Health Headlines - March 19

Food Industry a Target in Obesity Fight

It's tempting to blame big food companies for America's big obesity problem. After all, they're the folks who Supersized our fries, family-portioned our potato chips and Big Gulped our sodas. There's also the billions they've spent keeping their products ever on our minds and in our mouths.

Likened by some to the way tobacco companies seduced smokers, such practices have made the food industry the target of lawsuits and legislation seeking to yank junk food from schools and curb advertising to children.

But some experts say neither the problem nor the solution is nearly so simple.

"You don't have the collusion or the cover-up you had in smoking," says James Tillotson, a business and food policy professor at Tufts' Friedman School of Nutrition. "We want to blame somebody, but the thing is, we're all a part of it."

Sure, companies set the stage with cheap, calorie-dense foods.

But government also has propped up agribusiness, the medical community was slow to take on obesity and good nutrition, and consumers seem determined to move less and eat more, says Tillotson, a former food industry executive.

How much of that burden of blame belongs to the food industry can be difficult to answer.

___

Personal responsibility

The food industry emerged at a time when malnutrition was the nation's chief dietary concern. But at some point food became too plentiful, a change that altered the culture of the American diet.

Yale obesity expert Dr. David Katz says that's because companies aggressively peddle food to people who don't need it.

Food industry officials prefer to call it consumer choice.

"We don't think the food industry has done anything particularly wrong in this regard," says Robert Earl of the Food Products Association, a lobbying group that prefers to indict sedentary lifestyles and poor choices.

Companies have tried to help people make better choices, he says, offering healthier products and more nutrition data. But people can't be forced to make the right choice and consumer disinterest doomed many of those products.

He's right. Consumers bear much responsibility for their weight and the fact that two-thirds of Americans are overweight or obese. It's not the industry's fault that people don't get exercise, or that schools have cut physical education, or that people prefer the taste of Twinkies (500 million sold a year) to tofu (much less).

But critics call Earl's assessment disingenuous. Personal responsibility has limits in the face of a multibillion-dollar marketing whirlwind pushing countless high-calorie treats.

"They (food companies) are putting $36 billion into directing those choices," says Marion Nestle, a nutrition professor at New York University and critic of the food industry. "And their methods are very effective."

Meanwhile, efforts to market the healthier products Earl spoke of historically have been lackluster, acknowledges Brock Leach, an executive for new products at PepsiCo Inc.

As for nutrition data, it isn't always helpful. And attempts to standardize or clarify labeling still meet resistance.

Personal responsibility also falters when it comes to children, who are bombarded by junk food ads that undermine parents.

Everything from child-friendly merchandizing of sugary cereals to cartoon ads is designed to give companies more sway over what children eat, says Dr. Susan Lynch, a child obesity doctor and wife of New Hampshire Gov. John Lynch.

Such tactics make it tougher to teach good eating habits to kids who equate food with entertainment, she said.

"It becomes a marketing thing, a fashion thing," says Lynch. "You want to buy the food with the cartoons on the box or the toy."

The industry should have done more to direct the child obesity debate, agrees Pepsi's Leach. Much of the focus has been on getting junk food out of school vending machines, but Leach argues that's just a tiny part of the solution.

He says food companies — including his own, one of the biggest losers in the vending machine fight — should have offered healthier vending options long ago, then redirected attention to other critical issues, such as getting physical education back in schools.

___

Science lag

In many ways the food industry is chasing a moving target. For years, food production was a better understood science than nutrition. And so whole grains were abandoned and hydrogenated fats embraced.

The medical community takes much of the blame, says Dr. George Blackburn of Harvard Medical School's nutrition division.

"We didn't even put nutrition in the medical curriculum except in the last 30 or 40 years," he says. "As soon as we got drugs, to hell with nutrition. We're just now getting it to be a professional responsibility to be sensitive to people's healthy eating."

Today, the food industry suffers from nutrition research overload, with tidal waves of new and sometimes contradictory health findings that strain its ability to produce appealing foods that are in sync with the latest science.

Even when companies succeed, they still are susceptible to scientific surprises that can break a business.

When saturated fat was the enemy, companies reformulated their products, says Grocery Manufacturers Association spokeswoman Stephanie Childs. Only later did they learn that the trans fats they had replaced them with were even worse.

But the science lag can't explain the growing ubiquity of food or the ballooning portions of it, from bigger buckets of movie popcorn to McDonald's much vilified — and now defunct — Supersized burgers.

The industry again points to the consumer, saying that starting in the 1970s people demanded convenience and bargains. Smart companies launched family sizes and sold food everywhere from office supply chains to hardware stores.

"It's a tremendous way of getting people to buy more at lower cost to the producer," says Nestle, who notes research has shown that the more food people have, the more they eat. "There's no question that that's an incentive to buy. Everybody loves a bargain."

This has changed how Americans eat. So-called portion distortion has contributed enormously to obesity.

And overeating becomes even easier when food is everywhere, Nestle says. Meal time is all the time when everything from cars to backpacks to grocery carts are redesigned with snack food holders to accommodate constant munching.

But Nestle acknowledges it becomes a chicken-or-egg question. Lifestyles have changed and Americans want to eat big and on the run. Did that lead food companies to change, or did new products change Americans?

___

Engineering obesity?

Despite his criticism of the industry's practices, Yale's Katz acknowledges companies are in a difficult position. Ultimately, they sell food, and staying in business means selling the foods people want. Public health is secondary.

But what if those companies engineered their foods to make you eat more of them? Though he acknowledges that evidence is scarce, Katz believes companies do just that, much the way tobacco companies were accused of tinkering with nicotine.

Research shows that people eat more when faced with a variety of foods, or even a variety of flavors within a single food. For example, you are less likely to overeat plain baked potatoes than those drenched in butter, salt, sour cream and chives.

Sugary cereals, Katz notes, have more salt in them than many potato and corn chips. Katz believes that's one way to make a cereal's flavor more complex and appealing to get people to eat more of it.

Industry officials dispute Katz's theory. Earl, of the Food Products Association, says he knows of no company that has knowingly manipulated ingredients as Katz suggests.

Whatever the food industry's share of the blame, Tillotson, the Tufts professor, thinks obesity lawsuits are inappropriate and Congress is considering a measure to bar them. Food companies were asked to feed a hungry nation; suing now penalizes them for doing so, he believes.

Industry officials contend lawsuits divert resources from efforts to educate consumers and to produce healthier foods. Market demand and a sense of social responsibility are better catalysts for change, they say.

And some companies deserve real credit for living up to that.

• General Mills Inc., the nation's No. 2 cereal maker, now makes all its cereals from whole-grain flour.

• Kraft Foods Inc., the nation's biggest food manufacturer, says it's curbing snack food ads to children and will redesign packaging to flag its healthier products. The company also recently cut the fat in hundreds of products and stopped marketing snacks at schools.

• PepsiCo Inc., which credits healthier products with two-thirds of its revenue growth, has launched various healthy eating education efforts and even has tied executive bonus programs to the development and marketing of healthier items.

• The Coca-Cola Co. now labels some of its sodas with nutrition data for the entire bottle, not just one serving.

But while critics applaud the changes, they say industry goodwill and consumer demand aren't reliable enough. The realities of competition can push goodwill aside and consumers can't be counted on to want what's good for them.

Leach acknowledges it's true that industry will follow consumer demand, and that includes high-fat, high-sugar foods.

That's why Richard Daynard, director of the obesity and law project at Northeastern University School of Law in Boston, says lawsuits -— some are pending, some were dismissed or settled -— still are needed as part of a larger assessment of the obesity epidemic.

"You can't get to a solution until you get a diagnosis. If you don't see the role of the junk food industry in causing the problem and in continuing to maintain the problem, you've missed a big part of the diagnosis," says Daynard, who is leading a soda industry lawsuit.

"Things that dramatically assign blame, like a lawsuit, help people make a diagnosis."

Ellen Van Gelder, an obese 41-year-old health care worker from Concord, N.H., doesn't need a lawsuit to make her diagnosis.

Though she disapproves of many of the food industry's marketing methods and wishes food companies would make it easier to eat healthier, ultimate responsibility for her weight is her own, she says.

"I would love to blame somebody else. The reality is it's each person's responsibility," says Van Gelder, who has battled her weight her entire life. "You put the food on your plate. You choose whether to eat it."

Study Looks at All the Lonely People

More than a third of adults say they are lonely, especially people in their 40s, a new study shows.

U.K. and Australian researchers conducted 30-minute phone interviews with 1,289 adults in the state of Central Queensland, in Australia.

They found that 35 percent of the respondents said they were lonely. People aged 50 and older had the lowest levels of loneliness. Levels of loneliness began to rise at age 20 and peaked between the ages of 40 and 49.

People with strong religious beliefs were less likely to be lonely than people who had no such beliefs. Women were more likely to have strong religious beliefs, which may explain why women reported lower levels of loneliness than men, the researchers said.

Retired people were less likely than unemployed people to be lonely, and there was a link between household income and loneliness -- people with lower incomes reported higher levels of loneliness.

The researchers found no significant association between loneliness and how long a person lived in their current community.

"Understanding what makes people lonely is very important, as loneliness can increase the risk of health conditions, such as heart disease and depression, and other problems such as domestic violence," researcher Professor William Lauder, of the University of Dundee in Scotland, said in a prepared statement.

"One of the most interesting findings in this study is that it challenges the belief that retirement is linked to diminished social contacts and that people get lonelier as they get older," Lauder said.

Hormone Offers Promise of Youth, Risks

Injecting himself with human growth hormone six times a week and swallowing a handful of dietary supplements each day doesn't seem weird or excessive to 44-year-old Richard Weisman of Las Vegas.

"I have young children. I do it for them," said Weisman, the owner of a luxury and sports car dealership at Caesar's Palace. "I want to be healthy as I get older."

Not only that, he said, he also feels an increase in energy, muscle mass and libido. "My wife loves it and is going to start the program herself," he said.

Weisman is not alone. Other ordinary non-athletic Americans are injecting themselves with human growth hormone as part of a regimen prescribed by fringe doctors and a multimillion-dollar anti-aging industry that — depending on who is talking — is either solidly based on science or mostly hucksterism and quackery.

Much of anti-aging medicine, or as it is more often called in recent years "age-management" medicine, relies on dietary supplements, nutrition counseling and exercise programs.

But a portion of patients also get blood tests that detect supposedly low levels of a marker for human growth hormone. Those patients often go home with a prescription for injectable HGH and a $500 monthly hormone bill that insurance does not touch.

Human growth hormone is produced naturally by the pituitary gland and contributes to normal growth in children. In studies, HGH has been shown to increase muscle mass and reduce fat in men and women, with notable side effects, including diabetes.

A pharmaceutical version is approved for treating children who fail to grow for various reasons, for AIDS patients with muscle wasting syndrome and for adults with legitimate growth hormone deficiency caused, for example, by surgery or radiation.

Other uses are illegal, including to turn back the clock on aging. The FDA says it is investigating violations of the law -— the Food, Drug and Cosmetic Act as amended in 1988 and 1990 -— and has sent warning letters to companies selling HGH over the Internet for other uses.

University of Illinois-Chicago epidemiologist Jay Olshansky, who co-authored a paper published last year in the Journal of the American Medical Association on legal issues surrounding HGH, said anti-aging doctors were surprised to learn they were on shaky legal ground.

They now are changing tactics by redefining growth hormone deficiency and making questionable diagnoses of their patients, Olshansky said.

"They've been administering growth hormone as an anti-aging intervention for a long time. They haven't been hiding it at all," Olshansky said. "Now they're trying to redefine it as a treatment for growth hormone deficiency."

Most prescriptions for HGH should go to children, according to Dr. Thomas Perls of Boston Medical Center, but 74 percent in 2004 went to people age 20 and older.

"In my opinion, that suggests a large amount of illegal distribution," said Perls, a co-author with Olshansky of the JAMA paper and director of a project that studies people who live to age 100.

Sales of HGH in 2004 totaled $622 million for legitimate and non-legitimate uses.

Weisman, the Las Vegas car dealer, said he pays $1,000 a month for supplements and hormones, and a twice-yearly blood test costs him $650 each time. Plus, he paid $2,000 for an initial evaluation with Cenegenics Medical Institute in Las Vegas, the clinic that designed his program and was featured recently in GQ magazine.

"Some people might think it's expensive, but how do you put a value on health?" Weisman asked.

Whether HGH enhances health in already healthy adults remains uncertain, but small, short-term studies have shown benefits and risks.

In 2003, a placebo-controlled, randomized study of people 65 and older found that growth hormone increased lean body mass and decreased fat mass, but the study subjects experienced frequent side effects including diabetes and glucose intolerance.

Other studies have linked HGH to raised cholesterol levels, heightened blood pressure, joint problems, swelling and carpal tunnel syndrome.

Weisman said he has never experienced side effects, although his doctor informed him about them. Doctors interviewed for this article who prescribe HGH said side effects can be avoided by initial low doses or by giving smaller doses if side effects occur. These doctors insist they prescribe HGH only to patients whose blood tests show a deficiency.

Dr. Evan Hadley of the National Institute on Aging said legitimate research on growth hormone has been blown out of proportion by wishful thinkers and marketers.

"Science doesn't have immediate answers for people who want to know what the fountain of youth is today," Hadley said.

But age-management doctors said their work focuses on disease prevention, and so is an affront to the disease-oriented medical establishment.

"Many of my colleagues have criticized the work I do," said Dr. Geoffrey Jones, who puts about 15 percent of his patients on growth hormone. "I don't blame them. I was in the same shoes they're in. When I heard about it, I was critical of it. It's the old saying: If you're not up on it, you're down on it."

Holy smoke! Chinese city turns cigarettes to medicine

A city in China, a country that's home to the world's most enthusiastic smokers, is crushing fake cigarettes to make medicine, Xinhua news agency said on Sunday.

The northwestern city of Xian is using the counterfeit cigarettes to extract solanesol, a compound found in tobacco which is used to treat cardiovascular disease, it said.

"We used to incinerate the fake cigarettes, which is wasteful and causes air pollution," Xinhua quoted Zhou Yaqing, vice director of the provincial tobacco monopoly, as saying.

A kilo of solanesol is worth about $200, and 30 tons of tobacco leaf can produce up to 120 kilos, Xinhua added.

China is the world's largest cigarette producer, with a growing market of about 320 million. Chinese cigarettes are also among the cheapest in the world -- a packet can cost as little as 8 U.S. cents -- and smoking kills 1.2 million people a year in China, according to the World Health Organization.

Fake cigarettes, made of poor quality tobacco and often topped up with wood chips, are commonly sold on Chinese streets.

Food Fact:
Tofu to go.

Smoked pressed tofu products make it easier than ever to add near-perfect protein to your day. This convenience food is ready to be sliced and eaten as is in salads or sandwiches, or cooked in stir-fries and braises. Not all tofu tastes the same, so try different brands to find one you like. It also comes in several flavors: Look for plain smoked, Thai seasoning, barbecue or lemon-garlic flavors at your supermarket or whole-foods store. Fat content varies, so if you're counting calories, try a low-fat brand.

Fitness Tip of the day:
Do a half hour of "power chores."

A "houseworkout" can clean up your act in more ways than one. With a little advance planning, household tasks provide a surprisingly effective aerobic workout. Tackle that closet you've been meaning to clean out, or take the offensive against a scummy sink. Vaccuuming, scrubbing and picking up items off the floor all can be healthful exercise, as long as you keep consistently on the move.

FAQ of the day:
How do I know if I need extra iron?

Only a blood test checked by a health care professional will tell you if you need extra iron. If you're feeling tired, weak or have poor stamina, he or she can take a blood sample to check your hemoglobin level, or your hematocrit (your percentage of red blood cells). If levels are low, you probably need more iron, and will need to take an iron supplement for a time, as well as eat more iron-rich foods.