The Hidden Challenges of Dieting

Bad eating habits and poor diets are major health concerns in our society. Some of the most common diseases in our culture relate to how and what we eat -- coronary heart disease, diabetes, and obesity. As a result, many people try, often times unsuccessfully, to change their diet. There are a variety of diet guides to help people make the transition from an unhealthy diet to a healthy one. The themes are pretty consistent in these guides--the major goal to successfully dieting is willpower. A Google search on "how to diet successfully" will yield results for a popular web site that suggests boredom "is one of the main reasons that people give up their diets." Many people state self-control and willpower are the keys to a successful diet.

However, recent research has found that there are external factors that influence eating behavior which people are unaware of. The research, conducted by health psychologists, found that environmental factors can influence people's food intake. For instance, there is a strong relationship between the "presence and behavior" of other people and an individual's eating habits. A person is more likely to increase their food intake when there are more people eating with them, especially if those people are also eating large portions of their meal. Additionally, the portion of food people get influences how much they eat. If a person is served a smaller amount of food on a smaller plate, they are just as likely to feel full and satisfied as someone served with a larger plate with more food. This studied verified these claims, but went further by giving participants a survey to assess how much they were aware of the external influences of their eating habits. Nearly every participant said they ate how much they ate because they were hungry or that the food tasted good, even though the external factors had a significant influence on their eating habits. Overall, people were unaware of these external factors, even as it clearly led to certain eating habits.

Another study assessed the perception of eaters who ate from larger soup bowls. Participants were given large soup bowls that measured how much a person ate in comparison with participants with smaller soup bowls. The participants with larger soup bowls ate substantially more soup, 73% more, which was equivalent to 113 additional calories. However, those participants, on average, stated that they ate only around 4 calories more than the participants with smaller bowls. Obviously, the portions of food people get will influence how much they eat without them noticing exactly how much they are eating.

People will overeat without realizing they are doing it. Most importantly, they are unaware of the factors influencing higher food intake. "Willpower" cannot overcome factors that people are completely unaware of while they are eating. The researchers concluded "if external environmental factors influence people's food intake without their awareness or acknowledgement, then maintaing a healthy diet can be a challenge." There are hidden challenges to dieting that go beyond internal food desires.

Tom Daschle's Health Care Views

Former Senator Tom Daschle will be President-Elect Obama's Secretary of Health and Human Services. The Wall Street Journal looked through Daschle's book, Critical: What We Can Do About the Health Care Crisis, and reported on Daschle's health care views.



Tom Daschle's book can be found here.

Manasota World AIDS Day

Manatee and Sarasota counties participated in World AIDS Day 2008 today. The goal of this world-wide campaign is to bring attention to the AIDS epidemic. In keeping with the spirit of the event, I would like to bring up some important information regarding the global epidemic of HIV/AIDS.

In 2001, a United Nations and World Health Organization survey found that 40 million people are infected with HIV/AIDS. It is estimated that 60 million people have been infected with the virus since the start of the epidemic. The researchers wrote, "Twenty years after the first clinical evidence of acquired immunodeficiency syndrome was reported, AIDS has become the most devastating disease humankind has ever faced."

Advances in the treatment of HIV/AIDS have not been matched with "enough progress on the prevention front," according to the UN and WHO survey. The survey calls for prompt, focused prevention efforts, especially in developing countries where over 50 percent of young people (those between the ages of 15-24) "have never heard of AIDS or harbor serious misconceptions about how HIV is transmitted." These countries include the Dominican Republic, Bolivia, Ukraine, and Vietnam.

In the year 2000, approximately 3 million people died from HIV/AIDS. An estimated twenty thousand lived in North America.


According to the CDC, in 2003, an estimated 1,185,000 people in the United States were living with HIV/AIDS. Most shockingly, 24-27% of those living with HIV were undiagnosed and unaware of their infection.

In 2006, the most amount of AIDS cases were found in adults between the ages of 40 and 44 in the United States, with an estimated 7,298 cases. Adults between the ages of 35 and 39 had the second most number of cases, followed by adults between the ages of 45 and 49.

New York had the highest number of AIDS cases in 2006, with 5,495 being reported. Florida had the second highest reported number of AIDS cases in 2006, with 4,932 cases being reported.

It is estimated that 448,871 people are living with AIDS in the United States.

A reported 59,139 people have died from AIDS in the state of Florida.

For more information, please visit worldaidscampaign.org or any of the links found above.

To get more involved with the AIDS campaign, visit this web site.

History of Public Health

Community life has been at the center of public health throughout its history. Many major health concerns deal with community characteristics and conditions. For instance, the control of disease, the conditions of the physical environment, the quality and supply of water and food, medical care, disaster relief, and support for disabled or less wealthy citizens are all factors dealing with community health. Interestingly, these community health factors were addressed in civilizations dating as far back as 2100 BC. Community cleanliness and hygiene were important to Egyptians as early as 4500 years ago. Egyptian neighborhoods would “purify” the city by cleaning buildings inside and out, disposing of waste, and carrying out health ceremonies to rid the community of diseases.

The major health problems that we face today are very similar to the health problems humans encountered thousands of years ago, such as sanitation, spread of disease, and disaster relief. Although humans have experienced health problems all across the world and for thousands of years, some communities are affected differently by health problems. Throughout human history, societies that have focused on community health have been more successful at creating living conditions that protect the health and well being of its citizens. Researchers have found that these communities are usually more capable of controlling diseases, preserving water quality, and withstanding natural disasters. Longer life expectancy and lower infant mortality are usually the outcome.

Greek literature discussed the importance of healthy communities and environments as early as 400 BC. Hippocrates wrote that “ill-health developed when there was an imbalance between man and his environment." In his later book, Airs, Waters and Places, Hippocrates discussed the relationship between environmental factors and disease. He talked about how water and air quality, diet, and weather can affect the spread of disease.

Over 2000 years later, public health is still rooted in the community. However, there have been major advances in modern public health. Between 1880 and 1900, scientific investigators discovered a variety of pathogenic diseases, from typhoid and malaria to the plague using laboratory technology, such as light microscopes. The physical discovery of these diseases led to experiments that tested the behavior of these species and the possible treatments for fighting deadly pathogens. Our understanding of contagious diseases was based on the incredible amount of research conducted during the late 19th century and early 20th century. Researchers soon found that mosquitoes, ticks, and rats could quickly and easily spread diseases and used this knowledge to help prevent the spread of diseases, especially in urban environments. The development of vaccines during this time period went far to protect large populations from some of the most deadly diseases.

In the late 20th century, public health policy started to focus on the social factors that increase the risk of negative health conditions in certain populations. Health inequalities, education, and poverty received more focus from health specialists as researchers investigated the significant health differences found across communities. In the United Kingdom, approximately 20% of its health services budget goes to dealing with social and environmental conditions, such as unemployment, poverty, housing, and pollution.

Presently, public health encompasses a variety of different programs. Medical doctors, disaster relief workers, environmental groups, health educators, transportation planners, and public works experts all contribute to the field of public health. The goals of health programs are to protect citizens from health problems and to promote positive health behavior, whether it is through vaccinations or focusing on providing health services to at-risk groups. Most importantly, public health is, and always has been, about the community.

Transportation and Health Part III

One way to reduce the health consequences of traffic is to walk or cycle. Walking and cycling is a form of exercise and studies have shown that there are tremendous health benefits from participating in these activities. Health benefits include—

• a 50% reduction in the risk of developing coronary heart disease
  
• a 50% reduction in the risk of developing adult diabetes
  
• a 50% reduction in the risk of becoming obese
  
• a 30% reduction in the risk of developing hypertension
  
• reduced osteoporosis
  
• decline in blood pressure in people with hypertension
  
• relief of symptoms of depression and anxiety
  
• prevention of falls in the elderly

However, walking may not be something that is convenient or enjoyable. It depends greatly on location. Community planners use the term “walkability” to measure walking conditions in an area. There are a variety of factors that affect the walkability of a specific area. Perception of safety, population density, street connectivity, amount of retail, size of sidewalks, aesthetics of the route are just some of the factors. People want to feel that walking is worth it, so they seek safe and enjoyable routes. The most walkable routes focus on pedestrian traffic rather than vehicle traffic. For instance, larger sidewalks will make people feel safe from vehicle traffic and also increase the flow of pedestrian traffic.

Just like the traffic engineers who use Level-of-Service (LOS) measurements to assess the quality of roadways, community planners use Level-of-Service measurements to assess the quality of pedestrian routes. These measurements are often based on whether routes are convenient by looking at how routes connect with each other. Planners look at how easy it is for people to get from one destination to another. Planners also look at how dense pedestrian traffic is and whether sidewalks are providing ample amount of space for a good flow of traffic.

One popular walkability measurement looks at how far someone would have to walk to retail areas, schools, parks, libraries, and other sites. The website, walkscore.com, uses this measurement to assess how walkable an area is on a scale of 1-100. Downtown Sarasota is considered a “Walker’s Paradise,” with a score of 95 (depending on which area of downtown). However, the score drops significantly in the neighborhoods surrounding downtown. On Fruitville and Tuttle, the walkability score drops to “Somewhat Walkable” with a score of 52. This is a neighborhood that is just 1 mile away from downtown. Most dense suburban neighborhoods have a walkability score in the 40s and 50s, especially if retail plazas are nearby. Some areas of the county have a "Car Dependent" rating in the low 30s. Desoto Road and 301 received a 31. So, while many areas of downtown are highly walkable, the vast majority of residents are not in a highly walkable location.


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Walking and cycling make you active and provide numerous health benefits. However, for walking and cycling to be a major form of transportation, people need to have an environment that is walkable. This includes higher quality sidewalks, more convenient bike and walking trails, and community planning that focuses on the pedestrian.

More information:
Pedestrian LOS

Transportation and Health Part II

Transportation deals with environmental health in many ways. One of the most obvious ways is that traffic creates noise. Noise also creates problems. Noise pollution can easily cause stress and frustration for individuals. One of the major consequences to traffic noise is disturbed sleep. Not only can it be more difficult for an individual to fall asleep with a lot of traffic noise, but quality of sleep also decreases. Lack of sleep can cause fatigue, depression, and decreased performance. Traffic noise can interfere with memory, attention, and focus. Studies have shown that an increase in background noise decreases the ability for a person to solve analytical problems. Other studies show that aggression increases as noise increases. Aggression and stress can lead to heart disease and hypertension. Some noise pollution can cause hearing impairment. Overall, traffic noise is annoying and people go to great lengths to reduce their exposure to it.

A major environmental health issue dealing with traffic is air quality. According to a major study, traffic increases the amount of “particulate matter” in the air, which leads to “increased mortality, increased admissions to hospital for respiratory and cardiovascular diseases, increased frequency of respiratory symptoms and use of medication by people with asthma, and reduced lung function.” Vehicle exhaust also has health consequences. Studies have found carcinogens in diesel engine exhaust and have found higher rates of cancer among people who work around exhaust fumes. Vehicle exhaust also has a detrimental affect on our atmosphere. Carbon dioxide is a well-known air pollutant that is reported to be one of the major causes of climate change on Earth.

Hundreds and thousands of deaths across the world are attributed to air pollution. Respiratory disease has increased as more and more people are suffering from asthma and bronchitis. The World Health Organization wants stricter standards on vehicles to reduce the amount of air pollution caused by traffic each day.

Our psychological and social health are also tied to transportation in a variety of ways. Traffic can cause stress, aggression, and nervousness. An interesting quote from a study on aggressive driving behavior states, “the car has been described as an instrument of dominance, with the road as an arena for competition and control. The car also symbolizes power and provides some protection, which makes drivers less restrained.” Furthermore, accident victims experience long-term physical injuries, but also psychological problems. Long-term stress from motor vehicle accidents is common, even when there are no injuries from the accident. Some people experience trauma after a major accident, oftentimes having flashbacks or nightmares. A social consequence to driving is reduced social life. Researchers have noted that “close-knit communities have given way to neighborhoods that do not encourage social interaction, and this has resulted in increased social isolation.”

Overall, traffic has serious health concerns – from direct environmental effects to lower quality of life due to traffic noise and stress.

Transportation and Health Part I

In a previous blog post, I discussed the relationship “place” has with public health. I explained that there are many characteristics of a specific location that affect the health and well being of its citizens. In one example, I talked about the role transportation has for providing citizens with access to quality and affordable health care. Transportation has a large role in the health of a community, much larger than just providing health care access to citizens. I will be focusing on the connection between public health and transportation over the next few blog posts. This post will focus on traffic safety while the following posts will discuss environmental health issues and walkability.

Traffic safety is important. Motor vehicle fatalities are the leading cause of death for Americans under the age of 34. The highest rate of driving fatality occurs between the ages of 21 and 24. More experienced drivers are less likely to get into a fatal crash, however, more than 37,000 people each year die from a motor vehicle accident.

A significant proportion of motor vehicle deaths and injuries involve pedestrians and cyclists. Pedestrians and cyclists account for thirty-five percent of motor vehicle deaths and twenty-one percent of motor vehicle injuries.

Many accidents tend to occur in built-up areas where more pedestrians are affected. The highest risk areas for pedestrians and cyclists are on minor roads, especially around intersections. Sadly, schools and neighborhoods are often situated off these arterial roads, putting children at risk.

There are a variety of reasons for why traffic accidents occur. The three major reasons are the road, the car, and the driver. Roadway designs can greatly affect the rate of accidents in a certain area. Some roadways are better designed than others. The space between lanes, the length of merge lanes, whether there is a stop sign or traffic signal at an intersection, placement of traffic signs, posted speed limits, and roadway visibility are just some of the many variables that affect the safety of certain roads. Oftentimes, roadways are engineered exceptionally well, but over time, population growth, nearby development, and changes in traffic behavior put stress on roads and intersections. Interestingly, some transportation planners make roadways more dangerous to decrease risky driving behavior. Two ideas for making Tamiami Trail safer was to decrease the width of each lane or put roadside parking on the Trail in the downtown area. This would slow down traffic and force drivers to be more aware of their surroundings. It is what engineers call “traffic calming.”

Traffic engineers measure the quality of road infrastructures through a Level-of-Service (LOS) assessment that measures traffic flow on an A-F scale, F being the worst rating. Newly designed roads often score an A or B, even during rush hour. However, overtime, LOS ratings tend to drop as roadways reach their capacity. Many of Sarasota’s roadways have a D or F rating during rush hour. Low ranked roads can have serious safety issues, especially to pedestrians and cyclists. Driver stress and road rage increases at lower LOS ratings and many driving maneuvers become riskier.

Cars are often the cause of an accident. Popped tires, breakdowns, weak brake pedals, etc. There are many new car features on the market that have been proven to decrease vehicular accidents. Electronic stability control (ESC) is a newer feature that detects whether a vehicle is exceeding its handling capabilities. If a vehicle were at risk for losing control, the electronic stability control technology would reduce engine power and automatically apply braking power to individual wheels. ESC is only standard on some vehicles and optional in others. Car manufactures are also making vehicles safer for pedestrians in case there is an accident by designing the front-end of a vehicle in a certain way to decrease the force of impact on a pedestrian.

However, drivers are nearly always the primary cause of an accident. Speeding, reckless driving, impaired driving, road rage are all driving risks that the driver can avoid. The most common type of accident in Sarasota County are rear-end collisions. This type of accident is usually caused by a driver who was not paying attention. The most accident-prone intersection in Sarasota County is Center Road at U.S. 41.

Overall, traffic safety is a major concern. Deaths and injuries to drivers, passengers, pedestrians, and cyclists occur too often and can be easily avoided. Traffic engineers and city officials are always working towards improving roadways, car manufacturers are putting a large emphasis on safety features (not only features that protect individuals in case of an accident, but prevent accidents in the first place), and police officers and traffic safety campaigns are being aimed at stopping and preventing bad driving behavior. The life and safety of many residents are tied to transportation safety.

More information:
National Highway Traffic Safety Administration
Pedestrian Safety in Florida