March/April 2006 Volume 10, Issue 1
This issue of Nutrition Spotlight seeks to shed light on the multi-faceted issue of obesity. We share an overview of this pressing public health crisis, and in this issue we bring you summaries of current research addressing obesity in adults and children. Take a moment to meet Dr. Tanda Kidd, K-State Research and Extension's human nutrition specialist working in the area of nutrition, physical activity and obesity prevention. Are you "exercise challenged?" Read our article on "what's a couch potato to DO?"
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Overweight and obesity are epidemic in the United States. Why? The causes of obesity are more complex than simple energy imbalance. Many lifestyle factors affect an individual's ability to tackle weight issues.
TV viewing is at the top of the list. Screen time has the strongest evidence of increasing the risk of obesity of any factor, according to Joanne Ikeda, MA, RD, University of California, Berkeley, Center for Weight and Health. Her solution is to limit screen time to two hours or less per day for both adults and children.
It's plain and simple, calories count. Large increases in the amount of calories over the years adds pounds. Physical activity is most effective for preventing and maintaining weight loss, but it can not compensate for excessive energy intake. If you choose the super-size, double meat burger, know that the amount of energy expenditure must be 141 minutes of walking or 177 minutes of cycling to balance the 564 calories eaten. Limit fast food and restaurant foods, or choose carefully.
Portion size, energy density and dietary fat predict calorie intake. Reducing dietary fat, especially animal fat, is associated with lower calorie intake. Remember, fat has more calories than protein and carbohydrates, and reading the nutrition facts label teaches where to look for calories.
Increasing fruit and vegetable consumption is most effective at preventing excess weight gain when combined with other dietary changes. Increase fiber in the diet which increases satiety and has virtually no calories. Choose whole grains and follow MyPyramid guidelines to eat at least 3 ounces of whole grain bread, cereal, crackers, rice or pasta every day.
Low-fat dairy intake appears to increase effectiveness
of overweight prevention and weight loss programs, but in
recent decades, milk consumption has decreased and carbonated
soft drinks are on the rise. Limit or eliminate sweetened
beverages,
which supply 150 calories from almost 10 teaspoons of sugar,
and little else, in a 12-ounce can. Plan to drink more water and
low-fat milk.
Last but not least, eat breakfast! Breakfast is one factor that may prevent overeating later in the day. (KW)
You might say that she is the newest "Kidd" in the department. Dr. Tandalayo Kidd joined the Human Nutrition faculty in 2005 as a K-State Research and Extension human nutrition specialist in the area of nutrition, physical activity and obesity prevention. Her time is split between extension (60%) and research (40%) responsibilities. Her primary focus is on obesity prevention in children, adolescents and young adults.
"The middle school sector is an underserved population. I hope to develop programs for this age group," she said.
Although her position is new, Kidd is a familiar face to many. For the year prior to her new position, and while completing a Ph.D. in Human Nutrition, Kidd worked half-time as an extension associate in the department. In that role, she got to know many of the county extension faculty throughout Kansas.
Currently Kidd is collaborating on a grant-funded project to develop web-based childhood obesity prevention information targeting community and school leaders, youth leaders and parents.
Working with the successful Walk Kansas project, Kidd has contributed articles to the newsletter series and is exploring data collection options.
Another part of Kidd's attention has focused on the development of model guidelines for nutrition education in primary and secondary schools' health and wellness policy, in cooperation with the Kansas Department of Education. She is also working with local schools and county extension faculty to help them develop district policies and classroom programs that meet the new nutrition education guidelines.
Kidd is involved with regional research to prevent excess weight gain among young adults. The collaborative projects focus on using community-based participatory research methods promoting healthful eating, and Stages of Change Theory-based interventions to increase fruit and vegetable intake. Kidd did related research to complete her M.S. thesis in Dietetics.
Kidd also plans to continue the research project she began with her Ph.D. dissertation. In that study, she conducted focus groups and developed a survey to identify perceived nutrition education needs of the family members of Army junior enlisted soldiers.
"My goals for the future," Kidd said, "ultimately include developing programming that will cross over into health profession sites (such as physician offices, hospitals, etc.) and into schools in order to meld the messages into consistent and cohesive advice."
Kidd is a member of several professional organizations, including two dietetics associations, the National Nurses Association, and the National Organization of Blacks in Dietetics and Nutrition.
Growing up in Chicago with two older brothers, Kidd joined the Army. While stationed in Germany, where she served as a postal finance clerk, she met the soldier who was to be her future husband, Michael. Kidd completed her post-secondary education in Manhattan. She took licensed practical nurse training, and then worked at a local hospital in the evenings and weekends while earning a B.S. in Nutritional Sciences at K-State. She then completed requirements to become a registered dietitian while she earned a M.S. in Dietetics.
Kidd has two children. Her daughter, Tanzania, is a tenth grader while son Marcus is in the ninth grade. Her hobbies include writing poetry and plays. She teaches Sunday school to middle school children. Her professional and personal interests blend in the quarterly column she calls Walk for Jesus…to a better temple that she writes for a health ministry newsletter. And no kidding she remains young at heart! She enjoys listening to music, singing and dancing. She also plans to learn how to quilt this year. (MH)
According to the Centers for Disease Control and Surveillance, 16% of US children ages 6 to 19 years are overweight this rate is four times what it was in the 1960s. In Kansas, our numbers are only slightly better, with 13.6% of children at risk of overweight, and an additional 11% already overweight. It is believed that approximately one-half of children and adolescents who are overweight will become overweight adults. Adult obesity is a risk factor for many major health conditions, including high blood pressure, heart disease, stroke, gallbladder disease, osteoarthritis and diabetes. Many diseases previously termed "adult" diseases are now recognized in very young overweight children.
No single factor is the cause of overweight in children, and no simple solution will erase the problem. While many factors in the community affect a child's weight, it is factors within the family setting that may be most amenable to change. Ellyn Satter, noted child feeding specialist, believes that positive family feeding dynamics are key in providing the structure a child needs to avoid excess weight gain. That structure is provided through the sharing of feeding tasks, which Satter terms the "Division of Responsibility in Feeding." The division of responsibility identifies parents as responsible for the what, when and where of feeding, while the child is responsible for the how much and whether or not to eat.
Satter's research supports earlier findings that family meals matter and can positively affect children in many ways. Family meals offer numerous benefits to children, including:
A child's ability to regulate his food intake depends on trust, Satter believes. Children are excellent regulators, and when given appropriate feeding, they know how much to eat, and they will grow "in the way nature intended for them." When the lines of the Division of Responsibility are crossed, a child's ability to regulate food and body weight is distorted. (SP)
For more information on this subject, read Satter's book Your Child's Weight: Helping Without Harming, Kelcy Press, 2005.
What can a person do to improve health? When choosing beverages, drink plenty of water and get enough low-fat or fat free milk. Limit sugar-sweetened drinks, including juices, and diet soft drinks too.
Reducing sugar-added beverages, overall intake of sugary foods and excess calories from any source helps prevent excessive weight gain. For example, a two year study of the eating habits of 10,000 U.S. children ages 9 to 14 years found that consumption of sugar-added beverages may contribute to weight gain, because drinking sugar-added beverages encourages a higher total calorie intake. Girls who drank sugar-added beverages tended to be the heaviest.
Drinking diet soda may or may not help protect against weight gain. Both lower and higher body weights are seen amongpeople who drink diet sodas. Why would there be an increase in weight? Nobody is sure yet. Diet soda probably does not cause weight gain, but heavier people may choose diet sodas to help lose weight, or to prevent further weight gain. Use of diet soft drinks might be part of other eating habits and lifestyle choices that lead to weight gain.
Studies that linked sugar-free carbonated beverages to lower body weights include an experiment reported in 2002. Overweight adults given two different diets, in the amounts that they wanted, were compared after ten weeks. The group fed a high sucrose diet, mostly as sugar-sweetened beverages, increased their calorie intake, body weight and fat mass. The group that received artificially sweetened foods and beverages decreased their calorie intake, body weight and fat mass.
A 2001 survey study with 12-year-olds found that the chances of becoming obese increased by 1.6 times for each extra serving (one can) of sugar-sweetened drink consumed daily. By comparison, increasing the amount of diet soda consumed was associated with just half the risk for developing obesity.
Other studies have reported that drinking diet soda is linked to weight gain. The risk of becoming overweight was 33% for people who drank one to two cans of regular soft drinks, 55% for those who drank one to two cans of diet soft drinks, and 67% for those who drank one can of regular and one can of diet soda, according to a 2005 preliminary report of an eight-year study of 622 normal weight people.
Another team looked at a nationally representative sample of U.S. children and teens. Increased body weight was weakly associated with an increased intake of diet carbonated beverages.
In the large study of 10,000 children mentioned previously, diet soda intakes were not associated with higher total energy intakes. For boys, intakes of both sugar-added beverages and of diet soda were significantly associated with excess weight gain. The link between gaining weight and increasing their sugar-added beverage intake from one year to the next was strong, while the link between weight gain and increasing diet soda intakes was weak. The heavier boys drank both diet and regular soda. The overweight boys drank one serving per day of diet soda, while the normal-weight boys drank just one-third of one serving. Both groups drank about one-half serving a day of regular soda. (MH)
Sources: CS Berkey et al. Obesity Research 2004;A Raben et al. Am J Clin Nutr. 2002;76,721-729 DS Ludwig. Lancet 2001;357(9255):505-8; SP Fowler et al. 65th Annual Scientific Sessions of the Am. Diabetes Assoc., June 2005; RA Forshee and Storey, ML. Int J Food Sci Nutr 2003;54:297-307
It seems as though every time you turn on a television set, listen to the radio, or read a newspaper or magazine, someone is discussing the obesity epidemic in America. In the past, researchers, health professionals, and the media focused on adult obesity. However, with the increase prevalence of childhood and adolescent overweight and obesity, much discussion is making headlines on how to address this epidemic in this young population.
Children and adolescents spend most of their day in school, and that environment could have an affect on their eating and physical activity behaviors. Schools could provide a healthful environment by:
ü Making sure school breakfast and lunch programs meet nutrition standards set by the U.S. Department of Agriculture (USDA)
ü Offering food options that are low in fat, calories, and added sugars such as fruits, vegetables, whole grains, and low-fat or nonfat dairy foods
ü Reducing access to foods high in fat, calories, and added sugars and to excessive portion sizes
ü Enforcing existing USDA regulations that prohibit serving foods of minimal nutrition value during mealtimes, including vending machines
ü Providing nutrition education that builds skills and help students adopt healthy eating behaviors
ü Offering alternatives to food rewards, such as extra credit, "no or reduced homework" pass, school supplies, paperback book, or extended recess
ü Encouraging school foodservice staff to receive training or certification to enhance their skills in planning, preparing, and serving nutritious and appealing meals
ü Providing quality daily physical education in all school grades
Besides spending time in school, children and adolescents also spend time in their communities. Communities can make a difference by implementing and/or supporting programs that encourage proper nutrition and regular physical activity. Local governments could work with local food vendors (farmers, grocery stores, supermarkets, and fast food restaurants) to increase the accessibility of healthier foods within walking distance, especially in underserved and low-income neighborhoods. State and local governments could work with city planners and developers to create safe environments that would increase opportunities to be physically active, such as bike paths, sidewalks, parks, playgrounds, recreational facilities, routes for walking or bicycling to school, and safe streets and neighborhoods.
Schools and communities alone will not solve the overweight and obesity problems in children and adolescents. However, both could provide healthy environments for promoting good nutrition and developing and maintaining acceptable levels of physical activity. (TK)
Metabolic syndrome, sometimes referred to as Syndrome X or insulin resistance, is a set of complex risk factors or conditions that increase the chance for an individual to develop heart disease, stroke and type 2 diabetes. There is an estimated 47-50 million Americans who now have metabolic syndrome, most of whom are in the 60-69 year age range.
Although there are many risk factors, the major one is abdominal obesity that can be determined by measuring waist circumference. Typically a waistline greater than 40 inches in men or 35 inches in women indicates concern. However, this is not absolute, as there are racial variances.
In addition to abdominal fat, other conditions can increase an individual's susceptibility— physical inactivity, high fat diets, diabetes, aging, genetics, low birth weight and polycystic ovary syndrome (in women). Of particular concern, a pregnant woman with metabolic syndrome is more likely to have complications that can jeopardize her health as well as the health of her fetus.
In metabolic syndrome, insulin resistance is common. Overeating can cause fat cells to enlarge and can trigger development of insulin resistance where the body doesn't recognize the insulin it makes (a "pre-diabetic" condition). Most people with insulin resistance have "central obesity" as measured by a large waist-to-hip ratio.
The good news is with life-style changes especially weight loss in overweight people, metabolic syndrome can be controlled and thereby lower the likelihood of the development of heart disease and type 2 diabetes. Following a heart-healthy eating plan and increasing physical activity provides the best chance of long-term success. Metabolic syndrome is not only about lifestyle; it also can be about the genes we inherit. If genes are involved, it is even more important to help children develop healthy lifestyle habits early on. Unfortunately, many children already have metabolic syndrome risk factors. If you think this is true for you or your child, check with your health care provider and begin following the recommendations of MyPyramid and the Dietary Guidelines for Americans 2005. Work toward a healthy weight (BMI of 25 or less); increase physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week (encourage children to do more); consume healthy foods that are low in saturated fat, trans fat and cholesterol and consume three or more ounce-equivalents of whole grains each day. Research is ongoing into what foods can be helpful in moderating blood insulin. Consuming adequate amounts of whole grains may reduce the risk of developing metabolic syndrome. The Dietary Guidelines for Americans 2005 recommend people consume three or more servings each day--a delicious place to start! (KH)
Metabolic syndrome is suggested when three out of five of the following risk factors have
been identified in an individual, according to The American Heart Association and the National
Heart, Lung and Blood Institute: The criteria that are typically used are provided by the National
Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII).
|
Men |
Women |
|
| Elevated waist circumference | equal to or greater than 40 in. | equal to or greater than 35 in. |
| Elevated triglycerides | Equal to or greater than 150mg/dl | |
| Reduced HDL ("good" cholesterol) | less than 40 mg/dl | less than 50 mg/dl |
| Elevated blood pressure | Equal to or greater than 130/85mm Hg | |
| Elevated fasting glucose | Equal to or greater than 100mg/dl | |
Weight loss…while you sleep…with no pills and
no gimmicks? An emerging area of research has linked chronic lack
of sleep with higher risk for obesity. Or to put it another way, if you
get enough sleep, you may have a better chance of not being
as hungry and weighing less. In a 2005 Canadian study, 740
normal-weight adult men and women reported their nightly sleep.
Those who slept the least (five to six hours) weighed more than
those who slept for seven to eight hours each night. A 2004 study
found that people who sleep just two to four hours a night were 73
percent more likely to be obese than people who sleep seven to
eight hours. Another 2004 study, conducted in Wisconsin,
found that three out of four people average less than eight hours
of sleep. Body weights increased as sleep duration decreased.
People who averaged five hours of sleep weighed slightly more (three
to
four percent) than those who slept an average of eight hours a night.
The sleep-body weight connection may result from changes in the amount of a hormone known as leptin. Higher levels of leptin help control body weight (leptin decreases hunger and appetite, and increases energy used). Decreased leptin or not responding to its effects promotes weight gain.
People who sleep less seem to have less circulating leptin. In the Canadian study, 88 percent of the people who slept just five to six hours had lower leptin levels than those who slept longer. Similarly, a small experiment in 2004 found that sleep deprivation (four hours per night) decreased leptin levels and increased hunger and appetite in healthy young men. The 2004 Wisconsin study also found that leptin levels were decreased in people who reported that they consistently slept for five hours, compared with those who slept for eight hours.
Every little bit of extra sleep may help. A study reported in 2005 found that an extra 20 minutes of sleep per night was associated with a lower body weight. Americans report sleeping almost two hours less per night than they did 40 years ago. Even children often do not get enough sleep.
Thus, chronic sleep restriction may contribute to obesity. Your prescription for better health may involve getting a longer night's sleep more often. (MH)
"GET PHYSICAL!" Two-thirds of the United States population is overweight, one-third is obese, and two-thirds are physically inactive. These issues affect all age, racial, and socio-economic groups, and costs related to being overweight/obese or physically inactive are staggering. Direct costs of being physically inactive alone are estimated to be over $24 billion dollars while the total cost of being overweight or obese is in excess of $117 billion dollars. Imagine the benefits of using some of those expenditures on a great pair of walking shoes!
Physical activity not only assists in weight loss and management, it also provides such health benefits as reduced chance of heart disease, diabetes, cancer, and improved mental health. Despite these benefits, less than one third of Americans get adequate physical activity and the number of inactive individuals continues to grow. We have all made or heard the excuses for lack of physical activity, but the good news is — a little movement goes a long way! The protective factors provided by cardiovascular exercise and weight training benefit ALL who are actively engaged in increasing their physical fitness. Being an athlete is not a requirement to be physically active. Children, adults, older adults, and the disabled are all in need of increased physical activity. So how do we go about it?
The Centers for Disease Control and Prevention (CDC) have created facts sheets with specific guidelines, health benefits, and safety tips for various groups across the age spectrum. These fact sheets are available at: http://www.cdc.gov/nccdphp/sgr/fact.htm . The CDC's approach has been to motivate not only the individual into increasing physical activity but to also provide guidelines for communities to make it easier for members to participate in healthy lifestyles.
In general, a person's physical activity level may be increased as the result of simple changes made. Taking the stairs instead of the elevator, parking in the far parking lot at the grocery store, riding a bike or walking to work instead of driving, dancing while doing housework, or taking a walk during your lunch break are great places to start. Any kind of movement is better than none! Because consistency is essential in reaping the benefits of physical activity, it is important to reevaluate one's daily activities and see where positive activity changes can be made and maintained.
For those who have been sedentary or have chronic health issues, the first step should be a visit to the doctor. Then it is time to decide what kinds of activities are fun and enjoyable the factors that keeps motivation going! Joining a gym is not necessary; gardening, walking, dancing, hiking, and swimming all provide healthy benefits.
Appropriate clothing and shoes are necessary for comfort and safety, while listening to music, especially upbeat music, provides rhythm to your pace, strokes, repetitions, or steps. Physical activity shouldn't hurt but should gradually increase in intensity. Varying activity ensures all body parts are targeted while staving off boredom.
Recommendations for adults are to accumulate at least 30 minutes to 60 minutes of moderate activity most days of the week. If time is a limitation, breaking up the activity into two 15 or 30-minute blocks of activity is just as effective. As strength and endurance increase, greater health benefits can be gained by increasing the length or intensity of the activity. A more active life can mean a healthier and happier life, so get up off the couch and get moving! Your body will love you for it, and remember to have FUN! (TB)