Category Archives: nutrition

health market quality, healthy habits, nutrition, policy, rapid learning health systems

Croakey: Impact of big food health washing

 

http://blogs.crikey.com.au/croakey/2014/12/01/as-nutritionists-enable-health-washing-by-coca-cola-a-call-to-end-unhealthy-sponsorship/

As nutritionists enable health-washing by Coca-Cola, a call to end unhealthy sponsorship

MELISSA SWEET | DEC 01, 2014 10:00AM | | PRINT

When Big Food companies engage in health-washing tactics, what are the consequences for the reputations of the health organisations and health professionals involved?

It’s a question the Nutrition Society of Australia and its members might be pondering, after having Coca-Cola as a gold sponsor of their recent annual scientific meeting.

As the World Cancer Congress in Melbourne this week puts the spotlight on the implications of rising obesity rates for cancer, health advocate Todd Harper highlights the contribution of soft drinks to obesity, and argues that health organisations need to look for healthier funding sources.

***

Todd Harper, CEO of Cancer Council Victoria, writes:

No sporting club or health event would accept sponsorship from a tobacco company in Australia today, even if it was allowed.

We know that smoking kills, and so do everything possible to reduce its visibility to ensure younger people aren’t encouraged to take up the habit.

Obesity is also a known risk factor for many cancers, as well as other chronic diseases, yet organisations and events continue to accept sponsorship from the very companies peddling products that contribute to this significant health issue.

Despite this, some organisations focused on health, and particularly healthy kids, see little problem in holding their hands out for money from soft drink companies.

Our recent Cancer in Victoria: Statistics and Trends 2013 report revealed uterine cancer rates are steadily rising; a cancer for which obesity is a principal risk factor. Obesity is also a risk factor for breast, bowel, oesophageal, pancreas, uterine, kidney, gallbladder and thyroid cancers.

In fact, we recently learned from the World Health Organization (WHO) that nearly half a million new cancer cases around the world can be attributed to high Body Mass Index each year – including more than 7000 in Australia. (A new study by the International Agency for Research on Cancer found that nearly half a million new cancer cases per year can be attributed to high body mass index (BMI). The study was published on November 26 in The Lancet Oncology. Using its methodology, more than 7000 new cancer cases in Australia per year can be attributed to high BMI.)

The number of Victorians diagnosed with cancer is projected to double by 2024-2028 to more than 41,000 cases a year, with obesity considered a significant contributor to this. It’s a problem that we can’t ignore.

Many people are aware of the dangers of smoking, and the link between smoking and cancer – which is why we’ve seen such a rapid decline in smoking rates. At the same time we are seeing an equally rapid rise in the number of people who are overweight or obese. We need the same awareness about this as a risk factor if we are to stop more cancers before they start.

Drinking soft drinks contributes to higher kilojoule intake, weight gain and obesity. With one can of Coke containing 10 teaspoons of sugar, each can consumed increases the risk of being overweight.

The WHO recommends the consumption of sugary drinks should be restricted, as do Australia’s recently reviewed dietary guidelines, while the World Cancer Research Fund recommends consumption should be avoided entirely. Leaders in cancer control are meeting in Melbourne this week for the World Cancer Congress, and the challenges related to rising global obesity will be firmly on the agenda.

In the meantime, Coca-Cola continues to sugar-coat its image; fooling the community into believing it is part of the solution to the obesity epidemic.

Rather than being part of the solution like it claims, this multi-billion dollar company is trying to veil the impact of its products by positioning itself as a promoter of physical activity. This is merely a distraction from the fact that it continues to promote its sugary drinks as being part of a healthy diet.

Disturbingly, the company has aligned itself with organisations that encourage healthy active lifestyles, such as the Bicycle Network.

The decision by Bicycle Network to enter into a partnership with Coca-Cola attracted strong criticism from public health experts after a piece in Croakey a year ago, yet the partnership continues. This is especially problematic considering the ‘Happiness’ program is targeting teenagers, a group particularly susceptible to marketing and the highest consumers of these drinks.

Similarly, the Nutrition Society of Australia, the peak scientific nutrition group in the country, has Coca-Cola as a gold sponsor for its Annual Scientific Meeting underway in Tasmania.

This is disappointing on a number of levels, not least of all the fact that one of the themes for the conference is ‘Diet and cancer: what does the evidence show?’

Coca-Cola’s attempts to link itself with these organisations won’t reduce the consumption of sugary beverages and won’t make a gram of difference in reducing overweight and obesity.

Wouldn’t it be better to create alternative sponsorship sources for health-promoting organisations?

As was done with the banning of tobacco sponsorship and the creation of alternative funding sources through VicHealth, it’s time for some similarly creative thinking.

Creative thinking that will kick Coca-Cola out of sponsoring health-promoting activities, and create healthier options for organisations like the Nutrition Society and Bicycle Network.

My fear is that unless we take such action, we run the risk of limiting the impact of important health programs such as the Rethink Sugary Drinkcampaign, encouraging a switch to water and reduced-fat milk; and theLiveLighter campaign, which aims to help people make simple lifestyle choices to improve their overall health and cut their cancer risk.

These programs are vital yet are minnows in the campaign to win the healthy hearts and minds of the public when faced with the corporate might of the highly processed food and drink companies, but with some creative thinking and political will, the scales can be tipped in favour of a healthier way.

• Todd Harper is CEO of Cancer Council Victoria.

data saving lives, EF, health market quality, healthy habits, nutrition, research methodology

Jeffrey Braithwaite on Microlifes and Micromorts

Punchy.

http://www.jeffreybraithwaite.com/new-blog/2014/11/20/youll-be-dying-to-hear-about-this

You’ll be dying to hear about this

There’s lots of death in the world. Transport is risky, for instance—planes, automobiles, trains and ships can crash, maiming or killing passengers. You don’t have to go much further than seeing the road toll, or hearing about Malaysian Airlines Flight MH17 shot down over the Ukraine, or watching the TV scenes of the Costa Concordia, run aground just off Isola del Giglio near the coast of Italy, to appreciate that death is never far away.

Then there’s infectious diseases. You can all-too-readily catch a cold, or the flu, or TB, or lately, the Ebola virus. And there seem to be never-ending wars and skirmishes in the Middle East; and terror, spread by fundamentalists.

Each of these, depending on fate, can hasten someone’s demise. Wrong place, wrong time, wrong circumstances.

Lifestyle issues can cause problems for your risk profile too—but these are slower, and more stealthy. Think of smoking, drinking too much, eating yourself into a coma or just gross obesity, or the more insidious dangers of sitting at a computer for years on end with little exercise. These can translate over time into heart or lung disease, diabetes, and cancer.

Whether you are active or passive, things you do or don’t do can shorten your lifespan, or kill you a little or a lot faster than you would otherwise last. So what levels of risk do you actually, quantitatively, face in your own life?

*****

Stanford University decision scientist Ron Howard in the 1970s presented a novel way to calculate this risk. He introduced the idea of the micromort, defined as a one-in-a-million likelihood of death.  This is such an evocative unit of measurement that it deserves a little further attention.

If you live in the US or another relatively rich, OECD-style country, with good law and order, legislation that keeps society relatively risk free (such as with environmental and public health issues sorted out, effective building codes, and so forth), a well-educated population, access to health care, and a buoyant GDP, you can expect a micromort of one on any particular day. Another way of saying this is that’s the standard expected death rate for any individual today in any one 24 hour period: a microprobability of one in a million is your index of baseline risk.

These are great odds for you, today, as you read this; you are very likely to get through it. Congratulations if you do.

What circumstances lead to an elevated risk? Say if you do dangerous things or even just live life to the full? How does your micromort level get upgraded?

In the United States, you accumulate an extra 16 micromorts each time you ride a motorcycle 100 miles, for instance. Or 0.7 micromorts are added for each day you go skiing; so go for a week and you’ve added five more.

Or you might decide to do something a little more strenuous. With hangliding, the additional risk of dying equates to eight micromorts per flight; or skydiving, nine per freefall.

They are relatively benign compared to moving up to base-jumping. Do so, and you rapidly earn many more risk points: 430 micromorts per jump, in fact.

Marathon running, anyone? That will be seven micromorts to your debit account for each run. Even walking 17 miles adds one micromort, as does a 230 mile car trip, and add another one for every 6,000 mile train trip. But the puzzle is, it’s not always clear how to treat these: the walking introduces an element of risk (you could be out and about and get run over, or be struck by lightning) but it’s also beneficial (it contributes to improved health).

Perhaps even more interesting, there are microprobabilities associated with accumulated chronic risks in contrast to these other single-shot event risks. These are lifestyle choices and behaviors that incrementally add a little more risk through exposure. They won’t kill you if you have bad luck on a given day, but will slowly have an effect—and may claim you in the end.

Every half a liter of wine exposes you to a micromort because it can accrue into cirrhosis of the liver. Each one and a half cigarettes does the same, but the menace here is cancer or heart disease. Even eating 100 char-broiled steaks, 40 tablespoons of peanut butter or 1,000 bananas sneaks up on you in the form, respectively, of cancer risk from benzopyrene, liver cancer risk from aflatoxin B or cancer risk from radioactive potassium-40.

*****

Hang on though. I doubt I’ve done much to help anyone.

Because a clear problem is that people aren’t very good at doing these kinds of statistics, or applying them to their own lives—and are even less capable of acting on them. We can readily appreciate that skiing or motorcycling add some risk for the time you are doing them compared to the everyday activities of being at work or hanging out at home, yet many people are undeterred. People even cheerfully find ways of taking on more risk, such as by climbing Everest, driving fast cars, or having unsafe sex.

Everyone knows about that steadily accumulated risk, too: not too many of us are blind to the fact that drinking too much alcohol can lead to liver disease or smoking to lung cancer over time. And although both have been falling for decades, this hasn’t stopped millions of people indulging. There’s 42.1 million US smokers at last count, or 18.1% of the population, and on average each adult US citizen consumes 8.6 liters of alcohol annually.

This is not the best performance internationally but is by no means high by international standards, and Eastern Europeans smoke more heavily, and really give hard booze like vodka a nudge.  Nevertheless, both activities contribute to what public health people quaintly call excess deaths and the rest of us know by “their drinking or smoking (or both) killed them eventually.”

But what does it actually mean that you expose yourself to increased risk if you go out walking regularly or eat bananas?  We need another way of looking at this, because it’s too hard to do the sums.

*****

Enter the University of Cambridge medical statistician David Spiegelhalter and his colleague Alejandro Leiva who invented the idea of a microlife. This is another unit of risk which has the calculation built in for you. It is half an hour of your life.

If you increase your risk by one micromort, then this shortens your life by half an hour. These calculations apply to people on average, and work out for entire populations, but any one of us might be lucky or unlucky, depending on our individual characteristics. Any particular risk doesn’t convert exactly to the specific individual. But with enough people in the US (beyond 316 million now) and on the planet (7 billion and rising), there’s a relentlessness accuracy about the statistics.

So now let’s do some life expectancy math with Spiegelhalter. Smoke a pack a day? You lose up to five hours a day. Accumulated, that’s up to eight years off your life. Have six drinks a day and that binge costs you one half hour allocation—a shortened life by ten months or so. Stay eleven pounds overweight and you sacrifice half an hour every day you do so (another ten months across your lifespan), as you do if you watch TV for two hours. Your coffee habit at 2-3 cups daily takes away another half hour lot. So does every portion of red meat each day. Another ten months each time.

It’s not all negative. There’s good news. Eat five serves of fruit and vegetables every day and you gain up to a couple of hours each time. You get three years back. Exercise and the first 20 minutes per day earns you a surprising hour (there’s a good investment—a year and a half), and each subsequent 40 minutes adds up to one more half hour bonus to your credit (a bit more work but that seems a pretty good deal, too, to get a ten month return).

If you have a hobby, activity or diet and it’s not been dealt with so far, you can fill in some of the gaps with some good guesstimates. Do you have passive pursuits, akin to watching TV? This is a net deficit. Do you do active, exercise-oriented activities, such as weekly amateur netball, soccer, bowling or basketball—or just walking regularly? Add some lifespan.

These half hour allocations alter somewhat depending on your genetics of course (you can have lucky or unlucky genes) or your socioeconomic status (wealthy people typically live longer than poorer folks) or your gender (women on the whole live longer than men). That said, with this idea you are now able to alter your risk profile by changing your behavior with a tangible, calculable return.

*****

There’s a punchline to this, and it may be already occurring to you as you reflect on your own lifestyle and lifespan. There are a million microlives in fifty seven years of existence. That, for many of us, is roughly the adult allocation.

Let’s call that your life expectancy baseline. We can assume that you have had a reasonably healthy childhood (not so for everyone, of course, but true for many US children, and true for most readers). Then, from that point on, a large part of your healthy adult life is now measureable.

So: come out of your teens, reach your 21st birthday, and as the “jolly good fellow” and “happy birthday to you” songs subside, imagine you then have 57 years to go. That is, you have an allocation of 78 years in total, maybe a little longer, maybe a little shorter.

Yes, all sorts of unexpected things might happen along the way, but to some degree your lifespan is now no longer vague, but quantifiable. The actual life expectancy in the US indeed hovers around this: it’s 79.8 years overall, 77.4 for males and 82.2 for females. (It’s higher in some northern European countries and Japan, but that’s a story for another day).

However, you might be reading this thinking: Yikes. I’m not 21: I’m a bit older than that. In this case, you’ve already used up a proportion of your time left. Console yourself. At least you got through the riskiest stage of all: being a baby, up to one year of age, and childhood, up to six or so, when many things can go wrong.

But have you used what you were given so far, well? Or do you have a fair bit of regret?

To make an obvious point, however, this isn’t Doctor Who. You don’t have a Tardis to go back in time and fix the past. So stop any lamentations. Look forward.

By now, if you’ve come to value more readily each half hour and especially the cumulative effect of your lifestyle choices to date, don’t listen to me preaching. Feel completely empowered. You know what to do and how to alter your own numbers.

Now, all that’s left is to do the math. You’ll have a much clearer picture of your life and potential death than ever before. It’s your move: what’s next?

Further reading

Blastland, Michael and Spiegelhalter, David (2014). The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books.

Howard, Ronald (1984). On fates comparable to death. Management Science 30 (4): 407–422.

Spiegelhalter, David (2012). Using speed of ageing and “microlives” to communicate the effects of lifetime habits and environment. British Medical Journal 345: e8223.

Spiegelhalter, David (2014). The power of the MicroMort. BJOG: An International Journal of Obstetrics & Gynaecology 121 (6): 662–663.

data saving lives, EF, entrepreneurship, healthy habits, nutrition, policy, quantified self, rapid learning health systems

Bloomberg: Omada Health Pitch

  • Digital Therapeutics — “Prevent”
  • Digitally-mediated behavioural change
  • Business Model: Charge on success
  • Enterprise Customers

http://www.bloomberg.com/video/take-face-to-face-medicine-to-digital-omada-health-ceo-luSxUqctQcqbjUMc6Wf41g.html

Transcript:

Thanks for joining us on “bottom line.” tell me what your company does.

What is digital therapeutics?

Digital therapeutics is the idea that medicine in the past was conducted in a face-to-face setting.

On the web and social and mobile on the way we can create digital expenses is allowing us to be done digitally.

We take proven lifestyle and behavioral medicine interventions from face-to-face to digital.

That is what we do.

This could help me — well, i don’t smoke, but if i did, it could help me quit and eat healthier, which i don’t do.

Is that the idea — lose weight, quit smoking?

Matt, we can help you with that, and if you want a free pass to our program, let me know . our program helps people with high risk of type two diabetes lose weight and make lifestyle changes over the course of 16 weeks and it is conducted entirely digitally.

I use my iphone or ipad and this will actually work?

Is that the case?

That is the idea.

It can help people proven at risk for type two.

If you help them in a high-tech fashion, our program is digital, a small group environment, where you are paired with others like you and you see how others are doing and we get android and iphone apps and we have a whole bunch of things to make you successful.

Every time i want a delicious cherry coke at lunch, you suggest something that won’t give me diabetes?

The idea is that that moment you want that delicious cherry coke, you think of your health coach and your groups going on with you and maybe you will get a water instead of something better for you.

Very smart man , mark andreessen, is a big backer of you guys.

What is the future of this company?

What does he see there as far as growth is concerned?

You know, i think the interesting bit is what is happening from the company landscape is that you get folks like me with tech and health care backgrounds will bring companies.

I studied neuroscience and i worked at google for a well and went to harvard medical school.

My passion has always been tech plus health care.

I think andreessen horowitz saw a consumer grade, rich product and experience, but to an enterprise customer set with a unique business well behind it that got them excited and that is what led them to pull the trigger on the deal.

$23 million?

What’s next?

Next for us is working with customers.

We have an innovative business model and that we only charge our employer and health plan customers if we are successful with members . because of that model, we have had a lot of demand coming in and it is just scale, scale, scale.

You sold me with harvard med school and you are a neuroscientist with an nba paper you have competition out there — but you’d have competition out there.

What are the barriers?

We do have competition.

The biggest barrier is for entrepreneurs and companies like myself is figuring out health care.

It is incredibly complex.

But so far, so good.

We want competition.

This is a space where there is a lot of people at me.

One third of the adult population has prediabetes, the latest stats from the cdc.

Let’s have a lot of people take a bite.

I wonder about results.

How can you prove that your programs give people the results they want in order to pay money up front and center for your courses — sign up for your courses?

The first is in the world of behavioral medicine.

There are a lot of published studies that show you what you need to achieve from the results standpoint, and then because of the element in our program like the digital scale, the cell phone chip, we can determine if people are successful and show the results in a very transparent and authentic way to our enterprise partners.

Diabetes is obviously a huge and growing problem.

I am certainly at risk for it.

But the weight loss thing is where i guess you will make the big money.

Type 2 diabetes is correlated to being overweight but it is not the only thing good genetics comes into play as well.

As a country, if we are to avoid the stats the cdc put out, 40% of adults of finding out at some point in their life that they are thank you, there needs to be weight loss and lifestyle intervention programs.

I’m just saying that if your marketing materials show that i lost 10 pounds in weeks with this outcome everyone will sign up.

It’s fascinating, what happens when we work with a self-interested employer is that employees who go through a program and become successful rave about it and tell their colleagues and they get colleagues to sign up.

Thanks very much.

complex adaptive systems, data saving lives, EF, healthy habits, meaning, nutrition, policy, politics, rapid learning health systems

McKinsey’s Plan to fight obesity…

http://www.mckinsey.com/Insights/Economic_Studies/How_the_world_could_better_fight_obesity

Executive Summary: Innovation vs Obesity_McKinsey

MGI Obesity_Full report_November 2014

Sensible stuff. Possibly the most sensible stuff I’ve seen on this. Good for them…

How the world could better fight obesity

November 2014 | byRichard Dobbs, Corinne Sawers, Fraser Thompson, James Manyika, Jonathan Woetzel, Peter Child, Sorcha McKenna, and Angela Spatharou

Obesity is a critical global issue that requires a comprehensive, international intervention strategy. More than 2.1 billion people—nearly 30 percent of the global population—are overweight or obese.1 That’s almost two and a half times the number of adults and children who are undernourished. Obesity is responsible for about 5 percent of all deaths a year worldwide, and its global economic impact amounts to roughly $2 trillion annually, or 2.8 percent of global GDP—nearly equivalent to the global impact of smoking or of armed violence, war, and terrorism.

Podcast

Implementing an Obesity Abatement Program

MGI’s Richard Dobbs and Corinne Sawers discuss how a holistic strategy, using a number of interventions, could reverse rising rates of obesity around the world.

And the problem—which is preventable—is rapidly getting worse. If the prevalence of obesity continues on its current trajectory, almost half of the world’s adult population will be overweight or obese by 2030.

Much of the global debate on this issue has become polarized and sometimes deeply antagonistic. Obesity is a complex, systemic issue with no single or simple solution. The global discord surrounding how to move forward underscores the need for integrated assessments of potential solutions. Lack of progress on these fronts is obstructing efforts to address rising rates of obesity.

A new McKinsey Global Institute (MGI) discussion paper,Overcoming obesity: An initial economic analysis, seeks to overcome these hurdles by offering an independent view on the components of a potential strategy. MGI has studied 74 interventions (in 18 areas) that are being discussed or piloted somewhere around the world to address obesity, including subsidized school meals for all, calorie and nutrition labeling, restrictions on advertising high-calorie food and drinks, and public-health campaigns. We found sufficient data on 44 of these interventions, in 16 areas.

Although the research offers an initial economic analysis of obesity, our analysis is by no means complete. Rather, we see our work on a potential program to address obesity as the equivalent of the maps used by 16th-century navigators. Some islands were missing and some continents misshapen in these maps, but they were still helpful to the sailors of that era. We are sure that we have missed some interventions and over- or underestimated the impact of others. But we hope that our work will be a useful guide and a starting point for efforts in the years to come, as we and others develop this analysis and gradually compile a more comprehensive evidence base on this topic.

We have focused on understanding what it takes to address obesity by changing the energy balance of individuals through adjustments in eating habits or physical activity. However, some important questions we have not yet addressed require considerable further research. These questions include the role of different nutrients in affecting satiety hormones and metabolism, as well as the relationship between the gut microbiome and obesity. As more clarity develops in these research areas, we look forward to the emergence of important insights about which interventions are likely to work and how to integrate them into an antiobesity drive.

The main findings of this discussion paper include:

  • Existing evidence indicates that no single intervention is likely to have a significant overall impact. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to reverse the health burden. Almost all the identified interventions (exhibit) are cost effective for society—savings on healthcare costs and higher productivity could outweigh the direct investment required by the intervention when assessed over the full lifetime of the target population. In the United Kingdom, for instance, such a program could reverse rising obesity, saving the National Health Service about $1.2 billion a year.
  • Education and personal responsibility are critical elements of any program aiming to reduce obesity, but they are not sufficient on their own. Other required interventions rely less on conscious choices by individuals and more on changes to the environment and societal norms. They include reducing default portion sizes, changing marketing practices, and restructuring urban and education environments to facilitate physical activities.
  • No individual sector in society can address obesity on its own—not governments, retailers, consumer-goods companies, restaurants, employers, media organizations, educators, healthcare providers, or individuals. Capturing the full potential impact requires engagement from as many sectors as possible. Successful precedents suggest that a combination of top-down corporate and government interventions, together with bottom-up community-led ones, will be required to change public-health outcomes. Moreover, some kind of coordination will probably be required to capture potentially high-impact industry interventions, since any first mover faces market-share risks.
  • Implementing an obesity-abatement program on the required scale will not be easy. We see four imperatives: (1) as many interventions as possible should be deployed at scale and delivered effectively by the full range of sectors in society; (2) understanding how to align incentives and build cooperation will be critical to success; (3) there should not be an undue focus on prioritizing interventions, as this can hamper constructive action; and (4) while investment in research should continue, society should also engage in trial and error, particularly where risks are low.

Exhibit

Cost-effective interventions to reduce obesity in the United Kingdom include controlling portion sizes and reducing the availability of high-calorie foods.

The evidence base on the clinical and behavioral interventions to reduce obesity is far from complete, and ongoing investment in research is an imperative. However, in many cases this requirement is proving a barrier to action. It need not be so. Rather than wait for perfect proof of what works, we should experiment with solutions, especially in the many areas where interventions are low risk. We have enough knowledge to do more.

About the authors

Richard Dobbs, James Manyika, and Jonathan Woetzel are directors of the McKinsey Global Institute, where Corinne Sawers is a fellow and Fraser Thompson is a senior fellow; Peter Child is a director in McKinsey’s London office; Sorcha McKenna is a principal in the Dublin office; and Angela Spatharou is a principal in the Mexico City office.

 

MGI_Implementing_an_Obesity_Abatement_Program_Exibit18 MGI_Implementing_an_Obesity_Abatement_Program_Exibit3 MGI_Implementing_an_Obesity_Abatement_Program_ExibitE3 MGI_Implementing_an_Obesity_Abatement_Program_Exibit1

cool, healthy habits, nutrition, policy, rapid learning health systems

Advertising tells you how affluent your suburb is…

 

http://www.news.com.au/finance/work/how-suburban-commuters-are-coaxed-into-unhealthy-eating-habits/story-fnkgbb6w-1227089160388

How suburban commuters are coaxed into unhealthy eating habits

  • 3 DAYS AGO OCTOBER 13, 2014 5:33PM
If you’re surrounded by ice coffee ads, you’re probably in a poorer suburb. Real coffee o

If you’re surrounded by ice coffee ads, you’re probably in a poorer suburb. Real coffee on the other hand … well, you could be well off. Source: News Corp Australia

EVER wondered whether your suburb is well-off or disadvantaged? There’s a simple test you can use to find the answer as you head home from work this evening.

Just check out the food advertisements around your train station or bus stop.

If the ads encourage you to drink diet soft drink, tea or coffee, you reside in an area considered pretty plush.

But if a lot of ads push fast food restaurants, flavoured milk and fruit juice, there is a fair chance you can mark your suburb as “disadvantaged”.

These are the findings from research by Philippa J. Settle, Adrian J. Cameron and Lukar E. Thornton of Deakin University.

Their investigation of ads aimed at commuters in 20 Melbourne suburbs is published in the October issue of the Australian and New Zealand Journal of Public Health.

“This exploration of outdoor food advertising at Melbourne transit stops found 30 per cent displayed food advertisements, with those in more disadvantaged suburbs more frequently promoting chain-brand fast food and less frequently promoting diet varieties of soft drinks,” concluded the researchers.

“These findings may help raise awareness of unhealthy environmental exposures.”

The study reinforces the proposition there is a distinct difference in food eaten in various social-economic communities. And the lower the income, the higher the likelihood that unhealthy fast food will be promoted.

Kooyong station volunteer gardeners John Dale and Charlie Baxter were disappointed when n

Kooyong station volunteer gardeners John Dale and Charlie Baxter were disappointed when new billboards were installed at Kooyong Station in Melbourne. Source: News Limited

The researchers contend advertising influences the type of food we eat and that overseas studies have found that unhealthy foods are most likely to appear in these advertisements.

“This being the case, advertising is likely to have played a role in the current obesity epidemic,” write the researchers in their paper.

“Furthermore, targeted advertising of unhealthy foods may entrench and even increase existing socio-economic inequalities in the prevalence of obesity.”

So some advertising doesn’t just make you fat, it can keep you overweight.

Previous studies found ads at Sydney rail stations commonly advertised unhealthy snacks — although water was the most common beverage — while a Perth study found 23 per cent of commuter stops audited had ads for alcohol.

The Melbourne study is the first to cover all types of commuter public transport and to make socio-economic conclusions.

A total of 233 food advertisements were identified at the 558 public transit stops audited across the 20 sampled suburbs, the study reports.

If you’re seeing ads such as this at your local bus stop, you probably live in an affluen

If you’re seeing ads such as this at your local bus stop, you probably live in an affluent area. Picture: AP/PepsiCoSource: AP

Least-disadvantaged suburbs had a higher mean number of advertisements per suburb compared to the most-disadvantaged suburbs, although this difference was not statistically significant.

And it’s not just a matter of where you live which decides the exposure to food ads. It also depends on how you commute.

“… however, differences were observed by the type of stop. A higher proportion of train stations in the least-disadvantaged suburbs had at least one advertisement present (86 per cent v 42 per cent). Conversely, fewer tram shelters in the least-disadvantaged areas featured food (32 per cent v 50 per cent),” says the research.

“The proportion of bus stop shelters with food advertisements was similar in the least- and most-disadvantaged suburbs (22 per cent and 25 per cent).”

data saving lives, facts & data points, healthy habits, nutrition, policy

The Key to Changing Individual Health Behaviors: Change the Environments That Give Rise to Them

 

http://harvardpublichealthreview.org/the-key-to-changing-individual-health-behaviors-change-the-environments-that-give-rise-to-them/

The Key to Changing Individual Health Behaviors: Change the Environments That Give Rise to Them

PDF: HPHRv2-Stulberg

Over the past four decades, the United States has faced steadily rising rates of obesity and associated chronic conditions. Many of these chronic conditions are rooted in nutrition and physical activity behaviors, and are often referred to as lifestyle diseases. Historically, the prevention of lifestyle diseases has focused on changes in individual behavior and personal choices, and personal responsibilities. However, a growing body of research has demonstrated the strong influence of physical and social surroundings on individuals’ actions. The context in which options are presented can shape the decision-making processes that impact health. Altogether, the research suggests that altering environments may be an effective driver of behavior change. 1Intentionally designing environments to promote healthy behaviors holds promise to reverse the increase of lifestyle diseases.

The emerging field of behavioral science – which gathers insights from disciplines like behavioral economics, cognitive psychology, and social psychology – illustrates that while individuals retain “free choice,” their environment significantly influences the choices they make, and in some instances, may lead them to act in ways that are counter to their true preferences. 2 A few examples:

  • Individual preferences are often inconsistent over time, especially in situations where immediate pleasures carry long term consequences. In a study that asked [hypothetically] if people would prefer fruit or chocolate as a future snack, 74% chose fruit. But, when those same participants were presented with both fruit and chocolate in real-time, 70% selected chocolate. 3
  • A person’s actions can be dramatically influenced by related contextual features. For instance, research shows that kitchenware size significantly influences serving and eating behavior. In a series of studies, individuals who were given larger bowls served themselves between 28-32% more cereal than those given smaller bowls. Studies also report that people tend to eat 90-97% of what is on their plate, irrespective of plate size. 4
  • People tend to consent to the “default option.” This has been observed in numerous situations ranging from deciding whether or not to become an organ donor to making saving allocations for retirement. For example, organ donation rates are 4% in Denmark and 12% in Germany where the default option is “opt-in.” In contrast, the rates are 86% in Sweden and nearly 100% in Austria where the default option is “opt-out.” Cultural differences cannot explain the discrepancy. 5

When these behavioral science insights are applied in the context of health, the growth of lifestyle diseases is not surprising. This expanding body of research sheds light on the difficulties of healthy living when society is dominated by the marketing of unhealthy foods and unduly large portion sizes, and where sedentary behavior is often the default option.

The good news is that the same forces that currently promote unhealthy behaviors can be used to encourage healthy ones. In their bestselling book Nudge, Richard Thaler and Cass Sunstein described “choice architecture,” or the proactive designing of environments that “nudge” people to make healthier selections while still retaining freedom of choice. 6 There are many opportunities to apply this concept to promoting healthy behaviors. In particular, given their resources, broad reach, and financial and social incentives, both governments and employers are in a unique position to promote healthy behaviors in a way that would affect many lives.

Government food programs such as the Supplemental Nutrition Assistance Program (“SNAP”) and the school lunch program could be designed to make healthy selections more accessible, and in some cases, the default options. Those that oppose the trend toward encouraging healthier foods often cite added costs and waste, arguing that children don’t like healthy foods and will throw them away uneaten. But the data tell a different story. A recent study in Childhood Obesity found that a vast majority of middle-school and high-school students like the updated and significantly healthier school lunch that was introduced in 2012. 7

Nonetheless, making the change is not cost-free. A recent meta-analysis found that the healthiest diets cost $1.50 more per-person, per-day, which amounts to $550 per-person, per-year. 8 While this amount is not insignificant, it pales in comparison to the cost of treating most diet-related chronic conditions. Designing government food programs around the “healthiest diets” may yield a positive return on investment.

Even so, many individuals – including those who do qualify for SNAP, as well as those who do not qualify for SNAP (i.e. incomes just about the SNAP cut-off) – may still struggle with affordability and availability of healthy foods. Perhaps the most sustainable and far-reaching approach to making healthy foods more accessible is to change food policies (e.g., subsidies) that currently favor the production and systematic delivery of unhealthy foods to favor healthy ones. This would likely lead to higher volumes, more efficient delivery, and lower costs for nutritious foods.

The government can also promote healthier eating by improving nutrition labeling. While the FDA’s recent proposal to ensure that serving sizes listed on food products reflect actual average consumption (e.g., nutrition specifications would reflect an entire muffin, not one-third of a muffin) is a small step in the right direction, there is potential to go a lot further. Research suggests that catchier and simplified nutrition labels could have a much greater impact on consumer behavior. 9 For example, NuVal, an independently designed system that gives food items a single overall score based on more than 30 nutrient and nutrition factors, could be considered for more widespread adoption. 10 Not only does NuVal make for easier interpretation of a product’s nutrition profile, it also enables comparison shopping between options and encourages people to “trade-up” to healthier options. 11 An additional model to consider is a traffic-light rating system that marks foods with either a green, yellow, or red light. In instances where it has already been implemented (in some private organizations and outside the United States), the traffic-light model has increased consumer awareness of health and leads to healthier purchases. 12

In addition to promoting a healthy diet, government should play an active role in encouraging physical activity through the education system (e.g., ensure the existence of meaningful recess and gym programs), transportation system (e.g., create options for safe pedestrian/bike commuting), and by supporting relevant community resources (e.g., building, maintaining, and ensuring the safety of outdoor parks and recreation centers). When options for physical activity are easily accessible, people tend to be more active. For example, a recent study published in the American Journal of Public Health illustrated that the establishment of traffic-free cycling and walking routes increased overall physical activity among those that lived nearby. 13

Employers may have the ability and incentives to move faster than government in designing health promoting environments. A healthier workforce results in both reduced health care costs and absenteeism, and in increased productivity. Recent data from the Society of Human Resource Management’s annual Employee Benefits Survey shows that employers are taking notice and increasing their investment in workforce wellness programs. While these programs have traditionally focused on offering employees classes, counseling, and incentives for healthy behaviors such as discounts on insurance premiums, subtler tweaks to the workplace itself could prove just as, if not more effective.

An example of these subtler changes is happening at Google. There, company leaders have invested in promoting employee nutrition and health. Instead of relying solely on traditional programs such as nutrition counseling and weight-loss classes, Google redesigned cafeterias to encourage healthier eating. Now, the most nutritious options are positioned at the front of the cafeteria and unhealthy foods are hidden in corners and placed in opaque bowls. Smaller plates are the norm and marked with reminder messages that “bigger dishes prompt people to eat more.” Foods are tagged with either red “warning” stickers, or green stickers signifying healthy foods. Beverage coolers stock water at eye level, and relegate sweetened beverages to the bottom where they are not as easily seen or accessed. These changes – which notably do not restrict options, but simply rearrange the way options are presented – have led to dramatic reductions in candy and sugar-sweetened beverage consumption, and increases in the use of smaller plates. 14 15

To encourage physical activity, employers can adopt similar approaches to workplace design, such as centrally located staircases and ergonomically fit workstations. Further, similar to current LEED certifications for environmentally-friendly buildings, there could also be a meaningful certification for health-promoting buildings. In addition to the design of physical workplaces, the way that work itself is conducted can also be designed to promote health. For example, some employers have made “walking meetings” a cultural norm to build physical activity into otherwise sedentary jobs. 16

 

Other Considerations

While the value of these environmental interventions is promising, there is a need for additional research that focuses on cost effectiveness. This is especially true if we hope to see increased governmental action, where broad policy implementation almost always follows a positive cost/benefit analysis. That said, some of the ideas – such as using smaller plates in government cafeterias or simplifying nutrition labels – come at relatively little additional financial cost, and have already demonstrated health-promoting benefits. These ideas could be fast-tracked for more widespread adoption.

Another potential barrier that must be overcome is the political power of special interests groups that rely on built-environments conducive to unhealthy behaviors. For example, a large part of the reason that the migration to healthier school lunches has taken so long is because various food interests have launched strong lobbying campaigns against such changes. 17 In order to transition entrenched unhealthy built-environments to healthier ones, policymakers will need to prioritize the demands of public health against the backdrop of influential and longstanding special interests

A broader approach to designing environments that promote healthy behaviors must also account for additional barriers that individuals with lower socioeconomic status commonly face. The government cannot rely solely on the private sector to drive these changes since those who stand to benefit most may be unemployed or not working for progressive employers with the resources to launch effective health campaigns. Thus, focusing on government food programs and community-based approaches that effect a lower-income demographic is critical (e.g., sidewalk coverage and safe streets, eliminating food deserts, maintaining outdoor parks). In addition to these more specific interventions, the clear connection between environment and health should only bolster the case for expanding social service programs more broadly. Realizing and addressing the fact that so many of the outcomes that lie inside of health care are rooted in factors that lie outside of health care is thus critical to improving health.

 

If we want to avert a public health crisis at the hands of chronic lifestyle-driven diseases, we need not only focus on changing individual behaviors, but also on changing the environments that give rise to those behaviors. Governments and employers must recognize the overwhelming influence of context on action, and take advantage of their unique position to intentionally shape environments that promote healthy behaviors.
  1. Kahneman, D. Thinking fast and slow. New York: Farrar, Straus, and Giroux. (2011). ↩
  2. For more on Behavioral Science, see the Behavioral Science and Policy Association and its forthcoming journal Behavioral Science and Policy. ↩
  3. Read, D., & Van Leeuwen, B. Predicting hunger: the effects of appetite and delay on choice. Organizational Behavior and Human Decision Processes. 1998; 76 (2), 189-205. ↩
  4. Van Ittersum, K., & Wansink, B. Plate size and color suggestibility: the delboeuf illusion’s bias on serving and eating behavior. Journal of Consumer Research. 2012; 39 (2), 215-228. ↩
  5. Johnson, E. J., & Goldstein, D. Do defaults save lives? Science. 2003; 302, 1338-1339. ↩
  6. Thaler, R. H., & Sunstein, C. R. Nudge: Improving decisions about health, wealth, and happiness. New York: Penguin Books. (2009). ↩
  7. Turner, L., & Chaloukpa, F. J. Perceived reactions of elementary school students to changes in school lunches after implementation of the United States Department of Agriculture’s new meals standards: minimal backlash, but rural and socioeconomic disparities exist. Childhood Obesity. 2014; 10 (4), 349-356. ↩
  8. Rao, M., Afshin, A., Singh, G., & Mozaffarian D. Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open. 2013; 3 (12). doi:10.1136/bmjopen-2013-004277. ↩
  9. Roberto, C. A., & Khandpur, N. Improving the design of nutrition labels to promote healthier food choices and reasonable portion sizes. International Journal of Obesity. 2014; 38, 525-533. ↩
  10. Nuval.com. Accessed August 12, 2014. ↩
  11. Nuval.com: Trading Up Tips. Accessed August 28, 2014. ↩
  12. Sonnenberg, L., Gelsomin, E., Levy, E. D., Riis, D., Barraclough, S., & Thorndike, A., N. A traffic light food labeling intervention increases consumer awareness of health and healthy choices at the point-of-purchase. Preventative Medicine. 2013; 57 (4), 253-257. ↩
  13. Freeland, A. L., Banerjee, S. N., Dannenberg, A., L & Wendel, A. M. Walking associated with public transit: moving toward increased physical activity in the United States. American Journal of Public Health. 2013; 103 (3), 536-542. ↩
  14. Kuang, C. 6 ways Google hacks its cafeterias so Googlers eat healthier. Fast Company. April 2012; (164). ↩
  15. Wacther, Luke. Personal Interview on July 20, 2014. ↩
  16. Walking meetings could make work healthier, happier. CBS News. 07, May 2014. ↩
  17. Nixon, R. Nutrition Group Lobbies Against Healthier School Meals it Sought, Citing Cost. New York Times. 01, July 2014. ↩
cool, healthy habits, nutrition, policy, rapid learning health systems

MIT launches wellness advancing technology program…

Potentially very interesting work…

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2014/09/media-lab-to-launch-wellness-initiative-with–1-million-grant-fr.html

Media Lab to Launch Wellness Initiative with $1 Million Grant from the Robert Wood Johnson Foundation

New program, Advancing Wellness, combines academics with on-the-ground initiatives to prompt cultural shifts toward better health.

Princeton, N.J.—The MIT Media Lab this week launched a wellness initiative designed to spark innovation in the area of health and wellbeing, and to promote healthier workplace and lifestyle behaviors.

With support from the Robert Wood Johnson Foundation (RWJF), which is providing a $1 million, one-year grant, the new initiative will address the role of technology in shaping our health, and explore new approaches and solutions to wellbeing. The program is built around education and student mentoring; prototyping tools and technologies that support physical, mental, social, and emotional wellbeing; and community initiatives that will originate at the Lab, but be designed to scale.

The program begins with the fall course Tools for Wellbeing, followed by Health Change Lab in the spring. In addition to concept and technology development, these courses will feature seminars by noted experts who will address a wide range of topics related to wellness. These talks will be open to the public, and made available online. Speakers include such experts as Walter Willett, noted nutrition and clinical medicine researcher; Chuck Czeisler, physician and sleep expert; Ben Sawyer, game developer for health applications; Matthew Nock, expert in suicide prevention; Dinesh John, researcher on health sciences and workplace activity; Lisa Mosconi, neuroscientist studying the prevention of Alzheimer’s; and Martin Seligman, one of the founders of the field of positive psychology. More information about the courses, speakers, and presentation topics and dates can be found here.

The RWJF grant will also support five graduate-level Research Fellows from the Program in Media Arts and Sciences, who will be part of a year-long training program. The funding will enable each Fellow to design, build and deploy novel tools to promote wellbeing and health behavior change at the Lab in a living lab environment, and then at scale.

One of the significant ways that this program will impact Media Lab culture is in the review of all thesis proposals submitted by students in the Media Arts and Sciences program. The Media Lab faculty recently added a new requirement that all thesis proposals consider the impact of the proposed thesis work on human wellbeing.

Other Lab-wide aspects of the initiative include:

  • A monthly health challenge that would engage the entire Lab, with review and analysis of each month’s deployment to help inform the next month’s initiative
  • A buddy system to pair students at the Lab with one another—to build an awareness of wellbeing as a social function, and not just a personal one, and to draw on people’s inclination to solve the problems of others differently than we would solve our own.
  • The Media Lab will host a special event on October 23, 2014, when the creators of the X-Prize convene at MIT, presenting on a new X-Prize for Wellbeing.

“Wellbeing is a very hard problem that has yet to be solved by psychologists, psychiatrists, neuroscientists, biologists or other experts in the scientific community,” said Rosalind Picard, professor of Media Arts and Sciences and one of the three principal investigators on the initiative. “It’s time to bring MIT ingenuity to the challenge.”

“RWJF is working to build a culture of health in the U.S., where all people have opportunities to make healthy choices and lead healthy lifestyles. Technology has long shaped the patterns of everyday life and it is these patterns—of how we work, eat, sleep, socialize, recreate and get from place to place—that largely determine our health,” said Stephen Downs, chief techonology and information officer at RWJF. “We’re excited to see the Media Lab turn its creative talents and its significant influence to the challenge of developing technologies that will make these patterns of everyday life more healthy.”

The three principal investigators on the Advancing Wellness initiative are: Rosalind Picard, professor of Media Arts and Sciences; Pattie Maes, the Alex W. Dreyfoos Professor of Media Arts and Sciences; and Kevin Slavin, assistant professor.  PhD candidate Karthik Dinakar, Reid Hoffman Fellow at the Media Lab, will co-teach the two courses with the three principal investigators.  Susan Silbey, Leon and Anne Goldberg Professor of Humanities, Sociology and Anthropology, will also create independent assessments through the year on the impact of this project.

ABOUT THE ROBERT WOOD JOHNSON FOUNDATION

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national Culture of Health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

healthy habits, nutrition

On preventing dementia…

 

Jane Tolman. I don’t want to get Dementia.

Jane Tolman. I don’t want to get Dementia.

Posted on 09/15/2014 by John Menadue

Dementia is what many of us fear most, and the effective risk is largely related to age.   The statistics say that at 65 years of age, only 2% have dementia.  But this figure doubles with the passage of each five year period.  By 90, the risk of having dementia is about one in four.  Because of the “survivor effect” (those with the fewest risks will live to old age), the subsequent risk no longer increases at this rate.

There is no guarantee that dementia can be avoided, whatever we do.  But what does the evidence say about what strategies can reduce the risk? Genes account for only a small percentage of those with dementia, especially among the elderly.

There is now evidence that the risk can be reduced, and that this will lead to fewer people with dementia.  In fact, we think that if the onset of dementia could be delayed by five years, then the numbers would be halved (Dementia Risk Reduction, prepared for Alzheimer’s Australia, 2007).

Despite much controversy in recent years about the exact cause of Alzheimer’s disease- the most common form of dementia in the western world- it turns out that the factors which protect against heart disease also protect against dementia. The UK Blackfriars consensus produced this year suggested that within two decades up to 20% of predicted new cases of dementia could be prevented with lifestyle alterations designed to reduce blood pressure, obesity, cholesterol and diabetes.

So what can we do to minimise the risk of developing dementia?

The brain is arguably the most important organ and should be treated with respect at all times. “Getting knocked out” sounds bad, and it is. We are now aware that episodes of concussion are bad for the brain and there are reports that head injuries contribute to dementia.  Protect your brain, and not just from toxic substances.

It’s never too early to start with life style changes. Both physical and mental activity are critical, and the earlier they start, the better. Regular is good- say 30 minutes every day of sustained physical exercise.  Patterns established in youth are harder to break in old age.  When it comes to mental exercise, repetition of familiar tasks is not particularly useful (such as Sudoku or crosswords); there must be real stimulation and challenging to the brain. Learning a language or taking a university course in a new field is what’s needed.

Connectivity is the new buzz word for dementia.  This relates to the structure of the brain (how nerves connect with each other) and the disruption of neuronal connectivity is emerging as a key component in the impairment of brain function. But it also relates to social connections. People don’t thrive in isolation and neither do brains. As we age, we lose social connections (people die) so it’s necessary to have a large social network when we are younger. Being with people- having relationships, joining groups, developing interests which involve human contact- these will all improve brain function and help to reduce the dementia risk.  Ideally, you should have friends who are younger than you are, but at least a mixture of ages.

Nurturing the senses is about maximising the inputs to the brain.  Good vision and hearing are among the important predictive factors for a good memory in old age.  Fifty percent of older people have an incorrect prescription for their spectacles, and while most very elderly people have some deafness, hearing aids are often not worn. Now is the time- however young or old you are- to have a check and correct any sensory deficits as soon as possible.

What should you eat? Moderation and balance will usually do the trick.    Having a healthy weight before old age is critical: in older age weight loss means losing muscle, and this is a sure way of triggering falls, impairing the circulation and immune function. For most older people, care needs to be taken to maintain weight, and to have protein at the centre of every meal.  Salt is bad for the brain as it contributes to hypertension which itself causes damage.  Fats are essential, but are best in balance; avoid saturated fats as these may double the risk of dementia.  Fruits and vegetables are associated with longevity, but also promote good bowel function.  Constipation in old age is the enemy of health, happiness and functioning well, each of which helps us to live the dementia journey better. Broccoli and cauliflower also contain Vitamin E which is thought to be protective against dementia. If you need more guidance, the Mediterranean diet has recognised benefits.

Alcohol in moderation may be protective, but with excessive amounts (regular consumption in excess of two drinks a day or four in a single session) come increased risks for hypertension, cardiovascular disease and dementia.  Binge drinking may increase the risk of dementia three fold after 65.

Smoking is a serious risk for a range of illnesses, and if you survive cancers, chronic lung diseases (especially emphysema) and vascular disease (heart attacks and strokes) then dementia is also more likely in your old age.

Regular blood pressure checks and careful control are essential, as hypertension is the enemy of brain health. Avoiding diabetes, similarly dangerous for brains, means a healthy diet, weight control and regular screens.  See your doctor if there are any new symptoms, especially lethargy, blurred vision, increased hunger, unexplained weight loss or increased thirst.  If you have diabetes, keep the sugars under control.

Your psyche should be as important to you as your physical health. The responsibility for your state of mind rests with you, and while stress might not be avoidable, how you deal with it is up to you.  If you need help, get it.  Whether you get dementia is not up to you.  But there are ways to reduce the risk, and to make the journey less traumatic if you are unlucky.  What is up to you, is what you know (keep up to date) and your attitude to your health (be positive).  Reducing your risks for dementia is a lifelong undertaking and will make you a happier and healthier person.

 

Jane Tolman is Director of Aged Care, Royal Hobart Hospital.