Tell the FDA how you want the bad news delivered on your fave restaurant food

It's been just over three months since the landmark healthcare reform bill was signed into law, and the federal government is now drafting the regulations that will bring some of the law's key anti-obesity initiatives to a restaurant or fast-food counter near you.

Specifically, the bill made it the law of the land that restaurants that are part of a chain of more than 20 stores must post for consumers the calorie content of their offerings. Consumers must be able to get, in writing and on the spot, a lot of additional details about the nutritional content of the food served, including its total fat, saturated fat, sodium, fiber, total carbohydrates, complex carbohydrates, sugars, dietary fiber and total protein.

Now, several states and local jurisdictions beat the federal government to the punch on this. But the federal law will impose greater consistency on what is a patchwork of nutritional-posting requirements. 

For patients with diabetes, those who tote their points with Weight Watchers, or watch their carbs on one of the many low-carb diets, for consumers concerned about sodium's impact on their blood pressure or seeking to banish saturated fat from their plate, the way in which of all this information is presented can make it easier or harder to follow an eating plan. So here's your chance to tell the FDA how you would have restaurants, delicatessens, fast-food-joints, shops brewing coffee or scooping ice cream -- even movie theaters -- organize and provide nutritional information for consumers like you.

Here's the link to give the FDA a piece of your mind. (After choosing "submit a comment," you'll need to supply the following "Docket number": FDA-2010-N-0298 and hit "search.")

The site for comments opened midday Thursday and will stay open for 60 days.

Still wondering how healthcare reform will affect you? Here's the government's comprehensive site.

--Melissa Healy

Feeling hungry? Here are the 50 fattiest foods in the country

What a couple of weeks it's been. The United States government released its Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans 2010, which acknowledges that people are too heavy and should eat a more plant-based diet. Then a report from Trust for America's Health and the Robert Wood Johnson Foundation let us know that residents of 28 states are still gaining weight.

So it makes sense that Health.com would come out with its list of the "50 Fattiest Foods Across the Nation," a state-by-state rundown of the worst fat and sugar-laden offerings. Let's start with California, where the venerable In-N-Out Double-Double comes in at 670 calories and 18 grams of saturated fat. Although some people think this hamburger is the stuff dreams are made of, others see it as an artery-clogging nightmare.

We'll move on to Colorado, which typically gets good marks for having lower obesity rates compared with the rest of the country. They must be doing something right, and it probably isn't eating Jack-N-Grill's grande breakfast burrito that weighs in at -- what? -- five pounds. We're not even going to mention calories and fat because it would probably make us weep.

New York (or Manhattan, really) is known as foodie heaven, but the state's contribution to the list of fattiest foods doesn't exactly fall under the category of "gourmet." This one is called the "Garbage Plate," and it consists of a starchy base such as home fries, macaroni salad or baked beans topped with some type of meat (cheeseburger, fried ham, sausage) and covered with a boatload of condiments. There's even a veggie burger version! Considering the countless variations possible, it's no wonder there's no official nutritional information for this dish, which allegedly was born at a Rochester restaurant called Nick Tahou Hots in 1918. But estimates put it at anywhere from 93 to 203 grams of fat per plate. Mmmmmm.

Feeling queasy yet? No? Good, because there's lots more. Hey, Mississippi, we hear your obesity rates are through the roof! That's too bad, because your Mud Pie is one of our guilty pleasures. This sweet treat can be made a number of different ways, but basically relies on chocolate, cream, butter and sugar. There's a commercial version of the pie that has 35 grams of fat per serving. But who's counting?

Let's head north to Vermont, that pretty state that gave the world Ben and Jerry, as in Ben & Jerry’s ice cream. Yes, there are sugar-free and lower-fat frozen desserts, but beware the Vermonster, which has 20 scoops of ice cream, plus hot fudge, bananas, cookies, brownies and other toppings. Wait -- you're supposed to share this? With other people? Oh.

In Washington the big offender is a salad. Not just any salad, but a Crab Louis. And Louis apparently knows how to ratchet up the calories and fat. Blame it on the mayonnaise-based dressing, which probably accounts for most of the 15 to 25 grams of fat. But at least there's some lettuce and tomatoes in there.

And finally, give some props to Arizona, which hasn't been feeling the love so much these days. There you can indulge in a Quadruple Bypass Burger at the Heart Attack Grill. This puppy is guesstimated to have 8,000 calories and at least 60 grams of fat. We'll take ours with a side of irony, please.

-- Jeannine Stein

The In-N-Out Double-Double burger ranks as one of the fattiest foods in America. Photo credit: Gary Friedman / Los Angeles Times

A low-carb guru weighs in on the dietary guidelines

Experts buzzing about the scientific report of the dietary guidelines advisory committee released in mid-June certainly had a qualm here and there about the panel's tentative recommendations. But on the whole, a roundup of expert opinion gathered by The Times' Health section suggested there are some points of consensus about how -- and what -- to eat to get and stay healthy.

Proponents of a very low-carbohydrate diet such as that championed by Dr. Robert Atkins, however, found a lot to be steamed about as they read the report. The panel seemed to diss the low-carb lifestyle and its prospects for helping American adults shed excess weight.

Dr. Stephen Phinney, co-author of "The New Atkins for a New You," predictably took issue with the scientific advisory panel's assertion that "there is some evidence that [diets less than 45% of calories from carbohydrate] may be less safe."

That claim only works, says Dr. Phinney, if one is highly selective in the data one chooses to consider.

"Yes, in some -- but certainly not all -- studies, the Atkins diet raises total and maybe LDL cholesterol levels," Phinney acknowledges. But over the past two decades, thinking on cholesterol has changed. "That might have been worrisome" back when cholesterol was just a blunt instrument, a single number, says Dr. Phinney. "But now we know that the Atkins diet raises HDL (i.e., "good') cholesterol, which helps explain why the total cholesterol can go up without increasing risk."

Add to this what Phinney calls "the excellent evidence that carbohydrate restriction changes LDL cholesterol from the bad 'small dense' form to the lower-risk larger particles" -- a shift that represents a major reduction in risk, says Phinney. "But that is completely missed if one just uses the old way of measuring total LDL cholesterol." Finally, Phinney says, in most studies where it was measured, when people actually follow the Atkins diet, their level of inflammation -- which many believe is a predictor of heart disease risk -- goes down.

 "A great deal of recent data that the Atkins diet may actually be more safe," says Phinney.

Phinney also objected to what he called the "continued demonization of saturated fats by the committee."  He cites a recent journal article that makes the case there is no evidence to support the widespread belief that the consumption of saturated fat negatively affects heart health or overall mortality.

For people who follow the Atkins diet -- even those who eat more dietary saturated fat when they do -- blood levels of saturated fats go down, says Phinney. This apparent paradox, he adds, is due to a combination of the body adapting to a low-carb diet by rapidly burning saturated fats as fuel, plus a sharp reduction in the liver's production of saturated fats from dietary carbohydrates.

The dietary guidelines advisory committee, however, may have discounted evidence for these effects because published studies providing such data are relatively new. 

"Frankly, I agree there might be concerns about combining a heavy intake of saturated fats along with lots of sugar and refined carbohydrate," Phinney says. "This combination (think double bacon cheeseburger plus supersized soda) is a diabolical combination designed to dramatically raise the saturated fat levels in your blood triglycerides.

"But when one removes the refined carbs and sugars, eats the 'foundation vegetables,' moderate protein, and healthy fats as described in our book, blood levels of saturated fats plummet, particularly in people with high risk conditions associated with insulin resistance (such as metabolic syndrome and Type 2 diabetes)."


-- Melissa Healy

Obesity rate tops 25% in two-thirds of states; this should be shocking, but ...

Overall, Americans in 28 states are still gaining weight, but not residents of the nation's capital. They bucked the national trend, a new report has found, actually lowering their obesity rate. The former should be more surprising, more noteworthy than the latter; by this point, it might not be.

The latest numbers come from the annual obesity assessment offered by Trust for America's Health and the Robert Wood Johnson Foundation, and it's a goldmine of data, individual findings and broad overviews. Can't get enough of those "which state is fatter" comparisons? This analysis is for you.

Not only does the report rank states and the District of Columbia by their obesity rates, showing the trends over time, it compares ethnic groups within those states as well. It also includes a nice synopsis of what states are doing, in terms of legislation, to combat the seemingly unstoppable gain. Then there are various other comparisons -- breast-feeding rates, physical activity rates and the like. This doesn't imply causation, of course (so no need to e-mail us about it!) but the correlation is interesting: D.C. also has the highest rate of fruit and vegetable consumption.

In any case, Mississippi has the highest rate of adult obesity; 33.8% of its residents are obese. Colorado is the relative slimmest; only 19.1% of its residents are obese. California ranked fairly well as such things go, with 24.4% of its residents characterized as obese. (We have to point out, that's an increase over last year.)

As for obesity rates by ethnic groups, those numbers paint their own picture. Wisconsin has the highest rate of obesity among black residents; 44% are obese. Nevada, at 25.8%, has the lowest rate. Tennessee claims that distinction for Latinos; 39.5% of Latinos there are considered obese. D.C., at 20.6%, has the lowest rate.

By this point, the individual numbers are likely to garner quiet dismay more than the disbelief they warrant. Obesity rates now top 25% -- repeat, 25% -- in two-thirds of the states; that should be shocking, it should. But, somehow, it isn't.

If there's a bright side (other than D.C.), the trends, the ethnic differences -- all are useful in assessing where to go from here. The report offers its authors' thoughts, all policy-oriented, on that matter.

Here's the full report, "F as in Fat: How Obesity Threatens America's Future 2010." It can also be found at either organization's website, www.healthyamericans.org or www.rwjf.org, should you be interested in checking out the organizations.

-- Tami Dennis

Photo: If states were people, two-thirds would now be considering -- if not actually undertaking -- a diet.

Credit: Los Angeles Times

Obesity increases the risk of cancer death among Asians too

Historically, obesity has been a problem of western countries. For instance, nearly 1 in 3 Americans is obese (defined as having a body mass index that tops 30), as are about 1 in 4 members of the United Kingdom. According to this ranking compiled with data from the Organization for Economic Cooperation and Development, the most obese countries in Asia are Japan and South Korea, where a mere 3.2% of the population has a BMI over 30.

But with obesity rates rising in China, South Korea, Thailand, Singapore and other Asian countries, an international group of researchers wondered how those extra pounds might be raising the risk of death from cancer. After all, adding 5 points to one’s BMI is known to increase the risk of cancer among Caucasians by 10% to 60%. Was the same true for Asians?

To find out, they analyzed data from 424,519 people who were part of the Asia-Pacific Cohort Studies Collaboration. The researchers found that for every 5 points added to BMI, the risk of death rose 9%. (That calculation excluded two types of cancer – of the lung and the upper aerodigestive tract – whose risk is linked to a lower BMI.) Compared with people who have a healthy weight (BMI between 18.5 and 24.9), those who were obese were 21% more likely to die of cancer.

The increased risk was traced primarily across six types of cancer – ovarian, cervical, prostate, breast (among women older than 60), leukemia and cancer of the large intestine. The results were published online Tuesday by the journal Lancet Oncology.

Even though obesity is still a comparatively small problem in Asia, the large number of cancer patients there (6.2 million, compared with 1.6 million in North America and 3.4 million in Europe) means that a great many cases might be traced to excess body weight, according to an editorial accompanying the study.

— Karen Kaplan

Photo: These patients at a weight loss center in northeastern China have an increased risk of cancer. Credit: Sheng Li / Reuters.

Twinkies should be the new cigarettes, David Lazarus says

What to do about the obesity epidemic? Here's a thought: Substitute "tobacco" for "junk food." That provides a pretty clear road map about what government authorities should be doing to safeguard public health.

That’s the opinion of David Lazarus, our colleague in the Business section who writes a column focused on consumer issues.

He’s certainly not the first to propose taxing soda, Twinkies and Big Macs as a way of forcing Americans to cut back on these fat-, salt- and sugar-laden foods that we all know are bad for us but still can’t seem to resist. Experts at the Rudd Center for Food Policy and Obesity at Yale University and elsewhere have been advocating a tax for sugar-sweetened beverages for some time now.

The idea that junk food can be ostracized, as with cigarettes, through taxes and stigmatization is irresistible to many people. The logic of it seems undeniable – when something costs more, people will buy less of it. But as we have explained in the Los Angeles Times and on Booster Shots, the real-world data shows that taxes implemented to date have not led to any weight loss, even in cases in which the tax did prompt people to reduce consumption of the specific item taxed.

At least Lazarus’ argument doesn’t rely entirely on taxes. He applauds the efforts to get sodas out of schools and suggests a similar strategy for buildings occupied by grown-ups:

… a good place to start would be government buildings — eliminate all bad-for-you foods and beverages. Instead, make healthful alternatives available. Gradually, if the political will can be found, expand the junk food ban to all workplaces, just as smoking bans spread from the public to the private sector.

Lazarus also makes an argument heard often from Booster Shots readers – get rid of the subsidy to corn farmers and they might produce less high-fructose corn syrup.

You can read his entire column here.

-- Karen Kaplan

Photo: Think of these Twinkies as oversized cigarettes. Credit: Tim Boyle / Getty Images

Waiting period for weight-loss surgery is useless, study says

People who are slated to undergo weight-loss surgery are often required by their health insurance company to wait six months from the time of approval to the time of surgery. The wisdom behind the waiting period is that patients should use the time to try to adapt to new diet and exercise habits that will be essential to their long-term success.

A study presented Saturday at the annual meeting of the American Society for Metabolic & Bariatric Surgery suggests that the waiting period is ineffective. Researchers followed 440 people who had either laparoscopic gastric bypass or laparoscopic adjustable gastric banding. Of these, 116 people were required by their health insurance plan to wait six months. The study showed there was no significant difference between the two groups in weight loss prior to surgery or one year after surgery.

According to the study's author, Dr. Timothy Kuwada of the Carolinas Medical Center in Charlotte, N.C., typically all patients receive nutritional and psychological counseling about their post-surgical lifestyle in advance of the surgery. That approach is sufficient, he suggests. However, given the cost of surgery and the importance of lifestyle changes to success, it doesn't seem unreasonable for insurers to ask that patients prepare for the surgery and its aftermath -- whether that takes one month or six.

In another study presented Saturday at the meeting, researchers found that gastric bypass surgery restored levels of low-density lipoprotein -- or bad -- cholesterol to normal in 91% of patients within six months of the surgery and that these patients remained off medication six years later. Also, six years after the surgery, levels of HDL, or good, cholesterol, had increased by more than 10%. The study was conducted at the University of Iowa Hospital and Clinics.

-- Shari Roan

Photo credit: Karen Tapia-Andersen / Los Angeles Times

Have weight-loss surgery with a relative for best success

People who undergo gastric bypass surgery at the same time as a family member are likely to succeed far better than people who undergo the surgery alone, according to a study released Friday at the annual meeting of the American Society for Metabolic & Bariatric Surgery.

Prior research shows that having an exercise partner helps people stick to their workout regimen and accrue greater health benefits from exercise. It appears that the same dynamic can work for people having bariatric surgery. Researchers from the University of Medicine and Dentistry in New Jersey-Robert Wood Johnson Medical School followed 91 patients from 41 families who had surgery with a sibling, parent, child, spouse, cousin, grandmother, granddaughter, in-law, aunt, uncle, nephew or niece. They were compared with similar patients who had surgery alone.

After one year, the family members lost, on average, about 30% more of their excess weight than did the control group. Siblings, in particular, fared especially well. They lost about 40% more of their excess weight compared with the control group.

"Clearly the family dynamic, even a little sibling rivalry, can play an important role in patient success," the lead author of the study, Dr. Gus J. Slotman, said in a news release. "Family members are a built-in support system that can help turn a good result into a great result, particularly the first year after surgery, when adjusting to a new lifestyle and dietary requirements can be challenging."

In another study presented Friday at the meeting, researchers found that female patients have fewer complications and shorter hospital stays compared with male patients undergoing laparoscopic gastric bypass. The study of nearly 38,000 people also showed that Latinos and Caucasians have fewer complications than African Americans, and that younger patients do better than older ones. The research was performed at the University of Nebraska Medical Center.

— Shari Roan

Photo credit: Lisa Maree Williams / Getty Images

Patients denied weight-loss surgery don't get any healthier

Not all health insurance companies cover weight-loss, or bariatric, surgery -- especially if the patient's obesity isn't considered "severe" enough. A study released Thursday, however, offers a glimpse of what happens to people who want weight-loss surgery but are denied it.

Within three years of being denied surgery, patients developed a range of obesity-related diseases compared to a group of similar patients who received surgery. Researchers from Gundersen Lutheran Health System in La Crosse, Wis., examined the records of 587 patients who had laparoscopic gastric bypass with 189 patients who were medically eligible (meaning they were obese enough according to medical guidelines) but whose insurers denied the surgery. The average body mass index of the patients in both groups was 48. A BMI of 30.1 or higher is considered obese; a BMI of 35 to 40 is called Class II obesity and over 40 is considered Class III obesity.

After three years, the average BMI in the surgical group had dropped to 30.5 and less than 1% of patients had developed new obesity-related conditions. The patients who did not have surgery had BMIs that were, on average, unchanged. However, 40% had gone on to develop hypertension, 34% developed obstructive sleep apnea and 20% developed gastroesophageal reflux disease. Others developed diabetes or high cholesterol.

The research was presented Thursday at the annual meeting of the American Society for Metabolic & Bariatric Surgery.

"It is well-known that bariatric surgery treats obesity-related disease," the lead author of the study, Dr. Shanu N. Kothari said in a news release. "Our study now shows that it can prevent new diseases from occurring."

Only about 1% of Americans who are clinically eligible for bariatric surgery because of morbid obesity undergo surgery.

-- Shari Roan

Image credit: T: Joseph Daniel Fiedler / For the Times

Early fitness important to cutting future risk of diabetes, heart disease

Attention, college students: Get off that shuttle bus and start walking to class.

You’re already eating a diet of mainly beer and pizza, staying up all hours of the night, and living in cramped, potentially germ-infested dorms. The last thing on your mind is whether you’re setting yourself up for future cardiovascular disease or Type 2 diabetes.

Now might be a good time to start thinking about it…

A new study by Tufts University scientists found that body fat percentages are not the only precursors to health problems later in life. A person's physical fitness may matter a lot more -- at least when it comes to developing cardiovascular disease or diabetes.

Motivated in part by the astounding growth rate of obesity amongst college students -- approximately 31% of U.S. college students are overweight or obese -- researchers at Tufts' Friedman School of Nutrition Science and Policy tracked the health and health-related behaviors of 564 male and female college students over a nine-year period. They tracked body fat, fitness level and risk factors such as cholesterol and blood glucose levels.

Their findings: Students who were physically fit -- regardless of their body fat content -- had lower blood triglycerides, higher HDL (the "good" cholesterol). That effect was especially marked in women.

The fitter students also had lower blood glucose levels, an effect that was especially marked in men.

The findings are important, says Jennifer M. Sacheck, one of the study authors, because they suggest that the roots of later disease may be laid down early. "Because most of these health problems show up more often later in life, most studies have focused on adults, and very few have been done on college populations or anyone younger," she said in a phone interview.

However, she added, because students won't be tracked through their lives, there's no way to guarantee that heart disease and diabetes actually will develop in those students who look like they're heading that way.

The study does suggest that maybe we should change the way we think about health -- basing it not so much on weight and body fat composition, but more on physical fitness and the frequency of exercise.

And, Sacheck says, the message has particular importance for college students who are known to be more careless and reckless with their health than other age groups:

"In college, you think you're invincible, at the peak of your health, and that your body can handle anything. But my message [in this study] is that even at this age your body is susceptible."

For those who have long cursed the Body Mass Index, which stratifies a person's health level based on weight and height equations, this study is heartening. Perhaps it's time to stop worrying about the number on the scale and whether you can still fit in  the jeans you wore in high school, and instead pat yourself on the back for running each morning. It might seem paradoxical, but being physically active and a bit pudgy might be better than skinny and unfit.   

Here's the study abstract (the full report is available for a fee) plus a news release from Tufts laying out the nuts and bolts of the research and its findings.

And here's a link to the website of physiologist Linda Bacon, one of the proponents of health at every size.

-- Jessie Schiewe

Photo credit: Los Angeles Times