What parents and schools can do to make sure kids are ready to learn

Physical activity and good nutrition have long been recognized as essential for promoting good health in adults and children. More and more research suggests that these health behaviors can have beneficial effects beyond health, including how we perform both physically and mentally. The emphasis here is on children in school, but it applies to adults, too.

Unfortunately, taking time for activity and good nutrition is seen as a luxury or a distraction to learning in most schools. Far from being a distraction, physical activity and healthy eating are prerequisites for learning and academic achievement. In short, these often ignored factors can help make sure children are ready to learn.

Regular physical activity is essential for good health, growth, and physical development, including maintaining a healthy body weight. This last point is important given the epidemic of childhood obesity and related health problems, including “adult” diseases like high blood pressure and type 2 diabetes.

Current recommendations call for all children to get at least 60 minutes of activity per day. This can include activity at school from physical education classes, recess, other classroom activities as well as games, sports, and unstructured play. Unfortunately, most kids don’t get nearly enough activity at school and many aren’t active at home.

Physical activity is also important for academic performance. Research shows that children who participated in an activity program had better executive control, which includes resisting distractions and maintaining focus, improved memory, and doing better switching between tasks. This is particularly relevant for children with ADHD, but the effects can be seen in all kids. These positive changes can maximize class time and lead to improvements in academic achievement, especially math and reading test scores.

Similarly, good nutrition is also essential for health, growth, development, and academic achievement. Eating a good breakfast improves cognitive function, alertness, and academic performance in students of all ages. It should be no surprise, then, that skipping breakfast impairs cognitive function and academic achievement. This is one reason that many schools offer breakfast to start the day or include a healthy mid-morning snack.

The same is true for lunch, too. A good lunch can support learning in the afternoon and gives a chance to teach kids about good nutrition by providing healthy food that, unfortunately, many children may not get at home.

Schools have a unique opportunity to use physical activity and nutrition to promote health, support academic achievement, and teach healthy habits. Since formal nutrition education is missing from most curriculums and PE programs are being reduced or cut completely, schools must be creative to incorporate these essential subjects.

A way around this problem is to make sure children get a chance to move and play, ideally multiple times during the day. This is what recess is for. Teachers can also incorporate activity and nutrition education in the classroom and get away from the idea that kids must be sitting still to learn. As research shows, quite the opposite is true!

Schools are often hesitant to teach about nutrition and activity because it is thought of as a responsibility of parents, not schools. But most parents don’t teach these good habits at home, which affects what happens at school. Despite the obvious benefits, it will probably take years of effort to change this view.

In the meantime, parents can encourage their kids to be active and make smarter food choices at home so they are ready to learn in school.

What’s wrong with the way we eat, according to Jim Gaffigan.

I happened to catch a segment of the public radio show Here & Now yesterday afternoon. The guest was comedian Jim Gaffigan, who has a new book out, called Food: A Love Story. Food is a common topic in his comedy.

Anyway, in the discussion, he made a joke that I think perfectly describes what is wrong with the way we think about food. I’m paraphrasing a bit, but basically he says:

Artists have long painted bowls of fruit because no one will touch the fruit. There are no famous paintings of donuts because someone will eat them before the painting is complete.

That’s funny, at least partly because it is true. And that’s the problem.

Celebrate Food Day every day by eating real food

This Friday is Food Day, an annual event that aims to raise awareness about the food we eat and the impact it has on our health, environment, and quality of life. It turns out that many of us don’t know much about our food including where it came from, the method of preparation, and the quality and nutritional value.

As I describe in my Health & Fitness column in the Aiken Standard this week, we are increasingly disconnected from our food, a fact that has implications for our health and the health of the environment.

Our lack of knowledge about the food we eat has been replaced by a heightened awareness about nutrients. In fact, many people follow diets that either emphasize or restrict certain nutrients in order to obtain health benefits. But the research to support the importance of these individual nutrients is often mixed or lacking altogether. Still, as we seek out sources of these nutrients we are led to supplements, such as fish oil, or processed foods with added nutrients, like fiber.

To be sure, fish oil and fiber are good for us. But does that mean that taking a fish oil supplement will have the same health benefits as actually eating fish instead of, say, fried chicken? Or is adding fiber to a chocolate breakfast bar equivalent to getting more fiber from fruits and vegetables? Both research and common sense suggest that the answer is no.

Beyond the individual nutrients, the food we eat has changed. Even the way food gets to our table has changed. Since nearly half of our meals are eaten outside the home, it’s not even “our” table anymore. And when we do eat at home, take-out and prepackaged heat-and-eat meals have become the norm. In fact, the idea of cooking meals from ingredients is so foreign that we have to be reminded about how and why we should do it.

Events like Food Day are an attempt to get us back to the basics of cooking and eating real food. This, of course, is how people ate for years before the obesity and diabetes epidemics we are dealing with now, so eating real food again is a step toward reducing these, and other, health problems.

In addition to the potential health benefits of focusing on food over nutrients, this approach is also good for the environment and the economy. It turns out that eating healthier food promotes sustainable agriculture and can support local farmers. Locally grown produce, which is picked at the peak of freshness, can be more nutritious and have a lower environmental impact than food from factory farms which is often shipped great distances. And most important, food from local farms usually tastes better!

This is the point of Food Day. We should make ourselves aware of where our food comes from and do our best to eat “real food” as opposed to processed and pre-packaged foods that tend to be high in calories, added sugar, salt, and unhealthy fats. When possible, we should buy foods that are grown locally to minimize the environmental impact and support local farmers who live, work, and pay taxes in our area.

It turns out that focusing on food, not nutrients, will have a positive impact on your health, the environment, and quality of life for you and others. And that is why it is called Food Day, not nutrient day. You can learn more about how you can celebrate Food Day every day at www.foodday.org.

Don’t forget about breast cancer prevention!

October is National Breast Cancer Awareness Month and many local and national organizations are promoting breast cancer awareness, sharing information about the disease, and celebrating survivors. This month represents the most visible part of a year-round effort to educate about, screen for, and hopefully cure this devastating disease.

Of course, these are all worthy goals that deserve our attention and support. What is often missing are the steps women—especially young women—can take to reduce their risk for, or even prevent, breast cancer.

Approximately 1 in 8 women will develop breast cancer. The American Cancer Society estimates that around 300,000 new cases of breast cancer are diagnosed and nearly 40,000 women die from this disease each year. Breast cancer can occur in men, but these cases are rare, so the focus is rightfully on women.

Much attention is given to genetic factors that increase the risk of breast cancer. These include certain gene mutations, including BRCA1 and BRCA2, as well as family history. A woman who has a first-degree relative (mother, sister, or daughter) who has had breast cancer has nearly twice the risk of being diagnosed herself.

Considering that most women diagnosed with breast cancer have no family history, it is also important to try to reduce other modifiable risk factors. This involves making health behavior changes that are probably familiar to most people. The good news is that these changes can also reduce the risk of other cancers, cardiovascular disease, and most other chronic diseases.

Avoid tobacco use. While the results of studies of smoking and breast cancer are mixed, a conservative interpretation is that smoking may increase the risk. Smoking increases the risk of other cancers, especially lung cancer, as well as heart attack, stroke, and other lung diseases. Not smoking, or quitting now, is among the best health decisions a woman can make.

Consume alcohol in moderation. Women should limit their alcohol intake to one drink per day. Women who consume more than two drinks per day increase their risk of breast cancer by 20% over women who don’t drink.

Maintain a healthy body weight. Being overweight can increase the risk of breast cancer in post-menopausal women by 30–60%. Excess body fat can alter the levels of estrogen and other hormones. The good news is that losing as little as 10 pounds can reduce this risk.

Be physically active everyday. Regular activity and exercise can lower breast cancer risk by as much as 20%. In addition to helping with weight control, physical activity may lower the level of certain hormones that are associated with breast cancer. The biggest reduction in risk of breast cancer is seen in women who have been active their whole lives, but it is never too late to start.

Eat a healthy diet. The evidence from studies on the effect of diet on breast cancer risk is mixed, and more research is needed. In general, increasing fruit, vegetable, and whole grain intake and reducing red meat is associated with at least some decrease in breast cancer risk. These “healthy” foods are rich in vitamins, minerals, and other nutrients and eating more of these foods may lead to weight loss or prevent weight gain with age.

Every woman has a different breast cancer risk based on her unique family history, biology, and lifestyle. But by making some simple health behavior changes, all women can reduce their risk for, or even prevent, breast cancer and improve their overall health.

 

When it comes to your health, don’t take the high road.

When faced with challenging moral or ethical situations we are advised to do what is right, even if it is more difficult. “Taking the high road” is often synonymous with living a better life. When it comes to your health, though, taking the high road may lead you on a path to chronic disease, disability, and early death.

The high road I am referring to in this case has nothing to do with ethical decisions. It has to do with test results, specifically measurements your doctor makes of your weight and blood pressure as well as blood tests of cholesterol and glucose. This is the topic of my Health & Fitness column in the Aiken Standard this week.

These tests are indicators of your current health as well as risks to your health in the future. The results of these measures are used to classify you as having “normal” or “high” blood pressure, blood glucose, and blood cholesterol. For example, a fasting blood glucose between 70–100 mg/dl is normal but you are considered to have diabetes if your result is 126 mg/dl or higher.

Even if your blood glucose is above normal (100–125 mg/dl) but isn’t high enough for you to be classified as diabetic, it may still be too high. This condition is called prediabetes because without intervention most people in this category will eventually develop diabetes.

Considering that diabetes is a leading cause of heart attacks, blindness, and amputations, preventing your blood glucose from increasing should be a high priority.

The same is true for other measurements including blood pressure and body mass index (BMI), the most common assessment of obesity. Even if you aren’t considered obese or don’t have hypertension, the higher your BMI or blood pressure becomes puts you at increased risk of the condition getting worse over time or leading to other more serious health problems.

In fact, even within the normal range, a higher value is associated with increased health risks. Take blood cholesterol for example, where the risk of heart disease increases at total cholesterol levels above 150 mg/dl, well within the “normal” range of less than 200 mg/dl. At even higher levels, total cholesterol is associated with a much greater risk.

Clearly, having a high BMI, blood pressure, blood glucose, or cholesterol is concerning. But it is important not to be fooled into thinking that a value that is technically below the diagnostic criteria for “abnormal” is necessarily “normal.” For many, even slightly elevated levels of these variables now are likely to get worse over time.

The good news is that modest lifestyle changes including weight loss, regular moderate physical activity, and changes to what you eat can prevent conditions like prediabetes and prehypertension from getting worse. This can be achieved through losing as little as 10 pounds, walking or doing other activity for 30 minutes per day, and adding more fruits and vegetables to your diet.

To be sure, taking the “high road” with BMI, blood pressure, cholesterol, and glucose, even if your test results are within the normal range, can put you at increased health risk. For these conditions, you are far better off taking the low road and making the necessary lifestyle changes to stay there.

“Heart” your heart.

Today is World Heart Day, with a focus on encouraging all of us to make heart-healthy choices to reduce cardiovascular disease risk. I thought that sharing some information about the heart, how it works, and how to keep it healthy would be an appropriate way to celebrate. This is also the topic of my Health & Fitness column in the Aiken Standard this week.

Your heart started beating months before you were born and will continue to beat every second or so…until it stops, signaling the end of your life. During your lifetime, your heart will probably beat more than two billion times, or about 100,000 times per day. (more interesting heart facts here)

The major function of the heart is to pump blood to all of your tissues through the arteries and back again through the veins. The heart has four chambers: the left and right atria that receive blood from the veins and the left and right ventricles that pump blood into the arteries. The right ventricle pumps blood to the lungs to pick up oxygen and the left ventricle pumps oxygenated blood out to the rest of the body.

The activity of your heart will vary throughout the day. At rest your heart rate is low, typically around 70 beats per minute. Some athletes have resting heart rates that are much lower, owing to their bigger, stronger hearts.

But when you are active your heart beats faster and more forcefully to eject more blood to the working muscles. During intense exercise, a young person’s heart rate can go above 200 beats per minute and the amount of blood pumped can be five times higher than at rest!

The heart is made up mostly of muscle that functions similarly to the skeletal muscles you use to move your body. But cardiac muscle is different in that it can spontaneously contract when stimulated by a specialized area of the heart called the SA node or pacemaker. And unlike skeletal muscle, the heart is remarkably fatigue-resistant, meaning that it can contract repeatedly without needing a break.

In order to beat continuously, the heart needs a steady supply of oxygen which is delivered through coronary arteries, not from the blood inside the chambers of the heart. Normally, plenty of oxygenated blood gets through. But if the coronary arteries become narrowed through atherosclerosis, the accumulation of plaque in the vessels, blood supply can be limited.

This can lead to reversible symptoms like angina pectoris (chest pain), especially during exertion. If a clot forms in the narrowed vessel, blood flow can be blocked completely causing a myocardial infarction (heart attack). Heart disease can be managed using medications, angioplasty, or bypass surgery, but the best approach is to prevent the problem from occurring in the first place.

Taking care of your heart is one of the most important things you can do for your health. Like other muscles, regular exercise can make your heart larger and stronger to pump blood more effectively. Exercise also lowers your blood pressure and can help reduce your blood cholesterol, further reducing the risk of heart disease.

A diet that is low in salt and unhealthy fats, like trans fats, can help lower blood pressure and cholesterol, slowing the process of atherosclerosis and preventing heart failure, a condition in which the heart muscle becomes weak. Maintaining a healthy body weight and controlling blood glucose are also keys to a healthy heart.

More than anything, though, your heart likes to be active. So celebrate World Heart Day by taking your heart for a walk!

 

Loosening our belts. Expanding waistlines means expanding health problems.

In a report published this week, researchers showed that the waistlines of Americans are still expanding. This is bad news, since excess fat, especially around the waist, has serious implications for our health. Fortunately, there is much we can do to lose weight and improve our health.

This is the topic of my Health & Fitness column in the Aiken Standard this week.

The study, published in the Journal of the American Medical Association, looked at the percentage of adults who had a high waist circumference (over 35 inches for women and over 40 inches for men). Overall, the average American added over one inch to their waist circumference over the past decade. As of 2012, over half of U.S. adults (51%) meet the criteria for abdominal obesity, compared to 46% in 2000.

Since excess muscle tends to compress the abdomen, this really does reflect an increase in fat around the waist, not the benefits of a national sit-up campaign. And it is the location of the fat that makes this worrisome. Excess fat around the waist includes both subcutaneous fat beneath the skin (what you can pinch) as well as visceral fat stored deep in the abdomen.

Excess visceral fat is associated with an increased risk of high blood pressure, type 2 diabetes, and heart disease, among other chronic conditions. The only way to determine how much visceral fat a person has is through an imaging test like a CT scan. (In my lab we can estimate visceral fat by making a few abdominal measurements.) The important point is that the bigger your waist circumference, the more visceral fat you likely have.

You may have heard of people’s body shapes described as “apple” or “pear.” Upper body obesity (apple), sometimes called android obesity because it is more common among men, is associated with a high waist circumference and visceral fat. Lower body, or gynoid, obesity (pear shape) tends to involve a narrower waist but more fat storage in the hips, thighs, and buttocks.

These body shapes become apparent when you measure both waist and hip circumferences. A high ratio between waist and hip measurements indicates more upper body fat; a low waist-to-hip ratio suggests lower body fat. That said, just measuring your waist circumference can give you the same information. A waist measurement greater than 40 inches for men and 35 inches for women indicates excess upper body—and visceral—fat.

There is no single explanation for why waist circumference has increased so much in the population. But it almost certainly has to do with a combination of individual factors including what foods we eat, how much we eat, and how active we are. The average American with an expanding waistline likely eats too much poor quality food and doesn’t get enough exercise.

These are exactly the same factors that, when reversed, can lead to fat loss. Indeed, research shows that even modest weight loss from a low-calorie diet and exercise can result in reduced body fat, including visceral fat. This is one reason why weight loss is effective for reducing high blood pressure and controlling blood glucose.

Even if you don’t lose weight, increasing your level of physical activity, particularly regular exercise, can offset some of the negative health effects of excess visceral fat. In addition to helping you lose weight, exercise can also help you maintain your waistline and prevent abdominal obesity.

The bottom line is that when your pants start to feel tight, they are trying to tell you something. Listen to them!