NATION'S HEALTHThe Official Newspaper of the American Public Health Association March 2005

• • K)lQ by Stephen Chemin, courtesy Getty Images

A grocery worker arranges avocados at a New York City store inJanuary. Neiv federal dietary guidelines encourage Americans toconsume four-and-a-half cups of fruits and vegetables each day.

Educational outreach urged jbr public

New dietary guidelines advocatephysical activity, calorie control

T HE FEDERAL government's new "Dietary

Guideiines for Americans" were released in

January, receiving widespread praise for a height-

ened focus on physical activity and caiorie control

as well as an emphasis on eating fniiLs and vegetables.

However, advocates warn that the guidelines could yield

little progress without effective outreach and marketing.

Revised every five yearssince their debut in 1980,the 2005 dietary guidelinesare Iseing touted as a blue-print for action in the fightagainst obesity. Nearly two-thirds of Americans areoverweight or obese, andfederal officials are hopingAmericans will take heed of

the new recommendationsto not only lose weight, butprevent obesity-relatedhealth conditions. Federaldietary guideiines helpform the basis of govern-ment food-assistance

See DIETARY GUIDES,Page 10

President's2006 budgetproposal badnews forpublic health

RESIDENT

Bush's proposed

budget for fiscal

year 2006 is woefully short-

sighted in its cuts to public

health and prevention,

according to a wide spec-

trum of health advocates.

Unveiled Feb. 7, thepresident's budget proposalincludes a total of $642 bil-lion for the U.S. Departmentof Health and Human Ser-vices and its related agen-cies — an increase of $58billion over fiscal year 2005.However, within the HHSbudget is a proposed cut of$550 million, or nearly 7percent, for the Centers forDisease Control and Preven-tion, including a $60 millioncut to the agency's chronicdisease prevention andhealth promotion program.The funding numbers fail toreflect the growing need forprevention, as the nation'stop killers — heart disease,cancer and stroke — are

See 2006 BUDGET,Page 21

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Living longer, stronger in later years

Nuttitioii, exercise essentialcomponent for healthy agingFirst in an in-depth series on healthy aging in conjunction withAPHA's National Public Health Week 2005. The event, whichwill be held April 4~W, focuses on "Empowering Americans toLive Stronger, Longer!" Visit <www.apha.orgjnphw> for details.

A S THE LIFE expectancy of Americans

continues to increase, the pressing concern

for many public health professionals has

shifted from living longer to living healthier. Good nutrition

and physical activity are integm! parts of the healthy living

equation, and as such, researchers are always searching

for innovative ways to instill healthy behaviors.

The importance of pro-moting healthy agingbehaviors is gaining moreground every day as healthprofessionals ready them-selves for the coming waveof older baby boomers. By2030, about 20 percent ofthe U.S. population willhave reached age 65, andniany will face the nation'stop three killers: cancer,heart disease and stroke.The three conditions werethe leading causes of deathamong older Americans in2000, causing 60 percentof deaths among thoseages 65 and older, accord-ing to the "State of Agingand Health in America2004," a Centers for Dis-ease Control and Preven-tion report released inNovember 2004.

The good news, though,is that heart disease, strokeand cancer are oftentimespreventable with the adop-

tion of good eating habitsand regular physical activ-ity, among other healthybehavior choices. Suchbehavior could also staveoff diabetes, which cur-rently affects one in fiveAmericans ages 65 andolder, according to theCDC report. With over-whelming evidence sup-porting the benefits ofexercise and gtxxl nutri-tion, the challenge isspreading the message andbringing older Americansinto the fold.

"As public health pro-fessionals, what we wantto focus on is finding func-tional benefits tliat meansomething to older adults,like getting greater mobil-ity or being able to lifttheir grandchild," said KayLoughrey, MPH, RD, aging

See HEALTHY AGING,Page 13

Photoby Cfins Arrt^iuKriu. cnurlesy Senior Woliness Hroject

Participants in the Lifetime Fitness Program get a workout atSeattle's Central Area Senior Center in July 2002.

Good nutrition, physical activity hey to healthy aging among seniorsHEALTHY AGING,Continued from Page 1

program specialist at theU.S. Administration onAging. "Those are thekinds of benefits that peo-ple really care about,rather than the standardbenefits like better health,which most people alreadyknow."

AoA recently launchedthe national "You Can!"campaign, which is work-ing at a community level toengage more older adultsin becoming physicallyactive and improving theirnutrition. A big challengeto engaging the older pop-ulation is simply gettingthem information,Loughrey said. Communityorganizations need toreach out to health careproviders, such as givingdcK-tors a list of availablefitness and nutritionresources to which patientscan be referred, she toldThe Nation's Health.

"It's never too late tostart (exercising and eatingright)," Loughrey noted."There's so many benefits,both functional and physi-cal — there's almost toomany to list."

An important aspect inchanging lifestyle behav-iors is to "start slow withany change and determineshort-term as well as long-term goals," according toSerena Sanker, senior pro-gram associate at theNational Council on theAging, a non-profit organi-zation that has focused onaging issues for more than

50 years. For example,older Americans can makea commitment to walk afew minutes a diiy severaltimes a week or considersome easy diet changessuch as substituting anunhealthy snack such aspotato chips with fruit,Sanker said. Starting outwith small modificationscan ensure a longer lastingbehavior change, shenoted. According to theCDC aging report, olderpeople don't necessarilyhave to take part In strenu-ous physical activity to seehealth benefits — dailywalking or leisure-timeactivities such as garden-ing can also improvehealth.

"Physical activity isabsolutely the thing that allAmericans can do toimprove the way they feel,their level of independenceand the length of theirlife," Sanker told TheNation's Health.

Checking with a healthcare provider before begin-ning to exercise isn't nec-essarily a requirement forolder people, Sankernoted. In fact, "(olderAmericans) almost need adoctor's okay not to exer-cise," said AHHA memberSusan Hughes, DSW, co-director of the Center forResearch on Health andAging at the Institute forHealth Research and Polic-yat the University of Illinoisin Chicago. Although, forpeople living with condi-tions such as arthritis, itcan't hurt to consult aprovider, Hughes noted.

A senior does weight exetcises during a class offered by theLifetime Fitness Ptog;ram at Seattle's Central Area Senior Center.

"We can really cut into acycle of disability by inter-vening and 'reactivating'people," Hughes told TheNation's Health. "It's a ter-rific thing that people cando for themselves."

The solution, Hughessaid, is to tailor exerciseactivities toward differentpopulation characteristics.For example, a phasedbuild-up of aerobic activityover time might be best forfrail or sedentary people,she said. To learn how tomotivate people to l^eginexercising, Hughes and hercolleagues created "Fit andStrong!" a program forthose with osteoarthritisand lower-extremity jointproblems offered at severallocations in Chicago. Peo-ple who took part in "Fitand Strong!" experiencedreduced joint stiffness andpain, an increased confi-dence in their ability tosafely exercise as well asincreased participation inphysical activity, Hughesreported.

"I don't tliink we knowas much as we shouldabout barriers (to exer-cise)...but we are startingto learn that information,"she said.

Hughes' university isalso part of CDC's HealthyAging Research Network,which recently finished aseven-site survey of physi-cal activity programming.The survey found thatcompared to the numberof older adults, the supplyof programming will onlymeet about half of existingdemand. However, thegotxl news, Hughes noted,is that exercise can be assimple as using ankleweights and getting a goodpair of walking shoes.

Low-income olderadults can face additionalbarriers to exercise, suchas living in neighborhoodsnot safe for outdoor activi-ties. But, the "importantthing is for people to be ascreative as possible,"Hughes said, suggestingthat people get their exer-cise walking inside a mallor finding the local YMCA,

"People should bethinking of (exercising) inthe same vein as going tothe doctor," she said.

Not only does exerciseimprove physical health,but mental health as well.According to two Decem-ber 2004 studies published

Photo courtesy Ohio Departmenl of Aging

Seniors shop for fresh fruits and vegetables at afarnms' marketin Franklin Count)', Ohio. The Ohio Department of Aging spon-sors the markets, which increase seniors' access to healthy food.

in the Journal of the Ameri-can Medical Association.physical activities such aswalking are associatedwith better cognitive func-tions in lx>th older menand women. In Seattle,older residents who partic-ipated in a fitness pilotprogram reported adecrease in depressionafter .six months of activity,said Susan Snyder, directorof the Senior Wellness Pro-ject at Senior Services ofSeattle/King County. Thepilot program would laterbecome the award-winningLifetime Fitness Program.

"A lot of it is just gettingout of their homes andfeeling that they're still animportant person," Snydertold The Nation's Health.

The Senior Wellness Pro-ject serves thousands ofolder residents in the Seat-tle and King County area —most of whom are olderthan 75. Tlie project's Life-time Fitness Program,which has lieen operatingsince 1994, grew out of aresearch collalxiration tliatincluded the University ofWashington and has nowgn)wn to more than 80sites around tlie nation,according to Snyder.Participants are able to takeadvantage of low-cost fit-ness classes taught by certi-fied fitness instructors, andabout 99 percent of partici-pants said they would rec-ommend the classes to afriend, Snyder noted.

'"(Regular exercise) is aparadigm shift for a lot ofpeople," she said. "It's notabout aging, it's how theytake care of themselves."

Another program underthe Senior Wellne.ss Projectumbrella is the HealthEnhancement Program,

which was originallydesigned for people olderthan 75 living with chronicconditions who wanted tomake healthy Ijehaviorchanges. Participants in theenhancement programwork with a nurse andsocial worker to create ahealth action plan primar-ily around physical activityand good nutrition.According to Snyder, astudy conducted on theprogram found that partici-pants had a 72 percentdecrease in days spent inthe hospital from the prioryear.

"We want people tograduate from the programwith a feeling that they canmanage their health ontheir own," she said.

Good nutrition alsokey to healtliy aging

In addition to gettingphysical, making wise foodchoices could have a sig-nificant impact on healthyaging. While older Ameri-cans are more likely to eatfive or more servings offruits and vegetables daily,many arc not doing so.Some older Americans —and Americans in general— might view diet changesas a sacrifice, but theydon't have to be, saidSusan MtMjres, MS, RO, aspokeswoman for theAmerican Dietetic Associa-tion and a nutrition consul-tant in St. Paul, Minn.

"Diet is so important,and it's not all about .sacri-fice, but about embracingthe wonderful foods thatare out there," Moores toldThe Nation's Health. "As

See HEAO HY AGING,Page 14

M A R C H 2 0 0 5 • T H E N A T I O N ' S H E A L T H 13

Community nutrition, exercise programs encourage healthy agingHEALTHY AGING,Continued from Page 13

you get older, you need tomake more of your calo-ries count — there's lesswiggle room."

For some older Ameri-cans, a major barrier toeating healthily Ls cost. Infact, many seniors face dif-ficult financial trade-t>ffs: toafford prescription medi-cines and other necessities,fresh fruit and vegetablescan he left by the wayside,according to Shari Baker,RDLD, nutrition programmanager at the OhioDepartment of Aging.

Baker helps manage thedepartment's Senior Farm-ers' Market Nutrition Pro-gram, which works withlocal fanners to help low-income seniors gain accessto fresh produce. Tlie pro-gram — now in its fifthyear — operates in 13 Ohiocounties, and in 2004,served ahtiut 16,000 olderresidents. Baker said. TheU.S. IX'partment of Agricul-ture was the market's grantfunder, but such fundingwas recently cut and, in

turn, the program will notbe able to expand. Bakernoted.

"Seniors know that eat-ing fruits and vegetables isa good thing, but maybe inthe past, they didn't havethe wherewithal to do it,"Baker told Vw Nation'sHealth.

The Ohio Department ofAging aikxrates the liSDAgrant money to its partnersthroughout the state, whothen contract with localfarmers who take part inthe program. Eligibleseniors are given couponsthey can use to purchasefresh fruits and vegetablesat the farmers' markets andoftentimes, area agingagencies will also providetranspHjrtation. Tlie farmers'markets are also tied to aneducational component inwhich the senior center oraging agency involved willoffer classes on the benefitsof healthy eating, sharingrecipes and cooking tips,according to Marc Molea,MHA, MCRP, chief of plan-ning, development andevaluation at the OhioDepartment of Aging.

CDC: Deaths from obesity serious,but lower than original estimate

THE nation's obesity epidemic is having a serioustoll on the health of Americans, but l.sn't cau.sing

as many deaths as recently estimated, according to theCenters for Disease Control and Prevention.

In January', CDC officials revised their estimates onthe numlx^r of Americans whcj die each year ljecau.seof poor diet and physical inactivity. According to acorrection in the Jan. 19 issue of the humal of theAmerican Medical Association, about 365,000 peopledied Ixxause of those causes in 2000, up from about300,000 in 1990.

While significant, tlie new number is an almost 9percent decrease from die 400,000 deaths from poordiet and physical inactivity that were reported in aCDC study in the .same jcjumal last year. The mistakewas caused by a computational error, acc<irding toCDC, and was detected when researchers re-examinedtheir data.

Despite the error, the researchers' principal conclu-sions "remain unchanged," according to Ali H. Mok-dad, PhD, chief of the Behavioral Surveillance Branchwithin CDC's National Center for Chronic Disease Pre-vention and Health Promotion.

"Tobacco use and ptxjr diet and physical inactivitycontributed to tlie largest numlier of deaths, and thenumlxT of deaths related to poor diet and physicalactivity is increasing," wrote Mokdad in a letter in thesame journal issue as the correction.

The original estimates, reported in the March 10,2004. lounuil of the American l^edical Association, werefeatured in the May 2004 issue of llie Nation's Health.

For more information on the study, visit<http://jama.ama-assn.org>. •

Photo courtesy Ohio Depai

Seniors can use coupons to shop for fresh fruits and vegetables atfarmers' markets sponsored by the Ohio Department of Aging.

In addition. Baker said, asurvey of farmers' marketparticipants found that 77percent ate more fruits andvegetables than usual,almost 76 p>ercent ate morethan three servings per day— a 43 percent increa.se —and 93 percent said the besta.spect of the program wasaccess to fresh produce.

"(The farmers' market)serves .seniors, but It alsosupports the local econ-omy — it's a dual impactprogram," Molea said.

Unfortunately, fundingfor senior nutrition pro-grams such as tlie Ohiofanners' market has Ijeensteadily decreasing Overtime in propcjrtion todemand and increases incosts of living. Such issuesleave a discrepancyl')etween current and pre-dicted demand for seniorservices and their status asa national priority, accord-ing to Nadine Sahyoun,PhD, RD, assistant professorin the Department of FoodScience and Nutrition at theUniversity of Maryland.

"We're not puttingenough emphasis yet ondealing with some of theseissues," Sahyoun told TheNation's Health. "In order todecrease the expenditureson chronic disease and ill-ness, we need more pre-ventive work — the kind ofwork that will help peoplestay at home and livehealthfully."

In addition to eatingwholesome foods, olderAmericans should also bemindful of how agingaffects their Ixxlies' abilityto take in nutrients, Sahy-oun said. For example,there is often decreased .absorption of calcium andvitamin D in older women.

which can lead to osteo-porosis. In tum, older peo-ple should be aware of suchphysiological changes sothey can make appropriateaccommodatioas, she said.However, for some low-income seniors, just over-coming barriers that limitaccess to fresh produce isdiHicult enough, Sahyounsaid. For example, an olderperson with a fixed incomeand mobility i.ssues mighthave problems affordingtransp>ortation services toand from the grocery store.

"It is so complex tounderstand all of the fac-tors that aflect nutritionamong older adults,"Sahyoun noted.

Eating properly is alsoaffected by physical andmental well-being, accord-ing to Ruth Palombo, PhD,MS, RD, an independenthealthy aging consultant inBoston and co-chair ofAPHA's Task Force onAging. For in.stance,because Medicare —the nation's health careprogram for seniors —doesn't cover dental care.

an individual's ability toeat fruits and vegetablescould Ix- impacted by poorteetli or broken dentures,Palombo said. Also, socialisolation can affect dietaryintake, such as seniorswho live alone and don'twant to Ixjther cooking forthemselves — Palombocalled it the "tea and toast"syndrome.

"Social factors, physicalfactors and eating are verymuch tied together," shetold Vie Nation's Heahh.

One way to bridge thegap between good healthand gotxl eating is to trainmedical professionals innutrition, Palombo said.

"ir you tell someone toeat a healtliy diet withoutspecifics, it's difficult," shesaid. "(Nutrition) is abig area to look at and itdoesn't happen in a shortvisit. Our health care sys-tem needs to be workingmuch more as a team — tobe able to refer to a (regis-tered dietitian) or nutrition-ist who can help .someonewith the specifics."

Botli Palomlx) andSahyoun agreed that muehmore preparation isneeded to ready the nationfor the next generation ofolder Americans.

"Tliere is a gap hereIxitwecn knowledge andactual education of olderadults and this is where weneed to begin our efforts,"Sahyoun said.

For more informationon healthy aging, visit<www.aoa.gov>. •

— Kim Krisberg

For more on National PublicHealth Week events or tobecome a partner or sponsor,visit <wu'w.nphw.org>.

Photo by Chris Arredondo, courtesy Seniof Wellness Project

The Lifetime Fitness Program in Seattle is helping seniors gainaccess to low-cost fitness classes taught by ceitified instructors.

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