Class 3-2: Challenges to Eating Well

Overview

Today's Class Overview

In today's class, you will complete our section on nutrition by exploring some nutrition-related challenges to wellness.

Today's Class Objectives

By the end of this module you should be able to:

1. Recognize common eating disorders and how they can be treated.
2. Identify the health impacts of obesity.
3. Discuss issues related to undernutrition and food access.
4. Find reliable nutrition information.
5. Think critically about the impact of marketing on your nutrition.
6. Connect this information to ideas from our earlier classes.

Outline of Today's Class

• Materials
  1. Overview
  2. Review
  3. Eating Disorders
  4. Obesity
  5. Undernutrition
  6. What is a Food Desert?
  7. Case Study Conclusion
  8. Food Marketing and You
  9. Guide to Reading Food Labels
  10. Summary

Review

Reviewing 3-1: Eating for Wellness

• Six major classes of nutrients - substances the body needs for energy, building materials, and body processes.
  • carbohydrates, proteins, lipids, water, vitamins, and minerals
  • Essential nutrients must be obtained from food
  • Nonessential nutrients can be synthesized by the body.
  • Macronutrients - the body needs in relatively large quantities
  • Micronutrients - the body needs in relatively small quantities.
• Phytochemicals and their potential role in maintaining normal body functions and good health.
• Guidelines for healthy eating and good nutrition, and why a healthy diet can reduce the risk of many diseases.
• Being mindful of your eating habits means being aware of:
  • how you eat
  • why you eat
  • what you eat
  • when you eat
  • where you eat
  • how much you eat
• Resources for Reliable Nutrition Information
  • SNAP-Ed Resource Database
  • Nutrition.Gov Questions and Answers
  • EatFresh.org Ask A Dietician

Eating Disorders

The following has been excerpted and adapted from "Human Biology Butte 17-18" by CK-12 licensed CC BY-NC 3.0:

Eating Disorders

What Are Eating Disorders?

Eating disorders are mental health disorders defined by abnormal eating habits that adversely affect health. Eating disorders typically begin during late childhood, adolescence, or early adulthood. In developed countries such as the United States, they occur in about 4 percent of people and are much more common in females than males. In developing countries, they are less common but increasing in frequency. Eating disorders are serious diseases and can even be fatal. In fact, they result in about 7,000 deaths a year in the United States, making them the mental disorders with the highest mortality rate.

Major Eating Disorders

Common eating disorders in the United States include anorexia nervosa, bulimia nervosa, and binge eating disorder. They differ in the patterns of disordered eating that characterize them, but all of them can have life-threatening health consequences. They may also have similar causes.

• • Anorexia nervosa is an eating disorder in which people consistently eat very little and become extremely thin. They may also develop amenorrhea and other serious health problems. People with anorexia nervosa often fail to appreciate how thin they are and how severe their illness is.
  • Bulimia nervosa is an eating disorder in which people recurrently binge on large amounts of food, followed by purging the food from the body through vomiting, using laxatives, exercising excessively, or other methods. People with bulimia nervosa may have normal weight but often have serious health problems such as electrolyte imbalances and irregular heartbeat.
  • Binge eating disorder is an eating disorder in which people repeatedly binge on large amounts of food, followed by feelings of guilt but not by purging. This generally leads to excessive weight gain, obesity, and other serious disorders.

Causes of Eating Disorders

The causes of eating disorders are not fully understood and are likely to vary among individuals. However, in virtually all cases, both biological and environmental factors appear to play a role.

Biological Factors

Genes are likely to be involved in the development of eating disorders, because having a close biological relative with an eating disorder increases one’s own risk tenfold or more. At a biochemical level, eating disorders are thought to be caused in part by dysregulation of neurotransmitters such as serotonin and dopamine. Serotonin normally has an inhibitory effect on eating and dopamine regulates the reward property of food. Imbalance in these neurotransmitters is likely to affect appetite and eating behavior. Dysregulation of the hormones leptin and ghrelin may also be involved in eating disorders. These two hormones normally help maintain the body’s energy balance by increasing or decreasing food intake. This occurs through the regulation of appetite and eating behavior. Leptin is produced mainly by fat cells in the body. It normally inhibits appetite by inducing a feeling of satiety. Ghrelin is produced in the stomach and small intestine. Its normal role is to stimulate appetite. If these hormones are out of balance, the imbalance will affect appetite and may lead to disordered eating.

Environmental Factors

A number of environmental factors have also been shown to increase the risk of developing eating disorders. One of the most salient is abuse suffered as a child, including physical, psychological, or sexual abuse. Child abuse has been shown to triple the risk of developing an eating disorder. Parental pressure to control a child’s eating habits can also increase the risk, as can having a fragile sense of self-identify. In older individuals, social isolation increases the risk of eating disorders.

Cultural idealization of thinness in females is thought to be a major contributing cause of anorexia and bulimia nervosa. It may be part of the reason that these two eating disorders occur ten times more often in females than males. Dancers (like the one pictured below) and athletes such as gymnasts are two groups of young women who may feel exceptional pressure to be thin. Up to 12 percent of female dancers develop anorexia or bulimia, compared with about 2 percent of females in the general population.

Treatment and Recovery

Treatment of eating disorders varies according to the type and severity of the eating disorder. Usually, more than one treatment option is used. Treatment typically includes mental health counseling, which can take place in a variety of settings, such as a community program, private practice, or hospital. Treatment may also include the use of antidepressants or other medications because many people with eating disorders also suffer from depression or other mental health disorders. Nutritional counseling is often recommended as well. Hospitalization is occasionally required, in many cases to treat the adverse physical health consequences of the disordered eating.

The goal of treatment is recovery, including gaining control of eating, adopting normal eating habits, and attaining a normal weight. About 50 to 85 percent of people with eating disorders recover with treatment. However, some may have to struggle to maintain normal eating behaviors throughout the rest of their life.

Feature: Reliable Sources

People with anorexia nervosa, as with many other health problems, may seek information and advice online before or instead of contacting a healthcare professional. The web offers a plethora of useful information on eating disorders, including anorexia nervosa, but some websites, blogs, and social media pages actually have the agenda of promoting disordered eating. The term pro-ana (from “pro-anorexia”) refers to organizations, websites, and other sources that promote anorexia nervosa. Their mission is to normalize or even glamorize anorexia nervosa. They defend it as a lifestyle choice and an accomplishment of self-control rather than as a mental disorder. Research has shown that visiting pro-ana sites can have a negative impact on eating behavior in people both with and without eating disorders. After visiting such sites, people tend to decrease their Caloric intake, although most of them do not actually perceive that they have reduced their intake of Calories.

Following a 2001 episode of the Oprah Winfrey Show that focused on pro-ana, the mainstream press started covering the issue. Pressure from the public and pro-recovery organizations led to some social media and other websites adopting policies of blocking pro-ana pages or labeling them with warning messages. As result, many pro-ana groups have taken steps to conceal themselves. For example, they may claim that they are simply providing a nonjudgmental forum for people with anorexia nervosa to discuss their disorder. They may also claim that they exist in part to provide support those who choose to enter recovery.

Some clues that a website or page may be pro-ana include providing information on topics such as:

• crash dieting techniques and recipes.
• socially acceptable pretexts for refusing food, such as veganism.
• ways to hide weight loss from parents and doctors.
• reducing the adverse health effects of anorexia.
• ways to ignore or suppress hunger pangs.

Obesity

The following has been excerpted and adapted from "Human Biology Butte 17-18" by CK-12 licensed CC BY-NC 3.0:

What Is Obesity?

Obesity is a disease in which excess body fat has accumulated to the extent that it is likely to have negative effects on health.

Causes of Obesity

Like many other diseases, most cases of obesity are the result of an interplay between genetic and environmental factors. Obesity is most commonly caused by a combination of excessive food intake, inadequate physical activity, and genetic susceptibility.

Genetic Influences on Obesity

Various genes that control appetite and metabolism predispose people to developing obesity when sufficient food energy is present. It is likely that dozens of such genes exist. Family studies reveal the strength of the genetic influence on obesity. When both parents are obese, 80 percent of their offspring will also be obese. For comparison, when both parents are of normal weight, less than 10 percent of their offspring will be obese.

Diet and Obesity

From 1971 to 2000 in the United States, the average amount of food consumed by women actually increased by 335 Calories per day and by men by 168 Calories per day. During the same period, the rate of obesity in U.S. adults increased from about 15 to 31 percent. Most of the extra food energy came from an increase in carbohydrate consumption. Primary sources of these extra carbohydrates were sugar-sweetened beverages, like those pictured below. Sugary beverages include not only soft drinks but also fruit drinks, sweetened iced tea and coffee, and energy- and vitamin-water drinks. Such drinks now account for almost 25 percent of daily food energy in young adults in the United States. This is an alarming statistic, given that these drinks provide no other nutrients except energy.

Activity Levels and Obesity

A sedentary lifestyle plays a significant role in obesity. Worldwide, there has been a large shift toward less physically demanding work. There has also been an increased reliance on cars and labor-saving devices at home. Currently, an estimated 30 percent of the world’s population gets insufficient exercise.

Other Causes of Obesity

A minority of cases of obesity are caused by certain medications or by other diseases. Medications that may increase the risk of obesity include antidepressant and antipsychotic drugs, steroids such as prednisone, and some forms of hormonal contraception, among others. Diseases that increase the risk of obesity include hypothyroidism, Cushing’s disease, binge eating disorder, and Prader-Willi syndrome.

Consider Prader-Willi syndrome as an example. A young child with this syndrome is pictured below. The syndrome occurs due to loss of function of specific genes on chromosome 15. Symptoms of the syndrome include constant hunger, which typically leads to severe obesity in childhood. Prader-Willi syndrome is caused by genetic defects but it is not generally inherited. Instead, the genetic changes happen during the formation of the egg or sperm or during embryonic development.

Pathophysiology of Obesity

A recently proposed physiological mechanism for the development of obesity is leptin resistance. Leptin is called the satiety hormone. It is secreted by fat cells and helps to regulate appetite based on the body’s fat reserves. When fat reserves are high, more leptin is secreted and appetite is inhibited, so you eat less. The opposite occurs when fat reserves are low. In obesity, decreased sensitivity to leptin occurs, resulting in an inability to detect satiety despite high fat reserves. As a consequence, people wth leptin resistance never feel satiated and are likely to overeat and gain more weight.

Health Consequences of Obesity

Obesity increases the risk of many other health problems and diseases, including cardiovascular disease, type 2 diabetes, fatty liver, certain types of cancer, pancreatitis, osteoarthritis, obstructive sleep apnea, and asthma. The health consequences of obesity are mainly due to the effects of either increased fat mass or increased numbers of fat cells. Extra weight from excess body fat places a lot of stress on the body and its organ systems, causing diseases such as osteoarthritis and obstructive sleep apnea. An increased number of fat cells increases inflammation and the risk of blood clots. It also changes the body’s metabolism, altering the body’s response to insulin and potentially leading to insulin resistance and type 2 diabetes. This explains why the link between obesity and type 2 diabetes is so strong. Obesity is thought to be the root cause of 64 percent of cases of type 2 diabetes in men and 77 percent of cases in women.

Treating and Preventing Obesity

Most cases of obesity are treatable or preventable through changes in diet and physical activity that restore energy balance to the body. In fact, obesity is one of the leading preventable causes of disease and death worldwide. The amount of energy provided by the diet can be reduced by decreasing consumption of energy-dense (high-Calorie) foods, such as foods high in fat and sugar, and increasing consumption of high-fiber foods. Fiber in the diet cannot be digested, so it adds bulk and a feeling of fullness without adding Calories. All types of low-carbohydrate and low-fat diets appear equally beneficial in reducing obesity and its health risks. In some cases, medications may be prescribed to help control obesity by reducing appetite or fat absorption.

Public Health Approaches

Public health approaches to the problem of obesity include efforts to understand and correct the environmental factors responsible for increasing obesity rates. The goals are to reduce food energy consumption and promote energy expenditure in physical activity. Efforts to reduce energy consumption include promoting healthy meals and limiting access to sugary beverages and junk foods in schools. Efforts to promote physical activity include increasing access to parks and developing pedestrian routes in urban environments.

Undernutrition

The following has been excerpted and adapted from "Human Biology Butte 17-18" by CK-12 licensed CC BY-NC 3.0:

Undernutrition

Defining Undernutrition

Undernutrition is defined as insufficient intake of nutritious foods. People who are undernourished are likely to have low body fat reserves, so one indicator of undernutrition in individuals is a low body mass index (BMI). Adults are considered underweight if their body mass index (BMI) is less than 18.5 kg/m². Children are considered underweight if their BMI is less than the 5th percentile of the reference values for children of the same age.

Undernutrition in Children

The effects of undernutrition are particularly important during childhood, when energy and other nutrients are needed for normal growth and development. Children are more likely than adults to become severely undernourished as well as to suffer permanent effects from undernutrition. They may become dangerously thin, with loss of muscle as well as fat. This is called wasting. If they lack adequate energy for growth, they will stop growing. If they are chronically undernourished, the growth deficits may cause them to be too short for their age. This is called stunting. Unless adequate nutrition becomes available later so they can make up their growth deficits, stunted children will end up shorter than their genetic potential for height by the time they are adults.

Undernutrition and Infection

Undernutrition and infectious diseases in children have a positive synergistic relationship. Each increases the risk of the other and makes the other worse. Children who are undernourished may be weakened and have a less than robust immune system. This makes them more susceptible to infectious diseases and likely to become sicker when they have infectious diseases. Children who are sick with infectious diseases may need more nutrients to defend against infection. At the same time, they may have reduced intake or absorption of nutrients due to symptoms such as vomiting and diarrhea. In these ways, infectious disease increases the risk of undernutrition or makes existing undernutrition worse.

Undernutrition and Low Birthweight

Many children are born with the disadvantage of low birthweight (< 2.5 kg, or 5.5 lb.) caused by maternal undernutrition and intrauterine growth restriction. Babies with low birthweight are more susceptible to disease and more likely to die in infancy. In children that survive infancy, low birthweight may result in slow growth and developmental delays throughout early childhood.

Undernutrition Syndromes

Severe cases of undernutrition may develop into life-threatening syndromes such as kwashiorkor, first described in the medical literature in the 1930s. The name comes from a West African word meaning “disease of the deposed child.” The original meaning of the term is a clue to the cause of this syndrome. If a young child is weaned from the breast so a new baby can be breastfed, the “deposed child” is likely to go from a mostly breastmilk diet, which is high in protein, to a mostly plant-food diet, which is low in protein. Although Kwashiorkor may occur in a child who lacks protein but not Calories, it occurs more often when the diet is also deficient in Calories. That’s why kwashiorkor is commonly called protein-Calorie malnutrition.

The defining sign of kwashiorkor in an undernourished child is edema (swelling) of the ankles and feet and often a distended belly, both of which are clearly visible in the child pictured below. The lack of protein causes osmotic imbalances that prevent tissue fluids from being returned to the bloodstream. This mechanism accounts for the accumulation of fluid in the ankles, feet, and abdomen. Other common signs of kwashiorkor include enlarged liver (which contributes to the abdominal distension), thinning hair, loss of teeth, skin rash, and skin and hair depigmentation. Children with kwashiorkor may also be irritable and lose their appetite. Kwashiorkor can have a long-term impact on a child's physical and mental development and frequently leads to death without treatment.

Marasmus

Marasmus comes from a Greek word meaning “wasting away.” It is a severe undernutrition syndrome caused by extremely low intakes of food energy. Signs and symptoms of marasmus include wasting (as depicted below), low body temperature, anemia, dehydration, weak pulse, and cold extremities. Without treatment, marasmus is often fatal, although it generally has a better prognosis than untreated kwashiorkor.

Micronutrient Deficiencies

Besides deficiencies in food energy and protein, many undernourished people suffer from deficiencies of specific vitamins or minerals. Some of the most common micronutrient deficiencies worldwide are iron, vitamin A, and iodine deficiencies.

Iron Deficiency

Iron deficiency is the single most common micronutrient deficiency worldwide, affecting about 2 billion people. Iron deficiency, in turn, causes anemia, which is especially common in women and children under the age of five years. Anemia can lead to increased mortality in infancy and poor cognitive and motor development in early childhood. The problems caused by iron-deficiency anemia in childhood cannot be reversed.

Vitamin A Deficiency

Vitamin A deficiency is also very common in developing countries. In young children, vitamin A plays an essential role in the development of the immune system, so vitamin A deficiency adversely affects the ability of the immune system to fight off infections. Vitamin A deficiency also contributes to anemia and causes visual impairments, ranging from night blindness (inability to see well at low light levels) to total blindness.

Iodine Deficiency

Since the early 1900s, iodine has been added to salt in many countries, including the United States and most of Europe, virtually eliminating iodine deficiency in these countries. However, inadequate iodine intake is still a public health problem in dozens of countries, and about 30 percent of the world’s people are iodine deficient.

Iodine is needed for thyroid hormone production. In adults, iodine deficiency causes reversible signs and symptoms of inadequate thyroid hormone. These may include an enlarged thyroid gland, called a goiter (see the photo below), and a sluggish metabolism. In children, iodine deficiency is much more serious. It causes permanent intellectual disability because thyroid hormone is needed for normal brain growth and development, from the fetal stage through early childhood. Iodine deficiency is the most important cause of preventable intellectual disability in the world.

Causes of Undernutrition

A small percentage of undernutrition occurs because of diseases such as cancer, anorexia nervosa, celiac disease, and cystic fibrosis (all of which you can read about in other concepts). However, the vast majority of undernutrition globally occurs because people simply don’t have enough nutritious food to eat. They take in less energy than the minimum daily energy requirement so they are underweight, and they are likely to have other nutritional deficiencies as well. Worldwide food supplies are adequate to provide food to all, if the food supplies were equally distributed and accessible to everyone.

Although undernutrition is not as common in the richer nations of the world as it is elsewhere, it still occurs in significant proportions of people. Even in a land of plenty like the United States, socioeconomic disparities result in some people being undernourished due to lack of access to sufficient nutritious food. Besides lacking adequate money to buy nutritious foods, many poor people in the United States live in areas that are considered “food deserts,” defined as areas with limited access to nutritious foods. In these food deserts, supermarkets with fresh produce and other nutritious food choices are typically too far away for people to utilize. Instead, they must rely on small neighborhood stores that stock mainly over-priced processed foods or on fast food restaurants that offer primarily high-fat and high-sugar food options. With social inequalities on the rise in the United States and some other rich nations, problems of food access and undernutrition may worsen.

Treatment and Prevention of Undernutrition

Treating and preventing undernutrition is a huge and complex problem requiring multifaceted approaches. Potential solutions must target both individual and public health. Meeting individual needs is generally achieved through direct nutrition interventions (like the one illustrated in the following photo). In such interventions, the health-care sector typically delivers nutritional supplements directly to acutely malnourished people who might otherwise require hospitalization. Public health interventions may focus on improvements in agriculture, water, sanitation, or education, among other public health targets. Some of the most successful public health interventions have been those aimed at eliminating specific micronutrient deficiencies. For example, in the early 1990s, iodine deficiency was addressed by a global campaign to iodize salt. This campaign reduced the rate of iodine deficiency from about 70 percent to 30 percent.

What is a Food Desert?

The following has been excerpted from "The Grocery Gap: Who Has Access to Healthy Food and Why it Matters ," a policy report by the non-profit organization The Food Trust under fair use:

What is a Food Desert?

An apple a day? For millions of Americans—especially people living in low-income communities of color— finding a fresh apple is not so easy.

In hundreds of neighborhoods across the country, nutritious, affordable, and high quality food is out of reach.

Full-service grocery stores, farmers’ markets, and other vendors that sell fresh fruits, vegetables, and other healthy foods cannot be found in their neighborhoods.

What can be found, often in great abundance, are convenience stores and fast food restaurants that mainly sell cheap, high-fat, high-sugar, processed foods and offer few healthy options.

Without access to healthy foods, a nutritious diet and good health are out of reach.

And without grocery stores and other fresh food retailers, communities are missing the commercial hubs that make neighborhoods livable, and help local economies thrive.

As concerns grow over healthcare and the country’s worsening obesity epidemic, “food deserts”—areas where there is little or no access to healthy and affordable food—have catapulted to the forefront of public policy discussions.

Residents of many urban low-income communities of color walk outside their doors to find no grocery stores, farmers’ markets, or other sources of fresh food. Instead they are bombarded by fast food and convenience stores selling high-fat, high-sugar, processed foods.

Rural residents often face a different type of challenge—a lack of any nearby food options.

This has been a persistent problem for communities.

Beginning in the 1960s and 1970s, white, middle-class families left urban centers for homes in the suburbs, and supermarkets fled with them.

Once they left the city, grocers adapted their operations to suit their new environs, building ever-larger stores and developing chain-wide contracts with large suppliers and distributors to stock the stores with foods demanded by a fairly homogeneous suburban population.

Over the past several decades, the structure of the grocery industry has changed dramatically, with significant consolidation and growth in discount stores and supercenters and specialty/natural food retailers.

At the same time, alternative sources of fresh foods such as farmers’ markets, produce stands, and community-supported agriculture programs have proliferated, though predominantly in middle-class or affluent communities.

Policymakers at the local, state, and national level have begun recognizing the role that access to healthy food plays in promoting healthy local economies, healthy neighborhoods, and healthy people.

This report, a summary of our current knowledge about food deserts and their impacts on communities, provides evidence to inform this policymaking.

Findings of Their Review of Research

1. Accessing healthy food is a challenge for many Americans—particularly those living in low-income neighborhoods, communities of color, and rural areas.

• Lack of supermarkets. A 2009 study by the U.S. Department of Agriculture found that 23.5 million people lack access to a supermarket within a mile of their home.
  • A recent multistate study found that low-income areas had half as many supermarkets as wealthy tracts.
  • A nationwide analysis found that 20 percent of rural counties are rural “food desert” where all residents live more than 10 miles from a supermarket or supercenter.
• Lack of healthy, high quality foods in nearby food stores.
  • In Albany, New York, 80 percent of nonwhite residents cannot find low-fat milk or high-fiber bread in their neighborhoods.
  • In Baltimore, 46 percent of lower-income neighborhoods have limited access to healthy food (based on a healthy food availability survey) compared to 13 percent of higher-income neighborhoods.
• Predominance of convenience/corner/ liquor stores.
  • Nationally, low-income zip codes have 30 percent more convenience stores, which tend to lack healthy items, than middle-income zip codes.
• Lack of transportation access to stores
  • Residents in many urban areas have few transportation options to reach supermarkets.
  • In Mississippi—which has the highest obesity rate of any state—over 70 percent of food stamp eligible households travel more than 30 miles to reach a supermarket

2. Better access corresponds with healthier eating; Studies find that residents with greater access to an abundance of healthy foods consume more fresh produce and other healthful items.

• A survey of produce availability in New Orleans’ small neighborhood stores found that for each additional meter of shelf space devoted to fresh vegetables, residents eat an additional 0.35 servings per day.
• In rural Mississippi, adults living in “food desert” counties lacking large supermarkets are 23 percent less likely to consume the recommended fruits and vegetables than those in counties that have supermarkets, controlling for age, sex, race, and education.

3. Access to healthy food is associated with lower risk for obesity and other diet-related chronic diseases.

• A multistate study found that people with access to only supermarkets or to supermarkets and grocery stores have the lowest rates of obesity and overweight and those without access to supermarkets have the highest rates.
• In California and New York City, residents living in areas with higher densities of fresh food markets, compared to convenience stores and fast food restaurants, have lower rates of obesity.
• In California, obesity and diabetes rates are 20 percent higher for those living in the least healthy “food environments,” controlling for household income, race/ethnicity, age, gender, and physical activity levels.

4. New and improved healthy food retail in underserved communities creates jobs and helps to revitalize low-income neighborhoods.

• Though the economic impacts of food retailers are understudied, we know that grocery stores contribute to community economic development.
• Analysis of a successful statewide public-private initiative to bring new or revitalized grocery stores to underserved neighborhoods in Pennsylvania provides positive evidence that fresh food markets can create jobs, bolster local economies, and revitalize neighborhoods.
• The effort has created or retained 4,860 jobs in 78 underserved urban and rural communities throughout the state.

The evidence is clear that many communities— predominantly low-income, urban communities of color and rural areas—lack adequate access to healthy food, and the evidence also suggests that the lack of access negatively impacts the health of residents and neighborhoods.

These findings indicate that policy interventions to increase access to healthy food in “food deserts” will help people eat a healthy diet, while contributing to community economic development.

Case Study Conclusion

The following has been excerpted and adapted from "Human Biology Butte 17-18" by CK-12 licensed CC BY-NC 3.0:

Case Study Conclusion

Case Study Conclusion: What’s Wrong with Fast Food?

Last week, we began to ask what is wrong with fast food.

That is the question that Carlos, who you read about in the beginning of this section, asked himself after learning that his friend Kevin eats it five or six times a week, and thinks that this diet is not necessarily that bad for him. In order to find some answers, Carlos went to the website of Kevin’s favorite fast food restaurant and found nutritional information for his typical meal of a cheeseburger, large fries, and a large soda. Some of the information he found is shown in the tables below. Knowing what you now know about nutrition, what aspects of this meal could potentially be harmful to Kevin’s health if he eats like this frequently?

Nutritional Information for a Typical Fast Food Meal

% DV = percentage of adult recommended daily value (DV) for each nutrient, based on a 2,000 Calorie a day diet.

As Carlos already said to Kevin, fast food meals are often very high in calories. This meal has 1,350 Calories. A typical adult should consume around 2,000 Calories a day, so this single meal has more than half the calories typically needed by a person in one day. Some fast food meals have even more calories. The cheeseburger in this meal has 540 Calories, which is typical for a moderately-sized fast food cheeseburger. But some larger fast food burgers, or burgers with more toppings, can have over 1,000 Calories! As you can see, it can be quite easy to exceed your calorie recommendation for the day if you eat a typical fast food meal, considering that you will probably eat two other meals that day as well.

What is the problem with consuming excess calories? As you have learned, it is important to maintain energy homeostasis — that is, a balance between the energy you consume and what your body uses. If you eat more calories than your body needs, you will store that extra food energy as fat, which can cause you to become obese. Obesity raises the risk of many diseases and health problems, including cardiovascular disease, type 2 diabetes, stroke, liver disease, cancer, pancreatitis, osteoarthritis, sleep apnea, and asthma. Many of these medical conditions can be deadly, which is why obesity can shorten a person’s lifespan. Although Kevin is only slightly overweight at this point, if he regularly consumes more calories than he uses (which is likely with a diet high in fast food) he will gain excess body fat, raising his risk of obesity and its associated diseases.

Why do typical fast food meals have so many calories even if they don’t appear to be particularly large? For one, these foods are typically high in fat. Notice that this meal contains 80% of the recommended daily value (DV) of total fat — close to the limit for the entire day! As you have learned, fat is energy dense. One gram of fat has nine Calories, while one gram of protein or carbohydrate has only four Calories. This means that meals high in fat, like this one, will generally have more calories than a lower fat meal of equivalent size. The large amount of fat in the burger and fries contributes to the high energy density of this meal.

But fat isn’t the only reason this meal is so high in calories. The soda contains 300 Calories — about the same number of calories as three apples! For most people, three apples would be more satiating than a soda. This is in part because apples have fiber, which is filling. As you have learned, sodas and other sugary beverages generally have no other nutrients besides carbohydrates. You can see from the tables that the soda is the largest contributor of carbohydrates to this meal, with very few other nutrients. If Kevin is frequently drinking large sodas, he is getting a significant percentage of his calories from a substance that is not giving him a feeling of fullness, which may cause him to consume more calories overall. In fact, many scientists think that the increase in consumption of sugary beverages has been a major contributor to the obesity epidemic.

Besides excess calories, what nutrients in this meal could cause health problems? This meal has both a high percentage of saturated fat (66% DV) as well as some trans fat. The American Heart Association recommends that people limit their consumption of saturated fat, since it has been shown to raise the risk of heart disease. Trans fats are particularly dangerous, and can increase the risk of heart disease, stroke, and type 2 diabetes. In fact, in 2015 the U.S. Food and Drug Administration (FDA) ruled that trans fats have not been shown to be safe for human consumption, and ordered food producers to remove them from the food supply by 2018. While some fast food restaurants voluntarily removed trans fats from their food prior to this time, as of early 2017 some restaurants still had items containing trans fats on their menus —like the burger from Kevin’s favorite restaurant.

Another nutrient that fast food meals tend to have too much of is sodium. This meal has over half the sodium you should eat in a day, mostly from the burger. And this burger isn’t the worst one around — some fast food burgers have double the recommended DV for sodium! Burgers with bacon are particularly high in sodium. Consumption of excess sodium can lead to high blood pressure, cardiovascular disease, and stroke.

Consumption of excess nutrients is not the only concern when a person frequently eats fast food. As you can see from the tables, this meal is relatively low in some vitamins and minerals such as vitamin A (10% DV) and calcium (17% DV). As you have learned, vitamin A is important for maintaining normal vision and, in young children, the development of the immune system, among other functions. Calcium is a macromineral needed for bone strength, neutralizing acidity in the digestive tract, and nerve and cell membrane functions. Eating a diet low in specific nutrients can cause a form of malnutrition called unbalanced nutrition. If Kevin eats meals like this frequently, he would have to make sure to get plenty of essential nutrients from other sources in order to maintain his health, which may be difficult if fast food takes the place of healthier foods in his diet. Carlos was correct to be concerned about the lack of fresh food in most fast food meals. Fresh fruits and vegetables contain fiber, phytochemicals, and many vitamins and minerals that are important for maintaining health.

But as Kevin brought up, is fast food worse than other types of food? While it tends to be particularly high in calories, fat, and sodium, and is not very nutrient dense, the same is true for many other types of meals eaten outside the home. Many chain restaurants have nutritional information listed on their website — you can look up some of your favorites. You might be surprised to learn that some restaurant entrees contain more than 2,000 Calories for a single meal, combined with an excessive amount of saturated fat and sodium. These items are just as bad or worse for your health than some fast food meals.

The keys to healthy eating are to know what you are consuming and to make good choices. Preparing fresh food at home is usually healthier than eating out, but most restaurants have some healthier options. After Carlos tells Kevin what he found out about Kevin’s favorite meal, Kevin decides to make some changes. He doesn’t want to face a future of obesity and potentially life-threatening health conditions. He decides to pack a healthy lunch to take with him during the day, and will eat more dinners at home. When he does occasionally eat fast food, he will make better choices. Skipping the soda will easily save him 300 Calories. Kevin loves fries, but he realizes that if he orders small fries instead of large, he can save 280 Calories and 20% DV of total fat. If he orders a smaller cheeseburger, he can save an additional 240 Calories and 25% DV total fat. Then if he is still hungry, he can add a piece of fruit from home for additional nutrients. He will also try other options at fast food restaurants, such as salads or grilled chicken sandwiches, which may be healthier. However, he should check the nutritional information first, since some seemingly healthy options can still be high in calories, fat, and salt due to added dressings, sauces, and cheese. Healthy eating and good nutrition doesn’t have to be difficult if you are armed with information and make good choices with your long-term health in mind.

Food Marketing and You

The following has been adapted and excerpted from the Canada's Food Guide page "Marketing can influence your food choices" under fair use:

Food Marketing and You

Food marketing is advertising that promotes the sale of certain food or food products. Many foods and drinks that are marketed can contribute too much sodium, sugars or saturated fat to our eating patterns.

Food marketing can take on many forms, such as:

• branding
• sponsorship of events
• celebrity endorsements
• contests and sales promotions
• social media posts on:
• Twitter
• Pinterest
• Snapchat
• Facebook
• Instagram
• commercials
• on TV
• on the radio
• on the internet
• before the start of movies
• product placement
• on TV
• in movies
• in magazines
• on social media posts
• in music lyrics and videos

Newer forms of marketing like sponsored posts on social media can be more difficult to recognize. This can make it hard to know when you are being advertised to.

Astroturfing is the practice of masking the sponsors of a message or organization (e.g., political, advertising, religious or public relations) to make it appear as though it originates from and is supported by grassroots participants. It is a practice intended to give the statements or organizations credibility by withholding information about the source's financial connection. The term astroturfing is derived from AstroTurf, a brand of synthetic carpeting designed to resemble natural grass, as a play on the word "grassroots". The implication behind the use of the term is that instead of a "true" or "natural" grassroots effort behind the activity in question, there is a "fake" or "artificial" appearance of support. - via wikipedia.org

Marketing can also be targeted to you based on your personal data, like your:

• age and gender
• purchasing history
• web browsing history

Behavioural advertising tracks your personal data and online activities over time in order to deliver targeted ads.

How food marketing can affect your food choices

Food marketing is all around us. You likely receive a constant stream of changing and often conflicting messages about food. This can make it hard to make healthy food choices.

Food marketing can impact you in many different ways. It is designed to:

• create food trends
• encourage you to:
  • buy certain foods or drinks
  • buy foods in order to get promotional items such as:
    • loyalty points
    • tickets to movies or sports events
    • coupons for future food purchases
  • create links between certain foods or brands and a particular lifestyle
  • build brand loyalty so you will continue to purchase from a particular store or products with a brand name

Benefits of being aware of food marketing

Being aware of food marketing is a food skill that can help you:

• recognize when foods are being marketed to you
• decide whether a food item is healthy by using food labels rather than relying on marketing messages alone
• teach those who may be more vulnerable to food marketing, like young children and teens, about marketing techniques

How to be aware of food marketing when making food choices

Use these tips to help you make an informed choice:

Use food labels.

Stick to your grocery list and avoid impulse buys.

Question why you want to purchase a certain food or drink. Do you think:

• it’s cool?
• it’s healthy?
• it will improve your mood?
• it will provide nutritional benefit?

Question what form of marketing you got these ideas from, like:

• a sponsored blog post
• a celebrity endorsement
• messages on the product itself
• Explore ways to lessen your exposure to ads. Try:
• limiting screen time
• using ad-free platforms
• downloading software that limits advertising and pop-ups

Learn about:

• what you can do to protect your privacy
• how your online browsing history can be used to send you targeted ads

Before you share or like content online like a video, game, blog or quiz ask:

• if you really want to share a promotion for a food or drink product

Talk with those around you about the effects of marketing. Ask each other:

• whether you have ever purchased foods even if you did not intend to and why you think that is
• what strategies you use to help limit your exposure to food marketing

Guide to Reading Food Labels

Visit the FDA’s website to learn “How to Understand and Use the Nutrition Facts Label.”

Summary

Major Points

During today's class, you have learned about:

• Energy homeostasis - the balance between calories consumed and those that are used by the body.
• Types of malnutrition, including undernutrition, overnutrition, and unbalanced nutrition.
• Nutrient and energy density and how knowledge of these factors can be used to make healthier food choices.
• How appetite is regulated.
• Eating disorders including anorexia nervosa, bulimia nervosa, and binge eating disorder and their causes, health effects, and treatments.
• Obesity and how it is defined, its causes, health consequences, ways to prevent and treat it, and the impact on public health.
• Undernutrition and how it is defined, its causes, specific undernutrition syndromes, and the often irreversible effects on children.
• The impact of undernutrition around the world, including richer nations, and public health approaches to treat and prevent undernutrition.
• Food deserts are areas where access to food is limited to due the built environment, social and economic factors, etc.
• Food marketing can impact you in many different ways. It is designed to:
  • create food trends
  • encourage you to:
    • buy certain foods or drinks
    • buy foods in order to get promotional items such as:
      • loyalty points
      • tickets to movies or sports events
      • coupons for future food purchases
    • create links between certain foods or brands and a particular lifestyle
    • build brand loyalty so you will continue to purchase from a particular store or products with a brand name
• How to be aware of food marketing when making food choices
  • Use food labels.
  • Stick to your grocery list and avoid impulse buys.
  • Question why you want to purchase a certain food or drink.
  • Question what form of marketing you got these ideas from.
  • Explore ways to lessen your exposure to ads.
  • Talk with those around you about the effects of marketing.
• Reading Food Labels
  • Serving Size - The serving size is a measured amount of food. Check the serving size on food labels to determine if the number of servings you are eating is smaller or larger. This will help you stay within your daily calorie goal.
  • Calories - The number of calories is the total amount of energy the food provides. Pay attention to calories. If you eat more calories than your body uses, over time you will gain weight.
  • Limit These Nutrients - Americans typically eat too much saturated fat, trans fat, cholesterol, and sodium, which can increase the risk for heart disease, cancer or diabetes.
  • Get Enough of These Nutrients - You should get more fiber, vitamin A, vitamin C, calcium, and iron in your diet. Eating enough of these nutrients can reduce your risk for certain cancers, osteoporosis or hypertension. It is recommended to consume 100% of each of these nutrients daily to prevent nutrition-related diseases.
  • Percent Daily Value - Understanding the Percent Daily Values (% DV) on a food label can help you choose foods high in good nutrients and low in bad nutrients. Choose foods with a low % DV for fat, saturated fat, trans fat, cholesterol, or sodium.