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Healthy Weight Loss

Healthy Weight Loss | Heart and Vascular Health | Scoop.it

A useful approach is to select the best diet that works for you. This
is the eating plan you can live with.
What You Need to Know About Weight Loss
A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week. (500 calories per day × 7 days = 3500 calories.)
All foods have carbohydrate, protein, and fat.

Carbohydrates provide 4 calories per gram.

Proteins provide 4 calories per gram.
Fats provide 9 calories per gram.
Carbohydrates are either simple or complex. Simple carbohydrates cause more  weight gain than complex carbohydrates. Simple carbohydrates include sugar and starches (potatoes, pasta,and rice). Complex carbohydrates include fruits, vegetables, and whole grains.

Seth Bilazarian, MD's insight:

A 500 calorie reduction every day is a good basic rule to begin to have an understanding how to move weight down by about a pound per week - its a good start.  Slightly more advanced calculators are more accurate and can help understand how to move weight to a goal or ideal weight.  For those motivated to change habits on caloric intake these calculators can be very helpful.  See the Pennington Biomedial caculators at

 http://www.pbrc.edu/research-and-faculty/calculators/weight-loss-predictor/

 

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Action-Related Television Content Increases Food Intake

Action-Related Television Content Increases Food Intake | Heart and Vascular Health | Scoop.it

Television (TV) has generally been blamed for helping make Americans overweight owing to both its distracting influence and its encouragement of a sedentary lifestyle. Indeed, a recent correlational analysis of dinner patterns illustrated that the frequency of TV viewing during dinner was 1 of the 2 largest correlates of adult and child body mass index.

However, the focus to date has been on the medium and not the message. Granted, TV may lead distracted viewers to mindlessly eat past the point at which a person would usually stop. In this, it is not unlike other distracting activities that increase food intake, such as reading, listening to the radio, and interacting with dining companions. However, little is known about whether the content, valence, or pace of content influences how much a viewer eats while watching TV. For instance, how do objective technical characteristics, such as the frequency of visual camera cuts or the variation in sound, influence how much food is eaten?

More distracting TV content appears to increase food consumption: action and sound variation are bad for one’s diet. The more distracting a TV show, the less attention people appear to pay to eating, and the more they eat. Other potential causes, such as increased anxiety, agitation, and stimulation level, should be examined as contributing causes in future research.

While watching the programming, participants were given generous amounts of 4 snacks (M&Ms, cookies, carrots, and grapes) and allowed to eat as much as they wished. Food was weighed before and after the programs to determine the amount eaten by each viewer.

Subjects ate about twice as much watching the action movie compare to the talk show Charlie Rose.

Seth Bilazarian, MD's insight:

The paper does a good job highlighting the impact of distraction on overeating. There is a dose effect. The greater the distraction, the greater the over eating.

The talk show that was used in this trial was the Charlie Rose show. It was less distracting than an action movie and highlights the importance of knowing about distraction as a contributor to overeating.  For motivated patients, avoiding snacks when watching TV or having a limited quantity might reduce the hazard.  Alternatively you could limit your viewing to Charlie Rose.

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Global Girth Grows to 2.1 billion

Global Girth Grows to 2.1 billion | Heart and Vascular Health | Scoop.it
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F as in Fat: How Obesity Threatens America’s Future 2013

F as in Fat: How Obesity Threatens America’s Future 2013 | Heart and Vascular Health | Scoop.it

After three decades of increases, adult obesity rates remained level in every state except for one, Arkansas, in the past year, according to F as in Fat: How Obesity Threatens America's Future 2013, a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). The full report is available here. Visit http://www.FasinFat.org/ for interactives, graphs, charts and obesity rates for the states and nation going back decades.

Thirteen states now have adult obesity rates above 30 percent, 41 states have rates of at least 25 percent, and every state is above 20 percent, according to the report. In 1980, no state was above 15 percent; in 1991, no state was above 20 percent; in 2000, no state was above 25 percent; in 2007, only Mississippi was above 30 percent.*

Since 2005, there has been some evidence that the rate of increase has been slowing. In 2005, every state but one experienced an increase in obesity rates; in 2008, rates increased in 37 states; in 2010, rates increased in 28 states; and in 2011, rates increased in 16 states.*

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Obesity: consensus statement from National Lipid Association

Obesity: consensus statement from National Lipid Association | Heart and Vascular Health | Scoop.it

Adiposopathy: simplified relationship between pathogenic adipose tissue and cardiovascular disease. Adiposopathy is promoted by unhealthy nutrition and a sedentary lifestyle in genetically and environmentally predisposed individuals. With impaired adipogenesis of peripheral, subcutaneous adipose tissue during positive caloric balance, existing fat cells may hypertrophy, circulating free fatty acids may increase, and lipids may be deposited in nonadipose tissue organs (eg, liver, muscle, possibly pancreas) resulting in lipotoxicity. Adiposopathic endocrine and immune responses may be directly pathogenic to the cardiovascular system or otherwise interact with other body systems. If not mitigated by these other body organs, adiposopathy may indirectly cause or promote major atherosclerotic risk factors 

Seth Bilazarian, MD's insight:

A complex relationship made simple by realizing that the top is all that you need to know about preventing the hazards of obesity related medical illness.

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Fat Chance or Fat Choice? | Review of Fat Chance: The bitter truth about sugar

Fat Chance or Fat Choice? | Review of Fat Chance: The bitter truth about sugar | Heart and Vascular Health | Scoop.it

We see many examples of people who have never really engaged with behaviour change and many who have tried hard but failed to achieve any meaningful outcome. So, how do we encourage real, life-changing and long-lasting behaviour change in our patients? When faced with many disappointments, can it even work?

Lustig spends most of the first half of the book explaining why behaviour change alone is so difficult. Our bodies have multiple adaptations to protect our body weight and we do not relinquish it without a fight. This battle is waged day by day in our guts (gut hormones) and our brains (leptin) making sustained weight loss incredibly difficult. Lustig clearly believes that individual behaviour change, while important, is inadequate to fully tackle the global obesity epidemic. Orchestrating this disaster, according to Lustig, is a food environment which has changed dramatically over the last 50 years in the Western World, in parallel to the rise in obesity, and Lustig argues that tackling this aspect of our culture should be a greater concern.

Seth Bilazarian, MD's insight:

My patients' food environments are the biggest impediment to successful lifestyle modification adn weitght loss.

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Steve Kingsley's curator insight, October 1, 2013 8:41 PM

Yes, it's much more than changing one's diet - it really is about changing one's life style.

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Bypassing Diabetes

Bypassing Diabetes | Heart and Vascular Health | Scoop.it

Though existing research has shown that gastric bypass surgery resolves type 2 diabetes, the reason has remained unclear. A research team at Boston Children’s Hospital, has identified the small intestine—widely believed to be a passive organ—as the major contributor to the body’s metabolism, based on a study in rats. The report appears in the July 26, 2013, issue of Science.

Weight loss and improved diabetes often go hand in hand, but type 2 diabetes often disappears even before weight loss occurs after gastric bypass. To investigate why this happens, The team spent one year studying rats and observed that after gastric bypass surgery, the small intestine changes the way it processes glucose. The team saw the intestine using and disposing of glucose, thereby regulating blood glucose levels in the rest of the body and helping to eliminate type 2 diabetes.

Seth Bilazarian, MD's insight:

In practice the dramatic shedding of daibetic medications by patients immediately after bariatric surgery (such as gastric bypass or banding) is remarkable.

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Michael Wiener's curator insight, August 14, 2013 7:58 PM

If this was performed on rats successfully, hopefully it could work on humans, as well... 100%

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Baby Boomers Less Fit Than Last Generation

Baby Boomers Less Fit Than Last Generation | Heart and Vascular Health | Scoop.it

Because for all the talk of jogging, playing basketball on new knees and lacing up skates for late-night ice hockey games, it turns out baby boomers may be in worse shape than the generation that came before. That would be the one that, if urged by an ad to “just do it,” might have replied, “Just do what?”

Writing this month in the journal JAMA Internal Medicine, researchers offered a portrait of boomerdom at odds with its popular portrayal, and perhaps with its sense of itself. They found that boomers were more likely to be obese, more likely to have high blood pressure, high cholesterol and diabetes -- and less likely to be physically active.

 

Seth Bilazarian, MD's insight:

And if there is not a significant cultural change in nutrition and exercise habits the Gen X and Gen Y generation will be even worse.  Exercise and eat right! => save yourself.

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Twinkie Maker Hostess to Close

Twinkie Maker Hostess to Close | Heart and Vascular Health | Scoop.it

My comment: Is the demise of Hostess Brands a leading indicator that Americans are coming around to rational thinking on nutrition and making decisions with food purchases that will have a meaningful impact on obesity and health?  I hope so.  Joseph Schumpeter might be smiling.

==================== 

The maker of Wonder Bread and Ding Dongs announced it would close its plants and fire about 18,000 employees after being crippled by a nationwide strike.

Each Twinkie has (had) 150 calories, 2 gm fat, 17 gm sugar.

The company made 500 million of the creme-filled treats every year. The icons have been on shelves since 1930. Supposedly the cakes never go bad. Despite the high amounts of preservatives, Hostess says, Twinkies really only have a 25 day shelf life. President Clinton placed a package in the Millennium Time Capsule in 1999, scheduled to be opened in 2100. We'll see then if if they really do spoil.

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Diabetes Study Ends Early With a Surprising Result

Diabetes Study Ends Early With a Surprising Result | Heart and Vascular Health | Scoop.it
Diet and weight loss did not prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes.

A large federal study of whether diet and weight loss can prevent heart attacks and strokes in overweight and obese people with Type 2 diabetes has ended two years ahead of schedule because the intensive program did not help.  Many have assumed diet and exercise would help, in part because short-term studies had found that those strategies lowered blood sugar levels, blood pressure and cholesterol levels. Still, medical experts said there were many benefits to diet and exercise even if they did not reduce cardiovascular disease in people with diabetes.

About 25 million Americans have Type 2 diabetes. Many are overweight or obese. On average, the disease increases heart disease risk by 2 to 2 ½ times.  Study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

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Things you should never say to someone trying to lose weight

Things you should never say to someone trying to lose weight | Heart and Vascular Health | Scoop.it

I'm doing this the old-fashioned way by eating healthy and exercising. Plain and simple. I know these comments come from a place of love -- the people I've heard these from mean well. It just comes out wrong and winds up bugging me. So without further ado, here are the things I "nevah evah nevah" want to hear again about my loss of 45+ pounds:

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Obesity data by state - Orange is bad!

Obesity data by state - Orange is bad! | Heart and Vascular Health | Scoop.it

Obesity prevalence in 2011 varies across states and regions
By state, obesity prevalence ranged from 20.7% in Colorado to 34.9% in Mississippi in 2011. No state had a prevalence of obesity less than 20%. 39 states had a prevalence of 25% or more; 12 of these states had a prevalence of 30% or more: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.
The South had the highest prevalence of obesity (29.5%), followed by the Midwest (29.0%), the Northeast (25.3%) and the West (24.3%).

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What Really Makes Us Fat

What Really Makes Us Fat | Heart and Vascular Health | Scoop.it

Take Home:  Another review on the comparison of diets.  This is a good read.

Key sentence "the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed"

Of the 3 diets tested: Low Fat/High Carbohydrate, High Fat/Low Carbohydrate "Atkins",  the best is the Low Glycemic Index for weight loss and long term maintenance and health .  To achieve this many of my patients have implemented Belly Fat Cure by Jorge Cruise.

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Artificial sweeteners induce glucose intolerance

Artificial sweeteners induce glucose intolerance | Heart and Vascular Health | Scoop.it

Non-caloric artificial sweeteners (NAS) are among the most widely used food additives worldwide, regularly consumed by lean and obese individuals alike. NAS consumption is considered safe and beneficial owing to their low caloric content, yet supporting scientific data remain sparse and controversial. Here we demonstrate that consumption of commonly used NAS formulations drives the development of glucose intolerance through induction of compositional and functional alterations to the intestinal microbiota. These NAS-mediated deleterious metabolic effects are abrogated by antibiotic treatment, and are fully transferrable to germ-free mice upon faecal transplantation of microbiota configurations from NAS-consuming mice, or of microbiota anaerobically incubated in the presence of NAS. We identify NAS-altered microbial metabolic pathways that are linked to host susceptibility to metabolic disease, and demonstrate similar NAS-induced dysbiosis and glucose intolerance in healthy human subjects. Collectively, our results link NAS consumption, dysbiosis and metabolic abnormalities, thereby calling for a reassessment of massive NAS usage.

Seth Bilazarian, MD's insight:

We have been using non-caloric artificial sweeteners for more than a century. Today the food industry is using them in ever-greater quantities in 'diet' foodstuffs and they are recommended for weight loss and for individuals with glucose intolerance and type 2 diabetes mellitus. This report shows that consumption of the three most commonly used non-caloric artificial sweeteners — saccharin, sucralose and aspartame (Sweet-n-Low, Equal & Splenda)— directly induces a propensity for obesity and glucose intolerance in mice, by changing the gut microbiome in a way that leads to absorption of more calories and that compromises glucose tolerance.  In healthy human subjects, and suggest it may be necessary to develop new nutritional strategies tailored to the individual and to variations in the gut microbiota.

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Donovan Baldwin's curator insight, December 29, 2014 9:18 AM

A life without sweeteners of any kind is not actually that bad. However, if you must have sweetness, it appears that artificial sweeteners are still better than sugar. Try the 21 Day Sugar Detox. Learn more at http://nodiet4me.com/review/sugar_detox.html

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Obesity 'linked to 10 cancers'

Obesity 'linked to 10 cancers' | Heart and Vascular Health | Scoop.it

Being overweight and obese puts people at greater risk of developing 10 of the most common cancers, according to research in the Lancet medical journal. Scientists calculated individuals carrying this extra weight could contribute to more than 12,000 cases of cancer in the UK population every year. They warn if obesity levels continue to rise there may be an additional 3,700 cancers diagnosed annually.The study of five million people is the largest to date to confirm the link.

Seth Bilazarian, MD's insight:

Many patients know  the link between obesity and diabetes & heart disease, but the link to cancer is not as well known. This is another reason for urgency to address obesity and overweight for individuals and from a public health standpoint.

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Olivia Perez's curator insight, November 14, 2014 1:06 PM
If obesity keeps going on arise there will be an additional 3700 cancers diagnosed each year. Scientist and doctors say that tumor can start to develop on your Kinsey, uterus, cervix, thyroid, and ect. People with more body mass are more likely to develop liver, colon, ovaries, and breast cancer. But scientists she haven't connected of you BMI level is even associated on getting cancer.
Leeza Trainor's comment, November 17, 2014 9:25 AM
That is a whole lot of cancer
Lexie Ruscheinski's comment, November 17, 2014 11:01 PM
This is a huge wake up call and also scary. It shows how big of a problem obesity can be in our country!
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Tackling men's reluctance to join weight loss programmes

Tackling men's reluctance to join weight loss programmes | Heart and Vascular Health | Scoop.it

Male obesity is increasing but few men take part in weight loss programs.  We assessed the effect of a weight loss and healthy living program on weight loss in football (soccer) fans.

 747 male football fans aged 35—65 years with a body-mass index (BMI) > 28 kg/m2 from 13 Scottish professional football clubs. Participants were randomly assigned, stratified by club, to a weight loss program delivered by community coaching staff in 12 sessions held every week. The intervention group started a weight loss program within 3 weeks, and the comparison group were put on a 12 month waiting list. All participants received a weight management booklet.

At 12 months the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4·94 kg (10.9 lbs)  and percentage weight loss, was 4·36% (3·64—5·08), both in favor of the intervention. 

The FFIT programme can help a large proportion of men to lose a clinically important amount of weight; it offers one effective strategy to challenge male obesity.

 

Here's the link to the article on Lancet

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62420-4/abstract

 

Seth Bilazarian, MD's insight:

Weight loss achieved in this weekly education and accountability program was impressive and lasted 12 months.  Weight loss might be one of the educational opportunities best undertaken in a single sex environement

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Obesity: consensus statement from National Lipid Association

Obesity:  consensus statement from National Lipid Association | Heart and Vascular Health | Scoop.it

Inter-relationship between adiposopathy, type 2 diabetes mellitus, hypertension, dyslipidemia and atherosclerosis. FFA, free fatty acid; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

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Merits of Subtyping Obesity:  One Size Does Not Fit All

Merits of Subtyping Obesity:  One Size Does Not Fit All | Heart and Vascular Health | Scoop.it

 Within the obesity field there has been increasing recognition that prevention and treatment programs should be culturally sensitive and that the prevalence of risk factors and obesity may vary by race or ethnicity, but the same basic recommendations for prevention and treatment are given in all settings. An important question is whether this is one reason for not achieving better treatment outcomes.

Currently many obesity treatment studies have overall small effects, but substantial variability in results, with some individuals having a large amount of weight loss and others gaining weight. The focus on mean overall effects may preclude identifying an effective treatment program for a specific subtype of obesity, but not others.

High insulin secretion low responsiveness to internal satiety signals, high responsiveness to external food cues; learned patterns and preference for foods high in calories, fat, sugar, and salt; binge eating or food addiction; and low reinforcing value of activity or high reinforcing value of being sedentary. However, these are only several possible subtypes but others may exist.

Currently, major advances are being made in statistical methods to understand the development of obesity, the neuroscience of eating behaviors, use of sensors to better measure exposures, and exploration into the functional role of genetic polymorphisms associated with obesity. Additional advances are needed in how to conceptualize and phenotype the outcome of obesity. The one-size-fits-all approach is yielding small average weight losses. 

The molecular pathological epidemiology model has recently emerged to help address the heterogeneity of disease. Obesity is a heterogeneous and complex disease influenced by exogenous and endogenous exposures. Stratifying obesity into meaningful subtypes could provide a better understanding its causes and enable the design and delivery of more effective prevention and treatment interventions.

Seth Bilazarian, MD's insight:

Generalization is sometimes useful, but in medicine often results form intellectual laziness or pharmaceutical companies attempting to have broad commercial applications for their therapies.  This editorial on the need to sub-type different types of obesity so different treatment strategies can be tested and tailored for best outcomes for patients affiliated with obesity makes a lot of sense.  It would also have significant impact on the cost of treatment from a public health standpoint since therapies could be used when most effective and avoided when they are unlikely to be effective..  This may be why there are so many commercially successful diet programs iand books because some of the programs DO work fro some of the people who try them.

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Does seeing a dish's calorie count make you eat healthier?

Does seeing a dish's calorie count make you eat healthier? | Heart and Vascular Health | Scoop.it

The moment of truth: The creamy pasta dish sounds delicious, but it's 500 calories more than the grilled chicken and vegetables. Do you order it?

In many cases the answer is yes, say researchers who have studied what happens when calorie counts are included on menus.

More diners will open their menus to find calorie counts under a proposed federal law requiring the counts in restaurants with 20 or more locations. Health advocates and restaurants say the law could be finalized by the end of the year. A Food and Drug Administration spokeswoman says details of the law, first proposed as part of the 2010 health care bill, are still being worked out. It could also require grocery and convenience stores to list calories on prepared foods.

Many restaurants are reworking recipes, swapping in whole milk for cream or putting less oil in cooking pans. Some are adding less sauce to dishes or offering smaller portions. Many are creating lower-calorie sections on menus or sticking to calorie guardrails, designing dishes to come in under 500 calories, A study funded by the City of New York that reviewed about 15,000 receipts and surveys from fast-food lunch patrons before and after the city required those restaurants to list calories on menus showed no change in the average calories bought. But 1 in 6 people used the calorie information, and that group purchased an average of 96 fewer calories, an 11% decrease.

Seth Bilazarian, MD's insight:

Having this data available will lead food manufacturers to develop and produce lighter options since customer awareness will eventually change behavior.

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Weigh More, Pay More on Samoa Air

Weigh More, Pay More on Samoa Air | Heart and Vascular Health | Scoop.it
A tiny South Pacific airline is charging passengers based on their weight, at a time when other carriers have only ventured to seek payment for luggage and meals.

Customers flying Samoan upstart carrier Samoa Air Ltd. on short international hops to neighboring American Samoa are set to pay US$0.92 per kilogram, or $0.42 a pound, for each flight.

Seth Bilazarian, MD's insight:

Hard to beleive that Americans could ever tolerate this.  Paying $20 more for being 50 pounds over weight or $40 for being 100 pounds overweight does not seem like much of an incentive but the "weigh in" at the airport counter might encourage weight loss for some.

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How to Help an Overweight Partner Lose Weight

How to Help an Overweight Partner Lose Weight | Heart and Vascular Health | Scoop.it

Few subjects in a relationship are more difficult to talk about than one person's weight. Even people who aren't overweight can obsess about their appearance (sadly, these mostly tend to be women). How can a partner raise the issue with someone who is overweight without causing hurt or embarrassment? And how can an overweight person address his or her weight problem without obsessing and harming the relationship?

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The Unexpected Dangers of Obesity

The Unexpected Dangers of Obesity | Heart and Vascular Health | Scoop.it

Researchers are discovering more ways that obesity can damage the body. These include altering a person's ability to smell, disrupting sleep and sexual function, and accelerating cancerous tumor growth.

"Obesity is a complex condition," "Many, many things change in the body."

Fat produces numerous hormones, inflammatory molecules and other chemicals that can act directly on nearby organs or travel to wreak havoc in other areas of the body. Better understanding how this works might eventually open new avenues for treatment of obesity and linked conditions, experts say.

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Candy at the Cash Register — Obesity & Chronic Disease Risk Factor

Candy at the Cash Register — Obesity & Chronic Disease Risk Factor | Heart and Vascular Health | Scoop.it

A basic misconception has stymied our response to the obesity epidemic: the belief that food-related decisions are consciously and deliberately made. Our reluctance to interfere with or regulate the food environment is a direct consequence of the belief that people's food choices reflect their true desires. However, given the large proportion of people who claim that they want to lose weight and the small proportion who are actually able to do so, we must concede that human behavior doesn't always conform with professed goals. The reality is that food choices are often automatic and made without full conscious awareness. Placement of foods in prominent locations increases the rate at which they're purchased; purchase leads to consumption; and consumption of foods high in sugar, fat, and salt increases the risks of chronic diseases.  Although placement is a factor that is right in front of our noses, we should consider treating it as a hidden risk factor, like carcinogens in water, because placement influences our food choices in a way that is largely automatic and out of our conscious control and that subsequently affects our risk of diet-related chronic diseases.

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BCHS- Alyssa Snyder's curator insight, February 26, 2013 4:04 PM

Many people believe it is their choice conciously of what they will buy and eat that night for their dinner. Sometimes it isnt, it could possibly be a subconcious decision made when we go to a store and look at the candy surrounding a cash register. Due to the placing of the sweet and sugar-rich foods, we are chosing them more than the nutrisous foods past generations would chose. Many things effect our eating ehaviour though, such as commercials, placings of food, whic many people would not think of as a major thing for chosing food, and also what our parents usually buy. We can prevent this by avoiding those aisles that have suh=gary foods or foods that are attractive to us located in them.

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Obesity May Hasten Cognitive Decline

Obesity May Hasten Cognitive Decline | Heart and Vascular Health | Scoop.it

People who are obese in middle age and who have high blood pressure and other so-called metabolic risk factors have a speedier cognitive decline as they get older than people of normal weight, according to a large study published Monday in the journal Neurology.

The study, involving 6,401 participants and spanning 10 years, adds to research indicating that obesity increases the risk of dementia later in life.

"In the last 10 years or so, people started suggesting you could be fit and fat—you could be obese and metabolically healthy and have no health risk," said Archana Singh-Manoux, lead author of the study and research director at Inserm, the French National Institute of Health and Medical Research.

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Wider Testing to Head Off Diabetes

Wider Testing to Head Off Diabetes | Heart and Vascular Health | Scoop.it

Take Home Message:  Knowing your numbers including your blood sugar is valuable especially for overweight patients.  Unlike the person profiled in this article I find patients to be very responsive to this early warning sign and generally enthusiastic about efforts to reduce the risk of progresing to diabetes.

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Health-care providers are stepping up efforts to identify the millions of Americans believed to have prediabetes, a condition that can lead to full-blown diabetes, using the HgbA1cto check a greater number of hospital patients.  Prediabetes, typically defined as blood sugar that is higher than normal (over 100)  but not yet in the diabetes range (over 125).  NIH estimates that as many as 79 million Americans age 20 and older—or roughly one in three adults—have prediabetes. That figure dwarfs the 26 million Americans who have Type 2 diabetes, including seven million people believed to have the disease but don't know it.

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