Food [Log] for Thought

In January, Philadelphia magazine’s Be Well Philly blog rolled out the “Sweat Diaries,” what they’ve described as a “look at the time, energy, and money people invest in pursuit of a healthy lifestyle in Philly.” So far I’ve read about a woman training for an Ironman while following a vegan diet, a gym marketer who practices physical and mental health, and a full-time Barre, Yoga, and Pilates instructor who’s career is built on staying fit. While the “Sweat Diaries” seem to shine the spotlight on those who work in the fitness and nutrition fields—presumably because folks (myself included) want to know what it takes to look and feel fit ever day—I was left wondering what the more “average” person might have to say about their food intake and fitness, particularly here in Philadelphia.

“It can be challenging for people to make smart and healthy choices when it comes to diet and exercise, especially during the busy work week, or most importantly, if they don’t have access to fresh groceries,” said Colleen Tewksbury, PhD, MPH, RD, LDN, program manager for the Penn Bariatric Surgery Program.

While I was fortunate to grow up learning that the right foods and playing sports was important for living a long, healthy life, and I was surrounded by people with similar approaches to eating and exercising, these are lessons that may be hard to come by in the in the midst of socioeconomic difficulties or coping with other chronic illnesses.

A 2013 report from the Philadelphia Department of Public Health noted that “of the ten largest U.S. cities, Philadelphia has the highest prevalence of obesity among youth and adults,” that “low‐income residents and racial‐ethnic minorities face disparate burdens from obesity‐related conditions,” and a “lack of access to healthy, affordable foods is a well‐documented contributor to these disparities.”

A variety of Penn Medicine programs help patients and individuals in the communities our hospitals serve to implement healthy food and fitness behaviors. Take, for example, those who participate in Penn Medicine IMPaCT program, led by the Center for Health Care Innovation (CHIBE). This program brings in lay community health workers (CHW) to provide social support and to help those from lower socioeconomic areas, who are at risk of or coping with health challenges like heart failure and diabetes, navigate everyday life in order to achieve their health goals. The relationship with between CHWs and patients can include everything from sharing their own personal experiences to offer relatable educations, to going with patients to the grocery store to help them make smart food choices and learn about healthy eating. These community health workers serve as that same support system that Tewksbury recommends to her patients.

Access is also key: in Philadelphia, residents of low‐income neighborhoods are half as likely to have access to quality grocery stores as residents of high‐income neighborhoods, according to the city report. It’s these same neighborhoods that a team from the Penn Rodebaugh Diabetes Center visited last year to help education children on the importance of healthy choices – first at St. Martin de Porres school then in partnership with Wawa and the Police Athletic League (PAL) at the Harrowgate PAL Center, both in North Philadelphia. And other programs, some sponsored by Penn Medicine CAREs grants to employees who volunteer in the community, have brought community gardening plots to urban settings, taught cooking classes that put a healthy spin on salt- and fat-laden favorites, and encouraged city residents to take a “Walk with a Future Doc” to get exercise and chat about how to build healthy habits.

And experts here can offer anyone tips for meeting these daunting health and fitness goals. In an effort to put things into the perspective of someone who is, unlike the Philly mag subjects, neither a fitness instructor nor a weekend warrior training for an Ironman, I decided to keep track of my food and exercise for five days. I shared the log with Colleen for evaluation to find out some of the strengths and weaknesses of my eating habits, which these days skew a bit more vegetarian given some of the news in recent years that links some meat consumption with cancer. And, I looked at how some of my personal behaviors compared to the greater United States population.

“Abbey had an excellent week,” Tewksbury said, analyzing my food diary. “It’s clear that she has put a lot of thought and effort into the foods she chooses, and she relies on plant-based foods. These are foods tend to be higher in fiber, full of vitamins and minerals, and lower in calories – similar to the foods recommended by the American Heart Association and by the American Diabetes Association. Each meal included a high protein food, typically plant- or fish-based, which are typically lower in saturated fat and calories and great for heart health.”

Every day, I had to resist easy temptations to indulge in takeout or convenience foods, and I’m not alone: according to the Department of Health and Human Services and the Unites States Food and Drug Administration’s Dietary Guidelines 2015 – 2020, a majority of the population does not consume the recommended amount of vegetables, fruits or grains, and in fact, they exceed the necessary sodium, added sugars, and saturated fats.

“Variety in food choices, and relying on pre-planned breakfasts and utilizing leftovers for lunch, are great ways to set yourself up for success,” Tewksbury said. “The United States Department of Health and Human Services-recommended 75 minutes of high intensity activity and strength training for one week, which only about 1 in 5 adults in the United States are able to achieve. Maintaining this level of exercise, is great for preventing weight gain and other health conditions like diabetes and hypertension.”

The same FDA report noted, just as Colleen had, that only about 20 percent of country’s population meets the recommendations for exercise. In fact, 24 percent of males are more likely to report regular physical activity compared to only 17 percent of females – which may not be surprising to some. This is a statistic that is perpetuated in my own home, where my husband routinely exercises longer, and more frequently than I do. While occasional trips to the gym seem to keep me active enough for most recommendations, my choice in beverages seem to be the biggest area for improvement – which might be a similar problem for a majority of Americans.

“Even if you chose beverages with high antioxidant content, like coffee and wine, it’s always a good idea to focus on increasing water intake and staying hydrated,” Tewksbury said. “To balance the intake of beverages that can be dehydrating, increasing water consumption is a good goal moving forward. Maintaining these behaviors long-term and recovering from any lapses, which can be just as difficult as making the changes in the first place, are also challenges for most people.”