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Appearing today in the Sophian, as a Letter to the Editor:

Fat and fit?

Rachel Johnson’s Nov. 18th opinions piece on the burgeoning “Fat Studies” movement brought up some good points about the challenges of supporting a group marginalized not because of race, religion or ethnicity, but because of size.

As Johnson wrote, the movement strives to eliminate some of the stigma and discrimination that often come with being overweight or obese, as the 66% of Americans that fall into these categories can attest to. Furthermore, as Johnson noted, the field aims to promote the understanding that obesity is not simply the product of indolence and a lack of willpower, but rather a factor of “a range of social, economic and genetic factors.”

While Johnson supports the aim of Fat Studies to rectify the historic mistreatment of those Americans “of size,” she is critical of the notion attributed to the movement that the health community is biased and favors an alarmist agenda with regard to preventing and addressing obesity. While it is certainly legitimate to critique the nascent Fat Studies movement, I believe that Johnson’s criticism does not acknowledge the growing scientific understanding that weight is not necessarily correlated with health or lack thereof.

It is my opinion that public health agencies like the NIH, CDC and others do in fact approach the complex issue of obesity with an alarmist zeal, and perhaps some of that alarmism is warranted. After all, the NIH, CDC and so on have as a goal a reduction of risk to the general public, but their alarmism has done little to curb the growing numbers of Americans with a Body Mass Index of 25 or higher i.e. who are overweight.

What then is the basis of my disagreement with Johnson and others who see Fat Studies as promoting the faulty notion that being overweight and obese does not in fact put a person on a direct path to Type 2 Diabetes and other markers of poor health?

I believe that there is in fact sufficient evidence to suggest that overweight and obesity is not in and of itself deadly/a burden to society/etc. etc., and that some of the deleterious health consequences associated with obesity can in fact be attributed to the stigma that society attaches to carrying “excess” weight.

One avenue of research that has yielded such evidence has focused on the so-called “fit and fat” debate. That is, is it possible to be both “fat” (overweight or even obese) and physically fit? Moreover, is it more important to be thin, or to be fit?

University of South Carolina Professor of exercise physiology, epidemiology and biostatistics Steven Blair has made his life’s work to examine this very issue. Blair is himself an overweight and active individual who, after running almost every day for more than 30 years, is “still short, fat, and bald.” Although his daily activity has not resulted in weight loss, Blair maintains that he is in “much better shape than I’d be if I didn’t run.”

One notable study Blair conducted in 2007 investigated the relationship between fitness, weight and mortality. Fitness was found to be strong predictor of longevity in the participants, all adults 60 and older, while obesity was found to have little influence on risk of death. Especially in older people, Blair reported, obesity is “not as important a determinant of mortality as it is in younger people.”

Synthesizing the study’s results, age, low fitness levels and having multiple risk factors for heart and vascular disease were independently associated with death risk, and better fitness was associated with a lowered risk of diabetes, high cholesterol and high blood pressure.

As for fitness, death rates for those with the highest levels thereof were less than half that of the physically “unfit.” Being overweight and obese, however, was not an independent predictor of death, and among the physically fit, death risk was similar for normal weight, overweight and obese people. Blair also specified that 46% of study participants with a BMI of 35 or higher (“extremely obese”) did not fall into the lowest two tiers of fitness level.

The take-away message? Fat and fit can coexist, and fit is more protective than thin.

Blair is of course not the only researcher to examine the subject. A 2009 systemic review of the literature on the interaction of physical activity, fitness and “fatness” concluded that “the risk for all-cause and cardiovascular mortality was lower in individuals with high BMI and good aerobic fitness, compared with individuals with normal BMI and poor fitness.” These results did not apply to the very obese (BMI greater than 35), for whom risk of Type 2 diabetes and cardiovascular incidents was greater. In a similar vein, individuals who are underweight i.e. on the other extreme of weight, have been found to have a greater risk of mortality.

My point in highlighting this research is not to discount the evidence that a greater BMI may be associated with greater health risk, but rather to suggest that the relationship between weight and health is by no means a simple and straightforward one, and that I believe is where Fat Studies can play a crucial role. By challenging the “x leads to y” hypothesis, Fat Studies can help remind the public that measuring and predicting health is never a simple matter.

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Another reason to get more shut-eye

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Read about it on the Examiner here.

Dietary needs of vegetarians and vegans

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Talking last week with a group of girls from my house, I was discussing my plans to study nutrition in graduate school. Two of the three present shared that they as vegetarians were concerned about meeting their nutritional needs now that they had decided to forgo meat.

I was able to rattle off a few things, but realized that it wouldn’t be a bad idea to review the subject for their and my own benefit. After all, we just began our Digestive System and Nutrition unit in Anatomy & Physiology, so what could be a better time to review which macro- (protein, fats, carbohydrates) and micronutrients (vitamins and minerals) vegetarians and vegans are at risk of coming up short on?

Using several different sources (the Vegetarian Resource Group, Nemours’ Kids’ Health site, the American Heart Association), I pulled together the following. Have a look at it, and share with the vegans and vegetarians in your life!

Macronutrients:

Protein- The biggest concern regarding the macronutrients, as you may well know, is whether vegetarians and vegans get enough and enough quality protein sources. Ample empirical research, however, suggests that vegetarian diets can easily provide sufficient dietary protein as long as a variety of plant protein sources are utilized.

The overarching category of proteins, composed as they are of 20 amino acid monomers, becomes a dietary concern when the vegetarian or vegan in question is not getting the essential amino acids, which cannot be synthesized in the body.  Dairy and egg products provide the eight essential amino acids, but the only vegan food sources that contain all eight are soy, hempseed, chia seed, amaranth, buckwheat, quinoa and, perhaps surprisingly, the lupin plant (yes, of Lupin Lady fame).

Fortunately enough for those vegans and vegetarians that can’t afford or don’t have easy access to such foods, the essential amino acids can also be obtained by eating a variety of complementary plant proteins. While the idea of protein “combining” as necessary over the course of a meal has been repudiated by the scientific community, it remains important for vegans and veg-heads to eat a wide variety of plant proteins in order to assure they are getting their requisite eight.

Micronutrients:

Iron- I discussed the importance of dietary iron a little in my piece on hemoglobin. Again, while iron in plant sources abounds, the mineral’s bioavailability is less than that of meat sources, and its absorption is hampered by a number of dietary components. Vegetarian foods that are rich in iron include black and kidney beans, lentils, oatmeal, soybeans, fortified breakfast cereals, sunflower seeds, black-strap molasses and chickpeas. Interestingly enough, a 2009 position paper of the American Dietetic Association has argued that iron deficiencies among vegetarians and vegans is less prevalent than previously thought. A little planning, it seems, is all it takes to get adequate iron.

Vitamin B12- Plant foods are in general not significant sources of B12, which plays a vital role in nervous system functioning and in blood clotting. Lacto-ovo vegetarians can get their RDA of the vitamin from dairy products and eggs, while vegans may need to rely on fortified food sources.

Vitamin D- Vitamin D deficiencies seem no more likely in vegetarians and vegans than in the general population, but D-deficiency is a widespread issue among all segments of the general population. While this vitamin can be generated by the body with adequate sun exposure, getting enough “sunny D” is unlikely for those of us living in the Northern Hemisphere. Vitamin D is necessary for proper absorption of calcium, and fortified products like milk, soy milk and cereal grains are good sources of the essential vitamin. Supplementation is also an option.

Calcium- Calcium intake in vegetarians is on par with that of non-veg-heads, but can be harder to achieve in vegans. Leafy greens can provide ample supplies of dietary calcium, although the absorption of calcium from spinach, Swiss chard and beet greens is inhibited to a degree by the oxalate ion.

Fatty acids- Omega 3 fatty acids in particular are essential to the human body for a number of reasons, specifically in aiding normal human growth. Omega 3s are also necessary for supporting dermal (skin) integrity, renal function and ensuring a healthy childbirth.

Plant-based sources of the fatty acid include soy, walnuts, pumpkin seeds, canola oil, hemp-, chia- and flaxseed, as well as purslane. Plant foods supply alpha-linolenic acid but not long-chain omega 3 fatty acids EPA and DHA, which can be found to a small extent in dairy products and eggs. As a result, vegetarians and especially vegans are often found to have lower levels of EPA and DHA than omnivores, and supplementation may be recommended.

That said, a well planned vegetarian or vegan diet has been endorsed by the American Dietetic Association and Dietitians of Canada as “healthful, nutritionally adequate, and provid[ing] health benefits in the prevention and treatment of certain diseases. Specifically, mortality from ischaemic heart disease has been found to be markedly lower in vegan and vegetarians, as well as risk of hypertension, type 2 diabetes, kidney diseases, osteoporosis and dementias. Vegans and vegetarians also exhibit lower rates of obesity and better cholesterol profiles.

Beyond that, this future dietitian does not believe that any one dietary philosophy (beyond the baby food diet and other such fad diets) is better than another, and I would encourage eaters to choose foods in a fashion that fits their lifestyle. While I for example could easily go without meat, I find the occasional turkey or ham sandwich to be too tasty to pass up. And while I believe in the importance of eating locally-sourced meats and dairy/egg products grown in a humane and sustainable manner, I am also a realist and make do for the time being with dining hall meats.

My take-home message? Eat in a way that is congruent with your moral beliefs, and don’t let any quack nutrition or medical professional convince you than any one diet is superior to another.

Going gluten-free?

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The summer after my first year of college, I lived for three months with family in Melbourne (pronounced “Melbin”), Australia, nannying for my twin cousins Sammy and Marcus. S & M were almost three at the time, and had already developed quite the personalities. Sammy was affectionate with most everyone, while Marcus liked to stick to himself. As an introvert, I felt somewhat of a kinship with Marcus, and always cheered his solo ventures with Legos, reading and so on.

During my stay in Oz, I was lucky enough to sample countless delicious meals out on the town. My cousin’s husband works part-time as a restaurant developer, and has helped many a Melbourne hot-spot get going. Coupled with he and his wife’s busy schedules, we ate most meals out together as a five-some. While I did eventually desire the comfort and simplicity of a home-cooked meal, I greatly enjoyed the ceremony of meals artfully and delectably prepared in the many eateries Melbourne has to offer.

In our habitual quest for cafés and bistros that would appeal to three adults as well as two small children, we spent a fair amount of time cruising the streets of the city. Relishing as always time in the car as “time off” (with the exception of the occasional plea for the boys to “play nice, please!”), I spent these car rides watching the urban scenery pass by. From an abundance of kosher bakeries to “Op shops” (thrift stores to non-Ozzies), there was so much to see, and I loved taking it all in.

Just days after arriving and settling into my new routine as nanny and frequent restaurant-patron, I began to notice something I had yet to see on any sort of scale in the U.S.– every (and I do mean every) pizzeria, café and bakery we passed displayed signs advertising their gluten-free options. Because I had taken Nutrition and Health my previous semester at Smith, I knew that gluten was the protein responsible for wheat pasta and bread’s trademark elasticity. What I wasn’t familiar with was such a ubiquity in eating options for people following a gluten-free diet. Why, I asked my cousin, was gluten-free so common an offering at the neighborhood bistro? Were Australians uniquely plagued with celiac disease?

Yes and no, she responded. According to the Coeliac Society of Australia (gotta love that Commonwealth spelling!), celiac affects roughly one in 100 Australians, although the Society posits that as many as 75% of the afflicted population is unaware they have the autoimmune disease.

While it is unlikely that Australians are inherently more susceptible to celiac disease (many Ozzies, I will remind you, share the same Northern European genetic background as a large portion of Americans), it is clear that Australians are, as in other arenas, more advanced in their response to and treatment of celiac in the population.

Still, with the disease garnering more and more attention in recent years, it is unsurprising that many Americans have begun to consider going gluten-free. Everyone’s favorite diet whore went 21 days in 2008 without gluten, sugar, alcohol, caffeine and animal products. The View host Elizabeth Hasslebeck adheres to a gluten-free diet, as do a bevy of other celebrities.

If abstaining from gluten made Oprah and Ms. Hasslebeck “feel better,” why not you, then? What have you got to lose?

Improved health and quality of life, if you are indeed suffering from celiac or gluten-intolerance.

And the rest of us? Can simply slashing gluten help the average American without gluten-intolerance or celiac enjoy better health and lose weight?

No, say many dieticians and physicians who have experienced an influx of clientele convinced of the ability of a gluten-free diet to cure them of excess weight and other health complaints. If going gluten-free is not a medical necessity, “there’s probably no benefit” to adopting such a diet, says Massachusetts-based dietician Tricia Thompson, R.D., editor of glutenfreedietitian.com.

And the improved health of celiac/gluten-intolerance sufferers on a strict gluten-free diet? Such effects are not applicable to those without such health issues, unfortunately. Feeling “better and more energetic” on a gluten-free diet, says Thompson, is a result of those previously suffering from gluten-intolerance having felt so sick previously.

What of the argument that going without gluten can prevent and/or alleviate autism? Celebrity mom Jenny McCarthy has famously embraced a gluten-free diet for her autistic son Evan, sharing that a gluten-free diet helped improve his autistic symptoms.

But gluten-free diets tend also to eliminate casein, a protein found in milk that might be responsible for the abatement of symptoms instead. And objective clinical studies have not been able to show that the diet works in autistic patients. A May University of Rochester study that examined the effects of a strict gluten- and casein-free diet on 14 autistic preschoolers reported “no discernable effects” on autistic behavior, attention, sleep and other symptoms.

That said, a lack of conclusive evidence of the diet’s capability to mitigate autistic symptoms should not rule out attempting diet therapy, according to Timothy Buie, M.D., a pediatric gastroenterologist at Mass. General Hospital in Boston and author of a recent report in Pediatrics journal that concluded that a gluten-free diet is far from a cure for the developmental disorder.

Still, what it comes down to is this– a gluten-free diet will help alleviate the many uncomfortable symptoms of gluten-intolerance and celiac disease, but will not for those without such health problems. Nor is a gluten-free diet a surefire way to lose weight for those without a biological aversion to gluten.

So approach headlines that tout the ability of gluten-free diets to do x, y and z with skepticism, and remember that a dietary intervention is only as effective as its necessity.

P.S. Apologies to Oprah for the “diet whore” comment; I love the woman and think she is a fabulous role model. Still, she has sampled every diet known to man…

UVM’s weight loss program “Vtrim” reviewed

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Check it out on the Examiner here.

Modeling moderation: Celebrities endorse balanced approaches to nutrition and fitness

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Examiner article here.

Let me know what you think… it was not easy to find female celebrities who weren’t on some sort of fad/crash diet!

Examiner article up!

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Read it here. I posted it on the site last night, but my edits didn’t show up until this morning. Anywho…

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