The 750 Pound Man

I was taking a bite of food when the film started. I immediately lost my appetite.

The story started with John Keitz, his wife Gina, and his mentally handicapped sister Jessie being kicked out of their home. Their landlord refused to renew their lease. The paramedics in that city had developed a system to get him out of the house and to the hospital using a whale harness and a specially designed ambulance.

He checked into a hospital in Ohio saying that he was finally going to lose weight. His reaction to the nurse when she brought in a salad? "I want a hamburger."

They had to use a huge sling to get an accurate weight. While they were rolling him onto the sling he had to be put on oxygen because even that much movement was too hard on him.

While working with the physical therapists, when they asked him if he was ready he said, "If you wait until I'm ready, I won't get better." At least he knew that much. He was going to have to be pushed out of his comfort zone. However shortly following that, it was reported to the head nurse that during the night he ate chips, popcorn, sun chips, and little debbie cupcakes. She had to go in and remove his stash. He tried to convince them that he knew how to manage his snacks.

Most people become obese because they don't know how to cope with difficulties.

When there's not a lot of muscle, there's not a lot of fat being burned, so it's necessary to start slowly, especially when the patient is bed-bound.

He got an infection that originated in his skin (he had a lot of skin problems due to his lack of movement, and the constant pressure on the skin), then moved to his blood stream. He died of septic shock - it killed his organs. Due to his condition, he wasn't able to fight off the infection.

He died at 39.

I think it's really sad when people are in that situation, but at the same time, I can't help but think of what precautions and steps they can take to catch things early and keep themselves from getting to that point.

A nice side story of the video talks about a guy who's in the same nursing home that John is in. Nathan is about 13 years younger than John's 39 years, and not nearly as heavy. He checked himself into the nursing home for the morbidly obese at 400-some pounds. I think it's great to show a story like that. Yes, he's morbidly obese, but he's still walking, and he knows it's a health problem. At the end of the video, he had lost 70-some pounds since checking himself in.

for more, go here.

Healthy Body Healthy Mind

I was able to watch the DVD entitled Healthy Body, Health Mind, which is a TV series. The particular episode I watched was focused on overcoming obesity. The TV series is produced by the Information Television Network (http://www.itvisus.com/programs/hbhm/ ). The series is centered on doctors making home visits to average Americans and discussing their health issues with them and then advising them how to make healthy changes.

I thought this program was a unique idea of discussing obesity with the public. Instead of being a health DVD that someone might only find at a library, the producers of this series was able to reach television watchers across the country. In this particular episode the doctors made visits to obese adults and one overweight child. One of the main priorities the doctors had was to inform the individuals about the danger of having excess carbohydrates in the diet. Several of the individuals ate low fat foods and enough fruits and vegetables, but they were not losing any weight. The doctors and other health professionals taught them how to count carbohydrates and which foods to avoid. Some of these recommendations were to avoid white flour products, rice cereals, pastas, and certain fruits like raisins, pineapples, and bananas. I thought this was an interesting focus to take on obesity. Usually counting carbohydrates is associated with diabetes, but it also pertains to eating a healthy, balanced diet. To learn how to count carbohydrates, check out this website, http://www.diabetesnet.com/diabetes_food_diet/countcarbs.php.

Often times we hear “eat a healthy diet” as a response to how to overcome obesity; however, from this DVD I learned that focusing on a specific part of a healthy diet can possibly be more effective and manageable. They stressed the idea of food substitution, and that dieting does not have to become a chore, but rather a conscious effort to be healthy. I liked this emphasis because remaining on a diet for a lifetime is usually not possible. Small dietary changes are more effective and sustainable for weight loss.

After watching this DVD, I had a greater interest to learn how to count carbohydrates. I want to learn more about the difficulty level of counting carbohydrates and how sustainable this program is. Last weekend I was able to attend the Diabetes Expo in Sandy and I heard a lot of diabetics talk about the difficulty of counting carbohydrates at each meal and snack. It would be very helpful to find an easier way to do this in order to help diabetics and others eat healthier and lose weight. It would be interesting to follow up on other interventions using carbohydrate counting to lose weight and compare the success with other types of diet interventions.

Community Gardens

In preparation for the grant proposal (due today!), our group has looked over the Community Gardens project, and even modeled our own grant proposal around some of the main tenets of the Community Gardens project. Here is a brief overview of Community Gardens.

The vision of the project is to increase opportunities for Utahns in low-income neighborhoods to participate in gardening to improve health.

Goals:
1. Educate the public about the value of gardening to improve healthy eating and physical activity patterns and the availability of community and at-home gardening resources.

2. Create new community partnerships and a policy team to develop community gardens and home gardens in low-income neighborhoods in Salt Lake and Weber Counties.

3. Improve access to healthy options by working together with low-income neighborhood leaders and community members to develop community gardens, offer gardening workshops, and provide technical assistance for at-home and community gardens.

Stakeholders for this project included KUTV2 News and Univision (a Spanish language media partner), Governor Huntsman's Office, Utah DOH, Wasatch Community Gardens, Utah Department of Agriculture and Food, Utah Department of Human Services, Utah Commission on Aging, the SLC Mayor's Office, Weber-Morgan Health Department, 5 A Day Association of Utah, IFA, Girl Scouts of America, University of Utah, Utah State University - Extension, and Borski Organic Farms.

It is obvious that this project reached far into community organizations to build support among those who were already plugged into potential community resources.

The project's activities included collecting proposals from community organizations throughout the state to start community gardens. 10 proposals were selected and funding was provided to develop community gardens associated with schools, churches, low-income housing communities, and boys and girls clubs. The aim of the project was to target low-income communities, and with the exception of a charter school, all of the projects had access to low-income participants. A tool library was maintained in case additional supplies were needed. They could be borrowed by an individual project and then returned.

The intitiative can be compared to Wasatch Community Gardens, which is a group of community gardens thoughout the state. One of the aims of this program was to strengthen the capacity of Wasatch Community Gardens.

As far as evaluation, the final report from the project states that evaluation fell outside the timeline of the project. That sounds like a cop-out, and I hope that evaluation has been performed to determine if future efforts should be made to expand upon this program.

Supersize Me!

Every time I eat at McDonalds, I feel sick afterwards. This is not to say that the food doesn't taste good (because it does), but there is something about that food which my body likes to reject. Because of its effect on me, I avoid eating at McDonalds at all costs. In the past 5 years, the only times that I've eaten at McDonalds were in China when either my wife or my visiting mother couldn't take eating any more Chinese food. So when I rented "Super Size Me" a couple of weeks ago, I knew that it likely couldn't increase my repulsion for the double arches; however, the documentary while not increasing my disgust, did give me some wonderful facts to throw around about what McDonalds' food will do to your body.

The director and star of this documentary, Morgan Spurlock, decided to eat nothing but McDonalds food for 30 days. He had to try everything on the menu at least once and had to super size his order every time that the cashier invited him to do so. Before he started this experiment, he was medically tested by 3 doctors and found to be in remarkable health. By the end of the month, he had gained nearly 25 pounds (17 of these pounds were gained in the first 12 days), consumed 5,000 calories a day, and ruined the health of his body. All 3 of his doctors warned him that if he continued on this diet, he would soon die. His cholesterol, triglyceride, and liver enzyme levels were off the charts.

After the experiment was over, it took about 15 months for Morgan's body to return to how it was before the experiment started. BAD NEWS.

Lesson learned? Fast food is not good for you, and it will kill you if you eat it all the time. I know that this food is really cheap and calorie dense, and because of that readily becomes a staple to those of lower socio-economic class. This shows that there is a need for policy to help people have the freedom to make better eating decisions.

There is, however, a matter of free will in the matter. Should people be allowed to eat whatever they want? Isn't it their life? Morgan did find that he was becoming dependent (addicted) to the food, though, and that is another thing to consider when weighing policy options.

In summary, go rent "Super Size Me" and let me know what you think about it. It will be a well-spent $1.99 at Blockbuster.

Targeting the Taqueria

Steps to a Healthier Salinas

Targeting the Taqueria: Implementing Healthy Food Options at Mexican American Restaurants

http://hpp.sagepub.com/cgi/reprint/10/2_suppl/91S.pdf)

I love this intervention for many reasons. First, it is a perfect example of a culturally tailored message. Instead of attempting to change Mexican cuisine, this intervention encourages taqueria owners to simple make a few food preparation changes to make their menu items healthier. They also tailored all of the educational material to the proper audience, which helped diffuse the information more effectively. Second, this intervention empowers members of the community to take responsibility for the health of others. I feel that if the whole community came together to promote good health we would see much lower rates of obesity, diabetes, and other health problems. It will be interesting to read the results of this intervention when the analysis is complete and to see how this intervention can be implemented in other areas.

Vision and Goals

The vision of this intervention was to develop partnerships to promote healthy communities with nontraditional partners, such as the owners of taquerias in Salinas, California. The intervention was aimed to use community health workers to help foster cultural links between underserved communities and efforts to improve health outcomes. The goal was to empower the owners of taquerias to offer healthier menu options as well as encourage their customers to choose the healthier options. In the beginning of the study only 16 taquerias were chosen to become partners; however, an end goal of the intervention was to include all taquerias in Salinas in the partnership.

Stakeholders and Leaders

The stakeholders in this intervention were the CDC because they funded the program as well as the owners of the taquerias and their staff members. Another stakeholder could be the people living in Salinas who frequent taquerias because they were affected by the intervention. The initial leaders of the intervention were members of the Stanford Prevention Research Center; however, their goal was to empower the taqueria owners to become the eventual leaders of the intervention

Actions Taken by the Program

• The first step was to become familiar with taquerias and their owners and then to stress current health issues in their community that they could help prevent.
• Partnering with local taquerias to help them become promoters of healthy foods for their community.
• To educate taqueria owners about offering healthier food options such as whole beans, whole wheat tortillas, and fresh fruit.
• To provide food preparation suggestions such as using less fat in food preparation, increase vegetables in menu items.
• Improving access to healthy food options in disadvantaged communities.
• Providing taqueria owners with a “healthy nutrition tool kit” which included information about diabetes, social marketing of healthier foods and health education visuals (such as portion size posters).
• A small grant program was developed through the ‘Steps to a Healthier Salinas’ that allowed taquerias to apply for funds to help change their photo menus to look more appealing and healthy.

Comparable Programs and Possible Partnerships

This intervention is one of the eight initiatives funded by the CDC to help foster healthy communities in the United States. I have read a few of the articles and all of them focus on community partnerships and empowerment. A similar intervention to “Targeting the Taqueria” was an intervention entitled “Rock on Café” (http://hpp.sagepub.com/cgi/reprint/10/2_suppl/100S). This intervention also worked with nontraditional partners to improve the nutrition of a specific group of people. Instead of taqueria owners, cafeteria workers were empowered to make healthy changes in the school lunch menu to help prevent obesity and diabetes among children. The target audiences were different, but the principles of the intervention were very similar. I feel like the taqueria intervention would partner very nicely with a community garden effort. Fruits and vegetables are often not included in one’s diet due to economic barriers or not having access to these foods. Having a community garden in the disadvantaged areas of Salinas would allow individuals to cook with and eat more vegetables and fruits when they dine at home. Taqueria owners could also use the community gardens to supply their vegetables and fruit for their menu items. This could reduce costs and enhance feelings of community ownership. A great article on a community garden intervention in an underserved community can be found here: http://hpp.sagepub.com/cgi/reprint/10/2_suppl/146S.

Measurement of Success

The results of this intervention have not been published yet and they have not defined how they will measure their success. In the conclusion statement they mentioned, “It is hoped that this innovative, tailored intervention, which is responsive to community needs, will have a sustained positive influence on the large and growing Mexican American population that is at high risk for obesity, diabetes, and other chronic diseases.”

I feel that success could be measured in a variety of ways:

*The percentage of taquerias that have adopted healthier food options in Salinas

*Feedback from the taqueria customers about the healthier food, their health, etc. gathered through qualitative data (surveys or in-depth interviews)

*Increased awareness of diabetes and obesity among taqueria customers in Salinas

*The percentage of customers choosing healthier menu items

Return to UPHA -- Web 2.0

Carl, Mike, Emily and I are preparing for next week's UPHA conference in Midway, Utah! We're excited to share more experiences with Web 2.0 and public health. Please let us know what thoughts, questions or concerns you have about this topic.

Neonatal Health

This t-shirt was a gift from Bri's life flight crew:

Life Flight 24/7

My first foray into MPH posting...

Many of you know that our long-awaited baby was born in early July. Bridgette spent the first two weeks of her life in the NICU at Utah Valley Regional Medical Center in Provo and at Primary Children's Medical Center in SLC because she couldn't eat or stool, both of which are obviously critical to survival. She was eventually diagnosed with Total Colonic Hirschsprung's Disease, meaning, her large intestine doesn't function. It will be removed when she is big enough, at approximately 20-25 lbs. Until then, she has an ileostomy and requires some special care. We are hopeful that her ileum will adapt over time and play the part of both small and large intestine, although her digestion will never quite be the same as someone with a working colon.

I have had ample opportunity over the last month and a half to consider the excellent medical care that was at her immediate disposal and without which she would not have survived. Nothing to highlight the many discussions we share in classes about global health care like watching your own daughter struggle to live. I kept thinking, "What if she had been born in ____________?" or, "What if Dr. __________ hadn't been so close?" and, when that first bill for $30,000.00 came along, "What if we didn't have health insurance?"

"Failure to thrive" has a whole new meaning to me now. Bridgette has an uncompromised drive to thrive, but until she received the correct treatment, her illness made her appear despondent and uninterested in life. That same assistance is not available to so many babies. How many infants die and are simply diagnosed with "failure to thrive" when they could and would have turned into proper spitfires given adequate health care?

Kelly, Jeff & Bridgette Johnson with Chewy & Piper the Pups

Just wanted to share my new found emotions about the topic. Hopefully they will kindle a little fire under the aspirations of anyone interested in maternal/child health. We all have personal stories that have led us to the MPH program, and now I feel more strongly about our position and responsibilities than ever.

Dia de Salud -- healthy eating and diabetes-friendly food

Last night, I attended Dia de Salud at Centro Hispano (819 South Freedom Blvd, Provo, UT 84601) hosted by Community Health Connect. Maria Lopez was giving a presentation on healthy eating and diabetes friendly foods. She presents on the first Tuesday of every month.


Turnout was decent (9 adults, 4 teenagers, and a bunch of kids), but everyone was very attentive and stayed the full hour. Mrs. Lopez's presentation seemed interactive and very engaging.


Two Spanish-speaking volunteers, a LPN and an EMT, also conducted blood sugar and blood pressure testing. They wondered how effective the blood sugar test was since many of them had just eaten.


Her food was not only healthy, but looked and tasted wonderful too!


Some attendees were not able to report how they heard about Dia de Salud. The event is advertised through flyers, posters, and health educators/professionals at Centro Hispano, Community Health Connect, Mountainlands, and UCHD. Teresa Tavares also advertises at community English classes she supervises. They have also spread word through Spanish newspapers and TV news programs. The poster was modified to be more culturally appealing based on feedback from key informants.

Mrs. Lopez's daughter, Elsie, usually supervises this event as an intern for Community Health Connect. Lisa Schiffman, MPH, also provides support and health communications consultation.

Ashoka: Innovators for the Public

Hello Everyone,

Grant asked me some time ago, and he has been quite patient, if I would share with the group what I have been up to since I left the south end of the RB. So here's the scoop...

I came out to D.C. to take an internship with an organization I had admired from afar for some time. The name of the organization is Ashoka, named after an Indian king in the 3rd century B.C. who was very progressive in terms of serving the public good, renouncing war, and dedicating his life to social welfare. The Ashoka I work for describes itself as the "global association of the world's leading social entrepreneurs-- men and women with system changing solutions for the world's most urgent social problems." What does that mean? A social entrepreneur is often compared to a business entrepreneur with a similar sense of innovation, ambition, and tenacity in pursuing their vision and in creating practical institutions around their idea but in the case of a social entrepreneur the primary motivation and drive is in response to a social problem. A quote from the founder, Bill Drayton, summarizes it nicely, he says, speaking of these social entrepreneurs, "they are not content to give a man a fish, or teach him how to fish, they will not rest until they have revolutionized the fishing industry." The industries being health, education, human rights, the environment etc.

A few examples of their fellows in health:

Abel Albino is a physician in Argentina who was troubled with the status of childhood malnutrition in his country and responded by developing an entire system of lactation clinics and low cost "micro-hospitals" which are extremely efficient and cost effective due to a creative engagement of community volunteers and probono medical services.

Rani Bang was nominated for the Nobel Peace Prize in 2005 but Ashoka discovered her in 1984 at the very beginning of her work. She revolutionized health care in a poor rural area in India by building health services were designed by listening to the wants and needs of the local people, creating a unique blend of traditional medicine, government, and private services.

Rita Sembuya in Uganda has been the first to systematically respond to the unaddressed and complex issue of infertility in her country.

Every Ashoka Fellow has an amazing story and is doing absolutely incredible work. I enjoy being in their international headquarters to meet and hear the stories of their Fellows when they come through the office. If anyone ever wants to hear more feel free to get in touch and I'd be happy to spout off a few more. Go Cougs.

More on Media and Public Health

Well that UPHA presentation sure has stirred up a lot of conversation and action! One person I met at UDOH, said that she now has three blogs instead of one and is working on developing an arthritis blog for her program. Can't wait to see it!

Another result of this program is my new position at the Diabetes Prevention and Control Program at UDOH as a media specialist. I was just compiling some information about media, social marketing and public health and thought I'd share it here.

First, the video called Brochures to Blogs is a great resource (produced by the California Department of Public Health Immunization Branch). It summarizes the need for public health professional to have a presence on the web. I say check it out (even though I'm not a huge fan of the background music).


Watch the rest of the video here.

Second, one of the experts interviewed on that video is from the National Center for Health Marketing. Their website is another great collection of resources like examples of success (e.g. REACH's marketing efforts (4.62 MB)) to global health applications.

Third, I heard about a keynote address at the recent UPHA conference by R. Craig Lefebvre, PhD. Apparently I totally missed out because he spoke on "The Mobile World and Behavior Change." If you attended it, please fill me in. In the mean time, I found his blog and really like his post on Segmenting Black America. Another great resource.

Fourth, after just a few clicks, the Guide to Managing U.S. Government Websites has already given me simple ways to make improvements of the Diabetes Program's website.

Finally, the U.S. Department of Health & Human Services has a research-based guide to usable and useful websites (usability.gov). So far I'd say it's straightforward, easy to navigate, and ... practices what it preaches. It has a lot of great examples of how to organizations using their guidelines as well.

There you go! Hope this helps. Let me know what you think of these!



[UPDATE] We are gearing up at UDOH to develop an updated web presence based on the above guidelines. Speaking of, a colleague just forwarded this article to me, titled New Media Cases in Cases in Public Health Communication & Marketing: The Promise and Potential. Check it out and please share your thoughts!

Future applicant to the program

Meet Brianna McKell, MPH (c)

Newly installed Adobe Creative Suite 3.3 Design Premium

The MPH administration loves us! CS3 Premium was recently installed in the 126 RB Lab on computer #4. This is a potentially powerful tool for public health professionals. If you have questions on how to use it, try the online help, visit the multimedia lab in the Lee Library, or for examples of potential applications ask Lisa Schiffman about her Family Health History Toolkit.

Adobe® Creative Suite® 3.3 Design Premium combines Adobe Bridge CS3, Adobe Version Cue® CS3, Adobe Device Central CS3, and Adobe Acrobat® Connect™ with full new versions of the following components:

* Adobe InDesign® CS3
* Adobe Photoshop® CS3 Extended
* Adobe Illustrator® CS3

* Adobe Flash® CS3 Professional
* Adobe Dreamweaver® CS3
* Adobe Acrobat 9
* Plus Adobe Fireworks® CS3

Here is what past MPH students had to say about Adobe CS3:

Grant Sunada

I believe that InDesign, Illustrator, Photoshop, and Acrobat would greatly expand our skills, effectiveness, and marketability as public health professionals -- specifically when it comes to social marketing, health promotion, health advocacy, and other aspects of health communication. It will also help us more effectively frame the issues we address.

Lisa Schiffman

You already know that I am a fan of adobe products, that is why I splurged and bought them. I mainly used InDesign and Photoshop and adobe professional for pdf files. I'm not that familiar with the other programs, but maybe I would be if I knew how to use them. I'm an advocate for access to Adobe products. They are very useful if you know how to use them.

Lisa Morris

Adobe Photoshop & Illustrator would have been good for our social math assignment. I would love to know how to use Adobe Dreamweaver. This could have been used with our project in Mike's class.

Erin Johnson

I think I would have used Indesign and Photoshop if we had had it.

Jun Yanagishita

So you want to know how helpful Adobe is? The following are what I've seen in job qualifications: Dreamweaver, InDesign, Illustrator and Photoshop.

Marin Poole

Learning the Adobe Suite during class projects would provide an excellent skill to take to the job force. I know that photoshop would be valuable many times in laying out information pages and within presentations. It would also be useful in developing social math posters during Mike Barnes' class.

Heather Sanders

Yes, I think it would be really helpful. The InDesign training we went to was really helpful.

Web 2.0 and Public Health -- As seen at UPHA Conference 2008

(Click on "Menu" then "Web 2_0 and Public Health" to view it in full screen)

Carl and I had a great time presenting information from the upcoming publication in the American Journal of Health Education (Hanson, C.L., Thackeray, R., Barnes, M.D., Neiger, B.L., & McIntyre, E. (2008). The changing face of Internet communication in the 21st century: Integrating Web 2.0 in Health Education Preparation and Practice. American Journal of Health Education. [In press]). The crowd was very responsive and asked a lot of great questions. If you have questions too, please post them as a comment.

I enjoyed the presentation on Personal Leadership by Joyce Gaufin, BS. She was actually using ideas from The Leadership Challenge (as seen in Carl's class), which provided me with a bit more than a review since I had the added benefit of hearing the perspectives of public health professionals.

The final speaker was Nicole Hawkins, Ph.D. whose presentation on "Understanding the Pressures Placed on Women to be Perfect" ended with a quick summary of the nutrition philosophy of intuitive eating. Thanks to Dr. Steve Hawks, many current and past BYU public health are already fans of it. I certainly am a convert and can't wait to learn more about it!




The scenery and the conference center in Midway were both wonderful. On a personal note, sometimes my public health, Air Force, and LDS worlds overlap. I actually met a UDOH staff member whose family knew mine in Ohio 25 years ago.

In addition, a friend who was attending the conference recommended I try a 5-day old restaurant on Main Street -- The Cafe Galleria. What a great chance to give intuitive eating a try!


The place is a combination of a photo art gallery and wood fired pizza restaurant straight out of Italy, but right in the middle of Midway, Utah. As you can see below, I ordered a pizza with prosciutto (\prō-ˈshü-(ˌ)tō\) and fresh basil. Those toppings, mozzarella, great sauce, and crust simply melted in my mouth. I kept monitoring my body's satisfaction level. The pizza was so light compared to most "American" pizza, I ended up eating the whole thing! I've learned that one way that my body tells me that I have overstuffed myself is through feelings of grogginess. But after a couple hours, I still feel great.



Has anyone else had similar experiences with intuitive eating principles?

BYU MPHers Attend the 2008 Health Education Advocacy Summit in Washington D.C.

One of my favorite experiences during the BYU MPH program has related to the Health Education Advocacy Summit, hosted by SOPHE and made possible by the leadership of Dr. Michael Barnes and the funding of Mary Lou & Ira Fulton.


This year, we were able to increase our numbers to 20. This led to us building greater connections between faculty, graduate students, and undergraduates; meeting with representatives from a wide variety of states; eating a lot of great food; and making memories to last a lifetime. The sites to be seen and spirit to be felt in our nation's capital seemed to be amplified for me as we walked (and sometimes ran) back and forth between the Senate and House sides of the Capital building, advocating for public health programs and funding which have been shown to prevent disease and promote health on a population level and in a diversity of communities.


In between and following Hill visits and workshops, we able to tour Smithsonians, galleries of art, and monuments. What a blast!

Stay tuned for more about this!

For statistical purposes only...

Just wanna send out a public props to Mike B for sending out that alumni MPH survey. Honestly, I really enjoy taking surveys (TAKING, not administering nor analyzing).
And double props for the t-shirt reward! So benevolent of the department.