Category: Uncategorized (Page 3 of 5)

Sedentary behavior is a major contributor to rising rates of obesity, diabetes, cardiovascular disease, and other related health problems in the US. America Walks is a non-profit organization that fights against this threat by improving walkability in communities across the country. In collaboration with local governments and organizations, they work to promote and improve pedestrian access, safety, and general use of outdoor space. In an effort to educate others on their successes and failures, they’ve put together several webinars, including one on October 11, 2017 entitled “Friends and Allies in the Walking Movement”. This latest webinar featured representatives from three organizations working to improve walkability in their own cities.

Kim Irwin, the Executive Director of Health by Design, discussed several ways the organization has improved walkability in Indianapolis and surrounding communities. One initiative she highlighted, called “Moving INDY Forward”, engaged heavily with community members and utilized “walking audits”, where they walked around the city talking with local business owners, customers, and city officials. This initiative was successful because the organization took advantage of its connections to the local population to find out what projects were most pertinent to the community and smaller problems that they could solve relatively quickly. A similar group in California, called WALKSacramento, would not have found the success they have without the help of their collaborators. Executive Director Kirin Kumar detailed how their multidisciplinary team consisted of air quality management personnel, private companies, public officers, UC Berkeley, and other universities. Together, this group educated their community, created guidelines to healthier city planning, and received federal funding to put those guidelines into practice. Finally, Honolulu Walks addressed the alarmingly high rate of senior pedestrian injuries and deaths in their city by creating a unique partnership. As Colby Takeda explained, the program worked by infusing the energy and enthusiasm of the youthful generation with the wisdom and curiosity of their senior counterparts. By pairing on a photography project, they learned to see the city through each other’s eyes and saw how enjoyable and safe it can be to walk through.

While the three programs discussed in this webinar used different tactics to address different problems facing their respective cities, they shared a common value of collaboration and teamwork. Public health seems to be a field where collaborations are inherent. For a public health researcher to implement a physical activity intervention, s/he would greatly benefit from recruiting the help of an exercise physiologist to lend the expertise on physical activity s/he may not have. It seems common sense that collaboration should be inherent in research, as no one can have expertise in every aspect involved in his/her area of interest. Instead, exercise scientists often run their research without the consultation of public health researchers because they strive for statistical significance in highly controlled studies, and focus much less on the real-world implication of their results. Researchers should strive for the same values of teamwork that children are taught when they first start school.

In a recent webinar hosted by Dialogue4Health, Dr Robert Wallace from the University of Iowa presented on the Health Effects of Cannabis and Cannabinoids, Cureent State of Evidence and Recommendations for Future Research. Dr. Wallace presented on a variety of topics including therapeutics, respiratory disease, injury and death, cancer, immunity, prenatal, psychosocial, mental health, and other outcomes. With the recent legalization of cannabis in several states throughout the United States, the body of evidence for marijuana has been able to expand greatly, and better studies have been able to be produced to show its effects. This discussion is important for discussing the use of cannabis in states that are still attempting to prevent legalization.

With regards to therapeutic use of cannabis, or medical marijuana as is commonly used in the media, the systematic review showed moderate evidence in helping patients experiencing nausea from chemotherapy, reducing pain in patients with chronic pain, and decreasing self reported spasticity symptoms in patients with multiple sclerosis. It was also noted that all of these areas showed modest effects. However, it was noted that there were better options for some of these conditions. New studies that have been published since this review was released in 2016 have also shown some effects in children and adults with seizures, tremors, and adults with Parkinson’s, but a larger body of evidence needs to be produced before making a recommendation on those conditions.

As for the potential side effects, no evidence was shown to support the belief that cannabis smoking will lead to respiratory disease, COPD, or asthma. However there was substantial evidence with long term smoking and worse respiratory symptoms and chronic bronchitis. For cancer, there was moderate evidence of no statistical association between cannabis use and lung, head, neck, cervical, prostrate, penile, bladder, esophageal, lymphoma, anal, or liver cancers. With regards to injury and death, cannabis use before driving has shown to significantly increase the risk of causing a motor vehicle accident. It is unclear if it is associated with all cause mortality or occupational injury. No evidence was reported for immunity outcomes. For woman who are pregnant, moderate evidence was reported for lower weight birth in children whose mothers smoked cannabis during pregnancy. All other pregnancy related outcomes were unclear.

Psychosocial outcomes demonstrated that within 24 hours of using cannabis, there was a significant decrease in learning, memory, and attention. In addition, a limited number of studies showed long term decrease in all outcome after cessation of smoking cannabis.  Those who smoked cannabis long term were also substantially more likely to develop schizophrenia and other psychoses.

Dr. Wallace discussed that all of these outcomes do not necessarily prove or disprove any causation, but rather can guide research kn which outcomes may be more affected by cannabis use. As the prevelance of cannabis use continues to grow, more research studies will be able to be conducted and better recommendations can be made on its use. Based on this body of evidence that is available, it is difficult to see why cannabis use should be continued to be outlawed, at least for therapeutic purposes in all states. There is moderate evidence of its use for medicinal purposes, with low risk for most of the outcomes that were discussed. It will be interesting to see how this field continues to expand over the course of the next decade, and what uses it may develop.

Dr. Katrina Piercy from the Department of Health and Human Services (HHS) recently delivered a webinar titled “Developing the Second Edition of the Physical Activity Guidelines for Americans.” The purpose of the webinar was to provide an explanation of the development of the upcoming federal physical activity recommendations.

Dr. Piercy began by describing the events leading up to the start of the Second Edition of the Physical Activity Guidelines for Americans. The first edition, released in 2008, was the first time the federal government put out physical activity guidelines. These recommendations focused on the amount of activity necessary for overall health benefits for people over age 6. The guidelines state that adults should aim to get the equivalent of 150 minutes of moderate-intensity aerobic activity per week and perform muscle-strengthening exercises for each major muscle group on two days per week. It is recommended that children accumulate 60 minutes per day of aerobic, muscle-, and bone-strengthening activity. Currently only 20% of adults and adolescents meet the respective aerobic and muscle-strengthening guidelines.

After discussing the current recommendations, Dr. Piercy continued with an explanation of events leading to the updated guidelines that will be released in 2018. Since the release of the previous recommendations, the field of research regarding physical activity and health has grown exponentially with many previous gaps having been identified and addressed. In addition, several key documents supporting physical activity have been released such as the Surgeon General’s Call to Action to Promote Walking and Walkable Communities and the updated National Physical Activity Plan.

On the heels of these developments, the official process of updating the guidelines began with the chartering of the Physical Activity Guidelines Advisory Committee. This group of subject matter experts was selected through a nomination process to provide guidance to the federal government. The committee has since participated in several public meetings to discuss the process of developing the new guidelines. Their charge is to revisit the 2008 Guidelines and determine what is consistent with current literature, what needs to be updated, and what areas still need to be addressed. The committee was then divided into subgroups to examine the following topics specifically:

• Aging
• Brain health
• Cancer
• Cardiometabolic health & weight management
• Exposure
• Individuals with chronic conditions
• Promotion of physical activity
• Sedentary behavior
• Youth

From there, an extensive literature review was conducted, and the committees continued to hold meetings to provide updates on their findings. The final product of this process will be the Advisory Committee Report which will provide independent evidence and recommendations based on the current evidence. This document will be used by federal staff at HHS to develop policy documents, or the actual guidelines. The final step in the process is having the new guidelines reflected in federal initiatives and resources such as funding announcements.

Overall this webinar provided great insight into what can be a very complicated process to try to understand.

In a seminar to the UGA Foods and Nutrition Department, Dr. Amy Goss began by discussing the etiology of metabolic disease and the common misconception of obesity as a root cause for theses pathologies; she stressed that obesity should be viewed as a result of a common antecedent, instead preferring to categorize it as collateral damage due to multiple factors including inflammation and hyperglycemia.

Individuals who struggle with maintaining their weight might be predisposed to being overweight or obese due to a specific genotype or phenotype they possess that is multiplied by nutritional insult. Nutritional insult is defined as a diet rich in highly processed carbohydrates, such as added sugar, wheat bread, and flour that results in subsequent spikes in blood insulin levels. Since insulin regulates body fat storage, constant large increases in insulin are likely to lead to increased deposits of fat and an increase in adipose tissue. This turns into one seemingly endless cycle because both ectopic fat and visceral fat contribute to insulin resistance. Thus, the more fat a person has means the more insulin resistant they are, so they have to increase the output of insulin which increases fat storage.

Dr. Goss’s most recent research involved comparing a low carbohydrate, high fat diet (43%CHO;18%Pro;39%Fat) to a more standard, control diet (55%CHO;18%Pro;27%Fat). It was determined that the low carb, high fat diet intervention resulted in relatively greater decrease of visceral fat and insulin secretion as compared to the control diet. Additionally, more weight loss was observed with a hypocaloric diet (500 kcal reduction) after eight weeks. However, one big limitation of these findings is that both diets had different glycemic loads. Dr. Goss was able to replicate these findings in women with Polycystic Ovary Syndrome where a low carb, high fat diet (41%CHO;19%Pro;40%Fat) resulted in decreased visceral and intramuscular fat and increased fasting glucose, insulin sensitivity, and beta-cell function, as compared to a control diet (55%CHO;18%Pro;27%Fat).

Dr. Goss finished her talk by discussing the UAB EatRight Clinic’s various diet plans that have proven effective in their patient population. These include a low carbohydrate diet, a Risk Reduction diet that is prescribed to individuals at high risk for cardiovascular disease, and the OptiFast diet which is a complete meal replacement program for individuals who need to lose at least fifty pounds. A more specific low carb, high fat diet that involved eating three eggs per day for eight weeks resulted in decreased weight, total fat, and insulin resistance as compared to controls who consumed Kind Bars.

While the jury is still out on the most effective diet plan to follow for weight loss and sustained health and wellness, it certainly seems that low carb, high fat diets are still on the table. With more corroborating research across different populations, this can potentially be an important prescription for disease prevention among normal weight adults and children of the general population (18.5-24.9 kg/m² BMI) who are at a high risk of becoming overweight and obese.

The webinar “Activity Advocates: NCPPA” was hosted by the National Physical Activity Society in partnership with the National Coalition for Promoting Physical Activity (NCPPA) and is a bit different than many of their other webinars. While usually focusing on small policy changes to promote physical activity in our communities and worksites, this particular webinar was focused on federal policies that will impact physical activity at the national level.

The NCPPA is a group consisting of different associations, healthcare organizations, and private corporations that advocates for policies promoting physical activity. Currently, NCPPA is focusing on federal policies that are statutory and regulatory. To support such policies, members of NCPPA act as advocates in Washington. Representatives meet with members of Congress and other regulatory and federal partners, attend or lead legislative briefings about physical activity policy, and participate in lobbying efforts. The goal of the coalition is to keep members and partners informed of the work being done on physical activity policy at the federal level and advocate for key legislation regarding physical activity. In this way the coalition acts as a convener to help coordinate efforts across multiple groups.

The webinar focused on several key issues the NCPPA is currently engaged in. The first effort is related to physical education in schools. Recently, the Every Student Succeeds Act (ESSA) was passed, which replaced the former No Child Left Behind Act. Under ESSA, physical education is designated as part of a well-rounded curriculum. This is vastly different than previous legislation which focused on devoting more time to “core subjects” such as math and science, often at the expense of PE. This policy will also make PE available for funding through the Title I mechanism which is aimed at providing resources for schools with economically disadvantaged students. NCPPA’s second initiative is related to the CDC’s newest framework, Active People, Healthy Nation. This framework aims to unify the different aspects of work being done at CDC to promote physical activity (surveillance of physical activity levels, media campaigns to promote the benefits of activity, etc). As part of this initiative, NCPPA will be the leading body advocating for funding to reach the goal of saving lives and protecting health by helping 25 million Americans become more physically active.

The final major initiative being led by NCPPA is the Personal Health Investment Today (PHIT) Act. This policy would expand the IRS tax-related definition of “medical expenses” to include “qualified sports and fitness expenses.” This would mean that individuals could use pre-tax funds, such as those in a health savings account, to pay for gym memberships, youth sport fees, and other costs related to participating in physical activity. Personally, I was extremely excited to hear this and think it will be a great tool in promoting physical activity.

In summary, the NCPPA plays a vital role in advocating for federal policies that promote physical activity in all sectors of society. Their achievements to date indicate that the future for physical activity on Capitol Hill is bright!

Spices are a unique part of our diets. They are aromatic, dried, edible, rich in potent phytochemicals, often intensely colored, and have culinary and medical uses. Spices are used for preservation and for enjoyment by adding flavor to foods.

Dr. Mary Hardy recently gave a webinar about spices and health. I was interested in the topic because as a future dietitian I look forward to providing my clients with evidence-based advice about nutrition to help them improve their health. I believe that recommending the use of spices, both in general and for specific medical uses, has the potential to play a big role in the health of my clients.

Dr. Hardy talked about the use of ginger, turmeric, and cinnamon for use in specific medical contexts in detail, but I will focus this blog post on her discussion of general spice use.

There is research to support that eating spices in general is beneficial for human health. Epidemiological data from a 7-year study in 500,000 Chinese adults found that eating spices 6 to 7 times per week may increase longevity by reducing all-cause mortality by 14%. Other epidemiological data supports the of cooking at home to promote health due to the generally healthier diet (lower fat and sugar intake) of those who cook at home and their decreased risk for type 2 diabetes. *Important note- epidemiological data does not show cause and effect relationships. It only shows an observation.

Spices can improve adherence to healthy diets because they add flavor and make food increasingly palatable. There is evidence to support that teaching people to cook with spices improves adherence to a low sodium diet. In one study, a group taught to cook with spices ate 1000 mg/d less sodium than the control group after 20 weeks. Additionally, there is evidence that people have better acceptance of lower fat food when spices were added to the low-fat foods.

Recommending the use of spices and incorporating spice cooking lessons into nutrition therapy are promising techniques that dietitians can use to help clients maintain healthy diets and improve adherence to sodium restrictions. Cooking lessons have the potential to be positive, fun, and engaging, so client satisfaction will likely be high if that technique is used. Also, grocery store tours with a special focus on the spice isle may help clients gain confidence in selecting spices from the store for home use.

In a recent webinar hosted by Action for Healthy Kids, the topic of school breakfast and having breakfast after the school day has started was brought up for discussion. But why is this an important discussion? Well, because there are currently some problems with the way the public school systems breakfast programs currently operate. Some of these problems include lack of space (not enough room in cafeteria for entire school, at once), timing is another problem (students need to arrive well before the bell to get breakfast), competining activities such as talking with their friends, and the negative stigma that only the poor kids eat breakfast at the school. With all of these aspects in mind, it is important to have an open discussion about the changes that could and should potentially be made.

So, what options are there for school corporations to look into? Some options include breakfast in the classroom, second chance breakfast, and grab n’ go breakfast. Breakfast in the classroom would obviously be after the bell in class, second chance breakfast would be mid morning and in between classes, and grab n’ breakfast would be set up throughout the school for students to get in their way to class. All of these options could work effectively, depending on each individual school system.

I’m sure interested in the potential pros and cons of having breakfast after the bell. In the webinar they discussed each. The pros of having breakfast after the bell include increased classroom participation, eliminating the stigma, increases academic performance, increase in school attendance, decrease in tardiness, and improved behavior. Other studies have also noted that schools with breakfast after the bell had decreased the number of nurse visits from previous years. But what potential cons could we see? Decrease in productivity? Actually most teachers found an increase in student productivity. The only true cons discussed were the logistics of making this transition, such as getting all the faculty on board, and working on proper waste disposal from classrooms.

How do we know this can work? This webinar brought in Jessica Sankey, Wellness Director of Bellingham School District in Washington. This district had 11 schools in the district, and the average school had over a third of its students on free or reduced meals including breakfast.  One school in particular had 80% of its students one free or reduced meals. The interesting statistic about this school in particular, was that only 43% of its students were taking advantage of the free breakfast, which they offered to all students regardless of meal price status. To address this, the school switched to breakfast in the classroom. They now have 100% participation, higher attendance and better test scores than previous years. The entire district is currently in the process of changing over.

Based on the case study discussed, it is clear that breakfast in the classroom can offer some serious benefits for students. Further research should be conducted at different schools and in different areas of the country to determine if it is a truly effective way of improving schools in America.

Chris Vogliano, MS, RDN defines food waste as food that is lost, discarded, or uneaten. Food waste is mostly in developed countries and food loss is mostly in developing countries. Food waste for developing countries occurs early in the food supply chain. Food waste can occur due to harvesting, transportation, storage issues, and spoilage. Wasted food in developed countries happens later mostly due to restaurants, food service operations, and consumers.  Food waste can occur during production, harvest, and transportation (pests, insects, diseases, weather). Food waste can occur with retailers and food services (overstocking, past best buy, consumer expectation). Consumers also contribute to food waste (uneaten leftovers, overbuying, and confusion over the best buy dates). He even states that according to the USDA, supermarkets alone lose up to $15 billion annually in unsold fruits and vegetables. America wastes an estimated 40% of all food that we produce.

Alice Henneman, MS, RDN continues the discussion with different strategies to helping reduce food waste. One important strategy is decoding the food labels. Over 90% of consumers are throwing out food too early, which leads to massive food waste. Dieticians have the opportunity to educate consumers on the differences between sell by, use by, and best by on food labels that I’m sure we’ve all seen before while grocery shopping. She goes on to list other strategies which include “offer vs. serve” in schools, avoid overbuying fresh produce, switching to smaller plates, getting creative with scraps, etc. There are a variety of ways that everyone can participate in to help reduce the food waste that is occurring.

This webinar was interesting and shocking at the same time. It’s concerning for a number of reasons. One reason being that we have millions of people who live in America that do not know where their next meal is coming from. To have such a massive food waste issue, we still have so many people who deal with food insecurity. Food waste also creates the greenhouse gas methane when introduced to landfills (which should be a last resort if you can help it). Chris mentions that methane is 25 times more dangerous than carbon dioxide. Some additional information to consider would be the food recovery hierarchy from the EPA. Donate extra food to food banks or shelters, composting, using scraps for animal feed and a few other strategies are listed as well. There are even apps that can be downloaded to help reduce food waste: Is My Food Safe?, Love Food Hate Waste, and Green Egg Shopper were the few named during this webinar.

In a recent webinar from the American Society of Nutrition, Dr. Maret Traber and Dr. Joan M. Cook-Mills discussed the importance of meeting the ERA for vitamin E in expecting mothers and infants; specifically the a-tocopherol instead of g-tocopherol. In today’s society, we have some of the most advanced medical for people throughout the world, and new practices with pre-natal care that have shown to greatly help influence embryo development. However, even with all of these new practices and advancements, the current miscarriage rate amount women in the United States is over 20%. Currently, only about 4% of women meet the RDA for vitamin E, and 96% fall below the RDA of 15 mg a day.

So what role does vitamin E play in the development of the embryo and through the early stages of development, specifically to the brain? Vitamin e is a fat soluble antioxidant, meaning that it breaks down free radicals in the body, but not just any free radicals. This antioxidant breaks down a specific free radicals that can damage the brain and comes from a process known as lipid peroxidation.  Lipid peroxidation is the oxidative degradation of lipids, most commonly polyunsaturated fatty acids. In the process, free radicals “steal” electrons from the lipids in cell membranes, resulting in cell damage. Vitamin e, specifically a-tocopherol, block these free radicals from removing the electron from the cell membranes of these lipids and prevent cell damage.

You might be wondering how this matters, or if they can even tell that it has anything to do with embryonic development. However, Dr. Traber and Oregon State University conducted a study with zebra fish to examine the difference in embryo development in fish with a vitamin e sufficient diet compared to those with an insufficient vitamin e diet. Those fish who had a sufficient diet, had fully developed and normal functioning embryos. Those who were insufficient were not able to develop, specifically in the brain, and all fish had died after 5 days of birth. But how does this related to humans? Well upon examination of variations of vitamin e that was needed in a variety of species, all had the same core components, most specifically a-tocopherol.

Based on the current evidence paired with the lack of vitamin e intake in women, the speakers made some recommendations that could assist in improving vitamin e  supplementation. First, making sure that  an adequate amount of vitamin e is in pre natal vitamins. As for the diet during pregnancy, consuming more a-tocopherol and less g-tocopherol could be beneficial as g-tocopherol increases inflammation from allergic responses. Additionally, decrease the amount of N-6 fatty acids consumed as longer chain polyunsaturated fats increase the amount of free radicals produced, and increase the amount of N-3 fatty acids (omega-3) consumed as they are the shortest chains, and produce less free radicals. All of these recommendations could help improve the embryonic development and improve development in the early stages of childhood development.

Influencing people to walk more throughout the day is a common behavior change that is often promoted by physical activity researchers and health professionals. It seems that this may be attainable now more than ever with the advent and subsequent widespread use of wearable physical activity trackers, most notably brand name devices like Garmin, FitBit, and Apple Watch. Dr. Kelly Evenson has been on the forefront of researching this technology and applying it to increase the awareness of the need for, and practice of, regular participation in physical activity among the general population.

According to Dr. Evenson, 69% of U.S. adults track at least one health indicator on average, of which most is done mentally. Of course, a convenience of physical activity trackers includes the ability to monitor multiple measures of fitness. Five of the most common and useful health tracking measurements include number of steps, total distance, and level of physical activity achieved, energy expenditure, and sleep. The ideal device combines the aspects of being wearable, controllable, mobile, and enhancing of physical activity. However, above all else, Dr. Evenson stressed the need for devices to be proven to have both intra- and inter-device reliability and meet both construct and criterion validity. Dr. Evenson’s research is mostly focused on FitBit, and using the Behavior Risk Factor Surveillance System, she has found that there are poor correlations between activity and body mass index regarding the use of FitBits. However, the technology is still very much in its infancy and has positive implications for use among cardiac rehabilitation patients.

As an aspiring strength and conditioning professional, I am highly intrigued by the use of physical activity trackers and their ability to monitor fitness among athletes and non-athletes alike. Catapult is a popular and successful Australian-based company leading the way in fitness monitoring through its partnerships with Australia’s Cooperative Research Centres and the Australian Institute of Sport. Combining the technologies of GPS tracking, accelerometers, video and statistical analysis, and computer-based software programs, Catapult is on the forefront of the application, prescription, and analysis of physical activity trackers.

Ultimately, I see a link to public health practice when I think about Catapult being utilized in research studies for the general population. If public health practitioners could partner with a company like Catapult, the results could be astounding. Researchers could have endless opportunities to validate and test Catapult products and their reliability in the general population, which could lead to even better physical activity and fitness practices and recommendations. Also, Catapult could create a market among the general population with the advent of new devices, increasing competition and supply-and-demand for wearable technology that would create greater access for the general population.

What do you think – Is there a viable connection between companies like Catapult and public health researchers and practitioners? Are physical activity trackers apart of the future of public health research? What kind of impact can physical activity tracking have on the general population?

Follow this link for more information on Catapult: https://www.catapultsports.com/