In the previous post, I explained that Otzi descended in large part from early adopters of agriculture in the Middle East or nearby. What I'll explain in further posts is that Otzi was not a genetic anomaly: he was part of a wave of agricultural migrants that washed over Europe thousands of years ago, spreading their genes throughout. Not only that, Otzi represents a halfway point in the evolutionary process that transformed Paleolithic humans into modern humans.
Did Agriculture in Europe Spread by Cultural Transmission or by Population Replacement?
There's a long-standing debate in the anthropology community over how agriculture spread throughout Europe. One camp proposes that agriculture spread by a cultural route, and that European hunter-gatherers simply settled down and began planting grains. The other camp suggests that European hunter-gatherers were replaced (totally or partially) by waves of agriculturalist immigrants from the Middle East that were culturally and genetically better adapted to the agricultural diet and lifestyle. These are two extreme positions, and I think almost everyone would agree at this point that the truth lies somewhere in between: modern Europeans are a mix of genetic lineages, some of which originate from the earliest Middle Eastern agriculturalists who expanded into Europe, and some of which originate from indigenous hunter-gatherer groups including a small contribution from neanderthals. We know that modern-day Europeans are not simply Paleolithic mammoth eaters who reluctantly settled down and began farming.
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Sabtu, 28 April 2012
Rabu, 25 April 2012
The Biggest Loser: Who's Really Winning?
This week's guest post for Pop Health was written by Elana Premack Sandler, LCSW, MPH. Elana writes a popular blog for Psychology Today called, "Promoting Hope, Preventing Suicide". Written from both personal and professional perspectives, her blog explores suicide prevention, intervention, and postvention. Often using current events as a starting point, the blog poses questions about what could be done better or differently, what contributions research can make to practice, and challenges and opportunities inherent in new technologies. Elana earned a Master of Social Work and a Master of Public Health at Boston University and is a licensed social worker in the Commonwealth of Massachusetts. There’s a lot of TV I don’t watch, but there’s one show in particular. “The Biggest Loser.”
It’s true - I systematically avoid watching one of the most popular reality TV shows in history. What seems to have drawn in viewers is what bothers me so much about most reality TV. It’s like a car wreck you can’t stop staring at, even though you know it’s a tragedy.
But watching a car wreck is watching an accident, something that wasn’t designed for an audience. With an accident, there’s something very human about wanting to see what’s happened, wanting to know if everyone’s okay.
That’s very different from what I think happens when people watch “The Biggest Loser.”
The few times I watched (I kept trying - people I love and trust told me it was such a good show!), I just wasn’t able to get behind the premise of the show. Yes, I believe that people who have struggled to lose weight can benefit from personal training and major lifestyle changes. Sure, the power of competition can drive some people to work harder than they ever imagined possible.
But, shame? Does shame really help people change their behavior?
When I watched, I witnessed trainers shaming contestants, over and over, in different ways. I heard contestants talk about the shame they experienced as a part of being obese or overweight. The whole show was a shame-fest. Which made me extremely uncomfortable.
Because, when it comes down to it, “The Biggest Loser” is a game show. And I just can’t watch people shamed into losing weight just to win a game show. “But it’s not just a game show!” my friends-who-are-fans would say. “People change their lives.”
Oh, wait, you’re right. It’s not just a game show. It’s a franchise.
So, I guess what I really have a hard time with is people being shamed into losing weight to support a game show-Wii-resort-1,200 calorie-a-day diet franchise.
At my professional core, as a public health social worker, I know shame doesn’t work to change behavior. I had thought it was just me who thought that way, until I started reading researcher Brené Brown’s book, “I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power.”
Brown has been researching shame for the past 10 years. But, even before she was a shame expert, she was a social worker, working with people. What did she learn? “You cannot shame or belittle people into changing their behaviors.”
She explains in the introduction to the book:
- Can you use shame or humiliation to change people or behavior? Yes and no. Yes, you can try. In fact, if you really want to zero in on an exposed vulnerability, you could actually see a swift behavior change.
- Will the change last? No.
- Will it hurt? Yes, it’s excruciating. [I cringed when I read that part.]
- Will it do any damage? Yes, and it has the potential to sear both the person using shame and the person being shamed. [More cringing.]
- Is shame used very often as a way to try to change people? Yes, every minute of every day.
What’s extra-disturbing about how “The Biggest Loser” uses shame is that it doesn’t limit shame to contestants. The show projects shame into the viewing audience, reinforcing biases against people who are overweight or obese. The audience doesn’t root for contestants to work within the challenges inherent in their bodies to figure out a healthy, sustainable way to lose weight and maintain overall health. The audience roots for contestants to not be fat. (Please excuse my lax grammar- I hope it’s worth making the point.)
Finally, the drama of the show revolves around shame. There’s a big reveal every episode, when viewers find out who won’t continue to compete to be The Biggest Loser. If contestants can’t lose weight within the show’s parameters (which include unhealthy weight loss practices, like dehydration), they get kicked off. So, the ideal of working with a supportive trainer goes out the window - and you are shamed, shamed, shamed into returning home, still fat, and, well, not a winner. A loser.
“The Biggest Loser” raises several questions for me:
- Should a game show be allowed to promote unhealthy weight loss practices?
- What kinds of messages does the show send to young people about their worth and value?
- In what ways are people at a healthy weight influenced by “The Biggest Loser”?
Selasa, 24 April 2012
Lessons From Ötzi, the Tyrolean Ice Man. Part III
There are two reasons why I chose this time to write about Otzi. The first is that I've been looking for a good excuse to revisit human evolutionary history, particularly that of Europeans, and what it does and doesn't tell us about the "optimal" human diet. The second is that Otzi's full genome was sequenced and described in a recent issue of Nature Communications (1). A "genome" is the full complement of genes an organism carries. So what that means is that researchers have sequenced almost all of his genes.
Read more »
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Rabu, 18 April 2012
Integrating Public Health Content Into Media Coverage of Celebrity DUIs
Pop Health has written about related issues in the past: how soon is too soon to find a teachable moment in a celebrity DUI death? How does popular media help establish the public health agenda? How does media coverage of public health issues (e.g., suicide) affect the public's health?
So now let's put the pieces together and discuss the work of public health researchers that focuses specifically on media coverage of young female celebrity DUIs. In 2009, Smith, Twum, and Gielen published "Media Coverage of Celebrity DUIs: Teachable Moments or Problematic Social Modeling?" in the journal of Alcohol & Alcoholism. They conducted an analysis of US media coverage of four female celebrities (Michelle Rodriguez, Paris Hilton, Nicole Richie and Lindsay Lohan). The study examined media coverage in the year after their DUI arrests (December 2005 through June 2008). Among other things, the stories were coded for the presence of public health content (e.g., arrest, death, and injury statistics for DUI). The authors found that the coverage was primarily focused on the individual celebrities (i.e., their legal and professional repercussions) versus broader social or public health impacts. They recommended that future research examine both the news coverage and the comprehension and use of that content for policy and behavior change initiatives.
Coverage of a celebrity DUI has the potential to be a teachable moment, but we as public health practitioners need to take advantage of it. We need to be monitoring pop culture news so that these teachable moments can be identified. We need to partner with journalists in order to make sure that a "public health frame" is incorporated in the development of the articles. Most importantly, we need to continue to evaluate the media content and use that data to develop effective interventions and policy recommendations.
What do you think?
- What strategies/information channels do you use to stay on top of public health-pop culture news?
- How can the public health and journalism fields partner to take advantage of teachable moments and cover public health issues safely and effectively?
Selasa, 17 April 2012
Australia can lead the fight against Asia’s lifestyle disease epidemic*
Think Asia and we think millions – or billions when you combine the populations of both India and China.
Unfortunately, millions is also an appropriate unit with which to measure the number of people in Asia who suffer from chronic illnesses such as heart disease, stroke, cancer, ongoing respiratory disease (like asthma and emphysema) and diabetes.
The causes often spin out of rising affluence, shifts from traditional to processed diets, decreased physical activity – as people move from rural to city employment and living – and the pervasive, rising influence of tobacco smoke.
Snapshot of China
In China, around 80% of deaths and considerable disability are now attributable to chronic disease; this percentage is set to grow as the population ages and these conditions become more prevalent.
Around 300 million Chinese men smoke, but rates are much lower among women (it’s less socially acceptable for women to smoke). Sample surveys conducted among about 20,000 people living in nine counties suggest that around half of China’s smokers have high blood pressure and are missing out on treatment. This means they’re at heightened risk of heart disease and stroke.
For a health-care system committed to reform but struggling to come to terms with contemporary expectations of rural and urban populations, this is the stuff of nightmares.
In China, around 80% of deaths and considerable disability are now attributable to chronic disease; this percentage is set to grow as the population ages and these conditions become more prevalent.
Around 300 million Chinese men smoke, but rates are much lower among women (it’s less socially acceptable for women to smoke). Sample surveys conducted among about 20,000 people living in nine counties suggest that around half of China’s smokers have high blood pressure and are missing out on treatment. This means they’re at heightened risk of heart disease and stroke.
For a health-care system committed to reform but struggling to come to terms with contemporary expectations of rural and urban populations, this is the stuff of nightmares.
Snapshot of India
The scene isn’t any happier in India. Around half of all deaths – around five million each year – are now due to chronic illness.
In 2004, my colleagues and I published a study which estimated that India was losing more than nine million years of productive life each year from heart-disease deaths in people aged under 65 years. On current projections, this would double by 2030.
Comparable figures for China were six million years of lost life in 2004, which could rise to 11 million years by 2030.
The scene isn’t any happier in India. Around half of all deaths – around five million each year – are now due to chronic illness.
In 2004, my colleagues and I published a study which estimated that India was losing more than nine million years of productive life each year from heart-disease deaths in people aged under 65 years. On current projections, this would double by 2030.
Comparable figures for China were six million years of lost life in 2004, which could rise to 11 million years by 2030.
Snapshot of Thailand
Similarly to India, chronic illness accounts for around half of all deaths in Thailand.
But there are some positives to report. The World Health Organization (WHO) estimates that the proportion of men who are overweight is likely to remain steady, at around 35%.
Rates of excess weight among women, however, are expected to rise from 47% in 2005, to 57% in 2015, which reflects local cultural norms. These cultural factors alert us to the power of the environment in setting the range of individual behaviours, which can be as strong as conventional risk factors such as high blood pressure.
Efforts to reduce tobacco consumption in Thailand have been successful, with ratesdeclining over the past two decades. Unsurprisingly, this has raised the ire of the tobacco industry, which sees its market shrinking.
But other parts of Asia haven’t done so well in reducing rates of smoking. In fact, as the tobacco trade journal, Tobacco Reporter, noted in 2009, Asia is one of the world’s most promising cigarette markets, with Indonesia (southeast Asia’s largest market) selling 231 billion cigarettes in 2007 alone.
Similarly to India, chronic illness accounts for around half of all deaths in Thailand.
But there are some positives to report. The World Health Organization (WHO) estimates that the proportion of men who are overweight is likely to remain steady, at around 35%.
Rates of excess weight among women, however, are expected to rise from 47% in 2005, to 57% in 2015, which reflects local cultural norms. These cultural factors alert us to the power of the environment in setting the range of individual behaviours, which can be as strong as conventional risk factors such as high blood pressure.
Efforts to reduce tobacco consumption in Thailand have been successful, with ratesdeclining over the past two decades. Unsurprisingly, this has raised the ire of the tobacco industry, which sees its market shrinking.
But other parts of Asia haven’t done so well in reducing rates of smoking. In fact, as the tobacco trade journal, Tobacco Reporter, noted in 2009, Asia is one of the world’s most promising cigarette markets, with Indonesia (southeast Asia’s largest market) selling 231 billion cigarettes in 2007 alone.
Health promotion
So, what can Australia do to improve our neighbours' health? There are several compelling options.
First, we can provide an encouraging example of successful health promotion initiatives, particularly in tobacco control.
Thankfully, this has already been happening. Australia was a major advocate for the WHO’s Framework Convention on Tobacco Control, which aims to eliminate trade in illicit tobacco products. Now we should push for its full implementation among all signatory countries, including those in Asia.
Likewise, Australia’s approach to the detection and management of patients with elevated blood pressure has paid dividends, with an 83% drop in rates of death due to heart disease since 1968. This, too, can serve as a model that other nations can study and possibly adopt.
The commitment of the current federal government to health prevention is unusual and exemplary. Of note is the recently established Australian National Health Preventive Agency, which other nations may wish to emulate.
So, what can Australia do to improve our neighbours' health? There are several compelling options.
First, we can provide an encouraging example of successful health promotion initiatives, particularly in tobacco control.
Thankfully, this has already been happening. Australia was a major advocate for the WHO’s Framework Convention on Tobacco Control, which aims to eliminate trade in illicit tobacco products. Now we should push for its full implementation among all signatory countries, including those in Asia.
Likewise, Australia’s approach to the detection and management of patients with elevated blood pressure has paid dividends, with an 83% drop in rates of death due to heart disease since 1968. This, too, can serve as a model that other nations can study and possibly adopt.
The commitment of the current federal government to health prevention is unusual and exemplary. Of note is the recently established Australian National Health Preventive Agency, which other nations may wish to emulate.
Managing trade
Second, we should consider reviewing our trade relations with Asia so that our exports, especially for food, don’t compound the disease risk profile of Asian countries.
We can learn from the Pacific, where an aggressive trade push (not so much from Australia but other big economies) allowed multinational food companies and food producers to push their high-fat products to a new market. Small, relatively powerless countries fought hard to keep these companies out but, in the end, were defeated by edicts promoting commerce through the World Trade Organisation.
So, a thoughtful “health ethics” review of our trading relations with Asia may be possible. We could, at the very least, articulate a set of national expectations of our corporations in their dealings with Asia, in the form of a health “bottom line”. While these expectations may need the support of law, first we need a discussion about corporations' ethical obligations.
Second, we should consider reviewing our trade relations with Asia so that our exports, especially for food, don’t compound the disease risk profile of Asian countries.
We can learn from the Pacific, where an aggressive trade push (not so much from Australia but other big economies) allowed multinational food companies and food producers to push their high-fat products to a new market. Small, relatively powerless countries fought hard to keep these companies out but, in the end, were defeated by edicts promoting commerce through the World Trade Organisation.
So, a thoughtful “health ethics” review of our trading relations with Asia may be possible. We could, at the very least, articulate a set of national expectations of our corporations in their dealings with Asia, in the form of a health “bottom line”. While these expectations may need the support of law, first we need a discussion about corporations' ethical obligations.
People power
We should think carefully about the role we can play in helping our Asian neighbours develop effective, relevant health workforces.
Our obsession with recruiting overseas students to fuel our tertiary education institutions should be abandoned and replaced with a more responsive approach to assisting other countries appropriately develop their workforces.
This could include increased funding for the Colombo Plan, where Asian students are sponsored to study in Australia and, on completion, return home. The Plan operates on a shoestring budget but has provided 16,082 scholarships to 23 member countries in its lifetime.
Much else could be written about health in the Asian Century, including the need to implement a sophisticated surveillance and control system for emerging infectious diseases. Maternal and child health, and mental health, remain challenges for poorer countries and the disadvantaged in nations such as India.
But in priority order, we must focus on controlling chronic diseases, through heavy investment in prevention programs and effective, affordable health systems to treat existing patients. Australia can – and must – help.
We should think carefully about the role we can play in helping our Asian neighbours develop effective, relevant health workforces.
Our obsession with recruiting overseas students to fuel our tertiary education institutions should be abandoned and replaced with a more responsive approach to assisting other countries appropriately develop their workforces.
This could include increased funding for the Colombo Plan, where Asian students are sponsored to study in Australia and, on completion, return home. The Plan operates on a shoestring budget but has provided 16,082 scholarships to 23 member countries in its lifetime.
Much else could be written about health in the Asian Century, including the need to implement a sophisticated surveillance and control system for emerging infectious diseases. Maternal and child health, and mental health, remain challenges for poorer countries and the disadvantaged in nations such as India.
But in priority order, we must focus on controlling chronic diseases, through heavy investment in prevention programs and effective, affordable health systems to treat existing patients. Australia can – and must – help.
*Published in The Conversation 18 April 2012
Lessons From Ötzi, the Tyrolean Ice Man. Part II
Otzi's Diet
Otzi's digestive tract contains the remains of three meals. They were composed of cooked grains (wheat bread and wheat grains), meat, roots, fruit and seeds (1, 2). The meat came from three different animals-- chamois, red deer and ibex. The "wheat" was actually not what we would think of as modern wheat, but an ancestral variety called einkorn.
Isotope analysis indicates that Otzi's habitual diet was primarily centered around plant foods, likely heavily dependent on grains but also incorporating a variety of other plants (3). He died in the spring with a belly full of einkorn wheat. Since wheat is harvested in the fall, this suggests that his culture stored grain and was dependent on it for most if not all of the year. However, he also clearly ate meat and used leather made from his prey. Researchers are still debating the quantity of meat in his diet, but it was probably secondary to grains and other plant foods. It isn't known whether or not he consumed dairy.
Read more »
Otzi's digestive tract contains the remains of three meals. They were composed of cooked grains (wheat bread and wheat grains), meat, roots, fruit and seeds (1, 2). The meat came from three different animals-- chamois, red deer and ibex. The "wheat" was actually not what we would think of as modern wheat, but an ancestral variety called einkorn.
Isotope analysis indicates that Otzi's habitual diet was primarily centered around plant foods, likely heavily dependent on grains but also incorporating a variety of other plants (3). He died in the spring with a belly full of einkorn wheat. Since wheat is harvested in the fall, this suggests that his culture stored grain and was dependent on it for most if not all of the year. However, he also clearly ate meat and used leather made from his prey. Researchers are still debating the quantity of meat in his diet, but it was probably secondary to grains and other plant foods. It isn't known whether or not he consumed dairy.
Read more »
Senin, 16 April 2012
Exercise and Food Intake
The New York Times just published an article reviewing some of the recent research on exercise, food intake and food reward, titled "Does Exercise Make You Overeat?". I was planning to write about this at some point, but I don't know when I'd be able to get around to it, and the NYT article is a fair treatment of the subject, so I'll just point you to the article.
Basically, burning calories through exercise causes some people to eat more, but not everyone does, and a few people actually eat less. Alex Hutchinson discussed this point recently on his blog (1). Part of it depends on how much fat you carry-- if you're already lean, the body is more likely to increase hunger because it very much dislikes going too low in body fat. Most overweight/obese people do not totally make up for the calories they burn through exercise by eating more, so they lose fat. There is a lot of individual variability here. The average obese person won't lose a substantial amount of fat through exercise alone. However, everyone knows someone who lost 50+ pounds through exercise alone, and the controlled trials support that it happens in a minority of people. On the other side of the spectrum, I have a friend who gained fat while training for a marathon, and lost it afterward.
Read more »
Basically, burning calories through exercise causes some people to eat more, but not everyone does, and a few people actually eat less. Alex Hutchinson discussed this point recently on his blog (1). Part of it depends on how much fat you carry-- if you're already lean, the body is more likely to increase hunger because it very much dislikes going too low in body fat. Most overweight/obese people do not totally make up for the calories they burn through exercise by eating more, so they lose fat. There is a lot of individual variability here. The average obese person won't lose a substantial amount of fat through exercise alone. However, everyone knows someone who lost 50+ pounds through exercise alone, and the controlled trials support that it happens in a minority of people. On the other side of the spectrum, I have a friend who gained fat while training for a marathon, and lost it afterward.
Read more »
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