Reported last month at the American Heart Association’s Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions, the study analyzed data on food intake and body weight collected on residents in Minneapolis-St. Paul over 27 years. Although the original data focused on heart health, the new study looked at what impact added sugar had on participants’ weight during that period.

Added sugar is sugar that is added to processed foods, as well as sweeteners added in home cooking and at the table.

“When it comes to cardiovascular disease and dietary controls, most of the focus has been on fats, but carbohydrates – sugars – are a big component of weight gain and the cardiovascular risk that results,” said Cooper University Hospital cardiologist Kathleen M. Heintz, DO, FACC, a specialist in women and heart disease at the Cooper Heart Institute.

We’re eating more sugar

Among the women in the study, consumption of added sugar rose by 51 percent from 1980-82 to 2000-2002 and then declined somewhat, according to the research. Men followed the same pattern, increasing their intake of added sugar by 38 percent.

The participants’ weight mimicked that fluctuation. When sugar consumption increased, so did the average BMI (body mass index). Added sugars and body weight are increasing concurrently, the study authors reported.

These findings pose a particular threat for women, Dr. Heintz noted.

“As women reach menopause – the average age being 52 – metabolism slows down and causes a weight gain of 1.5 pounds per year for the rest of their lives. It’s mostly abdominal fat – the ‘middle-age spread’ – and the only way to combat this almost inevitable weight gain is to cut back on sugar, and exercise on a regular basis,” Dr. Heintz said.

Increases in weight can have ramifications for your heart health as well as your level of fitness, and result in metabolic syndrome. Metabolic syndrome is a collection of risk factors that increases your chance of developing heart disease, stroke and diabetes. According to a national health survey, more than one in five Americans has metabolic syndrome. The number of people with metabolic syndrome increases with age. It is characterized by a waistline of 40 inches or more for men and 35 inches or more for women (measured across the belly); a blood pressure level of 130/85 or higher (or the use of blood pressure medications); and higher-than-recommended levels of cholesterol, triglycerides, and blood glucose (sugar).

Limit added sugar

According to guidelines set by the American Heart Association (AHA), most women should eat no more than 100 calories of added sugars a day, and most men should consume no more than 150 calories of added sugars a day. That’s about 6 teaspoons of sugar a day for women and 9 teaspoons for men. (The AHA guidelines do not apply to naturally occurring sugars like those found in fruit, vegetables or dairy products.)

For those reading packaging labels, where sugar is listed in grams, 4 grams = 1 teaspoon of sugar. However, packaging labels do not differentiate between added sugars and natural sugars. For instance, one cup of skim milk has 12 grams of sugar, yet no sugar has been “added” to it.

Spotting added sugar on food labels requires a bit of detective work. You have to scan the ingredients list of a food or drink to find the added sugar. (For help, see “Identifying added sugar” below.)

The obvious sources of added sugar can be found in such foods as desserts, but also in such unexpected foods as granola bars, many fruit smoothies, and some trail mixes.

Foods that contain most of the added sugars in American diets are:

• regular soft drinks
• candy
• cakes
• cookies
• pies
• fruit drinks, such as fruitades and fruit punch
• milk-based desserts and products, such as ice cream, sweetened yogurt and sweetened milk
• grain products such as sweet rolls and cinnamon toast

Identifying added sugars

Reading the ingredient label on processed foods can help to identify added sugars. Names for added sugars on food labels include:

• brown sugar
• corn sweetener
• corn syrup
• dextrose
• fructose
• fruit juice concentrates
• glucose
• high-fructose corn syrup
• honey
• invert sugar
• lactose
• maltose
• malt syrup
• molasses
• raw sugar
• sucrose
• sugar
• syrup

Exercise more

To counteract the slowed-down metabolism of menopause, women can take steps to keep both their weight and cardiovascular health in check.

“The good news is, any kind of aerobic exercise may preferentially tap belly fat more so than other forms of exercise,” Dr. Heintz said. Walking, jogging and bicycling, whether outdoors or on a treadmill or stationary bike, all are good forms of aerobic activity. So is swimming.

“To lose weight and burn fat, the aerobic exercise should be performed at an intensity that reaches your target heart rate, which is based on your age, for 30  to 60 minutes a day, five to seven days a week,” Dr. Heintz said.

You can calculate what your target heart rate should be by using this formula: 220 minus your age, times .85. An example for a 55 year-old-woman would be: 220 -55 = 165 x .85 = 140 beats per minute.

“Of course, check with your doctor before beginning any exercise program, and remember to start slow and work up to your target heart rate,” Dr. Heintz said. “Through diet and exercise, women can control their weight and protect their heart,” she said.

About the Cooper Heart Institute

The board-certified cardiologists of the Cooper Heart Institute have seven outpatient locations throughout South Jersey and are dedicated to providing a full range of diagnostic testing and state-of-the-art cardiac treatments.

Related Links

• Cooper Heart Institute

In accordance with the American Dietetic Association, physicians at Cooper University Hospital offer these tips for adults who want to make changes in their lifestyle and move toward a healthier weight in 2010.

Start with a plan

Develop a plan for lifelong health, not just short-term weight loss. Don’t lose sight of the big picture, which is achieving overall good health. By putting more emphasis on your health, experts agree that you can raise your overall self-esteem, resulting in healthful eating, weight loss and improved health.

Set healthful, realistic goals

When you make changes step-by-step and set realistic goals, you are more likely to succeed in reaching them. Start with two or three specific, small changes at a time. Track your progress by keeping a food and activity log. When you’ve turned a healthful change into a habit, reward yourself with a fun activity.

Eat right

Eat at least three meals a day and plan your meals ahead of time. Whether you’re eating at home, packing a lunch or eating out, an overall eating plan for the day will help keep you on track.

Balance your plate with the right portions of a variety of foods. Half your plate should be filled with vegetables; one fourth with lean meat, poultry or fish; and one fourth with grains. To round out your meal, add a glass of fat-free or low-fat milk and a serving of fruit for dessert. Also, try changing from a large dinner plate to a smaller one. It may help you feel satisfied with reduced portions. Start your meal with low-calorie foods like fruits, vegetables and salads, then move on to the main course and side dishes.

Know when you’ve had enough to eat. Quit before you feel full or stuffed. It takes about 20 minutes for your brain to get the message that your body is getting food. When your brain gets this message, you stop feeling hungry. So, don’t eat fast—slow down and give your brain a chance to get the word.

Snack smart

To prevent between-meal hunger, plan for nutritious snacks. Choose snacks by the calories and nutrients they provide. Limit portions to one serving and include them as part of your daily calorie allowance.

Before starting any weight-loss plan, it is recommended that you see your primary care physician. If you need a physician, call 1.800.8.COOPER (800.826.6737) to find a Cooper University Physician at an office near you.

Related Links

• Health eTalk Web Chat: How to Eat Healthy in 2010
• The Healthy Weigh: A Six-Week Program for Weight Management

“If you have eaten too much during the summer, cutting any amount of calories will help you lose weight. Increasing daily activity will also help, starting with a daily 30-minute walk while the weather is still beautiful,” said registered dietitian Angela Shaw, D.T.R., coordinator of “The Healthy Weigh” weight management program offered at Cooper University Hospital’s out-patient locations in Cherry Hill and Voorhees.

Shaw offers these quick tips to help you eat smart and hold down the pounds:

• Eat a breakfast with protein, whole-grain carbohydrates (breads, cereals) and a small amount of fat every day. It will keep you satisfied much longer than had you grabbed a bagel.
• Try not to dine in restaurants more than once a week. Portions are grossly oversized and contain hidden calories. Stock your kitchen with healthful foods and cook at home.
• “Veggie-up” at every meal to add bulk with few calories.
• Serve all sauces and dressings “on the side.” Dip your fork in before every bite instead of dredging the food. Remember: Fat on the lips is fat on the hips!
• Choose “loin” and “round” cuts of beef and pork, and white meat chicken and turkey without skin.
• For calcium and protein, consume only low-fat or fat-free yogurts and cheeses. Drink skim or 1% milk.
• Eat only when you’re hungry and concentrate only on eating. Do not eat in the car, in front of the TV or the computer. This is mindless eating. Sit at a table and enjoy every bite.
• Balance out your splurges with more activity or eating less before those special occasions when you know you’ll be eating more. Make trade-offs!
• Try to stop eating after dinner. Go take a walk instead.
• Increase physical activity any way you can. Wash your car, work in the garden, clean the house. Find a partner and set up walk dates. Exercise is so much more enjoyable with the support of others. Walk while you talk on the cell phone. You can walk anywhere–it’s free and effective. Wear a pedometer to track the number of steps taken each day and set higher goals for yourself. The recommendation for good health is 10,000 steps a day; for weight loss, it’s 12,000 to 15,000 steps a day.
• Beware of party drinking! Those frozen margaritas could contain 300-500 calories each. These are called “empty” calories–no nutritious value. Stick with white wine spritzers or light beer—in moderation, of course.

About “The Healthy Weigh”

“The Healthy Weigh” is Cooper University Hospital’s individualized weight management program featuring a refreshing approach to successful weight reduction and nutritional well-being. Participants learn to identify the personal steps they need to take to achieve and maintain their optimal weight and good health. Also provided is information on foods to lower cholesterol and/or blood pressure and to reduce the risk of heart disease, cancer and diabetes.

The six-week program consists of six evening classes held on consecutive Tuesdays at 1210 Brace Road, in Cherry Hill, and on consecutive Wednesdays at 900 Centennial Boulevard, in Voorhees. The fee for each six-week program is $175. New classes begin on September 15 in Cherry Hill and on September 16 in Voorhees. The Healthy Weigh program is reimbursed by many insurance plans.

To learn how to effectively manage your weight, call (856) 321-0012 for details about “The Healthy Weigh,” Cooper’s weight management program.

Here are some tips from the National Heart, Lung and Blood Institute to help you get started:

Behaviors That Will Help You Lose Weight and Maintain It

Set the Right Goals

Setting the right goals is an important first step. Most people trying to lose weight focus on just that one goal: weight loss. However, the most productive areas to focus on are the dietary and exercise changes that will lead to that long-term weight change. Successful weight managers are those who select two or three goals at a time that they are willing to take on, that meet the following criteria of useful goals:

Effective goals are 1) specific; 2) attainable; and 3) forgiving (less than perfect). “Exercise more” is a commendable ideal, but it’s not specific. “Walk five miles everyday” is specific and measurable, but is it attainable if you’re just starting out? “Walk 30 minutes every day” is more attainable, but what happens if you’re held up at work one day and there’s a thunderstorm during your walking time another day? “Walk 30 minutes, five days each week” is specific, attainable, and forgiving.

Nothing Succeeds Like Success

Shaping is a behavioral technique in which you select a series of short-term goals that get closer and closer to the ultimate goal (e.g., an initial reduction of fat intake from 40% of calories to 35% of calories, and later to 30% of calories). It is based on the concept that “nothing succeeds like success.”

Shaping uses two important behavioral principles: 1) consecutive goals that move you ahead in small steps are the best way to reach a distant point; and 2) consecutive rewards keep the overall effort invigorated.
Success (But Not With Food)

Rewards that you control can be used to encourage attainment of behavioral goals, especially those that have been difficult to reach. An effective reward is something that is desirable, timely, and contingent on meeting your goal. The rewards you administer may be tangible (e. g., a movie or music CD or a payment toward buying a more costly item) or intangible (e. g., an afternoon off from work or just an hour of quiet time away from family). Numerous small rewards, delivered for meeting smaller goals, are more effective than bigger rewards, requiring a long, difficult effort.

Balance Your (Food) Checkbook

Losing weightSelf-monitoring refers to observing and recording some aspect of your behavior, such as calorie intake, servings of fruits and vegetables, exercise sessions, medication usage, etc., or an outcome of these behaviors, such as weight. Self-monitoring of a behavior can be used at times when you’re not sure how you’re doing, and at times when you want the behavior to improve. Self-monitoring of a behavior usually changes the behavior in the desired direction and can produce “real-time” records for review by you and your healthcare provider. For example, keeping a record of your exercise can let you and your provider know quickly how you’re doing, and when the record shows that your exercise is increasing, you’ll be encouraged to keep it up.

Some patients find that specific self-monitoring forms make it easier, while others prefer to use their own recording system. While you may or may not wish to weigh yourself frequently while losing weight, regular monitoring of your weight will be essential to help you maintain your lower weight. When keeping a record of your weight, a graph may be more informative than a list of your weights.

When weighing yourself and keeping a weight graph or table, however, remember that one day’s diet and exercise patterns won’t have a measurable effect on your fat weight the next day. Today’s weight is not a true measure of how well you followed your program yesterday, because your body’s water weight will change much more from day to day than will your fat weight, and water changes are often the result of things that have nothing to do with your weight-management efforts.

Avoid a Chain Reaction

Stimulus (cue) control involves learning what social or environmental cues seem to encourage undesired eating, and then changing those cues. For example, you may learn from reflection or from self-monitoring records that you’re more likely to overeat while watching television, or whenever treats are on display by the office coffee pot, or when around a certain friend. You might then try to sever the association of eating with the cue (don’t eat while watching television), avoid or eliminate the cue (leave coffee room immediately after pouring coffee), or change the circumstances surrounding the cue (plan to meet with friends in non-food settings). In general, visible and accessible food items are often cues for unplanned eating.

Get the (Fullness) Message

Changing the way you go about eating can make it easier to eat less without feeling deprived. It takes 15 or more minutes for your brain to get the message you’ve been fed. Slowing the rate of eating can allow satiety (fullness) signals to begin to develop by the end of the meal. Eating lots of vegetables can also make you feel fuller. Another trick is to use smaller plates so that moderate portions do not appear meager. Changing your eating schedule, or setting one, can be helpful, especially if you tend to skip, or delay, meals and overeat later.

In accordance with the American Dietetic Association, Cooper physicians offer these dietary guidelines that can help pave the way for a healthier, happier you. Just be sure to stay within your daily calorie needs to enjoy the benefits of balanced nutrition every day..
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A healthy eating plan

• Emphasizes fruits, vegetables, whole grains and fat-free or low-fat milk and dairy products.
• Includes lean meats, poultry, fish, beans, eggs and nuts.
• Is low in saturated fats, trans fats, cholesterol, salt (sodium) and added sugars.

To get the most nutrition out of your calories, choose the most nutritionally rich foods from each food group each day—those packed with vitamins, minerals, fiber and other nutrients but lower in calories.

• Focus on fruits. Eat a variety of fruits—fresh, frozen, canned or dried. For a 2,000-calorie diet, you need 2 cups of fruit each day.
• Vary your vegetables. Eat more orange and dark green vegetables, such as carrots, sweet potatoes, broccoli and dark leafy greens. Include beans and peas, such as pinto beans, kidney beans, split peas and lentils more often.
• Get calcium-rich foods. Have 3 cups of low-fat or fat-free milk—or an equivalent amount of low-fat yogurt and/or low-fat cheese every day (1 ½ ounces of cheese equals 1 cup of milk). If you don’t or can’t consume milk, choose lactose-free milk products and/or calcium-fortified foods and beverages.
• Make half your grains whole. Eat at least 3 ounces of whole-grain cereals, breads, crackers, rice or pasta every day. Look to see that grains such as wheat, rice, oats or corn are referred to as “whole” in the list of ingredients.
• Go lean with protein. Choose lean meats and poultry. Bake it, broil it or grill it.
• Vary your protein. Include more fish, beans, peas, nuts and seeds.
• Know the limits on fats, salt and sugars. Read the Nutrition Facts label on foods. Look for foods low in saturated fats and trans fats. Choose and prepare foods and beverages with little salt (sodium) and/or added sugars.

Published in the August issue of the research journal Obesity, the study showed that people on calorie-restricted diets or daily exercise programs ate more on Saturdays and exercised less on Sundays, resulting in a net weekly weight gain of almost nine pounds a year.

Compared to weekday weight loss, the higher dietary intake on weekends caused the dieters to stop losing weight on weekends, while the lowered-activity exercisers gained weight on weekends. These findings provide one explanation for the relatively slow rates of weight loss observed in many studies, as well as the difficulty with maintaining significant weight loss, the researchers said.

“Remember, little changes can mean a lot when you’re dieting,” said registered dietitian Angela Shaw, D.T.R., coordinator of “The Healthy Weigh” weight management program offered at Cooper University Hospital locations throughout South Jersey.

“To lose a pound a week, you have to cut and/or burn 3,500 calories from your diet per week. If you make a habit of treating yourself on Saturdays to a Burger King lunch of a Double Whopper with Cheese, a large chocolate shake and fries, that one meal is costing you 2,550 calories. If you add the Dutch Apple Pie for dessert and an eight-ounce bag of salted potato chips while you’re watching TV that night, you’ve taken in 4,067 calories—that’s almost 600 calories more than the 3,500 calories you needed to cut from your diet that week in order to lose one pound,” Shaw said.

“If you’re going to splurge on the weekends,” Shaw added, “make sure you increase your activity. Remember, it’s calories in, calories out. Take advantage of your weekend time off and go outside for a walk,” she said.

Also, Shaw suggests taking steps to balance and moderate your weekend splurges by having a game plan before you dine out. “For instance, when you know you’re going to have a Martini before dinner, you can plan to skip the appetizer or the dessert,” Shaw said.

About The Healthy Weigh
“The Healthy Weigh” is Cooper University Hospital’s individualized weight management program featuring a refreshing approach to successful weight reduction and nutritional well-being. Participants learn to identify the personal steps they need to take to achieve and maintain their optimal weight and good health. Information on foods to lower cholesterol and/or blood pressure and to reduce the risk of heart disease, cancer and diabetes also is provided.