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The weighting game.

It's spring, when a young man's fancy turns to love... and everyone else's turns to how they're going to look in a bathing suit.

This year it's worse. First, health officials announced that we're fatter than ever before. One out of three adults is overweight, up from one in four as recently as the late 1970s.

And last February, the New York Times baffled millions of dieters by declaring: "So It May Be True After All: Eating Pasta Makes You Fat."

That's all we needed. Just as people are learning to fill their plates with low-fat foods like pasta instead of 12-ounce steaks, one (rather confused) reporter says that pasta, etc., make you fat...and much of the media follow suit.

What's the best way to lose weight and keep it off? That's the $64,000 question.

Take your pick. There's the Why Women Need Chocolate diet, the Carbohydrate Addict's Diet, the Fit for Life diet, the Eat Smart, Think Smart diet, and dozens more.

All it takes is a catchy name, an energetic publicist, and an inspiring personality and you too can be a successful diet book author. Your readers, however, will succeed only temporarily, if at all.

"The top shelf of my bookcase is filled with popular diet books," says Kelly Brownell, director of the Center for Eating and Weight Disorders at Yale University. "They all have equally compelling testimonials, they all have these pseudoexperts thinking that they have something new. But they have no proof. Nothing that lasts."

Still, not all diets are junk. For years, the most sensible ones have had the same theme: cut the fat and replace it with carbohydrates and you'll automatically cut your calories.

Enter the New York Times. Last February, it ran a front-page article suggesting that carbohydrates like pasta--and low-fat diets--make you fat.

The latest skirmish in the battle of the bulge had begun.

THE PASTA PURGE

The pasta put-down wasn't based on a new study. Instead, it reflected the controversial opinions of biologist Richard Heller and psychologist Rachael Heller, authors of a diet book called Healthy for Life. They're a husband-and-wife team at the Mount Sinai School of Medicine in New York.

The Times reporter, who doesn't normally write about nutrition or science, didn't quite get it right. "That article is a nightmare, says James Hill, an obesity researcher at the University of Colorado Health Sciences Center. "It was really irresponsible," adds Hill, who was quoted in the article.

The Times's biggest mistake was this statement from the Hellers:

"The majority of overweight people are insulin-resistant. Carbohydrates are the worst thing they can eat because it causes them to overproduce insulin, which stimulates appetite, encourages the production of body fat, and, over the long term, has serious health implications."

Other reporters--and several books due out this spring--echoed the "carbohydrates make you fat" theme.

If only there were some evidence that it was true.

DOES INSULIN MAKE YOU FAT?

The Times and the Hellers got one thing right: Too much insulin is a problem. It appears to raise the risk of heart disease, diabetes, and high blood pressure (see "High Insulin, High Risk" . And it often occurs in the overweight.

But does excess insulin make people fat?

"There's nothing magical about insulin that makes people gain weight," says Stanford University's Gerald Reaven, an endocrinologist who was one of the first scientists to sound the alarm about insulin.

In studies that lasted roughly two weeks, Reaven has compared high-carbohydrate (low-fat) diets to low-carbohydrate (high-fat) diets in people who have high insulin levels. I "In study after study," he says, "insulin levels are higher on the high-carbohydrate diets. But there's no change in weight as long as we keep the calories in the two diets equal."

So much for the idea that insulin prompts the body to store extra calories as flab.

What about the notion that excess insulin makes people fat by increasing their appetite? "That's absolute speculation," says Reaven.

In fact, say many researchers, the Hellers have confused the chicken with the egg. It's not insulin that makes people fat. In most cases, it's being fat that makes people insulin-resistant.

"If people who are insulin-resistant lose weight, they oftentimes go back to being normal," says Ron Goor, co-author of the low-fat diet book Choose to Lose.

"Only if they persist in being fat over a long period of time do they go on to become diabetics."

CUT FAT, NOT FOOD

Okay. So pasta and other carbohydrates won't make you fat. And avoiding them won't make the pounds melt away. What will?

To some researchers, it doesn't matter what you eat, as long as you cut calories. But others say that a low-fat diet is best precisely because it makes it easier to cut calories.

"Fat has over twice as many calories as either protein or carbohydrate," explains researcher Dean Ornish, author of Eat More, Weigh Less. So when you shift to a low-fat diet, "you can eat the same amount of food but take in fewer calories."

"Fat is good to the palate, so you have a tendency to eat more," says Eric Ravussin of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix.

But where's the proof?

NO PROOF POSITIVE

There is evidence that fatty foods make you fat, but it isn't ironclad. In animal studies, rats lose more weight on low-fat diets than on high-fat diets with the same number of calories.(2) In humans, however, each study that's been done has had holes:

* When offered a low-fat diet, people ate fewer calories. In several studies, people ate fewer calories when allowed to eat as much low-fat food as they wanted.

Problem: The studies were small. In one of the few that lasted more than a week, 13 women who were offered a narrow selection of low-fat foods ate fewer calories--and lost weight--at first.(3) But after about six weeks, their calories started to climb. Would they eventually have gained back all their lost weight? The 11-week study didn't last long enough to find out.

* When people cut fat, they lost weight. In one large study, women who were taught to eat low-fat diets to reduce their risk of breast cancer lost weight without trying.(4)

RELATED ARTICLE: The Exercist?

Want to lose weight? Then get off your behind and start moving. "Regular physical activity is absolutely crucial to successful weightloss," says Yale University obesity expert Kelly Brownell.

While cutting calories cuts pounds, eating less and exercising is better ... because it helps keep lost pounds from creeping back.

Just ask the Boston Police Department. In the late 1980s, researchers from Boston University Medical Center put 110 overweight cops and other city employees on a strict diet regimen (420 to 1,000 calories a day). Half were told not to change their exercise habits, while half did 90 minutes o supervised exercise three times a week (they walked, jogged, and ran, they did calisthenics, and they were taught relaxation techniques).(1)

After eight weeks, the "dieters" had lost an average of 23 pounds; the "diet & exercisers" had lost 27 pounds--not the strongest argument for sweating away for 4 1/2 hours a week.

But 18 months after the study ended, the "dieters" had gained back more than 90 percent of the weight they had lost. On average, the "diet exercisers" who continued to exercise didn't gain back a single pound. Another reason exercise is so crucial: It can help you adjust to a life of needing less food.

Take Dan and Stan. They both exercise and weigh 170 pounds. Dan eats 2,500 calories a day and doesn't gain or lose weight. But if Stan eats 2,500 calories a day, he puts on extra pounds. Why?

Stan used to weigh 210 pounds. His body still wants to.

That's what researchers at Rockefeller University found when they studied 41 men and women who had lost 15 to 64 pounds by dieting. In order to keep that weight off, the dieters had to eat 220 to 300 fewer calories a day than people who had always been at the lighter weight.(2)

Why? The dieters' metabolic rates had slowed. The only solution for them: eat fewer calories or do more exercise.

(1) American Journal of Clinical Nutrition 49: 1115, 1989. (2) New England Journal of Medicine 332: 621, 1995.

RELATED ARTICLE: High Insulin, High Risk

Insulin. Most people know it as the hormone that diabetics lack.

In fact, most diabetics--those who get the disease as adults--have as much or more insulin than the rest of us. The problem is, their insulin doesn't do its job, which is to let sugar pass from the blood into the body's cells, where it's needed for energy.

And having ineffective insulin, also known as "insulin resistance," isn't healthy.

If your insulin isn't doing what it's supposed to, your body secretes more and more of it to keep your blood sugar down. Eventually, it loses the battle. Your blood sugar soars and you've got diabetes. Diagnosing diabetes is easy. Spotting high insulin levels isn't. And they need to be spotted.

"High insulin levels raise triglycerides, lower HDL ["good"] cholesterol, make LDL ["bad"] cholesterol denser, and raise blood pressure," says endocrinologist Gerald Reaven of Stanford University. All of those changes increase the risk of heart disease.

And it's not rare. "Excluding people with diabetes, we think that about 20 to 25 percent of the population is insulin-resistant," says Reaven. "But that's a very rough estimate."

The problem is: there's no practical way to accurately measure insulin levels. So how do you know if you're insulin-resistant?

The best indicator, says Reaven, is "if your triglycerides are over 200 and your HDL cholesterol is less than 35." There's also a good chance if you are overweight or have high blood pressure.

WHAT TO EAT

And what if you are insulin-resistant? Exercising and losing weight are, by far, the best ways to make your insulin work better. Beyond those crucial factors comes what you eat.

"Insulin levels are higher on a high-carbohydrate, low-fat diet," says Reaven, but only if you're insulin-resistant. (If you're not insulin-resistant, you can eat a high-carbohydrate diet and you'll have no problem.

Does that mean that everyone with high insulin levels should eat a low-carbohydrate (high-fat) diet? Not if a low-fat diet helps you lose weight. "If you ate a low-fat (high-carbohydrate) diet and lost weight, it would still lower your insulin," explains Reaven.

And the last thing anyone should do is eat a diet high in saturated fat, as books like Richard and Rachael Heller's Healthy for Life recommend. (It allows dieters to eat unlimited quantities of what it calls "risk reducing" foods like butter, sausage, and bacon.

"One of the healthiest meals anyone can eat is bruschetta, which is grilled crusty bread, and pasta with garlic and olive oil," says Reaven.

And you heard pasta was bad for you.

Reference: Metabolism 41 (Suppl. 1): 16, 1992.

RELATED ARTICLE: A LITTLE GOES A LONG WAY

You don't need to go all the way from tubby to trim to boost your health.

* Cholesterol. When researchers combined the results of 70 studies on almost 1,300 overweight volunteers, they concluded that for every five pounds you lose through dieting, your total cholesterol drops by 7 points, LDL ("bad") cholesterol drops by 3 points, triglycerides drop by 14 points, and HDL ("good") cholesterol rises by 1 point.(1) All reduce your risk of heart disease and diabetes.

* Blood Pressure. In study after study, losing weight has a powerful impact. In one of the best, 60 percent of people with high blood pressure were able to discontinue taking their medication after they lost just ten pounds through dieting.(2)

* Blood Sugar. Overweight diabetics who lost at least 15 pounds over a year's time lowered their blood sugar levels by 15 percent ... without medication. Those who lost at least 30 pounds lowered their blood sugar by more than 40 percent, even though they remained overweight.(3)

(1) American Journal of Clinical Nutrition 56: 320, 1992. (2) Journal of the American Medical Association 253: 657, 1985. (3) Archives of Internal Medicine 147: 1749, 1987.

Dieter's Choice

You've seen the before-and-after photographs. You've heard the "how I lost 187 pounds in just two weeks" testimonials.

But just how well do weight-loss programs work? Nobody knows...because nobody's looked.

"There is virtually no scientific evaluation of their effectiveness," says Paul Thomas, who directed a recent analysis of the weight-loss industry for the National Academy of Sciences. "The data we got from the industry was completely inadequate."

Bad data or not, millions of Americans spend billions of dollars every year on weight-loss programs. Some manage to shed their excess pounds ... at least for a while.

If you're considering a weight-loss scheme, here are some choices:

EXPENSIVE

* Nutri/System or Jenny Craig. You start with a mix of Nutri/System or Jenny Craig and supermarket foods. Eventually, you plan your own meals. Costs to join are $99 to $299, plus about $50 to $70 a week for the prepared foods. Call (215) 442-5411 (Nutri/System) or (800) 945-3669 (Jenny Craig).

INEXPENSIVE

* Overeaters Anonymous. A nonprofit organization of support groups. It's modeled after the 12-step Alcoholics Anonymous program. Members have to get their diets from outside health professionals. Costs are minimal. Call (505) 891-2664.

* TOPS (Take Off Pounds Sensibly). A nonprofit organization with weekly meetings. Members must get written weight goals and diets from outside health professionals. Encourages walking. Costs are low. Call (800) 932-8677.

* Weight Watchers. You choose from two diets. In one, you count the servings of all the foods you eat each day. In the "Fat & Fiber Plan," you aim for no more than 35 grams of fat and at least 20 grams of fiber each day. (The fiber sees to it that you fill up with vegetables and grains, not fat-free desserts.) There's no need to buy Weight Watchers brand foods. Costs to join are $20 or less; weekly meetings cost around $1 0. Call (516) 939-0400.

* Slim-Fast, Nestle's Sweet Success, and other diet drinks. These 200-calorie "shakes" are mostly sugar and skim milk fortified with nutrients. You're supposed to eat "one well-balanced meat" and drink two shakes every day. Do people regain any lost weight when they go back to three meals a day? No good studies have been published. Cutting fat had more impact on weight-loss than cutting calories.

Problem: On average, the women lost only seven pounds after one year. After the second year, the total loss shrank to just four pounds.

* Fat people said they eat fatty foods. In several studies, overweight people reported eating a greater percentage of their calories from fat than their leaner counterparts.(5,6)

Problem: That doesn't prove that eating fatty foods made them fat in the first place.

THE FAT-FREE MYTH

Ironclad it isn't, but the evidence that a low-fat diet is the ideal way to lose weight is the best we've got. And weight-loss isn't the whole ballgame.

"The greatest concern is how the diet affects health," says obesity expert Thomas Wadden of the University of Pittsburgh. On that score, low-fat is a clear winner.

That's because eating less fat cuts the risk of heart disease and cancer. And low-fat diets usually have more vitamins and minerals.

But watch out. When experts talk about low-fat diets, they don't mean the fat-free cakes, cookies, and ice cream that you may be conjuring up.

"I think the greatest myth is that fat-free means calorie-free and that that means I can eat all I want," says Robert Kushner, director of the University of Chicago Nutrition and Weight Control Clinic. "If people only pay attention to fat, they will drift to fat-free products that are high in calories."

Fat-free cakes and ice creams are certainly healthier than fatty ones. But soft drinks and candy are fat-free, and no dieter would gobble them up without thinking twice. "If you eat a low-fat diet and you abuse these low-fat foods, you're going to gain weight," says Colorado's James Hill.

THE BIGGER PICTURE

Feeling discouraged? It may be comforting to blame pasta, fat-free cakes--or ourselves--for being overweight. But it's not that simple.

"People are exposed to repeated, compelling messages to be thin, and repeated, compelling messages to eat bad food," says Yale University's Kelly Brownell. "It's not a fair fight.

"When obesity gets worse, we scratch our heads and wonder why. It would be similar to scratching our heads and wondering why we have a lot of lung cancer. People are exposed to a terrible environment that encourages them to smoke and eat bad foods and not to exercise. There's no mystery here."

(1) Metabolism 32: 750, 1983. (2) American Journal of Clinical Nutrition 53: 846, 1993. (3) American Journal of Clinical Nutrition 53: 1124, 1991. (4) American Journal of Clinical Nutrition 54: 821, 1991. (5) American Journal of Clinical Nutrition 47:995, 1988. (6) Journal of the American Dietetic Association 94: 612, 1994.

Taking (and Keeping) It Off

"The The hard part's not losing weight. It's keeping weight off." Nutritionist Anne M. Fletcher knows. She recently studied 160 men and women who lost an average of 63 pounds ... and managed to keep the weight off for at least three years.(1)

Among their keys to success: "They learned that it's far easier to deal with several pounds at a time than with 20, 40, or 50 pounds," says Fletcher. "So they immediately reversed small weight gains."

Most weighed themselves regularly; many every day. As soon as they noticed a small gain--typically no more than three to five pounds--some exercised a little harder or longer for a few weeks, others skipped dessert for a while. When they lost the extra weight, they returned to their normal routine.

If you've managed to lose at least 30 pounds--and keep it off for a year or more--the National Weight Control Registry wants to see what you have in common with other successful dieters. Write to Dr. Rena R. Wing, University of Pittsburgh School of Medicine, WPIC, 3811 O'Hara St., Pittsburgh, Pennsylvania 15213.

(1) Thin for Life: 10 Keys to Success from people who have Lost Weight Kept It Off (I 994, Chapters Publishing, Shelburne, Vermont).

THE BOTTOM LINE

* Any diet that helps you cut calories will help you lose weight. Most researchers think that it's easiest on a low-fat diet, but there's no definitive evidence that they're right.

* Exercise is critically important, especially for keeping weight off.

* Eat a diet that's low in saturated and trans fat. That means cutting way back on red meat, most cheeses, whole or 2% milk, fatty chicken or turkey (thighs and wings), and foods made with butter or palm, coconut, or partially hydrogenated oils.

* Load up on fruits, vegetables, and beans, not fat-free cakes and cookies.

* Have your triglycerides and HDL ("good") cholesterol checked. If triglycerides are above 200 and HDL is below 35, odds are you're insulin-resistant, especially if you're overweight or have high blood presssure.

* If you are insulin-resistant, the two most important things you need to do are exercise and lose weight.

* If you're one of the few people who are insulin-resistant and not overweight, try to eat more of a Mediterranean diet (Dec. 1994, p. 1) ... unless it makes you gain weight.
COPYRIGHT 1995 Center for Science in the Public Interest
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1995, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:includes related articles about the physiological effects of weight loss, exercise and insulin resistance
Author:Schardt, David
Publication:Nutrition Action Healthletter
Article Type:Cover Story
Date:May 1, 1995
Words:3215
Previous Article:Keeping food safe.
Next Article:Food labels: made with real tricks!
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