This is So Bad

Trust for America's Health and the Robert Wood Johnson Foundation have released their annual obesity statistics, and they're not pretty. See that map above? See how it's mostly red? That means over 25% of the adults living in those states in 2010 were not just overweight, but obese. Kids don't far much better. Click here for the children's obesity map, as well as interactive maps for both populations, and the full report (fittingly titled "F as in Fat: How Obesity Threatens America's Future").

What's even more shocking to me than the high percentages of obesity is how quickly the rates are rising. Eight states have obesity rates that are over 30%. Just four years ago, only one state was above 30%.

The report outlines troubling racial and economic disparities - more African Americans and Latinos were obese compared to whites, and more people making less than $15,000 per year were obese compared to those making more than $50,000 per year.

I'm not sure we can legislate ourselves out of this mess. A junk food tax might help pay for the end result of all the medical care that obesity-related conditions require and might dissuade some from purchasing sodas. Better labeling might enable consumers to see how much sugar is in certain foods by grouping all the sources of sugar together, for example. And subsidizing fruits and vegetables might help bring the costs of those important foods down. But the answer still comes down to education and choice. Unfortunately, changing behaviors is one of the most difficult public health challenges to take on, especially after those behaviors have become the norm. For example, if everyone you know snacks on sodas and chips, it is normal. You are odd if you choose fruit or yogurt. If you are surrounded by overweight people, that becomes the new normal for your community, which means it is accepted and even supported in the options available. Slim people may have trouble finding clothes that fit and healthy foods may be even scarcer as merchants cater to the tastes of their clientele. Those barriers are difficult to overcome.

Do you think changing the food labels like the Center for Science in the Public Interest suggests below will help? (Here is the report from which this image was taken.)



Michelle Obama is trying to bring attention to this issue, and kudos to her for using her platform as First Lady for this issue. States are trying to address the problem through school lunch nutrition guidelines and other legislation. But the problem just keeps getting worse. Any ideas?

Update: If you can't view the graphic for the food label, following the link to the report. The graphic is on page 10.

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The Green, Green Grass of Home

My neighborhood is very diverse when it comes to yards.

Directly across the street from me lives the former president of my state's organic farmers society. Because his front yard gets a lot of sun, he has transformed it into a yard/garden, with tomatoes, peppers, squash, eggplants, sunflowers and more. He has planted fig trees, locust trees, and blueberry bushes. When I walk my dog past his yard in the mornings, my movements flush out indigo buntings, yellow finches, and cardinals. There are good caterpillars that turn into blue butterflies, and bad caterpillars that eat the tomatoes. There are bees to pollinate the plants, and rabbits that sneak in to nibble the greens. It is a lively place if you look closely.

At the other end of the yard spectrum are the perfectly green, perfectly clipped lawns.  The chemical trucks show up a couple times each month to visit these lawns. The drivers spray the lawns and then stick little warning signs in them noting that children and pets should stay off of them for at least 24 hours. Even though it is dangerous to walk barefoot on them, these lawns look inviting, like outdoor carpets. When I walk my dog past those lawns, I don't startle many birds.

Other lawns are somewhere in the middle. They do not receive regular pesticide applications, but the owners use chemicals periodically to treat acute problems, like fungus, or use fertilizers to boost the blooms of ornamentals.

But by far  the outdoor carpet yards outnumber the others by a significant amount in this neighborhood. 

That's unfortunate for a number of reasons. Our neighborhood is beautifully hilly. When it rains, the runoff from all of our yards drains into storm sewers and creeks. Many of those chemicals that children and pets are warned against walking on eventually end up in the water supply, where they have to be (one hopes) removed. But before they are, those chemicals affect the wildlife that live in or drink from the creeks. When we first moved to this neighborhood years ago, we would see crayfish and minnows in the creeks near our house. I can't remember the last time I have seen any forms of life in them. I try my best not to let my dog drink out of them.

But the problems with the chemicals are not just in our water supply. We can breathe them in when they are sprayed, track them into our homes, and get them on our hands when we pick up baseballs that have been hit into the next yard. Our pets pick them up on their feet, and then they lick them off (did you know up to 50% of dogs develop cancer in their lifetimes? While not all canine cancers can be attributable to lawn chemicals, some probably are. Here is a veterinarian-written article on the risk of various chemicals to our canine friends.) I've come to view these yards as dangerous to my family's health as second hand smoke.

More and more research is showing that those green carpet lawns are wildly dangerous to the environment and to humans - especially children. ADHD, autism, and cancers are just a few of the terrible endpoints that have been linked to lawn chemicals, with headaches, rashes, and asthma, and many other health problems occurring frequently enough to serve as warning signs that something serious is amiss. Recent news noting that environmental factors play a role as large, if not larger, than genetics in autism should have everyone scrambling to remove as many impurities as possible from their personal environments until more is known about this issue.

The United States birth defect rate by month of LMP
versus atrazine concentration.
Source: Winchester, et al.
Acta Paediatr. 2009 April; 98(4): 664–669.

There is so much research on this topic! The graph to the right was published in a 2009 study. Even a grade school kid can see that the months that the concentrations of the weed killer atrazine were highest in surface water is associated with birth defects in kids conceived during those months (LMP stands for last menstrual period and is a marker for conception).

This chart is for atrazine only, which, coincidentally, is banned in many European countries and parts of Canada (the US periodically considers banning it, but never does). Chalk up another instance where our European friends have made it a priority to protect the health of their citizens. In the United States, the northeastern states, such as New Hampshire and Connecticut are leading the way in restricting the use of lawn chemicals. For example, in 2005, Connecticut banned lawn pesticides around daycare centers and schools out of recognition that children should not be playing on them. I think that's a great start.

Choosing to go pesticide free does not mean you are signing up for a patchy eyesore of a lawn. There is a lot of knowledge to tap into, and a lot of tips and techniques to create a green lawn that is indistinguishable from one that uses pesticides.  Here's a nice article from Organic Gardening that offers tips on a healthy lawn. Beyond Pesticides supplies information on lawn care, fact sheets, and "Tools for Change" to work with your neighborhood and policy makers to tighten up control measures for unnecessary pesticide application.  Even the Environmental Protection Agency encourages integrated pest management for lawn care, which includes the use of some chemicals for problems, but stresses the use of beneficial insects to counter harmful ones.

What does my lawn look like? Well, it's a mix of sod and other green things, like clover (obviously we're in need of nitrogen). It was originally all sod, but an unfortunate sewer line incident caused part of the sod to be replaced, and the replacement ground cover didn't completely take. This green mix is quite pretty when it's mowed to a uniform height. (We're not fooling ourselves when we think it's pretty - the EPA notes that the average consumer thinks lawns consisting of up to 15% weeds look fine.) We use dirt from our compost bin to fill the beds where our herbs and flowers live. If you dig into those beds, you'll find lots of worms. I'm thinking about getting one of these signs. After all, the birds in my yard need a place to rest, don't you think? 

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And Vegetables for All

Scrolling through the stats of this blog, I noticed that I was getting an unusual amount of traffic from Austin, Texas. Concerned that my Austin-based friend Erin had fallen asleep with her head resting on the "refresh" button, I followed the URLs back to their sources.

Turns out Erin was responsible for the bump in traffic, but not because she was reading my blog. She had graciously linked to me as an an example of how individuals can support small organic farmers, while also helping out families who cannot afford the fresh vegetables, fruit, eggs and meats from those sources, all from sitting in front of their computers hundreds of miles away.

There is a good story here.

A little over 5 years ago, Erin and her husband Skip embarked on an adventure to fulfill Skip's lifelong dream of being an organic farmer. This was no easy decision - both Erin and Skip had lucrative careers in a big city, an enviable house in an even more enviable neighborhood, two beautiful children who were poised to walk to the high-performing elementary school in their neighborhood. Life was good, and many people would have stopped there and just let it play out.

But something was missing for Erin and Skip. Ever since the two had known each other, Skip had cultivated a backyard garden, volunteered at local community gardens, took classes on organic gardening, raised chickens (yes, in the backyard), and just generally pined to do all that full time. The couple knew that if they didn't make the break and try to live their dream that they would be too old to make the change. So in a now-or-never, incredibly gutsy midlife move, they sold their house, packed up their stuff, and moved to Austin, TX, where Erin had family.

They found a small homestead to rent, with a centuries-old farm house built by the Swedish family who settled there and a few acres to farm. They started small, with vegetables and flowers, then expanded into more vegetables, heritage pigs, chickens that lay softly-hued eggs, sheep, goats, ducks, and more.  Faster than you can say Old McDonald, they had created a real, working farm that they called Green Gate Farms in honor of the green metal gate at its entrance. Last year, they purchased beautiful acreage on the Colorado River to expand their operation. Their delicious vegetables and humanely grown meats grace the menus of some of Austin's most highly regarded restaurants and their farm has become a destination for families who want their children to know where real food comes from.

But the heart of their operation - and of every organic farm's operation - is the community supported agriculture plan (CSA). Subscribers to the CSA get weekly or bi-weekly boxes of seasonal vegetables and flowers and can add on meats, eggs, and milk. Because the CSA is a subscription service, it provides a baseline of income for the farmers and allows them to plan their budgets for the seasons. The farm markets, special events, and restaurants are important for revenue, but only the CSA provides an idea of how much money the coming year will bring. It is as close to a salary as these farmers will come.

Erin with Callie, an orphaned goat.

The down side of a CSA subscription is that it can be pricey. After all, subscribers are committing to a generous weekly ration for an entire growing season. And that priceyness runs counter to one of the goals of the farm: to provide healthy foods to those who need it the most.

Green Gate Farms in located in an area that is not wealthy and where there are many working-class families. Further, Austin, like most American cities, has a significant rate of childhood obesity and chronic diseases, like diabetes, that could be prevented or helped by good nutrition. Erin and Skip wanted the public health aspect of good food to have a wide audience. So, in an effort to accommodate individuals with different incomes, they developed a "workshare" program, where people can work on the farm in order to get their vegetables. But for some people that is not enough. Erin has heard from many families in the area that they are too busy juggling multiple jobs and children to volunteer at the farm in order to get their shares. In response to that need, Erin and Skip instituted another program, one where anyone, anywhere can sponsor a CSA share for a family.

Thus began the Sponsored Share program. If you contact Green Gate Farms at this link, you can sign up to support a local family for the duration of the CSA season. The plan is beautiful because you are also supporting a small, family farm, the type that we desperately need to provide us with the healthiest seasonal produce imaginable, as well as humanely raised meats, free-range chickens and eggs (truly free range - those chickens have a lot of space to move around in), and milk products.

Some of the happy critters at Green Gate Farms

I like this program because Erin could tell me about the family that receives my donation (no names, just number and ages of the children, the mom's desire to get them the best food possible). I firmly believe that childhood nutrition is one key element to producing kids who are ready to learn and in preventing future diseases, so I was delighted to put my money where my mouth is and donate a share that will supply this family with excellent food.

Take a tour around Green Gate Farms' web site. Peruse the blog (bonus: both Erin and Skip have been professional writers for national publications and organizations. They make all that farm stuff sound really darn good). Importantly, they are committed to getting their healthy foods to some of the people who need it the most. I think it's a great model that is worthy of support no matter where you are.

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Can You Hear Me Now? Part II

I had no idea how timely my recent post on cell phones was until this story began moving across the wires.

Just one day after I shared my concerns about kids and cell phones, as well as the measures my family has put into place to minimize exposure to the non-ionizing radiation that they emit, the World Health Organization/International Agency for Research on Cancer (IARC) issued a press release noting that it was classifying such radiation as "possibly carcinogenic," just like some industrial chemicals and a few viruses, such as the human immunodeficiency virus and certain strains of the human papilloma virus.

Here is the IARC classification chart for various agents, with non-ionizing radiation assigned a 2B level.

The WHO/IARC issued a press release prior to the report being published, which is an unusual sequence of events in scientific circles. The report is scheduled to be published in The Lancet Oncology in its July 1 issue and will appear sooner online, perhaps as early as this week.

While the risk of cancer is low from agents in the "possibly carcinogenic" category, it makes sense to reduce your exposures when you can. Additionally, I would think individuals with a family history of brain tumors or other brain disorders, such as epilepsy, would be wise to practice extra precautions. As for children, well, perhaps all those countries that restrict sales or advertising of cell phones to tweens and younger and encourage headsets (France), encourage texting instead of talking (Finland), or even recommend against their use for kids under the age of 18 (Russia) are worth emulating. Fortunately, the chairperson of the WHO/IARC working group that authored the study, Jonathan Samet, MD, from the University of Southern California,  is a member of the United States' National Cancer Advisory Board. The NCAB advises the National Cancer Institute on its research agenda so perhaps Dr. Samet will encourage the United States to become more active in researching this type of radiation, especially its effects on our youngest citizens.

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Can You Hear Me Now?

During this graduation season, the gift of choice for the younger set seems to be a cell phone. By younger set, I'm talking about those kids graduating from elementary school or junior high and moving on to the next step.

A few years ago, this pint-sized arms race of communication technology would seem laughable. But with ever-more affordable phones and (seemingly) economical family plans to run them, most kids I know end up with a cell phone somewhere during their junior high or early high school years. The convenience of having your kids wired can't be beat - knowing when the school's game bus is nearing campus so you don't have to cool your heels waiting or easily locating your kids at crowded venues like outdoor festivals are huge pluses. (I'm purposefully ignoring the benefits my kids associate with cell phones - access to friends, texting, and access to friends.) Yes, cell phones are incredibly useful to organize family life.

But I have my concerns.

And these concerns are shared by others, ranging from governments to health agencies to cancer researchers. For years, in fact for as many years as I've been communicating science, there have been concerns about the effects of radiation from cell phones on the brain. And those concerns are especially acute for younger people, whose skulls are not as thick as those of adults (especially around the ear), which means that their brains, replete with their quickly replicating cells, are exposed to more radiation than an adult's.

No one is sure what these higher levels of radiation exposure mean. After all, we're talking about the usually benign non-ionizing radiation rather than the shorter, more intense waves of ionizing radiation that x-rays or radioactive materials emit. However, even though non-ionizing radiation is much less problematic overall, what is a problem is our increasingly higher and longer exposures to these sources. In other words, the source is less dangerous, but we are exposing ourselves to it for longer periods of time over many more years than ever before.

The EU, which is conducting a large, multi-national, case-controlled study focusing specifically on kids called Mobi-Kids, has a nice primer on electromagnetic fields here.

So what does the science tell us about cell phones and health risks?

Well, cancer surveillance tells us that brain cancers in young people, while still rare, are increasing in frequency. There are many possible reasons, including nutrition, family history, and exposure to chemicals, but non-ionizing radiation has not been ruled out as a contributing factor. Cancer aside, it is well documented that rates of attention deficit disorder and autism, both due to brain differences that were likely triggered in utero, are rising as well. And then there are worries about radiation's effects on other sensitive, still-forming parts of the body, like reproductive organs, especially for guys who often carry their phones in the front pockets of their pants.

To date, this has been a difficult field to research, and much of the research is sponsored by cell phone manufacturers. As a result, the findings are all over the place. Even the American Cancer Society (ACS) noted one of the largest studies to date just complicates the debate because it found heavy cell phone users had lower overall rates of brain cancer, but higher rates of a specific type of brain cancer called glioma. And what was considered heavy cell phone usage at the time of the decade-long study would not be considered heavy use today. The ACS concluded, not surprisingly, that more research is needed, especially for children because they were not included in this large study.

A recent report published in the Journal of the American Medical Association found that glucose metabolism was higher in the brain in areas nearest the cell phone antenna after a 50-minute conversation on a cell phone. No one is speculating what "increased glucose metabolism" means other than a change in brain activity, but it does show that the radiation does have some effect on normal cellular functioning.

Currently, the general consensus among respected organizations, such as the World Health Organization (which, incidentally, sets standards for radiation for mobile devices, as does our FCC), is that there is no evidence of adverse effects from the radiation from devices such as cell phones. However, many of these same organizations hedge their bets by offering tips for reducing personal exposure from those devices.  Sort of a "buyer beware" type of situation.

What's a parent to do?

Personally, I've adopted the tactics of the WHO by assuming a reasonable level of safety with these devices, but practicing precautions nonetheless.

For example, I shopped around and found phones that emitted lower levels of radiation. CNET, which provides tech products reviews, compiled a list of cell phones and their radiation outputs here.

I'm encouraging my family to practice "safe cells" to reduce the amount of radiation they're exposed to by

• limiting the time spent talking on cell phones
• holding the phone away from their heads when talking
• using headsets to create distance from the radiation-emitting phone
• opting to text rather than talk
• being aware of how many bars are in use - the lower the number of bars, the harder the phone has to work, i.e., the more radiation it emits, in order to connect to a tower. Similarly (and counterintuitively)...
• skipping the radiation "shields," which reduce the connection and force the phone to transmit at a higher power, with more radiation 
• carrying the phone away from their bodies, for example, in a backpack, rather than in a shirt or pants pocket
• not sleeping with it turned on near their heads, which means not using it every night for an alarm clock on the bedside table

This New York Times article offers additional ideas for reducing radiation exposure from cell phones.

This issue is being taken seriously by countries around the world. For example, in France, cell phones cannot be advertised to children under 12, they must be sold with hands-free extensions, and there are limits on radiation emissions. In Germany, low-emission phones carry a seal of approval. Finland advises that children should stick to texting rather than talking. The UK's National Radiological Protection Board recommends that children only use cell phones for essential phone calls. Perhaps the most strongly worded warnings come from Russia, which not only mentions cancers may be associated with  electromagnetic radiation, but also epilepsy, nervous system disorders, and immune disorders. In fact, the Russian National Committee on Non-Ionizing Radiation Protection recommends that children under the age of 18 and pregnant women not use cell phones at all.

The WHO, along with various countries, recently convened an international conference in Slovenia on non-ionizing radiation and children. The report will be issued soon and one hopes it will provide some clarity between Russia's dire warnings and the United States' laissez faire attitude.

But, as with every generation, it seems while the adults are busy fretting and the scientists are figuring out how to study an issue, the kids have moved on. What I've noticed from my older kid is that texting is more popular than talking on cell phones, and that Skype seems preferable to sitting with a phone on your ear for those extended, middle-of-the-night conversations. And really, at this point, the main known health risk of cell phones comes not  from radiation, but from automobile accidents caused by drivers distracted by the phones. So perhaps the concern about radiation is a red herring that diverts us from the real threat of cell phones - fragmented attention - but at this point, no one really knows.

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Zombie Apocalypse!

Regardless of whether you think the world is coming to an end on 5-21-2011, you have to admit that  floods, hurricanes, and other natural disasters happen all too frequently. Just this week, we heard heartstring-tugging stories from individuals who lost everything when a bloated Mississippi river swallowed their homes and towns. A few weeks ago, the earthquake and the resulting tsunami in Japan brought home how quickly nature can destroy civilization - some of the videos I saw showed the progression from dry streets to entire blocks of buildings being washed off their foundations in about 6 minutes.

That's not a lot of time to grab important documents or mementos and to flee the area, or to communicate with loved ones how or where to meet up if you are displaced from your home. That's why organizations, such as the US Centers for Disease Control and Prevention (CDC),* encourage people to think about what they would do if faced with a flood, hurricane, or other natural or man-made disaster in advance of any event actually happening.

Currently, the CDC is running a sort of corny, sort of weird, but ultimately extremely useful campaign for disaster preparedness. By getting our attention with, of all things, warnings of a zombie apocalypse, the government then proceeds to offer very practical advice on  how to prepare for events that could dramatically affect your life.

The site contains useful tips, such as what to put into an emergency kit that everyone should have in their house. Rations of water, food, and other necessary supplies (such as medicines) can get you and your family through the first few days after a disaster when there may be no power or if the roads are impassible. Did you know the recommended amount of water to stockpile is 1 gallon per person per day?

Emergency kits are not just for use in the house - CDC also recommends stocking the kit with copies of important documents in case you have to leave your house quickly. Having copies of your drivers license, insurance information, birth certificate, and so on located in one place makes it much easier to quickly leave a dangerous situation, and also to replace originals or to get appropriate help if, for example, someone is injured and urgently needs medical care.

The site also counsels on a family emergency plan - where you would go in an emergency and how you would get there. Every family should consider this practical issue and select a place to meet if you get separated, whether it is in the front yard by the mailbox, or a location outside of your neighborhood if you are unable to return home.

No one wants to think about the worst that could happen. But CDC's message is a good one - by preparing in advance for the unthinkable, you have a better chance of surviving a disaster and an easier time rebuilding your life after one. Go here to learn more about how you can prepare for and stay safe during an emergency.

CDC knows what it is talking about. This boots-on-the-ground organization sends public health professionals around the world to help countries deal with emergencies. Go here to learn more about CDC's emergency activities and how it responds to disasters around the world. Did you know that part of CDC is actually a branch of the military? The US Public Health Commissioned Corps is one of the seven uniformed services of the United States and consists of 6,500 health professionals that deliver the Nation's public health promotion and disease prevention programs.

Ben Franklin was right: An ounce of prevention is worth a pound of cure. So invest a little time in thinking through scenarios and preparing for the worst. And then you can hope for the best, secure in the knowledge that you will be as ready as possible.

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* Disclosure: CDC, but not this particular center (it's a big place!), is one of my clients. 

Snack Attack

Real fruit at the outdoor market, Belem, Brazil

When my kids were in preschool, it was routine to be assigned certain weeks of the school year to be "snack parent," which meant you were in  charge of purchasing snacks for the entire class for those weeks. Most parents, no matter how overworked and undernourished ourselves, tried diligently to be creative with snacks. Maybe not as creative as these bento-packin' mamas, but most of us tried to find interesting and nourishing foods for our kids to carry to school in the class-assigned snack basket.

We recognized that the purpose of the mid-morning snack was to refuel the kids by providing nourishment that would allow them to focus, follow directions, and play for a few more hours. Some protein, some fruit, a carbohydrate or a vegetable if you could swing it. Just a midmorning snack.

But there were always those parents who thought daily snacks should be like a party. You know those parents...the ones who would bring one huge muffin from a wholesale warehouse for each child, even though those muffins could feed four preschoolers and are just cake in disguise. But the worst offenders were those who brought Fruit Roll-Ups for the fruit part of the snack.

Now, the parents at this preschool were an educated bunch, and I'm fairly certain no one really thought there was any fruit at all in a Fruit Roll-Up. But they would say things like, "But the kids like them!" (Translation: "I want the kids to like me!") I could always tell when one of my kids had a Fruit Roll Up because of the tell-tale blue or green or red lips and tongue and the equally colorful irritation that would be following him around like a cloud.

The folks over at Fooducate, one of my favorite food blogs, have deconstructed another type of "fruit" snack. Check it out. The labels on these are especially mis-informative, tricking the unaware into thinking these snacks are much healthier than they really are. The masterful marketing ties into a well-known juice brand and tries for the halo effect by associating this completely manufactured food with the family farmer, thus implying natural and healthy. Because parents need a PhD in label reading to get past the slick marketing, I bet these snacks make regular appearances in the snack baskets at preschools across the country. What do you think?

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