Texture and fullness: The psychology of satiety
Texture is important for the liking of a food, but it also offers valuable clues to our expected feelings of fullness. Now experts believe that subtle alterations in food texture can trick us into feeling fuller for longer.
http://www.foodnavigator.com/Science-Nutrition/Texture-and-fullness-The-psychology-of-satiety
Food and drink with longer oral transit time may reduce calorie intake: Study
Designing foods and beverages to be consumed with small sips or bites, and a longer oral transit time, may be effective in reducing energy intake in consumers, say researchers.
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Nutrition Guidance: Who Needs to Know What?
DAVID L. KATZ June 11, 2013
I am writing today about nutrition guidance and who needs to know what to make it useful.
Permit me to disclose right away that I am the principal inventor of the Overall Nutritional Quality Index (ONQI) algorithm, used in NuVal – a nutritional guidance system that stratifies foods from 1 to 100 on the basis of overall nutritional quality: the higher the number, the more nutritious the food. As the Chief Science Officer for NuVal, LLC, I am compensated for my continuous and considerable allocations of time and effort. But it was never supposed to be that way – and the reasons why it is are an important part of this story.
As to why this column now, there are two recent provocations. One is our ongoing work to complete the updated algorithm, ONQI 2.0, and the window that provides into a world of weirder foods than I ever even considered possible. The other is a paper published in the Journal of the Academy of Nutrition and Dietetics a few months back and a more recent exchange of letters related to that article. The article described the advantageous novelties of a nutritional profiling system, such as weighting nutrients for their health effects rather than counting them all the same. But this was less about novelty, and more about NuVal, since the innovations described have long been included in the ONQI.
[See: Debunking Common Nutrition Myths.]
Claims about alleged novelties that were already included in NuVal prompted a letter from my colleagues and me to the journal, which was published along with a response from the original authors. In that response, they acknowledged that the NuVal system included the so-called “novelties” and acknowledged that the ONQI is, to date, the only nutritional profiling system shown to correlate directly with health outcomes. So the real concern, the letter went on, is that the ONQI algorithm is proprietary and the details are not fully in the public domain.
Which brings us back to why NuVal is a private and proprietary system in the first place and whether or not it matters that certain details of the algorithm – which populate 25 pages or so of computer code written in a language called SAS – are not on a billboard. Why isn’t the ONQI public rather than private, and who really needs to know every detail of the algorithm for it to be useful? (All of the nutrients included in it, and the basic approaches used to generate scores, have been published.)
The ONQI, and NuVal, are a private sector innovation because the public sector said: no thanks. In 2003, I was privileged to be a member of a group of 15 academics invited to Washington, D.C. by then-Secretary of Health Tommy Thompson. A Food and Drug Administration task force had been formed to guide efforts related to the control of rampant obesity and diabetes, and we were a part of that effort. We gathered in a conference room with Secretary Thompson, the FDA Commissioner (Mark McClellan) and others, including the surgeon general and the heads of the National Institutes of Health and the Centers for Disease Control and Prevention.
[See: Why Aren’t Americans Healthier?]
We were each given one three-minute turn to offer up one good idea the FDA and other federal agencies might use to help combat the ominoustrends in diabetes and obesity. I used my turn to describe, in essence, the project that later became the ONQI. I suggested that the secretary might convene a totally independent group of top-notch experts in nutrition and public health, perhaps under the auspices of the Institute of Medicine.
The group should have no political or industry entanglements and should be allowed to work for as long as it took to convert the best available nutrition science and knowledge into a guidance system anyone could understand at a glance. I was thinking, in essence, of the equivalent of GPS for nutrition, so that no one trying to identify a better food in any given category would get lost, confused or misled by Madison Avenue.
[See: 10 Things the Food Industry Doesn’t Want You to Know.]
I waited two years for the feds to do something along these lines. When they didn’t, I decided to undertake the project myself, with the backing of Griffin Hospital in Derby, Conn. – a Yale-affiliated, not-for-profit community hospital, which owns the ONQI algorithm to this day. Other than this being a private rather than federal endeavor, all other aspects of the project were just as proposed to the U.S. Secretary of Health. When we completed the algorithm, I offered it again to the FDA. A scientist at the agency recommended a private-sector approach if I hoped to live long enough to see the system do its intended good.
Why didn’t the feds take on the project? We can all conjecture. I suspect it has something to do with the story Marion Nestle told us all in Food Politics, and the stories we routinely hear about the Farm Bill from the likes of Michael Pollan, Mark Bittman and others. The very government agencies that regulate the food supply are extensively entangled with the entities producing our food, from farm to factory. In comparison, we mere eaters of food have very little clout. The government may be just a little too conflicted on the topic of food to be in the business of putting the truth, the whole truth and nothing but the truth on at-a-glance display.
[See: Seeking a More Perfect Food Supply.]
Certainly the big food manufacturers, the makers of glow-in-the-dark snackattackables, should NOT be in the business of nutrition guidance whatever their inclination. That approach makes the fox look like a highly qualified security officer for the henhouse.
Which leaves independent nutrition, and public health experts and private sector innovation. And here we are.
Private-sector innovation often involves intellectual property, trade secrets and patent applications. It involves some entity making an investment and wanting a return. That is all true of NuVal, for better or worse. It wasn’t my plan – it was just the only way to get this empowering system into the hands of shoppers. Of note, the ONQI remains under the independent control of scientists, and not the business.
[See: Mastering the Art of Food Shopping.]
Which leads us back to the second question: Is it a problem for a system like this to be a private-sector innovation? Who, really, needs to know every detail of such an algorithm?
Consider that if you are shopping for a car, you do need to know if it comes with anti-lock brakes or all-wheel drive. But to decide if these are working for you, you don’t need engineering blueprints; you just need to drive in the snow. When shopping for a smartphone, you may want to know if it has GPS. But you don’t need the trigonometry equations on which the GPS is based to determine if it works; you just have to see if it helps you get where you want to go.
Nutrition guidance in general, and NuVal in particular, are just the same. What are the exact formula details? Who cares. We routinely rely on tools based on math and engineering most of us don’t understand – but we don’t need all that input to know if the tools are working for us. We just need the output. We need to be able to use them. People using NuVal have lost more than 100 pounds, and even over 200 pounds. Choosing higher scoring foods correlates with a lower risk of dying prematurely. More than 100,000 scores are on public display in 1,700 supermarkets nationwide. The ONQI is at least as transparent as any car or smartphone or computer.
[See: The No. 1 Skill for Weight Management.]
Let’s acknowledge: If you are reading this on a computer screen, neither of us truly understands the engineering involved in me writing it, using word processing software, attaching it to an email and sending it to my editor at U.S. News & World Report so she could post it in cyberspace, where you found it. But we do know it worked.
We rely on private-sector innovation for a lot of important jobs, and even many that put our safety on the line. The private sector makes our cars and planes. We seem to be comfortable using these without scrutinizing patent applications. The private sector makes our computers, and smartphones and GPS systems, and we can tell whether or not these work, even if we don’t know how.
Why, then, is nutrition guidance different? The answer, I believe, is politics, profits and the inertia of the status quo. We are accustomed to vague nutrition guidance from conflicted sources, and those same sources are apt to imply there is something wrong with private-sector innovation and the intellectual property issues that come along with it. But if those issues don’t undermine the cars, and planes and navigation systems that get us from city to city and coast to coast, it’s not at all clear why they should be a problem when navigating among choices in a supermarket aisle.
[See: The Government’s MyPlate Celebrates Second Birthday.]
As a scientist, and not a businessperson, my preference would be to put the ONQI on a billboard for all the good it would do. But on this, I must defer to the businesspeople who have made the relevant investments and are entitled to safeguard potential returns. As for the scrutiny that all advanced systems should get, the ONQI has been shared with scientists at leading universities and health agencies around the world – but for private assessment and use rather than public display. Others like them who want to review the program need only ask.
We should all care that the military-industrial establishment seems opposed to putting the blunt truth about nutritional quality, as best we know it, on at-a-glance display. We should care that federal authorities responsible for nutrition guidance are also responsible, if only indirectly, for food politics and supply-side profits. That story may lack novelty. It may be old news. But it is nonetheless something everyone who eats does need to know – engineering blueprints not required.
This likely reflects the state of play pre-2012 (does not show Pringles sale to Kelloggs).
This does not reflect the Disney purchase of Lucasarts.
Full image: http://blog.panicola.com/wp-content/uploads/2013/11/Big-Food.jpg
When we look back at contemporary health systems 50 years from now, we will consider them to be an technologically indulgent folly of grand proportions, driven by an imperative to deliver more and more complex care in order to justify higher and higher costs.
In a fee-for-service context, elaborate technologies justify higher costs. An elective angiogram costs $25,000. If this had to be paid by individuals, there would be no interest in conducting them with the frequency that they are performed today.
Perhaps this is why Singapore, with its health savings accounts with health costing around 4% of GDP (achieving the same high outcomes of Australia), lacks the excesses of more universal health systems?
The use of bariatric surgery for obesity is perhaps the most egregious example of this phenomenon. A AU$20,000 – 30,000 procedure is now introducing moral hazard that will undermine attempts to introduce behavioural and lifestyle change i.e. “Why bother changing my lifestyle when I can simply get a lap band to fix me later?”
Pharmaceutical companies are also using this play book with the introduction of their new, highly-specialised, so-called “biologics” to the market, particularly in the cancer area. They are often protein based and extremely difficult to manufacture, but are also very targeted. Funders are responding to this threat with value-based payment schemes where by the drug company only gets paid if the treatment succeeds.
Current health market settings establish this perverse incentive. Moves to value/outcomes-based care will remedy these perversities, providing incentives for activities that reduce care costs. In such an environment, the cheapest interventions also become the most profitable.
Home delivered broccoli instead of lap-bands.
CBT SMS’s instead of SSRIs and psychotherapy.
A rapid learning health system instead of a profit yearning sickness market.
PN: This still leaves the door open to the solid food hypothesis
http://www.forbes.com/sites/davidshaywitz/2012/03/26/curing-diabetes-with-surgery-it-works-now-lets-figure-out-why/
Curing Type 2 Diabetes with Surgery: It Works — Now Let’s Figure Out Why
During my endocrinology training, I was captivated by a phenomenon I’d seen on the wards, and had just started to read about in the literature: type 2 diabetic patients receiving bariatric surgery exhibiting rapid, seemingly instantaneous improvements in their glycemic control, apparently related to profoundly reduced insulin resistance as a consequence of the surgery.
The first teaching seminar I gave as a fellow, at Endocrinology Grand Rounds, asked the distinguished medical faculty who gathered in the Ether Dome, “Is Diabetes a Surgical Disease?”
At the time, the answer was, “Yes?” Now, two recent reports presented today at the ACC, and simultaneously published in the NEJM (here and here), seem to upgrade this answer to “Yes!”
Both reports conclude that bariatric surgery surpasses medical therapy as a treatment for type 2 diabetes, and are fascinating not only because of the immediate clinical implications (as discussed by Matt Herper here, and in anNEJM editorial comment here), but also because there’s some really cool underlying science that nobody seems to understand.
The fundamental paradox is the same mysterious clinical phenomenon that so intrigued me years ago: the drastic improvement in diabetic function that occurs significantly before most of the weight is lost.
The authors of the first study note, “Reductions in the use of diabetes medications occurred before achievement of maximal weight loss, which supports the concept that the mechanisms of improvement in diabetes involve physiologic effects in addition to weight loss, probably related to alterations in gut hormones.”
The authors of the second study were also struck by the rapid improvement in glycemic control they observed, reporting that all patients treated surgically were able to discontinue all their diabetes medicines within fifteen days of their operation – a remarkable result (and entirely consistent with my own clinical experience). Almost all of the surgically-treated patients remained free of diabetes after two years, while none of the medically-treated patients were as fortunate.
As the authors write, “there was no correlation between normalization of fasting glucose levels and weight loss after gastric bypass and biliopancreatic diversion, findings that are consistent with results of previous studies, which suggests that such surgeries may exert effects on diabetes that are independent of weight.”
The authors also point out this result is in contrast with gastric banding procedures (which constrict the stomach but don’t otherwise alter the anatomy); the improvement in diabetes seen in those patients does appear to correlate more directly with weight loss.
The intriguing scientific question is how can bariatric surgery result in an almost immediate improvement in the insulin resistance profile of diabetic patients? To my mind, this is among the most important unanswered questions in endocrinology, and medical science more generally. While the effect is generally attributed to “gut hormones” (as the authors of the first study write), the biology beyond that gets a bit murky.
To be sure, some companies are working on it – the example that springs first to mind is NGM Biopharmaceuticals, a small Bay-area biotech (with which I have no personal nor professional connection) founded in 2008 as an ambitious science play by The Column Group, Rho Ventures, and Prospect Venture Partners. I’m sure others are working on this challenge as well.
A final point – as attracted as we are to the view of basic science driving clinical medicine, the experience with gastric bypass surgery arguably exemplifies the reverse, and represents a triumph of empiricism, as well as a reminder of the value of human physiology (see here), and more generally, the importance of studying people (and not just parts of people).
It also would not be the first (nor will it be the last) time that medical sophisticates learned a valuable lessons from those laboring – often, as in the case of many bariatric surgeons, with inadequate respect – on the front lines of patient care.
This article is available online at: Interesting interview with the slightly whacky author of Grain Brain. Key take aways:
Source: http://www.forbes.com/sites/nextavenue/2013/11/14/what-grain-is-doing-to-your-brain/
Yet another BBC documentary on obesity, this time featuring an emaciated looking surgeon who specialises in removing skin lesions. It was an excellent exposition of how broken and inappropriate it is to apply a reductionist, scientific lens to a problem of this kind.
A bunch of Imperial College scientists banging on about grellin and PPY and twin studies and epigenetics and fMRI and finishing up with a mandatory reference to bariatric surgery as the only successful intervention that actually changes the way your mind thinks about food.
If only there was a more expensive and complicated way to intervene?
Are we going to get to the point where bariatric surgery becomes a standard procedure, like desexing a dog?
The more of these programs I watch, the more distasteful and disappointing they seem.
If the end goal is to stop people eating crap, and also feel fuller quicker, then there has to be a better, more positive, less invasive way to achieve this than with surgery or a pill.
Program Site: http://www.bbc.co.uk/programmes/b01dzfgb
Video Source: http://vimeo.com/64960883
vanishing caloric density: energy dense foods that meltdown rapidly in the mouth, often lack satiety (Dr. Drewnowski)
the problem with sugared soft drinks: energy consumed as fluid calories are not counted by the body as contributing to satiety, in the same way that energy consumed in solids.
Putting these two data points together, It would therefore seem that non-solid foods don’t satiate.
It makes sense that industry includes these forms of food in our diet, as the less satiety we experience, the more food we eat.
This also explains why fruit juice, but not solid fruit, leads to weight gain. It’s nothing to do with fibre slowing the absorption of calories in the gut, it’s to do with the satiating effects of calories derived from solids vs liquids.
This thesis makes sense in evolutionary terms, as the only pre-agricultural sources of liquid calories would have been honey – water being the mainstay.
For many years Jamie Oliver has been on a crusade to fight obesity and bad eating habits, with the aim to equip people the world over with cooking skills and a greater appreciation of fresh food.
Sydneysiders have witnessed his mission through numerous television shows, campaigns and cookbooks. Now it’s closer to home, with the announcement of the first Ministry of Food centre in NSW.
The British chef will open a cooking school in August to teach basic kitchen skills. It will be at the Stockland Shopping Centre at Wetherill Park in western Sydney, which is undergoing a $222 million redevelopment. It will be Oliver’s fifth Ministry of Food kitchen in Australia.
“Obesity is not just a diet-related disease. It’s the biggest killer in Australia and what the Ministry of Food is, it’s a fix and response that really does transform people’s confidence in the kitchens,” Oliver said.
The cooking classes, funded by the not-for-profit arm of electrical goods retailer The Good Guys, will focus on basic cooking skills, nutrition, budgeting, meal planning and shopping tips.
Oliver said recipes would be healthy and tasty and would include desserts.
“We all love ice-cream. Life is about ice-cream and sometimes people get confused with some of my messaging,” he said.
“Of course we want to be as healthy as possible but we don’t want to edit out things in life. Life is about having beautiful treats and cakes and things like that.”
He said the problems began when parents gave in to their child’s requests for more soft drinks and desserts. “That’s the sort of repetition that gets us into trouble. Absolutely I give my kids ice-cream but my wife is fairly strict about when and how much.”
This year, the Australian Diabetes Council revealed that a diabetes epidemic had gripped the western suburbs of Sydney, with Liverpool in the south labelled as the suburb with the highest number of people with the disease.
Of the 10 suburbs with the highest incidence of diabetes, seven were in Sydney’s west, said head researcher, Alan Barclay. This includes Liverpool, Mount Druitt, Campbelltown, Westmead and Blacktown.
The high rates could be drastically reduced with a combination of improved primary healthcare and better knowledge of healthy cooking, he said in July.
“People need to know more about food and how to prepare it,” Barclay said. “We have to start doing more in schools and in the local community.”
The co-host of Channel Nine’s Today show, Lisa Wilkinson, will be the ambassador of the Ministry of Food centre.