Susan Dudley, PhD and Sarah Pedersen, Cancer Prevention and Treatment Fund

More and more research studies are confirming the importance of keeping body mass index (BMI) and waistline measurements under control in order to reduce the risk of cancer, other serious diseases, and premature death. But sticking to a healthy diet – especially when we’re trying to lose weight – can be hard for lots of reasons. Keeping track of calories and fat percentages can be confusing, and the nutrition labels on the foods we buy aren’t always that helpful. How are consumers supposed to figure out which diet advice is just hype – that ultimately don’t contribute to better health – and which advice offers good, medically sound information?

Here are some basic guidelines to keep in mind:

• Calories matter
• Serving size matters
• Fats and cholesterol matter
• Fruits, vegetables and whole grains matter
• Exercise matters
• Sticking to it matters

The Only Way to Lose Weight is to Eat Fewer Calories Than You Burn in a Day

Simply increasing your activity level might be enough if you only need to lose a few pounds to get your BMI into a healthy range.  Most of the time, however, eating fewer calories is also going to be needed.  The calories and fat in the foods we eat add up quickly!  For example, have you eaten at a fast food chain recently?  To work off the calories from a double cheeseburger, extra large fries and a 24 ounce soft drink – about 1500 calories – you would have to run for two and half hours at a ten minute mile pace! (For more information, see Fast Food Facts: Calories and Fats).

Eating Fewer Calories Doesn’t Necessarily Mean Eating Less Food

The trick to dieting without being hungry is to choose foods that contain fewer calories and also fill you up. An example of this would be having a piece of fruit instead of fries with lunch.  It helps to remember that not all foods are created equal!  Some foods, such as nuts, are high in nutrients and essential vitamins, while others lack nutritional substance, such as products containing added sugars. “Nutrient-dense food” provides substantial amounts of vitamins and minerals and relatively few calories, but leaves you feeling fuller while also supplying valuable fuel for your body.  A person is more likely to stick to a diet-while feeling better and healthier-if calories are nutrition-dense.  Empty calories from simple carbohydrates found in foods with processed and refined sugars, such as candy, pasta and bread made from white flour, and foods with corn syrup, leave you hungry again soon after, craving more food.  This is because simple carbohydrates quickly turn into useless sugar, whereas complex carbohydrates, such as vegetables, whole-grain breads and cereals, and low-fat yogurt and milk, provide long-lasting nutrients, improve digestion, help stabilize blood sugar, and keep your energy at an even level.  Although foods such as fruit are also considered simple carbohydrates, they contain vitamins and nutrients that occur naturally, unlike those found in processed and refined foods.

A 2011 study in the respected New England Journal of Medicine found that certain foods were linked to weight change more than others. After following participants for an average of 17 years, researchers found that weight increase was most strongly linked to foods such as potato chips, sugar-sweetened beverages, and unprocessed red meats.  Foods such as vegetables, whole grains, nuts, fruits, and yogurts were closely linked to preventing weight-gain.

Eating 5 Smaller Meals Might Work Better Than Eating 3 Larger Ones

Most people are surprised to learn that eating 5 or 6 times a day can be a better way to lose weight than eating only 3 times a day! This only works, however, if you take care to control not only the calorie content but also the amount of food you’re eating.  The goal is to eat a small amount of food – like a cup of no-fat yoghurt, for example – every 3 hours or so.  Eat only enough so that you don’t feel hungry, but never so much that you feel stuffed. Some people recommend eating your meals off of smaller plates, because research has shown that people have a tendency to try to eat all of what is served to them. Unfortunately, portion sizes for restaurant meals and other prepared foods, and even in our homes – everything from breakfast muffins to a plate of spaghetti – have grown to very unhealthy proportions in the last two decades.

Eat Less Cholesterol and Less Fat – Especially Less Saturated Fat, and Almost No Trans-Fat

Most people have heard that cholesterol is bad, and eating less of it is important.  But our bodies also make cholesterol from the fats that we eat. Fats are also very high in calories. So cutting down on total fat intake is helpful.

All fats, however, are not alike, and that’s why it’s important to check food labels to be sure that you’re eating the smallest amount of saturated fat and of trans fat possible. These tend to be the kinds of fat that are found in milk and milk products, those that are solid at room temperature – like the fat in meat products, butter, margarine, shortening and lard – and the fats that come from baked goods and fried foods. The fats you do eat should be mostly “unsaturated” or “polyunsaturated” fats. Although there are some exceptions, these tend to be liquid at room temperature, like canola oil, olive oil and some of the other vegetable oils.

Eat More Fruits, Vegetables, Whole Grains, and Low- or No-Fat Dairy Products Every Day

There are many good resources to help you learn about healthy eating. For example, the US Department of Agriculture website at My Plate helps you tailor the government’s dietary recommendations to your nutritional needs. Nutritionists at the Harvard School of Public Health have similar (but not identical) healthy food guidelines. What these diets have in common includes recommendations to:

• Aim for at least five servings of fruits and vegetables a day. Usually, the more colorful the fruit or vegetable, the more nutritious. For example, dark green spinach has more nutrients than light green iceberg lettuce.
• Try and choose whole grain cereal, pasta, rice, and bread. Many foods that claim “whole wheat” or “whole grain” on the front of the package are really made with mostly white, processed flour – which isn’t nearly as nutritious. Always check the ingredients to see if “whole wheat” or “whole grain” is thefirstingredient listed. And don’t be fooled by how a food looks. For example, some dark brown breads are colored with coffee or other dyes, not whole grains. And remember, whole grain rice is brown, not white rice.
• Avoid food that is high in sugar, like pastries, sweetened cereal, and soda or fruit-flavored drinks.
• Reduced-fat or no-fat (skim) milk, reduced-fat cheese, and low-fat or no-fat yoghurt are good sources of the protein and calcium we need. Try to eat 2-4 servings of low-fat or no-fat dairy products each day.

Exercise Does More Than Burn Calories

Increasing the amount of exercise you do each day means you burn more calories to help you lose weight.  And, research has shown very clearly that 30 minutes of moderately strenuous daily exercise is also one of the most important requirements for disease prevention – even for people who are already at an ideal weight.  The exercise you choose doesn’t need to be elaborate, or to take place in a gym.  Walking, biking, swimming, or gardening can do the trick, and getting a friend or family member to exercise with you can turn this into a valued part of your daily routine.  Learn more about the health benefits of physical activity and how to get started from the CDC.

Staying Healthy is a Life-Long Proposition

When we think about dieting, most of us think about setting a weight-loss goal that will determine how long we watch what we’re eating.  A better way to think about it might be to ask yourself the question: How long do I want to try to avoid developing chronic disease? Put in those terms, it’s easy to see that getting control of BMI and eating foods that contribute to continuing good health (or that don’t directly contribute to the development of dangerous disease conditions) is not a short-term goal.  For many of us, doing what it takes to get our BMI into a healthy range and to keep it there means learning to live our lives in a new way. Scientists have found that one of the keys to success is to think about these goals every day. For example, people who get on a scale and check their weight daily are more successful at keeping their weight under control than people who don’t.

Don’t Waste Your Time, Energy, and Money on “Quick Fix” Solutions

For some people, there may be faster ways to lose weight than following the diet suggestions listed here.  But the important thing to remember is that weight loss is not the only goal.  The more important goal is to keep your risk of developing chronic disease and dying younger as low as possible.  Fad diets, diet pills, protein powders, liposuction, and even intestinal or gastric bypass surgery might provide a leaner profile, but they don’t provide the nutrients needed to keep you as healthy as you could be.

For more information about BMI and how it is calculated, see Obesity in America: Are You Part of the Problem? Mozaffarian D, Hao T, Rimm, EB, et al. Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. The New England Journal of Medicine. 2001;364:2392-404.

A very useful demonstration of the trend toward larger portion sizes can be found in the two “Portion Distortion” slide sets that you can view at http://hp2010.nhlbihin.net/portion/.

Some fats that are liquid at room temperature, like coconut oil, are still high in saturated fats. Check the nutrition label before you buy, to be sure that you’re choosing the product with the lowest possible saturated fat content.

Emily Hartman, Cancer Prevention and Treatment Fund

If you are trying to lose weight to prevent cancer, you may notice that there are claims that the acai (AH-sah-EE) berry will help you lose weight. Dieters beware: these claims are false. Ads promising weight loss have been spotted on popular social networking sites and search engines. Before you give out your credit card number, read on!

The acai palm produces a very small berry that is found in South and Central America. It has become popular in the United States over the last few years. While there are plenty of good things about the fruit, make no mistake-there are no special properties that make you suddenly or quickly lose weight. Acai does have antioxidants-a substance our bodies need-but no more than cranberries or cherries, and less than blueberries, pomegranate, and grapes.[1]

Here are some tips that have been scientifically proven to help you lose weight:

• Exercise on a regular basis-most days of the week

• Eat well-balanced, nutritious meals

• Start each day off with breakfast

• Get enough sleep (at least 7-9 hours)

It is important to remember that if a product claims fast weight loss, either the product is risky or the claims are false. Healthy, safe weight loss consists of losing no more than two pounds per week-that’s 7,000 fewer calories consumed than burned off each week, since one pound equals 3,500 calories. Weight loss at the rate of .5 to 2 pounds per week is more likely to be permanent. If acai really were a miracle weight loss product, there would be no obesity epidemic in the United States! So please, use your better judgment next time you are tempted to buy an acai weight loss product.

Reference:

1. Navindra P. Seeram, Michael Aviram, Yanjun Zhang, Susanne M. Henning, Lydia Feng, Mark Dreher, David Heber. Comparison of Antioxidant Potency of Commonly Consumed Polyphenol-Rich Beverages in the United States. Journal of Agricultural and Food Chemistry 2008 56 (4), 1415-1422.

Blossom Paravattil, Cancer Prevention and Treatment Fund

Fast Food Facts

Let’s face it: With so much to do, it’s hard to eat right on the go.  And no matter how compelling you found the movies Fast Food Nation or Super Size Me, you sometimes find yourself making the occasional purchase at the nearest Wendy’s. While avoiding fast food may be the wisest and most health-conscious option, it may not be the most realistic.

With so many Americans being obese, President Obama signed a new law into the health care reform bill that requires every big restaurant chain (more than 20 stores) to post calorie information on every menu and drive-thru sign, as well as the amount of calories a healthy person should eat. The bill went into effect in this year.  The law also requires vending machines to have nutritional information on them

How Many Calories Should I be Consuming in a Day?

The United States Department of Agriculture (USDA) has recommended dietary guidelines that include the number of calories you should consume a day, depending on your age, level of activity, and whether you are a man or woman. The chart below will help you find out how many calories you should be getting. If you regularly consume more than the recommended amount, you will gain weight.

Recommended Daily Calorie Intake by Gender and Age based on Activity Level

Source: HHS/USDA Dietary Guidelines for Americans, 2005 

Sedentary means a lifestyle that includes only the light physical activity associated with typical day-to-day life. Moderately active means a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life.  Active means a lifestyle that includes physical activity equivalent to waling more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life. The calorie ranges shown are to accommodate needs of different ages within the group. For children and adolescents, more calories are needed at older ages. For adults, fewer calories are needed at older ages. So we at the Cancer Prevention and Treatment Fund give you the skinny on a variety of menu choices offered by some of the most popular fast food chains. Take a look–you may be surprised!

Fast Foods by Category

1http://healthreform.gov/documents/title_iv_prevention_of_chronic_disease.pdf

2 USDA. (2008). Dietary Guidelines for Americans 2005.

Susan Dudley, PhD and Jacqueline Britz, Cancer Prevention and Treatment Fund

The Women’s Health Initiative (WHI) began in 1992 as a long term national health research effort focused on disease prevention among postmenopausal women.  Over 161,000 women have participated in this research, which has provided information that has saved lives of women across the country.  The original study, lasting 15 years, was aimed at finding evidence-based strategies for prevention of many health conditions, including heart disease, breast and colorectal cancer, and fracture in postmenopausal women.  The WHI Extension Study, carried out from 2005 to 2010, followed up with 115,400 participants from the original study to gather more data and answer additional questions.

Many experts were disappointed when a 2006 dietary trial that was part of the original WHI study showed that a low-fat diet did not reduce women’s risks of heart attacks, strokes, breast cancer, or colon cancer.  Since then, other studies have come out, including subsequent diet trials with women enrolled in the WHI.  The results have been inconsistent: some positive and some negative.

So, what’s a woman to eat?  Is there, in fact, a right combination of fats, carbohydrates, proteins, and other nutrients?  Studying and understanding the effects of diet and changes to diet is always complicated.  Consider the following:

• Any time we limit our intake of one type or category of food, we tend to fill the gap by eating more of another type of food.  In the WHI, women were not encouraged to cut calories or lose weight.
• Our bodies have an astonishingly efficient “thermostat” that works hard all our lives to return us to whatever body weight and body composition it has been set at, based on what has been normal for us over the long-term.  That is why keeping weight off after just about any kind of crash diet is so hard to do.

The Women’s Health Initiative: Diet Trials

The main goal of the initial WHI dietary trial was to determine whether low-fat diets could reduce the risk of developing breast cancer, colon cancer, stoke, and heart disease.

The 19,541 women participating in the low-fat diet trial were divided into two groups: one group was encouraged to continue eating as they always had, while study participants in the other group were encouraged (through participation in a series of training sessions) to modify their diets by reducing fat and increasing their consumption of fruits, vegetables, and grains.  By later comparing the rates of health problems, including breast and colon cancer and cardiovascular disease, between the two groups of women, scientists hoped to see whether the training sessions would work and whether the low-fat diet would improve women’s health.

The results, reported in 2006, were not encouraging, since few differences emerged in the health status of the women in the two groups.  However, there were a number of weaknesses in the investigation that made the results difficult to interpret.  Two are especially important:

• All dietary fat is not alike. For example, we now know that saturated fats and trans-fats can have particularly negative health effects and that certain fats-like those found in walnuts or some fish oils-can actually be beneficial. However, the trial did not attempt to influence which types of fats the women were eating.
• The women who were in the group that was trained to improve their diet didn’t improve their diet as dramatically as the researchers hoped. The “low-fat” group for this study averaged 29% calories from fat instead of the targeted 20%. The 29% finding is not much different from the average adult in the U.S. who gets 32.7% or more of his or her calories from fat. The study participants’ reported consumption of fruits and vegetables was only slightly raised, and their consumption of grains did not change. It’s impossible to know if there would have been a bigger difference in the incidence of cancer, stroke, and cardiovascular disease in the two groups if the “low-fat” group had improved their eating habits more dramatically.

When the researchers studied the women in the diet modification group whose total fat intake was reduced the most, they found that they didsignificantly lower their risk for invasive breast cancer.  And those who consumed less saturated fat and ate more fruits and vegetables reduced their blood pressure, cholesterol and other problems that may eventually reduce their risk of heart attack, stroke, and heart disease.

Results from More Recent Studies

Since the publication of the initial results in 2006, subsequent diet trials with women enrolled in the WHI have shown a mix of positive and discouraging results.  Below are descriptions of four additional trials. While these studies also have limitations, their findings have implications for disease prevention among women.

Low-Fat dietary pattern and Cancer incidence (2007):

The same group of women from the original WHI study was followed for 8 years for a trial that investigated low fat dietary patterns and their effect on cancer incidence.  Despite the discouraging results from the first published investigation on the effects of a low-fat diet, this study found lower rates of ovarian cancer among the group of women who followed a low-fat diet.  For every 100,000 participants on a modified low-fat diet per year, there were 36 cases of ovarian cancer diagnosed, compared to 43 cases of ovarian cancer among the women who did not modify their diet.  This difference in ovarian cancer rates between the two groups was statistically significant, meaning that it was unlikely to have happened by chance.  So, while a low-fat diet was not associated with a reduced risk of breast cancer, colorectal cancer, or cardiovascular disease, it was associated with a lower risk of ovarian cancer.

Low-Fat dietary pattern and risk of treated Diabetes Mellitus in postmenopausal women (2008):

The same participants from the original 2006 trial were also subjects of an 8 year long investigation looking at the relationship between a low-fat diet and diabetes.  Just as was true in the initial trial, the group of women following a low-fat diet did not appear to have substantial health gains over the group of women who did not follow the low-fat diet.  The participants with a modified diet had only a 4% reduced risk of developing diabetes as compared with the participants in the usual diet group.  While that may not seem very impressive, the participants in the low-fat diet group maintained a lower weight, on average, than participants in the usual diet group.  The researchers noted that the participants with the biggest reduction of fat in their diets did have a lower diabetes risk that was statistically significant.  Based on this study, they concluded that losing weight is more important for reducing one’s chances for developing diabetes than the quantity of fat, carbohydrates or other nutrients consumed.  The women in the study who followed a low-fat diet were more likely to maintain a lower weight and, therefore, indirectly may have a reduced their risk of diabetes.

Calcium/Vitamin D supplementation may help prevent weight gain in postmenopausal women (2007):

A large portion of the participants from the initial 2006 trial were used for another study published in 2007 to determine the influence of calcium and vitamin D on weight gain.  Research suggests that these two nutrients may be able to initiate the decline of fat cells, reduce the generation of new fat cells, and consequently decrease the amount of weight gain.  For 7 years, researchers monitored a group of women taking pills with active calcium plus vitamin D, and others taking placebos.  The women taking pills with active calcium plus vitamin D gained on average about a quarter of a pound less than women in the placebo group.  Although this tiny difference was statistically significant, it isn’t a meaningful difference.   More important, the women in this first group were less likely to gain weight at all during the trial.  The women who benefited the most were those who, prior to the start of the study, consumed less than the recommended 1,200 mgs per day of calcium (this is the amount recommended for women in the age range of 50-79). Therefore, while taking active calcium and vitamin D may help women maintain their weight, its benefits are likely to be more substantial in women who lack sufficient calcium and vitamin D.

Multivitamin use and risk of Cancer and Cardiovascular Disease (2009):

Finally, a 2009 study used data collected from all participants in the Women’s Health Initiative throughout the hormone trials, observational study, and dietary study (a total of 161,808 participants).  Study enrollment took place between 1993 and 2008, with follow up conducted through 2005.  Data were collected for a median of 8 years in the clinical trials and 7.9 years in the observational study.  Participants using multivitamins (41.5%) were compared to participants not taking multivitamins to see which group had higher rates of breast, colorectal, endometrial, renal, bladder, stomach, lung, and ovarian cancer.  Researchers were also interested in seeing if there was a difference between the two groups in terms of cardiovascular events such as stroke or heart attack.  The women who took a daily multivitamin were no less likely to develop or die from cancer or cardiovascular disease than the women who did not take a multivitamin.

What We Have Learned from These Studies

Don’t let the negative headlines of some of these studies fool you.  Although these studies provide conflicting results, with only some supporting the relationship between certain diets and disease prevention, and others proving inconclusive, the studies taken altogether still provide a lot of important information:

• Women whose fat intake was lowered the most had better health outcomes.
• The women in the WHI were not encouraged to reduce their calories.  That may have been a mistake.  Research now clearly shows that being overweight increases the risk of breast cancer, heart disease, arthritis, and many other diseases, so more targeted dietary modifications that include emphasis on achieving and maintaining healthy body weight might be more effective.
• Even when evidence does not conclusively show that a particular kind of diet, such as low-fat, can prevent or reduce the risk of disease, the dietary change may still improve health by lowering or controlling weight.  Excess weight and obesity increase the risk for many diseases and cancer.
• There is no way to know whether the dietary intervention in this study would have been more effective if it had been started earlier in the women’s lives-when the women were in their 20’s, 30’s, or 40s, rather than at 50-79 years of age.
• We know that many cancers and other health conditions take 15-20 years to develop and usually show up among older individuals.  We still don’t know what impact dietary modifications will have on the women’s health 10 years after the study’s end.
• One of the most important messages is that dietary changes are easier to talk about than to do something about.  The participants in the dietary modification groups probably started out with very good intentions about following the recommended diet, but that turned out to be impossible for many of them.  Whether this is because of pressure to join the family for dessert, the endless temptation created by advertisements for foods that were not compatible with the diet, or other causes, it is important for us to take such real-world obstacles into account.  It doesn’t make sense to measure the effectiveness of dietary change by focusing on women in a “diet modification group” if the women didn’t substantially modify their diet.   It makes more sense to study the women who succeeded in modifying their diet compared to those who didn’t. Those are the women whose health tended to benefit most.

Maintaining moderation and balance

So, given the findings of these various studies, are there changes in our diet that we should make?  Even though the results are mixed, it’s clear that most people will benefit from a well-balanced diet that is low in sodium, added sugars, and saturated- and trans-fats, and a diet that is high in fresh fruits, vegetables, whole grains, and heart-healthy unsaturated fats, with moderate amounts of dairy products and meat protein.  The USDA Dietary Guidelines for Americans gives specific recommendations for dietary intake, suggesting that women should strive to consume between 1.5 and 2 cups of fruit each day, between 2 and 2.5 cups of vegetables, and 3 cups of low fat milk products.  Women should eat approximately 6 oz. of grains each day (with a minimum of 3 oz. coming from whole grains), and between 5 and 5.5 oz. of meat/beans.  “Good” fats, found in fatty types of fish (i.e. salmon, herring, sardines), plant oils like extra-virgin olive oil, avocados, seeds, and nuts, are also an essential part of a healthy diet and have been found to help prevent incidence of disease.

General guidelines for healthy eating may need to be modified to accommodate specific health problems or disease risks.  For example, people with high cholesterol may need to reduce the amount of fat and food they consume each day that comes from animals (red meats, eggs, and dairy products).  Helpful nutritional guidelines are available at: http://www.mypyramid.gov/index.html.

Also, do not forget to watch calories, because excess weight can cause or complicate so many health problems.  Reaching and maintaining a healthy body weight is important.  In order to lose weight, it is important to make sure that a person burns more calories than he or she consumes.  As a result it is essential to find a healthy balance between food consumption and physical activity.

Remember that serving size and portion size are not the same thing. Serving size is a standardized quantity of food that we use to measure nutrients.Portion size is the amount we pile on our plates.  Keep in mind that one serving of cooked vegetables is usually about one-half cup (about a hand-full!) and a serving of meat is about the size of a deck of cards.  This means that most people can fit in all those recommended servings of fruits and vegetables every day while still reducing their total calorie intake and losing weight.  But it also means that the portions you serve yourself may be much higher in calories than the standard serving size would be.

And don’t forget that beverages have calories too!  Try to limit your intake of high calorie or sugary drinks, as well as alcoholic drinks.  They should be consumed in moderation, or not at all.  It is recommended that women limit alcoholic intake to a maximum of one drink per day (i.e. 12 fl. oz. beer, 5 fl. oz. wine, or 1.5 fl. oz. 80-proof distilled spirits).  More resources regarding a healthy diet for women can be found at http://womenshealth.gov/FitnessNutrition/eatinghealthy/.

Lastly, women over 50 may want to take calcium and vitamin D supplements. There appears to be little risk in taking them and many potential benefits, including help in maintaining weight-particularly if their diet and indoor lifestyles are causing them to have low levels of these essential nutrients.

References:

1. The original reports of the WHI findings on low-fat diet can be found in the Journal of the American Medical Association, February 8, 2006 – Vol 295, No. 6, pages 629, 643, and 655.
2. This report, in addition to the other reports cited in this article, can be accessed online through the Women’s Health Initiative website: http://www.nhlbi.nih.gov/whi/index.html.
3. Dietary Guidelines for Americans [Current Guidelines – 2005 Dietary Guidelines]. (n.d.). Retrieved from USDA Center for Nutrition Policy and Promotion website: http://www.cnpp.usda.gov/DGAs2005Guidelines.htm
4. Vitamin D [Dietary Supplement Fact Sheet]. (n.d.). Retrieved from National Institutes of Health – Office of Dietary Supplements website: http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts/
5. Calcium [Dietary Supplement Fact Sheet]. (n.d.). Retrieved from National Institutes of Health – Office of Dietary Supplements website: http://ods.od.nih.gov/factsheets/Calcium-Consumer/

Cancer Prevention and Treatment Fund

A Guide for Parents of On-The-Go Kids and Picky Eaters

Between parents’ work schedules, after school activities, homework, and chores, you may find it impossible to make time for healthy meals that your kids actually want to eat.  The challenge is even greater when kids get hooked on the pizza, soda, and chips provided at friends’ houses, activities, and parties.  Even the most conscientious parent may find it hard to avoid the temptation of fast food and favorite snacks.  But there are solutions!

• Have easy foods on hand for last minute meals.  Keep healthy food on hand for quick and easy meals-frozen food can be an easy and healthy choice, especially all-in-one bag frozen family meals that are low on calories and fat (check out the many combinations of grilled chicken, rice or pasta, and vegetables in one bag).  If those family meals aren’t quite large enough for your family, you can easily add more fresh or frozen peas, green beans, or corn to make it more filling.
• Plan meals in advance.  This is hard for most families, but if you cook on the weekend you can freeze meals (or at least one major ingredient, such as cooked beans or rice) that you can use to make several meals during the week.  You can even look online for Once a Month Cooking (OAMC) plans that designate one day each month as “cooking day” and free up the rest of your time for other things.  Ask your kids to help you select and even help prepare the dishes-that way they are more likely to eat them when they are served.
• Out of sight, out of mind.  Don’t keep cake, candy, cookies, or chips (the 4 Cs!) in the house.  If you want to splurge occasionally, buy a small bag or individual portion as a treat.  Keep healthy snacks where kids can reach them.  You can “disguise” healthy foods by combining them with favorites-for example, try apple slices with low-fat peanut butter, baby carrots with veggie dip, or make your own trail mix with a combination of nuts, seeds, and dried fruit.
• Shopping Tips.  When you buy groceries, try to buy “whole foods” instead of processed foods – for example, buy fish, chicken, turkey, whole grain breads and cereals, brown rice, and fresh fruits and vegetables.  If fresh fruits and vegetables are too expensive or inconvenient, look for frozen ones without sauces, salt, sugar, or additives.  Whole foods are preferable because they have all their nutrients and they don’t have added chemicals, sugars, salt, or fat.  Experts call these foods “nutrition dense” because you get more nutrients per calorie than you do with processed foods.  Try to pick foods that look good together because they have different colors and textures.  It sounds funny-like you’re trying to have a “fashion forward” plate-but this is a great way to maximize taste and nutrition!
• Avoid misleading “health” claims.  Grilled chicken or fish are great choices, but fried chicken or fried fish are no healthier than hamburgers.  Remember that how food is prepared (fried, grilled, baked) is almost as important as what is in the food.  Most “juice drinks” have more sugar than the fruit they are made from, and contain little or no fiber, and many vegetable soups have more salt than vitamins.  If a salad has ham, eggs, cheese, and lots of salad dressing, it may be more fattening than a cheeseburger.  Remember that just because a label says “low calorie” or “sugar-free,” doesn’t mean the food or beverage is healthy.  Check food and beverage labels for nutrients like vitamins, protein, fiber, and minerals, not just for “bad” things like fat, calories, and salt.
• Transition slowly.  If you and your family are used to eating a lot of fast food and prepared meals, your kids will need to slowly get used to other foods.  For example, try adding some extra fruits and vegetables to your usual meals, gradually decreasing the portion size of other items on the plate.  Start using whole grain bread, lean meat, low-fat cheese in a sandwich.  Try applesauce for dessert.  Our taste buds adjust over time, so cravings for very sweet or salty foods will decrease if you gradually take those foods out of your children’s diets.
• Get young children involved in the kitchen.  The more kids are involved in making meals and snacks, the more they will enjoy eating healthy food.  Ask your kids to help you wash fruits and vegetables or do simple tasks like snapping the stems off of green beans, or making a salad.  Give children a few healthy choices for their sandwich or salad, so that they are involved and interested in eating healthy.  You can also teach kids where their food comes from by helping them start a small garden-even if all you have is a windowsill or fire escape.

All articles have been reviewed by Dr. Diana Zuckerman and senior staff.

References:

1. Diana Zuckerman & Brandel France de Bravo, The Survival Guide for Working Moms (and Other Stressed-Out Adults), 2009.
2. United States Department of Agriculture and Department of Health and Human Services, Dietary Guidelines for Healthy Americans 2010, available at: http://www.health.gov/dietaryguidelines/.

Margaret Aker and Brandel France de Bravo, MPH, Cancer Prevention and Treatment Fund

By now nearly everyone knows that being obese is bad for your health, but did you know that it is also bad for your wallet? This is especially true for women.

Obesity is usually defined as being 20% over ideal weight or as having a body mass index of 30 or higher (body mass index or BMI is calculated using height and weight). Obese people are more likely to suffer from chronic health problems, such as diabetes and heart disease, and they don’t usually live as long as people who are not overweight. The latest research indicates that obese men and women are at higher risk of colon cancer, and obese women are also more likely to get breast cancer and endometrial cancer (cancer of the womb). Obese people also experience a diminished quality of life because of physical difficulties and discrimination. While many reports have discussed the “cost to society” of obesity, none have looked at the additional costs in dollars for an obese woman or man.

A 2010 study by Avi Dor and his colleagues at the School of Public Health at George Washington University found that it costs an obese woman $4,870 more per year to live in America than a woman of healthy weight. Obesity costs less for men — an additional $2,646 per year.^[1] Some of those costs are paid directly by the obese person and part by employers and the government.

How did the Researchers Come Up with Those Figures?

They looked at all the data available on direct medical costs, work-related costs, and personal costs. Direct medical costs include out-of-pocket as well as insurance-covered expenses related to doctor visits, hospital care, and medications; work-related costs include differences in wages, missed work days and disability payments. Personal costs refer to the yearly dollar amount spent on transportation and life insurance.

The researchers believe that their estimates are on the low side because they did not take into account other expenses that typically are higher for obese people, such as clothing, air travel, or furniture.

Lower Wages

Most surprising, the researchers discovered that obese women do not earn as much as normal-weight female employees. No such wage differential was found for obese men who earn the same as normal-weight men. While no one knows for sure why it is that obese women have lower wages, one likely explanation is a double standard that places greater emphasis on women’s physical appearance than men’s. If obese women’s lower wages were the result of something else, like lower productivity or more missed days of work, wouldn’t that  be true for obese men as well?

The chart below shows the breakdown in obesity costs for men and women. For men, direct medical costs account for over half of their additional “cost of living,” whereas for women, reduced wages are the biggest contributor.

TOTAL COST OF OBESITY FOR AN INDIVIDUAL

Overweight vs. Obese: Do Costs go Down When Weight goes Down?

This study also found that there is an added cost for being overweight (BMI of 25 to 29.9), although not as high as for being obese. It costs an overweight woman an extra $524 per year to live in the United States, compared to $432 extra per year for men. So, how overweight you are matters. If a person is only overweight by a few pounds, losing those pounds could potentially save quite a bit.

The economic downturn has affected nearly all of us in one way or another, but this study reveals that its impact may be even greater for people who are overweight or obese. If health concerns aren’t enough incentive to change eating and exercise habits, knowing the economic costs might be.

Lastly, while many of us need to lose weight, all of us should be finding ways to fight discrimination. This study draws needed attention to another way obese people — particularly women — are discriminated against.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff. 

1. Dor, A., Ferguson, C., Langwith, C., Tan, E.: A Heavy Burdern: The Individual Costs of Being Overweight and Obese in the United States. The George Washington University School of Public Health and Health Services 2010.