Children, Obesity and a Weight Loss Update

In a study published in March by Andy Ness, Ph.D., of the University of Bristol (England) researchers have almost concluded that increased physical activity in children decreases their risk of becoming overweight. Almost, you wonder, what in the heck can she mean by that?

In a cross-sectional study of more than 5,000 12-year-olds, a daily fifteen minutes of moderate to vigorous exercise was associated with a 50% drop in the risk of obesity for boys and a 40% decline in risk for girls. "The association between physical activity and obesity we observed was strong," Dr. Ness said. "These associations suggest that modest increases in physical activity could lead to important reductions in childhood obesity."

The study is one part of a research project called the Avon Longitudinal Study, which enrolled 14,000 pregnant women in England in 1991 and 1992 and has followed these women and their children since that time. Children in the study wore equipment that measured their physical activity and the researchers calculated their body-mass index (BMI) using standard tools; they also measured fat and lean mass using dual energy x-ray absorptiometry scanning (I don't know either - but I'd guess that it's some fancy research tool that gives an accurate assessment of body fat and muscle). The point is of all this is that this study is the first of its kind to use objective measures of physical activity and the body's fat and lean muscle masses.

So what's the "maybe" about? Well first, studies have limitations; in this case the study involves a cross-section of a population, a brief picture of a group at a certain point in time. As such, the researchers can't say for certain that exercise reduces obesity risk, because they can't say for certain that the opposite is also not true. In this case it could be hypothesized that obesity causes a decrease in physical activity.

A second limitation of this study is that it is observational. The purpose of an observational study is to draw from your observations to create a hypothesis (scientific guess) about the possible effects of a treatment on your subjects, in this study the hypothesis is that exercise decreases the risk that a child will become overweight.

The authors conclude their analysis with the obligatory statement that their hypothesis will now need further study under controlled conditions, to prove the connection between exercise and reduced obesity risk in children. I would also add that they failed to note a third technical limitation of their study: that they only studied 12-year olds; therefore, they cannot automatically conclude that increased physical activity will decrease obesity risk in younger or older children.

Some of you may remember that at about this time last year I embarked on a weight loss plan of my own. On the downhill side of 45, I was getting concerned that I would look like a tea pot by the time I turned 50 (can you say central obesity three times fast??). Well I'm happy to report that regular moderate exercise has certainly helped me to lose weight; as of my recent 48th birthday I have lost a total of 13 pounds and I'm eating whatever I want-in smaller portions. I have set a goal of another 5 pounds and I'll be ecstatic and lower my risk of obesity.

Take care, Laurie

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Technorati Tags: weight loss, obesity, parenting

Dieticians Make a Difference and a Call For Recipes

Photo Credit: Chris Gladis

In a study¹ of the Mediterranean versus the American Heart Association Step II Diet, individuals had nearly identical morbidity (death) and mortality (recurrent disease) rates after two years. The more important factor in individuals' outcomes was not which of these diets were chosen, but the occurrence of ongoing support from a dietitian or not.

The study included 101 individuals who had a heart attack within six weeks of enrollment. The average age of the group was 58.5 years, the majority of who were men; 94% of the group was white. Members of each group were randomly assigned to eat either the AHA Step 2 diet, which emphasizes whole grains, fruits, and vegetables with moderate protein intake from animal sources such as chicken, beef, pork, or fish.

The Mediterranean diet emphasized fish and other sources of omega 3 fatty acids (flaxseed oil is one example) instead of animal-based fats and allowed for a greater total fat intake from these sources (up to 40% versus 30% of total calories in the Step 2 Diet). The Mediterranean plan also had higher allowances for monounsaturated fats (olive oil is an example), and a slightly smaller carbohydrate allowance (50% versus up to 60% of total calories in the Step 2 diet).

Regardless of diet plan, each study participant had individualized appointments with a registered dietitian at regular intervals, two within the first month, and then in months three, six, twelve, eighteen, and twenty-four, plus counseling in small groups six or more times over the study's two years.

After two years participants had equal mortality and cardiac event-free survival rates, said Katherine R. Tuttle, M.D., of the Sacred Heart Medical Center in Spokane, Wash., and the University of Washington, at the American College of Cardiology meeting. When the participants were studied out to six years, there were eight events, including death, stroke, unstable angina, or heart failure that occurred in each group, indicating nearly identical outcomes between the two groups.

The studied individuals were also matched to 101 heart attack patients for age, sex, high blood pressure and diabetes status, and heart attack type and treatment. This was the study's control group, who only received dietary instruction on a low-fat diet while in the immediate hospital after their heart attack.

During an average four-year follow-up, the AHA Step 2 and Mediterranean Diet groups had an improved survival rate compared to those who had not had ongoing dietary counseling with a registered dietitian. "It really supports the value of referring patients for dietary intervention," Dr. Tuttle said. "It's very hard to maintain a dietary intervention without assistance."

Personally I much prefer the Mediterranean style diet, with its emphasis on fish and whole grains. I love fish and live near a fishing fleet in the Northeast, where we have lots of fresh options. I also love the foods of the Middle East, with their emphasis on fruits, nuts, beans and whole grains. Somehow it seems much more interesting to me than a typical "Americanized" diet. If anyone among my readers wants to share recipes for heart-healthy foods I'd be glad to post them. If there are enough, we could blog a "recipe" of the week. Anyone want to get us started?

Happy, healthy eating, Laurie

¹American College of Cardiology, New Orleans, March 26, 2007

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Technorati Tags: diet, cholesterol, mediterranean diet, tlc diet, american heart association

Imus: What Line?

The "I-man," Don Imus is under attack this week for calling the Rutgers women's basketball team "nappy-headed ho's." Listening to those around me comment on his situation, I am hearing either outrage that he would stoop so low, or outrage that anyone would make 'such a big deal' out of his comments. After all, Imus and fellow "shock-jock" Howard Stern have battled for years about which of them is the most shocking radio personality. It is what makes their shows stand out in the crowd, and it draws a certain percentage of the morning radio market share to their airwaves.

The I-man's comments have me wondering, what does his popularity say about us as a community of the world?

I often listen to Imus in the morning if I am in my car commuting somewhere. He is carried by my local talk-radio station and I prefer this format to current musical hits or pablum morning TV, such as the FM NBC radio affiliate carries.

Imus has intelligent guests and they often have interesting, enlightening conversations. I also happen to share some of his views on politics, and support his wife's opinion that we should decrease our footprint on the earth by personally using green products and eating more vegetarian meals (Deirdre Coleman-Imus is actually a vegan).

But there is no question that Imus frequently makes me cringe, and I will change the station, put in a CD, or shut him off and make needed phone calls (with my hands-free of course :>) to avoid listening to him abuse anyone, or spout off on his latest tirade on a subject that doesn't interest me. His latest offense doesn't really surprise me, but I do wonder why the media and religious leaders of the African-American community have decided to make Imus an example of all that is bad in the entertainment community, especially the Reverend Al Sharpton, who has made his own mistakes in commentary.

There have been any number of media personalities who have made off-handed remarks in the name of being funny who have gotten away with an apology, so why can't the I-man? The answer may lie, in part, with the huge influence that Imus has in the media world, and the fact that he has consistently held himself up as an example of all that can be right in a person of fame and fortune: he has dedicated his life's professional and financial success to raising awareness of the needs of kids with cancer and to research into sudden infant death syndrome (SIDS).

I am more concerned about what this situation says about American society. Every day we tolerate all kinds of bad behavior, not only from famous people, but from the kids, the parents, the store employees, the patients, the health care workers, the world around us. We seem to have developed a standard of behavior that sets as its goal 'be as loud and obnoxious as people will tolerate, because you will become known and your needs will be addressed.'

It will always be true: everyone would like their fifteen minutes of fame. Some individuals are satisfied with knowing personally that they have done the right thing, but most of the world wants the stardom. This leads to much of the obnoxious public behavior that we observe and the popularity of live radio and reality TV.

In other cases, people aren't seeking global fame, but they want to be known within their community of influence that they are a force. They will behave in a way that gets someone's attention, and they believe that this will lead their perceived "needs" being met. These needs include demonstrating to the crowd of family or friends in their presence that they are important; they can draw attention to themselves and get taken care of, whether this means be waited on in a store, bank, or restaurant, or getting seen in the emergency department (ED).

In the ED I have to tolerate people being verbally abusive to me if they don't get what they want (never mind that in my medical judgment it's not what they need). I have to put up with kids under my feet, running around uncontrolled because even though they scream and yell at them, their parents can't manage to set limits and maintain control.

I have to work under the watchful eye of the intimidating lurker, typically an individual who looks like they'd smack me around if they thought they could get away with it. These individuals stand in the doorway of the exam room, hoping that if they look mean enough I'll see their family member before the chest pain that just arrived or the elder in septic shock.

I have to care for the sick and the wounded because they are worn down by abusive spouses or injured by their own addictive behaviors, and they carry that baggage into the ED with them, increasingly leading to violence and injury in acute care settings across the country. A lot of the world is in pain from their unmet needs, and they are lashing out.

When are we, as a society, going to draw the line? Where will we place it? When are we going to say to one another, "That behavior isn't acceptable?" When are we going to back that up the rules by teaching people a better way to cope than to be abusive to those around them?

Before the end of this month I will become 48 years old, middle-aged. I am not naive, nor am I an elder in this world tribe who might be thought to be out of touch by young people. I am a parent, and the most difficult thing that I do in that role is say no and mean it. It's hard. I have to practice all the time. But someone has to tell my child that this society, and the world, has rules. That breaking the rules has consequences. Someone has to help my child understand that that accepting stereotypes diminishes one's intelligence, that we don't say mean things to one another just to get someone's attention, that writing blogs that are hurtful or threatening is inappropriate, and that we all make mistakes that have consequences.

My child and Don Imus should know that life should never be lived at the expense of another's pain, joking or not. Mr. Imus and I, and all of society must set an example for our children. As far as I'm concerned, Don Imus's biggest crime is the example he sets every time he makes a comment that is not thought through. He well knows that life is about more than the fame and drawing attention to oneself.

Be peace, Laurie

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