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Health Costs, Health Disparities, Health Policy, In the News, Obesity, Public Health, Science Policy

Can food stamps help lighten America’s obesity epidemic?

shopping_12from SNAPIn a recent article in New Scientist, Peter Aldhous discussed several issues related to the Supplemental Nutrition Assistance Program, commonly referred to as food stamps. Noting that “because junk food is cheaper than fruit and vegetables, poverty and obesity tend to go hand-in-hand,” he offered several ways in which the program could be used to lower obesity and malnutrition rates among food stamp users. Here are some examples of the “economic carrots and sticks” he mentions in his piece:

One simple idea is to give the benefits every two weeks, rather than monthly. This would smooth out a cycle in which people load up on high-calorie food when the payments come in, then go hungry towards the end of the month – a pattern known to cause weight gain…

But most attention is focused on efforts to provide incentives to buy fruit and vegetables, or restrict purchases of junk food. A pilot project delivered promising results last month. Over 14 months to December 2012, 7500 households receiving food stamps in Hampden, Massachusetts, were given an extra 30 cents for every dollar spent on fruit and vegetables. Surveys run four to six months into the study show that their consumption of fruit and vegetables was 25 per cent higher than for people on regular food stamps.

Sanjay Basu of Stanford University in California has studied how changes in food prices affect what people put in their shopping baskets. His work suggests that banning food-stamp purchases of unhealthy foods, or increasing their price, should be even more effective…

If the food stamp program could be used to improve the diet of food stamp users, Aldhause writes, it could pave the way “for using taxes and subsidies to nudge the nation as a whole towards a healthier relationship with food.”

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: More evidence that boosting Americans’ physical activity alone won’t solve the obesity epidemicLucile Packard joins forces with Ravenswood School District to feed families during the summer breakFood stamps and sodas: Stanford pediatrician weighs inFood stamp use shows scope of child poverty and Denmark’s “fat tax” aims at life expectancy – not just waistlines
Photo by United States Department of Agriculture

Obesity, Research, Stanford News

Color controls the fate of your fat

Color controls the fate of your fat

Up until last week, I thought fat was fat, fat was white and that was that – as Dr. Seuss might have phrased it.

But then I spoke with Brian Feldman, MD, PhD, a pediatric endocrinologist here at Stanford, about some new work of his and learned that fat comes in two colors – white and brown – and that the proportion of each can make all the difference when it comes to determining how much fat you cart around.

White fat cells are basically tiny little couch potatoes lolling around inside you, shunning active participation in your metabolism, while brown fat cells are torrid little burners of energy. So what causes one fat cell to be white and slothful and another brown and busy?

Feldman and his colleague, research scientist Peter Malloy, PhD, have discovered a protein that acts as a toggle switch, determining which fate a fat cell meets. Called the Vitamin D receptor, the protein binds with Vitamin D (which is actually a hormone, not a vitamin, but old misnomers die hard) and together they are thought to see that adequate calcium levels are maintained in the body, among other jobs.

But the researchers found that the receptor is also critical to determining whether a fat cell ends up white or brown. It all depends on whether the receptor binds to a certain segment of DNA, the details of which you can read about in our press release. If it binds, the fat cell will be white. Says Feldman:

When we first made this discovery, we were curious about whether the amount of vitamin D that people were taking might be decreasing how much brown fat they had. But so far our data show that this activity of the receptor is independent of vitamin D, so people’s ingestion or reserves of vitamin D are unlikely to be affecting this process.

Feldman and Malloy don’t know yet whether the receptor causes white fat cells to turn brown or if they influence things earlier in the process of cellular differentiation by affecting one of the precursor cells along the road to finally becoming a fat cell.

The researchers are now working on developing a therapy to somehow block the Vitamin D receptor from latching onto the pivotal piece of DNA, the result of which would be to turn a fat cell brown. If they can do it, it could be a powerful new weapon in the battle against obesity and the ailments that accompany it. But they caution that even with success, any such therapy would be years away from reaching the general public.

Louis Bergeron is a San Francisco-based science writer covering pediatrics for the medical school’s Office of Communication and Public Affairs.

Health Policy, In the News, Obesity, Public Health

Obesity is a disease – so now what?

Obesity is a disease - so now what?

Much has been written about the American Medical Association’s decision to categorize obesity as a disease. In a recent Huffington Post column, Larry Cohen, MSW, director of the Bay Area-based Prevention Institute offers suggestions for what to do now and encourages readers to “recognize that there are social influences that affect what we eat, how we live and how healthy we end up — long before we enter the doctor’s office.” He elaborates:

For too long, there’s been an artificial barrier between healthcare and policies that impact people’s health. If Californians want to improve health and drive down medical spending, we need policies that incentivize the growing and marketing of healthy foods. We need transportation policy that encourages people to get out of their cars and walk. And we need regulations that limit junk-food advertising to children, discourage smoking and reduce outdoor pollution and the respiratory diseases it causes. Policy wonks like me even have a term for this approach — “health in all policies” — and it makes a lot of sense.

Previously: More evidence that boosting Americans’ physical activity alone won’t solve the obesity epidemic, Stanford forum on how food policies affect our nation’s obesity rates posted online, Four states examine their cultural environment to reduce obesity rates, Children and obesity: What can parents do to help? and Expert to new members of Congress: Don’t mess with health law’s prevention funds
Via @preventioninst

Health and Fitness, Nutrition, Obesity, Research

More evidence that boosting Americans’ physical activity alone won’t solve the obesity epidemic

More evidence that boosting Americans’ physical activity alone won't solve the obesity epidemic

runner_2_072213Although a significant portion of counties in the United States reported that Americans’ physical activity increased between 2001 and 2009, the percentage of obese adults continued to rise nationwide during the same period, according to research published this month in Population Health Metrics.

In an American Medical News story posted today, lead study author Ali Mokdad, PhD, a professor of global health at the Institute for Health Metrics and Evaluation, comments on how the study underscores the importance of physicians helping patients address both diet and exercise:

Physicians should explain to patients that losing weight is “about a balance between the [calories] the patient is consuming and expending through physical activity,” he said. Unless exercise and diet are both addressed, “we’re not going to see the benefits of physical activity on obesity.”

Mokdad said more aggressive strategies to prevent and control the epidemic are needed. Those strategies should include local policies to develop safe places for people to exercise, including parks and trails. He urged communities to continue taking steps to make nutritious food, such as fruits and vegetables, more accessible and to increase physical activity for students in schools.

A key component of such a strategy is that physicians discuss exercise and nutrition with patients and counsel them on practical ways to shed pounds or maintain a healthy weight, Mokdad said.

“People respect physicians and listen to them and take their advice seriously,” he said. “They have a big role.”

On a related note, a Stanford study published earlier this year found that to achieve weight-loss goals, individuals should make changes to their exercise routine and diet simultaneously. Participants who started exercise and healthy-eating programs at the same time were more successful than others in meeting national guidelines for exercise (150 minutes per week) and nutrition, which includes eating five to nine servings of fruit and vegetables daily and keeping calories from saturated fats at 10 percent or less of their total intake.

Previously: To meet weight loss goals, start exercise and healthy eating programs at the same time, Encouraging weight loss through group competitions for financial prizes, The trouble with the current calorie-counting system and Study shows weight counseling decreases despite increase in obesity rates
Photo by TheCoolQuest

Health and Fitness, Nutrition, Obesity, Pediatrics, Podcasts

Using hip hop to teach children about healthy habits

Using hip hop to teach children about healthy habits

At elementary schools around New York City, Harlem-based Hip Hop Public Health uses music videos, cartoons and interactive games to educate students about the importance of good nutrition, exercise and other healthy habits. This recent Scienceline podcast offers more details about the organization and how the program was implemented at Thurgood Marshall Lower Academy.

Previously: No bribery necessary: Children eat more vegetables when they understand how food affects their bodies, Free Stanford online course on child nutrition & cooking, Nutrition and fitness programs help East Palo Alto turn the tide on childhood obesity and Examining why instilling healthy eating and exercise habits in children may not prevent obesity later in life

Nutrition, Obesity, Parenting, Pediatrics, Stanford News

Stanford nutrition expert offers tips for a healthy and happy Fourth of July

Stanford nutrition expert offers tips for a healthy and happy Fourth of July

watermelon_070313For many of us, Fourth of July traditions are closely tied to food and fireworks. We look forward to chowing down on dad’s famous smoked brisket, mom’s homemade potato salad and aunt Sally’s delectable strawberry shortcake before kicking back and watching the local fireworks show.

But this year consider taking a healthier approach to celebrating Independence Day. Below Thomas Robinson, MD, a Stanford pediatrician and director of the Center for Healthy Weight at Lucile Packard Children’s Hospital, offers suggestions on how to enjoy the holiday while still being health conscious.

Healthy options to hydrate

A lot of people believe they are giving their children the benefits of eating whole fruit when give them 100 percent fruit juice. Unfortunately, juice drinks, including 100 percent fruit juice, are really no better than soda and other sugar drinks. A 12-ounce glass of fruit juice usually contains 10 or more teaspoons of sugar and lacks most of the beneficial nutrients and fiber that you get by eating whole fruit. The same principle holds true for sports drinks. Although advertised to replace electrolytes for athletes, they are packed with sugar, usually at least 5 teaspoons or more in 12 ounces. Almost nobody needs them. The best and most refreshing drink for kids and adults alike on hot summer days is water.  I suggest you:

  • Avoid fruit juices and eat the whole fruit instead.
  • Drink water rather than “sports” drinks.
  • Drop the TV remote, mouse or joystick and get yourself and your family outside.

Take a healthier approach to holiday barbeques

Additionally, little planning can make your Fourth of July barbeque more healthful for your family. If you are going to grill hamburgers, hot dogs and such, go light on the number and size of servings and portions. Instead of only meats, start a new summer tradition and grill zucchini, Portobello mushrooms, artichokes,  corn on the cob or vegetable shish kabobs.

Include a green salad or fruit salad to go with your barbeque. Go light on or avoid the chips and fill up with cut vegetables, such as carrot, celery and jicama sticks, broccoli tree tops and cucumber and zucchini spears. Instead of cake, cookies or other fat and sugar-laden deserts, enjoy the wonderful variety of fresh whole fruit available in the summer. In most regions of the country, this is a great time of year for sweet peaches, nectarines, plums, apricots, berries and melons. One way to make healthy deserts fun is to cut up a watermelon and hold a seed-spitting contest.

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Nutrition, Obesity, Videos

What if obesity has nothing to do with overeating?

What if obesity has nothing to do with overeating?

Peter Attia, MD, once judged patients who were overweight or obese until, despite exercising three or four hours a day and following the food pyramid to the letter, he gained a significant amount of weight and developed metabolic syndrome. As he explains in this recently posted TEDMED talk, the experience motivated him to radically change his diet, helped him lose 40 pounds, and greatly shifted his perspective on the conventional wisdom of nutrition. And he became almost maniacally obsessed in trying to understand the real relationship between obesity and insulin resistance.

Watch Attia’s talk to find out how he’s working with a team of researchers with competing hypotheses on the cause of the nation’s obesity epidemic to understand how the various foods we consume affect our bodies – and how use this information can be used to help people make sustainable lifestyle changes.

Previously: Free Stanford online course on child nutrition & cooking, The trouble with the current calorie-counting system and Stanford forum on how food policies affect our nation’s obesity rates posted online

Nutrition, Obesity, Parenting, Pediatrics, Sleep

Want teens to eat healthy? Make sure they get a good night’s sleep

Want teens to eat healthy? Make sure they get a good night's sleep

Sleep-deprived teenagers tend to make poor nutritional choices compared to their well-rested friends, according to findings presented at the recent annual meeting of the Associated Professional Sleep Societies.

In the study, researchers explored the connection between sleep duration and food choices using a national representative sample of more than 13,200 teenagers from the National Longitudinal Study of Adolescent Health. A release from Stony Brook University School of Medicine offers more details about the results and their significance:

The authors found that those teens who reported sleeping fewer than seven hours per night — 18 percent of respondents — were more likely to consume fast food two or more times per week and less likely to eat healthful food such as fruits and vegetables. The results took into account factors such as age, gender, race and ethnicity, socioeconomic status, physical activity and family structure, and found that short sleep duration had an independent effect on both healthy and unhealthy food choices.

“We are interested in the association between sleep duration and food choices in teenagers because adolescence is a critical developmental period between childhood and adulthood,” said the first author of the study, Allison Kruger, MPH, a community health worker at Stony Brook University Hospital. “Teenagers have a fair amount of control over their food and sleep, and the habits they form in adolescence can strongly impact their habits as adults.”

The findings add to the growing body of research showing that not getting enough sleep can increase an individual’s risk of obesity.

Previously: More evidence linking sleep deprivation and obesity, How lack of sleep affects the brain and may increase appetite, weight gain, Study shows link between lack of sleep and obesity in teen boys and Study: Staying up late tied to poor eating habits, weight gain
Photo by U.S. Department of Agriculture

Nutrition, Obesity, Parenting, Pediatrics, Stanford News

Free Stanford online course on child nutrition & cooking

Free Stanford online course on child nutrition & cooking

My lovely friend Maya Adam, MD, recently launched a free online course, “Child Nutrition and Cooking,” through Coursera, a web-based platform for “massive open online courses.”

In this fun, five-week “MOOC,” participants learn about the basics of child nutrition and how to make healthy meals for children and families. Weekly lectures are broken down into bite-sized, fact-filled video cooking tutorials, with homework assignments like “Prepare a colorful vegetable dish and send us a photo.” (Warning — your meal photos will be peer-reviewed, so presentation matters.)

For Adam, a lecturer on child health and nutrition in Stanford’s Program in Human Biology, developing this course was a labor of love. “My goal is to get people to return to a simpler, healthier and more economical way of cooking,” she recently told me. “By sharing a few tips and tools with family meal preparers, I hope to inspire a lifelong celebration of easy, home-cooked meals.”

So far, more than 22,000 aspiring cooks have signed up for the course, which just began its second week. Although the tutorials can be accessed at any time, by taking the course during this active period, participants benefit from live discussions with Adam, her teaching staff and fellow cooks.

Later in the year Adam will use these videos in her Stanford Human Biology courses through a “flipped-classroom” teaching model, which blends in-classroom and online lectures together to reinforce newly learned information.

Another caveat in taking this course: Don’t watch the cooking lessons on an empty stomach. Everything looks delicious, and it could lead to overeating.

Previously: Talking to kids about junk food ads, Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert, New evidence for a direct sugar-to-diabetes link, Kids don’t need “kids’ food” and Smaller plates may be a tool to curtail childhood obesity
Photo courtesy of Stanford Online Learning

Ask Stanford Med, Health Policy, Nutrition, Obesity, Parenting, Pediatrics

Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert

Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert

As I wrote about yesterday, new research in PLOS ONE suggests that sugar may play a stronger role in the origins of diabetes than anyone realized. Countries with more sugar in their food supplies have higher rates of diabetes, independent of sugar’s ties to obesity, other parts of the diet, and several economic and demographic factors, the researchers found.

Although the study focused on diabetes rates among adults aged 20 to 79, it got me thinking about children’s health. Type 2 diabetes, which accounts for 90 percent of adult cases and is tied to obesity, used to be unheard-of in kids. But over the last few decades, it has been showing up in many more children and teens at younger and younger ages. Meanwhile, reducing kids’ sugar intake is already the focus of several preventive-health efforts, such as campaigns to remove sugary drinks from schools and children’s hospitals.

To get some perspective on how the new findings apply to children, I turned to Thomas Robinson, MD, a Stanford pediatric obesity researcher who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital. Though Robinson, also a professor of pediatrics at the School of Medicine, cautioned that the epidemiological, “10,000-foot view” given by this study doesn’t prove a cause-and-effect link between sugar and diabetes in individuals – “it does not prove that the amount of sugar an individual eats is related to his or her diabetes risk,” he said – he had lots to say about the new results.

What do you think the findings mean for children’s health?

Children’s behaviors and environmental exposures have an impact on adult health and disease. This study used sugar data for entire countries, not individuals. That means that both the children and the adults were living in countries where higher levels of sugars in the food supply were associated with higher rates of diabetes. The potential implications are even stronger for children than adults. Children are being exposed to that environment for a much longer time. This is particularly a problem in developing countries where their food supplies, diets and weights are changing so rapidly.

A number of us here at Stanford focus on what we can do in early life, and throughout the lifespan, to prevent diseases that have origins in childhood but only first become apparent in adulthood. One can consider our work on obesity, physical activity, sedentary behavior and nutrition in children as really the prevention of diabetes, heart disease, many cancers and other chronic diseases in adults.

What factors has prior research identified as the biggest contributors to the increase in diagnoses of type 2 diabetes in pediatric patients?

The biggest contributor identified has been increased weight, but the increasing rate of type 2 diabetes at younger and younger ages probably reflects obesity plus lots of different changes, including changes in our diets, such as more sugars and processed foods, and less physical activity. The CDC now projects that 1 in 3 U.S. children will have diabetes in their lifetimes, and it will be 1 in 2 among African-American and Latina girls. That is a pretty scary thought. That is why we focus so strongly on helping families improve their diets, increase activity levels, and reduce sedentary time. We want to prevent and control excessive weight gain and all the problems that go with it, of which diabetes is just one.

In light of the new findings, do you think that parents whose children are not obese should be concerned about how sugar consumption could raise their children’s diabetes risk?

This study doesn’t really address the question of what happens at the level of an individual child. However, it is still consistent with the advice we would give now, for both normal weight and overweight children. I definitely recommend that parents try to reduce sugars in their children’s diets. Most parents are not even aware how much sugar their children are eating. Sure, sodas and sweets are the obvious sources but sugars are also added to seemingly all processed foods, including even bread, pizza and French fries. The added sugars are just empty calories — providing extra calories and no additional nutritional benefit. So I recommend that all parents try at least to reduce the obvious sources of sugary drinks, sweets and desserts.

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