SOCIAL MEDIA AS A TOOL FOR HEALTH PROMOTION

Social media as a potential platform for health education/promotion is an intriguing topic, one that is ripe with controversial permutations in the halls of academia.  I think that this may serve as an excellent example of a context in which graduates who obtained their degree in health education any more than two decades ago may be at a slight disadvantage in terms of utilizing social media as a tool in health promotion campaigns.  At 56 years of age, I can personally recall a time when the only community health education available were pamphlets in the waiting room of doctor’s offices or at the local YMCA or community center, or sometimes in the form of “junk mail” from local hospital networks (I still get those in my mailbox).

 

I’ve decided to adopt a slightly less formal tone for this discussion, given the nature of the subject matter.  Facebook, Twitter, and other forms of social media have in recent years de-evolved in many ways, reminiscent of the National Enquirer or The Globe in print media.  When I log into Facebook these days, the sheer amount of rubbish posts on health and fitness propagated by seemingly reputable commercial entities is overwhelming!  Most of the “health promotion” and “heath education” links are just advertisements for ridiculous “snake oil” products without any true science behind them.  In this disturbing era of legitimate science sometimes labelled as “fake news”, the problem is that even when a respected institution of learning or legitimate health provider posts information on social media for mass dissemination, the data are often distrusted by the recipient.  Yet, despite the inherent challenges of social media used for health promotion, health educators clearly cannot afford to ignore a form of public communication whose tentacles extend as far and wide as social media platforms.  As with any tool created by humans, social media can either be misused as a weapon for spreading ignorance and misinformation or it can be used as a force for positive change.

 

Board-certified health educators would benefit greatly from formal training in the use of strategies for social networking to promote public health.  Here are a few ideas that I came up with:

 

  • Every medical center and care facility should have a Facebook site that posts daily information on health issues.

 

  • Medical facilities should encourage their patients, especially a younger demographic, to “follow” them on Facebook or Twitter.

 

  • Facebook and Twitter should have a symbol or alert feature which notifies users that the source of a post or tweet can be traced back to a legitimate trustworthy authority that has been verified by a government agency such as the FDA or NIH, as opposed to some shady supplement company trying to sell its ‘snake oil juice’ to unsuspecting consumers.

 

  • Advertising and promotion of health-related products on Facebookand Twitter should be regulated by the FDA with disclaimers as applicable, same as any bottle of vitamins with the familiar FDA warning on the label.

 

  • Schools and universities should take the initiative to launch massive health education/promotion campaigns utilizing Facebook and/or Twitter that updates users on the most current findings in research and dispenses diet and lifestyle recommendations accordingly.  Such initiatives should emphasize to consumers that information disseminated on health-related topics should only be given credence if they originate from trusted academic sources.

 

  • The general public need to be educated on the use of alternative search engines, instead of relying solely to Google, which has become a virtual wasteland of misinformation and advertising. Examples of reliable sources for nutrition and health-related news and the latest scientific studies include:

 

https://scholar.google.com/

https://www.ncbi.nlm.nih.gov/pubmed/

https://examine.com/

 

  • Misinformation deliberately or inadvertently spread by any form of mass media, e.g. television and the Internet, such as the ridiculous ‘news story’ from a couple years back that misinterpreted and sensationalized a particular study which concluded that people should stop taking multivitamin/mineral supplements because they are “worthless” should have been immediately discredited on social media by the FDA or AMA or any respected institution of higher learning.

 

  • Health-related government entities (e.g. CDC, PubMed, FDA, USDA) should all have a strong presence on social media platforms in this day and age, but they do not currently. Our tax dollars hard at work, right?

 

In conclusion, social media presents as a mostly untapped resource for health educators and promoters, not only because it reaches a much larger audience than most web sites or printed literature, but also because it caters to a largely uninformed population that tends to be afflicted with what I like to call a “smartphone attention span” and who are inundated daily by confusing and often conflicting data.  In a political climate in which science is scorned and distrusted, in a time of ‘flat earthers’ and ‘climate change deniers’, is it any wonder that it has become so challenging to get out reliable information to the public on health-related matters?

 

social_media

THE PRESUMPTIONS OF COMMUNITY-BASED HEALTH PROMOTION INITIATIVES

The importance of empirical evidence-based interventions for community health promotion cannot be overstated.  Analysis and reporting of data are critical for the development of effective programs because they need to be founded on real-world needs within a specific community or population.  As always, I emphasize the point that communities are comprised of individual members of the community taken as a whole, an excellent starting point but hardly a “destination” in effective health interventions.  Public health programs, including those involving financial incentives, would likely be more effective if designed based not on how perfectly rational people ought to make health decisions but on how real people actually make them.  Clearly, any potentially efficacious health promotion program based on an assessment of community needs and program evaluations must be grounded on pragmatism to be truly successful. Academic constructs such as ‘Expected Utility Theory’, ‘Prospect Theory’, and ‘Nonlinear Probability Weighting’, all reflect to varying degrees individuals’ response to health promotion efforts within specific communities, most often via traditional asymmetric paternalistic approaches to public health policy on a micro and macro level.  Perhaps the most erroneous of these constructs is ‘Expected Utility Maximization’, i.e. the presumption that humans are always rational and driven primarily by “self-interest”, which is not only an unrealistic expectation but also a double-edged sword.  I would propose a not unusual scenario in which an individual’s personal definition of “self-interest” is to be extremely inebriated as often as possible while still holding down a job they hate and continuing to endure a loveless marriage for practical reasons, whereas another individual’s definition of “self-interest” might involve staying as fit and healthy as possible while maximizing their longevity.  We all have to have priorities, right?

So, what we have essentially is two or more target audiences for any grandiose health promotion campaign within a community.  How then do we judiciously apply needs assessments and program evaluations to a community composed of both similar and dissimilar individuals?  Do we just shrug and commit the sin of generalization, patting ourselves on our shoulders for our well-meaning intentions and meddling interventions?  Further complicating health promotion efforts is the hot topic of ‘Nonlinear Probability Weighting’, which strongly influences individual health choices, such as when reference dependence leads to getting drunk at a bar with co-workers every evening after work, a behavioral component not likely to be altered by health promotion programs warning of the dangers of excessive alcohol consumption.  It’s great to have some sort of well-designed health education program in place as a starting point for broad interventions but, in the final analysis, what people really need is not health education (they know full well what they’re doing to their bodies) but rather realistic motivations for change, based on the same emotional impulses that lead them to pursue an unhealthful lifestyle habit, since we already know that rational thinking is not what drives most unhealthful behaviors.  The precipitating impulse for an unhealthful behavior is usually just a selfish desire for immediate pleasure and satisfaction, further framed within the context of camaraderie and social norms, a desire to be loved and accepted, to simply “fit in”, none of which have anything to do with healthful practices, unless of course one makes the superhuman effort to change one’s environment and circle of friends.

Health education and health promotion are indeed complex, intellectually challenging propositions, further hampered by budgetary and legislative limitations, especially when it comes to government-sponsored programs.  I have nothing but the highest admiration and respect for anyone who chooses this difficult line of work as their vocation!

slide_5

SOME THOUGHTS ON IDUSTRIALIZATION AND GLOBALIZATION

On the con side of the industrialization/globalization of the food supply equation, it presents as particularly noteworthy that the hard sell attitude of the fast-food industry is self-evident all over the world.  For example, as we are now deeply immersed in the 2018 Winter Olympics, MacDonald’s and Coca-Cola are two of the nine major sponsors for the Games in PyeongChang, which is a rather odd oxymoron.  MacDonald’s accounts for less than 2% of the total revenue for the Olympics, but still splashed out $200 million for the four-year period leading up to the Olympics. They have been major partners with the IOC (International Olympic Committee) for the last 40 years.  Prior to the 2016 Olympiad, McDonald’s built a 1,500 seat restaurant on the Rio Olympic site, the biggest in the world, and stated that they are trying to “raise brand awareness”, as did Coca-Cola.  I just wonder who those people are, sitting in the stands watching the Olympics, that are unaware of the existence of MacDonald’s and Coca-Cola, absorbing the stagnant branding of these monolithic processed food corporations.  My point is that aggressive advertising is deconstructing food cultures that outdate us by millennia and have been a huge part of the formation of national identities around the world.  This for me is extremely disheartening.  When travelling these days, in certain areas, I have noticed that it has become nearly impossible to find and immerse myself in the flavors of a nation, a sad fact that is becoming more and more apparent with each passing year.  One must also keep in mind that just by calling your restaurant “Burgermeister”, your burgers do not suddenly become part of local German cuisine, even if the burger tastes wonderful!

On the pro side of the industrialization and globalization equation, in our carbon emissions-obsessed era, local food activists (“locavores”) have embraced the notion of “food miles,” i.e. the distance that food items travel from farms to consumers, as the be all and end all of the environmental impact of agricultural production.  As has been repeatedly and rigorously documented in numerous life cycle assessment (LCA) studies, however, the distance traveled by food is pretty much a worthless indicator of sustainable development.  Among other issues, producing food typically requires much more energy than moving it around, especially when significant amounts of heating and/or cold-protection technologies, irrigation water, fertilizers, pesticides, and other methodologies are required to grow crops in one region, but not in another.  Reducing food miles typically means a greater environmental footprint, given the use of additional resources in less desirable locations.  Another issue is that the distance travelled by food matters less than the mode of transportation utilized.  For instance, shipping food halfway around the world on a container ship often has a smaller footprint per item carried than a short trip by car to a grocery store to buy a small quantity of these items.  Very few issues are as straightforward as they might seem at first glance!

grade-10-industrialization-and-economic-development-22-638

THE CHINA STUDY: A CLASSIC EXAMPLE OF RESEARCH BIAS

You may or may not be aware of a notorious book published back in 2005 that was authored by a staunchly vegetarian “scientist”, Dr. T Colin Campbell.  The book came to many dubious conclusions about the “ideal” human diet, which was founded on the goal of demonizing animal protein as an essential component of healthy eating.  The book is named after a massive 20-year observational study that Campbell conducted in the rural Chinese population, replete with cherry-picked data sets and wildly distorted conclusions.  This type of study generates correlations between variables, but cannot provide evidence of cause and effect.  The scientific method, as unanimously agreed upon by the global community of scientists, delineates that correlations only constitute observations and that those observations later need to be tested and verified with experiments, including clinical trials, which has not occurred in respect to the China Study.

All in all, Campbell studied 367 variables and made about 100,000 correlations, out of which only 8,000 were statistically significant.  With those kinds of numbers, we would expect to find at least 5,000 correlations that are “statistically significant” just by random chance, so the study provided Campbell with ample means to mine the data however he wanted.  In his book, Campbell used the data generated from this study to support his hypothesis that animal protein causes cancer, without any clinical trials backing up this claim.  As observations, correlations do not by default equate with causation.  Had I constructed my Master’s thesis with this same level of scientific credibility, I would have received a failing grade from my professor!  Campbell had to make the connection with six surrogate blood markers that he claimed to be reflective of animal protein intake.  His method is buried deep in a footnote, he provides no references supporting his use of these markers, and most of them did not even correlate with animal protein intake within the China Study itself.

At this point, it is pertinent to point out that Campbell serves on the advisory board to the “Physicians Committee for Responsible Medicine” (PCRM), an advocacy group of doctors and researchers with strong ties to PETA and animal rights groups.  It would certainly not be a stretch to name the author and this group ‘militant vegetarians’ who are in denial of human evolutionary biology based on selective ethics, not science.  Also, Campbell openly admits to having examined the data gathered by the China Study with the express intention of seeking to find associations between animal food consumption and disease.  In academia, we call such perversion of data ‘confirmation bias‘.  When attempting to establish an association between animal foods and disease risk, the only scientifically-confirmed argument which emerges is that processed CAFO meat from animals fed an unnatural pro-inflammatory grain-based diet and administered hormones and antibiotics during their miserable confined existence is the only context within which one can find a valid causal association between meat consumption and chronic disease states such as cancer, which has been identified via both epidemiological and clinical data.  On the other hand, the consumption of humanely raised grass-fed cattle, for example, has not been shown to pose the same health risk as processed CAFO meat.  The proverbial ‘devil’ is indeed in the details, once again.

So, in conclusion, the true underlying intent of my post today is not to go off on the China Study (I chose it merely as an example), but to encourage us to engage our critical thinking skills whenever we’re confronted with the latest bombshell science news that lands in the laps of our sensationalizing media outlets, social media, or bookstore shelves.  Whenever I read or hear of a new study, the very first questions I ask are “Who funded the study?”, “What potential bias is lurking behind the study’s research methods?”, and most importantly: “Who stands to gain the most from broad public acceptance of the study’s conclusions?”.

bigdairy

Beauty and health, not the same thing!

I would posit that “beauty”, as it relates to thinness and fatness, is not only specific to a culture and a particular historical era, it is also very context-specific.  For instance, athletes in a specific sport tend to rate each other’s physical attributes and the attractiveness of those attributes as consistent with a physique considered most functional and conducive to their sport.  Admittedly, a perfect example of this phenomenon can be found within the subculture of my own somewhat creepy sport of road cycling, in which we envy other riders in direct proportion to the girth and veininess of their thighs and calves, which is just one of the unspoken reasons that cyclists shave their legs, aside from the dubious physics of body hair as a significant contributing factor in aerodynamics.  There are members of my cycling team who scoff at the comical homoerotic implications of straight men secretly admiring each other’s glutes and thighs, yet this happens silently on every group ride.  Ironically, women who come to bike races as spectators often giggle at the sight of a man with tree-trunk legs and a scrawny upper body!  Yet this is the preferred aesthetic in my sport.

On the flip side of my observation, gymnasts, swimmers, ballet dancers and Sumo wrestlers all have starkly contrasting perceptions of the ideal “beautiful body” in relation to the physical demands of their sporting aspirations.  Separate from the context of the sporting life, cultural definitions of “beauty” outside the athletic realm make me a tad nauseous, such as the unrealistic cliched version of “beauty” promoted by Madison Avenue and Hollywood, e.g. Victoria’s Secret super models and perfectly-proportioned fitness models with six-pack abs who look as though they were genetically engineered by the Tyrrell Corporation.  It’s all nonsense!

In the final analysis, all that matters really is how we feel about our own bodies when we look in the mirror, within the context of our age, genetics, lifestyle, and goals, as well as whether or not the people that truly matter in our lives perceive us as “attractive”, which is unfortunate if you happen to be a movie star like Tom Cruise or Jennifer Aniston, because the entire world is judging you on the basis of your physical appearance.  But the rest of us should not be held to the same standard.  We don’t get paid millions of dollars to look astonishing every time a camera is pointed at us.  Speaking for myself personally, I only care whether or not my wife finds me physically attractive.  The rest of the world can smooch my wrinkled old 55-year-old tush, which is not half bad for a guy my age, I think.  Cycling does after all have its aesthetic benefits, but I also make sure to keep up with my push-ups, so that my legs don’t end up looking like Schwarzenegger’s while my upper body looks like someone who was just liberated from a concentration camp!

Not only is “beauty in the eyes of the beholder”, I propose that beauty is whatever you think it is, which should not be dictated by the media and popular culture.  It’s far more important to be healthy than to be considered attractive by a consensus of the population at large.

Health education is NOT health promotion!

There exists a panoply of pretentious academic definitions of “health education” and “health promotion” as a vehicle for intellectual debate imbued with only a scant semblance of real-world applicability.  The parameters of any cogent discussion of these nomenclatures comprises a deeply personal reflection of whether we, as academicians, believe that our efforts are promoting change or educating people on how to change, if indeed they are in the mood to change!  In the spirit of this thought experiment, I have chosen in this post to convey an anecdotal viewpoint of this duality and let the reader decide where they stand on the issue.  Having been employed as a Clinical Nutritionist working in a Functional Medicine physician’s office a few years ago, I have had the luxury of exploring firsthand the nuances that differentiate health education from health promotion, both in the direct counseling of patients, as well as interacting with groups of individuals within the context of community outreach health promotion programs that were innovated by myself and my former physician-employer.

Although the mechanistic nuances of health education and health motivation are somewhat overlapping and interrelated, one distinct difference that emerges between the two is that health education is exactly that, i.e. education, and may not necessarily provide a compelling motivation for an individual or population group to implement actual changes in diet and lifestyle that will result in positive health outcomes.  Some may argue that effective health education is by its nature a vehicle for eliciting an intrinsic motivation to change, but such a presumption conflicts directly with the perspective of an individual for whom social and cultural factors are a far more powerful influence on their behavior than the practical considerations of maintaining or optimizing their health.  In a clinical setting, working day-to-day with patients who were referred to me by my physician-employer, I encountered an alarming number of people (age, gender and ethnicity irrelevant) who considered unhealthful social activities with friends and family, including the routine consumption of traditional unhealthful foods, and sometimes even American junk food, as indispensable components of their cultural identity.  These same patients often considered any type of health education as a personal attack on their culture and way of life, sometimes exclaiming that “If I have to give up ‘this or that’, my life would not be worth living”.  This was exactly the point at which I had to transition my modus operandi from that of health educator to health motivator, usually by trying to convince the person sitting across from me that giving up a particular food that was harming their health was in fact an act of love and sacrifice made for their children, grandchildren, and loved ones, all of whom want them to be healthy and around for as long as possible to contribute to the family dynamic and pass their wisdom on to younger generations.

In my role as a Clinical Nutritionist, I often found myself confronted with two distinct challenges in health education and health promotion.  My first challenge, as a health educator, was to overcome the deluge of misinformation on what constitutes “healthy eating” as disseminated by popular media, in an effort to convince patients that my advice on health and nutrition was more scientifically valid than the myths they had heard on their favorite daytime talk shows or had read on Facebook.  The second challenge, as a health promoter, was to get to know them as individuals and customize a motivational plan for each of them that was most likely to illicit positive lifestyle changes directed at achieving quantifiable improvements in health outcomes, as measured through lab tests ordered by their doctor.

My closing thought on all this is simply to delineate that the fundamental difference between “health education” and “health promotion” is analogous to two sides of the same coin, i.e. one must educate at the same time as promote.  In other words, in the same breath in which we dole out advice to someone on what to eat, we should also provide a why which is more compelling than the why of why they had been eating as they had in the first place, choices that had compromised their health.  The truest definition of an effective health educator and promoter, in my opinion, is a well-informed nutrition professional who educates compellingly, provides actionable information to their target audience, motivates individuals and population groups to pursue health as a core value, and does so with an emphasis on sensitivity toward cultural differences and individual proclivities.

strategies-for-promoting-health-2-728

The economics of childhood obesity

Full disclosure.  I have no children of my own, but that does not preclude me from caring about the health and welfare of the children of America.  I therefore wish to discuss a specific permutation of the “consumer sovereignty” principle proposed by economists, as specific to a population of children.  I do acknowledge empirically that “consumer sovereignty” is markedly applicable, to varying degrees, in a discussion of adult populations, but the same concept is easily deconstructed as a myth in respect to children.  It presents as a truism that children, though possessed of unique and distinct personalities and proclivities, are nonetheless far more impressionable than adults.  Psychologists refer to this as “imprinting”, which occurs in the psyche of a child via numerous external influences, including of course advertising that is manipulatively directed at them specifically.  It strikes me as stunningly disturbing that legislative restrictions have to be imposed on monolithic processed food corporations (‘Big Food’) to prevent them from promoting the consumption of unhealthful obesogenic pseudo foods to a child population, when simple human decency and morality should be sufficient to discourage corporate entities from irresponsibly damaging the health of our children to garner profits, yet apparently we live in a society in which capitalist gains are prized above all other considerations.  A classic example of this egregious paradigm was well-illustrated by an interview I heard a few years ago on a podcast in which the inventor and co-founder of “SnackWells“, one of the unhealthiest snacks directed at children, openly admitted after having left the company that he does not allow his own kids to consume SnackWells products, simply because he is well-acquainted with the toxic list of ingredients.  Let us pause for a moment to let this sink in.  The guy said that he left the company because he could no longer live with himself, knowing what products like SnackWells, as well as candy and sodas, were doing to wreck the health of the first generation of children that are expected to live shorter lives than their parents!

Speaking anecdotally, a few weeks ago, I was in my car stuck at a long red light next to a school and observed children playing at a playground, most of whom were between 7-10 years of age.  At least half of them were obese.  I distinctly recall that, when I was their age, there was only the rare overweight child in my classes, and they were looked upon as a “freak” by other children, often cruelly treated.  But nowadays, overweight and obese children appear to be the norm.  Meanwhile, Big Food continues to aggressively market unhealthful “edible food-like substances” (as I like to call it) to our child population and our public schools continue to install vending machines loaded with this crap food in the hallways of said schools.  Where does all this end?  Certainly, it could be argued that the aforementioned societal burden falls first and foremost on the shoulders of parents, but it could also be argued that the parental task of getting children to consume healthful foods is made far more difficult by irresponsible food advertising, both on television and on the Internet, especially in a time when children are inundated non-stop by the “imprinting” I mentioned earlier in my post, not just during Saturday morning cartoons, as I vividly recall from my own childhood.

My final thought on this epic Greek tragedy is the long-held psychological theorem that once a child has been brainwashed by Big Food and fast food corporations throughout their childhood, by the time they are adults, the imprinting is in fact permanent and they will forever nostalgically associate edible food-like substances like Big Macs, Doritos and soft drinks as inextricably intertwined with their quality of life.  By that point, a consumer is indelibly robbed of their “consumer sovereignty”, while soulless processed food corporations laugh all the way to the bank.  My point in this diatribe is simply that no amount of government-subsidized “nutrition education” programs can reverse the insidious pervasive influence of corporate marketing, which has had decades to refine its subconscious brainwashing of consumers, especially young impressionable minds, through the power of manipulative marketing.  I would therefore posit that real change must be enacted within the microcosm of family and local community, because we certainly will never convince corporations to take a cut in profits, even for the sake of our children, our most precious resource.

childhood-obesity

Beauty defined by health

Feeling in the mood for a good rant this morning!  My target is a topic that’s been in the news quite a bit lately.  The concept of feminine “beauty”.  Gender, unfortunately, is a profound factor in personal dietary choices in most industrialized nations sharing the common dysfunctional aesthetic of women deemed more sexually attractive on the basis of their thinness, especially in this social media fueled era of ‘body shaming’.  The real-world dietary result of this shallow premise marketed by Madison Avenue and Hollywood is the endemic cultural meme of women ordering “light fare” such as salads devoid of protein on restaurant menus, whilst their male counterparts indulge with shameless abandon in high-calorie fatty foods such as steak and potato, washed down with copious quantities of beer and spirits.  Speaking anecdotally, I have observed this phenomenon firsthand every time I eat out at a fancy restaurant.  I’ve watched women despondently pick away at their food with their fork, as though it were about to leap off the plate and attack them.  Meanwhile, the man or men at the same table mindlessly shovel food down their gullet as though it were going out of style!  The aforementioned disparity presents as neither fair, healthy, or sane.  Food restrictions as a vehicle for attempting to attain unrealistic standards of physical attractiveness is quite simply a dysfunctional behavior, an eating disorder, one that I blame on our society, not on the population of women who are being pressured to look like cokehead supermodels and genetically-blessed freaks of nature.

There was a time long ago in Western society when “full-figured” women were not only the norm, but also considered highly desirable by the opposite sex.  So I have a great idea.  Why don’t we all endeavor to be as emotionally and physically healthy as possible, realizing that our “uber health” will radiate a beauty that transcends superficial shallow notions of what women should look like, a version of beauty that is easily recognizable by any person operating outside the vacuous confines of commercially-defined aesthetics.  And I’m not even talking about the tired old cliché of “inner beauty”.  I’m talking about a kind of physical beauty that cannot be found in a Victoria’s Secret catalog, but one which you can find hanging on the walls of any world-class museum anywhere in the world.

Beauty should be defined by health, not by fashion.  When I first meet a person, I look at the pallor of their skin, the sparkle in their eyes, the sincerity of their smile, and whether or not they radiate that “healthy glow” that is so obvious to anyone with a pair of eyes.  I’m checking out their posture and muscle tone, not their curves or lack thereof.  I’m not judging them superficially, and neither should any of us.  A person can be a bit “overweight”, yet still perfectly healthy, or they could be outwardly thin while physically devastated internally, carrying around deadly visceral fat padding their vital organs, i.e. what we nutritionists call “skinny fat” and doctors call “Non-Alcoholic Fatty Liver Disease” (NAFLD).  So I can honestly say that when I lay eyes on a super-fit fitness model with a six-pack, male or female, the first thing that comes to mind is “Let me see their bloodwork and an ultrasound of their liver!“.  Ironically, numerous studies have shown that a person can be extremely fit, yet quite unhealthy at the same time.  Professional bodybuilders for instance, on the day of competition, are usually on the verge of death when they walk out on stage looking absolutely shredded, sporting networks of protruding veins caused by extreme dehydration.  Impressive?  Yes.  Healthy?  No.  Don’t be fooled by external appearances!

So let’s give the girls a break, fellas.  Have you taken a look at your beer belly in the mirror lately?  Rest assured that Jennifer Aniston will not be jumping on that protuberance any time soon!

venus

Food insecurity in a prosperous nation

My blog post today ties in well, I believe, to the one from yesterday.  Please excuse the upcoming rant, but this post is as close as I will ever come to spicing up the subject of nutrition with a sprinkling of politics, simply because I can see no way around doing so in this instance.

Hunger and food insecurity in the United States is a multi-generational phenomenon that is quite common in a socioeconomically oppressed strata of our society, a culture in which the middle class has continued to shrink in size, while the number of affluent people on one end of the spectrum and impoverished families on the other end also continue to increase exponentially.  I myself grew up in a scenario of extreme poverty and hunger for the first 7 years of my life, in Communist Hungary, which was so egregious that it actually stunted my physical growth.  To my mother and grandmother, this was a normal situation that they had both lived with their entire lives.  In the worst case scenario, during and after the Hungarian Revolution of 1956, my mother had to walk past rotting corpses every morning just so she could wait for hours in a bread line, in order that she could feed herself and my 3-year-old brother.  Please do not mistake this anecdote for hyperbole.  It is the stone-cold truth!

Americans in general tend to regard socialism with disdain, and I agree with them in principle, but somebody needs to explain to me how exactly a capitalist system of government is so much better if people under both systems go hungry, especially children, who did not choose to be born into poverty.  I like to call myself a “bleeding heart conservative” when it comes to the topic of food insecurity.  I acknowledge and appreciate that my life is infinitely better now, here in the US (48 years later), than it ever would have been had my mother not escaped with me across the Hungarian border in 1969, but that is all the more reason why the tragedy of global food insecurity and hunger infuriate me so.  When my mother and I arrived in New York City at the Hungarian Refugee Center, we were congratulated and assured by everyone we met that we had arrived in the “land of plenty”.  It took us only a few years to figure out that America was only a “land of plenty” for a privileged few.  It is far too rarely discussed in our culture that, in the same way that wealth is passed on from one generation to the next, such as in the case of our new President, poverty is also passed on through the generations.  As a result, many children come into the world with lowered expectations programmed into them.  In a society in which the wealthy and powerful are allowed to continue to prey on the vulnerabilities of the poor, such as during the subprime mortgage crisis of 2007-2009, the ongoing problems of hunger and food insecurity will never go away completely.

A further irony is that any person, including a child, can be both malnourished and obese at the same time, exhibiting symptoms of Metabolic Syndrome and Type II Diabetes Mellitus.  At least, back in Hungary in the 1960s, starving people were easy to spot.  They looked emaciated!  But today, in economically disadvantaged neighborhoods here in America, we now have the ancestrally unprecedented anomaly of malnourished overweight folks, who not only under-consume nutritionally dense foods but also overconsume sugar and “empty calories”.  At face value, the aforementioned may seem antithetical to the laws of thermodynamics, but in fact the human body is not a steam engine.  It is far more complex than that.  As Gary Taubes so eloquently illuminated in his seminal books, “Good Calories, Bad Calories” and “Why We Get Fat and What To Do About It“, it is indeed possible to gain or lose body fat in both a hypocaloric and hypercaloric state, due to the ubiquitous biochemical mechanisms of our hormonal signaling, e.g. insulin and leptin.  All calories are not created equal!  Cheap “convenience foods”, such as those that are frequently consumed by the impoverished (that which they can afford to buy with ‘food stamps’), generally consist of highly insulinogenic carbohydrates and pro-inflammatory saturated fats that promote obesity while being deficient in micronutrients and often protein.  This can contribute to comorbidities such as vitamin and mineral depletions, as well as wasting diseases such as kwashiorkor, a condition that causes the body to cannibalize its own muscle mass in the absence of adequate protein containing all 9 essential amino acids.  Nutrition in the modern world, especially amongst the poor and uneducated, is a tragic state of affairs that breaks my heart to see going on in a prosperous nation like ours.  You don’t have to go to Africa or the slums of Calcutta to find starving human beings.  There are plenty of them right here in the United States.  Maybe if we looked up every now and then from our smartphones, we would notice the hungry unhealthy people all around us and show some compassion, instead of constantly texting and taking selfies!

Childhood Obesity 2016 06 08

The murky science of health promotion

Ecological models of health behavior are truly fascinating.  It could be argued, both academically and pragmatically, that we are all to varying degrees a product of our environment.  When I discuss this topic, I cannot help but be reminded of the analogous relationship of ecological models to two specific areas of interest for me personally, the nascent disciplines of epigenetics and nutrigenomics.  Certainly, we all carry a specific set of genes in our genetic makeup, some good, some not-so-good.  Our behaviors and environment affect the expression of those genes, hence epi (above) genetics.  The same principle applies to ecological models of health behavior.  Historically, there are abundant examples of individuals who were exposed to negative influences in their childhood and early adulthood, yet managed to rise above those influences by sheer strength of will, intrinsic motivations, and familial social support, such as the example of a young African American male living in the projects who is surrounded by drugs and violence, then grows up to be a congressman, or a youth in an impoverished unhealthy community who becomes an Olympic gold medalist, or a child who attended an underfunded public school in a low-income neighborhood and is now a Harvard professor, etc.

The various principles inherent to an ecological model of health education and promotion are all consistent with a framework of overlapping modalities that profoundly influence communities and individuals within those communities.  Such a model is predicated upon a “greater good” approach to health promotion that seeks to identify community-wide epidemiological risk factors and, conversely, environmental factors that influence the expression of the epidemiology, hence my allusion to epigenetics.

The first priority of effective health promotion is critical, i.e. social assessment, participatory planning, and situation analysis, because one must first accurately identify the ecological environment in which epidemiological factors can be identified within a community or society before one can design a potentially successful intervention strategy.  The first step to a solution is to identify the problem, as opposed to routine dissemination of generic dogma.  Health promotion is never a “one size fits all” proposition.  Predisposing factors, reinforcing factors, and enabling factors all influence the behavior of individuals within a community, to varying degrees depending on the individual, as posited in my previous observation about persons who have risen above their proverbial station in life.  Nonetheless, the greatest strength of ecological models of health behavior may be illustrated by the following analogy: the best way to eliminate fast food consumption in a community is to get rid of the fast food restaurants (unrealistic however).  The second-best approach would be to educate the community on the severity of health dangers associated with routine consumption of fast food, but the best solution of all is to provide a real-world motivation for people to want to stop consuming fast food and start eating healthier (a tricky proposition indeed).

Unfortunately, it is unrealistic to believe that administrative and policy initiatives enacted through government programs will significantly impact individual behaviors anywhere near as much as a simple intrinsic motivation, e.g. a young boy who decides to stop eating junk food so that he can lose some weight and make it onto his school’s football team, or a mother who packs a healthy lunch box for her child that goes to a school which serves unhealthy foods in the cafeteria.  Local, state, and federal health departments can never take the place of good old-fashioned parenting or the intrinsic motivations of individuals who just want a better quality of life and want to like what they see in the mirror.

All these arguments raise the million-dollar question (pun intended) of to what extent intrinsic factors and family/friends within an environment are influenced by the macrocosm of the environment itself?  The most salient point is that there is a huge difference between logic models of problems based on identifying causal relationships versus models of change designed to evoke actual behavioral modification within a community, resulting in measurable positive health outcomes.  We already know that most people have unhealthy habits and eat unhealthy, but what are we as a society going to do to compassionately encourage others to take a little better care of themselves?  Here’s an idea.  Lead by example!

fast_food