Childhood Obesity and the Environment

April 15, 2014

Childhood Obesity and the Environment-Determinant factors

Remove all the obesity incentives within the environment for children. Research findings associate childhood obesity to the environment.

We are living in a very unpredictable world when it comes to physical health of the entire humanity. Every parent wish is to raise a healthy family and most importantly the good health of the children. The health complications among children is a serious concern to parents and this is going to form the basis of our discussion in this article focusing on obesity among children and the effects of their environment as a determinant factor.

New evidence is confirming that the environment children live in has a greater impact than factors such as genetics, insufficient physical activity or other elements in efforts to control child obesity. Three new studies, published in the April 8 Pediatrics, land on the import of the ‘nurture’ side of the equation and focus on specific circumstances in children’s or teen’s lives that potentially contribute to unhealthy bulk.

Studies revealed that in the past three decades child and adolescent obesity has more than tripled in the U.S and the world at large, estimates from 2010 classify that more than a third of children and teens as overweight or obese. Obesity puts these children at higher risk for type 2 diabetes, cardiovascular disease, sleep apnea, and bone or joint problems. The variables responsible are thought to range from too little or no exercise to too many soft drinks. Now it seems that blaming Pepsi or too little PE might neglect the bigger picture.

Experts express fears that we are raising our children in a world that is vastly different than it was several decades ago this is because Childhood obesity is a disease of the environment. It’s a natural consequence of normal children with normal genes being raised in unhealthy, abnormal environments. The environmental factors in these studies range from the seemingly minor, such as kids’ plate sizes, to bigger challenges, such as school schedules that may keep teens from getting sufficient sleep. But they are part of an even longer list: the ubiquity of fast food, changes in technology, fewer home-cooked meals, more food advertising, an explosion of low-cost processed foods and increasing sugary drink serving sizes as well as easy access to unhealthy snacks in vending machines, at sports games and in nearly every setting children inhabit—these are just a handful of environmental factors research has linked to increasing obesity, and researchers are starting to pick apart which among them play bigger or lesser roles in making children obese.

Childhood Obesity and the Environment-Size matters in “obesogenic environments”
In one of the three new studies dishware size made a big difference. Researchers studied 42 second-graders in which the children alternately used child-size 18.4-centimeter (7.25-inch) diameter plates with 237-milliliter (8-ounce) bowls or adult-size 26-centimeter (10.25-inch) diameter plates with 473-milliliter (16-ounce) bowls. Doubling the size of the dishware, the researchers found, increased the amount of food kids served themselves in a buffet-style lunch line by an average of 90 calories. They ate about 43 percent of those extra calories, on average.

Although children can typically adjust their energy intake by regulating their food, their surroundings and options may change that equation for kids in the same way that it does in adults. This notion that children are immune to the environment is somewhat misguided, to promote self-regulation, you have to constrain the environment in a way that makes the healthy choice the easy choice.

Childhood Obesity and the Environment-Link between obesity and screen time
Overconsumption might be a key component in the link between obesity and screen time, too, according to another of the new studies. Although past research already had linked increased TV time to widening waistlines, this study dug deeper. Ninety one children between ages 13 and 15 year olds filled out diaries for TV, video games and computer use during a one-week period. About four to seven times a day the teens were paged to record what they were paying the most attention to at that particular moment, followed by activities receiving their second- and third-most attention.

Kids live in a multitasking world and in trying to assess their technology use when they’re using different forms of technology at once. Three theories have been floated for the link between screen time and obesity: food advertising, unconscious eating and displacement—that is, the idea that the media use replaces physical activity. The findings lent more support to the first two variables and less to the third. They found video games and computer use had no impact on BMI (body mass index). Television did, but only if it was the main event. Background TV, for example, didn’t matter.

Childhood Obesity and the Environment-Less physical activity is not the problem
Screen-time study did find that kids engaged in more physical activity had lower BMIs, but that does not mean that more exercise is keeping those teens lighter. “What we’ve seen for so many years is research looking at physical activity as the preventative or the curative solution for childhood obesity, but the data on physical activity as a means to set children’s weight is abysmal. What the study confirmed is that screen time increases obesity consequent to calorie intake, not to a lack of physical activity. That’s a crucial message that people don’t understand obesity is not a disease of inactivity.

Childhood Obesity and the Environment-Modifying children’s environment

To help our children from being obese, we need to reorganize their environment to try as much as we can to eliminate elements that facilitate occurrences of obesity. These are some of the elements to be put aside:

Sugary drinks from vending machines
Snack food serving sizes
Removed deep fryers from school cafeterias and replaced whole milk options with 1 percent and skim
Ensure new healthy nutrition standards both in schools and daycare centers for the children.
Encourage corner stores around the schools to stock their shelves with healthier snacks.

Finally controlling the happenings in our environment may be an uphill task for you and me, yet we all need to keep our children safe from obesity. If for whatever reason this problem is already affecting you or your child directly or indirectly you can get help at AWAREmed Health and Wellness Resource Center under Doctor Akoury. Hear all your worries will be sorted out humanely in the most natural and efficient way. Doctor Akoury and her team are professionals who care for you and will focus on Neuroendocrine Restoration (NER) to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE. Giving this a try will be one of the most precious gift you can give to your children, friends and even yourself.

Childhood Obesity and the Environment-Determinant factors

Obesity and the Economy

April 13, 2014

Obesity and the Economy-Reality of Poverty

It is possible to eradicate obesity irrespective of your financial status or your environment.

The need to put food on the table is everyone’s concern globally. Each passing day the entire humanity gets out all for one assignment that is putting food on the table. Various governments are working round the clock with a view of ensuring that there are favorable conditions for doing business all these efforts are geared towards feeding their respective citizens. Much as billions of dollars is channeled in food security, ascertaining this has been a challenge for many families and governments. So many studies have been conducted world over to ensure that we have healthy and hunger free society with very little progress. It’s because of this disturbing phenomenon that I want to take you through the sad reality of how harsh economic situation is causing the poor their comfort and how the few rich people are also sharing in the problem of obesity.

Food security

Feeding the society is the number one priority of every state down to the family. In the process of doing this some people will have more than enough for them, others will not even be fortunate to have what to eat drawing the line between the poor and the rich. The rich have access to good quality and healthy foods while the poor survive on anything available, to them quality is a luxury they cannot afford. They do not have constant flow of income, majority of them live below the poverty line and can barely afford a single meal let alone the common three triangular meals.

Obesity and the Economy-Limited food budgets and choices

With limited resources the poor has to budget for food and make certain difficult choices. The little they have must take them through the month or the season before they can get another pay or income, this leads to unhealthy behaviors in many ways:

They spend on food they do it with a lot of caution making sure that they spend on durables to last them the season. In the process of doing this, they choose high fat food with dense energy: foods like sugar, cereals, potatoes and processed meat products, the choice is guided by the affordability and durability than fresh vegetables, fruits and lean meat and fish. Such foods are often not healthy with high risk of weight gain and eventually obesity to their consumers.
They often live in disadvantaged neighborhood where healthy foods are hard to get. Their environment has a disproportionate number of fast food chains and small food stores providing cheap, high fat foods.
Economic insecurity-such as problem paying bills, rent may lead to stress making them to eat high fat, sugary foods.

Obesity and the Economy-Restricted physical activities

Good health is not just about eating the right kinds of food, it involve other things including participation in physical activities. These may not be easily available to the poor. Their economic situation does not allow them to access the gym facilities for active physical activities. The absent of continuous body exercise is recipe for weight gain and obesity.

The poor cannot afford organized children’s events outside school making their children to be less active physically. This is evidence because of inflexible work schedule, lack of transportation or unmet needs for child care, poor parents especially the single mothers may find it hard to support extra activities for their children. Leaving kids in front of the television is often all stressed poor parents can manage. This inability is not helpful to the children and as a result of this many children from poor societies suffer from obesity and eventually health complications related to overweight.

Obesity and the Economy-Food deprivation and overeating

Those who are eating less or skipping meals to stretch food budgets may over-eat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain. Cycles of food restriction or deprivation also can lead to an unhealthy preoccupation with food and metabolic changes that promote fat storage – all the worse when in combination with overeating. Unfortunately, overconsumption is even easier given the availability of cheap, energy-dense foods in low-income communities.
The “feast or famine” situation is especially a problem for low-income parents, particularly mothers, who often restrict their food intake and sacrifice their own nutrition in order to protect their children from hunger. Such a coping mechanism puts them at risk for obesity – and research shows that parental obesity, especially maternal obesity, is in turn a strong predictor of childhood obesity.

Obesity and the Economy-High levels of stress

Low-income families, including children, may face high levels of stress due to the financial and emotional pressures of food insecurity, low-wage work and luck of access to health care, inadequate and long-distance transportation, poor housing, neighborhood violence, and other factors. Research has linked stress to obesity in youth and adults, including (for adults) stress from job-related demands and difficulty paying bills. Stress may lead to weight gain through stress-induced hormonal and metabolic changes as well as unhealthful eating behaviors. Stress, particularly chronic stress, also may trigger anxiety and depression, which are both associated with child and adult obesity.

Greater exposure to marketing of obesity-promoting products

Low-income youth and adults are exposed to disproportionately more marketing and advertising for obesity-promoting products that encourage the consumption of unhealthful foods and discourage physical activity. Such advertising has a particularly strong influence on the preferences, diets, and purchases of children, who are the targets of many marketing efforts.

Limited access to health care

Many low-income people lack access to basic health care, or if health care is available, it is lower quality. This results in lack of diagnosis and treatment of emerging chronic health problems like obesity.

It’s quite unfortunate that this avoidable health problem is still with us and causing serious suffering to the human race. I don’t know what is ringing in your mind right now that you are a bit enlightened on the risk of obesity as a result of poverty. If you feel discouraged and hopeless for being obese, I have good news for you, at AWAREmed Health and Wellness Resource Center under Doctor Akoury all your worries will be sorted out doctor Akoury cares for you and will focus on Neuroendocrine Restoration (NER) to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE. This is something you don’t want to miss if you wish to have your life back and live it to the fullest.

Obesity and the Economy-Reality of Poverty

Obesity and Religion today

April 11, 2014

Obesity and Religion today-The truth of the matter

Weight gain, obesity has no room with this healthy but fun exercise

I come from a Christian background with good moral teachings at a family level and beyond. In my up bring I can state with certainty that apart from when in school all my days were spent either in the church or in a church related event or function, and so I am a son of the church if I may put it that way. Why this introduction in this health topic? Is there any meaningful relationship between the church (religion) and obesity as a health risk today? Answering these questions will form the basis of this article and I take the earliest opportunity to seek your indulgence to take a moment and read on.

Obesity and Religion today-Order of events

You are probably wondering why obesity in the church set up, I was wondering too but listen to this, in my introduction I mention that “apart from time spent in school, all my days were spent either in church or in a church related function” to understand this better let us discuss some of the orders of my church, every:

Mondays the church has fellowships in various local languages and this is a door to door event done in rotation depending on your cell group.
Tuesdays is set aside for senior believer’s fellowship that is those who are very strong and undoubtedly faithful to the doctrines of the church as spelt in the bible.
Wednesdays is for fellowship conducted in the national language meaning all ethnic groups attend in their respective cells (i.e.., eastern, western, central and more)
Thursdays is church bible study.
Fridays all the cell groups of Wednesdays have one regional meeting in a given location.
Saturdays is dedicated for young adult’s fellowship.
Sunday we have four different church services.

Obesity and Religion today-The diet

As you can see each day of the week is occupied. Now back to the problem of obesity in all these events and many others not mention there is food every time these meeting takes place. The feasting after each event is normally not under any control. Host members take their day and entertain their guest in their own way. You can now start to understand where I am heading to. The kinds of meals prepared are so luring and appetizing that everyone will always ask for more. At this time the knowledge of healthy feeding habits is not a consideration and faithful can only feast and make merry.

You can margin if you subscribe to all these groups and you are committed in each on a daily, weekly and monthly basis not withstanding your own poor feeding style at the restaurants and even at home, you will certainly become addicted to food and poor you it is with the wrong kinds of food which are not in any way healthy at all. It’s no wonder some studies have established that young adults who frequently attend religious activities are fifty percent more likely to become obese by middle age as compared with young adults with no religious involvement

We may not categorically state that religious participation is associated with development of obesity, but looking at the narrations above it’s possible that getting together weekly and associating good works and happiness with eating unhealthy foods could lead to the development of habits that are associated with greater body weight and obesity.”

Obesity and Religion today-Awareness

Previous research established a correlation between religious involvement and obesity in middle-age and older adults at a single point in time. By tracking participants’ weight gain over time, however the new study makes it clear that the normal weight of younger adults with high religious involvement became obese, rather than obese adults becoming more religious, this research is being presented at the American Heart Association’s Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011 in Atlanta, Georgia.

Obesity is the major epidemic that is facing the globe’s population right now. We know that people with obesity have substantial risks for developing diabetes, heart disease and certain types of cancer, and of dying much younger. It’s therefore very important that we use all of the tools at our disposal to identify groups at risk and to provide education and support to prevent the development of obesity in the first place. Once the weight is on, it is much harder to lose it. Knowing this, as writers and the society at large we must caution that the research findings should by all means be taken to mean that people with frequent religious involvement are more likely to become obese and not that they have worse overall health status than those who are non-religious. This is because we all can testify that people with frequent religious involvement tend to live longer than those who aren’t religious in part because they tend to smoke or take alcoholic drinks less if not at all.

Here’s an opportunity for religious organizations to initiate programs to help their congregations live even longer. The organizations already have groups of people getting together and infrastructures in place that could be leveraged to initiate programs that prevent people from becoming obese and treat existing obesity. This is an action point and these groups must desire to embrace teachings on how dietary changes and increased physical activity can lower cardiovascular disease risk factors such as obesity, cholesterol and high blood pressure.

Now that you know how to gain weight and become obese in the religion set up you need to make a positive decision about this problem. It’s not something you would want to try but instead run away from as much as you can. I want to make this conclusion remarks for you who is reading this article, if you are already have the problem of weight gain or obesity or if you know of a friend or relative going through this, help is just a stone through away with doctor Dalal Akoury of AWAREmed Health and Wellness Resource Center. Doctor Akoury cares for you and will focus on Neuroendocrine Restoration (NER) to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE. This is something you don’t want to miss if you wish to have your life back and live it to the fullest.

Obesity and Religion today-The truth of the matter

Obesity and Gender difference

April 10, 2014

Obesity and Gender difference-Do we have equality in this?

the issue of obesity cuts across all gender men and women suffer victims and must start healthy living

Many people think that there is a dramatic difference in how obesity affects men and women. The truth is, we have more in common than not, but some notable differences do exist.

The emotional and physical struggles are pervasive and attack a man’s self-esteem and social status in many of the same ways as women. It may be that the misconception about these differences applies to more overweight individuals.

It may well be that men are less sensitive to being overweight or on the leading edge of obesity as they are often considered to just be the “big guy,” and it is less socially acceptable for women to be even moderately overweight.

Men who are overweight are sometimes perceived as being stronger and the guy you ask over to help on moving day. There is however the point of no return where the “big guy” is just the “fat guy.” He is no longer seen as the helpful or strong guy but the one that can’t be physically active and would only hurt him on moving day.

Obesity and Gender difference-Eating Habits and Gender

It has been documented that there are gender differences in eating habits. Specifically, a study conducted by Foodborne Disease Active Surveillance Network (FoodNet) found that men tend to eat more meat (particularly red meat) and poultry and women were more likely to eat fruits and vegetables. Additionally, the sexes find comfort in food, but approach this aspect of food in very different ways.

Experts in a study conducted in 2005 Journal Physiology & Behavior (Vol. 86, No. 4) found that men were more likely to use food in celebration, and they will seek out higher protein foods such as steak. Whereas, women use comfort foods to cope with negative experiences and choose higher calorie sweet snack foods such as chocolate or ice cream.

The stereotype of the man going out for a big steak dinner to celebrate a promotion at work and the woman drowning her sorrows for the lost relationship in a half gallon of ice cream actually have scientific merit.

That is not to say that men do not also deal with negative emotions with food as women do, but that times of celebration are also times of risk for poor eating decisions. It is in these celebratory activities ware men seem to be more unique and choose to feed themselves in discriminatively to crown the event. In so doing they lose track of their diet and gain more pounds

The part where men get lost is that coping occurs not just with negative emotions, but with even the positive ones. We often think about our bad decisions and negative coping, but men are more apt to throw caution to the wind in the efforts of celebration.

Obesity and Gender difference-Weight Gain and Gender

These differences may well play into how men and women deal with weight gain. There has been a distinct appeal to low carbohydrate approaches to men as they get to keep some of their favorite celebratory foods and are not resigned to salads and raw vegetables. Whereas women may be more likely to struggle with such approaches; or the recommended “protein first” approach to the post-operative diet plans.

Men differ greatly in how they deal with their vanity. Don’t fool yourself – even the manliest of men can be vain. Whether it is coloring our gray or replacing our missing hairs, we want our youthful masculine appearance. Weight issues are no exception.

Men long for the six pack abs and gun show arms which will elude most of us. Some of us struggled with weight issues early in our childhood. The early experience left us scared of ridicule and social exclusion. Others mourn the loss of their physical abilities and looks with the addition of weight later in life.

Obesity and Gender difference-Male Weight Issues

I have been leading aftercare support groups as part of my work. When starting my work there, we developed a men’s-only group, as men were often the minority in the existing support groups. It appeared as though the men wanted such a venue as they felt that there were significant differences in their experiences from women who had undergone gastric weight-loss surgeries.

The reality was that their experiences were not as different, but the issues that they wanted to work through were often not appropriate for the coed setting. It seems the weight kept the men from feeling as sexual and that many had given up on themselves. Their comfort in being out of any relationship or taking their relationship for granted had caught up with them.

Yes, I am letting the secret out that men are often more motivated to stay healthy to attract the opposite sex, but irony rears its ugly head. With increased weight comes decreased sex drive, not to mention decreased attractiveness.

Reduced sex drive is a prominent theme of the men’s groups; with this comes isolation. Later with their weight-loss well underway they are equally surprised by the return of sex drive and the confusion now how to handle this. With fragile self-esteem damaged by weight and years of social isolation, this sex drive is often an unwelcome surprise.

Obesity and Gender difference-Conclusion

In conclusion, men struggle emotionally, socially and physically with obesity just as women do, but there may be subtle differences in how that weight evolves and how they deal with the need to reduce the weight. Celebration, isolation, sexuality and self-esteem all can be obstacles as well as incentives to men in their weight-loss efforts. A better insight into the individual’s reasons for eating and the consequences of their weight will lead to better weight-loss efforts and increased self-esteem. Looking at the struggle both gender go through, I want to offer a solution which will be long lasting. If you are struggling with weight gain or obesity no matter gender, a visit to AWAREmed Health and Wellness Resource Center under Doctor Akoury’s is all you need. At this facility you will be cared for. Doctor Dalal Akoury will focus only on Neuroendocrine Restoration (NER) to reinstate normality through realization of the oneness of Spirit, Mind, and Body, Unifying the threesome into ONE and you will live your life to the fullest.

Obesity and Gender difference-Do we have equality in this?

Food that inspire food addiction

April 9, 2014

Food that inspire food addiction-They cause physical and emotional dependencies

mind much a bout the kind of food you eat, you may be feeding on food that cause addiction

In many cases overweight people are often seen or believed to be either lazy or just don’t have the will power to actively operate normally. The choice of food you eat, when you eat and frequencies of exercise you do affect your weight significantly. The previously ignored element may be food addiction; this does not necessarily mean that we are desperate for a candy bar. By the way some of the food that causes addiction are:

Chocolate
Sugar
Cheese
Milk
Meat

Food that inspire food addiction-Chocolate

Experts have found out that chocolate stimulates the same part of the brain that opiate drugs do, that is to say chocolate acts like a drug producing food addiction which causes us to crave for more and more of it.

Before we know, we are on the road to being addicted to chocolate. Emphasis should be made to the public that food addiction is not a laughing matter. Chocolate as food contains other stimulant drugs like caffeine, theobromine and pheylethylamine, according to expert’s chocolate is not just a drug but a whole drug store wrapped up in one.

Food that inspire food addiction-Cheese

But chocolate’s not the only food addiction studies have established that when people who were consuming meat and other dairy products are stopped from consuming the same, the yearning for cheese was described as a “deep seated craving” that stayed with them much longer than their compulsion for other foods. Researchers also found a chemical in cow’s milk similar to morphine, and after testing it repeatedly, they discovered that it was, in fact, morphine. It was only a trace amount, and not all the samples contained the chemical in recognizable levels, but there was indeed a small amount of morphine in cow’s milk.

Assuming that the morphine must have come from the cows’ diets, they were shocked to find that the cows actually made traces of it within their bodies, along with codeine and other opiates that were produced in their livers. They were also surprised to learn that cow’s milk (and the milk of any species) contains the protein, casein that breaks down during the digestion process, and releases other opiate-like compounds called casomorphins. What does this have to with cheese? Casein is concentrated in cheese. So we have the makings of another possible food addiction.

Food that inspire food addiction-Milk

Why are there traces of morphine in milk? (Actually, it’s not some environmental problem.) Scientists believe that the mother’s milk has a relaxing effect on the baby, and this drug-like effect on the brain is responsible for the bonding that is necessary, for the baby to get the nutrition he needs. Researchers gave volunteers yogurt and skim milk, and found that the casein (milk opiates) not only acted within the digestive tract, but some of the fragments actually entered the bloodstream, with direct access to the brain. The effect was greatest about 40 minutes after eating. As mentioned before, cheese has more casein than other dairy products. (Recent studies have found that meat also stimulates the brain’s pleasure centers.) To further prove their theory, researchers found that when volunteers were given naloxone, (a drug that blocks opiates, used in the treatment of heroin and morphine overdoses), their desire for cheese, meat, chocolate, and other addictive foods was greatly decreased.

Food that inspire food addiction-Sugar

In addition, scientists have discovered that fast foods, like hamburgers and fries, may also be responsible for food addictions. The high fat and carbohydrate content causes changes in the brain that are normally correlated with drug addiction, (and the result is food addiction.) Sugar and fat stimulates the release of natural opiates in the brain, and may be triggering the same response as heroin. After giving rats a diet that was one quarter sugar, he abruptly withdrew the sugar, and the rats went into high anxiety mode, experiencing trembling and teeth chattering, similar to the effects that occur during morphine or nicotine withdrawal. So, in review, the sugar produced the same withdrawal effects that highly addictive drugs do.

Food addiction plays an enormous role in our eating habits, when we’re depressed, tired, lonely, anxious, worried, fearful, etc. We run to the addictive food of choice. For me many people, it is chocolate and sugar, with carbohydrates following close behind, which is particularly bad and that explains why diabetic is rising. Certain foods act as drugs, because our body responds to the natural opiates in them, just as it would to drug opiates. As we experience these effects over and over, we may develop a food addiction.

Medical scans have even been able to document these findings about food addiction. Researchers compared the brain scans of drug addicts with chronic over-eaters, and found startling similarities. If you think about it, many of the behaviors are the same–the obsession, compulsion, and preoccupation with drugs, is often also experienced with food. The overwhelming guilt, the tendency to use drugs to relieve emotional problems, and even the secrecy that is often involved in drug use, is also a part of compulsive overeating. While none of the researchers are suggesting that the physical and emotional drive is as strong with food, as it is with heroin, what they have found is that some of the previously mentioned food addictions are a part of the overall problem of obesity or overeating. Food addiction is real, according to scientific research.

So how do we kick the habit of food addiction? Interesting unlike coming off of drugs, we can’t just stop eating. Nutritionist suggests starting your day with a good breakfast that will help you keep food cravings at a minimum. Try to keep blood sugar levels normal by staying away from white sugar, white flour, white bread, and other starchy foods such as white potatoes, rice, and pasta. Instead substitute low-fat protein, vegetables, beans, low-sugar fruits, and whole grains. Eat enough healthy foods to satisfy your hunger, and don’t go on starvation diets. You’ll just end up binging sooner or later, because your body feels so deprived.

Take a break from some of the more addictive foods, and you will soon experience less of a craving for them. Food addictions are just one component of overeating, and obesity. There are often metabolic issues, genetic variables, and complex physical and emotional reasons why we overeat. But learning about the addictive nature of some foods, can enable us to understand the powerful cravings that we sometimes experience, and help us on our path to healthy food choices.

Food that inspire food addiction-They cause physical and emotional dependencies

Category Archives: Men’s Health