Making a Difference in the World

One of the most pressing health issues in developed countries is obesity. It is central to our fitness failure. This is the second post in my series on Global Issues: Human Health that is part of a survey of the issues designed to help seekers find their own way to make a difference. The video above is rather shocking. It may convince you about the dangerous relationship between our love affair with corporate profits and the ill-health that is making our health care costs skyrocket.

For a more academic view, you will want to view the videos from The Skinny on Obesity, produced by the University of California. Robert Lustig presents the first video in the series, An Epidemic for Every Body. You will discover the problems caused by eating too much sugar and why the high fructose corn syrup found in almost all processed and “fast” foods is a leading cause of the current epidemic of obesity and disease. Together, these videos might be enough to prompt you to make a change in your own life!

What can you do? Here are just a few suggestions for how to reduce sugar in your diet:

• Get rid of sugar-containing drinks (especially soda) and minimize fruit juices
• Increase fiber in your diet with natural foods (many boxed cereals are laced with sugar and corn syrup)
• Wait 20 minutes for second portions (satiety signals are at the end of your intestine)
• Buy screen time for your kids with physical activity

Eating natural whole foods such as meat, fruit and vegetables will support your health and contribute to eliminating sugar and refined carbohydrates at the same time.

Fructose may be the culprit, but the evidence supporting this hypothesis is controversial. A more holistic view is that we live in a “toxic environment” (see Food Fight by Kelly Brownell). High fructose corn syrup likely contributes to our problems, but we are better off examining a constellation of issues, including increased portion size. I remember going in the late sixties to a very special place near my father’s office in Detroit that served huge one-quarter pound hamburgers. Once or twice a year we might splurge and buy one on a Saturday, for lunch. Now, you can buy a hamburger with three such patties.

Lest you think obesity is a problem only for wealthy countries, consider this story from the United Nations Poverty and obesity: a new epidemic and this recent journal article: The emerging epidemic of obesity in developing countries. How is obesity related to malnutrition? This blog post from the UN, Overweight and malnourished, has some answers. It is possible to be obese and hungry at the same time; see The Obesity-Hunger Paradox and The Obesity Paradox.

Obesity and malnutrition are the most obvious signs of poor fitness. Personal fitness encompasses the health of our bodies, minds, and spirits. It includes all those practices we engage in during our everyday lives and those we choose to do to remain healthy, outside the realm of doctors, drugs, and hospitals. Being fit makes our own lives better and reduces the costs of health care. Poor fitness has become an epidemic problem for children, and Michelle Obama is leading a program to do something about it by getting kids outside and moving.

Hints for Further Research

The peptide hormone ghrelin helps make our hunger pangs go away, but we do not feel full until food reaches the end of our intestines, which release peptide YY. These hormonal signals are critical to ensuring that we do not get too fat. If we attempt to circumvent these natural signals with unnatural foods and eating patterns, we will contribute to our overweight problem.

Similarly, exercise itself can have beneficial effects on weight control. Part of this is the result of the increased basal metabolic rate of the physically fit and part is due to hormonal influences of exercise. High stress shifts our behavior to overeating. Mental stress makes us hungry. Exercise reduces stress. The relationships are an interesting area for further research.

Episode 5 of Skinny on Obesity brings us back to maternal health by emphasizing the importance of good nutrition for women of child-bearing years and during pregnancy and lactation. Especially important in the global perspective is the lack of critical nutrients. Lack of iodine and protein-calorie deficiency can cause serious mental impairment. A lack of iron causes anemia in mothers, a leading cause of maternal death during childbirth. An article from the Journal of the American Dietary Association, Poverty, Obesity, and Malnutrition: An International Perspective Recognizing the Paradox outlines the issues.

An interesting twist on the call for natural foods are special supplements designed in the laboratory to restore the malnourished. The United Nations World Food Conference of 1974 declared Spirulina “the best food for the future.” Is supplementation with micronutrients better than providing healthy, natural foods? You can answer that question for yourself, but my current thinking is that special supplements are good for emergency relief while we work to develop long-term nutrition supplies based on local, natural foods.

High fructose corn syrup has caused a great deal of controversy. Why is fructose bad? Is high fructose corn syrup worse than sucrose? Glucose stimulates insulin release from the beta islet cells of the pancreas, but fructose does not. Fructose is metabolized primarily in the liver. Once inside the liver cell, fructose can enter the pathways that provide glycerol, the backbone for triacylglycerol. So, even though the glycemic index of fructose is low, it may contribute to obesity.

Milk, meats and most vegetables have no fructose; only 5–10% fructose by weight is found in fruits such as grapes, apples and blueberries. Honey and molasses and common dried fruits have a content of less than 10% fructose sugar. One argument that our problems stem from the high levels of fructose found in corn syrups is the correlation between increasing numbers of overweight individuals and the increase in high fructose corn syrup since its introduction in 1974. The confounding variable is the increase in sugar consumption over the same time. Even so, an alarming issue is the extent of subsidies for food sources that are less than health and the high cost of health foods. See, for example Apples to Twinkies 2012 from US PIRG. We need to pay attention to these trends.

A research group at Princeton tells us fructose is bad. Even so, the American Medical Association and their experts at the American Journal of Clinical Nutrition disagree, although you can find articles in the same journal that take a different stance. Is the group at Princeton right? They propose that it may be the imabalance of higher fructose in corn syrup that is the culprit.

A very recent article from the Annals of Internal Medicine repeats the mantra that calories are the culprit and not fructose. The problem is that both fructose use and calorie counts have increased dramatically over the past fifty years. At the same time, consider the source. WebMD is adamantly opposed to the fructose hypothesis and the health system profits from our ill health, just as the military-industrial complex profits from our fear of terrorism. Fears in both camps are in their self-interest to preserve. Consider as one example Food without Thought: How U.S. Farm Policy Contributes to Obesity.

The Lancet recently published a series of their articles on obesity. Especially interesting is the metabolic syndrome, a group of health problems that include diabetes and heart diseas. “Obesity travels with those diseases” which account for some 75% of health care expenditures. The United Nations see this as a challenge of epidemic proportions even in developing world, even more so than infectious diseases.

Maternal health is Goal 5 of the United Nations Millenium Development Goals. This is the first Global Issue we will study. It begins and grounds our discussion of the issues that face us as a civilization, because of the central importance of caring for the next generation. After a brief introduction to the issue, I will provide some hints for further study and reflection that will be of special interest to students who are keeping blogs about these issues.

According to the World Health Organization (WHO), “maternal health refers to the health of women during pregnancy, childbirth and the postpartum period.” In our discussion, we will broaden that to include the health needs of newborns. The two are closely linked, according to the UNICEF site, “Babies whose mothers have died during childbirth have a much greater chance of dying in their first year than those whose mothers remain alive.”

“The major direct causes of maternal morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour” (WHO). We want to look behind these direct causes to the root causes, which include inadequate nutrition and limited access to effective medical care. We do not want to restrict our investigation to the developing world; we want also to consider pockets of poverty in the developed world and the possibility that even the wealthy have issues of maternal health that are worth our while to investigate. In all areas, education is an important component of the solution.

Hints for Study and Reflection

A great resource for issues that affect developed countries is the Maternal and Infant Health site from the Centers for Disease Control and Prevention (CDC). Among issues that speak to me, I find Tobacco Use and Pregnancy and Postpartum Depression. Resource Guides are available through The Maternal & Child Health Library at Georgetown University. For example, you can study the Guide and links for Postpartum Health by clicking on the link.

Another list of health risks can be found at the Healthy People site, Maternal, Infant, and Child Health. “Healthy People provides science-based, 10-year national objectives for improving the health of all Americans.” What factors make it difficult to improve maternal health in the United States? The CDC site and their MICH objectives is a good place to start.

The World Health Organization (WHO) site provides a rich vein in which to probe global issues of maternal and newborn health. WHO provides snapshot statistics of Maternal and Newborn Health by Country. You might want to discuss the situation in a particular country of interest to you.

The UNICEF site and WHO lay out some solutions worth considering. Which of these solutions is practical? How might they be implemented? What is keeping us from implementing them?

According to a joint report, “Trends in maternal mortality,” jointly funded by World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank, maternal deaths dropped by 34% from 1990 to 2010. You can read the news announcement and find a link to the report at The Partnership for Maternal, Newborn, and Child Health website. Consider how increasing wealth leads to more positive maternal outcomes.

Family planning that includes abortion counseling is a sensitive topic for many of us, but one that cannot be ignored. Some religious groups also object to contraceptive use. Contraceptive approaches include Engender Health’s Advanced Family Planning and the work of Marie Stopes International. Natural Family Planning does not use contraceptives and is supported by The United States Conference of Catholic Bishops. Students will want to review and discuss those programs compatible with their own views on life and ethics.

WHO has links to Maternal Health News and maternal health topics from the Bulletin of the World Health Organization and from other scholarly journals. The United Nations Population Fund also has News on Reproductive Health from a wide range of sources.

Action

National funding is provided by the Maternal and Child Health Division of the Department of Health and Human Services. Their Title V Block Grant Program provides matching grants to the states to “ensure the health of the Nation’s mothers, women, children and youth, including children and youth with special health care needs, and their families.”