Meeting News

Providers crucial to debunking obesity, ‘junk food’ myths

Roxanne B. Sukol

ORLANDO — As the obesity epidemic continues to grow in the United States, it is critical that health care providers confront patient misconceptions about the causes of obesity and how the surplus of “nutritionally-bankrupt food” has contributed to a rise in such chronic diseases, according to a presentation at the Rheumatology Nurses Society Annual Conference.

Obesity has changed the way we practice,” Roxanne B. Sukol, MD, MS, an internal medicine physician at the Cleveland Clinic, told attendees. “It doesn’t matter if it is orthopedics, obstetrics, pulmonology, pediatrics, rheumatology or rehabilitation – we are all overwhelmed and we just don’t know where to start.”

She added that “most Americans are operating under a fundamental misconception that obesity is caused by overindulgence – if that were true, then diets would work. In actuality, obesity is a malnourished state and when patients improve the nutritional value of the food they are eating, their clothes start to fit better.”

Sukol noted that food itself can be high in calories or low in calories, but are nonetheless always high in nutrients. However, food items that typically have a prefix word – processed food, junk food, fast food – are paradoxically high in calories but nutritionally “bankrupt.”

“If someone has to tell you it’s food, it’s not,” Sukol said.

Beneficial food items that are high in calories include olive oil, avocado, nuts, seeds and dark chocolates, and valuable low-calorie foods include beans, spinach, raspberries and broccoli.

“Virtually all of these [low-calorie] items come with a fiber matrix,” Sukol said. “We used to think that fiber was a placeholder, but now we understand that it is actually nourishing some of the cells in the gut.”

According to Sukol, there is another entire other food category widely available in the U.S. – which is high in calories, low in nutrients – comprised almost entirely of ‘stripped grains’ that have been stripped of their fiber and phytonutrients.

“There is a reason that a pile of white flour looks exactly like a pile of cornstarch and a pile of powdered sugar: We have removed the original identity of these foods and all that is left is a pile of white powder,” Sukol said. “And what happens when you eat a pile of white powder? It spikes your insulin. This is the central problem that we need to focus on to address the epidemic of chronic diseases in this country.”

Sukol noted that insulin is a fat storage hormone that tends to store fat in the abdominal area “because that’s where the gut is and where all the action is happening.” Contrary to the multitude of popular diet trends, Sukol doesn’t care about how much her patients weigh.

“We don’t have any control over what we weigh so having weight as a goal can be extremely self-defeating,” she said. “Our actual goal should be to lower our insulin levels, and we get hundreds of choices every single day about whether to do something that lowers your insulin or something requires a ton of insulin.”

Conveying these principles of appropriate food choices and managing insulin levels to patients can be daunting, especially with widespread misunderstanding of what drives obesity. When discussing this concept with her patients, Sukol uses this analogy: “Imagine you were invited to huge party and that party starts at 7 p.m. exactly. At 7, one thousand cars show up – they are going to need a lot of valet staff to park all those cars. But, what if the party was, instead, an open house? Say 3 p.m. to 9 p.m.? At the end of the day, the valet still parked one thousand cars but you wouldn’t have needed nearly as many valet staff to do it.”

“The sugar is the cars, the insulin is the valet staff – if all of your sugar shows up all at once, you are going to need a ton of insulin to catch all that sugar and ‘park’ it,” Sukol said. “However, if you eat a bowl of guacamole, salmon or Brussels sprouts, then you will only need a little insulin to catch all that sugar, because it will only be a little and it will come in slowly. The goal is to shift our diet in the direction of more slowly-absorbed foods and to eat fewer quickly-absorbed foods.” – by Robert Stott

Reference:
Sukol RB. The impact of diet and nutrition on the inflammatory process. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 7-10, 2019; Orlando.

Disclosure: Sukol reports no relevant financial disclosures.

Roxanne B. Sukol

ORLANDO — As the obesity epidemic continues to grow in the United States, it is critical that health care providers confront patient misconceptions about the causes of obesity and how the surplus of “nutritionally-bankrupt food” has contributed to a rise in such chronic diseases, according to a presentation at the Rheumatology Nurses Society Annual Conference.

Obesity has changed the way we practice,” Roxanne B. Sukol, MD, MS, an internal medicine physician at the Cleveland Clinic, told attendees. “It doesn’t matter if it is orthopedics, obstetrics, pulmonology, pediatrics, rheumatology or rehabilitation – we are all overwhelmed and we just don’t know where to start.”

She added that “most Americans are operating under a fundamental misconception that obesity is caused by overindulgence – if that were true, then diets would work. In actuality, obesity is a malnourished state and when patients improve the nutritional value of the food they are eating, their clothes start to fit better.”

Sukol noted that food itself can be high in calories or low in calories, but are nonetheless always high in nutrients. However, food items that typically have a prefix word – processed food, junk food, fast food – are paradoxically high in calories but nutritionally “bankrupt.”

“If someone has to tell you it’s food, it’s not,” Sukol said.

Beneficial food items that are high in calories include olive oil, avocado, nuts, seeds and dark chocolates, and valuable low-calorie foods include beans, spinach, raspberries and broccoli.

“Virtually all of these [low-calorie] items come with a fiber matrix,” Sukol said. “We used to think that fiber was a placeholder, but now we understand that it is actually nourishing some of the cells in the gut.”

According to Sukol, there is another entire other food category widely available in the U.S. – which is high in calories, low in nutrients – comprised almost entirely of ‘stripped grains’ that have been stripped of their fiber and phytonutrients.

“There is a reason that a pile of white flour looks exactly like a pile of cornstarch and a pile of powdered sugar: We have removed the original identity of these foods and all that is left is a pile of white powder,” Sukol said. “And what happens when you eat a pile of white powder? It spikes your insulin. This is the central problem that we need to focus on to address the epidemic of chronic diseases in this country.”

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Sukol noted that insulin is a fat storage hormone that tends to store fat in the abdominal area “because that’s where the gut is and where all the action is happening.” Contrary to the multitude of popular diet trends, Sukol doesn’t care about how much her patients weigh.

“We don’t have any control over what we weigh so having weight as a goal can be extremely self-defeating,” she said. “Our actual goal should be to lower our insulin levels, and we get hundreds of choices every single day about whether to do something that lowers your insulin or something requires a ton of insulin.”

Conveying these principles of appropriate food choices and managing insulin levels to patients can be daunting, especially with widespread misunderstanding of what drives obesity. When discussing this concept with her patients, Sukol uses this analogy: “Imagine you were invited to huge party and that party starts at 7 p.m. exactly. At 7, one thousand cars show up – they are going to need a lot of valet staff to park all those cars. But, what if the party was, instead, an open house? Say 3 p.m. to 9 p.m.? At the end of the day, the valet still parked one thousand cars but you wouldn’t have needed nearly as many valet staff to do it.”

“The sugar is the cars, the insulin is the valet staff – if all of your sugar shows up all at once, you are going to need a ton of insulin to catch all that sugar and ‘park’ it,” Sukol said. “However, if you eat a bowl of guacamole, salmon or Brussels sprouts, then you will only need a little insulin to catch all that sugar, because it will only be a little and it will come in slowly. The goal is to shift our diet in the direction of more slowly-absorbed foods and to eat fewer quickly-absorbed foods.” – by Robert Stott

Reference:
Sukol RB. The impact of diet and nutrition on the inflammatory process. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 7-10, 2019; Orlando.

Disclosure: Sukol reports no relevant financial disclosures.

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