Category: Uncategorized (Page 1 of 5)

Nutritional concerns are rising faster than ever before. With the increase of processed and packaged foods, Americans are, on average, consuming over 75% of their daily sodium intake from these foods alone. This is resulting in an excess of sodium consumption across the entire American population. Excess sodium consumption can become concerning as it is linked to increased blood pressure. High blood pressure can, in turn, cause stroke and other heart diseases. Sodium reduction is necessary and needs to be addressed by the food service industry and policy change with revised guidelines.

The webinar consists of a variety of speakers who share their health projects with sodium reduction efforts. One of the projects the webinar focused on was the Child Nutrition Program with the National School Lunch and Breakfast Programs. This program was reauthorized though the Healthy Hunger-Free Kids Act in 2010. The breakfast and lunch programs were being revamped as a response to the increasing epidemic of overweight and obese children in the country. Nutrition guideline recommendations were taken from the National Academy of Medicine. In 2012-2014, fruit was offered daily and various vegetables were offered throughout the week. A year later, they replaced all grains with whole grains for both breakfast and lunch. In addition, sodium levels were targeted for reduction. Over time, sodium in products was slowly being reduced so that the children could adapt to the change in flavor. When children were challenged to make tastier meals without sodium, they got creative with various herbs and spices. Flavor can come from more than just salt; other spices can play a role in food taste, too, and this was a great way to get the kids involved in a fun activity.

These kinds of improvements in school lunch are a huge stepping stone to establish healthy eating habits for children early in life. If approximately a third to half of the child’s food source is coming from the school breakfast and/or lunch program, then a program like this has the ability to make a tremendous impact for future health. School-based interventions have the ability to influence a majority of kids to make healthier choices when they have healthier options presented to them.

In conclusion, children are a vulnerable population. Addressing and preventing childhood obesity early on will not only help their heath now, but also in the long run with heavily reduced risks of high blood pressure and heart disease.

It’s important to rethink what streets are for. Just for cars… or any other number of things?

Three intentions of streets as places include:

– Slow cars down

– Prioritize space for people

– Create “sticky” streets (encourage people to stop and hang out)

If there are about 10 things to do in a space, then that makes it a good place for a variety of age groups.

Examples from the webinar:

1. Read the paper

2. Window shop

3. Learn about upcoming events

4. Go inside

5. Walk by

6. Sit and relax

7. Read someone else’s book

8. Take a break from a bike ride

9. Pet a dog

10. Have a conversation

Ideas to slow down traffic that encourage people to hang out include:

– Protective bike lanes

– Protective crosswalks

– Intersection repair projects,

– Amazing piece of art

– Reducing crossing distance

– Farmer’s markets

– Community gardens

– Art/murals

– Downtown art projects

Creating targeted questions and finding solutions are a great way to tackle issues. For example, the webinar discusses how one of the programs wanted to get more young people to visit downtown. So, someone was paid to activated a Lure (from the PokemonGo App game on phones). This is a special timed condition that a player can send out, and it is intended to benefit anyone in the vicinity for a short period of time. As a result, approximately 25 people came pouring in within minutes, all because of a game.

Another example that works with this were the free summer concerts that were being held around lunchtime. However, barely anyone attended. To address the issue, pedestrians were surveyed as to what they wanted to see in the concert area, assuming it was an environmental issue, rather than trying to fix it themselves. Surprisingly enough, after applying the suggestions that were given, people started showing up. This helped shape the future of that environment, and gave people a new idea of, “Hey, we can walk around and enjoy ourselves.”

Overall, the main goal of these projects is to create more interesting and safe street areas. With these efforts, it is important to take into account public opinion. There’s no point in making changes for the community if no one uses them. Create places where people want to be.

Over the course of the last years the American Publif Health Association (APHA) has hosted a series of webinars on the impact of climate change and health. More specially, they have hosted a webinar on climate changes impact towards children. In this webinar, Annie Willis discusses the impact it had in her as a teenager, while Dr. Laura Anderko and Dr. Stephanie Chalupka discussed the specifics impacts on health and some options for responses.

First, Annie Willis discussed the impact that hurricane sandy had on her, as a 15 year old. While physically there were no changes to her health, mentally, she was devastated by the event. Not only did she have to eventually relocate to NYC, she also lost all of her resources, and had very little when she moved. Additionally, she had no one to relate to or communicate with in her new school. This presented a unique problem because people did not know the struggles she had been through, and even if they did, they could not relate. This lead to increased stress and anxiety for her future. This was an interesting discussion, because the mental health component of dealing with a natural disaster is commonly overlooked, especially in our youth.

Next, Dr. Anderko discussed the specific health concerns for children and dealing with climate change. First, she discussed the key differences between children and adults. Children consume more water, eat more food, and breath more air per pound of body mass than adults. Additionally, children are not fully developed, and therefore can not react as well to environmental stresses. Children also spend more time outdoors and are more exposed to environmental changes. In addition to increased temperatures, and rising waters, climate change has also caused an increase in vector borne diseases (zika, Lyme disease, etc.). These diseases can be specifically more lethal to children because of their lower immunity, and less efficiently functioning bodies. Another key increase is heat related deaths in the last decade, specially seen in football. With rising temperatures, practices are forced to be moved into different times to limit exposure to heat.

The last presenter for the webinar was Dr. Chalupka. She discussed the different options for responses to climate change for our youth. Obviously the best response would be stronger policies to require a major change in energy expenditure to limit the impact humans will continue to have on the degradation of the environment. However, some other options include building resiliency against climate change and the impact its effects will have. Education on food, water, and vector borne diseases and the impact they can have in children. Lastly, providing more psychosocial programs for children that are displaced by natural disasters.

Obviosuly, the youth of the world is important, as they will be the one’s to suffer the harsh consequences of global warming. Additionally, their health could be affected even more than that of adults,. While recent policies have taken a step backwards in regards to improvements in public policy, there are still many things that could be done to improve the future health of the children facing global warming,

Medical marijuana has been a hot topic in the medical world for the past few years. A seminar at this year’s Food and Nutrition Conference and Expo entitled “Going green: use of medical cannabis in medical nutrition therapy” discussed the efficacy and use of medical marijuana. Specifically in the second half of the seminar, Zachari Breeding presented the use of cannabis in nutrition related conditions.

He prefaced his talk by discussing the challenges surrounding researching the efficacy of cannabis use. Cannabis is still regarded as a schedule 1 substance, which means it has no currently accepted medical use and has a lack of accepted safety use under medical supervision. The only place to procure research grade cannabis is the University of Mississippi. The university has a very limited amount of space for production, limiting the amount available for research. Not only that, but research into the efficacy of cannabis is rarely funded when compared to research into its detrimental effects. Because of this, there is limited good evidence about the efficacy of cannabis.

However there are still nutrition-related conditions that are qualifying conditions for cannabis use in many states. The most common are cachexia, anorexia, nausea, irritable bowel syndrome, and cirrhosis. With more research, other conditions could also benefit from cannabis use. Two of the main effects of cannabis use researched in nutrition are appetite stimulation and weight gain. In rat models, low dosing of THC was shown to increase both homeostatic and hedonic control of eating. It was also found that cannabis use promoted weight gain, regardless of calorie intake. These uses make cannabis a consideration for treating the elderly who have poor nutrition status. It is also a potential treatment for chemotherapy-related emesis, however most research has found that cannabis use leads to increased food intake because of improved mood instead of increased appetite.

While there are multiple uses for medical marijuana in a nutrition setting, it can’t be prescribed for everyone. There are still risks associated with cannabis as with all drugs. Understanding the risks and benefits is necessary for recommending medical cannabis. Further research is needed on the efficacy of cannabis so that nutrition professionals and their patients can make informed decisions on their best plan of treatment.

The webinar, Incorporating Traditional Foods in Child Nutrition Program Menus, from April 2016 discusses practices for incorporating traditional foods into child nutrition programs. Traditional foods were defined by Alaska State Director of Child Nutrition Programs, Jo Dawson, as food that have traditionally been prepared and consumed by an Indian tribe. Today, if there is a way to save money, we typically lean in that direction. MPRO Farm to School Lead, Bob Gorman pushed that instead of paying to have food prepared and shipped to schools, local farming and hunting groups are great ways to save money. Gorman continued by giving an Alaskan traditional meal, but surprisingly enough his other example of a traditional meal was from Georgia. This included local chicken, egg corn squash, corn bean soup, a roll, and some lettuce and looked a lot better than I remember my options being in grade school.

Jo Dawson helped start “Let’s Eat More of Alaska’s Traditional Foods!” This project was funded by the US Department of Health and Human Services and pushed to keep Alaskans healthy by sharing local hunted and gathered foods to food service programs, senior meals, food banks, schools, and hospitals. Their flyer was easy to understand and clearly displays what is acceptable and unacceptable to donate.

“Fish for Kids” gave local commercial fisherman the opportunity to participate in a monthly donation day, since 2007 has averaged 12,000 pounds of fish per year. They are able to build community pride by eating the donated fish once per week with their children at school and even share with a senior center another school district. Dawson noted that many districts in Alaska have partnerships with local fish processing plants. State and Federal Regulations and supply were the top two barriers for incorporating traditional foods in schools.

Nutritionist, Jenny Montague, gave the presentation with the most takeaways for those not living in Alaska. She highlighted techniques for food substitutions, including growing traditional food, and using traditional ingredients and recipes. Another substitution technique was by meal component, which focused on finding alternative sources of protein, grains, fruit, vegetable, and carb/starch and then from those five categories, individually looking to find healthier, locally available options that could be substituted in. This approach is easily adaptable for any state/district.

The climate, region, and weather all play a role, but many schools can grow and cook local, traditional options that they can eat. Doing so will help save money, but can also bring the community closer together and allow students to work and learn about this field. Grants, partnerships, or funds of any kind certainly help these kinds of projects because startup resources or donations are necessary. With all of the agriculture and farming in the state of Georgia, I am sure that many districts have local partnerships to help incorporate healthy, traditional foods in our school lunches.

Food addiction has become a hot topic in the media, but is food addiction real? In a seminar entitled “Food addiction: fact or fiction?”, doctoral student Carolina Cawthorn questioned if food addiction can be considered a true addiction. She explained that true addiction is when a person compulsively used a substance despite harmful consequences to health, behavior, and relationships.

In regular substance abuse, pleasure is the main motivator for initial drug use. Increased dopamine secretion from drug use becomes a positive reinforcement that drives drug use. At this stage, a person can stop drug use if they want. Prolonged drug use, though, can remodel the brain so it becomes accustomed to the elevated dopamine levels. When the “high” wears off, dopamine levels end up dipping below baseline, causing withdrawal symptoms. The person now takes the drug, not for pleasure, but to avoid distress. The person is now dependent upon the drug and cannot easily stop. Dependency must occur for addiction to occur, however, dependency is not addiction. This seminar tried to discover if not only a person can become dependent on food, but if they can become addicted.

Rat models can be used to simulate human addiction, as they mimic human addiction models and have relatively the same rate of addiction as humans (17% compared to 20%). In an addicted state, as demonstrated by rats self-administered cocaine, they will do more to get the cocaine (bumping their nose to a button upwards off 400 times) and will disregard harmful consequences to get the drug (stepping on a lever and receiving a shock). When repeated with food, only rats who had high-impulsivity and given high-palatability food ate more and did more for the food. Actual analysis of these rat’s brains showed high indication of remodeling. This indicates that rats can become addicted to food, but they have to be susceptible to begin with. Another study showed that rats fed a high-sugar, high-fat diet had significantly less dopamine secretion when switched to a low-fat, low-sugar diet and it stayed down until the high-sugar, high-fat food was reintroduced. However, their dopamine bump from reintroduction was still lower than rats who had only ever eaten the low-sugar, low-fat food getting their regular meal. This indicated a dependency on food. Looking at food-dependency in rat models, it can be assumed that humans can develop similar food dependency.

The Yale food addiction scale (YFAS) is a questionnaire based on the Diagnostic and statistical manual of mental disorders’ codes for substance dependence. It’s used to assess food addiction in humans. It was found there was a 19.9% prevalence of food addiction, the same prevalence as regular substance addiction. But is this true addiction, and not just a dependency? In a German version of the YFAS, the top two symptoms were the “persistent desire or unsuccessful effort to cut down on eating” and “eating anyway – regardless of anything.” This demonstrates a loss of control, but true addiction includes prolonged use regardless of consequences. So how can food addiction be determined? We don’t know. No full conclusions have been made and there is no official diagnosis for food addiction. More research is needed to say if food addiction is on par with drug addiction.

With heart disease being the number one cause of death in America, reducing risk for CVD is a major concern among health professionals. One of the current recommendations is to reduce sodium intake as increased sodium intake, as increased sodium has a positive correlation with blood pressure, and hypertension is a leading risk factor for CVD. Mary (Molly) Cogswell discusses sodium in a seminar titled “sodium intake assessment, monitoring, and applied research”.

The first thing Dr. Cogswell discussed is where to find sodium. We can’t make recommendations if we don’t know where the problem is. First, while a bulk of sodium comes from table salt (NaCl), there are still other dietary sources of sodium, such as baking soda (NaHCO₃). Second, while many recommendations suggest seasoning with less salt, in actuality, that will do very little. Seasoning while cooking and at the table only account for 11% of sodium intake. Pre-processed and restaurant foods account for 71% of sodium intake. This means the biggest way to reduce sodium intake is to change the US food supply. The institute of medicine recommends setting national policies to gradually reduce to sodium used in commercial foods. A similar policy in the UK led to a 42% decrease in ischemic heart disease and a 15% decrease in sodium intake.

The second thing Dr. Cogswell discussed was how to assess and monitor sodium. Accurate measurements are needed in a clinical setting, and especially a research setting, where a small error could be the difference in statistical significance. However, the problem with clinical sodium assessment is, the more accurate a test, the more it costs, which becomes a barrier to many facilities. For example, the 24-hour urinary excretion is the gold standard for sodium assessment. All voided urine over 24 hours is collected and analyzed. This is very labor intensive and time consuming, leading to its high costs. This test still has random measurement error though, since sodium intake and excretion vary day to day. To make it more accurate, the measurement from multiple days would need to be averaged together, which exponentially increases the cost. To make it cheaper, a predicted 24-hour urinary excretion could be conducted. A single sample of urine is taken and used to predict the daily sodium excretion. This is much less accurate, since sodium excretion changes through-out the day, especially at night when the samples are usually taken for convenience. Finding a balance between cost and accuracy is key.

With sodium being such an important factor in reducing CVD risk, it’s necessary to create appropriate recommendations and assessment tools that will help in this endeavor.

According to Ms. Amy Rauworth and Ms. Allison Hoit Tubbs, from the National Center on Health, Physical Activity and Disability (NCHPAD), disability is projected to increase as aging population increases. Although the prevalence of disability in the U.S. indicates that 57 million Americans have some type of disability, this has been an underserved population and often ignored by the general health community having the highest rate of health disparities out of any subgroup in this country.

Accessibility and inclusion of people with disability in existing and future public health promotion programs geared toward improving their PA, nutrition and healthy weight management are imperative. As approximately one in five Americans has a disability of some sort, I wonder if as practitioners, can we develop skills to identify, include, and collaborate with a diverse range of individuals to increase community health inclusion? Are we aware of the principles of inclusive organizations, policies, and programs? And what actions can be taken to create inclusive programs and organizations in public health?

In the webinar, the presenters detailed how inclusion means to transform communities based on social justice principles in which all community members, for example, are presumed competent and experience reciprocal social relationships. They emphasized the need to go beyond the traditional medical approach, which is not always easy, to achieve inclusion. They also recommended what is commonly known as Universal Design, meaning the design of projects and environments to be usable by all people, to the greatest extent as possible, without the need for specialized design.

Creating inclusive communities, we can provide equal access to and opportunities for healthy living by implementing environmental designs that increase access to PA and healthy food. It has been also demonstrated that persons with disabilities are best served by public health when they are included in mainstream public health activities and programs. Having this in mind, some efforts for reaching individuals with disabilities through healthy communities could include the availability of trails designed for those individuals who have low vision, curb cuts and wide sidewalks that are easy to navigate, accessible entries, wheelchair accessible spaces in public places for recreation, audible traffic signals and elevators, lower sinks, toilets and dryers, wheelchair charging stations, parking that is safe, among others. A small change can make a big difference for somebody to live as independently as possible, the key is prioritizing accessibility, setting expectations, engaging the community –and its diversity- we wish to serve, and commit to inclusion.

Childhood obesity is a widespread concern for the country, especially for southern states, where the prevalence is considerably higher. For example, 39% of children in South Carolina are overweight and/or obese, which is almost double the national average (20%). For this reason, the Public Health department at the University of South Carolina has started an annual childhood obesity lecture. For the second installment, they invited Dr. Brian Saelens, a professor of pediatrics, psychiatry, and behavioral sciences at the University of Washington in Seattle. The purpose of his talk was to discuss his current research on family based care and weight management interventions.

Often based in family behavior therapy (FBT) techniques, popular interventions targeting pediatric weight management via their parents employ four common strategies: self-monitoring of food and activity, goal-setting and contingent reinforcement, environmental control, and parent modeling. These techniques and interventions have shown some success, but have not met their potential for change as they are cost and labor intensive, they are limited to certain populations, and most improvements are not long lasting after conclusion of the intervention. Dr. Saelens proposed an alternative where parents and families who have completed the intervention become peer leaders and run the intervention for other parents and families. This “pay it forward” mentality should maintain the intensity and comprehension of the intervention, reduce costs, improve reach and availability, and sustain longer lasting outcomes.

A pilot study testing the efficacy of this idea, called Parent Partnership Project, showed limited results. There was no preference among parents or kids whether professionals or other parents acted as their leaders during the intervention and it was dramatically more cost effective. However, the sample was too small to definitively show better weight related outcomes in the peer leader group over the professional-led group. Dr. Saelens and his group were able to use this pilot data to secure federal funding to implement a much larger study. Over the course of this long-term study, families will be randomly assigned to receive treatment by peers who’ve completed the program or by professionals. So far, they’ve had more than 50 families begin treatment and 10 have committed to becoming peer interventionists.

This bold new style of intervention with family weight management is brilliant for so many reasons. Above all, parents leading other parents will allow for longer lasting sustainability of weight management techniques utilized in the intervention. When parents are tasked with teaching other parents, they themselves have an accountability to continue the techniques they’re teaching in their own family. It’s analogous to how being a sleepaway camp counselor is the best training for teenagers heading off to college. They cannot fulfill their jobs of taking care of young campers without also taking care of themselves. Furthermore, for every family who completes the intervention and decides to become a peer leader, there is an exponential increase in families getting this intervention. This kind of creative thinking is what’s necessary to truly improve the obesity epidemic facing us today.

The “Effective Walking and Walkability Interventions” webinar part 1, from August 2016, highlighted different evidence-based strategies that would increase physical activity, specifically walking in communities. Important populations, vulnerable or underrepresented racial, ethnic, and socioeconomic groups at risk for inactivity was a group that they wanted to include throughout their discussion. Dr. Gregory Heath began by highlighting a few improvement areas needed to progress in order to move forward as a whole; an increased knowledge about physical activity benefits, increased awareness about ways to increase physical activity in the community, explain how to overcome barriers and negative attitudes about physical activity, and increase participation in community-based activities. By improving in these four areas, as a whole, we should be much more active and healthier.

Dr. Heath continued by addressing successful characteristics specific to community-wide campaigns, with examples. “Wheeling Walks” was a community-wide campaign that targeted 50-65-year-old for adults meeting CDC/ACSM physical activity recommendations. Making the campaign as specific as possible helps the target population know that this is available and helps generate the needed participants. In public health, basing the design off of theories like the planned behavior and trans theoretical model as behavioral guides will often help your argument when applied correctly. Dr. NiCole Keith made the point that implementation of community-based physical activity campaigns have many barriers and challenges. She suggests that the Multiple streams framework could help move physical activity into population’s health because this theory addresses problems of politics and policy changes.

Practitioners would be able to use this information in many ways. Including minority groups and not just focusing on the majority groups was often discussed in this webinar. Dr.  Keith made the point that often times those minority groups are the ones at risk and more needing of assistance, whether informational or resources. Dr. Chanam Lee promoted to design communities in a way that makes it safe and easy for people of all ages and abilities to walk. Doing that, along with promoting programs and policies to support walking where people live, learn, work, and play are two ways to improve walkability.

Improve our roadways (make more inviting with sidewalks, crossing lights, and bicycle lanes), local walking/bicycle days, and the opportunities to save money while being active are all common ways try to get communities to use more active transportation routes.

Any other (hopefully low-cost) ways that come to mind that could increase community walkability?

(I remember hearing of a weekend carnival type setup with a few location spots. Each location has few games/activities and can get stamp/sticker, then walk or bike to the other locations and get all stamps to get some prize (certificate, t-shirt, food coupons, local businesses). But that takes many volunteers and resources, so I am curious to hear if anyone has any local ideas that could promote more active transportation?