Effect of Exercise Duration and Intensity on Weight Loss

Do I have to exercise vigorously to lose weight? How long do I need to exercise to lose weight? These are questions addressed in a study of 184 women aged 21-45. They all followed a low calorie eating plan (1200-1500 calories per day) but were assigned to various exercise programs, some vigorous, some moderate, some shorter in duration, some longer. Here is what they found.

First, they all lost weight; 15-20 pounds in one year! It appears that high intensity exercise is not necessary to lose weight. Those who exercised vigorously did not have greater weight loss than those who got a similar dose of exercise at a moderate intensity.

Increased duration, however, improved both weight loss and fitness levels the most. Women who exercised less than 150 minutes/week lost 4.7% of their body weight. Those exercising 150+ minute/week lost 9.5%, and those exercising 200+ minutes per week lost the most, 13.6%. Here is what the researchers concluded: To lose weight, reduce calories to 1500 or less (average in this group was about 1450 cal/day). Aim for 30 minutes of moderate exercise daily, eventually progressing toward 60 minutes per day for optimum results. In this study, most women chose brisk walking.

Journal of the American Medical Association, Sept. 10, 2003

Effect of Ketogenic Diet on Blood Cholesterol Levels

A diet high in protein and fat but low in carbohydrates (a ketogenic diet) is used for difficult to control seizures in children and seems to be quite effective. Many people are also using a ketogenic diet to lose weight. The Atkins diet is a ketogenic diet. When losing weight rapidly, blood cholesterol levels don't seem to rise. One of the concerns of following this diet long term, however, is the potential adverse affects on blood cholesterol levels.

A study of children on a ketogenic diet, long term (6 months) shows what can happen to blood cholesterol levels in the absence of weight loss. At baseline (before the ketogenic diet was started) 75% of the children had desirable LDL cholesterol levels (<110 mg/dL). After 6 months on a ketogenic diet this dropped to only 28%. At baseline only 14% had high LDL cholesterol levels but after 6 months on the high protein-fat and low carbohydrate diet, 53% (3.8 times as many) developed high LDL cholesterol levels. Similar adverse results occurred to HDL cholesterol levels. This certainly illustrates the potential adverse effects a ketogenic diet can have on ones health. You certainly wouldn't want to use a ketogenic diet to maintain long-term weight goals following a weight loss program!

Journal of the American Medical Association, August 20, 2003

Can You Accurately Predict Heart Disease?

A common belief by many people in the medical community is that "up to 50% of people who experience a heart attack have no major risk factors." To see if this statement was true, researchers looked at the data in 14 clinical trials including 122,458 people, and 3 large population studies including 386,915 people. The data shows that 80% to 90% of people who experienced a heart attack, and more than 95% of people who died from a heart attack had one or more major risk factors for coronary heart disease:

• High cholesterol (240+ mg/dL)
• High blood pressure (140/90+)
• Smoking
• Diabetes (fasting blood sugar of 126+)

This is pretty powerful data indicating that heart disease is caused by known risk factors and is thus largely preventable if people eliminate those risk factors. If you have none of these major risk factors you a strong chance of avoiding a heart problem! To be even more careful, follow the new prevention guidelines:

• Cholesterol -- keep below 200 (160 or below if you are high risk)
• Blood pressure -- keep below 120/80 for ideal health
• Smoking -- never smoke and avoid second-hand smoke
• Diabetes -- keep fasting blood sugar levels below 110 mg/dL

In addition, the authors of this research recommend you eat a healthy diet (low in saturated and trans fats, using healthy fats, low in sodium, and moderate in calories), get regular exercise, at least 30 minutes daily, and maintain a healthy weight (BMI less than 25). If you follow these guidelines, you can reduce your risk of a heart attack even more than the 80-90% mentioned above.

Journal of the American Medical Association August 20, 2003

Health Insurance Premiums up 13.9%

Health care premiums for employees rose 13.9% this last year (premiums rose 12.9% last year). This is the largest annual increase since 1990! In some regions of the country, premiums have risen by 19-25% and more. This is the third straight annual double digit increase. Higher premiums are expected again in 2004.

The average premium for a single employee is now $3,383 and $9,068 for a family. Of this amount, companies pay 84% and single individuals 16% of the premium costs. For families, companies pay 73% and employees 27%. Companies on self-inured plans saw medical claims rise by 12.4% in the last year. Employees are also paying higher deductibles and co-pay at the time of health services.

Because of the high costs, many smaller companies can't afford to offer health insurance. In companies with less than 50 employees, 26 to 45% do not offer health benefits. Including all companies surveyed, 1/3 (34%) do not offer health insurance.

Of the various health plans available, PPOs are the most common (they enroll over half of all employees), HMOs enrolled 24% of the insured population, and regular indemnity plans have nearly disappeared (5%).

What is driving these high increases? Here are a few suggestions from this survey of 1,865 companies surveyed. Higher drug costs (drugs cost more and there are more drugs being taken), higher hospitalization costs, more high tech diagnostics,  an increase in certain diseases, (hypertension, congestive heart disease, and diabetes, all linked to the increase in weight), and some claim increased profit margins for insurance companies. The bottom line is that there is a larger demand for services.

These alarming statistics stress the importance of putting more emphasis on prevention and health promotion. Health providers, companies, and individuals all need to take more responsibility for promoting healthier lifestyles that will reduce the demand on the health care system. Companies that are initiating disease management and comprehensive wellness programs as part of their employee benefits package are seeing a decrease in demand and lower health care costs. It's estimated that up to 40% of all disease can be prevented by living a healthy lifestyle (see previous story for an example).  For more information on this employer survey read the 8 page summary (pdf).

Survey conducted by the Kaiser Family Foundation and the Health Research and Education Trust.
News Release, Sept. 9, 2003

Hormone Replacement Therapy and Heart Disease

The final report of the large Women's Health Initiative (WHI) study (16,608 women 50-79) on hormone replacement therapy (HRT) and coronary heart disease in now published. Preliminary data showed that women taking HRT had greater risks than benefits so the study was halted early. Here are the final results:

After 5+ years of follow-up, those women randomly assigned HRT had a 24% increased risk of coronary heart disease. During the first year the risk was 81% higher. Towards the end of the study, many women stopped taking HRT. After adjusting for actual use of HRT the risk for heart disease increased by 50%. The risk for breast cancer also increased each year the women continued HRT.

In a special study of women with existing coronary heart disease, taking HRT was not effective in slowing the progression of the disease as was previously thought.

In summary, HRT was associated with excess risk for coronary heart disease, stroke, blood clots in the veins, and breast cancer. Two benefits noted were reduced hip fractures and colorectal cancer. Both of these conditions, however, can be reduced even more effectively with other options than HRT.

The New England Journal of Medicine, August 7, 2003

A New Found Peptide that Reduces Appetite

Researchers are looking for the "magic bullet" that will help the body control appetite. They are finding several substance (peptides) in the body that help regulate body weight. Some peptides, such as alpha-melanocyte-stimulating hormone decrease food intake and increase energy expenditure. Other peptides stimulate appetite, such as agouti-related protein and neuropeptide Y which are released by the brain. Other substances such as insulin and leptin also control food intake and energy expenditure.

The gut (intestine) releases several peptides controlling satiety and hunger such as cholecystokinin, ghrelin, and a newly discovered peptide YY or PYY for short. PYY is secreted after eating a meal, in proportion to the amount of calories eaten, and signals the body that it has had enough to eat.

When PYY is experimentally infused into the blood 2 hours before a meal, people eating at a buffet reduced their calorie intake by 30% compared to an infusion of saline (used as a control). The people felt no adverse effects and it did not decrease the palatability of the food. PYY causes a decrease in food intake by decreasing gut motility (causing a sense of satiety) and blocking the release of peptides, such as ghrelin, that stimulate hunger .

When dieting by restricting calories, circulating levels of ghrelin increase and so does hunger.  If ghrelin signals hunger and PYY signals satiety, can these hormones be manipulated to control weight? Researchers are not sure but they are getting a much better understanding of how the body controls eating and energy metabolism. They may soon have preparations that can help the body control weight "naturally" by increasing the level of satiety peptides such as PYY in the body.

"How the Gut Talks to the Brain", The New England Journal of Medicine, Sept. 4, 2003

Metabolic Syndrome in Teens

In a nationwide health assessment of adolescents, researchers found that at least 4% of American youth ages 12-19 have metabolic syndrome, a condition that increases the risk of heart disease and diabetes similar to the increased risk that occurs from smoking. In significantly overweight teens the prevalence increases to 30%.

Metabolic syndrome is characterized by high blood pressure, elevated triglycerides, low levels of heart-healthy HDL cholesterol, elevated blood sugar, and abdominal obesity. Persons with three or more of these conditions have metabolic syndrome.

The researchers say that the study data was collected between 1988 and 1994 so by now with the increased prevalence of obesity, the actual rate may be as high as 7% of all teens. The treatment to correct metabolic syndrome is to get regular aerobic activity and to lose excess fat weight.

Archives of Pediatrics and Adolescent Medicine, August 2003

Whole Grains and Risk of Type 2 Diabetes

A new study from Finland found a reduced risk of type 2 diabetes in persons with a high whole-grain intake. The reduced risk was apparently due primarily to the high fiber intake on those eating whole grains.

The study included 2286 men and 2030 women with 10-years of follow-up. In Finland, the principle whole-grain is rye. Those persons who ate the most whole-grains had a 35% risk of type 2 diabetes. When comparing the people who ate the most cereal fiber (top 25%) they had a 61% lower risk of type 2 diabetes compared with those eating the lowest amount of cereal fiber (bottom 25%). This relationship remained even after adjusting for BMI, energy intake, smoking, fruit and vegetable intake, etc.

Cereal fiber appears to be especially protective against type 2 diabetes. Those people with the lowest risk of getting type 2 diabetes ate about 30 grams of cereal fiber daily. Whole-grain breads have 2-3 g/slice. Whole grain cereals have 4-5 g/serving. All-bran has 9.5 g per 1/2 cup. Oatmeal and brown rice have about 3.5 g/serving.

Look for ways to include more whole-grain cereals in your diet: whole wheat bread, whole-rye bread, rye-crisp, oatmeal, barley, millet, buckwheat, and brown rice. Add wheat germ, bran (oat or wheat) and whole grains into other recipes such as cookies, pancakes, waffles, muffins etc. By eating more whole-grains you may cut your risk of diabetes by 35 to 60 percent!

American Journal of Clinical Nutrition, March 2003

Whole Grains and Effect on Total Mortality

The value of whole-grains continues to grow. In the  Atherosclerosis Risk in Communities (AIRC) study, those persons who ate the most whole grains had a mortality rate nearly half (48% lower risk) that of those eating few whole grains. After adjusting for excess weight, activity level, blood pressure, cholesterol level, etc. they still had a 23% lower risk of dying from any cause and were 28% less likely to have a heart attack.

What we choose to eat daily can have a profound effect on our health. The group with the highest mortality rate ate less then 1/10 of a serving of whole grains daily. The group with the lowest mortality rate ate 3 or more serving of whole grains daily.

For interest sake, the researchers also looked at how often the study population ate refined grain foods (white bread, white rice etc.). They found that the more often they ate refined grain products, the higher their mortality. Those who ate the most refined grains had a 34% higher mortality from any cause and a 54% higher risk of coronary artery disease. The researchers conclude their study by saying, "Our data specifically suggests that whole-grain foods are more healthful than refined-grain foods."

It seems clear from these large studies (15,792 people studied for an average of 11 years) that to enjoy better health and a longer life, it is very important to choose primarily whole grain foods and avoid refined grain foods as much as possible. Read food labels to see if you are eating primarily whole grains or not. You can be adding years to your life.

The American Journal of Clinical Nutrition, Sept 2003

Steps to a Healthier Company

Secretary of Health and Human Services (HHS) Tommy Thompson launched a new worksite wellness program encouraging department employees to become more physically active.

The Secretary is challenging all HHS employees to participate in a 6 week physical activity program. To meet the challenge, employees need to engage in moderate or vigorous physical activity for at least 30 minutes per day, five days each week for the six seeks. Participants will log in their weekly activity on a fitness web site. Those who complete the challenge will receive special recognition and prizes.

He also met with business leaders from around the U.S. to encourage private businesses and organizations to become involved in wellness and prevention. Thompson feels prevention is a top priority for our nation. He prepared a 35 page document building the case for wellness and case studies of companies who are reducing health care costs at their organization. You can get a copy of this executive report (pdf) in the "Featured Health Links" section below.

U.S. Dept. of Health and Human Services, News Release, Sept. 14, 2003

QuickFacts

Use these stats as attention getters for health enhancement programs.

One out of every 5 breast cancers could be prevented if women would simply walk briskly for 30 minutes each day.  JAMA Sept. 10, 2003

Obese Americans spend $700 more per year on medical bills than those who are not overweight. Americans pay $150-$200 or more yearly in taxes for additional medical care expenses for overweight Medicare and Medicaid recipients.  Time magazine, Sept. 8, 2003

Health care costs are increasing at the rate of 12-14% per year. This is about 6 times faster than inflation in general which is about 2.2% per year.  Employer Health Benefits Survey 2003

In a survey of 660 benefit managers, 96% rank high health care costs as their top concern.  Employee Benefit News Sept 1, 2003

People with one or more major (but modifiable) risk factors (smoke, high cholesterol, high blood pressure, high blood sugar) are 80% to 90% more likely to have a heart attack.  JAMA Aug. 20, 2003

Nearly 90% of those with newly diagnosed type 2 diabetes are overweight.  Weight Loss Matters, American Diabetes Association, 2003

The average annual insurance premium for a single worker is $3,383 and $9,068 for a family.  Employer Health Benefits Survey 2003

Dark chocolate contains polyphenols (plant substances that promote health) that help lower blood pressure. In a 2 week study, those eating dark chocolate daily had a 5 point drop in their blood pressure. You can't really call chocolate a "health food" because it's loaded with calories, but an occasional treat might not be that bad for you!  JAMA August 27, 2003

The Institute of Medicine estimates the cost to American society for underage drinking at $53 billion annually. Losses stem from traffic accidents, crime, and other alcohol related problems.  NAS, Institute of Medicine, September 9, 2003

A dietary trial compared the effects butter and olive oil have on blood fat and HDL cholesterol levels. Using olive oil resulted in lower blood fat levels and higher HDL cholesterol than butter. For heart health, do as the Italians do, use olive oil on your bread in place of butter!  Am J Clin Nutr Mar 2003

A high levels of homocysteine in the blood is linked to lower mental ability late in life. Taking B vitamins, especially folic acid, and vitamin B-12, can lower elevated levels of homocysteine in the blood and may help prevent early mental decline.   The American Journal of Clinical Nutrition, Sept. 2003

Power Point Slides

The following slides are taken from studies reviewed in this newsletter and are available to view and download for your use in presenting health information in your local health promotion programs. Do not copy slides to distribute to other people.

Physical activity and breast cancer
Prevalence of metabolic syndrome in teens
Rising health insurance premiums
Prevalence of major risk factors in person with heart disease
Exercise intensity/duration and weight loss
Ketogenic diet and cholesterol levels 
Whole grains and risk of type 2 diabetes
Whole grains and mortality from all causes

Featured Health Links

Weight Loss Matters. A new resource site developed by the American Diabetes Association to help people lose weight. Check it out

Health Benefits Survey Report. Learn more about what companies are thinking and doing about high health care costs and health insurance in this new survey of over 2800 companies and organizations.

Diet, Nutrition and the Prevention of Chronic Disease recently released by the World Health Organization. Gives specific guidelines for reducing risk of heart disease, cancer, osteoporosis, obesity, diabetes, etc. It gives a little different perspective from U.S. guidelines. 150 pp (pdf).  WHO, 2003

Building the Case for Corporate Wellness This is a "must have" for any organization interested in controlling rising health care costs in their organization. It was developed by Health and Human Services. It gives several case studies of what other companies are doing to reduce health costs (32 page pdf).

Healthy Recipes

Looking for something new and good to eat? Here are a few ideas for you to try that are tasty and good for you!

• Fun with Fruit - Here is a quick, simple way to make fruit more fun and enjoyable for your family.

• Sweet and Sour Tofu - A very tasty  way to enjoy tofu, and a high quality vegetable protein.

• Sesame Eggplant -- Another way to enjoy eggplant. If you haven't eaten eggplant lately, try something new. A great tasting dish and low in calories!

New Health Age Program Released

Health Age Plus is the latest assessment tool from Wellsource. The program combines a classic longevity study with the latest research and offers the opportunity to add screening test results for use in Health Fairs.

In addition to the 7 basic health practices in the previous version, this new program adds questions on: whole grains, fruits and vegetables, amount of meat in the diet, intake of nuts, a question on happiness, and one on social support. All of these new questions are linked to increased longevity.

In addition, a set of 11 screening tests can also be included which makes this program very desirable for use at health fairs and health screening programs. The questionnaire is only one page for quick completion and data entry. The personal report is 2-3 pages plus a preprinted “Guidelines for Healthy Living” educational piece explaining each health test and how to make lifestyle enhancements to lower risk. For availability or further information, contact your Wellsource representative or see the product information sheet on the Wellsource web site.