Obesity

Sugar and High Fructose Corn Syrup

Sugar (actually anything that tastes sweet) releases dopamine to pleasure centers in the brain. These are the same centers that get activated by things like cocaine, heroin, methamphetamine and alcohol. Anything that activates the pleasure centers has the potential to be addictive. Most experts agree that sugar (and high fructose corn syrup, which tastes even sweeter) are addictive. Here is a link to an article from Healthline.org that gives further information about the addictiveness of sugar: Is Sugar an Addictive Drug?

Our hunter gatherer ancestors did not have to worry about addiction, because things that tasted sweet were rare and seasonal. In our society, sweet tasting food is everywhere and easily available. That, of course, is a recipe for addiction.

Sucrose and fructose

The vast majority of the sweetener that is added to processed foods (or that we add on purpose) is either sugar (sucrose) or high fructose corn syrup. Sucrose is also what makes honey and maple syrup taste sweet. High fructose corn syrup tastes sweeter than sucrose and is also considerably cheaper. That is why it is so prevalent in processed foods.

Americans eat an average of 37 pounds per person per year of high fructose corn syrup and 52 pounds of sugar per person per year. This is a huge health problem as I will outline below.

Sucrose is broken down in the body to glucose and fructose. Glucose is used as fuel for the body and especially the brain. If we take in more glucose than we need immediately for fuel the excess gets stored. Some is stored in the liver as glycogen. Glycogen gives us a ready energy source and is easily converted back to glucose. Any extra glucose is used to make triglycerides, which are then stored as fat. It is much harder to mobilize fat from storage.

Fructose is a much bigger problem. Fructose can only be broken down in the liver. Fructose is found in small quantities in fresh fruits, but eating sugar and/or especially high fructose corn syrup produces more fructose than the liver can handle. This excess fructose causes fat deposits in the liver (called fatty liver disease). The medical term is NAFLD (non alcoholic fatty liver disease). More than 25% of the population in the United States has NAFLD. The excess fat in the liver causes inflammation and twenty to thirty percent of people with NAFLD progress to something called NASH (non alcoholic steatohepatitis). Between five and twelve percent of people with NASH progress to cirrhosis of the liver. NASH is now a much more common cause of cirrhosis of the liver than alcoholism! Even more disturbing is that 2.6% of people with cirrhosis from NASH develop cancer of the liver.

Lets do a little math. If we randomly choose 1000 adults in the United States, 250 of them will have fatty liver (NAFLD). That is one in every four people. Of that 250, 75 will develop inflammation of the liver (NASH). Of that 75, 9 will develop cirrhosis of the liver. Think about those numbers for a minute. Eating foods with added sugar or especially high fructose corn syrup causes cirrhosis of the liver in 9 out of every thousand adults in the United States. If we choose a hundred people with cirrhosis from NASH, three of them will get liver cancer. That is a huge burden of disease! If you want to read more, here is a link to the NIH: How high fructose intake may trigger fatty liver disease

How to avoid high fructose corn syrup

You should look at the labels of everything you buy in the grocery store or convenience store. Foods that contain high fructose corn syrup have to list it on the label. You would be surprised at the number of foods that have high fructose corn syrup added. Here is a link to a web page that lists 23 different foods that often have high fructose corn syrup added: 23 Surprising Foods That Contain High Fructose Corn Syrup. If you stay away from the middle aisles in the grocery store as much as you can, then you will avoid most of these foods. I would strongly suggest that you not buy anything that contains high fructose corn syrup.

What about sugar, honey and maple syrup?

Sugar, honey and maple syrup are all sweet because they are or contain sucrose. Once again, the operative word is moderation. It is not going to damage your health to have an occasional cookie, piece of cake, piece of pie or small bowl of ice cream. It should be less than once a week, though. You have to be vigilant not to buy food that has ”stealth” sweeteners added. Soft drinks are the worst. Mountain Dew, for example has 46 grams of sugar per can. It is best to avoid soft drinks altogether. For other grocery items I can’t emphasize enough to read the labels.

Bottom Line

Sugar and high fructose corn syrup are addictive. In excess both of them are toxic to the liver and can lead to cirrhosis of the liver and liver cancer. They also make people fatter with all the health risks of obesity. Read the labels when you grocery shop and avoid foods containing high fructose corn syrup. Limit foods containing sugar, honey or maple syrup to less than once a week.

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Good Nutrition: A Review of the Evidence

The previous post was about how to change your food environment so that you automatically eat fewer calories. This post is the first of several to discuss the evidence (or lack thereof) about what constitutes a healthy diet. Before I get to that though, I discovered a newer book by Brian Wansink, the author of Mindless Eating that I discussed in the last post. This one was published in 2014 and is called Slim by Design. Mindless Eating Solutions for Everyday Life. It is also very much worth reading.

What kinds of foods are healthy?

There is so much conflicting information about what makes for a healthy diet that it’s enough to make you crazy. It comes from books, web pages, newspaper articles and any other media you can name.

I think the most succinct description of a healthy diet comes from the journalist and author Michael Poulin: ”Eat food (food is anything your grandmother would have recognized as food), mostly plants, not too much.” That is excellent advice but I will expand on that short definition to give you something a little more useful.

Mediterranean Diet

The mediterranean diet has been the subject of more research than any other way of eating. It is the traditional diet of southern Italy. It has been shown to reduce the risk of heart disease, stroke and dementia. The mediterranean diet consists of very little meat and sweets. Fish is a bigger part of the diet as well as lots of fruits and vegetables, and whole grains including bread and pasta. The main fat is olive oil, Most descriptions of the diet include red wine, but that is controversial. I will talk about alcohol intake later. Here is a link to the OldWays version of the mediterranean diet food pyramid.

For most Americans, this would be a very big change, not a small one. If you want to adopt the mediterranean diet whole hog, more power to you. It clearly is a very healthy diet and has the most research supporting it. Remember however that whatever you do needs to be a permanent change in the way you eat. If this is a big change from the way you eat now, that kind of big change may not be sustainable for you.

Unprocessed foods

If the mediterranean diet is too much of a stretch for you, you could work toward buying and preparing unprocessed (or minimally processed) foods. Unprocessed foods include fresh fruits, fresh vegetables and fresh or frozen meat, poultry or fish. Frozen or canned fruits and vegetables count as minimally processed foods as long as nothing else (like sugar, preservatives or other food additives) has been added to them. Oils are processed foods, but vegetable oils, particularly olive oil have significant health benefits. There is good evidence that eating predominantly unprocessed foods does not lead to obesity and diabetes. They also decrease risk of heart disease and stroke. Here is an article from Healthline.com that summarizes the health benefits of unprocessed foods: 21 Reason to Eat Real Food.

By definition many unprocessed foods (other than fresh fruit and some vegetables) require more food preparation and cooking. For those of you who have busy lives with jobs to go to and children to care for, taking more time to prepare food may sound impossible. On the other hand, what is more important than your own health and especially that of your children? There are shortcuts to healthy food preparation. I’m sure most of you know many of them but food preparation shortcuts will be the subject of another post.

Processed and highly processed foods

Processed foods contain sugar, sometimes fats, preservatives, emulsifiers, artificial colors, thickeners, etc. Sugars go by many different names. If anything on the label ends in the letters ose, then that means that sugar has been added. Honey and maple syrup also contain sugar (more about sugar in the next post). Although all of the food additives have been approved by the FDA, that does not mean that many of them have had adequate testing in humans. We have no idea whether many of these additives are safe. Sixty per cent of them have no research showing they are safe in humans. Here is a link to an article from Healthychildren.org that discusses the effect of food additives on children: Additives: What Parents Should Know.

Food additives have to be listed on the food label. A good rule of thumb is that if the label has two things on it that you don’t recognize, don’t buy it!

Fat

I’m sure that you have heard fat is bad for you, especially saturated fat. I’m sure you have also heard that fat has more calories per gram than carbohydrates (9 calories per gram of fat versus 5 calories per gram of carbohydrates) and that eating fat will make you fat. The real story is a lot more complicated.

Eating fat stimulates very little insulin release and release of insulin makes you hungry. Eating fat makes you feel more full and therefore less hungry. That is a good part of the reason that the old Atkins diet worked. If you eat lots of fat, you actually eat less calories because you are not as hungry.

Saturated fats

While it is true that eating lots of saturated fat (animal fat and coconut oil) increases your risk of heart disease and stroke, eating modest amounts increases your risk very little if at all. You can have your bacon and eggs once or twice a week and your steak or pork chop occasionally and be just fine. Grass fed beef has healthier fat content than grain fed beef. Moderation is the key here. Most Americans eat far too much beef and pork. Americans eat 82 pounds of beef per person per year and 66 pounds of pork per person per year! Remember the mediterranean diet food pyramid? Beef and pork are at the top of the pyramid, so that means you should eat those the least. By the way, using a little butter is fine.

Unsaturated fats

Extra virgin olive oil is the healthiest choice and actually tends to lower blood cholesterol values. Extra virgin olive oil is not processed and is the best olive oil to use. It has a low smoke point, so is not good for cooking at high heat. Avocado oil and peanut oil have high smoke points and are great for things like stir fry. Most vegetable oils on the market are a blend of canola, corn, soybean, safflower, palm and sunflower oils. These tend to be highly processed and are not as good for you. You are better off using extra virgin olive oil, avocado oil and/or peanut oil.

Trans fats

Trans fats are partially hydrogenated vegetable oils. They include things like margarine and Crisco. The food industry developed these so they would be solid at room temperature. They were initially thought to be healthier than butter and lard, but research has shown that they cause more cardiovascular disease than saturated fats. They should be avoided entirely.

Fish

Eating fish, particularly oily ocean fish, is very good for you. It significantly lowers the risk of cardiovascular disease and stroke. Unfortunately most of these fish are top predators, which means that mercury contamination does exist. Pregnant women and children have to be a little careful about how much fish and which fish they eat. The levels are too low in most fish to affect non pregnant adults. Here is a link to a chart from the FDA that is very helpful in deciding which fish to eat and which to avoid: Advice About Eating Fish.

Poultry

Broiled or baked chicken or turkey is healthier than beef or pork, but there are some caveats. A lot of chickens and turkeys are raised on factory farms. They are given hormones and low doses of antibiotics to make them grow faster. The practice of giving low dose antibiotics to livestock markedly increases bacteria that are resistant to most antibiotics and that infect humans. When you buy chicken or turkey check the label to make sure antibiotics and hormones were not used in their growth.

Free range on the label does not mean much. Factory farms leave open a chicken house door into small fenced in spaces. The chickens are ”free” to go outside, but none of them do. Organic chicken from a farmer’s market is a much healthier and environmentally safe option. The same goes for eggs. If you can buy fresh eggs from a farmer it will be better for you and for the environment.

Bottom Line

Fresh or frozen fruits and vegetables, seeds, nuts and whole grains should make up the majority of what you eat daily. Use olive oil, avocado oil and peanut oil as your primary sources of fat. It is ideal to eat fish at least once or twice a week. Beef, pork and sweets should be the smallest amount of what you eat, no more than once or twice a week. Chicken and turkey are good for you, but check the labels to make sure they have not been raised with antibiotics and hormones. Get organic chicken and eggs from farmers markets if you can.

The Psychology of Eating and How to Use It to Your Advantage

We eat according to internal cues. We eat when we are hungry and stop when we are full. Both of these statements are false! Our bodies are very poor at letting us know how many calories we are eating. External cues in the environment are powerful influencers of what and how much we eat. Study after study shows that many of our eating habits are automatic and influenced by: the size of the plate we use; whether we use a short wide or a tall skinny glass; the size of the package that our food comes in. All of these studies are summarized in a very readable book by Brian Wansink called Mindless Eating. It’s an old book, published in 2006, but human nature and the psychology of eating have not changed since 2006. He is a little easier on the food companies than I would be, but I highly recommend reading it. Here is a list of external cues, validated by research, that cause us all to eat more than we think.

  • Distraction (eating while watching television, reading the newspaper or eating with friends or family)
  • Size of food package (we automatically eat more from a bigger package)
  • Size of plate (we eat less when we eat from a small plate than a large plate)
  • Tall skinny vs short wide glass (a tall skinny glass looks like more liquid than the exact same amount in a short wide glass. We drink more from the short wide glass)
  • Convenience (the more conveniently a food is available, the more we eat)
  • Labels (If foods are labeled low fat, or make health claims we eat more of them)
  • Portion size (we tend to eat everything we are served, regardless of portion size)

The Mindless Margin

Depending on how these external cues are manipulated we generally tend to eat twenty percent more or twenty percent less without even realizing it. Dr. Wansink calls this ”The Mindless Margin.” His research and that of others shows that we can cut our calorie intake twenty percent without triggering all the things that the body does to make us regain the fat we lose. That is somewhat controversial, but we know that modest weight loss can be permanent so lets do the math.

The average American eats about 3600 calories per day. Even eating that many calories, for most people weight stabilizes because we burn more calories to move our large bodies around. If we reduce that average daily calorie intake by twenty percent, that means that we have reduced our average daily calories by 720 calories per day. Over the course of a year we will have reduced our calorie intake by 262,800 calories. That equals a fat loss of 75 pounds!

Big changes vs small changes

Big changes to anything in our lives are much harder to sustain than small changes. Most diet and exercise plans involve big changes to our lifestyle. Those are hard to sustain by themselves and also maximally trigger our bodies to do all the things that eventually make us regain the fat we lost (see my previous post The Biology of Fat Gain and Fat Loss).

Small changes are much easier to stick with. These kinds of changes need to be individualized to our own eating and exercise patterns, but there are a few small changes that work for everyone. If you make three consistent changes that reduces your average calorie intake by only 300 calories a day you will lose 30 pounds in a year. If in addition you increase your exercise by 100 calories a day (walking one mile) you will lose an additional 10 pounds. You will not feel deprived or hungry.

Small changes everyone can make

  • Switch from dinner plates to salad plates. You will automatically eat about 20% fewer calories without even knowing it.
  • Do not eat food out of a box or package or while standing in front of the refrigerator. Always serve whatever you plan to eat on a salad plate or in a small bowl.
  • Do not eat your food while watching television or while reading. If you must eat for a particular TV show, serve your plate before you sit down and don’t go back for seconds.
  • Stay away from the snack food aisle in the grocery store. Willpower does not work. If snacks are easily available, you will eat more calories. If someone else buys snacks, store them in the back of the pantry where it takes more effort to get to them. If you do the shopping, make a list before you go to the grocery store and stick to it.
  • If you drink beverages with calories (soft drinks, fruit juices) Use a tall skinny glass rather than a short fat glass. You will automatically reduce the calorie intake from the beverage by about ten to twenty percent. It is better of course to drink water or other calorie free beverages.
  • Eat slowly. Food should taste great, which means you should enjoy every bite. Do not put another bite in your mouth until you have chewed and swallowed the previous bite.
  • Wait at least twenty minutes after finishing one serving before you have seconds. It takes about twenty minutes for the feeling of satiety (feeling full) after a meal.
  • When you are shopping, park your car as far away as you can from the store. Take at least one flight of stairs rather than take the elevator. Remember that every mile of walking burns about 100 calories. You don’t have to walk the whole mile at one time.

How often should you weigh yourself?

This is pretty much up to you. If you decide to weigh yourself daily, make sure to do it at the same time every day. The morning is best. Weigh yourself without clothes just before or after your shower. Remember that your body is 60 percent water so that your state of hydration and how much water you retain (say from eating something salty the night before) will cause your daily weight to vary as much as two or three pounds. If you weigh yourself daily you should keep a record of your average daily weight for each week. That will be a much better measure of fat loss or gain.

You could also weigh yourself once a week or even once a month. You could decide not to weigh yourself at all, but then you won’t know if the habit changes you have made are enough to produce fat loss. I recommend weighing yourself at least once a month.

Good Nutrition

If you make the small changes I have suggested (or others that are individualized for you) you will lose fat slowly without changing the foods you eat and like. If you want to eat healthier as well as lose fat then check out my next post.

The Biology of Fat Gain and Fat Loss

Fat storage is a way for mammals to manage energy allocation. Fat cells are not simple storage depots, but are metabolically very active. They respond to and produce hormones and other messenger molecules. A certain amount of body fat is essential for mammals, especially humans who have to maintain a large brain which uses a lot of energy. In adult humans 20% of basal metabolism is devoted to maintaining the brain. For infants, that number is closer to 80%. Fat storage gives humans the flexibility to manage environmental stresses such as variation in food supply.

In most of human history there was a balance between energy intake (eating) and energy output. Energy output includes energy to keep the body intact (basal metabolism), energy required to digest food (thermic effect of food) and exercise. Some of the energy from eating goes into fat storage, but the quantity of body fat is also kept in balance. This balance of energy intake, fat storage, and energy output is maintained by a complex feedback system. Most of the research into how energy balance happens has been done in animals, and we still don’t understand exactly how that translates to humans, but we are able to sketch the broad outlines of how the system works. This system involves messenger chemicals and the reward system in the brain. I won’t go into all the complexities here (It is so complicated it would make your eyes cross) but I will give you the simple version.

Leptin

Fat cells produce a hormone called leptin. The amount of leptin they produce is proportional to the amount of fat storage. Leptin decreases appetite and increases satiety (feeling that we have had enough to eat).

Ghrelin
When the energy output is greater than the energy input fat storage decreases and leptin decreases. The stomach makes a hormone called Ghrelin, which increases appetite. We then eat more food until the body fat gets back to the balance point.

The brain reward system

Humans evolved to find sweet high calorie density foods intensely pleasurable. That is probably because such foods were rare or at least seasonal for our hunter-gatherer ancestors. These kinds of foods cause dopamine release in the brain. This is the same system that makes drugs of abuse pleasurable. Eating in general stimulates this system to some extent. From an evolutionary standpoint eating being pleasurable has obvious survival benefit.

How fat storage gets out of balance

Our hunter gatherer ancestors took in lots of calories, but they also burned lots of calories in the hunting and gathering part. In our modern society we don’t have to exercise very much to get our food, so our daily calorie expenditure is a lot less on average than our hunter gatherer ancestors. Moreover, we have the big food industry which has learned very well about the kinds of foods that stimulate our brain reward system the most. The more calories we eat, the bigger their profits. The foods that maximize their profits are calorie dense processed foods with lots of sugar and starchy carbohydrates. We live in what the scientists call an “obeseogenic” environment. The easy (and cheap) availability of high sugar, high carbohydrate foods maximally stimulate the brain reward centers and overwhelm the rest of the energy and fat regulatory system. The result is that many of us increase fat storage up to the point that the extra calories it takes to move our large bodies around get most of us into balance again, but at a much higher level of body fat. Some unfortunate people continue to gain fat until they become disabled by the huge amount of body fat they carry. As I discussed in the previous post, that increased percentage of body fat increases the risks for heart disease, diabetes and cancer.

Addressing the epidemic of overfatness

While I intend to focus later on what individuals can do to lose fat permanently the thing that all of us need to do is to work at a political and social level to change the ”obeseogenic” environment. That will include things that increase the expense of high sugar high carbohydrate foods (like voting for taxes on sweetened beverages) and decrease the expense of healthy unprocessed foods like fresh fruits and fresh vegetables (like allowing food stamps to be used at farmers markets). It is unconscionable that ”food deserts” exist in some communities so that the only foods available are at convenience stores that sell only obeseogenic foods. We also need to work toward changing the exercise environment so that all communities (not just the wealthy ones) have safe walking trails and exercise facilities. All of us, fat or thin, need to do what we can to change the food and exercise environment.

The biology of fat loss

The only way to lose fat is for the calories we eat to be less than the calories we burn. That is a truism, but it is not very helpful in creating strategies for successful fat loss. So what does the body do when we change our energy balance to less energy in than energy out?

The first thing that happens when we have a negative energy balance is that leptin, the satiety hormone secreted by fat cells goes down. It actually goes down before we lose any fat. Ghrelin, the appetite enhancing hormone goes up.

As the body starts to lose fat several other things happen. The basal metabolic rate decreases. Muscles get more efficient, so the calories we burn per minute of exercise goes down as well. All these changes decrease energy output to try to match the decrease in energy input. This means that fat loss starts to slow down and eventually stop, even though we are eating the same number of calories that caused fat loss in the beginning. Not only does energy output decrease, the body sends powerful signals that increase appetite that make it more and more difficult to keep from increasing our calorie intake. The end result is that 90% of people who lose a lot of fat gain most or all of it back eventually, most within a year. Even more depressing, the low metabolic rate persists even after the fat is regained. Contestants in show The Biggest Loser still had low metabolic rates 6 years after the show, when almost all of them had gained back the fat they lost. In fact, their basal metabolic rates were even lower than when they lost the fat.

I’m sure at this point after hearing all this you are depressed and are saying to yourself, ”what is the point of even trying to lose fat.”

Bad News and Good News

The bad news is that all these mechanisms that operate to make you regain the fat you lost are proportional to the amount of fat you lose. Very fat people who lose enough fat to get close to ideal body fat have an almost impossible time staying there. The body mechanisms that work to bring the body back to the original amount of body fat are just too powerful to resist.

The good news is that permanent fat loss of around 10 percent of your body weight is possible by making permanent changes in your eating and exercise habits. The other good news is that modest fat loss makes a big difference in your risk of high blood pressure, diabetes, heart disease and cancer.

In the next post I will talk about the unconscious mechanisms that contribute to over eating. I will also talk about setting reasonable goals for weight loss and how to go about making permanent changes in your diet and exercise.

Why is the United States So Fat and What to do About It

I’m going to take a break from the series of posts on healing relationships for a while and start a new series of posts about the epidemic of fatness in the U.S. This is an especially opportune time to talk about the epidemic of overfatness in the U.S.. Many people have gained fat during the last few years of the pandemic, and the holidays always make it worse. In this series I will talk about the causes of the epidemic, how to measure body fat, some common myths about fat loss and then discuss the science behind fat loss and fat gain. Finally I will give some practical suggestions for losing fat and keeping it off.

The epidemic of fatness

I use the term fatness on purpose, rather than overweight or obesity. It is really too much fat that causes bad health consequences. The CDC defines obesity as a BMI (body mass index) of 30 or higher. I will talk later about the problems of using BMI as a measure of fatness, but when the BMI is 30 or higher it is a pretty good indicator of fatness and health risks. In 2018 (the last year we have complete data) 42.4% of adults in the U.S. had a BMI of 30 or greater. That means nearly half of adults have all the health risks associated with overfatness! These include heart disease, stroke, cancer and diabetes. More than 10% of adults have type 2 diabetes. In the 1950’s only 10% of adults in the U.S. had a BMI of 30 or greater and less than 1% had type 2 diabetes. We see the same trends in children and adolescents. What happened?

In 1980 there was a scientific consensus that dietary saturated fat caused heart disease. The evidence was flawed, but that will be a subject for another post. The US dietary guidelines for that year recommended lowering dietary fat to 30% of calories. People reduced their fat intake modestly, but the food industry substituted sugars for fats in processed foods. This increased total calorie intake. There were other factors as well. The average restaurant meal is four times larger than it was in the 1950’s. The size of American manufactured dinner plates increased from 9.6 inches to 11.8 inches. Average physical activity for both adults and children has decreased as well. The result of all of these factors has resulted in a 24% increase in average daily calorie intake.

Type 2 diabetes is caused not by insufficient insulin, but by resistance to the insulin your body makes. The most common cause of insulin resistance is being too fat. Thus the epidemic of diabetes parallels the epidemic of fatness.

Are you too fat?

The most common measure of how fat you are is called BMI (body mass index). The BMI is your weight in kilograms divided by your height in meters squared. The easiest way to calculate your BMI is to use a BMI calculator app that lets you enter your height in inches or feet and your weight in pounds. Here is a link to one BMI calculator.

Although BMI is easy to calculate it is not a very good measure of body fat. It is most useful at the extremes. If your BMI is over 30 then there is a 95% chance that you have an unhealthy amount of fat. If your BMI is less than 18 then your body fat percentage is likely to be too low to be healthy. In between these extremes, BMI is not very good as an estimate of unhealthy body fat. For people who have a high amount of muscle mass (professional athletes for example) BMI can significantly overestimate body fat. For others, particularly the elderly, BMI significantly underestimates per cent body fat.

Other ways to estimate body fat

Ideal body percent body fat varies by sex and age. Below is a table of ideal body fat percentage from Beth Israel Lahey Health Winchester Hospital.

AgeHealthy Body Fat % (Women)Healthy Body Fat % (Men)
20-3921%-32%8%-19%
40-5923%-33%11%-21%
60-7924%-35%13%-24%

Electrical impedance

There are a number of consumer grade scales that advertise that they measure weight and per cent body fat. They use something called electrical impedance to do this. A small imperceptible electric current is passed through your body. Fat and bone have more resistance than muscle and body water. The machine uses a formula to calculate per cent body fat. The formula uses age, sex and height. These values are usually entered through some sort of smart phone app.

Most of these scales use only two electrodes, one for each foot. These are not very accurate. Scales that use four electrodes, one for each foot and one for each hand, are considerably more accurate. Most of the four electrode models cost thousands of dollars, but I did find one that sells for $349. Here is a link to that scale’s website.

Skin fold calipers

Measurement of per cent body fat using skin fold measurements is quite an accurate way to measure body fat. Skin fold calipers are not particularly expensive but it takes a lot of experience to use them correctly. The skin folds have to be measured in seven different places. Some trainers at gyms have been trained to do skin fold measurements. This is not a practical method to use at home.

Other methods for measuring body fat

There are some very accurate ways to measure body fat including a special kind of x-ray and being immersed in a tank of water to see how much water you displace. Both of these methods require expensive specialized equipment. These methods are mostly used in research and are not even available at most hospitals.

Waist circumference

The biggest health risk is the amount of fat inside the abdomen around the intestines and organs. This is called visceral body fat and it is easy to measure. Get a cloth tape measure and measure your waist circumference. The correct way to do this is to feel for the top of the pelvic bone on both sides and measure just above this. That will be about at the level of your belly button. For women if your waist circumference is greater than 35 inches you have triple the risk of diabetes, heart disease and cancer. Women with a waist circumference of 31.5 inches to 35 inches have a lower risk, but still moderately elevated. Women who have a waist circumference of less than 31.5 inches have the lowest risk. For men the equivalent numbers are: High risk: greater than 40.2 inches. Moderate risk: 37 to 40 inches. Low risk: less than 37 inches.

Fat around the hips and buttocks is not associated with any significant health risk. In other words, pear shaped is better than apple shaped!

Losing Fat

Lets say you have calculated your BMI, measured your waist circumference and perhaps measured your body fat percentage using one of the impedance devices. You have determined that you have an unhealthy amount of body fat. The next post will discuss myths about fat loss strategies as well as what we know about the science of fat loss and fat gain. For those of you who want to get a little preview, you can review the brief post I did in 2015 called How to Lose Weight and Keep It Off.