Uh oh.  There may be trouble in energy balance land. 

In the Stand Up and Eat blog we have touted the energy (i.e., calorie) burning benefits of all different types of movement.  Getting people to burn more calories to balance out the calories they eat is a way to prevent weight gain.  With the epidemic of obesity growing unabated, that’s a good thing.

But a recent study published in the American Journal of Clinical Nutrition shows that exercising may make it a bit harder to lose weight  - for some people¹.  It turns out that getting active may affect appetite – for some people.

In a study conducted in Australia, researchers had 58 overweight men and women exercise to burn 500 calories a day, five days a week for 12 weeks.  They exercised in a lab so the scientists could be certain that they burned the right number of calories each session.  Participants also completed questionnaires about hunger and appetite throughout the study. 

At the end of the 12 weeks, 32 of the subjects (responders) lost a significant amount of weight.  But strangely enough, the other 26 (nonresponders) lost only a small amount of weight.  As it turns out, the nonresponders  increased their daily calorie intake whereas the responders did not.  Why?

Analysis of the hunger and appetite data suggest that exercise caused an increase in nonresponders’ hunger levels.  This probably contributed to them eating more during the study and ultimately, their lower weight loss compared to the responders. 

While we have not been wrong to promote physical activity as a way to combat overweight and obesity, this study points out that people respond to exercise differently.  And right now, scientists don’t know how to determine for whom exercising might increase appetite.  So keep the following in mind:

• Exercise and physical activity is good for you regardless of what you weigh now or if you lose weight. 
• Some people may lose a lot of weight from exercise and others may not.
• If you start an exercise program you will likely lose some weight but perhaps not as much as you would have expected.  This means you need to pay especially close attention to modifying your diet to reduce the calories you eat.
• Pay attention to your hunger levels during weight loss attempts.  Satisfy any increased hunger feelings with low-fat, low-calorie foods such as fruits and vegetables.

Does your hunger level increase when you exercise?  If so, tell us how you cope with this.

¹ King NA et al.  Dual-process action of exercise on appetite control:  increase in orexigenic drive but improvement in meal-induced satiety.  American Journal of Clinical Nutrition.  2009;90:921-927.

With so many demands this time of year, it is important to re-evaluate what you value and how you will keep these things at the top of your "to do" list. Think about your most important values. Some examples might be health, family, energy, work, weight loss, financial stability, or physical fitness. Then, take a few minutes to think about how you actually spend your time. On a piece of paper jot down the activities that keep you busy in the morning, mid-day, and evening. Next, compare how you spend your time to your list of values. Are you spending your time doing things that matter most to you? If not, you're probably feeling frustrated that you're not doing activities that you really care about. What could you do to replace some lower priority things with ones that are higher priority?

One time-management technique that can help you during the upcoming hectic holiday month is to make a list of the activities you want to accomplish each day. On a calendar or piece of paper, create three columns and title them, "Must Do," "Hope to Do," and "Do if I Have Time." Make sure that the things you value most are included in your "Must Do" list. Read over this list and determine whether it is realistic. After all, there's only so much you can accomplish in a day. A list of "to do's" that is too ambitious will only make you frustrated and discouraged.

People who are successful at calorie balance have something in common: they make physical activity and healthy eating a priority and something they value. Use this handout to find ways to include physical activity into each of your values.

In earlier blogs, we highlighted physical activity recommendations, resources, and programs that for seniors and young children from infants to pre-schoolers. We now want to bring you up to date on similar resources for elementary and middle-school age kids.  Happily, there is a bunch of stuff because this is an important age for kids to develop healthy habits that combat obesity all life long.

Physical Activity Recommendations

But before we go there, let’s take a look at how physical activity should fit into the lives of children ages six through twelve.  According to the American Academy of Pediatrics¹, elementary children should:

• Enjoy free play
• Begin emphasis on fundamental skill development (dance, jumping rope, throwing, ball dribbling, etc.)
• Participate in organized sports that have flexible rules and brief periods of instruction.  The focus should be on having fun rather than winning.

With regard to being physically active, middle school-aged kids can:

• Focus on learning the enjoyment of movement with family and friends
• Increase skill development and begin learning tactics and strategies to enable participation in sports, if desired
• Become involved in contact sports being careful that teams are comprised based on maturity (i.e., size) and skill rather than chronological age
• Begin weight training but only under supervision and with light weights using many repetitions instead of heavy weights with fewer repetitions.

Resources and Programs

In keeping with these recommendations, there are many wonderful programs, web sites, and materials that can help engage youth – yours or others in your community – in becoming a physically active kid.   We have introduced some of them to you in earlier blogs:

Take 10! – an age-specific curriculum to get children moving (and learning) for 10-minute mini-workouts

Discover the Forest – a campaign by the National Forest Service to promote outdoor play

But here are a few more:

BAM! – stands for "Body and Mind" and is a web site for kids age 9-13 to learn about healthy lifestyle choices, including physical activity.  The focus is on presenting topics of interest to this age group via games, quizzes and other interactive features.

Kidnetic – is an active living and healthy eating web site that engages children with parents/caregivers in a variety of high-energy games including one in which the child creates their own dance by self-selecting a series of dance moves and music.  Who wouldn’t want to get up and boogie to their own choreographed masterpiece?

We CAN! – an acronym for Ways to Enhance Children’s Activity and Nutrition, We Can! provides a centralized place where parents, caregivers, health professionals, journalists, and other partners can access information and resources to promote healthy weight in kids.

Childhood is a critical time to learn active living and calorie buring habits.  As a parent, caregiver, or community member, you have a responsibility to help children develop a healthy lifestyle foundation.  But you don’t have to reinvent the wheel.  Check out these resources and let us know which you think are the best.

1 American Academy of Pediatrics Council on Sports Medicine and Fitness and Council on School Health.  Active healthy living:  Prevention of childhood obesity through increased physical activity.  Pediatrics.  2006;117:1834-1842.

The debate over cutting fat or carbohydrate calories for successful weight loss and weight loss maintenance continues. While some people say an eating plan filled with low-fat fruits, vegetables, and whole grains is best for people trying to lose weight, others argue that eliminating excess carbs (breads, added sugars, and even fruits and dairy) is key. Well, a new study published in the Archives of Internal Medicine adds another twist by identifying a certain diet with improved mood in the short and long term.¹  

Researchers randomly assigned about 50 overweight/obese adults to a calorie-restricted very-low-carbohydrate, high-fat diet and another 50 or so overweight/obese adults to a calorie-restricted high-carbohydrate, low-fat diet for one year. Changes in body weight, mood and well-being, and cognitive functioning (thinking, learning, and memory skills) were measured throughout the study. After one year weight loss was the same in both groups (about 30 pounds), but improved mood which was originally found in both groups lasted to one year only in people following the low-fat diet. The researchers suggest that some aspects of low-carbohydrate diets may have detrimental effects on mood over time like: the social difficulty of adhering to a low-carbohydrate plan, which is counter to the typical Western diet full of pasta and bread; the prescribed, structured nature of the diet; or effects of protein and fat intake on brain levels of serotonin, a neurotransmitter related to psychological functioning.

As we've mentioned before on this blog, the real indicator of success of any "diet" is whether it can be maintained for a lifetime. Short-term changes to eating habits may lead to weight loss, but the weight will be regained if the eating habits aren't part of your new lifestyle. When you cut calories pay attention to your mood and how the foods you eat affect your mood. Do you find that an eating plan with more low-fat (vs. low carbohydrate) foods is easier to stick to? Do moderate amounts of breads, fruits, vegetables, and low-fat dairy products keep your mood at an even keel? If so, a low-fat eating plan is probably best for you because these are all things that will influence your long-term success with calorie control.

¹Brinkworth, GD. (2009). Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Arch Intern Med, 169(20), 1873-1880.

We posted an earlier blog to remind people that if you don’t have time to get in a 30-minute workout, you can still meet the current health guidelines by doing three, 10-minute mini-sessions.  We want to share with you a program that can help you get your kids (and you!) moving – and learning – in short bouts. 

Take 10! Program

The Take 10! program was developed with elementary teachers in mind.  The idea was hatched because despite the many health benefits of physical activity, many schools had cut physical education classes.  “There is not enough time” or “We have to cut the budget somewhere, and PE is not academically essential” are reasons often given for making the cuts.  So the International Life Sciences Institute (ILSI) developed Take 10! to:

• Combat childhood obesity
• Help children meet the recommended daily physical activity requirements
• Reduce sedentary time during the school day
• Help children develop lifetime healthy habits

The Take 10! activities are safe and age-appropriate games and tasks that get kids moving for 10 minutes.  They are great for teachers because they don’t require a lot of prep time and they integrate academic learning objectives (math, social studies, science) into the activity.  Click here to see a Take 10! activity that teaches counting while using an imaginary jump rope. 

But Take 10! can also be used by parents, grandparents, and other caregivers  as a way to help get their kids moving and burning calories.  It’s perfect for bad weather weekends, school breaks, and summer vacations. 

Take 10! Kits

There are six age-specific kits (kindergarten through grade 5).  Each kit provides a detailed manual that includes over 35 different activity cards to guide you in doing the activities.  There are also worksheets that the child can complete to reinforce the learning objective for the activity.  And you can log the activities you do over time with the tracking poster.   Here’s a link to sample materials for different age groups.  Check out the videos here to see Take 10! in action.

With the holidays coming, the $82 you spend on a Take 10! kit is about the same as you would spend for a Nintendo Wii Fit program.  But you get over 35 activities and worksheets that that will also help your child learn important concepts in science, math, health, language arts, and social studies.  That’s something the Wii Fit can’t do.

Check out the Take 10! program and let us know what you think.

Researchers recently compared the behaviors and home environments of 167 weight loss maintainers (people who had lost at least 10% of their maximum body weight and kept it off for 5 or more years) to two groups of treatment-seeking obese individuals (one Caucasian and another African American) in an effort to understand what distinguishes the two groups. What did they find? Weight loss maintainers:

• expended many more calories through physical activity each week than the obese individuals.
• had more dietary restraint (efforts to limit food intake) than obese individuals.
• had more home exercise equipment than obese individuals.
• had less TVs in their home than obese individuals.
• had less high-fat foods and more low-fat foods (fruits, vegetables, low-fat dairy) in their home than obese individuals.

It makes sense. Calorie balance is easier when set yourself up for success. Keep a step counter, a pair of tennis shoes, and some exercise bands/tubing at your bedside instead of a TV. You'll be more likely to do something physically active when you wake up in the morning. Keep fresh fruit and vegetables on your kitchen counter and in the front of your refrigerator instead of chips and cookies. You'll be more likely to snack on them when you get home from work or are making dinner. The more opportunities you have for healthy behaviors the more likely you'll make the healthier choice.

To learn more weight loss strategies from successful weight loss maintainers check out the National Weight Control Registry at: http://www.nwcr.ws/default.htm.

¹ Phelan, S. (2009). What Distinguishes weight-loss maintainers from treatment-seeking obese? Analysis of environmental, behavioral, and psychosocial variables in diverse populations. Ann Behav Med, doi: 10.1007/s12160-009-9-9135-2.

Note to the reader:  This blog provides detailed fitness information. 

Our chance for improvement is sometimes called a “Window of Adaptation.” When you are just starting something you have a very large window of adaptation. When you are new to something you are going to see big improvements. But as you make improvements your window of adaptation becomes smaller, this analogy holds true for fitness.  So when you become more trained and you get closer to your genetic potential changes are harder to see.

So when your window becomes smaller, training efforts need to be targeted and intentional to see improvement. Make sure you consider your exercise selection, exercise progression, volume changes and even rest intervals.

Rest intervals between sets determine the amount of energy stores that are re-synthesized. It takes more time for some energy sources, such as ATP-PC, to become restored than others. More rest between sets is needed when working absolute strength versus dynamic strength, but recent research has shown an interaction of the window of adaptation and rest.

Research found that shorter rest intervals can be effective for strength increases in less trained individuals, muscles or exercises. New areas or exercises, or those coming off of a break were shown to need shorter rest intervals between sets.  And longer rest intervals were shown to “become increasingly important as the potential for continued strength increases diminishes over time for a given exercise.”1

As you begin or start back up on a strength training regiment, take advantage of the window of adaptation in using shorter rest intervals and experiencing rapid gains. But it is important to remember that you are building a foundation so this is a good time to pay attention to form and technique. As training progresses, activities will need to be more specific to achieve goals and rest intervals.

1Salles, B.F., et al. (2009). Strength Increases in Upper and Lower Body are Larger with Longer Inter-set Rest Intervals in Trained Men. J Sci Med Sports. October 2009.

You know that regular physical activity provides all sorts of health benefits. In fact, if it could be bottled, it would probably be the most effective medication available for preventing and treating many of our most common health conditions, including obesity. So in effect, exercise IS medicine. And the American College of Sports Medicine (ACSM) is spreading that idea to healthcare providers, fitness professionals, and the lay public with its “Exercise is Medicine^TM” campaign.

Healthcare Providers

The primary focus of Exercise is Medicine^TM (EIM) is to get all healthcare providers – physicians, nurses, dietitians, health educators, psychologists, etc. to assess and review every patient’s physical activity program at every visit. Recent research has shown that patients are more likely to start an exercise program if given an exercise “prescription” than if given general advice to “get more exercise.” The prescription can be a simple sheet that outlines patient-focused goals for how to improve their physical activities in line with the current public health guidelines. ACSM is developing resources and toolkits to help all types of healthcare providers integrate physical activity into their conversations with patients and clients. So if you are a healthcare provider, click here for more information and existing toolkits.

Health and Fitness Professionals

Another objective of the EIM program is to enhance health and fitness professionals’ ability to market themselves to and work with healthcare providers. After all, consumers who have a new exercise prescription in hand will likely need help as they try to implement the plan. The EIM web site, www.exerciseismedicine.org, includes a resource-rich area for health and fitness professionals that provides:

• downloadable step-by-step action guide
• introductory letter to healthcare providers
• sample health and medical questionnaire
• informed consent form
• links to instructional handouts and videos
• and many other related materials.

Lay Public

Consumers are a third target for the EIM message. Healthcare providers and fitness professionals can refer their patients and clients to the EIM public page. There they can access an action guide that will help them:

• learn how to meet current physical activity recommendations
• get a personalized exercise plan (this includes assessments and behavior change tools)
• find answers to common physical activity questions
• have productive conversations with their healthcare provider about getting physically active
• encourage their healthcare provider to get involved with the Exercise is Medicine initiative

There are many other consumer-friendly handouts and instructional videos that will make it easier for people to adopt and maintain a healthy habit of physical activity.

Call To Action

The EIM campaign is also making strides in promoting exercise as a preventive and treatment option by tapping into media and public policy channels. In this era of healthcare reform, let’s hope that our legislators finally realize that something as simple as moving more can be as effective, if not more effective, as expensive drugs and medical treatments in promoting the health of our nation. Click here to sign on to support the EIM initiative.

So check out the EIM web site and report back how you intend to use the resources and links or if you have signed up as a supporter.

Many people mistakenly think that if they eat lots of protein their muscles will get larger and that excess protein won't lead to increases in body weight. Well that's just not true! As nutritionists we've known for a long time that there is a limit on how much protein the body/the body's muscles will use and that protein contains the same number of calories as carbohydrates - 4 calories per gram. Thus, the daily recommendation for protein is 0.8 grams per kilogram of body weight or 10-35% of calories for the generally healthy person.

For example, if someone weighs 150 pounds and eats 2000 calories per day, he/she should consume:

150/2.2 = 68 kg

68 kg x 0.8 = 55 grams of protein

OR

2000 x .10 = 200 calories from protein/4 calories per gram = 50 grams of protein

2000 x .35 = 700 calories from protein/4 calories per gram = 175 grams of protein  

50-175 grams of protein per day

New research from the University of Texas Medical Branch at Galveston¹ takes this a step further by suggesting that the body can only use 30 grams of protein (a 4-ounce serving) per meal for muscle protein synthesis (production). Therefore, 4 ounces (approximately the size of a bar of soap, a checkbook, or a deck of cards) of chicken, fish, dairy, or lean beef may be all your body can use at one time.

Here's more detail from the study... researchers compared changes in muscle protein synthesis in response to a single moderate serving (30 grams protein or 4 ounces) or large serving (90 grams of protein or 12 ounces) of 90% lean beef in about 20 healthy young adults and 20 healthy elderly individuals. Study subjects were under resting/nonexercising conditions and provided blood samples and thigh muscle biopsies so that muscle protein synthesis rates after meal ingestion could be determined. In both young and old adults, researchers found that the large serving of beef gave exactly the same increase in muscle protein synthesis as that small serving.

Thus, while these results may not apply to highly active individuals, most Americans would probably benefit from spreading their protein consumption throughout the day - 20-30 grams at breakfast, lunch, and dinner - rather than 90 grams at dinner, given that excess protein consumed will be converted to glucose or fat and ultimately stored as body fat.

So what might a 20-30 gram of protein/meal meal plan look like? Here's an example:

Breakfast - 20 grams of protein

1 whole wheat english muffin with 2 tsp soft margarine; 1 medium grapefruit; 1 hard-cooked egg; 1 cup fat-free milk 

Lunch - 30 grams of protein

2 slices rye bread; 4 ounces tuna (packed in water) mixed with 2 tsp mayonnaise and a splash of lemon juice; 2 slices tomato; 1 medium pear

Dinner - 30 grams of protein

3 ounces roasted skinless chicken breast; 1 large baked sweet potato; 1 ounce whole wheat dinner roll with 1 ounce soft margarine; 1 cup leafy green salad with 3 tsp oil and vinegar dressing

Sure don't need big portions of steak or protein supplements to meet these recommendations, do you?!?

¹Symons, T.B. (2009). A Moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects.. Journal of the American Dietetic Association, 109, 1582-1586.

What do all soon-to-be parents want?  A healthy baby.  Being physically active during and after pregnancy may significantly improve the health outcomes for both baby and mother according to two recent studies.

Excessive weight at birth is associated with higher rates of health problems – and even death – in newborns.  To test whether a mother’s physical activity level can impact birth weight, researchers in Norway tracked the exercise habits of nearly 37,000 pregnant women¹.  The women completed physical activity questionnaires at week 17 and week 30 of their pregnancies.  The weights of their newborns were recorded in a national registry upon delivery. 

The analyses clearly showed a strong association between regular physical activity (at least 3 times per week) at both time points and birth weight.  Women who exercised at this level reduced their risk of having babies with unhealthy high birth weights by 23-28 percent. 
 
Interestingly, in this study regular exercise the three months before the start of the pregnancy was not associated with a lower risk of excess birth weight.  So physically active moms-to-be need to be sure to keep up their activity throughout their pregnancy.  And for inactive women who become pregnant, perhaps these research findings will provide the motivation they need to get moving. 

There is another reason to get and stay physically active before, during, and after pregnancy.  A new study showed that being physically active while breastfeeding helped nursing moms retain more of their bone mass².  That’s important because:

• Breast milk is rich in calcium to help support the rapid growth of an infant’s bones and other tissues.
• The calcium comes from the mother’s own stores, i.e., her bones.
• Reduced bone mineral density increases risk of osteoporosis - or weak bones - later in life. 

It has been well-established that weight-bearing (walking, jogging, dancing, etc.) and strength-training types of exercises can stimulate the retention of bone minerals.  Thus, researchers hypothesized that getting breast-feeding moms to exercise would impact bone health.  And it did.  The breastfeeding women who exercised lost only 4.8 percent of bone mass compared to a 7.0 percent bone mass loss in the lactating moms who did not exercise.

So if you are a new mom, know a mom-to-be, or will be a mom someday, make sure you build regular physical activity into your life -- and keep it up for a lifetime.  It will help not only you, but also your baby.  While exercise is safe for the vast majority, be sure to work with your obstetrician to identify what, if any, limitations you might have with you specific pregnancy.

¹ Owe KM et al.  Association between regular exercise and excessive newborn birth weight.  Obstetrics and Gynecology.  2009;114(4):770-776.
² Lovelady CA et al.  Effect of exercise training on loss of bone mineral density during lactation.  Medicine and Science in Sports and Exercise.  2009 Sept 2 (epub ahead of print).