Monthly Archives: June 2013

Illusion and Health

A recent University of Texas study about the gap between perception of adequate exercise and optimal diet and the reality of an individual’s regime sent me googling.

I remembered a similar meme about body image. My memory was that men do not see how fat they are, and women imagine themselves fat when they are not, leading to anorexia.

Here are a few of them, and there are no doubt more:

Those studies raised an important question: how do reality and perception diverge when it comes to health?

So, let’s look at the University of Texas study from the Journal of Women’s Health, entitled Lifestyle and Cancer Prevention in Women: Knowledge, Perceptions, and Compliance with Recommended Guidelines.

Among those who believed that good diet and physical activity prevented cancer, the study found discrepancies (I have color-coded them) between what they believed they were doing and were actually doing as shown in the following table:

Women's Perceptions JWH 20130610

It can be seen that while 85 percent believe they are consuming a healthy diet, only 8.5 percent are eating an adequate amount of fruits and vegetables. While 73.1 percent reported engaging in physical activity to prevent cancer, only 31.5 percent were active enough to have a positive impact.

The study found that the significant predictors of the discrepancy were education, and to a lesser extent race-ethnicity independent of education. While the authors speculate about the reasons for those findings, they are clear and unambiguous about the implications, which I quote at length with the footnotes removed:

This finding has important public health implications. The first implication is that women in the current study reported understanding that engaging in regular physical activity and eating a healthy diet are important behaviors for cancer prevention. Thus, media campaigns and targeted public health messages should focus on the importance of specific frequencies and durations of recommended behaviors (i.e., 5 a Day for Better Health), and place less emphasis on the general importance of health behaviors. This may help attenuate the “underdosing” observed in the current study. Current public health efforts are focusing on making community-wide changes to reduce obesity and improve health.19 These efforts may be enhanced by promoting awareness of potential discrepancies between perceptions of behavior and actual behavior and by highlighting practical ways to integrate specific cancer prevention behaviors into daily life at adequate levels. Furthermore, they should consider the imbalance between educational resources for healthy eating and physical activity and barriers to these behaviors (i.e., society encourages the overconsumption of unhealthy food; low access to fresh produce and places to exercise safely sometimes exists). Given that women often serve as “gatekeepers” of health behavior within their families, efforts to address these discrepancies among women may ultimately have a positive downstream effect on men and children. Because dietary habits are often solidified in childhood, the discrepancies observed in this study could potentially set children up for a lifetime of poor health behaviors. These findings add to the body of existing literature indicating that although health-relevant knowledge and attitudes are generally positively associated with the practice health behaviors, the associations are only modest.

Results further indicated that the observed discrepancies for diet and physical activity were significantly more common among women with less education and among members of racial/ethnic minority groups. This is consistent with a large body of research supporting a social gradient in health (i.e., lower socioeconomic position and minority status are associated with poorer health behaviors and poorer health outcomes). One explanation for this is differential exposure to obesogenic environments. That is, individuals with low socioeconomic status and racial/ethnic minorities have less access to healthier foods such as fruits and vegetables due to higher cost and lower access to grocery stores that carry fresh produce. They also have fewer safe places to engage in physical activity. These women may be particularly vulnerable to perceiving that they are engaging in specific diet and physical activity behaviors to help prevent cancer. However, they may lack the opportunity to fully engage in preventive behaviors, thus failing to engage in such behaviors with sufficient frequency and duration to reduce their cancer risk. Such women may need to be specifically targeted for intervention and may benefit from tailored messages and interventions regarding diet and physical activity.

Do we not all know friends and family and clients who believe they are eating well and exercising adequately, but do not understand why their weight keeps rising, with the attendant complications? Our challenge as a society is not only to find ways of addressing the health problems that are undermining our economy and personal functioning that underpin our nation, but to communicate those findings in a way that is unambiguous and specific. The challenge of communicating the findings of a solution to the public health issues may be even more daunting than isolating those causes.

Doing the porcelain dance

As a general rule, food-borne illness, commonly called “food poisoning,” has remained fairly constant over the years. Indeed, since 1996 only one pathogen has shown considerable increase.

Based on 19,531 cases from Foodborne Diseases Active Surveillance Network (FoodNet) the CDC found:

Food  Illness Trends 1996_2012

If Vibrio were a stock instead of a pathogen, you would have wanted to buy in around 1996 as it has enjoyed a considerable rise. Perhaps, like me, you wondered what Vibrio was. Most of the others have been in the news media or are simply well-known.

The trend continued in the period 2006 to 2012:

Foodborne Illness 2012

Vibrio is a genus of bacteria–one species causes cholera. This species Vibrio parahaemolyticus, however, likes sea water so much that it hangs out with oysters. If you get this infection, antibiotics do not help, so you drink liquids and wait it out.

Vibrio

By contrast, another species Vibrio Vulnificus can respond to anti-biotics. Among healthy people, the experience is likely to be the same as for Vibrio parahaemolyticus, but for those with compromised immune systems, immediate medical attention is indicated. Fortunately, this seems to be the more rare form of non-cholera Vibrio, and the incidence is much less frequent, generally occurring in the Gulf States.

One mystery in the data: incidence of Vibrio is higher among adults over 65 years old. While it can be contracted by an open wound in the wrong sea water, most Vibrio results from consumption of raw oysters or other uncooked seafood. I have not been aware of any trend to gulping raw oysters among seniors, but as the boomers enter old age, maybe they are going for anything that might keep the Sexy Sixties going. It would be of interest to see the geographic distribution of these cases–are there a lot of them in South Florida, for example?

Be careful out there.

Obesity confusion

We are agreed that obesity is a problem, for individuals and for society.

We are agreed that dieting alone will not help. The latest popular diet approach is part of the background noise not part of the solution. Here is some noise from my Facebook feed as I was writing this posting.

Obesity diet noise

Exercise and dieting combined would work, but is probably beyond the ability of many if not most people facing obesity. Indeed, starting any exercise program may be a challenge to both will and health of someone morbidly obese.

We know that bariatric surgery can work; however, it is invasive, expensive, and there are debates among specialists about what works sufficiently.

Indeed, after Governor Chris Christie of New Jersey announced that he had had a gastric band implanted, there was considerable debate about whether that was sufficient compared to gastric bypass surgery, particularly given the failure rate of the laparascopic gastric band or “lap band.”

There is open debate about whether obesity prevention measures are cost-effective.

As if the problem were not challenging enough, a study has shown that physicians fail to demonstrate to obese patients the empathy necessary to effect change.

Al Lewis argues that many of our workplace wellness programs are ill-conceived and ineffective.

The seriousness of the problem is underscored by a Metlife study showing that obesity contributes $1,723 per person per year to the Medicare budget, or 8.5 percent of the total.

We are not left with a solid place to make a stand against obesity. My plan is to walk a bit more and eat a bit less as I contemplate next steps. What are your thoughts?

Fast food and slow death

My father returned from a business trip with great enthusiasm for a new food product he had experienced. A company had found the best meat available and mass produced hamburgers, with the mustard, ketchup, and pickle already on the bun. Dad had eaten his first McDonald’s hamburger, more than a half century ago.

He died at age 45 of a massive heart attack, a product not only of McDonald’s and other fast food, but of a sedentary lifestyle, poor heredity, and a 1950’s diet, in which it wasn’t a meal without meat.

He and others who lived through the Second World War had experienced the deprivation of rationing following not long after the Great Depression. Having enough to eat, enough protein to eat, and then seeing opulent food as a sign of material success were all very real to that generation.

The success of feminism led to changes in America’s eating habits. Instead of one partner packing the lunch pail and preparing dinner, both were in the work force, too hurried and harried to spend as much time on meals. Quick meals, whether processed from the grocery store or from a fast food chain, became the norm. In the not too distant future we will learn what the impact has been on gut bacteria that process nutrients and play a role in regulating our weight.

In October 2011 researchers from the University of Michigan, Warsaw School of Social Science and Humanities, and the University of Texas published a study showing significant correlation between national rates of obesity and the density of Subway restaurants in 28 developed nations. Their study ‘Globesization’:
ecological evidence on the relationship between fast food outlets and obesity among 26 advanced
economies
found high rates of obesity in countries such as the United States and Canada with high density of Subway restaurants compared to low rates of obesity in countries such as Japan and Norway with low rates.

We can safely assume that it is not Subway alone, but a propensity to support fast food restaurants that is related to obesity. In the study graphic below, the clustering of values along a rising trend line from lower right to upper left, demonstrates the correlation between obesity on the vertical and subways on the horizontal:

Subway_Obesity

Source: Roberto De Vogli , Anne Kouvonen & David Gimeno (2011): ‘Globesization’: ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies, Critical Public Health, 21:4, 395-402

My father’s generation died sooner, from fatty diets, cigarettes, and a sedentary lifestyle. If anything, computers have made our lifestyles more sedentary, but we know the dangers of cigarettes and saturated fats. We have statin drugs to stave off early death. Now we live longer, die slower, and endure chronic illnesses, such as cardiovascular disease and diabetes.

One of the singular distinctions between children and adults is the ability of adults to postpone pleasure and even endure discomfort in pursuit of a greater good. That may mean planning healthier meals, lighter meals, walking more and driving less. It means, in short, all the things we know we should do but sometimes do not. A long life need not be accompanied by a slow death–if we are willing to act on the knowledge we already have.