Food Variety, Calorie Intake, and Weight Gain

Let's kick off this post with a quote from a 2001 review paper (1):

Increased variety in the food supply may contribute to the development and maintenance of obesity.  Thirty-nine studies examining dietary variety, energy intake, and body composition are reviewed. Animal and human studies show that food consumption increases when there is more variety in a meal or diet and that greater dietary variety is associated with increased body weight and fat.

This may seem counterintuitive, since variety in the diet is generally seen as a good thing.  In some ways, it is a good thing, however in this post we'll see that it can have a downside.
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Food Reward Friday

This week's lucky "winner"... ice cream!!

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"Call Me Crazy": Lifetime's New Movie That Champions Hope and Resilience Around Mental Illness

*Warning: it was difficult to write this post without including a few small spoilers, but I hope you'll watch the whole film anyway.

On Saturday April 20th, Lifetime debuted "Call Me Crazy: A Five Film".  The film (which boasts a star-studded cast and director list) includes five short stories that examine the impact of mental illness from various perspectives.  Each story is named after the main character: "Lucy", "Grace", "Allison", "Eddie", and "Maggie".

In the first story, we are introduced to Lucy (played by Brittany Snow).  Lucy, a law student, has recently been admitted to a psychiatric institution after experiencing a schizophrenic episode.  She is struggling to see how she can live a "normal" life that includes relationships and a career.  Her clinician encourages her to finish law school because she has insight into something very few people understand (mental illness)- so who knows how many people she could help?

In "Grace", we meet a daughter who has been living with a bipolar mother for her entire life.  Grace is played beautifully by Sarah Hyland from "Modern Family"- I loved seeing her in a dramatic role.  We see the "highs" and "lows" of her mother's condition.  We also see the devastating impact that it has on Grace's life when it is not treated.  Grace often plays the role of caretaker- making sure her mother is safe.  We see her struggle to have her own life aside from her mother's illness.

"Allison" offers the viewers a twist.  She plays Lucy's younger sister.  So we step back from Lucy's view and we see how mental illness has affected her entire family.  Allison's childhood, her sense of safety, her relationship with her parents- were all changed as a result of her sister's illness.  She has bottled up a lot of anger and finds it difficult to support her sister through her recovery.

"Eddie" introduces the only male main character.  He is suffering from severe depression.  He has withdrawn from his wife and his friends.  He has stopped receiving help from his therapist.  We watch his wife intervene after discovering that he may be thinking about suicide.

Finally, "Maggie" introduces topics that (unfortunately) are all too common these days- post traumatic stress disorder (PTSD) and military sexual trauma among our returning veterans.  Maggie (played by Jennifer Hudson) was victimized during her time in the Army and its lasting impacts are threatening her ability to have a healthy relationship with her family.  Here we get another update on Lucy- she is now a lawyer and is representing Maggie in court.

While each story stands on its own, Lucy's story is woven throughout "Allison" and "Maggie" as well.  I really liked this strategy.  Not only because I became invested in her character during the first story...but also because seeing her evolve over time helped to demonstrate some key themes from this film- hope and resilience.

As Lucy says to Maggie: "I am living proof". [Of what?] "That there is hope".  In court, Lucy reminds Maggie's judge that having mental illness does not mean that you are a bad person or a bad mother.  She also reminds him about the importance of social support, "it is nearly impossible to get well alone".  Even though we see all of these characters at their lowest point- there is still hope that they can feel better, have strong relationships, and contribute positively to the world.

It seems fitting that Brittany Snow's character delivers these messages about hope and resilience, as she is a strong advocate for them in real life.  Together with the Jed Foundation and MTV, she founded Love is Louder.  Love is Louder is an inclusive movement that amplifies messages of love and support to combat negative messages resulting from bullying, loneliness, and stigma.  She has also publicly shared her own battles with anorexia, depression, and self harm.

As a health educator, I highly recommend this film as a resource for discussing mental illness, suicide, stigma, social support, and help-seeking.  Since each story is approximately 20 minutes, they can be broken down into segments or watched all together.  This film is a great example of Entertainment Education, which is an area of public health that acknowledges the strong impact that television and movies play in educating the public about health issues.

If you or someone you know is struggling with a mental illness, please reach out:
National Suicide Prevention Lifeline (1-800-273-8255)

Book Review: Salt, Sugar, Fat

Michael Moss is a Pulitzer prize-winning journalist who has made a career writing about the US food system.  In his latest book, Salt, Sugar, Fat: How the Food Giants Hooked Us, he attempts to explain how the processed food industry has been so successful at increasing its control over US "stomach share".  Although the book doesn't focus on the obesity epidemic, the relevance is obvious.  Salt, Sugar, Fat is required reading for anyone who wants to understand why obesity is becoming more common in the US and throughout the world.

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Food Reward Friday

This week's lucky "winner"... energy bars!

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Emergency Response to the Boston Marathon Bombings: Looking to Social Media for Information, Resources, and Connections

Boston is my second home.  I lived there for 6 years.  I went to school there.  I made some of the best friends of my life there.  I got married there.  I spent many Marathon Mondays along the race route cheering for friends, colleagues, and absolute strangers.  As many have reported on the news, Marathon Monday is the best day of the year in Boston and you have to experience it to truly understand its excitement and feeling of community.

I am absolutely heartbroken about yesterday's bombing at the Marathon.  In tears, I sat and watched the news alone in my home.  However, I did not feel alone.  As news broke, I quickly connected with Boston friends via text and social media to make sure they were okay.  Many had been watching at various points along the route.  I also connected with public health colleagues to follow the news and to catalog resources and information being deployed to my friends in Boston and also to those of us watching from home.

As with Hurricane Sandy last November, I think it is important to document all the ways that social media is being used to disseminate information and support public health and emergency management.  Here are the key themes that I saw:

Immediate Public Safety Concerns and Instructions

With the #tweetfromthebeat hashtag, Boston Police communicated regularly with twitter followers, instructing marathon spectators to clear the area around the finish line and refrain from congregating in large crowds.

Investigation

To assist with the investigation, Boston Police and FBI are asking all spectators and eyewitnesses to submit video and photos taken at the finish line.  This message has been widely disseminated via social media.

Reconnecting Runners, Spectators, and Resources

As we have seen with emergency management of natural disasters, social media and technology play a critical role in reconnecting victims with their families and friends.  For example, the following resources were quickly deployed on social media:

• American Red Cross: Safe and Well
• Google: Person Finder
• Google document: Local Boston residents offering shelter to displaced runners/friends/families

Resources for Journalists

Along with tweets from respected news organizations and reporters reminding each other not to speculate early on in the investigation, there were also formal resources circulated regarding how to effectively cover such a story.  For example, the Dart Center for Journalism & Trauma offers comprehensive resources on the reporting of disasters and terrorist attacks.  A resource focusing specifically on the Boston Marathon bombings was tweeted out:

Mental Health & Support Resources

Many public health professionals linked to resources to support those in distress following the bombings and/or those who needed help communicating about the events (e.g., discussing it with children).

HHS Secretary Sebelius tweeted about federal disaster resources:

Philadelphia (like many other cities) tweeted about local disaster resources:

Massachusetts General Hospital and other organizations tweeted out tips for discussing the Boston Marathon bombings with children:

As I discussed in my coverage of Sandy, the power of social media also brings challenges to public health and emergency management.  We have seen some early postings about the lessons learned from this event- which does include a discussion of concerns such as rumors spreading rapidly on social media.  For example, it was first reported that cell coverage in Boston was being turned off so that additional bombs could not be detonated remotely.  We later learned that information was not true.  The cell service was slow or not operational due to the extreme overload of users trying to communicate simultaneously.  There was also a lot of concern about very disturbing images of the crime scene and victims being shared on social media.

So there is much to learn about the use of social media for public health and emergency management through close examination of this event and others.  In any case, it is very clear that social media needs to be a part of every organization's disaster and response plan. 

Tell me what you think:

• What was your impression of the use of social media by federal/state/local organizations yesterday after the Boston Marathon bombings?  
• Can you share additional examples of how it was used effectively?  
• What did you see that concerned you?

Social Media: Providing Connections, Voices, Adventures to Many with Chronic Illness

I am in awe of social media.  

I am in awe of it in my professional life.  I have connected with colleagues all over the world who share my passion for public health, health communication, blogging, pop culture- you name it.

I am also in awe of it in my personal life.  As someone who lives with a chronic illness, I have connected with others who suffer from similar symptoms, offer support, advocate for patient rights, and recommend creative solutions to balancing work and life.

In the past month, I have been struck by several examples of how social media is transforming the lives of people with chronic illness.  Without the networks available within social media, many of these people may have been very isolated due to their conditions.

On March 11, 2013 NBC Nightly News with Brian Williams ran a story about Virtual Photo Walks.  The project's tagline is "Walk the walk for those who can't".  Using the social media platform Google+, Virtual Photo Walks enables people to become "interactive citizens" again.  They connect with smart phone enabled photographers to "travel" and see places and people that they used to see...or always wished that they could.  The news story profiled a woman with Lupus who could not travel due to her serious health condition.  She always wanted to go to Italy and with Google+ she did.  We watched World War II veterans no longer able to travel, "visit" the USS Arizona Memorial through the collaboration of photographers and Google +.  It was incredible to watch.    

On April 5, 2013 CNN Tech ran a story called "On Twitter, Roger Ebert Found a New Voice".  The story describes how Roger became an avid twitter user in 2010, years after cancer had silenced his voice.  He wrote, 

"Twitter for me performs the function of a running conversation. For someone who cannot speak, it allows a way to unload my zingers and one-liners".

As someone growing up in the 80's, I regularly watched "Siskel and Ebert and the Movies".  Keeping up with Roger through twitter and his blog "Roger Ebert's Journal" in recent years has been a seamless transition.  I felt like the show never ended.  I kept up with his running commentary and of course- his movie reviews.

Sustaining your presence in the world is important with a chronic illness.  I felt that point strongly when reading his final blog post, "A Leave of Presence".  

"What in the world is a leave of presence?  It means I am not going away".  

Please Share:

• What creative ways do you see social media being used to support those with chronic (or acute) illnesses?
• Why do you think these communication channels are so effective in "sustaining your presence"?

Glucagon, Dietary Protein, and Low-Carbohydrate Diets

Glucagon is a hormone that plays an important role in blood glucose control.  Like insulin, it's secreted by the pancreas, though it's secreted by a different cell population than insulin (alpha vs. beta cells).  In some ways, glucagon opposes insulin.  However, the role of glucagon in metabolism is frequently misunderstood in diet-health circles.

The liver normally stores glucose in the form of glycogen and releases it into the bloodstream as needed.  It can also manufacture glucose from glycerol, lactate, and certain amino acids.  Glucagon's main job is to keep blood glucose from dipping too low by making sure the liver releases enough glucose.  There are a few situations where this is particularly important:

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Writing Public Health Blogs: Do We Get Back What We Put In?

Last week I attended a great webinar hosted by AcademyHealth called: “Traditional and New Methods for Disseminating What Works”.  One of the speakers was Dr. David Kindig and he touched on the evaluation component of writing a public health blog- do we get back what we put in?  As the tweet below indicates, this is an important question for all of our blogs.

My exploration of this question nicely coincides with the theme for this week’s National Public Health Week- “Return on Investment”.  I was initially going to write just my own thoughts, but then decided it would be a much richer piece if I could incorporate input from other public health bloggers.  The following colleagues were kind enough to send me their thoughts:

Jim Garrow: The Face of the Matter, Public Health Memes

Elana Premack Sandler: Promoting Hope, Preventing Suicide for Psychology Today

Jonathan Purtle: The Public's Health for the Philadelphia Inquirer

Michael Siegel: The Rest of the Story: Tobacco News Analysis and Commentary

Thomy Tonia: International Journal of Public Health-Blog 

1. How much time do you dedicate to your blog per day/week/month?

Jim: I wish I could post more blogs per week; right now I'm averaging about a post a week (sometimes it'll be 3-4 posts in a week, sometimes no posts for a few weeks in a row). Each post takes about an hour between research, linking and writing. And I've got to be constantly on the lookout for new and time-relevant material.

Elana: When I was writing weekly, I spent 3-5 hours a week researching, writing, editing, and posting (using the content management software, sometimes the hardest part!). I have a background in journalism, so I'm able to write and self-edit relatively quickly. Now that I'm posting only once a month, I probably spend 5-7 hours a month between culling through stories of interest, thinking about the relevance of various topics, writing, editing, and posting. It's actually more challenging to post only once a month, as I get out of practice and have more material to comb through to see what rises to the top.

Jonathan: On average, a 500-750 word post takes me 4-5 hours. I currently post twice a month. I used to post weekly, but the time burden was too much. 

Michael: Approximately one hour per day, mostly devoted to writing my daily posts.

Thomy: I blog as part of my job as an Editorial Assistant/ Social Media Editor for the International Journal of Public Health. When I was focused only on the blog, I dedicated about 4 hours per week (divided between blogging and visiting other blogs/public health sites- to get ideas, keep informed and interact). Since I now also manage the twitter and Facebook accounts, I have reduced my blog time to 2-3 hours per week. 

Leah: I spend about 5 hours on each blog post- between finding the story, writing, and marketing the posts on social media. Since I try to address topics that are hot in the news that week or that day (like Jim says above), I'm constantly on the lookout for relevant stories.  Throughout the week I save all my possible stories/links/ideas on a spreadsheet and pick the best one.  While my posting frequency has varied over the past three years of writing Pop Health, my goal is to post at least once per week.

2. Who is the audience for your blog?

Jim: The blogs that I write are written for professionals in the fields of public health and emergency management. My thought is that I can affect more change by finding and teaching best practices to the people on the ground actually working with the public.

Elana: My blog is read by mental health and public health professionals as well as laypeople interested in psychology, mental health, pop culture, and suicide prevention. Since I blog on a site that does a lot of promotion for itself, I have a relatively wide readership. Each post can generate 500-2000 hits; I haven't done any real numbers-running, but 100-300 hits on the day the post is published is probably average, and then each post accrues hits over time.

Jonathan: The general public in Philadelphia and surrounding areas. Given the size of the health care sector in the region, I like to think health professionals read it as well. I also dream that policy makers read it—although I’m not sure if either health professionals or policy makers read Philly.com.

Michael: Incredibly diverse audience of anti-smoking advocates, groups, and researchers, smokers’ rights advocates, government agencies, tobacco companies, newspaper reporters, stock market analysts, consumers, trade groups, and policy makers.

Thomy: Originally, our intended audience was mainly public health students, as we are affiliated with the Swiss School of Public Health. However, especially through social media, our audience seems to be not only public health students and professionals but also people who just have an interest in public health. Nevertheless, it is not easy to know exactly who our audience is, as we do not get a lot of comments and it is difficult to know who actually reads the blog. We try to engage people to write guest posts for us. This generally works quite well.

Leah: I write for a broad public audience with an interest in public health, pop culture, or both. Therefore, I use it as a platform to breakdown and explain public health/communication concepts (e.g., "teachable moments"; "cue to action"). From the analytics, emails, and comments that I receive, I know that I have a large following among public health professionals, students, and teachers.  I have heard from more than one faculty member to say that they use my blog with their students to demonstrate the connection between public health and their everyday lives (e.g., movies, magazines, advertising).

3. What is the ideal “return/s on investment” for your blogging efforts? 

Jim: I've been writing blogs relevant to public health and emergencies for more than six years. I've found it to be one of the best investments I've made in my career, even with the huge investment in time and effort required for success.  I've found that the best return I've realized is my network of contacts and friends across the country and around the world; none of whom I would've met without being available and "out there" online.

Elana: For me, the ideal return on investment is reader engagement. I really get a lot out of seeing reader comments (the good and the not-so-good) and corresponding with readers via the comments section, or with friends and more personal connections on Facebook when I promote my posts there.

Jonathan: The ideal return is three-fold: (1) A public which understands that health is about more than just individual choices. A public which begins to see the reverberating impacts of social/economic policies, beyond the health care sector, on people’s health. A public which is knowledgeable about trauma theory and research on trauma/stress. (2) Networking. (3) Increased readership. While this is the most measurable, I’m not convinced it means all that much. Who’s reading? How are they reading? How is the information changing their perceptions? Is it at all? We have no idea.

Michael: The ideal “return on investment” is the blog having an actual impact on public policy.

Thomy: Increasing readership and dissemination of ideas is always a good return. We would ideally like to have more engagement in the form of interaction (e.g., comments). Networking is also quite satisfying and really helps broaden our blogging horizons. As a public health journal, we are also interested in disseminating our research articles.  I personally would like to see more and more public health students, researchers and professionals having blogs and engaging in social media to learn new things, disseminate their knowledge, “meet” interesting people and also –why not- for the fun of it!

Leah: Pop Health began as a hobby that just happened to incorporate my field of public health.  Now it has become a key part of my professional portfolio.  Therefore, the key returns are now different than three years ago.  Now, I'm looking for increased readership and referrals to my site.  I'm looking for increased dialogue with readers and colleagues.  I'm also looking for new and exciting professional opportunities (e.g., guest blogging, writing, and teaching) that can emerge by branding my expertise in this niche of public health.

4. Do you measure these “returns”?  If so- how?

Jim: I've seen a tremendous benefit professionally. As a direct result of my online identity and interactions, I've been invited to more than a dozen international, national and regional conferences to speak on those topics I blog about.  But even beyond those personal returns, I've seen a tremendous benefit professionally. Not only am I able to call on friends I've made around the globe to help with ideas for work, but I've grown as a result of being forced to flesh out my ideas. When I write about something, I want it to be well thought-out and considered. By writing these ideas out, I am forced to consider not only my idea, but how it affects other, larger problems...Without writing it out, I would just have a nugget of an idea, no more than that.

Elana: I measure this ROI very unscientifically. I notice which topics generate more interest (both in terms of hits, which are tracked by Psychology Today, and comments) either on the Psychology Today site or on Facebook. I've wanted to get more sophisticated with Google Analytics, but can't do that as I don't actually manage the website that hosts my blog. I've also enjoyed meeting people at professional conferences who recognized my name because of my blog. That really blew me away - it meant that I was really reaching people (not just my Mom!).

Jonathan: Philly.com tracks usage statistics and sends them to us on a weekly basis. Posts on animals, kids, and pop culture typically do the best.

Michael: Yes, but not formally. I assess the actions of public health agencies and organizations to determine whether the blog seems to be changing their thinking about these issues. I also assess the state of public opinion in the field regarding these issues.

Thomy: We keep track of visitors, time spent on blog (etc.) via Google Analytics and StatCounter. We also monitor the most popular posts and try to have some ongoing themes corresponding to these popular posts.  Regarding the “return on investment” to the Journal, we are trying to monitor whether articles that have been featured in the blog are downloaded more often from our website.

Leah: I have used Google Analytics and Blogger Statistics for measurements like page views, referring sites, and key words used to find Pop Health. I also take note of the posts that stimulate more engagement with readers- I would note that more dialogue seems to take place directly on social media where I market the posts (i.e., Facebook & Twitter) vs. the comment section on the blog itself.  As a result of the blog, I have also been invited to guest write on other sites like The Public's Health- so tracking those opportunities helps me to measure return on investment as well.

Evaluation and Return on Investment are key concepts in public health

With public health professionals constantly being asked to do more with less, it is imperative that we show how our investments are paying off. It is important to think of "investments" broadly- they are not just money...they are our time too.  As you can see from the responses to question #1, creating and maintaining a blog is a huge commitment.  And although we write for a variety of audiences with different goals (ranging from promoting research to trying to impact policy), we share the challenge of trying to evaluate those goals.

Therefore, we need to lead ongoing dialogue about the goals and evaluation of public health blogs. CDC's National Prevention Information Network (NPIN) is continuing its "In the Know: Social Media for Public Health" webcasts this spring and the June 4, 2013 event will focus on Measurement & Evaluation.  I look forward to continuing this discussion there and elsewhere.

Thank you again to Jim, Elana, Jonathan, Michael, and Thomy for your contributions!  I appreciate you making the time and sharing your experiences.

I would like to invite other public health bloggers to weigh in on these questions:  

• How much time do you dedicate to your blog per day/week/month?
• Who is the audience for your blog?
• What is the ideal “return/s on investment” for your blogging efforts? 
• Do you measure these “returns”?  If so- how?

Are Animal Crackers Paleo?

Every child loves animal crackers, those sweet and crunchy animal-shaped biscuits.  But are they compatible with a Paleo diet?  Some people might think they already know the answer, but consider this: our ancestors evolved on the African savanna, eating the plants and animals found there.  Inside each box of animal crackers is an assortment of tiny savanna creatures such as giraffes and elephants.

To get to the bottom of this, I interviewed Robert Pearson, CEO of Animal Cracker Products Inc., who explained to me how these crackers are made.

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