What would it take to make Americans eat better and live healthier lives? The answer may be higher taxes, according to a provocative article recently published in the New York Times (7/24/2011).

The author, food writer Mark Bittman, suggests that a 20 percent increase in the price of sugary drinks by adding a federal soda tax would result in a 20 percent decrease in consumption over a decade. This alone could prevent one and a half million Americans from becoming obese and almost half a million from becoming diabetic, which in turn could save the government a whopping 30 billion dollars in health care costs. Could it really be so easy?

There is little disagreement that radical changes in the typical American diet are necessary if we can ever hope to win the fight against our obesity crisis. Banking on the food industry’s “voluntary” measures has long been proven fruitless. Food manufacturers are not concerned with issues of public health but their bottom line. They will continue to sell products that are most profitable, whether they are damaging to people’s health or not. And they will keep doing so – until another force skews things otherwise. That “other force” could be the federal government acting in the interest of the common good.

Taking on the role of a powerful public health advocate would indeed be a departure for our government as we know it. The production of unhealthy foods has long been heavily subsidized with tax dollars. The beneficiaries are farms (or rather large agricultural corporations) where corn is grown for making high-fructose corn syrup, an ubiquitous ingredient of most processed foods.

Rather than supporting the making of foods of poor nutritional quality, the federal government could turn the tables and impose heavy taxes on sodas, French fries, doughnuts, candy and other snack items. The resulting revenues then could be applied to subsidize produce prices and make staples like seasonal greens, vegetables, fruit and whole grains more affordable. Healthy items that are now prohibitively expensive could be offered not only cheaper but also in many more locations, including low-income neighborhoods, which are notoriously underserved by supermarkets chains and grocery stores.

A program like this, of course, would upset the food industry, which is well connected in Washington, to put it mildly. It would also cause a great deal of resentment among those who are principally opposed to tax increases of any kind or for any purpose and who would see such a step as another attempt of the “nanny state” to meddle in their private affairs. We all have heard these arguments ad nauseam.

Still, safeguarding the public’s health is one of the responsibilities government is entrusted with. Why would the food we eat be of less concern than the water we drink or the air we breathe? There is no good reason why government should not get involved when the nutritional health of its citizens is at risk, which is no different from any other dangerous threat (like oil spills or acts of terrorism).

As it has been shown time and again, appealing to individual responsibility does not suffice. Especially poor people are disproportionally disadvantaged in their abilities to make better dietary choices by themselves. For many it is harder to find fresh fruit than Froot Loops. Junk food is often the only option, not because it’s cheap (that too), but because there is nothing else within reach for the elderly, the handicapped and those who depend on public transportation to get around. What’s needed are structural changes, and those can only take place with new public policies.

Some states have already imposed taxes on sodas, but those are mostly ineffective sales taxes. A better way would be to incorporate higher taxes into the shelf price, so-called excise taxes, so customers realize the cost increases before they make their purchasing decisions, not afterwards.

Even in today’s anti-tax climate, there is a growing realization that generating extra revenues from soda- and fast food consumption could lead to a welcome windfall for cash-strapped state- and city governments, comparable to legalized gambling. New York, San Francisco and Philadelphia have already taken steps in this direction. One study conducted by Columbia University predicted that adding a single penny tax per ounce of sugary soda drinks would save the State of New York three billion dollars in health care costs over the course of a decade. Another study showed that a two cents tax increase per ounce would reduce the obesity rate among children and adolescents in the state of Illinois by 18 percent, save $350 million in health care expenditures and add $800 million to the state’s coffers annually. This money could be returned to the local communities for spending on public gyms, pools, parks and bike paths as well as for providing food banks with better quality supplies.

The costs for treating weight problems and other related diseases are staggering. They are already in the hundreds of billions and they keep rising. The lion share will be borne by the federal government, meaning all of us taxpayers. So it is in our interest that these catastrophic developments will be stopped by any means necessary.

We have been here before. In the historic tobacco settlement of 1998, American tobacco companies finally gave in to the government’s demands to curtail their marketing efforts and cooperate with anti-smoking campaigns. Many other factors have contributed as well to the radical decline of smoking in the U.S., including federal and state tax policies. The overall results are quite impressive: Between the mid 1970s and the mid 2000s, cigarette use fell by 57 percent. We have no reason to think that this success story cannot be repeated in the fight against obesity.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

When I started out as a dietitian in private practice, I saw one or two patients in their teenage years. Today, it’s a different story. Some of my colleagues say that half of their clientele is under the age of 18. Childhood obesity has been on the rise for more than a decade, but now it’s out of control.

Parents often find it hard to address their youngsters’ weight issues. They don’t want to embarrass them or don’t think it’s that much of a big deal. In many cases, the adults in the family are overweight as well. They themselves feel helpless and confused in their efforts to cope with eating problems at home. The younger kids nag them for their favorite snacks and treats and the older ones make their own choices when they go out with their friends.

Many doctors are also ill-equipped to talk about nutrition, exercise and weight management. These subjects are still considered peripheral in most medical schools, although there have been some notable changes in recent years. Especially pediatricians seem to have difficulties discussing weight problems with their young patients. In a recently published study on the subject, researchers found that doctors often miss important opportunities to deal with early signs of unhealthy weight gain. That is highly unfortunate. “Focusing on these issues in overweight adolescents [could] give doctors a chance to stop unhealthy behavior that could be setting kids up for obesity before it’s too late. Once kids are obese, these behaviors are entrenched, and it’s much more difficult,” said the author of the study, Dr. Carolyn Bradner Jasik.

Nutrition experts agree that prevention of weight problems is the best option, especially when it comes to children. The American Academy of Pediatrics explicitly recommends that doctors do “preventive screening for the benefit of kids’ weight and health.” According to the study by Dr. Jasik, more obese children reported to have talked with their doctors about dieting and weight control, but that wasn’t the case with overweight kids. “There’s an increased recognition that obesity is a problem and physicians are starting to do more with the population that is defined as obese. But they still are neglecting this population that is on a trajectory toward developing obesity,” said Dr. Randall Stafford of Stanford University in California, an expert on obesity counseling.

Most pediatricians agree that preventive measures through counseling would greatly benefit children with weight problems as well as their parents who are ultimately responsible for implementing positive diet- and lifestyle changes in their homes. “It’s not like physicians don’t want to do these things, but whether they have the tools, have the time, and get reimbursed for these things makes a lot of difference,” said Dr. Stafford.

Of course, that is one of the big problems with prevention. Most insurance companies don’t pay doctors for preventive visits. The same goes for dietitians or nutritionists. Morbidly obese adolescents may be covered for weight loss surgery but not for weight-related counseling sessions. Parents who seek professional help for their kids before things get out of hand have to pay out of pocket.

Still, Dr. Jasik hopes that the alarming rise in childhood obesity will eventually change the current policies. Health experts and policy makers know full well that prevention would be the best solution – health-wise and bottom line – but so far there is not enough political will to follow that path.

Well-meaning initiatives like Michelle Obama’s “Let’s Move” program are laudable, but they don’t reach far enough. What is badly needed is a heightened awareness that childhood obesity has become a serious crisis with the potential of destroying the future of an entire generation. What is needed is a sense of urgency to take on this threat on every level and make it a priority for government, the medical community, parents, teachers and the kids themselves who suffer the consequences if we don’t stop this trend. “Preventing obesity needs to be a lot bigger, “ wrote Dr. Jasik in her report. “It requires efforts from the whole healthcare system and the community.”

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

The Center for Science in the Public Interest has published a list of the worst meals served in restaurants in terms of calorie-, fat- and sodium content. The Cheesecake Factory, a restaurant chain popular with families, has been named as one of the worst offenders, followed by Denny’s and IHOP, both fast food places.

The Cheesecake Factory’s “Farmhouse Cheeseburger” contains a whopping 1,530 calories and 36 grams of saturated fat – that is without the humongous pile of French fries that comes with it. The biggest punch comes from the smoked pork belly meat that is topped with cheddar cheese, a fried egg, onions, lettuce, tomato, plus a spread of mayonnaise on the buns.

If that doesn’t fill you up, there is always dessert. The “Ultimate Red Velvet Cake Cheesecake” packs 1,540 calories – even more than the cheeseburger – not including the whipped cream and frosting for decoration.

The runner-up, Denny’s, offers a really big bang for the buck with its “Fried Cheese Melt,” which consists of mozzarella sticks wrapped in cheese (!) and sandwiched between two slices of fried (!) sourdough bread, adding up to 1,260 calories, not to mention the 21 grams of fat and the 3,010 milligrams of sodium. Of course, you can have fries with that, too.

IHOP’s “Monster Bacon ‘N Beef Cheeseburger” comes with two beef patties wrapped in bacon and a thick layer of American and Provolone cheese. If you eat it all, you have a fill of 1,250 calories and 42 grams of saturated fat.

These are just three examples. There are plenty of others that deserve to be on this list. What this shows is that portion sizes in restaurants have completely gone out of control. The Dietary Guidelines of the U.S. Department of Agriculture (USDA) recommend a maximum daily calorie intake of 3,000 calories for men and 2,400 for women. By eating items like those named above, you can easily exceed these limits with just one meal.

It’s not hard to see why restaurants offer supersized portions. The differences in costs between smaller and larger sizes are minimal to them, but consumers feel they get lots of “extra value” if the food on their plates is stacked to the ceiling. “All you can eat” is no longer just an advertising slogan, it is now an expectation people have when they place their orders. “Pigging out” has become a popular pastime. What used to be a special occasion is now an everyday occurrence. Studies on the subject show that Americans eat at least a third of their meals outside the home.

The government is trying to push restaurant operators to disclose more nutritional information, such as calorie counts, on their menus. New rules to that effect are expected to become law nationwide by the end of the year. Some of these measures may be helpful, but they are not the solution to the entire problem. They can’t be.

Interest groups and organizations of the food service industry keep stressing that they only respond to customers’ demands. It is up to the individuals themselves, they say, to act responsibly and control their impulses.

It is true that dining out is often seen as an occasional indulgence and a time when one has to be less concerned with weight issues – even if it takes place regularly.
What is more concerning is that unhealthy eating habits have become acceptable as somewhat “normal.” People almost expect to overeat when they sit down at a restaurant table or order take-out.

Much of that has become plausible because of cultural shifts. The way many of us value (or rather don’t value) food itself has changed. Just look at popular TV shows like “Man v. Food” on the Travel Channel. Its host, Adam Richman, travels around the country to take on so-called “food challenges,” which means devouring impossibly large quantities of food in record time. Mr. Richman enjoys a growing following (no pun intended). He has a large network of fan clubs whose members mimic his example to “find and destroy food wherever they can find it” (quote from a fan’s website). Now in the fourth season, the producers of the show are inviting others to join in and turn the whole thing into a team effort. No shortage of willing candidates, of course.

All this may sound like a lot of harmless fun. It isn’t. The underlying messages conveyed by spectacles like these impact the ways we view our relationship to food, to our bodies, to our health. They change the conversation and there is a price to be paid for all this. Our current obesity crisis together with the vast array of lifestyle-related health problems we are facing today has not emerged in a vacuum. We have met the enemy, and it is us, all of us.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com



A study published in the Archives of Internal Medicine found that people on a tight budget don’t necessarily spend their money on healthier foods, even when they have easier access to them. The survey, which studied the eating habits of several thousand people in a number of cities in the U.S. for more than a decade, showed that making more fruits and vegetables available to poor families was not incentive enough to make them change their diets. Cheap snacks and fast food still remain the preferred choices.

Nutrition experts and policy makers have long argued that the scarcity of grocery outlets in low-income neighborhoods, a.k.a. “food deserts,” is one of the reasons why obesity and other lifestyle-related diseases are so widespread among the poor. That is why many, this writer included, have called on supermarket chains to set up shop in these deprived areas.

While the omnipresence of fast food places can explain a preference for burgers and fries, it comes as a surprise that easier access has done little to increase consumption of healthier food items.

“This raises the serious issue of how we get people to eat healthy,” said Barry Popkin, director of the Nutrition Transition Program at the University of North Carolina in Chapel Hill and lead author of the study.

Limiting the number of fast food joints and opening more grocery stores in these neighborhoods is obviously not enough. In 2008, the Los Angeles city council tried just that. It ordered a moratorium on new fast food restaurants and gave supermarkets incentives to expand their presence. “We had great success in building grocery stores, but selecting healthful foods from a store is up to the individual, said Jan Perry, Los Angeles councilwoman and one of the sponsors of the legislation.

The issue of money, of course, comes first to mind. The healthiest foods are routinely the most expensive ones. Especially the costs for fresh fruits and vegetables have dramatically gone up in recent times. Obviously, it makes no sense to stock a lot of items people can’t afford. Perishable foods will always be pricier because of their shorter shelf life and extra expenses for refrigeration and labor.

“The cheapest calories come from fried foods, chips and sodas,” said Dr. Jonathan Fielding, director of the Los Angeles County Department of Public Health, who wrote a commentary for the study. What matters most for people with limited funds is to get the biggest bang for their buck. In terms of calories per dollar, fast food wins out every time.

Still, nutrition experts insist that improving the food environment is an important step to change people’s eating habits. “It can’t happen in a vacuum,” said Gwen Flynn, director of community health and education at the Community Health Council in Los Angeles. “What is needed is a comprehensive plan to change what people are eating, including community education and government and private subsidies for healthful foods.”

Programs like these actually exist already, although they are few and far in between. For instance, the U.S. Department of Agriculture (USDA) sponsors what it calls the Expanded Food and Nutrition Education Program (SNAP-ED), which provides free health- and nutrition education for food stamps recipients.

Educating the public is never an easy task, no matter what the subject is. Getting people to change their ingrained eating habits is probably one of the hardest things anyone can try. Predictably, there are plenty of voices decrying the involvement of government in such personal matters and their arguments are not always unjustified. However, most would agree that only informed choices are truly free choices. If people don’t know they have alternatives available to them, they will just keep doing what they’ve been doing before, whether it’s in their best interest or not.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

A number of restaurant chains, among them Burger King, IHOP, Denny’s and Sizzler, plan to add healthier meals for children to their standard menus. So far, 19 chains, which collectively operate about 15,000 restaurants nationwide, have agreed to participate in a new initiative, called “Kids Live Well.”

To be part of the program, which is completely voluntary, restaurants will have to offer more servings of fruits, vegetables, lean protein, low-fat dairy and whole grains. They will also have to put at least one meal on their kids’ menus that has no more than 600 calories and 35 percent fat and sugar.

The National Restaurant Association (NRA), the primary sponsor of the initiative, sees it as an important step to provide families with healthier options and to make it easier for parents to choose more wisely on behalf of their children. While the participating chains will still be able to feature traditional items, like hamburgers, chicken nuggets, French fries and sodas, their customers will now have alternative choices that were not available to them before.

Ype von Hengst, the founder and CEO of Silver Diner, one of the participating restaurants, agrees that the time has come for the industry to do its part in the fight against obesity, especially when it affects so many children. “I think we all have […] a moral obligation to give our kids better and healthier food,” he said. “Kids are not born with chicken tenders in one hand and macaroni and cheese in the other. If that’s all we’re going to give them in restaurants, that all they’re going to eat.”

The U.S. Department of Agriculture (USDA) has welcomed the NRA plan as well. “This is a great start to help empower consumers – kids and parents especially – with more choices at restaurants,” said Robert Post, deputy director of the USDA’s Center for Nutrition Policy and Promotion.

Others are more skeptical. “It’s a baby step,” said Margo Wootan, nutrition policy director at the Center for Science in the Public Interest (CSPI), a consumer advocacy group. “It’s not enough to have one healthy option in a minefield of high calories, high fat and high salt,” she said. Last year, CSPI sued McDonald’s for using toys to lure children into its restaurants. (McDonald’s is not among the participants in the “Kids Live Well” program.)

Critics see a familiar pattern in this latest initiative. This plan, like many others the industry has brought forth in the past, sets the mark conveniently low, they say. It is designed to be modest and doesn’t ask for many changes. Most of the cooperating restaurants already meet these requirements, but either way the measures fall far short of the standards desired by nutrition experts and government regulators.

Advocacy groups like CSPI say the program has nothing to do with wanting to provide healthier eating options for children. They see it as another maneuver to prevent government from taking further regulatory action. “This is a typical industry tactic of a pre-emptive move,” said Wootan. “Rather than have government come up with the standards […], they want to develop them themselves.”

The federal government will soon require all restaurant chains with more than 20 outlets to post calorie counts on their menus. That may be a good first step, but by itself it will not help to improve people’s eating habits. The problem is that the nutritional quality of the meals many of these restaurants offer is so poor that a little tweaking here and there won’t make much of a difference.

The industry must do more than simply change its image – it must change the ways it has done business for decades. This will not happen either through regulatory changes, for which there will always be plenty of loopholes, or voluntary window dressing. The only thing that will make a difference in the long run is consumer demand. If that changes, all else will eventually follow.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

Eating too much salt and too little potassium is not only bad for your health, it may significantly increase the risk of premature death, according to a study by the U.S. Centers for disease Control and Prevention (CDC).

For the study, researchers tracked the eating habits of more than 12,000 people for 15 years. The goal was to better understand the long-term health effects of sodium and potassium intake.

At the outset of the survey, none of the participants followed a low-sodium diet and no one had a history of heart problems or stroke. By the end, 2,270 had died, including 1,268 from cardiovascular disease. Using death certificates, the research team looked at each cause of death.

Those who died from heart attack typically ate a diet high in sodium and low in potassium, according to Dr. Elena Kuklina, one of the lead scientists involved the study.
“[These people] had a 50 percent increased risk of death from any cause, and about twice the risk of death – or a 200 percent increase – from heart attack,” she said.

These findings stand in sharp contrast to another recently published report that saw no evidence that reducing salt consumption lowers the risk of heart disease.

Dr. Kuklina agrees that eating less salt alone may not make all the difference, but that the amount of potassium in one’s diet also plays a role. Potassium counteracts the effects of salt, she said. “If sodium increases your blood pressure, potassium decreases it. If sodium retains water, potassium helps you get rid of it. We need to strive to do both – decrease sodium intake and increase potassium intake.” That is why the CDC researchers focused on the sodium-potassium ratio, hoping to better understand the effects of both nutrients on one another and, subsequently, to shed more light on the causes of cardiovascular disease.

Not everyone agrees with their findings, though. Morton Satin, vice president of science and research for the Salt Institute, a trade association for salt companies, said the CDC report is “highly flawed and reveals more of this dogmatic anti-salt agenda.” In his view, “the public should ignore this study and focus on eating more salads, vegetables and fruits. If people do that, the sodium will take care of itself.”

Not so, said Dr. Robert Briss, director of the National Center for Chronic Disease Prevention and Health Promotion at the CDC. He estimates that 90 percent of Americans consume more sodium than they should, which is detrimental for their blood pressure. “Most of that sodium is not related to the salt shaker but is in foods and especially processed and restaurant foods. Consumers, even motivated ones, don’t have as much choice as they could,” he said.

The Dietary Guidelines by the U.S. Department of Agriculture (USDA) recommend a maximum sodium intake of 2,300 milligrams per day and 1,500 milligrams or less for people with known heart disease or hypertension. The participants in the CDC study with the highest sodium intake had about 5,000 milligrams per day; those at the low end had 2,176 milligrams. The USDA recommendation for potassium is 4,700 milligrams a day. Those in the study who consumed the most had 4,069 milligrams; those who ate the least had about 1,800 milligrams.

Most health experts agree that Americans should cut back on salt, regardless of the amounts of potassium they get. Potassium may neutralize some of the heart-damaging effects of salt, but consistently high sodium intake still increases the risk of high blood pressure, heart disease and stroke, said Dr. Kuklina. No one should go over the recommended limit of 2,300 milligrams, which roughly equals a teaspoon of salt. But only one in 10 Americans meets that goal.

Exactly how salt and potassium interact with one another is not yet fully understood. People should not think they are protected against the effects of high levels of sodium in their food simply by adding more fruits and vegetables or by taking supplements. Healthy eating requires both: Increasing the good as well as eliminating the bad.

Some fruits rich in potassium
Apricots, avocados, bananas, cantaloupes, mangos, oranges, papayas, pears, strawberries

Some vegetables rich in potassium
Bell peppers, broccoli, Brussels sprouts, cabbage, cauliflowers, chards, crimini mushrooms, cucumbers, eggplants, garlic, lettuce, lima beans, onions, parsley, potatoes, spinach, squash, tomatoes

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

Parents of severely obese children should lose their custody rights for not controlling their kids’ weight, according to the authors of a recently published opinion piece in the Journal of the American Medical Association.

“In severe instances of childhood obesity, removal from the home may be justifiable […] because of imminent health risks and the parents’ chronic failure to address medical problems,” wrote Dr. David Ludwig, an obesity expert at the Children’s Hospital Boston and author of the article, which he co-wrote with Lindsey Murtagh, a lawyer and researcher at Harvard’s School of Public Health. Under these circumstances, “state intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors.”

As an example, Dr. Ludwig cited a case of a three-year-old girl who weighed 90 pounds when her parents brought her in for treatment. At the age of 12, her weight exceeded 400 pounds. By then she suffered from diabetes, high cholesterol, hypertension and sleep apnea. Eventually, the state placed the girl in foster care, where she was put on a weight loss diet and lost 130 pounds.

The idea of government intervention when there is a serious threat to a child’s life is not new. In cases of obesity, such actions may not even need backing up by new laws. Health care providers are already required to report instances where children are at immediate risk, and that can be for a number of reasons, including neglect, abuse and what is called “failure to thrive,” which is a term commonly used by doctors to describe children who are severely underweight.

Ludwig and Murtagh are not the first to call for better protection of children with weight problems. In an article published in 2009 in the journal Pediatrics, its authors argued in favor of “temporary removal from the home […] when all reasonable alternative options have been exhausted.”

While this discussion may just have begun in earnest, some states have already taken action on several occasions. For instance, in South Carolina, a mother lost custody over her 14-year old son who weighed 555 pounds at the time. Childhood obesity was cited as the reason for loss of custody in California, New Mexico, Texas and New York. Other countries have taken similar steps. A Scottish couple had their children removed from home because of “failure to reduce the kids’ weight” after repeated warnings from social services were ignored.

Childhood obesity in the U.S. is reaching crisis level. According to the Centers for Disease Control and Prevention (CDC), over 12 million children and adolescents are obese today. Two million children are considered morbidly obese with a body-mass-index (BMI) at or above the 99th percentile.

Not everyone in the health care community agrees with the measures proposed by Ludwig and Murtagh. Dr. David L. Katz, founder of the Yale Prevention Center, expressed doubts that state-appointed caregivers would do a better job of feeding children than the parents. “Without knowing cost and benefit tradeoffs when the state takes children from their parents, it’s too early to say whether this is an appropriate response. I do believe that severe obesity in a child is a serious problem. The best approach [is] to prevent it rather than fix it. But when we need to fix it, for now, the state should identify the problem and offer solutions, but not impose them,” said Katz.

Others have pointed out that it can be extremely difficult for parents to monitor their kids’ weight, especially when they reach adolescence and parental control is diminished. “It’s unfair to blame solely the parents, when there’s a myriad of other factors influencing a child’s weight,” said Dr. Dana Rofey, professor at Pittsburgh University and director of a weight-management clinic. In her work, she said, she sees an array of contributing factors to childhood obesity, including genetic predisposition, socioeconomic status, environmental factors and exposure to advertising.

Predictably, the Ludwig/Murtagh article has caused considerable controversy. While the obesity epidemic is widely acknowledged as one of the biggest health problems today that may affect even more the next generation, there is little consensus on what countermeasures to take. “Forcing heavy children out of their homes is not the solution,” insists Dr. Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania. “I am not letting parents off the hook,” he wrote in response to the article, “but putting the blame for childhood obesity on the home and then arguing that moving kids out of homes where obesity reigns is the answer is short-sighted and doomed to fail. We need the nation to go on a diet together and the most important places to start are the grocery store, schools and media.”

These are all good points, but I don’t think it has to be one or the other. Parents, like the rest of us, need to be educated about the ins and outs of healthy nutrition for themselves and their kids. These messages are extremely hard to get through, as we can see from the efforts of the First Lady, Michelle Obama, who has made the fight against childhood obesity a high priority. We are dealing with multi-faceted, complex issues and it would be foolish to hope for simple solutions. Resorting to drastic measures when everything else fails may be part of the equation.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

Two studies have recently been published, both trying to shed more light on the causes of the ever-growing obesity crisis in America. One of them blames restaurant food, the other sees snacking as the main culprit – both point to the changing eating habits in American culture. They each make good points.

Approximately a third of all calories consumed by Americans come from restaurants, including fast food places, according to the U.S. Department of Agriculture (USDA). More than half of adults eat out at least three times a week and 12 percent eat restaurant food almost every day, including on weekends. People have less time for grocery shopping and home cooking; they work longer hours, have longer commutes, don’t have a large enough kitchen or lack cooking skills.

Even the poor economy has not made much of a difference. “The data suggest that the recession is not making us eat out less, but we are eating out cheaper, choosing more fast food and takeout options over restaurants with tableside service,” says Lisa Mancino, a food economist who works for the USDA.

The problem is that eating away from home only once a week can translate into weight gain of two extra pounds per year. This may not sound much, but it adds up – and these are the low-end numbers.

Eating lunch out has the greatest effect, adding an average of 160 calories compared to lunch made at home. Going out for dinner increases the calorie intake by 140 calories and breakfast out adds about 75 calories, according to USDA data.

The main reasons for this are portion sizes. Restaurants try to lure in customers by offering big plates and other “extra values.” The nutritional quality of restaurant food is also a factor. Added sugar, high-fructose corn syrup, processed and refined grains, oils and trans fats are liberally used in restaurant kitchens to add flavor and keep costs down. These are also the ingredients known to contribute to weight gain. “One meal out typically lowers diet quality enough to shift the average adult’s diet from fair to poor,” said Dr. Mancino.

While customers don’t have a lot of influence over the nutritional quality of the meals they order, they also quickly lose control over the quantity of the food they consume. “People often associate eating out as a special occasion, or a time to splurge – even if eating out has become a routine,” said Dr. Mancino.

A different study blames frequent snacking for the dramatic rise of obesity in recent times. Over that last three decades, Americans have gone from consuming about four snacks to five snacks per day on average, an almost 30% increase. “The real reason why we seem to be eating more is [that] we are eating often,” said Dr. Barry Popkin, professor of nutrition at the University of North Carolina at Chapel Hill and lead author of the study. “The frequency of eating is probably […] becoming a huge issue.”

Popkin and a co-author analyzed data from several food surveys conducted by the USDA and the Centers for Disease Control and Prevention (CDC) between 1977 and 2006. Their report was published in the June issue of PLoS Medicine journal.

The most striking part of their findings was that snacking has become more frequent and the time periods between snacks and regular meals have become shorter over the years. Dr. Popkin concludes that, although portion sizes have substantially grown larger, it is more likely the frequency of eating that seems to be driving widespread weight gain.

The reason why people are now snacking almost constantly throughout the day is that consumers are faced with snack food everywhere and all the time. “You never used to see food staring you in the face when you went to a drugstore. You go get a magazine [and] you can get a candy bar,” said Dr. Lisa Young, professor of nutrition at New York University and author of “The Portion Teller,” who was not involved in the study.

“We overeat because there are signals and cues around us that tell us to eat. It’s simply not in our nature to pause […] and contemplate whether we are full,” writes Dr. Brian Wansink, professor of marketing and nutritional science at Cornell University and author of “Mindless Eating – Why We Eat More Than We Think.”

The only way out is to become more aware of our eating habits and to pay better attention to our actions, said Dr. Young. “In our food-filled environment we need to be conscious of when we eat, how much we eat and what we eat.”

Learning to watch both portion sizes and control snacking may not be as easy as some experts seem to think. Food plays many roles in people’s lives other than just stilling hunger. Many of us reach for edibles to cope with stress or boredom, or perhaps simply because they are so easily available.

Some researchers have suggested that sweet, fatty and salty snacks are irresistible because their intake results in the release of certain chemicals, both in the gut and in the brain, that keeps us craving for more. (Remember the potato-chip commercial that had the slogan: “Bet you can’t eat just one.”?)

Still, being more alert about the ways we eat is certainly a necessary step and, so far, our best hope.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

Are there any diet programs that work better than others? Do any of them work? As most seasoned dieters will tell you, dieting is a hard and often frustrating undertaking. Commercial diets are notorious for promising astonishing results in no time and without much effort and (heaven forbid) deprivation.

A team of journalists of U.S. News has spent six months investigating 20 of the best-known diets. The results of their research were then submitted to a panel of 22 leading experts in the fields of nutrition, diabetes and heart disease. The panelists were asked to rate each diet program on a scale from 1 to 5 in seven categories: Short-term weight loss, long-term weight loss, user-friendliness, nutritional completeness, safety, ability to prevent or manage diabetes and ability to prevent or manage heart disease.

The experts were also quizzed about the reasons for their preferences of one diet over another. All had to disclose beforehand whether they had any affiliation or commercial interests in the programs they were to vote on. None did.

In the end, the DASH diet (Dietary Approaches to Stop Hypertension) was selected as the best overall diet, just ahead of the Mediterranean Diet as the runner up. The DASH diet also came out first as the best diabetes diet, followed by the Mayo Clinic diet. The Ornish diet captured the top spot for heart healthy eating, followed by the TLC (Therapeutic Lifestyle Changes) diet. In terms of effectiveness for weight loss, two commercial diet plans won the nomination: Weight Watchers, closely followed by Jenny Craig.

The overall winner, the DASH diet, was found to fulfill all the demands of being easy to follow, nutritious, safe, effective for weight loss and able to prevent or control both diabetes and heart disease.

Interestingly, the DASH diet did not originate as a commercial diet but as a dietary recommendation by the National Heart, Lung and Blood Institute, a department of the National Institute of Health (NIH), which is a U.S. government agency.

The main purpose of this diet plan is not weight loss but control of hypertension (high blood pressure). The idea is to provide patients with liberal amounts of key nutrients, such as potassium, calcium and magnesium, all of which are associated with lowering blood pressure. One of its unique features is the focus on dietary patterns rather than on single nutrients like proteins or carbohydrates. Equally important is the emphasis on anti-oxidant rich foods to prevent or control an array of other chronic health problems, including heart disease, stroke and certain types of cancer.

The DASH diet guidelines recommend a rich variety of fresh fruits, vegetables, whole grains and low-fat dairy products. It allows meat, fish, poultry, nuts and beans in moderate amounts. But it advises to restrict consumption of salt, fat and sugar in both food and drink. Although at first intended for heart patients, the diet is now considered to be highly beneficial for anyone who wishes to eat healthily. It is officially endorsed by the U.S. Department of Agriculture (USDA) as an ideal eating plan for all Americans.

Starting the DASH diet
Here are some tips to get started on the DASH diet:

• Add at least one serving of vegetables at lunch and dinner.

• Add at least one serving of fruit to all your meals, including snacks. Frozen, canned (in their own natural juices) and dried items also work if fresh fruit is not available or out of season.

• Reduce the use of butter, margarine and salad dressings by half. Buy only low-fat or fat free condiments.

• Consume only low-fat or skim dairy products.

• Limit meat (especially red meat) to six ounces or less a day. Eat more vegetarian meals.

• Add brown rice and dry beans to your diet.

• Reduce or eliminate consumption of sweet, fatty and salty snacks.

• Read Nutrition Facts labels carefully and choose products that are low in sodium.

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com

Several states have recently passed new laws prohibiting local governments and municipalities from imposing their own rules and regulations on restaurants and fast food chains, such as labeling requirements or the mandatory elimination of trans fats and other ingredients in the food they serve.

As of late, a growing number of local legislators has been trying to take measures in their own hands to curb obesity and improve public health within their districts. Now lawmakers at the state level are responding to complaints from restaurant owners who say they have to comply with a patchwork of regulations that can differ not only from state to state but even from one city to another.

Some state level legislators readily admit that their actions are primarily intended to make life easier for the restaurant industry. “Hodgepodge regulations, requiring nutrition labeling on menus and other requirements would put restaurant owners in an unsustainable dilemma,” according to one representative from Alabama who co-sponsored what he called “pre-emptive legislation.”

These efforts will not affect federal law requiring menu labeling for chains with more than 20 outlets (the law is scheduled to go into effect nationwide by 2013). Still, more than half of all restaurants in the country won’t fall under the federal rules. Individually owned eateries and smaller franchises operate under state regulations, and they hope they will continue to benefit from a favorable business environment that imposes no new restrictions on them.

Any movement among cities and counties to take on the obesity crisis and promote public health will be frustrated by the state legislators’ growing assertion of their power, say health advocates who support these local initiatives. As a case in point, they cite places like Louisville in Kentucky where recently new policies were adopted for the improvement of the nutritional quality of school lunches and the creation of public parks and bike paths, all of which received nationwide attention. However, when the city tried to set higher nutritional standards for restaurant foods, it faced predictable resistance (not only from restaurant owners).

Cleveland in Ohio introduced a ban on the use of trans fats in restaurants within its city limits as part of a public health program called “Healthy Cleveland.” Now, Ohio’s governor is expected to sign a bill that strictly limits local control over restaurants by enforcing the state’s “sole and exclusive authority” to regulate marketing, labeling and other consumer incentives in restaurants.

When Santa Clara County in California banned fast food places from giving away toys for promotional purposes, at least one state government reacted swiftly: Earlier this year, Arizona forbade local law makers anywhere in the state to interfere with the use of consumer incentives by restaurants, including toys.

Many public health advocates applaud the legislative efforts by local community leaders. “This battle will involve policy changes at all levels of government,” says William H Roach Jr., chairman of the American Heart Association, “but it is easier fought locally because it allows greater accountability to ensure implementation and addresses the unique needs of communities.”

The “battle,” of course, is also waged over political and ideological differences. The (mostly conservative) lawmakers who oppose local policy-making say they are concerned about interference with private enterprise and over-regulation. Progressives, on the other hand, see a role for government intervention when there’s a threat to the safety and wellbeing of the public.

It would seem that our national obesity crisis qualifies as such a threat. A report by the Surgeon General in 2001, titled “Call to Action to Prevent and Decrease Overweight and Obesity,” warned that the weight problems in America constitute the greatest risk to our national security, ahead of terrorism and climate change.

Since then, governments on all levels have begun experimenting with ways to reverse the tide of obesity through imposing taxes and offering subsidies. An example is the attempt to curb soda consumption by adding surtaxes on sugary drinks. Other measures include giving employers tax credits if they install exercise equipment in their work places or offer free health club memberships to workers.

Those who support the notion of government taking an active role in the fight against obesity say that intervention is necessary because the actions of some cause substantial costs to all others, comparable to environmental pollution, food safety, smoking in public places and the likes. In other words, because obesity-related costs place such a large burden on society as a whole, government may not only be justified but may be required to intervene.

While government should not become overbearing in terms of controlling individual behaviors and practices, it has a greater responsibility to protect the public from harmful consequences. Part of good governance is also to accept the fact that people don’t always make decisions that are long-term in their own best interest. For these reasons and others, an all-out hands-off approach on part of the government is not always the answer.

This article is based in parts on a report by Stephanie Strom, titled “Local Laws Fighting Fat Under Siege,” which was published in the New York Times (7/1/2011) as part of the series, “The Big Picture.” (nytimes.com/bigpicture)

Timi Gustafson R.D. is a clinical dietitian and author of  “The Healthy Diner – How to Eat Right and Still Have Fun™,” which is available on her blog  http://www.timigustafson.com and at amazon.com. Her latest book, “Kids Love Healthy Foods™” is now available in e-book format, also at www.amazon.com