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WIN Notes

Winter 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:

Cyber Notes

Resource Notes

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Research Notes

Physical Fitness versus Body Mass Index—Which Has a Greater Effect on Health?

Physical inactivity and a body mass index (BMI) greater than 25 can each lead to increased health risks such as heart disease, stroke, and type 2 diabetes. But when they are considered together, which presents the greater risk? Two recent studies examining the combined effect of BMI and physical activity on health reached different conclusions.

A prospective study of 37,878 healthy women enrolled in the Women’s Health Study (WHS) looked at the association between BMI, physical activity, and the development of type 2 diabetes. Each year for 7 years, researchers gathered information on the women’s BMI and physical activity levels, and whether they had been diagnosed with type 2 diabetes in the last year. They divided study participants into six groups based on BMI and activity levels: normal-weight active, normal-weight inactive, overweight active, overweight inactive, obese active, and obese inactive.

As expected, when the researchers looked at BMI and physical activity levels separately, they found that women who were overweight or obese had a higher risk of developing type 2 diabetes than normal-weight women, and inactive women had a higher risk than active women. However, when they examined the effects of BMI and physical activity together, increased activity within the same BMI group—normal-weight, overweight, or obese—offered a negligible reduction in the risk of developing type 2 diabetes, but increased BMI, regardless of activity level, led to a significantly higher risk.

A second study that examined the relationship of BMI and physical fitness to the development of cardiovascular disease in women found the opposite effect. Researchers assessed BMI and fitness among 906 women with suspected coronary artery disease (CAD) who were enrolled in the Women’s Ischemia Syndrome Evaluation for diagnostic testing. The women completed two questionnaires, one to assess fitness based on self-reported ability to perform various activities that correlate with treadmill test results, and one to assess average physical activity levels at home, work, and leisure.

Both high BMI and low fitness and activity scores were associated with CAD risk factors such as hypertension, diabetes, and dyslipidemia. However, diagnostic tests showed no difference in the presence or severity of CAD across BMI categories. In contrast, women with low fitness scores were significantly more likely to have obstructive and severe CAD. Follow-up over the course of 4 years revealed that these women suffered more adverse events including stroke, congestive heart failure, and death, regardless of BMI.

In a commentary on the two studies, researchers from the Cooper Institute, a research and education center that focuses on physical activity and health, noted differences in the studies that could partially account for the divergent results. Each one measured different outcomes—development of type 2 diabetes versus adverse cardiovascular events. The diabetes study followed healthy women; the CAD study followed women with suspected heart disease. Each study used different measures of self-reported physical activity with potentially unequal levels of accuracy.

Regardless of the disparities in study methods and results, the Cooper Institute researchers conclude that physical activity is the common denominator in achieving both increased fitness and long-term weight management. Rather than focus on the “fit vs. fat” debate, they suggest that the medical community support physical activity to promote both health and weight control.

Both studies were supported by the National Institutes of Health. The full reports, “Relationship of physical activity vs body mass index with type 2 diabetes in women” and “Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women,” appear in the September 8, 2004 issue of JAMA, as does the commentary.

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High-Calcium Diets Do Not Promote Weight Gain in Girls

Parents and girls who are concerned that diets high in dairy foods—and potentially in fat—may lead to excessive weight gain can breathe a sigh of relief. A pilot study conducted by researchers at the Osteoporosis Research Center of Creighton University in Omaha, NE, concludes that pubertal girls on calcium-rich diets gain weight at the same rate as girls on a normal diet. In addition, high-calcium diets significantly increase overall nutrition and contribute to optimal bone mass accrual in childhood and adolescence.

The researchers assigned 59 normal-weight, 9-year-old girls to either a treatment group that was instructed to consume at least 1,500 mg per day of calcium-rich foods or to a control group of girls who maintained their usual diet over the course of 2 years. Girls in the treatment group got most of their calcium from nonfat or low-fat milk and low-fat and regular cheese, yogurt, and ice cream. Although girls in the treatment group reported consuming nearly double the amount of calcium and an average 150 calories more per day than girls in the control group, they did not have greater increases in body weight, body mass index, or fat or lean mass.

Recent studies have suggested that dietary calcium, especially that from dairy foods, may decrease the risk of overweight. (Experts recommend low-fat and nonfat dairy foods over full-fat versions.) Although the girls on the calcium-rich diet reported consuming more calories per day more than girls in the control group, they did not gain more weight. They also increased their intake of eight essential nutrients, six of which could be attributable to milk consumption, and most of which are not provided by calcium supplements. The study authors suggest that prepuberty is the best time for parents and health professionals to encourage calcium-rich diets, not only to contribute to bone health but also to instill health behaviors that children can carry with them throughout their lives.

The pilot study was funded through a research grant from the National Institute of Nursing Research. The full report is available in the September 2004 Journal of the American Dietetic Association.

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Eating Food with High Glycemic Index Makes Rats Fat

Can a high glycemic index diet lead to obesity and diabetes? The results of a recent study from the Harvard Medical School suggest that this is true – in rats and mice at least.

In the investigation, three experiments were performed. The first used rats that had 60 percent of the pancreas removed, leaving them with fewer working beta cells to produce insulin in response to a rise in blood sugar. This is similar to the working of the pancreas of a person with pre-diabetes – the group of people thought to be most susceptible to the effects of dietary glycemic index (GI). GI is a measure of how a food affects blood sugar levels after eating.

Eleven rats received a high-GI diet and 10 a low-GI diet for 18 weeks. When the high-GI group began to show greater weight gain at 8 weeks, the amount of food they received was reduced slightly to maintain similar mean body weight between the two groups. At the end of 18 weeks, rats fed a high GI-diet had 71 percent more body fat and 8 percent less lean body mass than rats fed a low GI diet, despite weighing the same. The rats eating the easily digested carbohydrates also had higher blood sugar and insulin levels after eating, higher triglyceride levels, and changes in the structure of pancreatic islets – the beta cells of which produce insulin.

In the second experiment, seven rats were fed a high-GI diet and then changed to a low GI diet after 7 weeks. Seven more rats got a low-GI diet and were then changed to a high-GI diet after 7 weeks. Although food was not restricted and body weight between the two groups remained similar, the rats changed to the high-GI diet showed greater increases in blood sugar and insulin levels.

The third experiment followed 24 obesity-prone mice. Mice receiving high-GI feed for 9 weeks had 93 percent more body fat than mice fed a low-GI diet. Again, the mice fed freely and maintained similar body weights.

The GI of the diet has been linked to increased risk for obesity and diabetes in people. An eating plan with a high GI causes regular increases in blood sugar levels. The study authors speculate that these rises could stimulate hunger and the deposit of fat in the body. Chronically high blood sugar levels could also stress the beta cells of the pancreas. The authors suggest that large-scale, long-term trials of low-GI diets should be undertaken.

The full report “Effects of dietary glycaemic index on adiposity, glucose homoeostasis, and plasma lipids in animals” appears in the August 2004 issue of The Lancet.

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Women Who Feel Good About Weight Loss More Likely to Keep It Off

Studies show that most patients who are obese would like to shed much more weight than is realistic using a non-surgical method. These patients typically want to lose up to 34 percent of body weight. Weight losses of 25 and 17 percent are viewed as only “acceptable” and “disappointing” respectively.

Researchers at the University of Pennsylvania School of Medicine sought to change these perceptions, and encourage individuals to find the smaller weight loss goal of 10 percent acceptable. They enrolled 17 women with a mean BMI of 34.7 in a 40-week modified cognitive behavioral treatment program.

The program was divided into four phases. In Phase I (weeks 1 to 4), patients did not change eating or physical activity behaviors. Instead, they focused on factors that influence unrealistic weight loss expectations, including cultural and personal meanings attached to weight status. Personal weight and dieting histories were used to make the point that large weight losses are often short-lived.

During Phase II (weeks 5 to 12), participants were instructed to eat 1,200 to 1,500 calories a day, begin a program of regular physical activity, self-monitor eating and exercise behavior, identify times and places that lead to overeating, and learn to eat highly desired foods in a controlled way.

Participants focused on improving body image and self-esteem during Phase III (weeks 13 to 20). The women learned to modify body image, develop tolerance for imperfect body areas, and change behaviors associated with negative body image such as avoiding social situations and mirrors.

In the fourth phase of the program (weeks 24 to 40), participants developed weight maintenance skills that included maintaining a program of enjoyable physical activity, reversing small weight gains as they occur, and living life now, rather than waiting to lose more weight.

After 40 weeks, participants lost an average of 5.7 percent of their body weights. This amount of weight loss would have been classified as “not successful in any way” at the study outset. However, the women reported significant improvements in satisfaction with their body weight, as well as their body image, self esteem, and quality of life.

One year after the program, participants gained back weight, but self-esteem remained improved. The women had maintained an average loss of 2.9 percent of their original weight. However, those who were less satisfied with their weight after the 40-week program regained three times as much weight as other women. The study authors suggest that satisfaction with body weight at the end of a treatment program protects against weight regain.

The full report “Promoting more modest weight losses: A pilot study” appears in the journal Obesity Research (2004;12:1271-1277).

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Dietary, Obesity Reports

New Dietary Guidelines Released

U.S. Department of Health and Human Services (HHS) Secretary Tommy G. Thompson and U.S. Department of Agriculture (USDA) Ann M. Veneman unveiled the 2005 Dietary Guidelines for Americans at a press conference on January 12. The guidelines, updated every 5 years, form the basis of Federal food, nutrition education, and information programs. Recommendations of a 13-member Dietary Guidelines Advisory Committee, with input from experts and the general public, were used to develop the new guidelines.

In addition to the sound nutritional advice offered to the general public in previous editions, the 2005 Dietary Guidelines address the growing public health problems of obesity and physical inactivity. They also speak to the needs of specific groups such as children and people with certain chronic diseases. The emphasis on physical activity and calorie control to achieve a healthy weight and reduce the risk of chronic diseases offers “a solid combination of research science and common sense,” said Secretary Thompson.

Key recommendations—for the general public and for special populations including people who are overweight, pregnant women, children and adolescents, and older adults —are grouped into nine interrelated focus areas. Their main messages are:

Consume a variety of foods within and among the basic food groups while staying within energy needs.
Balance calorie intake with calories expended to manage body weight.
Be physically active most days of the week—30 minutes a day to reduce the risk of chronic disease, 60 minutes or more to maintain or lose weight.
Increase daily intake of fruits and vegetables, whole grains, and fat-free or low-fat milk and milk products.
Choose fats wisely and keep total fat intake between 20 and 35 percent of calories.
Choose fiber-rich foods with limited added sugars.
Choose and prepare foods with little salt.
If you drink alcoholic beverages, do so in moderation.
Keep food safe to eat.

The 2005 Dietary Guidelines, oriented toward policymakers, nutrition educators, and health care professionals, are based on a rigorous analysis of the latest scientific research. To make the information in the guidelines more accessible to the public, HHS/USDA also released an easy-to-read consumer brochure, Finding Your Way to a Healthier You. Both are available at www.healthierus.gov/dietaryguidelines.

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New Report Marks Action Steps to Prevent Childhood Obesity in U.S.

Clear recommendations for helping children have a healthy weight are spelled out in the report Preventing Childhood Obesity: Health in the Balance. The report, released by the Institute of Medicine (IOM) on September 29, 2004, calls on members of government, industry, media, health care, communities, schools, and families to take action to improve kids’ health. Although there is no universally accepted definition of childhood obesity, the report defines it as age- and gender-specific BMI at or above the 95th percentile on the 2000 CDC growth charts.

Preventing Childhood Obesity puts forth 10 recommendations, and outlines action steps for implementing each of them. The recommendations are:

The U.S. Government should make the prevention of childhood obesity a national priority by funding and coordinating prevention efforts.
Industry should develop and promote products and information that encourage healthful eating and physical activity behaviors.
Nutrition labeling should be clear and useful so parents and youth can make informed product choices.
Industry should develop and stick to guidelines for marketing and advertising to children that minimize obesity risk.
The U.S. Government should develop a long-term, national public relations campaign focused on obesity prevention in children.
Local governments and community groups should work together to develop and promote programs that encourage healthful eating and physical activity behaviors.
Local governments, community groups, and private developers should work together to create opportunities for physical activity such as recreational facilities, parks, sidewalks, and bike paths.
Health care professionals and organizations including insurers should work toward preventing childhood obesity by tracking body mass index (BMI), establishing programs on obesity prevention, and other means.
Schools should provide an environment that makes it easy for students to eat healthfully and be physically active including providing access to nutritious foods, physical education classes, and sports programs or clubs.
Parents should promote healthful eating and physical activity behaviors at home.

The report’s recommendations were developed after a 24-month analysis of behavioral, cultural, societal, and environmental factors involved in childhood obesity. The report was prepared with support from the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Department of Health and Human Services (DHHS) Office of Public Health and Science, and the Robert Wood Johnson Foundation.

The IOM is part of the National Academies of Sciences, a private, non-profit society that advises the Federal Government on scientific and technical matters.

The report can be ordered from the National Academies Press, www.nap.edu. The report’s executive summary can be downloaded free from the same website.

NIH News

WIN Unveils Redesigned Website

Nearly a decade has passed since the Weight-control Information Network (WIN) first launched its website. Since that time, technological advances, user demands, and ever-expanding content have prompted many updates to the site. In October, WIN launched its newly redesigned, user-friendly website, www.win.niddk.nih.gov. The new site features a clean, colorful appearance with easier navigation and access to information.

Navigational panels across the top and bottom occur on nearly every page to expedite movement throughout the website. The revised Publications page is organized by audience: For the Public, For Health Care Professionals, and En Espanol. Both PDF and HTML versions of the publication and video order forms are available. Other new features include an electronic version of WIN Notes, an expanded selection of links to obesity-related research activities supported by NIDDK and NIH, and a new Interactive Tools feature on the Resources page.

Pay us a visit at www.win.niddk.nih.gov.

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A Scientific Approach to Health. . . Beyond Calorie Counting in the Classroom

Through five lessons with clever names such as Burning It Up and Munching Mice, the new curriculum module “The Science of Energy Balance: Calorie Intake and Physical Activity” motivates middle school students to explore the principles of energy balance on their own health. Classroom activities focus on the problems of obesity and maintaining a healthy lifestyle through nutrition and activity.

The National Institutes of Health (NIH) released this free module, in cooperation with the Biological Sciences Curriculum Study of Colorado Springs, to introduce students to the concept of energy balance as a long-term goal by exploring the relationships among knowledge, choice, behavior, power, and human health. Instructional materials help students meet defined objectives and build scientific reasoning skills by integrating the latest research.

For middle school teachers, the module integrates science, mathematics, and health, and utilizes a web-based component with built-in assessment tools. A middle school student, who completed this module in a life science class, said “the lessons related to our lives more than most science.”

The NIH also recently released two other modules. “The Brain: Our Sense of Self” helps seventh and eighth graders expand their understanding of brain function and the nervous system. Using “Technology to Study Cellular and Molecular Biology” engages ninth through twelfth graders in discovering how technological advances enhance health and the quality of life. The modules are available online at http://science.education.nih.gov/supplements; print copies can be ordered through the same website.

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WIN Reaches New and Familiar Audiences

Since August, 2004, WIN has exhibited at five summits and conferences attended by a variety of audiences. The American Association of Diabetes Educators (AADE), the American Dietetic Association (ADA), and the American Public Health Association (APHA) conferences gave WIN the opportunity to potentially reach up to 27,500 health care professionals. WIN staff also delivered a poster presentation at ADA entitled “News Articles and Radio PSAs: Developing Science-based Nutrition and Physical Activity Information for Consumers,” which generated a great deal of interest.

For its Sisters Together: Move More, Eat Better initiative, WIN exhibited in some new venues. The Department of Health and Human Services (DHHS) Office on Women’s Health sponsored the Minority Women’s Health Summit attended by approximately 500 health professionals. Many participants commented that health initiatives focusing on obesity and weight control were a top priority in their State or organization. WIN also exhibited at the Bronner Brothers International Hair Show, the world’s largest Black beauty convention with 100,000 attendees. Hair care professionals visiting the Sisters Together exhibit expressed an interest in and appreciation for the Sisters Together initiative and publications, and many planned to distribute publications at their churches and salons.

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Cyber Notes

Harvard and Aetna Team to Produce Health Information Site

In partnership with Harvard Medical School, Aetna’s www.intelihealth.com offers information on fitness, nutrition, and weight management in its Healthy Lifestyle section. Each topic area offers articles on smart restaurant eating, exercise injury prevention, keeping weight off, smart snacking, and related subjects. Other features include Learn the Basics, Take Action Now, Ask the Expert, health news, and interactive tools such as a body mass index calculator, the USDA Nutrition Database, and an exercise quiz.

The Healthy School Meals Resource System (HSMRS)

The Healthy School Meals Resource System (HSMRS) at http://schoolmeals.nal.usda.gov provides information to people working in USDA's Child Nutrition Programs. Sections include Recipes & Menus, Food Safety, and Chef’s Connection. The Resource Café provides easy access to resources for education and training programs for schools and child care facilities. The site also includes the Training Center, a section to locate conferences, online courses, and tools to educate and motivate staff. HSMRS is developed by the National Agricultural Library's Food and Nutrition Information Center and the University of Maryland Department of Nutrition and Food Science in collaboration with USDA's Food and Nutrition Service.

The Emotional Aspects of Weight Loss

The premise of Health-e-Weight for Women www.brighamandwomens.org/healtheweightforwomen, is that “It’s not about counting calories. It’s about what counts in your life.” The site provides information on the emotional issues of eating, a Why I Eat Inventory, tips for preventing relapse into unhealthy eating patterns, and 15 behaviors of people who manage their weight successfully. The Eating section offers guidelines for healthy eating, recipe makeovers, and a Create Your Plate meal planner. The Exercising section provides tips to get started and keep going on a physical activity program, a target heart rate guide, and making time to be physically action. Visitors to the site can sign up for the electronic Health-e-Weight Newsletter.

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Resource Notes

Materials from WIN

Binge Eating Disorder

Readers of the newly updated binge eating disorder (BED) fact sheet will learn the latest about treatment options for people with BED. New information about links between BED and emotional and psychological problems is outlined. In addition, up-to-date information for locating helpful resources about BED is included in this revised publication. Available from WIN and at www.win.niddk.nih.gov/publications/binge.htm.

Prescription Medications for the Treatment of Obesity

This publication presents clear information about prescription weight loss drugs currently available in the U.S. The newest research-based information about the side effects of medications and how safe and effective they are, is included. Who might benefit from taking a medication and how much a prescribed drug might cost is also reported in this updated fact sheet. Available from WIN and at www.win.niddk.nih.gov/publications/prescription.htm.

Statistics Related to Overweight and Obesity

This updated fact sheet includes the latest statistics from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) conducted by the Centers for Disease Control and Prevention. The survey shows modest increases in overweight and obesity among adults from 1999 to 2002 as well as increases in the prevalence of overweight among children and teens. New information includes the prevalence of type 2 diabetes among people who are overweight or obese. Available from WIN and at www.win.niddk.nih.gov/statistics/index.htm.

Call us at 1-877-946-4627 to order copies or view WIN’s publications online at www.win.niddk.nih.gov.

Materials from Other Organizations

The American Heart Association (AHA) offers brochures for people at risk for heart attack or stroke, including several on healthy eating, weight management, and physical activity. “Easy Food Tips for Heart Healthy Eating” provides low-saturated fat, low-cholesterol alternatives to common high-saturated fat, high-cholesterol foods. “Tips for Eating Out” suggests ways to order heart-healthy foods at many types or restaurants including Chinese, family style, Indian, Italian, Mexican, steakhouses, and more. Other titles include “Nutritious Nibbles: Our Guide to Healthy Snacking,” “Just Move: Our Guide to Physical Activity,” and “Managing Your Weight: Our Guide to Help You Reach and Maintain a Healthy Weight.” Most brochures are also available in Spanish. The first 10 copies of each brochure are free and are available from www.americanheart.org/presenter.jhtml?identifier=1200021.

“Selecting and Effectively Using A Health/Fitness Facility,” a brochure from the American College of Sports Medicine (ACSM), helps readers make an informed decision when selecting a health/fitness facility that meets their needs. It describes the benefits of physical activity and covers safety, personnel, youth services, special needs, and components of a well-rounded program of physical activity. Single print copies are available free from www.acsm.org/health%2Bfitness/brochures.htm. The brochure is also available in pdf format at www.acsm.org/health%2Bfitness/pdf/brochures/SEUHFFbrochure.pdf.

Editor's Note

Please send questions or comments, including information you would like to see included in future issues of WIN Notes, to: Editor, Weight-control Information Network, 1 WIN Way, Bethesda, MD 20892-3665; telephone 202-828-1025 or toll-free 1-877-946-4627; fax 202-828-1028; email: WIN@info.niddk.nih.gov. Educational Services, Inc., operates WIN for the Department of Health and Human Services, Public Health Service, National Institute of Diabetes and Digestive and Kidney Diseases under Contract No. N01-DK-0-2402.

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.