two epic video games, “Escape from Diab” and “Nanoswarm: Invasion from Inner Space”. These games incorporate behavior change procedures woven into the gripping stories, and were designed to improve diet and increase physical activity and were especially planned to lower risks of type 2 diabetes and obesity.

The 103 Kids playing these video games did increase their fruit and veggies intake when compared to kids playing diet and physical-activity knowledge-based games on popular websites, but only by about half a serving a day. They did not drink more water or engage in more physical activity (as measured by an accelerometer), nor did they improve body composition.

There are hidden messages in any programming. If the hero in a film smokes it may glorify smoking , yet if he eats vegetables it might make veggies cool. That’s what’s so good about Popeye. So by all means, I’m all for trying to get the right subliminal messages in. Every little bit helps.

The good, the bad and the violent

Video games are just a medium. Any medium can be used for good or bad. A better video game is possible — there are educational and active games, just like there are excellent TV programs — but they are the exception that proves the rule.

I hope you’re not feeling too sorry for my kids. They don’t have a gaming console — they’ve stopped asking for it — and we strictly limit screen time. But, could these kids play! They have an amazing capacity to play with each other and with friends, and whether it’s in the sun outside or on a cold day inside, they never fail to come up something wonderful to do.

Dr. Ayala

Marketing to kids: Candy ads decline as fast-food ads gain

Kids watch TV for about three and a half hours a day. They’re exposed to it as background many hours more. Advertizing on TV therefore remains the central vehicle brands use to reach kids. Ads are clever and compelling, and their effect on kids—especially young ones—is very clear. The Institute of Medicine reviewed the scientific literature and concluded that ads influence food consumption and that the current food and beverage marketing practices put children's long-term health at risk.

In 2006, in response to criticism from many health organizations and children advocates, the Council of Better Business Bureaus launched the Children's Food and Beverage Advertising Initiative. There are a little more than a dozen major US food companies that joined the initiative, and these companies pledged to devote at least half of their child-targeted advertising to promote healthier or "better-for-you" products and encourage good nutrition and healthy lifestyles. "Better-for-you" is not clearly defined, and neither is “kids programming”, so it’s interesting to see how much has really changed since these voluntary limits on kids’ advertizing have been initiated.

A new study, led by Lisa Powel, and published in the Archives of Pediatrics and Adolescent Medicine, looked at TV ratings from Nielsen Media Research to assess total yearly exposure to food advertising for the years 2003, 2005, and 2007. Trends of TV exposure to food advertising were analyzed by age and race.

The data comparing food ads in 2003 and 2007 exposes a few interesting trends:

• Ad quantity: In 2003 kids saw, on average, a little more than 13 food ads a day. By 2007, the number of food ads seen daily by very young kids (2-5 year-olds) fell by 13 percent to about 11.5 ads per day, decreased a little bit for kids 6-11 years, and increased a tad for adolescents (it's still above 13 ads a day for these older age groups).

• Food product categories: ads for beverages and sweets (candy bars and cookies) declined the most while exposure to ads for fast food restaurants increased the most. By 2007, fast food ads were the most frequently food ad seen by kids. In fact fast-food ads surpassed cereal ads in the 2-5 year-old programming by almost 2.5 ads-per-day. McDonald's is the most dominant marketer to kids, with Burger King coming in second.

• Racial disparity: African American kids in all age groups saw more food ads per-day than their white counterparts, and got a double dose of fast-foods ads compared to white kids. There were more food ads on African American targeted after-school and prime-time TV programs compared to general public programs, and the racial gap in exposure grew between 2003 and 2007.

Is self regulation working?

The study finds that among the 13 companies who pledged more responsibility in advertizing to kids by 2007 there were a few promising changes—overall ads aimed for young kids declined somewhat. The largest reductions were seen from Hershey, Coca-Cola, and Mars, companies that promised not to engage in child (under 12 year-old) directed advertizing. However, because the interpretation of “better for you” was left to food-makers “better for you” was often far from good enough (for example: sugary cereals may be better than a donut, but both aren’t a healthy breakfast). The pledge also regulates only advertizing to very young kids under the age of 12 years—the most vulnerable age group—while leaving out pre-teens and teens, who are still quite impressionable, but considered by this initiative fair game. Most importantly, membership in this initiative is voluntary, and many food companies that advertize to kids haven’t signed on.

The authors conclude:

“The bar was set so low, with more than 9 of 10 ads seen by children for products high in fat, sugar, or sodium, that the move to “better for- you” advertising is likely to be inadequate. Rather, regulatory calls requiring “good-for-you” advertising for healthy products may lead companies to compete to reformulate products and to make the monetary investments and harness the effective persuasion techniques typically used to market unhealthy foods to children.”

Do you think self-regulation can result in a real change in the food-ad landscape, or is self-regulation just a delaying tactic and a way for industry to set lenient rules in order to get regulators and the public off their back without changing much?

Dr. Ayala

Related post: The TV diet and your health

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

The TV ad diet and your health

What would you eat if your food choices were based on TV ads? A new study in the June issue of the Journal of the American Dietetic Association looking at the nutritional content of foods advertized on prime-time and kids’-time TV suggests you’d be eating a very imbalanced diet, rich in (guess what?) sugar fat and salt.

The authors, led by Michael Mink, PhD, analyzed ads placed in 84 hours of prime-time and 12 hours of Saturday morning (cartoon-time) broadcast in the four major US networks (ABC, CBS, Fox and NBC). Each advertized food item was then analyzed for nutritional content.
Here’s what they found:

• Of 3,584 total ads 614 (or 17 percent) were for foods. There were 3 food ads for every 30 minutes of broadcast

• A 2000 calorie diet consisting entirely of advertized foods would contain 25 times the recommended daily intake of sugar, and 20 times the recommended daily intake of fat

• During the 96 TV hours observed there were 116 public service announcements—none addressed nutritional education

• The hypothetical TV ad diet oversupplies the same nutrients Americans are known to consume too much of: protein (lots of meat), sodium, fat, saturated fat, and cholesterol

Do TV ads influence food choices?

Americans are exposed to TV for almost 7 hours a day, and food and beverage related TV ad spending was $11.26 billion in 2004. To put this sum in perspective: The federal budget for the 5-A-Day program (promoting fruits and veggies) was just $4.85 million and the entire US Department of Agriculture (USDA) nutrition education budget was $268 million for the same year. I’m sure food and beverage makers see proven results for their mass spending—otherwise they wouldn’t be incurring these costs.

Ads do affect our consumption habits, and are especially effective on the very young. Most toddlers can’t tell programming and advertising apart and many toddlers have been known to sing the tunes and repeat the message after being exposed to some ads just once, and to remain loyal to a brand forever.

Suggestions for a healthier advertizing environment

The authors have a few recommendations:

• Consumer education: Let the public know that food advertizing has a bias for foods that provide a whole day’s worth of sugar and fat in a single serving

• Food industry education and collaboration: Let food makers know they’re promoting nutritionally imbalanced foods (Does anyone actually believe they aren’t aware of that?)

• Public media strategies: Air more public service announcements to balance the nutrition message

• Regulation: Require nutritional warnings for imbalanced foods similar to those mandated on direct-to-consumer drug ads

I’d like to add a few suggestions of my own:

• Teach your kids how to apply critical thinking skills to the ads they see: here’s a Federal Trade Commission website with some great tools and fun games that may help

• Turn the TV off: Sorry, I know some say we’re in the midst of a new golden age of TV, and there are some very good programs to watch, but I truly believe that watching much less TV is a health promoting bit of advice, especially if you have kids at home. The 1 to 2 hours of quality programming per day upper limit suggested by the American Academy of Pediatrics seems indulgent enough

On the up side: I watched the French Open men's finals yesterday, and during these not necessarily representative few hours on NBC, food ads were scarce and Rafael Nadal drank water and ate a few bites of banana at critical points in the match (Nadal is well known for his banana habits)—overall a viewing session with a balanced health message.

I assume the researchers are still recovering from the 96-hour TV overload.

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

Three healthy habits to fight childhood obesity

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 at home 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 but self-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