Study: Lack Of Seat Belt Use By The Obese Puts Them At Greater Risk In A Car Crash

Dr. David Schlundt pinpoints another obesity-related problem

We all know the health dangers associated with obesity, including diabetes, heart disease, hypertension, cancer, and a whole host of other health calamities. But now researchers out of Vanderbilt University have stumbled upon another unexpected side effect of the overweight and obese population that is likely being overlooked by a lot of statisticians: automobile accident injuries and death.

Lead researcher Dr. David G. Schlundt, associate professor in the Department of Psychology at the Nashville, TN-based Vanderbilt University, hypothesized that the use of seat belts among the obese was likely less than their non-obese counterparts because of a variety of concerns, not the least of which is the comfort of use. He wanted to test this theory against hard data regarding BMI rates to calculate the rate of seat belt use among the increasing degrees of obesity.

Using existing data from the Center For Disease Control's 2002 Behavioral Risk Factor Surveillance System Survey, Dr. Schlundt and his team of researchers implemented a multivariable logistic regression to determine the seat belt use among the following groups split up according to their BMI:

- OVERWEIGHT (BMI 25.0-29.9)
- OBESE (BMI 30.0-39.9)
- EXTREMELY OBESE (BMI 40.0+)

These statistics were compared with the non-overweight/non-obese (BMI below 24.9) and the numbers were adjusted for age, race, gender, education, and the individual state seat belt laws. According to what Dr. Schlundt found, here was the breakdown of seat belt use among the various categories of people according to their weight:

- NON-OBESE 82.6 percent
- OVERWEIGHT 80.1 percent
- OBESE 76.6 percent
- EXTREMELY OBESE 69.8 percent

The researchers found that women especially were discouraged from seat belt use the higher their BMI was, but they noted an increase in seat belt use the older they got, the more education they received, and in states that have a secondary seat belt law in place legally requiring it. The conclusion of Dr. Schlundt and his team was that obesity now can lead to reckless behavior when the obese get behind the wheel of an automobile.

"Lack of seat belt can be added to the list of risk factors associated with obesity," the researchers contended. "Effective preventive interventions are needed to promote seatbelt use among overweight and obese persons."

This study was published in the November 2007 issue of the journal Obesity.

When I was researching this study, I couldn't help but think about that scene in the Eddie Murphy movie called Norbit where one of his characters named Rasputia, an ornery 300+ pound monster of a woman, was trying to get inside of her car and her stomach was so big she was pushing up against the car horn. This wouldn't be so funny if it didn't have at least an ounce of truth to it:



Yes, that makes for a good laugh scene in Hollywood, but for some people this is no laughing matter. I can remember vividly weighing over 400 pounds with the seat as far back as it could go and my stomach would STILL touch the steering wheel. I always joked with my wife Christine that I could drive with no hands and it was quite embarrassing. And let's not even talk about how I got in and out of the car (bad memories, bad memories!).

When I was morbidly obese at 400+ pounds (my BMI was around 52 at my highest weight), I absolutely HATED with a passion having to wear a seat belt. It really got to the point that I refused to wear one because it rubbed up against me in ways I couldn't tolerate and the stupid thing never seemed to fit right no matter what I did. Well duh, it's not made for a gargantuan man with a 62-inch waist wearing 5XL shirts and with a stomach looking like I was carrying quintuplets!

Then, an event happened in August 2003 that was likely the thing that set the wheels in motion for me to start livin' la vida low-carb--although that was the furthest thing from my mind at the time. This really shook me into reality about my increasing weight problem in the Fall 2003 and in hindsight I'm thankful it happened.

My wife's grandfather had died suddenly and we traveled to Virginia to be with the family for the burial. It was about an hour until the funeral when Christine remembered she left a picture she drew to place inside the casket with her grandpa at her parent's house about a mile away from her grandmother's home. The limousine was scheduled to pick us up within a few minutes, so I told Christine I'd hop in the car and go get the picture for her.

So I drove to my in-law's house, grabbed the picture, and started heading back when suddenly it happened--SCCCCCRRREEEEEECH...CRASH!!! A man driving an SUV with his wife and kids ran a stop sign and I swerved off the road to avoid hitting them. My Ford Escort then made a beeline for a tree hitting it head-on at about 35 mph. I'll never forget three memories from that day when the car came to a stop.

1. I couldn't breathe at all and was in severe pain across my chest.
2. The horn was stuck and blared loudly throughout the neighborhood.
3. I knew I would miss saying goodbye to Christine's grandpa.

As the white dust from the air bag filled the car, I immediately opened the door so I could try to get some air. I recall taking the seat belt loose (thankfully, I was wearing one that day!), putting my feet outside the door, and standing up dizzily looking for help. The man who ran the stop sign called for an ambulance and he asked me if I wanted to borrow his cell phone to call someone. I was so disoriented from the crash that I couldn't remember grandma's phone number. I leaned up against my car and finally the number came to me. I reached Christine's dad.

A neighbor who heard all the commotion came over to turn off my very annoying horn which was making my headache ten thousand times worse and my father-in-law was there in mere moments. He's a police officer, so he is familiar with coming on scenes like this quite often in his line of duty. I can remember him asking me if I needed him to stay with me, but I knew going to his father-in-law's funeral was important to him. I wasn't bleeding anywhere, but a couple of my fingers were twisted and my entire chest and stomach was one big contusion. When the ambulance arrived to pick me up, I rode to the hospital alone and told him to get to the funeral. I'm glad he did.

Within a couple of hours, I was in and out of the emergency room with some minor injuries considering the accident. But even with the seat belt on, I sustained a lasting impression on the front of my body that took several months to heal. Looking down at my big blob of blubber with my man boobs and oversized keg of a stomach every morning that literally turned every shade of black, blue, purple and green was enough to make me wanna get rid of that ugly sight forever. It would only be a matter of months before I decided to go on the Atkins diet that would change my life forever.

With around 3 million injuries and a total of 42,000 deaths that happen annually as a result of car crashes in the U.S., this new research shines a bright light on an issue that should capture the attention of anyone who is obese--currently estimated at close to 60 million Americans. Seat belts have been shown to reduce the rate of injury and/or death by as much as 50 percent, so this is a rather alarming trend that should be a major motivating factor for anyone carrying around extra pounds around their waistline to do something about it. If you can't wear the seat belt in your car, then something bad is wrong that needs addressing! And it's not your seat belt!

Many car companies make seat belt extenders that are very low-cost for their customers to use, so take advantage of that while you can. By all mean, don't let your pride get in the way of your personal safety in your automobible. More than anything, though, you really need to find a weight loss plan that will work for you and then DO IT! Whether it is low-fat, low-carb, vegan, or whatever, just choose one and GO FOR IT! Pick a plan, follow it precisely, and never give up on it. That's what will melt the pounds away and get you on the right path for your weight and health.

Even Dr. Schlundt admits there is no direct correlation found between having a higher body weight and seat belt use, but from a practical standpoint as a former 400-pounder who has been there--it's undeniable! And even WITH a seat belt, you can still get injured pretty badly just like I did. I took gobs of pain pills (and I NEVER like taking medicine of ANY kind) and couldn't get up out of a chair by myself for about two months...and that was WHILE WEARING A SEAT BELT! Losing weight wasn't just an option for me after this accident, but rather a real necessity. I wonder if I would have been as gung ho about livin' la vida low-carb had it not been for this accident. Who knows? But I'm glad it happened--er, sorta. :)

You can e-mail Dr. David Schlundt about his research at David.Schlundt@Vanderbilt.Edu.

Stanford Researchers Confirm Atkins Diet Best For Weight Loss, Improved Health

Dr. Christopher Gardner says Atkins diet deserves a second look

Are you one of those people who STILL thinks the Atkins low-carb diet is just another dangerous fad that is a far inferior way to lose weight and improve overall health compared to the more highly-recommended, yet unsubstantiated traditional low-fat, low-calorie diets? If so, then you may be interested in the very latest research released in today's issue of the highly-respected Journal Of The American Medical Association which could very well change how all of us view the much-vilified, yet extremely effective Atkins diet.

Lead researcher Dr. Christopher D. Gardner, from the Stanford, CA-based Stanford Prevention Research Center and Associate Professor in the Department of Medicine at the Stanford University Medical School, and his fellow researchers conducted a one-year randomized trial they entitled "A TO Z: A Comparative Weight Loss Study."

Recognizing the severity of the obesity epidemic that has become what they describe as "the single most significant nutrition-related health issue of the new millennium," Dr. Gardner wanted to know in his study if the monopolistic low-fat dietary recommendations that have been coming directly from government and health agencies for decades really were better for weight loss and improvements in various health outcomes than some of the other popular weight loss methods to come out in recent years, including the lower-carb Zone and Atkins diets.

Observing 311 women who were overweight or obese at baseline with a body mass index of 27-40, non-diabetic, pre-menopause, and willing to participate in the 12-month study, the researchers divided up the study participants into one of four diet groups:

ATKINS (20g carbs daily for 2-3 months, 50g daily thereafter)
ZONE (40-30-30 ratio of carbs to protein to fat)
LEARN (55-60% carb intake, less than 10% saturated fat)
ORNISH (No more than 10% calories from fat)

Additional recommendations for each study group regarding exercise, supplements, and other behavioral strategies for being successful on each plan as prescribed by the various diet books used were also provided to the study participants. Dr. Gardner explained to the "Livin' La Vida Low-Carb" blog that each of the study participants were also provided with eight weeks of intensive education from a nutritionist about their respective diet plan and then left on their own for the remaining ten months of the study.

While the primary outcome studied was weight loss, the researchers were also interested in some of the secondary outcomes such as differences in cholesterol, including LDL, HDL, and triglycerides, body fat percentage, waist-to-hip ratio, fasting insulin and glucose levels, and blood pressure.

Each of the study participants were measured for their progress on their specified diet plan at the beginning of the study, after two months, after six months, and then at the end of the 12-month study.

Interestingly, although the percentage of study participants who were able to stay on their specified diet plan was not statistically different, it was the ATKINS group that led the pack for retaining the most dieters for the duration of the study among the four study groups:

ATKINS - 88 percent
ZONE - 77 percent
LEARN - 76 percent
ORNISH - 78 percent

So, what did Dr. Gardner and his team find at the end of the study?

Weight loss among the ATKINS group was statistically higher as compared with the other diet groups, including triple the weight loss of the ZONE group, nearly twice as much weight loss as the LEARN group, and more than double the weight loss of the ORNISH group. Statistically speaking, there was very little difference in the weight loss between the ZONE, LEARN, and ORNISH groups.

While most people expected the ATKINS group to produce higher weight loss (although the infamous Dansinger study indicated there was no significant difference in weight loss after 12 months between the various diet groups), the unexpected aspect of Dr. Gardner's study is what happened to the health of the individuals who followed this dietary plan as compared to the others.

One of the frequent criticisms of the low-carbohydrate approach is the assertion that it can lead to certain health complications, including the loss of muscle mass rather than body fat (contradicted by this previous study, an increase in cholesterol (again, not an issue for people following a low-carb diet), a rise in blood pressure, and other such heart health risks (despite this study which found there were none associated with low-carb diets).

But this new study confirms most of those flailing arguments are all for naught.

The body mass index of the ATKINS group at the end of the study had been reduced by more than three times as much as the ZONE group and twice as much as the ORNISH group. At the same time, the body fat percentage loss for the ATKINS group after 12 months was three times higher than the LEARN and ZONE groups as twice as high as the ORNISH group. This echoes what previous research found regarding body fat loss on a low-carb diet.

As for cholesterol, LDL remained relatively stable among all groups except for the ORNISH group which saw a noticable drop, but it was the HDL and triglycerides numbers (which this recent study confirms is a better marker for measuring heart health anyway) that were dramatically different.

The ORNISH group saw HDL remain exactly the same after 12-months while the ZONE and LEARN groups saw equally modest increases in HDL. But it was the ATKINS group's rise in HDL that was more than double that of ZONE and LEARN while their triglycerides dipped twice as much as ORNISH and LEARN groups and seven times as much as the ZONE group.

While the waist-to-hip ratio and blood glucose levels were not statistically different among all groups (although the ATKINS group again saw a greater drop in insulin levels), blood pressure among the ATKINS group was significantly lower than all the other groups, including nearly four times lower than the ORNISH group.

This groundbreaking study was published in the March 6, 2007 issue of The Journal Of The American Medical Association.

In an exclusive interview with "Livin' La Vida Low-Carb" blog, Dr. Gardner was quick to point out that this was a smaller study and that his research should not be misconstrued as an endorsement of the Atkins low-carb diet. However, he did say the previous rush to judgment about the low-carb nutritional approach was probably a bit premature.

"This [study] is more evidence for shifting to low-carbohydrate diets," he said.

He added that the average weight loss among the ATKINS group was only about 10 pounds each and that several of the groups had people who lost 30 pounds or more, which proved that there are multiple ways to lose weight. However, Dr. Gardner admitted there were limitations in his study that are impossible to measure, including whether the dietary changes are the key to permanent weight loss or if there are qualities about individuals that make them more prone to success.

"We need to find out what internal mechanisms are at work in people to make them successful and bottle it up somehow," he exclaimed.

He said there was a noticable drop in performance among all groups when they were left to do their respective diet on their own following the eight weeks with a nutritionist. Dr. Gardner believes the support the dieters received was a key to their success early on regardless of the plan they were using. This is proof that having a weight loss buddy could be a beneficial ingredient for people desiring weight loss.

Foreshadowing his future research on carbohydrates as it relates to obesity, Dr. Gardner wants to study whether there is a limit on the carbohydrate intake for people to consume for weight loss.

"Is there threshold on the continuum of carbohydrates consumed," he asked. "Is it below 40 grams carbohydrates, 30 grams? That's what I'd like to know."

Regarding his decision to conduct this study comparing the Atkins diet with three other higher-carb diet plans, Dr. Gardner said he feels the low-fat diet has been too heavily publicized and recommended without seeing the beneficial results to make a dent in the health and obesity crisis we now find ourselves facing.

"People have been asking about diets for years," he stated. "We think it's time to give them some answers."

Although there have been widespread concerns about what is allegedly lacking in the Atkins diet, the researchers concluded that this particular diet is just as good a place to start for people who are committed to losing weight and living a healthy lifestyle.

"These findings [in the study] have important implications for clinical practice and health care policy," the researchers remarked. "Physicians whose patients initiate a low-carbohydrate diet can be reassured that weight loss is likely to be at least as large as for any other dietary pattern and that the lipid effects are unlikely to be of immediate concern."

Convincing the medical community of this fact is now the real challenge. How much longer will they continue to ignore studies like this one while millions upon millions of people keep getting fatter and sicker than they've ever been before following the low-fat recommendations, hmmm? This is something low-carb practitioner Dr. Mary C. Vernon wondered in response to this study.

"The evidence in favor of carbohydrate restriction continues to accumulate," she wrote on her blog today. "Once again, this study quantifies what physicians using this technique to treat disease and return metabolic parameters to normal have reported over and over again. Wow."

She added that we need to stop being shocked every time the Atkins diet is confirmed by credible scientific research that it works as well as it has been proven to work.

"The surprise in today's Journal Of The American Medical Association is not that Atkins works and confers health benefits, the surprise is that it's still a surprise," Dr. Vernon expressed. "You can lead a mainstream doctor to water, but clearly you can't make him drink. Oh, wait, sorry, that's a horse."

Ironically, it was Dr. Vernon who said in my interview with her last year that the National Institutes of Health (NIH) needs to step up to the plate and fund more studies comparing the Atkins diet with the low-fat diets that unfairly dominate dietary recommendations.

Well, she and everyone else should be pleased to hear that this study was indeed underwritten with grants from the NIH, the Community Foundation of Southeastern Michigan, and Human Health Service. Will this funding trend for low-carb research from our health entities continue on based on the positive response Dr. Gardner found in his study about the Atkins diet? We shall see.

I have long held the belief that the future of low-carb hinges on the research proving it is everything that those of us who support it believe it is. I guess it's not enough that I lost nearly 200 pounds on the Atkins diet in 2004 and kept it off ever since.

While low-carb weight loss success stories like mine are interesting and important in communicating the message that the Atkins diet really works for people, the real difference in our culture will come when more and more research like this one today is brought to the attention of family doctors and those who work directly with overweight and obese patients. People trust their doctors and will heed their advice about diet. Now if we can only get the healthcare community to absorb this research.

If that happens (and I believe it will at some point), then it could very well bring about the much-needed paradigm shift within the world of diet, health, and nutrition that has been needlessly dominated by what has been proven in another JAMA study last year to be the high-carb, low-fat lie for far too long. Keep the low-carb research coming because sooner or later the truth will break through. Hopefully, not before it's too late.

You can e-mail Dr. Christopher D. Gardner to thank him for his outstanding research comparing the Atkins diet with the low-fat diets by writing to cgardner@stanford.edu.

3-7-07 UPDATE: Upon reading my blog post about his study, Dr. Christopher Gardner was not at all pleased with what I had written regarding his research. It seems his disdain for low-carb diets as a long-term solution to obesity and health problems is an ever-present concern and he did not want people to misunderstand his position about the diet despite the favorable findings in his study.

Here's what he wrote:

Jimmy,

I did not particularly enjoy your blog. I do not endorse the Atkins as wholeheartedly as you do. I find the results interesting, and I do intend to follow up on them. However, I am disappointed that you included many of the interesting findings I discussed, but few of my concerns.

The line below, in particular, was a misunderstanding.....

"Is there threshold on the continuum of carbohydrates consumed," he asked. "Is it below 40 grams carbohydrates, 30 grams? That's what I'd like to know." I was referring to 40% of calories from carbohydrates, not 40 grams. Please do not allow that misunderstanding to remain as it is.

On 20, 30 or 40 grams a day there are several important vitamin and mineral deficiencies that can't be avoided. I don't believe it is healthy to go that low, and I don't believe many people can sustain a diet that low.

I would not be surprised to learn that you, with your iron will (that I truly would like to bottle) could go this low. But the average person cannot or would not and I believe it is fair to say should not go on that low a carbohydrate diet.

I'm glad it has worked for you. But I have numerous concerns about being on that kind of diet long-term, and our study was not able to address long-term concerns.

I wish you the best in your endeavors. I would prefer to not be included in your blog, or, if included, to be presented as being much more cautious about the findings and their interpretation than you have portrayed me.

Sincerely, and in the hopes of finding more ways for more people to lose and keep off weight,

Christopher Gardner

WOW, that's a rather strong reaction to what most people have e-mailed to tell me was a well-written article. But, it is what it is and Dr. Gardner is trying to keep up the that proverbial wall that many medical researchers are scared to death of tearing down--between the reality of the effectiveness of low-carb and their fantasy that it is healthy or sustainable to eat less than 50g carbs daily.

I couldn't let his e-mail go without a response:

Dr. Gardner,

THANK YOU for writing and I apologize if you felt I made it appear you were endorsing the Atkins diet with your study released in JAMA on Tuesday. I spent nearly 7 hours writing this column with painstaking details reading the full text of the study and in conducting personal research for it.

It was not my intention to mislead my readers into believing you supported low-carb as a permanent and healthy lifestyle change as many of us do. If you still have questions about the long-term implications, then certainly the door is open for you and other researchers to continue looking for the answers to those questions (many of which HAVE been answered by research in the links I provided).

Very clearly your research provides a solid basis for continuing to look at the low-carbohydrate approach as it relates not just to weight loss, but also health management. When I spoke with you about your theory for a new study, it was not made clear you were referring to the percentage of the macronutrient rather than the actual grams. Again, I apologize for that.

Feel free to contact me anytime you have any questions or concerns. My blog is about providing people with education and hope for a brighter tomorrow. That's exactly what I'll keep doing sharing the good news of livin' la vida low-carb with them. Take care and THANK YOU again for your e-mail!

Do you feel Dr. Gardner overreacted a bit in response to my column? It was never my intention to put words in his mouth, but rather share what his amazing study found--that is, that for at least one year, we can say that the Atkins/low-carb nutritional approach is at the very least just as effective for managing weight and health as any other way of eating. Why is there such vitriol opposition...STILL?!

Study: Increased Exercise For Children Must Be Accompanied By Diet Change

Researchers found exercise by itself will not help kids lose weight

This MedPage Today article pours buckets of cold water over the notion that young children are not getting enough exercise to ward off obesity.

Lead researcher Dr. John J. Reilly from the Division of Developmental Medicine at the University of Glasgow along with his fellow researchers wanted to look at the effectiveness of physical activity on the prevention of childhood obesity in a randomized controlled trial. Specifically, they were looking at the reduction in the body mass index (BMI) of preschool-age children over a one-year period.

The research included 545 children from 36 preschools in Glasgow, Scotland with a mean age of 4.2 years old when the study began. They were required to participate in three 30-minute exercise sessions each week in the first six months of the study as well as health education courses in the home to foster increased physical activity among the young study participants outside of school rather than doing such slothful activities such as watching television, playing video games, or any other non-exercise activities.

While the primary focus of the study was on the BMI, Dr. Reilly also wanted to see how much exercise the children got versus their sedentary behavior and whether that made any measurable difference.

The results? NO SIGNIFICANT EFFECT WAS MADE ON BMI AFTER SIX MONTHS AND TWELVE MONTHS! The control group and study group were virtually the same with a standard deviation score for BMI at 0.46 after six month and 0.41 after twelve months. The control group BMI was exactly the same at 0.43 after six and twelve months.

However, one difference was the kids who had increased exercise did have significantly better motor skills than their control counterparts when adjusted for sex and baseline performance.

As a result, Dr. Reilly and his researchers concluded that physical activity is not a factor in weight loss among children. They state that perhaps other changes are necessary to turn the tide of obesity among young children.

"Successful interventions to prevent obesity in early childhood may require changes not just at nursery, school, and home but in the wider environment," the researchers found. "Changes in other behaviors, including diet, may also be necessary."

This study was published in the October 2006 issue of the British Medical Journal.

So all the talk about kids needing to sneak in more exercise has been just a smokescreen to avoid dealing with the real culprit in childhood obesity--POOR DIET! While ideas such as weighted toys sound like a good thing to do at face value, this study by Dr. Reilly clearly shows exercise alone is not the answer. It MUST be in correlation with other changes, including what we are feeding kids.

Whether people realize it or not, this is a very serious issue that has potentially lethal consequences for overweight and obese children when they mature into adulthood. Fat babies make fat adults and there's no getting around that fact. If we can stop the obesity epidemic while children are still young, then a lot of the health problems that are plaguing the adult population today can be avoided. That doesn't mean we need more money thrown at the problem either.

But the changes in diet have to make good nutritional sense for our children as well. Kids these days are eating way too much sugar and other refined carbohydrates for their bodies to use for energy. You've got people like former President Bill Clinton pushing for healthier food choices in schools, but many of these recommended foods are still LOADED with carbohydrates!

Considering the state of childhood obesity is where it is today, it may not be a bad idea for parents to start looking at the low-carb lifestyle for their children and themselves for that matter. It's certainly something worth a closer look in light of the failure of what we are doing right now.

Clearly, something is NOT working, so making measureable and meaningful changes in the diet we are feeding our kids is sorely needed. Your children can exercise to your heart's content and that's a good thing--A VERY GOOD THING! But if you keep feeding your family garbage foods that are doing nothing to add value to their health, then all that exercise is negated.

Of course, critics of Dr. Reilly's study will claim the children did not get the 30-minutes-a-day minimum amount of moderate-to-vigorous physical activity recommended recently by the American Heart Association. But it may not make a difference if they're still eating all those high-carb, high-sugar foods that tend to plague our diet in modern times.

The study was paid for by the British Heart Foundation, the Glasgow City Council, and the Caledonian Research Foundation.

You can e-mail Dr. Reilly about his study at jjr2y@clinmed.gla.ac.uk.