Walter Willett for Newsweek, February 5, 2010
Until last year, the residents of Albert Lea, Minn., were no healthier than any other Americans. Then the city became the first American town to sign on to the AARP/Blue Zones Vitality Project—the brainchild of writer Dan Buettner, whose 2008 book, The Blue Zones, detailed the health habits of the world’s longest-lived people. His goal was to bring the same benefits to middle America—not by forcing people to diet and exercise, but by changing their everyday environments in ways that encourage a healthier lifestyle.
What followed was a sort of townwide makeover. The city laid new sidewalks linking residential areas with schools and shopping centers. It built a recreational path around a lake and dug new plots for community gardens. Restaurants made healthy changes to their menus. Schools banned eating in hallways (reducing the opportunities for kids to munch on snack food) and stopped selling candy for fundraisers. (They sold wreaths instead.) More than 2,600 of the city’s 18,000 residents volunteered, too, selecting from more than a dozen heart-healthy measures—for example, ridding their kitchens of supersize dinner plates (which encourage larger portions) and forming “walking schoolbuses” to escort kids to school on foot.
The results were stunning. In six months, participants lost an average of 2.6 pounds and boosted their estimated life expectancy by 3.1 years. Even more impressive, health-care claims for city and school employees fell for the first time in a decade—by 32 percent over 10 months. And benefits didn’t accrue solely to volunteers. Thanks to the influence of social networks, says Buettner, “even the curmudgeons who didn’t want to be involved ended up modifying their behaviors.”
Isn’t it time we all followed Albert Lea’s example? Diet and exercise programs routinely fail not for lack of willpower, but because the society in which we live favors unhealthy behaviors. In 2006, cardiovascular disease cost $403 billion in medical bills and lost productivity. By 2025 an aging population is expected to drive up the total by as much as 54 percent. But creative government programs could help forestall the increases—and help our hearts, too. A few suggestions:
Sponsor “commitment contracts” to quit smoking. Yale economist Dean Karlan spearheaded a test program in the Philippines in which smokers who wanted to quit deposited the money they would have spent on cigarettes into a special bank account. After six months those who had succeeded got their money back, while those who had failed lost it. Such a program could be run here by public-health clinics and offer greater incentives, such as letting winners divvy up the money forfeited by losers. Even without such an enhancement, says Karlan, “Filipino participants were 39 percent more likely to quit than those who were not offered the option.
“Require graphic warnings on cigarette packages. It’s easy to disregard a black-box warning that smoking is “hazardous to your health.” It’s not so easy to dismiss a picture of gangrenous limbs, diseased hearts, or chests sawed open for autopsy. These are exactly the types of images that the law now requires on cigarette packages in Brazil. In Canada, such warning images must cover at least half the wrapping. In 2001, the year after the Canadian law took effect, 38 percent of smokers who tried to quit cited the images. Think of it as truth in advertising.
Subsidize whole grains, fruits, and vegetables in the food-stamp program. The underprivileged tend to have disastrously unhealthy diets, and no wonder: $1 will buy 100 calories of carrots—or 1,250 calories of cookies and chips. The government should offer incentives for buying produce. The Wholesome Wave Foundation has shown the way in 12 states, providing vouchers redeemable at farmers’ markets to people in the SNAP program (the official name for food stamps). “We’ve seen purchases of fruits and vegetables double and triple among recipients,” says president and CEO Michel Nischan.
Set targets for salt reduction. The average American consumes twice the recommended daily maximum of sodium, most of it from processed foods. The result: high blood pressure, heart attacks, and strokes. But New York City is leading a campaign to encourage food manufacturers to reduce added sodium over the next five years. Consumers will barely notice the changes because they will occur so gradually. The FDA should follow New York’s lead.
Incorporate physical education into No Child Left Behind. American children may be prepping like crazy for standardized tests, but they’re seriously lagging in physical fitness. Regular exercise improves mood, concentration, and academic achievement. It can also help reverse the growing trend toward type 2 diabetes and early heart disease in children and teenagers.
Require that sidewalks and bike lanes be part of every federally funded road project. The government already spends 1 percent of transportation dollars on such projects. It should increase the level to 2 to 3 percent. When sidewalks are built in neighborhoods and downtowns, people start walking. “The big win for city government is that anything built to a walkable scale leases out for three to five times more money, with more tax revenue on less infrastructure,” says Dan Burden, executive director of the Walkable and Livable Communities Institute. He recommends a “road diet” in which towns eliminate a lane or two of downtown traffic and substitute sidewalks. “When roads slim down, so do people,” he says.
It’s all reasonable. But Dan Buettner isn’t waiting for any of these measures to surmount the inevitable industry hurdles. This year he’s looking to scale up the Blue Zones Vitality Project to a city of 100,000 or more. “If this works, it could provide a template for the government that’s replicable across the country,” says his colleague Ben Leedle, CEO of Healthways, which is developing the next phase of the project. The challenges will be much steeper in large cities. But with measures like these, we could one day find ourselves growing fitter without specifically dieting or exercising. Finally, a New Year’s resolution we can all keep.
via How Public Policy Can Prevent Heart Disease – Newsweek.com.
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One out of every five U.S. teenagers has a cholesterol level that increases the risk of heart disease, federal health officials reported Thursday, providing striking new evidence that obesity is making more children prone to illnesses once primarily limited to adults.
A nationally representative survey of blood test results in American teenagers found that more than 20 percent of those ages 12 to 19 had at least one abnormal level of fat. The rate jumped to 43 percent among those adolescents who were obese.
Previous studies had indicated that unhealthy cholesterol levels, once a condition thought isolated to the middle-aged and elderly, were increasingly becoming a problem among the young, but the new data document the scope of the threat on a national level.
“This is the future of America,” said Linda Van Horn, a professor of preventive medicine at Northwestern University who heads the American Heart Association’s Nutrition Committee. “These data really confirm the seriousness of our obesity epidemic. This really is an urgent call for health-care providers and families to take this issue seriously.”
Earlier research found that the obesity epidemic has been accompanied by an increase in a host of health problems in youths that were previously found mostly among adults, including high blood pressure, diabetes and arthritis. The new data detail the obesity’s effect on cholesterol levels, which can increase the risk for a variety of illnesses, including diabetes and heart disease.
“The current epidemic of childhood obesity makes this a matter of significant and urgent concern,” said Ashleigh May, an epidemic intelligence service officer with the federal Centers for Disease Control and Prevention’s division for heart disease and stroke prevention, who led the analysis.
Although the latest government data suggest that the obesity epidemic might be leveling off after increasing for decades, at least one-third of youths are overweight or obese, and the heaviest boys continue to get heavier.
“People are worried that this generation is going to grow up to have more cardiovascular disease than the current generation,” said Denise Simons-Morton of the National Heart, Lung and Blood Institute. “This problem is poised to negate all of the advances we’ve made in cardiovascular health.”
In the new study, published in the CDC’s Morbidity and Mortality Weekly Report, researchers analyzed data collected from 3,125 youths through the National Health and Nutrition Examination Survey, which is conducted every two years.
According to data from surveys conducted between 1999 and 2006, 20.3 percent had abnormal “blood lipid” levels, which includes low levels of high-density lipoprotein (HDL), or the “good cholesterol”; high levels of low-density lipoprotein (LDL), the “bad cholesterol”; and high levels of triglycerides, which can also clog arteries.
The percentage of teens with an abnormal blood lipid level varied by weight, ranging from 14.2 percent of those whose weight was normal to 22.3 percent among those who were overweight to 42.9 percent among those who were obese.
The findings support a 2008 recommendation by the American Academy of Pediatrics that children and adolescents get blood tests to see whether they need to be treated for abnormal lipid levels if they are at risk for heart disease because of a family history of high blood cholesterol or early heart disease or if they are at risk because they smoke, have high blood pressure or diabetes or are overweight.
High cholesterol puts 1 of 5 teens at risk of heart disease – washingtonpost.com.
]]>Pam Belluck – October 15 2009
Bans on smoking in places like restaurants, offices and public buildings reduce cases of heart attacks and heart disease, according to a report released Thursday by a federally commissioned panel of scientists.
The report, issued by the Institute of Medicine, concluded that exposure to secondhand smoke significantly increased the risk of a heart attackamong both smokers and nonsmokers. The panel also said it found that a reduction in heart problems began fairly quickly after a smoking ban was instituted and that exposure to low or fleeting levels of secondhand smoke could cause cardiovascular problems.
“Even a small amount of exposure to secondhand smoke can increase blood clotting, constrict blood vessels and can cause a heart attack,” said Dr. Neal L. Benowitz, a professor of medicine, psychiatry and biopharmaceutical sciences at the University of California, San Francisco, and a member of the panel.
“Smoking bans need to be put in place as quickly as possible,” Dr. Benowitz added. “The longer we wait, the more disease we are accepting.”
The report, commissioned by the Centers for Disease Control and Prevention, examined data from 11 studies from communities in Canada, Italy, Scotland and the United States.
The degree of heart attack reduction in those communities varied widely, from 6 percent to 47 percent, but every study showed a decline.
“The evidence is now overwhelming,” said Dr. Richard D. Hurt, director of the nicotinedependence center at the Mayo Clinic, who was not involved in the report.
“Secondhand smoke kills a lot of people,” Dr. Hurt said, “and one of the mechanisms by which it does is through exposure and the effect on the cardiovascular system.”
The committee said that none of the 11 studies were optimal in method or in data collection, making some significant questions unanswerable. Some studies were small, some were conducted over a short time, and only two, in Scotland and in Monroe County, Ind., noted whether heart attack victims were smokers or nonsmokers.
These limitations left the committee unable to determine why reduction rates varied so much. But some members speculated that places like New York State, which had some smoking restrictions in place before instituting more comprehensive bans, would already have been showing improvement, so reductions from bans would be smaller.
“Evidence was not strong enough to say the degree” to which smoking bans reduce risk or the degree to which “individual lifestyle, community and societal factors can also influence the magnitude” of heart disease reduction, said Dr. Lynn R. Goldman, the panel’s chairwoman, a professor of environmental health sciences at Johns Hopkins University.
Dr. Michael Siegel, professor of community health sciences at Boston University, said that such limitations were significant flaws and that the panel was being “sensationalistic” about the impact of smoking bans.
“Anybody could have told you without any kind of review that smoking bans don’t raise heart attacks,” Dr. Siegel said, but “it could be that they have an exceedingly small effect” and that reductions were “just occurring anyway” because of improvements in treatment of heart disease.
A panel member, Dr. Eric D. Peterson, a cardiologist at Duke, said that even if reduction rates were small, the studies supported bans.
Dr. Goldman said the committee found that “a cause-and-effect relationship exists between heart disease generally and secondhand smoke exposure.”
“It increased the risk of coronary heart disease by about 25 to 30 percent,” she added.
Dr. Siegel said that connection was “unequivocal,” but that a significant risk applied only in people who have severe heart disease. “An otherwise healthy person is not going to walk into a bar for 20 minutes and have a heart attack,” he said.
Seventeen states, Puerto Rico and the District of Columbia ban smoking in bars, restaurants and workplaces, while 14 other states ban smoking in one or two of those types of establishments, according to Americans for Nonsmokers’ Rights, an advocacy group. More than 350 cities and towns have similar bans.
The panel’s report echoes two recent studies which found that one year after smoking bans were put in place, the average rate of heart attacks had dropped by 17 percent, and continued to drop more over time.
David Sutton, a spokesman for Philip Morris U.S.A., said that he could not comment on the institute report until the company had had a chance to review it, but that the company supported smoking bans in public areas.
“Private business owners should have the flexibility” to “cater to smokers and nonsmokers alike,” Mr. Sutton said, but “there are sufficient reasons to warrant measures that regulate smoking in public places, places where people must go.”
Smoking Bans Reduce Heart Attacks and Disease – NYTimes.com.
]]>The study was published online on Monday in The Journal of Clinical Investigation.
Researchers at the University of California, Davis, assigned 32 overweight men and women, whose average age was 55, to groups consuming either fructose-sweetened or glucose-sweetened drinks over a 10-week period. The drinks, specially formulated for the study, contained only pure fructose or pure glucose.
For the first two weeks, the volunteers lived in a clinical research center, consuming abalanced diet high in complex carbohydrates and undergoing various blood tests and measurements of body fat. This phase established baseline measurements for the study.
As outpatients for the next two weeks, the subjects ate their usual diets, plus either fructose- or glucose-sweetened drinks consisting of 25 percent of their energy requirements. After returning to the center for more tests, the participants spent six more weeks as outpatients on their usual diets, then finally two more weeks in the clinic on the high-carbohydrate diet while drinking the sweetened beverages.
While outside the hospital, the subjects’ diets were tracked with daily phone calls, and compliance with consumption of the drinks was measured by urine tests.
The two groups had been matched for age, weight, fasting triglyceride levels, insulin concentrations, total cholesterol and other factors. But by the end of the study, the researchers found, those participants consuming fructose beverages had significantly increased blood levels of triglycerides and L.D.L., compared to those consuming drinks sweetened with glucose.
Although there was a similar moderate weight gain in both groups, the fructose drinkers also had larger increases in fat inside the abdomen, also associated with an increased risk of cardiovascular disease.
The study was intended only to learn more about the metabolic impacts of glucose and fructose consumption, the authors noted, not the health effects of high-fructose corn syrup, which is a mixture of fructose and glucose. Table sugar also contains both glucose and fructose, as do many fruits and some vegetables.
Dr. Peter J. Havel, the senior author and a nutrition professor at the University of California, Davis, said that the findings “do not imply that anyone should avoid fruit, which contains only small amounts of fructose and has other important nutritional benefits.”
John S. White, a biochemist who has published widely on nutritive sweeteners and was not involved in this study, said that the experimental setup did not reproduce a real-life diet. The study did not test high-fructose corn syrup, he said, and judgments should not be made about it from the findings.
Fructose-Sweetened Beverages Linked to Heart Risks – NYTimes.com.
]]>Researchers used data on 80,360 Swedish men and women ages 45 to 83 who were enrolled in two long-term health studies over a seven-year period ending in 2004. During those years, 1,100 of them were either hospitalized for heart disease or died from it.
The researchers measured waist size, waist-to-hip ratio, waist-to-height ratio, and B.M.I., or body mass index, a weight-to-height ratio. All four measures were associated with heart disease, but waist circumference alone predicted heart disease risk regardless of other measures. B.M.I. was a significant predictor in women only if they had a large waist size. The study appeared online April 7 in the journal Circulation: Heart Failure.
The researchers found that a four-inch increase in waist size was associated with about a 15 percent increase in risk for heart disease, both in people of normal weight with a B.M.I. of 25 and in the obese with a B.M.I. above 30.
“If people are using waist size to monitor body weight, that’s fine,” said Emily B. Levitan, the lead author and a research fellow at Harvard. “But what we really found is that excess weight, no matter how you measure it, is associated with increased risk.”
via Vital Signs – Risks – Waist Size Strongly Tied to Heart Disease – NYTimes.com.
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