Making Sense of Health News and Popular Diets

	Class Overview

	In these two sessions, participants will learn how to evaluate health news and popular weight loss diets.  To constitute a class, Lifestyle Coaches will need to add at least two additional sessions (examples might include a group activity session, a potluck dinner featuring low-fat/low-calorie recipes, and a featured speaker on a related topic).

	Session 1: Health News:  Fact or Fad?
	Participants will learn how to evaluate health news.

	Session 2:  Popular Diets:  Do They Make Sense?
	Participants will learn how to evaluate popular weight loss diets.

Portions of this class were developed by the Lifestyle Coaches in the Southern and Midwest/Southwest regions as part of their monthly lifestyle conference calls.

Notes to the Lifestyle Coach:   

1.	Because of unavoidable technical terms and large words, the reading level of some of the handouts for this class is high.  Be careful to review the key information on the handouts aloud in simple terms and make sure participants understand how to use the information, particularly those who have lower literacy skills.

2.	The leader of this class should be a registered dietitian.  

Session 1: Health News: Fact or Fad?

Objectives:	Participants will learn how to evaluate health news.   
Materials needed:
∙	Name tags
∙	Blackboard and chalk or flipchart and markers
∙	Handouts

1.	Explain the purpose of the four-session class:  to learn how to evaluate health news, popular diets, herbal remedies, and vitamin supplements.

2.	Review the topics, schedule and locations for each session.   

3.	Have participants share their reasons for joining the class.  

4.	Ask participants to picture the last time they made a health-related decision (e.g., to join the DPP, find a new dentist or doctor, try a new vitamin, try a remedy for hot flashes, join a health club).  
	∙	What sources of information did you use to make the decision?  (Write the responses on the board.  If not mentioned, include television, newspapers, magazines, tabloids, neighbors, friends, doctors, nurses, family members, coworkers, radio, the Internet.)  
	∙	Which sources were the most helpful?  Least helpful?  In what way?
	∙	What influence does the media (e.g, radio, newspapers, TV, magazines) have on your health decisions?  

	Make the point, based on the discussion, that the public often complains that health news is confusing and frustrating.  It can be contradictory (e.g., one study may conclude that coffee increases your risk of heart disease, another may conclude the opposite).  And it can be difficult to apply to our own lives (e.g., a study may draw a conclusion but caution that more studies need to be done before specific recommendations are made).  Becoming skilled in evaluating health news can make all the difference between frustration and peace of mind.

5.	Distribute and review the handout, Health News:  Fact or Fad?  If appropriate for the group, you may also want to present some of the differences between types of studies, such as the following:
	∙	Observational (population-based) studies compare one group of people to another (e.g., the eating and exercise habits of people who have diabetes with those who do not).   Observational studies are designed to show association, but they don’t prove cause and effect.
	∙	Retrospective studies ask people about their habits in the past.  These can be unreliable because people may forget or omit important information.
	∙	Intervention studies compare a conventional treatment or placebo in people who are randomly assigned to at least two groups (intervention and control).  These are known as randomized, controlled studies.  Even better are “blinded” studies, in which participants don’t know which treatment they are getting until the study is over.  In “double-blind” studies, the investigators don’t know either.  These studies are able to establish cause and effect, but they take a long time and a large number of people.

	Ask participants to imagine that the results of the DPP were published in an article.  Go through the questions on the handout, naming the features of the DPP that should be included in the article to show that the results are believable.  (Write the answers on the board.  Highlight the facts that the DPP is a randomized clinical trial, it features a long-term lifestyle intervention based on many previous studies published in scientific journals, and the participants are a large number of both men and women in a variety of ethnic groups.  Name some of the reputable scientific journals that might publish the results, such as the New England Journal of Medicine, Journal of the American Medical Association, Diabetes, Diabetes Care, etc.) 

6.	Distribute the article, “Low-fat diet doesn’t block breast cancer, study shows” (used with permission from the participant manual of the Women’s Health Initiative).  Ask for volunteers to read each paragraph aloud, and ask the group to point out where in the article they find answers to the questions on the Fact or Fad handout.  For example:
	∙	Paragraph 1: The study was published by scientists at a respectable institution (Harvard).  However, the article does not specify where the study was published or who paid for the study.
	∙	Paragraph 2: It is unclear how many women were in the study and what their age ranges were.  It appears that some of the women were menopausal and some were not.  The length of the study is not stated.
	∙	Paragraph 4: The article refers to seven previous studies (objective research, not personal experience).  However, no details are given on the study designs.    
	∙	Paragraph 5:  Qualifying words are used in an appropriate way (“our results suggest....” “....is unlikely to reduce breast cancer risk.”)
	∙	Paragraph 9:  Here it is clear that the study was published in a peer-reviewed, recognized scientific journal.  Also, the recommendation to follow a low-fat, high fiber diet is sensible and in line with recommendations made by many reputable organizations such as the American Heart Association, American Cancer Society, etc.   The study results are not exaggerated, and there are no promises of quick fixes or easy answers.
	∙	Paragraph 12:  Again, qualifying words are used in an appropriate way (“the fat factor seems to be....”).
	∙	Paragraph 14:  Another reputable institution is referred to (Brigham and Women’s Hospital).  Qualifying words are used appropriately (“strongly indicative of...”).  By quoting a comment from another expert, the article provides a broader perspective than if the article had only quoted the study results.
	∙	Headline:  By the end of the article, it is clear that the headline is somewhat misleading.  It implies that the study has proven that a low-fat diet is not associated with breast cancer; however, as you read the article, the question appears to be open for debate.

	Ask participants what questions they have after reading the article and where they might find answers to their questions.  Distribute the handouts Top 10 List of Bread Statistics; Resources for Reliable News About Health, Nutrition, and Physical Activity; and Making the Net Work for You.  Make the points that it’s becoming more and more difficult for lay people to accurately interpret the constant stream of health information available in the media or on the Internet, it’s easy to misrepresent and misunderstand statistics, and it’s critical for the public to rely on both common sense and professional guidance from reliable sources of information such as the American Dietetic Association, the American Council on Exercise, and so on.

8.	 Summarize main points from this session.  Assign home activity:
	∙	Practice reading articles related to health information using the questions on the handout, Health News:  Fact or Fad?
Session 2:  Popular Diets:  Do They Make Sense?

Objectives:	Participants will learn how to evaluate popular weight loss diets.
Materials needed:
∙	Name tags
∙	Blackboard and chalk or flipchart and markers
∙	Handouts
∙	Optional support materials:  The PowerPoint slide presentation from the Wheat Foods Council called “Setting the Record Straight” which introduces several fad diets  (you can download this from the Wheat Foods Council web site at http://www.wheatfoods.org).  
	An 8-minute video is also available from the Wheat Foods Council.  You may also want to bring in some popular weight loss books for display.
Before the session:
∙	Review the attached article entitled  “News You Can Use: The High-Protein, Low-Carbohydrate Diet Craze” (for Coach reference only). 
∙	For a simple, accurate analysis of many popular weight loss diets, visit the web site Nutrio.com (http://www.nutrio.com).
Note:  During this session, participants may ask the leader about following another weight loss program (e.g., Weight Watchers) while in the DPP or state that they are currently doing so.  The leader should ask the participants to describe what motivates them to follow another program and remind participants that the same approaches can be offered to them in the DPP (e.g., exchanges, a point system, group support, packaged foods, or structured meal plans).  Participants are to be encouraged to discuss this further with their individual Lifestyle Coach.  Participants should be discouraged from joining another weight loss program, even reputable ones such as Weight Watchers, and Lifestyle Coaches should try to offer participants what they are seeking from another program, e.g., a more structured meal plan or group support.

1.	Briefly review the main points of the last session.   Ask if participants read any articles related to health information using the questions on the Health News:  Fact or Fad? handout.  If so, ask the participants to share with the group how they evaluated the articles.    

2.	Explain purpose of this session: to evaluate some popular diets. 

3.	Make the point that losing weight and keeping it off is not easy, and it takes time.  So a weight loss diet that promises quick and easy weight loss, as if by magic, sounds like a dream come true.  Unfortunately, it’s just that--a dream.  As you evaluate various popular weight loss diets, keep that in mind.  As is the case with health news in general, promising a “magic answer” for weight loss is one of the most important red flags to watch out for.  

	Distribute the two advertisements for Bio-Mince and Trilean as examples of weight loss programs that promise “magic answers.”  Briefly point out some of the negative aspects of the advertisements that were addressed in the last session on the Fact or Fad handout.  For example:  dramatic headlines, promises of easy answers, a product being sold, not based on published scientific data (although misleading references are made to “this world famous medical doctor’s program” (Bio-Mince) and “the study report” and “clinical trials” (Trilean), without any substantiation).   

4.	Distribute and review the handouts, Keys to a Healthy Weight Loss Diet and What About the Popular High-Protein, Low-Carbohydrate Diets?  Also distribute and review Do Fad Diets Work?  (See below for additional background information on the diets.)  Stress that none of these diets have been scientifically validated.  Make the point that high-protein, low-carbohydrate diets have been around since the 1960s and, like many fad diets, resurface periodically (Dr. Atkins first book was published in the early 1970s).  If interest and time permits, you may want to show the slide show “Setting the Record Straight,” which can be downloaded on Power Point from the Wheat Foods Council website (http://www.wheatfoods.org).       

5.	Summarize main points from this session.  Assign home activity:
	∙	Ask participants to practice evaluating popular weight loss diets that they see in bookstores or in advertisements.  

Background information for Coaches on popular weight loss diets:

Dr. Atkins’ New Diet Revolution
∙	Author:   Dr. Robert C. Atkins (Founder and Medical Director of the Atkins Center for Complementary Medicine in New York City established in l970)
∙	Products Available:   Several books on weight loss.  Multiple food items and vitamin/nutrient products available via 1-800 number and web sites. 
∙	Claims
	∙	Obesity is caused by high blood insulin levels and not metabolizing fat.
	∙	A carbohydrate-restricted diet dissolves body fat.  
	∙	Ketosis (a condition in which the kidneys cannot keep up with filtering the blood of ketones, a byproduct of fat breakdown) and the accompanying loss of appetite is a natural part of the diet’s effectiveness.
∙	What You Do
	∙	Stop unnecessary medications.  
	∙	Reduce carbohydrates to 20 grams per day. 
	∙	Restrict alcohol, caffeine, sugar, chocolate and any addictive or allergy-prone foods such as wheat or corn grains or gluten.  
	∙	Take vitamin supplements: B complex and C, L-glutamine (500-1000 mg) before meals for sugar cravings, “borage oil” capsules, 2 tablespoons lecithin granules and pantethine (300 mg) before meals for concerns related to high cholesterol levels.  
	∙	Use lipolysis testing strips to measure ketosis (fat burning success).  
∙	Facts
	∙	Dehydration can occur on a diet restricted in carbohydrates and fluids.
	∙	Ketosis causes tiredness, dizziness, headaches, and nausea. 
	∙	This diet is low in fiber and fruit and vegetables which can cause constipation and  intestinal disorders.
	∙	Cholesterol levels may increase with the high fat foods allowed (cream, cheese, eggs, bacon, etc.).  
	∙	This diet is not safe without medical supervision, even in the short-term.  (For example, dramatic loss of body water can require adjustments in blood pressure medication.) 

Eat Right for Your Type
∙	Author   Dr. Peter J. D’Adamo
∙	Products Available:  Books (Eat Right for Your Type and Cook Right for Your Type) and a web page (ASPARTAME, the artificial sweetener).
∙	Claims
	∙	Lectins (proteins on the surface of certain foods) cause certain molecules and cells to stick together.  This can cause illness and disease, including the agglutination of blood cells, a condition in which blood cells stick together.   Blood type determines your reaction to lectins. 
	∙	Blood type therefore determines your susceptibility to illness, which foods you should eat, and how you should exercise.  Weight loss is a by-product of eating according to your blood type.
	∙	Type O:  Risk factors for ulcers and inflammatory diseases increase if you eat incorrectly.
	∙		Type A:  Risk factors for cancer and heart disease increase if you eat incorrectly.
	∙	Type B:  Risk factors for slow-growing viruses that attack the nervous system increase if you eat incorrectly.
	∙	Type AB:  This type has the friendliest immune system of all the blood types.
∙	What You Do
	∙	Type O:  Eat meat (high protein, low carbohydrate), eliminate wheat and most other grains, and engage in vigorous aerobic exercise.
	∙	Type A:  Be a vegetarian (high carbohydrate, low fat), engage in gentle exercise such as yoga or golf, and meditate to deal with stress.
	∙	Type B:  Eat a varied diet (this is the only type that does well with dairy) and engage in exercise such as moderate swimming or walking.
	∙	Type AB:  You have the benefits and intolerances of both types A and B.   Engage incalming exercises and relaxation techniques

∙	Facts     
	∙	Lectins are mostly destroyed by cooking and stomach acids.
	∙	Harvey Klein, MD, Chief of the Department of Transfusion Medicine, NIH, says, “We know of no food that attacks and agglutinates blood cells after you ingest it.”
	∙	The diet has not been validated scientifically.  

The Zone
∙	Author   Barry Sears, PhD
∙	Products Available:  Books (The Zone and Mastering the Zone), nutrition bars and other products.
∙	Claims
	∙	Most people suffer from an overproduction of insulin which causes weight gain.  Eating the specified mix of protein, fat, and carbohydrate will correct that.   
	∙	Too much insulin creates bad “super hormones” called eicosanoids.  These will  reduce oxygen transfer to the cells, interfere with the breakdown of body fat, disturb blood glucose levels, and may contribute to heart disease, cancer, and autoimmune diseases.  
	∙	A high protein intake will create good eicosanoids.  These will create a better insulin balance, maintain blood glucose, and help in the breakdown of body fat.   
∙	What You Do
	∙	Eat 40% of your calories from carbohydrate, 30% from protein, and 30% from fat.  Eat three small meals (400 calories each) and two snacks (100 calories each).
	∙	Build meals with a one-to-one ratio of protein to carbohydrate.  Do this by choosing from lists of “food blocks,” each with a certain amount of protein and carbohydrate.  
∙	 Facts
	∙	Weight gain results from eating too many calories (regardless of the proportions of carbohydrate, protein, and fat) and not getting enough exercise. 
	∙	The plan provides at most 1200 calories (1700 for athletes).  This is lower than what many people consume. This would explain weight loss while on the plan, regardless of the ratio of carbohydrates, protein, and fat.   
	∙	Weight loss is not simply a matter of hormone imbalance.  It involves many other factors.
	∙	This diet requires you to limit the amount of so-called “bad” carbohydrates: bananas, cranberries, apple juice, orange juice, bagels, bread, carrots, dry cereal, popcorn, rice, potatoes, lima beans, raisins, ketchup, pasta and grains.  Essentially the only grain-based food that’s good is slow-cooking oatmeal.  This is not practical or healthy.
	∙	The diet has not been validated scientifically.  It is based on personal accounts  and poorly conducted studies that have not been published.  

The Carbohydrate Addict’s Diet 
∙	Authors:   Richard Heller PhD and Rachael Heller PhD
∙	Products Available:  7 books (Carbohydrate Addict’s Healthy Heart Program, Carbohydrate-Addicted Kids, The Carbohydrate Addict’s Lifespan  Program, The Carbohydrate Addict’s Gram Counter, The Carbohydrate Addict’s Program for Success, The Carbohydrate Addict’s Diet, Healthy for Life), Carbohydrate Addict’s brand foods
∙	Claims
	∙	75% of overweight and many normal-weight people are addicted to carbohydrates. 
	∙	Carbohydrate addiction is biological and not a matter of will power.  It is caused by an over-release of insulin in response to carbohydrate-rich foods.  Too much insulin results in a drop in blood sugar and a compensatory strong impulse to eat. 
	∙	Eventually, muscle cells become resistant to insulin and excess sugar is stored in fat cells.  When fat cells also become insulin resistant, Type II diabetes develops. 
	∙	By cutting out carbohydrate foods, including fruits, vegetables, and whole grains, you can reduce insulin levels, and therefore hunger and fat storage. 
∙	What Do You Do
	∙	Eat two non-carbohydrate meals per day and one “reward” meal per day (with equal portions of protein, fat, and carbohydrate).  
	∙	The reward meal must be eaten within one hour.  
	∙	No snacking is allowed during the first 2 weeks of the program.
∙	Facts
	∙	High blood insulin levels are associated with being overweight, not eating carbohydrates.
	∙	Being overweight is the result of eating too many calories (from any foods, not just carbohydrates) compared to the calories burned in exercise.  
	∙	High levels of dietary protein and fat can be stressful to the kidneys and increase the risk for heart disease and cancer.
	∙	Calorie intake can vary widely depending on the protein and fat foods chosen.
	∙	Lack of fiber can cause constipation, and too little carbohydrates can cause weakness, nausea, and deficient levels of vitamin B, calcium and potassium.
	∙	The diet has not been validated scientifically.  

Sugar Busters  
∙	Authors:  Leighton Steward, Morrison C. Bethea, MD, Sam S. Andrews, MD, Lewis A. Balart, MD 
∙	Products Available:  Book, shopper’s guide, web page that endorses approved products 
∙	Claims 
	∙	Refined sugar and food with a high glycemic index cause increased insulin levels, which promotes fat storage.  Obesity results from this insulin overload.
	∙	Low fat, high carbohydrate diets don't work. 
	∙	Most of our body fat comes from ingested sugar, not ingested fat.
∙	What You Do 
	∙	Avoid "insulin-stimulating foods" such as white rice, bread from refined flour, carrots, potatoes, corn, beets, refined sugar, corn syrup, molasses, and honey.
	∙	Focus on carbohydrates with low glycemic indexes (whole grains and cereals, fruits, vegetables, and dairy products).
	∙	Fruit should not be eaten with meat dishes but can be consumed 30 minutes before a meal or 2 hours after.
	∙	Portion size guidelines are vague ("portions of food that you select for each meal should fit nicely on a plate…do not go back for seconds or thirds").
	∙	Misleading claims are made ("enjoy steak, eggs, cheese and even wine as you get healthy and lose weight " appears on the cover of the book).
∙	Facts
	∙	A high intake of complex carbohydrates can protect against many nutrition-related diseases.  A high intake of fat, saturated fat, and cholesterol increases the risk of heart disease and cancer.
	∙	The body does produce insulin in response to rises in blood sugar, but insulin promotes fat storage only when a person consumes excess calories.  
	∙	Eating too many calories in any form will promote fat storage if not matched by  calories expended. 
	∙	No success-rate data or case studies are published anywhere in the book or in a scientific journal.  The book lists about 20 references throughout, many of them unknown textbooks and journals.

Eat More, Weigh Less  (Note: This diet is not included on the Do Fad Diets Work? handout.  It is much more reputable than the other diets, however, participants are not to be encouraged to follow a non-DPP weight loss program.  Information is included here for your background in case participants ask about it.)
∙	Author   Dean Ornish, MD
∙	Products Available:  Five best-selling books including: Dr. Dean Ornish’s Program for Reversing Heart Disease; Eat More, Weigh Less; Love & Survival: The Scientific Basis for the Healing Power of Intimacy.  Also video and audiocassettes and cookbooks.
∙	What You Do
	∙	Nutrition
		∙	No animal products except egg whites and non-fat dairy foods
		∙	No more than 10% of total calories per day from fat with approximately 15% of total calories from protein and 75% from complex carbohydrates
		∙		No more than 10 milligrams per day of dietary cholesterol
		∙	Restricted salt intake for people with high blood pressure, heart failure or kidney disease
		∙	Moderate sugar intake
		∙		Less than 2 ounces of alcohol per day and no caffeine
	∙	Exercise  Moderate activity (walking preferred) (30 minutes/day or 60 minutes 3 times/week)
	∙	Stress management  May include stretching, breathing exercises, meditation, progressive relaxation
	∙	Group support (designed to create community, enhance intimacy and adherence)
∙	Claims
	∙		Improvement in cardiovascular endurance (treadmill time)
	∙		Improvements in coronary artery blockages and heart blood flow
	∙		Reduction in frequency of anginal episodes
	∙		Decreases in blood pressure, cholesterol, triglycerides and heart rate
∙	Facts 
	∙	Five randomized, controlled clinical trials (ranging from 24 days to 5 years) have been done with small numbers of heart patients.  Results have been published in peer-reviewed scientific journals.  
	∙	Ornish has received national and international awards from scientific and educational institutions.  Some health insurance companies cover the program.
	∙	Dietary changes are too extreme for many people to maintain long-term, especially people without disease symptoms. 

Health News:  Fact or Fad?

	Here are some basic questions to ask when evaluating health news.

Questions	What to keep in mind
	1.	Are there dramatic headlines?  Are there promises of easy answers or quick fixes?  Are there claims that sound too good to be true?  Are there exaggerated warnings of danger from a single product or plan?		Headlines are designed to grab your attention.  So are promises of quick fixes and dramatic warnings about a single product or plan.  They are often misleading.   
	2.	Is the information based on personal experience or objective research?		What happens to one person or even a few people may be due to chance.  
	3.	Are there any hidden motives?  
		Who paid for the study?  
		Where was the study done?  
		Is there a product or book being sold?  		Watch out for conflicts of interest or personal biases.  Beware if a special interest group would gain or lose by particular results.  Beware if there are related products or books for sale.

	4.	Has the information been published?  If so, where?
		Don’t trust unpublished information. On the other hand, just because something is published doesn’t mean it’s accurate.  Most trustworthy are articles published in scientific journals because they have been reviewed and approved by fellow scientists.  

	5.	Are the results qualified with words like “may,” “seem,” or “in some cases”?  Are simple conclusions drawn from a complex study?
		The results of one study seldom prove anything.  Reliable researchers usually want you to interpret the results with caution and will often use qualifying words.  Also, beware of simple conclusions drawn from a complex study.
	6.	What kind of study was done?		Studies that follow and observe large groups of people can provide clues for future research.  But they usually can’t prove the cause of a disease.  Only studies that test ways to prevent or treat a disease can do that.
	7.	Who took part in the study (e.g., age, male/female)?   Are differences among individuals or groups ignored?		Results found in one group of people (e.g., middle aged men) may not apply to others (e.g., middle aged women).  Also, what works in animals or test tubes doesn’t necessarily work in humans.

	8.	How many people took part in the study?  		In small studies there is a greater risk that the results may be due to chance. 
	9.	How long did the study last?		Longer studies are needed to follow a disease that takes a long time to develop (e.g, diabetes, heart disease).

Was the article believable?

What questions do you have after reading the article?  	

Top 10 List of Bread Statistics

Be careful when you read statistics in health news.  Something may sound scientific.  It may even be true, in a limited way.  But does it make sense?  
	Enjoy the following nonsense about the “dangers” of eating bread.    
Note:  This story originally appeared in Nutrition News Focus on November 25, 1998.

 1.	More than 98 percent of convicted felons are bread users.

 2.	Fully HALF of all children who grow up in bread-consuming households score below average on standardized tests.

 3.	Bread is made from a substance called "dough."  It has been proven that as little as one pound of dough can be used to suffocate a mouse.  The average American eats more bread than that in one month!

 4.	Newborn babies can choke on bread.

 5.	Bread has been proven to be addictive.  Subjects deprived of bread and given only water begged for bread after as little as two days.

 6.	Bread is often a "gateway" food item, leading the user to "harder" items such as butter, jelly, peanut butter, and even cold cuts.

 7.	In the 18th century, when virtually all bread was baked in the home, the average life expectancy was less than 50 years; infant mortality rates were unacceptably high; many women died in childbirth; and diseases such as typhoid, yellow fever, and influenza ravaged whole nation.

 8.	More than 90 percent of violent crimes are committed within 24 hours of eating bread.

 9.	Bread is baked at temperatures as high as 400 degrees Fahrenheit!  That kind of heat can kill an adult in less than one minute.

10.	Many bread eaters are utterly unable to distinguish between significant scientific fact and meaningless statistical babbling.
Resources for Reliable News about
Health, Nutrition and Physical Activity

∙	DPP Lifestyle Staff 

∙	American Dietetic Association, 1-800-366-1655, www.eatright.org

∙	National Health Information Center, www.nhic-nt.health.org
                   
∙	American Heart Association 1-800-242-8721, www.americanheart.org

∙	National Women’s Health Resource Center, 1-202-537-4015, www.healthywomen.org

∙	National Women’s Health Information Center, www.4woman.org

∙	American Cancer Society, 1-800-227-2345, www.cancer.org

∙	National Cancer Information Service Hotline, 1-800-4-CANCER

∙	Tufts Health and Nutrition Letter (to subscribe, write Tufts Health and Nutrition Letter, 50 Broadway, 15th Floor, New York, NY 10004, or visit their website at www.healthletter.tufts.edu)

∙	Center for Science in the Public Interest, 1-202-332-9110, www.cspinet.org

∙	American Running Association, 1-800-776-2732, (www.americanrunning.org)

∙	American Council on Exercise (http://www.acefitness.org/)

Making the Net Work for You

On the Internet, information about lifestyle change is just a click away.  The key is knowing where to click.  Some web sites offer accurate information.  Others offer junk.  The web sites below are generally reputable and usable.  Some offer direct links to other sites.

Nutrition and Weight Loss on the Web
∙	Tufts University Nutrition Navigator (http://www.navigator.tufts.edu/)  Nutritionists at the highly regarded Tufts University School of Nutrition Science and Policy provide helpful ratings and reviews of nutrition websites.
∙	Mayo Clinic Health Oasis (http://www.mayohealth.org/mayo/expert/htm/ask2.htm/)  Jennifer Nelson, MS, RD, CNSD, staffs Mayo Clinic’s on-line ask-an-RD service.  Fun and user-friendly.  
∙	CyberDiet (http://www.cyberdiet.com/)  Timi Gustafson and Cynthia Fink Gustafson, registered dietitians, provide sane, fun, and well-presented nutrition information.  Lots of interactive stuff.  
∙	Vegetarian Resource Group (http://www.vrg.org/)  Reed Mangels, PhD, RD, and Suzanne Havala, MS, RD, offer free newsletters and complete vegetarian information.
∙	Food and Nutrition Information Center (http://www.nal.usda.gov/fnic/)
	This site provides information from the US Department of Agriculture about the Dietary Guidelines and the Food Guide Pyramid.  
∙	The American Dietetic Association--Your Link to Nutrition and Health (http://www.eatright.org/)  This site provides hundreds of quick tips, monthly hot topics, and the Find-a-Dietitian searchable database.
∙	American Diabetes Association (http://www.diabetes.org/)  This site offers state-of-the-art information about diabetes prevention, treatment, research and education, plus daily low-fat recipes.  Guidelines to educational programs and events in your locale are provided.
∙	Nutrition Links (http://www.oznet.ksu.edu/ext_F&N/Nutlink/n2.htm/) From Kansas State University.  Countless nutrition topics are covered, including nutrition throughout the life span, medical nutrition, exercise and fitness, and vegetarianism.
∙	Ask a Dietitian (http://www.dietitian.com/) Joanne Larson, MS, RD, posts common-sense answers to more than 75 common nutrition questions, along with links to other nutrition information.
∙	Meals for You (http://www.mealsforyou.com/)  This commercial site offers recipes, personalized meal plans, and customized shopping lists.
∙	Grains Nutrition Information Center (http://www.wheatfoods.org/)  This site provides grain recipes, handouts, and fad diet updates from the Wheat Foods Council. 
∙	Alternative Health News On-line (http://www.altmedicine.com/)  Consumers and health professionals who want to keep current with alternative medicine (e.g., herbs, macrobiotics, and vitamin supplements) should find this site, developed by a journalist, to be a great resource.

Physical Activity on the Web
∙	American Council on Exercise (http://www.acefitness.org/) This site offers “Fit Facts,” handouts on a wide variety of fitness topics that can be copied for use with participants.  
∙	Go Ask Alice (http://www.columbia.edu/cu/healthwise/) This is a very highly rated on-line question-and-answer site by health educators and health care providers at the Columbia University Health Service.  The archive includes about 1,600 previously answered questions.  Topic categories include nutrition, fitness, and general health. 
∙	Shape Up America (http://www.shapeup.org/) As part of Dr. Koop’s initiative to promote physical activity and weight loss, this site includes lots of information for the public and professionals.  
∙	The Physician and Sports Medicine (http://www.physsportsmed.com/) An excellent sports medicine magazine with resources, links, and past issues.
∙	Connecting the Connectors (http://www.connectingconnectors.com/)  Inspired by Oprah Winfrey, this site offers “support for running, weight loss, marathoning, and life.”  Includes motivational tips, guidelines for beginning runners, and e-mail discussion groups.  
∙	Phys (http://www.phys.com)  This site is colorful, hip, and filled with useful nutrition and fitness information, including a Debunking the Diets section.  Sponsored by CondeNet.
∙	Be Active (http://www.beactive.org/)  An upbeat site with information from the Surgeon General, personal accounts from people of all ages, and practical ideas for staying active.
∙	Runner’s World (http://www.runnersworld.com/)  Not just for runners, this site includes sensible articles on sports nutrition and general recommendations for a healthy diet.
∙	Asimba (http://www.asimba.com/)  An upbeat site with health and fitness information, motivational tips, e-mail discussion groups, and personalized training programs for walking and running.
Keys to a Healthy Weight Loss Diet   

     Diets that include the features below are more likely to be safe and to help you lose body fat and keep it off.

☐	The diet meets your needs for all nutrients while lowering the total calories.

☐	Foods are the basis for the diet, not supplements or pills.

☐	“Forbidden" foods are kept to a minimum.  Foods are not labeled “good” or “bad.”

☐	The expected rate of weight loss is no more than 2 pounds per week.

☐	The diet contains a sensible balance of protein, carbohydrate and fat.  Recommendations are for 10-20% of calories from protein, 50-60% from carbohydrate, and less than 30% from fat (with <10% from saturated fat).

☐	The diet emphasizes portion control.

☐	Some method for increasing awareness of foods eaten is encouraged.  Examples: Self-monitoring or individualized meal plans.

☐	Healthful snacks are part of the plan. 	

☐	Regular aerobic exercise is part of the plan.

☐	The diet is practical.  You could follow it long enough to reach your long-term weight loss goals.  You could follow it forever.

☐	You would be able to follow the plan anywhere – at home or away from home.

☐	The diet allows you to eat when you are hungry.  You feel satisfied when you eat.  

☐	The diet is based on scientific evidence, not personal experience.  The endorser is respected and  knowledgeable in nutrition.

What About the Popular
High-Protein, Low-Carbohydrate Diets?     

Keep in mind that any diet with fewer calories than you usually eat will result in weight loss.  But can you stick with it for the long-term?
 
The Claims	The Truth
Americans are getting fatter because we are eating too much carbohydrate.	Americans are getting fatter because we are eating too many total calories and exercising less.
Eating too much carbohydrate causes high levels of insulin in the blood.  This leads to insulin resistance which causes weight gain. 	Being overweight is associated with insulin resistance.  However, there is no scientific evidence that weight gain is caused by insulin resistance or that eating too much carbohydrate causes insulin resistance. 
You’ll lose weight on the diets because they are low in carbohydrate.   	You may lose weight on the diets because they contain fewer total calories than most Americans consume.  Most of the diets range from 1000-1800 calories.  Also, many cause ketosis.  In ketosis, the body breaks down fat stores, producing toxic substances called ketones.  To flush out the ketones, the kidneys pull water from the body.  It’s the loss of water, not fat, that results in quick weight.  
The diets will improve your health.	There have been no scientific studies on the health effects of these diets.  Concerns have been raised about dehydration and the possibility that the diets may increase the risk of heart disease and certain cancers due to the high-fat foods emphasized. 
The diets have been proven to work.	Success is documented by personal accounts only.  No scientific studies have been published on these diets.

The fact is, many overweight adults do eat too many calories from carbohydrate-rich foods when they cut back on fat.  The key to healthy weight loss is to cut back on total calorie intake, get more exercise, and choose carbohydrates (whole grains, fruits, and vegetables) that are high in fiber and nutrients.

Do Fad Diets Work?

Some popular weight loss diets may produce weight loss in the short term.  But most of them will jeopardize your health and your permanent weight loss efforts.  Here’s why:

Diet	Claims	What You Do	What’s Wrong With the Diet
Atkins	Eating too much carbohydrate causes high insulin levels.  That causes weight gain.   	Eat mostly meat, poultry, fish, shellfish, eggs, cheese, and low-carbohydrate vegetables.  Eat no more than 20 grams of carbohydrate per day (increase during later phases of the diet).  Take many vitamin supplements.  	High in fat, saturated fat, and cholesterol, which increases risk of heart disease and cancer.  Low in fruits, whole grains, and vegetables (important sources of fiber, vitamins, minerals, and phytochemicals).  Concerns have been raised that this can lead to ketosis (a condition in which the kidneys cannot keep up with filtering the blood of ketones, a byproduct of fat breakdown).  This may stress the kidneys and cause dehydration, fatigue, and headaches.  Depletes stores of glycogen in the liver, an important source of energy for exercise.  Initial quick weight loss is from water loss.  Dramatic loss of body water can require adjustments in medication doses.
Eat Right for Your Type	Lectins (proteins on the surface of certain foods) cause illness and disease.  An example is a condition in which blood cells stick together.	Eat only certain foods depending on your blood type.  For example, if you are type 0, eat meat and no wheat.  If you are type A, be a vegetarian.	Extremely restrictive for certain blood types.  Can cause nutrient deficiencies.  No scientific basis.  No food attacks blood cells after you eat it.  No advice given on portion size.
The Zone	Eating the right combination of foods leads to lower insulin levels and desirable levels of hormones called eicosanoids.  This leads to weight loss and peak performance.  	Eat 40% of calories from carbohydrate, 30% from protein, and 30% from fat.  Build meals with a 1-to-1 ratio of protein to carbohydrate by combining “food blocks.”	No scientific basis.  Weight gain results from eating more calories than are expended, regardless of the source (carbohydrate, protein, or fat).  (The eating plan is low in calories, which would explain weight loss while on the plan.)    Extremely restrictive of many fruits, vegetables, and grains, important sources of vitamins, minerals, fiber, and phytochemicals. 
Carbohydrate Addict’s Diet	High insulin levels cause carbohydrate addiction.  That causes weight gain.	Eat two meals of protein and fat only and one meal with equal proportions of carbohydrate, protein, and fat.  The third meal must be eaten within one hour.	No scientific basis.  Weight gain results from eating more calories than are expended, regardless of the source (carbohydrate, protein, or fat).   High in fat, saturated fat, and cholesterol, which increases the risk of heart disease and cancer.  Low in fruits, vegetables, and whole grains, important sources of vitamins, minerals, fiber, and phytochemicals.  Calorie intake can vary widely depending on the protein and fat foods chosen.
Sugar Busters

	Refined sugar and certain carbohydrate foods cause high insulin levels.  That causes weight gain.   	Avoid insulin-stimulating foods (e.g., potatoes, white rice, corn, carrots, beets, white bread, all refined white flour products).  Do not combine certain foods (e.g., don’t eat fruit with meat).  	No scientific basis.  Weight gain results from eating more calories than are expended, regardless of the source (carbohydrate, protein, or fat).  (The eating plan is very low in calories, which could explain weight loss on the plan.)  High in fat, saturated fat, and cholesterol, which increases the risk of heart disease and cancer.   Portion guidelines are vague.