Tips to help you reach your exercise and weight loss goals
Harvard Medical School Healthbeat@mail.health.harvard.edu, August 7, 2012
Need to lose weight? Cutting back on calories consumed while bumping up total activity level is the most effective method.
Wolfing down a candy bar takes a mere minute or two; walking off those calories would take most people about 40 minutes. To lose a single pound, you need to burn approximately 3,500 calories. Doing so through activity alone could easily take a few weeks of regular, moderate exercise. On the other hand, consuming 500 fewer calories a day will result in the loss of a pound a week. For that reason, dieting alone seems as though it would be a fast path to weight loss.
But regular exercise offers certain benefits beyond calorie burning. It slightly increases your resting energy expenditure— that is, the rate at which you burn calories even when the workout is over and you are at rest. And pounds lost through boosting your activity level consist almost entirely of fat. Plus, some studies suggest exercise preferentially targets abdominal fat, which plays a role in hypertension, cardiovascular disease, and diabetes.
Counting calories: What it takes to burn a pound of fat
It takes roughly 3,500 additional calories spent in physical activity to burn a pound of fat.
Walking or jogging uses up roughly 100 calories per mile. (Note: Your actual calorie expenditure depends on a number of factors, including your weight and pace.)
You'll shed approximately a pound of fat for every 35 miles you walk, assuming your levels of food intake and other physical activity remain the same.
If you walk briskly (at a pace of 4 mph) for half an hour on five out of seven days, you'll log 10 miles a week. At the end of three-and-a-half weeks, it's possible to lose 1 pound even if the number of calories you consume stays the same.
If you also cut back on the amount of food you eat by a few hundred calories a day, you can hasten the pace of your weight loss.
Enjoy the Great Outdoors
By: Terry Briggs, M.D.
Spring has sprung. The grass is turning green, birds are returning from their winter homes and early spring flowers are in bloom. March Madness is or will soon be over. It is time to put down the T.V. controller, put away the salsa and chips and reconnect with the great outdoors. Participating in outdoor activities can lead to several of the Power 9 behaviors that are so important in living the life in a “Blue Zone”.
Moving outdoors helps us be to be more physically active and to move naturally. We can walk or bike to run errands or attend activities that are close by. This is good for us physically and mentally and saves money and the ecology. Enjoying the beauty of nature allows us to relax and “Down Shift”. This reverses the inflammation which is related to every major age-related disease. Outdoor activities can be done with family and friends putting “Family First”. We will belong to the “Right Tribe”.
Those of us living in Marshalltown and Marshall County do not have to travel far to enjoy outdoor activities and take in the beauty of nature. While we do not have the oceans or the mountains, Marshalltown and Marshall County do have a total of 47 parks, trails and natural areas. Many have playgrounds for us to enjoy with our children and grandchildren. Several have excellent lakes and ponds in which to fish and canoe. Marshalltown’s Aquatic Center is second to none. For the sports minded we have numerous golf courses, tennis courts, outdoor basketball courts and baseball and softball diamonds. Our sidewalk system, while not perfect, is available for walking and for the young to bike on. Signed bike routes and dedicated bike lanes interconnect the city and make commuting by bicycle easier and safer. Finally, and arguably one of our biggest gems, is our recreational trail.
Marshalltown and Marshall County’s Recreational Trail is a hard surface trail which now runs 18 ½ miles from Riverview Park to just south of Melbourne. It is utilized by walkers, runners, in-line skaters and bikers – individually or with family and friends. It runs through heavily wooded areas where the many beauties of nature can be appreciated –numerous birds, squirrels, deer and chipmunks scurry about. It is a wonderful facility in which to move naturally, downshift and enjoy time with family and friends.
It is time for us all to move outdoors and live in a “Blue Zone”.
Live Well in 2012
By: Terry Briggs, M.D.
The beginning of a year new is a good time for all of us to reassess our life style choices and make any necessary changes. As we do this we should be aware of some new twists on old advice on how to live well that appeared during this past year. An article by Janice Lloyd and Nanci Hellmich published recently in USA TODAY reviews the 2011 diet and fitness updates very well.
The practice of taking daily vitamins took a real beating this past year. Several studies raised serious questions about the advisability of routinely taking vitamins or other dietary supplements. Researchers found that older women who took a daily vitamin had an increased risk of dying from cancer and cardiovascular disease. Men who took vitamin E supplements were shown to significantly increase their risk of developing prostate cancer. Unless you have a nutritional deficiency and the use of such supplements is recommended by your health care provider, the routine use of supplements may not be beneficial and may actually harm your health.
The latest diet research provides us with practical recommendations to follow. As we age we gain almost a pound a year. The most comprehensive study of diet and weight gain says that this is caused by adding extra servings of such foods as chips, french fries, sugar sweetened drinks, white bread and low fiber cereals. Significant findings include:
- Fiber rules – a high fiber diet appears to reduce our lifetime risk of cardiovascular disease, especially if we consume lots of fiber when we are young and middle aged.
- Meat – especially processed and red meat - increases the risk of developing type 2 diabetes.
- We eat more when we are tired - consuming some 300 calories a day more than when we are well rested.
- Consuming soda and energy drinks adds over 300 calories a day to a diet.
The benefits of exercise were further shown in 2011:
- Research revealed that people who exercise vigorously continue to burn extra calories long after they have finished working out. This is in addition to the calories they used while exercising.
- Studies are showing that exercise provides health benefits – even when it is below the recommended 150 minutes of moderate intensity activity a week. As little as 10 to 15 minutes a day lowers the risk of coronary heart disease. Doing more, however, is better in helping us to maintain optimal weight and to achieve maximum health benefits.
- Faster walking speeds were found to be associated with living longer – and are especially beneficial after age 75.
The federal government is took a proactive approach to healthy living, releasing its new healthy eating icon My Plate and issuing new dietary guidelines. My Plate is divided into four sections – fruits, vegetables, grains and protein. It is recommended that we eat healthier by slashing sugar, salt and solid fats from our diets and by eating more seafood, fruits, vegetables and whole grains. The government announced that, for the first time, it will pay for screening and preventive services to help obese patients on Medicare to lose weight.
The incorporation of these 2011 findings and recommendations into our life styles can help us live a healthier and happier life in 2012.
Life in a Blue Zone
By: Terry Briggs, M.D.
It has long been assumed that we will live a long, happy life if we have a family history of longevity, eat well, exercise regularly and avoid self-destructive habits such as smoking and excessive alcohol consumption. A study done in the early 2000’s, funded by the National Geographic and the National Institutes on Aging, found that while all of these are important, there are other lifestyle characteristics that are associated with health and wellbeing in advanced age. The term “Blue Zones” was coined for regions in the world where large numbers of people live to be 100 and thrive in the advanced ages. The findings of the study were published by Dan Buettner and David McLain in the National Geographic Magazine, November 2005 and further described by Buettner in his 2008 book entitled The Blue Zones: Lessons for Living Longer from the People Who’ve Lived the Longest.
It turns out that while our family history is important it actually accounts for only 20% of our life expectancy. The other 80% is determined by the lifestyle choices we make. The authors describe nine lifestyle characteristics that are common to Blue Zones and termed them the Power 9. These important behaviors can add an additional 12 years to our lives and make us 40% happier. They are:
- Move Naturally – get more physical activity naturally by walking and performing activities that require physical effort.
- Know Your Purpose - get up in the morning with plans to accomplish something, no matter how seemingly small.
- Down Shift – find time each day to nap, mediate, pray or enjoy a happy hour.
- 80% Rule for Eating – stop eating when you feel 80% full. It takes your stomach 20 minutes to tell your brain it is full.
- Plant Slant – eat mostly a plant-based diet that is dominated with beans, nuts and green plants.
- Wine at 5 – one or two glasses of wine daily may help add years to your life when consumed with a healthy diet.
- Family First – invest time with your spouse, children and aging parents. Living in a thriving family adds a dozen years to life expectancy.
- Belong – reconnect or explore a faith-based community. It can add an extra 4 to 14 years to your life.
- Right Tribe – the people you associate with have a significant impact on your well-being. Associating with healthy-minded, supportive people may be the most important thing you can do to add years to your live.
Living the Power 9 lifestyle is possible and is best accomplished when supported by friends and neighbors. The great news is that all of us in the Marshalltown community now have the opportunity to do this. In August, Governor Branstad announced plans to make Iowa the healthiest state in the union. The Blue Zones Project will play a very significant role in this effort. It is a community -based approach that can transform the environment in which we live, work and play into one of a Blue Zone. Wellmark Blue Cross Blue Shield has pledged up to $25 million over the next five years to help ten Iowa communities become Blue Zones. The process of choosing the ten is highly competitive and Marshalltown is in the competition. Marshalltown’s Pioneering Healthier Communities Coalition has coordinated our application and we have been invited to be one of 59 Iowa communities to submit a full application.
The full application is due on January 4, 2012 and it is now that the help of every Marshalltown resident is needed for our application is to be successful. The percentage of residents who pledge support for their community to become a Blue Zone Community will play a very important part in determining the ten chosen. If you have not already done so, please visit www.bluezonesproject.com to learn more about Blue Zone Communities and the project and to pledge your support for this very important effort (encourage your friends and neighbors to do the same). Marshalltown can become a Blue Zone Community in which each and every one of us can lead a longer, healthier and happier life.
Succeed in Losing Those Extra Pounds
By: Terry Briggs, M.D.
65% of Iowans are considered to be overweight or obese. This is resulting in numerous health problems and quality of life issues and is lowering our life expectancy. It is a problem that many must or should be addressing. Successful weight loss – and then, equally important, success in keeping the pounds off – is challenging but is one that, with the right lifestyle changes, can be achieved.
There are no quick fixes for weight problems and reasons for failure are numerous. If you eat too few calories and are always hungry, there is the risk of failure through loss of willpower. Diets eliminating an entire food group such as carbohydrates are difficult to follow, may not be healthy and are unrealistic for the long term. Diets can be expensive as buying special foods can rack up a big bill very quickly. Association with overweight family and friends can make it difficult to lose weight. You sense a “normal eating behavior and weight” and can lose your motivation. (Ask them to join you in your weight loss efforts) Finally, and very importantly, diet is only half of the equation - weight management also requires adequate physical activity.
For a weight loss program to be successful and enduring, it important that you are prepared to make the necessary lifelong commitments that will make it possible. Be honest, knowing that you need to make changes in your life which may not be easy. Be realistic about how much weight you will lose and how quickly you will lose it. Look for support and accountability by having a friend or weight-loss support group to offer encouragement and help. Finally embrace the vision of your new lifestyle, focusing on how good you will look and feel when you weigh less and are more active.
Setting realistic weight-loss goals and the means to achieve the goals are very important. A long utilized rule for weight loss is to set a goal weight and reach it by losing one pound of body fat per week by burning some 500 calories more that you consume each day. This can be accomplished through a combination of a lower-calorie diet and an increase in regular physical activity. The initial weight loss occurs most quickly so it is important not to get discouraged when losing those later pounds.
A study recently published in The Lancet by Dr. Kevin Hall and his colleagues at the National Institute of Diabetes and Digestive Kidney Diseases shows that this 500 calorie rule may not be completely correct or even the most successful. They offer an alternative which may help the many. They suggest that lasting weight loss takes longer to achieve and should be undertaken in two phases: a first temporary more aggressive change in behavior, followed by a second more relaxed phase. A typical weight-loss program results in significant losses over a period of six to eight months which unfortunately is often followed by gradual weight regain in the years that follow. This new study suggests the more gradual approach of cutting out 250 calories a day more that you burn. This will lead to a weight loss of 25 pounds over three years. It takes longer to reach your ideal weight, however it makes it easier to both achieve and then maintain your ideal weight.
Weight loss programs based on diet alone are difficult to maintain and most often fail. Adding regular exercise is a must. It helps you burn off calories and you will reach your goal weight faster. It also keeps you motivated in that you will see the inches cut off faster than by diet alone. Multiple research studies have concluded that the most successful diets include a combination of both diet and exercise.
Evidence shows that the best weight-loss plans include adequate choices from a wide variety of foods, are reasonable and flexible, partner with exercise and have the support of peers. Successfully losing those extra pounds and then keeping them off will help form the lifestyle habits that can lead to a healthier, longer and higher quality life.
Live Well to Prevent Alzheimer’s Diseas
By Terry Briggs, M.D.
The aging process is one that we all must face. As we age most of us will find that our short-term memory and ability to process new information is not what it used to be. This is arguably normal. Dementia is different. In dementia everyday tasks and decisions become difficult or even impossible. With progression, living independently is no longer possible. Alzheimer’s disease accounts for between 60% and 80% of cases of dementia, affecting nearly 10% of the population over age 71.
A big question is whether or not there are ways to avoid developing Alzheimer’s disease? Not according to the 2010 National Institutes of Health conference on preventing Alzheimer’s disease and cognitive decline. However the good news is that physical activity, a healthy diet, mental stimulation and avoidance of tobacco products may help to delay both its onset and progression when present.
Two studies published this past month in Archives of Internal Medicine support the idea that regular exercise and increased physical activity can cut the risk cognitive decline. They found a clear association between a sedentary lifestyle and the incidence of Alzheimer’s disease. It seems to be important to exercise and to simply keep moving throughout the day. It is estimated that 1 in 5 Alzheimer’s cases are attributable to a sedentary lifestyle. Daily physical activity, such as that 30 minute brisk walk, appears to delay cognitive aging by some 5 to 7 years. It may, at a given age, reduce your risk of developing Alzheimer’s disease by 50%!
Like the rest of your body, your brain needs a nutritious diet to operate at its best. The evidence is as yet inconclusive but diets low in saturated fat and simple carbohydrates may be protective against Alzheimer’s disease. It is important to keep your weight appropriate as insulin resistance may also be an important mechanism underlying brain aging and the development of Alzheimer’s disease. Focus on eating a healthy diet containing plenty of fresh fruit and vegetables, lean protein and healthy fats.
Individuals who challenge their brains and continue learning new things throughout life have been shown to be less likely to develop Alzheimer’s disease and dementia. Activities involving multiple tasks or requiring communication, interaction and organization offer protection. Engaging in challenging board games, reading, working crossword puzzles, playing a musical instrument and acquiring other new skills can help keep your mind fit.
Finally quit smoking. In 2010, a National Institutes of Health paned found that current smokers were 41% more likely to exhibit cognitive decline and develop Alzheimer’s disease than former smokers or nonsmokers.
Any of us may unfortunate and develop dementia and Alzheimer’s disease. Eating smart, moving more and living well can and in all likelihood will delay its onset and slow its progression.
Waist Size and Longevity
By: Dr. Terry Briggs, M.D.
Even if you don’t need to watch your weight, you do need to watch the size of your waist. You may assume that because your body mass index is in the healthy range, you have a low risk of heart disease, diabetes, and other obesity related conditions. New research shows that waist size may play as important a role as body weight in determining how long we live (Arch Intern Med. 2010;170(15):1293-1301).
Researchers found that those with the largest waistlines have nearly twice the risk of dying as those with the smallest waistlines. Equally or even more troubling was the discovery that big-waist individuals who have a healthy body mass index also have a higher risk of dying. Having a larger waist is associated with a higher risk of death whether a person is normal weight, overweight or obese.
A large waist is associated with large amounts of fat surrounding the abdominal organs. This visceral fat causes inflammation, high cholesterol and insulin resistance – all linked with poor health. Every four inch increase in waist size is associated with a 25 percent greater risk of death. An ideal waist size seems to be less than 35 inches for men and 30 inches for women – which is significantly lower than the American Heart Association’s definition of optimal: below 35 inches for women and 40 inches for men.
Where you carry your fat is largely determined by your genes. There are things, however, you can do to help redistribute fat away from your belly. Eating smart can help weight loss efforts. You can’t exercise to spot reduce but exercising can also help shed excessive pounds. Often the first fat our body sheds comes from our bellies. Interestingly getting adequate sleep and reducing stress both result in the decreased production of the stress hormone cortisol which can result in decreased belly fat.
The bottom line is watch your waist size even if your body mass index is normal. If you notice it to be large or increasing, it’s time to start eating smarter and moving more.
By: Dr. Terry Briggs, M.D.
Osteoporosis, which means “porous bones” is the most common type of bone disease. It results when the body fails to form enough new bone or when too much bone is reabsorbed by the body, or both. It causes bones to become so weak and brittle that even a simple fall or seemingly mild stresses can result in a fracture. These fractures can result in long term disabilities and shortened life expectancy.
Osteoporosis is often called a silent disease as bone loss can occur without symptoms. There are generally no symptoms in the early stages. Later it can present as bone pain or tenderness, fractures with little or no apparent trauma, loss of height, low back or neck pain and stooped posture. Your doctor can diagnose the early stages of the disease known as osteopenia or actual osteoporosis by measuring your bone mineral density (BMD). The most common test used is the DXA scan. It can detect low bone density before fractures occur and treatment can be initiated. The National Osteoporosis Foundation recommends a bone density test if you are:
• A woman older that 65 or a man older than 70
• Older that 50 with a history of a broken bone
• Take medications such as cortisone, aromatase inhibitors or anti-seizure drugs
• A postmenopausal woman who has recently stopped taking hormones
• A woman who experienced early menopause
• A postmenopausal woman with one other risk factor
• A man between 50 and 70 who has one other risk factor
Our likelihood of developing osteoporosis depends on how much bone mass we attain in our 20s and early 30s and how rapidly we lose it later. The more bone we have “in the bank” the less likely we are to develop osteoporosis as we age. To reach optimal peak bone mass and to continue building new bone tissue as we age, we should practice a healthy lifestyle and live well.
Especially important practices include:
• Exercise – Like muscle, bone is a living tissue and becomes stronger with exercise. Weight bearing exercise is best because you are working against gravity. Examples include walking, hiking, jogging, climbing stairs, resistance training and dancing.
• Don’t smoke – Smoking is bad for our bones as well as for our heart and lungs. It causes less calcium absorption form our diets.
• Avoid or moderate alcohol consumption – Alcohol intake of three or more drinks per day is detrimental to bone health and increases the risk of falling.
• Attempt to avoid the long term use of certain medications that weaken bones such as cortisones and some anti-seizure medications. Talk to your doctor before discontinuing any medication.
• Consume adequate amounts of calcium and vitamin D. We will discuss this in the next article.
Calcium and Vitamin D
By Dr. Terry Briggs, M.D.
Low calcium intake and vitamin D deficiency are major risk factors for osteoporosis. Unfortunately too many individuals consume inadequate amounts of one or both of these.
Adequate calcium intake is important for maintaining good bone health. Low calcium intake appears to be associated with low bone mass, rapid bone loss and high fracture rates. National studies show that many p eople consume less than one half the recommended amount of calcium. This is especially true for teenage girls and women. The amount of calcium needed to stay healthy changes over your lifetime. The Institute of Medicine recommends the following amounts of daily calcium from food and/or supplements:
• Birth to 1 year old – 210 to 270 milligrams (mg)
• 1 to 3 years – 500 mg
• 4 to 8 years – 800 mg
• 9 to 18 years – 1,300 mg
• 19 to 50 years – 1,000 mg
• 51 and older – 1,200 mg
Food sources of calcium include low-fat dairy products, dark green, leafy vegetables, sardines and salmon with bones, tofu, almonds and foods fortified with calcium. If you don’t get enough dietary calcium, you may need to take a calcium supplement. Consuming more than 1,200 to 1,500 mg of calcium per day has limited potential for benefit and may increase the risk of developing kidney stones and cardiovascular disease.
Over the past ten years there has been increased interest in the health benefits of vitamin D. It has been called a miracle vitamin. We know it is important for bone health as it both aids the absorption of calcium from the gut and is necessary for the proper mineralization of bone. Many studies have also suggested a role for vitamin D in reducing the risk of various cancers, heart disease, stroke, diabetes, autoimmune diseases and more. Scientists don’t yet know the optimal daily dose of vitamin D. The Institute of Medicine recently set the following recommendations for vitamin D:
• Ages 1-70: 600 international units (IUs) per day
• Over 70: 800 IUs per day
• The tolerable upper limit is 4000 IUs per day for ages 9 and above
Vitamin D is synthesized in the skin through exposure to sunlight. Many people obtain enough naturally by get ting about 15 minutes of sunlight each day. Vitamin D production, however, decreases in the elderly, people who are housebound, in the winter months and with the use of sun block (important for preventing burns and skin cancers). Food sources include egg yolks, fatty or oily fish, liver, and fortified milk and cereals. Supplements may be the primary source of vitamin D intake for many. The only way to be sure that you are consuming enough is to have your blood level checked by your doctor.
The adequate daily intake of calcium and vitamin D is important for bone health – but it will only be successful when it is combined with exercise and other healthy life style practices.
Heart Healthy Lifestyle
By: Dr. Terry Briggs, M.D.
Coronary heart disease is the number one killer of both men and women in the United States. A heart healthy lifestyle is a powerful means to improve quality of life, minimize mortality and lower healthcare costs.
Numerous articles are appearing in both the medical and general literature about the important role that reducing inflammation has in lowering the risk of coronary vascular disease. The statin cholesterol lowering drugs are anti-inflammatory and have been shown to reduce the risk of a heart attack even when cholesterol levels are normal. Their routine use, however, can cause unpleasant side effects and may have potential risks. Many healthy lifestyle choices can naturally lower excess inflammation and lower your heart disease risk.
Don’t smoke: Smoking sends inflammatory levels surging and hardens the arteries. The good news is that, if you smoke, the effects on your arteries will all reverse within 10 years of quitting.
Eat a heart healthy diet: A Mediterranean-style diet rich in fruits, vegetables, whole grains, nuts and olive oil can lower the levels of inflammation. You should consume a diet rich in alpha-linolenic acid and omega-3 fats.
Be active: A study published in the May 20, 2009 issue of the Journal of the American Medical Association showed that individuals with the lowest level of cardiorespiratory fitness had a 56% higher risk for having a coronary heart disease event when compared with those with the highest level of fitness. Those with intermediate levels of fitness had a 47%higher risk. Aim for at least five days a week of steady exercise such as brisk walking, swimming or biking for 30 to 45 minutes.
Watch your waist size: Measure your waist right around the point of your bellybutton. If you are a woman with a waist measurement of over 30 inches or a man of over 35 inches you probably have high levels of inflammation (the older numbers were 35 and 40 respectively). Taking a few inches off the waist by exercise and a proper diet can help significantly.
Get adequate sleep: Research has shown that too little sleep (less than six hours) or too much (more than eight hours results in more inflammation.
Reduce stress in your life: High levels of stress hormone causes inflammation. Plan for at least 15 minutes of relaxation every day.
Living a healthy lifestyle can and will lower levels of inflammation. This will result in reducing the risk of developing coronary heart disease or, if already present, its progression.
Exercise and the Common Cold
By: Dr. Terry Briggs, M.D.
The cold and flu season is here. In the United States, adults can expect to catch a cold two to four times a year. While there may not be a cure for the common cold, a recent study published in the November 2010 issue of the British Journal of Sports Medicine suggests that people who exercise regularly seem to have fewer and milder colds.
The researchers found that the more the participants exe rcised, the less they reported being sick. Those who were physically active five or more days a week had a 41% lower incidence of colds than those who were largely sedentary. The study also showed that colds appeared to be less severe for those in better shape. The severity of symptoms dropped 32% among those who exercised the most. Researchers are not certain why exercise has this affect. One explanation is that exercise activates the immune system at a higher rate than normal and causes the immune cells to get out and kill the viruses. This affect is short lived so it is important to exercise regularly.
Because exercise seems to help boost our immune systems, it is usually but not always safe to exercise with a cold. The neck up or neck down rule seems to be the easiest to follow. If your symptoms are primarily from the neck up, meaning a stuffy or runny nose and headache with perhaps a mild c ough, it is probably okay to perform a mild to moderate workout. If they are primarily neck down meaning a deep chest cold or a fever you should probably skip working out altogether until you feel much better. Be cautious with the use of cold medications when you exercise. Many will increase your heart rate and, when added to the increase associated with exercise, may cause you heart to pump very hard and you may become short of breath.
When you have a cold it is importance to show courtesy to the other people at the gym where you work out. Stay away until you know you are not contagious. This is generally three to four days after the onset of cold symptoms. Even then, use arm coverage when coughing and wipe down the equipment you use especially well.
Other factors may play a role in our susceptibility to the cold virus. People who sleep less than 7 hours a night are 2.9 times more likely to get sick that people who sleep 8 hours or more. The risk of getting the common cold also seems to increase with increased stress. The prevention and treatment of the common cold are yet another good reason for all of us to live a healthy lifestyle.
Lifestyle and Longevity
By: Dr. Terry Briggs, M.D.
With the start of the new year we should all take some time to review our life style choices. From 1900 until today the average life expectancy in the United States increased from 50 to 78 years. Three factors influence longevity – genetics, environment and life style. Our genetic factors are the ones that we cannot yet change. Environmental changes are important but are largely controlled by society and governme nt. Lifestyle choices are the ones that we are able to individually control. The beginning of the new year is a wonderful time for all of us to start or continue to make the smart choices that will help improve and lengthen our lives.
The Harvard Medical School HEALTHbeat, November 30, 2010 lists ten tips to increase the odds of living a longer and higher quality life. These include:
1. Don’t smoke
2. Enjoy physical and mental activities every day
3. Eat a healthy diet rich in whole grains, vegetables and fruits and substitute healthier monounsaturated and poly unsaturated fats for unhealthy saturated fats and trans fats
4. Take a multivitamin and be sure to get adequate amounts of calcium and vitamin D
5. Maintain a healthy weight and body shape
6. Challenge your mind – keep learning and trying new activities
7. Build a strong social network
8. Follow preventive care and screening guidelines
9. Floss, brush and see a dentist regularly
10. Ask your doctor if medication can help control potential long-term side effects of certain chronic conditions
It is never too late to begin making these lifestyle changes. A study published in the American Journal of Medicine in 2007 evaluated individuals ages 45 to 64. Those who embraced a healthier lifestyle had a 40% lower rate of death for any reason and 35% fewer cases of heart disease than those who did not. These lifestyle choices included eating five or more daily servings of fruits and vegetables, exercising at least two and a half hours per week, not smoking and avoiding obesity.
No matter what our age or stage of life, we have the power to change many of the variables in our lives that can and will improve our lives. Now is the time to make those changes.
Gifts That Keep Giving
By: Dr. Terry Briggs, M.D.
The Christmas season is a time of giving. Possibly one of the greatest gifts we can give our loved ones is the encouragement to live a healthy life style. By simply encouraging them to “live well” we may help them to have a longer, happier and healthier life.
Arguably the two easiest lifestyle changes to encourage by example are an increase in physical activity and the eating a healthy diet. Suggest activities that can be done together – and do them together. Social interaction is a great motivator for all of us to become and stay physically active. Start small and mix it up. Go for a walk after dinner. Use the steps instead of the elevator or escalator while shopping. Park the car a little farther from the front door of the store. Sign up for a fitness class together and take time before, during and after the class to interact.
Choose gifts that encourage a healthy lifestyle. At times of giving such as Christmas consider such gifts as sneakers, workout clothes or a gift certificate to an exercise class. The box of candy or fruitcake can be replaced by a box of fruit. At parties set a healthy example by choosing from the fruit or vegetable plates and avoid high caloric foods and drinks.
It is important to be understanding and to be patient. Your loved one may be embarrassed about attempting activities that are new and physically demanding for them or they simply may not want to participate. Ask how you can help and then be a good role model. Point out positive changes. Recognize small efforts and offer praise when appropriate.
The commitment to life a healthy life style must be ongoing and not one made as a short lived New Year’s resolution. Your encouragement can motivate your loved ones to make and continue to fill this commitment. It can result in them having a healthier and longer life. You will have more time and especially more quality time to share. It is a gift that will keep on giving.
Exercise and Depression
By: Dr. Terry Briggs, M.D.
We all have days on which we feel anxious and depressed and exercising is the last thing that we want to do. Once we get motivated, however, we find that exercising can have a significant positive impact on our mood. It is well recognized that exercise can help prevent and improve many health problems. Research is now showing that it also can help reduce or prevent anxiety and depression. Individuals seeking treatment for these have had two choices: medications and/or psychotherapy. We now know that they have a third choice that has a low cost, few side ef fects and many other health benefits – exercise.
It has been no secret that exercise can boost mood. “Runner’s high” is legendary. How it works is not well understood but it seems to help through a number of mechanisms. It releases feel-good chemicals in our brains (neurotransmitters and endorphins) that ease depression, reduces immune system chemicals that worsen depression and raises our body temperature which has a calming effect. Exercise has many positive psychological benefits:
• It helps us gain self confidence in ourselves and allows us to feel better about our appearance.
• It can be a distraction and take our minds off worries.
• It allows for social interaction.
• It gives us something positive to do to manage our anxiety or depression which is low
cost and has few side effects.
Depression and obesity have a bidirectional association. Obese persons have a significantly increased risk of developing depression and depressed individuals have an increased risk of becoming obese. Obesity is an inflammatory state that increases the risk of developing depression. Depression causes weight gain by interfering with the endocrine system and through antidepressant side effects. While depression and obesity many times may require medical intervention, exercising and smart eating can help in the prevention and treatment of both medical problems.
How much and what kind of exercise is needed to best treat depression? Most research has focused on aerobic types of exercise, but a wide range of activities have been shown to be helpful. One study showed that walking fast for 35 minutes a day five times a week or 60 minutes three times a week had a significant influence on relieving depression. We can also benefit from such simple activities as taking the steps instead of the elevator, gardening, mowing the yard or washing the car. Anything that gets us moving can help to improve our mood and ease depression.
Obesity and Cancer
By: Dr. Terry Briggs, M.D.
It is well accepted that excessive weight contributes to the development of diabetes and heart disease. Evidence now shows that overweight and obese people are also more likel y to develop various kinds of cancer. A recent report from the American Institute for Cancer Research estimates that, in the United States, more than 100,000 cases of cancer are caused by excess body fat each year. The American Cancer Society estimated that in 2008 14 to 20 percent of cancer deaths in our country were attributed to excessive weight.
The American Institute for Cancer Research report says that 49 percent of endometrial cancers are caused by excess body fat. That is followed by 35 percent of esophageal cancer, 28 percent of pancreatic cancer, 24 percent of kidney cancer, 21 percent of gall bladder cancer, 17 percent of breast cancer and 9 percent of colorectal cancer. The other bad news is that not only does obesity increase the risk for getting cancer, it also makes treatment more difficult and has a negative effect on survival.
Scientists are not sure why obesity increases the risk of developing these cancers but the real culprit seems to be the fat, not the weight. Athletes with lots of muscle and little flab are not at increased risk even when their BMI falls into the overweight category. Popular explanations are that extra fat boosts the body’s production of hormones such as estrogen, insulin and insulin-like growth factor 1 – all of which have the potential to promote the growth of certain tumors. Another is that increased body fat leads to an increased level of stress and inflammatory compounds in the blood which are linked to mutations in chromosomes and increased growth of diseased cells.
Just as excess weight increases the likelihood of developing certain cancer, research is suggesting that losing weight may reduce this risk. Studies have also found that increased phy sical activity has a protective effect on the chances of developing certain cancers and that this protection is independent of weight. The number 1 lifestyle measure that we should all take to reduce our risk of cancer is to avoid smoking and second hand smoke. Number 2 is to exercise and to maintain a healthy weight.
By: Dr. Terry Briggs, MD.
Diabetes affects over 21 million Americans or 7% of our population. An additional 41 million are estimated to have pre-diabetes, a condition that significantly increases the risk of developing type 2 diabetes (www.idph.state.ia.us/iowansfitforlife). Pre-diabetes is a condition in which blood sugar levels are higher than normal but not yet high enough for a diagnosis of diabetes. If untreated those with pre-diabetes are likely to develop type 2 diabetes with its associated medical problems within 10 years. The good news is that this progression may be prevented.
Pre-diabetes generally has no symptoms and is only diagnosed through blood tests ordered by your doctor. You should ask about blood sugar screening if you have any of the risk factors for pre-diabetes:
- You are inactive
- You have a body mass index over 25
- You are over 45
- You have a parent, brother or sister with diabetes
- You are African-American, Hispanic, American Indian or Asian-American
- You had gestational diabetes or gave birth to a baby weighing over 9 pounds
- You have high blood pressure
- You have a HDL cholesterol below 35mg/dL or a triglyceride over 250 mg/dL
- You are female with polycystic ovary syndrome
Testing may include a glycated hemoglobin (A1C) test, a fasting blood sugar or an oral glucose tolerance test.
If you have pre-diabetes, healthy lifestyle choices can help bring your blood sugar level back to normal – preventing or significantly delaying the development of diabetes. Eating healthy foods, getting more physical activity and loosing excessive pounds can reduce the risk of developing diabetes by over 58 percent (http://www.diabetes.niddk.nih.gov/dm/pubs/preventionprogram/index.htm).
These healthy lifestyle choices many times will require intensive individual counseling and motivational support. They must be individually planned and then maintained for life to be successful. Alternative therapies have been touted as possible ways to prevent and/or treat pre-diabetes and diabetes. Unfortunately none have been shown to be effective.
By: Dr. Terry Briggs, M.D.
Obesity is a pandemic affecting both adults and children. During the past 30 years the frequency of overweight children has tripled. More than 30% of children in the United States are overweight or obese and 2010 statistics show that 11.2% of Iowa’s children are obese. The majority of these will become obese adults and suffer from related medical problems that we have previously mentioned. Obesity in young adults decreases life expectancy by 5 – 20 years. It is second to only cigarette smoking as a leading cause of preventable death.
Changes in diet and lifestyle are the principle causes of this epidemic in our children. Calories in exceed calories out. By age 5, children are more likely to eat the amount of food they are served, regardless of their appetite. Portion sizes in food outlets have increased significantly. A super sized serving may be minimally more expensive than a more appropriately sized serving and we all want to get the best value for our money. High caloric soft drinks and foods are the norm. Children today are much less physically active. The automobile is the principle mode of transportation. Children may lack safe places to play outside. Time spent watching television and playing computer games has significantly increased.
Prevention of childhood obesity is the first line of treatment. We need to promote healthy eating habits, physical activity and limit television viewing. The Center for Disease Control and Prevention recommends that children and adolescents have 60 minutes or more of physical activity each day. They should perform both high intensity and muscle strengthening activities at least 3 days per week. The American Academy of Pediatrics recommends that children limit television and video game time to no more that two hours per day. Foods should be selected for nutritional value. Healthy family meals around the table at home should be practiced and portion sizes should be reasonable.
If obesity is not prevented, treatment is based on the same principles as prevention - modification of dietary and exercise habits. Diet modification is important but alone is not sufficient to achieve weight loss and control. The exercise guidelines described above must be implemented. None of the surgical procedures or drugs used to treat obesity in adults are approved for use in children.
It is apparent that our children need to be encouraged to eat nutritious foods and exercise regularly. Public health campaigns targeted at children and their parents may be an effective means of controlling the problem of childhood obesity. A very good discussion of the problem is available on the internet. While prepared for physicians, it is easily understood and very well outlines this problem and its prevention and treatment. http://www.iowamedical.org/documents/publichealth/ObesityWhitePaper.pdf
The Obesity Epidemic
By: Dr. Terry Briggs, M.D.
Obesity is a national epidemic costing our country billions of dollars annually. It is resulting in higher medical costs, lower quality of life, shorter life expectancy and loss in productivity. America has become an “obesogenic” society, characterized by environments that promote excessive caloric intake, consumption of unhealthful foods and physical inactivity. Obesity means having excess body fat. The body mass index (BMI) is calculated using our height and weight. If it is greater than or equal to 30, we are considered to be obese. This epidemic is occurring simply because we, as a society, are consuming too many calories and/or are not getting enough physical activity. Calories in all too often exceed calories out. The Centers for Disease Control estimates that 34% of the United States adult population and, sadly, 17% of children are obese.
The reasons for this epidemic are both societal and personal. Access to stores that provide healthy, affordable food may be difficult for many. Less healthy and higher caloric foods and beverages are often less expensive and more heavily marketed. Many communities are designed and built in ways that make it difficult or unsafe to be physically active. Access to parks and recreation centers may be difficult. Safe routes for walking or biking to school, work or play may not exist. Our population spends much of its time in sedentary behaviors such as watching television and using computers. We often feel that we are simply too busy to exercise and be physically active.
The adverse health consequences of obesity are numerous. Obesity shortens life expectancy and reduces quality of our lives. It is associated with an increased risk of developing coronary heart disease, Type 2 diabetes, certain cancers, high blood pressure, stroke, liver and gall bladder disease, sleep apnea, osteoarthritis and some gynecological problems. It may cause low self esteem and depression because of its social stigmata.
The cost of obesity is also enormous. A recent article in USA Today cites a study from George Washington University researchers estimating the cost in the United States at a staggering $168 billion! This results from both increased health care costs and loss in productivity. It is estimated that yearly obesity and its associated health problems cause productivity to be down 40 million work days, result in at least 63 million doctors’ visits a year and cause 239 million restricted activity work days due to employee’s inability to function.
In future articles, we will discuss the causes and health consequences of obesity in greater detail and outline steps that can and are being taken both nationally and locally to wipe out this epidemic.
Prevention of Dementia
By: Dr. Terry Briggs, M.D.
Dementia does not appear to be a normal, natural process of aging. As we discussed in our last article, being physically active has consistently been shown to reduce the risk of developing Alzheimer’s disease and other forms of dementia. Recent studies have shown that additional components of a heart healthy lifestyle may also significantly reduce our risk of developing these devastating conditions.
Heavy smoking in midlife more than doubles the risk of developing dementia later in our lives (Archives of Internal Medicine, October 25, 2010). Smoking more than two packs per day in middle age increases the risk by more than 100%, smoking one to two packs per day has a 44% increased risk and one half to one pack a 37 % greater risk. If you smoke and are fortunate enough to not develop respiratory disease, cancer or cardiovascular disease, you are still at an increased risk for developing this very devastating condition later in life. Individuals who quit smoking in mid life do not have a greater risk when compared to those who have never smoked, showing that there is yet another reason to quit smoking.
Eating a heart healthy diet high in fruits, vegetables, whole grains, fish and low in saturated fat is expected to have a role in preventing cognitive decline (Ann Intern Med. 2010:153:182-193). What appear to be of little or no value and where we may be able to avoid wasting our money is the consumption of high-dose supplements of vitamin C and E, and beta-carotene along with gingko and DHEA. Vitamin D deficiency may increase the odds of cognitive impairment while Vitamin B12 may curb the risk for Alzheimer’s disease. More research is being conducted on these issues (Neurology. 2010;75:1408-1414).
Activities that exercise the brain, such as reading, writing, and playing games may help prevent or delay cognitive decline (Neurology. 2009;73:356-361). Even if they only delay its development they will allow us to have a longer period of cognitive independence. This can significantly increase the quality of life in our later years.
Finally, psychological stress may place us at increased risk for the development of dementia. Stress causes our bodies to produce more adrenaline and cortisol. When present in excess, these damage the cells in the memory center of our brains. Balancing our daily stress and possibly meditation may help.
In summary, it appears that there is a great deal that we can do to prevent or delay cognitive decline. These interventions also play a very significant role in preventing heart disease, stroke, certain cancers and many other chronic diseases that reduce the quality of our lives.
Life Style and Dementia
By: Terry Briggs, M.D.
We all look forward to the “Golden Years” – a time in our lives when we will no longer have to work and will have more time to enjoy our many other interests.. Unfortunately as we age, many of us will have a significant loss in the quality of our lives by developing dementia – a condition in which we will have a loss in our cognitive functioning – thinking, remembering, and reasoning. It can affect us to the extent that it will interfere with our daily lives and activities. We may no longer be able to live independently or even do even the most simplest tasks.
It is estimated that over 5.1 million Americans have Alzheimer’s disease which is the most common form of dementia. (NIH Publication No. 08-6423) Scientists don’t yet fully understand the causes Alzheimer’s disease or dementia but they likely include genetic, environmental and lifestyle factors. We cannot change our genetics and possibly our environment, but we can live a healthy lifestyle. Recent studies have shown that living a healthy life style can significantly reduce our chances of developing dementia. (Neurology 2010; 75:1415-1422, Alzheimer’s Association International Conference on Alzheimer’s Disease 2010: Abstract 01-01-03, Ann Intern Med. 2010:153:182-193)
Being physically active has consistently been shown to reduce the risk of developing dementia and Alzheimer’s disease.
- Walking as little as 6 miles per week appears to preserve brain function in old age.
- Moderate to heavy physical activity reduces the risk of any form of dementia by 45%
- Regular physical activity can reduce the risk for developing Alzheimer’s disease by 50%.
Participating in moderate to heavy levels of physical activity has the greatest potential for lowering the development of any type of senility. This physical activity can include walking, jogging, bicycling, swimming, participating in aerobics classes, yard and garden work, etc. Start now because evidence shows that exercise begun early in life is associated with a reduced risk of cognitive impairment as we age!
Eating a heart healthy diet, avoiding tobacco and excessive alcohol consumption, performing mental activities, social engagement, and avoiding excessive stress all seem to have a role in preventing cognitive decline and Alzheimer’s disease. We will discuss this in subsequent articles. For now, stay or become physically active!
Life Style and Quality of Life
By: Dr. Terry Briggs, M.D.
Life expectancy for adults living today is estimated to be about 78 years (http://www.cdc.gov/nchs/data/hus/hus08.pdf#026). Many factors will affect the quality of life as we age and good mental and physical health are the cornerstones. Health is determined by lifestyle, genetics and the environment. Studies show that lifestyle factors have the most significant impact on health and quality of life during mid and late adulthood. (Johns Hopkins Medical Letter Dec. 1998) How we will experience our final years will, in part, be determined by decisions we are making today.
In general, Americans are eating more and engaging in less physical activity. Many work at sedentary jobs. Numerous households have two full-time workers resulting in less time to shop wisely and prepare healthy meals. A healthy lifestyle cannot be taken for granted and can be achieved only through deliberate action requiring time and commitment. According to the Johns Hopkins Letter, there are significant life-style factors which prevent or delay disabling illness, improve quality of life and increase longevity. These include:
- Exercise – by itself the most important factor. Exercise improves heart and lung function in addition to increasing bone mass and muscle strength, aids bowel function and helps to prevent depression.
- Healthy diet – working with exercise to control weight.
- Not smoking – reduces the risk of heart and lung disease and some cancers.
- Avoidance of excessive alcohol – reduces the risk of liver disease, some cancers, falls and other accidents.
- Stress reduction – strengthens the immune system.
- Cultivating satisfying relationships – reduces stress, prevents depression and helps cognitive functioning.
- Challenging the mind – promotes healthy mental functioning.
Cost initially seems to be an impediment to living a healthy lifestyle. Fresh fruits and vegetables and healthier meat products frequently cost more than canned goods and may require more time to prepare. Memberships to health facilities, exercise classes and home exercise equipment require a monetary commitment. The good news is that a recent study shows that exercise and a healthy diet are very cost effective (Arch Intern Med. 2010; 170:1470-1479). The long-term saving in health care costs and increased productivity markedly exceeds the short-term increased expense.
Living a healthy life style cannot guarantee a long healthy life – but can and will markedly improve our chances!
By: Terry Briggs, M.D.
The 2010 – 11 flu season is rapidly approaching. While the flu season generally runs from October to May, it is expected to strike early this year. Symptoms include fever, chills, sore throat, stuffy nose, muscle aches and fatigue. The virus is spread through direct contact with droplets in the air produced by coughing or sneezing and by touching contaminated surfaces.
The Centers for Disease Control and Prevention recommend a three action plan to fight the flu:
- Take tine to get a flu vaccine. The vaccine is now available and supplies should be adequate. Get it now - there is no advantage in waiting. The sooner you get it, the sooner you are protected. The CDC recommends a yearly flu vaccine as the most important step in protecting against flu viruses. Nearly everyone 6 months of age or older should get vaccinated (there are very few exceptions). Since children under 6 months are too young to be vaccinated and are at high risk for complications of the flu, it is extremely important that people who care for them be vaccinated.
- Take everyday precautions to stop the spread of the flu virus. Cover your nose and mouth with a tissue or your sleeve when coughing or sneezing – not your hands. Wash your hands often with soap and water (antibacterial soap is probably no better than ordinary soap). If soap and water are not available, use an alcohol-based hand rub. Avoid touching your mouth, nose and eyes and avoid close contact with sick people. If you are sick with the flu-like illness, stay home for at least 24 hours after the fever is gone.
- Take flu antiviral drugs if your doctor prescribes them. If you get the flu, antiviral drugs can be beneficial. They must be used early and can lessen the symptoms and shorten the duration of the illness. They are especially beneficial for those at increased risk for flu symptoms and complications such as pregnant women, young children, people 65 and older, and people with certain chronic health conditions.
Visit the CDC’s website for a complete discussion of the flu and their recommendations. http://www.cdc.gov/flu
A special concern is protection of individuals - especially children - who are allergic to eggs. Since the flu vaccine contains egg protein the CDC doesn’t recommend the vaccine for people with severe allergies to chicken eggs. Check with your physician to see if you can be checked for allergies to eggs and what they would recommend. At the very least, it is important that everyone who is in contact with these individuals be vaccinated against the flu and that they practice everyday precautions.
Buy Local for the Health of It
By: Dr. Terry Briggs, M.D.
Once again we are reading about tainted food affecting our food supply – scary stuff. Of recent concern is a salmonella strain infecting eggs. To date, reports show over 2000 people nationwide have been affected by this outbreak, but the estimated number of actual people affected is far greater. Public reports of food borne disease trail actual incidences by at least two months.
We as Iowans feel doubly dismayed. First, eggs are an economical and fabulous source of high quality protein. Most people think they taste good, even most kids. Second, the recent source of contaminated eggs seems to be two main producers, both of whom operate in Iowa. This is not the kind of notoriety we seek as a state, particularly since we value the opportunity to market ourselves as part of the breadbasket of the world.
(For more information about salmonella and its symptoms go to www.cdc.gov/salmonella.)
This is the second major food borne illness in the U.S. in four years. An e-coli bacterial strain wrecked havoc nationally in 2006. This virulent bacterium, first sourced in spinach and then in green onions, seriously infected a couple hundred people in 26 states. Three people died from having consumed the tainted food. Far greater were the numbers of us whose sense of security was rattled. How safe is our food supply?
The food supply in the United States is remarkably safe. www.cdc.gov/ncidod/diseases/food/
In fact, our food systems and products are among the most safe and varied in the entire world. Even so, unwholesome food makes its way into our markets, and there is evidence that the frequency of food borne illness is increasing and the breadth of outbreaks is expanding.
In industrialized countries, the percentage of the population suffering from foodborne diseases each year has been reported to be up to 30%. In the United States of America (USA), for example, around 76 million cases of foodborne diseases, resulting in 325,000 hospitalizations and 5,000 deaths, are estimated to occur each year.
Food born illness has been with us since the beginning of time. Microbiologists and bacteriologists estimate that up to 80 % of what the population reports as 24-hour flu is in fact some response to bad food, especially if symptoms are not accompanied by a significant fever. Why are incidences and numbers affected by an outbreak this high?
One answer might be the way we as U.S. citizens source our foods. Before the Civil War, the vast majority of our population lived in rural areas and relied on foods grown or found within a 5-10 mile radius of their homes. Beginning in the 1860’s and continuing to date there is an ever-accelerating movement of people from rural areas to urban areas. (www.census.gov/population/censusdata/table-4.pdf) Today, 75% of the population of our nation resides on 2% of our land. As a result, we have distanced ourselves from the places where food is actually produced and have become increasingly dependent on enormous centralized producers who ship their foodstuffs (animal and vegetable) often hundreds or even thousands of miles to us the consumers. Such mass production invites mass contamination. So too do the many layers of food handling entailed in such a distribution system from afar.
So how do we reduce the risk? One approach that might help is to buy locally whenever possible or better yet, consider planting a garden for you and your family. Fewer handlers between the farm and the consumer would help. Also, less reliance on mega-manufacturers of foods will decrease exposure of the whole population to local food borne outbreaks. Go to our website resource list for a host of local food producers in our area. Try ‘em out, just for the health of it!
By:: Dr. Terry Briggs, M.D.
Welcome to the new Pioneering Healthier Communities website! In this section of our “e-newsletter” we hope to offer important information to Marshall County residents that helps to clarify not only how to become healthier, but why it’s worth our time and energy to choose a lifestyle that encourages wellness. It is the “why” part of our mission that this section of the website, “Live Well!” will emphasize. In the weeks and months to come, I with others will share worthwhile material we think everyone should know. Information that helps us to understand the influence our dietary choices and our physical activity levels have on risk factors for disease. We will also highlight some valuable resources for those who hope to learn more.
The American Institute of Cancer Research (AICR) is a nonprofit scientifically reliable organization committed to cutting-edge research and providing practical tools and information to help people prevent and survive cancer. Their website home page notes the following:
Scientists estimate that about a third of the most common cancers could be prevented by eating a healthy diet, being physically active and maintaining a healthy weight.
Tobacco use is a separate risk factor that is itself responsible for one-third of all cancer deaths.
The AICR “Science Now” newsletter of Spring 2010 goes on to explain, “AICR’s 2009 policy report calculated that approximately 100,000 cancers in the United States each year are linked to excess body fat.” Types of cancer showing the greatest association with excess body fat are: esophageal, pancreatic, gallbladder, colorectal, breast, endometrial, and kidney.
Here’s the good news. Even small amounts of weight loss may have a positive influence on risk factors for cancer. Plus, irrespective of weight, improved physical fitness is associated with lower risk of many cancers.
The message from AICR and from Marshall County Pioneering Healthier Communities is that we should all shoot for more fruits and vegetables in our diets, less fat and sugary foods and more time walking, biking, gardening, using the stairs and any form of exercise we can easily fit into our already busy lives.
For a worthwhile read with many practical tips, including some great recipes, go to the AICR website, http://www.aicr.org/.