Nurse Puts Diet Where Her Mouth Is

Posted in Nurse Safety, Nursing, Obesity

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One thing that comes up sometimes with nurses is the disparity between the talk and the walk — when great advice is being given about how to get and stay fit, but the nurses giving that advice are not fit, themselves.

A Minnesota nurse named Michelle Williams says that she always felt hypocritical when she stressed the importance of being fit to her patients. “I’m telling people to lose weight, watch their diet. And I weighed 270 pounds,” she says in this article in the Star Tribune.

Not anymore, though. After a lot of hard work and dedication, she’s dropped 95 pounds. She has improved her health, changed her outlook, and serves as an inspiration to patients and colleagues.

Her identification badges at the hospital still have photos that were taken before her weight loss — she keeps wearing them, to show patients that she’s putting her diet where her mouth is. She’s been on a strict diet while also exercising regularly.

Long before she decided that her ideal meal was a cup of garden vegetable soup with pesto and a half sandwich at Panera, she pretty much ate whatever she wanted, whenever she wanted. Her parents were overweight. Williams was big as a child. For her, this was normal.

And she’s a good cook.

Obesity brought Williams awkward moments as a child. But when she reached 33, she was in crisis mode. She was diagnosed with hypertension. As a cardiology specialist, she didn’t have to read any health charts to predict what her future might be like unless she drastically changed her lifestyle.

North Memorial offered the Optifast program. Williams, who is single, began 14 months ago. She has lost 34 percent — or one-third — of her total body fat.

It hasn’t been a piece of cake.

“I’d go hours and hours without eating,” she recalled. “And then I’d eat a ton.”

When she started the program in May of last year, she immediately gave up soda, which she loved. She reduced her carbohydrate intake, a difficult task for someone who loves bread. But the hardest part was the exercise.

“I’m not crazy about running or some of the machines,” she said. “But I do what I need to do. At first, I forced myself. Eventually, it became part of my routine.”

Doctors at North Memorial now point to Williams as an example of what can be.

She’s not sure how far her journey will take her. But on Labor Day weekend, she will be in New York, where half of one of those 2-inch-thick deli sandwiches could last the entire three days.

“I’m excited,” she said. “This is a dream come true.”

The trip to New York is just the cherry on the cake. Her greatest reward is what she no longer sees in the mirror.

Developing Healthy Habits

Posted in Nurse Safety, Nursing, Nursing News, Obesity

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Physician, heal thyself — and nurse, get thyself fit.

It’s one of the paradoxes of the health care field that often the very people who are dispensing valuable advice about fitness have a hard time following it, themselves. According to several studies, more than half of all nurses are obese, and more than 10% smoke. Many nurses feel they are too busy to take care of themselves, tending to help others first.

Why is there this disconnect between the clinical knowledge about how to be healthier, and actually putting that into practice? How can nurses successfully reach their wellness goals?

One thing they can do is look to the behavior-change concepts they use with patients, such as the Stages of Change and the Health Action Process Approach, according to this article on Nurse.com.

Behavior change science is still evolving, but nurses who are involved in wellness and behavior change say that the first step toward health is often finding a strong motivation to change.

It’s also important to set realistic goals, going inch by inch rather than trying to do everything at once (and getting discouraged when that doesn’t work). One nurse in the article started by just walking a mile or two around the neighborhood regularly. Another made sure she built breaks into her schedule — for every 50 minutes of work, she would take 10 minutes to get up to walk around and stretch. She not only made gains in her health but was more energetic and productive when she went back to work.

Planning for change and possible barriers also is important, said Karen Gabel Speroni, RN, BSN, PhD, MHSA, director of nursing research at Inova Loudoun Hospital in Leesburg, Va., and co-creator of a research program called Nurses Living Fit. She suggests nurses start any self-care plan by documenting their lifestyle practices — what they eat, how much water they drink, how much sleep they get — and use that information to work in small changes.

Darlene Trandel, RN, PhD, FNP, PCC, an International Coach Federation-certified professional health coach and consultant for health, wellness, lifestyle and chronic care, has worked with many nurses to create environments to help them succeed. This may mean keeping sweets out of the house, planning an activity program or finding a satisfying substitute for a cigarette. She also helps them plan for things that might sabotage their good intentions, such as treats in the break room or feeling too tired to exercise after work.

Start small, finish big

After nearly a year of neighborhood walking, Cotter’s friend suggested they walk the 2011 Oklahoma City Memorial Marathon. Cotter said she thought she could do the 13.1 mile half-marathon, so they began to increase their walking times and distances, got up early nearly every day, trained with a running group and entered short races.
Although she wasn’t dieting, Cotter started decreasing portion sizes and increasing fruits and vegetables. She didn’t lose weight at first, but she dropped a dress size and began feeling better. People started telling her she looked better, too.

The half-marathon was a success, and the friends agreed they would try for the full marathon in 2012. They finished the 26.2 mile race in 6 hours, 46 minutes. By the start of the April 29 marathon, Cotter had lost 50 pounds and six dress sizes. She was off all but one medication, including the blood pressure medications she’d assumed she would take for the rest of her life. In January, three months before the marathon, Cotter made a resolution to give up fast food, a vow she has kept “with three small lapses,” she said.

Worth the effort

Creating and sustaining a healthy lifestyle is not easy, said nurses who work in behavior change, and the process almost always involves setbacks. Tracking progress, enlisting the support of others and changing strategies to avoid boredom can help people continue with healthy changes. “Don’t hate yourself for doing behaviors that are not what you wanted,” Speroni said. “Forgive yourself and move on.” Support from friends, family and colleagues through the entire change process is crucial, Melnyk said.

There are professional reasons for nurses to take care of themselves, said Speroni, whose report, “Effect of ‘Nurses Living Fit’ Exercise and Nutrition Intervention on Body Mass Index in Nurses,” cites a recent study that concludes patients may not have as much confidence in the wellness advice of nurses who do not appear to have followed it themselves. “Weight-appropriate nurses had more public confidence in their teaching,” her report states.

Nurses who strive for a healthier lifestyle can provide inspiration for their patients to change, Harrington said. They can acknowledge that change is difficult, but also show it can be done. “Health isn’t a goal, health is who we are,” she said. Making healthy changes provides “an opportunity to be excellent role models, educators and advocates.”

Cotter said her new motivation is to be a model for others. When she teaches her students about the need to take care of themselves now, she is passionate. She brings in photos from her marathons and uses her own experiences as an example. She still has some back pain and wants to lose 25 more pounds, but she feels like she can do it. The most important lesson of her wellness journey, she said, was “figuring out that you just make time. Taking the time is hard, but eventually the benefits are worth it.”

Love Me, Love My Microbiome

Posted in Maryland, Nursing News, Obesity

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Bacteria is bad. Right?

That is now being rethought. The New York Times has a fascinating article about new research into the “good bacteria” that live in or on the human body — all 100 trillion of them.

They’re needed for digesting food, forming barricades against the bad bacteria, even synthesizing some vitamins. But we’ve known remarkably little about them — what they look like in healthy people, and how they vary amongst individuals.

The Human Microbiome Project has been looking into this, and what they’ve found is pretty cool.

Each person’s collection of microbes, the microbiome, was significantly different from another person’s.

Their work has helped establish criteria for a healthy microbiome, so more is known about how to fix one that isn’t functioning correctly. It also helps figure out what antibiotics do to a microbiome, and how long it takes for the microbiome to recover from antibiotics.

The various microbiomes also help explain why different people react differently to various drugs, and why some people are more vulnerable to certain infectious diseases. When microbiomes cease to function correctly they are thought to contribute to chronic diseases and conditions such as asthma, irritable bowel syndrome, and maybe even obesity.

Dr. David Relman, a Stanford microbiologist, describes the microbiome as analogous to coral, with humans taking the coral role and the bacteria as the many life-forms that live within it. Dr. Barnett Kramer, from the National Cancer Institute in Maryland, says that instead we should instead consider ourselves mostly made of microbes. “We may just serve as packaging.”

The microbiome starts to grow at birth, said Lita Proctor, program director for the Human Microbiome Project. As babies pass through the birth canal, they pick up bacteria from the mother’s vaginal microbiome.

“Babies are microbe magnets,” Dr. Proctor said. Over the next two to three years, the babies’ microbiomes mature and grow while their immune systems develop in concert, learning not to attack the bacteria, recognizing them as friendly.

Babies born by Caesarean section, Dr. Proctor added, start out with different microbiomes, but it is not yet known whether their microbiomes remain different after they mature. In adults, the body carries two to five pounds of bacteria, even though these cells are minuscule — one-tenth to one-hundredth the size of a human cell. The gut, in particular, is stuffed with them.

“The gut is not jam-packed with food; it is jam-packed with microbes,” Dr. Proctor said. “Half of your stool is not leftover food. It is microbial biomass.” But bacteria multiply so quickly that they replenish their numbers as fast as they are excreted.

The bacteria also help the immune system, Dr. Huttenhower said. The best example is in the vagina, where they secrete chemicals that can kill other bacteria and make the environment slightly acidic, which is unappealing to other microbes.

Including the microbiome as part of an individual is, some researchers said, a new way to look at human beings.

It was a daunting task, though, to investigate the normal human microbiome. Previous studies of human microbiomes had been small and had looked mostly at fecal bacteria or bacteria in saliva in healthy people, or had examined things like fecal bacteria in individuals with certain diseases, like inflammatory bowel disease, in which bacteria are thought to play a role.

But, said Barbara B. Methé, an investigator for the microbiome study and a microbiologist at the J. Craig Venter Institute, it was hard to know what to make of those studies.

“We were stepping back and saying, ‘We don’t really have a population study. What does a normal microbiome look like?’ ” she said.

The first problem was finding completely healthy people for the study. The investigators recruited 600 subjects, ages 18 to 40, poking and prodding them. They brought in dentists to probe their gums, looking for gum disease, and pick at their teeth, looking for cavities. They brought in gynecologists to examine the women to see if they had yeast infections. They examined skin and tonsils and nasal cavities. They made sure the subjects were not too fat and not too thin. Even though those who volunteered thought they filled the bill, half were rejected because they were not completely healthy. And 80 percent of those who were eventually accepted first had to have gum disease or cavities treated by a dentist.

When they had their subjects — 242 men and women deemed free of disease in the nose, skin, mouth, gastrointestinal tract and, for the women, vagina — the investigators collected stool samples and saliva, and scraped the subjects’ gums and teeth and nostrils and their palates and tonsils and throats. They took samples from the crook of the elbow and the folds of the ear. In all, women were sampled in 18 places, including three sites in the vagina, and men in 15. The investigators resampled subjects three times during the course of the study to see if the bacterial composition of their bodies was stable, generating 11,174 samples.

To catalog the body’s bacteria, researchers searched for DNA with a specific gene, 16S rRNA, that is a marker for bacteria and whose slight sequence variations can reveal different bacterial species. They sequenced the bacterial DNA to find the unique genes in the microbiome. They ended up with a deluge of data, much too much to study with any one computer, Dr. Huttenhower said, creating “a huge computational challenge.”

The next step, he said, is to better understand how the microbiome affects health and disease and to try to improve health by deliberately altering the microbiome.

But, Dr. Relman said, “we are scratching at the surface now.”

It is, he said, “humbling.”

Flavor Is a Health Issue

Posted in Nursing, Nursing News, Obesity

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Dr. David Eisenberg, an associate professor at the Harvard Medical School and the Harvard School of Public Health in Boston, Massachusetts, is the founder and chief officiant of an annual event called “Healthy Kitchens/Healthy Lives.” This is an “interfaith marriage,” as he calls it, that brings together physicians, public health researchers and distinguished chefs. The program seeks to tear down the wall between “healthy” and “crave-able” cuisine.

Health care providers are on the front lines of America’s diabetes and obesity crises, but many of them have little knowledge of nutrition, let alone cooking.

To Dr. Eisenberg, son of a Brooklyn baker, “flavor is a health issue.” He thinks that it’s vitally important that people know how to cook healthy food that is enjoyable to eat. And he’s striking a chord; the “Healthy Kitchens/Healthy Lives” event is now in its eighth year, and typically sells out, according to this article in the New York Times. It is an example of a major shift in attitude among a young generation of medical professionals who grew up with farmers’ markets. As a physician participating in the event says, “I want to help my patients not need my services… I’d love to be put out of work.”

For Dr. Eisenberg, 56, a passionate cook who spent weekends as a child filling cream puffs and sprinkling cinnamon and nuts on rugelach in his father’s bakery, deprivation in the form of low-fat diets and bland overcooked vegetables is an enemy of doctors and patients. “For years we’ve told people ‘Don’t eat that’ or ‘Here’s your problem,’” he said of the physicians’ party line. “Sometimes,” he added of his own thrice-yearly yearning for steak, “you have to feed your inner jerk.”

His commitment to healthy food began when his father, a cake artist who “always smelled like a cross between a cinnamon stick and a whiff of Old Spice,” died of a heart attack when Dr. Eisenberg was 10. An expert on integrative medicine, Dr. Eisenberg was one of the first United States medical exchange students to the People’s Republic of China. He started “Healthy Kitchens/Healthy Lives” in partnership with the Culinary Institute and the Harvard School of Public Health, based on the radical notion that if doctors could learn to channel their inner Julia Child (sans butter), they could serve as role models and cheerleaders for their patients.

It’s not about ego. Over the years, research has shown that doctors who practice healthful behaviors like exercising, using sunscreen and not smoking have a greater likelihood of advising patients to do the same. A study last month in the journal Obesity reported that overweight doctors may be less prone than other physicians to discuss diet and exercise with their patients. “We’re all human,” said Dr. Matt Everett, a now-gangly 55-year-old physician from Marysville, Ohio, who was inspired to lose weight after seeing patients in their 40s and 50s having strokes and heart attacks. “We all struggle with the same things.”

For doctors like Martin Abrahamson, the chief medical officer for the Joslin Diabetes Center in Boston, there were revelations within Greystone’s cool, monasterylike stone walls, where chefs in white glide up and down staircases with nary a glance at the school’s historic corkscrew collection. “I’ve never cooked in my life,” he said, wearing a pinstripe suit beneath his apron, his hands drenched in marinade.

Dr. Abrahamson and his cronies listened raptly as the chef Tucker Bunch talked about “the little worm that unfurls” in overcooked quinoa (he advocates toasting it). “Doctors treat salt like an exacerbator of disease,” Mr. Bunch observed somewhat wryly. “So they under-season food with religious fervor.”

Nevertheless, they soaked up the dazzling feats of culinary derring-do, especially when the chef Patrick Clark sliced an onion in 10 seconds that fell into Sydney Opera House-like curves on the cutting board.

The collaboration between the Culinary Institute and Harvard epidemiologists and nutritionists goes back to 2002, when Dr. Willett, chairman of the institute’s scientific advisory board, began researching the health benefits of the Mediterranean diet. The team is now working with chefs from mega-chains like Applebee’s, Starbucks and Subway, to encourage them to reduce sodium and add more whole grains, nuts, legumes and healthier oils to their menus.

Dr. Eisenberg would like to see teaching kitchens in the places that need them most: medical schools, hospitals, universities, public schools and military bases. “What if teaching kitchens were as prevalent as computer labs in schools?” he asked. (He is working on a prototype.) Nutritionists often don’t know how to cook, Dr. Eisenberg pointed out, “which is a little bit like psychiatrists who are all screwed up.”

Yet after three days of thinking deep thoughts, all the while gorging on aromatic wheat-berry salads and peanut limeade (sounds revolting, tastes great), there was a palpable sense of a wellness tide turning.

For instance, Dr. John Principe of Palos Heights, a Chicago suburb, said that he seriously thought about quitting medicine, fed up with “a pill for every ill.” Fantasizing about a second career as a chef, he attended “Healthy Kitchens” five years ago and realized that he might be able to combine the two.

He now holds a culinary boot camp in the 2,400-square-foot kitchen and lecture room he built below his medical office, where he teaches people how to whip up cauliflower crust pizza and other dishes. (The sessions qualify for insurance under the group medical appointment model.) “Instead of being in the downtrodden mode, it’s given me a zest for life,” he said.

At the Baylor College of Medicine, Jasdeep Mangat, a 24-year-old medical student, was a founder of Choosing Healthy, Eating Fresh (CHEF), enlisting a chef from a local bistro to teach classes for 20 students using five portable gas burners in the student lounge. “We need to walk the talk,” he said.

And seven years ago, Dr. Daniela Connolly, now 40, and her husband, Patrick, bought a farm in Chester, N.H., to feed their five children healthy and reliable food.

She often runs into her patients while selling eggs at the farmers’ market and sometimes when they unknowingly show up at the house to pick up their Field to Fork Farm C.S.A. boxes. They are invariably surprised by how dirty she is.

After three days of “Healthy Kitchens,” she is now convinced she needs to teach her patients healthy cooking. “In a perfect world, I would have my patients meet me at the farm,” she said. “That would make me a really happy doctor.”

Helping Obese Diabetes Patients Stay Mobile

Posted in Nursing, Nursing News, Obesity

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The Look AHEAD trial funded by the National Institutes of Health has found that lifestyle changes have been effective in reducing disability in people with type 2 diabetes.

This article appearing on Nurse.com indicates that the risk of losing mobility in overweight or obese adults with type 2 diabetes was nearly halved with weight loss and increased physical fitness.

Look AHEAD (Action to Health in Diabetes) is a randomized clinical trial that is intended to figure out whether losing weight has an effect on the risk of developing cardiovascular diseases in overweight and obese people who have type 2 diabetes.

The study found that a group of these adults who attended meetings to help them achieve and maintain weight loss through diet and exercise were much more mobile than those who did not receive this intervention. Mobility is important for quality of life, allowing them to live independently rather than in a nursing home, for example, and also helps reduce healthcare costs.

Beginning in 2001, a total of 5,145 participants were randomly assigned to either an intensive lifestyle intervention group (ILI) or a diabetes support and education group (DSE). Participants receiving the intervention attended group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity. The DSE group attended three meetings each year that provided general education on diet, activity and social support.

To assess mobility and disability, participants rated their ability to carry out activities with or without limitations. Included were vigorous activities such as running and lifting heavy objects and moderate ones such as pushing a vacuum cleaner or playing golf. Participants also separately rated their ability to climb a flight of stairs; bend, kneel or stoop; walk more than a mile; and walk one block. Both groups were weighed annually and completed a treadmill fitness test at baseline, after one year and at the end of four years.

After four years of the study, participants in the ILI group experienced a 48% reduction in mobility-related disability compared with the DSE group, and 20.6% of ILI participants reported severe disability compared with 26.2% of participants in the DSE group. Likewise, 38.5% of those in the ILI group reported good mobility, whereas the rate was 31.9% in the DSE group. Weight loss was a slightly stronger predictor of better mobility than improved fitness, but both contributed significantly to the observed reduction in risk.

“This study highlights the value of finding ways to help adults with type 2 diabetes keep moving as they age,” Mary Evans, PhD, project scientist for the study, said in the news release. “We know that when adults lose mobility, it becomes difficult for them to live on their own, and they are more likely to develop more serious health problems, increasing their healthcare costs.”