Quality vs. Quantity – A New Approach to Weight Loss?

I wanted to take a moment to highlight a new study that was released last week in The Journal of the American Medical Association (JAMA) that challenges the traditional notion that weight loss is only possible through calorie reduction (i.e., counting or restricting the number of calories you eat). In the DIETFITS study, researchers found that participants who cut back on added sugar, refined grains and highly processed foods while focusing on eating plenty of vegetables and whole foods — without counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The study was a randomized clinical trial that included 609 overweight adults, who were assigned to either a healthy low fat (HLF) or a healthy low carb (HLC) diet group. Members of both groups attended classes with dietitians where they were educated about eating nutrient-dense, minimally processed whole foods, preferably cooked at home. A key difference in this study is that it did not set restrictive limits on the amount of carbohydrates, fats or calories that participants could eat. Rather, the researchers emphasized that participants focus on eating whole or “real” foods and as much as they needed to avoid feeling hungry. The emphasis was on the quality, not quantity, of food that was consumed.

The researchers also wanted to test the hypothesis that some people are predisposed to do better on one diet over the other depending on their genetics and their ability to metabolize carbs and fat. A growing number of services offer people personalized nutrition advice tailored to their genotypes. (See this previous post about my experience with one of these genetic testing services). Somewhat surprisingly, they found that participants’ genotypes did not appear to influence their responses to the diets. This is something to keep in mind if you are thinking about pursuing genetic testing for guidance on nutrition.

The general outcome of the study was that after one year of focusing on food quality, not calories, both groups lost substantial amounts of weight. On average, the members of the low-carb group lost about 13 pounds, while those in the low-fat group lost almost 12 pounds. The good news is both groups also saw other health improvements such as reductions in their waist sizes, body fat percentage, and blood sugar levels.

It is important to note that there was variability among the participants – some people gained weight, and some lost as much as 50 to 60 pounds. One key finding though is that the people who lost the most weight reported that the study had “changed their relationship with food.” For example, they no longer ate in their cars or in front of the television. They also started cooking more at home and sitting down to eat dinner with their families. To me, this demonstrates that how we eat is just as important as what we eat.

As with any research study, there are limitations. This was only one study involving a relatively small number of participants. Repeat studies with larger sample sizes should be conducted to see if results can be replicated. This study also just focused on initial weight loss. Maintaining weight loss can be as hard, if not harder, than losing the weight in the first place. Future studies may want to follow participants over time to see if they can maintain a healthy weight following the same approach of focusing on quality, not quantity.

I hope that this study is just one of many that will show that traditional dieting, where people make themselves miserable by counting or restricting calories, is not the best or most sustainable way to attain and maintain weight loss.  Rather, if we shift our focus to the quality of foods we eat and take time to enjoy and savor our meals, we will change our relationship with food and reap the many health benefits that come along with eating a well-balanced diet.

Be the Change You Wish to See

Gun violence. For some it may seem like an odd subject for a health and wellness blog. I debated whether to post about this topic, given the controversy and sensitivity around the 2nd Amendment. In my heart I knew I had to address it, especially in the wake of the latest school shooting in Parkland, Florida. It hurts so much to type those words. How are we here, AGAIN, facing more unnecessary loss of precious lives? Didn’t we say “enough” after Sandy Hook? Charleston? San Bernadino? Orlando? Las Vegas? I know there are other events I’m missing as the Parkland tragedy was reportedly the 18th gun incident involving a school or university since January 1, 2018. Wow – we’re only 54 days into the new year. Something must change.

I grew up around guns – primarily hunting rifles – as my dad, uncles, and brothers were all outdoorsmen who enjoyed the sport.  We had a healthy respect for guns in our house though. My dad kept them unloaded and locked up in a safe place. The only time I ever saw them was when they went on a hunting trip. I preferred it that way as I was never really comfortable around any type of firearm – and I’m still not. Even passing an armed police officer on the street makes me nervous. I think it’s fear of the damage that can be done with such a small piece of equipment.

In my ideal world, there would be no guns. If no one has them, no one has to worry about shooting someone else or being shot. Problem solved. Realistically, I know it’s not that easy. So, if guns aren’t going away, then we need to find some way to address the issue of gun violence and the destruction it causes in this country. As a public heath professional, I am excited to see momentum growing behind the idea of using a public health approach to reducing gun violence in this country. What would that look like? In a nutshell, it would involve using a social-ecological model to better understand violence and the effect of potential prevention strategies.

If there is one thing we have learned in the public health arena, it is that it we are usually more effective trying to change the environment than trying to change people. There are many, many people who just refuse to give up their guns. Not to mention the lobbying power of the NRA and the power it holds over Congress. I mean, if the near fatal shooting of former Representative Gabby Giffords wasn’t enough for her fellow legislators to turn down contributions from the gun lobby or to propose stricter laws around access to assault weapons, I am not sure what will be.

Given these circumstances, many health professionals are proposing that the United States use the same harm reduction approach to gun violence that it uses to treat other public health threats, like car crashes, air pollution and even tobacco use – using a wide variety of methods to reduce the problem. You can learn more about these approaches here:

https://jamanetwork.com/journals/jama/fullarticle/1556167#qundefined

https://gunresponsibility.org/solution/public-health-research

https://www.hsph.harvard.edu/news/features/public-health-gun-violence-vegas

One solution that has been proposed in the last few days is arming teachers and other school personnel so that they can respond in the event of an active school shooter or other threat. I am whole-heartedly against this approach. These learning institutions should not have to spend one iota of their time or resources thinking about how to defend against an armed intruder or other violent event. For those who think it is just a reality of modern times, I say we can and must do better than that. That is a band-aid approach to a more systemic problem. Let’s be proactive rather than reactive and figure out how to reduce or even eliminate the possibility of such threats by focusing on common-sense gun laws and improving access to mental health services for those in need.

I have struggled this past week with how to be part of the solution to this problem. I am encouraged by the actions of individuals – like this gentleman who turned in his assault rifle and more so, the young adults who survived the Parkland shooting and are making their voices heard at the national level. As the title of this post suggests, we must each take steps that will help achieve the outcomes we want for this country, our communities and our families. For me, it will mean donating my time and money to organizations like Moms Demand Action that support common-sense gun laws. It will also mean making my voice heard at the polls this fall and voting for candidates that support a proactive approach to this national epidemic. I must admit that I do not know if any of the state or national candidates I have supported in the past accept money from the NRA. I do know that I will have this information before I vote this fall and I will not support any candidate, regardless of political party or my previous support for their election, if they do. These are just some of the first steps that come to mind for me. I will continue to follow the discussion about gun violence and determine additional steps that I can take to help keep our children and our communities safe.

Addressing gun violence is probably one of the greatest challenges this country will face. I have faith that we can and will succeed, but it will take every one of us reaching into our hearts and finding a way to take action, so that we can finally say – and mean – never again.

What small step will you take today to move us toward that goal?

 

 

 

Prevention and Intervention – Focus on the Flu Vaccine

The outer ring of the Wheel of Health focuses on Professional Care, which is just as important as the areas of self-care I have discussed in previous posts. Maintaining optimal health includes seeking routine preventive medical care such as annual physical exams, recommended cancer screenings (e.g., mammogram, colonoscopy) and vaccinations.

You can find the latest recommendations for adult preventive care on the US Preventive Services Task Force website.  I highly encourage you to review the recommendations for your age and sex and discuss them with your healthcare provider. However, there is one recommendation I want to focus on for this post and that is the annual influenza vaccination, better known as the flu shot.

As a public health professional, I am often befuddled by the level of disagreement over getting vaccinated against the flu. I see friends debating it on Facebook. Some get the shot every year, others have never gotten it and never will. I have had friendly debates within my own family about the importance of annual vaccination. I agree with the Centers for Disease Control and Prevention (CDC)’s recommendation which is routine annual influenza vaccination for all persons aged ≥6 months who do not have contraindications. That last part is important – there are some individuals who cannot and should not receive the vaccination. But for most of us, there is no reason not to take this simple step to protect yourself from a potentially serious and sometimes fatal illness.

If you have any access to mainstream media, you are likely very aware of the toll that the flu has taken on communities across the country this year. This flu season is the worst in nearly a decade and we are not out of the woods yet.  Children and adults alike are getting sick, being hospitalized and dying – yes, dying – from the flu and its complications. I know several people who have had the flu and developed pneumonia, requiring hospital stays and heavy-duty antibiotics in order to recover.

I know there are some myths and incorrect beliefs circulating about the flu shot. Some people think they will get the flu if they are vaccinated (they won’t – if they get sick, they were likely exposed before they received the vaccine). Others argue that it is not worth getting vaccinated if the vaccine is not a good match to the virus strains that are circulating. It is difficult to get an exact match of the virus strain each season, as vaccine production must begin months before the flu virus presents itself. However, even if the vaccine is not an exact or even a good match, getting vaccinated will help reduce the risk of flu-associated complications that often require hospitalization. It can also make your illness milder if you do get sick.

Some people claim that they have never gotten the flu shot and have never gotten the flu, thus, they believe they are not susceptible. The flaw in that argument is that the flu virus strain changes every year so it’s likely they will eventually be exposed to a strain that does cause them to fall ill – especially if they decline to be vaccinated. That is why annual vaccination against the flu is so important. The flu is not simply a “bad cold” that someone can weather through. It is a serious illness that should not be taken lightly.

If you’re still not convinced to get vaccinated for your own protection, please consider doing so to protect the people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions. If you haven’t yet been vaccinated and are now willing to do so, it’s not too late. I encourage you to act fast though as flu shots are running low due to the heavy flu season.  You can use the Flu Vaccine Finder tool on the CDC website to see where vaccine is still available in your area. The flu vaccine is typically covered by most health insurance plans and many pharmacies offer the flu shot at reduced cost for those who don’t have insurance.

For more information about the flu and how to protect yourself, please visit the CDC website.