uams journal - fall 2012

JO RN LUNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES • FALL 2012

ObesityHow Does Arkansas

Measure Up?

2 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

Welcome to this issue of the UAMS Journal!

No other health issue affects more Arkansans

than obesity. It’s a nationwide epidemic with

strong roots in the rural and impoverished South,

and Arkansas is no exception.

Nearly two-thirds of Arkansans are obese

or overweight. Obesity is a major contributor to

diabetes, stroke, heart disease and some cancers. At

UAMS, we are involved in clinical programs, community initiatives and research that address

obesity in adults and children.

In this issue, you will read how we fight childhood obesity through a weight-management

clinic at Arkansas Children’s Hospital and a Delta Garden project in which middle school

students learn about fresh fruits and vegetables by working in a school garden. Our Department

of Dietetics and Nutrition is helping educate Head Start preschoolers and their parents about

proper nutrition, and parents in southeast Arkansas are learning activities they can play with

their children to encourage physical activity.

Church-going African-Americans in the Delta are praising a weight-loss program that

connects faith and health and group exercise. The Arkansas Coalition to Prevent Obesity

is facilitating cooking demonstrations at a farmers market in southwest Arkansas. And a

32-year-old tells how he lost more than 170 pounds through the UAMS Weight Loss and

Metabolic Control Program.

Researchers are asking how to prevent obese mothers from programming their babies

toward obesity, whether an online weight management program provides significant results

and how to increase the availability of long-term care services for obese clients.

We’ve got a long way to go, but together we are making a difference.

Dan Rahn, M.D.Chancellor, University of Arkansas for Medical Sciences

At UAMS, we

are involved

in clinical

programs,

community

initiatives and

research that

address obesity

in adults and

children.

Message from the Chancellor

UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES www.uamshealth com 3

JournalFAll 2012

Editor

Elizabeth Caldwell

CrEAtivE dirECtor

Laurie Shell

WritErs

Sally GrahamNate HinkelJon Parham

David RobinsonSusan Van Dusen

PhotogrAPhEr

Sam GiannavolaJerry Davis

-----------------------

ChAnCEllor

Dan Rahn, M.D.

viCE ChAnCEllor For CommuniCAtions

& mArkEting

Pat Torvestad

AssoCiAtEviCE ChAnCEllor

For CommuniCAtions & mArkEting

Leslie Taylor

AssistAntviCE ChAnCEllor

For CommuniCAtions & mArkEting

Tim Irby

The UAMS Journal is published twice a year by the Office of

Communications & Marketing, University of Arkansas for Medical Sciences,

4301 W. Markham St. #890, Little Rock, AR 72205.

Phone: (501) 686-5686Fax: (501) 686-6020

ContentsPublic Enemy no. 1 ........................................................................................................4

Childhood obesityon the Front lines ..........................................................................................................6

unearthing healthy habits ..............................................................................................8

nutrition Education: it’s for the kids ..............................................................................11

have nutrition knowledge, Will travel ...........................................................................12

starting Early ................................................................................................................14

A toy Box of the Future ................................................................................................16

Blueprint for success .....................................................................................................8

Community ACtionA new Approach ..........................................................................................................20

Power of Faith ..............................................................................................................24

it takes a Coalition .......................................................................................................27

reaching out ...............................................................................................................30

talking nutrition to older Arkansans ............................................................................33

ready or not ................................................................................................................34

sCientifiC ReseARChlike mom, like Baby ....................................................................................................36

Weight Watchers ..........................................................................................................38

Challenges in the delta .................................................................................................40

links in obesity and disease development ..................................................................42

losing Weight on the Web ...........................................................................................44

bRiefsradiation oncology Center serves All Ages .................................................................46

graduate school Begins regulatory science Program .................................................46

reynolds insititue on Aging Celebrates Expansion .......................................................47

Cancer institute unveils new research labs ...............................................................47

14 20 36

THE TRIGGERS for obesity are everywhere. A fast food chain implores customers to grab a “fourth meal.” Another touts any size soft drink for a dollar. Escalators replace stairs. Even the tele-vision remote provides one more opportunity to be sedentary. The results of an inactive and overindulgent lifestyle make for some scary statistics. More than a third of Arkansans are overweight; almost another third are obese. One in 10 has been diag-nosed with type 2 diabetes, and Arkansas is No. 2 in the nation for stroke. For Arkansas children, the numbers are just as staggering, with 21 percent of school-aged children obese and an additional 17 percent overweight. Obese children are more likely to have high blood pressure, high cholesterol, increased risk of type 2 diabetes and sleep apnea, according to the federal Centers for Disease Control and Prevention. “Obesity can have a profoundly damaging effect on cardiovascular health,” said David L. Rutlen, M.D., professor and director of the Divi-sion of Cardiovascular Medicine in the UAMS College of Medicine. “Some studies suggest more than 75 percent of hypertension can be contrib-uted to obesity.” “Obesity is a risk factor for developing most of the common cancers seen in the United States,” said Laura Hutchins, M.D., director of the Divi-sion of Hematology/Oncology in the College of Medicine. “Furthermore, reducing weight has a major effect in reducing the risk of breast cancer metastases in patients already diagnosed – as much as chemotherapy for some risk groups.” Obesity is a public and population health problem that is the result of several environmental factors, said Joe Thompson, M.D., M.P.H., Arkansas surgeon general and director of the

obesity is the root cause of poor population healthBy Elizabeth Caldwell

“It really

is about

environmental

change so

that a healthy

choice

becomes an

easier choice.”

Arkansas Center for Health Improvement. “Our bodies are incredibly well-adapted for an environment we no longer live in,” Thompson said. “When we had to hunt our own food or grow our own food on the frontiers of America, we worked hard and burned a lot of calories. Today, we’re a lot less physically active at the same time that we’re inundated with a lot more calories.” Individual responsibility to make healthy choices plays a part, he said, but that by itself doesn’t explain the obesity epidemic. “It really is about environmental change so that a healthy choice becomes an easier choice.” In Arkansas, the high rate of obesity is directly related to poverty, Thompson said. Everyone is susceptible to obesity, but “it’s the poverty issue that drives the availability of the food supply.” For example, in Little Rock, he said, “you’ve got your best fresh fruits and vegetables in the Heights, and nonfat milk and high-quality-nutrient products, and you can’t find them on Asher. So if we have someone with an obesity problem who wants to eat better, we’ve got to have an environ-ment that’s available for them to procure that food at a price they can afford.” Another tie to poverty: “You have a poor family that can’t afford to keep the oven on for an hour, but two minutes of frying can make the lower-quality meat edible,” he said. If the obesity epidemic isn’t addressed more fully, Arkansas is not going to be able to afford the health care that people are going to need, he said. And for Arkansans to enjoy better health, they have to address the root cause of the problem. “When you look upstream from all the things that kill people, obesity is sitting right there as the root cause,” Thompson said. ❖

Public enemy no. 1


>


Childhood obesity

IT’S SO MUCH MORE than measuring a child’s body mass index (BMI). Act 1220 of 2003, called Arkansas’ Child-hood Obesity Law, is best known for mandating schools to measure students’ BMI, a method of determining overweight and obesity based on a person’s height and weight. And indeed, three years later, state health officials declared a halt to the progression of childhood obesity. But the Arkansas Center for Health Improve-ment (ACHI), which, along with health and policy professionals across the state, champi-oned Act 1220, has not stopped working on the obesity epidemic that hit Arkansas as hard as any place in the country. “We’ve got to get it where most, if not all, communities recognize that this is a major threat to families,” said Joe Thompson, M.D., M.P.H., ACHI director and the state’s surgeon general. ACHI is an independent, nonpartisan health policy center funded by UAMS, Arkansas Blue Cross and Blue Shield, Arkansas Children’s Hospital, the Arkansas Department of Health, and Delta Dental of Arkansas. It was established in 1998 as a catalyst for

on the Front LinesArkansas Center for health improvement continues work against childhood obesityBy Elizabeth Caldwell

“It is a social

mindset shift

that we have

to achieve.”

improving the health of Arkansans. G. Richard Smith, M.D., now chair of the UAMS Depart-ment of Psychiatry and director of the Psychi-atric Research Institute, was founding director. Thompson, a pediatrician, took the mantle five years later. Thompson said the childhood obesity epidemic can be traced to 1970. Just 5 percent of kids were obese. That number shot up over the next 25 years across America, with Arkansas no exception at 38 percent of school-aged children either overweight or obese. Around 2000, people started waking up to the epidemic, he said. The Institute of Medicine and the American Academy of Pediatrics said every parent should know their child’s BMI. In 2002, Arlo Kahn, M.D., a professor in the UAMS College of Medicine Department of Family and Preventive Medicine, led efforts to convene the Arkansas Preventive Nutrition and Physical Activity Summit. A year later, the Legis-lature passed Act 1220. ACHI was tasked with implementing the BMI portion. In addition to BMI screening, the Act set up a Child Health Advisory Committee, whose recommendations went directly to the state

>


Board of Education. Its efforts led to school districts prohibiting junk foods and changes in the contracts they have with soft drink compa-nies. Also, school superintendents worked to allow more time for physical education and activity. As ACHI continues to fight childhood obesity, it is working with school wellness committees to engage communities. Arkansas has become the first state to provide funding to expand safe opportunities for physical activity and to make school facilities available for public use during non-school hours. Through joint-use agreement funding provided through the Department of

Education, the city of Cabot has built a commu-nity center with an indoor pool and four gyms used by both the schools and community groups. Looking toward the future, ACHI hopes to provide an evidence base showing the impact of physical education in the schools on health and behavior. Some communities are starting to see a decrease in childhood obesity, Thompson said, but not enough to claim success. Still, it’s the little things. Like the mayor replacing a missing basketball net at the city park, or offering healthy options at vending machines. “It is a social mindset shift that we have to achieve.” ❖

The children of Cheryl and Kevin Breedlove of Cabot are on the swim team at the Cabot Community Center, built with funding for joint use by schools and community groups.

As ACHI

continues to fight

childhood obesity,

it is working with

school wellness

committees

to engage

communities.


Mablevale Magnet Middle School teacher Graham Goodloe engages students (from left) Sonya Wilkins, Joseline Gutierrez and Daeleesha Smith in the school’s garden.

GETTING KIDS TO EAT their fruits and vegetables is every parent’s goal … and struggle. But with obesity rates at an all-time high, the value of teaching healthy eating habits is more important than ever. Enter the Delta Garden Study. “There are no other national studies that come close to the rigor or size of our study,” said Judith Weber, Ph.D., lead investigator of the study, associate professor in the Depart-ment of Pediatrics in the UAMS College of Medicine, and co-director of the Childhood Obesity Prevention Research Program at the Arkansas Children’s Hospital Research Insti-tute (ACHRI). The Delta Garden Study is one of the community-based childhood obesity research programs at ACHRI. Now in the final year of the four-year study, Weber is seeing her work come to fruition. “With the school gardens we are addressing several areas, including increased fruit and vegetable intake, increased physical activity, improved academic performance and reduced social risk behaviors, such as bullying and fighting,” she said. Kids can get all of that by working in a garden? Weber and her colleagues believe they can, in part because the »

UnearthingHealthy Habitsdelta garden study puts good health right in kids’ hands By Susan Van Dusen

>


study extends beyond planting seeds and watching them grow. It reaches into all areas of the middle school curriculum, from science and math to literacy and physical education. “It’s more fun for the students to learn because they are actually experiencing the concepts. When

they can see and feel the chemical change in hot compost, it brings it to life for them,” Weber said. Twelve Arkansas schools are involved in the study so far. Half have a one-acre garden

and greenhouse on their campus and receive the full program, with a curric-

ulum that meets state guidelines and allows students to work in the

garden at least twice each week as part of their regular

schoolwork. The other six serve as the control group

and have no garden. The study is funded by a $2 million grant from the USDA

Agricultural Research Services Delta Obesity Prevention Research Unit. Not only do the students plant and harvest the crops — promoting increased physical activity — they also learn to prepare the food in some unex-pected ways. “Most kids have eaten carrots, but we teach them how to make carrot salad. We want them to know they can experience the fruits and vegetables in many different ways,” she said. While most of the food produced in the gardens is used for class instruction, the remainder is prepared by the school cafeterias. Recipes also are sent home with the students in the hopes that they will share what they’ve learned with their families. A surprise that arose from the study involves a segment of the student population that Weber hadn’t specifically considered: special education students. “We didn’t realize that special ed students would find a place to shine in the gardens,” she said. “You don’t have to be academically, artisti-

cally or athletically gifted to thrive here. That’s what we were hoping for.” As the study concludes, Weber and her team will determine its success based on a number of factors, including test scores, diet, physical activity and grade point average. They’ve also enacted a plan for AmeriCorps volunteers to be placed in each school to help maintain the program after the funding concludes. “If the outcomes are positive, it will open up the possibility of more funding with the goal of a statewide school garden network addressing Arkansas’ health and academic outcomes.” ❖

The Mablevale Middle School garden is expecting a bumper crop of pumpkins this fall.

Addressing Childhood Obesity With a focus on reducing childhood

obesity in Arkansas, the Arkansas Children’s

Hospital Research Institute launched its

Childhood Obesity Prevention Research

Program in April 2012. The program is co-

directed by UAMS Department of Pediatrics

faculty Judith Weber, Ph.D., associate

professor, and Thomas Badger, Ph.D.,

professor. Badger also is a professor in the

UAMS Department of Physiology/Biophysics

and director of the Arkansas Children’s

Nutrition Center.

Among the projects under the program’s

umbrella are the Delta Garden Study, a

science-based garden program in Arkansas

middle schools, and the GLOWING Study

at the Nutrition Center, which examines

how a mom’s diet and health influence

her child’s growth and development. For

information, visit www.achri.archildrens.

org/ObesityPrevention.htm.


The lessons aim to mix nutrition education and entertainment to make a difference in molding healthy eating habits at a young age. “We’ve got to take every opportunity we can to reach out to school-age kids to impress upon them the impor-tance of good nutrition,” said Reza Hakkak, Ph.D., chairman of the Department of Dietetics and Nutrition. Preliminary results show a significant improve-ment in overall nutrition knowledge for most grade levels. “When students are actively participating in learning, they are more likely to remember the information.” Maddox said. Other student research projects have included the introduction of a nutrition education curric-ulum taught by graduate students at a local Boys and Girls Club afterschool program and to another local elementary and middle school where teachers were also in the audience. ❖

UAMS DIETETICS AND NUTRITION FACULTY and students are using the latest inter-active educational technology to fight childhood obesity in Arkansas. Through funding from the College of Health Professions Dean’s Society, Lori Maddox, a regis-tered dietitian and faculty member, and graduate student Susan Melhorn created and taught nutri-tion lessons with the use of interactive whiteboards to kindergarten through fifth-grade students this spring. Students learned nutrition concepts such as food group identification, proper serving sizes, balanced meals and important nutrients utilizing hands-on activities. The touchscreen feature of these whiteboards enabled students to drag and drop food items to create a balanced meal and match foods to their appropriate food groups, along with other fun learning activities.

UAMS dietitian Lori Maddox, right, and graduate student Susan Melhorn used interactive technology to teach nutrition at a Little Rock elementary school.

> nutrition education: It’s for the Kids By Jon Parham


Have nutrition Knowledge,Will travel By Jon Parham

WHETHER IT’S NUTRI-TION education lessons for elementary schools, health assessments for preschoolers, or counseling patients on weight loss, faculty and students in the Department of Dietetics and Nutrition at UAMS are engaged

in their community. For students, the work is sometimes tied to academic requirements for a research project or to gain work expe-rience. Community work also connects students to what many will do following gradu-

>

ation through jobs in schools, health care facilities or other workplaces that need nutrition education. “It’s what we do,” said Lori Maddox, a registered dietitian and instructor in the Depart-ment of Dietetics and Nutri-


tion in the UAMS College of Health Professions. “Working in the community gives students hands-on experience, witnessing the obesity problem firsthand.” The department has had a long partnership with the UAMS Head Start preschool program. For 11 years, the dietetic interns have conducted height and weight assessments of 1,000 Head Start students twice a year.

Working with the Head Start program’s full-time dietitian, the interns gather the data then calculate the body mass index (BMI) for each child. The preliminary data from those 11 years shows that much like Arkansas and the rest of the nation, a significant number of Head Start students fall into the overweight or obese categories, said Tina Crook, Ph.D., a regis-tered dietitian and an assistant professor in the department.

Armed with the BMI measure-ments, the interns then work with the Head Start dietitian on nutrition education materials for parents. “In many cases, the parents are overweight or obese too, so we want to talk to them and offer nutrition education or support,” said Reza Hakkak, Ph.D., department professor and chair. The interns also get expe-rience with nutrition coun-seling of patients in weight-loss programs like the UAMS Weight Loss and Metabolic Control program, the MOVE! Program in the Central Arkansas Veterans Healthcare System, and the Pediatric Fitness Clinic and WHAM! Program at Arkansas Children’s Hospital. The interns provide the coun-seling under supervision of each program’s dietitian. In one-on-one sessions, the interns can offer guidance on healthy lifestyle changes to promote weight loss and improve overall health. Crook said the experience helps interns see how a structured weight-loss program is set up. “Anyone who asks us to help, we will help,” Hakkak said. “Our faculty and interns have a passion for nutrition education, and working in schools and in these programs is a way that they can use their knowledge to help the community.” ❖

UAMS nutritionist Tina Smith, left, and nutrition intern Chelsie Kauffman talk about food choices with Head Start students.

Working with

the Head Start

program’s full-

time dietitian,

the interns

gather the data

then calculate

the body mass

index (BMI) for

each child.

startIng earLy

For children, weight management is a family affair By Susan Van Dusen

>

IF SAMIYA RAzzAq, M.D., could make one item disappear from every child’s diet, it would be sugary drinks. “If we can get a child to stop drinking sugary drinks, that’s a success,” she said. And in her chosen field of pediatric weight management, successes can sometimes be slow and hard to come by. As medical director of the Weight Management Clinic at Arkansas Children’s Hospital, Razzaq sees patients affected by obesity and the many physical and emotional variables that come with it. The clinic, which is open two and a half days per week, sees about 40 patients each week. “The issues we face in the clinic don’t just affect the child, they affect the entire family and some-times even earlier generations. We have to get everyone in the family on board, and that can be challenging,” she said. Razzaq also is an associate professor in the Department of Pediatrics in the UAMS College of Medicine. When the clinic was founded in 2000, it housed just one physician and one nutritionist. After it quickly become apparent that exercise should be incorporated into each child’s treatment plan, a physical therapist came on board, followed by a second nutritionist and a psychologist.

“We’re a multidisci-plinary team that works together to help children live healthier lives,” she said.

“If we can

get a child to

stop drinking

sugary

drinks, that’s

a success.”

This includes addressing not only the physical results of obesity, but also the causes behind a child’s weight gain. And it can require convincing some parents that there is a problem in the first place. “Some people think that weight problems are simply tied to genetics or the belief that their family is ‘big boned.’ I don’t buy it. We can change this situation for a lot of kids just by changing their envi-ronment,” she said. To be seen at the Weight Management Clinic, children must be referred by their primary care physician. At each visit they can expect to spend about two hours with the specialists, including a psychologist who addresses the emotional aspects of overeating. "Kids can’t control what is happening around them. Things like divorce, bullying or a death in the family can be very stressful, and eating is the easiest way for them to comfort themselves,” Razzaq said. While children don’t engage in exercise at the clinic, they are taught ways to incorporate activity and movement into their daily lives. Each patient also receives an exercise DVD produced by the clinic. With patients as young as 2, much of the nutri-tion and exercise education provided by the clinic staff is aimed at the parents. “Our success rate is dependent on compliance. For children younger than 9, we focus on the parents controlling the envi-ronment, but for patients age 10 and up we have to get their buy-in,” she said.

For Razzaq, any child who maintains his or her weight and eliminates sugary drinks is a success story. “These families are facing a complex situation. More often than not,

we’re asking them to change every aspect of their lives.” ❖


A PILOT PROJECT in rural southeast Arkansas aims to beat childhood obesity before lack of exer-cise sets in as a habit for young children. “We have a whole generation of young parents who were raised on video games,” said Martha Phil-lips, Ph.D., assistant professor of Epidemiology in the Fay W. Boozman College of Public Health at UAMS. “They’ve watched a lot of TV, grown up with computers, video movies and games, and hand-held computer devices and that is how they spend their leisure time.” Phillips emphasizes these parents are doing what they know to do and are taking good care of their children. But, “if you didn’t learn hopscotch or Duck, Duck Goose as a child, how do you teach these running and jumping games to your child?” “Research shows that our younger children ages 3 to 4 are spending about 75 percent of their waking hours engaged in sedentary activity, such as playing video games,” said Phillips. “That is not establishing good health habits.” Phillips is leading a feasibility study funded by the National Institutes of Health to measure how teaching parents about activities they can share with their children will be accepted by the community, and whether this kind of home-based intervention can improve the lives of young children. The project team includes Elizabeth Taylor, who serves as the project coordinator, along with Onie Norman and

Christie Newton-Lindsay, who live and work in Dumas, where the program will be tested. Already, they’ve got support from community leaders in Dumas who see the benefit of putting tools into the hands of parents to help them engage their preschool children. The pilot project’s planned enrollment is 25 families. Parents will meet once a week for eight weeks with a facilitator who will introduce a new set of activities that parents can play with their children in ten- or fifteen-minute blocks of time. At the end of the eight weeks, parents will have a toy box filled with tools for each activity to get their child moving. Newton-Lindsay, who serves as deputy director at the Phoenix Youth and Family Services and is the mother of four-year-old twins, supports the project and is helping with it. “Many moms are working two full-time jobs (employment + motherhood),” said Newton-Lindsey. “It is hard to fit physical activities in along with homework, taking care of the family, church, and other community activities. Oftentimes, mothers are exhausted at the end of the day. The activities provided through the toy box will inspire parents to become more active with their children, and at an important development period when they are developing motor skills and learning eye-hand coordination.” ❖

a toy Boxof the FutureBy Sally Graham

At the end

of the eight

weeks, parents

will have a toy

box filled with

tools for each

activity to get

their child

moving.

>


Elizabeth Taylor is coordinator for a project in rural southeast Arkansas that teaches parents about activities they can share with their children.


IN 2003, when Arkansas became one of the first states to pass comprehensive legislation to combat childhood obesity, critics worried about negative social and emotional consequences for students. Now that the decade-long experiment is entering its final year, the foundation that funds regular reviews of implementation of the legis-lation says Arkansas will be looked upon as a national blueprint in addressing unhealthy eating habits of youngsters and their families. “We are incredibly proud of the evaluations of Act 1220 of 2003, which initially gave us confidence to invite other states to take a look at school policies that affect children’s healthy weight,” said Laura Leviton, Ph.D., a senior advisor at the Robert Wood Johnson Foundation that funds the assessments. “The evaluation gave us a strong sense of what schools could feasibly do over time. And key insights for the country, such as documenting the changes in parents’ understanding of healthy weight, came directly out of the UAMS yearly reports.” Obesity continues to be one of the most pressing health threats facing families and communities in Arkansas and in the nation. And

with one in three children overweight or obese, the direct health care cost attributed to child-hood obesity in the United States is estimated at $14 billion per year. “Act 1220 encouraged schools and school districts to review their policies, practices and facilities, and to implement changes that will promote healthy lifestyles for students, staff and families,” said Martha Phillips, Ph.D., assistant professor in the UAMS Fay W. Boozman College of Public Health’s Depart-ment of Epidemiology. Phillips and Jim Raczynski, Ph.D., dean of the College of Public Health, were the evalua-tion’s lead investigators. The legislation required annual body mass index (BMI) screenings for all public school students with the results reported to parents, restricted access to vending machines in public elementary schools, and disclosure of schools’ contracts with food and beverage companies. Critics predicted BMI screenings would lead to an upswing in teasing and bullying among students. Despite the initial concerns, the data suggests that few adverse effects, if any, have occurred. A College of Public Health research team

Blueprint for success Arkansas a national model for childhood obesity interventionBy Nate Hinkel

“The evaluation

gave us a

strong sense of

what schools

could feasibly

do over time.”

>


designed a study to look at that concern. The team conducted telephone surveys of 6,417 parents and 1,042 students ages 14 and older who attend public schools in Arkansas. Their surveys were done before BMI testing began and then one and two years afterward and found that teasing did not increase after the changes mandated by Act 1220. “We found no downside at the group level to student BMI assessments,” said Delia West, Ph.D., a researcher and psychologist at the College of Public Health. “And if the assessments and the law’s other provisions motivate kids to eat healthier

foods and get more exercise or encourage parents to make changes at home, there is the upside of a major public health benefit.” In the midst of the final year of data collection, Phillips said a key realization has been the role that support plays in following policy changes. “We found that those implementing policies needed to feel like the people above them were supportive of the change,” Phillips said. “Support is the deal maker or deal breaker.” Full reports for each year can be found online at www.uams.edu/coph/reports/#Obesity. ❖


Community ACtion

CROUCHING NExT TO HIS BACK-YARD POOL for a routine skimming of its leaves and drowned insects, Jim Brown saw a reflection of a man he didn’t want to be. After having let his health go a little bit following the death of his wife in 2006, Brown was hit with the realization that he couldn’t muster the strength or agility to get back up from his poolside routine. “I was too fat, bottom line,” said the 67-year-old Brown. “I just didn’t care too much anymore and overate regularly.” He’d heard about the UAMS Program for Weight Loss and Metabolic Control from his daughter, Melody, and friends in casual conver-sations. When he entered the program June 25, 2009, Brown weighed 307 pounds. A lot of people don’t realize how much their weight and eating habits affect their lives,” Brown said. “It affects your mood, your relationships, your health, and overall just your quality of life. The program at UAMS has worked for me and it’s been a guiding factor in my life.” The program gives the patient knowledge and tools to succeed by aiming to permanently change unhealthy lifestyles and eating habits, said clinic coordinator Betsy Day. Getting participants to reach their ideal weight is accomplished through a documented, medically proven strategy. “Many people get caught up in losing weight as quickly as possible and don’t have an under-standing of the dangers of fad diets and drugs that often are more risky than being overweight or obese,” Day said. “The key part of any rational diet includes behavior modification to avoid regaining the lost weight as soon as previous eating habits resume.”»

a newapproach

By Nate Hinkel and Sally Graham

“A lot of

people don’t

realize how

much their

weight and

eating habits

affect their

lives.”

>


Jim Brown, 67, has lost about 130 pounds and is running marathons after participating in the UAMS weight-loss program.


With the program’s encouragement for a steady dose of exercise, Brown picked up a passion for running, which he shares with his multi-mara-thon-running daughter. “We always used to travel around and support Melody in her marathons,” Brown said. Nowadays, he isn’t just watching, he’s partici-pating. He’s completed one 5k, six half-marathons and the full Little Rock Marathon in March 2012. He trains locally with the Little Rock Marathon training group, which includes up to four runs a week. He also mixes in strength training about

three times a week. But even with plenty of exercise, he sometimes needs additional motivation and discipline required to stay on track. “That’s what is great about the program,” Brown said. “I know myself, and I know I need to stay involved. The people at UAMS have been great, and they’re always there for advice and positive reinforcement to keep me on track.” Brown keeps his weight around 180 pounds and stops by UAMS to weigh in almost weekly. Now that he’s training for another marathon, it requires

Clinic coordinator Betsy Day, right, says the UAMS Weight Loss Clinic gives patients the tools to succeed.


eating more calories to keep his energy level where it needs to be. The staff at UAMS helps him regu-late his eating habits and keep him sufficiently fueled for his runs. “I’m going to be around to enjoy my family much longer now,” Brown said. “I’m a changed man and I would encourage anyone thinking about doing this to do it for themselves. You only live once so you have to make it count.”

Fit for the Future At 448 pounds, Daniel Moix, 32, knew he needed “a multifaceted approach to weight loss.” And like Brown, he found it last year at the UAMS Weight Loss and Metabolic Control Program. “I’d had many wake-up calls in the past, but I kept hitting snooze,” Moix said. The UAMS plan consists of Health One Meal Replacements, weekly classes in nutrition and behavior modification taught by registered dieti-tians and nutritionists, and regular visits with a board-certified endocrinologist. The UAMS Weight Loss and Metabolic Control Program helps patients: • Loseweight• Improvetheirhealth• Maintaintheirweightloss• Enhancetheirchancesforlongevity Moix is one of about 250 active patients in the program that’s been a fixture at UAMS for nearly 20 years. Former Arkansas Gov. Mike Huckabee may be the plan’s most high-profile success story, but there are many patient-champions eager to share their before-and-after photographs. Elizabeth Vaughn-Neely, who has reached her goal and is on the maintenance plan, says learning how to keep track of what she eats has helped. She lost 132 pounds and eliminated blood pres-sure medication and having to prick her fingers because she is no longer diabetic. “I feel it! My blood pressure is now 101/62!” Betsy Day, the weight control clinic coordi-nator, said many patients sign up who don’t need to lose a dramatic amount of weight. “Cancer,

cardiovascular diseases, hypertension would all decrease tremendously by a 20-25 pound weight loss in some patients.” What distinguishes the UAMS program is that a board-certified endocrinologist consults with patients throughout the process. Stavros C. Mano-lagas, M.D., Ph.D., an endocrinologist who directs the program, says patients are assigned a track. “Red patients see the doctor once every two weeks,” said Manolagas. “Orange patients see the doctor every month. Yellow patients see the doctor once every 2-3 months. Green patients no longer have to see the doctor.” Moix said he is glad a doctor is with him every step of the way. He started the program as a red, transitioned to orange and calls himself “a yellow fellow” now. Besides the formal education classes, patients take field trips to grocery stores and restaurants to test their new skills. They learn practical guides, such as a 3-ounce serving of meat is the same size as a deck of playing cards, not the oversized portion served in restaurants. Patients also look to each other for inspira-tion, support and understanding when they may encounter what Moix calls “lapses, relapses and collapses.” As a self-proclaimed data nerd, Moix manipulates his weight statistics in a spreadsheet and has shared his ups and downs on an informa-tive and entertaining blog. As a sedentary child of an obese parent, the native Arkansan weighed 165 pounds in the third grade. By high school, he could no longer find a scale to accommodate his size. He’s lost 173 pounds so far, but measures his progress in real “a-ha” moments. “I simply didn’t fit through the vessel’s water-tight doors,” Moix says about the USS Razorback, a World War II-era submarine at the Arkansas Inland Maritime Museum. A recent photograph captures a beaming Moix fitting through the door. “Serving as a motivator to my peers both in-person and through my blog is rewarding,” said Moix. “Finally, being able to do the things that I want to do makes it all worth it. ❖

Besides

the formal

education

classes,

patients take

field trips to

grocery stores

and restaurants

to test their

new skills.

24 www.uamshealth com UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCESFaith

Powerof Faith

CHURCH-GOING African-Americans in the Arkansas Delta are feeling the power of faith a little more than usual these days, especially around their waistlines. Researchers at the UAMS Fay W. Boozman College of Public Health targeted that demo-graphic to test a faith-infused weight-loss inter-vention that showed promising results. Partici-pants not only lost weight, but also credit spiritual support in making healthier choices altogether. The series of studies are led in part by Karen Hye-cheon Kim Yeary, Ph.D., associate professor in the UAMS College of Public Health’s Depart-ment of Health Behavior and Health Education. “We know that faith plays a large role in the lives of residents there, and so creating an interven-tion to fit into the teachings and lifestyles of a faith-based community is where we feel we can make a difference,” Yeary said. “Basing an intervention on faith and community components shows promise for engaging this demographic to change health outcomes.” So after having wrapped up a smaller scale National Institutes of Health-funded pilot study a year ago showing promise that a faith-based approach can work, Yeary and a team of researchers are taking those results, adding a maintenance component, and thinking big. »

Faith-infused study shows weight-loss benefits inArkansas delta By Nate Hinkel

Faith

>

25


FaithCombining resources Research indicates that African-Americans and rural residents are disproportionately affected by obesity. Several studies have shown faith-based interventions can have some success, but they have all been done in urban settings without using a community-based participatory research approach. The UAMS research team has worked with the Faith Task Force, a group that represents more than 30 churches and community organizations in the Delta. The Faith Task Force connects faith and health to improve lives in the communi-ties they represent. “Participating churches initially identified physical activity, nutrition and obesity as primary health concerns,” Yeary said. “While very few churches had existing health promotion activities, they all expressed an interest in imple-menting a health program.” Given those findings, the Faith Task Force chose to focus on obesity and related health behaviors and to adapt the weight-loss program for African-American adults. Incorporating materials and practices from similar efforts in North Carolina, the study sought to adapt a successful weight-loss program for the faith-based rural population

that was also led in churches by trained community leaders.

Faithfully devoted The pilot study chose three small African-American churches in the Delta, and two members from each church were trained to lead programs at their place of worship. “They were given knowledge about healthy weight, weight-related health behaviors, faith and health, and behavioral strategies, and then had to pass a test,” Yeary said. Ten participants from each church took part in the 16-week intervention that included weekly lessons, a Bible study that connected faith and health, and group exercise. Yeary said a focus was put on goal setting and problem solving, with an emphasis on self-monitoring. Participants were encouraged to “spend 15 minutes per day with God” about the health program, she said. “What we found was that participants lost about 4.5 percent of their initial weight on average and reported signifi-cantly more physical activity,” said Jerome Turner, leader of the Faith Task Force. “They also had greater encouragement to eat healthier and be more phys-ically active from family and friends.” Participants said the biggest motivators were the group exer-

cise sessions and using scripture to promote health. “They reported that the connection between faith and health motivated them to make positive behavior changes because it increased their confi-dence to make healthy choices and provided an incentive to do well in the program to show devotion to God,” Yeary said.

Added value Next, the research team is planning a full-scale NIH-funded study to begin in January 2013 that will include 30 churches and about 450 partici-pants. “We know that weight loss can be obtained in rural African-American communities of faith,” Yeary said. “We also know that the positive effects tend to diminish unless weight loss is maintained.” So in addition to the 16 sessions will be a 12-week main-tenance period. The team thinks the previous weight-loss inter-vention with the added benefit of the maintenance program will result in higher weight loss maintained over a longer time period. “We know it worked on a smaller scale, and we expect to learn a lot more this time around that will hopefully have a lasting and significant impact on health in the Arkansas Delta,” Yeary said. ❖

Participants

said the

biggest

motivators

were the

group exercise

sessions and

using scripture

to promote

health.


Faith

It takes a Coalition

THIS PAST SUMMER has been exciting and a little overwhelming for Debra Bolding and Glenda Rice, volunteer co-managers of the Howard County Farmers Market in the southwest Arkansas city of Nashville. Since finishing out a kitchen at the farmers market last year, the demand for cooking demonstrations there has meant weekly rather than monthly demonstrations as originally planned.

“It’s been a hit, almost too big of a hit,” Bolding, a master gardener, said with a laugh. With the focus on preparing fresh, seasonal produce, audiences have been treated to the cooking expertise of local market growers, the county extension office, a local Mexican restaurant, a grocery store and market customers. The cooking demos are part of Nashville’s Growing Healthy Communities initiative, which »

uAms Part of Coordinated statewide obesity Fight By David Robinson

>

Cooking demonstrations using fresh, seasonal produce were a hit at the Howard County Farmers Market in Nashville.

Pho

to c

ourt

esy

of D

ebra

Bol

din

g


“The Arkansas

Coalition

for Obesity

Prevention

is a jewel for

Arkansas.”

received $12,000 in 2009 from the Arkansas Coalition for Obesity Prevention (ArCOP), with funding from the Arkansas Blue & You Foundation.

The funds helped expand a demonstration garden adjacent

to the farmers market and the integration of workshops with

demonstrations and other activities at the market. In addition, the effort helped establish

a beekeepers club and a junior beekeepers program, producing several new beekeepers – and many more honeybee hives – in the community. The Nashville initiative, which has 14 total strategies, is one that stands out among the 18 Growing Healthy Communities grant recipients, said UAMS’ Todd Moore, an ArCOP member who manages the Community Engagement program for the UAMS Translational Research Institute. Moore also noted that Springdale’s Growing Healthy Communities Initiative received a $5,000 match from the mayor’s office and used it to provide grants of $750 to $1,000 to support community gardens. “I think what has happened in Springdale and Nashville really epitomizes what can be accomplished with just a small amount of seed money,” said Moore, who provides technical assistance to the communities. “Taken together, all of our Growing Healthy Communities grant recipients have leveraged nearly $1 million in additional support from the original $500,000 Blue & You grant.” ArCOP was established in 2007 with dozens of public and private partners, including the UAMS colleges of Medicine, Nursing and Public Health, and the Arkansas Center for Health Improvement. Soon after, the coalition integrated the similar goals and activities of its partners and

established a comprehensive obesity strategy. The coalition has six teams: Access to Healthy Foods; Built Environment; Early Childhood and Schools; Healthcare; Worksite Wellness; and Social Marketing. Growing Healthy Communities is one of two major ArCOP programs; the other is Be Our Voice (a project of the National Initiative for Children’s Healthcare quality). “The Arkansas Coalition for Obesity Prevention is a jewel for Arkansas,” said Allyson Cook, a coalition member who directs the Division of Continuing Medical Education in the Department of Family and Preventive Medicine in the UAMS College of Medicine. “Its collaborative structure allows it to capitalize on all the available resources, avoid duplicating effort and energize Arkansas communities to address this issue.” Following through on the brainchild of another ArCOP member, Meenakshi Budhraja, M.D., Cook recently coordinated the first statewide conference to teach primary care physicians about nutrition, including a kitchen session focused on preparing healthy, flavorful meals led by WinRock’s certified Executive Chef, Robert Hall. The two-day conference, Healthy Food, Healthy Living Arkansas, held in August at the Winthrop Rockefeller Institute on Petit Jean Mountain, included a presentation from Rick Deroque, a former contestant on NBC’s “The Biggest Loser,” and Jaymo Mayo, who directs Conway-based Nabholz Construction’s wellness program. Nabholz was featured in a segment of HBO’s “Weight of the Nation” documentary, which was replayed during the conference. Faculty from UAMS also presented at the conference, including Jeanne Wei, M.D., Ph.D., executive director of the UAMS Reynolds Institute on Aging and chair of the Reynolds Department of Geriatrics in the College of Medicine; David Nelson, M.D., a UAMS family medicine physician; and Jeremy Thomas, Pharm.D., an


associate professor in the College of Pharmacy. “Primary care doctors are on the front lines trying to help their patients with this complex, often frustrating chronic disease,” Cook said. “By focusing on nutrition, easy cooking methods and partnering with patients, we are giving doctors additional tools to help them effectively treat their patients. That’s a crucial part of this obesity fight.” Back in Nashville, Bolding’s group has begun

to reach more people in the region through a regular “Did You Know?” radio spot, which provides healthy eating tidbits and promotes activities of the initiative. The 30-second to one-minute spots, along with the group’s other activities, seem to have struck a chord with the community, Bolding said. “If we can get more people to at least think more about what they eat and what their children eat, then that’s a good start.” ❖

UAMS’ Jeanne Wei, M.D., Ph.D. was one of several presenters at a two-day healthy food conference last summer.

“Primary care

doctors are on

the front lines

trying to help

their patients with

this complex,

often frustrating

chronic disease.”


FROM “A’HEC OF A BREAK” to “Bust a Move & Improve,” programs offered at UAMS Area Health Education Centers (AHEC), are addressing childhood and adult obesity in exciting ways. The AHEC program of regional centers was started in 1973 to address the shortage of health care providers in the state. Eight AHECs are spread across the state embracing innovative strat-egies to reach out to the communities they serve. “The AHECs serve one of UAMS’ most vital missions – to reach out to rural Arkansas with the best care and medical education opportunities available,” said Mark Mengel, M.D., M.P.H., vice chancellor for Regional Programs and executive director of the AHEC program.

south Arkansas The CATCH program is an evidence-based plan that teaches children the importance of making healthy food choices. (CATCH stands for Coordinated Approach to Child Health and is one of the largest elementary health studies in the country.) In its fourth year at AHEC South in El Dorado, the program has reached more than 1,600 chil-

reaching outAhECs bring health education to every regionBy Sally Graham

dren in first through third grades. Children learn about the concepts of why one food is better than another. Parents report that their children are now asking for whole wheat bread. Michael Fitts, Psy.D., AHEC South director, and Rebecka Wendling, community outreach coordinator, are proud of the program’s reach, with more than 88 classes in seven schools in Ouachita, Columbia and Union counties.

southwest Arkansas Most of the anti-obesity work in the nine counties AHEC Southwest in Texarkana serves is through community education and outreach, said Patrick Evans, AHEC Southwest director. In addi-tion to nutritional guidance and raising awareness about poor food choices, the AHEC has partnered with Arkansas Children’s Hospital to help chil-dren who are already obese. Evans reports one of the most insightful discoveries took place at the Texarkana Community Clinic where the AHEC’s licensed clinical social worker sees patients. “Kelli Cook helped us realize a side of obesity that we were not aware of,” said Evans. “She helped us to see that many women who were obese and had poorly controlled diabetics had »

>


experienced sexual trauma. The women seemed to adopt obesity as a protective mechanism from further sexual attacks.”

West Arkansas AHEC West in Fort Smith serves 13 counties. Don Heard, Ed.D., AHEC West director, says the clinic provides patients with health education handouts related to height and weight, calculates patients’ body mass index and offers counseling to obese patients. Interactive video connects a dieti-tian at UAMS with patients in Fort Smith. Courtney Cathey, an outpatient dietitian, meets with patients one-on-one. She reviews their typical day of food choices and provides them with meal patterns, portion sizes, and perhaps equally as important, emotional guidance. “I want my patients to know I’ve been there and I know what they’re going through,” said Cathey.

northwest Arkansas AHEC Northwest in Fayetteville serves six counties. Eleanor Hughes meets with adults and children to provide weight loss and nutritional education. Hughes has been instrumental as a health coach partnering with area schools. In the Lincoln School district in rural Wash-ington County, Hughes takes part in an after-school program called Girls on the Run, teaching third- through fifth-grade girls about staying active, regular exercise and self-esteem. And in the Fayetteville School District, she works with Apple Seeds Inc. to teach children in elementary schools about healthy eating, growing their own food and eating locally grown food.

north Central Arkansas AHEC North Central has two offices serving 11 counties and offers a series of efforts to curb obesity. Diabetes support groups have been estab-lished in three counties and focus on exercise and weight control. Many patients with diabetes benefit from a clinical education program that

helps them manage their condition. The Batesville office was instrumental in obtaining a “Growing Healthy Community Grant” in 2010 in partnership with the city of Batesville and the Independence County Home-town Wellness Coalition for development of a community garden, walking trails and ensuring water is available in vending machines. The Mountain Home office, in cooperation with the Baxter County Cooperative Extension office, developed a Mini-Camp Fit and Fun for the children at Cotter Elementary School, high-lighting the benefit of physical activity.

northeast Arkansas “Childhood obesity is not just about numbers on a page. It’s real issues affecting real people,” said Sandra Lusby, director of outreach at AHEC Northeast in Jonesboro, which provides outreach to nine counties. A Miles for Smiles pilot program focused on the children at the Micro-Society Magnet School. They raised money for the D.D.S. 4 NEA Foun-dation and received tooth care kits and dental seal-ants. The AHEC is developing a camp called BMI: Bust a Move & Improve in partnership with the St. Bernards Health and Wellness Institute. It will introduce portion control, healthier eating habits and physical activity.

Arkansas delta For combating obesity, the Delta AHEC’s crown jewel is its fitness center. Becky Hall, Ed.D., AHEC director, said boot camps for working mothers are held in Helena and Marianna. The fitness center hosts programs such as AHEC of a Break for elementary through high school kids during spring break, discussing exer-cise, CPR, first aid and personal hygiene. The fitness center has become a vehicle for improved communication between the diverse communities of the area. ❖


ALL AGES can benefit from education on nutrition and obesity prevention, as demon-strated this year by presentations to a group of older adults by faculty in the UAMS College of Health Professions Department of Dietetics and Nutrition. Lifequest of Arkansas, a central Arkansas nonprofit group that hosts activities for older adults, invited the depart-ment to speak. Eight one-hour sessions covered topics ranging from weight management to meal planning to obesity and disease. “When you’re talking nutri-tion to an older population, you must consider that some may live alone, on a fixed income or may not be able to drive,” said Tina Crook, Ph.D., a regis-tered dietitian and an assistant professor in the department. “These factors can influ-ence their food choices

talking nutritionto older arkansans By Jon Parham

and must be considered when offering them suggestions for a healthy diet.” Many chronic diseases such as diabetes, heart disease or high blood pressure, are linked to obesity and nutrition, said Dana Gonzales, Ph.D., an assistant professor in the department. The faculty members offered diet recommendations that will help with management of those diseases. Recommendations included so-called “super foods” high in nutrition content, such as beans, berries, avocadoes, tomatoes, nuts and leafy vegetables. In older adults, a steady diet of these foods can help protect against age-related problems

like macular degeneration, neurodegenerative diseases like Parkinson’s, and some types of cancer, Gonzales said. “The participants were very interested in learning about nutrition in chronic diseases. They asked great questions and gave insightful feedback,” said Lori Maddox, a registered dieti-tian and department faculty member. She taught classes on nutrition-related cardiovascular disease and hypertension. “One of the participants told me he already knew a lot of the information discussed but it was good to hear it with a group of friends who could provide a strong support system and offer suggestions for sticking with the nutrition recommenda-

tions,” Crook said. ❖

Recommendations

included so-called

“super foods”

high in nutrition

content, such as

beans, berries,

avocadoes,

tomatoes, nuts

and leafy

vegetables.

>


Obese

patients

are much

younger when

admitted

to a long-

term care

facility than

non-obese

patients.

HOLLY FELIx, PH.D., recalls a day six years ago when she learned about an obese elderly woman whose family couldn’t find a nursing home that would admit her. Felix, an assistant professor in the UAMS College of Public Health, said the story helped crystallize her research focus. The patient’s expe-rience raised many questions about the impact of obesity on access and quality of care. To help her devote time to the issue, she received a $180,000 KL2 Scholar Award from the UAMS Translational Research Institute, which is funded by the National Institutes of Health. “Obesity has a major impact on our ability to function, to perform the activities of daily living,” Felix said. “When people lose the ability to be independent, they usually need care that may only be provided in a long-term care setting. But if long-term care facilities won’t take them, then what happens to them?” Felix said she’s learned from nursing homes that sometimes they simply lack the ability to care for obese patients. They may not have bariatric equipment or a bed to hold an obese person, or may not have enough staff to move someone who is obese, and they don’t want to risk injury to the resident or staff. Given their numbers, baby boomers will practically overwhelm the supply of existing nursing home beds. When obesity is factored in, access becomes a bigger issue. In a pilot study, Felix found that obese patients are much younger when admitted to a long-term care facility than non-obese patients. This means they potentially will need care for longer periods of time, which

ready or notobesity Adds to Challenges for long-term Care By David Robinson

would further tighten the supply of available beds. Felix said she’s still documenting this as an emerging issue. “I’m trying to understand what it means for those facilities and their residents.” Some preliminary work suggests that long-term care for the obese differs from that of lean nursing home residents. In a study in partnership with the University of Pennsylvania, patients are interviewed regarding their continence care. “We’ve had obese patients report that they’ve had to sit in wet incontinence pads waiting for help because staff weren’t readily available, and they couldn’t manage themselves to the toilet,” Felix said.

>


Interventions that reduce obesity rates and help people remain independent are part of the solution. Felix has joined Delia Smith West, Ph.D., principal investigator of a weight-loss study that involves 16 senior centers around the state. Funded by the federal Centers for Disease Control and Prevention, the study incorporated a weight-loss program that was taught to staff and volunteers at the senior centers. Study results, published in the American Journal of Preventive Medicine, show 38 percent of those in the program experienced at least a 5 percent weight loss. That compares to less than 5 percent of study participants not in the

weight-loss program. Felix notes that a 5 percent weight loss has been shown in other studies to produce signifi-cant health benefits. “Part of translational research is trying to get solutions that can sustain themselves out in the communities,” Felix said. “So we took this evidence-based program that was studied and developed in a very controlled setting, and we repackaged it and trained senior center staff and volunteers to deliver it. Now the researchers have gone away, but those people are still there helping participants.” ❖

UAMS’ Holly Felix, Ph.D., is studying the impact obesity has

on access to nursing home care.


“We’re focusing

on obesity

because it is the

major problem

of our time in

medicine.”

SCIENTISTS TODAY know that the key to a major reduction in obesity rates lies beyond prescriptions for diet and exercise. Between 20 and 30 percent of babies may be fated to a lifetime of weight battles by their exposure to obesity while in the womb, known as maternal programming of fetal metabolism, said UAMS’ Thomas Badger, Ph.D. Badger is director of the Arkansas Children’s Nutrition Center, one of six Human Nutrition Research Centers in the nation funded by the U.S. Department of Agriculture (USDA). “We clearly demonstrated in animal models that the exposure to obesity before birth can permanently change the offspring metabolism to utilize energy from food much more efficiently and store the remaining energy as fat” said Badger, a professor in the Departments of Pedi-atrics and Physiology/Biophysics in the UAMS College of Medicine. “If you take two sets of children, one programmed and one not, the programmed children may become obese despite consuming similar amounts of food and having the same level of physical activity as the other children,” Badger said. Significant weight loss prior to a pregnancy has been shown to moderate such programming, but it may not be a realistic solution for all situa-tions. Badger is on a team of seven UAMS scien-tists who are researching ways to prevent the life-altering side-effects of maternal obesity. Their $3.2 million study is funded by the USDA and is led by Aline Andres, Ph.D., an assistant professor

Like Mom, Like Baby

in the Department of Pediatrics and an investi-gator at the Arkansas Children’s Nutrition Center, which is based at Arkansas Children’s Hospital. Together, they designed the study to investi-gate how children’s ability to use and store energy may get programmed from their mothers. The five-year study will involve 320 lean, over-weight and obese pregnant women. It will follow participants during pregnancy and study the growth and body composition of their children until age 2. The research will focus on the link between maternal metabolism and their child’s growth, development and metabolism. The exact mechanisms by which maternal programming occurs are still unknown. But the researchers are focusing on the placenta, the key organ linking the maternal and fetal circulation, to understand the potential signals that may be transmitted from the mother to the fetus. The study represents translational science at its best, with collaboration across a large group of scientists to expedite the application of knowl-edge gained from animal models to humans. With help from Kartik Shankar, Ph.D., Andres and Badger are already testing potential interven-tions to prevent obesity as early in life as possible. “We hope that in a few years we can develop an effective prevention strategy for the general population,” Andres said. As part of this trans-lational enterprise, the UAMS Translational Research Institute is providing nursing support.In a separate study also led by Andres, researchers are trying to determine if programming may occur prior to conception. The study of fetal metabolism is one of the center’s most significant projects because the knowledge gained is expected to advance prevention and treatments of other diseases, such as diabetes and cancer. “This has much wider implications, but we’re focusing on obesity because it is the major problem of our time in medicine,” Badger said. ❖

maternal obesity programs offspring toward obesity By David Robinson

sCientifiC ReseARCh

>


(From left) UAMS researchers Aline Andrews Ph.D., Thomas Badger, Ph.D., and Kartik Shankar, Ph.D., are seeking to prevent effects of maternal obesity.


overweight and obese pregnant women more likely to gain more than recommended By Nate Hinkel

a Healthier Weigh>

Cynthia Elizondo Gregory, right, continued to exercise throughout her pregnancy to help avoid excessive weight gain.


“There is

promise for

programs that

help women

gain a healthy

amount during

pregnancy.”

more than the recommended amount of weight because that group has a higher obesity rate. The question was timely, she said, because in 2009 the Institute of Medicine changed its gestational weight gain guidelines. Before 2009, obese women were advised to gain at least 15 pounds with no upper limit. The new guidelines rec-ommend obese women gain 11 to 20 pounds, “a much more restricted range,” Krukowski said. The study shows that contrary to what researchers initially believed, African-American women and Hispanic women are not more likely than Caucasian women to have excessive weight gain. It also showed that women’s pre-preg-nancy weight category is the best predictor of meeting the gestational weight gain guide-lines. “Having programs that focus on achieving a healthy weight prior to pregnancy would be tricky because most pregnan-cies aren’t planned,” Krukowski said. “However there is promise for programs that help women gain a healthy amount during pregnancy. These findings will help us target programs to the women most vulnerable to excessive gestational weight gain that could make a differ-ence in the lives and health of Arkansans.” ❖

WOMEN CATEGORIzED as overweight or obese before pregnancy have a much higher tendency to gain more weight than recommended during preg-nancy than women at a normal weight. But while overweight and obese women are about four times as likely to gain too much during pregnancy, one out of two normal weight women are also gaining unhealthy amounts of weight. “This is concerning,” said Becca Krukowski, Ph.D., assis-tant professor in the UAMS Fay W. Boozman College of Public Health. “This means it will be important in future work to determine strategies to keep gestational weight gain within recommended guidelines, partic-ularly among overweight and obese women. It’s a vital concern for not only the health of the mother, but a growing concern about their offspring.” Expectant mothers gaining too much weight can develop gestational diabetes, backaches, leg pain, increased fatigue, vari-cose veins, increased risk of cesarean delivery, high blood pressure and many other prob-lems. Research is finding that babies born to mothers with excessive weight gain are more likely to be overweight later in their lives. Krukowski was part of a team of researchers looking to find the proportion of women exceeding

the recommended amount of weight gain during pregnancy and explore the racial and ethnic differences of those who were. Funded by the UAMS Center for Health Disparities, the team collaborated with the Arkansas Department of Health, which held the exper-tise and the key to a wealth of data through its Pregnancy Risk Assessment Monitoring System (PRAMS). Developed by the federal Centers for Disease Control and Prevention, PRAMS is an ongoing state- and popula-tion-based survey that collects information on self-reported maternal behaviors and experi-ences that occur before, during and shortly after pregnancy among women who deliver a live-born infant. “The questionnaire is mailed to a sample of mothers ran-domly selected from state birth certificate records,” said Mary McGehee, Ph.D., a senior research analyst at the Health Department who collaborated with the College of Public Health on the study. “Responses are accumulated during the calendar year, combined with birth certificate data, and then weighted to be representative of all mothers who had a live-born infant in the state.” Krukowski said some have assumed that during pregnancy African-American women would be more likely to gain


Challenges in the DeltaBy Sally Graham

THE ARKANSAS FLOOD PLAIN of the Mississippi River is the richest soil in the state, supporting extensive rice and soybean produc-tion. A common image of the Arkansas Delta is that this fertile soil provides families with space for personal and community gardens. A new National Institutes of Health-supported study, led by epidemiologist Martha Phillips, Ph.D., in the UAMS Fay W. Boozman

College of Public Health is discovering just how skewed this popular image really is. The study, in collaboration with commu-nity networks, is focusing on 19 counties in the Arkansas Delta. The study’s geographic region – St. Francis County in the north to Union County in the south – has some of the worst health issues in the state. “Obesity is really a function of calories in

>


What’s hard to

comprehend is

the challenge

most people

in rural

communities

actually face

when trying to

achieve this

seemingly simple

nutritional goal.

and calories out plus a little metabolism in the middle,” said Phillips. The U.S. Department of Agriculture touts the benefits of eating nine servings of fruits and vegetables a day. Fruits, for example, make up half of its stylized plate at choosemyplate.gov, mapping what a healthy meal should look like. This seems straightforward: A trip to the grocery store could easily fit the bill. What’s hard to comprehend is the chal-lenge most people in rural communities actu-ally face when trying to achieve this seemingly simple nutritional goal. The study’s researchers say most people in the Delta don’t have gardens because people living near commercial crops are concerned about overspray of pesticides. Calories are also cheap. For people hovering at or below the poverty line, it’s hard to deny the appeal of a convenient 99-cent cheeseburger and a 99-cent order of fries off a dollar menu at a fast food restaurant. So, Phillips and her team set out to assess the food systems in the 19 counties. Where do people purchase their food? How far do they have to go to shop? And, what kinds of fresh fruits and vegetables are actually available? The team first docu-mented all the places people are able to purchase food, including supermarkets, drug stores, convenience stores and grocery stores, using commercial and publicly available databases. Next, they drove the streets, actually veri-fying the establishments listed in those databases exist. The team found some places were no

longer in business and others were selling food but were not in the databases. Results indicated that unless residents in the rural research area want to, or have the ability to, drive 30 or 40 miles to shop for groceries, they end up purchasing their food from convenience stores where canned meat, white bread and an occasional can of green beans, orange or banana are mainstays. A third phase of the study is assessing what kinds of fruits and vegetables are available and if they are canned, fresh or frozen. In the final segment, community residents will have an opportunity to share their perspec-tives about the challenges they face to eat healthy. What kinds of changes do community leaders want? “We make it hard for people to eat in a healthy way,” said Phillips. “But we believe that before we can change the system, we have to know more about the realities of the system.” ❖


With statistics showing almost 65 percent of American adults are overweight or obese, Reza Hakkak, Ph.D., believes obesity has changed the way the body responds to diseases, connecting the dots to cancer and liver disease among others. In the late 1980s when he joined the UAMS faculty as a nutrition researcher, Hakkak, now chairman of the Department of Dietetics and Nutrition in the College of Health Professions, said not many were talking about the growing

Links in obesity Disease DevelopmentBy Jon Parham

obesity problem in America. But as American diets included more and more greasy, fried foods and super-sized fast food meals, the impact was seen not only on the waistline but on people’s health. “As a researcher, one cannot say that we are normal anymore – you have to factor obesity rates into any study about disease development,” he said. “We have changed. We must now consider obesity as a factor in most all disease-related research.” In two decades of research, he has focused

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to assume that the same thing is happening in women with weight problems. He also is looking at how a diet rich in soybeans and soy products, a major source of protein for many, may increase or decrease cancer risk depending on body weight. The relation-ship between soy consumption and disease is a complicated one, Hakkak said. While a soy-heavy diet may lower the cancer risk for someone at a healthy weight, obesity appears to raise the risk. Hakkak linked extra body fat to higher hormone levels that promote breast cancer devel-opment. He also sees a connection between obesity and fatty liver disease. Long-term soy consump-tion may offer some protection against fatty liver disease caused by obesity, so a diet high in soy products could be one way of reducing fatty liver disease among the obese population, he said. Hakkak is now focusing on how obesity may affect bacteria in the intestines. Obesity, he said, may affect how this bacteria breaks down food and serve as a link to disease prevention or promotion, which is the focus of research in his lab at the Arkansas Children’s Hospital Research Institute. “If we can identify the dietary factors that lead to disease prevention, we can try to get people to modify their lifestyle,” said Hakkak, who also serves as the editor for the Journal of Obesity and Weight Loss Therapy. “That is why nutrition education and research is so important.” He believes there is a need to educate the community and the effects of diet and lifestyle on disease development. “The bottom line is we’ve got to lose weight,” he said. “We continue to find that obesity appears to promote disease development.”❖

on how obesity relates to tumor development and has already pointed to some dietary-cancer connections. He was among the first to connect obesity and breast cancer development. In research funded in part by a 2005 grant from the Susan G. Komen Foundation, a cancer-causing substance found in cigarette smoke, car exhaust and some cooked foods was more likely to cause mammary tumors in obese rats compared to lean rats. He said it isn’t a far stretch

While a soy-

heavy diet

may lower the

cancer risk

for someone

at a healthy

weight, obesity

appears to

raise the risk.


LosIng WeIgHton tHe WeB researcher examines the

effectiveness of online weight-loss groups By Susan Van Dusen

>


FOR MANY PEOPLE, groups are a great motivator. Take a group of likeminded people, put them in a room together and watch them get posi-tive results. That’s one reason why behavioral-based weight-loss programs often occur in a group setting. But what about people who live in isolated areas or don’t have transportation? Should they be denied the benefits that a group-based weight loss program can offer? Delia Smith West, Ph.D., doesn’t think so. That’s why, for about nine years, she has studied the benefits of an online group-based behavioral weight-loss program. “The appeal of the Internet is being able to reach people who might not other-wise have access to group programs. If we can take our expertise and make it accessible for these folks, we can have a greater impact,” said West, director of the Center for the Study of Obesity at the UAMS College of Public Health. In collaboration with a colleague at the Univer-sity of Vermont, West received a $3.7 million grant from the National Institutes of Health (NIH) in 2005 to look at the effectiveness of delivering an identical weight-loss program in person, online or as a hybrid of the two methods. The five-year study involved 481 people in Arkansas and Vermont. Each participant signed on for 18 months, six months of which were dedi-cated to weight loss and the remainder to weight maintenance. Each participant had an equal chance of being chosen for one of the three delivery methods.

Each group of 10-15 participants met weekly for six months and monthly there-

after, either face to face or in a password-protected chat

room online. A trained facilitator presented

information, helped the group problem solve and promoted skills needed to maintain long-term weight loss. “In the end, we found that in-person delivery actually produced greater weight loss than the online or hybrid delivery,” West said. However, the story didn’t end there. Although the online participants lost about 2 percent less than their counterparts, more than half of them lost at least 5 percent of their body weight. “A 5 percent weight loss is considered clini-cally significant and produces a cascade of health benefits, including improved blood pressure and blood sugar, as well as improvements in depressive symptoms,” she said. In addition, the Internet program was more cost effective, largely due to the reductions in commute time, and warranted further investigation. “We learned that although online wasn’t quite as good as in person, it had potential,” said West, also a professor of health behavior and health education in the UAMS College of Public Health. A competitive renewal of the initial NIH grant was awarded in 2010 and examines how further to improve online delivery. The study added a coun-seling technique called motivational interviewing. “Motivational interviewing is about helping people figure out what’s important to them and how behavioral changes fit into their long-term personal goals,” West said, adding that most partic-ipants discuss focusing on improving their family and social experiences. “When you get down to the core why they want to change, it’s about quality of life,” West said. After the study ends in 2015, West and her colleagues will examine the data to determine their next steps. “The Internet delivery seems an effec-tive way to go. The question going forward is how we continue to refine it.” ❖

“The appeal of

the Internet is

being able to

reach people

who might not

otherwise have

access to group

programs. If

we can take

our expertise

and make it

accessible for

these folks,

we can have a

greater impact.”


Radiation Oncology Center Serves All Ages UAMS is now the exclusive provider of radiation oncology

services on its campus. Services are provided for both adult and

pediatric patients in the UAMS Radiation Oncology Center, a

component of the UAMS Winthrop P. Rockefeller Cancer Institute.

“UAMS will offer a complete spectrum of comprehensive

cancer services in one location,” said UAMS Chancellor Dan

Rahn, M.D.

Previously, radiation treatment was provided in partnership

with CARTI on the UAMS campus. That affiliation ended by mutual

agreement June 29, 2012.

UAMS physicians will continue to staff the new Radiation

Oncology Center and are led by Vaneerat Ratanatharathorn, M.D.,

chair of the UAMS Radiation Oncology Department and professor

in the UAMS College of Medicine. Most of the nurses and other

staff members whom patients have come to know will remain.

In addition to adult patients, children treated by UAMS

pediatric oncologists at Arkansas Children’s Hospital will be

treated at the center.

Graduate School Begins Regulatory Science Program

The rapid expansion of

the biomedical industry has

created a large demand for

regulatory professionals in

the food, biopharmaceutical,

biotechnology, medical devices

and chemical industries.

To help meet this need,

UAMS this fall began offering

a Graduate School certificate

program in regulatory science,

with plans to expand it into a

master’s degree program.

Regulatory science

professionals are typically

the primary communications

links between companies and

regulatory agencies and are

responsible for keeping up

with the increasing scope and

complexity of regulations both

in the U.S. and abroad.

“The goal is to train

scientists so they can take the

basic science they learned

in other disciplines and

apply that in the regulatory

environment,” said Jay Gandy,

Ph.D., program director, who

is a professor and chair of the

Department of Environmental

& Occupational Health in the

College of Public Health that

administers the program.

bRiefs

ReynOlDS InStItUte On AGInG CeleBRAteS exPAnSIOn

The UAMS Donald W. Reynolds Institute on

Aging has expanded research and education

capabilities this year with the addition of four new

floors built atop the existing four-story building.

“This expansion will make a huge difference

in our ability to meet the needs of the elderly

in Arkansas and to train clinicians as well as

researchers,” said institute director Jeanne Wei,

M.D., Ph.D.

The 55,000-square-foot vertical expansion

was made possible by $30.4 million of a $33.4

million gift in 2009 by the Donald W. Reynolds

Foundation of Las Vegas.The expansion adds

more basic and clinical research laboratories,

classrooms and office space to the award-winning

facility that houses a primary care clinic, a fitness

center with a therapy pool, and an auditorium.

UAMS earlier dedicated two bronze outdoor

sculptures and a new 396-foot pedestrian bridge

connecting the Reynolds Institute with the Jackson

T. Stephens Spine & Neurosciences Institute.

Cancer Institute Unveils new Research labs Cancer research in Arkansas took a huge step forward with

the unveiling of new research labs in the UAMS Winthrop P.

Rockefeller Cancer Institute this year.

Located on the ninth and 11th floors, the 33,660 net square

feet of space features UAMS’ first research labs designed with

an open floor plan to promote collaboration and interaction

among scientists.

“Research is the key to understanding why cancer develops

and in finding new, more effective ways to treat our patients,”

said Peter Emanuel, M.D., Cancer Institute director and

professor of medicine the UAMS College of Medicine.

The construction project, paid for by a nearly $10.5 million

grant from the National Institutes of Health (NIH), completes two

previously unfinished floors in the Cancer Institute’s expansion

tower that opened in August 2010. Funding for the grant came

from the American Recovery and Reinvestment Act of 2009

stimulus monies allocated to the NIH for construction grants.

Newly finished labs provide more room for research in the UAMS Winthrop P. Rockefeller Cancer Institute.


University of arkansas for Medical sciences

• Arkansas’ only comprehensive academic health center

• CollEGES of Medicine, nursing, Pharmacy, Health Professions and Public Health; and a Graduate School

• A StAtE-of-tHE-Art hospital

• A StAtEwidE nEtwork of regional centers

• named bESt little rock metropolitan area hospital by U.S. News & World Report

• SEvEn inStitutES: winthrop P. rockefeller Cancer institute, Jackson t. Stephens Spine & neurosciences institute, Myeloma institute for research and Therapy, Harvey & bernice Jones Eye institute, Psychiatric research institute, donald w. reynolds institute on Aging and translational research institute.

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uams journal - fall 2012

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