More than a third of patients at risk of developing type 2 diabetes who reside in the UK avoided developing the condition after they were referred by their family doctor (GP) to a diabetes prevention program delivered by the commercial weight management provider, Weight Watchers, finds research published in BMJ Open Diabetes Research & Care.
The initiative also helped more than half of those referred either to reduce their risk of developing diabetes or to get their blood sugar levels back to normal. The number of people diagnosed with type 2 diabetes in the UK has increased from 1.4 to 2.9 million since 1996. An even more substantial increase can be seen in the United States (U.S.) with a rise from 7.6 to 23.4 million. A new diagnosis is made every 2 minutes, and by 2025, an estimated 5 million people in the UK and 53 million in the U.S. will have the condition. Horrifying statistics! Risk of developing type 2 diabetes is strongly influenced by lifestyle factors but can be significantly reduced by weight loss, achieved by eating less and exercising more.
The UK’s national health and social care guidance organization, the National Institute for Health and Care Excellence (NICE) says that certain commercial weight management providers, such as Weight Watchers, can help obese people shed pounds. A U.S. study showed that participation in a commercial weight management program succeeded in reversing progression to type 2 diabetes. However, the effectiveness of this approach in UK primary care has not been thoroughly evaluated. Therefore, the researchers identified 166 patients from 14 general practice surgeries at high risk of developing type 2 diabetes: Those with impaired glucose regulation known as pre-diabetes or non-diabetic hyperglycemia and with a body mass index (BMI) above 30 kg/m2.
These patients were then invited to contact Weight Watchers to book a place on their diabetes prevention program, which included a 90-minute induction session followed by 48 weekly group meetings. From among the 166 primary care referrals, 149 patients were eligible. Some 117 attended the induction, and 115 started the weekly sessions, representing a take-up rate of 70%, which is high for a lifestyle intervention, according to the researchers. The program focused on improving diet quality, reducing portion size, increasing physical activity levels, as well as boosting confidence in the ability to change and a commitment to the process.
Blood tests were repeated at 6 and 12 months to check risk factors, and any changes in weight were recorded by trained Weight Watcher staff. Analysis of the results showed that the initiative led to an average fall in HbA1c (a measure of average blood glucose levels over several weeks) of 2.84 mmol/mol after 12 months to levels regarded as standard. Blood glucose levels also returned to normal in more than a third (38%) of the patients and only 3% developed type 2 diabetes after 12 months. The average weight loss amounted to 10 kg (22lb) at the 12 month time point (a reduction in BMI of 3.2kg/m2).
The researchers acknowledge that not all patients at high risk go on to develop type 2 diabetes, added to which the referral numbers were low, based on the funding available, with few black or minority ethnic participants, men, or those on low incomes. Nevertheless, they conclude that the initiative has the potential to have considerable impact. “A UK primary care referral route partnered with this commercial weight management provider can deliver an effective diabetes prevention programme,” they write. “The lifestyle changes and weight loss achieved in the intervention translated into considerable reductions in diabetes risk, with an immediate and significant public health impact.”
Adapted from: Carolyn Piper, Agnes Marossy, Zoe Griffiths, Amanda Adegboye. Evaluation of a type 2 diabetes prevention program using a commercial weight management provider for non-diabetic hyperglycemic patients referred by primary care in the UK. BMJ Open Diabetes Research & Care, 2017; 5 (1): e000418 DOI: 10.1136/bmjdrc-2017-000418
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Daily Nutrition Nugget
Add Protein To Your Breakfast! A protein-packed breakfast will reduce hunger later in the day. This doesn’t mean load up on three kinds of breakfast meats, instead add a hard-boiled egg or some Greek yogurt to your first meal of the day. Try a cup of plain Greek yogurt with some sliced almonds, mixed berries, honey and chia seeds mixed together.
Before you say goodbye to ice cream and mozzarella, here’s what you should know.
What to know before you give up dairy
Thinking about eliminating milk, cheese, butter, and other dairy products from your diet (God help you; I could never give up cheese!)? You’re not alone. Whether or not to give up dairy, and how to do it is one of the top questions Cynthia Sass, MPH, RD, is often asked. One possible reason why so many people are ditching dairy? It’s gotten the A-list stamp of approval from those in the spotlight, from Jessica Biel who says she “just feels better” when she doesn’t eat dairy, gluten, or wheat to the Kardashian family where the women claimed that by going dairy-free they lost over 11 pounds in two weeks. And I have to be honest here and say, “Who Cares” but unfortunately these are some of the most “prized” role models.
Many experts stress that quitting dairy is not something to be done spontaneously or without cause. “You don’t need to eliminate an entire food group unless there’s a legitimate reason,” says Keri Gans, RDN, a nutritionist based in New York City. That said, if you do decide to give up dairy, there are five side effects you might experience.
You could miss out on some essential nutrients
Before you swap out your 1% for almond milk, it’s important to remember that dairy products can be part of a healthy diet. After all, there’s a reason why the USDA recommends adults have three cups of dairy per day; milk, cheese, and yogurt are rich sources of vitamin D, protein, and calcium, a critical nutrient for bone health. “It’s important to know how to replace them [if you give up dairy],” Sass says. If you’ve decided to eliminate dairy, work with a dietitian nutritionist (RDN) to create a diet plan that still includes plenty of these nutrients. “It’s not to say that someone who gives up dairy can’t get enough vitamin D and calcium, but it’s not as easy,” says Gans.
Dark leafy veggies, such as kale and collard greens, and fatty fish like sardines and canned salmon are good non-dairy calcium sources. Certain brands of plant-based milk and orange juice are also fortified with calcium and vitamin D, Sass notes, although “they’re low in protein so you may need to bump up your intake of foods like eggs, pulses, or salmon to maintain your total protein intake.” If you’ve eliminated dairy and are having trouble finding calcium and vitamin D alternatives that you enjoy, meet with an RDN to discuss whether or not you should start taking a supplement.
You might lose weight
Wanting to lose weight is often cited as the main motivation to cut out dairy, and Sass acknowledges that doing so may help you shed pounds. “I have had clients reduce body fat after giving up dairy,” she says. An important caveat, though: Weight loss after eliminating dairy “is often due to how they consumed it [before], how much, and in what form,” Sass explains. If pizza, mac and cheese, and grilled cheese sandwiches were your go-to meals, and you replaced them with lean proteins, whole grains, and fresh produce, then yes, you’d probably see the numbers on the scale drop.
“It’s not dairy itself, it’s the way it’s being consumed,” says Gans. In fact, research suggests that full-fat dairy, in particular, may actually aid weight loss. In an extensive 2016 study in the American Journal of Nutrition, researchers found that women who consumed higher quantities of high-fat dairy products had an 8% lower risk of being overweight or obese. One possible explanation: Full-fat dairy contains more calories, which may keep you feeling satiated for longer, and less likely to reach for known weight-gain culprits like sugar and refined carbs.
You could feel less bloated
“When people inquire about giving up dairy, it’s usually because they’re feeling bloated,” says Gans, adding that the culprit is almost always lactose intolerance. People with this condition can experience bloating and gas, plus severe stomach pain, diarrhea, and cramps when they consume dairy products. The reason: Lactose intolerant folks do not produce enough lactase, an enzyme that’s important for breaking down a type of sugar called lactase found in milk products. However, “not everybody with lactose intolerance needs to 100% remove dairy from their diet,” Gans says. Cutting back on your overall intake, or consuming dairy products along with other foods (such as cereal with milk instead of ice cream by itself) may be enough to ease symptoms.
If you have a condition that damages the digestive tract, such as Crohn’s disease or celiac disease, you may also get relief from inflammatory bowel disease (IBD)–like symptoms when you cut back on dairy.
Your skin might clear up
Some may swear that going dairy-free helps the fight blemishes, but the relationship between diet and acne is an ongoing source of debate among dermatologists. Research stretching back to the 1940s suggests at most a weak link between dairy consumption and breakouts. However, some experts believe the hormones in milk products could play a role in exacerbating hormonal acne, and many people do report clearer complexions when they give up these foods. The American Academy of Dermatology recommends noting any food triggers that seem to aggravate the skin and cutting back with the help of an RDN to make sure you’re still eating a balanced diet.
Other skin conditions may improve, too
There’s no scientific evidence to back up claims that dairy aggravates skin conditions. That said, some people with eczema and psoriasis report fewer symptoms after they cut back or entirely eliminate dairy. In general, when skin is acting up, an RDN may recommend an elimination diet to help pinpoint the offender. Dairy is considered one of the most common food allergens (along with wheat, eggs, soy, fish, shellfish, tree nuts, and peanuts), and is usually one of the groups excluded in such a diet. After a few weeks, food groups are added back to see which one is triggering inflammation.
The bottom line: Cutting out dairy is not a guaranteed fix for those with psoriasis and eczema. However, if you’re experiencing a sudden flare of symptoms, it may be worth trying an elimination diet to find out if a particular food is to blame; However, consult an RDN before attempting this diet.
Nutrition Daily Nugget
Drink Warm Lemon Water! Drinking a glass of warm lemon water in the morning will start your day off right! You’ll get a boost of vitamin C, clean out toxins from your body and keep your digestion system on track.
Even the most health-conscious among us can go a little crazy on snacks and drinks during the holidays and at springtime and during the summer months, and before we know it, we are back at the holidays. Really, where does the time go? If we are having fun with people we love and care about, then that may also be another reason for indulging in our favorite snacks and drinks. So, when is it not a perfect reason or season to fall victim of the snack trap?
Thankfully, you can kind of have your cake and eat it, too. It’s OK to indulge a little in the foods you love, as long as you know how to get your body back on track. One of the best ways to help your body feel like it’s working at an optimal level is to support the bodies natural detoxification. Your organs are already incredibly well-suited for detoxing things, such as heavy metals, pathogens, and other deleterious compounds from its system. However, sometimes, especially when it’s overloaded and working overtime, your body can use a little bit of detox support.
Eating these foods regularly will help you feel energized and clear-minded. You’ll also notice that side effects of chronic inflammation caused by toxins will disappear. For many people, common side effects are bloating, indigestion, and weight gain, so in a sense, these are “flat tummy” foods, too!
Beets: The root veggie is available year round, but be sure to grab a few at the farmers market before your next summer cookout. Beets support healthy liver function and help it filter out toxins all thanks to something called betaine. This compound, unique to raw beetroot, encourages the liver to cleanse itself and promotes healthy bile production. Try wrapping beets in foil and throwing them on the grill next time you BBQ!
Grapefruit: Juicy, sweet, and tart, grapefruits are good to keep on hand the morning after a heavy meal. The antioxidants in the citrus fruit protect cells from free radical damage. Grapefruit is also very high in fiber, which acts like a broom for your digestive system, sweeping out the gut and intestines until everything is clean and good as new.
Dandelion Root Iced Tea: Not exactly something you can snack on, but still an excellent detoxifying ingredient to have in your pantry! Dandelion Root promotes the production of bile in the liver. In other words, it helps your liver break down and cleanse your internal organs. Make a big batch and sip on this stuff the morning after a night out.
Asparagus: According to the Journal of Food Science, the amino acids and minerals found in asparagus protect liver cells. Because so much of detoxification happens in the liver, it’s important to support this critical organ however possible.
Avocado: Next time you’re feeling a little woozy after one too many skinny margaritas, whip up some avocado toast. A study published in The Journal of Agricultural Food Chemistry found that of all fruits, avocado has the most liver-friendly benefits. It’s even able to reverse liver cell damage!
Daily Nutrition Nugget
Be an advocate for healthier kids! Insist on good food choices at school and childcare centers. Contact public officials and make your voice heard.
Irritable Bowel Syndrome (IBS) is an extremely common gastrointestinal (GI) disorder that significantly reduces the quality of life. Treatment options for IBS have long been limited to symptom management. However, a new understanding of IBS has recently emerged, in which a dysfunctional gut–brain–microbiome axis is responsible for the development and progression of the disorder. Right now, you may be asking yourself “How does a dysregulated gut–brain–microbiome axis promote IBS and what therapeutic measures can be used to modulate this axis and reverse the course of the disease?” Well, let’s find out!
What is the gut–brain–microbiome axis?
IBS has an extremely high worldwide prevalence; it is estimated to affect approximately 10-25% of people in developed countries. Despite its vast influence, an understanding of the pathophysiology of this disorder has remained elusive for many years. In addition to abdominal pain, bloating, and abnormal bowel movements, IBS adversely impacts brain function and has been linked to psychiatric disorders such as anxiety and depression. Furthermore, research suggests that people with IBS have an altered gut microbiota compared to healthy individuals. These findings have led to the development of a new understanding of IBS, in which the interrelationship between gut symptoms, mental health, and the microbiome is mediated by the gut–brain–microbiome axis.
The gut–brain–microbiome axis connects the body’s central nervous system (CNS), which houses the brain and spinal cord, with the enteric nervous system (ENS) of the GI tract. This axis facilitates bidirectional neural, hormonal, and immunological communication between the gut and brain. The microbiome is the third key component of this axis. It serves as an intermediary between the gut and brain since the microbes it contains produce metabolites that relay messages to both organs. When the gut–brain–microbiome axis is in balance, the digestive system and brain function optimally. Conversely, dysregulation of this axis may initiate IBS and influence its progression and severity.
The microbiome is altered in IBS
Over the past several years, numerous studies have documented alterations in the gut microbiota of people with IBS relative to healthy people. This has led researchers to postulate that the microbiome may play a key role in the pathogenesis of IBS. In people with IBS, proportions of specific bacterial groups are altered and the diversity of microbial populations is reduced. Researchers have observed decreased levels of Lactobacilli and Bifidobacteria and an increased prevalence of pathogenic anaerobic organisms such as E. coli and Clostridia in fecal samples from IBS patients. In addition, IBS patients exhibit an increased Firmicutes-to-Bacteroidetes ratio.
There are several factors that may lead to microbiome disruption and the onset of IBS. These include antibiotic use, infection, diet, and stress. Stress is perhaps one of the more insidious factors that contribute to IBS; while dietary changes and treatment for gut infections can be relatively simple to institute, stress is an entirely different beast that must constantly be managed. However, the significance of stress and the psychological toll it creates in IBS cannot be understated, given our understanding of the gut–brain–microbiome axis.
The psychological toll of IBS
IBS sufferers have long understood the connection between their gut symptoms and mental health. Indeed, mental health issues such as anxiety and depression are a common comorbidity of IBS. However, this problem has only recently begun to receive the attention it deserves from the medical community, with the scientific discovery of neural links between the gut and brain in the gut–brain–microbiome axis. Further investigation into the psychological health of IBS patients has found that they exhibit a maladaptive stress response. This includes an exaggerated response to stress and an inability to appropriately shut down the stress response once the stressor is removed. IBS patients also demonstrate visceral hypersensitivity, a condition that increases the level of attention paid to gut symptoms, thus perpetuating anxiety about IBS. There is also evidence that people with IBS may experience stress-related deficits in cognitive function.
The enhanced stress response, anxiety, and altered cognition found in IBS patients may be due in large part to the influence of their gut microbes. There are several mechanisms by which gut microbes affect the gut–brain–microbiome axis. Via the axis, an altered gut microbiota can send neural signals from the gut to the brain, leading to the heightened stress response and increased visceral hypersensitivity characteristic of IBS. This promotes a sustained level of attention to the gut in IBS patients and an inability to “turn off” anxiety surrounding gut symptoms (I think this research is speaking to me 🧐). Gut microbes also alter the availability of tryptophan, an amino acid required to produce the mood-regulating neurotransmitter serotonin. Gut microbes influence the release of immune system mediators and glucocorticoids, which can heighten intestinal pain in IBS. Finally, pathogenic gut microbes can also initiate a proinflammatory state that increases intestinal permeability, resulting in the leakage of neuroactive metabolites from the gut into the CNS, where they have adverse effects on cognition.
Stress, in turn, has harmful effects on the intestinal microbiota. Stress increases intestinal permeability, allowing bacteria and bacterial antigens to cross the epithelial barrier into the bloodstream, inducing an immune response that alters the microbiome. Stress hormones, including epinephrine and norepinephrine, also increase the virulence of gut pathogens by enhancing the availability of iron, which the pathogens use to fuel their activities. Increased levels of gut pathogens may further exacerbate IBS.
Clearly, an imbalanced gut microbiome and an unhappy brain walk hand in hand. The complex relationship between the gut, brain, and microbiome in IBS creates a vicious cycle of intestinal symptoms, stress, and poor mental health. To break this vicious cycle, the gut–brain–microbiome axis must be repaired.
Repairing the gut–brain–microbiome axis to treat IBS
To successfully treat IBS, strategies must be employed that address each component of the gut–brain–microbiome axis. Modulation of the axis with dietary changes, prebiotics, probiotics, select antibiotics, and stress-reduction strategies offer a holistic means of treating IBS.
Diet and prebiotics
Significant positive changes can be induced in the gut–brain–microbiome axis through the implementation of dietary modifications and prebiotic supplementation. One dietary approach that has received substantial attention in the treatment of IBS is the low-FODMAP diet. Briefly, gut bacteria metabolize FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), which include various types of fermentable dietary fibers, into short-chain fatty acids (SCFAs). High levels of two SCFAs, acetic acid, and propionic acid, have been associated with GI symptoms, anxiety, depression, and reduced quality of life in IBS patients. Reducing dietary intake of FODMAPs can lower levels of these SCFAs and therefore alleviate IBS symptoms.
However, research on the low-FODMAP diet for IBS conflicts with other studies suggesting that prebiotics, a type of fermentable fiber, improve both guts- and brain-related symptoms of IBS. The regular consumption of fructooligosaccharides (FOSs) has been found to reduce GI symptoms and improve quality of life markers such as anxiety and sleep in people with functional bowel disorders. Prebiotics also offer brain-health benefits; the intake of galactooligosaccharides (GOSs) increases hippocampal levels of the brain-derived neurotrophic factor, a protein involved in normal brain function, and N-methyl-D-aspartate (NMDA) receptors, which regulate brain plasticity and memory. More research is needed to understand the divergent responses to low-FODMAP diets and prebiotics in IBS patients. Clinically, practitioners should encourage patients to experiment with FODMAPs and prebiotics and find what works best for them.
Probiotics are another promising treatment option for IBS since they modulate both the gut and the brain components of the gut–brain–microbiome axis. Supplementation with Bifidobacterium infantis has been found to improve gut-related symptoms of IBS by reducing abdominal pain and bloating and normalizing bowel movements, while also inducing antidepressant effects through the augmentation of plasma tryptophan levels, increasing levels of the “feel good” neurotransmitter, serotonin. Bifidobacterium animalis is effective for promoting intestinal motility and reducing abdominal discomfort in IBS-C (constipation) patients. Lactobacillus acidophilus supplementation reduces visceral hypersensitivity to IBS by activating opioid and cannabinoid receptors, thus ameliorating intestinal pain and reducing hypervigilance to GI sensations. Finally, probiotic strains that repair the intestinal barrier may reduce the leakage of neuroactive metabolites from the gut into the systemic circulation, protecting brain function.
Mark Pimentel, a noted small intestinal bacterial overgrowth (SIBO) researcher, has found that up to 85% of IBS patients have SIBO. However, other research suggests that this may be an overestimation, due to the high false positive rate associated with the lactulose breath test used to diagnose SIBO. While not a cure-all, the eradication of SIBO using specific antibiotics, such as rifaximin, may benefit some cases of IBS.
Chronic stress perpetuates the vicious cycle of IBS by altering the gut microbiota, increasing gut pathogen virulence, and promoting intestinal permeability. The implementation of stress reduction strategies is crucial for breaking the cycle and restoring health to the gut–brain–microbiome axis. While there are many stress-reducing practices to choose from, three in particular—yoga, exercise, and mindfulness meditation—have demonstrated IBS-specific benefits. Yoga has exploded in popularity in recent years and has become the subject of extensive scientific investigation. A recent study found that a yoga practice consisting of postures and breathing exercises beneficially modulates gut and brain function by reducing sympathetic nervous system activity and increasing parasympathetic activity, making it an effective remedial therapy for IBS.
A generalized exercise program may also benefit the gut–brain–microbiome axis and reduce symptoms of IBS. Exercise increases GI motility, reduces intestinal gas retention, relieves stress, and increases the number of beneficial microbial species in the gut. Finally, mindfulness training is another beneficial stress reduction strategy for IBS. Mindfulness training (MT) promotes nonreactive awareness to emotional and sensory experiences, such as GI symptoms, and has been found to beneficially alter pain processing. An eight-week course of mindfulness training in women with IBS significantly reduced gut-focused anxiety and abdominal pain, thus breaking the vicious cycle of stress and intestinal symptoms.
A diagnosis of IBS no longer needs to be vague and frustrating for people. The newfound knowledge of the gut–brain–microbiome axis, and the variety of treatments that can be used to modulate it, offers IBS patients the possibility of a full recovery.
The number of obese children and adolescents (aged 5 to 19 years) worldwide has risen tenfold in the past four decades, according to a new study led by Imperial College London and the World Health Organization (WHO). If current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022. The study is published in The Lancet. It analyzed weight and height measurements from nearly 130 million people aged over five (31.5 million people aged 5 to 19, and 97.4 million aged 20 and older), the largest number of participants ever involved in an epidemiological study. More than 1000 researchers contributed to the study, which looked at body mass index (BMI) and how obesity has changed worldwide from 1975 to 2016.
During this period, obesity rates in the world’s children and adolescents increased from less than 1% (equivalent to five million girls and six million boys) in 1975 to nearly 6% in girls (50 million) and nearly 8% in boys (74 million) in 2016. Combined, the number of obese 5 to 19-year-olds rose more than tenfold globally, from 11 million in 1975 to 124 million in 2016. An additional 213 million were overweight in 2016 but fell below the threshold for obesity. Lead author Professor Majid Ezzati, of Imperial’s School of Public Health, said: “Over the past four decades, obesity rates in children and adolescents have soared globally, and continue to do so in low-and-middle-income countries. More recently, they have plateaued in higher income countries, although obesity levels remain unacceptably high.”
Professor Ezzati adds: “These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities. The trend predicts a generation of children and adolescents growing up obese and also malnourished. We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods.”
More obese than underweight 5 to 19-year-olds by 2022
The authors say that if post-2000 trends continue, global levels of child and adolescent obesity will surpass those for moderately and severely underweight for the same age group by 2022. Nevertheless, the large number of moderately or severely underweight children and adolescents in 2016 (75 million girls and 117 boys) still represents a major public health challenge, especially in the poorest parts of the world. This reflects the threat posed by malnutrition in all its forms, with there being underweight and overweight young people living in the same communities. Children and adolescents have rapidly transitioned from mostly underweight to mostly overweight in many middle-income countries, including in East Asia, Latin America, and the Caribbean. The authors say this could reflect an increase in the consumption of energy-dense foods, especially highly processed carbohydrates, which lead to weight gain and poor lifelong health outcomes.
Dr. Fiona Bull, the programme coordinator for surveillance and population-based prevention of noncommunicable diseases (NCDs) at WHO, said: “These data highlights, remind and reinforce that overweight and obesity is a global health crisis today, and threatens to worsen in coming years unless we start taking drastic action.”
Global data for obesity and underweight
In 2016, there were 50 million obese girls and 74 million obese boys in the world, while the global number of moderately or severely underweight girls and boys was 75 million and 117 million respectively. The number of obese adults increased from 100 million in 1975 (69 million women, 31 million men) to 671 million in 2016 (390 million women, 281 million men). Another 1.3 billion adults were overweight but fell below the threshold for obesity.
Regional/Country data for obesity, BMI and underweight
The rise in childhood and adolescent obesity in low- and middle-income countries, especially in Asia, has accelerated since 1975. Conversely, the rise in high-income countries has slowed and plateaued. The largest increase in the number of obese children and adolescents was seen in East Asia, the high-income English-speaking region (USA, Canada, Australia, New Zealand, Ireland and the UK), and the Middle East and North Africa. In 2016, obesity rates were highest overall in Polynesia and Micronesia, at 25.4% in girls and 22.4% in boys, followed by the high-income English-speaking region. Nauru had the highest prevalence of obesity for girls (33.4%), and the Cook Islands had the highest for boys (33.3%).
In Europe, girls in Malta and boys in Greece had the highest obesity rates, at 11.3% and 16.7% of the population respectively. Girls and boys in Moldova had the lowest obesity rates, at 3.2% and 5% of the population respectively. Girls in the UK had the 73rd highest obesity rate in the world (6th in Europe), and boys in the UK had the 84th highest obesity in the world (18th in Europe). Girls in the USA had the 15th highest obesity rate in the world, and boys had the 12th highest obesity in the world. Among high-income countries, the USA had the highest obesity rates for girls and boys.
The largest rise in BMI of children and adolescents since 1975 was in Polynesia and Micronesia for both sexes, and in central Latin America for girls. The smallest rise in the BMI of children and adolescents during the four decades covered by the study was seen in Eastern Europe. The country with the biggest rise in BMI for girls was Samoa, which rose by 5.6 kg/m2, and for boys was the Cook Islands, which rose by 4.4 kg/m2.
India had the highest prevalence of moderately and severely underweight (BMI <19) throughout these four decades (24.4% of girls and 39.3% of boys were moderately or severely underweight in 1975, and 22.7% and 30.7% in 2016). 97 million of the world’s moderately or severely underweight children and adolescents lived in India in 2016.
Solutions exist to reduce child and adolescent obesity
In conjunction with the release of the new obesity estimates, WHO is publishing a summary of the Ending Childhood Obesity (ECHO) Implementation Plan. The plan gives countries clear guidance on effective actions to curb childhood and adolescent obesity. WHO has also released guidelines calling on frontline healthcare workers to actively identify and manage children who are overweight or obese. Dr. Bull added: “WHO encourages countries to implement efforts to address the environments that today are increasing our children’s chance of obesity. Countries should aim particularly to reduce consumption of cheap, ultra-processed, calorie dense, nutrient poor foods. They should also reduce the time children spend on screen-based and sedentary leisure activities by promoting greater participation in physical activity through active recreation and sports.”
Dr. Sophie Hawkesworth, from the Population Health team at Wellcome Trust, which co-funded the study, said: “Global population studies on this scale are hugely important in understanding and addressing modern health challenges. This study harnessed the power of big data to highlight worrying trends of both continuing high numbers of underweight children and teenagers and a concurrent stark rise in childhood obesity. Together with global health partners and the international research community, Wellcome is working to help identify new research opportunities that could help better understand all aspects of malnutrition and the long-term health consequences.”
My thoughts: The unfortunate and sad reality is that I was not surprised when I read the research. 😔 However, this is just more proof that we have to work together as a world, not a country, to fight this epidemic…..and not only obesity but eating disorders as a whole. We can win!
Adapted from: NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128*9 million children, adolescents, and adults. The Lancet, 2017 DOI: 10.1016/ S0140-6736(17)32129-3
Nutrition Tip of the Day
Schedule time each week to plan healthy meals! Keep your recipes, grocery list, and coupons in the same place to make planning and budgeting easier.
Fans of anti-inflammatory diets say they can transform you inside and out. Is this another “health” fad…or do we all really need to go AI?
An anti-inflammatory diet=less pain, happy gut, more energy, and more! This diet may be buzzy, but the tenets of an AI diet; more plants, less sugar, no refined stuff, is far from a passing fad. “Who needs to eat a more anti-inflammatory diet? Everyone,” says Barry Sears, PhD, creator of The Zone diet, who has spent decades studying chronic inflammation. Here’s the lowdown on inflammation, and how to fight it with food.
What the heck is inflammation, anyway?
Believe it or not, inflammation starts as a good thing. It happens when your immune system sends out white blood cells and “warrior” compounds, such as eicosanoids to attack invading viruses, bacteria, or toxins. A classic example of normal inflammation: Pain, heat, redness, and swelling around a wound or injury (think of a tender sprained ankle). “There’s a separate response called ‘resolution’ that brings the dogs of war back to their barracks and heals your tissues,” says Sears. “The first phase of inflammation causes cellular destruction, and the second phase, resolution, begins cellular rejuvenation. As long as those phases are balanced, you stay well.”
However, for most of us, the balance never happens. That’s because sugar, refined grains, and saturated fat can also trigger an inflammatory immune response, notes Sears, and the typical Western diet is packed with them, meaning we’re inflaming our bodies over and over, every time we eat. Meanwhile, guess what the average American gets way too little of? Fruits, non-starchy veggies, and fatty fish. Fruits and vegetables are packed with antioxidants that help cool things down and reduce the intensity of the initial inflammatory response and fatty fish, a great source of omega-3 fatty acids, can help your body move into the resolution phase.
Air pollution and environmental toxins also trigger your immune system in the same way, but “most of the chronic, extra inflammation in our bodies is diet-related,” says Sears. In arteries, chronic inflammation can lead to heart disease. In the brain, it’s linked to anxiety and depression. In your joints, it causes swelling and pain. In the gut, inflammation throws off the balance of helpful bacteria and causes direct damage to the lining of the intestines, says Mark Hyman, MD, director of the Center for Functional Medicine at the Cleveland Clinic and author of The Blood Sugar Solution: 10-Day Detox Diet. This may contribute to IBS, food sensitivities, autoimmune diseases, and even obesity, research suggests.
In contrast, research shows that following a more anti-inflammatory style of eating may reduce the risk of heart disease, obesity, and some cancers and may even extend your life, says Frank Hu, MD, professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health. Other claims about anti-inflammatory diets, such as reversing autoimmune disease (the goal of the Autoimmune Protocol, an extremely restrictive AI diet) or improve mental health, have less solid proof, he says.
How to spot an anti-inflammatory diet
There isn’t just one specific “AI Diet,” unlike Atkins or South Beach. Sears’s Zone diet and Dr. Hyman’s Detox are both highly anti-inflammatory, as is the soy-heavy plan from integrative medicine guru Andrew Weil, MD. Paleo and Whole30 diets are both AI, as well. However, the plan with the most research-backed anti-inflammatory credibility is the traditional Mediterranean diet, emphasizing fruits, vegetables, whole grains, legumes, fish, and olive oil. Several very large studies, including the famed Nurses’ Health Study, have found that people who follow a Mediterranean pattern of eating have lower levels of the inflammatory markers C-reactive protein and interleukin-6 in their blood compared with those who do not. This may be one reason the Mediterranean diet is linked to so many health benefits, from keeping weight down to slashing heart and stroke risk, notes Dr. Hu.
The goals of an AI plan are simple: Cut back on foods that trigger an inflammatory response and eat more of the foods that heal damage. While there are some variations in what’s allowed and what isn’t, most AI plans share an emphasis on eating whole, minimally processed foods, non-starchy vegetables, monounsaturated fats, such as olive and avocado oil, colorful berries and other fruits, omega-3s from fatty fish (or supplements), and avoiding added sugar and refined grains. That said, your plate may look a little different from your friend’s or coworker’s, and that’s the way it should be, says Dr. Hyman. Some people thrive on a grain-free Paleo plan, while others would rather die than give up bread. Food sensitivities also play a role: “People react to foods differently, and if someone has a sensitivity to a particular food, it will lead to cytokine production and an increase in other inflammatory chemicals,” says Dr. Hyman. If you suspect you have a sensitivity, talk to your doctor or a dietitian, who can design an elimination diet to help ID the culprit.
What’s off the menu?
While all AI plans give a thumbs-up to veggies, fatty fish, and olive oil, the foods you can’t eat vary. Women with a history of eating disorders take note: “Restricting whole food groups can be triggering,” says Sonya Angelone, RDN. Here is what’s not allowed in four different diets:
Paleo: All grains, dairy, legumes, (chickpeas, lentils, beans, peanuts).
The Zone Diet: All refined grains, white potatoes.
Mediterranean Diet: Added sugar, refined sugar.
So what exactly do you eat?
You don’t have to follow any AI diet perfectly to make a big impact. A healthy body is built to handle the occasional onslaught of inflammation (like having a cupcake at a party); it’s the regular, consistent consumption (and overconsumption) of inflammatory foods, such as sugar and saturated fat that’s linked to serious disease, says Sonya Angelone, RDN, a spokesperson for the Academy of Nutrition and Dietetics. A 2012 study of nearly 2,000 people, for example, found that those who ate the most sweets over two years had significantly higher levels of interleukin-6 than people who ate more veggies, fruits, and whole grains. That’s why it’s more important to eat an overall “super” diet rather than focus on individual superfoods, says Angelone. “If you’re regularly eating a bunch of doughnuts along with a bunch of anti-inflammatory veggies, you’re still harming your body,” adds Dr. Hyman. Follow these AI guidelines on most days:
1. Aim for half to two-thirds of your plate to be nonstarchy vegetables. Greens of all kinds, mushrooms, summer squash, beets, cauliflower…the list goes on and on, as well as at breakfast, too, says Dr. Hyman. They’re packed with gut-balancing fiber and powerful antioxidants.
2. Limit added sugar and sweet drinks. That includes fruit juices and natural sweeteners, such as honey, says Dr. Hyman. In a small 2005 study, people who were fed a high-sugar diet for 10 weeks had significantly elevated blood levels of haptoglobin, an inflammatory marker that in high concentrations is associated with diabetes, heart attack, stroke, and obesity, compared with controls.
3. Eat fish. Especially fatty kinds, such as salmon, mackerel, herring, and anchovies, or take omega-3 supplements, at least 1,000 milligrams daily, says Dr. Hyman.
4. Nix white flour and limit other flour-based foods. Focus on whole, intact grains, such as quinoa, brown rice, and bulgur wheat instead of loading up on whole-grain crackers, breads, and tortillas. Even 100% whole-grain flour will cause a spike in blood sugar that exacerbates inflammation, especially for people with insulin resistance, metabolic syndrome (i.e., prediabetes), or diabetes, so use them moderately, says Sears.
5. Choose fats carefully. The most abundant saturated fats in our diet contain the same fatty acids as do fragments of the cell walls of many bacteria. No wonder our immune system sees a bacon cheeseburger as a threat! Limit saturated fats and skip vegetable oils that are high in omega-6 fats, such as safflower and corn oils. Opt instead for olive, avocado, or walnut oil. “It might sound tough, but if you think about it, it’s exactly how your grandmother probably told you to eat!” says Sears, and a diet endorsed by your nana? Now that sounds like a plan.
Yes, you might lose some weight
Going AI doesn’t automatically mean you’ll drop pounds, says Angelone, especially if your weight is in a healthy range to begin with. However, research does suggest that an AI diet packed with veggies and low in sugar and refined carbs can help with weight loss goals. “You feel fuller on fewer calories because the high-fiber foods have so much more volume,” she says. The healthy fats in an AI plan may also play a role: A large, five-year study published in 2016 found that people who ate a veggie-and fat-rich Mediterranean diet lost more weight than those who went on a low-fat plan.
The 10 best foods for fighting inflammation
These are foods that research has shown to have exceptionally strong effects on inflammation:
• Dark green Leafy vegetables (like kale, spinach, Swiss chard)
• Fatty fish
• Garlic and onions
• Green tea
• Tart cherries
What are your thoughts on an AI diet? Can it transform you from the inside out?
Nutrition Tip of the Day
Cook vegetables in healthy ways that will help bring out their natural flavors, including roasting, grilling, steaming and baking. You’ll need less salt (if any) and may even turn the most anti-veggie kid into a fan!
When hunger pangs strike, we usually interpret them as a cue to reach for a snack; when we start to feel full, we take it as a sign that we should stop eating. However, new research shows that these associations can be learned the other way around, such that satiety becomes a cue to eat more, not less. The findings, published in Psychological Science, a journal of the Association for Psychological Science, suggest that internal, physical states themselves can serve as contexts that cue specific learned behaviors. “We already know that extreme diets are susceptible to fail. One reason might be that the inhibition of eating learned while dieters are hungry doesn’t transfer well to a non-hungry state,” says psychological scientist Mark E. Bouton of the University of Vermont, one of the authors on the study. “If so, dieters might ‘relapse’ to eating, or perhaps overeating, when they feel full again.”
To test this hypothesis, Bouton and co-author Scott T. Schepers conducted a behavioral conditioning study using 32 female Wistar rats as their participants. Every day for 12 days, the rats, who were already satiated, participated in a 30-minute conditioning session. They were placed in a box that contained a lever and learned that they would receive tasty treats if they pressed that lever. Then, over the next 4 days, the rats were placed in the same box while they were hungry, and they discovered that lever presses no longer produced treats.
Through these two phases, the rats were conditioned to associate satiety with receiving tasty food and hunger with receiving no food. However, what would the rats do if they were placed in the box again? The results were clear: When the rats were tested again, they pressed the lever far more often if they were full than if they were hungry. In other words, they relapsed back to seeking treats. “Rats that learned to respond for highly palatable foods while they were full and then inhibited their behavior while hungry, tended to relapse when they were full again,” Bouton explains.
This relapse pattern emerged even when food was removed from the cage before both the learning and unlearning sessions, indicating that the rats’ internal physical states, and not the presence or absence of food, cued their learned behavior. Findings from three different studies supported the researchers’ hypothesis that hunger and satiety could be learned as contextual cues in a classic ABA¹ (sated-hungry-sated) renewal design. However, the researchers found no evidence that an AB design², in which the rats learned and subsequently inhibited the lever-treat association in a hungry state and were tested in a sated state, had any effect on the rats’ lever pressing. Together, these results show that seeking food and not seeking food are behaviors that are specific to the context in which they are learned.
Although our body may drive food seeking behavior according to physiological needs, this research suggests that food-related behaviors can become associated with internal physical cues in ways that are divorced from our physiological needs. “A wide variety of stimuli can come to guide and promote specific behaviors through learning. For example, the sights, sounds, and the smell of your favorite restaurant might signal the availability of your favorite food, causing your mouth to water and ultimately guiding you to eat,” say Schepers and Bouton. “Like sights, sounds, and smells, internal sensations can also come to guide behavior, usually in adaptive and useful ways: We learn to eat when we feel hunger, and learn to drink when we feel thirst. However, internal stimuli such as hunger or satiety may also promote behavior in ways that are not so adaptive.”
¹A-B-A design involves establishing a baseline condition (the “A” phase), introducing a treatment or intervention to effect some sort of change (the “B” phase), and then removing the treatment to see if it returns to the baseline (“A”).
²An AB design is a two part or phase design composed of a baseline (“A” phase) with no changes, and a treatment or intervention (“B”) phase.
Adapted from: Scott T. Schepers, Mark E. Bouton. Hunger as a Context: Food Seeking That Is Inhibited During Hunger Can Renew in the Context of Satiety. Psychological Science, 2017; 095679761771908 DOI: 10.1177/0956797617719084
Nutrtition Tip of the Day
Package your own healthy snacks! Put cut-up veggies and fruits in portion-sized containers for easy, healthy snacking on the go, without the added sugars and sodium.