Health Journal Online

Category: Nutrition

  • Obesity medications | Dietitian Connection

    Obesity medications | Dietitian Connection

    US dietitians: “Obesity medications: What every dietitian needs to know” awards 1.0 CPEU in accordance with the Commission on Dietetic Registration’s CPEU Prior Approval Program. You can claim 1.0 CPEU for watching the webinar recording OR listening to the podcast version.
    You can access your post-test learner assessment here.  
    CPD/CEU hours are applicable for Australia and New Zealand dietitians. Check your local country requirements to see if you can claim for continuing education.
    To obtain your CPEU/CPD certificate or certificate of completion, click here then fill in your name and the date you listened to the podcast.

    With the ongoing development of medications used in the treatment of obesity and weight management, dietitians must stay on top of the latest information and understand how they fit into a comprehensive treatment plan. In this episode of Dietitian to Dietitian, NBC’s Today Show nutrition and health expert Joy Bauer along with Beth Czerwony, MS, RD, CSOWM, LD and Colleen Dawkins, FNP-C, RDN, CSOWM discuss the integration of GLP-1 medications in nutrition therapy: the indications for use, who is most likely to have success, and the potential side effects and how to manage them.  

    Hosted by Joy Bauer 

    Biographies

    Beth Czerwony MS, RD, CSOWM, LD is a Clinical Registered Dietitian with the Cleveland Clinic’s Center for Human Nutrition since 2007. In 2019, Beth earned her Certification in Obesity and Weight Management and serves as a preceptor for dietetic interns and mentors both ASMBS and Weight Management DPG. She is member of the Weight Management DPG for the Academy of Nutrition and Dietetics, American Society of Metabolic and Bariatric Surgery, and The Obesity Society. Outside of the clinical setting, Beth has completed multiple local and national presentations and media interviews.

     

     

    Colleen Dawkins, MSN, ARNP, FNP-C, MS, RDN, CSOWM is a Nurse Practitioner in private practice at Big Sky Medical Wellness. She is board-certified in family medicine, a Registered Dietitian Nutritionist, and a Certified Specialist in Obesity and Weight Management. Colleen serves as treasurer for the Washington Obesity Society, vice chair for the Commission on Dietetic Registration’s Obesity Certificate of Training program advisory board, member of the Obesity Medicine Association’s algorithm committee, associate editor and reviewer for Obesity Pillars journal, and is a doctoral student at the University of Southern Mississippi.

     

    Joy Bauer, MS, RDN, CDN, one of America’s leading health authorities, is the nutrition and healthy lifestyle expert for NBC’s TODAY show. She also hosts her own Amazon Live weekly show, Health, Happiness, Joy, where she cooks up mouthwatering recipes, answers viewers’ questions in real-time, and shares her favorite products and kitchen hacks. In addition, Joy is the official nutritionist for the New York City Ballet, the creator of JoyBauer.com, and a #1 New York Times bestselling author with 14 bestsellers to her credit.

     

    In this episode, we discuss:​

    • How these medications can complement dietary interventions and the vital role of the dietitian in providing patient-centered care
    • What to do when medication isn’t the answer for a patient 
    • Best practices for collaborating effectively with your medical team 

    Additional resources

    You can find a handout with information and additional resources here and the speakers’ references here.  


    The content, products and/or services referred to in this podcast are intended for Health Care Professionals only and are not, and are not intended to be, medical advice, which should be tailored to your individual circumstances. The content is for your information only, and we advise that you exercise your own judgement before deciding to use the information provided. Professional medical advice should be obtained before taking action. The reference to particular products and/or services in this episode does not constitute any form of endorsement. Please see  here  for terms and conditions.

     

     

     

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  • What Is the Role of Our Genes in the Obesity Epidemic? 

    What Is the Role of Our Genes in the Obesity Epidemic? 

    The “fat gene” accounts for less than 1 percent of the differences in size between people.

    To date, about a hundred genetic markers have been linked to obesity, but when you put them all together, overall, they account for less than 3 percent of the difference in body mass index (BMI) between people. You may have heard about the “fat gene,” called FTO, short for FaT mass and Obesity-associated). It’s the gene most strongly linked to obesity, but it explains less than 1 percent of the difference in BMI between people, a mere 0.34 percent. 

    As I discuss in my video The Role of Genes in the Obesity Epidemic, FTO codes for a brain protein that appears to affect our appetite. Are you one of the billion people who carry the FTO susceptibility genes? It doesn’t matter because it only appears to result in a difference in intake of a few hundred extra calories a year. The energy imbalance that led to the obesity epidemic is on the order of hundreds of calories a day, and that’s the gene known so far to have the most effect. The chances of accurately predicting obesity risk based on FTO status is “only slightly better than tossing a coin.” In other words, no, those genes don’t make you look fat.

    When it comes to obesity, the power of our genes is nothing compared to the power of our fork. Even the small influence the FTO gene does have appears to be weaker among those who are physically active and may be abolished completely in those eating healthier diets. FTO only appears to affect those eating diets higher in saturated fat, which is predominantly found in meat, dairy, and junk food. Those eating more healthfully appear to be at no greater risk of weight gain, even if they inherited the “fat gene” from both of their parents.

    Physiologically, FTO gene status does not appear to affect our ability to lose weight. Psychologically, knowing we’re at increased genetic risk for obesity may motivate some people to eat and live more healthfully, but it may cause others to fatalistically throw their hands up in the air and resign themselves to thinking that it just runs in their family, as you can see in the graph below and at 2:11 in my video. Obesity does tend to run in families, but so do lousy diets. 

    Comparing the weight of biological versus adopted children can help tease out the contributions of lifestyles versus genetics. Children growing up with two overweight biological parents were found to be 27 percent more likely to be overweight themselves, whereas adopted children placed in a home with two overweight parents were 21 percent more likely to be overweight. So, genetics do play a role, but this suggests that it’s more the children’s environment than their DNA.

    One of the most dramatic examples of the power of diet over DNA comes from the Pima Indians of Arizona. As you can see in the graph below and at 3:05 in my video, they not only have among the highest rates of obesity, but they also have the highest rates of diabetes in the world. This has been ascribed to their relatively fuel-efficient genetic makeup. Their propensity to store calories may have served them well in times of scarcity when they were living off of corn, beans, and squash, but when the area became “settled,” their source of water, the Gila River, was diverted upstream. Those who survived the ensuing famine had to abandon their traditional diet to live off of government food programs and chronic disease rates skyrocketed. Same genes, but different diet, different result. 

    In fact, a natural experiment was set up. The Pima living over the border in Mexico come from the same genetic pool but were able to maintain more of their traditional lifestyle, sticking with their main staples of beans, wheat flour tortillas, and potatoes. Same genes, but seven times less obesity and about four times less diabetes. You can see those graphs below and at 3:58 and 4:02 in my video. Genes may load the gun, but diet pulls the trigger.

    Of course, it’s not our genes! Our genes didn’t suddenly change 40 years ago. At the same time, though, in a certain sense, it could be thought of as all in our genes. That’s the topic of my next video The Thrifty Gene Theory: Survival of the Fattest.

    This is the second in an 11-video series on the obesity epidemic. If you missed the first one, check out The Role of Diet vs. Exercise in the Obesity Epidemic. 



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  • Are We Polar Bears in a Jungle? 

    Are We Polar Bears in a Jungle? 

    Rather than being some kind of disorder or a failure of willpower, weight gain is largely a normal response by normal people to an abnormal situation.

    It’s been said that “Nothing in biology makes sense except in the light of evolution.” The known genetic contribution to obesity may be small, but, in a certain sense, you could argue that it’s all in our genes. The excess consumption of available calories may be hardwired into our DNA. We were born to eat.

    Throughout human history and beyond, we existed in survival mode—in unpredictable scarcity. We’ve been programmed with a powerful drive to eat as much as we can while we can and just store the rest for later. Food availability could never be taken for granted, so those who ate more at the moment and were best able to store more fat for the future might better survive subsequent shortages to pass along their genes. So, generation after generation, millennia after millennia, those with lesser appetites may have died out, while those who gorged may have selectively lived long enough to pass along their genetic predisposition to eat and store more calories. That may be how we evolved into such voracious calorie-conserving machines. Now that we’re no longer living in such lean times, though, we’re no longer so lean ourselves.

    What I just described is the “thrifty gene” concept proposed in 1962. As I discuss in my video The Thrifty Gene Theory: Survival of the Fattest, it suggests that obesity is the result of a “‘mismatch’ between the environment in which humans evolved and our modern environment”—like being a polar bear in a jungle. All that fur and fat may have given polar bears an edge in the Arctic but would be decidedly disadvantageous in the Congo. Similarly, a propensity to pack on the pounds may have been a plus in prehistoric times but can turn into a liability when our scarcity-sculpted biology is plopped down into the land of plenty. So, it’s not gluttony or sloth. Obesity may simply be “a normal response to an abnormal environment.”

    Much of our physiology is finely tuned to stay within a narrow range of upper and lower limits. If we get too hot, we sweat; if we get too cold, we shiver. Our body has mechanisms to keep us in balance. In contrast, our bodies have had little reason to develop an upper limit to the accumulation of body fat. In the beginning, there may have been evolutionary pressures to keep lithe and nimble in the face of predation, but thanks to things like weapons and fire, we haven’t had to outrun as many saber-toothed tigers for about two million years or so. This may have left our genes with the one-sided selection pressures to binge on every morsel in sight and stockpile as many calories as possible in our bodies.

    What was once adaptive is now a problem—or at least so says the thrifty gene hypothesis that originated more than half a century ago. It “provides a simple and elegant explanation for the modern obesity epidemic and was quickly embraced by scientists and lay people alike.” Although the researcher, James Neel, later distanced himself from the original proposal, the basic premise, despite remaining mostly theoretical, is still “largely accepted” by the scientific community, and the implications are profound.

    In 2013, the American Medical Association voted to classify obesity as a disease (going against the advice of its own Council on Science and Public Health). Not that it necessarily matters what we call it, but disease implies dysfunction. Bariatric drugs and surgery are not correcting an anomaly in human physiology. Our bodies are just doing what they were designed to do in the face of excess calories. Rather than being some sort of disorder, weight gain is largely “a normal response by normal people to an abnormal environment.” As you can see below and at 4:12 in my video, more than 70 percent of Americans are now overweight. It’s normal. 

    “A body gaining weight when excess calories are available for consumption is behaving normally. Efforts to curtail such weight gain with drugs [or surgery] are not efforts to correct an anomaly in human physiology, but rather to deconstruct and reconstruct its normal operations at the core.”

    If weight gain is largely a normal response by normal people to an abnormal situation, what exactly is that abnormal situation? Calorie-Rich-And-Processed Foods. (I’ll let you work out the acronym.) That’s the topic we’ll turn to next.

    This is the third in an 11-video series on the history of the obesity epidemic. If you missed the first two, see The Role of Diet vs. Exercise in the Obesity Epidemic and The Role of Genes in the Obesity Epidemic.

    There are eight more coming up. See the related posts below.



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  • Cutting the Calorie-Rich-And-Processed Foods 

    Cutting the Calorie-Rich-And-Processed Foods 

    We have an uncanny ability to pick out the subtle distinctions in calorie density of foods, but only within the natural range.

    The traditional medical view on obesity, as summed up nearly a century ago: “All obese persons are, alike in one fundamental respect,—they literally overeat.” While this may be true in a technical sense, it is in reference to overeating calories, not food. Our primitive urge to overindulge is selective. People don’t tend to lust for lettuce. We have a natural inborn preference for sweet, starchy, or fatty foods because that’s where the calories are concentrated.

    Think about hunting and gathering efficiency. We used to have to work hard for our food. Prehistorically, it didn’t make sense to spend all day collecting types of food that on average don’t provide at least a day’s worth of calories. You would have been better off staying back at the cave. So, we evolved to crave foods with the biggest caloric bang for their buck.

    If you were able to steadily forage a pound of food an hour and it had 250 calories per pound, it might take you ten hours just to break even on your calories for the day. But if you were gathering something with 500 calories a pound, you could be done in five hours and spend the next five working on your cave paintings. So, the greater the energy density—that is, the more calories per pound—the more efficient the foraging. We developed an acute ability to discriminate foods based on calorie density and to instinctively desire the densest.

    If you study the fruit and vegetable preferences of four-year-old children, what they like correlates with calorie density. As you can see in the graph below and at 1:52 in my video Friday Favorites: Cut the Calorie-Rich-And-Processed Foods, they prefer bananas over berries and carrots over cucumbers. Isn’t that just a preference for sweetness? No, they also prefer potatoes over peaches and green beans over melon, just like monkeys prefer avocados over bananas. We appear to have an inborn drive to maximize calories per mouthful. 

    All the foods the researchers tested in the study with four-year-old kids naturally had less than 500 calories per pound. (Bananas topped the chart at about 400.) Something funny happens when you start going above that: We lose our ability to differentiate. Over the natural range of calorie densities, we have an uncanny aptitude to pick out the subtle distinctions. However, once you start heading towards bacon, cheese, and chocolate territory, which can reach thousands of calories per pound, our perceptions become relatively numb to the differences. It’s no wonder since these foods were unknown to our prehistoric brains. It’s like the dodo bird failing to evolve a fear response because they had no natural predators—and we all know how that turned out—or sea turtle hatchlings crawling in the wrong direction towards artificial light rather than the moon. It is aberrant behavior explained by an “evolutionary mismatch.”

    The food industry exploits our innate biological vulnerabilities by stripping crops down into almost pure calories—straight sugar, oil (which is pretty much pure fat), and white flour (which is mostly refined starch). It also removes the fiber, because that effectively has zero calories. Run brown rice through a mill to make white rice, and you lose about two-thirds of the fiber. Turn whole-wheat flour into white flour, and lose 75 percent. Or you can run crops through animals (to make meat, dairy, and eggs) and remove 100 percent of the fiber. What you’re left with is CRAP—an acronym used by one of my favorite dieticians, Jeff Novick, for Calorie-Rich And Processed food.

    Calories are condensed in the same way plants are turned into addictive drugs like opiates and cocaine: “distillation, crystallization, concentration, and extraction.” They even appear to activate the same reward pathways in the brain. Put people with “food addiction” in an MRI scanner and show them a picture of a chocolate milkshake, and the areas that light up in their brains (as you can see below and at 4:15 in my video) are the same as when cocaine addicts are shown a video of crack smoking. (See those images below and at 4:18 in my video.) 

    “Food addiction” is a misnomer. People don’t suffer out-of-control eating behaviors to food in general. We don’t tend to compulsively crave carrots. Milkshakes are packed with sugar and fat, two of the signals to our brain of calorie density. When people are asked to rate different foods in terms of cravings and loss of control, most incriminated was a load of CRAP—highly processed foods like donuts, along with cheese and meat. Those least related to problematic eating behaviors? Fruits and vegetables. Calorie density may be the reason people don’t get up in the middle of the night and binge on broccoli.

    Animals don’t tend to get fat when they are eating the foods they were designed to eat. There is a confirmed report of free-living primates becoming obese, but that was a troop of baboons who stumbled across the garbage dump at a tourist lodge. The garbage-feeding animals weighed 50 percent more than their wild-feeding counterparts. Sadly, we can suffer the same mismatched fate and become obese by eating garbage, too. For millions of years, before we learned how to hunt, our biology evolved largely on “leaves, roots, fruits, and nuts.” Maybe it would help if we went back to our roots and cut out the CRAP. 

    A key insight I want to emphasize here is the concept of animal products as the ultimate processed food. Basically, all nutrition grows from the ground: seeds, sunlight, and soil. That’s where all our vitamins come from, all our minerals, all the protein, all the essential amino acids. The only reason there are essential amino acids in a steak is because the cow ate them all from plants. Those amino acids are essential—no animals can make them, including us. We have to eat plants to get them. But we can cut out the middlemoo and get nutrition directly from the Earth, and, in doing so, get all the phytonutrients and fiber that are lost when plants are processed through animals. Even ultraprocessed junk foods may have a tiny bit of fiber remaining, but all is lost when plants are ultra-ultraprocessed through animals.

    Having said that, there was also a big jump in what one would traditionally think of as processed foods, and that’s the video we turn to next: The Role of Processed Foods in the Obesity Epidemic.

    We’re making our way through a series on the cause of the obesity epidemic. So far, we’ve looked at exercise (The Role of Diet vs. Exercise in the Obesity Epidemic) and genes (The Role of Genes in the Obesity Epidemic and The Thrifty Gene Theory: Survival of the Fattest), but, really, it’s the food.

    If you’re familiar with my work, you know that I recommend eating a variety of whole plant foods, as close as possible to the way nature intended. I capture this in my Daily Dozen, which you can download for free here or get the free app (iTunes and Android). On the app, you’ll see that there’s also an option for those looking to lose weight: my 21 Tweaks. But before you go checking them off, be sure to read about the science behind the checklist in my book How Not to Diet. Get it for free at your local public library. If you choose to buy a copy, note that all proceeds from all of my books go to charity. 



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  • Processed Foods and Obesity 

    Processed Foods and Obesity 

    The rise in the U.S. calorie supply responsible for the obesity epidemic wasn’t just about more food, but a different kind of food.

    The rise in the number of calories provided by the food supply since the 1970s “is more than sufficient to explain the US epidemic of obesity.” Similar spikes in calorie surplus were noted in developed countries around the world in parallel with and presumed to be primarily responsible for, the expanding waistlines of their populations. After taking exports into account, by the year 2000, the United States was producing 3,900 calories for every man, woman, and child—nearly twice as much as many people need. 

    It wasn’t always this way. The number of calories in the food supply actually declined over the first half of the twentieth century and only started its upward climb to unprecedented heights in the 1970s. The drop in the first half of the century was attributed to the reduction in hard manual labor. The population had decreased energy needs, so they ate decreased energy diets. They didn’t need all the extra calories. But then the “energy balance flipping point” occurred, when the “move less, stay lean phase” that existed throughout most of the century turned into the “eat more, gain weight phase” that plagues us to this day. So, what changed?

    As I discuss in my video The Role of Processed Foods in the Obesity Epidemic, what happened in the 1970s was a revolution in the food industry. In the 1960s, most food was prepared and cooked in the home. The typical “married female, not working” spent hours a day cooking and cleaning up after meals. (The “married male, non-working spouse” averaged nine minutes, as you can see below and at 1:34 in my video.) But then a mixed-blessing transformation took place. Technological advances in food preservation and packaging enabled manufacturers to mass prepare and distribute food for ready consumption. The metamorphosis has been compared to what happened a century before with the mass production and supply of manufactured goods during the Industrial Revolution. But this time, they were just mass-producing food. Using new preservatives, artificial flavors, and techniques, such as deep freezing and vacuum packaging, food corporations could take advantage of economies of scale to mass produce “very durable, palatable, and ready-to-consume” edibles that offer “an enormous commercial advantage over fresh and perishable whole or minimally processed foods.” 

    Think ye of the Twinkie. With enough time and effort, “ambitious cooks” could create a cream-filled cake, but now they are available around every corner for less than a dollar. If every time someone wanted a Twinkie, they had to bake it themselves, they’d probably eat a lot fewer Twinkies. The packaged food sector is now a multitrillion-dollar industry.

    Consider the humble potato. We’ve long been a nation of potato eaters, but we usually baked or boiled them. Anyone who’s made fries from scratch knows what a pain it is, with all the peeling, cutting, and splattering of oil. But with sophisticated machinations of mechanization, production became centralized and fries could be shipped at -40°F to any fast-food deep-fat fryer or frozen food section in the country to become “America’s favorite vegetable.” Nearly all the increase in potato consumption in recent decades has been in the form of french fries and potato chips. 

    Cigarette production offers a compelling parallel. Up until automated rolling machines were invented, cigarettes had to be rolled by hand. It took 50 workers to produce the same number of cigarettes a machine could make in a minute. The price plunged and production leapt into the billions. Cigarette smoking went from being “relatively uncommon” to being almost everywhere. In the 20th century, the average per capita cigarette consumption rose from 54 cigarettes a year to 4,345 cigarettes “just before the first landmark Surgeon General’s Report” in 1964. The average American went from smoking about one cigarette a week to half a pack a day.

    Tobacco itself was just as addictive before and after mass marketing. What changed was cheap, easy access. French fries have always been tasty, but they went from being rare, even in restaurants, to being accessible around each and every corner (likely next to the gas station where you can get your Twinkies and cigarettes).

    The first Twinkie dates back to 1930, though, and Ore-Ida started selling frozen french fries in the 1950s. There has to be more to the story than just technological innovation, and we’ll explore that next.

    This explosion of processed junk was aided and abetted by Big Government at the behest of Big Food, which I explore in my video The Role of Taxpayer Subsidies in the Obesity Epidemic.

    This is the fifth video in an 11-part series. Here are the first four: 

    Videos still to come are listed in the related videos below.



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  • Can We Safely Use Melamine Dishes and Polyamide Plastic Utensils?

    Can We Safely Use Melamine Dishes and Polyamide Plastic Utensils?

    I recommend glass, ceramic, porcelain, or stainless steel tableware and wooden or stainless steel cooking utensils.

    Melamine is used to make a variety of hard plastic “food contact items such as cups, plates, bowls, and utensils because they are dishwasher safe, inexpensive, and durable.” If that word sounds familiar, it may be because melamine has also been added illegally to protein products to game the system to make it appear that “food commodities” like pet food contain more protein than they actually do. By 2007, more than a thousand potentially contaminatedpet food products were recalled after “the chemical was found to be a contaminant in wheat gluten used in those products,” but not before it caused disease and death in pets throughout North America. 

    “It is presumed that melamine was intentionally added by suppliers in China to falsely elevate the measured protein content and, hence, the monetary value of these products.” The pet food scandal was just the writing on the wall. The following year, “melamine was discovered to be the cause of an outbreak of urinary tract stones and renal failure” (kidney stones and kidney failure), affecting hundreds of thousands of infants and young children throughout China. “Investigations revealed that the compound was added illegally to powdered milk and baby formulas to falsify protein content.” 

    As I discuss in my video Are Melamine Dishes and Polyamide Plastic Utensils Safe?, in the United States, you can find it in food packaging and sneaking its way into animal feed. However, those using melamine dishware can be exposed directly, as it migrates straight into the food upon exposure to heat. In fact, “cooking spoons and crockery made of melamine resin are not suited for microwaves and cooking,” according to food safety authorities. Okay, but what if you never cook with it, fry with it, or microwave it? What if you just use melamine to eat out of? 

    In “A Crossover Study of Noodle Soup Consumption in Melamine Bowls and Total Melamine Excretion in Urine,” researchers measured the amount of melamine flowing through the study subjects’ bodies compared to eating the same soup out of ceramic bowls. Their findings? “Melamine tableware may release large amounts of melamine when used to serve high-temperature foods”—and not even hot foods. “Melamine migration can be detectable from daily-use melamine-made tableware, even in the low temperatures,” like just warm water. Why do we care? Because the level of melamine you’re exposed to “is significantly associated with kidney function deterioration in patients with early-stage CKD,” chronic kidney disease, in which even relatively “low melamine levels may cause a rapid decline in kidney function.” So, I would suggest glass, ceramic, porcelain, or stainless steel tableware instead. 

    What about polyamide utensils, common black plastic spoons, spatulas, and the like? All sorts of different plastic materials are used in kitchen utensils. Polyamide is “typically used for turners [spatulas] or ladles due to their high heat and oil resistance.” “However, components of this plastic can migrate from the utensils into the food and consequently be ingested by consumers.” Out of 33 utensils tested, nearly 1 in 3 exceeded the upper safety limit. The German Federal Institute for Risk Assessment “recommends that consumers keep contact with food as brief as possible when using PA [polyamide] kitchen gadgets, especially at high temperatures,” such as above the temperature at which we may drink hot tea or coffee. 

    A different survey of black plastic kitchen utensils found about a third contaminated with flame retardant chemicals. Why? Because it may be made from plastic recycled from electronic equipment that was impregnated with the stuff. Then, should you dip the polyamide utensil into oil, the chemicals can trickle out, suggesting that using such “utensils for frying may lead to considerable dietary exposure.”

    The black dye itself in some polyamide utensils can leach out, too. Eventually, with enough use, the levels drop, but it may take the equivalent of boiling the utensils for about a hundred hours before the dye leaking approaches safety levels. It’s probably just easier to use utensils that are wooden or stainless steel.

    This is the last in a three-part series of cookware videos. If you missed the others, check out Are Aluminum Pots, Bottles, and Foil Safe? and Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe?.

    It may not be safe to microwave melamine, but what about microwaving in general? See Are Microwaves Safe? and The Effects of Radiation Leaking from Microwave Ovens. 



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  • Do Taxpayer Subsidies Play a Role in the Obesity Epidemic? 

    Do Taxpayer Subsidies Play a Role in the Obesity Epidemic? 

    Why are U.S. taxpayers giving billions of dollars to support the likes of the sugar and meat industries?

    The rise in calorie surplus sufficient to explain the obesity epidemic was less a change in food quantity than in food quality. Access to cheap, high-calorie, low-quality convenience foods exploded, and the federal government very much played a role in making this happen. U.S. taxpayers give billions of dollars in subsidies to prop up the likes of the sugar industry, the corn industry and its high-fructose syrup, and the production of soybeans, about half of which is processed into vegetable oil and the other half is used as cheap feed to help make dollar-menu meat. You can see a table of subsidy recipients below and at 0:49 in my video The Role of Taxpayer Subsidies in the Obesity Epidemic. Why do taxpayers give nearly a quarter of a billion dollars a year to the sorghum industry? When was the last time you sat down to some sorghum? It’s almost all fed to cattle and other livestock. “We have created a food price structure that favors relatively animal source foods, sweets, and fats”—animal products, sugars, and oils.

    The Farm Bill started out as an emergency measure during the Great Depression of the 1930s to protect small farmers but was weaponized by Big Ag into a cash cow with pork barrel politics—including said producers of beef and pork. From 1970 to 1994, global beef prices dropped by more than 60 percent. And, if it weren’t for taxpayers “sweetening the pot” with billions of dollars a year, high-fructose corn syrup would cost the soda industry about 12 percent more. Then we hand Big Soda billions more through the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamps Program, to give sugary drinks to low-income individuals. Why is chicken so cheap? After one Farm Bill, corn and soy were subsidized below the cost of production for cheap animal fodder. We effectively handed the poultry and pork industries about $10 billion each. That’s not chicken feed—or rather, it is! 

    This is changing what we eat. 

    As you can see below and at 2:03 in my video, thanks in part to subsidies, dairy, meats, sweets, eggs, oils, and soda were all getting relatively cheaper compared to the overall consumer food price index as the obesity epidemic took off, whereas the relative cost of fresh fruits and vegetables doubled. This may help explain why, during about the same period, the percentage of Americans getting five servings of fruits and vegetables a day dropped from 42 percent to 26 percent. Why not just subsidize produce instead? Because that’s not where the money is. 

    “To understand what is shaping our foodscape today, it is important to understand the significance of differential profit.” Whole foods or minimally processed foods, such as canned beans or tomato paste, are what the food business refers to as “commodities.” They have such slim profit margins that “some are typically sold at or below cost, as ‘loss leaders,’ to attract customers to the store” in the hopes that they’ll also buy the “value-added” products. Some of the most profitable products for producers and vendors alike are the ultra-processed, fatty, sugary, and salty concoctions of artificially flavored, artificially colored, and artificially cheap ingredients—thanks to taxpayer subsidies. 

    Different foods reap different returns. Measured in “profit per square foot of selling space” in the supermarket, confectionaries like candy bars consistently rank among the most lucrative. The markups are the only healthy thing about them. Fried snacks like potato chips and corn chips are also highly profitable. PepsiCo’s subsidiary Frito-Lay brags that while its products represented only about 1 percent of total supermarket sales, they may account for more than 10 percent of operating profits for supermarkets and 40 percent of profit growth. 

    It’s no surprise, then, that the entire system is geared towards garbage. The rise in the calorie supply wasn’t just more food but a different kind of food. There’s a dumb dichotomy about the drivers of the obesity epidemic: Is it the sugar or the fat? They’re both highly subsidized, and they both took off. As you can see below and at 4:29 and 4:35 in my video, along with a significant rise in refined grain products that is difficult to quantify, the rise in obesity was accompanied by about a 20 percent increase in per capita pounds of added sugars and a 38 percent increase in added fats. 

     

    More than half of all calories consumed by most adults in the United States were found to originate from these subsidized foods, and they appear to be worse off for it. Those eating the most had significantly higher levels of chronic disease risk factors, including elevated cholesterol, inflammation, and body weight. 

    If it really were a government of, by, and for the people, we’d be subsidizing healthy foods, if anything, to make fruits and vegetables cheap or even free. Instead, our tax dollars are shoveled to the likes of the sugar industry or to livestock feed to make cheap, fast-food meat. 

    Speaking of sorghum, I had never had it before and it’s delicious! In fact, I wish I had discovered it before How Not to Diet was published. I now add sorghum and finger millet to my BROL bowl which used to just include purple barley groats, rye groats, oat groats, and black lentils, so the acronym has become an unpronounceable BROLMS. Anyway, sorghum is a great rice substitute for those who saw my rice and arsenic video series and were as convinced as I am that we need to diversify our grains. 

    We now turn to marketing. After all of the taxpayer-subsidized glut of calories in the market, the food industry had to find a way to get it into people’s mouths. So, next: The Role of Marketing in the Obesity Epidemic. 

    We’re about halfway through this series on the obesity epidemic. If you missed any so far, check out the related videos below.



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  • Is Stainless Steel or Cast Iron Cookware Best? Is Teflon Safe?

    Is Stainless Steel or Cast Iron Cookware Best? Is Teflon Safe?

    What is the best type of pots and pans to use?

    In my last video, I expressed concerns about the use of aluminum cookware. So, what’s the best type of pots and pans to use? As I discuss in my video Stainless Steel or Cast Iron: Which Cookware Is Best? Is Teflon Safe?, stainless steel is an excellent option. It’s the metal chosen for use “in applications where safety and hygiene are considered to be of the utmost importance, such as kitchenware.” But what about studies showing that the nickel and chromium in stainless steel, which keeps the iron in stainless unstained by rust, can leach into foods during cooking? The leaching only seems to occur when the cookware is brand new. “Metal leaching decreases with sequential cooking cycles and stabilizes after the sixth cooking cycle,” after the sixth time you cook with it. Under more common day-to-day conditions, the use of stainless steel pots is considered to be safe even for most people who are acutely sensitive to those metals.

    A little leaching metal can even be a good thing in the case of straight iron, like a cast iron skillet, which can have the “beneficial effect” of helping to improve iron status and potentially reduce the incidence of iron deficiency anemia among children and women of reproductive age. The only caveat is that you don’t want to fry in cast iron. Frying isn’t healthy regardless of cookware type, but, at hot temperatures, vegetable oil can react with the iron to create trans fats. 

    What about using nonstick pans? Teflon, also known as polytetrafluoroethylene (PTFE), “is used as an inner coating material in nonstick cookware.” Teflon’s dark history was the subject of a 2019 movie called Dark Waters, starring Mark Ruffalo and Anne Hathaway. Employees in DuPont’s Teflon division started giving birth to babies with deformities before “DuPont removed all female staff” from the unit. Of course, the corporation buried it all, hiding it from regulators and the public. “Despite this significant history of industry knowledge” about how toxic some of the chemicals used to make Teflon were, it was able to keep it hidden until, eventually, it was forced to settle for more than half a billion dollars after one of the chemicals was linked to “kidney and testicular cancers, pregnancy-induced hypertension, ulcerative colitis, and high cholesterol.”

    “At normal cooking temperatures, PTFE-coated cookware releases various gases and chemicals that present mild to severe toxicity.” As you can see below and at 2:38 in my video, different gases are released at different temperatures, and their toxic effects have been documented. 

    You’ve heard of “canaries in the coal mine”? This is more like “canaries in the kitchen, as cooking with Teflon cookware is well known to kill pet birds,” and Teflon-coated heat lamp bulbs can wipe out half a flock of chickens. 

    “Apart from the gases released during heating the cooking pans, the coating itself starts damaging after a certain period. It is normally advised to use slow heating when cooking in Teflon-coated pans,” but you can imagine how consumers might ignore that. And, if you aren’t careful, some of the Teflon can start chipping off and make its way into the food, though the effects of ingestion are unknown.

    I could find only one study that looks at the potential human health effects of cooking with nonstick pots and pans. Researchers found that the use of nonstick cookware was associated with about a 50 percent increased risk of colorectal cancer, but that may be because of what they were cooking. “Non-stick cookware is used in hazardous cooking methods (i.e. broiling, frying, grilling or barbecuing) at high temperatures mainly for meat, poultry or fish,” in which carcinogenic heterocyclic amines (HCA) are formed from the animal protein. Then, the animal fat can produce another class of carcinogens called polycyclic aromatic hydrocarbons (PAH). Though it’s possible it was the Teflon itself, which contains suspected carcinogens like that C8 compound from the movie Dark Waters, also known as PFOA, perfluorooctanoic acid.

    “Due to toxicity concerns, PFOA has been replaced with other chemicals such as GenX, but these new alternatives are also suspected to have similar toxicity.” We’ve already so contaminated the Earth with it, though, that we can get it prepackaged in food before it’s even cooked, particularly in dairy products, fish, and other meat; now, “meat is the main source of human exposure” to these toxic pollutants. Of those, seafood is the worst. In a study of diets from around the world, fish and other seafood were “major contributors” of the perfluoroalkyl substances, as expected, given that everything eventually flows into the sea. Though the aquatic food chain is the “primary transfer mechanism” for these toxins into the human diet, “food stored or prepared in greaseproof packaging materials,” like microwave popcorn, may also be a source. 

    In 2019, Oral-B Glide dental floss was tested. Six out of 18 dental floss products researchers tested showed evidence of Teflon-type compounds. Did those who used those kinds of floss end up with higher levels in their bloodstream? Yes, apparently so. Higher levels of perfluorohexanesulfonic acid were found in Oral-B Glide flossers, as you can see below and at 5:28 in my video.

    There are a lot of environmental exposures in the modern world we can’t avoid, but we shouldn’t make things worse by adding them to consumer products. At least we have some power to “lower [our] personal exposure to these harmful chemicals.”

    This is the second in a three-video series on cookware. The first was Are Aluminum Pots, Bottles, and Foil Safe?, and the next is Are Melamine Dishes and Polyamide Plastic Utensils Safe?.

    What about pressure cooking? I covered that in Does Pressure Cooking Preserve Nutrients?.

    So, what is the safest way to prepare meat? See Carcinogens in Meat. 



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  • Marketing Takes Off and Obesity Soars 

    Marketing Takes Off and Obesity Soars 

    The unprecedented rise in the power, scope, and sophistication of food marketing starting around 1980 aligns well with the blastoff slope of the obesity epidemic.

    In the 1970s, the U.S. government went from just subsidizing some of the worst foods to paying companies to make more of them: “Congress passed laws reversing long-standing farm policies aimed at protecting prices by limiting production” and started giving payouts in proportion to output. Extra calories started pouring into the food supply.

    Then Jack Welch gave a speech. In 1981, the CEO of General Electric effectively launched the “shareholder value movement,” reorienting the primary goal of corporations towards maximizing short-term returns for investors. This placed extraordinary pressure from Wall Street on food companies to post increasing profit growth every quarter to boost their share price. There was already a glut of calories on the market and now they had to sell even more.

    This placed food and beverage CEOs in an impossible bind. It’s not like they’re rubbing their sticky hands together at the thought of luring more Hansels and Gretels to their doom in their houses of candy. Food giants couldn’t do the right thing even if they wanted. They are beholden to investors. If they stopped marketing to kids or tried to sell healthier food or did anything else that could jeopardize their quarterly profit growth, Wall Street would demand a change in management. Healthy eating is bad for business. It’s not some grand conspiracy; it’s not even anyone’s fault. It’s just how the system works.

    As I discuss in my video The Role of Marketing in the Obesity Epidemic, given the constant demands for corporate growth and rapid returns in an already oversaturated marketplace, the food industry needed to get people to eat more. Like the tobacco industry before them, it turned to the ad makers. The food industry spends about $10 billion a year on advertising and around another $20 billion on other forms of marketing, such as trade shows, consumer promotions, incentives, and supermarket “slotting fees.” Food and beverage companies purchase shelf space from supermarkets to prominently display their most profitable products. They pay supermarkets. The practice is also known as “cliffing,” because companies “force suppliers to bid against each other for shelf space with the loser pushed ‘over the cliff.’” With slotting fees costing up to $20,000 per item, per retailer, and per city, you can imagine what types of foods get the special treatment. Hint: It ain’t broccoli.

    To get a sense of what kind of products merit prime shelf real estate, look no further than the checkout aisle. “Merchandising the power categories on every lane is critical,” reads a trade publication on the “best practices for superior checkout merchandising.” It was referring to candy bars and beverages. Just a 1 percent power category boost in sales could earn a store an extra $15,000 a year. It’s not that publicly traded companies don’t care about their customers’ health. They might, but like most of the leading grocery store chains, their “primary fiduciary responsibility is to increase profits” above other considerations.

    For instance, tens of millions of dollars are spent annually advertising a single brand of candy bar. McDonald’s alone may spend billions a year. Now, “the food industry is the biggest spender on advertising of any major sector of the economy.”

    “Reagan-era deregulatory policies removed limits on television marketing of food products to children.” Now, the average child may see more than 10,000 TV food ads a year, and that’s on top of “the marketing content online, in print, at school, at the movies, in video games, or at school,” or even on their phones. “Nearly all food marketing to children worldwide promotes products that can adversely affect their health.”

    Besides the massive early exposure and ubiquity, food marketing has become “highly sophisticated. With the help of child psychologists, companies began to understand the factors that unconsciously influenced sales. They found out, for example, how to influence children and get them to manipulate their parents.” Packaging was designed to best attract a child’s attention, and then those products are placed at their eye level in the store. You know those mirrored bubbles in the ceilings of supermarkets? They aren’t just for shoplifters. Closed-circuit cameras and GPS-like devices on shopping carts are used to strategize how best to guide shoppers toward the market’s most profitable products. Behavioral psychology is widely applied to increase impulse buying, and eye movement tracking technologies are utilized.

    The “unprecedented expansion in the scope, power, and ubiquity of food marketing…coincided with an unprecedented expansion in food consumption in predictable ways.” Some techniques have “skyrocket[ed] from essentially zero to multi-billion-dollar industries” since the 1980s, including “product placement, in-school advertising, event sponsorships.” This led one noted economist to conclude that “the most compelling single interpretation of the admittedly incomplete data we have is that the large increase in obesity is due to marketing.” Yes, innovations in manufacturing and political maneuvering led to a food supply bursting at the seams with close to 4,000 calories a day for us all, but it’s the advances in marketing manipulations that try to peddle that surplus into our mouths. 

    I think the natural reaction to the suggestion of the power of marketing is: I’m too smart to fall for that. Marketing works on other people, but I can see through it. But that’s what everyone thinks! For a splash of cold water to shake us all out of this delusion, I next bring you some data: The Role of Food Advertisements in the Obesity Epidemic. 

    Also, for both the role of marketing and food advertisements, check out Friday Favorites: The Role of Marketing and Food Advertisements in the Obesity Epidemic.

    This is the seventh in an 11-video series. If you missed any of the first six, check out the related posts below. 



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  • Are Food Ads Making Us Obese? 

    Are Food Ads Making Us Obese? 

    We all like to think we make important life decisions, like what to eat, consciously and rationally, but if that were the case, we wouldn’t be in the midst of an obesity epidemic.

    The opening words of the Institute of Medicine’s report on the potential threat posed by food ads were: “Marketing works.” Certainly, there is a “large number of well-conducted randomized experiments” I could go through with you that “have shown that exposure to marketing—especially, but not only, advertising—changes people’s eating behavior. Marketing causes people to choose to eat more.” But, what do you need to know beyond the fact that the industry spends tens of billions of dollars a year on it? To get people to drink its brown sugar water, do you think Coca-Cola would spend a penny more than it thought it had to? It’s like when my medical colleagues accept “drug lunches” from pharmaceutical representatives and take offense that I would suggest it might affect their prescribing practices. Do they really think drug companies are in the business of giving away free money for nothing? They wouldn’t do it if it didn’t work. 

    To give you a sense of marketing’s insidious nature, let me share an interesting piece of research published in the world’s leading scientific journal: “In-Store Music Affects Product Choice” documented an experiment in which French accordion music or German Bierkeller music was played on alternate days in the wine section of a grocery store. As you can see below and at 1:27 in my video The Role of Food Advertisements in the Obesity Epidemic, on the days the French music played in the background, people were three times more likely to buy French wine, and on German music days, shoppers were about three times more likely to buy German wine. And it wasn’t a difference of just a few percent; it was a complete three-fold reversal. Despite the dramatic effect, when shoppers were approached afterward, the vast majority of them denied the music had influence on their choice. 

    Most of our day-to-day behavior does not appear to be dictated by careful, considered deliberations, even if we’d like to think that were the case. Rather, we tend to make more automatic, impulsive decisions triggered by unconscious cues or habitual patterns, especially when we are “under stress, tired, or preoccupied. This unconscious part of our brain is estimated to function and guide our behaviors at least 95% of the time.” This is the arena where marketing manipulations do most of their dirty work. 

    The part of our brain that governs conscious awareness may only be able to process about 50 bits of information per second, which is roughly equivalent to a short tweet. Our entire cognitive capacity, on the other hand, is estimated to process more than 10 million bits per second. Because we’re only able to purposefully process a limited amount of information at a time, if we’re distracted or otherwise unable to concentrate, our decisions can become even more impulsive. An elegant illustration of this “cognitive overload” effect was provided from an experiment involving fruit salad and chocolate cake.

    Before calls could be made at the touch of a button or the sound of our voice, the seven-digit span of phone numbers in the United States was based in part on the longest sequence most people can recall on the fly. We only seem to be able to hold about seven chunks of information (plus or minus two) in our immediate short-term memory. The study’s setup: Randomize people to memorize either a seven-digit number or a two-digit number to be recalled in another room down the hall. On the way, offer them the choice of a fruit salad or a piece of chocolate cake. Memorizing a two-digit number is easy and presumably takes few cognitive resources. As you can see in the graph below and at 3:52 in my video, under the two-digit condition, most study participants chose fruit salad. Faced with the same decision, most of those trying to keep seven digits in their heads just went for the cake. 

    This can play out in the real world by potentiating the effect of advertising. Have people watch a TV show with commercials for unhealthy snacks, and, no surprise, they eat more unhealthy snacks compared to those exposed to non-food ads. Or maybe that is a surprise. We all like to think we’re in control and not so easily manipulated. The kicker, though, is that we may be even more susceptible the less we pay attention. Randomize people to the same two-digit or seven-digit memorization task during the TV show, and the snack-attack effect was magnified among those who were more preoccupied. How many of us have the TV on in the background or multi-task during commercial breaks? Research suggests that may make us even more impressionable to the subversion of our better judgment. 

    There’s an irony in all of this. Calls for restrictions on marketing are often resisted by invoking the banner of freedom. What does that even mean in this context, when research shows how easily our free choices can be influenced without our conscious control? A senior policy researcher at the RAND Corporation even went as far as to suggest that, given the dire health consequences of our unhealthy eating habits, “the marketing techniques of which we are unaware should be considered in the same light as the invisible carcinogens and toxins in the air and water that can poison us without our awareness.”

    Given the role marketing can play even when we least suspect it, what is the role of personal responsibility in the obesity epidemic? That’s the subject of my next video.

    We are winding down this series on obesity, with three videos remaining: 

     If you missed any of the previous videos, see the related posts below. 



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