Text 4

In an obesity epidemic, what’s one cookie?

By Tara Parker-Pope

[1] The basic formula for gaining and losing weight is view of what they can accomplish. ‘As clinicians, we
well known: a pound of fat equals 3 500 calories. That celebrate small changes because they often lead to big
simple equation has fuelled the widely accepted notion changes,’ said Dr David Ludwig, director of the
that weight loss does not require daunting lifestyle 40 Optimal Weight for Life programme at Children’s
5 changes but rather, ‘small changes that add up’, as the Hospital Boston and a co-author of the JAMA
United States’ first lady, Michelle Obama, put it last commentary. ‘An obese adolescent who cuts back TV
month in announcing a national plan to counter viewing from six to five hours each day may then go on
childhood obesity. to decrease viewing much more. However, it would be
45 entirely unrealistic to think that these changes alone
[2] In this view, cutting out or burning just 100 extra produce substantial weight loss.’
10 calories a day – by say, replacing fizzy drinks with
water or walking to school – can lead to significant [6] Why don’t they? The answer lies in biology. A
weight loss over time: a pound every 35 days, or more person’s weight does not increase as long as the number
than 10 pounds a year. of calories consumed doesn’t exceed the amount of
50 calories the body spends, both on exercise and to
[3] While it’s certainly a hopeful message, it’s also maintain basic body functions. As the balance between
15 misleading. Numerous scientific studies show that calories going in and calories going out changes, we
small caloric changes have almost no long-term effect gain or lose weight.
on weight. When we skip a cookie or exercise a little
more, the body’s biological and behavioural adaptations [7] But bodies don’t gain or lose weight indefinitely.
kick in, significantly reducing the caloric benefits of 55 Eventually, a cascade of biological changes kicks in to
20 our effort. But can small changes in diet and exercise at help the body maintain a new weight. As the JAMA
least keep children from gaining weight? While some article explains, a person who eats an extra cookie a
obesity experts think so, others disagree. day will gain some weight, but over time, an increasing
proportion of the cookie’s calories also goes to taking
[4] As a recent commentary in the Journal of the 60 care of the extra body weight. Eventually, the body
American Medical Association (JAMA) noted, the adjusts and stops gaining weight, even if the person
25 ‘small changes’ theory fails to take the body’s adaptive continues to eat the cookie.
mechanisms into account. The rise in children’s obesity
over the past few decades can’t be explained by an [8] Similar factors come into play when we skip the
extra 100-calorie fizzy drink each day, or fewer physical extra cookie. We may lose a little weight at first, but
education classes. Skipping a cookie or walking to 65 soon the body adjusts to the new weight and requires
30 school would barely make a dent in a calorie imbalance fewer calories. Regrettably, however, the body is more
that goes ‘far beyond the ability of most individuals to resistant to weight loss than weight gain. Hormones
address on a personal level,’ the authors wrote – they and brain chemicals that regulate your unconscious
would need to make much bigger changes, such as drive to eat and how your body responds to exercise
walking 5 to 10 miles a day for 10 years. 70 can make it even more difficult to lose the weight. You
may skip the cookie but unknowingly compensate by
35 [5] This doesn’t mean small improvements are futile eating a bagel later on or an extra serving of pasta at
– far from it. However, people need to take a realistic dinner.

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 [9] ‘There is a much bigger picture than taking out 105 keep overweight kids from gaining even more excess
75 the cookie a day or the Coke a day,’ said Dr Jeffrey M. weight. ‘Once you’re trying for weight loss, you’re out
Friedman, head of Rockefeller University’s molecular of the small-change realm,’ he said. ‘But the small-
genetics lab, which first identified leptin, a hormonal steps approach can stop weight gain.’
signal made by the body’s fat cells that regulates food
intake and energy expenditure. ‘If you ask anyone on [13] While small steps are unlikely to solve the nation’s
80 the street, “Why is someone obese?” they’ll say, “They 110 obesity crisis, doctors say losing a little weight, eating
eat too much.” That is undoubtedly true, but the deeper more heart-healthy foods and increasing exercise can
question is why do they eat too much? It’s clear now make a meaningful difference in overall health and
that there are many factors that motivate us to eat and risks for heart disease and diabetes. ‘I’m not saying
that it is not purely a conscious decision.’ throw up your hands and forget about it,’ Dr Friedman
115 said. ‘Instead of focusing on weight or appearance,
85 [10] This is not to say that the push for small daily focus on people’s health. There are things people can
changes in eating and exercise is misguided. James O. do to improve their health significantly that don’t
Hill, director of the Center for Human Nutrition at the require normalising your weight.’
University of Colorado Denver, says that while weight
loss requires significant lifestyle changes, taking away [14] Dr Ludwig still encourages individuals to make
90 extra calories through small steps can help slow and 120 small changes, like watching less television or eating a
prevent weight gain. few extra vegetables, because those shifts can be a
prelude to even bigger lifestyle changes that may
[11] In a study of 200 families, half were asked to ultimately lead to weight loss. But he and others say
replace 100 calories of sugar with a noncaloric that reversing obesity will require larger shifts – like
sweetener and walk an extra 2 000 steps a day. The 125 regulating food advertising to children and eliminating
95 other families were asked to use pedometers to record government subsidies that make junk food cheap and
their exercise amount, but were not asked to make any profitable.
diet changes.
[15] ‘We need to know what we’re up against in terms
[12] During the six-month study, published in 2007, of the basic biological challenges, and then design a
both groups of children showed small but statistically 130 campaign that will truly address the problem in its full
100 significant drops in body mass index; the group that magnitude,’ Dr Ludwig said. ‘If we just expect an
also cut 100 calories had more children who maintained inner-city child to exercise self-control and walk a
or reduced body mass and fewer children who gained little bit more, then I think we’re in for a big
excess weight. The study didn’t look at long-term disappointment.’
benefits, but Dr Hill believes that small changes can

Source: adapted from Tara Parker-Pope’s ‘In obesity epidemic, what’s one cookie?’, New York Times, 1 Mar 2010.
New York Times, Copyright © 2010. Reprinted with permission.

END OF READING PASSAGE

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AIO (Vol.1) • Paper 1 • Supp MT (Reading – Part B2) 11
 Write your Candidate Number in the space provided on this page.
Read Text 4 and answer questions 53-77. (53 marks)

53. What is the main purpose of paragraph 2?

54. a) What is the ‘widely accepted notion’ (line 3)? (1 mark)

b) In the writer’s opinion why is this notion ‘misleading’ (line 15)? (1 mark)

Answers written in the margins will not be marked.

Answers written in the margins will not be marked.

55. Find a word in paragraph 5 with the opposite meaning to ‘worthwhile’.

56. Which one of the following best describes Dr David Ludwig’s tone in paragraph 5?

A. matter-of-fact
B. dismissive
C. hopeful A B C D
D. trusting

57. What does the pronoun ‘they’ (line 47) refer to?

Answers written in the margins will not be marked.

AIO (Vol.1) • Paper 1 • Supp MT (Q-A – Part B2) 13 ALL-IN-ONE (Vol.1)

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 58. Based on the information in paragraphs 4-6, complete the following summary by using ONE word only to fill in
each blank. You should make sure that your answers are grammatically correct. Pay attention to word form,
plurals, etc. (6 marks)

Although small measures, such as (i) a favourite snack or walking to school every

day, might not make much of a (ii) in terms of countering the imbalance between

calories (iii) and those (iv) , they should not be discouraged.

Specialists like Dr David Ludwig claim that (v) can be

initiated by the (vi) that precede them, though significant

reduction of weight will not be accomplished in this way.

Answers written in the margins will not be marked.

Answers written in the margins will not be marked.

59. Which word in paragraph 7 has a similar meaning to ‘forever’?

60. Decide whether the following statements are True, False, or the information is Not Given in paragraphs 4-7.
Blacken ONE circle only for each statement. (3 marks)

T F NG
i) Our bodies’ adaptive mechanism plays a part in the rise in children’s
obesity today.
ii) Infrequent periods of over-exercise is the culprit for fluctuating weight.

iii) Once our bodies’ adaptive mechanism is triggered, our bodies will settle
into a new weight which is hard to alter for better or worse.

61. How is the ‘skip the extra cookie to lose weight’ theory flawed according to paragraph 8? Find two examples from
the paragraph. (2 marks)

a)

b)

62. With reference to paragraph 9, which scientific discovery is the reason behind the rethinking about the causes of
weight gain?

Answers written in the margins will not be marked.

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 63. Who is Dr Friedman referring to when he says ‘us’ (line 83)?

64. a) What general assumption do people have about obese people according to paragraph 9? (1 mark)

b) What is Dr Friedman’s view regarding the above assumption? (1 mark)

65. Which of the sentences from the text is closest in meaning to what Friedman means by ‘There is a much bigger
picture than taking out the cookie a day or the Coke a day’ (lines 74-75)?

Answers written in the margins will not be marked.

Answers written in the margins will not be marked.

A. ‘we celebrate small changes because they often lead to big changes’ (lines 37-39)
B. ‘This doesn’t mean that small improvements are futile – far from it.’ (line 35-36)
C. ‘Regrettably, however, the body is more resistant to weight loss than weight gain.’ (lines 66-67)
D. ‘The rise in children’s obesity over the past few decades can’t be explained by an extra 100-calorie fizzy drink
each day …’ (lines 26-28) A B C D

66. Why might the ‘six month study, published in 2007’ (line 98) not be enough to refute Dr Friedman’s view?

67. What phrases does Dr Hill use to describe the tiny lifestyle alterations strategy? Answer using phrases taken from
paragraph 12. (2 marks)

a)

b)

68. Compared to Dr Friedman’s, Dr Hill’s take on skipping cookies is more …

A. upbeat.
B. complex.
C. defensive. A B C D
D. controversial.

69. What is the phrase ‘throw up your hands’ (line 114) a metaphor for?

Answers written in the margins will not be marked.

AIO (Vol.1) • Paper 1 • Supp MT (Q-A – Part B2) 15 Go on to the next page
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 70. Name THREE things mentioned in paragraph 13 that people can do to improve their overall health. (3 marks)

a)

b)

c)

71. According to Dr Ludwig, eating more vegetables could represent …

A. the start of a love affair with healthy eating.

B. stage one of a positive lifestyle overhaul.
C. little more than small-scale tokenism. A B C D
D. a feeble and half-hearted effort.

72. Identify TWO changes that Dr Ludwig suggests in paragraph 14 that could be implemented in the face of a

Answers written in the margins will not be marked.

Answers written in the margins will not be marked.

widespread obesity crisis. (2 marks)

73. Find a phrase in paragraph 15 that means ‘facing’.

74. Use ONE word only to complete each of the blanks in the summary below. (6 marks)

The ‘skip a cookie’ approach can be effective in arresting (i) but

not in ensuring (ii) , which requires (iii)

lifestyle shifts. Meanwhile, we need to be concerned more about our (iv) , rather than

just concentrate on our (v) or (vi) .

75. Do you agree with the ‘skip the extra cookie’ idea? Explain your answer using information given in the text.
(2 marks)

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AIO (Vol.1) • Paper 1 • Supp MT (Q-A – Part B2) 16

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 76. Use information given in the text to match each person with the correct speech bubble. Write the letter of the
speech bubble on the line next to the person given. (5 marks)

B. We publish our piece

to tell people that they’ll
need to do much more than C. My molecular research
A. I specialise in human
skipping a cookie or a short has led me to discover a
nutrition so I feel my walk to combat obesity.
calorie reduction idea possible biological key to
is relevant. losing weight and combatting
obesity.

Dr Friedman:

D. People can be scared Dr Ludwig:

of changing their
lifestyles drastically, E. We can’t just
Dr Hill: assume city kids’
that’s why I want to
encourage them to willpower will

Answers written in the margins will not be marked.

Answers written in the margins will not be marked.

take little steps with Michele Obama: deliver the results

the new campaign. without support.
JAMA commentary
authors:

77. Match the subheadings with the paragraphs by writing the letters (A-F) in the table below. One has been done for
you as an example. (5 marks)

Subheading
A Time to get real about how much can be achieved
B Effective campaign builds on knowledge
C A plan backed by the US President’s wife
D The ‘skip a cookie’ theory disputed
E Biological factors that influence weight lose and weight gain
F Baby steps may be able to help us after all

Paragraph Subheading
1-2

3-4

6-9

10-14

15 B

END OF PART B2

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