Category Archives: health

Menu labels having no effect? Evidence from Taco Time

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Being a pioneer in adding calorie and nutrition labels to menus at fast-food restaurants has made King County a good place for researchers to visit.

A team based at Duke-National University of Singapore has been watching consumers at Taco Time restaurants, both in King County and in other counties, and found that adding all that info to the menus appeared to have no impact on people’s choices.  He published his results today (January 14, 2011) in the American Journal of Preventive Medicine.

As Shari Roan writes in the Los Angeles Times:

Thirteen months after the law went into effect, food purchases at the Taco Time restaurants in King County were identical to those at Taco Time restaurants where menu boards did not list nutritional information.

“Given the results of prior studies, we had expected the results to be small, but we were surprised that we could not detect even the slightest hint of changes in purchasing behavior as a result of the legislation,” the lead author of the study, Eric Finkelstein, of Duke-National University of Singapore Graduate Medical School, said in a news release. “The results suggest that mandatory menu labeling, unless combined with other interventions, may be unlikely to significantly influence the obesity epidemic.”

This will not be the last word on menu labeling.  The labels are coming soon to restaurants across the nation, Continue reading →

Michelle Obama’s “Obesity Task Force” – watch the details

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We’ll find out on Tuesday what the White House thinks we can achieve, regarding childhood obesity.   I just got this announcement:

Tuesday, May 11th – First Lady Michelle Obama and Domestic Policy Council Director Melody Barnes will unveil the findings of the Childhood Obesity Task Force report, the result of the 90-day review that the President ordered around the launch of the Let’s Move! initiative in February.

Several of the Cabinet members and administration officials who are part of the task force will also attend this press briefing and be available to the media afterwards: Office of Health Reform Director Nancy-Ann DeParle, Secretaries Donovan, Duncan, Sebelius, SBA Administrator Mills, and FTC Chairman Leibowitz.

If the findings emphasize physical activity without making major recommendations about diet, then you can call it a victory for the food and beverage companies.  But, I expect they’ll have a little of everything.  From what I’ve learned lately, I wonder …

  • Will it discuss ways to teach young families how to cook, especially using ingredients they’ve never tried?
  • Will it suggest ways to make sure produce is affordable?
  • Will it suggest a major tax on sugary beverages?
  • Will it tackle the issue of food labeling and food marketing (health claims on packages and advertising to children)?
  • Will it promote further study of the effects on obesity of hormone-mimicking chemicals on pregnant mothers and newborns?

Promoting physical activity is a good idea, too, for a lot of health reasons separate from weight-loss.  Mostly, I wonder if the report will spur any new action, beyond what’s already been attempted over the past decade.

(If you missed my story on why cooking classes might be important, here’s the link to KPLU.

Healthiest children … in wealthy zip-codes

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It’s a little provocative sounding, but the research from Adam Drewnowski at the University of Washington shows most of the obesity and overweight epidemic is closely tied to poverty.

I’ve been blogging about obesity issues all week (see “recent posts” or the tag “obesity”).  Today, I talked to Drewnowski.  I’ll share more about his ideas later. But, this one merits re-stating.  In work that was published in 2008, he took the basic federal data on obesity trends, and overlaid that onto a map of King County.  The wealthier the zip code, as measured by property values, the lower the obesity rates, and vice versa.

He told me the data might have been even more dramatic, because it turns out that the wealthiest areas (such as Medina) are not even represented.  As he put it, Rich people don’t answer surveys.

For the past two years, he’s been digging into some of the reasons why poor people are less healthy.  His baseline theory is the most obvious: eating well and taking care of yourself can be expensive, in time and money.

In work to be presented soon, he’ll argue against the idea that poor people need more grocery stores and fresh produce sold in their neighborhoods.  It turns out, most people will go several miles to get their groceries (except for the very poorest 1%).  Some people drive to the cheapest store, others drive to what they see as the better quality store. So, having more grocery stores wouldn’t make a difference.

You might get different results in Los Angeles, or Detroit — two cities where a lot of the research was conducted re.  lack of access to grocery stores.  He says that work doesn’t hold for Seattle/King County.

He does see a role for better food education (such as, cooking classes).  I’ll have that report Friday morning on KPLU.

Sodas and sugary drinks, an obesity culprit

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How much blame goes to the beverage industry?  NPR’s All Things Considered is looking into this topic (yesterday and today).

Many states are planning to tax sodas.  Washington has jumped on this one, too. The taxes are mostly to help fill budget gaps, and way too small to make a meaningful health difference.

The man who’s studied this the most, and made it into a crusade, says the tax needs to be much higher than any state is considering: a penny-an-ounce.  That would add 12 cents to a can of soda, and more than 60 cents to those 2-liter bottles.  Kelly Brownell, of Yale University’s Rudd Center on Food Policy and Obesity, argues this would compel Americans to make healthier choices.

Yesterday’s NPR reports included a good overview from Jeff Brady, plus a pair of interviews by Michelle Norris.  Several listeners told me they felt Norris was too easy on the beverage industry spokesperson.

Studies have shown a pretty strong correlation between soft-drink consumption and weight gain.  And, the beverage industry response that Americans just need more exercise?  Exercise is good, but it’s not a major factor in the obesity crisis and can’t compensate for the big jump in calorie consumption.  The scientific evidence is pretty strong on that.  But, nutritionists will also tell you it’s too simplistic to think that cutting down on sodas by itself will solve the weight-gain problem.  It’s an important step, but there are additional dietary problems.

Why eating in America may be less healthy than in Mexico

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Another angle on obesity.  I just got back from interviewing Marian Neuhouser, a nutritional scientist at the Fred Hutchinson center.  She’s launching a new study of Mexican-American women.  She says more than 76% of Hispanic women in the U.S. are overweight or obese (the overall rate for women in the U.S. is 64%).  The experience of Mexican immigrants is similar to Japanese immigrants – within one generation in this country, the rates of obesity skyrocket.  That’s why many scientists say there’s something about living in modern America that is “obesogenic” – causing people to become obese.  The most likely and most important factor: diet.

Neuhouser’s hypothesis is that the switch in diet is a trigger, going from typical rural Mexican meals dominated by beans, rice and fresh-made tortillas, to a more American diet that’s full of processed foods, white flour, fatty meats, and sugary drinks.  But, she also suspects the problem for Mexican immigrants is exacerbated by their genetic profile and how it reacts to the American foods.

She just received funding to study this in detail, by getting 50 Seattle-area Mexican women to eat their meals at the Hutch for a month, so she can control their diet, while monitoring their blood for a number of biomarkers.

The biomarkers might also help explain why Hispanic women tend to get a more virulent, hard-to-treat form of breast cancer.

The leanest kids live in …

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All states are not equal, when it comes to obesity.  It’s well-known that the problem is much worse in southern states, and not quite as bad in the Rocky Mountain states and on the West Coast.  A new study is the first to allow comparisons of childhood obesity trends among the 50 states.  Here’s the condensed story from the Associated Press, although I added the third paragraph and the Washington state numbers:

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CHICAGO – A new government study finds that most states are failing to meet federal goals for childhood obesity.

The federal Healthy People initiative set a childhood obesity goal of 5%. Oregon has the nation’s lowest rate of hefty kids, at just under 10%. Oregon was the only state whose childhood obesity fell significantly from 2003 to 2007.  Washington’s obesity rate went up slightly, to about 11% – tied for third lowest among the states.  Mississippi topped the nation with more than one-in-five of its kids obese.

By another measure – how many kids are simply overweight — Washington’s near the national average, with about 30% of kids overweight.  (Oregon places 3rd in this category, with Minnesota and Utah having the lowest percentage of overweight youth, at 23%.)

What works? That’s still debated.  Diet and nutrition have a role. But poverty, race and family history all have complex links to obesity.

The study appears in May’s Archives of Pediatrics and Adolescent Medicine.

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More links:

Whose truth about childhood obesity?

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It’s no secret Americans have been getting fatter — and the future’s not so bright when children are getting fatter, at younger ages.  I’m looking into why, and what should be done.

A lot of solutions have been proposed.  Some are promoted by trusted sources.  But they may miss the mark, even if they’re good ideas for overall health.

  • Couch potatoes and too much TV?  This may seem like common sense, but there’s pretty decent data that “sedentary behavior” has not changed over the past 30 years.  So, promoting exercise and walkable communities — while good for overall health — may do very little to slow the rise of obesity rates.
  • Poverty?  There’s a lot of data showing that the more poor you are, the more likely you are to be overweight.  But why?  Adam Drewnowski at the University of Washington says it’s because of simple food economics.  It’s cheaper to buy a filling meal that’s unhealthy than it is to buy a healthy one.  Think dollar meals and junk food.  Sodas.  They’re full of calories, but low in nutritional value.  That’s his argument.  But, is that what’s really happening?
  • Too much food?  Many nutritionists argue it’s all about calories and consumption.  We’re eating on average more calories per day than we did 50 years ago.  Their story says, in the 1980’s some agricultural policies changed and food got really cheap.  Now, the temptation to eat is everywhere, all the time.  And, since the ingredients are cheap, portions got bigger.
  • Processed vs. whole foods? This is related to the ideas above.  And this has become a trendy way to frame the problem.  If we could only get more people, and especially poor people, to have “healthier food choices,” they would choose the delicious fruits and vegetables and whole grains.  Then, they’d lose weight.  I haven’t seen any good scientific evidence that demonstrates this, but it’s seen a logical conclusion to draw from other research about nutrition.

I’m still exploring these questions. If you know of scientific studies that support/undermine any of these arguments, please share them.   If there’s a better theory missing from this list, share that, too.

Schools ready for swine flu?

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Soon after kids return to school, in the coming few weeks, we may see  the H1N1 swine flu come back with sudden swiftness.  That’s based on what’s happened during past pandemics, such as in 1957, and on the virus’ behavior in the southern hemisphere.  Are the schools ready?

It’s hard to tell.  They basically are continuing where they left off when the first wave of sickness passed through last spring.

My colleague, Jennifer Wing, reports on discussions between Public Health Seattle & King County and school districts.  They don’t plan to close schools this time, and sick kids won’t have to stay home for as long (it was a full week last spring).  But, from what we’ve heard so far, it doesn’t seem like anyone’s making contingency plans for absentee rates that might range in the 30-50% range.

The Virus: H1N1

The Virus: H1N1

Epidemiologists are concerned with getting timely updates on the numbers of absent students.  This is essential for monitoring when and where outbreaks are happening, and last spring some schools were better than others about reporting.

Don’t be surprised if outbreaks begin as early as September.  The evidence keeps mounting that wherever kids congregate in large numbers, that’s where you’ll see rapid transmission of flu virus.  In 1957, it took just 3-6 weeks after school started before  many cities saw a surge of illness.

What about a vaccine, to prevent illness?  The first doses may not be available until after the first wave of sickness.  But, there may be additional outbreaks long into winter, and the vaccine will protect against those.

On the other hand, swine flu infections still appears to be mild, unless you have an underlying sickness or medical condition.

The Magic Sweetener?

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Dental researchers have known something most of us don’t know – that the natural sweetener xylitol can prevent cavities.  It may be about as good as fluoride.   Dr. Peter Milgrom, who teaches, researches and practices dentistry at the University of Washington, has become a big fan of xylitol.   Earlier this week, I reported on his latest study, showing a benefit to babies.

Here are some additional xylitol facts from Dr. Milgrom that I couldn’t shoe-horn into the story:

  • The shortcomings of xylitol:   It has “cool” taste, similar to mint, so works best in cold foods or mint flavors. And it’s a little more expensive than other sweeteners.
  • Most studies so far have shown you need to get at least two, often three, doses of xylitol per day to get a benefit.  And if it’s in a gum or toothpaste, for example, it needs to be the number one ingredient, not diluted with other sweeteners.
  • But, if you get too much xylitol (admittedly rare), you might get stomach upset and diarrhea.
  • There were some suggestive studies from Finland, using very small samples, saying xylitol also might prevent ear infections.   Weird, and not verified.   Milgrom has applied for funding to investigate that.
Birch trees in Finland (Flickr photo by Slider5)

Birch trees in Finland (Flickr photo by Slider5)

Finland, by the way, is like the World Capitol for xylitol.  The Finns have been building up a xylitol industry, presumably because they can grow big crops of birch trees, which are the main source of the substance.

Milgrom’s research is mostly government funded, but he does get free xylitol for his experiments from a Danish company called Danisco.   If you’re intrigued, he says Danisco runs a credible website for basic facts about xylitol.

(What does xylitol do?  Basically, it blocks the bacteria that form dental plaques, interfering with their ability to feed and to stick to teeth.)

A concussion is a brain injury

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Concussions are scary, the more you learn about them.  I like the way Brian Adler summarizes the underlying message:  “All concussions are brain injuries, and all brain injuries are serious.”  (Adler is an attorney who represents accident victims, not a doctor, but he seemed to get a lot of nodding heads at a  sports medicine conference in Seattle.)

The biggest danger is getting a second injury.

There’s been a lot of discussion among scientists and neurologists about concussions and athletics.  The most common system for many years makes a distinction between people who lose consciousness and people who don’t.  But, the latest guidelines, published this month as the “Zurich concussion statement,” says you don’t have to lose consciousness to have a serious concussion.  (I can’t find a free accessible version online.)

The new guidelines say youth athletes should never return to action on the same day as the injury (and adults should only take that risk after a medical evaluation).

Washington’s new youth concussion law (reported on KPLU) is perhaps the most advanced in the world, because one of its architects also served on the Zurich panel.  That’s Dr. Stan Herring of the UW/Harborview.  One big change is simply recognizing that each individual and each injury is different.  You can’t simplify by saying, it’s only minor because he never lost consciousness.  Instead, someone trained to evaluate head injuries needs to run the  victim through a series of tests, similar to a neurological exam.  If there are any problems with balance or coordination, for example, then the brain needs time to heal.

Technically, a concussion is less severe than a “mild traumatic brain injury.” But it can be hard to tell where one stops and the other starts.  A head injury can lead to internal bleeding, which damages brain cells by creating pressure inside the skull.  And a lot of damage happens when the “wiring” of the brain, the long axons that connect one brain cell to another, get severed.  There are bundles of axons, and a jolt to the head can rip them in clusters.  Such damage may not show up in x-rays.

Helmets?  Surprisingly, the international panel can’t agree on whether they’re a good thing in many sports, since they may encourage athletes to take bigger risks and hit things with their heads.  Helmets are definitely recommended for bicycling, skiing and snowboarding.

Oh yeah, one bit of good news.  Most concussions heal within a week and leave no lasting damage.