Sunday, January 30, 2011

Odds and Ends

This week's few odds and ends are more reflections on headlines then mini reports.  You know that my passion for this blog site is to read beyond headlines, but I am not always able to do so.

Breast Cancer:  Conflicting reports?  I wonder about the news (which may be more or less valid based on the science behind it) that says having hot flashes is protective (a good thing) but taking HRT early in life is a risk.  Wouldn't the hot flashes be a reason for a woman to seek out HRT?  Are there comparisons on hot flashes and the timing and if they trigger HRT?  Hopefully, clinicians are steering women away from hormone replacement therapy all together, but that would be an interesting correlation to study.

McDonald's:  I read that the company was doing fairly well with profit and revenue and was benefiting from its efforts to change the image of many stores.  The upgrades include coffee drinks and smoothies, change in decor, the addition of wifi and most importantly, oatmeal, fruit and salad.  I would be interested in learning the demographics of the neighborhoods within 5 miles of these updated Micky D's.

Fitting it in:  I reviewed an employee survey over the weekend.  The respondents were asked about their interests for programming in regards to wellness.  A majority of persons wanted to know ways to incorporate more physical activity into their days.  Here is a thought, arrive at your destination a bit early and take a brisk walk around the parking lot.  My friend and I met for a 4:10 movie yesterday, at 3:30, and we walked both before and after the show.  It was great for me because I had driven 40 minutes to meet her and would be driving 40 minutes home - recalling that 60 minutes of continuous sedentary activity is the suggested limit, it was a disease preventing endeavor.

The Military:  A few months ago, maybe when I was in Florida for the Holiday - I heard a story on NPR regarding the lack of men and women who were "fit for duty" and the intervention that the military had created for basic training.  It included physical activity of course, but the cafeteria also got an upgrade.  The recruits interviewed said that they liked the food, they lost weight and they felt better.  It was also said that after they left basic training, the foods that they were exposed to were high in fat and calories and the old habits of overconsumption returned.  This week, the First Lady is said to be praising the military efforts and hopes that similar attitudes will permeate civil society.  I am sure she means the basic training environment.  I hope that low calorie, nutrient rich, eating makes a splash as well.  I also hope that Mr. Obama remains in office, simply because his wife is a formidable champion in the fight to curtail childhood obesity.

Saturday, January 29, 2011

Directions in Childhood Obesity Prevention

In regard to childhood obesity prevention programs that I have spent the better of two weeks reviewing, I have chosen the CATCH one to promote to my community partners and community. To better help me wrap my mind around what I want to say, I will use you, my loyal blog readers, for a practice articulation. (I have found graduate school to be similar to emasculation – my ability to form cohesive thoughts and sentences is considerably weakened. As Sarah Palin might say WTF? Which, incidentally,  is the only time you will see THAT name in my blog)

Back to childhood obesity…

Though my review is far from complete or exhaustive, a concept or theme is developing. I see that the Coordinated Approach To Child Health, a revision of the Child and Adolescent Trial for Cardiovascular Health, is the program that is the most comprehensive, most studied and seemingly the most socio-ecological (it involves all areas of exposure – individual, school, home and community). CATCH has been involved in randomized controlled trials and evaluated for sustainability. After the initial transnational project, smaller studies on more diverse populations were completed. Though low-income schools with minority populations have been studied, the sole program that involved an adequate number of black children measured the changes in the school environment only. In other words, they did not look at knowledge, skill or behavior change on the individual level. In the larger trial, one district did have a 15% representation of black children, but during analyses it was noted that more black children were lost to follow up (left the schools) than the whites. According to our public health databases, black children have much higher rates of OW/OB than white children do, though all races have higher rates than expected/acceptable. It is this researcher’s assumption that individual subcultures are not the causal factor in our obesity epidemic. Instead, the overall culture or sociopolitical climate is obesogenic. Poverty, not race, promotes obesity as much as overconsumption. If we can deliver this comprehensive program in a majority black school and or majority low income school and allow these children the knowledge, skills and resources to eat well and exercise more– the positive outcomes will add to the research questions we ask and the policy decisions we make. This is not to say we do not to continue work with ALL children, but to make sure we do not leave out the group with the greatest risk. The studies already completed may have been nationally representative – meaning that they may have had the right proportion of race and gender to start the study, but they did not finish in parity. Even so, if most of our evidence for childhood obesity was on girls and not boys, wouldn’t that be a problem?

And that is where I am headed with my research these days – though I also have a proposal in for a worksite wellness program that would be Internet based. I will let you know if that one gets funded :)

Monday, January 24, 2011

Informed Drinking

This may be my only post this week (ACK!) but I cannot let it get away from me, as I am apparently about a year behind already.

There is a call for more nutrient labeling on alcohol.  This initiative includes a debate of course and I agree with Marion Nestle (author, and nutrition professor) who has said that alcohol has calories and calories add up.  But she also said that there is no real need to list protein, fat or carbs because (other than sugars, or sugar alcohols) those things are not usually in alcohol.

The Beer Institute and liquor power house Diago also support the efforts.  See number three here on this Beer Institute regulatory response letter.   The comments by Dr. Nestle and Diago VP can be found in numerous headlines from yesterday.  The one that first caught my attention  came from the USA Today.  You can see it here.

What is important and telling is who is against the labeling idea.  The mixed drink and wine companies/industry.  The beverages they sell would be the ones that have the most calories per ounce.  In order to quantify the calories the manufacturer would have to list what the serving size REALLY is. 

Ok. That beer is getting warm, gotta go :)

Sunday, January 23, 2011

Odds and Ends

Vitaminwater - Never a fan myself - high in calories which are empty ones, no matter what essence they add to it. And face it, it is a sugar sweetened beverage.  SSB is the abreviation to note these days.  Public Health folks, such as myself,  are trying to limit (perhaps by keeping out of schools or raising taxes) the consumption of sodas AND sugar sweetened beverages.  Vitaminwater is actually a brand of drinks that are sold by Coca Cola.  However, I can't find it in their list of products on their website which is weird.  Anyways, the UK has an organization that seems a little like a combination of the FDA and FTC in the USA.  This organization, the Advertising Standards Authority told CocaCola that they could not use the advertisement that claims Vitaminwater is good for you because it contains too much sugar.  Gotta love it :)

Skinny Cocktails - It looks like the Cheesecake Factory wants to challenge the DeeDee Sour.  They are offering 150 calorie cocktails.  Okay - it does fit with my Informed Eating agenda, so they get credit for that.  A person, such as yourself,  can go to the restaurant and order a Mich Ultra at 95 calories, a glass of wine at (200-300 by their glass size) or a skinny new margarita or mojito for 150 calories.  If I were not going to get the beer, I expect the cocktail would have less calories than the wine because the wine will be served at more than the standard 4 ounce size.  My DeeDee Sour still wins at 100 calories.  (Fresca with Whiskey [1.5 oz] and a twist of lemon)

Starbucks and Wendy's - They get the "WHAT?" award for the week as they are both making something BIGGER.  To think that the industry is going to modify or regulate itself, skinny mojitas aside is naive.  Starbucks is adding a 31 ounce drink to the line up and Wendy's is making its burgers bigger.

Pizza Please - I reviewed a program that was used at a school to increase students nutrition knowledge and to impact dietary behavior.  A goal was for the children to eat more fruits and vegetables and less fatty foods.  The way the researchers evaluated the program was by having the children play a game in which answering a question correctly got them toppings to add to a pizza.  The winner was the one with the most toppings on their pizza.  HUH?  Those poor kids - how confusing is that,

Marketing Tricks - To be fair, I am critical of all advertisements for diets and diet products as they do not work, can cause harm, provide false hope, delay real change and waste peoples money.  I did not catch the name of the product being promoted on the radio recently, but the spokesperson was someone who had been on the equally disconcerting television show The Biggest Loser.  Guess what?  She gained back a lot of the weight she lost on the show and she isn't able to follow the regimen that she followed during taping. (really? wasn't it a realistic program?)  So she is taking some supplement.  In the "after text" the announcer says, people who lose more than ten pounds in ten days will need to contact their trainer (sales rep) to have their dose adjusted.  As IF?!?

Measurements - No, not that kind.  Researchers often measure the amount of fat one ingests, or the pounds we carry, or points on a knowledge scale, or amounts of types of foods we eat.  In an article I read recently, a menu assessment listed items as ones to eitherpromote (like vegetables) or limit (french fries, soda).  I was not pleased to see that fruit juice was in the same category as fruit and that dairy products were being pushed without a low fat and full fat distinction.

Saturday, January 22, 2011

B 12

I am not sure what triggered my current B12 interest and inquiry. Almost a year ago a coworker had asked me about B12 as she started to get injections and consume Nutritional Yeast. I stuck with my usual supplement response – that under most circumstances they are not necessary. The very best way to get nutrients and to have then absorbed- is to eat them in foods. (my friend is young and impressionable)

Said friend had brought this up to me because she knew I was a vegetarian and that B12 deficiency sometimes occurred in persons who did not eat meat. I told her that my dairy products, seafood, cereal and meat substitutes had me covered.

I must have heard or seen an ad in the last week that suggested feeling fatigued and having tingling hands or feet was a sign of B12 deficiency. I have been tired and my hands and feet are often cold. Still, I have not been sleeping so well (school stress perhaps :)) which may be why I am TIRED and being cold is not the same as tingling. Whatever it was, it caught my attention and forget that I had looked into it (food wise) when my friend asked.

It was enough to have me consider buying a supplement which I would not do blindly which led me to get out my nutrition text book and take it from there. In the first section I read, it was noted that a deficiency would be more likely in a lean person because B12 is stored in fat – huh.

Though it is true that some persons that do not eat meat will have a deficiency the condition is actually quite rare. The section on supplementation for athletes also downplayed deficiency and reiterated the benefit of getting nutrients from foods – naturally or fortified. For my diet, I see that cereal is fortified with B12 and tuna fish is a good source as is Morning Star Crumbles. The article I read mentioned dairy products as a source, but the nutrient database of the USDA did not have them as high sources. I searched on line and learned that some milks are fortified and others are not. The brand of skim milk in my fridge does not have B12.

I considered a supplement and read about them in my text book and on Wikipedia. I felt that Wikipedia was a better source than a webpage trying to sell me a product! It appears that one does not have to get injections for the B12 to absorb and that oral administration – pills – is just as potent as the shot. There are skin patches and under the tongue varieties as well, but research does not support an increase in efficacy or absorption.

I was still undecided when I was shopping today. I did look more closely at labels. In the milk aisle I saw that a brand of milk that costs a dollar more than the one I usually buy DOES have a good amount of B12 and since I have a cup of milk a day – I bought it. Seems cheaper that a bottle of pills because I already use it.

So there you have it – my thoughts on B12. Next time I have blood work – I will check to be sure.

Friday, January 21, 2011

Exercise Recommendation

I became a subscriber and relative fan of Netflix more out of frustration and desperation than choice.  Those of you who were reading the blog in August and September of 2010 might remember the problems I had with TWC television

Letting go of broadcast services was scary but I tried the free 3 month trial with Netflix and then the approx 10 a month service and now I have the just under 8 dollar a month plan which includes unlimited video/shows that they have on line (no DVDs by mail).

I do not watch a lot of TV, and many shows are available free on the Internet without a subscription service.  You do have to wait sometimes and apparently sometimes is forever when it is a show like Criminal Minds.

This really is about exercise though.  It seems that several events led to this place and that was the first - I lost my cable TV.

Then I lost my gym membership because I moved and the school rec center which I absolutely use, caters its classes to the young - step aerobics at 8PM !!

Then I had a little injury and needed to cross train - then it snowed, and it gets cold as hell from time to time...

Hence I discovered exercise videos on Netflix.  All types.  I have been doing mostly the core work - pilates and yoga.

I may be sitting at my desk doing research and then just click on the Netflix and do a workout.  A couple of them are 10 minute routines that equal 50 or so minutes.  You do not have to do all 5 sections but after you do one, it is easy to do another - You can do ANYTHING for ten minutes and poof - there goes an hour.

Have an urge to eat when you really don't need to be eating, do a ten or twenty minute video!  Not comfortable going to a gym yet?  Try out a video.  Want to learn how to use free weights, kickbox, yoga?  Just hit play.

Can't afford 40 dollars a month for the fitness center - how about 8 dollars and you can work out in pajamas? 

The programs I tend to like the most are led by either Lara Hudson or Ellen Barrett.  Some of the options are terrible - if you can't find a good one, drop me an email and I will make a recommendation.

Thursday, January 20, 2011

Price is EVERYthing

Friends - You may have noticed - I am swamped :)
But I heard and saw this fantastic news that has everything to do with my passion for obesity prevention and making the healthy choice the possible choice -
Read On and Thank You Wal-mart - may you be the leader with many to follow

Tuesday, January 18, 2011

Take The Kleenex

This afternoon I was in the campus library and stopped in the restroom.  On the sink counter were two packages from an apartment community - goodie bags for marketing purposes.  They were little ziplock bags with the apartments name and number on them.  Inside one baggie were two tootsie pops (candy) and a package of pocket kleenex.  In the other baggie there was just kleenex.  Someone had taken the candy and left the tissue behind.  

 Of course, I would have left the candy not the kleenex.

The point is - more of us should just take the kleenex!   (which I did)

Monday, January 17, 2011

Move More - Sit Less - It MATTERS

Healy, G. N., Matthews, C. E., Dunstan, D. W., Winkler, E. A. H., & Owen, N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. European Heart Journal. January 2011

The study referenced above was only recently completed and published on line this month.  It is very important and adds to a growing body of evidence that is linking sedentary (inactive/sitting) behavior, in and of itself, with risk for disease.  This is emerging and important work.  I want you to wrap your head around that a bit.  This is like when scientists first began to report that second hand smoke could cause heart disease and lung cancer.  It took many years before policies to protect people from SHS were put into place.  Most did not think the science was convincing but today you would be hard pressed to find any US building (or UK, or France, Ireland,  etc) that allows indoor smoking. 

The association between sitting and heart disease IS new.  This is not about the protective result of exercise, but the damaging effect of sitting for over an hour at a time and the even worse outcomes from having those hours of sitting add up in a day. I am reading the research studies and they are well done and valid.  The most recent one was even more convincing as the persons involved wore accelerometers - devices that tracked their movements and logged the amount of time that they were sedentary(not moving). The accelerometer tracked counts per minute and was only worn during waking hours

 The results of the study are important on several levels.

The researchers wanted to know if total time sitting/sedentary impacted certain biological measures of disease and if there was a dose response effect.

The markers that were assessed (clinically - with lab tests) were blood pressure, blood fat, HDL, several blood sugar and insulin measures, C reactive protein levels, and waist circumference.

They wanted to know if there would be a difference on these markers (blood sugar, blood fats, etc) if the total sedentary time was broken up with any amount of break time (1 min to 15 minutes, for example)

Lastly, they compared the above across certain demographic differences like sex, age and ethnicity.

The findings were that YES the people who sat the most time compared to the people who sat the least, had worse readings across those markers (in degrees or dose response) with significant and pronounced differences on waist circumference (white only), blood fat levels and blood sugar levels.  This has been seen in previous research, but new for this study was that CRP was also adversely effected by sitting.

  The scientists found that the differences between sitting without taking a break and sitting for the same total time with breaks were profound enough to recommend that a National Health Message on Sedentary Activity should include the benefits of taking breaks every hour or so.  In fact, they suggest that a substantial decrease in heart disease in this country could occur if people did NOT sit at their desk all day!

Take that to the boss tomorrow - the study is available here :)

Sunday, January 16, 2011

Odds and Ends

Eric Schneiderman - Have you heard this name?  He is the new Attorney General of NY and he is concerned about the environment and has a preference for "healthy" foods. I expect that he will be a friend to this blog.  The Wall St Journal noted that he has already filed suit against a state for sending toxic emissions into NY and is known for challenging producers of products who claim to be "green" without actually following eco-friendly processes.

Tuna fish - Not to be confused with tuna in sushi or tuna steak, I refer to light canned tuna in water - It is a low calorie, protein and omega 3 power house.  Throw some drained tuna on a salad, add a little Parmesan cheese and a light dressing for a great, filling, low calorie meal that doesn't leave you nutrient deprived. 

Target/Walmart - Yesterday, I was at Target buying a curtain and whenever I am at a store that sells food, I check the prizes on some of my favorite packaged items (yikes, yes - I do buy some processed foods) to see if they are on sale.  Walking down the isles, I came upon two men - manager types.  One of them asked if he could help me find something and I replied, "No thanks, I am just checking prices."  He then said, "Oh, are you from Walmart?"  Ha Ha - he thought I was a spy :)  I laughed and said no, and added, "But I shop there!"  And off I went, to Walmart - :)

Pepsi-Naked Juice, Sports Drinks and now a Fruit Puree - The company may be targeting the health conscious but are these really healthy products?  Remember, containing fruit or nutrients - even electrolytes does not in and of itself make a product good for you.  An orange has electrolytes and vitamins, along with fiber and is low in calories.  These other items are much more likely to contain sugar and as beverages, are less likely to feel like foods - which calorically they would be .  Instead they would not trigger caloric moderation.  So in plain speak - forget about them :)

Saturday, January 15, 2011

Why Labels Are Needed

In my continuing quest to promote and instigate Informed Eating, I share a grocery story with you.

This is not my story alone.  A friend shared that she observed two women as they pondered fruit choices.  They were in the canned fruit isle and one said to the other that she would be better to buy frozen fruit over canned as it would not be in syrup, would have less calories and of course, be better for her. 

Did the friend give good advice?  It depends?  Sometimes canned fruit comes only in its natural juice and sometimes frozen fruit has added sugar.  Recall a few months ago when I was searching for frozen strawberries (because the fresh were 4- 5 dollars a quart and also prone to molding) - I kept wondering why the frozen berries had more calories per cup than the fresh ones - it took me a while to find a bag that did NOT have a syrup.  Of course, I wrote about it.

I would be very interested to find if, in general, frozen fruit was less caloric (more unadulterated) than canned fruit. 

That sounds like a fun bit of observational research which I do not have time to do right now, but it could happen.  In the meantime, the only way to know which of the options is lower in calories, fat and sugar (possibly sodium) is to read the labels.

I can say with confidence that dried fruit is always the more caloric because it like juice, is concentrated.

Friday, January 14, 2011

Getting Our Attention

This past week I completed an online training program (12 modules) on Environmental Public Health Tracking. It was very interesting and I am now familiar with several databases and systems that track things from air quality to disease outbreaks, industry emissions and controls to emergency room visits for carbon monoxide poisoning.  It would be an indulgence for me to toy with those things just now but it is good to see that the systems are in place and the data is available.

Also in the training was a segment on risk and health communications.  For example, one might want to make a community aware of a health risk that has arisen after a toxic chemical leached into the water supply. Another type of communication could be to encourage persons to switch from high fat foods because of the obesity or heart disease issue.  There are many more examples, but the notes I highlighted referred to the comments in the training manual about factors that sway or mobilize an audience.  Most of this I have studied as a health educator - but you have not studied it - so I share these points verbatim from the course.  And in reading them you may see why the job of a public health advocate can be so challenging!

People are more afraid of risks that others impose on them than of risks they choose to take. People might be more afraid of suffering respiratory damage from a hazardous substance in their office or school than of suffering respiratory damage from smoking, even if the risk from smoking is much higher.

People generally are more afraid of risks that could cause a painful or grotesque death as opposed to risks that cause death in more common ways. For example, people are more afraid of dying in a plane crash or of radiation poisoning than they are of heart disease.

Catastrophic vs. Chronic
People are more afraid of risks that could kill many people all at once than they are of risks that could kill many people over time. Terrorist attacks or plane crashes inspire more fear than do heart disease, stroke, or car accidents, even though the latter might be much more likely to actually happen.

COURSE: Environmental Public Health Tracking 101 – Part 3 ACTIVITY NUMBER: WB 1811

PRESENTED BY: Centers for Disease Control and Prevention and the National Environmental Health Association
FUNDED BY: Centers for Disease Control and Prevention

  The course I took can be found at this website.

Thursday, January 13, 2011

ECT - Shock Therapy - Proof of Safety?

Electroconvulsive Therapy or ECT or Shock Treatment has been used to treat mental illness at least since the 1940s though the concept of shocking the brain or body to treat maladies is much much older.  Instead of going the way of bleeding and leeching; however, ECT has been revised.  It is now conducted under more human conditions.

Longtime readers would recall that when I started my weekly newsletters, I was a psychiatric social worker and in fact, worked with people who received ECT.  I did not blog about it of course.  I supported the treatment decisions of patients and their families and I respected the psychiatrists and psychologists with whom I worked.  At the same time - after witnessing the treatment itself (in an hospital room, with anesthesia, muscle relaxants and the monitoring of vitals - electrodes are attached to the head - shock can be unilateral or bilateral and lasts a minute at most) and seeing the affects on mood (it usually worked) and memory (it sometimes impaired it) I went home and made sure that my living will excluded the use of ECT.  I think I may have written that I had to be on the verge of death with no chance of recovery before it could be considered.

ECT is primarily meant for the treatment of severe, resistant and recurring depression.  Some persons who suffer a nihilistic type of depression will think that they are already dead or will die.  They lose touch with reality, are unable to function, and stop eating.  I have written letters to support emergency ECT in such cases noting that without the treatment the patient might require feeding tubes and such to sustain life.

But I do not like ECT.  And I am not comfortable with studies that compare ECT with antidepressants and with nothing and then say it is better.  I was not an emerging scientist when I worked at the hospital - but I am now and the research is flawed.  Where is the study that compares it with exercise, for example? 

Another concern is that ECT as a medical device/treatment was approved under the 1976 FDA legislation that allowed current drugs to stay on the market temporarily.  The new FDA would henceforth require standardized, rigorous clinically controlled trials before deciding on whether to grant approval to any drug or device maker to unleash its product on the people of the USA.  The PMA status or premarket approval - was meant to be a temporary stay - the companies were supposed to submit the safety and efficacy data for after market approval - no one did.

The gig is up.  The FDA has requested this information and a hearing is to be held this month.  Here are links to some FDA documents pertaining to the issue.  This one lists several devices that are being asked to provide information. If you scroll down, you will see what that information must contain.

The agenda for the ECT meeting is as follows:
On January 27 and 28, 2011, the committee will discuss and make recommendations regarding the possible reclassification of devices indicated for use in electroconvulsive therapy.

And this is the link to PMA policy.

If you or a loved one has had ECT and found it to be helpful then it WAS helpful.  If you are concerned about the treatment for yourself or another, check out the announcement again.  There are means by which the public can comment and of course, follow up to see what information was provided to the FDA on the safety and efficacy and review the subsequent panel recommendations.

Wednesday, January 12, 2011

A USA Size Gut to Follow

It is not only tobacco companies that target Asia for increased market share - profit - globalization - but the fast food bellwethers as well.  This week McDonald's is promoting its introduction of four new burgers specifically for Japan.  These burgers are named after states or cities in the USA and contain from 500+ to over 700 calories each.  This is disturbing to me on several levels, not the least of which is the tendency for obesogenic environments to be located near  McDonald's restaurants. 

But even more disheartening because of something a good friend told me.  She recently spent a year living in Japan and during that stay she called to tell me that the regular combo meals at fast food restaurants there were the size of American Happy Meals or kids meals.  She notes that many Americans would order two or three meals for themselves. Well - that is no longer necessary.

Here is the website for McDonald's Japan - see those smiling Japanese faces?  They should be warned. 

Currently Japan has a longer life expectancy than the USA.  They also have much lower rates of heart disease death. In Japan 14% of all death is from heart disease - in the US it is 21%. 

However, here is the REAL difference.  The most recent statistics for both countries (World Health Organization) have the percent of Japanese men who are obese at just below 3 and the percent of  Japanese women who are obest at just over 3.  Of course, the USA rate is well over 30% - add overweight and it is 66%.  But that is okay, if Japan embraces the Idaho 2  with hashbrowns and bacon on the burger or the Texas 2 with chili, bacon AND extra bread they just might catch up. 

Tuesday, January 11, 2011

When in Scotland

When in Scotland, we might follow the advice we hear on their radio stations.  I have never been to Scotland.  My father's family tree does include Scotland,  and my favorite batch of books centers on a Scotsman named James Fraser.  Which may explain why I like to listen to their radio shows.

I enjoy shows from the BBC radio Scotland from time to time and did so as I was falling asleep last night.  The news program staff interviewed some persons on the streets about plans for dieting in the new year.  They also had  a nutrition professor from the University of Glasgow as their in studio guest. 

I stored (in my brain for safe keeping) two specific bits of information to share with you today.  They are truths we already know, but it doesn't hurt to repeat them and to show that they are universal concepts.

The professor noted that ALL diets work.  They work because they cut calories and they do so in any number of ways, some more bizarre than others.  The problem is what happens when the diet ends.  Losing weight is possible with a diet, maintaining a healthy weight takes more of a lifestyle approach.

A lady who spoke to the news team about her weight loss goals said that she thought it would be good to eat warm thick soups.  The professor concurred and suggested that people start the day with porridge which is filling but low in calories.  He noted how he recently had a bowl of porridge for breakfast and went skiing until the mid afternoon.

I don't have porridge, but I have oat bran and it IS filling. It has the lower of the calories of my four or five normal breakfasts but is the most satiating and takes the longest to eat.  Here is a You Tube video I made some time ago - for the oatbran breakfast.   Remember, oat bran and porridge would be foods that are whole grains which keep our blood sugar levels nice and even for many hours.   They are complex carbs.

Monday, January 10, 2011


According to Merriam-Webster - to exacerbate is to make more violent, bitter or severe.

Something I saw as I was logging off last night and something I heard this morning led me to this day's post.

The first was a headline regarding a study that found (and I don't know the nature of the study, but let us just say it was a well designed one and the results are valid) persons who are obese and have fibromyalgia have worse symptoms than those who have this ?disorder/disease who are not obese.  The obese fibromyalgia sufferers have more weakness, more pain, and worse sleep. 

When I saw the headline I thought "Was that really something that needed to be studied? We already know that obesity has adverse affects on the body."   Obesity is like smoking.  They are both like lighter fluid on a lit grill. Anything that might be wrong with a person is going to be worse if they are obese or if they smoke.

Today as I listened to a newstory regarding the prognosis for  US Congresswoman Giffords (shot in the head this weekend) the point was validated.

The surgeon being interviewed noted that Ms. Giffords had several things working for her at this time.  She is not obese, does not smoke, is young (40ish) and is in good general health.

You see when you take away the health promotion/health educator programs, big brother, insurance company qualifiers, all the people trying to tell you what to do and others telling you it is your right to smoke and that fat is beautiful - you are left with the truth.

If you are diagnosed with an illness or suffer a severe injury- being a nonsmoker of normal weight who exercises and does not have chronic disease - will significantly increase your odds of survival.  If ill, your symptoms may be less and your condition "cured", if injured, your recovery is likely to go smoother and happen quicker. 

That surgeon talking today - he didn't have an agenda - he was just giving a prediction based on what he knows about the human body.  He spoke truth.

Sunday, January 9, 2011

Odds and Ends

McDonalds - two things here.  The first is related to the use of branding and marketing by fast food companies, especially McDonalds.  With regard to childhood obesity, there is grave concern about the outcomes when we market cheap, high energy dense nutrient poor foods to children.  If children were not the target of restaurants like McDonald's then movie characters wouldn't be on their glassware and toys wouldn't come in the Happy Meal.  At least one state is proposing legislation that would prohibit this toy association if certain nutrient criteria are not met.  I think that it is a grand idea.  The second item regards this new concept of tailored or focused ads.   As companies learn all about us from our on line activities, promotions are supposed to reflect our true desires, needs and habits.  Probably this strategy needs some tweaking as I received a whole booklet of McDonald's coupons in the mail this week.  None of the offers included salads!

P.T and the Back - I was talking with a physical therapist this week about back care.  From reading the blog, you might be aware that the guidelines for treating chronic, even acute, back pain have changed in the last decade.  It is now considered unwise to treat back pain with bed rest and pain pills.  This particular  physical therapist (who has a doctorate) said it another way.  "The best thing you can do for a hurt back is to keep doing everything you did before you hurt your back."  Amen.

Weight Watchers - Though I find the WW program to be the best lifestyle approach to maintaining a health promoting weight, I do not endorse the point system or the WW branded foods, per se.  The foods in the grocery store are processed foods, but if one was going to buy calorie controlled meals, WW would be just as good as an another.  It does exclude a good portion of persons who could benefit from the low point foods, as they cannot afford them.  I say all this and then admit that I will buy a WW branded food if the nutrient content appeals to me.  I bought one such product this week.  I like to use low calorie spreadable cheeses on Wasa crackers and usually buy the light Laughing Cow wedges.  This week at Wal-Mart the Laughing Cow was 50 cents more than the WW brand and the WW wedges have a few less calories.  I did not pay attention to the cost per unit though  and realized later that the WW brand had 6 wedges and the Laughing Cow had eight!

Trusted Sites - I do not have time to vet the many - hundreds, thousands, of websites that offer nutrition advice and include calorie need calculators.  Because some of you are feeling a need to adjust your intake, let me share two sites that as of today I do trust.  These are  from the US government's MyPyramid and  The Cooper Institutes's Stand Up and Eat program. 

PCBs - This abbreviation is for the chemicals Polychlorinated biphenyls which were used in manufacturing until being banned in or around 1970.  The are toxic.  Of course, products that contain them are still in use or in landfills.  PCBs are still contaminating our soil and water.  This past week a warning about eating large mouth bass and catfish from some North Carolina rivers/lakes was announced.  In fact, we were told to not eat these fish at all due to very high levels of PCBs.  I bring this up to make a political point.  There is some discussion about whether or not the EPA should have such "strict" standards on emissions and chemical agents and to that I say YES - they should - these contaminations affect health, tourism, jobs, animal and plant life.  It is time to give a damn.

Arthritis -  I saw an ad while visiting one of my (web) home pages.  It was from the Arthritis Foundation and the Ad Council.  It said "Moving is the Best Medicine."  Very cool.  In the sub text it advised that exercise and weight loss would be helpful in managing arthritis.

Lung Cancer - Here is exactly what the commercial or PSA said - you can make the obvious conclusion.  "Among non-smokers radon gas is the leading cause of lung cancer."

Pumpkin Spice - OMG - Have you seen the video or had any of  my pumpkin cream cheese?  I modified a recipe that my sister had - fat free cream cheese, pumpkin, nutmeg, cinnamon and splenda.  I add a little water when I whip it so it is fluffier.  Well, it may be an acquired taste but I really like it especially on a certain Jacobsen's Cinnamon Toast.  Anyways,  I just noticed a Pumpkin Spice Cream Cheese at the grocery store.  I don't know - better start copy right patent proofing my recipes :)

Saturday, January 8, 2011


I am torn between two or three things for today.  These are fluoride, backs and shapers.  I suppose that the other two can be added to the Odds and Ends list for tomorrow.

I will briefly express my pet peeve then - Shapers.  I guess it is that time of year.  In the magazines, talk shows, websites and dailies - this January 2011 - "how can I look slimmer in my clothes", may be more popular a statement then "how do I lose weight." 

Those persons who can look in a full length mirror day after day and never express dissatisfaction are few. Trust me - I have issues with my body too.  I certainly want to dress in a way that will bring out whatever assets I have and hide the rest.  For me that means tighter tops and loser, wide legged pants.  Or as my Mom suggests, perhaps I could get padding for my butt :)  [bring back the bustle?]

However, the fashionista's are addressing the "do I look fat in this dress question." There is a  problem with hiding belly fat and it is two fold.  The compression involved cannot be good for you and having excess body fat is a precursor to many chronic diseases - debilitating and often fatal diseases.  You may squeeze a stomach into a girdle like garment, but that doesn't do a thing for blood sugar, clogged arteries or overburdened joints.

Being super slim is not healthy - but that doesn't erase the risk to health in being overweight.  Denying weight by dressing to hide it, if that is what is going on, is not the wisest response to either.

Friday, January 7, 2011

All Seriousness Aside

My brother-n-law (a regular reader) passed along an email that pokes fun at some of the very things I have rang bells and sounded alarms on -to get your attention and save your lives - but at the end of the day - this email is damn funny - ENJOY :)

As we progress through the year 2010, I want to thank all of you for your educational e-mails over the past year. I am totally screwed up now and have little chance of recovery.

I no longer open a bathroom door without using a paper towel, or have the waitress put lemon slices in my ice water without worrying about the bacteria on the lemon peel.

I can't sit down on the hotel bedspread because I can only imagine what has happened on it since it was last washed.

I have trouble shaking hands with someone who has been driving because the number one pastime while driving alone is picking one's nose.

Eating a little snack sends me on a guilt trip because I can only imagine how many gallons of trans fats I have consumed over the years. (a blog post for sure)

I can't touch any woman's purse for fear she has placed it on the floor of a public restroom.

I MUST SEND MY SPECIAL THANKS to whoever sent me the one about rat poop in the glue on envelopes because I now have to use a wet sponge with every envelope that needs sealing. ALSO, now I have to scrub the top of every can I open for the same reason.(oh yeah the can one, I say that on YouTube)

I no longer have any savings because I gave it to a sick girl (Penny Brown) who is about to die for the 1,387,258th time.

I no longer have any money, but that will change once I receive the $15,000 that Bill Gates/Microsoft and AOL are sending me for participating in their special e-mail program.

I no longer worry about my soul because I have 363,214 angels looking out for me, and St. Theresa's Novena will grant my every wish .

I can't have a drink in a bar because I'll wake up in a bathtub full of ice with my kidneys gone.

I can't use cancer-causing deodorants even though I smell like a water buffalo on a hot day. (hee hee)

THANKS TO YOU I have learned that my prayers only get answered if I forward an e-mail to seven of my friends and make a wish within five minutes.

BECAUSE OF YOUR CONCERN, I no longer drink Coca Cola because it can remove toilet stains.

I no longer buy gas without taking someone along to watch the car so a serial killer doesn't crawl in my back seat when I'm filling up.

I no longer use Cling Wrap in the microwave because it causes seven different types of cancer.  (HEY that is definately a blog warning!)

AND THANKS FOR LETTING ME KNOW I can't boil a cup of water in the microwave anymore because it will blow up in my face. Disfiguring me for life.

I no longer go to shopping malls because someone will drug me with a perfume sample and rob me.

AND THANKS TO YOUR GREAT ADVICE I can't ever pick up $2.00 coin dropped in the parking lot because it probably was placed there by a sex molester waiting to grab me as I bend over.

AND LASTLY, I keep my toothbrush in the living room because I was told by e-mail that water splashes over 6 ft out of the toilet.

If you don't send this e-mail to at least 144,000 people in the next 70 minutes, a large dove with diarrhea will land on your head at 5:00 p.m. tomorrow afternoon, and the fleas from 120 camels will infest your back, causing you to grow a hairy hump. I know this will occur because it actually happened to a friend of my next door neighbor's ex-mother-in-law's second husband's cousin's best friend's beautician .


Happy 2011

Thursday, January 6, 2011

30 dollars gets you 2 Grand

My classes start in less than a week and could prove quite challenging – Hence, today I take a break from heady research and talk about the special at Red Lobster Restaurant.

Two people can dine for $29.99 which includes a choice of one of eight entrees, either a Cesar or garden salad, as many cheddar cheese biscuits as they’d like ( and MOM tells me they like ‘em plenty), and a choice of an appetizer or dessert – but just one to split between the two.
WHY am I talking about this? It relates to my passions of obesity prevention and informed eating and thus it caught my attention. The promotion is advertised in the restaurant (point of purchase), on the Internet and on the TV. A full meal for fifteen dollars at a restaurant is not necessarily cheap but certainly inexpensive.

 Two of the issues that come up in the obesity discourse are marketing (advertising) and cheap foods. To expand, the cheap food is often high in calories, low in nutrients, and marketed heavily and disproportionately to children. This “special” meets most of the criteria. I wanted to break down the meals to see just how many calories were packed into that 30 dollars.

I have two sample meals, but first let me give you some numbers to ponder.

The guests can choose one entrée each from a list of eight. The entrees range from 210 calories (tilapia) to 1260 calories (a pasta and meat dish). The fat grams are from 3 to 60. Can you imagine 60 grams of fat in one dish?! The average then is 625 calories and 29 grams of fat. There are only two options under 300 calories.

The entrees come with broccoli and a side starch – unless it is a pasta dish. The broccoli has 45 calories, fries 330, plain potato 220, mashed 210 and rice 180.
Each person gets a salad. A garden salad has 90 calories and a Cesar has 270 (cheese). The lowest dressing is 60 cals and the highest is 280 with an average of 170 for the salad dressing.

A biscuit has 150 calories. I did not look into butter or any sauces. I did not look at beverages. All that would be EXTRA calories.

There are three appetizers and three desserts from which the couple can choose only one. If they are looking at the appetizers, the shrimp cocktail is the clear winner at 120 cals. The cheese sticks are a scary 680, which make the 380 calorie stuffed mushrooms, look reasonable. The desserts range from 580 to 1490 calories. Yes, I said that one dessert (a chocolate something) has about 1500 calories – or the amount of calories many less active women need in a whole day.

So I created two meals. The first is the lowest calorie choice from every category – with the appetizer or dessert at ½ the calories (a shared item). The second is the highest of everything, but again only half the dessert. The low meal gets one biscuit, the high gets two. No drinks or dipping sauces included. READY??

Best Case w/ ½ appetizer - 795
Best case w/ ½  dessert - 880
Worst Case w/ ½ appetizer - 2495
Worst case  w/ ½  dessert - 2900

My point is not to tell you what to eat. Just know what you are getting. I have no beef (ha) with Red Lobster. Their own website provided all the calorie and fat information and I can see that they have reduced some of the calories in the last couple of years.

 I ate dinner at a Red Lobster last night. My meal was tilapia and broccoli without any oil, fat or butter and a garden salad (no croutons) and my own dressing. Add 95 calories for that deliciously ice cold Michelob Ultra. Oh, it was $17.50 before tip – supporting the notion that healthy costs more!

If you go to Red Lobster in Bradenton Florida – say HI to my MOM for me.

Wednesday, January 5, 2011

More than 20% Wrong

A study that was published in the Journal of the American Medical Association recently made the popular press yesterday.  It is a review of hospital records (primarily of medicare/medicaid recipients) from 2006 to 2009 that list ICD procedures.  An ICD is better known to us as a defibrillator but the full name is implantable cardioverter-defibrillator.  The device can restart the heart or shock the heart back into normal rhythm.  A great overview on the device, the diseases it treats, the difference and similarity to a pacemaker and more, can be found at the NHLBI website.  To learn more about who makes them and the industry aspect I had to go to the Wall St Journal and search, and you can read on that as well.

The ICD was developed to treat arrhythmia or heart beat irregularities and it was tested in a certain population for which it was approved for use.  As you know, once a device or drug is approved for use, a physician may use that same device or drug in patients that do not meet the sanctioned criteria, but device and drug makers are not supposed to market the device or drug for anything outside of the original application and testing (unless they test again)

I am not saying that the device makers tried to influence clinicians - except that I most certainly suspect that they have.  According to the research described in the JAMA article, the 22% of people who recieved the defibrillators  outside of the "guidelines" suffered a much higher percentage of serious adverse events.  The people who should not have an ICD under most cicircumstances are those who have recently had a heart attack (40days),  have a new diagnosis of heart failure, who have had surgery to clean out arteries - and subsequent stent placement and a few other criteria.  What I was not able to find were the actual practice guidelines.  I could find articles about them, but not the guidelines themselves.  Certainly, there are some cases were a person is outside of these conditions who would benefit from the device, but it would not be so frequent.

I feel that the issue of over medication and over testing and over "devicing" is not only a waste of resources, but as the JAMA article suggests, can lead to unnecessary death.

(email readers, click on the yourhealtheducator link and check out the new template - looks like wasa crackers :))

Tuesday, January 4, 2011

Report Card

Not my grades (but they were ok)! 

 Tonight I want to make a few points about a report on women's health in the USA.  I will also provide you the link to the Health Care Report Card that is provided  by the National Women's Law Center. 

This organization has provided a report card every three years since 2004 (possibly longer).  The most recent one compares the status of certain bench marks to 2007. 

This report card regards women's health; however, you do not have to be a woman to have a vested interest in their access to services and the state of their health.

[I had planned to really delve into this report over the holiday and only got so far as to print some summaries to read on the plan.  Alas, I read those today.]

The report, benchmarks and grades can be reviewed here.  Things are pretty bleak with only two states being considered Satisfactory and the is with a minus sign. S- for Massachusetts and Vermont. 

There are three or four things that are relevant to our blog.  There has been progress in smoking cessation.  There is more coverage for quit smoking services and there was a decline in the number of women who are current smokers in 84% of the states.

In regards to sexuality, reproductive health and sex education, more schools are including comprehensive education that includes contraception information.  Notable, 24 states did without the federal monies that are available to schools for sex education under the "abstinence only" condition.

This is important for the following point as well.

One of the benchmarks took a significant hit in the last three years.  The number of women receiving annual pap smears.  The pap smear is THE screening tool for cervical cancer.  The pap smear prevents the cancer by detecting abnormal skin cells that can be removed.  I strongly suspect that the decline in screening is the fault of drug makers who market the HPV vaccine.  HPV is the virus that can cause the cancer.  The vaccine can prevent some strains of the virus but it does not prevent cancer.  (safe sex and pap smears are still vital for reproductive health)

Another thing that I relate to drug company promotion is considered a positive by some.  Cholesterol screening in women has increased.  I imagine the number of women now taking statin drugs has increased proportionately.

For the blog theme I think that is the most of it - again, you can view it all at this webpage.  Here you can see the ten states that received an F as well.

Monday, January 3, 2011

Which Tips are Tops

Today I took a look at the list that USA Today put together as the best weight loss tips they have recommended over the years.  You can see that list by clicking here.

I do hope that you will read their advice.  My post is in response to it.

 I found these tips to be ones that I might also suggest or have taken advantage of myself.  They are significantly abbreviated from the article.

1. set realistic goals, 6. portion size, 7. clean out fridge and pantry, 8. create a "dinner deck", 10. load up on produce and keep it handy, 12. make changes for everyone (i.e. non-fat milks and cheeses), 13. cut out liquid calories, 21. dine at the table, 22. dine out without over indulging, 23. get plenty of sleep, 24. weigh regularly.

Now some of these I REALLY liked, and some I liked with reservations.  For example, portion size is related to informed eating and one of my great passions.  If you are creative, you can still have a full plate.  Number seven is a must.  People who are quitting tobacco should not keep a pack of cigs around and recovering alcoholics do not need a pint hidden in the freezer.  You are either IN or OUT - lose the Twinkies.  Number eight is referring to index cards that have some favorite low cal recipes that you can prepare quickly and easily - to that I add "use some of the meals that Deirdre has on You Tube."   With regard to cutting out liquid calories - oh my gosh, fruit juice, sports drinks and soda - must go - if you would like to have alcohol on occasion, remember that light beer has about 100 cals for 12 ounces, wine has 100+ for only 4 ounces and liquor has 100 cals for 1.5 ounces.  That 1.5  can be mixed with 12 ounces of Fresca for a nice cocktail :) 

I have mixed feelings about the weigh regularly advice especially because in the article it notes that some persons weigh daily.  Now, it is true that the National Weight Control Registry lists the behaviors of successful weight reducers and moderating calories, exercising daily and weighing are all there - but weighing can become an obsession.  I weigh about twice a year but notice how my clothes feel all the time.  With that - give yourself permission to be bloated every now and again :)

There are two things in the article with which I categorically disagree .  The writers keep referring to dieting and dieters - BOO - diets are disasters and dieters feel defeated.  Instead, choose to eat in a way that maintains a weight that is good for YOUR health. 

In the article, number 18 suggests never eating after 8 pm and that is more myth than truth.  It always depends on what you eat and how much you eat in a given day.  If one goes to bed on an empty stomach the restorative sleep that is a top priority will be compromised.

Don't forget to check the article.  Review some You Tube video recipes.  And read this book

Sunday, January 2, 2011

Odds and Ends

It hardly feels like a week's end with a new year just begun, but it is and I have a few notes to share. 

Scanners:  I was in the security screening line at the Sarasota airport a few days ago.  This was my first experience flying out of that airport.  As I handed my pass and license to the official who scrutinizes both and scribbles something on the paper, I noticed an odd contraption. It was enclosed, with plastic strips like a restaurant cooler and about the size of a (obsolete?) phone booth.  I asked the serious official, "Is that a full body scanner?"  She replied that it was and I said that I would rather not do that.  She gave me an even more severe look and said that the machine was not yet in use - it would be in a couple of weeks.  Whew - I did feel that my saying comment was seen a red flag but no additional screening awaited me.

Labeling:  As you know, I am a fan of all nutrient labeling as it allows for informed eating.  One food that has heretofore escaped the packaging law is raw meat.  That will change soon and our beef, chicken, pork etc will soon offer information on serving size, calories and fat.  Of note, if a product declares a certain % of leanness, it also has to profess its fatness.  When you see and use this new info, be mindful of two things - the serving size (ounces or grams) and whether that is raw or cooked.  To fully grasp this, I suggest that you weigh your serving a time or two.

Eating Out:  When I started to eat more mindfully and wanted to avoid added uncontrolled calories, eating out was uncomfortable.  I no longer hesitate to tell the server that I want my food without any added fat, oil or butter - and the focus on healthy eating has made my request more common place.  I will order that way regardless and am increasingly tickled to have my dining companions say, "make mine the same."  In a recent Runner's World magazine article, the suggestion for those trying to eat low calorie when dining out was that they order first.  That way the person is not tempted by the high fat orders of their friends.  Thus, if you are not dining with me, perhaps you should take that advice.

But Dr. Oz:  I was getting some loose oat bran from a bin at Earth Fare and a lady near to me was looking for pumpkin seeds.  She said something out loud about this, I do not recall exactly what it was, but I replied that pumpkin was certainly nutritious.  (I was thinking that seeds were good for you, but higher in calories - density wise - and the flesh of pumpkin was more volume friendly).  Anyway, the lady said that someone on the Dr. Oz show said that pumpkin seeds were good for you.  I said, "AH, Dr.Oz - well then, it must be true."  She responded as though I had spoken gospel. Sigh -I liked Dr. Oz before he became such a media star.

Biscoff:  More stories from my travels.  Delta provided me with a snack on my flight.  It was a small package and as such did not have to contain full nutrient information.  It did say what the ingredients were and that I could call to learn more.  I went to the website instead - out of curiosity mostly.  The little cookies had 60 calories each and a significant amount of saturated fat.

White Potatoes:  I continue to read research articles on obesity prevention and initiatives.  Recently I read about a program that was encouraging the purchase of fruits and vegetables for persons receiving WIC (women, infants and children) benefits.  I believe that the women were given WIC credits for the purchase of this fresh produce.  In the fine print it said, "excluding white potatoes."  That is a hint for you.

Short Lists:  Here is another point generated from the same recent Runner's World issue (january 2011).  When you see a list of certain foods that you should add to your diet because they are "good for you," I suggest two considerations.  One - adding nutrient rich foods is a grand idea, but if you add without taking away, your calorie intake will increase and so will your weight. Two- be suspicious or at least discerning.  IF a food or something in a food was found to "reduce inflammation" for example, ask the question, "under what circumstances was that true?"

SLT Products:  Ah, my last airline story.  This past week was the first time I heard the announcement include SLT.  WHAT?  "Smoking and smokeless tobacco products are not allowed on the flight."

Saturday, January 1, 2011

A New Year

It is a new year.  People can be in three places with regard to fitness and health as the year begins.  They may plan to 1) keep the progress and motivation, 2) change and make some progress or 3) continue to ignore that progress needs to be made.

I am not going to take much of your time today and I am not going to give you many hints about exercise and food as people far more influential than I are busy doing just that.  (and that is what I do every day anyways)

I think the most important thing I have to say today and the "wisdom" I want you to keep is this, "temporary actions bring temporary results." 

Please do not start 2011 with the last great diet.  Start it with the intention of eating well and exercising every day - and 2011 will pass - one day at a time.

I am an extremist.  This is true for all aspects of my life - I don't run neutral (ha).  I do not suggest that anyone be as focused as I, but that everyone be focused.  I have been the same weight (give or take a pound) for ten years now.  I know what I like. I know what is nutritious and what is not.  I work around it all so that at the end of any day I am comfortable with my choices and my body.   

You must be consistent.

Do set goals for yourself.  A goal for living.  A goal for a long active life.  Goals for the year, for the month, for each week.  Most importantly a goal for tomorrow. 

Planning is important.

Have you seen those yogurt commercials where someone is declining an offer for some junk food because they have "red velvet cake" or "black forest cake."  The cake turns out to be a tasty, but low calorie snack?  I think that is the advice I should give you today. 

 On most days, plan your meals (eating small but often) and arrange to eat foods that you enjoy, that you want to eat, and when someone offers you a treat, smile and decline because you actually WANT what is in your lunch bag.  You are in control of what you eat.

My other advice is for exercise. Start where you are and move forward - key word, MOVE.  Ten minutes of walking today and take it from there.

Lastly, I use a web based activity tracker that is associated with my Garmin GPS.  You may have seen some of my runs from the link on the left.  I try to upload or add ALL my activity, however, things do get left off.  That being said, today I looked at my 365 day report and was very proud of myself.  The summary below is NOT all that I did - I'd say at least 20% is missing.

I think that I can add the picture here.  I do so in the hopes that you might take inspiration and start your activity log today.  You can find an interactive log on line.  You may wish to try the MyPyramid website.

Look at ALL those miles and calories burned!!