The take home message in the diet study published today in the New England Journal of Medicine is that diets don’t work.

Real news flash, huh? It’s the calories that count no matter where they come from –fat, protein or carbohydrates. Eat more than you burn, you get fat.

I thought the editorial in the NEJM, written by Martijn Katan, Phd., from the Institute of Health Sciences at VU University in Amesterdam, clearly outlined the only solution to the obesity epidemic. And it’s not weight-loss surgery for all.

 The inability of the volunteers to maintain their diets must give us pause. The study was led by seasoned investigators who were experienced in the performance of diet and drug trials. The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions over the course of 2 years. Nonetheless, their body-mass index (the weight in kilograms divided by the square of the height in meters) after 2 years averaged 31 to 32 and was moving up again. Thus, even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic. The results would probably have been worse among poor, uneducated subjects. Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices. (My emphasis)

In other words, it’s the environment stupid. Obesity experts have been pounding this drum for a long time. Overeating and obesity is not a matter of self control — we can’t defeat our biology. We are programmed to over eat. The only way to halt the obesity epidemic is to change our environment. Katan offers a case in point. She describes a little noticed study in France. Starting in 2002 two small towns in France built a community-wide effort to prevent overweight schoolchildren.

   Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling.

The results were remarkable. By 2005 the rate of overweight in children had fallen to 8.8%, while in neighboring towns it rose to 17.8%, in line with the national trend. That community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l’obésité des enfants [Together, let’s prevent obesity in children]).

Could we do that here? What would it take? Banning food advertisements on TV? Is it worth the investment up front to give kids healthier lives and to prevent higher costs later on?

What’s the magic number? 35 inches for women — 40 inches for men, measured right at the belly button.

I can’t help but wonder what Tim Russert’s number was, especially when I read what his internist, Dr. Michael Newman, told the New York Times: “If there’s one number that’s a predictor of mortality, it’s waist circumference.” Russert was taking both blood pressure and cholesterol medication and exercising every day. But he was significantly overweight, he said.

(more…)

Eat a big breakfast.

Well, maybe not that big.

Moving right along from coffee to what goes with it, we know (and our mothers knew) that it’s always important to eat breakfast. Researchers know that teenagers who eat breakfast are healthier and are less likely to become overweight.

Now research presented this week at a national medical conference has found that eating a substantive breakfast high in carbs and protein actually helps obese people not only lose weight, but keep it off long term.

Diets that restrict carbohydrates are notoriously short lived. They increase cravings for carbohydrates and slow metabolism. As a result, after a short period of weight loss, most people regain their lost weight quite quickly.

The scientists, who presented their study at the Endocrine Society Conference underway in San Francisco this week, put 94 obese, physically inactive women on two different diets. Both were low in fat and calories. Half of the women were on a very low carb diet, consisting of 1,085 calories per day and a breakfast of 290 calories — 7 grams of carbs and 12 grams of protein.

The “big breakfast diet” consisted of 1,240 calories a day, but about half of those calories were consumed at breakfast — 58 grams of carbs and 47 of protein. They ate 395 calories for lunch and 235 calories for dinner. (Think of it as an upside down food pyramid.)

After four months, the women on the low-carb diet dropped an average of about 28 pounds, and the women on the big-breakfast diet lost nearly 23 pounds on average. But after 8 months, the low-carb dieters regained an average of 18 pounds, while the big-breakfast group continued to lose weight, shedding another 16.5 pounds on average. Women who ate a big breakfast reported feeling less hungry, especially before lunch, and having fewer cravings for carbs than did women in the other group.

Problem solved. Does this inspire you to change what you eat for breakfast?

Dianne Neumark-Sztainer is a mom and an expert on what drives a lot of parents nuts — adolescents and their eating habits. She is a professor of epidemiology at the University of Minnesota and the lead researcher on a study published today that looks at what happens when parents of overweight kids tell them to go on a diet. They are more likely to stay fat. You can read about the study and the university’s  Project EAT project here.

She will be here on BodyTalk today to answer questions from readers about the epidemic of overweight and obesity in teenagers and what parents can do. 

She is also the author of a book called “I’m, Like, SO Fat,” which provides advice and guidance for parents on how to help their teenagers (productively) with eating and exercise in a weight obsessed world. The motto of her book she says is “Do more. Talk less.” That means you have to walk the walk you want your kids to walk. Yes, easier said than done. That gets us back to the whole do more talk less thing.

Her study published today, based on surveys of Minnesota adolescents and their parents, found that half of the parents whose kids are overweight don’t know it. That’s pretty par for the course, she says, butn itn turns out their kids might be better off. The parents who do know that their kids are too heavy often do the wrong thing by telling them to go on a diet. That tends to backfire, she found.

But she has a lot of useful, practical advice on what parents can do to help their kids.  So ask her a question, and check back this afternoon.