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Health Prescribed or Health Deprived?
By Steven G. Aldana, Ph.D.
Brigham Young University

[Dr. Steven G. Aldana, a professor in the College of Health and Human Performance at Brigham Young University, has published 4 books and over 60 scientific articles on nutrition and exercise. He is currently one of the nation's leading authorities on chronic disease prevention.]

Overview
Diet, exercise and the related health conditions have been discussed a great deal in Wilderness Treatment Programs. Complaints from participating students suggest that there may be valid concerns regarding the quantity and nutritional quality of the foods provided to program participants. Certainly the validity of these concerns must be addressed, yet it is important to view these complaints in the context that these teens are coming into the program with perhaps the worst diets possible. Any dietary changes from the nutritionally poor fast food/junk food they are accustomed to, would most likely be described as unpleasant. An independent evaluation of the nutritional value of the diet given to students in the RedCliff Ascent Wilderness Program appears to refute any allegations of deprivation. In fact, the results of the evaluation show that the nutritional quality of the food provided to RedCliff participants is much healthier than the foods eaten by the public at large. When combined with a regimen of regular physical activity, the quality of the nutrition given to participants in this wilderness program represents an intervention that can prevent cardiovascular disease, and most cancers.

This report summarizes the results of the independent evaluation. The diet of RedCliff Ascent Wilderness Program student participants was analyzed in terms of its nutritional value, quantity and its effect on the body while they were hiking in the wilderness. From March, 2002 to January 2003, 112 youth with complete sets of data, including a baseline and a discharge physical exam, graduated from the wilderness program. Of the 112 participants in this data set, 80 were male, 32 were female and the average time spent in the wilderness was 59 days. During the physical examination, resting heart rate, body composition, height, and weight were ascertained.

Fat mass and lean mass in the participants was estimated using the Tanita Electrical Impedance Scale. Fat mass, a calculated estimate of the total amount of fat a participant has, is measured in pounds. Lean body mass is by definition everything else but fat mass. For example, a person who weighs 150 pounds could have 50 pounds of fat (fat mass) and 100 pounds of muscle, bone, skin, connective tissue etc. (lean mass). Measurements of weight and body mass index were also taken but were not used because they can mask changes in muscle and fat tissue. If deprivation is occurring it will likely occur to all participants, even those who have sufficient fat stores to tolerate long-term caloric deficits.

Results
For this analysis, individual baseline measures of both fat and lean mass were ranked from the lowest to highest amounts and were categorized into equal fourths, or quartiles. These quartiles are represented by Q1-Q4 and can be seen in Table 1. Baseline quartiles were calculated separately for males and females for fat and lean mass.

The top half of the table shows changes in fat mass for males and females. For example, the line that starts with Q1 on the male half of the table represents the lowest 25% of fat mass scores for males at baseline. Visually, these teens would appear to be very lean with little visible body fat. The average fat mass for this group was 13.1 lbs and after an average of 59 days in the program they had 16.6 pounds of fat at discharge, a gain of 3.5 pounds of fat. Line Q4 of the same section of the table shows the quartile with the highest amount of fat at baseline. This group of boys started with an average of 66.6 pounds of fat and lost 22.4 pounds of fat at discharge. Paired t-tests and a Repeated Measures ANOVA statistical test were used to determine whether differences in fat and lean mass were significant; if so, they were marked in the table with an asterisk.

Both males and females who had low levels of body fat at baseline actually gained fat by the end of the program, which is demonstrated in Table 1. Those with approximately average levels of fat at baseline, represented in Q2, didn't change much. Those who entered the program with elevated levels of baseline body fat, those in Q3 and Q4, lost significant amounts of body fat. Changes in lean mass or muscle are also dependent upon baseline levels of muscle mass, as is the case with fat mass. All the females (Q1-Q4) gained muscle mass. Only the boys with the least amount of muscle tissue at baseline (Q1) gained additional muscle. For the boys with the highest amount of muscle (Q3,Q4), there was a small, but significant decrease in muscle mass.

Discussion
These changes in body composition are considered to be favorable, and are the result of adequate and wholesome nutrition and regular vigorous physical activity. To verify this assumption, additional nutrition and physical activity data were gathered.

RedCliff staff provided detailed information about the foods each participant received. The nutritional composition of each participant was analyzed using the Nutrition Analysis Tool 2.0. On average, each participant received enough food to provide him or her with 3,137 calories per day. The composition of the calories was: 18% protein, 33% fat, consisting of 11.8% saturated fat, and 49% carbohydrates, of which less than 5% was from simple sugars. Each participant received approximately 5.5 servings of fruits and/or vegetables each day and as much water as desired. The diet also included ample servings of nuts, whole grains, beans, and lean meats. The overall content of the food was recommended by Dr. Walter Willett, Chair of the Department of Nutrition at Harvard University. Many of these Eat, Drink, and Be Healthy.

The energy expenditure per participant was quantified using basal metabolic rates that were calculated by gender and age using the Harris-Benedict equation. As part of their program, participants hiked with packs weighing approximately 30% of their body weight for 2-5 hours, five days a week. Measures of resting their heart rate, a crude estimate of cardio-respiratory fitness, revealed that both males and females had lower resting heart rates at discharge, with the likelihood that their fitness was improved.

Participants are able to consume 3,137 calories per day and expend approximately 2,400-3,000 calories in metabolism and exercise. If participants consume all of the food they receive, most will gain weight. Interviews with RedCliff staff confirm that many participants had extra food at the end of each week.

Parents of teens as well as RedCliff staff have frequently commented that many participants have a dramatic reduction of their acne by the time they graduate. It is possible that the changes in diet and regular physical activity could be responsible for these improvements. Increased exposure to the sun is also a likely explanation. Staff have also observed that many teens stop taking common medications such as inhalers without ill effects. There is no empirical data to support this observation, but is possible that such benefits could be caused by the newly acquired lifestyle. Studies of adults have documented that those who undergo lifestyle change can reduce or eliminate the need for many medications required to treat common chronic diseases.

Conclusion
In addition to the potential benefits the participants experience from RedCliff counseling and group support, results from this analysis of data shows that the nutrition and activity components of the program appear to refute any allegations of deprivation. Surprisingly, the nutritional quality of the food provided to participants is much healthier than the foods eaten by the public at large. This diet, when combined with a regiment of regular physical activity, represents an intervention that will prevent cardiovascular disease, and most cancers. Indeed, by altering their therapeutic modalities slightly, RedCliff could have the perfect wilderness health program for anyone in the rest of the U.S. population who wants to learn how to live a healthy lifestyle. People who eat and exercise like these teens will lose excess fat, gain muscle mass, improve their fitness and dramatically reduce their risk of heart disease, stroke, diabetes, and cancer.

Table 1.