In 2018 restaurant menus were required to list calorie counts, "to support informed consumer choice, reduce caloric intake, and potentially encourage restaurant reformulations." Since a majority of Americans eat in fast and slow food restaurants (or COVID induced take-out), a reduction in caloric intake here would have a significant effect on reducing our weight, especially since we tend to underestimate our caloric choices. The researchers sought an additional benefit of the regulation, a reduction in disease, in this case, their favorite condition to study, cardiovascular disease.

Taxes of sugary beverages have been with us for some time, with variable results. The second study considered three approaches to taxes seeking the one yielding the most substantial savings.

The researchers used a "validated microsimulation" of cardiovascular disease, treatment, and costs using as their evidence-base, survey data from the National Health and Nutrition Examinations Surveys (NHANES). NHANES dietary habits were based on recall by participants, which introduces some uncertainty. The validated microsimulation is a black-box as the source-code is "not publicly available." As to validation, the model was 80% predictive of the actual values at five years.

The assumptions were, in most part, reasonable, evidence-informed choices. There were a few notable exceptions. In the labeling study, almost half of the data used to make their assumptions came from supermarkets, vending machines, and laboratories where national labeling did not apply. And while the researchers report that the population's demographics were reasonably consistent, two-thirds of the labeling data was missing racial data and a quarter of the socio-economic data making that statement by researchers more opinion than fact.

In the labeling study, the model utilized modest reductions in calories, 19 calories/day if the food was unchanged, 44 calories/day if the food was reformulated. By reformulation, the researcher reference manufacturer initiated changes in food content to make their labeling appear "better" a response to consumer's "demand." The tax study used a reduction in consumption of roughly 25%, which is consistent with a price increase of about the same percentage. Both studies used the now estimated reduction in sugar to estimate the decrease in BMI [1]. In turn, the BMI was utilized from studies for cardiovascular disease to estimate a reduction in cases so a lot of estimating going on.

The most significant assumption is the one hiding in plain sight that the public is only afflicted by heart disease and diabetes. Other conditions that may be altered are safely ignored when your interest is cardiovascular disease, not a more expansive view of population health that includes cancer, accidents, and lung disease.

As you might expect, both labeling and taxation resulted in less disease and their associated costs. The benefits accrue to younger patients, in their 30's and 40's as well as to black and Hispanic populations where soda consumption is higher. That racial benefit is also associated with a higher cost to those populations, as sugar taxation is a regressive tax. The model's output was most sensitive to the number of calories consumed and the pass-through rate of the tax to consumers.

"Our model cannot prove the health and cost effects of these SSB tax designs in US adults. Rather, the estimates provide evidence that can be considered and incorporated into the design, implementation, and evaluation plans of SSB taxes, including at local, state, or federal levels."

With that statement from the researchers in mind, let us consider which regulatory approach, labeling, or taxation you might choose. The summary data of the two studies are condensed into thesetable.

The first three columns show the estimated impact of reducing sugar on reducing cardiovascular events, diabetes, and the resulting changes in the quality of one's life. Any reduction seems to help, but that absolute tax has the greatest impact. The next three columns consider the cost to gain those benefits. Implementation costs refer to spending by the government to write and enforce the laws, as well as collect the taxes in the tax scenarios. It also includes the cost to restaurants and manufacturers for changing labels. Reformulation costs are estimated spending by manufacturers as they reshape their products based on consumer response to the new labels and taxes. Labeling has a small effect on reformulation costs; an absolute sugar tax provided the greatest nudge to reformulation. Government revenue is, of course, the amount of taxes being paid.

Net cost is a bit misleading. In the labeling argument, the expenses are "borne" by the manufacturer. In the tax argument, those costs are to the consumer. In both instances, these costs may be absorbed by the manufacturers or restaurants, but in most situations a percentage, in this case, 75% is passed through to the consumer. More importantly, when we talk about costs, remember that the consumer is the one spending the money, in higher prices or taxes there is no free lunch or beverages.Health care savings were taken from the papers and reflected estimates of direct costs of care as well as indirect costs in terms of productivity and impaired life quality.

In the final column, I compute a return on investment for the additional money spent, how much do we save. This is the place where the policymakers tradeoff cost and benefits. If we were all to read labels and make wise choices, we would get the most bang for our buck. Of course, that is not what humans do. The argument for most sin taxes is that we need to be nudged along. Of all the tax schemes, an absolute tax on the quantity of sugar present provides the most significant value, an ROI of 274%. But that value is less than the return on investment of market-driven reformulations at 331%.

Regulations reducing the quantity of added sugar by manufacturers will provide the highest return on investment. Taxation will return the most significant benefit. Which would you choose?

[1] To make this calculation, the researchers needed to convert caloric reduction to BMI, the factor, among others, that drives cardiovascular disease and diabetes. They provide a 3-page discussion in the supplement but conclude that a 55 calorie/day reduction results in one lost pound over the year and that this new weight loss is permanent. Your own experience with dieting can inform you as to the plausibility of a consistent weight loss. And you may wonder how sensitive the model is to weight when losing 5 ounces will result in nearly 15,000 fewer cases of cardiovascular disease and 21,000 cases of diabetes. Since the model is "not publicly available," I suppose we will never know.

Source: Health and Economic Impacts of the National Menu Calorie Labeling Law in the United States Circulation Cardiovascular Quality Outcomes DOI:10.1161/circoutcomes.119.006313

Health Impact and Cost-Effectiveness of Volume, Tiered, and Absolute Sugar Content Sugar-Sweetened Beverage Tax Policies in the United States Circulation DOI: 10.1161/circulationaha.119.042956

Read the rest here:
Taxing or Labeling Sugar - Which Is Best At Promoting Better Health? - American Council on Science and Health

More Americans than ever are living with obesity. The number of adults with the condition has skyrocketed 200 percent over the past 40 years. Obesity continues to contribute to a number of public health concerns such as its associated comorbidities and healthcare costs in addition to legitimate concerns about overall population health in the face of novel health threats like COVID-19.

However, as the number of Americans struggling to manage their weight continues to grow 72 percent of the country lives with overweight or obesity so has our clinical understanding of this complex but treatable condition. We know that there are hormonal and metabolic differences between people who live with obesity and those who do not. We know that there is a range of effective treatment options for obesity, and while it certainly includes behavior modification and cognitive therapies, we can also explore pharmacological and surgical interventions. We also know that there are limitations to the effectiveness of physical activity on weight loss and obesity management.

Given all that we now know about obesity, it is vital that clinicians and other healthcare professionals make it a priority to educate themselves on best practices for effectively integrating physical activity into obesity treatment plans.

We need to re-examine the role of physical activity in obesity management. Heres why.

The notion that people can win the fight against obesity simply through dieting and exercise was taken to a new level with the introduction of The Biggest Loser to the cultural landscape. Contestants experienced dramatic weight loss while appearing on the show just as we might expect to happen when patients with obesity are prescribed high levels of physical activity along with around-the-clock monitoring but maintaining highly intense exercise regimes is unsustainable for most people with overweight and obesity. Additionally, a key insight from a long-term study of Biggest Loser contestants tells us that physical activity plays a larger role in maintaining weight loss than it does in catalyzing it.

Certainly, that doesnt mean that physical activity plays no role in the weight loss journey. But it does mean that we should exercise caution in thinking about physical activity in terms of isolated exercise not only is it an ineffective weight loss treatment for patients with obesity, but it reflects an outdated understanding of the metabolic mechanisms behind weight loss.

We know that sitting for long periods of time can negatively impact insulin resistance, but breaking up those periods with short walks can reduce insulin and glucose responses. With that in mind, a more effective and sustainable approach would dispense with eat less, move more and instead encourage patients to sit less, walk more.

What healthcare professionals need to know about incorporating physical activity into obesity treatment.

Heres what we do know about physical activity it can power a number of positive health outcomes. Exercise can improve lipoprotein levels, blood pressure, insulin resistance, mood and brain function and cardiovascular health in patients with obesity.

Healthcare professionals should keep the following best practices in mind when collaborating with patients on obesity treatment plans:

Keep patients grounded: Create realistic expectations of weight loss results, if any, based on individual patient activity programs. Help patients start to take a longer-term view of the weight loss journey to stave off feelings of burnout or frustration with the process. And level-set about the risk of sore muscles after starting a new exercise program.

Slow and steady wins the race: Patients often begin the treatment process with a great deal of enthusiasm which can inspire positive behavior changes, but it can also create the risk of exercise-related injury from doing too much, too fast. Help patients learn their individual exercise level and collaborate on finding ways to support and gradually increase the intensity.

Get things going: Starting a new exercise program can be a major hurdle to overcome. Help patients make the first step by connecting them with an easy-to-follow, actionable regimen that incorporates physical activity into their everyday lives. An easy place to start is by advising patients to walk a certain number of steps each day and gradually increase that footprint over time.

Reframe it: As discussed, physical activity delivers a number of health benefits beyond weight loss. Keep the myriad positive outcomes of physical activity top of mind for patients and help them to understand that exercise is just one part of a broader plan of care to improve their overall health. This insight can make it easier for patients to prioritize physical activity everyday.

Grow your obesity medicine knowledge: Healthcare professionals can better meet the needs of this rapidly growing segment of Americans by deepening their understanding of obesity medicine. The Obesity Medicine Association (OMA) provides a number of resources to encourage this endeavor, including The Obesity Algorithm, Obesity Treatment Proficiency Badges, ABOM certification preparation materials and more. OMA is also hosting a series of virtual courses on the fundamentals of obesity treatment an informative primer on evidence-based approaches for evaluating, diagnosing and treating obesity.

The number of Americans struggling with obesity may be growing but so is our knowledge of how to effectively treat the condition. Healthcare professionals who bring this knowledge into their practice areas can play a more active role in guiding patients with obesity to better health outcomes.

For more obesity medicine resources, or to become an OMA member, please visit: http://www.obesitymedicine.org.

Angela Fitch, MD, FACP, FOMA is the Associate Director of the Massachusetts General Hospital Weight Center and faculty at the Harvard Medical School. She is board certified in obesity medicine, internal medicine and pediatrics. Dr. Fitch serves as Vice President of the Obesity Medicine Association and previously served as Secretary-Treasurer.

Read more here:
Why we need to rethink treating obesity with physical activity - Medical Economics

In a world where we are rushing from meeting to meeting, running errands, driving kids around and exercising, preparing a healthy, nutritious meal for lunch or dinner is not always the highest on our priority list.

To lose weight, we might also consider meal replacements as they're quick and easy. However, the number of products on the market makes it difficult to decide which one to choose.

What is a meal replacement (MR)?

Meal replacements are pre-packaged bars or powders that can be mixed and consumed as a shake to replace a meal. Some of the replacements are energy (kilojoule) controlled and are successfully used for weight loss and management.

A protein-enriched and energy-controlled MR can assist with preserving lean muscle mass, as well as reducing visceral fat (the dangerous fat that sits around our organs).

Do meal replacements have benefits?

In terms of weight loss, both the types and quantity of foods we consume are important, and many of us find it difficult to control portion sizes. In addition, we easily consume foods high in energy with a low nutrient content, such as fast foods and refined starches (white rice, pasta etc.).

We should, however, consume nutrient-dense foods that provide a high level of nutrients with relatively low caloric value. The benefit of MRs is that they are portion-controlled with a limited number of kilojoules, added essential nutrients (vitamins, minerals and fibre) and are therefore considered to be a nutrient-dense food. They are also an easy and convenient way of preparing a meal, which limits the possibility of making an unhealthy food choice.

What should I be checking when shopping?

Be sure to check the label and ingredients list thoroughly. Make sure the MR has a balanced combination of the three macronutrients and not only protein but carbohydrates and fats as well. It should provide a wide variety of vitamins and minerals and fibre.

1.Energy

The value should vary between 800 and 1200kJ per serving. When calculating meals for a weight loss diet from foods, the values are generally around 1 000 to 1 400kJ per meal.

Therefore, you want the MR to have a similar energy value as it is a "meal replacement".

2.Carbohydrates

The source of carbohydrate should have a low glycaemic value. This means that the release of sugar (glucose) into the bloodstream should be slow, to avoid a rapid spike and drop in blood sugar levels. Rather avoid MRs that contain "added sugar" (e.g. sucrose, glucose, fructose, dextrose and corn syrup) as these have a less desirable effect on blood sugar levels.

A guideline for carbohydrate content would be around 15 to 30g per serving (which would again be the equivalent of a real meal carbohydrate serving).

3.Dietary fibre

When recommending fibre in real food items, we consider 6g per 100g as adequate. Therefore, when selecting an MR, the value should be around 4 to 6g per serving as well.

Fibre assists with lowering the blood glucose response after the meal and keeps you fuller for longer (vital when drinking a meal). Fibre is essential for maintaining regular bowel movements and can even, depending on the type of fibre, assist with lowering blood cholesterol levels.

4.Protein

Protein assists with the feeling of satiety, reducing hunger and ensuring that muscle mass is maintained. Aim for 15 to 21g per serving (which would be the equivalent of a protein serving for lunch or dinner). The meal replacement should be at least 15g of protein per serving. It is important to note that protein powder products are not considered an MR.

5.Fat

Your fats of choice should be monounsaturated and polyunsaturated fatty acids. Check that the saturated, trans and hydrogenated fats are minimal. The quantity of fats should be 5g to 10g fatper serving. Not all MRs contain essential fatty acids (such as Omega-3). If they do, it is a bonus, as these have huge health benefits.

6.Micronutrients

Choose an MR that contains a wide variety of nutrients added, such as your vitamins and minerals. The quantity of these nutrients should meet at least 25% of the daily reference value. The bigger the variety, the better.

So, should I be buying a meal replacement?

Taking an MR is an easy practice to maintain good nutrition or to lose weight should your lifestyle not allow for preparing and packing three nutritionally balanced meals a day. It is also convenient when travelling when the availability of healthy meals is compromised.

On the other hand, the same objectives can be met selecting, preparing and packing real food such as a variety of wholegrain carbohydrates, lean proteins and healthy fats. Getting your nutrients from a food source is also more "bioavailable" (how well your body can absorb the nutrients from the food) to the body.

Should you decide to choose an MR to lose weight, it is recommended to do this with the assistance and guidance of a registered dietitian. They can assist you with strategies to keep the weight off once you have decided to include real food back in your diet. You can contact Nutritional Solutions if you wish to schedule a consultation.

READ | 5 tips for eating healthier during lockdown

READ | Lost your motivation to eat healthy and exercise during the pandemic? You are not alone

READ | Coronavirus lockdown: Stay fit at home with these tips

Image credit: VisionPic from Pexels

Read more from the original source:
I need a meal replacement - what should I check before buying? - Health24

Everyone who is in a weight loss program has hit a plateau at least once in their decent to a healthy weight. When you first start a new exercise and diet program, you often lose a lot of weight quickly as you burn many more calories than you consume and shed water weight.

As you lose weight however, you need fewer calories to maintain your body, and you no longer have the relatively easy pounds of water weight to shed. On top of this, your body learns the new routine and learns how to do the exercises they are used to as efficiently as possiblemeaning fewer calories are being burned.

All this can lead to you no longer losing weight, or even gaining a little bit back even though you are still sweating it out every day. While restricting your diet even more and exercising even harder is an option, you may be able to break the plateau by changing your routine.

Mixing it up

If you're a runner, you may be steadily increasing on time and distance. You may be able to break out of your plateau by choosing to do sprint exercises or if you're a weight lifter, switching to maximum volume instead of maximum weight. These changes are approaching the same goals, but in a different way that may help you see improvements.

Overtraining can actually lead to poorer performance. If you are working hard and never taking breaks, your body won't be able to change. Your body needs rest in order to rebuild the muscles you broke down during exercise, so if you never give your body the chance to rest, you won't see the results you are working for.

If you are counting calories carefully, it may be worthwhile to recheck how many calories you need in order to have a deficit at your current weight. If you have lost a significant amount of weight already but are still using your starting calculations, you may no longer be in deficit.

If you aren't counting calories, now may be a good time to start a food diary. If you aren't aware of how much you are eating, or just how many calories are in your favorite foods, you may be over eating without realizing it.

It may also be that you are simply not doing enough any more. As you grow, it gets easier for your body to meet the demands of a normal workout. You can help break out of that by developing a new skill. Maybe you've only ever hit the treadmill and want to try weights instead. Maybe you've never done a push up, or have focused exclusively on weights and want to try cardio. What ever it is that challenges you, give it a try. It may be the break you need.

If you're in a plateau, there could be a lot of reasons why this is happening. Try using these tips to break out of it, and get back on the path to better fitness.

Go here to read the rest:
Not losing weight anymore? This can help - Jill Lopez

The best thing about making shakes is that you can use any fruit as per your taste preference, but at the same time adding fruits that can blend well without causing any reaction are the ones you should add to your shakes and smoothies. If you want to give your body the much needed boost of energy post workout, then this Papaya Banana Pomegranate shake is perfect for you.

To make this easy shake, take a juicer, add 400 gm pomegranate seeds and extract the juice. Next, cut papaya and banana, take a blender, add the fresh fruits along with pomegranate juice, blend all this into a smooth blend.

Next, add in chopped almonds and cashew nuts, then add 3 tablespoon condensed milk. If you want to make it a bit more healthy, then replace condensed milk with unsweetened fat milk and to add some sweetness you can add some honey. Blend it all again with some crushed ice and serve chilled. This heavy shake can be a perfect healthy meal replacement.

Both pomegranate and papaya are a good source of fiber, folate, magnesium and other vitamins, which will give your body the right amount of nutrition to stay energized and hydrated throughout the day. Moreover, the addition of nuts will add a tasty twist and amp up the health quotient of your shake.

More:
Get back to shape with these homemade weight loss shakes - Times of India

A 29-year-old Glasgow woman who dropped six dress sizes after joining an NHS funded weight-loss scheme has told how online support stopped herpiling the pounds back on during lockdown.

Lindsey Kinlochsays her weight battle began at the age of 18 when she had surgery to treat a foot and ankle deformity which left her unable to exercise.

At her heaviest Linsdey, who lives in Stepps,weighed15st 3lb, dangerously overweight for her 4ft 8inch frame.

She suffers from the genetic condition pseudohypoparathyroidism, which affects height and also causes learning difficulties.

After her blood pressure soared and she started experiencing breathlessness Linsey decided to try to lose weight and while initially successful she was worried about being able to sustain it.

READ MORE: Michelle Mone tells Loose Women she exercisesthree times a day during lockdown

Her GP referred her toa local group run by WW, (formerly Weight Watchers) which is funded by NHS Greater Glasgow and Clyde.

Lindsey admits that the journey from high-caloriefast food and takeaways to healthy meals made from scratch wasnt easy but she persevered andnow weighs a much healthier 10st 11lb and says she is delighted she can still enjoy her favourite tipple of malt whisky.

She said: I have struggled with my weight from the age of 18 or 19 when I had a procedure to treat my foot and ankle deformity. This reduced my mobility to almost zero and post op I was in a wheelchair to get around.

In 2018 I had a second procedure as due to mobility issues I was using a wheelchair and my health was rapidly deteriorating.

"I wanted to try to improve my health but my motivation never came until January 2019 when I had high blood pressure concerns and when I checked my weight I was 15 stone 13lb. Beingonly 4ft 8 I could not afford to be carrying this extra weight.

"My GP decided to refer me to WW and I wans't sure this was going to be for me, but I decided to give it ago.

Lindsey says she was nervous about attendinggroup workshops because of her disabilities.

She said: I was used to mixing in restricted circles, so the thought of attending a new workshop with lots of people I didnt know made me nervous, but I had nothing to worry about as the coach Lesley Park made me feel welcome and all the other members quickly made me feel part of the community.

I have never regretted that choice I made joining and its been the best thing I have done, as its for me.

Its not been easy Im very surprised at how well I have done.

READ MORE: Did you have a baby during lockdown? The Glasgow Times wants to hear from you

I used to eat without any thoughts to portion sizes, I liked takeaways and loved cake.

"I now enjoy including different food and drinks and love cooking fresh healthy meals and get meal ideas from my app. I enjoytrying different whiskyand one of my favourites is Dalmore and it's great to know I can still enjoy a wee dram and still lose weight.

I used to wear a size 24 but now wearing a size 12, and its great clothes shopping."

Linsey says she was nervous her good habits would slip when lockdown kicked in and her local group workshops stopped.

She said: Thankfully, WW are now running virtual workshops, and make sure I attend every week.

My advice to anyone trying to lose weight would be that there is no quick fix so be proud of every small loss as everyones journey is different, listen to your body more and take time for you if you need it.

See original here:
'There's no quick fix': Glasgow woman halved dress size with NHS help - Glasgow Times