Should You Forget “Eat Less, Move More”?

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Eat less. Eat better. Move more.

If you’ve been reading the Health Memo for any length of time, you know that’s my simplified solution, my mantra, to the problem of excess body fat we face in the U.S. and around the world. That’s why an article about an endocrinologist from Ireland who said “Eat less, move more is not the treatment for obesity—get over it” caught my attention. The quote was taken from a talk and interview given by Dr. Donal O’Shea that included a series of recommendations to primary care physicians on how they should approach the topic of excess body weight with patients. He went on to suggest that in a short time, medicine will have solutions for obesity that will essentially render obesity obsolete. Semaglutide is just the first jab at it—pun intended.

I went a little further and listened to a talk by Dr. O’Shea in which he went into detail about why 90% of weight gain is irreversible in 90% of the people. Then he used this example: if you donate a pint of blood, your body will replace it over the next six weeks to get your body back to its blood-volume set point. He says your body weight also has a set point and once it’s raised, it cannot be reversed; no matter what you do, your weight will return to its set point. Therefore, medications such as semaglutide and the ones being developed that will impact other receptors are the only solution.

Should we just buy stock in pharmaceutical companies and forget about nutrition and exercise? Dr. O’Shea is a good scientist and is certainly compassionate toward patients. But is he correct? No, and I’ll explain why on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Eilish O’Regan. Irish Independent. 04-28-24
2. SETU. Understanding Obesity: Rethinking Diagnosis & Treatment. 2024.

Nobody Got It Right

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The topic of the last Memo came from an article co-written by writers from The Examination and the Washington Post. The “exposé” was that credentialed nutritionists and registered dieticians (RDs) were accepting sponsorships and payments from industries they covered, especially the cereal industry. The “angle” was that the influencers were using the anti-diet movement to promote the consumption of cereals to adults and children—not just granola and oatmeal, but every sugar-laden cereal.

I don’t watch TikTok videos, and I don’t have a TikTok account. But to be fair, I used the hashtag #DerailTheShame to check out some of the videos that were mentioned in the article. It was a couple of weeks after the article was posted, so there were responses from some RDs that typically use TikTok. To say they were upset was an understatement. But in the responses, no one addressed the real issues in the TikToks and the article, so I will.

Both Sides Made Mistakes

The writers who collaborated on the article were all investigative journalists with a lot of experience, but none had a nutrition background. How do you know what’s good or bad from a nutrition perspective? This happens a lot in non-scientific journalism. I’m not saying such articles aren’t worth reading, just keep in mind that an important viewpoint is missing.

Some of the RDs certainly made it seem like they were promoting the sugar-laden cereals only. That’s the problem with using short videos; you don’t get to address the issue completely, and it would appear you have to sell yourself more than anything else.

On the other hand, the RDs were using elements of “fat shaming is bad” together with eating all foods. Fat shaming is bad and should never happen; you don’t know what kind of stressors people are dealing with or the medical, physical, psychological, and budget issues that keep them from losing weight right now. But eating as much processed food as you want isn’t a good solution.

At least one of the authors of the article wrote about Big Food and their sponsorships of RDs. The results were new laws legislating that compensation must be revealed when it comes to such influencers. On the other hand, I didn’t find any criticism by the RDs of Big Food companies who oppose new and plainly written food labels to reveal exactly what’s in processed foods.

Partial Solutions

I think the article writers should have spent more time on the Big Food angle rather than the influencers, credentialed or not. Many health insurance companies will not pay for nutritional counseling for obesity. One of the results is that nutrition professionals turn to other venues to be able to earn a living, and sponsorships can help them do that.

As for the credentialed influencers? With all the mind-numbing music, graphics, and dancing around in kitchens, it seems appropriate to post the serving size and calories from the cereal (or whatever food is being promoted) and to emphasize sticking to reasonable portions per day. That solves the issue in my mind. I’m not opposed to earning a living.

The Bottom Line

While cereals and any processed food have their place in a healthy diet, they should be eaten in the proper serving size and servings per day. I am opposed to the anti-diet sentiment. The only way to lose weight and maintain it is to eat less, eat better, and move more. (Ozempic isn’t magic; people lose weight because the drug causes them to eat less.) We all have to figure out for ourselves how to do that, and it won’t be the same for everyone, but it’s the only way to solve the obesity epidemic we face.

However, a physician from across the pond says that eating less and moving more just won’t work. That’s our topic for next week.

What are you prepared to do today?

        Dr. Chet

Reference: 04-03-24. Washington Post. As Obesity Rises, Big Food and Dietitians Push ‘Anti-Diet’ Advice.

What Should You Believe?

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What happens when you mix:

  • Social media
  • Certified expert influencers such as dieticians
  • The food industry paying or sponsoring food influencers
  • The message that dieting is wrong

You get up to 40% of the social media influencers saying, “Why diet? Love yourself and eat whatever you want!”—especially cereals or other highly sweetened grain products. You get partial truths that bastardize the original concepts of loving yourself and end up with people confused and, in some cases, fatter than they have ever been.

Welcome to a new reality. I think we expect that people who talk about health will have their own point of view; I certainly do. Some people believe that being a vegan is the only way to eat while others believe that a ketogenic diet is the absolute best. Both can selectively use research to support their opinion—and do. That seems normal because everyone can have a point of view.

But what if an organic farming association were paying the vegan supporter to promote a vegan diet? How about beef producers paying the ketogenic diet promoter to favor not only meat but especially beef? That connection must be reported in any scientific study about specific diets, but if you’re an influencer, that’s not mandated.

What about nutritionists and registered dieticians that are supported in part by the food industry? Could they take that too far? We’ll see on Saturday.

And just for the record, no company pays me—only you do when you join drchet.com, buy my health-info products, attend my seminars and webinars, or book me to speak to your group. I work for you.

What are you prepared to do today?

        Dr. Chet

Reference: 04-03-24. Washington Post. As Obesity Rises, Big Food and Dietitians Push ‘Anti-Diet’ Advice.

Obesity and Prenatal Omega-3s: Premature Conclusions

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Women frequently ask about prenatal supplementation, and omega-3 fatty acids are always part of prenatal recommendations; that’s why this study attracted my attention. Did they come to the right conclusions? I think the best place to begin is by reading the conclusion statement of the abstract, and then examine the data from the paper to see if it supports those conclusions.

Here we go:

“In this randomized clinical trial, children of mothers receiving omega-3 fatty acid supplementation had increased BMI at age 10 years, increased risk of being overweight, and a tendency of increased fat percentage and higher metabolic syndrome score. These findings suggest potential adverse health effects from n-3 long-chain polyunsaturated fatty acid supplementation during pregnancy and need to be replicated in future independent studies.”

Problems with the Conclusions

The difference in body weight was two pounds, with the fish oil group weighing more than the placebo group; neither group was classified as being overweight by international standards. With height being equal, that automatically meant that the BMI would be higher in the fish oil group. However, both groups would be classified as underweight based on standards for children five to ten years old. The implication was the omega-3 group might be overweight. They were not; in fact they were closer to normal weight than the lighter kids. The increased risk of being overweight isn’t supported by the data presented.

Related to the higher metabolic syndrome score, the researchers calculated the score using an algorithm that considered waist circumference, systolic BP, negative HDL cholesterol, the log of triglycerides, and the Homeostatic Model Assessment for Insulin Resistance or HOMA-IR for short. There was a difference of 3/10 of an inch in waist circumference, with the omega-3 group being slightly larger. There was no difference in triglyceride levels, and the omega-3 group had a higher HDL cholesterol level than the control group. There was no difference in systolic blood pressure between the groups. That leaves us with the HOMA-IR calculation.

Typically, serum insulin would be used in the calculation to determine the HOMA-IR number. They didn’t collect insulin data, so they used another indicator of insulin levels in calculating the HOMA-IR. The problem is that that algorithm was based on 21 adult subjects; it was never validated with a larger group or for use in children. I question its use, but for argument’s sake, let’s say it doesn’t matter.

The Real Problem

The real problem that I have is with the remark about a tendency towards increased percent body fat. When they assessed body composition at 10 years of age, they used bioelectrical impedance analysis (BIA). I worked on comparing methods of body composition analysis when I was a graduate student, so I can tell you from experience that underwater weighing is the gold standard for any group (and, yes, I’ve underwater weighed 10-year-olds). Specifically, there are two factors that are always concerning with BIA:

  • The algorithm is 95% dependent on height and weight. A two-pound difference in body weight in children could impact the calculation, even if the actual body composition was the same.
  • BIA is sensitive to fluid levels of the body. It assesses total body water and calculates fat mass by making an assumption about the water content of the remaining tissues. It’s not the best way to assess body fat in a major study such as this.

The Bottom Line

How?!!!

We hear that a lot when our grandson plays a videogame. When something happens that he doesn’t anticipate or understand, he yells “How?!!!” and that’s what I’m thinking right now. The most frustrating part of this research paper is their conclusion that omega-3 supplementation in the last trimester of pregnancy may result in adverse effects to the children.

How? How would supplementing with omega-3 fatty acids cause the offspring to have an increased risk of being overweight or obese? They did not provide any comment on how that could occur.

As it stands now, we really don’t know much more about omega-3 supplementation in the third trimester of pregnancy other than the kids whose mothers took omega-3 fatty acid had fewer serious asthma and allergy symptoms; because the incidence of asthma and allergies are rising steadily, that may be the most important observation from this study so far.

As for body composition? Not so much. This study will continue until the subjects are adults, so maybe further testing will yield more conclusive results.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

Obesity and Prenatal Omega-3s

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Scientists continue to research the causes of obesity. For many, as we’ll see, it’s not as simple as eating less and moving more; in the study I’m going to review this week, the researchers are going prenatal.

The Copenhagen Prospective Studies on Asthma in Childhood 2010 (COPSAC) is an ongoing longitudinal study to examine the effects of omega-3 supplementation in the third trimester of pregnancy on a number of factors. The primary objective was to see if allergies and asthma were reduced in the offspring of women who took the omega-3s versus those who took a placebo. Asthma or persistent wheeze showed a 31% reduction in risk in the group receiving fish oil compared to 23% the placebo group.

The researchers also collected a variety of anthropometric data, plus blood samples for metabolic and blood lipid analysis, and assessed body composition. In a prior paper when the children were age six, the omega group were about one pound heavier but with a proportional increase in lean and fat mass.

In the current analysis at age ten, the omega group were determined to have an increased BMI, increased risk of being overweight, a tendency for increased fat percentage, and higher metabolic syndrome score when compared to the placebo group. That doesn’t sound good. Does this mean women should avoid omega-3 fish oil during pregnancy, especially the third trimester? I’ll let you know on Saturday.

Tomorrow is the monthly Insider Conference Call. I’m going to cover starvation but not the Minnesota Starvation Study—you’ll come away stunned. I’ll also answer your questions. If you’re not an Insider, become one by 8 p.m. tomorrow and you can join in.

What are you prepared to do today?

        Dr. Chet

References:
1. BMJ 2018. doi: https://doi.org/10.1136/bmj.k3312
2. AJCN. 2024. doi.org/10.1016/j.ajcnut.2023.12.015

The Ridiculous: Obesity and Weight Loss Scams

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As I planned this series of Memos, I wrestled with using the word “obesity” because everyone appears to hate that term—especially when directed at themselves. I decided to stick with it because it afflicts close to 40% of us in the United States. Before I get to ridiculous weight loss plans people are hawking, how did we get here?

Obesity is the product of success. We’ve been successful in creating so many labor-saving devices, we can’t burn enough calories in everyday activity anymore. We’ve successfully produced so much food, available just about everywhere, and made to appeal to all our tastes—sweet, salty, fatty, and umami. They’re hard to resist. The U.S. and Canada have worked hard to produce so much food. But with that success comes overconsumption. Pure and simple.

I question whether obesity is a disease. The dieticians and nutritionists have tried health education without success. Now the medical community has taken over with surgery and pharmaceuticals. And we’re still getting fatter, not because we’re failures but because we’re reaping the rewards of success. We have to change our approach to how we treat food if we’re going to be successful in changing the outcome.

In this series, I’m going to cover recent ads, commentaries, and research on obesity and weight loss. Let’s begin with a Facebook ad my daughter-in-law sent Paula the other day.

The Ridiculous

Paula got a text from Kerri that showed the benefits of MagnaGermanium earrings; these magnetic earrings will activate your lymphatic system, drain away toxins, detox your body, and allow you to lose weight naturally. I had to check it out—after all, it was FDA approved!

It was just a bunch of testimonials. No science, even though the ad referred to it. Claimed to be made in an FDA-approved facility, but there’s no such classification. It’s a pure scam but reasonably priced: just $22.97 a pair in the ad I reviewed. Look around a little, and you can find them for one cent; that tells you all you need to know about the quality.

I don’t think I have to say anything else. By the way, those Kelly Clarkson “ads” for Keto-ACV Gummies? Worst artificial intelligence effort I’ve seen so far. They’re also in the ridiculous category.

We’re just getting started. Next week, a look at fish oil and the potential for overweight children. You don’t want to miss it.

What are you prepared to do today?

        Dr. Chet

Nature in Motion

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There are just some events in nature you don’t want to miss: Niagara Falls, glaciers in Alaska, the Grand Canyon. Those are relatively stable.

A total eclipse of the sun is something fleeting that you have to see on its timetable. That’s why, with his mom’s blessing, Paula and I took Riley out of school his first day back after spring break and headed for the border: we drove to Northeast Indiana to view the eclipse. (We wore Purdue shirts in honor of Paula’s alma mater and their trip to the NCAA Finals.)

As we approached the area, Riley used his eclipse glasses to give us a running account of how much the sun was blocked. Where we chose to stop resulted in about 99% of totality—better than if we had stayed in Grand Rapids. It was amazing to experience in real time. Was it worth the time to drive that far? Yes. As I said, some things you just have to see in motion.

The rest of this month is going to be about obesity and weight loss. There have been several studies and commentaries published in the last few weeks, and I have to comment on them. I’d like to think of it as a trip from the ridiculous to the sublime; I think you’ll enjoy the journey.

Insiders: our next conference call is Wednesday, April 17, at 9 p.m. Eastern Time.

What are you prepared to do today?

        Dr. Chet

The Look of Success

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With this being a holiday weekend, the Memo comes a day early. We hope that your holiday weekend is filled with safe travels and good times with family and friends, plus at least one chocolate bunny, whatever your beliefs.

As motivation to get up every time you stumble and fall, here’s the look you make when you fail at something a couple hundred times and finally nail it, courtesy of our grandson Riley who just turned nine; here’s a link to the whole 11-second video of Riley’s first successful frontflip.

See you after Spring Break.

What are you prepared to do today?

        Dr. Chet

Your Last Resort

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Did you ever have one of those days where you just didn’t have it?

  • Maybe you wake up just a little later than expected.
  • Maybe your energy got up and went before you had a chance to get up and go.
  • Maybe everyone in the world seemed to want a piece of you today—and they succeeded.
  • Maybe nothing you wanted to do got done.

What do you do? Here are some ideas:

  • Put on some weather-appropriate clothes and go for a walk.
  • Get on the exercise bike and move those legs.
  • Grab the dumbbells and work those biceps and triceps.
  • Or just get up and sit down 25 times to work those quads.

It doesn’t matter what type of exercise you do, but get that one thing done and you’ve done something positive you can feel good about. It may do wonders for you mentally and make the day a success, or at least not a total loss. Use exercise as the last resort to rescue your day.

What are you prepared to do today?

        Dr. Chet

Flavonols: Eat, Drink, and Maybe Live Longer

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The analyses of the NHANES study on flavonols and mortality did more than just look at a class of phytonutrients; researchers also looked at the individual flavonols and how they impacted mortality. A little background first.

Flavonoids

Flavonoids are a group of phytonutrients made up of six classes of nutrients. They are flavan-3-ols, flavones, flavanones, anthocyanidins, and the previously mentioned flavonols. Each of those classes are made up of individual phytonutrients. Flavonols have four primary phytonutrients in its class: quercetin, kaempferol, myricetin, and isorhamnetin. We’ll skip the rest of the individual phytonutrients in the other classes because they weren’t part of the study.

The researchers examined the reduction in mortality for each flavonol phytonutrient. When comparing the first quartile (lowest) with the fourth quartile (highest) intake, not every phytonutrient reduced the mortality from all conditions. In other words, the overall reduction in mortality was greatest when looking at total flavonol intake, not in any single phytonutrient. Too often research focuses on single phytonutrients as potential treatments of conditions and diseases, so it’s great to see a study that looks at total intake of a class of nutrients.

Absorption

As mentioned, flavonols are one part of the flavonoids. One characteristic is that they seem to be poorly absorbed. Or are they? It could be that there are unknown genetic factors that impact absorption and/or utilization of those nutrients. It may be that when isolated from a plant, the absorption is interfered with in some way that’s not apparent. It may be that the microbiome has a role to play in absorption.

What is most likely is that when eaten or drunk in its natural or prepared state, it is the interaction of all the flavonols that help absorption. Or it may be the combinations of flavonoids found in specific foods that work together for absorption.

What foods have the highest flavonol content? When looking at mg/100 grams, raw onions, cooked onions, apples with the peel, brewed black decaf tea, and brewed black tea top the list. When looking at the top three consumed? Onions, black tea, and apples top the list, but beer comes in fourth place. While the amount per 100 grams is low, we consume a lot of it.

The Bottom Line

At the end of the day, the most important thing to know is that we have to consume flavonols to get the benefits. In reality, your mama was right: eat your fruits and vegetables. They’re good for you. And if you chase them down with a beer, that’s probably okay as well.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reports. 2024. https://doi.org/10.1038/s41598-024-55145-y2. Arch