TIME Obesity

This Place Just Became the First Part of the U.S. to Impose a Tax on Junk Food

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Elizabeth Renstrom for TIME

It also eliminated a 5% sales tax on healthy produce

The Navajo Nation, which suffers from a 10% obesity rate, is imposing a 2% junk-food tax on its reservation beginning April 1.

Navajo president Ben Shelly approved the Healthy Dine Nation Act last November, which from this week will also eliminate a 5% sales tax on healthy fare including fresh fruits and vegetables.

Revenues from the sin tax will reportedly be channeled toward community wellness projects like farmer’s markets, vegetable gardens and greenhouses in the 27,000 sq. mi. of Navajo reservation spanning from Arizona and New Mexico to Utah.

Approximately 24,600 Navajo tribe members face obesity, according to the Navajo Area Indian Health Service. Type 2 diabetes has emerged as a growing public health concern afflicting up to 60% of reservation residents in some areas.

With nearly half of the Navajo youth population facing unemployment and 38% of the Navajo reservation at the poverty level, supporters say the act may serve as a prototype for sin taxes to curb obesity in low-income communities across the U.S.

By comparison, around one-third of Americans nationwide are classified as obese, the highest rate in the world.

TIME Research

Google Granted Patent for Smart Contact Lens

This undated photo released by Google shows a contact lens Google is testing to explore tear glucose.
Google/AP Google's smart contact lenses.

May allow people with diabetes to easily measure glucose levels

Google has been granted a patent for a contact lens with an embedded chip,

The patent, which was discovered by WebProNews, features a sensor in the lens. Google has previously said that it is partnering with the pharmaceutical company Novartis to create a smart contact lens that could monitor blood sugar for people with diabetes.

As TIME has previously reported, Google has been testing various prototypes of smart contact lens and is currently in talks with the U.S. Food and Drug Administration (FDA) about a lens that measures glucose levels in users’ tears. The company says the chip and sensor are embedded between two layers of contact lens material and a tiny pinhole lets tear fluid from the eye reach the glucose sensor, and the sensor can measure levels every second.

Diabetics must currently prick their fingers throughout the day to measure blood sugar levels, but Google believes the contact lenses would be less invasive and allow people with diabetes to check glucose more often and more easily.

When asked if the patent is indeed for the smart contact lens for diabetes patients, Google told TIME the company does not comment on patent filings. “We hold patents on a variety of ideas—some of those ideas later mature into real products or services, some don’t. Prospective product announcements should not necessarily be inferred from our patents,” a Google spokesperson said in an email.

TIME Diet/Nutrition

What Diet Soda Does to Belly Fat

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More evidence that diet soda contributes to weight gain, not weight loss

A new study published in the Journal of the American Geriatrics Society found that people who drank diet soda gained almost triple the abdominal fat over nine years as those who didn’t drink diet soda. The study analyzed data from 749 people ages 65 and older who were asked, every couple of years, how many cans of soda they drank a day, and how many of those sodas were diet or regular.

Those answers ended up being extremely predictive of abdominal-fat gain, even after the researchers adjusted for factors like diabetes, smoking and levels of physical activity. People who didn’t drink diet soda gained about 0.8 in. around their waists over the study period, but people who drank diet soda daily gained 3.2 in. Those who fell in the middle — occasional drinkers of diet soda — gained about 1.8 in.

That change in waist circumference is especially concerning because it highlights an unfortunate truth about weight distribution: the belly is a bad place for extra pounds. The kind that pads the abs from the inside, called visceral fat, is associated with increased cardiovascular disease, inflammation and Type 2 diabetes.

MORE Is Diet Soda Bad for You?

These results, which the study authors call “striking,” add to the growing body of evidence that no- and low-calorie sweeteners may come with health concerns. Though scientists are still puzzling through the mechanisms by which diet soda seems to have the unintended consequence of weight gain, they have some ideas. Sugar-free sodas contain substances that sweeten up soda at 200-600 times the sweetness of sugar.

“Regular sugar has caloric consequences,” says the study’s senior author Dr. Helen Hazuda, professor of medicine at the University of Texas Health Science Center at San Antonio. And one of those is that it triggers satiety — a sense of fullness or satisfaction. “Your body is used to knowing that a sweet taste means you are ingesting energy in the form of calories that, if you don’t burn them off, is going to convert to fat,” she says. Artificial sweeteners, however, confuse our bodies and weaken the link in our brains between sweetness and calories. That, Hazuda says, can lead to weight gain and cravings for sweeter and sweeter treats.

There may be something else at work. A recent study in mice showed that artificial sweeteners actually changed the gut bacteria of mice in ways that made them vulnerable to insulin resistance and glucose intolerance — both of which can lead to weight gain. And other mice research suggests that artificial sweeteners are associated with a drop in the appetite-regulating hormone leptin, Hazuda says. Leptin is the hormone that inhibits hunger.

MORE 13 Ways to Stop Drinking Soda for Good

The Calorie Control Council, an association that represents the reduced-calorie food and beverage industry — including alternative sweeteners — disagreed with the study’s findings. “The use of low-calorie sweeteners (LCSs) in weight management has been shown to be beneficial,” the group said in a statement. “While approaches to treat obesity in older individuals is controversial, diet modifications can be a successful part of a weight-management program for older adults.”

Researchers in the new study found that belly-fat gain was most pronounced in people who were already overweight. “People who are already at cardiometabolic risk because they have higher BMIs are really in double or triple jeopardy,” Hazuda says. “When they think they’re doing something good by drinking artificially sweetened beverages, it’s actually totally counterproductive.”

Read next: 5 Weird Ways to Consume Guinness on St. Patrick’s Day

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TIME Healthcare

The Most Expensive Place in the World to Have Diabetes

A new review looks at the global impact of diabetes

The U.S. is the most expensive place to have Type 2 diabetes, with an average lifetime price tag of $283,000, according to a new study published in the journal PharmacoEconomics.

Researchers at the University of East Anglia (UEA) analyzed 109 studies on the economic impact of Type 2 diabetes and found that costs are higher in the U.S., even compared with other countries with similar income levels.

“Employment chances for women with diabetes in the U.S. are decreased by almost half,” said study author Till Seuring of UEA’s Norwich Medical School in a statement. “Women with diabetes also lose out on $21,392 in earnings per year — the highest loss due to diabetes worldwide,” In other countries, men with diabetes suffer more when it comes to employment options, the data shows.

Still, the U.S. appears to be an exception. Diabetes has the greatest economic toll for people in low- and middle-income countries, the research finds. Most new cases are appearing in countries in this economic stratum, including Mexico, India and China.

Diabetes affects over 380 million people worldwide, the researchers say. That number is expected to balloon to 592 million people by 2035.

Check out the findings in the infographic below.

University of East Anglia

Read next: What Diet Soda Does to Belly Fat

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TIME Heart Disease

Statins May Seriously Increase Diabetes Risk

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Statins can lower cholesterol and even tamp down inflammation to keep the risk of heart disease down. But these commonly prescribed drugs may increase the risk of diabetes, and by a considerable amount

Doctors may have to weigh a serious potential risk before prescribing statins, the cholesterol-lowering drugs that are among most prescribed drugs in America. In a study published in Diabetologia, scientists from Finland found that men prescribed statins to lower their cholesterol had a 46% greater chance of developing diabetes after six years compared to those who weren’t taking the drug. What’s more, the statins seemed to make people more resistant to the effects of insulin—which breaks down sugar—and to secrete less insulin. The impact on insulin seemed to be greatest among those who started out with the lowest, and closest to normal, levels of blood glucose. And the higher the dose of the statin, and the longer the patients took them, the greater their risk of diabetes.

Previous studies have suggested that statins can raise blood sugar levels, and increase the risk of diabetes by anywhere from 10% to 20%, but none have documented an effect this large. Doctors often consider statins for patients who are at higher risk of heart disease, and one of the risk factors for future heart trouble is diabetes. So how do these results affect that decision?

“It’s a good news-bad news scenario,” says Dr. Robert Eckel, past president of the American Heart Association and professor of medicine at University of Colorado School of Medicine. “Although there is convincing evidence that patients on statins are at increased risk of new-onset diabetes, the benefit accrued [from statins] in reducing risks of heart attack, stroke and fatal heart disease trumps the effects of being new onset diabetics.”

In other words, the good that statins can do for people who are not yet diabetic but at higher risk of heart problems outweighs the increased risk of diabetes.

MORE New Guidelines for Cholesterol Treatments Represent “Huge Change”

And while the increased risk that the Finnish scientists found — 46% — is noteworthy, Eckel points out that the study involved only white men, and therefore may not be generalizable to a broader population. It’s not clear what the men’s family history or personal history of diabetes was; some may have had other risk factors for the disease that put them at higher risk of developing diabetes anyway, even if they didn’t take a statin.

Those who developed diabetes while taking statins were similar on many metabolic measures to those who developed diabetes but weren’t taking statins, suggesting that “that statin treatment increased the risk of diabetes independently of the risk profile of the background population,” the authors write. In a separate, U.S.-based study on statins, researchers found that those who went on to develop diabetes while taking statins also had risk factors for the disease before they started taking the medications.

MORE Should You Take Statins? Study Says Heart Benefits Outweigh Diabetes Risk

Which means that for confused patients, and their doctors, the current advice about who should take statins doesn’t change. The results, in fact, highlight the need for a discussion rather than just working through a checklist before prescribing statins. For patients who may not yet be diabetic, but are vulnerable to developing the disease and also may need a statin, Dr. Neil Stone, lead author of the 2013 American College of Cardiology and American Heart Association cholesterol guidelines, says he stresses the importance of lifestyle changes in diet and exercise.

“If you have a patient who is prone to developing diabetes, you’re getting into a higher risk group, because they also have risk factors associated with heart disease. So they have the potential to benefit from statins. If they are going to take a statin, I tell them we are going to help you get more fit, and work with your lifestyle. It’s even more important because if you don’t do that, and the patient decides to take the statin and go on with their unhealthy habits, then they are going to be even more prone to developing diabetes,” says Stone.

The patient’s family history of diabetes is another important part of the decision to start someone on a statin. It’s all about making sure that each patient’s risks and benefits are weighed carefully. And the potentially greater risk of diabetes created by statins should be part of that consideration. “Communication here is everything,” says Eckel.

Read next: New Hormone Discovered That Curbs Weight Gain, Diabetes Just Like Exercise

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TIME Research

New Hormone Discovered That Curbs Weight Gain, Diabetes Just Like Exercise

“This represents a major advance in the identification of new treatments for age-related diseases such as diabetes”

Scientists have discovered a new hormone that mimics the health benefits of exercise by normalizing the metabolism and slowing the weight gain caused by fatty diets.

Appearing in the scientific journal Cell Metabolism on Tuesday, the study found the newly discovered MOTS-c hormone increases insulin sensitivity, allowing the body to more effectively process glucose sugars, according to a press release from the University of Southern California.

Insulin is a hormone that is used to move glucose sugars from food into the blood stream; resistance occurs when levels are high for a long period of time — commonly from a poor diet — which increases the body’s tolerance to the hormone and can lead to type 2 diabetes.

The new MOTS-c hormone targets muscle tissue and reverses age-dependent and diet-related insulin resistance.

“This represents a major advance in the identification of new treatments for age-related diseases such as diabetes,” said Dr. Pinchas Cohen, senior author of the study.

Researchers injected the new hormone into lab mice eating high-fat foods that usually lead them to become obese. The injection suppressed the weight gain and also reversed the insulin resistance caused by their diet.

While tests were only administered on mice, the necessary mechanisms are present in all mammals, humans included.

Read next: 5 Non-Diet Factors That Can Affect Your Weight

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TIME Exercise/Fitness

The Best Workout for Weight Loss

Why intensity matters in exercise

Everyone knows that cardio exercise—by way of a bike ride or a sprint—is key to weight loss. But a high-intensity cardio workout may do a better job of decreasing blood sugar levels than lower intensity exercise, according to a new study in Annals of Internal Medicine.

The study assigned 300 obese people to a group: one that exercised with low intensity for long periods of time or another that engaged in high-intensity workouts for short durations. By the end of six months, people in both groups experienced similar levels of weight loss. But those who had exercised with higher intensities saw reduced two-hour glucose levels, a key measure for predicting conditions like heart disease and stroke. People in the high-intensity group saw a 9% improvement in glucose tolerance, compared to a negligible change in people who took part in low-intensity exercise.

Increasing the intensity of a workout isn’t beyond the reach of most exercisers, according to lead study author Robert Ross, a researcher at Queen’s University in Kingston, Ontario. “Higher intensity can be achieved simply by increasing the incline while walking on a treadmill or walking at a brisker pace,” Ross says.

Read more: This Is How Much Exercise Experts Think You Really Need

Still, while high-intensity exercise may have some unique health benefits, the study showed that any exercise is better than none. People who exercised lost 5-6% of their body weight, a 4- to 5-centimeter reduction in waist size.

The study challenges the way public health officials tend to think about the health benefits of exercise. Health organizations often issue guidelines based on time spent exercising. Instead, the study suggests, health officials should consider intensity as well.

Read more: The 50 Healthiest Foods of All Time

Read next: The Best Workout Move You’re Not Doing

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TIME Heart Disease

Why Your Heart Disease Risk Might Be Lower Than You Think

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Of the five popular tools that doctors rely on to predict whether you’re headed for heart trouble, four of them have a pretty major flaw

For decades, doctors have relied on the undisputed champion of heart disease risk assessment: the Framingham Risk Score. It emerged from a massive study of heart disease risk factors in more than 5,000 men and women and pointed out advanced age, being male, smoking, having diabetes, high total cholesterol, low levels of good cholesterol and high blood pressure. Scoring higher on these factors meant you had a greater chance of developing heart problems in the next 10 years, and most successive models included some version of these core culprits.

Now, scientists led by Dr. Michael Blaha, director of clinical research at the Ciccarone Center for Prevention of Heart Disease at Johns Hopkins Medicine, have published a new study in the Annals of Internal Medicine that finds that those risk calculators—four of which doctors use regularly—tend to overestimate the risk of heart attack in patients.

MORE: New Guidelines for Cholesterol Treatments Represent “Huge Change”

“It’s not that scientists made mistakes when coming up with the [calculators],” says Blaha, “They did the best job they could with the data they had. But there may be inherent problems in using historical data to predict things now.”

The diet and lifestyle of Americans have changed considerably since the Framingham days, when heart attacks occurred more frequently in younger people and more often in men than women. Americans on average now eat more trans fat and salt and have lower exposure to secondhand smoke, which can all affect heart disease rates.

MORE: Cholesterol Whiplash: What to Make of the New Heart-Risk Calculator

But even the most recent guidelines for predicting heart disease risk, released in 2013 by the American Heart Association and the American College of Cardiology, relied on the Framingham Risk factors. In the current analysis, these guidelines overestimated heart attack risk by 86% in men and 67% in women when Blaha and his team compared the predicted risk to actual rates of heart events in a group of more than 4,000 people aged 50 to 74 years, who were followed up for an average of 10 years. The other models overshot the risk by anywhere from 37% to 154% for men, and from 8% to 67% for women.

That’s a lot of extra heart disease that, under current guidelines, doctors may start treating with blood pressure medications, insulin and cholesterol-lowering drugs. All of those come with potential side effects and complications. In fact, the study found that statins to keep cholesterol in check were least effective among those with the lowest risk of having future heart events, meaning the benefits may not outweigh the risks for many.

MORE: Single Gene Responsible for Group of Heart Disease Risk Factors

“We’re getting close to the idea of re-thinking risk,” says Blaha. Instead of relying on decades-old data that draws conclusions and recommendations on a population level, ideally everyone’s risk should be more individualized and based on his own particular history. The Framingham model, for example, includes data collected from a single measurement of blood pressure and cholesterol, and a yes-or-no answer on whether the patient smokes. But someone who has smoked for years and just quit is physiologically different from someone who never lit up at all, just as having blood pressure that’s under control thanks to medication is not the same as never having hypertension to begin with. The most accurate way to predict someone’s risk of having a heart attack is to survey his blood pressure and cholesterol readings over his lifetime, or at least for many years. That may soon be possible with electronic health records and the popularity of medical monitoring bracelets. But until then, any model that relies on population-based data like Framingham may suffer from overestimating someone’s heart danger, Blaha says.

MORE: Eating Fruit Cuts Heart Disease Risk by 40%

“These data point squarely to the idea that we need to be rethinking risk prediction,” he says. That may require not just combing through more data per patient, but also folding in other factors that may be more sensitive to the health of a person’s heart. Imaging techniques, including coronary calcium scores that measure the amount of calcium—a foundation for the plaques that eventually rupture to cause heart attacks—may provide more valuable and accurate information on a person’s risk, for example.

In the meantime, Blaha isn’t advocating for the elimination of current risk predictors or guidelines that help doctors decide when a patient’s risk warrants treatment with a drug. “The guidelines are still useful, but patients and doctors have to understand the caveats and limitations to them,” he says. Whatever score a patient receives from these calculators, that number should be the starting point of a discussion between doctor and patient about that patient’s particular risk factors—including his family history, whether and how much he smoked, and how much exercise he gets on a regular basis. “Patients need to demand, or ask their doctors to go beyond the number and say, ‘Do you really think I need to starting taking medicine?’ or ‘How much risk do I really have of having a heart attack?’” That kind of conversation is far more valuable than a single-risk calculator will ever be.

TIME Innovation

Five Best Ideas of the Day: February 13

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. After the shootings in Chapel Hill, a Muslim-American school teacher asks what they must do to be ‘part and parcel’ of America.

By Deanna Othman in the Chicago Tribune

2. Imagine insulin that can read a diabetic’s blood sugar level from inside the body and start working on-demand.

By Anne Trafton in MIT News

3. City governments are using Yelp to warn the public about restaurant health code violations.

By Michael Luca and Luther Lowe in Harvard Business Review

4. The FDA is cutting the red tape so doctors can get experimental drugs to patients more quickly.

By Peter Lurie in FDA Voice

5. How can we support entrepreneurial inventors in developing countries? Create innovation ecosystems.

By Alexander Pan in the Aspen Journal of Ideas

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Diet/Nutrition

This Is the No. 1 Driver of Diabetes and Obesity

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"A sugar calorie is much more harmful," says the lead researcher

A primary driver for type 2 diabetes is sugar, according to a new report.

In the report, published Thursday in the Mayo Clinic Proceedings, a team of researchers performed a literature review to determine whether certain ingredients are much more dangerous than others when it comes to diabetes, and to challenge the idea that all calories are equal. To do so, they looked at the effects of carbohydrates from similar calories. They compared starch, pure glucose and lactose to added sugars like sucrose (table sugar) and fructose, which occurs naturally in fruit but which we mostly consume as a sweetener, such a with high-fructose corn syrup, added to food and drinks).

What they found was that the added sugars were significantly more harmful. Fructose was linked to worsening insulin levels and worsening glucose tolerance, which is a driver for pre-diabetes. It caused harmful fat storage—visceral fat on the abdomen—and promoted several markers for poor health like inflammation and high blood pressure. “We clearly showed that sugar is the principal driver of diabetes,” says lead study author James J. DiNicolantonio, a cardiovascular research scientist at Saint Luke’s Mid America Heart Institute. “A sugar calorie is much more harmful.”

DiNicolantonio and his fellow authors say current dietary guidelines are harmful since they recommend levels of sugar consumption that are unhealthy. For instance, the Institute of Medicine says added sugar can make up 25% of the total calories we consume, and the 2010 Dietary Guidelines for Americans say up to 19% of calories from added sugars is alright. That varies greatly from the American Heart Association, which recommends no more than 6 tsp of sugar a day for women 9 tsp for men. The World Health Organization has proposed that added sugar make up only 5% of a person’s daily calories.

“The studies that we looked at clearly show that once you hit 18 percent compared to just 5 percent of your total calories from sugar, there’s significant metabolic harms promoting prediabetes and diabetes,” says DiNicolantonio. “In fact, there’s a two-fold increase.”

This is not the first time sugar has been fingered as a primary culprit in American’s bad health. Other researchers are pushing the message that it’s refined carbohydrates like added sugars that are the problem.

“We need to understand that it isn’t the overconsuming of calories that leads to obesity and leads to diabetes. We need to totally change that around,” says DiNicolantonio. “It’s refined carbs and added sugars that lead to insulin resistance and diabetes, which leads to high insulin levels, which drives obesity.”

DiNicolantonio recommends major changes to combat the problem. He says the government should stop subsidizing corn which makes high fructose corn syrup so cheap and should instead subsidize healthy foods so that consumers are encouraged to make the switch from processed foods to whole foods, since it’s the processed stuff that’s putting so much sugar in our diets. He adds that in his opinion, sugar-sweetened beverages should not be sold in schools or hospitals, and perhaps the government should put warning labels on them.

Such severe changes are not likely in the immediate future, but if sugar is indeed the number on cause for diabetes among all other foods, then more needs to happen to help Americans cut back. Especially since there is no real need for added sugar in our diets.

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