Yesterday’s ‘Large’ becomes today’s ‘Small’

 by Peter Janiszewski, MSc, PhD Candidate
Peter is a PhD candidate in the School of Kinesiology and Health Studies at Queen's University. For more health and fitness news, visit his website at obesitypanacea.com

ALOYAL READER, BECKY MERCER, brought our attention to a seemingly dishonest change that has occurred in portion sizing at the Wendy’s fast-food chain. Apparently, Wendy’s has made the health-conscious change to reduce their default size of fries and soft drinks which accompany a combo from the “Medium” to “Small”. Unfortunately, as Becky rightfully noticed, and what has been previously written about in the US, this change was only one of name and not actual portion size. Thus, rather than decreasing some of their ludicrous portion sizes of both fries and drinks, Wendy’s has instead opted to make the following semantic alterations:

Old ‘Medium’ = New ‘Small’
Old ‘Biggie’ = New ‘Medium’
Old ‘Great Biggie’ = New ‘Large’

This sort of stunt is reminiscent of some of the tactics employed by ‘Big Brother’ in George Orwell’s “1984”. Unfortunately, we today are just as vulnerable to these tactics as were the drones in Orwell’s dystopian fantasy: our reader, Becky was apparently commended on being ‘healthy’ by sticking with the default ‘small’ drink and fries with her meal, which really are the ‘medium’ drink and fries of yesterday. As Becky writes in her email, “apparently the word ‘small’ is enough to make people think that what they are consuming actually is small.” This, of course, despite the fact that a ‘small’ drink consists of 37 g of pure sugar while ‘small’ fries contains 340 kcals, half of which are derived from fat.

Now if you are feeling REALLY hungry and were previously ashamed to order a ‘Great Biggie’ drink and fries – fret no more! You can now get the combined 820 kcals of sugar and fat with your order of the less stigmatizing ‘large’ drink and fries.

Way to go Wendy’s!

While this is news to both us and Becky, apparently this change occurred in US Wendy’s locations over 2 years ago – the same may have happened in Canada. Thus, if this is old news to regular Wendy’s customers, I do apologize for being so behind the times.


On another sizing note, recent news from the UK suggests that many children’s clothing manufacturers are attempting to change the sizes of their clothes to accommodate the larger bodies of today’s youth. Apparently, today’s youth clothing sizes are designed based on the average proportions of children from 1990 and are usually sold by age ranges (i.e. 7-8 years). Given the drastic increase in the proportions of today’s kids, parents of 7-8 year olds have had to purchase clothing for 10-11 year olds to accommodate their children’s expanding waistlines.

In response, a number of clothing stores in the UK are performing a survey of 6000 boys and girls to get a better idea of what a typical 7 year-old of 2009 looks like in contrast to what he/she may have looked like 20 years ago.

So now you can eat an order of medium fries but not feel bad about it because it comes in a container labeled ‘small’ and soon enough morbidly obese kids will be able to fit into a ‘small’ pant size for their age.

The obesity epidemic is cured by an easy shift in perceptions as Orwell turns in his grave.

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The doable paths to thinness — A study that found the magic amount of exercise needed to keep pounds off — 275 minutes a week — demonstrates, inadvertently, how steep is the public-policy challenge in reducing obesity. It may be that the battle is doomed, as currently conceived, and we would be better off focusing on how to live healthier lives while overweight or obese.

Why close to impossible? Because 275 minutes a week is 55 minutes a day, five days a week. Add in 10 minutes a day for stretching, and 20 minutes for a shower (the scientists who did the study never said anything about shower time or stretching), plus transportation time to tennis courts, swimming pools and the like, and people would need to reserve at least an hour and a half to two hours a day, five days a week, for exercise.

And even that is not enough, on its own, to accomplish much. The 196 women in the study, some of them overweight and some obese, were asked to limit themselves to 1,200 calories a day (unless they were supersized, in which case they were permitted 1,500); no more than 30 per cent of those calories could be fat. And only if they stuck to this insanely strict regimen for two years, did they succeed in keeping weight off.


How many people could do such a thing? Not many in the study, led by John Jakicic of the University of Pittsburgh and published in the Archives of Internal Medicine's current issue. And these were, one presumes, highly motivated people. The participants were all drawn from the ranks of a weight-loss clinic. They were each given a motorized treadmill for their home. They held group strategy sessions and were telephoned regularly. And even then just 47, or 25 per cent, were able to lose 10 per cent of their body weight and keep it off.

Most people lack the desire, discipline or time to devote an hour and a half five times a week to exercise, let alone to eat like a prisoner of war for the rest of their lives, so they throw up their hands and do nothing. Dr. Jakicic must be a utopian. "This shouldn't be discouraging. It can be done." Yes, it can, but it would take a complete overhaul of how our society is structured — of family life, school and work.

Obesity is a serious problem in North America and around the world (even in developing countries); obese people are at greater risk than others of heart problems, diabetes and some cancers. And all those problems add to the strains on health systems worldwide. But there's a danger in setting overambitious targets that tell people, in effect, that if they fall outside the normal-weight range on the Body Mass Index, they need to make drastic changes to their lives. The implicit message is that anything less isn't worthwhile.

The answer is to look for something doable. "The most compelling alternative strategy is an increase in non-exercise activity," two doctors say in a commentary that follows Dr. Jakicic's study. "Striking differences in non-exercise activity have been shown between thin 'couch potatoes' and heavy 'couch potatoes.'" The thin ones are on their feet and moving about for 150 minutes more than the heavy ones. Even walking at one mile per hour burns 125 calories an hour, the doctors say.

Rather than wait for the revolution, everyone would be better off rebelling against the sedentary lifestyle that has overtaken so many people, by taking even small steps to try to improve their cardiovascular fitness, no matter what one weighs.

Beyond the BMI — A Canadian doctor has helped create a new way to gauge the health of obese patients — one that goes beyond simply measuring how much body fat someone is carrying.

Edmonton's Dr. Arya Sharma says obesity is about more than fat, which is why he's developed a system to complement the widely used body mass index.

While the BMI is good at giving patients and doctors a general idea of how much body fat a person has, Sharma said the calculation, which is based on height and weight, doesn't adequately reflect someone's health.

Two people with BMIs of 34, for instance, are both considered obese, but one might have high blood pressure, sleep apnea and diabetes, while the second person could be healthy and quite active.

"There's not a clear relationship between the amount of body fat a person might have and the magnitude to which that body fat affects their health or life," Sharma said.

"Just knowing someone's fat (level) or knowing someone's BMI alone is not a good marker on how severe the obesity is or how best you treat that obesity."

He and a colleague in Chicago have created a new categorization system. It pairs the three classes of BMI — where Class 3 is the heaviest, but not necessarily the worst — with five new "stage" rankings that reflect overall health.

Stage 0 would be someone with no health problems. Stage 1 would be someone with such conditions as snoring or borderline hypertension.

Stage 2 and 3 would be someone whose condition is worsening, possibly risking a heart attack, liver cirrhosis, sleep apnea or the need for hip or knee replacement.

Stage 4 patients would have so many medical problems they would need extremely aggressive treatment or palliative care because losing the weight would be so difficult.

Using the two systems together would mean someone could have a Class 3 BMI, but only be at Stage 0 — heavy, but relatively healthy. Doctors would encourage that person to lose weight, but not suggest stomach surgery or prescription drugs.

Medical advice would become much more urgent for someone at Class 3, Stage 3, where bariatric surgery — also known as weight-loss surgery — might be necessary.

"That staging system will not differentiate how big people are, but about how sick people are," said Sharma, whose new system appears in February's edition of the .

"It helps (patients) in terms of recognizing how obesity is affecting their health."

100 Steps Per Minute

YYou should be taking 100 steps each minute for half an hour a day if you want to achieve "moderate" exercise by walking, a study shows. A US team reached the figure after measuring the body's oxygen demand in some 100 people walking on a treadmill.

They wrote in the American Journal of Preventive Medicine that a pedometer alone was not enough to gauge exercise as it gave no data on intensity.

US and UK guidelines urge half an hour of moderate exercise five days a week.

But there is often confusion as to what constitutes moderate exercise, and the amount of gardening, housework or walking needed to confer health benefits.

Researchers at the San Diego State University based their conclusions on exercise tests given to 97 healthy adults who had an average age of 32.

In general, men needed to walk at a pace of 92 to 102 steps per minute to achieve a moderately intense workout for their hearts. The range for women was between 91 and 115 steps per minute.

"Because health benefits can be achieved with bouts of exercise lasting at least 10 minutes, a useful starting point is to try to accumulate 1000 steps in 10 minutes, before building up to 3000 steps in 30 minutes," said Simon Marshall, lead researcher.


A pedometer was not useless, but should be used in conjunction with a wristwatch to work out how many steps were being taken.

Gary O'Donovan, lecturer in sport and exercise medicine at the University of Exeter said: "Regular physical activity is important for health and well-being and brisk walking is a great way to start.

"Most pedometers don't provide a measure of intensity, but Dr Marshall's team has identified a simple and effective method to ensure that every step counts."

Ken Fox, professor of exercise and health science at Bristol University, warned however that while 100 steps per minute was a good target for healthy walkers, it would be "dangerous to make this an across the board recommendation.

"We should note that the study was conducted on healthy young adults. People who are overweight or obese — which is the majority of middle to older adults — are working harder in order to carry their weight for any walking speed. They will need to down grade their speeds accordingly."

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More physical activity needed — Greater amounts of physical activity than currently recommended may be necessary to prevent people from gaining weight, and to help them lose weight and keep it off, according to updated guidelines issued by the American College of Sports Medicine (ACSM).

"In the midst of a genuine crisis in Americans' health related to what we eat and how little we move, these guidelines are meant to provide an understanding and clarification of the role of physical activity and its relationship to weight," Dr. Joseph E. Donnelly of the University of Kansas in Lawrence and chair of the advisory committee noted in a statement.

"Now that we have the latest information on how much physical activity is part of the equation, we can continue the educational process to help people who struggle with their weight," Donnelly added.

In a 2001 position paper, the ACSM recommended a minimum of 150 minutes per week (roughly 30 minutes per day 5 times per week) of moderate-intensity physical activity for overweight and obese adults to improve health; however, 200 to 300 minutes per week was recommended for long-term weight loss.

"More recent evidence has supported this recommendation and has indicated that more physical activity may be necessary to prevent weight regain after weight loss," reads the ACSM's position paper published in the latest issue of the College's journal Medicine & Science in Sports & Exercise.

Specifically, evidence published after 1999 indicates that between 150 and 250 minutes per week of moderate intensity physical activity is effective in preventing weight gain greater than 3% in most adults but will provide "only modest" weight loss.

Greater amounts of weekly physical activity — in the order of 250 minutes or more per week — have been associated with "significant" weight loss, the ACSM notes. Overweight and obese adults will most likely lose more weight and keep it off with at least 250 minutes per week of exercise.

The ACSM also recommends strength training as part of a health and fitness regimen. "Resistance training does not enhance weight loss but may increase fat-free mass and increase loss of fat mass and is associated with reductions in health risk," the writing committee notes.

Dieting combined with increased physical activity will increase weight loss as compared to dieting alone.

Danger of Obesity in Pregnancy — Obese women are more likely to give birth to children with spina bifida, heart problems, cleft palate and a number of other defects, British researchers said on Tuesday.

The findings published in the Journal of the American Medical Association underscore obesity's role as a major health problem and add to evidence that being too heavy while pregnant carries risks for both mother and child.


Katherine Stothard and colleagues from Britain's Newcastle University combined data from 18 studies to look at the risk of abnormalities of babies whose mothers were obese or overweight.

Obese women were nearly twice as likely to have a baby with neural tube defects, which are caused by the incomplete development of the brain or spinal cord, the study found. For one such defect, spina bifida, the risk more than doubled.

The researchers also detected increased chances of heart defects, cleft lip and palate, water on the brain and problems in the growth of arms and legs.

There were hints the same may hold true for overweight women too but the data did not turn up enough evidence for the team to reach any firm conclusions.

Researchers stressed that because birth abnormalities affect only about two to four percent of pregnancies, the absolute risk for obese women remains low.

"Obesity increases the risk of many pregnancy complications, and this article further clarifies that obesity impacts the risk of birth defects, especially neural tube defects and congenital heart defects," said Loralei Thornburg of the University of Rochester Medical Center in New York, who was not involved in the study.

The World Health Organization classifies around 400 million people around the world as obese, including 20 million under the age of five, and the number is growing.

Obesity raises the risk of diseases such as type 2 diabetes, heart problems and is a health concern piling pressure on already overburdened national health systems.

Recent research has tied weight to other problems during pregnancy. A team from the Rand Corp think tank in California reported in 2008 that women who get pregnant after weight-loss surgery tend to be healthier and less likely to deliver a baby born with complications compared to obese women.

Further study may show how obesity may cause these problems, Judith Rankin, a Newcastle University researcher who worked on the study, said in a telephone interview.

"Women who are thinking about trying for a baby need to check their own weight first and then think about seeking help if they are overweight," Rankin said.

Dieting Tips From the Over-100 Crowd

BRITAIN'S OLDEST WOMAN, Florence Baldwin, who turns 113 on Tuesday, puts her longevity down to a daily fried egg sandwich. It's one of many dietary tips from those who have reached three figures.

Everyone wants to live to a ripe old age — and it doesn't take a dietary expert to know that eating healthily does that ambition no harm.

But ask anyone who has actually reached the magic 100 how they got there, and their dietary tips don't always square with the official advice. So we asked Dr Elisabeth Weichselbaum, of the British Nutrition Foundation, to cast an eye over a selection of centenarians' staples.

1. HERRING AND ORANGE JUICE

Dutch woman Hendrikje van Andel-Schipper, who lived to the ripe old age of 115, swore her longevity was down to a daily dose of herring and a glass of orange juice.

Herring is a good source of omega 3 fatty acids, "which are really good for your heart and the whole cardiovascular system," says Dr Weichselbaum. "And that can help you avoid heart attacks for a long time."

"Orange juice — if you only drink a glass a day — provides you with Vitamin C and a lot of antioxidants."

2. VEGETABLES

The traditional mealtime exhortation to "eat your greens" has the ultimate champion — "120-year-old" Israeli Arab Mariam Amash, who has allegedly notched up six score years thanks to lots of vegetables.

No admonishment from Dr Weichselbaum, who says: "Green vegetables provide you a lot of important vitamins and minerals like iron and carotene and dietary fibre, and vegetables reduce the risk of heart disease and cancer. Make sure you eat a full range of coloured vegetables in a balanced diet."

3. CUSTARD CAKES

One out of left-field by Japanese centenarian Mitoyo Kawate, who ascribed some of her 114 years to a regular intake of custard cakes. Japanese custard's health-giving qualities (we're basically talking a straight-up-and-down recipe of sugar, water, butter and vanilla extract) do not figure prominently in the world's good eating guides. An oversight?

The brow of Dr Weichselbaum furrows: "It depends on how many she'd eaten. It's probably not the custard cakes that made her live so long, but if it was as part of a balanced diet then there's no need to cut out the sweets."

Mrs Kawate, it appears, has gone to her grave giving custard the credit for all the hard work green tea and sashimi were doing.

4. ALCOHOL

There's no shortage of volunteers happy to lay the secret of a long life on the odd tipple. Lucy d'Abreu, for instance, who passed away in Scotland aged 113, believed it was her "customary sun-downer of brandy and dry ginger ale" that helped her avoid an early death.

According to Dr Weichselbaum, alcohol in moderation "has been shown to lower the risk of heart disease but it can increase the risk of some forms of cancer." Perhaps it was the ginger ale ...

5. SAUSAGE IN BREAD

Rural Ukrainian Hryhoriy Nestor's greatest extravagance was a slice of sausage in a bread roll — he ate a simple diet of home-made food like cabbage and sausage and warm potato and herring. He never married and led an active life on his farm in the west of Ukraine to the last.

Dr Weichselbaum is resistant to the suggestion of sausage as a lifesaver. "I would say eat processed meat in moderation — eat sausages in moderation in a balanced diet with plenty of vegetables."

6. BREAD, DRIPPING, SALT

Yorkshirewoman Ada Mason's longevity tip is a one-woman two-fingered salute to the healthy-eating brigade. She lived to 111 thanks to "eating bread and dripping every day — lots of it with lots of salt on," according to her grand-daughter.

"In this case I'd say if she ate a lot of this she managed to become 111 despite the dripping and salt," exclaims Dr Weichselbaum. "Dripping is not only pure fat but high in saturated fats which raises the risks of heart disease, and the lots of salt leads to high blood pressure which is also a heart disease risk."

7. PORRIDGE

The traditional Scottish breakfast has many a cheerleader in the healthy eating camp, and Scot Annie Knight was no stranger to an oat-based start to the day — she claimed it helped her reach the age of 111.

"Food like this should make up a third of our diet," says Dr Weichselbaum. "Porridge is a great source of fibre — and if you have it with milk it's a great source of calcium too."

8. BOILED RICE AND CHICKEN

No booze for retired silkworm breeder Yukichi Chuganji, who lasted until the respectable age of 114 despite an aversion to vegetables. Meat and milk were on the list, but his favoured dish was boiled rice with pieces of chicken.

"Rice is a great source of starch, and if it's wholemeal rice it's a very good source of fibre, vitamins and minerals," says Dr Weichselbaum. But she adds: "It is important to have a variety of vegetables in your diet." That's you told, Mr Chuganji.

9. COTTAGE CHEESE

Sakhan Dosova is, Kazakhstani authorities say, the world's oldest woman. She has allegedly just turned 130 — a good 16 years older than the next-oldest person on the list. She stays away from sweets and instead is partial to cottage cheese.

"Cottage cheese is a good source of calcium, which is great for your bones and teeth," says Dr Weichselbaum. "Its fat content is relatively low compared to other cheeses — it contains about half of the fat you find in cheddar cheese. I can't really comment on bacterial strains they may have used in this region."

10. DONKEY MILK

You might have a to wait a while to find this in the aisle of your local Tesco, but apparently Ecuadorian Maria Esther de Capovilla's age of 116 was down to her regularly drinking the milk from the family donkey as a child.

Cue the sound of heads being scratched at the British Nutrition Foundation... "I can't really comment on this," Dr Weichselbaum admits.

But how crucial is diet to a long life? Experts agree that the food you eat can only go so far in affecting your life span.

Dr Aubrey de Grey, whose Methuselah Foundation is funding research into regenerative medicine for aging through stem cell and gene therapy research, cautions against adopting the centenarian diet plan wholesale.

"My favourite answer is one given by the person who has lived the longest, Jeanne Louise Calment. She was asked what's your secret every year for years from a million journalists. When she was 120 she said it was because she gave up smoking — when she was 117!

"The problem is we don't really know. There are things we know shorten your life, such as smoking and if you're overweight."

The average number of people dying at, for instance, the age of 85, is less today than it was 20 or 30 years ago. But people now living to a grand old age — 100 years and over — are doing so thanks to things in early life, such as their mother's good nutrition when carrying them and lack of stress in very early life, says Dr de Grey.

It's these early factors which are likely to have the most dramatic effect, rather than popping supplements and cod liver oil, he says.

Good food and exercise only build on the start we get in life. And even if it may not be as important as what happened very early on, Dr de Grey says, the members of this long-lived club also seem to share another trait.

"If there's one thing we can say about centenarians, it's that nothing bothers them."

N E W S  N U G G E T S  3

Frankenfood: WHOLE chicken in a can — [With permission from Yoni Freedhoff's Weighty Matters blog] If you needed one more reason why Armageddon's a bad thing here's a food that I imagine when the world is gone you'll be willing to fight your neighbour gladiator style for the privilege of eating — Whole cooked chicken in a can!

The pictures are astounding.

I've clipped just two — you really owe it to society to click through to see the rest.


Here's the view when you open the can »









« Here's the can giving birth

No nukes!

Health Canada does NOT advise you to stop taking Hydroxycut — [With permission from Yoni Freedhoff's Weighty Matters blog] By means of example as to just how pathetic Canada's natural health product laws and regulations are one needs to turn no further than the recent Hydroxycut recall.

In case you're unaware, on May 1st the FDA warned consumers to immediately stop taking 19 different Hydroxycut products due to adverse effects including liver failure and death.

So what happened in Canada?

On May 1st Health Canada issued a press release stating that they were looking into the issue.

Then on May 3rd they issued an advisory that does not in fact advise Canadians to stop taking Hydroxycut. Instead they have this generic line,

"Health Canada advises consumers not to use any unauthorized health products, as they may pose a risk to health. Authorized health products will bear either an eight-digit Drug Identification Number (DIN), a Natural Product Number (NPN), or a Homeopathic Medicine Number (DIN-HM) on the label." Why such a non response? Because there is no Canadian mechanism or government body that oversees Hydroxycut products. Meaning that even though they're not "authorized", clearly there's nothing stopping companies like Iovate Health Sciences (the makers of Hydroxycut) to sell whatever they want, with whatever claims they want, in Canada. All that said, I still can't help but scratch my head at the fact that Health Canada still hasn't told Canadians to stop taking Hydroxycut. I wonder if they're worried about being sued by Iovate?

Hey here's a conundrum. what if the folks currently taking and buying hydroxycut don't read health canada bulletins? what if one of those folks develops serious complications?

I'd recommend they sue our government for failing to provide even the smallest amount of due diligence on a drug that even the manufacturer has decided is deadly enough to voluntarily recall it.

Doesn't health canada have an obligation to review all products sold to canadians purporting to affect their health?

Speakwell has obtained permission from the following writers to reproduce some of their material in our WELL Newsletter. Please visit their sites:

Dr. Yoni Freedhoff: Obesity expert and medical director of the Bariatric Medical Institute in Ottawa, Dr. Freedhoff is one of Canada's most outspoken nutrition watchdogs and appears regularly in national media to advocate for healthier living. bmimedical.blogspot.com.

Dr. Arya Sharma: Widely recognized as one of Canada's leading obesity experts, Dr. Sharma was recently appointed Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta in Edmonton, Canada. Dr. Sharma passionately believes in educating the public on this chronic disease. drsharma.ca

Peter Janiszewski: A PhD candidate in the School of Kinesiology and Health Studies at Queen's University. For more health and fitness news, visit his website at www.obesitypanacea.com .