Your Health Educator

How's Your Fresh Food Access?

2012-02-01T23:42:00.000-04:00

Do you live in a food desert ? - defined by the US Farm Bill 2008 as an area in the United States with limited access to affordable and nutritious food, particularly such an area composed of predominantly lower income neighborhoods and communities.

Last night I attended a sustainability meeting for a 12 county region. There were many display boards in the room, but one caught my attention. It was a map of the area food deserts, showing that 17% of residents lived in one.

If you would like to see if you live in a food desert - enter your zip code in this locator. IF your dot is in a pink area, then you live in a food desert. I entered my last zip code in Florida and there was no pink to be found.

But when I put in my current zip code, I was surrounded by food deserts.

Treating Depression

2012-01-31T23:50:00.000-04:00

*** Please discuss the use or discontinuation of any medication with a physician.

I actually spent a few minutes in my car today as I traveled to a community meeting (still working on those school vending machines!). I heard a bit of a news story discussion a new medication that is meant to treat severe depression (suicidal thoughts/harm to self or others/hospitalization). What is unique about this particular drug, because there are PLENTY, is that it is supposed to work fast. That matters because psychotropic medications generally take at least two weeks to take effect and old or new, most psychiatric meds are associated with significant side effects and minimal treatment benefit.
Experts on the show today, made note that in many situations, exercise with or without talk therapy can be as effective if not more so, than standard medications. It was also said that the positive outcomes from exercise last longer. Sadly, it was further noted that though these things were true; exercise works, is not harmful and has better results, many people are not willing to commit to an active recovery/treatment regime and would rather just take a pill. And that to me is "stinking thinking."

*** Please discuss the use or discontinuation of any medication with a physician.

Caring About Our Young Parents

2012-01-30T23:58:00.000-04:00

I was working out in the gym (the student rec center) this morning while two young men (age 19-21) were talking. Actually, one was just listening as the other went on for quite a while. I believe that he was talking about his aunt, who he said was not even 50 yet (gasp). Whoever she was, the young man was concerned about her weight - what she was eating and her lack of physical activity.
It was not his Mom because later I heard him say that his mother had four or five siblings and she was the small one. I think he said that she weighed about 110 pounds and he could toss her "over his shoulder."
He was about 6 foot or taller and muscular. He also spoke with an accent, possibly eastern European. I have worked out at the same time as he several times.
Anyways...
The young man was concerned that this person ate the wrong things or too many calories because I heard him say something about her eating a lot of bread and that if she just changed that it would make a big difference. I also heard him tell his friend that he encourages this person to do more physical activity. When there is some place to go, he tries to get her to walk. Since she isn't exercising at all, he suggested she try swimming.
The woman he was referring to is not much older than me but appears to be my polar opposite. I know that as children we sometimes worry about our parents when they get into their 70s and 80s, but this young man is much more intuitive and on target. If his aunt is not taking care of herself in her forties, her likelihood of a long, healthy, active life is significantly compromised.

I also wanted to take a moment to remind you that everyone, (exercisers and non-exercisers) is at risk of metabolic changes (problems) when they spend uninterrupted hours sitting. It is worse for non exercisers but bad for all persons.

By exercise I mean - activity that is intended to increase the heart rate or respiration during the activity's duration.

Exercise as defined in the Physical Activity Guidelines for Americans document:. A subcategory of physical activity that is planned, structured, repetitive, and purposive in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. "Exercise" and "exercise training" frequently are used interchangeably and generally refer to physical activity performed during leisure time with the primary purpose of improving or maintaining physical fitness, physical performance, or health.

Odds and Ends

2012-01-29T23:23:00.000-04:00

Oral Cancer - To continue on an issue of concern... HPV is the virus associated with cervical cancer, but it is also linked to oral cancer (more so than smoking or smokeless tobacco). This week researchers who published in the Journal of the American Medical Association or JAMA, found that 7% of us (US Adults and Teens) carried the HPV in our oral tissue (mouth). Transmission of HPV is through sexual contact, i.e. the genital area including the anus . It is believed that the virus is transmitted through all types of sex; oral, anal and vaginal - but not through kissing. Still, the finding of the virus in the mouth can help to explain the increase in oral cancer cases that we are seeing. Once the virus enters the body, the cells that it tends to attack are of the cervix and oral cavity - with regard to cancer.

Grief - There is an effort underway to have grief added to the diagnostic manual that psychiatrists use. If this were included in the manual, one can be said to be suffering from grief in the manner of a psychiatric disorder. Everyone will, at one time or another, lose a loved one (human or pet) and experience grief. Who would benefit from identifying this normal and inevitable part of life as a disease? Well, as I have said, name it - treat it - medicate it. I am 100% against this initiative. You can hear a podcast about the debate at this link from Australia's national radio.

Tablets - I am passing on some advice I heard somewhere this week - probably the NBC nightly news. People who have tablets, notepads - basically your IPAD, who read from them in laps or on the table - without using the little legs that let you tilt the screen, are having painful cases of neck strain. The advice is - don't do that.

Heart Disease - The biggest for last today. In a study that is being published in the NEJM, scientists looked at certain risk factors for heart disease in persons at various ages and tracked the outcomes up to age 80. In other words, they looked at people who had or did not have the risks at age 45, 55, 65 and 75. The risks that they considered were related to blood pressure, cholesterol, diabetes and smoking. The ideal profile is to be normal for all levels and to not smoke. The researchers compared the normal profile to persons who had two or more of the risk factors. The results were staggering. A 55 year old person with two or more factors was much more likely to have a heart attack and die, have a heart attack and not die, have a stroke and have fatal heart disease - any and all of those things before age 80. The difference between people with no risk factors compared to those with two or more - in regards to percent of adverse outcomes was approx. 6% and 30% . In other words, I might have a 6% of having a heart attack and a person with high blood pressure who smokes might have a 30% chance of having one. A further point of the research is that it didn't matter at what age the risk factors were present, the risk of death or other bad consequence was much higher among the group that had only two of the factors (i.e. high cholesterol and high blood pressure) than those with none.The full article was not available this week but I expect that there are increased risk differences based on age of onset of the 'factor.' I hope to review the full article soon.

SWOOOOOSH!

2012-01-29T00:20:00.000-04:00

I hope that I can do this story justice, as it must be told. No one was really there to see it – what a waste. It is a funny story. It isn’t about disease prevention directly, but I suppose it qualifies indirectly. It is a story about what happened when I went running yesterday morning – and running is exercise and exercise is medicine and the fountain of youth so let’s dig in:

On Friday, I needed to get up and complete my run before a meeting on campus at 11am. I wanted to run about six miles and was considering trying an amended route. I had explored this on USATF running routes to make sure it would be about right and I would not get lost. I was looking forward to the run because we have been having some unusual weather here in Greensboro NC. It has been very cold (for me, for NC), and I have run in hats, gloves and tights in 25* weather but it has also been in the 40*s and even higher. It also has rained often, but I have managed to work my run days around that. I keep a steady eye on the weather, as I had Thursday evening. And the expectation was a near 60 degree morning for Friday! Crazy, I know. I had put out running shorts and a tee shirt the night before as I had not run in shorts since my December visit to Florida.

I was ALL set.

The first thing that went wrong was my GPS watch – but I didn’t know that until later. Instead, as I awakened with my coffee and the news, I was confused because the rain showers from the night before had not exactly ended. It was not raining, but storms or showers were still possible for the next hour or so. Of course, I could not wait – I had a meeting. I vacillated, but I could not stay undecided for long. The weatherman was saying that the temperature would be moderate all day, but would be dropping, not rising. I finally decided to go out. Thinking, I can always turn around if it does start to storm ( I say, and never do).

As I started running, in my shorts(!), my watch failed. “Oh, bother.” I did not want to run the new route without my tracking device, but I was fine. I chose another way. About ¼ of a mile into my run, it began to rain. Not heavy and it was not cold. About one mile out, well, it was raining pretty hard. At about two miles, it stopped and the sun came out. It rained again later, but at about mile five, when I was almost done, it seemed that the rain was all past. I smiled. I was proud of myself for sticking with it. The day would be even better because I had gone on this run. I had even run a little faster than usual (it was raining and a bit chilly after all).

So here I came into the home stretch. Of course, this was not the first time I ran in the rain, heaven’s no. And certainly it was not the worst rain I have run in. Not on purpose, but I have gotten caught in storms so bad I was certain to meet ‘my maker’ with a lightning bolt. I have run into and through puddles that came half way up my shins. And I have chosen to start a 13 mile run in a very heavy downpour in Florida (no thunder and lightning then - though). I have run when it was cold enough to freeze my face and another time, when ice cycles formed on my gloves (I knew because I heard a funny sound and it was the rubbing of the ice on my stomach as my arms and hands moved back and forth). I have run in wind gusts that pushed me backwards. Oh YES – ' - insert chest thumping ' – I AM a RUNNER.

But I had NEVER experienced what was about to happen at mile 5 of my Friday 6 mile run…

I came around the corner which had me back on same traveled ground – if that makes sense. Can’t show you the map because the watch wasn’t working. But here is a similar map.

I had run up one road, crossed over so I ran back on a parallel road and then came back across at an under pass. So that the first and last mile were on the same roads – get it?

I crossed the street at the light, and in the glory I described above, went back under the bridge (see where the lines reconnect) and as I did so….. cars were in both lanes going West past me (I was on the sidewalk). The car in the nearest lane to me hit a puddle that literally gushed over me from Feet to Face – drenched as though a tidal wave had hit me. I was totally engulfed in the water, and I squealed out loud. I don’t think the driver caught it, but the lady in the outer lane sure did. It was PRICELESS. My shirt and shorts, everything was plastered to my body, to the left side of my body - because of torquing water flow. The splash went directly into my face as well.

Of course I kept running!! About a ¼ mile after that, because I had no running buddy to say it for me, out loud I exclaimed, “THAT was Awesome!!”

NSLP debut

2012-01-27T23:23:00.000-04:00

Today is the day. The National School Lunch Program has its first thorough revision in 15 years and now more closely aligns to the USDA's Dietary Guidelines for Americans 2010.

In the past few months, I talked (blogged) a lot about the new rules based on the recommendation from the Institute of Medicine and the challenges they faced in Congress. The potato lobbyists won their fight and the limits to potatoes were directly changed (omitted), but my indirectly be implemented. I found it very important and telling that the DGAs and the school rec's recognized that starchy foods and vegetables needed to be limited in the diets of the American adult and child. These types of foods are more calorically dense. It is a good idea to limit them in schools because this could lead children to limit them as adults. We eat what we're fed.

The school lunches still have to limit calories, salt, saturated and trans fat. Servings of leafy vegetables and fruits must increase. No whole milk will be available. All milk will be 1% or less fat. (that is another thing for adults to consider - whole milk and even 2% milk is too high in saturated fat to be considered healthy). I think that these conditions will lead to less potatoes, peas and corn served, even if the actual mandate to limit them was thrown out. I believe this because the schools still have to keep the calories low and trust me, potatoes and marcaroni are not low on calories.

If you are interested in more information on how the NSLP played out - my previous posts on this issue are available here.
For news on the implementation that started this week, this article from the NY Times may interest you.

Social Norms

2012-01-26T23:50:00.000-04:00

People whose work involves behavior change, often use theories that incorporate the concept of social norms.

However, because a person believes something to be normal (common or routine) doesn't mean that it is.

We often base our ideas about behavior outcomes and behavior frequency on what is happening in our personal world (our view or frame).

Consider the 16 year old smoker. He may have started smoking because his friends smoke or chose his friends because they smoke. Either way, he is surrounded by 16 year olds who smoke.

Now I ask him, "What percent of 16 year olds smoke cigarettes?" and his answer is, "60 to 70%"
The true number is closer to 20%. The teenager is basing his truth about the world based on what he sees in his circle of friends. He thinks almost ALL teenagers smoke. He is mistaken.

So when you hear about heart attacks, dementia cases and other diseases that are related to poor diets and being overweight and say, "well - my grandmother ate fried foods every day and lived to be a 100." or "I know people who are overweight and eat whatever they want and they are just fine." You should recall the mistaken perceptions of the teenage smoker. Just because the three or four people you know did the wrong things and didn't get sick, doesn't mean those things don't make people sick.

Calorie Burning (dancing) Bats

2012-01-25T22:36:00.000-04:00

Today's post is going to be a lot more fun than yesterdays... even if it does involve statistics.
Well - not much statistics, but that is where we have to start.

In my class today, we were discussing a research study involving the energy expenditure (i.e. calorie burn) of bats who use echolocation verses non echolocating birds and non echolocating bats. Ebat and Ne bats. The researcher wondered if the ebats, would burn more calories because they are doing more (flying and sending out sound waves), or if they somehow compensate for it by conserving energy elsewhere.

The scientists used a procedure called regression so that they could control for body size (weight). As you know, the bigger a person or BAT is, the more calories they burn. This type of statistical procedure can make it so that all the birds and bats weigh the same (hypothetically speaking) and then the only difference should be - echolocating.

So - do you know what echolocation is??? I think you will enjoy watching this video (for children) which may lead you to burn some extra calories from laughing!

Enjoy.

PPACA - Your Health Benefits

2012-01-25T00:35:00.000-04:00

I was inspired to write today’s blog post after receiving an email from my health insurance company this morning. More on that email in a bit.

I have very basic health insurance through a company that is affiliated with my university – because of the PPACA (Patient Protection and Affordable Care Act)– they have to provide for (no charge to me) screenings that are recommended for my age and gender – mammograms and pap smears and if I wanted it, birth control. This was not true before the law. (BTW – all companies have to pay for screening mammograms, not diagnostic ones, so beware)

There are many parts of the new law that benefit people and I am concerned that the law could be appealed. I believe that some of the problem is the stigma associated with this law because it is attributed to a democratic president. In other words, it has a party affiliation – the kiss of death.

I sincerely, and most fervently wish that we would stop dismissing things out of hand because whatever it is (policy, law or issue) is accompanied by a party label-

These labels are doing us no good at all and I, for one, would like to see an end to them.

I am registered to vote in my state – of course, but I am registered as unaffiliated and I AM – unaffiliated. I do not have a loyalty.

I choose sides and evaluate issues or programs based on their substance, not on what president or congressperson is associated with them

I have great fear that many people discount things out of hand based on a misguided affiliation with or aversion to, a certain party (and much of the time people do not even know why they are a republican or democrat, much less what that party might have, at one time, stood for in general principal)

The very basic dichotomy is that democrats want more government and republicans less –

However, in reality, it seems to depend on the type of government or government program one is referring to –

Regardless, that is not the point I meant for today.

I just want to encourage people to know what they are aligning themselves with or against before being so adamantly for or against something –

The PPACA does good things for a great many people (and some not good things) – but if the whole thing is appealed – a helluva lot of folks are going to miss the benefits they do not even know they are receiving.

If you clink on this link you will see some of the services that are provided to persons age 65 and older who have Medicare. You can also search for preventative care for women or men, special services for children etc.

The email I got today was a notice that my plan would only cover elective abortions if I opted in for this coverage. Interesting. If I had more time I would look into that – I think it has something to do with an abortion law that passed in my state senate this year. I am not a candidate for pregnancy, planned or other wise, so the issue doesn’t matter to me personally. I won’t opt in for that coverage. I can see where some women might.

Here is what the email actually says:

Effective January 1, 2012, if elected, your coverage under the System-Wide Student Health Insurance Plan will not include an Elective Abortion benefit unless you "opt-in" to include this benefit. This benefit option, if selected, applies to the 2012 Spring/Summer Semester. The inclusion of this benefit in the Plan does not change the premium amount.

******************************

I think it unfortunate that I felt inspired to write this blog when the President was about to do his state of the union address because most people will be pissed off when they read this – but remember, the law –PPACA- is (or can be) a good one. If you are going to complain about it – complain because you do not like what is in it, not because you don’t like who voted for it.

Pains

2012-01-24T00:00:00.000-04:00

In keeping with the goal of this blog - let's break down a headline from today...

Women experience more pain than men.
Women report more pain than men.
*****************************************************************
Leading to these questions - you should be asking

Is it that women are asked more often whether or not they are in pain, by physicians or researchers?
How was this information collected? Did researchers ask physicians about pain reporting in their patients (i.e. a second hand report)?
Do physicians ask the same questions to men and women?

Was the man or woman asked about pain in a written self completed survey?
Were they asked in an interview? Did a man ask a man and a woman ask a woman - or opposite sex pairs or was there any "set" way?
Would a woman say something to a doctor, a researcher, on paper or in person that she wouldn't say the other way? Would a man?
Does it matter who is asking?
Do men and women always tell the truth about their pain levels or frequency? Does that answer change based on who or how the question is asked?

Isn't it more socially acceptable for a man to hide his pain from others?

Does the pain level or frequency reported equal that experienced?
I.e. if I say I have x amount of pain x days a week - do I have that exact amount or more or less?
Do women really have more pain than men, or do they report more pain than men - could be yes' and no's.

My personal experience - (not an experiment or a survey)- Men may not tell their friends, doctors or coworkers that they are in pain, but boy do they tell their partners... and the tolerance for pain in the men I know has been rather low!!

Odds and Ends

2012-01-22T23:54:00.000-04:00

Heart Attacks and Sex: This week many news anchors and print reporters noted that the AHA released guidelines on when persons who had had a heart attack could resume sexual relations. The part that got the most attention was in evaluating your sex readiness based on your ability to walk up two flights of stairs without complications (shortness of breath, chest pain). If you are having trouble with this now, and you have NOT had a heart attack - I suggest you think about that. My first thought when the guidelines made headlines was that it was man centered. But what I found in the AHA's own publication was more important. 1) they want physicians to talk to their patients about sex and 2) having sex is a "miniscule" risk factor for heart attacks, as said here.

Environment and Paper: My natural gas bill came this week and as usual it had a note that thanked me for doing something good for the environment, i.e using natural gas. Ironically, the company does not offer paperless billing. I am sure that countless trees are killed every year in order for customers to get a 2-3 page bill, and a return envelope (not used because I pay online), delivered in another envelope. I suppose the post office is thankful for their business.

Grading Obesity: I had time to read the full report from the NCHS obesity trends brief that I referenced on Friday. A few interesting extras there. Did you know that there is a grade 2 and 3 of obesity based on BMI? Obesity has been defined as a Body Mass Index (BMI) greater than or equal to 30 for as long as I can remember. But these grades.... I wonder when it became necessary to add categories of 35 or greater (grade 2) and 40 or greater (grade 3). Actually, I do recall references to morbid obesity. This must me a different way of expressing that. In regards to these grades, for women specifically, in nearly all adult age groups, there are twice as many black women in grade two and in some age categories, there are three times as many black women in grade 3. However, here is a caveat that deserves some thought. Man or Woman - whites have higher body fat percents at any given BMI than blacks. (Flegal, K., Carroll, M., Kit, B., Ogden, C. 2012 JAMA)

It is called TESTOSTERONE: Okay well - I, for one am tired of hearing the commercial for a drug that is supposed to increase testosterone levels. First - I hate direct to consumer advertising for drugs and Second - hello - it is called testosterone - not T. "you may have low T." Seriously, can't men say or hear the word testosterone? It is their primary hormone for goodness sakes.

Mexico: Kudos to President Calderon for taking steps to address fraudulent advertising and for pointing out that his people have very high obesity rates and the health conditions that are associated with being overweight. He contends that the issue is too serious to let people be misguided by false claims on weight loss. Read more from ABC news

Eye Trick:. It is possible that my mother told me one or both of the following statements, but I also heard it from friends while growing up - especially as a teenager and young adult.
1) Don't go out with out make up on (what a drag), and
2) your make up is not complete without lipstick.
Well- when I was between 15 and 30 years old, that was pretty much the way of things. However, I realize now that make up is not a necessary part of being a woman nor is it exclusively for women. Funny how we change with age, education and experiences. What has not changed however, is that I have a certain amount of vanity and I don't want to look unattractive and I cringe at the thought of looking old. This has led me to be hyper critical of my face, and especially my eyes. Mediterranean skin, eye swelling and living in a colder climate has not really helped. However, I have found something that absolutely improves the appearance of my eyes - Lipstick. No - not on my eyelids - But only Lipstick. Lipstick and NOTHING else... funny that - but it works :) It takes everyone's direct attention away from my eyes, including mine - but also softens the look of my eyes - hard to explain - but try it!

It's the Flour and Sugar

2012-01-21T23:08:00.000-04:00

This is the word. As you know from many past posts, my favorite nutrition scientist (and professor) is Walter Willett from Harvard University School of Public Health. The HSPH had a press release on January 12 in which Dr. Willett says this:

“Unfortunately, many well-motivated people have been led to believe that all fats are bad and that foods loaded with white flour and sugar are healthy choices. This has clearly contributed to the epidemic of diabetes we are experiencing and premature death for many."

The press release highlights the need for whole grains and good fats as part of a health promoting diet. Recipes are offered as are comparisons to other muffins.
The recipes are worth a look as are the ones that I have posted on You Tube, however, mine do not contain any heart healthy fats - mine are 100% fat free.

Disturbing Numbers - Our Obesity Epidemic

2012-01-20T23:31:00.000-04:00

I will tell you the numbers first but I hope you stick around for a little more (I moved the technical stuff to the end).

78 Million (plus) American adults are obese, or were obese when the numbers were gathered in 2009-2010. That is 35% of our population and that should give you pause because the 78 million does not include the additional 78 million who are overweight - when you combine overweight with obese the number is just over 69 percent.
12 Million (plus) American children and adolescents are obese (2009-2010 data). The definition of obesity is different in children than adults so we have different percentage points here. By most accounts it is 12 percent, if the cut off is a little lower it is 16 percent and if we include overweight it is about 30% of children ages 2-19 . For children we look at percentile rankings (we compare their BMIs to all children that age and if 85, 95 or 97 percent of children are lower, the child is considered overweight or obese, accordingly. Don't let this confuse you - the words obese and child should not occur in the same sentence.
There is separate information for infants and toddlers and sadly, about 10 percent of them are also 'obese.'

I am going to share the NCHS data brief with you. It is not long and contains graphs that show the differences in obesity prevalence (the number of person's who are currently obese) by age group and gender. Interestingly, the most obese age group for women is age 60 and older and the lowest is the 20-39 age group. You can read the report for details on differences between men and women, boys and girls and who is catching up to the other.
When you hear the news reports this week - because you will if you haven't already, the main message is that we seem to be stabilizing.
***My point for the post today is to clarify what that means.
We are not getting fatter at the same rate as we were ten years ago - we have slowed down, we have not stopped.
Here is an example using small numbers...

At some point, 10 people per year were NEW to the obese category (they joined the already obese people)
then it changed to 15 people per year, and then 20 people per year and it kept going up - every year MORE people joined the group than the year before- but (mostly) no one LEFT the group....
We have now stopped increasing the amount per year that we add, but we still add people every year.... GOT THAT?

technical stuff:
The National Health and Nutrition Examination Survey or NHANES is a nationally representative survey that has been conducted through the National Center for Health Statistics since the 1970s and which is now a continuous survey which collects information in two year cycles.
It has 3 components and complex sampling procedures that allow the type of extrapolation that I speak of today and that informs the CDC report that I linked.
NHANES is not an experiment. It is a voluntary study, but people are invited to participate through random selection - in other words, people don't so much volunteer to be in the study as they consent to be in it, once the researchers contact them.
A household interview takes place, some persons also visit a Medical Examination Center (MEC) where lab work is completed, including height and weight, cholesterol readings, etc. A group of individuals who attend the MEC are also interviewed with a very sophisticated food frequency recall program. They report 24 hours of food intake and within a week, they get a phone call and complete a second 24 hour recall. [this information will be invaluable for me and my research, but it really doesn't have anything to do with this particular obesity report - sorry]

BK Fights Back

2012-01-19T23:44:00.001-04:00

Truthfully, I couldn't think of an appropriate title for the post today - but it seems that Burger King is my arch enemy.

It is bad enough that fast food joints increase in density the poorer an area becomes - making high calorie food the easier choice both for price and location for people living there - and to that-
BK is now (in select places) making deliveries.

All I can say - is ... You MUST be kidding me....Actually PLEASE be kidding me -

Those of us working to fight obesity have to beg, borrow and steal every dime we can in order to promote and support funding for mobile Farmer's Markets and now Burger King decides to bring 'junk' straight to peoples' doors.

I could give up - but I am too darn stubborn. Still - GEEEZ

Relationships

2012-01-18T23:24:00.000-04:00

My studies and this blog are specifically related to chronic disease that is attributed to dietary factors and exposure to tobacco or other carcinogens. Generally however, I am interested in anything related to health and so from time to time the blog post may wander in another direction - like financial health for instance.

Today I mention something associated with relationships because I have been reading an article that mentions theories that lead to successful ones.
One of the theories is exchange theory and according to Buhrmester, Furman, Wittenberg and Reis (1988), an important component of exchange theory is this:

-"appropriately asserting displeasure with others"-

I think you should read that line again. It is really saying TWO things. The first is that when you are in a relationship (romantic, friendship, or familial), it is important that you DO share your feelings when you are displeased (unhappy, etc). The second part is that you do so appropriately.
Sulking and withholding affection or attention, for example, are NOT assertions. Yelling that your spouse is a jerk IS communicating, but not appropriately.

I think what I want most to impress upon you, the reader, is this: It is not healthy to keep things inside. It does not help you or the relationship. Suffering in silence - being a dutiful (yet,conflicted) person - or being unhappy, gracefully - these are not strategies to improve the health of a relationship. It does not help you, the relationship, or the other person(s).

Promoting Moderation

2012-01-17T23:45:00.000-04:00

As many of you may have heard by now, the celebrity chef Paula Deen appeared on the NBC Today show today and announced that she has type two diabetes.
If you will recall from this post, diabetes onset is triggered by a high fat diet and one of the the body's responses is the inability to manage blood sugars. Diabetics have circulatory problems which lead to heart disease.
Paula Deen is famous for her high fat recipes and today when asked about changing the way she eats, she indicated that she always tells her audience that moderation is key. (It is also being said that she has been sick for some time while continuing to 'peddle' her less healthy creations.
I wonder if people realize that when you moderate something you LESSEN it.
It was also disclosed, and I heard this from 1) my nephew on FAcebook and 2) Brian Williams the news anchor, that Paula Deen is a paid spokesperson for a diabetes drug maker.

I will leave you with the great words of wisdom that my young adult nephew had for Ms. Deen-
"Join Weight Watchers!!!"

Switching Bad Habits for 'Good' Ones

2012-01-16T23:43:00.000-04:00

There is a difference between nasty or bad habits and good ones. We are often enticed to learn about the 7 Habits of Highly Successful People, for example. So we agree - a habit, routine, regimen, something you ALWAYS do, can be a positive thing.

This is the case with health. Adopting practices that will reduce your risk of disease and improve your chance for healthy active aging is smart.

Sometimes your routine may include a habit that is good practice but for some reason needs to be revised. It is good to brush your teeth every day (at least twice) and you should do this for the rest of your life! Of course, if you are brushing them wrong or with the wrong type of brush or paste, then you should switch - even though you have always done it the other way... Now you will always do it 'this' way.

Many people enjoy a drink of alcohol after a days work. In regards to health, there is some evidence that one drink (and the definition for what a drink is - 4 ounces of wine, 12 ounces of beer or 1.5 ounces of liquor) can have a positive impact on health (not for all people however).
I have family and friends who enjoy too much alcohol. I myself have had periods in my life where I also drank too much. I am very careful not to do that now. Remember, it is not just the impact on your system and organs but also your waistline that is of concern.
I have a drink on the weekend (sat and sun). If I go out to dinner during the week, I may also have A drink (but this is rare). I have my drink at 630ish because dinner is 730ish. These times change with my life phases, it is just the routine I am in these days.
On weekday evenings, I have a cup of hot tea and a little snack (the same 100 calories that would be in my alcohol {because I have one light beer or one fresca whisky sour whenI drink}) at this 630 time, while thinking of what to prepare for dinner.
I tend to look forward to 630 on all seven days of the week because whatever the 'treat,' it is calming to me and isn't that why many people drink? To unwind or relax?

Just letting you know, substitutes can help.

Odds and Ends

2012-01-15T23:24:00.000-04:00

Weight Watcher's Meals - In the convenience section of my local grocer, i.e. the deli, I noticed Weight Watchers (TM) single serving microwavable meals. Costly, but calorically sensible. Choose these over sandwiches and you're likely to make the better choice.

Listen - Unlike many people, perhaps some of you included, I am much more likely to follow my health promoting routine or lifestyle as it is encrypted in my head than to make day to day decisions based on how my body feels. This week, I had two occasions which challenged my rigidity and I listened. One of them involved feeling that a running related muscle pain (old injury) was speaking a little louder than usual. I believe that was Wednesday. It was also forecast to be a cold and rainy day. I listened to my body. I did not run on Wednesday but chose an alternative cardio activity that would not work my muscles in the same way and which took place inside. On Thursday, the day I ran in place of Wednesday, I noticed that my DOMS (delayed onset muscle soreness) from Monday's weight training session had not truly abated. If my muscles were still that sore, they needed more rest (so that I could work them hard again, as that is how muscles strengthen and grow). I did my weight routine on Friday instead. SO- if I can be more attentive and smart, so can you. You may have the opposite problem however - not feeling like sticking to any sort of routine whatsoever, esp. if your body is telling you it is tired. Sometimes the weary feeling comes from lack of activity - so GET GOING.

Hostess - Ah - the bakery company is filing bankruptcy or bankruptcy protection. I heard a joke on the radio in regards to the absurdity of a snack food company going bankrupt in AMERICA, but my thoughts on hearing the news were different. I thought, "Hmm > that is because they charge too darn much for the 100 calorie cupcakes and I cannot afford to but them!"

Vegetables Ahead - Yesterday I roasted (baked in the oven) two bags of frozen cut green beans (with onion powder and thyme), a bag of frozen Brussels sprouts (first time I bought frozen - better price, better quality) with red pepper flakes and curry powder (because I was out of ginger), I cut a yam into three pieces and boiled it, and I cut, cleaned and baked a spaghetti squash (to add garlic powder and Parmesan cheese with I reheat it later) and I think that is about it! I am ready for the week ahead. I portioned the veggies out and froze them.

Give the Man... (NO) Today was a great day in that my favorite football team, the NY Giants won their division and are on their way to the NFC championship. When the game is on any channel other than NBC (which airs it live online!), I can only listen on the radio. I have a favorite radio station out of NY and I like the announcers. However, when a NY Giant has a great play, one of the show's sponsors gives them an award - I can't remember the name of the business, but the announcer says that so and so gets the (business name)"Give the Man a Cigar" award. Boo - cigars are full of toxins and I don't want my awesome men of Big Blue to get a lung disease !!

What You Don't Know

2012-01-14T22:07:00.000-04:00

In another reading today, I came across a quote attributed to a congressman as he was speaking to his colleagues... He was talking to them about a policy decision or a program that they were considering and he said, "Don't pretend that you know what you don't know..." This is attributed to Senator Moynihan and he was urging congress not to pass something with no knowledge of the theory that drove the idea or testing the theory itself.

(I read this in a book chapter written by Eleanor Chelimsky.)

I want to think about that statement because it is very important. I will think about it(out loud to you) in regards to the theory/idea that I support - that 1)providing access to information about food (calories for example) and 2)access to healthier foods (perhaps with lower pricing) will lead to informed eating and possibly a lessening of the obesity crisis that America and many countries now face.

Do I KNOW that the policies that make these strategies a reality will work? NO. Are the ideas based on a theory - YES. Can this be tested? Yes. Has it been? Yes - on a small scale. Should we continue to test it when we implement it? Yes. Does the theory include more than just providing the information? YES. What else is needed? Education and Promotion. Should the evaluation of the policy also consider the amount of education and promotion that was delivered? Absolutely.

What are we waiting for? I have no idea!

FOP Labeling Goes On

2012-01-13T23:52:00.000-04:00

Busy day for my assistantship work so this will be a brief post.

I stopped at a higher end grocer yesterday to grab a few things on my way home from class. They had some frozen vegetables on sale and I wanted a bag of cauliflower so I grabbed one. Tonight as I was opening the bag, I noticed these strange pictures and letters, like EV and LS. Looking more closely, I realized that it was some type of front of pack labeling system. Of course , it was not the standardized and simple format that is recommended by the IOM.
It looked like this:

I noticed that the heart healthy part was explained on the back of the pack, seen here.

But the clincher, which has nothing to do with FOP systems, were these words...
'product of Mexico'

Hence - I can get the same product for a lot less money if I shop at Wal-Mart - which I usually do.

A Telling Definition

2012-01-12T23:51:00.000-04:00

The terms health education and health promotion have several definitions,no agreed upon definition and are sometimes used interchangeably.

Though I use this blog and other venues to educate people on health related issues - I still consider myself someone who primarily promotes health and wellness.

In a reading for one of my classes, I came across this definition of health education and thought, "Well - that is it then isn't it?" And I wanted to share:

Attributed to Griffiths(1972) from the text listed below:

" health education attempts to close the gap between what is known about optimum health practice and that which is actually practiced."

In other words - the difference between what we know will keep us healthy and what we actually do.

From : Glanz, K., Rimer, B.K., & Viswanath, K. (eds). (2008). Health behavior and health education:

Theory, research and practice (4^th Edition). San Francisco: Jossey-Bass. [page 10]

FEVone and FVC for Pot Smokers

2012-01-11T23:37:00.000-04:00

Ah ha - got your attention on that last part didn't I?

You may recall from past posts, several of them, that I am a advocate for spirometry testing in smokers - in fact, I find it much more important and necessary than CT scans. A spirometer is the device used in a lung function test. It is relatively simple and straight forward. The patient takes a deep breath and then blows into a tube which measures the volume you expire (blow out) in one second (FEVone) and your full expiration or FVC. Read more here.
Certain values are indicative of lung problems and the diagnosis of Chronic Obstructive Pulmonary Disease. Pulmonary means lungs. COPD is very common in cigarette smokers and involves lung enlargement, air sac destruction and loss of elasticity. It can feel like one is drowning and unable to breathe. Emphysema is a type of COPD.
When I was doing presentations on the medical complications of tobacco use, the audience would sometimes ask about marijuana use. I would say, "Anything that you light on fire and breathe into your lungs will cause them harm." I still stand by that statement, however, research reported in the Journal of the American Medical Association this month, shows that marijuana smokers do NOT have the same decline in lung function, based on FEVone and FVC as cigarette smokers do.
This was not a lung cancer study, but it was a study that followed many people over 20 years. The people in the study were classified as either 1) non users of both cigarettes and marijuana, 2) cigarettes users only, 3) marijuana users only and 4)users of both.
The marijuana only group did not fair as well as the nonusers of both but certainly better than the smokers or both group.
Some thoughts put forward by the researchers include

Cigarette smokers consume several cigarettes every day whereas marijuana users might have a whole marijuana cigarette or two only once per week. Most marijuana users do not use every day or even every week.
Marijuana smokers breathe in very deep and hold their breath before exhaling - similar to what one does with spirometry (so they practice what the test requires and they may strengthen their lungs in the process)
THC, which is found in marijuana may actually soothe or heal lung tissue.

Interesting study - it does not imply that marijuana use is safe nor that we should add THC to our cigarettes, but it is evidence that marijuana smoking does not damage lungs to the same extent as cigarettes do. This study does confirm the severe, adverse effect that cigarette smoking has on lung function.

Association Between Marijuana Exposure and Pulmonary Function Over 20 Years
Mark J. Pletcher, Eric Vittinghoff, Ravi Kalhan, Joshua Richman, Monika Safford, Stephen Sidney, Feng Lin, Stefan Kertesz JAMA. 2012;307(2):173-181.

FOP Delay Breeds Confusion

2012-01-10T22:21:00.000-04:00

When the Institute of Medicine was conducting its review of front of pack labeling systems prior to making its final recommendation to the FDA at the end of 2011, it addressed several existing systems that were currently in use.
Included in their analysis were NuVal and Guiding Stars. Both of these systems were deemed inadequate and misleading and the IOM ended with a recommendation that would be used across all products and would include a point earned for meeting certain criteria, only after an overall benchmark of "goodness" was achieved. My past posts in regard to this issue can be found here.
Unfortunately, the FDA is not ready to make the new national labeling system happen and I am most certain politics abound and work to delay the efforts.
You are probably seeing front of pack systems on the products you buy now, but education on their use has not begun and they are not the symbols created by health experts.
Some big grocers are themselves adopting the systems that the IOM discredited - which is really the fault of the FDA not the grocers. In the article I read today, a couple of the health experts are consulted and stand by the IOM report. You can read it here.

Comparative Fatness

2012-01-09T23:29:00.000-04:00

My title is a word play on a concept that was addressed in a recent news paper article or series of articles. A journalist, Marni Jameson, interviewed several health experts for her four part series "Why We're Fat."
I was most interested in the last piece and you can read it in its entirety here. Part 4 focuses on the environment and governmental policies, which are also my areas of research and career interest. I particularly would suggest that you look at numbers, 1,2, 4 and 8-10 if you are curious about my leanings.

Item 8 is the one that inspired my title, but in Jameson's article, Steve Smith, PhD is credited with saying "Fat is the new normal" and Ms. Jameson's header is "Fat is Relative." Sadly, both have a legitimate point. If everyone around you is overweight, then your obesity does not stand out with the importance that it should. Not only is fat prevelant, so is chronic disease - i.e. diabetes and hypertension. These conditions might then be normal, if you take normal to mean "majority," but they are not 'healthy' states of being. Also, in this particular section of the article - vanity sizing is noted. In other words, the clothing industry has responded to our vanity - not wanting to wear a size 12 or 14 because those are fat sizes - and takes those SAME patterns and calls them a 10. This is a grand form of denial - not of attractiveness or unattractiveness - that is size neutral and really IS a matter of opinion - but of disease. Disease states are measureable and objectively defined - overweight> diabetic>hypertensive.... >disability>unsuccessful aging> premature death or disability adjusted life years (living as long but in poor health).

Read the entire article and see if you can guess why I do NOT like the way it ends - (hint (ok answer) - the article explores reasons why people are fat as related to government subsidies, marketing ploys, food availability, food content, etc... and then tells the individual to do something different)

Odds and Ends

2012-01-08T22:12:00.000-04:00

My first few points for the O&Es today can be traced back to my recent Florida visit and time spent in close proximity to my mother - i.e. we cooked and ate together :)

Twist Ties: A trick I learned from my Mom - but only recently, (which makes me wonder why we didn't do this when I was little and who she might of picked it up from ) is: if you have a bag of something like lettuce or frozen vegetables, cut the bag open with a long, straight, 1/4 inch strip, and use that strip as a twist tie to reclose the bag. I do it all the time now!

Water Conservation: Happy to see my Mom doing something I do and have mentioned in the blog. When you wash your produce, e.g. grapes that you have to swish around and strain several times, you can use the used water for your plants. If you do not have plants, you can pour it on the grass instead of down the drain.

Batteries: Recall that I was very excited to report that my university offers recycling stations that include a place for batteries. This is important because they can be harmful if placed in the trash and eventually, our landfills. Making the recycling of toxic materials convenient is something that all states and cities should work on and few have. I went through quite a few batteries taking pictures over the holiday but there was nowhere to put them. So I flew home with them in my bookbag and promptly placed them in the school recycling cube. Which, by the way, had plenty of batteries in it :) It is meeting a real need.
Oranges: My sister has an orange tree as is common in Florida. She brought me some fruit when she came to see me. She made a point to note that she picked the smaller ones because she knows that I prefer them. YES!!! Jumbo fruit has less taste and more calories... we really only need what we need. And, I love my sister.....

Toilet Bowl: I asked Mom where her toilet bowl cleaner was and she replied, "I don't have any, I just use the brush." Well - that is actually super cool - the chemicals would just find their way into the ground water.

******************* In thinking of the above posts,
I am reminded that because many of us in many countries do not
continue to live in close networks or villages,
the things we would learn from each other are lost*************

Ford - I am watching: Ford motor company is requiring that its materials suppliers use a certain percent of recycled material. They are also using recycled plastic bottles to make seats in some of their vehicles. This is very cool. Read about it here.

Weight Loss Goal Setting: I have mentioned my dear friend who has had WLS - weight loss surgery - the major one, gastric bypass. This is the woman with whom I take an hour walk on most Saturdays (yes, we're still at it). I love her very much and so this past week I asked her about losing more weight this year - I suggested 10 pounds. She thought that was not a big enough goal but I pointed out that it doesn't appear that she lost much last year, so we should start small. To help her, (and playing it forward, my readers...) we went through her day to find any repetition that we could attack. It is easier to identify a pattern and go for it then to just say "oh, I will eat 50 calories less." So we found her iced coffee. She is going to replace her whole milk (sometimes 2%) with skim milk, BUT she is going to froth it up first so it will be thick! [I gasped when she said she was using whole milk!!] Remember, WLS shrinks the stomach and the patient has to eat smaller amounts of food but that does NOT equal lower calories... that is a conscious choice. I am not a fan of WLS - I am a fan of my friend.

And lastly - the semester starts tomorrow. My classes included Advances Theoretical Basis for Community Health Education, Advanced Statistics for Behavioral and Social Sciences, Advanced Program Evaluation in Health Education and Public Health Practicum... so... not sure how much time that will leave for blogging - recall I also have an assistantship (which involved data analysis related to college athletes and alcohol, tobacco, OTC and RX drugs - not obesity, but quite interesting)

McDonald's Resource

2012-01-07T23:54:00.000-04:00

Though it does pain me to do so, I am alerting you to a pretty cool feature on the McDonald's website. First I will tell you what led me to explore their website today. I had mentioned that I received a coupon book from them in my mailbox (the post office appreciates their business). On one of the pages there was mention of wholesome choices and on this page were pictures of a few items with the caption, "300 calories or less." I took that to mean that they had a line of entrees that were called Wholesome Choices and I wanted to check them out to see if they really were on the lower end of the calorie spectrum. My plan was to make a note of these special items for readers of my blog.
In fact, they do not have that category, but they do have a search feature that lets you see all items that they sell, presented in order of calories (or fat, or sodium, or sugar-you pick the sort feature). After you select the nutrient of interest, a list of the items in order from lowest to highest will appear. They display as icons, pictures, and if you let you mouse hover on the picture, it tells you the nutrient info for the item. Pretty darn neat.
This will not get me into McDonalds and there are three points that should be made - beyond the fact that currently, the people who would be most likely to make use of this resource (like me) don't eat at fast food joints and do not have a weight problem.

That last point is the basis for these important steps:
1) first we have to make the resource relevant - i.e. educate people on the impact of calories and why they should limit them
2) drive people to the resource - and that includes providing access because not everyone has a computer or an internet connection
3) get people to use the resource once one and two are in place (promotion)

The webpage and search feature that McDonald's provides is a tool that allows for informed eating and for that I must give... Kudos! It is called the Full Menu Explorer and can be seen/used by clicking here.

Beware the Food Bargains

2012-01-06T22:17:00.000-04:00

(First - I did not blog yesterday because after I wrote my last post and viewed it in my email - I saw how very long it was. I heard my Mother's voice "Sometimes they are too long and people get tired of reading." Hence, I gave you an extra day to absorb it. I really loved that post myself!)

As you prepare to live a healthier 2012, the purveyors (suppliers) of calorie dense (high fat high sugar), nutrient poor foods are looking for ways to increase their sales. In other words, they are out to sabotage your efforts and their strategies will be especially directed at persons with limited incomes.

I came across an article on a financial webpage which describes some of the tactics, such as the dollar menu (and more meat(i.e. even bigger portions)) as well as ten dollar pizza's, coupon books, cheaper buckets of chicken and promises not to raise prices. You can see the story here.

I hope that you will not succumb to their tricks, gimmicks, ploys or strategies because what the special ads do not tell you is how many grams of fat and sugar the items contain, nor what large amounts of calories and sodium(salt) they have. I believe it was the same news story that offered this link, but here you can see a picture of some of the highest calorie items along with the numbers.

So I offer you another thing to add to your list of 2012 commitments - packing your own meals.
I hope that in the future, a future I plan to impact, foods that are nutrient dense and lower in calories will be offered as two for one deals and found on dollar menus. I hope that coupon books - like the two I received this week (BK and McDs) will include salads and healthier items for cheap prices, too.

Protein - Calories - Weight - (from headlines to clinical studies)

2012-01-04T23:58:00.000-04:00

Last night I came across a news story comparing calories vs protein intake in regards to weight gain. I went to the news story only to find out who the authors were and where the study was published. I found it today and it is available free for anyone to read by clicking on this link.

I did not keep the link to the news paper story but you could probably find it easily through a web search. It is a little complicated - three groups of people ate an additional 900 or so calories from their stable baseline, but different amounts of fat and protein within that same calorie amount.
One of the groups gained less weight (pounds), but the other two gained leaned body mass. The extra calories seemed to turn into fat and were provided as fat. The amount of protein did not impact weight gain, but it does appear that one of the groups increased what is called metabolic efficiency. This is a number - a ratio - determined by the increase in calories divided by the number of pounds gained. Thus having a low denomenator (fewer pounds gained) creates a higher 'score' indicating efficiency. The weird thing is that the group which gained the least and had the greatest score, lost lean mass whereas the less efficient groups gained lean mass!

But what I really wanted to tell you about was the intricate details of the study because the news paper article doesn't give the low down. Trust me that what they did in the lab - well - it won't be happening at your house!

First there were only 25 people in the whole study and these people were put into one of three conditions so that each group had less than 10 people in it. (in research the best studies are said to be controlled - but they are expensive and use fewer people - another marker of good research is having a large amount of subjects! It is hard to get both of these things)
There were men and women in the experiment and they were between the ages of 18 and 35. More participants were black than white and all lived in Louisiana. They all had normal BMIs at the start of the study.

The participants stayed in the center for the duration of the project. The scientists used fancy, expensive and ultra sensitive equipment to determine each persons total energy intake, as well as resting, non resting and total energy expenditure. The scientists then fed each person the amount of calories necessary to make sure their baseline weight remained stable (the test lasted four days). Stable meant that the weight could not fluctuate more than 2 pounds. They tried this up to three times and if the weight wasn't stable when everything else was being held constant - the people were sent home (:(.

(During the study, the meals were prepared by the 'metabolic kitchen' staff and sent to a lab for analysis - later in the study, when the people were put into separate groups, the people and the scientists who measured their body changes did NOT know who was getting which protein amount- in other words, it was "blind.")

During the stabilization phase, the caloric amounts were the same and the breakdown of macro nutrients was protein 15%, fat 25% and carbs 60%. The people were then randomized into the three groups - low, normal and high protein intake.
The carbohydrate amount was not manipulated and stayed around 40% of total calories for all three groups. The low protein group had 47g protein per day (6% of total cals) with 52% calories from fat, the normal protein had 15% and 44% fat while the high protein (228g) or 26% of total cals and 33% from fat. They all started off at about 2400 calories a day and added 900 cals a day in the 8 weeks of overfeeding.

If you look at the information above carefully, you can see what the problem may be. The groups did not only change protein - they changed fat percent as well and the low protein group ate the most fat. They also gained on average 6 pounds compared to 12+ pounds for the other two groups. They ate more calories from fat but gained the least pounds. The other groups gained more pounds, but also gained lean tissue mass.

The conclusion offered by the researchers - calories impact fat storage while protein impacts energy expenditure (burn) and lean body mass - do not carry over to practical application, that I can see. I.e the group with a higher energy expenditure at rest still gained more weight.
We know from this study that if you eat more calories than you need you will gain weight (which is old news). It also looks like the amount of calories that you consume in fat grams will have a negative impact on body composition and metabolism (this is related to how nutrients in fat are metabolized and is beyond the scope of this blog).
The problem with the outcome is that the low protein group did not increase their total expenditure (where as the other two did [no group changed activity level - this is all related to the intake]) and still the low protein group gained the least amount of weight.
Other studies have noted that over time, if people continue to overconsume, the increase energy burn from the protein increase will abate and they too would stop gaining lean tissue.
PS - the participants stayed in the lab an extra day or two after the overfeeding to get their cals back to normal.
PSS - this was a very well controlled laboratory experiment! and super fun to read and there are lots of charts you can see in the actual study if you go to the journal article.

Unhealthy by Default

2012-01-03T22:00:00.000-04:00

I may not always present it this way, but my focus for obesity prevention policy is to make the healthy choice the default choice (more people desire to make it the easy choice). In other words, I think it should be hard to eat unhealthy - not the other way around.

So, imagine my chagrin when my friends and I went to the movies last week (war horse) and were ushered over to the concession stand to BUY OUR TICKETS.

I can think of four reasons why a theater/cinema would close the ticket counter. They could all easily be true.

It was a slow time of day and the ticket window employees had not yet arrived
The ticket window employees all called "off" sick
The company does not want to pay that many people so they are having the concession clerks do two jobs, AND
By having people buy their tickets at the candy and popcorn display, they are more likely to buy popcorn and candy. [my work is never done!]

And a funny story about that - one of my friends ordered a (diet)soda at that concession stand when she bought her ticket. Another friend remarked how the movie price really wasn't so bad - only a little over 5 bucks. My soda friend said,"really?" as she looked at her receipt more closely, and then, "oh my gosh, did that soda cost 5 dollars!?" Indeed it did - the regular soda probably costs less.

Half the Risk of Lung Cancer - Erasing the damage of smoking

2012-01-02T21:20:00.000-04:00

January 2 1997 - January 2 2012 (15 years)
No - not a life span - a quit span. On January 2, 1997 at about 1pm, I smoked my last cigarette.

Interesting facts from the Behavioral Risk Factor Survey

in 1997 19.1% of Americans were every day smokers (21% in NC, a tobacco state where I lived then and now)
in 2010 12.3% of Americans were every day smokers (14.3% in NC)
in 1997 52.1 % had NEVER smoked and more recently, in 2010 that number was up to 56.7%

The body begins to heal itself within hours of the last puff. It is the smoke - the chemicals in the smoke- that cause the damage to the lungs, arteries, cells, tissues (including skin) and organs of the body. Nicotine acutely increases heart rate and pulse, but it does not cause the long term damage - it is the smoke. This is why I am so consistent and adamant in encouraging you to avoid tobacco smoke from any source. Think about it - anything that is on fire creates smoke and only a fool would stand there and suck it in.

Many of the health risks associated with active or past smoking can be alleviated completely within just a few years of quitting. For instance, the heart attack risk can be reduced to that of someone who never smoked (other risk factors for heart disease may remain [weight, genetics, saturated fat diet]). Lungs can heal if emphysema and chronic bronchitis have not set in. Quitting smoking only protects the undamaged tissue. (trust me smokers, you want to keep as much healthy lung tissue as possible - it is NEVER too late to quit.

The marker that has been on my radar- the one I was most looking forward to has finally arrived. At 15 years after quitting smoking, my risk of 'smoking related' lung cancer is half that of someone who is currently smoking. It is not as though I never smoked, and of course, I could get non smoking related lung cancer or any cancer for that matter, but by gosh, I did something hard and important 15 years ago and I will embrace this 50% reduction and say to you with conviction

"quitting smoking is the most important thing I have EVER done"

Ironically - I have been looking forward to this day for some time and as a tobacco treatment specialist (my credentials expire this year) I often talk about the health benefits. So today when I went to find these links for you - I saw that my risk for lung cancer 'death' was half that of a current smoker 5 years ago and my risk of heart disease is NOW the same as a non smoker (as I said above). Whatever the actual years are - my conviction stands!

Here are some resources for you today.
Quitting smoking resource
Time line for healing
Another time line with additional resources

Your Health in 2012

2012-01-01T23:28:00.000-04:00

I will try to keep this New Years Day post in the tradition of
Sunday Odds and Ends

Fight Fat (No Ali?) - This is the year that you will not spend any money on diet products, pills, powders, shakes, etc - these products are more gimmick - more foe - than friend. Science does not support their use. IF you read the fine print, you will notice that the results are not typical and diet and exercise are necessary to achieve weight loss.

Celebs and Diet Ads - This year you will believe science over celebrity. If you MUST trust a program - trust Weight Watchers. There are NO products that you have to buy with WW- every thing you need is at your local grocer. The education they provide is legitimate. The lessons are doable and all is safe.

Say Yes to Change- In research studies there is always an interest in the effect size. For example, a certain teaching method may improve the scores for students who receive this new method as opposed to students who do not. Thus the new method is effective. But, HOW much so? Are the scores 5 points apart or 10 or 20? I.e., is the effect size small, medium or large? Small changes will get you small results. IF you walk ten minutes a day it will not improve your health as much as a twenty minutes a day. However, NO change will lead to NO change. Start where you are this year and take it from there - but this year, you will START.

Scrub Your Own Toilet - Not sure where to put this little gem, but I must include it. I saw a commercial for a toilet bowl scrubber that is automatic. You attach it to the bowl and it does its thing. It is devices like this that add up to make us an overwhelmingly sedentary society. This year - you will use less automation and more elbow grease.

Clothing - Beginning today - man or woman, if the clothes you put on make you feel unattractive or uncomfortable - take them to Goodwill. They could very well make someone else feel beautiful. You should feel beautiful or handsome, too.

Sit Less - This is a change you can make. Vow to keep those sit downs to one hour or less. This does not mean that you have to take a 30 minute walk every hour, but you must get UP. Remember, this improves your brain functioning and reduces the risk of dying from any cause - as it relates to metabolic changes that occur when you sit for prolonged periods of time.

Move More - This is NOT the same as sitting less. What ever physical activity you have now - unless it is 60 minutes 7 days a week - do MORE. If you do not do any, start with 15 minutes a day. IF you find that you can not do 15 minutes a day, change the activity, not the 15 minutes. This year you will move more - not a few times - but consistently.

Eat Better - One more time again - more fruits and vegetables, whole grains, lean protein and fish. Less fried foods and saturated fat - reduce (restrict) sugar and processed food consumption. Not sure what to do with fresh food? Subscribe to my You Tube channel - or just visit it from time to time. It has a search feature. You could search green beans, cereal bars and dessert - for example.

Be Open to New Findings - Science is improving. We will learn that some medications, screenings and foods are better for us and some are not necessary or helpful. Don't be afraid if the new science challenges your old beliefs - we need to accept that things change and change with them.

Buy and Wear - a bicycle helmet!

Avoid Extremes - There is no quick fix and there is no need for extremes.

Avoid All Forms of Tobacco Smoke - active or passive - it is all toxic - it is a carcinogen - tobacco smoke is proven to cause cancer and severe lung diseases, heart disease and a multitude of other fatal, acute and chronic conditions.

This year you will make healthy choices every day because each day is the foundation for the next - this is how you stack the deck in your favor for the years to come.

Inventory

2011-12-31T20:01:00.000-04:00

It is likely that you are thinking of things that you will do differently or for the first time in 2012. The New Year is fast upon us and has already arrived for some. I would caution you to carefully consider your 2012 aspirations. I would most definitely set goals but only after careful and deliberate thought of how you will achieve them and if those steps (the how) are doable.

But really that is a post for tomorrow - or one you might find elsewhere.
Tonight's post is about what has past.
For me it is the end of the year and my most important time for journaling or reflection. I make a point to touch in at important times, but my New Years Eve or New Years Day journal entry is a tradition. Sometimes I write on both days. I also weigh myself at the end of the year and midway through (that is all). The journaling and weighing have similar purposes. I am touching base with myself - in print. Am I on the course I wish to be? Are the things I want to keep stable (like weight and relationships) in good shape? Am I on course to meet the goals I have set? Is it time to set a new goal (it always is!)? What important things have happened in the past year? What obstacles have I over come? Which have I constructed? What challenges need more attention. ETC

I strongly encourage you to explore, touch base and make peace with 2011 before you make your plans for 2012.

Obesity Epidemic Permeates

2011-12-30T21:51:00.001-04:00

The expansive girth of Americans is not only the topic of research articles and news shows, but fodder for popular novels. I know this because I am enjoying the rare opportunity of reading one.
During this brief break between semesters, I checked out a library book. The novel is by one of my favorite mystery writers, Patrica Cornwell. It is titled Port Mortuary.
As I read today, I came to a passage where the medical examiner's administrative assistant remarks about all the SUVs and men in suits in the complex's parking lot.
He was speculating on who they could be, FBI perhaps.
He noted that the men were quite strapping and noticeably fit. Then said this,
"I think the FBI fires people if they get fat." Followed by,
"Well, good luck hiring in America."

Ah, sad but true. Perhaps the year 2012 will offer promise for reducing the number of Americans who are now overweight or obese. IF anything, maybe we can keep the children who are born in the year 2012 from ever becoming overweight. Now that is something that is entirely possible!

What you Eat - How you think - Memory Booster

2011-12-29T21:32:00.001-04:00

Several popular press stories are covering the research cited at the end of this post. The work is published in the journal Neurology. It is a legitimate scientific study.

I think that you will get a lot from reading one of the news stories, this one for example, but let me make a few points before you go.

The scientists did a small study and they based their associations on what people reported eating and their subsequent blood work. Most of the time food frequency recall is fine, but people may forget some items and may list things that they think others want to hear instead of what they really ate.
Still, the results of the study are most likely accurate, though they need to be duplicated.

The researchers found that people in the study who had certain levels of certain nutrients in their blood streams, had better brain functioning and memory outcomes.

They associated the nutrients with the intake of fruits and vegetables and the type of fat - omega 3 fatty acid - that is found in fish like salmon. People in the study who ate more processed foods and fried foods (like burgers and fries) had worse outcomes.

The most important thing I want you to understand is this:
The results are related to FOOD - they are not about taking supplements. When someone tries to use the study to sell you vitamins - don't be fooled.

As January rolls around, consider eating a more plant and fish based diet. It can be good for your waist and your brain (as long as you don't fry the veggies and add oil, fat and butter to them!)

Bowman, G.L. ND, MPH; Silbert, L.C. MD, MCR; Howieson, D. PhD; Dodge, H.H. PhD; Traber, M.G. PhD; Frei, B. PhD; Kaye, J.A. MD; Shannon, J. PhD, MPH; Quinn, J.F. MD

Title	Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging.
Source	Neurology.

Misinformed or in Denial

2011-12-28T22:01:00.000-04:00

I am not sure which it is (lack of info or aversion to restriction) but the products displayed in the pictures below are not the answer to anyone's weight problems. Instead, the only scientifically proven safe and effective way to manage weight is through energy balance. If weight loss is necessary, and for most of us it is, then a negative balance must occur. This means that the energy you take in is less than you need to maintain the current weight. You can eat less (the strongest factor) or exercise more or both. The only problem with this approach is that most people, without the help of experts (not those on TV or in fashion mags, but licensed nutritionists or health educators), do not know how many calories they are consuming now (energy in) or how many calories are burned in the exercise that they do.
Also, the change in calories in or out has to be consistent every day. If you are going to exercise more to lose weight, you must do the extra every day and you must not eat more because you have exercised!
Imagine that you know you are eating 2000 calories a day now - for the next year you might try eating 1800 calories a day (but you have to know the amount of calories in the food you eat) and/or, you are walking 20 minutes a day now, and to lose weight you double that to 40 minutes a day, you have to do that EVERY day.
It is much easier to get 200 calories off your plate than to burn them so I suggest you learn about food. I also recently reviewed an article which discussed effective strategies and the ONLY commercial program on the list was Weight Watchers.
However, for your health, mood, aging, fitness and such - I and other health promotion specialists, recommend daily exercise.
But the most important thing, for anyone is that they Do NOT get tricked into buying the scam products seen here !!

Whatever it takes?? Seriously?? It takes eating less that is what it takes!

Really Large/X Large?? Because a size small makes sense??

Magnets do NOT cause weight loss...

Winter Holiday

2011-12-24T23:39:00.000-04:00

Taking a short break to enjoy the holiday - may you do the same ~ Deirdre

War on Cancer

2011-12-23T21:12:00.000-04:00

I won't add much of my voice to the headlines of today - that it has been 40 years since President Nixon enacted a law that led to much cancer research and subsequent medical breakthroughs.

But I will concur with those who attribute the decline in cancer death and cancer rates to

screenings (i.e. pap smears, colonoscopy, and mammograms),
a significant reduction in tobacco use and tobacco exposure,
diets that are plant based and calorie controlled and
to daily excercise

This is my last post for a bit - enjoy the holiday-

Menu Labeling in Action

2011-12-22T22:51:00.000-04:00

First, I am kicking myself for not taking a picture especially because I had my camera in my purse.
Today I had lunch with friends at a Panera Bread. Like Ruby Tuesday, it is a chain restaurant that will be required to post calorie information within the next year.
But Panera is not a sit down and order establishment so to have the information at the point of purchase, it has to post it on the menu board.
I noticed it today as I was in line. Next to each item, all across the walls of the menu board, behind the long double counters, are numbers. The first number is the price and next to it, in a lighter color and in narrower font, is the calorie information.   Sometimes the numbers for calories are given in a range. The truth is that the number is not ever likely to be the exact amount, but it is a place to start.

This is a new policy and it will need to be evaluated. Some smaller studies have been done. I have read them and blogged about them. We find that if a person sees the information, knows what it means both generally and specifically to their bodies, and uses it, then caloric intake is reduced.
The new policy includes directions and maybe funds, for education and promotion regarding calorie control. The display that I viewed today was not prominent and there was no prompt to bring attention to the posted information. I am not surprised that it is there but not highlighted because many restaurants are wary of posting the calorie and other nutrient information for their products, as we might find some of it shocking.
\

Rollerblade - Really??

2011-12-21T22:36:00.000-04:00

For the semi regular "really?" segment, I offer you this evidence of stupidity.

As I was running (in Florida) the other morning, I came across a woman who was rollerblading. She was on a road, not a street, a road with a double yellow line down the center. She was in the bicycle lane.

She was going with the flow of traffic and thus coming AT me - running in the bicycling lane (which of course, is NOT stupid :). She may have had on knee pads, but no protective gear for her head. AND.... wait for it......
................................................................
....................................she was talking on a cell phone.

As she and I passed, I said in my head, no, I said it out loud, "going the wrong way AND talking on the phone?!?...you're an idiot." But a few feet later I realized, that technically she and I were both on the right side of the road because she was on wheels.
My Dad always said, (so it must be true)-

if you are on your feet (face the traffic - i.e. walking and running)
if you are on wheels (i.e a bicycle) go with the flow of traffic.

He might have added,

if you are stupid, you should have good life insurance.

Of Mice and Calories

2011-12-20T22:46:00.000-04:00

There is a small but growing body of science that relates low caloric intake with longevity and cognitive health. In other words, the slowing of aging and the preservation of memory.

The studies are taking place in the lab and with animals. This science is at the molecular level - or way under the skin - in the cells and in the brain. We don't know if what these studies show will carry over into human biology, but it is worth a shot.

Because there seems to be a correlation between caloric restriction and memory enhancement, scientists have searched for the particular mechanism that might be responsible. Recent work has focused on a protein, CREB1 - which is also a gene and a molecule - I think. It is a protein associated with memory. Something happens in lab mice on a restricted diet that activates the protein. Creb1 does not act alone and more is not known than is known.

A recent study, attributed to a Dr. Pani, showed that mice who were fed 70% of their usual caloric intake responded by producing the protein. The production of CREB1 is at the heart of many anti-aging studies.

I wanted to mention this study in light of the one I mentioned a few days ago in which the VLCD or very low calorie diet in one study meant only 890 calories per day.

The work of Dr. Giovambattista Pani implies a more doable strategy. Again, we do not know if the same result would occur in the human body, but most of us could stand to lose a few pounds anyway. If someone is consuming 2500 calories a day and dropped to 1750 - that is a reasonable reduction(with a doctor's go ahead of course).

Looking the Part

2011-12-19T21:34:00.000-04:00

I am not going to get this exactly right, but it was something close to this:

Last night, after I excitedly told my sister about the calorie information on the restaurant menu, someone at the table said, "She doesn't have to worry about counting any calories herself." To which I replied, (as one of my favorite teaching moments), "That's because I do." In other words, I look like I don't have to watch what I eat only because I do (watch what I eat).

Weight control and weight loss are NOT easy. Well over 90% of all people have to be mindful of energy intake and expenditure in order to prevent overweight and obesity. In other words, there are very few people who can eat "anything they want" without paying some price for that.

Dining Out

2011-12-18T23:44:00.000-04:00

In preparation for a meal out tonight, I went to the restaurant's on line menu. I was surprised to find that there were certain entrees and sides that were categorized as fit and trim and which had caloric content listed.
I should not have been surprised because it was a chain restaurant and soon all items will have to have this information as part of a new national policy. I love this policy. I like to be informed when making important choices and what is more important then the food we put in our bodies? Well - there are more important things, but this is one that is worthy of some diligence.

I was delighted to have the calorie information but also perplexed by it. In the vegetable section, steamed broccoli had close to 100 calories. Why is that? If you get something steamed you do not want oils or butters, generally speaking (or you would get it sauteed). A whole cup of broccoli has about 60 calories.
I tell you this to remind you that healthy by default is NOT the nature of restaurants and to be certain, you should tell your server, no oil, fat or butter - if even it is a steamed item.
I had a great meal of broiled tilapia and dry steamed broccoli and even though the light dishes offered weren't perfect, they are appreciated.
The restaurant and its menu information is available here.

Staying Fit to Serve

2011-12-17T22:12:00.000-04:00

During my travels today, I changed planes in Atlanta. I must have seen over 100 men and women in military fatigues, returning home from war ( I assume). Not one of them was overweight or obese. Fit they were - though I did spot one or two in the smoking lounge and that was heartbreaking.

Seeing them - all of them - beating the odds(besides those of surviving war)- i.e over 66% of American men and women are overweight or obese, and they are not, stimulated many research questions.

1) Do people who are more likely to take care of their bodies join the service?
2) Does being in the service 'prevent' obesity?
3) What percent of service men and women who return to civilian duty, become overweight or obese?
4) How long after leaving active military service do men and women begin to gain weight?

Those were some research questions I had - but truth be told, I was just damn glad to see these brave, fit people - predominantly young people, home where they belong.

I am not naive, I know that there will be problems and weight gain is not high among them, I just thought it relevant fodder for the blog.

Health Risks of Excess Fat

2011-12-16T22:55:00.000-04:00

I came across a graphic that shows the outline of a body of a child next to a body of an adult. Each figure is surrounded by text boxes with headers like lungs, throat, legs, etc and in the boxes are the risks associated with being overweight or obese for that particular body part or organ.

The health problems of the child often carry over to the adult and are worse over time. The bottom of the chart shows an arrow going from the words children to adults. There is states that childhood obesity predicts adult health risks. This information is similar to that found in the study I talked about a few days ago. In fact, it was probably the references in that article that helped me to find this chart. However, I cannot find it again. I have only my one printed copy.

I wanted to make a note of the health risks for the people who continue to minimize the outcomes of being overweight or obese. Remember, the good of the country is very much tied to the health of its people. The public health.

I used the information in the handout to make the table below. The graphic is attributed to Drs. Ann Prentice and Susan Jebb who are with an organization called Human Nutrition Research in the UK. I found the authors on line, just not the document. If you are curious, here is the website.

My table doesn't include the citations that the scientists included with the risk factors. Everything in the table is associated with a research study, but I did not list them.

In the table, if a person has a greater risk, it means greater than someone who is not overweight or obese. (I could have done a better job on this, but I really need to be packing for my trip to Florida in the morning, so sorry)

Children	Adults
Obese females have 3x the risk of asthma	Obese adults have 85% higher risk of asthma
3x risk of hypertension	6x the risk of hypertension
77% of obese children have fatty liver disease	76% of obese adults have fatty liver disease
Overweight and obese children have lower QOL scores	More than 4x higher depression
20% have sleep problems related to breathing	Most obese adults have chronic obs. sleep apnea
30% of overweight and 50% of obese have metabolic syndrome	7x the risk of diabetes for the morbidly obese
	93% higher risk for colon cancer
Increase in type 2 diabetes in all children	Twice the risk of breast cancer
7% higher risk of fractures	More than 4x greater chance of arthritis
Increase in kidney impairment	Losing weight returns ovulation to normal in many
Decreased tolerance for exercise	Higher risk for all cancer except, brain, lung, bladder and stomach
	Lower sperm counts in obese males

Calories and Diets in the Lab

2011-12-15T22:13:00.000-04:00

I was reading an article earlier this week which referred to the research referenced at the end of this post. I was curious about the study because it compared the weight loss results of three or four groups. I searched for the study itself so that I could see the actual requirements for each of the groups. Here are the 4 categories that intrigued me:

Consume 25% Less Calories per day
Consume 12.5% Less Calories per day and Increase Physical Activity by 12.5%
Consume a Very Low Calorie Diet (VLCD)
Consume as usual (control group)

Instead of going too much into the study, I want to share what these group assignments meant for the people involved in the research. I think the information is relevant and interesting to people who "cut their calories." Ironically, it was the VLCD group that got my attention. The article I was reading mentioned 25% and 12.5% reductions but did not give any clue as to what was meant by very low calorie.

The scientists were able to determine the near exact total energy expenditure (TEE) and total energy intake (TEI) of the participants when they signed up for the project. This was a small study. The participants stayed overnight (once or twice) in the lab and ate all their meals according to a strict protocol in the weeks that followed (except the control group). Each of the reduced calorie groups had a different caloric plan, based on their individual baseline and metabolic (energy burn) needs.

For the purpose of an example, let us say that the TEI of a person in group 1 was 1900 calories at the start of the study. That means they would then eat 475 calories less (25%)or 1425 calories a day. I believe the person did this until they lost a certain amount of body weight and then the calories were adjusted in order to maintain the new weight. It could be that the end caloric intake was 1600 a day.
Take a similar person in group 2. They would eat about 235 calories less than 1900 and would have to burn the other 240 calories in exercise. The heavier a person is, the less time they would need to burn those calories, but according to the article, the average time spent walking (or something similar) per day was between 45 and 50 minutes. This group had to exercise 5 days a week and 3 of those days had to be under the supervision of a research assistant.
Group 3 got the worse of it to be sure. They were given 890 calories a day until they lost 15% of their body weight. After which, whatever calorie amount was needed to maintain their new weight was adopted.
So - all this to say that in the 24 weeks for which results are provided up until week 24 when groups 1 and 2 merged, the diet only group lost more weight than the diet and exercise group.
The VLCD group -the 890 folks- lost the most weight and lost it the fastest, but it is unrealistic for ANYONE in a "free living" environment to manage a diet that extreme. I would not have known if the VLCD was feasible if I had not tracked down the study protocol.

If you are interested in the study, the information to access it is below.

Effect of 6-Month Calorie Restriction on Biomarkers of Longevity, Metabolic Adaptation, and Oxidative Stress in Overweight Individuals: A Randomized Controlled Trial
Leonie K. Heilbronn, Lilian de Jonge, Madlyn I. Frisard, JAMA. 2006;295(13):1539-1548.

The Swim

2011-12-15T00:03:00.000-04:00

It is done. I did it. With rare exception, I swam twice a week (indoors) during the entire fall semester - even when it got cold outside and before the pool water was warmed. From August until now, I swam twice a week except two times when I only swam once a week (because the pool was closed). If we go back six months, I had 3 once a weeks and the rest were twice a weeks.

I did get my money's worth from the suit!

The only time that I truly dreaded the swim was in October - when the water temperature really dropped and I tended (literally) to shiver the entire time I swam.

Actually, if you look back at this September post, you'll see some of my angst as I struggled to keep my vow of swimming through to December.

And then there was this post on October 31st when my resolve was wearing thin. I was called out for being a wimp and "torturing myself" by easing into the pool. I started to jump in the very next time and things looked up from there.

If I look back to June of this year, so roughly six months, I went from 12 laps to 20 - finishing today with 22 laps which is OVER a half mile (1100 yards). The half mile (880 yards - or just over 800 meters) was my goal.
Oh, and don't forget, I added the kick board for my final (extra) lap for the last month or two as well.

I did try the flip turn one more time today, but I missed the wall on the kick off and got water up my nose. So, well - I can't do everything I set out to do.

I looked at the usual distances for swimming, biking and running in triathlons and I qualify for the sprint distance on all three and almost the olympic distance (the swim is .93 miles).

Now that is something to worry about after grad school. Maybe it will be my 50th birthday present to myself.

I really enjoy the swimming and it has gone from "something to do to rest from running" to a true stand alone fitness activity. In fact, lap swimming has a pretty high MET value - so WOW - yay me.

That's not really all - I made it through the entire semester without missing a day of exercise - my regular running, weight training, swimming and walking - all adhered to and all kept me sane. I am just about as proud of that as I am my final grades!

So - I don't know - there may be swimming in the New Year after all. The pool is officially closed until January 9th and I am off to Florida for a while - by the time I return I may be over it... however, I thought of packing my suit and maybe going to a Y while traveling :)

Childhood Obesity and Adult Outcomes

2011-12-13T21:38:00.000-04:00

Juonala, M. M. D. P. D., Magnussen, C. G. P. D., Berenson, G. S. M. D., Venn, A. P. D., Burns, T. L. M. P. H. P. D., Sabin, M. A. M. D. P. D., . . . Raitakari, O. T. M. D. P. D. (2011). Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors. New England Journal of Medicine, 365(20), 1876-1885.

The purpose of the study that is referenced above was to determine if people who were overweight or obese as children but who were NOT overweight or obese as adults would have similar cardiovascular risk factors as people who remained overweight/obese or who became overweight/obese as adults.

I know, a lot to wrap your mind around. If you figured out that they were comparing outcomes between 4 groups, then you are on the right track.

It has already been established that being overweight or obese as a child greatly increases the risk of adult obesity. It has also been established that the heart disease (cardiovascular) risk factors associated with overweight and obesity are hypertension, diabetes, low HDL, high LDL, high triglycerides and thickening of the carotid artery. It is those six outcomes that the researchers measured in this study of over 4000 persons.

The current research involved four studies that were started about 23 years ago and which took place in USA, Canada and Finland. The average age of the student at the start of the 4 studies (when their BMIs were collected the first time) was 11. AT the end of the individual studies, the BMIs were collected again and each study had information on the risk factors for heart disease that I mentioned above.

Here are just a couple of things from the current study that I found interesting:

Of the students who were normal weight at the start of the study - over 14% became obese adults.
Of the students who were overweight/obese as children, over 64% became obese adults.
OF the students who were obese, as other research has suggested, 82% became obese adults.

Everyone who was obese/overweight as an adult had 2 to 3 times greater risk of all of the above outcomes with few exceptions.

The children who were overweight or obese and became normal weight adults had the same level of risk as normal weight adults. (this is great news)

The two things that need to be done with the findings are
1) prevent our children from becoming obese
2) provide treatment to obese children so they do not become obese adults. The best chance at reversing the weight is going to come in early childhood - before age 11.

Metabolic Fuel

2011-12-12T22:13:00.000-04:00

In the article that I referenced last night (regarding the erroneous contention that 3500 cals was the equivalent of one pound of body weight), there was a separate discussion regarding the macronutrient composition of diets.

What?

When I say macronutrient, you should hear; fat, protein and carbs. For as long as I have been writing about and studying obesity (ten years now), people have asked and studies have explored, which is better – low fat, low carb or high protein diets. My answer has been and the research supports, a calorie is a calorie. For this truism, Dr. K. Hall and the other authors (from the study referenced in the last post) do not object.

The sub article does give three possible reasons why the composition of the diet might impact the amount of weight lost. By this I mean, if a person consumes 70% carbs and 15% protein and fat – or any such combination, does it change the amount or the speed in which they will lose weight.

In the short term, which is all that has really been studied, there is no true difference between types. In the end, if a person consumes less calories than they have been and everything else stays the same, they will lose weight. This is often true of exercise as well. IF one adds more activity to their day (consistently) and does not change anything else, they will lose weight (albeit at a slower pace). What tends to happen with the addition of PA is that people DO eat more.

Okay – the three points that were made in the article.

Intracellular or physiological changes take place within the body based on the amount of each macronutrient that a person consumes. I learned today that the fat, protein and carbohydrates that we take in are mirrored in the body by what is called metabolic fuel. In the body, it is fat, protein and glycogen. The body maintains a balance of the metabolic fuel. It has been shown in lab experiments that if you change your balance, say you eat more carbs and your body needs some fat, it will then use the stored fat to make up the difference. This is possible, but the effect to date has not been enough to unseat the calorie is a calorie stance.

Energy burn can be impacted by the foods that we eat. Certain macronutrients have an immediate but short term effect on your metabolism in the few hours after you eat it. Scientists are using simulation techniques to explore this phenomenon, but again, it has not been found to improve outcomes – or cause more weight loss then simply creating a negative energy balance. (less in and more out)

The composition of a meal may have an impact on one’s satiety and reduce hunger so that over consumption (over eating) does not occur. When discussing this area, the article author’s noted how notoriously bad “free living” folks were at reporting what they actually eat and in following the recommendations of any meal plan.

So for us the bottom line is – a calorie is a calorie. Now as I have said before, this is regarding weight. For health – what you eat – i.e. what the DGA 2010 recommends – is of great consequence and importance.

Don’t eat all your calories in chips, dip and twinkies.

Odds and Ends

2011-12-11T23:27:00.000-04:00

Spandex: I heard part of a story and some interviews on the radio show, Weekend Edition, this morning. You can actually listen yourselves, and may I suggest that you do. It is only six minutes long and can be accessed here. The main point was that with so many women overweight, comfort was more important than style. (the statistic offered on the percent of women who are now wearing plus size clothing, was shocking) The overwhelming use of spandex in women's fashion was highlighted in the story. I found it disheartening. Of course, I had my years of wearing stretchy clothes - in the 1980s. I wish I had written down some of the comments that were made this morning, but suffice it to say, spandex might allow you to wear more clothing styles than your body type implies, but it doesn't do anything to reduce your risk of diabetes, heart disease and cancer. The only spandex to be found in my current wardrobe is in my exercise attire! As an added bonus to hearing the story today, I became aware of this informative website as well.

Diet Fallacy: I am reading an article that was published in the Lancet in August of this year (my studies have winded down and now I can catch up!) I only want to make one or two points here. It is a complicated article on mathematical simulation for weight loss interventions. The citation is :

Hall, K. D., Sacks, G., Chandramohan, D., Chow, C. C., Wang, Y. C., Gortmaker, S. L., & Swinburn, B. A. (2011). Quantification of the effect of energy imbalance on bodyweight. The Lancet, 378(9793), 826-837. doi: 10.1016/s0140-6736(11)60812-x

If you can access the article, I would give it a read. I know I just said it was complicated, but there are pieces that most would understand and find illuminating. The most important take away from this research is the proclamation that the 3500 kcal = 1 pound, weight loss rule is incorrect. The authors call it the diet myth and hold it responsible for unrealistic expectations and disappointment. Several factors fail to be considered in the erroneous message. First, individuals are different. Second, when a person loses weight, metabolism and energy needs change. Also, the less you weigh, the less calories you burn in any of the activities that you do. Third, lean tissue burns more calories than fat tissue. Initially, a person loses fat tissue. A heavy person loses weight faster than a person with a higher ratio of lean to fat mass.
Either way, the body composition changes during weight loss and this also impacts energy expenditure. One of the examples in the article refers to a man who weighs 220 pounds. His baseline intake is 3000 calories a day. He is initially put on a 1200 calorie deficit, so he is consuming 1800 calories a day. He loses weight over six months (44 pounds) using that 1800 calorie plan. Then he maintains that new weight with 2600 calories a day. He does not and you can NOT return to your usual caloric intake. What happens in weight loss programs is that 1) baseline caloric intake is not accurately captured, 2) adherence to the caloric and or exercise recommendations is not 100%, 3) patients return to their baseline caloric amounts and regain their weight. It is also worth noting that in a simulation example, the scientists state that after a certain change in intake, half the goal weight will be lost in the first year and 95% of the goal will be achieved in 3 years. Read that again - 1 year and 3 years - not overnight. Fast does NOT work.

Return on Investment: Exercise. I had a couple of challenges to work around this week - rain one day and 30 degree weather on another. I am not one that enjoys changing my "plans," but on Wednesday when we had a cold heavy rain, I swam (yup) and did my weight training and then on Thursday I did the run. If you cannot do what you intended, it is still important to do something. Today it was quite cold, but I knew that the return on my investment - running - would be immeasurable and lead to a productive and balanced day. You must believe this. It is true.

Party Favors: I also did a little cooking and baking for the week. I have a couple of potlucks to attend. First, I made a nice vegetarian chili. As I graded papers, the house filled with a heart warming, comforting aroma. I also made some new fruit wantons and a pumpkin cake. It is nice to bring sweet but low calorie items to gatherings. In fact, my wantons are coming out so good that I am going to make little treat bags for my sweet nieces in Florida. Here is a picture. They taste like little pies. The recipe will be posted to You Tube in the future.

Not the best photo, the wantons are in the back, YUM - I promise

The Less Pills No Brainer

2011-12-10T22:15:00.000-04:00

There is a change in the recommendation for treating people who have been exposed to the tuberculosis virus - or TB. In other words, persons who test positive for TB with the tine test but who do not have symptoms or active infection. However, instead of getting into the details of this contagious and sometimes fatal lung disease, let me cut to the chase.

The usual treatment regimen for persons who meet certain conditions, like being over age 12 and not having any chronic disease conditions, consists of taking several pills, several times a day, for 9 months. The compliance rate for this is pretty low. [surprising]

As is the case with most things, and as I like to say, the best method, treatment, exercise activity, etc is the one the person is most likely to do.

There is a new way to treat this latent form of TB that involves a once a week drug combination that is given under supervision of a physician. It lasts only 12 weeks - 3 months instead of 9. You can read about it here.

I wanted to speak to this issue, even though TB is not a chronic disease nor is it related to lifestyle or obesity. I am one of those exposed to the virus. It happened many years ago when I was a child. A spouse of a family member had the disease and had to "go away" for treatment. I had to take pills for EVER and at the time I could not swallow pills. It was awful. I recall it was three pills three times a day, but you know how memories are. I just remember that my dad was disappointed in me, and then one day I DID it!!! I was so happy with myself. It was empowering - as silly as it seems. I have been able to swallow pills ever since. And I did not contract TB :)

Coal Fired Irony

2011-12-09T23:13:00.000-04:00

In 2005, I became interested in addressing the issue of mercury contamination of ground water and soil. This environmental pollution leads to methylmercury in fish, and this can be harmful to humans.
I wrote a lot about it then and since. I believe I shared my Good Fish Bad Fish powerpoint with blog readers at some point. As part of completing my "project," I attended an EPA meeting in the NC state capital, Raleigh. It was actually an open forum or hearing on rules for coal fired power plants. Most of the mercury that is contaminating our environment is from this source. There are other forms of energy that are clean or cleaner, AND there are ways to make coal fired power plants themselves cleaner. I do not recall everything, but something about scrubbers -
There is also cap and trade policy and our clean air acts.
As you are aware, legislation is often challenged and companies find work arounds.
When I was actively engaged in my Master's program and the study of this issue, I emailed my senators and congressperson. They replied with reasons why they were NOT going to push for the regulations to be enforced.
Imagine my "hhhmmph" moment when I recently heard on the radio that a few counties in NC were having meetings to determine how they would use their settlement money from the Tennessee Valley Authority. TVAs mercury emissions from coal fired power plants had led to local contamination.
No more really need be said.
By the way, I also made a pamphlet those many years ago and I uploaded it to Google Docs in case you want to take a look.

What Doctor's Think

2011-12-08T21:32:00.000-04:00

I have just come across the published results of a new survey of 1,000 primary care providers and pediatricians conducted by Harris Interactive on behalf of the Robert Wood Johnson Foundation (RWJF). I was able to take a glance at the results, presented with graphs and bar charts and think that you would enjoy taking a look. I plan to read the survey, but I don't have the time right now. Many of the questions that were asked have to do with the social needs of patients. What doctors think about them and meeting them.
You can see the results here.

Breast Cancer Report

2011-12-07T23:45:00.000-04:00

I will be brief here because I am going to link you to a handout that should answer most of your questions. The best part in highlighting this report by the Institute of Medicine(IOM) is that it was commissioned and certainly funded by, the Susan G Koman foundation. I have donated and raced for Koman, so my money and probably some of yours, helped to pay for this. We made this report on the environmental factors associated with breast cancer happen. How AWESOME.
In this report, instead of reviewing the non genetic or non changeable factors (i.e. age and family history), things that we may have some control over, either personally or publicly (policy) were explored. Remember though, there is always the unknown element and the under-the-skin piece. The environmental factors in the report were broken down into the categories below. I will give a quick overview and then I encourage you to go to the handout. There are also plenty of news stories on this topic today.

Evidence of Cause - certain types of hormone therapy, excess weight, esp. after menopause, alcohol consumption and medical radiation (yes, those scans I keep warning you about and railing against)(ionizing radiation), and to a less conclusive but still suggestive extent, smoking
Evidence to Prevent - physical activity - meaning that women who are the most physically active (but exactly the same in other ways) have less breast cancer
Things that do NOT cause it - hair dyes and the other kind of radiation (non ionizing) found in microwaves and other electrical devices like cell phones
Possible Associations- second hand smoke, any tobacco smoke and chemical pollutants, such as we find in gasoline fumes and the air we breathe
Probable or Plausible Factors - scientists believe that the chemical BPA (discussed here recently) used in the making of plastics and banned in some countries could cause the cancer. In other words, it makes scientific sense when studying it in the lab and in animials.

Please do not stop here - also read the handout which has more information.
Disclaimer: I am not sure if I have been open about all of this in my blogging, but heart disease, arthritis and breast cancer are in my family history. I have at least two relatives who are breast cancer survivors and my paternal grandmother died of breast cancer long before my birth. That being said, it is always a personal issue for me.

The Way We Celebrate

2011-12-06T23:27:00.000-04:00

My sister told me, some years ago, that as people and life changes, so must our traditions. We find new ways to celebrate, show love, be together. Her first mention of this may have come not long after our father had died. It was hard to do things, especially holidays, different than I was accustomed and comfortable. We did though - now we have new traditions that may be replaced in time, but for now, they are good.

A lot of us celebrate with food that is not the best for us. That is okay when the celebrations are spread out, but not so good when they occur in sequential, multitudes. (i.e from Thanksgiving to New Years)

Tonight one of my dearest friends and I (who live near enough to see each other frequently, but who do not because our lives are so crazy), shared each others company as our holiday gift.

We attended a YOGA class together and then shared a healthy meal and one libation. We returned to our separate homes renewed, refreshed and feeling good about ourselves and our friendship.

I even took a picture of my meal to share with you!
It's a bit blurry because my phone doesn't have a flash..

steamed broccoli and mixed vegetables - YUM!

Sufficient and Necessary

2011-12-05T23:34:00.000-04:00

When I attended Dr. Jakicic's lecture last week, I wanted to point out one of the necessary components for addressing obesity that he did not include in his closing thoughts.
I thought of it again today as I recalled my studies as a Master's student last decade (2004-07). I believe it was in a class that discussed disease etiology - or the processes that occur and lead to an illness. Some things are necessary for a disease to occur, some of them are sufficient to cause the disease on their own and others only cause disease in the presence of some additional necessary factor.
One example; Smoking. Cigarette smoking is sufficient to cause lung cancer on its own but smoking is not necessary for lung cancer to occur. Some people who never smoke also get lung cancer. Sun burns may be necessary for one to get a certain type of skin cancer(but not sufficient). DNA damage must also occur. ETC

So Dr. Jakicic ended his presentation by saying that in order to address obesity, several disciplines need to work together.
On the individual level, people who special in behavior modification or health coaching can work on motivating and supporting persons who are interested in losing weight. Actually, they may even create programs to move people from not wanting to lose weight to making plans to change their lifestyle so they will. Exercise specialists or kinesiologists stress the importance of physical activity as advised by the Physical Activity Guidelines. This PA is not primarily for weight loss but for reducing the adverse consequences associated with being overweight. Nutrition professionals encourage caloric modification and the adoption of the recommendations made in the Dietary Guidelines - foods to limit and foods to include.
[btw -reducing calories is sufficient for weight loss]
The piece that was left out is the one that is of most interest to me as a student and future researcher/policy analyst.
The missing piece is modifying the environment in which people find themselves so that the suggestions of the exercise and nutrition folks can actually be adopted. The availability of healthy foods and food information and opportunities to be physically active and to sit less, at school, work, within faith communities, restaurants, community places, etc.
This last piece is not enough - it is not sufficient, but it is absolutely necessary.
We need the opportunity to use the skills and apply the knowledge - that's my passion. I am not telling people what to do, but making it possible for them to do the right(healthy) thing, should they want to.

Odds and Ends

2011-12-04T23:08:00.000-04:00

This week's O&Es are associated with one subject as broached in one news story. I.e., I am cheating, but it IS finals week (almost done, one project to go before I start helping my 'supervisor' with her grading)
I haven't had time to pay much attention to anything but my studies...
Still, I was intrigued when a headline re: obesity was connected to the Wall St. Journal - the financial experts. Especially because many of their readers (and I AM a fan) might be considered conservative and conservatives might, in general, shy away from issues they consider to be related to individual "rights".

When obesity has a nationwide impact (as discussed a few posts ago) it is a public health issue, not a personal one.

The numbers from the WSJ article on the Economics of Obesity are these:

Regarding the year 2011, the percent of Americans over the age of 20 who are obese is 29.5. The article does not define obesity, but it is usually a BMI 30 or above. It is expected that, if nothing changes, the percent of obesity in adults will be 50 in just about 8 years. [these are obese numbers only - over 30% are overweight currently]

Of the annual health care expenditures in the US, 16.5% are associated with treating obesity.

Obese persons appear to prefer larger, gas guzzling vehicles - i.e. causing energy costs to increase.

Obese workers are sick more than non obese workers. This is not well qualified in the article. It may be that on average they are sick 3.7 more days or that for every one day a non obese person is absent, an obese person is absent almost 4.

The gains that we have made for life expectancy, reduction in disease and saving money in health care expenses from a 20% reduction in the smoking rate could be erased by the economic burden of obesity.

No fact checking was done for this blog post - I am simply telling you what was included in the WSJ article. Again, that is available here.

Too Much Chair Time

2011-12-03T22:49:00.000-04:00

The body of research that associates prolonged sitting with all cause mortality, heart disease and several types of cancer continues to grow. A news story published last month in a WebMD newsletter listed three recent studies that support those previously published.
The studies can control for other factors, including how much exercise a person gets or what their BMI (fat status) is and look only at the effect of prolonged sitting. The findings are that sitting for more than an hour at a time has significant adverse consequences.

The health promotion message is being modified accordingly. It now goes beyond telling people to get daily exercise and advises them to limit sitting as well. (you realize 'people' and 'them' is you, right?)

I have read at least one of the studies that was mentioned in the article and I am in the process of reading another, but here are some of the findings that you might find interesting:

A study by Owen associates sitting with an increase in inflammation and other physiological changes that have been linked to cancer occurance.
Friedenreich reports that exercise can prevent colon and breast cancer. She looked at both colon and breast cancer incidence and compared people who exercised the most to those that exercised the least or not at all and found between 20 and 30% fewer cancer cases in the exercisers.
Patel and Berstein (the study I am reading now) have found a link between sitting, regardless of weight and exercise levels, with any cause of death in the 14 years that they followed a group of persons. Results included that for men who sit more than 6 hours continuously, there is a 18% greater risk of death than for men who sit the least and for women the increased risk was 37%.
A study that I reported on earlier this year (here), found that sitting time increased the risk of heart disease.

The WebMD article ends with the suggestion that everyone make time for exercising but also include break times in their sitting occasions. I have to be honest with you, and you can verify this with my classmates and even my mother (though I see her less often) - I have read so many of these studies that I have become almost incapable of sitting for more than an hour for fear that it will kill me :)

What Physical Activity Can Do

2011-12-02T23:40:00.000-04:00

I had the opportunity to attend a lecture conducted by a scientist from the University of Pittsburgh today. He studies the impact of physical activity/exercise on weight loss and conditions related to obesity (diabetes, inflammation, HTN, heart disease). His name is Dr. John Jakicic and he has had numerous studies published in peer reviewed science journals. IN fact, I recall having read some of the studies that he referenced today.

I went to the lecture to see if he would present anything to support or challenge my assertions. In case you have forgotten my stance (which developed from reading a lot of research), it is this:
Physical activity is very important and effective in reducing disease occurrence, in preventing adverse outcomes due to a disease, in promoting successful or active aging and for managing moods - or mental health. It assists in weight loss and weight maintenance, but is not the best strategy for weight loss on its own. Physical activity is associated with significant weight loss only in the presence of caloric reduction or restriction. I.e. eating less.

Before we get into that - let me be very clear that exercise can improve health even in the absence of weight loss and even in persons who are obese. Obese persons who exercise are healthier than obese persons who do not. Obese persons who exercise can have some improvement in risk factors even if they do not lose weight. Let me break that down. An obese diabetic person who only exercises may not lose weight, but research supports that exercise alone can improve their blood sugar (or hemoglobin A1C). Exercise can moderate blood pressure numbers and reduce inflammation (CRP) that increases the risk for heart attacks. Exercise alone is helpful.
Exercise AND weight loss are the best treatments for obesity and overweight.

Dr. Jakicic showed that exercising more than 300 minutes a week (w/out changing the amount of food eaten) led to a 3% weight loss - or about 5 pounds. [that is equal to about ten 30 minute walks a week] He told us that we (exercise and public health professionals) needed to be careful about what we said to people regarding exercise. We needed to make sure that people maintained realistic expectations. He gave the example of the beginning of a new year when everyone heads to the gym and works out every day but the weight does not come off because they do not also change their eating. The people have gone to the gym because they think they just have to exercise more and the weight will come off. When that does not work, they quit the gym.

He actually showed a great chart during his presentation. The chart had several lines that went from left to right. The lines represented time one (baseline) and time two and the further the line dropped at time two the more weight the person lost. Each line represented a different condition. 1) for just calorie reduction, 2) a line for exercise > 300 min a week, 3) a line for exercise at ~ 150 min a week, and 4) a line for a combination. The diet alone line and the combo line were close together (low on the graph) - the others were up high, indicating no or few pounds lost.
Therefore, as I have said, diet alone is far more powerful than exercise alone for ONE specific thing- losing weight. Together they are better and best, but singularly they both have a powerful impact on health in general.

Take the Test

2011-12-01T22:06:00.000-04:00

Today is World Aids Day.

My general focus is on non communicable chronic diseases, which AIDS is not. However, as a public health educator, I have had opportunity to promote safer sex practices and screening for sexually transmitted infections.

The infection that can lead to AIDS is human immunodeficiency virus or HIV. HIV weakens the body and can lead to the diagnosis of a group of infections and other symptoms that are considered AIDS or Acquired Immune Deficiency Syndrome.

The most common way that HIV is transmitted is through unprotected sex. The highest risk is having UAS or unprotected anal sex, followed by UVS or unprotected vaginal sex, however, oral sex can lead to HIV as well. Other transmission sources are blood and body fluids. A mother can transmit the virus to her child in child birth (this is preventable).

Anyone can get HIV. Man, woman, gay or straight, ANY age.

I have two links to share with you today. The first is a Vital Signs report from the CDC and the other is a link to a page about testing. The second website is sponsored by the CDC. HIV tests come in several forms, including blood draw, saliva and urine. The website can answer your questions and you can search for a testing center in your area.

I am not going to say more because it is not my area of expertise and the linked pages are quite informative.

Public Health

2011-11-30T23:55:00.000-04:00

A newscaster was discussing what appears to be a growing trend where parents are choosing not to have their children receive any or all of the recommended (even mandatory) vaccines. The change may be related to fears that are unsubstantiated, but I am not venturing into this argument - well, I would say that if you are contemplating not having your children vaccinated that you make sure your reasons are supported by reputable scientific sources.

The statement that caught my attention the other night was, to paraphrase:

That is why they call it Public Health. The actions or inactions of an individual can have an impact on the health of others.

A person's family, friends, community - the country can become sick or pay a cost because of one or more individuals behavior.

I, and many others, consider obesity to be a public health concern, but there are those that don't. Some will say that being overweight or obese, to whatever degree that it is a choice, is a personal decision and thus, one's personal business. Even if I believed that obesity was (always) solely the responsibility of an individual (I don't), I would still think that a high population rate of obesity is a Public Health issue.

Obesity relates to a loss of productivity, mobility, mental health, physical health and independence. Those losses can be devastating to one person, but we have about 75 million obese people in this country. The CDC estimates over 147 billion in medical costs for treating them in 2008 alone. The mental and economical costs are not included

It is a good thing then that Medicare is going to start paying for some preventative services, but that's another story. Point for today - Obesity IS a public health issue, if not crisis.

Cervical Cancer Screening

2011-11-29T23:10:00.000-04:00

When I have discussed my concerns about the HPV vaccine, it has had more to do with the implied message in the marketing campaign. The idea that the maker of the vaccine presents is that it could prevent cervical cancer (or now, oral cancer). But the vaccine does not prevent cancer, it can prevent some, if not most, of the strains of the humanpappiloma virus that leads to cancer.
It is the pap smear, the testing of cells from the cervix, that can prevent the cancer.
It seems that I started to hear conflicted recommendations on how often a woman should have a pap smear in recent years. What has remained consistent it that they are recommended to begin at age 18 or when a woman becomes sexually active. When I turned 18, the recommendation was for annual pap smears. Within the last 5 years or so, some professional organizations began to tweak recommendations so that three and five year tests were acceptable in some situations. It also was determined that after a certain age or a hysterectomy, the tests might not be necessary.
In the last year or two, another screening measure was tentatively and with some controversy, recommended.
This week the New England Journal of Medicine has a nice "perspective" piece on the varied recommendations.
I believe it is best that you read it yourself and it is available here for free. If nothing else, skip down to the table that makes suggestions based on the personal situation of the woman.

Reduced Risk Drinking

2011-11-28T23:58:00.000-04:00

I participated in my second alcohol related motivational interviewing session for college athletes tonight. Let me quickly clarify that we are using motivational interviewing techniques not to encourage drinking, but to reduce binge drinking and alcohol abuse. I have used MI with tobacco cessation programming as well. The idea behind this technique is that you get better results by avoiding paternalism. Instead, persons who might be affected by the issue (smoking, drugs, alcohol, not exercising) tell you what is wrong with the current situation. The people involved come up with ideas that can prevent the adverse consequences of a behavior or the reasons to start a new behavior (like eating right). We always begin with what is good about the issue and what is not so good. You can even do this when asking someone to talk about "that boyfriend" who you personally know is a jerk and all wrong for your friend. If your friend is the one that says he is a jerk - THAT will motivate change.

From the session we held tonight, I share a couple of things that you may not have known or given much thought to:

the reason men can drink a little more than women during the same time period has to do an enzyme that breaks down alcohol - they have more of it than women.
body fat does not absorb alcohol (women usually have more than men and some people have more than others)
carbonated beverages whether mixed with alcohol or drunk in the same time period as an alcoholic beverage, exacerbate the effects of alcohol because the carbonation irritates the lining of the stomach and alcohol is absorbed quicker
food can help slow absorption but only if you eat before and during a drinking "event" and only if it is a substantial food - i.e. protein and whole grains, NOT white bread (that is a myth and a bad one)
drinking most often includes an initial buzz and then a depressive phase, it is said to be biphasic. As the alcohol content goes up, the depressive symptoms increase. One of our talking points tonight was that when a person is fatigued and drinks, the initial buzz phase does not occur. As we talked about this, it became clear that alcohol seems to emphasize or exaggerate whatever one is feeling. IF you are happy, alcohol makes you happier, sad - sadder, angry -angrier.
water! both alcohol and carbonated beverages can lead to dehydration. To prevent it, one needs to drink water the whole evening, not at the end of the evening. At that point, it will just be "peed" away. This has to do with upsetting the body's water table. I am not sure how that works, but you can cut me some slack for not knowing. I am the obesity person remember!

I will offer one comment the young ladies made in the what is good about alcohol section - someone said something about feeling grown up - which led her peer to say, "what like being 30 and having wine night." I could not stop laughing....

Odds and Ends

2011-11-27T23:49:00.000-04:00

HPV Vaccines: The UK has opted to cover Gardasil only, not Cervarix which also protects against HPV and vaginal warts. To the best of my understanding, certain strains of HPV produce greater risks for both cervical and oral cancers. They are not necessarily the same strains. I recall reading that Cervarix had studies supporting its efficacy in preventing oral cancer. I remember because at the time I couldn't understand why that would matter. A few years later, oral cancer cases associated with HPV have greatly increased and the company that makes Cervarix is not pursuing those earlier findings. Isn't that odd?
BPA - We are used to hearing that BPA is present in some plastics and it is harmful. This knowledge encourages many of us to reduce the use of plastic and to buy reusable plastic bottles that are BPA free. It should also motivate us to avoid microwaving in plastic containers or to use plastic food wraps that are specifically noted as being "microwaveable." I actually thought BPA was banned but not quite. This week news came out that BPA was also found in the blood of animals or people (I forget) who had been eating canned foods. Not to worry said the news report, BPA has only been found to be harmful in animals and babies. WELL! If it is bad for animals and babies, why in the world would I think it wasn't bad for me too! In fact, Canada and the state of CT have banned the use of the chemical - full name is bisphenol A. The federal government has yet to take action - its under consideration. I assume that means the chemical industry is doing some hard lobbying to retain the right produce/use it.
Restaurants - Last week USA Today published an article that discussed some of the ways restaurants were changing their offerings to meet the finicky eating habits of Americans. I was hopeful that by finicky they meant healthy - like me! Not so. Interesting findings include, more snacks. One of them being Chicken McBites. Note to everyone: When something is deep fried (or fried or baked) in smaller pieces, that means more oil and more breading per bite. In essence, more fat and calories. People also like to eat breakfast foods at all hours, but I hardly find that news. However, some people like to have yogurt as a snack before they sit down for breakfast. More disturbing trends - Maple Bacon Sundaes and Red Velvet Pancake Puppies with cream cheese icing, white choc chips and powdered sugar. There is more, but as a student of obesity prevention, I can't write more without crying. (after I wrote this, I heard a commercial from Subway - if you buy a 6 inch sandwich before 9 am, you get a second one free! Guess if people can eat breakfast for dinner.....)
Employee Wellness- Of course, after reading about 95% of McDonald's stores staying open 24 hours a day, this next blurb makes sense. Employers are using money to get people to change their behavior - more is planned in 2012 then ever before according to a survey of 335 employers. In fact, this strategy is termed, and I did NOT make this up, "behavior influencing incentives." Nice (sarcastic comment). The survey comes from the National Business Group on Health. The article I read indicates that there will be a "dramatic increase in health care costs because of obesity." This article also stated that overweight employees cost an employer (productivity, absenteeism and health care costs) about 5000 dollars more each year than a normal weight employee. In 2012, 80% of those surveyed will be offering monetary incentives. Some include reduced gym memberships and waived co pays. In one part of the article, it was noted that obesity is linked to depression. This is true. In another section, one employer group that was interviewed connected frequency of gym attendance with lower medical costs. In fact, they had numbers to back them up. In other words, the more the person attended the gym,the more the company saved. I would like to explore that data because I think that the persons going to the gym the most would have less depression, overall better mood and motivation to adopt healthy eating behavior as well.
Strahan Hero- Just in case you missed it yesterday. Former NY Giant Michael Strahan is promoting COPD screening in a current public service announcement. This makes me happy.

Spirometry

2011-11-26T22:07:00.000-04:00

A year or two ago, I wrote a few passionate posts regarding smokers and the risk for COPD. Earlier this year, I wrote with similar passion when results from a national lung cancer screening trial suggested that smokers received CT scans as a measure to prevent lung cancer or lung cancer death.

My concern has always been the under use of the spirometer for lung function status. Forced Expired Volume or FEV is a measure of lung health (how much air can a person blow out in seconds). The value is used to determine if one has COPD. COPD is one of the leading causes of death in the USA. More smokers are effected by COPD than lung cancer and many cases of COPD go undetected and thus untreated. It is a devastating disease, but I have said all this in the past.

Today I am quite jazzed to report that a public service campaign is underway - I uncovered it by accident. The public service announcement or PSAs appear to be grounded in sports.

I am beyond thrilled to say that one of my favorite former NYGiants football players is part of the initiative.

When I did presentations regarding the medical consequences of smoking, I often had my audience jog in place while breathing through a straw. In the PSA I heard, Michael Strahan says that COPD is like breathing through a straw.

I found the website associated with the campaign and you can visit it here.

The campaign or awareness goal is to get people tested - this is grand. A lung function test is simple and cheap. Keeping a person with COPD from having exacerbations is essential in preserving lung tissue and lung function.

Days of Being Thankful

2011-11-22T22:47:00.000-04:00

One of the things that I am most grateful for is the opportunity to pursue a terminal degree - I know that sounds funny, but it means the highest academic degree in a certain field.
It is this chance to earn a doctorate in public health that keeps me away from family this Thanksgiving weekend.
I have a lot of work to do and I will not be lonely or bored but I will be melancholy and miss being with those that I love so much.
It also has occurred to me that most people who read my blog on a regular basis, surely more than half, are living in the US and will be traveling to be with family or entertaining family in their homes.

That being said, I should probably take a few days off from blogging - not as much to save time as to save ideas. I think that blog reading is not on many agendas for the rest of this week. I might as well save my thoughts for when people will read them. I do need to get some YouTube videos made and finish my final projects for this semester, in the meantime. And this may come as a shocker, but I am going to miss my second day of swimming this week. Never saw that coming!

I will leave you with one more article related to the school lunch SCANDAL. This article is from the Harvard School of Public Health.

(enjoy your feasting and don't make your belly hurt by eating too much - remember it's bad for the heart to super, over indulge - and I mean it is bad at the moment -acutely- makes it work too hard)

A Half a Dollar a Year

2011-11-21T22:13:00.000-04:00

That is all it would take, according to a report issued in September by the World Health Organization.
The report was meant for international leaders and stakeholders who might benefit from cost effective measures to reduce the incidence and burden of noncommunicable disease conditions (formerly known as chronic disease).
The information from the report is similar to what was highlighted in a recent blog post centered on the UN Summit that was held in NYC this past September.
I saved the article that gave an overview of the report because it mentioned something that is of great interest to me: population based public health measures.
The examples given include taxes on alcohol and tobacco, promoting smoke free indoor environments, reducing the availability of foods high in saturated fat content and using health promotion to encourage positive dietary behaviors and exercise. Population level strategies can reach a great number of persons and therefore allow us to get the most for every penny we spend.
It is really important to note that this is not only a US problem, or a UK, Australian or Mexican one. It is a world problem. As countries move from low income to middle and high, the incidence of obesity and chronic disease also rises. This is in large part due to the influx of energy dense, nutrient poor foods and to a lesser extent, a decrease in physical activity.

Odds and Ends

2011-11-20T21:26:00.000-04:00

For this week's odd and ends I bring you two pictures.
The first is a picture of three box tops from cereal. Each box has its own front of pack labeling scheme. The manufacturers chose to include six items instead of the three that are recommended by the Institute of Medicine(IOM). If the system was standardized, as I have previously explained, the cereals would look the same with different numbers (perhaps) in the scheme. I drew a box in the picture to give you an idea of what I am mean.

The next picture is one I snapped at the grocery store yesterday. It would qualify for my "outrageous" or "are you kidding" segment, if I had one. I believe that the product is meant to be similar to margarine or some type of butter spread. It contains 50 calories for 14 grams (this qualifies as a very small RACC - or reference amount customarily consumed). It would be considered an energy dense food. Recall that fruits and vegetables have ranges of 0.3 to 0.7 cals per gram and this item has 3.5 cals per gram. This product is also an example of something the IOM wanted to prevent when it came up with a front of pack labeling system. That would be the fortification of products so that they would get a point or some other kind of shout out when they really should not. That appears to be what this company is trying to do with the name of the product and the supplements they added. The truth is this. IF something is bad for you, adding something that is good for you does not change that! (for example fiber in your honey buns or soda). Also, the ingredient list on this product is pretty scary.

The Wisdom of Youth

2011-11-19T22:10:00.001-04:00

My plan to tell you about a cool website that I found has been derailed.
I was reviewing some feedback from my students and two comments are just too important and insightful to go unshared.

We watched a film last week (or parts of one) that showed footage from the "sexual revolution." It discussed sex and objectification of women among other things. These two comments refer to different things. The second comment was made by several students in similar fashion. These are college aged adults.

1) beauty is not earned (this may be one of the most profound statements I have ever heard)
2) sex doesn't always result in disease or children - sometimes it just feels really great and leads to an orgasm.
(note that the people who said this also gave foot notes about using protection and contraception - because they are smart!)

I am really going to miss teaching next semester.

National School Lunch Program

2011-11-18T22:56:00.000-04:00

In a follow up to the NLSP and the recommendations from the USDA and the IOM, I give you this video because I am too depressed to actually write about it. [recall that by law, the school lunch program has to align with the current Dietary Guidelines for Americans. It does not.] Someone else has written about the recent events and you can read that here. Also, you can contact your congressperson with a form letter (very easy email activity) to request that they support the recommendations.

Click here for more.

Visit msnbc.com for breaking news, world news, and news about the economy

Hold the Stuffing

2011-11-17T23:02:00.000-04:00

No - I did not forget. If it has not already started, it soon will. Besides the usual temptations of an obesogenic environment, we will all be challenged by and delighted with, the foods of our holiday traditions. It is the favorite time of year for many of us and food pushers will flourish.
This is NOT the time to lose weight, but it is not the time to go crazy either. I personally hate the saying, "everything in moderation," because it is not true. And still, I think it unwise to turn away from the love and good cheer that those holiday treats are wrapped in. Therefore, I suggest that for the next three weeks a little creative food navigation is in order.
[I am not going to list all the tips and tricks for party going - I have done that before and many websites offer more.]
I do want to bring back the Hold the Stuffing Challenge. This is a commitment you make to yourself or to a group. Whether you do it alone or with others, the first thing to do is weigh yourself. I suggest you do that soon. If you are having a group contest, add everyone's weight together. The goal is to keep your weight or the groups weight within two pounds (or five for a group) of the original weight. It can be that much less or that much more. IF a group, you can pitch in for some kind of group prize. I created a tracking sheet which you can find here. If you have a really cool boss (like I had), people who meet the plus or minus 2 pound goal, can get a prize.
Remember, you can taste the things you love, even have a large piece of your favorite pie - but then something else has to go. I do not suggest turning everything down because, especially at this time of year, it hurts people's feelings. (For those of you whose weight is putting you at risk for chronic disease conditions, this is not a way to avoid personal responsibility nor is it intended to derail you. This is just a way to hold steady for a few weeks.)
Hold the Stuffing is centered around the US Thanksgiving and Christmas Holiday period. The goal is to hold weight steady until the first of the new year. The strategy can be used during other holiday times that are equated with over indulgence as well.

Degree Not Needed, Sugar Pooh

2011-11-16T23:04:00.000-04:00

I purposefully left my Monday blog up for two days. I felt that the issue was important enough for us to dwell on. Yesterday the Diane Rehm show discussed diabetes and its association with weight, the importance of choosing better foods and the benefit of adding exercise to every day. A caller to the show talked about his diagnosis of diabetes and how hard it was to eat well outside of his own home. He had gone to an event to support one of his children and he recalled the breakfast they served; toast, hashbrowns, bacon, eggs, and so on . He said it was as if the culture we live in was set up to create a diabetes epidemic. Some public health experts would agree. Diane added some comments about how hard it was to find anything of quality to eat when traveling by plane. I think that is changing a little, but you really have to know what you are doing in order to make healthy choices. I linked her show in case you want to listen. She had several experts on as guests.

I had to mention the show because it was important, but my post today really centers on something that I observed in one of my classes last night. The student sitting next to me had a canned drink that at first appeared to be an energy drink because of its size. I think it was just a smaller can of coca cola. I could see the back and the label. I noticed that it had 25 grams of sugar and 90 calories. I thought, well, if she would have had a 150 to 200 calorie drink, that is better. At class break, she came back with a pack of nabs and a 12 ounce bottle of regular Dr. Pepper. Meanwhile, I had a diet Mt Dew and half a peanut butter sandwich. My classmate weighs significantly more than me, possibly 100 pounds more.
On the one hand, we could say, "Well this isn't rocket science then. One of us was monitoring or moderating our intake and the other was not." Of course, what an observer doesn't know and I don't know, is what goes into the decisions people make. Food decisions tend to be much more nuanced than they appear to be. I would, however, like to show people how they can eat and drink more without taking in extra calories (extra meaning more than they need to maintain a healthy weight).

But especially after the last post on sugar sweetened beverages, I found last nights observation troubling.

SSBs - HD, TG, WC, IFG and that is not what the headline said......

2011-11-14T21:55:00.000-04:00

The American Heart Association held a conference in Orlando Florida over the weekend. Many sessions were held during the event and new research was presented during some of them. The conference topics were broken into large core groups and one of them, Epidemiology and Prevention of CV Disease: Physiology, Pharmacology and Lifestyle contained several presentations regarding sugar sweetened beverages and added sugar. A particular session titled, You Are (mainly)What You Eat, regarded a new (not yet published) study, by Christina Shay. Dr. Shay is from Northwestern University. The findings that she reported at the conference have been making headlines all over the place in the last two days. I have read the abstract and you can too, as well as some of the news stories themselves.

There is a little bit of a disconnect between the two and as I LOVE to share truth - I will do so now.

I will start by deciphering my title. SSBs you should know from reading my blog. It stands for Sugar Sweetened Beverages. For the study in question, the researchers compared the number of sugar sweetened beverages a person consumed in an average day to cardiovascular risk factors they later developed. I will spell those out in a moment. The amount of SSBs was determined through self report in a Food Frequency Questionnaire. A sugar sweetened beverage was defined as sodas, teas and coffees - a health professional interviewed by one of the news agencies referred to the coffee drink as a dessert more than a beverage. (I am not sure what they did about fruit, energy and sports drinks)

The people involved in the study were part of a bigger study but we won't get into that just now. For this analysis, the study included men and women of several ethnic backgrounds (US). All were between the ages of 45 and 84 at the beginning of the study which lasted from 2002 to 2007.

At the start (or baseline), none of the participants had been diagnosed with heart disease (HD). They were evaluated or measured at two additional times. Associations between a person's intake of certain nutrients was compared with incidence of several outcomes. (I imagine that SSB was not the only thing they looked into, but it is the only behavior they made associations with in this report).
The outcomes for which they found a statistically significant difference between groups include WC or waist circumference, IFG or impaired fasting glucose (a sign of insulin resistance and possible risk for diabetes), and TG or triglycerides (blood fats).
They compared groups by SSB status. The group that they considered a reference included persons who had one or less SSB per day. Compared to that reference group, women in the study who drank 2 or more SSB a day, had more of an increase in waist size (WC), IFG and TG. One of the results that is getting a lot of attention is that the 2+ a day SSB group was 4 times more likely to have clinically high TG. Triglycerides are blood fats and it appears that excess sugar in the diet can lead to increased TGs.
I am not sure what the news stories were trying to articulate, but the emphasis they made was on increasing TG levels related to sugary beverage consumption, "even in skinny girls." This may be related to the finding in the actual study or the truth that the 2+ group had increased waist size whether or not they had increased weight. Increased WC is the risk factor for heart disease not increased weight - so the headline is misleading.

It is also worth reminding people that sugar consumption is one of the main contributors to obesity because it is easy to consume more calories than you need or even realize your consuming with sugar products.
It is also important to note that refined sugar, in drinks or sweets, spikes the blood sugar. Having this type of action in the body several times a day every day is a great risk for insulin resistance. Diabetes is a cardiovascular (heart) problem. We do not often think of it that way, but the condition leads to heart damage.
The soft drink case is especially pronounced in women.

Odds and Ends

2011-11-13T22:11:00.000-04:00

Testing - Children. Testing the cholesterol level of children by the age of 11. I hate the idea and the recommendation for one reason - medication. At the same time, I respect the National Heart Lung Blood Institute and its expert panel. It suggests that all children should be tested for high cholesterol by age 11 and as early as age 9. They also recommend testing for diabetes at age 9 and every 2 years thereafter. I GET it. Our children are overweight and obese. They are eating foods high in saturated fat and sugar. We do need to let parents know when their children are showing adverse health effects so that they can DO something. I would hope that the strategy involves better foods and more exercise and NOT medication. The medications for treatment of both conditions have serious side effects and no one knows what would happen if the drugs were taken by younger persons and for the decades that could follow. I think that the title of the guidelines, which includes the words cardiovascular health and risk reduction in the same sentence with the word 'children' should give us all pause.

Love of Bread - I love the smell of baking bread. I love bread. When I was a little girl, my mother made homemade bread. She made both regular white bread and crusty Italian bread. The smell that filled our house was pure heaven - ah, to think of it now. What a comfort! She would give me a little bit of her dough and I would make tiny breads in my EasyBake oven. As a young woman, bread consumption added most conspicuously to my waist line. These days I still eat and love bread, but I use Joseph's Pita Bread. It is very low calorie and still smells great in the toaster oven and tastes great for wraps and pizza and even as cinnamon toast.

A New Experience - My swimming adventure (though I am really saving the best for the end) continued this week. I told you that a fellow swimmer challenged me for my slow, torturous pool immersion, and that I was the first one in the pool the next time. I also jumped in. But this week, I dove in (both days) and on the first day I received the most awesome surprise. I kid you not. The water was WARM. I had no idea they would or could heat it, because I had already bailed on swimming by this time last year. OF course, the second time I dove in this week I didn't know which "experience" to trust! Would it still be warm? It was - but seemed a bit less so. Wonder what tomorrow will bring:)

Cardio Myopathy Takes a Four Legged Friend - Cardiomyopathy is a catch phrase to some extent. It means diseases of the heart and it often results in heart failure. It occurs in people and in dogs. In dogs it is called dilated cardiomyopathy. I read about it today because it took the life of a dog that I used to see "around." In the last month or two, I gave another example of a runner with a knee injury that wasn't from running. In that story, I recalled a conversation I had with a woman who walks in the neighborhood where I run. We struck up a conversation the day she saw me walking backwards up a hill. She was walking her dogs and she shared that her husband was a runner, but not able to run as much as he'd like. I see her several times a week. But for the last week or two, she has had only one of her dalmatians with her. Today I saw her and stopped to inquire about the dog. (recall that I am notoriously self centered when I am running so stopping is sort of an event for me) It turns out that the other dog had recently died of cardiomyopathy. She was very surprised when the dog was diagnosed and she told me that this dog often went running with her husband. In a way she was telling me that the dog lived a healthy life style and his heart disease was therefore a shock (it happens). The disease causes the heart(or its chambers) to enlarge and the heart cannot pump properly.

Full Body Weight Routine : 2

2011-11-12T23:49:00.000-04:00

Here is another example of one of my full body workouts. If you saw the first one, you know that I work out (with weights) on Monday and Thursday and I use the same routine 4x in a row. It is a good idea to walk in the door with a plan, it keeps you focused and less intimidated.

I have done this workout twice so far. As before, the website which offers the most detailed and visual examples is RxEx.net but it is advertisement heavy so don't click on anything that looks like cartoons!

Bench Press with barbell- You should know that I do not use any weight plates on the barbell because I do not have a spotter. It is pretty heavy for a light weight girl such as myself, but when I workout with someone I do add some plates. I am doing 3 sets of 12 reps now.

Piriformis crossovers - This is an exercise that I learned from my physician (sports medicine). I do have a video of this lunge type move, but it is not yet posted anywhere. IF you are interested, check with my You Tube channel in a few weeks and it should be there.

Triceps extension and presses with dumbbells - The example in the link is not exactly what I do but it is close. I take the dumbbells straight down to the sides of my head, not over the bench (remember to extend from your elbow - your upper arm should not be moving at all). For this training period, I am doing alternating sets of the extensions and pulses. (I bring my elbows to my sides (still lying on the bench) and just pulse up - keeping my arms almost at a 90 degree angle). So I do 8-10 extensions and then 8-10 pulses and repeat at least once.

Deltoids raises with dumbbells - The demonstration here is very similar to what I am doing for this two week period. However, I am standing upright and my arms are at 90 degree angles. [elbows into my sides and then with arms bent, I raise my arms leading with the elbows and stopping when my elbows are even with my shoulders. I concentrate on the squeeze on the way down. This works several parts of the shoulder.] I am using light weights currently because of a slight tear in my right shoulder that is recovering. I do three sets of 8 to 10 reps.

Cable machine leg work - This is not one to easily explain or provide pictures (I will insert some similar examples). I use the pulley or cable machine and attach a strap to my ankle. With a straight leg, I pull the cable back, kick backs. Then I turn to one side and take my leg (still straight) across my body (this example is close, but I concentrate on crossing my body, not taking it high out to the side), then I turn the other way and take my leg out laterally. I do two sets with each leg with about 10 - 12 pounds. This is working by buttocks, inner and outer thighs and to some extent my hamstrings.

Rotating Biceps curls with dumbbells - I am up to fifteen pounds - 3 sets of 8 reps - and the last set is still a challenge. When I can do 10 easily, it will be time to consider the 20 pounders! I really can't imagine that just now.

Abdominal machine crunches - I believe I showed you this one last time. I did work another full body routine between these posts and in the other 2 weeks I did traditional crunches.