A big pill to swallow? FDA approves new diet pill

Jun 29

This week, the Food and Drug Administration (FDA) approved the first new prescription diet pill in 13 years, providing a new option for the roughly one-third of American adults considered obese. This approval was covered widely due not only to the opportunity that it provides for some people trying to lose weight to bridge the gap between using diet and exercise to lose weight or using surgery, but also because of the rocky history of diet pills and the potential pitfalls of relying on a pill to achieve a more healthful lifestyle.

With over 1/3 of the American population overweight or obese, is this new diet pill the silver bullet? Or will it still come down to a matter of behavior modification to address this epidemic? With diet pills coming soon to a store or doctor’s office near you, is there still a role for social marketing in preventing overweight and obesity?

For me the answer is overwhelmingly yes. There is no one answer to changing an individual’s behavior to better their health, and ultimately reduce the incidence of overweight and obesity. While a diet pill may aid in weight loss, ultimately it still comes down to an individual’s choice to eat better and get more exercise – the old adage that it’s all about calories in and calories out still applies. So in fact, in some ways, we’re all working in partnership, whether it be the manufacturers making a diet pill or those of us working to affect positive behavior change to prevent overweight and obesity as a public health imperative.

Tackling obesity isn’t just about any one thing or one approach. It’s about changing perceptions and attitudes about health. And for that, it’s all hands on deck!

It Takes Two to Treat

Jun 22

When was the last time you openly questioned your doctor’s advice?

Think about it. When was the last time your doctor prescribed a treatment, and you said, “Well, I don’t think that’s best for me. Let’s talk about what other options are available”?  If you’ve never said those words, you’re not alone.

As a society, we put a lot of emphasis on personal responsibility for maintaining health and preventing disease: eat healthy foods, exercise, get screened for cancer. But what happens when we get sick? Suddenly, it seems that expectation for personal responsibility evaporates. Instead, we look to our doctor to provide the answers—to tell us what we should do, which treatment is best, and how it will affect us.

A recent study published in Health Affairs found that most patients felt they couldn’t talk to their doctors about treatment options—they were worried about angering or upsetting them, and some even worried that they would receive worse care if they questioned their health care provider.  As a post on the New York Times’ Well Blog put it:

The participants responded that they felt limited, almost trapped into certain ways of speaking with their doctors. They said they wanted to collaborate in decisions about their care but felt they couldn’t because doctors often acted authoritarian, rather than authoritative.

Image Credit: hang_in_there, Flickr

I can understand those patients in the study. I too have sat on that exam table, ready to ask questions and get advice—and then promptly clammed up when the doctor finished her rushed exam and looked up.  It’s not an environment that invites engagement; and the hurried nature of most medical appointments makes it hard to get a word in.

I’m not saying that doctors aren’t the experts—they are.  But we do ourselves a disservice when we don’t speak up about our treatment preferences—never asking if there may be a more effective treatment, or one with fewer side effects or a lower cost, never challenging our doctors to see us as individuals.  When we rely solely on our doctors’ opinions, we run the risk of getting care that doesn’t address our individual needs.

In public health, our campaigns often urge people to “talk to your doctor” about various disease or treatments. But, perhaps it’s time for us to focus not only on starting the conversation, but empowering patients to participate in meaningful, two-way conversations with their doctors—helping patients believe that they have the right (and the responsibility) to ask questions, assert their opinions, and challenge themselves and their doctors to a higher standard of care.

Come Dance With Me

Jun 14

Me: “Hi, I’m Alex and I’m a ballerina.” Other: “Ballet, huh? Uhh, I’ve seen ‘Black Swan!’”

Now believe me, as a former ballet dancer, I am thrilled when the art to which I have dedicated years of my life in the studio is brought to the center stage of mainstream media. In the past few years, we have had an inundation of films and TV shows, which show dance through a somewhat unfiltered lens:  “First Position,” “Black Swan,” ABC Family’s “Bunheads,” CW’s “Breaking Pointe,” FOX’s “So You Think You Can Dance,” and Lifetime’s “Dance Moms.” The list goes on but their messages are myopic and more or less the same:  dance is hard, unforgiving, and the moms are crazy.

That’s why it was like a breath of fresh air when I saw this video posted to the New York City Ballet’s Facebook page a few weeks ago.

The song, “Man on Fire” is the lead single from the Indie-folk band Edward Sharpe and the Magnetic Zeros’ recently released album Here. Shot in New York City in May, it features just about every kind of dance from the New York City Ballet, NY Junior Destiny Allstars, National Double Dutch Junior League, Soul Steps, and Brooklyn Divas, among others. Also, let’s please take note of the portrayal of supportive parents and coaches.

Amidst the dramatic, exclusive, and competitive dance world we’ve seen so much of on TV lately, this video truly positions itself as separate from the mix, pointing to something beyond dance life in a studio.

With its faded colors and sparse composition, it doesn’t take itself too seriously.  Its message is simple and straightforward, yet powerful:  dance is everywhere, it’s transformative, and anyone can do it. Now I don’t mean to underestimate the work and commitment that goes into the pursuit and maintenance of a professional dance career, however, what ever happened to just dance—as exercise, as a mental and physical release, as an expression of spontaneity and personality?

One of my former dance teachers Liz Lerman, founding artistic director of Dance Exchange and a 2002 MacArthur “Genius Grant” Fellowship awardee, understood what Sharpe coveys in his video:

“Sometimes art achieves what therapy, medicine, or the best of health professionals cannot…inspiring motivation, engaging parts of people’s bodies or brains that they haven’t been using, or allowing them to transcend their environments for a little while.”

Lerman’s work, supported by MetLife Foundation Healthy Initiative, concentrates on two main areas:  1) arts in healthcare settings combining movement, verbal expression, creative challenge, and collaboration among patients with Huntington’s disease, brain injury, addiction, etc., and 2) integrating dance, which is easily adaptable for different bodies and ages, into activities for adults over 50.

In its third year, the MetLife Foundation Healthy Living Initiative at Dance Exchange has supported the incorporation of art programs, namely dance, into the medical and health/wellness fields to people nationwide. Arts integration has been shown to improve the quality of the healthcare experience for patients, their families, and for the health professionals who serve them, reporting benefits such as shorter hospital stays, less medications, and fewer complications.

This partnership between the Healthy Living Initiative and the Dance Exchange is a step in the right direction to making arts accessible to all ages and promoting dance as an art form that can enhance lives to be more productive and healthier for the mind and the body through the creative expression of movement.

To give some scientific backing, the National Institute on Aging funded a 2003 study published in the New England Journal of Medicine, reporting that in addition to the numerous physical benefits from dance, it is also the only physical activity to provide protection against dementia, and offered the greatest risk reduction of any activity studied, cognitive or physical.

Schools are also integrating dance programs—the National Dance Association’s work with First Lady Michelle Obama’s Let’s Move campaign, entitled Let’s Move in School, educates youth about the benefits of a creative, healthy lifestyle; and the Washington Ballet’s DanceDC has an in-school program which serves young people in all five wards of the District to offer extensive education, physical activity, and engagement through dance.

The bottom line is that dance doesn’t always have to be in a studio to be called dance.  Maybe you’ll turn on the radio and dance with your kids before dinner, maybe you’ll have a little dance party of your own while you’re washing the dishes, or who knows you may happen upon an alley in the middle of New York City with the corps de ballet of the New York City Ballet. Whatever form it’s packaged in, dance can achieve something unexpected and unparalleled for individuals and communities alike. So, come dance with me.

Making mHealth a Reality

Jun 14

We’ve all had at least one frustrating experience with the health care system. A moment where you’re left thinking: “There has to be a better way of doing this.” For me, these moments often come when the paper-filled world of health care doesn’t jive with my increasingly mobile-based lifestyle. (You can count me in the 35% of all U.S. adults who own a smart phone.)

Mobile health (mHealth) technology offers a potential solution to connecting an increasingly mobile population (83% of U.S. adults own a cell phone) to our experiences with the health care system.

For me, this means a world where after you visit your doctor, the name and dosage of your prescriptions are transferred from your doctor’s electronic health record system to an application in your phone, along with the name of the condition you’re being treated for. The condition links over to a website trusted by the physician that has more information about that condition, which you can read on your own time. From there, you can send your physician additional questions you have through a secure messaging system. That same app would also allow you to enter your symptoms as you experience them, so you aren’t stuck trying to recall their frequency and intensity at your next appointment.

All of this and much more could be possible in the near future, according to a new report from PwC resulting from interviews with 1,805 patients, physicians and health care payer executives. Patients surveyed for the report said they thought mHealth would help improve the convenience (52%), cost (46%), and quality (48%) of their health care within the next three years. Sixty percent of the physicians and payers surveyed said that widespread adoption of mHealth is inevitable.

Despite agreement that mHealth is coming, people interviewed for the report noted there are substantial hurdles to jump through before we’ll see widespread adoption of mHealth solutions. According to the report:

  • mHealth will require a big shift in how the health care system operates—and most health care systems hate change. mHealth tends to focus on prevention and, unfortunately, most health care systems don’t reimburse enough for prevention.
  • Players within the health care system—health care providers, patients, payers—all have different interests in mHealth and these differing interests will make it challenging to implement solutions.
  • For mHealth adoption to become widespread, any solutions must appeal to payers, because patients are “highly sensitive to price” and won’t be willing to foot the bill for mHealth technology.

The report offers several recommendations for overcoming these hurdles. The two that resonated most with me:

  1. In developing mHealth solutions, focus on actually providing a solution to a business problem; don’t focus on what technology can do. In my work, we say this all the time: Don’t focus on the tactics, focus on the strategy. From there, the best tactics to achieve the strategy will follow.
  2. mHealth creators should build partnerships to create solutions that can be part of an mHealth ecosystem rather than stand on their own. These partnerships can help identify the best ways to implement a solution and move its adoption along. Interoperability with other mobile health solutions is one of the ingredients to a successful mHealth model, says the report.

All that said, even a perfectly designed mHealth solution requires something bigger to be successful: it requires behavior change on the part of everyone involved in the health care system. All physicians will need to be electronic so that data can be shared with their patients, and they’ll need to input quality data so patients understand what they are reading. Payers will need to provide incentives, likely financial, for physicians to be active participants in making these solutions work. Finally, patients will need to take an active role in their care: using mHealth solutions to track their symptoms, interact with their physician and research their conditions (in other words, become a “quantified patient”). All of this will take time, but like the people interviewed for the PwC report, I believe we will get there.

Photo credit: Alvimann from morguefile.com

Messages About Sun Protection and Skin Cancer Must Include People of Color

Jun 07

With the official start of summer approaching in the next two weeks the thought of outdoor events and relaxing vacations fill my mind. When the summer sun hits my skin I immediately feel happy. I’m ready to throw caution to the wind and hit the beach – which is exactly what I did last weekend. I had perfect beach weather in Fort Lauderdale, Florida.

After enjoying a day of lounging and playing in the ocean I noticed my friend, a fair-skinned African American woman, with a nice red glow. She’d forgotten to apply sun screen and had a pretty serious burn. Her painful predicament reminded me just how important sun protection is, and how sharing this message with everyone, especially people of color, can save a life.

Last month The Huffington Post posted the article, Skin Cancer and African Americans: Why You Shouldn’t Ignore It that focused on this topic.

According to the Skin Cancer Foundation, skin cancer comprises just 1 to 2 percent of all cancers among African Americans, but less than half of melanomas in African Americans are diagnosed at an early stage compared to 74 percent in Hispanics and 84 percent in Caucasians. Reggae music lovers may remember that reggae legend Bob Marley discovered a type of malignant melanoma under the nail of one of his toes, and the cancer ultimately spread to his lungs and brain causing his death 31 years ago.

While skin cancer is less likely in people of color, it is more deadly because it is most often caught in its later stage. The article also provides an interesting slide show to address the most common misconceptions about cancer in dark skin, such as black people don’t get skin cancer (we do!) and dark skin is a natural SPF (not entirely true!).

Even the American Medical Association (AMA) has adopted the cause. In 2010 the AMA established a policy to support and encourage efforts to increase awareness of skin cancer risks, skin cancer screening and sun protective behaviors in communities of color. The policy includes partnerships with the National Medical Association, the National Hispanic Medical Association and the American Academy of Dermatology to get the word out about the importance of sun protection.

The Centers for Disease Control and Prevention provides the following tips on ways everyone can protect their skin from the sun:

  • Take precautions against sun exposure every day of the year, especially during midday hours (10 a.m. – 4 p.m.), when UV rays are strongest and do the most damage. UV rays can reach you on cloudy days and can reflect off of surfaces like water, cement, sand, and snow.
  • Seek shade, especially during midday hours.
  • Cover up with clothing to protect exposed skin.
  • Wear a hat with a wide brim to shade the face, head, ears, and neck.
  • Wear sunglasses that wrap around and block as close to 100 percent of both UVA and UVB rays as possible.
  • Put on sunscreen with broad spectrum (UVA and UVB) protection and a sun protective factor (SPF) of 15 or higher.
  • Avoid tanning beds and sunlamps. The UV rays from them are as dangerous as the UV rays from the sun.

I plan to share these tips with my friends and hopefully this weekend we’ll avoid sun burns!

What are sun protection habits you use regularly? Do you encourage friends and family to do the same?

With Summer Comes Hurricane Season

Jun 01

Today marks the first day of the Atlantic hurricane season, which lasts through November. Today the media is abuzz with the question “are you prepared?” with various experts explaining the steps individuals should take to prepare for hurricane season:

  • Build and emergency kit: In addition to your flashlights, batteries, and canned food, do you have a few days of any prescription medications? Food for your pets? A battery operated weather radio?
  • Make a family communication plan: Where will you meet if you get separated from your family? Do you have an out-of-town contact who can act as a communications liaison for your family?
  • Know your evacuation route: Do you know where you would go, if you need to evacuate? How about the best way to get there?
  • Determine your flood risk: Are you near a levee, dam, or body of water? Are you within a storm surge zone? Do you have flood insurance?
  • Have a plan to secure your property: as the folks at the Federal Alliance for Safe Homes (FLASH) will tell you, tape won’t protect your windows during a hurricane or tropical storm. Do you have storm shutters or plywood? Do you knave a place to tie down your patio furniture or a place to put it away?

There are a number of social marketing and risk communications efforts underway to help people understand and prepare for the hazards of hurricane season, from Ready.gov to the National Oceanic and Atmospheric Administration’s Hurricane Preparedness Week to FLASH’s Go Tapeless campaign. Each campaign takes a different approach to helping the public understand their risk and encouraging them to act. But each clearly employs foundational risk communication principles: a trusted source providing actionable steps the public can use to mitigate their risk.

But I wonder if more attention ought to be spent on understanding risk. In Florida, studies have shown that those at the highest risk underestimate their hazard, while those at low risk are more likely to overestimate the danger they face from hurricanes. Countless times, I have tried to explain to my parents that they live in a coastal area and ought to consider flood insurance. Every time they tell me that they can’t see the water from their house—it could never reach them. So if they have no incentive to prepare…are all these campaigns white noise to them? How do we educate people on risk, in order to get them to prepare?

Two questions remain. Do you know your risk? Are you prepared for hurricane season?

Kitty Harding at the National Hurricane Conference

Ride or be ridden.

May 31

Control diabetes or let it control you.  That’s a rallying cry for the “Red Riders” who cope with Type I and Type II diabetes and will be participating in the American Diabetes Association’sTour de Curethis weekend on June 3rd.

The group knows all too well the importance of exercise and staying in shape when dealing with this potentially deadly condition. They’re taking to the roads in Virginia with 1,500 other riders –including an Ogilvy Team!—to generate funding for diabetes research, advocacy, and information programs.

Last week, the news on diabetes could not have been more stunning.  A report published in the journal Pediatrics indicated that, in less than a decade, the numbers testing positive for diabetes or pre-diabetes jumped from nine percent to 23 percent of American teens. That’s nearly one in four.

The risks from diabetes are huge—kidney failure, vision loss, amputation, stroke, heart attack, and nerve damage.  It’s a heavy prospect for a person at any age.  But it’s particularly frightening to consider what such a large number of youth are facing so early in their lives.

The situation is one more resounding alarm for embracing a healthy lifestyle.  As a parent, it’s a reminder for me to be a good example to my kids; to get them to eat a vegetable by doing so myself; to lead from the front by dropping the bag of chips and jumping on the bike. Just like those Red Riders.

Is Your Life Glass Half-Empty or Half-Full?

May 24

Credit: NYimes, Yvetta Fedorova

Credit: Yvetta Fedorova

In both our personal and professional lives, we all encounter situations where the perception of our life glass is either half-full or half-empty. Our response to that age-old question helps to define us as individuals, as well as inform our personal outlook on life. I have been an optimist my entire life, for better (always seeing the good in people) or for worse (even when I shouldn’t), continually looking on the bright side of life (not to quote Monty Python). But, I never thought about the health benefits of my personality traits until now.

Earlier this week, Jane Brody, Personal Health and Wellness contributor to The New York Times, wrote a blog post on optimism and its various health benefits. While reading her blog, it made me think, “How can optimism actually make me healthier?”

In her blog post, Brody talks about “Breaking Murphy’s Law,” by Suzanne C. Segerstrom, a professor of psychology at the University of Kentucky, who explains that “optimism is not about being positive so much as it is about being motivated and persistent.” She adds that people can become more optimistic by simply acting as if they were more optimistic, providing some support for the notion of positive thinking.

An example of this persistence in the sports world is clear in a recent tweet on May 1 from Drew Brees, a spokesperson for Ogilvy Washington’s client, the President’s Council on Fitness, Sports & Nutrition (PCFSN): “Just enjoyed a lunch with Billie Jean King in DC between PCFSN meetings. Quote of the Day from her: Failure is not failure, its feedback.” I am sure that this positive perception on failure helped Ms. King overcome any challenges in her amazing tennis career.

The Mayo Clinic notes that “optimism is the belief that good things will happen to you and that negative events are temporary setbacks to be overcome.” In a study the Clinic released in May 2011 entitled, “Positive thinking: Reduce stress by eliminating negative self-talk,” the overwhelming physical and mental health benefits of positive thinking are discussed, including (but not limited to):

  • Increased life span
  • Lower rates of depression
  • Lower levels of distress
  • Better psychological and physical well-being
  • Reduced risk of death from cardiovascular disease
  • Better coping skills during hardships and times of stress

While the study is unclear as to why positive thinking provides these health benefits, it does theorize that perhaps a positive outlook allows individuals to better handle stressful situations and thus reduce the harmful effects of stress.

To help develop a more positive outlook on life (for those pessimists or realists out there), the Mayo Clinic identified six ways to lead a healthier lifestyle:

  • Identify areas to change
  • Check yourself
  • Be open to humor
  • Follow a healthy lifestyle
  • Surround yourself with positive people
  • Practice positive self-talk

As part of my resolution for 2012 (yes, I know, I am a little late), I will try to incorporate at least three ways to lead a healthier lifestyle (listed above) into my daily life. What will you do?

*For applications on Optimism and Social Marketing, check out Lisa Charnitski’s blog post from January 2012.

“Gamifying” Weight Loss and Behavior Change

May 21

We all know that weight loss is a simple equation – more calories expended than consumed. Eat healthy and increase physical activity. But if it was that easy to change behavior, break habits, and stave off cravings, then we would not be facing the problem of obesity among over one third of all adults in the U.S.

Last week, amidst all of the Weight of the Nation buzz, an article in The New York Times caught my eye. Nicole LaPorte’s article, “Dieting for Dollars (or Maybe a Movie Ticket),” presents a few important ideas:

  • “Gamification,” or applying techniques from games and psychology, can change real world behavior. The IBM engineers featured in the article wanted to make weight loss fun, so they took inspiration from their favorite video games to develop a program that helps with weight loss every step of the way.
  • Real time encouragement and feedback is key. The IBM program takes a card from the Honda Insight hybrid and gives immediate feedback on behavior – meaning someone is “scolded” when they eat a candy bar but praised when they opt for a salad.
  • Tangible rewards don’t hurt either. Beyond the encouragement, the program offers actual incentives like money and movie tickets as a reward for successful weight loss.
  • Workplace participation and support means success. IBM envisions the program being offered by health insurance providers through workplaces, meaning employees are encouraged to get up and take a 15 minute walk at lunchtime, or bike into the office. Institutionalizing healthy living and weight loss encourages actual lifestyle changes rather than fad diets.

Gaming is being applied more and more often in social marketing – and not just in the weight loss arena. For more posts about the use of games to change behavior, check out these previous posts: Using Games in Social Marketing and Modifying Behavior Through Video Games.

image from istockphoto.com

Effective Communication Strategies Can Help Reduce Non-Communicable Diseases

May 18

This blog was co-authored by Maria James and Carrie Dooher.

Chronic diseases, often referred to as “lifestyle” diseases, including heart disease, stroke, cancer, diabetes, and arthritis – are among the most common, costly, and preventable of all health problems in the U.S. and also the leading causes of death and disability. According to the Centers for Disease Control and Prevention (CDC), four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early death related to chronic diseases. Specifically with regards to obesity, just last week the CDC released a new report published in the American Journal of Preventive Medicine warning that 42 percent of the U.S. population will be obese by 2030 – while that may seem to be some time in the future, that’s actually just 18 years away.

But this is not just an issue that afflicts the U.S.; it is a global epidemic estimated to kill 36 million people a year and is so important and acute that in 2011 for only the second time in its history, the United Nations (UN) addressed the prevention of non-communicable diseases, or NCDs, at their General Assembly meeting to set a new international agenda on the prevention of NCDs. The first and only other time that the UN General Assembly met on a health issue was to discuss the world epidemic of AIDS.  World leaders joined Health and Development Ministers in the consensus adoption of a wide-ranging Political Declaration on the prevention and control of NCDs; this Declaration’s implementation will be evaluated in 2014. And progress is already beginning to be benchmarked against it – on May 16, the World Health Organization released new data highlighting increases in hypertension and diabetes incidence around the world in anticipation of the World Health Assembly, to be held in Geneva from 21 to 26 May 2012, which will consider progress made from last Septembers meetings. In addition, the World Health Assembly will continue discussions about developing a global monitoring framework and a set of voluntary targets for prevention and control of these diseases.

While there are many disciplines considering solutions to NCDs, one that should not be ignored is social marketing. As an effective health promotion strategy, social marketing can be, and has been, used to motivate people to use health information and change behavior in ways that promote and maintain good health. And a critical step in creating positive behavior change to impact health is simple, science-based, behavior-focused communication messages on nutrition and health.

On May 1st, the International Food Information Council (IFIC) Foundation announced the publication of the proceedings from its 2011 Global Diet and Physical Activity Communications Summit: “Insights to Motivate Healthful, Active Lifestyles,” in the May 2012 issue of the peer-reviewed journal Nutrition Reviews, stressing again the need for health communicators to be part of the solution in addressing NCDs. As U.S. Surgeon General Dr. Regina M. Benjamin stated in the keynote address at IFIC Foundation’s Global Summit in September 2011, there is an essential need for communicators of global health to provide clear, simple information based on the latest science, to stress prevention and to employ a comprehensive, holistic approach to combating non-communicable diseases or NCDs.

Along with the release of the Nutrition Reviews article, last week the IFIC Foundation also released a helpful one-page fact sheet entitled, “Communication Strategies to Help Reduce the Prevalence of Non-communicable Diseases.” The fact sheet combines the key findings from the Summit into 10 helpful tips for communicating health messages with consumers.

The top five tips include:
1.    Use easy to understand messages.
2.    Set realistic goals.
3.    Connect with children early in life on how they can succeed.
4.    Focus on “how to do it” instead of “what to do.”
5.    A key message should be “do something.”

When the UN measures progress in 2014, what are your thoughts on how far we will have come?