high blood pressure

a few inmates can be seen walking down a grassy prison yard through chain link fencing

Prisons contribute to racial imbalance in COVID-19 impact in NC

February 15, 2021 by Carolina Public Press

Prisons contribute to racial imbalance in COVID-19 impact in NC - North Carolina Health News

Inequity in sentencing and building more prisons in mostly Black communities add up to increased COVID-19 among people of color, including prison workers, inside and outside of NC prisons.

By Jordan Wilkie

Carolina Public Press

One in five people who have been in North Carolina’s prisons since March have tested positive for COVID-19, matching the national average for prison infections. One in four prison staff members have tested positive, according to data from the N.C. Department of Public Safety, which oversees state prisons.

That’s compared with one out of 13 people testing positive for the virus statewide.

Because inmates and prison staff are much more likely to be Black than North Carolina’s population as a whole, the outbreaks happening behind prison walls are disproportionately harming Black people and Black communities in North Carolina.

What’s happening in North Carolina follows the national trend, according to Aaron Littman, deputy director of the COVID-19 Behind Bars Data Project at UCLA School of Law.

“The incidence of this disease has been heavier on communities of color, and our practice of racially discriminatory mass incarceration worsens that,” Littman said.

The factors that cause greater infection rates among Black communities create a cyclical process for infection, and prisons act as both incubator and distribution center for the disease, according to multiple experts in the law, public health and sociology.

John Eason, founder and director of UW Justice Lab and sociology professor at the University of Wisconsin-Madison, studies where prisons are built and who works at prisons. He was among the first to show a correlation between where prisons are located and the rapid spread of COVID-19, a conclusion that has since been supported by work from other researchers.

More often than not, communities around prisons are mostly Black, Eason said, and those communities were among the first to get COVID-19. Essential workers, like correctional officers, have to go to work in person.

Though census data shows that roughly 22 percent of people in North Carolina are Black, just over half of people in prison and half of correctional officers are Black.

Eason’s research has shown correctional officers are often the vectors that bring COVID-19 inside prisons, where it spreads rapidly among the incarcerated population and exposes other prison staff to the virus, who then take it back out into their communities.

Because a disproportionate number of people in prison and correctional officers are Black, because prisons are disproportionately built in Black communities and because Black people live in disproportionately segregated communities, prisons put Black people behind the walls and across the state at higher risk of exposure to COVID-19.

“This is compounded, and this is why all of this inequality is being laid bare,” Eason said.

“COVID is just ravaging Black people because it shows the depth of the daily existence of being Black in this country, the depth of inequality that goes along with being Black in this country.”

Not making disparities worse

The limited data provided by DPS and the state Department of Health and Human Services shows prison policy and medical care are not making racial disparities for COVID-19 infection, serious illness or death any worse for the people who are already incarcerated.

But the data is incomplete. Not only does DHHS not differentiate between prison staff and inmates in its data, but the race is also not known for one out of every three correctional officers or incarcerated people who have tested positive for COVID-19.

The data is more complete for COVID-19-related deaths in the prison system, and it shows people are dying roughly in proportion to the racial makeup of the prison population and staff.

It is not a surprise that the medical outcomes for people in prison are similar across race, according to Taleed El-Sabawi, an assistant professor at Elon University Law School who specializes in health care management in correctional facilities.

For years, studies have shown that mortality was not worse for Black people than white people in prisons, El-Sabawi said. Since the virus is indiscriminate in whom it infects and prisons provide the same health care to everyone behind bars, it is not surprising that the trend is holding true in the age of COVID-19.

But the long-term effects of the disease are still unknown and could still reveal racially disparate outcomes, according to El-Sabawi.

“We don’t really know what the true mortality rate of COVID is yet from complications,” El-Sabawi said.

She pointed to studies showing that people who have been incarcerated have higher rates of underlying health conditions than the rest of the population, including asthma, diabetes, heart conditions and high blood pressure.

“We’re going to see increases in mortality in years to come in prisons from heart conditions, for example,” El-Sabawi said. “For people who are released, that can mean, you know, lower life expectancy rates after release.”

Aging, and dying, in prison

The social disparities in housing, education, job opportunities and racially targeted policing that drive up Black incarceration rates are born out of 400 years of United States history, according to Frank Baumgartner, professor of political science at UNC Chapel Hill.

In 1994, the North Carolina legislature passed criminal justice reforms that extended prison sentences. As a consequence, North Carolina’s prison population is getting older, according to Baumgartner’s research.

The older a person is, the greater the risk for serious illness and death due to COVID-19.

Racial disparity is again present in COVID-19 deaths. The vast majority of deaths from COVID-19 in North Carolina’s prisons were people age 55 or older. Black people make up 48 percent of this elderly prison population, more than twice the proportion of Black people in the general population.

While Black people in prison are not dying at higher rates than other groups, they are dying in prisons at much higher rates than white people compared with the state’s population as a whole.

Not only did North Carolina create longer sentences in 1994, but the way the sentences have been applied is racially imbalanced. Baumgartner’s research and an analysis by Ben Finholt, director of the Just Sentencing Project at the North Carolina Prisoner Legal Services, show that the longer a prison sentence, the more likely it is that it’s being served by a person of color.

“I think it is really our responsibility and a test of our level of civilization to keep these people safe, even if they are being punished,” Baumgartner said. “They’re not supposed to be put in a situation where they get preventable diseases. So, I think that that’s the real moral question.”

A woman a hat and thumbs up at a race in the desert.

Fat bias at the doctor’s office takes a serious toll

February 2, 2021 by Liora Engel-Smith

Fat bias at the doctor’s office takes a serious toll - North Carolina Health News

Even with health insurance and ample provider availability, fat discrimination by providers can be a barrier to care for overweight people.

By Liora Engel-Smith

Alyssa McCord would rather not see a doctor at all. The upstate New York native who now lives in Jacksonville with her husband and daughter attributes some of her reluctance to upbringing. Her parents only went to the doctor when absolutely necessary, she said.

The other part of that reluctance, says the 38 year old, is how providers react to her weight.

McCord, who wears size 20 pants, is used to providers making demeaning comments about her body. Often, they’d blame her weight for every ailment — from heavy periods to colds to numbness and tingling in her hands.

In September, McCord had an experience that surprised even her. She’d gone to a family doctor to discuss consistently heavy periods and constant exhaustion. The doctor said her stomach was cramping because she is fat. If she lost weight, he told her, the pain would go away.

The doctor did not order any of the customary tests, such as abdominal ultrasound or blood tests to confirm his assertion. He looked at her and made up his mind, McCord said.

McCord would later learn from another provider that an enlarged uterus caused the cramps and heavy bleeding. Blood loss from the heavy periods made her anemic, accounting for her fatigue.

Nearly every person in a bigger body has their own story of weight-based bias at the doctor’s office. It could be anything: a too-small blood pressure cuff or medical gown, a wince from a triage nurse during a weigh-in, a negative comment from a physician, or as in McCord’s case, blaming every symptom on weight.

It’s impossible to know exactly how pervasive weight bias is in the health care system, especially because it involves provider attitudes, but it’s safe to say that fat discrimination is rather common, said Ya-Ke “Grace” Wu, assistant professor at the UNC Chapel Hill’s school of nursing.

Current estimates are that 19 to 24 percent of obese adults experience some form of discrimination because of their weight, from bullying at home or work to fat discrimination in clinical settings. The rates of weight bias are even higher in women and people with higher body mass index scores.

Alyssa 3 — Alyssa McCord of Jacksonville, and her daughter Mozelle, now 7, pose for a photo after a 5K in 2018. Photo credit: Alyssa McCord.

Wu, who studies weight discrimination, said the maltreatment can also be nonverbal, from flimsy chairs that cannot accommodate larger bodies in the clinic waiting rooms to weighing them in hallways, rather than in a room that offers some privacy from passers-by.

No matter how the bias is delivered, the message is clear to any person in a big body: Weight isn’t just a number, it’s a moral failing and a cause for shame.

These negative attitudes from providers have far-reaching health implications, Wu said. Some fat people may avoid the doctor altogether, delaying diagnosis of conditions such as diabetes, high blood pressure, or more serious conditions, such as cancer. Sense of shame about body size can also lead to a host of mental illnesses, from depression to anxiety to suicidal thoughts. It’s even correlated with weight gain and binge eating disorder, a condition that involves cycles of compulsive and restrictive eating.

“The ‘fat is bad’ lense kind of corrupts everything,” said Lindo Bacon, author, researcher and a member of the Health at Every Size movement, a grassroots effort to eliminate weight stigma in all areas of society. “And at this point, it just seems like it’s basic good health care or so it seems to the doctors, that everybody’s supposed to get thinner.”

Negative treatment, negative outcomes

Weight stigma isn’t just about hurt feelings, it is also linked to higher mortality rates, in part because discrimination often leads to unhealthy behaviors, such as exercise avoidance, overeating and substance use. The stress of weight stigma is associated with metabolic changes that can make people sicker, including higher levels of the stress hormone cortisol and inflammation markers.

Evidence of harm is so robust that last spring, a panel of experts from universities and health care systems all over the globe published a call to end weight stigma in all areas of life in the prestigious journal Nature Medicine.

“Weight bias and stigma can result in discrimination, and undermine human rights, social rights, and the health of afflicted individuals,” the authors wrote.

As obesity rates in adults continue to rise, the public health consequences of fat discrimination could be significant. In North Carolina, for example, adult obesity rates more than doubled between 1990 and 2019.

While the scientific community has established that weight alone is not a predictor for health, societal understanding of obesity continues to lag. Many people, including health care providers, believe that diet and exercise are the only ways to manage obesity, despite evidence to the contrary.

Public health experts have known for years that obesity is a multifactorial condition, affected not only by behaviors but by the social determinants of health, including income, access to healthy food and neighborhoods that may discourage walking, to name a few. The focus on diet and exercise alone assumes that obesity is always within a person’s control, said Bacon, the Health at Every Size advocate.

“From a global perspective, we know that it’s the social determinants of health that play a much larger role [in obesity],” Bacon said. “ … So even our messages of bringing it down to individual behavior, are ignoring the really big issues in health, which is about inequity.”

Weight and nothing else

Rashelle Hamilton was used to providers taking her seriously. Hamilton, who had always been trim, had gained 30 pounds after the birth of her youngest daughter, Violet. She thought her birth control implant may be at fault.

Hamilton, who weighed 218 pounds late last year after the birth, was surprised to find that her new weight affected the quality of care she received.

“Before they would mostly believe me when I said I had a problem,” the Cary resident said. “They believed me and listened to my symptoms and then went off of my symptoms.”

A woman in a pink puffy coat smiles — Rashelle Hamilton lives in Cary. Photo credit: Rashelle Hamilton

But at an annual physical last December — her first in a larger body — the doctor looked at her and determined that she had Type 2 diabetes without a blood test or a review of diabetes symptoms, Hamilton said. The physician immediately prescribed Hamilton an $800-a week diabetes injection and then ordered tests to confirm what she thought was the correct diagnosis.

Hamilton didn’t have diabetes, the blood tests later showed. The experience left her with a sense that she cannot trust medical providers. At the recommendation of a friend, Hamilton found a different doctor to go to. But the December physical cost her time, money and aggravation.

Wu, the UNC researcher, said that many overweight and obese people take the same route, moving from doctor to doctor until they find someone who would listen. But that approach can still cause damage, because of delayed diagnoses.

“Some diseases have a golden window for treatment,” Wu said. “And so if you delay the treatment, you may delay the whole improvement [trajectory] of the disease.”

The economic impact of repeated appointments for the same complaint is unknown, Wu said, but with rising health care costs and the lack of provider availability in rural areas, patients may not have the money or ability to find a provider who would listen.

Health without weight?

If you walk into Aimee Feste’s clinic in Asheville, odds are, the word “weight” won’t come up unless you say it. Feste, a body-positive nurse midwife with the Asheville-based Mountain Area Health Education Center, says she first learned about the weight discrimination from her patients.

“People can be healthy in a larger body size,” she said. “I say to my own patients who are worried about their weight ‘I could cut off your arm and you would lose 10 pounds and you can be a whole heck of a lot less healthy.’”

Feste says very few conditions, such as water retention during eclampsia, require in-office weight measurement. Instead, Feste focuses on the patient’s life as a whole, even when patients have chronic diseases, such as diabetes, that would traditionally trigger a discussion about weight.

She might talk to diabetic patients about their stress levels, their sleep, their ability to get medication and access food that nourishes them. That approach may take more conversation, Feste added, but it’s far kinder and respectful to patients who are already ashamed about their bodies.

Wu agrees with that approach. A provider is in a position of power, she said, and their job is to build trust with patients.

“We don’t have to push patients to talk about weight, we should just focus on whatever health issue they come in [with] for that day’s appointment,” Wu added. “If the patient wants to talk about weight, then we can talk about it, but I always suggest that the patient lead that conversation.”

Feste said that rather than bringing up weight to patients with larger bodies, providers should educate themselves on approaching all patients, regardless of size, kindly and without judgment.

“The more we shine light on it, the more it’s talked about, the more it’s going to be an open conversation,” she said.

we see an industrial complex / poultry plant where multiple Latino workers have tested positive for COVID

Latino North Carolinians infected with COVID-19 ‘simply by going to work’

June 11, 2020 by Anne Blythe

Latino North Carolinians infected with COVID-19 ‘simply by going to work’ - North Carolina Health News

Duke professors, physicians and state leaders eye ways to slow the spread of COVID-19 in Hispanic communities, where it's hit hard.

By Anne Blythe

Many Latino North Carolinians have felt the disproportionate impact of COVID-19 because they have been essential workers during the pandemic, working at meat processing plants, on construction sites or in grocery stores and other places where it can be difficult to avoid the virus.

A nursing professor, a pediatric physician and doctor in family medicine at Duke University held a media briefing on Wednesday to discuss how the state could provide more resources and health protections for these communities.

Viviana Martinez-Bianchi, a professor of family medicine, Rosa Gonzalez-Guarda, a nursing professor, and Gabriela M. Maradiaga Panayotti, a pediatrics professor, ticked off a list of interventions that could push down the infection rates for Latinos.

Those included such things as more targeted health education campaigns, expanding access to health insurance, making sure employers provide paid sick leave so they won’t feel the pressure to work when infected, and insisting that workplaces make it possible for them to follow social-distancing measures while on the job.

Latinos, the coronavirus and a single ZIP code

“The primary way the Latinx community is becoming infected is simply by going to work,” Gonzalez-Guarda said. “If we think about prevention, it’s important for us to do more around providing appropriate protections in the workplace.

“This means not only providing masks and social distancing measures in the workplace but putting pressure on business owners to provide paid sick leave … so people don’t have to make the decision between going to work while they’re sick and potentially infecting others, or paying rent and providing food at home.”

Testing for COVID-19 also is important, Gonzalez-Guarda said, but just as important is letting the community know who will pay for it and how to gain access to health insurance.

Confusion about testing costs

The state has created a program to ramp up testing and tracing efforts in Latino and African American communities, which have felt the brunt of the virus in large part because of long-standing health access disparities.

Data, graphics courtesy: NC DHHS

Martinez-Bianchi said it is important for all the public health departments to release ethnicity data and all demographics to better inform and prepare a pandemic response.

One interesting phenomenon has been that even though Hispanics are about 10 percent of the population, they have comprised some 42 percent of cases as of June 10 but only 7 percent of the deaths. Ethnicity data is missing for about a third of the state’s cases.

“Many of them are younger,” speculated pulmonologist Shannon Carson from UNC Hospital during an interview with NC Health News on June 5. At that point, Latinos had comprised about 40 percent of the cases treated at UNC Hospital in Chapel Hill.

a man in a mask worn against COVID looks at the camera. He's standing in a hospital ward. — UNC pulmonology chief Shannon Carson talks about the many adjustments to practice required by his staff in response to COVID-19. He said that many of the patients they’ve seen in their intensive care unit have been Latino. Photo credit: Rose Hoban

“Many of these patients did have some comorbidities whether it be diabetes or hypertension … but otherwise being working people, active, came in with some strength and reserve, which is what it takes to endure multi-organ failure and the recovery time that’s required.”

Building trust

Mandy Cohen, secretary of the state Department of Health and Human Services, was also in on a conversation with advocates for the Latino population on Wednesday and mentioned it at a media briefing in the afternoon.

She mentioned the testing, tracing and surging work that the state plans to do, but acknowledged that additional focus would be needed.

Gonzalez-Guarda, who is doing research on COVID-19 and the Latino community, said that she has been hearing from some of her research participants their fears for reaching out for help. Some are worried their immigration status could be compromised, she said, and others are worried about the bills they could rack up getting tests or care.

“There’s so much work to do,” Cohen said. “We’re always wanting to get better as a state to make sure that we are appropriately responding, particularly as we see our historically marginalized communities more disproportionately impacted by COVID-19.”

Isolation at home challenging

One of the issues that has come up with workers around meat processing plants, farms and construction crews is how to prevent virus spread in a household, especially when it can be difficult to isolate someone who has been exposed.

“This is very challenging,” Maradiaga said. “Anybody who lives with any other person knows how much contact one has with each other. We are recommending a few basic things but also recognizing this can be hard. If possible, the person who is sick should be isolated in a separate room and a separate bathroom.

“Often, that’s not possible so we’re trying to say, in whatever way you can, minimize contact with that person. That person should wear a mask, and the other people in that house, including children two and up, should wear a mask. Good hand washing, not quick hand washing, good hand washing, 20 seconds or more. And being especially careful with anything that touches the mouth.”

Mike Sprayberry, director of emergency management, told reporters on Wednesday that the federal government had granted a 30-day extension for a program through which counties can tap into federal money to pay for motel rooms for people with the virus who are homeless or who otherwise cannot isolate themselves from people in their homes.

Federal resources available

Forty counties have used the program, according to Sprayberry.

Cohen said she hoped others would use it, perhaps to help in communities of color where isolating and social-distancing can be difficult.

“I’m excited to see as many as 40 taking advantage of it,” Cohen said. “I want to see even more take advantage of this federal support. It’s federal dollars that support non-congregate sheltering. I think that’s going to be really important as we continue to go forward here.”

Cohen also wants people to take advantage of the increased testing opportunities across the state to help identify and slow the spread of the virus.

“We have 400 testing sites, but it’s not like we have lines out the door or we have waits at our labs,” Cohen said. “We need to make sure folks know there is capacity. We want them to get tested, that these kinds of occupations can lend themselves to more exposure.”

Rose Hoban contributed to this report.

Children sitting around a table cutting greens as part of a program that tackles physical activity in Durham.

Fighting childhood obesity by teaming up

December 16, 2019 by Sarah Ovaska

Fighting childhood obesity by teaming up - North Carolina Health News

How one Durham program, Bull City Fit, is partnering doctors concerned about children’s health with parks departments to change young lives.

By Sarah Ovaska

On a rainy, cold and dark winter evening, several dozen children from age 5 into their teenage years gathered in the courtyard of a Durham Parks and Recreation building, counting out stretches, jumping jacks, lunges and leaps in unison.

“1-2-3-4-5 …”

Between the numbers were shouts relaying the rules of Bull City Fit, an innovative community-based program focused on reducing child obesity, particularly in low-income children: Play hard, play fair, play safe and play as a team.

The nightly activity at Durham’s Edison Johnson Recreation Center is a partnership between pediatricians at Duke Children’s Healthy Lifestyles Program and the city of Durham’s Parks and Recreation Department. Children struggling with obesity have been referred by their health practitioners to a year of the no-cost, organized sessions that are available six days a week. Bull City Fit has two locations in the city. The one at Edison Johnson is for children ages 5 to 18. The other, at W.D. Hill Recreation Center, focuses more on pre-teens and teens in the 11-18 age group.

The program is the brainchild of Sarah Armstrong, a pediatrician at Duke University Medical Center, and her colleagues. Armstrong, who has dedicated much of her professional life to the growing epidemic of child obesity, routinely sees young patients presenting with conditions that used to be reserved for later in life: 8-year-olds with Type 2 diabetes and in need of daily insulin shots, 10-year-olds on blood pressure medicine.

Growing problem

Overweight children aren’t served well by concentrating solely on diet and calorie intake, a method more effective with overweight adults, she said. Concentrating on what an individual child can control – their activities and being open to healthy habits – can help build self-confidence and instill healthful behaviors that can continue into adulthood.

“In kids, it’s helpful to focus on the physical activity side of things,” said Armstrong. “Being active is inherently a kid thing.”

At Bull City Fit, children get their choice of rotating activities each night, from dance classes, track events, Capture the Flag games, basketball, tennis and more. Each offers an opportunity to try out new sports and activities in an environment where everyone around them is facing the same challenges.

There’s also a twist to how Bull City Fit works — it’s not just the children referred by the doctors who are there.

Two preteens who participate in Bull City Fit, a childhood obesity program. — Crysta Hilliard and her son Kaden, 7, have begun regularly attending the Bull City Fit program. Photo courtesy of Crysta Hilliard.

The program requires a parent or guardian to take part in physical activities while there as well. Adults can either join their kids in what they are doing, work out in a small gym with exercise equipment or take such Durham Parks and Rec classes as Zumba or Spin offered at the same time. Older and younger siblings also are welcome. A highlight of Bull City Fit is weekly cooking classes on Tuesdays, in which families learn new ways to prepare healthy foods.

The Durham-based program is a small but strong stand against the scourge of child obesity in the state, where an estimated 13.5 percent, or one in every seven North Carolina adolescents ages 10 to 17, are currently defined as obese, according to an annual survey put out each year by the Robert Wood Johnson Institute.

Turning research into reality

Though the number is higher than child health advocates would like, the 13.4 percent child obesity rate lands North Carolina in the lowest third of states. Faring worse are states such as Mississippi (25.4 percent), West Virginia (20.9 percent) and Kentucky (20.8 percent) at the top.Utah (8.7 percent) and Minnesota (9.4 percent) have the lowest rates in the country. The trend follows through to the youngest children, with 14.2 percent of children in North Carolina ages 2 to 4 who receive WIC supplements considered obese in 2016.

Children playing tennis at Bull City Fit, a childhood obesity program. — Children enrolled in the obesity-reduction Bull City Fit program explore tennis as an activity. Photo courtesy of Bull City Fit.

And while there’s been no shortage of research into the epidemic of obesity in general, and child obesity in particular, the large-scale solutions continue to be elusive, with incremental public health victories.

“We don’t have soda machines in schools and, by and large, recess is required every day in North Carolina schools,” Armstrong said, about those public health wins. But, “we haven’t really seen the comprehensive changes that make a dent in the epidemic of childhood obesity.”

Part of the challenge is that childhood obesity is often framed as a failure of some sort, either on the part of parents or the children and not seen through the lens of the health condition that it is, Armstrong said.

“There’s blaming of the parents for not regulating their children’s well-being, there’s blaming of the children themselves, there’s blaming of the school system for not feeding them the right food,” Armstrong said. “All of that blaming is not getting us anywhere. We have to remove the shame and stigma of what essentially is a health condition.”

Tasking a community with change

That’s exactly what Bull City Fit is trying to do, by getting rid of the stigma and building support on the community level to support largely low-income families as they face childhood obesity issues.

A study of Bull City Fit published in JAMA Pediatrics in early 2018 has shown that the community approach to child wellness is working, perhaps without dramatic weight loss numbers but in ways that showed promise through increased activity levels. A randomized clinical trial followed nearly 100 children, 70 percent of them living in impoverished homes, who spent six months with Bull City Fit. The trial didn’t show reductions in BMI over that short period of time, but it did indicate there were significant improvements in quality of life and activity levels.

Now, the Bull City Fit model is being recreated in seven other counties around the state – Cumberland, Montgomery, Moore, Richmond, Rowan, Wake and Wayne, with assistance in funding from the Duke Endowment. [Disclaimer: N.C. Health News also receives grant funding from the Duke Endowment, but the foundation has no input into editorial decisions.]

Open-ended participation

Crysta Hilliard has already come on board with what Bull City Fit is aiming to do, just a few weeks into her family’s participation. Her son Kaden, 7, joined the program earlier this fall at his pediatrician’s suggestion. Hilliard is planning on making it two to three evenings a week, a big commitment given the family is coming from Hillsborough, about 15 miles away.

“Our main goal is to have him lose weight and make him as healthy as possible,” she said.

Kaden, an African-American child participates in a childhood obesity program designed to help kids be more active. — Kaden, 7, was a recent Kid of the Week at Bull City Fit, where he says you can fun if are kind and try your hardest. Photo courtesy of Crysta Hilliard.

Only a few weeks in, they already have made changes. Weekends have shifted to limit computer time and instead include family walks. Kaden, typically a bit shy, has been outgoing and excited to try new things and connect with other kids. His mom signed up for a spin cycle class, a challenge but one that’s making her feel good about her own exercise.

He used to complain about running, telling his mom he was too slow. But after trying it out with Bull City Fit crew and staff, he’s enjoying the activity and proudly telling his mom how fast he is getting.

Kaden was selected as the program’s “Kid of the Week” in early December, reporting that his favorite healthy food is now broccoli and that you can have fun if you are kind and try hard.

Mother and son also really enjoy the regular Tuesday night cooking program, making zucchini noodles, broccoli tots and parsnip fries on a recent evening, things they had never tried before.

There are no requirements about how frequently families need to attend Bull City Fit. Some will come a few times a month while others may come a few times a week.

Elser Aguilar comes every night with his 6-year-old son, Elser Jr., and daughter Catalina, 4. The time at Bull City Fit is not only a positive way to instill healthy habits, but it’s also important family bonding time.

Aguilar works a full-time job at a grocery store before going to another job cleaning offices in the evening hours. The hours the trio gets to spend together at Bull City Fit are valuable, Aguilar said.

Nights at home aren’t as productive, he said, with him getting tired from his long days and nights of work, and the children then gravitating toward sedentary activities like video games. At Bull City Fit, the whole family can play, bond and be active.

The idea is to build up the whole family to address the effects of obesity, by finding ways to get kids excited about playing and moving, and cementing that parental support as well, said Rachel Fleming, the Bull City Fit program director who first connected as a volunteer when she was an undergraduate at the University of North Carolina at Chapel Hill.

“We really want to encourage families to do what’s realistic for them,” Fleming said. “Whatever they do, we want to celebrate that.”

Approach spreading beyond Durham

The Bull City Fit model is one that people across the state are also getting excited about.

The program also has received attention for the way it links community parks departments with medical providers, connections that don’t necessarily exist otherwise. In 2017, the program was recognized for a National Partnerships Award from the National Recreation and Park Association.

A schedule of activities as part of Bull City Fit, a childhood obesity program designed to help children be healthier. — The weekly program activities for Bull City Fit, a partnership between Duke pedestrians and Durham parks department, includes adventure walks, playground games and field games. Photo credit: Sarah Ovaska.

Michelle Wells, the executive director of the N.C. Parks and Recreation Association, is a strong proponent of what Armstrong and Bull City Fit are doing. She’s had Armstrong come speak at the annual conference her group holds for city and county park departments around the state.

Every year, people leave excited about the program’s approach to obesity and families and begin looking for ways to replicate it in their communities.

It’s not only participants in these programs who benefit, Wells said. Once those connections are made through programs like Bull City Fit, a doctor may more readily talk to other patients and their families about the greenway systems in a community, available swimming pools and lessons, or low-cost or free sports and recreation programs that are available.

Child obesity, after all, isn’t a problem that one person or one pediatrician or one recreation director is going to solve on their own.

“It takes lots of partners in that community to combat all types of issues,” Wells said. “No one group has all the answers.”

Mediterranean food design (!) and cooking by TRG, shows a fish being braised in a pan with red and yellow peppers

UNC’s southern twist on Mediterranean diet keeps diners on track, earns $3.8M grant

July 19, 2019 by Thomas Goldsmith

UNC’s southern twist on Mediterranean diet keeps diners on track, earns $3.8M grant - North Carolina Health News

UNC researchers have devised an inviting mix of the Mediterranean diet and down-home cooking, aimed at keeping dieters motivated by providing food they actually like.

“… I am drawn to conclude that any plan to reform eating habits must not lose sight of the fact that people want to enjoy their food. Any sort of cooking or diet is doomed to failure if it fails to give people pleasure.” — Michel Guérard, Eat Well and Stay Slim: The Essential Cuisine Minceur

By Thomas Goldsmith

People will stick with a healthier diet in the long term if it offers food that they like and find satisfying.

That’s one of the tenets behind a five-year study at UNC-Chapel Hill that recently earned a $3.8 million grant from the federal National Heart, Lung, and Blood Institute. With a modified Mediterranean diet at its core, the study aims for protracted weight loss among its clients — people with obesity cared for by general practitioners in the central North Carolina “stroke belt.”

The Mediterranean cuisine variation for North Carolinians has been labeled the Med-South diet by UNC research principals Carmen Samuel-Hodge, assistant professor of nutrition at the Gillings School of Global Public Health, and Thomas Keyserling, a physician and professor of medicine.

The approach by Samuel-Hodge, Keyserling and associates starts with the widely studied Mediterranean diet, with its key elements including extra virgin olive, whole grains, nuts, fruits, vegetables, lean meats and fish. Then diners can add elements as varied as additional protein, limited servings of full-fat dairy products, cocoa-laden chocolate and even hushpuppies. If adding some bacon to leafy collard greens tastes good enough to keep participants on track, that’s all right, too.

“It’s easier for them to not feel as if they have to give up the palatability that comes with a higher fat content,” Samuel-Hodge said during a recent phone interview with both principals.

“I think that piece will allow them to feel as if, ‘Oh, I’m not going to be deprived with this dietary pattern.’ And if the feelings of deprivation are lower they’re likely to maintain the pattern for a longer period of time.”

fresh nc seafood — Researchers at UNC-CH recently won a $3.8 million grant to test the value of a modified Mediterranean diet on 350 North Carolinians with obesity. The diet incorporates seafood as well as lots of fruits and vegetables, leafy greens, beans and nuts. Staff photo: Thomas Goldsmith

Doctors and nutritionists have tried for decades to induce Americans to eat more healthily, given the knowledge that most don’t get enough fruits, vegetables and fiber, Samuel-Hodge said. But, she said, changing many Southeasterners’ eating habits must rely on elements that are already familiar to diners, such as vegetables, peanuts and peanut butter. Some former no-nos like whole milk are back on the table.

“Foods that were highly restricted 20 or 30 years ago, when we were trying to follow the old guideline of not having much fat in the diet, are the actual foundation of a healthful diet, plus people like to eat them,” Keyserling said. “People like to eat nuts, and they like to eat peanut butter. They like full-fat salad dressing and they like tartar sauce. And so those are all foundation foods for regular consumption.”

Fresh produce is part of the modified Mediterranean diet designed to be more appealing to Southeastern tastes. An upcoming test will assess its value for Tar Heels with obesity. Photo credit: Thomas Goldsmith

The topic of carbohydrates gets complicated because the name covers everything from “good” foods such as fruits, vegetables, grains, beans and other unrefined carbs, to highly processed foods such as sugary soft drinks and refined grain products.

‘More weight loss’

“Our focus in the carbohydrate realm was to try to decrease consumption of sugar-sweetened beverages and to encourage the consumption of mostly familiar fruits and vegetables that people are already used to eating,” Keyserling said. “Then we’d recommend some substitution away from refined grain products to whole grain products. So maybe a common example would be brown rice instead of white rice and whole wheat bread instead of white bread.”

Samuel-Hodge and Keyserling led a previous study of the Mediterranean diet involving participants in Lenoir County. The enrollees showed significantly improved diet quality and blood pressure results, as well as weight loss even among those who did not choose a specific diet option to take off pounds.

“In our Heart Healthy Lenoir project, the participants who did not elect to be in a weight loss weight program had lost 3.8 kilograms at the end of two years,” Keyserling said. “That’s more weight loss than is seen in many weight loss studies.”

Weight results in the Lenoir study were observational, as opposed to a randomized trial involving a control group as in the new study, which will survey 350 people at five general practices in the central part of the state.

“The first phase of this intervention will prepare participants for the weight loss phase by teaching them a set of ‘stability skills,’ which include learning to eat a healthful diet without feeling deprived, becoming comfortable with frequent self-weighing and navigating inevitable disruptions,” Samuel-Hodge said in a news release.

Cooking healthy OBX-style

Sharon Peele Kennedy, a Hatteras-based chef and cookbook author, said that some North Carolinians might be put off by, say, the omission of salt pork from the traditional local recipe for clam chowder. However, she’s able to satisfy many with a “meatless” version, serving corn cakes on the side to vary the offering.

Sharon Peele Kennedy, a chef and cookbook author from Hatteras Island, comes up with healthy recipes for traditional Outer Banks fare such as clam chowder. A new study at UNC-CH will encourage people in North Carolina to skip some high-fat foods and sugary drinks to be healthier and lose weight. Photo courtesy Sharon Peele Kennedy

“A lot of Southerners, if you tell them they can’t have salt pork or bacon fat, they’re like, ‘Ohhh, I don’t want that,’” she said in a phone interview.

Kennedy has been using both old-school and new techniques to prepare food that’s tasty and healthy, just as the UNC researchers suggest.

“We all love our fried fish, but we grew up with stews and chowders,” she said. “You cooked with what you had, onions, potatoes, peppers. Most of the recipes are basically braising, baking, sautéing.”

In a fusion approach, Kennedy suggests heating a jar of kimchi, the Korean staple of pickled cabbage, in a skillet as poaching liquid for fish. As in the Med-South approach, she draws the line at the excessive use of high-fat items and processed carbohydrates.

“So many people use cheese and butter and sauces on their fish,” Kennedy said. “I say, ‘You paid a premium for that seafood, why would you cover it up?’”

One size doesn’t work

The Med-South study will examine specific markers such as inflammation and skin carotenoid levels as well as typical weight, heart and lung indicators. Results of the research will be used to design further study in the concluding years of the effort.

First, there’s a four-month introductory period, eight months of the weight-loss program and a year-long followup to see whether people stick with a version of the plan that they’ve helped develop.

Poached fish, Mediterranean style, this time with tomatoes — Fresh-caught Outer Banks fish don’t have to be fried to be tasty. Hatteras Island chef Sharon Peele Kennedy recommends the no-fat method of poaching, seen here as a flounder filet cooks in black beans and salsa. It’s easy! Photo credit: Thomas Goldsmith

“You can have a healthful dietary pattern that actually is Mediterranean style that might have a little bit more protein for some people who want that,” Samuel-Hodge said. “And there are others who might want a different combination.”

Current weight-loss research has shown that no one diet pattern fits everyone who wants to lose weight.

“One of the things we find is that you can vary dietary composition quite widely,” Samuel-Hodge said. “That’s what determines weight loss, because when you start comparing the high protein, the low fat, the medium-range fat, it really comes down to what that person can actually adhere to over a long period of time.”

A wall of blue bins, each labeled with a code, some are full of prescription bags

MedAssist fills prescriptions for Tar Heels in need

April 30, 2019 by Yen Duong

MedAssist fills prescriptions for Tar Heels in need - North Carolina Health News

NC MedAssist, based in Charlotte, is a mail-order pharmacy which sends free medicine to uninsured and low-income people across the state.

By Yen Duong

The first time Natalie Holloway’s heart failed, her husband of 38 years drove her the 33 miles from their hometown of Columbia to an emergency room in Edenton.

“We was the only ones that night on the road,” Holloway recalled. “I couldn’t breathe so I had to roll down the window. I don’t really know how I made it. When I woke up, I was in the emergency room and I don’t remember much after that.”

Holloway stayed at a hospital for five days in November 2017, then went home. She received prescriptions for medicines to help with cholesterol, high blood pressure and heart failure but couldn’t afford to fill them. In April 2018, she landed back in the hospital for 11 days after another episode.

Facing costs of $900 a month for one medication and over $300 for a separate one, Holloway prayed for a solution. That’s when she heard about MedAssist.

A woman scans a bin of pills in a large machine with an array of pills — MedAssist pharmacists and technicians use a pill-counting robot to fill over 20,000 prescriptions each month. Photo credit: Yen Duong

“[MedAssist] kept me alive,” Holloway said. “Today I can knock on wood that I [won’t be] going back [to the hospital] ‘cause I been getting my medicine.”

MedAssist is a non-profit pharmacy, partially funded by the state, which ships 90-day supplies of free prescription medications to people in need across all 100 counties of North Carolina.

Based in Charlotte, the program also runs a free “store” for over-the-counter medications for local residents, a mobile free pharmacy with OTC giveaways and a consultation program for seniors who fall in the Medicare “donut hole.” Last year, MedAssist served more than 37,000 Tar Heels across its three programs and gave out $68.5 million worth of medications.

Unifying different requirements

Pharmaceutical companies run patient assistance programs for those who cannot afford their medicines, but each program has different requirements on income or insurance status.

“Let’s say a patient is on five medications, and you have to apply to three different drug manufacturers, that’s three different applications you’re going to have to use,” said Nicole Banahene, who works for MedAssist. “But with our program, […] a patient only needs to apply once and they have access to the generics and the brand-name medications.”

MedAssist acts as a middleman–the companies ship drugs in bulk for free to MedAssist, which makes sure that patients who qualify for each company’s program get the medications.

If a patent expires or brand-named drugs are no longer available for free, MedAssist purchases generic drugs for its patients. About 77 percent of drugs shipped by MedAssist are generic, Banahene said.

“This is the only place in North Carolina where you can get multiple generic medications from one place and they’re free if you’re low-income and uninsured,” Banahene said.

Free for low-income, uninsured

To qualify for MedAssist’s free pharmacy program, North Carolina residents must be uninsured and fall at or below 200 percent of the federal poverty level, which comes out to $24,980 for one person or $51,500 for a family of four. Banahene said that about 84 percent of MedAssist patients live below the federal poverty level of $12,490 for individuals.

A graph with two pie charts showing revenue and expenses — MedAssist’s tax returns show almost $56 million in revenue, but that includes around $53 million in donated prescription medicines. Graph credit: MedAssist

Across the state, 109 partner agencies help find and guide potential patients such as Holloway through the enrollment process, which involves tax returns, proof of citizenship and original prescriptions. Last year, partners referred about two-thirds of the 15,818 free pharmacy patients; the remaining third enrolled directly.

“We work with all different types of organizations that are serving those patients in their community that are uninsured, and they will send their patients to us,” Banahene said. “They could be a hospital or a free clinic, or a community health center, or a shelter or a health department that still does primary care or transition clinic or rehab center.”

Scaling up

The program began in 1997 as Mecklenburg MedAssist to help local low-income seniors get their prescriptions. After initial success, it expanded to cover all low-income residents of Mecklenburg County in 2001.

By 2009, then-N.C. Attorney General Roy Cooper granted more than $2 million to MedAssist over two years to expand statewide.

Read more about MAP in a 2012 NCHN story.

The state grants for MedAssist are administered by the state Medication Assistance Program. MAP, which began in 2003, works with clinics to help patients apply to individual programs offered by pharmaceutical companies for free drugs.

“The programs complement each other to meet the needs of North Carolina,” said Stephanie Nantz, an assistant director in the N.C. Office of Rural Health, part of the Department of Health and Human Services. “There’s such a high need to assist individuals with obtaining the medications that they’re prescribed.”

MAP helped over 32,000 patients get the equivalent of $223 million in medications in fiscal year 2018, according to their report.

Last summer, MedAssist opened its free store in Charlotte. Nearby residents can come once a month to pick up over-the-counter drugs, subject to some limitations.

“People can abuse pain medicine and abuse allergy and cold [medicines], so we make sure that folks are not taking away a whole slew of one type of item,” said store manager Renée Warner. “I won’t give out three sleep aids at one time.”

Hitting the road

A woman with a shopping basket perusing the goods on three store shelves of medications — Customers shop for free over-the-counter medications at MedAssist’s store in Charlotte. Photo credit: Yen Duong

Roughly every week, MedAssist partners with a local agency and sends out a truck to a different location in the state with 140 boxes of over-the-counter medications, from prenatal vitamins and allergy medications to wart removers and diaper cream.

“We take about $100,000 worth of over-the-counter medications in a truck, and we get about 75 to 150 volunteers and we set up basically a pharmacy,” said Sheila Kidwell, director of communications for MedAssist. “When we have these events, about 23 percent of the people who come […] identify as uninsured. That is the best way to identify who needs our free pharmacy.”

The mobile free pharmacy often acts as a nexus for more public health resources. For instance, past organizers have given out hepatitis A vaccines, checked blood pressure and brought a vision van for on-site eye exams and same-day glasses.

Patients, pharmacy students and civic organizations made up many of the 5,352 volunteers from last year. Volunteers sort medications into boxes at the Charlotte warehouse and help give out medications at the mobile free pharmacy events, which reached over 20,000 North Carolinians last year.

For Holloway, volunteering is a way to give back to the program which helped her through her darkest days.

“I tell anybody that I don’t wish this [illness] upon my enemies. It was a rough time,” Holloway said. “This is my way of saying ‘thank you’ because I’m so grateful. They didn’t have to [help me], but they did. That’s why I volunteer.”

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