Insights from the Editor

We've all heard the usual explanations for Americans' expanding waistlines – everything from too many carbs to too little exercise. But might hardware stores and hair salons also be responsible? The idea isn't as farfetched as it may seem.

Virtually everywhere we go these days – pharmacies, bookstores, banks, airports, auto repair shops – there's food. And much of it is in the form of high-calorie snacks like sodas, candy, cookies, muffins, frozen sweets, and chips, all of which can be hard to resist.

A new study, published in the American Journal of Public Health, provides startling evidence of just how ubiquitous these temptations are. The researchers sent volunteers to visit more than 1000 retail stores in 19 U.S. cities. They found that snack foods were available in 41 percent of businesses, often close to the cash register.

Some of the stores were places you'd expect to find food, such as pharmacies and gas stations. But many others were not. More than one in five furniture stores sold snacks, as did 16 percent of clothing stores, 54 percent of car dealerships, and 55 percent of home and garden stores.

Let's assume you're exposed twice per week to these temptations and succumb just 10 percent of the time, buying a typical snack containing 250 calories. The researchers calculated that this would add up to 2600 extra calories a year. Keep doing this for several years, and before you know it, you're packing on pounds.

As this video shows, the more accessible that snack foods are, the more we tend to eat. Unfortunately, steering completely clear of them isn't an option (unless you're willing never to leave your house). One solution is to become more mindful of what and how much we're eating and to think twice before we buy. If that big muffin at the bookstore is beckoning you, try counting to ten and asking yourself "am I really sure I want to eat this?" Often the answer will be no, and you can summon the willpower to skip the snack.

It's also a good idea to carry healthful, lower-calorie snacks with you. That way, when the sight of an oversized cookie gives you the urge to eat, you can grab an apple or a handful of nuts. And by not blowing money on snacks in the store, you'll have a little more to spend on what you came to buy in the first place.

Dining out with a dietitian is a bit like being behind the wheel of a car with a driver's ed instructor in the back seat. The pressure's on to make a good impression. While the burger and fries may be calling your name, you probably end up going for the grilled fish and steamed veggies. It's far less likely to raise eyebrows.

In her blog, Everwell's registered dietitian Carolyn O'Neil describes a recent meal with a group of fellow nutrition experts. She writes that "there were impassioned pleas for splitting entrees, sauce on the side, spinach steamed not creamed, salads sans croutons, and probing questions about how much oil is brushed on the broiled fish."

For Carolyn, the experience wasn't intimidating as it would be for most of us non-dietitians. But it did provide an opportunity to pick up some tricks for eating out on a diet. Here are five that she shares:

1. Start with soups that aren't creamy. They're usually low in calories and help fill you up.

2. Ask the wait staff to remove, or better yet, never bring free foods such as bread and chips to the table. Otherwise, you can consume hundreds of calories before you even get your main dish.

3. Choose only one starch. If you want the bread, skip the potato. If you want the chips, skip the rice and beans.

4. Never assume grilled, baked, or broiled means without butter or oil. Always ask questions of the wait staff. Most chefs add extra butter even when not necessary.

5. Share an entrée or ask the server to put half your meal in a to-go container.

For advice from Carolyn on eating healthfully at fast food restaurants, check out this video.

Resolved to get healthier in 2010? If so, good for you. Of course, the big challenge with any resolution is following through. When it comes to health resolutions, there's another one: making sure you're following sound advice.

Too often, the health advice we get is filled with hype, half-truths, and spin. While we think we're helping ourselves, our efforts may actually be wasting time and money, and doing little to promote our health. They may even cause harm.

Here are some pitfalls to avoid for three common resolutions.

1. LOSE WEIGHT
We're bombarded with ads for weight loss plans that promise dramatic results, and bookstore shelves bulge with guides that offer all kinds of "secrets" to help us shed those unwanted pounds. The sad reality is that there are no magic bullets for weight loss, and over the long term, dieting rarely works. About 95 percent of dieters eventually regain lost weight.

One reason is that most diets leave us feeling deprived, and we fall back on our old eating habits. Another is genetics. No matter how much they diet, people prone to be heavier are unlikely to become skinny, and even if they do shrink substantially, their bodies eventually return to a higher weight. (Just ask Oprah.) This doesn't mean we're completely powerless regarding our weight, just that there are limits to how much we can control.

If you've tried and failed at counting calories, cutting out carbs, or combining foods, consider a different approach: focus on eating healthfully (meaning more fruits, veggies, and whole grains, and less junk food) and getting more physical activity. Unlike many diet plans, this method offers no guarantees to melt away pounds quickly. But it will make you healthier, give you more energy, and help you feel better.

2. EAT BETTER
Every day, it seems we hear about another food that we're supposed to eat to ward off illness. Acai berries, pomegranate juice, green tea, dark chocolate, yogurt, garlic, tomatoes. The list goes on and on. While there's nothing wrong with most of these foods–indeed many are quite healthful–the claims for them tend to be overblown.

In recent years, there's been an explosion of research on all kinds of constituents in superfoods–everything from alpha-linolenic acid to zeaxanthin. Though this line of inquiry is interesting scientifically, it's still in its infancy. Because foods contain multiple nutrients, which may interact with one another and with other foods to affect our bodies in a myriad of ways, teasing out the precise effects of a single constituent in one food is tricky, to say the least. But that hasn't stopped superfood promoters from pushing the misleading idea that specific foods, in isolation, are proven to keep us healthy.

While it's tempting to believe that tossing some blueberries into a cup of ice cream will keep heart disease at bay, what matters in the long run is our overall diet–not whether we include one specific food or another. Instead of stuffing yourself with superfoods, focus on broad categories–fruits, veggies, whole grains, fish, legumes–that constitute a healthful diet. When you can choose a variety of foods you like, rather than specific ones you feel compelled to consume, it makes eating far more enjoyable.

3. EXERCISE
We've all seen those ads for gadgets promising to give us rock-hard abs or thinner thighs. Targeted exercises can in fact strengthen muscles in a particular area, but they can't get rid of fat that covers those muscles. How quickly and easily fat disappears depends on where it's located, as well as your age, gender, and genes. But in any case, it requires vigorous, whole body exercise. Unfortunately, you can't spot reduce flab with ab crunches or leg lifts alone.

Likewise, you generally can't reshape your body with moderate exercise. Yet that's sometimes the promise we get from fitness clubs or personal trainers. Certainly, a half-hour a day of walking on a treadmill or riding a bike is highly worthwhile; it can provide an array of benefits from improved heart health to increased energy. But don't expect it to give you a perfectly-sculpted body. Changing your physique requires far more intense, sustained activity.

False promises about exercise create unrealistic expectations that eventually lead to disillusionment. After failing to get the results we're led to expect, we may give up entirely. Don't let that happen to you in 2010. Set reasonable goals–and get going!

Heard that onions can absorb the H1N1 virus? That there's a special spray that can shield you from the flu? That H1N1 is wiping out entire Asian villages? If you spend much time online, perhaps some of this sounds familiar. In fact, none of it is true.

During any epidemic like the one we're now experiencing, urban legends are inevitable. But the Internet is giving hucksters, hoaxsters, and ill-informed individuals unprecedented power to spread false--and sometimes harmful--information. We need to remain on guard against not only the H1N1 virus but also hype and hokum about it.

One of the latest hoaxes is a widely-circulated e-mail message stating that everyone age 18 and older must create a personal H1NI "vaccination profile" on the CDC Web site. According to the CDC, there is no such program. A link on the e-mail takes you to a fake site that tries to collect personal information, and ironically, may infect your computer.

Other e-mails about H1N1 are perhaps less malicious but equally misleading. One warns that the H1N1 vaccine contains ingredients that cause autoimmune disorders and "a lifetime of crippling illness and early death." Another, urging everyone to "start stocking up on food now," says the virus has mutated and is expected to kill 60% of Americans beginning early next year. According to the e-mail, the CDC is hiding this fact "because they don't want people to panic."

You can also find a plethora of products marketed on the Web that falsely claim to fight the flu. Among them: masks and inhalers, air fresheners and herbal extracts, shampoos and sprays. There's even a fake version of the drug Tamiflu, made of talc and Tylenol.The FDA's Web site lists about 150 products that are not approved to fight H1N1 yet are being marketed for that purpose. And there are likely far more that have managed to escape detection.

Next time you encounter sites promoting germ-killing gels or immune-boosting herbs that promise to protect you from H1N1, think twice before you buy. As for forwarded e-mails you receive about the flu, check out snopes.com or about.com to see if the messages are legitimate. If you can't verify the information with a reputable source such as the CDC, hit the delete key and tell the sender to do the same.

New breast cancer screening recommendations from an expert panel are turning conventional wisdom on its head. Rather than starting mammograms at age 40, as the panel previously recommended, women are now advised to begin at 50--and then to be tested every other year, rather than annually. The recommendations do not apply to those at increased risk of breast cancer, who may need to be tested at younger ages and more frequently.

Internet chat rooms, message boards, and Facebook postings from my friends reflect the widespread confusion, consternation, and even anger that the new guidelines have unleashed. The decision about whether and when to test can be tricky, and the scientific data are open to different interpretations. Other groups, such as the American Cancer Society, are still suggesting yearly mammograms, beginning at 40, at least for now.

Because there are no black and white answers when it comes to this issue, it's important for each woman to talk to her doctor and decide what makes sense for her. That requires being armed with accurate information, but unfortunately, there are a number of falsehoods floating around about the new recommendations. Here are five that seem to be especially popular:

• This is all about saving money. In fact, it's about science. The group issuing the recommendations, the U.S. Preventive Services Task Force (USPSTF), is an independent panel of experts in prevention and primary care. Its job is to objectively analyze the scientific evidence for a wide array of clinical preventive measures--ranging from testing newborns' hearing to taking aspirin to prevent heart disease--and determine whether, on balance, they improve public health. The USPSTF's mission is not about money. In fact, one of the other steps that the group now recommends against, teaching breast self-exams, is very inexpensive, while others it embraces, such as routine screening for colon cancer, are relatively costly.


• This is about rationing.The new recommendations are just that--recommendations--and if a woman prefers to get screened earlier or more often, she can and should do so. Insurers have said they will continue to cover the cost for annual mammograms beginning at 40. The idea behind guidelines like this is not to withhold life-saving tests and treatments; it's to help us figure out what works--and therefore make more rational decisions--by looking at outcomes. Guidelines that we take as gospel, whether starting mammograms at 40 or colonoscopies at 50, always involve subjective judgments. Why not start mammograms at 35, for example, or colonoscopies at 40? It's because scientists have determined that the drawbacks outweigh the benefits for the population as a whole. The latest mammography guidelines are simply one panel's attempt to re-draw that line, based on new information.


• Early detection saves lives. Not always. For some conditions, such as cervical or colon cancer, early detection and treatment are unquestionably beneficial. But for others, it's not so clear-cut. With breast cancer, it depends on the type of tumor. Some breast cancers are so slow-growing that they don't spread or cause harm. In such cases, a woman will live just as long whether the tumor is found earlier or later. At the other end of the spectrum are aggressive cancers that spread quickly and kill, no matter how early they're detected. Mammography saves lives most often when it finds tumors between these extremes, but it's impossible to predict how an individual tumor will behave. One concern is that too many of the cancers that are found through mammography may be those for which it doesn't change the outcome.


• The fact that I or someone I know was saved by a mammogram proves that more testing is better. There are two problems with this logic. First, while an individual who was diagnosed with a cancer in her 40s may believe that early detection saved her life, there's often no way to know for certain. As discussed above, depending on the type of tumor, the ultimate outcome may have been the same had the cancer been found later. Second, anecdotes aren't the same as evidence. Just because certain individuals have benefited from mammography in their 40s doesn't necessarily mean that it's warranted for all 40-somethings. Public health recommendations are based on aggregate data, which in this case show that starting screening at age 40 has only modest benefits over beginning at 50. Plus there's an increased risk of potential harms, such as unnecessary follow-up tests and biopsies.


• The shifting recommendations prove that scientists are clueless. Science is about accumulating knowledge and getting smarter so that we get closer and closer to the truth. In this case, new research prompted the panel to change its recommendations. While flip-flops like this can certainly be frustrating, we want researchers to continue learning and sharing their findings so that we can make the best possible decisions about our health. And we should be grateful that there are groups like USPSTF that synthesize the science without an agenda. What we do with the information is up to us.