Obesity: Some Solutions?

September 26, 2019 by foodworksblog Leave a comment

The Obesity/Diabesity Pandemic

Obesity is a major risk factor for the development of type 2 diabetes mellitus, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system.

Global Statistics, Source: Lancet

  • Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
  • Diabetes is fast becoming a major problem in low and middle-income countries.
  • From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
  • Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.

So what are some solutions?  

The standard American diet is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking.

Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half. In people over 60, the reduction was 70%.

Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why nutritious foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high schools’ levels by returning to a revamped and modernized home economics course in the curriculum.

A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.

Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program.

There should be an increased access to professional treatments. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or the new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced to keep patient volume high and lessen out-of-pocket expenses.

We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.

Educate the public on food labeling including ingredient lists. Beware of food companies that promote products with a “health halo” meaning exaggerated claims made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling, so they include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.

Stop corporate-government partnerships and diminish lobbying.
“Lately, the food industry (Big Agriculture, Big Meat, and Big Food ) has been highly implicated in this epidemic. This includes the advent of ultra-processed foods. “To sell these foods, companies bombard us with billions of dollars in ads, normalize eating junk food, and make it available 24/7, everywhere, and in large amounts at remarkably low cost.”

Source: “Against the Odds: Why our food system makes it tough to eat healthy, Nutrition Action Healthlettter  November, 2020.  

The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by myriad food companies such as Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. A good example is the placing of a glass of milk on the MyPlate Logo. Often this practice only serves the dairy industry and not necessarily the consumer.

Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another fee annually. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may still contain high levels of sodium. If the AHA were sincere in their efforts to help consumers choose healthier foods to rein in obesity/diabetes, they would realize that research has shown that a 1.8 oz. daily serving of processed meat raised the risk of diabetes by 19 percent and heart disease by 42 percent. Most current dietary recommendations emphasize a reduction in processed meats (my emphasis).

Bottom Line: It will take a concerted effort from government, politics, industry, communities, and consumers and the perpetrators of our obesigenic culture to begin to change this trend.

How to Eat (most of the time)

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Do you feel guilty if you do not eat healthy foods? Most of us don’t but there are people who now comprise a group exhibiting a new eating disorder called orthorexia. 

The following article by Mark Bittman may put this eating pattern in a reasonable perspective. The Bottom Line? Enjoy food but make healthy choices (most of the time). This philosophy as stated by Bittman is refreshing – Seems to resemble the traditional diet of the French – the Good Life Savored.

“Eating well is an integral part of their national heritage. To say the French know their food is an understatement and it has been said that even their children are serious “foodies” with two-hour multi course lunches (not uncommon in France)” – all this without guilt. Contrast that with the typical American with a quick drive-through grabbing a burger with fries and eating them in the car with some snacking throughout the day.  The French also maintain their weight with little dieting, calorie counting or snacking.” They simply say: If you eat too much one day, cut back the next day. Pretty simple advice but it seems to work (at least for them).

Source: 30 Secrets of the World’s Healthiest Cuisines. by Steven Jonas, M.D, and Sandra Gordon.

Note: Obesity rates in France are among the lowest in Europe, but have been increasing steadily. The increase has been attributed to an increased adoption of the Western diet or Standard American Diet.

In France, almost 40% are overweight (including obese). You can contrast that with the U.S. at 70% (overweight and obese).

CLICK HERE.

The Nutritional State of the Nation: Does it Affect Covid-19?

A number of diseases and disorders share common risk factors of low intakes of vegetables, fruits, and whole grains, excess calorie intake, body fat, and high animal fat intake. These risk factors are associated with the development of chronic inflammation and oxidative stress, conditions that are strongly related to the development of heart disease, diabetes, osteoporosis, Alzheimer’s disease, cancer and other chronic diseases that include stroke, osteoporosis, and obesity.

Metabolic syndrome is a cluster of at least three of five conditions: hypertension, high blood sugar, obesity, high triglycerides, and low HDL cholesterol that increase the risk for cardiovascular disease. These diseases are all related to our diets and other lifestyle factors – namely exercise and smoking habits.

A new study in the journal Diabetes Care is the first to look at the impact of metabolic syndrome on outcomes for Covid-19 patients. “Together, obesity, diabetes and prediabetes, high blood pressure and abnormal cholesterol levels are all predictors of higher incidences of death in these patients and were more than three times more likely to die from the disease.

“The more of these diagnoses that you have, the worse the outcomes”, says lead author Joshua Denson , assistant professor of medicine and pulmonary and critical care medicine physician at Tulane University of Medicine.

“The underlying inflammation that is seen with metabolic syndrome may be the driver that is leading to these more severe cases.” Dr. Denson adds.  In this study, the most common conditions were hypertension (80%), obesity (65%), diabetes (54%), and low HDL (39%.)

Dr. Denson would advise anyone who meets the criteria for metabolic syndrome to be vigilant in taking measures to reduce risk or exposure to the coronavirus.  “It doesn’t matter if you’re young or old, we took that into account” he says.

 

 

 

 

 

 

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Is Dieting Dead?

A Diet History Timeline

The picture above is an ad from the early 1900’s attempting to promote the effectiveness of a tonic “that not only cures everything, but adds heft to the figure.” Ironically, a full figure in those times represented wealth and prosperity.

I love timelines – they tell us where we have been and how we evolved to where we are now.   This is a fun timeline on the History of Dieting.  Where can we go from here?

According to the latest issue of Eating Well magazine, October 2020, it is predicting in the future that dieting will be done for good. “We will finally wake up to the fact that following a regimen of temporary deprivation to achieve health or aesthetic goals is an exercise in futility – and that healthy eating is for life and  building ongoing habits, not quick fixes.”

AMEN!!! But first, what is our dieting history?

1850

In England, William Banting consulted Dr. William Harvey for weight loss who recommended he cut most sugar and starch from his diet since foods containing those substances tend to create body fat.  He lost 50 pounds and wrote the first diet book, “Letter on Corpulence Addressed to the Public” in 1862. It was a best seller!

1898

Horace Fletcher loses 42 pounds by advocating that we need to chew food about 32 to 80 times before being swallowed and it should be in liquid form. He later became known as “The Great  Masticator”.

1918

Dr. Lulu Hunt Peters writes the first best selling diet book, “Diet and Health with a Key to the Calorie”.   She promoted calorie counting over our entire life.

1919

The Continental Scale Company produces the first bathroom scale called the “Health O Meter”.

1929

A cigarette advertisement tells women to “reach for a Lucky instead of a sweet”.  Another slogan says:  “Light a Lucky and you’ll never miss sweets that make you fat”.

1930

The “grapefruit diet” also known as “The Hollywood Diet” is promoted which involves eating only 585 calories a day for 18 days with boiled eggs, green vegetables and Melba toast.

1936

Self-proclaimed diet guru Victor Lindlahr reaches thousands via the radio to produce his regular broadcasts entitled “reducing party”. He wrote the book You Are What You Eat, one of the earliest texts of the health food movement in the United States, which sold over half a million copies.

1942

The Metropolitan Life Insurance Company published standard weight tables for “ideal weight”.  The charts used weight, height, frame size, and gender but only used data from life insurance policyholders which biased the conclusions.

1948

Amphetamines were first prescribed for some obese patients but later research determined that these were dangerous.  Amphetamine –like drugs are still used today in a limited fashion.

1958

Saccharin, the first manufactured artificial sweetener is produced and becomes a popular sugar substitute.  It is still used today after years of research that absolved critical reports of its cancer connection. Some doubts still linger.

1961

Weight Watchers was born as a result of Jean Nidetch and several friends who met in her apartment to offer each other support about dieting. Weight Watchers and other diet programs like Nutrisystem and Jenny Craig has turned weight loss into a multi-billion dollar industry. However, the results are dismal. In 1993, the Federal Trade Commission charged that five weight loss programs (including the above) made false and unsubstantiated claims about the effectiveness of their products. To settle the charges, the companies were required to add dislaimers, like “For many dieters, weight loss is temporary.” By 2002, the FTC released a report suggesting that little had changed.

1967

Twiggy, 5’7” and weighing about 92 pounds becomes a supermodel and icon for the slender female.

1972

Dr. Atkins introduced his first “Diet Revolution”, a high protein, high fat, low carbohydrate diet.

Richard Simmons opens Ruffage and the Anatomy Asylum, a Beverly Hills restaurant and exercise studio.  He quickly becomes known as a fitness and diet guru.

1978

Dr. Herman Tarnover introduces the “Complete Scarsdale Medical Diet”, another version of the high protein, low-carb diet.

1979

The Pritikin Diet answers the trend of the high protein, low – carb diets with a high fiber, very low fat diet.  The system was originally designed for heart patients but became popular for those who followed the newer trend of the low –fat diet approach.

1981

The Beverly Hills Diet is introduced – it recommends eating nothing but fruit for the first 10 days.

1982

Aspartame is introduced as another alternative sugar substitute. It was marketed as NutraSweet and is still used today in many products.

Liposuction is performed in the U.S. for the first time and now becomes a popular cosmetic procedure for the obese.

1983 

Jenny Craig is formed which sells their own line of diet foods and offers diet counseling.   Nutrisystem soon followed.

1988

Oprah Winfrey loses 67 pounds on the liquid diet Optifast.

1993

The Federal Trade Commission charged that five weight loss programs, including Weight Watchers, Nutrisystem and Jenny Craig) made false and unsubstantiated claims about the effectiveness of their products. To settle the charges, the companies were required to add disclaimers, like “For many dieters, weight loss is temporary.” By 2002, the FTC released a report suggesting that little had changed.

1994

The FDA mandates that food labels must include detailed information about calories, fat, and fiber. We must thank Dr. Lulu Hunt Peters for this.

1995

“The Zone Diet” is introduced by Dr. Barry Sears. He promotes eating lots of fruits and vegetables and protein, while cutting back on breads and pastas.

1996

It is reported that 40% of nine and ten-year-olds are dieting and trying to lose weight.

2000

Experts are stating that there is now a global epidemic of obesity and that for the first time in history, this number of overweight people equals the number of underfed and undernourished.

2002

Dr. Atkins introduces his second diet book, the “New Diet Revolution” to a new generation of dieters. The Low-carb diet is back after multitudes of diet books promoting low fat diets.

2013

It appears we may have come full circle – we are now promoting cutting sugars and counting calories (again).  We have progressed from low carbohydrate, low fat, and low carbohydrate diets again along with some pretty scary schemes, e.g. the Tapeworm Diet.  Many weight loss books, gimmicks and pills have come and gone over and over again and many still exist, but with no real breakthroughs.

2020 “if dieting makes us fat, what should we do instead to stay healthy and reduce the risk of diabetes, heart disease, and other obesity-related conditions?,” asks Dr. Sandra Aamodt, PhD?  She is the author of  Why Diets Make us Fat” and coauthor of “Welcome to Your Brain”and earned her doctorate in Neuroscience from the University of Rochester.

New concepts in weight loss and management are beginning to emerge like mindful eating, weight acceptance, and a different mindset about healthy weights. A new field of genetics called epigenetics may provide some answers that includes how the environment can influence gene expression. A new field of lifestyle medicine focuses not on weight alone but eating for health during a lifetime.

More effort and focus should be made on weight gain prevention and weight loss maintenance if we are finally going to declare dieting “dead”.

 

 

The Glycemic Response: Sugar and Your Body

Blood sugar control is the goal of people who are either prediabetic or diabetic (type 1 or 2).

Why are high blood sugar levels bad for you? Glucose is precious fuel for all the cells in your body when it’s present at normal levels. But it can behave like a slow-acting poison and become a “silent killer.” when the normal rises.

  • High sugar levels slowly erode the ability of cells in your pancreas to make insulin. The organ overcompensates and insulin levels stay too high. Over time, the pancreas is permanently damaged. Insulin resistance may ensue.
  • High levels of blood sugar can cause changes that lead to a hardening of the blood vessels, what doctors call atherosclerosis.

Almost any part of your body can be harmed by too much sugar. Damaged blood vessels cause problems such as:

  • Kidney disease or kidney failure, requiring dialysis
  • Strokes
  • Heart attacks
  • Vision loss or blindness
  • Weakened immune system, with a greater risk of infections
  • Erectile dysfunction
  • Nerve damage, also called neuropathy, that causes tingling, pain, or less sensation in your feet, legs, and hands
  • Poor circulation to the legs and feet
  • Slow wound-healing and the potential for amputation in rare cases

Keep your blood sugar levels close to normal to avoid many of these complications.

What is the Glycemic Response?

The glycemic response is the rate, magnitude, and duration of the rise in blood glucose that occurs after a particular food or meal is consumed. It is affected by both amount and type of carbohydrate eaten and the amount of fat and protein in that food or meal.

Refined sugars and starches generally cause a greater glycemic response than refined carbohydrates that contain fiber. This is because sugar and starches alone leave the stomach quickly and are rapidly digested and absorbed, causing a sharp, swift rise in blood sugar. For example, when you drink a can of soda or eat a slice of white bread on an empty stomach your blood sugar increases within minutes. Eating a high fiber food causes a slower, lower increase in blood sugar. The presence of fat and protein also slows stomach emptying, and therefore foods high in these macro- nutrients generally causes smaller glycemic response than foods containing sugar or starch alone. For example , ice cream is high in sugar but also contains fat and some protein , so it causes a smaller rise in blood glucose than sorbet which contains sugar but no fat or protein. In fact, the GI for a baked potato is higher than for a serving of ice cream (due to the fat and sugar).

What is the Glycemic Index? (GI) 

Glycemic index is its ranking of how a certain food effects blood glucose compared to the response of an equivalent amount of carbohydrate from a reference food such as, white bread or pure glucose. The reference food is assigned a value of 100 and the values for other foods are expressed relative to this. Foods that have a glycemic index of 70 or more compared to glucose are considered high glycemic index foods those with an index of less than 55 are considered a low glycemic index food.

What is the Glycemic Load? (GL)

Glycemic load (GL) is a method of assessing glycemic response that takes into account both the glycemic index of the food and the amount of carbohydrate in a typical portion. To calculate glycemic load, the grams of carbohydrate in a serving of food are multiplied by that foods glycemic index expressed as a percentage.  A glycemic load of 20 or more is considered high, where a value of less than 11 is considered low.

For example: A raw carrot provides about 7 grams of carbohydrate and has a glycemic index of 47. It’s glycemic load (GL) is calculated as:

7 X 47 = 329.

329 / 100 = 3.29

Glycemic load = 3.29 

Bottom Line: Some high-GI foods, such as baked potatoes and French bread, are good sources of a number of nutrients. Just because a food has a high glycemic index doesn’t mean it should not be used as part of a balanced diet. Adjusting food choices toward selection of mainly  low GI foods is most helpful for people attempting to prevent or control type 2 diabetes.

Type 2 diabetes is usually diagnosed using the: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Normal levels are below 5.7 percent, and a result between 5.7 and 6.4 percent is considered prediabetes. It is important to see your physician who then may refer you to a certified diabetes educator or registered dietitian. Weight and carbohydrate control appears to be the best approach to deal with or even prevent diabetes type 2.  

The following links can further discuss the glycemic response as well as provide a table of the glycemic index and glycemic load of 100 foods tested.

CLICK HERE. and HERE

Source:

The American Diabetes Association

Nutrition. Smolin and Grosvenor, Wiley, 3rd Edition

Nutrition Now. Judith E. Brown, Wadsworth Centage Learning, 7th Edition

 

Chronic Inflammation: Understanding the “Cytokine Storm”

The leading causes of death among Americans are slow developing, lifestyle-related chronic diseases. This includes diabetes, heart disease,  stroke, cancer, hypertension or high cholesterol levels. Diet can often be (but not always) the underlying condition reflected as obesity.  Obesity is now considered to be a major risk factor for complications of COVID-19 infections.

A previous post  explains the role of diet in this occurrence. The post was written before the  co-morbidities   (underlying conditions) were associated with inflammation and severe COVID infections. The following well written article was initially published in The Conversation and succinctly explains how the role of inflammation can contribute to severe COVID and death often described as the “cytokine storm”.

CLICK HERE.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Food Additives and the Metabolic Syndrome

 

What is the metabolic syndrome?

The metabolic syndrome is cluster of conditions that increase the risk of heart disease, stroke, and diabetes.

Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The syndrome increases a person’s risk for heart attack and stroke. Weight loss, exercise, a healthy diet, and smoking cessation can help. Medications may also be prescribed.

In the current study presented, the results support the emerging concept that perturbed host–microbiome interactions resulting in low-grade inflammation can promote obesity and its associated metabolic effects. Moreover, they suggest that the broad use of emulsifying agents might be contributing to an increased societal incidence of obesity/metabolic syndrome and other chronic inflammatory diseases.

Emulsifiers as a food additive act as detergents to  reduce stickiness, control crystallization and prevent separation. They are commonly used in many processed foods such as mayonnaise, ice cream, peanut butter, chocolate, salad dressings to create a smooth texture, prevent separation and extend shelf life.

Commonly used emulsifiers in modern food production include mustard, soy and egg lecithin, mono-and diglycerides, polysorbates, carrageenan, guar gum and canola oil. Lecithin in egg yolks is one of the most powerful and oldest forms of an animal-derived emulsifier used to stabilize oil in water. These ingredients are required by law to be included on a food’s ingredient label. Emulsifiers can disrupt the tight seal called tight junctions formed by the intestinal tract lining, enabling gut bacteria to cross and gain access to nearby immune cells, promoting metabolic toxemia.

Even though these ingredients are on the Generally Recognized As Safe (GRAS) list , many have not been thoroughly tested. Testing can occur if an ingredient is found to causes a health problem.

Conclusions:
The mice study presented below was concluded by the co-author, Andrew Gewirtz, PhD, as saying, “We suspect some emulsifiers act like detergents, upsetting the friendly bacteria in the microbiota, which triggers low-grade inflammation and causes excess  eating and weight gain”. A follow-up study suggested the changes in gut bacteria from emulsifiers could trigger bowel cancer;  however, more recent findings confirmed that emulsifiers remained safe at the estimated exposure levels. However, based on the study, the use of these emulsifiers may need some revision.

Bottom Line:  The current use of emulsifiers in the food production system may affect the health of the microbiome and parameters of the metabolic syndrome. This in turn can contribute to a higher risk of several chronic diseases, namely obesity and/or diabetes type 2. Consumers are encouraged to read labels and consume less highly processed foods and substitute more minimally processed foods to prevent these occurrences.

UPDATE: Source: Medical News Today, August, 2020

A new study has found that people with metabolic syndrome, which refers to a cluster of conditions that increase a person’s risk of cardiovascular issues, are more likely to have worse COVID-19 outcomes — including requiring ventilation and death.

The research, which appears in the journal Diabetes Care, August, 2020, provides further information on the underlying risk factors that affect the severity of COVID-19.

CLICK HERE.

Do we need to take obesity more seriously?

 

By now, most people understand that the elderly are especially vulnerable to COVID-19. But studies of COVID-19 patients in France, Italy, China and the United States have also identified chronic conditions that place even younger patients at risk. Near the top of the list: obesity.

The resulting diseases of obesity such as hypertension and diabetes type 2 are often found in the most serious cases of COVID-19 and are thought to contribute to the death rates from the infection.  Childhood overweight and obesity now affects 1 in 5 children and adolescents in the United States. Overweight children tend to be overweight adults. Prevention is the key. The earlier the intervention – the better.

CLICK HERE.

The Pima Indians: A Study of Lifestyle and Obesity

By Sally J. Feltner, MS, Ph.D

The Pima Indians of Arizona have the highest rates of diabetes and obesity in North America. An estimated 50 percent of Pima adults are obese, and of those, 95% have diabetes type 2.

WHAT HAPPENED?

The story is not new – it more than likely began in the 1500’s when the Spanish explorers made contact with them in the New World. They and most Native tribes of that time were hunter-gatherers. They were lean, active and healthy people.

Pima Indians are believed to be descendants of people who crossed the Bering Strait from Asia to the Americas. Their traditional diet included meals made from the crops they cultivated including corn (maize), kidney beans, sunflower seeds, pumpkins and squash.  Small game such as rabbit, was a staple part of their diet together with meat from their livestock such as sheep and goats. Larger game was also available such as deer, elk and bear. As they were in close proximity to rivers, fish, duck and many different types of shellfish were major elements of their diet, which was also supplemented with herbs, acorns and roots. Sadly, as the years went on, the Arizona group met with some unavoidable circumstances that changed their way of life considerably – especially their traditional diets, economics, and well-being.

  • In 1859, the Arizona Pimas’ land along the Gila River was taken away by the U.S. government which left them to live on what land was left known as the Gila Reservation.
  • In 1866, new settlers began to populate the Pima region and diverted the water from the Gila River for their own use.
  • By 1869, the river had dried up and the Arizona Pimas were left with no water and less land to grow their food and crops resulting in an on – and – off – 40-year-old famine. As a result, the government exacerbated the problem again by providing subsidized foods to the tribe consisting of white flour, sugar, lard and canned goods, a far cry from their traditional diets of corn, beans and squash.

The timing of these significant changes in lifestyle and livelihood of the Arizona Pima population coincides with their development of diabetes type 2.  At the turn of the nineteenth century, studies recorded only one case on the Gila River Reservation. In 1937, a study documented twenty-one persons with diabetes. By the 1950’s, however, the prevalence had increased ten-fold and a study initiated in 1965 documented in the Arizona Pima Indians the highest prevalence of diabetes ever recorded.

THE PIMA INDIANS IN MEXICO

The Pima Indians who had settled in Mexico resided in the small town of Maycoba. For decades they had been isolated until 1991 when a paved access to the town was constructed.  Before that they grew a majority of their own food and still adhered primarily to their traditional diet that was similar to the Arizona tribe. Since they are genetically similar to the Arizona Pima, they present an opportunity to study and compare the two-lifestyle patterns of both tribes (diet and exercise) on their health statistics.

What Has Been Learned from Various Studies of these two Populations?

An Abstract from one study in 1994 that compared the two groups gives us the following details:

OBJECTIVE The Pima Indians of Arizona have the highest reported prevalence of obesity and diabetes type 2 In parallel with abrupt changes in lifestyle and the incidence in Arizona Pimas have increased to epidemic proportions during the past decades. To assess the possible impact of the environment on the prevalence of obesity and diabetes type 2, data were collected on members of a population of Pima ancestry living in a remote mountainous location in northwestern Mexico, with a lifestyle contrasting markedly with that in Arizona.

RESULTS  The Mexican Pimas were significantly lighter and shorter with a lower Body Mass Index. They also had a significantly lower plasma total cholesterol level than the Arizona Pimas. Even more startling was that diabetes type 2 was less prevalent with only 2 women (11%) and 1 man (6%) in the Mexican group compared with a prevalence of 37% and 54% in male and female Arizona Pima Indians respectively.

CONCLUSIONS This preliminary investigation shows that obesity, and perhaps type 2 diabetes is less prevalent among people of Pima heritage living a “traditional” lifestyle than among Pimas living in an “affluent” environment. These findings suggest that, despite a similar potential genetic predisposition to these conditions, a traditional lifestyle, characterized by a diet including less animal fat and more complex carbohydrates and by greater energy expenditure in physical labor, may protect against the development of cardiovascular disease risk factors, obesity, and diabetes type 2.

DISCUSSION:

These results indicate that a more traditional lifestyle of the Mexican Pimas protects the group against obesity, diabetes and kidney disease, even though they may have a genetic predisposition for such health problems.

What explains the results of experiences of the Arizona Pima?  One popular theory is one thing that drives obesity is a switch to a diet of highly refined carbohydrates that are so common in the Standard American Diet (SAD). When the Pima replaced traditional, unrefined carbohydrates with refined (sugar and flour), they became obese. It may not be the amount of food we eat but what kinds or quality we consume.

The lessons learned here support the theory that lifestyle factors appear to significantly influence the prevalence of obesity and diabetes type 2 in a population predisposed genetically to these conditions. Their story gives us all the opportunity to reassess our own current diets and lifestyle factors that may lead to healthier food environments and ultimately prevent our current situation of the diabesity dilemma.

SOURCES

Stephen Guyenet, Lessons From the Pima Indians. Whole Heath Source: Nutrition and Health Science.

Leslie O Schulz, PhD, Lisa S. Chaudhari, PhD. High-Risk Populations: The Pimas of Arizona and Mexico. Curr Obes Rep. 2015 March 1; 4(1): 92-98

Ravussin, et al. Effects of a Traditional Lifestyle on Obesity in Pima Indians, Diabetes Care 1994 September 17(9): 1067-1074

Obesity on the Rise – Some Solutions?

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The Obesity/Diabesity Pandemic

Obesity is a major risk factor for the development of  type 2 diabetes mellitus, so much so that the epidemic is often called diabesity. It has been described as one of the most important crises that has invaded our public health system.

Global Statistics,  Source: Lancet

  • Since 1980, the number of adults with diabetes worldwide has quadrupled from 108 million to 422 million in 2014.
  • Diabetes is fast becoming a major problem in low and middle-income countries.
  • From 1980 to 2014, the prevalence of diabetes more than doubles for men in India and China.
  • Half of adults worldwide with diabetes in 2014 lived in five countries: China, India, USA, Brazil and Indonesia.

So what are some solutions?  

The standard American diet is in much need of an overhaul and our national food systems need to change if we wish to reverse or at least slow down this trend. Many say that it would take the same determination as the campaigns to change behaviors that were utilized during the campaigns against smoking. .

Prevention awareness should be first on the front lines of treating the people with prediabetes that can often be reversible using lifestyle modifications. There are already some prevention models in the community; however, these should be expanded so that they become more easily accessible to more people. The Diabetes Prevention Program (DPP) uses intensive behavioral therapy to help people lose a little bit of weight (typically 5-10%). When this program is followed, the number of people progressing to have diabetes comes down by more than half. In people over 60, the reduction was 70%.

Nutrition education should be incorporated into the school system in the early years to help young children understand the importance of knowing where our food comes from and why nutritious foods are the best choice. They can be taught about balanced eating, calories, reading labels and grocery shopping. Nutrition education can also be offered at the middle and high schools levels by returning to a revamped and modernized home economics course in the curriculum. 

A lingering problem has existed for many primary care physicians for many years in that they say they were never adequately prepared in nutrition principles in medical schools. In a survey of family physicians (2009), two thirds said that dealing with extremely obese patients is “frustrating “and one-half said treatments are often ineffective. This is reflected by a lack off obesity training.

Shockingly, another survey in 2010 of 140 doctors revealed that nearly one-third were not even familiar with the American Diabetes Association (ADA) prediabetes guidelines. Only 6 percent were able to identify all 11 risk factors and on average, the doctors could only identify just eight of the warning signs. Only 17 percent knew the correct laboratory values for blood glucose and only 11 percent said they would refer a patient to a behavioral weight loss program..

There should be an increased access to professional treatments.  Physicians in reality do not have the time to directly counsel their patients on the myriad of diets designed for healthy weights. Medical professionals not trained in obesity management should refer their patients to outside providers such as dietitians, exercise trainers, behavior therapists, psychologists, or a new concept of health coaches. These providers should be trained, certified, and credentialed to protect the public from unscrupulous treatments and to provide quality care. Reimbursement of qualified health professionals needs to be enhanced to keep out of pocket expenses reasonable for patients.

However, doctors can act as “cheerleaders” and in a  support role encourage their patients to practice lifestyle behaviors (diet included) that can overall prevent the onset of chronic diseases that make up the leading causes of death. This new paradigm of medical practice has abeen recently called “lifestyle medicine”.

We have become a nation of non-cooks and prefer to have our meals prepared by someone else. Encourage home cooking and home kit meals to help to counter using fast foods and packaged highly processed meals loaded with calories, fat, sugar and salt.

Educate the public on food labeling including ingredient lists. Beware of food companies that promote products with a “health halo” meaning exaggerated claims are made that appear to make unhealthy foods seem healthy because of an added nutrient or ingredient. Corporations also mislead consumers with their labeling so they include four different types of sugar to keep sugar from being listed as the first ingredient. This is misleading to the consumer when attempting to make wise food choices.

Stop corporate-government partnerships and diminish lobbying.
The Academy of Nutrition and Dietetics (formerly the American Dietetic Association) is funded by a myriad of food companies such as Coca-Cola, PepsiCo and Kellogg’s. The dairy industry has a long history of influencing the food pyramid and Dietary Guidelines. A good example is the placing of a glass of milk on the MyPlate Logo.

Another health organization guilty of taking in millions from food companies is the American Heart Association. They offer a “Heart – Check logo for a price: $5, 490 to $7,500 that is renewable for another fee annually. The product has to be low in fat, saturated fat and cholesterol to gain this “honor.” However, some products such as Boar’s Head processed meats have the logo and still may still contain high levels of sodium. If the AHA were sincere in their efforts to help consumers choose healthier foods to rein in obesity/diabetes, they would realize that research has shown that a 1.8 oz. daily serving of processed meat raised the risk of diabetes by 19 percent and heart disease by 42 percent. Most current dietary recommendations emphasize a reduction in processed meats (my emphasis).

There is bad news on rising obesity rates – read about them HERE.

It will take a concerted effort from government, politics, industry, communities,consumers and the perpetrators of our obesigenic culture to begin to change this trend.