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Chapter 11. Diet and Health. Photo courtesy of the USDA. Introduction. Infectious diseases Bacteria, viruses, parasites, and other microbes Vaccines and antibiotics have made them less of a risk Degenerative diseases Lifestyle diseases, or the diseases of age

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Chapter

11

Diet and Health

Photo courtesy of the USDA


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Introduction

Infectious diseases

  • Bacteria, viruses, parasites, and other microbes

  • Vaccines and antibiotics have made them less of a risk

    Degenerative diseases

  • Lifestylediseases, or the diseases of age

  • Chronic, irreversible diseases characterized by degeneration of body organs


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Introduction

  • Degenerative diseases far outrank infections as the leading cause of death and illness-in developed nations

    • Degenerative diseases occur as people age from a mixture of risk factors

      • Genetic predisposition

      • Environmental factors

      • Personal medical history

      • Lifestyle choices that in the later years can make the difference between a life of health or chronic disability


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Lifestyle Choices and Risks of Degenerative Disease

  • The exact contribution diet makes to each disease is hard to estimate

    • Many experts believe that diet accounts for about a third of all cases of coronary heart disease

    • The links between diet and cancer incidence are harder to estimate

  • Tobacco, effects everyone’s health


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Cardiovascular Diseases

  • Atherosclerosis (hardening of the arteries)

    • The most common form of cardiovascular disease (CVD)

    • Characterized by plaques along the inner walls of the arteries

    • Plaques damage artery walls making them rigid and narrowing the passage through them

    • Most people have well-developed plaques by the time they reach age 30


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Cardiovascular DiseasesAtherosclerosis

  • Damage may begin from a number of factors interacting with the lining of the arteries

    • High LDL cholesterol

    • Diet high in saturated fat

    • Hypertension

    • Toxins from cigarette smoking

    • Elevated blood levels of the amino acid homocysteine

    • Or viral or bacterial infection


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Cardiovascular Diseases

  • Arteries hardened and narrowed by plaques cannot expand

    • Blood pressure rises & damages the artery walls and strains the heart

  • As pressure builds the artery wall may become weakened and balloon out, forming an aneurysm

    • Can burst and lead to bleeding and death


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Cardiovascular Diseases

  • Abnormal blood clotting is a symptom of CVD

    • Arterial damage, plaques in the arteries, and the inflammatory response can lead to the formation of blood clots

    • A clot may attach to a plaque in an artery and grow until it shuts off the blood supply to the surrounding tissue (thrombosis)

  • Or a clot can break loose becoming an embolus if it lodges in an artery of the heart it causes a heart attack, if it lodges in an artery of the brain, it causes a stroke

  • A diet that has omega-3 fatty acids (EFA) may reduce clot formation


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Cardiovascular Diseases

  • Hypertension and atherosclerosis worsen CVD

    • A stiffened artery is strained by each pulse of blood through it (high internal pressure)

    • Hardened arteries cannot expand, the heart’s beat raises blood pressure

    • Hardened arteries also fail to let blood flow freely through the kidneys, which control blood pressure


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Risk Factors for CVD

  • Age, Gender, and Family History

    • Men: age becomes a significant risk factor for heart disease at age 45 or older

    • Women: age becomes a significant risk factor after age 55

      • After menopause, the rate of heart disease increases 2x-3x

  • Men die earlier of heart attacks than women

  • CVD kills more women than any other disease

  • Early heart disease in immediate family members is a major risk factor

  • The higher the LDL, the greater the risk

  • LDL carries cholesterol to the cells that line the arteries

  • HDL carries cholesterol away from the cells to the liver for other uses and disposal


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    Risk Factors for CVD

    • Hypertension

      • Chronic hypertension worsens CVD

        • The higher the blood pressure above normal, the greater the risk of heart attack or stroke

        • Hypertension injures the artery walls and accelerates plaque formation

    • Diabetes

      • A major independent risk factor for all forms of cardiovascular disease

      • In diabetes, atherosclerosis progresses rapidly

    • Obesity (especially central obesity) and Physical Inactivity

      • Elevates LDL cholesterol

      • Lowers HDL cholesterol

      • Worsens hypertension

      • Worsens diabetes


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    Reducing Risk Factors for CVD

    • Weight loss and physical activity

      • Lower LDL, Raises HDL (Sometimes)

      • Improve insulin sensitivity

      • Lower blood pressure

    • Routine physical activity

      • Strengthens muscles of the heart and arteries

      • Improves the heart’s response to everyday demands

      • Stimulates the development of new arteries to nourish heart muscle

        • An hour a day, as recommended by the DRI, benefits the heart


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    Increased Risk Factors for CVD

    Smoking

    • The more a person smokes, the higher the CVD risk

      • Smoking damages the heart and raises the blood pressure

      • Deprives body tissues of oxygen and increases heartbeats to deliver blood

      • Damages platelets making blood clots a risk

      • Toxins in cigarette smoke directly damage the lining of blood vessels increasing atherosclerosis risk

      • When people quit smoking the risk of heart disease begins to drop within a few months


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    Increased Risk Factors for CVD

    • Metabolic Syndromeaffects ≈47 million people in the U.S.

      • Central obesity

      • Abnormal blood lipids

        • Low HDL

        • High triglycerides

      • Elevated blood pressure

      • Elevated fasting blood glucose or insulin resistance


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    Risk Factors for CVD

    An Atherogenic Diet increases CVD risks

    • Diet high in saturated fats, trans fats, and cholesterol

    • Increases LDL cholesterol

      A diet that lowers the risk of CVD includes

    • Vitamins & minerals

    • Antioxidant phytochemicals

    • Omega-3 fatty acids

    • Viscous Fiber


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    Diet to Reduce CVD Risk

    • Controlling Dietary Lipids

      • Lowering intakes of saturated fat and trans fat lowers blood LDL cholesterol and reduces heart disease risk

      • Saturated fat, including trans fatty acids, should account for no more than 10% of calories

        • DRI recommends: the diet should contain no more that 35% of total calories from fat

        • Others recommend: no more than 30% of total calories from fat

        • Healthy people should limit cholesterol intake to 300 mg a day


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    Diet to Reduce CVD RiskRecommendations

    • Fish oils (omega-3 polyunsaturated fatty acids)

      • Lower triglycerides

      • Prevent blood clots

    • The American Heart Association recommends at least 2 servings of fish per week

    • Plant sources of essential fatty acids also offer benefits on the heart

      • Flaxseed, canola, soybean oils

      • Flaxseed and nuts

      • When diets consists mostly of unsaturated fats with abundant fish, fruits, vegetables and low fat milk blood cholesterol and the rate of death from heart disease is low


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    Diet to Reduce CVD RiskRecommendations

    • Fiber and Phytochemicals

      • The viscous (soluble) fiber of oats, barley, legumes, and pectin-rich fruits and vegetables helps to improve blood lipids

      • Foods rich in viscous fiber provide

        • Minerals to help control blood pressure

        • Antioxidants to help protect against LDL oxidation

        • Vitamins and minerals


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    Diet to Reduce CVD Risk

    • Alcohol (moderate consumption)

      • Research on middle-aged and older people who drink one or two drinks a day with no binge drinking supports the idea that moderate consumption of alcohol will reduce their CVD risk

    • Alcohol (heavy use) more than three drinks a day:

      • Elevates blood pressure

      • Damages heart muscle

      • Elevates the risk of stroke

    • Heart attacks among healthy young people have been associated with alcohol intoxication from heavy weekend drinking

      • the risks from alcohol outweigh any benefit to the heart


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    Diet to Reduce CVD Risk

    • Other Dietary Factors

      • Sterol and stanol esters

        • Block absorption of cholesterol from the intestine

          • Dropping blood cholesterol by about 7%-10%

          • The effect may be as powerful as some medication in lowering blood LDL cholesterol

          • Can reduce the absorption of some potentially beneficial phytochemicals

      • Pharmaceutical doses of a specific form of niacin act like a drug in lowering blood cholesterol

        • The “statin” drugs lower blood LDL, work best in association with a cholesterol-lowering diet and exercise


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    Nutrition and Hypertension

    • Chronic high blood pressure (hypertension) is the most common forms of CVD

      • Affects one-third of the entire U.S. adult population

        • For people age 65 or older, the lifetime risk of approaches 90%

      • Contributes to half a million strokes and over a million heart attacks each year

    • Ideal resting blood pressure is 120/80

      • 130/85 can be considered borderline normal

        • In the absence of other risk factors

      • Above this level the risks of heart attacks and strokes rise


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    High Blood Pressure

    • Risk Factors

      • Atherosclerosis, obesity, and insulin resistance

        • Excess fat means miles of extra capillaries through which blood must be pumped

      • Age

        • Most people who develop hypertension do so in their 50s and 60s

      • Genetics

        • A family history of hypertension and heart disease raises the risk of developing hypertension 2x-5x

      • Environment Africans living in Africa have a much lower rate of hypertension than African Americans living in the U.S.


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    How Does Nutrition Affect Hypertension?

    • Nutrition factors for lowering blood pressure

      • Lower salt intake

      • If overweight, lose weight

      • Moderate alcohol use

      • Increase intakes of fruit, vegetables, fish, and low-fat dairy products

      • Reduced intake of fat

      • Consume calcium, potassium, magnesium

      • Increase physical activity


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    How Does Nutrition Affect Hypertension?

    • DASH (Dietary Approaches to Stop Hypertension) and other similar diets consistently improve blood pressure

      • Recommends significant increases in fruit and vegetable intakes

      • Provides 30% of its calories from fat

      • Emphasizes legumes over red meats

      • Restricts sodium

      • Meets other recommendations of the Dietary Guidelines for Americans


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    How Does Nutrition Affect Hypertension?

    A high dietary intake of salt and sodium is associated with hypertension

    • For people with hypertension, a lower salt (or sodium) intake often leads to a reduction in blood pressure, and reduced or no blood pressure medication

    • Salt-sensitive people often: have a family history of hypertension, are African American, have kidney problems or diabetes, are older, have experienced sustained psychological stress


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    How Does Nutrition Affect Hypertension?

    • Salt, Sodium, and Blood Pressure

      • People who consistently consume diets low in sodium have lower blood pressure than people with higher intakes

      • Recommendation: everyone should moderately restrict salt and sodium intake to DRI committee’s UL/ No more than 2,300 mg of sodium per day


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    How Does Nutrition Affect Hypertension?

    • Alcohol

      • In moderate doses, at first relaxes the peripheral arteries and reduces blood pressure

      • High doses raise blood pressure

      • Hypertension is common among people with alcoholism

    • Hypertension caused by alcohol leads to CVD

    • Alcohol may cause strokes

    • The Dietary Guidelines for Americans recommends moderation for those who drink alcohol

      • No more than one drink a day for women

      • No more that two drinks a day for men


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    How Does Nutrition Affect Hypertension?

    • Calcium, Potassium, and Magnesium

      • Increasing calcium often reduces blood pressure

      • Potassium and magnesium appear to help prevent and treat hypertension

      • Lowpotassium diets are associated with hypertension

      • Magnesium deficiency causes the walls of arteries and capillaries to constrict and may raise blood pressure


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    How Does Nutrition Affect Hypertension?

    • Vitamin C and other nutrients

      • Adequate vitamin C seems to help normalize blood pressure while vitamin C deficiency may tend to raise it

      • Other dietary factors that affect blood pressure

        • Cadmium, selenium, lead, caffeine, protein, and fat are being studied


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    How Does Nutrition Affect Hypertension?

    Dietary recommendations to keep blood pressure low

    DASH diet often reduces blood pressure

    A low-fat diet with abundant fruits, vegetables, and low-fat dairy products that provide the needed nutrients while limiting sodium intake

    If diet and exercise fail to reduce blood pressure, drugs as diuretics and other antihypertensive agents may be prescribed


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    Nutrition and Cancer

    • Cancer ranks second only to heart disease as a leading cause of death and disability in the U.S.

    • Genetics exerts a modest risk on cancer development

    • Lifestyle and environmental factors play a role in the development of cancer

      • Lack of physical activity plays a role in the development of colon and breast cancer

      • If everyone in the U.S. quit smoking future cancers would probably drop by a third

      • Another 15% may be preventable by preventing overweight and obesity


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    How Does Cancer Develop?

    • Cancer is really a disease of the genes

      • Cancer begins with one healthy cell whose genetic material sustains damage from a carcinogen (cancer-causing substance)

      • such as a free-radical compound, radiation or other influences

    • Damage to a cell’s DNA occurs every day

      • But most of the damage is quickly repaired if the damage cannot be repaired and the cell becomes unable to replicate its genome, the cell usually self-destructs

    • Occasionally, a damaged cell loses its ability to self-destruct and also loses the ability to stop reproducing

      • The result is a tumor


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    How Does Cancer Develop?

    Cancer develops through the following steps

    • Exposure to a carcinogen

    • Entry of the carcinogen into a cell

    • Damages to the cell’s genetic material

    • Cells begin to multiply out of control


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    Dietary Factors and Cancer

    • Low rates of many cancers correlate with high intakes of fruits, vegetables, and whole grains

    • Under study for possible effects dietary effects on cancer are: Excess calories, diets high in certain fats, daily use of alcohol, vitamins and minerals, diets in which meat plays a dominant role

    • In studies with humans, evidence is mixed as to whether a diet high in fat promotes cancer

      • Comparisons among world populations reveal that high-fat diets often correlate with high cancer rates (direct relationship)


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    Dietary Factors and Cancer

    • Dietary fat tends to oxidize when exposed to high cooking temperatures

      • They may trigger cancerous changes in the tissues of the colon and rectum

    • The type of fat in the diet may be important

      • Some evidence implicates omega-6 polyunsaturated fatty acids promote cancer

      • Some evidence suggests that omega-3 fatty acids from fish may protect against some cancers


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    Dietary Factors and Cancer

    • Alcohol

      • Cancers of the head and neck correlate strongly with the combination of alcohol and tobacco use

      • Alcohol intake alone is associated with cancers of the mouth, throat, and breast

      • Alcoholism often damages the liver and effects the development of liver cancer


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    Dietary Factors and Cancer …

    • Smoked, Grilled, and Well-Done Meats

      • Red meat may be linked to an elevated risk of developing cancer of the rectum and colon

      • Chemical reactions during the browning of meat at high temperatures, in pan-frying, broiling, or grilling formcarcinogens in the food


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    Dietary Factors and Cancer

    • Fiber and Fluid

      • Epidemiological studies often report links between eating plenty of fruits and vegetables and a low incidence of many cancers

    • A theory is that a fiber-rich diet may protect against some cancers by:

      • Increasing stool weight, diluting the colon’s contents, stimulating bacterial fermentation, and speeding up the transit time of materials through the colon

      • This limits exposure of the colon walls to cancer-causing substances in the feces


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    Dietary Factors and Cancer

    • Bladder cancer may be related to intake of fluids

      • Men who drink about 10 cups of fluid a day develop substantially less bladder cancer than those drinking only about half this amount

      • A greater fluid intake dilutes the carcinogens that naturally form in urine and causes more frequent urination


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    Dietary Factors and Cancer

    • Folate deficiency seems to increase risk of cancers of the cervix and colon

    • Vitamin A

      • Helps to maintain the immune system

      • Identifies cancerous cell and destroys them

    • Vitamin D and exposure to sunshine have been suggested as protective against cancers

      • Except skin cancer

    • Calcium

      • Laboratory evidence suggests that a high-calcium diet may help to prevent colon cancer

    • Taking supplements has not been proved to prevent or cure cancer


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    Dietary Factors and Cancer …

    • A literature review since 1990 showed an association between colon cancer and increased dietary iron intake and highiron stores

      • Iron is a powerful oxidizing substance

        • Oxidation may damage DNA and may initiate cancer

      • Iron supplements are constipating

        • Constipation raises a person’s risk of colon cancer

      • Meat is high in iron

        • High-meat diets often directly correlate with colon cancer

      • If the iron and cancer link holds up the benefits of iron enrichment to iron-deficient populations must be weighed against the harm to those at risk for colorectal cancer


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    Dietary Factors and Cancer …

    • Foods and Phytochemicals

      • The phytochemicals in some fruits and vegetables are thought to be anticarcinogens

      • Some of these may protect against cancer by acting as mild toxins that force the body to build up carcinogen-destroying enzymes


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    Dietary Factors and Cancer

    Population studies find that diets lacking in green and yellow fruits and vegetables and citrus fruits correlate with cancers of many types (inverse relationship)

    • Some evidence suggests that a number of antioxidant nutrients and phytochemicals from a diet rich in fruits, vegetables, and whole grains may be necessary to minimize DNA damage from certain types of radiation

  • A low intake of fruits and vegetables may leave cells unprotected against DNA damage

  • Eating few cruciferous vegetables - broccoli, Brussels sprouts, cabbage, cauliflower, turnips, etc. - is common in colon cancer victims


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    Dietary Factors and Cancer

    • Foods that contain phytochemicals are believed to promote health and fight diseases

      • Such foods are called functional foods

      • Functional foods are any modified food or food ingredient that may provide a health benefit beyond the traditional nutrients it contains.


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    Diet as Preventive Medicine

    • Reduce saturated fat and trans fat intake

      • Limit foods as: high-fat milk and dairy products, stick margarine, high-fat baked goods and convenience foods with sauces, commercially fried foods, fat-marbled meat cuts, sausages, and fatty ground beef

    • Increase the essential fatty acids

      • Include foods as: nuts, olive oil, canola oil, and liquid margarines. (They are high in calories, use them only within your daily calorie budget.)

      • Include fish: particularly fatty fish which helps to balance intakes of omega-6 and omega-3 fatty acids


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    Diet as Preventive Medicine

    • Include Fruits, Vegetables, and Whole Grains

      • For nutrients and the phytochemicals that combine synergistically to promote health

      • The “5 A Day” program recommends eating 5 to 9 servings of fruits and vegetables each day to support health

    • Go for Variety

      • Eat foods high in potassium (whole foods), high in calcium and magnesium, low in fat, high in fiber

      • If you are prone to hypertension, experts advise that you eat fewer high-sodium foods and less salt

      • If you switch from food to food, you are diluting whatever is in one food with what is in the others (possible toxins)

      • If something is lacking in one food it may be in another

      • It is safe to eat some salty foods, smoked or grilled meats but not all the time

      • Be Physically Active


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    The Obesity Epidemic - How Can We Gain Control?

    • There are 97 million overweight and obese people

      • They are at increased risk of serious illnesses as heart disease, diabetes, arthritis, cancer, etc.

    • There are 300,000 early obesity-related deaths per year

    • $60 billion spent on obesity-related health care


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    The Obesity Epidemic

    • Why Has Our Society become Obesity-Prone?

      • Many people regularly overeat large portions of inexpensive high-calorie foods

        • Consuming about 500 calories more daily than in 1970

        • At the same time they have grown accustomed to leisure time in front of television sets, labor saving devices, and jobs requiring more sitting than moving

      • 25% of people get little or no physical activity


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    The Obesity Epidemic

    More women are in the workforce and the hours for all wage earners have increased

    • There is less time for meal planning, grocery shopping, and preparation of meals from fresh foods

    • More people rely on prepared or partially prepared foods to save time and effort

    • Along with convenience, manufacturers often include flavorful ingredients such as salt, sugar, and fat and remove fiber


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    The Obesity Epidemic

    • Food Advertising

      • The food industry spends more than $33 billion each year on advertising, trade shows, special product promotions, fees to supermarkets to ensure prominent product placement, attractive packaging, games and prizes, and other efforts to attract consumer dollars

      • Compare this to the $1 billion spent by the National Cancer Institute to promote fruit and vegetable intake


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    The Obesity Epidemic

    • The “Buy More” Strategy

      • To increase food sales marketers must convince consumers to buy their brand over others

        • A proven strategy is to appeal to their economic sense

        • Offering more food for just a little more money pays off in greater profits

        • To a consumers, a deal seems better if significantly more food can be obtained for just a few cents more

  • Portion sizes and obesity rates have increased proportionately over the years

  • Along with restaurant food, prepared food portions have grown larger, and most portions exceed recommended sizes

  • Food supersizing strategies are a tremendous financial success wherever they are employed


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    The Obesity Epidemic

    Marketing to Children

    • The food industry spends almost $12 billion annually promoting high-calorie fast foods, fried snack foods, high-sugar cereals, candies, and soft drinks during children’s television viewing hours and in other media

  • Techniques used to sell foods and other products to youth include

    • Manipulating children’s emotional and physical needs as their needs for peer acceptance, love, safety, and security and their desire to be independent, to act older, and to develop an identity


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    The Obesity Epidemic

    Does The Food Industry Cause Obesity?

    • Is the food industry similar to tobacco companies in harming people’s health?

      • The evidence against tobacco smoke as a cause of diseases is ironclad, even when the products are used as intended

      • Individual foods are unlikely to be found to cause obesity because many people eat them in moderation and remain lean


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    The Obesity Epidemic

    • Tobacco smoke is a toxic, addictive, and unnecessary hazardous substance

    • Food is necessary for life

      • Even fast food provides some nutrients and is tolerated by the body when eaten in moderation

      • The fast food industry provides a service of preparing foods for today’s families who cannot or choose not to prepare foods at home


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    The Obesity Epidemic

    • The president of the national association representing restaurant owners stated

      • “Restaurants have a wide variety of choices on their menus, and people make the choice to eat what they want and when they want every day. This is all about personal responsibility and moderation.”

      • Other spokespeople argue that the cause of obesity is the Americans’ lack of exercise, rather than the availability of certain food products or the prevalence of advertising

    • New Menu of Choices

      • Many food companies have recently added lower-fat, lower-calorie products to their lines, others have eliminated the largest of the overlarge portion options


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    The Obesity Epidemic

    • Can Government Actions Reverse Obesity Trends?

      • Many government resources and private money have been spent over the years on developing initiatives to reverse obesity in the U.S.

        • Since 1950, at least 35 consumer education reports have specified sound weight-control practices as essential to maintenance of good health

        • Not one of these public health efforts has succeeded in slowing obesity rates in this country


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    The Obesity Epidemic

    • Previous initiatives that focused on individualresponsibility failed to acknowledge the societal factors that place barriers in the path of those who try to follow health-promoting advice

    • Individuals are ultimately responsible for their own behavior, but in the current social environment, few are prepared to choose behaviors that support health when doing so is difficult


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    The Obesity Epidemic

    • Nutrition Education

      • A law passed in 1977 mandates that federal funds be supplied to states for training teachers and school foodservice workers and to teach basic nutrition science to the nation’s schoolchildren

        • Although the law still exists, money to deliver nutrition information is inadequate

    • The Healthy People 2010 report sets a goal of increasing the proportion of schools that provide a minimum of three years nutrition education for the nation’s children

      • Including such skills as balancing food intake with physical activity


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    The Obesity Epidemic

    • New Ideas for Change

      • When healthy foods cost less, people choose them more often

        • One suggestion is to use monetary incentives to encourage food producers and consumers to make healthier food and exercise choices

        • This plan would raise taxes on high-calorie, high-fat, high-salt foods, sugary sodas, candies, and fried snack foods

        • These tax revenues could then subsidize purchases of health-promoting foods or education programs

    • If consumers choose more of the less costly healthier items, manufacturers will respond by making then available in greater varieties and market them more heavily


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    The Obesity Epidemic

    • Using this idea, taxing automobiles and other labor saving devices that rob people of the exercise they need. Use the money for purchasing and bicycles, exercise equipment, and walking shoes

      • This could lead to a healthy restructuring of our whole society into one that promotes fitness rather than obesity


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    The Obesity Epidemic

    • Conclusion

      • On hearing of economic plans such as the one just outlined, many people react with skepticism and resistance

        • They believe that in a free-market society, citizens are capable of making decisions in their own best interest and do not need the government to step in and restructure their lives


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    The Obesity Epidemic

    Consumers can choose to live as though such incentives were already in place

    Consumers Can

    • Turn off the television and take up a physically active recreation

    • Choose to live close enough to shopping, work, and school to allow walking as an option

    • Park farther away than usual and walk through the parking lot

    • Lobby for laws that require landscaping, trees, and walkways in parking lots to make them safe and inviting

    • Seek out and use stairways instead of elevators

    • Take walks and get to know the neighbors


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    The Obesity Epidemic

    • Write letters to building owners, asking them to improve stairwells and access to them

    • Obtain an inexpensive pedometer and vow to walk 10,000 steps each day

    • Make a point to remember standard portion sizes and use them to decide how much to eat at a sitting

    • Take some of the food home for another meal when restaurant portions are too large

    • Lobby lawmakers to fund nutrition education classes and physical education classes

    • Pressure schools to replace candy and soda with fruit and low fat milk options and to reverse the trend toward hiring fasts-food companies to provide school lunches for children


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