"What's Your Weapon?": Billie Jean King, Arthritis Foundation, Ad Council, and USTA Launch Arthritis Campaign

Before Twitter and the U.S. Open was a flutter this afternoon with the news of Venus Williams withdrawing due to the diagnosis of the autoimmune disease- Sjogren's Syndrome, the U.S. Tennis Association was focused on another health related issue. Today the press release went out that tennis legend Billie Jean King was joining the Arthritis Foundation, the Ad Council, and the US Tennis Association (USTA) to launch a public service campaign against arthritis (the leading cause of disability in America).



The ads, launched at the U.S. Open today, feature King (who has osteoarthritis- OA) and highlight the power of movement and exercise as "weapons" in the fight against arthritis. King tells viewers "tennis is my weapon" against arthritis. The ad then asks viewers, "what is your weapon against arthritis?" and directs them to the campaign's website in order to find out: Fight Arthritis Pain. On first view, I was not terribly impressed. The brief ad (33 seconds) does not tell you very much (e.g., King says tennis is her "weapon" but nothing is said about the benefits of movement). The goal of the ad simply appears to be motivating viewers to visit the website for additional information.



The other thing that is not clear in the ad (but clarified in the press release and website) is that this campaign is targeting OA specifically. While OA is the most common type of arthritis, it is not the only type. For example, in contrast to OA which breaks down cartilage, rheumatoid arthritis (RA) (a chronic autoimmune disease) causes inflammation of the lining of the joints. Would the exercise recommendations be the same no matter what type of arthritis? I would say that distinction is unclear for viewers.



However, I did feel better when I read the press release and saw that these ads were tested in focus groups by the Ad Council. Testing your images and messages with your target population is incredibly important. It is reported that participants felt that the concept of "having a weapon" against arthritis was powerful and motivating. That is good news considering formative research by the Ad Council found that only 16% of OA sufferers surveyed felt "very confident" that they could manage their pain. Therefore, if an ad can make viewers feel empowered and confident- that is a good thing.



The press release did not describe the demographics of the focus group participants, but I am assuming they were similar to those originally surveyed (adults age 55+ with OA). If so, it would mean that Billie Jean King was an appropriate "Champion" for the cause and someone that audience admired, having watched her in the 1960s-1970s, her prime competitive years. However, I wonder if she would be the best choice for ads targeting arthritis sufferers in a younger demographic? After all, different types of arthritis can affect people of all ages. Again, this is another reason that I would have wanted to see a clearer definition of the audience for these ads. If we are focused on older adults with OA, then it is a great choice. If we are focused on people of all ages with all types of arthritis, then maybe not.



Overall, I give this campaign a "B". The impetus of the campaign is good in that it is based on research...research that shows that arthritis suffers are too sedentary and do not feel like they have control over their pain management. The campaign aims to address these barriers by empowering viewers with a "champion" who they admire and can model. The campaign also links them to a website with all the information they need about the benefits of exercise for arthritis. However, the execution of this campaign is not as strong as its foundation. It would have benefited from a more clearly defined audience and message.

A Roadmap to Obesity

In this post, I'll explain my current understanding of the factors that promote obesity in humans.  

Heritability

To a large degree, obesity is a heritable condition.  Various studies indicate that roughly two-thirds of the differences in body fatness between individuals is explained by heredity*, although estimates vary greatly (1).  However, we also know that obesity is not genetically determined, because in the US, the obesity rate has more than doubled in the last 30 years, consistent with what has happened to many other cultures (2).  How do we reconcile these two facts?  By understanding that genetic variability determines the degree of susceptibility to obesity-promoting factors.  In other words, in a natural environment with a natural diet, nearly everyone would be relatively lean, but when obesity-promoting factors are introduced, genetic makeup determines how resistant each person will be to fat gain.  As with the diseases of civilization, obesity is caused by a mismatch between our genetic heritage and our current environment.  This idea received experimental support from an interesting recent study (3).

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The East Coast Earthquake, Real Time Twitter Chat, and Facebook Applications for Disasters

Well! Today was an interesting day at the office. Up and down the east coast, many of us felt the tremors resulting from an earthquake in Virginia. While I would like to report that we all stayed calm and participated in orderly, safe, and well rehearsed evacuations...that was not the case. It appeared that the shock of experiencing an earthquake (such a rare event on the east coast) caused a little chaos. On my way into my office to grab my bag before hitting the stairs, I experienced a "George Costanza" type moment as a fellow staff person almost knocked me down in her rush to get out. I heard similar stories from my husband who works 4 blocks away. Upon recognition of the earthquake, his co-workers made a beeline for the safest escape route...the elevator?!



After the shaking took us down 13 flights of stairs, I quickly turned to the only reliable source for real time information- Twitter. Since I was the only one in the area who either grabbed my phone or had twitter, I quickly read off what I knew: "It is a 5.9 earthquake in Virginia"; "My colleagues felt it in- Baltimore, DC, Boston, NYC, North Carolina"; "No damage except one broken window is reported in Philadelphia". After being given the go ahead to return to the building and settling back into our work, we received an official text/email from the University reiterating the information Twitter delivered an hour before. According to Twitter's official profile tonight, within one minute of the #earthquake, there were more than 40,000 earthquake-related tweets. They reached 5,500 tweets per second (TPS).



As I discussed in a related post back in March 2011, the question for public health professionals continues to be- "What is the role of social media in emergency preparedness and recovery?"



I believe we are making some strides in answering that question. Just yesterday, the Office of the Assistant Secretary for Preparedness and Response (ASPR)- located within the US Dept of Health and Human Services (HHS)- launched a contest: The ASPR Lifeline Facebook Application Challenge. The goal of the contest is to create applications that prepare individuals for disasters and build resilient communities. Those who opt into the application will be able to identify "lifelines" or Facebook friends that agree to be an individual's emergency contact and act on their behalf in case of an emergency. They will also be able to create a personal preparedness plan and share that plan and the application with others.



Even without the formal application, we have seen social network sites be used for checking in with friends/family and for getting information out quickly. For example, I follow the Philadelphia Office of Emergency Management on Twitter, so I got the message quickly that our 9-1-1 system was being inundated with calls since the earthquake and we should only use it with a real emergency...for infrastructure damage, call 3-1-1 instead.



While the Facebook application sounds like a great addition to emergency preparedness, it is important to also consider implementation issues which will impact its reach and effectiveness:

• Is the application only available to Facebook members who download it ahead of time? Or will it be available to anyone via the mobile web?
• Do these Facebook members typically update their profile via mobile devices in addition to stationary computers (which may not be available during an emergency)?
• During the emergency, are there cell networks/wifi to support the communication? (e.g., many reported that cell networks were jammed immediately following the earthquake)
• Do these "electronic" preparedness plans need to be rehearsed the same way as "in person" plans in order to increase effectiveness?

The HHS-ASPR contest runs August 22-November 4, 2011. I look forward to seeing the winning applications and hearing about how the dissemination will be conducted and evaluated.



What were your experiences today during the east coast earthquake? What did you hear/see from your colleagues? How did you get/send information to others? Please share in the comments section below.

Seed Oils and Body Fatness-- A Problematic Revisit

Anthony Colpo recently posted a discussion of one of my older posts on seed oils and body fat gain (1), which reminded me that I need to revisit the idea.  As my knowledge of obesity and metabolism has expanded, I feel the evidence behind the hypothesis that seed oils (corn, soybean, etc.) promote obesity due to their linoleic acid (omega-6 fat) content has largely collapsed.

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Food Palatability and Body Fatness: Clues from Alliesthesia

Part I: Is there a Ponderostat?

Some of the most important experiments for understanding the role of food palatability/reward in body fatness were performed by Dr. Michel Cabanac and collaborators in the 1970s (hat tip to Dr. Seth Roberts for the references).  In my recent food reward series (1), I referenced but did not discuss Dr. Cabanac's work because I felt it would have taken too long to describe.  However, I included two of his studies in my Ancestral Health Symposium talk, and I think they're worth discussing in more detail here.

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I Got Boinged, and Other News

The reaction to my post "The Carbohydrate Hypothesis of Obesity: a Critical Examination" has been overwhelmingly positive, particularly among the scientists I've heard from. 

On Saturday, the inimitable maker and writer Mark Frauenfelder posted a link to my post on the variety blog BoingBoing.  BoingBoing has been on my sidebar for three years, and it's the place I go when I need a break.  It's a fun assortment of science, news, technology and entertainment.  BoingBoing was originally a zine started by Frauenfelder and his wife in 1988, and it has been on the web since 1995.  Today, it has multiple contributing authors and it draws several hundred thousand hits per day.  I'm thrilled that Frauenfelder posted my article there.  Apparently he likes my blog.  Thanks!

I added a new section (IIB) to my original post.  It discusses what human genetics can teach us about the mechanisms of common obesity.  It is consistent with the rest of the evidence suggesting that body fatness is primarily regulated by the brain, not by fat tissue, and that leptin signaling plays a dominant role in this process. 

The Carbohydrate Hypothesis of Obesity: a Critical Examination

Introduction

I'd like to begin by emphasizing that carbohydrate restriction has helped many people lose body fat and improve their metabolic health.  Although it doesn't work for everyone, there is no doubt that carbohydrate restriction causes fat loss in many, perhaps even most obese people.  For a subset of people, the results can be very impressive.  I consider that to be a fact at this point, but that's not what I'll be discussing here. 

What I want to discuss is a hypothesis.  It's the idea, championed by Gary Taubes, that carbohydrate (particularly refined carbohydrate) is the primary cause of common obesity due to its ability to elevate insulin, thereby causing increased fat storage in fat cells.  To demonstrate that I'm representing this hypothesis accurately, here is a quote from his book Good Calories, Bad Calories:

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Should Public Health Professionals "Give A Shit" About MTV's New Campaign?

Has anyone else seen #giveashit on Twitter in the past few days? MTV has launched the "Give a Shit" campaign to increase civic engagement and encourage people to voice their concerns for any issue about which they are passionate. Many are voicing concerns about important public health issues like access to clean water. Great way to engage young people, right? Using a play on words. Using foul language. But the question remains- what are the goals of the campaign? Will the campaign actually improve public health?



The primary strategy for messaging about the campaign is a YouTube video featuring Nikki Reed (of Twilight fame). The tone of the two-minute video is hard to classify. In some ways it appears to be a parody of a real PSA (e.g., it simulates Nikki on the toilet so she can use that time to "give a shit"). But then it seems to have genuine moments when it motivates people to join a movement- any movement. Nikki tells viewers that all they have to do is "give a shit". It doesn't matter if they don't actually DO anything...if they CARE, then the world's problems will cease to exist.



As you can imagine, I take issue with this premise. So much of what we know in public health is based on evaluation data that has shown us that "knowledge" does not equal behavior change. "Increasing awareness" about pregnancy does not eliminate unprotected sex. Having the "intention" to stop smoking does not help when someone is addicted to nicotine. Therefore, it is unclear to me how just caring about an issue like access to clean water will result in positive change.



Next, the video goes on to say that once you care about the issue, you should alert your social networks. It shows images of posts to Twitter like, "I just gave a shit about global warming". So I went into Twitter to see if it is actually happening, and it is. The #giveashit hash tag is alive and well and users are reporting that they care about children with special needs, animal cruelty, etc. But again, I'm still at a loss as to how this "caring" and "twitter posting" actually leads to an increase in positive civic engagement. I tried to look for additional information on their website: www.give-a-shit.org but the site is not currently functioning. That is a problem as well. If the goals of the campaign are already unclear, it does not help that users cannot access information beyond the YouTube video. Several advocacy websites offer a brief overview of the campaign that may be helpful in the absence of a functioning website.



So while the play on words is "cute" and I appreciate a campaign that aims to combat the apathy that can be rampant regarding serious public health issues...I don't understand how this campaign will actually change behavior. And no- I don't agree that just caring about an issue will make all problems go away. If it did, we in public health would be out of a job.

Media Must Cover Suicides Cautiously- In Today's Philadelphia Inquirer

An editorial that I co-authored ran in today's Philadelphia Inquirer. The piece is in response to media coverage of the suicide of a Philadelphia Firefighter. In a previous blog post following a celebrity suicide, I discussed the public health implications of the media coverage that follows. It can either encourage negative behavior in the audience by including unsafe and unnecessary details like detailing suicide methods...or it can encourage positive help-seeking behavior by including resources like the National Suicide Prevention Lifeline. I encourage all bloggers, communication professionals, and journalists to review the expert recommendations on how to safely report on suicides.

I look forward to hearing your comments!

Ancestral Health Symposium

Last weekend I attended the Ancestral Health Symposium at the University of California, Los Angeles, organized by Aaron Blaisdell, Brent Pottenger and Seth Roberts with help from many others.  It was a really great experience and I'm grateful to have been invited.  I was finally able to meet many of the people who I respect and admire, but knew only through the internet.  I'm not going to make a list because it would be too long, but if you take a look at the symposium schedule, I think you'll understand where I'm coming from.  I was also able to connect with a number of Whole Health Source readers, which was great.  I recognized some of them from the comments section.  Now I know it wasn't just my mom with 57 Google accounts.

The symposium was the first of its kind, and represented many facets of the ancestral health community, including "Paleolithic" diet and exercise patterns, low-carbohydrate diets, Weston Price-style diets, traditional health-nutrition researchers as well as other camps.  For the most part they coexisted peacefully and perhaps even learned a thing or two from one another. 

I was very impressed by the appearance of the attendees.  Young men and women were fit with glowing skin, and older attendees were energetic and aging gracefully.  It would be hard to come up with a better advertisement for ancestrally-oriented diets and lifestyles.  I saw a lot of people taking the stairs rather than the elevator.  I like to say I'll take the elevator/escalator when I'm dead.  I think integrating exercise into everyday life is healthy and efficient.  Escalators and elevators of course make sense for people with physical disabilities or heavy suitcases.

The first talk was by Dr. Boyd Eaton, considered by many to be the grandfather of the paleolithic diet concept.  I was very impressed by his composure, humility and compassionate attitude.  Half his talk was dedicated to environmental and social problems.  Dr. Staffan Lindeberg gave a talk titled "Food and Western Disease", which covered his paleolithic diet clinical trials as well as other evidence supporting ancestral diets.  I like Dr. Lindeberg's humble and skeptical style of reasoning.  I had the great pleasure of having dinner with Dr. Lindeberg and his wife, Dr. Eaton, Pedro Bastos, Dr. Lynda Frassetto, Dr. Guy-Andre Pelouze and his son Alexandre.  Pedro gave a very nice talk on the complexities of traditional and modern dairy.  The following night, I was able to connect with other writers I enjoy, including Chris Masterjohn, Melissa McEwen, John Durant, and Denise Minger. 

Dr. Pelouze is a french cardiovascular surgeon who strongly supports the food reward/palatability concept of obesity.  We had a conversation the evening before the conference, during which he basically made the same points I was going to make in my talk.  He is particularly familiar with the research of Dr. Michel Cabanac, who is central to the food reward idea.  He eats an interesting diet: mostly raw, omnivorous, and extremely simple.  If I understood correctly, he mostly eats raw meat, fish, fruit and vegetables with little or no preparation.  He sometimes cooks food if he wants to, but most of it is raw.  He believes simple, raw food allows the body's satiety systems to work more effectively.  He has been eating this way for more than twenty years, and his son was raised this way and is now about my age (if I recall correctly, Alexandre has a masters and is studying for an MD, and ultimately wants to become an MD/PhD).  Both of them look very good, are full of energy and have a remarkably positive mental state.  Alexandre told me that he never felt deprived growing up around other children who ate pastries, candy et cetera.  They woke up early and ran six miles before the conference began at 8 am. 

I gave my talk on Friday.  Giving a talk is not like writing a blog post-- it has to be much more cohesive and visually compelling.  I put a lot of work into it and it went really well.  Besides the heat I got from from Gary Taubes in the question and answer session, the response was very positive.  The talk, including the questions, will be freely available on the internet soon, as well as other talks from the symposium.  Some of it will be familiar to people who have read my body fat setpoint and food reward series, but it's a concise summary of the ideas and parts of it are new, so it will definitely be worthwhile to watch it.  

We have entered a new era of media communication.  Every time someone sneezed, it was live tweeted.  There are some good aspects to it-- it democratizes information by making it more accessible.  On the other hand, it's sometimes low quality information that contains inaccurate accounts and quotes that are subsequently recirculated. 

It was a great conference and I hope it was the first of many.

Let's Talk Safety Climate and the Airlines: "Welcome Aboard"

I spent the past few weeks out on vacation in the beautiful Pacific Northwest (which explains my brief absence from Pop Health). While the trip was wonderful, it is quite nice to be back on the blog. And in fact, my trip provided me with the inspiration for this post. On my return flight home, I encountered an array of travel nightmares (delays, mechanical problems, cancelled flights, lost luggage). While many people may just consider these as an inconvenience, they also got me thinking about my safety. As we sat at the gate and waited for test after test, my husband assured me that they wouldn't put us on the plane if it wasn't safe. However, I wondered aloud if that was true. With the pressure for the airlines to have better on-time statistics and less angry customers, can we be put on a plane that is unsafe? My experience with USAirways, the similar experiences that I read about on Twitter, and the information I found regarding their dysfunctional relationship with their Pilots Association got me interested in the safety climate of the airline industry.

Everyday we encounter airline advertising that hopes to recruit our business by highlighting a company's high standards for safety, comfort, reasonable prices, and customer service. The ads also try to capitalize on things that we value, for example- freedom. Some memorable slogans include, "You are now free to move about the country" (Southwest); "We love to fly and it shows" (Delta); "Come fly the friendly skies" (United). While these slogans are catchy and convincing, they represent the "espoused values" of the airlines. Espoused values are values and norms stated by the organization. They can often be found in companies' strategic plans, goals, and/or taglines. For example, USAirways has an initiative called "Customers First" which strives to address key service elements that affect their customers.

In addition to espoused values, we also find "enacted values"; these are the norms that are actually exhibited by employees. These values may or may not be in line with the espoused values. That is why even though "Customers First" can be an espoused value, you can still end up bumped off a flight and sleeping in the airport because the rude gate agent told you there was no flight availability. In order to hear about other customers experiences with enacted values, I turned to Twitter and was amazed by what I saw. There were hundreds of comments to or about @usairways that were identical to mine- lots of mechanical failures ending in flight cancellations and luggage that was lost for days. I understand Twitter may be skewed towards the negative because people are less likely to tweet about the on-time departures...however, if you look at another airline (e.g., @southwestair) you see almost nothing about mechanical problems.

A less biased way to learn about employees' values and their level of congruence with the organization executives, is to hear from them directly. Just a few weeks ago, the US Airline Pilot Association- USAPA (the union that represents USAirways pilots), posted on their website to alert customers to the pressure they are receiving from USAirways executives to fly under unsafe conditions. On June 16, 2011, a pilot with 30-years of experience was escorted from the airport after she refused to fly a plane overseas after it failed multiple safety checks. A second group of pilots refused to fly the plane as well. This is not the first time that USAPA has spoken out against the executives. In 2008, they posted a customer alert in USA Today because they were being pressured to fly with less fuel in order to save money.

The examination and measurement of espoused/enacted values and their connection to safety outcomes (e.g., occupational injuries) is the exciting field of safety climate research. The term "safety climate" was coined in 1980 by Dr. Dov Zohar and has been prevalent in the Industrial and Organizational Psychology literature before making its way into the public health literature. For those interested, the journal Accident Analysis & Prevention recently dedicated an issue to safety climate and occupational health.

Safety climate research has been used to assess the climate of a variety of industries (e.g., healthcare). I propose that it is essential for examining the values within individual airlines and their connection to safety outcomes (e.g., worker injuries, passenger injuries, mechanical failures, near-misses, etc). The discrepancy discussed above between employee and company values can become a very dangerous combination.