Healthy Eating - Healthy Action
Oranga Kai - Oranga Pumau

Newsletter
Issue 4, July 2007

In this issue:

• An Introduction from Dr Debbie Ryan
• Feeding our Futures: Gaining Momentum
• Ngahuru Agencies for Nutrition Action Conference
• Ngati and Healthy
• HEHA Finalists in New Zealand Health Innovation Awards
• Profiling Pacific islands Heartbeat
• Introducing Naomi Murray, Tairawhiti DHB HEHA Project Manager
• Ministries of Health and Education set to Survey Schools and ECE Services about Food and Nutrition
• Mission-on Lifestyle Ambassadors
• Library Corner
• Healthy Eating Healthy Action Tips

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An Introduction from Dr Debbie Ryan

There’s been a lot of talk within the sector over the past couple of months about health targets. From 1 July 2007, the Ministry of Health is adopting 10 health targets in key priority areas aimed at improving the overall health and well-being of New Zealanders.

The health targets are part of a new direction for the health sector, a direction that is designed to establish clear and manageable priorities, improve management systems and increase collaboration within the health sector.

New Zealand is not the first country to develop and implement health targets. Australia, the UK and Norway all have some form of health targets. A publication on the experience of health target setting in Europe found that:

“Setting population health targets:

• Makes a clear statement that you can plan for health outcomes, not just for health services;
• Encourages debate on priorities and direction;
• Moves the public health sector to a new kind of accountability and assessment;
• Promises rational action based on evidence.”

Nutrition and Physical Activity make up one of the ten target areas. The Healthy Eating – Healthy Action team at the Ministry has responsibility to lead the work for two targets in this area.

They are:

• Increasing the proportion of infants exclusively and fully breastfed: 74% at six weeks, 57% at three months and 27% at six months;
• Increasing the proportion of adults consuming at least three servings of vegetables per day and at least two servings of fruit per day. The target has been set at 70% for vegetable consumption and62% for fruit consumption.

These two targets are aimed initially at goodnutrition and a key focus will be reducinginequalities. Targets on physical activity may comelater. It is important that health targets are not seenas an end in itself but that the process undertaken to influence the targeted outcome will lead to new and better ways of delivering services. Establishing health targets can help to focus a wider discussion on the determinants of health and design of the health system.

Achieving improvement in the nutrition and physical activity health targets particularly, will require all the players involved in HEHA to work together e.g.the Ministry of Health, DHBs, Ministry of Education, NGOs, SPARC, local authorities and all the varied stakeholders for Healthy Eating – Healthy Action.

The implementation of the targets will have two components. The first is Accountability and Monitoring through the District Health Boards reporting and monitoring mechanisms, and the second is through a programme of improvement support, sharing best practice and learning on effective interventions and programmes that have had measurable impact on targets. The Ministry is also bound by the targets in working with the sector.

The Ministry of Health’s new structure will facilitate support for achievement in the target areas. The new Sector Capability and Innovation Directorate is intended to identify innovative models and effective approaches and to ensure that these are shared across the system. The Ministry has appointed a ‘champion’ to each target area to work with the sector to improve performance. I have been appointed ‘champion’ for the nutrition and physical activity target areas.

The health targets are designed to challenge the health system to do better. I look forward to working with you all to continue the progress that has already been made and to make a real difference in achieving better nutrition and physical activity for all New Zealanders.

Feeding our Futures: Gaining Momentum

Launched at the end of May by the Minister of Health,Pete Hodgson, Feeding our Futures has begun to establish itself as a recognised brand.

Feeding our Futures is the first healthy eating social marketing campaign to be launched as part of the Government’s Healthy Eating – Healthy Action Strategy.

Developed and coordinated by the Health Sponsorship Council, Feeding our Futures is aimed at parents and caregivers of 8–12 year-olds particularly Maori, Pacific and low socio-economic households. The campaign provides parents with information about accessible, affordable and easy ways they can provide healthy diets for their children.

Feeding our Futures campaign manager Michelle Mako says they’ve had positive feedback on the mass-media campaign which involved a series of television, radio and print advertising which kicked off on May the 24th. The ads promote three key tips:

• Eating together as a family;
• Making water or milk the first choice, kids don’t need sweet drinks;
• Getting kids involved in the preparation of meals.

“But the mass-media campaign is only one small part of Feeding our Futures. We are now developing an implementation plan in partnership with Te Hotu Manawa Maori to plan how the programme can be implemented in Maori communities.”

Michelle says seven hui were held around the country throughout June. The hui were intended to identify effective processes for implementing the social marketing campaign for Maori, mechanisms for the campaign to reach and support those working with Maori, kaupapa Maori approaches to social marketing and to identify activities already in place that support Feeding our Futures.

“We have been really happy with the attendance at these hui which will inform the development of approaches that can be used by Maori and community providers in their communities.”

“Another challenge is to ensure we equip those working in the public health nutrition and physical activity sector with the right opportunities to reinforce the messages behind Feeding our Futures,” says Michelle.

“The Health Sponsorship Council has developed a number of programme resources to support those working in the sector. We also welcome any feedback on ways that Feeding our Futures may support the work people are doing in their local communities.

”To view and purchase resources and for further information on Feeding our Futures please go to- www.feedingourfutures.org.nz

Ngahuru Agencies for Nutrition Action Conference

Around 250 people from the public health nutrition and physical activity sectors recently spent three days together learning, sharing ideas and networking at the Agencies for Nutrition Action Conference ‘Ngahuru’ in Rotorua at the end of May.

ANA’s Executive Officer, Nicola Chilcott, says food security and increasing engagement with Maori and Pacific communities and Non-Government Organisations were two of the key themes which emerged from the conference.

Dr Martin Caraher from the Department of Health Management and Food Policy at City University in London was one of the international speakers and spoke at length on food security.

Nicola Chilcott says food security is the ability of individuals, households and communities to acquire appropriate and nutritious food on a regular and reliable basis and using socially acceptable means.

Nicola says Dr Caraher’s presentation left those that attended with a few things to think about.

“If we don’t deal with the underlying factors that lead to food insecurity,we will never get to the root of poor nutrition and obesity. That often comes down to factors such as income and other environmental issues.”

“Another key theme that also emerged was the issue of self-regulation. Dr Caraher and other guest speakers were of the view that self-regulation doesn’t work. I think the Government’s response to date is to test this theory by measuring the effects of Government interventions, like the voluntary agreement signed recently between the Government and the New Zealand Television Broadcasters Council, to improve food advertising to children.”

Nicola says the conference was also a chance for groups to raise issues they were concerned about Maori, Pacific and Non-Government Organisations made it clear that they would like to be more widely consulted and included in implementing the Ministry of Health’s Healthy Eating – Healthy Action
Strategy.

“It was also clear that the Ministry of Health’s HEHA representatives at the conference took these messages on board and they will endeavour to be as inclusive as possible within political processes and timeframes.”

Professor Wendy Brown from the School of Human Movement at the University of Queensland presented her current research project at the conference, which looks at the levels of physical activity amongst women and the links between physical activity and overall well-being. Wendy’s research showed us that women in their 20’s are more likely to be less active than other age groups and gain weight at a higher rate than those in their mid-40’s and 60’s. She also presented reasons as to why that was the case, for example, women in their 20’s are more likely to get married and have children which makes many of them less active.Activity levels increase as women get older,once children leave home or women reach retirement age.

Nikki says this gave conference delegates some food for thought, when it comes to planning campaigns around target audiences.

“Another highlight was the launch of the Feeding our Futures social marketing campaign, launched by the Minister of Health, Pete Hodgson, as well as the release of the ANA Scientific Committee report into the link between eating breakfast and children’s academic performance. The authors of this report were Associate Professor Robert Scragg, Dr Rachael Taylor and Rob Quigley.”

The report, which was developed after an extensive literature search, found that many New Zealand children are not eating breakfast. Overall, 23%of Maori, 41% of Pacific and 8% of New Zealand European and other ethnicities don’t eat breakfast.“This equates to approximately 83,000 children each day”, said report co-author Rob Quigley. The study’s authors are calling for information about the importance of eating breakfast for achieving educational outcomes to be disseminated widely to parents and schools.

“Overall, the second ANA conference was a success and we hope those that attended came away feeling energized and inspired to continue to work towards our mutual goal of improving nutrition, increasing physical activity and reducing obesity.”

A disc of PowerPoint presentations will be sent to all conference participants. A limited number are available to anyone wanting further information from any of the presentations made at the conference.

Ngati and Healthy

Communities living on the East Coast are seeing huge benefits and reaping the rewards following the continuing success of Ngati and Healthy.

The Ngati and Healthy Diabetes Prevention Project began in 2003 as a collaboration between Ngati Porou Hauora and the University of Otago’s Edgar National Centre for Diabetes Research, to prevent diabetes in the Ngati Porou rohe (region).

Ngati and Healthy programme manager Terry Ehau says, “Back in 2001, a committed team of about 9 people began working on this project,following a challenge from Ngati Porou Hauroa, the local primary health provider and the Ngati Porou community, to do something to address the growing number of new Type 2 Diabetes cases amongst East Coast Maori.

”Since then, things have gone from strength to strength. In November 2006, the Ngati and Healthy project won the Whanau Whanui section in the Whanau Ora Awards as well as the supreme award “Te Tohu Kahukura”. Early in 2007 the final draft of the process evaluation of Ngati and Healthy was produced, showing the project continues to be successful and have wide-reaching benefits for the Ngati Porou iwi.

Terry Ehau says the East Coast community population is about 6000 and over half are at high risk for or have diabetes. Ngati and Healthy has used a three pronged approach including a community education and monitoring programme, a health promotion strategy and a structural strategy to try and reduce the risk of diabetes in the community.He says the process evaluation has found that community awareness of the Ngati and Healthy‘brand’ has increased over the course of the project and it is now widely recognised in the Ngati Porourohe as well as nationally. It should not only be seen as a diabetes-related intervention, rather an intervention as a way of life, which carries messages about healthy eating and healthy exercise.

“The community views Ngati and Healthy very positively. The process evaluation found that this is due to its focus on community and its emphasis on community ownership which asserts being Ngati Porou and being healthy.”

Terry Ehau says Ngati and Healthy has impacted on whanau life. Those who were interviewed as part of the process evaluation indicated that their diet and exercise levels had improved since coming on board with the project and they were now more likely to pass on the Healthy Eating – Healthy Action message to their wider whanau, especially their mokopuna.

‘Pa Wars’ the annual Ngati Porou Sports Festival has now incorporated the Ngati and Healthy kaupapainto their programme with three categories having been added in the last two years – Ngati and Healthy Cooking, Ngati and Healthy Gardens and Ngati and Healthy Recipes.

Community groups in Matakaoa, Ruatoria, Tokomaru Bay and Tolaga Bay have been assisted to develop their own programmes which incorporate exercise and nutrition with support from SPARC, initially with their Green Prescription funding and more recently with their Active Communities funding.

Mr Ehau says, “We supported the community to initially develop their own programmes and then upskilled those involved to run their own programmes, identifying and building a good group of local champions along the way. Ngati and Healthy still supports the community groups with clinical and infrastructure support but the rest belongs to them.”

He says there’s a huge range of regular activities that are now being run and led by the community.These include a group of young mothers from the local Kohanga Reo in Matakaoa who go walking regularly, take part in Tai-Bo and circuit training and other older women who do line dancing and Taichi each week. One group started their own version of the reality TV show ‘The Biggest Loser’ which has been extremely successful.

The Kaiawahina for Matakaoa, Marina Ngatai,along with some of the participants have developed their own resource kits which include measurement statistics (weight, blood pressure,waist measurements) and health-related hand-outs,recipes and exercise routines.

“This is just one example of the amazing initiatives that have been created by taking a whole community approach to a public health problem like diabetes.”

Terry Ehau says the evaluation is clear that Ngati and Healthy should continue. We are taking on board some of the suggestions and recommendations made in the process evaluation to further enhance this intervention.

HEHA Finalists in New Zealand Health Innovation Awards

Four innovative healthy eating and physical activity programmes have been selected as finalists in the 2007 New Zealand Health Innovation Awards.

The awards are a long-standing initiative between the Ministry of Health and ACC, celebrating innovative thinking in the health sector and the winners will be announced at a gala event in Wellington in October.

Of the 22 finalists, four projects represent the goals of the Healthy Eating – Healthy Action Strategy.

Kahungunu Health and Community Services Charitable Trust is one of the finalists for its after-school programme encouraging healthy lifestyles ‘Te Wananga Taitamariki – Promoting Healthy Lifestyles to Decile 1 Tamariki’. The 10-hour a week after-school programme targets 8 to14-year-olds from Decile 1 schools in Hastings. Using a gymnasium as its base, the programmeis supported by home visits and healthy livinginformation from a community worker to help whanau improve their lifestyles.

Tamaki Healthcare PHO is also a finalist for itsDietician in Primary Healthcare project. The PHO isthe largest Maori-led primary health organisationin New Zealand and the project aims to reduceinequalities and give high quality services to those with the greatest need. Dietician Amy Liu runs free one-on-one consultations with patients and providesthem with culturally-sensitive treatment plans,education sessions and ongoing support.

The Mangere Healthy Kai programme promotes healthy eating choices at Mangere Town Centre andthe programme has had great success in improvingthe food supply in Mangere. Healthy foods like sushi,kebabs, rolls and low fat milk have been introducedin food outlets throughout the town centre.

The fourth and final HEHA-related finalist is LIFE – A Personal Wellness Programme for Older People, which is being run by Elder Care NewZealand. Increased fitness in older people requires that person to have the right diet for their individual needs and this project aims to improve older peoples’ quality of life and improve independence through an exercise programme within rest homes and hospitals around the country.

Ministry of Health spokesman Dr Colin Feek says New Zealand is showing it is at the cutting edge when it comes to progressive thinking and the development of ideas.

“It is great to see these four finalists have a focus on healthy eating and healthy action given that this is one of the Government’s priority areas. These awards celebrate those in the health sector who are making a huge difference when it comes to improving nutrition, increasing physical activity and reducing obesity.”

Profiling Pacific islands Heartbeat

Pacific Islands Heartbeat (PIHB) is a community health promotion initiative of The National Heart Foundation of New Zealand, and was established in 1991 in response to Pacific people’s high rates of cardiovascular diseases.

Manager of Pacific Islands Heartbeat Iutita Rusk says PIHB offers a range of services and resources throughout New Zealand aimed at encouraging and supporting individuals and community groups to make positive lifestyle changes. Services include train the trainer courses, community education and health promotion programmes in church settings.

“The Certificate in Pacific Nutrition (CPN) course is primarily aimed at Pacific health promotion workers but is available to any individual with an interest in working with Pacific people. The course provides theory and practical information in accordance with New Zealand Food and Nutrition Guidelines. Over eighteen courses have been held between 2002 and 2006 and 364 students have enrolled on the CPN course throughout New Zealand. The training facilitators are Pacific educators assisted by Heart Foundation health professionals. The certificate is awarded by Auckland University of Technology”, says Iutita.

She says smokefree services include smoking cessation and smokefree promotion training.Smoking cessation is for health professionals and community health workers looking for the knowledge and skills needed to assist patients in the cessation process. The course also provides the skills needed to provide brief intervention for patients. The skills and principles are evidence-based with a strong emphasis on what is culturally relevant and appropriate for Pacific cultures. Smokefree promotion training promotes a smokefree environment and encourages communities to prevent an uptake in smoking. This course has been running for over two years and has seen over a hundred participants.

Iutita says, “the Health Promoting Churches (HPC) programme is a community based health promotion initiative aimed at promoting healthier lifestyles in the church setting. It is a joint partnership between PIHB and churches, formalised by a Memorandum of Understanding. Thirty churches are involved in the HPC programme with five in Wellington and twenty five across Auckland.”

Written resources in Pacific languages are available for download at www.pacificheart.org.nz or contact our office at 9 Kalmia Street, Ellerslie, Auckland.

Introducing Naomi Murray, Tairawhiti DHB HEHA Project Manager

The first step towards achieving a healthy diet for children begins with bringing a family to the dinner table, according to the new national healthy eating programme.

I te taha o toku mama
Ko Marotiri te maunga
Ko Mangahauini te awa
Ko Tuatini te marae
Ko Ngati Porou te iwi
Ko Whanau a Ruataupare te hapu

I te taha o toku papa
Ko Whakarara te maunga
Ko Matauri te whenua
Ko Tapui te marae
Ko Nga Puhi te iwi
Ko Ngati Kuri te hapu

The Healthy Eating – Healthy Action (HEHA) Strategic Framework has been the basis for the role that Naomi has recently filled.Naomi has come from a background of physical activity and sport, hence her previous role as the Operations Manager for the Regional Sports Trust.

Although the HEHA Project Manager is a new role, the desired outcomes are familiar to Naomi. At Sport Gisborne Tairawhiti (SGT) she also held the position as Project Manager for the Tairawhiti Active Recreation Strategy(TARS), which was developed and completed upon her departure from SGT. The development of TARS was the vehicle for the identified need of collaboration and avoiding duplication of service delivery in the region in ‘activere creation’. The HEHA strategy will follow a similar framework, with an included emphasis on nutrition, breastfeeding and priority groups. Naomi has been completing a ‘stocktake’ of what is available in the region, looking at gaps and working with the region to fill them.

Naomi also takes part in voluntary work and is the Chair of the Gisborne Netball Centre. This role is a tool for Naomi to give back to a sport that has taken her to an international level. In addition to her governance experience, Naomi also volunteers as a current Director for the Gisborne YMCA of which she was the Health and Fitness Centre manager before SGT. Naomi has grown up experiencing YMCA programmes and wishes to provide guidance for others to experience the same. She is a mother of two beautiful girls aged 7 and 11 who are constantly challenged by the ‘healthier and more active options’in life, however, Naomi is the first to admit it’s not an easy job encouraging a healthier lifestyle to even her own children when the community is surrounded by other options, but she will continue to strive for change and better choices.

Active Mokopuna

Active Mokopuna is a Sport Gisborne initiative to improve the nutrition and activity levels of under-5’s.

Naomi Murray says Active Mokopuna is about creating a community/whanau environment to engage children in quality active movement and healthy food experiences.

Before Naomi joined Tairawhiti DHB recently as their HEHA Project Manager, she worked for Sport Gisborne, running this project.

“The Active Mokopuna team believe by focusing at the early childhood level, they can contribute to building the fundamental skills necessary for maintaining a physically active lifestyle with healthy food choices.”

Naomi says she’s pleased she can continue to work with Sport Gisborne and the Active Mokopuna team in her capacity as HEHA Project Manager.

For further information on Active Mokopuna please email info@sportgisborne.org.nz

Ministries of Health and Education set to Survey Schools and ECE Services about Food and Nutrition

The Ministries of Health and Education are preparing to survey nearly two and a half thousand schools and early childhood education (ECE) services to study their food and nutrition environments.

The 2007 NZ Schools and ECE Services Food and Nutrition Environment Survey (2007 FNES Survey)is the first part of a three phase programme to describe the food and nutrition environment in schools and ECE services and any changes in their environments over time.

A random sample of 1000 ECE services and 1000 primary schools, and all secondary schools will be invited to participate in the survey, which begins next month.

Senior Adviser of Public Health Medicine at the Ministry of Health Kirstin Lindberg says, “the aim of the 2007 FNES/Food and Nutrition Environment Survey is to collect information about the availability,supply and sale of food and beverages, as well as food and nutrition policies and procedures that exist within schools and ECE services.”

“It’s really helpful if schools and ECE services that are selected, do actually participate. This means that we’ll be able to produce reliable results. It’s also important to note that responses to the survey will be strictly confidential and no school or ECE service will be able to be identified in the data or results.”

Once the survey is completed, results will then be analysed with the aim of being available in April next year. The survey will then be repeated in 2009.

“The 2007 FNES Survey will provide valuable information to look for changes over time within the food and nutrition environment. The information will also be used to support the further development of food and nutrition policies and resources.”

Kirstin Lindberg says the survey supports the monitoring and evaluation of the Healthy Eating– Healthy Action Strategy and Mission-On campaign aim to improve the food and nutrition environment in schools and ECE services, such as the Food and Beverage Classification System and the Food and Nutrition Guidelines for Health Confident Kids.

Mission-on Lifestyle Ambassadors

A celebration to announce the new Mission-On Lifestyle Ambassadors was held at the end of May at Aotea College.

Four of the five Mission-On Ministers, Pete Hodgson, Nanaia Mahuta, Steve Maharey and Trevor Mallard were there to congratulate and celebrate with the Ambassadors.

The 2007/8 Ambassadors, who will visit schools promoting healthy lifestyles with children and young people are:

• John Campbell, TV3 broadcaster
• Bernice Mene, former Silver Fern
• Keven Mealamu, current All Black hooker
• Indira Moala, runner-up on series three of New Zealand Idol
• Nathan Rarere, both in his capacity as Mervyn and as a television host and comedian
• Laura Langman, Silver Fern
• Spacifix, a successful band from West Auckland
• Footnote, a contemporary dance company

Studio 2/ The Hub

Mission-On’s involvement with Studio 2/HubTV was launched by the Minister of Sport and Recreation Trevor Mallard on May the 19th.

Mission-On content promoting good nutrition and physical activity is now a major feature of this Saturday morning show for children and young people. Young people are encouraged to interact with the programme though the Hub website www.the-hub.tv

Coming up Soon

• The winter series of Activity Cards – in both English and Te Reo Maori – will be released to give children an alternative to the television during the school holidays. Check them out online at www.sparc.org.nz

Mission-On is a package of initiatives aimed at improving the lifestyles of young New Zealanders by targeting improved nutrition and increased physical activity. The outcomes sought are improved health,high educational achievements and a valued‘Kiwi lifestyle.’

Library Corner

The following include the latest publications and articles in the HEHA arena:

Articles:

The Role of Physical Activity in Producing and Maintaining Weight
Victoria A. Catenacci; Holly R. Wyatt Nature Clinical Practice Endocrinology &Metabolism. Volume 3, Number 7
Summary: The majority of randomised, control led trials (RCTs) show only modest weight loss with exercise intervention alone, and slight increases in weight loss when exercise intervention is added to dietary restriction. In most RCTs, the energy deficit produced by the prescribed exercise is far smaller than that usually produced by dietary restriction. In prospective studies that prescribed high levels of exercise, enrolled individuals achieved substantially greater weight loss-comparable to that obtained after similar energy deficits were produced by caloric restriction. High levels of exercise might, however,be difficult for overweight or obese adults to achieve and sustain. RCTs examining exercise and its effect on weight-loss maintenance demonstrated mixed results; however, weight maintenance interventions were usually of limited duration and long-term adherence to exercise was problematic.

Epidemiologic, cross-sectional, and prospective correlation studies suggest an essential role for physical activity in weight-loss maintenance, and post hoc analysis of prospective trials shows a clear dose-response relationship between physical activity and weight maintenance. This article reviews the role of physical activity in producing and maintaining weight loss. We focus on prospective, RCTs lasting at least 4 months; however, other prospective trials, meta-analyses and large systematic reviews are included. Limitations in the current body of literature are discussed.

Greater Survival After Breast Cancer in Physically Active Women With High Vegetable-Fruit Intake Regardless of Obesity
Journal of Clinical Oncology
Volume 25, Number 17 (June 10, 2007)
John P. Pierce, Marcia L. Stefanick, Shirley W. Flatt,Loki Natarajan, Barbara Sternfeld, Lisa Madlensky,Wael K. Al-Delaimy, Cynthia A. Thomson, SheilaKealey, Richard Hajek, Barbara A. Parker, Vicky A.Newman, Bette Caan, Cheryl L. Rock
From the Moores University of California, SanDiego Cancer Center, La Jolla; Stanford Prevention Research Center, Stanford University, Palo Alto;Division of Research, Kaiser Permanente Medical Group Inc, Oakland, CA; Arizona Cancer Center,Tucson, AZ; and The University of Texas M.D.Anderson Cancer Center, Houston, TX

Purpose: Single-variable analyses have associated physical activity, diet, and obesity with survival after breast cancer. This report investigates interactions among these variables.

Patients and Methods: A prospective study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000. Enrollment was an average of 2 years post diagnosis. Only seven women were lost to follow-up through December 2005.

Results: In univariate analysis, reduced mortality was weakly associated with higher vegetable-fruit consumption, increased physical activity, and a body mass index that was neither low weight nor obese.In a multivariate Cox model, only the combination of consuming five or more daily servings of vegetables fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk), was associated with a significant survival advantage (hazard ratio, 0.56; 95% CI, 0.31 to 0.98).The approximate 50% reduction in risk associated with these healthy lifestyle behaviors was observedin both obese and nonobese women, although fewer obese women were physically active with ahealthy dietary pattern (16% v 30%). Among those who adhered to this healthy lifestyle, there was no apparent effect of obesity on survival. The effect was stronger in women who had hormone receptor–positive cancers.

Conclusion: A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables, fruits and moderate levels of physical activity. The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival.

Book:

The seven deadly sins of obesity: how the modern world is making us fat
Sydney : UNSW Press, 2007.
Argues that the skyrocketing increase in obesity levels is not caused by individuals’ moral weakness,but is due to modern society lacking the virtues necessary for people to adopt and maintain healthy behaviours. In a fresh and highly original approach,the book proceeds to identify a set of seven social and environmental ‘sins’ that characterise our contemporary world, and then describes how each impacts on the level of obesity.

Healthy Eating Healthy Action Tips

Healthy Eating is...
Breakfast is an important meal of the day. Some good ideas for foods before work and school are fruit, for example, bananas, apples, oranges or tinned fruit in juice; cereal and milk; toast and spreads. Other options include leftovers, toasted sandwiches, baked beans, spaghetti or an egg on toast. A glass of milk or a yoghurt is also a good choice. Some ready to eat cereals are high in sugar, fat and salt and it’s best to use the low sugar/low salt options, such as porridge and wheat biscuits, as everyday choices.

Healthy Action is...
In winter it is often harder to motivate yourself to be active. Try setting yourself a goal or event to aim for and train for. This might be a 5 km or 10km walk or run or a mini-triathlon. Encourage your family/whanau, friends and work colleagues to participate as well.

Contact details
We would love to get your feedback on this bi-monthly newsletter and, of course,to hear how HEHA is being implemented in your respective regions. Please send your contributions to heha@moh.govt.nz