Cultural tweeking

An RD at my work passed along a most interesting article highlighting the benefits of culturally-based nutrition education. Specifically, this article was summarizing research performed on a very specific cultural group: Native Americans (the Cheyenne River Sioux Tribe, most specifically). Why of such interest to me? I work with a Native American population, predominantly Cherokees.

Upon moving to Oklahoma, I accepted my current position working with this most unique population, native to Oklahoma following the Trail of Tears. While I’m not a history guru by any stretch of the imagination, I’ve learned a lot about Native Americans, Cherokees, Indian culture, and of most importance to me, the food-based practices surrounding this population.

If you’ve never heard of fry bread, Indian tacos, or goulash, you’re on par with my prior knowledge of Cherokee food preferences. While I’m still not quite clear on goulash, I have the basics down. In addition, popular Cherokee foods include: black-eyed peas, fried potatoes, poached eggs, fried okra, cornbread and beans, beets, turnips, and much, much more. I’ve received a thorough first-hand education on Cherokee food culture and I find it fascinating…being the Yankee that I am. Cherokees like pizza, too, don’t worry!

My advice to fellow nutrition providers is to expand your cultural awareness and meet the needs of your patients. I’ve converted the word “refrigerator” to “ice box”… and “lunch” to “dinner” …and “dinner” to “supper” …and “morning” to “of a morning” …and “evening” to “of an evening”. While such dialect, if you will, if not native to me, I consider it a form of cultural sensitivity. I have far fewer patients asking me today if I’m Indian compared to my first few days in my role…and my hair remains blonde and my eyes remain blue. I do believe my “dialect” and “cultural awareness” have enabled me to appear more credible to my patients.

Somewhat similarly, culturally adapted diabetes education was associated with a reduction in both weight and BMI among type 2 diabetics from the Cheyenne River Sioux Tribe, according to research published in the September issue of the Journal of the American Dietetic Association. A six-month study performed by Kendra K. Kattlemann, PhD, RD at South Dakota State University in Brookings revealed said results. The study included 114 type 2 diabetic Northern Plains Indians from the Cheyenne River Sioux Tribe aged 18 to 65 years. The participants were randomized to receive either standard care diabetes education or diet education based on the components of the traditional Medicine Wheel which includes foods common to the tribe including: water, teas, corn, bread, potatoes, seeds, nuts, greens, elk, buffalo, and rabbit [1].

When compared with the control group receiving traditional diabetes care education, the culturally-adjusted group had significant weight loss and a decrease in BMI at the 6-month mark [1].

This research speaks volumes on the importance of knowing your patient culture. While I was largely familiar with African American and Hispanic cultures of Chicago, I am widening my span of cultural practice with the Cherokees…learning, loving, and having a blast!

What cultural make-up do you work with in your practice? Do you adapt your message based on the recipient? Age group? Gender? Diagnosis? Prognosis?

And I’ll take this opportunity to show-off my office and my FOOD MODELS! How COOL are they? Other employees are so jealous of my fun, colorful office. I think it’s super inviting and non-threatening to patients. What do you think?

 Food models galore!

My food products for label reading 

Indian Fry Bread (food model)

My favorite poster!

More nutrition posters in my office!

[1]. Culturally Based Nutrition Education Helps Weight Loss. Modern Medicine; Health Day News. September 16, 2009.

Food Stamps for Pounds!

A 14-year nationwide study shows the U.S. Food Stamp Program may help contribute to obesity among its users. The average BMI of a Food Stamp participant was found to be 1.15 points higher than nonusers. Specifically, women's BMI rose with food stamp usage, while men's did not [1].

People's BMI's increased faster when they were on food stamps than when they were not, and also increased the longer they participated in the Food Stamp Program. While the Food Stamp Program is intended to increase food security and combat hunger, there may be unintended consequences, such as obesity [1].

Based on these findings alone, the Food Stamp Program may have a significant impact on America's obesity rate with nearly 1 in 11 U.S. residents receiving food stamps in 2008. Because poverty and obesity are linked, the study accounded for income and a variety of other factors, including race and education [1].

Is this trend worsening? Yes. While Food Stamp Program participant BMI's have increased in the past, the rate is increasing. The average food stamp user's BMI rose 0.4 points per year on food stamps, compared with 0.07 points the year before they were receiving food stamps and 0.2 points the year after they no longer received food stamps [1].

While 2002 was the last year included in the study, participants were then receiving a mere $81 in food stamps per month. The study co-author of the study, Jay Zagorsky states, "I think it would be very difficult for a shopper to regularily buy healthy, nutritious food on that budget...Modifying the Food Stamp Program to include economic incentives to eat healthier might be an important tool for fighting obesity." It is true that calorie-dense, high-fat, processed foods tent to be less expensive and the least healthy of the available options out there [1].

So, the Food Stamp Program needs some tweeks. Maybe they should consult with WIC which recently removed juice (yes, even 100% juice) from their program. Just like with soda, juice is now being linked to excess weight gain among American's, and specifically among children.

Any thoughts on ways to better the Food Stamp Program? Should certain foods be excluded from the program due to their nutritional content...or lack thereof? Weigh in! Tax dollars making our nation more unhealthy should be concern for us all!

[1]. Food Stamp Use Linked to Weight Gain. Today's Dietitian. Source: Ohio State University. September 4, 2009.

Tax the people, not the products.

I think this idea is more feasible than taxing products. However, I don’t advocate BMI as an indicator of weight status. So, what gives? I’m not sure. Weigh in, folks. Pun intended : )

Undoubtedly, taxing “unhealthy” foods will lead to a further socioeconomic gap between the rich and the poor as such taxes would more proportionately affect the poor than the rich. I’m way too liberal to support such a thing – sorry, Oklahoma and your redness. But how can we quantify an American “fat enough” to be taxed? Hmm.

Many of America’s large companies and corporations reward employees for healthful actions. A friend who recently visited was given a health coach with whom she speaks with over the phone on a regular basis. She’s started keeping food records and reporting them to the coach. After my initial reaction of, “Health Coach? Can I see some credentials?”…I saw our friend recording her intake, despite our not-quite-ideal intake each day. The incentive? Money! Talk about a win-win…or at least that’s how I see it. Same goes for working out. Record your hours in the gym and receive monetary reward for your efforts. Suh-weet. Similarly with husband’s workforce, those employees who fill out the Health Questionnaire are rewarded monetarily. And they’re on the clock while they fill them out – again, win-win! Here’s the real kicker: make and keep regular preventive doctor appointments and earn money for doing so (i.e. dental exams, colonoscopies, and mammograms). Sound insane? There’s companies out there paying their employees for maintaining their health. Hard to believe there can be such extremes in the world.

More and more companies are building gyms with employee-only access, free of cost to employees. Husband’s work is hiring a Certified Diabetes Educator (CDE) next year, even. Seemingly, if you want the support in weight-loss and health endeavors…they’re at most people’s disposal -- especially those in corporate America. If we could get cafeterias on board with palatable (maybe even delicious…), nutritious food, maybe we’d see some overall health benefits.

Anyways. Rant over. If the US were to tax the fat – what criteria would their “fatness” be based off of?

…Waist-to-hip ratio?
…A modified Metabolic Syndrome (2-3 qualifying criteria versus the current standard)?
…A BMI greater than ______? What do you think?

P.S. I still advocate a sales tax on sugar and high-fructose corn syrup sweetened soda!
P.P.S. Thanks for the blog topic request, Erin...it was a great one!

7-Day Slim-Down

CNN Health may be on to something. I enjoyed their article, anyways. Here’s the scoop.

Sunday: Bite it, write it.

Keeping a food journal and recording your intake (everything you eat AND drink) certainly aids in accountability. Plus, Robert A. Charles, Ph.D. says you can expect to shed a whopping 5% of your body weight by adopting this habit [1]. Hey, 150-pound people out there…that’s nearly 8 pounds lost!

Monday: Take a multi-vitamin!

Two studies in the British Journal of Nutrition say that taking a multi-vitamin daily can help make you less hungry. Besides, those taking a multi-vitamin daily tend to weigh less and have lower BMI’s [1]. I’m sold on taking one!

Take a vitamin containing 100% of the RDA (recommended daily allowance) for: chromium, copper, folic acid, iodine, manganese, molybdenum, niacin, pathothenic acid, riboflavin, thiamin, zinc, and vitamins B6 and B12 [1].

Tuesday: Circuit train the WHOLE body.

Circuit training burns more calories than traditional strength-training says Dr. Jim Stoppani, author of, “Encyclopedia of Muscle and Strength.” Strength-training is more effective due to the shorter rest periods between sets. Leave about 20 seconds between sets and aim for 3 sets [1].

Wednesday: C-up

The Journal of the American College of Nutrition supports research on the use of vitamin C in fat burning – up to 30% more efficiency when consuming 500 milligrams or more of vitamin C while working out [1]. Plus, it’s good for immune function and wound healing.

Vitamin C-packed foods include: papaya, red bell peppers, broccoli, brussel sprouts, strawberries, oranges, cantaloupe, kiwi, cauliflower, kale, parsley, and lemon juice.

Thursday: Grab a gab partner

Create a weight-loss network. Grab a friend and motivate one another to keep up an exercise routine and healthy habits [1]. Exercising with a friend can not only make the activity more enjoyable, but you’re more likely to keep up with the routine and stay consistent with your regimen.

Friday: Eat the rainbow

Cutting calories can be as simple as adding more fruits and vegetables to the diet, according to the American Journal of Clinical Nutrition [1]. Due to the fiber content and low caloric-density, filling up on fruits and vegetables (5-9 a day every day!) can help decrease the consumption of all other, more calorically dense foods. Challenge yourself to snack on fruits and vegetables only. You may learn to like it…or to at least love the results!

Saturday: Relax!

Ralph LaForge, exercise physiologist at Duke University Medical Center, explains that people make better food choices when they are relaxed. He adds, you’re less likely to suffer from hunger pains when you’re relaxed. Take a few moments to perform some deep breathing when hunger strikes – it may just reduce your instinct to eat or to help curb your appetite for awhile longer.

Try the above each day this week and see how it goes. I’m going to give it a go!

[1]. Rossi, Carey. One Week to a Slimmer You: Focus on the Little Things. CNN Health. July 28, 2009.

Beyond "Baby Fat"

Maury Povich is infamous for his obese babies episodes (a close second to paternity testing, of course) featuring children who are double…triple… even quadruple the weight that is recommended for their age and length. While I’ll admit to partaking in the Maury episodes in the past myself, the reality is scary. Some go as far as to call such cases that of child abuse. What do you think?

USA Today ran a recent article on this very topic: does extreme childhood obesity qualify as child abuse? Jerri Gray, a South Carolina resident, was arrested in June with charges of criminal neglect despite her claims of doing all that she could to help her son lose weight. Her son, Alexander, tipped the scale at 555 pounds at the age of 14 and this unfortunate story has made nation-wide headlines [1].

Those opposing the charges, take the stance that if and when Jerri Gray is found guilty, “you have set a precedent that opens Pandora’s box,” says Grant Varner. Fortunately and unfortunately, I guess…I have to agree. In recent years, Texas, Pennsylvania, New York, New Mexico, Indiana, and California have toyed with the same predicament: what quantifies as a abuse when it comes to childhood obesity [1]?

Because the health implications of obesity many times don’t become chronic until adulthood, it makes it difficult to charge parents with child abuse, explains Linda Spears, Vice President of Policy and Public Affairs for the Child Welfare League of America. As for our South Carolina mother charged with criminal neglect, she could not comment as she has signed an agreement with a film documentary company for exclusive rights to her story [1]…what a winner of a mom, huh? If 555 pounds wasn’t evidence of abuse, benefiting from your son’s morbid obesity ought to be.

Some states are taking strides to reduce the rates and severity of childhood obesity, however. Twenty states (up from 4 states five years ago) have passed laws requiring schools to perform BMI screenings on children and adolescents. And while physical education is required in every state, the requirements “are often limited, not enforced, or do not meet adequate quality standards.” Not surprisingly, the CDC reports the number of obese children more than doubling in the past twenty years among children 10 to 17, and more than tripling among adolescents [1].

Rob Jones, a corporate wellness expert, advocates for charges being placed on parents rearing severely obese children. He explains that when parents give children drugs harmful to their health (illicit or not), they would be held responsible in court. Jones argues the same should hold true for food. Jones poses the question: is killing your children by way of food acceptable? Well, it’s not necessarily acceptable, but obesity does not necessarily put a child in immediate danger, either. Oh, the loopholes!

Keep yourself healthy and lead by example for your children. Introducing foods at a young age is key and participating in family meal times is integral to family togetherness and the maintenance of a healthy weight.

[1]. Barnett, Ron. S.C. Case Looks on Child Obesity as Child Abuse. But Is It? USA Today. July 22, 2009.

"First Comes Love, Then Comes Obesity?"

I lovingly borrowed the title of this blog entry from today's American Dietetic Association Daily News. I couldn't have come up with anything more clever myself...wise people those ADA'ers.

It is wedding season, and yay for marriage!! I am a May 2009 bride and so now... I'm a married old hag myself. Turns out, my life may be over...or at least ending sooner than anticipated now that I'm in a romantic partnership for life.

Published in April 2009 by the University of North Carolina at Chapel Hill (ew..) was a study performed on adult obesity in relationships [1]. What the study results revealed is that individuals in relationships with overweight individuals are more likely to become overweight themselves. BMI, thus, is correlated between spouses [2]. Worse yet, one's chances of becoming obese double after just a few short years of matrimony [1]. And if you think you're in the clear for living (in sin - kidding) with your boyfriend/girlfriend, you're wrong. The study showed that those living with their significant others are also at risk for packing on "some excess lbs" [1].

While a woman's risk of weight gain is incremental after year one, men's weight gain spikes only between years one and two of cohabiting [1]. Gee, that sounds fair.

The study looked at dating, cohabiting, and married adult couples. Concordance of outcomes observed included obesity, moderate-to-vigorous physical activity, screen time by romantic partnerships, and duration of time living with romantic partner. Negative obesity-related behaviors were most predominant in married couples while dating couples not cohabiting were less likely than cohabiting and married couples to become obese [2].

But...I guess I can see where the mistakes begin: wedding night. Forgive the RD...it was a rough job being the bride. You know what they say, be sure to eat. ....Check!

[1] Rochman, Bonnie. First Comes Love, Then Comes Obesity? Time. 2009.
[2] Gordon-Larson, Penny. Entry into Romantic Partnership Associated with Obesity. Obesity. Department of Nutrition, University of North Carolina, Chapel Hill. April 9, 2009.

Fit over fat?

I'd like to discuss the below excerpts from a Forbes article by Lacey Rose and Leah Hoffmann, as I strongly agree with the underlying health claims within.

"Joanne Ikeda, a nutritionist at the University of California at Berkeley, 'It's not about how we can help people lose weight; it's about how we can help them be healthier.' Despite popular diets' one-size-fits-all claims, she says there is not one single way to be healthy."

"Lean unfit people actually had a higher risk of death than the 'overfat' physically fit people," says Dr. Andrew Jackson, professor at the University of Houston and one of the study's authors."

In today's society we peg people as skinny (healthy) and overweight/fat (unhealthy), and this generalization is certainly incorrect in many, many instances. American's, as we well know, are under an immense amount of pressure to achieve and maintain a thin, attractive appearance...but health goes far beyond aesthetic preferences and social acceptance. While I took slight offense to my husband regarding my body as that of a "softball player" while out on a hike recently...I simply picked up my pace as if to say, "what's your point?!". And for the record, it's a hockey player's body, my dear.

I am not suggesting that 500-lb Smack-Jack is at a significantly lower risk of Metabolic Syndrome [1] because he swims laps five times a week...absolutely not. However, a shout-out goes out to all you adults who maintain a weight within or close to within BMI suggestive guidelines [2] while maintaining an active lifestyle (moderate to vigorous physical activity for at least 30 consecutive minutes most days of the week). Lighten up about the scale already and rejoice in knowing your next workout, and every workout, is duly noted by each and every of the billions and trillions of cells involved in your overall health and well-being.

[1] Metabolic Syndrome is defined as a group of metabolic risk factors: central/abdominal obesity, dyslipidemia, insulin resistance, hypertension, prothrombotic state, and/or a pro-inflammatory state (source: American Heart Association).

[2] A BMI (body mass index) between 18.5 and 24.9 is classified as "normal", a BMI of 25 to 29.9 is classified as "overweight", and a BMI over 30 is classified as "obese". To find out your BMI, click here.