Background. Lifestyle behaviors have a significant effect on preventing and treating disease, yet there is minimal graduate medical training in lifestyle medicine (LM). LM stakeholders’ perspectives regarding components of a LM fellowship have been examined. However, the student perspective has not been studied. Methods. A cross-sectional study design analyzed medical student perceptions surrounding LM domains and educational experiences. A Kruskal-Wallis analysis of variance and a Wilcoxon Rank-Sum Test were performed for each topic. Results. In all, 21 medical students completed the survey. All domains (nutrition, physical activity, behavior change, stress resiliency, and personal health), except smoking cessation, were rated as important or very important by at least 75% of the respondents (P = .002). The 4 highest-rated educational experiences, by at least 69% of respondents, included developing LM interventions and health promotion programs, clinical experiences, and teaching other health care providers about LM. Significant differences overall were found among the educational experiences (P = .005), with research and fund raising considered the least important. Conclusions. Medical students felt strongly about including nutrition, physical activity, behavior change, personal health, and stress resiliency as part of a LM fellowship curriculum. There was significantly less interest in smoking cessation. Desired experiences of students focused on delivery of LM.
Sedentary behaviors, activities spent sitting, or lying down during waking hours, are of significant public health importance. Television-viewing (TV-viewing) hours and total hours sitting are common self-report measures of sedentary behaviors. Given the widespread usage of these measures, the study purpose was to measure the concordance between TV-viewing hours and total hours sitting to determine whether they can be used as interchangeable measures of time spent in sedentary behavior. Using a sample (n = 2687) of workers from a group-randomized control trial, the current study assessed the concordance between weekday total hours sitting and TV-viewing hours. Tertiles were created based on the distribution of total hours sitting and TV-viewing hours. Weighted Kappa (Kappaw) statistics were calculated for the full sample and subgroups. Half of the sample reported 2 to 3 daily hours of TV-viewing hours and the most reported total hours sitting was 8 hours (14%). Kappaw statistics for tertiles of total hours sitting and TV-viewing hours were 0.005 (95% CI = –0.02 to 0.03), indicating little agreement. Kappaw statistics for subgroup analyses (body mass index categories, gender, and intervention assignment) showed poor agreement. Results do not support the use of total hours sitting and TV-viewing hours as interchangeable measures of sedentary behavior.
Context. An instrument is needed to facilitate a brief, but effective, counseling interaction between a patient and a provider. Such an instrument should raise patients’ awareness of their behavioral patterns and indicate their likelihood of weight loss statistically. Objective. To determine if the Lifestyle Questionnaire–Weight Management (LQ-WM) contains statistical properties that discriminate subjects’ weight trajectories. Design and Participants. A convenience sample of 269 college students at Utah Valley University in Orem, Utah, were administered the LQ-WM and a weight history questionnaire. Main Outcome Measure. A Lifestyle Score was created by subtracting the amount of self-reported unhealthy behaviors from the amount of healthy behaviors in the previous week. Results. The Lifestyle Score was significantly different among subjects who reported recently losing, maintaining, or gaining weight recently (P < .001) and in the previous year (P < .05). The Lifestyle Score was also significantly different among individuals losing weigh rapidly, moderately, and slowly (P < .05). Conclusions. This pilot study of the statistical properties of the LQ-WM supports that higher Lifestyle Scores associate with weight loss cross-sectionally. Future studies should examine its statistical properties longitudinally and with diverse samples to assess its suitability for clinical practice.
Purpose: Cardiac rehabilitation is associated with improved clinical outcomes, but the impact of individual cardiac rehabilitation sessions on readmission rates is less studied. Methods: A retrospective evaluation of the relationship between the number of cardiac rehabilitation sessions completed and all-cause and cardiac readmission rates at 1 year was conducted. The 1-year cardiac readmission counts were modeled via Poisson regression. Results: Of the 347 patients included in the primary analysis, 227 (65%) completed all assigned cardiac rehabilitation sessions. At 1 year, 135 patients (39%) had at least 1 cardiac readmission, and 155 patients (45%) had at least 1 all-cause readmission. The primary result was that every additional cardiac rehabilitation session completed was associated with a 1.75% lower incidence rate of 1-year cardiac readmission (P = .01) and a 2% lower incidence rate of all-cause hospital readmission (P = .001). Conclusion: Regardless of the number of cardiac rehabilitation sessions assigned, each additional session attended was associated with reduced cardiac readmission by 1.75% and all-cause readmission by 2%.
Objective. The aim of this study was to identify lifestyle habits that contribute to night sleep reduction in the Kuwaiti population. Methods. Children were 10 to 12 years old and were approximately equally distributed among 138 elementary schools representing the 6 governorates of Kuwait. In the first phase of the study, data were collected from 8317 children. The same data were collected 2 years later from 6316 of the children from the first phase of the study. Calibrated examiners conducted sleep evaluation, lifestyle habits interviews, and body weight measurements. A multilevel random intercept and slope model was conducted to determine the effect of screen-based activities on the daily night sleep hours at 3 levels: within schools, among children, and over time. The primary dependent variable was the number of daily sleep hours. Independent variables assessed were lifestyle habits including screen-based activity variables including TV and video game use. Results. Screen-based activities were significant factors that reduced daily sleep hours (P < .05). There were statistically significant variations between schools and children over time. Conclusion. Longitudinal analysis of Kuwaiti children revealed that TV and video game use were major risk behaviors contributing to decreased sleep duration with strong clustering effect of the observations within schools across time.
Neurology is often not discussed in lifestyle medicine circles, but it might be an area that will propel the cause of lifestyle medicine in the future. This is especially relevant in increasingly common neurodegenerative conditions such as Alzheimer’s disease, which have no known disease modifying therapy but lifestyle factors are implicated in causation.
Background. Skin cancer is the most common cancer in the United States with melanoma rates increasing. Sunscreen use is an effective way to protect the skin and reduce skin cancer risk. Limited research has been conducted examining the relationship between sunscreen use and other lifestyle factors. Interventions aimed at multiple lifestyle factors have shown promise for prevention and reduced health care costs. Objective. This study explores the relationship between sunscreen use and lifestyle factors associated with mortality and morbidity among young adults. Lifestyle factors examined included physical activity, substance abuse, smoking, sexual behavior, unintentional injury, and mental well-being. Methods. A convenience sample of 747 college students was surveyed about sunscreen use and other health risks. Data were analyzed using SPSS 19. Results. White, female students older than 21 years were more likely to use sunscreen. Texting while driving, low life satisfaction, and binge drinking were associated with inadequate sunscreen use. Limitations. Convenience sampling limits generalizability and surveys are subject to recall, self-report, and self-selection bias. Conclusions. The findings provide the framework to develop multiple risk factor interventions.
Medication adherence plays an important role in the effective management of chronic conditions, yet nonadherence related to therapeutic complexity and numerous visits to the pharmacy is well documented in the literature. Medication Synchronization (Med Sync) programs work to overcome this barrier by standardizing medication refills for a less frequent, generally once monthly pickup. Features of Med Sync programs as well the impact on adherence will be discussed.
COPD is a common, preventable, and treatable disease characterized by persistent airflow obstruction associated with enhanced inflammation in the airways and the lung in response to noxious particles or gases. Clinical history and pulmonary function testing are necessary for accurate diagnosis. While exposure to tobacco smoke remains a common cause, other etiologies and underlying genetic predisposition play significant roles. Treatment options are numerous and should be individualized based on symptoms and exacerbation frequency.
Many health care providers are concerned with the role environmental exposures play in the development of respiratory disease. While most individuals understand that outdoor air quality is important to their health status, many are unaware of the detrimental effects indoor air pollution can potentially have on them. The Environmental Protection Agency (EPA) regulates both outdoor and indoor air quality. According to the EPA, indoor levels of pollutants may be up to 100 times higher than outdoor pollutant levels and have been ranked among the top 5 environmental risks to the public. There has been a strong correlation between air quality and health, which is why it is crucial to obtain a complete environmental exposure history from a patient. This article focuses on the effects indoor air quality has on the respiratory system. Specifically, this article will address secondhand smoke, radon, carbon monoxide, nitrogen dioxide, formaldehyde, house cleaning agents, indoor mold, animal dander, and dust mites. These are common agents that may lead to hazardous exposures among individuals living in the United States. It is important for health care providers to be educated on the potential risks of indoor air pollution and the effects it may have on patient outcomes. Health problems resulting from poor indoor air quality are not easily recognized and may affect a patient’s health years after the onset of exposure.
Diabetes threatens a patient’s health and quality of life, whereas disease diagnosis itself could potentially serve as a teachable moment for initiating behavior change. This study assessed diabetes diagnosis as a possible teachable moment for screen-based sedentary behavior among US adults. The nationally representative sample (n = 3690) came from the 2005-2006 and 2011-2012 National Health and Nutrition Examination Survey. Self-reported hours spent on screen-based sedentary behavior (television/video watching, computer/digital device use) were measured by the Global Physical Activity Questionnaire. Diabetes/prediabetes was identified by fasting plasma glucose and the glycated hemoglobin test. Logistic regressions were conducted to examine the relationship between diabetes diagnosis and screen-based sedentary behavior, adjusting for individual characteristics and sampling design. Compared with those with undiagnosed diabetes, the adjusted values for prevalence of daily television/video watching ≥2 hours (77.45% vs 65.14%), computer/digital device use ≥1 hour (43.20% vs 36.52%), and total screen time (ie, television/video watching plus computer/digital device use) ≥3 hours (66.75% vs 45.78%) were all noticeably higher among adults with diagnosed diabetes, although only the difference in the prevalence of daily total screen time was significant at P < .05. No evidence was found regarding diabetes diagnosis as a teachable moment in reducing screen-based sedentary behavior in US adults.
During the past 40 years, we have witnessed significant advances in the pharmaceutical and interventional treatment of cardiovascular disease (CVD), which have helped achieve a decrease in morbidity and mortality for this illness. Nevertheless, CVD remains the number 1 killer of women and men in Western civilizations. This fact is in stark contrast to the scenario in multiple whole food, plant-based nutrition (WFPBN) cultures, where CVD is virtually nonexistent. The utility of plant-based nutrition to halt and prevent CVD has been demonstrated epidemiologically, during wartime deprivation, in large cohort and population transitioning studies, and through prospective randomized and nonrandomized investigations. A basic scientific study confirms that omnivores have intestinal bacteria capable of converting animal food to trimethylamine oxide (TMAO), which injures blood vessels, whereas those eating plants only do not have intestinal bacteria capable of producing TMAO. Despite this overwhelming evidence for the safety, simplicity, and efficacy of plant nutrition to halt and prevent coronary artery disease, the cardiovascular medicine community has failed to embrace this option of therapy and persists in palliative treatments associated with high morbidity, mortality, and expense. It is long overdue to question why.
Intention can be a poor predictor of actual health behavior change—now termed the
What began as a National Geographic expedition, lead by Dan Buettner, to uncover the secrets of longevity, evolved into the discovery of the 5 places around the world where people consistently live over 100 years old, dubbed the Blue Zones. Dan and his team of demographers, scientist and anthropologists were able to distill the evidence-based common denominators of these Blue Zones into 9 commonalities that they call the Power 9. They have since taken these principles into communities across the United States working with policy makers, local businesses, schools and individuals to shape the environments of the Blue Zones Project Communities. What has been found is that putting the responsibility of curating a healthy environment on an individual does not work, but through policy and environmental changes the Blue Zones Project Communities have been able to increase life expectancy, reduce obesity and make the healthy choice the easy choice for millions of Americans.
As the number of people living with chronic diseases climbs upward, novel methods to address the root causes of these disease are necessary to transform the state of our nation’s health and our health care system. Interventions directed at making lasting lifestyle changes can have a major impact on the overall health of patients. In this pilot study, 4 obese patients, with unhealthy habits and abnormal blood profiles and biometrics, were able to significantly improve their lifestyles and their lab values with the 3-month intervention of a lifestyle medicine team, including a physician trained in lifestyle medicine, a certified wellness coach, a licensed nutrition specialist, a physical therapist, and a licensed mental health professional. Two patients had type 2 diabetes, and all 4 were hypertensive (blood pressure > 120/80 mm Hg). After the intervention, all improved their nutrition and increased their physical activity. In addition, all experienced improvements in lipid counts, blood pressure, weight loss, and cholesterol. The diabetic patients’ levels of hemoglobin A1C dropped to normal. These successes show the benefits of a lifestyle medicine team approach.
Objective: The objective of this study was to test the effect of an online education intervention on providers’ attitudes, beliefs, knowledge, and practices pertaining to antenatal physical activity. Study design: A sample of 181 providers (ie, obstetricians, family medicine physicians, and certified nurse-midwives) was directed to view an online training on antenatal physical activity guidelines, counseling methods, and resources. Providers completed surveys before and 12 weeks after viewing the educational website material. Repeated-measures analyses were conducted to examine the effects of the online education. Results: A total of 164 providers (87.2%) completed baseline and follow-up surveys. After viewing the online training, participants more strongly agreed that it was their responsibility to encourage engagement in antenatal physical activity (P = .02) and believed that women would follow their advice about beginning antenatal physical activity (P = .01). Viewing the website material facilitated an increased confidence in ability to effectively talk with overweight and obese women about physical activity (P = .04) and more frequent advising to begin a moderate-intensity physical activity program for sedentary women (P = .02). Knowledge on antenatal physical activity guidelines also improved. Conclusion: Findings suggest that online educational interventions may be an effective tool in altering providers’ knowledge and practices pertaining to antenatal physical activity.
Counseling patients on behavior change is an important skill that traditional medical training does not emphasize. Most practitioners are trained in the expert approach to handle problems, which is useful in the acute care setting. However, in the case of chronic disease, a coach approach is more effective. This approach allows the patient to reflect on his or her own motivators for change as well as obstacles hindering the change. Changing from the expert approach to the coach approach is contingent on the lifestyle medicine practitioner sharing information when the patient is ready to receive it, listening mindfully, asking open-ended questions, treating problems as opportunities to learn and grow, and encouraging patients to take responsibility for their actions. By collaborating with the patient, the practitioner can guide patients to find solutions to the problems they are facing and foster an environment that leads patients to self-discovery, accepting responsibility for their behaviors, and ultimately, achieving goals that result in healthier daily habits. As a framework and a guide, lifestyle medicine practitioners can use a 5-step cycle of collaboration and a ladder of behavior change when working with patients on behavior change.
Many challenges in reversing the chronic disease epidemic boil down to a lack of available time. Without time, implementing effective lifestyle medicine therapies and creating a therapeutic partnership between provider and patient is ineffectual. Although useful, the individual medical appointment model alone has not proved to "bend the cost curve" or improve morbidity. Lifestyle-based group visits (LBGVs) are extended clinical encounters that allow physicians and their patients to exchange valuable information regarding optimal chronic disease management within a supportive group format. Clinically, LBGVs improve patient knowledge scores and chronic disease outcome measures. Operationally, they reduce lobby wait times, increase available new and established patient appointment slots (ie, improving access), and improve provider and patient satisfaction measures. LBGVs simultaneously improve patient lives, disease management costs, and practice revenue when used in primary care and specialty practices. By providing personalized lifestyle education coupled with in-depth behavior modification support from a provider and a peer group with similar successes and struggles, group visits reduce symptomatology and reverse disease progression without expensive medications, procedures, and technologies. Despite perceived obstacles, the group medical appointment model is easy to implement and provides consistent benefits in settings ranging from residency programs to cash-based boutique practices.
Thousands of dollars are spent today with policies encouraging physical activity and healthy eating, but nutritional consultation per se has continuously failed to yield consistent and lasting results. The aim of this case report is to detail and evaluate nutritional coaching (employing health coaching techniques) in promoting lifestyle changes, enabling improvement of nutritional and body composition associated parameters. The patient in this study had previously engaged in a series of different diet regimens, all of which failed in achieving the proposed aim. After 12 nutritional coaching sessions (one per week) with the strategy presented herein, reductions in body fat mass and in total body weight were attained. Nutritional habits also improved, as the patient showed decreased total energy intake, decreased fat intake, and increased fiber ingestion. Daily physical activity and energy expenditure were enhanced. The coaching program was able to induce immediate health benefits using a strategy with the patient at the core of promoting his own lifestyle changes. In conclusion, the nutritional coaching strategy detailed was effective at helping our patient develop new eating patterns and improve related health parameters.
Primary care physicians experience high rates of burnout, which results in diminished quality of life, poorer quality of care, and workforce attrition. In this randomized controlled trial, our primary aim was to examine the impact of a brief mindfulness-based intervention (MBI) on burnout, stress, mindfulness, compassion, and resilience among physicians. A total of 33 physicians completed the baseline assessment and were randomized to the Mindful Medicine Curriculum (MMC; n = 17) or waitlist control group (n = 16). Participants completed self-report measures at baseline, post-MBI, and 3-month follow-up. We also analyzed satisfaction with doctor communication (DCC) and overall doctor rating (ODR) data from patients of the physicians in our sample. Participants in the MMC group reported significant improvements in stress (P < .001), mindfulness (P = .05), emotional exhaustion (P = .004), and depersonalization (P = .01) whereas in the control group, there were no improvements on these outcomes. Although the MMC had no impact on patient-reported DCC or ODR, among the entire sample at baseline, DCC and ODR were significantly correlated with several physician outcomes, including resilience and personal achievement. Overall, these findings suggest that a brief MBI can have a positive impact on physician well-being and potentially enhance patient care.
Prospective studies examining postpartum weight retention (PPWR) in relation to the appropriateness of gestational weight gain (GWG) and leisure-time physical activity (LTPA) during pregnancy and postpartum are lacking. While utilizing varying estimates of prepregnancy weight, we sought to prospectively examine associations among the aforementioned variables. Our sample consisted of a subset of women from the Archive for Research on Child Health Study (n = 68). Prepregnancy weight was obtained via questionnaire and birth certificates. GWG (2 estimates) was calculated by subtracting prepregnancy weight estimates from weight at delivery and classified as "excess" or "not excess." Pregnancy and postpartum LTPA were self-reported and dichotomized at recommended levels. Prepregnancy weight estimates were subtracted from self-reported postpartum weight to calculate 2 estimates of PPWR at 6 months. Linear regression was used to examine relationships among GWG and LTPA, and PPWR. Estimates of excess GWG were associated with increased PPWR (mean difference = 3.3-8.9 kg), even after adjustment for prepregnancy body mass index and breastfeeding. Meeting pregnancy and postpartum LTPA recommendations did not significantly predict PPWR. Our findings highlight the importance of encouraging appropriate GWG and provide insight into the impact varying estimates of prepregnancy weight may have when exploring associations among these variables.
Objective. To examine the impact of a community-informed and community-based Health-Smart Church (HSC) Program on engagement in health promoting behaviors (healthy eating and physical activity) and health outcomes (body mass index, weight, and systolic and diastolic blood pressure). Design. A total of 70 overweight/obese Hispanic adults participated in an intervention group (n = 37) or a waitlist control group (n = 33) in 2 Hispanic churches in Bronx, New York. Results. Post-intervention the intervention group significantly increased in frequency of healthy eating and physical activity compared to the waitlist control group. Although no significant changes in body mass index or systolic blood pressure were found for either group, the intervention group decreased significantly in weight from pre-intervention to post-intervention. Conclusions. The results of the present study add to the growing body of literature evidencing the successful use of community-engaged and community-based participatory health promotion interventions with racial/ethnic minority populations and highlight important practices and considerations for similar health promotion interventions with these communities.
Background. Physical activity (PA) can facilitate weight loss, help avoid weight regain, and improve body composition. This study examined the relationships between PA level and changes in anthropometric measures among university employees in a worksite wellness program. Methods. A registered dietitian provided individualized assessments at baseline followed by a 12-week education intervention with follow-up at 12 and 26 weeks. The International Physical Activity Questionnaire–Short Form was used to calculate PA ≤150 or ≥150 min/wk, median min/wk, and metabolic equivalent of task (MET) min/wk at each time point. Repeated-measures general linear model and nonparametric tests were used to assess significant differences over time. Results. Of the 64 participants, 89% were women and 50% were non-Hispanic white. At 12 and 26 weeks, participants experienced significant decreases in weight (P = .001). Among women, waist circumference and abdominal obesity decreased significantly (P < .01). PA ≥150 min/wk (n = 21) was associated with continued weight loss (P = .03) and decreases in body fat percentage (P = .02) between 12 and 26 weeks whereas PA ≤150 min/wk was associated with weight and body fat percentage regain during the same time period. Conclusion. Among women in a worksite wellness program, higher levels of PA were associated with avoiding weight and body fat regain following successful loss.
Reducing Disability in Alzheimer’s Disease (RDAD) is an evidenced-based intervention for individuals with dementia and their caregivers aimed at reducing the psychosocial strain of the caregiver and improving functional ability of the individual with dementia. Overall efficacy, acceptability, and feasibility outcomes have been published regarding RDAD; however, no specific outcome information has been published on the objective physical performance measures (PPM) of gait speed, functional reach, and balance. Data from the Replication of RDAD (n = 508) was utilized to test the hypothesis that each PPM would show change for participants who completed the program. No significant changes were identified in 3 PPM: gait speed (t = .24, P =.81), balance (t = .23, P = .82), and functional reach (t = –.55, P = .58). To strengthen the research about exercise interventions for individuals with dementia, discussion and interpretation of nonfindings is important for improving intervention designs and methodologies. In the case of RDAD, the intervention protocol may require a sufficient dosage of exercise with respect to fundamental exercise science principles, or there may be misalignment between the intervention and outcome measures.
Lifestyle medicine interventions are typically intensive by design. This study explored the optimal "dosage" of a well-known lifestyle medicine intervention—the Complete Health Improvement Program (CHIP). A total of 2383 individuals (mean age = 61.0 ± 9.2 years; 34% males) participated in either an 8-session (N = 448) or 16-session (N = 1935) version of the CHIP intervention conducted over 4 weeks in community settings throughout North America. Both the 8- and 16-session groups experienced significant improvements in all the chronic disease risk factors measured. There was no difference between the changes experienced by the 8- and 16-session groups in lipid profile, fasting plasma glucose, or systolic blood pressure. The 8-session group experienced a significantly greater reduction in body mass (0.3 percentage points or 0.8 lbs, P < .01), but the 16-session group recorded a significantly greater reduction in diastolic blood pressure (2.8 percentage points or 2.2 mm Hg, P < .01). There was no clear difference between the outcomes achieved in 4 weeks by the 8- and 16-session versions of the CHIP lifestyle medicine intervention. This study suggests that the short-term outcomes achieved by a 16-session CHIP intervention can be achieved in half the number of sessions, which has implications from a resourcing and cost-effectiveness perspective.
Background. The results presented from a practice survey include cases of interest, demonstrating improvements in cardiometabolic risk factors utilizing a Nutrient-Dense, Plant-Rich (NDPR) diet. It includes changes in weight, blood pressure, and lipids parameters derived from the survey and retrospective chart review. Methods. Practice records and interviews were used for case history descriptions. Participants’ data were collected via an online survey. Results. Adherence to a NDPR dietary protocol resulted in reduced low-density lipoprotein cholesterol and serum triglycerides. Compliance of greater than 80% with the target diet resulted in an average sustained weight loss of over 50 pounds in 75 obese subjects. There was a corresponding average reduction of 27.8 mm Hg in systolic blood pressure for the 127 survey responders with untreated hypertension at baseline, and a 42.2 mg/dL average decrease in low-density lipoprotein cholesterol for the 328 survey responders, not on cholesterol reducing medications. Conclusion. The outcomes from both the survey responders and cases demonstrate the potential for the NDPR dietary intervention to improve weight, blood pressure, lipids, and even reverse severe cardiovascular disease. Though this is a report of cases and self-reported benefits, it adds evidence to support the need for further studies investigating the potential of this dietary intervention.
Interpersonal violence has a profoundly negative impact on individuals and our society. Health care providers are in a unique position to identify interpersonal violence, support survivors, and to contribute to violence prevention. The purpose of this article is to describe the nature, scope, and impact of interpersonal violence, its subsequent trauma on individuals, families, and society, and to delineate how providers can apply trauma-sensitive practice. The authors provide definitions, examples and prevalence rates and review theories of violence and violence prevention. They describe how to create a trauma-sensitive practice by being aware of the trauma that accompanies violence, the barriers to violence prevention, and how to intervene with patients about violence. Providers are urged to adopt universal screening practices, educate themselves on the nature of interpersonal violence and engage in screening, education, collaboration, and social justice activities to reduce interpersonal violence. Resources are provided to assist health care organizations, providers, and patients in addressing interpersonal violence.
The main objectives of this article were to determine the demographic factors, the program related factors and the behavioral factors that influence Michigan Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program–Education outcomes. Secondarily, we sought to understand the trends and changes in Healthy Eating Index (HEI) scores across the differing baseline score groups. The data were collected by nutrition instructors in a pretest, posttest design to capture change in healthy eating habits through changes in HEI scores. The participants were all low-income program participants during the years of 2011 and 2012, living in Michigan. Findings show that eating habits improved most in households with weekly per-person income within $100 to $500, and with Caucasian females living in cities or suburbs. Improvements were also greater with those who took part in the Expanded Food and Nutrition Education Program, where the participants exhibited higher baseline frequency of planning meals before grocery shopping, comparing prices, and budgeting enough money for food and food related purchases. Overall, the average change in HEI scores increased by 2.3 points, however, the variability between the participants’ changes was high, suggesting that more targeted program lessons might increase program efficacy, especially for those participants with high baseline HEI scores.
Gastric banding (GB) is considered an option to support weight loss for individuals who are unable to lose weight through diet and exercise alone. Exercise is an important element of maintaining gradual weight loss following GB. Dog walking may be one method to encourage exercise and contribute to continued weight loss. Over a 5-year period, 24 individuals aged between 31 and 58 years (21 female; 12 dog-owners) were weighed at 7 time points. Intention to treat MANOVA analysis showed both groups lost a significant amount of weight, F(6, 17) = 15.7, P = .001, p2 = .85, but no difference was observed between dog owners and non–dog owners, F(6, 17) = 0.66, P = .68, p2 = .19, although from 24 months postbanding, data indicated dog owners appear to weigh less than non–dog owners. Further longitudinal research is warranted beyond 5 year post-GB; and encouraging exercise through dog walking may be a useful adjunct to increasing activity and promoting weight loss following GB.
Type 2 diabetes (T2D), historically affecting primarily older individuals, now affects younger people. Few studies have analyzed diabetes risk factors among younger individuals, including college students. We investigated risk in that overlooked population. A 2-part diabetes risk assessment survey was administered to University of California Irvine (UCI) students, faculty, and staff for 2 months. Part I, including 26 questions, assessed participants’ nutrition, physical activity, and stress management behaviors. Part II assessed risk according to American Diabetes Association (ADA) Risk Assessment’s 8 demographic and lifestyle questions producing a risk score. Scores and behavioral factors analyzed risk on individual and community levels. Recruitment included emails and flyers promoting the UCI Electronic Educational Environment survey link. According to the ADA Risk Assessment scores of the 915 respondents, only 4% are at high risk of developing T2D. Although these scores indicate a small population at risk, our survey revealed a high prevalence of individuals practicing multiple unhealthy lifestyle behaviors associated with diabetes. These multiple behaviors may lead to high percentages of college students developing T2D, despite current low ADA risk status. We conclude the ADA Risk Assessment is geared toward an older demographic and may reflect short-term risk rather than longer-term risks.
We reviewed lifestyle factors that influence serum uric acid levels and risk of gout flare, and how to improve their deleterious effects. Since obesity increases uric acid and weight gain increases gout risk, weight reduction by daily exercise and limiting intake of excess calories is recommended. However, strenuous exercise, which causes adenine nucleotide degradation; starvation, which decreases uric acid excretion; and dehydration may raise the level of uric acid in serum and trigger gout. Increased intake of purine-rich foods, such as meat and seafood, raise the level of uric acid in serum and is associated with increased risk of gout, whereas dairy products, especially low-fat types, are associated with a lower risk of gout. Also, heavy alcohol drinking raises the uric acid level and increases the risk of gout through adenine nucleotide degradation and lactate production. Sweet fruits and soft drinks containing fructose should be moderated, since fructose may raise uric acid and increase gout risk through uric acid production and/or decreased excretion. On the other hand, the Mediterranean diet is recommended for gout patients, since it may also help prevent hyperuricemia. Furthermore, coffee and vitamin C supplementation could be considered as preventive measures, as those can lower serum uric acid levels as well as the risk of gout.
Foreign-body ingestions are common among children and usually resolve with limited, if any, treatment. The ingestion of rare-earth magnets, however, commonly results in serious injury or death. These dangerous high-powered magnets can be found in the United States in a variety of consumer products, including magnetic toy sets designed for children and adults. The ingestion of one of such magnet is unlikely to cause significant harm. However, if multiple magnets are ingested, or if a magnet is ingested along with a metal object, the magnets are powerful enough to attract each other through the walls of the intestine, potentially resulting in significant internal damage. Rare-earth magnet ingestion cases are difficult to diagnose and the symptoms are not easy to differentiate from other causes of gastrointestinal illness or pain. However, delays in medical treatment can lead to serious injury or death. This review article describes the epidemiology of rare-earth magnet ingestion-related injuries and provides recommendations for diagnosis and treatment. Federal regulatory efforts related to rare-earth magnets and other prevention strategies are also discussed.
Beginning early in midlife, natural/primary aging is inevitably associated with a progressive reduction in muscle mass and function. This process can progress with aging to a substantial loss of strength, particularly in the lower extremities, reducing mobility. This condition, commonly referred to as sarcopenia, can result in frailty, reducing one’s ability to live independently. This article reviews the underlying biological process contributing to the development of sarcopenia and the roles of regular exercise and nutritional support for attenuating aging-associated muscle loss as well as risk and management of sarcopenia and associated frailty.
The purpose of this review is to provide health practitioners and physicians the most current state of the research on sarcopenia, its consequences, and to offer a summary of consensus guidelines for identification based on the most recent and compelling investigations and analyses. To accomplish this, the causes and consequences of sarcopenia will be described, and definitions and screening methods are updated. Importantly, interventional recommendations for sarcopenia will be discussed with a special emphasis on the effects of resistance training on sarcopenia-related outcomes. Furthermore, due to the increasing usage of hormone treatment as a strategy to combat sarcopenia, special consideration on the effects of hormone changes with aging and as interventions will be briefly reviewed.
In the traditional debate between biological and environmental determinants of body weight, the body has most often been explored in terms of its anatomical, genetic, or hormonal influences on personality, experience, and behavior. While obesity has been identified as a threat to our public health, correlating attitudes toward body image and self-concept have been explored within women to a limited extent, and even less so in relation to men. Consequently, men’s body image will be discussed in light of current literature reveals for women. For men, as for women, as the social pressure to attain an "ideal" physique increases, the discrepancy between that ideal and one’s body increases as well. This dynamic is more readily recognized for women than for men. As men are socialized not to discuss their body image concerns, negative self-concept and esteem may reinforce behaviors resulting in weight gain. In recent years, the proliferation of media has served to reinforce messaging related to one’s body. This review of existing data and literature suggests that body image and self-concept are related to body weight in men (as with women) and need to be addressed as part of healthy weight management practices.
While mobile phones (henceforth cell phones) provide nearly constant access to activities (eg, watching videos, playing games) traditionally associated with sedentary behavior, the relationship between cell phone use, sedentary behavior, and physical activity is untested. The purpose of this study was to assess these relationships. A sample of college students (N = 236) completed surveys assessing daily cell phone use, sedentary behavior (sitting time) and physical activity. Regression demonstrated that cell use was positively associated (β = 0.23, P = .05) with sedentary behavior and not related (β = –0.02, P = .90) to physical activity. Tertile splits were performed for average daily cell phone use and participants were grouped as high (n = 81), moderate (n = 77) or low (n = 78) cell users. High users (495.1 ± 227.6 min/d) participated in significantly (P ≤ .03) more sedentary behavior than the moderate (417.1 ± 208.3 min/day) and low (395.2 ± 180.0 min/d) users. Sedentary behavior was not different (P = .5) between the moderate and low users. In conclusion, cell use was associated with college students’ sedentary behavior but not physical activity. High users allocated 18.7% and 25.3% more time to daily sitting than moderate and low users, respectively.
Purpose. To present results of a scoping review focused on skin cancer risk behaviors and other related health risk behaviors. Skin cancer is highly preventable, yet it is the most common form of cancer in the United States with melanoma rates increasing. Limited research has been conducted examining the relationship between skin cancer prevention behaviors and other health risks, yet multiple behavioral health risk interventions have shown great promise for health promotion and reduced health care costs. Methods. Online databases were searched for research articles on skin cancer risk behaviors and related health risk behaviors. Results. Thirty-seven articles met inclusion criteria examining skin cancer behaviors including risk, sun protection behaviors, sunburn, and indoor tanning. The majority of existing studies focused on the relationship between skin cancer prevention behaviors and physical activity, body mass index, smoking, and alcohol abuse. Adults were the primary population of interest with some studies of adolescents. Conclusions. Poor skin cancer prevention behaviors were associated with alcohol use, marijuana use, and smoking among adolescents and adults. Studies on body mass index and physical activity had mixed relationships with skin cancer prevention behaviors and warrant further investigation. Indoor tanning was associated with other risky behaviors but other skin cancer prevention behaviors were not studied.
We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants’ physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.
Adequate intake of dietary fiber is associated with digestive health and reduced risk for heart disease, stroke, hypertension, certain gastrointestinal disorders, obesity, type 2 diabetes, and certain cancers. According to consumer research, the public is aware of the benefits of fiber and most people believe they consume enough fiber. However, national consumption surveys indicate that only about 5% of the population meets recommendations, and inadequate intakes have been called a public health concern. To address the fiber consumption gap and formulate potential solutions, researchers, educators, and communicators convened at a Food & Fiber Summit on January 28, 2014, in Washington, DC. Panelists and attendees devised communication strategies to correct consumer misperceptions about fiber. These misperceptions include commonly held beliefs that all whole-grain foods are good sources of fiber and that foods with fiber are expensive, unpalatable, and complicated to prepare. To help close the fiber intake gap, nutrition and health educators can use communication strategies such as providing clear and concise information, recommending flavorful fiber-rich foods, and describing the benefits of adequate fiber intake. Several supporting messages were developed to effectively communicate about fiber. An example is to advise people to consistently check nutrition labels to find good sources of fiber.
High-intensity interval training (HIIT) has emerged as an attractive alternative to traditional continuous exercise training (CT) programs for clinical and healthy populations who find that they can achieve equal or greater fitness benefits in less time. Land-based HIIT may not be an appropriate choice for some participants. Few studies have explored the acute responses and chronic adaptations of HIIT in an aquatic environment, and no study has compared the cardiometabolic responses of an aquatic-based program to a land-based HIIT program. Shallow-water aquatic exercise (AE) programs utilizing HIIT have elicited comparable and, in some cases, greater physiological responses compared with constant-intensity or continuous AE regimens. Factors that may explain why HIIT routines evoke greater cardiometabolic responses than CT protocols may be based on the types of exercises and how they are cued to effectively manipulate hydrodynamic properties for greater intensities. Favorable aquatic HIIT protocols such as the S.W.E.A.T. system may serve as a beneficial alternative to land-based HIIT programs for clinical, and athletic populations, potentially reducing the likelihood of associated musculoskeletal and orthopedic complications. Hence, the purpose of this review is to examine the role of AE as an alternative safe and effective HIIT modality.
More than 29 million people in the United States have diabetes mellitus, including both type 1 and type 2 diabetes. The CDC also estimates that upward of 86 million people can be classified as prediabetic, with as many as 30% of these people transitioning into diabetes within the next 5 years. Individuals with type 1 diabetes account for roughly 5% of those patients. Dating back to 2008 and 2009, roughly 18 000 youth were diagnosed with type 1 diabetes each year. The prevalence of diabetes is well known; most of the studies that are completed today relate to the progression and/or treatment of those with type 2 diabetes. Yet most physicians will have to take care of a type 1 diabetic patient who will want to be active. Having a fundamental knowledge of how exercise affects insulin and blood glucose and how to manage these patients is important. Time must be taken to modify each treatment regimen for each individual. One cannot stress enough the importance of providing patient education, ensuring adequate hydration, recognizing signs and symptoms of hypoglycemia/hyperglycemia, and how to treat and prevent these serious complications. All patients must have a care plan and access to supplies during exercise. It is known that poorly controlled blood glucose can have detrimental consequences in the long term. The question is if type I diabetic athletes who are allowed to have higher blood glucose during exercise are at the same risk for these potential complications.
Mobile fitness trackers are increasingly used by patients as a means to become more involved in their own self-care; however, these devices measure disparate outcomes that may have equivocal relevance to true health status. It is vital for physicians to interpret both the quality and accuracy of the information that these trackers provide, and it is important to delineate which role, if any, these devices may serve in promoting quality patient care in the future. Potential benefits of mobile fitness trackers include the ability to motivate patients toward a healthier lifestyle, to develop a community of like-minded individuals seeking to improve their health, as well as to create an environment of sustainability and accountability for long-term promotion of health maintenance. However, limitations include the fact that mobile fitness trackers are not regulated by the Food and Drug Administration, that the employed metrics are not necessarily the best surrogates for true health status, and that the accuracy of measured endpoints has not yet been proven. As mobile fitness trackers both continue to rise in popularity and become increasingly sophisticated, physicians must be equipped to interpret and use this technology to better serve patients within an ever-changing, more technology-reliant health care system.
Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.
Improving health behaviors is fundamental to preventing and controlling chronic disease. Health care providers who have a patient-centered communication style and appropriate behavioral change tools can empower patients to engage in and sustain healthy behaviors. This review highlights motivational interviewing and mindfulness along with other evidence-based strategies for enhancing patient-centered communication and the behavior change process. Motivational interviewing and mindfulness are especially useful for empowering patients to set self-determined, or autonomous, goals for behavior change. This is important because autonomously motivated behavioral change is more sustainable. Additional strategies such as self-monitoring are discussed as useful for supporting the implementation and maintenance of goals. Thus, there is a need for health care providers to develop such tools to empower sustained behavior change. The additional support of a new role, a health coach who specializes in facilitating the process of health-related behavior change, may be required to substantially influence public health.
The human papilloma virus (HPV) is one of several viral pathogens linked to human cancer. This article reviews the current worldwide cancer burden related to this pathogen. The article also examines the role of HPV in oropharyngeal and gynecological malignancies, current treatment implications, and future directions in the treatment and prevention of HPV-related disease.
Infertility is a relatively common condition, greatly affecting couples medically and psychologically. Although infertility treatment is safe, it can be time-intensive, expensive, and increase the risk of multiple gestations. Thus, to reduce costs and risks, couples may initially consider lifestyle change to increase their fertility and chances of pregnancy. For many of the diet factors studied (eg, caffeine, soy, protein, iron), there are conflicting data. However, there are some items men and women consume that are detrimental to fertility, such as alcohol and tobacco. The data on exercise are varied but may have an effect on ovulation and fertility—positive or negative. Body mass index appears to affect fertility also, with obesity in both men and women negatively affecting pregnancy rates. In addition, there remains concern and a growing body of research on environmental toxin exposures and reproductive health. Finally, supporting patients through infertility diagnosis and treatment is critical, as psychological stress may affect conception. It is imperative that the relationship between lifestyle factors and fertility continue to be explored so as to lessen the morbidity associated with infertility.
Depression is often diagnosed using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. We propose how certain lifestyle choices and non-modifiable factors can predict the development of depression. We identified 10 cause categories (hits or "blows" to the brain) and theorize that four or more active hits could trigger a depression episode. Methods. A sample of 4271 participants from our community-based program (70% female; ages 17-94 years) was assessed at baseline and at the eighth week of the program using a custom test. Ten cause categories were examined as predictors of depression are (1) Genetic, (2)Developmental, (3)Lifestyle, (4)Circadian Rhythm, (5)Addiction, (6)Nutrition, (7)Toxic, (8)Social/Complicated Grief, (9)Medical Condition, and (10)Frontal Lobe. Results. The relationship between the DSM-5 score and a person having four hits categories in the first program week showed a sensitivity of 89.98 % (95% CI: 89.20 % - 90.73%), specificity 48.84% (CI 45.94-51.75) and Matthew Correlation Coefficient (MCC) .41 . For the eight-week test, the results showed a sensitivity 83.6% (CI 81.9-85.5), specificity 53.7% (CI 51.7-55.6) and MCC .38. Overall, the hits that improved the most from baseline after the eighth week were: Nutrition (47%), Frontal lobe (36%), Addiction (24%), Circadian rhythm (24%), Lifestyle (20%), Social (12%) and Medical (10%). Conclusions. The Nedley four-hit hypothesis seems to predict a depressive episode and correlates well with the DSM-5 criteria with good sensitivity and MCC but less specificity. Identifying these factors and applying lifestyle therapies could play an important role in the treatment of depressed individuals.
Extensive research has been performed investigating the effects of caffeine during exercise in adults with many reviews published in just the past 10 years. Limited research has been conducted in children despite the fact that they are one of the fastest growing consumers of caffeine. In light of the limited research, in writing this review no inclusion or exclusion criteria were used, as the aim of the review is to provide as wide a research base as possible. This review will present the data that has systematically investigated the acute effects of caffeine in children and youth during exercise.
Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥6 months postintervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: self-determination theory, theory of planned behavior, social cognitive theory, transtheoretical model, and social ecological model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.
Over the last decades the combination of both a sedentary lifestyle and excessive food availability has led to a significant increase in the prevalence of obesity, which is increasingly recognized as an important risk factor for type 2 diabetes. Several lines of evidence exist demonstrating that expanded visceral adipose tissue produces several pro-inflammatory mediators that activate signaling pathways that contribute to the development of insulin resistance. Exercise training is an important lifestyle factor that is widely used as a tool for preventing and improving lifestyle-related obesity and insulin resistance. In this regard, exercise training is useful to increase energy expenditure thereby counteracting a positive energy balance. Exercise training is also able to attenuate the activation of several obesity-induced pathways of inflammation and oxidative stress. Thus, a better understanding of the molecular mechanisms and immune pathways in exercise, obesity, and diabetes can be extremely useful to exploit optimized lifestyle strategies to combat the increasing incidence of metabolic diseases.
Glucose intolerance is a global health concern that encompasses glucose metabolism abnormalities such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes (T2D). There is an urgent need to focus on the prediabetes (ie, IGT and IFG) stage before the disease actually occurs. The progression from IGT to T2D can be prevented or delayed by modifying the lifestyles in high-risk individuals, and these health benefits are well documented in various ethnicities with prediabetes across the world. Specifically, consuming a healthy diet (high in polyunsaturated fatty acids, monounsaturated fatty acids, fiber, and whole grains), losing weight, quitting smoking, consuming alcohol in moderation, and increasing physical activity can improve glucose tolerance and reduce the risk of T2D. Also, pharmacological agents and botanicals can be used to manage glucose intolerance if the implementation of lifestyle changes is challenging. Pharmacological treatments have been successful in managing glucose intolerance; however, they have adverse effects. Also, more research on botanicals is warranted before a definitive recommendation can be made for their use in managing glucose intolerance. To make progress on this worldwide problem, efforts are needed to improve the awareness of prediabetes, increase promotion of healthy behaviors, and improve the availability of evidence-based lifestyle intervention programs to the community.
Laughter is a normal and natural physiologic response to certain stimuli with widely acknowledged psychological benefits. However, current research is beginning to show that laughter may also have serious positive physiological effects for those who engage in it on a regular basis. Providers who prescribe laughter to their patients in a structured way may be able to use these natural, free, and easily distributable positive benefits. This article reviews the current medical understanding of laughter’s physiologic effects and makes a recommendation for how physicians might best harness this natural modality for their patients.
Childhood obesity continues to be a major public health concern in the United States. This work reviews the current understanding of the relationship between sleep duration and obesity among children and adolescents. A systematic search was conducted for papers published between January 2000 and July 2013 using keywords: (sleep) and (overweight or obesity or obese or body mass index or BMI or adiposity or body fat or fat) and (children or child or youth or teen or pediatric or adolescent or paediatric or childhood or adolescence or boy or girl). Reference lists of relevant articles and reviews or meta-analysis articles were checked to identify additional studies. Only empirical work and longitudinal studies that focused on children and adolescents were included in this review. The search identified 22 longitudinal studies. The majority of the reviewed studies support the presence of an inverse relationship between sleep duration and obesity. However, in some studies the relationship was not significant in adjusted analyses. Differences as a function of age and gender were also noted. Despite more than a decade of research, the debate on the association between sleep duration and obesity continues. Further research with repeated assessments, valid objective measures, and better control of potential confounding variables is warranted.
In the past century, the average duration of life of people living in developed countries rose by 30 years. Most of this gain was a result of advances in public health that saved the young by warding off communicable diseases. However, in the latter half of the 20th century, improvements in lifestyle modification and advances in biomedical technology enabled people at middle and older ages to experience extended lives. Thus, aging as we know it today is a new phenomenon—experienced by a small but rapidly growing segment of our world. As appealing as our longer lives may be, there was a price to pay for life extension—the rise of noncommunicable fatal and disabling diseases. It was a fair exchange, but now humanity is left with the difficult task of dealing with this Faustian trade. A new approach to public health in a rapidly aging world has been proposed (the longevity dividend), with the idea that extending healthy life by slowing aging may prove to be the most efficient way to combat the fatal and disabling diseases that plague us today. Here, I articulate the case for why we now need to turn our attention to combating aging itself.
The Complete Health Improvement Program (CHIP) is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. The intervention has been used in clinical, corporate, and community settings, and the short-term and long-term clinical benefits of the intervention, as well as its cost-effectiveness, have been documented in more than 25 peer-reviewed publications. Being an easily administered intervention, CHIP has been presented not only by health professionals but also by non-health-trained volunteers. The benefits of the program have been extensively studied under these 2 delivery channels, consistently demonstrating positive outcomes. This article provides a brief history of CHIP and describes the content and structure of the intervention. The published evaluations and outcomes of the intervention are presented and discussed and future directions are highlighted.
Few randomized controlled trials of family-based psychosocial interventions involving patients and at least one other family member have been conducted in the context of advanced cancer. Moreover, existing interventions have largely been stand-alone programs that have not been well integrated into routine palliative and clinical care. Programs that address this gap may not only improve patient and caregiver quality of life (QOL) but also the quality of palliative and supportive care services. The aim of this narrative review is to describe published interventions that have attempted to improve the QOL of advanced cancer patients and their family caregivers (eg, spouses, partners, and other family members) and to describe some of the challenges that make it difficult to implement such programs in clinical settings. Toward that end, the added value that family-based psychosocial interventions can bring to advanced cancer care is first described. Next, the literature on family-based interventions in advanced cancer is reviewed, and different theoretical approaches and outcomes are highlighted. This is followed by a description of some of the health system barriers to supportive family care in advanced cancer care. The article concludes with a synthesis of research findings and proposes directions for future research.
This article explores and reviews the available evidence pertaining to lifestyle, disease, and economic losses in the workplace. The literature shows clearly that higher levels of health risks and behaviors lead to the development of disease and moving to a high-cost status. The data suggest that those individuals with lower health risks and those individuals who achieve a reduction in health risks and unhealthy behaviors result in lower probability of disease and high health care costs. The business case for wellness and prevention is also discussed, as is the concept of investing in health as opposed to a strict focus on health care cost reduction. Furthermore, additional determinants of health such as the social–emotional states and positive characteristics of the individual and of the environment and culture are described. Since health is much more than simply the absence of disease, the members of the College of Lifestyle Medicine are encouraged to expand their interests and research inquiry and efforts in evaluating, supporting, and treating these areas. Physicians play a special role in helping individuals improve their healthy behaviors and knowledge of these lifestyle factors will add significantly to their capacity to serve patients. It is very clear that there are growing research, prevention, and treatment opportunities for members of the College of Lifestyle Medicine. It was demonstrated that there is sufficient evidence that justifies the College of Lifestyle Medicine, as observed by the content and quality of the information shared at the conference in Arlington, Virginia in October 2013.
There is substantial evidence that lipids are critical in the development and progression of atherosclerotic cardiovascular disease. In November 2013, the American College of Cardiology/American Heart Association in conjunction with the National Cholesterol Education Program IV developed new guidelines for the treatment of blood cholesterol. In this report, we review these new guidelines and emphasize the potential benefits of physical activity and exercise training on plasma lipids.
We have known now for a span of decades that the leading causes of premature death and chronic disease in the United States and increasingly around the world are behavioral factors under our potential control. We have as well consistent evidence from diverse sources indicating that amelioration of a short list of such factors, with an emphasis on dietary pattern, physical activity, and tobacco use, can slash rates of chronic disease and premature death alike. But choices people make are governed ultimately by choices people have. In an obesigenic and morbidigenic environment that conspires mightily against healthful living, salutary behavior change is all too often forestalled. Constructive and compassionate guidance from clinicians can help confront this challenge, and the case is made that lifestyle in medicine is of real value. But the case is also made that lifestyle is not fundamentally a clinical issue but a cultural one. For the full promise of lifestyle medicine to be realized, it must be lifestyle as medicine—and spoons full of cultural change will be required to make that medicine go down.
Obesity is notoriously difficult to treat. Effective treatment has been encumbered by traditional assumptions about the cause of the disease. Obesity is typically considered a manifestation of the patient’s dietary misconduct, a simple lack of willpower, or the inability to modify dysfunctional eating habits. Abundant evidence suggests that eating behavior is much more complex than patient choice alone. Eating and the system of regulating eating and body weight are largely controlled by complex signals from multiple organ systems that monitor food intake, gastrointestinal function, and energy storage and send multiple messages to the brain. The brain coordinates the physiological messages and creates additional signals about eating, appetite, hunger, and satiety. Multiple survival, environmental, and genetic factors become part of a biological regulatory system that controls eating and body weight. The system appears to be unstable and often becomes dysfunctional, particularly in an environment of abundant food and calories. Despite the difficulty in modifying the regulatory system, opportunities for management of the disease do exist. Comprehensive lifestyle management can be useful, as can selective pharmacotherapy and bariatric surgery. Public policy changes will likely be helpful in changing community understanding of the disease and its management.
Nutrition controversies abound, particularly in an age of vast information and technology. Scientific information is often disseminated so quickly, via news outlets or lay bloggers, that the factual details are left out and in-depth analysis is omitted. Our food supply and our environment are intertwined, yet from a public health standpoint there seems to be a disconnection between what our society wants, and what it may need, in terms of nutrition and disease prevention. We want our food supply to be safe, available, affordable, fresh, and tasty. We also want our environment to be minimally affected, animal rights to be upheld, and less waste to occur. We need to provide adequate nutrition that promotes health to a diverse population at a reasonable cost. This article will address some current nutrition controversies surrounding genetically modified organisms in our food supply, sugars, calories, and high-protein diets; as well as a recommendation for helping your patients choose a healthy diet and adopt healthy dietary behaviors is reviewed.
A common call to action for addressing public health concerns of both obesity and hunger is improving access to and consumption of fruits and vegetables. Previous research has examined the nutritional merits of fresh, frozen, and canned fruits and vegetables. However, there are limited data on the cost-effectiveness of fresh compared with processed—that is, canned and frozen—food. This study examined the nutrition delivered in 8 common vegetables and 10 common fruits across multiple packaging options (fresh, frozen, and canned) relative to average costs. A method of scoring based on nutrient intake recommendations was used to calculate the nutrients per calorie, and average costs were obtained from the US Department of Agriculture’s Economic Research Service. Nutrient scores for the vegetables were similar across the 3 packaging options, whereas canned vegetables had a lower cost per edible cup compared with frozen and fresh. Nutrient scores were variable for the fruits across the 3 packaging options, and canned fruits were either lower or comparably priced per edible cup. The evidence from this study suggests that fruits and vegetables packaged as frozen or canned are cost-effective and nutritious options for meeting daily vegetable and fruit recommendations in the context of a healthy diet.
Background. Chronic pain is a major health condition that has significant financial and lifestyle implications. Due to the complex etiologies of pain, it is difficult to find treatment modalities that would be universally applicable to the general population presenting for care. Mindfulness meditation is a complimentary treatment modality that has some preliminary, inconclusive evidence in support of its benefit on patients with chronic pain. Objectives. The purpose of this article is to systematically review the current literature for randomized controlled trials that assess the outcomes of mindfulness as an intervention for individuals with chronic pain. Methods. An electronic database search was performed for studies investigating the efficacy of mindfulness in treatment for chronic pain. The studies included were randomized controlled trials, published in English, from a peer-reviewed journal that identified mindfulness as the primary treatment focus for chronic pain in at least one group, and included participants with at least a 12-week history of symptoms. Results. The database search revealed 283 articles, of which 6 met the inclusion criteria. Conclusion. Mindfulness meditation appears to have minimal or statistically insignificant effects on chronic pain according to the current data. However, the effects of mindfulness on mental health scores are significant and may be an area for future trials to target. Well-conducted research is necessary before the effects of mindfulness on chronic pain can be definitively determined.
Physical inactivity is a worldwide public health problem. Primary care physicians are in an excellent position to prescribe exercise and physical activity to their patients. This article discusses theories and methods of behavior change to help physicians motivate their patients to become more physically active. Calls to action for physicians are discussed.
The aim was to examine the hydration status of adults working in different jobs at the beginning and end of a shift and their reported water intake. One hundred and fifty-six subjects (89 males, 67 females) were recruited from workplaces within the local area (students, teachers, security, office, firefighters, catering). A urine sample was obtained at the start and end of the shift and was analyzed for osmolality (Uosm), specific gravity (USG), and sodium and potassium concentrations. Euhydration was considered Uosm <700 mOsmol/kg or USG <1.020. At the end of the shift, subjects were asked to report all water intake from beverages during the shift. Females had lower Uosm than males at the start (656 [range, 85-970] vs 738 [range, 164-1090] mOsmol/kg) and end (461 [range, 105-1014] vs 642 [range, 130-1056] mOsmol/kg; P < .05) of their working day. Fifty-two percent of individuals who appeared hypohydrated at the start of the shift were also hypohydrated at the end. Reported water intake from beverages was greater in males compared with females (1.2 [range, 0.0-3.3] vs 0.7 [range, 0.0-2.0] L, respectively; P < .0001). In conclusion, a large proportion of subjects exhibited urine values indicating hypohydration, and many remained in a state of hypohydration at the end of the shift.
Despite its pervasiveness in primary care, deficient sleep often is underappreciated as a cue to other health risks. Accordingly, this review discusses contemporary evidence-based perspectives on impaired sleep and its associations with other lifestyle medicine concerns, including obesity, cardiovascular conditions, psychological problems, and health-compromising habits. The potential clinical benefits of promoting sleep health also will be considered.
Latinos report less leisure time physical activity (PA) than non–Latino Whites and suffer disproportionately from diseases related to sedentary lifestyle, yet remain underserved and understudied. Gaining a better understanding of PA behavior in Latinos is critical to intervene on this significant public health issue. This article discusses the growing literature on the facilitators and barriers of PA in Latino men and women and reviews recent interventions to promote activity. Apart from acculturation influences, facilitators of PA in Latinos are similar to those of non–Latino Whites, with most research focusing on self-efficacy and social support. Barriers for Latinas, however, are more culturally distinct, such as a focus on caregiving and cultural standards for body shape. Barriers unique to Latino men largely have not been studied. Researchers have adopted a variety of approaches to increase PA, including using promotores and incorporating culturally appropriate activities, and have had mixed success. However, the community and randomized controlled trials almost exclusively included only women. Studies reviewed here suggest that interventions should target culturally specific barriers beyond language to successfully increase PA in Latinos and highlight a need for formative research and design of interventions for Latino men.
Research suggests that patient-centered culturally sensitive health care may be an important precursor to patient satisfaction and treatment adherence. Data from this study are a subset from the data collected for the Patient-Centered Culturally Sensitive Health Care and Health Promotion Research Project. The present study was designed to (a) explore the relationship between patients’ perceived patient-centered cultural sensitivity of their health care sites (ie, the physical and social environment and clinic policies) and their self-reported adherence to treatment and (b) investigate whether this relationship is mediated by satisfaction with health care experienced. Participants consisted of a low-income, culturally diverse sample of 1581 patients from 67 health care sites across the United States. A significant positive relationship between patients’ perceived patient-centered cultural sensitivity of their health care sites and their self-reported treatment adherence to a prescribed regimen was observed. Patient satisfaction with care partially mediated the relationship between these 2 variables. Assessing the level of patient-centered cultural sensitivity patients perceive in their health care sites might provide guidance to health care administrators as to how to make their sites more culturally sensitive from the perspective of patients. This, in turn, might increase patients’ treatment adherence, leading to improved health outcomes.
As the lifestyle medicine movement continues to gain traction and strength, it is critically important that lifestyle medicine practitioners base their recommendations on the best available evidence. This review outlines ways of accomplishing that goal. The core concepts behind lifestyle medicine reside in many different bodies of information. These include nutrition, exercise physiology, behavioral medicine, psychology, and many more. Lifestyle medicine practitioners will need to be knowledgeable in all of these areas. A good place to start is with the evidence-based recommendations put out by major national bodies. The Dietary Guidelines for Americans and Physical Activity Guidelines for Americans also provide comprehensive, evidence-based information regarding these 2 critically important modalities. This review also discusses ways that scientific information is often distorted and how conjecture may sometimes be confused with proof. The review concludes with some recommendations for how lifestyle medicine practitioners can ground their recommendations on sound scientific evidence.
Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs’ personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs’ PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs’ personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs’ PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs’ PA role-modeling and how it influences patients’ PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.
In the United States, the rate of cigarette smoking has significantly declined over the past 2 decades, but much more work is needed, as almost 20% of adults still smoke and smoking continues to be the leading preventable cause of death. Furthermore, rates of smoking in certain subpopulations have remained relatively stable and have historically been neglected in smoking cessation research. Pharmacotherapy (both prescription and over-the-counter) and behavioral support are known to aid cessation, and their combination is more effective than either alone. There are significant barriers to access, use, and adherence, however, especially with pharmacotherapy. Therefore, the purpose of this review is to provide an update and overview of the numerous behavioral approaches that have been used to enhance smoking cessation. The research described can be classified into the type of approach used, the setting in which it is delivered, and the population targeted. Regardless of the classification, all the approaches attempt to provide smokers with the information, motivation, and behavioral skills thought to be necessary for achieving initial cessation and sustained abstinence. Recommendations for future research on behavioral smoking cessation are also included.
Physical fitness is simply defined as the capacity to perform physical work. Energy is necessary to perform work and sustain life and is extracted aerobically and anaerobically. Evaluation of aerobic fitness is based on the assessment of maximal oxygen consumption (V
Adequate nutrition is absolutely essential for optimal training and performance of the athlete. Unfortunately many athletes lack sufficient nutrition knowledge to guide proper food choices. Similarly, the health professionals that athletes most frequently turn to for nutrition advice are often ill-equipped to address specific nutritional needs and issues. This article will summarize the most recent macronutrient (i.e., carbohydrate, protein and fat) and fluid recommendations for athletes. Micronutrients that have been shown to be inadequate in the diets of athletes will also be addressed. Finally, current controversies in sport nutrition will be examined in light of the most recent research and guidelines for applications to the athlete will be provided.
Chronic disease epidemiology currently lacks the mono-causal focus germ theory provides infectious diseases. However, the discovery of a form of low-grade, systemic, and chronic inflammation ("metaflammation) underlying many, if not all, chronic diseases induced by a range of stimulants labeled "anthropogens" may help change this. Anthropogens are "man-made environments, their by-products, and/or lifestyles encouraged by these, some of which are detrimental to human health." While an exhaustive list of anthropogens associated with chronic disease may be as elusive as a comprehensive list of "germs" with the potential to cause infection, a broad taxonomy provides a focus for the practice of lifestyle medicine. Such a list is considered here under the acronym NASTIE ODOURS.
Dietary or supplemental calcium intake has long been encouraged for optimal bone health. However, more recently, the safety of calcium supplementation has been questioned because of a possible association between supplemental calcium and cardiovascular risk. Whereas calcium may have a beneficial or neutral effect on cardiovascular risk factors such as blood pressure, cholesterol, weight, and diabetes, available evidence does not provide a definitive answer for an association with cardiovascular disease (CVD). To date, no calcium trials have studied cardiovascular disease as a primary end point, and larger trials with longer follow-up are needed. In this review, we present results from observational studies and randomized controlled trials (RCTs) that have evaluated calcium intake (dietary or supplemental) in relation to cardiovascular risk factors and cardiovascular disease as a secondary outcome. Results from RCTs are mixed regarding CVD risk in those using supplemental calcium with or without vitamin D, and more large-scale randomized trials designed specifically with CVD as the primary end point are needed. Evidence suggests that it is reasonable to encourage adequate dietary calcium intake, especially for postmenopausal women who are at greatest risk for osteoporotic fracture.
Food allergy has established itself as a matter of significant public health importance and relevance. It has had substantial impacts across the world and continues to represent the most common cause of anaphylaxis seen in emergent settings. However, its increasing incidence has yielded a silver lining of increased interest and investment, which has powered major research in the field. Much has been learned about food allergy as a result. Recent work has elicited increased understanding about food allergy prevalence, mechanisms, and risk factors. In turn, this has allowed for application of this understanding to potential treatments. Current practice of food allergy treatment through restricted exposure may ultimately be replaced with novel therapies including, perhaps ironically, introduction of the allergenic foods in question. This review presents broad highlights of the rapidly increasing understanding into food allergy mechanisms and experimental therapies.
The population of older adults in the United States is steadily growing and identifying factors that contribute to healthy aging is a public health priority. Changes in body composition are a hallmark of the aging process and have been implicated in the loss of physical function among older adults. In particular, age-related declines in muscle strength and power occur at a faster rate than the loss of muscle mass (sarcopenia), and this suggests a decrease in muscle quality of older adults. Muscle quality has traditionally been defined as muscle function (strength or power) per unit of muscle size (mass or cross-sectional area) and a growing body of literature suggests that lower body muscle quality may be critical for maintaining functional independence with age. However, the literature regarding the definition of muscle quality and its relationship with health outcomes in older adults has not been adequately reviewed. Thus, the aim of this report is to highlight the contemporary literature regarding age-related changes in muscle quality and its relationship with health outcomes in community-dwelling older adults.
This review summarizes the extant evidence of the effects of exercise training on anxiety among healthy adults, adults with a chronic illness, and individuals diagnosed with an anxiety disorder. A brief discussion of selected proposed mechanisms that may underlie relations of exercise and anxiety is also provided. The weight of the available empirical evidence indicates that exercise training reduces symptoms of anxiety among healthy adults, chronically ill patients, and patients with panic disorder. Preliminary data suggest that exercise training can serve as an alternative therapy for patients with social anxiety disorder, generalized anxiety disorder, and obsessive–compulsive disorder. Anxiety reductions appear to be comparable to empirically supported treatments for panic and generalized anxiety disorders. Large trials aimed at more precisely determining the magnitude and generalizability of exercise training effects appear to be warranted for panic and generalized anxiety disorders. Future well-designed randomized controlled trials should (a) examine the therapeutic effects of exercise training among understudied anxiety disorders, including specific phobias, social anxiety disorder and posttraumatic stress disorder; (b) focus on understudied exercise modalities, including resistance exercise training and programs that combine exercise with cognitive-behavioral therapies; and (c) elucidate putative mechanisms of the anxiolytic effects of exercise training.
Recently reported SEER data revealing an increase in the number of younger women who present with advanced breast cancer at diagnosis has led to much speculation regarding epidemiological factors that play a role in breast cancer risk and that may be modifiable by lifestyle. Molecular genomics has identified biological pathways that affect breast cancer prognosis and inform treatment decisions. Depending on menopausal status and breast cancer subtype, evidence is emerging that lifestyle could be implicated not only in the risk for breast cancer but also outcomes following breast cancer diagnosis. Several biologic mechanisms have been explored explaining the physiologic role of lifestyle and cancer risk and survival. In this report, we explore the interaction between lifestyle, breast cancer phenotype, and outcomes and review potential molecular mechanisms linking lifestyle to risk and prognosis in order to establish a platform for future exploration. The cost of breast cancer treatment and breast cancer morbidity and mortality during a woman’s productive years impose a psychosocial and socioeconomic burden on our nation. Efforts to ease that burden through lifestyle modification should be embraced and supported as we reevaluate and scrutinize the allocation of health care resources in our nation.
Because higher body fat and lower lean mass is associated with excess morbidity and mortality, health care teams need specific science-based recommendations to advise clients on lifestyle approaches to alter body composition. Combining exercise with modest energy restriction is recommended to cause up to 20% more weight and fat loss, improved function, and reduced lean mass loss than modification of diet alone. The optimal diet for developing a leaner body composition is one that is modestly reduced in energy and contains lower fat and higher protein than average. Aerobic exercise alone may cause minimal change in body weight (1%-3%) and fat if greater than 250 min/wk. Higher intensity or duration of exercise can cause more substantial fat loss but may have poor long-term compliance. Resistance exercise boosts lean body mass and improves some health indicators but generally does not cause fat loss. In summary, consumption of a low-fat (20%-25% of energy), moderately high-protein (>1.2 g/kg and up to 20%-25% of energy) diet with modestly reduced energy (500-1000 kcal/d) combined with aerobic (3-5 d/wk, at least 250 min/wk) and resistance exercise (2 d/wk) can improve body composition to reduce clinically relevant risks associated with obesity.
Dyslipidemia is defined as elevated fasting blood levels of total cholesterol (TC), and its primary lipoprotein carrier—low-density lipoprotein (LDL), triglycerides (TG), or reduced high-density lipoprotein (HDL), alone, or in combination (mixed dyslipidemia). Dyslipidemia is well known to be associated with cardiovascular disease (CVD) risk. All patients with dyslipidemia should initiate therapeutic lifestyle changes to target lifestyle-related factors such as physical inactivity, dietary habits, and obesity. The combination of a proper dietary plan and regular aerobic exercise has been reported to lower TC, LDL-C, and TG by 7% to 18%, while increasing HDL-C by 2% to 18%. Numerous pharmacological therapies are available and aggressive therapy using a HMG-CoA reductase (3-hydroxy-3-methyl-glutaryl coenzyme A reductase) inhibitor (statins) should be initiated if lifestyle therapy is not enough to achieve optimal lipid levels with a primary target of lowering LDL-C levels. Aggressive treatment of dyslipidemia with maximal dosage of statin drugs have been reported to reduce LDL-C by 30% to 60%. If mixed dyslipidemia is present, a combination therapy with statin, niacin, cholestyramine, or fibrates should be initiated to reduce the risk of CVD events. These strategies have been shown to reduce CVD risk and optimize LDL-C levels in primary and secondary prevention of CVD.
Being obese goes beyond moral failure or a character flaw. Obesity has the defining characteristics of a chronic disease for which there is no cure. Treatment may require lifelong treatment which may include pharmacotherapy. Experience with long term use of obesity drugs is limited but evidence suggests that pharmacotherapy can improve patient outcomes and patient outlook. With current obesity drugs, weight loss is usually modest but clinically significant satisfying the FDA threshold for drug effectiveness. This weight loss is associated with clinically significant improvements in many obesity co morbidities and risk factors and could eliminate some risk factors with continued use. When used in conjunction with a comprehensive program for weight management, obesity drugs can reduce appetite or hunger, increase satiety, provide improved control over aberrant eating behaviors and modify food seeking behaviors. Pharmacotherapy can enhance weight loss and compliance during the periods of weight loss and in maintaining that weight loss, increasing physical activity and may enhance a focus on making life long changes.
This article will discuss mechanisms of action of obesity drugs, theories of altered body defense of body weight, Food and Drug Administration (FDA) approved obesity drugs, and off-label use of FDA approved drugs. The value of over-the counter (OTC) medications and diet supplements, as well as fat substitutes in the treatment of obesity drugs will be explored. Obesity drugs awaiting FDA approval and compounds under development will be reviewed. The section on approaches to drug management will include clinical considerations for; who should receive pharmacotherapy and when, length of treatment and drug discontinuation, weight regain and the role of pharmacotherapy.
Objectives. A systematic review of randomized clinical trials and meta-analyses evaluating the efficacy, tolerability, and safety of statins in preventing cardiovascular disease (CVD) in women without cardiovascular disease. Background. Several meta-analyses have been performed evaluating statins in CVD primary prevention trials involving women. This review is an update incorporating the results of recent CVD primary prevention trials in women and the recent concerns of statins and new-onset diabetes. Method. PubMed database was searched for primary prevention trials and meta-analyses. The key terms "statins, cardiovascular disease, primary prevention in women" were used. Search was limited to all English publications published up to October 2012. Results. Statin use led to a trend towards reduction in cardiovascular mortality and morbidity in women. No significant increased risk in adverse events was observed. The slight increased incidence of diabetes is outweighed by the greater cardiovascular benefit derived from statin use. Conclusions. The data support the use of statins for primary prevention of CVD in women at higher risk of CVD. The lack of statistical significance in prior randomized controlled trials and meta-analyses is attributable to the lower numbers of women enrolled in these trials and the lower CVD risk of women in the trials resulting in the inadequate powering of these studies. Higher risk women who may benefit from CVD primary prevention with statins may be identified using validated tools such as the Reynolds scoring system, the 2011 American Heart Association risk algorithm for women, and the forthcoming National Heart, Lung, and Blood Institute risk equations.
As the incidence rate of lifestyle-related chronic conditions such as cardiovascular disease, obesity, and type 2 diabetes continues to increase, the importance of regular exercise and a healthy diet for improving or maintaining good health is critical. Exercise training is known to improve fitness and many health risk factors, as well as to improve the performance of competitive athletes. It has become increasingly clear, however, that nutrient intake before, during, and after exercise sessions has a powerful influence on the adaptive response to the exercise stimuli. In this review, the science behind nutrient timing will be discussed as it relates to exercise performance, recovery, and training adaptation. Evidence will be provided that validates intake of appropriate nutrients before, during, and immediately after exercise not only to improve exercise performance but also to maximize the training response. Ultimately, the combined response to exercise and proper nutrient intake leads to not only better performance in athletes but also greater health benefits for all exercisers.
The purpose of this review was to summarize findings from epidemiological studies that determined if sedentary behavior was associated with obesity, metabolic risk factors, and cardiorespiratory fitness in children and adolescents. We noted if studies adjusted for moderate-to-vigorous physical activity (MVPA), dietary intakes, and/or sleep duration. Articles were identified through PubMed using the search terms: (sedentary OR sitting OR television) AND (adiposity OR blood pressure OR body mass index OR cardiometabolic OR metabolic risk OR waist circumference). The search was limited to ages 6 to 18 years, humans, and published between January 1, 2008 and September 26, 2012. Cross-sectional and longitudinal studies observed associations between more sedentary behavior, especially screen-based sedentary behavior, and measures of obesity; and most associations were independent of MVPA and dietary intake. Cross-sectional and longitudinal studies reported associations between screen-based sedentary behavior and lower cardiorespiratory fitness, and most associations were independent of MVPA and obesity. Cross-sectional studies observed associations between more screen-based and objectively measured sedentary behavior and lower insulin sensitivity; and most associations were independent of MVPA and obesity. There was little-to-no evidence that sedentary behavior was associated with increased blood pressure and increased blood lipids.
In recent years, there have been increasing national calls for patient-centered, culturally sensitive health care (PC-CSHC). The impetus for these calls include (a) the reality that health care providers are increasingly having to provide health care to a more culturally diverse patient population without the necessary training to do so effectively, (b) the growing evidence that culturally insensitive health care is a major contributor to the costly health disparities that plague our nation, and (c) the fact that racial/ethnic minorities and individuals with low household incomes are more likely than their non-Hispanic white and higher-income counterparts to experience culturally insensitive health care and dissatisfaction with health care—health care experiences that have been linked to poorer health outcomes. This article (a) presents literature on the definition of PC-CSHC and the need for this care, (b) presents research on assessing and promoting this care, and (c) offers research-informed strategies and future directions for customizing and institutionalizing this care.
With almost 30 million individuals predicted to be diagnosed by the year 2025, type 2 diabetes mellitus (T2DM) has become one of the most prevalent diseases in the United States. Because of the progressive dysfunction of the pancreatic β-cells and increasing insulin resistance over time, the need for treatments with different mechanisms or addition of medications to a regimen is becoming commonplace. Because of this, developing new medications to treat T2DM has been the focus of a lot of recent research and drug development. Molecular substrates such as glucagon-like peptide-1 (GLP-1), dipeptidyl peptidase-4 (DPP-4), and the sodium glucose transporter-2 (SGLT2) have all become new therapeutic targets. GLP-1 agonists and DPP-4 inhibitors are 2 of the newest classes of Food and Drug Administration–approved medications for diabetes. By increasing GLP-1 to supraphysiologic levels (GLP-1 agonists) and delaying endogenous GLP-1 degradation (DPP-4 inhibitors), these drugs increase insulin secretion and decrease glucagon production. SGLT2 inhibitors, the newest antihyperglycemic class, promote glycosuria by inhibiting sodium and glucose reabsorption in the proximal tubule of the renal nephron. Other novel agents for the treatment of diabetes include the use of the dopamine agonist bromocriptine, the cholesterol medication colesevelam, and a new form of inhaled insulin.
Nutrition is a known, powerful determinant of perinatal health and one that is increasingly recognized to have further reaching effects than previously understood. It is well known that healthy nutrition during the peripartum period can prevent birth defects in the neonate. New research suggests that peripartum nutrition may also modulate the risk of chronic disease in later life. Proper nutrition and weight gain during pregnancy also have maternal benefits including lowered risks of pregnancy related disorders. Good peripartum nutrition is a potential tool to impact the rising prevalence of obesity and related health disorders. This article will review nutrition guidance in pregnancy including macro and micronutrient recommendations, newer recommendations for appropriate weight gain based upon body mass index categories, and avoidance of potentially harmful substances. Current topics will also be discussed including fetal origins of adult disease, pregnancy after weight loss surgery, environmental bisphosphonates, and glycemic index diets.
Today, children are at risk for disease stemming from the prevalence of sedentary behaviors. Schools are largely obesogenic environments but have the potential to promote and provide opportunities to meet the recommended daily minutes of physical activity. Yet educators must be prepared to do so. The objective of this review was to examine the strength of evidence from studies on professional development effectiveness in order to make recommendations on how to structure such experiences to prepare teachers to promote and provide physical activity in schools. Effective strategies for professional development that were confirmed in the literature focused on knowledge of subject matter, collective and collaborative participation, continual and long in duration, coherence with student learning, active learning, and the building of a community of practice. Further, research to examine the effectiveness of professional development on student physical activity participation within the school environment is warranted.
The utility of lifestyle-based health promotion interventions is directly affected by participant adherence to prescribed behavior changes. Unfortunately, poor adherence to behaviors recommended in lifestyle interventions is widespread, particularly over the long term; thus, the "adherence problem" represents a significant challenge to the effectiveness of these interventions. The current review provides an overview of the adherence problem and describes a theoretical framework through which the factors that affect adherence can be understood. To further understand the difficulties individuals face when adhering to health behavior changes, we focus our discussion on the challenges associated with adherence to lifestyle behaviors recommended for weight loss and healthy weight management (ie, reductions in dietary intake and increases in physical activity). We describe strategies that improve long-term adherence to health behaviors related to healthy weight management, including the provision of extended care, skills training, improving social support, and strategies specific to maintaining changes in dietary intake and physical activity. Finally, we discuss difficulties involved in implementing long-term weight management programs and suggest practical solutions for providers.
Over the past few decades, researchers have been developing and refining psychological theories and models to provide solid behavioral frameworks for evidence-based research. Each year new theories and models are created; however, a select few appear to have withstood the test of time and continue to be frequently utilized in present-day research. The objectives of this review are to highlight these psychological theories and models and describe their application to various public health issues and behaviors. Descriptions and example applications of the following theories and models are described in this review: health belief model, theory of reasoned action/planned behavior, social cognitive theory, transtheoretical model, and socioecological model.
Chronic low back pain (cLBP) is common and has a tremendous economic impact. With the prevalence and incidence of low back pain (LBP) on the rise, individuals often seek alternative treatments. Yoga is a widely used complementary and alternative medicine treatment for LBP. However, its efficacy as an intervention for LBP has not been thoroughly investigated. Therefore the purpose of this study was to systematically review the current literature for randomized controlled trials that assess the outcomes of Yoga as an intervention for individuals with cLBP. An electronic database search was performed for studies related to the efficacy of yoga in treatment for cLBP. Studies included were randomized control trials, published in English, from a peer-reviewed journal that identified yoga as the primary treatment focus for LBP in at least one group and included participants with at least a 12-week (3-month) history of symptoms. Our search revealed 185 articles. Of these, 10 met the inclusion criteria. We concluded Yoga intervention appears to be an efficacious intervention in alleviating cLBP. Yoga was demonstrated to significantly improve quality of life and reduce disability, stress, depression, and medication usage associated with cLBP in 8 of the 10 analyzed trials when compared with usual care, self-care book, or exercises. However, more research is necessary before recommendations can be made.
The use of alcohol can be traced back in time over thousands of years and remains prevalent in modern society. Alcohol consumption has shown to both improve health and cause health problems. One such health problem is the potential interaction that can occur when alcohol is consumed while taking certain medications. The drug–alcohol interaction can be due to alternations in the drugs absorption, distribution, metabolism, and/or elimination. It can also occur as a result of the additive effect that alcohol can have on an already existing effect of the medication (eg, enhanced sedation). Covered in this article are some of the common drug–alcohol interactions and a brief description about the interaction. The medication classes reviewed include pain relievers, antidepressants, antidiabetic medications, first-generation antihistamines, antipsychotics, sedatives and hypnotics, antibiotics, and warfarin.
The passage of Title IX in 1972 resulted in a tremendous increase in the number of females participating in high school and collegiate athletics. This rise in female athletes sparked new focus areas of research in sports medicine related to woman with an important area emerging in 1980, the female athlete triad. This triad consisting of low energy availability, menstrual irregularities, and bone health disruption spans a spectrum of severity and has evolved both in diagnosis and in management throughout the years. Many health questions arise for female athletes and their health care providers, often concerning the most effective management and treatment strategies for this triad. This review examines the research and latest advancements in recognizing and understanding the female athlete triad and explores the most current recommendations for treatment and prevention.
There have been dramatic increases over the past several decades in the prevalence of childhood obesity and childhood metabolic syndrome in the United States and other industrialized nations. Since the 2 conditions carry negative health implications, both during childhood and later in life, it is important for health care professionals to stay abreast of the current literature relative to both conditions. This review will examine definitional issues, prevalence rates, causative factors, and health consequences associated with childhood obesity and the metabolic syndrome, as well as current thinking regarding prevention and treatment efforts. The review will conclude with recommendations relative to future research needs.
Despite spending more per capita on health care than any other country, health outcomes in the United States rank low. In 2001, in an attempt to improve the situation, The Institute of Medicine defined ideal health care as safe, timely, effective, efficient, equitable, and patient centered. In 2008, to more clearly define the goals of health care, Berwick, Nolan, and Whittington of the Institute for Healthcare Improvement (IHI) introduced the concept of the Triple Aim—the simultaneous improvement of population health and patient experience while controlling costs. In 2011, the 3 goals of the IHI Triple Aim were adopted by the US National Quality Strategy. Whereas the IHI Triple Aim represents a powerful innovation in health care, population health extends far beyond the care delivery system. To increase the potential impact of efforts that promote the Triple Aim, we offer a model that includes the addition of lifestyle medicine and social policy initiatives to provide a bridge from the clinic to the community and address nonmedical determinants of health. Addressing lifestyle and social policy will require the engagement of nonmedical sectors of the community in new partnerships with health care. The power of these partnerships could result in large and sustainable improvements in health, economic status, and well-being.
Alcohol consumption is described in terms of both quantity and frequency of alcohol use. This article describes present knowledge of alcohol use in young adults, complex factors that influence alcohol use and binge drinking, nutrition and body weight consequences of alcohol use, and interventions that may decrease alcohol use. Young adults have the highest prevalence of infrequent, high-quantity alcohol consumption in any age group, placing them at an increased risk for weight gain, overweight, and obesity. Lifestyle medicine practitioners can have a positive impact by sharing 4 key recommendations about alcohol use: (a) alcohol provides calories but no essential nutrients;(b)if alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men;(c) moderate-level alcohol consumption is associated with the lowest risk of obesity (d) moderate-level alcohol consumption, when consumed in a binge-drinking pattern, is not protective against obesity.
Considerable evidence has accrued that cardiovascular disease (CVD) has its beginnings during childhood, with some reports of endothelial damage occurring in early adolescence. Thus, early prevention and intervention on developing cardiometabolic risk factors is important. Presently, diet and exercise are strategic parts of any CVD prevention or treatment program. Although diet is important, the effects of exercise training or regular moderate-to-vigorous intensity physical activity go beyond simply modifying the traditional risk factors. For children, the majority of studies show that regular physical activity can lower elevated blood pressure, positively influence lipid profiles, reduce inflammation, and improve vascular functioning. These changes are most evident in children who exercise and lose weight. Despite these potential benefits of physical activity, not all studies on children have found positive effects of habitual physical activity on CVD risk factors. Reasons for these differences are discussed throughout this review. The literature also suggests that habitual physical activity, although meeting guidelines, may not be sufficient for all individuals to bring about changes; thus, to be an effective modality physical activity needs to increase beyond habitual levels or be of a moderate to vigorous intensity. This review provides recent evidence (since 2008) regarding the influence of physical activity on the cardiometabolic risk factors in children.
Studies showed that nut consumption is associated with a reduced risk in cardiovascular disease (CVD) mortality and morbidity and an improvement
in the modifiable CVD risk factors. Our objective was to review studies that reported the effect of pistachios intake on blood lipid profile. A PUBMED and
Loma Linda University Nut Library database search was conducted to identify relevant studies. Eight relevant studies were identified and included in the
review. With a few exceptions, the results showed a consistent improvement in serum lipid profile, improving all cholesterol fractions. With one exception, all studies reported a large decrease in the mean LDL-cholesterol ranging from 7.6 to 9.7% of the baseline level. In four of the seven studies that reported a change in HDL-cholesterol level, the mean HDLcholesterol increased after the intervention. In all but one studies that reported the change in TG, the post-test values were reduced. The majority of the studies reported statistically significant reduction in the mean TC and LDL-cholesterol fractions. Similarly, all studies that reported a change in TC/HDL-cholesterol and LDLcholesterol/HDL-cholesterol ratios reported a statistically significant improvement. Adding pistachios to a typical diet of normo and hypercholesterolemic individuals have a beneficial effect on blood lipid profile.
There is no minimum fiber requirement for on-pack whole-grain claims, yet consumers perceive products made with whole grains to provide at least a good source of fiber. To understand how this misperception may be fueling Americans’ fiber intake shortfall, this study investigated the impact on fiber intakes of ready-to-eat (RTE) cereal products with whole-grain claims. A 14-day eating frequency diary was collected from US free-living households over 3 years in the NPD Group’s National Eating Trends (NET) panel (n=10,708). Average daily fiber intake and sources were calculated from the types and frequency of food and beverages consumed at meals. T-tests were conducted on mean fiber intake at breakfast and daily to identify significant differences between all adults, adults consuming whole-grain RTE cereals with <3 g of fiber per serving, and adults consuming whole-grain RTE cereals with ≥3 g of fiber per serving. Adults eating whole-grain RTE cereals with ≥3 g of fiber per serving consumed 42% more fiber at breakfast and 14% more daily fiber than typical adults. Individuals choosing whole-grain RTE cereal with ≥3 g of fiber per serving consume significantly more fiber at breakfast and throughout the day relative to all adults and to adults eating whole-grain RTE cereals with <3 g of fiber per serving.
Exercise could indirectly affect body weight by exerting changes on various components of appetite control, including nutrient and taste preferences, meal size and frequency, and the drive to eat. This review summarizes the evidence on how exercise affects appetite and eating behavior and in particular answers the question, "Does exercise induce an increase in food intake to compensate for the increase in energy expenditure?" Evidence will be presented to demonstrate that there is no automatic increase in food intake in response to acute exercise and that the response to repeated exercise is variable. The review will also identify areas of further study required to explain the variability. One limitation with studies that assess the efficacy of exercise as a method of weight control is that only mean data are presented—the individual variability tends to be overlooked. Recent evidence highlights the importance of characterizing the individual variability by demonstrating exercise-induced changes in appetite. Individuals who experience lower than theoretically predicted reductions in body weight can be characterized by hedonic (eg, pleasure) and homeostatic (eg, hunger) features.
Although alcohol has existed almost as long as human existence, its consumption and abuse can have many detrimental effects. Alcohol has been associated with a wide variety of injuries, both intentional and unintentional, and can lead to physical, verbal, and sexual violence as well as family dysfunction. The role of alcohol advertising and media plays a role in alcohol’s contribution to society, and youth may be more heavily influenced than adults. Moreover, alcohol has psychological, social, and physical consequences in addition to a direct impact on health. A number of methods may be advantageous for lifestyle medicine practitioners targeting this issue, including prevention strategies for alcohol misuse, increased legal reinforcement, screening and brief intervention, public campaigns, and media advocacy.
Bariatric surgery has been demonstrated to be an effective treatment for patients with severe obesity, producing improvements in many comorbid conditions, including type 2 diabetes, hypertension, obstructive sleep apnea, and dyslipidemia. The loss of body weight and resolution of comorbidities have been more recently found to be the result of functional and metabolic changes produced by the surgical procedures. Nonetheless, bariatric surgery is still considered to be a tool that is supported by health behaviors characteristic of all weight loss programs—that is, adoption of healthy eating patterns, engagement in robust physical activity, and implementation of constructive coping strategies. In addition, patients who undergo bariatric surgery face challenges that are particular to this population, including adjustment to rapid and significant reduction in body weight, forced alterations in eating behavior, and risk of alcohol misuse. This state-of-the-art review focuses on the research and resultant recommendations regarding lifestyle management for patients who have undergone bariatric surgery.