In Her Own Right The Institute of Medicine's Guide to Women's Health Issues (1997) / Chapter Skim
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7 Eating for a Healthy Life
7 Eating for a Healthy Life
Pages 119-150
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From page 119... ...
But in a lifetime spent concentrating on cooking and eating; in decade upon decade of perusing articles and clipping recipes from magazines and newspapers, of seeking nutritional counsel from obstetricians and pediatricians, of studying labels and assessing produce in supermarkets, of fretting about unwanted pounds, of helping a mate cut back on fat or salt or caffeine, of sharing kitchen tips with friends, and, often, of putting three squares (or at least one or two) on the table nearly every day of the year, many an American woman neglects to find out how best to eat for her own health.
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From page 120... ...
The monthly menstrual flow taxes their stores of iron. Pregnancy and lactation place immense burdens on both women's bodies and their ability to consume the nutrients they need to create and nourish a new life without depleting the nutritional stores they need to maintain their own health.
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From page 121... ...
Otherwise, the neighborhood grocery can provide virtually all the nourishment necessary for health. To face the special challenges of female life, and to reduce their risk of chronic disease, experts advise American women to follow the 121
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From page 122... ...
The committee believes that a varied diet low in fat; high in grains, vegetables, and fruits; and moderate in protein, salt, and sweets will provide the building blocks of health for every age beyond infancy and very early childhood. To cut the excessive fat typical of American meals, the ancient concept of "our daily bread" ought once again to form the foundation of our food choices, with complex carbohydrates like pastas, cereals, and whole grain breads accounting for our largest single food category.
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From page 123... ...
Limit the use of salt in cooking and avoid adding it to food at the table. Salty foods, including highly processed salty foods, salt-preserved foods, and salt-pickled foods, should be eaten sparingly, if at all.
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From page 124... ...
Many cultures prescribe special eating patterns during such nutritionally sensitive -- yet spiritually or socially powerful -- periods as menstruation, pregnancy, and nursing, whether to protect the community at large from the spiritual danger of menstrual blood or to ensure a healthy 124
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From page 125... ...
Curves were the fashion; men hankered after a shapely "broad" who met that description in various strategic locations. But the prepubescent contours of today's top fashion models and film stars contrast startlingly with the amplitude of erstwhile sex goddesses like Marilyn Monroe and Sofia Loren, not to mention the "sweater girls" and pinups who tantalized GIs during the 1940s.
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From page 126... ...
As only about half of Army women studied exercise three or more times a week, diet appears their main method of weight control. Many soldiers get most or all of their food through Army rations, which, in their various freshly cooked, "pre-plated," and freezedried versions, are designed to provide the Military Recommended Daily Allowances.
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From page 127... ...
And though some of this worry, especially among the young, involves frivolous concerns about appearance, much of it, especially as women age, involves far more serious considerations of health. Obesity has in fact been described as "the single most prevalent nutrition problem in the United States."14 A WEIGHTY PROBLEM "Life in the United States is conducive to obesity," is a truth obvious not only to the obesity committee, but also to anyone who examines the statistics showing that Americans are fatter and heavier than ever before.15 According to some counts, fully 35% of women and 31% of men older than 20 fall into the category of obese.16 But while all authorities agree that excessive heft carries significant health hazards, not everyone agrees on how to define it.
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From page 128... ...
"For practical purposes, however," concludes the committee, "most overweight people are also obese."17 But, as if to exemplify the general interchangeability of the terms, the committee itself chooses to use the term "obesity" "consistently in referring to the condition of excess body weight."18 If defining the word requires precision, deciding exactly whom it applies to involves even finer distinctions and sometimes complicated methodology. The several available methods for gauging body fat, which include underwater weighing, measuring the thickness of skin folds, using dual-energy X-ray absorptiometry, and sending a tiny electric current through a person's body for bioelectric impedance analysis often require skilled examiners using sophisticated equipment.
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From page 129... ...
and Body Mass Index Body Mass Index 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 Height Body Weight 58 91 95 100 105 110 114 119 124 129 133 138 143 148 152 157 162 59 94 99 104 109 114 119 124 129 134 139 144 149 154 159 164 169 60 97 102 107 112 117 122 127 132 138 143 148 153 158 163 168 173 61 101 106 111 117 122 127 132 138 143 148 154 159 164 169 175 180 CHAPTER 7 62 103 109 114 120 125 130 136 141 147 152 158 163 168 174 179 185 63 107 113 119 124 130 135 141 147 152 158 164 169 175 181 186 192 64 111 117 123 129 135 141 146 152 158 164 170 176 182 187 193 199 129 65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 66 118 124 131 137 143 149 156 162 168 174 180 187 193 199 205 212 67 121 127 134 140 147 153 159 166 172 178 185 191 198 204 210 217 68 125 132 139 145 152 158 165 172 178 185 191 198 205 211 218 224 69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 70 133 140 147 154 161 168 175 182 189 196 203 210 217 224 231 237 Eating for a Healthy Life 71 136 143 150 157 164 171 179 186 193 200 207 214 221 229 236 243 72 140 148 155 162 170 177 185 192 199 207 214 221 229 236 244 251 73 143 151 158 166 174 181 189 196 204 211 219 226 234 241 249 257 74 148 156 164 171 179 187 195 203 210 218 226 234 242 249 257 265 75 151 159 167 175 183 191 199 207 215 223 231 239 247 255 263 271 76 156 164 172 181 189 197 205 214 222 230 238 246 255 263 271 279 continued on next page
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From page 130... ...
TABLE 7-2 Continued Body Mass Index 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Height Body Weight 58 167 172 176 181 186 191 195 200 205 210 214 219 224 229 233 238 59 174 179 184 188 193 198 203 208 213 218 223 228 233 238 243 248 60 178 183 188 194 199 204 209 214 219 224 229 234 239 244 250 255 I N 61 185 191 196 201 207 212 217 222 228 233 238 244 249 254 260 265 62 190 196 201 206 212 217 223 228 234 239 245 250 255 261 266 272 H 63 198 203 209 214 220 226 231 237 243 248 254 260 265 271 277 282 E R 64 205 211 217 223 228 234 240 246 252 258 264 269 275 281 287 293 O 65 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 130 W N 66 218 224 230 236 243 249 255 261 268 274 280 286 292 299 305 311 R 67 223 229 236 242 248 255 261 268 274 280 287 293 299 306 312 319 68 231 238 244 251 257 264 271 277 284 290 297 304 310 317 323 330 I G H T 69 236 243 250 257 263 270 277 284 290 297 304 311 317 324 331 338 70 244 251 258 265 272 279 286 293 300 307 314 321 328 335 342 349 71 250 257 264 271 279 286 293 300 307 314 321 329 336 343 350 357 72 258 266 273 281 288 295 303 313 317 325 332 340 347 354 362 369 73 264 272 279 287 294 302 309 317 324 332 340 347 355 362 370 377 74 273 281 288 296 304 312 319 327 335 343 351 358 366 374 382 390 75 279 287 294 302 310 318 326 334 342 350 358 366 374 382 390 398 76 287 296 304 312 320 328 337 345 353 361 370 378 386 394 402 411 SOURCE: Institute of Medicine, Weighing the Options: Criteria for Evaluating Weight-Management Programs, 1995, Table 2-1, pp.
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From page 131... ...
Only 29% of Americans who have been to college are overweight, as opposed to 36% of the high school graduates and 39% of those with less than a high school diploma.26 Indeed, some studies suggest that African American and white women hold somewhat different views about weight, with African American women less concerned about being thin. The added stress of lower-class life could also make weight loss more difficult, 131
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From page 132... ...
Health-care providers or counselors can offer only advice and technical support at this time," the obesity committee notes.28 132
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From page 133... ...
"Perhaps most laypersons, health-care providers, and even obese individuals themselves do not perceive the metabolic nature of the disease and thus view obesity as a problem of willful misconduct -- eating too much and exercising too little." Two out of three family doctors surveyed, for example, thought that obese people "lack self-control," and more than a third believed them "lazy." Third-year medical students expressed similar views, finding them "unpleasant, worthless, and bad."30 Clearly, though, it is our lack of knowledge about the condition's roots rather than the individuals struggling to overcome it that should be criticized. An obese person trying to control her weight faces "a continuous, lifelong struggle with no expectation that the struggle required will diminish with time," the committee believes.
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From page 134... ...
between the early decades of the last century and the middle of this.32 MOTHERS OF RETENTION This close and specifically female tie between fat and fertility lies at the root of what many women consider their basic weight problem, the time they spent bearing and nursing their children. Nutrition and weight become literally vital issues during pregnancy.
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From page 135... ...
Until the early twentieth century, therefore, doctors seeking easier and safer deliveries restricted the mother's diet to keep the fetal weight down. The first published study on the subject, appearing in 1901, in fact noted that limiting a pregnant woman's intake could drop her baby's birth weight by 400 to 500 grams.34 By the 1920s, however, with medical care and maternal survival improving, doctors began to consider that the mother's weight gain also related to the baby's growth, indeed, that her weight gain could serve to indicate her -- and, presumably, the baby's -- state of nutrition.
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From page 136... ...
For example, African Americans need to gain more than whites on average to bear babies of the same weight, and girls who become pregnant within a year or two of menarche need to gain more than girls who are older. Obese women, on the other hand, might do well to gain less because they have higher rates of complicated births and infant mortality than women of normal weight or below.40 Weight gain depends largely on how much a woman eats.
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From page 137... ...
Particular attention should go to "screening for women who may have problems relating to their lifestyle."44 These include smoking, drug abuse, previous extreme dieting for weight loss, multiple pregnancies, and pica, the practice of eating nonfood substances such as laundry 137
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From page 138... ...
Twice as many married mothers as unmarried breastfeed, nearly twice as many whites as African Americans, and nearly twice as many residents of the mountain and West Coast states as of the Southeast. (See Figures 7-1 and 7-2.)
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From page 139... ...
CHAPTER 7 139 Eating for a Healthy Life FIGURE 7-1 Breastfeeding initiation rates, by census region and ethnic background (W: white, B: black, and H: Hispanic)
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From page 140... ...
I N H E R O 140 W N R I G H T FIGURE 7-2 Breastfeeding rates at 5–6 months postpartum, by census region and ethnic background (W: white, B: black, and H: Hispanic)
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From page 141... ...
Because research has concentrated overwhelmingly on the supply and composition of the milk -- in other words, on the baby's needs rather than the mother's experience -- "the nutritional status of lactating women has not been thoroughly or extensively studied," the lactation subcommittee notes.47 It does appear that well-nourished American women generally have no difficulty providing their babies ample nutrition. Nursing demands about 640 calories per day, more than twice the 300 needed each day to support the last six months of pregnancy.48 A daily 2,700 calories rich in sources of calcium, protein, vitamins, and minerals appears to supply essentially all the nutrients a woman needs both to nourish her baby and to sustain or replenish her own body's stores of nutrients, with the possible exception of calcium and zinc.
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From page 142... ...
And studies have found higher bone mass among postmenopausal white women who had nursed than among those who had not. But the evidence about a possible relationship between the vital female function of nourishing one's children and one of the most prevalent feminine diseases of later life remains, in the subcommittee's words, "inconclusive."53 The other big reproductive question weighing, as it were, on women's minds is the connection between pregnancy, lactation, and obe 142
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From page 143... ...
Thus, staying at the low end of the recommended weight gain range in each pregnancy might save her five or more retained pounds. Deciding to breastfeed will also help her get back to where she started, especially if she watches her calories during the time she nurses.56 THE LATER YEARS What she ate and did in earlier decades has obviously already said a good deal about a woman's health before she passes into the last 143
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From page 144... ...
"And there is where I think the nutrition and health nexus is particularly important."57 Though an older woman can no longer affect the maximum mineral density of her bones, she can do a good deal to preserve the bone mass she has. In addition to calcium, vitamin D appears crucial to the state of the older skeleton, although blood levels of the vitamin tend to drop with age.
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From page 145... ...
Regardless of how they go about it, though, whether they join a support group or enroll in a commercial plan, whether they buy special foods or count their calories or fat grams, most Americans experience results that are, in the words of Judith Stern, Sc.D., professor of Nutrition at the University of California at Davis, "quite dismal." Even among those enrolling in obesity treatment programs, most "really don't lose significant weight permanently." According to one classic study, "about a third won't lose any weight, a third will lose significant amounts of weight, and a third will drop out." And over a period of years, even the big losers regain much or all of their hard-lost flab.60 That's because, even more dishearteningly, "based on scientific evidence, it appears that some obese people, when they reduce their weight, are not made normal by weight reduction."61 They may, for example, have started out with more fat cells than thinner individuals. For them, losing weight merely reduces the size but not the number of "these cells waiting to be filled up" again, Stern notes.
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From page 146... ...
"In this country, where successful weight management has proven an elusive goal for most obese individuals, the marketplace has provided many legitimate, as well as unfounded, products and services," the obesity committee warns. The latter operators "play legal tag with government regulatory agencies while taking financial advantage of a public desperate for answers.
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From page 147... ...
The details of each individual's private system -- counting calories, cutting out certain categories of foods, keeping track of fats, adopting bits and pieces of various commercial methods -- seem less important, Stern believes, than the fact that "it was the individual who took responsibility for the weight loss program, not the health care worker."66 Personal motivation and values are clearly central to successful diet control. In the Women's Health Trial, a precursor to WHI, women inspired by the possibility of reducing their known high risk for breast cancer succeeded in dropping their fat intake to a mere 20% of total calories -- about half of the average American level -- for an impressive 24 months.
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From page 148... ...
For those whom overweight threatens to harm, the obesity committee advises the goal of weight management, which, in contrast to mere weight loss, judges eating and other habits "more by their effects on the overall health of participants than by their effects on weight alone."71 If every woman in America adopted this attitude, and the eating pattern it implies, if we could break the tyranny of thinness and refocus on physical and mental well-being, then young girls would not starve themselves in the cause of fashion, mothers and babies would receive the nutrition they need, and the rates of chronic diseases in the later years would fall. By "eating for life" rather than for appearance's sake, women can not only lengthen their lives but enrich them.
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From page 149... ...
CHAPTER 7 Eating for a Healthy Life NOTES 1. Barrett-Connor (1991)
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From page 150... ...
52. Eat for Life: The Food and Nutrition Board's Guide for Reducing Your Risk of Chronic Disease, 21.
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