Running a marathon: how to survive the historic endurance race

As the weather improves, so does the likelihood of people going out and running. While many people go running as a simple way of keeping fit, for others, it is a necessary part of a long-term project; training for a marathon.

Millions of people around the world run marathons every year, often raising large sums of money for charity.

Those who have signed up to take part in marathons this autumn are likely to have already begun training regimes. If they are going to be running in their first ever marathon, it is recommended that they should have done. Meanwhile, others whose local marathons are held in the spring may only now be thinking about participating in one.

Marathons are rightly considered to be one of the most demanding physical challenges that an individual can undertake. They require months of preparation and dedicated training for the running to be a success and not hazardous to the runner's health.

What could possibly motivate someone to take on such an arduous task? And where should one begin when it comes to preparing to take on running a marathon? For many, running a marathon for the first time is a completely different prospect to any form of exercise they will have encountered before.

In this Spotlight feature, we take a brief look at what running a marathon involves, along with what levels of preparation are recommended for someone taking on the challenge.

Why would anyone want to run a marathon?

Last week, Medical News Today reported on two new studies that found exercising at extreme levels such as marathon running could lead to blood poisoning. Studies such as this beg the question: why would anyone want to run a marathon?

One reason is that people might wish to take part in a long tradition of endurance running. A tradition that has its roots in ancient history, inspired by the legend of an ancient Greek who ran from the battlefield of Marathon to Athens to spread news of a Greek military victory.

Athens was host to the first organized marathon, held at the 1896 Olympics. The original distance of the marathon was 40 km, representing the distance from Marathon to Athens, but this was extended at the 1908 Olympics in London to accommodate a request from the British royal family.

This increase in distance - allegedly done so that the course started at Windsor Castle and ended in front of the royal box at the Olympic Stadium - then became the official length for a marathon; a distance of 42.195 kilometers (26.2 miles) that runners worldwide are now familiar with.

Although once a very exclusive event only open to male athletes, marathon races are now open to all and take place all over the world. In America alone, there are more than 1,100 marathons each year, including the Boston Marathon - the world's oldest annual marathon.

As well as a desire to tackle a historical and immense challenge, marathon runners are often spurred on by charitable motives. At many marathons, elite runners will share the streets with eager amateurs running to raise money for good causes.

Marathon runners generate huge amounts of money for charity, including significant funds for various medical research groups. Last year, the Boston Marathon and the New York Marathon raised $27.5 million and $30 million respectively in funds for charities, yet these figures pale in comparison with the estimated $79.1 million raised by the London Marathon.

With figures like these, it is clear to see that marathon runners participating in these races and doing so successfully can make a big difference for charities. There is a lot of pressure to succeed, and so prospective runners do well to spend a lot of time planning out their training regimen.

The importance of well-planned physical training

Running a marathon is without doubt an extreme form of exercise. For this reason, it is recommended that people aiming to participate in one should build up a considerable amount of running experience prior to tackling one for the first time, including running shorter distance races.

It is also recommended that you inform your doctor that you plan to train for and run a marathon. If there are any personal health concerns you need to be aware of, they should be able to let you know and provide advice. You should seek medical clearance before beginning training in case you have a health condition that might make training dangerous.

"While I think that any healthy individual who is willing to commit to the training can complete a marathon, I don't recommend that runners jump right into the marathon distance," states Christine Luff, a running and jogging expert for About Health.

Training for a marathon is a long process that should build up endurance gradually and consistently.

Instead, Luff recommends that beginners first establish a regular running habit, going out around 3-4 times a week, building up a base mileage for runs gradually over the course of 6 months. Once this has been done, runners can get some experience of endurance running by entering shorter distance races, such as a 5K, a 10K or even a half marathon.

Training for a marathon is not just about practicing running for long periods of time. Runners also need to prepare their body for the immense strain that extreme exercise will put it under. Cross-training activities such as cycling and swimming not only improve your aerobic conditioning but also boost the body's resistance to injury.

Activities that increase the body's strength, such as Pilates, Yoga or using weights, can also be beneficial.

A good training schedule for around 20 weeks will include runs over a variety of distances that increase gradually, cross-training and rest days. Rest days can either involve no training at all or "active recovery," a short run at an easy pace to allow the muscles to loosen up.

Shorter training runs should be run at a moderate pace while longer runs - slowly building up toward marathon distance but never reaching it - should be taken slowly, at an easy, conversational pace.

In the final weeks before the marathon, it is important that training is tapered, cutting back on the amount of training that is done in order to allow the body and mind to recover. After 18 weeks of training, fitness is not going to improve any further, so the focus should be on keeping the body as healthy as possible.

Three weeks before the marathon, runners should run their last long run, treating it as a dress rehearsal of sorts. The subsequent weeks should see training reduced gradually, with less attention paid to cross-training and more on easy runs and resting.

Be prepared: eat and dress appropriately

Of course, there are other measures that need to be taken when preparing oneself for a marathon. Improving fitness is crucial, but runners can give themselves a huge advantage by eating properly and wearing the right clothes.

Every runner should have proper footwear. A runner's feet are crucial to their training and their ability to complete the marathon, and so aiding and protecting them with a good pair of running shoes can make a massive difference to a runner's prospects.

With running shoes, there are a lot of factors that need to be taken into consideration when deciding what pair to go for, so discussing the available options with staff in a running store is a good place to start. Runners will need to take into account the running surfaces they will training on when making a purchase.

Appropriate clothing is also important, and women should be sure to find the right sports bra to ensure comfort while running. As a marathon training schedule is likely to take in a variety of seasonal climates, clothing that fits well, allows for good air ventilation and dries quickly is ideal. Again, the staff in a running store will be well-placed to make suggestions.

Eating healthily during the training period is beneficial, but food choices on the day of the marathon - both before and during - can have a big impact too. Dr. Ed Laskowski, co-director of the Mayo Clinic Sports Medicine Center, states that hydration and energy-boosting carbohydrates help toward running a healthy race with a low risk of injury.

In the weeks close to the marathon, a runner's diet should involve eating plenty of complex carbohydrates, such as wholegrain bread and pasta, and drinking lots of fluids. Around 65-70% of total calorie consumption should ideally come from carbohydrates. Alcohol is best avoided as it can dehydrate and disrupt sleep.

To increase fluid absorption during exercise, runners should start drinking fluids at least 4 hours prior to beginning. On the day of the race, Dr. Laskowski states that water, milk, fruit juice and sports drinks can be consumed up to 1 hour before the start.

Sports drinks are a good source of energy while running as their sodium content can replace electrolytes lost through sweat. Other options for mid-race sustenance include energy bars and gels.

When the going gets tough

Everyone who runs a marathon will have different reasons for doing it and different expectations for what they want to achieve. It is important to focus on what you personally want to get out of running a marathon, especially if it is your first time running one.

Of course, some people like to take the challenge further, particularly in the name of charity. At many marathons, spectators are likely to spot participants dressed up in costume eliciting huge cheers from onlookers.

Wearing appropriate, comfortable clothing can be crucial to marathon running success.

These costumes are rarely made for the purpose of endurance running and so present extra challenges for the runner to overcome. They can be hot and heavy, they can chafe and they can restrict vision and breathing. As such, additional preparation is needed for people taking on this extra challenge.

"Training for a marathon is always tough. I'm not the most disciplined runner in history, but adding a 10 kg hippo suit to the mix has certainly given me food for thought," Martin Neal toldThe Guardian, ahead of running last year's London Marathon.

In order to prepare himself for the rigors of running in the suit, he decided to travel to Disney World Florida for a long-distance running event at higher temperatures than he was used to. He also went for several runs while wearing the suit to get his body accustomed the challenge. "It was really hard going, incredibly hot and I used muscles I didn't know I had," he stated.

Meticulous preparation is key to running a successful and enjoyable marathon. Runners should work to prepare both their bodies and minds for all eventualities. Seeking advice from experts - trainers, doctors, people who have ran marathons before - is a great way to do this.

It is important that prospective marathon runners should be well aware of the health risks of the task ahead before beginning and also listen to their body when the going gets tough.

"Pain associated with joint swelling or that causes the joint to feel unstable should be checked," advises Dr. Laskowski. "You should also seek an evaluation for pain that persists or intensifies after rest from running or pain that causes you to compensate, change your running, or change your gait."

Running a marathon when not 100% healthy can be dangerous. Runners should not put their long-term health at risk by forcing their bodies to do things they are not adequately prepared for or able to do.

Marathon running has grown hugely in popularity over the last few decades. Around 25,000 runners were estimated to have finished marathons in the US in 1976, and by 2013 this number is believed to have risen to 541,000. With appropriate preparation, anyone can add to these numbers and if you intend to, good luck!

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Experts call for dropping of total fat intake limits

A head of the publication of the 2015 Dietary Guidelines for Americans, researchers have called for the US government to drop recommended restrictions on total fat consumption.

The researchers state that healthful fats such as those found in nuts, vegetable oils and fish can protect against illnesses such as cardiovascular disease.

The paper, published in JAMA is written by Dr. Dariush Mozaffarian from the Friedman School of Nutritional Science & Policy at Tufts University and Dr. David Ludwig from the Boston Children's Hospital.

In the paper, the researchers discuss one of the new recommendations made by the 2015 Dietary Guidelines for Americans Committee (GDAC), an independent group of scientists tasked with reviewing existing scientific and medical research on nutrition.

A lot of recent debate has centered around the GDAC's recommendations that a diet higher in plant-based foods is better for the environment than one based more on meat and that taxing sugary snacks and drinks could improve diets. In their paper, however, the researchers focus on a recommendation that may be receiving less attention.

For the first time since 1980, the technical report of the GDAC did not include a recommendation for the restriction of total fat consumption.

"We wanted the emphasis to be on fat quality rather than total fat, because the evidence really emphasizes that saturated fat is the driver of risk rather than total fat intake," says Barbara Millen, chair of the DGAC.

Dr. Mozaffarian supports this, stating that placing limits on total fat intake has no basis and leads to poor decisions from both industry and consumers:

"Modern evidence clearly shows that eating more foods rich in healthful fats like nuts, vegetable oils, and fish have protective effects, particularly for cardiovascular disease. Other fat-rich foods, like whole milk and cheese, appear pretty neutral; while many low-fat foods, like low-fat deli meats, fat-free salad dressing, and baked potato chips, are no better and often even worse than full-fat alternatives. It's the food that matters, not its fat content."

When the dietary guidelines began to recommend low-fat diets, the consumption of low-fat and non-fat products increased. These foods often contain refined grains and added sugars that are associated with increased metabolic dysfunction and obesity.

"Lifting the restriction on total fat would clear the way for restaurants and industry to reformulate products containing more healthful fats and fewer refined grains and added sugars," says Dr. Ludwig.

2015 Dietary Guidelines For Americans: 'a critical opportunity'

Alongside dropping restrictions on total fat consumption from the dietary guidelines, Dr. Mozaffarian and Dr. Ludwig call for the limit on fat intake to be lifted by numerous government agencies and food programs.

One such program is the National School Lunch program that recently banned whole milk from its menus while retaining sugar-sweetened non-fat milk. Other targets include the US Food and Drug Administration (FDA) and the National Institutes of Health (NIH) who regulate food package labeling and issue diet advice to families and children respectively.

"From agriculture to food producers to school cafeterias to restaurants, the Dietary Guidelines for Americans serve as a beacon for countless dietary choices in the public and private sector," states Dr. Mozaffarian. "With obesity and chronic disease impacting public health so deeply, we can't miss this critical opportunity to improve the food supply."

Not everyone agrees with this viewpoint, however. Lisa Moskovitz, a registered dietitian, told Yahoo Health removing restrictions on total fat consumption might not automatically lead consumers to follow balanced, healthy diets.

"If there are no guidelines on how much fat they should be eating, there is a chance that they will eat more fat and, as a result, consume less high-fiber, whole-grain carbohydrates and muscle-preserving lean proteins," she warns.

The US Department of Agriculture (USDA) and the US Department of Health and Human Services (HHS) will refer to the DGAC report when drawing up the final 2015 Dietary Guidelines for Americans. The guidelines are due to be published toward the end of the year.

"The USDA and HHS must use the 2015 guidelines to send the message that limiting total fat provides no benefits and actually leads to confusion and bad dietary choices," Dr. Mozaffarian concludes.

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Eat protein before carbohydrates to lower post-meal glucose

In a new study, researchers from Weill Cornell Medical College in New York City, NY, found that the order in which different types of food are consumed has a significant impact on post-meal glucose and insulin levels in obese people. Writing in the journal Diabetes Care, the authors suggest their findings may have dietary implications for diabetic and other high-risk patients.

Eating protein, vegetables and fat before carbohydrates in a meal may help to keep glucose and insulin levels low.

For people with type 2 diabetes, it is important to maintain normal glucose levels after eating, because if their blood sugar level spikes then they are at increased risk of complications, including hardening of the arteries and heart disease, which can eventually lead to death.

Some previous studies had found that eating vegetables or protein before carbohydrates could be an effective way to lower post-meal glucose levels. The researchers behind the new study wanted to see whether this association applied to a typical Western diet, with meals consisting of a mix of vegetables, protein carbohydrates and fat.

In the study, 11 patients with obesity and type 2 diabetes who were taking metformin - a drug that helps control glucose levels - ate the same meals in different orders 1 week apart, so that the researchers could observe how their glucose levels were affected.

The set meal consisted of ciabatta bread, orange juice, chicken breast, lettuce and tomato salad with low-fat dressing and steamed broccoli with butter.

Glucose and insulin levels lower when carbohydrates were eaten last

The researchers first took the patients' glucose levels in the morning, 12 hours after they last ate. On the first day of the study, the participants were told to consume the carbohydrates in their meal (ciabatta bread and orange juice) first, and to follow this 15 minutes later by the protein, vegetables and fat in the meal. The participants' glucose levels were checked 30, 60 and 120 minutes after eating.

The experiment was then repeated 1 week later, except this time the food order was reversed - the protein, vegetables and fat were eaten first, with the carbohydrates consumed 15 minutes later.

When the vegetables and protein were eaten before the carbohydrates, the researchers found that glucose levels were 29%, 37% and 17% lower at the 30, 60 and 120-minute checks, compared with when carbohydrates were consumed first. Also, insulin was found to be significantly lower when the participants ate vegetables and protein first.

"Based on this finding, instead of saying 'don't eat that' to their patients, clinicians might instead say, 'eat this before that,'" says senior author Dr. Louis Aronne, the Sanford I. Weill Professor of Metabolic Research and a professor of clinical medicine at Weill Cornell Medical College.

Dr. Aronne acknowledges that follow-up work is required - the findings are from a pilot study with a very small sample group - but says that "based on this finding, patients with type 2 might be able to make a simple change to lower their blood sugar throughout the day, decrease how much insulin they need to take, and potentially have a long-lasting, positive impact on their health."

"Carbohydrates raise blood sugar, but if you tell someone not to eat them - or to drastically cut back - it's hard for them to comply. This study points to an easier way that patients might lower their blood sugar and insulin levels," Dr. Aronne concludes.

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Fasting: what are the health benefits and risks?

Fasting is commonly associated with the month of Ramadan. As you read this, billions of Muslims around the world are engaging in this declaration of faith that involves abstaining from food and drink from dawn until dusk. While fasting for Ramadan is down to spiritual beliefs, many of us choose to fast with the belief that it benefits our health. But does it?

A number of studies have suggested intermittent fasting has numerous health benefits, including weight loss, lower blood pressure and reduced cholesterol.

In recent years, numerous studies have suggested that intermittent fasting - abstaining or reducing food and drink intake periodically - can be good for us, making it one of the most popular diet trends worldwide.

One of the most well-known intermittent fasting diets is the 5:2 Fast Diet - a plan that involves eating the recommended calorie intake for 5 days a week but reducing calorie intake to 25% for the remaining 2 days - to 500 calories a day for women and 600 a day for men.

According to Dr. Michael Mosley - author of The Fast Diet books - this eating plan can not only help people lose weight, but it offers an array of other health benefits.

"Studies of intermittent fasting show that not only do people see improvements in blood pressure and their cholesterol levels, but also in their insulin sensitivity," he adds.

In June 2014, for example, Medical News Today reported on a study suggesting periodic fasting - defined in the study as 1 day of water-only fasting a week - may reduce the risk of diabetes among people at high risk for the condition.

Another study, conducted by Dr. Valter Longo and colleagues from the University of Southern California (USC) in Los Angeles, found longer periods of fasting - 2-4 days - may even "reboot" the immune system, clearing out old immune cells and regenerating new ones - a process they say could protect against cell damage caused by factors such as aging and chemotherapy.

But what are the mechanisms underlying the suggested health benefits of fasting?

The potential benefits of intermittent fasting

Since the body is unable to get its energy from food during fasting, it dips into glucose that is stored in the liver and muscles. This begins around 8 hours after the last meal is consumed.

When the stored glucose has been used up, the body then begins to burn fat as a source of energy, which can result in weight loss.

As well as aiding weight loss, Dr. Razeen Mahroof, of the University of Oxford in the UK, explains that the use of fat for energy can help preserve muscle and reduce cholesterol levels.

When the body has used up glucose stores during fasting, it burns fat for energy, resulting in weight loss.

"A detoxification process also occurs, because any toxins stored in the body's fat are dissolved and removed from the body," he adds, noting that after a few days of fasting, higher levels of endorphins - "feel-good" hormones - are produced in the blood, which can have a positive impact on mental well-being.

As mentioned previously, the study by Dr. Longo and colleagues suggests prolonged fasting may also be effective for regenerating immune cells.

"When you starve, the system tries to save energy, and one of the things it can do to save energy is to recycle a lot of the immune cells that are not needed, especially those that may be damaged," Dr. Longo explains.

In their study, published in the journal Cell Stem Cell, the team found that repeated cycles of 2-4 days without food over a 6-month period destroyed the old and damaged immune cells in mice and generated new ones.

What is more, the team found that cancer patients who fasted for 3 days prior to chemotherapy were protected against immune system damage that can be caused by the treatment, which they attribute to immune cell regeneration.

"The good news is that the body got rid of the parts of the system that might be damaged or old, the inefficient parts, during the fasting," says Dr. Longo. "Now, if you start with a system heavily damaged by chemotherapy or aging, fasting cycles can generate, literally, a new immune system."

With the potential health benefits of fasting widely hailed by nutritionists worldwide, it is no wonder many of us are putting our love of food to one side in order to give it a try.

But intermittent fasting isn't all bells and whistles, according to some researchers and health care professionals, and there are some people who should avoid the diet altogether.

The health risks

According to the UK's National Health Service (NHS), there are numerous health risks associated with intermittent fasting.

People who fast commonly experience dehydration, largely because their body is not getting any fluid from food. As such, it is recommended that during Ramadan, Muslims consume plenty of water prior to fasting periods. Other individuals following fasting diets should ensure they are properly hydrated during fasting periods.

If you are used to having breakfast, lunch, dinner and snacks in between, fasting periods can be a major challenge. As such, fasting can increase stress levels and disrupt sleep. Dehydration, hunger or lack of sleep during a fasting period can also lead to headaches.

Fasting can also cause heartburn; lack of food leads to a reduction in stomach acid, which digests food and destroys bacteria. But smelling food or even thinking about it during fasting periods can trigger the brain into telling the stomach to produce more acid, leading to heartburn.

While many nutritionists claim intermittent fasting is a good way to lose weight, some health professionals believe such a diet is ineffective for long-term weight loss.

"The appeal is that [fasting] is quick, but it is quick fluid loss, not substantial weight loss," says Madelyn Fernstrom, PhD, of the University of Pittsburgh Medical Center's Weight Loss Management Center. "If it's easy off, it will come back quickly - as soon as you start eating normally again."

"My experience has been that [this] way of eating does not produce weight loss even in the short term," dietitian and author ofDiet Simple Katherine Tallmadge told ABC News in 2013.

Some health professionals believe intermittent fasting may steer people away from healthy eating recommendations, such as eating five portions of fruits and vegetables a day. Many fear fasting may also trigger eating disorders or binge eating.

In a blog for The Huffington Post last year, fitness and nutrition expert JJ Virgin wrote:

"The 'anything goes' mentality some experts permit during the feeding state could lead someone to overeat, creating guilt, shame, and other problems that only become worse over time. For someone with emotional or psychological eating disorders, intermittent fasting could become a convenient crutch to amplify these issues."

While Dr. Mosely says there is no evidence to suggest the 5:2 Fast Diet is associated with eating disorders, he stresses people who have eating disorders should not engage in intermittent fasting.

Other people who should not follow this diet include people who are underweight, individuals under the age of 18, pregnant women, people with type 1 diabetes and individuals recovering from surgery.

Could we reap the benefits of fasting without fasting?

While intermittent fasting may have health risks, nutritionists claim it can be good for us if individuals consult with their doctors before adopting such a diet and adhere to it correctly.

But could there be a way to reap the potential health benefits of fasting without actually having to fast? Dr. Longo believes so.

Researchers say a fasting-mimicking diet could simulate the effect of fasting without the food deprivation and side effects.

Earlier this week, Dr. Longo and colleagues from USC published a study in the journal Cell Metabolism revealing how a fasting-mimicking diet (FMD) triggered immune cell regeneration and extended the lifespan of mice.

What is more, on testing the diet in humans - who adhered to it for only 5 days a month for 3 months - they found it reduced a number of risk factors associated with aging, cardiovascular disease (CVD), diabetes and cancer.

The FMD is low in protein, low in unhealthy fats and high in healthy fats, according to the researchers. It stimulates markers linked to fasting, such as low glucose levels and high levels of ketone bodies, in order to mimic the effects of prolonged fasting.

Dr. Longo and colleagues say their diet could promote immune cell regeneration and longevity associated with fasting without the need for food restriction and the potential adverse effects that come with it.

"Although the clinical results will require confirmation by a larger randomized trial," they add, "the effects of FMD cycles on biomarkers/risk factors for aging, cancer, diabetes, and CVD, coupled with the very high compliance to the diet and its safety, indicate that this periodic dietary strategy has high potential to be effective in promoting human healthspan."

The team hopes that clinicians will one day have the ability to prescribe this diet to patients. "This is arguably the first non-chronic preclinically and clinically tested anti-aging and healthspan-promoting intervention shown to work and to be very feasible as a doctor or dietitian-supervised intervention," says Dr. Longo.

It may be a while before the FMD receives approval from the US Food and Drug Administration (FDA) for clinical use. First, the team needs to put the diet through a rigorous testing process.

Further research is required to gain a better understanding of the exact benefits and risks the FMD poses, and this appears to be the case with existing fasting diets. One thing is clear, however; talk to your doctor before engaging in any form of fasting.

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Obese teens' brains unusually susceptible to food commercials, study finds

TV food commercials disproportionately stimulate the brains of overweight teenagers, including the regions that control pleasure, taste and -- most surprisingly -- the mouth, suggesting they mentally simulate unhealthy eating habits that make it difficult to lose weight later in life.

The most surprising finding of a new Dartmouth College study was that TV food commercials activated overweight adolescents' brain region that controls their mouths, suggesting they mentally simulate unhealthy eating habits.

Credit: Kristina Rapuano

A Dartmouth study finds that TV food commercials disproportionately stimulate the brains of overweight teen-agers, including the regions that control pleasure, taste and -- most surprisingly -- the mouth, suggesting they mentally simulate unhealthy eating habits.

The findings suggest such habits may make it difficult to lose weight later in life, and that dieting efforts should not only target the initial desire to eat tempting food, but the subsequent thinking about actually tasting and eating it -- in other words, you should picture yourself munching a salad rather than a cheeseburger.

The study appears in the journal Cerebral Cortex. The study included researchers from Dartmouth College's Department of Psychological and Brain Sciences and the Norris Cotton Cancer Center at the Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth.

The prevalence of food advertising and adolescent obesity has increased dramatically over the past 30 years, and research has linked the number of television shows viewed during childhood with greater risk for obesity. In particular, considerable evidence suggests that exposure to food marketing promotes eating habits that contribute to obesity.

Using functional magnetic resonance imaging, the Dartmouth researchers examined brain responses to two dozen fast food commercials and non-food commercials in overweight and healthy-weight adolescents ages 12-16. The commercials were embedded within an age-appropriate show, "The Big Bang Theory," so the participants were unaware of the study's purpose.

The results show that in all the adolescents, the brain regions involved in attention and focus (occipital lobe, precuneus, superior temporal gyri and right insula) and in processing rewards (nucleus accumbens and orbitofrontal cortex) were more strongly active while viewing food commercials than non-food commercials. Also, adolescents with higher body fat showed greater reward-related activity than healthy weight teens in the orbitofrontal cortex and in regions associated with taste perception. The most surprising finding was that the food commercials also activated the overweight adolescents' brain region that controls their mouths. This region is part of the larger sensory system that is important for observational learning.

"This finding suggests the intriguing possibility that overweight adolescents mentally simulate eating while watching food commercials," says lead author Kristina Rapuano, a graduate student in Dartmouth's Brain Imaging Lab. "These brain responses may demonstrate one factor whereby unhealthy eating behaviors become reinforced and turned into habits that potentially hamper a person's ability lose weight later in life."

Although previous studies have shown heightened brain reward responses to viewing appetizing food in general, the Dartmouth study is one of the first to extend this relationship to real world food cues -- for example, TV commercials for McDonald's and Burger King -- that adolescents encounter regularly. The brain's reward circuitry involves the release of dopamine and other neurotransmitter chemicals that give pleasure and may lead to addictive behavior.

Children and adolescents see an average of 13 food commercials per day, so it isn't surprising they show a strong reward response to food commercials. But the new findings that these heightened reward responses are coupled with bodily movements that indicate simulated eating offer a clue into a potential mechanism on how unhealthy eating habits are developed.

"Unhealthy eating is thought to involve both an initial desire to eat a tempting food, such as a piece of cake, and a motor plan to enact the behavior, or eating it," Rapuano says. "Diet intervention strategies largely focus on minimizing or inhibiting the desire to eat the tempting food, with the logic being that if one does not desire, then one won't enact. Our findings suggest a second point of intervention may be the somatomotor simulation of eating behavior that follows from the desire to eat. Interventions that target this system, either to minimize the simulation of unhealthy eating or to promote the simulation of healthy eating, may ultimately prove to be more useful than trying to suppress the desire to eat."

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Story Source:

The above story is based on materials provided by Dartmouth College.

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Desk-based employees 'should work standing up'

A group xperts have advised that people working in office environments stand for at least 2 hours a day during working hours, as part of a number of recommendations to protect those engaged with typically sedentary forms of work.

Breaking up long periods of sitting with activity is considered by most experts to be advantageous to the health of workers.

Workers whose jobs are predominantly desk-based should eventually progress to a total of 4 hours standing, advises the panel.

The recommendation comes as part of a set of guidelines, published in the British Journal of Sports Medicine, with the aim to provide guidance to employers and office workers to counteract the health risks that come with long periods of seated office work.

"For those working in offices, 65-75% of their working hours are spent sitting, of which more than 50% of this is accumulated in prolonged periods of sustained sitting," write the authors. "The evidence is clearly emerging that a first 'behavioral' step could be simply to get people standing and moving more frequently as part of their working day."

An increasing number of studies associate sedentary living - including time spent at work - with an increased risk of several serious illnesses and causes of death, including cardiovascular disease, diabetes and some forms of cancer.

Although much of the evidence the panel used to inform its recommendations comes from observational and retrospective studies, they state that "the level of consistent evidence accumulated to date, and the public health context of rising chronic diseases, suggest initial guidelines are justified."

The key recommendations of the guidelines for office workers during working hours are:

• Two hours daily, eventually progressing to 4 hours, of standing and light activity (such as light walking)
• Breaking up periods of seated work with standing work using adjustable sit-stand desks and workstations
• Avoiding prolonged static standing, which may also be harmful
• Altering posture and light walking to reduce fatigue and musculoskeletal pain while adapting to new work practices
• Employers should inform staff of the dangers of spending too much time sitting down, both at work and at home
• Employers should also promote the benefits of other healthful behaviors such as eating a balanced diet and not smoking.

Guidelines 'pose no significant physical or cognitive challenges' for workers

There is a growing interest in changing working environments so that they are no longer wholly sedentary. Many companies now provide office furniture with sit-stand attachments for desks or fully adjustable sit-stand desktops, allowing office employees to work without having to be seated.

While a number of companies have already begun investing in changes to enable their employees to work in a more active environment, many have not. The panel state those that have yet to do so should begin to evaluate how best they can implement these recommendations.

Potential measures that can be taken include making provisions for breaks that involve standing and movement and investing in desks and office designs that allow employees to work easily while standing up.

The panel warns, however, that simply changing a working environment may not be enough to alter behaviors in the long term. "Strategies and programs for implementing change will need careful organizational and behavioral support and public education to prevent current interests in active office environments from simply being a passing fad," they write.

"On the basis that there are a large number of occupations which involve people standing and moving for considerably more than 4 [hours a day] (e.g., hospital staff, teachers, factory workers, retail and catering staff), it is expected that for office-based workers, in general, this should not pose too many significant physical or cognitive challenges," the authors conclude.

The panel of international experts was commissioned by Public Health England and a British community interest company, Active Working CIC.

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How do race and ethnicity influence childhood obesity?

Obesity is a serious public health problem in the US and can affect anyone regardless of age. In particular, childhood obesity prevalence remains high. As well as compromising a child's immediate health, obesity can also negatively influence long-term health dramatically. Unfortunately, some racial and ethnic groups are affected by obesity much more than others.

There is a disparity in the prevalence of childhood obesity between different racial and ethnic groups in the US.

For example, the US Department of Health and Human Services Office of Minority Health (OMH) report that African-American women have the highest rates of being overweight or obese, compared with other racial or ethnic groups in the US.

Approximately 4 out of 5 African-African women were found to be overweight or obese and, in 2011, African-American women were 80% more likely to be obese than non-Hispanic white women.

Researchers have identified that disparities in obesity prevalence can be found just as readily among children as among adults. It is alarming that these disparities exist to begin with, but more so that they exist so early in life for so many.

In this Spotlight feature, we take a brief look at the prevalence of childhood obesity in the US and the disparities in childhood obesity prevalence that exist among different racial and ethnic groups. We will examine what factors may contribute to this disparity and what action can be taken to remedy the situation.

A growing problem

"Obesity is the terror within," states Dr. Richard Carmona, the former Surgeon General. "Unless we do something about it, the magnitude of the dilemma will dwarf 9-11 or any other terrorist attempt."

These are strong words, but they illustrate the scope of the obesity problem. According to the Centers for Disease Control and Prevention (CDC), in 2009-2010, over a third (35.7%) of adults in the US were obese.

On average, childhood obesity in the US has not changed significantly since 2003-2004, and overall, approximately 17% of all children and adolescents aged 2-19 years are obese - a total of 12.7 million.

There are a number of immediate health problems that childhood obesity can lead to, including:

• Respiratory problems, such as asthma and sleep apnea
• High blood pressure and cholesterol
• Fatty liver disease
• Increased risk of psychological and social problems, such as discrimination and low self-esteem
• Joint problems
• Type 2 diabetes.

In the long term, obese children are much more likely to grow up to be obese as adults than children with healthy weights. Not only that, but the obesity experienced by these children is likely to be more severe, leading to further and more extreme health problems.

Significant disparities exist in obesity prevalence between different racial and ethnic groups. The CDC report the following obesity prevalence percentages among different youth demographics:

• Hispanic youth - 22.4%
• Non-Hispanic black youth - 20.2%
• Non-Hispanic white youth - 14.1%
• Non-Hispanic Asian youth - 8.6%.

From these figures taken from 2011-2012, we can see that levels of obesity among Hispanic and non-Hispanic black children and adolescents are significantly above average.

When the parameters are extended to include overweight children as well, the disparity persists. Around 38.9% of Hispanic youth and 32.5% of non-Hispanic black youth are either overweight or obese, compared with 28.5% of non-Hispanic white youth.

In 2008, Dr. Sonia Caprio, from the Yale University School of Medicine, CN, and colleagues wrote an article published inDiabetes Care in which they examined the influence of race, ethnicity and culture on childhood obesity, and what their implications were for prevention and treatment.

"Obesity in children is associated with severe impairments in quality of life," state the authors. "Although differences by race may exist in some domains, the strong negative effect is seen across all racial/ethnic groups and dwarfs any potential racial/ethnic differences."

However, if there are specific factors contributing to these disparities that can be addressed, the numbers involved suggest that attention should be paid to them. The long-term health of thousands of children in the US is at stake.

Socioeconomic factors

"Rarely is obesity in children caused by a medical condition," write the National Association for the Advancement of Colored People (NAACP) in their childhood obesity advocacy manual. "It occurs when more calories are eaten than calories burned."

The NAACP outline a number of factors that contribute to increases in childhood obesity, including:

• The development of neighborhoods that hinder or prevent outdoor physical activity
• Failure to adequately educate and influence families about good nutrition
• Ignored need for access to healthy foods within communities
• Limited physical activity in schools
• Promotion of a processed food culture.

The CDC report that childhood obesity among preschoolers is more prevalent in those who come from lower-income families. It is likely that this ties in with the disparity with obesity prevalence among different racial and ethnic groups.

"There are major racial differences in wealth at a given level of income," write Caprio, et al. "Whereas whites in the bottom quintile of income had some accumulated resources, African-Americans in the same income quintile had 400 times less or essentially none."

Children living in high-poverty areas may find their access to safe outdoor play areas limited.

Fast food and processed food is widely available, low cost and nutritionally poor. For these reasons, they are often associated with rising obesity prevalence among children. According to Caprio, et al., lower-cost foods comprise a greater proportion of the diet of lower-income individuals.

If adults need to work long hours in order to make enough money to support their families, they may have a limited amount of time in which to prepare meals, leading them to choose fast food and convenient processed food over more healthy home-cooked meals.

Living in high-poverty areas can also mean that children have limited access to suitable outdoor spaces for exercise. If the street is the only option available to children in which to play, they or their parents may prefer them to stay inside in a safer environment.

Hispanic youth and non-Hispanic black youth are more likely to come from lower-income families than non-Hispanic white youth. According to The State of Obesity, white families earn $2 for every $1 earned by Hispanic or non-Hispanic black families.

Over 38% of African-American children aged below 18 and 23% of Latino families live below the poverty line. This statistic suggests that the effects of living with a low income that increase the risk of obesity may be felt much more by African-American and Latino families and their children.

Not only do these socioeconomic factors increase the risk of obesity among these demographic groups but equally obesity can compromise a family's economic standing.

The NAACP point out that families with obese children spend more money on clothing and medical care. Additionally, as obese and overweight girls frequently start puberty at a younger-than-average age, there is a possibility that their risk of adolescent pregnancy is also higher.

Cultural factors

Alongside these socioeconomic factors, a number of additional factors exist that may be linked to an increased prevalence of childhood obesity among Hispanic and non-Hispanic black youth.

The NAACP give one such example, stating that one component of body image is how a person believes others view them or accept their weight:

"This also poses unique challenges in African-American communities because of cultural norms that accept, uplift and at times reward individuals who are considered 'big-boned,' 'P-H-A-T, fat,' or thick.'"

Cultural norms such as these may lead to parents remaining satisfied with the weight of their children or even wanting them to be heavier, even if they are at an unhealthy weight. Other sociological studies have also suggested that among Hispanic families, women may prefer a thin figure for themselves but a larger one for their children, according to Caprio, et al.

As well as being influenced by socioeconomic status, the type of foods eaten by children can be influenced by the cultural traditions of their families.

"Food is both an expression of cultural identity and a means of preserving family and community unity," write Caprio, et al. "While consumption of traditional food with family may lower the risk of obesity in some children (e.g., Asians), it may increase the risk of obesity in other children (e.g., African-Americans)."

As mentioned earlier, the promotion of a processed food culture may be a contributing factor to childhood obesity. As fast food companies target specific audiences, favoring cultural forms associated with a particular race or ethnicity could increase children's risk of being exposed to aggressive marketing.

Caprio, et al., report that exposure to food-related television advertising - most frequently fast food advertising - was found to be 60% among African-American children.

The amount of television that is watched may contribute as well; one study conducted by the Kaiser Family Foundation observed that African-American children watched television for longer periods than non-Hispanic white children.

A number of these cultural factors are associated with socioeconomic factors. African-American children may be more likely to watch television for longer, for example, if they live in areas where opportunities for playing safely outside are limited.

What can be done?

This subject area is far too detailed to do justice to in an article of this size, but these brief observations suggest that there should be ways in which the disparity in childhood obesity between racial and ethnic groups can be addressed.

Increasing access to healthy food for low-income families is one step that could improve rates of childhood obesity.

Having more safe spaces to walk, exercise and play in low-income areas would give children a better opportunity to get the exercise need to burn the required number of calories each day. Improving the availability of and access to healthy food would give families more options when it came to maintaining a healthy, balanced diet.

The NAACP state that low-income neighborhoods have half as many supermarkets as the wealthiest neighborhoods, suggesting that for many low-income families, accessing healthy food can be a challenge.

These problems are ones that would need to be solved by local government and businesses that have influence over the planning and development of public living spaces.

Caprio, et al. propose that a "socioecological" framework should be adopted to guide the prevention of childhood obesity. Such a framework would involve viewing children "in the context of their families, communities, and cultures, emphasizing the relationships among environmental, biological and behavioral determinants of health."

This approach would require large-scale collaboration, involving peer support, the establishment of supportive social norms and both the private and public sector working together.

"For health care providers to have a meaningful interaction about energy intake and energy expenditure with children/families, providers should have training in cultural competency in order to understand the specific barriers patients face and the influence of culture and society on health behaviors," the authors suggest.

In order for this disparity to be adequately addressed, a lot of work will need to be done. Not only might certain cultural norms need to be altered, but most importantly, environments will need to be provided in which children will have the opportunity to live as healthy lives as possible.

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