Sleep

Physical and mental activity is important for health, but so is rest and recovery. Adequate sleep is not only essential for health, but for life itself. Rodents that are deprived of sleep begin to die off after about 2 weeks. Immune defenses deteriorate and the animals die of overwhelming infection. Inadequate sleep impairs thinking, promotes inattention and is associated with motor accidents. A high proportion of Americans live in a state of sleep deprivation. Are you getting enough sleep? Try this test to find out. Insufficient or disrupted sleep may be associated with increased risk of early mortality, high blood pressure, weight gain and possibly diabetes. Sleep may be disturbed by the rapid pace and stresses of daily life, stimulants such as caffeine in coffee, tea, and chocolate, and sleep disorders, such as restless leg syndrome, nocturnal myoclonus, and sleep apnea. Alcohol consumption and depression may lead to early morning awakening. Loneliness may have a negative impact on the quality of sleep. Many people have difficulty initiating or maintaining sleep (insomnia). Test your general knowledge about sleep here.

The best approach to sleep problems is to try to find the underlying cause and treat it. Sleeping pills may be used for short term treatment of insomnia or when other treatments have failed. Otherwise, it is best to use strategies such as changes in lifestyle (e.g., not consuming caffeine containing food and drinks after noon), or treatment of depression, sleep apnea or other problems first. Cognitive behavioral therapy and relaxation techniques, such as meditation, are better in the long term than sleep medications.

Try this exellent website, designed for children, for a simplified explanation of the science of sleep. The following have excellent general information on sleep: National Sleep Foundation, Medline Plus: Sleep Disorders, and a website National Institute of Neurological Disorders and Stroke, National Institutes of Health, called Brain Basics: Understanding Sleep.

Self efficacy and locus of control

The concept of self-efficacy was developed by Dr. Albert Bandura. Self-efficacy refers to the perception that one can perform a certain action successfully. More and more research is demonstrating that self-efficacy is associated with better social and health outcomes. If we believe that we can successfully carry out an action , we are more likely to be successful. More interesting is that people can be trained to revise their thinking to develop greater self-efficacy.

A related concept is locus of control. We do better if we think we can exert some measure of control in a situation. This also has implications improving mental and physical health.

Improvement in self-efficacy can be accomplished through several strategies. One example is the use of cognitive behavioral therapy (CBT). When an event results in negative and counterproductive thoughts and beliefs, the thoughts or beliefs can be examined and countered with more realistic or positive thoughts. For example, if we wake up with a headache and realize, one hour later that we still have it, thinking “I’m never going to get rid of the headache” is unlikely to be true for almost any person. Of course, if it is unusual, extremely severe, or has been around for days, it would be best to seek medical attention. But for some people these headaches occur regularly, and have been discussed with doctors. Also, to say to ourselves, “I can’t take it” is also not true and not useful. In CBT, the adverse event, the automatic thought, and countering thought are written down. A countering thought for the headache might be that, “My headaches have always gone within a few hours. This is inconvenient, but I can manage.” The countering thought is more true and more useful than the initial thought.

Self-efficacy and locus of control are important in changing habits for the better. How we feel about our efforts, especially after setbacks, has a role in our success. As alluded to above, CBT can be useful in the process of change. CBT has been used in coping with chronic diseases, anxiety, depression, and other conditions. See this posting on depression, which discusses CBT and follow the links there to InfraPsych site, which has an excellent description of CBT. CBT, in the context of changing habits, can be seen as a technique for dealing with counter-productive thoughts and feelings that could sabotage efforts to develop healthier habits.

See the postings on depression, and "More on depression," which discuss CBT and follow the links there to the InfraPsych site, which has an excellent description of CBT and how to do it.

Social action

Why social action? Because it improves social connectivity. It is beneficial to the person who is involved in the social action and to others.

What can we do that makes a difference? Many programs to prevent or correct social problems have little research to back them up. Does educating children about the types of drugs available and the dangers of drug use, decrease drug use among teens? Does educating teens on the virtues of abstinence decrease teenage sexual activity and pregnancy? Would a “Just say no” diet be effective? Behaviorists for Social Responsibility mention a number of social actions that have a sound basis of social and behavioral research to support them. Included among them is Peace Power! To quote from their website: “PEACE POWER is a strategy for building nonviolent community and organizational cultures incompatible with violence, threat and coercion. Unlike many untested violence prevention programs, the PEACE POWER strategy is based on state-of-the-art behavioral research, particularly from the science of behavior analysis.” For a reasonable cost, they provide training materials and also training workshops. Another organization with similar goals and methods is PeaceBuilders.

Another area for social action is crime prevention. What works? A review has been published on the web here. There is little data to support many existing crime prevention programs, and more research is needed. Also, there could be wider application of programs and methods that have been shown to work.

Constructive social action is possible in so many areas. So where do we begin? We can participate in ongoing activities in our communities. We can join a club. Another is to start an activity ourselves. Forming a study circle is a time tested way of engaging in useful social action. The idea is to form a group of 8 to 12 people with a common interest in trying to understand and identify solutions to a problem in our community. For more information on study circles go to http://www.studycircles.org/. For examples of tools for social action see http://www.indiana.edu/~ythvoice/socialtools.html and http://www.teaching.com/EarthDay97/. Besides study circles, another example is Drums Not Guns (see http://www.drums.org/dng/), where drumming circles are promoted as a way to increase social cohesion in a positive way. Some people use this as a way to relieve stress.

Environmental threat and anxiety

As mentioned in a previous posting, anxiety may be related to environmental threat. The environmental threat does not have to be real, though. The news and entertainment media find new threats for us all the time. If the full threat and its implications haven’t occurred to us, the media will bring it to our attention. After the September 11 attacks on the World Trade Center, the news media showed the same pictures of the attacks over and over again. The media seemed to be more intent on how strong the terrorists were and how much more damage they could do to us than how such a heinous and cruel act would turn the full power of the United States and other countries against the terrorists. It seems that the news media were asking questions such as, “Will we ever be safe again? Will America suffer worse attacks?” The media went on to outline all of the opportunities that the terrorists or the public may have overlooked for causing damage to the American people. Bad news sells. Heart warming stories are popular, but the threats to your daily life will drive people to tune in again and again.

But if the media had reacted by emphasizing the strength of America, and called upon the resolve of Americans not to play into the hands of terrorists, perhaps it would have been healthier. After the attacks, the proportion of the general population with stress disorders increased. The approach of the media tends to inflate the risk of rare events. Americans have a far greater risk of dying in a motor vehicle accident, of cancer, of innumerable other risks to which we are exposed daily than being attacked by terrorists. In our daily lives, the news media show us the disasters, the destruction, the corruption, the crimes, the deaths, and all manner of threats to our health and life as we know it. This is also true not only of the news media, but of the movie industry. Examples of how things could go wrong abound. If these threats are major part of experience and thought in everyday life, why wouldn’t people be anxious? I think that it was Dr. Andrew Weil, the alternative medicine expert, who advocated for taking a news holiday. Perhaps that could be a way to lower stress and anxiety. Although, the media have been singled out here, others, especially politicians and some of those who are out to make a quick buck have also added fuel to the fear for their own purposes.

The purpose is this posting is not to add to the fear and distrust. The message is that we can do something about it. We can look at how real any given threat actually is. If it is a threat, is this more risky than traveling in a car? I think most people are just trying to do a reasonable job and lead honest lives. Is that not how you approach your own life? Perceived threat can be more important than actual threat. Social action can be taken to encourage others to think of the real level of threats. We can call into account the individuals, media, businesses and politicians and other leaders as to how they exaggerate and disseminate threats. We can look for ways to increase social connectedness in our daily lives. We can seek ways to build trust between individuals, neighborhoods, institutions, and nations.

Go here for more on anxiety.

Social connectedness

Lack of social connectedness is generally under-rated, in my opinion, as a factor in the anxiety and depression that abounds despite the general material and economic prosperity of the industrialized world. So many distractions take us away from the face-to-face and eye-to-eye contact with our families and friends. Eyes on the television, movie, or videogame, ears on the radio or music emanating from the CD player, our full attention is not on the person who is with us. Many of us spend more time giving that full attention to those in the workplace. But even that attention is starting to fragment with the advent of wireless laptop computers, cell phones, person digital assistants, and other devices that are supposed to make us more connected to our world. But it is not only the quality of time that we spend with family and friends that has declined, it is also the quantity.

Enhancing social connectedness holds the prospect of improving anxiety and depression. Those who are members of organizations and attend religious services regularly are likely to be healthier physically and mentally. Social connectedness has been invoked in the vast array of support groups that have arisen to address anxiety, depression, addiction, obesity and other problems. Social connectedness is also part of a relationship between a patient and therapist. But it seems that the groups and therapies are aimed at treating the end result, not the underlying problem. In some cases, it is like treating the heart attack rather than what caused it. The heart attack can be treated in an intensive care setting and perhaps even treated with bypass surgery, if necessary. But we know that it’s better to treat the high cholesterol and high blood pressure with medications that might prevent the heart attack in the first place. We also know that it is better still to treat the high cholesterol with dietary changes and exercise first, except in those with inherited forms of high cholesterol. Both high cholesterol and high blood pressure have the potential for being improved by lifestyle changes. For anxiety and depression, social connectedness could have a role early on before a person moves on to support groups and therapists. As the hero of the movie Crocodile Dundee remarked when he was told that someone was seeing a therapist to discuss his problems, “Doesn’t he have mates?” or words to that effect. This is not meant to imply that social connectedness is a panacea, or that its only role is in prevention, or to detract from the value of good therapists and support groups.

See the following postings for more on anxiety and depression.

See the following postings for more on how social connectedness relates to work, disability, and drinking problems.

Why are anxiety and depression on the increase?

For one thing, it seems unlikely that the increase in anxiety and depression is based on purely genetic factors, because it has happened so quickly. It would take a number of generations to change a characteristic in the general population. If this is true, what environmental factors might be contributing to this wave of anxiety and depression? Jean Twenge has published an interesting article pointing to the role of declining social connectedness and increases in environmental dangers in anxiety and depression. The decline in social connectedness can be seen, for example, in the increasing divorce rate over decades and the increasing number of people who live alone. Do we trust people, organizations, and institutions as much as we did in previous decades? An example of environmental dangers can be reflected in violent crime and other threats. Interestingly, as Twenge points out economic factors don’t seem to be important in anxiety and depression. This echoes the results of studies that suggest that happiness is not affected by economics, once one is out of poverty, or if one is extremely rich.

See the following post for more about anxiety and depression.

Effective parenting

In the busy daily rush of the modern world, those of us with children do our best. Are there ways to do a better job of parenting? Here are two interesting sites. One is the Center for Effective Parenting, which has general information on the topic. Another interesting site is the is an attractive book in PDF format, published by the National Institute of Child Health and Development (NICHD) called "Adventures in Parenting." This is the result of information gathered over 30 years of research. After a careful review of the research and discussions with parents and others about what works, the NICHD developed, and tested, an approach called RPM3. This stands for Responding to your child appropriately, Preventing risky behaviors before they occur, Monitoring your child's contact with his or her world, Mentoring your child to support and encourage desired behaviors, Modeling your own behavior to set a consistent, positive example for your child. How to do this is outlined in the book. More information about the NICHD and their programs can found found at this site.

Financial stress

An important part of life that can create stress is money. Beyond this is financial planning, including making sure that we have a will. If we have children or dependents it is important to have a will so that they will be cared for in accordance with our plans. But also day-to-day concerns about money not only add to the stress of daily living, but may take their toll on marriage and relationships with others.




While the main focus of this site is on health and related topics, good financial planning alleviate some day to day stress. Part of this is to become more educated about money. The Investopedia site provides much basic and more sophisticated information on finance. The tutorials, dictionary, financial calculators and other tools can be useful depending on one's level of knowledge. Also, included are sites of two well-known experts in finance and investment, Suze Orman and Jonathan Pond. These sites are more directed at the issues of individual personal finance.

More about changing habits

It's easier to make small changes than big ones. For example, to give up sugar in your coffee or tea can be accomplished by gradually taking less. First, we can heap the spoons a little less each week. Then take less and less (even a grain or two) in one spoon until one spoon has gone, and so on. The same with low fat versus high fat milk. I remember trying skim milk in coffee and tea and it tasted terrible! But by moving down from whole milk (4%) to 2% or adding a little skim milk to whole milk, gradually whole milk will taste like cream. If these changes take a year to accomplish, it's not a problem. These are long term changes, new habits.

To increase physical activity, the same principles apply. We begin by being kind to ourselves. We set our expectations low. We can use what is known about behavioral psychology to help ourselves develop new habits towards increasing physical activity. For example, instead of walking for two miles the first day, feeling exhilirated and pleased with ourselves for a really good effort, we may just walk out to the street and go back inside. If we have a treadmill, we might go to it and just stand there for a minute. When that is a habit that we do every day, we can add on a minute or so. If we continue to do this each day, eventually we will want to add on more.

A gem of a book about how to effectively make small changes is "One Small Step Can Change Your Life" by Robert Maurer (See more about the book to the right at Amazon).

For more information on changing habits see the posting on Self-efficacy and locus of control.

Changing habits for the better

Often, it is good to find out what has worked for others. For example, when it comes to diet, a high proportion of people are able to reduce weight - for a while. People who are successful in the long term at losing and maintaining weight loss, gain social support, change their diet to reduce their intake of calories, eat smaller meals more frequently, for example five small meals per day, and stay on an exercise program.

What’s the good, though, of knowing about diet and physical activity, if we can’t change our habits? Prochaska has developed a useful, validated model of change. Whether we can change successfully at any time depends in part on what stage of change we have reached. The model involves six stages of behavioral change: 1) Pre-contemplation, where we think that there really isn’t a problem; 2) Contemplation, where we are aware there’s a problem, and we’re thinking of changing. 3) Preparation, where we are preparing to take action; 4) Action, where we are actively doing something about the problem; 5) Maintenance, where we have changed our behavior successfully and working to avoid relapsing into our old ways; and 6) Termination, where it is no longer necessary to work on our behavior. He, and others, have investigated the kinds of interventions that work at each stage. For more on this topic see the book "Changing for Good" written by Prochaska, Norcross and DiClemente. This model of change has been successfully applied across a wide variety of problems, including dieting, giving up smoking, and addiction. If we know someone who is in the pre-contemplation stage, the best strategies for maintaining a weekly exercise schedule will not be helpful. If we are preparing to take action, then information about the best approaches and what has worked for others is useful.

For more on this topic go to the posting More on changing habits.

Do you know your numbers?

Most people can tell you their height and weight. Using these numbers we can look up the body mass index (BMI) or we can calculate it. Here is a convenient BMI calculator. How is the BMI obtained? The weight in pounds is multiplied by 703 and the answer to that is divided by the height in inches. This will be equivalent to the body mass index in kilograms (kg) per meter (M) squared. In the metric system, it is obtained by taking the weight in kilograms and dividing by the height (in meters) squared, that is (weight)/(height X height). If the number we obtain for the body mass index is 25 or more, it indicates being overweight. If the number is greater than 30, this indicates obesity.

While not every expert is in complete agreement as to whether being overweight or obese is bad for our health - some say that it is really physical fitness that counts - most experts seem to think that being overweight or obese is unhealthy. Obesity is associated with a greater tendency to osteoarthritis (the common kind of arthritis that is associated with wear and tear on the joints, which tends to increase with age). Obesity is also associated with a greater tendency to type 2 diabetes. This is the kind which tends to develop in adults rather than children and tends not to require insulin. Diabetes may be associated with blurring of vision, fatigue, dry mouth, itchy skin, and more importantly hunger, thirst and frequent urination, a number of times a day and especially at night. Also, wound healing may be poor. If sleep is being disrupted because a person has to get up to go to the bathroom at night, diabetes should definitely be considered. A fasting blood glucose (sugar) test, if above normal, would be suspicious for diabetes. Also, the blood sugar will tend to become chemically bound to hemoglobin in red blood cells, producing what is called glycosylated hemoglobin. If a glycosylated hemoglobin test show that this chemical is present in higher than normal levels, it would also favor a diagnosis of diabetes mellitus (sugar diabetes).

If we are overweight, we will of course tend to have a bigger waist. Many of us think that we know our waist measurements. But some of us may be underestimating. The waist size in clothing is deceptive. We can place a belt or button the waist of a garment under our largest area and the belly may hang over. If we feel for the top of the hip bone and place a tape measure around ourselves, we will get a more accurate measure. This should be done with the belly relaxed and at the end of breathing out. In men, a waist circumference of more that 40 inches, and in women of 35 inches is associated with health risks like those mentioned above for obesity. It is good to know our real waist measurement.

The downside of high cholesterol and LDL (bad) cholesterol and low HDL (good) cholesterol have been mentioned in a previous posting. It is good to know these numbers, especially as middle age approaches and beyond.

The problems of high blood pressure were also mentioned in a previous posting. Blood pressure machines in supermarkets and public places tend to be a little inaccurate, but often on the high side. If it is high it should not be ignored. It is best to get the blood pressure measured by a health professional periodically. For a person with high blood pressure, it is best to buy a blood pressure machine to check it from time to time. While the best kind uses a cuff around the arm, a wrist blood pressure monitor may be more practical, if it is checked against a more accurate machine, and it is used to look for trends or big changes. The good thing about wrist monitors is that they are small, and easy to use. It is better to have a lesser machine that is used regularly than a fancy one that is neglected. If is important to know whether or not the blood pressure is normal.

Your heart rate or pulse is also good to know. If it is over 100 beats per minute when you are at rest and have not been exerting yourself, it is too fast. It could indicate anxiety, stress, heart problems, an over active thyroid gland (a gland in the front of the neck under the Adam's apple), or other problems. If it is less than 60 beats per minute and you are not very physically fit, you may want to see your doctor. The resting heart rate will tend to decrease with exercise.

It is good to know your your numbers:
body mass index,
waist circumference,
cholesterol (total, LDL and HDL),
blood pressure,
and heart rate.

If you are overweight or have symptoms diabetes mentioned above you should discuss them with your doctor, who will likely order a fasting blood sugar test.

If the numbers are not good, they can be improved by lifestyle changes in diet, physical activity, getting adequate sleep, and other adjustments. Medications are often necessary, though, and have improved health and quality of life considerably for a very large number of people.

Why is high blood pressure important?

High blood pressure is usually without symptoms, but over time high blood pressure will damage blood vessels and cause damage to organs, notably the heart, brain and kidneys. High blood pressure, also known as hypertension, increases the chance of having strokes, heart attacks, and other problems. Your heart muscles contract (systole) and then relax (diastole). During the contraction, the blood pressure rises (systolic pressure) and when the heart relaxes the pressure falls to a lower level (diastolic pressure) before the next contraction. Normal systolic pressure is about 120 mm Hg (millimeters of mercury). Normal diastolic blood pressure is around 80 mm Hg. A standard way of writing blood pressure would describe this as 120/80. A blood pressure of 140/90 or more is regarded as high blood pressure.

It is important to have the blood pressure checked periodically to avoid walking around with undiagnosed high blood pressure. Hypertension can be treated by lifestyle changes and medications. The lifestyle changes include giving up smoking, decreasing alcohol intake, stress management, increasing physical activity and adjustments in diet. A diet that is rich in vegetables, low in salt, and includes daily fruit is beneficial. The DASH diet has been shown to be helpful in lowering blood pressure. Changing habits is difficult (See Dr. Prochaska's book, using the Amazon.com link for an approach). Click here for information on giving up smoking. Click here to find information about blood pressure medications. More information on hypertension can be found here.

Cholesterol

What is cholesterol? It is a kind of fat that is found in the blood circulation and is made by the liver. Most of cholesterol is produced by the body, rather than taken in as food. Food, though, can increase the amount of cholesterol that the body makes by providing the chemicals needed to make it. Saturated fat is a particularly important culprit. This fat occurs naturally, for example in the fat found in meat, but is also made by chemically saturating fat molecules with hydrogen atoms. This process is known as hydrogenation, the fat is called saturated fat. For example, margarine tends to be an oil at room temperature, but after saturation becomes a little more solid. The fat can be partly saturated, as in monounsaturated fat, which is healthy in moderation, and saturated fat, which is unhealthy and promotes the production cholesterol by the body.

While it is useful to know the total cholesterol, it is important to know the ratio of HDL (good) to LDL (bad) cholesterol. Lower levels of total and bad cholesterol tend to be healthier, and decrease the risk of cardiovascular disease. The desirable levels are: (total) cholesterol less than 200 mg/dl; LDL cholesterol less than 100 mg/dl. Higher levels of good cholesterol (HDL) are protective, and when greater than 60 mg/dl are protective. By knowing these numbers, we can find out whether we need to change our diet, increase physical activity. If these lifestyle changes don't work, then medications are indicated.

For more information on cholesterol go to this site. A new cooking oil has been produced by a Japanese company that is reported to lower cholesterol. It will be interesting to see how this stands the test of time.

Relationships

Much has been written about relationships. It is said that marriage is good for health, and divorce is a major stress - as stressful as losing someone because they have died. While much has been written on marital relationships, the authors of such books may not have a solid basis for their advice. I, too, am no expert in this area. But it does seem that advice that is based on research is better than that which is based on catchy phrases and buzz words. One impressive researcher is Dr. John Gottman, who together with his wife, has studied marital relationships for years. They observe couples in the "Love Lab" - a cross between a weekend get-away to an apartment and a therapeutic intervention, where the couple's every move is video-taped, analyzed and scored for a variety of behaviors. Dr. Gottman is able to predict with greater than 90 per cent accuracy, whether a couple will stay together after about five minutes of observation. You will notice that there are links to sites about people or issues that are described in this website. Also, for your convenience, there are links to Amazon.com for the books on the topics mentioned at this site. Dr. Gottman emphasizes getting to know your spouse, the importance of admiration, the benefits of turning toward each other in little ways every day, allowing your partner to influence you, and other findings of his research, which began in 1972. For more information, see the links to books by Dr. Gottman on the right. Here is an interesting site on marital relationships, which has a mix of scientifically based and other approaches.

Britney Spears and your favorite Super Bowl stars

People like Britney and your favorite football players have a great incentive to keep fit - lots of money, and their performance is watched by millions. But overdoing it, as we have seen, can result in knee injuries. Whether we are trying to get fit or lose weight, a gradual approach is better a crash program. For fitness, it is better to start out by gradually increasing your physical activity throughout the day. It is also better to mould a habit of exercising for just five minutes or less every day. If we effortlessly increase exercise by a minute or so per day every week, we will find after a year that we are much fitter without forcing ourselves to exercise. The same applies to losing weight. It is better initially to add one healthy item of food each day and gradually add to this over time. Since we eat the same weight of food every day, we are likely to consume fewer calories. Also, after a while we can decrease or drop one unhealthy food or drink at a time, and wait until we are comfortable with that.

Physical activity

Moving toward a healthier body composition is the way to go. This means decreasing the percentage of body fat. For most of us, decreasing our intake of calories will not be sufficient. We will need to increase our level of physical activity. Dr. James Levine of the Mayo Clinic has been in the news lately. He has studied the effects of everyday activity that is not related to formal exercise. This has been called non-exercise activity thermogenesis (heat production), which has been abbreviated to NEAT. Dr. Levine has found that those who are obese tend to be less physically active over the course of the day. That is they engage in less NEAT. By standing instead of sitting, using stairs instead of an elevator and generally looking for ways increase our physical activity throughout the day, we can burn a substantial number of calories over the day with little effort. Step counters are useful also in encouraging physical activity. These are readily available at sports stores, and perhaps some pharmacies. About 10,000 steps per day is a healthy level of physical activity. I have found that using a step counter from time to time is an incentive to increase physical activity. If we find that we are only walking 2,000 to 4,000 steps per day, it is an incentive to look for opportunities to increase our physical activity throughout the day to get in more steps.

Why are so many of us gaining weight?

Why are so many people gaining weight? This is not just happening here in America, but in Europe, and other parts of the world. In the developed world, we are faced with daily advertising about tasty snacks. These snacks are generally high in calories. Regular sodas generally have loads of sugar. Fruit drinks often have a little fruit juice and high fructose corn syrup. Every one is aware of the high content of fat, sugar and salt in many of the popular snacks. By processing food to retain or include the tastes that we enjoy most at the expense of other nutrients, we find that we are able to consume many calories, and to load our bodies up with salt.

One of the most useful facts that I learned about food is that, on average, people eat the same weight of food each day. So it is better to eat food that is higher in fiber and water content, and lower in calories per unit weight. Another useful fact is that serving sizes are crucial. Besides the "super-sizing" of fast food, restaurants often have very large portions. I was surprised to learn that a portion size of steak or fish is the size of a pack of playing cards! There is more information on this in the Okinawa Program, which also points out the the American food pyramid may not be as healthy as the Okinawan food pyramid. The Okinawan diet includes 7-13 servings of grains, 7-13 servings of vegetables, and 2 to 4 servings of fruit daily. It is also high in soy, and meat is eaten sparingly compared with the American food pyramid. While diet is important, physical activity is just as important in maintaining an optimal body weight. Another factor is inadequate sleep.

See this posting for more information on physical activity and this one on sleep.