Whether you super-sized a meal, counted carbs, or read a nutrition label, you were one of millions of Americans who looked at their food as well as their waistlines a bit differently in 2003.
In the past year, Americans added terms such as "low-carb" and "trans fat" to their vocabulary, yet the country's epidemic of obesity continued to explode. One in three adults in the U.S. is now classified as obese, weighing in at about 30 pounds more than he or she should.
If you're wondering where those extra pounds are coming from, you don't have to look much further than your plate. Portion sizes have doubled and even tripled in recent years, and it's no coincidence that the average restaurant plate has also grown from 9 to 14 inches in diameter.
The Low-Carb Craze
Those added calories quickly become fat, and in 2003 people looking for the next magic bullet turned in record numbers to low-carbohydrate diets to help them lose the weight.
Modern carbohydrate counting may have started with the Atkins diet, but it reached a fever pitch in 2003 with the emergence of the South Beach Diet. The book, The South Beach Diet: The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss, was published in April 2003 and has been near the top of the New York Times Best-Seller list ever since.
The South Beach diet follows many of the same low-carb principles as the Atkins diet but groups carbohydrates into "good" and "bad" categories based on their glycemic index, a measure of how foods affect your blood sugar.
Dena Bravata, MD, senior research scientist at Stanford University, conducted a study evaluating the research on low-carb diets, which was published in the Journal of the American Medical Association earlier this year.
She says that although studies released this year show that low-carb diets are relatively safe and effective in promoting short-term weight loss for many people, the jury is still out on the long-term effects. Nor has any study evaluated the impact of these diets on people over age 50.
"That said, in the short term and for people under that age, low-carb diets are clearly an effective means of weight loss for many people, and there is no evidence of harm in terms of cholesterol, diabetes measures, and high blood pressure," Bravata tells WebMD. "Whether weight loss is sustainable over time is not really understood."
"The evidence about low-carb diets is that the reason why people lost weight is not because they were restricting carbs but because they restricted calories," says Bravata.
She says there is also little evidence that the glycemic index of a food or how it affects your blood sugar plays any significant role in weight control.
The food and restaurant industry responded to the growing popularity of Atkins and other low-carb diets with new menu options and a flood of low- and reduced-carbohydrate versions of traditionally carbohydrate-rich products such as candy, bread, and even beer.
Nutritionists say these tempting new offerings may get low-carb dieters into trouble because the carbs have been taken out of the once-restricted foods but not the calories.
Cindy Moore, MS, RD, director of nutrition therapy at The Cleveland Clinic Foundation, says she's also concerned about the recent demonization of carbohydrates. Rather than making all carbohydrates out to be the enemy, she says there are both good carbohydrates, such as whole grains and fruits and vegetables, and bad ones, such as refined sugars.
"The marketing is way ahead of the science," says Moore. For example, she says there isn't a FDA standard for what "low carbohydrate" means because it's not clear that carbohydrates are something people need to limit in their diets such as sodium or cholesterol.
Many fast food chains expanded their offerings of meal-sized salads in 2003, but that didn't stop them from piling on the bacon or extra beef into their sandwich offerings. Despite the hype, experts say excess is still the rule when it comes to restaurant portion sizes.
"I know that there has been a lot of talk about reducing portion sizes," says Nelda Mercer, RD, spokeswoman for the American Dietetic Association. "But I don't think we've experienced it."
"We still have a really long way to go," says Mercer. "It's still the super-size mentality."
Not only have restaurant portions grown out of control, but the size of pre-made and packaged foods at the store have also swelled.
A study released in January showed that typical marketplace portions of many popular foods and beverages now exceed federal recommended serving sizes by as much as eight times. For example:
- Bagels: The typical bagel from a bagel shop is now five times larger than it used to be and up to 6 inches in diameter -- a far cry from the fist-sized bagel first introduced to the U.S. by Jewish émigrés.
- Snacks: What used to be a small, snack-sized bag of potato chips has grown into a "grab bag" that often contains several servings.
- Drinks: Bottled sodas, fruit drinks, and other beverages are also filled with two to three times the standard 8-ounce serving.
- Candy: The smallest single-sized Hershey bar has grown from 0.6 ounces when it was introduced in 1908 to double that today and is also available in sizes up to eight times as large.
To help ease the confusion, FDA officials said they're now considering forcing companies to base nutritional information for some of these items on the container size rather than serving size to give consumers a better idea of how many calories they're getting.
Trans Fat Fervor
In July 2003, the FDA announced the first major change to its nutrition facts label since it was introduced in 1993 by requiring food manufacturers to include information on the amount of trans fatty acids, or trans fat, in foods.
The rule goes into effect in 2006, and manufacturers are already incorporating the change into their labels. But interpreting that new information is going to be up to consumers
Trans fatty acids are the result of a process called hydrogenation that converts a relatively healthy, unsaturated liquid fat, such as vegetable oil, into a solid one, to make the product shelf stable and stay fresh longer. When the fat becomes solid, the body treats it more like a saturated fat, such as butter or animal fat.
Trans fats are frequently found in the same foods that contain other types of fat, such as cookies, crackers, fried foods, donuts, and margarine sticks.
Because the government hasn't established a recommended daily amount for trans fat, Moore says there won't be a percentage daily value listed to guide them on the nutrition facts label.
Instead, people will have to judge for themselves how much trans fat is too much. A 2002 report from the Institute of Medicine recommends that Americans keep their trans fat intake as low as possible.
"The only number that we have to go on is the average trans fat intake that Americans now consume, which is 5.8 grams per day," Moore tells WebMD. "All we can really say is try to keep track of foods you are eating that contain trans fatty acids and try to keep it below that level."
Moore says it's also important to watch for the words "hydrogenated" or "partially hydrogenated" on the ingredient list because manufacturers can indicate "0 trans fat grams" on the label if the product contains less than 0.5 grams per serving.
"If someone is routinely eating more than a serving's worth of the product, those grams could mount up," says Moore.
Some snack-food manufacturers and fast-food chains have already announced plans to lower the trans fat content of their products before the law goes into effect, and Moore says more will likely follow suit.
"Manufacturers want to include trans fat information, but they don't want to include it unless it's going to be good news," says Moore.