USA TODAY Collegiate Case Study: Foodology

THE NATIONS NEWSPAPER

Collegiate Case StudyAuthor of Mindless Eating wields a new bully pulpitBy Nanci Hellmich ..................................................................................5

www.usatodaycollege.com

Foodology 101Everyone every single one of us eats how much we eat largely because of what is around us. We overeat not because of hunger but because of family and friends, packages and plates, names and numbers, labels and lights, colors and candles, shapes and smells, distractions and distances, cupboards and containers. We all think we are too smart to be tricked by packages, lighting or plates. We might acknowledge that others could be tricked, but not us. That is what makes mindless eating so dangerous. We are almost never aware when it is happening to us. This topic, as illustrated in th book Mindless Eating, emphasizes how small changes can make big differences in how much we weigh.

They aced Get Healthy 101By Nanci Hellmich ...............................................................................6-7

Which diet is best for you?By Nanci Hellmich ..............................................................................8-9

From South Beach with HeartBy Nanci Hellmich ..........................................................................10-11

Overweight teens bear extra burdenBy Nanci Hellmich ..........................................................................12-13

Is your house making you fat?By Mary Cadden ......................................................................................14

Critical inquiryDiscussion and future implications ................................................................................15-16

Case Study Expert: Dr. Brian Wansink, Chief, Center for Nutrition Policy and Promotion

USA TODAY SnapshotsFad diets often fruitlessResults for those who followed a popular weightloss program, such as Atkins, South Beach or The Zone, and then stopped: Returned to original weight 44 %

By Katie King for USA TODAY

Life of fitness: Kemichelle Taylor, 33, of Mobile, Ala., has lost 227 pounds. She became a personal trainer in December 2006. She is seen here working with client Robert Allen Tharpe Jr., 24, of Mobile on abdominal crunches using a medicine ball.

Dieters keep fat on the runThe secret is finding an activity they loveBy Nanci Hellmich USA TODAY If there's one lesson that successful dieters have learned, it's this: If you keep moving, your old fat can't catch up with you.

Kept weight off, with ease

Gained more than weight lost

12%Source: Impulse Research for Americas Milk Processors

27%Kept all weight off, with constant effort 17%By Justin Dickerson and Robert W. Ahrens, USA TODAY

Copyright 2007 USA TODAY, a division of Gannett Co., Inc. All rights reser ved.

AS SEEN IN USA TODAYS LIFE SECTION, MAY 29, 2007

Kemichelle Taylor, 33, of Mobile, Ala., lifts weights and works out on an elliptical trainer six days a week to maintain her weight at 162 pounds, down from 389. "I'm in the best shape of my life," she says. Kelly Rhoads, 48, of Bowie, Md., who now weighs 160 but once hit almost 330 pounds, walks briskly with friends for an hour several days a week. It's girlfriend time, and walking is an activity "I can do the rest of my life," she says. Aidan Murphy, 41, of Annapolis, Md., bikes for nine or more hours every week to try to keep his weight at 205 pounds, down from 328. "I'm doing it because it makes me feel better about myself," he says. Taylor, Rhoads and Murphy are among the dozen weight-loss champions who have been profiled during USA TODAY's Weight-Loss Challenge this spring. They and other participants lost weight in a variety of ways, from following eating plans of their own to joining Weight Watchers. But one thing they all have in common is that they are devoted to exercise and a lot of it. Most allot chunks of time to endurance activities such as walking, jogging and biking, and they also strength-train. Many worked out for an hour or more a day to lose the weight and have continued that pace to keep the pounds off. The bottom line: "You have to maintain a high level of physical activity to keep the weight off. It's a lot of hard work," says Suzanne Phelan, a researcher with the National Weight Control Registry at Brown University in Providence. "We see this over and over again: If people's exercise starts unraveling, they start regaining weight." Want proof? Supporting evidence mounts:

o Family photBy Tim Dillon, USA TODAY

Attitude adjuster: Aidan Murphy, 41, of Annapolis, Md., bikes for nine or more hours every week to try to keep his weight at 205 pounds, down from a high of 328. I feel grumpy if I dont exercise, he says.

u Members of the weight-control registry, about 5,000 people who lost an average of 66 pounds and kept off at least 30 pounds for more than six years, walk an average of an hour a day (11,000 steps) or burn the equivalent calories by doing other activities such as cycling, aerobics, strength training and running. u A Brown University study of more than 300 people who had shed at least 10% of their starting weight found that those who were most likely to keep it off did an hour of physical activity a day. u Scientists at the University of Pittsburgh discovered that overweight people who lost and kept off 25 to 30 pounds walked briskly for 50 minutes to an hour a day, five days a week. If people adopt exercise early in their weight-loss program and increase it steadily, they eventually will be doing enough to maintain the loss, says John Jakicic, director of the Physical Activity and Weight Management Research Center at the University of Pittsburgh.

Plus, people who are physically active during weight loss compared with those who diet only will lose more fat and retain more of their lean muscle, says Russell Pate, professor of exercise science at the University of South Carolina. Doing what you love Experts have said for years that the best exercise is one that you will actually do. "The secret to the challenge of participants' exercise success is that they've found something they like," says Edith Howard Hogan, a registered dietitian in Washington, D.C., who helped select the people featured in this year's Weight-Loss Challenge. "They don't think of it as a chore. It's a joy." But it wasn't easy at first. Kelly Rhoads says that when she first started exercising, "I did it because I had to." She weighed almost 330 pounds at the time. "I had to start moving. The first thing I did was walk around a city block for 15 minutes. I got out of breath. My hips hurt."

Reprinted with permission. All rights reser ved.

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Family photo

By H. Darr Beiser, USA TODAY

Before: Kelly Rhoads, of Bowie, Md., once weighed nearly 330 pounds.

After: Kelly Rhoads, right, walks with friend Marya Dennis. Rhoads, 48, calls her brisk walks girlfriend time, and is down to 160 pounds. Rhoads also does strength training and toning exercises.

Rhoads gradually started walking faster and farther. Right now, a good hike for her is about 4 miles and takes her just about an hour, she says. She walks briskly several days a week and does strength-training and toning exercises by following DVDs, in addition to watching her food intake and getting enough rest. She does all this to maintain her 170-pound weight loss. "Exercise is important, and I feel better when I do it," she says. Kemichelle Taylor says that early in her weight loss she focused more on strength training but quickly realized she was gaining muscle mass and not losing much weight. So she worked up to doing about 30 to 40 minutes a day of walking or biking and 20 minutes of weight training. She also got serious about improving her diet. Over time, she increased her activity level and now works out two hours or so a day to maintain her weight at 162 pounds, 227 pounds lower than her original weight.

But what about people who say their busy family and work lives force them to choose between sleep and exercise? Taylor says the exercise comes out of her TV time. "I watch very little TV. This is about getting off the sofa and making sacrifices." It's all a matter of scheduling, dietitian Hogan says. People must schedule exercise just as they do visits to the doctor or their hairdresser. It's easy to have your computer or BlackBerr y remind you that it's time to get out and get moving, she says. People who have children can squeeze in small amounts of exercise all day, Hogan says. When your little one goes down for a nap, jog up and down the steps several times or walk around the house wearing a pedometer. Do squats when you're talking on the phone or drying your hair. 'Energized by exercise' When your child is at soccer practice,

walk up and down the field, she says. "Remember you will be energized by exercise." Aidan Murphy says that when he decided to lose weight, he also changed his TV-watching experience. "Instead of sitting on the sofa and watching TV, I was on the treadmill watching T V. I walked without fail, and I lost 40 pounds the first year." Now, he weight-trains regularly and bikes 50 to 60 miles outside on both weekend days, as well as inside on an exercise bike several days a week. There are times when he's so busy at work that he can't do this much activity, but the next week, he tries to get back on track. It's important to prioritize, he says. "I always feel bad when I do not get to ride my bike, because it means I am putting everything before something for me," Murphy says. But, he says, if you don't exercise for a day or two or even a week or more, that


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"doesn't mean that everything you have done goes away. Tomorrow is a new day, so just get back to the plan." He agrees that it's much easier to commit to an activity you enjoy: "If you feel it's a chore, it's impossible to do." Two approaches to exercise Endurance and strength training contribute significantly to weight control and overall good health, says Miriam Nelson, an exercise scientist at Tufts University in Boston and one of the authors of Strong Women, Strong Hearts. Studies show that regular endurance exercise strengthens the heart and the entire cardiovascular system so it works more efficiently, which translates to making it easier to do things such as climbing steps or walking longer distances. It also reduces the risk of many diseases, including type 2 diabetes, heart disease, cancer and osteoporosis, Nelson says.

Cardiovascular exercise is "the real sledgehammer" when it comes to burning calories, she says. "If you go out for a brisk walk for 30 to 45 minutes, you are going to burn 150 to 200 calories during that time." Jakicic agrees. In one study, he found that exercisers burned three times as many calories in 30 minutes of walking and biking as they did in the same amount of time strength-training. Both Nelson and Jakicic have done research on the benefits of strength training and are big supporters of this type of exercise. Strength training, which can be done with free weights, machines or functional exercises such as push-ups, squats and lunges, helps preserve and build muscle, and reduces the risk of getting type 2 diabetes, heart disease, osteoporosis, osteoarthritis and other problems, Nelson says.

People lose about one-quarter of a pound of muscle a year, starting in their early 40s, she says. Much of that loss of muscle can be avoided if they strengthtrain two to three times a week for about 30 minutes. Research suggests strength training may increase resting metabolic rate, the calories you burn while sitting still. One study showed that people who strengthtrained vigorously for six months gained about 3 pounds of muscle and burned 100 more calories a day. Each pound of lean muscle burns an additional 30 or more calories a day, the study concluded. "Up until your 60s or 70s, you can hold onto a heck of a lot of muscle with strength training," Nelson says. "Once you're 80 or 90, you are probably going to lose some muscle, but the resilience of the human body always amazes me."


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AS SEEN IN USA TODAYS LIFE SECTION, NOVEMBER 27, 2007

Author of 'Mindless Eating' wields a new bully pulpitBy Nanci Hellmich USA TODAY Brian Wansink, one of the nation's top experts on eating behaviors and the author of Mindless Eating: Why We Eat More Than We Think, hopes that in his new federal job he can take a stab at reversing the obesity epidemic. Wansink, who last week was named executive director of the U.S. Department of Agriculture's Center for Nutrition Policy and Promotion, wants to encourage people to "bump up their activity level." And he would like to work with registered dietitians and schoolteachers to help them teach others to use the government's nutrition tools, including the Food Pyramid (www.mypyramid.gov). He'll also be forming an advisory committee to create the 2010 Dietary Guidelines for Americans. These would be a science-based update of the 2005 federal guidelines, which are considered the gold standard of nutrition advice. Wansink says it took about 30 years for obesity to get where it is today, and "it's going to take some time to reverse it." He is taking a leave of absence from his job as director of Cornell University's Food and Brand Lab. During the past 20 years, Wansink has conducted more than 200 studies of environmental factors that push Americans, sometimes unconsciously, to overeat. He believes that people are constantly "trapped" by their surroundings into consuming 100 to 200 calories more than they need or want. He says Americans can trim a couple of hundred calories a day and lose 10 to 20 pounds a year by doing things such as avoiding open food dishes at the office, using smaller serving

By Eileen Blass, USA TODAY

Healths a-popping: Behaviorist and author Brian Wansink is the new chief of the federal Center for Nutrition Policy and Promotion.

bowls and spoons, and leaving serving dishes on the stove instead of on the table. His research includes the McSubway Project, a series of studies that examine the habits of fast-food customers. Much of the research compares foods at McDonald's and Subway, which advertises that it has more healthful options. Wansink found that there's a "health halo" around a lot of the foods at restaurants such as Subway in which customers feel virtuous about their choice of meals. So, his research shows, they overeat in side dishes and grossly underestimate the number of calories they consume.

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They aced Get Healthy 101USA TODAYs Nanci Hellmich profiles two college students who won big at losing After a diagnosis of obesity, former 'fat kid' gets seriousBen L aForest, 20, who just finished his second year at the University of Buffalo, says he was always the "fat kid" when he was growing up. When he was about 14, a doctor weighed him and wrote on his chart "an adolescent with obesity." LaForest was stunned. "I couldn't believe he had written that down about me," he says. So in the summer between ninth and 10th grades, he started exercising - rollerblading, running, biking, weight lifting. He also began eating high-fiber foods and lean protein. "I saw results and didn't look back." His weight dropped from 260 pounds to 170 pounds in three months. He maintains it now at 180 pounds. He's 6foot-1. LaForest and Katie Adler are among the readers profiled in the annual USA TODAY Weight-Loss Challenge, which ends today.USA TODAY

Temptations of college living are no match for determinationKatie Adler, 20, who just completed her third year at the University of Michigan, says trying to shed weight in college is as challenging as making good grades. Both take focus, planning and commitment. "You have to be dedicated, because there are so many temptations, with all the drinking and late-night food," she says. "I was eating a lot of pizza and dorm food and not exercising." Her weight ballooned to 216 pounds. "Finally, I said, 'I'm tired of this. It's time to do something'" She changed her eating habits with advice from a personal trainer, and she star ting making time to exercise. She has dropped from 216 pounds in January 2006 to 156. Adler star ted watching what she eats last summer and kept at it when she

USA TODAY

"One of my favorite tricks was chewing sugar-free gum and drinking water when I was hungry," LaForest says. "It helped me not think about food, because I was constantly chewing on something." He plays tennis for two hours three times a week and weight-trains for 30 minutes three times a week. "I never thought I could be as fit as I am today. I thought I was definitely always going to be fat. And now I can't imagine myself as being that big again."

returned to college in the fall. "The hardest thing in the beginning was breaking the candy addiction. My candy of choice was Milky Ways. Every now and then I (still) have a piece of candy. But I've really lost the taste for it." She limits her calories to 1,500 to 1,800 a day, eating every three or four hours and consuming lots of vegetables. The payoff: "The weight loss has boosted my self-image and my self-confidence. I didn't like who I was. I didn't think I was pretty, but now I have more self-confidence."

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Ben LaForest, 20Hometown: Cohoes, N.Y. Occupation: Just finished sophomore year at the University of Buffalo. Going to Cornell University next year to major in food science. Height: 6-1 Weight in August 2000 Current weight Loss Pounds 260 180 80

Katie Adler, 20Hometown: Milford, Mich. Occupation: Just finished her third year at the University of Michigan, majoring in chemical engineering Height: 5-10 Weight in January 2006 Current weight Loss Pounds 216 156 60

BEFORE

BEFORE

Goal: I love my new healthy lifestyle and plan on becoming a food scientist making healthy, nutritious food for everyone. Hopefully, I can work with the company that makes Kashi bars. Insight for others: Exercise as much as you can. When you exercise, you want to eat better, and you feel better about everything.

Goal: If I could tone up, that would be nice. Insight for others: For college kids, its really hard. You need to make a conscious effort and ask yourself: Should I really be eating this? You have to stick with it and do it for yourself and not for anybody else.

A sample day10 a.m.: Has a breakfast of Egg Beaters or oatmeal with apple slices 1 p.m.: Snacks on a South Beach Diet bar and some kind of fruit or vegetables, either an apple or green beans and cucumbers 4 p.m.: Has a lunch of tuna or chicken with a little Miracle Whip,vegetables, salad and apple 8 p.m.: Has dinner 10 p.m.: Goes to the gym 11 p.m.: Snacks on yogurt and an apple What she eats Lean Cuisine Cooked vegetables with broccoli, carrots, cauliflower Salad with lettuce, tomatoes, green peppers, celery Fruit Dieters routine Abdominal exercises Runs Total weekly exercise Amount 1 entree 3 cups

A sample day10:30 a.m.: Eats one packet of instant oatmeal and a banana 1 p.m.: Eats lunch of a turkey sandwich on whole-wheat bread, large salad (about two cups) with light dressing and an apple 1:30 p.m.: Weight-trains for 30 minutes, three times a week 2 p.m.: Snacks on about 25 wholewheat pretzels with peanut butter and a low-fat yogurt 2:30-4:30: Plays tennis for one to two hours, three times a week 5:30 p.m.: Eats dinner 7:30 p.m.: Snacks on 100-calorie pack of popcorn What he eats Grilled chicken Green beans Brown rice Dieters routine Plays tennis Weight-trains Total weekly exercise Amount 6 ounces 2 cups 1 cup Amount One to two hours, three times a week 30 minutes, three times a week 4 1/2 to 7 1/2 hours

2 cups

1 piece Amount 15 minutes, five times a week 1 1/2 to 2 1/2 miles in 20 minutes,five times a week 3 hours


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AS SEEN IN USA TODAYS LIFE SECTION ON JANUARY 3, 2007

Which diet is best for you?One size does not fit all when it comes to diets, says Liz Vaccariello, editor in chief of Prevention magazine. Research shows that to lose weight -- and keep it off -- you must pick a plan that suits your personality, food preferences and schedule, she says. USA TODAY's Nanci Hellmich asked Vaccariello and the editors of Prevention to pick their favorite programs for different types of people:For people who hate to cook Jenny Craig It satisfies most dieters' needs: prepackaged meals and snacks, tracking via private weigh-ins, weekly consultations (by phone or in person) and a website for additional information and support. Plus, it offers meal plans that you can get delivered -- all you need is a microwave. For people who like to cook The South Beach DietBy cardiologist Arthur Agatston

with less-than-perfect numbers, Weight Watchers teaches you how to make it work within your allotted limit. It's this kind of real-life dieting that makes the program one diet that's easy to follow for the maintenance phase. For people who love science You: On a Diet: The Owner's Manual for Waist ManagementBy Michael F. Roizen and Mehmet C. Oz

This best seller explores the hows and whys of weight loss in a friendly, easyto-understand way. Roizen and Oz provide an in-depth analysis of how your brain, stomach, hormones, muscles, heart, genetics and stress levels all interact biologically. For fruit-and-vegetable lovers Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy EatingBy Walter C. Willett with Patrick J. Skerrett

Never mind the fluffy name of the diet book. This smart-carb, high-fiber plan is an excellent way to reduce your intake of highly processed carbs and increase your awareness of super-healthy and satisfying protein sources such as seafood. The South Beach cookbooks allow dieters the opportunity to flex their culinar y muscles and enjoy gourmet food, while still keeping calories controlled. Last but not least, because of its high-fiber requirements, this diet is unlikely to leave you feeling hungry. For number crunchers Weight Watchers The Flex Plan points program makes counting fun. We like that no food is off-limits. If you choose a food

Willett's insightful critique of the U.S. Department of Agriculture's Food Guide Pyramid reveals its limitations, and he constructs an alternative. His ideas are nothing we haven't read before: Eat more vegetables and complex carbohydrates, emphasize healthy fats, and enjoy small amounts of a variety of foods. But his matter-of-fact delivery and no-nonsense tone earn this a place on Prevention's reference shelf.


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For people who eat out a lot Dr. Shapiro's Picture Perfect Weight Loss: The Visual Program for Permanent Weight LossBy Howard M. Shapiro

For people who want a gimmick that works Slim-Fast You know the deal: a shake for breakfast, shake for lunch, then a sensible dinner. We'd love to say it's just a fad, but numerous published studies show why it works: It's a simple, but effective, way to reduce your calorie intake. It also has a built-in maintenance plan. Pounds creeping up? Shake 'em off. For people who like the Web

If you have trouble telling right-size from super-size when you're at a restaurant, fast-food joint, coffeehouse or even in your own kitchen, this book will set you straight. For people who enjoy walking The Step DietBy James O. Hilland John C. Peters with Bonnie Jortberg

WebMD Weight Loss Clinic This online program gives you an accurate assessment of your nutritional status, and the daily e-mail reminder program provides accountability. But what we really like about this program is that it helps you improve your diet by making small changes rather than requiring you to overhaul your entire refrigerator.

The co-founders of America on the Move offer a plan that's based on one of Prevention's favorite fitness routines: walking. It comes with a pedometer, in itself a $20 value, plus conversion charts and dozens of reduced-calorie recipes. First, use the pedometer to gradually increase the number of steps you take in an average day, then reduce your food intake by a quarter. Simple.


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From South Beach with HeartIn Agatston's new book, 'accidental diet doctor' keeps the beat goingBy Nanci Hellmich USA TODAY One of the nation's top diet doctors has trimmed many waistlines with his bestselling The South Beach Diet. Now he's going for the heart with a new book out today. Cardiologist Arthur Agatston, who calls himself an "accidental diet doctor," originally created his eating plan to help his patients lose weight, improve their cholesterol and avoid diabetes and heart disease. He says he never dreamed it would take off as it did. His 2003 book evolved into one of the best-known diet programs. About 11 million copies are in print worldwide. It recommends eliminating most processed and fast foods and eating plenty of fish, vegetables and fruit. It also emphasizes whole grains and healthy oils. Now he wants to trade on that fame to save hearts with his book, The South Beach Heart Program (Rodale, $25.95). In this book, he explains how the way people live directly affects the heart and all its machinery: the arteries, the blood vessels, the hear t muscle itself. He outlines the diagnostic tests for heart disease and urges people to learn the condition of their arteries and adopt hear t-healthy living: eating better, exercising regularly, stopping smoking and reducing stress. The book offers a crash course on his diet with a few daily menus. The Miami Beach doctor says he wants to "speed up the cardiac prevention revolution. One of the biggest secrets in medicine today is that cardiologists and internists who are practicing aggressive Three key principles of 'The South Beach Diet' 1. Eat good fats. Choose good fats from olive oil, canola oil, peanut oil, flaxseed oil, walnut oil, avocados, nuts and fish. Omega-3 (fish oil) supplements also are fine. 2. Eat good carbs. Good carbs include high-fiber, nutrientdense fruits, vegetables, legumes and whole grains. 3. Eat lean protein. Eat eggs, low-fat dairy, nuts, seeds, legumes, white-meat poultry, fish, shellfish and lean cuts of meat. prevention are rarely seeing premature heart attacks and strokes in people under 70." Early reactions from doctors and nutritionists who have read the book have been mostly positive, with some reservations. "We need to reawaken people. Heart disease is a plane crash. We want to prevent the crash and the near-misses as well," says renowned New York heart surgeon Mehmet Oz, co-author of the best-selling YOU: On a Diet: The Owner's Manual for Waist Management. Keith Ayoob, a registered dietitian at the Albert Einstein College of Medicine in New York, says Agatston's new book "won't appeal to fad dieters who are worried about getting into a bikini, but it will appeal to aging boomers who have realized they are not immortal." Cardiovascular disease is the No.1 killer in the USA, according to the American Heart Association. About 865,000 new and recurrent heart attacks strike each year, Agatston says. He believes these grim statistics can be changed. He'd like to see more doctors working as "healers" to stop hear t disease before it goes too far, instead of working as "plumbers" who go in after the damage is done to make repairs with scalpels, balloons and stents. He says he treats mostly high-risk patients who have multiple risk factors, but he rarely has to use invasive procedures such as angioplasty or bypass surgery. These procedures are done far too often in the USA, he believes. If patients had a clearer picture of what is going on in their arteries, they would be more motivated to clean up their lives, he says. Oz says more doctors are moving toward prevention and agrees that knowledge may help inspire people to change. As a surgeon who does many bypass surgeries and heart transplants, when he opens his patients' chests, he sees all the "sludge" that's blocking their arteries. "This is not something they were born with. It's actually something they did to themselves." He's often disappointed that the patient needed surgery. "It's like I'm bringing new pipes to your home when what I should have been doing is teaching you how to change the corrosive fluids that were rusting your pipes." What's really going on inside Agatston, an associate professor at the University of Miami Miller School of Medicine at Mount Sinai, says arteriosclerosis, or hardening of the arteries, is caused by a combination of genetics and environment. "Some people


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have fabulous genetics and can get away with almost anything smoking and eating whatever they want," he says. "Some people have horrible genetics and can do everything right and live a perfect life and still develop heart disease. But most of the rest of us are somewhere in between." He writes that when he went to medical school in the 1970s, he was taught the "plumbing model" of heart disease. Doctors believed heart attacks resulted from a blockage of a major coronary artery caused by a gradual buildup of plaque. The idea was that as the artery became more clogged with plaque, it would narrow to the point at which blood flow to the heart would be cut off. But this theory was wrong, he says. The biggest reason for heart attacks are what are called "vulnerable plaques." These plaques are like little pimples, but instead of being filled with pus, they are filled with cholesterol, Agatston says. When they pop, they cause tiny injuries to the vessel wall. To heal the injury, a blood clot forms. If the blood clot is large enough, it will block the artery and cut off part of the heart's blood supply, he says. Bloodstarved heart tissue dies. This is a heart attack. The good news is that by improving their diet, exercising and possibly taking medications, most people can stop the plaques from growing and bursting. "In a sense, the plaques stabilize. They can regress." When it comes to improving the condition of their arteries, most people need to begin with their diets because they "have horrible eating habits." People are killing themselves with high-fat burgers, sugary milkshakes and trans-fat-laden fried foods, highly refined foods with little nutritional value, he writes in the book. "If we had deliberately set out to design a diet to make people fat, diabetic and candidates

for heart attack or stroke, we couldn't have done a better job." That can be changed, he says. Good eating and exercise habits produce weight loss, which improves cardiovascular health. Every pound of fat takes lots of tiny blood vessels to feed it, he says. When a person loses weight, there is less stress on the heart. Plus, weight loss helps reduce waist circumference, which is key. Having a lot of belly fat increases the chance of type 2 diabetes and heart disease. Agatston says that to improve heart health, people should: u Avoid trans fats, hydrogenated and partially hydrogenated oils found in some commercial baked goods and fastfood fries. u Increase the intake of fruits and vegetables. Supplements won't give you all the micronutrients that these foods will. u Increase their intake of omega-3 fatty oils by eating flaxseed oil or fatty fish such as salmon or by taking supplements. Agatston's South Beach diet program is divided into three phases. The first twoweek portion is the most rigorous and eliminates such foods as fruits, carrots, bread, cereal, potatoes and pasta. Dawn Jackson Blatner, a registered dietitian at Northwestern Memorial Wellness Institute in Chicago, doesn't like the first phase because, she says, "it eliminates healthy foods." Phase 2 is much better because it "encourages people to eat a wide variety of healthy foods, such as colorful fruits and vegetables, fiber-rich whole grains and heart-smart fats," she says. Robert Eckel, former president of the American Heart Association, says many of the dietary principles outlined by Agatston are consistent with those from the AHA. "But we have no science that

the South Beach Diet is any better than some other evidence-based diets for weight control and prevention of heart disease." A battery of tests Agatston says people would eat better if they knew the condition of their ar teries. He suggests a variety of diagnostic tests, including blood tests for cholesterol, triglycerides and other factors. For men over 40 and postmenopausal women over 50 who have risk factors for heart disease, he recommends having a non-invasive heart scan, which indicates the amount of plaque that's present in the arteries. Some of his patients keep pictures of their ar teries on the refrigerator. "Before they open the refrigerator, they look at their arteries." Eckel says Agatston does a good job outlining the principles of heart disease prevention and diagnosis, but he says Agatston is overly "zealous" in his advice for some tests, including heart scans. The heart association calls the scan a "potential useful tool" for people who are at moderate risk but stops shor t of recommending it. "The decision should be made by the patient's physician," Eckel says. Although Agatston is a passionate believer in the power of diet and exercise, some patients at high risk for heart disease should be taking statins and other drugs. "Millions of people who should be taking cholesterol-lowering drugs are not. That means that millions of Americans have an unnecessarily high risk of heart attacks, strokes or sudden death. "The medications we have today have a fraction of the side effects that they used to have. They are lifesaving."


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AS SEEN IN USA TODAYS LIFE SECTION JANUARY 4, 2007

Overweight teens bear an extra burdenKids who trimmed down share their trials and triumphsBy Nanci Hellmich USA TODAY Registered dietitian Anne Fletcher has heard the worst when it comes to the emotional torture suffered by overweight teens. She has interviewed more than 100 teenagers who were able to lose weight, and she recounts their stories of struggle, pain and triumph in a new book. Among them: *One 13-year-old girl said kids chased her around the playground yelling, "Run, Fatso, run!" She came home cr ying almost every day. She eventually lost 100 pounds. *A high school boy said his baseball coach taunted him, saying the teen hit home runs because he "was so damn slow" that he needed the extra time to circle the bases. Both guys and girls said being overweight affected their body image, self-esteem and ability to attract friends and members of the opposite sex. "One of the things that hit me was the pain most of these kids had suffered. This is not a society that is kind to overweight people, particularly teenagers," says Fletcher, who lives in southern Minnesota. On the other hand, they told her how weight loss changed their lives for the better. She believes their stories will inspire others. "Success stories help other people believe in themselves and their ability to change," says Fletcher, who shares insights from adolescents, their parents and nutrition professionals in Weight Loss Confidential: How Teens Lose

BEFORE

AFTER

Family photos

Dramatic change: Wes Gilbert at age 18, above, after losing about 65 pounds, and at age 17.

Weight and Keep It Off -- and What They Wish Parents Knew (Houghton Mifflin, $26). She wrote Thin for Life in 1994 about adults who successfully lost weight. The teens lost weight in a variety of ways. Half received help from weight-loss programs, health professionals or summer weight-loss camps. The other half slimmed down on their own, cutting calories, reducing por tions and eliminating sugary drinks. The teens attribute their success to: u Being ready to lose. They made the

decision to slim down and found a way to do it themselves. One girl said she changed her eating habits because she realized feeling good about herself was more important than eating an order of supersize french fries. u Having parents who helped them out, not singled them out. They didn't like their parents' nagging but said it was helpful if they offered encouragement, bought the right types of food, served more healthful meals, paid for exercise programs and joined them in losing weight, Fletcher says.

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u Becoming more physically active. This was their No. 1 strategy for losing the weight and keeping it off, she says. u Setting realistic goals. Many said they are still heavier than they'd like but realize that few can look like supermodels. Edith Howard Hogan, a registered dietitian in Washington, D.C., says weight loss is especially hard for teens because "these are years of emotional turmoil." They must select a program that's nutritionally sound so they get enough calcium for their bone health and enough other nutrients for their general health, she says. Boston nutrition expert Elizabeth Ward, who is the mother of three schoolage daughters, says teens may be tempted to tr y to lose quickly by following low-calorie diets or exercising excessively, so it's impor tant their families support a healthy approach. "Showing concern without nagging is one of the hardest challenges parents face. A parent may be afraid that their child will have the same weight problems they did in their youth. But try as they might, parents can't always prevent a child from becoming overweight," says Ward, author of The Complete Idiot's Guide to Feeding Your Baby and Toddler. Fletcher says that if teens aren't ready to lose, then parents must show them unconditional love and be good role models by eating healthfully and exercising regularly.

Are you ready to take that step?Here are some questions teens can ask themselves to see whether they are ready to take steps to lost weight. Check the answer that applies to you: How concerned am I about my weight? How much do I want to do something about my weight right now? How confident am I that I can do something about my weight? Do I think I can do something about the things that are getting in my way? How ready am I to change my eating habits? Is my family ready to support me in my efforts? Key: The more answers you choose that begin with "very," the more likely you are ready to turn things around.Source: Weight Loss Confidential

Very

Sort of

Not very

From personal experience, she knows how hard this is to do. One of her two sons, Wes Gilbert, began struggling with extra pounds during sixth grade. Even though she is an expert in weight control, Fletcher says nothing she said or did seemed to stop him from gaining. He eventually lost 65 pounds and has kept it off.

"When Wes was heavy, he never acted like his weight bothered him, in part because he had other things he was confident about," Fletcher says. "But I know he feels better about himself now."


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Is your house making you fat?Decor does more than express our style it can also expand our waistlines. USA TODAY's Mary Cadden asks Brian Wansink, author of Mindless Eating: Why We Eat More Than We Think, to identify the most common diet traps in our homes and design guru Christopher Lowell how to steer clear of them with good design. DinnerwareProblem: Over the y e a r s , portions got bigger in restaurants a n d package d food. As a Maki plate/platter, $2.95- result, "our $5.95 at CB2.com expectations of what constitutes a proper serving increased in our homes," Wansink says. And so did the size of our dishes -- from a standard of 9 inches to 11 or even 12. Solution: Focus on the tablescape. "Think tapas many courses, but much smaller por tions," Lowell says. "Go with individual ramekins, even sushi-style plates, long and shallow," to shrink portions.

ElectronicsProblem: "Anything that distracts us from monitoring how much we're eating is bad," Wansink says. The television is a major culprit. "We mindlessly eat while we mindlessly watch TV."

Chandelier with base and shades in opaque resin, $999 at Horchow.com

Living Marine Aquarium,Vol. 2, $14.95 at Screendreamsdvd.com

You can accomplish the same thing by swapping incandescent bulbs for halogens.

Sleep spacesSolution: If you feel the need to have your plasma in plain view of your dining area, trying turning the screen into an aquarium. "It adds texture and mood to the space, but it becomes background -the architecture of the room vs. entertainment that pulls you in," Lowell says. Problem: A good night's sleep matters. "When we're tired, we often overindulge in carbohydrates," Wansink says. S o l u t i o n : Don't let television intrude on your sleep. "Create a sitting area where the screen isn't viewable from the bed," Lowell says. "If you don't have the space, you can buy a great curio cabinet or screen to divide the room in half. Keep activity separate from sleep."Shoji folding screen in black, cherry, natural or white, $79-$149 on sale at JCPenney.com.

ColorsProblem: Bright, stimulating colors such as red or yellow can "increase the speed at which you eat," Wansink says. And you guessed it: "The faster you eat, the more calories you ingest." On the flip side, wood tones encourage us "to eat slower but longer." Solution: Stay away from colors found in food red, yellow gold, brown and green, all of which are popular right now. "They stimulate us in the wrong way," Lowell says. "Think in terms of a men's haberdashery: taupe, a warm flannel gray with white trim or a very pale blue. Those are all very calming."

LightingProblem: "People tend to underestimate the amount of food they eat in the dark," Wansink says. "Dimmed rooms set a more relaxing tone" that prompts us to eat longer. Solution: If your dining-room chandelier is on a dimmer, "add dark shades that are metallic-lined," Lowell says. "This will focus the light on the table and take the focus off the rest of the room, making you more aware of what you are eating."


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CRITICAL INQUIRY

1. USA TODAY articles referenced in this case study suggest exercising more and eating less. Which do you think would be more effective for helping a person keep from gaining weight? Which would be more effective in helping a person lose weight? Justify your rationale.

2. The book Mindless Eating (Bantam 2006) refers to small 100 calorie changes small changes that help mindlessly break bad eating habits. Based on the articles, what are three small changes you could suggest your roommate try out to help him or her either lose a few extra pounds or maintain his ore her current weight? 3. There is frequent mention of the Freshman 15 on college campuses. When you look at your friends who have gained weight, what are the two top reasons you think theyve put on the pounds? What simple suggestion could you give them that could let them be themselves but not gain so much weight? 4. Busy, busy, busy. When youre on the run from class to class, how could you possibly get more fruits and vegetables into your diet? The more of these goodies you have the less youll naturally eat of the other foods that arent nearly as good. What are two easy ways you can eat two more servings of these each day?

1. One of these articles uses an extreme Boot Camp approach to dieting. What are two other options?

FUTURE IMPLICATIONS

2. When are some of the bad eating habits that youve seen other college students acquire? Think of a specific person who adopted some of these habits. What are two specific suggestions you could give the individual? How could you present your suggestions in a way that doesnt make your friend defensive? 3. We could all enjoy the foods we like and still eat healthy. The problem is that we tend to overdo it. What keeps people from eating reasonable amounts and instead leads them to overeat? What strategies could help people learn to eat in moderation?

Additional Resourcesv Wansink, Brian (2006), Mindless Eating Why We Eat More Than We Think, New York: Bantam-Dell. v Just put your mind to it" by Nanci Hellmich USA TODAY, 10-11-06, Life, 5D v "The Wizard of Why" by Robin Jenkins Mather The Chicago Tribune, 3-30-05, Section 7 v Seduced By Snacks? No, Not You" by Kim Severson The New York Times, 10-11-06, D1.


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Meet the ExpertBrian Wansink (Ph.D. Stanford 1990) is the author of the bestselling book Mindless Eating: Why We Eat More Than We Think (Bantam 2006). He also holds the John S. Dyson Endowed Chair in the Applied Economics and Management Department at Cornell University, where he is Director of the Cornell Food and Brand Lab. Previously, he was a USA TODAY Dr. Brian Wansink professor at Dartmouth College, the Vrije Universiteit (The Netherlands), the Wharton School at the University of Pennsylvania, the University of Illinois at UrbanaChampaign, INSEAD (France), and he was a visiting scientist at the U.S. Army Research Labs in Natick, MA. He is a Fulbright Senior Specialist in food marketing and nutrition, and in addition to writing Mindless Eating, he is author of the books Marketing Nutrition, Asking Questions and Consumer Panels. His award-winning academic research on food has been published in the worlds top marketing, medical and nutrition journals. It has been presented, translated, reported and featured in television documentaries on every continent but Antarctica. The research findings of Wansink and his colleagues have also contributed to the introduction of smaller 100 calorie packages (to prevent overeating), the use of taller glasses in some bars (to prevent the overpouring of alcohol), and the use of elaborate names and mouth-watering descriptions on some chain restaurant menus (to improve enjoyment of food). An Iowa native, he lives with his family in Ithaca, NY, where hes a mediocre saxophone player in a rock-and-roll band and where he regularly enjoys both French food and french fries.


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USA TODAY Collegiate Case Study: Foodology

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