Thursday, May 31, 2012

Putting Your Fruit Where the Cookie Was

I attended a community forum tonight - the second part of the one I mentioned early this month (where they had two cookies trays and only one fruit tray).  There was no food this time, which in my opinion, is better than calorically dense nutrient poor food.

This particular group of folks is focused on providing food for our community poor.  One way is in assisting food pantries in disseminating whole foods and better foods by soliciting donations from stores, farmers and restaurants. Not exactly what my research interests involve, but it is a worthy venture to be sure.

Tonight we sat in small groups and brainstormed ideas to address food insecurity.  I sat at the restaurant and grocery table.  One of the persons at my table was the co-owner/manager of a local co-operative food store, Deep Roots Market (Greensboro, NC).  As I did mention my concern about calorically dense foods being heavily marketed, cheap and convenient to the point of  unavailability my new friend offered this.

At the Deep Roots Market, kids always get a free piece of fruit to eat while the adults are shopping.  This helps to keep kids happy and healthy.  I told him that was super awesome and would totally get in my blog!  Everyone I meet is subject to finding themselves in my blog.  The only thing I failed to clarify... I hope that it is always fresh and not dried fruit... which of course, would be calorically dense.

Wednesday, May 30, 2012

Stand Up and Work

The European Congress on Obesity met earlier this month and another research study that reviews the relationship between sitting time (at work only) with the risk of death from any cause and from causes related to cardiovascular or metabolic diseases was presented.

{Metabolic disease refers to inflammation markers such as high cholesterol, high blood pressure and abnormal blood sugars.  Cardio refers to the heart and vascular refers to the circulatory system (blood, arteries, etc).  Someone who dies from these conditions could have a heart attack or stroke, for example.}

In this type of study, researchers ask people some personal questions (hopefully they tell the truth!  Some studies include lab work and in person weighing) and then years later (in this case it was 12-14 years)  the researchers review the deaths that occurred in their sample.  They will go back to those original answers and see what is different and what is the same about those who did and did not die.  The researchers will analyze the data and then say things such as, "more likely" or "greater odds" of death in relation to something - in this case, sitting time at work.  This is not an experiment so we cannot say that sitting causes anything.  The participants involved here were from Norway so the results may not apply to other countries.

The results (for this group) show that as weight goes up so does the rate of death.  When sitting time goes up (4 or more hours), so does the rate of death.  They are both positively associated with dying when compared to people who either weigh less OR with people who sit less.  When the researchers looked at effects of sitting time (at work) in weight groups - they saw something a little different. Normal weight persons, about 40% of the sample, had the same rate of death whether they sat at work or not.  Overweight people compared to other overweight people had more deaths if they did not have a job that involved walking or physical labor.  The same finding was true for obese persons.  Sedentary-at-work obese people were 27% more likely to die during the study than obese people who did walk on their jobs.  The differences were even higher when looking only at heart and metabolic disease deaths.

These findings held true regardless of gender or time spent exercising. 

I read a great review of the study written by Daniel Keller, PhD but I did not read the actual study.  The lead researcher was Anne Grunseit Phd, from Australia.

The lead author and other experts said that its important for people to get up during the day and that standing during meetings was not a bad idea!

Those Lazy Golfers

Physical activity is something I do more than something I study.  But sedentary behavior and its health outcomes intrigue me.  Many of the articles I read on obesity causes and prevention strategies, will mention the amount of physical activity that Americans engage in and that we have more sedentary time.
The article I mentioned Sunday, by researcher Roland Sturm, went over some of the changes in our energy expenditure - supporting still that the increase in the calories we consume is far greater than the decrease in the ones we burn.  
He was discussing that it is a myth that Americans spend less time in leisure activities.  In fact, we have increased the amount of time we spend doing things besides work and chores.  But Sturm, as Swinburn has, notes that the type of leisure activity we engage in has changed.  Our leisure is sedentary - or sitting, passive.  
Not all of the change was purposeful.  One instance he noted was related to a technical advance and an unintended consequence.  Golf and the golf cart.  Sturm said that golf carts came into the scene so that people who were unable to walk more than a few feet could still participate.  Then some people who did not need carts started to use them too - THEN, walking golfers started causing backups on the course and began to get dirty looks and such. Now most people use golf carts and it is not as active a sport as it used to be.

Sunday, May 27, 2012

Odds and Ends

A few blurbs from the news and my readings this week, which sometimes converged.

Bacon, Veggies and CPI: A financial analyst from CNBC noted that the price of bacon was falling because there were too many pigs. Jane Harris also reported that lettuce was down 30% and tomatoes 20% with an overall price reduction for vegetables of 10%.  Interestingly, I read an article by Roland Sturm this week and in his article he placed a chart with a graph of the Consumer Price Index (CPI) and showed that as the CPI went up so did the prices of some foods.  In his chart, the index for sugars and sweets remained below the CPI line, but the index for fruits and vegetables soared above it.  In 2002, the CPI was 180 and the fruits and veggies were marked at 260! 

PSA:  News came out this week that due to the unreliability and absence of life saving benefit, the prostate specific antigen test as a prostate cancer screening measure should be revisited and possibly curtailed.

Soda and SNAP: I listened to an official with our (US) governmental nutrition supplement program speak against policy that would disallow the purchase of sugar sweetened beverages or soda with program dollars.  As I thought about his argument; discrimination, enforcement and embarrassment, I had a couple of counter points.  Let's consider SNAP (formerly food stamps) and WIC.  I believe that recipients cannot use these benefits to purchase tobacco or alcohol.  The people receiving SNAP and WIC know this and tend not to "try" to buy them.  This obviates any embarrassment that would occur when the system (cashier) tells the customer, sorry that is not allowed.  More importantly, another government entity has determined that there is no nutritional value to these beverages - they are empty calories.  SO, why would a nutritional program pay for something with NO nutritional value?

Food Deserts: The more I read the less I believe.  People do have access to grocery stores and supermarkets and research shows that in some cases, the density of stores is associated with higher BMI not lower.   This is counter to the arguments on food deserts, but I can explain it.  The same toxic environment of a 7-11 is alive and well in the grocery store.  I.e. high calorie foods are cheap and mercilessly promoted in the aisles.

Calcium: You CAN consume too much and calcium needs, unlike vitamin D, can be easily met through food sources.  Researchers from Switzerland raised concern on the issue this week.  They note that supplements may not be necessary for all people, esp.  women who take them the most, and that excess calcium intake is associated with heart disease.  [actually, my mom recently decided to eat a little more hummus and less cheese because of her high calcium intake - she didn't have to wait for these scientists - she has me :)]

What do you want to weigh?  I have saved my favorite for last so I hope you are still reading.  I received an alert in one of my Linked IN groups on a NY Times article where Carson Chow from the NIDDK was interviewed.  He is a mathematician.  As I read the article I realized that Chow was one of the authors on the study discussed both here and here. The NY Times article is certainly an easier read than the journal article I reviewed and you may want to read it yourself - click here to do so.  Two things stood out for me, or one thing stood out for two reasons.  As you may recall from my past posts, Dr. Hall cautioned that a 100 calorie reduction in intake might cause 1/2 the goal weight loss in the first year, but it could take 3 years for the total loss to occur.  Weight loss is not a fast process when the change is small.  Chow talks a little bit about the other side. Weight gain can also be slow (not if you keep adding calories, but if your additional increase is stable - that same 100 calories say).  He talks about averages - average intake.  Saying that if on average the caloric intake is balanced, weight gain will not occur. (this also argues against only cutting calories on some days of the week for weight loss to occur, because on average you won't be eating less).  I know that he is right because I see my sister eat very well 'on average' and she looks great - maintaining a significant weight loss for several years.  I remember that my father used to tell me the same thing.  The problem is, most people do not control their intake on any day - none the less, on average.  I am uncomfortable deviating from my daily goals (because of problems like that), but this article and the very cool simulator provide evidence against my fears.  This version, much different than the excel document Dr. Hall sent me a year or two ago, is much easier to use.  If you use it, you can determine how long it will take you to reach your goal based on what you are willing to do calorie and activity wise. I really encourage you to check it out.  You may get a window that asks if you want to accept the applet - a computer issue.  I went ahead and said yes, but you have to make your own decision there.

Saturday, May 26, 2012

Sleep Apnea and Cancer

When I heard news this week that a study found an association between sleep apnea and cancer, [ persons with sleep apnea, compared to those without it, where over 60% more likely to be diagnosed with cancer] I thought.. wait..... is that the statement we need to make?

Because the majority (but not all) of the persons with chronic obstructive sleep apnea (OSA) (stopping breathing while sleeping) are overweight.  Overweight is directly tied to cancer and it is also directly tied to OSA - the problem maybe not OSA but weighing too much.  The National Heart Lung Blood Institute is a good place to get more information.  Click Here.

Many articles and health sources suggest that weight loss can reduce the problem of sleep disturbance and the adverse metabolic changes that occur when one does not get a restful sleep.

This particular article shows a relationship in the rise between obesity and other health related problems including OSA.  It is long past time for the country to eat less.

Friday, May 25, 2012

Special Treats for 1$

Burger King or BK is promoting 4 new beverages and this weekend they are all available for one dollar.  I did not realize that they were going to be on sale when I searched them out.  I recently saw an ad for Real Fruit Smoothies.  I thought, a less nutrition focused consumer, might see this ad and take it for granted that a smoothie made from real fruit would be a nutritious, low calorie treat.  Unfortunately, the nutrition information that BK provides, leaves out the items that could help us assess nutritional value.  I think, however, it is a safe bet that IF the drinks were high in something we need, like potassium, vitamin D, calcium or fiber, it would be mentioned in the promotional language.

Instead, the four new drinks, two smoothies and two frappes have an average of 415 calories  6 g of saturated fat and 55 grams of sugar.  But the averages are misleading.  The fruit drinks don't have any saturated fat, so that means the coffee drinks have 12 grams of sat fat each.  Not to fret, the high fat drinks do have less sugar.  The coffee drinks have 49 g of sugar and the fruit have 60 and 63g (banana has the most sugar).  

Because all of the drinks have below 3 g of fiber, the coffee drinks having none, they qualify as sugar sweetened beverages.  SSBs are ones we should avoid due to their empty calories which add substantially to over consumption in the American diet.  The drinks are also a poor source of protein.  In essence, a person would waste 300 to 500 of their daily calorics (because they would still have to meet their nutritional goals but have only 1200 or so calories left to do so).

BTW, this information relates to the medium size drinks. 

And thanks BK for adding to my 'evidence' that calorically dense foods are cheap, convenient and heavily promoted.  
 I wonder if I could hire you guys to sell fruits and vegetables for the government?


Thursday, May 24, 2012

Lives vs Dollars

The pharmaceutical  industry is constantly a point of contention for me.  I continue to have ambivalence regarding its worth or maybe its motives.  I am aware of the benefits that certain drugs impart. They can be as simple as treating a headache, rash or infection, to managing a chronic condition > improving quality of life > preventing the chronic disease from becoming a less treatable one, to curing cancer, dissolving a blood clot and many things in between.  

My life and the lives of those I love have been enhanced if not saved, with medicines, the positive side of the drug industry.

However, because I keep track of financial news on drug companies, I am acutely aware of the free market, for profit side of our medicine making. In this context, it doesn't feel like an altruistic "save lives" venture, but a capitalist driven "make money" one. And making money is OK!  The investment and the risk for companies is great.  I understand and that is why I am conflicted.

In order for companies to profit, more people need to take the drug, the drug needs to be used long term and it needs to be a multipurpose drug.  This results in a great number of people taking drugs they do not need and people taking drugs for longer than is medically necessary.

Currently, some of the big drugs - ones that treat conditions a majority of Americans have (like high cholesterol), are coming off patent.  Companies stand to lose billions when generics enter the market.  This is so scary for shareholders and CEOs that one blogger referred to this and the next year as Pharmageddon. That declaration speaks clearly of the profit making drive of the companies and their investors.

Wednesday, May 23, 2012

Bicycle Diaries

Two stories does not a diary make - but it was a catchy title.

As I was walking around the block the other day (as to not sit for more than an hour at a time), an older neighbor was riding his bicycle.  I had seen him before - he just seems to be killing time, not cycling for transportation or fitness.  I believe that he has seen me riding my bike to class.  On this particular day he said something about my not being on my bike and I said, "Oh, I just got back from riding it to the grocery store."  Which was true.  And, I had to add, because it was also true, "But I was wearing a helmet." (as he was not) His response to that was something like, "I go too slow for that to matter."   I replied, "Your speed doesn't matter when the car hits you!"

My second story has to do with the cycling group that I met up with about a year ago.  They are a mixed group, my age and older and super welcoming.  Some of them have body shapes that are atypical for cyclists.  A reason for this could be ascertained from an email one of the riders sent out yesterday, HOURS before the ride was to start....
"Looks like rain. I am bailing for ride this eve. But if anyone wants to meet. Hams Battleground Ave for $3 burger at 6pm."

Tuesday, May 22, 2012

Moderation: A Vague Recommendation

Today I read a research article written in 2002.  The study involved the Dietary Guidelines for Americans (DGA) 1995.  It assessed the awareness and knowledge of the recommendations in one specific geographical location.  The design of the study was a telephone survey.  The people telephoned lived in a few zip code locations in one state.  The results were not promising.  (citation)

The majority of the 400 people who answered the questions had no idea that the government issued nutritional advice, could not name them (the Dietary Guidelines for Americans), and when they were aware of guidelines, they often incorrectly identified them.  On average, the respondents provided two right answers.  For 1995, there were 13 specific recommendations.  

The authors were concerned that the guidelines, in existence since 1980 and updated every five years, were not changing anyone's behavior.  Their particular study did not measure behavior but I hope to do so in my research career.

What is worth repeating are some of the specific limitations and suggestions that were offered in the article.  They are similar to issues I have discussed over the years, though I had not read this article before today.  

Consumers are confused.  They do not (in general) understand the (%) percent recommendations, i.e % of calories from fat or % of DV (daily value) that are promoted and identified on labels.  The scientists suggest that the guidelines use language that the public uses instead.  For example, state specifically that one needs less that 300mg of cholesterol a day, or 65 grams of total fat (a number in line with the 1995 recommendation of 30% fat (obsolete now) instead.  They caution against vagueness with this statement:
 Health practitioners are urged to avoid providing nonspecific and vague advice to consumers such as "balance" and "moderate."
 What we tell people should be direct and simple.  This reminds me of something a man said to me on Saturday.  I was in the trail parking lot waiting for my friend and he was waiting for his brother.  He saw my Eat Smart Move More sign in the car window and asked ME, "How does one eat smart?"  HA, he asked ME.  

He shared that he had done well with his weight previously.  He was drinking wheat grass and lots of carrot juice that he made from his own juicer.  He doesn't do that anymore.  Really? Too complicated?  Weird even?  Nothing in the recommendations advises one to drink their calories.. NOTHING.  And in fact, recommends against too much fruit juice.

 Keenan, D. P., AbuSabha, R., & Robinson, N. G. (2002). Consumers’ understanding of the Dietary Guidelines for Americans: insights into the future. Health education & behavior, 29(1), 124-135.

Monday, May 21, 2012

A Truly Inconvenient Test

When considering cancers we often ask which is the most common but that doesn't tell the whole story.  We would also want to know which cancer causes the most death (from the disease).  The numbers are not always the same.  For example, most people do not get lung or colon cancer, but they are top killers because of a lack of treatment options.  When looking at men and women together, because we ARE different, colon cancer is the second largest cancer killer.  You can learn about this cancer, and the risks for it at the website of the American Cancer Society - click here.  The lifetime risk for colon (including rectal) is about 5% .  It appears that, lung, breast, prostate and colon have similar rates of new cases per year, but colon kills second only to lung.

Colon cancer CAN be prevented and this is where the messy, inconvenient test comes in.  The colonoscopy.  The procedure can find pre cancerous lumps or polyps and they can be removed.  People who are not at high risk (explained in the ACS link above - are currently recommended to have the test at age 50 - and then in ten year intervals)

To see some of the past posts on this procedure and its place in the prevention of colon cancer, click here.

The upshot for all those past posts is that I am crossing my fingers and biding my time for a screening that does not involve the colonoscopy as it is performed today.  I cannot believe that with all the technological advances of the 21st century - we still have this to look forward to (see below).  I suggest that the geniuses at Microsoft and Apple get into medical testing... (not that the virtual colonoscopy hasn't been created, it just needs work to be accepted and effective).

My walking buddy(well one of them), too young for a test, had to have one anyway - a few weeks ago.  I had her tell me every single detail about the procedure.  And, this is a horrible thing for a heath educator/promoter to say - but several times during her very detailed narrative I said, "I am NOT doing it."

I am not sure what I am most concerned with  - a two day bowel cleanse  - which dehydrates you to the point of being told to drink gatorade - or the anesthesia - prophenol is now being used by some providers to put you under "deeper."

The part about a camera being inserted through the rectum - as my friend described it - is maybe the least of a deterrent because, for her, there was no discomfort or no memory of a discomfort.

To continue with the full disclosure, after the procedure, which requires air to be "inserted" in the large intestine, the 'patients' have a lot of gas to expel.  In fact, the nurses won't approve your discharge (from the out patient procedure) until you pass a predetermined amount of gas - My friend assured me that this started as soon as she woke from the anesthesia.

So again I say, REALLY?  We can't do better than this in the year 2012?  Come on....
For more details, well, of a different sort, WebMD offers an overview of the the test, prep and rationale here.

Sunday, May 20, 2012

Odds and Ends

Sleep Routines:  Funny that the first day of my 2 day abrupt schedule change (having to get up at 7:30 instead of 9:00), my news radio alarm began with a story about sleep inconsistency and increased risk of obesity.  (meaning, it is not a good idea to sleep in on the weekends, according to the report)

Science Debunked: Good Cholesterol, or HDL in and of itself is not necessarily enough to reduce adverse health outcomes related to heart disease.  I was going to talk more about what the newest study found when I read the linked post and I think that the reporter did a great job, so I refer you to the hyperlink under the words Science Debunked.

Alzheimer's:  Good news that a substantial amount of research dollars are now being funneled to test certain ways to prevent Alzheimer's Disease or its progression.  This is a horrific, brain wasting disease and preventing it is a desperate need.

Food System: A simple example of the way environment or context makes the healthier choice harder with regard to price. I was at a Cultural Center recently and went in search of the water fountain.  It happened to be next to the vending machines.  Of course, the water from the fountain was free, but in the vending machines, it was $1.25 while the sodas were $0.75.

Heart Attack beyond Life Style:  This week we learned that one of our most over used medications, an antibiotic, was associated with increased risk of sudden death from heart attack.  In a study that showed very few deaths overall, the more expensive Zithromax increased the chance of death when compared to people who were taking the cheaper and less convenient (longer course of treatment) amoxicillin.

Bottle Cap Collector:  In the recreation center(gym) I saw a smaller recycle container next to our commingled one.  In my state, you do not have to separate paper from plastic and glass.  Anyways, I had never seen the shorter container before, but it was specifically labeled for bottle caps only.  Pretty cool!

Thyroid Cancer:  One of my friends told me that she heard of a new warning regarding radiation through medical testing and this particular cancer. Radiation is one of my hot topics so I was interested when she said that thyroid cancer cases were being linked to mammogram and dental X Rays.  However, I follow the advice that I give to you and did not just take her word for it.  I went back to the Presidents Cancer Panel report - the one that lists environmental causes of cancer, such as medical radiation.  Again, the bigger concern is with CT scans and much less so with dental X rays and mammograms, though mammograms do exert more radiation than Xrays.  I am not going to review the report again, but you can search my past posts for a lot of information.  I suggest that you go to the report yourself and revisit table 7 which shows doses of radiation associated with different tests, but focus on the right column.  Also, I think I missed this last time but Appendix F shows which cancers have been associated with which chemicals or exposures and whether or not that is strong evidence or just suspected.  Thyroid cancer is on the list.  I provide snap shots of these two items below to entice you.


Hepatitis C VirusBecause the US government (CDC) is suggesting that all persons born between the years of 1945 and 1965 (that is  70 million people) be tested for the virus and this recommendation is making the news airways, I have a few questions and their answers.

What is it? A viral infection which targets the liver
What does it do? It causes inflammation and scarring as the virus attacks the liver.
How do you get it? It is blood borne.  Sharing needles with an infected person or receiving a blood transfusion from a person with the virus are the primary causes.
What is the test for it?  A simple blood draw.
What is the treatment?  An injection and oral medication can clear most but not all of the virus.
What is the prognosis? It has an acute and chronic phase and there are no symptoms.  It can progress to cirrhosis or liver cancer.  These illnesses can be fatal.  Liver cancer and cirrhosis kill about 8 to 10 thousand people  each year (USA), but hepatitis C is not the only cause of these two illnesses . (furthermore, greater than 400,000 people die from tobacco related illnesses a year, more than 400,000 people die from obesity related diseases a year, and heart disease and cancer account for over 500,000 deaths per year separately)

What are the Hep C numbers? I am not a math person, though I am getting better, so if these calculations feel wrong to you, I welcome corrections.  Either way - these are just my out loud musings.
There are 70 million people in the group that the CDC considers to be at risk and in need of testing.  That is 30% of the adult population of approx 234,564,000.  In general, 2% of that larger number has hepatitis C.  The number I read was a little less than that, 1.36% - or 3.2 Million (from a WSJ article on Thursday).  The target population, those boomers, have 2/3 of the cases, 2/3 of the 3.2 Million.  Not very many.  I am not sure how to wrap my mind around the boomers having a five time greater risk of hep c than the general 2% risk.  I am not sure if the risk for the new group is  2.1% or 3%  (but it is low).  Also, the average baby boomer, I suspect, has not had a blood transfusion and did not use IV drugs, so I am not buying this 'crisis'.  I did read that the CDC is concerned that those boomers who DID engage in recreational IV drug use might not want to admit it now that they are 50 - 65 years old.  The strategy then, "why not just test everyone to save some lives and remove the embarrassment factor."  It probably is cost effective.

The evidence to support hep c transmission from tattoos, piercing, sex, etc is quite limited.  The primary ways are again IV drug use and transfusion - blood is the common denominator.

There are at least 3 hepatitis viruses, Hep B has a vaccine, Hep A usually clears itself from the body without harm and Hep C can be acute or chronic. It is important to have the disease diagnosed in order to protect the liver and increase survivability.  See this CDC website page for more information.

Friday, May 18, 2012

Coffee Drinkers Live Longer

UNLESS - they are coffee drinking smokers.

This study caught my attention because I often hear people say they are going to stop drinking coffee and my response is always the same, "Why?"

 I thought that I could read the research (summary) abstract from the study by Freedman, Park, Abnet, Hollenbeck and Sinha (N Eng Jour Medicine, May 2012) and be satisfied to give you the highlights.  However, the summary doesn't answer a fundamental question - is it only regular coffee that provides a benefit?

I will get to that, but before I do - here is the bottom line.
The study involved a large sample of men and women who were enrolled  by AARP.  Over 80% of the sample was white, and only 6 states and 2 municipalities were represented. The people were between ages 50 and 71 at the start. The study lasted from 1995 to 2008.  In 1995, people were asked questions about their lifestyle habits (including a food frequency questionnaire), disease conditions and other things, like age, gender, race, etc. All of this was self reported so there could be some mistakes. To be in this particular substudy, the people could not have had heart disease,  history of stroke or cancer in 1995.  At this one time only, the researchers asked them how much coffee, in cups, they drank per day.

By 2008, 14% of the 229,119 men had died and 11% of the 173,141 women had died.  

When the researchers did not control for smoking, it seemed like coffee increased all causes of death - because a majority of smokers drink coffee.  But in statistical analysis, a scientists can make it as though smoking didn't happen or that everyone was "the same age"  so that the only difference between people is coffee consumption (they controlled for eating habits and exercise level, as well). They analyzed the results separately for men and women. When controlling for these other factors that are known to be related to heart disease and cancer and all death, coffee drinkers had  a lesser number of deaths in the study period than non coffee drinkers. 

When reviewing the methods in the full study, I found that over 90% of the people did answer the question "Is the majority of your coffee consumption caffeinated or decaffeinated." 

The results for all death as reported by the authors, is that men who drank 6 or more cups per day had 10% less death and women had 15% less death than those of each gender who drank less than one cup a day.  They also broke it down to show less incidence of specific diseases in coffee drinkers.  They include a really cool graph showing coffee drinking and risk vs protection for many different diseases.   For all the diseases they mention, coffee is protective EXCEPT cancer.  It either increased the risk of cancer death in men and women, or was neutral, but it did not protect against it.  This makes sense in my real world experience as my dearest, most beloved aunt, drank coffee from sun up to moonset, smoked just as much and died of lung cancer.  I miss her a lot.

So -It is an interesting study.  Not perfect - and it doesn't make causal determinations, it can't.  But in this group of older white folks, coffee drinking seemed to lower risk of death from all causes and specific causes. The findings held regardless of whether the coffee drinker usually drank regular or decaf!  

What you also need to hear is that it is something in the COFFEE not in the caffeine. [maybe phytochemicals] You cannot take the caffeine out of context and expect the same results (i.e. don't start drinking energy drinks, or assume that tea or soda does the same thing - it might, but this study doesn't tell us that).

Here is the link for the free summary.  

Now, time for my evening decaf cappuccino.

Thursday, May 17, 2012

"Mass Medication"

I listened to a story on the BBC World News as I drank my morning coffee (more on coffee tomorrow!).  It regarded the suggestion by some researchers that statins or cholesterol lowering drugs, be given to most adults over the age of 50 - in the UK. 

High cholesterol is a risk factor for heart attack and stroke.  Lowering levels of cholesterol can greatly reduce cardiac events and deaths from those events.  Statins are only one strategy for the reduction.

In a meta analysis (a study that looks at many individual clinical trials), persons who were not at high risk but received statins had less heart attack deaths and events than similarly 'healthy' people who did not receive the medications.

The UK has a national health plan and it is now considering whether or not to approve these drugs as routine care for adults over age 50 who may have only a 10 to 20% increased risk of heart attack or stroke.  The medications are cheap (now) and would save the government a lot of money in the long run (all those heart procedures are costly!).

The side effects, which are minimized by some of the researchers are NOT minimal to me.  To be honest, not everyone experiences the side effects and the degree to which one might experience them can differ.  Complications include kidney failure, muscle weakness, cataracts and diabetes. (and I suppose if one starts the medications at age 50 there is less time for these side effects to become disabling.)

It may cost the government little money to use pills and it is certainly politically and socially acceptable, but it doesn't get at the real problem. IF entire countries, and there are many, have a life style related cholesterol problem, the food system MUST be targeted or the problem will keep recurring.

I find prescribing medications to low risk adults as untenable as prescribing  them to high risk ten year olds.  Medication should be the last resort.

I located the story in print and share it with you here, but I want to requote another scientist.  Dr. Ebrahim conducted a different study and then warned of the risk associated with side effects and over reliance on these drugs:
He questioned whether it would be good for people or society to resort to mass medication for lifestyle issues.
I second that concern and raise it higher.

Wednesday, May 16, 2012

Breaking Routines

It can be empowering to do something different.

For the past 2 days I was required to be in meetings during the time that I would normally be 1) sleeping and 2) running.  Many(all) people who know me on an 'in person' basis, consider me the most routine oriented person they've met.  I expect that could be true and I will add that it is a positive thing.  Remember, "Everything I needed to know, I learned in Kindergarten."  Schedules prevent 90% of daily conflicts.  

At the same time, the ability to break from a routine can be important.   I did get up at 7:30a.m. instead of 9 a.m.(both days) and I ran in the afternoon/evening instead of  at 10:00a.m. (noting that it would have been a rearrangement of weight training and swimming if the meetings had been held on Mon or Thurs).

My decision to run at a different time wasn't as simple as I just implied.  When I was faced with the "routine" challenge, several thoughts and options went through my mind.  Only briefly did I consider the one that most people probably would have chose - "just don't exercise those days."  I did tell myself that the world would not end if that happened, but it would not be my first strategy.

I considered running Monday night in place of Tuesday morning or getting up even earlier on Tuesday and running before the meeting.  Those were bad ideas because my body would not be adequately rested from running Fri- Sun on Monday evening and because getting up that early on Tuesday would have me running with sleep deprivation.  Putting those together, the risk of injury was high.

My self talk continued.  For the negative thoughts that I had, I tried to use counterfactuals - you know, think of an instance where what I was thinking was NOT true.  "I don't feel as good when I run in the evening as when I run in the morning."  "Not, true.  I used to ONLY run in the evenings."  "My legs feel heavy in the evening."  "DO they, really?" Instead, "Think of how they will feel light and start off with a short quick stride."

I also challenged myself to recall and employ things that had worked in the past.  "Lay out clothes."  "Go home and change and get out the door without stopping to check email, wash dishes, etc." "Think of what can be positive."  "Different time of day, different sounds, different people, different feeling."  AND most important... "It doesn't matter WHEN you do it, the end result is always the same.... Feeling Good."

It was also different metabolically because I run on an empty stomach in the morning and had to think about when I was eating so that I would not be too full at the start of the run.  Tuesday I ran at 4:30 and had my diet soda (caffeine) around 3pm (instead of after 5).  Today I had lunch around 1:30 and ran at 2pm.  I think I actually felt better today.  Yesterday I was a little pressured, not sure why.  Both runs were indeed awesome... but I don't think I'll change my routine permanently :)

Tuesday, May 15, 2012

Burning Calories

The Weight of the Nation website has a great deal of information and many interactive components.  I explored a few of the pages today with a special interest in what was being said about causes > genetics, choices, environment and consequences.

If you go to the main page and click on the tab that says LEARN, hover over the words The BASICS, you'll get a drop down list.  First I chose, What Is Obesity?  Many interesting points are offered on that page.  What I'd like to focus your attention on is the last piece, Understanding Energy Balance.  There you will find the amount of time by activity type that it takes to burn off a usual serving of french fries or 610 calories. When you look at the chart, be sure to note that the weight of the person determines the length of time it takes to burn the cals. So if you weigh less than either of the examples, you will have to do that activity longer to burn the same calories and if you weigh more, you need to go on a diet - I mean, you need to exercise longer.  The examples for burning off these 610 calories, included running (slowly) for an hour +-, or walking (very slow - 30 minutes per mile) for over THREE hours.  Yikes.  Isn't it easier to eat a non starchy fruit or vegetable with 80 calories that you don't need to burn off?

On that same page, and under the chart, you'll find a very basic caloric need estimater.  The table is very general and does not factor in height or body type. For instance, I am a very active (meeting  or exceeding the 1 hr per day goal), petite, woman of middle age.  It suggests I need 2200 calories.  I eat closer to 1800 which keeps my weight around 100 pounds.    As helpful as that chart might be, to most safely and effectively apply it to your life you should talk to a licensed nutritionist/registered dietician.  Of course, you also need to figure out how many calories are in the foods you eat so you can get a baseline for yourself.

Speaking of weight loss, I also like the weight loss tab - available from the same LEARN > The Basics> drop down list. On the Weight Loss page, successful methods are described as are clues to watch out for when evaluating a "diet" promotion (i.e. danger signs), such as ads that suggest:
  • Losing more than 1-2 lbs a week
  • No need for exercise
  • Purchasing foods, pills, powders
  • Personal stories instead of scientific evidence
All of the tabs available from the drop down LEARN list are enlightening, but I will end with the Food Systems one because it makes note of the access problem. In the Food Systems section, local food environments with a pervasive amount of energy dense nutrient poor food outlets are called food swamps.  There is also a food comparison chart and other tools that you can use (they are in a list on the right side of the page).  You can even make pledges to change certain things about your life in order to be a healthier you.

I hope you can make some time to go to the website.

Monday, May 14, 2012

Don't Miss the Show!

The Message below was sent to me in an email from WeCan – Working to Enhance Childhood Activity and Nutrition -and I wanted to share it with you.  I am also going to embed the trailer video and hope that you will watch the shows, live or on You Tube.  I will do my best to watch them as well. The links to watch the shows on line are at the end of this post.

See Trailer here if you prefer.

Long-awaited THE WEIGHT OF THE NATION documentary confronting America's obesity epidemic premiers tonight on HBO

The four-part documentary series THE WEIGHT OF THE NATION premieres tonight and tomorrow at 8pm ET/7pm CT on HBO. We hope you plan to tune in and can share information about this powerful documentary with your networks. Note that HBO will open its channel for free for the broadcast, for those viewers that have cable TV but not HBO.
THE WEIGHT OF THE NATION is a presentation of HBO and the Institute of Medicine, in association with the Centers for Disease Control and Prevention and the National Institutes of Health, and in partnership with the Michael & Susan Dell Foundation and Kaiser Permanente.
The documentary features case studies, interviews with our nation's leading experts, and individuals and their families struggling with obesity.
  • The first film, CONSEQUENCES, examines the scope of the obesity epidemic and explores the serious health consequences of being overweight or obese.
  • The second, CHOICES, offers viewers the skinny on fat, revealing what science has shown about how to lose weight, maintain weight loss and prevent weight gain.
  • The third, CHILDREN IN CRISIS, documents the damage obesity is doing to our nation s children. Through individual stories, this film describes how the strong forces at work in our society are causing children to consume too many calories and expend too little energy; tackling subjects from school lunches to the decline of physical education, the demise of school recess and the marketing of unhealthy food to children.
  • The fourth film, CHALLENGES, examines the major driving forces causing the obesity epidemic, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the strong influence of the food and beverage industry.

 After the premiere, we encourage you to commit to Take Action. You can also sign up to make the Pledge for Progress ( to help turn the obesity epidemic around.
If you miss any of the four-part documentary, you can view the films for free at or on YouTube at

Sunday, May 13, 2012

Odds and Ends

Infections and Cancer >> Many of our new cancer cases are related to infections that in some instances can be avoided.  They are Hepatitis B and C, HPV and H. Pylori (ulcer bacteria).  Two of these have a vaccine associated with them and though there doesn't seem to be a way to prevent the H. Pylori bacteria, there is a treatment to remove it from the stomach.  I would like to point out that that news stories this week discussed HPV and its link to cervical cancer but not its link to oral cancer.  We need to start talking about that connection because it is important and unexpected.

Labeling Delay>> Please refer to this post written almost a year ago on the FDAs decision to require changes in sun screen labeling.  It has to do with being clear that lotions do not block the sun, that they must be reapplied, should offer protection against both UVA and UVB rays, and that SPF cannot be suggested above the number 50.  SPF also does not tell you how long you can safely be in the sun.  Anyways, the label changes discussed in the past blog past are being delayed until 12-2012 or 2013 for smaller companies.  This does NOT mean that you have to wait to  make smart decisions about the product you buy.  Also this week, more caution on getting burned and the dangers of using a tanning bed.  We cannot and should not ban the SUN, we need our Vitamin D, but tanning beds?  Legal?  Really??

HIV Prevention>>  With a pill?  How exactly is that studied?  It must be that researchers ask people about their past year(s) sexual behavior, i.e how often, who with, use of protection, type of sex,  and determine the persons HIV status.  But drug trials mean that some people get a drug to take and others don't.  The researchers are obligated to promote condom use and safer sex to the study participants.  It would be interesting to read the most recent study to see how the scientists handled this. 

Helmet Message>>  This week I saw several families out riding bicycles.  I was happy to see more adults wearing helmets along with their kids, but some were not.  I believe that the unhelmeted adults are giving kids a message that, because of the age requirements in many states, a helmet is warn because it is the law.  The better message, which is true, is that helmets protect against head injuries and save lives.  If you, as a parent, are teaching your children the law part only, your children may stop using helmets when they are 16 or 18.  Don't you want your children to be safe for EVER?  Role model helmet use - everyone should wear a helmet.

Counter Attack>>  Yesterday I shopped at a full, large, retail grocer with a nice produce section.  I needed to go to the other side of the store, about a foot ball field length, and  walked in a straight line to get there.  I passed no less than 10 free standing, middle of the aisle, candy displays.  One of which was for Avenger M&Ms, I think.  This kind of in your face, branded, low cost, junk food marketing is one of the reasons why having access to fresh foods is not in itself a cure for the obesity problem.

Saturday, May 12, 2012

Tobacco Diversification

Tobacco companies are choosing to diversify as fewer Americans are choosing to smoke. Reynolds American is exploring smokeless tobacco products, like Snus and dissolvable products like orbs, strips and sticks.  I have discussed these non cigarette products in the past.

Recently, tobacco company Lorrilard (known for Kools and based in NC) announced that it has purchased a company that makes electronic or e cigarettes.
I do NOT like these devices which heat nicotine (extracted from tobacco) with a battery and allow smokers to inhale a vapor of  nicotine and other chemicals.  Learn more about them here

My reason for writing about it today has to do with something that a reporter said when announcing the purchase.
She correctly stated that the e cigarette was regulated as a tobacco product not as a medication (which is the less restrictive option) but then she said that e cigarettes were often used as a cessation (stop smoking) aid.


One cannot have it both ways.  In order for the e cigarette to be marketed as a medication it has to prove safety and efficacy through drug trials. It has not and thus cannot and it isn't -  by the way- safe (probably not effective either).

Friday, May 11, 2012

Swim Workout

I have been working for my professor all day (well - a dinner break) and I am not yet done with my tasks - so just briefly:

I did make my two days of swimming this week so that day 2 could be the variation workout (i.e. not the .6 mile lap swim).  Here is what I ended up with and think will work for the summer - hopefully I will get stronger as time goes by, because this was pretty tough.

2 full laps of freestyle or front stroke or crawl (whatever its called)
2 full laps of backstroke (water up my nose!)
1 full lap of kickboard (my legs are so weak)
 (full lap means back to where I started)
Times FOUR!

so it ends up to be 1000 yards  - just 50 short of the 21 lap swim :)

Thursday, May 10, 2012

Food Insecurity and More WOTN

Today I attended a community meeting titled "Food for Thought."  It had a panel of experts which included the director of a food bank (a retired tobacco exec!!!), two school food and nutrition employees, a community member(college graduate, mother of two and a food stamp recipient), health department community nutritionist, and the director of the Food and Nutrition Services at the local social services department.  The forum was focused on food insecurity, but food deserts were also mentioned.  I attended because I misunderstood and thought the primary purpose of the gathering was to discuss how access to food type correlates to overweight and obesity.

The food desert inclusion was important, but seemed misplaced. The panel members were stressing that many of the residents of our county were going hungry.  At the end of the presentation and questions, a documentary film was shown.  It was called Food Stamped.  It explored the difficulty people face meeting the recommended guidelines for healthy eating when on benefits.  The film started by giving numbers and graphic images of our overweight problem. 

I felt that two  separate messages were being given at this meeting and that it might be better to present them individually. They are both extremely important. 

The spokesperson from DSS gave us some information about who was on food stamps(SNAP/EBT) in order to challenge some myths.  The community member who was on food stamps added that the people receiving benefits need our understanding as much as our help.

The refreshments that they provided were NOT that bad.  Sandwiches on whole wheat bread, water to drink BUT two trays of cookies and one tray of fruit.  (guess why - cookies are cheaper - and isn't that the problem!)

Also today, three things related to the posts from the last two days came to my attention so I have to share them.  I received emails from the IOM and the Robert Wood Johnson Foundation about the Weight of the Nation Conference in DC and the HBO documentary -both referencing the new report on Accelerating Progress.  Additionally, the Diane Rhem Show discussed the same and had as guests, experts in the field.  I linked all for you.  

The IOM link has a really AWESOME graphic that I'd love to share with you.  You can click on this link to get to it, but you may have to then click the picture again to maximize it - to make it bigger so you can see the really cool pictures and the obesity related numbers that go along with them.

BTW - I had to go past the Guilford County Courthouse to go to this meeting.  The street was lined with TV station vans - i.e. John Edwards.  There were NOT any reporters at the community forum.  Sad isn't it.

Wednesday, May 9, 2012

Sports Drinks, Fruit Drinks and Accelerating Progress

I have finished reading the IOM Accelerating Progress in Obesity Prevention overall summary and chapter six.  I am very excited about this esp. because nearly every page in the chapter makes a reference to the DGAs.  In fact, the closing section states that the goal of making the healthy option the routine is to be achieved by making the the foods recommended by the DGA accessible and by limiting access to the ones that the DGAs say we should avoid.  This document is a perfect support for my research interests and the food and beverage environment piece could inform my entire post doc career - 30 years or so!  Anyways, some last thoughts and tomorrow I will move on to something new. 

A few points of interest:
  • Sports Drinks - who really needs them? As said here before - very few people need sports drinks, especially because the majority are sugar based.  I make my own sports drink from an electrolyte suspension.  On page 172 it is stated clearly, with regards to youth, only student athletes should be allowed access to sports drinks and only if they are engaged in vigorous intensity sports for 1+ hours.  Further, on page 182, doctors are encouraged to tell patients (children and adults) about "the linkage among consumption of sports drinks, excess caloric intake, and obesity and overweight...." and they suggest that water consumption be promoted in place of soda and other sugar sweetened beverages.
  • 100% Fruit Juice - is it the best substitute for soda?  No!  See above and further on p 171, "there may be concern that the calorie content will promote obesity," and "it lacks dietary fiber and can contribute excess calories .... thus, the majority of fruit servings should come from fruits."
  • Food environments - access and limits.  With regard to communities that are attempting to modify the local food environment to reduce obesity, p 202 , an approach should "both increase the availability of and access to healthy food options and limit the concentration of and access to unhealthy food options."
  • Movie Theatre Kudos - I am stunned that this somehow escaped me in 2011 when it occurred.  But a couple of movie cinema conglomerates have made efforts to provide healthier or lower calorie options for movie goers - and as I read this I thought, "for double the price of popcorn."  But no - AMC for instance, as highlighted on p 198 and in this news story, has a 7$  Smart Pack with water, baked chips and fruit snacks.  Other entertainment venues were highlighted and encouraged to follow suit.  Maybe the most amazing one was Dodger Stadium which had two offerings that meet my low calorie high nutrient preferences!
  • Agriculture Policy - I am not going to get into the details, but the last part of chapter six discusses commodities and subsidies and how we might improve conditions so that farmers are better able to take the risks involved with growing fruits and vegetables.
Special Note - those of you who read my blog in your email... I have noticed that yahoo email tends to put a dotted line under some terms - ones that might be popular - and will offer you information or ads pertaining to those words.  MY links however, are underlined with a solid line... you can click on the ones with a solid line (mom). Like the one today under the words news story above.

Tuesday, May 8, 2012

Obesity Numbers and Solutions: Recent News

I have read the journal article that was released yesterday during the Weight of the Nation Press Conference.In it, researchers  project the percent of adults who will be obese in the years to come.  You may have heard about it on the news.  The numbers are staggering, but the money that could be saved by just a one percent difference is also substantial.  We are talking billions spent and billions saved.  I don't think the article added anything new, but kept referring to the reduction that could occur if the recommended obesity prevention programs were even moderately successful.  There was no mention of what those programs entailed.  Of course, you know that I feel the most effective obesity prevention strategy is limiting access to calorically dense foods.

Today the Institute of Medicine released its report on what needs to be done. You can see the 475 page book which I embedded on my blogsite - to the right.  I am most interested in chapter 6 which discusses the food and beverage environment.  I am happy to see that some of my ideas are included here and that everything ties back to the Dietary Guidelines for Americans. Such as, limiting SoFas and adding fruits, vegetables and whole grains.  There are some cool tables (calorie rec - p 163) and graphics (percent of Americans meeting those DGA goals - p 164) included.  You can flip through the document  or click this link if you prefer to go to the source.

I highlight that the recommendations address access to healthy foods by calling several sectors to action, i.e. private industry, governments, health care professionals and schools.  There is mention of agricultural policies and evaluating the impact that they have on the American diet.  Locally, zoning laws and tax incentives for fresh food retailers is advocated.  I especially like that the IOM IS talking about taxing SSBs, limiting fast food restaurants in neighborhoods (per capita) and encouraging restaurants to lower the calorie content in the meals that they sell to children!  The recommendations focus on ways to reduce the consumption of solid fats and added sugars through as many means as possible.  There is also a push for doctors, dentists, nurses and registered dieticians to tell their patients that sugar sweetened beverages should be avoided.

 I wanted to note that the obesity prevalence article used individual and state level factors to predict who would be overweight and in their report, the scientists mention the change in density of restaurants - i.e. the number of restaurants per 10,000 people - which the IOM is trying to get at with limiting them (through zoning).  According to Finkelstein et al, there were 12 restaurants per 10,000 people in the year 2000 and a near doubling to 23 per 10,000 in 2008.  Eating out is associated with over consumption of  calories, esp. through high fat and high sugar foods and is considered a risk factor for obesity. 

I may have some other tidbits from this report to offer at a later date, but I wanted to add a statement that is often repeated in the document.  It is worth repeating verbatim.

If people are to meet the Dietary Guidelines for Americans' recommended food pattern/caloric intake for their age, sex and activity level, they must minimize their intakes of all solid fats and added sugars. (p 169)

By the way, the IOM report does define activity levels.  See the notes under the table on p 163. The highest level noted was 'Active' as the equivalent of 3 miles of walking a day at a 15 to 20 minute per mile pace. 

If you view the book here or on the host website, you can probably search by page number.

Monday, May 7, 2012

Access or Limits

As promised, here is an excerpt from my current (working) research interest statement where I am discussing my focus on policy and the environment (regarding informed and health promoting nutrition).

      More proximately, our efforts must mirror those of the “manufacturers” who provide the foods linked to over consumption and adverse health.  These foods are nutrient poor, calorically dense, highly processed, high in sugar, high in saturated fat and ubiquitous.  The companies behind them did not just plop them down in existing establishments and walk away.  The foods were and continue to be cheap, convenient (wherever you are, whenever you want it), heavily promoted and formulated to appeal to taste buds and perhaps neurological reward centers.  The foods have become iconic.
 If we expect consumers to choose healthier foods we must use similar tactics.
      Thus, recommendation 1 MUST be implemented in unison with the second which specifically notes the need to “limit access to less healthy foods.”   The politically unfavorable use of pricing and organizational bans is most effective.  For example, taxing sugar sweetened beverages as proposed by the Rudd Center and others, or excluding their purchase with food supplement programs (as NYC suggests) and removing them from school and work sites as has been done in Boston. The counter to this type of intervention has been that people will just consume these “forbidden” foods at home.  This is not a research finding but a supposition.  In fact, many people who are concerned with their weight do not keep such items at home.  These same individuals cannot avoid their workplaces or schools.  In truth, the less opportunity for poor eating the less it will occur.  Access does not equal consumption but lack of access certainly prevents it.

Sunday, May 6, 2012

Odds and Ends

First I must say - if you are viewing the blog on the website-I made some changes to my template and I don't know if they are positive - but I can't go back!  SORRY.

Sleep: If you heard about or read any of the stories that came out in the past week regarding obesity genes and sleep and are confused... you are not alone.  The study and the stories about it are not easy to follow.  With twins, researchers attempted to see if a propensity for obesity was attenuated or exacerbated by sleep duration.  The problem with this line of reasoning is that very few obesity cases are related to genes and even in those that are heredity has a much lesser impact then actions do.  So the scientists ended up saying, people have control over what they eat and how active they are and taking care of those two pieces will reduce the adverse effect that too little or too much sleep has on gene expression.  YES - this means that the sleep study doesn't change anything.  Eat wisely and move more.

Ambien:  Oh well - speaking of sleep. I am anti-medication for sleep disturbance.  There is a strategy called sleep hygiene that is safer and as effective if not more so, than sleep pills. I have several posts on this. However, there are many prescription drugs for sleep.  One of them is ambien.  I have discussed problems associated with the drug in the past.  This week, in the testimony for the John Edwards trial, of all places, those same concerns were noted.  One of the witnesses referred to her husband as having been on ambien at the time which made him "loopy and forgetful."

Enbrel: I have a more tolerant view of medications that treat autoimmune disorders, such as rheumatoid arthritis because as far as I can tell, there is nothing a person can do to stop their body from attacking itself.  Medications are therefore necessary.  I am not endorsing this particular one, Enbrel.  I just wanted to make a note about the current ad the company that makes it is using.  The ad has Phil Mickelson, the golfer, as spokesperson, but not everyone who might take the drug is a golfer. So the ad shows him bending down to set his tee, or grabbing his golf club, placing his ball and shaking the hands of fans.  In each of these situations the ad switches to him doing something the rest of us might do.  He stoops to pick up a paper, he grabs a baseball bat for "his" son, he opens a jar for his mother, he bends down to tie his shoe etc.  Pretty clever.

Sine qua non: This is a Latin phrase.  It means that something is essential to another thing.. that without this first thing, the other will not exist. I say to you that exercise is the sine qua non to health.  Health - not weight control. A person can lose or maintain weight whether they exercise or not, but health - a state of being free from disease and in a state of wellness- is dependent on physical activity.  Without daily exercise, thin, normal and overweight persons (and pets) will be less healthy.

Saturday, May 5, 2012

Access and Consumption

I have been writing my research interest statement which is a required first step in preparing for my comprehensive exams. I take my exams at the end of the summer.  The statement isn't a statement in the sense of it being a sentence, or even a paragraph.  It is to be 2-3 pages long. My draft is a full three pages and I feel good about it, but my professors have to review it and that always means more writing is ahead.  I am particularly partial to one  section that I wish to share here with you  - even in its current version.

As you are certainly aware, my interests involve the Dietary Guidelines for Americans and Informed Eating.  I also speak of location and food deserts in my blog posts.  Food deserts have been in the news lately (for a different reason) and I have some of the recent studies set aside to read. 
Location is included in my research interests though I am beginning to see it a little differently now.  I don't think that the way to reduce chronic disease and obesity rates in impoverished neighborhoods is as simple as providing a grocery store, or even my favorite, a "healthy" local corner store.  Instead, I believe that there is an underlying psychosocial stressor inherent in a neighborhood so poor that certain retailers won't sell there.  For the adults who live in food deserts, this stress may lead to a sense of helplessness and lack of agency.  It is that powerlessness that could leave them feeling that it is no use - and thus healthful eating - well, it isn't even on the radar.  YES - the neighborhoods should be improved and healthy food options provided, especially to get in front of this for children, but again, not quite that simply.

So - I think that really is enough for one post - I will share my specific writing on access in another post, likely Monday bc tomorrow is O&Es.