Making Healthy Choices

We are enveloped in a wave of wellness. It’s hard to not feel the swell. Everywhere you look someone is promoting exercise videos, healthy food, weight loss routines, or the newest fad diets. Many of us have goals of living long and healthy lives. We want to be able to enjoy our children and grandchildren when we get older, not be a burden to our families, and remain independent and non-disease ridden. American consumers spend more than $50 billion on weight loss attempts including 200,000 bariatric surgeries. Obesity has become the most common preventable cause of death and accounts for almost 10 percent of total annual medical expenditures in the USA.

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So how can we best eat in a healthy manner? The logical answer is that we turn to science. What is the best way to exercise? What are the best foods to eat, and what should my diet consist of? Unfortunately, science doesn’t have all of the answers. Worse than that- Science has some blatantly wrong answers! So how can we know what the RIGHT answers are? How do we make healthy choices when we don’t know which scientific theories will turn out to be “true”?

For the most part, time may eventually tell. We continuously need to critically evaluate claims and ads. We must carefully scrutinize data that directs us to intermittently fast, eat paleo diets, become fruitarians, or avoid all fats at all costs. We, the media, and even the government become swayed and manipulated toward buying into what appear to be very reasonable theories, and we accept them as facts and truisms. In a limited sense, they are true. But only within a narrow spectrum of limited knowledge. Whether they are true in a universal sense may never be known, but may become more convincing with time.

A famous example of poor science gone wild.

For years we were told by the government that dietary fat and cholesterol were dangerous. Why? 1) Feeding rabbits extremely high levels of dietary cholesterol raised plasma levels and increased atherosclerotic plaques. However, rabbits are herbivores and their bodies haven’t adapted to dietary cholesterol – so there is little correlation with humans. 2) Studies in humans showed that increasing fat and cholesterol consumption raised total cholesterol levels. However, cholesterol levels were assumed, incorrectly to be a marker for cardiovascular risk. 3) Epidemiological studies from the 1950’s, primarily instigated by Ancel Keys, suggested that increasing dietary fat and cholesterol intake would increase cardiovascular disease.

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Society was searching for a scapegoat as President Dwight Eisenhower had just suffered a heart attack in 1955 and heart attack rates were climbing. The evidence – Dr. Keys believed that countries that consumed greater amounts of fats and cholesterol had higher rates of heart disease. Unfortunately, in this study there was no control group, no randomization, no control for multiple other variables like level of physical activity or anything else they ate, it was purely observational, and he eliminated data that did not fit his theory, and could not show a causal relationship. But that did not stop the AHA in 1968 and the American Government in 1977 from recommending that everyone limit their dietary intake of cholesterol and fat.

A multi-million dollar low-fat, low-cholesterol food industry was born. As government guidelines recommended low-fat food, the food industry needed a way to improve the now bland taste of many foods. They did this by adding refined sugars. Lots and lots of sugars and processed foods. So are we better off now? No! It turns out that sugar was the culprit all along. Consumed sugars convert to fat in our bodies. The government’s promotion of low-fat foods had the unintended consequences of increasing the consumption of simple carbohydrates, which are now to blame, along with the government, for the dramatic rise in diabetes, obesity, and heart disease in our society.

It’s interesting to note that 50 years ago a British physiologist, John Yudkin, correctly asserted that sugars were the main cause of cardiovascular disease, but his suppositions were ignored. It turns out that eating fat can help you burn fat! Meanwhile, obesity in the USA has increased from 12 percent in 1950 to 15 percent in 1980 to 35 percent in 2000 and remains at about 38 percent today.¹

Has anything changed today?

The government is now recommending that we eat what they believe to be “healthier foods.” There is an inaccurate belief that most people eat in unhealthy ways because of a lack of knowledge. With that in mind, new government regulations seek to improve our education and to direct our consumption to what they believe is the “new and best” type of diet.

For example, restaurants and fast food establishments are now required to list ingredients and calorie information and in some states, they are required to provide “healthy” alternatives. Research has shown that those who rely on menu labels tend to purchase fewer calories. The challenge is defining what is “healthy”. Unfortunately, “healthy” is typically defined by governmental dietary guidelines that have been unreliable in the past.

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A recent study by J. Gruner and P. Ohri-Vachaspati at Arizona State University, published in the Journal of the Academy of Nutrition and Dietetics² investigated the effect of menu labels on food and beverage selection in restaurants. For the study, participants submitted restaurant receipts and completed oral surveys.

The results? - Showed that Ccustomers who used labels were more likely to choose “healthier” sides and beverages. “Healthier” sides = 7.5% (users) vs 2.5% (non-users). “Healthier” beverages = 34% (users) vs 11.6% (nonusers). However, the use of labels did not influence purchasing of the main course (entrée), nor did it decrease the number of calories consumed! Further, even for the label users, only 7.5% chose the “healthy side alternative (vs 2.5% of non-users and about one-third chose the “healthy beverage” alternative (vs 11.6% of non-users). Showing that even when you provide the information and force the disclosure of caloric data and ingredients to people who value and read the information, you may not change behavior. Therefore, it isn’t always a matter of education. Sometimes it’s just a matter of having the freedom to choose.

An analysis of the pitfalls of trying to influence healthy eating was published in Cust. Need. and Solut. In 2014.³ There is an implicit assumption that consumer purchasing is based on intention. However, purchasing is often based on mindless habit, lack of knowledge of alternatives, or biases toward immediate gratification. Of course, purchasing behavior may also be influenced by cost, and typically “unhealthy” foods are less expensive than more “healthy” alternatives. Although even when costs are similar, unhealthy options are often chosen. Why does this happen?

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People often eat mindlessly and in general, mindless habits involve less healthy alternatives. For example, the amount of food that people eat often depends on the size of the dishes or containers, and on the size of the utensils. People served themselves 31% more ice cream when given larger bowls and 57% more when supplied with larger bowls and larger serving spoons.⁴ Should the government regulate the size of dishes and glasses used in restaurants? People also tend to get full faster when there is less variety.^5,6 For example, fewer M&M’s are eaten if there are less colors available. So perhaps the government should put forth legislation to increase blandness in restaurants. They might also regulate the order in which the food is presented at a buffet or listed on the menu. More healthy foods are consumed if they are found earlier in the buffet line or listed prominently and on the first page of a menu. Lighting and music have been shown to influence food choices. Wwhen the government reads this research, might we expect this to be regulated as well?

Further, people tend to be less concerned about future outcomes and more present-biased. We all inherently know this to be true. Delayed gratification is certainly not one of our societal traits. The immediate satisfaction of eating chocolate cake now - versus the potential weight gains and blood sugar issues in the future. They also believe that these choices are being made in the moment and detrimental effects are unlikely to occur unless these choices are repeated over and over again.

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There is often an assumption that if people increase their purchases of healthy foods they will necessarily decrease consumption of unhealthy foods. However, this has not been shown and in fact, may not be true. Simply increasing your consumption of healthy foods will not be of any benefit if there is not a corresponding decrease in the consumption of unhealthy foods. There is frequently an assumption that healthy foods are less filling and have fewer calories. Nudging people away from potato chips increased their consumption of other starches and nudging away from candy increased desert consumption⁷ leaving people with no net benefit. People ordering healthy alternatives in a restaurant may order more food overall or snack more at home later thus increasing their total caloric intake. As we saw with the government enforced low-fat diets, new governmental regulations which strive to create a healthier eating environment may (again) increase the incidence of obesity as another unintended consequence and potentially wprsen diabetes, cardiovascular diseases and other chronic illnesses.

I may not have been legally allowed to buy a 16 oz soda in New York (The Sugary Drinks Portion Cap Rule) from 2013 - 2014, but I could buy as many 8 oz drinks as I wanted or get free refills. As long as there is freedom of choice, people will find a work around. We have to ask ourselves, “how much do we want to prevent the work around and remove our ability to choose for what MAY be a healthier alternative.” We need to keep in mind that as in the case of fat-free food, governmental good intentions may be the cause of many chronic illnesses, worsening health, and a nation with an obesity epidemic.

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Big brother is concerned about us, but big brother doesn’t necessarily know what the right answer is and needs to be cautious about what it is regulating. Big brother is also influenced by political dealings, lobby groups, special interests, untoward motivations, and undisclosed financial incentives.

We all have a personal responsibility to decide whether or not making "healthy" choices is important. If so, become educated, make a plan, and take action to adjust your purchasing habits and eating habits accordingly. We are blessed to live in a country that allows us the freedom to decide.

Just some thoughts from the side-line.

Be Well.

Neil

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