Posted by on April 17, 2011 - 11:16am

Addictive eating behavior and substance dependence have similar patterns of brain activity, finds a new study from the Rudd Center for Food Policy and Obesity at Yale. The study is published in the Archives of General Psychiatry and is the first to link symptoms of addictive eating behavior with specific patterns of brain activity in both obese and lean individuals.

Previous research has identified similar patterns of brain activity in obese and substance-dependent people, which has led to the theory that some people may be addicted to high-calorie foods, but no previous studies have explored whether lean as well as obese individuals who exhibit symptoms of addictive eating behavior have neural responses similar to those of drug addicts.

In the current study, 48 healthy adolescent women ranging from lean to obese completed the Yale Food Addiction Scale (YFAS), which applies the diagnostic criteria for substance dependence to eating behavior. Next, using brain-imaging procedures such as functional magnetic resonance imaging (fMRI), the study examined the relation of food addiction symptoms, as assessed by the YFAS, with the women’s brain activity in response to food-related tasks. The first task looked at how the brain responded to cues signaling the impending delivery of a highly palatable food (chocolate milkshake) versus cues signaling the impending delivery of a tasteless control solution. The second test looked at brain activity during the actual intake of the chocolate milkshake versus the tasteless solution.

Both lean and obese participants with higher food addiction scores showed different brain activity patterns than those with lower food addiction scores. In response to the anticipated receipt of food, participants with higher food addiction scores showed greater activity in parts of the brain responsible for cravings and the motivation to eat, but less activity in the regions responsible for inhibiting urges such as the desire to drink a milkshake. Thus, similar to drug addicts, individuals exhibiting signs of food addiction may struggle with increased cravings and stronger motivations to eat in response to food cues and may feel more out-of-control when eating highly palatable foods.

According to Ashley Gearhardt, clinical psychology doctoral student at Yale University and lead author, “The findings of this study support the theory that compulsive eating may be driven in part by an enhanced anticipation of food rewards and that addicted individuals are more likely to be physiologically, psychologically, and behaviorally reactive to triggers such as advertising. The possibility that food-related cues may trigger pathological properties is of special concern in the current food environment where highly palatable foods are constantly available and heavily marketed.”

The authors assert that efforts to change the current food environment may be critical to successful weight loss and prevention efforts since food cues may take on motivational properties similar to drug cues. The current emphasis on personal responsibility as the reason for increasing obesity rates may have minimal effectiveness as palatable food consumption may be accompanied with a loss-of-control for individuals exhibiting signs of food addiction.

Source:  Yale University

Posted by on April 14, 2011 - 2:44pm

We all keep hearing that we need to eat more whole grains, but does everyone know what they are?   It's pretty obvious they are NOT that swishy white bread that we used to make dough balls out of when we were kids (to use for bait while fishing!).    Whole grains are cereal grains that consist of the intact, ground, cracked or flaked kernel, which includes the bran, the germ and the inner most part of the kernel (endosperm).  Examples of whole grains include whole wheat, oatmeal, whole-grain cornmeal, brown rice, whole-grain barley, whole rye, and buckwheat.

When checking the ingredient list, it is best if they list the whole grain first on the list (usually the most abundant of the ingredients).  The general recommendation is to have have three one-ounce equivalents of whole grains daily to help reduce the risk of chronic disease such as heart disease and cancer.

Examples of a one ounce equivalent are:

  • 1/2 cup cooked oatmeal
  • 1/2 cup cooked 100% whole-grain pasta
  • 1/2 cup cooked brown rice or whole-grain barley
  • 1 regular slice of 100% whole-grain breast
  • 1 cup of whole-grain ready-to-eat cereal (flakes or rounds) or 1 1/4 cup puffed.
Posted by on April 4, 2011 - 8:45am

High-fiber diets during early adult years may lower lifetime cardiovascular disease risk

A new study from Northwestern Medicine shows a high-fiber diet could be a critical heart-healthy lifestyle change young and middle-aged adults can make. The study found adults between 20 and 59 years old with the highest fiber intake had a significantly lower estimated lifetime risk for cardiovascular disease compared to those with the lowest fiber intake.  This is the first known study to show the influence of fiber consumption on the lifetime risk for cardiovascular disease.

“It’s long been known that high-fiber diets can help people lose weight, lower cholesterol and improve hypertension,” said Donald M. Lloyd-Jones, M.D., corresponding author of the study and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine. “The results of this study make a lot of sense because weight, cholesterol and hypertension are major determinants of your long-term risk for cardiovascular disease.”

A high-fiber diet falls into the American Heart Association’s recommendation of 25 grams of dietary fiber or more a day.  Lloyd-Jones said you should strive to get this daily fiber intake from whole foods, not processed fiber bars, supplements and drinks.

“A processed food may be high in fiber, but it also tends to be pretty high in sodium and likely higher in calories than an apple, for example, which provides the same amount of fiber,” Lloyd-Jones said.

For the study, Hongyan Ning, M.D., lead author and a statistical analyst in the department of preventive medicine at Feinberg, examined data from the National Health and Nutrition Examination Survey, a nationally representative sample of about 11,000 adults.  Ning considered diet, blood pressure, total cholesterol, smoking status and history of diabetes in survey participants and then used a formula to predict lifetime risk for cardiovascular disease.

“The results are pretty amazing,” Ning said. “Younger (20 to 39 years) and middle-aged (40 to 59 years) adults with the highest fiber intake, compared to those with the lowest fiber intake, showed a statistically significant lower lifetime risk for cardiovascular disease.”  In adults 60 to 79 years, dietary fiber intake was not significantly associated with a reduction in lifetime risk of cardiovascular disease. It’s possible that the beneficial effect of dietary fiber may require a long period of time to achieve, and older adults may have already developed significant risk for heart disease before starting a high-fiber diet, Ning said.

As for young and middle-aged adults, now is the time to start making fiber a big part of your daily diet, Ning said.

Erin White is the broadcast editor. Contact her at ewhite@northwestern.edu

Posted by on March 18, 2011 - 8:55am

 

Grapes or Raisins?

Almost everyone who is health conscious agrees that American food portions are out of control!  One of our most visited blogs "Eat less, Move More" has generated a lot of comments and many readers are surprised how small portions need to be if you want to lose weight.   We've also received a number of suggestions like using a smaller plate, eating 5-6  mini meals every day, etc.   But the bottom line remains the same:   If you want to actually lose weight and you are not an exercise buff, portion control is a good way to go. However, not all portions represent the same amount of calories.

Feel fuller on fewer calories. This requires understanding the concept of "energy density".   Energy density is the number of calories (energy) in a certain amount of food.   High energy density means that there are a lot of calories in a small amount of food.   Low energy density means there are few calories in a lot of food.

One of the classic examples is raisins vs. grapes.    A one cup of raisins (dried grapes)  has about 434 calories.  A cup of fresh grapes has about 104 calories.  So to eat the same amount of calories, you would have to limit the raisins to 1/4 a cup!  Which choice would make you feel fuller?   One ounce of potato chips is 150 calories, the same amount of calories found in 3 1/2 cups of air popped popcorn.

In order to lose or maintain your weight, your goal should be to eat more  low energy dense foods.  That way, you eat larger portions that make you feel fuller.   Let's explore this density concept a bit further.   Several factors play a role in what makes food high or low in energy density.

1.  Water.   Fruits and vegetables have a high water content which provides volume but not calories, making them a low energy dense food.  A grapefruit is 90 percent water and a  half grapefruit is only 39 calories.  Watermelon is 92% water.

2. Fiber.  High fiber foods provide volume and take longer to digest, making you feel fuller with less calories.

3.  Fat.  Fat is very high in energy density (remember we are really talking about calories!).   One teaspoon of butter contains almost the same number of calories as 2 cups of low energy dense broccoli.

What about nutrition?   Does  "fullness" translate into a adequate nutritional intake?   What foods are better options when it comes to energy density?.    According to the Mayo Clinic Health Weight Pyramid:.

  • Most vegetables are low in calories but high in volume especially lettuce, asparagus, broccoli and zucchini.    Add more vegetables to your pastas instead of meat and cheesy sauces.   Put veggies on your sandwiches instead cheese slices and gobs of mayonnaise.
  • Fruits are healthy but some are lower calorie choices than others and certain fruits have more concentrated sugars (such as raisins) and have higher calories with less volume.   Fruit juices are also relatively high in calories and don't necessarily fill you up.   Eating a whole orange with its natural fiber will fill you up more than a glass of orange juice.
  • Carbohydrates are either grains or foods made from grains like cereals and pasta.  Select carbs that are higher in fiber like oatmeal, whole grain breads, brown rice and avoid breads made with refined white flour and sweeteners.
  • Fats are a high energy dense food but some are healthier than others.   Watch your portions and include monounsaturated and polyunsaturated fats in your diet like nuts, seeds, healthier vegetable oils (flax see, olive, and safflower oil). Just keep the portions small.
  • Sweets are high in energy density and are a challenge when it comes to caloric intake.   Try to find desserts that have low fat and sugar content, such as fruits and low-fat yogurt.  If they are baked, look for whole grain flour pastries.   The key to limiting the effect of sweets is to keep the servings small (share with your table mates--1 dessert, 4 forks--most restaurants are accommodating).
  • Protein comes from plant and animal sources and the healthiest low-energy dense choices are those high in protein but low in fat  such as lentils (also high in fiber!), skinless white meat, and fish.  Select fat-free dairy foods.

Substituting low density foods keep you from feeling food deprived, make you feel better about your meal and will help keep those calories down!  Here's a final example:   A small order of McD's french fries has 225 calories.  You could substitute (with the same amount of calories)  a salad made with a small apple, 10 cups of fresh spinach, and 1 1/2 cups strawberries with a splash of diet dressing.

Posted by on December 21, 2010 - 5:11pm

Study Shows Strong Link between Obesity and Mortality

The largest study of its kind has confirmed a strong association between overweight and obesity and an increased risk of death. The study also identified a range of body-mass index (BMI) at which mortality risk is lowest, confirming earlier studies indicating that people who are in the normal weight range have a significantly lower risk of dying from a host of causes compared with those who are overweight. The findings were published December 2 in the New England Journal of Medicine.

Obesity and overweight continue to be major health problems in the United States. Approximately two-thirds of the adult U.S. population are overweight or obese, meaning that they have a BMI of 25 or higher.

Researchers from NCI and other NIH institutes, as well as from other U.S. and foreign health agencies and universities, pooled data on 1.46 million people from 19 long-term prospective cohort studies. The participants in these cohort studies were white and from more industrialized countries, limiting the extent to which the findings can be extrapolated to other populations, the researchers explained. The analysis focused on participants who had never smoked and did not have cardiovascular disease or cancer at study entry, eliminating “potentially strong confounders” of mortality risk that have affected some earlier studies, explained the study’s lead author, Dr. Amy Berrington de Gonzalez of NCI’s Division of Epidemiology and Cancer Genetics.

Overall, the lowest mortality risk was seen for those with a BMI between 20 and 24.9. Above that level, every 5-unit increase in BMI increased the risk of death by 31 percent. The risk of death was substantially elevated in the severely obese, those with a BMI of 40 or higher. Women who fell into this category had a 2.5-fold higher risk of death compared with women in the lowest risk BMI range. The risk relationship was similar for men.

Across the BMI levels that correspond with overweight and obesity, the relationship between BMI and mortality was strongest for participants who were younger than 50 at study entry, Dr. Berrington de Gonzalez added.

Although the cancer-specific mortality risk was smaller than the mortality risk associated with cardiovascular disease, the study only assessed overall cancer risk, she said. “Based on previous studies, we know that the relationship between obesity and cancer varies by cancer type,” she continued. So, while obesity is strongly associated with an increased risk of postmenopausal  breast cancer and renal cancer, for example, it is not associated with some other cancers. As a result, when cancer is considered as a single disease, the overall association is weaker, Dr. Berrington de Gonzalez said.

Posted by on December 16, 2010 - 3:03pm

People will gain significantly less weight by middle age – especially women – if they engage in moderate to vigorous activity nearly every day of the week starting as young adults, according to new Northwestern Medicine research.

Women particularly benefitted from high activity over 20 years, gaining an average of 13 pounds less than those with low activity; while men with high activity gained about 6 pounds less than their low-activity peers. High activity included recreational exercise such as basketball, running, brisk walking or an exercise class or daily activities such as housework or construction work.

“Everyone benefits from high activity, but I was surprised by the gender differences,” said lead author Arlene Hankinson, M.D., an instructor in preventive medicine at Northwestern University Feinberg School of Medicine. “It wasn’t that activity didn’t have an effect in men, but the effect was greater in women. Now women should be especially motivated.”

The study will be published Dec. 14 in the Journal of the American Medical Association.

There could be several reasons for the gender difference, Hankinson said. Women are less likely than men to overestimate their activity, according to previous studies. “Men may not be getting as much activity as they report,” Hankinson explained.  In addition, men in the high-activity group compensated by eating more than their low-activity counterparts, which could have led to more weight gain. The highly active women didn’t eat more than low-activity women in the study.

There were many ways to achieve the study’s definition of high-activity levels, Hankinson noted. One way was 150 minutes of moderate to vigorous activity a week.

The study participants -- 1,800 women and nearly 1,700 men — are part of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a multi-center, longitudinal and population-based observational study designed to describe the development of risk factors for coronary heart disease in young black and white adults.

Coauthor Stephen Sidney, M.D., associate director for clinical research at the Kaiser Permanente Division of Research. “Common medical problems such as heart disease, diabetes and obesity have their origins in childhood and can generally be prevented by maintaining a normal weight, not smoking, exercising regularly and eating a healthy diet throughout life.”

Hankinson’s research is the first to measure the impact of high activity over 20 years between young adulthood and middle age and to frequently examine participants (seven times) over that period. Study participants are more likely to remember and accurately report their behavior with regular exams, she said.   Previous studies, Hankinson said, looked at a single exercise intervention’s effect on weight for a short period of time or examined participants in longer studies at only two points in time -– the beginning and the end.

“We wanted to see if people’s activity levels during their youth were enough to help them keep weight off in middle age, or if they needed to up the ante,” Hankinson said. “It’s difficult to avoid gaining weight as you age. Our metabolic rate goes down. We develop conditions or have lifestyles that make it harder to maintain a high level of activity.”

“The study reinforces that everyone needs to make regular activity part of their lifestyles throughout their lives,” she said. “Not many people actually do that.” The active group in the study comprised only 12 percent of the participants.  Lower levels of activity had a negligible effect on weight gain in the study. “High activity was the only kind that made a significant difference,” Hankinson noted.

Marla Paul is the health sciences editor. Contact her at marla-paul@northwestern.edu

Posted by on December 13, 2010 - 8:44am

A new study found that nearly 1 in 4 overweight American women believes her body weight as normal, while conversely, around 1 in 6 normal weight women regards herself as overweight.

The study was done by researchers at the University of Texas Medical Branch (UTMB) and is published in the December 2010 issue of Obstetrics and Gynecology. Over 2200 women ages between 18 and 25 complete questionnaires that asked about health behaviors including how they perceived their body weight.  Then actual measurements were taken using the current standard definition of body mass index  (Normal 18.5-24.9; overweight 25-29.9; and obese >30).

Among the 1162 women that were actually overweight, 23% of them (misperceivers) believed they were of normal weight. Of the 1062 women who had normal weight based on their BMI, 16% considered themselves to be overweight.

The researchers concluded that weight misperception was especially common among reproductive age women and that this should be taken into account while counseling patients about weight management.

To reach the entire article found in Medical News Today click HERE.

Posted by on November 24, 2010 - 12:45pm

In a new meta-analysis published in the November 2010 issue of Diabetes Care, researchers from the Harvard School of Public Health report that consumption of just one or two sugar-sweetened beverages per day is associated with a 26% greater risk of developing type 2 diabetes and a 20% increased risk of developing metabolic syndrome.   Senior author Dr. Frank Hu put this into perspective,  "So for those who drink two to three sodas per day, their risk of developing type 2 diabetes would be increased by 30-40% which is not very different from the increased risk associated with cigarette smoking."

It is not clear from the study if the main reason for the increased risk is due to the increase in calories or due to the combination of  excess calories and some unique metabolic effects of fructose and other components of soft drinks.

The authors note that the jury is still out on the long-term effects of artificial sweeteners in soft drinks, so they caution against substituting diet sodas or drinks for sugar sweetened ones.    Water, nonsweetened tea or coffee may be better choices.

Posted by on October 7, 2010 - 2:39pm

I just got back from a brief vacation in the Italian region of Emilia Romagna--the land of Parma ham, proscuitto, Pasta Bolognese and tasty hard cheeses. One of the regional specialties is a ravioli filled with spinach and ricotta covered in a butter sauce and sprinkled with parmesan cheese (Are your arteries choking yet?).    I was immediately struck by the lack of overweight people despite these wonderful foods that are high in fat and quite salty.   What is it about Italy that allows people to stay thin, yet eat these rich foods?

Now, I admit that this particular blog posting is not based on comparative research but rather a reflection on a brief vacation experience.   I really don't know if Italians have more heart attacks than Americans---but to the watchful eye, I was struck by all the healthy "looking" people who were strolling the piazzas who were significantly thinner than the people I see walking around the malls in America.  In fact, I saw almost NO overweight people.

Yes, they walk a lot, ride bicycles and spend time walking off their meals during their traditional passegiata (Lots of the men walk with their jackets thrown over their shoulders like a cape....molte elegante!).    But they also eat dinner very late (after 8 pm), close their shops for a 3 hour lunch break, and enjoy their  bread, wine and gelato.  On the other hand, not all meals are large, there are no fast food places in the small towns, and their cups of espresso hold about a tablespoon of caffe in those cute little cups.  Everything is freshly made and the small grocery stores are not lined with freezers filled with processed foods.

We spent some time with friends who lived in the community and learned that they have all their health care covered (even though taxes are high), work about 35 hours max. a week, and have 32 plus days vacation a year which they often spend in neighboring countries hiking and biking.  Many of the pharmacies provide basic health care services locally.    The school children play lots of sports and not everyone has a car.  Trains are plentiful between cities but, in the small towns,  the best way to get around is to walk.    Their houses and apartments are half the size of those in America but very adequate.   Their way of life seems more relaxed---everywhere you looked, people were gathered and simply enjoying each other----and talking to each other!    Cell phones were plentiful  but they didn't seem to replace face to face conversation.    I didn't see people eating at tables and talking on their phones as much as you see here.  They don't seem to watch nearly the amount of TV that Americans do.    I'm sure they have the usual worries about their jobs and families but they still have a quiet zest that permeates their everyday lives.   Overall, the stress level was definitely less apparent than it is in the U.S.    Maybe the word I am looking for is "content".   They seemed happy with their lives whether they were farmers, teachers or stay at home moms.

People say that traveling is educational.  On this trip, I learned that there are lifestyles that may be different---but perhaps better-- than ours.

Posted by on September 21, 2010 - 4:01pm

Today,more than 200 health professionals attended the Institute for Women's Health Research at Northwestern University's first educational research forum of the 2010-2011 school year that  featured Bonnie Spring, PhD, a behavioral psychologist at Northwestern.   Her lecture entitled  "Untangling the Web of Women, Smoking and Weight"  made me realize how much we still need to learn about the power of addiction.  Here are some interesting notes about smoking cessation and weight gain from her lecture:

  • Reasons women continue to smoke:   mood and stress management, addiction/craving, social network, weight management.
  • Fear of weight gain discourages 50% of women and 26% of men who smoke  from quitting.   The reality is that 80% of people who quit smoking gain weight but the actual weight gain is about 6-10 lbs. , not the 15 lbs. that people assume.
  • The major cause of post cessation weight gain:   decreased metabolism (from nicotine cessation) and increased energy intake from snacks. Evidently, when we take away something the body values or provides pleasure (e.g., nicotine), we tend to substitute it with something else that we value (e.g. food).
  • Education about the benefits of not smoking is not enough to change behavior;  exercise alone to keep weight off while quitting smoking does not work.
  • Drugs sometimes used during smoking cessation to keep weight down work while they are being used, but once they are stopped, the weight returns.
  • Several studies have been conducted to determine if weight loss programs should be done simultaneously during smoking cessation therapy; shortly after smoking cessation has begun;  or completely after the person quits.  The results vary and it is not yet clear what the best approach is.
  • A lot of controversy persists around the question:   Do weight management efforts undermine tobacco abstinence?  Despite several national guidelines that state so, there is no study that demonstrates that trying to prevent weight gain while trying to quit smoking makes it less likely that a woman will succeed at quitting smoking, according to Dr. Spring.

Some promising approaches that are being evaluated include:

  • Sequential behavioral treatment (cessation, then diet and activity change) more effective than simultaneous treatment because it is  less overwhelming to the patient.
  • Exercise alone does not suppress weigh gain
  • Bupropion, varenicline, NRT suppress weight gain in the short term, but not long-term (after medications discontinued)
  • Weight acceptance (but so far tested only among very weight concerned smokers)

So the jury is still out on the best way to quit smoking.  Dr. Spring also shared some of the early advertising campaigns that were highly successful in raising the number of women smokers.   She noted, "Perhaps the best way to get women to quit smoking is to hire the companies that have been so successful in getting women addicted!"

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