Year's End

Of course I have something to say as you approach 2011 - but it is going to wait until tomorrow.

Enjoy this last day of the year where you are both physically and mentally - we'll start there tomorrow.

I appreciate all of you and salute your efforts at salubrious living!

Burning Fat

Because I have some (minimal) education as a personal trainer, and because I read research (a lot), I am often asked what burns more fat - intensity or duration.  It is not that simple of course, but the question for me is always, which burns more calories.  That thought is shared by some who are experts.


An even more complex question was posed in research from The Queensland University of Technology in Australia.  The scientists wanted to know which of two intensities was best for fat loss - the million dollar question.  Their study hardly offers a conclusion as it involved only 11 people, but it adds to the dialogue.

The obstacle is understanding the intensities themselves. If any reader can explain more than I, please do comment. 

The scientists compared an hours worth of activity at the level of maximum fat oxidation per individual vs 80% of a persons ventilatory threshold.  Ok.  There must be an intensity that one reaches where they are pulling fat from cells and turning it into free fatty acids, or oxidising it, and thus burning it.  The other, VT, is about breathing - but seems similar to maximum heart rate and perceived exertion etc.  It is far more technical and relates to expiration of carbon dioxide and oxygen, but lets just say it is the level where you are not comfortable talking - or on a scale of 1-10 with ten being the hardest effort you've got, you are doing an 8.

It seems that the fat oxidation effort would be harder - but that is a completely arbitrary statement on my part.

The researchers found that in the one hour session, the amount of fat that was burned was the same, BUT, the amount of overall calories was higher in the 80% VT group.  The researchers conclude that people should be told to exercise at the 80% ventilatory threshold.  If you are interested in learning more, Google away :)

Frito Alert

It is rather timely that Frito Lay should announce its plans for making snacks "all natural" and free of chemicals like MSG.  Timely in that this is the type of industry behavior that can delay government action and mislead the public, of which I have recently spoken.

When your salty snacks come without extra chemicals and contain all natural ingredients (remembering that the term all natural only means minimally processed) they are STILL chips and not considered a healthy food.  Be discerning and check the nutrient label for serving size, fat, sugar and salt/sodium content.

PED

An article I read today gives me some points to ponder.  The information on the article is this:

Andreyeva T., Long M., Brownell K. (2010) The Impact of Food Prices on Consumption: A systematic review of research on the price elasticity of demand for food. American Journal of Public Health. 100(2). 216-22.

PED stands for price elasticity of demand.  It refers to the amount of change in purchasing that can be expected by a one percent change in the price of a product  The article referenced above reviewed 160 studies across food categories and across decades to suggest certain mean values of price elasticity for 16 food categories.  With regard to PED, there is inelasticity and elasticity - which refers to whether or not the change is above or below the number one when the product price is increased or decreased.  In other words, lower numbers indicate that a product may not be effected by a price change (or the effect is small). 

This systematic review, which has some limitations, showed very little difference in purchasing behavior regarding eggs, but some change when the cost of dining out and soft drinks went up.  None of the food categories they studied provided values over one.

Interesting points from the study include that some persons will change behavior when the price of whole milk is increased and will switch to a healthier version, i.e. low fat milk, but did not switch to skim milk, the healthiest.

Because pricing of foods to promote wellness is on the minds of many in government and public health, the authors of this study made several suggestions.  One is that the many factors regarding purchasing behavior be considered and that when price changes are implemented,  several areas be assessed for possible ripple effects - good and bad.

For instance, would an increase in the cost of soda lead to a decrease in soda consumption but a switch to high calorie sports drinks?  OR would it lead to consumption of low or no calorie beverages.  Would the consumer switch categories  - for example, if the whole milk price is too high would the person switch to OJ or soda, or make up the fat in a food product instead?  Inversely, would the person who changed to low fat milk because of price decide to buy fruit instead of a snack cake because they are now thinking healthier.

The researchers noted that many of the foods that we are encouraged to eat, like fruits and veggies and whole grains,  have barely been studied for price elasticity if at all.  Would increasing white bread  and rice prices lead to a switch to whole grains? 

Several states already place higher taxes on soda and snacks, often unbeknowst to the public and simply to earn more revenue.  If the prices are raised for the purpose of promoting health and changing behavior, Andreyeva et al suggest that the extra income be used to offset the prices of healthier items.  I find that to be a grand idea!

The authors discuss the other factors that influence our purchasing decisions.  Of note is how price changes occur within many contexts.  For example - does the consumer expect this to be a permanent increase (think gasoline!) and has the consumer's income also changed.  With regard to the current economic situation, which none of the studies evaluated pertained to, there is great concern that the amount of high calorie low nutrient foods that are purchased will increase because of the low cost.

This is interesting work, I enjoyed reading the article. 

Sedentary Entertainment

In the current discussion of obesity, the running themes are energy dense and nutrient poor foods, marketing of those foods and sedentary entertainment.  I am just beginning to wrap my mind around the sedentary entertainment or recreation aspect of causation.  It is different from lack of physical activity or exercise and different from being sedentary. Public health advocates, experts, and scientists point out that the amount of exercise people get has not changed as drastically over the last 30 years as has the calorie content of food and the way we entertain ourselves.

The video games that get people up and out of their seats are new and rare, more often gaming - on line or otherwise, involves long bouts of sitting.   As does social media and interactive websites.

Today I went to an arcade with my Mom.  She goes there once a week or so and "gambles."  I want to say that there are positives and negatives about this FunCenter and I am not writing to condemn it.

The majority of the people in the game room were over age 70.  It is important that people stay engaged and social as they age, so this is a good thing.  The arcade has a happy hour, with beer and wine, which is scary - but they have a two drink maximum, which is good.  It seems to be a safe and welcoming place and most importantly - it is a tobacco free environment.

There are no clocks around.  There are many games, but mostly they are like the one armed bandits or slot machines found in casinos.  There was not one machine out of the 100 there that did not have a chair in front of it.  They were all sit down machines and people spend hours there.

Thus, the sedentary entertainment issue includes the older adult population and would have the same deleterious effects.

Odds and Ends

Fruit Cups- I have two points to make.  First, my Mom has some fruit cups in her fridge and at first glance I thought that they were healthy.  I define a food as healthy if it is high in nutrients and low in calories, per serving.  The cups in Mom's fridge were relatively small and had 70 calories.  On closer inspection however, the small container held TWO servings - so it wasn't low in calories for the size.  The other thing to say is that a local theatre I visited this weekend sold fruit cups!  In that regard, they WERE a healthy option -  next to the candy and buttered popcorn.

Rheumatoid Arthritis - I did not personally pursue this tidbit but on the news I heard  that new research associates smoking with about 30 percent of RA cases.  My aunt has this type of arthritis and is in great pain.  What the research of today supports, confirms and adds to is this- smoking can cause any number of diseases and those it does not cause it certainly makes worse.

Marketing and Partnerships - I am reading some articles that relate the obesity pandemic (global problem) to the marketing of high calorie, low nutrient foods to children and adolescents.  The food industry spends billions of dollars on the ads and the branding of their products.  They have done this for decades and would not continue to do so if it were not gaining them profit and customer loyalty.  Public health advocates discuss mimicking their work with health messages as well as partnering with them to promote healthy lifestyles and to provide less energy dense foods.  This topic really deserves its own post, but in the readings I find some vindication or support of my own findings.  This is that physical activity as a weight control strategy is the salient message - the one most promoted and the one most believed - it is the one that food companies are willing to stand behind and it is not enough of a strategy.  It makes sense when others note that the food industry is not very likely to suggest that people eat less!  They are in this to make money.  When the companies do create healthier versions (lower calorie - fat - salt - sugar) I am delighted and I certainly buy them.  This however is still not sufficient because I am not in the priority population.  The priority population, the most obese of us, are also the poorest.

True Grit - This weekend I saw the remake of True Grit.  In this version, Jeff Bridges plays Reuben and he has the most gravely voice.  He is a heavy drinker and smoker.  I imagine he had throat or esophageal cancer.  It was hard to listen to.

Hands Full- Oh, Burger King - you do a fine job of making my points for me.  The current promotion is two for one chicken sandwiches.  There is no suggestion in the TV ad that the second sandwich would go to a friend.  The announcer makes some comment about this lunch,this  chicken, not being a handful but hands full.   Yes indeed at 630 calories  and 39 grams of fat EACH that is quite the meal.  Where, I ask, is the two for one salad??

Ad Council - I didn't really catch this, but I will be on the look out - A public service announcement regarding obesity and disease.  I am in Florida a few more days, where I have TV access so I will keep my ears open.

Strenuous Movies - I didn't mean to get a movie theatre theme going here, but one last thing.  The kiosk that was selling the fruit cups and granola bars also had gatorade.  REally?  We need Gatorade at the movies??  Sports drinks and their sugar content are clearly one of the unhealthy items that are branded and heavily marketed.

Holiday Adjusting

Hello Readers
I just wanted to post something, though I really don't have a topic.  I have traveled to Florida for the Holiday and had to adjust to a new routine.  I also have a product to deliver to my Graduate Program Director before the January faculty meeting which has kept me busier than I had expected.  (This includes the two hours of lost content that apparently was sucked into some Internet wormhole.  My friends tell me that Macs don't have wormholes, but I am not ready for that kind of change just yet.)

First thing I did do when I arrived was get to the grocery store for some healthy comfort foods and the next was to  get a ten day membership at my old fitness center. I love that gym and I have to tell you, working out with men and women my own age is a wonderful welcome change.  I just know that I have to get unused to all of this again next month -back to my cave like dwelling in the cold.

I am still trying to do some reading on my favorite health related topics, but the work assignment has usurped my time and energy. 

With the Christmas holiday just days a way, and a family who celebrates close at hand, I expect my blogging will be pushed aside.

If so, please know that every post I write is one I enjoy and bringing news, along with a good dose of opinion, to all who read these pages, is one of my greatest pleasures.

Take good care then and enjoy the season and the people with perhaps a little restraint on the over indulgence - if you can...

Best ~
Deirdre

Motivation

In my research proposals, I talk about relevancy, access and opportunity with regard to making obesity related progress with our programming.  I want to be clear that those three things are not necessarily within an individual's control.  I think that any one of the three might have degrees of influence and power. It varies within people and across the place, the politics and the circumstance.  Even the relevancy is shaped by the environment to more or less of an extent.  There is just so much influence from the market and from our peers who are influenced by their peers and family and again, the market (advertising).

Still, what does get a person to pay attention when they have the opportunity to make a change or take advantage of a resource like a menu label or a fitness trail?  What will motivate a person who has the means to change?

I saw something today that seems useful. It was a pretty smart social/health marketing type of advertisement on the screen of a cardio equipment monitor.  I mean the TV attached to a treadmill at the gym.  The ad was simple.  It showed a burger dripping with cheese and sauce in a bun and then a gym scene.  It had an arrow pointing towards the burger that said, "Are the decisions your making out there" pointing now to the gym, "going to get you the results you want in here?"  Or something like that - pretty slick - I may have to steal it.  And it is a question you might ask yourself when you are indulging next year.

Odds and Ends

Fast Food - Why don't restaurants offer 1/2 price or two for one deals on the healthy items?

Keyboards - I bought a new keyboard (well, my mom did) and it has a warning label regarding repetitive motion injuries. I suppose this is to protect Microsoft from carpel tunnel lawsuits.

CNN - There was a special report recently regarding lap band surgery and the company that is hoping the FDA will revise the guidelines on qualification.  In other words, making it so people somewhat less obese (lower BMIs) can still have the invasive surgery.  Some of the same arguments that I made a week or two ago, against this proposal, were offered by the "experts."

Alcohol-  I am subscribed to receive the Harvard School of Public Health's nutrition updates.  Most recently the email referred to alcohol. The timing was purposeful.  Some of us drink more during the holiday period, which is bad for the waist line but also - in extremes, it is bad for overall health.  To read more about both the good and bad of alcohol, you can click here.

Exercise-  Many countries and particular areas within them, are having unusually cold and wet winters.  If you find yourself stuck inside, Netflix has a good number of fitness videos which allow you to get up and get the blood flowing, if nothing else, for 30 to 45 minutes at a time.  I am certainly taking advantage of them.

Madness!!!  - I took a break while working on this post to show my mother the free games that came with her new HP laptop.  I almost fell off my chair when, as the game was loading, a dialogue box ran through I list of feelings that I might be experiencing that I should talk to my doctor about - as brought to me by some pharmaceutical company selling an antidepressant medication.  This was on a home computer!  - Big Pharma is everywhere. Why isn't the USDA telling me that I should eat less calories and more vegetables while I wait for my page to load?!  Why aren't they???

High Cost of Health

No not health care, but being healthy, specifically eating low calorie or energy dense foods in order to moderate energy intake and weight.  Why would you watch intake and weight?  To prevent chronic disease states such as heart disease and diabetes, that is why.

I have made comments regarding the cost of processed foods - where the manufacturer reduces calories by adding water or artificial sweetener or reduces the serving size and then charges a dollar more for the product.

Currently I am working my way through an article by Goldberg and Gunasti (2007) which is interesting but I have a ways to go. I bring it up today because they noted that the burden on schools which try to improve the nutritional value of foods is significant.  In one example, low fat cheese slices cost 4 cents more each, over full fat cheese.  Now multiply that over an entire school district and it can be a deal breaker.  Perhaps - if all the schools stopped buying full fat cheese, the prices would reverse! 

Remember consumers, you are the target of marketing campaigns but are not powerless - the wallet talks!

Eat Them, Alice

I took note of a Press Release from a company named Total Nutraceutical Solutions or TNS.  The press release was announcing the company's continued work with a compound found in mushrooms that is thought to be protective with regards to heart disease.  Mushrooms (and fruits and vegetables) contain bioactive agents that protect against inflammation and plaque buildup.  In other words, many fruits and vegetables, because of their antioxidant properties are said to be anti-atherogenic.  (Exercise is also considered to be anti-atherogenic, btw).

In mushrooms, the chemical ergothioneine is considered almost a super anti oxidant.  The press release noted that a study had just been published in the Journal for Medicinal Food (what?) that supports the company's efforts to make an ergothioneine supplement, or a mushroom pill.

Well I found that study,(the link may be accessible) but I want to quote the scientist who did the experimental  work with this chemical(bioagent) and cells from human blood vessels.  What he states in his conclusion is very important -

"The finding that dietary bioactive agents such as ERT are protective against human diseases, i.e., CVD, further supports the notion that consumption of fruits and vegetables, and particularly ERT-rich mushrooms, is an important and efficacious cardioprotective approach."  ~ Keith Martin

In plain speak, scientific evidence supports that EATING fruits, vegetables (and mushrooms) can prevent diseases, such as heart disease.  (No mention of taking mushroom pills)

The study citation is thus:

The Bioactive Agent Ergothioneine, a Key Component of Dietary Mushrooms, Inhibits Monocyte Binding to Endothelial Cells Characteristic of Early Cardiovascular Disease.



Keith R. Martin

Journal of Medicinal Food. December 2010, 13(6): 1340-1346

The Wrong Product

You may be familiar with the Yogurt commercial that "stars" Jamie Lee Curtis and suggests that the product helps with digestive issues.  If I recall correctly, I used that commercial as a way to direct you to my You Tube video for cereal bars, as they are high in whole grains and fiber which also helps the digestive track.

But the marketed ingredient in this particular yogurt is probiotics (a bacteria).  There are substantiated health claims regarding active cultures in yogurt, but there is not evidence that Activa and  DanActive (a dairy drink) are by and of  themselves health promoting.  So the company settled a claim with the Federal Trade Commission regarding their false advertising which includes a 21 million dollar fine.

It appears that the FTC is paying more attention to product claims, as this is not the first company to take a hit this year.  Many times the products are claimed to improve health or prevent a condition, like a cold.

According to a USA Today article, the yogurt industry brings in billions.

We have some problems in the country that is certain.  We have a national chronic disease burden that is epidemic in scope and cost to treat.   But to be honest, Omega 3s and probiotics are not going to change that.  

The true need, the one the food makers really ought to put their might into, is fat, sugar and calorie reduction.  We need foods that are less energy (calorie) dense.  Let them make and market those.

The FTC report on the yogurt can be read here.

Health Care - Timing is Everything

Most TV, print, and radio news programs have discussed the Health Care Reform  (Patient Protection and Affordable Care Act and the Health Care and Education Reconcilliation Act)  and how it is impacting the country and employers/businesses. 

I remember being excited when some proponents of the measures talked about mandatory health insurance and how it would bring costs down through competition, especially if people could get insurance from any state, not just the one in which they lived.

I imagined searching the web in much the way we do for loans and other types of insurance.  The company that could offer me the best deal would win my or my company's business. 

But as states begin to sue and employers talk about raising premiums I have to rethink this.  What is wrong?  Why isn't this a good thing?  Competition is always a good thing in our counry, isn't it?

Well, if we look at auto insurance or even long term care insurance and annuitites - the premise for the insurer is - most people are not going to wreck their car, get debilitating dementia OR out live their own money (ok only the first one seems realistic these days, and THAT is the problem.)

Now is not the time to add people to health insurance rolls because (according to the CDC) fifty percent of the adults in America have at least one chronic disease.  And we can't  expect children to help out, 20% of them are obese and thus, very likely to have risk factors for chronic disease(hypertension and high cholesterol) if not chronic disease out right(diabetes and heart disease).

We do not have enough people who will NOT need medication and surgery to make the programs profitable.  We have too few healthy people to cushion the provider. 

What insurance company wants to operate on margin, if not worse.

Perhaps we need to invest the money in prevention for a few years first! 

Point of Purchase Pondering

Blumenthal, K., Volpp, K. 2010. Enhancing the effectiveness of food labeling in restaurants. JAMA. 303: 6. 553-54.


I found much contention in the above cited commentary on menu labeling.  It is true that the point of purchase information that is currently available (limited places) has not been found (in limited research) to be making a difference in the items that people purchase.  This is not a reason to abandon the strategy, but to review theory and practice before using outcomes as a judgment.

My argument continues to be that the relevancy and education pieces are missing.

Blumenthal and Volpp discuss other factors.  They suggest that the notion that persons underestimate the amount of calories in prepared foods is FALSE and that seeing that the item has less calories than they expected prompts them to eat more (or choose the high calorie option). Another thought they propose is that the person reading the menu does not know exactly how to take the information on calories and apply it to their personal situation and daily needs.

I say, this is a reason for the education piece which will happen more earnestly when people get the message that calories are important. The authors also refer to a lack of self control as the bigger problem  - to which I shudder.

However, to use the argument that persons cannot refrain from indulgence because of their need for taste, I suggest  implementing the Volumetrics approach which dilutes calories while retaining flavor.

After the authors note why they think the POP strategy is failing, they suggest some ways to enhance it. With regard to presenting the calorie information in a way that is more understandable to the individual, the researchers suggest providing targets (perhaps by day or meal – they do not say) or giving the equivalent of calories in energy expenditure (EE) or specific physical activity. As the EE equation involves weight of person, duration of activity, intensity of it and other factors, this is likely to cause more of a problem than less.

Though, I do not agree with the authors suggestion that people are NOT underestimating calories in foods (I think in general people do not have a clue how many calories are in the food they eat), I am convinced that most people overestimate the amount they burn in exercise - or how effective exercise is at burning calories.

Blumenthal and Volpp also suggest framing the content as in "by drinking one glass of OJ every day for a year, you'll gain X pounds,"  which is problematic for the same reason as the burning calorie suggestion (people are different).

Lastly, they suggest defaulting or staging the healthy item which is one of the better ideas here. This of the same line of thought as the smart lunchroom. The concept is to create an environment where healthy is easy.  For the menu boards, it means putting the low calorie foods first and make their prices similar to that of the high calorie combo meals.  

If you have not seen the smart lunchroom interactive website, it is really worth a look so click here.

Man Down

There are quite the number of clever news stories out today from the likes of CNN and CBS to USA Today - but I went for the plain text of the FDA website.

The FDA warns that men looking to enhance their sexual performance (i.e. get and maintain an erection) should NOT try to do so with the "herbal"  - "supplement" - or chemical compound,  known as , Man Up - as it contains ingredients that might  - well - kill ya. 

You can read the warning here - or Google Man Up and read the more colorful stories. 

Odds and Ends

I did generate a list this week, but I am not sure I can make heads or tails of it just now...

Stents and Ethics - The WSJ let me know that a doctor who had gotten in trouble (I'm sorry - barred from practicing medicine in the hospital where he was a cardiologist) for placing too many stents in too many patients (stents are the devices that prop open arteries that have been cleared of that clogging, heart attack inducing plaque that comes (mostly) from a high fat diet) was hired by Abbott Laboratories.  Since they make stents, and he seemed their biggest fan, it makes sense.  This also explains why some consider heart disease an industry.  I should think that the general public would ease up on the steaks and french fries just to put these folks out of business.

Meals a Day - I was a little shocked to read that an Olympic level athlete only ate one meal a day.  I should not have been that surprised as I myself have told people that the total amount of calories in and out is all that really matters at the end of a day.  (you know, people ask how many minutes do I have to exercise to burn fat, should I eat first, etc etc - and the answer is - energy in energy out - for weight - not for performance and health - for optimal response- what and when DOES matter).  "The body doesn't really know what time it is" has been my defense for eating most of my calories at night.  I do.  I think that the methods of this man, whom I read about in a magazine, support a technique I encourage.  Figure out what you like to eat and when you like to eat and then work around it so that you still consume the right amount of calories, HOWEVER, what those calories are can impact your health so think about low fat, low sugar, high fiber and lean proteins as well.

Exercise Variety - A friend and I have this conversation from time to time and I cannot recall whether I have shared it with you - but variety doesn't only mean that you have something to do if you can't do what you love, but it also adds fitness and aesthetically - toning and shape.  There are many people who run marathons once a month who have no definition and really are not athletic because running is the ONLY thing they do.  Lift weights, work your core, watch your intake and do cardio work to have a higher level of fitness and health.

Menthol and SLT - In the news this week - the FDA is considering whether it should (YES) do something about the additive menthol in tobacco.  Menthol is (research suggests) related to higher levels of nicotine dependence and higher rates of lung cancer in persons who smoke menthol cigarettes.  Separately, a lawsuit against US Tobacco was concluded and the jury or judge found the tobacco company responsible for a young mans oral cancer.  He began using smokeless tobacco (SLT) as a thirteen year old in the 1960s or 1970s.  Not all smokeless tobacco products have the same level of Tobacco Specific Nitrosamines, but that was another blog - you can search for it if you like (to the right).

Walmart - HEY!  I went to a different Walmart this week and instead of a McDonald's at the entrance they had a Subway.  Very cool.

The Perils of Middle Class - Another story I read this week (wow, I had time to read a little!) spoke of changes in Africa where many countries are improving economically.  Because the countries are gaining purchasing power, the fast food industry is planning to expand.  It will not be long then before the obesity epidemic hits the continent.  I seriously think it would be a great research study.  We should get a country by country measure of the rates of overweight/obesity - which I think the WHO has on its website and see what happens when the KFC gets there.

Most of my reading this week has been on front of pack labeling and dietary behavior surveys.  I thought that sharing those research articles with you would be easy but at the end of most days my brain is too full to regurgitate - suffice it to say - I am learning a lot and planning my dissertation research.

I am saddened that my NYG didn't get to go to Minn and play today - I hope the game gets played tomorrow and of course, that they win -

Warm Water

My main concern with power plants and the environment has been  emissions and industrial waste.  I hadn't thought of water temperature and marine life only polluted water and marine life.

An article about the Oyster Creek nuclear power plant that appeared in the WSJ this week suggested another problem with power plants.  (nuclear and coal fired) 

The problem is  the use of water from natural sources, i.e. bodies of water near the plants and the return of that water to the natural source at a temperature about ten degrees warmer than it had been.  Not a big deal if we are talking a gallon or two, but according to the article by  R. Smith, the Oyster Creek plant uses a BILLION gallons a day.  This change in water temperature impacts the marine life and can lead to algae blooms and oxygen loss. 

It seems that the only energy sources that do not cause this level of  harm are wind and solar.  You can learn more at this website.

Energy Consumption

I am going to take a little environmental liberty with my energy in energy out mantra....

As I was driving home from campus one recent evening I oohed and aahed at the holiday lights.  Pretty, I thought. 

I considered the extra energy being used in the decorations, but not too seriously.  It seems a tradition to light up the eaves, doors and yards of America this time every year.  In Winston Salem,NC, they also have the Festival of Lights at Tanglewood Park.  I have never been, but I hear that it is remarkable.

That is when I had my Debbie Downer moment.  Not only are there miles of lights but  miles of idling cars.  Thus people ooh and aah as they sit (not burning calories) and their cars run (burning gas and emitting toxic chemicals).

I propose that we keep the lights, but people should view them either in horse drawn buggies or on foot.  That way people can burn some calories at the time of year when they REALLY need to burn them and we can waste a little energy without adding to the green house gas level ?

Notice - I did not say to kill the lights. 

Know How to Work It

That I found myself surprised by this was actually the surprise.  The Family Smoking Prevention and Tobacco Control Act signed in 2009 gave the FDA the power to regulate tobacco.  It also called for several changes related to marketing and production of tobacco.  One of the first changes had to do with warning labels and messages for smokeless tobacco (SLT) products.  Cigarette warning labels will be changing in 2014. 

The law provides four warning messages that must rotate on packages and advertisements.  The cans and pouches of SLT must have warnings that encompass 30% of the label.  Any print ads, including billboards, must also contain one of the warning phrases and it must take up 20% of that media.

I have seen the cans already, but today I saw a big sandwich board display at a gas station.  The warning label on this ad, in combination with the picture and product tag line is a marketing stroke of genius.  I took a picture.  There is a glare from the sun but take a look - I'll tell you what my reaction was a little further down in the post. 

To me the advertisement is challenging and bold.  DARE

means one should be brave and brave people do not heed WARNINGS so the fact that "Tobacco is Addictive" adds to the appeal of the product, for those that are adventurous - yes? We just can't get in front of Big Tobacco - 

Sunscreen

I had been tracking down headlines and research articles to bring you news about a study that comes to us from Australia and relates to skin cancer.  Unfortunately, though the research is said to be posted on line in the December 6th issue of the Journal of Clinical Oncology, I cannot locate anything past December 1st and I just have to move on to other activities tonight.

The study has some quality measures. It followed people over time and then verified a specific outcome in the two groups.  The groups were similar in make up but may have practiced two different health behaviors.  The purpose was to determine if daily use of sunscreen on head, neck, arms and hands would decrease the incidence of melanomas.  

The population size was good -1600 people who live in Australia.  The issue I have is that the "control" group was told to use sunscreen however they decided to use it, if at all. 
The researchers then followed up each year with questionnaires. 

Without seeing the actual research study I can't make any inference on causation.  Well, I expect that the conclusion will just be that people who used sunscreen daily had less skin cancer than those who did not.  I think we know that we should wear sunscreen.  The type of study does not allow us to say using sunscreen every day will prevent skin cancer.

My biggest concern is whether or not the control group was educated on preventing skin cancer.  It is like the opposite of what we usually worry about in clinical drug trials.  We worry about the side effects for the treatment group (taking the drug) but here I worry about the group that was considered the control group.  This feels like telling a group to smoke as much as they like while we tell another group not to smoke at all and then wait to see if the ones who do not smoke get cancer.  We will say that there was much less cancer in the non smokers, but we put the others at great risk.

WHAT?

Here is a link to a website I do trust and they give an overview of the study which was conducted by researcher Adele Green.

Is a little cushioning protective?

Here is the information on the study I mentioned yesterday.  It is in the current issue of the New England Journal of Medicine.

The title of the research article is Body-Mass Index and Mortality among 1.46 Million White Adults. The title does not explain the research but indicates to whom the results can be applied.

I did read the article today and the results offer strong associations between a BMI range and all cause mortality.  The study does have some limitations. For instance, it does not start with a group of indivudals that are followed over time and tested periodically over that time, but reviews previous studies. That being said, the research is sound for what it claims and is important for all of us to consider.

The scientists chose 19 prospective studies that collected baseline data on persons and followed them for no less than five years.  Each study had its own criteria for inclusion and its own outcome of interest.  To be included in the new study, there had to be at least 1000 white person deaths during the course of the study and the study had to include information on age, marital status, alcohol consumption, physical activity, education, smoking history and disease status.  The new study researchers had a cut off of BMI as well.  They did not include persons with BMIs under 15 or over 50 and they excluded people who were less than age 19 or more that age 85 at the start of those individual studies.  The particpants that were included in this study were white.  The researchers felt that race differences could impact the outcome and separate studies should be completed to measure BMI and mortality with regard to specific races.

The researchers did look at everyone together and compared their BMI (adjusted and unadjusted) with rates of death in each 5 pt BMI category during the study periods.  They controlled for all of the above mentioned variables so that alcohol consumption or education for example, did not impact the statistics.  They also standardized age so that the increase in mortality of older persons did not confuse the data on BMI risk.

Separately they analyzed ONLY those who were healthy at the start of each study and who had never smoked.  The findings were similar in the all subject and select subject groups but the association was stronger in the second group.  As the people did not smoke and were healthy at the start, the higher hazard ratios suggest that the BMI - the weight - is the reason for the increased death.  (see below)


What are the results?  They are given in hazard ratios (the odds that one group will have the outcome vs a referent group).  For example, the odds that a smoker will have a heart attack vs the odds that a non smoker (referent) will.

In this study, the group that the overweight and obese persons were compared to - or the referent group - were those whose BMI was between 22.5 and 24.9.  They were considered to have expected or average mortality rates.

For each five point rage, hazard ratios were calculated, including the lower BMI groups.

I am starting to sound more technical than I prefer for the blog.  If you want to know more about analyses, confounders, limitations,  etc - please email or comment.

The rates of death for any cause were higher for every group as the weights (which BMI represents) went up so that the group with BMI of 35 to 40 was 1.8 times more likely to die from anything than the referent group (BMI 22.5 - 24.9).  For men, that same group (35-40) was twice as likely to die as the referent.  These are obese persons.  What the authors really wanted to determine (in response to some conflicting data) was if just being a little overweight was also associated with increase in mortality.  They have found this to be true.  Starting with BMI over 25 the HR go above one.

Also noted, there was a HR of 1.4 for BMI 15 to 18.4  and a HR of 1.1 for 18.5 to 19.9.  There were several reasons offered for the higher mortality in low BMIs, such as disease, low weight due to fitness and low weight due to wasting.  They found that if a study lasted more than 5 years, the low BMI HR was no longer strongly associated with increased death.  Thus the authors suggest a weak correlation between very low BMI and all cause mortality but do not rule it out. 

The researchers do state that a BMI between 20.0 to 24.9 is health promoting.  And to answer the question in the post title - NO< being a little overweight is not a good thing.

Some last words:  The BMI is helpful with regard to population numbers, and this research is about populations not individuals.  Previous research on weight and disease tells us that body fat is detrimental and the BMI is a poor substitute for indivual body fat status. For most people however, if the BMI chart shows them as overweight, they do have excess body fat.  The better measure is waist circumference but people don't always calculate it correctly.  The best measurement involves water and we certainly can't go putting thousands of people in those underwater pods.  So the BMI is helpful, not perfect. 

These results also tell us that people with BMIs at this range are more likely to have an outcome (mortality) but that doesn't mean that you (insert name) will die before someone else because of your number.  

I want to include one of the tables from the study because it is very important.  The reference for the study is below.  As the journal allowed the download of this graphic I am taking that as permission to use it with credut.  The study article is not available without a journal subscription but you may have access if you are in school or work for a company that pays for a journal service.




If you can see this chart, there are confidence intervals.  That means that the researchers are sure that all the people in this BMI category have a HR between those two numbers in the parenthesis.  In some cases the low BMIs actually have LOWER death rates than those with the normal range.  With a HR you are looking at anything above or below the number one. 

 If it is below one, there is less death if it is above one there is more death. One is even - no difference. 

Think about all that while you study this chart.  And if you do not know your BMI you can use the link here to calculate it.  You can also see in this chart that the obese persons rates of death stay high regardless of the length of the study.


Reference: Berrington de Gonzalez, A., Hartge, P., Cerhan, J. R., Flint, A. J., Hannan, L., MacInnis, R. J., . . . Thun, M. J. (2010). Body-Mass Index and Mortality among 1.46 Million White Adults. New England Journal of Medicine, 363(23), 2211-2219. doi: doi:10.1056/NEJMoa1000367

Odds and Ends

My favorite posting day - little bits and pieces that have nothing much to do with each other and may or may not be related to news and research.

Hostess:  I am not going to let you forget my new tag line -  "obesity prevention through informed eating".  I am most interested in point of purchase food content information and it's proliferation (grocery, restaurant and school).  Some of the manufacturers of the foods I purchase have been putting information on the front of the label for some time - i.e. Morning Star Farms vegetarian products. 

note calorie info on front of package

Most companies highlight their labels if they are selling 100 calorie packs.  Some cereal boxes have fiber and sugar content on the front.  We do not as of yet have a uniform system.  This week I noticed that Hostess is putting some information on the front of  dessert cake packages that are not 100 calorie packs.  They are 150 calorie cakes and I can see this without picking up the box.  Pretty exciting.

Abilify:   I was surprised to hear a commercial for this medication on my computer.  I must have been watching a TV show on line for free (w/ads).  Abilify is a psychotropic.  It is a medicine that can alter ones mood by effecting neurotransmitters and or the secondary chemicals they trigger.  It was originally approved for use in people with schizophrenia (as an antipsychotic), and then for people having manic episodes who are diagnosed with bipolar disorder, and THEN for treatment of depression that isn't responding to other medicines and most recently for use in children with autism related problems. It is also approved for use in children with the above other conditions.   You can confirm this by visiting the FDA website here.  Abilify is not approved for treatment of agitation in elderly patients with dementia.  Every time the drug receives approval for another indication, the company that makes it can advertise it as such.  But we know which one gets the most air play - depression. I haven't looked this up, but I imagine that more people are diagnosed with depression than schizoprenia and/or are more likely to tell their doctor they are depressed and want this drug.  (schizophrenics are often out of touch with reality and do not seek treatment themselves).  The drug company that makes Abilify stands to make a lot of money from all these approved uses (YES?).  When I listened to the commercial earlier this week, the side effects associated with the medicine clearly freaked me out.  What we don't hear on the TV is results of research studies that often show the same benefits without the risks that exercise can provide in the treatment of depression specifically.

Natural Fries:  Speaking of marketing, what do you suppose is the goal behind Wendy's new commercial for natural cut french fries.  Are we to assume that this french fry would be better for us than one that was an artificially cut french fry?  Either way, it IS fried. 

Soft:  I feel ambiguous about this observation. It was unusual enough to consider mentioning here, though I wondered if I were hyper critical (NO - really, me?).  I mentioned it to a friend and she confirmed that she had noticed the same thing when she attended a dance performance at this venue, so I will say it.  I went to a student/faculty winter dance concert and the dancers seemed soft.  Not heavy and soft, though some were heavier than is common and very few were that too thin waif size, but soft - undefined.  I am used to athletic dancers with toned even sculpted muscles.  Rather odd that they were soft.

BMI in the News:  Most people add books to their must read lists and I add research articles/studies.  My next must read is  the NCI's BMI and All-Cause Mortality Pooling Project.  Very briefly, and without review of validity (i.e. this is not a controlled lab experiment), persons with BMIs that are over 25 are more likely to die (in a given time period) then persons similar to them with BMIs from 18 to 24.  The information is specific to NON SMOKERS only.  Smoking ups the risk of death from all causes at any given time, period. In quick review, this looks like a good study so I am going to punt it for a full blog post next week.  Stay tuned :)

Social Norming and the Environment:  I tend to listen to World Have Your Say or On Point when I am falling asleep.  A recent discussion topic for World... was climate change and social norming.  Social norming is a strategy for health educators/promoters to use when seeking behavior change.  For example, if most people do not smoke and I make it a point to tell people not the percent of tobacco users, but number of people who do not use - I am using social norming to make 'not using tobacco' the thing to do - "Your peers are not smoking.  Smoking is not cool.  Don't Smoke."  Social norming is often effective.  On this recent show, researchers used social norming to increase the percent of hotel guests who reuse their towels.  (you do, don't you?)  If you have been to a hotel in the last year or so, you might have seen a little table tent in the bathroom that encourages you to save water by reusing your towel.  The researchers in this study simply added to that card.  I WAS falling asleep so I didn't catch any numbers, so I am making this one up.  The card might have said, "75% of people reuse their towels".  The scientists compared towel reuse between guests whose room cards did and did not have that extra sentence.  When we think everyone is doing something - well, we want to do it too! 

Lap Band -

With all the news of late regarding the FDA and device makers - i.e. influencing decision making through unethical practices, it is hard not to suspect Allergan and  Bioenterics Coorporation of such tactics. 

An FDA advisor panel has just recommended that the inclusion criteria for Lap-Band surgery be changed to allow more obese persons to qualify.  Currently one has to be morbidly obese as defined by BMI of 40+ or have chronic disease conditions and a BMI as low as 35.  The recommendation is to change those numbers to 35 and 30 respectively.  As much as 30% of the US population  could qualify and the price is well over $10,000 when its all calculated.  How much money would all the players make?  Device seller and maker, surgeon, hospital, anesthesiologist,  etc etc.  Will this be covered by Medicare and Medicaid?

I remain opposed to this procedure and any invasive weight loss measures - drugs, surgery of electroconvulsive therapy.  But not because of the money -  my main reason - straight from the FDA website, is this:

 When should it not be used?  It should not be used for people who are poor candidates for surgery, have certain stomach or intestinal disorders, have an infection, have to take aspirin frequently, or are addicted to alcohol or drugs. It should not be used on patients who are not able or willing to follow the rules for eating and exercise that are recommended by the doctor after surgery.

Radiation Follow Up

In May of this year the President's Cancer Panel Report was reviewed in this blog.  As we left off, there were discussions about calibrating machines, reducing radiation dose to the least needed to be effective, and advice on tracking radiation both personally and through electronic medical records.  The last post that was specific to these issues can be found here.  However, many posts regarding the dangers associated with overuse of medical imaging can be found by putting the word "radiation" in the search engine to the right of this post on the main Your Health Educator blogsite.

Today I am happy to report that the Radiological Society of North America (RSNA) recently met and is working with the American College of Radiology, among others, to address this issue.  Within the last week, a new campaign was launched that encourages the least amount of radiation possible for the desired test image.  Over 700 centers or providers have signed on.  You can visit the Image Wisely website.  Perhaps in the near future, there will be some type of certification process for providers who calibrate their machines and use low dose technology.  In the meantime, it is YOUR job to ask.

The RSNA conference ended today.  Here is a press release from yesterday which discusses the efforts to reduce unnecessary radiation and cancer related to accumulated radiation.  The scientists recommend that all persons keep a record of their imaging.  This is REALLY important for children and young adults.  The effect of radiation on the body will build up over time.  It is the same as skin and lung cancer, the dose and the frequency, both affect the risk of cancer, but the cancer doesn't happen right away - it is 20 or 30 years later. 
Take Heed.  Imaging is necessary and life saving in some situations - but too much is simply too much.

Catfish from China?

I was going to do a little number crunching to give you some points to ponder but I quickly realized two things.  One, you really cannot get numbers about anything in China and Two, if you do, they are probably inaccurate.

Here is what we know - China is the country with the most people.  This source, lists China as the number two oil consumer, (second to USA) and the number two electricity generator and consumer.  

China is the number one producer and user of coal and this is where I was going with my post.  If not the greatest source of mercury and other green house gases,  coal fired power plants are at the top.  China has the most coal fired power plants in the world - we believe.  China is listed as the number one polluter - the greatest producer of carbon dioxide emissions.

I was going to track automobile emissions in China and realized that auto ownership per capita would not include everyone who drove - but when I tried looking for vehicle miles traveled by country - China was never on the list. China doesn't like to share.  In fact, I think that if you look  too hard they charge you with spying.

So, let us never mind about cars. 

China is reported to have the most coal production and use.  In 2006, I wrote a lot about mercury contamination of fish.  (mercury from coal fired power plants)  I looked into the fish that I like to eat, salmon, tilapia, mahi mahi, shrimp etc  -all good.  I noted shark, swordfish and tuna steak as being risky.  Any of this ring a bell?  I may have encouraged you to check out the EPA/FDA research on mercury and fish, here.

To be honest, I do not know where the fish that the EPA samples comes from - our oceans, our fish farms, or our stores.  I can tell you that the assessment for catfish was completed from 1990 to 2004 and the 2004 numbers are much higher than the 1990 - so the number you see as the average is not a recent number.

This is all about what I heard on the radio today - the USA does not get catfish from the USA - it is imported from China.  We get our catfish from the most polluted country in the world - makes you pause... actually, they are the leading seafood importer for the USA - so I'd check  all those fish packages if I were me.  Oh I AM me, so I will check them.

Salt, Sodium, Sense

Last week, results of a study out of Harvard's School of Public Health (co authored by one of my fav's, Walter Willett) were released in the popular press and the Harvard Crimson.  I do not think that the study has been published as I cannot find a journal citation.

I was busy last week, but when I saw the story which essentially states that Americans have consumed the same amount of salt for the last fifty years I did mention it on my FaceBook page.

Clearly if the salt or sodium levels (lab verified) are the same but cases of hypertension and heart disease have increased (alarmingly), the problem is something else.  Obesity for instance - our weights have not stayed the same in the last 50 years.

But to be fair, my initial reaction has to be tempered with my new "doctoral student" mind, yes?  First, the reports on overall salt consumption on the population level do not necessarily equal what individuals consume. 
Secondly, Dr. Willett's study was an analysis of research where urine was actually tested and that holds some sway.  A third consideration is better detection of hypertension, changing definitions of hypertension (high blood pressure) and different detection and measures of heart disease.  YES?  Meaning the number of high blood pressure cases did not really increase just the detection of them.  (I don't think that explains everything)

At the end of the day however, my take is still that obesity is driving chronic disease not salt.