Eating Cherries Lowers Risk Of Gout Attacks By 35%

A new study found that patients with gout who consumed cherries over a two-day period showed a 35% lower risk of gout attacks compared to those who did not eat the fruit. Findings from this case-crossover study published in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR), also suggest that risk of gout flares was 75% lower when cherry intake was combined with the uric-acid reducing drug, allopurinol, than in periods without exposure to cherries or treatment.

Previous research reports that 8.3 million adults in the U.S. suffer with gout, an inflammatory arthritis triggered by a crystallization of uric acid within the joints that causes excruciating pain and swelling. While there are many treatment options available, gout patients continue to be burdened by recurrent gout attacks, prompting patients and investigators to seek other preventive options such as cherries. Prior studies suggest that cherry products have urate-lowering effects and anti-inflammatory properties, and thus may have the potential to reduce gout pain. However, no study has yet to assess whether cherry consumption could lower risk of gout attacks.

For the present study, lead author Dr. Yuqing Zhang, Professor of Medicine and Public Health at Boston University and colleagues recruited 633 gout patients who were followed online for one year. Participants were asked about the date of gout onset, symptoms, medications and risk factors, including cherry and cherry extract intake in the two days prior to the gout attack. A cherry serving was one half cup or 10 to 12 cherries.

Participants had a mean age of 54 years, with 88% being white and 78% of subjects were male. Of those subjects with some form of cherry intake, 35% ate fresh cherries, 2% ingested cherry extract, and 5% consumed both fresh cherry fruit and cherry extract. Researchers documented 1,247 gout attacks during the one-year follow-up period, with 92% occurring in the joint at the base of the big toe.

"Our findings indicate that consuming cherries or cherry extract lowers the risk of gout attack," said Dr. Zhang. "The gout flare risk continued to decrease with increasing cherry consumption, up to three servings over two days." The authors found that further cherry intake did not provide any additional benefit. However, the protective effect of cherry intake persisted after taking into account patients' sex, body mass (obesity), purine intake, along with use of alcohol, diuretics and anti-gout medications.

In their editorial, also published in Arthritis & Rheumatism, Dr. Allan Gelber from Johns Hopkins University School of Medicine in Baltimore, Md. and Dr. Daniel Solomon from Brigham and Women's Hospital and Harvard University Medical School in Boston, Mass. highlight the importance of the study by Zhang et al. as it focuses on dietary intake and risk of recurrent gout attacks. While the current findings are promising, Gelber and Solomon "would not advise that patients who suffer from gout attacks abandon standard therapies." Both the editorial and study authors concur that randomized clinical trials are necessary to confirm that consumption of cherry products could prevent gout attacks.

Exercise Does a Body – and a Mind – Good

We’ve heard it time and time again: exercise is good for us. And it’s not just good for physical health – research shows that daily physical activity can also boost our mental health. But what actually accounts for the association between exercise and mental health?

A new article in Clinical Psychological Science, a journal of the Association for Psychological Science, explores whether certain psychosocial factors may help to explain the benefits of daily physical activity for adolescents’ mental health.

Karin Monshouwer of the Trimbos Institute in the Netherlands and colleagues at Trimbos and VU University Medical Center specifically wanted to examine two existing explanations for the link between exercise and mental health. The self-image hypothesis suggests that physical activity has positive effects on body weight and body structure, leading to positive feedback from peers and improved self-image, and ultimately improving mental health. The social interaction hypothesis, on the other hand, holds that it’s the social aspects of physical activity – such as social relationships and mutual support among team members – that contribute to the positive effects of exercise on mental health.

Monshouwer and her colleagues surveyed over 7000 Dutch students, ages 11 to 16. The adolescents completed validated surveys aimed at assessing their physical activity, mental health problems, body weight perception, and participation in organized sports. The researchers also gathered data on the adolescents’ age, gender, and socioeconomic status; whether they lived at home with their parents; and whether they lived in an urban area.

The researchers found that adolescents who were physically inactive or who perceived their bodies as either “too fat” or “too thin” were at greater risk for both internalizing problems (e.g., depression, anxiety) and externalizing problems (e.g., aggression, substance abuse). Adolescents who participated in organized sports, on the other hand, were at lower risk for mental health problems.

Confirming both the self-image hypothesis and the social interaction hypothesis, adolescents’ body weight perception (i.e., “too heavy,” “good,” or “too thin”) and sports club membership each partially accounted for the relationship between physical activity and mental health, even after taking adolescents’ backgrounds into account.

These results suggest that certain psychosocial factors – body image and social interaction – may help to explain at least part of the connection between physical activity and mental health. The researchers acknowledge, however, that other factors, such as the physiological effects of exercise, are probably also at work.

“We think that these findings are important for policymakers and anyone who works in healthcare or prevention. Our findings indicate that physical activity may be one effective tool for the prevention of mental health problems in adolescence,” says Monshouwer.

Monshouwer and her colleagues hope that future studies will be able to examine similar questions while following participants over time. Such longitudinal studies could help researchers to understand how physical activity type and context might influence the relationship between exercise and mental health.

Eating fish may reduce the risk of heart attack, but watch out for mercury

Eating fish may reduce the risk of heart attack, but it is important to steer clear from the type of fish that contains the most amounts of mercury, according to experts from Umeå University in Sweden.

The researchers have worked together with teams from Finland and other countries in order to assess whether the advantages of heathy fatty acids outweigh the risks of mercury proportion.

Previous research has said that individuals who consume fish have a decreased risk of heart disease, compared to those who eat none or very little. However, certain types of fish carry pollutants from the environment, which can be detrimental to the health of humans.

Methyl mercury, which can be found in many types of fish, may actually raise the risk of cardiovascular disease. Therefore, consuming fish with a lot of mercury, or with ample amounts of pollutants, can severely increase the risk of heart problems. However, if people are too health conscious of fish, they increase their risk of the disease because they are not receiving the benefits of healthy fish.

A recent study said that tuna, which has high levels of mercury, should be given to children less often.

The current research, which will be published in the October 2012 issue of American Journal of Clinical Nutrition (AJCN), was carried out with the intention of finding a middle point between not eating any fish and eating too much, or types that are unhealthy.

The authors analyzed why heart attack risk is linked to the amount of mercury and omega-3 fats in the body due to fish consumption. They did so by measuring hair and blood samples of volunteers who had been involved in other trials in eastern Finland and northern Sweden. The blood samples of the Swedes were taken from the Medical Biobank in Umeå. Researchers compared blood from the patients who had suffered a heart attack after their check-up appointments and those who remained in good health with no heart attacks.

They found that while mercury content increased the chance of heart attack, omega-3 fatty acids decreased the risk. The researchers noted that higher risk of heart attack due to mercury consumption was only prevalent when there was a large amount of pollutants found in the body. If there was a high level of omega-3 fatty acids, the risk was low.

The findings suggest that it is important and beneficial to reach an equilibrium between healthy and unhealthy content found in fish. In this particular study, the environmental pollutant used was mercury. However, in regards to organic pollutants, such as dioxin and PCD, the results are the same. The authors note, though, that there has been no trial done thus far concerning these substances.

According to the Swedish National Food Agency, 2-3 servings of fish should be consumed per week. However, Swedes tend to eat predatory fish, which have a high amount of mercury and should not be eaten on a regular basis. In addition, a study conducted by the National Food Agency revealed that 7 out of 10 people in Sweden do not eat enough fish.

A 2011 study said that people who eat fish on a regular basis have lower blood glucose concentrations, and a lower risk of cardiovascular disease and type 2 diabetes. The researchers conclude that it is safe, as well as beneficial, to eat fish, but staying away from fish with high levels of pollutants is important in avoiding health problems.

Eunuchs outlive other men

Castrated men living in Korea centuries ago outlived other men by a significant margin. The findings, reported in the September 25 issue of Current Biology, a Cell Press publication, suggest that male sex hormones are responsible for shortening the lives of men, the researchers say.

The evidence comes after careful study of genealogy records of noble members of the Imperial court of the Korean Chosun dynasty (AD 1392-1910).

"This discovery adds an important clue for understanding why there is a difference in the expected life span between men and women," said Kyung-Jin Min of Inha University.

The castrated boys in Korea lost their reproductive organs in accidents—usually after being bitten by dogs—or underwent castration purposefully to gain early access to the palace. Eunuchs were allowed to marry and had families by adopting castrated boys or normal girls.

People in those days kept careful genealogy records as proof that they were of the noble class. By poring over those records, Min and colleague Cheol-Koo Lee of Korea University found that eunuchs lived 14 to 19 years longer than other men did. Amongst the 81 eunuchs they studied, three lived to the ripe old age of 100 or more, a feat of longevity that remains relatively rare even in developed countries today.

The incidence of centenarians among Korean eunuchs is at least 130 times greater than it is in the developed countries, Lee notes, and that can't be explained simply by the benefits of life in the palace, either. Most eunuchs spent as much time outside the palace as they did inside it. And, in fact, kings and male members of the royal family had the shortest lives of all, typically surviving only to their mid-forties.

The findings may offer some clues to life extension and, in the meantime, men might take heed, Min and Lee quip. "For better health and longevity, stay away from stresses and learn what you can from women."

Vitamin D deficiency increases risk of heart disease

New research from the University of Copenhagen and Copenhagen University Hospital shows that low levels of vitamin D are associated with a markedly higher risk of heart attack and early death. The study involved more than 10,000 Danes and has been published in the well-reputed American journal Arteriosclerosis, Thrombosis and Vascular Biology.

Vitamin D deficiency has traditionally been linked with poor bone health. However, the results from several population studies indicate that a low level of this important vitamin may also be linked to a higher risk of ischemic heart disease, a designation that covers heart attack, coronary arteriosclerosis and angina. Other studies show that vitamin D deficiency may increase blood pressure, and it is well known that high blood pressure increases the risk of heart attack.

"We have now examined the association between a low level of vitamin D and ischemic heart disease and death in the largest study to date. We observed that low levels of vitamin D compared to optimal levels are linked to 40% higher risk of ischemic heart disease, 64% higher risk of heart attack, 57% higher risk of early death, and to no less than 81% higher risk of death from heart disease," says Dr. Peter Brøndum-Jacobsen, Clinical Biochemical Department, Copenhagen University Hospital.

The scientists have compared the 5% lowest levels of vitamin D (less than 15 nanomol vitamin per litre serum) with the 50% highest levels (more than 50 nanomol vitamin per litre serum). In Denmark, it is currently recommended to have a vitamin D status of at least 50 nanomol vitamin per litre serum.

The higher risks are visible, even after adjustment for several factors that can influence the level of vitamin D and the risk of disease and death. This is one of the methods scientists use to avoid bias.

Blood samples from more than 10,000 Danes
The population study that forms the basis for this scientific investigation is the Copenhagen City Heart Study, where levels of vitamin D were measured in blood samples from 1981-1983. Participants were then followed in the nationwide Danish registries up to the present.

"With this type of population study, we are unable to say anything definitive about a possible causal relationship. But we can ascertain that there is a strong statistical correlation between a low level of vitamin D and high risk of heart disease and early death. The explanation may be that a low level of vitamin D directly leads to heart disease and death. However, it is also possible that vitamin deficiency is a marker for poor health generally," says Børge Nordestgaard, clinical professor at the Faculty of Health and Medical Sciences, University of Copenhagen and senior physician at Copenhagen University Hospital.

Long-term goal is prevention
The scientists are now working to determine whether the connection between a low level of vitamin D and the risk of heart disease is a genuine causal relationship.

If this is the case, it will potentially have a massive influence on the health of the world population. Heart disease is the most common cause of adult death in the world according to the World Health Organization (WHO), which estimates that at least 17 million people die every year from heart disease.

"The cheapest and easiest way to get enough vitamin D is to let the sun shine on your skin at regular intervals. There is plenty of evidence that sunshine is good, but it is also important to avoid getting sunburned, which increases the risk of skin cancer. Diet with a good supply of vitamin D is also good, but it has not been proven that vitamin D as a dietary supplement prevents heart disease and death," says Børge Nordestgaard.

Diet high in total antioxidants associated with lower risk of heart attack

Coronary heart disease is a major cause of death in women. A new study has found that a diet rich in antioxidants, mainly from fruits and vegetables, can significantly reduce the risk of myocardial infarction. The study is published in the October issue of The American Journal of Medicine.

"Our study was the first to look at the effect of all dietary antioxidants in relation to myocardial infarction," says lead investigator Alicja Wolk, DrMedSci, Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. "Total antioxidant capacity measures in a single value all antioxidants present in diet and the synergistic effects between them."

The study followed 32,561 Swedish women aged 49-83 from September 1997 through December 2007. The women completed a food-frequency questionnaire in which they were asked how often, on average, they consumed each type of food or beverage during the last year. The investigators calculated estimates of total antioxidant capacity from a database that measures the oxygen radical absorption capacity (ORAC) of the most common foods in the United States (no equivalent database of Swedish foods exists). The women were categorized into five groups of total antioxidant capacity of diet.

During the study, 1,114 women suffered a myocardial infarction. Women in the group with the highest total antioxidant capacity had a 20% lower risk, and they consumed almost 7 servings per day of fruit and vegetables, which was nearly 3 times more than the women with the least antioxidant capacity, who on average consumed 2.4 servings.

Dr. Wolk notes that trials testing high doses of antioxidant supplements have failed to see any benefit on coronary heart disease and, in fact, in one study higher all-cause mortality was reported. "In contrast to supplements of single antioxidants, the dietary total antioxidant capacity reflects all present antioxidants, including thousands of compounds, all of them in doses present in our usual diet, and even takes into account their synergistic effects," she explains.

In a commentary accompanying the article, Pamela Powers Hannley, MPH, Managing Editor of The American Journal of Medicine, observes that with the industrialization of our food supply, Americans began to consume more total calories and more calories from processed food high in fat and sugar. As a result, obesity rates began to climb steadily. "Although weight-loss diets abound in the US, the few which emphasize increasing intake of fruits and vegetables actually may be on the right track," she says. "Yet only 14% of American adults and 9.5% of adolescents eat five or more servings of fruits or vegetables a day."

Yogurt Fights High Blood Pressure

Adding more yogurt to your diet without increasing the number of calories you eat may help lower your risk of high blood pressure, according to new research presented at the American Heart Association's High Blood Pressure Research 2012 Scientific Sessions.

A recent study found long-term yogurt-eaters were less likely to develop high blood pressure and on average had lower systolic blood pressure than those who didn't eat yogurt. Systolic blood pressure is the top number in a blood pressure reading. It measures the force of blood against the walls of your arteries when your heart is beating.

During the 15 year study, researchers followed more than 2,000 volunteers who did not have high blood pressure at the start of the study. Yogurt consumption was measured by questionnaires filled out by the volunteers at three intervals over the study period. Study participants were 31 percent less likely to develop high blood pressure if at least 2 percent of their daily calories came from yogurt, which would be like eating at least one six-ounce cup of low-fat yogurt every three days. In addition, their systolic blood pressure increased less than that of people who didn't eat yogurt.

Exercise too much and you won't lose weight!

The amount of weight loss induced by exercise is often disappointing. A diet-induced negative energy balance triggers compensatory mechanisms, e.g., lower metabolic rate and increased appetite. However, knowledge about potential compensatory mechanisms triggered by increased aerobic exercise is limited. A randomized controlled trial was performed in healthy, sedentary, moderately overweight young men to examine the effects of increasing doses of aerobic exercise on body composition, accumulated energy balance, and the degree of compensation.

A moderate dose of exercise induced a markedly greater weight loss, than a higher dose.

No statistically significant changes were found in energy intake or nonexercise physical activity that could explain the different compensatory responses associated with 30 vs. 60 min of daily aerobic exercise. In conclusion, a similar body fat loss was obtained regardless of exercise dose.

Related article

Scientists conclude high fructose corn syrup should not be blamed for obesity

A new article published today in International Journal of Obesity found there is no evidence to suggest the current obesity epidemic in the United States can be specifically blamed on consumption of high fructose corn syrup (HFCS).

The commentary concludes that after an extensive review of all available HFCS research, there is overwhelming evidence showing HFCS is nutritionally equivalent to sugar. This opinion is in-line with the American Medical Association and the Academy of Nutrition and Dietetics, both of which concluded that HFCS is not a unique cause of obesity.

The authors state that while there has been a large amount of debate in the media about the impact of HFCS on obesity levels, the fact is "Sucrose (sugar) and HFCS are very similar in composition….and are absorbed identically in the human GI tract."

"The public discussion about HFCS will likely continue to rage on and more studies will be conducted," said James M. Rippe, M.D., Founder and Director of the Rippe Lifestyle Institute, and Professor of Biomedical Sciences at the University of Central Florida, one of the article's authors. "However, at this point there is simply no evidence to suggest that the use of HFCS alone is directly responsible for increased obesity rates or other health concerns."

The article goes on to discuss a number of research trials that have been conducted on the issue of HFCS and obesity, and concludes that at this time the evidence shows no short-term health differences between the use of HFCS or sugar could be detected in humans. Weight gain, glucose levels, insulin and appetite were not adversely affected by the use HFCS over sugar.

The commentary was co-authored with Dr. Rippe by David M. Klurfeld, Ph.D. of the USDA Agricultural Research Service, John Foreyt, Ph.D. of Baylor College of Medicine, and Theodore J. Angelopoulos, Ph.D., MPH Professor and Director, Laboratory of Applied Physiology Department of Health Professions at University of Central Florida.

HFCS was developed in the mid-1960's as a more flexible alternative to sugar and was widely embraced by the food industry. The use of HFCS grew rapidly from 1970-1999 where usage peaked. Since 1999, the use of HFCS has declined while obesity rates have continued to rise. Sucrose is still the dominant sweetener worldwide with over nine times the consumption of HFCS.

Geneticists verify cholesterol-cancer link

University of Rochester Medical Center scientists discovered new genetic evidence linking cholesterol and cancer, raising the possibility that cholesterol medications could be useful in the future for cancer prevention or to augment existing cancer treatment.

The data, published in the online journal Cell Reports, support several recent population-based studies that suggest individuals who take cholesterol-lowering drugs may have a reduced risk of cancer, and, conversely that individuals with the highest levels of cholesterol seem to have an elevated risk of cancer.

The cancer-cholesterol question has been debated since the early 20th century, and along with it doctors and scientists have observed various trends and associations. However, until now genetic evidence directly linking cholesterol and malignancy has been lacking, said senior author Hartmut (Hucky) Land, Ph.D., Robert and Dorothy Markin Professor and chair, Department of Biomedical Genetics, and director of research and co-director of the James P. Wilmot Cancer Center at URMC.

"Scientifically it is very satisfying to have data that support longstanding ideas about cholesterol in the context of cancer," Land said. "Our paper provides a rationale for cholesterol targeting as a potentially fruitful approach to cancer intervention or prevention strategies."

Cholesterol is a fat-like substance supplied in foods and made in cells throughout the body. Too much cholesterol is bad for the heart and vascular system. It is typically measured as serum cholesterol by routine blood tests.

Unlike serum cholesterol that is bound to proteins, however, cholesterol also hides inside cells. While locked inside cell membranes before it is eventually exported, cholesterol has an impact on cell growth and survival. A gene, known as ABCA1, is at the crossroads of the process that shuttles intracellular cholesterol outbound.

Several years ago while conducting unrelated experiments that were published in the journal Nature, Land and colleagues first noticed the importance of ABCA1. At that time, they identified a network of approximately 100 so-called "cooperation response genes" that mediate the action of cancer genes. ABCA1 was found among these genes and is frequently turned off in presence of other mutant cancer genes.

In the latest investigation, Land and co-author Bradley Smith, Ph.D., a post-doctoral fellow in the Land lab, wanted to further understand the role of ABCA1 and cholesterol in cancer. They found that defective cholesterol exportation appears to be a key component in a variety of cancers.

The proper function of ABCA1, in fact, is critical for sensing of cell stress. If ABCA1 function is lost in cancer cells, cholesterol is allowed to build up in the cells' mitochondria, or energy centers, making their membranes more rigid. This in turn inhibits the function of cell-death triggers that normally become activated in response to cell stresses, as for example cancer gene activation. Therefore, when functioning properly ABCA1 has anti-cancer activity – in the sense that by keeping mitochondrial cholesterol low it protects the functioning of cellular stress response systems and acts as a barrier to tumor formation and progression.

Smith and Land also demonstrated that some of the relatively rare ABCA1 mutations found in human colon cancers by other investigators disabled the gene's ability to export cholesterol. And by re-establishing the cholesterol export function in human colon cancer cells, they inhibited the cells' ability to grow as cancers when grafted onto mice.

The URMC study, therefore, is the first to directly show how ABCA1 loss-of-function and cholesterol may play a role in cancer.

Millions of Americans take cholesterol-lowering drugs or statins, as prescribed by physicians. The drugs work by blocking the action of key enzymes in the liver, which synthesizes cholesterol. Clinical trials also are evaluating statins as a tool against cancer, and some previous studies suggest that when used in combination with chemotherapy, statins might make chemotherapy more effective by sensitizing certain cancer cells to chemotherapy-induced cell death.

Land, however, urges caution and further study. Doctors do not know the appropriate statin dose for cancer prevention or treatment of cancer-related conditions. Side effects cannot be ignored either, and little research has distinguished between the responses among people who take statins.

"The link between cholesterol and cancer is clear," Land said, "but it's premature to say that statins are the answer."

Exercise May Protect Against Future Emotional Stress

Moderate exercise may help people cope with anxiety and stress for an extended period of time post-workout, according to a study by kinesiology researchers in the University of Maryland School of Public Health published in the journal Medicine and Science in Sports and Exercise.

"While it is well-known that exercise improves mood, among other benefits, not as much is known about the potency of exercise's impact on emotional state and whether these positive effects endure when we're faced with everyday stressors once we leave the gym," explains J. Carson Smith, assistant professor in the Department of Kinesiology. "We found that exercise helps to buffer the effects of emotional exposure. If you exercise, you'll not only reduce your anxiety, but you'll be better able to maintain that reduced anxiety when confronted with emotional events."

Smith, whose research explores how exercise and physical activity affect brain function, aging and mental health, compared how moderate intensity cycling versus a period of quiet rest (both for 30 minutes) affected anxiety levels in a group of healthy college students. He assessed their anxiety state before the period of activity (or rest), shortly afterward (15 minutes after) and finally after exposing them to a variety of highly arousing pleasant and unpleasant photographs, as well as neutral images. At each point, study participants answered 20 questions from the State-Trait Anxiety inventory, which is designed to assess different symptoms of anxiety. All participants were put through both the exercise and the rest states (on different days) and tested for anxiety levels pre-exercise, post-exercise, and post-picture viewing.

Smith found that exercise and quiet rest were equally effective at reducing anxiety levels initially. However, once they were emotionally stimulated (by being shown 90 photographs from the International Affective Picture System, a database of photographs used in emotion research) for ~20 minutes, the anxiety levels of those who had simply rested went back up to their initial levels, whereas those who had exercised maintained their reduced anxiety levels.

"The set of photographic stimuli we used from the IAPS database was designed to simulate the range of emotional events you might experience in daily life," Smith explains. "They represent pleasant emotional events, neutral events and unpleasant events or stimuli. These vary from pictures of babies, families, puppies and appetizing food items, to very neutral things like plates, cups, furniture and city landscapes, to very unpleasant images of violence, mutilations and other gruesome things."

The study findings suggest that exercise may play an important role in helping people to better endure life's daily anxieties and stressors.

Smith plans to explore if exercise could have the same persistent beneficial effect in patients who regularly experience anxiety and depression symptoms. In collaboration with the new Maryland Neuroimaging Center, he is also exploring the addition of functional magnetic resonance imaging, or fMRI, to measure brain activity during the period of exposure to emotionally stimulating images to see how exercise may alter the brain's emotion-related neural networks.

Smith also investigates the role of exercise in preventing cognitive decline in older adults. His research has shown that physical activity promotes changes in the brain that may protect those at high risk for Alzheimer's disease.

A healthy outlook leads to a healthy lifestyle

Researchers from the Melbourne Institute of Applied Economic and Social Research analysed data on the diet, exercise and personality type of more than 7000 people.

The study found those who believe their life can be changed by their own actions ate healthier food, exercised more, smoked less and avoided binge drinking.

Professor Deborah Cobb-Clark, Director of the Melbourne Institute of Applied Economic and Social Research, said those who have a greater faith in ‘luck’ or ‘fate’ are more likely to live an unhealthy life.

“Our research shows a direct link between the type of personality a person has and a healthy lifestyle,“ she said.

Professor Cobb-Clark hoped the study would help inform public health policies on conditions such as obesity.

“The main policy response to the obesity epidemic has been the provision of better information, but information alone is insufficient to change people’s eating habits,” she said.

“Understanding the psychological underpinning of a person’s eating patterns and exercise habits is central to understanding obesity.”

The study also found men and women hold different views on the benefits of a healthy lifestyle.

Men wanted physical results from their healthy choices, while women were more receptive to the everyday enjoyment of leading a healthy lifestyle.

Professor Cobb-Clarke said the research demonstrated the need for more targeted policy responses.

“What works well for women may not work well for men,” she said.

“Gender specific policy initiatives which respond to these objectives may be particularly helpful in promoting healthy lifestyles.”

Portion Control Program w/o Food Limits Works For Weight Loss

Effect of a Novel Food Portion Control Program (Lifesize®) on Dietary Intake and Body Weight

Study by Colorado State University

Background: Food portion sizes have increased in the U.S. which contributes to excess energy intake.

Objective: We determined the effect on body weight, energy intake, and dietary energy density of a portion control program (Lifesize(R)) that encourages free choice of foods, but limits portion sizes while allowing unlimited consumption of fruits, vegetables, and low_ fat dairy.

Methods: 22 overweight and obese subjects (n= 19 females, n=3 males; X (SD) age= 40(12); X BMI= 30.0(2.4) kg/m2) completed a 12_ week portion_control program. Participants used measuring devices to limit quantities of energy_dense foods. Body weights were recorded bi_ weekly and 3_day dietary records were collected at baseline, and weeks 1,6, and 12.

Results: Reported energy intake during the 12 weeks decreased by ~500 kcal/d compared to baseline, and mean weight loss was 2.4 kg. Relative intake of fruits and vegetables significantly increased from baseline at week 1 (X=+125.9 g/1000Kcal), week 6 (X= +80.7 g/1000Kcal), and week 12 (X= +192.6 g/1000Kcal). Despite free access to ‘favorite foods’, participants’ energy density (kcal/g food) was significantly decreased.

Conclusion: Including favorite foods while limiting portion sizes and allowing unlimited intake of fruit, vegetables and low_fat dairy may be an effective approach to lowering dietary energy density to elicit weight loss. Funded by Lifesize(R)

Related articles:

NY Times

Huffington Post

Effect of a Novel Food Portion Control Program (Lifesize®) on Dietary Intake and Body Weight

9/19/2011
Colorado State University
1
Effect of a Novel Food Portion Control Program (Lifesize®) on Dietary
Intake and Body Weight
Final Report submitted to Lifesize, Inc.
September 19, 2011
Principal Investigator: Chris Melby, Professor and Department Head
Department of Food Science and Human Nutrition
Colorado State University
Fort Collins, CO 80523
Co_Investigators: Sarah Fawcett, Cassi Freed, and Darlene Weber_Dewitt
INTRODUCTION AND BACKGROUND
Despite a host of recommendations established by various health organizations for
improving diet and increasing physical activity, the prevalence of obesity has increased
dramatically in the United States during the past two decades. The fattening of America
has spawned a billion dollar weight loss industry, with advertising of diet books, exercise
programs, and supplements offering quick fix remedies to boost metabolism and melt away
fat. Given the confusion, misinformation, and pursuit of the ‘magic bullet’ that
characterizes the weight loss industry in the U.S., it is especially important to identify
approaches to long_term weight loss that are based on sound scientific principles of body
weight regulation.
Body fat stores can be reduced by creating an energy deficit, but severe energy restriction
produced by many fad diets may result in metabolic adaptations that sabotage
maintenance of lost weight. Also many fad diets require the avoidance of ‘favorite foods’,
an approach that can jeopardize dietary adherence. A more realistic approach to body
weight regulation and health is recommended, characterized by an emphasis on smaller
serving sizes without wholesale changes in the types of foods consumed. This approach
could significantly reduce energy intake without perceptions of deprivation, which can
result in rebound eating binges. The portion control approach to weight regulation can
reduce the intake of high energy density foods without eliminating such foods from the
diet. This approach also allows the consumption of a variety of nutritious whole foods
including fresh fruits, vegetables, whole grains, lean proteins, and reduced fat milk.
A novel approach to weight loss and maintenance, the Lifesize Program has surfaced, which
focuses on the use of portion control measuring devices to limit energy intake while
simultaneously allowing the individual to consume their usual foods. The underlying
premise of this program is that by following one’s customary eating patterns, but limiting
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the quantities of the most energy dense foods by portion control and allowing unlimited
intakes of vegetables, fruits, and low fat dairy, an energy deficit and weight loss will occur
without a sense of ‘dieting’ and food deprivation. While this approach has a strong
theoretical foundation, important questions remain to be answered including the
following:
• How much weight and fat loss will overweight and obese individuals achieve by
following the Lifesize Program for 12 weeks?
• Do individuals who follow the Lifesize portion control approach to food
consumption lower their average daily food intake relative to their usual intake?
What is the magnitude of the average energy deficit that results from following the
Lifesize Program?
• Given the focus on portion control rather than on avoidance of favorite foods, what
will individuals actually choose to eat, and how will the Lifesize Program affect the
nutritional quality of their diets?
• What are the perceptions of the study participants regarding the Lifesize Program?
METHODS
Subjects
A total of 27 individuals (n=22 women, n= 5 men; mean age=40.4+12.2 years; mean BMI=
29.7 +2.6 kg/m2; mean percent body fat = 39.5+7.3%) were enrolled in this 12_week study.
All participants were informed verbally and in writing as to the purpose of the study, and
provided their informed, voluntary consent prior to enrollment in the study. This study
was approved by the Institutional Review Board of Colorado State University.
Experimental Design
Participants were enrolled in a 12_week weight loss program. Prior to enrollment, baseline
data were collected regarding personal health history, previous experience with weight
loss diets, and habitual food intake using 3_day dietary records. Body weight, body
composition, blood pressure, resting metabolic rate, and average daily steps taken using a
pedometer were also measured at baseline. After collection of baseline data, participants
were provided with a 2_hour orientation to the Lifesize Program. At this meeting,
individuals were informed as to the overall principles of the program, were provided with
the Lifesize measuring devices with a detailed explanation as to their use, and were given
the Lifesize training DVD and instructions as to how to use it. Enrolled participants
3
reported to the Nutrition Center at Colorado State University at regular time periods during
the next 12 weeks for follow_up and repeated testing as described below.
Specific Procedures
Preliminary Session 1: Upon obtaining voluntary informed consent, subjects underwent the
following screening tests to determine eligibility.
• Each subject’s height, weight, and BMI were measured using the Tanita Body Fat
Analyzer (Model TBF_105, Tanita Corporation of America, Inc., Arlington Heights, IL).
Subjects were measured without shoes and socks, and wearing light indoor clothing.
Body weight was measured to the nearest 0.1 kg.
• Each subject’s percent body fat was measured using Bioelectrical impedance (BI). This was
completed with the Tanita Body Fat Analyzer mentioned above.
• Health History Questionnaire_ Subjects’ age, health_related habits, and personal and
family health history were measured using a standard health history questionnaire.
Preliminary Session 2
Volunteers reported to the Nutrition and Metabolic Fitness Laboratory in a 12_h fasted state for the
purpose of baseline testing which involved the following tests:
• AnthropometricsAll
anthropometric measures were made under identical
conditions for all subjects during the entire study. Subjects were fasted, consumed
250 ml of water after waking, voided their bladders, and wore only shorts and a tshirt.
Body weight was measured on the same calibrated physicians’ balance scale
to the nearest 0.1 kg. Height without shoes was measured to the nearest 0.1 cm
with a wall_mounted stadiometer. Body mass index was calculated as weight in kg
divided by height in m2.
• Waist, hip, thigh, and upper arm girths were obtained in centimeters using a nonstretchable
measuring tape. The waist circumference was measured at the
umbilicus in men and the natural waistline in women; the hip circumference was
measured at the level of the maximum hip circumference. Bioelectrical impedance
(BI) was used to assess percent body fat using the Tanita Body Fat Analyzer (Model
TBF_105, Tanita Corporation of America, Inc., Arlington Heights, IL). All subjects
were instructed to follow specific manufacturer guidelines for BI testing. Fat free
mass and percent body fat was calculated using prediction equations supplied by
the manufacturer based on weight, age, and impedance index (ht2/z score).
• Resting blood pressure and heart rate were measured using a standard automated
sphygmomanometer (Dynamap) with subjects resting quietly in a sitting position
for 5 minutes. Systolic, diastolic, and mean arterial pressure values were recorded.
• Basal metabolic rate (BMR)_ Subjects arrived at the metabolic fitness laboratory
after a 12_h overnight fast and before engaging in any type of physical activity.
Indirect calorimetry (Parvomedics, Salt Lake City) was used to measure BMR based
on the VO2 and VCO2 measures while the subject lay quietly on a comfortable bed
with a clear plexiglass respiratory canopy over the head for 20 minutes. The
respiratory gas exchange data were converted to kcal expended per minute using
the Weir equation.
4
• Study participants completed 3_day dietary records. A co_investigator monitored
the dietary data entered and verified and corrected discrepancies (e.g. out_of_range
kilocalorie intakes) with participants.
• Pedometers were provided for measuring daily step counts during the entire 12_
weeks of the study. Participants were instructed on how to use the pedometers and
record their daily step counts.
Preliminary Session 3: Study participants attended a group orientation session to learn
about the portion control approach to weight loss. They were given instruction as to how
to follow the program for the 12 weeks, which involved the use of the unique portion
control devices, the DVD, and the wall chart. Participants were also asked to complete a
pre_program questionnaire to assess their knowledge, beliefs, and attitudes about weight
loss and portion size.
The Portion Control Program
Program Week1: After completion of the baseline tests and the orientation session,
participants began the program. The goal of the program was to provide a means of
measuring the amount of food and types of food they should be eating to be healthy and to
lose weight. The program emphasizes limiting the quantities of the most energy dense
foods by portion control and allowing unlimited intakes of vegetables, fruits, and non_fat
milk, which theoretically should result in an energy deficit and weight loss without a sense
of ‘dieting’ and food deprivation. At the end of the first week of the program participants
reported back to the Nutrition Center to meet with the project staff to discuss their
adherence to the program based on 3_day food records and step counter records. Their
body weight, body fatness, heart rate and blood pressure were also measured at this time.
Program Week 2: At the end of the second week of the program participants returned to
the Nutrition Center for further consultation. Body weight, body composition, heart rate
and blood pressure were again measured and participants provided their pedometer
records.
Weeks 412:
After week 2 in the program, participants reported to the Nutrition Center every two weeks
for further consultation and measurement of body weight, body fatness, heart rate and
blood pressure, as well as providing step count records. During week 6 and 12, they also
recorded their food intake for 3 days. The food records were for the purpose of
determining how effective the program is at helping reduce food intake relative to preprogram
values, and also for examining their diets for macro_ and micronutrient intake.
PostProgram
Testing: After participants completed 12 weeks in the program, they
underwent post_intervention testing identical to the preliminary tests: body weight, body
composition, heart rate, blood pressure, basal metabolic rate, and circumference
measurements. They also completed a post_program questionnaire in which they were
asked to report their perceptions of the program regarding ease of adoption, compliance
with the protocol, use of the measuring devices, etc. They were also asked several
5
knowledge questions to determine their level of understanding of the Lifesize approach to
weight loss.
Data analysis: Data were analyzed for dietary intake, anthropometric characteristics,
RMR, and blood pressure using paired t_tests and a within_subjects repeated analysis of
variance with post_hoc comparisons. Statistical significance was established at P<0.05.
Given the pilot nature of this study, a non_intervention control group was not be used.
6
RESULTS
Of the 27 individuals who were enrolled in the study, a total of 23 completed the 12_week
program. The four individuals dropped out for various reasons including lack of time,
pregnancy, moving from the area, and one individual felt unsatisfied with the program.
The physical characteristics of the remaining 23 individuals are provided in Table 1. The
study volunteers were mostly overweight and obese women, with a history of previous
dieting. Resting metabolic rates were not different than predicted based on body size,
indicating that the study subjects did not have unusually low metabolic rates that would
affect their ability to lose weight when energy intake was modestly restricted.
Table 1. Physical Characteristics of Study Participants (n=23) at Baseline Prior to
Implementing the Lifesize Program
Variable Mean (SD)
Age 40 (12)
Height (cm) 169.2 (8.1)
Weight (kg) 86.3 (12.1)
BMI (kg/m2)* 30.0 (2.4)
% Body Fat 38.7 (7.4)
Lean Body Mass (kg) 53.0 (10.9)
Upper Arm (cm) 34 (3)
Waist (cm) 94 (9)
Hips (cm) 113 (7)
Thigh (cm) 58 (4)
BMR (kcal/d)** 1751 (290)
*BMI= Body Mass Index
**BMR=Basal Metabolic Rate
Anthropometric changes: Table 2 provides the data on the changes that occurred in
body weight (also shown in Figure 1) and body composition over the 12 weeks of the
program. The mean weight loss during the 12 week program was 2.24 kg (~5.0 pounds)
with the men losing about twice as much weight as the women (8 pounds versus 4
pounds). There was a small decrease in percent body fat, which did not reach significance.
Table 2. Mean bodyweight and percent body fat in study participants (n=23) at
baseline and
after 12 weeks
of the Lifesize
Program.
Baseline Week 12 Mean Loss
Variable Mean (SD) Mean (SD)
Body Weight (kg) 86.0 (9.7) 83.7 (9.3)* 2.24 (2.25)
% Body Fat 39.7 (7.5) 39.1 (8.2) 0.52 (1.70)
7
*Mean weight loss of 2.24 kg, week 12Figure 1: Changes in weight during the Lifesize program.
Figure 1 illustrates average total weight loss during the Lifesize study. As seen above,
although weight loss was modest, it was consistent throughout the program.
Figure 2: Average changes in circumference measurements for 22 participants. Blue
bars=pre_program; Red bars=post_program.
86.25
85.70 85.82
85.26 85.13
84.56
84.30
83.90 83.95
82.50
83.00
83.50
84.00
84.50
85.00
85.50
86.00
86.50
Pre
Program
Baseline Week 1 Week 2 Week 4 Week 6 Week 8 Week 10 Post
Weig
ht
(
kg)
Change in Weight
94.3 91.4
113.4 111.6
58.5 57.4
34.4 33.7
20.0
40.0
60.0
80.0
100.0
120.0
cm
Circumference Measurements
8
In accordance with the modest weight loss that occurred during the program, there was a
significant decrease in the sum of the waist, hip, thigh, and arm circumference
measurements of 6.5 + 7.1 cm (p<0.01) from pre_program (baseline) measures compared
to those obtained at the end of the program.
Figure 3. Pre_ and post_program basal metabolic rates for the Lifesize study participants.
There was a decrease of approximately 125 kcal in basal metabolic rate over the 12 weeks
of the program. This decrease was expected with the modest weight loss that was
achieved.
Changes in calorie and macronutrient intakes: Table 3 provides information regarding
the changes in energy and macronutrient intake based on 3_day dietary records that were
reported during the 12 weeks. The decrease in self_reported average daily energy intake
relative to the pre_program baseline energy intake was on the order of 400_500 kcal per
day for weeks 1, 6, and 12. The decrease in reported energy intake was fairly consistent
across the entire 12 weeks of the program. The decline in energy intake was reflected by
decreased intakes of all three macronutrients—protein, carbohydrate, and total fat. At
least a portion of the total reduction in dietary carbohydrates during the Lifesize Program
was due to a significant reduction in sugar intake. Dietary saturated fat intake was also
reduced from pre_program and baseline compared to intake at weeks 1,6, and 12. There
was no significant reduction in dietary cholesterol. Dietary fiber intake in grams was also
1751.41
1624.45
1000.00
1100.00
1200.00
1300.00
1400.00
1500.00
1600.00
1700.00
1800.00
Pre Post
kcals/24hrs
Basal Metabolic Rate
9
reduced at weeks 1, 6, and 12 relative to the pre_program values; however there were no
changes in fiber intake relative to total calorie intake from pre_program to week 12.
Table 3. Mean energy and macronutrient intakes of study participants before
implementing the Lifesize Program and during weeks 1, 6, and 12 of the Program.
a denotes statistically significant difference from pre program, p< 0.05
b denotes statistically significant difference from Week 1, p<0.05
Table 4. Mean intakes of specific micronutrients in the study participants before
implementing the Lifesize Program and during weeks 1, 6, and 12 of the Program.
a denotes statistically significant difference from pre program, p< 0.05
Pre_Program Week 1 Week 6 Week 12
X (SD) X (SD) X (SD) X (SD)
Total Kcal/d 2177 (520) a1680 (368) a1608 (331) ab1510 (176)
Protein (g/d) 89.9 (26.5) a73.8 (19.7) 73.8 (23.5) a74.3 (15.5)
% of kcal 16.4 (2.4) 17.4 (3.3) a19.1 (4.2) ab19.5 (3.8)
CHO (g/d) 257.5 (75.7) a200.3 (52.2) a196.3 (54.6) a185.5 (42.5)
% of kcal 46.6 (7.1) 47.3 (6.8) 47.7 (7.2) 48.2 (7.9)
Sugar (g/d) 95.5 (40.4) a76.9 (26.8) a71.0 (26.6) a67.5 (25.0)
Fat (g/d)* 88.2 (25.1) a63.4 (18.3) a57.9 (16.3) ab53.1 (9.4)
% of kcal* 36.3 (5.6) 33.6 (6.5) a32.0 (7.1) a31.4 (5.4)
Sat Fat (g/d)* 28.3 (8.9) a19.5 (8.0) a20.0 (6.2) a17.0 (5.2)
% of kcal 11.9 (3.0) a10.3 (3.1) b11.0 (3.1) a10.1 (2.7)
Cholesterol (mg/d) 267.7 (127.5) 251.4 (107.7) 242.2 (97.3) 240.8 (86.6)
Fiber (g/d) 23.2 (8.5) a18.9 (7.1) a18.3 (4.9) a17.2 (6.4)
Fiber (g/1000kcal) 10.7 (3.0) 11.3 (3.6) 11.5 (2.9) 11.4 (3.9)
Pre Program Week 1 Week 6 Week 12
X (SD) X (SD) X (SD) X (SD)
Sodium (mg/d) 3712.3 (1562.0) a2626.2 (922.9) a2570.2 (1042.5) a2252.2 (710.5)
Vitamin A
(RE/d) 900.0 (634.6) 1051.0 (845.2) 879.2 (561.0) 948.9 (797.3)
__
Carotene(ug/d) 2172.8 (2986.7) 3022.8 (3974.3) 2887.3 (4199.2) 2834.2 (4083.2)
Vit C (mg/d) 94.2 (65.5) 98.7 (65.6) 82.9 (40.2) 67.5 (45.6)
Iron(mg/d) 17.5 (8.7) a14.3 (8.6) a13.9 (4.3) a12.1 (4.0)
Calcium(mg/d) 908.6 (284.4) a725.5 (294.8) a764.7 (239.3) a734.0 (240.8)
10
Changes in micronutrient intakes: Table 4 shows the changes that occurred in specific
vitamins and minerals from self_reported pre_program values taken from 3_day dietary
records for those reported at weeks 1, 6, and 12 of the Lifesize Program. There were
significant reductions in sodium intake from baseline (pre_program) at weeks 1, 6, and 12.
Despite the decrease in reported food intakes during the program, there were not
significant reductions in vitamin A, B_carotene, and ascorbate (vitamin C). However, there
were significant decreases in iron and calcium at weeks 1, 6, and 12 relative to preprogram
intakes.
Change in water, vegetables, fruit and lowfat
dairy: Table 5 shows the changes that
occurred in water, vegetables, fruit and low_fat dairy intake based on 3_day dietary records
reported prior to the start of the program and at weeks 1,6,and 12 of the Lifesize Program.
Vegetable and fruit consumption increased at week 1, 6, and 12 of the Lifesize Program.
However, this increase was only statistically significant at weeks 1 and 6 and when
vegetable and fruit intake was calculated relative to total energy intake. The percent of
low_fat dairy relative to total dairy intake also increased throughout the program. This
increase was found to be statistically significant at week 6. Despite continually
emphasizing the importance of increased water consumption, there was no significant
change in water intake.
Table 5: Mean intakes of water, vegetables, fruit, and lowfat
dairy in the study
participants before implementing the Lifesize Program and during weeks 1, 6, and 12
Baseline Week 1 Week 6 Week 12
X SD X SD X SD X SD
Water (g/d) 920.5 (568.1) 809.5 (757.8) 848.4 (664.1) 914.9 (657.8)
Vegetables (g/d) 97.8 (89.7) a213.7 (184.0) 157.7 (126.1) 215.7 (308.9)
Vegetable (
g/1000Kcal) 48.3 (48.4) a125.8 (116.9) a96.61 (69.2)
155.5 (245.9)
Fruit (g/d) 132.7 (106.7) 182.5 (117.8) 149.8 (90.9) 199.8 (270.9)
Fruit ( g/1000Kcal) 61.5 (47.6) a109.9 (68.7) a95.9 (59.0) 137.19 (194.1)
Low_Fat Dairy (g/d) 187.6 (199.5) 157.1 (203.7) 193.1 (149.5) 178.8 (151.8)
Low_Fat Dairy (
g/1000Kcal) 87.83 (93.29) 87.89 (112.5) ab127.9 (107.11) 115.4 (95.2)
11
Percent of Dairy as
Low_Fat Dairy (%) 61.0 (42.8) 61.7 (45.2) ab80.9 (33.8) 77.0 (37.6)
a denotes statistically significant difference from pre program, p< 0.05
b denotes statistically significant difference from Week 1, p<0.05
There were no differences in the average daily number of steps recorded from pedometer
counts from pre_program (x=8950 steps/d) to week 12 (x=8800 steps/d).
Knowledge and Perceptions of the Participants in the Lifesize Program: After 12
weeks of the Lifesize Program participants completed a questionnaire (see appendix), in
which they were asked to report their perceptions about the program relative to their
expectations. The graphs below represent the response percentages of individuals to each
of the questions. Two participants that had dropped out of the program also completed a
questionnaire, increasing the n for questionnaire responses to 25 for most questions. Not
everyone answered the questionnaire in its entirety, therefore some figures report
different total n values, and they are noted below the figure.
Figure 4
*n=24 for this question
The results of this question show that 56 percent of participants were somewhat or
extremely happy with their weight loss. Referring to the open comments from participants,
further explanation as to the factors that affected their satisfaction are apparent. Some
participants stated that even though they did not lose as much weight as they wanted, they
were happy because it wasn’t a restrictive program and they could still eat the foods that
they enjoy.
12
Figures 5,6 and 7 show responses to questions about the usefulness of Lifesize supporting
materials. Overall, participants found the CDs, DVD and wallchart to be helpful. Most
(59%) only watched the DVD one time, and did not refer back to it.
Figure 5
Figure 6
Figure 7
n= 3
n= 4
n= 11
n= 7
0%
10%
20%
30%
40%
50%
Strongly Disagree Somewhat
Disagree
Somewhat Agree Strongly Agree
"I found the Lifesize CDs to be very
helpful."
n= 1
n= 16
n= 5
n= 3
0%
10%
20%
30%
40%
50%
60%
70%
Watched and
referred back
Watched and
didn't go back
Jumped around Didn't use
"Which statement describes your use
of the DVD?"
13
Figure 8
Figure 9
n= 0 n= 1
n= 6
n= 18
0%
20%
40%
60%
80%
Strongly disagree Somewhat
disagree
Somewhat agree Strongly agree
"I found the Lifesize wall chart to be
very helpful."
n= 0
n= 1
n= 10
n= 14
0%
10%
20%
30%
40%
50%
60%
Extremely difficult Somewhat difficult Somewhat easy Extremely easy
"How difficult or easy was it to use the
Lifesize portion control devices?"
14
Figures 8 and 9 refer to the portion control devices themselves. Figure 8 shows that 89
percent of participants believed the devices were easy to use. Figure 9 shows that 70
percent believed the devices were easy to incorporate into their lifestyle.
Figure 10
*n=23 for this question
n= 0
n= 6
n= 15
n= 4
0%
20%
40%
60%
80%
Extremely
inconvenient
Somewhat
inconvenient
Somewhat
convenient
Extremely
convenient
"How inconvenient or convenient was
it to incorporate the portion control
devices into your lifestyle?"
n= 13
n= 10
0%
10%
20%
30%
40%
50%
60%
Yes No
"Did you know what Lifesize meant
by the phrase: It is a complete 5 step
program?"
15
Figure 11
Figure 12
n= 0
n= 3
n= 11 n= 11
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Extremely difficult Somewhat
difficult
Somewhat easy Extremely easy
"How would you describe the
difficulty or simplicity of following
the Lifesize program as a whole?"
16
Figures 11 and 12 refer to questions regarding the difficulty or simplicity of the Lifesize
program. When looking at the program as a whole, 81 percent responded that the program
was somewhat or extremely easy. However, when looking at the simplicity of the program
while dining out or away from home, that number dropped to only 59 percent finding the
program somewhat or extremely easy.
Figures 13 and 14 refer to the questions regarding the number and sizes of Lifesize
portions. When looking at the size of the portions, 70 percent of participants agreed that
the size of the portions was appropriate for weight loss. Looking at the number of Lifesize
portions, 70 percent believed that the number of portions were appropriate for weight loss.
Figures 19 and 20 provide more information regarding the number of Lifesize portions.
Figure 13
n= 0
n= 9
n= 13
n= 3
0%
10%
20%
30%
40%
50%
60%
Extremely difficult Somewhat
difficult
Somewhat easy Extremely easy
"How would you describe the
difficulty or simplicity of using your
knowledge of Lifesize portion sizes to
choose portions of food while dining
out or away from home?"
17
Figure 14
Figure 15
n= 2
n= 4
n= 12
n= 7
0%
10%
20%
30%
40%
50%
60%
Strongly disagree Somewhat
disagree
Somewhat agree Strongly agree
"The Lifesize portion sizes were
appropriate for weight loss for me."
18
Figure 16
19
Figure 17
*n=22 for this question
Figure 18
Figures 15 through 18 represent the questions concerning changes in consumption of
fruits, vegetables, low fat dairy and water throughout the Lifesize program. Looking at
20
these responses, 66 percent of participants stated they increased their intake of fruit, 74
percent stated they increased consumption of vegetables, 33 percent stated they consumed
more low fat dairy, and 64 percent stated they increased the amount of water they
consumed throughout the study. Almost 15 percent of participants believed they
consumed less lowfat dairy, while only about 4 percent said they consumed less fruit,
vegetables or water.
Figure 19
*n=24 for this question
Figure 20
*n=24 for this question
Figures 19 and 20 address the questions about deviation from the Lifesize program.
Approximately 80 percent of participants reported deviating from the program by eating
n= 6 n= 7 n= 6 n= 5
0%
10%
20%
30%
40%
Zero to two times Three to seven times Seven to eleven times Twelve or more times
"During the 12 weeks, on how many occasions
did you deviate from the Lifesize portion control
approach by consuming significantly larger
quantities of food?"
n= 3
n= 9
n= 8
n= 4
0%
10%
20%
30%
40%
Zero to two times Three to seven times Seven to eleven times Twelve or more times
"During the 12 weeks, on how many occasions
did you deviate from the Lifesize portion control
approach by consuming significantly lower
quantities of food?"
21
larger quantities of food, with the most responses (26 %) being in the range of three to
seven occasions during the program. When looking at deviation by eating smaller
quantities of food, 90 percent of participants reported some deviation, with 60 percent
reporting that they deviated on three to eleven occasions throughout the study. This
correlates with the finding that 22 percent of participants believed that the number of
allotted portions was not appropriate for them.
Figure 21
Figure 22
*n=23 for this question
n= 4
n= 11
n= 6
n= 2 n= 2
0%
20%
40%
60%
Always Most of the time Sometimes Rarely Never
"During the first 6 weeks of the Lifesize
program,if you were still hungry immediately
after finishing a meal, how often did you wait 15
minutes before getting a second helping of
food?"
n= 6
n= 4
n= 6
n= 5
n= 2
0%
10%
20%
30%
Always Most of the time Sometimes Rarely Never
During the last 6 weeks of the Lifesize program, if
you were still hungry immediately after finishing
a meal, how often did you wait 15 minutes
before getting a second helping of food?"
22
Figures 21 and 22 refer to questions regarding the “wait 15 minutes” concept of the
Lifesize program. During the first 6 weeks, 55 percent of participants said that they waited
15 minutes most of the time or always before getting a second helping of food. During the
last 6 weeks, that number dropped to 37 percent.
Figure 23
Figure 24
*n=23 for this question
n= 9
n= 13
n= 1
n= 2
0%
10%
20%
30%
40%
50%
60%
Strongly disagree Somewhat disagree Somewhat agree Strongly agree
"During the first 6 weeks of the study, I
often felt deprived of eating my favorite
foods."
n= 9
n= 12
n= 0
n= 2
0%
10%
20%
30%
40%
50%
60%
Strongly disagree Somewhat disagree Somewhat agree Strongly agree
"During the last 6 weeks of the study, I
often felt deprived of eating my favorite
foods."
23
Figures 23 and 24 refer to feelings of deprivation during the program. During the first 6
weeks, only 11 percent of participants indicated that they felt deprived of eating their
favorite foods. During the last 6 weeks, this number dropped to about 7 percent. These
values are typically well below any reported percentage of feelings of deprivation in other
weight loss programs.
Figure 25
Figure 26
*n=23 for this question
n= 1 n= 1
n= 8
n= 15
0%
10%
20%
30%
40%
50%
60%
70%
Zero to twenty_ five
percent
Twenty_six to fifty
percent
Fifty_one to seventyfive
percent
Seventy_six to one
hundred percent
"During the first 6 weeks, I would
estimate my compliance with the
program to be:"
n= 1
n= 3
n= 12
n= 7
0%
10%
20%
30%
40%
50%
60%
Zero to twenty_five
percent
Twenty_six to fifty
percent
Fifty_one to seventyfive
percent
Seventy_six to one
hundred percent
"During the last 6 weeks, I would
estimate my compliance with the
program to be:"
24
Figures 25 and 26 give information concerning the participants’ perception of their
compliance with the Lifesize program. These graphs demonstrate that compliance was
greater during the first 6 weeks of the program compared to the last 6 weeks.
Figure 27
Figure 28
*n=23 for this question
Figures 27 and 28 deal with responses to questions asking what percentage of food was
measured using the devices and natural portion guidelines. During the first 6 weeks, 85
n= 0
n= 2
n= 13
n= 10
0%
10%
20%
30%
40%
50%
60%
Zero to twenty_five
percent
Twenty_six to fifty
percent
Fifty_one to seventy_five
percent
Seventy_six to one
hundred percent
During the first 6 weeks, the percentage of food
I ate using the devices/natural portions was:"
n= 3
n= 6
n= 10
n= 4
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Zero to twenty_five
percent
Twenty_six to fifty
percent
Fifty_one to seventy_five
percent
Seventy_six to one
hundred percent
"During the last 6 weeks, the percentage of food
I ate using the devices/natural portions was:"
25
percent of participants said they used them at least half the time. During the last six weeks,
only about 50 percent of participants stated that they used the devices/natural portions
more than half the time.
Figure 29
Figure 30
CSU staff was found to be helpful by 90 percent of participants, and knowledgeable by 85
percent.
n= 0 n= 0 n= 1
n= 24
0%
20%
40%
60%
80%
100%
120%
Strongly disagree Somewhat disagree Somewhat agree Strongly agree
"I found the CSU staff to be very helpful."
n= 0 n= 0
n= 2
n= 23
0%
20%
40%
60%
80%
100%
Strongly disagree Somewhat disagree Somewhat agree Strongly agree
" I found the CSU staff to be very
knowledgeable."
26
DISCUSSION
This study was designed to address specific questions regarding the Lifesize portion
control approach to weight loss.
Question 1: How much weight and fat loss will overweight and obese individuals
achieve by following the Lifesize Program for 12 weeks?
The major finding of this study is that the average weight loss for overweight and mildly
obese individuals was approximately 5 pounds, with the four men losing an average of 8.5
pounds and the 19 women losing an average of about 3.9 pounds. The men had higher
body weights and resting metabolic rates compared to the women, and thus were more
likely than the women to create a greater energy deficit on the Lifesize Program, which
uses a fixed number of portions for all participants. This finding is not unexpected as men
typically lose weight more readily than women owing to greater daily energy expenditure.
As the investigators have discussed with the inventors of Lifesize, weight loss would be
predicted to be quite variable across study participants, given that the number of portions
allowed with Lifesize is constant, regardless of the individual’s initial body weight and
energy requirements.
The magnitude of the reduction in body fat was small and did not reach statistical
significance. However, the method used in this study, bio_impedance analysis, is not the
gold standard and was likely lacking adequate resolution to identify small changes in total
body fat. We used a second approach to indirectly measure weight and fat loss using
circumference measurements of the waist, hips, thigh, and arm. There was a statistically
significant reduction in the sum of these girth measurements.
Question 2: Do individuals who follow the Lifesize portion control approach to food
consumption lower their average daily food intake relative to their usual intake?
What is the magnitude of the average energy deficit that results from following the
Lifesize Program?
While on the Lifesize Program, the subjects reportedly reduced their daily energy intake an
average of 400_500 kcal per day based on their three day records. The energy intake while
using the measuring devices was fairly constant for weeks 1,6, and 12, indicating the
sustainability of this approach to lowering energy intake. The magnitude of the reported
energy deficit over the 12 weeks would have predicted a greater weight loss. However, as
expected, there was an average decrease in basal metabolic rate by approximately 100 kcal
after 12 weeks on the program. This is a common finding in weight loss studies. Also, it is
well recognized that study participants who are expected to lose weight by lowering their
energy intake, often under report their food intake when asked to provide this information.
Thus, the lower actual weight loss compared to what would be predicted based on the
magnitude of the reported reduction in food and energy intake, is not surprising.
27
Question 3: Given the focus on portion control rather than on avoidance of favorite
foods, what will individuals actually choose to eat, and how will the Lifesize Program
affect the nutritional quality of their diets?
The dietary quality data as determined from the 3_day food records, suggest that the study
participants changed the amount of food ingested rather than changing the types of foods
consumed. There were decreases in the absolute amounts of carbohydrates, proteins, and
fats consumed which reflects a reduction in total food intake rather than targeted
reduction only of specific high fat, high sugar, or “forbidden” foods. This notion is further
substantiated by the lack of significant decreases in the percentages of these
macronutrients consumed relative to calories, suggesting that individuals were in fact just
lowering their food intake without attempting to specifically lower their intakes of fat or
carbohydrates. This would be expected given the emphasis that the Lifesize approach
places on portion control while eating foods that one enjoys.
There were reductions in sodium intake, which likely reflects a reduction in nondiscretionary
sodium found in foods. In other words, if individuals consumed smaller
portions of food, most of which contained at least some sodium, the intake of this mineral
was necessarily reduced. Similar findings were also found for iron and calcium. The latter
finding was somewhat surprising, as dairy products provide approximately 75% of the
dietary calcium for most Americans. Given the use of low_fat milk products as free foods,
which the study participants could freely consume, we hypothesized that dietary calcium
would increase, even in the face of a reduction in calories. This was apparently not the
case.
Fruits and vegetables are also ‘free’ foods in the Lifesize Program; thus we hypothesized
that participants would exhibit increased fruit and vegetable intakes. The responses to the
final questionnaire showed that the majority of individuals reported increases in
consumption of these foods. Additionally, based upon the 3_day dietary records we found
that fruit and vegetable intake increased relative to calories consumed. This phenomenon
should in turn be reflected by increased dietary intakes of vitamin C and beta_carotene.
However, the intakes of these nutrients did not increase as determined by the 3_day dietary
records. The reason for this discrepancy could be related to the types of fruits and
vegetables consumed, wherein study participants increased their intakes of fruits such as
apples, pears, and bananas which are not rich sources of vitamin C and beta_carotene.
Question 4: What are the perceptions of the study participants regarding the Lifesize
Program?
The participants’ responses to the final questionnaire used to address this question
revealed some interesting findings. The majority of the participants were at least
somewhat happy with their weight loss, although some clearly expected larger amounts of
body weight loss than they achieved. We might recommend that a smaller number than 6
portions, possibly only 4 or 5 portions depending on the person’s goals, be allowed initially
28
to ‘jump start’ the weight loss. Then the current approach using 6 portions could be used
for slower weight loss later in the program and also for weight maintenance.
The majority of the participants seemed to understand the essence of the Lifesize approach,
and found the DVDs and wall charts to be helpful. Most participants stated that they only
watched the DVD once, and did not refer back to them. This may be useful to know for
future evaluation of the resource materials. Why some individuals did not find the
materials helpful is unclear. The majority of participants found the devices easy and
convenient to use, more so when eating at home than when dining out.
Participant Comments to OpenEnded
Questions Asked Upon Program Completion:
The respondents were asked to provide open_ended comments at the end of the program,
and these are provided below as brief summaries and the individual comments.
QUESTION: Please Tell Us Briefly Why You Are Happy Or Unhappy With Your Weight
Loss.
10 participants stated that they were unhappy with their weight loss. They stated that they
were unhappy because they would have liked to lose, or had expected to lose more weight.
But half of those cited life events as the reasons they didn’t lose weight. 11 participants
stated that they were happy with their weight loss. They stated that even a few pounds
made a difference in how they felt, they experienced health benefits, such as a decrease in
reflux, and that they only had to make minor changes to the food and drinks they already
ate. They said they experienced healthy weight loss, and learned how to eat better foods
and control amounts taken at each meal.
“I am happy I found a program that is practical but not life altering to use.”
DID YOU WANT OR NEED TO SEE FASTER WEIGHT LOSS
17 participants said yes, they wanted faster weight loss. But some commented that they
understood why the weight loss was slower. 4 participants stated that they didn’t want
faster weight loss.
IF YOU HAD TO DESCRIBE LIFESIZE IN 3 SENTENCES, WHAT WOULD THEY BE?
*It’s simple. It’s user friendly. It’s a solo program.
*It trains you to eat the right amount. You can still eat balanced. It’s a long term plan not a
quick weight drop.
*You can eat what you want, just not as much as you think you need. It is simple and
straight forward. You can always be drinking more water.
*No counting calories, carbs, point, etc. Fairly simple to follow. Effective if program is
followed.
*It provides a new perspective on eating. It promotes well_being. It’s not a “diet”, it’s a
lifestyle.
*Easy portion control system. Allows you eat what you like. Helps add fruits and veggies to
the diet.
*Realistic. Portion control. Exercise.
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*Safe way to lose weight. It helps you portion food without being deprived. I think it is a
practical
program for everyday life.
*Easy to use and understand. Never feel deprived. Gives you the power to stay in control.
*Portion control. Portion control. Portion control.
*Lifesize uses portion sizes to lead to weight loss. Lifesize uses number of portions to lead
to weight loss. Lifesize lets you eat any food you want.
*Portion control. Begin with water. Wait 20 minutes. Free foods are a good thing.
*Portion control. Limit number of portions. Don’t go hungry, fill up on healthy choices.
*It’s all about moderation so you can eat what you like. It teaches you how to portion food
reasonably without counting calories. It’s fairly easy to use with the tools they give you.
HOW IS LIFESIZE DIFFERENT FROM OTHER DIET PROGRAMS?
The participants said unanimously that it is not restrictive, they felt they could eat what
they wanted, and that it was more of a lifestyle change than a diet. They all understood that
the focus of the program was portion control. A few mentioned that the devices and wall
chart made it simple.
“Because you don’t go without your favorite foods, just learn how to eat correct amounts.”
WHAT DIDN’T YOU LIKE ABOUT THE PROGRAM?
Most participants stated that the program was harder to follow when eating away from
home and on vacation. Some participants said the program was actually too simple, that
there weren’t enough examples of typical restaurant choices or combo meals, and that
there weren’t a lot of ethnic foods discussed. Some participants stated that the portions
were too large, and that they felt they were adding in food to get all 6 portions in.
Participants stated that they thought the program should be more individualized, that
there wasn’t any emotional support for overeating/emotional issues related to eating, and
that because it was very simple, it was easy to go back to having larger portions by
accident.
DOES LIFESIZE WORK?
Seventeen participants agreed that the program works. They felt it worked because they
didn’t feel deprived and they had freedom to eat what they wanted. Most felt that it
worked because they realized the importance of portion sizes. Six participants that stated
that the program doesn’t work stated so because it wasn’t individualized, it doesn’t address
what they were eating, or why they might be overeating, and that the program should
reinforce the importance of exercise. They stated that they found themselves making poor
nutrition choices because there was no structure.
“Yes, because it allows a person to still enjoy food, but understand the need for
moderation.”
ADDITIONAL COMMENTS:
*Needs to have some form of support: online or group.
30
*Learning portion control has had health benefits beyond weight loss. Prior to participating
I had terrible reflux problems. I have not needed medication for that since about the
second week. I’ve also learned what it truly feels like when my body needs food and when I
am full. Overall this has been a good learning experience. I think the counseling and
guidance component of the experiment has been beneficial. I am not sure that someone
using the program without it will be as successful or satisfied.
*I think calories are slightly overlooked. Some portion sizes seemed to have much higher
calories than others. 3 slices of pizza pack a lot more calories than a lifesize portion of
grilled chicken breast, yet they count the same. And pizza is a whole lot easier than grilling
chicken. I tended to stray towards the easy “big” portions that probably gave me more
calories than I needed.
*The videos were helpful, however they showed the same food items over and over. It
would have been nice to see more variety to give me a better idea, instead of just mac and
cheese and steak.
*Being able to eat as much fruit as I wanted was a down fall for me.
*If there was an interactive program online that could be used in tandem with Lifesize, I
could see it being beneficial.
*Travel size wall chart would be great.
*There should be a square dessert measurement tool along with the pie shape. Most cakes,
brownies and cobblers are in square servings.
*Foods like sushi and crystal light should be included in the chart. Otherwise, THANK YOU!
*The portions were sometimes bigger than what I would normally eat. I think the pizza and
hotdog portions should be smaller.
*I see lifesize as working for maintenance, but not really as a weight loss program. I also
don’t agree with some of the portion sizes. For example: I don’t think a granola bar,
especially a 90 calorie one, should count as two portions.
* I think exercise could be emphasized more. THANK YOU!!
*I am glad I attended the lifesize program. Not only because I lost about 5 kg but also
because I know I can lose my weight in a healthy way even if I don’t have a lot of time for
exercise.
*It can be a little difficult to compare natural portion size for food that is not listed.
*didn’t change “what” to eat.
*Controversy over diet soda.
*The scoop versus portion idea confused me a lot.
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ID: _______________________________/____________/__________
Last four digits of your phone number/month of birth/day of birth
Post-Program Questionnaire
Introduction: Thank you for your participation in the Lifesize program. As part of the evaluation
process for the program, we are asking that you complete this post-program questionnaire. This
questionnaire is designed to gain feedback on changes in your attitudes about diets and your eating
behaviors as a result of the Lifesize program. The information obtained in this questionnaire will be
confidential.
Goal: To determine weight loss satisfaction on the Lifesize program.
First tell us about your weight loss results during the Lifesize program.
1. How much weight did you lose during the 12 week program? ______ (lbs)
2. When you enrolled in the study, how much weight did you hope to lose? _____ (lbs)
3. Are you happy with the amount of weight you lost during the 12 week program?
extremely unhappy somewhat unhappy somewhat happy extremely
happy
4. Please tell us briefly why you are happy or unhappy with your weight loss. ________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Did you want or need to see faster weight loss?______________________________________
Now we would like to ask you questions about components of the Lifesize program.
1. I found the Lifesize CDs to be very helpful.
strongly disagree somewhat disagree somewhat agree strongly agree
2. Which one of the statements below best describes your use of the DVD?
I watched it all the way through once and later referred back to all or parts of it as I needed to.
I watched it all the way through once, but did not refer back to it.
I did not watch the entire DVD, but jumped around to find bits and pieces of important info.
I didn’t use the DVD.
3. I found the Lifesize wall chart to be very helpful.
strongly disagree somewhat disagree somewhat agree strongly agree
4. Did you understand the "Quick Start" chart? Yes No
5. How difficult or easy was it to use the Lifesize portion control devices?
extremely difficult somewhat difficult somewhat easy extremely easy
6. How inconvenient or convenient was it to incorporate the portion control devices into your lifestyle?
32
extremely somewhat somewhat extremely
inconvenient inconvenient convenient convenient
Now we would like to know your thoughts about the statements below.
(Please mark an X for your level of agreement with the following statements.)
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
1. I have to give up my favorite high fat/high
sugar foods to lose weight.
2. I need to increase my activity and/or
exercise to lose weight.
3. I think that having my family/roommate(s)
eat the same foods as me would help with
my weight loss.
4. I won’t stay on a weight loss program when
I feel deprived.
5. I expect to feel deprived on a weight loss
program.
6. I will eat a food that is not on my program
when I feel deprived.
Now we would like to ask you specific questions about the first 6 weeks of the Lifesize Program.
1. During the first 6 weeks of the Lifesize Program, if you were still hungry immediately after finishing
a meal, how often did you wait 15 minutes before getting a second helping of food?
Always Most of the Time Sometimes Rarely Never
2. During the first 6 weeks of the study, I often felt deprived of eating my favorite foods.
strongly disagree somewhat disagree somewhat agree strongly agree
3. During the first 6 weeks of the study, the percentage of food I ate using the devices/natural portions
was:
0-25% 26-50% 51-75% 76-100%
4. During the first 6 weeks, I would estimate my compliance with the program (how closely I followed
the program) to be:
0-25% 26-50% 51-75% 76-100%
5. During the first 6 weeks of the Lifesize Program, how often did you portion out your food before
you ate it? (Please mark an X in only one box for each meal)
33
Never 1-2 times/week 3-4 times/week 5-6 times/weeks Every day
Breakfast
Lunch
Dinner
Snack
6. During the first 6 weeks of the Lifesize Program, how often did you drink water before the following
meals? (Please mark an X in only one box for each meal)
Never 1-2 times/week 3-4 times/week 5-6 times/weeks Every day
Breakfast
Lunch
Dinner
Snack
7. During the first 6 weeks of the Lifesize program, how much of each beverage did you drink
throughout the day? (Please mark an X in only one box for each beverage. If a beverage you
drink is not listed, write it in on the line contained in the last box.)
Less than 1 serving 1-3 servings 4-6 servings 7-9 servings 9+ servings
Water
Low Fat/skim Milk
Whole Milk
Juice
Regular Soda
Beer /Wine/Spirits
Other (please write in
the beverage)
_______________
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Now we would like to ask you specific questions about the last 6 weeks of the Lifesize Program.
1. During the last 6 weeks of the Lifesize Program, if you were still hungry immediately after finishing
a meal, how often did you wait 15 minutes before getting a second helping of food?
Always Most of the Time Sometimes Rarely Never
2. During the last 6 weeks of the study, I often felt deprived of eating my favorite foods.
strongly disagree somewhat disagree somewhat agree strongly agree
3.During the last 6 weeks of the study, the percentage of food I ate using the devices/natural portions
was:
0-25% 26-50% 51-75% 76-100%
4. During the last 6 weeks, I would estimate my compliance with the program (how closely I followed
the program) to be:
0-25% 26-50% 51-75% 76-100%
5. During the last 6 weeks of the Lifesize Program, how often did you portion out your food before you
ate it? (Please mark an X in only one box for each meal)
Never 1-2 times/week 3-4 times/week 5-6 times/weeks Every day
Breakfast
Lunch
Dinner
Snack
6.During the last 6 weeks of the Lifesize Program, how often did you drink water before the following
meals? (Please mark an X in only one box for each meal)
Never 1-2 times/week 3-4 times/week 5-6 times/weeks Every day
Breakfast
Lunch
Dinner
Snack
7. During the last 6 weeks of the Lifesize program, how much of each beverage did you drink
throughout the day? (Please mark an X in only one box for each beverage. If a beverage you
drink is not listed, write it in on the line contained in the last box.)
35
Less than 1 serving 1-3 servings 4-6 servings 7-9 servings 9+ servings
Water
Low Fat/skim Milk
Whole Milk
Juice
Regular Soda
Beer /Wine/Spirits
Other (please write
in the beverage)
_______________
Now we would like to ask you some questions about changes in your eating patterns and the
Lifesize program.
In the chart below, please consider your consumption of these foods during the Lifesize Program as
compared to before you started. (Mark an X in only one box for each food column that best
describes your intake of that food.)
Fruit Vegetables Low-fat/nonfat
dairy
Water
I consumed less during the Lifesize
Program
I consumed the same amount during
the Lifesize Program
I consumed slightly more during the
Lifesize Program (1-2 servings/day
increase)
I consumed substantially more
during the Lifesize Program (3 or
more servings/day increase)
1. How would you describe the difficulty or simplicity of following the Lifesize program as a whole?
extremely difficult somewhat difficult somewhat easy extremely easy
2. How would you describe the difficulty or simplicity of using your knowledge of Lifesize portion sizes
to choose portions of food while dining out or away from home?
extremely difficult somewhat difficult somewhat easy extremely easy
3. The Lifesize portion sizes were appropriate for weight loss for me.
36
strongly disagree somewhat disagree somewhat agree strongly agree
4. The number of Lifesize portions used per day was appropriate for weight loss for me.
strongly disagree somewhat disagree somewhat agree strongly agree
5. During the 12 weeks, on how many occasions did you deviate from the Lifesize portion control
approach by consuming significantly larger quantities of food?
0-2 occasions 3-7 occasions 7-11 occasions 12 or more occasions
6. During the 12 weeks, on how many occasions did you deviate from the Lifesize portion control
approach by consuming significantly lower quantities of food?
0-2 occasions 3-7 occasions 7-11 occasions 12 or more occasions
7. After a few weeks on the program, I felt comfortable with the Lifesize portions and didn’t need to use
the devices constantly.
strongly disagree somewhat disagree somewhat agree strongly agree
8. Did you understand how and why the Lifesize program suggested that you drink a lot of water?
Yes No
9. Did you know what Lifesize meant by "It is a complete 5 step program”? Yes No
10. If you had to describe LifeSize to a friend in 3 sentences, what would they be?
1._____________________________________________________________________________
_____
2.
__________________________________________________________________________________
3.
__________________________________________________________________________________
11. In a sentence, how is LifeSize different from other diet programs?
_____________________________________________________________________________________
______
12. What didn't you like about the program?
_______________________________________________________________
_________________________________________________________________________________________________________
____
13. In a sentence, does LifeSize work ? (Why or Why not?)
_______________________________________
_____________________________________________________________________________________
___
14.I found the CSU staff to be very helpful.
strongly disagree somewhat disagree somewhat agree strongly agree
15. I found the CSU staff to be very knowledgeable.
strongly disagree somewhat disagree somewhat agree strongly agree
37
Please provide any additional comments about the Lifesize program in the box below.
Thank You

Literary reading provides "a truly valuable exercise of people's brains."

Test subject Matt Langione, a doctoral candidate at the University of California-Berkeley, leisurely reads Jane Austen's 'Mansfield Park' in the mock scanning room. The researchers found that blood flow in the brain increases during such leisurely reading, but in different areas of the brain than when the subjects read the novel more closely. (Photo: Linda A. Cicero / Stanford News Service)

The inside of an MRI machine might not seem like the best place to cozy up and concentrate on a good novel, but a team of researchers at Stanford are asking readers to do just that.

In an innovative interdisciplinary study, neurobiological experts, radiologists and humanities scholars are working together to explore the relationship between reading, attention and distraction – by reading Jane Austen.

Surprising preliminary results reveal a dramatic and unexpected increase in blood flow to regions of the brain beyond those responsible for "executive function," areas which would normally be associated with paying close attention to a task, such as reading, said Natalie Phillips, the literary scholar leading the project.

During a series of ongoing experiments, functional magnetic resonance images track blood flow in the brains of subjects as they read excerpts of a Jane Austen novel. Experiment participants are first asked to leisurely skim a passage as they might do in a bookstore, and then to read more closely, as they would while studying for an exam.

Phillips said the global increase in blood flow during close reading suggests that "paying attention to literary texts requires the coordination of multiple complex cognitive functions." Blood flow also increased during pleasure reading, but in different areas of the brain. Phillips suggested that each style of reading may create distinct patterns in the brain that are "far more complex than just work and play."

The experiment focuses on literary attention, or more specifically, the cognitive dynamics of the different kinds of focus we bring to reading. This experiment grew out of Phillips' ongoing research about Enlightenment writers who were concerned about issues of attention span, or what they called "wandering attention."

Phillips, who received her PhD in English literature at Stanford in 2010, is now an assistant professor of English at Michigan State University. She said one of the primary goals of the research is to investigate the value of studying literature. Beyond producing good writers and thinkers, she is interested in "how this training engages the brain."

Pioneering in a number of respects, her research is "one of the first fMRI experiments to study how our brains respond to literature," Phillips said, as well as the first to consider "how cognition is shaped not just by what we read, but how we read it."

Critical reading of humanities-oriented texts are recognized for fostering analytical thought, but if such results hold across subjects, Phillips said it would suggest "it's not only what we read – but thinking rigorously about it that's of value, and that literary study provides a truly valuable exercise of people's brains."

Though modern life's cascade of beeps and buzzes certainly prompts a new kind of distraction, Phillips warned against "adopting a kind of historical nostalgia, or assuming those of the 18th century were less distracted than we are today." Many Enlightenment writers, Phillips noted, were concerned about how distracted readers were becoming "amidst the print-overload of 18th-century England."

Rather than seeing the change from the 18th century to today as a historical progression toward increasing distraction, Phillips likes to think of attention in terms of "changing environmental, cultural and cognitive contexts: what someone's used to, what they're trying to pay attention to, where, how, when, for how long, etc."

Ironically, the project was born out of a moment of distraction. While sitting on a discussion panel (which happened to be one of the first on cognitive approaches to literature), Phillips found herself distracted from the talk by the audience's varieties of inattention: "One man was chatting to his neighbor; another person was editing their talk; one guy was looking vaguely out the window; a final had fallen asleep."

The talk inspired Phillips to consider connections between her traditional study of 18th-century literature and a neuroscientific approach to literary analysis. Phillips was especially intrigued by the concept of cognitive flexibility, which she defines as "the ability to focus deeply on one's disciplinary specialty, while also having the capacity to pay attention to many things at once," such as connections between literature, history of mind, philosophy, neuroscience and so on.

Phillips delved into the project during her time as a Mellon Fellow at the Stanford Humanities Center in 2010-11. Her first stop was the Stanford Center for Cognitive and Neurobiological Imaging (CNI).

Samantha Holdsworth, a research scientist specializing in MRI techniques, recalled an early conversation about the project when two scientists were trying to communicate with three literary scholars: "We were all interested, but working at the edge of our capacity just to understand even 10 percent of what each other were saying."

After working through the challenges of disciplinary lingo, the team devised a truly interdisciplinary experiment. Participants read a full chapter from Mansfield Park, which is projected onto a mirror inside an MRI scanner. Together with a verbal cue, color-coding on the text signals participants to move between two styles of attention: reading for pleasure or reading with a heightened attention to literary form.

The use of the fMRI allows for a dynamic picture of blood flow in the brain, "basically, where neurons are firing, and when," said Phillips. Eye-tracking compatible with fMRI shows how people's eyes move as they read. As Phillips explained, the micro-jumps of the eyes "can be aligned with the temporal blood flow to different regions in the brain."

When participants are done with a chapter, they leave the scanner and write a short literary essay on the sections they analyzed closely. The test subjects, all literary PhD candidates from the Bay Area, were chosen because Phillips felt they could easily alternate between close reading and pleasure reading.

After reviewing early scans, neuroscientist Bob Doherty, director of CNI, said he was impressed by "how the right patterns of ink on a page can create vivid mental imagery and instill powerful emotions." Doherty was also surprised to see how "a simple request to the participants to change their literary attention can have such a big impact on the pattern of activity during reading."

The researchers expected to see pleasure centers activating for the relaxed reading and hypothesized that close reading, as a form of heightened attention, would create more neural activity than pleasure reading. If the ongoing analysis continues to support the initial theory, Phillips said, teaching close reading (i.e., attention to literary form) "could serve – quite literally – as a kind of cognitive training, teaching us to modulate our concentration and use new brain regions as we move flexibly between modes of focus."

With the field of literary neuroscience in its infancy, Phillips said this project is helping to demonstrate the potential that neuroscientific tools have to "give us a bigger, richer picture of how our minds engage with art – or, in our case, of the complex experience we know as literary reading."