Communicate Health

If you’re having trouble with portion sizes, meal planning, budgeting, or getting your fruits and vegetables, check out MyPlate!

There’s tips, such as to Start with Small Changes.

A Daily Checklist to help keep you on track with what you should be eating based on your calorie intake.

To find your daily calorie needs, use a TDEE calculator (such as this one or this one) and find what you need to eat to lose, maintain or gain weight!

Tips to increase your Physical Activity. 

Breakfast biscuit!

61g biscuit (approx. 200 calories)

15 gram chipolte gouda cheese (half slice / 55 cal)

Egg (70 cal)

Kumar, J., Kidd, T., Li, Y., Lindshield, E., Muturi, N., & Adhikari, A. (2014). Using the Community-Based Participatory Research (CBPR) Approach in Childhood Obesity Prevention. International Journal of Child Health and Nutrition, 3, pp. 170-178.

The purpose of this research is to inform why it is important to look holistically – at the whole – of the problem of childhood obesity within different communities and to propose solutions based on what would be most effective within the community and that would benefit the community as whole. Community-based participatory research (CBPR) engages the community, organizations and experts and encourages them to work together to find effective and long-term solutions, especially in low socio-economic areas where there may be less health/nutrition information, access to a variety of fresh foods and less opportunity for varying physical activities. This research could help address some of these issues by helping to influences policies that would make access to information, foods and places for physical activity more readily available.

The theoretical framework this article uses is SEM – the socio-ecological model – which details the interactions between individuals, groups and the larger environment (political and community) and shows the different structural levels that need to be addressed to create effective change within a community.

Some of the benefits of CBPR are that it is collaborative, community focused (with the community itself being a participant and not a subject), diverse, sustainable, long-term, research-based, continuous, able to focus on community strengths and address social inequalities.

Boseley, S. (2017, April 14). Amsterdam's solution to the obesity crisis: no fruit juice and enough sleep. The Guardian. Retrieved April 21, 2017 from https://www.theguardian.com/society/2017/apr/14/amsterdam-solution-obesity-crisis-no-fruit-juice-enough-sleep.

The purpose of this news story is to inform the public about the steps that Amsterdam (Netherlands) is taking to help reduce childhood obesity in the city, as one-fifth of children there are overweight (which has dropped by 12% between 2012 and 2015).

Amsterdam’s campaign does not just focus on schools or families, but communities as a whole. In schools, students are only allowed milk or water (no juice or squash [concentrated syrup] due to the amount of sugar) and the schools keep different vegetables on hand for students to try. The program also encourages students to get enough sleep. Near one school, De Achtsprong, which has a high population of Suriname migrants, they’ve even partnered with the McDonald’s next door to prevent students from buying fries without a parent, only allowing them to purchase an apple if they are alone.

The article states that, in the beginning, parents did not agree with taking away the sugary drinks and treats, but that it has now become normal to eat healthier at schools. In addition, healthy cooking classes are offered to parents and children across the city, teaching them how to cook healthier versions of traditional dishes. Even sporting events have been affected by the changes in Amsterdam – companies such as Burger King and Monster Energy cannot co-sponsor sporting events, and other proposed changes include banning soda advertisements and selling healthy food at the events. Gym (sport center) memberships are also subsidized for low-income families to encourage them to get active. Counselling for mothers-to-be and health education focusing on the first three years of a child’s life is another step Amsterdam is taking to help alleviate the childhood obesity epidemic.

I think this is important because if Amsterdam can take the steps necessary to improve the lives of its citizens, then cities in the United States should take action as well. However, due to the extreme amount of individualism in the U.S., I do not know if such action will be possible without citizens screaming that not allowing their children to drink Pepsi at school infringes upon their rights and does not affect anyone else (even though declining health of the population does affect every citizen).

Not all physical activity has to be boring! For $3 each, my significant other and I were able to wander around the Arboretum and Botanical Gardens for a couple hours. Children 12 and under only cost $1 for admission.

While this particular trip was not free, it is an example of a relatively cheap way to get in some physical activity, sun and interesting views in a safe and clean environment. 

For more information and resources on physical activity, check out these links!

Office of Disease Prevention and Health Promotion

American Heart Association

NHS (United Kingdom)

CDC

Rosenthal, E. L. (2015, August). The Food We See, The Food They Eat: The Image of Food in Entertainment. Retrieved from the Hollywood, Health & Society website: https://hollywoodhealthandsociety.org/sites/default/files/attachments/page/The%20Food%20We%20See%20Report.pdf

The purpose of this paper was to examine the results of content analysis done on television show data relating to food and food consumption collected between January and May of each year (excluding 2007 and 2008) from 2004 to 2013 via the TV Monitoring Project. The questions this paper was able to answer via the content analysis were which diseases were depicted most on television, how health messages were framed to achieve positive effects, if certain people were exposed to more health-related messages than others and which issues were most prominent in the plot or as part of a larger character arc.

Fifty different types of food (under the umbrella of either “healthy food” such as fruits and vegetables [three food codes: (1) fruits, (2) vegetables or (3) fruit/vegetable {“unable to tell” pp. 4} or “unhealthy food” such as desserts and other sweets [seven food codes: (1) cakes, cookies, etc., (2) donuts, (3) ice cream, (4) candy, (5) chocolate, (6) other desserts or sweets, or (7) desserts and sweets {“unable to tell” pp. 4}]) were coded so they could be measured in each episode (N= 1334), with another measure for food shown and another for food consumed. If either healthy or unhealthy food was shown or consumed, it was marked with a yes or no, resulting in four categories ([1] fruits and vegetables shown, yes or no, [2] fruits and vegetables consumed, yes or no, [3] dessert and sweets shown, yes or no, [4] desserts and sweets consumed, yes or no).

The results show that nearly 80% (79.1%) of shows show some type of food, though it did not have to be either fruits/vegetables or desserts/sweets. Both healthy and unhealthy food were shown in about 30% of the episodes, with desserts/sweets being more likely to be consumed at 14.6% as compared to fruits and vegetables (9.3%). Despite the similar instance of appearance for fruits and vegetables and dessert/sweets, those watching still see the desserts and sweets being consumed more often, which may affect their own eating habits.

This research is important because if we, as a society, can encourage producers and directors to increase the amount of fruits and vegetables (and other healthy food) shown being consumed, then maybe more Americans will be encouraged to engage in similar behavior. Another tactic could be showing characters actively choosing a healthier alternative, such as a scene showing a character putting down a candy bar or energy drink, and instead choosing grapes or a black coffee or tea.

Further research could look into developing specific television shows with optimal exposure to healthy habits to encourage the public to cultivate better habits. These television shows or movies would have to address a variety of audiences from a variety of cultural, socio-economic and other demographic backgrounds. PBS could be of use here, as it is available for free and operates in different areas; different regions could show different programming to better reach the target audiences.

Jacoby, C., Brown, J., Kumar, U. B. & Velu, S. (2014). Entertainment Education Saves Lives and Improves Health: Key Steps to Developing Effective Programs. In D. K. Kim, A. Singhal & G. L. Kreps (Eds.) Health Communication: Strategies for Developing Global Health Programs, vol. 5 (pp. 83-100). New York: Peter Lang.

In this book chapter, the authors discuss entertainment education and its effectiveness in increasing knowledge (and change) in regards to different public health issues. The overall goal of entertainment education is to shift societal norms and behaviors as well as to create a positive attitude in regards to implementing the changes necessary.

The article has short case studies, detailing different entertainment education campaigns and their effects. It also includes the basic steps of creating an entertainment education production, which is detailed below.

1.     Audience assessment, theory and technical brief.

In this step, the needs, beliefs and demographics of the target audience are analyzed to get an accurate picture of who the target audience is. From that, the producers must decide, based on the information gathered, which behavior-change theory (social cognitive theory [SCT – learning from the behavior of others; people will replicate what they see as having positive consequences; goal of strengthening self-efficacy] or extended parallel process model [EPPM – change will happen if people perceive that there will be great negative consequences if they do not and having others model the correct behavior; people must believe that they have the ability to change {a high self-efficacy}]) will be most effective to create change within the target audience.

The technical brief includes the above information, as well as the behavior objectives (what changes they want to see and how to measure them), communication objectives (what they want to the audience to understand or walk away with), a call to action (what individuals can do), creative concerns (style, visuals, editing, etc), along with other considerations, such as location and other needs.

2.     Artistry and pretesting

The next step is to make sure that the story and characters proposed in 1 will be relatable to its target audience and that the target audience will want to emulate the good habits of those in the story. As the chapter states, characters must be relatable, unique, believable, have quirks/flaws that help drive the plot and they must be human when implementing the changes to improve their life (by failing and trying again, making mistakes, etc). The story itself must touch the target audience with a conflict that goes beyond just health. Pretesting is important because it shows how well a sample audience will like a story; focus groups can be one way for producers to study this.

3.     Implementation

Implementation begins with promoting the film or series to garner interest in it. Without interest, no one will watch it and thus no one will learn from it. Community engagement is part of this step, the authors say. Community engagement can include group discussions, infographics, handouts, and social media.

4.     Evaluation

After the show or film premieres, researchers can study the effects of the production on the audiences’ behavior, from those were both directly and indirectly exposed to it.

The authors offer some suggestions for those thinking about making a film or movie in entertainment education style, which boils down to something relatively simple: cooperate and form partnerships. Form partnerships with distributers, partner with companies in the private sector, cooperate with community leaders or governmental resources (such as the CDC, in the case of the United States), cooperate with experts in the communication and health fields and hire the best people for the job.

One of the first things anyone needs to know when they start to think about losing weight is their TDEE -- their Total Daily Energy Expenditure. 

TDEE is the amount of Calories a body burns over the course of a day. 

For example, a sedentary (office job) 5′4″ woman (the average woman’s height [https://www.cdc.gov/nchs/fastats/body-measurements.htm]) at 166 pounds (average weight [CDC, see link by “average height”]) who is 25 years old (chosen randomly) has a TDEE of 1,780 Calories. That means that woman would GAIN weight while eating 2,000 calories per day (what is considered the recommended average). 

Dobson, P. W. & Gerstner, E. (2010). For a Few Cents More: Why Supersize Unhealthy Food? Marketing Science, (29)4, 770-778. DOI: 10.1287/mksc.1100.0558.

To read the full article click here (hosted by Imgur). 

The purpose of this article is to explore the consequences supersizing food (and increased portion sizes) and what could be done to counter it and encourage moderation when eating (p. 770-771). The article states that supersizing can exploit consumers, as sellers can “push larger sizes to consumers who underestimate the calorie intake that comes with larger portions of food,” (Chandon and Wansink, 2007, as cited in Dobson and Gerstner, 2010, p. 771).

The article uses a frame of temptation to study supersizing. In this article, the authors used a model to understand the consequences of supersizing and employed the use of two different types of consumers – the disciplined consumers, who eat in moderation and are willing to pay a higher price for it; they see additional portions as unhealthy and are concerned about the negative and delayed effects from consuming them; their value for the supersized food is less than that of the cost of it (as “price conscious” consumers, these tempted consumers are more likely to be overweight [p. 771-772]) , so they typically do not buy it and the tempted consumers, who are more focused on the (low) price, more susceptible to the “pleasure” of eating fatty, salty and sweet foods and they also value the supersizing more because the larger size is worth more to them than the incremental price increase (as it is a “bargain”) (p. 772).

According to this article, social welfare can be negatively affected by supersizing (the costs that add up over time from being overweight, i.e. healthcare costs, sick days off work, higher gasoline consumption and spending more money on food to stay at a higher weight), which is why the authors state that policies should be introduced to curb the phenomenon (p. 774). To help protect the public, the authors have a few policy suggestions, as described below.

Policies to help prevent overeating due to supersizing could include bans on it, taxes or warning labels explaining the dangers of overeating unhealthy foods (like soda or fries) (p. 771). Banning supersizing would prevent consumers from being able to upgrade to the supersize, but it would not prevent companies from going around the ban and offering two-for-one or buy-one-get-one-half-price deals (p. 775). Taxing the supersized goods is another policy suggested by the authors, as taxing excess calories (or fats, p. 776), they say, has been shown to help reduce weight (p. 775). However, vendors could potentially get around this tax by cross-selling the unhealthy food (fries) with a salad (instead of just supersizing the fries) (p. 776). For the authors’ last suggestion, warning labels, they suggest that companies should either warn consumers of the dangers of overeating or tout the benefits of moderation, and since people are not huge fans of extremes, they may choose a smaller portion size (p. 776). However, the authors do say that previous attempts to decrease portion sizes have been unsuccessful as people are somewhat resistant to downsizing (p. 776).

Swinburn, B., Sacks, G., & Ravussin, E. (2009). Increased food energy supply is more than sufficient to explain the US epidemic of obesity. The American Journal of Clinical Nutrition, 90(6), 1453-1456. doi: 10.3945/​ajcn.2009.28595

The purpose of this study was to determine whether or not an increase in energy intake (via food and beverages) or decrease in physical activity levels contributed to the levels of obesity seen in the United States, and which one is the “major driver” of the obesity increase in order to better target prevention measures (p. 1453).

The authors used doubly-labeled water to test the total energy expenditure (TEE) of children and adults (n= 963 and n= 1,399, respectively) in the 2000s (p. 1453). Because a majority of people are relatively weight-stable for each single day, energy intake (TEI) and TEE were assumed to be equal, due to fact that human bodies “are constrained by the first law of thermodynamics,” which means that “equations can be used to predict changes in weight in response to changes in energy intake and physical activity,” (p. 1453). The data gathered in the 2000s (1999 to 2002) were compared to data from the 1970s (1971 to 1976), which was from the National Health and Nutrition Examination Surveys (NHANES) that measured the heights and weights of both adults and children in the United States (p. 1453). The food supply level was also measured to estimate the per-capita energy supply, which would be over the amount of food actually consumed due to food spoilage and waste (p. 1453).

The energy supply was then apportioned between children and adults based on the ratio of children to adults, which was then used in the equation for estimated weight increase (and then compared to measured weight gains for the age ranges) (p. 1454).

The results showed that the estimated food energy intake for children from ages 2 through 18 was 1,690 kcal per day (at 35.1 kg in weight) in the 1970s and 2,043 kcal per day (at 39.1 kg in weight [identical to predicted weight gain based on the equation]) in the 2000s (p. 1454). Adults consumed on average 2,398 kcal per day (at 68 kg in weight) in the 1970s, which increased to 2,895 kcal per day (at 76.6 kg in weight [slightly lower than the 78.8 kg predicted weight]) in the 2000s (p. 1454). Due to the adult weight being slightly lower than expected, the authors suggest that physical activity may have increased from the 1970s to the 2000s (p. 1454).

The major findings of this article show that increased food consumption is sufficient to explain the increase in obesity across the United States (p. 1454) which is supported by other studies showing the same as well as studies showing that physical activity has not decreased nor increased significantly since the 1970s (p. 1455). However, the authors state that in countries where there is less car ownership, the rise in obesity has a less-steep trajectory, suggesting that reductions in physical activity do not appear to be the driving force behind the rise in it (p. 1455).

The authors state that:

For the US population to return to the mean weights of the 1970s, the increased energy intake of ~1500 kJ/d (350 kcal/d) for children (about one can of soda and a small order of French fries) and 2000 kJ/d (500 kcal/d) for adults (about one large hamburger) would need to be reversed. Alternatively, compensatory increases in physical activity (~150 and 110 min/d of extra walking respectively) would achieve similar results (p. 1455).

Throughout the USA, there are farmer’s markets. 

This one, specifically, is hosted by the Graham County Health Department of Arizona and Produce on Wheels - With Out Waste. 

For $10, a person gets:

3 spaghetti squash

9 grey squash (which look like zucchini)

8 red bell peppers

13 green bell peppers

8 yellow bell peppers

45 Roma tomatoes

6 eggplants

2lbs of jalapenos

2lbs of Anaheim chili peppers

As per their website: 

Produce On Wheels - With Out Waste (P.O.W.W.O.W.) disperses fresh produce to communities at churches, schools and other entities throughout Southern Arizona and the Metropolitan Tucson and Phoenix service areas. 10 million lbs. of fresh nutritional rescued produce annually are delivered to agency sites for distribution to supporters. Anyone can contribute $10 to shop for up to 60 lbs. of fresh produce, to share with neighbors, friends, family or someone who's in need.

http://www.borderlandfoodbank.org/POWWOW.html

Mujcic, R. & Oswald, A. (2016, August). Evolution of Well-Being and Happiness After Increases in Consumption of Fruit and Vegetable. American Journal of Public Health, (106)8, 1504-1510. DOI: 10.2105/AJPH.2016.303260.

This article exams whether peoples’ well-being and happiness increases after they increase their intake of fruits and vegetables with the goal of bettering the unhealthy diet Westerners’ have (p. 1504). If the public is informed of the short-term effects of increasing fruit and vegetable consumption, they may be more likely to do so, which could lead to a healthier lifestyle overall (p. 1504).

The authors used a longitudinal study, with food diaries from 12,389 Australians aged 15 to 93 from the years 2007 and 2009 (with a validity check from the years 2009 and 2013) via an in-person national survey given to roughly 14,000 Australians (p. 1504-1505). Participants were asked how many times per week they ate either fruit and how many times per week they ate vegetables (0 [never] to 7 days per week) as well as how many servings (guesstimated by being visually shown a serving size) they ate on the days they ate fruits or vegetables (p. 1505). The average Australian ate 3.84 servings (combined) each day, (SD= 2.01) with some eating zero servings per week (a none consumption category) (p. 1505). Total, roughly 85% of respondents ate less than 3 servings of fruit while 60% ate less than 3 servings of vegetables; very few, 1.83% and 7.75%, age more than 5 servings of fruit and vegetables each day, respectively (p. 1505). Demographics such as “household income, age, education, whether working, marital status, health, children, alcohol and food patterns, BMI, and exercise” were controlled for (p. 1506).

To measure well-being and happiness, participants were asked to (1) rate on a scale from 0 to 10 how satisfied they were, overall, with their life (with an average of 7.91, SD= 1.41); and (2) to indicate how much time in the past month they had “been a happy person” with answers ranging from none of the time (1%; coded at 1), a little of the time (4.8%), some of the time (13.9%), “a good bit of the time” (19.5%), most of the time (51.9%) and all of the time (8.9%; coded at 6) – the participants averaged 4.43 out of 6 for the happiness scale (p. 1505).

The results showed that those who ate more fruits and vegetables were substantially happier (a statistically significant result) (p. 1506). The authors also checked their results against differing lengths/intensities of public health campaigns in the various states of Australia, as different states had differing health campaign time frames (p. 1508). Do to that, the authors found that, “some evidence that the Australian healthy-eating campaign may have improved people’s levels of life satisfaction and happiness, [but] [n]evertheless, it is not possible statistically to be certain of that conclusion,” (p. 1509).

More oatmeal -- anything can go in oatmeal!

150 calories worth of oatmeal (about 1/2 cup)

80 calories of dark chocolate (1tbsp)

Hruby, A., Manson, J. E., Qi, L., Malik, V. S., Rimm, E. B., Sun, Q., Willett, W. C., and Hu, F. B. (2016). Determinants and consequences of obesity. American Journal of Public Health, 106(9), 1656-1662. doi:http://dx.doi.org/10.2105/AJPH.2016.303326

This paper reviewed the Nurses’ Health Studies (NHS in 1976 and NHS II in 1989) contributions to the study of obesity and its related health risks.

In the NHS study, 121,701 female nurses in the US aged 30 to 55 participated; 116,671 younger female registered nurses participated in the NHS II study – both NHS and NHS II participants were followed for 40 years, filling out biannual questionnaires (with a 90% follow up rate for every two-year cycle) (p. 1656). Over the course of the study, nurses self-report weight, along with waist, hip, and upper arm circumferences, childhood and adolescent somatotypes (body type), and what the participants remembered their weight being at 18 years old.

Overall, the study states that:

“Limiting weight gain and obesity—even in the face of genetic predisposition, childhood size, or adolescent weight—is possible through healthy diet, physical activity, and other positive lifestyle choices, which have consistently been shown to be the best preventive measures against most chronic morbidity and mortality. The public health messages from these studies are clear: even small improvements in diet quality, small increases in time spent physically active and decreases in time spent sitting, are significantly inversely associated with weight gain and obesity and the risk of chronic disease and mortality,” (p. 1661).

During 1986 and 1987, 140 of the nurses from NHS had their measurements taken by technicians and the data were compared to the nurses self-reported weights; the nurses, on average, under-reported their weight by 1.5 kilograms (about three pounds), their hip measurements by 0.5 inches while waist measurements tended to be similar to technician measured circumference (p. 1657). Nurses (118 of them) from the NHS II were relatively accurate in recalling their weight at age 18 (r=0.87) and well as height (r=0.94) and body mass index (BMI, r=0.84), though BMI was reported on average 0.5 lower than records indicate (p. 1657). Through mid-life/middle age, nurses in the study gained on average of 0.4kg (0.88 lbs) each year (p. 1675).

This paper also looked at the dietary choices of the nurses in the NHS and NHS II. According to the study, after an 8-year follow up, overall fat intake was weakly related to weight gain, though (especially in already overweight women) an increase in consuming animal, saturated and trans fat was associated with weight gain (p. 1657). After a 12 year follow up, higher whole grain and dietary fiber intake was associated with less weight gain and less chance of becoming obese (19% and 34% less chance, respectively); women with higher level of refined grain intake weighed more and had a higher risk level of becoming obese.  Fruit juices and other sugar-sweetened drinks were positively related to weight gain while increasing (or replacing sugar-sweetened beverages with) coffee (without sugar), tea, water and/or diet soda by one serving was related to weight loss over a 4-year time frame (p. 1657).

As logic would dictate, higher level of physical activity were positively associated with less weight gain and long-term weight management while nurses who were sedentary were at an increased risk for obesity – an hour of brisk walking each day was associated with a 24% lower risk of obesity (p. 1658). 

As for genetic interplay, the study showed that genetic predispositions to weight gain and/or obesity were exacerbated by poor lifestyle choices, while healthier lifestyles mitigated the risks posed by genetics (p. 1658-1659). 

Type 2 diabetes risk was also higher in women with a higher BMI – those with a 22 or less BMI were 3.6 times less likely as compared to women with a BMI of 23-23.9; in addition, women with a smaller waist (less than 28 inches) were six (6) times less likely than their counterparts (with a waist circumference of 38 or more inches) to get diabetes (p. 1659).

In relation to hypertension, BMI at 18 years old and weight in mid-life were “significantly associated;” long and mid-term weight loss was associated with a lower risk of hypertension while weight gain was associated with a higher risk of hypertension (p. 1659). As for heart disease, NHS nurses who gained 10kg or more (22lbs) from 18 had a 60% higher risk of heart disease, compared to those who maintained their weight within 3kg (6lbs) (p. 1659). The study also found that, “weight gain through middle adulthood of more than a few kilograms significantly raises heart disease risk, even if those gains are not enough to explicitly classify an individual as overweight or obese … the then-current US weight guidelines were likely ‘falsely reassuring’ to the large proportion of women who were within the normal BMI range,” (p. 1660).

In relation to incidence of cancer, the studies found that a higher BMI was associated with a higher risk of cancer; after a 16 year follow up from NHS, the study showed that obese women had a 59% higher risk of breast cancer, with other types of cancers, such as kidney and pancreatic, also increasing in risk with weight gain (p. 1660). In higher BMI nurses, quality of life was lower, and weight loss improved vitality, physical functioning and pain (p. 1660). Excess weight, in addition to weight gain after 18, was associated with (“significantly predicted”) diminished chances of successful aging, which means that a person has “no substantial cognitive, physical, or mental limitations at age 70 years,” (p. 1660).

In overall mortality: “Some researchers have suggested that excess weight is protective against mortality, but this ‘obesity paradox’ is likely observed because of confounding by smoking and existing or preclinical conditions that lead to weight loss preceding death (i.e., reverse causation),” (emphasis added, p. 1660). However, accounting for existing/preclinical conditions, those with an overweight or obese BMI are at a higher risk of premature death, compared to healthy weight individuals (p. 1660).