Nutrition standards urged for foods sold in school

WASHINGTON (AP) -- Millions of children soon could be saying goodbye to regular colas, candy and salty snacks during school hours.

Concerned about the rise of obesity in young people, Congress asked the Institute of Medicine to develop a set of standards for foods that would be available in schools.

The Institute responded Wednesday with a two-tier system designed to encourage youngsters to eat more fruits, vegetables and whole grains and to avoid added sugars, salt and saturated fats.(Check out a list of recommended foods.)

"The alarming increase in childhood obesity rates has galvanized parents and schools across the nation to find ways to improve children's diets and health, and we hope our report will assist that effort," said Virginia A. Stallings, head of the committee that prepared the report.

"Making sure that all foods and drinks available in schools meet nutrition standards is one more way schools can help children establish lifelong healthy eating habits," said Stallings, director of the nutrition center at Children's Hospital of Philadelphia, Pennsylvania.

"Foods and beverages should not be used to reward or to discipline for academic activities or behavior," she added.

And don't think their recommendation applies only to children. The committee also urged that Parent Teacher Associations adhere to the same standards, as should food items sold at school fund raisers.

Bag lunches not affected

Foods sold in school cafeterias under federally assisted lunch programs already must meet nutritional standards. The IOM recommendation covers items considered competitive with those foods, such as items sold in vending machines and other food and drinks sold in the school but not under the federal program, an area often profitable for the schools.

The standards would not apply to bag lunches that students bring from home.

The report now goes to Congress for consideration. Copies will also go to the Departments of Agriculture, Health and Human Services and Education and it will be available for state and local school boards and administrators and the food and beverage industry. Putting the recommendations into practice would involve federal, state or local laws and setting school standards and policies.

The report drew prompt praise and criticism.

Sen. Tom Harkin, D-Iowa, said: "For the first time, we have gold-standard recommendations for school nutrition standards from one of America's most distinguished scientific bodies. And as it turns out, they are also just common sense -- promoting fruit and vegetable consumption, and also seeking to reduce things like calories, fat, and sodium."

Harkin, chairman of the Senate Agriculture Committee, said the "recommendations offer a tool kit for local, state, and federal policy-makers who already know that we need to do more much more -- to promote sound child nutrition and prevent childhood obesity."

The School Nutrition Association, which represents school food service directors, applauded the report but said it believes "it will be ineffective in making change happen.

"Any voluntary guidelines, such as those of this report, are unenforceable and present a major challenge for schools to incorporate," the Association said.

The Center for Consumer Freedom worried that the report could lead to a government "no child with a fat behind" program.

Response is mixed

The growing rate of obesity is caused by lack of physical activity rather than overeating, argued the group, which describes itself as representing restaurants, food companies and individuals.

"These decrees may seem surreal, but many schools have already implemented similar measures. Birthday celebrations are a thing of the past with cupcakes banned in classrooms across the nation. Many schools forbid parents from bringing their kids fast food," the Center said in a statement.

On the other hand the Center for Science in the Public Interest, which describes itself as promoting nutrition, food safety and a healthy lifestyle, welcomed the report.

"Congress should support parents and protect kids by having USDA bring its disco-era standards into line with modern science," said CSPI nutrition director Margo C. Wootan.

The American Beverage Association, which represents companies that make and sell nonalcoholic beverages, said it is already working with schools to "improve the product mix" sold in schools by reformulating products, changing packaging, retrofitting vending machines and working with school districts.

This is a time-consuming process which should be complete by the 2009-2010 school year, the Association said.

Foods listed as Tier 1 would be allowed at all grade levels during the school day and during after-school activities.

These foods would have to provide at least one serving of fruits, vegetables, whole grains or nonfat or low-fat dairy, would be limited to 200 calories for snacks and would have limits for fat, sugar and salt.

Examples of Tier 1 snacks were whole fruit, raisins, carrot sticks, whole-grain low-sugar cereals, some multigrain tortilla chips, some granola bars and nonfat yogurt with no more than 30 grams of added sugars. Entrees could include such items as fruit salad with yogurt or a turkey sandwich. Beverages would be limited to plain water, skim or 1 percent milk, soy beverages and 100 percent fruit or vegetable juice.

The IOM recommended that, because of their calorie content, juices be limited to 4-ounce servings for elementary and middle-school students and 8-ounce portions for high school students.

Tier 2 foods would be available only to high school students and only after school hours.

These foods would also be limited in calories, salt, sugar and fat and the drinks could have just have five or fewer calories per portion and no caffeine; they are not vitamin- or mineral-fortified, but may be carbonated and may contain flavoring or a sugar substitute.

Examples include single servings of baked potato chips, low-sodium whole wheat crackers, graham crackers, pretzels, caffeine-free diet soda and seltzer water.

Sports drinks would be available to students engaged in an hour or more of vigorous athletic activity, at the discretion of coaches.

The committee said fortified water should not be available in either tier.

The Institute of Medicine is a branch of the National Academy of Sciences, an independent organization chartered by Congress to advise

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Weighing in on weights

Jessica Belasco
Express-News

The clients at Tracey Keller's gym work hard. Leg presses, seated dips, shoulder presses, lat pulldowns. It's a workout that would make an adult sweat.

But most of Keller's clients are in still in elementary school.

"We want them to come in, have fun, knowing (exercise) doesn't have to be something they dread. It can be fun and hopefully change their life," says Keller of Kids Get Fit, a small gym for kids ages 5-15 on Blanco Road.

Gyms for kids are nothing new — the Little Gym, for example, offers gymnastic instruction to young children. But Kids Get Fit, opened by Keller and her business partner, Tracy Chaco, in November, may be the only gym in San Antonio that offers gym-style strength training for prepubescent kids. The kids do a weight circuit (a la Curves) on machines manufactured especially for children by Hoist Fitness Systems.

It was once believed that pumping iron could hurt the growth plates in young children's bones. But the American College of Sports Medicine, the National Strength and Conditioning Association and the American Academy of Pediatrics have given it the green light.

The latter states that "strength training programs for preadolescents and adolescents can be safe and effective if proper resistance training techniques and safety precautions are followed." But, AAP warns, children should "avoid competitive weight lifting, power lifting, body building and maximal lifts until they reach physical and skeletal maturity."

Despite the proven safety, weight training for kids remains controversial. Some experts think machines and free weights are for adults only.

Kids' fitness is a growing trend, and children younger than 18 represent the second-fastest-growing demographic of health-club membership, according to the International Health, Racquet & Sportsclub Association. The trade group estimates that one-third of health clubs in the country offer children's programs, some of which include weight training.

Sarah Kennington brings her home-schooled daughters, 9-year-old Hannah and 10-year-old Hope, to Kids Get Fit three or four days per week. Kennington likes the organized circuit program. "For homeschooling purposes, we needed P.E., and this is perfect," she says.

Her daughters were all smiles as they followed other kids to machine after machine.

"The circuit is fun. Sometimes it's easy, sometimes it's hard," Hannah said after her workout — which Keller monitored, as she monitors every kid's workout.

"Under supervision, it's probably the safest activity a child can do, at least according to the results of the injury data," says Wayne Westcott, Ph.D., senior fitness/research director at the South Shore YMCA in Quincy, Mass.

Westcott, who served on the President's Council on Physical Fitness and Sports during the Reagan administration and has studied the effects of strength training on kids for more than 20 years, says it can improve strength, strengthen bones, raise metabolism to burn more calories and boost self-confidence, especially among obese children, who don't do well in competitive sports.

Westcott's program, implemented at the YMCA and many school districts in Massachusetts, consists of 15 to 20 minutes of strength training twice a week paired with aerobic conditioning. The kids do one set each of 8-10 basic exercises, focused on the major muscle groups. He recommends that kids be at least 7 years old so they can follow directions.

CATZ Sports San Antonio, a new training center for athletes up to age 17, offers sports-specific weight training and emphasizes building strong muscles and joints to prevent injuries from overuse.

At the facility, part of a national chain, kids use different methods of resistance training. They use their own body weight while doing sit-ups, pushups, lunges and squats. Or they step up on high boxes to work their lower body muscles and roll on an Ab Dolly to increase core strength. They also play with weighted balls. The goal is increasing endurance as well as strength.

"Strength training isn't necessarily bulking up," says Dr. Shaylon Rettig, president of CATZ Sports San Antonio. "If you want to make your muscles work for longer periods of time, that is a form of strength training."

Dr. David Schmidt endorses sports-specific training for kids, but otherwise he doesn't think the effort of weight training is worth it.

"The effectiveness of weight training at a young age is not very high, particularly in males, until their testosterone levels get up a little higher," say Schmidt, team physician for the San Antonio Spurs and doctor at Sports Medicine Associates of San Antonio. "The work they put in is not as efficient."

Stevan Falk has his own concerns with strength training for kids.

"It's not that it's dangerous, it's just totally unnecessary and stupid," says Falk, owner of Bikram Yoga San Antonio and strength conditioning coach at Trinity University. "You're asking them to do something very boring and totally unnecessary. Kids need to be outside playing leapfrog and climbing trees."

Instead of sending their kids to a gym, Falk says, parents should send them outside to get fit the old-fashioned way: playing like kids. It's lack of activity and unhealthy eating habits that have caused the rise in childhood obesity, he says, not lack of weight training.

"The fact that we're even discussing whether a kid should be doing strength training is a tremendous comment on what's going on in our society today," he says.

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Overweight and Overlooked: A Hidden Heart Risk for Kids

Ron Winslow, Wall Street Journal

Heart researchers say they have uncovered a surprising development in the
obesity epidemic: Overweight children who go undiagnosed at the doctor's
office but who are in fact in the early stages of heart disease.

At Cincinnati Children's Hospital Medical Center, researchers found that a
number of kids viewed as normal, healthy children by their parents and even
the medical staff at the hospital were later found to have enlarged hearts
-- a thickening in the wall of the main pumping chamber. Even some children
under 10 years old showed signs of the condition, known as left ventricular
hypertrophy, or LVH.

When researchers went back later to look for clues, they calculated these
children's body mass indexes and found that many were actually overweight.
Research has previously detected enlarged hearts in children, but generally
in those who were clearly obese. What surprised the Cincinnati Children's
researchers is that they found LVH in children whom doctors hadn't initially
deemed overweight.

Given the attention on childhood obesity today, how could doctors not notice
that these kids were heavy? One argument is that there are so many of them.

"We've grown so accustomed to an overweight child walking into the exam room
that we've lost our visual representation of what a normal child is supposed
to look like," says Tom Kimball, a pediatric cardiologist at the hospital.
In short, overweight is the new "normal."

Doctors rarely look for enlarged hearts in kids. But in adults, LVH is an
important sign of heightened risk of cardiovascular disease. The worry in
kids is that, left unmanaged, these early physical changes to the heart
could set children on a life course for premature coronary artery disease
and heart attacks.

"We found that kids we consider 'normal' actually are not, from a
cardiovascular standpoint," says Sandy Witt, a cardiac sonographer at
Cincinnati Children's. "But no one is alerting the children or the families.
Even for the physician, it is going under the radar."

Spurred by the concerns about overlooked obesity in kids, Ms. Witt and her
colleagues conducted further research that showed an overall rise in
children's BMIs in recent years, and linked high BMI with risk for an
enlarged heart.

The report, which researchers presented at the recent American College of
Cardiology meeting in New Orleans, is based on a comparison of children that
doctors viewed as normal during the past three years with a similar group
from the late 1980s.

The findings heighten the stakes in an already intense struggle under way in
homes, schools and communities over how to encourage kids and their families
to change eating, exercise and other habits to promote better health.

Dr. Kimball says fewer cases of overweight children would be missed if
doctors routinely calculated their patients' body mass index -- a ratio
based on height and weight. Both the American Academy of Pediatrics and the
U.S. Centers for Disease Control and Prevention recommend doctors chart and
track BMI for children, but the indicator isn't perfect and for a variety of
reasons, not widely used, Dr. Kimball says. For one, muscle mass can vary
widely in kids.

Though there are exceptions, those whose BMI is above the 95th percentile
for their age are generally considered overweight; above the 85th percentile
is at risk of being overweight.

Dr. Kimball and his colleagues conducted the study after making a curious
observation among some 50 seemingly normal children who were recruited to
serve as a control group for a clinical study. The trial was to look at the
effect of high blood pressure on children's hearts. As part of the
assessment, researchers took the kids' height, weight and blood pressure,
but didn't calculate their BMI or otherwise identify them as overweight.
They didn't look overweight, says Ms. Witt, the sonographer.

But when the researchers performed an echocardiogram -- an ultrasound image
of the heart -- they found that in many of the kids their hearts were
enlarged. "None of these kids seemed to be somebody who would have that,"
she says. In trying to understand why the children's hearts were enlarged,
researchers calculated the BMIs. "They all seemed like normal, healthy kids,
but when we calculated their BMI, they weren't normal."

Many of these recruits were children of doctors and other staff at the
hospital. When they were told about the echocardiogram findings, "it came as
a surprise to them," says Ms. Witt.

The researchers figured that a look at a previous generation of the
hospital's patients might offer an answer, she says.

Using the hospital's database, they culled data on 465 children between the
ages of 2 and 17 who had undergone echocardiogram exams between 1984 and
1990 -- a period shortly before the sharp rise in childhood obesity began --
and 548 kids of similar age from the current era, 2004 to 2006. All told,
the study included 559 boys and 444 girls.

The kids had all been deemed healthy from a cardiovascular standpoint. Kids
in each group had been evaluated for heart murmurs or chest pain that turned
out not to have a cardiac cause and they had been found to be free of any
signs of heart disease. The researchers compared them on both BMI and what
their echocardiograms revealed about thickening in their left ventricles.

Body mass index among kids in the most recent group was 18.8 on average,
compared with 17.9 in the group from the 1980s. The echocardiograms revealed
a 10% increase in left ventricular mass in the current group compared with
their earlier counterparts.

While body mass in children is influenced by numerous factors, the
researchers said that even after accounting for two prominent ones -- male
gender and age -- the higher body mass index among the kids in the study
correlated significantly with enlarged hearts. "The higher your BMI, the
worse your hypertrophy," Dr. Kimball says.

Exactly what impact that has on future risk isn't clear. "I don't think
anybody has data on how this would translate into cardiovascular issues as
adults," Dr. Kimball says. But it was enough to prompt him to change his
practice. He now carefully charts his patients' BMI and counsels them and
their parents about weight-losing strategies.

The study has limitations. For one, it looked at a limited, nonrandom group
of kids -- all treated at Cincinnati Children's and mostly from southwestern
Ohio and northern Kentucky.

But Christopher Bolling, medical director of the hospital's
weight-management center who was in private practice until 18 months ago,
believes many kids aren't getting appropriate advice in community doctors'
offices either.

"Pediatricians don't know how to bring it up with parents," Dr. Bolling
says. "They're afraid to alienate them or they don't know where to send
them" for help.

The good news is that other research indicates that by losing weight, kids
can reverse the deleterious physical effects on the heart as well as other
weight-related risks for cardiovascular disease.

In a recent study of extremely obese adolescents who underwent bariatric
surgery to treat their condition, weight loss led to a shrinking of the
hypertrophy, says Holly Ippisch, a pediatric cardiologist also at Cincinnati
Children's. She says such benefits would occur regardless of how children
shed weight.

"The important thing is to lose the weight," she says.

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People who exercise regularly may be less likely to develop Parkinson's disease

People who exercise regularly may be less likely to develop Parkinson's
disease -- but leisurely strolls may not be enough.

That news comes from a study of more than 143,300 U.S. men and women who
were followed from 1992-2001.

When the study started, participants were 63 years old, on average. They
reported their weekly hours of light exercise (walking or dancing) and
moderate to vigorous exercise (jogging, running, swimming, bicycling,
playing tennis or racquetball, or doing aerobics or calisthenics).

A total of 413 participants were diagnosed with Parkinson's disease by the
end of the study.

The most active participants were the least likely to develop Parkinson's
disease in the next decade, according to the researchers, who included Evan
Thacker, SM, of Harvard School of Public Health.

Exercise and Parkinson's

"The most important thing we learned from this study was that high levels of
moderate to vigorous recreational physical activity (like biking, swimming,
aerobics, etc.) were associated with lower Parkinson's disease risk,"
Thacker tells WebMD.

"Those with the highest levels of recreational physical activity at the
beginning of the study had a lower risk of getting Parkinson's disease over
the next 10 years, compared to the people with low levels of recreational
physical activity or none at all," says Thacker.

Thacker will present the study in Boston on May 1, 2007 at the American
Academy of Neurology's 59th annual meeting. How Much Exercise?

The drop in Parkinson's disease risk was only seen in people who got a lot
of moderate to vigorous exercise.

"People who reported the highest levels of recreational physical activity in
the study were doing about the equivalent of 5-6 hours of aerobics or 3-4
hours of lap swimming each week ," says Thacker.

"Their Parkinson's disease risk was 40% lower than the people who reported
zero physical activity, or only light activities like walking," he says.

Exercise Intensity Mattered

"Light physical activity such as walking or dancing was not related to
Parkinson's disease risk at all," says Thacker.

"On the other hand," he says, "higher participation in moderate to vigorous
activities such as biking, lap swimming, jogging, etc., was associated with
lower Parkinson's disease risk."

No particular form of moderate to vigorous exercise stood out as being best.

"The amount of time spent and the overall level of intensity were more
important than the specific activity," says Thacker.

Study's Limits

The study was purely observational. That is, participants weren't asked to
exercise.

The researchers considered participants' age, gender, and smoking -- but
they can't rule out the possibility that other factors influenced the
results.

Thacker and colleagues aren't blaming Parkinson's disease on insufficient
exercise. Their study also doesn't promise that exercise will prevent
Parkinson's disease.

Many factors may affect the odds of developing Parkinson's disease, and
doctors often don't know precisely why someone develops Parkinson's disease.

"Our study is just one piece in a complicated puzzle of discovering what
might prevent Parkinson's disease," says Thacker.

SOURCES: American Academy of Neurology's 59th Annual Meeting, Boston, April
28-May 5, 2007. Evan Thacker, SM, Harvard School of Public Health.

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"Glycemic load" of diet has no effect on weight loss

NEW YORK (Reuters Health) - When it comes to losing weight, the number of
calories you eat, rather than the type of carbohydrates, may be what matters
most, according to a new study.

The findings, published in the American Journal of Clinical Nutrition,
suggest that diets low in "glycemic load" are no better at taking the pounds
off than more traditional -- and more carbohydrate-friendly -- approaches to
calorie-cutting.

The concept of glycemic load is based on the fact that different
carbohydrates have different effects on blood sugar. White bread and
potatoes, for example, have a high glycemic index, which means they tend to
cause a rapid surge in blood sugar. Other carbs, such as high-fiber cereals
or beans, create a more gradual change and are considered to have a low
glycemic index.

The measurement of glycemic load takes things a step further by considering
not only an individual food's glycemic index, but its total number of
carbohydrates. A sweet juicy piece of fruit might have a high glycemic
index, but is low in calories and grams of carbohydrate. Therefore, it can
fit into a diet low in glycemic load.

However, the effort of figuring out what's an allowable carb might not be
worth it, if the new study is any indication.

Principal investigator Dr. Susan B. Roberts, of Tufts University, Boston,
and colleagues found that a reduced-calorie diet, whether glycemic load was
high or low, was effective in helping 34 overweight adults shed pounds over
one year.

Study participants who followed a low-glycemic-load diet ended up losing
roughly 8 percent of their initial weight, as did those who followed a
high-glycemic-load diet.

"The bottom line is that in this study we don't see one single way to eat
that is better for weight loss on average," Roberts told Reuters Health. Of
course, that doesn't mean "anything goes" as long as you're cutting
calories."

A super-sized serving of French fries won't do any dieter any good, she
noted.

Both diets her team used in the study were carefully controlled. For the
first 6 months, participants were provided with all the food they needed,
and both diets were designed to cut their calories by 30 percent while
providing the recommended amount of fiber, limiting fat and encouraging
healthy foods like fruits and vegetables.

The comparable outcomes suggest that, among healthy diets, no single one
stands out as better, according to Roberts. So the focus should be on
calories, rather than specific foods to avoid or include.

"Focusing on calories is something we need more of, especially when portion
sizes are so absurd," Roberts said, referring to the portions served at so
many U.S. restaurants.

This doesn't mean, however, that there's no place for diets that focus on
glycemic load, according to the researcher. Some studies, for example, have
found that low-glycemic index foods might help control blood sugar in people
with type 2 diabetes.

And in their own research, Roberts said she and her colleagues have found
that low-glycemic index diets do seem more effective for overweight people
who naturally secrete high levels of the hormone insulin, which regulates
blood sugar.

SOURCE: American Journal of Clinical Nutrition, April 2007.

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CDC Data Says Number Of Severely Obese People Highest In Last Few Years

Nidhi Sharma - All Headline News Staff Writer

Washington D.C. (AHN) - A recent study by the Centers for Disease Control and Prevention has found that there has been a sudden increase in the proportion of extremely obese Americans, whose body mass index is 40 or more.

Recent data by CDC says that extremely overweight people have increased by 50 percent from 2000 to 2005, twice as fast as the increase in moderate obesity. Also during the same time, the proportion of overweight people (BMI of 30 or more) increased by 24 percent, and the proportion of those with a BMI of 50 or more increased by 75 percent.

In the past 20 years, this has been the highest percentage increase ever to have occurred in the heaviest weight groups.

According to experts, a body mass index, or BMI, is a ratio of weight to height and those men who weigh 300 pounds at a height of 5 feet 10 inches are considered morbidly obese. However a severely obese woman is described as the one who weighs 250 pounds at a height of 5 feet 4 inches.

Experts have expressed their concern over the sudden increase of people whose BMI are higher than normal despite increased public awareness on the risks of obesity and the increased use of drastic weight loss strategies.

CDC data also added that nearly three percent of Americans are severely obese and health officials are worried over the health costs for severely obese people that are expected to be double that of normal weight people. In comparison, health costs for moderately obese people are expected to be 25 percent more.

People who are very obese are at increased risks for diabetes, heart disease, cancer and many other diseases. The total economic costs of obesity in the nation is pegged at more than $100 billion annually.

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'Fat' gene found by scientists

A gene that contributes to obesity has been identified for the first time, promising to explain why some people easily put on weight while others with similar lifestyles stay slim.

People who inherit one version of the gene rather than another are 70 per cent more likely to be obese, British scientists have discovered. One in six people has the most vulnerable genetic make-up and weighs an average 3kg more than those with the lowest risk. They also have 15 per cent more body fat.

The findings provide the first robust link between a common gene and obesity, and could eventually lead to new ways of tackling one of the most significant causes of ill health in the developed world. One in four British adults is classified as obese, and half of men and a third of women are overweight.

Obesity is a main cause of heart disease, cancer and type 2 diabetes. An adviser to the Government’s health spending watchdog said recently that the condition was a bigger national danger than smoking, alcohol or poverty.

If the biological function of the gene, known as FTO, can now be understood, it could become possible to design drugs that manipulate it to help people to control their weight. “Even though we have yet to fully understand the role played by the FTO gene in obesity, our findings are a source of great excitement,” Mark McCarthy, of the University of Oxford, who led the research, said.

“By identifying this genetic link it should be possible to improve our understanding of why some people are more obese, with all the associated implications such as increased risk of diabetes and heart disease. New insights will hopefully pave the way for us to explore novel ways of treating this condition.”

While it has long been understood from family studies that obesity is heavily influenced by genetics, scientists have struggled to pin down individual genes that are involved.

A handful of serious genetic mutations that cause rare obesity disorders such as Prader-Willi Syndrome have been found, but the search for common genes that affect an ordinary person’s risk of becoming obese or overweight has remained elusive.

The effect of FTO emerged from a key study of the genetic origins of disease funded by the Wellcome Trust known as the Case Control Consortium, in which 2,000 people with type 2 diabetes had their genomes compared to 3,000 healthy controls.

Scientists from Oxford and the University of Exeter first found that certain versions of the FTO gene were more common among people with type 2 diabetes, but that the effect disappeared when the data were adjusted for obesity. This led them to wonder whether FTO really influenced obesity instead, and they followed up their theory in a further 37,000 people.

FTO comes in two varieties, and everyone inherits two copies of the gene. The team found that those who inherit two copies of one variant — 16 per cent of white Europeans — were 70 per cent more likely to be obese than those who inherited two copies of the other variant. The 50 per cent of subjects who inherited one copy of each FTO variant had a 30 per cent higher risk of obesity.

Those in the highest risk group weighed an average of 3kg (7lb) more and those at medium risk were an average of 1.2kg heavier. In each case the extra weight was entirely accounted for by more body fat, not greater muscle or extra height. The results, published in the journal Science, apply to men and women, and to children as young as 7.

FTO will not be the only gene that influences obesity, and inheriting a particular variant will not necessarily make anyone fat. “This is not a gene for obesity, it is a gene that contributes to risk,” Professor McCarthy said.

The research involved too many people to control for exercise and diet, so it is not yet known whether FTO affects how much people eat or how active they are. But it may explain how people with apparently similar lifestyles differ in propensity to put on weight.

Independent experts called the discovery highly significant. Susan Jebb, of the MRC Human Nutrition Unit, said: “This research provides clear evidence of a biological mechanism which makes some people more susceptible to gaining weight in a world where food is plentiful and sedentary lifestyles the norm.”

Genetic trigger

— The FTO gene comes in two varieties. 16% of people have two copies of the high-risk variant, 50% have one high-risk and one low-risk, and 34% of people have two low-risk variants

— Those with two high-risk copies have a 70% greater risk of obesity than those with two low-risk copies. They weigh an average of 3kg more

— Those with one high-risk copy have a 30% greater risk of obesity. They weigh an average of 1.2kg more

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Small Steps Lead to Healthier Hearts for Women

But many still don't know cardiovascular disease is their biggest enemy

By Dennis Thompson
HealthDay Reporter

SUNDAY, April 8 (HealthDay News) -- For years, doctors have been fighting the perception that heart disease is a mainly male affliction.

But, in fact, cardiovascular disease is the number one killer of both men and women in the United States, according to the National Institutes of Health. Two of every five women who die are taken by heart disease or stroke, more than from all forms of cancer combined.

Now, health officials are broadening their push to educate more women about their heart risks. The renewed campaign follows an American Heart Association study, initially done in 1997, that found that only 30 percent of women were aware that heart disease and stroke were their greatest health threats. A follow-up survey released last year found that number had climbed to 55 percent.

"The problem I see is that, yes, women are much more knowledgeable, but they aren't translating that knowledge into action," said Dr. Jennifer Mieres, director of nuclear cardiology and associate professor of clinical medicine at New York University School of Medicine, and a national spokeswoman for the American Heart Association. "That's where the disconnect is."

The heart association continues to push its "Go Red for Women" campaign, which includes an online self-survey to evaluate an individual woman's specific risk factors.

"That way, women can increase their thought process about their risk factors," said Dr. Nieca Goldberg, a cardiologist and associate professor of medicine at New York University, and medical director of the university's Women's Heart Program. "We still have to get women to take the plunge to personalize it. If you ask the average woman on the street, she will not say, 'It's going to affect me.' "

A big part of the problem is that women often don't experience a heart attack the same way men do.

"Women's symptoms can be more subtle," Goldberg said. "It can be shortness of breath without any chest pain. Some suddenly feel very exhausted with minimal activity. Pain often is felt lower in the chest and mistaken for a stomach problem."

Because the symptoms are less obvious, women often wait too long to get treatment.

"If you look at statistics of women who've died suddenly of heart attack, two-thirds died before they could reach the hospital," Goldberg said.

Heart disease also often takes place in women differently than it does in men, Goldberg added.

In men, plaque forms on the walls of blood vessels in specific places, eventually causing a "kink" in the vessel that stops blood flow. To treat it, doctors implant a stent -- an artery-opening mesh tube -- at the point of blockage, which reopens the blood vessel.

But as many as 30 percent of women suffer from micro-vascular coronary disease, Goldberg said. The plaque distributes more evenly throughout the blood vessels, slowing blood flow without creating a flow-stopping kink.

In those cases, arteries have difficulty dilating during exercise or exertion, causing extreme fatigue in women.

"When women go to have an angiogram, there have been situations where doctors don't see any blockages, even though the patient has symptoms and a bad stress test," she said.

Since there's no specific blockage, treating micro-vascular coronary disease is much harder.

"When doctors go in to look, there are no kinks, so they can't be stented," Goldberg said. "Women are given drugs to thin the blood and take care of symptoms, as well as reduce cholesterol levels."

Since heart disease is often harder to detect and harder to treat in women, prevention is the key to saving most women's lives. Women need to take a hard look at their risk factors, Mieres and Goldberg said.

"If they can't recite their cholesterol levels or blood pressure, they need to schedule a visit with their doctor because that shows those probably haven't been checked in a while," Goldberg said.

Women also should consider whether or not a relative has had heart disease. There is a genetic risk involved, and family members often share the same lifestyle risks, such as drinking, smoking or eating unhealthy foods.

Once that risk is known, women can take steps to improve their health, Mieres said.

Mieres recommends taking small steps that lead to big ones -- walking 10 minutes a day and increasing that to 30 minutes, or eating an apple for a snack instead of a candy bar.

"Everyone thinks it's so overwhelming in terms of making lifestyle changes," Mieres said. "Doctors want women to realize that simple steps can make a world of difference in terms of your heart health."

More information

For more information on the "Go Red for Women" campaign, visit the American Heart Association.

SOURCES: Nieca Goldberg, M.D., cardiologist and associate professor of medicine, New York University, medical director of the university's Women's Heart Program, and author of The Women's Healthy Heart Program; Jennifer Mieres, M.D., director of nuclear cardiology, and associate professor of clinical medicine, New York University School of Medicine, New York City, and a national spokeswoman, American Heart Association

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