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Healthnotes Newswire (July 17, 2008)—A new study has shown that education, combined with healthy behaviors such as eating fruits and vegetables each day, exercising, and keeping a food diary, are key ingredients for maintaining weight loss. While it is well known that such behaviors can help a heavy person lose weight, few large studies have looked at behavioral interventions for keeping weight off, which is critical for overweight people with high blood pressure or high cholesterol.

Healthy habits are key

The study, known as the Weight Loss Maintenance Trial, compared various strategies for maintaining weight loss over a 30-month period. All 1,684 participants were 25 years or older and were overweight or obese and taking medication for high blood pressure and/or high cholesterol. Each participant was encouraged to attend 20 weekly group educational sessions, restrict calories, use a daily food diary, exercise daily at a moderate to intense level, and follow the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, and low-fat dairy foods, and limits saturated fat, total fat, and cholesterol.

After two and a half years, people who lost the most weight (18.7 pounds [8.5 kg] or more) had, on average, attended more weekly educational sessions (15), exercised more (159 minutes per week), kept more food diary records (4.2 records per week), and eaten more fruits and vegetables (3.6 servings per day).

“A combined emphasis on dietary intake and physical activity is important to both short- and long-term weight loss goals,” said the study’s author, Jack Hollis, PhD, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. “Behavioral strategies to modify these health behaviors are important components of weight-loss interventions because they emphasize the individual’s ability to monitor and regulate behavior, and target the barriers to both initial weight loss and long-term maintenance.”

Smart slimming strategies

People with high blood pressure, high cholesterol, and diabetes are at high risk for cardiovascular diseases such as stroke or heart attack, but weight control can help prevent and treat these conditions. There is no quick fix for losing weight or maintaining weight loss. If you are overweight, start by eating right, exercising, keeping stress in check and seeing your doctor.

Here are some tips for losing weight and keeping it off:

• Eat an abundance of fruits and vegetables based on recommendations from your healthcare provider. Limit saturated fat and sugar and avoid “empty” calories that provide little or no nutrition such as some processed foods, snacks, and beverages.

• Get enough exercise. A report from the Institute of Medicine suggests that adults need 60 minutes of moderate physical activity every day in order to optimize health and prevent disease; children need a minimum of 90 minutes.

• Keep a diary to track your daily food and calorie intake and help you learn how to identify eating patterns and make healthy choices throughout the day.

• Join a support group for health lifestyle behaviors or share the experience with friends and family, which can help improve your chances for success.

(Am J Prev Med 2008;35:118–26)

Healthnotes Newswire (July 17, 2008)—If you are chronically tired, getting moving might be just the thing to put some pep in your step. A new study has found that exercise can improve energy and lessen feelings of tiredness in people who suffer from persistent fatigue.

The effects of exercise on people with certain chronic medical conditions (heart disease and cancer, for example) are well documented, but less is known about its role in improving stamina in people suffering from fatigue without an underlying disease. The new study aimed to determine how exercise affects feelings of fatigue and energy in young people with fatigue unrelated to a medical condition.

In the study, published in Psychotherapy and Psychosomatics, 36 sedentary people with persistent fatigue ranging in age from 18 to 35 were assigned to a low- or moderate-intensity exercise group, or to a no-treatment control group. The low-intensity group worked out on a stationary bicycle at 40% of their peak oxygen consumption (roughly equivalent to walking at a leisurely pace) and the moderate intensity group at 75% of their peak oxygen consumption (about the same as walking at a fast pace), for 30 minutes three times per week for six weeks.

Slow and steady the best bet for persistent fatigue

People in the low- and moderate-intensity exercise groups had a 20% improvement in energy levels after six weeks compared with levels at the beginning of the study. Low-intensity exercise decreased feelings of fatigue by 65%, compared with 49% in the moderate-intensity group. The changes in fatigue and energy levels were unrelated to changes in aerobic fitness. The authors suggested that energy and fatigue improvements are due to the direct effects of exercise on the central nervous system.

Exercise professionals agree

“I have found that maintaining a consistent exercise routine keeps me feeling well balanced and energized,” says Rachel Weisz-Nesshoever, Aerobic and Fitness Association of America certified group exercise instructor in Narragansett, Rhode Island. “Exercise has a way of lifting the spirits and combating fatigue. Sometimes people who are chronically tired tend to avoid exercising. What they don’t realize is that—if it’s done right—exercise can actually give you more stamina and energy to do the things you want to do.”

(Psychother Psychosom 2008;77:167–74)

Healthnotes Newswire (July 3, 2008)—Eating less and exercising more leads to weight loss. But does it matter which diet you follow? A new study suggests that it does: researchers found that a low-fat diet might be more effective than a low-carbohydrate diet at preventing cardiovascular disease in the long term, as it has better effects on the blood vessels.

Atkins vs. the American Heart Association

The study, published in Hypertension, included 20 obese but otherwise healthy adults who were assigned to eat either a low-fat diet or a low-carb diet for six weeks. The low-fat diet was based on the American Heart Association’s diet, which limits calories from fat to 30% of total calories. The low-carb diet was based on the Atkins diet in which only 20 grams of carbs (approximately the amount in one medium apple or two slices of whole-wheat bread) are allowed each day. The diets were designed to provide the same number of calories.

At the end of the study, people in both groups had lost about ten pounds, and blood pressures had decreased, though they were normal throughout the study. Vascular ultrasound showed that blood vessels dilated more readily in response to increases in blood flow after six weeks on the low-fat diet, indicating improved vascular health. In the low-carb group, this measure of blood vessel health had worsened.

Low-Fat Best for Heart Health, but Low-Carb Can Still Help

The low-carb diet was not without benefits, however. Fasting insulin levels decreased in this group, indicating that their insulin sensitivity and ability to control blood sugar had improved. This suggests that the relative benefits of the two diets might be different in people with diabetes. In addition, triglyceride levels, which are associated with heart disease risk, fell in the people consuming the low-carb diet.

Weight loss can help lower the risk of high blood pressure and hardened arteries (atherosclerosis) and their associated conditions: stroke and heart attack. People with obesity will benefit from losing weight, and a low-fat diet might be healthiest for their blood vessels. In addition, quitting smoking, exercising, and reducing stress can all contribute to a lower risk of cardiovascular disease and a healthier life.

Obesity is a major risk factor for cardiovascular disease, the number one cause of disability and death in the developed world. In response to rising obesity rates, weight-loss diets and fads continue to rotate through awareness and popularity. An estimated 45% of women and 30% of men in the United States diet to lose weight, but their choice of diets—and their results—vary widely.

“The composition of diet may be as important as the degree of weight loss in determining the effect of dietary interventions on dietary health,” said the study’s authors in their conclusion. “Low-fat diets may confer greater cardiovascular protection than low-carbohydrate diets.”

More information about the American Heart Association’s low-fat diet recommendations can be found at www.americanheart.org.

(Hypertension 2008;51:376–82)

Healthnotes Newswire (June 26, 2008)—Yet more proof points to the importance of exercise and healthy eating to reduce the chance of developing diabetes in people at risk for the disease. With the onset of type 2 diabetes, the body’s ability to keep blood sugar (glucose) levels in check begins to diminish. Losing weight, exercising regularly, and eating well can help improve insulin sensitivity, protecting against diabetes or possibly halting its progression.

“In people with impaired glucose tolerance, group-based interventions targeting lifestyle changes such as diet and exercise produce a durable and long-lasting reduction in incidence of type 2 diabetes,” said the authors of a new study in the Lancet.

As part of the 20-year study, 577 people with impaired glucose tolerance (a prediabetic condition) were assigned to a control group (no intervention), or to one of three lifestyle intervention groups (diet, exercise, or diet plus exercise). The dietary intervention focused on eating more vegetables and consuming less sugar and alcohol. The exercise intervention concentrated on increasing leisure time physical activity.

The interventions lasted for 6 years; then the people were followed for 14 more to determine the long-term effects of the lifestyle changes on the risk of developing diabetes and related complications, including heart disease.

During the first 6 years, the people in the intervention groups had a 51% lower incidence of diabetes than did people in the control group. After 20 years, the intervention groups sustained a 43% lower diabetes incidence, and people in the intervention groups were diabetes-free for almost 4 years longer than people in the control group. The interventions did not seem to affect the risk of cardiovascular disease and other diabetic complications.

The World Health Organization estimates that at least 180 million people worldwide are living with diabetes. The risk of type 2 diabetes is higher in people with a family history of the disease; being overweight, having high triglycerides (a fat in the blood), and high blood pressure also raise risk.

Simple steps to protect your blood sugar

Dr. Leon Hecht, a New Hampshire naturopathic doctor specializing in diabetes, offers these tips for stabilizing blood sugar and avoiding diabetes and related problems.

• Focus your diet on whole foods, including vegetables, fruits, whole grains, lean animal proteins, legumes, nuts, and seeds.

• Eat a larger breakfast and a smaller dinner.

• Each day, make one meal a large salad with all the fixings.

• Decrease foods with flour in them—this means all cakes, cookies, and breads—as these foods will raise your need for insulin, causing you to store fat.

• Aim to lose abdominal fat, as weight in this area is a principal risk factor for type 2 diabetes.

(Lancet 2008;371:1783–9)

Healthnotes Newswire (June 19, 2008)—Childhood and teen obesity has leveled out, according to statistics from 2006. But it’s not time to celebrate yet—there is work to be done to reverse the trend and help kids become healthier. A new study reports that overweight and obesity rates in kids have not changed since 1999, giving us reason for both optimism and concern.

The study, published in the Journal of the American Medical Association, included data from the National Health and Nutrition Examination Survey, which has been conducted in multiple stages by the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC) since the 1960s. The researchers used health information collected from 2003 to 2006 for 8,165 children and adolescents ages 2 to 19. Body mass index (BMI) was calculated for each child and placed on the percentile graphs for boys and girls established in 2000 by the CDC.

What researchers found when the children weighed in

The surveys found:

• 11.3% of children and adolescents had an extremely high BMI, falling at or above the 97th percentile for their age

• 16.3% were obese, with BMI at or above the 95th percentile

• 31.9% were overweight, having BMI at or above the 85th percentile

• Children between 12 and 19 years old were more likely to have high BMI than younger children

• Mexican–American boys and girls and non-Hispanic black girls had higher BMI than non-Hispanic white boys and girls

When the researchers compared these percentages to those from previous surveys, no real change was seen since nearly a decade ago.

Based on data from older surveys, the trend in childhood overweight and obesity was clearly upward from 1980, when only 6.5% of children ages 6 to 11 were obese. By 1994 that number had risen to more than 11%, and by 2002, it had climbed to more than 16%, where it seems to have reached a plateau.

An opportunity to outpace obesity

Although the reasons for the change in trend is not yet known, we do know that some behaviors can help children avoid becoming overweight and obese. Taking steps when your children are young will help them develop positive habits that will keep them healthy into adulthood.

• Avoid fast foods, which are high in calories and fat. Home-cooked meals made with whole grains and lots of vegetables will help your family stay healthy.

• Watch the portions. Portion sizes of prepared foods are large and growing. Eat at home and try letting your children serve themselves. We tend to eat what’s put in front of us, but left to dish out their own food, children tend to take and eat smaller portions.

• Skip sugary soft drinks. These add empty calories in the form of high-fructose corn syrup, implicated in the rising trends in overweight, obesity, and type 2 diabetes.

• Keep kids active and limit screen time—including television, movies, and computers.

Healthcare professionals who work with children agree that these rates need to come down before we can breathe a sigh of relief. Said Cynthia Ogden, PhD, the study’s lead author and an epidemiologist at the National Center for Health Statistics, “It doesn’t mean we’ve solved it, but maybe there is some opportunity for some optimism here.”

(JAMA 2008;299:2401–5)

Healthnotes Newswire (June 5, 2008)—Studies have consistently shown a link between physical activity and lower breast cancer risk. The British Medical Journal reports that a new review of the research confirms this relationship and further finds that women who exercised the most had a 25% less breast cancer risk than women who exercised the least.

A lifetime of physical activity (compared with only several years or months) and vigorous physical activity (compared with mild or moderate) were associated with even greater cancer protection. The majority of studies suggest that the more a person exercises, the more benefits she might gain, but further research is needed to determine the optimal frequency, type, and duration of physical activity to reduce risk.

The association between physical activity and decreased cancer risk was strongest in postmenopausal women, women with a normal body mass index, and non-white racial groups.

One recent study found that women who exercised throughout their lifetime had a 23% lower risk of premenopausal breast cancer than women with less activity. The women’s activity levels were equivalent to 3.25 hours per week of running or 13 hours per week of walking. High activity levels from 12 to 22 years old were associated with the lowest risk in that study.

What’s the bottom line on exercise?

Physical activity may reduce cancer risk by lowering the levels of hormones such as estrogen, insulin, and insulin-like growth factor. These hormones are important for health but when present in excess can promote cancer development in certain people.

An Institute of Medicine report recommends that women exercise moderately for 60 minutes each day. This may include brisk walking (faster than three miles per hour) or running. Children should engage in 90 minutes or more of physical activity each day. Tips for a successful exercise plan include:

• Choose something you like to do so that you are more likely to stick with it.

• For some, social support may increase the likelihood of engaging in exercise; work out with a buddy to keep it interesting.

• Mix it up. Choose different physical activities so that you don’t get bored (a major reason that people stop exercising).

• Always check with a doctor before starting a new exercise plan, particularly if you are over age 40 or have a medical condition.

(Br J Sports Med 2008; doi:10.1136/bjsm.2006.028132; J Natl Cancer Inst 2008;100:728–37)

Healthnotes Newswire (May 29, 2008)—The President’s Council on Physical Fitness and Sport recently released a fitness test for people over age 18. The test helps estimate aerobic fitness level, muscle strength and endurance, flexibility, and body composition.

Better overall physical fitness helps lower the risk of cardiovascular disease, diabetes, high blood pressure, stroke, and certain cancers. It can also improve mood and help avoid accidents and muscle strain due to underused and inflexible muscle groups.

The new President’s Challenge and Adult Fitness Test was created to help people understand their own fitness level and make positive gains in physical fitness. The test is available as a downloadable booklet at www.adultfitnesstest.org/resources/testbooklet.pdf; individual results can be entered and evaluated online.

Each test section is followed by a “FITT” box which stands for Frequency—how often the exercise is performed; I—the intensity at which the exercise is carried out; T—time, or how long the session lasts; and T—type of exercise being performed. These boxes help users customize their fitness goals.

Aerobic Fitness

To test aerobic, or cardiovascular, fitness, choose a 1-mile walk or a 1.5-mile run. For the walk, after a brief warm up, have a partner time you walking at a brisk pace for one mile, and take your pulse immediately after finishing. For the running option, warm up with a light jog. Then, having a partner time you, run as fast as possible for 1.5 miles. Only attempt the run if you currently run for at least 20 minutes three or more times per week.

FITT tips

Frequency: Depending on the level of intensity, exercise three to five days per week.

Intensity: Moderate-intensity exercise is a brisk walk; vigorous activity is running.

Time: For moderate activity, do at least 30 minutes per session; vigorous activity should last for 20 to 30 minutes.

Type: Examples are walking, running, dancing, cycling, and swimming.

Muscular Strength and Endurance

These tests assess basic muscle strength required to carry out household or work-related tasks. Do half sit-ups by lying face-up on a rug or mat with knees bent at a right angle and feet flat on the floor. With palms flat on the floor, sit up and slide hands forward 3.5 inches (mark distance with masking tape on the working surface before starting). Having a partner time you, do as many sit-ups as you can in one minute. Then do push-ups with legs extended (men) or with knees touching the floor (women). Do as many push-ups as you can and record the number.

FITT tips

Frequency: Do muscular strength and endurance exercises on at least three days per week.

Intensity: Vary the intensity during the workout.

Time: Gradually increase the number of half sit-ups and push-ups until you can do three sets of 25 half sit-ups and three sets of 10 to20 push-ups.

Type: Master the test movements and then add other equipment (balance balls, weights, or elastic tubing).

Flexibility

These tests assess the range of motion of muscles needed to walk, lift, and step normally. Sitting on the floor, place a yardstick between the legs with feet about a foot apart. Place a piece of tape across the yardstick at the 15-inch mark. With fingers on the yardstick, slowly reach forward as far as possible. Record to the nearest inch that your fingertips can reach.

FITT tips

Frequency: Do flexibility exercises at least three days per week.

Intensity: Stretch to the point of tension, never to pain.

Time: Hold each stretch for 20 to 30 seconds, repeating three times.

Type: Begin with static stretches, gradually adding dynamic (moving) stretches. Try learning a practice that includes flexibility exercises, such as yoga and Pilates.

Body Composition

Body mass index (BMI) and waist circumference can be measured to estimate disease risk. To calculate BMI, weigh yourself and have a partner measure your height with shoes off. Wrap a flexible tape measure around your abdomen just above the hip bones; measure and record. Determine your BMI using the booklet’s chart.

A normal BMI is between 18.5 and 24.9; overweight is between 25 and 29.9; obese is greater than 30.

If you are overweight or obese, you can improve your BMI and waist circumference by making sure that you burn more calories than you eat. In order to lose weight, emphasize whole grains, fiber, fruits and vegetables; limit processed and high-carb, high-fat foods, and work in 60 to 90 minutes of daily moderate intensity exercise.

(www.adultfitnesstest.org/adultFitnesstestLanding.aspx; accessed 26 May 2008.)

Healthnotes Newswire (May 29, 2008)—If you want to help your kids do better in school, you can start by providing them with healthy food. A new study has found that a high-quality diet is linked to a higher level of academic performance in schoolchildren.

The researchers surveyed 5,200 fifth-graders and their parents for the study, published in the Journal of School Health, and used the information to calculate a score for each child’s diet that represented nutrient content; food variety; balance of protein, fat, and carbohydrate; and the amount of saturated fat, salt, and junk food eaten. Academic performance was measured using a standardized reading and writing test.

Children who had the highest diet quality scores—and therefore the healthy diets—were 41% less likely to fail the literacy test than children with the lowest diet quality scores, which indicated poor diets. Variety and adequate nutrition were linked with academic performance, and children who ate more fruits and vegetables and fewer calories from fat did better on the test.

“Dietary adequacy and variety were the specific factors found to positively influence academic performance, highlighting the value of eating a diverse array of foods in order to reach recommended levels of intake for nutrients and foods,” said study coauthor, Dr. Paul Veugelers, at the School of Public Health, University of Alberta, Canada.

Previous research showing that eating a healthy breakfast can help children do better in school influenced the widespread implementation of school breakfast programs. Other studies have found that being overweight or obese has a negative influence on academic performance, suggesting that school programs emphasizing both healthy eating and physical exercise might have the best effect on raising achievement in school.

Tips to build your kids’ brainpower

Parents can take the following steps to improve their children’s likelihood of doing well in school:

• Make sure your children get to bed on time and get plenty of sleep.

• Start them out with a healthy breakfast, including whole grains and fruits.

• Pack healthy foods to take to school, including whole grain bread for sandwiches, vegetables, fruits, and nuts and seeds.

• Make dinner a family affair and keep it wholesome and varied, introducing new foods to kids on a regular basis.

• Turn off the television, computer, and video games and encourage your kids to be active.

Establishing good habits early in life will help your children to be successful now and in the future.

(J Sch Health 2008;78:209–15)

Healthnotes Newswire (May 1, 2008)—Weight-loss diets can lead to a modest decrease in blood pressure among people with hypertension, confirms a recent review published in the Archives of Internal Medicine.

Modern weight-loss programs range from dietary changes, weight-loss pills, and surgical procedures. A recent review looked at seven studies that compared a weight-loss diet with usual care among 1,632 people who had high blood pressure. After 12 months, the people on the weight-loss diet saw a decrease in their systolic blood pressure (the top number of the blood pressure reading). A weight loss of 4 kg (about 9 pounds) was necessary to achieve a reduction of 6 mm Hg in systolic blood pressure.

High blood pressure and being overweight are both major risk factors for developing cardiovascular problems such as heart disease and stroke. Maintaining a healthy weight and lowering blood pressure can decrease cardiovascular disease risk.

“High blood pressure is estimated to lead to more than 7 million deaths each year, approximately 13% of the total deaths worldwide,” said lead author of the review, Karl Horvath, MD, and his colleagues from the Department of Internal Medicine, Medical University of Graz, in Austria. “Lowering blood pressure levels in hypertensive patients has been shown to be a very effective means of reducing patients’ cardiovascular risk, with a significant reduction in cardiovascular morbidity and mortality.”

How to lower your risk

Being overweight and having high blood pressure are two independent risk factors for cardiovascular disease. But when you have both conditions, the risk is even greater. The following lifestyle tips may help you lower your risk of cardiovascular disease by maintaining a healthy weight and keeping blood pressure down:

• If you’re overweight, lose weight to maintain your optimal weight, which can be determined based on your height, body composition, and level of physical activity.

• Regular exercise is important for keeping weight down and for lowering blood pressure. Adults should engage in moderate physical activity for one hour each day.

• Follow a healthy diet that is low in cholesterol, added salt, and total fat, and emphasizes fruits, vegetables, and whole grains.

• Don’t smoke. Smoking is a risk factor for cardiovascular disease and other serious diseases.

If you are overweight or have high blood pressure, see a doctor to determine your optimal weight and to discuss other lifestyle changes that can help lower your risk for cardiovascular disease.

(Arch Intern Med 2008;168:571–80)

Healthnotes Newswire (May 1, 2008)—Concerns over body image and fitting in might lead some teens to skip meals in an attempt to lose weight. A new study in Pediatrics suggests that this approach could backfire, though; teens who miss out on breakfast are actually more likely to be overweight.

The new study, as part of Project EAT (Eating Among Teens), gathered information from 2,216 adolescents about their eating and exercise habits, as well as dieting and weight-control behaviors to see what effect eating breakfast had on weight changes over a five-year period.

Although teens who ate breakfast regularly took in more calories in a day than their breakfast-skipping counterparts, they were less likely to be overweight. Eating breakfast more frequently was associated with lower body mass index (a measure related to body weight) in a dose-response fashion—meaning that the more often teens ate breakfast, the lower their body mass index. Breakfast-eating teens were also more likely to be physically active. “Breakfast habits may be important markers of an overall healthful lifestyle pattern in youth and … frequent breakfast consumption may impart important weight gain prevention effects,” the authors concluded.

It may seem counterintuitive that eating more can lead to weight loss. A possible explanation could lie in the body’s fat receptors. With extreme caloric restriction, the body makes more receptors on fat cells, causing them to gobble up any available fat when it’s eaten. People who eat more regularly and include healthy amounts of fat in the diet have less fat receptors on their cells; these people are likely to be thinner than “fad dieters.” Eating breakfast regularly can help keep fat receptors in check, leading to healthier weight. Breakfast eaters might also be thinner than teens who skip meals because the quality of their diet and their attitudes toward food might be better.

Results from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) showed that about 17% of children and adolescents ages 2 to 19 are overweight. Being overweight can lead to health problems including heart disease, diabetes, and the development of certain cancers. As more people are becoming overweight earlier in life, the incidence of these diseases is rising in the younger population.

According to the authors, “More emphasis should be placed on breakfast habits, especially among adolescents and young adults, when behavioral patterns are developing and stabilizing.”

(Pediatrics 2008;121:e638–45)