Skipping Meals and Metabolism

People often miss meals because they get busy or are trying to lose weight. But how you skip meals, and the amount you eat at your next meal, can affect your overall health.

The scientific data on skipping meals has been confusing. In some studies, fasting has resulted in measurable metabolic benefits for obese people, and in animal studies, intermittent feeding and fasting reduces the incidence of diabetes and improves certain indicators of cardiovascular health. Even so, several observational studies and short-term experiments have suggested an association between meal skipping and poor health.

In recent months, two new studies may help explain how skipping meals affects health.

The most recent study, published this month in the medical journal Metabolism, looked at what happens when people skip meals but end up eating just as much as they would in a normal day when they finally do sit down to a meal. The study, conducted by diabetes researchers at the National Institute on Aging, involved healthy, normal-weight men and women in their 40s. For two months, the study subjects ate three meals a day. For another eight-week period, they skipped two meals but ate the same number of calories in one evening meal, consumed between 4 p.m. and 8 p.m.

The researchers found that skipping meals during the day and eating one large meal in the evening resulted in potentially risky metabolic changes. The meal skippers had elevated fasting glucose levels and a delayed insulin response — conditions that, if they persisted long term, could lead to diabetes.

The study was notable because it followed another study earlier this year that found that skipping meals every other day could actually improve a patient’s health. In that study, published in March in Free Radical Biology & Medicine, overweight adults with mild asthma ate normal meals one day. This was followed by a day of severely restricted eating, when they ate less than 20 percent of their normal caloric intake, or about 400 or 500 calories a day — the equivalent of about one meal. Nine out of 10 study participants were able to stick to the eating plan.

After following the alternate-day dieting pattern for two months, the dieters lost an average of 8 percent of their body weight, and their asthma-related symptoms also improved. They had lower cholesterol and triglycerides, “striking” reductions in markers of oxidative stress and increased levels of the antioxidant uric acid. Markers of inflammation were also significantly lower.

The conclusion, say the authors of the more recent meal-skipping study, is that skipping meals as part of a controlled eating plan that results in lower calorie intake can result in better health. However, skipping meals during the day and then overeating at the evening meal results in harmful metabolic changes in the body.

Tis the season

November 22, 2007, 10:33 am

The Skinny on Holiday Weight Gain

Reports of your holiday weight gain have been greatly exaggerated. Media stories often suggest that the average person gains 7 to 10 pounds between Thanksgiving and Christmas. And in surveys, people say they gain, on average, about five pounds this time of year.

But several studies now show that the average weight gain during the winter holidays is just one pound.

The news isn’t all good. Most people don’t ever lose the pound of weight they put on during the holidays, according to a report in The New England Journal of Medicine. Since the average weight gain during adulthood is about one to two pounds a year, that means much of midlife weight gain can be explained by holiday eating.

For people who are already overweight, the holiday weight news is worse. Although the average gain is only one pound, people who are already overweight tend to gain a lot more. One study found that overweight people gained five pounds or more during the holidays.

And we start packing on that extra pound of holiday weight early in life. Researchers at the University of Oklahoma studied holiday weight gain among college students during the Thanksgiving break. The students were weighed the day before Thanksgiving, then weighed again about two weeks later. The average weight gain for the 94 students was about one pound. Students who were of normal weight gained about a half a pound during the period. Students who were overweight, meaning their body mass index was 25 or more, gained about two pounds.

Holly Hull, the lead researcher on the Oklahoma study, says Thanksgiving marks the beginning of a “high risk” time for the overweight. “I think the number of people who only overeat at the Thanksgiving meal is slim to none,'’ said Dr. Hull. “The holiday season doesn’t represent one day of overeating. You have this period that extends through the new year where there’s more alcohol, more snacks, more finger foods and appetizers that are energy dense.'’

Empty calories+empty glass= full sized

Nutritionists: Soda making Americans drink themselves fat

By Caleb Hellerman
CNN

(CNN) -- If you're searching for a villain in America's obesity epidemic, most nutritionists tell you to put one picture on the wanted poster: a cold, bubbly glass of soda pop.

"Liquid candy" to detractors, sweetened soft drinks are so ubiquitous that they contribute about 10 percent of the calories in the American diet, according to government data.

In fact, said Dr. David Ludwig, a Harvard endocrinologist whose 2001 paper in the Lancet is widely cited by obesity researchers, sweetened drinks are the only specific food that clinical research has directly linked to weight gain.

"Highly concentrated starches and sugars promote overeating, and the granddaddy of them all is sugar-sweetened beverages," said Ludwig, who runs the Optimal Weight for Life Program at Children's Hospital in Boston.

The rise in soft drink consumption mirrors the national march toward obesity. At the midpoint of the 20th century, Americans drank four times as much milk as soda pop. Today, the ratio is almost completely reversed, according to the U.S. Department of Agriculture. Meanwhile, in the past 30 years the national obesity rate has more than doubled, and among teenagers, more than tripled, reports the Centers for Disease Control and Prevention.

"Soda pop is a quintessential junk food," said Michael Jacobson, who heads the Center for Science in the Public Interest, which lobbies for government restrictions on foods it considers unhealthy. "It's just pure calories, and no nutrients. It's like a bomb in our diet."

Jacobson said the CSPI is pushing to require obesity warning labels on the sides of soda cans, like the surgeon general's warning on cigarettes.

While nutritionists are united in their dislike for nondiet soda, the "why" is controversial.

Some point a finger at high-fructose corn syrup, or HFCS, the sweetener used in most nondiet drinks. Last month, researchers at Rutgers University said they'd identified compounds in HFCS which may start a chemical chain reaction, leading to diabetes.

Most scientists, though, say there's little difference between HFCS and simple sugar, either in chemistry or the way they're handled by the body.

A bigger problem, doctors say, is simply the sheer number of calories. You'll find about 400 calories in a 32-ounce "extra-large" Coke, a fast-food staple. That's nearly a quarter of what the average adult woman needs in a whole day.

Scientists also say the body doesn't respond to liquid calories in the same way it would if those calories came in the form of French fries or chocolate cake. Appetite is controlled by a complex mix of hormones. Some signal the brain that your stomach is getting full. Others, including a hormone known as ghrelin, signal it's time to eat again.

If you eat a big burger, the level of ghrelin drops for a few hours. That drop doesn't happen if you drink a Big Gulp soda, even if it has more calories than the burger, according to Wayne Campbell, a professor in the Department of Foods and Nutrition at Purdue University.

"We're finding your hunger does not go down as far when you consume a beverage, as when you consume a solid," Campbell said. The result: Even with 400 liquid calories in your stomach, you polish off the burger too.

Campbell cautioned that the ghrelin theory isn't proven and that other factors -- such as a food's smell, or the sensation of chewing -- may affect appetite just as much, or even more. Our expectations also play a role.

"Soup is the anomaly to the liquid calorie research," he said. "People perceive soup as a meal, unlike drinking a Coke. So when we've done these types of studies, but used soup as the liquid, we don't see the same differences in [appetite] response."

The sugar in soda pop not only provides a massive dose of calories, but triggers a vicious appetite cycle, said Ludwig, who wrote "Ending the Food Fight," about healthy eating for children.

"It's rapidly absorbed, which raises blood sugar and in effect causes the body to panic." The body releases insulin to break down the sugar, "but the body overcompensates, and blood sugar drops below the fasting level," lower than it was in the first place.

Recognizing low blood sugar, the body releases ghrelin and other hormones, inducing hunger, inducing us to eat even more, Ludwig said.

The public is catching on, he said.

"In our obesity clinic, we used to routinely see patients coming in who were drinking four or five soft drinks a day. Now it's rare. That seems to be the first factor that comes to mind, when people are trying to lose weight."

Soft drink companies, under fire, are taking steps including a pledge last year to phase out nondiet soft drinks from America's schools.

A progress report issued Monday by the American Beverage Association said that shipments to schools of sweetened soda are down 45 percent since 2004, while shipments of bottled water are up 23 percent.

"There's no question the changes that are happening in schools are a mirror of what's happening in the larger marketplace," said Susan Neely, the ABA's president & CEO. "Adults, like kids, are reaching for lower-calorie beverages. ... As a consumer product company, we want to give consumers what they want."

While fighting obesity is complicated, Ludwig said, the first step is clear. "Giving up sugary soda for diet drinks, or water, will cause you to lose weight."

My Opinion: Obesity is Contagious?

Firstly, I would like to say that this is a gross misuse of the word "contagious," and to me the study seems to be anecdotal science at best.

Perhaps the article should have began: Bad habits can "spread from person to person, much like a virus, researchers are reporting today. When a person gains weight, close friends tend to gain weight, too."

Consider the following paragraphs, and how they fail to support the word choice "contagious":

There was no effect when a neighbor gained or lost weight, however, and family members had less influence than friends.

Proximity did not seem to matter: the influence of the friend remained even if the friend was hundreds of miles away. And the greatest influence of all was between mutual close friends. There, if one became obese, the odds of the other becoming obese were nearly tripled.

If "contagion" in the true sense was a concern, then wouldn't proximity matter? If only genetics were to blame, then family members would have more, not less, influence than friends. Contagion, hardly. Think instead of influence.

Our parents might have been on to something (shocking!) when they were concerned about whether or not we were hanging out with the wrong crowd. They did not want us becoming desensitized to the other teens' bad habits: smoking, drinking, &c. In the case of gaining weight, perhaps the bad habits off less fit friends that are easy to assume would be larger portion sizes, snacking, extra helpings, and tempting but unhealthy food choices. People who are friends with each other tend to share common interests which are reinforced through shared experiences. If you're trying to become healthier and spending a lot of time with an unfit friend whose favorite activities include watching a videos or playing x-box, it wouldn't be surprising if you gained weight. This influence works both ways. A client mentioned that one of the pluses of her work environment was that her coworkers are fit and like to partake in group activities such as kayaking, hiking, and sports.

So don't panic when you read the headline about obesity being contagious. If obesity was truly a matter of infection and not the result of more complicated factors, wouldn't doctors, dietitians & nutritionists, and personal trainers be the first to fall ill? If you have friends who are obese don't worry about catching obesity from them, but be open to exposing them your positive influence and healthy lifestyle choices. Fitness and health can be catchy too.

I've highlighted some parts of the article (which I've included in its entirety following this post) that are interesting.

Controversial New York Times Article On Obesity

Study Says Obesity Can Be Contagious

By GINA KOLATA

Published: July 25, 2007

Obesity can spread from person to person, much like a virus, researchers are reporting today. When a person gains weight, close friends tend to gain weight, too

Their study, published in the New England Journal of Medicine, involved a detailed analysis of a large social network of 12,067 people who had been closely followed for 32 years, from 1971 until 2003. The investigators knew who was friends with whom, as well as who was a spouse or sibling or neighbor, and they knew how much each person weighed at various times over three decades. That let them examine what happened over the years as some individuals became obese. Did their friends also become obese? Did family members or neighbors?

The answer, the researchers report, was that people were most likely to become obese when a friend became obese. That increased a person’s chances of becoming obese by 57 percent.

There was no effect when a neighbor gained or lost weight, however, and family members had less influence than friends.

Proximity did not seem to matter: the influence of the friend remained even if the friend was hundreds of miles away. And the greatest influence of all was between mutual close friends. There, if one became obese, the odds of the other becoming obese were nearly tripled.

The same effect seemed to occur for weight loss, the investigators say. But since most people were gaining, not losing, over the 32 years of the study, the result was an obesity epidemic.

Dr. Nicholas Christakis, a physician and professor of medical sociology at Harvard Medical School and a principal investigator in the new study, says one explanation is that friends affect each others’ perception of fatness. When a close friend becomes obese, obesity may not look so bad.

“You change your idea of what is an acceptable body type by looking at the people around you,” Dr. Christakis said.

The investigators say their findings can help explain why Americans have become fatter in recent years — each person who became obese was likely to drag some friends with them.

Their analysis was unique, Dr. Christakis said, because it moved beyond a simple analysis of one person and his or her social contacts, and instead examined an entire social network at once, looking at how a person’s friend’s friend’s friends, or spouse’s sibling’s friends, could have an influence on a person’s weight. The effects, Dr. Christakis said, “highlight the importance of a spreading process, a kind of social contagion, that spreads through the network.”

Of course, the investigators say, social networks are not the only factors that affect body weight. There is a strong genetic component at work as well.

Science has shown that individuals have genetically determined ranges of weights, spanning perhaps 30 or so pounds for each person. But that leaves a large role for the environment in determining whether a person’s weight is near the top of his or her range or near the bottom. As people have gotten fatter, it appears that many are edging toward the top of their ranges. The question has been why.

If the new research is correct, it may mean that something in the environment seeded what many call an obesity epidemic, leading a few people to gain weight. Then social networks let the obesity spread rapidly.

It also may mean that the way to avoid becoming fat is to avoid having fat friends.

That is not the message they meant to convey, say the study investigators, Dr. Christakis and his colleague, James Fowler, an associate professor of political science at the University of California in San Diego.

You don’t want to lose a friend who becomes obese, Dr. Christakis said. Friends are good for your overall health, he explains. So why not make friends with a thin person, he suggests, and let the thin person’s behavior influence you and your obese friend?

That answer does not satisfy obesity researchers like Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University.

“I think there’s a great risk here in blaming obese people even more for things that are caused by a terrible environment,” Dr. Brownell said.

On average, the investigators said, their rough calculations show that a person who became obese gained 17 pounds, and the newly obese person’s friend gained 5. But some gained less or did not gain weight at all, while others gained much more.

Those extra pounds were added onto the natural increases in weight that occur when people get older. What usually happened was that peoples’ weights got high enough to push them over the boundary, a body mass index of 30, that divides overweight and obese. (For example, a six-foot-tall man who went from 220 pounds to 225 would go from being overweight to obese.)

While other researchers were surprised by the findings, Dr. Christakis said the big surprise for him was that he could do the study at all. He got the idea from talk of an obesity epidemic.

“One day I said, ‘Maybe it really is an epidemic. Maybe it spreads from person to person,’ ” Dr. Christakis recalled.

It was only by chance that he discovered a way to find out. He learned that the data he needed were contained in a large federal study of heart disease, the Framingham Heart Study, that had followed the population of Framingham, Mass. for decades, keeping track of nearly every one of its participants.

The study’s records included each participant’s address and the names of family members. In order for the researchers to be sure they did not lose track of their subjects, each was asked to name a close friend who would know where they were at the time of their next exam, in roughly four years. Since much of the town and most of the subjects’ relatives were participating, the data contained all that Dr. Christakis and his colleagues needed to reconstruct the social network and follow it for 32 years.

Their research has taken obesity specialists and social scientists aback. But many say the finding is pathbreaking, and can shed new light on how and why people have gotten so fat so fast.

“It is an extraordinarily subtle and sophisticated way of getting a handle on aspects of the environment that are not normally considered,” said Dr. Rudolph Leibel, an obesity researcher at Columbia University.

Dr. Richard Suzman, who directs the office of behavioral and social research programs at the National Institute on Aging, called it “one of the most exciting studies to come out of medical sociology in decades.” The institute financed the study.

But Dr. Stephen O’Rahilly, an obesity researcher at the University of Cambridge, said the uniqueness of the Framingham data will make it hard to replicate the new findings. No other study that he knows of includes the same kinds of long-term and detailed data on social interactions.

“I don’t want to look like an old curmudgeon, but when you come upon things that inherently look a bit implausible, you raise the bar for standards of proof,” Dr. O’Rahilly says. “Good science is all about replication, but it is hard to see how science will ever replicate this.”

“Boy, is the Framingham study unique,” Dr. O'Rahilly said.

How Does Your Waistline Matter? Let Us Count the Ways.

NYTimes Explores Obesity



AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”

But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.

It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.
“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”

Obesity specialists differ on what measurements are best.

Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)

If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.

B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.

In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.

Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”

But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.

And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.

“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”

For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.

As for Linda M., waist measurement made the difference.

“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”

She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”
Talk To Your Doctor:

• What is my body mass index?
• What does it tell me about my health risk?
• Does my waist size put me at higher risk for medical problems?
• Are there metabolic conditions that might be causing me to gain weight?
• Where can I go for practical advice on how to improve my diet and an exercise regimen to lose weight?

My Philosophy: Not a New Year's Resolution, a New Life Resolution/Revolution

Part 1
Because I am slim and fit, a lot of my clients and friends ask me if I diet. I don't believe the word "diet" should be a verb (as in, "Are you dieting?"). I'm a strong believer that one's diet should be a way of life. I don't believe in good foods or bad foods (chocolate cake=bad, rice cake= good). It should be noted that I do not consider highly processed foods, most fast foods, and foods containing certain artificial ingredients (hydrogenated oils, artificial sweeteners, &c.) real food that is fit for consumption. Few things in life are black and white, so why should we expect what we eat to be so simple and binary?

My philosophy is that we should listen to what our bodies are telling us. If we are gaining weight, are becoming hypertensive, if our cholesterol levels are high, if we're always hungry/stuffed, we should take a good, unbiased look at what we eat, when we eat, why we eat, and how we eat, and we should modify those things until we are healthy. What we consume should not negatively affect us, and if it does and we do not change our eating habits, we only have ourselves to blame. We don't have to diet (ie. deprive) we need to adjust our diet (how, how much, and what we eat).

Losing Weight

To effectively lose weight, one needs to adjust their diet as well as their activity level. Doing one without the other probably won't have much of a lasting effect. Think of it as a lifestyle change that will give you a changed body, a healthier body. Our bodies are amazing things. They will do only what we ask of them. If you want the strong, lean body of an active, healthy person, you are going to have to embark on the process of becoming a strong, active, healthy person. You won't get a strong, lean body by watching 20 hours of tv a week and substituting rice cakes for potato chips. If you're willing to accept that your lifestyle as it is now is not giving you the physique you want and committed to altering your lifestyle and adopting a healthier diet and more physical activity, your body will listen. It may grumble, it may ache and complain, but it will listen.

A good friend of mine is always saying, you are the master of your own destiny. You are the master of your body as well.

Change Your Diet, Change Perspective

It's common for many people to improve the quality of their food, make healthier choices, and still find they are not losing weight. Portion size is very important. It is crucial. American meals, especially the ones served at restaurants, have lost all sense of proportion. Our dinner plates are huge. Our spoons are huge. We need to relearn what a real portion size is and accept that. As long as we believe that a steak should be 24 ounces (as opposed to 4-6 ounces), we are not going to get the bodies we want.
At home, use smaller plates and fill them mostly with brightly colored vegetables. Keep your protein portion about the size of a deck of cards and your starch about 1/2 cup (think of a baseball cut in half). Still hungry? Have some more steamed string beans, some more beets, another helping of broccoli.
When you are actively trying to change your diet, to nurture your palate to accept and enjoy healthier real flavors, and to lose weight, you may want to step away from the desserts for a while. You should probably cut out alcohol, which is high in calories. This does not mean that you will forever forgo these items, but just know that for the time being, you are taking a break and resetting your palate and your body. If you must, savor just a bite of some high quality sweet instead of having a whole dessert or candy bar.
When you achieve your goal weight, remember that you can have anything you want occasionally and in moderation.

Exercise

The healthiest way to lose weight is to adopt a healthy diet and exercise. We should all be getting 45 minutes a day of exercise. At least. Our bodies are designed to be active. Unfortunately, our jobs often require we sit still for long periods of time. This starts a vicious circle of fatigue and inflexibility. This vicious circle continues even when we first start working out. It can last a few weeks, but slowly, surely, your body will wake up and rise to the occasion. It will do what you ask of it; it will get stronger, more flexible, healthier. You will feel stronger, healthier. You'll have more energy. As you come into your body, you'll be amazed at how good it feels to be more active, to be stronger. Your body is meant to be strong and healthy and your hard work and exercise will be rewarded. Your body is a part of you. Don't neglect it.

Math

While I don't believe we should be wed to the scale, there are some important numbers to consider. 3500 is the number of calories in a pound. If over the span of a month, you consume 7000 extra calories, you will gain two pounds of fat. Likewise, if over the span of a week, if you decrease your calorie consumption by 200 calories a day (that's about equal to a slice of cheese and a can of soda) while increasing your energy expenditure (exercise) by about 300 calories every day, you can expect to lose a pound.
What about all those diets you read about that tell you to cut out carbs and you'll lose 10 pounds in a week.... well, most of that is water. It is safe and reasonable for most people to lose between 1-2 lbs a week. Unless you have an excessive amount of weight to lose, dropping more than 1-2 lbs a week usually indicates you are dehydrated (a side effect of ketosis, the state your body goes into when it's deprived of carbohydrates).
Going back to what I wrote earlier about being wed to the scale... you should use how you look, how you feel, how your clothes fit, as better indicators of your progress. Muscle weighs more than fat. How much more? A pound of fat is about the size of a large grapefruit. A pound of muscle is about the size of a small orange or tangerine. So if you are losing fat and gaining muscle, the numbers on the scale might not be moving very much. If the jeans you banished to the back of your closet or some other "thin clothes" are telling you you lost weight but your scale is telling you otherwise, rest assured that you may not have lost "weight" but you certainly lost fat.

Maternal Fitness: Spotlight Obesity

Obesity Damages
Women who are obese during pregnancy have more complications and their babies tend to have more medical problems at birth according to a new report. Excess weight increases the risk of hypertension, gestational diabetes and bloodclots, and babes of obese mothers are more likely to have neural-tube defects and spend more time in the neonatal intensive care unit. To avoid gaining more weight than necessary it is critical to exercise regularly and eat nutritiously. -Wiley Institute for Fit Pregnancy