Author: zz02359

Food insecurity is defined as limited or uncertain ability to acquire nutritionally adequate and safe food in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, or other coping strategies) (Wunderlich & Norwood, 2006). About 48.1 million Americans were food insecure as of 2014, accounting for 15% of the population. The proportion of children in food insecurity is even higher, at 20%(America, 2015) . When the rate of food security is increasing and remaining high, as seen recently, the rate of obesity is also going up. However, participation in a food assistance program was previously shown to exacerbate the problem of obesity (Franklin et al., 2012). The real problem faced with food stamp programs is the access to adequate healthy foods and education about what healthy foods are, especially for women and children.

In the blog ” How Food Subsidy Programs Pushed Junk Food Off the Table”, the author cited the review by Andreyeva T. and Tripp A.S. (2016), and comes to the conclusion that nudging shoppers toward more healthful foods pushed cheap junk food out of the family shopping basket, and lower-income families were buying more healthful food as a result of the option restriction the government made. However, in the actual review article, the researcher only find that new restrictions lowering purchase of moderation (less healthful) food and beverages, without significant increase in healthful foods purchase. The biggest change found was purchase in moderation beverages. These findings do not support the claim that lower-income families are buying more healthful food.

We’ve already noticed that calorie-dense foods are significantly cheaper while healthy foods are increasingly more expensive, as shown by researchers (Wiggins et al., 2015). The energy density of food was found to be negatively associated with price. Reasonably, the recipients of food stamps would be attracted to cheaper foods with sufficient energy when on a tight budget. In this situation, the government can either put effort on educating the recipients why and how to eat healthy on a budget or just restrict their buying options.  From the results of the original review, we can see that while restriction of shopping option had a fast impact on lowering purchase and thus intake of unhealthy foods and beverages, education on nutrition may still be needed in order to make people choose to buy more healthful products voluntarily. It is practitioner’s job to figure out how much effort is enough to get people to choose wisely.

STROM, S. (2016). How a Food Subsidy Program Pushed Junk Food Off the Table. Eat Well. Retrieved from http://www.nytimes.com/2016/10/05/well/eat/how-a-food-subsidy-program-pushed-junk-food-off-the-table.html

America, F. (2015). Hunger in America 2014, national report. August 2014: Print.

Franklin, B., Jones, A., Love, D., Puckett, S., Macklin, J., & White-Means, S. (2012). Exploring mediators of food insecurity and obesity: a review of recent literature. J Community Health, 37(1), 253-264. doi:10.1007/s10900-011-9420-4

Wiggins, S., Keats, S., Shimokawa, S., Alberto, J., Hernández, V., & Claro, R. M. (2015). The rising cost of a healthy diet.

Wunderlich, G. S., & Norwood, J. L. (2006). Food insecurity and hunger in the United States: National Academies Press.

While it is already a common sense that physical activity can lower the risk of cardiovascular disease (Temporelli, 2016), there is an article(Reynolds, 2016) tells us that acute exercise can trigger a heart attack. It is thus confusing to general public what role PA really plays in heart attack.

According to the blog author, “Exercising with unusual vigor while you are enraged or emotionally distraught could be dangerous for your heart.” However, this is not the conclusion that the original scientific study achieved. The original study was a case-control study which asked the patients who had experienced their first attack whether they had had heavy physical exercise or had been emotional before the episode(Smyth et al., 2016). The researchers did not examine how physical activity interacted with emotion, thus it is unfair to say exercising with anger triples the risk as said by the article author. The impact of physical activity and emotion was studied separately in the case-control study.

So what did the original study say about the impact of physical activity on heart attack? Should we avoid PA in order to lower our risk ? First, to be clear, the question presented to patient was “Were you engaged in heavy physical exertion?”. So exercise of moderate or light intensity is almost always considered safe. People do not have to worry about heart attack when they exercise at a level that they’re used to. Second, although the study tried to match acute MI patients with similar controls in the study, the heart attack patients had significantly less habitual PA and worse comorbidity compared to the control group. The validity of a case-control study lies in how similar the cases and controls are. This indicates that if you are a person that do not exercise regularly but suddenly have a short and intense work out, it may have a higher chance of causing a problem. But if you’re a regular exerciser, there’s no point in avoiding exercise. Third, exercise may trigger heart attack, but only under the condition that someone already have underlying CVD. If you have never had heart problem, fear of a heart attack should not be your excuse for stopping exercise.

For us practitioners, we certainly don’t want to scare anyone away from exercise because we know the benefits outweigh the risks. However, when working with populations of high CVD risks like deconditioned older adults and those with high blood pressures or dyslipidemia, the exercise intensity should be suggested or prescribed with caution. Progression in intensity and duration should be slower than for apparently healthy populations.

REYNOLDS, G. (2016). Think it’s cathartic to run angry? Think again.   Retrieved from http://www.nytimes.com/2016/10/19/well/move/running-while-angry.html

Smyth, A., O’Donnell, M., Lamelas, P., Teo, K., Rangarajan, S., & Yusuf, S. (2016). Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial InfarctionClinical Perspective. Circulation, 134(15), 1059-1067.

Temporelli, P. L. (2016). [Physical activity and cardiovascular health]. G Ital Cardiol (Rome), 17(3), 176-180. doi:10.1714/2190.23654

With the proportion of processed food consumed away from home increased to nearly one half through the recent years[2], education on how to prepare nutritious meals at home is not enough to help people eating healthy. If we take a look into food bought at restaurants and homemade meals, we can see that people consume significantly more calories when they eat out. Overconsumption of fat and sugar as well as underconsumption of iron, calcium and vitamins is seen when people eat at restaurant[3]. It is thus not surprising, when researchers found that eating out is associated with childhood obesity across the United States[4]. Part of the reason could be people are less aware of the ingredients, portion size and nutrition when the food is not prepared by themselves, or their healthy options are limited by the menu. Either way, it is necessary to involve the restaurants if we were to improve overall nutrition.

The food portion we see in the restaurants is increasingly larger over the years. With portions getting larger, the appetite of the customers grows, too. While some people realizing the growing portion size and trying not to finish their plates, the restaurants are responsible for offering flexible sizes and options that include vegetables and fruits to the customers. The researchers of Choose Health LA have made a lot of effort in educating and communicating with the restaurants. The first step was how to make the message of smaller size and healthier option heard by the restaurants. Next is how to make it a win-win choice for both the restaurants and the society. In other words, the policy makers and researchers need to think through how this project can make the community around those restaurants healthier without hurting the profit of the restaurants as indicated by Pareto efficiency. Only in this way will the restaurants be willing to participate in the program and be committed even after the campaign finishes. A successful approach used by the administrators of Choose Health LA program was to advertise the participating restaurants on local news and social media, which was an efficient way to market those restaurants and make the restaurants feel that their efforts were being recognized. When we are trying to implement a public health program, it is important to make it align with the market rules, appealing to stakeholders and cost-effective. Sometimes, it might be beneficial to calculate the return on investment value of the possible public health projects in order to select the most rewarding one.

1. Food-Away-from-Home. 2016; Available from: http://www.ers.usda.gov/topics/food-choices-health/food-consumption-demand/food-away-from-home.aspx.
2. McGuire, S., Todd J.E., Mancino L., Lin B-H. The impact of food away from home on adult diet quality. ERR-90, U.S. Department of Agriculture, Econ. Res. Serv., February 2010. Adv Nutr, 2011. 2(5): p. 442-3.
3. Boumtje, P.I., et al., Dietary habits, demographics, and the development of overweight and obesity among children in the United States. Food Policy, 2005. 30(2): p. 115-128.

Intense interval training could be the one of most painful workout . While it’s efficiency in improving  fitness is proven to be superior to moderate-intensity continuous training (MICT)by many studies (Gillen et al., 2016; Weston, Wisloff, & Coombes, 2014), the anticipated pain still is intimidating for many exercisers, especially beginners .

According to NY Times, music makes young people more willing to try HIIT.

Matthew Stork, a doctoral candidate in University of British Columbia, has been studying the impact of music on HIIT. His previous finding on this topic is that self-selected music has a positive impact on the peak and mean power output(Stork, Kwan, Gibala, & Martin Ginis, 2015). The new study added more psychological and emotional factors to the findings(Stork & Martin Ginis, 2016). The study showed that the exercise attitudes was significantly better in the music group but the intention score did not change, which left the meaningfulness of the study questionable. The question needs to be answered is whether those questionnaire scores utilized in the study were valid. The scale for attitudes had a Cronbach’s alpha of 0.72, which is low for an instrument, for an instrument usually needs a Cronbach’s alpha of over 0.9 to be justified as a reliable instrument. Even if we assume the questionnaires were valid , what a better attitude towards HIIT means is still not clear. Is it enough to convince people that the results of HIIT is worth the pain? Or this study only tells us those who love HIIT will love HIIT with or without their music, and those who don’t will never do even adding some music can make you feel slight better if you try.

Another problem with this study was its sample size. Only 20 people aging 18 to 30 who usually had moderate-level exercise and had not been exposed to intense interval training were included in the study, which make its generalizability very limited . Some fitness enthusiasts may think of music as a distraction and do not like music when they exercise. Thus this study only revealed the possibility that music may be used as a sort of comfort or stimulant, but whether it helps motivating people to choose a higher intensity remains unclear.

Gillen, J. B., Martin, B. J., MacInnis, M. J., Skelly, L. E., Tarnopolsky, M. A., & Gibala, M. J. (2016). Twelve Weeks of Sprint Interval Training Improves Indices of Cardiometabolic Health Similar to Traditional Endurance Training despite a Five-Fold Lower Exercise Volume and Time Commitment. PLoS One, 11(4), e0154075. doi:10.1371/journal.pone.0154075

REYNOLDS, G. (2016). How Music Might Improve Your Workouts.   Retrieved from http://www.nytimes.com/2016/10/26/well/move/how-music-might-improve-your-workouts.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=4&pgtype=sectionfront

Stork, M. J., Kwan, M. Y., Gibala, M. J., & Martin Ginis, K. A. (2015). Music enhances performance and perceived enjoyment of sprint interval exercise. Med Sci Sports Exerc, 47(5), 1052-1060. doi:10.1249/MSS.0000000000000494

Stork, M. J., & Martin Ginis, K. A. (2016). Listening to music during sprint interval exercise: The impact on exercise attitudes and intentions. J Sports Sci, 1-7. doi:10.1080/02640414.2016.1242764

Weston, K. S., Wisloff, U., & Coombes, J. S. (2014). High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis. Br J Sports Med, 48(16), 1227-1234. doi:10.1136/bjsports-2013-092576

A lot of people believe that fat is harmful and we should avoid when we possibly can, especially when we are on a diet plan. Before we deny fat as a whole, we need to know that there is more than one kind of fat. And different kinds of fat may play different roles in human body.

There is already agreement on artificial trans fat contributes to heart problems and diabetes[2]. The previous popularity of trans fit has been contained in the nation, especially in big cities like New York and Los Angeles[3, 4]. But debates continue on whether saturated fat is harmful and should be replaced with polyunsaturated and monounsaturated fatty acids. There is more evidence we can find in the literature associating saturated fat and cardiovascular disease. A meta-analysis published in 2010 synthesizing 21 prospective cohort studies showed that there is no link between higher saturated fat consumption and increased risk of CVD[5]. The studies chosen were relatively small in size and short in duration and thus studies of larger sizes and more years are still needed to assess the effect of saturated fat. However, on the website of American Heart Association, saturated fat has already been categorized as bad fat along with trans fat[6]. It might be too early to make this judgement based on the available evidence. On the other hand, are there better substitutes than saturated fat? The AHA recommended polyunsaturated fat and monounsaturated fat. A newly published meta-analysis suggests that polyunsaturated fat might be a better option than both saturated fat and monounsaturated fat[7]. Certainly when trans fat goes out, something has to go in to replace it. What will that be? For manufacturers, this is usually saturated fat. The total fat amount in food before and after the trans fat ban did not change.

Low fat is one of the biggest pitfalls about diet. While everybody knows that the excessive body fat contributes to development of chronic diseases, fats (except trans-fat), when consumed in a moderate amount, are actually protective of bones, reproductive health, etc. It is not dietary fat, but the excessive body fat caused energy imbalance through a long period of time that is negatively affecting for public health.

1. Sifferlin, A., Here’s New Proof That Not All Fats Are Bad For You. 2016.
2. Willett, W.C., Trans fatty acids and cardiovascular disease – epidemiological data. Atherosclerosis Supplements, 2006. 7(2): p. 5-8.
3. Angell, S.Y., et al., Cholesterol control beyond the clinic: New York City’s trans fat restriction. Ann Intern Med, 2009. 151(2): p. 129-34.
4. McCarthy, M., US gives food manufacturers three years to ban trans fats. BMJ, 2015. 350: p. h3315.
5. Siri-Tarino, P.W., et al., Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr, 2010. 91(3): p. 535-46.
6. Monounsaturated Fats. 2016; Available from: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Monounsaturated-Fats_UCM_301460_Article.jsp#.WBT_MfkrJEY.
7. Imamura, F., et al., Effects of Saturated Fat, Polyunsaturated Fat, Monounsaturated Fat, and Carbohydrate on Glucose-Insulin Homeostasis: A Systematic Review and Meta-analysis of Randomised Controlled Feeding Trials. PLoS Med, 2016. 13(7): p. e1002087.

Schools now are responsible for providing kids with healthy school lunch with vegetables and fruits.  They have to make sure that every step in meal preparation is done appropriately in order not to cause any safety problem, especially when foods are consumed raw. Anything in the food processing, from use of contaminated water to handling the produce to unsanitary hands can cause illness. Unluckily, the regulations regarding food processing are not stringent, making the delivery of food from manufacturers to the schools the most modifiable step in this loop.

The only Federal law regulating fresh food produce is the FDA Food Safety Modernization Act (FSMA),  focusing on preventive control of food contamination was developed and signed by President Obama in 2011 (Sawtelle, 2013). However, the farmers are not required to comply with it until 2018. It is still questionable whether the program will be able to finish the training and facility extension with the limited resources by then.

Schools need also to be aware of the local regulation beforehand and establish their own rules in the process of contracting or purchasing with local farmers. According to the webinar, the schools are suggested to come up with a specific list of safety items and are recommended to observe, inspect and evaluate the food produce of each kind of fruit or vegetables they buy. However,  schools don’t receive any support from the government on what this safety list should include, when to inspect the farms and where the resources for these inspections come from. The fresh produce added in the school lunch may end up becoming a burden on the schools financially, considering the fact that each kid on average is only reimbursed for less than $3 for each of their lunches(“School Meals,”). The $3 has to cover the cost of both vegetables and the inspection of them. Schools short in funds/staff may not be able to put fresh produce on the lunch table.  Students are thus restricted to the processed food and fast food that are easier to preserve and transport, much cheaper and calorically denser. It was reported that some schools only use pizzas as the vegetables, since the they have tiny amount of tomatoes on them. Chain restaurants such as Pizza’s Hut are seen participating in the National School Lunch Program. It is doubtful whether this regulation on food safety is actually assuring kids to eat better or it is prohibiting kids coming from socioeconomically disadvantaged families from getting the best  food they can. Since this issue affects both children and teenagers, it raises more concern about the health of the future generation.

Sawtelle, M. (2013). Food Safety Modernization Act (FSMA).

School Meals. Rates of Reimbursement.

Service, U. F. a. N. (2016). Planning for Farm to School Success – Farm to School Food Safety.