So, by now, everybody knows that, at the 11th hour, a New York State Supreme Court Judge overturned Mayor Bloomberg’s plan to ban the sale of large sugary drinks in New York City restaurants. Constitutionality aside, I think the judge didn’t want to wait in the long line at Dunkin’ Donuts. There will be appeals and the lawyers will get rich because the American Beverage Association spends millions and billions to fight soda taxes and laws like Bloomberg’s across the land every year. People don’t understand that we all pay for obesity in higher taxes to support Medicare, Medicare, disability benefits, etc. And “personal responsibility” is no match against foods that are engineered and marketed to make us overeat. Stephen Colbert explains it better than I. Watch.
I love reading about gut bacteria. I really do. We have ten times more bacteria living in us than we have human cells, yet we had been unaware. (What else don’t we know?) This month, I wrote about the research exploring the relationship between gut bacteria and obesity for Diets In Review for Vidazorb in Altering Gut Bacteria to Manipulate Weight Could be the Next Big Thing in Obesity Management.
I’ll always remember my first time.
The first time I read about gut bacteria and obesity was in 2006. It was August at Wildwood on the Jersey Shore and I had time to leisurely read a New York Times Magazine article about the microbial theory of obesity. Fat Factors by Robin Marantz Henigmind will blow your mind. It was so far ahead of its time that it is still au courant.
This is a good time to bring up “Health At Every Size“, a movement to accept and respect the natural diversity of body sizes and shapes. HAES acknowledges that “good health can best be realized independently from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors.”
Every case of obesity is not so easily explained. In clinical practice, I’ve seen people who couldn’t lose weight despite their best intentions. (Believe me, I’m not easily duped by patients.) Individuals vary in the way they store and burn body fat and in how they adapt metabolically to weight change. The studies of microbes and obesity show how little we know. Meanwhile, everyone, regardless of size, should focus on health and not only on weight.
A penny for your thoughts….
There are some things we would rather forget and I’ll bet Coke would like to forget this.This picture was taken from a poster at the New World of Coca-Cola Museum in Atlanta. Judging by the outfit and decor, it is nearly 60 years old. It was included in a recent presentation by the New York City Department of Health in support of Mayor Bloomberg’s “Maximum Size for Sugary Drinks: Proposed Amendment of Article 81.”
Mike Bloomberg wants to ban the sale at restaurants, food carts, movie theaters, and concession stands at sports arenas of any cup or bottle of sweetened drink larger than 16 ounces. Bloomberg says the proposed ban is a way to fight obesity in New York City, but opponents say that soda is unfairly singled-out as the cause of a multidimensional problem. In fact, the premise that soda causes obesity is unproven. The most that can be said comes from the CDC: “Sugar drinks have been linked to poor diet quality, weight gain, obesity, and, in adults, type 2 diabetes. U.S. dietary guidelines issued in 2010 recommend limiting the consumption of foods and beverages with added sugars.” Save them for a special occasion.
Many people dislike Mayor Bloomberg’s healthier-than-thou arrogance, but I like his attention-getting style. But whether you are for or against the mayor’s proposal, the poster shows that even Coke agreed a “big” 16-ounce soda is enough for three people. His proposal is simply a handy reminder that today’s food portions are out of control. Presently in NYC, you can’t even buy a soda that is smaller than 16 ounces — not even on the kid’s menu; 16 ounces is usually the “small” size, while 32 to 64 ounces is the “large.” Studies show that when people are given larger portions, they simply eat more without realizing it. It is especially true when it comes to beverages. This quote from Michelle Obama’s address to the National Restaurant Association Meeting in 2012 is a good one. She said, “…no matter what you do, it’s important, truly important, to keep portion sizes in check, because we all know that the size of a meal is just as important as the ingredients it’s made of.” And so, next time you see a 16-ounce soda, remember that it “serves 3 over ice – nice!” Coca-Cola said so in writing. Ouch.
Your thoughts: Where do you stand on the 16-ounce sweetened drink limit?
Now that summer is here and the clothes have come off, I like to use my favorite nutrition assessment tool. It is the Stunkard Scale, a series of images of progressively heavier body types labeled 1 through 9, with 9 being the heaviest. It is mainly used in research to measure body image perception. Subjects are usually asked to choose the silhouette that most closely resembles how they look and how they would want to look.
Silhouette 4 corresponds to Body Mass Index (BMI) 23, the upper half of the healthy weight range. Women are most satisfied with Silhouette 3, whereas men prefer to be heavier. Silhouette 1 is too skinny to be healthy, and for some, Silhouette 2 is as well. Silhouette 5 rests on the border of the healthy to overweight range. Silhouettes 6 – 9 are too heavy and, as such, increase the risk for disease.
A Matter of Perception
People who live in societies that put a premium on thinness often see themselves as fat when they are thin. For instance, my beautiful, healthy daughter saw herself as a bit heavy while living as a nanny in the skinny minny Hamptons. On the other hand, according to a study from Quebec, children with heavy parents and peers are more likely to underestimate their weight than those with healthy-weight parents and friends. Underestimation of body size is more common among African-Americans, Hispanics, and heavy people who are active, although research shows that people with education and higher incomes are not more likely to perceive their weight more accurately than less educated people who make less money. People who lose weight commonly continue to see themselves as larger. Presently, I am Silhouette 3 or 4; however, I felt scrawny while visiting one of America’s fatter states.
This woman is using a stationary bicycle to power a generator to run electrical devices. The generator might be on the other side of the blue tarp. The picture was taken at Zucotti Park, the Occupy Wall Street camp in New York City last fall. When you think about it, why aren’t we using human power to generate electricity and turn mechanical cranks more often? Pedal power offers so many solutions: fuel, exercise, disaster-preparedness, and “the obesity crisis”. Pedal power could be mandatory to run laptops and TVs. (Calories burned: Stationary Bicycle: 333/hour; Sitting Quietly: 47/hour) There is really no reason NOT to have a pedal power generator. Even in my small apartment, I could keep the apparatus in the basement. To bring pedal power into your life, read this article: Pedal powered farms and factories: the forgotten future of the stationary bicycle
Your thoughts: Do you know anyone who generates energy by pedal power?
Thousands of sailors wearing their summer dress whites hit the streets of New York City today, the start of Fleet Week. You’d think I’d be over the uniform by now, having worked as a cocktail waitress in the enlisted man’s club back in the day when the Navy was in Newport, Rhode Island. But, no, I’m still captivated by that costume, unchanged since the late 1800s. It is a uniform is build on tradition: bell bottom trousers are easy to roll for deck work, the neckerchief functions as a sweat band, the jumper’s collar keeps tar spots off the shirt, and the indestructible “Dixie Cup” hat is comfortable and easy to make and clean.
The Future of the Fleet
Here’s hoping our shores stay safe because we don’t have the men to defend them. Of all military applicants, 25 percent are declared unfit to serve and rejected because they are overweight or obese. CDC data shows, in 1960, the average American man was 5’8” tall and weighed 166 pounds; by 2004, he was 5’9” tall and weighed-in at 191. The military only accepts candidates who fall into a specific height and weight range. A fighting man’s height is between 5’0” to 6’6” and the Navy’s maximum allowable weight is around BMI 25.5, which translates to 174 pounds at 5’9.” If an applicant exceeds the weight on the chart, then his body fat is measured and the goal is 23 percent or less, a realistic number. I’m not worried because those young guys can get fit fast when they try, and in a Star Wars defense system, unfit sailors can sit at computers. But what about those cute sailor suits? They won’t look nearly so fine.
Your thoughts: Is weight threatening national defense? How ’bout that sailor suit?
Have you heard about the documentary, Weight of the Nation™, on HBO in four parts starting on May 14th? The show is so important that HBO is airing it for free! It coincides with a conference in Washington this week also called, Weight of the Nation, hosted by the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. (What a mouthful!) The conference showcased the Institute of Medicine’s (IOM) new report, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.
The IOM evaluated prior obesity prevention strategies and identified recommendations to accelerate progress. They say:
- Integrate physical activity every day in every way (e.g. make more green space)
- Make healthy foods and beverages available everywhere (e.g. health vending machines)
- Market what matters for a healthy life (e.g. industry-wide guidelines on food and drinks marketed to kids)
- Activate employers and health care professionals (e.g. more worksite wellness programs – yawn)
- Strengthen schools as the heart of health (e.g. 60 minutes of physical activity in schools every day! That’s after you lay-off the teachers and teach to the test.)
Do you remember last November when the IOM recommended ways to made school lunch healthier? Congress sold out to Big Food in the “pizza as a vegetable” fiasco. I wrote about it for Diets In Review, Congress Denies All Changes to School Lunch Throwing Children’s Health Under the Bus.
Sorry, but I’ve been following this issue going on 40 years, and don’t think this will make a difference. I see the ultimate solution (to all things) as coming from the people. Kids who were practically born fat and sick will find their indignation and provide the critical mass needed to turn the tide toward all things healthy. Alternately, a good famine could save the day. In the end, only the obese will survive!
Read all of the IOM’s recommendations here.
Your thoughts: What will it take to fix the obesity crisis?
On LinkedIn, I am a member of the Intuitive Eating Professionals Group, where Evelyn Tribole, MS, RD, group founder, asks us to “share something…that is not included in your profile, perhaps an “aha” moment in your career.” I am inspired to share my “aha” moment after attending the BEDA (Binge Eating Disorder Association) national conference on Saturday, where I learned that, treatment-wise, not much has changed over the years.
In 1985, I worked in a large gastroenterology practice affiliated with a teaching hospital. I saw lots of eating disordered patients because one of the docs did medical evaluations of patients with bulimia and AN. At the same time, another gastroenterologist performed a procedure with a device called the Garren-Edwards Gastric Bubble. A deflated ‘bubble’ made of stretchable plastic (like a pool toy) was placed by endoscopy in the stomach of a severely overweight patient. With the pull of a cannula, the bubble was inflated and left in place to fill the stomach while the patient followed a low-calorie diet. That’s where I came in. The bubble was developed by a team at Johns Hopkins. It was all above the board. The hospital asked us to do the procedure, but we stopped after a patient got a small bowel obstruction from the bubble. Those were interesting days. My patients’ eating patterns were all over the map.
But my “aha’ moment came by way of a patient referred by an internist for a simple weight loss diet. She was a favorite patient, a young woman of my age, overweight but far from obese, with my mother’s maiden name. We were doing the balanced, flexible diet thing with a focus on behaviors when one day, she looked at me and said, “Mary, you don’t understand. I peek behind the curtain, and when my husband drives away, I make a batch of scalloped potatoes, and I eat the whole thing.” Aha! I thought, “they didn’t teach us this in school.” And then I thought, “this is really real.”
I was lucky because psychologists who specialized in EDs would stop into the office. They turned me on to Susie Orbach, Fat Is a Feminist Issue (1978); Geneen Roth, Feeding the Hungry Heart (1982) and Breaking Free from Compulsive Eating (1986) and, of course, Hilde Bruch. Evelyn’s book, Intuitive Eating (1995), wasn’t published yet and there was no Gurze catalogue. But, I read and read and saw lots of patients, and attended Geneen’s workshops, consulted with therapists, and taught others how to do it. And now it’s wonderful to see so many dietitians espouse the non-diet approach. But, after all those years, the pills, shakes, meals, stomach stapling (but not swallowing pool toys) are all still here.
Your thoughts: Why don’t more people give up dieting and follow a non-diet approach?
There are people who “Tweet what they eat.” I follow one, and I saw an entry on his/her Twitter stream that bothered me. To me it said that, despite losing 90 pounds, I’m at risk for weight regain because I do not think like an Intuitive Eater. The Tweet (not the actual words) was “three donuts with a mea culpa.” My tip off was the apology. An Intuitive Eater has no reason to apologize.
How to Approach Donuts from an Intuitive Eating Mindset
The Tweeter sees donuts, and asks “Am I hungry?”
If YES: “Do I want donuts now?”
-> YES: Eat donuts, enjoy, stop when satisfied, skip ‘my bad’
-> NO: Eat different food, enjoy, stop when satisfied, skip ‘my bad’
If NO: “Do I want donuts now?”
-> NO: Walk away; enjoy, skip ‘my bad’
-> YES: Ask, “What am I feeling?” Walk away, soul-search, process feelings.
Ask again, “Do I want donuts now?”
-> NO: Walk away; enjoy, skip ‘my bad’
-> YES: Eat donuts, enjoy, stop when satisfied; skip ‘my bad’
There are lots of tricky questions: Am I hungry? Am I satisfied? What do I feel? Why do I feel bad? What do I want? Also worth noting is that (1) formerly starved people – through natural circumstances or intentional dieting – tend to hoard food, (2) really hungry people usually prefer wholesome food, and (3) emotionally healthy people – who have the knowledge and have not dieted – tend to value nutritious food and learn to prefer it.
Your thoughts: Does this make sense?