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Obesity, Parenting, Pediatrics, Research

Study shows that toddlers benefit from rules about eating habits

Study shows that toddlers benefit from rules about eating habits

toddler_eatingA recent study from pediatrics researchers at the University at Buffalo suggests that toddlers who are faced with parental rules about what to eat develop better eating habits later in their childhood, regardless of the self-restraint they demonstrate. The connection between self-restraint and eating habits has been studied widely in adults and adolescents, but this research is among the first to investigate it in very young children.

The findings suggest that self-restraint in two year-olds doesn’t itself lead to healthier habits by the time the child is four; it must be combined with parental rules about eating. Neha Sharma, a co-author of the paper, explained the significance when presenting the research at ObesityWeek 2014 in Boston, as quoted in a University of Buffalo news release:

It is amazing to see that a parental rule about which types of food a child can and cannot eat could have such a great impact on child eating habits. Without these boundaries set by caregivers, the benefits of high self-regulation on weight gain and childhood obesity could be diminished. This illustrates just how important parental involvement is in influencing child eating habits.

Seventeen percent of American children age 2-19 are obese, as are nearly 35 percent of adults, according to the Center for Disease Control and Prevention. Obesity is well-known as a pressing public health issue, and children who are obese are much less likely to attain healthy weights as adults.

Furthermore, a study published this week in Pediatrics suggests that obese youth are very likely to become obese teens, contrary to a popular idea that overweight adolescents have “baby fat” that will disappear with puberty. Researchers found that a child’s weight at age 11 is a good indicator of his or her weight at age 16: 83 percent of obese fifth-graders remained obese, and 87 percent of normal-weight fifth graders remained at a normal weight five years later.

By setting guidelines and rules for toddlers, parents and caretakers can play a key role in guiding society’s very youngest members towards healthy eating habits with life-long impacts.

Previously: No bribery necessary: Children eat more vegetables when they understand how food affects their bodies, Examining why instilling healthy eating and exercise habits in children may not prevent obesity later in life and How to combat childhood obesity? Try everything
Photo by David Goehring

Nutrition, Obesity, Public Health

A physician realizes that she had “officially joined our nation of fellow sugar addicts”

A physician realizes that she had "officially joined our nation of fellow sugar addicts"

sugar_11.11.14Over on CommonHealth, Terry Schraeder, MD, an internist at Mt. Auburn Hospital and a clinical assistant professor at Brown University, speaks candidly about her realization that she was consuming way too much sugar – likely more than 22 teaspoons – each day.

Her addiction started with a sugar-laden drink disguised as sparkling orange juice and spiraled into regular consumption of flavored coffees, muffins, snacks, desserts and “healthy foods” containing hidden corn syrup. In the piece, Schraeder explains that a high triglyceride level convinced her to change her eating habits:

For the past eight weeks, I have tried to limit adding sugar in any form to my food and started searching nutrition labels for sugar content. If the food lists the grams of sugar on the nutrition label (these may be natural or added), then I check the list of added ingredients to see if there is any added sugar in the form of corn syrup, sucrose, fructose, brown sugar, juice concentrate, honey, molasses, etc. If there is, I know it is “added” sugar. I try to limit my added sugar to less than 24 grams (or six teaspoons) each day.

It has not been easy but it has been well worth the effort. For the first time in years, my moods and energy are more level, the sweet cravings are gone and I feel calmer. The fat around my belly has disappeared. My teeth feel smoother and cleaner despite the same oral hygiene. The late afternoon slump and brain fog are no more. I will have my triglycerides rechecked soon.

I feel great but I am still in shock. I had no idea I was consuming too much sugar. If you had asked me, I would have denied it. For years, I have railed against fat and calories, smoking and lack of exercise. I had not considered my own sugar intake.

The piece is worth a read and may inspire you to take a closer look at your own daily sugar intake.

Previously: Study shows banning soda purchases using food stamps would reduce obesity and type-2 diabetes, What do Americans buy at the grocery store? and Mindful eating tips for the desk-bound
Photo by Moyan Brenn

Chronic Disease, Obesity, Parenting, Pediatrics

Getting a handle on screen time: tips for parents

Getting a handle on screen time: tips for parents

child watches TV

Most parents know that they should keep screen time to a minimum, but how much is too much? Moreover, with the advent of many educational apps for tablets and smartphones, it’s easy as a parent to get confused about managing their childrens’ use of televisions, computers and tablets. Watching “Frozen” for the hundredth time is clearly entertainment, but what about playing with a Dora the Explorer app that teaches vocabulary? Should that count against a child’s screen time “budget?”

The Lucile Packard Children’s Hospital Stanford blog, Healthier, Happier Lives, had a post earlier this week that offers concrete tips from Thomas Robinson, MD, MPH, director of Packard’s Center for Healthy Weight. Robinson notes that educational screen time doesn’t need to count toward entertainment screen time, which he recommends keeping to less than an hour a day. But he cautions that parents should distinguish between real educational programs and entertainment disguised as education.

He also says that it’s easier to get kids to follow screen-time rules if parents are judicious about their own screen use (this includes time in front of a computer or with a smart phone, as well as TV time). One of the key reasons to turn off the TV (and other screens) is to avoid bad habits associated with screen time like eating high-fat, high-sugar snacks, especially while in front of a TV or computer. Another is simply to get kids to move more and be more active.

The bottom line? Robinson says:

More than anything else, just having family rules about how much, what, when, where, and with whom is the most important step in making screen time and technology work for your family, instead of against it.

Previously: Examining the effects of family time, screen time and parenting styles on child behavior, Childhood obesity expert to parents: Reduce your child’s screen time and Study: Too much TV, computer could hurt kids’ mental health
Photo by Vidmir Raic

Obesity, Pediatrics, Public Health, SMS Unplugged

When the wheels on the bus (don’t) go round: Driving the spread of local health programs

When the wheels on the bus (don't) go round: Driving the spread of local health programs

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

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A few years ago, I was doing a summer internship in which I looked at health outcomes for hospitalized patients. I sat in an office and read about patients with issues like high blood pressure and cholesterol. At a certain point, I realized that the reports on their outcomes were interesting, but the real solution to the problems I was studying was happening outside my window. My window overlooked a park, where kids would run around all day until they were exhausted. And it got me thinking that if all kids were as active as those ones, there would a lot fewer reports for me to read.

So last year, I worked with several medical and law students to design a county-level childhood obesity prevention policy. The need for such programs is self-explanatory: More than one third of children in the U.S. are overweight or obese. By the time people reach adulthood, that proportion goes up to two thirds. By creating a team of both medical and law students, we hoped to come up with approaches that achieved the goal of improving health, and did so in a practical and implementable way.

Over the course of several months, we analyzed dozens of programs that have been used to bring down childhood obesity rates in various communities across the country. The programs ranged from well-known approaches (e.g. a soda tax or menu calorie counts) to some more obscure ones. My personal favorite was the “Walking School Bus” (WSB). Think about how your parents used to tell you that things were tougher in their day when they had to walk to school (in the snow, going uphill, barefoot, etc.). The goal of a WSB is to bring that world back. The catch is that parents/adults walk along a predetermined “bus” route, pick up kids along the way, and then walk them to school. Kids get a supervised walk that allows them to get some exercise every day.

Case studies, and one meta-analysis, suggest that WSBs are an effective way to increase the amount of exercise kids get. But odds are, you’ve never heard about them before. Neither have most school officials, local politicians, and others in a position to take action on childhood obesity. That’s because WSBs are not widely used. This realization led me to an interesting question: Which factors make a local program or intervention spread to other communities? What does it take to turn a single success story into a widespread strategy?

These are hardly new questions. Every business or non-profit that plans to scale up considers it. Atul Gawande, MD, attempted to figure out why certain medical interventions spread in a New Yorker article last year. Whether you’re talking about social programs, technology, or just an idea, the question remains. I don’t pretend to have the answer, but my work reviewing obesity prevention policies did lead me to a few conclusions about the spread of local programs.

First, success is necessary but not sufficient for a program’s spread. Just because it proves to be successful does not mean anyone else will adopt it. WSBs were one example. Granted, WSBs are not adaptable to every community – they require schools to be within walking distance and rely on good weather. But the same story is true for other approaches. For instance, joint-use agreements are a strategy where schools open up their facilities (e.g. outdoor fields, basketball courts, etc.) after school hours to give children and families access to recreational space. Despite a correlation between these agreements and better health outcomes, they remain in limited use in many of the communities where recreational space is most lacking.

So if success doesn’t lead to a program’s spread, what does? I believe one factor is the involvement and enthusiasm of multiple stakeholders, potentially including local government, businesses, school administrators, and involved community members. A second factor is the development of measurable and achievable goals. It is nearly impossible to see incremental changes in health outcomes, so programs designed to change health must establish metrics that can demonstrate progress.

The list of lessons from our survey of local programs goes on, but the biggest takeaway is clear. Problems in health care require not only a solution, but successful execution.

Akhilesh Pathipati is a second-year medical student at Stanford. He is interested in issues in health-care delivery.

Image by EME

Nutrition, Obesity, Research, Stanford News

When it comes to weight loss, maintaining a diet is more important than diet type

When it comes to weight loss, maintaining a diet is more important than diet type

bathroom_scaleSelecting a weight-loss plan can be tricky. Everywhere you look, media reports bombard you with stories about how Jennifer Hudson lost 80 pounds by joining Weight Watchers, Sharon Osbourne shed 23 pounds on the Atkins diet, and other A-listers slimmed down on the Zone Diet. And then there’s that close friend who dropped three dress sizes after following the South Beach Diet. How do you determine which dieting plan is the most effective?

To answer this question, Edward Mills, PhD, a visiting associate professor at Stanford, and colleagues completed a network meta-analysis of 48 randomized trials of brand-name diets, which included a total of more than 7,200 overweight or obese adults. In addition to those mentioned above, researchers also evaluated six other diets: Ornish, Vulumetrics, Jenny Craig, Rosemary Conley, Biggest Loser and Nutrisystem. The diets were divided into three categories —  low-carb, low-fat and moderate macronutrient.

The diet that a person can maintain for the long term, or for as long as possible, is the most effective weight-loss plan

Overall, the study showed that if people stuck to their diets (no matter the type) they lost weight, but ultimately the “weight-loss differences between individual diets were minimal and largely unimportant,” according to Mills. The study authors concluded that the diet that a person can maintain for the long term, or for as long as possible, is the most effective weight-loss plan. They also found that exercise and behavioral support can enhanced weight loss.

Interested to know more about the research, I reached out to Mills, who explained how the evidence failed to support recommending a specific diet and discussed the potential of being able to combine diets to achieve lasting weight loss without having to maintain strict eating habits.

Why did you and your colleagues complete a comparison study of popular diets?

There is a massive weight-loss industry that promotes different diets that are marketed in different ways. Some diets are promoted as being more medical, such as the Ornish diet, while others target people according to lifestyle, for example the South Beach diet. With all the promotion of different diets occurring and people discussing what they believe works or does not work, we wanted to examine whether the clinical trial evidence demonstrated superiority of any particular diet, a strategy we are calling “evidence-based dieting.”

In the study, individuals on a low-carb and low-fat diet lost the most weight (8 kg over six months), compared to those who were not on any diet. Why are these diets not considered to be the most effective of those studied?

These diets do appear to offer the largest weight-loss benefits, but the difference between the different diets was so small that other issues begin to be more important. We looked at the diets using two different analyses. First, we grouped diets according to their type of diet, called a class, and then examined whether the individual diet resulted in different outcomes. Although we found differences according to the classes of diets, these were not really observed when we examined the individual diets. So at this point, we can’t recommend any particular diet over another. But those that are low carb or low fat are preferable.

What did you find most surprising about the study results?

What is most surprising about the results is that the individual diet a person chooses doesn’t seem to be the most important aspect of dieting, instead maintaining a diet is. Some people have a lot of difficulty adhering to a diet because they find the particular diet too difficult to maintain, such as avoiding carbs if they’re trying the Atkin’s diet. It appears that if all diets offer more or less the same benefits, then people should be able to switch between diets when they need to. This approach may be really helpful in adhering to dieting in general.

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Mental Health, Nutrition, Obesity, Research, Women's Health

Stressed? You could be burning fewer calories

Stressed? You could be burning fewer calories

cupcakesBad news, ladies: Findings (subscription required) recently published in Biological Psychiatry show that women who consumed comfort food while feeling stressed burned fewer calories than their zen-like counterparts.

In the study, Ohio State University researchers quizzed a group of women about what was causing stress in their lives before they ate a caloric meal consisting of eggs, turkey sausage, biscuits and gravy. Scientific American reports:

Turns out that the most stressed women had higher levels of insulin. Which slows down metabolism and causes the body to store fat. And that fat, if not burned off, accumulates in the body.

The women who had reported feeling stressed or depressed in the day before eating the meal burned 104 fewer calories during the seven hours following the meal than women who felt more mellow.

If eating high-calorie comfort food to alleviate stress becomes habitual, the result could be an average weight gain of 11 pounds per year.

So next time you’re feeling overwhelmed and exhausted, you might want to reconsider reaching for a cupcake.

Previously: Learning tools for mindful eating, Mindful eating tips for the desk-bound and Want to curb junk food cravings? Get more sleep
Photo by Class V

Obesity, Parenting, Pediatrics, Research, Sleep

Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”

Study shows poor sleep habits as a teenager can "stack the deck against you for obesity later in life"

11386276_c148dfd9bd_zNew research examining the effect of sleeplessness on weight gain in teenagers over time offers strong evidence that inadequate sleep may increase the risk of obesity.

In the study, researchers at Columbia University and the University of North Carolina pored over health information from the the National Longitudinal Study of Adolescent Health on more than 10,000 Americans ages 16 and 21. In addition, details about individuals’ height, weight and sleep habits were collected during home visits in 1995 and 2001.  According to a release, results showed:

Nearly one-fifth of the 16-year-olds reported getting less than six hours of sleep. This group was 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep. While lack of physical activity and time spent watching television contributed to obesity, they did not account for the relationship between sleeplessness and obesity.

“Lack of sleep in your teenage years can stack the deck against you for obesity later in life,” says [Columbia researcher Shakira Suglia, ScD]. “Once you’re an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer.”

“The message for parents is to make sure their teenagers get more than eight hours a night,” adds Suglia. “A good night’s sleep does more than help them stay alert in school. It helps them grow into healthy adults.”

Previously: Want teens to eat healthy? Make sure they get a good night’s sleepProlonged fatigue and mood disorders among teensMore evidence linking sleep deprivation and obesityStudy shows link between lack of sleep and obesity in teen boys and Study shows lack of sleep during adolescence may have “lasting consequences” on the brain
Photo by Adrian Sampson

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Evolution, Genetics, Obesity, Research, Science, Stanford News

Tiny fruit flies as powerful diabetes model

Tiny fruit flies as powerful diabetes model

Seung Kim

Fruit flies in your kitchen are unquestionably annoying. But the next time you’re trying to bat one out of the air around your too-ripe apples and bananas (or maybe that’s just me?), spare a few seconds to realize how important the tiny insects have been to science. They’ve been a darling of developmental biology for decades, as researchers identified genes (subsequently shown to be shared in mammals and humans) critically important in the metamorphosis from egg to animal. Frankly, it’s hard to over-estimate their contribution to science.

Now they’re set to take up a starring role in diabetes research. Stanford developmental biologist and Howard Hughes Medical Institute investigator Seung Kim, MD, PhD, and research associate Sangbin Park, PhD, have devised a way to measure insulin levels in fruit flies at the picomolar level – the level at which insulin concentrations are measured in humans. They’ve done so by successfully tagging the fruit fly insulin-like-peptide 2, or Ilp2, with a chemical tag. Their research was published today in PLOS Genetics.

From our release:

The experimental model is likely to transform the field of diabetes research by bringing the staggering power of fruit fly genetics, honed over 100 years of research, to bear on the devastating condition that affects millions of Americans. Until now, scientists wishing to study the effect of specific mutations on insulin had to rely on the laborious, lengthy and expensive genetic engineering of laboratory mice or other mammals.

In contrast, tiny, short-lived fruit flies can be bred in dizzying combinations by the tens of thousands in just days or weeks in small flasks on a laboratory bench.

In 2002, Kim and developmental biologist Roel Nusse, PhD, surprised many researchers when they showed that fruit flies develop a diabetes-like condition when their insulin-producing cells are destroyed. Further research has been stymied, however, by the difficulty of accurately measuring circulating insulin levels in the tiny animals. When speaking to me about the research, Kim called the new technique a “breakthrough” in the field.

Unlike many previous attempts by many groups, Park found two places in Ilp2 where the tag can be placed without affecting its biological activity. This allowed Kim and Park to track Ilp2 through its life cycle, as it’s produced by neurons in the brain (this is different from humans, who make insulin in beta cells in the pancreas), secreted into the blood stream and binds to insulin receptors in cells throughout the body. Parsing the effect of each mutation on the way the body produces, secretes and responds (or not) to insulin is critical to further understand the disease and to devise new therapeutic approaches. More from our release:

Park and his colleagues then turned their attention to mutations associated with type-2 diabetes in genome-wide studies in humans. These studies don’t reveal how a specific mutation might work to affect development of a disease; they show only that people with the condition are more likely than those without it to have certain mutations in their genome. Hundreds of candidate-susceptibility genes have been identified in this way.

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Health and Fitness, Nutrition, Obesity, Parenting, Pediatrics, Stanford News

Childhood obesity expert to parents: Reduce your child’s screen time

Childhood obesity expert to parents: Reduce your child's screen time

screen-tvTake a few minutes to read a brief and informative piece about the negative health effects of too much screen time for children and how you can set boundaries for your kids – or perhaps yourself. In a Stanford Medicine News Q&A, pediatrician Thomas Robinson, MD, MPH, director of the Center for Healthy Weight at Lucile Packard Children’s Hospital Stanford, explains how watching TV or playing video games contributes to inactivity, overeating and obesity. Robinson also speaks to the modern-day concern of restricting access to screen devices that can also be educational tools, such as the iPad.

From the Q&A:

What’s the relationship between excessive screen time and childhood obesity?

It’s a true cause-and-effect relationship. The more time kids spend with screens, the less time they are spending being active. The best evidence supports two primary mechanisms—that kids eat more while watching screens and that exposure to food advertising leads to an increased eating of high-sugar, high-fat and calorie-dense foods. Lots of research shows that kids—and adults—eat more when distracted by a screen. So one of the most important things a family can do is eliminate eating while watching TV and other screens.

Previously:  Talking to kids about junk food ads, This is your 4-year-old on cartoons, Study: Too much TV, computer could hurt kids’ mental health, Does TV watching, or prolonged sitting, contribute to child obesity rates? and Paper explores effects of electronic media on kids’ health

Health and Fitness, Obesity, Research, Stanford News

Without exercise, Americans are growing more obese, according to Stanford researchers

Without exercise, Americans are growing more obese, according to Stanford researchers

gym_smallerMore than half of all American women don’t exercise at all, according to a survey that tracked the health of nearly 7,000 people in 2009 and 2010. Men don’t fare much better: 43 percent don’t work out at all.

Those percentages are dramatically higher than results from a similar study conducted in the early 1990s, which uncovered only 19 percent of sedentary women and 11 percent of inactive men.

More troubling, obesity rates jumped during the same period, according to an analysis by Stanford researchers published in the August issue of The American Journal of Medicine and now available online in a draft form.

What gives? Experts have been intoning “exercise 30 minutes a day most days” for more than a decade. People are just lazy, right?

It’s not that simple, says Pamela Powers Hannley, MPH, the journal’s editor, in a sharply worded commentary that accompanies the study. Many women work long hours, then spend their “spare” time parenting, not jogging, Hannley said. Exercise alternatives need to be convenient and low-cost, Hannley said, noting that some communities, like Tucson, Arizona, where she lives, are considering reducing hours at swimming pools or even closing pools entirely to save money.

“It’s going to take widespread change, not just individual change, not just an app for your iPhone,” Hannley says.

She, along with primary study author Uri Ladabaum, MD, associate professor of gastroenterology, heartily endorse the five recommendations issued by the Institute of Medicine in 2012. They are: integrate physical activity into daily life; make healthy food choices easy and routine; reinvigorate messages about exercise and food; focus on schools; and expand the role of employers, medical professionals and insurers.

Some people, including my editor here at Stanford, aren’t convinced that exercise can single-handedly curb obesity. Diet, the other obvious causal factor, didn’t play a leading role in this data set. The study considered the total calories consumed, but that didn’t vary significantly from 1988 to 2010, Ladabaum and his colleagues write. Genetics, environment and plain ‘ol chance all play a role in overall weight.

This study dug up another worrying trend, as well, one that particularly jumped out to second author, Ajitha Mannalithara, PhD, a Stanford social science research associate: Independent of weight, Americans are getting thicker around the middle.  The incidence of so-called abdominal obesity climbed from 46 percent to 62 percent in women and from 29 to 42 percent in men.

Abdominal girth is linked to increased risks of cancer and cardiovascular disease, even in normal weight individuals, Mannalithara said.

The stats are all based on the robust National Health and Nutrition Examination Survey, a long-term project of the Centers for Disease Control and Prevention that collects information from both surveys and physical examinations to assess Americans’ health.

Becky Bach is a former park ranger who now spends her time writing, exploring, or practicing yoga. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Lack of exercise shown to have largest impact on heart disease risk for women over 30, More evidence that boosting Americans’ physical activity alone won’t solve the obesity epidemic, To meet weight loss goals, start exercise and healthy eating programs at the same time and Study shows regular physical activity, even modest amounts, can add years to your life
Photo by Ms. Phoenix

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