All I need is a little help from my friends...

Although my roommate has thus far been unable to convince me to join her at bikram yoga, a couple of news items this week attest to the powers of peer pressure in changing one’s lifestyle.

The first is a study out of Stanford about the families of patients who underwent gastric bypass surgery. The investigators found that obese family members of bariatric patients lost an average of 3% of their total weight in the first year following the surgery – this is equivalent to the amount of weight loss achieved on the average diet plan such as the Atkins diet. So although the family member wasn’t officially on the post-op bariatric diet, it is as if they were.

The second is a program called the “Daniel Plan” created by Rick Warren (best known for “The Purpose Driven Life”) at his church in California. Warren has used what he calls “the healing power of the group” to motivate members of his church to lose weight; he effectively utilizes the existing foundation of church small groups not only for spiritual growth but also physical betterment. The first point of his six-point program is to “connect” or create partnerships that foster positive change. Fourteen thousand people signed up and 72% lost weight. A survey found that participants lost nearly 7 more pounds following the plan in a group than they following the plan on their own.

Both of the above examples involve groups – either natural or constructed. What is fascinating about the Stanford study is that the weight loss was unintentional – it was purely a product of environment. The other interesting thing is that there is really nothing inherently special about either diet plan. What is amazing is the difference the support of a group makes in adhering to that plan. Not surprisingly, this has great implications for global and public health. It is one of the reasons why Alcoholics Anonymous and Partners in Health have been so successful.

Message to my roommate: if exercise is anything like nutrition, the stats are on your side! Eventually, I may succumb to your good example.

(Arch. Surg. 2011;146:1185-90)

Practicing what we preach: Hospital Cafeterias

It's relatively common knowledge in the medical field and to many people that poor diet and physical inactivity is a leading "actual" cause of death. It is quickly catching up to tobacco and may soon overtake it to become the leading cause of death in America; no question, a leading public health threat.

So it may seem ironic when a cafeteria at a health care institution actively promotes a leading cause of death. While many institutions have taken the steps to a smoke free campus, saturated fat filled cheese pizza, fries, hamburgers, hot dogs, and macaroni and cheese still seems to be the rule, not the exception.

How would we feel if a hospital not only allowed tobacco on campus, but sold cigarrettes from vending machines? From a public health standpoint, these practices are equally harmful.

The cynical side of me recognizes that other than institutional philosophy, there has been little financial incentive for a hospital cafeteria to provide healthful food (and perhaps even has some incentive to keep their vascular surgeons and cardiac cath lab busy!). This may change if the new payment system under discussion, Accountable Care Organizations becomes the norm where the hospital or provider group stands to save money by promoting a healthy patient population.

So far, it is the rare hospital that has made health a priority. St Joseph Mercy Ann Arbor is one of those, employing a chef from Google and investing $1million to remodel their cafeteria in the name of health; reducing portion sizes, color coding options to help indicate nutritional value, and saying goodbye to their deep fryer.

By popular request, WooFood is actively working with the Cafeteria at UMass Memorial to promote change that will at least encourage healthful options. (Disclaimer; the author of this post is a founding member of WooFood). The need has been recognized by many people including the CEO of UMass Memorial who has stated that the healthcare community needs to practice what it preaches when it comes to healthful options.

What are your thoughts on hospital cafeteria food? How is the food at your school's or hospital's cafeteria? Does a hospital cafeteria have a responsibility to serve healthful foods because it is a healthcare institution?

Food for Thought - Comments on a Pediatrician's Reaction to the Haitian Earthquake

Last week, I had a chance to hear a pediatrician from Massachusetts (Dr. Dennis Rosen from Children's) talk about his experiences in Haiti in the months following the earthquake. Many of the experiences he described demonstrated the incredible ingenuity required to practice in such a resource poor and devastated setting. He told stories through pictures and the pictures spoke volumes about the condition health care in the country, both before and after the disaster.

When they could not find an incubator for preterm baby, one was fashioned from a cardboard box and a desk lamp. The baby in a box lived in soon they did this for many more. They saw many children who were malnourished and didn't quite know what to do. This was a condition the Haitian doctors and residents took great pride in knowing how to treat: " This we do very well."

Taking a photographic tour through the pediatric wards in Haiti - the small tents crammed with patients, parents sleeping underneath their children's cribs in streams of water flowing through the tents, parents taking children home with defects like omphaloceles - one found it difficult to not what to render assistance.  Stepping past the urges to offer assistance perhaps the most important lessons of the night were lessons of perspective.  There were numerous doctors in the audience who commented on a Haitian health care system that was largely in a similar condition when they visited 30 or 40 years ago.  Certainly the economy was no better at that time.  We discussed some of the disorganization that ensues when aid pours in from many sources.  When aid is given without regard to the specific needs on the ground, there tends to be a mismatch between what supplies are given and what is actually required. 


The take home? ... Perhaps aid is best rendered through established and organized groups instead of individual donations or traveling as part of a small contingent.

He reminded us of the Chinese proverb:

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."

In some ways, rendering aid after the disaster works a bit like this.  There's an immediate need we need to help out with, but for a lasting change, aid needs to be delivered in a sustainable way that seeks to build up the infrastructure and the economy of the country in need.

Deadline for Photo Submission this Saturday!

The Committee on Global and Public Health is preparing a photographic newsletter featuring the public health and global health initiatives of medical students at various medical schools throughout the country. If you have photographs of members of your Chapter engaging in a global or community health project, working at a free clinic, teaching at a local school, etc. please send them along with a brief caption to Lauren.page.black@gmail.com by Saturday October 29th. Please note that in addition to this newsletter these photos may be used in other CGPH publications and programs.

Thanks,
Lauren Page Black
Vice-Chair, Committee on Global and Public Health

Soda, SNAP, and Policy

The Supplemental Nutrition Assistance Program (SNAP), formerly the food stamps program, was started in 1961 and was made permanent in 1964 with the goal of providing improved levels of nutrition to low-income households.  Almost 50 years later some 40 million individuals participate in the program but the nutritional state of this country is drastically different than it was in 1961.  While hunger still plagues individuals in the U.S., malnutrition due to overeating has been an increasingly larger problem.  This has led many, including Dr. Kelly Brownell, to question the role of SNAP in meeting its goals of improving levels of nutrition for all who participate. 

In August, the USDA denied a request from the state of New York to conduct a pilot program that would have allowed the elimination of sugar-sweetened beverages from SNAP in its state.  In a recent JAMA article, Dr. Brownell outlines the USDA's concerns for denying the proposal and argues that keeping sugar-sweetened beverages in the program only leads to an increase in obesity, diabetes, and heart disease.  If the USDA already denies non-essential items including those with adverse health effects (alcohol and tobacco) then it would seem logical to deny food items that offer no nutritional value to its participants.  Dr. Brownell also urges the USDA to fund research to generate the needed data to inform policy decisions when denying future pilot programs.

While the AMA does not have specific recommendations on the most recent decision denying the New York proposal, H-150.936 and H-150.937 from AMA policy clearly support the use of evidence based nutrition and reduced calorie-dense, nutrition-poor foods.  Dr. Brownell's article illustrates the need for the AMA and other professional healthcare organizations to become active in shaping nutrition policy by adopting a stance that supports optimal nutrition in government programs.  

Regarding Male Circumcision

Male circumcision is an issue discussed in the MSS house a couple of times in recent years (2000, 2009).  One resolution was a request for CEJA to investigate the implications of such a practice and the other asked for our section to oppose the practice.  Both were not adopted as policy, though I remember significant heated testimony on the issue.

It's not just the MSS that's been dealing with the issue.  The discussion has taken place in many states across the country and the AAP is readdressing their current policy (that circumcision may have some health benefits, but that data doesn't necessarily support routine circumcision).

This week, JAMA published an commentary no the issue with some interesting public health arguments.  In brief:  imagine a vaccine that would reduce the risk of HIV transmission by 60% (verified in 3 RCTs) and reduce the risk of herpes and high risk HPV transmission by roughly 30%.  That would be huge news!  The authors argue with these and several other points that male circumcision does in fact have a significant long-term pubic health benefits.  With the publication of new data to this end over the past few years, they encourage everyone to take a new look at the body of data before coming to conclusions on the practice.  Read the rest of the article here: http://jama.ama-assn.org/content/306/13/1479.extract

JAMA.2011;306(13):1479-1480. doi:10.1001/jama.2011.1431

Send us pictures of your Chapter!

The Committee on Global and Public Health is preparing a photographic newsletter featuring the public health and global health initiatives of medical students at various medical schools throughout the country. If you have photographs of members of your Chapter engaging in a global or community health project, working at a free clinic, teaching at a local school, etc. please send them along with a brief caption to Lauren.page.black@gmail.com. Please note that in addition to this newsletter these photos may be used in other CGPH publications and programs.

Thanks,
Lauren Page Black
Vice-Chair, Committee on Global and Public Health