Obesity, meaning and measurement

This week an obesity expert with the World Health Organization stated unequivocally that our weight problem had everything to do with the amount of food we eat and not the amount of exercise we do not do. His statement does not contradict what Kenneth Cooper said in a recent lecture, as physical activity is the key to health and calorie control is the key to weight loss. So we are fat and we eat too much. This does not mean that we exercise enough as we most certainly do not. One can be thin and be in a poor state of health and many are. Again it is what we eat, how much we exercise and our smoking status that has the greatest impact on our health.

I knew that I was going to write a note about this today before I went on my run, but no one else did. While running, one of my friends who is originally from England told about one of her very first experiences in and impressions of the USA. This was in the mid 1980s. My friend went out with some others to see a movie and after entering the theatre she turned to them, rather perplexed and asked "why does everyone have a bucket?" A bucket. A bucket of popcorn. She said to her friends, in England we have bags of popcorn not buckets and we certainly don't have "pails" of soda. Well, there you go. We eat TOO MUCH.

Scientifically speaking, obesity is having too much body fat and being overweight is having too many pounds. Gone are the charts that once offered ideal weights, thank goodness. In lieu of these we have the Body Mass Index, the waist to hip ratio and a waist circumference measure. The BMI is a good indicator for most people, but it does occasionally identify very muscular and fit people as overweight or obese. The BMI is a formula : weight in pounds x 703 divided by your height in inches x your height in inches . You would like a BMI under 25. A calculator you can use on line is here:
http://www.cdc.gov/healthyweight/assessing/bmi/
I like this one because it has one for children as well and because the CDC message is that healthy weight is about lifestyle not dieting.

The waist to hip ratio (WHR) is determined by first measuring the smallest part of your waist and then the largest part of your hips, you divide the smaller number (waist) by the larger (hips over buttocks). This measure is said to be a better indicator of body fat and heart disease mortality risk. Women should be near .7 and men .9. This is the number for optimal health.
After you take your measurements, you can use this calculator http://www.healthcalculators.org/calculators/waist_hip.asp. I chose this website as it is hosted by a university and doesn't advertise diet products, etc.

Lastly is the waist circumference. If you have been "playing along" you should know your number from the above activity. The numbers for this measure are( again in inches) 35 and 40. Of course men get to have the higher number, did you even really wonder? Which ever your gender, you want to keep your waist circumference below that amount. This is a good measure of disease risk for people who have BMIs that are normal or overweight, but it is not helpful for the near morbidly obese. I like this website from the National Heart Lung Blood Institute because it explains a lot.

http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/4142.htm

Well I do know my BMI, but all this talk has got me curious. You know they say too that the waist measurement is accurate for older persons body fat levels. I am not an older person, though I do hope to someday be one, but am going to grab my tape measure just now. BRB.

You know it is hard not to hold your stomach in when you are taking the measurements!

OK my circumference is around 25 inches so that is safe and my WHR is well... my suck in my belly one is .75 and my relaxed one is .78. And yes, it is bare skin measurement.

So pick a measure or try all three. Maybe next time I will talk about easy and painless ways to cut a few (100) calories out of your day.

A Change of Plan

The Wellness Weekly is getting a makeover, in fact, it will cease to be. Ironically, I began doing a weekly news update because of how fast new research was coming out and how important it was to keep people in the know. That is all still true but blogging has also emerged since I began writing in 2000 and my understanding is, the more you blog, the better your blog will be. So:
I am going to try to blog on current issues more frequently, ideally that would be daily. Instead of keeping my bits of paper for the weekend, I will share research and thoughts as it or they come to me. And you know by now, my opinions are without limit.

My hope is to one day be a self employed health and wellness advocate and when that happens I should be able to greatly improve the blog entries.
Research and teaching are my great passions. I would hope to increase my knowledge constantly and then not only write, but also speak at conferences and consult with communities. This is very important because I am not able to reach a significant portion of the population by Internet and they need this service as much if not more than my web based audience.

My topics for the blogs will include anything that can improve a person's lifestyle in order to avoid disease or to improve disease outcome. I will share research on medication and supplements as well as side effects; on prevention screening; on health promoting foods and how to cook them; on exercise and where and how to start and more. At times I will dedicate a page to a recipe, but will post most of my food videos on You Tube.

I have added a few links this week and changed a few things along the side of the blog.

Next time I will talk about one of the stories I followed this week, but all this change talk has wore me out for now.

wellness weekly

Okay back to the regular news and a video meal:

The News:

Prescription Drugs: I believe that anyone who has read at least three of my blog entrees, even ones from the early 00s, knows that I have a very strong inclination against prescription drugs. It is also true that when a disease can be controlled or cured and quality life years added, I support pharmacotherapy. That is my little disclaimer I guess. I don’t want people to think that I never advocate for meds. I am not doing so today however. This past week has been a disturbing one in several ways. One big pharma is reported to have paid less taxes than one would expect due to a certain way that they closed a deal, and another kept worrisome clinical trial results hidden from people taking a certain antipsychotic drug. By the way, this is NOT the first case like that. Another company is in trouble for over charging Medicaid. All are being investigated. I also spoke to a man this week who listed six or seven prescription meds he has to take, though he couldn’t name any chronic disease that he had. Another woman told me that the doctor keeps putting her adult daughter on more and more meds and is stymied because she isn’t losing weight. The mother said to me, “He doesn’t understand. She eats like a pig.” Another woman told me how when she was first diagnosed with emphysema, she continued to smoke and could not make her inhaler last for the whole month. On a positive note, she told me that she has quit smoking and hardly needs to use the inhaler. That is EXACTLY why it is never too late to quit smoking. If you have a disease and are in treatment for it, that treatment will be more effective if you stop the activity that is causing the disease. I know, I am so smart. Back to the drug companies, one of them markets an inhaler for COPD in TV commercials and actually says during the commercial that the medicine can be used by current smokers. WHAT?!?!?! Too many meds, too many side effects, and too little personal responsibility. Remember, at least four of the ten leading causes of death and disability CAN and should be prevented.

Omega 3s: I want to say more about this today. First I advise that you read a little more from a trusted source, i.e, a non profit volunteer agency that does not also sell supplements! The American Heart Association. Here is a direct link: Fish and Omega-3 Fatty Acids. I want to revisit this for two reasons. First, last week I reported that Dr. K Cooper said in his lecture that everyone needs to take Omega 3s in supplement form and that the dose is 1g per day. I know he said 1 gram and that it should be 60% DHA/EPA, both of those statements are supported in other literature but the AHA has different dosage recommendations based on an individuals health. According to the AHA for example, I do not need to take the supplement but someone wanting to reduce their LDL or with existing heart disease should. Also they recommend even higher doses for some people, with physician supervision. You must make your own educated decisions. But here is the second thing I want to emphasize. The amount and type of Omega 3 that these companies are adding to your bread, eggs, milk and whatnot, are both WRONG. I checked out a milk carton today that very boastfully claimed 36 mg of Omega 3, well, great, where are you going to get the other 964 mg you need to get 1 GRAM. One place is in salmon, but oh my gosh, there is another awesome link on the AHA, it lists mercury content in one column and omega 3 in the other (by gram). This is wonderful and the kind of info I need to bring out to the community. Fish, Levels of Mercury and Omega-3 Fatty Acids
Device Recall Hits ‘em Where it Hurts: Drugs and devices, both types of companies can get seedy with their direct to consumer advertising and their doctor pandering. More reason to eat your fish and not your chips! We have had recalls of pacemaker batteries, wires that misfire, defibrillators, stents that reclog and more, but this time Medtronic got in trouble with a bone graft device that doctors recommended and used for off label conditions. They can do that, but the concern is that they may have been paid consulting or speaking fees and indirectly marketed the device for a treatment for which it was not FDA approved. Things have gotten bad because a lot of adverse health outcomes were reported for the off label use. Seriously, the FDA didn’t seem that keen on the device for the regular use either. This off label stuff is serious business, I myself had to sign a disclaimer before talking to docs about tobacco addiction treatment. Anyway, according to the WSJ this week, there has been a near 70% profit drop for Medtronic and jobs are being cut.
Fitness: Just a short bit to remind you that physical fitness is measured by muscle strength and endurance as well as flexibility and cardiovascular conditioning. It is important and imperative to good health to exercise your heart. Cardiovascular activity, what we often think of as aerobic, includes activities that get your heart rate up. A weight bearing exercise is not necessarily cardio and cardio is not necessarily weight bearing. What does weight bearing have to do with it? Weigh bearing exercises help men and women prevent bone loss. So running is an example of both cardio and weight bearing while swimming and cycling are just cardio. Of course walking can really get your heart rate up and you can cycle without increasing your heart rate much. Effort counts! Weight training for fitness is not the same as weight training for a competition. Ladies, relax, really, you won’t bulk up unless you spend hours and hours and hours in the gym weekly. Flexibility can be gained through simple stretches, yoga, pilates, etc. Whatever You are willing to do. You can work your core also without doing crunches, by doing the plank for example.

Okay then what are you doing? Don’t just sit there you have diseases to prevent…


Live Well
Deirdre

the following video is a dinner I put together after work one day. enjoy

My Cooper Institute Experience

This past week has been physically, intellectually, and socially rewarding. I went to a training at the Cooper Institute that was founded by Kenneth Cooper, MD, MPH. Dr. Cooper also founded the Cooper Aerobics Center. The institute hosts or provides several types of trainings, including personal training, wellness coaching, nutrition for kids and more. My course was Health Promotions Director. The content was broad and delivered in 4 days of lectures by PhD, M.Ed, MS and BS level instructors. Each day we had a lunch AND physical activity break. Two days we had actual physical activity in the curriculum. We also worked within small groups to plan an employee wellness challenge which we presented by power point on day five. Also on day five we had an 87 question exam – not a post test, but a comprehensive exam. Monday was a rainy day, but Tues – Thurs I was able to run on the mile long trail on the CI campus at lunch and at the end of class. I brought my lunch each day and stayed at an extended stay hotel which brought guests to the grocery store on Monday. There were limited refreshments served at the training, but certainly NO unhealthy ones. No juice, no soda, no bakery items. In other words, I traveled and was able to maintain my level of health and wellness. This training was also refreshing because the group cohesion was high. This held true class wide, table wide and within our small groups. Also, there was a pretty even mix of males and females, no age group dominated, no one discipline was more represented, people came from 13 or 14 different states and 95% of the 27 participants were physically fit. In this class were members of law enforcement and fire safety, military, corporate and hospital wellness, education and local government programs. We even had someone from the DOD. Oh yes, there was even a retired NFL player, Keith Thibodeaux, who told ME that I was the fittest person in the class. J A person would take the HPD training in order to be able to create, market, budget and evaluate effective health promotion programs for employees.

Now, when people hear “aerobics institute” the immediate association is step, cardio or even zumba class, but those are actually types of aerobic activities. Dr. Kenneth Cooper promotes and has promoted for decades, cardiorespiratory and cardiovascular fitness. He has VO2max tested some of our Olympic runners and is himself a runner. He is approximately 78 years old at this time and remains engaged, dynamic, agile and energetic. Dr. Cooper believes and has the research to support his belief, that disease can be prevented and that quality life expectancy can be increased. Indeed we have increased life expectancy but he fears that we are at the point now that we are more focused on prolonging death then prolonging life. I agree. He spoke to the class one morning and every thing he said meshed with the vision of this blog.

I will now write my top ten CI bullets and I strongly encourage you to consider adopting, adhering to, contemplating and applying these principles. They are supported by peer reviewed, prospective, longitudinal clinical studies, i.e. the gold standard.

• For nonsmokers, the most important factors affecting cancer occurrence are dietary intake and physical activity.
• Cardiovascular disease can be prevented.
• We have NOT seen the same reduction in cancer rates and deaths from cancer as we have with heart disease. This is certainly related to the obesity epidemic and emerging evidence is showing a correlation to the amount of visceral fat a person has and their risk of death. Visceral fat cells tend to dump toxic substances into the blood stream and increase inflammation and insulin resistance. To note, EXERCISE is the most effective strategy for reducing visceral fat. This is the fat you can’t pinch, it is inside.
• Dietary factors are associated with four of our ten leading causes of death. Those four are Coronary Heart Disease, Diabetes (formally known as adult onset), Cancer, and Cerebrovascular Disease.
• Consider lean and fit a baseline state – the ideal. Research shows that an obese fit person has less excess risk of death than a lean unfit person. Also, when looking at categories of normal, overweight and obese persons both fit and unfit, (fit is actually clinically measured in these studies, not self reported), the unfit group always has a higher mortality rate from cancer than the fit group. Exercise matters.
• To lose weight, calorie reduction is the quicker and easier strategy. To maintain weight loss, exercise is more effective. (It takes a lot for a person to burn a 100 calories but a soda has 200 calories.)
• Children! Dr. Cooper has done great things for children with his FitnessGram program. You can look that up. Dr. Cooper is very concerned that he is seeing 20 year olds with resting heart rates of 90. A healthy one is around 60-70. Dr. Cooper said that as a group and with regards to public health programming, there is not much we can do for adults at this point, to prevent chronic disease. He said people who lose weight, usually gain it back. But again, he is speaking of cohorts, not individuals. You MUST do something about yourselves. However, he feels that it is unconscionable for us to allow our children to go on as they are. The consequences of overweight and inactivity at these young ages include very early diagnosis of debilitating chronic disease. If we do not get a handle on this there will be no one to protect and serve, no one to fill the jobs once there is a rebound and no one to lead our country. He has the data to show a link between obesity and low IQ, in children. For those of you more interested in this, I can share the journal information on the study.
• Certain elements of food guidelines are most important. Whole grain and fruit and vegetable intake are key as is fiber. Fiber is important as a means to rid the body of unhealthy cholesterol. Mono and poly unsaturated fats are healthful to the body and saturated fat is not. There is no amount of saturated fat that the body “needs.” Dr. Cooper did note a study that showed how the permeability of cells was lessened because of the layer of fat around them. In class we were told that it is not the proportion of macronutrients that should drive a meal plan, but that you have the right energy balance for your needs. Of course, you have heard that here.
• Consume vitamin D of at least 1000 IU a day. Walter Willett has also made this recommendation. Dr. Cooper said that if we did not get adequate vitamin D the calcium we consume will not be put to use. Omega 3 in the form of fish oil is also recommended by Dr. Cooper and for the first time, I will concur on a supplement recommendation. He states 1 mg a day and that it should have 60% EPA/DHA. I am going to purchase mine from the Cooper Aerobics Center as he has it formulated correctly and because I do NOT trust the unregulated supplement market. I will feel better doing it this way. By the way, these are the ONLY two things that he recommends as supplements.
• Intensity is key. The amount of activity needed to maintain health is 30 min of moderate activity 5 days a week or 20 minutes of vigorous activity 3 days a week. That is the very minimum. For optimal health and fitness it is 60 minutes most days of the week. Vigorous activity is worth more than moderate. Cooper gives points. The aerobically fit earn 35 points a week, but to improve health and longevity 15 are fine. This is only the fitness part of the equation, remember our beginning, the formula is dietary intake AND physical activity. His expectations are high. To earn the 35 points >
  Run 2 miles in less than 20 minutes 4x a week (less than 10 minutes a mile)
  Walk 3 miles in less than 45 minutes 5x a week (less than 15 minutes a mile)
  Aerobic (dance) class 45 minutes 4x a week
  To earn the 15 points a week>
  Walk 2 miles in less than 30 minutes 3x a week
  Walk 2 miles in less than 35 minutes 4x a week
  Walk 2 miles in less than 40 minutes (less than 20 minutes a mile) 5 x a week
  Walk 3 miles in less than 45 minutes 2x a week
  Or do aerobic 45 minutes 2x a week
• Ok 10 + One: Cheating does matter. One hundred extra calories, calories you do not burn, every day, will lead to a 10 pound weight gain in a year. According to the Weight Control Registry, those who have lost weight and maintain the loss for over six years, exercise 60 minutes a day, rarely eat fast food, and weigh daily. It is important to note, as one of the instructors did, that the evaluation of weight should occur monthly, as weights fluctuate for reasons other than real gain.
  
  Oh well, that is it then. There is more of course, but if I overload you then you’ll lose information. More cooking videos are on the way. Stay fit!
  
  Deirdre

wellness weekly

The News:

I started hand writing the blog at the airport where my yogurt was confiscated. I am now typing the blog on the seat of the city shuttle bus, in Dallas as we wait for more riders. BTW, I did not know that I was going to gain an hour, so I am a little weirded out. But I am on battery power on this little think pad so I better get to blogging.

Use Sunscreen: Even though it has been suggested in research that increased risk for skin cancer comes from sun burns we receive as children, especially if we are fair skinned, middle aged burns can not be harmless. I have one! I spent the day at the beach yesterday and have spent most of today with a burning itching chest. I did not wear sunscreen yesterday because I usually spend a half hour in the sun with no problem. Well I did wear it on my early morning run today because enough is enough of that. But the reason for wearing sunscreen that may get more of your attention is that sun ages you. I saw a man at the beach yesterday who may have been seventy but looked over eighty. He had skin the color and texture of shoe leather.
Governor Pataki’s Wisdom: I wish I had kept a note or two from the former governor’s guest appearance on CNBC this week, but I didn’t. He was nonetheless, advocating for the prevention of disease and he was pointing out the vast numbers of individuals who have diabetes and the lessened life quality that comes with it. He rightly noted that our obesity epidemic was most to blame and that the toll of this was far more dire then say, the flu and that obesity was the real health crisis. A caller to NPR made a similar statement later in the week regarding tobacco’s effect on health to the tune of about 438,000 US deaths per year.
Don’t Mix Those Drugs: A study that adds to existing evidence has shown an increase in heart attacks with patients who are taking plavix, an anticlotting drug, along with one of 4 proton pump inhibitor drugs for acid reflux (Nexium being the most popular of the four). These persons have most often developed the reflux after being prescribed plavix. The plavix is used in persons who have had a heart attack or stroke and or who have had stent placement to prop open previously clogged arteries. In the study, people who were on both drugs had 50 percent more heart attacks than those not on the PPIs. If reflux is a side effect of the plavix it must be addressed because untreated GERD can lead to esophageal cancer. Some cardiologists are now switching their patients on plavix who have acid reflux to non PPI meds. I read this week that almost one million stent surgeries are performed in this country a year. Plavix and the four PPI medications that treat the reflux are billion dollar drugs. What this study should really instigate is a health promotion campaign that works to prevent heart disease and the invasive and risky treatments it demands.
& More Pills: When I saved this article to read I believed it was about more use of psychotropic (mental illness) medications in general, but when I did read it, I learned about the increase in use with seniors. The story I read showed at least a doubling in use with seniors and also a rise in use with children. One reason for the rise of use in our older population is that medications used to treat dementia are considered psychotropics and they have become more common. Some mental health professionals say the rise in use in both populations is due to better access to care. I think it is due to marketing and that many times the risk from the medications far out weighs the benefit.
OMG: More food knowledge imparted by Melinda Beck from the Wall St Journal. Did you know that a food can still be called all natural if it’s “additives” are natural too? Buyer beware indeed. Ms. Beck offers important info regarding sodium in fresh, all natural chicken. Some chicken is processed in a way that adds 200 to 400 mg of sodium per serving. For those with salt sensitive high blood pressure that is no little deal. Other things we’ve touched on before, but read your labels – not just the per serving part but the ingredient list as well. You may be unpleasantly surprised. Also, if you can get restaurant info online it would behoove you to read it.

Not able to post a video from my laptop so no cooking demo this week.
BTW I ended the blog sitting in the classroom during the lunch break. Tomorrow I plan to run on the mile track here, it is supposed to be made of some special material that has less impact. I have learned of a new concept and will tell you about it next time. It is called compressed morbidity.

Live Well
Deirdre

wellness weekly

Gynecology Exams: ACOG or the American College of Obstetricians and Gynecologists has made a recommendation on the annual pelvic exam and cervical cytology screening. The reason that ACOG chose to make a statement at this time regards the confusion that has been created by Merck’s advertising of Gardasil as a cervical cancer vaccine. The recommendations for the exam appear to be the same as pre gardasil. Once a woman becomes sexually active or when she turns 21 the general exam and cervical cytology should begin. The cervical cytology is the pap smear. Women who do not have risk factors only need exams every three years and women over age 65 can forgo the pap smear as long as they have no history of cancer and have had ten years of normal paps. The important message is that the vaccine for HPV does not take the place of gynecological care.


Disclosure: The concern that clinicians and researchers have been receiving incentives from drug and medical device makers has gained credence. The Institute of Medicine is calling for voluntary changes and policies regarding conflicts of interest. They urge that those practicing direct care do not accept any sample meds, free meals, stipends or gifts. All relationships should be identified and shared with employers and organizations. The IOM makes this recommendation on the heels of Senator Charles Grassley’s call for action and also encourages legislation. They assert that voluntary changes are encouraged and without them, strict regulation will be necessary.

OTC Label Changes: In 2006 it was proposed that some over the counter pain and or fever medications have their labels updated to include a health warning from overuse. I am not certain, but I believe that the concern was first raised by the Center for Science in the Public Interest. The label change is now mandated by the FDA and will include liver damage warnings for acetaminophen containing products and stomach bleeding warnings for ibuprofen products. Two less familiar drugs are noted as well so keep an eye on the labels. Note that acetaminophen concerns are aggravated by alcohol and that individuals on the blood thinner warfarin should not take acetaminophen without informing their doctor.

Behavior Economics: In reading an article about incentive programs that are being implemented by employers, I learned of this concept – behavior economics. Those in the field note that consumers do not always act in ways that would be in their best interest.(say like buying things that they cannot afford or will never use) Of course, those of us in the field of public health know better than anyone that people struggle mightily with doing the right thing. So employers are offering incentives to people who struggle with life changes when the only reward is well.. a changed life… you know, a healthier one! So to get people to quit smoking, start exercising and stay on their blood pressure meds, companies offer days off, money, lotteries and continuous incentives. The newest thing in employee wellness being the need to keep offering the incentive after the change has been completed, or else, people will revert to their old unhealthy ways. Hey, no one changes for free, not even for their own benefit it seems.

Prostate Cancer Treatment: We have recently been concerned with whether or not to test, but now I am asking whether or not to treat. At least, in regards to the latest story on a drug called Avodart. The drug in question is from GSK and is sold now for treating an enlarged prostrate. In one study, the drug was compared to placebo in men who had an increased risk of getting prostate cancer. Over 8000 men were involved and after four years, 22.5% of the men on the drug versus 29 % not on the drug, got the cancer. The report on the study does not tell us if the four percent is statistically significant or what the side effects of the drug are. The side effects may be worse than the effects of the cancer which is usually slow growing. So I am waiting to learn more about this. BTW, Fosomax, the drug many women take to prevent osteoporosis was once tried for prostate cancer prevention but caused more aggressive cancers instead.

FLU: Just a brief note on this very current issue. H1N1 is a combination virus of bird, pig and human making. We do not currently have a vaccine for this strain and that is why it can spread more rapidly and take more lives than the “regular” flu. There is no herd immunity. This was a concern a few years ago with Avian flu which had not mutated to human to human transmission as the current flu has. It is usually the case that healthy people may get ill, but not critically so, with a flu virus. For now, avoid sick people, eat right, exercise, drink water, wash your hands and if you become ill, isolate yourself, talk to your doc and perhaps treat your symptoms with an antiviral like tamiflu.


Today’s video is for pumpkin cream cheese. You will need fat free cream cheese, canned pumpkin, ground cloves and cinnamon, a sweetener and a mixer. There is about 10 cals per TBSP.

Get Moving!
Deirdre




pumpkin cream cheese video