Mobile telephone food journal-Just take pictures!

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Have you ever used a food diary to make healthy eating choices or to lose weight? We know that keeping a food diary helps us stay more accountable to our health plan, but we would surely be happier if we could make do without having to use cumbersome traditional paper-based food diaries.

Mobile apps that act as food journals could very well be your knight-in-shining-armor. These days there are numerous available apps once downloaded to your mobile that can serve as online food diaries. Some that even allow pictures of foods to be taken and sent to a dietitian partnered with the mobile app. But, how reliable are these apps?

According to a recently published study in the Journal of the American Dietetic Association, a new mobile telephone food record has been successfully tested. The study set out to test how much easier would it be for adolescents to capture a useful image of their food and what is their ease of using a mobile telephone food record, in general and after training. The adolescents in this study, aged 11-18 years, used their cell phones to capture an image of their meals (including snacks) before and after eating.

Current problems with food recall especially among youngsters include estimating how much one ate and drank and being able to compare it to the suggested portion sizes. Catherine McCarroll, Registered Dietitian and Coordinated Program Director, Division of Nutrition at Georgia State University says, “from my experience working with both healthy weight adolescents and above average weight adolescents, it is difficult to obtain accurate food records with this age group.  Parents are not a reliable source of information since adolescents typically are not with their parents for one or more meal and snacks per day.”

According to the study, a majority of the adolescents (79%) found the mobile telephone food record easy to use and the longer they used it, the more likely they were to continue using it. Training the adolescents to use the food record on their cell phones made them more agreeable to take images of the food before snacking.

The authors of the study suggest that successfully testing the mobile telephone dietary food record is valuable not only to adolescents and to others, but also benefits health care professionals such as Registered Dietitians. The study lends valuable information to the further development of the mobile telephone food record. Dr. Mildred Cody, PhD, RD, Professor Emeritus, Division of Nutrition, Georgia State University says, “use of a familiar mobile, multi-purpose technology that can take pictures of the food and record other notes, such as information on where the food is consumed and other information relevant to the individual's situation, has potential to improve both record-keeping compliance and diet recall detail.”

While the mobile telephone food record is further being developed, such studies lend support to a user-friendly food record soon within our reach. At the end of the day, adolescents are more likely to accept tools that fit into their lifestyles. When it comes to staying in shape, technology is helpful and interactive products more acceptable.  As Evelyn Leo, Diabetes Educator and Registered Dietitian summarizes, “using a phone camera to take pictures of foods may improve accuracy of food recalls for a population accustomed to using technology in their everyday lives.” 

What’s in it for you?

Not only youngsters, but as a consumer you stand to gain from using a mobile telephone food record because:

• It is easy to use. You need not be tech-savvy
• It will literally be available at your finger tips
• It is reliable having undergone successful testing
• A pictorial food diary would most likely be preferred over using a paper-based food diary
• Frequently using it after undergoing training will make you more efficient in recording your food intake 
• You will be able to send valuable dietary information and receive feedback from your dietitian
• You will be a true eco-friendly citizen saving paper otherwise used for paper-based food diaries!

Mobile telephone food records seem promising. We might soon joyfully bid adieu to keeping old-fashioned food diaries.

About the author: Nida Shaikh, MS, RD, LD

A self-confessed chocoholic, outdoor enthusiast, half-marathon distance runner and an ambidextrous Registered Dietitian currently pursuing a doctoral degree in nutrition at Emory University.

Reference: Six BL, Schap TE, Zhu FM, Mariappam A, Bosch M, Delp EJ, Ebert DS, Kerr DA, Boushey CJ. Evidence-based development of a mobile telephone food record. J Am Diet Assoc. 2010 Jan;110(1):74-9.

Pass the Cheese, Please! - Miriam Abouelnasr

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It has been nearly a year since the Institute of Medicine (IOM) issued a new report on Vitamin D and Calcium.  The report found that calcium and vitamin D are so important for bone health that new recommendations for the public were made. 

• Men and women under the age of 50 need 1,000 milligrams (mg) of calcium and 600 international units (IU) of vitamin D per day. 
• Women age 50 and older need 1,200 mg calcium and 600 IU vitamin D per day and women age 70 and older need 1,200 mg of calcium and 600 IU of vitamin D per day.
• Men over the age of 50 need 1,000 mg calcium and 600 IU per day and men over the age of 70 need 1,200 mg of calcium and 800 IU of vitamin per day.

The recommendations are different for pregnant women, children, and infants so be sure to consult your doctor or dietitian regarding supplement use.

To give you an idea of how much calcium and vitamin D are in food, one cup of milk has about 550 mg of calcium and 120 IU of vitamin D.  Calcium is mainly in dairy, including milk and cheese, but it can also be found in non-animal sources, such as broccoli, some breakfast cereals, juice, and soy milk.  Our bodies are able to make vitamin D as long as we have access to sunlight.  Food sources of vitamin D include fatty fish (like salmon, tuna, and sardines), dairy, eggs, and some breakfast cereals.  Be sure to check out the food label, as both of these nutrients are listed there.  Supplements, such as multivitamin pills, can be a good source of calcium and vitamin D as well, but only if you are not getting enough from your diet. 

Despite the importance of this vitamin, The IOM also determined that certain groups of people are at risk for low blood levels of vitamin D.  These groups include people who live in northerly latitudes, people who live in intuitions (like prisons and mental health facilities), and people with dark skin.  This is because these three groups of people may have less access to sunlight.

Just when you were thinking that more is better, there are upper levels for each calcium and vitamin D.  So, if you eat more than the maximum level, which is 2,000 – 2,500 mg calcium and 4,000 IU vitamin D, it can actually have a negative impact on your health.  Bottom line, don’t go overboard!

Quote from an expert:

“The new recommendations on Vitamin D are conservative and target vitamin D doses to maintain health.”

-Nida Shaikh, MS, RD, LD

Miriam Abouelnasr MS, RD, LD spent a year at Grady Memorial Hospital in Atlanta, Georgia working for the Women, Infants, and Children (WIC) Program.  She is currently a registered dietitian and working towards her PhD in nutrition at Emory University in Atlanta.  She enjoys dairy, but especially chocolate soy milk!

                                    

Reference:

Ross, Catherine A., et al "The 2011 Dietary Reference Intakes for Calcium and Vitamin D: What Dietetics Practitioners Need to Know." Journal of the American Dietetic Association (2011): 524-527.

A Desert within a Desert: NYC’s Green Cart Program Fails to Reach Neediest Areas (Brooke Hixson)

NYC’s Green Cart program, designed to increase the availability of fresh produce in disadvantaged neighborhoods, has not been successful in reaching those the most in need. Researchers at Montefiore Medical Center, a Bronx hospital, investigated the Green Cart program, looking at how well the carts were fulfilling their intended purpose of selling fresh produce in areas where fruits and vegetables were otherwise unavailable. They found the carts were unevenly distributed around the Bronx with clusters of carts in some areas and no carts in others.

A woman buys produce at a Bronx Green Cart

The Green Cart program began in 2008 when the NYC City Council approved a measure allowing mobile food carts selling fresh produce to operate in areas with traditionally low consumption of fresh fruits and vegetables (often caused by a lack of supply in local stores). Neighborhoods where fresh produce and other healthy foods are difficult to find are often referred to as “food deserts.” Green Carts were touted by anti-hunger and child-advocacy groups as one solution to food deserts in poorer areas of NYC.

While the NYC Department of Health backed the Green Cart program and administers the permits, they also acknowledged that it was not a comprehensive solution to community health issues such as obesity and diabetes. Dr. Thomas Frieden, then city health commissioner and current CDC Director, expressed measured support, saying, "This is not going to end the obesity epidemic, but it is an important step to increase access to healthy food in the communities that need it most."

Despite fierce opposition from local bodega owners, support from the NYC DOH and a $1.5 million grant to provide microloans to cart vendors has resulted in Green Carts appearing across all five boroughs. However, the Green Carts must follow specific guidelines on where they can sell (only in food deserts determined by the NYC DOH) and what they can sell (only raw unprocessed fruits and vegetables – no peeling, chopping, etc.). Since the program's implementation in 2008, public reaction has been generally positive with some carts operating 24 hours/day, 7 days/week to meet demand.

Researchers looking at Green Carts in the Bronx, however, found the Green Carts tended to cluster in "hotspots" around hospitals, schools, subway stops, libraries, and the Bronx Zoo. As a result, some of the neighborhoods in the greatest need of fresh produce still did not have local access. Thus, even within an area generalized as a food desert, some areas are “drier” than others. Researchers also found a few carts operating outside the legal zone in areas that are not considered food deserts.

Maps of Green Cart Locations in the Bronx

Most disturbingly, researchers found about 10% of the carts were selling sugary drinks and cookies, defeating the entire purpose of the carts. Although selling anything other than fresh produce is expressly forbidden (and results in a $550 fine), there appears to be little oversight on the street.

During this time of skyrocketing obesity and diabetes rates, any effective intervention that reduces the risk of these diseases is important to invest in and to implement correctly. If NYC can work out the kinks in their Green Cart program and get its most at-risk residents to eat more fresh produce, the program is likely to expand to other metropolitan areas across the country. Government officials need to provider stricter oversight of current Green Carts’ inventory. Program coordinators should work with community groups to create local demand in Green Carts deserts and to enlist local residents to become vendors. Green Carts should also be designed to accommodate electronic benefit transfers (i.e., food stamps). Finally, public health officials must continue to work with established community businesses (such as bodegas) to encourage them to supply their communities with affordable fresh produce rather than relying on Green Carts alone to provide much needed nutrition in food deserts.


Brooke Hixson has worked in various aspects public health for almost 10 years. She is currently a doctoral student in Biostatistics at Emory University studying spatial analysis. She enjoys both fresh produce and NYC.


Source: Lucan SC, Maroko A, Shanker R, Jordan WB. Green Carts (Mobile Produce Vendors) in the Bronx-Optimally Positioned to Meet Neighborhood Fruit-and-Vegetable Needs? J Urban Health 2011 Oct;88(5):977-81.