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If Your Kids Are Awake, They’re Probably Online

Thursday, March 25th, 2010

A new study from the Kaiser Family Foundation, and expert Dr. Michael Rich, a pediatrician at Children’s Hospital Boston who directs the Center on Media and Child Health, examined the potential link between the increased use of media products by America’s youth and the effects on their behavior and health. Physical activity is important for children to stay healthy. People wonder and worry that the increased amount of time young people spend playing with electronics could have negative social and health related impact

By TAMAR LEWIN
New York Times

The average young American now spends practically every waking minute — except for the time in school — using a smart phone, computer, television or other electronic device, according to a new study from the Kaiser Family Foundation.

Those ages 8 to 18 spend more than seven and a half hours a day with such devices, compared with less than six and a half hours five years ago, when the study was last conducted. And that does not count the hour and a half that youths spend texting, or the half-hour they talk on their cellphones.

And because so many of them are multitasking — say, surfing the Internet while listening to music — they pack on average nearly 11 hours of media content into that seven and a half hours.

“I feel like my days would be boring without it,” said Francisco Sepulveda, a 14-year-old Bronx eighth grader who uses his smart phone to surf the Web, watch videos, listen to music — and send or receive about 500 texts a day.

The study’s findings shocked its authors, who had concluded in 2005 that use could not possibly grow further, and confirmed the fears of many parents whose children are constantly tethered to media devices. It found, moreover, that heavy media use is associated with several negatives, including behavior problems and lower grades.

The third in a series, the study found that young people’s media consumption grew far more in the last five years than from 1999 to 2004, as sophisticated mobile technology like iPods and smart phones brought media access into teenagers’ pockets and beds.

Dr. Michael Rich, a pediatrician at Children’s Hospital Boston who directs the Center on Media and Child Health, said that with media use so ubiquitous, it was time to stop arguing over whether it was good or bad and accept it as part of children’s environment, “like the air they breathe, the water they drink and the food they eat.”

Contrary to popular wisdom, the heaviest media users reported spending a similar amount of time exercising as the light media users. Nonetheless, other studies have established a link between screen time and obesity.

While most of the young people in the study got good grades, 47 percent of the heaviest media users — those who consumed at least 16 hours a day — had mostly C’s or lower, compared with 23 percent of those who typically consumed media three hours a day or less. The heaviest media users were also more likely than the lightest users to report that they were bored or sad, or that they got into trouble, did not get along well with their parents and were not happy at school.

The study could not say whether the media use causes problems, or, rather, whether troubled youths turn to heavy media use.

“This is a stunner,” said Donald F. Roberts, a Stanford communications professor emeritus who is one of the authors of the study. “In the second report, I remember writing a paragraph saying we’ve hit a ceiling on media use, since there just aren’t enough hours in the day to increase the time children spend on media. But now it’s up an hour.”

The report is based on a survey of more than 2,000 students in grades 3 to 12 that was conducted from October 2008 to May 2009.

On average, young people spend about two hours a day consuming media on a mobile device, the study found. They spend almost another hour on “old” content like television or music delivered through newer pathways like the Web site Hulu or iTunes. Youths now spend more time listening to or watching media on their cellphones, or playing games, than talking on them.

“I use it as my alarm clock, because it has an annoying ringtone that doesn’t stop until you turn it off,” Francisco Sepulveda said of his phone. “At night, I can text or watch something on YouTube until I fall asleep. It lets me talk on the phone and watch a video at the same time, or listen to music while I send text messages.”

Francisco’s mother, Janet Sepulveda, bought his phone, a Sidekick LX, a year ago when the computer was not working, to ensure that he had Internet access for school. But schoolwork has not been the issue.

“I’d say he uses it about 2 percent for homework and 98 percent for other stuff,” she said. “At the beginning, I would take the phone at 10 p.m. and tell him he couldn’t use it anymore. Now he knows that if he’s not complying with what I want, I can suspend his service for a week or two. That’s happened.”

The Kaiser study found that more than 7 in 10 youths have a TV in their bedroom, and about a third have a computer with Internet access in their bedroom.

“Parents never knew as much as they thought they did about what their kids are doing,” Mr. Roberts said, “but now we’ve created a world where they’re removed from us that much more.”

The study found that young people used less media in homes with rules like no television during meals or in the bedroom, or with limits on media time.

Victoria Rideout, a Kaiser vice president who is lead author of the study, said that although it has become harder for parents to control what their children do, they can still have an effect.

“I don’t think parents should feel totally disempowered,” she said. “They can still make rules, and it still makes a difference.”

In Kensington, Md., Kim Calinan let her baby son, Trey, watch Baby Einstein videos, and soon moved him on to “Dora the Explorer.”

“By the time he was 4, he had all these math and science DVDs, and he was clicking through by himself, and he learned to read and do math early,” she said. “So if we’d had the conversation then, I would have said they were great educational tools.”

But now that Trey is 9 and wild about video games, Ms. Calinan feels differently.

Last year, she sensed that video games were displacing other interests and narrowing his social interactions. After realizing that Trey did not want to sign up for any after-school activities that might cut into his game time, Ms. Calinan limited his screen time to an hour and half a day on weekends only.

So last Wednesday, Trey came home and read a book — but said he was looking forward to the weekend, when he could play his favorite video game.

Many experts believe that media use is changing youthful attitudes.

“It’s changed young people’s assumptions about how to get an answer to a question,” Mr. Roberts said. “People can put out a problem, whether it’s ‘Where’s a good bar?’ or ‘What if I’m pregnant?’ and information pours in from all kinds of sources.”

The heaviest media users, the study found, are black and Hispanic youths and “tweens,” or those ages 11 to 14.

Even during the survey, media use was changing.

“One of the hot topics today is Twitter, but when we first went into the field and began interviewing, Twitter didn’t exist,” Ms. Rideout said.

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Snack Time Never Ends

Thursday, March 25th, 2010

According to a large study of American nutritional habits conducted by the Agriculture Department with the Department of Health and Human Services, snacking habits have increased. In addition, the amount of snacking went up and number of meals went down for children. Kara Nielsen, a “trendologist” at the Center for Culinary Development, a brand development company in San Francisco, Dr. Howard Taras, a pediatrics professor at the University of California, San Diego, who specializes in community and school health policies, and Ellyn Satter, a family therapist, speak about the role of parents in regards to their child’s snacking habits.

By JENNIFER STEINHAUER

New York Times
OF the many horrors that lurk in the e-mail in-box of a working parent — dental reminders, Facebook invitations involving some weird farm, “thoughts” from the boss — nothing quite rivals the snack request.

Not a month goes by without someone somewhere asking me to serve up some snack for an event that one of my children will attend and that, generally speaking, will not last more than 90 minutes.

During a single week in December, I was pinged with requests to bring a little food for one play rehearsal, three religious-school events, a school administrative meeting, two soccer games and two multicultural festivals. (O.K., so multicultural day is one of my favorite events of the school year. Step away from the Sichuan dumplings, kids, Hannah’s mom is moving in! Still.)

The obligations to bring a little something to eat extend to the adult world, too — I’ve baked for PTA meetings and child-rearing seminars that I didn’t even attend. But when it comes to American boys and girls, snacks seem both mandatory and constant. Apparently, we have collectively decided as a culture that it is impossible for children to take part in any activity without simultaneously shoving something into their pie holes.

“Children used to come home, change into play clothes and go outside and play with other children,” said Joanne Ikeda, a nutritionist emeritus at the University of California, Berkeley. “There were not snack machines, and the gas stations only sold gas. Now there are just so many more opportunities to snack and so many activities after school to have snacks.”

Between 1977 and 2002, the percent of the American population eating three or more snacks a day increased to 42 percent from 11 percent, according to a large study of American nutritional habits conducted by the Agriculture Department with the Department of Health and Human Services.

Further, researchers found, the percent of children surveyed who said they had eaten three meals on the previous day went down, while those who had had a snack went up more than 40 percent.

“None of this trend has reversed,” said Rhonda Sebastian, a nutritionist with the Agricultural Research Service, the unit of the Agriculture Department that participated in the survey. (The data for 2008 exists but the snacking component has not yet been analyzed.) “Food is everywhere now. It is part of everything.” I began to wonder how other parents see all this extracurricular eating, so I asked around a bit. Apparently, I am not the only one being driven crazy.

“It has all just gotten out of hand,” said Sean O’Neill, an illustrator and father of two in Chicago. Mr. O’Neill wonders why snacks must be served at every sporting event, even those taking place at 10 a.m. or an hour before lunch.

“The kids are playing baseball, they are covered in Chicago Park District dirt and then they eat a handful of fruit bites,” he said. “It’s pretty disgusting.”

Some of the moms I see around the school corridors and the soccer field told me they felt backed into a corner by the omnipresence of snacks.

Once a week, Vivian Zachary’s 6-year-old son, Joel, goes dashing for the vending machine at the gym after his gymnastics class ends at 5 p.m. “Last week it was a Fruit Roll-Up and a can of 7Up,” Ms. Zachary wrote in an e-mail message. “I’m not sure why I let this go on, and I often think that if I were a better parent, or at least more able to tolerate incessant complaining, I would let him buy the snacks but not actually consume them until after dinner. But I have already established the pattern (the ‘rule’ in Joel’s mind), so there’s no going back now.”

The spread of snacking has been abetted by parental guilt, the much-lamented death of the family dinner, over-scheduled children. Kara Nielsen, a “trendologist” at the Center for Culinary Development, a brand development company in San Francisco, cites the proliferation of activities, from soccer to chess club to tutoring sessions, that now fill children’s afternoons.

“You’ve got this desire for parents to control their kid’s diet,” Ms. Nielsen added, “and add this with this increase in activities, so it has become up to the parents to provide the snacks. And the marketers have picked up on this.”

Indeed, this nation consumed $68.1 billion in packaged snack foods in 2008, up from $60 billion in 2004, according to Packaged Facts, a consumer research group. One of the newest concepts — and among the best sellers, Ms. Nielsen said — are 100-calorie packs of cookies and other junk foods. They are targeted at parents, who are always looking for something to toss into the backpack for after-school time.

Fast-food restaurants are in on the act, and over the last two years have begun to introduce their own mini-meals, like the McDonald’s Snack Wrap. According to the Agriculture Department, American children get 40 percent of their calories from food of poor nutritional quality.

What is especially baffling where I live, in Los Angeles, is how often the kind of parental paranoia that obsesses about school ratings, vaccines and myriad imagined plagues is matched by utter disregard for the nutritional downsides of mowing down Fruit by the Foot every afternoon at 4. Rarely do I see a parent show up on the soccer field with a homemade snack, or even a bag of carrots. Oreos are the post-game snack of choice, even in sports leagues dominated by upper-income parents.

“There is definitely a big disconnect,” said Dr. Howard Taras, a pediatrics professor at the University of California, San Diego, who specializes in community and school health policies. “I think there is this natural tendency among parents to not want their child to go hungry. It is more difficult for them to think about the long-term outlook for the child.”

Ellyn Satter, a dietitian and family therapist, thinks there is little point in worrying too much about what children are eating — unless it is “pure sugar,” like juice, she said — or how much, because children self-regulate portions. The key, she said, is to end grazing. “The parents’ job is to do the what, when and where of feeding,” she said, “and it is up to the children to do the how much and whether of eating. In order to have successful family meals, you have to structure the snacks.”

Carolynne Dyner sees the purpose of snacks for her children, Quinn, who is 7, and Sadie, 5, through a fairly simple prism. “To stave off tantrums, of course,” she said. From their days caring for infants, she said, parents are conditioned to be prepared for a sudden attack of hunger. And so she keeps her car and purse amply packed with pretzels, baggies of Cinnamon Life cereal, Goldfish crackers and Clif bars.

For her children, little bites between meals have in some ways supplanted the meals themselves. “They usually need a snack midmorning and midafternoon,” explained Ms. Dyner, who lives in Beverly Hills, Calif. “There may be a third snack, and this is usually due to the fact that our kids didn’t care much for what we provided for dinner, so now it is 7:30 and they are hungry. At this point we may give them a yogurt.”

Parents who give in too many times may find that snacks are the culinary equivalent of letting your 2-year-old sleep in your bed. “People get themselves into these habits, which they later regret tremendously,” said Ms. Ikeda, the nutritionist. “We do, as parents, make mistakes and then we either have to live with them or suffer the consequences in fixing them. It gets exhausting saying ‘no’ all the time.”

On the other hand, saying ‘yes’ can be tiring, too. I am happy to serve on any refreshment committee there is. I like to bake, and am far more efficient at that than at any other classroom obligation. Just ask the parent liaison for my younger child’s classroom, whose response to my failure to properly manage a canned goods drive was only slightly less frosty than that of a rogue nation asked to cease nuclear development.

But a person can’t just bake whole-wheat banana bread and call it a day. Here was the memo I received concerning my recent snack obligation for a play practice. “Please note, we have the following allergies in mini players: Peanuts, cashews, nuts, wheat, dairy, strawberries, milk, egg whites.”

Food allergies are a real problem. But did no one ponder the idea that perhaps the solution is for children to bring their own snacks?

Or to eat no snacks at all?

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Childhood Obesity Alone May Increase Risk of Later Cardiovascular Disease

Thursday, March 25th, 2010

It’s no wonder that in a country where the rates of obesity are rising, other negative health consequences are increasing too. According to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM), Nelly Mauras, MD, of Nemours Children’s Clinic in Jacksonville, Florida and senior author of the study, investigated the correlation between childhood obesity and cardiovascular risk factors.

ScienceDaily (Jan. 26, 2010) — By as early as 7 years of age, being obese may raise a child’s risk of future heart disease and stroke, even in the absence of other cardiovascular risk factors such as high blood pressure, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).
“This new study demonstrates that the unhealthy consequences of excess body fat start very early,” said Nelly Mauras, MD, of Nemours Children’s Clinic in Jacksonville, Florida and senior author of the study. “Our study shows that obesity alone is linked to certain abnormalities in the blood that can predispose individuals to developing cardiovascular disease early in adulthood.
These findings suggest that we need more aggressive interventions for weight control in obese children, even those who do not have the co-morbidities of the metabolic syndrome.”
The metabolic syndrome is a cluster of risk factors that raise the risk of developing heart disease, stroke and diabetes. It is being increasingly diagnosed in children as being overweight becomes a greater problem. Although debate exists as to its exact definition, to receive a diagnosis of metabolic syndrome, one must have at least three of the following characteristics: increased waist circumference (abdominal fat), low HDL (“good”) cholesterol, high triglycerides (fats in the blood), high blood pressure and high blood glucose (blood sugar).
Mauras and her colleagues wanted to know if obesity could raise cardiovascular disease risk prior to the onset of the metabolic syndrome. Researchers therefore screened more than 300 individuals ages 7 to 18 years and included only those without features of the metabolic syndrome. They included 202 participants in the study: 115 obese children and 87 lean children as controls. Half of the children were prepubertal and the other half were in late puberty. Obese children had a body mass index (a measure of body fat) above the 95th percentile for their sex, age and height.
To be eligible to participate in the study, the children and adolescents had to have normal fasting blood sugar levels, normal blood pressure and normal cholesterol and triglycerides. Lean controls also could not have a close relative with type 2 diabetes, high cholesterol, high blood pressure or obesity. The latter group proved very difficult to find.
All study participants underwent blood testing for known markers for predicting the development of cardiovascular disease. These included elevated levels of C-reactive protein (CRP), a marker of inflammation, and abnormally high fibrinogen, a clotting factor, among others. Obese children had a 10 fold higher CRP and significantly higher fibrinogen concentrations, compared with age- and sex-matched lean children, the authors reported. These abnormalities occurred in obese children as young as age 7, long before the onset of puberty.
The results were striking Mauras stated, as the children were entirely healthy otherwise. Although it is not yet known whether early therapeutic interventions can reverse high CRP and fibrinogen, she said it would be prudent for health care providers to advise more aggressive interventions to limit calories and increase activity in “healthy” overweight children, even before the onset of puberty.
“Doctors often do not treat obesity in children now unless they have other features of the metabolic syndrome,” Mauras said. “This practice should be reconsidered. Further studies are needed to offer more insight into the effects of therapeutic interventions in these children.

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Super Sizing Insanity

Thursday, March 25th, 2010

 

Super-Sizing Insanity

It’s no secret that American children and teens are struggling with their weight.  As of 2008, 1/3 of all children and teens were classified as either overweight (85% – 95% BMI – Body Mass Index – weight adjusted for height or BMI -  based on their age and gender), or obese (95%+).

Super-sizing Children and Teens

One particularly disturbing recent trend was reported last week by Kaiser Permanente, the large Health Maintenance Organization based in California, in a study published in the journal Pediatrics.  According to Kaiser, more kids are graduating from the “obese” category to “extremely obese.”  Based on the study, Kaiser estimates that 6.4% of children and teens are now “extremely obese.”  The CDC defines extreme obesity as having a BMI 20% higher than the 95th percentile BMI.

The Kaiser study drew from the electronic medical records of 710,949 patients ages 2 to 19 years old enrolled in 2007-2008 in Kaiser health programs in Southern California.  About 7.3 percent of boys and 5.5 percent of girls were extremely obese, translating to about 560,000 children and adolescents in California. For a 10-year-old girl who is 4 feet 6 inches tall, extreme obesity starts at 129 pounds, according to Kaiser. For an 18- year-old boy who is about 5 feet 10 inches, 272 pounds is classified as extremely obese. 

Extremely obese children develop heart and other deadly diseases at a rate much higher than the already elevated levels of obese children, including increased rates of hypertension, high cholesterol and elevated liver enzymes. “Without major lifestyle changes, these kids face a 10-to- 20-years shorter life span and will develop health problems in their 20s that we typically see in 40-60 year olds,” one of the Kaiser researchers said in a statement.

Super-sizing on Purpose – A Mom Striving to Become the First Half Ton Mom

Meanwhile, on the other side of the country, a 600 lb. woman received a great deal of media attention by announcing that she wants to weigh 1,000 lbs. within the next two years. Yes, Donna Simpson of New Jersey has a goal:  to become the world’s heaviest woman. 

The 42-year-old Donna already holds the Guinness World Record as the world’s heaviest mother (530 lbs.).  She needed a team of 30 medical personnel to deliver her daughter Jacqueline during a high-risk Caesarean birth. When asked whether pursuing this goal might conflict with her desire to be a good parent, Donna agreed:  “It might be hard [to achieve this goal].  Running after my daughter keeps my weight down.”

To achieve her goal, Donna says she will need to eat up to 12,000 calories a day.  And to fund her $750 weekly grocery bill, she runs a Web site where men pay her to watch her eat fast food.

Donna says she loves eating, and people love watching her eat:  “It makes people happy, and I’m not harming anyone.”

Really?

Super-sizing the World’s Most Famous Supper

 

In this March 16, 2010 photo provided by Cornell University, Prof. Brian Wansink, holds a plate illustrating how food portion size has grown over the centuries, in front of a projection of Leonardo da Vinci’s The Last Supper at Cornell University in Ithaca, N.Y.. The food in famous paintings of the Last Supper has grown by biblical proportions over the last millennium, researchers report in a medical journal Tuesday, March 23, 2010.

(AP Photo/Cornell University, Jason Koski)

Speaking of big and getting bigger, the brilliant Cornell University researcher Brian Wansink, shown in the photo above and renowned at Wellspring for his “bottomless bowl of tomato soup” and “stale popcorn” studies, has done it again in a study published in the International Journal of Obesity. Professor Wansink and his team examined 52 of the most famous paintings of the Last Supper over the past 1,000 years, paying particular attention to portion sizes.  They found that the main courses, bread and plates put before Jesus and his disciples have progressively grown by up to two-thirds. 

“The last thousand years have witnessed dramatic increases in the production, availability, safety, abundance and affordability of food,” said Dr. Wansink.  “We think that as art imitates life, these changes have been reflected in paintings of history’s most famous dinner.”The main meals grew 69% and plate size 66% between the oldest and most recent paintings. Bread size grew by about 23%.  The sharpest increases were seen in paintings completed after the year 1500.

On Being Sane in Insane Places

These stories clearly illustrate a point we emphasize with Wellspring’s campers, students and families (see www.wellspringweightloss.com).  When weight controllers embrace the changes in behaviors and attitudes necessary for effective long-term weight loss, they must face the insanity all around them very directly – and learn how to master it.  Asking children and teens to become sane in an apparently insane world is asking a lot.  Professionally conducted programs like Wellspring provide the modeling, education, training and support that can arm young weight controllers for this remarkable challenge. Without these tools in place, most young weight controllers get swept along in a culture heading in a very unfortunate direction.

 

 

Photo from: http://news.yahoo.com/nphotos/Leonardo-da-Vinci5Cu00e25Cu00805Cu0099s-The-Last-Supper-food-portion-size/photo//100323/480/urn_publicid_ap_org5a1b40b3722d444cae2b8752dae518cb//s:/ap/us_med_last_supper_obesity

 

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How Childhood Trauma Might Affect Adult Obesity

Friday, March 12th, 2010

This article, in Time Magazine, explores the possible effects that childhood trauma could have on health: psychologically and physiologically. Dr. Vincent Felitti, founder of Kaiser Permanente’s Department of Preventive Medicine and director of its obesity-treatment program, asked himself, after many successes in his program, “Why, invariably, did so many patients quit just as they approached their healthy goal weight?” Other studies by Michael Meaney at McGill University in Canada and his colleagues have shown how such childhood traumas might impact adults.

Tuesday, Jan. 05, 2010

By Maia Szalavitz
Time Magazine

Dr. Vincent Felitti, founder of Kaiser Permanente’s Department of Preventive Medicine and director of its obesity-treatment program, was seeing some good results. His patients were losing 50, 80, even hundreds of pounds. He might have considered the program a success, if not for the fact that the participants who were doing the best — those who were both the most obese and losing the most weight — kept dropping out.

Felitti was baffled. Why, invariably, did so many patients quit just as they approached their healthy goal weight? Ella, for instance, a middle-aged woman who entered the program in the mid-1980s morbidly obese at 295 lb., had managed to whittle her frame by 150 lb. over six months. “Instead of being happy, she was having anxiety attacks and was terrified,” Felitti says.

He asked Ella what she thought was going on. “Finally, the story comes out,” he says. “She had been molested as a child, both within her family and outside it. She tried to escape by marrying at 15, at her mother’s urging. It was a disastrous marriage — her husband was crazy jealous. They divorced in two years. She remarried. Her new husband was also jealous. He was convinced that when she was out hanging the laundry, she was sexually posturing to attract the neighbors.”

When Ella was overweight, Felitti learned, her husband was less suspicious. And her fear of his rage — perhaps he saw her new slimmer weight as a provocation? — was probably spurring her anxiety.

Felitti wondered if there was something similar barring weight loss in other patients — or causing obesity itself. In the late ’80s, he began a systematic study of 286 obese people, and discovered that 50% had been sexually abused as children. That rate is more than 50% higher than the rate normally reported by women, and more than triple the average rate in men. Indeed, the average rates of sexual abuse are themselves unsettling: according to a large 2003 study conducted by John Briere and Diana Elliott of the University of Southern California, 14% of men and 32% of women said they were molested at least once as children.

In recent years, studies by both Felitti and others have largely confirmed the association between sexual abuse — as well as other types of traumatic childhood experience — and eating disorders or obesity. A 2007 study of more than 11,000 California women found that those who had been abused as children were 27% more likely to be obese as adults, compared with those who had not, after adjusting for other factors. A 2009 study of more than 15,000 adolescents found that sexual abuse in childhood raised the risk of obesity 66% in males in adulthood. That study found no such effect in women, but did find a higher risk of eating disorders in sexually abused girls.

Discoveries by Felitti and colleagues have also helped give rise to broader work linking stressful experiences early in life — as early as in the womb — to effects on health and behavior later on, such as an increased risk of heart disease or becoming addicted to drugs. Scientists are finding that such effects are not only long-lasting, but can even be inherited by future generations.

In decades of experiments with rats, for instance, neuroscientist Michael Meaney at McGill University in Canada and his colleagues have shown how such environmentally induced traits can be passed down — then undone, also by environment. Meaney studied rats with differing maternal styles — some were naturally nurturing (they licked and groomed their pups constantly), others were less attentive and even neglectful (mother rats placed in stressful environments like isolation had greatly decreased capacity for nurture). What researchers found was that these behavioral traits were passed down to future generations: pups born to neglectful mothers endured stressful childhoods and grew up to become neglectful mothers themselves. But when babies born to stressed or less attentive mothers were instead placed with nurturing, affectionate mothers, that early experience changed the pups. They adapted quickly to the new mothering style and grew up to tend carefully to their own offspring. These pups’ adaptation was then passed to successive generations as well.

When Felitti first presented his Kaiser Permanente data connecting obesity with child molestation at a national meeting on obesity in 1990, most colleagues dismissed him immediately (one even claimed that obese people made up such stories to justify their “failed lives”). David Williamson, an epidemiologist at the Centers for Disease Control and Prevention (CDC), was the lone exception. He said that a large epidemiological study was needed to determine whether there were any implications of Felitti’s findings for public health.

Felitti knew that he had just the right data set: Kaiser Permanente has the largest medical-evaluation facility in the developed world, diagnosing some 58,000 patients annually. Even if only a minority agreed to discuss their childhoods and allow anonymous use of their medical records, that would be a huge sample. And so the Adverse Childhood Experiences (ACE) study was born, as a collaboration of Felitti and another CDC researcher, Dr. Robert Anda.

For the past several decades, the ACE study has recorded reports of negative childhood experiences in more than 17,000 patients. Adverse experiences include ongoing child neglect, living with one or no biological parent, having a mentally ill, incarcerated or drug-addicted parent, witnessing domestic violence, and sexual, physical or emotional abuse. The researchers then searched for correlations between these experiences and adult health and the risk of disease.

The connections became clear: compared with a person with no adverse childhood experiences, or ACEs, a person with four or more has almost double the risk of obesity. Having four or more ACEs more than doubles the risk of heart attack and stroke, and nearly quadruples the risk of emphysema. The risk for depression is more than quadrupled. Although many of these outcomes could reflect the influences of genes and other environmental influences — beyond those occurring in childhood — the tight relationship between increasing ACE numbers and increasing health risks makes the role of child trauma clear. Dr. Jack Shonkoff, director of Harvard’s Center on the Developing Child, calls the research “a tremendous contribution.”

But how does the psychological experience of childhood neglect cause physical effects like obesity, heart attack or stroke? There are at least two interconnected pathways — one physiological, the other psychological.

The psychology is relatively straightforward: being abused or otherwise traumatized is painful, and food can be a numbing or comforting escape. Hence, abused children may turn to overeating, which causes obesity. Indeed, ACEs are also strongly linked with other types of unhealthy “self-medication”: for instance, cigarette smoking (which accounts for the increased rate of emphysema among high ACE scorers) and drug abuse (having four or more ACEs increases the risk of injectable-drug use by a factor of 10). As Felitti puts it, “Being fat [or having other unhealthy behaviors] is not the problem. It’s the solution.”

The psychological effects often exacerbate health problems that the physiological stress response has already caused. High ACE scorers who do not overeat, smoke or take drugs still have high rates of obesity, heart disease, depression and diabetes. The mechanism for these risks appears to lie in the biology of the stress-response system and in the way environment affects a person’s genetic activity.

For most of human evolution, a stressful world would have been marked by famines or periods of starvation, and that environment might have resulted in a particular pattern of gene expression that would have prompted the body to store more fat in preparation for the next bout of scarcity. Today, of course, the same response to stress would result in obesity. This theory of a thrifty fat-storing system that kicks in under high levels of early stress was originally proposed by British physician David Barker.

If, for instance, a modern child’s early life experience — in the womb and during the first five years, particularly — is constantly stressful, it would be incredibly energy-consuming, says Dr. Bruce Perry, senior fellow at the ChildTrauma Academy. “If your genes get the message that you are entering a stressful world, it makes complete adaptive sense to take the existing metabolism and tune it up to deposit fat and store energy to prepare for what the body is expecting will be a challenging and stressful life,” he says.

“Early adverse experience can disrupt the body’s metabolic systems,” says Shonkoff. “One of the cornerstones of biology is that our body’s systems when they are young are reading the environment and establishing patterns to be maximally adaptive.”

Researchers also posit that high levels of stress hormones caused by ACEs can wear down the body over time. A temporary spike in blood pressure in response to a stressful event may be useful to power an adaptive fight-or-flight response, but over the long term constant high blood pressure could raise a person’s risk for heart attack and stroke. Studies have also found that consistently elevated levels of stress hormones, like cortisol, can lead to permanent damage in certain brain regions linked to depression.

Recently, scientists have discovered that these changes can themselves be passed down from one generation to the next — a burgeoning new area of study called epigenetics. Such research may have significant and long-term implications for the prevention of obesity, addiction and other illnesses related to early life stress. After all, reducing childhood exposure to trauma in one generation may further benefit that generation’s children and grandchildren.

Some initiatives, such as the nurse home-visiting program and President Obama’s proposed Promise Neighborhoods program, already put this theory into practice, by offering support and services to low-income parents in order to reduce child abuse, increase access to prenatal care and provide parenting education and high-quality day care.

The goal is not only to improve conditions for the current participants of such programs, but also hopefully to reduce the risk of problems in successive generations, including major causes of death and disability like obesity, heart disease and stroke. “It’s not a secret that there is a growing epidemic of obesity and there’s no question that the way we eat and the way we exercise, or do not exercise, is contributing to it. But it’s a huge mistake to attribute it just to the need to close down fast-food restaurants and turn off the TV. There’s important biology here early in life that needs attention,” says Shonkoff.

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Do You Overestimate Your Child’s Activity?

Friday, March 12th, 2010

Children and parents are quite busy these days. It is no wonder that when some parents are asked about their children’s activity levels, they might not provide an accurate estimate. A British Study, in Norfolk, England, examined the amount parents over or underestimate their children’s activity level. It is referred to as “The Speedy Study (Sport, Physical Activity and Eating Behavior: Environmental Determinants in Young People)”.

January 6, 2010, 11:07 am

Many parents overestimate how much physical activity their children get, a new study found.

Compared to adults, children seem to be moving constantly. So it’s no surprise that most parents who are quizzed about their child’s physical activity level describe their children as fairly active.

But a new study of nearly 2,000 British school children suggests that many parents overestimate the amount of physical activity their children are really getting.

The researchers equipped 1,892 British school children, ages 9 and 10, with accelerometers, gadgets that measure all physical activity during a given time period. The research, known as the Speedy study (an acronym for Sport, Physical Activity and Eating Behavior: Environmental Determinants in Young People), collected the exercise data from children at 92 schools in Norfolk, England, between April and July 2007.

A child was deemed inactive if he or she recorded less than an hour a day of moderate and vigorous physical activity. Although the majority of children studied were getting a sufficient level of physical activity, a sizable minority of children were not. Overall, 39 percent of girls and 18 percent of boys studied were getting less than an hour of physical activity each day.

But if you asked the parents of the inactive children to describe their child’s activity level, the vast majority — 80 percent — described their children as fairly or very physically active, according to the findings published in the American Journal of Preventive Medicine. Interestingly, the children themselves had more awareness about their lack of physical activity. Overall, 40 percent of children overestimated their physical activity compared to their peers.

But it wasn’t the parents of overweight children who were most likely to guess wrong about physical activity levels. The parents who were most out of touch about their child’s physical fitness were more likely to have children who were slim. Parents of girls were also more likely to overestimate physical activity. The researchers noted that parents should be educated about the importance of physical activity for children even if the child is not overweight.

“Parents of children with a lower fat mass index appear to assume that their children are adequately active,” the study authors reported. “Increasing awareness regarding health benefits of physical activity beyond weight control might help reverse misperceptions of physical activity levels and encourage behavior change.”

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Stand Up While You Read This!

Friday, March 12th, 2010

This article examines the importance of getting up off of your chair and moving around! It is extremely important to be active as opposed to sedentary. In fact, many researchers have found that sitting in your chair is the enemy. The more sedentary a person is, the more likely he or she could be at risk for major health problems such as heart disease, diabetes, hypertension, obesity, some cancers, and an early death. So get up off of your chair and read this article!

Your chair is your enemy.

It doesn’t matter if you go running every morning, or you’re a regular at the gym. If you spend most of the rest of the day sitting — in your car, your office chair, on your sofa at home — you are putting yourself at increased risk of obesity, diabetes, heart disease, a variety of cancers and an early death. In other words, irrespective of whether you exercise vigorously, sitting for long periods is bad for you.

That, at least, is the conclusion of several recent studies. Indeed, if you consider only healthy people who exercise regularly, those who sit the most during the rest of the day have larger waists and worse profiles of blood pressure and blood sugar than those who sit less. Among people who sit in front of the television for more than three hours each day, those who exercise are as fat as those who don’t: sitting a lot appears to offset some of the benefits of jogging a lot.

So what’s wrong with sitting?

The answer seems to have two parts. The first is that sitting is one of the most passive things you can do. You burn more energy by chewing gum or fidgeting than you do sitting still in a chair. Compared to sitting, standing in one place is hard work. To stand, you have to tense your leg muscles, and engage the muscles of your back and shoulders; while standing, you often shift from leg to leg. All of this burns energy.

For many people, weight gain is a matter of slow creep — two pounds this year, three pounds next year. You can gain this much if, each day, you eat just 30 calories more than you burn. Thirty calories is hardly anything — it’s a couple of mouthfuls of banana, or a few potato chips. Thus, a little more time on your feet today and tomorrow can easily make the difference between remaining lean and getting fat.

You may think you have no choice about how much you sit. But this isn’t true. Suppose you sleep for eight hours each day, and exercise for one. That still leaves 15 hours of activities. Even if you exercise, most of the energy you burn will be burnt during these 15 hours, so weight gain is often the cumulative effect of a series of small decisions: Do you take the stairs or the elevator? Do you e-mail your colleague down the hall, or get up and go and see her? When you get home, do you potter about in the garden or sit in front of the television? Do you walk to the corner store, or drive?

Just to underscore the point that you do have a choice: a study of junior doctors doing the same job, the same week, on identical wards found that some individuals walked four times farther than others at work each day. (No one in the study was overweight; but the “long-distance” doctors were thinner than the “short-distance” doctors.)

So part of the problem with sitting a lot is that you don’t use as much energy as those who spend more time on their feet. This makes it easier to gain weight, and makes you more prone to the health problems that fatness often brings.

But it looks as though there’s a more sinister aspect to sitting, too. Several strands of evidence suggest that there’s a “physiology of inactivity”: that when you spend long periods sitting, your body actually does things that are bad for you.

As an example, consider lipoprotein lipase. This is a molecule that plays a central role in how the body processes fats; it’s produced by many tissues, including muscles. Low levels of lipoprotein lipase are associated with a variety of health problems, including heart disease. Studies in rats show that leg muscles only produce this molecule when they are actively being flexed (for example, when the animal is standing up and ambling about). The implication is that when you sit, a crucial part of your metabolism slows down.

Nor is lipoprotein lipase the only molecule affected by muscular inactivity. Actively contracting muscles produce a whole suite of substances that have a beneficial effect on how the body uses and stores sugars and fats.

Which might explain the following result. Men who normally walk a lot (about 10,000 steps per day, as measured by a pedometer) were asked to cut back (to about 1,350 steps per day) for two weeks, by using elevators instead of stairs, driving to work instead of walking and so on. By the end of the two weeks, all of them had became worse at metabolizing sugars and fats. Their distribution of body fat had also altered — they had become fatter around the middle. Such changes are among the first steps on the road to diabetes.

Conversely, a study of people who sit for many hours found that those who took frequent small breaks — standing up to stretch or walk down the corridor — had smaller waists and better profiles for sugar and fat metabolism than those who did their sitting in long, uninterrupted chunks.

Some people have advanced radical solutions to the sitting syndrome: replace your sit-down desk with a stand-up desk, and equip this with a slow treadmill so that you walk while you work. (Talk about pacing the office.) Make sure that your television can only operate if you are pedaling furiously on an exercise bike. Or, watch television in a rocking chair: rocking also takes energy and involves a continuous gentle flexing of the calf muscles. Get rid of your office chair and replace it with a therapy ball: this too uses more muscles, and hence more energy, than a normal chair, because you have to support your back and work to keep balanced. You also have the option of bouncing, if you like.

Or you could take all this as a license to fidget.

But whatever you choose, know this. The data are clear: beware your chair.

Notes:

The term “calorie” sometimes causes confusion. Most people, when referring to the energy content of food, use “calorie” instead of “kilocalorie” — which is the actual unit that food energy is measured in. When I refer to 30 calories, I am following this convention and therefore technically mean 30 kilocalories. For metric system users, that’s about 125 kilojoules.

For sitting a lot causing heart disease, obesity, diabetes, certain cancers and early death, independently of whether you exercise regularly, see, for example, Katzmarzyk, P. T. et al. 2009. “Sitting time and mortality from all causes, cardiovascular disease, and cancer.” Medicine and Science in Sports and Exercise 41: 998-1005. (This study looked at the fates of 17,013 Canadians over a span of 12 years.) See also Dunstan, D. W. et al. 2010. “Television viewing time and mortality: the Australian diabetes, obesity and lifestyle study (AusDiab).” Circulation 121: 384-391. (This study considered 8800 Australians followed for a median time of 6.6 years.)

For the negative effects of sitting a lot on healthy people who exercise regularly, see Healy, G. N. et al. 2008. “Television time and continuous metabolic risk in physically active adults.” Medicine and Science in Sports and Exercise 40: 639-645. For fatness and three hours of television, see Dunton, G. F. et al. 2009. “Joint associations of physical activity and sedentary behaviors with body mass index: results from a time use survey of US adults.” International Journal of Obesity 33: 1427-1436.

For energy expended during sitting as opposed to gum chewing, fidgeting, and standing, see Levine, J. A. et al. 2006. “Non-exercise activity thermogenesis: the crouching tiger hidden dragon of societal weight gain.” Arteriosclerosis, Thrombosis, and Vascular Biology 26: 729-736. For weight gain by slow creep, see Hill, J. O., Peters, J. C. and Wyatt, H. R. 2009. “Using the energy gap to address obesity: a commentary.” Journal of the American Dietetic Association 109: 1848-1853. Note that the process of gaining weight is different from the process of losing weight.

For fatness versus leanness being a consequence of small differences in daily movements, see Levine, J. A. et al. 2005. “Interindividual variation in posture allocation: possible role in human obesity.” Science 307: 584-586. For some doctors walking four times further than others while doing the same job, see Conzett-Baumann, K. et al. 2009. “The daily walking distance of young doctors and their body mass index.” European Journal of Internal Medicine 20: 622-624. I have borrowed their “long-distance” and “short-distance” terminology.

Two outstanding papers provide fascinating overviews of the more sinister aspects of sitting. See Hamilton, M. T., Hamilton, D. G. and Zderic, T. W. 2007. “Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease.” Diabetes 56: 2655-2667; and Pedersen, B. K. 2009. “The diseasome of physical inactivity — and the role of myokines in muscle-fat cross talk.” Journal of Physiology 587: 5559-5568. The Hamilton et al. paper discusses the results for lipoprotein lipase, and describes how sitting differs from standing in terms of muscles flexed. The Pedersen paper discusses a variety of other compounds that are released by active muscles, as well as the impact they have on metabolism. For muscular activity in rats and the production of lipoprotein lipase, see Bey, L. and Hamilton, M. T. 2003. “Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity.” Journal of Physiology 551: 673-682.

For the physiological impact of men reducing how far they walk for two weeks, see Olsen, R. H. et al. 2008. “Metabolic responses to reduced daily steps in healthy nonexercising men.” Journal of the American Medical Association 299: 1261-1263. For the advantages of taking breaks from sitting, see Healy, G. N. et al. 2008. “Breaks in sedentary time: beneficial associations with metabolic risk.” Diabetes Care 31: 661-666.

For the advantages of having a stand-up desk attached to a treadmill, see Levine, J. A. and Miller, J. M. 2007. “The energy expenditure of using a ‘walk-and-work’ desk for office workers with obesity.” British Journal of Sports Medicine 41: 558-561. For a set of radical suggestions regarding how to reduce sitting, including the idea of attaching the television to some kind of exercise device, see the crouching tiger hidden dragon paper mentioned above.

The advantages of rocking chairs have mostly been explored in the elderly. See, for example, Pierce, C., Pecen, J. and McLeod, K. J. 2009. “Influence of seated rocking on blood pressure in the elderly: a pilot clinical study.” Biological Research for Nursing 11: 144-151. However, I see no reason why rocking wouldn’t be preferable to passive sitting in younger people too. For the advantages of using a therapy ball instead of a desk chair, see Beers, E. A. et al. 2008. “Increasing passive energy expenditure during clerical work.” European Journal of Applied Physiology 103: 353-360.

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Restaurant and Packaged Foods Can Have More Calories Than Nutrition Labeling Indicates

Friday, March 12th, 2010

Obesity is an overwhelming and increasing problem in the United States and globally. Many efforts have been made to raise the awareness of food consumers. In a study published in the January 2010 issue of the Journal of the American Dietetic Association, researchers such as Susan B. Roberts, PhD, director, Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, and colleagues investigated the accuracy of information on food labels.

ScienceDaily (Jan. 6, 2010) — With obesity rising markedly, reliance on the accuracy of food labeling is an important weight management strategy. Since people who are trying to reduce their weight are encouraged to choose meals labeled as “lower in calories” or “reduced-energy” in restaurants and supermarkets, it is essential that the listed data are accurate. In a study published in the January 2010 issue of the Journal of the American Dietetic Association, researchers from Tufts University found that some commercially prepared foods contained more calories than indicated in nutritional labeling.
Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more calories than the stated values. Likewise, measured energy values of 10 frozen meals purchased from supermarkets averaged 8% more calories than stated on the label.
The commercially prepared restaurant foods and supermarket frozen convenience meals were obtained in the Boston, MA, area. The energy content was measured and compared with nutrition data stated by the vendor or manufacturer. The restaurant chains included both quick-serve and sit-down establishments with broad distribution throughout the United States.
Because the goal of the study was to examine the accuracy of stated energy content of foods typically selected for weight control, specific restaurant menu items were chosen based on three criteria. Selected foods were (1) less than 500 kcal/serving as stated on the label, (2) typical American foods and (3) among those with the lowest stated energy contents on the menu. Supermarket purchases were focused on frozen complete meals that would be alternative choices to eating out.
The authors found a further complication with some restaurant meals. Five restaurants provided side dishes at no extra cost. The average energy provided by these items was 471 kcal, which was greater than the 443 kcal for the entrées they accompanied. Furthermore, some individual foods had discrepancies that were extreme, including three supermarket-purchased complete meals and seven restaurant foods that containing up to twice their stated energy contents.
The authors also note that the US Food and Drug Administration allows up to 20% excess energy content but weight must be no less than 99% of the stated value. This might lead manufacturers to add more food to the package to insure compliance with the weight standards and thereby exceed the stated energy content.
Lead investigator Susan B. Roberts, PhD, director, Energy Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, and colleagues write, “These findings suggest that stated energy contents of reduced-energy meals obtained from restaurants and supermarkets are not consistently accurate, and in this study averaged more than measured values, especially when free side dishes were taken into account, which on average contained more energy than the entrees alone. For example, positive energy balance of only 5% per day for an individual requiring 2,000 kcal/day could lead to a 10-lb weight gain in a single year. If widespread, this phenomenon could hamper efforts to self-monitor energy intake to control weight, and could also reduce the potential benefit of recent policy initiatives to disseminate information on food energy content at the point of purchase.”

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Obesity Rates Idle as Most of Us are Already Overweight

Friday, March 12th, 2010

The good news is the rise in obesity rates has not significantly increased in ten years, but the bad news is majority of adults and children are overweight and there has been little improvement. Researchers and experts such as Dr. Gary Foster, director of the Temple University Center for Obesity Research and Education, Dr. Carolyn Ogden, the report’s author and a CDC researcher who has tracked obesity for years, and Dr. William Dietz, an obesity expert with the CDC, discuss whether this data is due to a better awareness of food, dieting, and exercise or if we have just reached a maximum level of obesity.

Have we simply reached a maximum level of tubbiness?
msnbc.com
updated 9:22 a.m. PT, Wed., Jan. 13, 2010
America’s rapid rise in obesity appears to have leveled off, with new government figures showing no significant increase in a decade.
But there’s little reason to cheer. More than two-thirds of adults and almost a third of children are overweight, and there are no signs of improvement.
Experts say they’re not sure whether the lull in the battle of the bulge can be attributed to more awareness and better diets — or whether society has simply reached a maximum level of tubbiness.
“Maybe in this environment, this is as overweight as we’ll get,” said Gary Foster, director of the Temple University Center for Obesity Research and Education.
Being thin is the exception
Not only are the vast majority of adults — 68 percent — overweight, 34 percent are obese; and 17 percent of children are obese. Even the youngest Americans are affected — 10 percent of babies and toddlers are precariously heavy.

The most recent Centers for Disease Control and Prevention data, from the years 2007 to 2008, were contained in two reports published online Wednesday in the Journal of the American Medical Association.
“The absolute numbers here are staggering,” said Foster. “This isn’t something that should be celebrated.”
The new data are based on health surveys involving height and weight measurements of 5,700 adults and 4,000 children, surveys the CDC does every two years.
“In the most recent decade, we saw a slowing in the increase,” said Carolyn Ogden, the report’s author and a CDC researcher who has tracked obesity for years. “It was better news, but it’s still a serious problem.”
In most age groups, black adults had the highest rates of obesity, followed by Mexican-Americans and whites.
Heaviest boys getting heavier
Among children ages 2 to 19, 32 percent were too heavy — a rate that was mostly unchanged. But disturbingly, most obese kids were extremely obese. And the percentage of extremely obese boys ages 6 to 19 has steadily increased, to 15 percent from about 9 percent in 1999-2000.

Ogden said it was disappointing to see no decline, and troubling that the heaviest boys seem to be getting even heavier. The study didn’t examine the causes, but Ogden cited the usual reasons — soft drinks, video games and inactivity — as possible explanations.

“We shouldn’t be complacent. We still have a problem,” Ogden said.

Dr. William Dietz, an obesity expert with the CDC, cautiously called the results promising. “We’re at the corner; we haven’t turned the corner,” he said.
Turning point?
One factor in the plateau may be the barrage of information about the obesity epidemic — and what to do about it, said Foster.
“There’s an increased availability of healthier options than there was five years ago,” he said.
School- and community-based efforts to emphasize fitness and healthy eating may also have had some effect, although Foster acknowledges that there’s no good data to prove the point.
“I think there’s lot of things you could point to, but the truth is, it’s a confluence of factors,” he said.
One of those factors might be the intersection of genetic predisposition to obesity and an environment that encourages weight gain, Foster said.
“This is about what we can expect,” he said. “For it to go down, we’re going to have to greatly change the environment for the better.”
The obesity epidemic is considered a top White House priority. President Barack Obama has pushed to make obesity prevention part of health care reform. Overhaul measures pending in Congress include encouraging employer-based wellness programs and requiring large restaurant chains to list calories. And Michelle Obama has made childhood obesity and healthy eating habits a pet project.
People like Darrell Pender are paying attention.

Obesity “is constantly in the news,” said Pender, a 42-year-old New York City computer technician who decided to get serious about fighting fat after being diagnosed with diabetes three years ago.

Pender was tempted by a TV ad for obesity surgery, but chose a less drastic option — a nutrition support group that he credits with helping him make healthier food choices. So far, he’s lost 50 pounds over several months. At 350 pounds, he’s still very obese, but his diabetes is under control and he feels healthier.

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Pedometers can motivate users to get in step

Friday, March 12th, 2010

Self-monitoring continuously is an effective intervention for losing weight. Using a pedometer is just another way you can track your steps and progress to your weight loss goal. Simon Marshall, associate professor of exercise and nutritional science at San Diego State University, Karen Croteau, a professor in the department of exercise, health and sport sciences at the University of Southern Maine, and Dr. Kathy Magliato of St. John’s Health Center in Santa Monica or Torrance Memorial Medical Center discuss the benefits and positive effects a pedometer can have in building a healthy lifestyle.

The step-tracking gadgets are easy to use and relatively inexpensive. Plus, evidence indicates that they truly inspire people.

By Jeannine Stein

January 11, 2010

If the journey toward fitness begins with a single step, make sure it’s counted with a pedometer.

These little step-tracking gadgets now have a solid track record when it comes to motivating people to exercise. And their popularity is growing.

Inside this small-as-an-egg device are the keys to exercise success that have eluded far more complex and expensive fitness programs: accountability, goal-setting and being able to monitor progress. If the objective is to reach 10,000 steps in a day (the recommended amount), seeing a tally of 4,000 steps at 3 p.m. is a wake-up call to start walking.

“When we ask people to start an exercise program, it’s important to have measurable, achievable goals, and adding this self-monitoring component is very critical,” says Simon Marshall, associate professor of exercise and nutritional science at San Diego State University. “We don’t know why exactly, but keeping a number, a prompt, in our consciousness on a regular basis is important, and that’s why pedometers are superior to other methods. It’s on you all the time.”

Pedometers are easy to use day after day in various settings, none of which has to be a gym.

Perhaps better yet, the average cost is around $20.

“People describe them as being like little personal trainers,” says Catrine Tudor-Locke, associate professor and director of the Walking Behavior Laboratory at Pennington Biomedical Research Center in Baton Rouge, La. “They provide ready, real-time data so you can make decisions about how you’re going to spend the rest of your day and make adjustments as needed.”

Los Angeles-based personal trainer Harley Pasternak has been studying the health habits of various cultures for his latest book, “The 5-Factor World Diet.” He says, “What I found was that in the 10 healthiest countries in the world, they all have different [dietary habits]. But one thing they all share is that they all walk way more than we do in America. For those in these 10 countries, being fit and healthy is about having an active lifestyle, while here in America, being fit is about performing an exercise in a room designated for fitness.”

Pedometers can create that lifestyle balance that many Americans otherwise would lack.

Fits any lifestyle

At 12:30 on a recent afternoon, Dr. Kathy Magliato’s pedometer already reads 19,000 steps for the day. “I’m a cardiothoracic surgeon who’s also a busy mommy with two small kids, so I run around quite a bit,” she says. She typically gets her steps in while doing rounds at St. John’s Health Center in Santa Monica or Torrance Memorial Medical Center. On days when she’s in surgery for 10 hours, she takes her children for a walk when she gets home.

Magliato clipped on her first pedometer six years ago after the birth of her first child. With 10 pounds to lose and no time to go to a gym, she had to do something to stay in shape — both for herself and as a role model for her patients, many of whom have heart disease. Through walking and watching her diet, she dropped the 10 pounds and realized that walking provided the activity she needed, which some fitness experts and researchers say is the key to true health.

“When my patients tell me they can’t work out because they don’t have time, I say, ‘Look at my lifestyle.’ ”

Pedometers have even made their way into the White House. In October, Peter Orszag, director of the Office of Management and Budget, issued a pedometer challenge through the end of 2009 to all willing agency employees. In an office blog post, Orszag (a runner and marathoner) wrote: “This year, as part of their budget submissions, federal agencies have been asked to report on their efforts to improve the health and wellness of their employees. I want to make sure that the staff at OMB doesn’t just talk the talk on wellness, but that we also walk the walk — literally.”

With approximately 115 to 200 men and women taking part, weekly step averages went from 10,871 the first week (beginning Oct. 4) to 13,000 in early December. (Final tallies aren’t yet available.)

Research confirms that monitoring daily steps helps people get the recommended amount of exercise, bolsters their cardiovascular system and often contributes to weight loss.

A 2007 study in the Journal of the American Medical Assn. analyzed data from 26 studies assessing pedometer use among adults and found the device to be linked with considerable increases in physical activity and decreases in blood pressure and body mass index. In a 2004 study in Medicine & Science in Sports & Exercise, 27 people were assigned to a pedometer-based exercise group with an emphasis on daily steps and 33 people to an exercise program emphasizing time spent exercising.

At the end of the study, the pedometer-based program proved to be more effective in increasing daily activity than the time-based program.

Set a goal

Clipping on a pedometer and counting steps — even brisk ones — isn’t the end of the fitness story. “It’s one thing to wear a pedometer, but it’s another to have a goal in mind of how many steps you want to get,” says Karen Croteau, a professor in the department of exercise, health and sport sciences at the University of Southern Maine. “These gadgets are effective when serving as a cue, but that has to be in conjunction with setting goals.”

She suggests that new users monitor steps for a few days to find a daily average before upping the amount. Some fitness experts recommend adding 5% to 10% of the starting average per day, but Tudor-Locke believes that fitness levels and daily routines should be taken into consideration. “One person has to juggle child rearing while another has different lifestyle impediments,” she says. “People should find out where they are and realize that more is better.”

And while walking 10,000 steps a day is admirable, reaching that goal every day over a long period of time may cause a fitness plateau, in which cardio gains stop and weight sneaks back on. In that case, users must increase both steps and intensity.

(But keep in mind, walking shouldn’t be the only exercise in the repertoire. Strength training for both the upper and lower body prevents muscle loss and helps stave off bone deterioration, both important as people age.)

Choosing a pedometer can be challenging, considering how many models are on the market. Some are equipped with accelerometers that record movement and intensity. Others tally weekly steps, have calorie counters and come with software to track progress. Some cellphones now come with a pedometer, but since the devices track steps by monitoring hip movement, they won’t work if left on a table or in a purse on the floor.

Many exercise physiologists and trainers generally recommend starting with a basic model that just counts steps and costs about $20. To ensure accuracy, count out from 20 to 50 steps a few times, checking the pedometer. If the count is within a few steps, it should be adequate. You can always upgrade later to a model with more bells and whistles.

Says Marshall, “You’re only limited by how creative you can be.”

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