Eat Right and Excercise
Eat Right and Exercise ... You Talkin' to Me? Yeah!
Food, one assumes, provides nourishment; but Americans eat it fully aware that small amounts of poison have been added to improve its appearance and delay its putrefaction.
- John Cage
by Shari Roan
We followed the rules, and we're still overweight. Now, health professionals say we should just say no to dieting.
For as long as she could remember, Annette Pfau fussed over food. She counted calories, agonised over eating and scolded herself in sessions before the full-length mirror. "My memories of junior high school are of constantly eating cottage cheese or some other crash-diet food. Food was always an enormous part of my life," says Pfau, 33, a Los Angeles graphic designer. "I was always super-conscious of my body image. I felt I had to conform to whatever the standard of beauty is: tall and thin. But I'm not even tall."
She moved into adulthood even more compelled to mould herself into the image locked in her brain. Dieting and exercising were a way of life. Then came the revelation.
"It dawned on me one day that I was spending an inordinate amount of time on food. I told myself, 'This is wrong.'" That was five years ago. Today, with the help of a dietician, Pfau says she is free from the grip that food, weight and body image had on her. She exercises and still tries to eat healthfully. But she does not weigh herself, and she has endorsed the body that she was born with. "I have completely changed my thinking about food," Pfau says. "It's like night and day. The main thing I've learned is, food is a neutral thing. It's not good. It's not bad. Chocolate cake isn't evil and celery isn't virtuous."
Pfau is among a small group of Americans embracing a new model of personal health that is revolutionary for its approach - or lack of approach - to dieting. There is no name for this model, although it's sometimes called "health centred" as opposed to "weight centred." If it had a motto, it would be, "Don't diet."
In a nutshell, the health model, which has a growing number of health professionals from medical doctors to dieticians to psychologists behind it, demands an end to restrictive dieting (counting calories, fat, cholesterol). It not only takes away the scales, but simply asks the individual to try to eat a variety of healthful foods to satisfy hunger, to exercise and — perhaps most central — to accept your body as it is.
Why opt for this stop-trying-so-hard approach? Because dieting doesn't work in any permanent way, says Jeanine Cogan, a Washington, DC psychologist and public-policy scholar specialising in body image with the Society for the Psychological Study of Social Issues. "The prevailing model on obesity is now being recognised as short sighted by researchers across disciplines," she says. "If restrictive dieting as a treatment for obesity has a 95% failure rate and increases the chance of developing an eating disorder, then dieting is not a successful health behaviour."
Cogan is among a group of psychologists informally pressing the federal government to back a new health-centred approach. (A similar model was recently adopted in Canada as part of a major public health media campaign.) "This is an idea that has been floating around for many years," she says. "It's just now getting some attention. We're at a point now where even the leading weight loss researchers are saying restrictive dieting isn't working."
Psychiatrists too are pushing for the new paradigm. They have added a category called "binge eating" to the listing of psychiatric disorders, a move that reflects the emotional component to eating problems and acknowledges the large group of Americans who are not bulimic or anorexic but who are troubled by food, body image and weight issues. Meanwhile, the American Dietetic Association has created a branch of training — nutritional therapy — that focuses on teaching this philosophy.
The new model suggests that if you just eat normally and exercise moderately, you will be mentally and physically healthier and may even lose a modest amount of weight, although the measures of success are whether you are healthy and whether you feel good about yourself. The model also frowns on the use of obesity drugs, such as Redux and Pondimin, both of which were voluntary withdrawn from the marketplace last week due to safety concerns. The medications suppress appetite, another form of food restriction that goes against the health model.
"You can't measure self-esteem with a scale," says Evelyn Tribole, a registered dietician and co-author of Intuitive Eating: A Recovery Book for the Chronic Dieter (St Martin's Press 1995), which looks at the non-diet model. "I've stopped using a scale. I've changed my motto about nutrition. It now includes having a healthy relationship with food and taking the morality out of eating."
Adds Frances Berg, a registered dietician in North Dakota and author of Afraid to Eat: Children and Teens in Weight Crisis (Healthy Weight Publishing Network, 1997): "The old paradigm was, first lose weight and then get healthy. The new paradigm is that we need to be healthy first, with the goal of being healthy at whatever size we are." But Berg and others acknowledge that it won't be easy to change the norm of a society in which it seems every advertisement features a gaunt model, in which dieting is an estimated $40-billion business, in which research dollars flow to scientists performing dieting research and in which Americans hold tight to the belief that anything is possible — even altering a body that may be genetically determined to be large.
To embrace a new model, Tribole says, "People have to grieve that they are never going to have a skinny body." But Americans won't buy that concept, says Linda Webb Carilli, general manager of corporate affairs for Weight Watchers International. Five years ago, when Weight Watchers suggested that clients aim for a "healthy weight" as opposed to an "ideal weight," the idea flopped. "To tell someone who is a binger, 'Don't think about your weight,' is not helpful," Webb Carilli says. "You can tell them to think about how healthy they are in other ways. But if that doesn't match their value system, if that isn't significant for them, it won't work."
According to a 1994 report in the Journal of the American Medical Association, one-third of US adults are overweight, a 25% increase from the 1960s. A quarter of all teenagers and children are overweight. Obesity rates have soared despite the proliferation of diet programs, pills and foods. "The myth is that overweight is cured by dieting," said Connecticut psychologist Lisa G Berzins before a congressional briefing on eating disorders in July. "The truth is that treating overweight by dieting most commonly results in eventual weight gain. Weight is a complex result of heredity, culture and lifestyle. It is not 'cured' by a pill or powder. Some large-size people maintain a healthful lifestyle, yet remain at above-average weight."
It's hard to pinpoint why so many Americans are obese when more people than ever are dieting and obsessing about their weight. Berg, a nutritionist who has studied the issue, blames obesity rates on fewer people smoking, more sedentary lifestyles, higher-fat diets and women being encouraged to gain more weight during pregnancy to have bigger babies (a tactic that may leave some with a healthy baby but a long-term weight problem). Berg also blames Americans' approach to food. "There is a big group of adults and kids who fit the criteria of dysfunctional eating: skipping meals, fasting, bingeing, chaotic eating, under- or overeating for reasons not to do with hunger but with body shape or feelings. They feel ashamed and uncomfortable," she says.
According to Berg, Americans' misguided notions about weight and food have led to a range of problems, including obesity, eating disorders, eating dysfunction (a less severe pattern of eating disorders) and size prejudice. "We need to deal with these things in an interrelated way. Instead, we look at them separately. If we address obesity and help overweight kids, we may increase the other three problems' severity," she says. For example, if children receive the message that being overweight is bad, then they may assume that it's okay to discriminate against fat people. Another example is the teenage girl who, disgusted with being plump, forces herself to vomit after eating.
"I work with people who have eating disorders, and I can see how classic dieting, even in a healthful way, isn't really healthful," Tribole says. "If you are truly focusing on health and healthy behaviour, you really can't do harm." But many people assume that good health can be obtained only by achieving an optimal weight. "One trouble that people have is they say, 'I'm exercising, I'm fit, my blood pressure and cholesterol are good, but I'm not the weight I want to be.' The problem with that approach is that it's a vanity issue. This can't be a vanity issue," Tribole says. And, much worse than being somewhat overweight, the new-model proponents say, is weight cycling - losing, then regaining weight, which takes its toll on the body, particularly the heart. "Disproportionate attention is paid to the risk of obesity while little attention is paid to the risks of weight fluctuation. And yet there is very good information on this; at least 10 studies have looked at this," Cogan says.
Lindsey Elan started battling her weight in high school. It was the beginning of an odyssey that would end with a diagnosis of an eating disorder. "My girlfriend and I would eat these regimented diets, such as an apple for breakfast, salad with nothing on it for lunch and vegetables for dinner. We would do that for a week before the prom. In college, I would go on liquid diets," says Elan, 27, a graduate student who lives in Santa Monica. After graduating from college and living alone for the first time, Elan began to binge and purge. She was eventually treated for bulimia.
"The preoccupation with weight and eating was part of the cause," she says. "I had to relearn a relationship with food. I had to become comfortable with my body. I realise now that body shape is not what's important."
Mechthilde Dunofsky also learned the hard way. Years ago, while working as a model in Europe, she found herself in a battle with food. She starved herself to be skinny, but then began to eat as a way to deal with the boredom of her work. "I was in a struggle with my weight," says Dunofsky, now a Beverly Hills psychotherapist who specialises in body image issues. "Finally, I changed careers. I'd had it with eating rabbit food and dreaming each night of chocolate pies and my mother's roasts. From that time on, I didn't pay attention to my weight, and I've been the same size for 25 years."
She now counsels clients to toss out the scales and to concentrate on all their positive attributes instead of dwelling on weight. "I tell people it's all right to be bigger. You can be attractive if you are healthy, whatever your shape. And people often lose weight easier when they feel better about themselves."
But can Americans really give up dieting?
"The current approach is so entrenched in all of our organisations and in people's everyday thinking," Cogan acknowledges. "I see this as a very liberating message, but that depends on where people are. I think the hardest part for those of us who are advocating this shift is that people do not want to give up the dream that they can change their body size. It's almost like we're the bad guy saying, 'Folks, research says this will have a 95% failure rate. So instead of focusing just on weight as a determinant of health, let's look at other things.'" Cogan and others also see the dieting industry as a force to be reckoned with because of advertisements and programs that make dieting look easy.
Last year, Berzins succeeded in helping Connecticut enact the first state laws to regulate diet industry advertising. The laws require diet programs to disclose accurate information regarding long-term weight loss and other health and cost information. "The diet industry thrives on failure while perpetuating success," she says.
But many diet companies also discourage highly restrictive dieting, says Weight Watchers' Webb Carilli. "If people engage in weight management as restriction and deprivation, it's definitely not going to work," she says. "I think [the health-centred model advocates] are trying to free people from that mind-set. We also work toward freeing people from that mind-set. We put a lot of emphasis on choice." Under a new Weight Watchers program, foods are assigned a point value to indicate their nutritional characteristics. Clients try to stay within a set number of points per day. But this kind of counting approach would not sit well with the health-centred advocates.
"We're giving people parameters," Webb Carilli admits. "People don't come to Weight Watchers to hear, 'Hey, eat anything you want.' These are people who want to have some parameters."
A similar approach is proffered by Jenny Craig. That program also tries to emphasise choice, moderation and exercise, says Lisa Talamini Jones, director of nutrition and program development. "We have a menu, but we don't think of it in terms of restriction. We think of it as a model for balance, variety and moderation. Cookies, for instance, are on the menu," Talamini Jones says. "That is consistent with what health experts are saying. But you still have to be concerned with your weight. One-third of the population is overweight, and that has important health consequences."
But the industry is clearly facing criticism. Following on Berzins' success in Connecticut, a group of health experts is challenging the Federal Trade Commission to toughen diet advertising standards nation wide. Earlier this year, the FTC denied a petition submitted by a non-profit watchdog group, the Centre for Science in the Public Interest, asking for more consumer information in diet industry advertisements. The FTC, however, agreed to hold a public forum on the issue. The conference will be held 16 - 17 October at the FTC's Washington offices. "We are not taking a stand on whether or not these [diet] programs should be in business," says CSPI attorney Layla Farzan. "But we want to see data on how effective these programs are. What are the costs, risks, staff credentials? If the data are not positive, people may decide to drop out of them. And the programs will either get better or whither away."
Source: Times Online Monday 22 September 1997; Shari Roan is the Times health writer
Approximately one-half of all Americans are on a diet on any given day.
Rethinking Weight Loss
What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease.
- Alexander Pope
More health experts are saying it's time for Americans to stop dieting and to use different measures — other than weight — to assess health. This model has already been proposed by the Canadian government.
New Model Health Centred:
Source: Adapted by registered dietician Frances M Berg from Vitality, a public health program in Canada
by Angela Gregory
New research has linked a common milk protein with increased rates of heart disease and childhood diabetes. The study by Auckland medical researchers has been published in the latest issue of the New Zealand Medical Journal and suggests a strong link between consuming milk with A1 beta-casein - which most New Zealanders drink each day - and heart disease and Type 1 diabetes. Emeritus Professor Bob Elliott and Dr Murray Laugesen looked at heart disease rates in 20 countries and diabetes rates in 19. Medical experts say their research supports the need for more studies on the potential health risks of A1 milk. All cows' milk in New Zealand contains the A1 beta-casein protein, although some herds are understood to be free of it. Dr Laugesen said populations that consumed a lot of A1 milk showed a higher rate of heart disease. There was an even stronger correlation for childhood diabetes that required treatment with insulin (Type 1).
For the first time the researchers had looked at health data from the Channel Islands, where milk has either very low or zero levels of the A1 protein. Guernsey Island showed the 3rd-lowest rate of heart disease, behind Japan and France. New Zealand had the 3rd-highest rate of heart disease and the 4th-highest consumption of A1 milk. Dr Laugesen said much French milk came from brown cows such as simmentals, which produced less A1, while the Japanese drank little milk. He said more research was needed comparing people with heart disease and their consumption of A1 milk. Dr Laugesen believed New Zealanders should have the choice of A1-free milk. But he said smoking, diets high in saturated fats and lack of exercise were all significant contributors to heart disease.
In the journal's editorial Professor Robert Beaglehole, of the World Health Organisation, and Professor Rod Jackson, of the Auckland Medical School, said the greatest short-term gains in controlling heart disease would still come from existing knowledge. But they called for further research on A1, given its relatively high levels in New Zealand milk and the importance of the dairy industry. It would be reasonably straightforward to change New Zealand dairy herds to produce only A2 milk if that was necessary, they said. "The intervention would require no change in behaviour by New Zealanders and could be implemented with little personal difficulty for substantial health gain."
Dr Diana North, medical director of the Heart Foundation, said the "potentially exciting" research clearly showed an association between A1 beta-casein and heart disease. But she agreed more research was needed to establish whether the protein actually caused the diseases. Biotech company A2 Corporation, which is a partner with Fonterra in a patent for non-diabetogenic (non-A1) milk, said the research confirmed findings of earlier studies. A2 Corporation chief executive Dr Corran McLachlan said A1 milk was probably the most powerful risk for heart disease yet identified. Dr McLachlan claimed some farmers wanted to supply A2 milk but Fonterra was stopping them. Supermarkets were also reporting a demand for A2 milk. He said A2 Corporation was in a legal dispute with Fonterra over whether warnings should be placed on A1 milk. The company also wanted Fonterra to disclose all its information on links between A1 milk and health risks. Last September, Fonterra said it had studied the effect of A1 milk on heart disease and found no link. Yesterday, the company declined to comment on the new research.
A Ministry of Health spokesman said the research was of interest and would be looked at closely. The ministry and the Food Safety Authority are expected to make a joint statement about the research today.
Source: nzherald.co.nz 24 January 2003
For over 5 years, Dr Corran McLachlan worked full-time on research into the correlation between beta-casein A1 consumption and heart disease. He contacted government organisations and universities all over the world. Statistical data was collected and analysed from 16 countries, including the UK, France, West Germany, Iceland, New Zealand, USA, Canada, Finland and Ireland. In each case there is a very strong correlation between beta-casein A1 consumption and heart disease, leading to the conclusion that beta casein A1 may be one of the most powerful risk factors associated with heart disease that has ever been recorded. Dr McLachlan believes that A1 milk is more likely to break up in the bloodstream and cause damage to the arteries. Dr McLachlan then filed his own patent claiming the link between beta-casein A1 and heart disease and other illnesses, also including a method of producing pure A2 milk which does not have this problem.
A1 or A2 milk? Where's the Research?
by Tim Hunter
The following is a summary of New Zealand government-sponsored research, clinical or otherwise, into A1 and A2 milk since July 2004:
Why July 2004? That was when Professor Boyd Swinburn, public health specialist at Deakin University in Melbourne, published a review into existing research on A1 milk and human health risks such as diabetes and heart disease. Swinburn's study, for the New Zealand Food Safety Authority, said the need for further research was "abundantly clear". Because of vested commercial interests, he said, "the appropriate government agencies have several important responsibilities in this matter: to support further research in the area (especially clinical research); to clearly communicate the state of knowledge and judged risks to the public; and to take specific actions to promote and protect the health of the public. The first two actions are clearly warranted based on the evidence to date."
Most of the milk we drink contains A1 beta-casein, a kind of protein commonly produced by the Friesian cattle breed. The other kind, A2 beta-casein, is more common in Jersey cows, for example. Goats' milk is all A2, as is milk from native Asian cows. One theory, supported by several research studies but by no means proven, is that A1 milk increases the risk of diabetes and heart disease. Swinburn's advice that more work was needed seems unequivocal, yet none was done.
The Health Research Council, which manages government investment in public good health research, has funded no studies relating to A1 and A2 milk, ever. Auckland diabetes specialist Professor Bob Elliott sought Health Ministry approval to fund a repeat of a potentially important animal study, which was later found to be fatally flawed by contaminated feed supplied by the NZ Dairy Research Institute. The ministry declined to meet the several hundred thousand dollar cost of the project. The ministry has since approved no further studies and cites the Food Safety Authority as the relevant body, although the FSA has also neither promoted nor funded any scientific follow-up to Swinburn's report.
Food Safety Minister Lianne Dalziel told the Sunday Star-Times on Thursday: "NZFSA has no mandate or facility to sponsor clinical research itself, which is why no further research was undertaken despite the recommendation in the Swinburn report. When I was briefed on the A1/A2 milk issue late last year, I felt this was a gap in the process. I believe that any such recommendation should be assessed by health or science and research officials and a decision made about whether further action is required." Two weeks ago, Dalziel announced a further review of existing scientific studies. This will be done by the European Food Safety Authority after inquiries by New Zealand officials discovered it was also interested in the subject, which neatly flicks the burden of responsibility and funding on to the Europeans.
Dr Murray Laugesen, a public health scientist and co-author of research relating to A1 and A2 milk in 2003, said Dalziel's announcement would achieve little. "OK, so they do another review of the existing evidence that won't get you anywhere at all. It's like washing the same clothes twice. The main purpose seems to be to get the NZFSA off the hook, to get clarity where clarity is not possible."
The EFSA's conclusions are not expected before the end of this year, but already their value is in doubt. In a January letter to EFSA head Catherine Geslain-Laneelle in Parma, Italy, her New Zealand counterpart Andrew McKenzie advised her to note the Health Ministry's view that "further research, especially independent human trials and animal experimental studies, will be required to definitively identify A1 beta-casein in milk as a risk factor in disease". Whether the EFSA will come up with definitive results from its review is unclear since so little science has been done in the interim.
But if Geslain-Laneelle, an experienced bureaucrat who speaks 3 languages, needed guidance, McKenzie advised she read Devil in the Milk, a review of A1/A2 science by Lincoln University professor Keith Woodford. It was good advice. Woodford's book, published in September, awakened the sleeping giant of controversy over A2 milk with a collection of evidence from more than 100 research papers (Swinburn had reviewed 38). The issue goes back to the early 1990s, when Elliott got together with dairy industry scientist Dr Jeremy Hill to examine potential links between milk consumption and Type 1 diabetes. Their hypothesis was that the culprit could be in the beta-casein proteins found in milk. Elliott and Hill's study of international data, funded by Fonterra predecessor the New Zealand Dairy Board, found that the incidence of diabetes and heart disease was correlated with consumption of A1 milk. The correlation is acknowledged by scientists of all stripes to be unusually strong but it does nothing to prove that A1 milk actually causes these health problems. The latter point is what several scientists have been working on ever since. The evidence to date, as presented by Woodford, suggests it's worth persevering with the effort.
Fonterra did enough work in this area to own important patents around A2 milk and related genetics. The other main owner of patent rights is New Zealand's A2 Corporation, which acquired them from the Child Health Research Foundation a funder of Elliott's research. However, Hill and Fonterra have since become sceptical of the A2 hypothesis and the giant co-op no longer funds research exploring it. The dairy industry's position is understandably awkward. If its research found evidence of links between A1 milk and disease, it would be faced with marketing a compromised product while simultaneously promoting its alternative, A2.
Then there is the thorny question of legal risk. If A1 was subsequently shown to be a factor in diabetes, for example, and Fonterra had known about it, the potential costs of legal action would be truly eye-watering. Furthermore, any general loss of confidence in milk as a source of nutrition could have a significant financial impact on dairy companies and by extension on New Zealand. Fonterra is so big and so important to this country's economy that the repercussions would be felt far and wide. So its position is naturally one of careful risk management note the science is inconclusive, monitor developments but do nothing to promote further research.
A comment from Fonterra CEO Andrew Ferrier exemplifies this view: "Whenever any new science (both good and bad) about milk and its components is presented we carefully review that science. We have done this on a number of occasions on this issue and found no cause for concern." Behind the scenes, however, dairy farmers may be heeding Swinburn's advice to consider changing the composition of their herds. Thanks to the industry's work, it is now a relatively simple matter to classify cattle according to A1 and A2 genes.
As Swinburn noted, "a New Zealand dairy herd that produced predominantly A2 milk would have no apparent negative health effects and could potentially have significant population benefits if the A1/A2 hypothesis proved to be correct". According to cattle genetics specialist LIC, about one million of New Zealand's 3.9 million cows are now A2. The farmer-owned company does not have a view on whether A1 or A2 traits are desirable but said in its spring newsletter that it could respond to market demand for A2 semen within 48 hours. When the Star-Times spoke to LIC in September its view was that there was sufficient genetic variation within A2 bulls to avoid losing other desirable traits. The New Zealand herd could be almost entirely A2 in 8 to 10 years, it said, and the shift "could be done without compromising other genetic qualities".
Last week LIC's general manager of genetics, Peter Gatley, said the picture was not quite so simple. "There is always a trade-off," he said. "Any time you require a certain trait you have to let go other genes. As we restrict the total gene pool to the 3rd [with A2] you immediately diminish the gene pool. A large diverse gene pool is always a good thing and to make any move to restrict the gene pool is a major step."
So although the move could be made, there is a good reason not to do it if the benefits are uncertain. In terms of New Zealand's fresh milk supply, milk from one million A2 cows is more than enough to meet local needs if there was any demand for it. Collecting it would require some reorganisation, however, because the animals tend not to be gathered into complete herds.
This country's biggest marketer of A2 milk, Hamilton-based Ridge Natural Foods, has two of its own A2 herds and milks about 180 cows year round. One other local farm supplies Ridge but the company says it needs more. There are several other herds wholly or nearly 100% A2, but their milk is supplied into Fonterra's pool and not separately marketed. The question, then, is not whether anything can be done if A1 milk turned out to be a problem there is a clear path towards a solution. The question is whether there is a problem.
A1, A2: The Difference
Source: stuff.co.nz 2 March 2008
Wake Up, I'm Fat!
by Camryn Manheim
I was doing speed in the morning to get through the day and Valium at night to get to sleep. Speed in the morning to get through the day and Valium at night to get to sleep.
Speed in the morning. Valium at night.
Speed in the morning. Valium at night.
Speed. Valium. (Pant, pant.)
Speed and Valium... It's got a certain rhythm, but you can't dance to it.
Source: Anderson Valley Advertiser, Boonville, California
Being Overweight Wrecks Women's Lives
Probably nothing in the world arouses more false hopes than the first four hours of a diet.
- Dan Bennett
London - Almost 60% of overweight women in Britain say they would not allow their partner to see them naked, a body image survey showed on Thursday. Despite the current craze for curvy figures, too much body fat has a devastating impact on every aspect of a woman's life, Slimming Magazine said. The magazine's annual survey of 2,000 women, all of whom regarded themselves as overweight, revealed that more than 80% believed their excess weight was damaging their health, ruining their sex lives and holding back their careers.
"Overweight women don't want to be stick insects, they just want to fall within an average weight range and feel healthier, sexier and more confident," said Alison Hall, the magazine's editor. What the media is talking about at the moment is that curves are back. People want to be more like Catherine Zeta-Jones and Jennifer Lopez, and that's great. But we're into making sure women are at a good weight for their height."
The survey showed 76% of women believed overweight people were seen as being less intelligent than slim people. Some 80% thought it was easier for slim women to climb the career ladder. Government statistics show that more than half the British population is now overweight, but 81% of women received no guidance from their general practitioners, the survey said.
National Health Service spokeswoman Gail Robinson said the government did not record information about dieters seeking advice from their doctors. "Anyone considering reducing their weight should, in the first instance, discuss it with their GP," she said.
Hall said a woman's body mass index, a relationship between height and weight, determined whether or not she was overweight. She scoffed at the idea that women should be taught to accept their excess fat. "If they're that unhappy about all those areas of their lives, then they would want to do something about it," she said.
Source: reuters.com 9 November 2001 © Reuters 2001
Source: Funny Times November 2000
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