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A Debate on Nutrition and Physical Activity


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    Miller School of Medicine Dean Pascal J. Goldschmidt discusses nutrition and exercise during Wednesday's first panel, while UM President Donna E. Shalala (standing at podium) and former USDA Agriculture Secretary Ann M. Veneman, who are co-chairs of the new Nutrition and Physical Activity Initiative, look on.

    As fast food replaces the family dinner and online shopping makes walking almost obsolete, the nation’s first sedentary generation has contributed to an epidemic of soaring obesity rates that have triggered dramatic increases in diabetes, cancer, and other chronic diseases.

    But it will take more than acute care medicine to reverse such trends. Education and preventive strategies touting healthier eating habits and exercise are needed.

    That was the consensus shared by a panel of former Bush and Clinton administration cabinet members as well as University of Miami researchers and physicians who convened on UM’s Coral Gables campus Wednesday for a public forum on the importance of nutrition education and physical activity.

    “It’s imperative that we find a way to help people make healthier [eating] choices so that we can reduce obesity and obesity-related diseases and the many associated health care costs,” UM President Donna E. Shalala, the former secretary of health and human services under President Bill Clinton, told an audience of mostly students, faculty, and staff at the Newman Alumni Center.

    Shalala, along with former Agriculture Secretaries Dan Glickman and Ann M. Veneman, are co-chairs of the Bipartisan Policy Center’s Nutrition and Physical Activity Initiative, a new yearlong project that will focus on ways to improve nutrition education, promote access to healthy food choices, examine partnerships between the public and private sectors, and remove barriers to increased physical activity.

    Mike Leavitt, former HHS secretary in the George W. Bush administration, also is a co-chair of the initiative but was unable to attend the forum.

    During Wednesday’s discussion, which was the culmination of a day of site visits at which the co-chairs learned about nutrition and exercise programs at a low-income private preschool and on UM’s Miller School of Medicine and Coral Gables campuses, Veneman cited a laundry list of alarming statistics from the Centers for Disease Control and Prevention, helping to shed new light on just how serious the obesity problem is in the United States.

    Among the disturbing numbers: 68 percent of Americans ages 20 and older are overweight, while 34 percent in the same age group are considered obese. Among children 2 to 19 years old, 32 percent are overweight and 17 percent are obese.

    “Obese children are likely to become obese adults,” Veneman said, “and we also know that high obesity rates correspond to higher incidence of diabetes.”

    The former USDA secretary, whose tenure included record farm income, record agricultural exports, and the creation of stronger pest and disease protection systems for the country, cited a Gallup study that had reported states with the highest obesity levels, including West Virginia, Kentucky, Alabama, Mississippi and Tennessee, also had the highest rates of diabetes. That same study, she explained, included an analysis of obesity data from 187 metropolitan areas, which demonstrated that if obesity levels were reduced by 15 percent, the nation could save $32.6 billion in health care costs.

    ATTACKING THE PROBLEM

    Addressing the problem will begin with better nutrition education. But the process must start early, panelists agreed, because poor eating habits begin early in life. Any educational discourse must include physicians, nurses and other healthcare providers because they “play an important role in delivering key nutrition information,” Shalala said.

    One key strategy involves getting more medical schools to adopt preventive medicine and nutrition education in their curriculums while also urging healthcare providers to not only focus on medical procedures but also dialogue with patients explaining the benefits of healthy behavior—all of which are strategies more schools are now beginning to take, Miller School Dean Pascal Goldschmidt said.

    “We’re also trying to personalize this intervention—diet and exercise—in a way that will fit individuals the best,” he said, “and we’re very interested in trying to explain the genetics of why one individual responds better to one form [of exercise] than another.”

    Sylvia Daunert, who chairs the Miller School’s Department of Biochemistry and Molecular Biology, called for sending students into communities on outreach missions that would teach community members “the benefits of knowing what you’re eating and where it comes from.”

    Encouraging and, more importantly, getting people to exercise also is critical in lowering obesity rates. “There needs to be a climate that encourages people to exercise,” said Arlette Perry, professor and chair of kinesiology and sport sciences in UM’s Department of Education.

    A researcher who has published several studies on the impact of diet and exercise on weight loss, Perry said getting people to ramp up their physical activity levels can start with something as simple as getting them to walk longer distances by parking further away from where they’re headed—something UM’s Walking Canes program encourages.

    Evadnie Rampersaud, a research assistant professor in the Miller School’s Dr. John T. Macdonald Foundation Department of Human Genetics; and Tracie Miller, a professor of pediatrics and director of clinical pediatric research, also participated on the panel.

    TIPPING POINT

    During a closing panel, preventive cardiologist Arthur Agatston, author of The South Beach Diet, said the nation has “reached a tipping point.”

    “We’ve produced enough food where people are getting enough calories,” he said, but those calories are supplied by fast food, to which technology has provided people quicker and greater access. “We’ve lost the family dinner,” Agatston said.

    Smart phones, iPads, and other technology, he added, have also made us more sedentary.

    “We’re developing belly fat that we never had before, and with this belly fat, we are releasing every day what’s really a chemical bath of inflammatory cytokines,” Agatston said. “It comes from the fat of our overextended bellies. We’ve known for quite some time that it’s affected the heart. We now realize it’s causing every chronic disease—cancer, arthritis, Alzheimer’s, macular degeneration.”

    FIRST OF A SERIES

    The forum and site visits were the first of a series that will be held around the country as part of the Nutrition and Physical Activity Initiative.

    “For our purposes, we’re looking for specific achievable, high-impact solutions, particularly in areas that have not received very much attention in the ongoing national discussion,” President Shalala said. “For example, we’re taking a hard look at large institutions such as universities and hospitals that procure and serve large amounts of food every day. Within their procurement process is the incentive to promote healthy food choices.”

    The co-chairs also will examine strategies to impact legislation. “We plan to look at the reauthorization of the next farm bill and whether there are opportunities there to improve access to healthy food choices,” Shalala said. “We’ll also look at the implementation of provisions of the 2010 Affordable Care Act and the Child Nutrition Act, and determine if some of our suggestions might help in the effectiveness of that law.”

    Several models of effective nutrition education are already up and running in many U.S. cities. “We know that there’s a lot of great work being done in both the public and private sectors, and therefore this effort is not to reinvent the wheel or to do a great deal of original research,” Glickman said, “but instead to compliment and contribute to and hopefully shine a light on the discussion and good work already being pursued.”

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