School has started (or will be soon) so it's time to think about what your child will be eating during the day. Given that school-aged children spend at least 6 hours at school every school day and obtain up to 47% of their calories from meals and snacks consumed at school, parental involvement is important. So will it be school lunch or a sack lunch?

Despite what you've heard in the media (e.g., Jamie Oliver's Food Revolution) public school meals provided by the National School Lunch Program (NSLP) can be very healthy - especially if your child's school district is progressive and has received recognition awards from programs like the HealthierUS School Challenge and Alliance for a Healthier Generation Healthy Schools Program. All NSLP meals have to meet certain nutrient standards set by the US Department of Agriculture (USDA) and state standards like those set by the Texas Department of Agriculture, but research does show that on average school meals are too high in fat and sodium and too low in fiber. Standards are getting more stringent, however, and while far from finalized, the Senate did pass last week the Healthy, Hunger-Free Kids Act of 2010 which would change many of the foods served in schools if passed by the House. The bottom line is that you should look at your child's school menus and discuss healthy choices with your children. Last week I received a sneak peak at the 2010-2011 Dallas Independent School District school menus and was quite impressed. Brown rice is replacing white rice and whole grain breads are offered daily. Fresh ingredients are replacing many processed products and hamburgers and fries are limited to once every two weeks in elementary and middle schools. On the menu I saw Black Bean Burgers, Veggie Salads with Whole Grain Flatbread, and Fruit and Yogurt Parfaits. What an improvement over previous years' menus!

If, on the other hand, your child prefers to brown-bag-it, review last year's blog, Better Brown Bag Ideas for Kids Headed Back to School. Think "color" and "food groups". Does your child's lunch contain reds, oranges, greens, yellows, blues/purples, and dark browns? And no, the flashy packaging doesn't count! Is there something from each of the food groups: grains, vegetables, fruits, milk, meat and beans? For more ideas of foods from each food group visit MyPyramid.gov.

Share your brown-bag tips or stories how you have helped make the foods served by your school healthier. 

Physicians Committee for Responsible Medicine. School Lunch Report Card: A Report by the Physicians Committee for Responsible Medicine. August 2007. http://www.healthyschoollunches.org/reports/report 2007_card.cfm. Accessed April 30, 2008. 

Crepinsek, M.K. (2009). Meals offered and served in us public schools: do they meet nutrient standards. Journal of the American Dietetic Association, 109, S31-S43.

The latest stats say 62 percent of U.S. adults report using the Nutrition Facts panel of the food label at least sometimes when deciding to buy a food product. Fifty-two percent look at the list of ingredients; 47 percent look at serving size; and 44 percent review health claims.¹ So 38 percent of people never look at the Nutrition Facts panel of the food label?!? So how do they know what they're eating? 

The above data, published in August's Journal of the American Dietetic Association, was collected as part of the 2005-2006 National Health and Nutrition Examination Survey (NHANES). Over 5,000 adults answered the food label questions and of those 5,000 people about 4,500 completed two 24-hour dietary recalls. This data allowed researchers to make the following conclusions about food label use:

• Women and participants with greater education and higher income were more likely to report using food labels.
• Non-Hispanic whites reported more frequent use of food labels.
• Participants with limited English language skills had greatly reduced rates of label use, but label use among foreign-born participants increased with duration of residency.
• Users of the Nutrition Facts panel were found to have lower reported values for total energy (calories), total fat, saturated fat, and sugars.
• Users of the ingredient list had lower reported values for total fat, saturated fat, and sodium.
• Users of the serving size had lower reported values for total energy (calories), total fat, saturated fat, cholesterol, and sugars.
• Users of the health claims had lower reported values for total fat and saturated fat.
• Reported dietary fiber intake was found to be higher among label users for all sections of the food label.

Given that food labels seem to help people make healthier choices, why aren't more people using them? Here are some potential answers...

1. They are they too difficult to understand/interpret. Test your ability to read a food label with this quiz.
2. It takes too much time to look at the side of a package before throwing it in the cart. Really?!? Maybe key information like calories should be bolded.
3. People do not want to know how unhealthy that packaged food might be. Unfortunately, it may very well be loaded with fat, sodium, and/or sugar.

What's your guess? How might we help more people use the food label to make healthier choices? Or maybe we should promote the use of fresh foods without labels like fruits, vegetables, and fish? While these foods aren't required to display the standardized food label, their nutrition information can be found here.

¹Ollberding, N.J. (2010). Food label use and its relation to dietary intake among us adults.. Journal of the American Dietetic Association, 110, 1233-1237.

 

Enter a coffee shop and you'll see a group of teens sipping lattés. Drive by a high school sporting event and you'll see kids slamming energy drinks. Or cross through a park and you'll see a few children drinking soda pops. Kids and caffeinated beverages have become the norm. But is it okay?

According to a recent editorial in the Canadian Medical Association Journal, the answer is no. Excessive caffeine in kids can cause nervousness, irritability, sleeplessness, and occasionally rapid heart rate. And way too many caffeine-laden products are marketed to children through advertising and sponsorship of events like snowboarding and skateboarding competitions. Thus, the authors of the editorial urge their government officials to step in and mandate labeling, marketing, and even sales of all products with caffeine levels exceeding 100 mg. Furthermore, they urge Health Canada (similar to the U.S. Department of Health and Human Services) to provide the public with more information on the health consequences of caffeine in children.

Sounds like a good idea, doesn't it? Well, the research behind the ill effects of caffeine in children is not so clear. Several other groups (and not just the beverage industry!) say that while caffeine may not benefit children, it probably won't hurt them either. The International Food Information Council (IFIC) reminds consumers that the U.S. Food and Drug Administration as well as the American Medical Association and American Cancer Society state that moderate caffeine consumption produces no increased risk to health. And in reference to children, IFIC says research has found no evidence to suggest the use of caffeine at the levels in foods and beverages is harmful; that caffeine-containing foods and beverages do not cause children to become hyperactive; and that while someone may exhibit short-term symptoms if they stop consuming caffeine suddenly, it isn't addictive.

So what is "moderate consumption"? For adults, moderate consumption has been defined as 200-300 mg caffeine per day. The U.S. doesn't provide specific guidelines for children, but Health Canada recommends:
-no more than 45 mg/day for children ages 4-6
-no more than 62.5 mg/day for children ages 7-9
-no more than 85 mg/day for children ages 10-12
-no more than 2.5 mg per kilogram body weight per day for kids 13 and older

Can kids easily exceed these recommendations? I'd say so! One 8-oz cup of drip-brewed coffee has 65-120 mg caffeine; one 8-oz energy drink has 50-200 mg caffeine; and one 12-oz soft drink has 30-60 mg caffeine. A 2007 study of U.S. adolescents aged 12-18 found that 73% consumed 100 mg or more of caffeine per day, with most consumption in the evening, the time of the day most likely to negatively effect sleep.

What do you think? Should parents watch or restrict their children's caffeine intake? Might caffeinated beverages be replacing healthy beverages like milk and water in children's diets? Or, is caffeine consumption in children (coffee and energy drinks) just another harmless fad that will pass with time?

MacDonald, N. (2010). Caffeinating children and youth. Canadian Medical Association Journal, Retrieved from http://www.cmaj.ca doi: 10.1503/cmaj.100953.

Fact sheet: caffeine and health. (2007, August 1). Retrieved from http://www.foodinsight.org/Resources/Detail.aspx?topic=Fact_Sheet_Caffeine_and_Health.

Malinauskas B.M. (2007). A survey of energy drink consumption patterns among college students. Nutr J;6:35. 

It’s time to make physical activity as routine as brushing our teeth! Did you know that research is starting to show that oral hygiene along with exercise may help reduce cardiovascular (CV) disease?

A recent blog, “Physically Active with a Sedentary Lifestyle: Are you at risk?,”explored the effects of prolonged sitting on all-cause and CV death rates in individuals who exercised and those who did not¹.  Researchers reported the highest death rates in persons who spent most of the day sitting and those who spent more time sitting.  And this was true even if they met their recommended PA requirements.  In fact, death rates were similar for exercisers and non-exercisers who sat during the day.

So moving throughout the day is seen as a way to lessen the risk of CV deaths, but it’s time to add more teeth brushing too. de Oliveira and associated (2010)² investigated whether the number of times individuals brush their teeth is correlated with the risk of developing heart disease.

In the 8+ year study, just over 11,000 individuals were tracked through to hospital admissions and deaths. During the study, 555 cardiovascular events occurred. Those that brushed less had an increased risk for CV disease than those that brushed twice per day.

The stats from the study compared to twice per day brushers:
• Once per day  - 1.3 increased risk for CV events
• Less than once per day - 1.7 increased risk for CV events

So keep those pearly whites nice and clean (at least twice a day) for a longer and healthier life!  And don’t forget to walk to the water cooler for an extra swish.

¹Katzmarzyk, P.T., Church, T.S., Craig, C.L., & Bouchard, C. (2009). Sitting time and Mortality from All Causes, Cardiovascular Disease, and Cancer. MSSE, 41(5),998-1005.
²de Oliveira, C, Watt, R, & Hamer, M. (2010). Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish health survey. British Medical Journal, 340(c2451), Retrieved from http://www.bmj.com

A recent report shows that adult obesity rates rose in 28 states during the past year and now exceed 25 percent in more than two-thirds of the states! Furthermore, while 4 states last year had obesity rates over 30 percent (Mississippi, Alabama, Tennessee, West Virginia), 8 states now have that distinction (4 previously mentioned states plus Louisiana, Kentucky, Oklahoma, and Arkansas).

This report, F is in Fat 2010: How the Obesity Crisis Threatens America's Future published by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) this week, shows that while steps have been taken to address the obesity crisis in recent years the effort is not nearly enough to address the problem. The report recommends ensuring that the disease-prevention measures in the new health reform law are implemented strategically to help prevent and reduce obesity, expanding the commitment to community-based prevention programs, and sustaining investments in research and evaluation around obesity.

Other interesting findings from the report include:

• In 1991, no state had an obesity rate above 20 percent.
• Only the District of Columbia experienced a decline in adult obesity rates during the past year.
• Adult obesity rates for Blacks and Latinos are higher than those for Whites in at least 40 states and the District of Columbia.
• Eight states, plus the District of Columbia, have childhood obesity rates greater than 20 percent: Arkansas, Georgia, Illinois, Kentucky, Louisiana, Mississippi, Tennessee and Texas.
• Every state has some form of physical education requirement for schools, but these requirements are often limited, not enforced or do not meet adequate quality standards.

How does your state rate (see interactive map)? If you print the report's Executive Summary you can see detailed information on your state including 2010 obesity-related standards in schools (e.g., whether your state has nutritional standards for school lunches, breakfasts and snacks that are stricter than U.S. Department of Agriculture requirements or collects Body Mass Index or other health information from students).

More than half of U.S. adults play video games with one in five playing daily or almost every day.¹  Video games are gaining popularity, especially those that use arm gestures and motions or force plates to control the system.  Sedentary individuals who like video games may find these more active types of video games attractive.  But is the intensity of these video games high enough to provide health benefits?

Japanese² researchers investigated the energy cost of theWii Fit Plus videos for yoga, resistance, balance and aerobic exercise and Wii Sports including golf, bowling, baseball, tennis and boxing.  They measured caloric expenditure in a special airtight room called a metabolic chamber while subjects performed each activity for eight minutes. 

Researchers measured the intensity of each video activity in units called metabolic equivalents (METs).  Resting energy expenditure is defined as 1 MET; if you are exercising at 3 METs then the intensity of the activity is three times resting.  According to the American College of Sports Medicine, an activity must reach a level of moderate intensity to provide health benefits.  Moderate intensity exercise is defined as an intensity of 3-6 METs.  Vigorous activities have an intensity >6 METs.

Results of the study showed that Wii balance exercises and yoga were below the minimum intensity of 3 METs.  These exercises produced only light activity levels which were not adequate to provide health benefits.  Many but not all the resistance training and aerobic exercises met the minimum 3 MET criteria and would be considered adequate to provide health benefits.  Of the Wii Sports activities, boxing had the highest energy expenditure averaging just over 4 METs.  Tennis and baseball averaged 3 METs with golf and bowling <3 METs.  None of the sports or fitness activities were considered vigorous activity. 

The activity guidelines for health benefits are 30 minutes of moderate intensity (3-6 METs) activity performed 5 days/week. Some of the Wii sports games and fitness activities are sufficient to meet these minimum guidelines and could be used to meet part of the recommended 150 minutes of activity per week.  However, many of the games (about 2/3 of those tested) provide only light activity (<3 METs) and do not meet the criteria.  For this reason it is important to choose games requiring the greatest energy expenditure.  It is also important to note that 150 minutes of moderate intensity activity is the amount recommended for health benefits like improving cholesterol, blood pressure, and blood sugar levels.  If an individual’s goal is weight loss, the recommendation for activity is 300 minutes of moderate intensity exercise per week. 

Worth noting, the Wii Sports games and Wii Fit Plus aerobic exercise videos expend fewer calories than performance of the actual sport or exercise itself.  There is not much horizontal movement involved in playing Wii games; the added movement increases energy expenditure when playing the real sport or aerobic exercise.  So if you get the opportunity select the actual activity or sport to get the most fitness improvements and the greatest caloric expenditure.

1.  Lenhart, A. Jones, S., and Macgill, A. (2008). Adults and video games. In: Pew  Internet and American Lift Project. 2008 [cited July 1, 2009]. Available from http://www.pewinternet.org/Reports/2008/Adults-and-Video-Games.aspx

2.  Miyachi, M, Yomamoto, K, Ohkawara, K, Tanaka, S. (2010). METs in Adults While Playing Active Video Games: A Metabolic Chamber Study. Med Sci Sports Exerc. 42(6), 1149-1153.

The more time you spend laying in bed asleep the fewer calories you burn and thus, the greater your risk for overweight and obesity.  Right?

That may seem logical but that is not what the research is showing.  In fact, a growing body of scientific literature suggests that sleep duration is inversely related to obesity.  That is, with increasing hours of sleep, obesity risk goes down.  To a point. 

What studies have found so far is that sleeping on average less than seven hours per night increases obesity risk.¹ But sleep duration of longer than eight or nine hours per night may also slightly increase obesity risk.   So for now, it appears that the sleep sweet spot for reducing obesity risk is 7-8 hours per night.  Now, these data are from large studies that average information across many different people.  So scientists and health professionals know that within a large group, everyone’s personal sleep need will be slightly different. 

Nonetheless, given the obesity epidemic, the link between sleep duration and obesity is intriguing.  And because there is little harm (and potentially a great benefit in terms of health and safety) in recommending adequate sleep, public health campaigns are gearing up to remind Americans that  getting enough (but not too much) sleep is a healthy obesity prevention habit that goes hand in hand with healthy eating and active living.

Getting Your 7 to 8 Hours

Do you sleep for seven to eight hours a night?  Be honest.  If so, good for you.  Keep it up. 

If not, take a hard look at what prevents you getting enough sleep.  Here are tips from the National Sleep Foundation:

• Establish consistent sleep and wake schedules, even on weekends
• Create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music – begin an hour or more before the time you expect to fall asleep
  Exercise regularly during the day or at least a few hours before bedtime
• Finish eating at least 2-3 hours before your regular bedtime
• Avoid caffeine and alcohol products close to bedtime and give up smoking
  Create a sleep-conducive environment that is dark, quiet, comfortable and cool
• Sleep on a comfortable mattress and pillows
• Use your bedroom only for sleep and sex (keep "sleep stealers" out of the bedroom – avoid watching TV, using a computer or reading in bed)

For more information and helpful tips on healthy sleeping habits for people of all ages,

• National Sleep Foundation
• National Heart, Lung and Blood Institute

 

¹ Patel JR.  Short sleep and obesity.  Obesity Reviews.  2009. 10(Suppl 2):61-68.

Does Exercise Make Us Hungry?

There has been much debate about the effect of exercise on appetite and energy intake.  Although some scientists have proposed that exercise stimulates appetite; most studies do not support this finding. 

A recent study published in Medicine & Science in Sports & Exercise⁴ examined the effect of walking on appetite and food intake.  In the study, subjects participated in two different trials – an exercise and a nonexercise (control) trial.  One day subjects walked for 60 minutes on a treadmill with some mild shortness of breath but were still able to hold a conversation.  On another day, they came to the lab at the same time of day but did not exercise (control trial).  Subjects were offered an “all you can eat” buffet style meal two hours after exercise and again at five hours after exercise. When subjects did not exercise they were offered the same buffet meal at the same time of day.  Subjects also rated their appetite every 30 minutes.

The results showed that after a 60-minute brisk walk subjects did not increase the amount of food they ate for the next seven hours compared to the control trial.  In fact, exercising subjects had a 439 calorie deficit after accounting for the amount of food consumed.  There was also no difference in the fat or carbohydrate content of meals on the exercise vs. nonexercise days.  Researchers also measured levels of a hormone (ghrelin) produced in the stomach which is known to increase hunger.  They found no difference in the hormone levels or ratings of appetite on the exercise compared to nonexercise trials. 

This study supports the findings of other researchers¹ that moderate intensity exercise does not increase appetite.  With regard to high intensity aerobic exercise, studies^2,3 tend to show that appetite is suppressed for a brief period after 60 minutes of treadmill running.  Another study² also reported a brief suppression of appetite after 90 minutes of resistance training. 

Dieting alone to lose weight can be brutal.  So why not go for a bigger calorie deficit by adding exercise to your diet program.  Exercise yields lots of health benefits like improvements in blood pressure, cholesterol, and blood sugar levels.  Plus, exercisers have lower all-cause death rates.  It's time to get moving!     

1.  Blundell, J.D., and King, N.A. (2000). Exercise, appetite control, and energy balance. Nutrition, 16(7-8), 519-522.

2.  Broom, D.R., Batterham, R.L., King, J.A., Stensel, D.J., Batterham, F.L., and King, J.A. (2009). Influence of resistance and aerobic exercise on hunger, circulating levels of acylated ghrelin, and peptide YY in healthy males. Am J Physiol Regul Integr Comp Physiol, 296(1), 29-35.

3.  Broom, D.R., Stensel, D.J., Bishop, N.C., Burns, S.F., and Miyashita, M. (2007). Exercise-induced suppression of acylated ghrelin in humans. J Appl Physiol, 102(6), 2165-71.

4. King, James A., Wasse, L.K. Broom, D.R., and Stensel, D.J.. (2010) Influence of brisk walking on appetite, energy intake, and plasma acylated grehlin. Med & Sci in Sports & Exerc, 42(3), 485-492.

 

With the arrival of spring you may have seen some people out running without any shoes on or wearing something that looks like a glove on their feet. Well the latest buzz around the fitness industry is—yes, you guessed it—barefoot running. While barefoot running is in the spotlight now, it actually has been around for quite some time. The running shoe wasn’t invented until the 1970’s so this is a relatively new piece of equipment when you look at how long humans have been running. And even since the running shoe emerged, the trend of barefoot running has come around the pike several times.

So why the sudden increase in interest again?

 A new study published in the January 28th issue of the journal Nature shows that barefoot runners have a different running technique which may help to decrease the collision forces that act on the body. The authors analyzed the running styles of five groups of people—U.S. adult athletes who have always worn shoes, Kenyan adult runners who grew up barefoot but now wear cushioned running shoes, U.S. adult runners who grew up wearing shoes but now run barefoot or with minimal footwear, Kenyan adolescents who have never worn shoes, and Kenyan adolescents who have worn shoes for most of their lives. They found that most shoe runners strike their heels when they run, whereas barefoot runners tend to strike toward the middle or front of the foot.

So what is the big deal?

Well the authors found that heel striking causes a large and sudden collision force to act on the body which is often equal to two or three times the runner’s body weight. Because barefoot runners land more on the balls of their feet, less collision force develops. It is believed that the spring in the arch of the foot and the Achilles tendon help to mitigate the collision forces. 

So less collision force has to mean less injury—right?

Well, not necessarily. Experts can’t seem to agree and there isn’t enough research to support the thinking one way or the other. The authors of this study hypothesize that forefoot or midfoot striking can help avoid or lessen repetitive stress injuries, especially stress fractures, plantar fasciitis, and runner’s knee. However, they are quick to point out that their hypothesis has yet to be tested and that there have been no direct studies on the efficacy of forefoot strike running or barefoot running on injury.  Other experts believe that forefoot striking for long distances can actually lead to Achilles tendon issues, shin splints, and more knee pain. As you can see, the verdict is still out.

So what if you have been thinking about starting to run barefoot?

Barefoot running is definitely something that should be started gradually. Most people in this country spend most of their time in shoes whether it be walking in them or running in them. As a result, their mechanics and muscles within their feet and lower leg have developed differently. It is common to experience “tired” feet and very stiff and sore calf muscles when first beginning. Doing too much too quickly can lead to injury. The authors of the study suggest starting by walking around barefoot more frequently. Then they suggest no more than a quarter mile to one mile every other day the first week. From there they suggest increasing your distance by no more than 10% per week. If soreness remains they suggest NOT increasing the distance. Additionally, if there is pain, they always suggest stopping, letting the body heal, and seeing a physician if necessary. This information is not to take the place of information provided by a coach or physician and, as a reminder, there is no evidence that barefoot running is better for you so many experts believe there is no need to make this transition.

What about running surface?

Even on hard surfaces such as pavement, collision forces are low with barefoot running so barefoot advocates claim that it can be done on any surface. Because so many surfaces have debris such as glass, pebbles, and sticks, wearing a “minimal” shoe (those that do not have a heel cushion or arch support, that have a flexible sole) may be a good idea.

Of final note, anyone who has sensory loss to their feet (i.e. a diabetic) should not run barefoot or in minimal shoes. In fact, these individuals should probably wear shoes of some type at all times in order to protect their feet. If you have any foot-related problems, you should seek the advice of a medical professional before you start barefoot running. Hopefully with this latest interest, more research will be conducted that will provide more insight into the benefits and/or disadvantages of barefoot running.

Lieberman, D. E. et. al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463: 531-565, 2010.