TCS Daily

To Do List

By Sandy Szwarc - August 6, 2003 12:00 AM

What separates those of us who are the healthiest from those who aren't is not what we look like, how much we weigh or what our measurements are. It's what we do.


Svelte people aren't necessarily healthy just because they match how we think healthy people should look; likewise, fat people aren't necessarily unhealthy just because they don't.


Lifestyle choices


Remember that early study that found lifestyle factors predictive of early mortality? Well, there have been hundreds like it, such as the 10-year SENECA Study published last year in the American Journal of Epidemiology, that have consistently shown the same things -- three major lifestyle factors determine a healthy life:


·         Smoking

·         Quality of diet

·         Physical activity


The Truth About Obesity
The Skinny on Fat
The Diet Problem
Dying to Be Thin
The War on Fat's Casualties
To Your Health
Where's the Epidemic?
To Do List
A Simple Plan
Mikey Doesn't Like It

"All the evidence suggests that as far as one's health is concerned, lifestyle is far more important than body weight," Glenn Gaesser, Ph.D., associate professor of exercise physiology at the University of Virginia and a Fellow of the American College of Sports Medicine (ACSM), said. "This goes for longevity as well."


That point was illustrated in the 1997 DASH clinical trial published in the New England Journal of Medicine (NEJM). The trial proved high blood pressure could be effectively lowered by simple changes in the diet, without losing weight. Just eating more fruits and vegetables and low-fat dairy products worked comparably to medicines, but without the side effects.


It's hard to find a healthful reason to smoke. Smoking doubles our risk of a heart attack and puts us at two to four times greater risk for sudden cardiac death as people who don't smoke. The most renowned and comprehensive study on cancer causes, published in 1982 in the Journal of the National Cancer Institute by epidemiologists Sirs Richard Doll, M.D., D.Sc., D.M., and Richard Peto, M.D., F.R.S., at Oxford University, found tobacco causes about one-third of U.S. cancers; a following third by a poor diet.


What is a good diet?


The first step to eating healthfully is to stop obsessing about it. Eating well is measured over days, not fretting over every morsel that passes our lips. There is no one perfect diet. There are no miracle foods, just as there are no forbidden foods. When we hear otherwise, we know we're being sold. Everything can and should be part of a healthful diet ... all together now ... in moderation!


Dietary ideologies are rampant and there will probably always be disagreements. You can find a study to support just about any dietary dogma you care to follow, but in the end the strongest evidence indicates no one food or diet is the secret to health and longevity. "It appears to be a combination of ingredients and not one food," David Klurfeld, Ph.D., professor and chairman of the Department of Nutrition and Food Science at Wayne State University, editor-in-chief of the Journal of the American College of Nutrition and Nutrition News Focus, said in the May 14 issue of Nutrition News Focus.


The soundest data time and again comes down to one simple, common sense message: Eating the largest variety of foods possible, in moderation and without excluding any food or food group, is the  diet that contributes to the healthiest and longest life.


"There is little scientific controversy on this," Klurfeld wrote in the July 22, 1999, Nutrition News Focus. The guideline to "eat a variety of foods" in the U.S. Department of Agriculture's Dietary Guidelines for Americans is one of the more important ones, he noted.


What all the healthiest diets have in common is that they include lots of different fruits and vegies; whole grains; a healthy mix of meats, poultry, fish, eggs and dairy; with a reasonable balance of indulgences. Most of us have a pretty good idea which foods are good for us, but we may not realize just how important the quality of our diet is.


Fruits and Veggies. Those who don't eat many fruits and vegetables have the highest risks for heart disease, stroke, high blood pressure and cancers, Stephen Barrett, M.D., vice president of the National Council Against Health Fraud, scientific advisor to the American Council on Science and Health (ACSH) and recipient of the FDA's Special Citation Award for Public Service in fighting nutritional quackery, wrote in Antioxidants and Other Phytochemicals: Current Scientific Perspective.


There are hundreds of studies, all  amazingly consistent, showing that those who eat the most fruits and vegetables -- a variety of deeply-colored selections -- have half the cancer rate for practically every type of cancer than those eating two or less servings a day, Klurfeld wrote in a recent column for ACSH. They live longer, too, according to Bruce Ames, Ph.D., biochemist at the University of California at Berkeley and member of the National Academy of Sciences, in the Spring 2000 issue of Berkeley Science Journal.


Produce, like all foods, is loaded with hundreds of good things, many of which haven't been identified, that appear to work together to give us health benefits. Popping supplement pills doesn't do the same thing, and in fact, some may be harmful. Like Barrett and Klurfeld, the Nutrition Committee of the American Heart Association (in their 1997 Statement for Healthcare Professionals) summarized the research on phytochemicals and other nutrients in foods and recommended a balanced diet of a wide variety of fruits and vegetables and grains as the most prudent way to ensure optimum intake.


Animal proteins. But, this doesn't mean studies, comparing similar populations in terms of lifestyles and amounts of fruits and vegetables consumed, demonstrate we need be vegetarians, either. As Klurfeld noted in the Sept. 10, 2002, Nutrition News Focus, the benefits attributed to vegetarian diets are invariably attributed to healthier lifestyle factors. And the scares over the link between red meat and cancer have been repeatedly challenged. Scientists have even found red meat offers plenty of healthful benefits. Lean meats, poultry and seafood are some of our best sources for essential B vitamins and certain minerals, and they appear to have a significant role in lowering our risk for heart disease. Their protein helps build strong muscles and appears to improve bone density in all ages, according to the Rancho Bernardo Study  published in the American Journal of Epidemiology in 2002. It's also vital for our immune system and healing, and for proper insulin levels.


Milk. We never outgrow our need for milk, noted Frances M. Berg, M.S., in Women Afraid to Eat-Breaking Free in Today's Weight-Obsessed World (Healthy Weight Network, 2000). Those who don't drink milk are advised to take special care to get enough calcium, she said. Calcium isn't just essential for strong bones and teeth in growing children. Repeated studies have demonstrated that grown-ups -- both men and women -- may have the most to gain by getting enough dairy products: less obesity, strikingly lower blood pressures, less risk for heart disease and strokes, fewer kidney stones, less periodontal disease, and lower risks for certain cancers and osteoporosis.


Grains. Whole grains and grain products - such as breads we've all wrongly come to fear will make us fat --  supply folic acid, a B vitamin that prevents spinal cord birth defects. It also halves our risk of heart disease and stroke by lowering homocysteine which damages the lining of the blood vessels and may contribute to plaque build-up. Whole grain foods are also associated with a reduced risk for type-2 diabetes, according to a 10-year study published in the March issue of the American Journal of Clinical Nutrition.


Indulgences. Along with the need for all of us to stop being preoccupied with what we and others eat comes allowing indulgences. We've already learned in Part Two not to fear sweets, fat and fast food in moderation. We can also stop worrying about a drink with dinner. Compared to nondrinkers, decades of sound research has shown those who consume small to moderate amounts of any alcoholic drink have lower death rates and a 30- to 50-percent lower risk of heart disease. Alcohol increases the protective HDL-cholesterol and may reduce blood clotting. Its ability to improve vascular health affects our brains, too. A prospective study in four U.S. communities, published on March 19 in the Journal of the American Medical Association (JAMA), even found light drinking was associated with a reduced risk of dementia as we age.


Eating healthfully


Eating healthfully means developing a healthy attitude towards food, according to virtually every clinician working in the field of obesity and eating disorders. The first step is to stop obsessing and give ourselves permission to enjoy food and nourish our bodies. All of us -- it's not just a right of those genetically slender. Many of the world's nutritional guidelines, such as England's, begin with the advice, "enjoy your food" or the Japanese, "make all activities pertaining to food pleasurable ones." We eat for nourishment, health, energy, and well-being, but also for pleasure and socializing, says Frances Berg, M.S., editor-in-chief of the Healthy Weight Journal.


Second, it's important to not let food control our lives and be used to judge ourselves or each other. Eating a certain way doesn't make someone a better person, and moralizing over what we eat or don't eat isn't healthful for anyone. Our self esteem shouldn't be tied up with what we eat or what we weigh, said Carol A. Johnson, M.A., a research sociologist and certified therapist specializing in issues of size and weight, president of Largely Positive, and author of Self Esteem Comes in All Sizes (Gurze Books, 2001). Her self-esteem makeover is a tool used by many women and girls to get their self-esteems back into shape.


The next step to a healthier relationship with food, most clinicians believe, is to eat normally. In our society's fixation with thinness, it can be hard to avoid diets and dietary extremes. Most of us have controlled our eating for so long, we literally don't know how to eat normally anymore and have to relearn to trust our bodies and our appetites. Eating normally relieves us from preoccupation with food, dieting and our weight, and frees us to pursue LIVING. Ellyn Satter, M.S., R.D., a clinical therapist specializing in eating disorders and developing sound approaches to eating, defined "normal eating" in her book, How to Get Your Kids to Eat ... But Not Too Much (Bull Publishing, 1987). Her definition is used by most health care clinicians today.


The third lifestyle factor


When we're confronted with mountains of studies that show correlations between fatness and health problems, we've learned that doesn't prove cause. After weight-loss diets, which we've seen to be dangerous, the most critical factor most studies don't account for is ... [drum roll, please] ... physical activity or exercise. When fitness is taken into account, weight-related health problems almost always disappear.


Being sedentary is an independent risk factor for poor health and high mortality, regardless of body weight. Sedentary lifestyles are linked to heart disease, cancer, type-2 diabetes and a plethora of other health conditions, according to the 1987 study in JAMA, "Body weight and longevity: a reassessment," led by JoAnn Manson, M.D., at the Department of Epidemiology, Brigham & Women's Hospital in Boston. Likewise, those who are active or fit can virtually eliminate most all the health problems typically associated with obesity, no matter what they weigh!


Unfortunately, for some 40 years we've been told that exercise is all about our weight, and we never hear the most important message that could really help us. According to a National Health Interview Survey report published in the October 27, 1999, issue of JAMA, most physicians don't bother counseling their patients to exercise. Misdirected advice goes to dieting instead. Yet, multiple studies published in NEJM have found people are much more likely to stick with a program of physical activity than meet weight loss goals. Sadly, women who typically aren't eating enough calories to begin with, rarely have the energy to exercise and are, not surprisingly, the most sedentary. Most girls develop sedentary lifestyles by age 15 as they, too, fervently watch what they eat. Most fat people have been deterred from active lives out of shame or fear of ridicule, and made to believe that it's pointless to exercise unless they lose weight.


In fact, most reasonable changes in exercise and diet won't change body weights much at all,  Gaesser said. "People will lose little more than 10 or 15 pounds, most just five to seven."


But weight loss isn't the end goal of exercise. At the American Enterprise Institute's June conference, "Obesity, Individual Responsibility and Public Policy," Gaesser said, "An abundance of epidemiological evidence shows a 20 to 70 percent reduction in all-cause mortality with increased fitness or physical activity, independent of BMI."


In other words, it's much more important to be fit than trim. "There's too much focus on BMI and body weight," said Steven Blair, P.E.D., president of the Cooper Institute in Dallas. Exercise does a lot of good whether you lose weight or not. "Fitness is a more powerful predictor of mortality than BMI," he said.


The Aerobics Center Longitudinal Study (ACLS), an ongoing clinical follow-up study of 25,389 men seen at Cooper from 1970 to 1989 has found that those who improved from low to moderate or high fitness levels cut their overall mortality rates in half, compared with those who didn't exercise. Obese men who were fit had lower risks of dying than normal weight or thin men who were unfit. Studies on women at Cooper Clinic published last year in the June issue of Obesity Research found similar exercise benefits. Those women reduced their risk of dying from all causes by 43 to 52 percent, regardless of their BMIs.


Yes, you can be fat and fit.


Exercise does a body good


Cooper Institute's studies are just a part of a body of solid evidence showing the health benefits of exercise, I-Min Lee, MBBS, MPH, Sc.D., of the Harvard School of Public Health noted. The National Institutes of Health (NIH) 1995 consensus panel on Physical Activity and Cardiovascular Health summarized the research and the growing consensus among fitness experts. According to them, the National Center for Chronic Disease and Prevention and Health Promotion, Centers for Disease Control, and the American Heart Association, the benefits of regular exercise‚ aerobic, flexibility and strength, include:


·         Lower mortality rates.

·         Lower cardiovascular disease and high blood pressure.

·         Reduced triglyceride and HDL-cholesterol levels.

·         Lower risks for colon cancer.

·         Lower risks for type-2 diabetes,

·         Fostered peak bone mass.

·         Favorable changes in body fat distribution.

·         Relief of symptoms of depression and anxiety.


Exercise may not appreciably change our body weight, but it does favorably change our body's composition, lowering the amount of body fat and increasing lean muscle, Jack Wilmore, Ph.D.,  wrote for the President's Council on Physical Fitness and Sports.


A 2002 study of the National Health and Nutrition Examination Surveys found these changes were significantly related to lowered mortalities. Looking at changes in body fat, the just-released findings of the five-year clinical trial STRRIDE (Studies of Targeted Risk Reduction Interventions through Defined Exercise) at Duke University, funded by NHLBI, found low-intensity exercise prevented the notable increases in unhealthy visceral fat seen in sedentary people (women proportionately accumulate twice the amount as men) and enabled them to lower levels by 8.6 percent after just eight months. Increasing the amount of exercise, not the intensity, saw the greatest benefits, according to Cris Slentz, Ph.D.


Everyone can enjoy the benefits of exercise. Multiple studies published in JAMA and International Journal of Obesity have found exercise helps prolong life even in those with other health risk factors, such as high blood pressure, high cholesterol levels, glucose tolerance, and smoking. It's never too late to start. A 12-year prospective study of 9,500 elderly American women published this year in JAMA, found those who increased their physical activity to just over a mile of walking a day, reduced their risk of dying from all causes by 48 percent, their risk of dying from heart disease by 36 percent and cancer by 51 percent.


It doesn't take that much exercise to make someone fit, Blair said. The recommendation of the American College of Sports Medicine (ACSM), CDC, and NIH of just 30 minutes a day of moderate exercise, such as brisk walking, on most days can do the trick.


Walking is cheap, easy, low-impact, and something most of us can do throughout our lives, no matter what shape we're in. Plus, we can walk when (during TV commercials, after dinner or during our lunch hour) and where (the mall, the stairs of our apartment or around the block) we please. Not surprisingly, the Cooper Institute has found walkers are most likely to stick with exercise than those in structured exercise programs or sports. And that's the point -- to make being active a lifelong habit.


Go lite! advocates the American College of Sports Medicine, and do anything that gets you moving and that's fun for you. If gardening, salsa dancing, bicycling, swimming, or playing hopscotch is more your thing -- go for it. If you prefer to ride your exercise bike while enjoying a favorite television show or novel, or exercising to your favorite tape, in the privacy of your living room -- go for it.


Some sports medicine doctors believe more exercise may provide greater gains in certain people, namely naturally-athletic body types. But, as of yet, research is unclear of how long, frequent or intense it's best to exercise, and it may prove different for each of us. Increasing intensity has to be weighed against the increased injuries and diminished compliance, says Robbie Parker Bed, Ph.D., research fellow at Children's Hospital Institute of Sports Medicine, Children's Hospital at Westmead. For now, the unanimous advice is one of moderation.


The Good News


Bottom line in all of this is good news. Understanding that our weight says nothing about our health or our self-worth, eliminates the negative judgments we place on ourselves and each other. It's not hopeless, nor are we failures, just because we naturally come in all shapes and sizes. Remember, we've come to think this way because we've been sold.


Once we can get past those trying to sell us on the myth that we should all want to, or that we all can, be svelte Ms. or Mr. Americas by following a special diet or exercise regimen, we can take charge of our own bodies and our own health. The differences between us melt away. All of us can be healthy because it's what we do that counts.


Friday: What obesity experts believe we should do as individuals, healthcare providers, and as a nation to solve the obesity crisis.


© 2003 Sandy Szwarc. All rights reserved.

TCS Daily Archives