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Your Meal Has 6 Times More Salt Than You Think

Originally posted on:

Written by Mandy Oaklander on April 24, 2017


How much salt was in your lunch? Whatever your guess, chances are you’re off. By a lot.

In a new study, published in the journal Appetite, researchers stood outside fast-food restaurants and asked people to guess how much sodium they just ate. Their answers were almost always six times too low.

 That’s because people don’t tend to use a lot of salt to season meals cooked at home, but restaurants use much more of it to enhance the flavor of their meals. It’s also used in food additives and as a preservative to extend shelf life, so even foods that don’t taste salty, like pastries, donuts and bread, can have a lot of it.

As a result, 89% of Americans eat too much salt. People should get no more than 2,300 milligrams of sodium a day—about one teaspoon, public health groups recommend—but the average American eats about 3,600 mg every day. Eating too much salt makes the body retain more water, which raises blood pressure and can affect the heart, blood vessels, brain and kidneys. Overconsuming sodium can lead to hypertension, heart attack and stroke, according to the Harvard T.H. Chan School of Public Health.

To test the sodium knowledge of real-world eaters, researchers stationed themselves at several fast-food restaurants—McDonald’s, Burger King, Subway, Wendy’s, Kentucky Fried Chicken and Dunkin’ Donuts—and polled adolescents and adults on their sodium consumption. When people approached the entrance, the researchers asked them to save their receipts; on their way out, they estimated how much sodium they ate.

Adults ate about 1,300 mg of sodium in a single fast-food sitting, which is more than half of the upper recommended limit for the day. Yet the average guess was just 200 mg, says study author Alyssa Moran, a registered dietitian and doctoral student at the Harvard School of Public Health. They were off by about 650%.

That’s when they ventured a guess at all. “25% of the people we approached had absolutely no idea about the amount of sodium in their meal and couldn’t even provide an estimate,” Moran says.

Sodium information isn’t visibly published in chain restaurants. But in 2015, New York became the first city in the country to require chains to post warning labels on menu items with more than 2,300 mg of sodium. “Right now it’s only in New York City, but we have a feeling that other local governments will probably follow suit,” Moran says. “We saw that that happened when New York City started posting calories on menu boards.”

Doing so may finally help people learn how much sodium is in their food, and it may even encourage companies to reformulate the worst offenders.

30-Minute Workouts for Any Schedule

By Heather Mangieri, MS, RDN, CSSD, LDN

Published July 26, 2016

Originally posted on:

Who isn’t in a time crunch these days? Even with the best intentions, it’s easy to fall off the workout wagon after a hiccup in a weekly routine. Yet, the beneficial effects of exercise are undeniable and far outweigh any risk in most adults. Current recommendations suggest that in a week, adults get at least 150 minutes of moderate-intensity aerobic exercise such as such as brisk walking or cycling, and two to three days of muscle-strengthening activities.

It’s best to spread your activity out during the week, as well as breaking it up into smaller chunks of time throughout the day. In fact, “research continues to emerge supporting the notion that small bouts of exercise accumulated throughout the day may provide many of the same benefits as one continuous bout of activity,” says Jessica Matthews, MS, an exercise physiologist at the American Council on Exercise. So, if you can’t seem to find 30 consecutive minutes in a day for your workout, you can still fit it in by splitting up the time.

So how do we put those recommendations into practice? “Making time for physical activity starts with changing our mindset and treating workouts just as you would any other important appointment or commitment,” says Matthews. “To help make fitness a priority, block off time in your day planner and treat it just as you would any other obligation.”

10-Minute Mini-Workouts

Matthews suggests taking 10 minutes in the morning, afternoon and evening to do some form of activity. This can include 10 minutes of bodyweight exercises (push-ups, crunches, lunges, squats, etc.) in the morning, a 10-minute brisk walk during your lunch break at work and 10 minutes of yoga-inspired stretching in the evening.

Involve the Family in Daily Fitness

Thirty minutes will fly by if you get the kids engaged in something that they, too, can enjoy. Grab the family and head out for a walk, game of tag or bike ride.

Clean with Purpose

Don’t just sweep the floor, scrub the floor. Don’t just unload the dishwasher, dance with the dishes. Minutes add up fast when you move more during your clean-up time.

Look for Opportunities to Walk

Suggest work meetings on the go. “Walk and talk in lieu of sitting in an office,” suggests Felicia Stoler, DCN, MS, RD, exercise physiologist. “I do that with clients when the weather is nice versus sitting in my office,” she says. If your job has you hanging out in airports on a regular basis, make that work for you, too. “When traveling, I like to walk and check out the stores in the airport — not to buy, but to keep moving before hours of sitting,” Stoler says.

Stoler also points out how quickly 30 minutes of activity accumulates when you seek out opportunities, such as taking the stairs, parking far away and doing yard work.

If you can’t seem to find the self-motivation needed to make it happen, consider recruiting a workout partner or hiring a fitness professional. Knowing that someone is expecting you at a certain place or time can help to enhance accountability for being more active, says Matthews.


Many of the most health-promoting and disease-reversing diets ever studied emphasize high bean and legume consumption:

Beans contain a multitude of nutrients that are known to be health-promoting:

Bean consumption appears to play a role in the following:

In fact, beans are so health promoting that their consumption is now believed to be the single most important predictor of longevity among older populations around the world.

Black beans appear to be slightly more antioxidant-rich than pinto beans. Lentils (red lentils more than than green ones) come in second after black beans for antioxidant content. Tempeh is a whole soybean food and as such is one of the healthiest forms of soy.

There appears to be little difference in nutrient profiles among cooked, sprouted and canned beans, but some canned beans may contain up to one hundred times more salt than beans prepared at home. One should also be aware that the plastic linings in bean cans produced by certain companies contain BPA.

Unfortunately, 98% of Americans are not utilizing the full potential of these versatile, cost-effective,environmentally friendly foods. Public health and economic policies could do more to promote the consumption of healthy foods. It’s never too late to accrue health benefits from switching to a healthier diet and lifestyle.

Originally posted on:

New Pediatric Obesity Guidelines: What You Should Know

Written By: Jackie Ballou Erdos, MS, RD, CSSD, Registered Dietitian & Owner, Balancing Act Nutrition, New York, NY
Reviewed by William A. Neal, MD, professor emeritus, pediatrics (cardiology), West Virginia University, Morgantown, WV

It’s been close to a decade since The Endocrine Society’s guidelines on pediatric obesity1 have been updated. For many clinicians, the latest revisions—from the European Society of Endocrinology and the Pediatric Endocrine Society, and funded by the Endocrine Society—are long overdue.
“Childhood obesity is not something that can be prevented in the doctor’s office, it’s prevented in the community in which the child lives,” says Dennis M. Styne, MD, Yocha Dehe Chair of Pediatric Endocrinology and a professor of pediatrics at the University of California, Davis. As chair of the task force that established the new guidelines, Dr. Styne has emphasized the need to form alliances among government officials, the education sector, urban development groups, and healthcare professionals.
What are the new recommendations?

In addition to strategic partnerships, the new guidelines encourage breastfeeding, given its many well-established benefits, yet with the caveat that the relationship between breastfeeding and obesity prevention is less clear than was once thought. As Dr. Styne explains, “We absolutely recommend breastfeeding. But unfortunately, several studies have suggested that maybe it isn’t the one unequivocal way to prevent obesity.”
Not surprisingly, Dr. Styne and his guidelines co-authors also continue to recommend decreasing or eliminating intake of sugar-sweetened beverages, and limiting juice intake to 4 to 6 ounces a day for children 6 months to 6 years old, and 8 to 12 ounces daily for kids 6 years and older. Whole fruit is preferred over juice, and 5 to 7 servings of fruits and vegetables per day are encouraged.2

Further, the guidelines recommend increasing the number of opportunities for children to be active. The authors acknowledge that technology, and with it, screen time, has increasingly become a part of everyday life. They endorse the practice of offsetting time spent being sedentary with physical activity, and prescribe a more moderate recommendation, given that the condition of obesity itself makes it more difficult to be active.2 While 60 minutes of vigorous physical activity 5 days per week is ideal, an initial goal of 20 minutes 3 to 5 days per week may be more realistic as a starting point, and has been shown to yield metabolic benefits.2
Rest is critical, too. Obtaining adequate sleep (8 to 11 hours a day) of good quality is a new prevention strategy recommended in the 2017 guidelines. As Dr. Styne explains, “If you don’t sleep enough, you’re more insulin-resistant and it affects your carbohydrate metabolism in an adverse manner.”2
Reducing stress and addressing dysfunctional family dynamics are also emphasized in the guidelines as important obesity-prevention tactics.2 Add to that school- and community-based interventions that employ specific behavior change strategies as part of childhood obesity-prevention measures.
Guidelines for screening young patientsThe guidelines recommend using body mass index (BMI) to diagnose childhood obesity. Although imperfect and limited in the information it provides, BMI is easily calculated and is still a useful tool, Dr. Styne believes.

Styne says diagnosing pediatric obesity and assessing the child for comorbidities early on are paramount. The 2017 guidelines recommend evaluating children and adolescents as young as 2 years old with a BMI greater than or equal to the 85th percentile (defined as overweight) for obesity-related comorbidities.2
The updated guidelines also include new benchmarks for alanine aminotransferase (ALT) levels, which are used to monitor the risk of non-alcoholic fatty liver disease (NAFLD). “We’re worried about a boy having a value over 25 and a girl having a value over 22,” Dr. Styne says.
What about evaluating young patients for diabetes?

“The hemoglobin A1c in a teenager isn’t necessarily as accurate as in the adult in diagnosing diabetes,” Dr. Styne says. The authors of the 2017 guidelines acknowledge that an international expert committee recommended in 2009 that the same diagnostic criteria for diabetes using HbA1c levels be applied to adolescents, but caution clinicians that this recommendation is based on adult studies only. Other pediatric studies, the authors go on to say, have shown that HbA1c isn’t a good indicator of prediabetes or diabetes (underestimating the incidence of both), and note that in high-risk youths, there’s good support for using other tests in combination with HbA1c when making a diagnosis (such as a fasting, random, or oral glucose tolerance test).2 The guidelines also steer clinicians away from testing insulin levels, given that there are no clear diagnostic criteria for insulin resistance, and that temporary insulin resistance commonly accompanies the conclusion of puberty.

In addition to diabetes and NAFLD, the authors encourage screening patients with a BMI greater than or equal to the 85th percentile for dyslipidemia, hypertension, polycystic ovary syndrome, obstructive sleep apnea, and psychosocial problems.2
Assessment of endocrine and genetic disorders is also covered in the guidelines. “An endocrine evaluation isn’t so important unless you have clear evidence of an endocrine problem, or the child’s growth is attenuated,” Dr. Styne says. “However, there are genetic causes of obesity which can be diagnosed. At present it’s about 7% of the most extreme obesity [cases].” Specifically, the guidelines recommend a genetic evaluation for patients younger than 5 years of age with extreme obesity (BMI >120% of the 95th percentile) accompanied by genetic obesity syndrome characteristics (such as food-seeking behaviors or hyperphagia), with or without a history of family members with extreme obesity.2

Treatment options can vary widely
“Lifestyle [modification] is most important for prevention, and it’s the most important method of treating obesity,” Dr. Styne stresses. Dietary changes endorsed by the guidelines are in agreement with recommendations set forth by the American Academy of Pediatrics and the U.S. Department of Agriculture, such as reducing intake of fast food, salty or fatty processed foods, added sugars, and high-fructose corn syrup, while increasing intake of fruits and vegetables. The guidelines also encourage educating families about portion control and strategies to address common eating cues, such as boredom and stress.2
Dr. Styne’s team recommends resources published by dietitian and family therapist, Ellyn Satter, to help clinicians and families navigate struggles at the dinner table. “Dietitians are an incredibly important resource,” Dr. Styne says.

Treatment guidelines for physical activity mirror prevention recommendations,2 and Dr. Styne says working with communities and schools to increase safe opportunities for children to be active is key to helping families meet physical activity goals. Additionally, the authors recommend limiting nonschool-related screen time to 1 to 2 hours per day.2
Screening for psychosocial comorbidities and making appropriate referrals to mental health professionals—as well as working with the entire family to support effective parenting styles and communication methods—is at the foundation of treating this chronic condition, per the guidelines.2 Notably, children with obesity have reported quality of life scores similar to those of patients with diabetes and cancer, and are at higher risk for anxiety, depression, eating disorders, substance abuse, and low self-esteem, underscoring the need for a sensitive approach.2

When is surgery warranted?
The new guidelines also discuss pharmacotherapy and bariatric surgery as treatment options. “We caution against the use of medications approved for adults in children under 16, and we recommend that no one do it [prescribe anti-obesity agents] unless they have experience in the area, as children are not the same as adults,” Dr. Styne says.
Regarding weight loss surgery, the authors of the new guidelines state bariatric surgery may be indicated in patients who meet certain criteria, including: Tanner stage 4 or 5 in puberty; BMI >40 kg/m2, or BMI >35 kg/m2 with major comorbidities; patients whose weight and comorbidities have failed to improve with intensive lifestyle intervention; those who have undergone psychological assessment and have been deemed appropriate for surgery; and patients who are prepared to undertake necessary long-term lifestyle changes post-surgery.2 These recommendations align with best practices put forth by the American Society for Metabolic and Bariatric Surgery.3
Though clinicians play an important role in preventing, diagnosing, and treating pediatric obesity, Dr. Styne stresses that health professionals can’t succeed alone. “There’s a lot of work to be done,” he says. “Everyone has to play a role, including policy makers, politicians, and education professionals.”
Originally Published on 03/27/2017:


Can “Diet” Make You Fat? The Truth on Artificial Sweeteners

By: By

Added sugar is a disaster and many people are trying to avoid it.

But most of us are accustomed to sweet foods, and don’t want to live our lives without them.

For this reason, various artificial chemicals have been invented to replicate the effects of sugar.

These are substances that can stimulate the sweet taste receptors on the tongue.

They usually have no calories and don’t have the harmful metabolic effects of added sugar.

These chemicals are known as “artificial” sweeteners… as opposed to “natural” sweeteners like sugar or honey.

These chemicals are very sweet, and they are often added to foods and beverages that are then marketed as weight loss friendly… which makes sense given that they are virtually calorie free.

However, despite increased use of these low-calorie sweeteners (and diet foods in general), the obesity epidemic has only gotten worse.

The evidence regarding artificial sweeteners is actually fairly mixed and the use of these substances is highly controversial.

So… what is the truth about artificial sweeteners? How do they affect appetite, body weight and our risk for obesity-related disease?

Let’s have a look…

There Are Many Different Types of Artificial Sweeteners

There are numerous different artificial sweeteners available and the chemical structure varies between them.

What they all have in common, is that they are incredibly effective at stimulating the sweet taste receptors on the tongue.

In fact, most are hundreds of times sweeter than sugar, gram for gram.

Some of them (such as aspartame) do contain calories, but the total amount needed to provide a sweet flavour is so little that the calories you ingest are negligible (1).

Here is a table showing the most common artificial sweeteners, how sweet they are relative to sugar, and brand names they are sold under:

List of Artificial Sweeteners

Then there are other low-calorie sweeteners that are processed from natural ingredients and therefore don’t count as “artificial.”

This includes the natural zero-calorie sweetener stevia, as well as sugar alcohols like xylitol, erythritol, sorbitol and mannitol. Sugar alcohols tend to have similar sweetness as sugar but less than half as many calories.

This article is strictly about the artificial sweeteners… but you can read about the natural ones here.


Bottom Line: There are many different types of artificial sweeteners. The most common ones are aspartame, sucralose, saccharin, neotame and acesulfame potassium

Artificial Sweeteners and Appetite Regulation

Animals, including humans, don’t just seek food to satisfy energy needs.

We also seek so-called “reward” from food.

Sugar-sweetened foods trigger brain chemicals and hormones to be released, part of what is known as the “food reward” pathway (2, 3, 4, 5).

“Food reward” is crucial to feeling satisfied after eating and shares brain circuitry with addictive behaviors, including drugs (6, 7, 2).

While artificial sweeteners provide sweet taste, many researchers believe that the lack of calories prevents complete activation of the food reward pathway.

This may be the reason artificial sweeteners are linked with increased appetite and cravings for sugary food in some studies (8).

Magnetic imaging in 5 men showed that sugar consumption decreased signalling in the hypothalamus, the appetite regulator of the brain (9).

This response was not seen with consumption of aspartame, suggesting that the brain does not register artificial sweeteners as having a satiating effect.

It may be that sweetness without the calories leads to further food seeking behavior, adding to your overall caloric intake.

But… there have also been studies where artificial sweeteners did not affect appetite or caloric intake from other foods (10, 11).

In a 6 month study of 200 individuals, replacing sugary drinks with either artificially sweetened drinks or water had no effect on food intake (12).

Bottom Line: Some researchers believe that artificial sweeteners do not satisfy our biological sugar cravings in the same manner as sugar, and could therefore lead to increased food intake. However, the evidence is mixed.

Sweeteners and Sugar Cravings

Another argument opposing artificial sweeteners is that the unnatural sweetness encourages sugar cravings and sugar dependence.

This idea is logical considering that flavor preferences in humans can be trained with repeated exposure (13).

For example, we know that reducing salt or fat for several weeks leads to a preference for lower levels of those nutrients (14, 15). Sweetness is no different.

While this is not proven, it does seem to make sense. The more we eat of sweet foods, the more we want them.


Bottom Line: The strong sweetness of artificial sweeteners may be causing us to become dependent on sweet flavor. This could increase our desire for sweet foods in general.

Observational Studies on Artificial Sweeteners and Body Weight

Many observational studies have been conducted on artificial sweeteners.

These kinds of studies take a group of people and ask them about various factors, such as what they eat.

Then many years later, they can see whether a particular variable (such as artificial sweetener use) was associated with either an increased or decreased risk of disease.

These types of studies don’t prove anything, but they can help us find patterns that warrant further investigation.

Several of these studies have paradoxically found that artificially sweetened drinks are linked to weight gain rather than weight loss (16).

However, the most recent review, which summarized the findings of 9 observational studies, found that artificial sweeteners were associated with a slightly higher BMI, but not with body weight or fat mass (17).

I should point out that this study was industry sponsored. It doesn’t mean that the results are invalid, just that we should be extra skeptical because the funding source of a study can often skew the results and the interpretation of the data (18).

That being said… correlation does not imply causation, so these studies don’t prove anything one way or the other.

Fortunately, the effects of artificial sweeteners on body weight have also been studied in numerous controlled trials (real science).

Bottom Line: Some observational studies have found artificial sweeteners to be linked with increased weight, but the evidence is mixed.

Controlled Trials on Artificial Sweeteners

Many clinical trials have concluded that artificial sweeteners are favorable for weight control (19, 20, 21, 22).

One of the largest trials looked at 641 children aged 4-11 years who had to drink either 250 ml (8.5 ounces) of an artificially sweetened drink, or the same amount of a sugary drink every day for 18 months.

The children who were assigned the artificially sweetened drinks gained significantly less weight and less fat than the sugar-drinking children (19).

The most recent review of 15 clinical trials found that replacing sugary drinks with their artificially sweetened versions can result in modest weight loss of about 1.8 lbs (0.8 kg), on average (17).

Two other recent reviews led to similar findings (23, 24).

So… according to the best available evidence, artificial sweeteners appear to be mildly effective for weight loss.

They certainly don’t seem to cause weight gain, at least not on average.

Bottom Line: Numerous controlled trials have studied the effects of artificial sweeteners on body weight. On average, replacing sugar-sweetened beverages with diet beverages may cause weight loss of about 2 pounds.

Artificial Sweeteners and Metabolic Health

All of this being said, health is about way more than just weight.

There are some observational studies (again, studies that don’t prove anything) linking artificial sweetener consumption to metabolic disease.

This includes an increased risk of metabolic syndrome, type 2 diabetes and heart disease.

Sometimes the results are quite staggering… for example, one study found that diet soft drinks were linked to a 121% greater risk of type 2 diabetes (25).

Another study found that these beverages were linked to a 34% greater risk of metabolic syndrome (26).

This is supported by a recent high-profile study on artificial sweeteners, showing that they caused a disruption in the gut bacterial environment and induced glucose intolerance in both rats and humans (27).

It is known that the bacteria in the intestine (gut flora) are incredibly important for health (28, 29, 30).

Whether artificial sweeteners cause problems by disrupting the gut bacteria needs to be studied further, but it appears that there may be some cause for concern.

Take Home Message

Replacing sugar with artificial sweeteners may be helpful in reducing body weight, but only very slightly at best.

Their intake certainly does not seem to cause weight gain, at least not in the short-term.

At the end of the day, artificial sweeteners are not “toxic” like some people make them out to be, but I’m not convinced that they’re perfectly safe either.

The research goes both ways… and the decision about using them must come down to the individual.

If you’re healthy, happy and satisfied with the results you’re getting and you happen to use artificial sweeteners… then there’s no need to change anything. If it ain’t broken, don’t fix it.

However… if you suffer from cravings, poor blood sugar control or any mysterious health problem, avoiding artificial sweeteners may be one of many things to consider.

Different strokes for different folks



Originally Published:

Here’s What Happened When a Dietitian Tried 6 Meal Delivery Kits

Written By: Toby Amidor February 24th, 2017

I admit: I’m late to the meal delivery kit game. Even my own brother has tried the services, which promise to deliver ingredients and recipes for quick, tasty meals to your door. But while I’m happy to see that cooking meals at home is becoming mainstream, I didn’t know whether the kits lived up to the hype. So I contacted six meal delivery kit services and tried them out with feedback from the pickiest of judges: my three kids. Here’s a summary of our experiences:

1. Blue Apron
This meal kit delivery service promotes meat with no added hormones, sustainably-sourced seafood and farm-fresh, seasonal produce. The three meals I made included spiced chicken chili with chickpeas and currants, Cajun catfish and spiced rice with collard greens and mushrooms, and baked ricotta cannelloni with romaine salad and Meyer lemon dressing.
[See: 13 Best Fish: High in Omega 3s and Environmentally-Friendly.]
I loved rolling the cannelloni using the fresh pasta dough. My kids and I also devoured the chili, although they wanted more bread to dip into it. The portions were very large – the chili lasted an entire week! From a nutrition standpoint, one of my main concerns was that the meals each packed between 620 and 750 calories per serving, which is too much for me as a 5-foot-7-inch woman. So, I cut back on the portions.

2. Plated
Plated is tailored to omnivores, seafood lovers, vegetarians and even those with a sweet tooth. I tried tomato-poached fish with crispy potatoes, cheesy baked potatoes with mushroom Marsala sauce and arugula salad, leek and mushroom ramen with bok choy and soft-boiled egg, and chili-dusted frozen hot chocolate.
My kids loved the baked potatoes with cheese, but weren’t so keen on the Marsala sauce. That wasn’t a problem; I kept the extra sauce for myself, and used it on scrambled eggs the next morning. The tomato-poached fish was probably one of the best meals I tried from all of the meal delivery kits – and it was really easy to make. My meals were between 460 to 550 calories, which is appropriate for my older kid and me. (Plated does offer meals in the 800-calorie range, but I didn’t order them.)

3. HelloFresh
This service touts the fact that it works with a registered dietitian to create healthy meals. I tried “Do the Dukkah” chicken with sweet potatoes and snap peas, “the Great Caper” cod piccata with couscous and baby spinach, and Tunisian freekeh stew. Surprisingly, the vegetarian stew was the highest in calories, with 757 per serving. But, it was so “freeken” good and very satiating! To lower the calories, I made the portions smaller than what the recipe card called for. The cod piccata was also one of the tastiest dishes, and my 9-year-old daughter definitely agreed. After she had the cod for dinner, I found her sneaking bites of the fish from the refrigerator the next day. She also now requests to have fish for dinner at least twice a week. Score!
4. Sun Basket
Advertised as healthy cooking made easy, Sun Basket provides organic and non-GMO ingredients with options like gluten-free, paleo, and vegetarian. I tried the Sicilian chicken breasts with salmoriglio sauce, pan-seared salmon with orange-jicama salad and lemongrass steak stir-fry with bok choy and basil. All meals were simple and quick to make, and they ranged from 560 to 650 calories.
[See: 10 Healthy Meals You Can Make In 10 Minutes.]
The chicken breasts were tasty, and I had leftovers with the orange-jicama salad. My older two children (ages 11 and 14) loved the salmon, but weren’t too keen on the citrus salad on the side, which was a favorite of mine. The beef in the stir-fry was a bit chewy, which was probably the worst issue I had with all the meals in any kit.

5. Chef’d
Like the name implies, the meals from Chef’d are created by popular chefs and websites. I loved the fact that I could order American Diabetes Association- and Weight Watchers-based meals, which all had the most reasonable calories per serving of all the kits (between 250 and 350 per serving). I tried the American Diabetes Association’s chicken lovers balsamic chicken with cherry tomatoes and green beans, The New York Times’ roasted glazed salmon with sauteed kale and herbed orzo, and Hershey’s s’mores cookies (I just couldn’t resist!).
The balsamic chicken was extremely easy to make, and the veggies complimented the flavors and texture of the chicken nicely. The glazed salmon was another favorite in my house, thanks to the simple glaze. And no surprise, the dessert – which my kids helped bake – was quickly devoured.
6. Purple Carrot
These plant-based meals were the most creative of any of the meal delivery kits. I made kimchi quesadillas, pumpkin fettuccine alfredo and buffalo tempeh tacos. Everything was crazy good and reheated fabulously, but the calories really shocked me. The quesadillas, for example, which were made with kimchi and black beans, were 840 calories per serving. Fortunately, halving the portions was no problem since there was so much food in one serving. The fettuccine, on the other hand, was so good it was really hard to stop myself from eating the entire (650 calories-per-serving) potful! The tacos called for a simple buffalo sauce to marinate the tempeh, which was baked. Still, they would have packed 840 calories per serving had I not cut back on the fillings. (The extra baked tempeh worked well on salad for lunch the next day.)

[See: 11 Healthy Veggie Recipes That Prove Slow Cookers Are for More Than Meat.]
Bottom line? I’d absolutely order from any of these services again – particularly Chef’d since the meals were lower in calories. Purple Carrot was another favorite, thanks to the extremely creative vegan dishes, but required halving the portion sizes. I’d recommend any of these services to anyone who just doesn’t have the time to shop and organize recipes for the week.

Originally Posted on:


If you think losing a meaningful amount of weight is so monumentally difficult that hardly anyone succeeds, think again.

 About 65 percent of patients lose 5 percent or more of their weight — enough to improve blood pressure and risk factors for diabetes — within six months of the tried-and-true approach of diet, exercise, and counseling, according to a review of obesity research published Wednesday in the New England Journal of Medicine.

The counseling piece is crucial — and should include at least 14 sessions over six months with a trained professional such as a dietitian or exercise specialist. That kind of hand-holding is readily available, the review said, not only at medical centers but through YMCA diabetes-prevention programs, commercial weight-loss plans such as Weight Watchers or Jenny Craig, and even through call centers that provide tailored guidance.

 “With intensive counseling, patients get a lot of instruction, but, equally important, they get a lot of support,” said psychologist Thomas Wadden, director of the Center for Weight and Eating Disorders at the University of Pennsylvania. “Partly, it’s the accountability that makes the difference. If you’re reviewing your progress every week with a counselor, you’re going to try harder than if you’re just recording your weight on a phone app.”

For the paper, Wadden teamed with Steven B. Heymsfield, an obesity researcher at Louisiana State University, to sum up what is known about the causes of the obesity epidemic and how to battle it.

Some parts of their scholarly review come as no surprise.  Two-thirds of the U.S.  adult population is overweight (a Body Mass Index of 25 to 29.9) or obese (a BMI of 30 or more), a result of increasingly sedentary lifestyles and eating too much high-calorie food in super-size portions. The girth of the nation has led to soaring rates of diabetes, heart disease, and other chronic illnesses.

But less well-known is the fact that research has uncovered 11 uncommon genetic forms of obesity, including a type that is found in about 5 percent of severely obese children. Moreover, studies suggest that when fat people slim down, they continue to suffer metabolic and psychological effects such as increased appetite and a preoccupation with food.

“The implication is that persons who are no longer obese may not be physiologically identical to their counterparts who were never obese,” the authors wrote.

If obesity permanently changes how the body functions, then that helps explain why so many who lose weight regain it. The authors say it also supports “the concept of obesity as a chronic disease that requires long-term vigilance and management.”

Because of the chronic nature of the problem, professional guidelines recommend that anti-obesity medications be considered to supplement intensive counseling and lifestyle changes. Six drugs have been approved for short- or long-term use, and research by Wadden and others has shown that adding a medication leads to greater weight loss and better maintenance.

Nonetheless, studies suggest the medications are underused, given the scale of the obesity epidemic.

Wadden and his co-author cite the reasons: Diet drugs have a history of being barely effective or unsafe; insurance usually doesn’t cover them; and patients are often disappointed that pills are no panacea — their losses are modest.

“It’s clear that these medications are beneficial,” said Wadden, who has been a paid consultant to pharmaceutical companies as well as Weight Watchers. “Unfortunately, there’s a sense that they must not work if you have to take them indefinitely. But I think obesity medications should be used on a long-term basis for chronic weight management, just as I take a [cholesterol-lowering] statin and a blood-pressure medication for the long term.”
Originally Published by The Philadelphia Inquirer on January 17, 2017.

5 questions: How to talk to kids about weight

Article by Sandy Bauers, For The Inquirer

istock_kid-overweight-dinnertable-3x2If your child has weight problems, it won’t help to focus on the numbers on the scale. Reminding kids about weight can lead to dangerous dieting tactics and unhealthy eating.

Family meals help develop balanced eating habits and foster communication. Slideshow icon SLIDESHOW
5 questions: How to talk to kids about weight
That’s the main message in a recent report by the American Academy of Pediatrics (AAP). The researchers found that adolescents whose parents focus instead on healthy eating and physical activity are less likely to have eating disorders or turn to unhealthy weight control methods.

This information is more important now than ever. The rate of teen obesity has quadrupled in the last 30 years, according to the academy.

For perspective, we recently spoke with two experts at the Renfrew Center, established in 1985 in Philadelphia as the nation’s first residential eating disorder facility, treating girls and women age 12 and over. Its 17 locations nationwide also include Mount Laurel and Radnor. Corrine Kopp, who has degrees in psychology and social work, is site director of the Renfrew Center of Southern New Jersey. Lauren Rooney is that center’s regional nutrition manager.

When the AAP said parents should focus on healthy eating, not weight, what did they mean? Why is this important?
Kopp: The report is really broadening the conversation with children and adolescents for both parents and providers. It’s incredibly important. Children’s and teens’ minds are very impressionable. They’re already inundated with unhealthy messages around weight. Broadening the picture takes the fixation off the number. When the focus is on weight alone, people begin to define themselves based on that number. When they see their worth as just that number, they’re minimizing their value.

If the only thing that’s important is the weight, then all that would matter to the patients we treat – or, really, anyone – might be whatever they are doing to manipulate their weight. We see patients who are bingeing on large amounts of food. We see patients who are undereating. They might not be eating starches or fats. We also see patients that are purging or using laxatives or diuretics.

We’ve definitely seen an increase in preteens, teens and adolescents who are not only overweight, but also obese and underweight. These issues are very much interrelated.

Rooney: Diets just don’t work. Although a multitude of factors contribute to eating disorder development, dieting is the most common. Diets can lead to the abuse of diet pills or laxatives or binge-eating behavior. Those that diet are also labeling food as good or bad. If they are consuming foods labeled bad, they would think of themselves as a bad person. It can lead to this very unhealthy relationship with food and with their bodies.

The academy’s report suggested that families have more meals together as a way to combat eating problems.
Rooney: Family meals are essential. They are a place where we can develop balanced eating habits and create communication within our families. They are an opportunity for parents to model healthy eating behavior – how important it is to have variety, balance and moderation in our diets. Our children are picking up on that.

Any opportunity to share a meal is an important one. It gives parents an opportunity to check in with their children about their day, to ask about their friends.

Kopp: If a child is struggling with overeating or undereating or harmful dieting behavior, the parents are more likely to miss it if they’re not sharing family meals. If they are sharing, they might, for instance, notice changes in mood or behavior or eating patterns that might be a red flag. Then they could talk about it with their child or with a health-care provider. Early identification is better.

Another recommendation was to promote a positive body image for your child. How does a parent do it?
Kopp: It comes back to teens being so inundated with all these negative messages. If they have a positive body image, a positive view of themselves and their bodies, they are going to have a healthier outlook on everything and not be so likely to diet or develop an eating disorder.

One thing that’s important is that the parent or other role model not be commenting on their own weight. If a parent is standing in front of a mirror, really scrutinizing their body, the child is probably going to do the same thing. If they are talking about needing to lose weight or this not being right or that not being right, the child may not be able to understand that the assessment is just of the parent. The child might think, “They must be talking about me, too. I must also need to lose weight.” They’re taking this as a lesson rather than just a comment that Mom or Dad made. It seems innocent, but the impact can be significant.

Instead, parents should talk about the good things their bodies can do. Maybe Dad goes to yoga and he’s been working on this one pose, a headstand. He can talk about his body’s abilities – how his muscles are able to support him doing a headstand – as opposed to proportions or height or weight.

Or, the parents could focus on a discussion about how their daughter went out with her friends and they went for a walk. Was that fun? Or, hey, you like new foods, how about trying some tomatoes?

But those numbers on the scale are important, right?
Kopp: Yes. A health-care provider will have an eye on that. But that number is not the discussion with the child. That will go something like, what do you do for fun? What are your hobbies? It would be a collaborative conversation – what the child is interested in, what activities the family can provide support for, what they can do together – rather than a blanket statement, such as “Why don’t you go for more walks?”

What should a worried parent do?
Kopp: Definitely the first place to start is getting in touch with a provider that knows eating disorders. They need to find someone who can give them an appropriate assessment and, if needed, intervene early. One of the things we know is that the earlier the intervention, the easier the recovery.

I would emphasize that recovery is possible. People can change, and they can lead a healthy lifestyle that isn’t based on weight.

Originally Posted on:

The Face of MD Weight Loss

The Face of MD Weight Loss

The Face of MD Weight Loss

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As quoted in Main Line Today January 2016:

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