Amelia's Additions

The fruit, the whole fruit, and nothing but the fruit!

UW-Eau Claire Team Arrives in Guangzhou!

Amelia, Rachel, Laurelyn, & Anja take a campus tour

On May 27th, early in the morning, the remaining members of our US team arrived safely in China. One of the first items of business: a tour of the Jinan University Campus. Here, a local student serves as a tour guide for our team!

It was a wonderful reunion between all of our University of Wisconsin-Eau Claire students and the Jinan University campus community. Also, it was a pleasure to introduce Nurse Educator, Cathy Berry, to the Chinese nursing students and to the Chinese nurses!

Because our blog is blocked from view in China, and because Cathy and our students are still working in China, they will post many additional comments upon their return in mid-June. In particular, they will share a discussion of the exercise intervention with middle school students.

I have heard from Cathy via E-mail, and it seems our students and she will also take a short journey to the Great Wall in Beijing next weekend! Lucky ladies!

Photos and blogging to follow!

Each of our students have selected one unique facet of the obesity epidemic to discuss on our blog. Rachel will focus upon the overuse of technology among Chinese youth (and too much 'seat time'); Anja will address changing patterns of dietary consumption in China, including sugary beverages, ice cream, and fried food; Laurelyn will emphasize the economics of the fast food industry, including slick marketing campaigns and high caloric (though extremely tasty) calorie laden choices.

Cathy has provided a link (below) to some of the health educational materials (PowerPoint Presentation) co-created with nursing translators, and presented to the middle schoolers.

Each of the groups will receive the same presentation, except that each presentation is also personalized with family photos.

Unfortunately, it isn't possible to open the link (though I promise to check with our university techno-gurus to see if there is a way to share it with you) and to view the PPT presentation in our blog. It contains the content of our educational intervention ~ discussion of the Group 8 logo (created by our UW-Eau Claire Chinese student) and also described in an earlier post here; tips for sensible eating and exercise; limiting intake of American fast food; information about the Chinese explanation of BMI (body mass index); conversation about balancing time on the computer with regular activity and exercise; and a personal photo of each member of our US Team.

Our Eau Claire students each brought a family or favorite photo to share with the middle school classes. Since the educational program described above is in English, it also gives the Chinese middle schoolers an opportunity to practice their English ~ as a cross-cultural exchange ~ and to ask questions (about the project) with members of our US team.

C:\Documents and Settings\Owner\My Documents\middleschoolpresentationGroup8withphoto

Our UW-Eau Claire International Fellowship Research with Chinese Middle Schoolers

Meeting together again ~ face-to-face! After four years of electronic conversation via E-mail regarding Type 2 Diabetes in China, Lee-Ellen and Peggy collaborate to finalize a simple quasi-experimental study design and to create a bi-lingual data collection tool for use with Chinese middle school students.

Armed with background information about the obesity epidemic among Chinese youth, and after securing all necessary permissions, our University of Wisconsin - Eau Claire research team will use a data sheet (see left) with items Chinese Nurse Educator, Peggy Zhou, translated into Mandarin. The data sheet will enable us to investigate middle school student perceptions about their own health.

The questions we ask are simple ones~How much time is spent on the computer? How much consumption of American fast food? How much physical activity? What is your height and weight? And finally: What are your perceptions of your body image?

We will analyze the results by gender and age. We also created a data coding sheet for use with the present instrument.

Because the Chinese obesity epidemic is an affliction of the affluent, we selected one (very affluent) middle school as the focus for our health education and exercise intervention (the Affiliated Middle School) and one (less affluent) middle school which will serve as the control group, receiving education only.

One hundred thirty two 7th grade students (representing 4 classes at the Affiliated Middle School) who self-report relatively high scores (on body weight, fast food consumption, little exercise, and poor body image) will be our target for a brisk 2 day health education and 2 day physical exercise program called 'Group 8'. Group 8 will meet after school on Mondays and Wednesdays.

As participants, all Chinese middle school students will receive T-shirts, water bottles, and pedometers to record their steps as they continue to walk and engage in physical activity (beyond the duration of our program).

Similar to the experimental group, the control group will consist of a large class of 7th grade Chinese youth. However, the control group will receive only a one time lecture from our team about the importance of sensible eating, remaining physically active, and balancing time on the computer with physical activity and exercise.

Using SPSS, we'll compare scores on the data sheet between classes at the Affiliated Middle School~ before and after our exercise + education intervention ~ and before and after the education program with the control group.

Avoid American Fast Food!

This teaching pamphlet (produced by the China Association of Health Education) shows a cart filled with fatty food.

If you look closely at the image, you can see McDonald's French fries.

Diabetes Type 2 was virtually unknown in China until a few decades ago. With the advent of the Fast Food industry in China, many persons changed their lifestyle to become more "Westernized." American fast food is big business in China, and over-consumption of saturated fat is a risk factor for diabetes. Fast food feeds obesity.

Restaurants such as KFC, Pizza Hut, and McDonalds are on virtually every street corner in the city of Guangzhou and hugely popular among young (and affluent) Chinese. Read on for more information about the food choices and their contribution to obesity in the United States.

Besides the fast food industry, the 'disease [of diabetes] industry' also nets large sums as Western and big Pharmaceutical corporations, such as Bayer, or product lines such as Glycerna (to help normalize blood sugar) become 'stakeholders'....

Bariatric surgery is now an option for obese men in China.

Other weight loss strategies are options as well. These include ingestion of parasites or participation in "fat farms" for extreme exercise ~ a 'boot camp' approach to weight loss.

In the United States, many of the same trends that helped create the modern fast-food industry are still helping fuel its growth. Many children, especially racial minorities, live in single-parent households, including a whopping 65% of black children and 37% of Hispanic children as of 2007, according to Kids Count. Mothers are working outside the home at much higher rates than in decades past. It is projected that women will account for 46.9% of the labor force in 2018, up from 46.8% in 2018. Add to this mix the high unemployment rates caused by an uncertain economy, and the allure of fast, cheap food becomes hard to resist. And therein lies the problem.

Obesity is an international public health crisis. In the US, obesity rates have tripled among children since 1980. In 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%, according to the Centers for Disease Control and Prevention. People who are obese are vulnerable to everything from diabetes to heart disease resulting in some $147 billion in direct medical costs annually.The degree to which fast food is at fault for the poor state of the health of many Americans "is impossible to quantify, but is definitely a factor," says Christina Munsell, a registered dietitian and research assistant at the Rudd Center for Food Policy & Obesity at Yale University, in an interview. The increase in obesity "definitely would correlate with eating quicker meals that are easier to obtain."

In order to create the rankings, 24/7 Wall St. examined the menus of the top 10 restaurant brands in the quick service category by sales as determined by QSR, an industry publication, looking for the most unhealthy options in the fast-food universe:items that were the highest in calories, carbohydrates, sodium and saturated fat.

These brands were then ranked against the nutritional guidelines of the United States Department of Agriculture. A couple of important caveats to consider. Not everything sold at fast food restaurants is unhealthy. The industry aggressively promotes healthier choice on their menus. Subway, for one, makes a special point of doing this, though its foot-long subs are not healthy choices. Moreover, experts point out that many items sold at sit-down restaurants are actually much more unhealthy than many fast food items.

Fast food, though, has gained ground during the economic slowdown while casual and fine dining chains have suffered. In the US, McDonald's alone earned $24.58 billion in revenue in 2010. Yum! Brands, parent of KFC, Taco Bell and Pizza Hut, made $11.42 billion.

Methodology: the rankings were determined by taking the average nutritional ratings of menu items compared with the USDA recommendations. Carbohydrates, saturated fat, and sodium were given the most weight. Calories and protein were also considered.

10. Wendy's Baconator Double> Calories (pct. daily diet): 930 (36%)> Saturated Fat: 25g> Carbohydrate (pct. daily diet): 41 (13%)> Sodium (pct. daily diet): 1840mg (80%)
Whose says you can never have too much bacon? Anyone with sense, that's who. The Rudd Center's Munsell noted with amusement how fast food chains "combine every type of meat on one sandwich." The Baconator was relentlessly hyped for a while. A Wendy's (WEN) spokesperson did not respond to a request for comment.

9. Burger King Triple Whopper with Cheese> Calories (pct. daily diet): 1180 (45%)> Saturated Fat: 30g> Carbohydrate (pct. daily diet): 52 (16%)> Sodium (pct. daily diet): 1330mg (58%)The Triple Whopper makes a mere Quarter Pounder with Cheese seem like health food. At 1,140 calories, it packs more than twice the punch of the McDonald's burger, which has 535 calories. In a statement to 24/7 Wall St., the company referred to the Triple Whopper as an "indulgent option for our guests." Burger King says it encourages customers to eat healthy choices that provide 650 calories or less -- approximately one-third of a 2,000-calorie daily diet.

8. Subway Footlong Sweet Onion Chicken Teriyaki> Calories (pct. daily diet): 750 (28%)> Saturated Fat: 2.5g> Carbohydrate (pct. daily diet): 117 (41%)> Sodium (pct. daily diet): 1810 mg (79%)

Subway, unhealthy? In some cases, the answer is "yes." While this sandwich is low in calories and fat, it is high in salt. The portions of Subway's foot-long sandwiches are too large, Munsell notes. Subway did not respond to a request for comment.

7. Wendy's Triple> Calories (pct. daily diet): 1030 (40%)> Saturated Fat: 28g> Carbohydrate (pct. daily diet): 43 (18%)> Sodium (pct. daily diet): 1800mg (78%)Anyone eating this monstrosity might not realize that the USDA suggests one portion of meat should be roughly the size of deck of cards. This Wendy's monster burger weighs in at a whopping 423 grams. Wendy's has struggled for years against larger rivals. It unloaded its underperforming Arby's chain earlier this week to private-equity group Roark Capital Group. Wendy's did not respond to a request for comment.

6. Taco Bell XXL Grilled Stuft Burrito Beef> Calories (pct. daily diet): 880 (34%)> Saturated Fat: 3g> Carbohydrate (pct. daily diet): 94 (26%)> Sodium (pct. daily diet): 2130mg (93%)
Taco Bell has mastered the art of blending meats and cheese in ever more creative caloric combinations. The XXL Grilled Stuft Burrito Beef is a monument to gluttony. Taco Bell calls it its "biggest burrito yet." It has "a blend of three cheeses – cheddar, pepper jack and mozzarella – flavorful seasoned rice, hearty beans, reduced-fat sour cream, chunky guacamole, avocado ranch and fiesta salsa, wrapped up in a warm flour tortilla." Taco Bell's sales have been hurt recently by questions surrounding the quality of its beef.

5. McDonald's Angus Chipotle BBQ Bacon> Calories (pct. daily diet): 800 (31%)> Saturated Fat: 18g> Carbohydrate (pct. daily diet): 66 (18%)> Sodium (pct. daily diet): 2020mg (88%)
The Angus Chipotle is big and has bacon, two red flags for any dieter. "It's problematic," says Munsell, adding that the Golden Arches have borne the brunt of negative publicity about fast food. That's unfair. "We did find that McDonald's did have more healthy options" than other chains, she notes. Indeed, it ended its Super Size promotion a few years ago, no doubt spurred by the publicity surrounding Morgan Spurlock's Oscar-nominated documentary Super Size Me.

4. Sonic SuperSONIC Bacon Double Cheeseburger with Mayo> Calories (pct. daily diet): 1370 (53%)> Saturated Fat: 36g> Carbohydrate (pct. daily diet): 55 (17%)> Sodium (pct. daily diet): 1610mg (70%)
The name alone should make a diner want to grab a fistful of Lipitor. Those brave enough to chow down on this 1,370 calorie colossus probably shouldn't eat much for the rest of the day. Once a regional operator in the South and Midwest, Sonic (SONC) now operates over 3,500 locations.

3. KFC Chicken Pot Pie> Calories (pct. daily diet): 790 (30%)> Saturated Fat: 37g> Carbohydrate (pct. daily diet): 66 (20%)> Sodium (pct. daily diet): 1970mg (86%)Salty and high in calories, there is little positive that can be said about the KFC Chicken Pot Pie. But a Yum! Brands spokesman had this to say: "It's all about providing our consumers with choices, and each of our brands has introduced products that are lower in calories and fat, such as KFC's Kentucky Grilled Chicken, Pizza Hut's Thin 'N Crispy Pizzas and salads and Taco Bell's Drive Thru Diet Menu with 7 items less than 9 grams of fat."In other words, diners have a choice about whether or not they eat something with almost a full day's allotment of sodium in one item.

2. Subway 12-inch Italian B.M.T> Calories (pct. daily diet): 900 (35%)> Saturated Fat: 16g> Carbohydrate (pct. daily diet): 94 (27%)> Sodium (pct. daily diet): 3,000 mg (130%)
It's easy to see why Subway does not list this sandwich under the "low-fat footlongs" on its web site. It has a whopping 3,000 mg of salt, 130% of the recommended allotment in a daily diet. "The problem with Subway is the portion size," Munsell says, adding that the problem with this sandwich is the salty luncheon meats. However, Subway is getting the message about salt. As an April USA Today article noted, "Beginning today, sodium content in Subway's 'Fresh Fit' sandwich line in the U.S. will be cut 28% vs. 2009, when Subway first began to cut salt. And sodium in its overall sandwich line will be cut by 15%, compared with the same period."

1. Pizza Hut Triple Meat Italiano (9-inch personal pizza)> Calories (pct. daily diet): 1,280 (49%)> Saturated Fat: 23g> Carbohydrate (pct. daily diet): 123 (38%)> Sodium (pct. daily diet): 3,070mg (133%)
Pizza -- plain, with cheese and sauce -- is not particularly unhealthy. This gastronomical overkill featuring "all-natural pepperoni, all-natural Italian sausage, and baked ham" is terrible for you. Pizza Hut is VERY POPULAR in China!

See the full article (about Fast Food in the United States) from DailyFinance: http://srph.it/kndIM4

Views of the Jinan University Campus

Here is an image of the pagota located on the campus of Jinan University. It presents a lovely picture in the early morning, with water lillies nearby.

i-POD 2 and SUGARY Beverages

As nearly every Chinese middle schooler knows, keeping up with technology is fun! Kids spend HOURS glued to their computers or electronic technology, and every child has not only plenty of 'seat time' in school, but also plenty of 'seat time' after homework (playing online games or chatting).

I think our work with middle schoolers could be termed "i-POD 2" ~ intervention for Prevention of the Onset of Diabetes Type 2.

Some current research suggests that hours spent on the computer (instead of exercising) is yet another risk factor for obesity.

Obviously, yet another risk factor in the obesity epidemic is over-consumption of sugary beverages, notably coke. The coca cola beverage is everywhere in China. Slick marketing and that sweet taste ~ a cold, carbonated drink (with a caffeine kick) ~ on HOT, sticky days add up to big sales for this corporate giant. Out of curiosity, I saved the label from a bottle of Chinese coke to compare with the same size of coke sold in the US. Unless I am misreading the label (always a possibility), it seems there are twice as many calories in the bottle of coke sold in China. Hmmmm. About that 'secret formula'.....

2011 data from the Chinese Center for Disease Control and Prevention indicates that middle schoolers are drinking, on average, approximately 350ml./day of sugary beverages ~ compared with 200ml./day back in 1998.

Laurelyn (in Guangzhou) poses with [perhaps] a healthier alternative: a honey and aloe beverage!

Foreign Expert Building

What a privilege for all of us to be considered an "expert"!


Once we arrived in China, we were taken to the Foreign Expert Building (pictured above) for our lodging. This place became our 'home away from home' for the duration of our stay.

Staying at the Foreign Expert Building on the campus of Jinan University is a special treat. Many people from all over the world stay here, so it isn't unusual to strike up a conversation with someone from another country. Pretty soon, 'what IS foreign, anyhow?' becomes a real question, as total strangers become fast friends.

Rooms are either deluxe or standard. Both styles of rooms are comfortable and the beds have mosquito nets. For us Americans, sleeping under a mosquito net was a 'first time experience' ~ and one that we all valued.

As Midwesterners, we appreciated the air conditioning (since the outside temperature in Guangzhou often felt like a sauna to us), the 'western style toilets,' the opportunity to boil water for tea, and the small frig for keeping left-over snacks (or water) at a cool temp. Drinking tap water or any cold water is not advised, so all water had to be purchased (or boiled). Even using water to brush our teeth was not advised.


The picture to the left illustrates 'breakfast' at the small restaurant adjacent to the Foreign Expert Building. Fried or soft boiled eggs, noodles with soy sauce, and sticky buns are available for the price of a few RMB (Chinese currency). Hot green tea is the beverage of choice, since coffee is not considered a healthy option.





This image illustrates the fish tanks located just outside the small restaurant mentioned above. Having 'fresh fish' for lunch or dinner really means FRESH!

The China Study

One of the Chinese nurses at the First Affiliated Hospital of Jinan University spoke highly of a book titled "The China Study." She suggested it was an important source for all of us. Here is a brief review:

The China study: the most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health [Book] by T. Colin Campbell, Thomas M. Campbell (II.) in Books

By T. Colin Campbell, Thomas M. Campbell (II.) - BenBella Books (2006) - Paperback - 417 pages - ISBN 1932100660
Referred to as the "Grand Prix of epidemiology" by The New York Times, this study examines more than 350 variables of health and nutrition with surveys from 6,500 adults in more than 2,500 counties across China and Taiwan, and conclusively demonstrates the link between nutrition and heart disease, diabetes, and cancer. While revealing that proper nutrition can have a dramatic effect on reducing and reversing these ailments as well as curbing obesity, this text calls into question the practices of many of the current dietary programs, such as the Atkins diet, that are widely popular in the West. The politics of nutrition and the impact of special interest groups in the creation and dissemination of public information are also discussed.

China Daily Reports ~ May 25, 2011

The timely news article with current data from the Chinese Center for Disease Control and Prevention (pictured above) captures the rationale for our planned nursing intervention!

The title: Poor Diets Harming Youth. In sum, Chinese middle schoolers are eating more sugary beverages, ice cream, fried food, and poor - no breakfast than they did back in 1998. According to data from the 2011 Report on Chinese Students' Nutrition and Health Conditions, more children and juveniles have seen their health harmed by undernourishing breakfasts, imbalanced diets and a habit of eating in restaurants or fast food establishments.

Taken from the May 25th China Daily News~ an English newspaper we read in the lobby of the Foreign Experts Building~ the article lays blame on Chinese parents, who focus almost exclusively upon their kids' schooling, but pay little to no attention to their diets, which may influence their entire lives.

We (my daughter and I) arrived safely in China on May 22nd after an uneventful flight from Minneapolis to Los Angeles to Guangzhou. My focus was to secure permissions to provide a cross-cultural health intervention to address the concerns mentioned above.

We secured permission from the Jinan University International Affairs Office, the President and Principal of the Affiliated Middle School, and made specific arrangements for the arrival of our nursing team.

Amelia and I arrived in Guangzhou on May 22nd, and we returned home (exhaused and happy) on May 29th.

As a side note, as soon as we arrived in China, Amelia and I looked for this blog! Although we were able to find the University of Wisconsin~ Eau Claire homepage, and a picture of our blog ~ the content is entirely blocked. We are guessing the Chinese government manages censorship by making the image of facebook, U-tube, and blogs available~ but blocks the content. Internet is painfully slow, however many websites are available, including a Chinese version of facebook.

About OUR Blog!

All of us love to share, and the blog is one way for us to tell the story of our upcoming adventures in China. Amelia and I will be leaving this week ~ so we are especially excited.

I know that I cannot wait to see my nursing colleagues in China. For me, it has been four years since we were last together in Guangzhou. To be frank, I never thought I would have the privilege of returning to China. This trip means a lot. I am very grateful to the University of Wisconsin-Eau Claire for giving us the opportunity.

We all hope to make a difference and to be a strong force for good in the world. We are hoping that our project will be the start of something new in the lives of young people in China. While we realize that making a lifestyle change is not easy and doesn't happen overnight ~ like swallowing a worm or magic pill! But we hope that maybe something that we say or do will ultimately result in behavioral change for kids who struggle with overweight and obesity issues.

I have corresponded via E-mail with Peggy, and she is eager to see us all. Peggy is a Vice Director for Outpatient Services at the First Affiliated Hospital of Jinan University. She works with patients who suffer from Type II Diabetes Mellitus. We hope that our exercise intervention with young students will be preventive for this serious chronic illness.

Our blog is a work in progress. Some of us will 'save up impressions' and enter them all at one time, and upon our return from China. We aren't certain how much Internet access and blogging capability we'll have in Guangzhou, so it could be that we'll enter most of our notes as a daily journal~ and once we return ~ in mid-June.

Also, since many members of our team have never visited China, we will want to share thoughts about the nursing care, the hospital, traditional Chinese healing practices, home and hospice care and other experiences in the rich and fascinating culture we are planning to see.

We may focus on a specific aspect of the culture ~ tea, for example. Or we may focus upon a person or character who truly impressed us: with their kindness or with their hospitality.

In any case, we are all soon to enter a wonderful journey ~ and one that may even be life-changing ~ who knows?

We'll add some journal articles, some personal impressions, and plenty of photos!

But the take home message of our blog is that it is our University of Wisconsin- Eau Claire sponsored China journal~and a way of sharing our trip with you. Stay tuned for personal impressions from all of us.

The Roundworm Diet?

http://www.dietsinreview.com/diet_column/01/roundworm-diet-popular-with-job-seekers/

The linked article provides information about a dangerous approach to weight management in China. Students are ingesting roundworms in order to lose weight (without diet or exercise).

While there are serious questions about the safety of the approach, the idea that it is possible to ingest something for a 'quick fix' to weight loss is also very common in the US.

International Research

As our research team prepares to leave the US and fly to China, we are discussing the process of conducting international research. The image to the right is a letter from the First Affiliated Hospital of Jinan University. Each Chinese middle school receives this letter of introduction (followed by a personal phone call from Peggy), explaining the study and asking permission to visit with the school administration. Upon our arrival in China, I will have a face-to-face meeting with the president and principal of each school and describe (with Peggy's translation) our study plans. Obtaining a green light to conduct international research in China includes many levels of permission, including (for our study) a medical committee at the First Affiliated Hospital of Jinan University and the Jinan University International Affairs Office.

In the US, we obtained a letter of approval after human subjects review at the University of Wisconsin-Eau Claire, and since middle schoolers are a protected group, we took care to ensure that their data will be kept private, secure, and treated confidentially. We are all certified in CPR, and our physical activity and exercise program will be approved by teachers in all the schools before we arrive. Exercise will be supervised by nurses and teachers, and no student will be asked to perform a skill that is too difficult or uncomfortable for their ability level.

Since obesity is a social, economic, and personal issue, we hope to make an impact upon all three dimensions, but only if students and their families make a commitment to lasting lifestyle changes.

Ambitiously, we hope that the increased activity and fun that will be part of Group 8 makes an indelible impact~ not only for the small groups of middle-schoolers we reach, but also for all of China ~ as the word spreads and as other schools and students participate in similar programs of enriched physical activity and sensible eating practices.

Group 8

Jialin Zhao, one of the Chinese students attending UW-Eau Claire, has been helping us learn Mandarin. She also designed our "GROUP 8" logo. It resembles a running shoe.

We're getting T-shirts designed at *Fleet Feet* so we'll have fleet-footed logos on the front and backs of all of the shirts.

Of course, we'll also include logos for our university and for The First Affiliated Hospital of Jinan University -- partners in our project. No one will be overlooked in the final design. Once you see Jialin's design, you will be amazed.

We hope the Chinese middle schoolers will be proud to be part of 'group 8'!

Our Chinese Names and Our Group Name

We chose Chinese names today. Everyone picked a name after their favorite flowers. I'm Rose and Cathy is Iris. Others chose Daisy and Tulip. We also learned that the number eight (8) in China is a number of special significance, since it represents good luck and prosperity.

So, we decided that our middle school students will be members of GROUP EIGHT.

This is important, because being physically fit and active does contribute to longer life and prosperous living.