15. Phat metrics: Reading the labels

When you are on a weight loss or weight management program, you are usually asked to carry out measurements to see how you are doing. These measurements might include the number of calories you eat each meal, the time spent exercising each day, the size of your belly, and your weight.

If things are not going as well as you would like, taking these measurements can be disheartening, even downright depressing, and you can easily feel guilty. That’s a bad thing, because guilt feels bad, and in order to feel good, we’re likely to eat something that makes us feel better. Now, we’re putting on the pounds and feeling doubly bad, and feeling like a failure.

However, if you want to manage your weight it is important to use sensible metrics. What is a “metric”? It is something measurable. Examples of metrics relevant to weight management are calorie intake, minutes of exercise, belly size, and weight, just the sort of things that many weight loss and weight management programs get us to measure. Metrics are important because they give us a reality check on how we are doing.

However, you should never, ever, be a slave to a metric. You should use metrics as your servants – faithful, truthful, reliable servants, but servants nonetheless.

Food manufacturers already provide us with useful metrics, by law. In your food store pick out a favorite food – one in a package – and look at the label. I’m going to use Ranch dressing as an example. My wife and stepson like Ranch dressing, and I’ve grown to like to too. We use it on salads:

In summer we typically make salads from iceberg lettuce, darker leaf lettuce, broad leaf parsley, green onions, red onions, tomatoes, radicchio, mint, spearmint, goat cheese, and boiled eggs. A little Ranch dressing mixed in with these vegetables is delicious.

So what’s on the label of a bottle of Ranch dressing ?

The brand we use is Litehouse Homestyle Ranch dressing and dip.

On the back of the bottle is a label which has the following information, and more:

√ Made Fresh √ No Preservatives √0g Trans Fat

√No MSG √100% Canola Oil √Guaranteed Delicious

That’s a lot of information. Some of it is metric information, and some is not. For example, the statement “Guaranteed Delicious” may be true (I happen to think it is) but it is not the result of a measurement – it might result from a number or people trying the dressing and saying that it is delicious, but the result is not reported as a measurement. If the label said “95% of people say it is delicious”, that would be the result of a simple measurement – counting how many people out of a sample of unknown size said the dressing was delicious. As it stands “Guaranteed Delicious” is not reported as the result of a measurement.

The statement “0g Trans Fat” is the result of a measurement. The manufacturer states that they have measured the amount of trans fat in the dressing and found no more than 0.5g of trans fat – that’s what the “0” means in this context: not necessarily zero, but close enough. What is “0g”? The “g” stands for “grams” – a unit of measurement in the metric system. Notice how much of the metric information is reported in the metric system (kind of curious given that we’re looking for useful metrics!). There’s about 28 grams to an ounce (click here for a metric conversion calculator), but the important thing if you are concerned about trans fat is there are 0 g of trans fat – none at all. It doesn’t matter if you measure in grams or ounces, the manufacturer is telling you there is no trans fat in this product.

Notice that I wrote “if you are concerned about trans fat”. You probably should be concerned about trans fat, but remember that we are not looking for metrics that enslave us – we are looking for metrics that are our faithful, truthful, reliable servants. You may not be so concerned about trans fats when you read the label. I wasn’t. I was glad to see there were no trans fats, but if the label had said “2g Trans Fat” I may still have bought the dressing: that’s my decision, no one else’s apart from my wife and stepson who will also be eating the dressing. My concern at the time I bought the dressing was carbohydrates. I noticed it had a low “2 g”. That’s 2 grams per serving, and the label also says there’s 13 servings in a bottle. The bottle says there’s 13 ounces of dressing in all, so that gives about 2grams of carbohydrates per ounce – or about 1/14th of an ounce of carbohydrates per ounce of dressing. Not much – it’s pretty low in total carbs. Because that is what I have been using as a metric – I want to keep my carb intake low – I was happy to use the Litehouse Ranch dressing.

There’s a lot of metric of information on the Ranch dressing label – measurements of vitamin content, sodium, protein, sugars, among others. I didn’t buy the dressing as a source of vitamins or protein – I bought it to flavor the salad I had made. So I was mainly concerned about the amount of carbs, the presence of nasty things like trans fat, and the fact that it was made using only canola oil. The carb metric is one of my faithful, reliable, truthful servants, and it informed me that, on the basis of that measurement, this dressing was possibly a good choice. If the dressing had been high in carbs I simply would not have bought it.

That is an example of how phat metrics – good metrics – are already out there for us to use in our plans to manage our weight. We do not have to obsess about every measurement, every detail, but focus on those aspects of food that can be measured that we deem to be relevant . It’s our life, our weight, and our bodies. We decide as intelligent people what we will eat and why.

Let appropriate metrics – phat metrics – be your guide, and your faithful servants. Liberate yourself by using appropriate metrics – ones that are useful to you and that do not enslave you, but help you achieve what you want because they are faithful, honest, reliable indicators.

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14. Australia’s Future ‘Fat Bomb’

Australia’s Future ‘Fat Bomb’

A report on the long-term consequences of Australia’s expanding waistline on cardiovascular disease.

Baker Heart Research Institute

April 2008

fat_bomb_report

Excerpts from the report:

“This report has been prepared by Preventative Cardiology at the Baker Heart Research Institute with the primary objective:

To provide the Australian public with an accurate description of the current weight profile of middle-aged Australians and the likely consequences of their expanded waistlines on CV-related admissions and deaths in the next 20 years.

… … there is a paucity of data regarding the projected, long-term impact of obesity on CV morbidity and mortality in middle-aged Australians. This “missing” information is critical as it would provide estimates of the direct and indirect costs of Australia’s future ‘Fat Bomb’ on our hospitals, health services and health departments. In the absence of such data (which will, unfortunately, take a long time to obtain) there is urgent need to accurately determine the future impact of excess weight in middle-aged Australians in respect to their long-term CV health status. It is only with such data can that we can prepare the health care system and public health initiatives to defuse our future ‘Fat Bomb’.”

Image from “The Age” newspaper.

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13. Effective solutions to obesity appear to be junked

Effective solutions to obesity appear to be junked

• Victoria Macdonald

• The Guardian,
• Wednesday July 30 2008
• Article history

A government report says almost nine in 10 adults and two-thirds of children will be overweight or obese by 2050 unless we do something now. Photograph: PA

How fat is our nation? A doctor at a south of England hospital told me recently that in the paediatric unit waiting room they have finally admitted defeat and ordered the arms to be removed from the chairs because obese children and their obese parents were in danger of becoming stuck every time they sat down.

The doctor said, somewhat despairingly, that when he sees the overweight child, accompanied by the overweight mother and the overweight grandmother, he fears that he will make no significant impact on that young person’s health. That they will, in their turn, grow up to be obese and will very likely suffer from the associated health problems, such as diabetes or heart disease. It was a very gloomy conversation.

Yet it is a conversation everybody agrees needs to be had. According to the government’s own Foresight report, Tackling Obesities: Future Choices, almost nine in 10 adults and two-thirds of children will be overweight or obese by 2050 unless we do something now. The problem is what to do. “Smoking kills” is an easy message to get across. “Overeating kills” is more complex.

The latest tack taken by the Conservative party is of the finger-wagging variety. In Glasgow recently, Tory leader David Cameron said: “We talk about people being ‘at risk of obesity’ instead of talking about people who eat too much and take too little exercise.”

The health secretary, Alan Johnson, takes the approach, currently trendy in Whitehall corridors, of libertarian paternalism – otherwise known as Nudge. This is the political concept that the nanny state does not work and that individuals should be free to make their own choices, but that sometimes they need the tools to help them make the right choice. In other words, a nudge along.

To this end, Johnson told a Fabian Society meeting last week that obese people must not be vilified, that lecturing them will not make them change their behaviour. Instead, obesity requires all of society to engage, to fight this battle, he said, describing a “broader partnership, not only with families, but with employers, retailers, the leisure industry, the media, local government and the voluntary sector”.

This whole-society concept reflects the well-regarded Foresight report and Sir Derek Wanless’s projections for the future health of the nation and how much it will cost the NHS in years to come – that is, it is not going to work only to say exercise more or eat five fruit and veg a day, because that is tinkering at the edges. Nor is it enough to say children should not eat so much junk.

You need, for instance, to change the planning laws so there are no fast-food outlets at the school gates. You need to ensure there are playing fields and access to sports facilities. You need “everyone, from the smallest community keep-fit class to the biggest retailers in the land” to join in, Johnson said.

All very admirable, said one obesity pressure group, but “what a pity he allowed his tummy to be tickled by Coca-Cola”. On the very day Johnson made his Fabian Society speech, he announced that a coalition of companies – including Coca-Cola, Kellogg’s and Nestlé – headed by the Advertising Association – had “pledged” more than £200m towards tackling obesity. Details, he added, were to be worked out.

The “£200m” claim needs to be treated with a serious pinch of low-sodium salt, since it suggests cash but is more vague. Air time, perhaps, or on-package messages – the value of which the companies make up themselves.

But, more importantly, how can a clear message be sent to children not to eat junk food by, er, the manufacturers of that junk food? Remember the fiasco over Cadbury’s sports equipment campaign, during which it was revealed that each child would need to eat 5,440 chocolate bars before claiming a free football net?

This is an industry with form – an industry, let us not forget, that has failed to stop advertising junk food before the 9pm watershed, adequately reduce salt and sugar levels in cereals, and institute universal food labelling so the consumer knows how much fat, salt and sugar they are about to eat. It is hard to have confidence that its commitment to fighting obesity is little more than free publicity handed to it by the health secretary.

· Victoria Macdonald is social affairs correspondent for Channel 4 News.

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12. Greece tops fat league

Greece tops fat league as diet of the Med decays

• John Hooper in Rome
• The Guardian
• Wednesday July 30 2008

Greece, the nation that gave rise to the idea of well-formed muscular men in the name of Adonis, now has the highest prevalence of obesity in the EU, according to a report issued yesterday.

“Greece today is the EU state with the highest average body mass index and highest prevalence of overweight [people] and obesity,” says the UN’s Food and Agriculture Organisation report.

It reveals that the XXXL factor is one effect of a dramatic retreat from the Mediterranean diet in the region itself.

Josef Schmidhuber, an FAO senior economist, said people, not only in southern Europe, but also in north Africa and parts of Asia, were increasingly eating food that was “too fat, too salty and too sweet”. The diet of fruit and vegetables, taken by their forebears, was in “a moribund state”.

His findings appear in a report given to a workshop on Mediterranean products, organised by the California-Mediterranean Consortium of academic institutions.

Schmidhuber said that in 40 years, up to 2002, there had been a 20% rise in the average daily calorie intake of people living in the former 15-nation EU – but in the countries bordering the Mediterranean the increase had been steeper. Greece, Italy, Spain, Portugal, Cyprus and Malta had increased calorie consumption by an average of 30%. Three-quarters of the Greek population was overweight or obese by the end of that period.

Spain, Greece and Italy are now the EU’s biggest consumers of lipids (fats and oils), the report says. In Spain fat made up 25% of the diet 40 years ago but now accounts for 40%, the FAO said. But sedentary lifestyles, supermarkets and fast-food restaurants, and a fall in home cooking, were also to blame, it said.

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8. Twice as high as your belly is around

A very simple pair of measurements gives a good indicator of potential for cardiovascular disease risk.

If your height is less than two times your waist measurement then you are significantly more likely (up to 11 times more likely) to have a higher cardiovascular disease risk than those people whose height is more than twice their waist.

These results come from a study Waist-to-height ratio: a simple option for determining excess central adiposity in young people, carried out by Drs. S. P. Garnett, L. A. Baur and C. T. Cowell and reported in the International Journal of Obesity (2008).

Everyone knows their height. Measure your waist in the same units (inches, or cm, for example) and divide the waist measurement into the height measurement. So, if you are 5 feet 7 inches tall that’s 67 inches, and if your waist is 36 inches then your height to waist ratio is 67/36 = 1.9, marginally below 2. If you are 5 feet 2 inches (= 62 inches) with a 38 inch waist then your height to waist ratio is a low 1.6

With a low height to waist ratio you know you aren’t going to get any taller – unless you are a kid, still growing – so the only way to increase the height to weight ratio to 2 or more is … you guessed it, lose weight to reduce that belly fat, which, as we already know, is an organ, sending out hormonal messages to the rest of your body.

Here’s a height-waist chart inidicating the maximum waist measurement for a given height that gives a height-waist ratio of 2 or greater:

See also:

Short And Fat Is Beautiful, As Required By Massachusetts State Law

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6. Belly fat isn’t just hanging there

Belly fat might look like it’s just hanging there, wobblng during walking, and blocking a clear view of the feet, but there’s much more to belly fat.

I use the technical term “belly fat” but what the heck, we might as well call it by its everyday name: “adipose tissue”.

This adipose tissue is most definitely not just sitting there doing nothing but making life heavier. Belly fat is an organ, believe it or not!

Adiopose tissue is made up of brown fat cells that generate heat, and are generally thought of as pretty good for weight regulation.

Then there are the white fat cells, around 30 billion or so even in thin people.

White fat cells don’t just sit there doing nothing. Oh, no! They are actively sending out signals via hormones to the rest of your body. For example, white fat cells convert steroids, that would help build muscle, into estrogen. White fat cells compete for nutrients in the body and slow down muscle build-up.

Belly fat secretes hormones, which are chemical messengers, taking a signal from one group of cells to another group of cells. In other words, your belly fat is talking to the rest of your body!

Two hormones secreted by belly fat are leptin and resistin.

Leptin was discovered in 1994 by Jeffrey Friedman and his colleagues at Rockefeller University. Its main role seems to be regulation of energy, both intake and expenditure. Leptin regulates appetite and metabolism.

Resistin was discovered in 2001 by Mitchell Lazar and colleagues at the University of Pennsylvania. It seems to be involved in reducing the effect of insulin on fat cells, in inflammation, and in energy balance.

Much research is still being done on the roles of these belly fat hormones.

So, belly fat is most definitely not just sitting there doing nothing. It is an active organ, sending poweful hormonal signals thoughout the body.

Try to be aware of what your belly fat is saying to you, and … eat responsibly!

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5. Phat belly? (not good)

Have you noticed that fat people come in different shapes? Some fat people are fat all over, while others, often guys, have very fat bellies only.

Is a fat belly phat?

Apparently not, according to the research of Dr. Rachel Whitmer, of Kaiser Permanente, Division of Research, Etiology and Prevention, Oakland, California.

She recently carried out a study of over 6,500 overweight people to figure out the long-term effects of excess belly fat on dementia. (The epidemiology of adiposity and dementia. Current Alzheimer Research, 2007 April;4(2):117-22).

Her long-term prospective study indicates that excess belly fat, to the point of being overweight or obese, as measured by body mass index and skinfold thickness, substantially increases the likelihood of dementia later in life.

On the other hand, she reports : “Weight loss in late life however is associated with dementia, and those categorized as underweight are also at a greater risk of dementia.”

The moral seems to be: if you want to reduce your chances of dementia in later life – and who wouldn’t ? – reduce that belly fat, and don’t become excessively thin.

Strive for a balance, get some exercise and, as always, eat responsibly.

______________________________________________________________

Published online before print March 26, 2008

Received August 15, 2007

Accepted December 14, 2007

Central obesity and increased risk of dementia more than three decades later

R. A. Whitmer PhD*, D. R. Gustafson PhD, E. Barrett-Connor MD, M. N. Haan DrPH, E. P. Gunderson PhD, and K. Yaffe MD

From Kaiser Permanente Division of Research (R.A.W., E.P.G.), Oakland, CA; Goteberg University (D.R.G.), Goteberg, Sweden; the Department of Family Medicine (E.B.-C.), University of California, La Jolla; the Department of Epidemiology (M.N.H.), University of Michigan, Ann Arbor; and the Departments of Psychiatry, Neurology and Epidemiology (K.Y.), University of California, San Francisco.

* To whom correspondence should be addressed. E-mail: rachel.whitmer@kp.org.

Background: Numerous reports show that a centralized distribution of adiposity is a more dangerous risk factor for cardiovascular disease and diabetes than total body obesity. No studies have evaluated whether the same pattern exists with dementia. The objective was to evaluate the association between midlife central obesity and risk of dementia three decades later.

Methods: A longitudinal analysis was conducted of 6,583 members of Kaiser Permanente of Northern California who had their sagittal abdominal diameter (SAD) measured in 1964 to 1973. Diagnoses of dementia were from medical records an average of 36 years later, January 1, 1994, to June 16, 2006. Cox proportional hazard models adjusted for age, sex, race, education, marital status, diabetes, hypertension, hyperlipidemia, stroke, heart disease, and medical utilization were conducted.

Results: A total of 1,049 participants (15.9%) were diagnosed with dementia. Compared with those in the lowest quintile of SAD, those in the highest had nearly a threefold increased risk of dementia (hazard ratio, 2.72; 95% CI, 2.33–3.33), and this was only mildly attenuated after adding body mass index (BMI) to the model (hazard ratio, 1.92; 95% CI, 1.58–2.35). Those with high SAD (>25 cm) and normal BMI had an increased risk (hazard ratio, 1.89; 95% CI, 0.98–3.81) vs those with low SAD (<25 cm) and normal BMI (18.5–24.9 kg/m2), whereas those both obese (BMI >30 kg/m2) and with high SAD had the highest risk of dementia (HR, 3.60; 95% CI, 2.85–4.55).

Conclusions: Central obesity in midlife increases risk of dementia independent of diabetes and cardiovascular comorbidities. Fifty percent of adults have central obesity; therefore, mechanisms linking central obesity to dementia need to be unveiled.

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4. Do fat people come in threes?

I’ve noticed that fat people tend to hang out together. Assuming I’m right, is it because they seek each other out, finding like-bodied people attractive, or is it because you’re more likely to get fat by hanging out with a fat person?

Drs. Nicholas A. Christakis and James H. Fowler addressed this and found that, as I thought, overweight and obese people tend to cluster. They found that a person’s likelihood of becoming obese increased dramatically (by more than half) if they had an obese friend. Obese siblings and obese spouses also increased people’s likelihood of becoming obese.

Their conclusion is that obesity seems to spread through social ties.

So what I see in Applebee’s, when two or three really overweight girls sit down for lunch, is a social group in which the girls are reaffirming each others right, and desire, to become and stay fat.

So, yes, it does seem that fat people come in threes.

Because being grossly overweight or obese has serious health implications, the social networking effect on weight is something that should be discussed by health professionals if a person desires to lose weight.

Eat out with friends, and … eat responsibly!

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3. Discrimination

Writing in the International Journal of Obesity, Dr. Rebecca M. Puhl has found substantial discrimination against overweight people. You can read a summary at MedlinePlus.

Dr. Puhl reports that weight discrimination in America is close to rates of racial discrimination for women.

Weight discrimination can involve being called names to being turned down for employment on the basis of weight. Like any other form of discrimination, weight discrimination is personally distressing, and should be both illegal and not tolerated.

Amy Norton, of Reuters Health, reports: “Of the men and women who reported weight discrimination, 60 percent said they had experienced work-related discrimination, such as not being hired, being passed over for promotion, or being wrongly fired.”

Treat each other kindly folks, and eat responsibly!

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2 Modern illnesses

The International Obesity Task Force writes that being overweight or obese increases the risk of a number of health conditions. These include the following:

• High blood pressure
• Osteoarthritis
• High total cholesterol or high levels of triglycerides
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Sleep apnea and respiratory problems
• Breast and colon cancer

None of these is much fun. My own blood pressure is mildly elevated – around 135/90. My wife Linda had a scare with a micro-cluster of calcifications in her breast, picked up at a routine mammogram. She was treated at the Avon Clinic at Massachusetts General Hospital, and cannot speak highly enough of the wonderful physicians and nursing professionals at Mass General.

Type 2 diabetes is on the rise. At a personal level, my brother-in-law, in Australia, was diagnosed with type 2 diabetes some years ago. He is over 300 pounds and around 5″ 10″. This has dramatically affected what he eats – no more huge plates of meat and mashed potatoes – and what he drinks: a glass of wine, and no beer.

My friend and colleague David Tall is grossly overweight, mainly because he has been on steroids for years to treat sarcoidosis. He developed both type 2 diabetes and sleep apnea several years ago.

The Encyclopedia of Surgery reports that 300,000 people die in the United States each year from weight-related causes. This is more than 8 times a capacity crowd at Fenway Park, home of the Red Sox. That’s a lot of people to die, probably unnecessarily in most cases.

Take care out there folks, and eat responsibly!

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