Watching Women's Health

A conspiracy to make us fatter?

For the fourth year in a row, the general health of Americans has not improved. A nationwide report, America's Health Rankings, says continued tobacco use and increasing obesity are the main reasons our health improvement has flat-lined.

This report began in 1990 and for many years showed steady gains in Americans' health. The trend stopped in 2005. Now, among world nations, the US ranks 28th in life expectancy, 20th in child well-being and 19th in mortality from treatable conditions.

Depending on how we respond to our current economic woes, our national health could get worse. Smoking and over-eating are time-honored ways of dealing with stress. But if we can find other ways of managing stress, some of which also save money, we could actually get healthier.

One change we can make is to eat more home-cooked meals, which are almost always cheaper and  healthier than fast food or restaurant fare. But even recipes from scratch have become more calorie-laden over time.

A recent analysis of recipes in Joy of Cooking looked at 18 recipes that have been published in every edition since 1936. In that time span, average calories per recipe increased 47%, and average calories per serving increased 63%.

Over the same time, our plates, bowls and silverware are growing ever larger, along with portion sizes  in restaurants.  Women's clothing manufacturers have adjusted sizes, so today's size 10 is a 1990 size 14. This could be a brilliant conspiracy to make us all fatter.

I have an Asian food cookbook that assigns Asian and American portions for each recipe. A typical example is "4 American portions — 8 Asian portions". So an American is expected to eat twice as much as an Asian. The problem is, a lot of us do.

Cooking at home will benefit us most if we pay attention to our portions and then downsize them. At home, we often serve up food casually, giving men a bit more than women, then going back for seconds as our tastebuds dictate, before we even know if we're still hungry.

A new lifestyle phrase I like a lot is "eating mindfully." We can get satisfaction from less food if we use smaller plates and bowls, arrange our food artfully, then eat slowly and appreciatively. That way, even an Asian portion might seem like enough.

Eat less, move more

The New England Journal of Medicine recently reported on long-term success of weight-loss diets. 811 overweight adults were randomized to one of four diets with differing amounts of of fat, protein and carbohydrates.

Each diet allowed participants to eat approximately 1500-1600 calories per day. 90 minutes of self-monitored exercise per week was also part of the program. The goal for each individual was a 750 calorie daily deficit, obtained by eating less and exercising more.

80% of participants completed the study. At 6 months, 1 year and 2 years of followup, there were no significant differences among the four groups in amount of weight lost or satisfaction with the diet.

After 2 years, participants had maintained an average weight loss of 4 kg (10 lbs). Measurements of blood pressure, waist circumference and cholesterol and glucose metabolism were all improved even though the amount of weight lost was modest.  

Obviously, participants were not able to achieve a 750 calorie daily deficit long-term or they would have lost more weight. Those who attended group sessions and stuck closer to study guidelines did have better individual results.

Diets claiming success through special food combinations should be recognized as gimmicks. These approaches sell books and fill hours of daytime TV, but ultimately mislead people into thinking they can lose weight without cutting calories.

What every overweight person needs is a long-term personal strategy for moving more and eating less.

I've seen the best results in my clinic when people honestly evaluate their habits and make changes they can live with over time. For starters, find a way to exercise that you actually enjoy and limit your access to foods that are your downfall.

Follow a diet that allows you to eat foods you like but accept you will be eating them less frequently and in smaller amounts. Stick with your plan and be patient.

Shortcuts — whether to lose weight, avoid traffic or fix a relationship — hardly ever work. Perhaps that's why the shortcut isn't the way we'd usually go.

How not to have a stroke

Many people say having a stroke is one of the medical events they want most to avoid. A British study provides some strategies for individuals who want to reduce their personal risk of stroke.

Researchers followed just over 20,000 men and women aged 40-79 for an average of 11 years. After controlling for other stroke risk factors, they identified four lifestyle habits that reduced risk.

These habits were: not smoking, some level of physical activity, moderate alcohol use and eating five fruits and vegetables daily. 

Physical activity was defined as either having an active job or getting at least 30 minutes of leisure exercise daily. Moderate alcohol use was having between 1 and 14 drinks per week.

Fruit and vegetable intake was verified by serum vitamin C levels. (How they determined serum vitamin C levels reflected food intake, not use of supplements, was not made clear.)

Each healthy behavior was found to reduce risk of stroke and the risk reduction was additive. If an individual practiced all four behaviors, risk of stroke was about half that of people without these habits.

More women than men practiced all four healthy habits. The four healthy habits provided stroke protection regardless of body mass index.  Refraining from tobacco had single greatest impact on women's stroke risk.

If you don't drink alcohol, few physicians would recommend that you start. But alcoholic beverages do have some health benefits for moderate users.

The key is to keep alcohol use moderate, since excessive use adds a host of other risks. Elsewhere, moderate alcohol use for women has been defined at a lower cutoff, somewhere between 7 and 11 drinks per week.

There are some stroke risks that we inherit and can't change. This study identifies four habits most of us can adopt to reduce whatever stroke risk we do have.