This summer has probably been the first time that I have been in a hospital for an extended period of time. Although I think ideally I would pack a healthy meal everyday, I have inevitably turned to the hospital cafeteria too many times. The somewhat limited and unhealthy variety and selection of the choices available at the Royal Alexandra Hospital was surprising for me. Eventually, I did come to realize that their are relatively good options available at some of the food joints at Royal Alex, it gave me an idea to try and analyze the food choices available in Edmonton hospitals.
As a warning, I don't have a nutrition degree or am nowhere close to a dietician in my skillset in analyzing meal content. However, I am going to try and research this stuff, use help from friends, and put together what I can in this area.
I hope to cover these hospitals:
- Royal Alexandra Hospital - 10240 Kingsway Avenue - University of Alberta Hospital - 8440 112 Street - Misericordia Hospital - 16940 87 Avenue - Grey Nuns - 1100 Youville Drive NW - Alberta Hospital (if time permits!) - 17480 Fort Road
After taking a break from this blog, I am going to try and restart writing and exploring some concepts regarding obesity trends. If you have any ideas that I should explore, let me know and I will look into it.
I hope you enjoyed reading through the blog and had a chance to think about the broad pictures of some of the social determinants that impact obesity and the associated comorbid conditions. The reason I chose to do this assignment in blog format was to explore a different way of expressing and synthesizing information that is found on the health topics that we are researching. Social media allows health care professionals to access new forms of intervention and health promotion strategies that have not been allowed conventionally. It also gave me an opportunity to compare the things that I was reading about in academic journals with how these things play out in my own environment. Finally, use of this format gives me the freedom to synthesize different sources of information, from news articles, Youtube, other blogs etc.(things the general public uses and is familiar with) into this assignment.
Please feel free to give feedback and comments on what you think about the issues and arguments I have included here.
Traditional approaches of combating obesity have often consisted of health care professionals encouraging individuals to eat less and exercise. This has led to a multi-billion industry revolving around dieting and intense exercise routines that are difficult for people to incorporate into their daily lives. Meanwhile, despite these efforts, the rates of obesity have continued to increase.
The Heart and Stroke Foundation of Canada released a position statement calling for different levels of governments, policy makers, and Canadians to get involved in creating healthier environments. For instance, strategies to change the built environment to promote walking impact our health have been advocated for. The article describes that the risk of obesity "can decline by 4.8% for each additional kilometre walked per day".
New York City has taken some of the research on the built environment and the importance of involving non-traditional stakeholders to heart, and has developed strategies to promote a healthier city through. The New York Fit City project couples the health department with non profits, community groups, and academic institutions. Over the short span the project has been running, they have documented significant improvements in dietary patterns and physical activity. The initiatives range from opening community gardens to changing building designs and having stair prompts beside elevators. Such imaginative strategies are inspiring and serve as good models for seeing the research being translated into action to improve health for people.
From all the different posts that I have included in this blog, it is clear that obesity and the associated comorbid conditions is a complicated problem with a very complex etiology. The following chart was presented to our class in a lecture from Dr. Arya Sharma, that captures the complexity of the situation quite well:
I could go on describing each one of these factors and how they impact obesity. The big picture to consider is the same one that we hear numerous times regarding many different conditions: "Genetics loads the gun, and environment pulls the trigger." The tremendous rise in obesity and associated comorbidities begs health care providers, policymakers, and the general society to consider interventions that address the issue in a broad manner, rather than blaming the individual and reducing the debate to simply being a matter of over eating and energy balance.
Research indicates that broad issues such as socioeconomic status, the built environment, and changes in dietary patterns have all contributed to the rising prevalence of obesity. In addition, these factors do not impact obesity in isolation. They overlap and influence each other, and greater understanding of these relationships is required to enhance our ability to create meaningful interventions. Considering obesity from a multi-factorial model also allows us to use a bigger toolkit aiding with prevention and management strategies. For instance, considering addiction to food as a cause of obesity among some people, and use of strategies used among mental health and addiction issues may be worthwhile to consider.
It is also important to remember that health care workers and policymakers will need to integrate information and strategies from different professions to make future interventions more successful. We need to be able to draw from diverse backgrounds ranging from architects and civil engineers involved in building design and urban planning to nutritionists and physicians to tackle the deficits in health that are created by our environment.
By exploring the different issues around obesity in this assignment, I have started to realize the complexity of the problem and have begun to recognize the vast number of factors contributing to the epidemic. New research on this area is growing and is helping to guide interventions and strategies aimed at reducing risk factors for obesity. The two different stories below illustrate the variety of factors that increase unhealthy behaviors in our society.
It's Addictive:
A few weeks ago, the Edmonton Journal had a news story about high fat foods leading to addiction. In it, the Journal described a study that explored the re-hardwiring of rat brains that led to their dependence on high fat foods. Dr. Valerie Taylor and her colleagues have explored addiction to certain components of food, where people develop tolerance to food, and require increased "dosage" to maintain satiety. According to Taylor, many of the characteristics of intake and withdrawal are consistent in certain individuals with other addictive substances. If you are looking for a more scientific explanation, it seems that high calorie foods may lead to down-regulation of dopamine D2 receptors linking them to addictive behaviours.
Broadening the search for the etiology of the obesity epidemic has helped Taylor and others develop new approaches and strategies. Although this is not true for the general population, for numerous individuals struggling with obesity, use of behavioral therapy, along with evidence and techniques that have been learned in dealing with other addictions can be applied in the treatment model for obesity.
H/t to Rohan Parab for pointing this out to me. Here is a movie coming up "Lbs" that follows two friends, one dealing with food addiction and another with crack.
Is it the gym teachers fault?
Did you have a bad experience in gym while growing up? In his research on early childhood experiences in physical education, Dr. Billy Strean found that up to 45% of kids were called names and teased during play time as kids. Many kids were excluded from physical activity and unvalued by teachers and coaches. These early experiences can have lifelong implications in the person's physical activity profile as an adult. Strean calls for an increased emphasis on developing skills, and making physical activity enjoyable and fun for children, rather than focusing on performance. Strean's research indicates that addressing and using educators to increase participation and sustainability of physical activity can have positive influences on reducing childhood and adult obesity in the future!
A review on the role of energy density and food costs by Adam Drewnowski and SE Specter, reveals that there is an established relationship between the low cost of calorie-rich foods. People are getting higher percentage of their calories from energy dense foods (high in fat and sugar). Meanwhile the volume of food we eat has remained about consistent. Moreover, energy dense food are more palatable and influence preference of dietary tastes.
Over the past few decades, the cost of energy-dense foods has become very low. For instance, the energy cost of potato chips was about 20cents/MJ(1200kcal/$) while fresh carrots were about 95 cents/MJ(250kcal/$). Energy dense foods have been increasing in the mainstream diet readily over the past few decasdes, and cost for these foods has increased much slower than it has for healthier options of fruits and vegetables. Diets which include a lot of these energy dense, unhealthy options have been linked with higher risks of developing type 2 diabetes and obesity.
The review also revealed that income affects the quality of foods people eat, with higher SES groups having better quality diets. Food costs were found to be an issue for low income families as they spend a higher percentage of their disposable income on food.
This review demonstrates that there are broad factors at play when explaining the rise of the obesity epidemic. The study reveals that cost of food, access to income, how our palate and biopsychological dietary patterns develop based on the energy density of foods, confluence together to influence the rise in obesity!
