Timi Gustafson, R.D.

Helping people to live healthy and fulfilling lives.

Lack of Awareness Heightens Diabetes Risk, Study Finds

July 4th, 2015 at 4:58 pm by timigustafson
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Only about 10 percent of people who are at risk of developing type 2 diabetes know about their condition, which makes it hard to take proactive measures while there is still time to prevent the full-blown disease, according to a new study.

Lack of awareness keeps a vast part of the population with elevated blood sugar that is not yet diabetic but can lead to worsening outcomes from making important lifestyle changes, such as cutting back on sodas and sugary foods as well as losing weight and getting more exercise, says Dr. Anjali Gopalan of the Philadelphia VA Medical Center, the lead author of the study.

“People with pre-diabetes who lose a modest amount of weight and increase their physical activity are less likely to develop diabetes. Our study importantly shows that individuals with pre-diabetes who were aware of this diagnosis were more likely to engage in some of these effective and recommended healthy lifestyle changes,” she told Reuters.

The prevalence of type 2 diabetes has dramatically increased in recent years and is estimated by the World Health Organization (WHO) to affect now about 9 percent of the adult world population. It has become the seventh leading cause of death.

Once considered a disease of older adults, it is fast spreading among children and adolescents, primarily in the developed parts of the world like North America and Europe, but also increasingly elsewhere.

Pre-diabetes is considered a precursor to diabetes, a chronic disease that occurs when the pancreas does not produce sufficient amounts of insulin or when the body cannot effectively use the insulin it is provided with. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or elevated blood sugar, is a common result of uncontrolled diabetes that can lead to irreversible harm, including to the nerves and blood vessels.

Although the causes of pre-diabetes and diabetes are well known, there is still much confusion and myth creation among the public that make it difficult to separate fact from fiction.

It is important to understand that diabetes comes mainly in two forms: type 1, which is caused by genetics and perhaps some other factors that are not yet fully understood; and type 2 diabetes, where genetic makeup can also play a role, but which is more often connected to diet and lifestyle.

The latter can usually be prevented or at least controlled through weight management, healthy eating and regular exercise as well as medication where necessary.

Unfortunately, pre-diabetes has no specific signs or symptoms, which makes timely detection so much harder. However, increased thirst, frequent urination, fatigue, and problems with vision can be red flags and should be brought to a doctor’s attention.

Experts recommend that especially people who are overweight, have a family history of type 2 diabetes, suffer from high blood pressure and/or high cholesterol, are over the age of 45, or belong to certain ethnic groups should be tested for pre-diabetes as part of their regular physical, regardless of symptoms.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Don’t Grow Old Sick, Experts Warn Baby Boomers

June 17th, 2015 at 11:57 am by timigustafson
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As more and more members of the Baby Boomer generation – those born between 1946 and 1964, about 75 million in all – enter retirement age and move from commercial healthcare plans to Medicare, the national insurance program for Americans over the age of 65, the question becomes more urgent how the ever-rising medical costs will be absorbed by society.

Roughly three million people will be added annually to the program over the next two decades or so, and it will affect and likely change every part of healthcare as we know it, according to experts.

Cause for concern does not come from these changing demographics per se but rather the fact that Baby Boomers have turned out to be less healthy and less prepared to shoulder (at least part of) their medical expenses by themselves than previously hoped.

Although the average life expectancy has dramatically increased over the last half century, Boomers are not necessarily better off in terms of their health status than those before them. Many have to cope with serious health issues for decades, and the existing medical system is not prepared for such drawn out crises.

Two-thirds of today’s Medicare beneficiaries suffer from multiple chronic conditions like obesity, diabetes, hypertension, heart disease, kidney disease, and pulmonary problems, according to surveys. The sickest among them, about four million, or 15 percent, account for almost half of the current annual costs of about $324 billion.
Medicare data show that healthcare spending on one person with just one chronic disease amounts to nearly three times that of someone who has no long-terms ailment.

The good news is that much of these expenses could be reduced with diet and lifestyle improvements. Unfortunately, too many Boomers tend to overindulge, and adhere to a predominantly sedentary lifestyle, says Dr. Dana E. King, a family physician and researcher at West Virginia University who has studied chronic conditions among Baby Boomers for many years. Nearly 40 percent are obese, and more than half don’t get any regular exercise at all, he laments.

Also, he says, patients often rely exclusively on medications as their remedy, when in fact the drugs they are taking should be used in conjunction with lifestyle changes.

In one of his studies, involving 15,000 Baby Boomers, Dr. King found that participants who implemented health-promoting diet and lifestyle changes over a period of just four years reduced their risk of dying from a heart attack by an impressive 40 percent.

With better information and greater awareness of the importance of such changes, we could still stave off the otherwise impending crush on the medical system that will surely occur if the chronic diseases these people are now plagued with are not brought under control, he says.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Noise Pollution, a Widely Underestimated Health Hazard

June 10th, 2015 at 1:44 pm by timigustafson
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You may get a headache, be unable to concentrate, become annoyed over seemingly simple things. Your heart races, you break a sweat, feel anxious and unsettled for no particular reason. And then you realize that it’s just awfully loud where you are. It’s called noise pollution, and it can do serious damage to both your physical and mental well-being.

Some experts have called noise pollution “a modern plague” because it’s ubiquitous and nearly impossible to escape. In their 2007 study, the authors Lisa Goines, RN, a nurse, and Louis Hagler, MD, a physician at the Alta Bates Summit Medical Center in Berkeley, California, have found that environmental noise is a growing threat on par with water and air pollution that can lead to wide-ranging negative outcomes in public health, especially among the poor, the elderly, and young children.

“Noise produces direct and cumulative adverse effects that impair health and that degrade residential, social, working, and learning environments with corresponding real (economic) and intangible (well-being) losses,” the authors say.

Far from being just another inevitable nuisance in modern-day life, excessive noise can interfere with sleep, concentrated work, communication, and recreation. In many ways, it can be as damaging as exposure to second-hand smoking and other environmental health hazards, and should be treated as such, Goines and Hagler recommend.

As far back as 1971, the World Health Organization (WHO) issued warnings about the impact of environmental disturbances on humans, including increasing noise levels from traffic and industrial activities, and called for regulations.

In its 1999 Guidelines for Community Noise, the organization lists specific risks from excessive noise exposure to hearing, person-to-person communication, sleep, cardiovascular health, mental health, cognitive development in children, task performance, and social behavior.

More recent studies have shown that especially the growing rate of heart disease may be linked, among other factors, to environmental noise. Like other stressors, noise can affect the cardiovascular system by elevating blood pressure and releasing stress hormones such as cortisol.

Tragically, children who grow up in noisy surroundings are especially vulnerable to some of the repercussions. Attention span, learning, problem solving and memory can be severely affected by noise. The cognitive development of young ones can be hindered when homes and schools are located near sources of loud noise such as highways and airports, according to the WHO report and other studies.

Despite the many effects of noise pollution on the public’s health we know about, not much consideration has been given to the issue to date, according to Dr. Richard L. Neitzel, a professor at the University of Michigan School of Public Health in Ann Arbor and co-author of a study on environmental noise pollution and the need for effective public health responses.

The U.S. Environmental Protection Agency (EPA) first published a set of recommendations for protecting the public from environmental noise in 1974, but its research was discontinued in the 1980s and only recently renewed.

What we need is to raise greater awareness that noise does not only damage people’s hearing but that the potential risks to their well-being are much graver, said Dr. Mathias Basner, a professor of Sleep and Chronobiology in Psychiatry at the University of Pennsylvania Perelman School of Medicine in Philadelphia to Reuters. Installing new windows and insulation at home and protecting one’s hearing from loud noise sources as much as possible can be very effective, but it should not be our only resort, he said. “Noise that is not produced cannot have effects.”

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Creating a Culture of Health and Fitness

May 29th, 2015 at 6:11 pm by timigustafson
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People who live in California spend on average almost 90 minutes per week on running, swimming, bicycling, lifting weights and other measures to stay healthy and fit, which is close to the minimal amount of time recommended by the U.S. government, and more than the residents of all other states seem able to manage, according to data collected by MapMyFitness, a manufacturer of activity tracking software with over 20 million users. Runner-ups are Arizona, Colorado, Oregon and Washington.

Some of these findings seem unsurprising. California offers good weather conditions for outdoor activities almost all year round, and the other leading states are known for their natural beauty as well. A comparatively high standard of living and an educated populace add to the advantages. And there are other important benefits, such as a health-promoting infrastructure that includes sidewalks, bike paths, public pools and other spaces for recreation, which are not as ubiquitous elsewhere.

None of this, however, can fully explain the sometimes dramatic differences within the country in terms of public health and fitness. While personal wellness depends on multiple factors that can be hard to calculate, it is clear that besides geographic diversity, culture also plays a role.

Much has been reported about the ‘über-generous’ perks the employees of giant tech companies like Google and Microsoft (headquartered in California and Washington respectively) receive, including cafeterias stocked with health food for free, state-of-the-art gyms on campus, all-inclusive healthcare plans, and more. But an ever-increasing number of mid-size and small businesses also realize how imperative it is, including for their own bottom line, to invest in the well-being of their staff – so much so that corporate wellness has become a multi-billion industry in and of itself.

Ideally, corporate health and fitness programs continue to influence people’s behavior outside the workplace as well. Studies have shown that once workers buy into a culture that emphasizes wellness, they stand a much better chance of succeeding long-term on their own.

Company policies work best when those whom they are designed for participate freely, not because they feel they are expected to but because they recognize the benefits they are reaping for themselves. Prying, prodding or punishing only gets you so far, says Al Lewis, a lawyer and consultant on issues of workplace wellness. He is critical of programs he considers unreasonably intrusive in people’s private affairs. Under federal law participation in all employer-sponsored wellness plans must be voluntary and non-discriminatory.

Still, nurturing a culture that favors healthy over unhealthy behavior can serve as an effective tool for the prevention of many illnesses, according to the Centers for Disease Control and Prevention (CDC).

“Prevention should be woven into all aspects of our lives, including where and how we live, learn, work, and play,” the agency states in its recommendations, titled National Prevention Strategy. “Everyone – businesses, educators, health care institutions, government, communities, and every single American – has a role in creating a healthier nation.”

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Independent Living Considered a Top Priority Among Seniors

May 22nd, 2015 at 2:32 pm by timigustafson
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Every day, roughly 10,000 members of the Baby Boomer generation – those born between 1946 and 1964 – reach the official retirement age of 65. Many will continue to enjoy a high level of physical and mental health and be better off in multiple aspects than preceding generations. But a growing number will suffer from steep decline and be plagued by debilitating illnesses, some of which could have been prevented in time.

One of the most dramatic consequences of age-related deterioration is loss of independence, and it is more feared by seniors than almost any other outcome. For many, even an untimely death seems preferable to becoming beholden to others, according to surveys.

Not only do most older adults not want to become a burden to their loved ones, nearly all – 90 percent of respondents to polls – plan to live out their days in their own homes instead of entering a retirement facility.

“Aging in place,” as it is now widely called, is particularly popular among seniors who cherish the lifestyle they have become accustomed to and wish to maintain for as long as possible. Besides staying indefinitely within one’s four walls, it also includes being able to move around safely in neighborhoods and communities as well as having access to vital resources such as food outlets, public transportation, day-to-day services, places of entertainment, etc.

The concept has also given birth to a fast-growing industry that caters to these exact needs and desires. According to a new report by the National Association of Area Agencies on Aging, an advocacy group with focus on community building, eliminating obstacles and breaking down barriers that tend to isolate older citizens are important first steps for an aging population’s ongoing participating in communal life. Efforts to make urban and suburban surroundings more senior-friendly – for example by facilitating greater walkability – can benefit members of all ages and should therefore be universally embraced, the report suggests.

On the other hand, as critics have pointed out, staying put for as long as possible may not always be the best option. The prospect of ending up in an assisted-living establishment, separated from loved ones and surrounded by strangers, is so repulsive to some people that they would rather rot away in their own place before accepting much-needed help, says Dr. Steven M. Golant, a professor of gerontology at the University of Florida.

Despite their advanced age, older people tend to overestimate their strength and ability to cope with everyday challenges on their own. Some of it may have to do with the messages we receive in the media about aging and how much better we all fare compared to our forbearers. It makes some folks feel close to invincible when that is definitely not the case.

The whole “aging-in-place” model is probably being oversold, Dr. Golant argues. It may be a profitable idea for home healthcare providers, builders specializing in home modifications for senior residents, financial institutions offering reverse mortgages, etc. But it is not a one-fits all solution for an aging generation.

“There are many downsides to the aging-in-place experience,” he adds. “Obviously there’s a good side. […] But older people are a really diverse lot. Their ability to count on family members is very variable. Their ability to cope with their declines and their losses in health and people is very variable. So to suggest indiscriminately that aging in place is good for everyone is an irresponsible position to take.”

On the upside, one might add, it is also welcome news that living independently at any age has become easier in many ways, including through technological innovations and improved services. As everyone else, today’s seniors have countless opportunities to stay connected and get assistance if needed. Food can be ordered online, as can transportation and most other services. All this can secure a large degree of independence. What it cannot do is to overcome loneliness and isolation, which unfortunately are also part of aging for so many…

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Facing the Facts of Childhood Obesity

May 13th, 2015 at 3:13 pm by timigustafson
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As childhood obesity rates continue to rise worldwide, we are now approaching the level of a major public health crisis. While that is common knowledge among experts, the alarming news doesn’t seem to reach millions upon millions of parents who keep overfeeding their offspring with unhealthy meals and fattening treats. In fact, many of those whose children have been diagnosed as overweight or obese insist that there is nothing wrong with a little chubbiness at a young age.

A recent study published in the medical journal Childhood Obesity found that most parents perceived their kids’ weight as “about right,” even when there was ample evidence to the contrary.

For the study, which was conducted by the New York University Langone Medical Center, researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), a project of the Centers for Disease Control and Prevention (CDC), involving thousands of children between 1988 and 1994, and again between 2007 and 2012.

According to the findings, 95 to 97 percent of parents of overweight boys, and 88 to 93 percent of parents of overweight girls thought their kids were within a normal weight range. And although many children in the later study were significantly heavier than in the earlier one, the parental perception did not noticeably change.

The study results are of particular concern because eating habits tend to form early in life and parents have the greatest influence on young children’s eating behavior. But when parents adhere to poor diets themselves or are ignorant about the nutritional needs of their little ones, the consequences can be dire. Eating disorders that develop during childhood can lead to a number of diet-related diseases, which can continue and potentially worsen in adolescence and adulthood.

One of the problems we’re facing is that many parents compare their own children to other kids in deciding whether they are overweight, instead of consulting with pediatricians or using science-backed growth charts. They rather look to neighbors and peers as the standard, according to Dustin Duncan, ScD, an assistant professor at the Department of Population Health at NYU School of Medicine and lead author of the study report.

Another issue is that children with weight problems often find themselves stigmatized, which makes it even harder to address those constructively. Parents will be hesitant to add to the embarrassment young ones already feel by signaling their disapproval, explains David L. Katz, MD, the director of the Yale University Prevention Research Center and editor-in-chief of the Childhood Obesity journal. Oftentimes, this results in parents ignoring the long-term consequences before it’s too late.

The best approach to fighting childhood obesity, experts say, is educating the adults in the household. They are supposed to decide what kinds of food are purchased, what portion sizes are served, and how many meals and snacks are made available throughout the day. If they lead by example, their youngsters will follow suit – and everyone will benefit.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Lessons in Positive Thinking

May 9th, 2015 at 3:13 pm by timigustafson
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For most of my career as a dietitian and health counselor I have paid much attention to the deficiencies in my clients’ diet and lifestyle choices and how these could be changed for the better. Over the years, however, I began focusing more on what went right in their lives and how their strengths could be utilized in order to overcome their weaknesses. You may say I applied (unknowingly) what is now known as “positive psychology.”

When I say, “what went right in their lives,” I do not necessarily mean whether they were successful at their work, were financially secure, or had stable marriages and relationships – although these may be important aspects as well – but rather, on a more intimate level, whether they had a sense of self-esteem, fulfillment, gratitude, purpose, and looked optimistically to the future.

This is in fact what practitioners of positive psychology are also most interested in. Their goal is to overcome existing negative thinking styles, mainly by fostering positive ones. They try to achieve this by having their clients recall pleasant past experiences, build on advantageous traits and characteristics, cultivate supportive relationships, and so forth. The desired end result is what proponents call “living the good life,” which, again, is not simply to be equated with material wealth.

The “good life” is happy, engaged, and meaningful. To realize it, one must mobilize inherent strengths, thereby increasing positive emotions while decreasing negative ones, according to Dr. Martin E. P. Seligman, a professor of psychology at the University of Pennsylvania and author of several best-selling self-help books who is widely credited as one of the founders and early developers of positive psychology as its own academic branch.

Traditional psychology has almost always been concerned with mental and emotional disorders and malfunctions and ways to treat them, he explains. By contrast, positive psychology adds an important emphasis on the human potential for building and maintaining highly functional and constructive lives.

A number of distinct theories have entered this relatively new field lately. Some focus on basic emotions like joy and happiness, others on the human capacity to create purpose and meaning. The ability to blissfully immerse oneself in one’s work, to flourish while encountering challenges, or to stay resilient in the face of adversity – these are all elements that can contribute to a person’s well-being and are worthy of further exploration.

And the positive effects are not limited to the mind but benefit the body as well. Plenty of research has already shown that a positive attitude can be enormously advantageous for good health, and even longevity. One study from the Netherlands found that heart disease patients who maintained a generally optimistic outlook were able to slow down the progress of their illness and extend their life expectancy by several years.

Of course, the reason why some people continue to thrive while others quickly succumb in similar situations is still a mystery. However, clearly distinguishable ways of thinking seem to make at least some difference that can determine outcomes.

And no doubt, in my own work as a health counselor, I have also reaped the benefits from seeing the glass more often as half-full than half-empty. And because optimism tends to be contagious, there lies some healing power for my clients in that, too.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Food and Wine Pairing Made Perfectly Simple

April 29th, 2015 at 3:26 pm by timigustafson
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You have guests over for dinner. You are confident about your cooking (or caterer) but less sure about what drinks to serve. Or, you are at a business lunch or company retreat and want to make a good impression. Or, how about going out to a fine restaurant on a first date? Wine is usually the obvious choice, but how do you know what to select, especially if there are several meal courses involved?

Admittedly, too much ado is sometimes being made about matching the right wines with specific foods, which can be intimidating and unnecessarily off-putting. Some critics say there is a ridiculous amount of snobbery around wine to begin with, and all the talk of what goes with what is no exception. While there may be some truth to that, it is also a fact that a well-chosen wine does indeed have the ability to enhance the enjoyment of almost any dining experience.

The legendary winemaker Robert Mondavi is credited with saying that “Fine wine can turn a good meal into a feast.” Those who had the privilege to meet this icon of vinification (myself included) know that he lived his life with the intent to prove his point.

Although, I’m not an authority on wine by any stretch of the imagination, I like an occasional glass with my favorite eats, and after having spent many years visiting wine regions around the world, I do appreciate what I’ve been able to learn along the way.

The best formula for successful food and wine pairing I’ve ever come across was offered by the famed wine writer Tom Stevenson.

“There is only one golden rule when you are selecting a wine to accompany a dish,” he writes. “The more delicately flavored the dish, the more delicate the wine should be, whereas fuller-flavored foods can take fuller-flavored wines. It’s as simple as that.”

Of course, this rule is extremely flexible, depending on personal tastes and preferences as well as multiple other factors. An often recommended approach is to start out with something you already know and like. If you are unfamiliar with a certain culinary creation, it won’t do you much good to combine it with a wine you’ve never tasted either. You may encounter some exotic specialty, but how do you know which wine(s) make the experience complete? Of course you can follow expertly advice, but in most cases, it makes more sense to go with a conventional pairing until you’re ready to experiment and further explore.

For absolute novices, it may initially suffice to learn how to keep reds and whites apart. The basic guidelines hereto are that red meat (including big game) goes well with red wine, while salads, most seafood, and poultry are best matched with white varietals. You may also be interested in finding out which wines can be enjoyed on their own, as aperitifs or dessert drinks. Here too, the options are plentiful.

Let me add one quick remark about the quality of the wines you should order or purchase. Generally speaking, as with your food, the wines you enjoy are almost always the right ones. Similarly to Stevenson’s advice on delicacy, you may wish to consider matching elaborate meals with more complex wines, and conversely, simpler dishes with something easier.

In any case, you should never get seduced by overpriced wine lists, ratings and reviews by self-appointed authorities or niche publications, or any other party keen on selling you a product you know little or nothing about. Instead, follow your own desires, perhaps even instincts, and don’t allow yourself to feel pressured or hurried. So what if you make mistakes here and there. Nobody is born a sommelier. The fun lies in all the experiences you can have, and there is no telling what discoveries may come your way.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Not One ‘Plus Size’ Fits All

April 23rd, 2015 at 1:20 pm by timigustafson
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When it comes to treating weight problems, even experts believe that similar methods can be applied almost universally: Put your patients on a diet, have them engage in regular exercise, and, if all else fails, recommend some surgical procedure. What gets rarely looked at are the differences between overweight individuals that may have led to their unhealthy weight gain in the first place. Only one such study has recently been published, and the results are eye-opening.

For the study, scientists from the universities of Sheffield, England, Harvard, United States, and Toronto, Canada, analyzed medical data of over 4,000 overweight or obese men and women in terms of common and distinguishing characteristics. In the end, they came up with six ‘categories’ or ‘types’ that helped them better understand their subjects’ eating behaviors and lifestyle choices.

The first group was identified as “heavy drinking males” whose excessively high alcohol intake resulted in weight problems. Getting members of this category to limit their consumption of alcoholic beverages would obviously be an important step toward successful weight control.

The second group, named “younger healthy females,” consisted of women who were generally healthy except for their weight issues. Eating patterns and exercise levels were viewed as largely acceptable but were interspersed with bouts of binge eating and occasional heavy drinking, which, again, contributed to weight gain. Remedies hereto would be similar to their male counterparts.

A third type was called “the affluent and healthy elderly,” seniors who enjoyed retirement life a bit too much and paid the price with an unhealthily expanding waistline. Tuning it down a little would be the appropriate strategy.

Another group of older individuals was diagnosed with one or more chronic health conditions like diabetes and high blood pressure, in addition to being overweight. Those “physically sick but otherwise happy” people were often unaware of how their weight aggravated their other ills. Counseling with the aim of diet and lifestyle changes could lead to major improvements in such cases.

Mental dysfunctions like anxiety and depression were also found to be increasingly damaging to people as they grew older. The “unhappy, anxious middle-aged,” as the researchers named this group, often showed a close connection between their inner feelings and their outer appearance, especially in terms of weight. As psychological disorders oftentimes manifest themselves physically, equal attention must be paid to both the roots and symptoms before any progress can be hoped for.

Lastly, the research team focused on those whom they found in the “poorest health.” The prevalence of weight problems and chronic illnesses was especially high in this group, and eating and lifestyle patterns were predictably dismal. Overweight and obese patients of this type require intensive care and should be treated with the most effective methods. Because of the severity of the health conditions typically found in this category, the researchers saw here justification for the clinical weight loss approaches now widely in use.

Obviously, attempts like these to find patterns in complex phenomena have their limits. There might be numerous additional factors leading to weight gain that have not received enough attention in this particular study. But its central take-away is that the overweight and obese are not a homogenous part of the population with the same health needs, says Dr. Mark Green of Sheffield University, the lead author of the study report, in a press release about his findings. If we don’t come up with better solutions and more customized, or as he calls it “bespoke,” forms of treatment, we will continue to fail serving those who need our help most.

As a dietitian and health counselor, I couldn’t agree more. After all, that is what one-on-one counseling entails. But, unfortunately, the system is not set up for this sort of effort. For instance, health insurance companies favor short-term treatments like weight loss surgery over open-ended approaches, including diet and lifestyle coaching. We can only hope that studies like this will eventually bring a different view to the agenda.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

Eating out is generally considered a pleasurable experience, not least because of its convenience. Busy lifestyles as well as lack of cooking skills and amenities make it an easy choice for many working-age adults to let others take care of their nutritional needs. Unfortunately, not being in charge of your own food preparation can prove hazardous for your health in the long run.

For example, a new study from Duke-NUS Graduate Medical School in Singapore showed for the first time a direct link between eating meals away from home and hypertension, a.k.a. high blood pressure.

Hypertension is considered a risk factor for heart disease, heart attack and stroke, all of which are among today’s leading causes of death.

Even young adults were found to suffer from pre-hypertension or full-fledged hypertension if they ate out on several days a week. In fact, just one weekly restaurant visit was associated with a six percent increase in risk of pre-hypertension. The researchers involved in the study advised especially younger males to have their blood pressure checked regularly and, if necessary, modify their eating behavior.

Although this particular study focused mainly on young Asian adults, the warnings should be heeded worldwide. It is estimated that hypertension affects about one in three Americans to various degrees, based on statistics of the Centers for Disease Control and Prevention (CDC). Only half of all patients diagnosed with the disease have their condition under control through medication as well as diet and lifestyle changes, the agency says.

Almost 30 percent of what causes hypertension is attributed to excessive dietary sodium (salt). Processed foods, which are widely used in restaurants like fast food places and other low-cost eateries, are notorious for high sodium contents.

Although consumers have shown greater interest in reducing their salt intake in recent years, and some restaurant chains have pledged to cut back on salt use, there is still not enough progress to make a noticeable difference. According to the Center for Science in the Public Interest (CSPI), a consumer advocacy group, too many food outlets are making it hard for their patrons to identify how much sodium they are getting with their meals. Items that don’t even taste salty can nevertheless have sodium levels that exceed recommended limits.

Eating out on a regular basis makes it difficult for people to control their salt intake because they don’t know how the food was prepared. And many fast food and fast-casual restaurants don’t monitor the quality of their ingredients, since they often only assemble their meals instead of making them from scratch. So it’s hard to make special requests for less salt use in these places, explains Sarah Krieger, a registered dietitian, professional chef, and media spokesperson for the Academy of Nutrition and Dietetics (AND).

Still, patrons should be able to ask questions and navigate around the worst pitfalls, she says.

Preferably patronize locally owned eateries where the food is mostly cooked to order. Avoid dressings, toppings, and sauces as much as possible, and stick to whole food items like fresh vegetable dishes and fruits, and go easy on cheese platters and desserts, she advises.

Of course, none of this will give you the kind of control you have in your own kitchen, but a little bit of awareness and caution when eating out can be a good first step.

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Timi Gustafson R.D. is a registered dietitian, newspaper columnist, blogger and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”®, which is available on her blog and at amazon.com.  For more articles on nutrition, health and lifestyle, visit her blog, “Food and Health with Timi Gustafson R.D.” (www.timigustafson.com).

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About timigustafson

Timi Gustafson, RD, LDN, FAND is a registered dietitian, health counselor, book author, syndicated newspaper columnist and blogger. She lectures on nutrition and healthy living to audiences worldwide. She is the founder and president of Solstice Publications LLC, a publishing company specializing in health and lifestyle education. Timi completed her Clinical Dietetic Internship at the University of California Medical Center, San Francisco. She is a Fellow of the Academy of Nutrition and Dietetics, an active member of the Washington State Dietetic Association, a member of the Diabetes Care and Education, Healthy Aging, Vegetarian Nutrition and the Sports, Cardiovascular and Wellness Nutrition practice groups. For more information, please visit http://www.timigustafson.com

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