3Qs: Health in America

The newly released 11^th edi­tion of Modern Nutri­tion in Health and Dis­ease has been called an "author­i­ta­tive ref­er­ence on nutri­tion and its role in con­tem­po­rary med­i­cine, nursing, and public policy." Northeastern University news office asked co-​​author and editor Katherine Tucker, a pro­fessor of nutri­tional epi­demi­ology in the Depart­ment of Health Sci­ences, to expound upon the cur­rent state of health in America.

Some 42 percent of the American population will be obese by 2030, according to a report in the American Journal of Preventive Medicine. What is the solution to solving this public health crisis, for which the textbook devoted two full chapters?

This is by no means a simple problem, and its solu­tion lies in uniting all stake­holders. The text­book high­lights the com­plexity of the epi­demic and the new research that has been con­ducted in order to better under­stand its causes. What we do know is that there is a high cor­re­la­tion between obe­sity and the con­sump­tion of low-​​cost and nutrient defi­cient processed foods. Foods with ingre­di­ents such as refined flour and sugar and high fruc­tose corn syrup have long shelf lives and a lot of calo­ries to keep us sat­is­fied, but we need to return to eating real, whole foods that can restore our meta­bolic balance.

When we look at the social deter­mi­nants of health and obe­sity, we notice that low-​​income com­mu­ni­ties often lack high quality food in corner stores, which are often con­sid­ered to be too expen­sive. Increasing avail­ability of fresh fruit and veg­eta­bles and whole grain prod­ucts at rea­son­able prices is key. On the other side of the equa­tion, a post-​​World War II move­ment toward effi­ciency has reduced our phys­ical activity. I am thankful for the pub­licity that people like first lady Michelle Obama have given to the impor­tance of exer­cise through her Let's Move ini­tia­tive. Pro­grams like this won't solve the problem, but incor­po­rating healthy habits can go a long way.

Four-dozen pages of the textbook are dedicated to the link between diet, nutrition, and cancer, and this year's Annual Report to the Nation on the Status of Cancer noted that maintaining a healthy weight throughout life might be among the most important ways for non-smokers to avoid the disease. Armed with information linking obesity to cancer and other chronic health problems, why is it so difficult for many people to control their weight and stick to a healthy diet and exercise regimen?

The World Cancer Report noted that many forms of the dis­ease could be avoided by eating a healthy diet. The problem, how­ever, is that many healthy people don't think about the prospect of get­ting a chronic dis­ease like dia­betes, which may only appear in earnest sev­eral years down the road. Each risk factor, including obe­sity and Type 2 dia­betes, increases the like­li­hood of early mor­tality form heart dis­ease or cancer or another illness.

The million-​​dollar ques­tion is how to get people to follow a healthy diet and exer­cise rou­tine. In today's world, we're con­stantly in front of a com­puter screen or TV. We don't know how to cook, and phys­ical edu­ca­tion and home eco­nomics classes have been removed from the school cur­riculum in favor of more aca­d­emic courses. Doc­tors, for their part, have gone to med­ical school and are not well trained in nutri­tion and obe­sity pre­ven­tion; they do, how­ever, know how to pre­scribe and per­form laparo­scopic weight loss surgery. Pre­ven­tion must be viewed as more impor­tant if we are to change the population's health.

One of the textbook's new chapters focuses on the connection between diet and exercise performance. What should we be eating in order to stay in shape?

I often get asked this ques­tion, and there's not 100 per­cent agree­ment on the answer. What everyone can agree on is that resis­tance exer­cise com­bined with a high pro­tein diet is the best way to build lean muscle mass. Unfor­tu­nately, many people try to boost their pro­tein intake and muscle mass by drinking shakes and taking sup­ple­ments, which can have neg­a­tive side effects. At the same weight, having more solid muscle mass, as opposed to fat mass, keeps your metab­o­lism bal­anced and your bones healthier. You often hear about car­bo­hy­drate loading—a strategy used by ath­letes to max­i­mize the storage of energy in the muscles—but that's designed to max­i­mize per­for­mance rather than health.