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Sept. 1, 2005 - When it comes to maintaining a healthy weight, most nutritionists agree that breakfast really is the most important meal of the day. But what you eat is as important as when you eat, and two new studies show that cold-cereal eaters may have an edge.

In a study of girls followed from age 9 to age 19, regular cereal eaters had fewer weight problems than infrequent cereal eaters, with the risk for being overweight increasing by 13% among girls who ate cereal only occasionally.

Eating cold cereal for breakfast was also found to be more closely associated with maintaining a healthy weight than eating breakfast in general in a separate study that included adults of both sexes.

The studies were paid for by the nation's two largest cereal manufacturers -- one by General Mills and another by Kellogg.

But a dietitian who calls herself a "cereal advocate" but says she has no ties to the cereal industry tells WebMD that she isn't surprised by the findings.

"I don't work for the cereal companies, but I really do think that cereal is a pretty good food for kids and adults to eat," says American Dietetic Association spokeswoman Bonnie Taub-Dix, RD.

"You wouldn't believe how many people skip breakfast or grab cookies or doughnuts. Cereal with milk is quick and easy, and if you choose the right cereal you get calcium, fiber, and plenty of nutrients."

Teens Tend to Skip Breakfast

Both new studies are published in the September issue of the Journal of the American Dietetic Association.

In one, researchers reanalyzed data from a government-funded study that followed more than 2,000 young girls through their teens to identify risk factors for obesity. The original study was conducted from the mid-1980s through the 1990s.

Nearly one in three adolescent girls are overweight or obese in the U.S.

Breakfast skippers tended to weigh the most through their teen years and girls who regularly ate cereal for breakfast weighed the least. Those who ate other foods for breakfast were somewhere in the middle, says statistician Bruce Barton, PhD, who led the research team.

Other findings from the look-back analysis included:

• Breakfasts that did not include ready-to-eat cereal averaged 60% higher in fat content.
  
• The number of girls skipping breakfast doubled from age 9 to age 19.
  
• Fewer than one in 10 18-year-olds reported eating cereal for breakfast every day.
  
• Regular cereal eaters tended to have healthier diets overall.

"They tended to eat less fat and cholesterol and their nutritional profile was much better," Barton tells WebMD. "We can't say if eating cereal is the reason. But most cereals are heavily fortified with mineral and vitamins, and many are also high in fiber."

In addition to Barton, who is president and CEO of Maryland Medical Research Institute, researchers from General Mills took part in the study.

Breakfast and Weight Control

In the second study, researchers from Michigan State University and Kellogg analyzed data from the National Health and Nutrition Examination Survey, 1999-2000, to evaluate the relationship between eating breakfast and body weight among adult men and women.

The researchers found that regular breakfast eaters were more likely to be older, female, and white than breakfast skippers. They were also more likely to exercise regularly.

Women who ate breakfast regularly tended to take in more calories overall during the day, compared with nonbreakfast eaters. But eating cereal for breakfast was more closely associated with maintaining a healthy body weight than breakfast eating in general.

Overall fat intake was also lower for men and women who reported regular cereal consumption than for those who ate other foods for breakfast.

Not Just Any Cereal

The studies did not include information on what types of cold cereals the subjects ate, and it is clear that eating a cereal loaded with sugar straight from the box is not a particularly healthy breakfast option, says Taub-Dix.

Her more ideal breakfast is a cereal with no more than 3 grams of sugar per serving and roughly 5 grams of fiber, topped with skimmed milk and berries.

If your child has to have his Cocoa Puffs, which has 13 grams of sugar per serving, she recommends cutting the sugar by mixing it with a low-sugar cereal like Cheerios or Kix.

"It will still look and taste like chocolate, but you can literally cut the sugar in half and your kids may never notice," she says.

Aging: everyone does it, yet some people seem relatively unaffected by getting older. Could good nutrition be the key to a healthier, longer life?

Does Aging Equal Illness?

"Aging is often associated with the development of one or more chronic diseases, but it doesn't have to be that way," says Jeffrey Blumberg, PhD, professor at the Friedman School of Nutrition Science and Policy at Tufts University.

It's not always just a matter of time before you have a heart attack or stroke, get type 2 diabetes or cancer, break a hip because of osteoporosis, or develop Alzheimer's, even though these conditions are often associated with aging, Blumberg says.

Your risk for disease and disability increases with inadequate physical activity, genetic susceptibility, and poor diet.

Aging: Defy It With Diet

So what's the best eating plan for preventing, delay, or minimizing the conditions associated with aging, including inflamed joints, flagging memory, and failing eyesight?

"The most beneficial diets rely heavily on fresh vegetables, fruits, and legumes -- foods that are naturally lower in calories and packed with nutrients," says Bradley Willcox, MD, MPH, co-author of The Okinawa Diet Plan and professor of geriatrics at the University of Hawaii.

Experts suspect the antioxidant compounds found in produce, legumes, and whole grains are largely responsible for holding back the march of time.

Antioxidants, such as vitamins C and E, and other compounds, including polyphenols and anthocyanins, battle free radicals -- unstable forms of oxygen that damage cell function. Free radicals form from normal metabolism. Your body also produces them in response to strong ultraviolet rays from the sun; air pollution; smoking; and secondhand smoke.

The buildup of free radicals contributes to the aging process and to the development of a number of age-related diseases such as cancer, heart disease, and inflammatory conditions, including osteoarthritis. What's worse, aging increases free radical production. That means your diet should be healthier than ever with the passage of time.

The question, of course, is how do we do that?

Anti-Aging Nutrition

Antioxidants generate a lot of buzz when it comes to longevity, but aging well takes more. You must optimize a myriad of beneficial nutrients, including protein, calcium, and vitamin D, and minimize detrimental dietary components including saturated and trans fats.

While none of these foods is the "Fountain of Youth," including them on a regular basis as part of a balanced diet can reduce the toll time takes on your body.

Nuts

Nuts are cholesterol-free protein sources, and are worthy substitutes for fatty meats. Research published in the American Journal of Clinical Nutrition found that in a group of nearly 35,000 women, those who ate foods rich in vitamin E, including nuts, lowered their risk of having a stroke.

Top picks:

Almonds for their high vitamin E levels; pecans, for their antioxidants; and walnuts, for omega-3s.

Tips:

• Top breakfast cereals, yogurt, salads, and cooked vegetables with an ounce of chopped nuts.
• Snack on an ounce of whole almonds (about 24) for almost half the vitamin E you need for the day.
• Enjoy a nut butter sandwich on whole-grain bread.
• Concoct a smoothie by blending a medium frozen banana, 1/2 cup plain fat-free yogurt, 1/4 cup chopped walnuts, and 2 teaspoons sugar (optional).

Fish

According to the American Heart Association, fish harbors omega-3 fats that reduce the risk of plaque buildup in your arteries; decrease blood triglyceride (fat) levels; help lower blood pressure; and lessen the odds of sudden death. Fish is a wise protein choice because of its relatively low saturated fat and cholesterol content.

Top picks:

Salmon, sardines, and canned tuna are among the fish with the highest levels of omega-3 fatty acids.

Tips:

• Have at least two fish meals a week instead of fatty meats.
• Add canned light tuna or canned salmon to salads instead of chicken or cheese.

Sept. 24, 2004 -- Regular stretching cuts your risk of a sports or workout injury. But stretching just before an activity slows performance, researchers conclude.

These surprising conclusions come from a systematic review of all published studies of stretching by Ian Shrier, MD, PhD. Shrier is past president of the Canadian Academy of Sport Medicine and a researcher at SMBD-Jewish General Hospital in Montreal, Quebec, Canada.

"If strength or power is important to you, don't stretch before exercise. If you enjoy stretching, stretch after exercise, or at other times," Shrier tells WebMD in an email interview. "There are certain exceptions to these rules where performance depends only partly on force and power, and partly on aesthetics and range of motion -- a good example is ballet."

Shrier examined 23 articles on "acute stretching" -- stretching just before exercise. He found that:

• 22 of the 23 reports showed no benefit in terms of force, torque, or jumping height.
• One study showed that stretching before exercise made for more efficient running.
• Of the four articles that looked at running speed, one showed that stretching before exercise was helpful, one found it slowed runners, and two had "equivocal" results.

Shrier examined nine articles on regular stretching -- either after exercise or at some other time. He found that:

• 7 of the 9 reports showed a benefit.
• The two reports showing no benefit looked only at running economy.
• None of the reports found any harm in regular stretching.

"An acute bout of stretching will decrease pain temporarily but will not prevent injury," Shrier says. "Stretching over weeks to months will increase your force, power, and speed of running, and may prevent injury. Both an acute bout of stretching and regular stretching over weeks to months will increase range of motion."

Many Still Recommend Before-Exercise Stretching

Despite these studies, Shrier notes that many fitness experts still advise stretching before exercise. One of them is certified athletic trainer and physical therapist Michele Raya, PhD, assistant professor of physical therapy at the University of Miami in Coral Gables, Fla.

"In my opinion I do think it prevents injury. The benefits are pretty clear," Raya tells WebMD. "I do recommend to the athletes I am working with to stretch before activity. And I work with athletes at the high school, college, and professional level in running and jumping sports."

Raya says that stretching before exercise:

• Helps to regulate imbalances between opposing muscles
• Helps minimize musculoskeletal injuries by reducing stress to the tissues involved
• Helps with shock absorption
• Helps runners conserve energy by loosening tight muscles

Shrier notes that the effect of acute stretching on running speed has yet to be determined. However, he finds no proof that stretching before exercise cuts injury risk.

"If you don't like stretching, don't worry about it. Just remain active and work your muscles through their full range of motion when possible -- bench press, for example," he says. "If you do like to stretch, the general recommendation is to stretch after your activity or at other times. Exceptions to this rule are when the range of motion is more important than the force or power you need from your muscles, such as aesthetics in ballet."

How to Stretch

Shrier and Raya both agree that a warm-up before stretching is essential. And while he doesn't recommend acute stretching, Shrier strongly advises warm-up before exercise. What kind of warm-up is best?

"Use the muscles you plan to use in the activity. Start slow, increase gradually," he says. "If jogging, start with walking, then jog slow and then slowly increase the speed until you are running at your regular pace -- maybe five to 15 minutes depending on your level of fitness. If you are planning to race, don't worry about tiring yourself out. Do this before the race to have the best race time. Don't stretch before."

Regular stretching improves flexibility, Shrier and Raya agree.

Raya says that people who want to improve their flexibility should stretch every day. Those comfortable with their flexibility, she says, need to stretch only three times a week. She advises athletes preparing for a specific event to be sure to stretch the all the muscles they'll be using in the sport.

"It is real important to maintain the stretch for 30 seconds," Raya says. "If you hold a stretch for less than 30 seconds, there's no proof you lengthen the muscle. And if you hold it longer, you do no extra good beyond the first 30 seconds."

Raya warns that bouncing while stretching -- known as ballistic stretching -- seems particularly unhelpful. She advises against it unless a person has specifically trained to perform these kinds of stretches.

Sure, chest exercises help give a man a nice physique, but working out the chest can help women, too, by lifting sagging chests and breasts.

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Think of anything you do that involves pushing and you've discovered what you use the chest muscles for. Whether it's pushing a lawn mower, baby carriage, or grocery cart, strong chests help us perform these tasks.

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In addition, chest muscles are essential in sports like tennis, free-style swimming, and all sports where you throw a ball.

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"Just because of the forward motion of daily life, the pectorals tend to get used," says Richard Cotton, an exercise physiologist in San Diego.

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Things like driving or working at a computer all day keep chest muscles activated at a low level. That's good and bad, he says.

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"The challenge is too much pec exercise," says Cotton. For example, someone who sits at a computer eight hours a day can really suffer negative effects from having continually engaged pectorals.

Posture Is Key

"We tend to get shorter muscles from working keyboards," he says. Shorter muscles mean a tighter chest and that usually translates to weak back muscles.

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This can become a postural problem, having rounded shoulders and not being able to stand upright. It can also lead to shoulder injuries as the arms suffer a decreased range of motion.

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When sitting at a desk, be conscious of posture, says Lisa Cooper, fitness director of Little Rock Athletic Club in Arkansas.

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"Think about dropping your shoulders down and pulling your shoulder blades back and together; visualize holding a pencil between the blades while keeping your abdominals engaged to support the back," she says.

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Cotton says working the chest is great when done in balance.

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"Chest exercises need to be integrated into a whole-body workout including other major muscle groups, especially the abdominals," he says.

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Cooper agrees.

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"People need to think of working muscles in pairs, doing equal amounts of exercises with opposing muscle groups. If you're working chest, you should also work back. If you're working biceps, you should also work triceps."

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And, she says, if you alternate between the two opposing muscle groups, you don't have to rest between sets, which can cut down your workout time.

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If done correctly, many chest exercises simultaneously recruit and work other muscles groups.

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"If you're pushing a car or a lawn mower," explains Cotton, "naturally the back and abs are also very activated. Having weak abs is going to hurt your back."

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Chest exercises primarily use the chest but recruit supporting muscle groups to assist. In a push-up, for example, not only are the pectorals engaged but the abdominals, the latissimus dorsi in the back, the deltoids in the shoulders, and the triceps in the back of upper arms are involved.

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Experts say pectorals are not usually a neglected group among those developing a workout program. Quite the contrary.

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"The show muscles [such as pecs and abs] are usually something that people that are motivated to exercise are going to try to build -- men especially," says Cotton.

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Many men focus solely on their upper bodies and particularly their chests, says Cooper, because they can see the progress.

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But everyone should be wary of sacrificing balance in a zealous desire to have a nice chest.

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"This is not a muscle group you want to overemphasize to the detriment of the opposing back muscles," Cotton says. "You should balance the two for a healthy program."

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For women, chest exercises, done in balance can help to lift a sagging chest, strengthening the muscles that help lift the breast tissue, particularly in someone who's overweight, losing weight, or has just had a baby.

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"Getting the chest in shape lifts the chest," says Cotton. "It may appear that you have a bigger chest (whether you're striving for that or not), but it's a healthier look. It's better posture."

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Women concerned with building bulk shouldn't be, he says.

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"Only 10% of women actually gain significant muscle mass doing chest exercises," says Cotton.

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"You'd have to be on a pretty serious body-building regime to get that bulk," says Cooper. "And you'd have to be genetically predisposed to it."

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"It would take heavy weights and low repetitions to create size," says Cooper. Women are generally doing higher repetitions with lower weights so bulk is not really an issue.

Aug. 23, 2006 -- Scientists may have figured out how high-fiber diets help digestion.

Basically, fiber (sometimes called "roughage") roughs up the outer membrane of gut cells a bit. As those cells heal, they release mucus, which helps move food along the digestive tract.

The process is detailed by Paul McNeil, PhD, and Katsuya Miyake, PhD, in the early online issue of Public Library of Science Biology.

McNeil and Miyake work at the Medical College of Georgia, located in Augusta, Ga.

"When you eat high-fiber foods, they bang up against the cells lining the gastrointestinal tract, rupturing their outer covering," McNeil explains, in a Medical College of Georgia news release.

"What we are saying is this banging and tearing increases the level of lubricating mucus. It's a good thing," he adds.

How Much Fiber?

McNeil and Miyake studied roughage in a lab. But what about the real world, where fiber goes on your plate, not into test tubes?

Fiber is a cornerstone of the latest dietary guidelines issued by the U.S. Department of Agriculture (USDA).

In those guidelines, issued in 2005, the USDA recommends getting 14 grams of dietary fiber for every 1,000 calories you consume.

So if you consume 2,000 calories per day, you should get 28 grams of dietary fiber that day.

Fiber is found naturally in fruits, vegetables, whole grains, and legumes. How much fiber will you get from different foods? Here's a list from the USDA:

• Navy beans, 1/2 cup, cooked: 9.5 grams
• 100% bran cereal, 1/2 cup, ready to eat: 8.8 grams
• Sweet potato, medium-sized and baked, including peel: 4.8 grams
• Whole-wheat English muffin: 4.4 grams
• Mixed vegetables, 1/2 cup: 4.0 grams
• Raspberries, 1/2 cup, raw: 4.0 grams
• Apple, medium-sized, including skin: 3.3 grams
• Whole-wheat spaghetti, 1/2 cup, cooked: 3.1 grams
• Banana, medium-sized: 3.1 grams
• Broccoli, 1/2 cup, cooked: 2.8 grams
• Collard greens, 1/2 cup, cooked: 2.7 grams

For instance, a breakfast of a medium-sized banana and half a cup of 100% bran cereal yield 11.9 grams of dietary fiber.

Add an apple as a morning snack, a half cup of Navy beans with an equal amount of mixed vegetables at lunch, and whole-wheat spaghetti at dinner, and you've reached 31 grams of dietary fiber -- more than the 28 grams recommended for a 2,000-calorie diet.

Of course, that's just an example, not a menu recommendation. Each person is different, and not every food that you eat has to be loaded with fiber.

The take-home message: Mix and match fruits, vegetables, whole grains, and legumes to help you get recommended amounts of dietary fiber as part of a healthy diet.

March 3, 2006 -- Yoga could be a way for overweight teens to get in shape and lose weight, new research shows.

According to the CDC, the percentage of young people who are overweight has more than tripled since 1980, with 16% of children aged 6-19 considered to be overweight.

In a recent study, high school students practicing yoga and breathing exercises on a regular basis shed an average of 6 pounds and trimmed their BMI (body mass index) by nearly 6%.

The finding comes from Anand Shetty, EdD, of Hampton University in Yorktown, Va.

"I recommend 30 minutes of pranayama [breathing exercises] and yoga, three to four times a week," Shetty says in an American Heart Association news release. "This also can easily be incorporated at home during leisure time with other family members."

Shetty's study is being presented in Phoenix, at the American Heart Association's 46th annual conference on Cardiovascular Disease Epidemiology and Prevention.

Striking a Yoga Pose

Shetty studied 60 high school students for three months.

He randomly assigned half of the students to do yoga and breathing exercises for 40 minutes, four days per week, during the study. The breathing exercises used "quiet, deep, forced breathing," Shetty says. Yoga includes postures that help build overall well-being.

For comparison, the other students did their normal activities, without the yoga program.

At the study's start, average BMI was 22.8 in the yoga group and 22.3 in the comparison group. Those BMIs aren't considered overweight for adults. But teens are different, because they're still growing taller and BMI relates height to weight.

"Therefore, by adult BMI standards, we underestimate the normal BMI for teens," Shetty says. "For this study, only students with a BMI greater than 22 were selected."

Yoga Group Slimmed Down

When the study ended, the yoga group had lost 6 pounds and 1.3 points on their BMI, on average.

Dieting wasn't required. The yoga group's weight loss may stem from the exercises, or perhaps they ate less, Shetty says.

The yoga and breathing exercises used the teens' abdominal muscles. Using those muscles temporarily contracts the abdomen, including the stomach, Shetty notes.

He didn't study stomach size but suggests future research on the relationship between stomach size and hunger, as well as yoga's effects on brain function, feelings of fullness, and hormones related to metabolism.

Aug. 3, 2005 -- Overweight people are less likely to receive recommended preventive care services, such as mammograms, Pap smears, and flu shots, according to a new study.

Overweight women are more likely to get breast and cervical cancer, and overweight elderly people have a higher risk of complications from flu, says researcher Truls Ostbye, MD, PhD, a professor of community and family medicine at Duke University, in a news release.

Despite this, overweight people are less likely to receive preventive services, he says.

More Weight, Less Services

Researchers found that the more overweight middle-aged white women were, the less likely they were to receive mammography or Pap smears to screen for these diseases.

For example, white women of normal weight were more than 50% more likely to receive a mammogram than a severely obese white woman in 2000.

Even moderately overweight women were less likely to receive mammograms and Pap smears.

In addition, elderly obese white men and women and were less likely to get their recommended flu shots.

However, the study showed that the link between obesity and less frequent use of these three preventive care services was not found among black men or women.

The results appear in the September issue of the American Journal of Public Health.

Obese Miss Out on Cancer Screening, Flu Shots

In the study, researchers analyzed the relationship between body mass indexbody mass index (BMI, a measure of weight in relation to height used to indicate obesity) and use of the following preventive care services: mammograms to screen for breast cancer, Pap smears to screen for cervical cancer, and flu shots to reduce the risk of influenza.

Researchers found that as BMI increased, the likelihood of receiving each of the three recommended preventive care services decreased in 1995-1996 and in 2000, although overall use of these services increased during this time period.

• Mammograms. 75% of normal-weight women had received a mammogram for breast cancer screening within the last two years compared with 67% of obese women in 1996. The same trend held true in 2000, although a greater proportion of all women received screening mammograms.
• Pap tests. 73% of normal-weight women vs. 66% of obese and 54% of severely obese women (BMI over 40) received Pap smears in 2000.
• Flu shots. 78% of normal-weight men and women received flu shots in 2000 compared with 70% of moderately obese people and 56% of severely obese.

The higher a person's BMI the less likely they were to receive any of the preventive services. In other words, normal-weight people most likely received these services, followed by overweight people and then obese people.

Missing Out on Screening Risky

Researchers say delaying or avoiding cancer screening can make the difference between life and death in some cases. Earlier detection and treatment leads to better chances of survival.

In addition, failure to get a flu shot among the elderly increases the risk of potentially deadly complications from influenza.

Ostbye says the study suggests that income, education, and access to health care were not important reasons for the discrepancies in preventive care services. Instead, researchers say significant reasons may include social stigma, avoidance of health care by patients, and bias by health care providers.

They say these results present an example of the "inverse care law" in which people who need health care services the most are often the least likely to get them.

Everyone, including normal- and overweight people, needs to discuss the need for preventive services with their doctor.

Jan. 4, 2005 -- Four popular diet plans faced off in a new study. Which one won: Atkins, Ornish, Weight Watchers, or the Zone?

These were the rules: 40 overweight or obese adults aged 27 to 42 were randomly assigned to the Atkins, Ornish, Weight Watchers, or Zone programs. For two months, a doctor and a dietitian coached each player on their game plan. Then they were on their own until a weigh-in at the end of a year of dieting.

Who lost the most pounds? Those who followed their diets most closely, no matter which of the four plans they followed. Those who didn't follow their program -- 42% of the participants -- didn't lose much weight.

The findings, as reported in the Jan. 5 issue of The Journal of the American Medical Association:

• On average, those on the Atkins plan lost 4.6 pounds. 53% of participants stuck with the Atkins plan for one year.
• On average, those on the Weight Watchers plan lost 6.6 pounds. 65% of participants stuck with the Weight Watchers plan for one year.
• On average, those on the Zone plan lost 7.1 pounds. 65% of participants stuck with the Zone plan for one year.
• On average, those on the Ornish plan lost 7.3 pounds. 50% of participants stuck with the Ornish plan for one year.

The weight loss differences between the plans were not considered significant, meaning the small differences seen between the various plans easily could have been due to chance. So does this mean that diet plans don't work?Weight Loss That Works: Kathleen Zelman, MPH, RD, director of nutrition for WebMD Health, offers her tips for successful weight loss.

No, says study leader Michael L. Dansinger, MD, director of obesity research for the atherosclerosis research lab at Tufts-New England Medical Center, Boston. It means that the plan you like the best is the plan that works the best.

"I would suspect that most of the popular diet books in the bookstore are likely to produce weight loss if you follow the plan closely, since almost all plans are similar to the diets we studied, or to a cross between two of them," Dansinger tells WebMD. "Most eating strategies will work well if you stick closely. The key is finding a plan you can stick to."

Finding a diet plan is like finding true love. Dansinger recommends playing the field until you find Ms. or Mr. Right.

"Date the diets until you can find a life partner," Dansinger says. "The best way is to try a number of them and give each a fair chance. There is a whole spectrum of options out there. The main finding of our study is that we need to find a way to improve adherence rates to the various diets that are available. The best way might be to be open minded about all of the options rather than focusing on finding the same 'best one' for everybody."

In an editorial accompanying the Dansinger study, Robert H. Eckel, MD, notes that the key to weight loss is a focus on not just food quantity, but food quality. Eckel is a professor of medicine at the University of Colorado Health Science Center and president-elect of the American Heart Association.

His three-way prescription for weight loss - or better still, obesity prevention:

• Eat a diet high in fruits and vegetables, whole grains, and fish.
• Get regular exercise.
• Eat just a little less, and keep it up.

This is what Eckel calls "the low-fad diet."

"Losing weight is not easy. So why be desperate to lose weight quickly on these fad diets?" Eckel tells WebMD. "Let's go about weight loss slowly. Let's modify our diets by trying to eat a little less each day. Unfortunately, that is too simple -- and too difficult -- for most people."

Oct. 26, 2004 -- Dietitians and doctors plead with increasingly obese Americans to eat less and exercise more, often to no avail. Now, one diet researcher is pointing to growing evidence that fewer food choices could be part of the answer.

"We're all eating more calories, and you have to ask yourself why that is," says Susan Roberts, PhD, who runs dietary and metabolism research at a Tufts University in Boston.

According to Roberts, one reason for Americans' increased caloric intake -- as much as 350 more calories per day on average than 15 years ago -- is that we have too many food choices, especially of bad foods, and that animals, especially humans, find that variety irresistible.

Researchers are quick to point out that there are many proven reasons behind the 60%-plus rate of overweight and obesity in the U.S. population. In addition to eating more, technological improvements mean that we have to exercise less to work, do chores, or do just about anything else.

"Individuals are now left with a stark choice of whether or not to fill the gap with voluntary physical activity" such as joining a gym or blocking of time each day for a run, says Elizabeth Frazao, an assistant deputy director with the U.S. Department of Agriculture Economic Research Service.

But at the same time, inexpensive, high-fat, high-calorie foods abound in restaurants, vending machines, and on dinner tables. Americans love this abundance of food choices -- a stubborn fact that haunts advocates and dietitians trying to push lighter eating.

But Roberts points to evidence showing that simply limiting the variety of available foods, therefore limiting food choices, can be effective in limiting consumption.

"The more varied your diet, the more calories you consume," she told an audience at a national obesity prevention conference sponsored by the USDA.

More Food Choices Makes Us Eat More

As many as nine studies suggest that mere choice makes humans eat more, even when the food choices are seemingly meaningless. Experimenters in one trial got subjects to eat 14% more on average per meal just by offering them two different pasta shapes instead of one.

The studies have been confirmed dozens of times in animals, Roberts says. And a 2001 University of Buffalo study backed up the conclusion by analyzing 39 animal and human trials.

Part of the reason for the variety effect is that humans and other mammals just like food more when it differs from what they just ate. One study showed that people reliably ate more when sausages, bread, chocolate, and bananas were each served in four consecutive courses than when they were served four times together on a plate, the Buffalo researchers wrote.

Few suggest that asking or forcing food manufacturers to market fewer food choices is the answer. But Roberts says researchers have paid relatively little attention to effective ways of helping people design meals or tailor shopping so that their evolutionary drive to eat less kicks in.

"I think we should be putting more effort into looking at this," she says.

June 28, 2004 -- Obesity may interfere with a natural hunger hormone and override the body's natural ability to regulate appetite and weight, a new study shows.

Researchers found obesity suppressed the natural spike in the hunger hormone that occurs at night. Findings also showed that obese people have a blunted hormone response associated with meals.

If more studies confirm these findings, researchers say this may open up new avenues for developing treatments for obesity that help people restore their natural weight control mechanisms.

The hormone ghrelin is released by the stomach, and is part of a complex system that regulates how much people eat and how many calories they burn off. In obesity this system may be abnormal. Blood levels of ghrelin are known to increase prior to meals and decrease after food intake in normal healthy people.

"It's possible that obese people have developed biological mechanisms that make them resistant to their own hormones," says Julio Licinio, MD, professor of psychiatry and medicine at the University of California, Los Angeles, in a news release. "We must try to solve this mystery and explore new drugs to make them more sensitive to their bodies' internal cues."

Obesity Disrupts Hunger Hormone

In the study, published in today's online edition of the Proceedings of the National Academy of Sciences, researchers compared ghrelin and other hormone levels during the course of a day in five obese and five lean males.

Levels of the hormone usually show specific daily patterns, spiking just before meals and dropping after eating. But researchers found the pattern of ghrelin levels differed significantly between the obese and lean men.

Ghrelin levels spiked among the lean men at night, between midnight and 6 a.m. These surges surpassed spikes found before meals. But the levels of the hormone throughout the 24-hour period remained relatively flat among the obese men. The researchers found that the hormone response before and after meals was blunted in the obese men.

"The most powerful ghrelin surge was missing in the obese men, suggesting that their regulatory system has gone awry or can no longer able to listen to its own cues," says Licinio.

"This defies the stereotype of overweight people waking up in the middle of the night to raid the refrigerator," says Licinio. "The men in our study slept through the night, and both groups ate meals designed to maintain their current weight."

Researchers say the blunting of the nighttime ghrelin surge may be a biological feature of obesity that merits further research in order to develop better treatments to target obesity.

SOURCE: Yildiz, B. Proceedings of the National Academy of Sciences, online early edition, June 28, 2004.

Feb. 11, 2004 -- Much like the controversy surrounding the health of diet guru Robert Atkins, MD, at the time of his death last April, the debate about the safety of the low-carbohydrate diet Atkins became famous for isn't likely to calm down any time soon.

Critics of low-carb approach say the high-fat content of the Atkins diet, which advocates meat, eggs, and cheese and limits bread, pasta, and fruit, raises the risk of heart disease. But low-carb devotees say the diets are safe and effective in promoting weight loss, which in turn lowers the risk of heart disease.

But researchers say the facts boil down to this: There simply isn't enough data on low-carb diets to support either argument.

"There are two extremes, but I think there is no evidence to support either extreme in terms of benefits or harmful effects of this kind of diet," says Frank Hu, MD, PhD, associate professor of nutrition and epidemiology at the Harvard School of Public Health.

Many Questions, Few Answers

The prevailing view during the last 20 years has been that a low-fat diet is the best way to achieve weight loss and reduce the risk of heart disease. But the epidemic of obesity that the U.S. is currently experiencing indicates that low-fat diets may not be the solution.

"The question now is whether the other extreme, a low-carb diet, is the answer," says Hu.

During the "induction" phase of Atkins, in which carbohydrates are most strictly limited, people typically consume as much as 60% of their calories from fat, including "bad" saturated fats from animal sources that raise cholesterol levels and "good" unsaturated fats, such as those found in olive oil and fish, which have favorable effects on cholesterol profiles.

Although the Atkins diet has never specifically prescribed recommended amounts of fat or protein, an Atkins educator recently told The New York Times that only 20% of a dieter's calories should come from saturated fat.

Hu says getting even 20% of calories from saturated fat is still too high. The American Heart Association and many other health organizations recommend a maximum intake of 10% of total calories from saturated fat in order to reduce the risk of heart disease.

"Based on what we know so far, you can expect that if you eat this kind of diet for many years, there could be harmful effects on heart disease and diabetes," says Hu. "The benefits of weight loss may outweigh the potential harmful effects of saturated fat and cholesterol within the short-term, but in the long-term we don't know."

The Evidence on Low-Carb Diets

Researchers hope studies currently underway will help answer some of those questions about the safety of low-carb diets. Until then, only short-term studies have addressed these issues.

A review of the research currently available on the safety and effectiveness of low-carb diets published last year in The Journal of the American Medical Association concluded that there was "insufficient evidence for or against the use of these diets."

"Despite the large number of Americans who have apparently adopted this approach to weight loss and/or weight maintenance, we know little of its effects or consequences," write researcher Dena Bravata, MD, of the Center for Primary Care and Outcomes Research at Stanford University and colleagues.

Some short-term studies have shown an improvement in cholesterol levels after six months on the Atkins diet. But Bravata's study showed that of the few low-carb studies that included information on cholesterol levels of the participants, there was no change in total, LDL ("bad") and HDL ("good") cholesterol levels. In contrast, the larger number of studies on higher-carbohydrate diets that included information on cholesterol levels showed a significant decline in total cholesterol levels.

Researchers say the lack of long-term data on low-carb diets severely limits their ability to evaluate their safety and effectiveness in promoting weight loss as well as reducing the risk of heart disease.

"The bottom line is that there is no single diet that is optimal for everyone," says Hu. "But if you choose the healthy sources of fats, carbohydrates, and protein, you can have many options to design a healthy diet not only for weight loss but also for the prevention heart disease and diabetes."

Oct. 28, 2003 -- A growing number of Americans are now turning to weight loss surgery to overcome their battle with obesity, but months later many are literally left with a shell of their former selves.

That excess skin and fat below the abdomen can be removed though a surgical procedure known as body contouring (or panniculectomy), but many plastic surgeons have been reluctant to perform this procedure because of a high risk of complications. But a new study shows that body contouring may be much safer than once thought, as long as patients wait nearly a year after weight loss (bariatric) surgery to allow their weight to stabilize and health to improve.

"When a patient loses large amounts of weight, the skin does not retain its shape, leaving the patient with a large hanging apron of excess skin and fat below the stomach area, otherwise known as the pannus," says researcher Ernest Manders, MD, in a news release.

"By focusing on patients who undergo a panniculectomy to remove the pannus, we found significantly fewer complications in patients who had the procedure one year after bariatric surgery rather than during the initial surgery," says Manders.

Manders presented the results of the study Wednesday at the Plastic Surgery 2003 conference in San Diego.

Waiting Reduces Risks

In the study, researchers compared the results of having body contouring performed at the same time as the weight loss surgery versus waiting in 120 men and women.

The study showed that there were significantly fewer complications reported among patients who waited nearly a year after undergoing weight loss surgery before having the body contouring procedure. Specifically, researchers found that people who waited to have the procedure had:

• Fewer wound infections
• Less wound reopening
• Shorter hospital stays

In addition, none of the patients who waited experienced respiratory distress or died as a result of the procedure compared with 24% of the others who had breathing problems and 14% who died.

Researchers say patients who waited had lost an average of about 100 pounds and fared better because they were healthier and their bodies were in better shape than at the time they had the weight loss surgery.

Many of the patients had also gotten their diabetes under control, lowered their blood pressure, and lowered the stress on their hearts, which makes the additional surgery safer and lowers the risk of complications.

The researchers do note that the group that underwent body contouring at the same time as weight loss surgery were heavier prior to surgery. This could have interfered with the results since the heavier study participants may have been unhealthier from the start.

April 8, 2003 (New York) -- Dieters are more likely to lose pounds and keep them off when they get additional support. Researchers at a news conference say that structured weight-loss programs not only help people lose more weight but also help maintain that new weight.

In his research, Stanley Heshka, PhD, compared dieters randomly assigned to either a self-help regimen or to a structured commercial weight-loss program -- in this case, Weight Watchers. The well-known company did fund the study, but investigators conducted the clinical trial independent of the firm.

After the first year of the study, researchers found that the self-help participants lost and maintained about three pounds, while the Weight Watchers group lost and maintained about 9 to 11 pounds. After two years, the self-helpers' weight went back to near normal, while the Weight Watchers set had gained a little weight but had still kept a loss of about six pounds.

The study appears in the April 9 issue of The Journal of the American Medical Association.

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Researchers have not yet figured out the particular reasons why the commercial weight-loss program was more effective than the self-help regimen, but Heshka says the structure and assistance provided by Weight Watchers may be important factors.

"It keeps your attention focused," says Heshka, the lead researcher of the study and a research associate at the New York Obesity Research Center at St. Luke's-Roosevelt Hospital. "It may be support in a sense that others are giving you hints about what works for them, others are encouraging you, and may actually be motivating you to try harder."

The group support environment surrounding certain weight-loss programs may be more effective for women, Heshka says, because they tend to like the idea of sharing success and failure stories more than men. He points to the fact that 85% of the participants at Weight Watchers are women.

In another study published in the same issue of JAMA, researchers led by Deborah F. Tate, PhD, of the Brown University School of Medicine/Miriam Hospital in Providence, R.I., randomly assigned people who were at risk of type 2 diabetes to two different Internet weight-loss programs.

Both sets of dieters were given at least one face-to-face counseling on proper nutrition, exercise, and behavior change. They were both given a private Web site with a tutorial on weight loss, and each week, all patients received educational materials and were prompted to submit his/her weight information. Only one of the groups, however, also received at least weekly email support from a professional therapist as part of their weight-loss program.

After one year, investigators found that those who received email counseling fared better in losing and maintaining the weight loss (roughly 9 pounds) compared with their counterparts (4 pounds).

At least one expert isn't surprised about the role counseling has apparently played in both Tate's and Heshka's studies. "If you're with somebody who's encouraging you, somebody who's telling you that you look good, you're not fighting anything. You're making these people a part of your life," says Catherine D. DeAngelis, MD, MPH, editor of JAMA, who notes that lifestyle changes are proven to work for weight loss.

Another authority on weight management, however, says it's too soon to tell what exact component works best for losing and keeping off the pounds. "We don't really have the research to tease out whether it's support or physical activity or diet that's important," says Susan Z. Yanovski, MD, executive director of the National Task Force on Prevention and Treatment of Obesity with the National Institutes of Health.

Successful weight loss today, says Yanovski, involves multiple elements, including a modest decrease in caloric intake and increasing exercise -- necessary parts of any weight-loss program.

Oct. 10, 2002 -- Southerners may be famous for their hospitality, but they could become infamous for their poor health, according to a new list of America's least healthy states. Seven of the top ten unhealthiest states are south of the Mason-Dixon line, and researchers say an unhealthy lifestyle and high-fat diet are putting the health of the millions who call the South home at risk.

Mississippi topped the list of unhealthy states that was released this week by the Physicians Committee for Responsible Medicine (PCRM), followed by West Virginia and Tennessee. The group compiled the list after analyzing the most recent data from the CDC on the rates of three major health-related killers -- heart disease, diabetes, and obesity.

According to PCRM, the least healthy states in the US are:

1. Mississippi
2. West Virginia
3. Tennessee
4. Michigan
5. Louisiana
6. Texas
7. Kentucky
8. Illinois
9. Missouri
10. Arkansas

The PCRM is launching a monthlong healthy eating campaign designed to help the residents of these states lower their risk of disease. The organization has also offered the government of each state a nutrition makeover.

"Americans are in the midst of a health crisis, and, as a physician, it's my job to make a diagnosis and prescribe treatment options. In this case, it's a meat-based diet that is putting these folks at risk for diabetes, obesity, and heart disease," says Neal Barnard, MD, president of PCRM, in a news release. "Our studies show that a low-fat, vegetarian diet is the most effective method of treatment and prevention for those diseases. Unfortunately, that prescription has not gotten to those who need it most -- the people in these 10 states." -->

Dec. 5, 2000 -- If you're like a lot of Americans, you probably could stand to lower your cholesterol. A new study shows that the choice to do so is up to you -- well, sort of. The researchers tell WebMD that genes may have more power than sheer will in the fight against high cholesterol.

"We were looking into why people differ in their response to cholesterol lowering diets," says study leader Margo A. Denke, MD, associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas. "Some people try very, very hard on a diet, but can't even budge their cholesterol levels. We were trying to determine how much of that was due to genetics."

Between 1997 and 1999, 56 families -- 92 adults and 134 children -- in the Dallas-Ft. Worth area followed two special diets.

During the study, all members of a family got their fat -- 20-25% of total calories -- in the form of either saturated fat-laden butter or margarine with unsaturated fat. For each regimen, families were provided with specially formulated breads, baked snacks, and spreadable fat for cooking. After five weeks, they went back to their normal diet for a month, then switched to the other diet for five more weeks. Cholesterol levels were measured at different intervals during the study.

The research -- which, luckily for the study participants, was halted between Thanksgiving and Christmas each year -- is published in the Dec. 6, 2000 issue of The Journal of the American Medical Association.

"In our study, 80% of people had lower cholesterol levels when they consumed margarine compared to butter," Denke, who is also at the UT Southwestern's Center for Human Nutrition, tells WebMD. Although the overall trend was for cholesterol levels to drop with less saturated fat intake, genetics definitely played a role. Parents who responded -- whose cholesterol went up and down with diet -- had children who responded as well. "And if the parents don't respond, neither do the children," she says.

People are powerless over their genes but one take home message "is that margarine is a better choice than butter, which is one of the most potent cholesterol-raising fats," says Denke. There is increasing evidence, including a recent study looking at the blood vessels of children who'd died in car accidents, that plaques that clog blood vessels begin forming much earlier than previously thought. "What you eat really is very important," she says, "and it is especially important to start out right. There will be big pay-offs as you get older for learning a good diet when you're young."

The second, less obvious point, she says, is that heavier people reap much less benefit from cholesterol-lowering diets than do thinner folks. "A person who's overweight gets into trouble for two reasons. Being overweight itself raises their cholesterol," she explains, "and even when they try to lower cholesterol by diet, they won't get as much cholesterol lowering."

People "should realize that being overweight has very major consequences, and the only way to undo those consequences is to get thin. And "the only way" to do that, says Denke, is by eating fewer calories.

Exercise is more helpful for maintaining -- rather than spurring -- weight loss, says Denke. "We can undo an hour's worth of exercise with one little cookie. People will overeat for five minutes, not realizing that it will then take them five hours to burn off those calories with exercise. We have to focus on what we're putting in our mouth. Our study shows that it's really important to make good, sensible choices."

In the struggle with genes, Denke recommends switching from higher-fat choices to lean meats and low-fat dairy products, such as 2% or lower milk and low-fat sour cream.

A morning multivitamin. A couple of E's. Maybe some C. A protein shake for lunch. A calcium pill or two, later in the day. We've come a long way since our Flintstones days. But are Americans overdoing it?

It's true, vitamin-fortified foods are flying off store shelves. Even orange juice comes with calcium and vitamin D. Energy bars, meal-replacement drinks, protein shakes, cereal bars, cereal itself -- all claim lots of vitamins and minerals, up to 100% of the recommended daily allowance (RDA).

Then, too, specially blended multivitamins -- with hot new "additives" such as green tea -- are nearly irresistible to health nuts.

But you do the math: You could be getting up to 500% of the RDA, maybe more, in one day's time -- up to five times what your body needs. Are we toting up toxic levels of vitamins? Or throwing our money away?

Experts Weigh In

Chris Rosenbloom, PhD, RD, professor of nutrition at Georgia State University in Atlanta, counsels plenty of people who are overdoing it.

"If you're eating two energy bars a day, plus a protein shake that is vitamin fortified, plus taking vitamin supplements, you don't need all that," says Rosenbloom.

But most people still aren't getting the right vitamins despite their best efforts, says Jeffrey Blumberg, PhD, professor of nutrition at Tufts University in Boston. "Most people need a multivitamin as 'insurance.' Everybody needs to eat more healthfully. While you're trying to get there, take supplements."

In fact, many people don't know what they're taking, Rosenbloom says. "They're picking up OJ at the store, and they don't know what's in it -- is it calcium-fortified, they don't know. People are taking vitamin C supplements but don't know how much."

A Tidbit of Data

A couple of years ago, the Institute of Medicine issued a report listing "tolerable upper intake level" for all vitamins and minerals -- the maximum safe amount that anyone should take.

Vitamin A

The upper tolerable limit for adults is 10,000 IU for vitamin A. You get it from animal foods, fish, and dairy products. Also, beta-carotene (from orange and yellow veggies) gets converted to vitamin A in the body. "But the body is smart enough that it doesn't convert all that to vitamin A," Rosenbloom explains.

If you're taking a multivitamin that contains 5,000 IU, plus getting A-fortified foods in your diet, plus eating foods that contain vitamin A, you're probably OK. "It's the supplements we worry about. It's easy to overdo it with pills," she says.

Vitamin C

"Most people think it's fine to take as much as they want," says Rosenbloom. "I know people who take 10,000 mg a day." However, the upper tolerable limit is 2,000 mg a day. "People at risk for kidney stones can increase that risk; people also can get diarrhea. Some people have complained of food poisoning, but it turned out they had taken too much vitamin C. People just aren't aware how potent these vitamin supplements are."

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Vitamin D

"This can be tricky because we need some, and as we get older we need more," Rosenbloom tells WebMD. "But the risk is that we get too much, which can actually cause calcium to leach out of your bones." Vitamin D is found in some calcium supplements; some orange juice products are fortified with vitamin D. If you're somebody who can't drink dairy, getting vitamin-fortified orange juice makes sense. "But if you do drink dairy, and then you take a supplement, it's that layering that I get concerned about," she says.

Vitamin B-6

This is a water-soluble vitamin, which means you just pee out the excess, says Rosenbloom. The upper tolerable limit is 100 mg day, and in pill form it's easy to get that much. "In high doses, people have problems with temporary nerve damage -- they lose feeling in their hands and feet," she tells WebMD.

Fifteen years ago, women were told to take megadoses to help with depression and PMS, but that's been debunked, she says.

In today's on-the-run society, where sitting down for a meal is sometimes an impossible luxury, the emergence of nutrition bars may seem to be just what the doctor ordered. Though these pocket-sized bars once found favor primarily with serious athletes looking for a competitive edge, now anyone who feels the need for a nutritional boost may keep a few stashed in a purse or a briefcase.

In the current bar-wars environment, there are literally hundreds of these prewrapped and portable products competing for shelf space at gyms, health-food stores, and supermarkets, with names ranging from PowerBar and Luna Bar to Balance Bar and MET-Rx. But nutritionists agree that not all bars are created equal. There are high-carbohydrate bars, protein bars, energy bars, breakfast bars, brain-boosting bars, meal-replacement bars, diet bars, and women-only bars. And with so much to choose from, consumers hungering for a quick nutritional fix -- whether they're recreational athletes, workaholics tied to their desks, or overcommitted moms with barely a moment to spare -- may feel dizzy from all the product overkill and heavily hyped claims.

Digesting the Bar Facts

Without a doubt, grab-and-gobble nutrition bars are great for people who race nonstop from sunup to exhaustion. "They're a convenient alternative for someone who would otherwise be reaching for a doughnut or using the vending machines for snacks at the office," says Liz Applegate, PhD, lecturer in nutrition at the University of California at Davis. "But there's nothing magical about these bars. Most of them are fine, but some are too high in fat."

Dawn Jackson, RD, spokeswoman for the American Dietetic Association, concurs, noting that the bars are convenient, especially when you're physically active. "You wouldn't put a turkey sandwich in your pocket when you go on a bike ride, but you could easily bring one of these bars with you." However, she cautions, "some of the bars have as much sugar and as much saturated fat as a candy bar. So use them in moderation."

Steve Hertzler, PhD, RD, assistant professor of medical dietetics at Ohio State University, conducted a study showing that endurance athletes may not get the sustained energy boost that they're expecting from certain bars. In his research, he compared the effects on blood glucose levels of two popular energy bars -- the Ironman PR Bar and the PowerBar.

Hertzler found that the Ironman PR Bar provided increases in blood sugar levels that remained fairly steady, which could translate into enhanced performance for endurance athletes. By contrast, the PowerBar produced a quick rush of blood sugar, but it was followed by a rapid decline -- not much different than occurs with a Snickers bar.

The composition of the Ironman PR bar -- 40% carbohydrate, 30% fat, and 30% protein -- may have been responsible for its more sustained effect on blood glucose, says Hertzler. For endurance events, he "research shows that consuming a little bit of carbohydrate every so often during a race is going to improve performance."

Nutritionist Nancy Clark, MS, RD, points out that anything that provides calories will give you some energy. "Bananas give energy," says Clark, director of nutrition services at SportsMedicine Associates in Brookline, Mass. "Twinkies give energy. Energy bars give energy. That's because they all provide calories."

It's five hours until her holiday dinner is to be served, and Evelyn Tribole's gargantuan kitchen is already cluttered and humming. Every pot and pan she owns is out, sharing space on the countertops with enough food to feed an army. Wearing a cobalt blue apron, she's ready to work her magic.

By 3 p.m., if this holiday dinner is typical, she will serve the 30 guests she routinely expects, and the meal will look like many of those traditionally served in any other home. But Tribole has a secret: Her fare is festive but not overly fattening.

A longtime dietitian and cookbook author, Tribole has learned to make holiday dinners with a fraction of the fat and calories of many holiday menus, without ruining the taste or making her guests feel deprived. In fact, according to her, most have been unaware of her culinary sleight of hand. She says she can't recall any scrunching their noses and asking, "Is this one of those low-fat dishes?"

If you've had guests skeptical of eating holiday food that's been "healthified" (read: ruined), there may be hope. Most cooks try too hard to eliminate calories from holiday dinners, Tribole says. "They try to get out all the fat." That's not the goal, she says. The key is modifying with moderation -- and maintaining the perspective that holiday meals should be special.

To learn more, WebMD asked Tribole and two other dietitians to tell us more about their holiday menu strategies.

The Tribole Plan

Stick with your favorite holiday dishes, Tribole suggests, but change one fattening ingredient to reduce fat and calories. "If you change one ingredient and don't like the result, you'll know what the problem is," says Tribole, MS, RD. For instance, if she makes quiche, she may substitute evaporated skim milk for cream.

She cautions not to go overboard, however. While substituting low-fat ingredients can work, resorting to nonfat foods can spoil the taste of a dish. "I will use light butter instead of regular," she says, to top off dishes and at the table. For a fruit mold, she often uses sugar-free gelatin. "You can't tell," she promises. "I use light cream cheese instead of regular, but I never use fat-free cream cheese alone. It's too blah. I might mix fat-free with light cream cheese for a dessert."

For twice-baked potatoes, she uses nonfat milk, light butter, and light cheese (never fat-free cheese, she says). For more healthful gravy, she uses nonfat milk and skims the fat off the meat juices with a fat separator. She uses cornstarch instead of flour and butter to thicken the gravy. And for her vegetable side dish of asparagus, she drizzles some olive oil over it. "My goal is not to end up with zero fat."

But, again, knowing when to leave well enough alone is important. Certain ingredients, she says, should remain. "I don't mess with chocolate," she says. "I'd never use carob instead of chocolate."

The Hampl Strategy

Jeff Hampl, PhD, RD, an assistant professor of nutrition at Arizona State University in Mesa, cooks Christmas dinner for family and friends and knows all about substitution, too. He suggests replacing oil with an equal amount of applesauce when baking cakes. "No one can tell," promises Hampl, a spokesman for the American Dietetic Association.

Spreading out the high-fat foods over the course of the dinner is another strategy. "It's a shame not to prepare [some traditional] foods," he says. "Modify the recipe as much as you can." Then just don't serve them all at once. His main course, for instance, is goose -- high in fat. A 3.5-ounce serving with skin has 305 calories and a whopping 21.9 grams of fat. But he limits the damage by using a turkey baster to remove the fat from the pan every 45 minutes.

March 3, 2004 -- If weight loss is your goal, a 15-minute walk might not be enough, one study shows.

"Fifteen minutes is good for your heart and your psyche, but not if you're not going lose weight," researcher Michael Costanza, PhD, a biostatistician at the University of Geneva in Switzerland, tells WebMD.

His paper appears in the current issue of the American Journal of Public Health.

Some researchers suggest that people could battle obesity by cutting 100 calories out of their diets -- or by burning an extra 100 calories through 15-minutes a day of a moderate or brisk walking, he says.

His study provides "a more realistic look" at the calorie burn from these recommendations. People have to walk a whole lot farther to walk off those extra pounds, Costanza tells WebMD.

In his study, Costanza uses five years of lifestyle surveys completed by 6,010 Swiss adults aged 35 to 74 years old. He then projected the calories burned by following a daily physical activity recommendation that involved walking. The participants walking program involved 15 or 30 minutes of daily walking done at a pace that was either slow, moderate, brisk or athletic-brisk -- the pace followed determine what the metabolic rate was and how many calories would be burned.

If the population as a whole followed the recommendation for physical activity his findings showed that:

• The average adult who walked 15 minutes per day at a slow pace would burn only an additional 9 calories per day.
• The average adult who walked 30 minutes a day at a slow pace would burn only an addition 25 calories per day.

Assuming that the population as a whole participated in harder levels of the physical activity, the following results would be expected:

• Walking moderately for 15 minutes per day burned 36 calories per day, where as moderate walking for 30 minutes burned only 85 calories per day.
• Walking briskly resulted in an increase in the calories burned. Fifteen minutes of a brisk walk per day resulted in 60 calories burned, whereas 30 minutes a day of a brisk walk resulted in 129 calories burned.

"If your goal is to burn 100 calories a day, 15 minutes just won't do it," says Costanza. "There's very, very little calorie burn in a slow walk. Walking briskly for longer periods will provide a fairly substantial boost in calorie burn. Then you will lose weight."

That's not true, says Madelyn Fernstrom, PhD, director of the Weight Management Center at the University of Pittsburgh Medical Center.

"You can lose 10 pounds with a 15- or 20-minute slow walk -- if you do it daily -- and even if you didn't cut back on calories," Fernstrom tells WebMD. "That 100 calories you burn will give you that 10-pound weight loss in a year's time."

What gets people into trouble is eating an extra 150 calories to compensate for all that activity, she explains. People waste their weight-loss efforts.

Fernstrom dislikes public health messages that "overwhelm" people -- messages about walking 10,000 steps, or for 45 minutes or an hour every day -- for weight loss. "People end up think nothing is good enough," she says.

She advises setting realistic goals: Start with a half-mile, 30-minute walk; then do a mile in 15 minutes; then two miles in 30 minutes. "The idea is, can you get more activity into the time you have," says Fernstrom.

For faster weight loss, cutting back on calories will also help -- "but exercise allows you to barter for a little more food," she explains. "Say you're cutting back 500 calories a day to lose 1 pound a week. If you get some exercise every day, you only have to cut out 350 calories. And let me tell you, 150 calories are really precious when you're trying to lose weight."

"Sure, you can lose weight by cutting back on eating, without the physical activity component," Fernstrom says. "There are a lot of books out there that tell you how to do it. But weight loss is much easier with physical activity."

March 7, 2007 -- Once happy, always happy? Once grumpy, always grumpy? Maybe not, according to a new review of happiness research.

The review focuses on the "happiness set point" theory, which suggests that people have a happiness set point, a natural level of happiness they gravitate to, despite temporary rises and falls in happiness.

But your happiness set point may not be carved in stone, suggests Michigan State University professor Richard Lucas, PhD.

Major life events such as getting divorced, losing a job, or becoming disabled may reset your happiness set point, writes Lucas.

"Happiness levels do change; adaptation is not inevitable; and life events do matter," Lucas says.

His review appears in the April edition of Current Directions in Psychological Science.

Psychology of Happiness

Lucas reviewed data from a German study of nearly 40,000 people and a British study of more than 27,000.

The German study lasted 21 years; the British study for 14 years. Participants annually rated their life satisfaction and reported any major life changes they had experienced in the past year.

As the happiness set point theory suggests, people tended to adapt to major life events. But that process sometimes took many years and didn't always lead back to previous levels of life satisfaction.

For instance, Lucas notes that it takes about seven years after the death of a spouse for widows and widowers to return to the level of life satisfaction they had before their spouse died.

Meanwhile, the temporary bounce in happiness after getting married generally fades "within just a couple of years," writes Lucas. That doesn't mean married people are unhappy, just that -- within a few years -- they become about as happy as they were before saying "I do."

Lucas also noticed that, understandably, people reported less life satisfaction after getting divorced or losing a job. But he didn't see people bounce back to their previous level of life satisfaction after those events.

That doesn't mean getting divorced or losing a job always lowers long-term happiness.

Not all marriages or jobs are happy and satisfying. So for some, divorce and job loss may ultimately lead to a better life.

People also vary a lot in how much they adapt to life events, Lucas notes.

The researcher doesn't dismiss the happiness set point theory. He says happiness is "moderately stable" over time but warns that people can still experience "large and lasting changes" in the feeling.

Nov. 8, 2004 (New Orleans) -- Wedded bliss has its rewards: Being married and having a strong social network may help protect against heart disease, a new study suggests.

The study of nearly 15,000 men and women shows that those who have a spouse, go to church, join social clubs, and have a lot of friends and relatives have significantly lower blood pressure and other heart disease risk factors than unmarried loners.

People who are married and have a strong social network are also less likely to smoke than their unmarried, less social counterparts, says Chris J. Armstrong, PhD, research associate in the division of epidemiology and community health at the University of Minnesota in Minneapolis.

Men seem to get an added bonus from taking a trip to the altar: "Married men with strong social support are also more likely to engage in physical activity, though this doesn't hold true for women," Armstrong tells WebMD.

High blood pressure and smoking are classic risk factors for heart disease, while physical activity can help ward off the nation's No. 1 killer.

For the study, presented at the annual meeting of the American Heart Association (AHA), the researchers interviewed nearly 15,000 Minnesotans between 1990 and 2002. Participants were asked about their marital status, church attendance, membership in social clubs such as the PTA, bridge club, or runner's club, and how many friends and relatives they had to help them through the good and bad times. All the men and women also underwent a physical exam looking at risk factors for heart disease.

Though the study was not designed to look at how family and social ties protect against heart disease, Armstrong says he suspects that "at least as far as smoking [goes], spousal and peer pressure are involved."

Coronary heart disease is the single largest killer of American men and women, responsible for more than one in five deaths in the U.S. in 2001, according to the AHA. About every 26 seconds an American will suffer a coronary event such as a heart attack, and about every minute, someone will die from one.

Importance of Social Ties

Raymond J. Gibbons, MD, the Arthur and Gladys D. Gray professor of medicine at the Mayo Clinic in Rochester, Minn., tells WebMD that the new research is one of a series of recent studies showing that social support in general and marriage in particular may be important for our heart health.

Another study presented at the meeting, for example, shows that married people who receive implantable defibrillators to correct heart disease due to abnormal heart rhythms have significantly less anxiety and depression than those who live alone.

Although the subject of a flurry of recent reports, the connection between social support and heart health has probably always been there: It was just a matter of looking for it, says Tim Gardner, MD, professor of surgery at the Hospital of the University of Pennsylvania in Philadelphia.

"We haven't looked at the impact of behavior on health as much as we should," he says. "Especially within the scientific community, the emphasis has been on new drugs."

But health conditions such as obesity are actually both a medical problem and a behavioral problem, Gardner says.

"We need to pay more attention to the behavioral aspects of our health," he tells WebMD.

Sept. 9, 2003 -- Reaching for the cookie jar at the first sign of bad news may actually be healthy.

New research suggests that high-fat, high-carbohydrate comfort foods actually fight stress by stemming the tide of stress-related hormones that are released when people are acutely exposed to stress.

But there's a hitch.

Researchers say those same ingredients in your favorite comfort foods that work to reduce stress and decrease stress hormones also pile on the pounds around the waist and increase the risk of obesity when stress is chronic. The researchers say that over the long haul habitual use of these comfort foods may cause an increase in those same hormones, leading to increased amounts of abdominal fat -- a risk factor for heart disease.

Comfort Food Fights Short-term Stress

In the study, which appears in the Proceedings of the National Academy of Sciences, researchers investigated the effects of comfort foods on stressed-out rats.

They found that when rats exposed to stress ate foods high in carbohydrates and fat, an unknown component in the foods acted like a brake on the cascade of stress-related hormones, such as the steroid cortisol, and hormones that are related to the "fight or flight" syndrome.

Stress sets off this syndrome and causes non-vital bodily functions to shut down. Meanwhile, adrenaline levels increase, heart rate quickens, and the immune system gets a boost.

Although this type of reaction is good if you're staring down a grizzly bear, researchers say chronic exposure to stress puts the body into overdrive, continuously stimulating these hormones, which can increase long-term health risks.

In addition, researchers say that their findings suggest that this constant exposure to stress can also trigger a potentially dangerous urge to indulge in rich comfort foods.

"There is no doubt that eating high fat and carbohydrate comfort foods cheers people up and may make them feel and function better," write researcher Mary F. Dallman, of the University of California, San Francisco, and colleagues.

"However, habitual use of these foods, perhaps stimulated by abnormally elevated concentrations of cortisol as a consequence of underlying stressors, results in abdominal obesity," they write. Unfortunately, this type of obesity is strongly associated with type 2 diabetes, cardiovascular disease, and stroke."

Researchers say occasionally indulging in mom's macaroni and cheese or chocolate chip cookies is probably useful to relieve anxiety in the short-term. But habitually using comfort foods to combat chronic stress is likely to be bad for long-term health and could be contributing the current epidemic of obesity in the U.S.

Oct. 16, 2002 -- Cancer patients are avid users of herbal remedies and dietary supplements. They're also much more willing than others to talk to their doctor about it. And researchers say that's good news for their health.

Two new surveys show cancer patients are about 30% more likely than others to tell their healthcare provider about herbal or dietary supplement use.

"Cancer patients are very forthcoming with their doctors about everything they're taking," says researcher Jessie A. Leak, MD, of M.D. Anderson Cancer Center in Houston, in a news release. "We don't know why, but perhaps they feel the need to disclose everything about themselves to better their chances of getting well."

Leak presented the results of the surveys today at the annual meeting of the American Society of Anesthesiologists in Orlando, Fla.

Researchers say doctors are concerned about their patients' use of herbs and dietary supplements because some of the preparations have been linked to potentially hazardous drug interactions, or shown to reduce the effectiveness of cancer surgery and chemotherapy drugs.

Products linked to negative side effects include ephedra, licorice, St. John's wort, ginkgo biloba, valerian, feverfew, ginger, and echinacea. The effects of these supplements can linger long after the body has processed them.

In the first survey, researchers asked 300 cancer patients scheduled to undergo surgery about their use of alternative treatments. About 18% reported using at least one herbal or other supplement. That rate of use is roughly comparable to that seen in the general population.

But 70% of the patients said they told at least one physician about their herbal use, and that's about one-third higher than the rate at which other types of patients report herbal use to their doctors. Researchers say previous studies have shown about 40% of preoperative patients tell physicians about using herbal products.

In a second survey, researchers looked at 154 cancer patients being treated in the center's pain management clinic. They found that 43% of these patients were using herbals, and like the other group, about two-thirds said they'd informed their doctor.

Leak says the fact that the patients in the pain clinic were more than twice as likely to be using herbals may be due to the fact that they were farther along in their cancer treatment and probably had spent more time educating themselves about alternative options. -->

Upon its release this Ash Wednesday, Mel Gibson's new film The Passion of Christ is sure to add to the passionate debate already surrounding the film. In the process, the film is poised to join a select list of films that highlight the unique ability of movies to sometimes go beyond mere entertainment to something more universal ... call it movie magic?

For a start, The Passion of the Christ is one of the first R-rated movies in a while that has moviemakers and marketers encouraging young and old alike to see the film.

The Passion of Movies

But what is it about movies, in particular, that can affect us with emotions, insights and inspiration ?

The Passion of the Christ has a lot of impact because there is a lot of charge surrounding it, says Oakland, Calif.-based cinema therapist Birgit Wolz, PhD.

However, Wolz tells WebMD, "an article or book would not have this much impact because all of our senses are affected through movies," Wolz says. "Our psyche is much more directly impacted by movies, especially when we hear music that arouses emotions as we watch."

Movies affect us through more than the story they are telling, she says. "They also elicit emotions by stimulating our senses: sight through visual images and hearing through music and other sounds. Directors use visual effects, spatial relations, timing, sound effects, and music to prompt the emotions of the audience in a particular direction, thus widening the range of their perception."

For Better or for Worse ...

"Movies are like a proverbial hammer, you can use them for good or for bad," she says. "They can re-traumatize people if they are so powerful and violent, and if people are not treated, they can worsen anxiety and depression."

For example, families may be re-traumatized when they see Holocaust movies such as Schindler's List and The Pianist. Other movies, too, can remind viewers of a traumatic event or loss.

Vietnam-era movies like Platoon and Born on the Fourth of July help raise consciousness about what happened in Vietnam. The effect "really depends who is seeing it, but I believe that these movies can make us more aware of what's happening in a war and learn compassion and empathy," she says.

Suspended Disbelief at Play

Gary Solomon, PhD, MPH, MSW, author of The Motion Picture Prescription and Reel Therapy and a professor of psychology at the Community College of Southern Nevada, agrees with Wolz when it comes to the power of movies.

"Movies are very visual as opposed to books, where we must visualize the story on our own, so with movies we are getting a story along with visual image, and that creates a very powerful impact," he says.

Suspended disbelief is also at work, Solomon says. "This is a process where we view something and for an hour-and-a-half to two hours and suspend our disbelief about the story and what's going on around us and accept the concept for what it is," Solomon explains.

"People will undoubtedly look at [The Passion of the Christ], suspend their disbelief, and will, for whatever period of time, believe that this is exactly the story that took place," Solomon says.

That has left many people fearful that the film will spark anti-Semitic sentiments because of how the film portrays the involvement of Jews in Jesus' death.