National change in diet reduces health risk; upper arms training
April 2008
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National Change in Diet and Lifestyle Reduces Death from Heart Disease and Diabetes
by Barbara J. Moore, PhD
In contrast to many developing countries, Cuba has a national health care system and a well developed system for tracking vital events. It is known, for example, that life expectancy in Cuba is 77 years and cardiovascular disease is the leading cause of death.1

Since the 1960s, Cuba has been subjected to an economic embargo by the United States. In 1989, with the fall of the Soviet Union — Cuba's primary trading partner — Cuba entered a prolonged economic crisis, referred to as the "Special Period." The crisis deepened over the next six years with economic output in 1995 reaching only half the level in 1990. Foreign trade contracted by 80% with reduced imports, limited fuel availability, and a scarcity of many food items. Food was rationed and reductions in per capita daily energy intake were documented along with significant increases in walking and cycling as public transportation became unavailable. Since complete economic recovery did not occur until 2000, the Special Period lasted an entire decade.1

In 1993, nutritional studies documented that 27% of Cubans lost 10% or more of their body weight over the previous 12 months and 43% experienced severe caloric restriction. The prevalence of obesity decreased from 11.9% to a low of 5.4% during the height of the Special Period. Physical activity — walking and cycling — increased from 30% before the crisis to a high of 70% in 1995. This change was apparently sustained at 67%, as documented by national surveys in 2001.1

Substantial declines in mortality, or death, from type 2 diabetes (-51%), coronary heart disease (-35%), and all-cause mortality (-18%) were documented between the years 1995 and 2002, while rates of cancer mortality, which are not sensitive to obesity, remained relatively constant throughout the Special Period.

The Special Period in Cuba is the first demonstration of how decreased food intake and weight loss, coupled with increased levels of physical activity — circumstances that lasted for 4 to 8 years — produced significant reductions in diabetes and heart disease mortality throughout an entire nation.1

It is interesting to note that diet composition shifted during the Special Period. Carbohydrate intake increased from 65% to 77% of calories, as sugar cane and rice became the primary sources of energy. Fat consumption decreased from 20% to 13% of calories, as the availability of animal products declined throughout the country, and protein fell from 15% to 10% of calories.1 Some authorities would consider such a high carbohydrate, low protein/low fat diet to favor the development or exacerbation of diabetes; yet, it was accompanied by marked decreases in diabetes mortality.

There were many negative consequences of the Special Period. More elderly persons died, primarily of infections; the decline in infant mortality was interrupted for three years; and the incidence of low birth weight increased from 7.3% to 9.0%. An epidemic of neuropathy, or nerve damage, was documented. This was attributed to vitamin and protein deficiencies affecting at least 50,000 people examined between 1992 and 1993.1

With the end of the Special Period, the Cuban economy started to grow, productivity increased, and energy and food availability increased. Public transportation improved, so levels of physical activity declined again. Mortality from type 2 diabetes and heart disease reached its lowest point in 2001, but increased every year for the next four years. Like most countries around the globe, including the US, Cuba now faces the challenge of crafting public health initiatives to stem these increases.

The Special Period in Cuba suggests the potential public health impact that could be achieved with a carefully designed population intervention that maintains nutritional sufficiency while encouraging weight loss in overweight individuals. This natural experiment points to the importance of boosting physical activity and reducing calories while maintaining a high-quality diet with adequate sources of lean protein and other nutrient-rich foods such as vegetables, fruits and whole grains.

Barbara J. Moore, PhD, is President and CEO of Shape Up America!

Upper Arms Training: Part 1
by Shape Up America!
The muscles in the upper arms can be a challenge to maintain. With age, the strength and tone of these muscles can decline and in particular, the muscle at the back of the upper arm tends to droop. Some call it flabby arms — technically, the muscle is called the triceps brachii. There are a variety of exercises that you can do at home to strengthen the muscles in your upper arms and neck.

Here is one exercise to get you started:

Stand tall with your back straight and your feet planted firmly on the ground. It's important to maintain good form throughout the exercise. Your feet should be slightly apart so that you are well-balanced and stable. Now raise your arms to shoulder height and extend them out horizontally. Make a loose fist and move your thumbs to a "thumbs up" position toward the ceiling.

If you are a beginner, make small circles 10 times in the air. Each circle should be about 12 inches in diameter. Keep your arms straight (and your thumbs pointing up) as you make your circles; don't let your arms drop. If you need to, rest for a few seconds with your arms at your sides, before continuing.

Next, rotate your thumbs forward a quarter turn. Your arms will now be straight out to each side, but your hands will in a "thumbs forward" position. Repeat your 10 circles. Rest again if you need to.

With your arms straight out, rotate your thumbs another quarter turn so your thumbs are in a "thumbs down" position. This is the most difficult position because it is hard to keep your arms up as you do your 10 circles in this position. You have now completed one set. Bring your arms down to your sides and rest for about 10 or 15 seconds.

Repeat the set. Beginners should do 2 sets twice a week for several weeks before advancing to a more challenging variation of this exercise.

When you are able to complete 2 sets without stopping, you may advance to the intermediate level. Do 2 sets with the circles in one direction and then add 2 more sets with the circles in the opposite direction. After several weeks of working at this level, if you no longer have to rest between sets, you can increase the number of circles in each thumb position from 10 to 20.

At the advanced level, add a ONE POUND weight to each hand. This will make the exercise significantly harder, especially if you maintain good form by keeping your arms up as you make your circles. To make a one pound weight for each hand, fill two plastic water bottles with two 8-ounce cups of water and screw the lids on tight (16 ounces = 1 pound). If it feels too heavy, fill each bottle with one (8-ounce) cup of water to equal a half pound weight per bottle.

Grip the water bottles with each hand. Start with 10 circles for each position (cap pointing up, forward, then downward). Work your way up SLOWLY — over several weeks — until you are comfortable doing the exercise in each position without resting between sets and in each direction (circles forward and backward). At that point, you can start to increase from 10 to 20 circles per position.

To summarize:
Beginner 2 sets/30 reps per set, divided into 10 circles for each of 3 thumb positions
  • Extend arms out, make a fist. One set = 10 circles with thumbs up, 10 with thumbs forward, 10 with thumbs down.
  • Rest between each thumb position.
2 sets twice a week
Intermediate 4 sets/30 total reps per set
  • Do 2 sets as above, circling arms forward. Add 2 sets, circling arms backward.
  • Increase from 10 to 20 circles in each thumb position.
4 sets twice a week
Advanced 4 sets/30 total reps per set
  • Add 1-pound water bottle to each hand. Do 10 circles in each of 3 cap positions. Complete 2 sets, circling arms forward and 2 sets circling arms backward.
  • Slowly increase from 10 to 20 circles in each cap position.
4 sets twice a week

NIH Debuts First Annual Yoga Week
From May 19-23, the National Institutes of Health (NIH) will premier the first annual Yoga Week, in Bethesda, MD. Highlighting the science and practice of yoga, this five-day event will serve NIH employees and the public. Participants will not only learn about the benefits of yoga but also experience them first-hand through stretching and practice. Novice and experienced yoga students are encouraged to attend.

NIH Yoga Week events include lectures by current NIH grantees conducting research on yoga and presentations by leading yoga instructors. The kick-off event on Monday, May 19 from 11 A.M.-1 P.M. at the Natcher Auditorium (45 Center Drive, Bethesda, MD) is free and open to the public. Also incorporated into Yoga Week is "Karma Yoga," which is a theme of giving back to the community and those in need. Two charity outreach events will take place during Yoga Week for the NIH Safra Family Lodge and Manna Food Center in Rockville.

For more information on NIH Yoga Week, contact Dr. Rachel Permuth-Levine at

Menus for Weight Loss and Healthy Eating
Shape Up America! offers these simple, convenient 1500 calorie and 2000 calorie menus to help you eat healthfully while controlling your calories. If you have any suggestions or comments, feel free to e-mail us at

My Story
Suzannah honored her father's life by creating a better one for herself. She lost weight, got fit, changed careers and transformed herself into a healthier, happier person with a new zest for life.

In June of 2006 my father died in the hospital after dealing with complications from a stroke. The stroke, on his 77th birthday, was only a small part of his problems, though. He had led a sedentary lifestyle, had heart disease, type 2 diabetes, and was depressed for most of his life. My father spent the last month of his life in a new state-of-the-art cardiac-ICU. It was the jewel of a hospital already renowned for its expertise in cardiology. Nevertheless, spending almost a month in a hospital is sufficient time to make anyone decide that they never want to be a patient in one. Fancy schmancy or not.

Similar to being a middle school teacher, I am quite sure that I'd never want to go back to middle school. Of course losing a parent necessitates change, but two messages from that hospital experience stood out that moved me to do a complete overhaul on my own life. First, I read in some waiting room pamphlet a quote that struck me in the right way at just the right moment. It said, "If I'd known I was going to live so long, I'd have taken better care of myself" (by Leon Eldred). The second thing that struck me in a serious way was finding out that many of the ailments that had plagued my dad could be prevented or slowed through diet and exercise.

So, I had been dieting for 25 years, smoking for six years, talking about getting fit since high school. I weighed 192 lbs, was seriously depressed, single for the first time since I was 14, and had just lost my father after watching him struggle with his health for years. At 40, I decided that I'd had enough and I decided to create a body that would make me comfortable. I would tackle all areas at once with diet and exercise. I would get healthy and free myself from pain and body image issues. I would focus on myself for a change. I would change my lifestyle, use movement to work through grief, and best of all honor my father's life by creating a better one for myself. Read More…

If you would like to share your personal success story and be an inspiration to others who desire to lose weight, simply use our story submission system on the SUA Web site.

Recipe of the Month
Turkey Meatloaf
Makes 6 servings


  • 1 Tbsp. olive oil
  • 1 medium onion, peeled and finely chopped
  • 1 carrot, peeled and grated
  • 1/2 cup celery, finely chopped
  • 2 garlic cloves, finely chopped
  • 1 tsp. fresh or a pinch dried thyme
  • 2 Tbsp. parsley, finely chopped
  • 2/3 cup canned tomatoes, finely chopped
  • 1 Tbsp. balsamic vinegar
  • 1 Tbsp. dark brown sugar
  • 3 drops Tabasco sauce
  • 1 egg white, lightly beaten
  • 1/2 cup bread crumbs
  • 1 1/2 lbs. ground turkey *
  • Dash salt and pepper
  • 2 Tbsp. Dijon-style mustard


  1. Heat olive oil in a large non-stick skillet over medium high heat. Add onion and sauté until it begins to soften.
  2. Add carrot, celery, and garlic, sauté until soft, about 5 minutes. Add thyme and parsley and place in a bowl to let cool.
  3. Heat oven to 375 degrees.
  4. Place tomatoes, vinegar, brown sugar and Tabasco in a mixing bowl. Add egg white, bread crumbs, turkey, cooled vegetables, salt and pepper. Mix until well combined.
  5. Transfer to a non-stick loaf pan (8" x 4"). Smooth top of loaf and brush with mustard. Bake about 1 hour, or until slightly golden on top. Pour off any fat and let stand 10 minutes before slicing and serving.

* Use lean ground turkey to cut down on calories, fat and saturated fat.

Nutritional analysis per serving: 325 calories, 20 grams total fat, 6 grams saturated fat, 77 milligrams cholesterol, 16 grams carbohydrate, 21 grams protein, 2 grams dietary fiber, 390 milligrams sodium

Source: Shape Up America!

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Editor: Adrienne Forman, MS, RD

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