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July 16, 2001 -- Like many others around the world, psychologist Jonathan Haidt, PhD, recalls the first time he heard South African civil rights leader Nelson Mandela speak after his release from prison. Jailed since the early 1960s, Mandela emerged in 1990 urging reconciliation and cooperation in building a democratic, post-apartheid South Africa.

"Here was a man who had been imprisoned his whole life," says Haidt, assistant professor of psychology at the University of Virginia, in Charlottesville. "If anyone had a right to be angry, it was Mandela. Yet it was he who said that we all must work together."

Haidt recalls a sensation upon hearing Mandela's words, something subtle but undeniably real -- something similar, perhaps, to what you felt the last time you witnessed any act of remarkable generosity or largeness of spirit: a momentary pause, a flutter in the chest, a tingling in the hands.

"It gave me chills," Haidt recalls. "Just remembering it brings the sensation back."

That "sensation," Haidt believes, is neither an inconsequential response limited to one transitory moment of awe, nor a vague and indecipherable "feeling." Rather, the effect that comes from witnessing acts of charity or courage may be a profoundly important universal phenomenon worthy of scientific research, he says.

Haidt is a pioneer in studying the effects that good deeds and acts of valor have on those who witness them -- an effect he has termed "elevation."

While Haidt's work is still largely theoretical, he says parents can apply the principles of elevation in everyday interactions with children. For instance, he cites William Bennett's The Book of Virtues -- which describes models of virtuous behavior from history and literature -- as a potent source of what he calls "moral exemplars" for kind and virtuous behavior.

"No one thing is going to make much of a difference, but talking about virtues and vices when they arrive in daily life, plus modeling virtuous behavior yourself, can help to create a sense of a moral world," Haidt says.

Positive Psychology

The study of elevation by Haidt is part of a larger movement termed "positive psychology." It is a growing area of scientific inquiry focusing on aspects of human experience once considered off-limits to scientists: forgiveness, spirituality, gratitude, optimism, humor.

In part, this movement is a reaction to a long tradition within the psychological sciences of concentrating on what's wrong with an individual rather than what's right. That tradition has contributed to a tendency to attribute all human behavior to dark or dishonest motives, and given an excessive focus on mental disease and illness, at the expense of attention to mental health and happiness, Haidt and others say.

"Funding [for research] has been almost entirely for disease prevention," Haidt says. "There's lots of money for mental illness, but not for mental health. Positive psychology doesn't say that's wrong, just unbalanced. Even a little bit of research [on mental health] would have huge payoffs."

Psychologist Christopher Peterson, PhD, of the University of Michigan, agrees.

"Psychologists know a lot about stress and trauma," he says. "Why don't we know as much about what makes life worth living?"

Feb. 6, 2007 -- Teen sex -- oral or vaginal -- may have negative emotional consequences, especially for girls, according to a new study in Pediatrics.

Parents and health professionals should help teens prepare for and cope with the emotions attached to sex, say Sonya Brady, PhD, and Bonnie Halpern-Felsher, PhD.

The two researchers work at the University of California, San Francisco.

They studied a diverse group of 273 sexually active students at two California public schools between 2002 and 2004.

The students, 56% of whom were girls, all reported having had vaginal and/or oral sex by spring of 10th grade.

Of the students, 116 said they had had only oral sex, 43 said they had had only vaginal sex, and 114 said they had had both.

Consequences From Teen Sex

For the study, the students completed surveys every six months between 9th and 10th grade about the consequences they experienced from sex.

Overall, the teens reported positive consequences -- such as pleasure, popularity, and stronger relationships.

But a sizeable percentage noted negative consequences such as feeling used, getting pregnant, contracting a sexually transmitted infection, or feeling bad about themselves.

Those reporting at least one negative effect included 31% of those who had had only oral sex, 58% of those who had had only vaginal sex, and nearly 62% of those who had had both.

Gender Gap

Girls were more than twice as likely as boys to say they felt bad about themselves. Girls were also more than three times as likely to say they felt used as a result of having sex.

Those findings may partly stem from society's double standard about sex.

"These findings are consistent with research showing that boys are encouraged to be sexually experienced, whereas girls are encouraged to restrict sexual behavior," the researchers write.

Boys were more likely to say their popularity rose when they became sexually active.

But they were also more likely to report a pregnancy or sexually transmitted infection as a result of their sexual activity.

The reasons for those findings aren't clear. The boys may have been more sexually active, had more partners or risky sex, or been more willing to admit those consequences, say the researchers.

Researchers' Advice

Teens may need help in coping with the emotions that surround sex, the researchers say.

They encourage health professionals and other adults to talk with adolescents "about how decisions to engage in any type of sexual activity may have important consequences."

The study has limits. For instance, it's not clear if the results apply to all sexually active 9th and 10th grade students.

Also, the surveys didn't label the listed consequences as good or bad; the researchers classified consequences as positive or negative without teen input.

"We do not know whether consequences were viewed as positive or negative by adolescents," write Brady and Halpern-Felsher.

July 28, 2006 -- Kids mix up their nuts -- even kids with potentially life-threatening nut allergies.

Kids age 4-19 are, on average, able to identify only three out of 11 different nuts, find Los Angeles Children's Hospital researcher Ronald M. Ferdman, MD, and USC researcher Joseph A. Church.

Ferdman and Church invented the nut box. It's a clear plastic box with 12 nut samples -- peanuts in the shell, peanuts out of the shell, cashews, pecans, mixed shelled and unshelled pistachios, hazelnuts, slivered almonds, Brazil nuts, almonds, macadamia nuts, pine nuts, and walnuts.

The researchers tested 100 children, 37 of whom had nut allergies. In general, the youngest kids knew the fewest nuts. But older kids didn't do a whole lot better.

Overall, nine out of 10 kids could identify peanuts in the shell. After that, their nut IQ went downhill.

Only half the kids could identify peanuts out of the shell. Almost a third of them could pick out pistachios. Brazil nuts stumped them all -- and only two of the 100 kids knew a hazelnut (or filbert) when they saw it. Twenty-one of the kids thought all the nuts were peanuts.

Kids with nut allergies did much worse. Only one in three kids with nut allergies could identify out-of-the-shell peanuts.

"Many nut-allergic children lack the nut recognition skills that could protect them from future reactions," Ferdman and Church conclude. "The best strategy would incorporate actively teaching the affected child to recognize nuts so that he or she will be protected in every environment regardless of the skill of adult caretakers."

Even so, a lot of the allergic kids had a great strategy of their own. Nearly three-fourths of the kids with nut allergies said they would not eat the nut to which they were allergic -- and half of these kids said they avoided all nuts.

The study appears in the July issue of Annals of Allergy Asthma & Immunology.

Jan. 18, 2006 -- Don't cover babies with extra blankets or clothes during winter because of the risk of SIDS (sudden infant death syndrome).

That advice comes from the National Institute of Child Health and Human Development (NICHD), a branch of the National Institutes of Health (NIH).

The number of infants who die of SIDS rises during the winter, notes an NICHD news release.

"During these colder months, parents often place extra blankets or clothes on infants, hoping to provide them with more warmth. In fact, the extra material may actually increase infants' risk for SIDS," states the release.

"Unless there's a medical reason not to, infants should be placed on their backs to sleep, on a firm mattress with no blankets or fluffy bedding under or over them," the release continues.

"If a blanket is used, it should be placed no higher than the baby's chest and be tucked in under the crib mattress. The baby's crib and sleep area should be free of pillows and stuffed toys, and the temperature should be kept at a level that feels comfortable for an adult," states the release.

About SIDS

SIDS is the sudden, unexpected death of an infant who is less than 1 year old with no explanation for the baby's death after a thorough investigation.

Although rare, SIDS is the leading cause of death in infants between 1 month and 1 year of age. Every year, about 2,500 U.S. babies die of SIDS, according to the NICHD.

Most SIDS cases happen when babies are 2 to 4 months old, states the NICHD.

SIDS cases have dropped by more than half since SIDS education campaigns began more than a decade ago. However, SIDS is still more common among minorities than among whites, notes the NICHD.

Tips to Help Prevent SIDS

The American Academy of Pediatrics recently updated its recommendations on SIDS prevention. The updated guidelines, which appeared in the November 2005 issue of Pediatrics, are:

• Always place your baby on his or her back to sleep -- for naps and at night.
• Place your baby on a firm sleep surface, such as on a safety-approved crib mattress, covered by a fitted sheet.
• Keep soft objects, toys, and loose bedding out of your baby's sleep area.
• Do not smoke or allow smoking around your baby.
• Don't share your bed with your baby during sleep. Keep your baby's sleep area close to, but separate from, where you and others sleep.
• Consider offering a clean pacifier when placing your baby on his or her back to sleep.
• Don't let your baby overheat during sleep.
• Avoid products that claim to reduce SIDS risk. Effectiveness and safety of these products have not been thoroughly tested.
• Don't use home monitors as a way to reduce SIDS risk. There is no proof that these monitors decrease the occurrence of SIDS.
• Reduce the chance that flat spots will develop on your baby's head by providing "tummy time" when your baby is awake and someone is watching, changing the direction that your baby lies in the crib, and avoiding too much time in car seats, carriers, and bouncers.

Recently, British researchers warned that parents shouldn't share a couch with a baby during sleep, either.

Aug. 1, 2005 -- Next to your car, your home may be one of the most dangerous places for your child.

New research shows that aside from motor vehicle injuries, children are more likely to die from an accidental injury they sustained at home than in any other place.

The study shows that despite recent reductions in unintentional injuries at home, more than half of child deaths caused by accidental injuries in a known location happen at home. The top causes of accidental deaths among children at home were fires, submersion in water, suffocation, poisoning, and falls.

Researchers say child deaths due to intentional injuries and child abuse may get more attention, but child deaths caused by unintentional injuries at home occur far more often, and most could have been prevented with adequate safety measures and supervision.

Where Accidental Child Deaths Happen

In the study, which appears in the August issue of Pediatrics, researchers analyzed injury-related deaths among children under 20 from 1985-1997 using National Vital Statistics System Mortality Data.

The results show that more than 14,500 children died each year from unintentional injuries. Of those, 65% of the injuries were caused by motor vehicle injuries, railway accidents, or medical complications not coded for location of injury occurrence. The other 35% of unintentional injuries happened in a known location.

Of the more than 5,100 unintentional injuries that happened each year in a known location, more than half (55%) of the injuries happened at home.

Researchers say the rate of fatal accidents at home decreased by 22% from 1987 to 1997. The majority of unintentional injuries sustained at home were preventable, such as injuries due to fire, drowning, or poisoning.

The death rate due to accidental injuries in the home was highest among infants under 1 year of age and children aged 1-5 years compared with other age groups.

Boys were nearly twice as likely to die from unintentional injuries sustained at home as girls. Black children were also twice as likely to die from accidental injuries at home as white children.

Researchers say the racial differences in accidental child death rates may be due to substandard housing, lower levels of education, and poverty. They say strategies to develop and enforce health-based housing standards could dramatically reduce the number of accidental child deaths at home.

May 2, 2005 -- A new study suggests parents cannot count on the current movie ratings system to determine how much violence is in a film.

According to the study, some PG films have more acts of violence than the average R film.

In the May edition of the journal Pediatrics, Lucille Jenkins, MPH, and colleagues write that the movie ratings system "has failed to adhere to its definitions of the PG and PG-13 ratings, which state, 'horror and violence do not exceed moderate levels' and 'rough or persistent violence is absent,' respectively."

Most Movies Contain Violence

The researchers reviewed the 98 top-grossing PG, PG-13, and R films of 1994 and identified more than 2,000 violent acts. Every film but three was found to contain at least one act of violence, and more than a quarter of the violence in all ratings categories involved deadly force.

The average number of violent acts per film was 14 in the PG category, 20 in PG-13 and 32 in R. But six PG films had more violence than the PG-13 average and three had more violence than the R average. For example, the researchers identified 97 acts of violence in The Jungle Book, rated PG. In addition, the most violent films had a similar number of violent acts regardless of their rating.

A Call for New, Improved Movie Ratings System

The researchers say that the current movie ratings system is of little help in determining which films contain the most violence.

They say a new movie rating system should be created that determines the frequency and seriousness of the violent acts, the frequency and types of problematic language, the frequency and graphicness of sexual representations, etc.

Content Descriptors More Helpful

The current movie ratings system also offers "content descriptors" that specify the type of violence, language, and sexual content in every film it rates. The researchers say these descriptors provide a better indication of violent content than standard ratings.

"Our final recommendation is that the content descriptors be made clear and legible on all print advertisements and on all film, video, and DVD trailers, which would provide parents with meaningful descriptive ratings as well as the traditional age-based guidelines."

Dec. 21, 2004 -- Toys that make noise, encourage poking, or present the world in a new way may leave a lasting impact on the brain, according to a new animal study.

Researchers say the findings show that educational toys that foster the development of new learning skills may leave a permanent mark on young brains that can help them adapt as adults.

"This work shows the importance of investing in childhood experiences," says researcher Eric Knudsen, PhD, a professor at Stanford University School of Medicine, in a news release. "Early learning can have long-lasting effects on the architecture of the brain."

Early Learning Produces Lasting Effects

In the study, which appears in the Dec. 19 online edition of Nature Neuroscience, researchers looked at the impact of early learning in a region of the brain that owls use to create spatial maps based on sounds, such as the squeak of a mouse or rustling of leaves. The owls then use these maps to locate their prey.

Researchers outfitted a group of young owls with special goggles that shifted the world to one side. When the owls peered through the goggles, a sound coming from the left appeared to be straight ahead, which confused the owl and allowed its prey to escape.

Eventually the young owls learned to create new auditory maps that matched the shifted map to successfully capture their prey. When the goggles were removed, the owls shifted back to their original maps.

After the human equivalent of many years, researchers tested the owls again with the goggles and found that those who had used the goggles as young owls were able to once again adjust to the shift. But those who hadn't used the goggles were baffled.

Researchers say that brain cells in the mapping part of the brain in the owls that had used the goggles had formed connections with a completely new group of cells in the brain that links noises with the visual world. Having those extra connections allowed the animals to easily readapt to the goggles as adults.

Knudsen says the results indicate that brain regions that help children sense and interpret the world are dramatically affected by early childhood experiences, and educational toys that stimulate young minds and encourage them to explore the world in a new way may help build their brain for future tasks.

Sept. 9, 2004 -- Does it seem like your kids or spouse turn a deaf ear every time you talk to them? You may be choosing the wrong ear to shout in.

New research suggests that the right and left ears are not created equal; each one processes different types of sounds. The right ear is better for processing speech sounds, according to a report in the Sept. 10 issue of Science.

"Behaviorally, reaction time is faster and stimulus identification is more accurate when a subject's right ear is presented with speech-type stimuli," write co-authors Yvonne S. Sininger of the University of California, Los Angeles, and Barbara Cone-Wesson of the University of Arizona.

When we hear a sound, tiny hair cells in our ears amplify the noise, causing vibrations that are converted into signals the brain can understand. For the study, Sininger and Cone-Wesson examined how hair cells in babies' left and right ears responded to certain noises. Clicks represented speech; tones resembled music.

The researchers conclude that the right and left ears of infants have unique hearing capabilities. Specifically, the left ear responded more strongly to tones, and the right provided more amplification for speech-like stimuli.

Scientists have long known that the two sides, or hemispheres, of the brain process sound differently. The left side of the brain -- which controls the right ear -- dominates in deciphering speech, while the right side of the brain -- which controls the left ear -- leads in processing music-like sounds. Previous research has assumed that cellular discrepancies in each brain hemisphere were responsible for the differences in sound processing.

The findings suggest that the differences begin in the ears and serve to help the brain hemispheres specialize in sound processing.

"We always assumed that our left and right ears worked exactly the same way," Sininger says in a news release. "As a result, we tended to think it didn't matter which ear was impaired in a person. Now we see that it may have profound implications for the individual's speech and language development."

June 16, 2004 -- Seattle is the best major city for kids and Cleveland is the worst, according to a new ranking.

Among the 20 major cities on the list, only Seattle and Boston get an "A." Cleveland is joined by Detroit and Phoenix in getting a "C."

Des Moines, Iowa, tops the list of the next 80 largest cities. It gets an even better grade than Seattle: an "A+." So does Spokane, Wash. At the bottom of this list -- with a "C-," the worst grade given -- are Birmingham, Ala., Shreveport, La.; and New Orleans.

The ratings come from a group called Population Connection (formerly, Zero Population Growth), a group that sees overpopulation as the greatest threat to the world's quality of life. It supports family planning - including sex education -- and strongly opposes abstinence-only programs.

The ratings are based on a complex formula. The rankings consider several "indicators" of child welfare, including population indicators, health indicators, education indicators, and community indicators. These are:

• Percent change in population, an indicator of whether a city is growing or shrinking too quickly (5% of grade)
• Percent of population under 18, an indicator of whether a city's population is stable (2% of grade)
• Percent of births to teens (13% of grade)
• Infant mortality rates (9% of grade)
• Percent of eligible women getting public reproductive health services (1% of grade)
• Whether state laws require insurers to cover contraceptive drugs (7% of grade)
• Percent of children without health insurance (3% of grade)
• Percent of residents with a high-school diploma (11% of grade)
• Ratio of teachers that received training from Population Connection (6% of grade)
• Whether sex education is required, whether it is medically accurate, whether it discusses abstinence and contraception, and whether it is age appropriate (8% of grade)
• Student proficiency in reading (2% of grade)
• Student proficiency in math (5% of grade)
• Percentage of kids living in poverty (5% of grade)
• Percent growth in urbanized land (3% of grade)
• Violent crime rate (8% of grade)
• Recycling (12% of grade)

The report, Kid-Friendly Cities Report Card 2004, is available on the Population Connection web site. It offers detailed information on each city. It also features one thing each city is doing especially right.

Here are the ratings, and the grade assigned to each city. But Population Connection says the ratings and grades don't matter as much as what you do with them.

"Forget about the rankings. Ignore the grades," the report states. "We hope that [the report] will inspire families, individuals, activists, and officials to work together to create better communities -- instead of just moving to 'better' places."

Major Cities:
1 Seattle: A
2 Boston: A
3 San Diego: A-
4 San Francisco: A-
5 Minneapolis: A-
6 New York: B+
7 Denver: B+
8 Philadelphia: B+
9 Chicago: B+
10 Los Angeles: B
11 St. Louis: B
12 Washington, DC: B
13 Atlanta: B
14 Baltimore: B-
15 Houston: B-
16 Dallas: B-
17 Miami: C+
18 Phoenix: C
19 Detroit: C
20 Cleveland: C

Large Cities:

1 Des Moines, Iowa: A+
2 Spokane, Wash: A+
3 Madison, Wis.: A
4 Fremont, Calif.: A
5 Yonkers, N.Y.: A
6 Glendale, Calif.: A
7 Kansas City, Mo.: A
8 Indianapolis: A
9 Fort Wayne, Ind.: A-
10 St. Paul, Minn.: A-
11 Raleigh, N.C.: A-
12 Tacoma, Wash.: A-
13 Anchorage, Alaska: A-
14 San Jose, Calif.: A-
15 Greensboro, N.C.: A-
16 Portland, Ore.: A-
17 Lincoln, Neb.: A-
18 Lexington, Ky.: A-
19 Virginia Beach, Va.: A-
20 Grand Rapids, Mich.: B+
21 Rochester, N.Y.: B+
22 Pittsburgh: B+
23 Omaha, Neb.: B+
24 Louisville, Ky.: B+
25 Oakland, Calif.: B+
26 Honolulu: B+
27 Jersey City, N.J.: B+
28 Austin, Texas: B+
29 Wichita, Kan.: B+
30 Buffalo, N.Y.: B+
31 Irving, Texas: B+
32 Plano, Texas: B+
33 Colorado Springs, Colo.: B+
34 Scottsdale, Ariz.: B+
35 Augusta, Ga.: B
36 Aurora, Colo.: B
37 Sacramento, Calif.: B
38 Newark, N.J.: B
39 Charlotte, N.C.: B
40 Anaheim, Calif.: B
41 Riverside, Calif.: B
42 Arlington, Texas: B
43 Long Beach, Calif.: B
44 Garland, Texas: B
45 Milwaukee, Wis.: B
46 Akron, Ohio: B
47 Columbus, Ohio: B
48 Mesa, Ariz.: B
49 Tucson, Ariz.: B
50 Norfolk, Va.: B-
51 Jacksonville, Fla.: B-
52 Fort Worth, Texas: B-
53 Albuquerque, N.M.: B-
54 San Antonio: B-
55 Chesapeake, Va.: B-
56 Glendale, Ariz.: B-
57 Hialeah, Fla.: B-
58 Toledo, Ohio: B-
59 Santa Ana, Calif.: B-
60 Cincinnati: B-
61 Tampa, Fla.: B-
62 Corpus Christi, Texas: B-
63 Stockton, Calif.: C+
64 Lubbock, Tex.: C+
65 Richmond, Va.: C+
66 Tulsa, Okla.: C+
67 Nashville, Tenn.: C+
68 Las Vegas: C+
69 Montgomery, Ala.: C+
70 St. Petersburg, Fla.: C+
71 Fresno, Calif.: C+
72 Oklahoma City: C+
73 Mobile, Ala.: C
74 El Paso, Texas: C
75 Baton Rouge, La.: C
76 Bakersfield, Calif.: C
77 Memphis, Tenn.: C-
78 New Orleans: C-
79 Shreveport, La: C-
80 Birmingham, Ala.: C-

The report card comes out once every two years.

March 22, 2004 -- New research challenges the widely held belief that delaying the introduction of solid foods helps reduce an infant's risk of developing asthma and allergies later in life. German investigators found no evidence that this is the case, calling into question expert guidelines recommending such delays in high-risk infants.

But a separate investigation from the U.K. appeared to contradict the German conclusion, finding that preterm infants did seem to benefit from later introduction of solid foods. Both studies are published in the latest issue of the journal Archives of Disease in Childhood.

"The advice of expert committees in the U.S. and Europe to delay the introduction of solid foods to reduce allergy risk is based on very little evidence," childhood allergy specialist Abbas Khakoo, FRCPCH, tells WebMD. "In my mind, the (German) study finding no benefit to such a practice is among the best research that has been done in this area. Given what we know right now, the expert recommendations cannot be justified."

Four percent to 6% of children have food allergies, and according to the American Academy of Pediatrics, the rate of food allergies in children has increased in the past decade. Chicken eggs, cow's milk, peanuts, fish, nuts, wheat, and soy are the most common.

The Studies

In the German study, 642 children were followed from birth to age 5 1/2. Researcher Anne Zutavern and colleagues found no evidence that delaying the introduction of solid foods helped protect the children against asthma, allergies, wheezing, or eczema.

On the contrary, the researchers found that introducing eggs later in life increased the risk of eczema and preschool wheezing, which is a common predictor of asthma.

The U.K. study included 257 infants born prematurely and studied for a year following their birth. Researchers showed that the introduction of four or more different solid foods prior to age 4 months was associated with a threefold increased risk of eczema.

Morgan tells WebMD that it is probably safe to introduce one or two solid foods that are not linked to allergies prior to age 4 months.

AAP Recommendations

In an editorial accompanying the two studies, Khakoo called for further research, noting that these and other conflicting studies do not allow a definitive statement on the impact of solid food introduction on allergies.

"It is surprising that expert committees like the ones in the United States and Europe have taken stands on this issue when there is so little evidence to support the link," Khakoo tells WebMD.

The American Academy of Pediatrics' recommends that infants at high risk for allergies, asthma, and eczema be exclusively breastfed for at least six months. Further delays are recommended for the introduction of foods typically associated with allergies. The guidelines call for delaying the introduction of cow's milk for one year; eggs until age 2; and tree nuts, peanuts, and fish until age 3.

AAP nutrition committee member Frank Greer, MD, agrees that there is little scientific evidence to support the recommendations. He tells WebMD that he is currently revising an AAP policy statement of infant formulas and allergies.

"The data just aren't there to make a strong statement on this issue," he says.

Khakoo says he supports a recent World Health Organization statement calling for the exclusive breastfeeding of babies until they are at least 6 months old, but he adds that, "from an allergy point of view, we can't really say right now if it is beneficial."

Nov. 4, 2003 -- There is growing evidence that lifestyle factors influence heart disease risk as early as adolescence and even childhood. Two new studies suggest a link between early obesity, high cholesterol, high blood pressure, and an elevated risk of cardiovascular disease later in life.

The findings point to the importance of promoting healthy lifestyles early, says researcher Gerald S. Berenson, MD, who has followed a group of children living in Bogalusa, La., for the past 30 years to assess their risk for heart attacks and strokes.

His study and similar research from Finland are published in the Nov. 5 issue of TheJournal of the American Medical Association.

"These latest findings confirm what we have known for some time," Berenson tells WebMD. "Cardiovascular damage occurs early and is strongly linked to obesity and other known risk factors. It is never too early to be concerned about these risk factors."

Childhood Cholesterol and Obesity Matter

In the latest report on the Bogalusa study, Berenson and colleagues studied 486 people between the ages of 25 and 37 with at least three traditional risk factors for heart disease since childhood.

Although the young adults had no outward signs of heart disease, cardiovascular risk factors measured during childhood such as obesity and "bad" LDL cholesterol were associated with increased carotid artery wall thickness.

Carotid arteries on either side of the neck carry oxygen-rich blood away from the heart to the head and body. A thickening of the walls of these arteries due to fat and cholesterol deposits -- known as atherosclerosis -- is a marker for heart disease.

The researchers also found that adult measures of obesity, higher than normal LDL cholesterol levels, and systolic blood pressure were independent risk factors for carotid artery wall thickening. The men in the study had a higher overall risk than did the women, and blacks were at higher risk than whites.

Larger Study, Similar Findings

The second study included 2,229 white adults between the ages of 24 and 39 who were also first examined during childhood and adolescence. Lead author Olli T. Raitakari, MD, PhD, and colleagues from the University of Turku, Finland, found that risk factors measured between the ages of 12 and 18 were linked to carotid artery wall thickness prior to age 40. These risk factors included obesity, high levels of LDL cholesterol, high systolic blood pressure, and smoking, and they remained significant after adjustment for other potential risks.

These same risk factors, measured during adulthood, also predicted thickening of the carotid artery wall.

"Exposure to risk factors in childhood may contribute to the development of future atherosclerosis," Raitakari and colleagues write. "These findings suggest that the prevention of atherosclerosis ... could be most effective when initiated in childhood or adolescence."

Targeting Kids and Teens

In an editorial accompanying the two studies, Henry C. McGill Jr., of the Southwest Foundation for Biomedical Research, says there is little doubt that prevention programs aimed at kids and teens could have a dramatic impact on future public health.

"I think it will take massive cultural changes in what we eat and how we raise our kids to really see a reversal in the obesity epidemic, and I don't have any illusions about this happening tomorrow," he tells WebMD. "It has taken 40 years to make a significant impact on smoking, and I think that is the kind of major public effort we are talking about."

March 6, 2000 (Berkeley, Calif.) -- With the coming of spring, children are venturing outdoors again -- for soccer games, track and field events, and lunches on the schoolyard grass. But according to a trio of U.S. senators, those playing fields and lawns may not be good places for kids. Each year schools spray any number of different herbicides and pesticides on their grounds to control pests of all kinds, from yellow jackets to ants. But no one is paying enough attention to the harmful effects that such chemicals may have on the nation's schoolchildren, says Sen. Joseph Lieberman, D-Conn., one of the concerned legislators.

Like public areas anywhere, classrooms and playgrounds are inviting places for pests and annoyances: weeds, fleas, mosquitoes, flies, cockroaches, ants, wasps, mold and mildew, bacteria, rodents, and more. So, not surprisingly, schools use a variety of herbicides, insecticides, fungicides, rodent baits, disinfectants, wood preservatives, soil sterilants, and other chemicals to control these perceived threats. Although some schools have set their own standards, there is currently no overarching authority regulating what substances are used around school children, and this realization has caused mounting concern among parents, environmentalists, and government officials.

Lieberman is a sponsor of a U.S. Senate bill (H.R. 3275) to make school districts accountable for the pesticides and herbicides they use in and around schools. Workplaces have far stricter standards, he says, than do our schools, and he is also urging the Environmental Protection Agency (EPA) to step up surveys of what's used in and around the places where children spend most of their days.

According to a report released just over a month ago by the U.S. Government Accounting Office (GAO), "Use, Effects, and Alternatives to Pesticides in Schools," most states have no procedures for tracking or regulating pest-control procedures in schools (see link to GAO report). And in the past few years there have been sufficient numbers of children exposed to pesticides on school grounds to warrant concern. The GAO has tracked more than 2,000 instances of pesticide exposure in schools during a three-year period -- including more than a dozen cases that required hospitalization.

It's official: certain essential nutrients have gone missing from our kids' diets. That's according to the latest "Dietary Guidelines for Americans" from the U.S. government, which encourages children to eat more foods with these five nutrients -- calcium, fiber, magnesium, vitamin E, potassium -- as part of a balanced diet.

Your child may resist your efforts to help him eat better, so use the stealth health tip in each section to covertly include what he needs to develop a strong, healthy body and ward off common illnesses.

Calcium: Essential Nutrient for Bolstering Bone

Dairy foods are the best sources of calcium, a mineral that's vital for bolstering bone strength and development in growing children, and promoting normal heart and muscle function and blood clotting. Dairy foods are the best calcium sources; most kids need three servings a day.

• Serve up a bowl of whole-grain cereal topped with milk and fresh fruit for breakfast or snack.
• Make smoothies with milk, yogurt, or calcium-added orange juice or soy beverages and fruit.
• Top pancakes or waffles with a mixture of yogurt and fruit instead of syrup.
• Serve cheese and fruit for snacks or dessert; add a slice of hard cheese, such as cheddar, to sandwiches.
• Stir reduced-fat shredded cheese into scrambled eggs; sprinkle grated Parmesan cheese on popcorn.
• Serve milk with every meal; flavored milk and lactose-free milk have just as much calcium as plain. Nonmilk drinkers should sip calcium-fortified soy beverages or orange juice.
• Make pudding with low-fat milk and serve it to children instead of cookies, cake, and candy.

Stealth Health Tip: Microwave oatmeal with 8 ounces of milk instead of water.

Fiber: Essential Nutrient for Digestion

Fiber does more than keep a kid's digestive system in working order. Getting into the habit of including fiber-rich foods may curb your child's chances of developing heart diseaseheart disease and type 2 diabetesdiabetes down the road, too. Whole grains, legumes, fruits, and vegetables are generally fiber-rich.

• Serve sliced, raw or cooked vegetables with peanut butter or a yogurt-based dip.
• Include a fruit or vegetable with every meal and snack.
• Swap white bread for whole-grain types, and refined cereals for whole-grain choices, including oatmeal.
• Try whole-wheat pasta and brown rice as side dishes.
• Add chopped vegetables such as broccoli and carrots to marinara sauces.
• Focus on whole fruit for the most fiber, and limit juice intake.

Stealth Health Tip: Prepare your favorite chili recipe with twice the beans and half the meat.

Magnesium: Essential Nutrient for Growth

You probably know little about magnesium, even though it's a mineral that gets around. Magnesium participates in hundreds of bodily functions that keep a child's body running smoothly. Plus, magnesium contributes to a fracture-free skeleton by bolstering bone densitybone density. Nuts and seeds, legumes, and whole grains are packed with magnesium. So are certain fish.

• Encourage older children to munch on nuts and seeds, including pumpkin seeds, Brazil nuts, almonds, and cashews as snacks. (Chop nuts and seeds well for children under age 4.)
• Serve halibut, pollock, or haddock in place of meat or chicken.
• Experiment with magnesium-rich grains including quinoa and bulgur (cracked wheat).
• Start your child's day with whole-grain cereals or waffles.
• Prepare a stir-fry with vegetables and tofu, or half tofu and half chicken.
• Have hummus on hand for snacks and sandwiches.
• Encourage your kids to munch on flavored roasted soy nuts.

Stealth Health Tip: Puree cooked white, black, or navy beans and add to soups and stews to boost magnesium and fiber.

Aug. 4, 2005 - A daily multivitamin appears to do little to prevent infections in people 65 and over.

Older people are more likely to be deficient in vitamins and minerals. Lower nutrient levels can affect the immune system and make it harder to fight off infection.

Thus, it makes sense that a low-cost daily vitamin may help boost nutrient levels and help prevent infections.

But in a study by researchers at Aberdeen University in Scotland - reported in the August edition of the British Medical Journal -- a daily multivitamin did not help fend off infections in elderly people.

Vitamins for a Year

The researchers studied 910 men and women aged 65 or older who did not take vitamins or minerals. Participants all lived at home. They were placed on either a daily multivitamin and multimineral supplement or a placebo for one year.

Participants completed daily diaries noting any infections as well as any visits to doctors for infections. They also completed a quality-of-life questionnaire.

They were cautioned to avoid vitamins or minerals from other sources during the trial.

Little Effect Seen

The participants who took the multivitamin did not report fewer infections than the placebo group. There was also no difference in antibiotic prescriptions or hospital admissions.

In addition, quality of life was similar between the two groups.

The researchers write that it's possible that the vitamin doses provided in the study were inadequate to affect the immune system.

But at this point there is little evidence to suggest that a daily multivitamin helps boost the immune system and prevent infection in elderly people living at home.

Whether vitamin supplements would help other elderly people, such as those in nursing homes, is not known.

Last year's hottest supermarket craze -- low-carb products -- can be found in this year's clearance aisle. In a country obsessed with dieting, we've seen low-fat, fat-free, sugar-free, low-carb, and no-carb foods come and go with little impact on our girth. In fact, as a nation, we're heavier than ever.

So what new foods can you expect to see next on your supermarket shelves? WebMD asked the experts for their predictions on the latest trends.

As with most everything else, baby boomers are affecting how the nation eats, according to the NPD Marketing group. Boomers made their mark with fast food in the '60s, fern bars in the '70s, microwaves in the '80s, take-out in the '90s, and a trend toward healthier foods today, according to Harry Balzar, NPD's vice president. As the boomers age, they are coping with health and weight concerns that drive their eating patterns.

But boomers aren't the only ones behind changes in food buying habits.

"Increasing Latin populations have had an enormous impact on our food trends," says supermarket guru Phil Lempert, editor of the Facts, Figures and the Future newsletter. "They don't drink sodas with high-fructose corn syrup, and their diets are more abundant in fruits, vegetables, and fresh foods."

Among the once-exotic fruits and vegetables Hispanic cuisine is bringing to supermarket shelves are mangoes, cherimoyas, and a host of others, says trend tracker Linda Gilbert, president of the HealthFocus market analysis firm.

Another issue that continues to exert a huge influence on food manufacturers: our ever-increasing desire for convenience.

What's In, What's Out

To address the nation's health concerns, manufacturers are scrambling to reformulate foods that taste good but are lower in fat, salt, cholesterol, and sugar. Many are designed to help reduce cholesterol, prevent type 2 diabetes, and protect the heart.

Cholesterol-lowering, plant-derived chemicals called sterols are being added to orange juice, dark chocolate, yogurt, and margarine. The FDA has determined that some products containing sterols may carry a heart-healthy claim.

Another heart-protective ingredient comes from fatty fish and vegetable oils -- omega-3 polyunsaturated fatty acids. Higher intakes of food that contain these fats are an option for the heart-healthy conscious. Flaxseeds, walnuts, and their oils are among the richest sources of these fatty acids.

Another trend is foods that are enriched, fortified, or otherwise pumped up nutritionally. Manufacturers are adding nutrients such as calcium and folate to foods to help fill the nutritional gaps in our diets.

"This is great for minerals such as calcium for people who have trouble tolerating dairy," says Linda McDonald, RD, editor of the Supermarket Savvy newsletter. But she notes, "some food manufacturers have taken it too far." Eating some foods or beverages is similar to taking a vitamin pill -- and they don't always taste so great, she says.

At the same time, manufacturers are rushing to remove another ingredient, artery-clogging trans fats, from their products. Trans fats, also known as hydrogenated fats, are found in many processed foods and are made by turning liquid vegetable oils into solid products like margarine and shortening.

On the heels of the 2005 Dietary Guidelines' recommendation to limit trans fats, many manufacturers are reformulating products to reduce or eliminate them. In January 2006, all food labels will be required to list the amount of trans fats the foods contain. (In the meantime, be sure to read labels and compare brands.)

Of course, new food technology is about taste as well as health.

Consider slow-churned ice cream technology, which makes lower-calorie ice cream taste like the real thing without artificial sweeteners or fat substitutes. This means manufacturers can deliver the creamy taste of full-butterfat ice cream at a fraction of the calories -- now that's progress!

What's a holiday feast without a turkey or a roast with all the trimmings?

Indeed, that's what we love about the holidays -- all that rich satisfying food we don't often get. We load up the dinner plate with our favorites, then go back for more. Trouble is, those foods are full of fat. For people prone to heartburn, too much fat - and too much food - that is just asking for problems.

"Holiday foods are rich, festive foods, which is why we gravitate toward them," Elaine Magee, MPH, RD, tells WebMD. "These are foods we don't normally eat, and we tend to indulge in them. That's what gets us into trouble."

In the kitchen, there are tricks that cooks can use to lighten the fare. "No one's here to take away the traditional flavors," says Magee, who is WebMD Weight Loss Clinic's 'Recipe Doctor.' "We have a way of making mashed potatoes, gravy, stuffing, sweet potatoes, and pie a few pounds lighter (in fat) without compromising taste and integrity."

To make a lighter version of turkey gravy, use the brown bits at the bottom of the pan to flavor your gravy, she suggests. "Don't add too much of the actual fat, because the flavor is in the brown bits... not so much the 'drippings.' For creamy gravy, I use fat-free half-and-half or low-fat or whole milk instead of real half-and-half."

Magee's book Tell Me What to Eat if I Have Acid Reflux offers these suggestions:

• Most pumpkin pie recipes call for at least 1 cup of cream or evaporated whole milk and 2 eggs. Use evaporated skim and 3 egg whites to cut about 300 calories and 30-38 grams of fat.
• Buy brown-and-serve bread rolls instead of higher-fat crescent rolls to cut about 1,100 extra calories and about 100 grams of fat per dozen.
• Use light cream cheese instead of regular cream cheese in your holiday dips, spreads, and cheesecakes to cut about 16 grams of fat per cup of cream cheese.
• Use a great tasting fat-free sour cream (like "Naturally Yours" in the black-and-white cow hide container) for dips, spreads, and potato dishes to cut about 320 calories and about 35 grams of fat per cup of sour cream.
• Use reduced-fat cheese in cheese logs, appetizers, and side dishes to cut 36 grams of fat and 320 calories for every 8 ounces.
• Make dips, appetizers, and side dishes using a blend of real mayonnaise and fat-free sour cream. This cuts over 1,000 calories and 132 grams of fat per cup of mayo.

When we cut fat, we cut calories and heartburn, Magee tells WebMD. "The dish still tastes great, so there's still a feeling of satisfaction."

Her stuffing recipe, for instance, uses much less butter than traditional recipes -- with chicken broth serving as the substitute. Also, her recipe doesn't use spicy sausage. "Both the spices and the fatty sausage can be problematic for people," Magee tells WebMD. "A traditional recipe for dressing would have twice the fat that's in my recipe."

Here's another tip: When going to a potluck, take a "safe" dish - one you know you can eat without heartburn trouble. "You'll know there's at least one thing there you can eat," Magee says.

Here are three recipes from recipe doctor Elaine Magee, MPH, RD.

Creamy Green Bean Bake

Journal as: 1 cup vegetables without fat + 1/2 cup broth-based soup
OR 1/2 cup vegetable without fat + 1/2 cup vegetable with 1 tsp fat
OR 1/2 cup hearty stew, chili, or bean soup

4 cups lightly cooked French-style frozen green beans
10-3/4 oz.-can condensed Healthy Request cream of mushroom soup (or similar)
1/2 cup fat-free or light sour cream
1 tbsp diced pimento (optional)
1/4 cup canned chow mein fried noodles

• Lightly cook frozen beans.
• Preheat oven to 350 degrees.
• In a 1-quart casserole dish or 9x9 inch dish, combine condensed soup, sour cream, and pimento. Measure 4 cups of cooked green beans, add to dish, and stir.
• Bake for 20 minutes or until bubbly. Sprinkle chow mein noodles over the top and bake 5 minutes more.

Makes 6 servings.

Per serving: 102 calories, 4 g protein, 16 g carbohydrates, 2 gram fat, 2 mg cholesterol, 3 g fiber, 337 mg sodium. Calories from fat: 20%.

Dec. 1, 2005 - More than half of U.S. adults still do not get a minimum amount of daily exercise recommended to help stave off obesity and chronic disease, according to government figures released Thursday.

The report shows that Americans were only slightly more likely to exercise regularly in 2003 than in 2001. That's troubling to public health experts, who have long pegged Americans' inert lifestyles as a major factor in rates of obesity that now top 30%.

Government health recommendations call for adults to engage in at least 30 minutes of moderate physical activity five days or more per week. That includes walking or bicycling, but also minimally exertive household chores like gardening or vacuuming.

Just under 46% of Americans surveyed in 2003 said they get that amount of exercise, up 0.6% from 2001, the CDC reported Thursday. One-sixth of adults reported that they participate in moderate physical activity for less than 10 minutes per week.

Obesity and Exercise

Lack of regular exercise is closely intertwined with obesity, and both factors are known risks for the leading killers of American adults, including heart disease, diabetes, and several forms of cancer.

Sixty-four percent of Americans over 20 years old now qualify as overweight, while 30% are classified as obese, according to government figures.

Sanjeeb Sapkota, MD, a CDC epidemiologist who co-authored the physical activity report, called the 2001 to 2003 results frustrating. But he pointed out that states where physical activity rates improved outnumbered those where they declined, suggesting some progress in approaching national public health goals.

"The frame we looked at is two years, and two years is not a lot of time to change behavior," he tells WebMD.

The Role of Environment

Still, overall exercise rates remain low in a nation where daily suburban highway commutes and office cubicles long ago replaced farm and factory work, and television, computers, and video games now overwhelmingly dominate leisure time.

Those forces have largely overwhelmed messages extolling the benefits of regular exercise, says Tegan Boehmer, PhD, an epidemiologist at the St. Louis University School of Public Health.

While almost all adults know exercise is a good idea, many spend too much time commuting to and from work to set aside time. Public health researchers have turned increasing attention to the large number of suburban communities with no bike paths, open spaces, or even sidewalks.

"There's just not access to the things that even make you think about being physically active. We've almost transitioned it out of our lives and our daily thinking," says Boehmer, who conducts research on the connection between obesity and the made-made environment.

"Right now there's conflicting messages between the public health messages we send people and the opportunities to actually do it," she says.

Nebraska Gets Active

Just 34% of adults in Nebraska reported regular physical activity in 2001, putting the state among the worst in the nation. But activity rates jumped more than 10% by 2003, far more than in any other state. At the same time, the number of the state's sedentary adults dropped by half, according the CDC's report.

State health officials said they were pleasantly surprised by the drastic improvement and could not point to any specific cause.

Money from states' multibillion settlement with tobacco companies helped extend public health departments to 20 locations around the state. Public campaigns urging adults to be more active with their kids may also have helped, says said Joann Schaefer, MD, Nebraska's chief medical officer.

"It is a constant message that we send, I'm not kidding you. We harp on it," she says.

Schaefer speculates that part of the reported improvement may also come from experts' redefinition of what constitutes exercise. Adults who spend enough time gardening or walking through shopping centers -- and not necessarily on a gym stair climber -- now qualify as physically active.

"I think the whole idea of act vs. exercise has been introduced and sold," she says.

Neither Nebraska nor the CDC yet has evidence that increases in mild activity will translate to lower disease or obesity rates.

Aug. 24, 2004 -- While the world's elite athletes go for the gold at the Olympics in Athens, endurance records have been shattered on the other side of the globe. And although these unlikely "competitors" were lab mice, they may shed new light on the mechanics of physical endurance, metabolism, and weight.

In a pair of experiments in Southern California, researchers used genetics to create "marathon mice" that left normal mice in the dust in head-to-head endurance trials.

The tests were done by two separate research teams at the University of California San Diego and the Howard Hughes Medical Institute. The studies took different approaches using genetically altered mice.

University of California San Diego biology professor Randall Johnson, PhD, led one of the research teams. They bred mice without the "HIF-1" gene, which is needed to allow muscles to work when there is little oxygen available or when there is a shift from aerobic to anaerobic metabolism.

Most muscle activities are powered with oxygen or aerobic energy; this allows muscles to work at a consistent level of intensity. During the anaerobic process, muscles can work at a higher level of intensity by using other sources of fuel; this process takes over when there are low oxygen levels such as during a short or intense sprint.

The genetically altered mice showed greater endurance; they swam nearly 45 minutes longer and ran 10 minutes longer uphill on a treadmill than normal mice.

However, the normal mice won out in a downhill treadmill test. Running downhill apparently takes more anaerobic metabolism than the genetically altered mice could muster.

Unfortunately the marathon mice couldn't maintain their pace forever. After four days of exercise tests, their muscles were significantly more damaged and they couldn't keep up with normal mice at running or swimming.

"It's a double-edged sword," says Johnson in a news release.

The study findings could lead to identifying ways to help maximize muscle endurance and may help medical researchers understand genetic disorders such as McArdle's disease, which makes it hard to use anaerobic metabolism. McArdle's patients suffer from severe muscle pain and cramps during normal everyday activities because of abnormal muscle metabolism.

Another set of marathon mice were developed at the Howard Hughes Medical Institute in La Jolla, Calif. Researchers led by Ronald Evans altered a mouse gene to boost the activity of a protein called "PPAR-delta."

Enhancing PPAR-delta activity transformed the mice's muscles, increasing their "slow-twitch" muscle fibers and decreasing their "fast-twitch" muscle fibers. Slow-twitch muscle fibers are muscles that contain a large number of energy-converting machinery; this allows them to be fatigue resistant. These muscles are used during endurance exercise. Fast-twitch muscle fibers tire rapidly; they are used during rapid burst of energy or sprints.

The genetically altered mice ran about twice as long as the normal mice before tiring.

They also resisted weight gain, even when they ate a high-fat, high-calorie diet and were only as active as normal mice.

"The increased number of fat-burning muscle fibers appears by itself to be protective against a high-fat diet," says Evans, in a news release.

If drugs are developed to enhance PPAR-delta in humans, it could let people "increase their metabolism to burn more energy," says Evans.

Of course, even if science makes it possible, athletes would likely be banned from tweaking their genes to improve their physical endurance.

Both studies appear today in the online edition of the journal Public Library of Science Biology.

Trying to get in shape? Then don't depend on your bathroom scales. To get the most accurate measure of your progress, experts say, you need to track your body fat as well as your weight.

"Most people focus only on losing weight, not on the fat," Cedric X. Bryant, PhD, chief exercise physiologist with the American Council on Exercise, tells WebMD.

"Preserving lean tissue and losing body fat -- that's what you need to strive for," Bryant says. "The only way to know how you're doing is through some form of body-composition assessment."

You know about the old standard measuring tools, like the body mass index (BMI) and the tape measure. And thanks to today's technology wizards, some very good new devices are available to measure your body fat.

To learn which are worth your time and money, WebMD got ratings from Bryant and from two more top exercise physiologists: Megan McCrory, PhD, an energy metabolism scientist with the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston; and Len Kravitz, PhD, senior exercise physiologist for IDEA Health and Fitness Association.

The BMI Test

This is a simple calculation, using the most basic tools -- your height and weight. Plug these numbers into a BMI calculator to learn whether you are obese, overweight, or normal weight.

The BMI was developed using large, population-based studies. Though it doesn't address percentage of body fat or muscle, it helps health care professionals quickly assess which patients may be at risk of health problems linked to excess weight.

Price: None.

The verdict: Free and readily available; good for assessing health risks but doesn't measure body-fat percentage. If you are short, or very muscular, results tend to be less accurate.

"It's a good starting point, a really good way to get a basic estimate of whether you are overweight or not," says Bryant. "BMI tends to correlate pretty closely with health risks associated with being overweight or obese."

The experts' grade: D. "The BMI doesn't give you body fat measurement," says McCrory. "But if gives an excellent BMI measurement!"

Body Fat-Measuring Scales

"Bioelectrical impedance analysis" has been added to traditional bathroom scales. The scales send a harmless electrical current up through your body to "read" the amount of fat body mass and lean body mass -- calculating your percentage of body fat.

Price: $50 to $100 per scale.

The verdict: Convenient, but not always the most accurate.

"The problem is, these devices are very sensitive to hydration -- how much fluid is in your body," Bryant tells WebMD. So it's important to strictly follow the guidelines for weighing yourself -- time of day, fluid and food intake. Even your menstrual cycle affects this reading. "However, with all this factored in, the scales are an easy, at-home way to keep track of your weight and fat-loss progress."

There also are handheld versions that use this same technology. Just remember: You get what you pay for. Higher price equals greater accuracy.

Grade: C+. "Even though they may not be accurate, it may be good for tracking changes with a diet and exercise program," says McCrory. "Just keep in mind that the scales might be off by 5%, plus or minus. Follow the instructions carefully. Taking a shower beforehand really makes the reading inaccurate!"

March 12, 2007 -- After weight loss surgery, some patients risk brain damage from vitamin B-1 deficiency, researchers report.

Too little vitamin B-1 -- thiamine -- causes a syndrome called Wernicke's encephalopathy. It's most often seen in malnourished alcoholics.

If treated right away with vitamin B-1 shots, patients quickly recover. But if the syndrome isn't recognized quickly, it can result in permanent brain damage.

And that can be a problem, says Wake Forest University researcher Sonal Singh, MD. Singh and Abhay Kumar, MD, of the University of Iowa, found 32 reports of Wernicke's encephalopathy in weight loss surgery patients.

"Early diagnosis is essential," Singh tells WebMD. "Yes, thiamine shots are helpful. But you get full recovery only when it is given early. Once [advanced symptoms] develop, there is going to be neurological damage."

Singh and Kumar report their findings in the March 13 issue of the journal Neurology.

Tricky Symptoms

Wernicke's encephalopathy has three classic symptoms: jerky, uncoordinated movement; uncontrollable eye movements; and mental confusion.

That sounds easy to recognize. But not all weight loss surgery patients who develop the syndrome get all three symptoms. And some patients have unusual symptoms, such as hearing loss, weakness, convulsions, and tingling or numbness in the arms and legs.

Symptoms of Wernicke's encephalopathy most often occurred four to 12 weeks after weight loss surgery. However, one case began a year after surgery, and another started only two weeks after surgery.

There's one major warning sign for weight loss surgery patients: frequent vomiting. Twenty-five of the 32 reported patients were vomiting after their surgery.

However, not all the patients had this symptom. And many developed vitamin B-1 deficiency even though they were taking oral thiamine supplements, suggesting that deficiencies in other nutrients may also play a role.

How often do weight loss surgery patients get Wernicke's encephalopathy? That isn't yet known. Singh says it's an issue that clearly needs study.

"Maybe giving shots of thiamine after surgery would prevent this," Singh says. "We might do it preventively rather than waiting for symptoms to appear. That, too, needs to be studied."

Bariatric surgeon Ioannis Raftopoulos, MD, assistant professor of surgery at the University of Pittsburgh, says he regularly monitors thiamine levels in his patients and routinely gives his patients thiamine supplements, either orally or by monthly injections.

The result: Raftopoulos says he has never had a patient develop Wernicke's encephalopathy.

"This kind of thing only happens when a patient has been vomiting for weeks," Raftopoulos tells WebMD. "That kind of neurological impairment means a patient has had a lot of problems for a long time. That is why the key here is patient follow-up. All my patients have my personal beeper number so they can contact me immediately, before there is a serious problem."

Singh says patients should immediately call a doctor if, after weight loss surgery, they have coordination problems -- especially changes in their gait -- or any changes in their hearing or vision.

July 27, 2006 -- Women may pay a higher health price for obesityobesity than men.

Compared to men, "women suffer a disproportionate burden of disease attributable to overweight and obesity," write Peter Muennig, MD, MPH, and colleagues in a new study.

Muennig works in New York at Columbia University's Mailman School of Public Health. His study appears in September's American Journal of Public Health.

The study used information from two sources:

• U.S. death data from 1990-1995.
• A 2000 survey on health and quality of life for more than 13,600 U.S. adults.

The health survey included participants' height and weight. Muennig's team used those numbers to calculate BMI (body mass index), which relates height to weight.

A BMI of 25 to 29.9 is overweight; a BMI of 30 or more is obese.

Gender Gap

Being overweight or obese has been tied to a greater risk of health problems, including heart diseaseheart disease, high blood pressurehigh blood pressure, type 2 diabetesdiabetes, and some cancers.

Muennig's team crunched the death, health, and quality-of-life numbers. Their key finding: Extra weight seemed to be a bigger burden in terms of health and quality of life for women than for men.

Health-related drops in quality of life were:

• Nearly four times steeper for overweight women than for overweight men.
• A bit more than twice as great for obese women as for obese men.

But neither sex escaped the effects of excess weight.

The study also came up with estimates for the number of additional deaths per year among those carrying extra weight:

• 57,000 more deaths among overweight and obese men than among normal-weight men
• 107,000 more deaths among overweight and obese women than normal-weight women.

Study's Limits

The study has several limits, the researchers note.

First, they don't know if obesity was solely responsible for the results.

It's hard to prove cause-and-effect in big statistical studies like this one. Sometimes it's difficult to know which came first -- the health problems or the excess weight.

Also, participants reported their own height and weight. Self-reports aren't always accurate.

Lastly, the researchers excluded people without complete height and weight data. Those people may or may not have been exceptions to the findings -- there's no way to know for sure.

The study doesn't suggest all overweight women are headed for health problems. Not everyone who's overweight is unhealthy. And being lean doesn't guarantee good health.

Feb. 3, 2006 -- Leading birth defects specialists say maternal obesity during pregnancy puts both mom and baby at risk, and they are calling on health care providers to spread the message.

Studies indicate obesity doubles a woman's chances of having a baby with neural tube defects, and even adequate folic acid intake does not fully protect against the increase in risk.

Compared with normal-weight women, obese women have a greater risk of developing complications during pregnancy. Their babies are also more likely to be admitted to neonatal intensive care units.

In a report published today, the public affairs committee of the Teratology Society officially declared obesity a pregnancy risk factor, adding that women should be told about the risk in the same way that they are warned about the dangers of smoking and drinking alcohol during pregnancy. The Teratology Society studies the causes and processes of birth defects to improve diagnosis and prevention.

"Just as clinicians have been encouraged to counsel women who are pregnant or may become pregnant about folic acid, smoking cessation, and avoidance of [alcohol], [we] recommend that clinicians counsel women about appropriate caloric intake and exercise," the report noted.

Pregnancy Complications and Outcomes

Committee chairman Anthony R. Scialli, MD, tells WebMD that the epidemic rise in obesity helped bring the issue to the forefront.

Nearly two-thirds of Americans are considered overweight and one in three are obese, meaning they have a body mass index of 30 or greater.

A woman who is 5 feet, 5 inches tall would be considered obese if she weighs 180 pounds or more. A 5-foot-8-inch woman would be considered obese if she tips the scales at 200 pounds or more.

The new report outlined specific risks associated with obesity during pregnancy, based on findings from recent studies.Among the report's highlights:

• Obese women have an increased risk of infertility and pregnancy-related complications, including hypertension, gestational diabetes, and blood clots.
• Women who are obese are more likely than women who aren't to require cesarean sections.
• A study from France found that hospital costs for prenatal care were dramatically higher for overweight and obese women. Costs were fivefold to 16-fold greater than for normal-weight women, depending on how much extra weight the women carried.
• The committee recommended that obese women should try to lose weight before becoming pregnant. But it warned women not to diet during pregnancy, noting that "adequate nutrition is important for pregnant women and women planning pregnancy."
• Some recent reports suggest that women with gastric banding can have normal pregnancies and better pregnancy outcomes than women who do not have the surgery, but the committee concluded that "it appears reasonable to recommend that pregnancy be delayed until surgery-related weight loss has stabilized."

July 11, 2005 -- Severe obesity may be harder on men than on women, new research shows.

That's what scientists saw in a small group of severely obese people -- 22 men and 34 women. Data came from blood samples and endurance tests on stationary bikes.

The results show that severely obese men had more trouble handling carbohydrates and less endurance than the women.

"It appears that carbohydrate intolerance is more common in obese men, which would cause them to be less physically fit than obese women," says researcher Emile Dubois, MD, PhD, FCCP, in a news release.

The findings appear in the July issue of Chest.

Fat Location May Matter

The participants were enrolled in a hospital's weight management program. They each had a body mass index (BMI) of at least 40.

Obesity is defined as a BMI of 30 or more. A person who is severely obese has a BMI of greater than 40. Obesity is the principle driver for the metabolic syndrome (a cluster of risk factors that increase the risk of type 2 diabetes and heart disease) and diabetes, they write.

Obesity-related heart disease and diabetes risk are specifically related to upper body fat distribution, they add.

In men, obesity tends to gather around the upper body. In women, it's often centered in the lower body, write Dubois and colleagues.

"It is possible that women are better equipped for energy storage due to their inherent need to feed their offspring," write Dubois and colleagues.

Dubois works in the pulmonary diseases department of the Hospital Reinier de Graaf Groep in the Netherlands.

Obesity Common in the U.S.

About one in three U.S. adults aged 20 or older (60 million people) is obese, according to the CDC.

Adding those who are overweight but not obese (BMI of 25-29.9), the figure rises to 65% of the same age group.

The CDC does not provide statistics on severe obesity.

"Obesity can lead to impaired lung function, sleep disorders, [heart] disease, and other health conditions," says Paul Kvale, MD, FCCP, in the news release.

"Therefore, health care providers should encourage their obese patients to lose weight and assist them in doing so in a healthful manner," he says.

Kvale didn't work on the study. He's the president of the American College of Chest Physicians.

Dec. 13, 2004 - Most men who remarry let their weight and health go by the wayside and essentially become couch potatoes, Boston scientists have found.

Epidemiologist Patricia Mong Eng, ScD, and colleagues examined the dietary and health behaviors of 40,000 U.S. men aged 40 to 75. Men answered questions every four years on their marital status, diet, and health.

Compared to men who remained single after a divorce or spouse's death, remarried men increased their body mass index (BMI) - an indirect indicator of body fat. In addition, remarried men worked out much less. The study is published in the Journal of Epidemiology and Community Health.

The good news is that remarried men actually eat better than those who remain single. Remarried men, particularly younger, widowed men, tend to eat a lot more vegetables and lean poultry and drink less alcohol and fewer sugary drinks.

On the other hand, divorce or death of a spouse had detrimental effects on the health habits of men who never remarried. Overall, marital breakup, or the death of a spouse, led to the consumption of more fast food compared with men who stayed married. Over time, vegetable intake decreased and alcohol consumption increased in both divorced and widowed men.

The results are consistent with previous studies that show that marital breakup or dissolution resulted in higher alcohol intake and weight loss, while entry into marriage promotes weight gain and less alcohol use.

Researchers say doctors should be aware of a man's marital status because marital breakup has a negative overall impact on a man's health.

Sept. 30, 2004 -- Counting calories? Try starting your next lunch with a salad.

A new Pennsylvania State University study suggests that eating a salad as a first course at lunch can make people feel full enough to reduce their calorie consumption for the rest of the meal.

But not just any salad will do. The best bets have plenty of vegetables and few calories, says researcher Barbara Rolls, PhD, and colleagues.

Rolls' team studied 42 women who were about 26 years old, on average. Participants were in good health, regularly ate three meals per day, and were not dieting, training as athletes, pregnant, or taking medications that can affect appetite.

The Menu

Participants ate lunch at a lab once a week for seven weeks, sitting in private cubicles.

The basic menu was the same each time: a salad, followed by cheese tortellini with tomato sauce. The women were also given a liter of water to drink, if they wished.

The rules: Eat the entire salad first, and then have as much pasta as desired.

Six different salads were served over the course of the study. All had the same basic ingredients: vegetables (iceberg and romaine lettuce, carrots, cherry tomatoes, celery, and cucumber) tossed with Italian dressing and shredded mozzarella and parmesan cheese.

Low, medium, and high-calorie versions were tested.

The high-calorie salad used full-fat dressing and cheese. The medium-calorie salad used reduced-fat dressing, and the low-calorie salad featured fat-free dressing and light cheese.

Participants said the high-calorie salad tasted better than the low-calorie version, but taste didn't appear to make much difference.

Salad Strategies

The women tried small and large portions of each salad. The small portion was 150 grams, or about 1.5 cups by volume. The large portion was 300 grams, or about 3 cups.

Participants ate the fewest calories after starting meals with the low-calorie salads.

But after eating the highest-calorie salad, they consumed more calories throughout the entire meal.

The women who ate a small high-calorie salad ate 8% more calories total. The women who ate a large high-calorie salad ate 17% more calories total.

On the other hand, the women who ate a small low-calorie salad ate only 7% more calories total, and the women who ate a large low-calorie salad ate only 12% more calories total.

The researchers say it's probably the calories -- not the fat content -- that mattered.

The bottom line: A first-course salad can help cut a meal's calories, but the salad's calories and portion size counts.

It may also be worth noting that the women took a break between courses. They were served the pasta 20 minutes after finishing their salads.

The study appears in the October issue of the Journal of the American Dietetic Association.

June 15, 2004 -- Looking for serious weight loss? Surgery may be the answer. By restricting the size of the stomach, surgery offers three times the weight loss compared with a medically supervised diet, new research shows.

LAP-BAND bariatric surgery involves placing an adjustable gastric band around the upper part of the stomach. It creates a small stomach pouch that holds about 1 tablespoon of food and a small narrowing to the rest of the stomach. The small pouch helps control a person's sense of fullness and how much he or she is able to eat -- thereby controlling appetite, which results in weight loss.

Few studies have compared the safety and effectiveness of bariatric surgery with a very low caloric diet, medication, and exercise regimen for weight loss in obese people.

But a group of Australian researchers presented their findings at the annual meeting of the American Society for Bariatric Surgery being held in San Diego this week.

The study "confirms that in appropriate patients, weight loss surgery has clear benefits over traditional medical therapy," says researcher Paul O'Brien, MD, of the Centre of Obesity Research and Education in Melbourne, Australia, in a news release.

His study involved 79 mild to moderately obese patients (BMI 30-35) who had either the LAP-BAND surgery or a medically prescribed diet of fewer than 800 calories, medication, and exercise plan.

During the two-year follow-up:

• The surgery group lost 67% of their excess weight.
• The surgery patients showed greater improvement in type 2 diabetes, high blood pressure, cholesterol levels, and quality of life.
• The diet/exercise group lost 17% excess weight initially -- but then regained it.

This study shows that bariatric surgery for mild to moderate obesity is safe and significantly more effective than optimal medical therapy for weight loss and improving health and quality of life, says O'Brien.

SOURCE: News release, American Society for Bariatric Surgery.

Jan. 27, 2004 -- In the wake of the first reported case of mad cow disease in the U.S., the FDA says it will ban the use of certain cattle and animal parts in dietary supplements, cosmetics, and animal feed.

The move strengthens current safeguards to prevent the spread and protect the public from exposure to the agent thought to cause bovine spongiform encephalopathy (BSE), also known as mad cow disease. A cow in Washington State tested positive for the disease on Dec. 23.

"Today we are bolstering our BSE firewalls to protect the public," says FDA Commissioner Mark McClellan, MD, PhD, in a news release. "We are further strengthening our animal feed rule, and we are taking additional steps to further protect the public from being exposed to any potentially risky materials from cattle."

The new regulations ban a wide range of bovine-derived material from dietary supplements and cosmetics regulated by the FDA. They also prohibit some currently allowed feeding and manufacturing practices involving feed for cattle and other hooved animals.

Materials derived from cows, such as gelatin, are currently used in a variety of cosmetic lotions and creams as well as dietary supplements.

Earlier this month, the U.S. Department of Agriculture (USDA) announced similar safeguards banning the use of risky animal parts, such as brain and spinal cord-related materials, in the human food supply.

New Mad Cow Safeguards

The new FDA regulations are effective immediately and include two main components.

The first bans the following materials from FDA-regulated human food (including dietary supplements) and cosmetics:

• Any material from "downer" cattle. (Downer cattle are animals that cannot walk.)
• Any material from dead cattle.
• Specified risk materials (SRMs) that are known to contain the highest concentrations of the infectious agent for BSE, including the brain, skull, eyes, and spinal cord of cattle 30 months or older, and a portion of the small intestine and tonsils from all cattle, regardless of their age or health.
• Mechanically separated beef, which may contain SRMs.

The second rule contains the following changes to the FDA's current animal feed rule:

• Eliminates the exemption that allows mammalian blood and blood products to be used in feed for other hooved animals.
• Bans use of bedding, spilled feed, feathers, and fecal matter collected from the living quarters of poultry as feed ingredient.
• Bans use of plate waste consisting of uneaten meat and other scraps collected from large restaurant operations and rendered into meat and bone meal for animal feed.
• To further minimize cross contamination, a new rule requires equipment, facilities, and production lines to be dedicated to non-hooved animal feed if they use any of the prohibited ingredients in manufacturing feed products.

Officials say that in addition to these measures, the FDA will step up its inspection of feed mills and rendering industries.

"The science and our own experience and knowledge in this area are constantly evolving. Small as the risk may already be, this is the time to make sure the public is protected to the greatest extent possible," says Health and Human Services Secretary Tommy G. Thompson in a news release.

Oct. 14, 2003 -- Could it be true? Can you actually cut back on carbs, eat more calories, and still lose weight? It may be so, say researchers.

Reported success behind low-carb diets is thought to be because you eat fewer calories. But this new study suggests that something more may be happening.

"It was a very happy study because everyone lost weight," reports Penelope Greene, PhD, a researcher with the Harvard School of Public Health. She presented her findings at the conference for the American Association for the Study of Obesity in Fort Lauderdale, Fla. this week.

In fact, her volunteers liked the food so much, they voted to continue the study, she tells WebMD.

Who wouldn't? The small group was catered to, literally, by an upscale Italian restaurant in Cambridge.

"The food had to be good, or people wouldn't eat it," Greene says. "Some salad ingredients were organic, chickens were free-range. That was the quality of restaurant we used."

As for the 21 volunteers: "All were over 50, overweight, and overly concerned about their future health problems if they didn't lose the weight," says Greene. "They were very motivated."

From the Kitchen ...

The chefs, she says, were fastidious in their preparation of these weight-loss diets. Under her tutelage, they got special training, special recipes, even specific, brand names to follow in preparing 12 weeks' worth of either low-fat or low-carb meals, she reports.

From the kitchens emerged quiches, puddings, halibut with Dijon sauce, poached salmon, chicken teriyaki, beef stroganoff, lots of vegetables, lovely salads, and foods made with only unsaturated oils -- all carefully prepared, all weighed to the gram and ready for pick up, every single day.

"There was very little red meat," Greene explains. In addition to teasing out the perfect weight-loss diet, "we wanted to show an effect on cholesterol, too."

Researchers randomly assigned two groups of volunteers to eat either low-fat or low-carb meals -- with women consuming up to 1500 calories a day and men maxing out at 1800 calories a day.

The low-fat weight-loss diet was outlined as 55% carbs, 15% protein, and 30% fat. The low-carb diet was 5% carbs, 30% protein, and 65% fat.

A third group also ate low-carb -- but this group got to eat an extra 300 calories, boosting their daily intake to 1800 calories per day.

"The extra-calorie group got the exact same recipes as the low-carb group," Greene explains. "But in the extra-calorie group, every item was increased by a few grams. The quiche, the crackers -- everything weighed a few grams more."

As for the low-fat changes: "If one group had chocolate pudding, so did the other. But one may have been made with skim milk whereas the other had cream. One quiche had cheddar cheese and bacon bits, whereas another had low-fat cheese and broccoli."

And 12 weeks later ... participants lost beaucoup weight:

• The low-carb, low-cal group lost 23 pounds.
• The low-fat group lost 17 pounds.
• The group getting 300 extra calories of low-carb food lost 20 pounds.

In fact, both low-carb groups lost more inches from their weight-loss diet -- four inches at the waist, and three at the hips, compared with the low-fat group, which lost three waist and two hip inches.

What's Happening?

"We really don't know," says Greene. "We know that it takes the body twice as much energy to process protein as it does fat or carbs. And low-carb diets tend to be higher in fat and protein."

However, she doubts that extra protein is enough to make the difference.

Perhaps more food is excreted, Greene tells WebMD. "This is all hypothesis. But it's possible that the body doesn't absorb it. These are questions that need to be answered."

Greene's results "do not surprise me," says Cindy Moore, MS, RD, director of the nutrition therapy department at The Cleveland Clinic, and a spokeswoman for the American Dietetic Association.

"For a number of years, we have been advising extremely obese individuals to eat a low-carb, high-protein, low-fat [weight loss] diet, and have had quite a bit of success," Moore tells WebMD. "I'm delighted that we are getting more specific science-based information comparing these diets."

It's interesting that the low-carb people lost more inches -- even with the higher calorie intake, says Moore. "What that begs is, we need to better understand what's happening."

For a long time, dietitians assumed that eating fewer calories was the perfect weight-loss diet, she says. "But it might be that something else is happening."

However, it's important to look at the long-term implications of staying on a low-carb diet, both researchers point out. Lack of certain vitamins and fiber could, in the long term, cause serious health problems (participants in this study took multivitamin/mineral supplements). But as a short-term solution, a low-carb weight-loss diet indeed looks promising.