TIME Sports

Watch This Freshman Win Free Tuition With an Amazing Half-Court Shot

That throw was money. Literally

An incoming freshman won free tuition in the best way possible: sinking a half-court free throw in front of a crowd of his peers.

Ball State University knows how to put on a pep rally. To inspire support for the school’s teams, for the past three years administrators has offered a free semester of tuition to the first student who sinks a half-court shot at Worthen Arena. This semester, the lucky student who won’t get a bill is Lem Turner of Illinois. Watch the amazing throw that led to a free ride.

TIME Love & Relationships

Why Women Are More Likely to Ask for a Divorce

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A new study suggests women are more likely than men to initiate a divorce in opposite sex relationships, but the same isn't true for non-marital relationships. If men and women were living together without marrying, each gender was equally likely to initiate a breakup

In a presentation to the American Sociological Association, researchers report that women are more likely than men to ask for divorce. But non-marital breakups are more gender neutral.

The results came from an analysis of the aptly named “How Couples Meet and Stay Together” survey, collected from 2,262 adults with opposite sex partners who answered questions about their relationship status between 2009 and 2015. Women initiated 69% of divorces, compared to 31% of men. But if men and women were living together without marrying, each gender was equally likely to initiate a breakup.

Almost all studies to date have shown that women are more likely to ask for divorce, the study’s lead author, Michael Rosenfeld, said in a statement. An associate professor of sociology at Stanford University, Rosenfeld said that social scientists assumed that women’s heightened sensitivities to the ups and downs of relationships would mean they were more likely to leave both marriages and non-marital unions.

But the latest data suggests that perhaps there’s more involved. Women may be responding to the still arcane conventions of spousal roles, which contrast with growing equality in other institutions, such as the workplace. “I think that marriage as an institution has been a little bit slow to catch up with expectations for gender equality. Wives still take their husbands’ surnames, and are sometimes pressured to do so. Husbands still expect their wives to do the bulk of the housework and the bulk of the childcare,” he said in the statement. “On the other hand, I think that non-marital relationships lack the historical baggage and expectations of marriage, which makes the non-marital relationships more flexible and therefore more adaptable to modern expectations … of gender equality.”

TIME Cancer

A Major Shift in Breast Cancer Understanding

Surgery
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A new study shows that previous assumptions about early breast lesions called ductal carcinoma in situ, or DCIS, may have been off the mark

—Breast cancer experts have been in a tumult in recent years over something called ductal carcinoma in situ (DCIS). These lesions, usually very small, are starting to emerge more frequently in mammograms that are better able to pick out even the smallest aberrations in breast tissue. But cancer doctors aren’t agreed on how significant DCIS actually is.

Technically labeled as a stage zero cancer, some experts don’t believe they are tumors at all, but pre-tumors, since the growths have not expanded beyond the milk ducts. In fact, a National Cancer Institute working group in 2013 recommended that the name “carcinoma” be removed from DCIS to highlight the fact that the lesions aren’t quite malignant, and therefore may not need the more aggressive treatment that cancers would warrant.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

But the latest study shows that thinking may be wrong. DCIS may not be as benign as doctors once thought.

In order to tease apart how a DCIS diagnosis and its treatment affects death from breast cancer, researchers reporting in in JAMA Oncology reviewed records from 108,196 women, the largest number yet in a study of DCIS. The large number was important to see if the number of deaths from DCIS made the findings statistically significant. Overall a diagnosis of DCIS was associated with a higher risk — 3% — of dying of breast cancer in 20 years compared to women who didn’t have the cancer. This risk was highest for younger women (diagnosed before age 35) and for black women.

But when the researchers looked more carefully at the women with DCIS, their rates of breast cancer recurrence and their death rates, they found that those getting surgery and radiation or just surgery did indeed lower their risk of getting a recurrent cancer, but did not reduce their risk of dying from breast cancer.

MORE: Here’s the Amount of Exercise That Lowers Breast Cancer Risk

That suggests that the DCIS may be not be pre-cancerous lesions, but more cancerous than doctors thought, says the study’s lead author Dr. Steven Narod, from the Dalla Lana School of Public Health at the University of Toronto. Surgery, surgery with radiation, and even mastectomy do nothing to lower the 3% risk of dying of breast cancer in 20 years once a woman receives a DCIS diagnosis. “These women are not dying of DCIS. They die the conventional way from breast cancer — because it spreads to the bones, liver and lungs. The women who die of DCIS died because their breast cancer already spread by the time they received treatment,” says Narod.

That’s a complete shift in thinking about DCIS. And could potentially result in a dramatic change in the way women diagnosed with DCIS are treated. If the results are confirmed, and treatments do not lower the risk of death from breast cancer, then would surgery, or surgery and radiation still be worth the side effects and complications of that these interventions carry? In an editorial accompanying the study, cancer experts from University of California San Francisco argue that radiation should not be routinely given to every woman diagnosed with DCIS and undergoing surgery to remove the lesion. More research, they say, is needed to find better ways to distinguish DCIS lesions, possibly by their genetic makeup, into those that are more or less likely to have spread.

TIME Obesity

A Fat-Burning Gene May Help Weight Loss

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Allen Donikowski—Getty Images/Flickr RF

There are many ways to get rid of excess fat, most of them involving diet and exercise. But scientists have identified a gene that may do the trick without all that effort.

A Holy Grail of fat—one that can turn more quickly into energy and melt away without building up in those unwanted bulges—is actually backed by some intriguing evidence. The trouble is, it’s hard to find in most adults. It turns out we have more of the less desirable kind, the white fat that accumulates around the middle and in our tissues, that potentially leads to dangerous health problems.

Now, scientists reporting in the New England Journal of Medicine report that they have connected the dots between the strongest gene associated with obesity and a way to make white fat more active. The idea is to literally give white fat fewer couch potato tendencies and help it more actively burn energy, more like the so-called brown fat that’s in such short supply.

MORE: This New Drug Turns ‘Bad’ White Fat Into ‘Good’ Brown Fat

The researchers, led by Melina Claussnitzer and senior author Manolis Kellis from the Massachusetts Institute of Technology (MIT) and the Broad Institute of MIT and Harvard, say that the key lies in an intermediate type of fat that experts have dubbed “beige fat”. While brown fat, often found in higher amounts in newborns and concentrated in the parts of cells that are responsible for generating energy, comes from entirely different cellular lineages than white fat, beige fat and white fat share more in common. By studying cells from people with mutations in an obesity gene called FTO, Kellis found that their cells contained certain mutations that inhibited the formation of beige fat. But by manipulating the mutations, he was able to both turn white fat cells into beige cells as well as increase the proportion of early fat cells that developed into beige cells (rather than white fat).

MORE: Why Brown Fat May Be the Key to Weight Loss

The net effect is a composition of fat cells that is more amenable to generating energy and heat, and less inclined to sequester into fat stores. Kellis further tested the theory by manipulating the genes in question in mice, and found that they could adjust the amount of obesity or leanness by reformulating the proportions of white and beige fat cells. In fact, they can reduce the amount of white fat by a factor of seven, give or take.

“What these results say is that we can reprogram all the major fat stores in humans by intervening in this particular pathway,” he says. “We can manipulate the process that makes [pre-fat] cells become either white fat cells or beige fat cells. That dramatically changes the picture.”

Fat cells take about four to five days to fully mature from pre-fat cells, and by intervening in this process, it may be possible to tip the balance in favor of the more energy-consuming beige fat over the fat-storing white fat.

The next step will be to manipulate these genes and this pathway in human patients—likely those who carry the mutations that predispose them to obesity—to see if the intervention has an effect on their weight and fat composition.

TIME Cancer

How Doctors Cured This Woman’s Brain Cancer

MaryAnn Anselmo Memorial Sloan Kettering
Christopher Morris—VII for TIME MaryAnn Anselmo in New York City on March 13, 2015

Earlier this year, TIME explored the promise of precision medicine in treating cancer patients. We featured one woman who was taking a drug typically used for melanoma to treat her brain tumor. Here’s an update on how she’s doing

In November 2013, MaryAnn Anselmo—who was on the cover of TIME in March—heard the words that most of us dread the most: she had cancer. Worse, it was stage 4 glioblastoma, a particularly aggressive brain tumor that often takes a patient’s life in a matter of months. Having just recovered from a devastating car accident, Anselmo thought, “Somebody wants me dead here.”

Nearly two years later, the New Jersey resident is receiving some completely different, and more welcome news. “The latest scan doesn’t show any tumor any more,” her physician, Dr. David Hyman, acting director of Developmental Therapeutics ad Memorial Sloan Kettering Cancer Center (MSKCC), tells TIME. The results from Hyman’s most recent study, which Anselmo participated in, is published in the latest issue of the New England Journal of Medicine (NEJM).

“I’m tired all the time,” she says, “but I’m dealing with it, living with it. I feel awesome compared to what this tumor could have done to me.”

MORE: The Cancer Gap

Hyman is reluctant to call it a “cure” for certain cancers—the burden of proof is higher than this one study or this one patient—but Anselmo’s cancer is gone. And for that, Anselmo can thank something called a basket trial, a new way for doctors to test promising cancer treatments that more precisely target the right therapies to the right patients at the right time. This is the first such trial of its kind.

The trial puts the idea of precision medicine to the test. At 23 cancer centers around the world, 122 patients with advanced cancer signed up for a last-resort treatment covered in the new study. All had their tumor genomes sequenced, so doctors could get a better sense of which mutations were driving the cancers, and whether there were any targeted therapies for those mutations.

Anselmo had three mutations fueling the growth in her brain, but she and her doctors at MSKCC decided to focus on one, called BRAF. A recently approved drug to treat BRAF mutations in melanoma helped shrink or halt tumor growth in half of treated patients, so doctors wanted to know whether the drug could help patients with the same mutation but with different kinds of cancer, like Anselmo. But while BRAF mutations occur in about 50% of melanoma cases, they are much rarer in other types of cancers. So creating a trial for patients like Anselmo would take both time and money that researchers couldn’t justify.

A basket trial, however, capitalizes on the growing understanding that cancers should be characterized by not just where they start (in the breast, colon or lung, for example) but also by how they grow — which mutations are driving them. A basket trial collects patients, all of whom have BRAF mutations, for instance, but who might have different types of cancer.

In the NEJM study, patients with non small cell lung cancer, colon cancer, thyroid cancer, multiple myeloma and, glioblastomas, among others, were included. By studying them as a group, Hyman says it’s possible to get a better idea of how feasible it is to target mutations like BRAF among those who don’t have melanoma.

So far, the results are encouraging. Patients with non small cell lung cancer seemed to have the best response rate to vemurafenib, 42%, after a year. More than 70% of the patients with this cancer saw their tumors shrink by at least 30% in length. There were promising signs that patients with the other, untreatable cancers also responded and took longer before their tumors progressed than they would have without the experimental therapy.

Anselmo was among the extraordinary responders. “It is unusual,” says Hyman of the apparent shrinkage of her tumor. “She really is an outlier in any way you measure it.”

NEJM 373; 8; 2015. Courtesy Dr. David Hyman: Anselmo’s brain tumor at the start of the study in 2014 (left) and on Aug. 11, 2015 (right)

But it’s precisely for patients like Anselmo that basket trials are being considered — the possibility that there may be one, two or however many patients who, rather than facing a poor prognosis with existing or non-existent options for treating their disease, may have a chance, however small, of living longer and even controlling their cancer.

“One of the things that gets lost when we talk averages and medians is how many patients benefit and for how long,” says Hyman. “There is a tremendous range and a concern that promoting the best successes sets the bar very high. But it also lets people know that things are not entirely hopeless, that there are people who have tremendous benefit from therapies and not get completely caught up in medians and averages.”

That being said, Hyman cautions that more work needs to be done to better apply the principles of precision medicine to improve patients’ outcomes. Since most tumors have many mutations, how can doctors determine which one, or ones, to target with drugs? Why do some patients respond very well, while others do not?

Another looming question has to do with how cancer doctors can start to incorporate what they are learning about mutations and cancer-causing pathways with their more traditional knowledge based on where tumors start. In the study, for example, patients with BRAF colon cancers did not respond to vemurafenib; but some started to show responses when vemurafenib was combined with another drug, cetuximab. That suggests that knowing where the cancer originates may still be an important part of the puzzle in figuring out which treatments might work best for which types of cancers.

In an editorial accompanying the study, researchers at the T.H. Chan Harvard School of Public Health and Boston University note that basket trials may be just the first step in a precision medicine approach to cancer. Once doctors figure out which types of cancers might respond best to, for example, a BRAF-focused drug, they might conduct additional trials on each of these cancers to determine which patients, like Anselmo, would benefit most.

For her, the trail has provided the chance to sing again. A jazz vocalist, she performed at a friend’s birthday party and attended a song-writing retreat in upstate New York. She makes weekly visits to her doctors — to the dermatologist to monitor any side effects from the drug, to Hyman every two months for a brain scan, and to get lab tests done to check on her immune system. And she’s tired all the time. “But that’s par for the course,” she says. “I’m just lucky to be alive at a time when cancer care is so different than it was years ago. Who would have known that treatments could be so customized? It’s so amazing, and I’m very thankful to be a part of it.”

 

TIME Cancer

The Connection Between Light Drinking and Cancer: Study

healthiest foods, health food, diet, nutrition, time.com stock, red wine, alcohol
Danny Kim for TIME

The latest study shows how much alcohol is linked to a higher risk of developing certain cancers

Researchers say that indulging in as little as one drink a day for women and two drinks daily for men can boost the risk of breast, colon, oral, liver and esophageal cancers. But the risk was higher for men who smoked, even those who had quit, than for non smokers.

Scientists at the Harvard T. H. Chan School of Public Health and Brigham and Women’s Hospital report in the BMJ on a review of nearly 136,000 men and women enrolled in studies that followed their health-related behaviors and outcomes for 30 years. Overall, those who drank more showed a higher risk of alcohol-related cancers, which wasn’t surprising, given that over-indulging can promote abnormal growths in certain organs like the liver.

MORE: 5 Things You Need to Know About Alcohol, Backed By Research

But what was more surprising was that, according to their observations, it didn’t take much. Previous studies have focused on heavy drinking, while the current analysis looked at light to moderate drinking. Among women, up to one drink a day contributed to a 13% higher risk of developing alcohol-related cancers, primarily breast cancer. For men, up to two drinks a day also increased the risk of certain cancers, but only for those who had smoked. Non smoking men didn’t show any higher risk.

The results suggest that smoking may be an important contributor to certain cancers, especially in combination with alcohol. In fact, says Yin Cao, a post doctoral research fellow at the School of Public Health and lead author of the study, it’s enough to consider becoming even stricter when it comes to imbibing. “For men, especially those who ever smoked, they should limit alcohol to even below the recommended limit,” she says. “And smoking and heavy alcohol consumption should be absolutely avoided to prevent cancer.”

 

 

TIME Reproductive Health

Premature Births Linked to Certain Bacteria

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Phil Schofield—Getty Images/Photographer's Choice

One of the contributors to preterm birth may be the myriad communities of microscopic residents living in mom

We know that microbes are everywhere, coating door handles, our cell phones, even blanketing our skin. Now researchers report that some of them may provide clues about why certain babies are born prematurely.

In the most complete look yet at how the microbes that live within us—most of them the good, non-disease-causing kind—change during pregnancy, scientists report in the Proceedings of the National Academy of Sciences that there may be a particular profile of bacteria residing in the vagina that is associated with a higher risk of preterm birth.

Dr. David Relman, professor of medicine at Stanford University and chief of infectious diseases at the VA Hospital in Palo Alto, and his colleagues obtained samples of microbes from 49 pregnant women from four different body sites — the vagina, the gut, the saliva and the tooth and gum line. The samples were collected weekly throughout their pregnancies, and then monthly for a year after they gave birth. The database allowed Relman and his team to look for any changes in the makeup of the bacteria that were present in these areas as the pregnancy progressed and then after delivery.

MORE: Your Diet May Be Causing Your Urinary Tract Infections

Overall, they found that pregnant women did not differ from women who weren’t pregnant in terms of the types of bacteria they harbored — most fell into one of five common profiles, four of which include high proportions of Lactobacillus, a helpful bacterium that produces vitamin K and breaks down the lactose in diary products. That was a bit of a surprise, given the dramatic hormonal and metabolic changes that occur with conception and gestation, says Relman. But he notes that while the members of the communities may be the same, what they do, and the factors they release (which he couldn’t analyze in this particular study) may change with pregnancy .

MORE: Here’s How Many Bacteria Spread Through One Kiss

But they did notice some bacterial similarities in the women who has a preterm birth. Women with this profile housed a more diverse array of bacterial species, including Gardnerella and Ureaplasma. While these don’t normally cause disease, they have been associated with conditions such as bacterial vaginosis, an infection of the vagina, and inflammation of the urethra in men.

Exactly why or how the presence of these species, and the relative lack of Lactobacillus, are linked to the higher rate of preterm birth isn’t clear yet. But the findings confirm other studies that have linked the presence of more some species to premature birth. Gregory Buck, director of the center for the study of biological complexity at Virginia Commonwealth University and member of the Vaginal Microbiome Consortium funded by the National Institutes of Health, notes that certain racial and ethnic groups, such as African-Americans, tend to have more diverse microbiota, and that preterm births are more common in these populations than among Caucasians. But, he notes, these are only pieces of the bigger picture of how the bacteria that live within us affect our health. “We have a lot of questions, and I don’t think the answers are all there yet but we are working on it,” he says.

Relman says that the documentation of which bacteria are present throughout pregnancy is an important step toward answering those questions. “It is important to know who is there, what their names are,” he says. “But that’s only a small part of the story. We also want to know what they are doing, with whom they are doing it, and how they are doing the things they’re doing.”

MORE: Probiotics Primer: What Science Says About Using Bacteria to Treat Disease

Ultimately, the goal is to use that information to better predict which women might be at higher risk of having a preterm birth. And if the role of microbes is strong enough, it may be possible to even intervene with antibiotics or probiotics to adjust the composition of the microbial communities. “The Holy Grail is to find some kind of intervention to predict and prevent preterm birth,” says Buck. “But there is a lot of ground to cross between now and then, so it’s hard to say exactly what that intervention might be.”

Relman may have some of the tools to answer that question: from this study, his group collected more than 100,000 samples that they hope will form the basis of future studies to better understand how the invisible residents that populate the vagina, gut and oral cavities might be influencing pregnancy and pregnancy outcomes.

TIME Diet/Nutrition

This Is the Worst Kind of Fat for Your Heart

High in fat
Mark Poprocki—Mark Poprocki

Not all fats are created equal, and the latest study shows that one in particular can lead to higher rates of heart disease, deaths from heart related problems, and diabetes.

As confusing as the diet message can be at times, one thing is clear. There are good fats and bad fats in the foods we eat, and some can really wreak havoc on the heart and its delicate vessels.

In a study published in the BMJ, scientists say that trans fats are linked to the highest rates of death from all causes, deaths from heart disease and heart problems. The trans fat risk surpassed even that associated with saturated fat, which is found in formerly taboo-for-the-heart foods like butter, eggs and red meat.

Russell de Souza, a dietician and epidemiologist from McMaster University, and his colleagues sifted through the published studies involving hundreds of thousands of participants on trans and saturated fats and their health effects. They found that those eating more trans fats had a 34% higher rate of dying from any cause compared to those eating less, a 28% higher risk of dying from heart disease, and a 21% greater risk of having heart-related health issues.

MORE: This Is Why FDA Is Banning Trans Fats

In contrast, eating saturated fat was not linked to a higher risk of early death, heart-related problems, stroke, or type 2 diabetes.

That doesn’t mean, however, that saturated fats now get a green light. de Souza points out that many people who try to cut back on saturated fats tend to substitute them with less healthy fats like those from margarine or with carbohydrates, which can contribute to heart disease. So while saturated fats when compared to trans fats did not substantially increase heart disease risk, that doesn’t mean saturated fats are actually heart healthy. It’s just that in the hierarchy of heart-friendly fats, trans fats are the worst and saturated fats are the next worst. “We didn’t find any evidence for increasing the allowable amount of saturated fat in the diet,” says de Souza.

MORE: Trans Fats Are Hiding All Over Your Grocery List

The group that showed the lowest risk of early death or heart disease were those who consumed the most vegetable oils such as olive and canola. “If there is one message to go away with from these results, it’s that substituting saturated and trans fats with whole grains and vegetable oils is a step in the right direction,” says de Souza.

The results, he says, support current dietary guidelines for how much of different types of fats people should eat to maintain healthy hearts and lower their risk of chronic diseases. For now, he says, the advice to consume no more than 10% of daily calories in saturated fat and to limit trans fats to less than 1% of calories, is reasonable.

TIME Exercise/Fitness

How Coke Is Subtly Blaming You for Obesity

SEC Launches Investigation Into Coca-Cola's Earnings History
Justin Sullivan—Getty Images

Which is more important for weight loss: diet or exercise? While science has one answer, soda manufacturers have another

For years the message from medical experts to the increasingly hefty American population has been the same—watch what you eat, and exercise. But since everybody eats, but not every person is physically active, the focus has really been more on the former rather than the latter. Diet is an easier target, too, because the biggest culprits are simple to spot: fried favorites, calorie-dense fast food, sugar-sweetened beverages and processed foods that pack a lot of fat-building carbohydrates and sugar. Eat less of these, the white-coat brigade keeps telling us, plus more fruits, vegetables and whole grains, and it’ll be easier to control weight, avoid putting on extra pounds and bypass serious diseases like heart problems and diabetes. The problem is, the messaging hasn’t worked. Obesity rates have continued to climb in recent decades. (While they’ve started to level off, there still aren’t many signs that they are beginning to drop.) So some people are now changing the mantra: instead of focusing on what you put into your body, turn your attention to what you do with the energy, stored up in the form of fat, that you’ve packed away. Worry less about your diet, and get active so you can burn off the unwanted calories you consume to keep your weight in check.

MORE: Here’s the Amount of Exercise That Lowers Breast Cancer Risk

The sugar-sweetened beverage industry has hungrily adopted the message. Facing mounting pressure to improve their products, both when it comes to calories and overall nutrition, they’re eagerly shifting the attention—or blame—from their fare to the American public. It’s not us, they seem to be saying, but you. You’re just not moving enough to burn off all the calories you’re taking in. First, the makers of Coca-Cola, Dr. Pepper, and Pepsi, along with the American Beverage Association, launched Mixify, a campaign that encourages young soda drinkers to “mixify” their balance of sugared drinks and exercise, giving license to indulge more if they’re more active. But the latest soda-backed program is the Global Energy Balance Network, a collaboration of leading medical experts with a mission to urge Americans to focus on finding a better balance between what they eat and what they burn off (which, for the mainly sedentary American population, is about getting more active.) The network is supported by Coca-Cola, though initial invitations to scientists failed to mention that.

MORE: This Is Your Brain on Exercise

What’s particularly insidious about this new spotlight on exercise and energy balance is that it’s good medical advice that’s being promoted in a misleading and potentially harmful way. There simply isn’t strong evidence to show that exercise alone, at least at the level that anyone other than a marathoner maintains, can actually help people to shed pounds. “The notion that we can exercise away a bad diet is absolutely unfounded,” says Dr. David Ludwig, director of the New Balance Foundation Obesity Prevention Center and professor of pediatrics and nutrition at Harvard, “and contradicted by many research studies.” Dr. Yoni Freedhoff, assistant professor of family medicine at University of Ottawa, agrees. “The average person who sees me is definitely under the impression that the ticket to the weight loss express is exercise,” he says. “These are well-intentioned people who want to change their weight or health status predominantly through exercise without paying much attention to their intake, because they don’t believe their intake is an important or valuable contributor to their weight.” No doctor or public health official would argue with the soundness of getting more exercise. Loads of studies show the benefits of being physically active on the mind, heart, metabolism and more. But in these new campaigns, this scientifically solid advice is being tweaked to encourage the less scientifically valid idea that extra calories from processed foods or sugared drinks can be so easily worked off. “By grabbing onto causes that are beyond reproach and tough to argue with, like ‘exercise is good for you,’ Coca-Cola is getting involved in a way that isn’t in the best interest of public health,” says Freedhoff. The campaigns want us to believe that we can figure out how many calories we’re taking in, then exercise the appropriate amount to work off that additional input. But people are notoriously bad at measuring how many calories they consume and work off–and, even more significantly, our bodies don’t work that way. Calories that come in don’t simply turn into fat and sit inertly as a back-up source of energy if it’s not used. A body that gets exposed to a lot of excess sugar, such as from sodas or carbohydrate-rich processed foods, isn’t the same as one that only sees a smaller amount. Consistently high levels of sugar can change the way the body breaks it down. Like a car that’s repeatedly driven at high speeds and needs to rely on the brakes more often in order to stop, the biological metabolic brake system—in this case the insulin that processes sugar—starts to wear down and become less efficient. That’s the first step toward weight gain and diabetes.

MORE: Strenuous Exercise May Not Be That Bad for You After All

If weight were as simple as burning off the calories that come in, then foods that are high in calories, such as nuts, would be a “nightmare,” says Ludwig. Instead, study after study shows that people who eat more nuts, which are also brimming with protein, healthy unsaturated fats and fiber, tend to lose weight and weigh less than those who don’t consume them. The key, he says, is insulin. The more processed and refined a food is, such as baked goods and carb-heavy snacks like chips, the quicker the body digests it, and the more insulin the body pumps out to break down the food. The more insulin that circulates around, the more fat is sequestered away, since the excess calories far exceed what the body needs so it stores the fat away for future use. That’s why the idea of just working off the calories you eat doesn’t quite capture all the hormonal and metabolic changes that occur in the body when food comes in. “If you’re a toaster oven, then the calorie balance model is for you,” says Ludwig. “If you’re a human, it’s not helpful. By the calorie balance theory, we should cut back on everything. There should be no difference in cutting back on fruits and vegetables than from cutting back on soda. Instead, we all intuitively know that’s not the case. Eating too much fruit is not the road to obesity.” But there is a certain appeal to the notion of being able to compensate for that can of soda with a jog around the block. And the beverage makers know that, which explains why they’re backing the exercise message, similar to the way that the tobacco industry supported and ultimately biased results of studies claiming that light or low tar cigarettes were less harmful. In response to a recent New York Times article about Coke’s involvement in the network, the company released a statement: “At Coke, we believe that a balanced diet and regular exercise are two key ingredients for a healthy lifestyle and that is reflected in both our long-term and short-term business actions,” the company wrote. But the soda makers’ strategy of shifting responsibility onto consumers and making it their choice to work off what they eat or drink misses the point. Consumers do have choices to make, but Dr. David Katz, co-founder and director of the Yale-Griffin Prevention Research Center, likens the American public to flood victims, caught in a dangerous current of sugar-sweetened beverages, fast food, calorie-dense but nutritionally barren options and forced to “swim” by adopting a healthier diet or becoming more physically active. But, notes Freedhoff, “Without a levy, even the best swimmers get tired.” Until the food environment in which Americans find themselves changes dramatically — such as with taxes on sugared sodas, bans on advertising sugared foods to children and stricter vetting of health claims, like the energy balance message being promoted now, Americans will continue to be carried along with the unhealthy tide toward obesity, diabetes, and heart disease. “If you want to live a healthful life and maintain a healthy body weight, you need to go out of your way to live abnormally in an environment where normal isn’t healthy,” says Freedhoff. “It should really be the other way around.”

Correction: An earlier version of this story misstated the affiliation of Yoni Freedhoff. He is at the University of Ottawa.

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