Parents, is it time to get schools to adopt nutrition programs?

Have you ever worried that all the good work you do at home to get your kids to eat healthily unravels the moment they step through the school gates? With obesity in kids on the increase, some public health experts believe that schools should be part of the solution. Now new research has shown that school policies can make a difference when it comes to making sure kids keep to a healthy weight.

Researchers worked with nearly 1,500 students in fourth to sixth grades in 10 Philadelphia schools. They introduced a two-year nutrition program in half the schools, banning candy and unhealthy snacks, replacing sodas with water, low-fat milk or pure juice, and educating teachers, students and families about the benefits of healthy eating and exercise. The students in all the schools had their height, weight and physical activity measured once a year.

The good news is that, after two years, only 7.5 percent of students who attended schools with a nutrition policy became overweight, compared with 15 percent of students in schools without a policy.

What you need to know

These findings are promising. If there are parents out there who want to help their kids' schools adopt a healthy living plan, this study could help you get started. It shows it can work. But the researchers say that the policies need to be tougher, with more emphasis on physical education. Plus, prevention programs probably need to start earlier than fourth grade. As many as 4 in 10 kids age 9 to 12 are already overweight. There's really no time to waste.

—Zosia Kmietowicz, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Exergaming: Fun and games for your health

If you think video games are just for fun, some folks beg to differ: more than 300 of them, to be exact, who gathered in  Baltimore recently for the 2008 Games for Health conference. Sponsored in part by the Robert Wood Johnson Foundation, the conference explored how cutting-edge video-game technology can be applied to health and health care. This can range from “exergaming,” or video games used for exercise (think Dance Dance Revolution or Nintendo Wii’s version of tennis), to games used to reduce stress or pain, aid in rehabilitation, or cut the risk of getting sexually transmitted diseases.

Among the most exciting advances are those that have the potential to help people with serious medical conditions. A few examples we heard about in a teleconference our reporter attended last week and in an accompanying press release:

• Guitar Hero for amputees. A new, one-armed version of the popular video game, unveiled in prototype form at the conference, is designed to aid in the rehabilitation of people who’ve had an arm amputated.
• Wii for Parkinson's. A specially designed version of the Wii—called PDWii, for Parkinson’s Disease, and currently under development in California—would be used to aid balance and mobility and help track progress in Parkinson's patients. Similar technology could also help people recovering from strokes.
• Ditto for young burn victims. A virtual-reality device designed to control pain and stress among young patients undergoing burn and orthopedic procedures.

For more on the burgeoning applications of video games in the health arena, check out the web site of the Games for Health Project, www.gamesforhealth.org. And stay tuned for our evaluation of the much-anticipated Wii Fit, which is to debut in the United States May 19.

—Jamie Hirsh, Associate Editor

Trying to save time? Do one task at a time.

Think you're saving time by preparing dinner, balancing your checkbook, and helping Junior with his Algebra homework all at the same time? Well, studies say, "Not so fast."

Researchers at the University of Michigan and the Federal Aviation Administration have found that working on several tasks at the same time can take two to four times longer than if you try tackling them one after the other. Brain-scan studies help explain why: When you try to do two or more things at once, your brain constantly switches back and forth between the tasks, a less efficient use of your neurons. Sleep loss, stress, and mood disorders can worsen the problem.

So fight the urge to multitask and try to do just one thing at a time.

How to find a good patient advocate

In 2004, Edward Moskowitz was hospitalized near his home outside Miami with internal bleeding, but after a week he was worse, his daughter Sandy Tepper says. That's when he became a human pinball. Over the next seven weeks, he was sent to rehab, grew worse, was transferred by a new doctor to a different hospital, then was bounced for insurance reasons to a second rehab facility (at 2 a.m.), despite his daughter's attempts to intervene. Ordered to physical therapy a few days later, he struggled from his wheelchair and fell to the floor, dead of apparent heart failure. He was 84.

What if someone had been there to ask the right questions and ease the family’s trauma? Enter the patient advocate, part of a growing field. Advocates, who are often former nurses or other health professionals, link patients and the health-care system. They can help get an elusive doctor's appointment, research treatments, file medical paperwork, or persuade an insurance company to cover a procedure. They might also stand in for faraway relatives by accompanying an ailing person to appointments or sitting at a hospital bedside. Some advocates work privately, on a case-by-case or hourly basis. Others work at no charge or are supplied by employers as part of benefits packages.

Is "grass-fed" beef a healthier choice?

Ever wondered what the "grass-fed" label on meats in your supermarket really means? Well, thanks to a new rule, the grass-fed claim on beef and lamb now means that the meat came from animals that actually, well, ate grass. The animals also have to have access to pasture during the growing season. Be sure to look for the accompanying "USDA Process Verified" shield, since a loophole allows producers who previously used the grass-fed claim to continue to do so without having to meet the new requirements. The shield also guarantees the farms were inspected by the USDA to meet the new standard.

Why it's good

Grass-fed meats are lower in total fats than conventional meats and have higher levels of good fats like omega-3s. But they may not be as tender. Grass-fed ground beef usually has more conjugated linoleic acid, which might improve the immune system and help fight cancer, atherosclerosis, and type 2 diabetes, lab and animal studies show.

To learn more about labels on the foods you eat, visit the Eco-labels center at www.GreenerChoices.org.

Are your kids drinking too much juice for their own good?

How much juice should your baby, your toddler, and your teen be drinking? Experts say less is more.

INFANTS. You shouldn't give your baby any juice for the first six months. Stick to breast milk or formula, which is much more nutritious, advises the American Academy of Pediatrics. After six months, if your little one is drinking from a cup, you can introduce some juice into his or her diet. Don’t give juice in a bottle, and never put your baby to bed with a bottle of juice—the sugar can lead to cavities. Four to six ounces a day is plenty. Or get your child to chow down on mashed-up or puréed whole fruits and vegetables.

TODDLERS AND SMALL CHILDREN. Fruit juice is sweet, and many kids will overindulge if given the chance. Don't give your tot a sippy cup full of juice, or a juice box, to walk around with all day. The prolonged exposure to sugar can cause dental problems. Instead, offer a cup of juice as a treat or a snack.

TEENAGERS. It can be hard to get a teenager to do anything you want, and drinking too much juice probably isn't a major worry. But at least one study has argued for a link between drinking more than 12 ounces of juice a day and obesity, though other research has indicated otherwise. One hundred percent juice is certainly better than soda, but try to encourage your kids to eat whole fruits instead and to limit juice to about 12 ounces a day.

Read more on ways to keep your child at a healthy weight.

Help yourself: Learn how to rate and manage pain

Pain is the main complaint for about 40 percent of patients visiting primary-care doctors with roughly half of the people with chronic or recurrent pain failing to get adequate relief. In many ways pain remains a medical mystery, but here’s what to do for occasional, severe, and recurrent pain:

Self assess. First, assess how bad the pain is. Rate it on a scale of 0 (no pain) to 10 (the worst pain you could imagine). For pain that you rate 5 or less, start by self-treating with nondrug measures. For example, use heat to help ease back pain or cramps. You can also use over-the-counter pain relievers, which typically suffice for this level of pain.

How to choose an over-the-counter. Choose a drug based on the type of pain and your risk factors. Acetaminophen (Tylenol or generic) is often a good option. At recommended doses it's reasonably safe and effective for most people. People who drink heavily or have a liver disorder should avoid acetaminophen, since it's toxic to the organ. Ibuprofen and naproxen are often good over-the-counter choices if acetaminophen isn't enough. They not only ease pain but also quell inflammation. Both drugs are probably safer than aspirin, which poses a higher risk of bleeding. And while long-term use of any NSAID poses serious gastrointestinal and possibly coronary risks, the short-term use of recommended doses is generally safe for most people who don’t have heart, kidney, or stomach problems.

Severe-pain solutions. If you rate your pain at 6 or higher, it doesn’t improve with nondrug steps and OTC drugs, or it lasts longer than a few days, see your doctor. He or she might suggest a prescription NSAID, because a different or stronger formulation may yield additional relief. Another approach can be a prescription opioid such as oxycodone (Oxycontin and generic). You or your doctor might resist using such drugs because of addiction concerns. But physical dependence typically requires several weeks of use, and psychological dependence in patients with acute or severe pain is unlikely because they rarely experience euphoria from the drugs.

Medications that pair an opioid with acetaminophen, aspirin, or ibuprofen may be an even better choice. Those can provide greater relief, since the two ingredients work in different ways, and they reduce the risk of side effects because the combination permits smaller doses of each.

Recurrent pain. Even when the pain is relatively mild, chronic or recurrent pain from arthritis, headaches, or other sources can seriously interfere with everyday activities. Since chronic pain often ebbs and flows, rating your discomfort on the 0 to 10 pain scale can help you decide, day to day, how to manage the problem.

For more information, see Consumer Reports’ Best Buy Drug report on opioids.

5 ways to cut costs while staying healthy

The government may not want to use the "R" word, but there’s no question that the economy is in trouble. It's affecting all of us and causing us to tighten our belts. When it comes to medical care, telltale signs come early. Reports of increasing numbers of elective surgeries have been attributed to fear of potential loss of insurance coverage, similar to when rumors of company cutbacks surface. Routine and preventive care visits decline, and in my practice, I see more patients forgoing referrals to physical therapy because of the frequent co-pays.

Taking care of your health during a recession poses quite a challenge. If you’re healthy, you want to stay that way, and if not, you want to make sure that your treatment is not jeopardized. So what can you trim without sacrificing quality? Consumer Reports has a wealth of information on how to get the best value when it comes to your health.

• Ask your doctor about pill splitting. It can save money because pharmacies often charge the same amount for a particular drug regardless of its dose. There’s no harm in splitting pills as long as your doctor agrees with the idea, you learn how to do it properly, you split only pills that are scored, never split extended- or continued-release tablets, and use a safe pill splitting device, available at most pharmacies for around $5.
• Look into a prescription assistance program. If you need medicines (especially for a chronic condition) and have no health insurance, limited insurance, or lack drug coverage under your current health insurance policy you may qualify for assistance.
• Consider switching to a generic prescription drug. Consumer Reports Best Buy Drugs can help you find the most safe and effective drug for your condition and give you the best value for your health. Not only are generic medications proven and more affordable alternatives, but the newest brand name drugs have less of a track record for safety.
• Put your fancy gym club membership on hold. As the Consumer Reports survey on health clubs showed, you can pay up to $95 per month for name brand chains and still not get a quality experience. Try out your local Y or community center—which got higher marks in our survey than most big chains—or change some habits: take the stairs, park at a distance, walk the dog. As an inexpensive pedometer shows, those steps soon add up.
• Shop smart. Although it’s tempting to reach for inexpensive processed foods on the supermarket shelf, resist the temptation. It’s important to remember to eat healthy foods including fresh fruits and vegetables. Warehouse club supermarkets fared very well in terms of price on the 2005 Consumer Reports Grocery Store Shopper Survey of 24,000 respondents. Those that gave our readers the biggest bang for the buck (subscribers only) were Aldi, WinCo, Trader Joe’s, Market Basket, Cost­co, Shoppers Food Warehouse, Wal-Mart, and Stater Bros. (These chains are a good choice if your top concern is low prices, and service and the quality of meat, produce, and fresh-baked goods are less important.) Use the FDA’s free nutritional label training program to find information that will help you stay healthy by selecting the right foods when you shop.

—Orly Avitzur, M.D., medical adviser to Consumers Union

8 secrets of successful dieters

There's no question that sticking to a do-it-yourself diet plan is never easy. We rated popular diet books and took away eight practical, evidenced-based strategies for DIY dieters who want to lose weight on their own. Pick one—or two or three that work for you, and start losing!

1. Start right. While dieters might prefer to save calories by skipping breakfast, eating a substantial morning meal is recommended by every diet book we analyzed. Seventy-eight percent of the successful losers at the National Weight Control Registry say they eat breakfast, typically some cereal and fruit. The Registry, which enrolls people who can document that they have lost more than 30 pounds and kept it off for at least a year, has more than 5,000 members.

2. Choose (and limit) your fats. Many diet experts have backed away from avoiding fats, though this traditional approach is still used by very low-fat plans such as Dean Ornish’s “Eat More, Weigh Less” and the diet endorsed by the Pritikin Longevity Center.

Some research shows that a very low-fat diet can slow the progression of heart disease and breast and prostate cancer. But the dropout rate from that type of diet is high. Scientists now distinguish good fats from bad, based on copious evidence about their effect on blood cholesterol. Most of the popular diet books we analyzed warn against eating "bad" fat, including trans fats created when vegetable oil is hydrogenated, and the saturated fats from meat and dairy sources. Good fats include olive and other monounsaturated oils, nuts, avocados, and omega-3 oils from seafood and plant sources.

But good or bad, all fats have big calorie counts. They contain 9 calories per gram, compared with 4 per gram for carbohydrates and protein. The diet menu in “Eat, Drink, and Weigh Less” recommends liberally consuming healthy fats. But when we analyzed the meal plan, it totaled 1,910 calories per day, about 40 percent of them from fat, which would make weight loss unlikely for many people.

3. Eat healthfully—but sparingly. Backed by a growing body of research, nutritionists have come to a rough consensus on what a truly healthful diet looks like: Eat plenty of fruits and vegetables, and some lean meat and fish, healthy fats, and whole grains. And minimize refined grains, potatoes, full-fat dairy products, and added sweeteners--especially in the form of soft drinks. Studies of large populations the world over have shown that this diet reduces the risk of heart disease, diabetes, and certain cancers.

With minor variations, all the diet books we evaluated recommended some version of this eating plan--and their uniformly high ratings for nutrition reflect that. But they didn’t seem "willing to emphasize calories, or tell people to 'eat less,'" said Rena Wing, Ph.D., a professor in the department of psychiatry and human behavior at Brown University's medical school and a founder of the National Weight Control Registry.

The bottom line is that no matter how "healthy" your diet is, you still have to restrict quantities to lose weight. "The Best Life Diet," which got top marks from our reviewers, provides detailed instructions on proper serving sizes for many different types of foods.

4. Crank up the activity. To control weight from exercise alone requires a devotion that few nonathletes can summon: 60 to 90 minutes a day of moderate to vigorous exercise. But increasing the time you spend out of your chair—in formal exercise and activities such as housework and yard work—helps you burn at least some calories. And an active lifestyle will help you maintain your weight loss. National Weight Control Registry participants report doing about an hour a day of moderate-intensity exercise, like brisk walking. Of the books we evaluated, "You on a Diet," "The Best Life Diet," and "The Abs Diet" got high marks for their clear and detailed sections on exercise.

5. Consider cutting carbs. Virtually all diets restrict or eliminate "bad" highly refined carbs such as white bread, cookies, chips, and soft drinks. But a wholesale cutback on grains, fruits, and the sweeter vegetables, such as beets and carrots, was first popularized by the Atkins diet. Recent research has found that for up to a year, some people can indeed safely lose weight on Atkins. In the most recent study, published in the March 7, 2007, Journal of the American Medical Association, 311 overweight women were randomly assigned to one of four diets: Atkins, Zone, Ornish, and a control group on a traditional low-fat menu plus various behavioral strategies. On some measures, Atkins dieters came out ahead. "They had better triglyceride lowering than Zone dieters, better HDL raising than Ornish, and better blood-pressure lowering than all three," said Christopher Gardner, Ph.D., assistant professor of medicine at Stanford University, director of the study. But while Atkins dieters lost modestly more weight than Zone dieters, at 12 months their weight loss was similar to those on the Ornish or control diet.

Very low-carb diets are not for everyone. As Gardner points out, at least some participants lost 30 pounds and kept it off for a year on all the diets in the study. Successful losers in the National Weight Control Registry overwhelmingly report that they consume plenty of carbs while restricting fat and portions.

6. Fill up on low-density foods. One way to spare calories and still eat a satisfying amount of food is to focus your diet on foods that have fewer calories per bite, or low "energy density." Starting your meals with a low-calorie soup or salad and eating main dishes that are full of vegetables and fruits are the main tactics of the low-density diet.

Using government food consumption surveys, researcher Barbara Rolls has shown that people who eat a low-energy-density diet consume hundreds fewer calories per day than those with a high-density diet, yet eat a greater amount of food. And in research on volunteers in her Penn State lab, Rolls has found that consuming a low-density diet helps people lose weight and keeps them thinner. "Volumetrics," based on this research, has now been studied in clinical trials and finished at the top of our diet Ratings.

Whether they say so explicitly or not, many of the other diets and books we evaluated recommend strategies to reduce the energy density of food. People on the Weight Watchers point system, for instance, soon learn that if they spend too many of their daily point allotment on calorie-dense foods, they’ll go to bed hungry. “The Sonoma Diet” sternly limits dieters to no more than 3 teaspoons of olive or canola oil per day but permits unlimited quantities of low-calorie-density vegetables such as broccoli, spinach, and tomatoes. The Ornish diet, which bans fats almost completely, had the lowest energy density of any that we studied.

7. Bring back the scale. Many of the books we reviewed discourage the practice of daily, or even weekly, weigh-ins, at least in the initial stages of a weight-loss diet. But 75 percent of National Weight Control Registry members weigh themselves at least weekly. "They remain vigilant about their weight loss," Wing said. "It seems likely that if they gain a pound or two, they take steps to lose it before it can accumulate."

8. Bore yourself thin. Though many books promise readers they’ll be eating a huge variety of foods, in practice they limit variety of high-calorie foods. "The South Beach Diet," "The Sonoma Diet," and "UltraMetabolism" were especially restrictive in their severe initial phases.

Since variety stimulates the appetite, the more monotonous your diet, the less you’ll eat. So steer clear of buffet tables, which can be the dieter’s worst enemy.

To learn more, read what optimistic dieters say about losing weight, watch our free video on diet ratings, and check out our diet book ratings (subscribers only).

Q&A: Are coffee and tea iron-blockers?

I’ve heard that coffee and tea can block the body’s ability to absorb iron. Is that true? —S.L., Montpelier, Vt.

Yes, but that applies to only one type of iron, and most people have high enough iron levels that they needn’t be concerned about it. Coffee, tea, and red wine can inhibit the body’s ability to absorb nonheme iron, the iron found in plant and dairy foods. The reason: Those beverages contain compounds that bind to the mineral in your intestine. One small study found that drinking a cup of coffee while eating lowered the amount of nonheme iron absorbed from the meal by 39 percent; a cup of tea reduced absorption by 64 percent. Red wine also appears to have a potent iron-blocking effect, based on other research. But the beverages don’t appear to block absorption of the other main type of iron, heme iron, which is found in meat.

In any case, most Americans consume more iron than they need. (Even vegetarians, who get iron exclusively from plant sources or supplements, appear to have no higher rates of iron deficiency than meat eaters.) So unless your doctor says you suffer from low iron levels, there’s no reason to avoid coffee, tea, or red wine.

This article first appeared in the February 2008 issue of Consumer Reports On Health.

Stay fit, be safe: Tips for preventing workout injuries

Planning on getting in shape for the warmer months? Here are some tips that will get your body up and running (or walking or swimming) without breaking down.

Get checked. See a physician before starting an exercise program.

Warm up. Muscles become more pliant and less likely to tear when they’re warm. Before you work out, spend 5 to 10 minutes (closer to 10 if you’re older or the weather’s cold) warming up. Choose a gentle exercise that engages the major muscles you'll be using during your workout.

Stretch. Don't confuse stretching with warming up; they’re separate but equally beneficial ways to loosen the muscles and joints. When stretching, pay extra attention to the muscles that will absorb the most shock.

Cool down. Stopping suddenly after vigorous exercise can trigger a potentially dangerous drop in blood pressure. Walk around until your heart rate drops to just 10 to 15 beats per minute over your resting rate. Then stretch again.

Slow down in extreme weather. Don't try to work as hard or as long as usual during the hottest or coldest times of the year.

Drink up. For most moderate exercisers, drinking as much as thirst dictates during or after a workout will usually prevent dehydration. But if you are overweight or over age 65, or if you tend to sweat heavily or exercise intensely or for a long time (especially in the heat), staying well-hydrated may take extra effort.

Graduate gradually. Increase the duration, distance, or intensity of your workouts by no more than 10 percent per week. And increase just one factor at a time. If you've lapsed in your exercise program, start at 50 to 75 percent of your old level and slowly work your way back.

Toss it up. Doing a mixture of different exercises can help fend off injury. Adding strength training to your aerobic workouts can fortify the muscles and joints, but if you do both on the same day, schedule the aerobic one first, since strength training temporarily tightens the muscles.

Don't work through the pain. Listen to your body. Aches and pains signal increased susceptibility to injury. As soon as you feel pain or shakiness, stop. If you're hurt, don't rush back to your regular workouts before you're fully recovered.

Block the shock. To protect your joints, shins, and feet, choose low-impact exercises and soft surfaces whenever possible.

Choose the right shoes. Make sure your footwear is designed for the type of exercise you're doing.

Check your medicine cabinet. Many drugs can impede athletic performance. If you suspect that a drug is interfering with your workouts, talk to your doctor.

Jump in the pool. Experts say that the greater resistance of water compared with air, combined with its buoyancy, offer benefits that are difficult to get on land.

Read more about preventing sports injuries and the perks of exercise.

Workout needs for every age

Physical-activity needs shift with age and with longer days and (slightly) warmer weather, here’s how to keep moving, from age 20 on up.

20s and 30s
Aim for at least five weekly 30-minute sessions of aerobic exercise. The sooner you start, the lower your lifetime risk of several common health problems, including coronary heart disease, hypertension, type 2 diabetes, obesity, and possibly certain cancers. Women should include weight-bearing exercises to help prevent osteoporosis later in life.

Ideally you should also work in two weekly strength-training sessions, although you can get by with one 20- to 30-minute session that involves all the major muscle groups. Stretch for 10 minutes at least every other day, preferably after workouts, when muscles are still pliable.

40s and 50s
Strive for a minimum of 30 minutes of aerobic exercise four days weekly, but squeeze in more if you can. Research shows that multiple bursts of activity are nearly as effective as one continuous session, so break it up if you need to. If you enjoy high-impact activities such as running or aggressive fitness classes, it’s a good idea to alternate with a lower-impact dance class, swimming, or other activity that is easier on the joints.

Try to strength train three times per week, but two sessions will still provide substantial benefit. Aim for 8 to 12 repetitions per set (15 if you’re out of shape) with enough resistance to make the last repetition difficult. Three sets are optimal; two work nearly as well. (Beginners can start with a single set.) Continue to stretch at least every other day.

60s and beyond
Aim for three to four 30 minute sessions of aerobic exercise each week, minimizing or eliminating high impact activities. Also, make time for strength, flexibility, and balance training, which become increasingly important as you age. Continue to stretch at least every other day.

If brisk walking or other weight-bearing exercises have become difficult, try water exercise. Two weekly strength-training sessions are enough, but wait at least a day, and possibly two, between sessions, as muscles need more time to recover. Use lighter weights and more repetitions—10 to 15 in each set. “It’s critical that people in this age group exercise with proper form to avoid injury,” says Cedric Bryant, Ph.D., chief science officer of the American Council on Exercise. It’s worth paying for at least a couple of sessions with a certified personal trainer to develop a safe, effective routine you can continue on your own. Look for someone certified by fitness organizations such as the American College of Sports Medicine, the American Council on Exercise or the National Strength and Conditioning Association.

Never too late
If you’ve never been active, or have fallen off the wagon, you can still significantly increase your strength and fitness at any age. And good news is that exercise can slow or even reverse age-related physical declines. It’s never too late to start!

Gym complaints soar

If your resolve to get fit has you headed to the nearest fancy fitness chain in your area, tread carefully: The Better Business Bureau has reported that complaints about fitness clubs are up by more than 90 percent in the past five years. In a recent release, the bureau notes that the most common gripes pertained to contract disputes (about 42 percent of complaints) and billing issues (about 32 percent). Another 15 percent of complaints came from consumers who joined a fitness center only to have it go out of business shortly after, leaving them to try to recoup their advanced payments.

The findings dovetail with the results of Consumer Reports’ first-ever fitness club survey More than 10,000 of our online subscribers who use a fitness facility answered questions about the staff, classes, crowds, equipment, cleanliness, locker rooms, billing issues, and other features at their respective gyms. We learned that consumers were happier with independent or nonprofit gym options—including private studios for yoga, dance, and Pilates, and gyms at community centers, schools, work, YMCAs, and Jewish Community Centers (JCCs)—than with most big health-club chains.

A common gripe was contract or fee issues (about 16 percent of respondents overall). At the two lowest-scoring chains (Bally Total Fitness and Town Sports International), a higher percentage of respondents had encountered problems, such as unexpected dues hikes or the inability to suspend a membership temporarily while away (34 and 28 percent, respectively).

Canceling was also problematic: Thirty-eight percent of respondents who’d left a big gym in the past three years reported at least one problem, such as continuing to get bills after cancellation or excessive time and effort needed to cancel.

Of course, large-chain gyms can offer certain extras that smaller outfits can’t, such as personal training packages, spa services, child care, and electronic tracking systems. If these extras are important to you, consider a big club but check out a company’s complaint history with the BBB’s free reliability reports.

In addition, both the CR and BBB reports offer useful tips for choosing a gym and avoiding common pitfalls, so you don’t get burned while you’re feeling the burn. Check out our Ratings (subscribers only) to see how your gym stacks up.

Happy sweating!

—Jamie Hirsh, associate editor

The hook in hookahs

Just last month my 15-year-old son, Daniel, mentioned that some of his friends were smoking hookahs (also known as shisha, narghile, goza, and hubble bubble). Daniel ticked off its advantages: It’s not addictive (like alcohol), not illegal (like pot), and safe from the health hazards of cigarettes. His friends’ parents think that it’s cool, he said, and someone he knew even had her Sweet 16 party at a hookah bar (before they became illegal in New York City).

Daniel and his friends were parroting the myths that are being perpetuated by many other teens and young adults in the U.S. As our reporting of the recent research reveals, 15 percent of freshmen surveyed at my alma mater, Johns Hopkins, admit to smoking water pipes. Although many Hopkins students are future doctors, they’re ignoring the facts. Last year  the American Lung Association reported evidence that hookah smoking carries many of the same health hazards as cigarette smoking—heart disease, clogged arteries, and lung cancer. And because the mouthpieces are shared with others, users are also at risk for infectious diseases, such as TB, hepatitis, and herpes. 

Furthermore, evidence suggests that an average 45-minute hookah session raises levels of nicotine in the blood up to 250 percent. It also delivers the equivalent of 100 times the smoke of a cigarette (with its related toxic agents such as carbon monoxide), contributing to a growing concern in the medical community that the practice may lead to regular cravings and addiction to cigarettes. 

As the February 2008 journal Nicotine & Tobacco Research illustrates, it seems that hookah users don’t have a clue! Data analyzed from 201 hookah smokers revealed that 79 percent felt that cigarettes were more addictive than water pipes, 67 percent felt cigarettes were more harmful, and more than 65 percent believed that cigarettes have more nicotine. 

So far, the part about germs has been enough to deter Daniel. But the battle is far from over. When I told him that I was writing this, he insisted, “They wouldn’t make something legal if it were so unsafe.” —Orly Avitzur, M.D., medical adviser to Consumers Union

How Mediterranean is your diet?

The first U.S.-based study of the Mediterranean diet and longevity has confirmed the life-extending benefits seen in several European studies.

Researchers with the National Cancer Institute used a 9-point scale to score the diets of about 380,000 men and women ages 50 to 71. Those with scores above 6 were significantly less likely to die over 10 years of follow-up, particularly from heart disease or cancer, compared with those scoring below 4. (Though this study didn’t measure dairy intake, the Mediterranean diet also typically includes modest amounts of dairy products, such as yogurt and cheese.)

Now see how Mediterranean your diet is. Read each item below and give yourself 1 point for each of the guidelines you follow, 0 for each of those you do not follow.

• Vegetables (other than potatoes)—4 or more servings a day.
• Fruit—3 or more servings a day
• Whole grains—2 or more servings a day
• Alcohol—½  to 1 drink a day for women, 1 to 2 for men (but no more)
• Fish—4 or more servings a week
• Legumes—2 or more servings a week
• Nuts and seeds—2 or more servings a week
• Fat—More unsaturated fats, such as canola and olive oil, than saturated fats, such as butter, lard, and tropical oils
• Red and processed meat—Fewer than 2 servings a day

Now tally your score to see where it fits on the Mediterranean diet scale. If you score below 6, it may be time to adjust your eating habits.

Hair removal: What’s best for you?

How you remove unwanted body hair—manual or electric shavers, creams, hot wax, epilators, electrolysis, or lasers—is mostly a matter of preference. But some methods make particular sense for certain individuals, and our tests show that not all products are created equal.

Blades tend to be easiest for most people, and they shave slightly closer than electrics. Two- or three-bladed razors may offer some advantage. If you develop razor bumps—caused by shaved hairs curling back into the skin—stop shaving for a few days, then apply a preshave lotion and shave with the grain, without stretching the skin. Or consider one of the options below.

Electric shavers rarely cause razor burn or cuts, a particular advantage if you take a blood thinner or have a bleeding disorder. But all models tested on women’s underarms—including some men’s shavers—caused skin irritation.

Electric epilators (with hundreds of tiny tweezers) and hot-wax treatments pull hair out. Most of the ones we tested performed well, though some women found them painful.

Depilatory creams dissolve hair just below the skin surface. But they produce an unpleasant smell and can cause skin reactions in some people, so test a small amount on your forearm first.

Lasers and electrolysis permanently remove hair by destroying the follicles. But they’re costly and time-consuming, and should be done only by licensed practitioners. Even then, they can sometimes darken, lighten, or scar the skin.

Tips for cleaner teeth

Whichever brand of toothbrush, toothpaste, or floss you choose, using proper brushing and flossing techniques is critical for adequately removing plaque, which causes cavities and gum disease.

Brush up on brushing
What to use: Choose a brush with soft or medium bristles, which are gentler on the gums and may clean better because they’re more flexible. The brush design does not appear to influence effectiveness, so choose any one you like.

How often: Brush twice a day, 2 minutes each time. And rinse your mouth after sugary or starchy snacks.

How to brush: Hold the brush with the bristles angled 45 degrees toward the gum line, so one row of bristle tips can slip slightly under the gums. Jiggle the brush head with a short, vibrating motion, then move on to the next spot. Finally, scrub the chewing surfaces.

Brush gently to avoid harming the gums; removing plaque doesn’t require much pressure. Brush both the outer and inner surfaces of your teeth and the tops of molars. Brush your tongue, too, to remove bacteria and freshen breath (or use a tongue scraper, sold at drugstores for about $1 each).

Flossing fundamenals
What to use: All flosses clean effectively. But if you find flossing uncomfortable, consider a slippery one like Glide.

How often: Floss once a day to remove plaque and food particles your brush can’t reach.

How to floss: Break off about 18 inches of floss and wind most of it around a finger; wind the rest around the same finger on your other hand. Use a careful sawing motion to slide the floss between your teeth down or up to the gum line; then gently move the thread slightly under the gums. Next, curve it into a “C” shape against the side of one tooth and sweep it up and down. Repeat for both sides of each tooth, unwinding clean floss from the first hand.

Find out more:

Our testers found a difference in how toothpastes clean, though, so look at our ratings to find out which toothpaste worked best (for subscribers only).

Brush up on your knowledge of toothpaste terms.

If you're pregnant, can the tuna

Many of us rely on the news to help us make decisions about what to buy and feed our families. But sometimes what seems to be good info from an authoritative-sounding source can be dead wrong. A recent advisory by the National Healthy Mothers, Healthy Babies Coalition encourages pregnant women not to cut back on fish, indicating that a little bit of mercury isn’t a problem because the benefits of eating omega-3 fatty acids for healthy brain development outweigh the risks of brain damage from mercury. But that advice counters what many doctors, government agencies, and consumer groups advise.

Hidden agenda?
So what’s up with the National Healthy Mothers, Healthy Babies Coalition? Turns out that the National Fisheries Institute, a fish-industry trade group, paid honoraria to an outside group of experts, who came up with the advice. Organizations that purport to serve the public but are backed by industry groups have been muddying the information pool for decades. The Center for Media and Democracy has been following these organizations.At Sourcewatch.org, its Web site, you’ll find lots of examples, like the Center for Consumer Freedom. Backed by the food industry, the group rails against any actions to combat obesity or smoking in public places.

What to do
While accepting industry money may not be proof positive of a hidden agenda, it’s a conflict of interest for a “consumer” group and should make you think twice about any advice.When it comes to eating fish, we recommend that pregnant women skip seafood with high levels of mercury like tuna and swordfish to lower risks to the developing fetus. And if you’re planning to become pregnant, cut back. For starters, don’t eat more than three cans of chunk light tuna a week. And avoid albacore, which tends to be even higher in mercury. Many women of childbearing age already have borderline high levels of mercury in their bodies so there’s no sense in adding to it, especially since you can get the nutrients you need without consuming mercury-laden fish. And the next time you hear any fishy advice, do some fishing around to find out whom it’s really benefiting; it may not be you.

—Urvashi Rangan, PhD., director of GreenerChoices.org.

Dr. Rangan's blog appears courtesy of ShopSmart magazine.

When you need extra water

As you ramp up your exercise routine this Spring, ensure you're staying hydrated with our advice based on a recent report from the American College of Sports Medicine.

For most moderate exercisers, drinking as much as thirst dictates during or after a workout will usually prevent dehydration. But if you are overweight, over age 65, tend to sweat heavily, or exercise intensely or for a long time, especially in the heat, staying well-hydrated may take extra effort.

A simple way to determine how much to drink is to weigh yourself before and after a typical workout. Water loss can be substantial: A 150-pound person can lose more than a pound of fluid during a brisk walk for just half an hour on a hot day. For each pound lost, plan to drink about two additional cups during or after your next session. If you gained weight during the workout, you drank too much. That can disturb your body’s sodium balance, potentially causing serious illness. After a few weigh-ins you’ll have a good idea of how much you need to stay well hydrated.

As an alternative or additional indicator, monitor your urine. If it’s dark yellow or amber after a night’s sleep, replenish your fluids by drinking a cup of water, particularly if you’ll be exercising that morning. But wait a while before working out, if possible, to let your body absorb the liquid. And drink extra fluid if your urine is dark or scant. If you’ve sweated heavily for a long time, you’ll also need something salty to replenish lost sodium.

For most recreational athletes, the main goal of staying hydrated is to avoid heat stress. So in addition to drinking on hot days, splash water on your face and wipe away sweat, which hinders evaporation. And watch for symptoms of dehydration: feeling sluggish, dizzy, faint, and weak.

Don't gamble with your heart during the Super Bowl

What is it about sporting events like the Super Bowl that turn even the most docile couch potato into a screaming, wildly gesticulating lunatic?  A subject that has long served as comedic fodder for sitcoms and hidden camera exposes has suddenly become deadly serious.  A new study released in the January 31st issue of the New England Journal of Medicine highlights the potential harm to the heart that can be caused by watching an intense and stressful sporting event.

Researchers in Germany analyzed the number of cardiovascular emergencies that occurred among German citizens during the World Cup soccer games in 2006 when their home team was playing and found that the fans experienced twice the number of heart attacks and other cardiac problems, especially within the first two hours of the soccer match.  Men with a history of heart disease were at highest risk.

As if that’s not bad enough, a University of Maryland study presented by Dr. David Jerrard at the American College of Emergency Physicians in 2006, found that there were 50 percent more visits to emergency rooms by men after professional football games than during the games over the three-year period examined.  This came on the heels of a previous study by the same investigator showing that men’s visits to emergency rooms declined during games. 

Not only are men at risk, they delay getting proper medical care so they can finish watching the fourth quarter!

Although triggers were not examined in these studies, Anthony G. Alessi, MD, ringside physician for the Connecticut State Boxing Commission points out that fans who don’t want to give up their seat at a match often skip the diuretic prescribed to control their blood pressure, to avoid having to take a bathroom break. This raises their risk for both heart attack and stroke enough to cause casinos, where boxing events are held, to keep large numbers of defibrillators throughout the house and have three teams of paramedics strategically placed and on alert at all times.

So, whether you’re rooting for the New England Patriots or the New York Giants, take heed:

• Avoid overeating, especially junk food
• Watch the alcohol
• Don’t smoke
• Take your prescribed medication
• Try to relax
• Reduce your stress…don’t bet on the games
• And above all else, don’t bet on your life—if you experience chest pain or shortness of breath, ACT IN TIME!

—Dr. Orly Avitzur, Medical Adviser, Consumer Reports

See how Super Bowl snacks stack up in our chip ratings.

Make this your year to reach your health goals

The media is saturated this time of year with models and celebs promising you’ll lose weight or develop sculpted abs quickly and with no effort. No matter how appealing the idea is, most of us know in our logical minds that there’s no magic bullet to help us be healthier. Reaching your goals takes planning and a conscious commitment, but it doesn’t have to involve deprivation and discomfort.

So think about realistic health goals and make 2008 your year to achieve them. We’ve brought together the best of our latest health ideas to help you, so make this your year to:

Lose weight

• Winning diets and diet books
• 8 dieting strategies that work
• Find out how supplements and prescriptions drugs rate for weight loss in our Treatment Ratings
• More about diet & nutrition

Get fit

• 10 health benefits of exercise
• Be safe, prevent sports injuries
• Minimize fatigue and try interval training
• We rate the top gyms
• Do infomercial fitness gadgets work?

Eat healthier

• Should you see a nutritionist?
• "Super" foods: Do you really need them?
• When buying organic pays (and doesn't)

Go green

• 20 free ways to save energy
• Animal feed: You are what they eat
• Chemicals in cosmetics
• Being green can save green
• Green product ratings from Greener Choices

Prioritize your health

• Get better care from your doctor
• Ensure you’re getting the best health plan you can
• Make the most of your health insurance
• How are we working to improve your health care?

Quit smoking

• Quiz: What can help you quit?
• Smoking treatment ratings

Pace yourself for better health in 2008

Around this time each year, I see a rush of patients with medical conditions and injuries related to New Year’s resolutions gone awry. Recently enrolled health club members come in with back pain and slipped discs, and crash dieters complain of dizziness and headaches. Simply put, pushing too fast or too hard often causes more harm than good. Just because you’ve made a decision to get healthy and fit, doesn’t mean that you have to try to reach your target by the end of January. To paraphrase a celebrity NFL quarterback, unless you are under the age of 23 or are a professional football player, it probably isn’t going to happen.

As someone who’s tried most diets from Atkins and Cabbage Soup to the Zone, and has been drawn to nearly every exercise craze du jour, I understand the craving to get quick results. But after recurring sprains and rebound weight gain, I’ve had to revise my approach. Contrary to the adage, “no pain, no gain,” good fitness programs start by finding enjoyable exercise that doesn’t hurt, and permanent weight loss begins with a nutritional plan designed for the long run. So, set your goals, make them reasonable, and pace yourself for a healthy 2008!—Dr. Orly Avitzur, Medical Adviser, Consumer Reports

Haemophilus Vaccines Recalled

Merck is recalling over a million doses of its Haemophilus influenzae Type B vaccine because of improper sterilization during manufacturing, according to the New York Times. Centers for Disease Control and Food and Drug Administration officials said there was no public health threat, although the recall may lead to a shortage of the vaccine this year.

The recall affects Pedvaxhib and the combination Haemophilus/hepatitis B vaccine Comvax  that were distributed as early as April 2007.

Merck says that physicians should not administer vaccines from the recalled lots. Patients who have already received the recalled vaccines should finish their series with an Hib conjugate-containing vaccine not part of this recall. Revaccination is not necessary, Merck says, because the vaccine's efficacy was not affected.

For further information, read the CDC's frequently asked questions on the recall.

5 steps to healthier winter skin

Cold, dry air, friction from heavy clothing, and indoor heating can turn your skin dry, itchy, and prone to cracks. Here's how to keep from drying out this winter.

1. Add humidity
   Place a water-filled bowl near a heating vent or radiator, or use a humidifier. The device should have a humidistat that shuts the humidifier off when the preset humidity level is reached.
2. Shun long, hot showers and baths
   Hot water washes away the skin's natural oils, so limit bathing to 10 minutes, use warm rather than hot water, and keep the bathroom door closed to lock in humidity. Skip antibacterial, deodorant, and perfumed soaps, which tend to be drying, in favor of a mild, moisturizing, scent-free cleanser.
3. Moisturize early and often
   Smooth on moisturizer—preferably with glycerin, fatty acids, ceramide, or cholesterol—after bathing, while your skin is damp. Reapply throughout the day, if necessary. Use a facial moisturizer or sunscreen with a sun-protection factor of at least 30, especially on sunny days spent out in the snow.
4. Pamper problem spots
   Lips chap easily because they lack sweat and oil glands. But don't lick your lips, since evaporation makes the chapping worse. Petroleum jelly works well, though lip balm or lipstick can help. Put on lotion after you wash your hands, and wear cotton-lined plastic or rubber gloves when cleaning dishes. If necessary, apply a heavy lotion at night and wear cotton gloves. Treat cracked heals with moisturizers containing lactic acid or urea. For severe cases, see a dermatologist.
5. Wear soft clothing
   Avoid wool and other rough fabrics. Wear cotton or silk next to your skin. Switch to an unscented fabric softener to avoid drying perfumes and chemicals. Finally, leave your electric blankets in storage—they can suck moisture from your skin as you sleep.

Tip of the day: How to handle a chatty M.D.

What’s up, doc?” may be the wrong question to ask your physician during an office visit. A recent study suggests that doctors already share too much personal information with patients. And while many do so to put patients at ease, it can actually be counterproductive. Researchers had actors pretend to be patients and secretly record visits with 100 doctors. Thirty-four percent of the time doctors chatted away about personal topics such as their own health or families. But 11 percent of those disclosures were deemed disruptive, and 85 percent were considered useless.

Since office visits are often too short to squander, get the most out of your time by writing out questions beforehand and prioritizing the three or four you want to talk about most. If you can’t get through the list, ask if you can follow up with e-mail.

How to curb mindless eating

So what’s mindless eating?
External cues influence how much we eat.You pour more liquid into a short, wide glass than a tall, skinny glass. You eat 92 percent of anything you serve yourself. You eat 20 percent more food served family style rather than left on a side counter. People eating with one other person eat 30 to 35 percent more than they otherwise would. Having a snack within arm’s reach doubles how much of it you eat.

How can you know all that?
We’ve tested it all empirically. For instance, most people say they eat until their plate or bowl is empty, so we wondered what would happen if the bowl was never empty. We made a soup bowl that continuously refilled through a hole in the bottom attached to a hose from a 6-gallon vat. People with refillable bowls ate an average of 73 percent more soup than people who ate from a regular bowl, yet they didn’t think they had eaten more. They said, “How can I possibly feel full? I have half a bowl of soup left.”

How can this help you control your weight?
Our research has identified the “mindless margin” of eating. Going on a diet and cutting out 1,000 calories a day triggers feelings of hunger and deprivation. But a typical person can cut out 200 to 400 calories a day without noticing the difference. That may not seem like a lot, but if you make three 100-calorie cuts a day, at the end of a year you’ll weigh 30 pounds less. Move your candy dish. Get rid of your short, wide glasses. Use smaller dishes. Make some rules for yourself. Only allow yourself to eat a midmorning doughnut if you’ve already eaten a piece of fruit, which means you probably won’t be hungry for the doughnut. Serve the vegetables family style but not the mac and cheese.

At a restaurant, use the “pick two” strategy. Order a main course and only two of the following: bread, appetizer, dessert, and alcoholic drink. At a reception buffet, follow the “rule of two.” You can have whatever you want, but you have to use the smallest plate and can put only two things on it at one time. Always have something to drink in your hand, because that’s one less hand to eat with. —Brian Wansink,Ph.D.

Dr. Wansink is director of the Food and Brand Laboratory at Cornell University and author of “Mindless Eating” (2007, Bantam Books).

Tip of the day: Take the stairs

Just 7 minutes a day of walking up stairs may help protect your heart, among other benefits. But only about 6 percent of people actually take the stairs in public buildings. Maybe we just need a friendly nudge in the right direction—in one British study encouraging signs posted in a mall nearly tripled stair use.

Q&A: How often do you really need to strength train?

What’s the least number of repetitions, sets, and days per week I can do strength training and still get results? —C.J., Midland, Texas

Good news: Unless you’re a bodybuilder or a serious athlete, a single set for each muscle group, twice a week, is all you really need. Beyond that, the benefits begin to taper off. As for repetitions, the general advice calls for 8 to 12 reps at a weight or resistance that’s challenging but lets you complete the set. If you’re frail or older than 65, substitute 10 to 15 reps at a slightly lower resistance. If you work out on consecutive days, switch off between muscle groups—say, the torso one day followed by arms and legs the next—since muscles need at least a day off to recuperate.

Protect yourself from staph infections at the gym

A strain of the bacterium methicillin-resistant Staphylococcus aureus (MRSA) has spread from hospitals into communities, mostly in gyms and health clubs, where people unknowingly share contaminated towels or athletic equipment. While the strain is less deadly than the version found in hospitals, it’s now a leading cause of skinrelated visits to the emergency room.

To protect yourself, don’t share towels, put a clean towel over workout mats, and wipe down equipment with the alcohol spray that most gyms provide. And see your doctor if you have signs of skin infection: boils or a localized, painful rash that doesn’t heal.

7 safety tips for mascara wearers

While most mascaras are safe when used as directed, they still carry some risk of eye injury and infection. Here’s how you can protect yourself:

1. Apply mascara only to the tips of your lashes. If you get it too close to the root, you could block glands on the eyelids that help form tears, and your eyes might not get the lubrication they need. That condition, called dry eye, can be painful or diminish your vision.
2. Don’t share mascara. The membrane around the eye can harbor bacteria that can easily latch on to a mascara brush. If you come in contact with another person’s germs, you could wind up with conjunctivitis or other infections.
3. Don’t add liquids to mascara. Tap water, which some people use to thin mascara, isn’t sterile and can allow potentially harmful bugs into the tube. Saliva is also full of bacteria and should not be used to moisten mascara.
4. Avoid lash-extending mascaras if you wear contacts. The microfibers can become trapped beneath your lens and scratch the cornea, increasing the risk of infection.
5. Never apply mascara in a moving vehicle. If the vehicle suddenly stops or jerks, you could injure yourself with the mascara brush.
6. Don’t store mascara at temperatures above 85° F (29° C) or leave it in your car for long periods, since the heat may encourage bacterial growth.
7. Throw out mascara every three months; by then bacteria will probably be growing in it. Throw it out sooner if it’s discolored, begins to smell, or if you’ve recently had an eye infection, all of which could signal contamination.

New idea for dieters

Dieters have new help in cutting calories. A six-month study of 130 obese diabetics found that those who used specially calibrated “diet” plates for portion control were more than three times as likely to lose 5 percent of their body weight than those who only got standard nutritional counseling. The plates, which are made by a British firm, have marks indicating proper portion sizes for various foods, and allow for about an 800-calorie meal for men or a 650-calorie meal for women. Go to their website to find out more about The Diet Plate.

Find out how the latest diets stack up, and see our ratings tables of the latest diet books and diet plans (available to subscribers).