Dr. Brian R. Matlaga, assistant professor of urology at the Johns Hopkins University School of Medicine and director of stone diseases and ambulatory care at Hopkins’ James Buchanan Brady Urological Institute, was the lead author of a study that explored the effects of excess weight in relation to kidney stone development, and was published in the February issue of the Journal of Urology. Many studies in the past have shown a strong correlation between obesity and kidney stone disease. As obesity is a growing problem throughout the world, researchers such as Dr. Matlaga are interested in the risks presented with varying ranges of obesity.

ScienceDaily (Feb. 18, 2010) — Obesity in general nearly doubles the risk of developing kidney stones, but the degree of obesity doesn’t appear to increase or decrease the risk one way or the other, a new study from Johns Hopkins shows.

“The common thinking was that as weight rises, kidney stone risk rises as well, but our study refutes that,” says study leader Brian R. Matlaga, assistant professor of urology at the Johns Hopkins University School of Medicine and director of stone diseases and ambulatory care at Hopkins’ James Buchanan Brady Urological Institute. “Whether someone is mildly obese or morbidly obese, the risk for getting kidney stones is the same.”

The findings are published in the February Journal of Urology.

Over the last decade, several epidemiological studies have shown a strong connection between obesity and kidney stone disease. However, as obesity continues to rise worldwide, Matlaga and his colleagues wondered whether different subcategories of obesity, ranging from mildly to morbidly obese, presented different risks.

To answer the question, the researchers used a national insurance claims database to identify 95,598 people who had completed a “health risk assessment” form with information about their body mass index (BMI), a measure of body fat calculated by dividing weight by height, and a general indicator of underweight, healthy weight, or overweight. The database, which spanned over a five-year period from 2002 to 2006, also had encoded information indicating whether these individuals had been diagnosed with kidney stone disease.

Using a definition of obesity as having a BMI greater than 30 kg/m2 (which, in English measurements, corresponds to a 5 foot tall person who weighs 153 pounds, or a 6 foot tall person who weighs 221 pounds), the researchers calculated the incidence of kidney stones in people who were non-obese and in those who were obese. Among the non-obese individuals, 2.6 percent were diagnosed during the study period with kidney stones, compared to 4.9 percent of the obese individuals. When the investigators arranged those in the obese group by their BMIs, ranging from above 30 kg/m2 to more than 50 kg/m2, they found that the increased risk remained constant, regardless of how heavy the individuals were.

Matlaga says that he and his colleagues aren’t sure why obese people are more at risk for kidney stones, though metabolic or endocrine factors unique to obesity are likely reasons, along with dietary factors such as a high-salt diet. The researchers plan to study these potential risk factors in subsequent studies.

The Journal of Gerontology: Medical Sciences Editor Luigi Ferrucci, MD, PhD, of the National Institute on Aging, published a set of ten articles examining the consequences and causes of obesity in older populations. He argued that the risk of obesity is not only limited to physical detriments but also can impair neurological functioning too. A study led by Anna Dahl, MS, of Sweden’s Jönköping University, studied individuals with higher body mass index scores in relation to general cognitive ability. Also, a team of researchers led by Alice M. Arnold, PhD, of the University of Washington, Seattle, studied changes in weight in relation to future physical limitations and mortality in the elderly.

ScienceDaily (Feb. 24, 2010) — The adverse affects of being overweight are not limited to physical function but also extend to neurological function, according to research in the latest issue of The Journals of Gerontology Series A: Biological and Medical Sciences.

The publication presents a collection of ten articles highlighting new findings related to obesity in older persons.

“One of the unanticipated consequences of improved medical management of cardiovascular disease is that many obese individuals reach old age,” saidJournal of Gerontology: Medical Sciences Editor Luigi Ferrucci, MD, PhD, of the National Institute on Aging. “We need a better understanding of the causes and consequences of obesity in older individuals — especially when obesity is associated with sarcopenia.”

A study headed by Anna Dahl, MS, of Sweden’s Jönköping University, found that individuals with higher midlife body mass index (BMI) scores had significantly lower general cognitive ability and significantly steeper decline than their thinner counterparts over time. These statistics were compiled from a study of Swedish twins that took place over the course of nearly 40 years, from 1963 to 2002; the results were the same for both men and women.

Other studies reported in the journal show that obesity appears particularly threatening in the presence of other health problems, such as poor muscle strength and depression.

Similarly, changes in weight also signify declines in overall health. A team of researchers led by Alice M. Arnold, PhD, of the University of Washington, Seattle, found that such fluctuations are significant indicators of future physical limitations and mortality in the elderly. Arnold and her colleagues used data from the Cardiovacscular Health Study, which included information from over 3,000 individuals aged 65 and older from 1992 to 1999. They discovered that a history of cyclically losing and gaining weight increased a person’s chance of having difficulty with activities of daily living — bathing, dressing, eating, etc. — by 28 percent.

Merrie Rebecca Walters, RN, and Julie Smith Taylor, PhD, RNC, WHNP-BC, reviewed the potential consequences of maternal obesity in a study that was published in the journal Nursing for Women’s Health. A relationship was investigated between obesity in pregnant women and the risk for childhood and adult obesity in infants of these mothers.

ScienceDaily (Jan. 26, 2010) — In recent years, there has been a large increase in the prevalence of overweight and obese women of childbearing age, with approximately 51% of non-pregnant women ages 20 to 39 being classified as overweight or obese.
A new article published in the journalNursing for Women’s Health finds that obesity in pregnant women is associated with pregnancy complications, birth defects, as well as a greater risk of childhood and adult obesity in infants born to obese mothers.
Merrie Rebecca Walters, RN, and Julie Smith Taylor, PhD, RNC, WHNP-BC, reviewed the potential consequences of maternal obesity. Results show that obese women are more likely to have an infant with a neural tube defect, heart defects, or multiple anomalies than women with a normal BMI.
Obese pregnant women also put themselves at a higher risk of pregnancy complications, including gestational diabetes, hypertension, preeclampsia, induction of labor, cesarean delivery, and postpartum hemorrhage, compared with women with normal pregnancy body mass indexes.
Additionally, information from the article explains that obesity among pregnant mothers is linked to childhood obesity in their infants. Obesity during pregnancy more than doubles the risk of obesity in children at two to four years of age. Also, the risk of obesity in children born to obese mothers may extend into their adolescence, with the risk of obesity during adulthood being greater among obese children.
The article emphasizes the need for women to consult with their healthcare providers about what their ideal pre-conception weight should be. “Assisting women of childbearing age to achieve and maintain a healthful weight prior to conception will potentially minimize health risks to both mothers and infants,” the authors note.
Additionally, strategies for breaking the cycle of obesity include breastfeeding. Research has shown that mothers who breastfeed have a significantly higher weight loss than mothers who formula feed from 1 to 12 months postpartum. Also, breastfeeding may be beneficial in reducing excessive weight gain in infants, therefore reducing the risk of future childhood obesity and type 2 diabetes.
“Health care providers must recognize the association between maternal obesity and childhood obesity and work to break the cycle of obesity before it becomes the leading cause of mortality in the United States.”

One tool that can help combat the obesity epidemic is increasing the public’s awareness of nutritional details. The Food and Drug Administration encourages food manufacturers to post nutritional information to raise awareness. Barry Popkin, a nutrition professor at the University of North Carolina argues posting nutritional information might scare some people off of some foods. William K. Hubbard, a former F.D.A. official argues the information that is currently given with foods is misleading. Lisa R. Young, an adjunct professor of nutrition at New York University, said that it is tough to assess how much people actually eat but serving sizes are certainly growing over time. Wendy Reinhardt Kapsak, senior director of health and wellness at the International Food Information Council Foundation speaks about serving sizes. The Obama administration has revived the effort for the FDA to re-examine their standards. Michael F. Jacobson, executive director of the Center for Science in the Public Interest, a consumer advocacy group, and A ConAgra spokeswoman, Teresa Paulsen, called such this misleading labeling disingenuous and confusing to consumers.

New York Times

Seeking a new weapon in the fight against obesity, the Food and Drug Administration wants to encourage manufacturers to post vital nutritional information, including calorie counts, on the front of food packages.

The goal is to give people a jolt of reality before they reach for another handful of chips. But the urgency of the message could be muted by a longstanding problem: official serving sizes for many packaged foods are just too small. And that means the calorie counts that go with them are often misleading.

So to get ready for front-of-package nutrition labeling, the F.D.A. is now looking at bringing serving sizes for foods like chips, cookies, breakfast cereals and ice cream into line with how Americans really eat. Combined with more prominent labeling, the result could be a greater sense of public caution about unhealthy foods.

“If you put on a meaningful portion size, it would scare a lot of people,” said Barry Popkin, a nutrition professor at the University of North Carolina. “They would see, ‘I’m going to get 300 calories from that, or 500 calories.’ ”

The problem is important because the standard serving size shown on a package determines all the other nutritional values on the label, including calorie counts. If the serving size is smaller than what people really eat, unless they study the label carefully they may think they are getting fewer calories or other nutrients than they are.

And if manufacturers increasingly push key nutrition facts to the front of packages — as many have begun doing — the confusion could be magnified. Rather than helping fight obesity, it may simply add to the perplexity over what makes a healthful diet.

“If people don’t understand the serving, whatever number they get for fat or calories is misleading,” said William K. Hubbard, a former F.D.A. official who consulted with the agency last year.

Consider the humble chip: most potato or corn chip bags today show a one-ounce serving size, containing a tolerable 150 calories, or thereabouts. But only the most disciplined snacker will stop at an ounce. For some brands, like Tostitos Hint of Lime, that can be just six chips.

In the real world, many people might eat two or three times that, or more. Munch half a bag of Tostitos while watching the Super Bowl and you could take in about half the 2,000 calories an average person needs in a day.

“We are actively looking at serving size and evaluating what steps we need to take,” said Barbara O. Schneeman, director of the F.D.A. office that oversees nutrition labels. “Ultimately, the purpose of nutrition labeling is to help consumers make healthier choices, make improvements in their diet, and we want to make sure we achieve that goal.”

The push to re-evaluate serving size comes as the F.D.A. is considering ways to better convey nutrition facts to hurried consumers, in particular by posting key information on the front of packages. Officials say such labeling will be voluntary, but the agency may set rules to prevent companies from highlighting the good things about their products, like a lack of trans fats, while ignoring the bad, like a surfeit of unhealthy saturated fats.

On today’s food packages, many of the serving sizes puzzle even the experts.

For ice cream, the serving size is half a cup. For packaged muffins, it is often half a muffin. For cookies it is generally one ounce, equal to two Double Stuf Oreos. For most children’s breakfast cereals, a serving is three-quarters of a cup.

It is difficult to say exactly how much people eat, said Lisa R. Young, an adjunct professor of nutrition at New York University, but she said that research showed that the portions Americans serve themselves had been growing in recent years.

When it comes to cereal, she said, many children probably eat two cups or more.

Parents who glance at a box of Frosted Flakes and see that it contains 110 calories per serving may not realize that their children may be getting several times that amount each morning at breakfast.

“To consumers, the serving size appears to be inconsistent and unintuitive,” said Wendy Reinhardt Kapsak, senior director of health and wellness at the International Food Information Council Foundation. “They have trouble trusting it.”

They may also have trouble seeing it, where it usually appears in small type in the Nutrition Facts panel on food packages. In surveys conducted by the foundation, many more people say they look at the calorie number than at the serving size on which it is based.

Standard serving sizes were created by the F.D.A. in the early 1990s, partly to make it easier to compare the nutritional values of different products. Congress required that the serving sizes match what people actually ate. To determine that, the F.D.A. evaluated data from surveys of Americans’ eating habits taken in the 1970s and 1980s.

Some nutritionists say those surveys may be suspect, since people typically underestimate how much they eat. And there is general agreement that they are out of date.

The F.D.A. has vowed to re-evaluate serving sizes before. Amid concern over obesity, it said in 2005 that it was considering changes. That effort languished, but has now been revived by the Obama administration.

Still, the solution is not as simple as merely bumping up the standard portions for some foods. Officials worry that could send the wrong message. If the serving size for cookies rose to two ounces, from one ounce, for instance, some consumers might think the government was telling them it was fine to eat more.

A trip to the store shows how a smaller serving size can affect health or nutrient claims in ways that may confuse consumers.

Duane Reade, the pharmacy chain, sells 1.3-ounce bags of its Delish potato chips with the words “100 calories” in bold type across the front. But the calorie count refers to a one-ounce serving, and the label says the bag holds one-and-one-third servings. That appears to conflict with F.D.A. rules that require packages of that type to be labeled as a single serving. Doing the math, the full bag would appear to contain around 130 calories.

After being questioned about the bags by The New York Times, Duane Reade said it would correct the chip labels.

While in some cases companies have leeway in how they label smaller packages, in 2004 the F.D.A. urged manufacturers to label them as single-serving containers. The agency was interested primarily in making calorie counts clearer, but other food ingredients, like salt, also raise concerns.

Healthy Choice soups, made by ConAgra Foods, are sold in 14-ounce microwaveable bowls. Although they appear to be meant for one person, the label says they contain “about two servings.”

Many of the soups are billed as “Heart Healthy” and claim to have a reasonable amount of salt per serving. But a shopper has to examine the label closely to understand that the salt claim refers to half a bowl. A full bowl may contain close to half the daily salt allowance recommended for people with high blood pressure.

Michael F. Jacobson, executive director of the Center for Science in the Public Interest, a consumer advocacy group, called such labeling disingenuous.

A ConAgra spokeswoman, Teresa Paulsen, said the Healthy Choice bowls contained more than one and a half times the F.D.A.-established standard serving for soup, which is about eight fluid ounces, or one cup.

Because of that, Ms. Paulsen said, “we think it makes sense to label the package as two servings.”

The UCLA School of Public Health published a study in the American Journal of Public Health looking at the link between watching television and childhood obesity, and particularly the impact of exposure to junk food commercials. This study was conducted by Frederick J. Zimmerman, professor and chair of health services at the School of Public Health and the lead author of the study, and Janice F. Bell. The results of the study show the deleterious effects of junk food commercials.

ScienceDaily (Feb. 10, 2010) — The association between television viewing and childhood obesity is directly related to children’s exposure to commercials that advertise unhealthy foods, according to a new UCLA School of Public Health study published in the American Journal of Public Health.
The study, conducted by Frederick J. Zimmerman and Janice F. Bell, is the first to break down the types of television children watch to better determine whether different kinds of content may exert different effects on obesity.
The researchers gathered data from primary caregivers of 3,563 children, ranging from infants to 12-year-olds, in 1997. Through time-use diaries, study respondents reported their children’s activities, including television viewing, throughout the course of an entire weekday and an entire weekend day.
Caregivers were also asked to report the format — television programs, DVDs or videos — and the names of the programs watched. This data was used to classify television viewing into either educational or entertainment programming and to determine whether or not it contained advertising or product placement. A follow-up was conducted in 2002.
The analysis controlled for the amount of physical activity and the children’s gender, age, race/ethnicity, mother’s body mass index (BMI), education and sleep time.
Among all children, commercial viewing was significantly associated with higher BMI, although the effect was stronger for children younger than 7 than for those older than 7, the study found.
“The persistence of these results, even when the child’s baseline weight status was controlled, suggests that the association between commercial television viewing and obesity does not arise solely or even primarily because heavier children prefer commercial television,” said Zimmerman, professor and chair of health services at the School of Public Health and the lead author of the study.
Non-commercial viewing, including watching DVDs or educational television programming, had no significant association with obesity.
According to the authors, the findings strongly suggest that steering children away from commercial television may be effective in reducing childhood obesity, given that food is the most commonly advertised product on children’s television and the fact that almost 90 percent of children begin watching television regularly before the age of 2.
By the time they are 5 years old, children have seen an average of more than 4,000 television commercials for food annually. During Saturday morning cartoons, children see an average of one food ad every five minutes. The vast majority of these ads — up to 95 percent — are for foods with poor nutritional value, the researchers say.
“Commercial television pushes children to eat a large quantity of those foods they should consume least: sugary cereals, snacks, fast food and soda pop,” Zimmerman said.
The authors conclude that the availability of high-quality, enjoyable and educational programs for all ages on DVD should make it relatively easy for health educators and care providers to nudge children’s viewing toward content that does not contain unhealthy messages about food and eating.
“Just as there are far better and more nutritious foods than those advertised on television, there are also far better and more interesting shows on television than those supported by advertising,” Zimmerman said. “Educational television has come a long way since today’s parents were children, and there are now many fantastic shows on commercial-free television and, of course, wonderful content available on DVD.”

The Hood Center for Children and Families at Dartmouth Medical School recently published research in the Journal of Pediatrics regarding the possible negative impact that food placement in the movies can have on children. Research shows the most of the food portrayed in movies are energy-dense, nutrient-poor foods or product lines. This may mean that these advertisements may have negative effects for adults and children watching the movies. Lisa Sutherland, Ph.D. the lead author of the study says that people must examine all contributing factors to the obesity epidemic that is affecting children. The co-authors of the study included Todd MacKenzie, Ph.D., Lisa A. Purvis, MPH, MBA, and Madeline Dalton, Ph.D. all with Dartmouth Medical School.

ScienceDaily (Feb. 8, 2010) — New research from the Hood Center for Children and Families at Dartmouth Medical School (DMS) for the first time sheds light on the significant potential negative impact that food product placements in the movies could be having on children.

The study, which appears in the current edition of the journal Pediatrics, shows that most of the “brand placements” for food, beverage, and food retail establishments that are frequently portrayed in movies, are for energy-dense, nutrient-poor foods or product lines. In addition, the study shows for the first time that product placements in movies may be a far more potent source of advertising to children in terms of food choices than previously understood.

“The current situation in the United States is very serious in terms of the health of our children, and we have to look seriously at all of the factors that may be contributing to it, including the impact of product placements in movies,” says Lisa Sutherland, Ph.D. the lead author of the study. Sutherland says that the diet quality of U.S. children and adolescents has declined markedly during the past 20 years, and current estimates suggest that only one percent of children eat a diet consistent with the U.S. Department of Agriculture’s (USDA) My-Pyramid food guidance. Additionally, fewer than one fifth of adolescents meet the dietary recommendations for fat or fruit and vegetable intakes, and during the last 20 years obesity rates have doubled for children aged 6 to 11 years and tripled for adolescents aged 12 to 19 years.

“While the issue of food advertising and its effect on children has been well documented in numerous studies, comparatively little is known about product placement in movies and how it affects the food and beverage preferences and choices of children and adolescents,” Sutherland said. The study notes that while there are similarities between television advertising and movie product placement, such as the low nutritional quality of the majority of branded products, there are also interesting differences. Recent studies that examined television ads during adolescent programming found fast food and ready-to-eat cereals and cereal bars to be the most prevalent during children’s programming. In contrast, the Dartmouth study found that sugar-sweetened beverages, comprised largely of soda, accounted for the largest proportion of all of the movie-based food product brand placements, accounting for one of every four brand placements overall.

The study notes that of particular concern are the food and beverage product placements in comedies and PG-rated and PG-13-rated movies, which are often geared specifically to older children and teenagers, who are at an age where they are gaining independence with respect to their food choices. Although the impact of this type of advertising on children is not fully known, it provides a likely avenue by which brand loyalty and product preference can be built in addition to eating patterns.

The study also revealed that six companies accounted for 45 percent of all brand placements and included PepsiCo, Coca-Cola, Nestle USA, McDonald’s, Dr. Pepper/Snapple Group and Burger King.

The study acknowledges that many companies have made pledges not to direct advertising at children in order to encourage healthier dietary choices, and that while this is a step in the right direction, more clearly needs to be done. In addition, the study’s authors say that a number of studies to date that focused on other health-related behaviors, including alcohol and tobacco use, showed that movies contain frequent portrayals of these risk behaviors and often include brand appearances of the products. They say it is well established that children who view these risk behaviors in movies are more likely to engage in the behavior themselves.

“This is an area of study which clearly requires more research,” says Sutherland who was part of a team of advisers that, in 2006, helped to develop the Guiding Stars program used by supermarkets to help shoppers better identify the nutritional values of food products. “At a time in their development where children and adolescents are very susceptible to outside influences, we have to carefully examine the influence of all the factors that are combining to create what may end up being lifelong habits around food and lifestyle choices. Certainly, food-product placement in movies is one of many factors, but it is one that may be far more influential than previously realized and perhaps the least well understood.”

Co-authors included Todd MacKenzie, Ph.D., Lisa A. Purvis, MPH, MBA, and Madeline Dalton, Ph.D. all with Dartmouth Medical School.