Health at Any Size: Science Based or Wishful Thinking?

I have taken an unpopular stance amongst my peers that “health at any size” is simply a fantasy. We are in agreement on a few points, however: we need to focus more on achieving health and not about reaching a certain number on a scale. And regardless of size, everyone deserves to be treated with respect and dignity. That said, to think that you can be 350+ pounds and still be “healthy” is the exception, NOT the rule. In my nearly 30 years as a clinician, rarely do I see someone of “size” who has a healthy percent body fat, is absent of joint pain or metabolic health challenges and so on. By the way, I don’t see NBA/NFL players – that might be the exception to the rule though a great many x-athletes who maintain their size but not their activity are prone to the same aforementioned concerns.

This article featured in the Huffington Post, by David Katz, MD, does a great job in pointing out the flaws in the “Health at any size” philosophy. Of course, I would welcome your thoughts and comments!

Why I Can’t Quite Be Okay With ‘Okay at Any Size’
by David Katz, MD

There has long been a movement to defend the overweight from a prevailing lack of understanding. And, alas, that defense seems to be needed.

The evidence of obesity bias in our culture is abundant and pervasive, and can be found from playground to boardroom. We have historically done a poor job of attacking the problem of obesity without attacking those burdened by the problem of obesity.

The defense has come in the form of professionals who highlight the pernicious effects of bias. It has come in the form of organizations, such as NAAFA, the National Association to Advance Fat Acceptance. In my own case, it comes in the form of the National Exchange for Weight Loss Resistance, which I launched to help spread the word that some people can eat well, be active, and still never get to thin.

There has long been some okay-at-any-size support from Hollywood and Madison Avenue, as well. The Dove ads for women with “normal” curves are already classics. Oprah has emoted on the topic. Plus-size models can do quite well. And Queen Latifah has brought her inimitable “what you see is what you get, if you’re lucky” brand of gumption to the issue.

Apparently, though, we’ve entered a new stage of evolution on the topic. The New York Times recently reported that a whole new cadre of celebrities prone to the same obesigenic influences as the rest of us are simply shrugging their shoulders, and letting it all hang out. In some cases, quite literally — by exposing the expanding epidermis in question.

So “okay at any size” seems to be gathering pop culture momentum. And I regret to say, I can’t be entirely okay with that. It’s not the size I’m not okay with — it’s the consequences.

Epidemic obesity is not just a reason we have epidemic diabetes — it is the reason. It is the reason why the CDC is projecting that as many as 1 in 3 of us may be diabetic by mid-century, at a cost the nation is unlikely to find manageable.

It is the reason why what used to be “adult onset” diabetes is now a disease of children as well, and called “Type 2.” It is the known reason for a proliferation of ever more cardiac risk factors in ever younger people. It is the reason behind a triple coronary bypass in a 17-year-old boy whose case I know. And it is the likely reason for a 35 percent increase in the rate of stroke among 5-to 14-year-olds.

And the toll of this menace continues to rise. Not so much now because of more people becoming overweight, although that continues to happen. Rather, since most of us vulnerable to becoming overweight or obese are already there, the relevant trend at present is the degree of overweight, which is worsening fast. A recent report indicates that the prevalence of severe obesity has “skyrocketed” in the past decade. We can probably no longer gauge this epidemic by noting how many are overweight; we now need to monitor how overweight the many are.

These, then, are the stakes in play. It’s true that people can be fat and fit, but few of us are. More and more of us are fat to one degree or another, and most of us are unfit as well. These can be unbundled, but in the real world they seldom are. And when they are unbundled, it’s because thin people can be unfit, too. In general, the behaviors that cultivate genuine fitness offer the best defense we have against fatness.

And this points to a message residing more than skin deep. Whether fat or thin, what we eat matters. Food is the fuel that powers the human machine. It is the one and only construction material for the growing body of a child. It is the construction material on which adults rely to replace spent cells and enzymes and hormones every day. Junk is a poor choice all around, no matter your size.

And exercise matters. It is the vital, conditioning work of the body, whatever its proportions. The “okay at any size” message does not explicitly say that junk food and lounging on the couch are fine, but it doesn’t tend to say explicitly that they aren’t, either. We could be more okay at any size if we took good care of ourselves, large or small. But if one of the reasons for larger size is lesser attention to health, that’s not really okay. And frankly, what we know about prevailing dietary and physical activity patterns suggests that’s just what’s going on.

Along with helping many patients lose weight over the past 20 years, I have talked some out of the enterprise. I have told them they were healthy — and as far as I was concerned, looked great as well. I encouraged them to love the skin they were in, and not obsess for the rest of their lives with themselves 10 pounds lighter, or a size or two smaller. Sometimes they listened to this advice, sometimes not. Those that didn’t listen might well have benefited from a bit more cultural emphasis on the “okay at any size” message.

So I am not only okay with “okay at any size” up to a point, but an active proponent. I oppose obesity bias, and reject the notion that widespread obesity among children and adults alike is somehow due to an inexplicable, global outbreak of personal responsibility deficiency syndrome. If you have evidence of such an outbreak, it would be the first I’ve heard of it.

I am more than okay with the notion that weight and waist circumference do not measure human worth. I will gladly stand shoulder-to-shoulder with others inclined to fight in defense of this proposition.

I am not just okay, but adamant, that we should be able to attack the problem of obesity without attacking those dealing with the problem of obesity.

And I can be okay with “okay at any size” if it includes a proviso: okay at any size as long as health is not adversely affected.

But when weight imperils health, as it clearly does all too often, I am not okay with it. In this context, bold displays of burgeoning flesh, and “flab is fab” bravado may do more harm than good. We do not, as a society, want to normalize ill health or the factors that impose it. Fewer years in life, and less life in years is not an acceptable endowment to the next generation.

We could choose to give our children a future in which 80 percent of all chronic disease goes away, because we commit to making tobacco avoidance, eating well, and being active our cultural standard. Or we can be okay with the trajectory we are on, and give them ever more serious illness starting at ever younger age.

When the bigger we are on average, the harder and younger we fall victim to serious chronic disease, I am not okay with it — and don’t think anybody else should be, either. It’s not the size that inspires my opposition; it’s the consequences.

Pork: The Other Right Meat

As seen on WebMD
By David Grotto, RD, LDN

For those of you who know me or have recently become familiar with my work here through Real Life Nutrition, it will come as no surprise that I profess that I am a plant-forward, unapologetic omnivore. I love all food and feel that, when placed in proper perspective, you can eat just about anything and still enjoy/achieve good health. Many of you already know that we consume nowhere near the quantity of fruits, vegetables and whole grains currently recommended in the Dietary Guidelines for Americans. In an effort to change this trend, my first book, 101 Foods That Could Save Your Life, focused on increasing that portion of the plate dedicated to members of the plant kingdom. At the time that I wrote it, I didn’t feel Americans needed a book that encouraged more meat consumption. I thought then, as I do now, that our work is cut out for us with just boosting our veggie intake. However, I also think that lean meat has a place at the table and on the plate in a healthy diet, if you desire to eat it.

Like most Americans, when I think “lean”, what first comes to mind is the classic boneless, skinless chicken breast. Ho hum. The description alone leaves me culinarily unexcited– so much emphasis on the “less” part. The problem with lean meats is that they can be prone to dryness and “less” flavor. Growing up, we were exposed to less marbled meats with any visible fat trimmed away. That fat had a function – flavor! I remember my mom trying to make challenging cuts more tender and favorable by whacking it with a mallet and soaking it in marinades – so much work. Sometime she was successful and other times…well…you know.

Recently, I received an invitation to attend a pork “immersion” provided by the National Pork Board. Did you know that compared to any other animal protein , pork is the most consumed meat in the world? Could have sworn it would be chicken! Though meat consumption trends are on the downturn, it is estimated that pork is consumed by about 81% of Americans. Anyway, I decided to take them up on their offer because I had lots of questions about pork – more pressing, how could I make lean cuts of pork taste better? Mom was always in the back of my head saying “If you want to avoid trichinosis, you’d better cook the pink out of it.” I had always followed her advice though I had no idea what “trichinosis” was – sounded to me that I be better off without it. The end result was often a product akin to shoe leather. In dietetics school, I learned I had to cook pork to an internal temperature of at least 160 degrees for food safety measures. Translated? More shoe leather. More ho hum…

During the immersion event, many of my questions and concerns about pork were addressed. I’m happy to share the answers I received with you.

Food Safety: Good news #1. Last year, due to advances in food safety, the USDA lowered the internal cooking temp of pork to 145℉ with a three-minute rest period. This allows the meat to continue to cook, retain its temperature and also its moisture. No more shoe leather or my mom talking inside my head! Yay!

Nutrition: Good News #2. During the immersion, I attended a lecture given by Mary Murphy, MS, RD, senior managing scientist at Exponent, a scientific consulting firm, and learned how today’s pork nutrition has evolved over the past 20 years or so. A 3-ounce portion of roasted and trimmed pork contains only 120 calories and is 16% lower in total fat and 27% lower in saturated fat then pork of two decades ago. Seven cuts of pork now qualify for “lean” status which includes:
Tenderloin
Top loin chop
96% lean ground pork
Top loin roast
Center loin chop
Rib chop
Sirloin roast
And compared to skinless chicken breast, today’s pork tenderloin is just as lean! And by the way, according to the Food and Drug Administration, a product can be considered lean if it had less than 10g of total fat, 4.5g or less of saturated fat, and less that 95mg of cholesterol per serving. But did you know that “lean” is not the leanest cut that you can buy? The FDA considers “Extra Lean” to be any meat that contains less than 5g of total fat, less than 2g of saturated fat, and less than 95mg of cholesterol. This would apply to boneless, skinless chicken breast and the tenderloin cut of pork.

Health: Good News #3:
Fresh lean pork which is low in sodium, saturated fat and cholesterol can be part of diets geared towards managing elevated cholesterol and blood pressure, like the DASH (Dietary Approaches to Stopping Hypertension) diet. Out of all of the macronutrients – fat, carbohydrates and fat – protein provides greater feelings of fullness, keeps hunger at bay and may help manage our waistlines. The Journal Obesity found that when a study group included lean pork and other lean proteins in their diets on a regular basis, there were less desires to eat late at night, less distracting thoughts of food, less overall calories consumed and greater feelings of fullness and satisfaction.

Animal Welfare: Good News #4: Lastly as part of the immersion, I had an opportunity to visit Wakefield farm in Gaylord Minnesota, hosted by pork farmers Mary Langhorst and her son Lincoln. I must tell you – I had mixed feelings about seeing where my food comes from but am really grateful for having the opportunity to see a factory pork farm in operation. It was not the cold and sterile environment I once envisioned. I was impressed by the many caring employees who took great strides to treat their pigs with dignity and care. I was pleasantly surprised to see how clean of an operation they had. According to representatives from the National Pork Board, the cleanliness and care of animals seen at the Langhorst’s farm was representative of US pork farming in general. I had always heard that factory pig farms were absolutely horrible smelling. I wouldn’t say that it smelt like daisies around there but it was really no more odorous than many dairy farms I had visited before. I also learned that when pigs are stressed, this can actually change the ph of the meat to produce a less enjoyable dining experience. Apparently everyone benefits from less stressed and content pigs. Their pigs indeed appeared content, clean and well cared for.

Have any of you been to a pig farm? I would love to hear of your experiences. Happy to answer any other nutrition questions or concerns you may have.

Very special thanks go out to Kyle Dent, BS, a masters program intern from Loyola University and Medical Center, for helping me with this post.

Pour One Out or Add a Healthy One In?

Photo Credit: thecitydesk.net (by the way folks, the poster is a parody!)

I get many daily solicitations to promote contests, interview book authors, support causes – you name it. I received this latest request from the Center for Science in the Public Interest (CSPI) to promote their “Pour One Out” campaign which encourages consumers to dump their soda. If you are not familiar with CSPI, they are a consumer advocacy group that’s been around since the early 70’s that provides information on food, health, and the environment. I applaud CSPI- they have been instrumental in raising public awareness of sodium, hidden sugars and the health impact of trans fats, to name a few accomplishments. But for some reason, I found this latest promotion of theirs to be unworthy of their reputation and frankly, down right silly.

So I thought I’d share my email exchange with one of CSPI’s policy associates. If you don’t want to read through the whole thing, I’ll cut to the chase. I argue a few things:

1. Sugary beverages are not the smoking gun in the obesity epidemic – eating too many calories from a variety of foods coupled with inactivity is.
2. Stats can be manipulated to support your cause.
3. Giving up your favorite foods has never worked to control obesity and will never work.
4. Adding in a healthy beverage is a far more positive approach than dumping out a sugary beverage. Want to avoid sugary beverages? Don’t buy them in the first place.

What do you think? I’d love to get your feedback.

Dear Mr. Grotto,

I’m writing from the Center for Science in the Public Interest, a national nutrition advocacy group. My organization is running a video contest that might be of interest to your readers and it would be great if you could help spread the word on your blog. The contest aims to raise awareness about the health effects of sugary drinks. Here is some basic text below and I have also included the contest logo. Let me know if you have any questions about the contest or our organization. Thanks!

******

POUR ONE OUT VIDEO CONTEST
Help spread the health message about sugary drinks and you could win $1,000!

Sugary Drinks make up the largest single source of calories in the American diet and each year more studies are finding a link between soda and obesity. We invite you to submit a short video pouring out sugary drinks in a fun and creative way for a chance to win up to $1,000! The Pour One Out video contest seeks to reframe perceptions about sugary drinks by raising awareness of the health effects of overconsuming beverages like soda, sports drinks, sweetened teas and energy drinks. Videos will be judged on creativity, originality and effectiveness of the health message. Prizes will go to the top 3 videos:
1st place video will receive a $1,000 cash prize
2nd place will receive $500
3rd place will receive $250

Submissions will be accepted until November 7th by email at: fewersugarydrinks@cspinet.org. For more details and the official contest rules, click here.
Sincerely,

Ashley P. Lowe

Policy Associate

Center for Science in the Public Interest

Hi Ashley:

Thanks for sending this on to me. Though I’m not interested in participating in the video contest (I think it’s better to simply not buy sugary sodas instead of wasting money on them and then pouring them out) I am very interested in the source for the “fact” that sugary beverages are the single largest source of calories in the American diet. Could you provide this for me?

Thanks in advance!

Dave

Hi Dave,

Thanks for your quick reply. We’re encouraging people to use soda they already have when they can to make their videos as an affirmation of their desire to change their lifestyle habits. If you were to encourage people to only use products they have, would that change your opinion of the contest at all?

I’m happy to provide you with the source of the fact on calories from sugary drinks. It comes from a table in the 2010 Dietary Guidelines listing the top 25 sources of calories in the American diet. Combining the category “soda/energy drinks/sports drinks” with “fruit drinks” (which does not include 100% fruit juices), puts sugary drinks in the number one spot. You can view the table (table 2.2) here: http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Chapter2.pdf

Best,
Ashley

Hi Ashley:

Thank you so much for getting back to me. I now see how CSPI came up with their final numbers. I thought grained based desserts was the #1 source of calories (I wrote a review article about this for the Journal of Nutrition in Clinical Practice about two years ago using the same data base as USDA – I’d be happy to send a copy to you, if you want to read it) but agree that when you add sugary sodas together with fruit flavored sugary drinks, this combined category indeed makes up the highest calorie intake in the American diet. However, I could have also combined any number of categories such as grain based desserts and yeast breads and said that was the number one source of calories. I think we are on the same team: America eats too many empty calorie foods…period! But where we part company clearly lies in the solution to our eating habits.

Though I respect CSPI and all the work they do, dumping sugary soda is not the solution to our obesity epidemic. Nor is capping off these beverages at 16 ounces ala Bloomberg (whom I also have respect for what he is “trying” to do). You might want to add dumping diet soda to your contest as a report today confirms we are consuming more diet beverages and LESS sugary beverages yet still our obesity rate is heading in the wrong trajectory. http://www.usatoday.com/story/news/nation/2012/10/11/diet-drink-consumption-increases/1624981/

My nutrition philosophy, which has worked with thousands of patients I’ve seen over my career, is to focus on adding in healthy foods while limiting, NOT eliminating decadent “foods”. To think that giving up soda at a movie, cake at a birthday party, candy at Halloween, or a beer and hotdog on a hot day at the ballpark is a sustainable behavior for most Americans is to be completely detached from and out of touch with the real world. We need real world solutions, not silly promotional stunts. I’d be happy to record a video for you called “Add in a real beverage instead”.

Respectfully,

David W. Grotto, RD, LDN

“We, the Vegetables”. Commentary on Our “Vegetative” State

Photo of kitchen garden courtesy of Burpee Seeds.

Spring is in the air and the smell of Spring makes me think of vegetables…I know, it’s a curse…

You’ve most likely have heard me drone on in the past about the disconnect between recommendations of vegetables for optimal health and the actual consumption of them. I often think, “What do we need to do [as health professionals] to get people to eat more produce? Maybe if vegetables got together and organized, like the toys did in Toy Story, people might be scared enough to start eating them…or at least treating them with some sort of respect?” 

Looks like George Bail Jr. from Burpee Seeds had similar thoughts when he drafted up this brilliant Bill of Vegetable Rights or “We, the Vegetables…” Enjoy!

Bill of Vegetable Rights or “We, the Vegetables”

It is our duty and our privilege to once and for all declare our Bill Of Rights as vegetables. For too long we have maintained a dignified silence in the face of human neglect, abuse and outright insult bordering on the libelous.

For 10,000 years we have nourished ungrateful people with uncountable harvests of delectable, nutritious food. Humankind must now grant vegetables the respect, consideration and care we merit.

For far too long, humans have relegated us to the side dishes of life. In the theatre of cuisine, vegetables serve as supporting players with mere walk-on roles, rather than the culinary stars we surely are.

The Congress of Vegetables hereby claims our God-given rights, and demands that people at last respect us for not only our nutritional value, flavor and texture, but also our distinctive personalities and panoply of colors and shapes.

Our human friends must acknowledge the indispensable role vegetables have played in their history and survival. Consider this: were it not for annual vegetables, people would not exist. Chew on that!

THE RIGHT TO RECOGNITION

Humans have an unhappy propensity for viewing vegetables as mere things, commonplace objects on offer in the produce department.

In the pantheon of human culture, we make a poor showing indeed. Where are the monuments, museums, poems, novels, films and symphonies inspired by vegetables?

Your Proust wrote several long, elaborate novels inspired by the bite of a madeleine—a cookie. Imagine how much greater his opus would be if he had dined on an artfully prepared eggplant.

What if, in Shakespeare’s “Hamlet,” the Prince’s soliloquy was addressed to an artichoke? Why not? Is the fear the artichoke would eat up the scenery? Or that Hamlet would eat up the artichoke?

In your entertainments, humans anthropomorphize—imbue with human traits—every kind of thing or creature. In ancient fables and today’s cartoons, humans take on the guise of all manner of creature—woodpeckers, rabbits, rodents, cats, spiders, elephants, dogs, chipmunks and sponges—all, evidently, plausible vehicles for human expression.

The names of your venerated sports teams are inspired by giants, birds, brigands, snakes, metals, jungle creatures, warriors and meat-packers.  In vain we look for the California Cauliflowers, Tucson Turnips or New York Yams. Cruelly, inexplicably, you refuse vegetables entrée to the garden of the human imagination.

Your diminution of vegetables diminishes all of us. So build temples to vegetables. Enshrine the role of vegetables in heroic legend. May a conqueror have the dignity to confess, “Were it not for vegetables, defeat would have been inevitable.”

THE RIGHT TO RESPECT

In so-called industrial western societies, vegetables play an ever-smaller role in people’s diet. Adults and children consume a fraction of the vegetables their bodies demand—a development with significant health and economic consequences.

Food manufacturers and restaurant chains apply considerable expense and ingenuity convincing the public to eat un-nutritious fat-laden products unworthy of the designation “food.”

Can it be difficult to convince the public of the appeal of us vegetables—which benefit your waistline, improve your appearance, enhance your well-being and prolong your life?

In the widespread agonizing over America’s obesity crisis, rarely mentioned is the problem’s antidote: Eat More Vegetables.

In the endless bickering over health insurance, did a legislator stand up in Congress to wax eloquent on wax beans and their vegetable cousins? Not that we remember. Looking for highly affordable health insurance? Remember this: “V for Vegetables!”

THE RIGHT TO CREATIVITY

Helping bring about vegetables’ wretched showing in the human imagination and daily diet is the way we are prepared.

In fact you humans don’t prepare vegetables, so much as abandon us to a merciless pot of boiling water or the brutality of the broiler. Our adieu is swift and unsentimental. Thanks to culinary creative destruction, you sacrifice our luscious color, sensuous texture, voluptuous flavor and spectrum of succulent sensations.  Still worse, your children come to regard vegetables as flavorless, lifeless things.

Today, it is true, vegetables enjoy a new vogue in culinary circles. At chic and expensive restaurants, we are transitioning from side dishes to entrées created with nuance and artistry.

Perhaps, for once, vegetables are escaping the stigma of being a duty, the anti-charisma bestowed on all things “good for you.” For once—for once!—we are being regarded as sensual, pleasurable and worthy of temptation.  “To the ramparts!”

On this first day of spring, these are the dreams—and the rights—of the undersigned:  a vegetable patch in every home, schoolyard and community garden.

Signatories:

THE BULB VEGETABLES

Chives, Garlic, Leeks, Onions, Scallions, Shallots, Water Chestnuts

FRUITED VEGETABLES

Avocados, Chayote, Cucumbers, Eggplant, Melons, Okra, Olives, Peppers, Squash, Tomatoes, Tomatillos

INFLORESCENT VEGETABLES

Artichokes, Broccoli, Cauliflower

LEAFY VEGETABLES

Arugula, Brussels sprouts, Cabbage, Chicory, Chinese cabbage, Collards, Cress, Dandelion nettles, Endive, Lamb’s lettuce, Lettuce, Nasturtium, Purslane, Radicchio, Savoy, Sea kale, Sorrel, Spinach

PODDED VEGETABLES

Beans, Peas

ROOTED VEGETABLES

Beets, Burdock, Carrots, Celeriac, Malanga, Parsnips, Radishes, Rutabaga, Salsify, Turnips

STALK VEGETABLES

Asparagus, Bamboo, Cardoon, Celery, Chard, Fiddlehead, Fennel, Kohlrabi

TUBEROUS VEGETABLES

Cassava, Crosne, Jerusalem artichoke, Jicama, Potato, Sweet potato, Taro, Yam

My Podcast Interview with Diana Dyer, RD Discussing the Health Benefits of Kale

I was inspired after my trip to Italy to dig out a great podcast interview from last year on the topic of Kale from my 101 Foods That Could Save Your Life radio program. I posted a recipe that uses “Black Cabbage” (aka Kale) in a traditional Tuscan dish called Ribollita last week – you may be inspired to make it after hearing my interview with Diana Dyer, RD, a kale lover and nutrition expert in the field of cancer care.

Diana Dyer is a wife, mom, long-time organic gardener and farmer, Registered Dietitian and author of the book A Dietitian’s Cancer Story. She is also a three-time cancer survivor and her website focuses on nutrition information for cancer survivors. She began a blog in June 2007 to share a wider scope of her thoughts about life as a cancer survivor, food and nutrition, gardening, recipes, our environment, and the urgent need for developing food systems that promote health not disease, ecological sustainability, and social justice.

In January 2009, she began the blog “365DaysOfKale” to write about her passion for one of her favorite (and mine) vegetable. The following is a podcast interview with Diana where we discuss the amazing health benefits of Kale. Enjoy!

All About Kale!