How weight bias in health care can harm patients with obesity: Research
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Patients who weigh more than what medical authorities generally consider healthy often avoid seeing doctors for fear of being judged, insulted or misdiagnosed, decades of research find. Meanwhile, academic studies consistently show many health care professionals discriminate against heavier patients and that weight bias can drive people with obesity to gain weight.
Weight bias refers to negative attitudes, stereotypes and discrimination aimed at individuals with excess body fat. When scholars reviewed 41 studies about weight bias in health care, published from 1989 to 2021, they found it comes in many forms: contemptuous language, inappropriate gestures, expressing a preference for thinner patients, avoiding physical touch and eye contact, and attributing all of a person’s health issues to their weight.
“Weight bias has been reported in physicians, nurses, dietitians, physiotherapists, and psychologists, as well as nutritionists and exercise professionals, and it is as pervasive among medical professionals as it is within the general population,” write the authors of the research review, published in 2021 in the journal Obesity.
That’s a problem considering an estimated 4 out of 10 U.S. adults aged 20 years and older have obesity, a complex and often misunderstood illness that the American Medical Association voted in 2013 to recognize as a disease. By 2030, half of U.S. adults will have obesity, researchers project in a 2020 paper in the International Journal of Epidemiology.
Worldwide, the obesity rate among adults aged 18 and older was 13% in 2016, according to the World Health Organization. If current trends continue, the World Obesity Federation projects that, by 2035, 51% of the global population will be living with overweight or obesity.
The harms of weight bias
Weight stigma — the societal devaluation of people perceived to be carrying excess weight — drives weight bias. It’s so physically and emotionally damaging that a panel of 36 international experts issued a consensus statement in 2020 to raise awareness about and condemn it. Dozens of medical and academic organizations, including 15 scholarly journals, endorsed the document, published in Nature Medicine.
The release of a consensus statement is a significant event in research, considering it represents the collective position that experts in a particular field have taken on an issue, based on an analysis of all the available evidence.
Research to date indicates heavier individuals who experience weight bias and stigma often:
- Avoid doctors and other health care professionals, skipping routine screenings as well as needed treatments.
- Change doctors frequently.
- Are at a higher risk for depression, anxiety, mood disorders and other mental health problems.
- Avoid or put off exercise.
- Consume more food and calories.
- Gain weight.
- Have disrupted sleep.
The consensus statement notes that educating health care providers, journalists, policymakers and others about obesity is key to changing the narrative around the disease.
“Weight stigma is reinforced by misconceived ideas about body-weight regulation and lack of awareness of current scientific evidence,” write the experts, led by Francesco Rubino, the chair of metabolic and bariatric surgery at Kings College London.
“Despite scientific evidence to the contrary, the prevailing view in society is that obesity is a choice that can be reversed by voluntary decisions to eat less and exercise more. These assumptions mislead public health policies, confuse messages in popular media, undermine access to evidence-based treatments, and compromise advances in research.”
Weight bias and stigma appear to stimulate the secretion of the stress hormone cortisol and promote weight gain, researchers write in a 2016 paper published in Obesity.
A. Janet Tomiyama, a psychology professor at UCLA who directs the university’s Dieting, Stress, and Health research lab, describes weight stigma as “a ‘vicious cycle’ — a positive feedback loop wherein weight stigma begets weight gain.”
“This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss,” Tomiyama writes in her 2014 paper, “Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model.”
The consensus statement spotlights 13 recommendations for eliminating weight bias and stigma, some of which are specifically aimed at health care providers, the media, researchers or policymakers. One of the recommendations for the health care community: “[Health care providers] specialized in treating obesity should provide evidence of stigma-free practice skills. Professional bodies should encourage, facilitate, and develop methods to certify knowledge of stigma and its effects, along with stigma-free skills and practices.”
The one recommendation for the media: “We call on the media to produce fair, accurate, and non-stigmatizing portrayals of obesity. A commitment from the media is needed to shift the narrative around obesity.”
Why obesity is a complicated disease
It’s important to point out that having excess body fat does not, by itself, mean an individual is unhealthy, researchers explain in a 2017 article in The Conversation, which publishes research-based news articles and essays. But it is a major risk factor for cardiovascular disease, including stroke, as well as diabetes, some types of cancer, and musculoskeletal disorders such as osteoarthritis.
Doctors often look at patients’ body mass index — a number that represents their weight in relation to their height — to gauge the amount of fat on their bodies. A BMI of 18.5 to 24.9 is ideal, according to the U.S. Centers for Disease Control and Prevention. A BMI of 25.0 to 29.9, indicates excess body fat, or “overweight,” while a BMI of 30 and above indicates obesity.
In June, the American Medical Association announced a new policy clarifying how BMI can be used to diagnose obesity. Because it’s an imperfect measure for body fat, the organization suggests BMI be used in conjunction with other measures such as a patient’s waist circumference and skin fold thickness.
Two specialists who have been working for years to dispel myths and misconceptions about obesity are Fatima Cody Stanford, an obesity physician and associate professor at Harvard Medical School, and Rebecca Puhl, the deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut.
Cody Stanford has called obesity “a brain disease” because the brain tells the body how much to eat and what to do with the food consumed. One pathway in the brain directs the body to eat less and store less fat, she explains in a February 2023 podcast produced by the American Medical Association.
“For people that signal really great down this pathway, they tend to be very lean, not struggle with their weight in the same way that people that have excess weight do,” she says during the podcast, adding that people with obesity receive signals from an alternate pathway that “tells us to eat more and store more.”
Academic studies demonstrate that a wide variety of factors can affect weight regulation, including sleep quality and duration, gut health, genetics, medication, access to healthy foods and even early life experiences.
For example, a 2020 paper in the journal JAMA Network Open suggests female infants born by cesarean delivery have a higher risk of obesity during adulthood than female infants born by vaginal delivery. The study of 33,226 U.S. women born between 1946 and 1964 found that a cesarean delivery is associated with an 11% higher risk of developing obesity and a 46% higher risk of developing type 2 diabetes.
Scholars have also found that traumatic childhood experiences such as abuse and neglect are linked to adult obesity, according to a research review published in 2020.
Income inequality seems to play a role as well. When researchers from the Johns Hopkins Bloomberg School of Public Health studied the link between income inequality and obesity for a sample of 36,665 U.S. adults, they discovered women with lower incomes are more likely to have obesity than women with higher incomes.
Their analysis indicates the opposite is true for men, whose odds of obesity rise with their income, the researchers write in a 2021 paper in the International Journal of Environmental Research and Public Health.
Weight bias among doctor trainees
While scholars have learned a lot about obesity and weight bias in recent decades, the information might not be reaching people training to become doctors. A study published in October finds that some resident physicians believe obesity to be the result of poor choices and weak willpower.
Researchers asked 3,267 resident physicians who graduated from a total of 49 U.S. medical schools a series of questions to gauge their knowledge of obesity and attitudes toward heavier patients. What they learned: Nearly 40% of resident physicians agreed with the statement, “Fat people tend to be fat pretty much through their own fault.” Almost half agreed with the statement, “Some people are fat because they have no willpower.”
The study also reveals that about one-third of participants said they “feel more irritated when treating an obese patient than a non-obese patient.”
“Notably, more than a quarter of residents expressed slight-to-strong agreement with the item ‘I dislike treating obese patients,’” the researchers write.
Another takeaway from the paper: Resident physicians specializing in orthopedic surgery, anesthesiology and urology expressed the highest levels of dislike of heavier patients. Of the 16 medical specialties represented, residents in family medicine, psychiatry and pediatrics reported the lowest levels of dislike.
Kimberly Gudzune, medical director of the American Board of Obesity Medicine, asserts that doctors and medical students need to be educated about obesity. The topic “is grossly neglected” in medical schools and medical training programs worldwide, research has found.
Many physicians don’t understand obesity, Gudzune explains in a July 2023 interview on the internal medicine podcast “The Curbsiders.”
“I think back to when I was a medical student, when I was a resident, I really didn’t learn much about obesity and how to treat it, yet it’s a problem that affects the majority of our patients,” she tells podcast listeners. “I think there’s a lot of evidence out there showing that primary care physicians don’t really know where to start.”
In 2011, the American Board of Obesity Medicine established a program through which doctors could become certified in obesity medicine. Since then, a total of 6,729 U.S. doctors have earned certification, the vast majority of whom specialize in family and internal medicine.
What health care providers think
The experts who created the consensus statement on weight bias and stigma noted health care providers’ shortcomings in the document. They write that the common themes they discovered in the research include “contemptuous, patronizing, and disrespectful treatment” of patients, a lack of training, poor communication and assumptions about weight gain.
Puhl, the deputy director of the Rudd Center at the University of Connecticut, is a pioneer in weight bias research and one of the experts who wrote the consensus statement. During an episode of “The Leading Voices in Food,” a podcast created by Duke University’s World Food Policy Center, she shares details about what she has learned over the years.
“[Health care providers’] views that patients with obesity are lazy or lacking control, are to blame for their weight or noncompliant with treatment,” she says during the interview. “We know, for example, that some physicians spend less time in their appointments with patients [who] have a larger body size. They give them less education about health. They’re more reluctant to perform certain screenings. They talk about treating patients with obesity as being a greater waste of their time than providing care to thinner patients. And we know that patients seem to be aware of these biases from providers and that can really contribute to patients avoiding health care because they just don’t want to repeat those negative experiences of bias.”
To set the record straight, the experts who wrote the the consensus statement listed the following five common assumptions as being “at odds with a definitive body of biological and clinical evidence.”
1. Body weight = calories in – calories out.
This equation oversimplifies the relationship between body weight and energy consumed and used, the experts write. “Both variables of the equation depend on factors additional to just eating and exercising. For instance, energy intake depends on the amount of food consumed, but also on the amount of food-derived energy absorbed through the gastrointestinal tract, which in turn is influenced by multiple factors, such as digestive enzymes, bile acids, microbiota, gut hormones, and neural signals, none of which are under voluntary control.”
2. Obesity is primarily caused by voluntary overeating and a sedentary lifestyle.
According to the experts, overeating and forgoing exercise might be symptoms of obesity rather than the root causes. There are many possible causes and contributors “including geneticand epigenetic factors, foodborne factors, sleep deprivation and circadian dysrhythmia, psychological stress, endocrine disruptors, medications, and intrauterine and intergenerational effects. These factors do not require overeating or physical inactivity to explain excess weight.” they write.
3. Obesity is a lifestyle choice.
“People with obesity typically recognize obesity as a serious health problem, rather than a conscious choice,” the experts write. “Given the negative effects of obesity on quality of life, the well-known risks of serious complications and reduced life expectancy associated with it, it is a misconception to define obesity as a choice.”
4. Obesity is a condition, not a disease.
The criteria generally used to determine disease status “are clearly fulfilled in many individuals with obesity as commonly defined, albeit not all,” the experts explain. “These criteria include specific signs or symptoms (such as increased adiposity), reduced quality of life, and/or increased risk of further illness, complications, and deviation from normal physiology — or well-characterized pathophysiology (for example, inflammation, insulin resistance, and alterations of hormonal signals regulating satiety and appetite).”
5. Severe obesity is usually reversible by voluntarily eating less and exercising more.
“A large body of clinical evidence has shown that voluntary attempts to eat less and exercise more render only modest effects on body weight in most individuals with severe obesity,” the experts write. “When fat mass decreases, the body responds with reduced resting energy expenditure and changes in signals that increase hunger and reduce satiety (for example, leptin, ghrelin). These compensatory metabolic and biologic adaptations promote weight regain and persist for as long as persons are in the reduced-energy state, even if they gain some weight back.”
Health care facility improvements
The expert panel also determined that many health care facilities aren’t equipped to treat people with obesity. Examination gowns, blood pressure cuffs, chairs and examination tables often are too small, patients have reported.
When researchers from the University of Minnesota, Minneapolis Veterans Affairs Medical Center and Mayo Clinic studied the quality of care that patients with obesity receive, they learned that a clinic’s physical environment can have a big effect on a patient’s experience.
They write in a 2015 study published in Obesity Reviews: “Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”
When medical equipment is the wrong size, it may not work correctly. For instance, chances are high that a blood pressure reading will be inaccurate if a health care professional uses a blood pressure cuff that’s too small on a patient with obesity, a 2022 paper finds.
To create a comfortable environment for patients with high body weights, the Rudd Center for Food Policy and Obesity recommends that health care facilities provide, among other things, extra-large exam gowns, chairs that can support more than 300 pounds and do not have arms, and wide exam tables that are bolted to the floor so they don’t move.
The consensus statement also recommends improvements to health care facilities.
“Given the prevalence of obesity and obesity-related diseases,” the 36 international experts write, “appropriate infrastructure for the care and management of people with obesity, including severe obesity, must be standard requirement for accreditation of medical facilities and hospitals.”
Source list:
Weight Bias Among Health Care Professionals: A Systematic Review and Meta-Analysis
Blake J. Lawrence; et al. Obesity, November 2021.
Joint International Consensus Statement for Ending Stigma of Obesity
Francesco Rubino, et al. Nature Medicine, March 2020.
Perceived Weight Discrimination and Chronic Biochemical Stress: A Population-Based Study Using Cortisol in Scalp Hair
Sarah E. Jackson, Clemens Kirschbaum and Andrew Steptoe. Obesity, December 2016.
Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model
A. Janet Tomiyama. Appetite, November 2014.
Association of Birth by Cesarean Delivery with Obesity and Type 2 Diabetes Among Adult Women
Jorge E. Chavarro. JAMA Network Open, April 2020.
Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies
David A. Wiss and Timothy D. Brewerton. Physiology & Behavior, September 2020.
Income Inequality and Obesity among U.S. Adults 1999–2016: Does Sex Matter?
Hossein Zare, Danielle D. Gaskin and Roland J. Thorpe Jr. International Journal of Environmental Research and Public Health, July 2021.
Comparisons of Explicit Weight Bias Across Common Clinical Specialties of U.S. Resident Physicians
Samantha R. Philip, Sherecce A. Fields, Michelle Van Ryn and Sean M. Phelan. Journal of General Internal Medicine, October 2023.
Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity
S.M. Phelan; et al. Obesity Reviews, April 2015.
One Size Does Not Fit All: Impact of Using A Regular Cuff For All Blood Pressure Measurements
Tammy. M. Brady; et al. Circulation, April 2022.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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The Brain Fog Fix – by Dr. Mike Dow
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The three weeks mentioned in the subtitle is in fact a week-by-week plan:
- Adjusting diet (inclusions and exclusions) and cognitive strategies
- Focusing on sleep, exercise, and memory-boosting “brain games”
- Bringing in the social aspect, and connection to something larger than oneself
In this reviewer’s opinion, a week is too short a time to completely overhaul one’s diet; most changes need to be gradual, so doing several at once in a week is quite extreme. But, even if it takes a month for each stage instead of a week, the method is reasonable.
The nutritional advice is good, and consistent with current best science on the topic. There’s a lot about keeping even blood sugars and improving insulin sensitivity, as well as doing what is best for the heart and blood in general (e.g. fiber, managing triglycerides, doing the right kinds of exercise, etc).
As a psychotherapist, he also talks a fair bit about neurotransmitters, and making sure one’s gut and brain are fed appropriately to keep the correct balance (remembering for example that serotonin is made in the gut, and dopamine is made in the brain). Unlike many of his colleagues, he’s not a fan of medicating beyond absolute necessity.
The style is a little salesy for this reviewer’s personal taste—but then again, perhaps he made the reasonable assumption that a person reading a book entitled “the brain fog fix” needs their attention grabbing and re-grabbing every paragraph or so. As such, maybe it’s not a bad call.
Bottom line: if you have brain fog and would like to not have brain fog, this book offers a scientifically sound, evidence-based, holistic approach that can certainly improve things.
Click here to check out The Brain Fog Fix, and fix your brain fog!
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End Your Carb Confusion – by Dr. Eric Westman & Amy Berger
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Carbs can indeed be confusing! We’ve written about it ourselves before, but there’s more to be said than fits in a single article, and sometimes a book is in order. This one is such a book.
The authors (an MD and a nutritionist) explain the ins and outs of carbohydrates of various kinds, insulin responses, and what that means for the body. They also then look at the partly-similar, partly-different processes that occur with the metabolism of fats of various kinds, and what that means for the body, too.
Ultimately they advocate for a simple and clear low-carb approach broadly consistent with keto diet macro principles, without getting too overly focused on “is this fruit/vegetable ok?” minutiae. This has the benefit of putting it well aside from the paleo diet, for example (which focuses more on pseudo-historical foods than it does on macros), and also makes it a lot easier on a practical level.
The style is very textbook-like, which makes for an easy read with plenty of information that should stick easily in most reader’s minds, rather than details getting lost in wall-of-text formatting. So, we approve of this.
There is not, by the way, a recipes section. It’s “here’s the information, now go forth and enjoy” and leaves us all to find/make our own recipes, rather than trying to guess our culinary preferences.
Bottom line: if you’d like an easy-to-read primer on understanding how carbs work, what it means for you, and what to do about it, then this is a fine book.
Click here to check out End Your Carb Confusion, and end your carb confusion!
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How extreme heat can affect you—and how you can protect yourself
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Because of climate change, last summer was the hottest in the Northern Hemisphere in 2,000 years—and this summer is expected to be even hotter. The record may continue to be broken: Extreme heat is expected to become even more frequent.
The scorching heat has led to an increase in heat-related deaths in the United States, according to the Department of Health and Human Services, with approximately 2,300 deaths in the summer of 2023. Extreme heat, defined as a period of two to three days with high heat and humidity with temperatures above 90 degrees Fahrenheit, can have serious health consequences, including symptoms like headache, dizziness, loss of consciousness, nausea, and confusion.
As we face more extreme heat, you may be wondering how you can protect yourself and your loved ones. Read on to learn about heat-related illness, who’s most at risk, and more.
What happens when our bodies are exposed to extreme heat?
As our body temperature rises, our bodies attempt to cool down by opening up more blood vessels near the skin to begin sweating. The evaporation of our sweat regulates our body temperature, but it also leads to losing fluids and minerals.
When it’s too humid, sweating alone doesn’t do the trick. The heart must work harder to bring blood around the body. It starts beating faster, which can cause light-headedness, nausea, and headache.
This process can affect our health in different ways, including increasing our risk of hospitalization for heart disease, worsening asthma, and injuring kidneys due to dehydration. It can also result in heat-related illness. Below are some effects of heat on our bodies:
- Heat cramps: Occur when a person loses salt through sweating, which causes painful cramps. Symptoms begin as painful spasms after heavy sweating, usually in the legs or the stomach. Heat cramps can lead to heat exhaustion or heat stroke.
- Heat exhaustion: This occurs when the body loses an excessive amount of water and salt, usually during intense physical activity. Symptoms include irritability, heavy sweating, and weakness, including muscle cramps. Heat exhaustion can lead to heat stroke.
- Heat stroke: This is the most severe heat-related illness. It happens when the body can’t cool down and reaches a temperature of 106 Fahrenheit or higher within 10 to 15 minutes. If the person doesn’t receive emergency treatment, it can cause permanent disability or death. Symptoms include confusion, loss of consciousness, and seizures.
What should I do if someone experiences a heat-related illness?
If you or someone you’re with begins to show signs of heat illness, the Centers for Disease Control and Prevention recommends the following:
- Heat cramps: Stop all physical activity, drink water or a sports drink, move to a cool place, and wait for cramps to go away before resuming activity. If the cramps last more than an hour, you’re on a low-sodium diet, or you have heart problems, get medical help.
- Heat exhaustion: Move the person to a cool place, loosen their clothes, use a cool bath or cloths to try to lower their body temperature, and give them a sip of water. If the person throws up, or if their symptoms last longer than an hour or worsen, get medical help.
- Heat stroke: Call 911 immediately. Then, move the person to a cooler place, use cool cloths or a cool bath to help lower their temperature, and don’t give them anything to drink.
Read more about heat-related illness and what to do in each case.
Who’s more vulnerable to extreme heat?
While everyone can be affected by extreme heat, some people are more at risk, including people of color.
A 2023 KFF report outlined that because of historical residential segregation in the U.S. (known as “redlining”), people of color are more likely to live in areas that experience higher temperatures from rooftops, asphalt, and sidewalks that retain the sun’s heat (known as the “urban heat island effect”). Additionally, communities of color are more likely to live in areas with fewer trees, which act as a canopy and provide shade, making the heat worse and more direct.
Children under 5, adults 65 or over, and pregnant people are also more vulnerable to extreme heat. If you have a chronic health condition like diabetes, heart problems, or a mental health condition, you’re also at higher risk. (Some psychiatric medications, like antidepressants, can also make people more susceptible to heat).
Lastly, anyone exposed to the sun and extreme heat for long periods is also at higher risk. This includes athletes, people who work outdoors, and unhoused people.
What can I do to prevent heat-related illness during a heat wave?
During a heat wave, follow these tips to stay cool and protect yourself from heat-related illness:
- Never leave your pets or children inside a car.
- Wear loose, light-colored clothing (dark colors absorb more heat).
- Find shade if you’re outside.
- If you don’t have air conditioning in your home, go to a place where you can cool down, such as a local library, community center, local pool or splash pad, or mall. Check to see if your city has designated cooling centers. (Cities like New York have a list of places.)
- Wear a hat.
- Drink (non-alcoholic) fluids often to stay hydrated—and if you have pets, give them water frequently as well.
- Check on your family members or older neighbors who may be more sensitive to extreme heat.
- Avoid using your stove or oven too often or during the hottest parts of the day.
- Cover your windows with shades to keep the heat out.
What are some resources to prevent heat-related illness?
If you need financial assistance to cool down your home, such as to purchase an air conditioner, apply to the federal government’s Low Income Home Energy Assistance Program.
Before you head outside during a heat wave, use the CDC’s HeatRisk tool: Enter your zip code to find the current heat risk in your area and get tips on what to do to stay safe with each risk level.
During a heat wave, also look for a cooling center in your state using the National Center for Healthy Housing’s list.
Check out the National Weather Service’s for more tips and resources.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Mythbusting Moldy Food
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Most Food Should Not Be Fuzzy
In yesterday’s newsletter, we asked you for your policy when it comes to mold on food (aside from intentional mold, e.g. blue cheese etc), and the responses were interesting:
- About 49% said “throw the whole thing away no matter what it is; it is dangerous”
- About 24% said “cut the mold off and eat the rest of whatever it is”
- The remainder were divided equally between “eat it all; keep the immune system on its toes” and “cut the mold off bread, but moldy animal products are dangerous”
So what does the science say?
Some molds are safe to eat: True or False?
True! We don’t think this is contentious so we’ll not spend much time on it, but just for the sake of being methodical: foods that are supposed to have mold on, including many kinds of cheese and even some kinds of cured meat (salami is an example; that powdery coating is mold).
We could give a big list of safe and unsafe molds, but that would be a list of names and let’s face it, they don’t introduce themselves by name.
However! The litmus test of “is it safe to eat” is:
Did you acquire it with this mold already in place and exactly as expected and advertised?
- If so, it is safe to eat (unless you have an allergy or such)
- If not, it is almost certainly not safe to eat
(more on why, later)
The “sniff test” is a good way to tell if moldy food is bad: True or False?
False. Very false. Because of how the sense of smell works.
You may feel like smell is a way of knowing about something at a distance, but the only way you can smell something is if particles of it are physically connecting with your olfactory receptors inside you. Yes, that has unfortunate implications about bathroom smells, but for now, let’s keep our attention in the kitchen.
If you sniff a moldy item of food, you will now have its mold spores inside your respiratory system. You absolutely do not want them there.
If we cut off the mold, the rest is safe to eat: True or False?
True or False, depending on what it is:
- Hard vegetables (e.g carrots, cabbage), and hard cheeses (e.g. Gruyère, Gouda) – cut off with an inch margin, and it should be safe
- Soft vegetables (e.g. tomatoes, and any vegetables that were hard but are now soft after cooking) – discard entirely; it is unsafe
- Anything else – discard entirely; it is unsafe
The reason for this is because in the case of the hard products mentioned, the mycelium roots of the mold cannot penetrate far.
In the case of the soft products mentioned, the surface mold is “the tip of the iceberg”, and the mycelium roots, which you will not usually be able to see, will penetrate the rest of it.
“Anything else” seems like quite a sweeping statement, but fruits, soft cheeses, yogurt, liquids, jams and jellies, cooked grains and pasta, meats, and yes, bread, are all things where the roots can penetrate deeply and easily. Regardless of you only being able to see a small amount, the whole thing is probably moldy.
The USDA has a handy downloadable factsheet:
Molds On Food: Are They Dangerous?
Eating a little mold is good for the immune system: True or False?
False, generally. There are of course countless types of mold, but not only are many of them pathogenic (mycotoxins), but also, a food that has mold will usually also have pathogenic bacteria along with the mold.
See for example: Occurrence, Toxicity, and Analysis of Major Mycotoxins in Food
Food poisoning will never make you healthier.
But penicillin is safe to eat: True or False?
False, and also penicillin is not the mold on your bread (or other foods).
Penicillin, an antibiotic* molecule, is produced by some species of Penicillium sp., a mold. There are hundreds of known species of Penicillium sp., and most of them are toxic, usually in multiple ways. Take for example:
Penicillium roqueforti PR toxin gene cluster characterization
*it is also not healthy to consume antibiotics unless it is seriously necessary. Antibiotics will wipe out most of your gut’s “good bacteria”, leaving you vulnerable. People have died from C. diff infections for this reason. So obviously, if you really need to take antibiotics, take them as directed, but if not, don’t.
See also: Four Ways Antibiotics Can Kill You
One last thing…
It may be that someone reading this is thinking “I’ve eaten plenty of mold, and I’m fine”. Or perhaps someone you tell about this will say that.
But there are two reasons this logic is flawed:
- Survivorship bias (like people who smoke and live to 102; we just didn’t hear from the 99.9% of people who smoke and die early)
- Being unaware of illness is not being absent of illness. Anyone who’s had an alarming diagnosis of something that started a while ago will know this, of course. It’s also possible to be “low-level ill” often and get used to it as a baseline for health. It doesn’t mean it’s not harmful for you.
Stay safe!
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White Bread vs White Pasta – Which Is Healthier?
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Our Verdict
When comparing a white bread to a white pasta, we picked the pasta.
Why?
Neither are great for the health! But like for like, the glycemic index of the bread is usually around 150% of the glycemic index for pasta.
All that said, we heartily recommend going for wholegrain in either case!
Bonus tip: cooking pasta “al dente”, so it is still at least a little firm to the bite, results in a lower GI compared to being boiled to death.
Bonus bonus tip: letting pasta cool increases resistant starches. You can then reheat the pasta without losing this benefit.
Please don’t put it in the microwave though; you will make an Italian cry. Instead, simply put it in a colander and pour boiling water over it, and then serve in your usual manner (a good approach if serving it separately is: put it in the serving bowl/dish/pan, drizzle a little extra virgin olive oil and a little cracked black pepper, stir to mix those in, and serve)
Enjoy!
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Black Olives vs Green Olives – Which is Healthier
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Our Verdict
When comparing black olives to green olives, we picked the black olives.
Why?
First know this: they are the same plant, just at different stages of ripening (green olives are, as you might expect, less ripe).
Next: the nutritional values of both, from macros down to the phytochemicals, are mostly very similar, but there are a few things that stand out:
• Black olives usually have more calories per serving, average about 25% more. But these are from healthy fats, so unless you’re on a calorie-restricted diet, this is probably not a consideration.
• Green olives are almost always “cured” for longer, which results in a much higher sodium content often around 200% that of black olives. Black olives are often not “cured” at all.Hence, we chose the black olives!
You may be wondering: do green olives have anything going for them that black olives don’t?
And the answer has a clue in the taste: green olives generally have a stronger, more bitter/pungent taste. And remember what we said about things that have a stronger, more bitter/pungent taste:
Tasty Polyphenols: Enjoy Bitter Foods For Your Heart & Brain
That’s right, green olives are a little higher in polyphenols than black olives.
But! If you want to enjoy the polyphenol content of green olives without the sodium content, the best way to do that is not olives, but olive oil—which is usually made from green olives.
For more about olive oil, check out:
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