Super Bowl, A Question of Life or Cardiovascular Death! ✰ Are Super BOWLs to Blame For the US Obesity Epidemic? ✰ By BMI Standards the Average NFL Player is "Obese"

Conundrum of the day: Is it really any wonder, that the average American has weight problems if their football stars are obese?

After reading the "Cultural Guide to the Super Bowl for People Who Don't Watch Football" (read it yourself) on Wire.com, I realized that I cannot simply ignore Super Bowl XLVIII and since I have absolutely no idea of how American Football works and how it came about that you, my dear US friends, are going crazy about people carrying a ball that's called FOOT-ball (I mean, it's not "carry-ball") around in your arms, I decided to do what I usually do, when I don't understand things: Look for answers on the science databases on the Internet.

I have to admit, I did not really find the answer to my initial question and I still don't know the rules of the game, but I found a couple of "related" stories, you may be interested in:

• Super-BOWLs to blame for the obesity epidemic (van Kleef. 2012) -- I guess this would be an appropriate headline for a press release based on a study that was published in 2012 in the peer-reviewed scientific Journal of Nutrition Education and Behavior.
  
  According to the data Ellen van Kleef and Mitsuru Shimizu and Brian Wansink present in this paper, "super bowls" with a capacity of 6.9-l betray people into overeating (in this case on pasta).

  

  Figure 1: Super BOWL Wargning - When pasta is served in large vs. medium sized bowls people have difficulties controlling their pasta intakes (van Kleef. 2012)

  If you take a closer look at the data in Figure 1 you will realize that ladies are much more prone to the "bowl trick" than guys. If you think about the different eating habits between men (eat until you're satieted) and women (eat until you feel guilty / think you had enough), it is yet not really surprising that the women stopped eating earlier, when they got their pasta in the medium-sized 3.8L bowls.
  
  What's particularly amusing is that Wansing et al. showed in a very similar experiment with ice-cream that even "experts", i.e. nutritionists, are not immune against the "big bowl, big appetite" phenomenon and served themselves ~30% of extra ice-cream when the latter was served in bigger bowls (Wansink. 2006).
• Super Bowl outcome's association with cardiovascular death (Schwartz. 2013) -- If you take a look at the messages on Twitter, Facebook and Co. it's quite clear that the Super Bowl is a matter of life or death for many Americans. That this is true in both the figurative and literal sense, is not immediately obvious, though - and still, according to a group of scientists from the Good Samaritan Hospital in LA, this is yet actually the case.

German soccer fans at greater risk than US football fanatics: If the scientists' assumption that the increased risk in cardiovascular death is proportional to the "strength of the support" for the home team, us Germans are must be really supportive of our soccer team. According to a 2008 study by Ute Wilbert-Lampen et al. the risk of dying from any sort of cardiovascular complication more than doubled during our home-worldcup in 2006 (Wilbert-Lampen. 2008).

• The scientists analyzed the number of cardiovascular incidences during two "high drama and intense Super Bowls" (NYC beat New England (Massachusetts) in 2008 and Pittsburgh defeated Arizona in 2009) and found
  
  • a +20% increase in circulatory and a +24% increase in ischemic heart disease deaths after Massachusett's defeat, and
  • a -25% decrease in circulartory, -31% decrease in ischemic heart disease, and a -46% reduction in myocardial infarction deaths in Pittsburg
  What's somewhat astonishing, though is that the cardiovascular death rates did not change in Arizona (all p > 0.19)... well, Schwartz et al. obviously have an answer: "Massachusetts and Pittsburgh show stronger support for their home teams compared with Arizona." (Schwartz. 2013 ;-)
• Fat or fit? By BMI standards he is obese, but what about the actual anthropometric data of the "average NFL player"? (Luke. 2014) -- Very timely, I should say... what? Ah, yes. I meant the ahead-of-print publication of a study by Pryor, Huggins, Casa, et al. in the online version of the Journal of Strength and Conditioning Research: "A Profile of a National Football League Team", that sounds promising, right?
  
  Well, if you look at the data the scientists from the Human Performance Laboratory of the University of Connecticut gathered, you will realize that this "profile" is a simple analysis of the anthropometric data of all players of the 2011 New York Giants team.

  

  Figure 2: NFL player comparison of pooled and weighted body fat (%), - mass (kg), and - height (cm); data based on anthropometric measurement of the 2011 New York Giants team (Pryor. 2014)

  So! Now you tell me, who do you wanna be, the ripped, wide receiver or the massive offensive lineman? What? You wanna be the quarter back? How did I know that!?
  
  "Interesting, but are there any practical implications to this?" In case that's what you are just thinking a brief quote from the paragraph on "practical applications" of this study may give you a leg up:
  

  "[Our] study adds new players' data to prototypical position-specific databases that may be used as templates for comparison of players for draft selection or physical training." (Pryor. 2014)

  In view of the fact that the anthropometric profiles did not dramatically differ over the past 13 years, we may also assume that aside from a trend toward improved body composition in some positions the "prototypical" and maybe even ideal football player is already out there, so that physical characteristics have little impact on the successful outcomes in the NFL.

I know you still have to fill the bowls with popcorn, so I am not going to keep you from fulfilling this important duty... just remember: you may turn from "wide receiver ripped" to "offensive lineman"... well, let's say "massive" in no time, if you keep choosing the SUPER (large) BOWL too often ;-)

References:

• Pryor, J. Luke, et al. "A Profile of a National Football League Team." The Journal of Strength & Conditioning Research 28.1 (2014): 7-13.
• Schwartz, Bryan G., Scott Andrew McDonald, and Robert A. Kloner. "Super Bowl outcome’s association with cardiovascular death." Clinical Research in Cardiology 102.11 (2013): 807-811.
• van Kleef, Ellen, Mitsuru Shimizu, and Brian Wansink. "Serving bowl selection biases the amount of food served." Journal of nutrition education and behavior 44.1 (2012): 66-70.
• Wansink, Brian, Koert Van Ittersum, and James E. Painter. "Ice cream illusions: bowls, spoons, and self-served portion sizes." American journal of preventive medicine 31.3 (2006): 240-243.

Muscle Activation of Chest, Core, Delts & Rotator Cuff When You Bench on Unstable Ground, Calcium Supplementation & Vascular Disease. BMI, BAI , Body Fat & CVD Risk

This week's SuppVersity figure(s) of the week deal with the leading cause of death in the USA (see paper attached to the guy's big toe ;-).

After reading yesterday's installment of the Science Round-Up Seconds, you already know that it is unlikely that you are going to die from prostate cancer.... but let's face it - we all are going to die one day, so if your death is not natural and not due to prostate cancer? What's going to the reason? Well, according to the latest CDC data you, my American friends are going to die from heart disease - ok, not you, a devoted follower of physical culturist, but the average American a devoted follower of Dr. Oz and the sedentary way of living, has an 0.2‰ chance of dying from heart disease and following one of the 597,689 victims the Western way of life claimed in 2010 (CDC. 2011)

Chest presses on an unstable surface - A new staple exercise? Or bogus?

(McHardy. 2013) -- I am not quite sure about the States, but over here in Germany much of the funky news sh*t like squatting on unstable surfaces, benching with your bag on a bogus... ah, pardon bozo ball etc. have literally disappeared from both, the mainstream fitness magazines and the gyms. Heavy iron, machine based circle training and classic, as well as HIIT cardio are what people do, so that the  twenty-seven healthy male subjects from the McHardy study would probably have attracted much attention, when they performed their isometric chest presses at maximal voluntary contraction (MVC), 75% MVC, and 50% MVC on a stability ball.

Figure 1: Exercise specific rel. activation patterns for DB chest presses; data expressed relative to to mean (McHard. 2013)

As it was to be expected the additional task of having to stabilize their trunk and body, lead to a significant reduction in MVC force output of the main, as well as the agonistic muscle groups. The core, on the other hand was trained pretty effectively, especially in the low(er) intensity conditions.

What's somewhat surprising, yet maybe highly relevant and an important argument that would speak against doing your chest presses on a stability ball, though, is the highly significant activation of the infraspinatus, the "small" muscle, most people tend to forget about until they suffer from their first rotator cuff injury.

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Bottom line: Due to an increased risk of injury and non-specificity of the exercise doing shoulder presses on a stability ball is probably useful only as a low weight additional movement used either to warm up or after a primary move like the classic or decline bench presses (learn more about the best chest exercises, here).

Calcium supplementation and vascular disease + Tip: Use Super Tracker

(Dpwning. 2013) --  It is one of those never-ending research stories, the quest for the answer to the (important?) question, whether calcium supplementation increases, decreases or does not influence the risk of cardiovascular disease at all.

As a student of the SuppVersity, you know that casein can build 3.2kg muscle literally overnight (learn more). But did you know that a single serving of one of the best selling casein proteins will satisfy 50% of your daily calcium needs? No? Well, in that case you probably don't know that that both lactose and certain caseinophosphopeptides greatly improve the bioavailability of calcium in dairy products over that of most other natural ans certainly supplemental sources (Cámara-Martos. 2002).

The latest and certainly not last chapter in this never-ending story has just been published in the medical journal Obesity. It is a meta-analysis conducted on 13 observational studies and 9 clinical trials pertaining to calcium supplement use and the risk of adverse outcomes such as cardiovascular disease (CVD), myocardial infarction (MI) that concludes:

"Overall, the benefits of calcium supplementation, including the positive effects on bone health, appear to outweigh the theoretical risk of increased cardiovascular events." (Downing. 2013)

Considering the fact that at least those of you who consume significant amounts (not "one serving") of preferably green vegetables and dairy on a regular basis are not in need of calcium supplements, I'd suggest you leave worrying about questions like this to people who should better look into the overall quality of their diet instead of resorting to supplements to maintain bone and heart health (yeah, low calcium is bad for the heart).

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Bottom line: Supplementation should not be necessary of someone who has both green vegetables and dairy in his/her diet. I would recommend you register a free account over at the USDA's SuperTracker and simply plug in your food choices for a couple of days to see if you get enough calcium and what other nutrients you may or may not be deficient in. Don't be shy, the registration is free - you don't even have to enter an email address and the USDA data base is the best source for accurate information about the nutrient contents of food you will find... just ignore "your plate" and you are good to go ;-)

Surprising superiority of the BMI over BAI as a marker of cardiometabolic risk

Table 1: If you go by the p-values which indicate the statitical significance of the correlations the BMI is even better than DEXA measured body fat percentages; nd. signifies no difference in p-value detected, while BMI and %BF tell you that the respective value is the "better" predictor (Lichtash. 2013)

(Lichtash. 2013) -- Let's get the most important things straight, first. The study we are looking at, here, was conduced on 698 Mexican subjects from 193 families (299 male and 399 female) which represent a cross section through the population of immigrants and the children of immigrants with average body fat percentages of 38% and 25% for female and male participants respectively. We are thus not talking about the average physical culturist, here.

Nevertheless, I personally was quite astonished, to read contrary to the BMI which was associated with all but two measured traits (carotid intima-media thickness and fasting glucose in men) of cardiovascular disease risk the body adiposity index (BAI) which has a 85% correlation with DEXA measured body fat index (Bergman. 2011) "lacked association with several variables" (Lichash. 2013).
 
Now if you come to think about the way the BAI is calculated (formula from wikipedia.com)

It is yet not really so surprising, after all the fat that's stored on the hip and buttocks has long been shown to be ugly and aesthetically displeasing, but not a major concern, when it comes to its impact on your metabolic health. The BIA will thus overestimate the risk of people who carry a relatively high amount of benign body fat and underestimate the risk of abdominally obese men and women, who often have a very low hip circumference.

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Bottom line: The important message of the study at hand is thus not that the BMI was a better, let alone good measure of cardiovascular disease risk, but rather that the BIA, i.e. the raio of hip circumference to body height is an even worse indicator of cardiovascular disease risk for the average (pretty chubby) American with Mexican ancestors.

That's it for today...

... as far as the official short news are concerned. If you want some additional up-to-date information from the realms of health, exercise, nutrition and supplementation sciences, I suggest you visit any of the following SuppVersity Facebook News

• 

  Are you inflamed enough to lose fat? "Inflammation Is a True Fat Burner: BSO-Induced Glutathione Depletion Wards off Fat Gains on Hypercaloric Diet" (read more)

  Chronically fatigued? Maybe you are just lacking the HDL to get the cholesterol into the adrenal gland!? | read more
• Who is to blame for the obesity epidemic? If you ask the public, the obese are primarily to blame | see more
• Meta-analysis shows: Neither high nor low fat diets have definite beneficial effects on blood lipids | learn more 
• Further evidence for the involvement of antioxidants in the proliferation of cancer. They are the ones that help the cancer cells to survive | freak out 
• Want to lose 15% chest & ab fat and 10% of the subcutaneous fat on your thighs? Do some ultra endurance cycling | believe it or not
  

and/or come back later to check for the latest updates on Facebook or Sunday's SuppVersity article. Have a nice weekend, everyone!

References:

• Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RM. A better index of body adiposity. Obesity (Silver Spring). 2011 May;19(5):1083-9.  
• Cámara-Martos F, Amaro-López MA. Influence of dietary factors on calcium bioavailability: a brief review. Biol Trace Elem Res. 2002 Oct;89(1):43-52. 
• Downing L, Islam MA. Influence of calcium supplements on the occurrence of cardiovascular events. Am J Health Syst Pharm. 2013 Jul 1;70(13):1132-9.
• Lichtash CT, Cui J, Guo X, Chen YD, Hsueh WA, Rotter JI, Goodarzi MO. Body Adiposity Index versus Body Mass Index and Other Anthropometric Traits as Correlates of Cardiometabolic Risk Factors. PLoS One. 2013 Jun 11;8(6):e65954. 
• McHardy, RD. An Electromyographical Analysis Of Shoulder And Trunk Muscles During Chest Press On Stable And Unstable Platforms. Thesis submitted to the Texas State University-San Marcos. August. 2013.

Increasing Adolescent Obesity Among Girls: How School Stress is the New Scapegoat When the Skinny Fat Phenomenon and Twinkie Diets Really are to Blame.

Image 1: Was it school stress that cost Michelle Obama her famous "guns" (=muscular upper arms)? Probably not - and despite contrary conclusions in the study at hand, I doubt that it is school stress that leaves our daughters fat, but undermuscled. What do you say?

According to the results of a recent evaluation of the data from the European HELENA trial, school, or rather the stress your children are exposed to within the educational system, may be one of the reasons for the increasing number of obese adolescents (age 12-18 years) - at least if we trust the statistical finesse of Tineke De Vriendt, Els Clays and 10 other scientists who recently published a paper on European adolescents’ level of perceived stress and its relationship with body adiposity in the European Journal of Public Health (DeVriendt. 2011). The study was part of the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (HELENA-CSS), the aim of which is to obtain "reliable and comparable data from a selected cohort of European adolescents concerning a broad variety of parameters related to nutrition, health, physical activity and fitness", or in other words, to provide the epidemiological back-bone for the formulation of more or less mainstream hypotheses on "why we are getting sick and obese"... be that as it may, with a sample size that allows for a confidence level of 95% and <0.3 error and 3865 adolescents from more than 10 European cities, the data from the HELENA study is probably the best we can get at the moment and thus you may nonetheless be interested to hear that ...

School-related stress was demonstrated to be a main source of stress in European adolescents, [...and] in adolescent girls (but not in boys), a positive association was observed between their level of perceived stress and measures of general and abdominal obesity.

If you have a closer look at the stress data, expressed on a 6-scale Likert scale from 1 = ‘Not at all stressful’ over  2 = ‘A little stressful’, 3 = ‘Moderately stressful’, 4 = ‘Quite stressful’ to 5 = ‘Very
stressful’ (with 6 indicating ‘Is irrelevant to me’), you will notice that school and the closely related fear of an "uncertain future" are in fact the major stressors in the life of our adolescent children (and you may safely assume that the results won't be very different in the US).

Figure 1: Overview of perceived stressors; values expressed on a Likert-scale from 1 to 5 (data adapted from DeVriendt. 2011)

In that, it is yet interesting to observe that none of the stressors is on average perceived as "quite stressful" or even "very stressful". It is also noteworthy that on 5 out of 10 scales and on the summary scores girls experienced more stress than boys. In view of the scientists previously cited conclusion (of which I do not have to tell you that it is based on one of those sophisticated *cough* statistical models) that only "in adolescent girls (but not in boys), a positive association was observed between their level of perceived stress and measures of general and abdominal obesity", it may thus surprise you to hear that the obesity rate among boys is more than 2x higher than among adolescent girls (cf. figure 2). So how is that?

Figure 2: Body adiposity characteristic of study sample (n=1121) of adolescents from the HELENA trial (data adapted from DeVriendt. 2011)

Well, we all know that even with a perfectly "normal" BMI, you can easily be "skinny fat". A phenomenon of which I feel that it is becoming the norm, not the exception, among adolescent girls, who - after their nth an-apple-a-day diets have lost nothing but muscle and thus have a very high body-fat percentage with a low overall body-weight.

This hypothesis would be confirmed by the regression coefficients of the statistical models from the study, according to which the association of perceived stress with the body fat level of the girls is 7x higher than the association of perceived stress and BMI, which is something that should you make reconsider, whether

1. body weight and BMI is an important biological measure, at all,
2. the real "obesity" rate, including skinny fats, among girls is not way higher than the 1.9% reported in the study would suggest, and
3. in how far school-stress, despite being the "major stressor" in this survey and not a misguided beauty-ideal is to blame for the increasingly unbalanced ratio of lean to fat mass in adolescent girls

The importance of the latter, i.e. a questionably beauty-ideal, in the etiology of (and this would be ironic if it was not so unfortunate) diet-induced obesity could also explain that the pubertal stage the girls were in and not stress or their diet had the greatest "explanatory value" (remember: we are talking of associations here) in regard of their body fat levels (cf. figure 3).

Image 2: Low self-esteem and false beauty-ideals pave the way into disordered eating and life-long misery. Something you want to spare your daughter and son, don't you?

Did you know that according to a 2000 national survey 45% of the girls, but only 20% of the boys from 5th to 12th grade reported to have tried one or more diets at some point in the past (Neumark-Sztainer)? And would you have guessed that 17% did even consider their own eating behavior as already "distorted"? Needless to say that both of these factors showed a high correlation with overweight status, low self-esteem, depression, suicidal ideation, and substance use; and certainly reason enough for you to help our children (girls and boys) not to fall victim to ill-advised beauty-ideals and false dietary recommendations.

And from the fact that the same variable had 7x less predictive value in boys, who obviously do not want to be skinny fat and refrain from Twinkie-style low calorie, low fat dieting, we can with some caution (due to hormonal effects on fat accumulation) conclude that it is not just a time factor, meaning that the older girls have more time to accumulate body fat...

Figure 3: Regression coefficients (=associative strength*100) of stress or pubertal stage with body-fat percentage in adolescent boys and girls from the HELENA trial - mind the logarithmic scaling! (data adapted from DeVriendt. 2011)

Now, what can you do about that? Well, without even knowing you probably have already done something! Assuming that you (just like every other reader of the SuppVersity ;-) are of above-average intelligence, your education has already provided your daughter, but not your son, with a better chance of staying lean than her peers from less educated parents (~80x higher explanatory value than stress!). All that is left now to make absolutely fat-proof, is to tell her that strong, not skinny fat is the new beautiful ;-)

The Hair-to-Belly Cortisol Connection: Hair Analysis As Reliable Tool for Longterm Cortisol Analyses

Figure 1: 3D model of molecular
structure of cortisol (Wikipedia)

Although cortisol is probably one of the most important hormones, and a lack of cortisol will provoke symptoms which can range from simple fatigue to death, chronically elevated levels of this essential corticosteroid are associated with increases in visceral obesity and its entailing metabolic pathologies, which are commonly described as "the metabolic syndrome". The results of a very recent study (Manenschijn: 2011), that was published in the medical journal Steroids, may thus turn out to be a valuable tool in the a:nalysis of the underlying causes of pathological obesity and its consequences.

Manenschijn et al. collected hair samples of 195 healthy individuals, 9 hypercortisolemic and one hypocortisolemic patient and measured the cortisol levels in the hais and saliva of their subjects. They then correlated the data with waist and hip circumferences, as well as blood pressure values of 46 of the healthy subjects and found:

[...] a positive correlation between hair cortisol and both waist circumference (r = 0.392, p = 0.007) and waist-to-hip ratio (WHR) (r = 0.425, p = 0.003). No correlations were found between hair cortisol levels and BMI, blood pressure or age. There was no decline in cortisol levels in six consecutive hair segments. Hair cortisol levels were elevated in patients with known hypercortisolism (p < 0.0001).

This is an interesting result. On the one hand, it does show that hair analysis may serve as a valuable tool in the assessment of longterm cortisol levels (as long as confounding factors, as washout effects due to certain shampoos and other hair care products are taken into consideration), on the other hand, however, it raises the question whether the well accepted association between stress, high cortisol and elevated blood pressure is practically relevant, if longterm cortisol levels remain within certain "healthy" limits.

Even Individuals on a "Healthy" Diet May Benefit from Supplemental Fiber

Fiber has been advertised for years as a universal health promoter. It curves appetite, reduces cholesterol and improves digestion - but is it really necessary to supplement with additional fiber, if your intake in fibrous veggies etc. is already high? A recent study by scientists from Australia (Pal. 2010) suggests that it may not be necessary, yet beneficial.

Figure 1: Changes in body weight (A); BMI (B); % body fat (C) and waist circumference (D).
From left to right: Control, FIB, HLT, HLT-FIB

Studying a cohort of 72 overweight and obese individuals with a BMI between 25 and 40 kg/m² and age between 18 and 65 years, the researchers found that over a time period of 12 weeks in which the subjects either practiced their "normal" eating habits or changed to a healthy food diet (HFT), supplemented with fiber (FIB) or switched to a healthy food diet that was supplemented with fiber (HFT-FIB)...

[...] weight, BMI and % total body fat were significantly reduced in FIB and HLT–FIB groups, with weight and BMI significantly reduced in the HLT group compared with control at 12 weeks. HLT–FIB and HLT groups had significant reductions in TAG and insulin compared with control at 6 and 12 weeks, and in insulin compared with the FIB group at 12 weeks. The HLT–FIB, HLT and FIB groups all had significant reductions in total cholesterol and LDL-cholesterol compared with control after 6 and 12 weeks.

As can be seen from figure 1 (above) the addition of fiber to an already healthy diet did in fact improve the overall beneficial results of the change in dietary habits. Bottom line: Firstly, eat healthy! Secondly, consider using a fiber supplement only if your diet is already in check.

Zinc Supplementation Helps Prepubescent Children with Metabolic Syndrome

Zinc ain't for bodybuilders, only! In a double blind placebo controlled crossover study Kelishadi et al. (Kelishadi. 2010) supplemented prepubescent obese children with metabolic syndrome with 20mg of elemental zinc to evaluate the effects of zinc supplementation on anthropometric measures and blood pressure, fasting plasma glucose, lipid profile, insulin, apolipoproteins A-1 (ApoA-I) and B, high-sensitivity C-reactive protein (hs-CRP), leptin, oxidized low-density lipoprotein (ox-LDL), and malondialdehyde:

Irrespective of the order of receiving zinc and placebo, in both groups, significant decrease was documented for Apo B/ApoA-I ratio, ox-LDL, leptin and malondialdehyde, total and LDL-cholesterol after receiving zinc without significant change after receiving placebo. In groups, hs-CRP and markers of insulin resistance decreased significantly after receiving zinc, but increased after receiving placebo. In both groups, the mean body mass index (BMI) Z-score remained high, after receiving zinc, the mean weight, BMI, BMI Z-score decreased significantly, whereas these values increased after receiving placebo.

So, if you do want to do you or your obese children a favor, I suggest, you go grab some zinc supplements. BUT, do not overdo it; as with all good things, too much of a good thing may actually be bad for you, cf. "Zinc, all that glitters is not gold".