What should we be eating?

Michael Pollan’s famous answer to that question seems the best one: “Eat food. Not too much. Mostly plants.”
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Sind einige Diäten "Massenmord?"

  Sind einige Diäten "Massenmord?" by Prof Dr Dr Ernst Hanisch

Kalorien zählen? Nicht effektiv ...

How calorie-focused thinking about obesity and related diseases may mislead and harm public health. An alternative

Sean C Lucan and James J DiNicolantonio
Public Health Nutrition, http://journals.cambridge.org/action/displayAbstract?aid=9428230

Myths, Presumptions, and Facts about Obesity

Passionate interests, the human tendency to seek explanations for observed phenomena, and everyday experience appear to contribute to strong convictions about obesity, despite the absence of supporting data.
When the public, mass media, government agencies, and even academic scientists espouse unsupported beliefs, the result may be ineffective policy, unhelpful or unsafe clinical and public health recommendations, and an unproductive allocation of resources. In this article, we review some common beliefs about obesity that are not supported by scientific evidence and also provide some useful evidence-based concepts. We define myths as beliefs held to be true despite substantial refuting evidence, presumptions as beliefs held to be true for which convincing evidence does not yet confirm or disprove their truth, and facts as propositions backed by sufficient evidence to consider them empirically proved for practical purposes. Mehr

Calories from Soft Drinks -- Do They Matter?

Obesity has emerged as one of the greatest global health challenges of the 21st century.1 Its increase among children and adolescents is particularly frightening, given the associated metabolic and cardiovascular complications.2,3 Studies from developing countries with populations that are undergoing rapid changes in nutrition are showing increases in the prevalence of childhood obesity.4
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Übergewicht verursacht Krebs...

On April 3, the National Cancer Policy Forum of the US Institute of Medicine released a welcome report entitled The Role of Obesity in Cancer Survival and Recurrence. Many epidemiological studies have identified obesity as a factor in cancer risk and prognosis. Obesity is associated with higher cancer incidence, recurrence, progression, and death. The report emphasises how little is still known about the precise cellular mechanisms that link obesity with cancer. Mehr

Nie wieder Fleisch...

In den letzten 50 Jahren hat sich der weltweite Fleischkonsum verfünffacht. Während man in Europa schon immer viel Fleisch gegessen hat, wächst die Lust darauf nun auch in Ländern wie China und Indien. Doch der Hunger nach Fleisch hat verheerende Konsequenzen. In China nehmen gesundheitliche Probleme der Bevölkerung durch die veränderte Ernährung stetig zu, in Paraguay führt der Futterexport nach Europa zu extremer Armut, in Frankreich und Deutschland ist das Grundwasser durch die extensive Landwirtschaft gefährdet und weltweit leidet das Klima. Viele Masttiere gleichen mittlerweile Futterverwertungsmaschinen und verbringen ihr kurzes Leben zusammengepfercht in dreckigen Ställen. Mehr

Wer nennt Sie fett?

Who are you calling fat?

Tony Delamothe, deputy editor, BMJ
tdelamothe@bmj.com
As England’s adults and children are plumping up (doi:10.1136/bmj.e2332) doctors are tying themselves up in knots over the right words to use with their podgy patients. It’s a minefield out there. On a ward round Ian Seetho wondered aloud whether a patient was too heavy for the hospital’s CT table—only to see his patient’s demeanour rapidly deteriorate (doi:10.1136/bmj.e1370). Apparently, studies show that patients prefer terms like "body mass index" and "excess weight" to "fat," "obese," and "extremely obese." Seetho’s bottom line: "When describing a diagnosis or talking to patients, it is important to be ever so mindful of our choice of words in relation to how they feel about their condition."
I wonder. Operations, pregnancies, and yes, even some investigations are riskier in obese people. Shouldn’t doctors be able to speak these simple truths in simple words? Seetho worries that the use of potentially pejorative terms may be interpreted as moral judgments. Perhaps, but I’m reminded of Robert Hughes’s lament at the heart of his Culture of Complaint: "It’s as though all human encounter were one big sore spot, inflamed with opportunities to unwittingly give, and truculently receive, offence."
2120).
Des Spence believes that medicine’s challenge this century is to fight the pandemic of iatrogenic harm, and general health screening checkups are firmly in his sights. They lack any scientific basis and lead to more investigations, anxiety, and profit—although not for patients. He blames these checks for the overtreatment of breast and prostate cancer (doi:10.1136/bmj.e2346).
Nevertheless, screening retains its allure. As part of his plan to make the UK a world leader in dementia care, the prime minister announced this week that everyone aged 65 to 74 will be screened for early signs of dementia (doi:10.1136/bmj.e2347). Does such a programme satisfy the UKNSC’s criteria for introducing a new screening test (www.screening.nhs.uk/criteria)? I don’t think so.
Cite this as: BMJ 2012;344:e2363

Das Gehirn in den Zeugenstand

Ist es meine Schuld, dass ich zu dick bin? Die fünfte Todsünde sollte in Zeiten moderner Medizin nicht länger als Rechtfertigung für moralische Urteile dienen. Hier kommt der Freispruch für Schwergewichtige.


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Drei-Affen-Übung - Oder: Wer will das schon wissen?

...dass in deutschen Ställen jedes Jahr mehr als 800 Tonnen Antibiotika verfüttert werden...


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Energy in and Energy out: What Matters for Survivors of Colorectal Cancer?

It has long been known that obesity increases the risk of type 2 diabetes and cardiovascular disease, but only in the past decade has it become widely accepted that obesity is also one of the risk factors for various cancers, including colorectal cancer.1,2 Renehan et al3 analyzed 29 data sets including 37,334 patients and reported that every 5 kg/m2 increase in body mass index (BMI) was associated with 24% higher incidence of both colon and rectal cancer in men and 9% higher incidence of colon cancer in women. Despite the consistency of the data associating adiposity with colorectal cancer development,4–6 the impact of obesity on mortality among patients with colorectal cancer is less clear.7–13 Some of the variability in the results seems related to the timing of BMI measurements (prediagnosis, at the time of diagnosis, postdiagnosis), potential gender interactions, site of cancer (colon v rectum), and stage of cancer. Mehr

Kinder, die zu wenig schlafen, werden häufiger übergewichtig...the FLAME study

Research: Longitudinal analysis of sleep in relation to BMI and body fat in children: the FLAME study
http://www.bmj.com/cgi/doi/10.1136/bmj.d2712
(Editorial: Is prolonged lack of sleep associated with obesity?)
http://www.bmj.com/cgi/doi/10.1136/bmj.d3306
Young children who do not get enough sleep are at increased risk of becoming overweight, even after taking account of lifestyle factors, finds a study published on bmj.com today.
Several studies have shown a relatively consistent relation between shorter sleep duration and increased body weight in children, but doctors are still not sure how sleep and body composition interact in early childhood and whether this shows cause and effect.
So a team of researchers in New Zealand set out to investigate whether reduced sleep is associated with differences in body composition and the risk of becoming overweight in young children.
They identified 244 children who were taking part in The Family Lifestyle, Activity, Movement and Eating (FLAME) study in Dunedin, New Zealand.
Each child's weight, height, body mass index (BMI), and body composition were measured every six months from 3 to 7 years of age. Sleep habits and physical activity levels were assessed by accelerometry (the children wore a belt carrying a device that monitors body movement) and dietary intake by questionnaire at 3, 4 and 5 years.
Other factors, such as birth weight, mothers' education, income, BMI, smoking during pregnancy and ethnicity were also recorded because of known links with BMI in children.
Average sleep duration was about 11 hours per day at all three ages.
The results show that young children who sleep less are at a significantly increased risk of having a higher BMI by age 7, even after controlling for other risk factors that have been implicated in body weight regulation.
Each additional hour of sleep per night at age 3 to 5 years was associated with a reduction in BMI of 0.49 and a 61% reduction in the risk of being overweight or obese at age 7.
In a child of average height, this corresponds to a difference of 0.7kg body weight. While this might seem minor at an individual level, the benefits for public health, if applied at the population level, are considerable, say the authors.
More importantly perhaps, the reductions in BMI were due to differences in fat mass, rather than any effect on fat-free mass, showing that poor sleep has negative effects on body composition.
They suggest that reduced sleep may increase dietary intake and may also influence energy expenditure, leading to reduced exercise.
In conclusion, it appears that sleep is an important determinant of future body composition in young children, say the authors. They recommend that appropriate sleep habits should be encouraged in all children as a public health measure, and call for more studies to determine whether more sleep or better sleeping patterns impact favourably on body weight and other health outcomes.
This view is supported in an accompanying editorial by Professor Francesco Cappuccio and Associate Professor Michelle Miller from the University of Warwick. They say that, not only may prolonged lack of sleep be a direct contributor of overweight and obesity in children, it could also have other effects on long term health.
They call for future research to explore new behavioural methods to prolong children and adults' sleeping time, and suggest that, in the meantime, it would do no harm to advise the general public of all ages that a sustained curtailment of sleeping time might contribute to long term ill-health in both adults and children.
Contacts:
Research: Rachael Taylor, Karitane Research Associate Professor in Early Childhood Obesity, Department of Human Nutrition, Dunedin, New Zealand
Email: rachael.taylor@otago.ac.nz
Editorial: Francesco Cappuccio, Cephalon Chair of Cardiovascular Medicine and Epidemiology, University of Warwick, Warwick Medical School, Coventry, UK
Email: f.p.cappuccio@warwick.ac.uk
For more information please contact: Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bmjgroup.com

Nudge

Can nudging help fight the obesity epidemic?
(Head to Head: Is nudge an effective public health strategy to tackle obesity?)
Yes: http://www.bmj.com/cgi/doi/10.1136/bmj.d2177
No: http://www.bmj.com/cgi/doi/10.1136/bmj.d2168
With obesity rates soaring, the government has been promoting nudge - a strategy that does not tell people how to live but encourages them to make healthy choices in respect of diet and exercise.
Experts on bmj.com this week go head to head over whether nudge is an effective way to tackle obesity.
Professor Tim Lang and Dr Geof Rayner, both from the Centre for Food Policy at City University in London, say that nudge is not new and that it is "a smokescreen for, at best, inaction and, at worst, publicly endorsed marketing."
They argue that the nudging strategy portrays governments in a soft light and allows them to shy away from taking tough action that can be unpopular - for example introducing more regulation, higher taxes and legislation that restricts or bans unhealthy habits.
The responsibility deals with industry that were formalised in the 2010 public health white paper add further concern to the use of nudging, they say.
Finally, they also worry that nudge "becomes collusion between the state and corporations to hoodwink consumers."
But Dr Adam Oliver from the London School of Economics and Political Science in London, argues that there is a lot of ignorance about what nudge actually means. He says that nudge should not be seen as a replacement for stricter forms of food regulation but rather as "an additional tool to complement regulation by moving society incrementally in a direction that might benefit all of us."
Oliver says that, while nudging is at an initial development stage and that little evaluation has taken place, "the beauty in the approach in that almost everyone can think up and pilot financially costless initiatives in their households or workplaces."
He concludes that, "in tackling obesity, the nudge approach will be no substitute for regulation of the food and drinks industry, but it may nonetheless serve the social good."
Contacts:
Geof Rayner, Honorary Research Fellow, Centre for Food Policy, City University, London, UK
Email: hollie.jenkins.1@city.ac.uk
Adam Oliver, Senior Lecturer, LSE Health, London School of Economics and Political Science, London, UK
Email: a.j.oliver@lse.ac.uk

A long Look at Obesity

Is the problem of obesity truly a recent phenomenon—the medical symptom of a sick western society overwhelmed by a cornucopia of calorie-laden food and drink? Or is it an unhealthy manifestation of what should be recognised as a natural inclination to adiposity, an evolutionary necessity without which many creatures, not merely human beings, could not survive the vicissitudes of an irregular food supply. There is a common presumption, particularly among those currently engaged in determining our approach to the issues of nutrition and obesity, that our ancestors must have been supreme specimens with healthy lifestyles. Even with their primitive understanding of nutrition, our neolithic forebears somehow made the “right choices”, thriving on a wholesome diet of nuts, seeds, and fruits with the occasional piece of meat. And what is more, their rare intake of animal protein could only have been obtained through vigorous exercise, which they would, of course, indulge in religiously every day.

Interestingly, the historical evidence suggests a quite different story.

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Vorsicht Bildschirm

"Fernsehen macht dick, dumm und gewalttätig." Davon ist der Hirnforscher Manfred Spitzer fest überzeugt und hat für seine Kinder daraus die Konsequenz gezogen, den Fernseher abzuschaffen.

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Obesity and sexual health

Etwas Speck ist gut - und schlecht

Leichtes Übergewicht kann durchaus schützen - sofern man bestimmte Krankheiten hat. So weit, so gut. Warum die Ärzte dennoch meistens zum Abnehmen raten, zeigt sich in vielen Studien.

Dem allseits grassierenden Übergewicht möchte so mancher etwas Gutes abgewin­nen. Das liest man in Berichten über den Unsinn von Diäten oder über magersüch­tige Models zwischen den Zeilen. Bereits die Wortfolge „Dicke leben länger" er­zielt über 700 000 Treffer in einer Such­maschine. Tatsächlich bringt Überge­wicht auch Vorteile mit sich, sogar er­kennbare Überlebensvorteile. Allerdings muss man, will man von den überzähli­gen Pfunden profitieren, erst einmal krank sein, zum Teil sogar schwer krank. So lautet das Fazit einer Zusammenschau der verfügbaren Studien, welche die Sozi­almediziner Anita Rieder von der Univer­sität Wien und Thomas Ernst Dorner von der Universität Graz in der „Deutschen Medizinischen Wochenschrift" veröffent-licht haben (Bd. 135, S.413).

Dass Übergewicht eigentlich auf lange Sicht krank macht, ist hinlänglich gezeigt worden. Experten halten sich dabei an den Body-Mass-Index (BDI) als Körper­gewicht dividiert durch die Körpergröße zum Quadrat. Die Spanne von 22,5 bis 25

Kilogramm pro Quadratmeter gilt ihnen als ein vergleichsweise zuverlässiges Maß für Normgewichtigkeit. Dass nun mitun­ter Menschen jenseits eines BDI von 25 länger leben als jene mit Normwerten, be­zeichnet man als Risikofaktor-Paradoxon oder Adipositas-Paradoxon. Für Men­schen ab einem Alter von 65 Jahren gilt eher ein Index von 27 bis 30 als optimal. Eine chronische Herzinsuffizienz wird von Übergewichtigen oft besser bewäl­tigt. Eine Studie mit 28 209 Personen hat gezeigt, dass bei Fettsüchtigen die Sterb­lichkeit im Vergleich zu normalgewichti­gen Herzpatienten um bis zu einem Drit­tel geringer ist. Das Risiko, speziell an ei­ner Erkrankung des Herz-Kreislauf-Sys­tems zu versterben, ist sogar um 40 Pro­zent geringer. Ähnliches gilt für das Über­leben nach Erkrankungen der Herzkranz­gefäße. Hier zeigte sich, dass Unterge­wicht bei dieser Erkrankung das Risiko zu sterben verdoppelt.

Der Nutzen eines erhöhten BDI be­schränkt sich nicht auf das Herz-Kreis­lauf-Erkrankungen. Vorteile von Überge­wicht für das Überleben wurden auch für dialysepflichtige Patienten und bei so un­terschiedlichen Leiden wie rheumatoider Arthritis, HIV-Infektion und Aids, chro­nisch-obstruktiver Lungenerkrankung, Prostatakarzinom oder Leberzirrhose ge­zeigt. Biologisch bietet der Schutz vor den Folgen von Entzündungen, den das erhöhte Körpergewicht offenbar mit sich bringt, eine plausible Erklärung. Chroni­sche Entzündungen lassen nämlich die Muskelmasse schmelzen und tragen gera-

de bei älteren Personen zu einer mitunter lebensbedrohlichen Gebrechlichkeit bei. Als weiterer Grund für längeres Überle­ben kommen erhöhte Cholesterinwerte in Frage. Dadurch gelingt es dem Organis­mus eher, bakterielle Giftstoffe, so ge­nannte Endotoxine, leichter zu neutrali­sieren. Nicht zuletzt kann das Fettgewebe selbst toxische Stoffwechselprodukte un­schädlich machen, wie sie beispielsweise im Laufe von auszehrenden Krebserkran­kungen vermehrt gebildet werden.

Diese Zusammenhänge zeigen jedoch allenfalls, dass Übergewicht unter ganz bestimmten pathologischen Bedingun­gen nützt. Wie wenig man daraus einen allgemeinen Freibrief für Übergewicht ab­leiten kann, zeigt sich etwa an überge­wichtigen Dialysepatienten. Selbst bei den bekannten Vorteilen wird ihnen den­noch eine Gewichtsabnahme nahe ge­legt, denn ein zu hohes Gewicht schmä­lert die Aussichten auf eine erfolgreiche Nierentransplantation. Und sogar überge­wichtigen herzinsuffizienten Patienten wird weiterhin eine Gewichtsabnahme empfohlen, da das Übergewicht auch hier letztlich als langfristiges Risiko das Fort­schreiten der Erkrankung begünstigt. All diese Beobachtungen bieten deshalb kei­nerlei Grundlage für Beschwichtigungen. Abgesehen von den genannten, oft schwerwiegenden Erkrankungen profitie­ren übergewichtige Erwachsene und vor allem übergewichtige Kinder stets von ei­ner Gewichtsreduktion, so bereitwillig man auch etwas anderes hören möchte. MARTINA LENZEN-SCHULTE

FAZ Seite N2 Mittwoch 12. Mai 2010 Nr 109

Genießen Sie doch!

Nach der Fastenzeit ist vor der nächsten Diät: Der Arzt und Autor Gunter Frank über das Abnehmen und warum es so schwer ist.

Mandometer - Abnehmhilfe

New eating device retrains dietary habits and helps children lose weight(Research: Treatment of childhood obesity by retraining eating behaviour: a randomised trial)http://www.bmj.com/cgi/doi/10.1136/bmj.b5388
A new computerised device that tracks portion size and how fast people eat is more successful in helping obese children and adolescents lose weight than standard treatments, according to research published on bmj.com today.
The Mandometer device, a portable computerised weighing scale, was developed at the Karolinska Institutet in Stockholm. It helps to retrain individuals to eat less and more slowly by providing real-time feedback during meal times. The device plots a graph showing the rate at which food actually disappears from the plate, compared to the ideal graph programmed in by a food therapist.
Childhood obesity is an increasing global problem and there is little evidence to support one specific treatment programme. While it is unknown whether specific eating patterns are common in all obese people, in this study the patients ate large portions very quickly.
Researchers at Bristol Royal Hospital for Children and the University of Bristol, led by Professor Julian Hamilton-Shield, carried out a randomised controlled trial of 106 obese patients aged between 9-17 years.
One group of participants received Mandometer therapy to lose weight and the other were provided with standard care. Both groups were encouraged to increase their levels of physical activity to 60 minutes of exercise a day and to eat a balanced diet based on the Food Standards Agency "eatwell plate."
Participants were assessed after 12 months and followed up at 18 months. During the research period they were also regularly monitored and offered telephone support and encouragement.
After 12 months, the Mandometer group not only had a significantly lower average body mass index and body fat score than the standard care group, but their portion size was smaller and their speed of eating was reduced by 11% compared with a gain of 4% in the other group. Levels of 'good cholesterol' were also significantly higher in the Mandometer group.
The improvement in body mass index was maintained six months after the end of treatment, suggesting an element of longer term behavioural change, add the authors.
"Mandometer therapy, focussing on eating speed and meal size, seems to be a useful addition to the rather sparse options available for treating adolescent obesity effectively without recourse to pharmacotherapy," say the authors.
They acknowledge that the Mandometer requires further evaluation in other settings and with different groups of patients, but conclude that "Retraining eating behaviour and reinforcing feelings of satiety, however, does seem to improve weight loss in obese adolescents."

Schlank werden, schlank bleiben...

Schlankwerden und Schlankbleiben ist Schwerstarbeit! Das wissen viele stark übergewichtige Erwachsene mit langer Diätkarriere aus eigener leidvoller Erfahrung. Herkömmliche Abnehmbemühungen bringen oft wenig und anfänglich purzelnden Pfunden folgt nicht selten eine noch größere Gewichtszunahme ...

Um Übergewicht zu senken, gibt es nur eine effektive Lösung: die dauerhafte Umstellung des Aktivitätsverhaltens in Richtung auf eine energetisch ausgeglichene Lebensweise und eine gleichzeitige Verbesserung der Ernährungsqualität. Kurz: Mehr bewegen. Gesünder essen.

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