While the November/December holidays are still a few months away, research shows that we should start planning for them now. The thought that overeating and physical inactivity for a month or two can be reversed by a New Year's Resolution and few months of dieting and working out at the gym may not be true.

Swedish researchers recently published results from a study that placed 18 normal-weight healthy participants (averaging 26 years of age) on a restricted physical activity regimen of no more than 5,000 steps per day and eating plan with about 70 percent more calories than usual, including at least two fast food meals per day, for four weeks. These intervention subjects (feasting group) were compared to a control group that did not change their physical activity and eating habits. Results showed that the feasting group gained an average of 14 pounds by the end of the month, with increases in both fat free mass and fat mass. At a 6-month follow-up the feasting group had lost body weight, but not to baseline (before the study) values. At a 12-month follow-up the feasting group still did not return to their baseline body weight and had an average 3 pound weight increase from before the study. In addition, at 12 months the feasting group had an unchanged fat free mass compared to baseline but higher fat mass. At 2 1/2 years the feasting group averaged around 7 pounds more than before the study while the control group had no changes in weight compared to baseline.

So what does all of this say? Well, that if you eat and lay around too much this holiday season 1) you will likely gain weight and 2) you will likely have a hard time losing all of the weight you gained. The researchers concluded that a brief period of excessive overeating coupled with little physical activity many change body composition and lead to a significant boost in body fat levels, which may endure despite a return to healthier behaviors. However, the sample studied here was small and fairly young so it's hard to know if the same results would be seen in older adults.

Either way, it wouldn't hurt to think about whether a few months of overindulgence is worth years with a few extra pounds along your waistline. Take another look at these previous blogs if you need some guidance on preparing for a healthy holiday season:

Have a Happy Calorie Controlled Thanksgiving

Fitness Strategies for Holiday Success

Ernersson, A. (2010). Long-term increase of fat mass after a four week intervention with fast food based hyper-alimentation and limitation of physical activity. Nutrition and Metabolism, 7.

Anyone who's been to a grocery store with kids would say "Yes... duh"! So why did researchers at the renowned Rudd Center for Food Policy and Obesity conduct a study on the influence of licensed characters on children's taste and snack preferences?¹ To provide solid, documented evidence that licensed characters can influence children's eating habits negatively. Based on their findings (described below) they suggest advocating the use of licensed characters for healthy foods and regulation of the use of this marketing approach for high-calorie, low-nutrient products. And not just foods targeted toward preschool-aged children. The four to six-year-olds in this study were influenced by characters watched more often by older children (like Scooby Doo and Shrek) even though they were less recognized.

In this study, 40 four- to six-year-old children were presented with two packages of three different snacks (graham crackers, gummy fruit snacks, and carrots) - one package of each snack with a popular cartoon character (Scooby Doo, Dora, or Shrek) and one package without. They tasted food from both packages of each snack and were asked 1) whether the two foods tasted the same or one tasted better and 2) which they would prefer to eat as a snack.

Results showed that children significantly preferred the taste of foods that had popular cartoon characters on the packaging, compared with the same foods without the characters. Likewise, the majority of children selected the food sample with the licensed character on it for their snack.

Study authors conclude that there is now evidence for advocacy groups to criticize the use of character licensing. While some industry-initiated efforts have already begun, like the Walt Disney Company ending its 10-year contract with McDonalds and Nickelodeon's 2005 announcement to license characters to produce companies, the vast majority of the licensing market still involves foods of poor nutritional value. For instance, while Shrek has become a spokesperson for various U.S. Department of Health and Human Services campaigns, his image still appears on products from M&Ms, Cheetos, and Keebler. Thus, the authors believe that these inconsistencies, in which characters are associated with both healthy and unhealthy foods sends mixed messages.

So what's the solution? Should the government get involved and regulate as was discussed in our Not So Happy Meal blog? Or should parents play a more active role in educating (as discussed in our blog Teach Your Kids to Spot the Block) and modeling healthy behaviors (as discussed in our blog Monkey See, Monkey Do)? Or all of the above? I do bring my young kids to the grocery store and I'll tell you they are drawn to the cartoon characters on the packages. But caving to their wants is not the answer and neither is leaving them at home. The grocery store presents so many good learning opportunities for healthy eating. So when I do buy them a treat I buy one without the character packaging and shift the conversation by asking them which fruit and vegetable they want to buy.

Share your two cents!

¹Roberto, C.A. (2010). Influence of licensed characters on children's taste and snack preferences. Pediatrics, 126, 88-93.   

School has started (or will be soon) so it's time to think about what your child will be eating during the day. Given that school-aged children spend at least 6 hours at school every school day and obtain up to 47% of their calories from meals and snacks consumed at school, parental involvement is important. So will it be school lunch or a sack lunch?

Despite what you've heard in the media (e.g., Jamie Oliver's Food Revolution) public school meals provided by the National School Lunch Program (NSLP) can be very healthy - especially if your child's school district is progressive and has received recognition awards from programs like the HealthierUS School Challenge and Alliance for a Healthier Generation Healthy Schools Program. All NSLP meals have to meet certain nutrient standards set by the US Department of Agriculture (USDA) and state standards like those set by the Texas Department of Agriculture, but research does show that on average school meals are too high in fat and sodium and too low in fiber. Standards are getting more stringent, however, and while far from finalized, the Senate did pass last week the Healthy, Hunger-Free Kids Act of 2010 which would change many of the foods served in schools if passed by the House. The bottom line is that you should look at your child's school menus and discuss healthy choices with your children. Last week I received a sneak peak at the 2010-2011 Dallas Independent School District school menus and was quite impressed. Brown rice is replacing white rice and whole grain breads are offered daily. Fresh ingredients are replacing many processed products and hamburgers and fries are limited to once every two weeks in elementary and middle schools. On the menu I saw Black Bean Burgers, Veggie Salads with Whole Grain Flatbread, and Fruit and Yogurt Parfaits. What an improvement over previous years' menus!

If, on the other hand, your child prefers to brown-bag-it, review last year's blog, Better Brown Bag Ideas for Kids Headed Back to School. Think "color" and "food groups". Does your child's lunch contain reds, oranges, greens, yellows, blues/purples, and dark browns? And no, the flashy packaging doesn't count! Is there something from each of the food groups: grains, vegetables, fruits, milk, meat and beans? For more ideas of foods from each food group visit MyPyramid.gov.

Share your brown-bag tips or stories how you have helped make the foods served by your school healthier. 

Physicians Committee for Responsible Medicine. School Lunch Report Card: A Report by the Physicians Committee for Responsible Medicine. August 2007. http://www.healthyschoollunches.org/reports/report 2007_card.cfm. Accessed April 30, 2008. 

Crepinsek, M.K. (2009). Meals offered and served in us public schools: do they meet nutrient standards. Journal of the American Dietetic Association, 109, S31-S43.

Dietary guidelines increasingly stress the importance of seafood in Americans' diets. The American Heart Association recommends that fish, especially oily fish rich in omega-3 fatty acids, be consumed at least twice a week (2 servings, about 4 ounces each) to reduce death from coronary artery disease. Likewise the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010 states that 250 mg per day of omega-3 fatty acids from marine sources (2 servings, about 4 ounces each) positively impacts health.

But what about the safety of seafood? The biggest concern that has circulated has been around methyl mercury. Large predatory fish like shark, swordfish, king mackerel, and tilefish have the potential for the highest level of mercury contamination and thus should be avoided by certain people like children and pregnant women. Instead, these groups are encouraged to eat up to 12 ounces per week of a variety of fish and shellfish that are lower in mercury like canned light tuna, salmon, pollock, and catfish. For more on the risks of methyl mercury and levels in fish go to the Food and Drug Administration's web site. Overall, however, for the majority of Americans the benefits of fish consumption far outweigh the potential risks when amounts of fish are eaten within the recommendations.

More recently, however, I've been asked if seafood caught along the Gulf of Mexico is safe to eat (given the April 2010 oil spill). The Food and Drug Administration (FDA) and National Oceanic Atmospheric Administration (NOAA) have released these statements that lead me to believe that we do not have to be concerned with seafood from the Gulf.

• Federal and state officials are closely monitoring the waters from which seafood is harvested and have closed areas contaminated by the oil and dispersants (chemicals that cause the oil to disperse into the water rather than float on top) used for fishing and seafood harvesting. They will reopen waters when they pass thorough sensory testing for contaminants.
• FDA has implemented a surveillance sampling program of seafood products at Gulf Coast area primary processing plants. It is currently targeting oysters, crabs and shrimp, which could retain contaminants longer than finfish. This sampling will provide verification that seafood being harvested is safe to eat.
• Fish and shellfish harvested from areas unaffected by the closures are considered safe to eat.

What do you think? Do you feel adequately protected by the FDA and NOAA? Do you eat and recommend that others eat adequate amounts of fish high in omega-3 fatty acids? Here's a list of various seafoods and their grams of omega-3's per 3-ounce serving.

Lichtenstein, A.H. (2006). Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association nutrition committee. Circulation, 114, 82-96.

Report of the dgac on the dietary guidelines for Americans, 2010. (2010, June 15). Retrieved from http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm.

Food and drug administration: gulf of mexico update. (2010, August 11). Retrieved from http://www.fda.gov/food/ucm210970.htm.

The latest stats say 62 percent of U.S. adults report using the Nutrition Facts panel of the food label at least sometimes when deciding to buy a food product. Fifty-two percent look at the list of ingredients; 47 percent look at serving size; and 44 percent review health claims.¹ So 38 percent of people never look at the Nutrition Facts panel of the food label?!? So how do they know what they're eating? 

The above data, published in August's Journal of the American Dietetic Association, was collected as part of the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Over 5,000 adults answered the food label questions and of those 5,000 people about 4,500 completed two 24-hour dietary recalls. This data allowed researchers to make the following conclusions about food label use:

• Women and participants with greater education and higher income were more likely to report using food labels.
• Non-Hispanic whites reported more frequent use of food labels.
• Participants with limited English language skills had greatly reduced rates of label use, but label use among foreign-born participants increased with duration of residency.
• Users of the Nutrition Facts panel were found to have lower reported values for total energy (calories), total fat, saturated fat, and sugars.
• Users of the ingredient list had lower reported values for total fat, saturated fat, and sodium.
• Users of the serving size had lower reported values for total energy (calories), total fat, saturated fat, cholesterol, and sugars.
• Users of the health claims had lower reported values for total fat and saturated fat.
• Reported dietary fiber intake was found to be higher among label users for all sections of the food label.

Given that food labels seem to help people make healthier choices, why aren't more people using them? Here are some potential answers...

1. They are they too difficult to understand/interpret. Test your ability to read a food label with this quiz.
2. It takes too much time to look at the side of a package before throwing it in the cart. Really?!? Maybe key information like calories should be bolded.
3. People do not want to know how unhealthy that packaged food might be. Unfortunately, it may very well be loaded with fat, sodium, and/or sugar.

What's your guess? How might we help more people use the food label to make healthier choices? Or maybe we should promote the use of fresh foods without labels like fruits, vegetables, and fish? While these foods aren't required to display the standardized food label, their nutrition information can be found here.

¹Ollberding, N.J. (2010). Food label use and its relation to dietary intake among us adults.. Journal of the American Dietetic Association, 110, 1233-1237.

 

Enter a coffee shop and you'll see a group of teens sipping lattés. Drive by a high school sporting event and you'll see kids slamming energy drinks. Or cross through a park and you'll see a few children drinking soda pops. Kids and caffeinated beverages have become the norm. But is it okay?

According to a recent editorial in the Canadian Medical Association Journal, the answer is no. Excessive caffeine in kids can cause nervousness, irritability, sleeplessness, and occasionally rapid heart rate. And way too many caffeine-laden products are marketed to children through advertising and sponsorship of events like snowboarding and skateboarding competitions. Thus, the authors of the editorial urge their government officials to step in and mandate labeling, marketing, and even sales of all products with caffeine levels exceeding 100 mg. Furthermore, they urge Health Canada (similar to the U.S. Department of Health and Human Services) to provide the public with more information on the health consequences of caffeine in children.

Sounds like a good idea, doesn't it? Well, the research behind the ill effects of caffeine in children is not so clear. Several other groups (and not just the beverage industry!) say that while caffeine may not benefit children, it probably won't hurt them either. The International Food Information Council (IFIC) reminds consumers that the U.S. Food and Drug Administration as well as the American Medical Association and American Cancer Society state that moderate caffeine consumption produces no increased risk to health. And in reference to children, IFIC says research has found no evidence to suggest the use of caffeine at the levels in foods and beverages is harmful; that caffeine-containing foods and beverages do not cause children to become hyperactive; and that while someone may exhibit short-term symptoms if they stop consuming caffeine suddenly, it isn't addictive.

So what is "moderate consumption"? For adults, moderate consumption has been defined as 200-300 mg caffeine per day. The U.S. doesn't provide specific guidelines for children, but Health Canada recommends:
-no more than 45 mg/day for children ages 4-6
-no more than 62.5 mg/day for children ages 7-9
-no more than 85 mg/day for children ages 10-12
-no more than 2.5 mg per kilogram body weight per day for kids 13 and older

Can kids easily exceed these recommendations? I'd say so! One 8-oz cup of drip-brewed coffee has 65-120 mg caffeine; one 8-oz energy drink has 50-200 mg caffeine; and one 12-oz soft drink has 30-60 mg caffeine. A 2007 study of U.S. adolescents aged 12-18 found that 73% consumed 100 mg or more of caffeine per day, with most consumption in the evening, the time of the day most likely to negatively effect sleep.

What do you think? Should parents watch or restrict their children's caffeine intake? Might caffeinated beverages be replacing healthy beverages like milk and water in children's diets? Or, is caffeine consumption in children (coffee and energy drinks) just another harmless fad that will pass with time?

MacDonald, N. (2010). Caffeinating children and youth. Canadian Medical Association Journal, Retrieved from http://www.cmaj.ca doi: 10.1503/cmaj.100953.

Fact sheet: caffeine and health. (2007, August 1). Retrieved from http://www.foodinsight.org/Resources/Detail.aspx?topic=Fact_Sheet_Caffeine_and_Health.

Malinauskas B.M. (2007). A survey of energy drink consumption patterns among college students. Nutr J;6:35. 

Year after year national guidelines urge Americans to do physical activity and eat a healthy plant-based diet. And year after year Americans become more sedentary and choose more highly-processed foods high in fat and calories. So what's the disconnect? Are our healthy messages too complex? Do Americans not see the benefits of a healthy lifestyle? Or, perhaps, are Americans trying to change, but just not using the right strategies?

This week the American Heart Association released a Scientific Statement titled, Interventions to Promote Physical Activity and Dietary Lifestyle Change for Cardiovascular Risk Factor Reduction in Adults. After reviewing dozens of physical activity and dietary behavior change interventions conducted from 1997 to 2007, the panel of authors determined the most efficacious and effective strategies for lasting lifestyle change. The key strategies (for individuals) are briefly described below. As you read through them, note whether you do or don't use each skill. 

• Set specific, attainable but challenging short-term physical activity and healthy eating goals
• Self-monitor, or keep track, of physical activity and foods (e.g., minutes of physical activity or calories consumed per day) to determine what changes are needed and monitor progress
• Frequent and long-term follow-up with healthcare providers or peers (in-person, oral, written, electronic) to assess goal attainment or progress toward goal(s) and provide support
• Problem solve barriers to physical activity and healthy eating (e.g., lack of access to affordable healthier foods, lack of resources for physical activity, or no time)
• Use incentives or rewards to induce or support behavior change
• Observe others performing healthy behaviors (e.g., engaging in physical activity or preparing healthy food)
• Recognize and plan for risky situations that may lead to lapses in healthy behaviors (e.g., vacations, injuries, or holidays)

Which of these do you do most often? Which might you start doing?

In addition to these individual behavior change skills, the report outlines policy changes like providing healthcare providers with the skills to assess and provide counseling around lifestyle change and calorie labeling on menus that should be implemented to assist Americans in adopting and maintaining a healthy lifestyle.

As a healthcare provider it's frustrating to tell people over and over that there's no magic bullet. Americans need to clearly understand that it's not about the latest diet or fitness fad. Changing one's lifestyle is about making healthy foods and physical activity part of their daily routine - that will be continued forever. And to do this, one must use strategies for change (as described above) to be successful. It's not necessarily easy and it's not quick. But if someone wants to reduce their risk for disease that's what they need to do.

How do you help people realize that achieving and maintaining a healthy lifestyle requires more than a meal plan and list of exercises to do?

Artinian, N.T. (2010). Interventions to promote physical activity and dietary lifestyle change for cardiovascular risk reduction in adults. a scientific statement from the American Heart Association. Circulation. Retrieved from http://circ.ahajournal.org doi: 10.1161/CIR.0b013e3181e8edfl.

If you read last week's blog you learned that prepared baby and toddler foods are often high in sugar, particularly added sugar. And as previously mentioned, because infancy and toddlerhood is a critical time period for forming taste preferences and possibly preventing future disease, the need for caretakers to take steps to limit these products is high.

This week, we're revealing the findings on SODIUM content of baby and toddler foods from the same research study (see last week's blog for information on what products were analyzed).¹

As we did with sugar, let's start with the sodium recommendations. The American Academy of Pediatrics and The American Heart Association recommend that children ages 1-3 consume no more than 1,500 mg of sodium per day; 4-8 consume no more than 1,900 mg of sodium per day; 9-13 consume no more than 2,200 mg of sodium per day; and 14-18 consume no more than 2,300 mg of sodium per day. The American Dietetic Association recommends even less at 1,200 mg/day or less for 4-8 year-olds and 1,500 mg/day or less for older children. Thus, toddlers should clearly be consuming less than 1,200 to 1,500 mg of sodium per day - about 3.8 grams of salt or 2/3 teaspoon of table salt.

So what did the researchers find? Over 12 percent of toddler products analyzed contain more than 130 mg of sodium per serving. Sixteen products contain more than 260 mg of sodium per serving. And 11 products contain over 400 mg of sodium per serving. Toddler entrees/dinners topped the 'high-sodium' list with some products exceeding 500 mg of sodium per serving - 1/2 to 1/3 of their daily limit.

And similar to what was found with sugar, sodium levels in baby/toddler products are not always nutritionally superior (less sodium) than adult products. One such case is yogurt where the amount of sodium was less in the comparable adult product.

Thus, while not quite as problematic as sugar, researchers found sodium levels in toddler products to be higher than expected. And therefore, the recommendation given at the end of the last week's blog on sugar also applies here:

Parents need to carefully select the foods they serve their babies and toddlers. Products marketed toward this age group are not necessarily healthy and oftentimes are quite the opposite. So what's the busy parent to do? Read food labels, in particular the Nutrition Facts panel of the food label where sodium is listed, and purchase as many whole foods like fruits, vegetables, whole grain breads, pastas, cereals, and lean meat, eggs, and beans. The more "whole" a product is, the less processed it is and less potential for additives like sodium and sugar. 

¹Elliott, C.D. (2010). Sweet and salty: nutritional content and analysis of baby and toddler foods. Journal of Public Health, Advance Access, doi: 10.1093, pp.1-8. 

If you read our recent blog on the 2010 Dietary Guidelines you know that added sugar and sodium are two dietary components that Americans are eating WAY too much of. While there are differing opinions as to why we're eating too much, it's clear that this is a problem in not only adults, but also children. This is concerning because research shows that dietary habits are formed early in life and persist over time. Furthermore, studies show that the composition of early childhood diet may directly impact metabolic pathways and health during adulthood. Thus, it's imperative that we feed our children the healthiest foods possible.

In this two-part series (see our blog on 7/16 for part two) we'll reveal the results of a study recently published in the Journal of Public Health which collected nutritional information on 186 baby and toddler foods and compared these foods against their adult counterparts for sugar and sodium.¹ Are baby and toddler foods nutritionally superior to adult foods or do they contain levels of sugar and salt that are just as high and may be promoting a taste for 'sweet' and/or 'salty' in young people?

While this study was conducted in Canada, it included brands frequently purchased by American parents like Gerber Graduates, Beech-Nut's Let's Grow, and Walmart's Parent's Choice. Excluded from the study were simple purees of 100% vegetables and fruits. While these foods have naturally occurring sugars, they differ from prepared dinners or desserts that have sugar and/or salt added to them. Thus, the 186 products analyzed included: pureed dinners and desserts, toddler entrees and dinners, snacks (including biscuits, cookies, fruit snacks, snack bars, and yogurts), and some cereals.

So how did the SUGAR content of these baby/toddler foods compare to what's recommended for a "healthy diet" and amounts found in similar adult products?

Let's start with the recommendations. The Institute of Medicine recommends that 25 percent or less of total calories come from added sugars. The World Health Organization recommends that less than 10 percent of total calories come from added sugars. And the American Heart Association recommends that added sugars are no more than half of daily discretionary calories. As an example, a 3-year-old girl who does 30-60 minutes of physical activity a day needs about 1200 calories and is allowed 171 discretionary calories. Thus, it would be recommended that she consume no more than 300, 120, or 85 calories from added sugar.

Determining how much added sugar a food product has is difficult, however. The Nutrition Facts panel on the food label does not distinguish added sugars from naturally occurring sugars. Thus, total sugar was considered for the products in this study, and a product that had more than 20 percent of it's calories from sugar was considered high.

So what did the researchers find? Over half (52 percent) of the products had more than 20 percent of their calories from sugar. Pureed baby food desserts averaged 48 percent of calories from sugar and snacks (biscuits, cookies, corn snacks, rice cakes/crackers, fruit snacks, yogurt) averaged 30 percent of calories from sugar. Forty percent of the products listed sugar or some variant of sugar (e.g., corn syrup, fructose) in the first four ingredients on the label and 36 products listed sugar or some variant of sugar as either the first or second ingredient! Therefore, it can be reasonably assumed that a child who consumes just two of the previously mentioned baby/toddler snacks will exceed his/her recommended daily limit of added sugar.

But these products are nutritionally superior to their adult equivalents, right? Not always! Researchers found that toddler cereal bars had more calories from sugar (on average) than adult cereal bars and teething biscuits had almost the same amount of calories from sugar as adult-targeted biscuits.

In conclusion, parents need to carefully select the foods they serve their babies and toddlers. Products marketed toward this age group are not necessarily healthy and oftentimes are quite the opposite. So what's the busy parent to do? Read food labels, in particular the ingredient list where sugar is listed, and purchase as many whole foods like fruits, vegetables, whole grain breads, pastas, cereals, and lean meat, eggs, and beans. The more "whole" a product is, the less processed it is and less potential for additives like sugar.

Did the results of this study surprise you? Stay tuned for the results of the SODIUM test in next week's blog.

¹Elliott, C.D. (2010). Sweet and salty: nutritional content and analysis of baby and toddler foods. Journal of Public Health, Advance Access, doi: 10.1093, pp.1-8.