The Start of Something Healthy

Happy 2013! And, as usual, it’s time to make good on that New Year’s resolution. What better resolution is there than to improve or sustain your family’s health? That may seem like a rather overwhelming task, but it doesn’t have to be an all or nothing resolution. As we say at the Major Easy 3 program, “Start small, win big!”
How about starting by just making a resolution to do one simple step: eating meals and snacks at the table. It is one of the Major Easy 3 obesity prevention steps, and although seemingly simple, it can have a HUGE impact.

Eating meals at the table is an important way to prevent overeating and subsequent obesity.

Eating meals at the table is an important way to prevent overeating and subsequent obesity.

How? Well, it’s the first step toward developing healthy lifestyle habits.
Sitting at the table for all snacks and meals prevents mindless eating. You know that type of eating where you walk around nibbling snacks, munch on junk food while watching TV, snack while riding in the car, and the like. You can actually eat and not be fully aware if it!
All of these eating behaviors usually lead to non-nutritious food consumption, i.e. empty calories. And it doesn’t take long for those calories to add up to extra weight. Eating food while performing these activities becomes such a habit, that as soon as we start the activity, we begin to feel hungry. You get in your car for a drive and within a short period of time you begin to think of eating because your mind associates eating with riding in the car. You sit down in front of the TV and within a few minutes you are wanting a snack. You may not have even been hungry but you will begin to crave food because “eating in the car or in front of the TV is a habit”.
So, it is time to break the bad habits and start a New Year of good habits.
Healthy snacks build good habits and strong bodies

Healthy snacks build good habits and strong bodies

Be a role model for the family. Don’t let your children pick up bad eating habits. Start them off on the right path this New Year by requiring all family members to sit at the kitchen table if they are going to eat. Not only will it reduce non-nutritious food consumption, but it may just be the start of more quality “family time”… and that is certainly healthy!


To Eat or Not to Eat: A Short Guide to Help You Find Healthy Meals

Parents of my patients frequently ask, “What kinds of food should I feed my children? What foods would be healthy?” Those are difficult questions to answer in an office visit. There are numerous fields of study, food science, dietetics, nutrition, medicine, etc., dedicated to answering those questions. People earn doctorates in these fields just to answer those questions. So how do I answer that in a single office visit? I can’t. But, I can start my patients’ families down a path to discovering the answers to those questions. After all, there is not one correct answer. There are many foods that are healthy.
So, where do you start? Well, I started many years ago reading articles on nutrition. During this journey I came across three publications that I found very useful, easy to read and I still subscribe to them today: Eating Well ( , Cooking Light ( , and Nutrition Action Healthletter ( . These publications provide in depth articles on all facets of nutrition and healthy lifestyles as well as healthy recipes for families. For example, in this month’s Eating Well magazine there was a great article on sugar, “Solving the Sugar Puzzle.” After reading that article, you will understand why I emphasize, “Drink only water for refreshment – no sweetened beverages” in the Major Easy 3 program. This month’s Nutrition Action Healthletter reviewed all the recent food/health rumors and had great tofu recipes.
You don’t need a degree in nutrition or medicine to understand the articles in these publications. While they are written by experts in the fields of nutrition and medicine, their target audience is the general public. Practical, useful information and no science degree required.
The poet, Maya Angelou, once said, “I did then what I knew how to do. Now that I know better, I do better.” So, start learning about nutrition. Subscribe to one or all three of these publications and you will begin to “do better” for yourself and your family.

–Dr. Paula Gustafson

Exercise a day, keeps the doctor away…

If there were a pill that was proven to reduce your risk for cancer, heart disease, and diabetes would you take it? How about if it also controlled your weight, improved your joint mobility, and strengthened your bones and muscles? Simple, easy once a day pill. Ooooo, Yes! Sounds too good to be true, but it is true. It is just not a pill… It’s exercise! Getting just 30 minutes of moderate exercise once a day, 5 out of 7 days a week, can do just that. And, it’s cheaper than a pill!

Dr. I-min Lee and colleagues from Harvard Medical School recently published online in The Lancet their findings on the disease burden and premature deaths that could be reduced if we increased our physical activity. (

It really is that simple. So give biking or walking a try. Make it fun and use a pedometer. That’s what I do. I try to get at least 7,000 steps a day, which is equivalent to about 3 miles. Most days I get around 12,000 steps by counting my walking, biking, and running activities. I even kept track of my steps during the RAAM race, getting well over 30,000 per day!

Exercising (and doing something you like – like biking) for just 30 minutes a day produces all kinds of great health benefits, including weight loss!

In a recent blog entry, I wrote about participating in school sports as a means to reduce the risk for childhood obesity and its associated diseases. School sports — what a great way for kids to get exercise. But, how do we get our children to want to participate in sports or to just be active. Well, we need to start by a setting a good example for them by being active ourselves. A study by Kristen Holm, assistant professor of Medicine at National Jewish Health, recently published in the Journal of Physical Activity and Health (, looked at the effect on children’s activity when parents increased their own activity. In this study, parents were encouraged to take an additional 2,000 steps per day. On days when parents met or exceeded the goal, their children also significantly increased their steps.

Parents, take the lead. We are the role models for our children. If we are couch potatoes without an interest in participating in athletic endeavors, there is a good chance our children will follow suit and be couch potatoes. Don’t let that happen.
So, swallow that “exercise pill” and start down that road to better health and your children will follow you!

When the School Bells Toll, Let’s Roll!

Do you hear that? That sound? It sounds like an alarm clock waking kids up for school. Yes, even though it is the middle of the summer it is time for back to school planning. And, just as we carefully planned our children’s summertime activities, now is a good time to plan their school physical activities, i.e., how to keep them physically active while attending school. Two thoughts on that subject

1) Start the day off with some exercise. Have your child walk or bike to school.
2) Have your child join a school sports team or a club sport activity.

If we just had our children participate in one or both of those activities we could make a significant impact on childhood obesity rates. This concept was the focus of a recent study by Keith M. Drake (, lead author and postdoctoral research fellow at the Geisel School of Medicine at Dartmouth. Dr. Drake and colleagues’ article, Influence of Sports, Physical Education, and Active Commuting to School on Adolescent Weight Status ( published in the journal Pediatrics July 16th 2012, determined that childhood obesity rates would decrease if students participated in one or both of these recommendations.

By studying the commuting habits, body weight and height, and level of sports participation of over 1,700 high school students, the Dr. Drake determined the prevalence of obesity would decrease by 26.1% if all adolescents played on at least 2 sport teams per year. Furthermore, if teens biked or walked to school at least 4 times per week during the school year, obesity prevalence could decrease by 22.1%. Wow! That’s quite an impact. Interestingly, the authors did not find a significant positive decrease in obesity with participation in physical education (PE) classes. They attributed that to the differences in intensity of activity associated with competitive sports versus PE class. I do not doubt that intensity plays a role in the difference. But as a mother of 5 children, who all played 2 or 3 sports throughout their high school years, I can add a little insight to what may be an even bigger factor in the difference.
When children participate in a sport after school, they are occupied during the “snacking hours”, the 3:30–5:30 pm time, before their parents get home from work. Teens who don’t participate in afterschool sports tend to come home and snack. I have found in questioning my adolescent patients about their eating habits, they (and their parents) readily admit they start snacking when they get home from school. And, left unsupervised, since the parents are often still at work, teens aren’t snacking on carrots and fruit but rather soda, chips, etc. One could easily see that eating an extra 500+ calorie snack each day, even if you participated in gym class, could prevent any weight loss from occurring.
I saw this behavior in my own children. If practice was cancelled for some reason, as soon as they set foot in the door they were in the pantry looking for food. But if they had practice, they might grab just a piece of fruit as they learned early on that too much on the stomach during intense activity causes one to vomit – not to mention poor athletic performance and social embarrassment. So it stands to reason that the combination of an after school, small, healthy snack and intense physical activity should have a more favorable impact on adolescent weight status.
I fully agree with the Dr. Drake’s conclusions especially the line, “Obesity prevention programs should consider strategies to increase team sport participation among all students.” So, parents, think about encouraging your children to participate in sports. And, the best way to do that is to model the behavior yourself. More on that later…….
When the school bells toll, be ready to cheer for your child.

Turn errands into biking!

Having recently finished six incredible days of the 3,000-mile “Race Across America (RAAM)”on a bicycle, I don’t want to lose the lessons learned in maintaining good health or the momentum it generated about preventing childhood obesity. I want to keep encouraging folks to “go by bike”.

Bicycling is an great way to slip exercise into your busy day. But, when can you find time to bicycle? Well, start by riding your bicycle to work. Think of the gas money you’ll save with gasoline prices now hovering around $3.50/gallon. Bicycling is also great for the environment. It’s a green form of transportation and will help reduce air pollution. I’ve ridden to work several times this summer, from Columbus to Shelbyville and back.  It’s about 25 miles one way. I must admit that is a bit extreme for a daily ride, but I needed the work-out to get ready for RAAM. If you work less than ten miles from home, however, biking to and from work might just be very practicable and an easy way to get your daily exercise. Your workplace does not have shower facilities? No problem. Invest in Nathan Power Shower body wipes ( Wipes are not just for babies!

If biking to work isn’t an option, how about biking to accomplish your daily errands.  That’s what I love to do. If you see me riding around town I most likely will be riding my favorite bicycle, the Trek Hybrid, AKA my “grocery getter”(Figure 1)

Figure 1: Me on my grocery getter after riding to Kroger

.  It’s a great sturdy bike, not very expensive, that I can use both on and off road. I have a rack on the back that panniers (cargo bags) snap on to and can hold a few days worth of groceries. A quick shopping trip to Kroger/CVS/Walmart and back takes only about an hour. And when I’m done, not only have I  completed my errands, but I’ve done my exercise for the day. Checking out the bike, you might think that the “grocery getter” can’t carry very much, but there are many bicycle accessories options out there for hauling just about anything. For example, the Travoy by Burley, will let you commute and shop in style(Figure 2)

Figure 2: The Travoy — an easier way to do exercise and errands

.  Or if you want to go big and strong, i.e., the Hummer of bicycles, consider the Trek Transport + (Figure 3).

Figure 3: The Hummer of all bikes – The Trek Transport

It can haul 220 pounds of cargo. And, the more you haul, the better your work-out.

So, stop by your local bicycle shop. Check out your bicycling options. There is something that will fit everyone’s need for sport, recreation, commuting and basic errands. And, most of all, it will give you an easy and fun way to get exercise into your life.  Forget the car! And ride on!

And now what am I going to do with my Sundays?

For months the people you have followed on this blog have been getting together on Sunday evenings to plan the RAAM event. It seemed like too much planning at times. But now after having been through this experience, the need for planning and meetings was more than necessary. I don’t know if anyone who went on this adventure knew exactly what we were in for. Infact…I am positive no one knew.

For the athletes it was training, equipment, gear, mental preparation etc… For the crew it was uncertainty of what our roles would be. Lists upon lists of anything and everything the riders and crew may need during the race. Navigators had to study the routes, learn how to use the equipment, double as drivers and much more. They needed food while on the road. We worked with nutritionists who helped plan menus and option for food since we did not have a kitchen to prepare the meals. If meals were prepared, it was done in the hotel the night before or morning of the ride.

We learned a lot along the way and made changes as needed. The most important thing was to stay safe out there. The cars and semi’s that raced by the cyclist would not change lanes away from the rider at times and created so much wind it was surprising that our riders weren’t blown right off of their bikes. The winds in Kansas were gusting but our riders all worked through it. The heat in the desert was intense. The wildlife that we encountered was beautiful and amazing yet potentially dangerous. Following Ben Weaver down a descent at speeds close to 60 mph has left our handprints forever embedded in the steering wheel of the Pri Pri. What a ride! What an adventure!

All of this and all of the preparation, all of the anticipation…but something we did not anticipate happening…

We became a family.

It’s amazing how we all came together for a great cause, to fight pediatric obesity, and an opportunity to do something that not many can say they have. Survive RAAM. A crazy 3000 mile race across America on bicycles. During the 7 days we were challenged with physically demanding courses for riders and physically demanding responsibilities for the crew. For both teams it was hard to stay awake for your shift. Once at the hotels if we got 2 hours of sleep it was a luxury.

We’ve been in touch with some of our riders and crew in the day after our arrival back home in Indiana. Dr. Paula has been out riding her bike. Dr. Carlos is sporting his medal around the hospital as he well should be! And Dr. Andy is recuperating at home and anxious to get back on his bike. Carlos and Andy plan to begin training with Ben Weaver as soon as possible.

Sounds to me like they have something brewing in their minds…… RAAM 2013?

The entire group…riders and crew minus Andy Cagle who was resting back at hotel.



Race to the end

Saturday am was our final day of racing. We were still going neck and neck with team 802. With approximately 110 miles left, it was time to deploy our secret strategy. Dr. Paula switched positions with Ben allowing 4 of our strongest racers, Ben, Scott, Matt and Liz, to bring it home. And that they did. We finished the race in 6 days, 14 hours, 50 minutes and 51minutes ahead of team 802 with an average speed of 18.81 mph giving us a 9th place finish.

While we did not meet our time goal we certainly met our purpose…to raise awareness about childhood obesity and its prevention through the Major Easy 3. Everywhere we went we attracted attention to our cause. Sometimes you have to do something over the top to get people’s attention. And RAAM is certainly over the top.

As far as the race itself, it was both exhilerating and exhausting and one of the hardest things we have ever done. Yet most of the riders and crew agreed, if given the chance next year, we would do it again…there was a little unfinished business…a few more teams we think we could beat.

Refueling after riding

Have you ever wondered how many calories a rider consumes in a day of RAAM riding?  Answer: several thousand calories depending on the terrain, weather conditions and the individual. For our team that meant we were constantly nibbling when you were off the bike. But it was not junk food. Check out our cooler. Of course, chocolate milk was our favorite.


Andy Cagle goes down but fine.

One of the Docs went down on a turn when he hit some gravel. Andy Cagle was checked out and seems to be fine. Andy’s follow car was being driven by his daughter Jordan who is crew. His wife Noreen was also in the vehicle and they stayed with him until the support vehicle arrived. Carlos Vieira checked him out and he’s good. Broken ribs and a concussion won’t keep him down for long. Andy had the best ride of the week today. Just cut short due to an annoying patch of gravel. Team’s lead cyclist, Ben Weaver told Andy that when the team makes the final ride into the finish at Annapolis he will be riding. Noreen told Ben , “only in a Burly”. We will see who gets the last word on this one. Lets go Docs and Jocks! The 802 team gained on the D&J’s but has not passed them and we are fighting them off.