Last week Jamie wrote a great piece about the relative cost of healthy vs. unhealthy food. It’s sad indeed that healthy food costs more – potentially thousands of dollars per year more – than less healthy processed food. Misguided government subsidies are certainly at the root of the issue in the United States. Designed to spur economic growth and provide cheap calories for the masses, current subsidies do perhaps more harm than good. Particularly when it comes to the absolute cost and relative value of food.
To put things in perspective, here’s an interesting question for you: how much money do Americans spend on food – a lot or a little? Responses will vary from person to person, but on average Americans spend just 10% of disposable income on food (USDA). Ten percent! That’s less than any other country in the world.
Which brings me to the next question: how much do Americans value food? Again, responses will vary, but the general consensus seems to be “not much”. Consider, for instance, that when finances get tight many folks resort to eating Top Ramen® or frozen pizza to make ends meet. We are too quick to sacrifice healthy foods. Some expenses, like rent and basic utilities, we can’t or shouldn’t cut, but what about “luxury” items like fancy clothes, cable television, smartphones, or cars? To be sure some people need a smartphone or car to survive in today’s society, but others not so much.
Do you think that the relatively small amount that Americans spend on food affects how much we value it?
Food for thought
Activist and author Michael Pollan once wrote that the only quality that Americans look for in food is quantity. Meaning that we place more emphasis on how much a food costs than on how it affects our health, our society, or the environment. Do you agree or disagree? Do you think food, particularly healthy food, is expensive? If a person opts to buy “cheap” processed food today, what do you think the long term health (and financial) consequences are? Do you think that government subsidies should be restructured to better address American health issues? Lastly, how much do you spend on and value food?
U.S. Department of Agriculture (USDA), Economic Research Service (ERS). Food CPI, Prices and Expenditures: Food Expenditures by Families and Individuals as a Share of Disposable Personal Income. Accessed January 26, 2014: http://www.ers.usda.gov/data-products/food-expenditures.aspx#.UuUrKbTTnIU
You may have heard or might predict that it costs more to consume healthier foods each and every day. Twinkies and a soda from the corner convenience store are cheap and loaded with calories (and not much else!). How much more would it cost to purchase nuts, fruits and vegetables from the grocery store with equal energy content as in the convenience foods? Good question. This is exactly what researchers from the Harvard School of Public Health wanted to know when they performed a recent meta-analysis of 27 existing scientific studies from 10 high-income countries that analyzed the cost of healthier versus less healthy dietary patterns. A meta-analysis is a quantitative statistical analysis of several separate but similar experiments or studies. This research was recently published in the British Medical Journal (BMJ Food Cost Article).
The studies analyzed in this meta-analysis included price data for individual foods and for healthier versus less healthy diets. The investigators at Harvard evaluated the price differences per serving and per 200 calories for particular foods, and prices per day and per 2000 calories (the USDA recommended average daily calorie intake for adults). Diets high in fruits, vegetables, fish and nuts were considered to be healthier, while those high in processed foods, meats and refined grains were considered less healthy.
The results of the study confirmed what you may have predicted: healthier dietary patterns cost more, about $1.50 per day per person. This might not sound like much, but multiply that amount by 365 days in a year and times 4 for an average sized family, and you come to a yearly price increase of $2200! That is a number that may be out of reach of many, particularly given the difficult times. One might also predict that healthier diets require more effort to obtain and prepare for consumption. After all, processed foods and many refined grain products are ready to eat right out of the packaging, and fruits and vegetable are less available at convenience stores and fast food restaurants.
This issue raises a number of pertinent questions. Why are healthier foods more expensive and less healthy foods cheaper? The Harvard researchers suggested that the price differential results from US government food policies which have focused on the production of “inexpensive, high volume” commodities, leading to an emphasis by food manufacturers on highly processed foods that maximize profits. What changes could be made to existing food policies to make healthier, less processed foods more readily available and cheaper? Does this situation exacerbate health disparities among Americans, whereby individuals of lower socioeconomic status are relegated to consuming less healthy foods on a daily basis that increase risk of chronic disease (e.g. diabetes, heart disease, metabolic syndrome)? It certainly costs substantially more to treat chronic disease after it has developed, than to focus on healthy dietary patterns throughout life. What would you do to change this situation and provide all Americans equal access to healthy foods?
It’s time now to discuss yo-yo dieting or “weight cycling”. Many folks are unfortunately familiar with this phenomenon, which can lead not only to lasting physiological damage, but psychological damage as well. Yo-yo dieting refers to the “annoying” habit of losing five pounds, only to later gain back seven. A person in this situation will often then refocus their energies to lose another ten pounds, only to gain back twelve. You get the idea. Fluctuating body weight in this manner is associated with high blood pressure and triglyceride levels. It’s also understandably difficult from a mental and emotional perspective.
Resting metabolic rate
Resting metabolic rate (RMR) is the amount of energy your body expends to maintain physiological equilibrium at rest. In other words, RMR accounts for the number of calories (kcal) needed to maintain your heartbeat, brain activity, organ function, etc. while you sit in bed and stare at the ceiling all day. There are many elaborate formulas to estimate a person’s RMR, but for the sake of this article let’s approximate it at 10 kcal/pound/day. Eddie, for example, weighs 200 pounds and has an RMR of 2000kcal/day.
Here is how RMR relates to yo-yo dieting: the primary determinant of RMR is muscle mass. As a person loses weight they will likely lose both fat and muscle mass. Thus, as Eddie drops from 200lbs to 185lbs his muscle mass decreases, as does his RMR (from 2000kcal/day to 1850kcal/day). The good news is that Eddie managed to achieve his weight loss goal. The bad news is that he can never “go home again”, meaning that unless he increases his physical activity energy expenditure he can never eat what he used to eat at 200lbs and maintain his new, current weight. His body simply doesn’t need as many calories to maintain itself.
Although this makes perfect sense, many folks fall prey to yo-yo dieting. Eddie, for example, decides to enroll in a new fad diet. He loses a significant amount of weight in a short period of time, but then cracks, binges, and gains it all back. Or perhaps he decides to lose weight for a special occasion, succeeds, and then returns to his previous diet and lifestyle. In both scenarios Eddie’s weight loss results from a decrease in both fat and muscle mass; subsequent weight gain is associated primarily with an increase in fat mass. When Eddie returns to his original weight of 200lbs, his RMR is less than what it used to be (perhaps 1950kcal/day) because he does not have as much muscle mass. Unless Eddie increases his physical activity, it shouldn’t come as a surprise that over the next few months he will put on several additional pounds.
The take home message is two-fold. First, be realistic about weight loss goals – both the total amount you intend to lose as well as the rate. Two pounds per week may be the maximum sustainable rate of weight loss, but one pound per week (or less) is more manageable. Second, no diet will be successful long term unless it is also accompanied by a change in lifestyle; physical activity is key to maintaining muscle mass and/or increasing energy expenditure. However, lifestyle changes can be difficult to make. Next week we’ll explore some practical behavior modifications related to weigh loss and management.
Weight loss or management is fraught with pitfalls. In order to avoid them down the road, it’s important to address them now.
The first stumbling block involves expectations. Unrealistic expectations, to be exact. Given the number and prevalence of weight loss advertisements these days, it’s no wonder that folks are out of touch with reality when it comes to weight loss. Claims of losing 10, 20, or even 30 pounds in a matter of weeks are not uncommon (often backed by heavily manipulated before-and-after photographic “proof”).
Two pounds per week
That’s the maximum sustainable rate of weight loss per week. And even that may be too much for some folks. In most cases one pound per week – or even a half pound per week – is far more realistic. Let’s explain it by the numbers.
One pound of excess body fat is equivalent to approximately 3500 kilocalories (kcal). Two pounds equals 7000kcal. In order to lose two pounds per week a person would need to create a 1000kcal deficit per day. On the intake side of the energy balance equation (see previous post), 1000kcal may be a third to a half of a person’s total caloric intake for a day. On the energy expenditure side of things, 1000kcal is equivalent to walking or running up to ten miles per day (depending on a person’s current weight)! Imagine how difficult these changes would be to make and sustain. Some folks might be able to handle it for a week or a month, but long term that sort of change is simply too much to ask.
That’s why it’s important to nip unrealistic expectations before they start. Think smaller, be reasonable. For instance, consider what it would take to lose a half pound per week: drink one less soda or latte per day (150kcal) and walk one more mile (100kcal). Sustainable weight loss will likely occur much slower than weight gain. Meaning that if it took a month to gain two pounds, it’s not unrealistic to expect it to take a month to lose two pounds. Regardless of what the television and internet advertisements claim.
Food for thought
What are some modifications that you could make to your current diet or lifestyle that would help with weight loss or management? Could you drink coffee or tea without cream or sugar? Could you switch an energy-dense snack (e.g., candy bar or bag of chips) with a less caloric alternative (e.g., whole grain crackers or a bag of carrot sticks)? Could you incorporate more physical activity into your lifestyle by riding or walking to work instead of driving?
Diets are popular among Americans, although most fail at sustaining long term weight loss. They are however big business and some folks are becoming quite wealthy off of them. Of the most popular diets, Google recently reported that the most searched-for eating plan of 2013 was the Paleo Diet (Daily Mail Google Diet Searches 2013). This ranked ahead of the ‘Juice Cleanse Diet’, the ‘Mediterranean Diet’ and the ‘Master Cleanse Diet’. In contrast to its popularity among average Americans, however, U.S. News and World Report recently ranked the Paleo Diet tied for last on its “Best Diets Overall” list for 2014 (CNN Best Diet Rankings). This report was developed through consultation with a panel of health experts from top academic institutions around the country, including nutritionists and specialists in diabetes, heart health, human behavior and weight loss. This panel of experts rated each of 32 diets diet in seven categories, including short- and long-term weight loss, ease of compliance, and safety and nutrition. How could such a popular diet be ranked so low by scientific experts? There seems to be a clear disconnect between the American public’s view on dietary eating patterns and what is recommended by health experts.
Let’s take a closer look at the Paleolithic dietary pattern and explore why it is not recommended by nutrition experts. The premise of this plan is to “consume everyday modern foods that mimic food groups of our pre-agriculture, hunter-gatherer ancestors” (Paleo Diet). This includes lots of meat protein, low carbohydrate, high fiber from fruits and non-starchy vegetables, and moderate to higher fat intake, with a focus on mono- and polyunsaturated fats. This dietary pattern restricts cereal grains, legumes and dairy foods. The purported benefits include decreasing risk of obesity, cardiovascular disease, type 2 diabetes, cancer, autoimmune disease and osteoporosis, among other stated benefits. The Paleo Diet web site states that these diseases were typically very uncommon among our early ancestors, and suggests that mimicking their diets should provide the same benefits to modern humans.
If this is all true, then why don’t the experts agree? First, it’s important to consider that prehistoric humans had shortened life spans (probably less than 35 years). In fact, as recently as the mid-20th century, the average human life span was less than 50 years. Another factor to consider is whether we really know how these early humans died and what diseases they suffered from, or exactly what they ate. Other aspects of the Paleo Diet were however considered negatives by the expert panel that ranked the diets. Their criticisms of this dietary pattern included a lack of scientific evidence that the Paleo Diet promoted weight loss or prevented cardiovascular disease, and its restrictiveness. In fact, most nutrition experts recommend consuming more grains (particularly whole grains), legumes (as an alternative protein source to meat) and low-fat dairy products (which on a population-wide basis are amongst the best sources of calcium and vitamin D). So who will you believe, scientific experts or those selling a product on a popular web site?