Obesity Research Update: SSBs vs. Artificially Sweetened Beverages, Food Availability, Prices, Variety & Palatability, or Eating Frequency - Is One or Are All Making Us Fat?

Food variety increases binge eating risk, studies show.

With the publication of the latest issue of "Advances in Nutrition" came a whole host of studies that may provide novel insights into potential causes of and solutions to the obesity epidemic. Among the things the researchers investigated and presented at the 20th International Congress of Nutrition were also studies on the possible involvement of artificial sweetened beverages, the availability and convenience of food, the effects of food prices on obesity, the effectiveness of changing the eating frequency, the importance of portion sizes in weight control, the impact of eating a highly variable and palatable diet.

You can learn more about meal frequency at the SuppVersity

Grazin' Bad For the Obese!

Breakfast Keeps You Lean?!

Frequent Protein Consumption

Myth: Few Meals More Bodyfat

8 Meals = Stable, But High Insulin

Int. Fasting & Exercise

• Sugar-Sweetened and Artificially-Sweetened Beverages in Relation to Obesity Risk - In his latest review, Mark A. Pereira set out to "critically evaluate the scientific evidence in humans on the potential effect of sweetened beverages on weight gain and risk of obesity in youth and adults" (Pereira. 2014).
  
  In particular, he compared the association of sugar-sweetened beverages (SSBs) include soft drinks, colas, other sweetened carbonated beverages, and fruit drinks with added sugar and their artificially sweetened counter-parts on obesity risk - with an expected outcome:
  

  "The totality of evidence to date demonstrates a pattern across observational and experimental studies of an increased risk of weight gain and obesity with higher intake of SSBs" (Pereira. 2014).

  The actual problem is that it is difficult to establish the strength of the association and the independence from other potentially confounding factors. In that, Pereira highlights that the primary reason for unclear conclusions regarding the robustness of any effect of SSBs is due to the heterogeneity and methodologic limitations of both observational and experimental studies on this topic.
  
  

  

  Experimental evidence shows artificial sweeteners help weight loss | more

  The latter is all the more true for studies investigating the effects of artificial sweetened beverages on obesity risk. As Pereira points out, "there is no clear mechanism for this pathway, and the epidemiologic studies are highly inconsistent" (Pereira. 2014).
  
  More specifically, none of the currently available epidemiologial studies was able to make sure that the associations the scientists observed were not the result of reverse causality, i.e. obese people consuming artificially sweetened beverage, because they are (already) obese and not the other way around. As Pereira points out, this is more than just a theoretical issue, "higher-quality studies demonstrate this possibility" (Pereira. 2014).
  
  Accordingly, the field needs "higher-quality experimental studies in humans, with relevant direct comparisons between sweetened beverages and their sweetened solid-food alternatives" (Pereira. 2014).
• Food Availability/Convenience and Obesity - Penny Gordon-Larsen reviewed the ever-increasing number of studies investigating the impact of certain qualities of the neighborhood environments on obesity risk. As Gordon-Larsen points out, "there are inconsistencies in the evidence base, suggesting a nuanced association between neighborhood environment, food availability, diet behaviors, and obesity" (Gordon-Larsen. 2014).
  
  With the currently available evidence being limited by a predominance of cross-sectional studies, a high reliance on commercial business listings, a lack of attention to the process by which diet resources are established and expanded within neighborhoods and the potential for individuals to selectively migrate to locate near such facilities, it is difficult to make a reliable conclusion with respect to the influence of food availability and convenience on obesity risk.
  
  Against that background it is difficult to tell, whether the results of a recent study from New York which shows that there is an inverse association between BMI and food outlet density (−0.32 BMI units across the IQR, 95% CI −0.45 to −0.20) is actually significant.
  

  

  Figure 1: Adjusted association between body mass index and food environment measures (Stark. 2014)

  Specifically in view of the fact that there is a positive association between BMI and the proportion of BMI-unhealthy food outlets (0.26 BMI units per IQR, 95% CI 0.09 to 0.43) and no association with outlet diversity. If we went by the results of this study, though, it would appear that living close to food outlets serving donuts, hotdogs and pizza will increase your obesity risk - according to a detail analysis of the New Yorker researchers, this risk is specifically pronounced for people living in areas with "poverty zip codes" (Stark. 2014).
• Food Prices and Obesity - is there a link? As a SuppVersity reader you will know that politics and researchers have repeatedly been debating about taxes on unhealthy foods. To estimate, whether these taxes would work, we would yet have to know "the extent to which overall energy intake or weight outcomes" are actually influenced by food prices.
  

  

  Table 1: Few people know that there are already food taxes in several countries all around the world - with little sucess | öow taxation is defined as less than 10 %; and moderate as 10 % or greater. *the dates for Denmark and Ireland indicate the dates during which the tax was in operation (Mytton. 2014)

  Finkelstein's et al.'s review is one of the first to access this link between food or beverage price changes and energy intake or weight outcomes among U.S. consumers. According to the researchers from the Duke University, the Yale University, and the University at Buffalo School of Medicine and Biomedical Sciences,
  

  "the current evidence indicates that, by themselves, targeted food taxes and subsidies as considered to date are unlikely to have a major effect on individual weight or obesity prevalence." (Finkelstein. 2014)

  Unlike the researchers I am thus not really optimistic that "food taxes and subsidies may play an important role in a multifaceted approach to reducing obesity incidence" (Johnson. 2014) - in particular, if the taxes are determined in accordance with the current US food pyramid, so that "healthy grains" are not taxed at all and "unhealthy eggs" are taxed in a way that even an "industrially" produced egg will costs a dollar.
• Evidence for Efficacy and Effectiveness of Changes in Eating Frequency for Body Weight Management - As Ashima Kant point out, in self-reported diets of free living individuals, frequent eating is associated with higher energy intake. In spite of the scientific evidence, beliefs about the possible beneficial effect of higher eating frequency for managing body weight persist.
  
  In her review of prospective cohort studies and controlled trials of manipulation of eating frequency published by 31 December 2012, Kant included four prospective cohort studies were identified - 2 of these included adults followed for 10 y and 2 followed  pre-adolescent / adolescent girls for 6 or10 y.
  
  

  

  Less Frequent Large(r) Meals & Caffeine - Proven Ways to Increase Your Energy Expenditure & Conserve Your Metabolic Rate While Dieting | more.

  As so often, the findings of the studies that were conducted with young subjects were contradictory.
  

  "Six controlled trials with adult subjects serving as their own controls found no significant changes in body weight due to manipulation of eating frequency interventions lasting 6–8 wk."

  In six additional intervention trials of 8–52 wk duration, free-living adults were counseled to change the eating frequency of self-selected food intake with no significant differences in weight loss attributable to eating frequency.
  
  Currently, the overwhelming majority of the available evidence does thus suggest that manipulation of eating frequency will not promote weight loss. The available scientific evidence is thus once more in conflict with common belief about "best practice", when it comes to losing weight - a "common belief", by the way that was, as so often, influenced by epidemiological data of which people simply don't understand that it cannot establish reliable causal relationships.
• Portion Size and Obesity - In their review of the contemporary literature on the effects of portion size on obesity and weight control, M. Barbara E. Livingstone and L. Kirsty Pourshahidi leave little doubt that "portion size has a powerful and proportionate effect on the amount of food consumed." (Livingstone. 2014).
  
  In spite of the fact that the positive effect of portion size on energy intake has been demonstrated for different types of foods and beverages, and is particularly pronounced with energy-dense foods, though, it is as of now not clear what types of interventions targeted at portion size are likely to be effective, in what settings, and among which target groups.
  

  

  Figure 2: You don't need to conduct a study to realize that portion sizes for foods and beverages - specifically the unhealthy ones - are ever-increasing (image from scienceinseconds.com)

  As the researchers point out, further research is thus urgently needed - specifically in view of the fact that the contemporary evidence indicates that the predisposition to overeat in response to large portions is pervasive and occurs regardless of demographic characteristics, such as socioeconomic status, age, body mass index, and sex. This is all the more true in view of the "secular trend toward greater availability of large portions. coupled with value-size pricing, effectively distorted consumption norms and perceptions of what is an appropriate amount to eat" (Livingstone. 2014).
• Variety and Palatability - Reasons We Get fat? As Fiona Johnson and Jane Wardle point out, "among the key characteristics of the Western obesogenic food environment is a highly palatable and varied food supply" (Johnson. 2014). At first, this sounds yummy and healthy. Unfortunately, the possibility to switch back and forth between a large variety of highly palatable salty and sweet junk food has been shown in both humans and animals to (a) have appetite stimulating effects, to (b) delay satiety, and to (c) promote excessive energy intake.
  
  

  

  Figure 3: When men are offered a sandwiches with identical or varied (4 different) fillings, they will consume significantly more if they are allowed to switch back and forth between the different fillings (Rolls. 1981).

  No wonder that the scientists found that there is a robust effect of food palatability and variety on short-term food intake, and increased variety and palatability also cause weight gain in animal models.
  

  "However, laboratory paradigms do not replicate the complexities of eating in a natural setting [...and t]here are substantial individual diffe- rences in susceptibility to the palatability effect and this may be a key determinant in individual vulnerability to weight gain" (Johnson. 2014).

  Or, put more simply, as long as we do not fully understand the pathways through which palatability and variety can affect eating, it is difficult to identify what helps those who can abstain from overeating maintain their weight and what we can do for those who fall for the temptations to help them stand the test of chocolate, chips, pizza and beer.

There are no simple solutions for complex problems: Obesity is a multifaceted problem. Against that background it's hardly surprising that the one thing all of the previously presented studies have in common is that none of them appears to offer a standalone solution to the obesity epidemic.

If you are working out and dieting like a maniac and still not losing weight, you should revisit your self-torture.. ah training and nutrition regimen and make sure that you didn't already shut down your thyroid by overtraining and undereating | learn more.

Sugar-sweetened beverages are certainly a problem - artifically sweetened ones rather not. The availability of food and more specifically the availability of a high variety of highly palatable food contributes to the obesity epidemic as well - the issue of portion sizes is still not settled and myths that eating more frequently would help to lose weight are still propagated by the mainstream media.

Against that background it seems questionable, whether there's ever going to be a one-size-fits-it-all solution... but hey, maybe that's the solution! We probably just have to stop looking for the one-size-fits-it-all solution and start working towards personalized nutrition programs that evolve as you evolve, e.g. from ketogenic to low carb to moderate carb as you progressively lose weight.

References:

• Finkelstein et al. "Food Prices and Obesity: A Review." Adv Nutr. 5 (2014): 818-821.
• Gordon-Larsen, Penny. "Food Availability/Convenience and Obesity". Adv Nutr 5 (2014):809-817 
• Johnson, et al. "Variety, Palatability, and Obesity." Adv Nutr. 5 (2014): 851-859.
• Kant, Ashima K. "Evidence for Efficacy and Effectiveness of Changes in Eating Frequency for Body Weight Management." Adv Nutr 5 (2014): 822-828.
• Livingstone, et al. "Portion Size and Obesity." Adv Nutr. 5 (2014): 829-834.
• Mytton, Oliver T., Helen Eyles, and David Ogilvie. "Evaluating the Health Impacts of Food and Beverage Taxes." Current Obesity Reports (2014): 1-8.
• Pereira, A. P. "Sugar-Sweetened and Artificially-Sweetened Beverages in Relation to Obesity Risk."  Adv Nutr 5 (2014): 851-859.
• Rolls, Barbara J., et al. "Variety in a meal enhances food intake in man." Physiology & Behavior 26.2 (1981): 215-221.
• Stark, James H., et al. "Neighbourhood food environments and body mass index among New York City adults." Journal of epidemiology and community health 67.9 (2013): 736-742.

The "Best Diet" for Obese Kids Has a Low Glycemic Load and Still 40-50% Carbs. Plus: Kids Hate Atkins / Low Carb!

Image 1: It's the "day of healthy eating", here in Germany... but wait: What exactly is "healthy eating"?

I don't know if it was a "happy coincidence", but it was a coincidence that I heard on the radio that today is the "Day of Good Nutrition" (here in Germany, at least). Unfortunately, nobody appears to really know what "good nutrition" means. While the experts are still arguing whether you may or may not eat meat, whether all carbs are created equal etc. the average customer has absolute no idea, what "good nutrition" may be. The one thing he (or she) knows is what the radio moderator mentioned as well "this means you are not allowed to go to the fast-food outlet, today". Now, while for a still astonishingly (or should I say shockingly?) large proportion of the obese population of the western convenience society, fast food remains one of the biggest obstacles to weight loss, Mc Donalds and Co. are probably not a major problem for the majority of people in the ever-growing health-conscious Internet community with its 1001 podcasts and blogs on weight loss and "healthy eating" in all its different incarnations. In the debate around paleo, ancestral, low carb, low fat, high protein, medium protein, grains-yes, grains-no, dairy-yes, dairy-no and all the other "sacred cows", the most important point in losing weight, fat and, by the way, also building muscle, i.e. consistency, is still overlooked way too often. If you consistently eat the SuperSize menu at McDonalds, you'll probably end up as obese type II diabetic. If, on the other hand, you do crossfit six times à week and follow a "healthy" low-carb diet, consistently, you end up spending bazillion of bucks for useless supplements about which you read on one of the countless bulletin boards where you posted your complains about "central fatigue" and "adrenal burnout"... as you see: Consistency is key!

Success in life come with consistency ...

... and when we define success as "dietary success", we measure "consistency" as dietary adherence; and exactly that, i.e. the degree to which the dieters adhered to their prescribed diets was also the first and, in my mind, most important determinant of dietary success in a 2012 study involving 100 obese children aged between 7-12 years (Kirk. 2012). The scientists, who financed their study with a grant from the Thrasher Research Fund and an Institutional Clinical and Translational Science Award, took a quite intriguing look at the effects of a 3-months (+9-months follow up), three-tiered dietary intervention, with a...

• low carb arm (LC), in which the subjects had to limit their carbohydrate intake to induce ketosis (had to be measured with keto sticks daily; if the subjects were not in ketosis the diet was reviewed / carbs further restricted); that was accomplished by an initial 2-week induction phase with <20 g CHO/day and unrestricted intake of high-pro tein foods (eg, meat, poult ry, fish, eggs) and added fats and a subsequent maintenance phase with in which the subjects were allowed to consume max. 60 g of carbs /day, with no limit on intake of high-protein foods and fats.
   
• reduced glycemic load arm (RGL), in which the subjects were instructed to limit their intake of high-glycemic index (GI) foods based on a "stoplight approach" (red, high GI [>70]; yellow, medium GI [56-69]; green, low GI [<55]); green foods were unrestricted; yellow foods were to be consumed less frequently; red foods were restricted to <7 servi ngs/week and <2 servings/day; there were no specific restrictions on protein or fat intake .
   
• portion control arm (PC), in which subjects were in structed to consume "age-appropriate" amounts of grains, vegetables, fruits, lean proteins, and skim/low -fat dairy products [help me I am puking!]; calories were distributed as 55%-60% CHO, 10%-15% protein, and 30% fat; the exact dietary prescriptions aimed at a daily caloric deficit of -500kcal

Exercise in the form of biweekly diet-specific group sessions fo 1hr of "active 'play', resistance training, aerobic activities" were obligatory and supervised by an exercise specialist. Additionally, subjects were "encouraged" to be physically active (=at least playing Wii instead of Playstation ;-) for >30 minutes/day.

Diet Wars! Atkins vs. South Beach vs. Weight Watchers

As you can see this study turns into a battle of Atkins vs. South Beach vs. Weight Watchers and the most important result, i.e. the reduction in body fat percentag (cf. figure 1), shows once more that "done right", or I should say "done the way it is supposed to" and "done consistently", everything works!

Figure 1: Change in body fat (%) over the 3 months controlled intervention and the follow up period - left; adherence to diet (%) - top-right; glycemic load (g/1000kcal) - bottom-right (data calculated based on Kirk. 2012)

The data in figure 1 does yet also show that the dietary adherence in the Atkins group was ridiculously low. While the adherence in the RGL arm of the study was constantly >75%, ...

[...i]n the LC group, only 16% of subjects tested positive for urinary ketones at any point (only 8% [6 of 76] of all tests done), and CHO intake exceeded the goal of 60 g/day at all time points (3 months, 85.3 +/- 11.8 g; 6 months, 108.2 +/- 11.6 g; 12 months, 122.6 +/- 11.4 g).

Against that background it is actually quite astonishing that the subjects lost that much body fat. It does yet not explain, why the body fat levels (measured by DEXA, not with hilarious body impedance scales) of the "Atkins dieters" bounced back up so profoundly (within the statistical margin, back to where they came from) in the months following the controlled intervention, while the fat loss in the other groups did slow down, yet remained persistent (and that despite the fact that the glycemic load was still -26% lower than in the RGL group).

Figure 2: Daily caloric deficit in months 1-3 (I), months 4-6 (II) and months 7-12 (post) - left; ration of body fat lost / reduction in caloric intake - right (data calculated based on Kirk. 2012)

If we also take into consideration that the low carb group had the largest caloric deficit in the post-study period (months 6-12) and still regained the greatest amount of body fat, while the reduced glycemic load group, who consumer ~47% of their daily caloric intake in the form of carbs ate only 240kcal less than at baseline and still kept losing body fat, it is pretty clear that this is a points win for the "South Beach" = reduced glycemic load diet.

"Do you want to tell me that South Beach was the way to go?"

Image 2: This is Alexa Iwan who "advertises" her strawberries on the website for the Day of Healthy Eating

As usual, these results are not representative of the average human being, not representative of the average American and by no means representative of you. So, if you asked me what a "healthy diet" looks like and expect me to answer your questions in terms of percentages and macronutrient ratios I will send you to another "guru"... if you are yet willing to accept an answer that revolves around my repeated recommendation to eat eggs, dairy (unprocessed = full fat), (organ-)meat, fish, coconut oil, olive oil, grass-fed butter, avocados, rice, potatoes, tubers, fruit (e.g. Alexa's strawberries, cf. image 2 ;-) and tons of veggies, to make sure not to starve yourself, to exercise and sleep(!), and to do all that consistently, you are no longer dieting, but just leading a healthy lifestyle - and at least for those who are still obese, this is more than enough to get to a pretty decent and moreover healthy bodyfat level - which, by the way, rarely is below the 10% mark ;-)

Super Bowl, A Question of Life or Cardiovascular Death! ✰ Are Super BOWLs to Blame For the US Obesity Epidemic? ✰ By BMI Standards the Average NFL Player is "Obese"

Conundrum of the day: Is it really any wonder, that the average American has weight problems if their football stars are obese?

After reading the "Cultural Guide to the Super Bowl for People Who Don't Watch Football" (read it yourself) on Wire.com, I realized that I cannot simply ignore Super Bowl XLVIII and since I have absolutely no idea of how American Football works and how it came about that you, my dear US friends, are going crazy about people carrying a ball that's called FOOT-ball (I mean, it's not "carry-ball") around in your arms, I decided to do what I usually do, when I don't understand things: Look for answers on the science databases on the Internet.

I have to admit, I did not really find the answer to my initial question and I still don't know the rules of the game, but I found a couple of "related" stories, you may be interested in:

• Super-BOWLs to blame for the obesity epidemic (van Kleef. 2012) -- I guess this would be an appropriate headline for a press release based on a study that was published in 2012 in the peer-reviewed scientific Journal of Nutrition Education and Behavior.
  
  According to the data Ellen van Kleef and Mitsuru Shimizu and Brian Wansink present in this paper, "super bowls" with a capacity of 6.9-l betray people into overeating (in this case on pasta).

  

  Figure 1: Super BOWL Wargning - When pasta is served in large vs. medium sized bowls people have difficulties controlling their pasta intakes (van Kleef. 2012)

  If you take a closer look at the data in Figure 1 you will realize that ladies are much more prone to the "bowl trick" than guys. If you think about the different eating habits between men (eat until you're satieted) and women (eat until you feel guilty / think you had enough), it is yet not really surprising that the women stopped eating earlier, when they got their pasta in the medium-sized 3.8L bowls.
  
  What's particularly amusing is that Wansing et al. showed in a very similar experiment with ice-cream that even "experts", i.e. nutritionists, are not immune against the "big bowl, big appetite" phenomenon and served themselves ~30% of extra ice-cream when the latter was served in bigger bowls (Wansink. 2006).
• Super Bowl outcome's association with cardiovascular death (Schwartz. 2013) -- If you take a look at the messages on Twitter, Facebook and Co. it's quite clear that the Super Bowl is a matter of life or death for many Americans. That this is true in both the figurative and literal sense, is not immediately obvious, though - and still, according to a group of scientists from the Good Samaritan Hospital in LA, this is yet actually the case.

German soccer fans at greater risk than US football fanatics: If the scientists' assumption that the increased risk in cardiovascular death is proportional to the "strength of the support" for the home team, us Germans are must be really supportive of our soccer team. According to a 2008 study by Ute Wilbert-Lampen et al. the risk of dying from any sort of cardiovascular complication more than doubled during our home-worldcup in 2006 (Wilbert-Lampen. 2008).

• The scientists analyzed the number of cardiovascular incidences during two "high drama and intense Super Bowls" (NYC beat New England (Massachusetts) in 2008 and Pittsburgh defeated Arizona in 2009) and found
  
  • a +20% increase in circulatory and a +24% increase in ischemic heart disease deaths after Massachusett's defeat, and
  • a -25% decrease in circulartory, -31% decrease in ischemic heart disease, and a -46% reduction in myocardial infarction deaths in Pittsburg
  What's somewhat astonishing, though is that the cardiovascular death rates did not change in Arizona (all p > 0.19)... well, Schwartz et al. obviously have an answer: "Massachusetts and Pittsburgh show stronger support for their home teams compared with Arizona." (Schwartz. 2013 ;-)
• Fat or fit? By BMI standards he is obese, but what about the actual anthropometric data of the "average NFL player"? (Luke. 2014) -- Very timely, I should say... what? Ah, yes. I meant the ahead-of-print publication of a study by Pryor, Huggins, Casa, et al. in the online version of the Journal of Strength and Conditioning Research: "A Profile of a National Football League Team", that sounds promising, right?
  
  Well, if you look at the data the scientists from the Human Performance Laboratory of the University of Connecticut gathered, you will realize that this "profile" is a simple analysis of the anthropometric data of all players of the 2011 New York Giants team.

  

  Figure 2: NFL player comparison of pooled and weighted body fat (%), - mass (kg), and - height (cm); data based on anthropometric measurement of the 2011 New York Giants team (Pryor. 2014)

  So! Now you tell me, who do you wanna be, the ripped, wide receiver or the massive offensive lineman? What? You wanna be the quarter back? How did I know that!?
  
  "Interesting, but are there any practical implications to this?" In case that's what you are just thinking a brief quote from the paragraph on "practical applications" of this study may give you a leg up:
  

  "[Our] study adds new players' data to prototypical position-specific databases that may be used as templates for comparison of players for draft selection or physical training." (Pryor. 2014)

  In view of the fact that the anthropometric profiles did not dramatically differ over the past 13 years, we may also assume that aside from a trend toward improved body composition in some positions the "prototypical" and maybe even ideal football player is already out there, so that physical characteristics have little impact on the successful outcomes in the NFL.

I know you still have to fill the bowls with popcorn, so I am not going to keep you from fulfilling this important duty... just remember: you may turn from "wide receiver ripped" to "offensive lineman"... well, let's say "massive" in no time, if you keep choosing the SUPER (large) BOWL too often ;-)

References:

• Pryor, J. Luke, et al. "A Profile of a National Football League Team." The Journal of Strength & Conditioning Research 28.1 (2014): 7-13.
• Schwartz, Bryan G., Scott Andrew McDonald, and Robert A. Kloner. "Super Bowl outcome’s association with cardiovascular death." Clinical Research in Cardiology 102.11 (2013): 807-811.
• van Kleef, Ellen, Mitsuru Shimizu, and Brian Wansink. "Serving bowl selection biases the amount of food served." Journal of nutrition education and behavior 44.1 (2012): 66-70.
• Wansink, Brian, Koert Van Ittersum, and James E. Painter. "Ice cream illusions: bowls, spoons, and self-served portion sizes." American journal of preventive medicine 31.3 (2006): 240-243.