Most of us would like to think that we’re in charge of how much we eat. We trust our bodies to tell us when we’re full, and that after we’re done, we have a good sense of how much we’ve eaten.

If only it were true. “Research tells us that subtle cues in our environment can pressure us to dish up more than we need and eat more than we should,” said Luigi Gratton, M.D., vice president of medical affairs at Herbalife. “Larger plates – even larger serving utensils – can prompt over-consumption.” In a self-serve ice cream experiment¹, people given large bowls and scoops doled out 57 percent more ice cream than those given smaller dishes and serving utensils.

So, how much we’re going to eat is generally decided before we even take that first mouthful. The reality is we pretty much eat whatever we’re served – whether it’s a little or a lot. From a supersized fast-food meal to a dainty portion in an upscale restaurant, we’re generally satisfied as long as we’ve polished off every morsel. Rather than letting our stomachs decide, we let an empty plate signal an end to the meal.

Controlling how much you put on your plate really becomes the first step in controlling how much you put in your stomach. But other cues can trigger overeating, too. Just smelling or seeing food – anything from the smell of fresh-baked bread to the sight of stale donuts in the company lunchroom – can trigger your desire to eat, even if you’re not hungry. Here are some ways to take charge:

• Think spoon, not shovel – It’s an old trick, but it really works – using smaller plates and tall, skinny glasses gives the illusion that there is more food on the dish and more to drink in the glass. Smaller serving utensils help keep you from loading up, too – think spoon, rather than shovel.
• Single-serving sizes – As serving containers get larger, so do portions. Those huge bargain-priced cereal boxes may be leaner on your wallet, but studies show you’ll pour yourself a lot more cereal – as much as 20 percent more – than you would from a regular-sized package. Go for the single-serving sizes.
• Out-of-reach sweets – Make it inconvenient to eat the unhealthy stuff. You may not make the effort to bake brownies from scratch when the mood strikes, but if you keep the microwavable version around you’ll have to constantly fight the urge. Get the candy dish off your desk and the cookie jar off the counter – set out a bowl of fruit instead.
• Mix it up, but not too much – Studies show that the more variety on your plate, the more you’ll eat – all that stimulation keeps your taste buds in high gear. An array of low-cal fruits and veggies is fine, but when faced with a buffet or a dinner served family-style, limit yourself to just a couple of items on your plate at one time.
• Shake it up – Try a protein shake for breakfast or lunch. Made from a set amount of milk, protein powder and fruit, it’s a natural when it comes to portion control. Add some ice cubes, and whip it up to increase the volume without adding calories – and enjoy from a tall glass.

The HealthGrades Fourth Annual Bariatric Surgery Trends in American Hospitals Study released today identifies 88 hospitals as “best” performers (five-star rated), with mortality rates, complication rates and patient lengths of stay that are dramatically lower than poorly rated hospitals.

In the study, HealthGrades evaluated the quality of bariatric surgery in hospitals across 19 states that provide all-payer information. The recipient list and full study results can be found at www.healthgrades.com. As other studies have found, high bariatric surgery volumes correlated with better inhospital outcomes. In this study, higher-volume programs, those with greater than 375 cases over three years, have a 32 percent lower risk of patient complications than lower volume programs, those with less than 75 cases over three years.

California was, on average, the most expensive state for bariatric surgery, with an average charge per procedure of $52,224, the study found. Maryland was the least expensive with an average charge per procedure of $14,577.

Bariatric surgery is a general term describing several types of weight loss procedures. The HealthGrades study analyzed the outcomes of the most common including gastric bypass procedures, less invasive laparoscopic procedures including gastric banding, malabsorbtive procedures and combined malabsorbtive/restrictive procedures.

Due to the growing number of obese Americans and the explosion of bariatric surgery programs in the U.S., patients have many choices when it comes to selecting a program. This study has found a wide variation in the quality and outcomes of these programs. Because bariatric surgery is an elective procedure, patients have the time to thoroughly investigate their surgeon and hospital before making a decision on where to have surgery performed.

“Due to the wide gap in quality we see among bariatric surgery programs, we encourage patients to carefully evaluate the volume and inhospital outcomes of the bariatric program they are considering,” said Rick May, MD, a senior physician consultant with HealthGrades and a co-author of the study. “Hospitals designated as five-star for bariatric surgery have best practices that drive their exceptional outcomes.”

Other findings identified in the study include:

• Bariatric surgery patients treated at top-rated hospitals have, on average a 67 percent lower chance of experiencing serious complications compared to patients who receive treatment at poorly rated hospitals.
• Patients having surgery at five-star hospitals spent, on average, more than half a day less in the hospital (2.15 days) compared to patients having surgery in one-star hospitals (2.72 days).
• Of the 19 states studies, over 61% of all procedures were performed in five states: New York, Texas, Pennsylvania, California and Florida.
• Patients in Vermont, on average, spent the most time in the hospital (3.26 days), while patients in Nevada, on average, spent the least amount of time in the hospital (1.56 days).
• The number of inpatient procedures during the study years 2005 through 2007 showed no significant increase, but an increasing percentage of surgeries are being performed outpatient.
• More Center of Excellence bariatric surgery programs earned a five-star rating (29.5%) than non-COE programs (12.3%).
• Laparospcopic bariatric surgery procedures account for 79% of all procedures, up from 54% in last year’s study.
• Patients had a three times lower inhospital death rate associated with a bariatric surgery if they had it performed at a five-star hospital versus a one-star hospital.

They’re called “fruit flies” for a reason, and it sure isn’t for lack of appetite. But like most animals, the pests typically lose their appetite when they get infected. We humans go them one better: Even when bug-free and hungry, some of us are tempted to do some serious fasting, in hopes of living longer, healthier lives.

Many studies indicate that caloric restriction extends life spans in fruit flies, mice and, most recently, rhesus monkeys, apparently by slowing the aging process. But virtually all these studies have been performed in sterile environments, on animals raised under relatively pathogen-free conditions. So Stanford University School of Medicine researchers decided to see if reduced caloric intake also helps creatures cope with infection.

Appetite loss as a response to infection seems a bit paradoxical. “Mounting a robust immune response is very energy-consuming,” said David Schneider, PhD, associate professor of microbiology and immunology. “You might think an infected animal would be better off eating more, not less.”

Working with fruit flies, Schneider and his graduate student Janelle Ayres have shown that caloric restriction can indeed alter the flies’ response to infection, but in different directions depending on what they’ve been infected with. (Ayres has since received her PhD and is a now postdoctoral researcher at the University of California-Berkeley.) This has potentially significant implications for humans, since flies are an excellent model system for studying certain aspects of our immune response.

In their study, to be published online July 13 in PLoS-Biology, the researchers measured the appetites of infected versus uninfected fruit flies, as well as the effects that restricting food intake in advance of an infection might have on flies’ response to the infection.

Ayres had previously conducted a search for mutant fruit flies that died faster, or more slowly, than normal flies after being infected with pathogenic bacteria. That laborious operation required injecting so many tiny flies with a special syringe that, Ayres said, “at one point, my hand got stuck in injecting position and I had trouble unfolding it.”

One batch of mutant flies Ayres identified were super-light eaters due, it was found, to a faulty taste receptor. She and Schneider used these mutants for several of the experiments in the new study. In addition, to make sure that what they saw was really because of reduced caloric intake and not some other effect of the mutation, they repeated their experiments with normal flies that had been placed on caloric restriction for some time prior to being infected. The observed results were the same in either case.

The investigators infected flies with three very different strains of bacteria, all of which can cause fatal disease in humans. Then they compared diet-restricted versus normally fed flies’ survival after infection.

Flies that had restricted caloric intake prior to infection with the pathogen, Enterococcus faecalis, ate no less than uninfected flies did. The “low-calorie flies” also survived for the same length of time as normal eaters.

Infecting mutant or previously diet-restricted “low-cal flies” with either of two other microbial menaces, Salmonella typhimurium and Listeria monocytogenes, did trigger appetite loss. But there the similarity ended. Injected with S. typhimurium, flies on prior caloric restriction outlived normal eaters, surviving about 15 days post-infection versus eight days for the control flies. Low-cal flies infected with L. monocytogenes, on the other hand, died faster than likewise infected normal eaters. They lived for only four days, as opposed to six or seven in the case of flies that had been on normal diets.

The Schneider lab is seeking physiological explanations for this divergent response. But taken as a whole, the results so far suggest that some skepticism might be in order regarding climbing aboard the caloric-restriction bandwagon, Schneider said. “There’s evidence that caloric restriction seems to rev up various individual components of the immune system,” he said, “but in the few studies where diet-restricted animals actually have been infected experimentally, they fared poorly.”

In their study’s conclusions, the authors write, “The work reported here should raise a cautionary flag, as it demonstrates that diet restriction can have complex effects on the realized immune response of a diet-restricted animal.” Attempts to extend life span through dietary restriction, or mimicking this process by gulping a pill, could thus be counterproductive, as the value of diminished appetite to an animal’s survival may vary with the infecting microbe.

There may be something to the celebrated admonition, “feed a cold and starve a fever,” after all. But much remains to be learned about exactly which infections can be fought best by gorging and which by fasting.