In a webinar presented by Coach Paul Zientarski of Naperville, Illinois, the main focus is on the importance of physical activity being implemented in schools and the positive effects of physical education programs. Not only can physical activity influence one’s body and weight, it also impacts the mind and can improve learning. Exercise prepares the mind in a number of ways, including improvements in impulse control, attention, and behavior. The webinar included evidence from previous studies that have shown the effects on the brain when physical activity is present in a child’s day. One example showed the comparisons of brain activity of students that were sitting quietly before taking a test and those that had taken a 20-minute walk before the test. Results showed that while taking the test, those that had walked for 20 minutes were using more brain activity than those that had not taken a walk beforehand (image below).  Based on this result, even the simple movement of walking can enhance the brain and prepare it for learning.

Paul Zientarski also discussed his own program, Learning-Readiness Physical Education (LRPE). The physical education course took place before a reading class, so that the influence of physical activity on learning and achievement in the classroom could be measured. The program included different components such as core strength, cross lateral activities, team building, and academic support while exercising. Academic support while exercising allowed students to study or do some type of academic tasks while doing low-intensity activity such as riding a stationery bike. By the end of the semester, kids in the exercise class did 56% better in the reading class than the ones that did not participate. The school was so impressed with these results, they did the same program with children struggling in a math class and saw improvements with that as well. Similar programs are being implemented in schools across the country, so it is possible to use this intervention in a variety of communities and schools. These physical activity programs could also be used during the school day to increase standardized test scores, and also show students a way to prepare for tests such as the SAT, ACT, and GRE.

This information could be useful for health educators to take into the schools and promote the positive learning outcomes for students that can come from exercising. This could greatly benefit many school districts that are considering taking out physical education and recess from the school day and help them to understand the many learning benefits that can result from exercise. However, it can only be successful if physical education teachers are willing to work hard and get the children moving and involved. If implemented in an appropriate way, this could lead many school administrators to improving physical education and motivating the physical education teachers to get more involved in programs like LRPE. For more information on the benefits of physical education in schools, check out https://www.cdc.gov/healthyschools/pecat/quality_pe.pdf.

Webinar: http://physicalactivitysociety.org/2016/09/13/naperville-illinois-webinar/

Bariatric surgery is an appealing weight loss option for many Americans for whom diet and exercise has not been an effective means of weight loss. The Roux en Y gastric bypass surgical procedure creates a very small pouch out of the stomach and reconnects this new pouch to a latter portion of the intestine. This limits the contact food has with absorptive tissues in the intestine as well as severely limiting the portion of food patients can consume at one time.

Anecdotally, patients report a decreased preference for sweet tasting and fatty foods after their surgery. Alan Spector, PhD, from Florida State University, hopes his research can help to identify a mechanism behind this phenomenon in an animal model. His work is part of a translational research project which will ultimately integrate human research being conducted in Ireland with his results in an animal model.

Dr. Spector designed a study that analyzed food intake of rats before and after bariatric surgery. The rats were familiarized with five food items with specific macronutrient compositions before surgery: refried beans (low sugar, low fat), low fat yogurt (low fat, high sugar), creamy peanut butter (high fat, low sugar), and sugar fat “whip” (high fat, high sugar). After a healing period where post-surgery weight loss and healing occurred, the intervention began.

On the first day of the reintroduction of the different food groups, the proportions of macronutrient intake between the gastric bypass rats and controls were the same. However, as days passed, rats with gastric bypass decreased their proportion of fat intake significantly compared to control animals. Fat intake was replaced by carbohydrate and protein but it is important to note that intake from “added sugars” remained constant–implying the majority of the changes came from increasing refried bean consumption and decreasing sugar whip intake. Importantly, the change happened over time, and considering this,  Dr. Spector theorizes that change in intake is taking place due to the experiences of the rats, rather their their taste preferences specifically (1).

These findings set the stage for exciting research in the future in the path to identify the mechanisms behind what is causing the behavior change anecdotally observed in humans. However, it is extremely interesting to see the observed human behavior change in rats, and implies there is a mechanism to be identified. Practitioners, especially Registered Dietitians, can benefit from this information. Many patients, because of insurance purposes, must go through intensive lifestyle counseling before and after surgery. Informing patients of the changes they will experience is crucial. Though Dr. Spector’s research doesn’t say with certainty what changes in the body may be driving taste preferences, his research does support what observational data has already concluded. Counseling on issues such as dumping syndrome as well as food preference changes can prepare patients for what to expect after such a life changing procedure.

1. Alan Spector. Taste, Palatability, Food Selection and Gastric Bypass. University of Georgia. Department of Foods and Nutrition Seminar Series. October 5, 2016.

Leah Shahum, the founder and director of the Vision Zero Network, discusses in a webinar the importance of traffic safety through the initiative of Vision Zero. Vision Zero is a project with the goal of zero traffic injury among all street users, including those walking, driving, or biking. This focuses on traffic safety with a public health approach to provide individuals with safe streets to move around on. Motor vehicle deaths are currently higher than firearms deaths, which is surprising due to the lack of traffic violence in the news and media. 38,000 people lost their lives on the streets last year due to vehicle-related incidents, so it is time to address this issue and make people aware that we are able to control the safety of our streets.

Of course there is no way to prevent all traffic accidents, but many factors often play into why a crash occurred, and it is not always just an accident. For example, it could be related to engineering problems, individual behaviors, or other preventable measures. Two important aspects of crashes that were addressed in the webinar were related to speed and engineering problems. Factors addressing speed issues are simply setting appropriate speed limits, enforcing them, and proper sign placement to make the streets safer. The base of making the streets safer also begins with engineering. Some ways to improve engineering could be having more sidewalks, wider bike lanes, and more space between the road and sidewalk. To do this, an entire community must get involved such as the mayor’s office, police force, and the public health department. It is a team effort focused on measurable goals to bring safety to a community.

Vision Zero has been effective in major cities across the United States, including Fort Lauderdale, Washington, D.C., and New York City with lower traffic-related death rates as Vision Zero has been implemented. Because of the success in major cities, it would also be useful to use this project in smaller communities and suburban areas as well. No one should be in danger or fearful simply moving around one’s own community. Health practitioners and professionals encourage people to get outside and be active through walking, running, or biking, but to do this effectively, policies like Vision Zero need to be in the environment to provide overall street safety. Practitioners can use this information to influence policy and legislation, promote community education, and change the practices of the community to put Vision Zero into action. Public health professionals can also encourage individuals to be aware of their surroundings when out on the streets, such as looking both ways before crossing and limiting cell phone use. For more information on taking action and an individual’s role in traffic and street safety, http://www.nyc.gov/html/visionzero/pages/home/home.shtml is a useful source.

http://physicalactivitysociety.org/2016/07/06/1958/

Can one meditate their GI symptoms away? In August 2015, Collective Evolution published an article which was titled “Harvard Study Reveals What Meditation Does to Gastrointestinal (Bowel) Disorders.”  According to the article, in a study that was published in PLOS One, researchers found that the relaxation response, which is described as a “physical state of deep rest that changes the physical and emotional responses to stress,”(Benson, n.d.) decreases inflammation of suffers of irritable bowel disease (IBS) and inflammatory bowel disease (IBD). Taking a look at the actual study, it does show that engaging in Relaxation Response-Mind Body Interventions (RR-MBI) does have a significant positive effect on decreasing pain and quality of life for the study participants.
While the article produces much excitement and potential about the use of RR-MBI in managing symptoms of chronic illnesses, the research design of the study is weak. The fact that it was not randomized means that the study could have a high amount of bias as a result. It was an uncontrolled study, so we cannot clearly see how much of a difference RR-MBI had in groups who received the intervention and groups who didn’t receive the intervention. Even the researchers admitted that because the study isn’t randomized, they cannot determine if the reported changes had to do with RR-MBI (Kuo et al., 2015).  We can only compare across those who have IBS and those who have IBD. In addition, the number of participants was small(only 48), mostly white (95%) and female (67%) (Kuo et al., 2015). Because of this, it would be an overgeneralization to say that meditation will benefit all sufferers of IBS and IBD.
The article was erroneous in saying that it was an eight-week study; it was actually a nine-week study.  Given the study was rather short, it can only be suggested that RR-MBI had a positive effect on decreasing pain and increasing quality of life. However, this was more the case for IBD patients than IBS patients during the follow-up period. Studies over a longer time period need to be done to see if there are any definitive long-term effects for both groups. That being said, this was the first study done of its kind and the results elicits the need for further studies.
While this was a short-term study with research design flaws, practitioners still can find this information useful for IBS or IBD patients who suffer from inflammation. Not all patients who suffer from IBS or IBD are keen on merely depending on medication to manage their symptoms. Practitioners could suggest RR-MBI techniques to those patients in helping mitigate their symptoms, but if they do so, it is recommended that they have the patient create a log in which they record their pain level, RR-MBI activities, and prescription use for pain management along with scheduling a follow up appointment to properly see if this intervention is actually effective.

SOURCES
Benson, H. (n.d.). RelaxationResponse.org. Retrieved from http://www.relaxationresponse.org.

Kuo B., Bhasin, M., Jacquart, J., Scult, M.A., Slipp, L, Riklin, E.I.K., Lepoutre, V.,…Denniger, J., (2015). Genomic and Clinical Effects Associated with a Relaxation Response Mind-Body Intervention in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disease. PLOS ONE 10(4) 1-26.

Walia, A (5 August 2015). Harvard Study Reveals What Meditation Literally Does to Gastrointestinal (Bowel) Disorders. Collective Evolution. Retrieved from
http://www.collective-evolution.com/2015/08/05/harvard-study-reveals-what-meditation-literally-does-to-gastrointestinal-bowel-disorders/.

Your best friend tells you that GMOs are in your food, and they are bad for the environment. You see an article posted by Dr. Oz saying that you should try this new life-changing diet. These are just some of the “tips” that consumers see and hear on a daily basis on what and what not to do when it comes to food choices. But how are consumers supposed to know what is reliable with all of the many sources and outlets in society today? This was the topic of a webinar with the Center for Food Integrity that seeks to gain consumer trust in the food system to provide the knowledge that is desperately needed. With the many nutrition “experts” in the media, bad science, and buzzwords everywhere, consumers are fearful of who they can actually trust.

Every year, the Center for Food Integrity conducts a survey to see what consumers’ thoughts and actions are when it comes to food choices. From their most recent survey, it was found that consumers make more of their food choices based on shared values from relationships with others rather than received facts. This emphasizes the influence of trust, and therefore the importance of the food systems shifting their approach to shared values to connect with the consumer. Consumers do not feel engaged to the food system and are seeking transparency and the need to be heard. Of course facts do not need to be abandoned all together, but the nutrition and health professionals should be leading the facts with shared values to be communicated effectively.  The goal of communication should not be to persuade or educate, but rather to embrace the skepticism. Sarah Downs, a registered dietitian that led part of the webinar, provided a helpful tool for communicating with individuals: “listen, ask, share”. She believes in listening without judgment and listening to a person’s values first, then asking questions about thoughts and beliefs. Everyone has different values, whether it is difficulty finding affordable food, being fearful of food recalls, or wanting to eat organic foods, therefore listening is key to understanding. Sharing should include sharing your own perspective and values with an individual, so a connection can be bridged together. Whether it is family, integrity, or quality, everyone has values that impact their food choices and beliefs.

This information is especially useful for dietitians, clinicians, and other professionals in the nutrition field when having conversations with clients about food choices. Dietitians should also use their expertise through social media as well since that seems to be the main outlet consumers receive information. For more information on this topic, FoodIntegrity.org and BestFoodFacts.org are great resources for nutrition professionals or for the everyday consumer.

http://www.healthyeating.org/Health-Wellness-Providers/Professional-Development/Webinars/Love-of-Eating-Fear-of-Food-Empower-Consumers-in-Age-of-Distrust.aspx

A popular phrase among some registered dietitians (RD) is “Anything is healthy in moderation.” Though other RD’s will roll their eyes at that idea and softly mutter under their breath “A small portion doesn’t mean it provides optimal nutrition”, Dr. VanDellen has some research to debunk the ‘moderation myth’. Dr. VanDellen is a researcher in the Psychology department at the University of Georgia and studies how people can be successful at self-regulation and self-control¹. Self-regulation and self-control are words often tossed around in the context of obesity research and understanding how people’s interpretations of moderate amounts of food can help understand their behavior.

Dr. VanDellen explained that “moderation” can take on different meanings, depending on when you ask questions related to moderation.² She went on to explain that the following two questions should have the same answer if a person is truly “eating in moderation”:

1. “How many cookies should you eat?”
2. “How many cookies would be considered ‘a moderate amount’?”

The results were conflicting; the answer to question (1) was “2” and the answer to question (2) was “3”. She went on to explain that, for her participants, “moderate consumption” was consistently reported as a greater amount than what they actually consumed, if they were prompted with the question after they ate the cookies. Additionally, if you asked them question (2) before they ate the cookies, the reported moderate” amount wasn’t as consistent across participants, but it was always more than what they ended up eating as the intervention time progressed.

The perceptions of moderation justified their actions—but their perceptions changed based on their scenario. Consistently with this, if more food was consumed during the study period, the more food subjects perceived they could eat it while still considering it “in moderation”. In a computer-simulated “Thanksgiving meal”, VanDellen compared participants who were told to either build their Thanksgiving plate as they would on the actual holiday, or to construct a plate “in moderation”. In the latter scenario, they put more food on their plates!

Her take home message? Moderation messages are not reducing the number of calories people are consuming!

These findings present an interesting new construct for healthcare practitioners, especially RDs, to consider. According to Dr. VanDellen’s research, participants consume more food when they are told to eat foods in moderation and the definition of moderation depends on when people are prompted with the question. From the evidence she presented, “moderation” is too abstract a concept to facilitate beneficial behavior change, especially if weight loss is the primary desirable outcome. A better option would be to teach people how to identify the amount of calories, fat and added sugars are found in specific foods, and providing them with the tools to assess how these foods can fit within their daily (or weekly) intakes.

1. Michelle VanDellen. University of Georgia. Internet: http://psychology.uga.edu/directory/michelle-vandellen. Accessed 21 September 2015.
2. Michelle VanDellen. Counterintuitive Finding in How Nutrition and Health Messages Affect Consumption. University of Georgia. Department of Foods and Nutrition Seminar Series. October 7, 2015.

Did you know that drinking water is the real key to losing weight? Well, not exactly. CNN says they have dug up some “serious evidence” that says drinking water or eating water-loaded fruits and vegetables when your stomach starts growling could help with weight management. The evidence, though, comes from a cross-sectional study in which the authors state “these data… cannot be used to infer causation.”

Chang and colleagues recognized that the relationship between weight status and hydration status is still relatively unknown. So, using data pulled from 2 recent National health and Nutrition Examination Surveys (NHANES), the researchers set out to see if there was an association between obesity and urine osmolality as a cursor of hydration status. No research had been conducted on this area of interest prior to this study, as urine osmolality was only added to the national survey in 2009. Additionally, the researchers only categorized study participants into two categories of weight: Body Mass Index (BMI) > 30 kg/m² or BMI < 30 kg/m² .  So after combining the results from the 2009-2010 and 2011-2012 NHANES surveys, what did they find?

The University of Michigan researchers found that hydration status could be quantified as adequate over 800 mOsm/ kg or inadequate below 800 mOsm/ kg. The overall average urine osmolality was 631.4 mOsm/ kg, well below the adequate hydration marker. Hydration status was associated with age, race, sex, poverty level, and BMI in this study. They reported that adults who were inadequately hydrated had a mean BMI of 1.32 30 kg/m² more than hydrated individuals. Additionally they stated that the odds of being obese were 1.59 times higher for inadequately hydrated individuals compared with hydrated individuals. Interestingly, about 68% of those who were classified as adequately hydrated were obese. The exact percentage of the 9,528 participants who fell about the BMI of 30 kg/m² is never reported.

As this is not a causation study, the researchers inferred reasons for the lower hydration status of obese individuals but made only suggestions and educated guesses. Even in CNN citations, Chang states that it could just be because “a bigger person needs more water than a smaller person to stay hydrated.” This would make sense, as urine osmolality is measured in mOSM/ kg. In the study discussion, higher sodium intakes from “unhealthy” foods and increased metabolism of individuals with higher BMIs were cited as a possible causes for decreased hydration. Overall, the reasoning has not been researched, though Chang encouraged new studies in this area. Clinicians can also take this into consideration for counseling weight loss clients, although water intake as a weight loss tool is not an evidence based recommendation. As for individuals trying to lose weight, eating more fruits and vegetables with higher in general is a great idea and replacing soda and other sugar-sweetened beverages can definitely help with weight loss. Unfortunately, for now, there is no single key to weight loss as it involves changing a multitude of daily behaviors and habits.

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.

Most individuals would assume that due to the low number of calories and artificial additives, sparkling water and seltzer water are considerably healthier alternatives to soda. The low sugar content pushes it above many juices and recovery drinks such as Gatorade or Powerade. However, Sophie Egan’s article in the New York Times, Does Sparkling Water Have a Downside, questions this healthy alternative¹. The first question posed is the risks of sparkling water contributing to low bone mineral density (BMD) and osteoporosis. In Tucker et al.’s study on the effects of coca cola and other carbonated beverages on low BMD, results showed only coca cola – regular, diet and non-caffeinated (albeit lower for the latter two types) – was associated with a decrease BMD in men and women who consumed more than one coca cola per month³. Other carbonated beverages, such as the essentially carbonated water that is seltzer and sparkling, showed no effects on bone mineral density or association with osteoporosis development³.

However, this leads to the second question. Sparkling water may not be correlated with detrimental effects on bone, but does its low pH (acidity) lead to a degradation of tooth enamel? Reddy et al., in a study on 379 United States beverages and their pH levels, established three classifications for beverage acidity (extremely erosive, erosive, and minimally erosive)². Sparkling water, plain without any additions, has a pH level of 5, which classifies it as minimally erosive, and hence not a danger to tooth enamel erosion¹. Yet, where individuals need to be careful is with adding citric flavors, such as lemon or lime, to their sparkling water. The natural acidity in these fruits can increase the pH levels and consequently decrease the healthy benefits of drinking a sparkling water over a carbonated soda.

Two additional comments Egan makes on the downside of sparkling water involve essential minerals. Drinking bottled sparkling water eliminates the benefits of the fluoridation process of tap water. Also, avoid making the mistake of confusing seltzer and sparkling water with club soda. These are not the same, as the latter includes a large amount of added sodium, which is already consumed in a larger than healthy amount among most Americans.

All in all, Egan utilizes two decently coordinated studies to effectively, and accurately, provide a better-rounded view on the health benefits, and risks, of consuming sparkling water. This media piece provides useful information that many individuals may have been unaware of, as they chose sparkling water with fruit flavorings over sodas in an attempt to make a healthier beverage selection.

¹Egan, S. (16 September 2016). Does Sparkling Water Have a Downside? New York Times. Retrieved September 18, 2016 from http://well.blogs.nytimes.com/2016/09/16/does-sparkling-water-have-a-downside/?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=9&pgtype=sectionfront.

²Reddy, A., et al. (2016). The pH of Beverages in the United States. American Dental Association. Retrieved September 18, 2016 from http://www.ada.org/en/~/media/ADA/Public%20Programs/Files/JADA_The%20pH%20of%20beverages%20in%20the%20United%20States.

³Tucker, K., et al. (2006). Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. American Society for Clinical Nutrition. Retrieved September 18, 2016 from http://ajcn.nutrition.org/content/84/4/936.

It’s raining outside. I do not have the time in my day. Walking is not vigorous enough to actually benefit my health. These are only a few of the excuses individuals use on a regular basis to justify a lack of daily physical activity. So how can practitioners reach communities regarding the importance of walking and staying active? Dr. Gregory Heath discusses some of the approaches and strategies as well as keys to success of implementing community and school level walking programs to increase individuals’ overall health and lower risk of chronic disease.

A large barrier to the success of walking programs is a lack of knowledge on the part of the community. The national physical activity guidelines suggest a minimum dosage of 150 minutes of moderate to vigorous physical activity each week to receive any health benefits. This could be spread into a short ten-minute brisk walk each morning and evening throughout every day of the week, or condensed into more vigorous activities on fewer days of the week, but either way physical activity promotes many health benefits. Dr. Heath discusses the importance of increasing this awareness using broad, multicomponent strategi
es that reach across many sectors. Implementing walking programs requires partnership among not only the local community health department, but also the schools, parks and recreation department, neighborhoods and citizens themselves. For example, many walking school bus interventions or Kids Walk-To-School programs require organization and advocacy at the school level via teacher support as well as parental
involvement.

Another important key to success is implementation of a social support network, a behavioral approach to walking interventions. Providing social support and groups can dispel many of the previously mentioned excuses. Exercise Honolulu, an initiative that aimed to improve walkability by implementing walking events at a central location, provided both a measure of accountability and a social environment in which to engage by establishing 6 Sunday walks throughout 25 neighborhoods. This campaign involved an informational approach in addition to the initiative being promoted via media press releases and radio advertisements to disseminate the benefits of the event.

Practitioners can utilize this overview of approaches and keys to success to help implement walking programs within their own communities. Ensuring a successful program requires multi-sector cooperation and coordination, appropriate use of promotional techniques, and provision of a social support to ensure an enjoyable environment.

“Effective Walking and Walkability Interventions” Webinar (August 3, 2016)