What keeps us healthy doesn't involve self loathing.

There are several diseases and poor health outcomes that may be related to weight gain and having excess adipose tissue (fat).  Research suggests an association among weight gain, diabetes, heart disease, and some cancers (see e.g., The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity.)  There is reason to believe that the increase risk in heart disease is related to inflammation caused by fat tissue (Berg & Scherer, 2005) and that belly fat specifically, increases the risk for diabetes (Chan, Rimm, Colditz, Stampfer, & Willett, 1994).  Being overweight is also associated with joint problems (Anderson & Felson, 1988) .  The studies that I have referenced here do not show cause and effect, but many scientists, myself included, agree that excess body fat is detrimental to health.

Disease and poor health may also be the result of sitting around too much, of being still. Researchers have found that people who spend continuous hours of time doing sedentary activities, like sitting at one’s desk, sitting and playing cards, sitting and watching TV, sitting and reading, etc, regardless of how physically active they are at other times, are at risk of premature death from any cause (Katzmarzyk, Church, Craig, & Bouchard, 2009).  Sedentary activity also increases the risk of metabolic syndrome (Bankoski et al., 2011), which is often seen as a precursor to diabetes or heart disease.

A lack of regular, consistent physical activity (exercise) is another risk factor for disease and early death. The Physical Activity Guidelines for Americans and several independent research studies have shown numerous health benefits of daily exercise.  For example, men and women who spend more time engaging in leisure time physical activity have less heart attacks and less heart attack deaths than men and women who engage in little or no leisure time physical activity, i.e., exercise (Leon, Connett, Jacobs, & Rauramaa, 1987; Oguma & Shinoda-Tagawa, 2004).   Lack of exercise is also related to incidence of diabetes, cancer, hypertension, obesity, depression and osteoporosis (Warburton, Nicol, & Bredin, 2006).

So, these things are clear to me and maybe to you as well:
· achieving and maintaining a weight that is considered low risk by waist to hip ratio, waist circumference and/or BMI -indicating normal levels of fat tissue, especially in the abdomen- is smart (i.e., it promotes health and reduces risk of disease and early death);
· limiting the amount of time spent in activities that require you to be still is also smart; and,
· engaging in physical activity for prolonged bouts - 20 to 60 minutes at a time, at least once a day is again, smart.

All of these lifestyle behaviors, which we have some or total control over, are good for us.  We are wise to be mindful of our dietary intake (what and how much), wise to sit for only short periods of time (< 1 hour), and wise to exercise every day.  We should do what we have the power to do to keep our bodies from becoming overfat and deconditioned.  I believe this and I promote it, but I believe something else just as vehemently.

I believe we have weight stigma in the USA and this stigma may be responsible for adverse health outcomes (Puhl & Heuer, 2010).  I find that the worst part of the stigma and the discrimination it promotes is its internalization: people turn the stigma onto themselves and become self-loathing. 

Please click on this link to read a story and watch a video about the hatred many women feel about their own bodies.  Being overfat is bad for health.  I will continue to say it, and continue to push back against body acceptance when body acceptance is a justification for poor dietary habits and a lack of exercise.  But let me be clear, hating oneself is more than bad for health; it is bad for the soul. Obesity researchers, myself included, must be ever mindful of the very difficult and complex process of weight loss and not let our work imply that obesity is a chosen disease, it is not. Weight loss is not easy, if it were easy, two out of three US adults wouldn't be overweight.  Please watch that video.

Anderson, J. J., & Felson, D. T. (1988). Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I) evidence for an association with overweight, race, and physical demands of work. American journal of epidemiology, 128(1), 179-189.

Bankoski, A., Harris, T. B., McClain, J. J., Brychta, R. J., Caserotti, P., Chen, K. Y., . . . Koster, A. (2011). Sedentary activity associated with metabolic syndrome independent of physical activity. Diabetes care, 34(2), 497-503.

Berg, A. H., & Scherer, P. E. (2005). Adipose tissue, inflammation, and cardiovascular disease. Circulation research, 96(9), 939-949.

Chan, J. M., Rimm, E. B., Colditz, G. A., Stampfer, M. J., & Willett, W. C. (1994). Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes care, 17(9), 961-969.

Katzmarzyk, P. T., Church, T. S., Craig, C. L., & Bouchard, C. (2009). Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998-1005. doi: 10.1249/MSS.0b013e3181930355

Leon, A. S., Connett, J., Jacobs, D. R., &; Rauramaa, R. (1987). Leisure-time physical activity levels and risk of coronary heart disease and death: the Multiple Risk Factor Intervention Trial. Jama, 258(17), 2388-2395.

Oguma, Y., & Shinoda-Tagawa, T. (2004). Physical activity decreases cardiovascular disease risk in women: review and meta-analysis. American journal of preventive medicine, 26(5), 407-418.

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6).

Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.

Diet Quality Not Based on Organic

   I have written for at least three years that science does not support a health benefit from organic foods or one that are labeled as all natural.  Organic produce may contain less pesticide residue (but you still need to wash what you buy). 
   I cannot locate the post, but I remember recently pointing out that none of the three healthy eating indexes I shared with you (the HEI from the Dietary Guidelines, the AHEI from Harvard and the heart healthy diet defined by AHA)  mention the word organic when making recommendations on what to include in a diet pattern.
   In case you missed it, the networks are abuzz with results of a recent study that confirmed these already known facts.  A new  finding was that non organic meats were more likely to be contaminated from bacteria because of non-medicinal antibiotic use in livestock (creating resistance).  This finding supports the argument for some kind of regulation on the use of antibiotics in animals that are not sick (which I thought we already had).
   Watch the video embedded here or click this link instead. 

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

Odds and Ends

This week's version is going to have to be a literal one liner - it is mid term project and exam week and my brain is literally about to implode... oh, ok - obviously - not literally... but I may be gone for a few days....

Prescribing Exercise -  I am really delegating this one.  One of my newsletters had an intriguing headline - doctors are telling patients to exercise!  That is great news.  I kept the article in my queue all week but never had the time to read it.  I will pass it on to you. Read Me.

Weight Watchers Gains Another - One of my professors told me he joined Weight Watchers - and I bet you know what I said...... "THAT is AWESOME!"  Followed by, WW is the only program that I have ever endorsed and that is because it teaches lifetime habits - not 'diets.'

Heart Attack - Women - We die from heart attacks more than men.  It may be related to the symptoms that both women and physicians miss.  Watch the CBS news video here.

My Ice Cream - Earlier this year, oh wait - late last year, I told you about a Blue Bunny ice cream that was sugar free with half the fat of regular ice cream.  Not all Blue Bunny but some types of it meet this criteria.  This week I noticed a change in the package.  It now says Sweet Freedom AND comes with some FOP labeling.  Listed on the front are calories, total fat grams and carbs.  Well - one out of 4 ain't bad.  The recommendations from the IOM were saturated fat grams, total calories or calories per RACC (i.e. 1/2 cup), sodium and sugar.  The IOM also said not to add the % DV.  This label had that as well.  It did not tell how many grams per serving or the household serving size that this info pertained to.  Still - I find the ice cream yummy.

Store Labels - On another shopping trip, I noticed that the grocer had put some FOP labeling on its packages of shredded cheese - store brand.  Again, they are not using the standard or the info that has been recommended by the IOM.  I truly hope the FDA gets on top of this.

Database updated - The USDA nutrient database that I have referred you to in the past, has been upgraded.  You can visit it here.  First click on the start your search here line and then put in the name of a food, like I just did - KALE  - It will come back with some options, like - cooked, raw, frozen, salt, no salt...etc and it will tell you the nutrient info, including calories.  SO the kale I made today - oh my goodness it was yummy.  I simmered it with garlic powder and a bouillon cube.  It isn't always yummy, but this batch was the best - it was only this good once before and I didn't make it that time.  My sister says that it has to do with when it was picked.  When I bought it - today - the tag said, fresh - local.

HA HA HA _ I said these would be one liners..... I am going to fail my classes......

Odds and Ends

Bone Drugs - The FDA has been reviewing several popular drugs that are used in the prevention of osteoporatic fracture and preventing bone density loss.  Some public health advocates are concerned over the risk of both femur and jaw fractures in women who take these medications.  I believe those in question are Fosomax, Actonel and Boniva.  The medications are classified in general as bisphosphonates.  You may recall my blogging about them in the past.  The FDA panel was debating  whether or not to recommend some type of time limit for taking these pills or a treatment holiday after a certain length of time.  The panel did not come to a conclusion.  Many members felt that the information was conflicting, but most agreed that the labels did need to be updated to warn women of the risk of these fractures.

Lactaid Free and Sugar - At a meeting this week, as we discussed the National School Lunch Program updates, the talk turned to milk.  Someone noted that she had switched to Lactaid Free Milk and that it was a lot sweeter.  I also drink Lactaid Free (skim) and had not noticed this.  One person in the group said that there was more sugar in the lactaid free type.  I compared two brands this weekend - two skims, one lactaid free and one not - they both had 12 grams of sugar.

Weight Watchers - Bone loss pills got bad press this week and the Weight Watchers Program got good.  I did not read the research study that shows a positive weight loss effect from Weight Watchers.  Friends and family have told me about the NEW Weight Watchers and from witnessing their progress I feel that the headline is likely true.  This leads me to continue my endorsement of WW.  And in case you are not sure, it is NOT a diet.

More Knee "research" - I was walking backward up a hill after I finished a run the other day.  It is good for the quadriceps muscles (thighs).  A woman that I often see walking her two dalmatians commented that I wouldn't want to do that in her neighborhood because of the sidewalk disrepair.  I turned and walked with her a block or so.  She said that her husband was a runner but does not do so much these days because of his knee.  Of course, most of you know what I said next, "OH?  what sport did he play?"  She looked at me quizzically, and I said that I was learning that most knee injuries were related to contact sports not running and indeed I was right again!  "football."

Helmet Promotion - In the arboretum this afternoon, I came across a family of four (they seemed a family).  Two small children were on tricycles and the little girl did not have her helmet on.  Her mother had it in her hand and seemed frustrated.  I stopped and said, "I have a pink helmet.  I wear it all the time."  This prompted the mom to say to the little one, "what color is your helmet?"  She pointed to the pink part of her purple and pink helmet.  I said, "Oh, it matches your dress!"  As I walked on, the little boy pointed out that he was wearing his helmet and the little girl let the mom get her helmeted.  The dad mouthed "thank you."  And that was my health promotion activity of the day :)

When in Scotland

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

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

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

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

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

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

Odds and Ends

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

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

note calorie info on front of package

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

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

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

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

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

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

Veracity Vs Clout

In one of my readings today I came across this little gem from Rogan Kersh and James Morone in their Politics of Obesity. I will summarize their point.

An assertion or finding does not have to be true to create change. Science about a health issue is important but so is the power of the message and from whence it comes.

The three issues they noted were tobacco, alcohol and sexual expression. Tobacco turns out, really does kill people - but we didn't start moving against it until the US Surgeon General made a big deal about it. Alcohol is not 100% evil, but we had prohibition when the government said it was, and many men feared blindness from being oversexed, when apparently that is not a real consequence. Now the government pays for ED drugs. (that part's from me :))

We have gotten to the point that obesity is associated with disease and the US Surgeon General and others have spoken on the seriousness of this problem and so - expect those policies to start happening.

It Ain't What You Shake

Dateline Sarasota: Last day of work....

Had a restive night, not used to the bed, the house, the whatnot - but Mom is very hospitable. Started the day with my usual Friday morning treadmill run and the routine of it, the normalcy, was calming. Received really nice gifts and sentiments from my coworkers this last day. Oh, I think I will add the picture of us...

Now the Health Mention:

I had mentioned not long ago that there was again a push to address the salt content in our foods as the majority of Americans are consuming far more than the recommended 2400 mg a day. Not only are we consuming more than is recommended, but a growing number of health experts are saying that the recommendation itself is too high. What's more, the amount that we really need is less than a teaspoon - the mg amounts to about 3/4 of a teaspoon. (BTW too much salt effects blood volume and flow which then effects the arteries and thus can lead to heart disease)

According to people quoted in a recent Wall St Journal article, the problem isn't what we add, it is what is already there. The best way to get control of this intake is to limit processed and restaurant foods.

Salt is basically sodium and chloride and it is sodium that we are trying to limit. At least with processed foods you can read the labels. And DO read them, all of them, because sodium sneaks into foods. Bread, cheese and vegetarian meals can pack a wallop as can cereal.

Also, did you know that salt has its own advocacy industry. Yup, the Salt Institute. It IS true that we need a certain amount of sodium to maintain our system. At the same time, it is highly unlikely that a person would have a sodium deficiency. Those most at risk might be athletes, but then they are aware that they need electrolytes and I expect they would hydrate accordingly.

So the simple message for today is really this: Read your labels and avoid foods that have more than 300 mg per serving and follow these other tips offered by the public health folks at Harvard - home of my favorite PhD/MD - Walter Willett.

Odds and Ends

This time, one week from today, I expect to be in a hotel room just north of Savannah GA on my way to a different life in NC. Just so you know!

CDC Vital Signs: This is something new that the CDC has started but it is pretty awesome. Each month they they will target a health issue or disease and give a few succinct statistics on it while suggesting some next steps. The July Vital Signs discusses cancer screening for both colon or colorectal and breast cancers. Though we have certainly made progress in this area, there is much to be done. You can find this Vital Sign here.

Antioxidants: These are wonderful substances that are thought to aid in ridding the body of waste material that can be harmful. Our body is able to make some of them, but we also benefit from consuming foods that are rich in them, like fruits and vegetables. In the grocery line today, I heard the cashier exclaim "Wow, cherry diet seven up!" I looked over at the conveyor belt, as it was not my order. I wasn't sure if I had heard her correctly as that flavor was not new. What WAS new, I noticed, was that the label claimed "antioxidants." Really guys, whether you drink soda or not, it isn't the place to get your free radical consuming antioxidants.

Beach Reports: We have heard a lot about the state of our beaches and ocean water due to oil spills lately, but the NRDC or Natural Resources Defence Council has also released its 2010 report on the safety of US beaches. The report does address the new threats, but for years the NRDC has tracked the amount of bacteria in our waters and sadly, it is rising. You can review popular beaches or all beaches by state if you like. It is a little confusing at first, but when you see the % of times that a state or a beach exceeds standards, the higher the number the worse the beach is. The standards are really limits of pollution and exceeding them is a bad thing. You can learn more here. You may recall that I go to a certain beach in Florida at least once a week and I was very happy to see that it did well.

Eco Salon: Hmm - I wrote my little notes some time ago, but if I remember correctly, there was a bit of investigative journalism in the WSJ where they tested salon services in places that claimed to be eco friendly. None of the places did very well - getting rid of the chemicals was not so easy and when they did the result was not so good. Personally, I only go to the nail/waxing salons on occasion for a BROW wax. Yes there I said it. I do go in and out as fast as I can. If I have to wait I go somewhere else. Those places are absolutely toxic. I know the employees wear masks but so should the customers.

Teen Business: It appears that hotels are trying to cater to the not yet adult but not still a child demographic. Of course, keeping a family happy will increase business and tips so it makes perfect sense. What was dismaying in the article I read was some of the tactics. Video game tournaments (not Wii fit) with prizes. So after being sedentary while playing video games the kids received ice cream sundaes. Now that's the way to fight this obesity epidemic in our youth, eh?

Speaking of: And lastly, I saw a display at the Publix Supermarket today. It was a cardboard school bus and in it were all types of sugary snacks for kids to take to school.

The GAO Gets Genetic

I didn't want my title to be so clever as to prevent you from reading, but my post is about the genetic tests that are marketed to YOU in magazines, Internet ads and on the TV. I have already told you that they are not ready for prime time and that the biggest concern from some experts and certainly from me, is that people will rely on the test results over common sense and family history. This view is vindicated in a very recent General Accounting Office report. I really think that you should read the whole thing. It is a 33 page pdf document that can be accessed here.

The GAO investigated several genetic tests and the companies that make them in 2006. They found them to be unreliable. They also found that the companies made disease predictions that were not medically valid. Since then, new tests have been developed and placed on the market. Some companies suggest that they have the support of experts. Very recently big chain drug stores agreed NOT to sell these new tests. The field of human genetics is a remarkable and valid science. Please do not take my strong distaste for the direct to consumer marketing of retail tests to be a judgment against the science. It is not. Genetic testing and counseling has been in place for many years and for a number of diseases it is VERY accurate.

The tests that are currently available for YOU to buy and use at home with a saliva DNA test are NOT scientifically valid, useful., accurate, legitimate or endorsed by the leading genetic experts. In fact, the GAO report has some charming quotes from some of them. Let us see, one person described them as "complete garbage." Another expert used the word "horrifying" and still others noted my most pressing concern which is that people might get a test result that demotivates them to make healthy lifestyle decisions.

Some of the companies try to sell supplements as well. They say the pills will prevent certain diseases. This is an illegal statement. The claims are fraudulent. The advertising tactics explained in the report are despicable. I would NEVER purchase these 300 to 1000 dollar kits.

It just gets crazier. Some of the people in the "sting" operation actually had the diseases that they were tested for and told that their risk for getting that particular disease was low. The GAO sent the same DNA sample to different companies and got completely different results on the same diseases for the same person. Companies offered consultation but rarely did more than regurgitate the results. People were told to talk to their doctors, but I gotta tell ya, the average doctor doesn't know what to do with these results either. That is NOT a reflection on the doctor but on the tests.

I write this blog in order to help people make decisions on things to do and not to do in order to increase their chances of a long, quality, active, limited diseased life. The best that any of us can do is know what has happened to people both with similar genes as ours (our family) and with similar lifestyles (people who smoke for example, or don't exercise or do exercise, etc). If you want a valid prediction of what will happen to YOU - that is where to look for answers and place your bets.

This sentiment is stated quite directly in the report. One expert suggested that people send in the DNA sample, the 500 dollars, complete the family history profile and then through out the DNA results and go from there!

Please read the report - a government agency doing something to protect the consumer from fraud. It is a good thing. (btw, the GAO report is not a clinical study or rigorous research, but it is informative)

Respect Your Feet

Not only do I now have more respect for my feet, I also have it for a certain organization. Actually, I have always taken care of my feet as I am a runner and though I can get through many aches, pains and strains, I cannot run on a hurt foot.

When I heard about cosmetic foot surgery however, I was a bit aghast. I sought the opinion of the American Orthopedic Ankle and Foot Society also known as AOFAS. They issued a press release on this topic in June and you can read it here. It definitely cautions against having these surgeries, which include toe shortening and fat injections. Yes, because wearing high heels is often uncomfortable at the balls of the feet, some podiatrists will take fat from another part of the body and put it into that tender area. Comfort is only one of the reasons women, mostly, have this elective surgery. Another reason is to beautify the feet for the super exposure they get in what we women call strappy shoes. I am the last person that will have this surgery because for five or more years, I have eschewed heels in general. I do buy gel pads to put inside my shoes though and so I get that, and SURE it is nice to have something to do with the fat we don’t need, but the AOFAS is very clear to point out that the risks are significant with these procedures. I want to add that I am now impressed with the folks at AOFAS for more than their stance against the surgeries. I clicked around on their website and found a link regarding healthy eating. SEE – there is nothing that being overweight doesn’t effect. Along with encouraging us to maintain a health promoting weight, the clinicians suggest that we engage in regular physical activity to avoid arthritis. Additionally, they address osteoporosis and encourage adequate consumption of vitamin D and calcium. I also learned that one of the first indications that a person has osteoporosis is a stress fracture in the foot!

The Grocery Aisle

I have done my best to educate my friends, family, coworkers and YOU on the importance of reading food labels and making choices that are best for your health and if you shop for others, theirs too. I may have mentioned that I had at one time created a proposal to teach people about labels right in the places where they need to know - the store.

Well, that isn't exactly what is underway now, but at least we are moving in the right direction. Some store chains are highlighting if not, ranking, certain food items at the point of purchase. The shelf tags encourage a person to buy a product because it is considered healthier than a similar product. If you think food manufacturers are miffed about this, you would be right.

My concern is over the criteria that is being used to judge the food. It is expected that salt, fat and sugar content will be taken into consideration, as will fiber content. I read that one of the large grocers was thinking of hiring a dietitian to walk the aisles and assist shoppers for a FEE. That got my dander up. I have advocated and will continue to advocate for making healthy choices possible for all people. These foods have to have an accessible price, and the knowledge about them has to be just as easy to get.

The store that probably needs a program like this the most is Wal-Mart and that is exactly where I had proposed to do my little label reading point of purchase "in service." I may change my intervention ideas a bit while in graduate school but I will not leave Wal-Mart and the community out of my sights.

These shelf tags are a good start and at the same time, people need to be empowered with nutritional truths. I propose to arm people with knowledge so that they understand WHY that food got a better score, not just that it did. For example, we don't all need the same amount of nutrients. In addition, all nutrients are not created equal and just adding good foods without addressing calories will NOT end our obesity epidemic.

I would like to see a national standard if we are going to start an onsite information program. Perhaps this is something that the DHHS would fund! I do not at all like heterogeneity in this area.

What I find most inspiring is that people are starting to deal with this problem. We have some school lunchrooms providing whole foods and lower calorie options. If manufacturers, grocers and restaurants continue to modify their foods, shelves and menus - we just might create an environment that is conducive to healthful eating.

BTW, Wal-Mart is expected to make an announcement about their nutritional planning before the end of the year. I look forward to hearing about their approach as the poorest of us frequent THOSE aisles and the poorest of us have the most obesity related diseases.

The Laser

Not long ago I mentioned the laser when I was discussing another topic and said that I would get back to that. I wanted to learn about and explain the FDA approved uses of the laser in regards to medical procedures. I am torn now about writing this post even though I spent an hour or more searching for the answers, because my intent is to enlighten the reader not confuse them more!

The laser, which is used in surgery, hair removal and even physical therapy, is a device that emits a very intense light, a single wave length, with non ionizing radiation. We don't generally think of this radiation as harmful or cancer causing. It could however, cause skin reddening and in the case of surgery, side effects are possible. The light is so intense that it can "burn" away tissue, hair, wrinkles even. In the case of wrinkles, the laser is essentially removing skin and is abrasive. The laser is used to remove tattoos as well. IN fact, I have had that done myself.

What I understand, and I could be mistaken, is that the device itself is approved by the FDA per manufacturer. The manufacturer has to abide by certain safety standards, including monitoring the radiation emissions. Each company has to label their devices specifically, and report any adverse events to the FDA. If a manufacturer wants to market the device, it has to submit an application and data to show that the device does what it says and does so without serious adverse consequences. This is the same criteria put on medication applications.

My quest was to find the FDA approved uses for the laser itself, but it seems that there isn't a clear list. It is not as simple as say, looking up Wellbutrin and seeing that it is indicated for depression. It is true that once the device or medicine is approved clinicians can use it as they see fit. I wanted to see what they could advertise for- which I still do not understand. One source of information on the FDA website implied that with safety approval (and not clinical study) a company could market but not advertise. These leads me to believe that the two words are not interchangeable in the medical world. Instead, market just appears to mean sell.

With regard to hair, I did learn that the laser can only be advertised as a means to reduce hair not to remove it! With regard to wrinkles, some laser devices are treatment "approved" while others are not. The consumer can look up the particular device to see what the FDA did give the ok on. Consumers are also encouraged to talk to the clinician and ask to see the labeling for that particular device.

I feel that is it safe to say that the laser, but not ANY (they have separate approvals) laser, is thought to be effective in these areas: surgery, eye surgery, hair reduction, wrinkle treatment, dental care, and maybe even pain reduction. Please read more here.

I DID finally email the FDA to see if I could get a list of approved laser uses - re promotable uses. Will let you know if I get a response.

Not just anyone can use a laser. There are also certifications and licensing issues for the practitioner. I can say and WILL say, the FDA did not at any time note the laser as an effective method for quitting smoking.

Prevent or Reduce Cancer Recurrence

Exercise and maintaining a health promoting weight have been recommended as ways to prevent many cancers. A growing body of evidence is available to support that exercise can reduce some symptoms associated with cancer treatment - first and second line - and that continuing to exercise and eat moderately after treatment is suspended, can reduce the recurrence of cancer.

I have blogged on this in the past, I say it again today because it was the topic of an article in the ACSM Certified News this month.

Dr. Jonathan Ehrman explored the existing research which was mostly focused on breast, colon and prostate cancer. One study regarding physical activity in women with breast cancer found a link between positive treatment outcomes and moderate physical activity. The study followed the women for two years. In that study, the positive benefit was found whether the women had begun exercising before diagnosis or after.



Though not all cancer patients receive radiation or chemotherapy, most are prescribed an oral medication after or instead. We are not used to hearing about weight gain with regard to cancer, but that is exactly what happens to many persons. The weight gain that occurs with treatment or after, is especially harmful if it leads to obesity and related diseases. Exercise can reduce the chances of weight gain, muscle wasting, diabetes and hypertension.

Physical Activity and Healthful Eating are elements that we should include in our lives at all times.

AIDS progress and insight

This is not the post I had planned for today, but as this issue has been staying in the news I could not resist.

What I have been hearing and reading is that the funding for treating AIDS is really taking a hit as countries around the world are having financial difficulties. Though a good deal of funding for AIDS treatment and research does come from independent sources, specifically Bill and Melinda Gates, many AIDS activists (for lack of a better term) are sounding alarms.

IN the last two days I have become more aware of a push for prevention. This was pronounced again in a WSJ article describing a promising research study. In that smallish, but well controlled study, women using a medicinal, vaginal gel, significantly reduced their risk for contracting HIV through intercourse. The particular study involved South African women. Many countries in Africa also have high rates of HIV and AIDS, including in pregnant women and children.


This study, which must be replicated and was not a clinical trial with regard to drug approval, is still important. However, in the WSJ article an AIDS researcher was quoted as saying something to the effect of how costly the treatment of AIDS has become and that the real effort should be in preventing it in the first place. YOU THINK? Do you think maybe we should spend time, talent and dollars on PREVENTION - oh my gosh, the guy is a genius!

Maybe I should go back to school to see if I can help with this prevention idea, maybe even, I know this will sound CRAZY, but maybe we could save money also if we worked to prevent OBESITY.

(after note: You might wonder about the human subject disclaimer and consent waiver in the AIDS/HIV research. I do too. I did not read the study protocol for the research I referenced though I have read others. IN some instances, the researchers educate the participants on how to prevent sexually transmitted diseases by abstinence and condom use. They might then ask them to use their "medicine/gel" if they choose to have unprotected sex and to keep a record of the times that they do. In other words, the research outcomes will have to be considered in this context.)

airlines, fats, and tobacco

Not going to be the post you are imagining!


After several unusual and harrowing tarmac flight delays, regulation was proposed and then passed, which limits the amount of time a plane loaded with passengers can sit idle. In other words, people no longer have to worry about being essential prisoners of the airline. As the rules neared enactment, the airline industry warned of dire consequences for THEM and an increase in cancelled flights for us. It turns out, um, that it is not so bad really. The industry has adapted and consumers are relieved.

I mention this in the health blog because the exact same thing could be said with regard to the legislation to rid foods of TFAs, to lower salt in products, to ban smoking in restaurants and so forth. Industry groups panic. Examples I recall for the TFA initiative include frying capacity, shelf life, and taste. As it turned out – the technology was there and NO ONE misses the TFAs. The sodium content in foods has been lowered once already and I doubt a second round is going to devastate the processed food industry. We will adapt. Moreover, those restaurants forced to ban smoking have had a BOOST in sales, not a reduction. We can be a healthier society and companies can maintain financial health. People balk at change, but change is not always bad.

A current instance, for example, is health care reform. The new law includes a provision for free preventative care in all new health insurance plans. The insurance companies might cringe at the new upfront costs, but the benefit is going to be the money they save by reducing the incidence of chronic disease in their plan participants.

Oh and two more I just thought of – oldies but goodies; lead paint and asbestos.

Children and Cholesterol

An interesting project has been underway in West Virginia for ten years. The purpose of the study, among other things, is to determine the amount of children who would not be screened for abnormal cholesterol levels under current best practice guidelines for this population (who should have been).

This is more of a pilot program than an intervention and some might suggest doing the evaluation in other states. I prefer using this data to do one or both of the following:

1) Begin standard screening of all children, in school and at no cost
2) Create systematic and intensive school and community based programs to address what West Virginia has already found

The findings include that a significant portion (more than 30%) of children have high enough levels of low density lipoprotein to warrant lifestyle interventions on nutrition and physical activity.

I have to say that in reading about the WVA work I was initially very skeptical regarding the end that they were heading to – which is medicating the kids and that did come up. However, the lead investigator Dr. Neal denies any industry ties or funding.

The study is published in a journal titled, Pediatrics.

Tan Tax - outrage

"Study after study has shown that sunbed tanning increases the risk of both melanoma and nonmelanoma skin cancers." This statement comes directly from the website of The Skin Cancer Foundation of the USA. Similar concern is noted on the website of the World Health Organization. I have no misgiving about these statements. In graduate school I worked on an awareness campaign regarding the dangers of tanning beds.

This was NOT the post I had planned for today, in fact, that post is already written and on standby because when I was reading the paper with dinner I became incensed. The WSJ has an article in today's paper that discusses a new tax that is now in effect. The tax was written into the Health Care Reform Act and will basically raise the cost of a tan by 10%. There are some exemptions to the tax. If a gym offers tanning in the monthly rate of all memberships then it is not taxed, but if it is an extra that members pay for as they use it - it is taxed. Owners of little tanning shops will be taxed. In the WSJ piece the reporter noted that fitness centers might use this exemption as a way to encourage people to join their gyms. The gym member would have access to tax free tanning. A person quoted in the story said something about it being wrong to try to keep people from becoming healthy. I have no idea what he meant. Yes, exercise improves health - tanning - NO SIR. Oh yes, and in the article it mentioned that people were trying to get more tans in before the price went up. OH MY GOSH> You may be able to view the article here.

The idea for taxing the tan SHOULD be based in the theory that higher prices for a tan would be a deterrent and thus have the potential to reduce the number of cases of melanoma. That was not mentioned in the article. No mention of radiation from tanning beds and the link to cancer was made. I was just aghast and thus had to change my blog.

Please - if you are a tanning bed user- let this be the reason you give it up. Learn more about the link to cancer from The Skin Cancer Foundation.

those darn blood fats

From my website:

Triglycerides are another type of blood fat. Having high triglycerides, over 150 mg/dl can increase heart disease risk and also worsen other health conditions. Being overweight and inactive, drinking too much and smoking are all risk factors you CAN control.

I note this because the newest research and development craze for pharmaceutical companies is finding a chemical or biologic compound to lower triglycerides in much the same way that statins can lower low density lipoproteins or LDL.

I ask the same type of question I usually ask – will lowering a persons blood fats reduce the adverse outcome of heart attack and death caused by heart disease? But I have more questions. How low is low enough? Wouldn’t it be more cost effective to educate persons on the dangers of high triglycerides and how to avoid them?

The drug companies and financial analysts are referring to progress in this area as a potential to gain a HUGE market share and to profit substantially from treating this self instigated disease. I want that to bother you. Some of the drugs that are in development have the same properties as Omega 3 fish oil supplements. What is wrong with eating salmon and taking regular fish oil supplements? Well, they are expensive and insurance doesn’t cover supplements so many people do not take them. If they were a medicine and insurance covered them – and doctor’s prescribed them – (because isn’t it easier for the doctor to say and you to hear, “take this pill twice a day” then “exercise five days a week?”) then the companies could make a lot of money.

With regard to increasing your risk for high triglycerides food high in saturated fat is surely an issue but so is just plain eating too much of any kind of food. When we eat more than we need, the body stores it and stores it as fat. Calorie moderation is the only answer – sorry – the truth hurts sometimes. To learn more about this and from a trusted source, please read the information on the AHA page here.

All Smokeless Tobacco is NOT the Same

I received an email from a colleague with a link to an online magazine piece about re: evidence on the dangers of smokeless tobacco (ST). When I read the brief article I felt the need to see the actual published study. This is because one of the things said in the ScienceDaily press release was that the tobacco was commonly used in other parts of the world. I had to ask myself, “What does this scientific finding mean to us – the USA?” I expected that I would find that the tobacco analyzed, which did cause some cellular changes that could lead to cancer, was NOT a product used in this country. That has happened before, both with good and bad outcomes, and it is important as a health educator that I know what I am talking about- yes?

I was able to access the journal article in Chemical Research in Toxicology.
Well of course I was blown away by the technical nature of the study and it was somewhat (ok very much so) over my head. Very basically an enzyme abbreviated as CYP and its protein subtypes will break down (in phases) the cancer causing agents in tobacco and other products. Often in tobacco we are referring to tobacco specific nitrosamines or TSNAs. In this instance the metabolism of the TSNAs or the breakdown of them by the enzymes can affect the cells in such a way as to change DNA. When DNA is changed, cells can mutate and become cancerous. This study showed that there are several organ systems affected by this toxic metabolism and thus smokeless tobacco could lead to several types of cancer. This is not a study to say that ST causes cancer, only that the processes that were seen are the same that in other situations have created a cancerous condition.

Still, the type of tobacco used in the region of study, Southeast Asia and India, is not the common tobacco used in the USA or even Western Europe. The researchers studied the effects of the tobacco metabolites from a certain blend called gutkha which according to Wikipedia and other sources is a mixture of tobacco and crushed betel nut, catechu, lime and other flavorings. What is catechu you might ask? It is some type of palm plant that grows in India and similar areas.

The ScienceDaily article did not at all note the type of tobacco or more exactly, tobacco juice (tobacco mixed with saliva), that was studied. This gutkha is not Copenhagen, Skoal or Redman and it is known to be worse than the Swedish brand of snus – so the article is good and as someone concerned with global health it is relevant, but as a US tobacco educator I would be wise to make the distinction of which tobacco causes which harm in my presentations as the one thing I want to be sure of is that I, unlike Big Tobacco, tell the truth!