Health and Fitness

With bathing suit season just around the corner, many of us are thinking more and more about how to shed a few extra pounds before hitting the beach or pool this summer. New research from Stanford shows that to successfully slim down, a dual approach - addressing both improving eating habits and increasing physical activity - is most effective.

In a study involving 200 people, Abby King, PhD, and colleagues divided participants into four groups: one made changes to diet and exercise at the same time, another adopted healthier eating habits without altering their fitness routine, a third increased their physical activity level before changing their diet, and a comparison group didn’t make any changes to their eating or exercising habits but were given instruction on stress-management techniques. Individuals’ progress was tracked for a year.

My colleague discussed the researchers’ findings in a release:

Despite the challenge of making multiple changes to their already-busy routines at once, those who began changing diet and exercise habits at the same time were most likely to meet national guidelines for exercise — 150 minutes per week — and nutrition — five to nine servings of fruit and vegetables daily, and keeping calories from saturated fats at 10 percent or less of their total intake.

Those who started with exercise first did a good job of meeting both the exercise and diet goals, though not quite as good as those who focused on diet and exercise simultaneously.

The participants who started with diet first did a good job meeting the dietary goals but didn’t meet their exercise goals. King, who also is a senior researcher at the Stanford Prevention Research Center, speculates this is because changing diet and introducing exercise both have unique challenges. “With dietary habits, you have no choice; you have to eat,” she said. “You don’t have to find extra time to eat because it’s already in your schedule. So the focus is more on substituting the right kinds of food to eat.”

Previously: What type of smartphone apps are effective for promoting healthy habits among older adults?, Computer-generated phone calls shown to help inactive adults get – and keep – moving, Eat a carrot and exercise – or your iBird dies and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
Photo by Jodi Green

While debating what to order for lunch last week, my brother explained that he was participating in a Biggest Loser-style contest with a group of co-workers and the winner received a sizable cash prize. As he described the competition, I took note of how he focused on strategies for beating other contestants, his weight-loss progress and odds at winning, rather than feeling deprived of his favorite foods or complaining about having to exercise more. The experience seemed to have given him a positive outlook on dieting and even motivated him to keep the weight off. When I mentioned that he only had to “be good” for a few more months and could go back to indulging afterwards, he said “No, I wouldn’t want to ruin my hard work.”

So I was interested to read about new research showing that weight-loss programs involving group competitions for financial prizes motivate people to shed more pounds than those offering individual rewards. Reuters reports:

Researchers compared two incentive scenarios. Under one, employees got $100 for each month they met the goal of dropping at least one pound per week. Under the second scenario, $500 was set aside each month for a group of five co-workers and the ones who met their goal got to split the prize.

“People may be more motivated to achieve a particular goal when a particular resource that had been allocated for them is given to someone else if they don’t achieve their goal,” said Dr. Jeffrey Kullgren, the study’s lead author from the University of Michigan Medical School and the Ann Arbor VA Healthcare System.

In the randomly controlled trial, participants offered individual incentives lost 3.7 pounds, on average, compared to 10.6 pounds among those with group-based incentives. The findings were published online today in the Annals of Internal Medicine.

Previously: The trouble with the current calorie-counting system, How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals, Can a food-tracking app help promote healthy eating habits?, Examining how friends and family can influence our weight loss and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
Photo by healthydieting

Many of us, myself included, can’t fathom the idea of exercising without listening to a carefully curated playlist. But what is it exactly about music that motivates us to run further, cycle harder and pump more iron?

An article today in Scientific American sheds some light on the psychology of music and exercise and offers insights into what types of tunes are best suited to working out. Ferris Jabr writes:

In the last 10 years the body of research on workout music has swelled considerably, helping psychologists refine their ideas about why exercise and music are such an effective pairing for so many people as well as how music changes the body and mind during physical exertion. Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency. When listening to music, people run farther, bike longer and swim faster than usual—often without realizing it. In a 2012 review of the research, Costas Karageorghis of Brunel University in London, one of the world’s leading experts on the psychology of exercise music, wrote that one could think of music as “a type of legal performance-enhancing drug.”

Selecting the most effective workout music is not as simple as queuing up a series of fast, high-energy songs. One should also consider the memories, emotions and associations that different songs evoke. For some people, the extent to which they identify with the singer’s emotional state and viewpoint determines how motivated they feel. And, in some cases, the rhythms of the underlying melody may not be as important as the cadence of the lyrics. In recent years some researchers and companies have experimented with new ways to motivate exercisers through their ears, such as a smartphone app that guides the listener’s escape from zombies in a postapocalyptic world and a device that selects songs based on a runner’s heart rate.

The full story is worth a read and is sure to energize you for today’s post-work run or gym session.

Previously: Study shows regular physical activity, even modest amounts, can add years to your life, Study shows short, daily jogs boost longevity and How physical activity influences health
Photo by davidd

As previously reported here, Stanford researcher Abby King, PhD, and colleagues have been testing different smartphone apps to determine what type of framework best promotes exercise and eating healthy among older adults.

All three apps in her study used the accelerometer in participants’ smartphone and a custom program to monitor how active individuals were during the day. The analytic version used goal-setting and feedback to motivate users. The social comparison design utilized support and competition among a group to encourage participants to meet goals. And the third one, the game-style app, promoted attachment to an avatar, a digital bird, that thrived or languished depending on the healthy habits of its “owner.”

In a talk at last fall’s Stanford Medicine X conference, King shared results from her research and discussed which types of apps were most effective in improving healthy behaviors. The video, which was just posted online, offers some interesting evidence on how mobile device apps can change users’ behavior quicker than traditional methods.

Previously: Computer-generated phone calls shown to help inactive adults get – and keep – moving, Eat a carrot and exercise – or your iBird dies, Research shows remote weight loss interventions equally effective as face-to-face coaching programs and Monitoring patient wellness from a distance

“Hello, Mrs. Jones. Your goal last time we talked was to do 30 minutes per day of brisk walking five days per week. Were you able to reach this goal?”

In 2007, Stanford researchers showed in a study of 218 older, inactive adults that computer-generated phone calls appeared to be an effective, low-cost way to encourage sedentary adults to exercise. In the trial, those participants in both the group called by trained health educators and the group called by a computer asking questions like the one above and delivering an interactive, individualized program wound up completing a regular 150-minute per week exercise program.

Now Abby King, PhD, and colleagues have found that the increases in regular physical activity seen during the year-long study were maintained in a subsequent six-month follow-up period – regardless of whether the participants had received human or automated advisor-initiated telephone contacts during those first 12 months. In looking at the trajectory of physical activity change over 18 months, the researchers also saw that the greatest physical activity increases for participants occurred during the first six months of intervention.

I recently discussed these findings with King, who told me that while advice and support is often important in maintaining healthy behaviors, “it doesn’t necessarily have to be delivered in person or by a human at all.” Below King talks more about the study, which appears online in the journal Health Psychology.

How significant is it that participants in the study – regardless of the intervention they received – were able to maintain their healthy habits? Were you surprised by what you found?

Given that participants in such programs tend to decrease their physical activity levels when instructor-initiated support ends, it is quite encouraging to see that both groups were able to “step up” and take charge of their programs during the maintenance period. Both groups received specific information from their physical activity advisors on how to do this during the initial program.

Your results also show the importance of the first six months of programming in establishing sustained physical activity change. How critical is this? Has this been shown in other studies, as well?

This study substantiates the observation seen in some of our prior studies as well as in those of others in the field that the initial six months of programming is a “critical period” for establishing the types of behavioral habits and skills necessary for continued behavioral success.

In your paper you and your co-authors call these automated technologies “attractive intervention tools” because of their reach, availability and cost. Can you explain how they might be beneficial in less-developed countries, where trained health educators are not in large supply?

The growing pervasiveness of mobile phones worldwide, particularly in less-developed countries, sets the stage for a “paradigm shift” with respect to how evidence-based health promotion programs can reach individuals regardless of where they live. Tele-health and the use of automated communication technologies allow for the types of “borderless health promotion” that can potentially make a substantive difference in the health promotion field worldwide.

What are your next steps? Are you conducting/planning more work in this area?

Based on this study, my group is currently collaborating with Dr. Marcia Stefanick here at Stanford and her colleagues in developing an automated tele-health physical activity coaching program specifically for older women. We have initially piloted the automated program with a group of older women here in the Bay Area, and were quite encouraged by the initial results from that effort. The goal is to be able to reach thousands of older women across the country with an easy to use automated tele-health program that is personalized to their needs and preferences.

Previously: Eat a carrot and exercise – or your iBird dies, Research shows remote weight loss interventions equally effective as face-to-face coaching programs and Monitoring patient wellness from a distance
Photo by comedy_nose

I quite like this entry on the U.S. News & World Report blog eat + run today; in it a New York dietician (and mom) candidly discusses the pressure of those in her field to “remain a model of good health and fitness,” admits that she’s a few pounds over her ideal weight (“I may still squeeze into the same size-28 jeans as before [I had kids], but I sure don’t look as good in them”), and describes the recent changes she’s made to get in better shape. And, because it includes a term that is (sadly) so familiar to many of us moms, I especially love her headline.

Previously: How learning weight-maintenance skills first can help you achieve New Year’s weight-loss goals

In case you haven’t seen it, the New York Times’ Well blog quotes Stanford childhood obesity expert Thomas Robinson, MD, in a piece on how to help your kids filter the barrage of pro-junk food messages they get from food advertisements.

As the story describes, Robinson, who directs the Center for Healthy Weight at Lucile Packard Children’s Hospital, has done extensive research on children’s responses to food advertising and branding. I’m particularly fond of the study where young children tasted pairs of identical foods in different wrappers and said which they liked better. Regardless of the food tested (hamburgers, baby carrots, french fries, milk, whatever), kids said food in a McDonald’s wrapper was yummier than food in a plain wrapper.

Food advertising targeted to kids has become so pervasive - it’s not just on TV but also all over social media, Well reports - that Robinson says parents should do more than just say “no” when their children ask for junk food:

“Respond, ‘Well, why do you want that? Where did you hear about it?’ ” said Dr. Robinson. And if the answer is that the child saw it on TV or on the Internet, “Say, ‘Well, they want you to want it, they’re trying to sell you that.’ And then have a discussion.”

And what about my aspirations of nurturing young cynics? Though teaching critical viewing skills does enhance children’s awareness, Dr. Robinson told me that relying too much on notions of media literacy can actually play into the hands of the advertisers.

“That takes the responsibility away from them and puts it on the kids to be educated consumers,” he said.

If you’re wondering how to help your kids deal with the barrage of messages they get from food ads, the entire entry is well worth reading.

Previously: Health experts to Nickelodeon: Please stop promoting unhealthy food to our kids, How food advertising and parents’ influence affect children’s nutritional choices and The First Amendment and marketing junk food to kids
Photo by quinn.anya

All of us are challenged in one way or another to stay healthy. But making smart choices doesn’t have to be difficult and, in fact, can be fun. That’s what Stanford Hospital & Clinics had in mind when it launched a month-long heart health challenge.

The 28-Day Heart Health Challenge focuses on simple changes people can make to their diets and exercise routines that can have a big impact on their heart health. Each day of the week features a different theme with a related challenge. For example, on Stress-less Saturdays you will be reminded of how detrimental chronic stress can be to heart health and be challenged to give meditation or yoga a try. On Meet A Doctor Monday you’ll be introduced to a Stanford physician who will describe what he or she does to keep the heart healthy and then be challenged to try out a similar strategy.

Robyn Horn, a Stanford Hospital employee and Scope contributor, has committed to take on the challenge full force, and she wants to share her experiences with the world. Every day this month, Robyn will try that day’s challenge and write about it in her Heart Health Challenge Blog.

And while the challenge may only be 28 days long, the hope is that after February is long gone, at least some of the information will stick and people like Robyn will continue making heart healthy choices for years to come.

So - are you up for the challenge?

In a move to make it one of the healthiest hospitals in the country, Lucile Packard Children’s Hospital has made some drastic changes to its menu. Greasy cheeseburgers and fries have been replaced with whole-grain breads and pastas and seasonal fruits and vegetables.

Karen Kemby, administrative director of strategy and business development for the hospital, explains the reason behind the healthier fare in a piece on the Packard Children’s website:

“As a children’s hospital, we have the responsibility to model the healthiest environment possible for our patients, their families, and the community. We take that responsibility seriously, and we are leading the way in making children’s hospitals healthier places.”

Packard Children’s was one of the first children’s hospitals in the country to eliminate sugar-sweetened drinks from its menu. (Each 12-ounce serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar.) Kemby adds that Packard Children’s is one of only ten children’s hospital systems among 155 hospitals signing on with the nonpartisan, nonprofit Partnership for a Healthier America, which is working with the private sector and Honorary Chair First Lady Michelle Obama to end the epidemic of childhood obesity in U.S.

Packard Children’s cardiologist Stephen Roth, MD, MPH, adds that having a healthier menu helps the many patients and families who come to the hospital. “We tend to eat more than we need, especially at stressful times. It’s hard for families to be in the hospital when their children are ill, and we should do whatever we can to make our environment healthier for them.”

And just because it’s healthy, doesn’t mean the food isn’t tasty. In fact, the story points out that the hospital’s cafeteria rates an average of four out of five stars on Yelp.

Previously: Kids don’t need “kids’ food”, Want kids to eat their veggies? Researchers suggest labeling foods with snazzy names,New federal nutrition standards mean healthier school lunches and To squeeze or not to squeeze: Using packaged foods to increase a child’s fruit and veggie intake
Photo by healthydieting

Year after year, many of us adopt New Year’s resolutions to slim down, and by the end of January we’re often back at square one. Perhaps it’s time to reconsider a different weight-loss plan: Instead of trying to immediately lose weight, vow to maintain your weight for a period of two months before shedding any pounds.

While this recommendation may sound a bit odd, a past study from Stanford researchers showed that a maintenance-first approach helped individuals shrink their waistlines and keep from regaining the weight. In the following Q&A, lead author Michaela Kiernan, PhD, senior research scientist at the Stanford Prevention Research Center, discusses the method and tips for implementing it to achieve your 2013 weight-loss goals.

In a 1:2:1 podcast, you discuss how an “all or nothing” mentality can negatively impact goals to keep those pounds off. How does the “maintenance-first approach” address this and other psychological challenges associated with shedding pounds?

Often people adopt New Year’s resolutions in an attempt to change their behavior in an intensive focused effort. This approach may work in the short term but it can be hard to sustain that type of focus in the long term. As a result, people give up and revert to their old ways - the “all or nothing” approach. In contrast, maintaining behavior changes over time may need a more subtle “fine-tuning” approach, in which the day-to-day experience is more positive and doesn’t require such intensive effort.

In our trial, we asked one group to learn a set of maintenance skills before losing weight, so that they had a chance to experiment and experience what it was like to “fine-tune” their lifestyle habits. The other group lost weight in the more traditional manner by losing weight first and then trying to maintain it.

How do the skills used to maintaining weight differ from those used in losing weight?

Losing a significant amount of weight can require considerable attention. For instance, keeping daily food records has been found to be a useful strategy for losing weight. However, most people can’t diligently record what they ate or drank multiple times a day for long periods of time, so they quit and regain the weight. Therefore, for weight maintenance, we focused on identifying a set of skills that would make the day-to-day experience positive while not requiring overwhelming amounts of effort. For instance, we encouraged people to learn to maintain their weight without keeping food records and instead to use their bathroom scale to inform them when to fine-tune their eating and physical activity habits with small, quick and easy adjustments they can make on the fly.

For those interested in mastering the skills of maintaining weight before they begin losing weight in the New Year, can you provide an outline of the approach used in the clinical trial?

Here are a few key areas. First, actively search out yummy, healthy foods that you enjoy eating as much as the high-calorie foods you’re replacing. If you don’t, you’ll feel deprived and continue to dwell on the unhealthy high-calorie foods you’re missing - and eventually you’ll go back to eating them. Finding tasty replacements will take proactive efforts to try a lot of new foods. At the same time, be sure to incorporate eating a few of your favorite high-calorie foods into your routine - and then eat them mindfully to savor and enjoy them.

Second, start to “make peace with the scale.” Try weighing yourself daily without the pressure of trying to lose weight. Watch how your body weight fluctuates for a few weeks at your current weight. Many people are pretty surprised that their weight fluctuates from day to day as much as it does. Then, a few weeks in, set a personalized range of about five pounds that accounts for your own body’s fluctuations and a little “give” for vacations and holidays.

Third, use the range to tell you when to make “fine-tuning” changes to your eating and activity habits. For instance, if your weight is fluctuating within a few pounds near the top of your five-lb range, you may want to eat 20 percent less during meals for a few days and get out for extra walks at lunch. Alternatively, if your weight is fluctuating at the bottom of the range, you may want to enjoy another glass of wine or share a favorite dessert with a friend. Develop a”‘quiver” of fine-tuning strategies that work for you.

Finally, navigate those pesky but always occurring disruptions in life that affect weight. For instance, strategically lose a few pounds with your fine-tuning strategies and get to the bottom of your range before going on vacation so you can mindfully indulge in your mother-in-law’s amazing sugar cookies during vacation.

Previously: Learning weight-maintenance skills first helps prevent diet backsliding, Stanford study shows, Can a food-tracking app help promote healthy eating habits?, Examining how friends and family can influence our weight loss and Research shows remote weight loss interventions equally effective as face-to-face coaching programs
Photo by Lisa Creech Bledsoe

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.