>> GOOD AFTERNOON, EVERYONE. MY NAME IS CHRIS GAINES. I'M THE PROJECT MANAGER THAT OVERSEES THE WELLNESS PROGRAM. I WANT TO THANK YOU FOR COMING THIS AFTERNOON TO TO OUR LECTURE SERIES,RECOLLECT TIRE FOCUS ON YOU. TODAY I'D LIKE TO INTRODUCE TO YOU DR. DENISE SIMONS-MORTON, WHO WILL BE GIVING US A GREAT PRESENTATION ON SAVE YOUR HEART. SO WITHOUT FURTHER ADO, DR. SIMONS >> GOT T IT'S GOOD TO BE BACK IN ROCK ROCKLEDGE. I'VE LEARNED A LOT SINCE I'VE BEEN HERE, LIKE ANIMATION. THAT'S SOUND EFFECTS. I DON'T KNOW IF YOU CAN HEAR IT. * WE'RE GOING TO TALK ABOUT PREVENTING HEART DISEASE AND DO SOME EXERCISES AS WE GO ALONG, EXERCISES AND EXERCISE. FIRST I'M GOING TO GRABWELL GROMMET'S STORY. HAS ANYBODY HEARD THAT STORY BEFORE? WELL, I'M GOING TO TELL YOU ABOUT HIM. HE WAS A VERY BUSY MAN. HE WORKED ALL SORTS OF HOURS, HAD EIGHT MEETINGS ON HIS CALENDAR EVERY DAY, STAYED LATE, A HUNDRED E-MAILS A DAY, HE WAS VERY BUSY. ONE NIGHT HE GOES TO SLEEP. AND HE WAKES UP HAVING WOKEN HIMSELF FROM A DREAM. THE DREAM, THERE WAS A BANNER ACROSS THE SKY THAT SAID GRABWELL GROMMET, SOMEONE IS TRYING TO KILL YOU. HE WOKE HIS WIFE UP. SHE SAID, IT'S OKAY, IT WAS JUST A DREAM, DEAR, GO BACK TO SLEEP. HE WAS WORRIED, AND HE KEPT HIS BUSY DAY, BUT HE WAS WORRIED ABOUT THIS. HE THOUGHT ABOUT IT. HE THOUGHT ABOUT IT OVER HIS THREE MARTINIS AT DINNER. HE THOUGHT ABOUT IT WHEN HIS WIFE GAVE HIM BEEF STROGANOFF. LET ME GIVE YOU ANOTHER HELPING, SHE SAYS. OH, YES, OF COURSE, I WOULD LOVE THAT, DEAR. IT WILL TAKE MY MIND OFF MY PROBLEMS. ABOUT IT WHEN HEEN HE RETIRED RETIRED IN FRONT OF TV TO SMOKOKE A CIGARETTE. THIS HAPPENED FOR YEARS. IT WAS IN THE BACK OF HIS MIND BUT HE WAS WORRIED SOMEBODY WAS OUT TO KILL HIM. YEARS WENT BY. FINALLY ONE NIGHT, AS IT DOES TO ALL MEN AND WOMEN, DEATH DID COME TO GRABWELL GROMMET. HE WAS AT HIS OFFICE AND COLLAPSED ON HIS DESK. HIS WIFE PORTIA WAS DISTRAUGHT AND DEMANDED A FULL AUTOPSY, REMEMBERING THREAT * THE THREAT SOMETHING WAS GOING TO KILL HIM. WHAT DO YOU THINK THE AUTOPSY SHOWED? WHAT? HEART ATTACK. WHY? BECAUSE OF HIS LIFESTYLE. BINGO. PLUS THAT'S THE TOPIC OF THIS TALK. SO HAD HE A MASSIVE HEART ATTACK. HE ALSO HAD A STROKE, WHICH WAS SMALL SO IT DIDN'T SHOW UP ON HIS -- HE DIDN'T HAVE THE SYMPTOMS. HE HAD CIRRHOSIS OF THE LIVER AND LUNG CANCER WHICH HAD BEEN GROWING SLOWLY OVER THE YEARS, AND HADN'T SHOWN SYMPTOMS YET. HIS WIFE WAS RELIEVED. SHE SAID THANK GOODNESS HE DIED OF NATURAL CAUSES. [ LAUGHTER ] SO YOU ALL GOT IT RIGHT AWAY. WE'RE GOING TO TALK ABOUT THE NATURAL CAUSES, WHAT WE CAN DO ABOUT THEM. BUT FIRST EVERYBODY STAND UP. WE'RE NOT GOING TO DO OUR EXERCISE JUST NOW. WE'RE GOING TO DO A LITTLE EXERCISE, NO NOT OUR EXERCISE JUST NOW, BUT YOU'RE GOING TO SIT DOWN, BUT NOT ALL AT ONCE. SIT DOWN IF YOU SMOKE. SIT DOWN IF YOU CAN'T REMEMBER WHEN YOU GOT YOUR BLOOD CHOLESTEROL CHECKED. THE GROUP HERE IS GOING TO DO GREAT PROBABLY BUT WE'LL SEE. HOW ABOUT IF YOU DON'T KNOW WHAT YOUR BLOOD PRESSURE IS. SIT DOWN IF YOU DON'T EAT FIVE SERVINGS OF FRUITS AND VEGETABLES A DAY. SIT DOWN IF YOU DON'T GET REGULAR WALKING OR OTHER EXERCISE SEVERAL DAYS A WEEK. SIT DOWN IF YOU GAINED MORE THAN TEN POUNDS SINCE YOU WERE IN YOUR 20s. IS THERE ANYBODY STANDING? MICHAEL DONOVAN IS STANDING. DOSE ALL THESE THINGS IS HARD. [APPLAUSE] YES, THAT'S THE APPLAUSE. WAY TO GO! HE WAS MY -- HE DID A ROTATION WITH ME AND LEARNED A LOT FROM ME. >> I DID. >> I LEARNED A LOT FROM HIM ACTUALLY. ANYWAY, WE'RE GOING TO TALK ABOUT FIVE TOPICS WHICH I JUST GAVE YOU A PREVIEW OF. BLOOD PRESSURE, CHOLESTEROL, OVERWEIGHT AND OBESITY, DIET AND NUTRITION, AND PHYSICAL ACTIVITY. BECAUSE THIS IS N.I.H. I'M GOING TO SHOW YOU SOME STUDIES AND THEIR RESULTS ON THESE TOPICS. THEY ARE ALL RELATED TO EACH OTHER. OFTEN WE THINK OF DIET AND PHYSICAL ACTIVITY AS ONLY RELATED TO OBESITY, WELL THEY ARE, BUT ASIDE FROM OBESITY THEY ARE RELATED TO BLOOD PRESSURE AND CHOLESTEROL, AND OBESITY IS RELATED TO BLOOD PRESSURE AND CHOLESTEROL. SO TAKEN TOGETHER, THESE CAUSE CARDIOVASCULAR DISEASE OR INCREASE THE RISK, WHICH COULD BE A HEART ATTACK. THIS IS MORE ANATOMICALLY CORRECT, OR A STROKE. THAT'S THE WRONG KIND OF STROKE. HOW ABOUT THAT. NO, THAT'S THE WRONG KIND OF STROKE. THERE WE GO. THERE'S THE RIGHT KIND OF STROKE. LET'S TALK ABOUT BLOOD PRESSURE FIRST. SO YOU KNOW THE SYSTOLIC BLOOD PRESSURE IS THE TOP NUMBER, IT'S WHEN THE PRESSURE IN YOUR ARTERIES, WHEN YOUR HEART CONTRACTS. THE DIASTOLIC IS THE BOTTOM NUMBER, THE PRESSURE IN YOUR ARTERIES WHEN THE HEART RELAXES. AND HERE ARE SOME CATEGORIES OF BLOOD PRESSURE. NORMAL, PRE-HYPEHYPERTENSION, STAGE ONE HYPERTENSION, I'LL PAUSE HERE BECAUSE THESE ARE THE NUMBERS I WANT YOU TO REMEMBER IF YOU DON'T KNOW THEM ALREADY. 140/90, IF YOU'RE ABOVE THAT HAVE YOU HYPERTENSION. AND THEN STAGE 2 IS HIGHER THAN THAT. WHY IS IT IMPORTANT? WELL, IT INCREASES THE RISK FOR HEART DISEASE. THIS WAS FROM THE FRAMINGHAM HEART STUDY FUNDED BY N IHLBI, AND YOU SEE THE INCIDENTS OF CORONARY HEART DISEASE PER 1,000 PEOPLE, ACROSS THE BOTTOM THE DIFFERENT BLOOD PRESSURE LEVELS. AND THE HIGHER THE BLOOD PRESSURE LEVEL, THE HIGHER THE INCIDENCE OF CORONARY HEART DISEASE, SPECIALFULLY OLDER PEOPLE. SPECIAL -- SPECIALFULLY ORDINARY PEOPLE. THIS IS DATA IN MEN, THERE'S A SIMILAR PATTERN IN WOMEN BUT IT'S A LITTLE LOWER. 40 OR 50 STUDIES SHOW THE SAME THING. I'M SHOWING YOU ONE. WE COULD SHOW 40 OR 50 BUT WE WOULDN'T GET TO THE OTHER TOPICS. SO WHAT CAN YOU DO ABOUT IT? WELL, YOU CAN TAKE MEDICATION, ANTIHYPER TENSIVES. HERE IS AN EXAMPLE FROM THE ELDERLY PROGRAM, RESULTS ON STROKE. YOU SEE ON THE LEFT THE STROKE. AND ACROSS THE BOTTOM HOW MANY MONTHS THEY WERE TREATED. A RANDOMIZED CONTROL TRIAL FUNDED BY BY NHLBI. THE PLACEBO GROUP, ANYTIME ANYBODY HAS A STROKE IT PICKS THAT UP AND ADDS IT UP. THAT'S THE PLACEBO GROUP, THAT'S HOW MANY PEOPLE WERE IN IT, NOT HOW MANY STREAKS. AND THISTROKES. AND THIS IS THE TREATMENT GROUP. IT'S SIGNIFICANTLY LOWER. MEDICATION. WEIGHT LOSS LOWERS BLOOD PRESSURE. AND 25 RANDOMIZED CONTROL TRIALS COMBINED STATISTICALLY, ON THE LEFT WE SEE THE CHANGE IN SYSTOLIC BLOOD PRESSURE. BASELINE IT WAS ZERO. AND THE AVERAGE BODY MASS INDEX WAS 31, IN THE OBESE RANGE. ON AVERAGE THEY LOST ABOUT 11 POUNDS, AND THE QUESTION IS HOW MUCH EFFECT DOES THAT HAVE ON BLOOD PRESSURE. I'LL SHOWS THE SAME FORMAT, BOX OR CIRCLE IN THE MIDDLE IS THE ESTIMATE, ON AVERAGE. BAR IS 95% CONFIDENCE INTERVAL. THIS IS ABOUT 5 MILLIMETERS OF MERCURY. THE PEOPLE WERE HYPER TENSIVE OR NOT, IT STILL LOWERED BLOOD PRESSURE. WEIGHT LOSS, THE MORE WEIGHT THEY LOST, THE LOWER THE BLOOD PRESSURE, GREATER THAN 5 KILOGRAMS. BY DIET OR PHYSICAL ACTIVITY, IT WAS PRETTY MUCH THE SAME, OR BOTH. WEIGHT LOSS LOWERS BLOOD PRESSURE. PHYSICAL ACTIVITY LOWERS BLOOD PRESSURE. HERE WE HAVE 72 RANDOMIZED CONTROL TRIALS, THE SAME KIND OF FORMAT. ON AVERAGE, FOUR MILLIMETERS OF MERCURY, LOWER BLOOD PRESSURE, IF THEY WERE -- DID NOT HAVE HYPERTENSION IT WAS THE SAME. IF THEY HAD PRE-HYPERTENSION, IT WAS ABOUT THE SAME BUT IF THEY HAD HYPERTENSION IT LOWERED BLOOD PRESSURE EVEN MORE. PEOPLE USED TO THINK IF HAVE YOU HYPERTENSION YOU SHOULDN'T EXERCISE. WELL, YOU SHOULD, BECAUSE IT'S GOING TO IMPROVE YOUR HYPERTENSION. I HAVE A COUPLE MORE SLIDES ON WHAT LOWERS BLOOD PRESSURE. DIETARY PATTERNS. THESE ARE ALL FUNDED BY N.I.H.LBI. THIS IS THE DAMAGE TRIAL. THESE PEOPLE WERE GIVEN ALL THEIR FOOD. AND IT WAS TO TEST THE PATTERN OF THE FOOD, NOT SODIUM OR WEIGHT, SO THOSE HELD CONSTANT. THEY HAVE GIVEN A DIET, THREE DIFFERENT DIETS. ONE A CONTROL DIET, THAT'S WHAT HAPPENED TO THE BLOOD PRESSURE OVER A PERIOD OF EIGHT WEEKS. THIS WAS A DIET HIGH IN FRUITS AND VEGETABLES, SIMILAR TO THE CONTROL. AND THIS, LOOK AT THAT. AFTER TWO WEEKS BLOOD PRESSURE WAS LOWERED AS MUCH AS YOU GET FROM MEDICATION. THIS IS THE DASH DIETARY PATTERN. IT'S A LOT OF FRUITS AND VEGETABLES, LOWER IN FAT, A LOT OF WHOLE GRAINS, IT HAS LESS MEAT, MORE FISH AND CHICKEN, AND LESS SWEETS AND NUTS AND THINGS LIKE THAT IN IT. THERE'S A HANDOUT ON IT. DIETARY SODIUM, LOWERING SODIUM AND SALT LOWERS BLOOD PRESSURE. THE SAME FOLKS DID THE DASH SODIUM STUDY, AND THEY TESTED PEOPLE EATING THE CONTROL DIET AT THREE LEVELS OF SODIUM. AM I GOING TOO FAST? NOPE? THREE LEVELS OF SODIUM, HIGHER, WAS ABOUT WHAT THE AVERAGE INTAKE IN THE UNITED STATES IS, YOU CAN ALL SEE THE ARROW? INTERMEDIATE IS WHAT WAS RECOMMENDED AS THE HIGHEST THAT PEOPLE DON'T REALLY ACTUALLY EAT, MOST PEOPLE. AND THEN LOWER WAS HALF THAT, IT WAS ABOUT 1500 MILLIGRAMS. THIS WAS ABOUT 3400 MILLIGRAMS, 2300, AND 1500. SO THE LOW -- EATING THIS DIET, THE LOWER THE SODIUM INTAKE, WHILE EATING THE SAME TIMES OF FOOD, THE LOWER THE BLOOD PRESSURE. EATING THE DASH DIET, WHICH IS THE DIET THAT WORKS SO WELL BEFORE, THE LOWER THE SODIUM, THE LOWER THE BLOOD PRESSURE BUT INTERESTINGLY AT EACH LEVEL OF SODIUM THE DASH DIET GAVE ADDITIONAL BENEFIT. IT'S NOT JUST SODIUM. IT'S THE FOODS YOU EAT ALSO. SO HERE IS WHAT WE WENT OVER. MEDICATION, WEIGHT LOSS, PHYSICAL ACTIVITY, HEALTHY DIETARYPATTERN, LOWER DIE SODIUM. WE'LL MOVE TO PHYSICAL ACTIVITY. HOW DOES PHYSICAL ACTIVITY IMPROVE CARDIOVASCULAR HEALTH? I TOLD YOU ONE WAY. WEIGHT LOSS, YES, BUT THAT'S NOT WHAT WE JUST COVERED. BLOOD PRESSURE. YOU WEREN'T PAYING ATTENTION. YES, SO I'LL PUT BLOOD PRESSURE FIRST. AND IT HELPS CONTROL OR REDUCE BODY WEIGHT. I SHOWED YOU THE PICTURE AT THE FRONT WITH THE CIRCLES THOUGH? PHYSICAL ACTIVITY DOESN'T ONLY WORK THROUGH BLOOD PRESSURE. THAT'S A PET PEEVE OF MINE. PEOPLE THINK YOU ONLY NEED TO BE PHYSICALLY ACTIVE BECAUSE OF BODY WEIGHT. IT DOESN'T ONLY WORK THROUGH BODY WEIGHT. IT AFFECTS BLOOD PRESSURE ALSO AND CHOLESTEROL. WHICH IS RIGHT THERE. IT ALSO ENHANCES CARDIO RESPIRATORY FITNESS, AND IT IMPROVES YOUR BLOOD FLOW INCLUDING THE BLOOD FLOW TO THE HEART MUSCLE, LUNGS AND PERIPHERY. SO WE TALK ABOUT MODERATE INTENSITY AND VIGOROUS INTENSITY. MODERATE INTENSITY IS LIKE BRISK WALKING, KIND OF LIKE WALKING LIKE YOU'RE IN A HURRY, AND NEXT ARE THE MULTIPLES OF YOUR RESTING EXPENDITURE. YOU'RE AT ONE MET RIGHT NOW. IF YOU WALK BRISKLY YOU'RE AT THREE TO FIVE METS, THREE TO FIVE TIMES ENERGY THAT YOU -- WHEN YOU'RE WALKING THAN WHEN YOU'RE SITTING. WE ALSO DISTINGUISH BETWEEN PHYSICAL ACTIVITY, ANY BODILY MOVEMENT, AND EXERCISE, WHICH IS SPECIFICALLY DONE TO IMPROVE FITNESS. SO YOU ALL DO KNOW THAT NO PAIN, NO GAIN, RIGHT? NOPE? NOT TRUE ANYMORE. WE USED TO THINK SO. I WANT TO SAY THAT AGAIN. DOES EVERYBODY SEE THAT? THAT'S THE ANIMATION. I'LL SHOW YOU WHY WE DON'T THINK THAT'S TRUE ANYMORE. HERE IS A STUDY THAT TESTED -- THAT COMPARED MODERATE INTENSITY WITH HIGH INTENSITY OR VIGOROUS EXERCISE ON THE OUTCOME OF FITNESS AND BLOOD PRESSURE. FOLKS WALKED ON A TREADMILL THREE TIMES A WEEK, 30 TO 45 MINUTES FOR SIX MONTHS. OVER HERE, WE SEE THE INCREASE IN FITNESS. YOU SEE THE VIGOROUS INCREASED FITNESS MORE THAN MODERATE. BUT THEY BOTH DECREASED BLOOD PRESSURE JUST AS MUCH. THIS IS REVERSE, SO THEY CAN PUT IT ON THE SAME GRAPH. SO HERE IS ANOTHER EXAMPLE. I'M SORRY, THAT'S NOT THE RIGHT ONE. OH, WELL, THIS ONE IS IN THE WRONG PLACE BUT I'LL SHOW IT ANYWAY. MORE EXERCISE IMPROVES WEIGHT LOSS COMPARED TO LESS EXERCISE. SO THESE ARE PEOPLE, THIS IS A SMALL STUDY BUT IT WAS INTERESTING ANALYSIS, THESE ARE PEOPLE WHO THIS WAS THE BASELINE WEIGHT, WHICH WAS SET AT ZERO. AFTER SIX MONTHS THEY LOST LIKE 8 KILOGRAMS. UP TO 18 MONTHS THEY STARTED GAINING IT BACK WHICH PEOPLE DO OFTEN. THESE ARE THE PEOPLE WHO WERE PHYSICALLY ACTIVE, 150 MINUTES PER WEEK. THAT'S LIKE 30 MINUTES, FIVE DAYS A WEEK. THESE ARE THE PEOPLE WHO WERE ACTIVE 150 TO 200 MINUTES A WEEK, AND THESE ARE THE FOLKS WHO WERE ACTIVE 200 OR MORE MINUTES A WEEK. THERE HAVE BEEN LOTS OF STUDIES THAT SHOW FOR IMPROVING WEIGHT LOSS, YOU HAVE TO PUT IN MORE MINUTES OF PHYSICAL ACTIVITY IN A WEEK THAN FOR OTHER HEALTH BENEFITS. NOW, THIS IS A BIG STUDY THAT WAS DONE OF 22,000 WOMEN, AND NONE OF THEM DID ANY VIGOROUS ACTIVITY. THE ONLY ACTIVITY THEY DID WAS MODERATE OR NONE. OVER HERE ON THE LEFT, YOU SEE THIS IS ABOUT MORTALITY. AND ACROSS THE BOTTOM IS THESE ARE FOLKS WHO RARELY OR NEVER WALKED, OR DID -- MOSTLY IT WAS WALKING. ONE TO LESS THAN TWO TIMES A WEEK. TWO TO FOUR TIMES A WEEK, FOUR TIMES A WEEK, THE RECOMMENDATIONS ARE UP HERE. BUT LOOK WHAT HAPPENS, AT ONE IS NO OH EFFECT EFFECT, NO DIFFERENCE. HERE WE GO. EVEN THE PEOPLE WHO WALKED ONLY ONE TO TWO TIMES A WEEK HAD A REDUCED MORTALITY RATE. THAT'S NOT THAT MUCH TO IMPROVE YOUR HEALTH. AND THEN IT GOT BETTER WITH THE PEOPLE OVER HERE WHO WALKED MORE THAN FOUR TIMES A WEEK. SO STUDIES LIKE THESE ARE THE ONES THE REASON WHY PHYSICAL ACTIVITY GUIDELINES FOR AMERICANS SAY MODERATE ACTIVITY IMPROVES YOUR HEALTH. WHAT ARE THOSE RECOMMENDATIONS? HERE THEY ARE. THEY RECOMMEND 150 MINUTES, TWO HOURS AND 30 MINUTES OF MODERATE INTENSITY A WEEK, OR HALF THAT OF VIGOROUS. OR ANY COMBINATION THAT'S EQUIVALENT. AND THEY ALSO RECOMMEND MUSCLE STRENGTHENING TWO DAYS A WEEK, EXERCISING ALL THE MAJOR MUSCLE GROUPS, PRIMARILY TO PREVENT WEAKNESS AS YOU GET OLDER AND IMPROVE YOUR ACTIVITIES OF DAILY LIVING. THE TWO AND A HALF HOURS, 150 MINUTE AS WEEK, WAS A COMBINATION OF STUDIES OF A VARIETY OF OUTCOMES, BLOOD PRESSURE, CHOLESTEROL, DEPRESSION, ARTHRITIS, CANCER, SOME CANCERS LIKE COLON CANCER, BUT THEY ALSO SAID IF YOU'RE INACTIVE, YOU HAVE TO BUILD UP GRADUALLY TO THE RECOMMENDED AMOUNTS, BECAUSE YOU DON'T WANT TO INJURE YOURSELF AND YOUR BODY NEEDS TIME TO GET ADJUSTED. IF YOU ALREADY ARE ACTIVE DOING MORE THAN THIS RECOMMENDATION IS EVEN BETTER FOR YOU. ALL RIGHT. HERE ARE SOME EXAMPLES. THE REASON WHY WE DISTINGUISH BETWEEN PHYSICAL ACTIVITY AND EXERCISE, WALKING BRISKLY, GARDENING, MOWING THE LAWN, WHICH IS WALKING BEHIND A LAWN MOWER, BIKING, NNIS, BALLROOM, I PUT SWING DANCING IN THIS CATEGORY, VIGOROUS IS JOGGING, BIKING UPHILL, JUMPING ROPE, HEAVY GARDENING. I GARDENED FOR A WHILE, I LUGGED 4 40-POUND BAGS. ANYBODY DO THAT? THE 40 OPINIO„h MULCH, AND GOING TO AEROBICS CLASSES. THE POSSIBILITIESES OF CREATING AN ACTIVE WEEK ARE ENDLESS. HERE ARE SOME EXAMPLES. HILARY BIKES 30 MINUTES TO WORK ON A FLAT SURFACE THREE DAYS A WEEK. SHE GOES SALSA DANCING FOR AN HOUR ON SATURDAY. AND SHE USES FREE WEIGHTS AT HOME TWO EVENINGS, WATCHING TV, DANCING WITH THE STARS, AMERICAN IDOL OR GLEE, HER FAVORITE SHOWS. BARACK WALKS BRISKLY FOR 30 MINUTES TWO DAYS A WEEK, PLAYS BASKETBALL AN HOUR ON SATURDAY, THIS IS NOT THE BARACK YOU'RE THINKING OF BECAUSE HE MOWS HIS OWN LAWN 30 MINUTES ON SUNDAY, AND THEN GOES INSIDE WHILE HE'S STILL HOT AND SWEATY, PICKS UP THE FREE WEIGHTS AND WATCHES SPORTS ON TV. DENISE GOES TO A 60-MINUTE STEP AEROBIC CLASS TUESDAY AND SATURDAY AND FREE WEIGHTS CLASS ON SUNDAYS. THAT WAS ME BEFORE I GOT SCIATICA AND HAD TO STOP. WE'RE GOING TO DO SOME EXERCISE. I'M GOING TO GET MY MUSIC STARTED HERE. AND WE'RE ALL GOING TO STAND UP. WHY DON'T YOU STAND UP. OH, I GOT TO TAKE THIS OFF. LET'S GO HERE. IT'S NOT GOING. WHY ISN'T IT GOING? [ MUSIC ] >> THAT'S NOT THE RIGHT ONE. THERE WE GO! ALL RIGHT. ARE YOU READY? RIGHT WHERE YOU ARE. MARCH. * ALL RIGHT. ONE ARM UP. OTHER ARM UP. ONE. UP. THERE'S A LOT YOU CAN DO JUST RIGHT IN YOUR PLACE. YOU DON'T HAVE TO RUN AROUND. ALTHOUGH MICHAEL RUNS AROUND. WE'RE JUST DOING MODERATE INTENSITY. OH, I STILL HAVE THIS. IS THIS STILL WORKING? >> YEAH. >> ALL RIGHT. HOLD YOUR HANDS. WE'RE GOING TO DO STEP TOUCH. STEP, TOUCH. STEP, TOUCH. STEP, TOUCH. ARMS. * I DON'T KNOW THE WORDS. ALL RIGHT. WE'RE GOING TO CHANGE THIS IN A MINUTE. MAKE YOUR FOOT GO ACROSS LIKE THIS. DON'T KICK YOUR NEIGHBOR. PUT YOUR ARMS UP. UP. UP. UP. THAT'S KIND OF HARD TO DO. FORGET IT. FORGET THAT. LET'S GO TO THE SIDE. LET'S GO TO THE SIDE. THAT WAS TOO HARD. BACK TO MARCHING. LEFT, RIGHT, LEFT. ALL RIGHT. UP. AND OUT. NOW THAT WAS BETTER! I DIDN'T THINK AHEAD OF TIME WHAT TO DO. I JUST MAKE IT UP AS I GO ALONG. LET'S DO STEP TOUCH AGAIN. NOT YET. NOW! * I WONDER HOW MUCH ROOM WE HAVE BACK THERE. DO WE HAVE ROOM TO GO IN A GRAPEVINE? YEAH? THIS WAY. THIS WAY. BACK, BEHIND, STEP, STEP, BACK, TAP. STEP, BACK. YES! WE'RE DOING THE WHOLE SONG, GUYS. * FIVE MINUTES. IT'S ONLY FIVE MINUTES. NOW, IF YOU WANT TO MAKE THIS MORE VIGOROUS, JUST PUT MORE OF A HOP TO IT. MOVE YOUR BODY, MOVE YOUR BODY, MOVE YOUR BODY. KEEP GOING. WE'VE ONLY DONE THREE MINUTES, BELIEVE IT OR NOT. * BACK TO MARCHS. MARCH. BRING THE KNEES UP HIGHER. UP AND OUT. ARE WE HAVING FUN YET? >> YES! * I'M HAVING FUN. WE'RE GOING TO SLOW IT DOWN A LITTLE BIT. CALM IT DOWN. I HAVE TO SEE HOW MUCH MORE TIME WE HAVE LEFT. YES, 22 SECONDS. COOLDOWN. COOLDOWN. WE DIDN'T GO VERY VIGOROUS, WE'RE STILL COOLING DOWN. THAT'S THE NEXT SONG. ALL RIGHT. PLANT YOUR FEET AND PUT YOUR HEADS IN A CIRCLE HERE. OTHER WAY. GOING INTO THE NEXT SONG. OKAY, GREAT! [APPLAUSE] GREAT, SIT DOWN. HAVE A SEAT. ALL RIGHT, TERRIFIC. WHEW! ANYBODY GET WINDED? NO? SO THAT WAS OUR MODERATE EXERCISE-EXERCISE. LET'S TALK ABOUT OVERWEIGHT AND OBESITY NOW. YES, CHRIS? >> A QUESTION I ASKED BEFORE. REGARDING THE AMOUNT OF TIME. >> OH, YES. CAN I ANSWER IT WITHOUT YOU ASKING IT? >> ABSOLUTELY. >> I KNOW WHAT HE'S GOING TO ASK. THE GUIDELINES SAY 150 MINUTES IS A WEEK. THE QUESTION IS HOW YOU CAN BREAK THAT UP. AND THEY RECOMMEND THE MINIMUM AMOUNT OF TIME IS 10 MINUTES. SO WHAT WE JUST DID WOULD NEED TO BE DOUBLED IN TIME. WE DID IT FOR FIVE MINUTES. THAT'S NOT THAT WHAT WE JUST DID IS NOT REALLY GOOD FOR YOU, BECAUSE GETTING UP AND MOVING IS GOOD FOR YOU, BUT IT'S THEREE THE DATA ARE NOT TO SAY FIVE MINUTES AT A TIME IS GOOD. PEOPLE ARE WORKING ON THAT QUESTION, BUT THERE HAVE BEEN STUDIES THAT HAVE TESTED EXERCISE, TEN MINUTES, THREE TIMES A DAY, MORNING, NOON AND EVENING, COMPARED TO ONE 30-MINUTE BOUT, YOU GET THE SAME BENEFIT. SO WHENEVER YOU CAN FIT IT IN, YOU CAN -- THAT'S WHY WE HAVE THE TAKE TEN ROOMS. >> DOES IT BURN ENOUGH FAT IN TEN MINUTES, IF YOU WANTED TO BURN FAT? >> DID I SHOW YOU -- >> WE'RE NOT TALKING ABOUT THAT. >> REMEMBER THE ONE I SHOWED BUT THE WEIGHT LOSS AND THREE LEVELS OF EXERCISE? 200 MINUTES A WEEK, MOST OTHER STUDIES HAVE ALSO CONFIRMED THAT, IF YOU FOCUS ON BODY WEIGHT, YOU SHOULD ACTUALLY DO MORE MINUTES THAN IF YOU'RE FOCUSED ON JUST IMPROVING YOUR HEALTH. >> AGAIN, IT DOESN'T MATTER IF IT'S TEN MINUTES, 20 MINUTES, RIGHT? >> 2010-MINUT 20 TEN-MINUTE BOUTS, FIGURE OUT HOW TO PUT THAT IN A WEEK. LET'S SEE THREE A DAY, FOR SEVEN DAYS, THERE YOU GO. YOU DON'T NEED TO CHANGE INTO GYM CLOTHES BUT IF YOU WANT TO DO MORE VIGOROUS, IT'S EVEN BETTER. IT'S WHATEVER WORKS FOR YOU. LIKE I SHOWED YOU, HILARY, BARACK AND DENISE, WHAT WORKED FOR THEM WAS DIFFERENT. THE IDEA IS TO TRY TO VAN HAVE AN ACTIVE LIFE. IF I I DON' DIDN'T DO ANYTHING YESTERDAY, I NEED TO DO SOMETHING TODAY. ARE WE READY TO MOVE ON? OBESITY IS A BIG PROBLEM IN THE UNITED STATES. PUN INTENDED. SO IT'S NOT JUST FOR COSMETICS. IT'S NOT FOR COSMETICS, IT'S HEALTH EFFECTS. THERE ARE SOME HEALTH EFFECTS OF OBESITY. I PUT THE ONES WE'RE PARTICULARLY INTERESTED IN, IN RED. I'M NOT GOING TO READ THEM BUT BASICALLY IT AFFECTS YOUR ENTIRE BODY. THE FRAMINGHAM HEART STUDY WHICH WE FUNDED ACTUALLY SAID OBESITY IS INDEPENDENT RISK FACTOR FOR HEART DISEASE BASED ON DATA LIKE THIS. AT THE TIME IN 1983, THEY USED PER CENT, METROPOLITAN DESIRABLE WEIGHT TO CATEGORIZE PEOPLE. AND SO IN MEN, HERE YOU SEE UNDER 50-YEAR-OLDS, I SIMPLIFIED THIS TO HAVE THREE BARS HERE. AS THE HIGHER YOU GO IN THE BODY WEIGHT, THIS WOULD BE LIKE 30% OVER IDEAL WEIGHT. THE HIGHER THE CORONARY HEART DISEASE. IN WOMEN, IT'S TRUE TOO BUT NOT AS BIG A SLOPE. WE DON'T USE METROPOLITAN DESIRABLE WEIGHT ANYMORE. WE USE BMI, WEIGHT AND KILOGRAMS OVER HEIGHT SQUARED, AND OVERWEIGHT IS A BMI OF 25 TO UNDER 30, OH BEAST IS BMI 30 OR GREATER. CALCULATE IT. I'M ABOUT 5'6" HERE. IN ORDER TO BE CONSIDERED OBESE, I WOULD NEED TO WEIGH 185 POUNDS. LUCKILY I DON'T. BUT YOU CAN CALCULATE USING A CHART. THERE'S BMI CALCULATORS. WEBSITE, THEHLBI REMEMBER PIECE THAT GETS MORE HITS THAN ANYTHING ELSE. DOWNLOAD OUR APP ON YOUR IPHONE, AN NHLBI WEBSITE. 6'1", 170, BMI OF 22.4, NORMAL RANGE. YOU SEE OUR LOGO ON THERE. THIS IS OUR APP. DONE BY MY DIVISION. SOME OF YOU HAVE SEEN THESE PROBABLY BEFORE. THESE ARE FROM C.D.C. THIS IS FROM THE BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM. THEY DO SURVEYS NATIONWIDE REGULARLY. AND THIS SHOWS IF YOU LOOK AT THE LEGEND DOWN AT THE BOTTOM HERE, THIS IS THE PERCENT OF THE PEOPLE IN EACH OF THE STATES THAT ARE OBESE. THIS WAS IN 1993. THIS WAS IN 1996. THIS WAS IN 1999. THEY ADDED ANOTHER CATEGORY HERE, 20 TO 24% OF THE PEOPLE IN THOSE STATES. THIS WAS IN 2002, ANOTHER CATEGORY,/v A QUARTER OF THE PEOPLE WERE OBESE. 2005, NOW WE HAVE STATES WITH MORE THAN 30%. 2007, IT KEEPS GETTING WORSE. SO WHAT DO WE DO ABOUT IT? LET'S TALK ABOUT WEIGHT LOSS. HOW MUCH DO YOU NEED TO LOSE TO IMPROVE YOUR HEALTH? TEN PERCENT? BEAUTIFUL. FIVE TO TEN PERCENT ACTUALLY. SOME STUDIES ONLY FIVE PERCENT. HERE'S THREE EXAMPLES OF ONES WE FUNDED. IN THE PREMIER STUDY AND THE HYPERTENSION PREVENTION 2, LOSING THIS AMOUNT OF BODY WEIGHT RESULTS IN A 20 TO 53% REDUCTION IN HYPERTENSION. IN THE PREMIER STUDY THEY LOOKED AT LDL CHOLESTEROL, BAD CHOLESTEROL, AND IT HAD ALMOST A 50% REDUCTION. IN PEOPLE WHO HAD HIGH LDL CHOLESTEROL, THE DIABETES PREVENTION PROGRAM FUNDED BY THE NIDDK, THERE WAS A 58% REDUCTION IN NEW DIABETES IN PEOPLE WHO WERE AT RISK FOR GETTING DIABETES. THOSE ARE REALLY GREAT IMPROVEMENTS, AND THEY IMPROVE HEART HEALTH. THEY ALSO CAN REDUCE THE NEED FOR MEDICATIONS. SO NOT A LOT OF WEIGHT LOSS IS NEEDED. WHAT WOULD BE PEOPLE'S WEIGHT MANAGEMENT GOALS? WHAT DO YOU THINK IS THE FIRST THING THAT YOU WOULD THINK OF FOR WEIGHT MANAGEMENT? WALKING. WHO SAID THAT? YES, WALKING IS IMPORTANT TO DO FOR CALORIE EXPENDITURE. I'M TALKING ABOUT HOW MUCH WEIGHT? WE JUST TALKED ABOUT 5 TO 10% WEIGHT LOSS. I WANT TO MENTION ANOTHER CONCEPT. PREVENT FURTHER WEIGHT GAIN. THE AVERAGE AMERICAN GAINS A POUND A YEAR. AND THEY DO NOT LOSE IT. THEY GAIN IT, BETWEEN THANKSGIVING, CHRISTMAS AND NEW YEARS. AND IF YOU GAIN A POUND A YEAR FOR 20 YEARS, GUESS HOW MUCH WEIGHT YOU'VE GAINED? IF YOU GAINED FOR 40 YEARS, YOU'VE GAINED 40 POUNDS. AND THEN IT'S HARD TO LOSE. AND SOME PEOPLE GAIN TWO POUNDS A YEAR, AND THAT'S FOR 40 POUNDS, THAT'S 80 POUNDS. IF THE POPULATION WOULD JUST HOLD THEIR WEIGHT CONSTANT WE WOULDN'T SEE THOSE TRENDS WE SEE IN THE STATE MAX THAT WE SEE. HOLDING YOUR WEIGHT CONSTANT IS VERY IMPORTANT. IF YOU WANT TO LOSE WEIGHT, IF YOU'RE OVERWEIGHT OR OBESE, YOU SHOULD HAVE REALISTIC GOALS. DON'T EXPECT TO GET TO A SIZE 2, AND HEALTH-RELATED GOAL IS 5% TO 10%. INCREMENTAL PROGRESS WORKS BETTER BECAUSE PEOPLE WHO LOSE A LOT OF WEIGHT AND GAIN IT BACK UP AGAIN, YOU SAW THE CHECK MARKS IN THE GRAPH I SHOWED YOU OF THE PHYSICAL ACTIVITY AMOUNTS. YES? >> I WAS GOING TO ASK, THEY SAY MUSCLE WEIGHS MORE THAN FAT. I WONDER HOW THIS DATA IS SKEWED BY PEOPLE BEING MORE IN SHAPE AND GAINING WEIGHT BECAUSE OF MORE MUSCLE MASS. >> SHE'S ASKING FOR PEOPLE WHO DIDN'T HEAR IN THE BACK ABOUT MUSCLE MASS, AND COULD THE CAT DATASKEWED. BE SKEWED? BMI IS THE EASIEST WE HAVE. ATHLETES HAVE A LOT OF MUSCLE AND HIGH BMI BUT THEY ARE NOT OBESE BECAUSE THEY DON'T HAVE A LOT OF FAT BUT THEY HAVE A LOT OF MUSCLE. THAT'S NOT THE TYPICAL AMERICAN. SO SOME PEOPLE DO WEIGHT TRAINING AND BUILD UP THEIR MUSCLES FOR EXERCISE. AND BUT STILL, THE BMI IS A GOOD SORT OF GENERAL JUDGE OF WHERE YOU ARE. IT'S NOT A TYPICAL PERSON WHO HAS SO MUCH MUSCLE MASS THE BMI IS NOT A GOOD RELATIVE MEASURE. DID THAT ANSWER YOUR QUESTION? AND THEN ONCE YOU LOSE WEIGHT, WHAT DO YOU DO? PREVENT FURTHER WEIGHT GAIN. YOU ALL PROBABLY KNOW THE SECRET TO WEIGHT LOSS. YOU SAID IT EARLIER. I'M HERE TO TELL IT TO YOU. THE SECRET TO WEIGHT LOSS, WHAT'S THE SECRET TO WEIGHT LOSS? CALORIES! RIGHT? CALORIES OUT MUST BE GREATER THAN CALORIES IN. AND THERE'S ALL THESE THINGS ABOUT SPECIAL FOODS, AND, YOU KNOW, GRAPEFRUIT DIET AND OTHER SPECIAL DIETS, BUT WHEN IT COMES DOWN TO IT, IF YOU LOOK AT THE STUDIES, IT'S THE CALORIE INTAKE THAT SEEMS TO MAKE MORE DIFFERENCE THAN THE TYPES OF FOODS. SO HERE I'VE LISTED SOME APPROACHES TO REDUCING CALORIES IN. AND LET'S SEE IF YOU CAN THINK OF MORE. CHOOSE FOODS BASED ON LOWER CALORIES. RIGHT? THAT MAKES SENSE. SERVE SMALLER PORTIONS. THAT MAKES SENSE. USE SMALLER PLATES. THEY HAVE DONE RESEARCH THAT HAS SHOWN THAT IF YOU GIVE THE SAME AMOUNT OF FOOD ON A SMALLER PLATE PEOPLE EAT LESS. DON'T EAT SECONDS. STOP READIN EATING WHEN FULL, PAY ATTENTION TO YOUR BODY WHEN EAT. IF YOU GO TO A RESTAURANT BRING HOME HALF THE MEAL OR SHARE IT. ORDER ONE ENTREE FOR TWO PEOPLE. DON'T EAT DESSERT, OR SHARE DESSERT. DON'T DRINK YOUR CALORIES. DON'T HAVE SNACK FOODS IN THE HOUSE. ELIMINATE MINDLESS EATING LIKE IN FRONT OF THE TV. AND A LOT OF PEOPLE FIND IT HELPFUL TO HAVE A DAILY CALORIE GOAL AND COUNT THEIR CALORIES. AND THEN THIS ONE IS NOT ABOUT CALORIES IN, BUT THERE HAVE BEEN STUDIES THAT SHOW PEOPLE WHO WEIGH THEMSELVES DAILY DO A BETTER JOB THAN PEOPLE WHO DON'T WEIGH THEMSELVES MUCH. SO CAN YOU THINK OF ANY MORE? >> DRINK WATER FIRST AND THEN WAIT A FEW MINUTES? >> THAT'S GOOD, DRINKING WATER FIRST BEFORE YOU EAT SO THAT IT FILLS YOUR STOMACH UP SOME SO YOU FEEL MORE FULL ON LESS FOOD. IT MIGHT BE THIRST RATHER THAN HUNGER, YES. >> I ALWAYS FELT A LONG TIME AGO IF I WAS HUNGRY, IF I DID A LITTLE BIT OF EXERCISE SOMETIMES I WOULD -- >> SHE'S SAYING IF DO YOU A LITTLE BIT OF EXERCISE SOMETIMES THE HUNGER WILL GO AWAY. I FIND WHEN I WAS DOING VIGOROUS AEROBIC, STEP AEROBICS, I WASN'T HUNGRY AFTER WARDS. I DO AFTER WORK AND WASN'T HUNGRY. DO OTHER PEOPLE FIND THAT EXERCISE HELPS STEM HUNGER? NO? YES? MIXED. IT DEPENDS. FOR A WHILE, YEAH. ALL RIGHT. WE JUST DID MODERATE EXERCISE FOR FIVE MINUTES. THIS IS 150-CALORIE COOKIE. IF WE WANT TO BALANCE OUR WEIGHT, HOW MUCH OF THIS CAN WE EAT? BALANCE OUR CALORIES. CAN WE EAT ALL OF IT? CAN WE EAT HALF OF IT? NO? CAN WE EAT A QUARTER OF IT? MAYBE. CAN WE EAT A SIXTH OF IT? I COULD HAVE GONE DOWN FURTHER, A TENTH, ET CETERA. THIS IS ABOUT RIGHT. SO HALF AN HOUR OF MODERATE INTENSITY ACTIVITY IS ABOUT # CALORIES, WE DID FIVE MINUTES, IT'S A SIXTH OF A HALF AN HOUR. IT TAKES MORE EXERCISE THAN YOU MIGHT THINK TO BURN CALORIES YOU EAT. SO MOST OF THE SUCCESSFUL PEOPLE, MOST OF THE STUDIES SHOW PEOPLE WORK ON BOTH, INTAKE AND OUTPUT. IT WORKS BETTER THAN IF JUST TRY TO DO IT WITH EXERCISE, FOR EXAMPLE. EXERCISE USUALLY IS NOT ENOUGH. ALL RIGHT. SO YOU HAVE TO PAY ATTENTION TO FOOD. AND ONE WAY TO DO THAT IS YOU CAN READ NUTRITION LABELS. SO THIS IS AN EXAMPLE OF ONE, UP HERE AT THE TOP, IT SHOWS SERVING SIZE AND NUMBER OF SERVINGS. AND THIS SECOND SECTION SHOWS THE AMOUNT IN ONE SERVING. CALORIES, CALORIES FROM FAT. I'M GOING TO STOP. THERE WE'RE GOING TO DEAL WITH THAT PART OF THE LABEL RIGHT NOW. AND WE'RE GOING TO THINK ABOUT MAKING CHOICES. SO I WANT TO HAVE SOMETHING TO DRINK WITH MY LUNCH. I NEED TWO VOLUNTEERS. WHO WANTS TO VOLUNTEER TO COME UP AND HELP ME? I HAVE SOME PROPS HERE. YES, COME ON UP. ANOTHER VOLUNTEER? OKAY, COME ON UP. I HAVE TO PUT THIS DOWN. NO, NO, DON'T LOOK. HERE THEY ARE. I WANT TO DRINK SOMETHING FOR MY LUNCH. HERE IS WHAT MY CHOICES ARE BECAUSE I'M AT A MEETING, THIS IS ALL THEY HAVE. YOU CAN HAVE -- DO YOU CARE? YOU CAN HAVE A COKE OR ORANGE JUICE. WHAT I WANT YOU TO DO IS WORK TOGETHER AND LOOK AT THAT AND COMPARE THE LABELS AND TELL ME WHICH ONE YOU PICK. THE PEOPLE IN THE AUDIENCE CAN SEE WHAT THE LABELS ARE BECAUSE I'M SHOWING THEM UP ON THE SCREEN. YEAH, MOVE OFF TO THE SIDE SO THEY CAN SEE. MOVE OFF TO THE SIDE. I JUST SHOWED YOU SOMETHING THEY DON'T KNOW. WELL, THEY SHOULD KNOW. THEY HAVE IT IN THEIR HANDS. ALL RIGHT. WHEN YOU ARE READY -- WELL, PEOPLE IN THE AUDIENCE CAN LOOK AND SEE HOW MANY CALORIES ARE IN EACH OF THESE. YOU SEE OVER HERE. AND THEN YOU SEE OVER HERE. BUT YOU ALSO SEE THIS. OOPS. YOU JUST PEEKED. OH, OKAY. ALL RIGHT. TIME'S UP. WHAT DO YOU SEE AND WHICH WOULD YOU PICK AND WHY? >> OKAY. THIS JUICE HERE IS TWO SERVINGS. >> SHE GOT IT. >> AND THIS ONE, 15 FLUID OUNCES. >> DOES THIS WORK? >> IT IS, BUT I CAN'T -- THERE. TESTING, THERE YOU GO. THIS JUICE, ORANGE JUICE FROM CONCENTRATE, IS TWO SERVINGS FOR THE 16 FLUID OUNCES. >> HOW MANY CALORIES IS IN THE BOTTLE? >> CALORIES IS 120. >> BUT HOW MANY IN THE BOTTLE? >> 2040. >> HOW MANY IN THE COKE? >> 240, THIS IS CONSIDERED ONE SERVING. >> SO WHICH ONE WOULD YOU PICK? IF YOU WERE JUST INTERESTED IN CALORIES, THIS IS A TRICK QUESTION. THIS IS WHAT YOU SHOULD PICK. AS A REWARD FOR COMING UP HERE YOU GET TO KEEP THE WATER. >> THANK YOU! [APPLAUSE] >> THANK YOU. YES. THE SUGARS ARE ABOUT THE SAME. THE ONLY DIFFERENCE IS THE VITAMIN C. OKAY. LET'S MOVE ON. THANK YOU FOR THAT. LET'S TALK ABOUT CHOLESTEROL. HOW ARE WE DOING FOR TIME? GOOD. CHOLESTEROL. WHY IS IT IMPORTANT? WELL, IT INCREASES HEART DISEASE, IT'S A TOPIC OF THIS TALK. THIS IS THE BIG STUDY CALLED MRFIT. IT WAS CRITICIZED FOR ONLY INCLUDING MEN IF PEOPLE CALL IT "MR. FIT FANTASTIC. "MR. FIT." PEOPLE WERE SCREENED TO BE IN THE STUDY. THIS SHOWS THE RELATIONSHIP BETWEEN THE SERUM CHOLESTEROL LEVEL. IT SHOULD BE 205. IT GOT MESSED UP WHEN I ENLARGED IT. NO, SORRY. FOUR, FIVE, SIX, SEVEN. I DON'T UNDERSTAND. THE HIGHER -- THIS MUST BE THE CATEGORIES. I DIDN'T NOTICE THAT WHEN I PUT IT ON HERE. THE HIGHER THE CHOLESTEROL, THE HIGHER THE CORONARY HEART DISEASE DEATH RATE. THAT'S ALL THAT MATTERS. THERE'S LOTS OF OTHER STUDIES THAT SHOW THE SAME RELATIONSHIP. SO WHAT CAN WE DO ABOUT CHOLESTEROL? FIRST OF ALL, LET'S TALK ABOUT TYPES. THERE'S MORE THAN ONE. THERE'S TOTAL CHOLESTEROL. THERE'S LDL CHOLESTEROL. AND THERE'S TRIGLYCERIDES. PEOPLE REFER TO THESE AS THE BAD CHOLESTEROL, SPECIFICALLY LDL IS THE BAD CHOLESTEROL. BECAUSE THE HIGHER THEY ARE, THE HIGHER THE RISK OF HEART DISEASE. HDL, HIGH DENSELY HYPO PROTEIN CHOLESTEROL, THE HIGHER, THE LOWER THE RISK. THAT'S THE GOOD CHOLESTEROL. YOU WANT LDL TO BE LOWER, HDL TO BE HIGHER. 130 FOR LDL, LESS THAN 100 IS BEST. OR 60, HIGHER THAN 60 FOR HDL. SO THIS IS RESULTS OF 45 CLINICAL TRIALS COMBINED IN A MET A ANNUAL 'TIS ON ANALYSIS ON LDL CHOLESTEROL. NO EFFECT IS ONE. THE LINES WILL GO TO THE SIDE OR NOT, IF IT'S OVER ON THE RIGHT IT'S HARMFUL. ON THE LEFT IT'S PROTECTIVE. THESE ARE THE THINGS THEY LOOKED AT. NEW CORONARY HEART DISEASE, DEATH FROM CORONARY HEART DISEASE, DEATH FROM STROKES, DEATH FROM OTHER REASONS, AND ALL CAUSE MORTALITY. AND ALL OF THESE NO CORONARY HEART DISEASE AND NEW STROKE WERE SIGNIFICANTLY IMPROVED FROM THE TREATMENT WITH MEDICATION AND SO IT WAS REGULAR MORTALITY. THE OTHER TWO DIDN'T HAVE AN IMPROVEMENT, NOR WAS IT HARMFUL. I'M SORRY. SO TREATING WITH STATINS REDUCES LDL, REDUCES HEART DISEASE AND STROKE. HERE IS A ANOTHER META ANALYSIS, WEIGHT LOSS, WEIGHT LOSS ALSO IMPROVES CHOLESTEROL. THIS IS THE LDL LEVELS ON THE LEFT. AND 68 STUDIES OF WEIGHT LOSS INTERVENTIONS FOUND A SUBSTANTIAL REDUCTION IN TOTAL CHOLESTEROL. AND IN LDL CHOLESTEROL. NO EFFECT ON HDL BUT THERE WAS A REDUCTION IN TRIGLYCERIDES. THE ONCE WE WANTED TO BE REDUCED BECAUSE THEY WERE THE BAD CHOLESTEROLS WERE REDUCED FROM WEIGHT LOSS. AND OTHER -- AND DIETARY CHANGES. THERE ARE CHOLESTEROL RAISING FATS. I WAS SURPRISED TO LEARN IN MEDICAL SCHOOL SATURATED FAT THAT YOU EAT BASICALLY TURNS INTO CHOLESTEROL IN YOUR BODY. IT'S NOT THE CHOLESTEROL YOU EAT THAT MATTERS AS MUCH AS THE SATURATED FAT. CHOLESTEROL YOU EAT DOES MATTER BUT SATURATED FAT MATTERS A LOT. TRANSFATS ALSO. YOU WANT THOSE TO BE LOWER. AND YOU WANT TO INCREASE YOUR PHYSICAL ACTIVITY. AND REDUCE YOUR BODY WEIGHT BASE THE ON THE STUDIES I JUST SHOWED YOU. BACK TO THE NUTRITION LABEL. WE LOOKED AT THE SERVING SIZE NUMBER OF SERVINGS, I ADDED MORE LABELS HERE. WE LOOKED AT CALORIES. NOW WE'RE INTERESTED IN CHOLESTEROL SO WE'RE INTERESTED IN FAT, AND SATURATED FAT. AND CHOLESTEROL. WE'RE ALSO INTERESTED IN BLOOD PRESSURE SO WE'RE INTERESTED IN SODIUM, IN THIS SECTION HERE. THIS PERCENT DAILY VALUE SAYS HOW MUCH OF THE RECOMMENDED AMOUNT IS IN THIS FOOD, HOW MUCH OF THE RECOMMENDED FOR A DAY IS IN THIS FOOD. SO THIS LABEL HAS 20%, 20% OF YOUR SODIUM REQUIREMENT FOR THE DAY. IT'S A FIFTH. IF YOU EAT THIS FOOD, IF YOU EAT BOTH SERVINGS IN THE CONTAINER YOU'RE 40% OF YOUR SODIUM ALLOTMENT YOU'VE EATEN. THE BOTTOM IS THE SAME, THE RECOMMENDED DAILY AMOUNT FOR TWO CALORIE LEVELS, AND MOST PEOPLE EAT 2,000 OR 2500, THAT IS TYPICAL. SO WE'RE GOING TO HAVE ANOTHER TWO VOLUNTEERS COME UP HERE. I'VE GOT SOME SNACKS, I WANT TO HAVE A CRUNCHY THING WITH MY LUNCH. ALL RIGHT. WHO WANTS TO DO THE NEXT ONE? NO? YES, BOTH OF YOU. ALL RIGHT. I WANT TO EAT SOMETHING CRUNCHY WITH MY LUNCH. I HAVE DORITOS AND LAY'S HONEY BARBECUE. THIS IS CUT OFF A LITTLE BUT I THINK YOU CAN SEE ALL THE NUMBERS. THEY ARE GOING TO COMPARE AND TELL US WHICH ONE THEY WOULD CHOOSE AND WHY. WE'RE INTERESTED IN BLOOD PRESSURE AND CHOLESTEROL NOW, NOT CALORIES. SO TELL PEOPLE WHAT YOU'RE COMPARING, AND GET THE MIC WHEN YOU'RE READY TO SPEAK. WHICH ONE WOULD YOU PICK AND WHY? >> HONEY BARBECUE. >> YES. >> IS IT ON? YES. ALL RIGHT. I HAVE DORITOS AND THE CALORIES ARE ABOUT THE SAME IN THE ENTIRE BAG OF BOTH. BUT THAT'S NOT WHAT WE'RE COMPARING. THE CHOLESTEROL IS ZERO IN BOTH OF THESE. THE SODIUM IS MUCH MORE IN THE DORITOS. IN THE LAY'S HONEY BARBECUE IT'S 190 MILLIGRAMS PER ENTIRE BAG, AND IN THESE IT'S 440 MILLIGRAMS IN THE DORITOS. >> WAIT A MINUTE. 440 -- WAIT. LOOK AT THE SERVING SIZE FOR THOSE BAGS. >> THAT'S FOR THE ENTIRE BAG. >> BUT LOOK AT BOTH BAGS. >> RIGHT. >> ARE THEY BOTH TWO SERVINGS? >> THIS IS ONE SERVING. >> THAT'S WHAT I WANT TO YOU TELL THE PEOPLE. TELL THE PEOPLE. LAY'S IS ONE SERVING. SERVINGS IN THESEARCHINGS IN ENTIRE BAG. >> RIGHT. THIS ACTUALLY LISTS BOTH ON THE BACK. IT LISTS PER ONE-OUNCE SERVING AND THE ENTIRE PACKAGE. THESE ARE 440 PER BAG, THESE HAVE 190 MILLIGRAMS OF SODIUM PER BAG. IS THERE ANYTHING ELSE? >> WHICH ONE WOULD YOU PICK? >> WE WOULD PICK NEITHER OF THESE BECAUSE THEY ARE BOTH -- >> I'M GOING TO GUESS THIS IS WHAT YOU WOULD PICK. >> I WOULD PICK AN APPLE. >> YOU WANT SOMETHING CRUNCHY WITH YOUR LUNCH. >> THAT'S RIGHT. >> THERE'S YOUR PRIZE FOR VOLUNTEERING. I'LL TAKE THESE BACK. [APPLAUSE] THANK YOU. VERY GOOD. EXCELLENT. THEY ARE TRICKY, THESE MANUFACTURERS. YOU HAVE TO LOOK AT HOW MANY SERVINGS ARE IN THE CONTAINER. BECAUSE OTHERWISE YOU'RE NOT COMPARING LIKE WITH LIKE. >> UNLIKE THE OTHER PARTS WE HAD UP -- >> THESE ARE FROM THE WEBSITE ACTUALLY. THESE ARE BOTH ONE SERVING. THIS IS BOTH AMOUNT PER SERVING, AND SERVING SIZE DOESN'T SAY HOW MANY, BECAUSE THIS IS NOT ON THE PACKAGE, YES. ALL RIGHT. WE'VE ALREADY TALKED ABOUT DIET AND NUTRITION IN THE CONTEXT OF EVERYTHING ELSE. WANT YOUR DIET TO BE LOWER IN SODIUM, CONTROL CALORIE INTAKE TO MATCH OUTPUT, LOW IN SATURATED AND TRANSFATS, EAT THE DASH DIETARY PATTERN, MY NEXT SLIDE, HERE IT IS, I'M RUNNING OUT OF TIME. MOSTLY WHOLE GRAINS, 6 TO 8 SERVINGS, LOTS OF FRUITS AND VEGETABLES, 8 TO 10 SERVINGS A DAY, LOWER IN SATURATED FATE, A LOT OF FIBER, POTASSIUM, CALCIUM AND MAGNESIUM, UP TO 3 A DAY.S OF DAIRY A DE. YOU NEED HIGHER CALORIES IF YOU'RE BIGGER, AND A MAN, WOULD YOU EAT THE HIGHER NUMBER OF SERVINGS. IT'S HARD TO EAT EIGHT TO TEN SERVINGS A DAY. I TRIED IT. YOU HAVE TO EAT BREAKFAST, LUNCH, SNACK AND DINNER, TWO SERVINGS, AT EACH TIME OF FRUIT, FRUIT AND A VEGETABLE, TWO FRUITS, TWO VEGETABLES. AND OTHERWISE YOU CAN'T FIT IT IN. >> WHAT IS A SERVING SIZE? >> IT DEPENDS ON WHAT THE THING IS. RICE IS HALF A CUP. THAT'S NOT A VEGETABLE. THE APPLES ARE MORE THAN ONE SERVING BECAUSE THEY ARE BIGGER THAN SMALL APPLES. THEY ARE PROBABLY ONE AND A HALF MAYBE. HERE IS THE FULL DAY'S WORTH OF THE DASH DIET. AND THAT'S PRETTY -- >> THAT'S A LOT OF FOOD. >> THAT'S WHAT PEOPLE SAID THE OTHER DAY. THESE PEOPLE DID NOT GO HUNGRY BUT DASH DID NOT HAVE THEM LOSE WEIGHT. THE STUDY WANTED THEM TO KEEP THEIR WEIGHT CONSTANT BECAUSE THEY WERE TESTING WHAT THE PATTERN DID OVER AND ABOVE ANY WEIGHT ISSUES. ALL RIGHT. WE'RE GETTING TO THE END HERE. SO EAT A HEALTHY DIET, BE PHYSICALLY ACTIVE, CONTROL WEIGHT, GET YOUR BLOOD PRESSURE CHECKED, IF YOU HAVE HYPERTENSION GET IT TREATED. CHECK YOUR BLOOD LIPIDS, IF YOU HAVE HIGH BLOOD CHOLESTEROL GET IT TREATED. AND THEN YOU SHOULD IMPROVE YOUR HEART HEALTH. BUT WE LIVE IN AN ENVIRONMENT THAT WORKS AGAINST US FOR HEALTHY BEHAVIORS. FAST FOOD, LARGE PORTION SIZES, SEDENTARY WORK, SEDENTARY TRAVEL AND LEISURE PURSUITS. SO HOW DO YOU WORK AGAINST THIS ENVIRONMENT? MOTIVATION IS REALLY IMPORTANT. AND I'M GOING TO SHOW YOU SOME BEHAVIORAL PRINCIPLES THAT CAN ALSO HELP. FIRST YOU HAVE TO IDENTIFY YOUR MOTIVATION. PEOPLE WHO AREN'T MOTIVATED WON'T MAKE BEHAVIOR CHANGES, AGAINST THIS UNHEALTHY ENVIRONMENT ESPECIALLY. THE GOALS NEED TO BE REALISTIC. THEN YOU -- STUDIES HAVE SHOWN IF YOU MONITOR YOUR PROGRESS, SELF MONITORING, HOW CLOSE TO YOUR GOALS YOU'VE GOTTEN, GETTING SOCIAL SUPPORT FROM A FAMILY MEMBER, FOR EXAMPLE, OR A FRIEND. GETTING FEEDBACK AND REINFORCEMENT, OR REINFORCING YOURSELF. GO BUY SOMETHING, NOT TO EAT, BUT, YOU KNOW, BUY SOMETHING AS A TREAT IF YOU LOST A CERTAIN AMOUNT OF WEIGHT, FOR EXAMPLE. IF YOU HAVE BARRIERS, FIGURE OUT WHAT THEY ARE. AND THEN FIGURE OUT HOW TO SOLVE THEM. THESE ARE BASIC BEHAVIORAL PRINCIPLES. AND THEN OF COURSE KEEP TRYING. SO IT MAY BE HARD. BUT YOU CAN DO IT! THAT'S MY LAST SLIDE. THANK YOU. I HAVE ONE MORE -- [APPLAUSE] AND THEN WE CAN PLAY MORE MUSIC AND GO OUT DANCING.