In an interesting article by Tara Parker-Pope, food labels get a new look. A consumer advocacy group called the Center for Science in the Public Interest proposes giving the standard food labels a makeover. Miss Parker-Pope does a nice job illustrating what the new food labels would look like and itemizes how each of these changes would occur.
The Nutrition Labeling and Education Act passed almost twenty years ago and is the law governing the descriptions that we now read on the foods we buy. Many of us have noted the problems with food labeling and my pet peeve has always been that food producers can still play fast and loose by choosing ridiculously small serving sizes and thus offering a misleading low amount of calories and carbohydrates. The new food labels would put calorie and serving size information in larger type at the top of the label. It would make changes in the ingredient list by separating them with bullets instead of allowing all the ingredients to run together. Similar ingredients would be grouped together and their percentage shown by weight. Miss Parker-Pope notes this would be especially important for sugars including things like sugar, corn syrup, high fructose corn syrup and grape juice from concentrate, all of which are forms of sugar that would be listed under a catch-all heading of sugars. In addition, the new labeling proposal would add the word “high” if a particular food had more than 20% of the daily recommended allowance for fat, sugar, sodium or cholesterol. It would also display the percentage of whole grains contained in the product. The proposed food label would also list the milligrams of caffeine contained in the product.
All in all, the new label makes some improvements. It will highlight the serving size more prominently and make is somewhat less easy to mislead consumers with unrealistically small serving sizes chosen. It is unlikely, however, to end this practice. The recommendations though do make a good deal of sense and highlighting which products are “high” in fat, sugar, sodium and cholesterol may help consumers make better decisions.
These recommendations do make a big assumption that fat, cholesterol, sugar and sodium are all similarly important to highlight and presumably for consumers to reduce or control consumption for these nutrients. It’s not entirely clear that is in fact the case. The best evidence would certainly suggest that calories alone would be the most important thing to highlight and control followed closely by sugars. For some people, especially those with hypertension, controlling sodium also makes sense. Controls on consumed fat and consumed cholesterol may be a bit harder to justify from a scientific basis, but the concept may have some validity. It does confuse body fat and serum cholesterol with consumed fat and consumed cholesterol and the link is not nearly as clear in science as such labeling would suggest.
Nonetheless, I support the proposed labeling makeover for the most part. In my position as head of organizations aimed at combating obesity and preventing childhood obesity, I would like to see greater emphasis placed on highlighting the serving size and preventing food manufacturers from choosing misleading and unrealistically low serving sizes. I would also like to see more emphasis on calories and sugar and less emphasis on consumed fat, cholesterol and caffeine, none of which have anywhere near the kind of impact on obesity and diabetes as calories and sugars.
What are your thoughts?

As we move into unprecedented levels of obesity, diabetes and disease, it is worth asking how the buckling healthcare budgets will manage to suffice in the future. As other aspects of healthcare are examined it must be considered how the social policies could potentially influence or at least finance what will be a huge healthcare burden in the future due to obesity related disease. So with more and more states in the United States lurching towards populations that one-third of which are obese (BMI over 30) how will these societies prepare to pay for unprecedented demand for healthcare for the burgeoning type II diabetes population, increased needs for cardiovascular treatments, CPAP machines, insulin injections, ER visits for stroke and kidney failure and cancer treatments all obesity related.

One proposal that has emerged and as was discussed recently on national public radio on the Diane Rehm Show, is taxation on calories or carbohydrates or some specific nutrients. The logic goes something like this: unprecedented costs arise from obesity. Obesity arises from excess consumption of calories, specifically carbohydrate calories. Therefore taxation on the consumption of these calories may both curb behavior in a healthier direction and lays funds to support the demand for medical services.

Is this just? Is it fair? Does it make sense?

Weight Loss Tip# 6 Fight Back When the Day Gets Crazy

From Doctors Orders: 101 Medically Proven Tips for Losing Weight

Some days just don’t fall into line, no matter how well you plan. The day turns crazy. The kids need something. A crisis happens at work. Unexpected events cancel your well-planned lunch and dinner regime.

What can you do to avoid the binge that can happen if you go too long without feeding the beast?

Keep some low-carb snacks available. Some of the protein bars don’t hold up well in the car in the summer heat, but others do. Experiment and try stashing a box of the kind that are not covered in chocolate somewhere in your car.

Then think of some other snacks that work for you: beef jerky, cheese sticks and other low-carb snacks, keep them available for when the day falls apart, you’re out running errands and there is no way to have an organized meal.

For more information on Doctors Order: 101 Medically Proven Tips for Weight Loss Click Here, and don’t miss out on our Twitter and Facebook Contest happening through November 31’st.

The choice of which bariatric procedure on should choose to do is an important one, but it might not be as important as you think.

When faced with deciding upon the right weight loss surgery for you there are many choices to consider. One should try and research every detail they can about them and make the best possible choice for themselves.  I have written a lot on this blog, in books, and articles regarding how to go about choosing the right surgery. I have examined the data very carefully to try and help guide people on this topic.  I also spend a lot of time one on one with my own patients in trying to help them make the best decision should they choose the laparoscopic Roux-en-Y gastric bypass, or perhaps the laparoscopic adjustable gastric band or the laparoscopic sleeve gastrectomy.  Sometimes the choice can be difficult and as we know there is no single, one clear cut right answer for everyone.

But, more important than the choice of weight loss surgery is a much richer, more challenging and more rewarding place to focus our mental energies: on staying prepared and motivated to do the work of losing the weight.  Regardless of what surgery is chosen, the procedure is not going to do the work by itself.  No surgery is going to magically make a person exercise more, decrease the glycemic index of their intake, reduce their portions and begin cutting out full meals and servings of carbohydrates such as: sweets, desserts, potatoes and snacks.  Only you can do that.

So while choosing the proper surgery is important, and some people may do much better with one kind of procedure than another, at the end of the day the variations and weight loss outcome between all the operations is dwarfed by the variations between individuals depending on their motivation level.

Yes, that is right, you could lose far more weight with the less invasive procedure simply by being more motivated and sticking to the regimen more closely.  That means dramatically cutting down carbohydrate intake and increasing the calories you burn with muscle activity.  On the other hand, you can have the most invasive operation that supposedly delivers the highest amount of pounds lost, and find that you don’t lose any weight because you are less motivated and less compliant with the recommended eating regimen.

If the difference between say, the gastric bypass and the gastric banding procedure in terms of average weight loss results is ten percent, the difference between highly motivated and less motivated individuals is 100 percent.

So, research as much as you possibly can.  Read the articles on this blog about the subject, read my book about which operation is right for you.  Read every other source you can, talk to as many people as you can.  But, once you have made a decision about which procedure to undergo, focus all of that mental energy and enthusiasm (and more of it!) on committing 100 percent mind, body and soul to achieving success in your weight loss journey.  This is going to mean sacrifice.  It is going to mean starting a difficult preoperative weight loss diet.  It is going to mean living with hunger.  It is going to mean making painful choices.  It is going to mean cutting down the carbohydrate intake.  It is going to mean reading every label.  It is going to mean increasing your muscular activity through things like: walking, swimming, use of hand weights, etc.  It is difficult, but with a consistent and dedicated effort you can achieve amazing results no matter which type of surgery you have chosen.

Research indicating that mice, and now primates, live longer with a calorie restriction diet appears to add fuel to the fire of the notion that reducing calories will prolong life in humans. Many commentators and scientists raise various objections to the notion that calorie restriction will have the same kind of effect in humans. The theories offered having to do with cellular metabolism and the change toward a protective metabolic posture versus a reproductive posture might no translate into human beings the same way they do in rodents or even Rhesus monkeys, so the argument goes.

I think that many of us who have experience in the real world of practical weight loss endeavors for human beings might have a slightly different answer that is less complicated. Let me explain what I mean: for many years we have seen an increasing number of well constructed studies showing a dramatic benefit in longevity after weight loss surgery. I have chronicled these studies elsewhere, but suffice it to say that five robust studies now exist demonstrating that people live markedly longer after weight loss surgery. It is not really necessary to delve into complex theories about cellular regulation in order to understand this survival benefit. It is really a matter of observing that obesity related diseases like diabetes, cancer and heart disease are all markedly reduced after substantial weight loss. In short the answer is the same thing that the life insurance actuarial tables have known for decades: the heavier we are, the shorter our life expectancy.

So, an intervention that results in losing weight and sustaining a lower body weight necessarily results in a longer life expectancy. Far less people who have a normal BMI develop type 2 diabetes than overweight people. And of course the more overweight we are, the more striking the increased risk of type 2 diabetes. Type 2 diabetes, of course, shortens our life by bringing on early heart attacks, strokes and other complications.

What’s different with laboratory animals and humans is that in the laboratory the scientists can control the calorie intake of all the animals. So one need only look at the photographs of the calorie restricted monkey versus the normal diet monkey to see what is going on here. The calorie restricted diet monkey is skinnier, plain and simple. The monkey’s also do not watch TV commercials and go to fancy restaurants and succumb to the delightful tastes of high fructose corn syrup and other delicious, modern, high carbohydrate cuisine. The simply eat what is passed to them on their tray at meal time.

It appears pretty simple to me, that all of these avenues of research show the same thing: that up to a point, being skinnier leads to longer life or put another way, being overweight is less healthy and shortens life.

It would be great if technology produced some cure to this problem and reduced the impact of weight gain on our bodies, thus allowing us to enjoy the longer, healthier life without actually losing the weight. That may take quite some time to develop technological pharmaceutical solutions for such a wide ranging affect on so many different cells and organs throughout the body leading to diseases as diverse as atherosclerosis, many different organ cancers, and diabetes.
In the meantime, since the data is so overpowering, perhaps we should all just focus on finding ways to lose weight. Clearly the data, whether it is in overweight humans, normal weight Rhesus monkeys, or calorie restricted mice, all point in the same direction: we live longer, healthier lives at lower body weight.

The next vitamin I want to discuss with regard to deficiences after weight loss surgery is folic acid or what is often referred to as folate. Folate, like vitamin B12, is very important for a number of aspects of metabolism and it’s very important in the production of our red blood cells.

Generally present in beans and green leafy vegetables, it is a B complex vitamin that is water-soluble and it does become deficient more often after gastric bypass surgery. The kinds of symptoms people might experience with a folate deficiency would include weakness, fatigue, pale skin, and possibly a feeling of coolness or cold intolerance. Sometimes there can be other symptoms of this deficiency such as nerve tingling, numbness, and confusion. It’s generally very well supplemented with a standard multivitamin containing folic acid, which nearly all of them do, and in a real severe unusual case it could be supplemented with an IV infusion in the hospital or in an infusion center. Generally speaking, we don’t specifically test for folic acid because it is not such a common deficiency, but we do generally test everybody after surgery at intervals in their three-month, six-month, 12-month and annual follow up visits by checking their red blood cell count. If they are anemic, if the hematocrit or hemoglobin or the red blood cell count itself has fallen, then that might be a reason to go ahead and check the folic acid level, as well as the other vitamin B complex levels. Generally speaking, however, we don’t specifically test folate in everyone just as a routine. If people are taking their standard multivitamin after gastric bypass surgery, then the risk of folate or folic acid deficiency is very low.

I think most of us have developed the idea that certain kinds of preparation techniques are better than others, but the truth may surprise you. I, for example, always held the notion that raw vegetables like carrots and broccoli were probably the healthiest of all. Picking these right out of the garden, washing them a bit and chomping on them for a snack seemed like the best possible connection with mother nature and therefore the best, most nutritious method of obtaining the nutrients.

These and other vegetables provide valuable nutrients in the form of carotenoids and other important antioxidants that play a helpful role in disease prevention, especially cardiovascular disease and cancers.

But food science studies have shown us that we are not as successful absorbing these valuable antioxidants if we just chew them up in their raw form. For one thing, without any fat mixed in with the raw vegetables, we are a lot less likely to absorb the fat-soluble vitamins and antioxidants (did someone say olive oil in salad dressing?) In addition, the lack of any cooking means that most of these fat-soluble molecules are not liberated and digested enough to be absorbed. So a little bit of cooking helps unlock these antioxidant nutrients. And want to know the strange part? Of all the cooking methods examined, it’s likely that microwaving may result in the best liberation of nutrients while still preserving their minimal absorbable form. So much for my theory of staying closely in touch with mother nature.

If ever the planet can ever solve the enormous problems of food distribution and consumption, we will look back on the present period with great dismay. Recent reports indicate that the global economic downturn has pushed at least an additional 100 million people into hunger, bringing the total to more than 1 billion worldwide. What a terrible irony then that this same number of people worldwide suffers from obesity.

It goes without saying that hunger afflicts those in the worst prevailing conditions on the planet, where war and severe poverty abound.  Terrible suffering and loss of life occur at this end of the nutrition spectrum and as an affluent society we must work to end this problem and this suffering.

At the other end of the spectrum obesity shortens life and leads to serious health problems. Because of the cultural, genetic and environmental factors that lead to obesity, combating it proves to be an extremely difficult proposition both individually and societal.  But the battle against obesity is winnable at all levels if we become determined and set our minds to a long-term solution.

These strikingly different problems at the opposite ends of the spectrum of nutritional intake remind us that there is ample food and nutrition supply to go around. The simultaneous persistence of these two problems lead one to believe there must be solutions that could solve both.

Recently, a series of papers in the New England Journal of Medicine have highlighted the importance of what is called brown fat. This is a  special type of fat that is involved in thermoregulation or heat generation for the body.  More commonly present in infants, “baby fat” and in some kinds of animals.

One of the more interesting ideas to emerge from brown fat research is that a method for losing weight may be found by simply turning down the thermostat in our homes.  The idea is that when the thermostat is down and the ambient temperature drops, our brown fat revs up and goes to work increasing our body temperature.  It’s our own sort of internal combustion engine.  It also burns quite a lot of calories.

So while more research will need to be done, the idea of lowering the thermostat in our homes may very well be a simple and yet effective way to increase significant calories burned by our bodies.  (As long as you don’t eat more when the room temperature is lower!).

For those of you who have received our emails and letters or seen the ads, the date is fast-approaching. The 7th annual Western Bariatric Fashion will take place this Saturday March 28th.

I will be signing books and selling advance copies of my new book, “Outpatient Weight-Loss Surgery: Safe and Effective Weight Loss with Modern Bariatric Surgery”, starting at 5:30 PM. There will be gifts and drawings and inspirational stories and entertainment. Local news anchor Joe Hart will be this year’s emcee.

I look forward to seeing you there!