Affordable care acts

The Affordable Care Act is in the news again, this time because the U.S. Supreme Court recently ruled on the legality of subsidies offered to help people afford health insurance. Health care has long been an important and contentious topic in both political and social circles. Given the importance that accessing quality health care has for everyone, it is unfortunate that promoting good health has turned into a political debate.

In addition to expanding access to health care, the Affordable Care Act should also make it easier for people to get preventive care. This is important since preventable chronic diseases including diabetes and heart disease, are among the leading causes of disability and death as well as contributing to high health care costs. It turns out that adopting some simple lifestyle modifications can go a long way toward making you and your family healthier, as well as saving money.

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

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Here are a few affordable care acts you can implement today:

1. Move more

Significant health benefits, including weight loss and improved fitness, can be achieved with as little as 30 minutes of activity per day, but more is better. The activity doesn’t have to be “exercise.” It can include walking the dog, yard work, or house work. Research shows that sitting too much is just as unhealthy as not exercising. Spending less time sitting at work, home, or in the car is another easy way to improve health. And getting up and moving for even a few minutes is better than staying seated for long periods of time. Every little bit of activity really does count.

2. Eat smart

Making dietary changes can be difficult, but a few simple changes can lead to big benefits. Eating more real food including fruits, vegetables, whole grains, and lean meats and less added sugar is a good place to start. Fresh fruits, vegetables, and whole grain bread, pasta, and cereals are rich in vitamins, minerals, and fiber and most are low in calories. Eating less added sugar in sweets and processed foods can help you cut down on calories and lead you toward healthier food choices. Controlling portion sizes plays as big of a role in weight gain and loss as the types of food you eat, so pay attention to how much you eat, especially when you eat out. Chances are, it is more than you think!

3. Chill out.

Reducing and managing stress is essential for good health. Uncontrolled stress can lead to high blood pressure, poor immune function, and weight gain. Daily exercise will help, as will using stress management techniques like progressive relaxation. When you can, avoiding stressful situations is wise. Taking time to do something you enjoy each day is a good idea, too. Getting enough sleep (most adults require 7–9 hours) is also important for good physical and mental health.

4. Don’t smoke

Cigarette smoking more than doubles your risk of heart disease and stroke, and is by far the leading cause of lung cancer and other lung diseases. If you smoke, quitting now is one of the most important things you can do to improve your health—and the health of those around you. Nicotine replacement therapy and prescription medications can help, but quitting really does require serious dedication. It’s well worth the effort and the benefits of quitting can be realized almost immediately.

Regular activity, quitting smoking, managing stress, and the types of dietary changes described here can have a profound effect on preventing and treating many health problems. Best of all, these affordable care acts are basically free to implement and can lead to both health and financial savings now and in the future.

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Vocabulary lesson: Exercise, activity, and fitness

When I write about health-related issues I routinely use terms like exercise, activity, and fitness. Some people have asked why I use these different words since they all have a similar meaning. That is an excellent question, since these terms are related they have different applications for health and wellness.

Physical activity (PA) is defined as any movement produced by muscles that expends energy. Physical activity can be classified as occupational, what you do at work, and leisure-time, what you do in your free time. Occupational PA can vary greatly depending on the job, but it is low for most of us who spend much of our work day sitting. Leisure-time PA is all activity outside of work. This is of great interest to researchers since it reflects how we chose to spend our discretionary time. Physical activity can be measured by questionnaires or using devices such as pedometers, which count the steps you take, or accelerometers, which measure how much you move.

Exercise is a type of physical activity that involves planned, structured, and repetitive movement to improve or maintain physical fitness. Physical fitness, then, is a set of attributes that relate to the ability to perform physical activity and exercise. The components of physical fitness include endurance, strength, and flexibility. Basically, participation in physical activity and exercise improves your fitness and the greater your fitness, the better able you are to participate in physical activity. This is true for completing occupational tasks as well as traditional exercise, such as jogging or lifting weights.

The good news is that both physical activity and exercise have health and fitness benefits. Physical activity can vary in intensity, from light (slow walking), moderate (brisk walking), or vigorous (exercise like running). The 2008 U.S. Physical Activity Guidelines recommend that, at a minimum, all adults participate in moderate-intensity physical activity for 2 hours and 30 minutes per week or vigorous activity for 1 hour and 15 minutes per week along with strengthening exercises at least 2 days per week. You can meet this recommendation by going for a brisk walk for 30 minutes on 5 days per week or running for 25 minutes on 2 days per week or some combination of the two. Additional benefits come from doing more, either higher intensity or longer duration activity.

Vigorous exercise is the best way to improve fitness while moderate-intensity activity is strongly linked to health benefits. Fitness benefits result from adaptations in the heart and muscles, which get stronger and become better able to resist fatigue. These changes also lead to health benefits including lower blood pressure, cholesterol, and glucose as well as helping with weight loss and weight control.

Recent research suggests that health and fitness benefits also result from light-intensity or intermittent activity, especially if it replaces sitting. At home or at work, the more time you spend sitting, the poorer your health, even if you exercise every day. A recent study shows that getting off the couch and stepping in place during TV commercials results in nearly 25 minutes of activity per hour and burns about 150 calories, compared to 80 calories just sitting the entire time. You won’t get in great shape doing this, but it will increase your overall activity.

With this is mind, a good recommendation is to reduce sitting time in favor of light activity—stand while you read the paper or walk around while you talk on the phone—and participate in moderate or vigorous activity each day by going for a brisk walk or doing other exercises, including strength training.

Start making deposits in your fitness bank

Saving money for emergencies is good advice and important for maintaining quality of life in the event of a lost job or other financial crisis. While this may seem like common sense, many people have been caught without enough savings when they needed it and found it difficult to meet basic needs.

This principle can also be applied to fitness. When you are healthy, you can maintain a high level of fitness. This makes your day-to-day activities easier and serves as a reserve or “bank” to draw on when you need it. Your good fitness now can get you through a health crisis just like saving money can help you through a financial crisis. This health crisis could come in the form of an injury or illness that keeps you from being active for several days or a hospitalization that keeps you in bed for a week, a month, or longer. This is the topic of my Health & Fitness column in the Aiken Standard this week.

The problem with periods of inactivity, like bed rest or hospitalization, is that there are severe physiological effects that occur within days and get worse over time. You may have noticed this as weakness and fatigue after spending a few days in bed with a cold. Muscle strength declines at a rate of over 1% per day of bed rest, and can be 50% lower following as little as three weeks. That 50% reduction in strength could limit a person who was already deconditioned to a point where he or she would have difficulty completing the most basic activities of daily living.

A person who was fit and strong when they went into the hospital would certainly be better off when released. And older adults fare worse than younger individuals. According to one study, the decline in strength seen in older men in just 10 days was equivalent to the change measured after 28 days in men 30 years younger.

It’s not just the muscles that are affected, the bones get weaker, too. In fact, 12 weeks of bed rest can reduce bone density by as much as 50%, exposing patients to a greater risk of fracture. This is due to the reduced stress on the bone from not standing and walking as well as the lack of muscle activity. Two of the most effective ways to build bone density are putting stress on bones through weight-bearing activity and the action of the muscles pulling on the bones from resistance training. Because bed rest eliminates both of these stresses, bone density declines rapidly.

One unique study had healthy young men complete three weeks of bed rest back in the 1960s. They all experienced a rapid decline (over 20%) in their aerobic fitness, but recovered quickly after the experiment ended. These individuals also had their fitness tested again 30 years later. It turns out that the decline in fitness in those young men in three weeks of bed rest was greater than the decline in fitness that occurred over 30 years of aging!

The good news is that most patients are encouraged to move around as much as possible. Some receive in-patient physical therapy or rehab, even after major surgery, to help lessen the effects of prolonged bed rest. It is important to take advantage of these opportunities if you, or a loved one, are hospitalized.

There are many reasons to exercise and be fit, but the most important reason may be to develop a fitness “bank” you can draw on if you become injured or hospitalized. Since the effects of bed rest are seen in people of all ages, everyone can benefit from a good fitness foundation. Just like putting money in the bank, doing a little now can have great benefits later when you need it most.

Finally, some smart advice: First, achieve and maintain a high level of fitness now, just as you would save money for a rainy day. You never know when you will need it. Second, if you are hospitalized, take advantage of opportunities to move, whether that is limited to moving from bed to a chair or if it includes short walks or even inpatient exercise–if the medical staff approves, of course. While many well-meaning friends and family members will tell you to rest and not move, true bed rest is almost the worse thing you can do.

For example, inpatient cardiac rehabilitation targets patients who are recovering from heart attacks and even open heart surgery. The goal is to get these patients up and moving as quickly as possible to prevent long-term consequences of bed rest.

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Keep your cool while you work and play outdoors this summer.

No doubt about it, summer is here. The kids are out of school, sports camps are underway, the playground is calling, and the lawn needs to be mowed. And it’s hot! But the high temperature and humidity doesn’t have to keep you from taking part in your favorite outdoor activities. By taking a few precautions, outdoor activities in the summer heat can be safe and enjoyable for your entire family.

summer splash fun

Drink plenty of fluids

When it’s hot you have to sweat to lose heat and maintain your body temperature. High humidity makes sweating less effective, so you sweat even more. Losing lots of water through sweating can lead to dehydration. At the very least, you probably will feel fatigued but in more severe cases dizziness, low blood pressure, and fainting can occur.

For this reason it is important to drink plenty of fluids before, during and after your outdoor activity. As a general rule, a cup (8 oz.) of water every 15 minutes is sufficient for most people. Thirst is a good indicator of fluid needs, but you should take frequent breaks to rehydrate.

Make sure to remind kids to take breaks since they can get so busy playing that they forget. Water, juice, sports drinks, and other soft drinks are equally effective, so pick something you and your kids will drink.

Take breaks

The longer you are active the hotter you will get and you may feel more fatigued because of the heat. Taking frequent breaks will give you a chance to rest, cool down, and get something to drink.

Seek out shade

Being in the sun means that you will feel even hotter because you gain heat from the sun’s rays. Spending as much time as you can in the shade will help you stay cool. While this isn’t always practical for all activities, look for shady spots to take breaks.

Keep in mind that shady areas at will change throughout the day, so plan your trip to the park accordingly. Also be aware that direct sunlight can make outdoor surfaces like playground equipment very hot. This is another reason to find shady areas to play.

Pick cool clothes

Lighter colored clothing will reduce heat gain from the sun. Synthetic fabrics that wick sweat from the skin can help keep you feel cooler, too. And having more skin exposed will allow you to lose more heat.

Wear sunscreen

Sun exposure is the leading cause of skin cancer. Always use a broad-spectrum (both UVA and UVB rays) sunscreen and apply—and reapply—it according to the instructions. You should also protect your eyes by wearing a hat or sunglasses.

Avoid the hottest times of the day

Try to plan your outdoor activity in the morning or evening to avoid the hottest times of the day. Keep in mind that the highest temperatures often occur in the late afternoon or early evening, so right after work may not be the best time for outdoor activities. Early in the morning is probably the best time since it tends to be cooler and less humid.

You may not be able to plan your activities in the shade or when it is cooler. This is especially true for people who work outdoors. In these cases, drinking plenty of fluids and taking frequent breaks is particularly important.

These tips should help you and your family safely enjoy spending time outdoors this summer. And never underestimate the cooling power of a popsicle on a hot summer day!

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Are your pants making you fat?

If you have purchased new pants recently you may have noticed that they have an adjustable or expandable waist. Some men’s pants include up to two extra inches to allow you to “flex” or “move more freely.” Women’s pants might have elastic hidden in the waist band for extra “stretch.” While these pants are designed to be comfortable, they could be making you fat!

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


Most people gain weight as they age, typically a slow process that may not be immediately noticeable. If you have pants with a two-inch expandable waist you could easily gain weight while still wearing the same pants size. In fact, you could gain two inches of fat around your waist before you noticed. For many people, tight-fitting pants are a signal that they may have gained a few pounds. If you miss that cue you could easily gain significant weight, which requires a significant effort to fix.

This might sound like a minor issue, but external cues like this are important to help us recognize weight gain. In a classic example, a man puts on his favorite suit for the first time in over a year to find that the pants are too tight. Immediately he realizes that he has gained weight since he last wore the suit. Imagine, though, if his suit pants stretched to accommodate his larger waist. He might still think that, since the pants still fit, he hasn’t gained any weight.

This is important since people typically gain weight little by little over time, which may not be appreciated without these external cues. One way to prevent surprise weight gain is to weigh yourself regularly so that you can make adjustments to your diet and activity to prevent further weight gain. In fact, one common characteristic of the “successful losers” in the National Weight Control Registry is that they weigh themselves at least once a week. This is important because it’s easier to make adjustments to lose weight that’s gained in a week versus weight that is gained over a month or more.

This is also why people who lose weight should get rid of their “fat clothes.” Typically, these clothes get pushed to the back of the closet. But they are still readily available, so when the person regains some of the weight, it is easy to reach for a larger size. If those clothes had been packed away in a box in the attic, retrieving and unpacking them would be a noticeable sign that they had gained weight and may motivate them to get back on track.

Even small changes to our diet and activity patterns can lead to weight gain over time. Since this weight gain can often go unnoticed, it is important that we pay attention to external cues. The way our clothes fit is one such reminder, but there are others. Do you notice that you feel more out of breath doing routine activities, like climbing a flight of stairs? Is it more difficult to bend over and tie your shoes? These are both signs that your fitness may be declining and that it is time to start exercising.

These cues are easy to ignore, but they are important signs that it is time to make changes to your diet and activity habits. It is even easier to prevent weight gain or to stay fit than it is to lose weight or get in shape. So, don’t let your pants trick you! Pay attention to how your clothes fit and how you feel and use these cues to guide you to maintain good health.

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Candy and soda for breakfast, again!

This is a follow-up to a piece I wrote previously about an analysis of what kids (and adults) commonly eat for breakfast. Considering that this is one of the topics I talk about most frequently, it seemed like time for an update It is also my Health & Fitness column in the Aiken Standard this week.


Eating a healthy breakfast provides energy to start the day and is important for weight control. In children, a healthy breakfast is essential for proper growth and development and is linked to improved attention and learning in school. Breakfast is often thought of as the most important meal of the day, for good reason. Unfortunately, many common breakfast foods are more similar to candy and soda than a healthy meal to start the day.

Some popular breakfast foods targeted at children include sugar-sweetened cereals, pastries, and bars, many of which look like candy or dessert. Pop Tarts and some granola bars are covered in frosting and favorite cereals often contain marshmallows, chocolate, or are shaped like cookies. No surprise that these foods are as high in calories and sugar as cookies or some candy bars!

Unhealthy choices sometimes come disguised as something healthy—juice. Many “fruit” drinks contain less than 5% juice but plenty of added sugar, so they are essentially soda without bubbles. For example, the orange drink Sunny D is a popular substitute for orange juice, but it is far from a nutritional equivalent. The same is true for other drinks, including juice boxes and pouches, that are commonly part of breakfast or snacks.

Even though the sugar and caloric content of these drinks is comparable to real fruit juice, consuming food and beverages that are flavored like fruit but are actually much sweeter may make real fruit less palatable. Children may develop an expectation that oranges or orange juice should taste as sweet as Sunny D and prefer the sugar-sweetened version over the real fruit. The same is true for food, too. A child who is used to breakfast or snack foods that taste like candy or cookies may resist real food when it is offered.

This really isn’t much different for adults. Breakfast foods like donuts and pastries are almost always topped with icing and it would be difficult to distinguish many muffins from cupcakes. For many people, coffee isn’t just coffee anymore, but a drink that contains as much sugar and as many calories as a milkshake, sometimes with whipped cream on top.

One of the biggest offenders for both children and adults is yogurt. Low-fat and fat-free flavored yogurt is almost always sweetened with sugar. This is true for the yogurt tubes that kids love and the Greek yogurt that is widely thought to be healthy. Sure, it contains protein and bacteria that seem to be beneficial, but the added sugar makes it equivalent in terms of calories and sugar to frozen yogurt or ice cream. Some of these yogurts even come with toppings, like bits of chocolate, just like fro-yo!

The good news is that you can make your breakfast healthier without too much effort. While there is much debate about what constitutes a healthy breakfast, there is agreement about what it doesn’t include—lots of added sugar! Look for cereals that are low in added sugars and high in fiber. Include real fruit, fruit juice, and milk (or soy milk) whenever possible. If you have time, eggs are an excellent source of protein and healthy fats. Yogurt is good, too, but watch out for added sugars in flavored yogurt. Whole grain toast or a bagel with peanut butter makes a good alternative to Pop Tarts or breakfast bars.

As a general rule, steer clear of foods that look like dessert. Marshmallows, chocolate chips, and frosting are best left for after a healthy meal, not a replacement for it.

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School gets out, weight goes up. Why now is the time to focus on preventing childhood obesity.

Obesity is a major concern for adults, linked to several leading causes of death and numerous other health problems. What you may not know is that obesity is also a serious health issue for children. It is troubling to note that nearly one-third of school-aged children and teenagers are over a healthy body weight and nearly 20% are considered obese. Remarkably, 10% of infants, toddlers, and preschoolers, are also considered obese.

This is important because the common combination of poor nutrition, physical inactivity, and obesity has physical, psychological, and social consequences for children that frequently persist into adulthood. There are many reasons why childhood obesity occurs and much that can be done to prevent it. Now that school is almost out for the summer, this is a critical time of year to focus on good nutrition and activity to help prevent unhealthy weight gain in kids. This is the topic of my Health & Fitness column in the Aiken Standard this week.

Childhood obesity cartoon

Overweight and obese children are at increased risk for type 2 diabetes, high blood pressure, heart disease and even stroke – conditions usually associated with adulthood. Even if an overweight child does not have these conditions now, he or she is likely on that path. Many experts predict that children born today will be the first generation in history to have a shorter lifespan than their parents due to obesity-related diseases that begin in childhood.

Children who are overweight are also more likely to suffer other consequences including lower self-esteem, social functioning, and academic performance. Overweight children are also less likely to play sports or participate in other forms of physical activity. Considering that the consequences of obesity are made worse by low levels of activity, this creates a cycle leading to poorer and poorer health.

There are numerous potential causes of obesity in children, but the most likely suspects are too little activity and excessive calorie intake, largely because of added sugars. Fewer than half of all kids meet the minimum recommendation of 60 minutes of activity each day and many children spend as much time watching television or playing video games as they do in school. We shouldn’t be surprised that we have a childhood obesity problem!

While poor nutrition and a lack of activity in schools is thought to contribute to the problem, many children get more activity and eat better at school than they do at home. A recent report suggests that children gain more weight over the summer than during the rest of the year. Furthermore, for many kids, fitness gains made during the school year are frequently lost over the summer. Since summer vacation is rapidly approaching, this is a critical time to help our children stay fit and healthy.

The good new is there is much we can do. Ensuring that children get plenty of healthy foods such as fruits and vegetables, reducing the consumption of added sugars, and eating appropriate portion sizes will go a long way to addressing the diet aspect of obesity. Making sure that kids of all ages have opportunities to be active while limiting time spent sitting, especially in front of a screen, are equally important.

Since children don’t make most of the decisions about their activity and diet, it is important to recognize the role that parents, grandparents, and other caregivers play. More often than not, obesity is a family issue. This means that  solving the problem is a family issue, too. Adults should model healthy behaviors by making diet and activity changes themselves. A good place to start is by turning off the TV and going outside to play or for a walk. It’s something all of us—adults and children—will benefit from.