Talking About Health; Why Health Communication Matters

Consumer Reports and Apple Juice: Why Did Dr. Besser Apologize to Dr. Oz?

December 11, 2011

Not long ago, near the end of September, I reflected on the debate that took place between Dr. Besser and Dr. Oz about apple juice. It was a chance to consider the meaning of evidence when reports appear about the safety of food or other substances. I noted that I would have appreciated it if Dr. Besser had spent more time talking about why the evidence was of poor quality and less time attacking Dr. Oz.

Well, new data is in. Dr. Besser apologized to Dr. Oz and aimed his criticism at the FDA where data about arsenic in applie juice had been piling up for a number of years. A new study released by Consumer Reports added to that data. Dr. Oz gives tips about the amount of apple juice that should be safe for children at different ages to drink. It is clear that all of us need to keep asking for answers to the question: how did the science reach that conclusion? When we ask, someone just might listen and try to give a more valid answer…

How are church dinners changing eating habits in the Mississipi Delta?

August 30, 2011

Access is everything. Access to health care. Access to education. Access to employment. Access to role models who walk the walk and talk the talk.

One of the followers on this blog brought the New York Times article, ‘Preaching a healthy diet in the deep-fried delta’, to my attention. You can find the article at http://www.nytimes.com/2011/08/22/us/22delta.html?pagewanted=all.

Why in the face of so many messages about diabetes, obesity, and heart disease would anyone continue to eat fried foods? Because it tastes good. And because we socialize and have fellowship with family and friends over meals that feature these foods. But Reverend Michael Minor and other church leaders have been working to change all that.

‘No fry zones’ and fruit platters, fresh water and no soda… these are the new ‘normal’.

O-meg-a… How to talk about nutrition and omega 3?

August 17, 2011

As my husband completed his annual check-up this year, the doctor adivsed him to increase his intake of omega 3. So my ears perked up when Dr. Oz talked about the supplement [ http://www.drozfans.com/dr-ozs-advice/dr-oz-omega-3-vs-omega-6-the-big-o-know-your-omegas/].

As with all supplements, it can be challenging to judge products and make informed decisions about their use. And this is not exception. There is a great example of this in http://www.omegavia.com/dr-oz-omega3-supplements/ where a nutritionist gives a different point of view than Dr. Oz gave about omega 3.

This is what I appreciated about this summary.

First, it does not present a recommendation that is EITHER — OR… Instead, it carefully describes omega 3 options. As a result, I am left feeling better informed about how to judge products containing omega 3.

Second, it provides research summaries, including the citations to the scientific articles that support the discussion. I was able to search out some of the work and get even better informed about omega 3. This helps me be a better consumer of this supplement and gives me confidence to talk to my husband about using omega 3…

What do we say to youth about exercise?

April 13, 2011 GUEST BLOG POST by Elliot Searer

In many previous studies, we have found out that a healthy balance of diet and exercise is the most efficient way of staying healthy. I feel more emphasis needs to be put on children and how much physical activity they receive, and if they are even coming close to the recommended 60 minutes per day. I feel that organizations, like YMCAs, should offer more opportunities for our youth to have a place to properly exercise. Questions I have are:

Do our youth have proper access to a clean, safe environment suitable for physical activity and play? Do our youth understand the importance of physical activity from a health perspective? Do our youth have access to information that answers their questions about different exercises or exercise equipment? Do children understand the importance of nutrition in order to gain the most from their physical activity? Are youth who lived in dirty, unsafe conditions permitted to exercise at facilities like YMCAs despite possibly not having the proper financial means?

In a study conducted by Bowman and Neal, particpants between 5 and 17 years of age were scheduled to attend nutrition classes only or nutrition classes and family YMCA membership. The primary outcome measure was change in BMI-for-age percentile. Four participants in the control group and one in the treatment group achieved the target reduction of 2 BMI percentile points. Within the treatment group overall, YMCA attendees had a mean increase of 0.30 BMI points compared with an increase of 0.60 BMI points in nonattendees. Questions I have about the study in particular are:

1) In what type of shape, physically, were the eligible participants in before the experiment? 2) After? 3) What type of guidance was received from YMCA workers or someone of a trainer’s capability?

Through my personal experiences as an athlete, I find it extremely surprising that better results weren’t seen. The study states that some of the participants didn’t even go to the YMCA despite having a paid membership. I would like to know what type of guidance they were getting. For example, if they were doing proper exercises to promote weight loss or if they even knew how to properly operate the equipment and machines.

I feel a lot more can be done by communities to stress getting the 60 minutes of daily physical activity. Organizations should take a stronger stance and venture out in the community, and set up activities in parks or rec sites. It wouldn’t be hard, and would be low cost. Also, the organizations may not even have to use their facilities as host sites for the gatherings. Getting our youth out in the community, learning how to properly take care of themselves through physical activity could possibly lead to more benefits. Better eating habits, spreading nutrition information to other family members, and overall healthier communities may encourage children to pursue sports or other careers based on exercise/play as opposed to sitting at home…

M. A. Bowman and A. V. Neal; Policy and Financing in Family Medicine and the Medical Home. J Am Board Fam Med, May 1, 2010; 23(3): 277 – 279.

Can you set the table please?

March 30, 2011 GUEST BLOG POST by Melissa VanAlstyne

“I have work to catch up on”, “I’m not hungry”, “I’m going out”, we have all heard these excuses when it comes to sitting down to a family meal and often it seems easier to just forgo it all together. However, research is proving just how big of an impact family meals do have. Not only is sitting down to a family meal a good way to keep the family connected but it also has a number of health benefits as well, one of which is promoting healthy eating habits among adolescents.

According to a journal article in the Journal of Adolescent Health [full citation below] having a family meal can help to detect early signs of disordered eating as well as help prevent disordered eating from ever beginning. Having a family meal allows adolescents to see their parents engaging in healthy eating habits and therefore model their own eating habits after them. In addition, eating together allows parents to monitor their children’s diet which allows them to detect signs of disordered eating earlier.

While simply prioritizing sitting and eating together is good in and of itself, family meals should be times that parents and children value and find enjoyable. This means keeping discussion at the meal free from conflict around food or other issues, thus making the meal something the family looks forward to each day.

While life is undoubtedly extremely stressful and busy and finding time to sit down and eat together may seem a daunting task, the benefits of making sure to prioritize this family time cannot be overstressed. Adolescents who report more frequent and enjoyable family meals have been repeatedly found to be at a decreased risk for engaging in unhealthy weight control behaviors. So find a time that works for your family, sit down, pass the chicken and enjoy!

Fulkerson, J. Neumark-Sztainer,D. Story, M. Wall, M.(2004).Are Family Meal Patterns Associated with Disordered Eating Behaviors Among Adolescents? Journal of Adolescent Health,35. 350-359

Why is belly fat bad for your health?

March 17, 2011

I guess we would have to be living under a rock not to have heard health messages about belly fat. What I remember hearing the most is something like, “Belly fat is bad for you.” or “You want to concentrate on that belly fat.” And what I really got out of the messages had to do more with how we look–that belly fat is not attractive–than how it relates to health. I had seen a number of programs addressing how to get rid of belly fat [ http://www.meandjorge.com/] but never really made a connection with why in terms of health. Until the other day…

I can’t even say what program was on as I was making a meal but I heard them say that belly fat is especially harmful for our health because it is fat that works it way between and around our organs. That it literally does harm by wrapping our kidneys, liver, and intestines in fat… that was a rather horrifying image. The program went on to say that one cannot have belly fat liposuctioned away…because it is wrapping and twisting its way through our insides. The fat that can be liposuctioned away is just beneath the skin… [see this for a discussion, http://blog.healia.com/00488/belly-fat-damages-blood-vessels-could-cause-cardiovascular-problems]

To me, this is an example of one of those messages that needs to be clearer. I especially think that men are being shown as at risk for having belly fat…but the emphasis is too often placed on how the men look and not on what is really happening inside their bodies when the pounds add up around their middles…

Does drinking diet soda cause osteoporosis?

October 11, 2010

As I observe in the chapter, ‘What are my risk factors?’, we have a lot of competing goals in life that put being healthy in competition with other things going on. I was attending a conference and met a graduate student who was on crutches. I asked her what happened. She said that she had a fractured pelvis and it was blamed on osteoporosis. She told me that her osteoporosis was caused by drinking too many diet sodas. I decided that I would find a research review article about osteoporosis to share with my undergraduate health message design class. I did. And it reported that the evidence is inconclusive about a link between diet soda and osteoporosis. There was a collective sigh of relief from my students about that statement. Until I asked them, “How would we draw a conclusive link between drinking diet soda and osteoporosis? Why isn’t the research finding considered to be conclusive?”

And so, we launched into another discussion about self-report data and relationships based on having a condition versus not having the condition. “How much diet soda do you drink each day?” I asked. Some were able to answer, while others said, “It depends…” “On what?” I asked. “How hot it is outdoors.” “How much money I have.” “…you know.”

“I do.” imgp1303 I know that we often build an understanding about health conditions based on asking people questions. As a form of communication, asking people health questions is both an art and a science. How do we ask a question in a way that someone can give us an accurate and complete answer? If asked about how much diet soda you drink on an average each day, how do you decide to respond if you only drink diet soda when it is hot? Do you say, “none,” because it is winter? Do you respond “less than one a day” because you divide it out and even though you may drink a six-pack a day in the summer, summer is only really two months long…so it seems to average out to…less than one a day?

Trying to answer a question about how much diet soda has been consumed for a survey that may later be used to relate to participant responses about whether they had been diagnosed with osteoporosis or not may give some evidence to support a relationship. But the evidence is not…strong. If there are enough survey participants to consider all those who consume large quantities of diet soda and divide them into two groups–those with osteoporosis and those without osteoporosis, one might find that there are significantly more with the condition than without… This provides another kind of evidence.

If we think about what bones are made from…and we take diet soda and soak a bone in it…either or both may also provide some evidence that drinking large quantities of diet soda weakens one’s bones and contributes to osteoporosis. But we are not going to have a medical research study in which we give a randomly selected group large quantities of diet soda in order to see if their bones become weak… So, yes, this story of a student whose doctor was willing to tell her, “Stop drinking a six-pack or more of diet soda a day. In fact, stop drinking diet soda–period–and maybe we can prevent more bone deterioration,” imgp13045 suggests that her doctor used the evidence of a patient before him to guide a recommendation that the published medical research says was based on inconclusive data… And I say, “Let’s be truthful about what we mean when we talk about the data and the evidence. Let’s be willing to consider the ethical boundaries of research studies. Let’s realize that ‘inconclusive data’ sometimes means that a clinical trial, the gold standard of medical research, is not appropriate and so, there will never be “conclusive data”…

What does the “food pyramid” tell us about health communication and ‘old science’, ‘new science’, ‘conflicting science’, and no science’?

143_07811 May 3, 2010

I cannot recall the first time I heard about the ‘food pyramid’ but it was decades ago. The United States Department of Agriculture [USDA] online site at http://www.mypyramid.gov/ provides an overview of the research in this area. Right under the image of the pyramid on the homepage, the follow sentence is bolded: “One size doesn’t fit all.” Over to the left of the pyramid, the heading, ‘Specific Audiences,’ includes ‘Preschoolers’, ‘Kids’, ‘Pregnant & Breastfeeding’, and ‘General Population’–giving us a sense of groups whose needs vary. Skimming through some of the information, it doesn’t take long to affirm one of the points that I make in my book, Talking about health…

When communicating about health, sometimes there is no science to guide prevention guidelines, diagnosis, or treatment. A quick review of the history of the food pyramid shows that even before vitamins and minerals had been discovered, the USDA provided dietary guidelines–the first time appearing in 1894. The first food pyramid was published in the 1960s. The goal is to help us know how to talk about food and nutrition without having to be an expert. So food is divided into groups and we gain a sense of how much of each group adds up to a more versus less healthy diet.

Often, what we know in any area relating to health is based on ‘old science’ that we learned in school several years or even decades ago–forgetting the simple fact that times change. New knowledge is generated everyday. If asked, we know this truth. The trick is to apply it when we are communicating about health. ‘New science’ may support the ‘old science’ or build on its core idea. ‘New science’ may also conflict with ‘old science’ creating doubt and indecision. It is helpful when talking about health to consider the ‘age’ of the science we are using and also the characteristics of the people the science is based on. As suggested by the latest food pyramid, when science takes into account the ‘age’ of and audience, the food pyramid looks slightly different for different groups…