The following article was taken from Newsweek Health at MSNBC.com:

Does where you live influence what you eat? A new study says ZIP codes are surprisingly accurate predictors of obesity.

WEB EXCLUSIVE
By Karen Springen
Newsweek
Updated: 9:19 a.m. ET Aug 30, 2007

Aug. 29, 2007 - ZIP codes are more than just a way to deliver mail, they can say a lot about their residents—and not just the ones living in California’s famed 90210. In a study published in the September issue of the journal Social Science & Medicine, University of Washington researchers found that adults living in ZIP codes with the highest property values were the slimmest, and those living in ZIP codes with the lowest property values were the fattest. The findings show that there is significant geographic variation in the obesity problem, and that this variation is very much tied to socioeconomic status and diet. Is this yet another reason for Americans to feel bad about not living on McMansion row? Would people lose weight if they moved to a tonier town? NEWSWEEK’s Karen Springen talked to the study’s lead author, Adam Drewnowski, director of the Center for Public Health Nutrition and professor of epidemiology and medicine at the University of Washington in Seattle. Excerpts:

NEWSWEEK: You looked at 8,803 people in 74 ZIP codes in the Seattle area and found that those living in areas with the highest property values were the thinnest. The inverse was true for those living in the lowest-property-value ZIP codes. Why? Is it because they have less disposable income to spend on healthy food, and they feel less safe going outside and exercising?

Adam Drewnowski: It’s a combination of everything. We’re using where people live as an index of what’s called socioeconomic position, which is usually predicted by education and income and occupation. We think that knowing where people live—not the exact address, but the neighborhood—tells you a lot about poverty and wealth. For most Americans, their biggest single asset is their house. If you live in a nice neighborhood with nice property values, that tells us something about who you are. For example, property values determine taxes, which in turn determine support of schools. The nature of the neighborhood determines access to healthy foods.

Do ZIP codes affect grocery stores?
Take a look at Whole Foods [the organic supermarket] in Seattle, I think now they’re in three locations. One is by the University of Washington, which means education. The second is on the east side, close to Microsoft, which means income and education. The third is downtown. Nice stores set themselves up in areas with buying power. In underserved or disadvantaged poor neighborhoods, you will not get very much other than, in some cases, fast food. People will be buying their groceries at the gas station.

Just how much fatter are people who live in ZIP codes with lower property values?
If we looked at the median prices of residential properties, for each $100,000 of added value, obesity rates go down by 2 percent. In Mercer Island, the median house price is around $1.5 million and the obesity rate is around 5 percent. In the worst areas, in south King County, the median asking price is $270,000 and the lowest asking price is about $10,000 for a manufactured home. The obesity rate there is around 28-30 percent.

Do you think the ZIP code effect would hold true in other parts of the country?
We know it holds in New York City because the department of health there conducted a survey of 10,000 residents in all five boroughs a couple of years ago. Those were not ZIP codes, they were neighborhoods. The department of health noted that if you go from the Upper East Side over to East Harlem, the obesity rates quadruple, from 7 percent to about 28 percent, and the rates of diabetes go up seven times, from 2 percent to 14 percent. You are, in fact, in a different world.

And outside Seattle and New York City?
We are used to thinking that obesity is largely genetic. But if you take a different approach and say obesity and diabetes are predicted by low incomes, neighborhood deprivation and neighborhood poverty, then you have a new angle. For example, looking at incomes in the poor Ninth Ward of New Orleans, it was quite possible to predict that 30 percent would be obese and about 7 percent would be diabetic. No one thought of that. But when the television images came on, everyone noticed that the people left behind were not just poor but obese. In fact, being able to predict obesity and disease by geographic location has implications for public health. There are predictable patterns.

Is it true for kids, not just adults?
I suspect it’s true for kids. The data is for adults.

How did you get the idea to investigate obesity in this way?
ZIP codes aren’t actually the ideal way to look at obesity because they are created for the convenience of delivering mail. The problem is there are no data at any other geographic scale below county level. Certain states sent a behavioral risk-factor survey, administered by the U.S. Centers for Disease Control, to adults in some states, including the state of Washington. We looked at King County. We stopped at ZIP code because there was no finer scale available.

What’s next? Will you look at other ZIP codes?
We would like to look at other geographic areas. The premise here is that maps of health and disease and maps of poverty and wealth are very often one and the same. The point of looking at maps is that if you’re a public-health official, you know where the problem is, so you can target your resources appropriately. You need to know exactly where to intervene, and which neighborhood is vulnerable. That’s why this work is so important.

Will everyone now want to move to rich, thin ZIP codes like Beverly Hills 90210?
That is probably the best way of losing weight!

What about the July study in the New England Journal of Medicine that said someone’s weight gain was associated with weight gain in his or her friends, siblings, spouse and neighbors?
I don’t think Paris Hilton has any fat friends. Most of your friends live in the same area. Or at least in a ZIP code much like yours.

I remember first meeting you nearly 20 years ago, when you were researching whether overweight people had a “fat tooth,” not just a “sweet tooth”—something that drew them to calorie-dense foods. Is there an update to that research, and does it relate to this work?
Yes, it does. I’ve talked about the sweet tooth and the fat tooth, and the kind of connection to this work is very direct. The sweet and high-fat foods are much, much cheaper. After I started studying taste, I started looking at cost. The added sugar and added fat were not only good tasting and satisfying. They were also cheapest. And they’re available even in the lowest-income ZIP codes. The whole thing connects up, like it or not, through money.

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© 2007 MSNBC.com

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Have you ever watched the Iron Chef America on the Food Network? While watching the show, did you ever get the urge for a burger and fries? If so, this may be the reason….I got this link from one of my nutrition group listserves.  It shows a clip of the show with the McDonald’s add running across the screen for a second or two.  I did not know that these tactics were actually being used. I wonder how often these subliminal adds are on tv.  In my case, perhaps there are subliminal adds for chocolate cake!

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I just got back from a relaxing week on Martha’s Vineyard with my family (some of you might ask - is that possible??). A lot of food, some exercise. I TRY to follow my own advice. I wanted to share my chocolate cake story. My step-mother baked me a cake to welcome me to MV. Yes, some people still do bake these days… just not us citygirls (too many bakeries around!).

The trigger
So here was the sceniero… my step-mother baked a flourless chocolate cake. Of course, I am not a rude girl, so I had a piece (ok - a big piece) to show my appreciation. It was amazing! Then my parents went out for the evening. I was left alone with the cake. I knew I was in trouble as chocolate is my weakness.

The tactics
I tried the techniques I teach my clients on how to deal with cravings or trigger foods.

1. Hide the food. I covered it with tinfoil and hid it in the cabinet. Of course, I knew it was still there.

2. Wait 15 minutes for the craving to pass. It did not pass!

3. Distract yourself.  Turned on the tv - nothing interesting. Went out and took a hour walk. That helped while I was out of the house, but when I was back in the house, thoughts of chocolate cake appeared once again.

4. Call a friend. I told my friend I would owe him $200 if I ate another piece of cake. This may sound bizarre - but this financial tactic often works for me. I made the price high because I really thought it would deter me (as it has in the past) from eating the cake.

So what do you think happened? You probably guessed that the tinfoil covering was opened and cake was consumed (not the whole cake, but another good sized piece!).

 Well, needless to say, I am $200 poorer. Not the end of the world…but I must say I am glad I do not live in a household where someone is always baking chocolate goodies. I would be poor and pudgy. Check out my other post on whether nutritionists can control their intake of sweets (obviously this one can’t!)

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One of my specialities is nutrition for women with PCOS (polycystic ovarian syndrome). I’ve been specializing in PCOS for the past 7 years or so and have worked with hundreds of women with this condition.  I am writing this post because of the frustration I see with some of my patients with PCOS who are trying to lose weight. Up to 75% of women with PCOS are overweight. Losing weight is difficult enough for most people but it is often even more difficult for women with PCOS.

Why is it so difficult to lose weight if you have PCOS?  No one is 100% sure, but it  likely has something to do with insulin resistance and genetics. The majority of women with PCOS are insulin resistant. High levels of insulin can increase fat storage as well as increase hunger and carbs cravings (both of which can increase caloric intake).

Everyone has a different metabolism
In my experience,  most women with PCOS are able to lose weight with a lower glycemic index reduced calorie diet plan along with regular exercise. Not all overweight women experience difficulty losing weight. Some of my overweight patients with PCOS are able to lose 1-2 pounds a week by making changes in their eating and exercise habits. However, other women who have great difficulty losing even a pound on the same diet plan that easily promotes weight loss in other people. I know that this doesn’t  seem fair and I empathize with you. It is really difficult when you see other people eating a lot more than you are - and they are able to lose weight while your weight will not budge. This just goes to show that everyone’s metabolism is different.

But it is not impossible to lose weight! The majority of my patients are able to lose weight with diligence, consistency and patience with following the meal and exercise plan. It  may take longer for you than for some other women - but hang in there and you will eventually see results.

Here are tips for those women who are “slow losers” much difficulty losing weight:

1. Experiment with a very low calorie low carb diet for a few weeks to see if it will promote weight loss. I know that this plan can be very difficult to stick with on a long term basis, but it is likely that following it for a even a few weeks will help you drop several pounds. You can then follow a more moderate carb plan for a few weeks before going back on the more rigid plan. I will post several  ”stricter” meal plans within the next week or two as well as some dietary tips specific for women with PCOS.

2. Now when I say stricter, I don’t mean a starvation diet! Skipping meals or taking your calories too low will slow your metabolism.

2. Keep a detailed food log. You will need to weigh and measure some foods to make sure you are 100% on track with your calories. Most people underestimate what they eat by as much as 75%!

3. Make sure you are as active as you can possibly be. Walk as much as possible, engage in formal aerobic exercise at least 4 times a week for 45 minutes, take the stairs, walk instead of taking the subway, bus or driving (when possible). It would also be a good idea to add in light weight training.  Check out my post on Breaking Plateaus for more advice on increasing/changing activities.

4. Work with a physician who specializes in PCOS. Are you insulin resistant? Discuss this issue with your doctor. Most women with PCOS are insulin resistant (you still may be insulin resistant even if your insulin levels appear in the high range of “normal “on your blood test).  Metformin (glucophage) may be indicated as a medication that can lower insulin levels. The therapeutic dose is often ~ 2000 mg.  Keep in mind that metformin is not a diet pill and does not decrease the appetite or speed metabolism, so do not expect it to have a major effect on your weight. However  it can help reduce insulin levels which in a round about way can help to promote weight loss. It can also help reduce carb cravings. In addition, some women say it makes them feel a little nauseas so they do not want to eat as much. (Not a great way to lose weight, but if it helps you eat less and the nausea is not too bad… then I guess it is not the worst thing in the world!).

5.  Have you have your thyroid checked?

6. Make sure you are getting adequate sleep. Lack of sleep has been associated with an increased tendency for obesity.

7. Work on stress management as increased stress has also been associated with obesity.

8. Consider working with a therapist if you feel depressed, anxious, eat compulsively or have any emotions that you are having a difficult time dealing with on your own. Having PCOS and the symptoms that may go along with it can be very stressful for some women.

 9. Find a nutritionist who is knowledgable about PCOS. For those women who live in the NYC area, feel free to call me to set up an appointment (see my website below).

 For more information on PCOS and nutrition, check out the following:

My website (this contains useful links on PCOS)

Article I wrote on Diet and PCOS on Obgyn.net

Article I wrote on  PCOS and Nutrition from “Nutrition Today“

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Check out Martha’s quote in Womansday.com        

Snack Off the Pounds
How to fit mini-meals into your weight-loss plan

Trying to lose weight? Snacking doesn’t have to be your downfall. In fact, having small, frequent meals can actually help you shed pounds. Not only does it rev up your metabolism so your body burns slightly more calories than it does when you eat less frequently, snacking also helps you stay in control so you’re less likely to overeat at lunch or dinner.

Don’t forget to keep calories in mind, however. “Many women who struggle with weight eat too many calories between meals, often without even realizing it,” explains Dawn Jackson, R.D., a Chicago-based registered dietitian and spokeswoman for the American Dietetic Association. “In some cases, snacks may pack in more calories than meals.”

How Many, How Big?
One midmorning snack and one afternoon snack, each containing up to 200 calories, will satisfy most people, suggests weight-loss expert Barbara Rolls, Ph.D., professor of nutrition at Penn State University and author of The Volumetrics Weight-Control Plan. Dr. Rolls says a daily diet containing about 1,600 calories, with about 400 for breakfast, 500 for lunch, 500 for dinner and two 100-calorie snacks, will promote weight loss among most overweight women.

“Snacks should also be planned,” adds Dr. Rolls. “Too often, snacking is mindless nibbling on whatever you have readily accessible in the refrigerator or cupboard. Before you know it, you’ve eaten five hundred calories’ worth of chips.” Instead, pay attention when you’re eating and don’t allow yourself to eat and read or eat and watch TV. When you’re eating, that’s all you should be doing.

The Right Snacks
The best snacks are those that are high in bulk and low in calories—essentially, foods that fill you up with the fewest calories. Ideally, a snack should contain carbohydrates, fiber and protein, with perhaps a small amount of fat.

Fruits and vegetables are among the best snacks of all because they’re rich in nutrients and fiber and low in calories. When you snack on most non-starchy vegetables, you don’t even have to account for them in your diet, says Dr. Rolls. Some vegetables that contain significant calories are potatoes, corn, beans, peas, lentils and winter squash.
Fresh fruit is a great option, too, because most women can have two or three pieces of fruit daily without worrying about gaining weight. Fruit juice and canned fruit in syrup are less filling and these should be limited.

Snack Attacks: Reality or Not?
Afternoon and after dinner are the times when most people have problems controlling what they eat, says Martha McKittrick, R.D., C.D.E., a registered dietitian and weight-loss counselor at the New York-Presbyterian Hospital in New York City. “Afternoon snacks are usually a good idea if there’s a long time between lunch and dinner, but most people can go without an evening snack. They’re eating more out of habit than because they’re physically hungry.”
Often, the desire for a snack comes from another emotion or from habit, not hunger, says McKittrick. Here’s what she has her patients do when they have a snack attack. Before grabbing something to eat, answer these questions: “Am I really hungry? Do I feel hunger pangs?” If the answers are yes, plan and eat an appropriate snack of up to 200 calories.

If not, you may be bored, stressed, frustrated, mad, worried or tired. If you can identify an emotion that is causing you to want to eat, find an appropriate way to deal with that emotion. Eating a snack cannot do anything to beat boredom or solve a conflict. Take a break, call a supportive friend, stretch or do something positive for yourself.
 

See my post on basic tips for snacks and suggestions for crunchy snacks (more ideas for snacks will be coming soon!)
 

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With the warmer weather, many of us are trying to eat lightly and are choosing more salads for lunch. Or perhaps you are eating more salads instead of sandwiches in attempts of cutting down on calories. Here is the bad news…depending upon your choice of salad dressing, your salad can contain more calories than a Big Mac! Some salad dressings can contain double the amount of calories of your actual salad. The problem is that most of the dressings - even those that sound healthy - are loaded with calories and fat.

For example, balsamic vinaigrette dressing sounds healthy - right? While the ingredients (oil, vinegar and seasonings) are healthy, a small container can pack in over 300 calories! The same goes for other dressings such as blue cheese, Russian, caesar, etc.

This “small” container is the typical 2 oz portion ( 4 Tablespoons) that many restaurants serve on the side or the one scoop of dressing add in when they are “tossing” your salad.  Actually, I have watched many servers who are tossing salads add 2 scoops of dressing. FYI - this container looks quite small… I never would have imagined it was actually 4 T. unless I measured it out myself!

Check out the list below to see the calories in some of your favorite salad dressings. They are all based on the standard sized portion of salad dressing you get at the various restaurant (ie. Cosi, Au Bon Pain). Many restaurants do not list the nutritional content of their salad dressings. In that case, I would tell you use this chart as a guide when it comes to estimating the calorie/fat content of a similar dressing. The caesar dressing from your local diner likely has similar calorie/fat content to the caesar dressing listed in this chart.

A few suggestions for eating salads outside the home:
1. Order light dressing when possible.
2. Get it on the side and use it sparingly.
3. Order extra vinegar on the side. Use all of that container and 1/2 of the container of the other dressing
4. Try the dip method. Rather than pouring the dressing on your salad, dip your fork in the dressing and eat the salad that way.
5. At home, measure how much salad dressing you put on an entrée sized salad (I doubt you want to bring your measuring spoons on your lunch date!).
6. If you have a refrigerator at work, keep a bottle of your favorite healthy low cal dressing. Add this to your salad instead of the dressing they give you.

Check out these individual packets of salad dressings. You can carry them with you. Here are the links as to where you can purchase the individual packets: Kraft Fat Free raspberry vinaigrette, Girards, Walden Farms.

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I recently did a post on my post drinking munchies.  Luckily, I am not a big drinker so it does not happen that often. But I notice after I have as little as 1-2 drinks, my appetite greatly increases later in the evening - even if I had a good sized restaurant meal. Alcohol especially seems to stimulate my  craving for chocolate.

Confession - I bought a pack of Funny Bones Saturday night on my way home from meeting a friend for dinner and drinks (I used to love these as a kid …chocolate and peanut butter). Normally, it would never occur to me to buy Funny Bones but somehow after I have had a few drinks, I develop cravings for Funny Bones or chocolate and “give myself permission” to make this purchase.

The reason why I writing about this post drinking activity (or after another activity that involves inhaling…) is because it happens quite frequently. I know this from experience because I listen to what people eat/drink 8 hours a day! I have had 2 clients so far this week that are experiencing this eating/drinking syndrome.  Both of these clients (of course, I never give names!!) are trying to lose weight and their late night eating post drinking/smoking is preventing them from meeting their goals. Both of these clients eat quite healthy and low calorie during the day. Even their dinner choices are healthy for the most part. Things take a turn for the worse later in the evening.

1. Client A:  Great breakfast and lunch. She has a very active social life which includes dinner parties, cocktail parties, meeting friends and boyfriend for dinner and drinks. Many nights of the week, she will have 1-2 drinks before dinner. This can lead to overindulging in appetizers or  hors d’oeuvres (which she would not normally do) and then bread and perhaps a dessert or other snack later on.

2. Client B: Same as above -healthy breakfast and lunch. He could not understand why he was not losing weight as he thought he was following my diet plan at least 80%. Finally, he agreed to keep a food log. The problem became obvious. Several nights a week, he would have 3-4 beers (along with another substance…). This led to the munchies where he consumed at least 600 calories of snacks late at night (cereal, soy chips, leftovers, candy bars, etc.). He did not realize the extent of this late night eating until he put it down on paper.

Morale of the story…  Not only is drinking alcohol in excess unhealthy for many reasons, it can contribute towards empty calories and an increase in appetite or stimulate cravings later on. For those people who enjoy a few drinks, it is probably unrealistic to say you will stop drinking totally.

Here are my practical recommendations to help you deal with the drinking/eating syndrome*:

1. Keep a food record of what you eat and drink
2. If you see a pattern occurring on the nights you drink, you will need to come up with a plan.
3. The best plan would be to limit your alcohol (as I have stated in previous posts). Allow yourself a set number of drinks a week. I often recommend 7 drinks a week for men and 5 for women.
4. Keep problem foods out of your house so you will not get into them when you get home. Foods that can be particularly problematic are those that come in large containers such as cereal, chips, pints of ice cream. Of course, avoid pizza shops and diners late at night!
5. Limit your drinks before dinner. Having cocktails before dinner will only stimulate your appetite for dinner. Instead, enjoy your drink with dinner.
6. Have an afternoon snack so you will not be drinking on an empty stomach.
7. Drink plenty of fluid during the day. Alcohol will effect you more quickly if you are dehydrated. Drink water in between alcoholic drinks.
8. If you know you will be hungry when you get home later at night, have a light snack waiting for you. Suggestions: individual pack of oatmeal, a yogurt, 100 calorie snack pack of whatever you choose, etc. Make sure it is portion controlled.

*the eating/drinking is not a medical sydrome… so do not ask your doctor about it. I made up the name!

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I was interviewed by Gina Shakespear on organic food and overall nutritional choices. She was reporting for New Tang Dynasty Television New York. Check out this link to see my first appearance on a Chinese TV station.

 My quote: “Over 66% of Americans are over weight. Foods tend to be processed … many foods are refined so you often don’t find whole grain breads and cereals.  When you’re eating on the run, we often do not eat enough fruit and vegetables, not enough fiber and too much fat and sodium. It is also difficult to make healthy choices from a weight control standpoint when you’re on the run  - especially in America - because of the jumbo sized portions.”

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A new study suggests the answer may be yes!  

We all try to do out best when it comes to feeding our children. Sometimes we are faced with the decision as to what kind of product would best - the “real thing” or a diet version of the same product. So should you feed your child real soda or diet soda? (or no soda at all!). Low fat frozen yogurt or Skinny Cow fat free fudge bars or Hagen Daz ice cream? Regular pudding or diet pudding? Regular salad dressing or diet salad dressing?

 I know that many parents are concerned (and rightly so) about their child’s weight. Combine this concern with a mother who is dieting and it is likely the child may also get served diet food. The following study done at University of Alberta suggests that diet foods and drinks for children may inadvertently lead to overeating and obesity.

A team of researchers contends that animals learn to connect the taste
of food with the amount of caloric energy it provides, and children who
consume low-calorie versions of foods that are normally high in calories may develop distorted connections between taste and calorie content, leading them to overeat as they grow up.

The research will be published today in the academic journal Obesity.

“Based on what we’ve learned, it is better for children to eat healthy,
well-balanced diets with sufficient calories for their daily activities
rather than low-calorie snacks or meals,” said Dr. David Pierce, a
University of Alberta sociologist and lead author of the paper.

The researchers conducted a series of elaborate experiments that proved substituting low-calorie versions of foods and drinks led to overeating in a sample of young rats, including ones that were lean and ones that were genetically obese. Although both lean and obese rats overate during their regular meals, the added calories have more serious health implications for obese animals.

Adolescent rats that were also fed diet foods did not display the same
tendency to overeat. The researchers believe the older rats did not
overeat because they, unlike the younger rats, relied on a variety of
taste-related cues to correctly assess the energy value of their food.

“The use of diet food and drinks from an early age into adulthood may
induce overeating and gradual weight gain through the taste conditioning process that we have described,” Pierce said.

Pierce added that his team’s “taste conditioning process” theory may
explain “puzzling results” from other studies, such as a recent one from researchers at the University of Massachusetts, who found links between diet soda consumption (among children”) and a higher risk of obesity, diabetes and heart disease, but further research is necessary with older animals using a variety of taste-related cues.

“One thing is clear at this point,” Pierce said, “our research has shown
that young animals can be made to overeat when low-calorie foods and drinks are given to them on a daily basis, and this subverts their
bodies’ energy-balance system.

“Parents and health professionals should be made aware of this and knowthat the old-fashioned ways to keep children fit and healthy—insuring they eat well-balanced meals and exercise regularly—are the best ways. Diet foods are probably not a good idea for growing youngsters.”

My opinion…

1. I agree that serving well- balanced healthy meals to your children and encouraging them to be active are the 2 most important things you can do for their health.

2. Base your family’s meals on lean proteins, vegetables and whole grains. I realize that not all families (especially in NYC!) cook but you can also get healthy take-out foods for dinner.  

3. Include moderate amounts of heart healthy fats such as olive oil, canola oil, avocado, nuts and nut butters in the diet. You do not need to create fat phobia in your child by serving only fat free products.

4. While fruit or yogurt are probably the best types of snacks for your child, I see no problem with including “treats” such as cookies or ice cream into their diet on occasion - assuming the bulk of their diet is based on healthy foods. 

5. There is no problem with buying some low fat, low sugar or other “diet foods”. For example, I think low fat dairy products (i.e. milk, cheese, sour cream, etc) are a good idea as to help lower the saturated fat content of your childs diet.  Children under the age of 2 should still drink regular milk.

6. I also feel that it is important for the parents to set a good example when it comes to eating as children often emulate what they see their parents doing. If a parent is always talking about their diet foods, it is likely the child will want the same food. Of course, I am NOT suggesting all parents load up on the bowls of Hagen Daz every night - but just talk  more about eating for health rather then diet or weight.

7. Bottom line, I do not think serving your child a diet food such as fat free frozen yogurt or low fat salad dressing will cause weight gain. I think the problem could occur (it the results of this study prove to be true in humans) if we consistently feed our children dietetic products such as diet soda and other drinks made from artificial sweeteners and/or have too little fat in their diet by only buying fat free products. Just my opinion!

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