Indiana University Research & Creative Activity


Volume 30 Number 1
Fall 2007

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Janet Wallace, Susan Middlestadt, and Alyce Fly
Janet Wallace, Susan Middlestadt, and Alyce Fly
Photo© Tyagan Miller


Behaving Healthy

by Tracy James

Denial. Big time.

When it comes to what, and how, we eat, our society is in a collective state of denial. So say Susan Middlestadt, a health behaviors expert in Indiana University Bloomington's Department of Applied Health Science; Janet Wallace, an exercise physiologist in the Department of Kinesiology; and Alyce Fly, a nutrition scientist in the Department of Applied Health Science.

"Everyone knows they should exercise and eat healthy but they don't necessarily do it," Wallace says. "This frustrates us as practitioners. We need to get people going in the direction they should go."

Or as Middlestadt puts it, "We know a lot of things we want people to do. We just don't know how to get people to do them."

As their titles suggest, these professors focus their expertise on studying human behavior, physical activity, and healthy eating. Together, they are leading a determined effort to help Americans, beginning with Hoosiers, trim their waistlines and feel better-- but they're keeping the "O" words out of it.

"I can't use the 'O' word anymore," says Wallace, who studies the role of exercise in preventing or treating diseases. "When you use the word 'obesity,' it turns people off; it stigmatizes the issue and the people."

Through a multi-year study called Eating Better Moving More, the three researchers are focusing on behaviors many adults and children enjoy and understand, such as eating breakfast, walking, and youth sports. They want to keep it simple, talking about eating habits involving fruits and orange and dark green vegetables, not nitty-gritty dietary do's and don'ts.

Breakfast and Beyond

Middlestadt, an applied social psychologist, has been involved with changing health behaviors for more than 30 years. During that time, she has evaluated and designed interventions for health behaviors surrounding HIV and other sexually transmitted diseases, health-care seeking, smoking, and more recently, overweight, obesity, and related diseases.

Before coming to IU several years ago, Middlestadt directed the Center for Applied Behavioral and Evaluation Research at the Academy for Educational Development, a nonprofit organization that works to solve critical social problems throughout the world, collaborating with organizations such as the national Centers for Disease Control and Prevention and the U.S. Agency for International Development. She helped design a variety of programs now in use in the United States and in developing countries.

In today's world, she says, behavioral factors are among the most prominent contributors to morbidity and mortality, reflected in the toll of chronic diseases of the heart, cancer, stroke, HIV, and other infectious diseases such as hepatitis C and human papilloma virus. Unlike these critical health issues, however, overweight and obesity are just beginning to see a real increase in research and programs that address the problem through screening practices and lifestyle changes.

"A lot of shifts in our everyday lives have had consequences for our weight and our fitness," Middlestadt says. "If I had to say one thing about what makes behavior change programs successful, it would be to examine and work at multiple levels, to work with individuals and all the systems that influence them. It's about playing video games, watching television, and eating in our cars. It's about sidewalks and parks. We'll need to link up with people who design cities and supply us with food--it's that complex.

"The term 'behavior' is used in a different way by almost every scientist I've ever talked to," she continues. "Behavior of humans is different than the behavior of molecules."

Fly, a nutritionist and dietitian, says she struggles with the language of behavioral research, but points out that the effort of reaching beyond disciplinary "silos" is well worth it.

"I know the most healthful food choices to make and which patterns are in most need of improvement," she says. "Susan can capture the important ideas that affect the decisions people make to practice such healthy behaviors. Together, we can help people make healthy food choices."

Fly, Middlestadt, and Wallace began their study by asking the people they want to help--Hoosiers in workplace settings and adolescents--what they think, rather than telling them what to think.

"To help people make a change, you have to understand how they think about it," Wallace says. "There are a lot of theories about why people behave the way they do. But if you don't ask the people directly, they're still theories."

By asking adults and students from rural schools open-ended questions in face-to-face interviews, Wallace and her colleagues were able to record what people think about the selected behaviors--eating breakfast, eating fruits and orange and dark green vegetables, and participating in physical activity. The responses offered insight and also some surprises. The researchers found, for example, that energy turned out to be an important consideration for people who eat breakfast regularly and that some people skip breakfast because they think it is disapproved of.

"We usually tie interventions to long-term health advantages," Middlestadt explains. "When you get the person's perspective, the health perspective is there, but it might not be the one that's driving the decision. With breakfast, getting energy seems to be a driving force, not that you might live longer."

They also found that although half of the working adults interviewed had access to some form of food service, such as a cafeteria or vending machine, many of the study participants thought their employers disapproved of them eating breakfast. Whether the employers truly disapproved is unknown--it's the employees' perception that is important to the success of creating programs employers can use as part of workplace wellness efforts.

"Most workplaces want to provide programs for their staff because of the established findings that wellness programs help with health-care costs, employee retention, and productivity," says Middlestadt. "In addition to having a stepping program, though, you have to get people to participate. In addition to providing a breakfast program, you need to get people to participate."

Downstream Eating

Breakfast, says Middlestadt, is an "upstream behavior." "Downstream" behaviors are things such as eating fruit, fiber, and protein, which you do by eating breakfast. Studies show that when people eat breakfast, they typically eat a better composition of food than during their other meals. That makes breakfast a "neat behavior," too. Instead of trying to specify certain amounts of each food group or talking about trans fats and other nutritional concerns, people can simply be encouraged to eat breakfast.

Study participants were asked about eating a cup of fruit each day and two cups each of orange and dark green vegetables every week. Fruits are a rich source of many nutrients, and eating fruits regularly is important in preventing chronic disease and obesity, Fly points out.

When it comes to vegetables, much of the interviewees' feedback concerned availability, food preparation, and packaging issues--vegetables just aren't as convenient to bring to work or eat on the run. One strategy to address these issues, Middlestadt says, could involve working with manufacturers to design more conveniently packaged vegetables, although smaller packages of veggies can mean higher prices, which creates new problems. Another approach could involve showing people how to prepare their veggies in ways that make eating them regularly easier.

For the physical activity component, the researchers asked people about activities that could be scheduled into a day, such as a workout or youth sporting activity, or activities worked into the day randomly, such as walking, counting steps, or playing at home after school. They want to understand better why some children, for example, choose to be active rather than playing video games.

The study, funded initially with a $134,000 grant from the state of Indiana, is still in the phase of organizing and analyzing the interviews with the adults and children. Once this stage is complete, a larger sample of participants will be interviewed before the scientists begin designing interventions--programs and strategies designed to help Hoosiers and Americans live healthier lives.

Middlestadt says they hope to work with employers to include some of their strategies in workplace wellness programs. They will work with schools as well.

"You can approach barriers to behavior in two ways, by changing the environment or by building skills to help people manage their own environment," Middlestadt says. She and her colleagues want to do both, without relying on fear tactics or invoking the "O" words.

"Rather than nagging people about obesity," says Middlestadt, "we need more fun things for people to do."

Tracy James is a media relations specialist in the IU Office of University Communications and a freelance writer in Bloomington.

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