Health and Fitness

In a move to make it one of the healthiest hospitals in the country, Lucile Packard Children’s Hospital has made some drastic changes to its menu. Greasy cheeseburgers and fries have been replaced with whole-grain breads and pastas and seasonal fruits and vegetables.

Karen Kemby, administrative director of strategy and business development for the hospital, explains the reason behind the healthier fare in a piece on the Packard Children’s website:

“As a children’s hospital, we have the responsibility to model the healthiest environment possible for our patients, their families, and the community. We take that responsibility seriously, and we are leading the way in making children’s hospitals healthier places.”

Packard Children’s was one of the first children’s hospitals in the country to eliminate sugar-sweetened drinks from its menu. (Each 12-ounce serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar.) Kemby adds that Packard Children’s is one of only ten children’s hospital systems among 155 hospitals signing on with the nonpartisan, nonprofit Partnership for a Healthier America, which is working with the private sector and Honorary Chair First Lady Michelle Obama to end the epidemic of childhood obesity in U.S.

Packard Children’s cardiologist Stephen Roth, MD, MPH, adds that having a healthier menu helps the many patients and families who come to the hospital. “We tend to eat more than we need, especially at stressful times. It’s hard for families to be in the hospital when their children are ill, and we should do whatever we can to make our environment healthier for them.”

And just because it’s healthy, doesn’t mean the food isn’t tasty. In fact, the story points out that the hospital’s cafeteria rates an average of four out of five stars on Yelp.

Previously: Kids don’t need “kids’ food”, Want kids to eat their veggies? Researchers suggest labeling foods with snazzy names,New federal nutrition standards mean healthier school lunches and To squeeze or not to squeeze: Using packaged foods to increase a child’s fruit and veggie intake
Photo by healthydieting

Year after year, many of us adopt New Year’s resolutions to slim down, and by the end of January we’re often back at square one. Perhaps it’s time to reconsider a different weight-loss plan: Instead of trying to immediately lose weight, vow to maintain your weight for a period of two months before shedding any pounds.

While this recommendation may sound a bit odd, a past study from Stanford researchers showed that a maintenance-first approach helped individuals shrink their waistlines and keep from regaining the weight. In the following Q&A, lead author Michaela Kiernan, PhD, senior research scientist at the Stanford Prevention Research Center, discusses the method and tips for implementing it to achieve your 2013 weight-loss goals.

In a 1:2:1 podcast, you discuss how an “all or nothing” mentality can negatively impact goals to keep those pounds off. How does the “maintenance-first approach” address this and other psychological challenges associated with shedding pounds?

Often people adopt New Year’s resolutions in an attempt to change their behavior in an intensive focused effort. This approach may work in the short term but it can be hard to sustain that type of focus in the long term. As a result, people give up and revert to their old ways – the “all or nothing” approach. In contrast, maintaining behavior changes over time may need a more subtle “fine-tuning” approach, in which the day-to-day experience is more positive and doesn’t require such intensive effort.

In our trial, we asked one group to learn a set of maintenance skills before losing weight, so that they had a chance to experiment and experience what it was like to “fine-tune” their lifestyle habits. The other group lost weight in the more traditional manner by losing weight first and then trying to maintain it.

How do the skills used to maintaining weight differ from those used in losing weight?

Losing a significant amount of weight can require considerable attention. For instance, keeping daily food records has been found to be a useful strategy for losing weight. However, most people can’t diligently record what they ate or drank multiple times a day for long periods of time, so they quit and regain the weight. Therefore, for weight maintenance, we focused on identifying a set of skills that would make the day-to-day experience positive while not requiring overwhelming amounts of effort. For instance, we encouraged people to learn to maintain their weight without keeping food records and instead to use their bathroom scale to inform them when to fine-tune their eating and physical activity habits with small, quick and easy adjustments they can make on the fly.

For those interested in mastering the skills of maintaining weight before they begin losing weight in the New Year, can you provide an outline of the approach used in the clinical trial?

Here are a few key areas. First, actively search out yummy, healthy foods that you enjoy eating as much as the high-calorie foods you’re replacing. If you don’t, you’ll feel deprived and continue to dwell on the unhealthy high-calorie foods you’re missing – and eventually you’ll go back to eating them. Finding tasty replacements will take proactive efforts to try a lot of new foods. At the same time, be sure to incorporate eating a few of your favorite high-calorie foods into your routine – and then eat them mindfully to savor and enjoy them.

Second, start to “make peace with the scale.” Try weighing yourself daily without the pressure of trying to lose weight. Watch how your body weight fluctuates for a few weeks at your current weight. Many people are pretty surprised that their weight fluctuates from day to day as much as it does. Then, a few weeks in, set a personalized range of about five pounds that accounts for your own body’s fluctuations and a little “give” for vacations and holidays.

Third, use the range to tell you when to make “fine-tuning” changes to your eating and activity habits. For instance, if your weight is fluctuating within a few pounds near the top of your five-lb range, you may want to eat 20 percent less during meals for a few days and get out for extra walks at lunch. Alternatively, if your weight is fluctuating at the bottom of the range, you may want to enjoy another glass of wine or share a favorite dessert with a friend. Develop a”‘quiver” of fine-tuning strategies that work for you.

Finally, navigate those pesky but always occurring disruptions in life that affect weight. For instance, strategically lose a few pounds with your fine-tuning strategies and get to the bottom of your range before going on vacation so you can mindfully indulge in your mother-in-law’s amazing sugar cookies during vacation.

Previously: Learning weight-maintenance skills first helps prevent diet backsliding, Stanford study shows, Can a food-tracking app help promote healthy eating habits?, Examining how friends and family can influence our weight loss and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
Photo by Lisa Creech Bledsoe

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.

Eight months ago, I went gluten-free. People often ask me why and how I manage, especially with all the treats that present themselves during the holidays.

First, I do not have celiac disease. I chose to avoid gluten on the advice of a nutritionist who I consulted because of thyroid issues. I have Hashimoto’s disease, a disorder of the thyroid. I learned that thyroid problems have been linked to gluten. Apparently, the molecular structure of gluten resembles that of the thyroid gland, so ingesting gluten may trigger an immune response that tells the body to attack the thyroid. Or so the theory goes.

So the nutritionist suggested I stop eating products with gluten and see whether my thyroid function improved. I honestly can’t tell if avoiding gluten has had any impact on the thyroid, but I do know it has led to many other positive changes.

For one, my joints began to feel a lot better. Gluten is said to cause inflammation; in my gluten-free travels, I have met people with arthritis who told me their symptoms disappeared after they stopped ingesting gluten, as presumably the inflammation went away. I don’t have arthritis, but I do exercise regularly and used to have to take a day off in between workouts because my joints were sore. Now I don’t experience that — I can go to the gym every day and feel OK.

My digestion also improved. One of the symptoms of low thyroid is digestive problems, especially constipation. On my new gluten-free regimen, this is never a problem. I also noticed that when allergy season came around this year, I didn’t get the sniffles, as I usually do. And, I began to feel a lot more energetic.

How do I manage food-wise? Well, I discovered a whole new world of wonderful gluten-free products. And I check restaurant menus online before I go out to dinner to make sure there is something there I can eat. I bring my favorite gluten-free crackers, nuts and other snacks to parties just in case there’s nothing on the table for me. I have even brought Tamari, a gluten-free soy sauce, to Chinese restaurants, some of which will prepare gluten-free meals for me. I have to admit that the moments that challenge me most are at restaurants that serve delicious breads before the main meal; it’s hard to stare those breads in the face when you’re hungry.

I’ve learned to avoid most desserts. I know I can always go home and eat a piece of chocolate or nibble on my favorite flour-free chocolate cake, which I often keep on hand for such emergencies. And honestly, I stick with this plan in part because it’s a great weight-control method. When presented with a vast array of gluten-filled tempting treats, I just look the other way. I just remind myself how good I feel.

Previously: Using your cell phone to test for food allergens, A discussion on going gluten-free, From frustration to foundation: Embracing a diagnosis of celiac disease and Guest post: Flying the friendly skies while navigating the challenges of eating gluten-free
Photo by Whatsername

Many of us, myself included, turn to yoga, meditation, tai chi or other mind body practices to reduce stress and relieve anxiety. While past studies provide insights into how these approaches can put us at ease, researchers are still working to understand exactly how such psychosocial interventions can lessen the adverse effects stress on our physical and mental health.

Tomorrow, the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health is hosting a Twitter chat on managing holiday stress and what recent research says about the safety and effectiveness of mind body practices for de-stressing. The chat will be held at 12:30 PM Pacific Time. To join participate in the discussion, use the hashtag #nccamchat or follow @NCCAM. Joining the conversation will be NCCAM program officer John Glowa, PhD, who oversees the center’s behavioral health research portfolio, and Daniel Pine, MD, from the  National Institute of Mental Health.

On a related note, the latest Ask Stanford Med Q&A features David Spiegel, MD, director of the Stanford Center for Stress and Health and medical director of the Stanford Center for Integrative Medicine, responding to questions about managing seasonal stress and depression. In the piece, Spiegel discusses the scientific evidence relating to the use of natural remedies, including fish oil and St. John’s wort, in treating holiday stress and depression.

Previously: Ask Stanford Med: David Spiegel answers your questions on holiday stress and depression, Report highlights how integrative medicine is used in the U.S., More hospitals offering complementary medicine and Meditate and call me in the morning: Study looks at doctors’ referrals for mind-body therapies
Photo by Toby Gray

As the holiday season kicks into high gear, we invite you to look back at some of our entries on ways to stay healthy this time of the year.  Last week, nutrition expert Christopher Gardner, PhD, discussed why it’s not a good idea to overindulge - even just for the short-time – during the season. And we’ve previously offered holiday-related tips on:

• eating healthy and keeping your caloric intake in check
• staying fit and active
• coping with stress and depression
• managing headache disorders

We’ve also linked to advice from pediatricians on how to help children eat healthier during the season and to a list of 12 health and safety tips from the Centers for Disease Control and Prevention.

Photo by Dawn – Pink Chick

How often have you heard someone complain of back pain? According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, it’s one of the most common medical problems, with about one-fourth of U.S. adults experiencing at least one day of back pain in a three-month period. In a new BeWell Q&A Jean Couch, author of The Runner’s Yoga Book and producer of the Your Pain Free Life DVD, offers some suggestions on coping and overcoming back pain.

Couch, who is the founder and co-director of the Balance Center in Palo Alto, attributes the prevalence of back pain in industrialized nations to long-term poor usage of our bodies:

We have lost our natural alignment. Most people think it is because we sit so much, but really there are people in other cultures who sit at looms or other workbenches for hours a day without collapsing the way we do. It really isn’t the sitting that is the biggest problem; it’s the way we sit that is killing us. A hundred years ago most people sat up-right; now people sit curved over, and it is this collapse that is ruining the spine. I hear myself saying all the time that this fashion of collapse is a cultural phenomenon, but the suffering is individual.

The rest of the Q&A is worth reading, and it includes one small change people that people can do to save their backs.“You have to sit on the bottom of your butt,” Couch says.

Previously: Relieving Pain in America: A new report from the Institute of Medicine

For better grades and higher test scores, kids might think about hitting the gym along with the books. A new study from Michigan State University, and published in the Journal of Sports Medicine and Physical Fitness, has found that physically fit children do better in the classroom. It’s the first research to show a link between children’s fitness and academic performance.

Researchers led by kinesiologist Dawn Coe, PhD, now at the University of Tennessee, Knoxville, examined 312 middle school students (grades 6-8). They tested the kids’ physical fitness with a program consisting of push-ups, shuttle runs and other exercise and, as described in a release:

Then they compared those scores to students’ letter grades throughout the school year in four core classes and their performance on a standardized test.

The results showed the fittest children got the highest test scores and the best grades, regardless of gender or whether they’d yet gone through puberty.

The findings suggest schools that cut physical education and recess to focus on core subjects may undermine students’ success on the standardized tests that affect school funding and prestige, said co-author James Pivarnik, who advised Coe on the project.

Previously: How physical activity influences health and Do siestas make you smarter?
Photo by Official U.S. Navy Imagery

Here’s a little motivation to not skip your fitness routine today: New research shows that people who regularly exercise, even in modest amounts, live longer regardless of whether they’re overweight.

In the study, researchers examined how leisure-time physical activities in adulthood contributed to increased life expectancy. The analysis included six population-based studies involving 650,000 people age 40 or older. According to a release from the National Institutes of Health:

After accounting for other factors that could affect life expectancy, the researchers found that life expectancy was 3.4 years longer for people who reported they got the recommend level of physical activity. People who reported leisure-time physical activity at twice the recommended level gained 4.2 years of life. In general, more physical activity corresponded to longer life expectancy.

The researchers even saw benefit at low levels of activity. For example, people who said they got half of the recommended amount of physical activity still added 1.8 years to their life.

…

The researchers also examined how life expectancy changed with the combination of both activity and obesity. Obesity was associated with a shorter life expectancy, but physical activity helped to mitigate some of the harm. People who were obese and inactive had a life expectancy that was between five to seven years shorter (depending on their level of obesity) than people who were normal weight and moderately active.

Previously: Examining exercise and cancer survivorship, Exercise may boost heart failure patients’ mental and physical health, Study shows short, daily jogs boost longevity and How physical activity influences health
Photo by Don DeBold

Michaela Kiernan

All of us who have struggled with our waistlines over the years know that sometimes losing weight isn’t the hardest part. Keeping it off is.

But an approach that sounds a bit odd might be the solution: Before you try shedding any pounds, learn the skills that will help you maintain your weight.

In a study published today in the Journal of Consulting and Clinical Psychology, researchers at Stanford’s medical school reported that women who spent eight weeks mastering weight-maintenance skills before embarking on a weight-loss program shed the same number of pounds as women who started a weight-loss program immediately. More importantly, the “maintenance-first” women had regained only 3 pounds on average a year later, compared to the average 7-pound gain for the immediate dieters.

“Those eight weeks were like a practice run. Women could try out different stability skills and work out the kinks without the pressure of worrying about how much weight they had lost,” lead author Michaela Kiernan, PhD, senior research scientist at the Stanford Prevention Research Center, said in our news release about the study.

Among the weight-maintenance skills the women learned were:

• Searching out low-fat or low-calorie foods that taste as good as high-fat/high-calorie options to avoid feelings of deprivation.
• Occasionally eating and savoring small amounts of favorite high-fat/high-calorie foods.
• Weighing daily to see how their body weight naturally fluctuates from day to day.
• Identifying a personalized weight-fluctuation range of about 5 pounds to account for common disruptions, such as water gain and vacations.
• Strategically losing a few pounds before a known disruption (such as a vacation) to minimize its effects.
• Eating a little more when reaching the lower limit of the personalized 5-pound range.

Kiernan said the maintenance-first approach, though sounding a bit unorthodox, could be a useful tool for those who are trying to slim down and be healthier. “This approach helps people learn how to make small, quick adjustments that can help them maintain their weight without requiring a lot of effort,” she said.

You can also listen to this podcast with Kiernan as she explains the study.

Back when I was in college, I drove my mother crazy whenever midterms and finals approached. I’d call her when I got mired in studying and wail, “I don’t know anything! I’m going to fail!”

My parents were glad I was studying hard, but my mom eventually got tired of talking me down out of my pre-exam tree. One spring after my transcript arrived, showing my usual excellent grades, she made me sign a piece of paper that said, “I did fine.” After that, she photocopied it and mailed me a copy every term.

I’m telling this embarrassing story for two reasons: One, in spite of my anxiety about exam preparation, I’ve always liked taking tests. Those quizzes in magazines? I am a total sucker. So, as soon as I learned about the Eat Real Quiz on the Food Day website, I was keen to take it. Two, I discovered by taking the quiz that I STILL WANT AN A, DAGNABBIT.

Food Day is coming on Oct. 24, and the Eat Real Quiz is designed to raise awareness of the value of a healthy diet centered around fruits, vegetables and whole foods. You enter your servings per week for several categories of food; the scores reflect the positive or negative impact of each type of food on your health, the environment and animal welfare.

I eagerly clicked through the questions. I should get a great score, I thought – I have a PhD in nutrition and my mom inculcated healthy eating habits. I answered all the questions and clicked on Grand Total. 73. It was only a B. (Cue the “Wah waaaah” trombone now.)

Scanning back over the scores for each category, I saw an obvious culprit: seven servings per week of refined-grain products such as “white” pasta and rice. That gave me seven negative health points, more than enough to tip me from an A to a B. Could my choice of noodles really be so bad? After all, I also eat at least a serving a day of whole-grain foods, meeting the USDA dietary recommendation to “make half your grains whole” (.pdf).

After a few moments of stewing about the quiz’s validity, I looked at the rest of my score and realized the real problem might be my cheese consumption (five servings per week, eight negative health points, plus a few negative points for the environment and animal welfare). But I love cheese; I’m not giving it up! Or maybe it’s fruit juice – I don’t drink much, but it gets counted with sugary junk and earns negative health points. Or maybe it’s beef; my single serving per week earns me negative points in all categories.

Or maybe it’s… my brain. Maybe I need to chill out and realize that “I did fine,” that my overall diet is indeed pretty healthy, with the good stuff balancing out the not-so-good, and that the point of this quiz is to get people thinking about what they eat. In my case, it worked. Maybe I’ll even cook brown rice a little more often, who knows?

I encourage you to try it, too – and feel free to comment below if you learn anything surprising.

Previously: Americans still falling short of national nutritional guidelines, Can a food-tracking app help promote healthy eating habits? and Goodbye, pyramid: USDA unveils MyPlate
Via Center for Science in the Public Interest
Photo by Tesseract84