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Behavior Change

The best and most fascinating studies for me are the simple ones.  I don’t want to know the genome of the brain, someone does, but not me.  I want to know why I eat and why I exercise.  More practical and applicable to my daily life than know the DNA of my left parietal lobe.  If indeed I have one of those.

Last week in Boston the annual Experimental Biology Conference took place.  This annual event gathers leaders from a diverse set of fields, including nutrition, to discuss the cutting edges of their disciplines.  I was thrilled that the study entitled, “Menu labels displaying amount of exercise needed to burn calories show benefits” was one that the New York Times chose to highlight earlier this week.  Out of all the amazing research presented, why we eat the way we do and ways to stop it grabbed the headlines.  Progress.

A small provision of the Affordable Health Care Act states that restaurant chains of more than 20 outlets must display the calorie content of their foods.  This is welcome news, however, how many of us know what that number means or even care? Calories in a McDonalds Double Quarter Pounder with Cheese?  750 big ones.  “Wow, that seems to be quite a few,” we think immediately before taking off a bite.  The issue with calorie counts and nutritional content is that the information is not salient to us, it is not meaningful.  Most know that high calories may want to be avoided, but even that is relative.  Enter the present study.

Researchers at Texas Christian University tracked what people ordered and what they actually consumed as a result of ordering from three different menu options.  The food items listed on the menus were identical with one exception:  one menu simply listed the food, another listed calories next to the food, and the third listed how long one would have to briskly walk if they ordered and consumed each food.  Now we’re talking.  Threaten people with exercise and watch them change their behavior.

When ordering from menus that listed how much brisk walking would be needed to burn off the consumed calories individuals ordered and ate significantly less calories when compared to the other two conditions.  There was no difference in calories ordered or consumed when comparing menus with and without calorie counts.

This isn’t to say that menus with calories listed are meaningless.  To some this information is useful, to others it is simply a moment for pause.  However, exercise is salient, people can relate to walking.  When you see a sirloin steak you want and next to it reads “You will have to walk briskly for 60 minutes” in order to burn those consumed calories behavior seems to change.

Take home message:  if we want to get people to change their behavior around food and exercise, the information we share with them must be relevant.  This information cannot be abstract, like calorie counts.  That Double Quarter Pounder with Cheese?  Go walk for two hours and get back to me.

How long will did I have to walk after I consumed last weekend’s birthday desserts?  Way too long.  And that means something to me.

How would you respond if I asked, “Why do you exercise?”  Would you pause and ponder?  Would you say “because it feels good”?  Or would it be something along the lines of “I exercise to extend my life”?  Most of the responses I have been given over the years fall into two general categories, those of “Because I am training for something” and “I want to lose weight.”  Rarely do people respond that they exercise to extend their lives.  This may be a thought in the back of their minds, especially if, for example, a family member has been diagnosed with heart disease and their is a strong family history of this condition.

This thought of heard disease lurks in the back of my mind as both maternal grandparents died due to heart disease and my mother has a few heart issues over the years.  I also think about the Alzheimer’s my father battles.  Will my exercise help stave off both?  In the far reaches of my mind, I hope so.  However, if I am honest with myself, this is not what drives me to exercise.  My drive comes from a lifelong battle with weight.  This battle is what most likely led me to my profession and my interest in why we eat.  Yet more on the surface, this battle is the force behind my exercise patterns.  Exercise does make me feel good, I get down without it.  I like to practice what I preach and it is easier to encourage others when you actively take part.

These were my thoughts as I saw the question posed to Gretchen Reynolds this week in the New York Times:  If I do 30 minutes of cardio exercise six days a week, would increasing it to 60 minutes a day be twice as good for me?  Her response intrigued me.  The answer all depends on the definition of “good.”

In her response, Ms. Reynolds, whom I enjoy reading and have high respect for, focused on lifespan as the definition of good.  Studies are cited that state those exercising moderately live just as long as those who exercise obsessively.  Bump your workout from 15 minutes a day to 30 minutes a day and you only see a 4% increase in lifespan.  So it would seem doubling your workout time doesn’t give you much bang for you buck.

However, is there another way to look at it?  Double your workout time from 30 to 60 minutes and you will burn more calories, perhaps leading to more meaningful weight loss provided you don’t eat more (we will present work out of our lab next month at the American College of Sports Medicine Meeting that shows when people exercise vigorously, they overestimate their calorie expenditure by nearly 20%, thus the idea of eating too much when you exercise more).  You’ll also simply move more and sit less.  And we know how important moving, even just standing, is.

So it all depends on the definition of “good.”  Why do I exercise?  So I can eat more and maintain an edge in my battle with weight.  Why do most people exercise?  Weight related responses reign supreme.  Perhaps by taking an active role in our health and moving as much as we can, we gain something more that immeasurable increases in lifespan.

Perhaps it’s my great, great, great, great, great, great, great, great, great, great grandparents fault that at times I am not motivated to exercise.  Perhaps it is my ancestor’s gift that I battle that amotivation and continue to exercise.  Why some people choose to be active and others choose not be is the never-ending question in my discipline.  One can be given a fantastic exercise program to follow, can even hire someone to guide you through it.  Yet, if we are unmotivated and choose not to do it, the program is no good.

Gretchen Reynolds, early this week in the New York Times, highlighted a fun study on motivation and exercise.  Albeit it rats a telling story is told.  Rats were put in a cage with a wheel and their activity was tracked for one week.  The most active females and males were bred together, as were the most inactive varieties.  This was repeated through ten generations.  The end product were a set of rats that loved to exercise and a set that loved to sit.  The exercising rats ran ten times as much as the couch potatoes.

Then the dissection began.

Surprisingly, the two groups of rats did not differ much in body composition (muscle and fat) and the lazy rats were only a touch heavier.  The differences lay in the genes:

“The scientists compared the activity of thousands of genes in a specific portion of the brain that controls reward behavior, or the motivation to do things because they’re enjoyable.  They found dozens of genes that differed between the two groups.  The rats’ decision to run or not to run, in other words, was being driven, at least in part, by the genetics of motivation.”

Wow.  Thanks great, great, great, great, great, great, great, great, great, great grandpa, you gave me the will to succeed.  Or at least the will to fight.

Those that came before us impact us.  In a powerful way.  We know this.  This can be a blessing and a curse.  We shouldn’t look backwards and say it’s their fault we don’t exercise, although tempting.  Rather, in our unmotivated moments, we should challenge them and say, “Here we go!”

The genetics of motivation.  Fascinating stuff.

Happy Friday.

 

Yesterday proved challenging indeed. The food stared, I ignored. The food screamed, I ignored. The food throw a tantrum, I ate. For the most part I was successful in meeting my challenge of not overeating during my meeting, however, there were moments. In laying out my challenge here yesterday I definitely felt the pressure of not eating so as to avoid having to take a picture and be held accountable. Maybe that is what I should do each day: take pictures of all food consumed. Ignoring the food was a challenge as it literally talks to me. At times it was hard to focus and when others grabbed a snack I wanted to and sometimes did. The power of the environment. So, as promised here is my day in photos (with apologies to size and formatting):

Walking into the conference room I had to giggle, here is the sign on the door:

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Have to love a group of exercise professionals that ignore rules from the get go.

Onward, here is the table as it started its day:

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Noting terribly daunting other than the fact it was simply there.

Onto snack #1, where one of the meeting organizers passed out chocolate covered espresso beans:

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A couple of cups of nuts. Come on, it’s a strength and conditioning meeting, I had to keep up with my colleagues on the protein front:

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Went for a higher healthiness score, banana:

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This brought me to noon, and the table went on steroids. Panera was brought in and laid out before us. Sandwiches, salads, and cookies, galore. I found myself think big, “I’ve been pretty good all morning, therefore I can splurge at lunch. Need to figure out how to combat the thoughts of being good = later binge:

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And my lunch:

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With an extra cook

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The afternoon proved successful with only an apple creeping in to get me. Easy to rationalize that one:

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So there you have it, my meeting food in pictures. The day proved interesting as I felt pretty good about my choices (save the extra cookie at lunch), yet I did find the conversations in my head instructive. By suggesting to myself I met the challenge of ignoring most of the food, I found myself being consumed by thoughts of my rewards. Pun intended.

Happy Saturday. Ten more hours of staring at the table for me.

I love this word, truthiness. Thank you, Mr. Colbert. The word has a certain playfulness to it, some ambiguity that allows for the bending of truth. Ever do that with food or with your weight? I bend it all the time. “Cookies? What cookies? Didn’t even know we had any in the house, couldn’t have eaten them.” Or, in response to my partner’s inquiry of how the scale treated me, “Oh, it wasn’t that bad of a weekend, only a couple of pounds.” Truthiness has afforded me that flexibility.

How about the word “healthiness”? I hadn’t heard that one before yet it jumped out at me when reading a soon to be published study in the journal Appetite. Seems we all judge “healthiness” of food a bit differently, especially if we are focusing on our weight. I love this highlight from the article:

“Consumers’ ideas of weight management (WM) and healthiness are intermingled.”

Without knowing the definition of “healthiness” I would agree. The article summarizes some interesting concepts on how we approach food and I’ve excerpted a paragraph here:

“According to many studies, people are relatively well aware of the principles of healthy eating that support weight management (e.g. Holm, 2003a, Margetts et al., 1997, Niva, 2008 and Paquette, 2005). However, research also shows that putting this knowledge into practice in everyday eating and food choices is problematic. First, health advice and nutrition guidelines may be challenging to reconcile with everyday life with its social and work-related commitments, time constraints, food traditions and taste preferences (Ely et al., 2009 and Holm, 2003a). As Ristovski-Slijepcevic, Chapman, and Beagan (2008) have suggested, people’s ideas of healthy eating draw on various kinds of cultural and traditional, nutritional as well as ethical discourses. Official health advice and nutrition guidelines are only one, albeit important element in this whole. Second, the generic advice is targeted for ‘average’ people and does not easily take into account individual nutritional needs or skills. Third, for non-experts it is challenging to estimate calorie or nutrient contents of foods let alone meals. Studies have shown, for instance, that people easily overestimate the calorie contents of ‘disreputable’ foods with unhealthy images and underestimate the calorie contents of ‘reputable’ foods with healthy images (Oakes, 2005; see also Carels et al., 2006 and Carels et al., 2007). Meanwhile, the market with expanding varieties of foods with differing nutritional contents and increasingly detailed claims on their health benefits, presumes people to be watchful and invariably concerned with nutrition and health aspects of food.”

Yesterday I mentioned the difficulty I have with real world eating. That is to say self-moderating when outside my normal food environment. Good to know that others have a hard time “putting this knowledge (principles of healthy eating) into practice in everyday eating and food choices…” The other pieces that caught my attention in the above paragraph are that people’s ideas of healthy eating come from a diverse array of information and that generic advice doesn’t take into account individual needs or skills as they relate to nutrition. Preach it, Sister Mari!! We overestimate calories of bad foods and underestimate the healthiness of “reputable” foods, like apples? You don’t say? Ever rationalize the energy bar you’re snacking on as meal replacement or say that the pre-made meals and snacks that your weight loss company promotes are good for you? We assign a high degree of healthiness to foods we are told are healthy and that we inherently believe to be healthy. This is a key to why we eat what we do.

People will repeatedly and consistently speak to the negatives of a small amount of high calorie, high fat chocolate while also screaming from on high that 7 cups of cottage cheese are healthy. When, in fact, 7 cups of cottage cheese are way more energy dense than 1 ounce of chocolate. We believe what we are told, we believe what works for us in keeping the “bad” food away, and both lead us to why we eat what we do. Healthiness matters. We just have to get it right.

Based on our own experiences we all ascribe different healthiness values to different foods. When listening to others tells us what to eat that experience gets lost. What to do? What to do about real world eating when faced with foods that I feel lack healthiness? Enjoy in moderation. Don’t have 7 cups of cottage cheese, have one. 6 cookies? Try 2. I just haven’t figured out how to moderate yet. Simply walk away? Easier said than done.

As far as I can tell healthiness may be described as how much I believe a certain food will impact my weight. Based on my individual experience I may think a food to have more healthiness than you. Why do I think a certain food has healthiness and you don’t? Personal experience, advertising, locker room conversations. Why do we eat what we do? Because we believe what we are told in terms of healthiness. Just because Weight Watchers tells us to replace our meals and snacks with their food, doesn’t mean we have to, and it doesn’t mean those choices are healthy.

Just another piece of the puzzle I find fascinating. Inherently we know the principles of healthy eating, yet, as the above excerpt makes clear, we have a difficult time deploying that knowledge. Healthiness is personal. Healthiness is challenging. Healthiness is moment by moment.

Damn, this weight management and food stuff is complicated. I am going try to moderate.

Thanks for letting me ramble.

No, not the world of Puck and Pedro and those other wonderful characters of MTV yore, but rather the real world of eating. And overeating. Upon returning from a wonderful four days visiting my in-laws in Wisconsin, and facing the reality of the scale this morning, my eating environment has hit me square between the eyes.

Over the past weekend we spent time with my partner’s parents. I like to think of us as GDD. That is short for “grandchild delivery devices.” Our daughters love spending time with their grandparents and vice-versa. While Grandma plays endless hours of “gift delivery” with our 5 year old and our 1 year old gets her sea legs, the rest of the adults sheet rock basements, move boats, and chop down trees. Throw in some chicken coop design time and dinner with friends and you have good times. Why then the real world of eating? Let me explain:

I live in a world of organic and home made dinners. Of baking from scratch, CSAs, and gardening. Soon, those chickens for whom the coop has been designed will be added. I do well in this environment, my sweet urges held in check by this place. And I enjoy it. Over the past couple of years I have lost weight and been able to maintain that loss with the help of the environment my partner has created.

And then Reedsburg happens.

Reedsburg, WI. Home of my in-laws. Home to an eating environment which I often crave. And oh, how I change. Cocoa Puffs are purchased and cookie jars stocked for my father-in-law knows me too well. I start munching, inhaling, and changing. I seek out food more often. I find it because its there. I eat it because it’s there. I eat because the rules have changed. My environment changes when we go for a visit and I don’t do well with change in this sense and the scale this morning backs me up. As does the red alert on my fitness app saying I overdid it. Have to love it when your phone tells you to get a clue.

My change is not my in-laws fault or my partner’s. The fault lies with me. This fault reminds me that I am on a journey that won’t end anytime soon. For the most part I have conquered, at least for the moment, my food environment at work and at home. I’ve got the Monday-Friday eating environment down pat. For the moment. I struggle on the weekends, I struggle at my in-laws, I struggle in the real world of eating.

Left to my own devices I will eat. And eat some more. My home and work environments, with some effort, have been adapted to help me be successful in my weight management goals. However, when I am released into the real world I still struggle and I am sure I always will. It is most likely too much to ask of me to go to a friend’s house, be placed in front of crackers and cheese, and say no. Or even say just a bit. I know this about myself. The key for me is to manage that environment. I am still working on that as this weekend past brings into stark relief.

This is the power of our food environments. The power of habits. These two factors conspire against us at times and help us at others. The trick is to swing the pendulum more to the helping side. The environments that we surround ourselves in, with regard to food, dictate our behavior. I can’t change, and don’t want to change, the food environment of Reedsburg, WI. I look forward to it. However, I need to keep moving forward with my change. Next visit, only three cookies after dinner. Only one bowl of Cocoa Puffs for breakfast. I’ll even promise to back off on the ice cream. Well, probably not, but at least I have something to aspire to.

Most nights I walk into our daughter’s room and ask her to lie down and go night-night. She’s 1 and this happens a couple of times per night. She’s a smart one, however, and has now taken to looking at me and then immediately to the door, for she knows if she fusses for just a moment longer mommy will come in. And who doesn’t like a good rock from mommy at 2:00 am?

Sleep is important, as any new parent knows. The effects of sleep deprivation are numerous and varied. My college students are experts. An association between bodyweight and lack of sleep was observed years ago and suggested that adults that get less than 5-6 hours per night and children who get less than 10 hours per night are at heightened risk of weight gain. Seems that even after a few nights of lost sleep your fat cells behave like their twenty years older. As any 40 year old can attest, they’d much rather have the fat cells of a 20 year old. I doubt the reverse is true.

Researchers at the University of Colorado have now demonstrated that just one week of sleep deprivation (defined as five hours per night) leads to immediate weight gain in individuals when compared to those who slept nine hours per night. When they say immediate, they meant it, as in two pounds gained within one week. When the sleep times were reversed (i.e. the five hour people got nine hours and vice-versa) those getting nine hours began to lose some of the weight that was gained. Some.

As is noted in the New York Times piece on the study only 16 subjects were studied and only for two weeks. We need to remember that weight gain is a chronic imbalance and not the function of what we do today. I can see the headlines now: “New weight-loss program tells people to simply sleep!” I bet their won’t be any motivation issues to follow that program. Although the present study was brief (and well developed and controlled, I might add) it serves to be instructive. Some highlights:

Individuals who slept only five hours per night actually raised their metabolism, to the tune of an extra 111 calories per day. However, this was more than compensated for by an increase in consumption.

Sleep deprived individuals also ate significantly more carbohydrates and ate more after dinner than any other time of the day.

The above results were more pronounced in women, who maintained bodyweight during adequate sleep and lost “dietary restraint” during sleep deprivation and gained more weight.  Damn gender bias.

Both of the above research notes point to a behavioral shift, a why we eat moment. Why do college students eat when they stay up late? To help keep them awake and alert. “…to provide energy needed to sustain additional wakefulness” in the researcher’s words. Why do I eat late at night? Because I’m bored, I’m already in the kitchen, and the food is there. This is why I go to bed at 7:00 pm, no late night craving for me. Do you find yourself lingering in the kitchen if you are up late? Why? Go to sleep.

When individuals in the aforementioned study were sleep deprived they consumed 6% more calories compared to when they were allowed to snooze for nine. That’s huge. The caveat here is that during the study individuals were allowed unlimited access to food. Not atypical when thinking of the average American home these days, but definitely setting the participants up for a challenge. Sleep deprive me and give me all the food I want? I’d gain at least two pounds.

The body has an amazing ability to adapt. To both the good and bad. I’d be fascinated at what the body would do if it was sleep deprived for months on end. (Aha, I shall study new parents and their food habits!). My guess is that physiologically it would settle into a new normal, however, our behavior might not. New habits might be developed, a late night snack becomes routine. Over time, chronically speaking, weight gain may follow. Just a thought.

Good night.

Last week I sat with a woman who had found my name in a recent magazine article about how to lose weight. Being from St. Paul she asked if we could meet and talk about weight loss. Roughly my mother’s age, she spoke of the times when she had lost weight only to gain it back again. Asking good questions, she spoke of metabolism and menopause, going for walks, and a former boyfriend who told her she’d look great if she lost ten pounds. We can be so cruel at times. As it became apparent that I would offer no magic pill I sensed interest was lost and the conversation ended. Too many conversations end that way. Good questions asked, no answers given, left to our own devices.

In a world that tells us to be thin yet begs us to eat many questions linger on how to best achieve our goals. There are fad diets, the old standbys, and apps a plenty. All promising what has eluded us since we were three. There are ads touting the latest and greatest in personal training, heart rate monitoring, and threshold training. I’m in the field and I have no idea of what half of this means. With the other half I am at a loss to explain how it might possibly work. Easy to see how the woman in my office got confused and hoped that I may provide some clues.

This morning I read an article in the Minneapolis StarTribune that kept my thoughts thinking of the questions I am most often asked. The theme of the article was if you want results, you have to think like a gym rat. Write things down, pay attention to your exercise, plan your workouts. Want to get up in the morning and hit the fitness center? Lay your clothes out the night before. Little things work, and so does exercise and watching what you eat. We can so easily get lost in a world of advice, social media, and our friend who tells us “This is the best program ever.” When it comes down to it diet and exercise do work. We just have to do them. Constantly and consistently.

I wish I could’ve offered the kind woman more advice. We could have talked about emotional eating, why eat, and why we exercise. Yet I have no magic answers for motivation. The most we can hope for is to put ourselves in a position for success and see what happens. For today, back off on the cookies and go for a walk. Tomorrow, walk a bit further. Who knows, if we ditch the apps and heart monitors, a low key approach may just lead us to where we want to go.

What’s that spell?  Mississippi! Mississippi?  Yeah Mississippi!  As in we are the fattest state in the country and we’re going for more!  As if a judge in New York City striking down the soda ban wasn’t enough, the governor of the most rotund state in these United States is set to sign the “Anti-Bloomberg” law into effect shortly.  Anti-Bloomberg as in the mayor of New York City.  Mississippi’s legislature has now gone on record saying “keep your hands off my soda, and any of my food for that matter.”

“The Mississippi Legislature wants to be the sole government body that controls its buffets, barbecue and sweet tea..That means that cities or counties cannot enact rules limiting soda size, salt content, shortening in cookies, toys in fast-food meals for children, how a menu is written or just about any other aspect of the daily dining experience in Mississippi.” (From the New York Times).

We’re going to get fatter!  And Bloomberg, there is nothing you can do about it!  I ask this question many times a day, whether food related or not: Why do people so often act against their own best self interest.   I am not one to judge your best interest, however, when you lead the country in obesitysome careful thought about how to address the issue might do you some good.

The latest data show that Mississippi has an adult obesity rate of 35% and it is projected that by 2030 nearly 67% of all Mississippians will be obese.  67%.  By telling government to keep their hands off the french fries and supersize sodas I am sure that number won’t be reached.  People will quickly realize they have personal responsibility and will limit consumption on their own.  Right.  I wonder how Mississippi feels about government “intrusion” on other individual rights?  Any guesses?

One of the main reasons that Judge Tingling of New York City and the legislature of Mississippi are behaving the way they are is that they say they don’t want to limit individual rights.  I don’t buy it.  Can’t smoke here, can’t get married there.  Food is personal, but the effects of obesity are not.  The reasons are nuanced and different for these locales  My best guess is that in New York Judge Tingling didn’t want to dampen the spirits of soda makers everywhere whereas in Mississippi it is more likely a ignorant confederate view telling others to leave us alone.  Disclaimer:  I have never lived in Mississippi so don’t claim to know exactly how they think, my assumption is pure speculation.

So go ahead Mississippians, eat and drink to your heart’s content.  However, your heart may not be content for very long.

On a more positive note for a Friday, some interesting research now suggests that even if you hate to exercise you still reap the benefits of it.  So no more excuses of “Exercise causes me to stress out therefore it can’t be good for me and it doesn’t make me feel better.”  Yes, it does make you feel better and yes, it will lower your stress and anxiety when put in new stressful situations.  At least if you are a rat.

Happy Friday.

So close.  Only hours before the ban on large sugary drinks was set to hit New York City a judge blocked it.  Calling the regulations “arbitrary and capricious,” Judge Milton Tingling sided with beverage companies.  I had to giggle at his choice of words as they echoed Kramer, of Seinfeld fame, and his attempts to keep an intern for his company, Kramerica.  The judge just got the words out of order.  In more than one sense.  Stopping the ban on large sugary drinks makes about as much as sense as creating a company that produces bladders for oil tankers.

The theme of the judge’s opinion was “It’s soooo hard.”  From the Times article:

The judge also criticized the rules themselves, noting they would apply only to certain sugared drinks — dairy-based beverages like milkshakes, for instance, would be exempt — and be enforced only in certain establishments, like restaurants and delis, but not others, like convenience stores and bodegas. The rules, the judge wrote, would create “uneven enforcement, even within a particular city block, much less the city as a whole.”

Yes, the rules would be difficult and there were exemptions.  However, a starting point is needed.  As Mayor Bloomberg stated, “Obesity kills. There’s no question it kills.”  We outsource our appetite to external forces.  When these external forces conspire against us we get the outcomes we are dealing with today.  An unprecedented rise in Type II diabetes, incredibly high rates of overweight and obesity, and a host of others.  Yet when someone such as Mayor Bloomberg takes a stand the American Beverage Association spends millions to defeat his plan and then states:

“With this ruling behind us, we look forward to collaborating with city leaders on solutions that will have a meaningful and lasting impact on the people of New York City,” the spokesman, Christopher Gindlesperger, said.

Past is too often prologue and I don’t see Americans’ best health entering the spotlight of the American Beverage Association anytime soon.  One of the most often stated refrains from those who  begin a weight management program is “It’s hard, so hard.”  To change habit  is hard, one of the hardest things we’ll do.  When it comes to food, for some of us, the most difficult thing we’ll do.  How do we typically respond to the “it’s hard” refrain?  Try harder, you can do it, find support.  And today, I say this to Judge Tingling: Try harder, you can do it, find support.  Resist the temptation to give into past habits and lobbyists.  Who knows, Mr. Judge, do something for the health of the people and you might just find yourself tingling.

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