U.S. Department of
Health and Human Services

National Institutes of Health

WIN Notes

Summer/Fall 2005

WIN Notes is a quarterly newsletter produced by the Weight-control Information Network (WIN), a project of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS). WIN provides consumers, health professionals, and the media with up-to-date, science-based information on obesity, weight control, physical activity, and nutrition.

In This Issue:

Cover Article

USDA Releases New Food Guidance System

The U.S. Department of Agriculture (USDA) recently released “MyPyramid,” a new educational tool designed to help consumers make healthier food and physical activity choices.

Unveiled at a press conference on April 19, this new symbol and interactive food guidance system replaces the Food Guide Pyramid introduced in 1992 and translates the principles of the 2005 Dietary Guidelines for Americans. The Dietary Guidelines form the basis of Federal food, nutrition education, and information programs.

On Sept. 28, the USDA unveiled a child-friendly version of MyPyramid called “MyPyramid for Kids.” This complementary food guidance system provides age-appropriate information about the Dietary Guidelines and MyPyramid.

MyPyramid takes a more personalized approach to improving eating and physical activity habits by offering consumers in-depth information via a new website, mypyramid.gov. The site features tools that can help individuals determine the right amount of food and physical activity needed to effectively control weight.

A new aspect of this food guidance system is its emphasis on the importance of physical activity. The MyPyramid design includes a physical activity element, represented by a figure climbing the pyramid’s steps. The food guidance system’s slogan, “Steps to a Healthier You,” suggests that individuals can benefit by taking small steps to improve their diet and lifestyle each day.

The new pyramid design has six color bands representing the five food groups and oils. The narrowing of each color band from bottom to top illustrates the importance of moderation, with the wider base standing for foods with little or no solid fats, added sugars, or caloric sweeteners. The different widths of the food group bands illustrate the concept of proportionality, suggesting how much food from each group a person should eat. The widths serve as a general guide, but consumers can get more personalized information at mypyramid.gov.

Visitors to the MyPyramid website will find an interactive tool that allows them to enter their age, gender, and activity level to learn what and how much food they should consume from the different food groups. The site also includes a “tracker” that compares individuals’ food intake with current nutrition guidance, and provides nutrition and physical activity messages tailored to their desire to lose or maintain weight.

Other features include web pages with in-depth information for every food group, downloadable documents with nutrition and exercise suggestions, and a worksheet for consumers to track what they are eating.

Additional information about USDA’s MyPyramid is available at mypyramid.gov. MyPyramid materials designed specifically for children aged 6 to 11 can be found at mypyramid.gov/kids/index.html. The 2005 Dietary Guidelines for Americans and consumer brochure are available at www.healthierus.gov/dietaryguidelines.

Research Notes

Report Shows Decline in Obesity-related Deaths

While two studies from the Centers for Disease Control and Prevention (CDC) indicate that medical and health care advances may be lowering the effects of obesity on mortality, people who are overweight or obese are still at increased risk for developing many serious health problems.

In a recent CDC study, researchers used results from three consecutive National Health and Nutrition Examination Surveys (NHANES) to estimate the risks of mortality associated with different body mass indexes (BMIs) for underweight, normal weight, overweight, and obesity. BMI is a measure commonly used by health care professionals to determine the effect of body weight on the risk for some diseases. The surveys, NHANES I, II, and III, were conducted from 1971 through 1975, 1976 through 1980, and 1988 through 1994, respectively.

Researchers found that compared to the number of deaths in the normal weight category, obesity was linked with approximately 112,000 excess deaths in the year 2000, while underweight was linked with 33,746 deaths in the same period. Overweight was not associated with excess mortality. Since the risks of obesity deaths were lower in the more recent NHANES surveys, researchers concluded that the impact of obesity on mortality may have decreased over time because of improvements in medical care and public health.

Another CDC study showed similar results. After examining the magnitude of change in cardiovascular disease (CVD) risk factors among U.S. adults in the last 40 years, researchers found that the prevalence of these medical conditions—except diabetes—decreased across all weight groups, particularly among the overweight and obese. Researchers defined CVD risk factors as high cholesterol levels, high blood pressure, smoking, and diabetes.

This study examined the following national surveys: NHANES, conducted from 1960 through 1962; NHANES I, II, III; and NHANES 1999-2000. In 1999 through 2000, persons who were obese had an 18 percent prevalence of high cholesterol levels, compared to 39 percent in 1960 through 1962. Other comparisons of the above dates showed that the high blood pressure prevalence among persons who were obese in 1999 through 2000 was 18 percentage points lower than 40 years ago, and smoking prevalence was also 12 percentage points lower.

Diabetes prevalence remained stable within all BMI groups over time, according to the study. However, the number of undiagnosed diabetes cases decreased considerably among the most obese people—especially those with BMIs that were greater than 35—while the proportion of total diagnosed cases increased dramatically.

A number of findings in the two studies suggest that medical and health care advances may have played a role in the lowering of CVD risk factors and obesity-related deaths. Improvements in drug management of high blood pressure and cholesterol may have resulted in far fewer people developing cardiovascular problems, according to the CDC. The study’s data may also reflect advances in life-saving interventions for obesity-related diseases, such as catheterization and reperfusion therapy for heart attacks.

The CDC will continue to monitor obesity mortality trends. Because the science continues to evolve and Americans’ health status continues to change, these latest estimates will likely change as more data become available and improved methods are developed.

These two studies were featured in the April 20, 2005 issue of the Journal of the American Medical Association.

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Obesity May Lead to Kidney Stones

A study in the Journal of the American Medical Association has linked obesity and weight gain to an increased risk for developing kidney stones.

Following up on earlier studies that indicated overweight and obesity may cause older adults to develop kidney stones, researchers at Brigham and Women’s Hospital and Harvard Medical School conducted a prospective study of three large cohorts to determine if weight, weight gain, body mass index (BMI), and waist circumference were associated with the formation of kidney stones in different age groups.

The following cohorts were analyzed in the study: the Health Professionals Follow-up Study (HPFS), which looked at 45,988 men ages 40 through 75; the Nurses Health Study I (NHS I), which looked at 93,758 women ages 34 through 59; and the Nurses’ Health Study II (NHS II), which looked at 101,877 younger women, ages 27 through 44.

After studying a combined 46 years of follow-up, researchers found 4,827 new symptomatic kidney stones: 1,609 in the HPFS, 1,687 in the NHS I, and 1,531 in the NHS II.

Researchers adjusted the study’s results for age, dietary factors, fluid intake, and diuretics use. They found that men weighing more than 220 pounds had a 44 percent increased risk for kidney stone formation compared to men who weighed less than 150 pounds. Older women in these weight categories had an 89 percent increased risk, and their younger counterparts, 92 percent. Researchers also found that higher BMIs and waist circumferences were associated with the development of kidney stones.

Some of the results indicate that weight gain may influence kidney stone formation. Men who gained more than 35 pounds since their 21st birthdays had a 39 percent increased risk for kidney stones compared to men who were weight stable. Older women who had gained more than 35 pounds since age 21 had a 70 percent higher risk, while younger women had an 82 percent increased risk.

The study did not yield information on the racial risk for kidney stones since it had only a small number of minority participants. No studies to date have suggested that the effect of body size on urine composition varies by race, however.

Results indicate that weight loss may not be associated with a reduced risk for kidney stones. Nonetheless, the investigators warned that since relatively few patients lost weight over time, that aspect of their study lacked statistical power.

The full report is available in the January 26, 2005 issue of the Journal of the American Medical Association.

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Gestational Diabetes May Be on the Rise

The proportion of women developing diabetes during pregnancy has increased over the past decade, according to a recent study.

Researchers at the University of Colorado Health Sciences Center found that the prevalence of gestational diabetes mellitus (GDM)—defined as glucose intolerance with onset or first recognition during pregnancy—nearly doubled from 1994 to 2002, with an increase of about 12 percent each year. GDM increases were significant in all racial and ethnic groups, investigators found.

This study looked at more than 36,000 women who were members of the Kaiser Permanente of Colorado (KPCO) health plan, a health maintenance organization that serves nearly 400,000 members in the Denver metropolitan area. Study participants had a single child birth between 1994 and 2002 and were screened via a two-step standard protocol, in compliance with KPCO’s routine screening procedure. Women without previously diagnosed diabetes were offered screening for GDM with a 1-hour, 50 gram oral glucose tolerance test (OGTT). Patients whose results exceeded 140 mg/dl underwent a 3-hour, 100 gram diagnostic OGTT. When two or more glucose values appearing in the diagnostic OGTT met or exceeded the criteria for a positive test, the women were diagnosed as having GDM.

The participants were divided into four cohorts according to their birth periods: 1946 through 1955, 1956 through 1965, 1966 through 1975, and 1976 through 1990. Results showed that women who were born in the most recent birth cohorts (1966 through 1975 and 1976 through 1990) were at higher risk for GDM than those born earlier. This finding may reflect the women’s increased exposure to risk factors such as obesity. Researchers speculate that the rising number of GDM cases may also explain the rising number of children who are obese or have type 2 diabetes.

The full report is available in the March 2005 issue of Diabetes Care. For a free copy of a WIN brochure providing information on women’s nutritional and physical needs during pregnancy, please call 1-877-946-4627.

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Manipulating Fat Cell Expression Could Prevent Heart Disease

Manipulating signals from fat cells may help combat heart disease, according to new scientific evidence.

In a recent study, investigators at Wake Forest University Baptist Medical Center sought to determine whether body composition, abdominal fat distribution, lipids (fats), glucose tolerance, and hyperinsulinemia (the presence of excess insulin in the blood) were related to the gene expression of five fat-related proteins. The scientists also wished to establish whether the abdominal fat tissue gene expression of these proteins differed between women who were obese and had metabolic syndrome—a cluster of three or more symptoms that increase the risk for heart disease—and those without it.

The study involved 20 post-menopausal women who were overweight or obese and whose waists measured more than 35 inches. Investigators measured the production of fat-related proteins by taking small samples of fat from the skin in their abdominal area and testing levels of messenger RNA, which acts as a template for the formation of proteins.

Three of the five proteins examined in the study were involved in the buildup of fatty deposits in the linings of blood vessels. Of these, two were proteins that induce inflammation, while another protein promoted blood clots. The remaining two proteins dealt with the regulation of energy metabolism (leptin) and anti-inflammation (adiponectin).

Investigators found that participants who did not have diabetes but showed higher levels of inflammation-promoting proteins had a reduced ability to respond to insulin and to use glucose. Since high blood sugar is often associated with heart disease, these results suggest that high levels of these proteins could pose a similar risk.

An increased ability to use glucose was linked to higher levels of adiponectin, while lower levels of this protein were found in eight women diagnosed with metabolic syndrome. The latter suggests that low levels of adiponectin in abdominal subcutaneous fat tissue are linked with a higher risk for heart disease, the researchers concluded.

The full report is available in the April 2005 issue of the American Journal of Physiology-Endocrinology and Metabolism.

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DHHS News

Lifestyle Changes Effective at Preventing Diabetes in Older Adults

A recent study indicates that older adults can delay or even prevent the onset of type 2 diabetes by losing a few pounds and exercising more often.

Nearly 40 percent of adults aged 40 to 74 are at risk for developing type 2 diabetes, according to Government data. Almost one in five people aged 60 and older already have diabetes. Such discouraging statistics have led many older adults to believe that they don’t have the power to prevent or delay the onset of the disease. But a U.S. Department of Health and Human Services’ (DHHS) study involving Americans from across the country showed that people who are overweight and who lose 5 to 7 percent of their body weight through healthful eating and regular exercise can prevent or delay type 2 diabetes.

In the study, titled “Diabetes Prevention Program,” adults over 60 were more successful at preventing or delaying the onset of the disease than adults in younger age groups. All participants were told to follow a low-fat, low-calorie meal plan, and get 30 minutes of exercise five times a week. These interventions reduced the development of diabetes by 71 percent in participants aged 60 and older.

To spread the word that diabetes prevention for older adults is possible and not as difficult as some may think, the DHHS National Diabetes Education Program (NDEP) launched a public awareness campaign in January titled “It’s Not Too Late to Prevent Diabetes.” The campaign, part of a larger NDEP initiative targeting groups at high risk for diabetes, includes radio and print public service announcements, free booklets, tip sheets, and other informational materials. These materials provide examples of simple activities older adults can engage in to stop diabetes in its tracks.

Older adults wishing to become more physically active can start off with an activity that gets them moving for 10 minutes a day, 5 days a week, and then gradually build up to the recommended 30 minutes a day, 5 days a week, according to NDEP. The exercise routine they adopt doesn’t need to be difficult or tedious, and could include simple activities like dancing or walking.

For more information about this diabetes prevention campaign, free materials and tip sheets, visit the NDEP website at www.ndep.nih.gov or call 1-800-438-5383.

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New NIH Program Targets Childhood Overweight

The National Institutes of Health recently launched a national education program to help prevent overweight and obesity among youth ages 8 through 13. Titled We Can!, Ways to Enhance Children’s Activity and Nutrition, this initiative provides resources and community-based programs for parents, caregivers, and youth that focus on behaviors to encourage healthful eating and physical activity.

This new program helps caregivers teach children to:

Eat a sufficient amount of a variety of fruits and vegetables per day.
Choose small portions at home and at restaurants.
Eat fewer high-fat foods and energy-dense foods that are low in nutrient value such as French fries, bacon, and doughnuts.
Substitute water or fat-free milk or low-fat milk for sweetened beverages such as sodas.
Engage in at least 60 minutes of moderate physical activity on most, preferably all, days of the week.
Reduce recreational screen time to no more than 2 hours per day.

We Can! resources include a parents’ handbook in English and Spanish, lesson curricula for children, and online materials providing up-to-date information on maintaining a healthy weight. The Weight-control Information Network is contributing to this effort by providing We Can! sites with 100 copies of each of three brochures addressing nutritional and physical activity issues.

More than 35 communities across the Nation have committed to participate in this program. Thirteen intensive community sites have been selected to receive training and participate in thorough evaluations of the We Can! program:

State of Alabama, Coalition led by the Department of Public Health
Tamarac, FL, City Parks and Recreation Department
Roswell/Athens, GA, Roswell Recreation and Parks Department and Athens- Clarke County Leisure Services
Gary, IN, Youth Services Bureau/Parks Recreation
South Bend, IN, City Parks and Recreation Department
Montgomery County, MD, County Recreation Department
Boston, MA, Boston Public Health Commission
Pittsfield, MA, Operation Better Start, Berkshire Health Systems
Springfield, MO, Springfield-Greene County Park Board
Las Vegas/Henderson, NV, University of Nevada, Las Vegas Department of Nutrition Sciences and Cities of Las Vegas and Henderson
Benton County, OR, Benton County Health Department
Lane County, OR, Lane Coalition for Healthy Active Youth
Temple, TX, The Children’s Hospital at Scott & White

This effort was developed by the National Heart, Lung, and Blood Institute, and is being promoted in collaboration with the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Child Health and Human Development, and the National Cancer Institute. Several national private sector organizations are also involved. More information on We Can! is available at http://wecan.nhlbi.nih.gov. To request a free We Can! parent handbook in English or Spanish, call toll-free 1-866-359-3226.

Program Notes

WIN Targets Spanish-speaking Consumers

The Weight-control Information Network (WIN) recently initiated an effort to inform consumers of the availability of its Spanish-language publication Cómo Alimentarse y Mantenerse Activo Durante Toda La Vida: Consejos para la futura mamá. Published in 2003, this WIN brochure provides information on women’s nutritional needs during pregnancy and outlines the benefits of physical activity during this special phase.

Earlier this year, WIN distributed a total of 292,500 “¡Año Nuevo, Vida Nueva!” postcards describing its Spanish-language brochure to 300 convenience stores, hair/nail salons, and laundromats across the Nation. Each of these commercial establishments displayed the WIN postcards in areas where they could be easily seen and picked up by their customers for 8 weeks or until their inventory was depleted.

Although this is not the first WIN initiative addressing Spanish-speakers, it is the first one targeting local establishments with a predominantly Spanish-speaking clientele. Each of the selected sites was located in U.S. cities with a high proportion of low-income Latino residents: Los Angeles, New York, Miami, and Washington, DC.

Consumers wishing to obtain a free copy of this publication should call 1-877-946-4627.

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WIN Travels the Country

WIN will be exhibiting at the following professional conferences this fall:

North American Association for the Study of Obesity 2005 Annual Scientific Meeting
October 15-19, 2005
Vancouver, British Columbia, Canada
American Dietetic Association
Food & Nutrition Conference & Expo
October 22-25, 2005
St. Louis, MO

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Cyber Notes

Kidnetic

Kidnetic.com is a website that encourages nutritious eating and physical activity for children ages 9 through 12 and their families. As reported in the summer 2002 issue of WIN Notes (www.win.niddk.nih.gov/notes/summer02notes/partnershp.htm), this website is an element of ACTIVATE, an educational outreach program of the International Food Information Council Foundation. The site contains interactive tools for children, such as message boards, easy recipes with nutrition information, and diet and fitness tips. It also includes resources for parents, health professionals, and educators.

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Nutrition Explorations

Nutrition Explorations is a program launched by the National Dairy Council that aims to provide parents, teachers, and other members of the public with fun and easy ways to teach nutritious eating. The program’s website, www.nutritionexplorations.org, contains teaching tools for parents and educators, and educational games for children. The site includes sections for food service professionals with information on school-meal programs and milk promotions.

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Resource Notes

NDEP’s Tips for Children With Type 2 Diabetes

The following tip sheets provide basic information about type 2 diabetes, encouraging children to take steps to manage the disease and enjoy a long and healthy life. These tip sheets focus on key components of a personal diabetes plan. Written at the sixth-grade reading level and field-tested with young people from a variety of ethnic groups, they are bright, colorful, and designed for school-age children and their loved ones. The tip sheets were published by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Diabetes Education Program. They are available at www.ndep.nih.gov.

What is Diabetes?

This tip sheet describes diabetes and provides information on how to control the disease. It discusses the effect of carbohydrates on blood glucose and encourages children to eat whole grains, fresh fruits, and vegetables. Regular physical activity, healthy weight maintenance, and frequent blood glucose monitoring are also encouraged.

Be Active

This tip sheet discusses the importance of physical activity for weight maintenance and weight loss. It highlights different types of exercise and provides tips for being more physically active. It also encourages children to involve their parents, family, caregivers, and friends in their physical activity endeavors.

Stay at a Healthy Weight

This tip sheet provides information on the health benefits of weight maintenance in children. Readers can get tips on how to reach a healthy weight and maintain it. It also provides ideas for eating nutritious snacks and meals away from home.

Eat Healthy Foods

This tip sheet discusses why children with diabetes need to eat healthy foods and the nutritional and physiological roles of carbohydrates, fat, and protein. It explains the relationship between carbohydrates and blood glucose and encourages readers to avoid foods and beverages that are high in sugar. It includes a “Healthy Food Guide” listing the food groups and serving sizes.

Materials From NIH/NIDDK

Updated WIN Publications

The Weight-control Information Network (WIN) is in the process of updating its publications to reflect the 2005 Dietary Guidelines for Americans. The guidelines were released jointly by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture in January. The new guidelines outline recommendations to promote health and reduce the risk of chronic disease through nutritious eating and physical activity.

The 2005 Dietary Guidelines for Americans and consumer brochure are available at www.healthierus.gov/dietaryguidelines. For more information on weight control, physical activity, and related nutritional issues, please visit the WIN website at www.win.niddk.nih.gov.

Materials From Other Organizations

Nutritious Nibbles: Our Guide to Healthy Snacking

Published by the American Heart Association (AHA), this brochure provides information on nutritious snacking. It lists ideas to satisfy all types of cravings, including calorie-free breaks and recipes taken from the AHA cookbooks.

This brochure is available at www.americanheart.org, product code 50-1477. Consumers may order up to 10 copies free of charge.

Selecting and Effectively Using Free Weights

This six-page brochure from the American College of Sports Medicine (ACSM) addresses the use of free weights to improve strength and fitness. It covers a variety of issues, including safety, technique, posture, and the use of spotters.

This brochure is complimentary, and is available from ACSM at www.acsm.org.

Editor's Notes

Please send questions or comments, including information you would like to see included in the future issue of WIN Notes, to:

Editor
Weight-control Information Network
1 WIN Way
Bethesda, MD 20892-3665

Telephone: (202) 828-1025
Toll-free: 1-877-946-4627
Fax: (202) 828-1028

Email: WIN@info.niddk.nih.gov.

WIN publications are not under copyright restrictions. Readers may make unlimited copies. To view WIN publications, visit our website at www.win.niddk.nih.gov.