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Chronic Disease, Health Costs, Health Policy, Nutrition, Obesity, Stanford News

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes

soda

In the late 1800s and early 1900s, carbonated beverages such as Coca-Cola, Dr Pepper and 7UP were sold as nerve tonics and health drinks. But, we now know that sugary sodas contribute to obesity, type-2 diabetes and cavities. Still, most Americans drink more soda than they like to admit.

Even though sugar-laden soft drinks have no nutritional value, they are still eligible for food stamps. Nutrition researchers and some politicians have advocated for a ban on buying sugar-sweetened drinks with food stamps but the U.S. Department of Agriculture, which runs the program, is under tremendous pressure from beverage company lobbyists to keep the existing regulations.

Sugary drinks are especially concerning because too many liquid calories put consumers at a higher risk of developing type-2 diabetes. Some nutrition experts are concerned that taxpayers are subsidizing an unhealthy diet, which will result in higher medical costs for Medicare and Medicaid down the road, when food stamp recipients experience the health problems associated with obesity and diabetes.

In a new study (subscription required) published in this month’s Health Affairs, Sanjay Basu, MD, PhD, an assistant professor of medicine at the Stanford Prevention Research Center, and his colleagues created a computer model to simulate the effects of a soda ban on the health of food stamp recipients. They found that obesity would drop by 1.12 percent for adults, and by 0.41 percent for children, affecting about 281,000 adults and 141,000 children. Type-2 diabetes would also drop by 2.3 percent.

The researchers also calculated the effects of reimbursing participants 30-cents for each dollar spent on fruits and vegetables. The subsidy did not affect obesity or diabetes rates, but doubled the number of people who ate the recommended number of fruits and vegetables each day. A county in Massachusetts tried the same reimbursement system as part of the USDA’s Healthy Incentives pilot study, and saw a similar increase in the fruit and vegetable purchases of food stamp recipients.

“It’s really hard to get people to eat their broccoli,” said Basu in a press release. “You have to make it really cheap, and even then, sometimes people don’t know what to do with it.” But, with one in seven Americans receiving food stamps, he points out that these small changes can have wide-ranging effects.

“It’s very rare that we can reach that many people with one policy change and just one program.”

Patricia Waldron is a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Food stamps and sodas: Stanford pediatrician weighs inCan food stamps help lighten America’s obesity epidemic? and Stanford’s Sanjay Basu named a Top Global Thinker of 2013
Photo by Andy Schultz

Nutrition, Pediatrics, Public Health

Who’s hungry? You can’t tell by looking

child for hunger post2How can you tell if a child is hungry? Well, looks alone don’t tell the story.

That’s the message of a new photo exhibit on child hunger, which opened May 22 at San Francisco City Hall. The exhibit includes 20 photos of Bay Area children, who all appear to be healthy and well-fed. But half of them qualify as “food insecure,” meaning they and their families often go without enough to eat. In fact, one of four children in California lacks adequate food and may suffer the ache of hunger, what pediatrician Lucy Crain, MD, MPH, and her colleagues are calling a “silent epidemic.”

“I think people don’t want to focus on the prevalence of hunger and poverty. But we have to get it out in the open and acknowledge that it’s there. There shouldn’t be one child that goes to bed hungry for lack of food,” said Crain, who is an adjunct clinical professor of pediatrics at Stanford. Crain helped organize the exhibit, part of a larger campaign of the Child Health Advocacy Committee of the Northern California Chapter of the American Academy of Pediatrics to end childhood hunger.

The campaign was begun in response to the recent recession, when committee members all were reporting increased rates of hunger among their patients, said Lisa Chamberlain, MD, MPH, an assistant professor of pediatrics at Lucile Packard Children’s Hospital Stanford and founder of the advocacy group. Then in 2013, Congress threatened to eliminate the Supplemental Nutrition Assistance Program, which includes food stamps, on which millions of families depend. Congress did decrease the program benefits, with the result that more families and children are hungry and food banks are scrambling to keep up with demand, said Crain, who recently retired from her practice at Lucile Packard Children’s Hospital Stanford, where she treated children with disabilities.

child for hunger postAt one meeting, the pediatrician activists were struck by the fact that it is hard to tell which patients were hungry, noting, “You just can’t tell by looking – it’s all around us.” They decided to draw attention to the problem among legislators and the public at large and increase awareness among pediatricians and other health care professionals, who often fail to screen children for hunger issues. Children who lack adequate food, particularly those younger than age 3, may have developmental problems and are more likely to be in poor health as they grow up, studies show.

To illustrate the problem, the group enlisted the help of San Francisco documentary photographer Karen Ande, who has won awards for her work in photographing children in Africa (Karen happens to be a friend of mine who collaborated with me on a book on AIDS in Africa). She volunteered her time for the project, in which she shot photos of 20 children at a health fair and in neighborhoods in San Francisco. The project team screened the same children for hunger issues using the two most reliable questions from a survey developed by the U.S. Department of Agriculture. Half of the children were found to be food insecure.

“The real power of these photos is that you can’t tell by looking who screened positive for food insecurity and who did not,” said Crain, who is also a clinical professor emerita at UCSF.

The advocacy group is recommending to the American Academy of Pediatrics that its guidelines include screening for food insecurity as part of routine child health visits. If pediatricians know a family has inadequate food, they can refer parents to local resources, such as food banks and food pantries, or encourage them to apply for CalFresh, the state’s food stamp, supplemental nutrition program, Crain said.

As part of its campaign, the group also is preparing posters to be delivered to 2,000 Northern California pediatricians, as well as a BART display of the children’s photos. Collaborators in the project include the Food Security Task Force of the San Francisco Department of Public Health, the San Francisco Food Bank, WIC, CalFresh and the San Francisco Unified School District, all working to help achieve San Francisco Mayor Ed Lee’s goal of eliminating widespread hunger in the city by 2020.

Previously: Could a palm oil tax lower the death rate from cardiovascular disease in India?Lucile Packard joins forces with Ravenswood School District to feed families during the summer breakDoctors tackling child hunger during the summer and Annual federal statistics on children’s well-being released

Photos by Karen Ande

Chronic Disease, Health Policy, Nutrition, Obesity, Pediatrics, Videos

Fed Up: A documentary looks for answers about childhood obesity

Fed Up: A documentary looks for answers about childhood obesity

I can’t wait to see Fed Up, a new documentary about childhood obesity.

In the early 2000s, when I was earning a PhD in nutrition at UC Davis, I heard a lot of scientific debate about possible causes of the U.S. obesity epidemic. Was it too much fat in our diets? Too much sugar? Processed food? Junk food ads on TV? An “obesogenic environment” – one in which snacks are ubiquitous, adults drive everywhere and neighborhoods aren’t safe enough for kids to play outside?

Or was it something else?

“The message has been pushed on us: It’s your fault you’re fat,” says Mark Hyman, MD, chair of the Institute for Functional Medicine, in the Fed Up trailer above.

The movie assembles an impressive roster of experts in nutrition research, pediatric health and public advocacy to oppose that message. Michael Pollan, Mark Bittman, Robert Lustig, Marion Nestle, Harvey Karp, former President Bill Clinton and others say we should not be blaming individuals – especially kids – for struggles with their weight. Instead, they are taking a hard look for answers at the food environment.

“This is the first generation of American children expected to lead shorter lives than their parents,” says a voice-over in the Fed Up trailer. That definitely makes untangling the causes of the obesity epidemic worthy of the efforts of our best scientists. Like I said, I can’t wait to see it.

Previously: Childhood obesity a risk for imminent heart problems, research shows, Using hip hop to teach children about healthy habits and Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert
Via Food Politics

Neuroscience, Nutrition, Obesity, Research

Changing views on dietary fiber’s role in weight loss

Changing views on dietary fiber's role in weight loss

food girlAs the brain-gut connection comes into sharper focus, new insights into obesity are emerging. A recent study has found that dietary fiber’s role in weight loss, commonly attributed to releasing appetite-suppressing hormones in the gut, may be a matter of the mind. As Nature News reports, researchers from the UK and Spain showed in a study in mice how a product of fiber fermentation reduced food intake by influencing a region of the brain.

From the piece:

[The researchers] fed mice fibre labelled with carbon-13, which has an additional neutron from the more common carbon-12 that gives its nuclei a magnetic spin and therefore makes it easy to track as it progresses through the body’s chemical reactions. The fibre was fermented as usual into acetate, which turned up not only in the gut, but also in the hypothalamus, a part of the brain known to be involved in regulating appetite. There, the researchers found, it was metabolized through the glutamine-glutamate cycle, which is involved in controlling the release of neurotransmitters associated with appetite control. The same model has been proposed for acetate metabolism after drinking alcohol.

The mice fed with large doses of fermentable fibre ate less food, and ended up weighing less than control mice that were fed unfermentable fibre.

The article notes the researchers plan to investigate enriching fiber with acetate to aid digestion and appetite control. “It’s sort of a way of having your cake, and not eating it,” said Jimmy Bell, PhD, one of the study’s researchers and a biochemist at Imperial College London.

Previously: Examining how microbes may affect mental healthCould gut bacteria play a role in mental health? and Animal study shows a protein in the brain may regulate appetite
Photo by Harmon

In the News, Nutrition, Public Health

Health initiatives at the White House gain popularity

Health initiatives at the White House gain popularity

Barack Obama, Michelle ObamaIn case you missed it, The Washington Post recently took a look at how the Obamas are bringing flavors of healthy eating and activity into their home. An article describes how a culture of health drives not only President and First Lady Obama, but also influences their family, members of the current administration and nation-wide initiatives.

From the piece:

Earlier this year, there was an intense battle for bragging rights inside the complex as teams of six with names such as “Runnin’ Like Amtrak,” from Vice President Biden’s staff, and “Team Engage (Our Core),” from the Office of Public Engagement, earned a point for every 30 minutes of “moderate-to-vigorous physical activity” performed each day. Each team totaled its points each week.

“The culture here has shifted pretty dramatically, in direct ways and indirect ways, based on their leadership,” said Sam Kass, executive director of first lady Michelle Obama’s Let’s Move initiative and the White House senior policy adviser for nutrition policy. “I think we really live that. I think that’s been a transformation for the kitchen

In Obamaworld, the methods staff members use to reach their diet and fitness goals reflect their faith in the power of technology and data. Council of Economic Advisers Chairman Jason Furman, [PhD,] who got kudos from the president after he lost 50 pounds, surveyed the scientific literature on weight loss, tracked his food consumption and rate of physical behavior electronically and converted it into a spreadsheet to analyze it properly.

Past presidents and presidential candidates have taken different stances on eating and exercise behavior; as the article notes, “the cultural shift has political consequences.”

Previously: Classroom cupcakes: Should “party foods” at schools be limited?, White House announces “Apps for Healthy Kids” winners and An edible forest grows in Richmond: Urban gardening program teaches kids about food, nutrition
Photo by ASSOCIATED PRESS

In the News, Nutrition, Research

Examining how food texture impacts perceived calorie content

Examining how food texture impacts perceived calorie content

brownies_041614The texture of a food – whether it’s creamy or crunchy – may influence a person’s overall consumption and his perception on whether the food is calorie-rich or diet-friendly. That’s according to findings recently published in the Journal of Consumer Research.

For the study, researchers conducted five laboratory studies during which individuals were asked to sample hard, soft, rough or smooth foods and then give calorie estimations for each food. During one of the experiments, participants were asked to watch TV ads while eating bit-sized brownies. As the Huffington Post reports:

… half of the participants were asked to estimate how many calories they thought the brownies had, while the other half were not. Within these groups, half of the participants were given brownie bits that were soft, while the others were given ones that were hard.

Among the participants who were not asked to focus on the calorie content of the brownies, they consumed more soft brownie bits than hard brownie bits. However, among the participants who were asked to focus on the calorie content, they consumed more of the hard brownie bits than the soft ones.

The study is part of a growing body of scientific evidence showing that several factors can impact whether we consider foods to be healthy or fattening and how much we eat. Past research has shown that people frequently underestimate the calories they’re eating and that many of us tend to overeat in sit-down restaurants rather than fast-food spots. Additionally, the sequence of foods may affect how we calculate calorie content, and the color of tableware can influence how much we eat.

Previously: Obesity and smoking together may decrease taste of fat and sweet but increase consumption, Cereal-eaters: How much are you really consuming?, Fruit-filled Manga comics may increase kids’ consumption of healthy food, and Can dish color influence how much you eat?
Photo by Sarah

Cardiovascular Medicine, Nutrition, Science

What’s not to love? Chocolate’s feel-good chemicals

Cabdury2Spring is here and symbols of new life abound. If Cadbury Cream Eggs (yes, gross, but I love them anyway) and Mini Eggs on drugstore shelves have you, too, thinking about chocolate, check out this piece in the Washington Post on the history and chemistry of the “feel-good” components of the stuff, including “the world’s most widely consumed psychoactive drug,” caffeine.

Chemist Simon Cotton, PhD, writes:

Another chocolate molecule believed to be important was discovered less than 20 years ago: anandamide. This binds to receptors in the brain known as cannabinoid receptors. These receptors were originally found to be sensitive to the most important psychoactive molecule in cannabis, Δ9-THC. Likewise, anandamide and similar molecules found in chocolate are also thought to affect mood.

Phenylethylamine, another family of chemicals, is found in chocolate in very small amounts. It is a naturally occurring substance with a structure that is closely related to synthetic amphetamines, which of course, are also stimulants. It is often said that our brain produces phenylethylamine when we fall in love. It acts by producing endorphins, the brain’s natural “feel-good” molecules. The bad news, however, is that eating chocolate is probably not the best way of getting our hands on phenylethylamine as enzymes in our liver degrade it before it can reach the brain.

There are other molecules in chocolate – especially in dark chocolate – such as flavonoids, which some scientists think may help improve cardiovascular health. But chocolate manufacturers have been known to remove bitter flavanols from dark chocolate.

One last feel-good factor, which isn’t a molecule: the melt-in-your mouth sensation. The fatty triglycerides in cocoa butter can stack together in six different ways, each resulting in a different melting point. Only one of these forms has the right melting point of about 34 degrees, so that it “melts in your mouth, not in your hand.” Getting the chocolate to crystallize to give this form is the product of very careful chocolate engineering.

I’m curious to know what kinds of chemicals give the sugary “whites” and “yolks” of the cream eggs their appeal, though maybe it’s better kept a foil-wrapped secret.

Previously: When caffeine dependence affects quality of lifeDo you (heart) chocolate? Evaluating the cocoa “prescription” for cardiac health and Mapping the DNA of wild strawberries and fine chocolate
Photo by Joel Kramer

Clinical Trials, NIH, Nutrition, Obesity, Research, Stanford News

Stanford seeks participants for weight-loss study

Stanford seeks participants for weight-loss study

Should diets come in different shapes and sizes? Stanford researchers are exploring that question and are seeking participants for a year-long weight-loss study that aims to understand why people may respond differently to the same diet. Titled “One Diet Does Not Fit All,” the study will examine how factors such as genetic influences and eating and sleeping habits have an impact on a diet’s effectiveness.

From a release:

Participants will be assigned randomly to either a very low-fat or very low-carbohydrate diet for 12 months. They will be required to attend weekly classes at Stanford for the first three months, once every other week for the following three months, and once a month for the remainder of the study. Participants must also be willing to have fasting blood samples drawn four times during the 12-month period and participate in online and written surveys. They will receive all test results at the end of the study.

The study is part of a five-year project funded by the National Institutes of Health and the Nutrition Science Initiative. Following an enrollment last year of 200, this spring researchers hope to enroll at least 135 men and women (pre-menopausal only) between the ages of 18 and 50 who are overweight or obese and are generally in good health.

For a complete list of inclusion criteria, click here. To determine eligibility for this study, complete a brief online survey. For more information, contact Jennifer Robinson at nutrition@stanford.edu.

Previously: How physicians address obesity may affect patients’ success in losing weight, To meet weight loss goals, start exercise and healthy eating programs at the same time, The trouble with the current calorie-counting system, Smaller plates may not be helpful tools for dieters, study suggests and Losing vitamins – along with weight – on a diet

Nutrition, Stanford News, Videos

Improving your health using herbs and spices

Can certain herbs and spices really boost immunity, control blood sugar, lower blood pressure and ease joint pain? As registered dietician Alison Ryan discusses in this Stanford Hospital & Clinics video, a growing body of scientific evidence suggests the answer is yes. During the 90-minute presentation, she explains in detail how ginger, turmeric, cinnamon and other ingredients can add a healthful punch to any meal, snack, or beverage by working to curb inflammation and prevent or delay certain types of cell damage. The talk is part of the Healthy Strides Ernest Rosenbaum Cancer Survivorship Lecture Series presented by the Cancer Supportive Care Program at Stanford.

Previously: How food may influence our cells and overall health and Nature/nurture study of type 2 diabetes risk unearths carrots as potential risk reducers

Behavioral Science, Nutrition, Obesity, Research, Women's Health

Obesity and smoking together may decrease taste of fat and sweet but increase consumption

puddingA study from Washington University School of Medicine in St. Louis and Philadelphia’s Monell Center has found that obese women who smoke cigarettes may have reduced sensitivity to the tastes of sweetness and fat in food and may be more likely to eat more calories.

Researchers engaged 47 female participants ages 21 to 41, grouped as follows: obese smokers, obese nonsmokers, normal-weight smokers, and normal-weight nonsmokers. All of the participants tasted vanilla puddings and were asked to rate the sweetness and creaminess of each one. The researchers found that the women who were obese and smokers rated less creaminess and sweetness in the puddings than the other three groups did.

From a release:

[Study author Yanina Pepino, PhD,] cautioned that the study only identified associations between smoking and taste rather than definitive reasons why obese smokers were less likely to detect fat and sweetness. But the findings imply that the ability to perceive fat and sweetness — and to derive pleasure from food — is compromised in female smokers who are obese, which could contribute to the consumption of more calories.

“Obese people often crave high-fat foods,” she said. “Our findings suggest that having this intense craving but not perceiving fat and sweetness in food may lead these women to eat more. Since smoking and obesity are risk factors for cardiovascular and metabolic diseases, the additional burden of craving more fats and sugars, while not fully tasting them, could be detrimental to health.”

The results were published in the journal Obesity.

Previously: Obesity is a disease – so now what?How eating motivated by pleasure affects the brain’s reward system and may fuel obesity and The brain’s control tower for pleasure
Photo by dutchfulthinking.blogspot.com

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