Be Healthy Winter 2016

Winter 2016

Be knowledgeable. Be well. Be healthy.

WHAT'S IN A NAME? STORE BRAND GROCERIES IN HIGH DEMAND

CHANGING NUTRITION LABELS AT-HOME EXERCISES HEALTHY RECIPE

Good health on a budget HELPFUL TIPS ON HOW TO STRETCH THAT DOLLAR

tips & tricks HEALTHY HOLIDAY FOR

Eating THE HOLIDAYS ARE A TIME TO EMBRACE ...

which can make things tricky if you’re trying to eat healthy.

Just a little bit of planning can help make healthy holiday eating a whole lot easier.

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DON’T SHOW UP HUNGRY

If you’re starving when you get to a party with food, you’re more likely to overeat.

FRONT LOAD FRUITS AND VEGGIES hosting, offer a fruit and veggie tray as an appetizer.

If you’re a guest: bring one along.

STICK TO 2–3 APPETIZERS

Pick a few of the healthiest options available, and take just a piece or two. Reach for veggies with dip, shrimp cocktail, mixed nuts, or stuffed mushrooms.

AVOID MINDLESS EATING

It can be easy to park yourself next to a bowl of chips and munch without thinking. To prevent this: eat only what you put on your plate and position

KEEP DESSERT SIMPLE

Around the holidays, dessert often takes the form of a buffet, with the temptation to try one of everything. Instead pick one fruit-based dessert and savor it

For healthy recipes, go to stopandshop.com/savory

2 Be Healthy | Winter 2016

Publisher Melvin Miller Health Editor Karen Miller Senior Editor Yawu Miller Art Director Daniel Goodwin Production Caleb Olson Proofreader Rachel Reardon For advertising opportunities please contact Karen Miller at (617) 936-7800 or kmiller@bannerpub.com

Be Healthy is published by Banner Publications, Inc. 1100 Washington St., Dorchester, MA 02124 Volume 4 • Number 3 Winter 2016 © 2016 Banner Publications Be Healthy is printed by TC Transcontinental Printing, 1603 Boul. Montarville, Boucherville, Québec, J4B 5Y2 Printed in Canada COVER PHOTO: THINKSTOCKPHOTOS.COM/ CYANO66

PHOTO: THINKSTOCKPHOTOS.COM/ GOIR

Editor’s note: The information presented in Be Healthy is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate for your age, sex, race and risk factors and make timely visits to your primary care physician.

14

Good health on a budget

Supermarket psychology Keep your grocery list handy

19

Recipe: Chicken paella

Winter 2016 The issue

4

Good health on a budget

4

Focus

9

Brand names SNAP Psychology of supermarkets Food labels Patient story

10 12 14 15 16

Healthy steps

17

Nutrition Recipe Exercise

18 19 20

baystatebanner.com/news/be-healthy | Be Healthy 3

The issue: Good health on a budget

GOOD HEALTH ON A BUDGET Tips on how to stretch that dollar

THERE IS A MISPERCEPTION THAT HEALTHY EATING — ESPECIALLY IN THIS STATE — IS EXPENSIVE. That’s understandable.

Massachusetts is one of the most expensive states in which to live.

Boston shares a similar distinction. In its Cost of Living Index, the Council for Community and Economic Research found that living expenses in Boston are exceeded by only New York City, San Francisco, Honolulu and Washington, D.C. While the poverty rate of Massachusetts is roughly 12 percent, the city of Boston is almost double that at 22 percent, according to the Boston Planning and Development Agency, formerly called the Boston Redevelopment Authority. That rate varies by location and race. For instance, the poverty rate in Hispanics, Asians and African Americans is 35, 27 and 23 percent, respectively, while that of whites is 13 percent.

It’s not surprising that a high cost of living has a direct effect on one’s purchasing power. Those living below the poverty level in Boston therefore have a greater challenge getting the most for every dollar.

High on the list of expenses is food. It’s right up there with housing, transportation and health care, and even exceeds medical 4 Be Healthy | Winter 2016

expenses in several households, according to the Bureau of Labor Statistics Consumer Expenditures: 2015.

How then does an individual, let alone a family of four or more, stretch its food dollar to make ends meet? It’s not easy, but, with a little know-how and perseverance, it can be done. You just have to know the ins and outs.

Julie Hersey pulls double duty. She is a registered dietitian as well as the nutritionist for Stop & Shop New England. That unique combination gives her an inside track on not only healthy eating but also tips on saving a few cents when grocery shopping.

What is healthy eating?

This is tricky. There is no specific plan that all must follow. Food requirements vary by

The issue: Good health on a budget

TIPS FOR BEING A SAVVY SHOPPER nM ake a grocery list … and stick to it. on’t shop when nD you’re hungry.

Unhealthy snacks are too enticing. n C ompare nutrition facts labels for healthier choices without spending more. nU se coupons for foods that you typically consume. ead the sales nR flyer and purchase store specials. sk for rain nA checks. n P urchase store brand products. n J oin your store’s loyalty program. rab from the nG back. Fresher dairy and meat products are typically placed behind older products. n P urchase fruits and veggies in season. n S tock up on staple foods, such as rice, when on sale.

PHOTO: COURTESY STOP & SHOP NEW ENGLAND

uy small amounts nB of perishable foods.

Julie Hersey, M.S., RDN., LDN Nutritionist, Stop & Shop New England Division

on’t look left or nD right at the checkout counter. Candy is on one side and magazines on the other, neither of which serves your diet or budget.

baystatebanner.com/news/be-healthy | Be Healthy 5

The issue: Good health on a budget

Fruits and veggies Produce is probably the easiest taste to accommodate because of the variety. If you don’t like bananas, perhaps those peaches will do. You may never allow a Brussels sprout near your palate, but welcome the taste of collard greens. Invariably, there is something in these two categories that will strike your fancy.

Produce does not have to be fresh to be nutritious and tasty, Hersey said. “Most important is that all forms can count, whether fresh, frozen or canned,” she explained. If you do prefer fresh, however, buy in season when the prices are lower. That strawberry that looks so tempting now is out of season for the Northeast. That means it travelled far to get here, losing nutrition along the way. It also means that it is substantially more expensive.

Frozen produce is a great substitute.

Veggies are frozen immediately after harvesting, thus maintaining a high level of nutrition. Canned fruits and veggies are fine as well, Hersey said. If canned in heavy syrup or sodium, they can be drained and rinsed before using.

And they are less expensive. The average price per unit of frozen plain vegetables in 2015 was $1.74, according to the Statistics Portal. Canned vegetables were $1.04.

Variety is important, said Hersey. “Rotate colors of fruits and veggies,” she said. “Don’t stick with the same ones every week.”

Proteins It’s hard for meat lovers to give up their beloved steak. Then compromise, Hersey suggests. “Control the portions of protein,” 6 Be Healthy | Winter 2016

TO EVERY FRUIT AND VEGETABLE, THERE IS A SEASON: A DIFFERENCE IN COST AND NUTRITION Although many fruits and vegetables are available all year round, that does not necessarily mean they are in season. When produce cannot be grown locally, it is imported from elsewhere or grown in heated greenhouses. Yet, according to a report by the University of California Division of Agriculture and Natural Resources, in addition to being more expensive, the out-of-season produce is less nutritious. Nutritional content of fruits and vegetables decreases from the moment of harvest. The long trip from overseas or across the country takes its toll.

To preserve your purse, buy produce when it is abundant locally. Or purchase them in season and freeze to enjoy all year round. Below are examples of produce by season.

Summer Blueberries Cantaloupe Cherries Corn Peaches Strawberries Watermelon

Fall Acorn squash Broccoli Brussels sprouts Cranberries Pears Pomegranates Pumpkins

Winter Collard greens Kale Oranges Sweet Potatoes Tangerines Turnips Winter squash

Spring Asparagus Broccoli Collard greens Peas Radishes Red leaf lettuce Spinach

Year-round Apples Bananas Bell peppers Cabbage Carrots Onions Potatoes

For a more complete list visit: www.fruitsandveggiesmorematters.org/what-fruits-andvegetables-are-in-season and https://snaped.fns.usda.gov/seasonal-produce-guide.

she said. “This is the most expensive part of a meal.” One serving size of proteins is about 3 ounces or the size of a deck of cards.

Regardless of the type of meat you buy, you pay more for cut, boneless and skinless,” she explained. “It’s cheaper to buy a whole chicken and cut it up.” Or you can purchase a whole fish and ask the butcher to slice it.

The trend is to go meatless. Beans and lentils and eggs are high in protein and much less expensive.

Whole grains Whole grains, like brown rice and cereal, are high in fiber, protein and a batch of B vitamins. This is one area where Hersey recommends buying in bulk, like oatmeal or rice. Popcorn is an old standby and is often overlooked as a whole grain. “But cook it the old fashioned way,” she said. “Buy the kernels and cook in a little oil.” You can even spice it up and top with parmesan cheese.

PHOTO: WIKIPEDIA.ORG

gender, age, physical activity and medical condition. For instance, a very active 15-year-old male teen might require 3,200 calories a day, while a sedentary 50-yearold woman needs only 1,800 calories a day.

What makes up those calories is the issue. Choose My Plate, a website of the U.S. Department of Agriculture describes a healthy eating plan of fruits, veggies, proteins, grains and dairy. Researchers at the Harvard T. H. Chan School of Public Health have designed their own Healthy Eating Plate and substituted water for dairy. Their contention is that calcium is essential to one’s diet but is also attainable through foods other than dairy.

The issue: Good health on a budget

UNIT PRICING Unit price is the cost per unit, such as per pound, per ounce or per liter. Determining the unit price enables consumers to determine the best price for an item.

As an example, a six-ounce container of yogurt is $1.19, or 19.8 cents an ounce. A 32-ounce container of the same product costs $4.29, or 13.4 cents an ounce. At first glance, this difference of 6 cents is not enough to make a dent in one’s pocket or change one’s buying habit. However, if you are a fan of yogurt and consume several containers a week, those cents begin to add up.

The larger size contains 5.33 times as much as the individual size. That means you would spend $5.95 to approximate the equivalence of the quart container. ($1.19 x 5 = $5.95) You would save $1.66 by purchasing the larger size. ($5.95 - $4.29 = $1.66) There are similar savings for meat and poultry. For a national brand chicken sold in several stores in New England, the boneless, skinless chicken breast is $6.19 a pound.

Chicken thighs are $3.49 a pound, while a whole chicken is $1.89 a pound.

A general rule of thumb is that meats that are cut, skinless and boneless are more expensive. It’s more economically sound to purchase a whole chicken and cut it up and freeze what you don’t immediately consume.

ORGANIC FOODS: BETTER BANG FOR THE BUCK?

PHOTO: YAWU MILLER

Another reason many consumers think healthy eating is beyond their reach is because they associate it with organic food. It is not uncommon for the cost of organic food to exceed its conventionally grown counterpart by 50 percent or more. However, to date, studies have been unable to prove a difference in nutrition between the two.

The National Organic Program of the U.S. Department of Agriculture has established strict regulations for growing organic produce. Organic fruits and vegetables are grown without the use of pesticides, synthetic fertilizers, sewage sludge or genetically modified organisms. Animals raised for meat, eggs and dairy products are not given antibiotics or growth hormones. Government-approved certifiers inspect farms where food is grown to make sure these guidelines are being followed.

The USDA has identified three categories of labeling of organic products: n 1 00 percent organic: made with 100 percent organic ingredients nO rganic: made with at least 95 percent organic ingredients nM ade with organic ingredients: made with a minimum 70 percent of organic ingredients. Strict restrictions are made on the remaining 30 percent, including no genetically modified organisms, or GMOs. Products with less than 70 percent organic ingredients may not make any claims on the front of the package. However, it is permissible to list organically produced ingredients on the side of the package.

One cannot distinguish between organic and conventionally grown produce. They look the same. You have to read the PLU, or Price Look Up code. PLUs have been used by supermarkets since 1990 to control inventory and facilitate check-out. The codes are fouror five-digit numbers that appear on a small sticker applied to individual pieces of fresh produce. Conventionally grown produce are four-digit codes that begin with a three or four. A five-digit number that begins with a nine is organic.

The PLU of conventionally-grown bananas is 4011; for organic bananas the PLU is 94011.

Dairy Yogurt is a great choice to get your calcium, but not all yogurt is the same. Greek yogurt has double the protein as regular yogurt, explained Hersey. It has a similar amount of calcium, but more protein. Here’s a tidbit, though. If you buy flavored yogurt, the protein content goes down. The added sugary fruits take up more space. It’s best to go for plain and add your own ingredients, such as fruit or nuts.

Hersey also recommends buying yogurt in larger sizes. While the “8-ounce” container has shrunk to less than 6 ounces, the price moved in the opposite direction.

Unit pricing Unit pricing is just fancy wording for the actual cost per unit for an item. It helps consumers make more informed decisions.

The units can be in pounds, ounces and grams, for example. When comparing two products, make sure you are comparing the same unit. “The lowest unit price is the better bargain,” explained Hersey, “as long as you can store it properly.”

For instance, it may be less expensive to buy a half gallon instead of two quarts of milk.

Your calculator will tell you the difference.

Sugar-sweetened beverages Sugar-sweetened beverages, such as soft drinks and energy drinks, are not only unhealthy, they can be expensive. Instead, Hersey favors plain drinking water flavored with citrus fruits or even a splash of 100 percent juice. Unsweetened, flavored tea and seltzer water are good substitutes as well.

Store brands At one time store brands were purchased only during down times when money was scarce. However, they can now hold their own against national brands and are equal in quality, taste and nutrition. All this at a big savings.

The demand for store brands is on the rise. “Millennials are not brand loyal,” explained Hersey. “They look for the best bargain and quality.”

Even with these tidbits of advice, food still takes a healthy portion of one’s monthly income. But if you do your homework before you even enter the store, the chances are higher that you can exit with change to spare. baystatebanner.com/news/be-healthy | Be Healthy 7

Look what’s coming next year in Be Healthy Creating opportunities. Building healthier communities.

To learn more about Brigham and Women’s Hospital community health and health equity efforts email cchhe@partners.org or visit www.brighamandwomens.org/communityprograms

CANCER PREVENTION HEART FAILURE ASTHMA … AND MORE Read health-related stories online at www.baystatebanner.com/news/health

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Focus:Nutrition on a budget Some helpful tips » Store brands 10 » SNAP 12 » Psychology of supermarkets 14 » Food labels 15 » Patient story 16

PHOTO: COURTESY USDA

Nutrition labels are undergoing a change. They will now list added sugars, which should not exceed 10 percent of a person’s daily calories.

15

baystatebanner.com/news/be-healthy | Be Healthy 9

FOCUS: Brand names

What’s in a name?

Store brand groceries in demand

happened, though. When the economy improved and incomes rose, consumers did not return to their previous shopping habits and preferences.

A 2015 report from consulting firm McKinsey & Company found that 75 percent of consumers say that they do not intend to go back to purchasing national brands. In fact, one-third no longer prefers the expensive brand. The report concluded that consumers are of the opinion that store brand items offer better value for the money and are of higher than expected quality.

This attitude marks a huge transition from the past. At one time there was a stigma associated with grocery store brands. They stood out with their no-frills packaging, and were considered necessary only for those on tight budgets. Fast forward to today, and an entirely different picture emerges. In 2015 total annual sales of store brands exceeded $118 billion, according to the Private Label Manufacturers Association. Store brands in supermarkets accounted for $63 billion of that amount.

Nearly one of every four items sold in the country’s supermarkets last year was a store brand.

Fresh foods in particular have developed brand loyalty, and constitute a double-digit percentage of the products sold in supermarkets: Eggs (65 percent), milk (56 percent), cheese (39 percent), bread and baked goods (35 percent) and fresh produce (21 10 Be Healthy | Winter 2016

ILLISTRATION: CALEB OLSON

SEVERAL YEARS AGO WHEN THE ECONOMY WENT SOUTH, CONSUMERS TURNED TO STORE BRAND GROCERIES TO MAKE ENDS MEET. A funny thing

FOCUS: Brand names

percent). These figures are a boon to supermarkets, according to PLMA, since fresh foods in supermarkets are growing faster than other sections of stores.

This change in preference has spurred the development of manufacturers to meet the rising demand. Some smaller companies concentrate on developing store brands exclusively, but even large national brand manufacturers have entered the market. All manufacturers must meet industry standards. The products are tested and analyzed for quality and safety by independent companies. Manufacturers are required to abide by the National Labelling and Education law that requires most foods to list calories and nutrients per serving size. Health claims must meet FDA regulations.

With comparable quality, some consumers say they cannot distinguish between national and store brands.

Consumer Reports published an article on its comparison of taste tests. Trained testers evaluated 19 different foods.

National brands won eight times, store brands once. The most significant finding, however, was that national and store brands tied 10 times.

Store brands are a boon to supermarkets. They help instill store allegiance.

They save money for not only shoppers, but for the stores themselves. Supermarkets pay the manufacturing cost, but unlike national brands, they avoid marketing costs. That’s a huge expense. The goal of national brands is to be available in every store in the country, while the store brands are more exclusive. That means money for advertising, merchandising and promotion.

In 2015 consumers who purchased store brands saved an estimated $30 billion, according to PLMA. On a typical trip to the supermarket, a shopper saves about one-third on basic grocery and household items when choosing store brands.

The once called “generics� have all grown up. They now go by several monikers: private label or private brand, house or own brand. Whatever you choose to call them, they are taking their place in supermarkets and will not be ignored. baystatebanner.com/news/be-healthy | Be Healthy 11

FOCUS: SNAP

A helping hand for good nutrition Public programs available PUTTING HEALTHY FOOD ON THE TABLE CAN BE A STRUGGLE. Food is right up there with housing and medical care as one of the three largest bites out of a consumer’s pocket. The Food and Nutrition Service of the U.S. Department of Agriculture administers several nutrition assistance programs for people who cannot afford healthy food.

Supplemental Nutrition Assistance Program — SNAP

12 Be Healthy | Winter 2016

Women, Infants and Children (WIC) The WIC program, also administered by the FNS of the USDA, was developed as a pilot program in 1972 and became permanent two years later. Its goal is to make sure that low income women, infants and children up to the age of five have access to nutritious food. The program also provides information on healthy eating and assists in referrals to health care services.

Population served: n Pregnant women through pregnancy and up to six weeks after

PHOTO: COURTESY USDA FOOD AND NUTRITION SERVICE

SNAP, formerly called Food Stamps, had its origin in the Food Stamp Act of 1964. Its purpose is to assist low income individuals and families purchase healthy food. Eligibility is based on several factors, including household size, income and resources, such as savings.

SNAP can be used for only certain items, as noted in the list below: n Fruits and vegetables n Breads and cereals n Meats, fish and poultry n Dairy products Other Items are not eligible: n Beer, wine, liquor, cigarettes n Any nonfood item, such as pet foods, soaps and vitamins n Foods that can be eaten in the store n Hot foods Once approved, SNAP benefits are deposited electronically into a person’s account each month. Purchases are made with an Electronic Benefit Transfer Card, or EBT. For information on eligibility, Massachusetts residents can call 877-382-2363.

FOCUS: SNAP birth or end of pregnancy n Breastfeeding women up to infant’s first birthday n Non-breastfeeding postpartum women up to six months after the birth or end of pregnancy n Infants up to first birthday n Children up to their fifth birthday For additional information, Massachusetts residents can call 1-800-942-1007.

The Emergency Food Assistance Program The Emergency Food Assistance Program is another USDA program that helps supplement the diets of low income people, many of whom are elderly. The program provides emergency assistance at no cost.

In contrast to SNAP and WIC, the TEFAP does not interact directly with consumers. Rather, it is a joint federal/state alliance which provides a range of foods, such as fresh and canned fruits and vegetables, fresh and dried eggs, meat, poultry, fish and dairy products directly to state programs, such as food banks and food pantries. These programs in turn distribute the goods to the public.

For more information, Massachusetts residents can contact the Food Distribution Coordinator at 781-338-6460.

developed an innovative program called Boston Bounty Bucks to enable people of all incomes to purchase produce at local farmers’ markets. The BBB enables SNAP recipients to match up to $10 per day at participating farmers’ markets.

The benefits of the program are two-fold. Residents who previously could not avail themselves of fresh local produce now have an avenue of purchase. In addition, it gives an economic boost to local farmers by expanding their customer base.

For more information about Boston Bounty Bucks, please call 617-635-3717.

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FOCUS: Psychology

The psychology of supermarkets Keep your grocery list handy

That’s because grocery stores are designed to lure you in — and keep you in — to entice you to buy more than just that quart of milk.

For instance, in most grocery stores, you are greeted by the produce department as soon as you enter. The reds, greens, blues and purples of strawberries, lettuce, blueberries and eggplant catch your eye. This placement of produce is strategic. Research shows that people are drawn to bright colors. In 2010, psychologists from University of California Berkeley found that people are attracted to bright red, blue, and green, while orange and yellow trailed closely behind.

In many stores, the flower shop and bakery are close by the produce. Like the produce, the bright colors of the flowers attract you, while it’s hard to resist the brownies and smell of cookies baking.

Another strategic design is the placement of the dairy section, which is typically far from the entrance towards the back of the store. People stopping in for just a dozen eggs must pass by an array of other products not necessarily on the grocery list.

End caps — displays at the end of aisles — are particularly lucrative for supermarkets. End caps sell eight times faster than the same product shelved elsewhere, according to the National Retail Hardware Association.

The end caps also lure consumers into the middle aisles which house a plethora of other foods. The idea from there is that customers will then walk slowly through each aisle, thus prolonging their shopping visit.

14 Be Healthy | Winter 2016

Shelf order is another strategic example.

More expensive items are at eye level. On lower shelves are generic brands, which, for the most part, are equal in nutrition and quality to brand names, but lower in cost.

Consumers must stoop or kneel to retrieve the less expensive substitutes. That takes work. People are more apt to take the easy route and grab products more easily accessible. Cartoon-bearing cereal boxes are also often on lower shelves to captivate the attention of youngsters.

Even the shopping carts play a role, according to a study by marketing consultant Martin Lindstrom. Doubling the size of the shopping cart he found leads consumers to purchase 40 percent more. And there’s a lot to purchase. The average supermarket carries 44,000 different items.

Grocery stores cannot be faulted for

their marketing ploys. Most industries, including health, rely on marketing tactics to keep them in business. Traditional food stores now face increasing competition from nontraditional food retailers, such as warehouse club stores, or even drug stores. Supermarkets must then not only stand out from their competitors but also sell more of their products to consumers.

That’s critical to their survival.

The problem is that those on a limited budget do not have the luxury of spending with abandon when entering the grocery store. Understanding the psychology of supermarket design is therefore important.

To save your dollars it is wiser to stick to the original plan and purchase only what is immediately needed.

It’s your financial survival that’s at stake here.

ILLISTRATION: CALEB OLSON

DO YOU EVER WONDER WHY YOU MADE A QUICK TRIP TO THE GROCERY STORE TO BUY JUST ONE OR TWO ITEMS, BUT WALKED OUT WITH A CART FULL OF GOODS?

FOCUS: Food labels

How much added sugar?

Change in nutrition facts label THERE’S SOMETHING “NEW AND IMPROVED” COMING DOWN THE PIKE. At least that’s how

KEY CHANGES TO NUTRITION LABELS Nutrition Facts Nutrition Facts

ORIGINAL LABEL

the Food and Drug Administration describes it. Actually, they are right. The Nutritional Labeling and Education Act of 1990 is undergoing a facelift. The act requires that food packaging include a nutrition label that lists the calories and certain nutrients per serving. Although it was modified in 2006 to include the number of grams of trans fat in each serving, the original law has stayed relatively unchanged for 25 years.

Updates in scientific information have spurred the change. There is a causal link between diet and chronic illnesses. Additionally, serving sizes on packages need to be updated to reflect typical portion sizes, which have ballooned since the initial act.

Serving Size 2/3 cup (55g) Servings Per Container About 8 Calories 230

Calories from Fat 72 % Daily Value*

Total Fat 8g Saturated Fat 1g Trans Fat 0g Cholesterol 0mg Sodium 160mg

12 % 5% 0% 7% 12 % 16 %

Total Carbohydrate 37g Dietary Fiber 4g Sugars 1g Protein 3g

10% 8% 20% 45%

Vitamin A Vitamin C Calcium Iron

* Percent Daily Values are based on a 2,000 calorie diet.

Your daily value may be higher or lower depending on your calorie needs.

Calories: 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g

PACKAGING Nutrition Facts AFFECTS SERVINGS Serving Size 2/3 cup (55g) Servings Per Container About 8

IMAGES: COURTESY FOOD AND DRUG ADMINISTRATION

Packaging size affects Amount how much Per Serving Calories from Fat 72 Calories people eat and drink. So now,230 for % Daily Value* example, both 12- and 20-ounce Total Fat 8g 12 % bottles will equal one serving, Saturated Fat 1g 5% Trans Fat 0g since people typically drink Cholesterol 0mg 0% both sizes in Sodium 160mg 7% one sitting.

Total Carbohydrate 37g 12 %

One serving per bottle for either bottle size.

8 servingsn per container The number S ervings: Serving size 2/3 cup (55g)

Amount Per Serving

Dietary Fiber 4g Sugars 1g Protein 3g

16 %

Vitamin A Vitamin C Calcium Iron

10% 8% 20% 45%

Calories 230 n S erving size changes: Because of in% Daily Value*

crease in serving10% sizes, new labels will be realistic to reflect how much people 5% Saturated Fatmore 1g Trans Fat 0g typically eat at one time.

Total Fat 8g

Cholesterol 0mg Sodium 160mg

0%

Dietary Fiber 4g

14%

n C alories: “Calories” 7% is now larger Total Carbohydrate 37g 13% and bolder. n F ats: “Calories from fats” have been 20%has found the type Includes 10g Added Sugars removed.

Research Protein 3g rather than the amount of fat has more 10% Vitamin D 2mcgsignificance.

Total Sugars 12g

Calcium 260mg

20%

45% fruits and vegetables dded sugars: While nA 6% Potassium 235mg contain natural sugars, which the body * The % Daily Value (DV) tells you how much a nutrient in requires fordiet.energy, added sugars add a serving of food contributes to a daily 2,000 calories a day is used for general nutrition advice. calories and no additional nutrients. The FDAhow recommends that children and adults Note: The images above are meant for illustrative purposes to show the new Nutrition NEW LABEL Facts label might look compared to the old label. Both labels represent fictional consume no products. more than 12½ teaspoons of When the original hypothetical label was developed in 2014 (the image on the left-hand added1gsugar side), added sugars was notFacts yet proposed so the “original” label shows of sugareach as an day, which amounts to Nutrition example. The image created for the “new” label (shown on the right-hand side)grams, lists 12gor 10 percent of one’s roughly 50 8 servings per total sugar and 10gcontainer added sugar to give an example of how added sugars would be broken Serving 2/3 cup (55g) daily calories. out with a %size Daily Value.

Amount per serving

230

Calories

% Daily Value*

Total Fat 8g

10%

Saturated Fat 1g

5%

Cholesterol 0mg Sodium 160mg

0%

Trans Fat 0g

Total Carbohydrate 37g Dietary Fiber 4g

* Percent Daily Values are based on a 2,000 calorie diet.

Your daily value may be higher or lower depending on your calorie needs.

Calories: 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g

of “servings per container” and the “serving size” are in Amount per serving larger and bolder type.

7% 13% 14%

Total Sugars 12g

Includes 10g Added Sugars Protein 3g

20%

Vitamin D 2mcg

10%

Iron 8mg

45%

Calcium 260mg

Potassium 235mg

20% 6%

* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.

Note: The images above are meant for illustrative purposes to show how the new Nutrition Facts label might look compared to the old label. Both labels represent fictional products.

When the original hypothetical label was developed in 2014 (the image on the left-hand side), added sugars was not yet proposed so the “original” label shows 1g of sugar as an example. The image created for the “new” label (shown on the right-hand side) lists 12g

Iron 8mg

utrients: Vitamin D and calcium are now nN required, while vitamins A and C have been removed since deficiencies in these two vitamins are rare today. The daily values for nutrients have been updated as well to reflect newer scientific evidence.

For instance, the daily recommended dietary fiber increased from 25 grams to 28 grams a day. In addition, the actual amounts of the nutrients, such as the actual milligrams of iron are listed. ulti-serving packages: Small packages, nM such as a bag of chips that can be consumed in one sitting will have dual column labeling, which will list nutrients per serving and nutrients per container. baystatebanner.com/news/be-healthy | Be Healthy 15

FOCUS: Patient story

Looking for that bargain Down the aisle of a supermarket

Since participating in the Cooking Matters program, Rev. Cornelio Lopez has been able to reduce his weekly food budget by $30.

likes it. “I go every day,” he explained.

You will find him at the local market every morning or sometimes in the evening. He’s in the hunt for bargains.

Unfortunately, nutrition took a back seat to his choices.

He admitted that initially he was not an efficient shopper. He was not a great fan of shopping lists. “I wing it,” he said. Nor did he take the time to read nutrition labels.

After all, the labels don’t tell what’s on sale.

At times, however, he paid the penalty.

Funds would get tight.

Things changed when he was introduced to Cooking Matters, a nonprofit that partners with community agencies to offer cooking courses and tours in grocery stores to teach consumers how to shop smarter and use nutrition information to make healthier choices. In Lopez’s case, Cooking Matters partnered with the Madison Park Development Corporation, whose mission is to “foster a vibrant, healthy Roxbury neighborhood that supports the well-being and advancement of the community.”

The program opened his eyes. Lopez has both high cholesterol and high blood pressure. He now knows how to check food labels for cholesterol as well as sodium. The American Heart Association recommends a daily limit of 1,500 milligrams of sodium a day, especially for those with high blood pressure. While the Dietary Guidelines for Americans 2015-2020 have relaxed the guidelines for cholesterol in food, they still recommend that people should eat as little dietary cholesterol as possible.

He likes peaches, cantaloupes, cherries 16 Be Healthy | Winter 2016

and turnips, but now knows how to buy in season when the products are bountiful and less expensive. At other times he opts for frozen and canned alternatives.

He can calculate the unit price of an item to make sure he is getting the best deal.

He’s a pro now at buying less expensive protein. Beef is too expensive, so instead he settles for chicken thighs and drumsticks. They tend to be at least a dollar less per pound than other cuts of chicken and beef. Meats aren’t the only source of proteins. He stocks up on red beans and pinto beans, and a dozen eggs cost less than a pound of beef any day.

Lopez is a bit of an anomaly. He likes sardines, an excellent source of protein, calcium and vitamin D, all rolled into one tiny fish. Sardines are making a comeback, but that means little to Lopez. He’s

been eating them long before they became in vogue.

Whole grains are an easy choice. He heads straight for the oatmeal and cream of wheat, both excellent sources of protein, and not hard on the budget.

He purchases store brands, but chooses them with discretion. “Why pay more for milk when store brands taste the same as national brands,” he asked. He picks and chooses though. He prefers national brands of sugar and coffee, for instance.

Lopez said that he has learned a lot from the program. What’s even better — he has reduced his weekly expenses for food shopping. “I save $30 a week,” he said.

Some things have not changed, however. He is still chasing that bargain. And he still does not make a list. Some habits are hard to break.

PHOTO: YAWU MILLER

REVEREND CORNELIO LOPEZ DOES THE FOOD SHOPPING IN HIS FAMILY. Apparently he really

Healthy Steps Eat right, stay active, live well » Healthy eating 18 » Recipe 19 » Exercise 20

One step at a time

PHOTO: THINKSTOCKPHOTOS.COM/ M-IMAGEPHOTOGRAPHY

Physical activity does not need to be expensive. You just need a good pair of running shoes. It shouldn’t take much time either.

Aerobics in 10-minute intervals will do the trick.

A winning combination: A healthy eating plan and regular physical activity. baystatebanner.com/news/be-healthy | Be Healthy 17

HEALTHY STEPS: Nutrition

How much of what?

Choose from a rainbow of colors

THERE IS NOT ONE EATING PLAN FOR ALL TO FOLLOW. The types and amount of food depend on a person’s age, gender, weight, level of physical activity and taste. At right is an example of a healthy eating plan based on roughly 2,000 calories a day. It shows the recommended number of daily servings and examples of serving sizes. Remember that fruits and vegetables can be fresh, frozen or canned. Fruits can also be dried, such as raisins. Variety is key. Choose reds, yellows, oranges and dark greens to get a diversity of nutrients.

For additional health benefits, limit sodium to 2,300 milligrams, saturated fat to 22 grams and added sugars to 50 grams a day.

HEALTHY EATING PLAN (SAMPLE) FRUITS: 2 CUPS Sample servings (1 cup equivalent) n 1 large banana n 1 large orange n 1 small apple n ½ cup raisins VEGETABLES: 2½ CUPS Sample servings (1 cup equivalent) n 1 cup collard greens n 1 ear of corn n 1 large red pepper n 2 cups lettuce WHOLE GRAINS: 6 SERVINGS Sample servings n 1 slice whole wheat bread n 1 cup dry cereal n ½ cup brown rice n ½ cup cooked oatmeal

DAIRY: 3 CUPS Sample servings n 1 cup low-fat or non-fat milk n 1 cup low-fat or non-fat yogurt n 1½ ounces natural cheese n 2 cups cottage cheese 18 Be Healthy | Winter 2016

PHOTOS: WIKIPEDIA.ORG

PROTEIN: 6 OUNCE EQUIVALENTS Sample servings n 3 ounces lean meat, poultry or seafood n 1 egg n ¼ cup cooked beans or peas n ½ ounce nuts or seeds

HEALTHY STEPS: Recipe

Chicken paella THIS SIMPLE RECIPE FROM THE AMERICAN HEART ASSOCIATION is low in calories and sodium, and high in potassium, fiber and protein. The combination of low sodium and high potassium is recommended to prevent or control high blood pressure. An additional perk is that the recipe costs $2.39 per serving.

NUTRITIONAL ANALYSIS (PER SERVING): n Calories: 380 n Total fat: 5.5 g (0 trans fat) n Saturated fat: 1 g n Cholesterol: 48 g n Sodium: 113 mg n Potassium: 628 mg n Carbohydrates: 57 g n Fiber: 7 g n S ugars: 5.2 g (0 added sugars) n Protein: 24 g n Calcium: 43 mg

INGREDIENTS n cooking spray n 1 lb. boneless, skinless chicken breasts or tenderloins, all visible fat discarded, cut into 1-inch cubes n 2 tsp. extra virgin olive oil or vegetable oil n 1 medium green bell pepper, thinly sliced n 1 medium red bell pepper, thinly sliced n 1 small onion, chopped n 2 medium chopped tomatoes, lightly mashed in

a bowl with a fork (save the juices!)

n 1 can no-salt-added green peas n 1 tsp. garlic, minced, from jar n ½ tsp. parsley n ¼ tsp. saffron or ¹/8 tsp. turmeric n 1 cup low-sodium chicken or vegetable broth

n 2 cups long grain rice, cooked to package instructions

* Makes 6 servings

DIRECTIONS n Spray a large skillet with cooking spray. Add chicken and cook over medium-high heat 5-7 minutes, stirring occasionally. n Remove chicken from pan. n Add oil, bell peppers and onions to skillet. Stir well and cook 5 minutes until onions begin to become translucent.

n Add tomatoes, peas, garlic, parsley and saffron or turmeric. Stir and cook 2 minutes more.

n Reduce to medium- low heat.

Add broth and chicken. Stir well and cover.

n Simmer for 20 minutes. n Add rice, mix well and heat

Source: Recipe copyright ©2016 American Heart Association. This recipe is brought to you by the American Heart Association's Simple Cooking with Heart® Program. For more healthy recipes, visit heart.org/recipes.

until warmed through. baystatebanner.com/news/be-healthy | Be Healthy 19

HEALTHY STEPS: Exercises

The benefits of physical activity Don’t sit down

The term couch potato — a person who spends several hours a day vegging in front of the TV — is well known. The active couch potato also vegges out but still manages to get the recommended 30 minutes of moderate activity on most days of the week.

Here’s the problem. There is an emerging field of sedentary behavior research, which is finding that sitting for long periods of time can increase some health risk factors, even among those who exercise frequently. In other words, sitting too much regardless of your other activity can be detrimental to your health.

The number of hours you sit might surprise you. They add up quickly: driving to and from work and on errands; sitting at your desk at work; eating; watching TV or surfing the net. That 30-minute workout constitutes about 3 percent of your waking hours. It’s the other 97 percent that’s causing concern.

The World Health Organization has now identified physical inactivity as the fourth leading cause of death worldwide.

The American Institute of Cancer Research agrees. There is strong evidence that weekly moderate physical activity decreases the risk of colorectal, uterine (endometrial) and post-menopausal breast 20 Be Healthy | Winter 2016

cancers by more than 20 percent.

The researchers also found that the 30 minutes of moderate or vigorous level activity in addition to what they called “break time” activity were even more effective in reducing the risk of cancer. Break time activities are smaller bursts of movements interspersed throughout the day, such as taking the steps or getting a drink of water.

The recommendations are simple. Break every hour of sitting with just one to two minutes of activity. That could be a short walk or even just standing.

Exercise or physical activity?

The words exercise and physical activity are bandied about and often used interchangeably. But there is a difference. Exercise is a planned, structured and repetitive activity, such as running, swimming or walking on a treadmill.

Physical activity is any movement that includes expenditure of energy and contraction of muscles. Examples are walking, raking leaves and doing housework. Exercise is actually a subset of physical activity.

The distinction, however, is important. Some people are loathe to exercise, but can more easily accomplish less demanding or structured activities.

The need for activity is not debatable. It is recommended for people of all ages. Senior citizens do not get a pass. The type of activity is your choice, however.

GETTING STARTED The hardest step is the first one. There’s a long list of why people aren’t active, but cost should not be one of them. It’s not necessary to join a gym to get a good workout. Exercising at home is fine. It’s economical and allows more flexibility in time. Free weights — specifically dumbbells and kettle bells — come in various sizes and materials and are easy to use. But it’s not necessary to buy weights. You can make your own from several household items.

DO IT YOURSELF 1. F ill a plastic milk jug or detergent container with water. n A quart container weighs about two pounds. n A gallon container weighs close to 10 pounds. n For a greater challenge, a 5-gallon bucket weighs about 45 pounds.

2. Fill a sock with dried beans and tie the end closed.

3. Use soup or vegetable cans or bags of rice or beans.

PHOTOS: NATIONAL INSTITUTE ON AGING; BANNER PHOTO

THE AMERICAN COUNCIL ON EXERCISE HAS COINED A NEW PHRASE ... ONE THAT SEEMS A BIT OF AN OXYMORON. Active couch potato.

HEALTHY STEPS: Exercises

PHYSICAL ACTIVITY GUIDELINES The 2008 Physical Activity Guidelines for Americans sponsored by the Centers for Disease Control and Prevention recommend two forms of physical activity for adults — aerobics and muscle strengthening. Adults should participate in 150 minutes a week of moderate intensity physical activity, such as brisk walking, biking and swimming.

The activity does not have to be 30 minutes straight. They can be broken into 10-minute or more intervals. Three 10-minute segments a day are fine.

Walking is the simplest aerobic activity. It is free and takes no training.

You need just time and a good set of sneakers.

WALKING IN PLACE For those unable to take a stroll outside, walking in place is a perfect substitute. You get the aerobic effects of walking; you’re just not going anywhere. Yet, walking in place is very effective.

Researchers at the University of Tennessee conducted a small scale pilot study to determine if walking in place during television commercials could increase physical activity and expenditure of energy. They discovered that walking in place during commercials in a one-hour show resulted in almost twice the energy expenditure during one hour of TV watching while sitting or reclining. The participants were active for an average 21 minutes and accumulated about 2100 steps during commercial breaks.

For those who have a tough time to get going, TV commercial stepping is a good spring board.

STRENGTHENING EXERCISES The guidelines recommend muscle-strengthening activities for all muscle groups — arms, legs and trunk — on two or more days a week.

ARMS: CHAIR DIP SOURCE: NATIONAL INSTITUTE ON AGING, NATIONAL INSTITUTES OF HEALTH; ERNESTO ARROYO

ARMS: WALL PUSH-UP These push-ups will strengthen your arms, shoulders and chest. n Face a wall, standing a little farther than arm’s length away, feet shoulder-width apart. n Lean your body forward and put your palms flat against the wall at shoulder height and shoulder-width apart. n Slowly breathe in as you bend your elbows and lower your upper body toward the wall in a slow, controlled motion. Keep your feet flat on the floor. n Hold the position for one second. n Breathe out and slowly push yourself back until your arms are straight. n Repeat 10-15 times. Rest; then repeat 10-15 more times.

This pushing motion will strengthen your arm muscles even if you are not able to lift yourself up off the chair. n Sit in a sturdy chair with armrests with your feet flat on the floor, shoulder-width apart. n Lean slightly forward; keep your back and shoulders straight. n Grasp arms of chair with your hands next to you.

Breathe in slowly. n Breathe out and use your arms to push your body slowly off the chair. n Hold position for one second. n Breathe in as you slowly lower yourself back down. n Repeat 10-15 times. baystatebanner.com/news/be-healthy | Be Healthy 21

HEALTHY STEPS: Exercises

PLANK

TRUNK

In the straight-arm variation, the weight is on the hands similar to the position for a push-up. n Begin on your hands and knees with your hands underneath your shoulders n Raise yourself onto your toes and straighten legs. Keep your body straight from head to toes. n Hold for three to five seconds. n Return to the starting position n Repeat five times. As strength improves build up to 10 to 15 reps.

While sit-ups and crunches are losing favor among trainers, planks are touted as one of the best exercises to increase the strength of the core. There are many variations of planks.

They can be performed with the weight on the forearms or in a side position.

LEGS: CHAIR STAND

BENEFITS OF PHYSICAL ACTIVITY n Decreases risk of: » High blood pressure » Heart disease » Stroke » Type 2 diabetes » Obesity » Osteoporosis

» Low back pain » Several types of cancer n Improves balance n Boosts energy n Improves mood n Reduces stress

PHOTOS: WIKIPEDIA.ORG; NATIONAL INSTITUTE ON AGING

This exercise strengthens your abdomen and thighs and will make it easier to get in and out of the car or rise from a chair.

If you have knee or back problems, talk with your doctor before trying this exercise. n Sit toward the front of a sturdy, armless chair with knees bent and feet flat on floor, shoulder-width apart. n Lean back with your hands crossed over your chest. Keep your back and shoulders straight throughout exercise. Breathe in slowly. n Breathe out and bring your upper body forward until sitting upright. n Extend your arms so they are parallel to the floor and slowly stand up. n Breathe in as you slowly sit down. n Repeat 10-15 times. n Rest; then repeat 10-15 more times

22 Be Healthy | Winter 2016

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Services: Health & Community Care Behavioral Health & Substance Abuse Services Child & Family Services 55 Dimock Street Roxbury, MA 02119 617-442-8800

baystatebanner.com/news/be-healthy | Be Healthy 23

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