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March 14, 2002 -- The U.S. government is bowing to the demands of tobacco companies, a U.S. congressman says.

"Without improvements in the U.S. position, a unique opportunity to control the enormous worldwide toll of tobacco consumption may be lost," writes Rep. Henry Waxman, JD, D-Calif., in the March 21 issue of TheNew England Journal of Medicine.

The charge -- together with alarming new studies -- suggests that big tobacco hasn't reformed. It's using its muscle to quash public-health efforts to reduce smoking. Boston University researcher Michael Siegel, MD, MPH, is co-author of a recent NEJM article showing that cigarette ads in magazines reach just as many young people as ever.

"I think that there has been a common misperception that the battle is over. In fact, the absolute opposite is true," Siegel tells WebMD. "Tobacco companies continue to market to kids, and they continue to produce a product as deadly as it has always been. There have not been changes in their behavior."

Every year, tobacco-related illness kills more than 3.5 million people. That's more people than die of AIDS. And the smoking epidemic is even more explosive than the AIDS epidemic. By the year 2020, cigarettes will kill an estimated 8.4 million people a year.

"The leading cause of preventable death globally is tobacco," Michael Cummings, PhD, MPH, tells WebMD. Cummings leads the department of cancer prevention, epidemiology, and biostatistics at Roswell Park Cancer Institute in Buffalo, N.Y.

These numbers have the attention of the World Health Organization. Delegates from around the world first met in October 2000 to negotiate an antismoking treaty. It's called the Framework Convention on Tobacco Control, or FCTC.

The FCTC met for the second time in May 2001 -- and this time the U.S. delegates were appointed by the Bush administration. These delegates supported 10 of 11 changes recommended by Philip Morris, the largest U.S. tobacco company. Criticism of these changes -- some of it by Waxman -- led the U.S. delegation to drop support for some of the changes at the November 2001 FCTC meeting.

"The U.S. appears to be retrenching on positions it had in the prior administration," Cummings says. "There are very small countries around the world that have a bigger economic stake than we do in promoting tobacco, yet they have stronger antismoking positions than the U.S. It shouldn't be a point of debate to restrict smoking in public places, or help people quit, or to limit the spread of the product through deceptive marketing."

Waxman lists several major changes in the U.S. position since October 2000:

• U.S. support for taxes to reduce tobacco consumption was changed to make such taxes optional.
• Support for a ban on advertising that "appeals" to children was changed to opposition to ads "targeted" at people age 17 or younger.
• Support for measures that would ban smoking in enclosed public places was changed to opposition to mandatory restrictions.
• Several countries have proposed that public health concerns should be more important than trade rules. The U.S. delegation opposes this proposal.
• The European Union has proposed that exported tobacco products should be held to the same standards as those that apply in the country where the products are made. The U.S. delegation opposes this proposal.

Waxman, a Democrat, notes that in the 2000 election U.S. tobacco companies made $8.4 million in campaign contributions -- $7 million of which went to Republicans.

"Smoking is an epidemic like smallpox," Cummings says. "You need to control the spread of the disease. In this case, tobacco companies spread the disease. Unfortunately they profit, and profits always trump health. It is an epidemic of profits. For politicians, those profits come in the form of campaign contributions."

Mark Berlind, an attorney who works on government affairs issues for Philip Morris Management Corp., says Waxman gives the tobacco industry short shrift.

"I think Mr. Waxman understates the degree to which Philip Morris is actively supporting the adoption of a reasonable treaty," Berlind tells WebMD. "We'd love to see a treaty with regulations for things like access, marketing, ingredients, cigarette smuggling, and other issues."

The efforts of big tobacco don't stop with campaign contributions. A July 2000 report by a committee of experts commissioned by the World Health Organization (WHO) details extensive efforts by tobacco companies to undermine the FCTC and other tobacco-control actions. These efforts by the companies include:

• Promising jobs to WHO officials in return for support;
• Having tobacco consultants placed in WHO positions;
• Using influence with other United Nations agencies to pressure the WHO;
• Secretly hiring individuals and institutions that "independently" attack the credibility of WHO positions;
• Getting outside organizations to lobby against WHO activities;
• Holding media events to distract from WHO activities;
• Surveillance of WHO activities including secret monitoring of WHO meetings and conferences.

"The WHO 2000 report made a lot of allegations with regard to past conduct," Berlind says. "That was a very adversarial time for the industry. Today we are working very hard to be constructive and to work with government and with the WHO. We are being very upfront about what we do."

The FCTC meets again on March 18. The meeting comes on the heels of new studies showing that cigarettes are even more dangerous than previously thought. One study shows that "light" or "low tar" cigarettes are just as deadly as their regular cousins. But perhaps the most striking report says that nearly all cigarettes are defective.

Cummings is co-author of the report, published in the journal Tobacco Control, offering evidence that cigarette filters leak dangerous fibers into the lungs of smokers.

"You are concentrating tar on the fiber, delivering a concentrated dose," Cummings says. "Your lungs are now receiving an inorganic material that does not biodegrade. Your body doesn't appreciate having inorganic material in your lungs, and you get inflammation. Of course tar causes that, too. We thought reducing tar was the benefit of filters, but they only introduce a new risk."

Cummings says tobacco companies have known about the problem since 1957 when Eastman Kodak -- which then made the chemical used in the filters -- expressed concern to Philip Morris Co.

"We take seriously any scientific report that an aspect of our product could affect the health aspects of smoking," Brendan McCormick, manager of media relations for Philip Morris USA, tells WebMD. "Based on our assessment we do not believe the filters we use pose an additional health risk to smokers. In looking at some of that data, the evidence does not suggest the fibers actually penetrate the lung. The risk of inhalation is very low."

Cummings is skeptical of this opinion. "The industry says it doesn't cause harm, but what did they tell you about cigarettes 50 years ago?" he says.

Dec. 10, 2001 -- It's true that heavy kids born to overweight parents will likely become hefty adults. But boys who are lightweights at birth -- then have a rapid growth spurt during childhood -- are also very likely to become beefy adults.

A recent study of more than 10,000 boys and girls born in the British Isles looks at the complex factors related to obesity. Of all the factors analyzed before and after the baby's birth -- until the age of 33 -- body weight of both the mother and baby seemed to carry the most... well, weight ...in whether a baby will become obese later on.

A mother's weight when she gives birth "may be a more important risk factor for obesity in the child than birth weight," writes Tessa J. Parsons, an epidemiologist at the Institute of Child Health in London. Her study is published in this month's British Medical Journal.

Nutrition is at the heart of the matter, writes Catherine Law, an epidemiologist with the MRC Environmental Epidemiology Unit in Southampton, England, in an accompanying editorial.

"This pattern of growth is becoming common in developing countries that are experiencing a nutritional transition to Western lifestyles," Law writes, adding that in these countries, women who come from an impoverished childhood tend to be small themselves, which often leads to them having small babies.

Then, Law continues, as the kids grow up, they eat mostly high-fat and high-sugar junk foods, getting little exercise to burn off all the fat and calories. Boys are more aggressive than girls in getting their share of the family's food. Thus begins the male's lifelong pattern of obesity.

Parsons' study examines patterns of child growth before and after they are born to understand why certain adults become obese. She examined records on 10,683 boys and girls born in England, Scotland, and Wales during one week in 1958, analyzing body mass measurements taken at various ages during their lives: at birth and at ages 7, 11, 16, 23, and 33.

She also looked at data on the parents -- whether either the mother or father was fat when the baby was born, the parents' socioeconomic status, the mothers' age, whether she had smoked during pregnancy, whether she had given birth to other children, and how old she was when her baby was born.

Some results were pretty straightforward: hefty mothers gave birth to hefty babies who became overweight adults. But thin babies were also likely to become fat adults -- especially if they reached most of their adult height by age seven, and if their mothers were thin. This pattern was less clear in baby girls and women.

"These findings are potentially important," writes Parsons, because research shows that thin baby boys are at risk for cardiovascular disease, and that baby girls' height seems to determine their risk for heart disease later on.

Law argues that research dollars should be aimed not at developing drug treatments for adult diabetes, but on developing better ways to change children's eating and exercise habits.

Nov. 21, 2005 -- Neglected babies may have lower levels of brain hormones tied to social bonding.

But those children can still develop satisfying relationships, researchers stress.

"It's extremely important that people don't think this work implies that these children are somehow permanently delayed," says researcher Seth Pollak, PhD, in a news release.

"All we are saying is that in the case of some social problems, here is a window into understanding the biological basis for why [those problems] happen and how we might design treatments," he continues.

Pollak is an associate professor of psychology, psychiatry, and pediatrics at the University of Wisconsin-Madison. He's also a researcher at the university's Waisman Center for Human Development.

The study appears in the early online edition of Proceedings of the National Academy of the Sciences.

Orphans Tested

The study included two small groups of children.

One group consisted of 18 children who had spent the first 16 months of their lives, on average, in overseas orphanages before being adopted by U.S. families.

The adopted kids had lived in typical American homes for about three years. They had been tested for fetal alcohol exposure, birth defects, and developmental disabilities.

The second group included 21 American children who were being raised by their biological parents in similar settings.

The researchers compared levels of two brain hormones -- oxytocin and vasopressin -- which are involved in social bonding.

Play Time With Mom

For the study, the kids played interactive computer games while sitting in the lap of their mother or a woman they didn't know.

The game included light physical contact, like counting fingers or whispering in the partner's ear. Afterwards, the kids provided urine samples, which were checked for oxytocin and vasopressin.

After physical contact with their moms, oxytocin levels rose for children living with their biological parents. The same wasn't true for children who had been neglected early in life.

Formerly neglected kids also had lower overall levels of vasopressin, the researchers note.

No hormonal differences were seen between the two groups after the kids played the computer game with unfamiliar women.

Nurturing Environment Helps

"Importantly, at the time of testing, children had experienced an average of three years in rearing in relatively stable, enriched, and nurturing family environments," write the researchers.

"However, this environmental change does not seem to have completely overridden all of the effects of early neglect," they continue.

Remember, the study just tracked the two brain hormones, not behavior or emotions. "It is critical to note that not all children who experience early neglect develop the same kinds of problems, and children with lower hormonal

reactivity may, over time, develop satisfactory relationships," write the researchers.

"It's exciting that we've taken an area of child development that has been very descriptive and can now look at it in more mechanistic way," says researcher Alison Wismer Fries, in a news release. Fries is a psychology graduate student at the University of Wisconsin.

She and her colleagues note that oxytocin and vasopressin levels varied among both groups of children.

July 19, 2005 -- Parents frequently give their children cranberry juice as an alternative treatment for recurrent urinary tract infections (UTIs), but they rarely tell their pediatrician about it.

A new study shows that nearly one in three parents have given their children cranberry juice or other cranberry products to treat or prevent recurrent UTIs, but less than one in four told their pediatrician about this practice.

"It has become clear that parents frequently use cranberry for therapeutic purposes -- occasionally in lieu of standard therapy," says researcher Kathi Kemper, MD, a pediatrician at Brenner Children's Hospital, in a news release.

Cranberry products are widely used to prevent UTIs in adults and are considered generally safe.

But researchers say their results show that new studies are needed to determine the safety and effectiveness of using cranberry products to treat healthy children with recurrent urinary tract infections.

Clandestine Cranberry Use

Researchers say UTIs are the most common serious bacterial illness treated by pediatricians. In children who suffer from recurrent urinary tract infections, the long-term complications may include high blood pressure or kidney problems.

Many doctors recommend treatment with antibiotics to prevent recurrent UTIs in children at risk. However, researchers say it's hard to get kids to take all their medicine. Using antibiotics as a preventive measure can lead to antibiotic-resistant bacteria, which makes it more difficult to treat other illnesses. Many of the antibiotics used to treat resistant bacteria can cause kidney problems.

In the study, researchers surveyed 117 parents of children treated at a pediatric nephrology (kidney treatment) clinic about their use of cranberry products in treating recurrent urinary tract infections. Their children ranged in age from 6 months to 18 years.

The results showed that 74% of the parents had heard of using cranberry products to treat UTIs, and 29% had given them to their children. Most of the parents used cranberry juice and a few used cranberry pills or dried cranberries.

About half of those who had given cranberry products to their children used them to prevent or treat urinary tract infections. The other half cited a variety of other reasons for using cranberry therapies, such as "flushing out the kidneys" or when their child seemed to be having problems with urination.

Of the parents who used cranberry therapies on their children, less than one in four discussed it with their pediatrician.

Most parents had heard about using cranberry products for treating UTIs from the media, friends, or family, and 12% were advised by a health professional to try them.

The results of the study appear in the current issue of the journal Ambulatory Pediatrics.

Urine infections affect millions of people each year. They are treated with antibiotics that fight the most common cause of urine infection -- a bacteria called E. coli. Yet doctors may suggest treatments like cranberries, which parents can take on their own to prevent infections. Though cranberry juice is the form of cranberries most widely used, other cranberry products include cranberry powder in hard or soft gelatin capsules.

The way cranberries work to prevent urine infection is not completely understood. It is believed that cranberries prevent bacteria from sticking on the bladder wall, which inhibits their growth.

Feb. 25, 2004 -- Thin infants face serious health problems if they gain a lot of weight after the age of 2 years.

Several studies have linked a low birth weight to a particularly high risk of diabetes and heart disease in adulthood. Now a report in the Feb. 26 issue of The New England Journal of Medicine suggests that the problem begins in childhood.

A research team followed some 1,400 men and women in Delhi, India, from birth until they were 26 to 32 years old. The main finding: Being thinner than average in early childhood and becoming fatter than average after the age of 2 years tended to increase the risk of developing glucose intolerance and/or diabetes.

"This is a continuing process after the age of 2 years," study co-author Harshpal Singh Sachdev, MD, a professor at Maulana Azad Medical College in New Delhi, India, tells WebMD. "However, most of the association [is seen in those who cross from low- to high-weight categories] between 2 to 12 years of age. Thus, category crossing at any age after 2 years is associated with development of disease. The earlier one detects it, the better it would be for initiating interventions."

Childhood Obesity, Adult Health Trouble

Sachdev says it's the same story all over the world. Kids don't get enough exercise -- and they eat too much "energy-dense" food. Translation: too much TV, too many computer games, too much fast food, too many sugary drinks, and too little physical activity.

His advice to kids -- and adults -- is short if not sweet.

"Avoid getting fatter relative to yourself, particularly if you were thin as an infant," Sachdev says. "Possibilities for this include optimal physical activity and nutrition."

Chubby children used to be thought of as healthy, notes Matthew W. Gillman, MD, an associate professor at Harvard Pilgrim Health Care and Harvard Medical School in Boston.

"I think that we are slowly coming to a consensus that overfeeding during infancy and early childhood -- which may have been seen as healthy decades ago -- can't be seen that way any more," Gillman tells WebMD. "It may be predicting the kinds of health outcomes that are the scourge of the modern world."

Gillman says it's now well known that lower birth weight is linked to risk of obesity, diabetes, and even heart disease and stroke. The Indian study, he says, adds to this body of knowledge.

"What is underlying these associations between lower birth weight and poor health outcomes? Where this particular article helps is it shows us that accelerated weight gain during childhood seems to be one of the culprits," he says.

Unfortunately, there is no quick fix. Sachdev and Gillman agree that ways must be found to encourage children to exercise more and to eat more nutritious foods. Public awareness is a necessary first step.

"Maybe years ago a fat child was a healthy child," Gillman says. "But today, in the developed world, that is not as big an issue as what will happen to these children in the future."

Did you ever notice that all fast food joints have the same "smell"? Hot oil mixed with eau de onion? Some people have even half-jokingly suggested there may be a secret addictive chemical pumped in.

"[The sense of taste] is in a bad way," Steven A. Witherly, PhD, president and CEO of Technical Products Inc., a food consulting firm in Valencia, Calif., tells WebMD. "Fast food has ridiculously high levels of salt, fat, and sugar -- and the brain likes salt, fat, and sugar."

Everyone has about 10,000 taste buds on his or her tongue (although these may thin as people grow older). "Fast food does not so much dull the taste buds as affect how the brain processes that taste as pleasurable or unpleasant," Witherly says. Hormones such as insulin and leptin also affect the brain's impression of a given food. "Snack food is affecting how we process food."

Sense of Taste Deceptively Simple

Traditionally, scientists have said the sense of taste can detect salty, bitter, sour, and sweet. Now, Witherly says, a fifth taste found to be directly received by the tongue is umami (pronounced "ooo-mommy"), which is the monosodium glutamate (MSG) taste. Parmesan cheese is huge on this, 1% by weight; soy sauce is also 1%. Umami is tied to a protein found in breast milk that the brain is attracted to.

Witherly also says the human sense of taste can recognize the hot pepper taste and another he calls the fatty acid taste.

Marcia Levin Pelchat, PhD, a psychologist and research scientist with the Monell Chemical Senses Center in Philadelphia, tells WebMD the hot pepper taste is more of a skin irritation signal in the inner cheek rather than a taste. (Carbonation, she says, provides a similar irritation that can be studied by taste researchers.)

Whatever triggers them, your sense of taste picks up the signal and sends it to the brain for interpretation and combination with other tastes.

Certain sensations -- like salt, sugar, and to some extent, the sensation of fat -- become an expectation. People want to experience them. "I have seen people's brain scans light up in the pleasure centers when fat passes over their tongue," Witherly says.

In fact, researchers at Yale University, led by Linda A. Bartoshuk, PhD, have discovered that about 35% of white women and 15% of white men are "supertasters," people with an exaggerated sense of taste, compared with the rest of us mortals. These souls inhabit a more limited food universe because their sense of taste is so much more intense. For one thing, they tend to eat fewer bitter vegetables, the kinds that are thought to ward off cancer. On the good side, supertasters also spurn fatty foods more often and thus develop less heart disease.

"Fast food," Bartoshuk tells WebMD, "does not physically affect taste buds, but it may affect appetite and food preferences."

June 12, 2006 - Want a big fat belly? Eat lots of trans fats.

Trans fats make you fatter than other foods with the same number of calories -- but that's not all. Researchers at Wake Forest University find that trans fats increase the amount of fat around the belly. They do this not just by adding new fat, but also by moving fat from other areas to the belly.

"Trans fat is worse than anticipated," Wake Forest researcher Lawrence L. Rudel, PhD, says in a news release. "Diets rich in trans fat cause a redistribution of fat tissue into the abdomen and lead to a higher body weight even when the total dietary calories are controlled."

Rudel colleague Kylie Kavanagh, DVM, reported the findings at this week's annual meeting of the American Diabetes Association in Washington.

In the study, researchers fed 51 male vervet monkeys a western-style diet -- that is, 35% of their diet was fat. Half the monkeys got a lot of trans fat, totaling 8% of their diet. The other monkeys were fed unsaturated fats such as olive oil.

Both types of diets were calorie-controlled. In theory, the monkeys should not have gained weight.

But they did.

Over six years -- what would, in humans, be a 20-year span -- the monkeys who ate unsaturated fats upped their body weight by 1.8%.

Those fed trans fats packed on 7.2%. In humans, that would be enough weight gain to significantly increase risk of diabetes and heart diseaseheart disease.

"Trans fatty acid consumption increases weight gain," Kavanagh says in a news release. "In the world of diabetes, everybody knows that just 5% weight lossweight loss makes enormous difference. This little difference [of weight gain seen in the study] was biologically quite significant."

Trans fats are found in vegetable shortenings, some kinds of margarine, and in manufactured baked goods such as cookies, crackers, and snack foods. A major source of trans fat in American diets is fast food fried in the stuff.

Nov. 16, 2005 -- Diet drugs can help you lose weight, and so can cutting calories and making other lifestyle changes. But combining the two approaches is far more effective than either approach alone, new research shows.

In the study, obese people who modified their eating and exercise habits and took the drug Meridia lost far more weight than people who relied on either lifestyle modification or medication.

"We found that a combination of the two approaches produced approximately twice the weight loss of either intervention used alone," says researcher Thomas A. Wadden, PhD.

The study appears in the Nov. 17 issue of The New England Journal of Medicine.

Many Rely on Drugs Alone

There are two FDA-approved prescription weight loss drugs being sold in the U.S.: Abbott Laboratories' Meridia and Roche's Xenical. Meridia works by suppressing appetite, while Xenical works in the digestive system to block the absorption of fats.

Both drugs are intended for use as part of a comprehensive program that includes diet, exercise, and behavior therapy. But all too often patients are sent home with prescriptions alone, Wadden says.

"Certainly, the doctors who prescribe these medications recommend that their patients cut calories and increase physical activity, but these recommendations may be left at the office door," Wadden tells WebMD.

In an effort to better understand the effectiveness of the different treatment approaches, Wadden and colleagues followed 224 obese men and women on different weight loss regimens for a year.

One group was prescribed standard doses of Meridia with scheduled 10-15 minute office visits with primary care providers. They received minimal lifestyle recommendations, which consisted of an initial pamphlet and "general encouragement." A second group did not take the drug but did participate in an intensive group lifestyle modification program. These patients attended 30, 90-minute group education and support sessions over the course of a year. They also kept daily records of the foods they ate and their physical activity.

A third group received a combination of the drug, brief visits with a primary care provider, and intensive lifestyle modification group sessions similar to the second group. A fourth group took the diet drug and received additional counseling during regularly scheduled office visits. They also kept food and exercise journals, which were reviewed during their office visits with the primary care provider.

This fourth group was added, Wadden says, to see if doctors can provide enough lifestyle counseling to have an impact on weight loss within the confines of the typical brief office visit.

Diet and Lifestyle Changes Get Best Results

At the end of a year, the patients who took the diet drug and participated in the intensive lifestyle modification program lost the most weight, averaging 26.6 pounds.

The Meridia plus brief, doctor-delivered counseling group lost 16.5 pounds. The group that participated in the intensive program but took no Meridia lost 14.7 pounds, and the Meridia-only treatment group lost 11 pounds.

Wadden says drugs and lifestyle modification complement each other because they address different issues. Support and education programs teach people the tools they need to achieve a healthy weight and the drugs help them take in fewer calories.

Can Doctors Do It?

The findings also suggest that doctors can provide meaningful lifestyle counseling, even during rushed office visits, Wadden adds. Having patients keep daily food and exercise journals, and helping them develop a weight loss plan that met their individual needs were two important components of this counseling.

But Howard Eisenson, MD, who has been on both sides of the issue, is skeptical.

He tells WebMD that he didn't have a lot of success getting patients to lose weight as a private practice family doctor. But he has seen plenty of success stories in his current job as director of Duke University Medical Center's well-known Diet and Fitness Center.

"We have a team approach that includes dietitians, fitness specialists, and behavioral therapists in addition to physicians," he says. "These are people who are very important to the process. I think the physician's role is primarily to be a cheerleader -- to show confidence in the patient's ability to make lasting changes and to follow up."

May 17, 2005 -- Work fatigue and overtime hours may raise the risk of gaining weight, new research shows.

Does that mean that people are seeking solace at the vending machine for their job frustrations? Are they too exhausted to exercise and cook healthy meals in their free time? Do extra pounds mean it's time to update your resume or structure a more balanced life?

Those are big questions, and the answers aren't clear yet. The cycle of eating, emotions, and energy is complex and can reinforce itself. Dissatisfaction in one part of life can spill into other areas and vice versa.

For some people, job angst and long hours may be one piece of the puzzle, suggests a new study in the International Journal of Obesity.

When Work Is a Burden

The study included more than 7,000 women and about 1,800 men working in government jobs in Helsinki, the capital of Finland.

The bureaucrats were asked if they'd gained weight in the last year. They also reported the number of hours they worked and rated their "worker fatigue."

Curious about how you would rate? See how many of these statements you agree with:

• I feel totally worn out after a day at work.
• I feel tired in the morning when I have to get up and go to work.
• I have to work too hard.
• I feel like I'm totally exhausted.
• My work is definitely too stressful.
• I worry about my work even when I'm off duty.

Agreeing with four or more of those statements qualified as high work fatigue. Intermediate work fatigue was defined as agreeing with up to three of those statements. Overtime was working more than 40 hours per week.

Fatigue, Overtime, and Work Dissatisfaction Increase Weight

High work fatigue and working overtime were associated with weight gain in both sexes. The association wasn't stronger for major weight gain (more than 11 pounds), says the study.

Work fatigue was high in 15% of the women and 13% of the men. Overtime was reported by one in five men and 13% of the women.

Almost a quarter of all women (24%) and 19% of men said they had gained weight in the last year.

Women who reported dissatisfaction with their balance between work and home were also more likely to gain weight than women reporting complete or some satisfaction with work.

Among men, those with less demanding jobs were less likely to gain weight.

Unanswered Questions

The researchers -- who included Tea Lallukka of the University of Helsinki's public health department -- say they don't know if their findings apply to other groups of people.

They also don't know what the participants ate or how much they exercised. Perhaps people burning the midnight oil eat more snacks and fast food, write Lallukka and colleagues.

"Those reporting work fatigue might also be too tired to consider a healthy diet and prepare healthy meals, instead replacing them with industrial snacks, fast food, and sweets, behavior associated with weight gain," says the study.

"This same group may be too tired to engage in regular physical exercise, thereby gaining weight," write the researchers.

Since exercise has been shown to help people cope with stress, working out might help smooth out the workday, easing some of that job angst while keeping weight in check.

Jan. 5, 2004 -- Whether your weight-loss strategy espouses carbs with no fat or protein with few carbs, there is one thing your plan most certainly recommends -- water. From the veggie-based Ornish diet to steak-loving Atkins (and virtually all diets in between) "drink lots of water" is part of the mantra.

Now comes scientific evidence that H₂O really does help you lose weight. Researchers in Germany report that water consumption increases the rate at which people burn calories. The impact is modest and the findings are preliminary, but the researchers say their study could have important implications for weight-control programs.

Eight Glasses a Day

Despite the fact that most diets call for drinking at least eight, 8-ounce glasses of water a day, few studies have been done to determine if the practice actually speeds weight loss. In an effort to answer this question, Michael Boschmann, MD, and colleagues from Berlin's Franz-Volhard Clinical Research Center tracked energy expenditures among seven men and seven women who were healthy and not overweight.

After drinking approximately 17 ounces of water, the subjects' metabolic rates -- or the rate at which calories are burned -- increased by 30% for both men and women. The increases occurred within 10 minutes of water consumption and reached a maximum after about 30 to 40 minutes.

The study also showed that the increase in metabolic rate differed in men and women. In men, burning more fat fueled the increase in metabolism, whereas in women, an increased breakdown of carbohydrates caused the increase in metabolism seen.

The researchers estimate that over the course of a year, a person who increases his water consumption by 1.5 liters a day would burn an extra 17,400 calories, for a weight loss of approximately five pounds. They note that up to 40% of the increase in calorie burning is caused by the body's attempt to heat the ingested water. The findings are reported in the December issue of The Journal of Clinical Endocrinology and Metabolism.

"Very, Very Small Effect"

The researchers write that up to 70% of the increase in metabolism, "cannot be attributed to the heating of the ingested water," but exercise physiologist Daniel Moser, PhD, tells WebMD that it is unclear from this small study if this is the case.

"Larger studies are clearly needed to confirm this extremely modest weight-loss effect," he tells WebMD.

Nutritionist and American Dietetic Association spokeswoman Leslie Bonci, MPH-RD, says even if the findings are confirmed the clinical implications are slight.

"Obviously people are looking for ways to increase metabolism, but this is an very, very, small effect," she tells WebMD. "We are talking about just a few calories a day."

Bonci says the standard weight-loss plan dictates encouraging people to drink more water stems from the belief that the liquid fills the gut to make people feel fuller.

"Some plans say that drinking water flushes fat out of your system, which is absolutely ridiculous," she says.

Aug. 8, 2003 -- A mother's eating patterns influence her daughter's diet, especially when it comes to eating high-fat foods, a new study shows.

The study, appearing in the August issue of American Journal of Health Behavior, suggests that mothers who are behaving in health-enhancing or health-compromising ways are teaching these behaviors to their children. The studyshows that there is a significant link between the amount of fat that mothers and their adolescent daughters eat. On the flip side, a mother's fiber intake had no influence on how much fiber her daughters ate.

"Limiting consumption of high-fat snack foods and fast foods may be an important dietary behavior that girls choose to emulate in their mothers in an attempt to diet and control their weight, whereas fiber consumption may not be an area women target when trying to lose weight," Cassandra Stanton, PhD, of Brown University says in a news release.

Stanton's team looked at the diet of 400 mother-child pairs in rural areas of New York and Virginia. The mothers and daughters tracked their daily food intake in a diary during a two-year process. Afterward, researchers calculated the number of grams of fat and fiber in each reported food they ate. Researchers also took into consideration demographics and home environment factors.

Black Children Most Influenced by Mother's Diet

The link between what mothers ate and what their children ate was noticeable only with daughters. The findings showed that the strongest influence was among black mothers and daughters.

The tie between mother-daughter eating habits still leaves some unanswered questions. For instance, if one daughter eats 100 grams of fat a day and another daughter eats 75 grams of fat a day, only 25% of the difference could be related to their mother's fat consumption, while 75% may be caused by other factors.

Researchers say recent evidence shows that only 1% of American children have diets that meet current dietary guidelines, and as much as 45% of children's energy intake comes from sugar and fat. The authors say that there is a "clear need to understand the home environment and it's impact on the establishment of eating behaviors among youth that may put them at risk for life-threatening disease in adulthood."

Open wide, America, for the Monster Burger. It's a near-mountain of beef, bacon, and cheese --fully loaded with 1,420-calories and 107 grams fat. In our diet-dizzy, low-carb world, it's almost comic relief. But nutritionists are not amused.

Putting this megaburger on the fast-food market "is social irresponsibility," says Kathleen Zelman, MPH, RD, director of nutrition for the WebMD Weight Loss Clinic. "Unless you're feeding your entire family that one burger, it's utter insanity."

This year, America turned a corner. Low carb and low fat became the dieter's Holy Grail.

Many fast-food outlets halted supersizing. Many began offering salads and fresh fruit. Kids' menus were retooled. Low-carb grilled chicken, carrots, celery, steamed broccoli, and applesauce are showing up on kids' menus -- not just the typical burgers, fried chicken fingers, and french fries.

Low-carb milk, pasta, and baked goodies popped up in grocery stores. Many products, however, had the same number of calories as the original versions. Plus, they were pricey.

Published reports now show:

• This fall, fewer people were following low-carb diets. In December 2003, nearly 12% were following either the Atkins or South Beach diet, compared with 8% by Oct. 2004.
• Low-carb products are gathering dust. Total low-carb sales made double- and triple-digit gains in the first half of 2004. But for the 13-week period ending Sept. 25, total low-carb product sales grew just 6%.

The low-carb craze, many say, is fading fast.

"You're doing so great -- you can have one little piece." Or: "C'mon, honey, I like a little meat on my women." Sound familiar? These people, consciously or not, are trying to sabotage your diet.

David L. Katz, MD, MPH, director of Yale University's Prevention Research Center and author of The Way to Eat, says sooner or later, you may find yourself in a toxic nutritional environment -- almost all dieters do. Some things that people might say or do to throw you off course:

• "Fear" for your health. "What's the matter -- you are wasting away. Are you sure you aren't losing too much too fast?" Or: "Are you sure that diet won't raise your cholesterol?"
• Acting insulted. "You don't like my pot roast all of a sudden? You're too good for my cheesecake?"
• Mixing up food with love. "You don't come to dinner -- you don't love me anymore."
• Making you an outsider. Katz says this sometimes happens among co-workers. "You can't eat Mexican because of your diet, so we will see you after we go out."
• Leaving food around. The big candy dish on the receptionist's desk in an office of dieters. Or: "Here, one doughnut left, want it?" The leftovers from the office party. Or the spouse who keeps dragging half the chips in the store into the house.
• Creating special food. One husband didn't want to babysit on Overeaters Anonymous night, so made a big dinner each time and told his wife to bring some of her "dieting friends" over.
• Making up special holiday rules. "It's your birthday -- one piece of cake won't hurt!"
• Imparting discouraging news. "I am so proud of you for trying this, even though you know that 95% of people fail to keep the weight off." Or: "It's not my business, but don't runners get a lot of injuries?"
• Volunteering amateur psychoanalysis. "You know, you don't seem to be as funny since you lost weight."

Why People Sabotage

"I have had people try to get someone who has lost a lot of weight to put it all back on!" exclaims Linda Spangle, RN, MA, author of Life is Hard, Food is Easy. "One woman had lost more than 100 pounds, but her husband bought her a size 4X blouse and candy for Christmas."

"He wants the old me back," she told Spangle. She saw it as a control issue and eventually divorced the man for trying to control her so destructively.

"In some instances," Spangle says, "a spouse may have the need to control. A man may think if his wife stays fat she won't be flirting or attracting notice. Sometimes, this spouse will compliment the heavy person. No one else does, so this is a way of keeping control."

Katz says people who are themselves overweight (two-thirds of Americans) feel threatened. "Most people struggle with weight issues," Katz says. "If I am fat and you go on a diet, you put me in the uncomfortable position of feeling bad about my own weight; deciding to do something about it, which I may not be ready to do; or trying to talk you out of what you are doing.

"People who are threatened," Katz sums up, "fight back."

Sexual anxiety is also a part of it, he agrees. "If the person gets thin, they may find someone else. That is a factor. 'My wife is getting so sexy, she may dump me.'"

And, Katz says, being reassuring to the dieter may be a higher form of love. "A mother may think it's her job to make the child feel better about themselves. They may be on a mission to get a daughter to accept her size."

Co-workers, he says, tend to be competitive. If you are succeeding at something, even losing weight, it makes them look less successful. Plus, you might attract notice for a promotion.

"You're doing so great -- you can have one little piece." Or: "C'mon, honey, I like a little meat on my women." Sound familiar? These people, consciously or not, are trying to sabotage your diet.

David L. Katz, MD, MPH, director of Yale University's Prevention Research Center and author of The Way to Eat, says sooner or later, you may find yourself in a toxic nutritional environment -- almost all dieters do. Some things that people might say or do to throw you off course:

• "Fear" for your health. "What's the matter -- you are wasting away. Are you sure you aren't losing too much too fast?" Or: "Are you sure that diet won't raise your cholesterol?"
• Acting insulted. "You don't like my pot roast all of a sudden? You're too good for my cheesecake?"
• Mixing up food with love. "You don't come to dinner -- you don't love me anymore."
• Making you an outsider. Katz says this sometimes happens among co-workers. "You can't eat Mexican because of your diet, so we will see you after we go out."
• Leaving food around. The big candy dish on the receptionist's desk in an office of dieters. Or: "Here, one doughnut left, want it?" The leftovers from the office party. Or the spouse who keeps dragging half the chips in the store into the house.
• Creating special food. One husband didn't want to babysit on Overeaters Anonymous night, so made a big dinner each time and told his wife to bring some of her "dieting friends" over.
• Making up special holiday rules. "It's your birthday -- one piece of cake won't hurt!"
• Imparting discouraging news. "I am so proud of you for trying this, even though you know that 95% of people fail to keep the weight off." Or: "It's not my business, but don't runners get a lot of injuries?"
• Volunteering amateur psychoanalysis. "You know, you don't seem to be as funny since you lost weight."

Why People Sabotage

"I have had people try to get someone who has lost a lot of weight to put it all back on!" exclaims Linda Spangle, RN, MA, author of Life is Hard, Food is Easy. "One woman had lost more than 100 pounds, but her husband bought her a size 4X blouse and candy for Christmas."

"He wants the old me back," she told Spangle. She saw it as a control issue and eventually divorced the man for trying to control her so destructively.

"In some instances," Spangle says, "a spouse may have the need to control. A man may think if his wife stays fat she won't be flirting or attracting notice. Sometimes, this spouse will compliment the heavy person. No one else does, so this is a way of keeping control."

Katz says people who are themselves overweight (two-thirds of Americans) feel threatened. "Most people struggle with weight issues," Katz says. "If I am fat and you go on a diet, you put me in the uncomfortable position of feeling bad about my own weight; deciding to do something about it, which I may not be ready to do; or trying to talk you out of what you are doing.

"People who are threatened," Katz sums up, "fight back."

Sexual anxiety is also a part of it, he agrees. "If the person gets thin, they may find someone else. That is a factor. 'My wife is getting so sexy, she may dump me.'"

And, Katz says, being reassuring to the dieter may be a higher form of love. "A mother may think it's her job to make the child feel better about themselves. They may be on a mission to get a daughter to accept her size."

Co-workers, he says, tend to be competitive. If you are succeeding at something, even losing weight, it makes them look less successful. Plus, you might attract notice for a promotion.

April 19, 2004 -- Eating breakfast on the run may be bad for your heart. A new study shows a typical high-fat, high-carbohydrate fast food breakfast can overwhelm the body's blood vessels and cause potentially dangerous inflammation.

Researchers found an egg muffin and hash brown breakfast dramatically raised inflammatory markers in the blood for up to four hours after eating the meal.

"People who experience repeated short-lived bouts of inflammation resulting from many such unhealthy meals can end up with blood vessels in a chronic state of inflammation, a primary factor in the development of atherosclerosis," says researcher Ahmad Aljada, PhD, research assistant professor at the University of Buffalo School of Medicine and Biomedical Sciences, in a news release.

Atherosclerosis or hardening of the arteries leads to clogged arteries and heart disease.

Fast Food Breakfast Bombards Blood Vessels

In the study, nine healthy adults ate a fast food breakfast consisting of an egg muffin, a sausage muffin, and two hash browns after not eating overnight. Then they had their blood analyzed. The fast food breakfast contained 910 calories, 81 grams of carbohydrates, 51 grams of fat, and 32 grams of protein.

Researchers found that levels of inflammatory markers increased significantly and remained elevated for three to four hours after eating the meal.

"Eating that 900-calorie, high-fat meal temporarily floods the blood stream with inflammatory components, overwhelming the body's natural inflammation-fighting mechanisms," says Aljada.

In addition free radicals increased by more than 100% and stayed elevated for more than three hours after eating the breakfast. Free radicals are destructive particles that have been linked to a higher risk of atherosclerosis.

The results of the study appear in the April issue of the American Journal of Clinical Nutrition.

Researchers say the influx of fat, calories, protein, and carbohydrates caused by eating a fast food breakfast may alter the behavior of cells and activate a mechanism that produces more powerful enzymes that are potentially damaging to the lining of blood vessels.

June 30, 2005 -- The weather in your area may be a plus or a minus when it comes to exercise.

Sure, you can exercise year-round inside. And many people brave hot, cold, rainy, or snowy conditions to be active. But the weather can still make a difference, new research shows.

The CDC advises getting at least half an hour of moderate intensity physical activity five or more days per week. According to the CDC, moderate-intensity physical activity includes walking at a brisk pace, biking on a level terrain, using a stationary bicycle, aerobic dancing, or water aerobics.

Ray Merrill, PhD, MPH, and colleagues aren't offering new excuses to slack on fitness. Instead, they looked at the weather's effects on workout habits.

Merrill is an associate health sciences professor at Brigham Young University. His report appears in the American Journal of Health Behavior.

Prime Exercise Conditions

Looking for the best weather for exercise? Head to "big sky" country.

Here are the five top-ranked areas, with the percentage of people meeting moderate physical activity guidelines:

• Montana: 60.9%
• Utah: 59.2%
• Wisconsin: 57.9%
• New Hampshire: 55.9%
• Vermont: 55.6%

The five with the lowest percentages were:

• Puerto Rico: 30.9%
• Hawaii: 36.4%
• North Carolina: 37.4%
• Kentucky: 37.6%
• Mississippi: 38.4%

For the complete list, click here.

Montanans are most likely to meet physical activity recommendations, says Merrill. People living in Puerto Rico are the least likely to do so, he writes.

You don't need radar to tell the difference between those climates.

The highest-ranked regions for physical activity also had the most dry, moderate days. Those at the bottom 25% of the list had the highest percentage of sticky, steamy, tropical days.

Seasonal Shifts

The time of year also affected activity. Activity peaked with:

• Moist, moderate winters
• Dry "polar" springs
• Dry, tropical summers
• Dry "polar" falls

Why the Difference?

The researchers suggest three reasons for the patterns:

• Some active people may consider climate in choosing where to live.
• Some older people may not feel comfortable in gyms. They may wait for good weather to be active.
• Good weather is often considered safer and more pleasant.
• Walking and cycling, two popular activities, are more convenient in good weather.

Data Sources

Physical activity data came from a 2003 phone survey done by the CDC and U.S. states or territories.

A total of 355 counties were involved. Surveys included adults aged 18 and older living in the community.

Weather information came from 255 weather stations.

Full List

1. Montana: 60.9%
2. Utah: 59.2%
3. Wisconsin: 57.9%
4. New Hampshire: 55.9%
5. Vermont: 55.6%
6. Maine: 55.1%
7. Idaho: 54.8%
8. Washington: 53.9%
9. Nevada: 53.8%
10. Wyoming: 53.4%
11. Rhode Island: 53.2%
12. Connecticut: 53%
13. Colorado: 52.8%
14. Washington, D.C.: 52.2%
15. Oregon: 52.2%
16. Massachusetts: 51.5%
17. Minnesota: 51%
18. Arizona: 50.8%
19. North Dakota: 50.7%
20. New Mexico: 50.2%
21. Pennsylvania: 49.2%
22. California: 49.1%
23. Maryland: 49.1%
24. Virginia: 48.5%
25. South Carolina: 47.9%
26. Ohio: 47.4%
27. Indiana: 47.2%
28. South Dakota: 45.7%
29. Texas: 45.7%
30. Missouri: 45.6%
31. New Jersey: 45.1%
32. New York: 45.1%
33. Delaware: 45%
34. Nebraska: 44.7%
35. Illinois: 44.2%
36. Michigan: 43.4%
37. Kansas: 42.4%
38. Georgia: 42.2%
39. Alabama: 41.7%
40. West Virginia: 41.5%
41. Iowa: 41.4%
42. Oklahoma: 40.1%
43. Florida: 39.4%
44. Arkansas: 39.1%
45. Louisiana: 39%
46. Tennessee: 39%
47. Mississippi: 38.4%
48. Kentucky: 37.6%
49. North Carolina: 37.4%
50. Hawaii: 36.4%
51. Puerto Rico: 30.9%

Results were not listed for Alaska.

Before starting any exercise program, speak with your doctor. Together you can find an activity that is safe for you and one that fits your needs.

March 10, 2004 -- People who take the over-the-counter supplement DHEA to increase testosterone may get less, and more, than they bargain for. New research suggests that instead of raising testosterone levels, the supplement raises levels of a hormone that promotes prostate problems.

Classified as a nutritional supplement in 1994, dehydroepiandrosterone, or DHEA, is used by athletes and body builders to build muscle mass because it is broken down into various steroid hormones, including the male sex hormone testosterone. But scientific evidence supporting it's effect on enhancing athletic performance is scant. Homerun slugger Mark McGwire sparked interest in hormone supplements like DHEA a few years later when he acknowledged using them during his record-setting season.

"All kinds of athletes, including high-school kids, are using DHEA, often at much higher doses than are recommended," University of Southern California researcher Rebecca Z. Sokol, MD, MPH, tells WebMD. "Yet most of the research has looked at the effect of this drug on aging men. It has hardly been studied at all in young men who are taking it to improve athletic performance."

Unexpected Findings

Sokol and colleagues recruited 12 men between the ages of 18 and 42 for their study, which is published in the March issue of the journal Fertility and Sterility. The men took either 50 mg of DHEA, 200 mg of DHEA, or a placebo every day for six months, and their blood levels of various hormones were tested at intervals throughout the trial.

The researchers expected to see increases in testosterone, but blood levels of this hormone stayed the same. But circulating levels of a hormone known as ADG, which is a byproduct of testosterone, did increase.

"Our findings suggest that DHEA is quickly turned into testosterone, and then just as quickly turned into [another hormone] DHT, and finally ADG," Sokol says.

Long-Term Risks Unknown

Studies have linked ADG to prostate enlargement, a condition that is almost universal among older men but rarely seen in men under the age of 40. Prostate enlargement was not seen among the study participants taking DHEA, but Sokol says the study follow-up period may have been too brief to detect a change.

"The concern is that young men who take this supplement long term will end up with enlarged prostates at younger ages than they ordinarily would," she says. "I am not of the school that thinks no one should ever take an anabolic steroid. That is absolutely not my perspective. But the fact is, we don't know much about the long-term risks of this drug."

Supplement expert and American College of Sports Medicine spokesman Doug Kalman, MS,RD, agrees, but says the USC study was far too small to offer definitive answers. He adds that elite athletes have all but abandoned the supplement because there is also little evidence that it helps build muscles.

"I am pretty sure that you would find that less than 1% of baseball players or football players at the professional or college level take this stuff," he says. "Most of the studies that have found positive uses for DHEA have been in older men, older women, or people who are HIV positive. No study has ever found a benefit among athletes."

May 17, 2005 -- Work fatigue and overtime hours may raise the risk of gaining weight, new research shows.

Does that mean that people are seeking solace at the vending machine for their job frustrations? Are they too exhausted to exercise and cook healthy meals in their free time? Do extra pounds mean it's time to update your resume or structure a more balanced life?

Those are big questions, and the answers aren't clear yet. The cycle of eating, emotions, and energy is complex and can reinforce itself. Dissatisfaction in one part of life can spill into other areas and vice versa.

For some people, job angst and long hours may be one piece of the puzzle, suggests a new study in the International Journal of Obesity.

When Work Is a Burden

The study included more than 7,000 women and about 1,800 men working in government jobs in Helsinki, the capital of Finland.

The bureaucrats were asked if they'd gained weight in the last year. They also reported the number of hours they worked and rated their "worker fatigue."

Curious about how you would rate? See how many of these statements you agree with:

• I feel totally worn out after a day at work.
• I feel tired in the morning when I have to get up and go to work.
• I have to work too hard.
• I feel like I'm totally exhausted.
• My work is definitely too stressful.
• I worry about my work even when I'm off duty.

Agreeing with four or more of those statements qualified as high work fatigue. Intermediate work fatigue was defined as agreeing with up to three of those statements. Overtime was working more than 40 hours per week.

Fatigue, Overtime, and Work Dissatisfaction Increase Weight

High work fatigue and working overtime were associated with weight gain in both sexes. The association wasn't stronger for major weight gain (more than 11 pounds), says the study.

Work fatigue was high in 15% of the women and 13% of the men. Overtime was reported by one in five men and 13% of the women.

Almost a quarter of all women (24%) and 19% of men said they had gained weight in the last year.

Women who reported dissatisfaction with their balance between work and home were also more likely to gain weight than women reporting complete or some satisfaction with work.

Among men, those with less demanding jobs were less likely to gain weight.

Unanswered Questions

The researchers -- who included Tea Lallukka of the University of Helsinki's public health department -- say they don't know if their findings apply to other groups of people.

They also don't know what the participants ate or how much they exercised. Perhaps people burning the midnight oil eat more snacks and fast food, write Lallukka and colleagues.

"Those reporting work fatigue might also be too tired to consider a healthy diet and prepare healthy meals, instead replacing them with industrial snacks, fast food, and sweets, behavior associated with weight gain," says the study.

"This same group may be too tired to engage in regular physical exercise, thereby gaining weight," write the researchers.

Since exercise has been shown to help people cope with stress, working out might help smooth out the workday, easing some of that job angst while keeping weight in check.

June 8, 2004 -- The FDA is warning breastfeeding women not to use an unapproved drug called domperidone to increase breast milk production.

The agency says there have been several reports of severe health risks, including irregular heartbeats, cardiac arrest, and sudden death, associated with use of the drug that have led to its withdrawal from the market in several countries.

Researchers say domperidone is also excreted in breast milk and may expose infants to unknown health risks.

FDA officials say they issued the warning after they discovered that some women who breastfeed and/or pump breast milk are purchasing domperidone from compounding pharmacies and from foreign countries to increase their breast milk production.

Domperidone has not been approved for use in the U.S., and officials say use of the drug for any purpose is illegal.

Domperidone may increase the secretion of the hormone prolactin, which is needed for lactation. However, due to the risk of serious adverse effects, the FDA recommends that breastfeeding women not use the drug to increase milk production.

Warnings Issued on Domperidone

In addition to advising women not to use the drug, this week the FDA also issued six letters to pharmacies that compound drug products containing domperidone and firms that distribute them.

The letters state that that all drug products containing domperidone are illegal and selling or distributing them violates U.S. law.

Officials say domperidone is approved for use in several countries outside the U.S. to treat some stomach disorders. But it is not approved in any country for enhancing milk production.

Oct. 7, 2003 -- Altering the natural mother and child bonding process soon after birth may have a lasting impact on the child's brain.

A new study shows that baby rats that were briefly separated from their mother in the days following birth behaved differently than others in response to stress as adults.

Researchers say the findings suggest that the immature brain is extremely sensitive to changes in its environment and separation of mother and child may have enduring effects on brain function and development.

Separation May Affect Brain Function

The study, published in the Proceedings of the National Academy of Sciences, tested the effects of separating rat pups from their mother for 30 minutes on the day after birth and 6 hours on the following day.

Researchers found these two episodes of brief separation and handling were enough to produce permanent changes in brain function.

In this case, the study showed that adult rats that had been separated as pups had an increased response to a stressful situation (a swimming test and water maze) compared with normally raised rats. The rats that experienced the separation had an immature brain system that helps handle stressful situations.

Researcher Tu-Chin Hsu, of the Children's Hospital of Philadelphia, and colleagues say the findings show that changes at the molecular and cellular level may occur after neonatal separation and handling that extend well into adulthood and merit further study in other animals, such as humans.

June 10, 2002 -- As a nation, we are eating more low-fat processed foods than ever ... and have never been fatter.

In an effort to address this seeming paradox, the American Heart Association is now weighing in on the health benefits of low-fat products that have become a basic food group for many Americans.

The message: even if you've switched to low-fat versions of your favorite high-fat foods, calories and portion size still count. Low fat doesn't necessarily mean low calorie. And if you eat twice as many reduced-fat cookies or a family-sized bag of no-fat chips, you're probably going to pack on the pounds.

"Many people don't understand that many of these low-fat products are really very calorie-dense," says nutritionist Judith Wylie-Rosett, RD, who wrote the newly released statement issued to clarify the role of fat substitutes in the diet. "There is a tendency to think that if something is low in fat you can eat as much as you want."

Even people who know that low-fat processed foods can be high in calories may still eat more than they mean to, Wylie-Rosett tells WebMD. That's because foods made with fat substitutes may be less satisfying than their higher-fat counterparts. Researchers are now looking into this, but several studies suggest that people may consume more calories on diets that restrict all fats than on those allowing fats, but restricting calories.

So are processed foods made with fat substitutes an essential weapon for dieters waging the battle of the bulge? Or are they really closer to a Trojan Horse -- delivering unsuspected calories that undermine weight loss?

The American Heart Association (AHA) statement says the jury is still out on whether fat substitutes provide a health benefit, but it does note that people rarely lose weight merely by switching to low-fat processed products. The key to losing weight and keeping it off is eating smaller portions and increasing physical activity, the statement reads.

"The bottom line is that foods made with fat substitutes, used in moderation, may provide some flexibility in food selection, but are not an effective strategy on their own for weight control," says Wylie-Rosett.

The AHA recommends limiting total fat intake to 30% or less of calories and saturated fats to less than 10%. More than 90% of adults in the U.S. report consuming foods that contain fat substitutes, and national surveys suggest that Americans are eating less fat -- an average of almost 10% less than they did in the 1950s.

But they are also more likely to weigh more than they should. The CDC recently warned that obesity has doubled in the last two decades, to epidemic levels. One in three Americans weighs too much, and one in four is considered obese.

The fact that the widening of the average American's waistline has coincided with the proliferation of low-fat products and early recommendations from health groups to restrict all fats has not been lost on Barbara Howard, PhD. The chairman of the AHA's nutrition committee, Howard acknowledges that people may be confused because the message on fat intake has changed over the last few years.

"We had a very good reason for putting out the low-fat message originally," she tells WebMD. "We knew that saturated fat was bad, and we thought that those were the fats that people would cut out. The problem is that they cut out all fats -- the good and the bad. But they haven't cut calories, and portions have become enormous."

Foods high in omega-3 fatty acids, like salmon and canola oil, have been shown to improve cholesterol levels. Olive oils and those found in most nuts have also found to be heart healthy. Howard says people who cut out high-fat foods and replace them with fruits, vegetables, whole grains, lean meats, and fish really do lose weight.

"Processed low-fat foods have a place, but people need to understand that calories do count, and portion sizes are critical," she says.

If the names of today's energy products have any truth to them, vitality and endurance are readily available in bars, drinks, gels, ices, herbs, and supplements.

PowerBar. Red Bull. Amp. Gatorade. Accelerade. Super Energizer. Energice.

The brand names do sound stimulating, but do they actually deliver? It depends on the product and its consumer, say experts, who note that the variety of merchandise and people make blanket statements difficult.

In the interest of getting the full story, WebMD explored different kinds of energy edibles, their ingredients, and general effects on the body. Some of the goods may not have as much information as others, but this is telling of the nature of the fountain of energy. Perhaps in a few years, after science has had a chance to study the virtue of different products, we will have more answers. Until then, it seems we're on a parallel mission with Juan Ponce de Leon.

June 12, 2006 - Want a big fat belly? Eat lots of trans fats.

Trans fats make you fatter than other foods with the same number of calories -- but that's not all. Researchers at Wake Forest University find that trans fats increase the amount of fat around the belly. They do this not just by adding new fat, but also by moving fat from other areas to the belly.

"Trans fat is worse than anticipated," Wake Forest researcher Lawrence L. Rudel, PhD, says in a news release. "Diets rich in trans fat cause a redistribution of fat tissue into the abdomen and lead to a higher body weight even when the total dietary calories are controlled."

Rudel colleague Kylie Kavanagh, DVM, reported the findings at this week's annual meeting of the American Diabetes Association in Washington.

In the study, researchers fed 51 male vervet monkeys a western-style diet -- that is, 35% of their diet was fat. Half the monkeys got a lot of trans fat, totaling 8% of their diet. The other monkeys were fed unsaturated fats such as olive oil.

Both types of diets were calorie-controlled. In theory, the monkeys should not have gained weight.

But they did.

Over six years -- what would, in humans, be a 20-year span -- the monkeys who ate unsaturated fats upped their body weight by 1.8%.

Those fed trans fats packed on 7.2%. In humans, that would be enough weight gain to significantly increase risk of diabetes and heart diseaseheart disease.

"Trans fatty acid consumption increases weight gain," Kavanagh says in a news release. "In the world of diabetes, everybody knows that just 5% weight lossweight loss makes enormous difference. This little difference [of weight gain seen in the study] was biologically quite significant."

Trans fats are found in vegetable shortenings, some kinds of margarine, and in manufactured baked goods such as cookies, crackers, and snack foods. A major source of trans fat in American diets is fast food fried in the stuff.

Nov. 16, 2005 -- Diet drugs can help you lose weight, and so can cutting calories and making other lifestyle changes. But combining the two approaches is far more effective than either approach alone, new research shows.

In the study, obese people who modified their eating and exercise habits and took the drug Meridia lost far more weight than people who relied on either lifestyle modification or medication.

"We found that a combination of the two approaches produced approximately twice the weight loss of either intervention used alone," says researcher Thomas A. Wadden, PhD.

The study appears in the Nov. 17 issue of The New England Journal of Medicine.

Many Rely on Drugs Alone

There are two FDA-approved prescription weight loss drugs being sold in the U.S.: Abbott Laboratories' Meridia and Roche's Xenical. Meridia works by suppressing appetite, while Xenical works in the digestive system to block the absorption of fats.

Both drugs are intended for use as part of a comprehensive program that includes diet, exercise, and behavior therapy. But all too often patients are sent home with prescriptions alone, Wadden says.

"Certainly, the doctors who prescribe these medications recommend that their patients cut calories and increase physical activity, but these recommendations may be left at the office door," Wadden tells WebMD.

In an effort to better understand the effectiveness of the different treatment approaches, Wadden and colleagues followed 224 obese men and women on different weight loss regimens for a year.

One group was prescribed standard doses of Meridia with scheduled 10-15 minute office visits with primary care providers. They received minimal lifestyle recommendations, which consisted of an initial pamphlet and "general encouragement." A second group did not take the drug but did participate in an intensive group lifestyle modification program. These patients attended 30, 90-minute group education and support sessions over the course of a year. They also kept daily records of the foods they ate and their physical activity.

A third group received a combination of the drug, brief visits with a primary care provider, and intensive lifestyle modification group sessions similar to the second group. A fourth group took the diet drug and received additional counseling during regularly scheduled office visits. They also kept food and exercise journals, which were reviewed during their office visits with the primary care provider.

This fourth group was added, Wadden says, to see if doctors can provide enough lifestyle counseling to have an impact on weight loss within the confines of the typical brief office visit.

Diet and Lifestyle Changes Get Best Results

At the end of a year, the patients who took the diet drug and participated in the intensive lifestyle modification program lost the most weight, averaging 26.6 pounds.

The Meridia plus brief, doctor-delivered counseling group lost 16.5 pounds. The group that participated in the intensive program but took no Meridia lost 14.7 pounds, and the Meridia-only treatment group lost 11 pounds.

Wadden says drugs and lifestyle modification complement each other because they address different issues. Support and education programs teach people the tools they need to achieve a healthy weight and the drugs help them take in fewer calories.

Can Doctors Do It?

The findings also suggest that doctors can provide meaningful lifestyle counseling, even during rushed office visits, Wadden adds. Having patients keep daily food and exercise journals, and helping them develop a weight loss plan that met their individual needs were two important components of this counseling.

But Howard Eisenson, MD, who has been on both sides of the issue, is skeptical.

He tells WebMD that he didn't have a lot of success getting patients to lose weight as a private practice family doctor. But he has seen plenty of success stories in his current job as director of Duke University Medical Center's well-known Diet and Fitness Center.

"We have a team approach that includes dietitians, fitness specialists, and behavioral therapists in addition to physicians," he says. "These are people who are very important to the process. I think the physician's role is primarily to be a cheerleader -- to show confidence in the patient's ability to make lasting changes and to follow up."

Jan. 5, 2004 -- Whether your weight-loss strategy espouses carbs with no fat or protein with few carbs, there is one thing your plan most certainly recommends -- water. From the veggie-based Ornish diet to steak-loving Atkins (and virtually all diets in between) "drink lots of water" is part of the mantra.

Now comes scientific evidence that H₂O really does help you lose weight. Researchers in Germany report that water consumption increases the rate at which people burn calories. The impact is modest and the findings are preliminary, but the researchers say their study could have important implications for weight-control programs.

Eight Glasses a Day

Despite the fact that most diets call for drinking at least eight, 8-ounce glasses of water a day, few studies have been done to determine if the practice actually speeds weight loss. In an effort to answer this question, Michael Boschmann, MD, and colleagues from Berlin's Franz-Volhard Clinical Research Center tracked energy expenditures among seven men and seven women who were healthy and not overweight.

After drinking approximately 17 ounces of water, the subjects' metabolic rates -- or the rate at which calories are burned -- increased by 30% for both men and women. The increases occurred within 10 minutes of water consumption and reached a maximum after about 30 to 40 minutes.

The study also showed that the increase in metabolic rate differed in men and women. In men, burning more fat fueled the increase in metabolism, whereas in women, an increased breakdown of carbohydrates caused the increase in metabolism seen.

The researchers estimate that over the course of a year, a person who increases his water consumption by 1.5 liters a day would burn an extra 17,400 calories, for a weight loss of approximately five pounds. They note that up to 40% of the increase in calorie burning is caused by the body's attempt to heat the ingested water. The findings are reported in the December issue of The Journal of Clinical Endocrinology and Metabolism.

"Very, Very Small Effect"

The researchers write that up to 70% of the increase in metabolism, "cannot be attributed to the heating of the ingested water," but exercise physiologist Daniel Moser, PhD, tells WebMD that it is unclear from this small study if this is the case.

"Larger studies are clearly needed to confirm this extremely modest weight-loss effect," he tells WebMD.

Nutritionist and American Dietetic Association spokeswoman Leslie Bonci, MPH-RD, says even if the findings are confirmed the clinical implications are slight.

"Obviously people are looking for ways to increase metabolism, but this is an very, very, small effect," she tells WebMD. "We are talking about just a few calories a day."

Bonci says the standard weight-loss plan dictates encouraging people to drink more water stems from the belief that the liquid fills the gut to make people feel fuller.

"Some plans say that drinking water flushes fat out of your system, which is absolutely ridiculous," she says.

Aug. 8, 2003 -- A mother's eating patterns influence her daughter's diet, especially when it comes to eating high-fat foods, a new study shows.

The study, appearing in the August issue of American Journal of Health Behavior, suggests that mothers who are behaving in health-enhancing or health-compromising ways are teaching these behaviors to their children. The studyshows that there is a significant link between the amount of fat that mothers and their adolescent daughters eat. On the flip side, a mother's fiber intake had no influence on how much fiber her daughters ate.

"Limiting consumption of high-fat snack foods and fast foods may be an important dietary behavior that girls choose to emulate in their mothers in an attempt to diet and control their weight, whereas fiber consumption may not be an area women target when trying to lose weight," Cassandra Stanton, PhD, of Brown University says in a news release.

Stanton's team looked at the diet of 400 mother-child pairs in rural areas of New York and Virginia. The mothers and daughters tracked their daily food intake in a diary during a two-year process. Afterward, researchers calculated the number of grams of fat and fiber in each reported food they ate. Researchers also took into consideration demographics and home environment factors.

Black Children Most Influenced by Mother's Diet

The link between what mothers ate and what their children ate was noticeable only with daughters. The findings showed that the strongest influence was among black mothers and daughters.

The tie between mother-daughter eating habits still leaves some unanswered questions. For instance, if one daughter eats 100 grams of fat a day and another daughter eats 75 grams of fat a day, only 25% of the difference could be related to their mother's fat consumption, while 75% may be caused by other factors.

Researchers say recent evidence shows that only 1% of American children have diets that meet current dietary guidelines, and as much as 45% of children's energy intake comes from sugar and fat. The authors say that there is a "clear need to understand the home environment and it's impact on the establishment of eating behaviors among youth that may put them at risk for life-threatening disease in adulthood."

"You're doing so great -- you can have one little piece." Or: "C'mon, honey, I like a little meat on my women." Sound familiar? These people, consciously or not, are trying to sabotage your diet.

David L. Katz, MD, MPH, director of Yale University's Prevention Research Center and author of The Way to Eat, says sooner or later, you may find yourself in a toxic nutritional environment -- almost all dieters do. Some things that people might say or do to throw you off course:

• "Fear" for your health. "What's the matter -- you are wasting away. Are you sure you aren't losing too much too fast?" Or: "Are you sure that diet won't raise your cholesterol?"
• Acting insulted. "You don't like my pot roast all of a sudden? You're too good for my cheesecake?"
• Mixing up food with love. "You don't come to dinner -- you don't love me anymore."
• Making you an outsider. Katz says this sometimes happens among co-workers. "You can't eat Mexican because of your diet, so we will see you after we go out."
• Leaving food around. The big candy dish on the receptionist's desk in an office of dieters. Or: "Here, one doughnut left, want it?" The leftovers from the office party. Or the spouse who keeps dragging half the chips in the store into the house.
• Creating special food. One husband didn't want to babysit on Overeaters Anonymous night, so made a big dinner each time and told his wife to bring some of her "dieting friends" over.
• Making up special holiday rules. "It's your birthday -- one piece of cake won't hurt!"
• Imparting discouraging news. "I am so proud of you for trying this, even though you know that 95% of people fail to keep the weight off." Or: "It's not my business, but don't runners get a lot of injuries?"
• Volunteering amateur psychoanalysis. "You know, you don't seem to be as funny since you lost weight."

Why People Sabotage

"I have had people try to get someone who has lost a lot of weight to put it all back on!" exclaims Linda Spangle, RN, MA, author of Life is Hard, Food is Easy. "One woman had lost more than 100 pounds, but her husband bought her a size 4X blouse and candy for Christmas."

"He wants the old me back," she told Spangle. She saw it as a control issue and eventually divorced the man for trying to control her so destructively.

"In some instances," Spangle says, "a spouse may have the need to control. A man may think if his wife stays fat she won't be flirting or attracting notice. Sometimes, this spouse will compliment the heavy person. No one else does, so this is a way of keeping control."

Katz says people who are themselves overweight (two-thirds of Americans) feel threatened. "Most people struggle with weight issues," Katz says. "If I am fat and you go on a diet, you put me in the uncomfortable position of feeling bad about my own weight; deciding to do something about it, which I may not be ready to do; or trying to talk you out of what you are doing.

"People who are threatened," Katz sums up, "fight back."

Sexual anxiety is also a part of it, he agrees. "If the person gets thin, they may find someone else. That is a factor. 'My wife is getting so sexy, she may dump me.'"

And, Katz says, being reassuring to the dieter may be a higher form of love. "A mother may think it's her job to make the child feel better about themselves. They may be on a mission to get a daughter to accept her size."

Co-workers, he says, tend to be competitive. If you are succeeding at something, even losing weight, it makes them look less successful. Plus, you might attract notice for a promotion.