Monthly Archives: July 2012

The Conundrum of Caving to the Food Industry in the Battle Against Obesity

I just wanted to bring your attention to an excellent piece by Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale, in which she addresses the perilous slippery slope of appeasing the food industry and how that specifically impacts our fight against obesity.

He points out that all the research of calories in versus calories out, increasing exercise, cutting sodium, sugar, and fat, the problems with cutting physical activity from the daily routine of children, the abundant prevalence of fast food, and the cost of healthy, organic alternatives has been well and good – but that we are purposely avoiding and not addressing one of the biggest challenges in combating the increasing waistlines in America. The total avoidance of tackling head-on the way food is marketed, made, sold, and how quickly even healthcare organizations in need of a little extra cash may take a sponsorship or donation from a group directly contributing to many of the health issues that organization is tackling.

I know we live in a capitalist society. I know that the element most prized in this economic system is a competitive market and that supporters think private enterprise should be able to do whatever it likes in terms marketing and aggressive behavior towards consumers and that the individual is supposed to be able to make an independent choice. I also think that’s ridiculous. To assume that someone’s behavior is not influenced by the massive inundation of public messages, no matter how smart they are, disproves years of communication and sociological research. I always find it amusing when major corporations or businesses decry critics who say that advertising is harmful and misleading, when in fact most corporations and businesses are counting exactly on that – that the constant (and often subliminal, or in the least, very sly) messages they’re strategically slinging at us all the time are working their magic and ensuring that people will take the bait. As a critic of many advertising practices, a supporter of progressive paternalism (known to those on the opposite side of the aisle as a nanny state), and someone who has worked with people trying to change a range if disordered eating behaviors and poor nutrition habits, I found her piece particularly compelling and in agreement with her claim that the food industry has had plenty of time to prove itself trustworthy.

I think this line really sums it up: “When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry. I expect history will look back with dismay on the celebration of baby steps industry takes (such as public–private partnerships with health organizations, “healthy eating” campaigns, and corporate social responsibility initiatives) while it fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages, and regulation of nutritional labeling).”

Check it out.

1 Comment

Filed under Advertising, Health Education, Media, Public Health

Integrating Family Planning and HIV Services Benefits All

Some pretty great research is cropping up at the 2012 International AIDS Conference, and it’s hard to pick just one finding to reference, but I do love infographics and I do love family planning – so I found something that combines the two! Population Action International, a truly fantastic research and advocacy organization focused on women’s reproductive health access and care, and they make a great point about the advantages and importance of providing both family planning and HIV services at the same time and in the same place. They point out that mother-to-child HIV transmission can be reduced, stigma may decrease, and both time and money are save. Take a look:

Combining HIV and family planning services (courtesy of Population Action International).

Another issue at hand is that of the relationship between a provider and a patient or client. Family planning clinics have a better chance of establishing long-term relationships with women – particularly if women have multiple children – given that they also sometimes aid in pre- and post-natal care or help connect women to those services, which increases the likelihood of women who test HIV+ to getting the treatment they need. Again, all in one place!

Follow along at #AIDS2012 on Twitter to stay abreast of everything going on in D.C.

Leave a comment

Filed under Health Education, International, Public Health, Reproductive and Sexual Health, Women's Health

Maternal Health and the Status of Women

Both globally and domestically, maternal health and the standing of women are inextricably linked. If women do not have the means and access to give birth safely, with trained and educated midwives, physicians and nurses, with appropriate prenatal education and care, it is often indicative of the standing of women in their communities and countries overall. Women’s inequality is also linked to the soaring population growth in developing countries, which will pose a range of new challenges for the next few generations.

Some may point to the United States as an anomaly, citing women’s increasing economic and financial independence, education, and leadership roles in America, while in terms of maternal health rankings, we remain pathetically far down the line for our resources (49 other countries are safer places to give birth than the U.S. – despite us spending more money on healthcare than anywhere else). Of course, the recent and incessant attacks on allowing women to access credible, accurate, up-to-date and comprehensive sexual and reproductive health education and services makes this statistic not entirely…surprising, shall we say.

So, I found the incredibly detailed and visually impressive infographic by the National Post, pulled from spectacular data and research done by Save the Children to be particularly fascinating. What they did was combine information on the health, economic, and education status of women to create overall rankings of the best and worst countries for women, splitting the countries into categories of more developed, less developed, and least developed, and the countries were ranked in relation to the other countries in their category (the divisions were based on the 2008 United Nations Population Division’s World Population Prospects, which most recently no longer classified based on development standing). While these divisions and the rankings can certainly be contentious and may incite some disagreement (nothing unusual there, these kind of rankings usually are), I thought the results were interesting. Some highlights – Norway is first, Somalia is last. The United States was 19th, and Canada was 17th (Estonia fell in between us and the Great White North) in the most developed. Israel is first in the less developed category, and Bhutan is first in the least developed category. The full report with data from Save the Children is also available, if you want to learn more about the information combined to make this image. Take a look:

A Woman’s Place – Courtesy of the National Post

One thing that I thought was particularly great was that the researchers combined women’s health and children’s heath data to create rankings specific to being a mother, when that category is sometimes only assessed based on access to reproductive care.The specific rankings of maternal health highlights largely mimics the overall standing of women, as seen here – Norway is number one, again, and Niger falls into last place:

Mother’s Index, Courtesy of Save the Children

I think these images and graphs are particularly moving given one of the top health stories coming out of the New York Times today, which showed that a recent Johns Hopkins study indicated meeting the contraception needs of women in developing countries could reduce maternal mortality (and thereby increase the standing of women in many of the nations doing poorly in the above ranking) globally by a third. When looking at the countries in the infographic that have low rates of using modern contraception and the correlation between that and their ranking in terms of status of women, it’s not surprising what the JH researchers found. Many of the countries farther down in the rankings have rates below 50%, and for those countries filling the bottom 25 slots, none of them even reach a rate that is a third of the population in terms of contraceptive use – which of course in most cases has to do with availability, not choice. Wonderfully, the Gates Foundation yesterday announced that they would be donating $1 billion to increase the access to contraceptives in developing countries.

Also of note, and in relation to maternal and newborn health, is a new study recently published by Mailman researchers that showed PEPFAR funded programs in sub-Saharan Africa increased access to healthcare facilities for women (particularly important for this region, as 50% of maternal deaths occur there), thereby increasing the number of births occurring in these facilities – reducing the avoidable (and sometimes inevitable) complications from labor and delivery, decreasing the chance of infection and increasing treatment if contracted. This has clear implications for children as well (and why I think this study relates to the National Post infographic and the NY Times article), since newborns are also able to be assessed by trained healthcare workers and potentially life-threatening conditions averted – including HIV, if the newborns have HIV+ mothers and need early anti-retroviral treatment and a relationship with a healthcare worker and system. And it goes without saying that if a new mother is struggling with post-delivery healthcare issues, including abscesses and fistulas, or was dealing with a high-risk pre-labor condition like preeclampsia, the child will have an increasingly difficult early life, perhaps even a motherless one.

1 Comment

Filed under Child Development and Child Health, Health Education, International, Politics, Public Health, Reproductive and Sexual Health, Women's Health

Physicians Won’t be the Ones to Help You Lose Weight

Surprise! Your doctor may not be the best person to get you to lose weight – and it seems that it’s largely because they are averse to talking about it at all. A recent article from NPR breaks down some of the troubling reasons behind why this relationship isn’t making real significant strides in this public health fight.

78 million Americans are obese. There are 164,000 primary care doctors that are able to treat them. That’s a daunting division as it is, but when you think about the average amount of time a physician sees a patient – maybe 20 minutes, it seems impossible to achieve the task of vastly reducing the prevalence of obesity. The kind of personalized information that is needed for each patient would take longer than 20 minutes to gather, and creating a personalized subsequent behavior change and nutrition plan takes even longer. Interestingly, the NPR pieces cites the American Association of Family Physicians in reporting that not even 50% of primary care providers calculate a patient’s BMI (there are a lot of problems with BMI as a measure, and they’ve been widely discussed – how they don’t take into account muscle mass, for example – but for some obese patients, they can be a reasonable crude measure of where the individual is in terms of major health risks and how to initiate a weight loss program). But physicians who know the history of a patient and have tracked their health for years are in the best position in terms of knowing how risky an individual’s weight is.

Of course that’s not all that needs to be considered – I actually don’t think it’s even the most pressing or pertinent issue as to why physicians aren’t able to tackle the obesity epidemic. As the NPR article says, the psychologist in charge of the University of South Carolina’s weight management center calls the topic of weight loss and obesity a “mine field.” There can be resistance in going to the doctor for any number of reasons – shame or embarrassment, frustration, avoidance or denial, and even the very real fear of what a physician might tell them. And, importantly, deep concern and worry about not having the means – financially, mentally, community or family-wise, to tackle what seems like insurmountable changes in lifestyle. On the other side, doctors claim that some patients react defensively if they suggest that weight loss needs to be in their future.

This is a complicated dance, and I can’t help but draw parallels in these kinds of responses to the relationship between eating disorder patients and their physicians, psychologists, and nutritionists. Weight is so inextricably tied to identity, personally and culturally, for so many people, that the mere suggestion of a necessary change – either gaining or losing weight – can feel like an assault on the person’s actual self. How do we best navigate this? These conversations, first of all, can’t be brief. They just can’t. They require a meaningful relationship between those negotiating solutions, and for the individual who is in a precarious health position – whether it be due to restricting and bingeing and purging, or due to inactivity and unbalanced diets and genetic factors – it requires the sense that the person ostensibly helping them knows them personally, what their fears and concerns are, is patient, and most of all, is able to be consistently present and supportive through the successes and inevitable failures of the journey. And those relationships can be mighty hard to come by.

6 Comments

Filed under Disordered Eating, Health Education, Public Health

Social Media Continues to Make People Feel Bad About Themselves

A study out of the UK has found (as have others more than once), that use of social media sometimes doesn’t make you feel like…really socializing. Instead, it can make you feel anxious and depressed, which are more likely to make you feel withdrawn than anything else.

The study found that participants noted a drop in their own self-esteem after viewing the accomplishments of their Facebook friends. Combine this with the fact that 25% of them claimed to have had relationship issues due to online ‘confrontations’ (which could, of course, mean many things), that more than half were rendered uncomfortable when they couldn’t easily access their social media accounts, that other studies have claimed more socially aggressive (subtly termed ‘hateful’) folks use Facebook more often, that people often deliberately post bad pictures of their friends to make themselves look better and subsequently compare their weight, body size, and physical appearance to these friends, and that Facebook is cited in divorce proceedings as being problematic for couples, and you may be liable to think that this phenomenon offer little in the way of improving our lives.

A good thing to remember here, aside from the pretty remarkable things being done with social media in terms of education, research, medicine, and public health (this USC study is great news, and touches upon the influence of social networks in ways I’ve been exploring as it relates to substance use, sexual behavior, and disordered eating behaviors, and that other studies have shown the exact opposite in terms of emotional response, is that social media does allow users to tailor the perception and identity they project. Another recent study (I’ll try to find the URL for it!) showed, unsurprisingly, that what users often admire about their friends’ virtual lives is the positive sliver that their friends elect to promote about themselves.

Also encouragingly, those children and adolescents who will have known no life without social media, recently were surveyed about their use of technology and reported that they still preferred face-to-face communication. I put limits on myself in terms of use (though I’m sure to some of you it may not seem like it!) since I feel as though I miss a lot in terms of nuance when communication online, but it remains true that both my research and personal communication projects require a fairly consistent social media presence – I admit that I’m torn. As with most everything, balance is key, but how can we monitor our behavior in ways that allow us to strike that balance without teetering into territory that destroys our positive sense of self?

Thoughts? How about you ironically follow me on Twitter to discuss?

1 Comment

Filed under Advertising, Child Development and Child Health, Education, Health Education, Media, Technology

Lung Cancer Drug Resistance Tackled by UCSF

As a former employee of theirs, I love all things UCSF. And again they’ve stepped out ahead of the curve to potentially solve a problem that plagues patients of the most deadly of all cancers – lung cancer. A common lung cancer drug, Tarceva, may initially shrink tumors, but it was inevitable that they would eventually return as patients developed resistance to the drug. Researchers at UCSF recently discovered that a human protein, AXL, may be what drives that resistance for people in treatment – and led them to the logical conclusion that blocking the protein could prevent the resistance to the drug, thereby diminishing the tumors for good.

This is great news for those seeking treatment from this most devastating of diseases. More people die from lung cancer every year than from breast cancer, prostate cancer, and colon cancer combined; about 85% of those diagnosed will die within five years of diagnosis. Part of this is due to the generally late stage that the cancer is in when it is detected – only about 30% of the cases are diagnosed in its earliest stages. This totals around 150,000 people each year, and while most cases can be traced back to cigarette smoke exposure, but this certainly isn’t the only culprit. Asbestos, chemical exposure,and genetic exposure play their own roles and contribute to the 10% of non-smokers with the disease. Young peopleeven those who are fit and healthy – are not immune to the disease, so this breakthrough really does have the potential to make a huge impact in the lives of those affected.

Image courtesy of UCSF

Leave a comment

Filed under Public Health