The Weight of the World in All Its Confusion
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Dr. Sarah LoBisco, ND

Do We Really Need Another New “Golden Boy” in Nutrition or Do We Need a New Movie Altogether? Part I

Consider a study to determine if parachutes can save the lives of people who fall out of planes. The study compares parachutes that are 1sq inch in total surface area to parachutes that are 1.25sq inch in area. Would you expect to see any difference in survival rates? Of course not. But now imagine the headlines: “parachutes useless; size does not matter…”1

The (Underrepresented) Weight of the World?

The “weight of the world” is becoming a heavier and heavier burden on the health of our nation.2-5 Not only does being overweight increase the risk for detrimental health results (e.g.; diabetes, heart disease, stroke, etc.),2-3,5 but it also results in economic ramifications on society. This is through direct costs (e.g., outpatient and inpatient health services, laboratory and radiological tests, and drug therapy) and indirect costs (e.g., lost work, increased insurance premiums, wages).2

According to a recent report in HealthDay, regarding this increasingly “bigger news”:

There’s no doubt about it: Americans are getting heavier and heavier. But new U.S. estimates may still come as a shock — since the late 1980s and early 1990s, the average American has put on 15 or more additional pounds without getting any taller.

Even 11-year-old kids aren’t immune from this weight plague, the study found. Girls are more than seven pounds heavier even though their height is the same. Boys gained an inch in height, but also packed on an additional 13.5 pounds compared to two decades ago.3

Specifically, from 2011-2014 adult men in the United States averaged at 5 feet, 9 inches in height while weight increased to 196 pounds in 2011-2014 from 181 pounds in 1988-1994 at 181 pounds. For the average female, height again remained steady at 5 feet, 4 inches, but weight increased to 169 pounds in 2011-2014 from 152 pounds in 1988-1994.3-4

This data was released on August 3rd from the National Center for Health Statistics. It consisted of analyzing anthropometric measurements by using a complex, multistage, probability sample from the National Health and Nutrition Examination Survey (NHANES) from 2011-2014. The sample included 19, 151 of noninstitutionalized civilians of all ages.3-4 Measurements that were assessed included weight, height, recumbent length, circumferences, limb lengths, and sagittal abdominal diameter (SAD).

However, the epidemic may be even greater than even the best statisticians can estimate. According to the report, there were several considerations that were adjusted for in order to be more representative of the overall population. For example, those aged 80 and over, Hispanic persons, non-Hispanic black persons, non-Hispanic Asian persons, and those with low income were “oversampled to improve the precision of the statistical estimates for these groups.” The 2011-2014 data was different from previous sampling in including the oversampling of the non-Hispanic Asian persons. Also, pregnant women were not included in the analyses of weight, body mass index (BMI), and circumference measurements.4

This could lead to some caveats in interpretation. The CDC reports that among non-Hispanic black and Mexican American men, those with higher incomes were more likely to have obesity then those with lower income. Furthermore, oversampling non-Hispanic Asians may skew the results when comparing to previous years in which the CDC site reported:

Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%)5

Therefore, although the strategy to oversample certain ethnicities may have helped with more accurate representation of the population, it may have missed a big part (no pun intended) of the population with the issue and/or skewed results.

Finally, excluding pregnant women in all measurements could be a factor in accurate sampling. A recent report by the CDC released on August 5, 2015 reported that many women were overweight prior to pregnancy. This can lead to complications such as high blood pressure and diabetes for mamma and birth risks for baby.6-7 By excluding pregnant, overweight females, the estimated numbers of obesity may have missed this part of the population. HealthDay reported:

…in 2014 nearly 4 percent of women were underweight before becoming pregnant. About 46 percent of women started their pregnancies at a normal weight. But slightly more than one-quarter were overweight, and almost another quarter were obese, the report found.

…Obese women were more likely to be older (over 40), black, American Indian or Alaska Native. They were also less likely to have a college degree and more likely to rely on Medicaid to pay for their delivery, Branum’s team found.6

These caveats are not related to this single report. With any statistical analysis and a representative sample, the method itself always has limitations and strengths. For example, a 2014 article in JAMA that reported on the prevalence of childhood and adult obesity in which the authors discussed how time trends impact reporting:

 Analysis of time trends depends on what is chosen as the initial point of examination. In this analysis, we selected 2003-2004 as the starting point because previous analyses had shown no change in sex- or race/Hispanic origin–specific trends in obesity prevalence between 2003-2004 and 2009-2010.8,9 The selection of the initial point can have an effect on findings. For example, analyses of childhood obesity trends between 1976-1980 and 2011-2012 show an increase in childhood obesity, whereas trends between 2003-2004 and 2011-2012 do not.8

We won’t go down the rabbit hole of downfalls of statistics and study reporting too much. (I did do that here, if interested). Let’s just say that the overweight population could be even worse than we thought. Sadly, awareness of even how bad it appears to be now isn’t making it go away, or at least slim down.

Why the Rising Scales?

Shockingly, the obesity epidemic has been in full force for years,9-10 with a jaw-dropping spike of 36% of states having an obesity rate of 25% or higher in 2010 versus less than 15% of the adult population in 1990.10 Still, we continue to be “at larger.” Currently, the CDC estimates that “More than one-third (34.9% or 78.6 million) of U.S. adults are obese.”9-10

Although Americans are not alone in its citizens continuing to pack on the pounds,11-13 producing such poor health outcomes with a healthcare system that is spending more money11 than any industrialized nation, can be a bit, well, embarrassing. (Not to mention frightening).

For years, conventional dietary wisdom, across continents has told people to eat less, move more, and to watch saturated fat intake in order to be “healthy.”12 Different cultures have different ideas of what that means, and this can cause confusion.14-15 (This leads me again to point out the definition of insanity, this time in regards to the current methods used for addressing the extra poundage).

On January 7, 2016, 2015-2020 Dietary Guidelines for Americans was released.16-17 The goal of these suggestions, which are released every five years and put forth by the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA) is to “promote health,” “prevent chronic disease,” and to “help people reach and maintain their optimal weight.”18

The main themes for the current guidelines were summarized as follows:

  • Eat a healthy combination of foods and beverages across the lifespan
  • Eat a variety of foods that are nutrient-dense and be mindful of the amount
  • Limit added sugars and saturated fats, and reduce sodium
  • Choose healthier foods and beverages
  • Healthy eating patterns should be supported for everyone17-18

Therein’ may lie one problem. Does anyone know what healthy really is in the current mass hysteria of dietary theories and tends?

Thankfully the guidelines also emphasized some more specific recommendations that detailed what was “healthy.” These included: eating a variety of vegetables, legumes, fruit, grains (half consisting of whole grains), fat-free or low-fat dairy, a variety of proteins (including eggs, lean meats, seafood, legumes, nuts, soy), oils from plants (canola, corn, olive, peanut, safflower, soybean, and sunflower), and those oils found in nuts, seeds, seafood, olives, and avocados.

The guidelines also empathized avoiding “harmful nutrients,” by keeping upper limits of added sugars and saturated fat to less than 10 percent of calories a day and sodium to less than 2,300 mg/day for people 14 years and older… less for younger. Alcohol was also recommended to be consumed in moderation, one glass a day for women and two a day for men tops.16-17

The release was very controversial.19-20 Though many Paleo followers and carnivores were happy that cholesterol was removed from its “hit list” of food offenders,16 many experts in the wellness circles disagreed with the continued demonization of saturated fat. Others were appalled at the sheer mention that “fat is back as a health food.”

“What about the heart disease link!” these experts touted.

For example, a 2015 prospective cohort study sought to compare saturated fats with unsaturated fats and sources of carbohydrates in relation to risk for coronary heart disease (CHD). The study consisted of 84,628 women (Nurses’ Health Study, 1980-2010) and 42,908 men (Health Professionals Follow-up Study, 1986-2010). Diet was also assessed with a semiquantitative food frequency questionnaire every four years. The authors concluded that unsaturated fats, especially PUFAs (polyunsaturated fats) and quality carbohydrates could be used replace saturated fats to reduce CHD risk. However, it should be noted that higher intake of carbohydrates from refined starches/added sugars were also positively associated with risk for CHD, but not when replacing them with saturated fats.21

As science and people continue to evolve, so does perception of what is considered “good” and “bad.” Basing conclusions on a study, such as the one above, could lead to many mistaking causation for association and not seeking for more conclusive evidence.22 In other words, without having a comparison and control group, it’s hard to determine which factors are at play that are linked to heart disease in observational research. Studies and reviews are only as reliable as their sampling population characteristics, methods used, reliability of statistics and measurements, and more.

For example, another factor not considered, such as if one used an alarm clock, could also be linked to a higher risk of heart disease. However, I doubt that using an alarm clock was the main association to heart disease. (Well, unless you are considering stress… another topic for another day). Furthermore, biases can exist based on the study population and the use of food frequency questionnaires.

This leads to the question, if we are basing “health recommendations” with only one inclusive side of the saturated fat debate, where does that leave us in regards to what is really “healthy?” I will get to more on that in the next part of this series.

The truth is, Americans aren’t being “noncompliant”, they are trying to be “healthy.” A report in Fortune recently reported that many were focusing on health versus dieting. This was making an unwanted dent in diet industry’s profit,23 but not for in the numbers of those afflicted with obesity. However, with failed results, the tides are turning once again. The dieting industry still enjoys and estimated $55-60 billion on revenue per year and is expected to see an upward trend again soon.24-25

Nutrition these days is controversial, hotly debated, rarely is it individualized, and everyone is right!

So, here’s my question- with the health care system failing on the obesity epidemic, and experts disagreeing on what is healthy, and Americans following incomplete advice, why do we continue to seek the solution using the same narrow viewpoint of a small parachute?

In other words, why does the general consensus seem to insist that we continue to focus microscopically on “good” and “bad” foods and not on “good for you” foods?

In the next blog, I’ll discuss the how focusing on one “dietary villain” is short sided, and why a new, individualized approach holds hope for a truly healthy nation.

LoBisco005Sarah Lobisco, ND,  is a graduate of the University of Bridgeport’s College of Naturopathic Medicine (UBCNM). She is licensed in Vermont as a naturopathic doctor and holds a Bachelor of Psychology from State University of New York at Geneseo. Dr. LoBisco speaks professionally on integrative medical topics, has several journal publications, and has completed her postdoctoral training as a certified functional medicine practitioner. Dr. LoBisco currently incorporates her training in holistic medical practices and conventional medicine through writing, researching, private wellness consultations, and through her independent contracting work for companies regarding supplements, nutraceuticals, essential oils, and medical foods.  Dr. LoBisco also enjoys continuing to educate and empower her readers through her blogs and social media. Her recent blogs about living naturally in our complex world and on the applications of essential oils can be found at www.dr-lobisco.com and at www.saratoga.com/living-well. Her new book BreakFree Medicine is now available on Amazon and Barnes & Noble’s. More information can be found at http://dr-lobisco.com/dr-sarah-lobisco-breakfree-medicine/

References:

  1. David Katz, MD. Dietary Puedoconfusion. July 29, 2016. http://www.davidkatzmd.com/articles.aspx. (Originally published on New York Times Syndicate.)
  2. Harvard TH Chan School of Public Health. Economic Costs: Paying the Price for Those Extra Pounds. Harvard School of Public Health Obesity Prevention Source Web site. https://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/
  3. Dotinga R. Average American 15 Pounds Heavier Than 20 Years Ago. Health Day. August 3, 2016. https://consumer.healthday.com/public-health-information-30/centers-for-disease-control-news-120/average-u-s-adult-packed-on-extra-15-pounds-in-two-decades-713484.html
  4. Fryar CD, Gu Q, Ogden Cl, Flegal KM. Anthropometric reference data for children and adults: United States, 2011–2014. National Center for Health Statistics. Vital Health Stat. 2016. 3(39). http://www.cdc.gov/nchs/data/series/sr_03/sr03_039.pdf
  5. Center for Disease Control and Prevention (CDC). Overweight and Obesity. Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html
  6. Reinberg S. Half of U.S. Women Weigh Too Much Before Getting Pregnant.HealthDay. August 5, 2016. https://consumer.healthday.com/pregnancy-information-29/pregnancy-news-543/1-in-2-women-weighs-too-much-before-pregnancy-713610.html
  7. Branum A, Kirmeyer SE, Gregoray ECW. Prepregnancy Body Mass Index by Maternal Characteristics and State: Data From the Birth Certificate, 2014. National Center for Health Statistics. U.S. Centers for Disease Control and Prevention. Aug. 5, 2016
  8. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814. doi:10.1001/jama.2014.732.
  9. Center for Disease Control and Prevention (CDC). Overweight and Obesity. Adult Obesity Facts. https://www.cdc.gov/obesity/data/adult.html
  10. Harvard TH Chan School of Public Health. An Epidemic of Obesity: U.S. Obesity Trends. The Nutrition Source Web site: https://www.hsph.harvard.edu/nutritionsource/an-epidemic-of-obesity/
  11. The Common Wealth Fund. U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries. 2015. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective/
  12. World Health Organization.Obesity and overweight:Fact sheet
    Updated June 2016. http://www.who.int/mediacentre/factsheets/fs311/en/
  13. Worldometers. Overweight and Weight Loss Statistics. http://www.worldometers.info/weight-loss/
  14. Maruyama K, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, et al. Dietary patterns and risk of cardiovascular deaths among middle-aged Japanese: JACC Study. Nutr Metab Cardiovasc Dis. 2013 Jun;23(6):519-27. doi: 10.1016/j.numecd.2011.10.007.
  15. Kurotani K, Akter S, Kashino I, Goto A, Mizoue T, Noda M, Sasazuki S, et al. Quality of diet and mortality among Japanese men and women: Japan Public Health Center based prospective study. BMJ. 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i1209
  16. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
  17. U.S. Department of Health and Human Services. Press Release: HHS and USDA Release New Dietary Guidelines to Encourage Healthy Eating Patterns to Prevent Chronic Diseases. January 7, 2016. Available at: http://health.gov/dietaryguidelines/2015/
  18. Office of Disease Prevention and Health Promotion. Dietary Guidelines: Purpose. U.S. Department of Health and Human Services. https://health.gov/dietaryguidelines/purpose.asp
  19. National Institute of Health. NIH study finds cutting dietary fat reduces body fat more than cutting carbs. August 13, 2015. http://www.nih.gov/news-events/news-releases/nih-study-finds-cutting-dietary-fat-reduces-body-fat-more-cutting-carb
  20. Heid M. Experts Say Lobbying Skewed the U.S. Dietary Guidelines. Times. January 8, 2016. http://time.com/4130043/lobbying-politics-dietary-guidelines/
  21. Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, et al. Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease: A Prospective Cohort Study. J Am Coll Cardiol. 2015 Oct 6;66(14):1538-48. doi: 10.1016/j.jacc.2015.07.055.
  22. Epiphany Partners, Inc. Understanding Hazard Ratios. April 2013. http://www.time4epi.com/docs/default-source/default-document-library/insight07_understandinghazardratios.pdf?sfvrsn=2
  23. Kell J. Lean times for the diet industry. Fortune. May 22, 2015. http://fortune.com/2015/05/22/lean-times-for-the-diet-industry/
  24. IBIS World. Weight Loss Services In the US: Market Research Report. Feb 2016. http://www.ibisworld.com/industry/default.aspx?indid=1719
  25. Worldometers. Overweight and Weight Loss Statistics. http://www.worldometers.info/weight-loss/

 

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