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The Key to Weight Loss Is Diet Quality, Not Quantity, a New Study Finds

Anyone who has ever been on a diet knows that the standard prescription for weight loss is to reduce the amount of calories you consume.

But a new study, published Tuesday in JAMA, may turn that advice on its head. It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat.

The research lends strong support to the notion that diet quality, not quantity, is what helps people lose and manage their weight most easily in the long run. It also suggests that health authorities should shift away from telling the public to obsess over calories and instead encourage Americans to avoid processed foods that are made with refined starches and added sugar, like bagels, white bread, refined flour and sugary snacks and beverages, said Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University.

“This is the road map to reducing the obesity epidemic in the United States,” said Dr. Mozaffarian, who was not involved in the new study. “It’s time for U.S. and other national policies to stop focusing on calories and calorie counting.”

The new research was published in JAMA and led by Christopher D. Gardner, the director of nutrition studies at the Stanford Prevention Research Center. It was a large and expensive trial, carried out on more than 600 people with $8 million in funding from the National Institutes of Health, the Nutrition Science Initiative and other groups.

Dr. Gardner and his colleagues designed the study to compare how overweight and obese people would fare on low-carbohydrate and low-fat diets. But they also wanted to test the hypothesis — suggested by previous studies — that some people are predisposed to do better on one diet over the other depending on their genetics and their ability to metabolize carbs and fat. A growing number of services have capitalized on this idea by offering people personalized nutrition advice tailored to their genotypes.

The researchers recruited adults from the Bay Area and split them into two diet groups, which were called “healthy” low carb and “healthy” low fat. Members of both groups attended classes with dietitians where they were trained to eat nutrient-dense, minimally processed whole foods, cooked at home whenever possible.

Soft drinks, fruit juice, muffins, white rice and white bread are technically low in fat, for example, but the low-fat group was told to avoid those things and eat foods like brown rice, barley, steel-cut oats, lentils, lean meats, low-fat dairy products, quinoa, fresh fruit and legumes. The low-carb group was trained to choose nutritious foods like olive oil, salmon, avocados, hard cheeses, vegetables, nut butters, nuts and seeds, and grass-fed and pasture-raised animal foods.

The participants were encouraged to meet the federal guidelines for physical activity but did not generally increase their exercise levels, Dr. Gardner said. In classes with the dietitians, most of the time was spent discussing food and behavioral strategies to support their dietary changes.

The new study stands apart from many previous weight-loss trials because it did not set extremely restrictive carbohydrate, fat or caloric limits on people and emphasized that they focus on eating whole or “real” foods — as much as they needed to avoid feeling hungry.

“The unique thing is that we didn’t ever set a number for them to follow,” Dr. Gardner said.

Of course, many dieters regain what they lose, and this study cannot establish whether participants will be able to sustain their new habits. While people on average lost a significant amount of weight in the study, there was also wide variability in both groups. Some people gained weight, and some lost as much as 50 to 60 pounds. Dr. Gardner said that the people who lost the most weight reported that the study had “changed their relationship with food.” They no longer ate in their cars or in front of their television screens, and they were cooking more at home and sitting down to eat dinner with their families, for example.

“We really stressed to both groups again and again that we wanted them to eat high-quality foods,” Dr. Gardner said. “We told them all that we wanted them to minimize added sugar and refined grains and eat more vegetables and whole foods. We said, ‘Don’t go out and buy a low-fat brownie just because it says low fat. And those low-carb chips — don’t buy them, because they’re still chips and that’s gaming the system.’”

In a new study, people who ate lots of vegetables and whole foods
rather than processed ones lost weight without worrying about calories or portion size.

Dr. Gardner said many of the people in the study were surprised — and relieved — that they did not have to restrict or even think about calories.

“A couple weeks into the study people were asking when we were going to tell them how many calories to cut back on,” he said. “And months into the study they said, ‘Thank you! We’ve had to do that so many times in the past.’”

Calorie counting has long been ingrained in the prevailing nutrition and weight loss advice. The Centers for Disease Control and Prevention, for example, tells people who are trying to lose weight to “write down the foods you eat and the beverages you drink, plus the calories they have, each day,” while making an effort to restrict the amount of calories they eat and increasing the amount of calories they burn through physical activity.

“Weight management is all about balancing the number of calories you take in with the number your body uses or burns off,” the agency says.

Yet the new study found that after one year of focusing on food quality, not calories, the two groups lost substantial amounts of weight. On average, the members of the low-carb group lost just over 13 pounds, while those in the low-fat group lost about 11.7 pounds. Both groups also saw improvements in other health markers, like reductions in their waist sizes, body fat, and blood sugar and blood pressure levels.

The researchers took DNA samples from each subject and analyzed a group of genetic variants that influence fat and carbohydrate metabolism. Ultimately the subjects’ genotypes did not appear to influence their responses to the diets.

The researchers also looked at whether people who secreted higher levels of insulin in response to carbohydrate intake — a barometer of insulin resistance — did better on the low-carb diet. Surprisingly, they did not, Dr. Gardner said, which was somewhat disappointing.

“It would have been sweet to say we have a simple clinical test that will point out whether you’re insulin resistant or not and whether you should eat more or less carbs,” he added.

Dr. Walter Willett, chairman of the nutrition department at the Harvard T. H. Chan School of Public Health, said the study did not support a “precision medicine” approach to nutrition, but that future studies would be likely to look at many other genetic factors that could be significant. He said the most important message of the study was that a “high quality diet” produced substantial weight loss and that the percentage of calories from fat or carbs did not matter, which is consistent with other studies, including many that show that eating healthy fats and carbs can help prevent heart disease, diabetes and other diseases.

“The bottom line: Diet quality is important for both weight control and long-term well-being,” he said.

Dr. Gardner said it is not that calories don’t matter. After all, both groups ultimately ended up consuming fewer calories on average by the end of the study, even though they were not conscious of it. The point is that they did this by focusing on nutritious whole foods that satisfied their hunger.

“I think one place we go wrong is telling people to figure out how many calories they eat and then telling them to cut back on 500 calories, which makes them miserable,” he said. “We really need to focus on that foundational diet, which is more vegetables, more whole foods, less added sugar and less refined grains.”

By ANAHAD O’CONNOR      FEB. 20, 2018
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Portion Size Versus Serving Size

Sometimes the portion size and serving size are the same, but sometimes they are not. Over the past few years portions have grown significantly in restaurants, as has the frequency of Americans eating out. Learn how much to put on your plate to help control how much you eat.

Big portion sizes can mean you’re getting more food than your body can stomach to maintain a healthy weight.

Do you know how much you’re really eating? Sometimes it’s hard to tell if the portions we are eating are the right serving size for our nutritional needs.  Portion sizes have increased drastically over the years, contributing to the rising obesity rate.

So how did it get this way?

Consider these statistics from the American Heart Association and the Robert Woods Johnson Foundation study “A Nation at Risk: Obesity in the United States”:

  1. Adults today consume an average of 300 more calories per day than they did in 1985.
  2. Portion sizes have grown dramatically over the last 40 years.
  3. North Americans eat out much more than they used to.

Understanding healthy portions can be hard. Here’s why:

  • Many of us don’t know what a healthy portion is.
  • Restaurants offer extras like breads, chips and other appetizers that add extra calories, sodium and fat but lack any nutritional benefit.
  • Some meals have portions that are enough for two or more people.
  • Many convenience foods and drinks are priced lower but packaged in larger sizes to sell more.
  • Clearing up the confusion.

 

Here are a couple of important definitions from the National Institutes of Health:

  • Portion is how much food you choose to eat at one time, whether in a restaurant, from a package or in your own kitchen. A portion is 100 percent under our control. Many foods that come as a single portion actually contain multiple servings.
  • Serving Size is the amount of food listed on a product’s Nutrition Facts label. So all of the nutritional values you see on the label are for the serving size the manufacturer suggests on the package.

Once we understand the difference, it’s easier to determine how much to serve and easier to teach kids the difference between the two. Learn some suggested servings from each food groups you and your kids can eat at mealtime or between meals.

How can we eat and serve smaller portions?

  1. When cooking at home: Offer the proper “serving” to each member of the family, then put the extra food away. Save leftovers for another meal.
  2. When dining out:  Skip the appetizers and split a large salad or main dish with a friend.
  3. When ordering takeout at home: Eat one slice of pizza instead of two, and order a small instead of a medium to split among the family so the pieces are smaller.
  4. Watching movies at home or at the theatre:  Don’t eat while watching TV or a movie or when you’re on the computer. It’s harder to control how much you’re eating if you don’t pay attention to what you’re putting in your mouth, and when. At the movies, share a box of popcorn, and avoid the free-refill tubs and skip the candy.
  5. At snack time: Never eat straight from the bag or box. Measure out snacks, including fruits and veggies, into appropriate portion sizes before giving them to your kids.
  6. All the time: Tracking your calories helps you monitor your weight. It helps to know what the appropriate serving size is so you can correctly estimate the calories in your portions, especially if you dine out a lot. Using a food diary can help you pay closer attention to what you’re eating, how much and how often.

You may be surprised to learn these are serving sizes:

  • 1 slice of bread
  • ½ cup rice or pasta (cooked)
  • 1 small piece of fruit (super-large apples are 2+ servings)
  • 1 wedge of melon
  • ¾ cup fruit juice
  • =1 cup milk or yogurt
  • 2 oz. cheese (about the size of a domino)
  • 2-3 oz. meat, poultry or fish (this is about the size of a deck of cards)
 March 21, 2017


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Eat Your Way Through the Holidays with Healthy Cancer-Fighting Options

With the many winter holidays upon us, one of the great challenges is maintaining a healthy diet. Choosing healthier options helps many of us ward off extra pounds, but for those with cancer it is crucial to overall health.

If you are undergoing cancer treatment, such as chemotherapy or radiation, you need extra nutrients to help maintain your energy and keep you feeling strong. Even if your appetite has waned, you still need to make good food choices that fuel your body and help you heal.

Many traditional holiday foods can be high in unhealthy fats, refined carbohydrates, and added sugars which, when eaten in excess, can make you feel fatigued and miss out on nutrients vital for healing

Knowing what to eat and what to avoid can make the holiday season a healthy one for you. Follow the guidelines below to increase your intake of cancer-fighting nutrients, and keep you feeling your best this holiday season.

Fill one-fourth of your plate with complex carbohydrates. Carbohydrates are essential nutrients because they provide energy for body and brain. Good sources include whole grains (like oats, barley, farro, millet, and buckwheat), fruits, vegetables and beans. They also provide phytonutrients that offer cancer-fighting benefits and fiber to keep you fuller longer. Start by adding extra veggies to side dishes. Switch to whole-grain flour for baking your favorite holiday treats, try a bean dip or hummus with veggies as an appetizer, and include fresh fruits for dessert.

Choose healthy fats. Fat has been given a bad rap, but all fats are not equal. You want to avoid or limit saturated fats (the ones found in animal products like butter, cheese, and red meat) and trans-fatty acids (those that have been hydrogenated — often found in packaged foods and baked goods). Unsaturated fats are the good ones — olive oil, nuts, seeds, avocado, and fatty fish.

santa

Include protein at every meal. Protein is important for healing during and after treatment. It also is essential for maintaining strength and energy.  Choose a variety of plant sources, such as nuts and nut butters, seeds, beans, legumes, and soy.  Good sources of animal proteins include grass-fed beef, free-range poultry, wild-caught fish, eggs, and low-fat dairy.

Emphasize “Seasonal” Superfoods. Superfoods are the superheroes of nutrition —many are rich in antioxidants, vitamins and minerals to help you heal and reduce inflammation, thus reducing your risk of chronic diseases and promoting cancer survivorship. Many superfoods are popular during the holidays — such as cruciferous vegetables (kale, spinach, broccoli, cabbage, cauliflower), beans and legumes, citrus, sweet potatoes, nuts and mushrooms. Fresh cranberry sauce with orange and sweetened with agave or honey is an ideal choice to include in your holiday meals. Try adding antioxidant-rich pomegranate seeds to a kale salad for a festive starter, or warm up with pumpkin or butternut squash bisque. Sweet potatoes, baked or mashed, with a drizzle of pure maple syrup and a sprinkle of cinnamon, make a healthy and delicious side dish. Green beans sautéed with mushrooms and red bell peppers, steamed broccoli with lemon zest and garlic, and roasted Brussels sprouts caramelized with balsamic vinegar are all foods to fill up on. And if you’ve saved room for dessert, top a scoop of vanilla ice cream or yogurt with blueberries or raspberries and a sprinkle of cacao nibs.  Looking for something decadent? Bake an apple with cinnamon and nutmeg, and top it with chopped almonds or walnuts and maple syrup.

Remember: it is OK to have small portions of your favorite holiday foods, but fill most of your plate with a variety of plant-based foods such as colorful fruits and vegetables, whole grains, beans, and nuts.

Make a conscious effort to focus on healthy options this holiday season that will keep you strong and help you fight cancer.

Presented by Massachusetts General Hospital Cancer Center
 
 
This post is a sponsored collaboration between Massachusetts General Hospital Cancer Center and Boston magazine’s advertising department.


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92 Percent Of All Restaurant Meals Have Crazy Calorie Counts

No, not just fast food restaurants. All restaurants.

Kate Bratskeir    Food and Health Editor, The Huffington Post    01/25/2016

You probably don’t expect every meal you eat at a restaurant to contain a large number of calories. Sure, the occasional fast food cheat meal might be excessive, but your local farm-to-table place feeds you well, right?

According to new research from Tufts University, nearly all restaurant meals – whether from a fast food joint or the luxurious confines of a Michelin-reviewed kitchen – contain way too many calories.

The study, published in the Journal of the American Academy of Nutrition and Dietetics, measured 364 restaurant meals from both large chain and local restaurants and a variety of cuisines, finding that 92 percent of them exceed the recommended calorie requirements for a single meal.

What’s more, one third of these meals exceeded the energy requirement for an entire day. And, just as a reminder, the meals didn’t include typical restaurant accompaniments, like drinks, appetizers or dessert.

We need to take control of our plates.

The researchers did not go into why restaurant dishes are so caloric, but it’s not hard to come up with a guess: sugar, fat and salt make things taste better. A chef’s priority is to make food enjoyable, so they use more of the stuff that also makes food more caloric.

What’s more, portion sizes all but guarantee overeating.  In a 2015 study from Cornell’s Food and Brand Lab, researchers did not find any correlation between the consumption of junk foods and being overweight. Instead, it is the size of the meals that most contributed to America’s obesity epidemic.

Eat

This isn’t a jab at the artful work that restaurant staffers do. It’s a reminded to eat more food at home, and to be mindful of the portion on your plate. You might consider boxing up half of a meal to have for lunch the following day, rather than scarfing it all down on a full stomach to make the most of your spent money.

“Although fast-food restaurants are often the easiest targets for criticism because they provide information on their portion sizes and calories, small restaurants typically provide just as many calories, and sometimes more,” said Susan B. Roberts, Ph.D., director of the Energy Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts in a statement.

And restaurants need to change, too.

We need to take a thoughtful pause and reconsider how we consume: In 2015, Americans spent more on dining out than groceries for the first time on record.

Bf we want to continue enjoying food outside of our homes but improve our health, restaurant practices will need to change, too. Legislation that makes it possible for customers to order smaller-sized portions could be a successful start, study co-author William Masters, Ph.D., professor of food economics at the Friedman School, said in the study’s press release.

“Customers could then order anything on the menu in a more appropriate size, and be able to eat out more often without weight gain.”

While you wait for restaurant meals to come in healthier sizes, you might consider making the majority of your meals at home. Besides being less caloric, studies show home-cooked meals are nutritionally healthier and socially beneficial, too.