TALK LIKE A HEALTH PROMOTION AND DISEASE PREVENTION RESEARCHER

Blood pressure — the force of circulating blood on artery walls. High blood pressure is associated with increased risk of heart disease

Chronic disease — health conditions that typically last over a year and require ongoing medical attention and/or negatively affect a person’s quality of life

High-quality fats — polyunsaturated and monounsaturated fats from vegetables, nuts and fish, as opposed to unhealthy trans fats, found in processed foods, and ‘neutral’ saturated fats, found in meat, dairy products, and some oils such as palm oil

Mediterranean diet — a diet traditional to Mediterranean countries, typically involving high consumption of vegetables, whole grains, nuts and olive oil, and moderate consumption of protein

Type II diabetes — a disease caused when the body produces insufficient insulin or does not respond to insulin. It is often associated with obesity and older age

Whole grains — grains used in food that still contain fibre and other essential components, considered healthier than processed or refined grains

Leading a healthy lifestyle is not always easy, and a person’s ability to do so is heavily affected by their environment. “In the US, chronic diseases such as type II diabetes, heart disease and obesity are more common among low-income, minority and rural populations,” says Dr Alice Ammerman, the Director of the University of North Carolina at Chapel Hill’s Center for Health Promotion and Disease Prevention (HPDP). “Limited access to healthy food is a significant contributor to this trend.” Healthier foods are often more expensive or harder to find, which poses barriers when promoting a healthier lifestyle.

There are no straightforward solutions to this issue. To change this trend, it is essential to make healthier foods more accessible and to encourage behavioural changes in those people with unhealthy diets. The Med-South Lifestyle Program (MSLP), developed and tested by researchers at HPDP, aims to do exactly that, promoting behavioural and structural changes that make living a healthy lifestyle less of a burden on people’s time or money.

The Mediterranean diet

Research from many different sources suggests that the typical diet found in Mediterranean regions is one of the healthiest out there. “A Mediterranean diet is linked to reduced risk of many chronic diseases and a longer lifespan,” explains Alice. A Mediterranean diet involves decent quantities of high-quality fats, vegetables, nuts and whole grains. “Contrary to popular belief, higher fat diets are not associated with weight gain,” says Alice. “In fact, high-quality fats, such as those found in vegetable oils, fish and nuts, reduce the risk of many chronic diseases.”

Equiti Foods and Good Bowls

Based on these principles, Alice founded Equiti Foods, which has begun producing Good Bowls: healthy frozen meals based on the Mediterranean diet, adapted to incorporate seasonal, locally-sourced food in the Southeastern US. “We work with local food organisations – Happy Dirt and Farmer Foodshare – who help us identify and purchase seasonal surplus and ‘cosmetically challenged’ products that might otherwise go to waste,” says Alice. “We are also working with farmers who have the capacity to freeze excess products, so they can be available later in the year.”

Alice’s team has worked hard to make Good Bowls as accessible as possible. The use of local surplus ingredients keeps the price down, and the team has also taken measures to make it truly convenient – for instance, introducing Good Bowls vending machines into worksites. Adapting the Mediterranean diet to the Southeastern US palate has also paid dividends. “It is so rewarding to see our work bring real benefits to people’s quality of life,” says Alice. “This is especially true when people enjoy this way of eating; ‘it doesn’t even taste healthy’ is our favourite compliment!”

A community-based approach

While providing access to a healthy diet is a key piece of the puzzle, there are other pieces also in need of attention. “It’s important to understand the health priorities of communities, so that solutions are designed to address them directly,” explains Alice. “This includes understanding the health problems found in the community, as well as identifying the specific factors that influence change.” These drivers of change might include involving particular people such as faith leaders, community-based organisations, and local farms and food production businesses. An approach that engages these points of influence and encourages them to facilitate change in the community is often more effective than a broad-stroke approach.

The MSLP has been tailored with this in mind. “The MSLP is an evidence-based, behaviour-change intervention that promotes the Mediterranean diet alongside broader behavioural changes,” says Alice. “It includes support for increased physical activity, as well as optional support to help with taking medication.” Participants receive a manual and cookbook written in easy-to-understand English or Spanish, which goes over the principles of the Mediterranean diet. “Participants also receive sessions with a health counsellor, who helps them set personal goals for behaviour change, and introduces problem-solving and self-monitoring skills to make changes to diet and physical activity levels more achievable,” says Alice.

Results

The principles of the MSLP are now well-established and have been tested in many studies. “In one study, led by Dr Carmen Samuel-Hodge and involving 360 MSLP participants, we found participants were, on average, eating nearly one more serving of fruit and vegetables per day, and 0.4 servings fewer sugar-sweetened drinks,” says Alice. “They also performed moderate-intensity physical activity for an average of 43 minutes more per week.” Participants also had healthier blood pressure at the end of the study. While these changes might seem small, they demonstrate how behaviours can be changed over a period of just a few months. With continued support, these changes can magnify into healthy habits that can stay with participants for life.

Now, the team has its sights set on further research and action. “We want to test the MSLP with young children and pregnant women, to see how it can improve particular aspects of health including birth outcomes and dental disease,” says Alice. “We also want to take Good Bowls further, adapting them to different cultural preferences, and developing medically tailored Good Bowls to address specific health issues.”

Dr Alice Ammerman
Director, Center for Health Promotion and Disease Prevention, and Professor of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA

Founder, Equiti Foods and Good Bowls

Fields of research: Nutrition, Health Promotion and Disease Prevention

Research project: Good Bowls: empowering communities to achieve good food access and health equity

Funders: US Centers for Disease Control and Prevention (CDC), US National Institutes of Health (NIH), US Department of Agriculture (USDA)

About health promotion and disease prevention

Health promotion and disease prevention are direct applications of research with the explicit aim of improving people’s lives. This can make careers in the area extremely fulfilling. Alice explains more about her field of work.