Thanksgiving statistic

Happy Thanksgiving!

It may or may not shock you to learn that the average American consumes 4,500 cals and 229 g of fat on Thanksgiving.

I'm not concerned with the caloric intake nearly as much as I am the fat intake. With all the healthy tweaks one can make without sacrificing taste, I don't understand it at all. But at least it's limited to once a year.

Make it a day to cherish your family and friends and have the holiday center around that.

By the way, I apologize for my lack of posts. I have so many articles I want to share with you - some really neat information and studies - and hope to soon.

Competitive female bodybuilders and disordered eating and other compensatory behaviors

While research examining disordered eating weight obsession, abnormal behaviors to control weight and full-blown eating disorders comparing female athletes to non-athletes is somewhat equivocal, research seems to support that “the incidence of eating disorders and subclinical levels of eating disturbances appears to be much higher among people who participate in sports, physical activities, or occupations which emphasize thinners or low body fat for enhanced performance” in order to be lean and to also show self-control and discipline.

This study, published in Eating Disorders, included 20 competitive female bodybuilders (CFBBs) and a control group of 20 recreational female lifters (RFWTs) to study the above as well as build on and compare previous results on body dissatisfaction, disordered eating, perfectionism and steroid use in their male counterparts.

To be a CFBB, a woman had to either be actively training for a competition or had done one within the last year. To me, those would be two separate subgroups, as the goals and mentality would be different. RFWTs lifted at least twice a week for 7+ months wh0o had never competed nor had any goal to within the next year.

Because we don’t know what stage the CFBBs were in (cutting, bulking, recomping, how far out from competition they were, etc), I think another control group should have been added: cardio. Some CFBBs rely on diet alone, but when cutting, especially as the competition nears, many engage in high intensity interval training (HIIT). It would also be potentially useful in determine if CFBBs were overdoing the cardio. I also think knowing what stage the CFBBs were in could be relevant to findings and potential implications and/or interventions. It seems like just like those are training for an upcoming competition versus those who recently competed should have been separate subgroups, so too would cutters versus bulkers. And all should be looked at as an aggregate and separately.

Measures included in Beck Depression Inventory, the Eating Disorder Inventory, a paper and pencil version of the Eating Disorder portion of the computerized Diagnostic Schedule, a Bodybuilding questionnaire, The Anabolic Steroid Questionnaire, Drive for Bulk and Drive for Tone.

Note that some of these measures are well-known and commonly used, whereas a couple were developed, and there was no mention of how the questions were formed or by whom, test-retest, reliability and validity, sample questions, etc.

I also think it would have been useful to know how long both groups were working out for. Were they overexercising, either in general or in a non-purging bulimia type of way?

CFBBs reported more binge eating behaviors, were more overly concerned with body weight and shape, had more strict dieting habits, were more dissatisfied with their bodies, exercised more vigorously and had a higher rate of anabolic steroid use than did RFWTs, although they too have a higher prevalence of some of these things than the general population.

For example, bulimia was an issue for 15% of the competitive bodybuilders and 12% of the control group, both of which are much higher percentages than are seen in the general population. Because the rate was so high among recreational lifters too, clearly body dissatisfaction, weight control via unhealthy eating can’t be 100% attributed to or connected with bodybuilding.

While eating behaviors among CFBBs  mimic those with eating disorders, the psychological profiles do not match.

40% of CFBBs used steroids, which kind of shocked me. But maybe this means many competitors were in the bulking stage, especially since they had a greater drive for bulk and muscle tone. This number really seems so high to me. Wow.

However, they also used extreme cardio and strict dieting to control their weight, which would suggest more of them were cutting, in my opinion.

Binge eating was also common in the competitive bodybuilders, which to me also resonates with cutting (prior to competition or soon after), “as “strict dieting, either by avoiding forbidden foods or caloric restriction both of which are common in competitive bodybuilding to reduce body fat, may predispose bodybuilders to binge eating by increasing deprivation of desired foods or decreasing sensitivity to internal cues such as hunger or satiety.”

Ultimately, there is a chicken/egg scenario: Do women recovering from eating disorders disproportionately gravitate toward competitive bodybuilding and/or do the characteristics of bodybuilding foster a subgroup that becomes prone to developing eating disorder-esque behaviors, body dissatisfaction and steroid use?

randi morse, randi.morse@gmail.com, newton, ma

Quote #5

"Overeating is overeating, whether it comes from nutritious food or junk food"  - Keith Ayoob, associate professor of pediatrics at Albert Einstein College of Medicine.

randi morse, randi.morse@gmail.com, newton, ma

A physiological change one year after weight loss among obese individuals

Sumithran et al recently published an article in NEJM wherein they studied 34 adults (originally 50 subjects, but 34 in the end) with an average baseline BMI of 34.7 to assess regulators of appetite (leptin, ghrelin, peptide yy, gastric inhibitory polypeptide, glucagon-like peptide l, amylin, pancreatic polypeptide, cholecystokinin and insulin) and subjective ratings of hunger throughout a 10 week weight-loss program and throughout a year following.

It had previously been shown that some of the peripheral hormonal signals as well as energy expenditure changed significantly in periods of caloric restriction, promoting weight regain, so the purpose of this study was to determine if this would be the case with prolonged maintenance of weight reduction.

This is important because many who attempt to lose weight and have an initial loss due to calorie restriction are unable to maintain their decreased weight and regain the weight lost. There is a “high rate of weight regain after diet-induced weight loss.” Many attribute this to lack of self-control, but if regulators of appetite remain changed, this would attest to a physiological reaction.

For 8 weeks subjects were put on 500-550 calories per day (optifast and some non-starchy veggies), which they call a “very-low-energy” diet.

I’d say it’s more like starvation and completely unnecessary. I think weight loss and potential hormonal changes from such an extreme deficit could confound findings and affect the results. I know there are other longer-term programs, like the HCG diet, that have a similar caloric intake, but most obese people do not go on such extreme diets, so I question the generalizability of findings in these obese individuals to the obese population as a whole.

For weeks 9 and 10, subjects who lost 10+% of their baseline body fat were gradually put on regular foods to stabilize their weight and discontinue further weight loss.

At the end of week 10, subjects no longer consumed the optifast shakes, and a dietician counseled individuals on what their caloric should be based on their energy expenditure and recommended low GI carbs, a reduced intake of fat and 30 minutes of exercise most days of the week.

Besides my issues with the calorie intake, I hate that body composition was measured via a Tanita scale. Scales are so inaccurate, and worse, inconsistent, as body fat measure. I am not sure why DEXA scans or something known to be more accurate was not used. Therefore, in my opinion, these numbers are crude estimates as opposed to hard data. At least the subjects did fast overnight before and consistently did so before each of the three tests (baseline, 10 weeks, 62 weeks), but I still find this method completely insufficient.

Many of the hormones, peptides and nutrients involved in one’s body weight regulation changed and lasted for 12 months after weight less, even after some weight was regain, showing that it’s not all about behaviors or willpower, but there were physiological changes.

A decreased energy expenditure lasted the full year.

At the end of week 10, the average weight loss was 13.5 (14% of their baseline weight) and body fat lost was 9.8%, and 7.9 kg and 5.3%, respectively, at the end of week 62, so subjects had gained some weight and body fat back, but were still 8.2% their initial weights and at a lower body fat. Everything was higher at week 10, which is when subjects first went off the supplement.

I want to note that no behavioral measures were involved, so we don’t know if subjects went back to old habits at all or if all results were based on the physiological changes, which, of course, were real. We don’t know how many calories subjects consumed, if they worked out, etc.

All subjective appetite-related factors – hunger, desire and urge to eat, prospective consumption - had increased at a statistically significant level from baseline to weeks 10 and 62, with preoccupation with thoughts of food increasing at week 10, but increasing substantially and at a statistically significant level at week 62. Interestingly, fullness didn’t change from baseline to the other two test points, but significantly decreased at week 62 than at week 10.

The authors suggest that medications might be necessary to manage long-term weight loss in obese individuals. People who continue to be obese after weight loss suggests that “there is an elevated body-weight set point in obese persons that efforts to reduce weight below this point are vigorously resisted,” a point which I agree with (in general, not just with obese people).

My concerns with the study have been noted above, but I do still think this is a useful study and has potential implications.

randi morse, randi.morse@gmail.com, newton, ma

Nutritarianism: Not another fad diet

“[Y]our body has an amazing healing potential waiting to be unleashed by the gift of superior nutrition.”

Simply put, the premise behind nutritarianism, developed by Dr. Joel Fuhrman, is to eat foods – focusing on a diet centered around greens, other vegetables, fruit, beans, nuts and seeds – that are micronutrient-dense and phytochemical-rich in order to strengthen our immune systems and protect us against and reverse illness and disease. An added bonus is weight loss or control (I will have a future post on an article about that).

Part of our problem is that we conform to fad diets that focus on low this and high that, paying complete attention to macronutrients, but the “health-enhancing qualities of a diet are not accurately determined by the level of either for or carbohydrate [or protein]. They are determined by the amount and the diversity of micronutrients.” You can be on a weight loss diet but still be really unhealthy.

The main idea behind nutritarianiam, though, is that food does not just supply us with basic nutritive functions but also has a level of nutrition that protects against and fights disease and benefits the immune system and promotes longetivity. Further, we can prevent most common modern day diseases, such as cancer, heart disease, heart attacks, strokes and dementia, by eating foods rich in vitamins, minerals, and especially phytochemicals.

Greens, cruciferous veggies, mushrooms, onions, and berries play a major role in our health, building our immune system, and protecting against cancer, especially when we eat a combination of them. As well, seeds are high in protein and nutrients.

Nutritional status and health are one factor determining whether or not you get sick and to what degree. When people are well-nourished and healthy, a virus can remain harmless. Optimal nutrition can indirectly and directly protect against infectious disease. Maintaining nutritional adequacy all throughout the year is the best way to protect against illness.

Those are strong claims, and ones he backs up with research and studies (to see more specifics on that as well as specific diseases and vitamins, check out his books, especially Super Immunity), and is a very powerful idea. It really does give credence to the idea that our health is in our hands and that “we are made from the food we eat.”

Dr. Fuhrman thinks 90% of our diet should come from plant-based foods, contrary to what the current practice in the US is, with less than 5% of our calories coming from fruits, veggies, seeds, and nuts. In fact, he thinks the standard American diet is so devoid of nutrients that most of our phytonutrient intake comes from a latte. How sad is that?

He recommends having less than 10% of non-micronutrient-dense foods, no more than one or two a day, and if this includes meat or fish for you, “choos[e] eggs, grass-fed meats, clean wild fish, and naturally raised,

In his pyramid, 30-60% of cals come from vegetables (1/2 raw and ½ cooked), 10-40% from beans/legumes, 10-40% from fruits, 10-40% from seeds, nuts, and avocado, 20% or less from whole grains and potatoes, rarely from eggs, oil, fish and fat free dairy, and rarely from beef, sweets, cheese and processed foods.  We should aim for six fresh fruits and eight servings of veggies a day, including 2 servings of cruciferous veggies (at least 1 of which is raw).

It is easy to find out the foods highest in nutrients by looking at the Aggregate Nutrient Density Index (ANDI), which compares different vitamins, minerals and antioxidxants, with scores ranging from 1000-0. A complete list can be found online, but kale is at the top, and soda is at the bottom. In general, green vegetables are the most nutrient-dense foods that exist.

Dr. Fuhrman has an equation, Health = Nutrients/Calories, suggesting that there is a direct relationship between health and longevity and the more nutrients consumed  per calorie. In other words, ““your health will improve as you eat more foods with a high nutrient-per-calorie density and fewer foods with a low nutrient-per-calorie density.”

There are a few things that Dr. Fuhrman is against (but I want to emphasize that nothing is completely off-limits) that others deem healthy and might surprise people.

First, fish. He acknowledges the benefits of omega 3’s (which he suggests getting instead from flaxseeds and walnuts), DHA and EPA, and thinks that fish is better than other animal products, but still suggests limiting it because it is polluted , containing mercury and PCBs. If you are going to eat fish, try to eat ones containing less mercury, such as shrimp, tilapia, haddock, scallops, squid, trout, hake and ocean perch.

Animal products. I don’t think this will surprise people, based on what I’ve already said about nutritarianism, but according to Dr. Fuhrman, animal products do not do a body good. It can be cancer-producing, and “even egg whites and lean white mean…[are] not longevity-favorable.” He even likes chicken to a cookie in terms of lacking phytochemicals, and immunity-protecting qualities. Reducing animal products is also an automatic consequence of having a diet that is high in micronutrients per calorie.

Milk and dairy. Dairy has sort of always been controversial, and claims on both ends are too extreme and are major exaggerations. But Dr. Fuhrman’s view is you can get the benefits of milk through plant foods, which are high in micronutrients and phytochemicals, and low in saturated fat (if you have whole milk, although he doesn’t like fat free either), which milk is not.

Oil. Finally, someone who agrees with me about oil. Yes, I have read all the research about its health benefits, and dieticians would always try to get me to include olive or coconut oil in my diet (I occasionally added the latter), but I wouldn’t, partly because I am a volume eater, but also partly because of Dr. Fuhrman’s beliefs, which do overlap with my volume eating behavior. Oil is high in calories, low in nutrients, contains no fiber, and is processed. Including more oil lowers the nutrient-per-calorie density of a diet. I will say, though, that for those who are trying to gain weight or just have a hard time getting enough cals in because they get full really quickly, oil is an easy solution. I would recommend nut butter instead, but do think that is a bit more filling and might be a harder choice for some.

I know the Mediterranean diet has proven to have so many health benefits, with heaps if research to back it up, but Dr. Fuhrman suggests this is because of its focus on vegetables and nuts and not because of its emphasis on fish or oil. But I do think the fact that the Mediterranean diet has so much research to back it up shows that you can eat those foods, even though nutritarianism recommends seriously restricting them.

Some people might think this diet is too restrictive to really be healthy, but I argue it’s not. Just like with vegetarianism, veganism, and raw foodism, which nutritarisnism is often compared to but is different than (in part because vegetarians and vegan can still eat a diet full of processed foods), supplementation with vitamin B12,  vitamin D and fish oil is advantageous and probably necessary, but otherwise, you can get everything you need. Avoiding meat and dairy as much as possible might make you think you can’t get enough calcium or protein (a future post will be on the issue of protein), but that is false. Calorie for calorie, bok choy, for example, has more calcium than milk, and broccoli more protein than beef. But those are two of a cornucopia of examples.

He can be a wee bit extreme, though, saying things like, “[t]he white the bread, the sooner you’re dead.” I do however, understand his point, and think the statement is more for shock value and might make people shy away from such a lifestyle, thinking there is no room at all for moderation, when there is, although I don’t think it’s encouraged (and I agree with that. I am not a “anything in moderation” person, although believe it’s  fine for others to be that way).

Basically, nutritarianism is about “the combination of more fruits and veggies in conjunction with a reduction in animal products that offers us the greatest opportunity for longevity.”

I am not a nutritarian. For example, I have two servings of dairy a day. But I still really believe in its tenets and it resonates and intrigues me more than any other lifestyle diet.

randi morse, randi.morse@gmail.com, newton, ma

Sports nutrition knowledge (or lack thereof) among college athletes

This study, “Evaluation of Iranian College Athletes’ Sports Nutrition Knowledge,” aimed to assess university athletes’ knowledge of nutrition as well as the factors that determine their knowledge, namely, their sources of information.

66 basketball players and 141 football players, almost evenly split among males and females, from 4 medical and 8 nonmedical schools (mean age 21.8) filled out a two-part questionnaire. The first part was demographic information and whether or not the subjects had any nutrition training, whereas the second part of the questionnaire examined the meat of the issue: sports nutrition knowledge.

I found Jesseri et al’s description of the questionnaire completely unsatisfactory, so I looked up the reference they used for the measure’s reliability and validity, and found a little more information.

The sports nutrition knowledge questionnaire was developed by six sports dieticians whose questions on concepts relating to sports nutrition were based on  their knowledge and expertise of “practices and misconceptions” encountered by athletes and coaches as well as on  literature.

The questionnaire is 84  questions  (according to the creators. The Jesseri article says 88) divided into five subcategories: 1) The ‘general nutrition concepts’ subsection, which comprised about half the questions, and dealt with identifying the main macro- and micronutrient in specific foods; 2) the recovery subsection (7 questions), which included theoretical and practical sports nutrition aspects; 3) the fluid subsection (5 questions), which asked about adequate fluid intake pre-, during, and post-workout; 4) the weight subsection (15 questions), which asked about weight gain (largely based on myths regarding protein) and weight loss; and, 5) the supplement subsection (11 questions), which addressed athletic supplements, especially creatine.

I wish I had sample questions, had more idea of what the questionnaire was about, and had more information on how the instrument was formed and had more substance, and I only went into the detail I did because I think it is important to know exactly what “sports nutrition knowledge” means in regards to this study and its findings and implications.

The results section too did not go into depth nearly as much as I would have liked. I am very interested in this topic, so I was disappointed. That said, the overall knowledge score was 33.2%, and women, athletes at med schools, those who had completed a university nutrition class, and those who got their information from a nutritionist or dietician scored better than their peers, and these were independent predictors.

For sources of information, 89.4% got theirs from their coach, which is important because, as the authors state, most have little nutrition-specific education (much like how I always say to never trust a personal trainer about nutrition unless they have a separate and specific degree or certificate in nutrition), followed by the media (e.g., cooking shows on which chefs impart their own nutrition beliefs, and, sadly, only two reported a dietician or nutritionist being in the top three sources. Further, only 3 subjects got their info from physicians, and 11 from college classes.

I really wish the subcategories section were richer and provided more in depth information, and there is some more information than I am providing here (barely), but for the subcategories, athletes scored highest on the nutrient subcategory (although none scored higher than 45.3%), and lowest in the supplement category.

The authors find the fact that the total mean percentage of wrong answers overrode the unsure responses (the questionnaire allowed for “yes,” “no,” and “unsure” answers) noteworthy because if they had answered “unsure,” maybe subjects would be more likely to look up the information or at least realize their gaps in knowledge, whereas wrong answers are more likely to indicate that subjects truly believe their responses are correct and are more likely to follow (and maybe pass along to others) faulty information. The authors didn’t say all of that, but that is what I understand and do agree with.

One finding that I think totally also pertains to bodybuilders and personal trainers, as well as the general public, is that two-thirds of athletes thought protein powder can increase size and muscle mass and 47% of men and 43% of women thought protein powder was necessary. I know people think this when it comes to cutting as well, and not just bulking.

Another comparison to bodybuilders is that a study found that96.8% did not know the important role minerals play and 88.2% did not know the importance of water. The latter really surprised me.

I do not think the fact that this study was an Iranian one matters at all. I think the fact is that people know little about nutrition and often obtain their knowledge from less-than-reputable sources, and athletes are hardly immune to that. Ones who are getting their knowledge from coaches and trainers probably think they are in good hands, but they these people are really doing them a disservice.

It might be important to note that Iranian schoolchildren do not receive any nutrition education in their curriculum. Changing this might be one change that would make a difference in both future athletes and coach’s knowledge of nutrition and provide a solid basis for nutrition as a whole. Moreover, requiring classes in college would do even more benefit as would having dieticians or nutritionists involved, especially as there is currently no defined position for them on sports-science teams in Iran. Providing college athletes with proper sources of information, which did make a statistically significant difference in this study, could also help dispel myths and increase athletes’ knowledge-base. Of course teaching coaches about sports nutrition could be key since the majority of athletes, and not surprisingly, I might add, get their info from them.

randi morse, randi.morse@gmail.com, newton, ma

Quote #4

"Exercise is not a thing we do to fix a problem - it is a thing we must do anyway, a thing without which there will always be problems." - Mark Rippetoe

randi morse, randi.morse@gmail.com, newton, ma

Micronutrient deficiencies in diets that focus on macronutrients

Weight loss books are plentiful and fad diets are ubiquitous, with many giving guidelines on and being structured around different combinations of macronutrients, but with little concern to micronutrients. A weight loss diet does not equate to a health-promoting one (similarly, a diet with healthier foods does not equate to weight loss). There is a paucity of research examining micronutrient intake on weight loss diets.

Thus, the goal of this study, presented in an article called, “Micronutrient quality of weight-loss diets that focus on macronutrients: results from the A TO Z study” was to look at micronutrient content of four common diets with varying macro’s: Atkins, the Zone, LEARN, and the Ornish.

This is a very crude description of the diets, but Atkins severely restricts carbs, the Zone has a 40/30/30 (carbs/fat/protein) distribution and recommends consuming less than 1700 cals, LEARN focuses on the food pyramid as well as eating less (1200 cals) and moving more, and the Ornish limits total fat to 10% of daily caloric intake.

Subjects were 311 (291 completed) premenopausal women (mean age = 41) who were overweight or obese (BMI ranged from 27-40). They were given books on the diet they were assigned to and then reviewed what they read at weekly one-hour sessions lead by a dietician for eight weeks. They were then to follow the diet for 10 more months (but this study uses 8 weeks as its end point).

Subjects were given “Food Amounts Booklet,” which taught them how to guesstimate their portions. Specific software was used to determine macro- and micronutrients during 24-hour dietary recalls.

I don’t understand why subjects weren’t told to weigh their food for within subject and between subject accuracy. That seems of utmost importance and makes me question the validity of results found. Also, the authors say that at baseline, the mean caloric intake was 1903 cals, but they hadn’t even been taught how to guesstimate (again, not good enough, in my opinion) their intake yet, plus, it is well-known that overweight individuals underestimate the amount they’re consuming (the converse is true as well, by the way). So where did this number come from?

Even though only two of the diets mentioned calories, all groups reported a similar reduction of 500 cals, but each group had a different and statistically significant ratio of macro’s, which make sense given that each diet focuses on a different macro distribution.

The researchers used the Estimated Average Requirement (EAR) values as cutoffs to examine vitamin A, thiamine, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, vitamin C, vitamin E, iron, magnesium, phosphorus, selenium and zinc.

At the end of the eight weeks, the various diets were higher and lower in specific vitamins and minerals. I am ignoring specifics right now, but feel free to ask me or look up the article, if interested.

What is important and noteworthy, however, is that for Atkins, LEARN and the Ornish diets, the risk of inadequacies increased (although, again, not all in the same micronutrients assessed), while, in contrast, the Zone group’s risk of inadequacies decreased at a statistically significant level for several vitamins and the risk didn’t increase for any of the other vitamins or minerals.

Importantly, this masks (and the authors made sort of confusing and downplayed) the fact that although the risk for certain inadequacies decreased, the inadequacies remained.  That is, in the Zone diet, while the levels of certain vitamins improved, they still remained at a deficient level. For vitamin E, for example,  the risk of inadequacy decreased, yet more than 25% of the women had levels lower than the EAR (proportion of participants deficient went from 80 to 55).

The authors don’t consider this, but it might not solely be the differences in macro distribution (or at least not alone) that are the cause of raising the inadequacies. Subjects’ caloric intake went from a reported average of 1900 to between 1373 and 1478. Lowering calories, especially to that level, and especially when the new diets don’t focus on whole, unprocessed, micronutrient-rich foods, could majorly increase the risk of deficiencies.

I should also note that we don’t know what subjects ate. Maybe providing a representative sample from each diet would have been useful.

I think the take-home message is what I said earlier – that diets don’t = healthier eating. In other words, “[o]f the specific weight-loss diets that are defined largely by their macronutrient content…micronutrient intakes tend to be overlooked,” and further, “micronutrient deficiency should be an important consideration when assessing the overall quality of weight-loss diets.”

ETA: I just looked at US News' "Best Diets for Health," and the Ornish came in at #8, the Zone tied at #11, and Atkins at #20. For weight-loss, Atkins came in at #7, the Ornish tied at #11, the Zone at #18.
randi morse, randi.morse@gmail.com, newton, ma

Guiltless Pumpkin Bisque

Another pumpkin recipe!

As halloween has come and gone and Thanksgiving is fast approaching, it's peak pumpkin time, and it, even in its canned form, may not be around much longer. So another pumpkin recipe is in order. STAT.

I thought of a recipe I used to make that I loved. It obviously has pumpkin, my number one food, and also has sweet potatoes, my number two food. I couldn't keep it to myself.

The recipe was initially called something else, a chili, perhaps, but when I requested it - I didn't remember it in its original form and wanted to get it right and get permission to post it - Melissa from http://www.ffactor.com/ gave the guiltless pumpkin bisque name.

Regardless of what it's called, it's hearty, healthy, and delicious.

Serves:8
Total Time: 1 hour
Ingredients:
  * 1 pound canned pumpkin (13-ounce can)
  * 4 cloves garlic, chopped
  * 2 tablespoons olive oil
  * 4 cups low sodium chicken or vegetable stock
  * 3 cups raw kale
  * 2 medium sweet potatoes, peeled and cubed
  * 1 medium white onion, chopped
  * 2 large carrots, chopped
  * 1 large red pepper, chopped
  * 2 celery ribs, chopped
  * 3/4 cup fresh or frozen corn
  * 1 cup edamame
  * 1/2 teaspoon salt
  * 1/2 teaspoon nutmeg

Cooking instructions:
 1. Pour the olive oil into a large saucepan and sauté the onion until
    tender.
 2. Add the chicken or vegetable stock, potatoes, kale, carrots, celery,
    pepper, edamame and corn. Bring to a boil. Reduce heat, cover, and
    simmer for 25-30 minutes.
 3. Stir in the pumpkin, salt, pepper, and nutmeg. Cook 5-10 minutes longer.

Nutrition Content:
Per  serving  (1 1/4 cup): 675 mg potassium (17%
daily need), 29,480 IU vitamin A (590% daily need), 70 mg vitamin C (115%
daily need)

My changes - 15-oz can of pumpkin, no olive oil, add in: 1 1/2 c dark red kidney beans, 3 c bok choy, 1 c mushrooms, curry powder, ginger.

I am not doing a full review of the F-Factor diet, but will say a few things.

The F-Factor diet was started by Tanya Zuckerbrot, M.S., R.D., who has become a celebrity nutritionist, meaning she's often interviewed in articles or on TV. The idea behind the diet is fiber. Love the idea of increasing fiber intake, especially in a society filled with processed foods that are completely devoid of fiber. I see its place in a weight loss plan (not to mention  it has health benefits) and have certainly seen much worse diets.

I say that only because I don't believe in any diet, while still believing that all can help you lose weight. A quick foreshadowing to tomorrow's blog entry, a lot of weight loss diets are lacking in antioxidants and phytonutrients. I am not saying that is the case with the F-Factor diet, and its focus does seem to be almost as much on health as it is on weight loss. That's a big strength.

A big negative is that it is too low calorie, especially if we assume that a person starting the diet is overweight. I have skimmed through the book (I read all diet books. Anything food, nutrition, or fitness-oriented, I read and make mental notes of), and have seen the sample meal plan, with daily caloric intakes ranging from 900-1400 cals a day. Too low and totally unnecessary. There are certainly diets that are even lower (e.g., HCG), but I think I would otherwise respect this diet so much more.

Anyway, make the recipe. Yum yum yum.

randi morse, randi.morse@gmail.com, newton, ma

Why more women are not weight lifting

If the avg person has the attention span of a goldfish, who is going to read this? I know, shorter = better. But a) I would be a bad academic (I have a graduate degree in psych) if I didn’t do articles justice, and b) I am so, so passionate and want you to be too!

So…

Salvatore and Marecek did four interesting studies exploring gender-differentiated patterns of weight-lifting.

You know I love strength training, and the authors mention some of its health benefits. Physically, it slows down aging, increases metabolism, increases fitness, and helps prevent osteoporosis. Psychologically, it helps with depression and some research has shown what I have experienced: that it helps with eating disorders and body image. I am a little surprised they did not talk more about the benefits, as the paper is concerned with weight lifting, but okay. Those are a few.

First, they acknowledge (assume?) that men value strength and want to build muscle, whereas women value thinness and want to “burn fat” and “tone.”

For studies 1 and 2, subjects were 56 female undergraduates.

In study 1, they wanted to see if there was a shared social knowledge linking the genders to have different fitness goals and to perform different exercises. The researchers were interested in culture-level associations.

The second study presented subjects as being part of one of two scenarios: the first lifting (specifically bench pressing), and the second, cardio (specifically the StairMaster). Afterwards, subjects completed measures on evaluation concern (whether they anticipated being negatively evaluated) and how characteristic it was for each gender to perform both types of exercising, what they did (lift or cardio) and which would be most advantageous to achieving their goals.

Results showed that women thought of bench pressing as more characteristic of men, that they thought of the StairMaster as more of a female exercise and they themselves used it more often than they benched, and that they would more likely reach their goal by doing so.

Subjects also reported more evaluation concerns for weight lifting vs cardio, and the greater the evaluation concern, the greater the disparity between reports of usefulness of benching and the time they spent doing it. No such relationship existed for cardio.

After reading about the procedures and results from studies 1 and 2, I had a few thoughts.

First, I hated that everything was about “muscle building” or “burning fat.” I kind of think that’s BS, but point taken.

I also think maybe avg BMI would have been relevant based on their hypotheses and these specific studies (i.e., I am not saying I think there is necessarily any correlation between BMI and the decision to lift, but rather, that it seems relevant here). If a hypothesis is that females would have less evaluation concerns for the StairMaster even when the scenario used said the males on the StairMaster seemed “really in shape,” and they thought women valued thinness and that cardio would help them achieve this, perhaps the women were thin and felt a high degree of confidence or self-efficacy, which would be a confounding variable.

As well, I am not sure why they chose bench pressing to depict weight lifting in general. Even among women who casually lift, benching isn’t done as often. Chest doesn’t take precendence, and while I still think the results might have been similar, it would have been interesting had they used a bi or tri exercise, for example, or a leg exercise that might be more neutral. Plus, a lot of women who semi-lift either only use machines or use dumbbells, not a bar you load plates on (so if they wanted to use chest, general “chest press,” which could include the (lousy) chest press machine or db press, would have been better).

Study 3 had two parts.

A difference in Study 3 is that both men and women were included. Subjects were 61 undergraduate students (not at the same school in which studies 1 and 2 took place).

First they looked at comfort level in the gym, equipment used, and if gender-differences are a result of the cultural background (Study 1). They used a questionnaire about cardio, machines and free weights, the frequency with which they used them (ranging from never or once a year up to 3+ times a week) and about comfort level.

There was no gender difference in gym usage, although women reported being less comfortable than men. Women used weight machines and free weights less than men and felt less comfortable. For cardio, results for use and comfort were similar.

Lastly, the researchers wanted to see what the cause of discomfort in the gym was and provided subjects with an open-ended question, asking about a single incident, however, many of the 37 (25 women, 12 men) who responded wrote about ongoing problems. Regardless, the difficulties were always emotional and not physical.

Coders put responses into 3 categories: 1) concerns about evaluation by others, 2) concerns about comparison (by self), and 3) concerns about ineptitude.

11 women and 1 man wrote about evaluation concerns on bodily appearance and competence. One women wrote, “…It’s hard to already feel uncomfortable, like it isn’t your place to use (i.e., only athletes can) and also know that people criticize the bodies of people in there when they are so vulnerable.”

More men than women had comparison concerns, feeling like other guys were bigger and stronger and like they didn’t measure up.

There was no gender difference in ineptitude concerns.

There might be an self-perpetuating cycles that exist: 1) Evaluation concerns about “gender-typing” prevents women from bench pressing more often, which in turn leads to a lower ability to press, creating additional evaluation concerns because others can see skill (improper use of equipment and/or bad form) and strength (amount of weight lifted), leading to even more decreased activity, and decreased competence, furthering decreased activity, ultimately strengthening the gender-typing! 2) They think lifting is more male-dominated which is shown, in part, by more men than women being in the lifting area, reaffirming the gender coding of strength training vs cardio and what a woman should be doing in the gym, perpetuating a woman’s avoidance of lifting. 3) The less women lift, the more likely it is that they won’t be as skilled, and if they feel like they’re incompetent, their evaluation concerns will be hightened, causing them to avoid lifting more.

Formally, we have Title IX, but informally, there are still barriers keeping women out of the weight room.

How do we fix this?

The authors suggest that appealing to its health benefits are not sufficient, but rather, we need to address the evaluative concerns. They say, “[t]he critical incidents that women reported suggest that their evaluation concerns often were produced and sustained by every day social relations in the gyms, including objectifying discourses, overt evaluative commentary by men, and exclusionary practices. Therefore, we favor interventions that aim to interrupt such practices.”

I’d add that we appeal to their concern for their physique and emphasize what lifting can do for them, as well as focus on the psychological benefits, such as, as said, increased body image.

randi morse, randi.morse@gmail.com, newton, ma

Exercise and cancer

I am very passionate about phytonutrients and antioxidants and foods and lifestyle changes that help protect us from inflammation and chronic disease, among which cancer is a major one. We read and hear about the consumption of various super foods potentially preventing cancer all the time (as we should, especially as more and new data and research become available), but the role of exercise is less often discussed.

When we talk about exercise and its protective role in cancer, we mainly hear about it as helping keep us in a healthy weight range, which is important because being overweight is one of the predictors of cancer. But the role of exercise is independent of weight. It’s also independent of diet.

I read a copious amount of studies and summaries of studies (interestingly, more breast cancer articles popped up than any other specific cancer or even cancer as a whole, although I did find a few on colon, lung and gastrointestinal), and exercise is beneficial in preventing cancer as well as once diagnosed with cancer.

While studies varied in the intensity of the exercise, it does seem like more strenuous activity was most advantageous.

Most studies did not give or had inconsistent results across studies about a time-frame for optimal effect.

For breast cancer specifically, vigorous exercise affects the production of estrogen, making more intense exercise most effective. A study of Finns that was not specific to breast cancer, found that for breast cancer, an hour of moderate or intense exercise produces a greater risk reduction than those who have longer (2 ½ hours a week), more moderate sessions.  However, less intense exercise is indeed helpful as well. Several studies found that walking for more than 3 hours a week at an average pace had a lower rate of cancer recurrence and higher survival rates and  brisk walking decreased death rate over the next 6 years by 70%. The most active women had a 29% lower risk of breast cancer than those who exercised least. Survivors who worked for more than 2 ½ hours had a 67% lower risk of all deaths.

Overall, 30 min a day of even just walking proved to have protective effects.

It seems that we know that exercise helps prevent chronic inflammation, helps keep one’s weight in check, potentially changes the micro-environment of a tumor cell as well as provides anti-inflammatory signals that making it harder for cancerous tumors to grow, helps fight existing cancer as well as recurrence, helps improve cure and survival rates and helps with side effects from treatment, but we don’t know why or how “brisk exercise affects risk or why only some types of cancers are affected.

The bottom line seems to be simple: Move. Move more. The best protection against cancer, its recurrence and death from it, as far as exercise is concerned, is being active throughout your life in general and throughout all stages of diagnosis/the disease, if cancer is found.

randi morse, randi.morse@gmail.com, newton, ma

Predictors of weight loss readiness

In an article published in the Journal of Behavioral Medicine, Teixeira et al followed 112 overweight or obese middle-aged (avg age = 47.8 years, and just under half were postmenopausal) for the first four months of the beginning of a two year weight loss intervention program.

The article is old – from 2002 – but I think its relevance remains timely, especially as we still, of course, have tons of people trying to lose weight, tons of people being unable to (particularly in the long-term), and tons of people dropping out of programs. Thus, finding out what affects successful and unsuccessful results is extremely important and a constant area of inquiry.

While no study is exhaustive, this study on “psychosocial predictors of success for behavioral weight reduction” included so many questionnaires and measures of data. They measured:

·        Weight (at two points)

·        Body fat and BMI (props to the researchers for using a DEXA scan, one of the most, if not the most, reliable ways of measuring body fat)

·        Physical activity (at baseline and at the end)

·        Number of recent diets

·        Number of years at current weight

·        Recent weight losses

·        Frequency of having about a 10 lb fluctuation in weight

·        The affect his/her weight has on his/her “health, social and interpersonal life, work, mobility, self-esteem, sexual function, activities of daily living, and eating in the past week”

·        General social support

·        Depression

·        Self-esteem

·        The tendency to “persevere, finish tasks initiated, maintain self-discipline, and motivate oneself”

·        Whether the participant is a binge eater and if the severity of the binges related to emotions, thoughts, and behavioral manifestations

·        Efficacy to control overeating and weight management

·        “Cognitive (eating) restraint, eating disinhibition, and perceived hunger”

·        Dieting and weight loss readiness and motivation

·        Self-efficacy for exercise for at least 6 months in several situations

·        Exercise perceived barriers to habitual physical activity

·        Exercise-specific support from family and friends over the past 3 months in terms of involvement and rewards/punishment

·        Concern with body image

·        Body size dissatisfaction

·        Feelings towards various parts or characteristics of a subject’s body and body function

See, tons of measures!

In short, they assessed eating- and exercise related behaviors, body image, quality of life, weight and dieting history, weight outcome evaluations and expectations, mood, self-esteem and self-motivation.

The subjects were divided into four groups, all receiving the same treatment, which included seeing an intervention team for a 50-min hour every week, being provided with information on physical activity, nutrition, psychology, behavioral modification, and overall healthy lifestyles and weight loss, being encouraged to lower cals and increase activity resulting in a 300-500 calorie deficit, the recommendation of losing about .5 kg a week, CBT-esque training regarding self-monitoring, enhancement of self-efficacy, relapse prevention, contingency management, and social support. Goals were individualized and tailored to the individual subject.

At the end they broke down the groups into 3 based on weight loss, with the first/highest/successful group losing about 6.4 kg, and the last/lowest/least successful losing 1.9 kg or less.

Compared to the most successful group, the least successful group had a greater amount of diet attempts and recent weight losses, a higher degree of body dissatisfaction, more strict weight outcome evaluations, higher perceived impact of weight on work and lower self-motivation.

Some of the greatest associations to and predictors of weight loss, both positive and negative, were having had more diets in the previous year, having higher weight loss expectations, having more self-motivation (perceived confidence to meet set goals, finish tasks started and persevere in spite of difficulties) and having less body size dissatisfaction. Other strong predictors were the number of years at the subject’s current weight, a high perceived impact of weight on health and work, the “obstacles” subscale of exercise perceived barriers and the “making time” subscale of self-efficacy. These were independent predictors.

Other studies have also shown recent and repeated diet attempts and body size dissatisfaction as some of the strongest predictors of weight loss, suggesting that these predictors may be some of the most consistent in successful weight loss.

When subjects believe their weight is responsible for a lower quality of life, they may be more likely to fail at initial attempts at weight loss.

The authors noted that one of the more interesting findings was that subjects who had more grandiose desires for their “acceptable” or “happy” weights lost significantly less weight than those who would be more okay with smaller losses.

Other findings included:

• 21% dropped out of the program (so 89 subjects completed it), and they were already losing less weight prior to dropping out.
• 63% expending less than 150 cals, which was the minimum recommendation, in physical activity at baseline, but at the end, 60% reported having met the goal of burning 1500 cal a week.
• Subjects’  “acceptable” weight at the end of the 4 months would be 75.9 kg.
• In order to get to their “happy” target weight for the 4 months, they would need to lose an average of 12.6 kg.
• More exercise and a higher rate of attendance both = increased weight and fat losses.
• Self-efficacy was not a predictor of weight loss.
• Self-efficacy regarding food, eating restraint, disinhibition, hunger and binge eating did not predict weight loss.
• Baseline scores of eating behavior did not predict changes in weight.
• A combination of independent baseline variables are better predictors than is any single one.

Teixeira et al propose including noncompleters in analysis, including psychosocial factors, to see if they have characteristics that predispose them to drop out and also to better be able to predict weight loss outcomes.

Finding predictors for readiness is important in order to best match interventions to individual patients, save resources, and best increase program efficacy.

As the authors state in the intro, “progress in eliciting short-term weight loss has not been met by a comparable improvement in weight management.” We need to learn more, predict better, and succeed in helping people lose weight for the long-term.

randi morse, randi.morse@gmail.com, newton, ma