Tuesday, May 31, 2011

from BOP to FOP the NFP and more

A few posts ago - the one titled Labels Everywhere - I began a discussion of front of pack labeling of which I am a big fan.  Today I was exploring the Institute of Medicine's website because they are supposed to be evaluating the concept and then making recommendations on which FOP sign post would be best and what it should involve based on expert opinion and clinical studies with consumers.  I found a power point presentation from the Rudd Center for Food Policy on the website.  It was used in one of the open meetings.  It seems most of the committee meetings are closed, and there is one later this month.

The IOM should be making recommendations by the end of this year.  The study presented in the power point was illuminating and I contacted one of the authors re why they were saying that the 2000 calorie diet phrase was to be on the label, esp,. because in their own research it did not make a real difference on the consumers behavior.

Most of what I have read about FOP labeling has come from Europe and today I found a USA based article that I have begun reading.  I will give you more on this in the next day or two.

I am happy to say that both pieces of literature noted the multiple traffic light label as the "best" on several measures.  If you are wondering what the FOP label really is - it is taking some items often found on the Nutrition Facts Panel (NFP) and putting them on the front of the package.  You are already seeing this on some products, but the food manufacturers that are placing them there are not necessarily promoting a healthy food.  Recall I recently noted a snack cake package that had all the info on the front, including that the calories per cake was 150.  That is FOP labeling.  The debate is whether or not to let the food industry decide on the labels or to have FDA supported scientific health promoting criteria  and standardized formats across all products - say yes, the second one!

Stay tuned for more.  You can see the same PPT that I viewed, by clicking here.

Monday, May 30, 2011

Estimating Calories

Burton, S., Creyer, E. H., Kees, J., & Huggins, K. (2006). Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. American Journal of Public Health, 96(9), 1669-1675.

This post refers to one of the studies I read in preparing my project ideas for a labeling initiative both on and off campus.  I like this article because the researchers asked a large group of people to estimate the amount of calories and fats in certain restaurant meals for which the scientists had the actual real values.  (the people who participated were at least high school educated (97%) and 60% female, with half above age 39 and half below.

The participants were given a description of the item and the serving size, as if they were reading a menu.  The researchers had two studies going on, but in this first one, there were 193 people.  There were ten food items for them to assess and five of them were considered less healthy than the other four, with a sixth being extremely unhealthy (re: amount of fat and cals).  The hypothesis (or assumption) was that the persons would guess closer to the truth with the healthier items.  That was in large part true, but the group overwhelmingly (90%) underestimated all the items' calories and fat grams.  The average amount of calories by which they erred was 642 and they were off by 44 grams on the fat content.  The average healthy meal had 543 calories and the subjects guessed 500.  The five less healthy items had an average of 1336 cals and 76 grams of fat (OH MY) and the group incorrectly guessed that those meals had 694 calories and 32 fat grams.  The worst item - cheese fries with ranch dressing  - had an actual calorie count of 3010 - yes three thousand calories and 217 grams of fat.  Thus - it is important to provide calorie information at the point of purchase.  It may indeed change a customer's mind - leading to a possible decrease in average caloric intake for  Americans.  At the same time, people providing those meals may very well shudder at having to put a little food tag next to a dish that says it has over 100g of fat and SO, they will revise the recipe! 

The second part of the study was to compare purchasing intent,  perceptions of weight gain and risk of heart disease based on the information provided.  So three groups were involved.  One group only got the description of the food, another received the description and calorie info while the third received calorie and fat and salt info. The researchers looked at the perception of weight gain for instance if a person was just given a description of a burger, compared to someone who also learned that the burger had 600 calories, compared to someone who knew it had 600 calories and 45 g of fat.  Same scenario with heart disease, and similarly with intent to purchase.  Does the information change anything? 

Want to know what happened?  You can view the abstract and the figure showing the change associated with the information here.  Succinctly,  calorie information alone is sufficient to change behavior - and this is all that the new law requires.

Saturday, May 28, 2011

Avoid Enticement and other interesting dietary snipets

I want to share just a few bits of information from the mounds of articles and documents I have explored in the past few days.

The first is from the Surgeon Generals report from 1979 titled Healthy People: Health Promotion and Disease Prevention. [I must add that almost every report before this one and most after have to do with smoking or tobacco!] The 1979 report notes obesity as an issue and suggests that people not eat more calories than they need.  The same reference is made in the next report Nutrition and Your Health (1980).  Interestingly, none of these reports or any of the dietary recommendations or guidelines that begin in the early 1900s say anything about 2000 calories a day and yet even in  the very first, in 1894 - percent of total calories are mentioned.

I could find no reference to a recommended amount of calories for adults until 1989 and even then, the amounts are not 2000.  The first I can find of that is on the nutrition facts label which was mandated in 1990.  The footnote statement, that the Daily Values are based on a 2000 calorie diet, must be on all labels.

Well - I said all that because I was frustrated in my efforts today.  I did find the science behind making population recommendations and the subsequent references to that same science from the WHO and the FAO, but not where the 2000 cals a day came from - in fact it seems arbitrary.  I finally gave in and emailed someone at the Rudd Center for Food Policy at Yale.
I did find reports on the trends over time which indicate, by self report , that people are not eating that many calories  and are obese anyways... CRAZY - but exactly why the sentence needs to be revised.  Still - how do people KNOW how many calories they are consuming if they do not know the amount in the food that they eat away from home?

Now  - what I meant to say today:  In 1979 the Surgeon General was making some statements on what individuals could do to keep from eating too many calories - "only sufficient calories to meet body needs and maintain desirable weight"... the exact phrase for meeting the above exact phrase  is "avoid situations that would entice them to overeat."  YA THINK?  Where is a person to go then??

In a commentary by Katan and Ludwig (JAMA 2010 vol 303) comes this pearl of wisdom -
First the context.  In regards to eating less to lose weight, the body acclimates to the new weight and so one's strategy must always be revised - after a period of loss, unless things are changed to trigger more loss, the weight loss will cease - the same is true of weight gain..  thus if one consumes 1800 calories a day for a few months and gets to their ideal weight - not only must they keep eating 1800 calories to stay at that weight, if they want to lose more, then the have to make other adjustments - in this discussion of persons who go "on a diet" to lose weight the authors say ...."after having achieved some weight loss.  Most do the opposite. They resume their original diet and exercise habits.  Consequently, weight gain recurs rapidly."  YES YES YES - I say this to people all the time - it cannot be something you do for a little while but something you do for your lifetime, thus it needs to be reasonable and pleasant.

In an article by Swinburn, Sacks and Ravussin (Am J Clincal Nur, 2009 vol 90) it is suggested that we are consuming 500 more calories per day than we were in 1970s.  If one were to try to make up for that extra intake  through exercise - it would take a two hour walk every day to do so.  Far easier, as I often say, to not eat that McDonald's burger or drink that smoothie.

okay that's it for today.....

Friday, May 27, 2011

Burning Less and Consuming More

That is really the bottom line from the research that came out this week and several studies published last year. With regard to work time physical activity, the study by Church indicates that in the last 50 years, the work force (gender) and the type of work has changed significantly. There are more persons doing service providing work and fewer doing goods-producing work. In this case, the amount of physical effort expended on the job has changed (not including technical changes that make work easier). The researchers used METs to describe the work activity as either sedentary, light or moderate. You may remember the metabolic equivalent charts and formulas from this post. The jobs that were considered to be of the moderate MET were mining and logging, construction and manufacturing. The scientists considered moderate to be an MET of 3 to 5.9 and sedentary was an MET of less than two. Recall that a moderately paced walk of 4 miles an hour - or one mile in 15 minutes, is an MET of 4.

Reviewing data from the US over the past 5 decades, Church et. al, determined that there are more women employees now than in 1960 and on average, all workers are expending about 100 calories less in work time activity. They state that this change can explain a lot of the obesity epidemic. I disagree with how they are stating it, as if calories in are not driving the weight gain, but not with the bottom line. We are burning less calories, but we are consuming far more (mathematically). Other studies, namely Swinburn(2009), Westerterp(2009) and Prentice(2004) note that as we become more sedentary we do not moderate the difference by eating less. Prentice explained the issue of failing satiation signals, and Swinburn notes that the average intake is up 500 calories. That is where I put most of my faith. Even if work time physical activity has declined and leisure time physical activity has not increased, likely declining instead, not only are we NOT eating 100 to 200 calories less - so that we would have the right balance, we are eating even twice that MORE. The excess has a lot to do with how food is prepared and our ignorance of the amount of fat, sugar and calories in the portion of any food we are consuming.
But let us say that all things WERE equal. If a person who weighs 150 pounds lost the expenditure of 100 calories, they would need to take a brisk 15 minute per mile walk for about 30 minutes a day. Clearly, the majority of US adults do not do so. In fact, Church notes a study that has indicates only 1 in 20 US adults meet that requirement on five days a week. Instead, as Swinburn et al suggests, if we take away a sugar sweetened beverage 200 calories can be deleted.

BTW, I did make my FDA comments on the labeling initiative today and I have an appointment with my campus vending contract supervisor on Thursday :) I am still preparing.

Church, T. S., Thomas, D. M., Tudor-Locke, C., Katzmarzyk, P. T., Earnest, C. P., Rodarte, R. Q., . . . Bouchard, C. (2011). Trends over 5 Decades in U.S. Occupation-Related Physical Activity and Their Associations with Obesity. PLoS ONE, 6(5), e19657.

Prentice, A., & Jebb, S. (2004). Energy intake/physical activity interactions in the homeostasis of body weight regulation. Nutrition Reviews, 62(7 part 2), S98-104.

Swinburn, B., Sacks, G., & Ravussin, E. (2009). Increased food energy supply is more than sufficient to explain the US epidemic of obesity. The American Journal of Clinical Nutrition, 90(6), 1453-1456. doi: 10.3945/ajcn.2009.28595

Westerterp, K. R., & Plasqui, G. (2009). Physically Active Lifestyle Does Not Decrease the Risk of Fattening. PLoS ONE, 4(3), e4745

Thursday, May 26, 2011

In Days to Come

Hello all.  I located the research study that was alluded to in the news story I linked you to last night.  This regards trends in occupational levels of physical activity.  I must wrap up my label and menu research review and write up before I dive into something else - but it is on the list.  And if you would rather not wait for my regurgitation of the article, I believe you can have full access yourself at the journal website.  If you do want to wait, never fear - it has my utmost interest.

As a side note, something I failed to do today was make my "public" comment on the FDA labeling rules.  I will do so tomorrow.  You can read about the law and make a comment yourself by clicking this link.

By the way, one of the readers, my friend Melanie, noted that the cafeteria at Mass General is traffic light coded and she LOVED eating there ( I believe her daughter was giving birth at the time :)).  I checked out the website quickly and they referenced a BeFit label.

Lastly, I am not doing a good job at relaxing and reading that novel - so I am going to get on that right now....

Wednesday, May 25, 2011

Labels Everywhere

The Affordable Care Act of 2010 did mandate nationwide menu and vending machine labeling for certain retailers.  Namely those with more than 20 restaurants or 20 vending machines under operation.  This is exactly the type of informed eating policy that I have supported as it rolled out in some 18 states, cities and counties of the US in the last few years.  It was led by NYC and San Francisco.  Menu labeling is supported by numerous health organizations including the ADA and the AHA.  You can view the substantial list here.
The FDA is still accepting comments on the final rule - but the basic gist is that the information that is mandatory is calorie content, but other nutrient information (fat, sodium, sugar) is welcome and often already available.  [because other states and cities have already passed rules like this, big fast food enterprises have been making this information available.  You know this because I often use the info in my posts] The additional nutrient information must be provided in writing if a patron requests it.  This nutrient disclosure is to be displayed on menu boards and food tags, near to the food and in the same format(size) as the name and price of the food.  It must also be made available on line.  The label or tag must include wording on the fact that the "average adult" should consume 2000 calories a day.  This is, in my opinion, a big mistake and I am going to make my comment on the FDA website tomorrow. 
A separate initiative by the FDA and IOM which is backed by many public health experts is Front of Pack or FOP labeling.  The issue is not whether to do it, but how.  This is a worldwide endeavor.  I have read a good deal of research and it appears that the most understood and useful concept is the multiple traffic light.  This system offers the green, yellow, red coding much like go slow whoa to which I often refer, but per nutrient.  So the label has four or five panels and fat, sugar, sodium, calorie, etc gets a color code.  Standards for use have been developed by a government entity in the UK.
In one of the research studies I reread today, focus group participants made comments about some additional information on the labels, as they were making comparisons across many versions.  They did not like the 2000 calories a day for an average adult as they did not KNOW what an average adult was - Amen to that.  Also, one of the label formats, and this has been put forth as an option in the USA, denotes how much exercise (say walking) is necessary to burn the amount of calories in a serving of the product.  Here the focus group participants noted that they did not like seeing how much exercise it took to burn so few calories!  Also in that article, the researcher noted the inherent problems with any such suggestion of how many calories a person would burn without knowing anything about THAT person. 
What I want to say tomorrow, and this is supported by research reported just moments ago - whatever science was used to determine that average adults burn 2000 calories a day is clearly outdated because we have ceased to be an active society.  More often, a sedentary adult, which most are, needs 1500 calories a day.  See this story.

For up to date information on labeling initiatives and current status - see the Rudd Center for Food Policy website.

We eat most of our meals away from home and there is no reason why we should do so without knowledge of nutrient content.  When we are advised to watch our intake, it makes sense that the information we need to do so be on ALL the products we consume, not just the ones at the grocery store.  Here, we are not telling people what TO eat, just letting them know what they ARE eating.  Lastly, if you know what the healthy option is, i.e. sometimes it is NOT the salad, and you choose that option, the retailer is likely to respond by providing more healthful and low calorie meals.  Research indicates that this is so.

Tuesday, May 24, 2011

Three Days Notice

That is right!  This Friday is protect your skin day.  This event is supported by the Environmental Protection Agency's Sun Wise program, but is the work of the National Council on Skin Cancer Prevention.  They are declaring the Friday before Memorial Day as Don't Fry Day.  There are tips, posters, stickers and videos at the EPAs website.  Click here to find them.

Monday, May 23, 2011


Post is in reference to:
Development of a Brief Measure to Assess Quality of Life in Obesity. BY -Ronette L. Kolotkin, Ross D. Crosby, Karl D. Kosloski and G. Rhys WilliamsThere is a graph in this research article that I would like to share with you, but when I open the figure on line it is hard to read.  If you download it, as it is free, you can see the chart very well in a PDF.  I will tell you what I wanted to point out.

This article explains the revision of a survey that measures quality of life (QOL) as it is impacted by ones weight. The researchers took a long survey (74 questions) which categorizes answers into five scales and made it 31 items that still measure the same constructs reliably. 
The different areas are 1) physical function, 2) self-esteem, 3) sexual life, 4) public distress, 5) work and the total QOL score.  Quality of life is correlated to the Body Mass Index of the indivual.  A high score means that ones quality of life is diminished.  Both versions of the survey find that the higher the BMI the worse one's QOL is in each of the areas.  What I wanted to show you was figure 1.  This figure parses out all the scales.  In each graph the outcomes are broken into categories.  The comparison of scores is by BMI group AND gender.  The BMI groups are as follows; people with normal weight BMI <25 , people with BMI 25- 25.9, 30-34.5, 35-39.9 and 40+.  The higher the BMI the worse the scores.  Think of an axis, the vertical and horizontal - the horizontal has these categories and the bars going up indicate what the score was.  For most of these categories, the male and female bar is like the twin towers, hardly a difference.  I wanted you to see the three places where there were noticable gender differences.  They make sense.  Women have worse QOL scores then men with regard to their self esteem and sexual life and men have worse QOL scores with regard to work.  This is in reference to being overweight and obese.

Sunday, May 22, 2011

Odds and Ends

Garbage - What was once a physically demanding job is now automated it seems. This week I watched a garbage truck picking up and dumping the rolling trash cans most cities/counties now use. An arm came out of the side and lifted, emptied and replaced the can at the edge of people’s driveways. Does this mean that garbage collectors now have sedentary jobs? If their jobs have changed, but not their lunches (super sized fast food combos) they will be the next obesity victims.

Policy - I am someone who advocates policy changes in order to address chronic disease. These policies could include nutrition labeling, sidewalks in neighborhoods, taxing soda, etc. Often times the rebuttal to these strategies is that people have or should have free choice to make their own (wise) decisions. I have recently seen two separate but related examples that regard street crossing. Along several blocks near a University in WS a fence has been erected down the middle of the road between the stoplights so that students will stop trying to cross the street without waiting for a signal or using the cross walk. It is a TALL, wrought iron fence (pretty even). Last week at my own university, the side walk near one of the buildings was roped off and volunteers were keeping watch. I asked what was going on and was told that people would leave graduation and all emerge into the street without really looking so they wanted to corral them so to speak, to use the cross walk. SIGH.

More Tobacco Tricks - I noticed an advertisement placard for Newport cigarettes at a gas station this week. To the best of my knowledge Newport has always been a menthol cigarette and it, along with Kools, is popular with black Americans. There has been some effort to ban menthol cigarettes, as all other flavored cigarettes are illegal. Kools, Newport and Salems, and any menthol cigarette I am familiar with, come in green boxes. If Newport switches to a red box now - which was the gist of the sign that I saw, Newport Reds... they may be readying the way to cross smokers over to the nonmenthol Newport.

Vegan Food Pusher - I was at a festival yesterday with a friend. Two women walked up to us and offered us a taste of vegan beef jerky. I declined, as did my friend. One of the ladies said, "But you are so thin, you look like a vegetarian." What the heck?? I said that I was a vegetarian. I just didn't want any jerky. People are so "pushy!"

Week Ahead - The week (months) ahead will be busy as I have identified my work projects for the summer. Most of my activities will involve policy related to informed eating and nutrition labeling. I will also continue work on the bicycle helmet use paper and assist the coordinator of the masters Public Health program at my school. I am assisting another of my professors with material for her two fall statistic/methods classes ( and thus learning more myself) and am working on a public health entrepreneurial course - I am engaged in several community groups as well and so - may be able to blog less than I have in the last few weeks. PLUS, someone I love dearly just gave me a brand new novel to read!

Saturday, May 21, 2011

20 to 40 - Growing and Being Well

From the World Health Organization comes the most commonly referenced definition of health by public health educators, promoters and scientists:

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The bibliographic citation for this definition is: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. The definition has not been amended since 1948.

I post that definition today because, as is my custom from time to time, I want to address well being and taking care of oneself outside of the usual prevention of disease talk that I engage in (i.e. health screenings, nutrition, physical activity).

Today on the radio show Weekend Edition, one of the hosts was speaking of commencement speeches. He himself was not making one, but he offered a little advice none the less.  I don't recall his exact phrasing, but it was profound enough to lead me into some self reflection and perhaps I can stimulate the same in you. 

He said that life would be different and things would change as we got older and that we should embrace this change.  He suggested that for life to have been truly lived, one should not have the same convictions at age 40 that they did at 20.  I had to think about that a while.  I find that too many people do not grow and that is a sad thing. I am not someone who is the same.  I was 20 in 1985 and I can assure you that I looked at the world through a very different lens.  I believed different things and I acted according to those beliefs. 

In May of 1985 I was finishing up my second year at a 4 yr college.  I had begun as a dance major, lost myself a little, college was hard for me.   I was so very shy.  I spent so much time in my dorm room the first year and in the second year I spent time lifting weights and over eating with one of my best friends who was also my eating buddy.  I recall that my dance instructors told me to back off on the weight lifting.  I was bulking up - not toning.  I am far from bulky now and in some ways physically stronger!

Then I quit the 4 yr college and enrolled in a community college - I began to study child development.  At the time and for some years, I was a "punk rocker."  I also became a vegetarian - except not really - I ate ALL kinds of baked goods and starchy foods.  I decided to become a social worker and save the world (switched to another college).  I moved to NY.  I wore T shirts that said meat is murder and only man hunts for sport and I was 100% pro life.  I cared about people in other countries more than those in this country because I was oblivious to the social ills of America. I do remember that in my classes we discussed the doomsday clock - so many minutes from midnight.
But outside of the classroom, I got involved with people who actually needed a social worker and soon dropped out of school altogether.  I spent most of the decade of my 20s striving to be a wife and mother.  I experienced/witnessed domestic violence and alcoholism.  At the same time, I had no concept of society's machinations and did not give voice to my concerns in ways that would be taken seriously.

At 40 - well, that person from the 1980s is not in this body (it would seem).  I eat well, but with restraint, and exercise is the key to my vitality.  I have numerous certifications, several degrees, and a history of productive careers.  I do not think my country should be helping so many people outside of its borders and I am often concerned that our borders are not more secure.  I am a true vegetarian (who eats fish) and I am still an introvert, but self confident and outgoing.  In fact, in the last month I have been called ambitious, tenacious and assertive enough to go far! 

I am politically, socially, financially, environmentally and physically(health) conscious.  I expect that I will continue to challenge and embrace new ideas and that at age 60 my beliefs and actions will be impacted by my experiential and academic knowledge so that I will once again be different.

Another popular concept regarding human functioning, is Maslows Hierarchy of Needs.  I will post the graphic here - it can be found in many publications, this clip is from Wikipedia and you can read about the theory at that site.  One belief that has stayed with me since my 20s is the quest for the top of the pyramid - self-actualization.

An interpretation of Maslow's hierarchy of needs, represented as a pyramid with the more basic needs at
the bottom.

Friday, May 20, 2011

5 Months to Plan that Walk

I am delighted to share this link with you.  It is about the International Walk to School Day that will take place in October.  The website will give you details about the initiative and you can click on your state (or any state) to see what city and what schools are participating.  You can also search to see which participated in 2010.  It is only May so you have lots of time to encourage the schools near you or to which your children attend to sign up for the walk.  You may even have the opportunity to volunteer.
I have just sent this information to the community obesity coalition in my town and hope to be involved in getting local schools to participate.

Thursday, May 19, 2011

Triple Threat

I was reading a commentary from 2009 written by the Senior VP of the Robert Wood Johnson Foundation. He said something important that I wanted to share:

"What we need is not more, expensive treatment; what we really need is less disease." 
- in Health Promotion Practice, April 2009 10 (2)

Time and again studies support that the preponderance of chronic disease, including cancer, is related to tobacco use, being overweight, not being physically active and being too sedentary.

For this reason I offer YOU the triple threat against disease:
1) do not smoke (or quit asap)
2) maintain a healthy weight (by eating low energy dense high nutrient foods -i.e. you can be skinny and unhealthy so just limiting your calories isn't enough)
3) get and stay active

normal weight, no tobacco, physical activity
 - triple threat against disease -

Wednesday, May 18, 2011

Today I participated in the National Ride of Silence which is described in the press release below. It was an eight mile, police escorted ride through the city of Greensboro - see the map below. No one spoke during the 8 mile ride. The extra 8 miles was my commute to and from the event. So yes, I rode 16 miles today even though I haven't ridden more than 6 or 7 since I got the bike out earlier this month - no worries, all went well. I must say that I am not a cyclist and have never ridden in a group like this - I imagine there were close to a 100 riders and that 20 or so of us were not "cyclists." It was cool watching the pros!  All their gear, expensive bikes, cute little bodies, shaved legs :) - their respect for each other and hand signals far beyond just right and left turns.  Very cool.  It was getting dark as I approached my driveway and some other cyclists rode by who had lights on their bikes.  They really do help.  My neighbor actually offered me his before I left, but I declined.  Oh BTW, the flyer for the event - which you can see here, specifies that helmets are mandatory!
This event was about safety and remembering people who have been injured or killed while bicycling. Similar rides took place on this same day and time around the world. You may have seen or will see this on your 10 or 11 o'clock news tonight. I know that we were photographed and filmed along our route.

(By the way, if you receive this blog in an email and the maps are not present, simply click on the very bottom of your email where it says Your Health Educator and you will come to the real blog post)
In May 2003, Chris Phelan organized the first Ride Of Silence in Dallas after endurance cyclist Larry Schwartz was hit by the mirror of a passing bus and was killed. The ride was a solemn event, to remember Larry and all cyclists killed while riding their bikes. It was only suppose to be a one time event, but as word got out about the ride, many cyclists contacted Chris with the desire to participate in this event.
Although cyclists have a legal right to share the road with motorists, the motoring public often isn't aware of these rights, and sometimes not aware of the cyclists themselves. The ride has several goals:
To HONOR those who have been injured or killed
To RAISE AWARENESS that we are here
To ask that we all SHARE THE ROAD

Over 600 cyclists are killed each year while riding. Most of them occur in our cities, and suburbs. With this ride, we hope to educate motorists that cyclists have the legal right to the road and to watch out for us.
The Ride of Silence is similar to a funeral procession. The ride will be slow (max 12 Miles/ 19 KM per hour). There will be no talking, only silence, to remember our fallen brothers and sisters. Black armbands are worn in memory of those who have been killed; red armbands are worn for those injured while riding.

[psss this morning I ran seven miles and fell down on the dirt trail (remember the one I found when I got lost on my bicycle!) at mile five  - but I jumped right up and kept going.  I say this because I have a feeling that my butt, thighs, knees and who knows what else, are likely to remind me of this day for most of tomorrow! - I am actually going to ice those knees right now, good night!]

What the heck - here is that map too!

Tuesday, May 17, 2011

From those who know

In a recent post I clarified the real risk of skin cancer but the low comparative risk of dying from it as compared to other cancers. 
That does not mean it isn't a real and increasing threat to young white women.  The significant rise in cases is likely due to tanning beds which persons did not have access to before the 1980s.

This article in the USA Today notes that 35% of girls who are aged 17, use tanning beds.  As we discussed in the last skin cancer post, many who use indoor beds also sunbathe. 

A few women who have been diagnosed with melanoma are speaking out about their experiences.  Social marketing research shows that serious messages about real health threats delivered by persons that are like the message target, can be persuasive.

The rate of 8700 deaths a year from this disease noted in the USA Today article is the same statistic noted on the American Cancer Society website.

[the main risk for skin cancer has been sunburns at early ages - one or two severe events can lead to the cancer - but it usually takes decades to develop. with this new threat,  it is important for parents to protect their children when they are young, but also when they are teenagers. if parents cannot prevent their children from going to tanning beds, and we can't outlaw them, then the next best thing may be national laws against tanning for persons under the age of 18]

Monday, May 16, 2011

a Quick Apology Allergy Sufferers

I listened to a report on NBC Nightly News and I thought of my blog post about people who never open windows.  At least two people commented that it was allergies that prevented them from enjoying the fresh air.  In this news video, someone notes that if they go to sleep with the windows open that they wake up very congested.  Though I have not had many of the symptoms associated with allergies, itchy, burning eyes and a cough, I have had the congestion and headaches.

The Asthma and Allergy Foundation has two lists.  There is a document of the 100 worst places to live (USA) with asthma.  Some pretty interesting correlates are offered in that document - like smoke free laws, insurance coverage, deaths from asthma etc. 
They have just released the Spring Allergy Capitals or metro areas list and in that one Charlotte NC (close to where I live) is number 3 - and my home town of Sarasota made the list at 91 (it is 92 on the Asthma list).  Knoxville is the worst allergy city at the current time.  If you or someone you care about suffers from either of these conditions, check out the lists to see what risk factors their home city may have.
The lists and the video are of interest.  The consensus is that this is the worst year on record and that doctors are seeing patients who deny ever having suffered from allergies prior to this year.  This website also lists some resources for treating the conditions.

Sunday, May 15, 2011

Odds and Ends

Smile Plate Lunch - A research study in Texas will involve  a computerized food analysis of what children eat at school.  A special camera will take a photo when the child leaves the receiving line and again when the child returns the tray.  The data analysis will give information on calories, fat, sugar and such that children (conceivably) consume.  I think that is a good idea, but there is one thing that concerns me significantly.  The school is going to send the reports of what a child is eating (individual reports) to the child's parents.  I think that an Institutional Review Board should have flagged that as an unacceptable risk.  Some parents just might not respond well to this information.  I think that there must be a better way to inform parents about consumption habits.   Or here is an idea - IF the food being served is NOT something that is considered health promoting, stop serving it!

Social Cues -  When reading about the causes of obesity or over consumption, it is often noted that people respond to social or environmental cues to eat and not to their body's physiological triggers.  Because we have been responding to outside cues and sometimes pressure, our internal regulation is impaired.  Eating then, does at times require mind over matter, strong will and what feels like rudeness.  I am one of the few people I know that pretty much eats on schedule, when I am ready to eat and not when someone else decides it is time to eat. (Of course, if I know someone is planning a special meal for me, I do try to work around that - what do I mean?  Well, I eat a little less  or a little more earlier so that my body will be ready to eat when it is socially time for me to eat)

the Doritos Index - Do you remember several months ago when I told the story about the school cafeteria manager who said that the honey buns were whole grain?  This goes in the same - huh- category.  I was eating my lunch the other day and someone at the same conference mentioned how she wished she had had time to pack her lunch the night before as the sandwiches and chips that were served didn't really suit her "diet."  She said she was avoiding white flour foods and starchy foods.  They had potato chips and she wanted Doritos, for example.  I kind of wrinkled my brow and asked, sincerely," why are the Doritos okay? " I asked if she had some allergy or if this were some specific diet plan she was following.  She said that she was trying to eat foods that had a low glycemic index - still my brow was furled?  "UM, so - the Doritos are okay because they are orange and not white?"  I think I embarrassed her but I was truly just trying to follow her thought process because this stuff is important to me.  She actually believed that the yellow chips would be better than the white.  Of course I had to look it up, and no, there is no difference.  Chips in general are starchy foods that spike blood sugar - which is what we try to avoid by eating low GI foods. (I have blogged about this in the past.) Oh yes, I forgot this part I actually looked up the ingredients for Doritos before I looked for the GI- the first ingredient on the Doritos bag is whole corn flour.  According to this index from Harvard, corn chips are WORSE than potato chips.

Imbalance - I mentioned a few research articles a day or two ago but had not fully explored the one by Cox, et al.  In reviewing it later, I was just STUNNED that the group of participants that were said to be the Gainers, were eating 1989 calories a day - plus/minus 617 and only half of them were engaging in 1 - 30 minutes of moderate activity a day.  The average BMI in that groups was 40 - which is considered morbidly obese.  You see, they are eating around 2000 calories a day - that is what those labels on our foods all reference- but you do not need 2000 calories a day if you are not doing anything!

Dogs Bite - Because this story involves bicycling, I am going to work it into the blog.  My sister told me a story today.  She lives in a rural area in NC - there are no bike lanes or sidewalks on the roads near her house.  She left out in her car one day and heard a girl screaming for help.  She stopped and found two girls in the woods.  One of them was lying on the ground crying and screaming as a dog had chased she and her friend as they rode their bicycles.  She had been bitten in the leg and was bleeding.  My sister helped her and called 911.  So - bicycle safety is more than wearing a helmet, traveling with traffic and using hand signals.  It also involves being aware of threats from canines.

Saturday, May 14, 2011

Fountain of Youth - Exercise and Work

One of the newsletters that purposefully reaches my inbox is from Medscape and is more clinical than some others. Usually I go to the public health section with only a brief scan of the other “headlines.” This week a story about aging and work caught my eye so I printed it for later and later was today. I am so glad that I read that article and am excited to share it.

It was written by a physician who is affiliated with Emory University, the CDC and the National Institute of Occupational Safety and Health. The doctor/author’s name is L. Cassey Chosewood, MD.

Dr. Chosewood discusses the benefits of working past retirement age and gives fellow physicians suggestions on how to treat or manage the care of their older, working patients. The benefits of working past the ages of 60 and 70 were noted (with the qualification that many persons could continue to work 10 or more years after!) and include:

“Many workers benefit significantly from continuing to work into old age. Work is “medicine” -- even better than medicine for many. In addition to providing economic security and often wider access to healthcare options, work enhances well-being, promotes social interaction, increases the variety and quality of life, and provides many people with a sense of accomplishment and achievement. Although some older individuals work out of necessity, many report that they continue to work to contribute, or to "make a difference." Almost all jobs help older people sustain and extend their physical activity level and support increased social engagement and larger support networks. Work provides accountability for many; an absence from work may serve as the first sign to warn distant family that something is wrong with a loved one. Emerging evidence also suggests that work may improve brain health, sustain healthy cognition, and protect memory.” (The evidence that Dr. Chosewood is referring to can be found in this journal article which is available for free.)

The best part of this article is the encouragement to keep older workers at their jobs!

Just think, Warren Buffet is 80, Alan Greenspan is 85 and Betty White is 89!

Sadly, it was also noted that younger workers have chronic disease conditions related to obesity, tobacco use, lack of activity and poor nutrition that makes their continuing to work a real challenge.

I was also thrilled to see this admonition:

“Remind yourself that chronological age matters little. One 75-year-old can differ markedly from another. When it comes to work, what matters is functional ability, not the number of candles on a birthday cake.”

My Mother is a perfect example of everything that is said in this article. She goes to work because she likes the security it provides her financially, but more importantly, it keeps her engaged and young and of sound mind. I am so damn proud of her - a waitress at 82. Now that is something.

So I close with the last part of the article:

“Although work may not be beneficial for all older persons, for many it is an important avenue to economic security, enhanced social interaction, and improved quality of life. Primary care clinicians can play a vital role in encouraging work when appropriate and by supporting positive health behaviors and interventions that allow work to continue. We can also take steps to manage chronic conditions to support safe, productive work and advocate for our older workers who need special accommodations.”

Thank you Dr. Chosewood for talking to your colleagues about the importance of helping those who need and want to work to continue. (The article includes very specific clinical recommendations, like making sure that the patient stays well, gets well fast, and is not taking medicines that would interfere with their working or driving :)) Oh - and one of those things for doctors to do is advise the patient on specific exercises for balance, core strength and stretching. You must know, my Mom has been “coached” on these things by yours truly - except maybe the stretching.

Friday, May 13, 2011

Take the Combo - but know the difference

Prentice, A., & Jebb, S. (2004). Energy intake/physical activity interactions in the homeostasis of body weight regulation. Nutrition Reviews, 62(7 part 2), S98-104.

Foster-Schubert, K. E., Alfano, C. M., Duggan, C. R., Xiao, L., Campbell, K. L., Kong, A., . . . McTiernan, A. (2011). Effect of Diet and Exercise, Alone or Combined, on Weight and Body Composition in Overweight-to-Obese Postmenopausal Women. Obesity.

Cox, T. L., Malpede, C. Z., Desmond, R. A., Faulk, L. E., Myer, R. A., Henson, C. S., . . . Ard, J. D. (2007). Physical Activity Patterns During Weight Maintenance Following a Low-energy Density Dietary Intervention[ast]. Obesity, 15(5), 1226-1232.

The articles referenced above and others that I have read support what I am about to tell you.  My assertion is NOT new, but research continues to support it.

Most importantly:  Physical activity is essential to health, the prevention of disease and disability, and the ability to bounce back from injury or illness.  Physical activity is proven to boost mood and reduce frailty.  Exercise and weight or resistance training can also improve metabolism.

Everyone benefits from physical activity and everyone needs it.  Current recommendations are anywhere from 45 minutes 5 days a week to 60 minutes every day.

When we are looking at weight loss and maintenance, the studies above show a differential impact by method.  Persons who combine diet and exercise lose the most weight, but in the second study above, the group that only exercised lost about 2% of their body weight while the group that only changed their diet (less calories) lost over 8% of their starting weight.  The combined group did the best at over 10%.  That study was specific to post menopausal women who were predominantly (85%) White.  I found it amazing that the women all weighed over 180 pounds, had BMIs of 30 and above, waist circumferences over 37 inches,  fat percents in the 40s, ate over 1800 calories a day and exercised less than 40 minutes a week.  Actually, the reasons they have high weights and BMIs is explained by their lack of activity and high calorie intake.  I.e. I exercise about 420 minutes a week (10 times more than those women) and eat less than 1800 cals a day. 

The first article listed above was not a research study in and of itself but a discussion of weight gain in Americans as a result of consuming incredibly high calorie, high fat foods and doing very little activity in regards to catching, growing or otherwise obtaining those foods.  The researchers in that piece suggest that the body's physiology has become impaired due to the types of foods that we eat.  Research studies on weight loss are noted in this article and "exercise alone is not an effective means of losing weight."  The reason for this may be, and I have said this before, that it is easier to reduce a certain amount of calories than it is to burn them.  It is also said in this article that low activity can drive the imbalance, but does not cause obesity.  The problem is that we are doing less but eating as if we were not.  But - they contend- the body's ability to tell us to eat less is ineffective.  That being said, as an individual, you have to override the brain and eat what you need, not what you want.

Lastly, the EatRight study followed women who had lost weight during an intervention and found that the majority were able to maintain the weight loss and to do so by eating less calories with low energy dense foods (my Volumetric :)).  The study looked at those who maintained their weight loss compared to do those that did not.  Between the two groups, the amount of exercise was the same.

I understand that the idea of cutting calories is overwhelming and that many people think of restriction and fight to avoid it - but if you learn about food and change the way you cook, it is possible to eat MORE food but less calories. 

Exercise, which is necessary for good health, will assist your weight loss efforts. 

I do not have statistics to back up this assertion, but what I have read and heard is that people prefer exercise over reducing calories - but in practice, they do neither.

None of this is going to work if you do not do it.

Wednesday, May 11, 2011

METS aren't just a baseball team -

To be honest, my post about metabolic equivalents or METs should wait until tomorrow.  I had what I wanted to say in my mind last night, but when I went to write early this evening, I had to reread the article and do some math in order to fully understand what I wanted to tell you.
The information comes from the current issue of the ACSM's Certified News.  The article is written for professionals with the objective of having them educate their clients.  Hence, it is important and I do want to share the information.
For now, let me just say that an MET is a simpler way to consider caloric expenditure as it relates to VO2 max.  The more oxygen our body demands the more calories we burn. 
METS are assigned to certain activities and the higher they are the more vigorous the activity and the more calories you will burn.  However, you could choose a low MET activity like golf and do it for an hour and burn the same as an activity with double the METS that you do for half an hour. 
(I was actually going to delay this post - but it looks like I am half way there - so let me go on)

Exercise recommendations can be found at this CDC website.  Vigorous activity is considered to be > 6 METs. 
Some METs are as follows:  extremely slow walking (46 minutes per one mile) = 2, walking 15 minute miles (i.e. 4 miles in one hour) = 4, jogging at 11.5 minute miles = 9 and full out running =14.  My 10 minute miles are about 10 MET.  Golf is 3.75 and bicycling can be anywhere from 4 to 16.  Here are two charts that can help you to know the MET of many activities.  The first one will allow you to search the document by entering an activity in the box on top - it saves time.  You will need to know the MET to plug it into the formula that I will be providing.

Now we are all different so try not to base your intake on programs that say if you do a certain activity (say dancing) for an hour you will burn x amount of calories.  Most of those equations are based on 150 pound persons and do not include the exertion level.  Even the formula that I will give you cannot be taken as "fact" because there are many variables or circumstances that can impact an individuals' burn.

The second thing you need to know is how much you weigh - in kilograms.  So go weigh yourself..... if its in pounds, divide by 2.2.
Okay - find your activity and think about how much time you did spend or will spend doing it - such that your MET is the number in the chart multiplied by duration.  If it is an MET of 8 and you are doing the activity for 20 minutes, the MET for the formula is 160.

MET*3.5*WT/200 = ~ calories burned

Let us do my run from yesterday  - it lasted 64 minutes and my pace was just over 10 minutes (10:03) Looking at this chart , my MET is 10:
10 * 64 = 640
640*3.5*43/200= 481.6 calories burned on that run.  [my garmin GPS watch calculated 489 and a web based calculator figured 430.]  The formula I have provided here is from the ACSM document and thus, I trust it most.
Now if the person who did that run weight 150 pounds or 68kg, the outcome would be 761 calories.

Remember all of this because my next post may be about the difference in calories burned and calories consumed - i.e. how much food is 481 calories?  Remember also that you burn calories all day and night - and there really isnt' a way to be 100 percent sure of your day to day caloric needs.

Tuesday, May 10, 2011

at Every Age - And then some

I didn't even bother getting the suitcase from the trunk when I reached my apartment at lunchtime today (after leaving Florida at 7 this morning).  I ran in, watered the plants, opened the windows and laced up the running shoes.  I actually ran out to that new dirt loop trail that I found on my last bicycle excursion - oh , you know the one.  I will link the map for the run - it was nice.

I found a paper in the Atlanta
airport - USA Today again.  A feature article spoke of the benefits of physical activity and how it is more important than ever for older persons to stay active or get active.  The journalist notes (through interviews with experts) that we are living longer, but not necessary better as many persons are suffering disease and frailty.  It appears that the best way to prevent that decline is to include cardio exercise and resistance training (weight training).  The resistance training can take several forms, but the important thing is to challenge all the muscle groups in order to keep atrophy at bay.  Take a look at the article itself.  There are several role models to be found - at least two are over age 80. 

The article does not stress core work so much, but it is the key to maintaining good balance and preventing falls.

I expect to talk about exercise for the next couple of nights.  I want to share some information about MET or metabolic equivalents.  This is related to vigorous activity and calorie burn.  I also have more information to share on the differential impact of diet and exercise on weight loss.

Monday, May 9, 2011

In the Company of Others

In thinking of the last few days, I realize that as much as some of us enjoy sharing in the pleasures of decadent gourmet and sometimes just high calorie food splurges - sharing healthy foods and calorie control is also pretty cool.

When I went to dinner Friday night, my friend, as she often does, told me to order first and then said, "I will have that exact same thing." 

Yesterday, my sister made beef, potatoes and corn for our Mom and my brother in law, while we shared a "bamboo" steamed seafood meal - see photo.  {yes, same sister who was a food pusher on Saturday :)}

dinner with my sister, she made heart shaped veggies!

Today, I was with a group of friends who are known both for their healthy,active ways and their love of red meat, fried foods and sweets.  Our server brought special donuts with a creamy, sugary dip at the end of the meal.  One of my friends politely declined the donuts (noting she could not exercise at the same level as our other friend who ate two).  I realized then that it was pretty cool to not be the only one in a group of seven who wasn't eating dessert. 

And at that, my vacation is over and I fly back to NC in the wee hours of Tuesday. 

odds and ends

Simply Fit:  Earlier this week I was watching TV with my Mother and a commercial from the IHOP restaurant chain aired.  The ad was for a Simply Fit Parmesan scramble.  I wanted to see if this was another of those tricks to make us think something was healthy when it really was not.  I was able to find a lot of information about the menu items at IHOP because of the laws that require restaurant chains to post calorie content.  Many of the items have over 1200 calories, some over 1500.  Knowing that, the Simply Fit options that come in at 500 or below, do seem better.  For the shock value alone, I encourage you to view this menu.

Portions, Expressions and Cues:  I read a few research journal articles regarding obesity this week.  One study measured the amount of calories consumed by persons in two groups. IN each group, individuals were asked to watch a TV show.  Group one individuals were put in a room which had a bag of snack crackers that had 400 calories worth of crackers.  Group two individuals had access to the same snack but with 4 individual bags of snacks with 100 calories each. None of the items were labeled.  The only significant finding, (results that were considered to be better than chance differences), was that both groups thought they ate less calories than they did.  Another study, (which I did not really appreciate) - compared three groups of persons, 40 persons per group.  The groups were 5 year olds, 8 year olds and 20 year olds.  The people saw pictures of foods that most people like and foods the most people dislike (they determined this through a previous study) - they also showed a normal weight person eating these foods and an overweight person eating these foods.  That is NOT all - the two "eaters" were either making a happy face, disgusted face or neutral face.  The point of the study was whether or not the facial expression, the size of the person or the food type, or any combination of these factors, made a person more or less likely to want to eat that food.  The researchers wanted to see if children were influenced by the emotional state of the eater and/or the size of the eater more so or less so than adults.  The researchers expected that the negative influence of an obese eater would increase over the age groups as older persons would have been exposed to negative stereotypes of the obese.  I did not read the whole study because many of the findings were not significant and I did not believe in the premise of the study.  I did however, wonder why it was taking place in France - I looked up the obesity stats for France and the rates are very low there. The other study was mentioned yesterday - whether or not people over eat or eat when not hungry in the presence of high fat foods.

Butter with that?  There really is such thing as good fat - monounsaturated fats and omega 3s are often said to be heart healthy.  Heart healthy does not mean calorie free and you can have too much of a good thing, but you should have some of this good thing.  My mother works at a seafood restaurant and told me that people order grilled salmon (yeah!  awesome good fat food) and then ask for melted butter to dip it in.  WHAT???  Butter is not a heart healthy food, but more importantly, why would someone add fat to their fat?

When meat matters:  Meat matters when you are a lion.  I heard a story on a national news cast - but only caught the middle. There is a zoo - somewhere in the world - that is without funding.  The staff has not been paid in weeks or months and animals are starving to death.  The reporter stated that one or more of the lions died after being fed vegetables.  I was really bothered by this story and I know that people in America and elsewhere, would THROW their money at this zoo - but I do not know what zoo it was and why they haven't asked for donations.

CHF: Yesterday after my Mom and I went to the movies and were waiting for our dinner table (you are getting my Mother's Day theme aren't you?) I came upon a woman who was promoting the bicycle ride across the country that is raising awareness and possibly money for the Children's Heart Foundation.  I told her that I would put a link about this on my blog.  This regards heart defects that are present from birth and not related to lifestyle factors.  To keep my word, here is the link.

Saturday, May 7, 2011

Food Pushing in the Family

The carry over from yesterday will have to wait one more day.  I told my family that they were blog material for tonight and I am sticking to that. 

Today my sister, whom I have previously mentioned as a super successful Weight Watchers graduate and now life time maintenance member, made a decadent breakfast for our niece and our niece's guest.  My mother and I were invited as well. 

My sister is very wise about foods and cooking techniques and keeps her weight stable (this is true of the last five years or so).  She is a fantastic, thoughtful host.  I believe I have blogged about the special care she takes in making sure that I have low calorie food options at all our get togethers.

Today she was not catering to me (:)) She made thick bread french toast, a cannoli filling spread (ricotta cheese and sugar, basically - I can't tell you everything - family secret), served fruit and Greek yogurt and a type of sausage.  She had butter on the table as well, but I do not know why.

Her first comment regarded people being shy or something to that effect.  She noted that everyone had only taken one piece of french toast.  I think everyone then took another.  Her next comment went to my mother who reached for the sugar free syrup - as if it were sinful and had to be a mistake on Mom's part.  Then she admonished my niece's beau to eat more, he declined and she "pushed"  - I called her out, she embraced it, we all laughed and my niece said that she would gladly be pushed and took some more.  She also reached for the sugar free syrup and almost got her hand slapped - she accepted the regular syrup.  My sister referred to the sugar free as not worthy to be poured on her french toast - so we asked why it was on the table.  Oh, she said, she put it on the table for ME.  [I was eating eggs and fruit - not french toast)
We did add - in our joking- that my niece, who ate the most, only paused between filling her plate to go and have a cigarette.
It was all in fun - sort of - I am still anti food pushers.  If someone says they have had enough, they have had enough.  Believe me, many people have had enough.

Interestingly, the research articles I have been reading these last two days are about external cues to eating - such as readily available high fat foods, large portion sizes and serving plates as well as social pressure.  Some of the theories being tested are that overweight persons do not respond to internal cues to eat - i.e. hunger, but to external cues. These persons are especially susceptible to overeating when (high fat) food is around and also eat when they are NOT hungry.  Another thought regarded eating all one needed vs eating all one wanted.  In these two small studies, and others before them, normal weight people are more in tune with their internal cues and do not give in to external cues or pressures.  A person may become overweight because they had this lack of self regulation in the first place, or vice versa.

In sync with these hypotheses, the man who refused the extra french toast was one of the normal weight people at the table :)

Friday, May 6, 2011

Both Sides of the Equation

I had several things come to my attention today through various sources; email, journal articles and an IHOPS commercial that warrant blog attention. I  am going to stick with the two emails for tonight.

Calories in - A former colleague and current friend emailed me today to let me know that she pulled a Deirdre.  If you have ever worked with me, you would know exactly what she meant by that and some of you who are reading, have in fact, worked with me:)  I absolutely live and breathe what I write, read and talk about - 100% of the time (no matter who is there, what is the occasion, and what everyone else is doing).  This requires me to bring my own food to most events - at first, years ago, I just thought about me - or didn't go at all, or ate before I went.  When I brought my own food, but only enough for me, people wanted to know what it was, how I prepared it and what it tasted like.  I then started to bring enough to share and found that people often were grateful to have that as an option.
My friend Jess is a Mom - a conscientious mother of a finicky four year old (I think her daughter is four). Her daughter's school was having an event and the parents were asked to bring in treats to share - Now I suppose the word treat has a certain "sweet" and high caloric connotation, but my friend considered a treat to be something extra or special and brought a veggie platter and fruit tray.  All the other "treats" were what you would expect, brownies, cookies and cupcakes.  Mind you, my friends daughter is on the low side of a normal weight - and just like me - one day she will be saying that she looks like she can eat anything not because she CAN, but because she doesn't.  Did I say, the teachers were THRILLED to have this healthy addition to their appreciation luncheon.  Strong Work Jes!

Energy Out - and for this delightful news - I will post a link.  Michelle Obama (and hundreds - thousands? of children) celebrates Beyonce's promotion of physical activity - song and dance - Get Moving indeed!

Thursday, May 5, 2011

What is it and should you care?

The lady who sat to the right of me on my first plane ride this morning, lent me her USA Today when she was finished.  There were several health or public health related articles in today's edition but the one that I understood the least regarded information from the CDC.

The CDC is concerned that persons over age 50 who may have kidney disease or be otherwise  compromised, are eating  lunch meat and hot dogs without heating them to a relatively high temperature of 165* or steaming hot.

Lunch meat is susceptible to a bacteria named listeria which can lead to a deadly food born illness.  AT the same time, a spokesperson from the American Geriatrics Society noted that most every senior she knows does not heat their lunch meat and does not get sick.

This sounds like another serious but rare illness.  What the article didn't explain is how someone would know if they had the illness.  I did find the symptoms on the mayo clinic website.  Actually, that was the second website I visited. The first website I found was a little better at describing the illness, but then I noticed that it was run by a law firm that sued companies who were responsible for food born illnesses.  Really.

I will post the CDC information from their own website which describes the bacteria, how it gets into our system and the symptoms of the illness.  You can make your own informed decision on what to do about lunch meat - like switching to fried bologna sandwiches.

Wednesday, May 4, 2011

Skin Cancer Survey Triggers Questions.

I started this blog(site) because I like to go beyond headlines and explain things to people from a health educator stand point. That passion is one of the reasons I  went back to school.  I want to improve my skills in reading, evaluating, and reporting research.  In time, I could be making my own  headlines.

Well, it seems that my critical thinking has improved, though it doesn't necessarily lead to better explanations of research articles. In fact, tonight I found myself going back and forth chasing down all sorts of validity issues with the survey results presented in this article.

I have spoken out about the dangers of tanning and tanning beds in the past. I do not question the results of this study that young white women tan too much and that the risk for melanoma is increased by this use.

My first questions were about the survey itself. (I just completed a course about survey design research).
We can see that 3800 women ages 14 thru 22 responded to the survey. It was an online survey and it was meant for white women. The survey results summarized in the link above are as follows:  of those women who responded, 32% have visited a tanning salon and 25% of that number do so once a week. The article also states that 81% of the women tan both indoors and outdoors - this is unclear, but I think that it is 81% of the 32%. You can do all that math.

So how were the surveys disseminated? How did the research agency target them? Who didn't respond? In survey research, we always want to know if there is something different about those who did not respond. Also the results noted much higher use in the older girls, older being 18-22. Some places have limits on the use of the beds by age - so that is important to note when giving results. Anyways - I could not find those answers - no sample characteristics or research design is provided - the study is not published in a journal which leads me to believe it was more like a little poll.

Then I looked at this 75% increase from the use of the beds. The American Cancer Society provides the rate of risk by various age groups for the ten most common cancers - you can see it here. If we look at life time risk of melanoma for women, it is 1.79. Thus the 75% increase, would be 1.79 + (1.79 * .75) = 3.13. That is a 3 %  lifetime risk of this type of skin cancer, if you use tanning beds. I got a little shock when I looked at the top of the cancer chart - our lifetime risk for getting cancer of ANY type is 50% for males and 33% for females.
But again, if you go down the column on the right - 1 in 56 (the average melanoma risk) is about the fifth highest cancer incidence for women -  the top is breast cancer at a 1 in 8 chance (1.2%).

As I was searching for information, I saw where the state or city of NY is attempting to ban the beds or ban them for girls under the age of 18. The legislator behind the bill has been a lifeguard and has had melanoma. He was quoted as saying that melanoma was the most common cancer. That is not true and I cannot figure out where it is coming from, because the CDC had the same statement, but the same real cancer numbers as the ACS.

By number of new cases per year and cases of death per year, melanoma falls quite short of being the most common. It comes after lung, colon, breast and prostate.  I have shared this cancer chart with you in the past, but take another look.  The only thing I can think of is that melanoma is the most prevalent. Meaning people keep being diagnosed with it and not dying from it so that at any given time it is the cancer that most Americans have. Make sense?

And to my dear math friend who reads my blog - if I did that 75% thing wrong PLEASE correct me :)

I have a very early flight tomorrow and have no idea why I am still sitting at my desk - but I will log off now and dream of my day at the beach tomorrow ...