domingo, 16 de enero de 2011

For Healing, Meals Made to Order

Nicole Bengiveno/The New York Times

TAKING REQUESTS Pnina Peled, executive chef at Memorial Sloan-Kettering Cancer Center. More Photos »

By SHIVANI VORA

Published: January 14, 2011

JULIEN COLLOT, who is 8 and has had leukemia, has been on a low-microbial diet since his two bone-marrow transplants, in 2006 and 2007. When he developed diabetes last year, he had to go low-fat and low-sugar as well.

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Delicious, and Healing

So Pnina Peled, the executive chef atMemorial Sloan-Kettering Cancer Center, makes Julien his beloved shrimp scampi with Promise, a butter substitute, and eggplant Parmesan using egg whites, whole-wheat bread crumbs and soy cheese. When Julien told Ms. Peled about his love of pumpkin spice cake, she presented him one baked with egg whites and applesauce. After he rejected the hospital’s whole-wheat ravioli, she hauled her pasta maker on the subway from Brooklyn to roll out a handmade version.

“She came in on her day off with a stack of cookbooks and sat with us to come up with a menu for him,” Julien’s mother, Jacqueline Collot, said the other day as her son relished whole-wheat spaghetti dressed with sesame oil and topped with green beans minced fine to look like scallions — Ms. Peled’s response to his stated craving for “unspicy spicy noodles.”

“What Pnina offers Julien is a combination of love of food and the freedom that was taken away for so long,” Ms. Collot added. “To see him interested in meals gives us great comfort.”

Ms. Peled, who came to Sloan-Kettering a year ago after working in some of the city’s finest restaurants and winning an episode of the popular Food Network show “Chopped,” is part of a revolution in hospital food. Bland broths, neon Jell-O and unidentifiable white-meat products are slowly becoming scarce. Instead, hospitals like the University of TexasMD Anderson Cancer Center in Houston and Cincinnati Children’s Hospital Medical Center have extensive room-service-like menus and give patients the freedom to order meals whenever they are hungry, while the kitchen staff at St. Jude Children’s Research Hospital in Memphis is happy to duplicate recipes provided by parents.

Sloan-Kettering patients, too, order meals from one of 75 room-service menus — kosher, halal, vegan, low-sodium, etc. But Ms. Peled said that when she started, she saw that patients who did not find anything appealing on the menu often would not eat at all, which motivated her to make the food service more flexible.

She has a team of 35 chefs from diverse backgrounds catering to the special requests of patients, particularly the younger ones, who come to the renowned cancer center from around the globe. In recent months, one chef has been serving dal, curries and rotis to a 16-year-old patient from India; another has made yellow rice for a 3-year-old Latino boy who wanted the version like his mother’s; and a third devised a menu of low-microbial foods for an 8-year-old girl from Italy who wanted dishes that reminded her of home, like fish Francese (it has a lemon sauce).

“There’s no substitute for a good diet, and appetizing food can make all the difference,” said Dr. Susan Prockop, a pediatric oncologist at Sloan-Kettering, noting that eating well can speed recovery and keep patients off intravenous nutrition.

Dominique Symonette, the registered dietitian in charge of pediatrics at the hospital, said that cancers, and chemotherapy, often result in mouth sores, nausea, vomiting and difficulty swallowing. Low-sodium, low-sugar and low-microbial diets — which limits raw and fresh food because of the risk of infection — are common for patients with compromised immune systems or those who are taking steroids or other medications long term.

Enter Chef Peled or one of her three sous-chefs, who spend an hour each afternoon meeting with pediatric patients and their parents to discuss food preferences. (Adult patients at Sloan-Kettering can also make personalized requests, but as the mother of a 2-year-old, Ms. Peled, 37, has a soft spot for sick children.) Veronica McLymont, director of food and nutrition services at the hospital, says the customized approach has not increased costs because when the children get what they want, less food is wasted.

Ryan Brennan, 17, was not very hungry during his second inpatient stint at Sloan-Kettering for sarcoma in the fall. So Ms. Peled made a pu pu platter-style tray with small amounts of items he enjoyed, like buffalo wings and vegetable skewers. “The meals stimulated my appetite,” Ryan said, “and I could push myself to eat because they tasted so good.”

Valerie Ramo said she was convinced that Ms. Peled was crucial to the recovery of her daughter, Joely, from a bone-marrow transplant in July. Doctors had warned that Joely, who was 8 and had spent two months at Sloan-Kettering being treated for severe aplasticanemia, would most likely be fed through a tube after the surgery. Instead, Ms. Peled fulfilled Joely’s wishes for pressed turkey and cheese sandwiches similar to the ones sold at Dunkin’ Donuts, a combination of strawberry daiquiri and piña colada mixers, and “takeout” pizza delivered to her hospital room in a pizza box.

“I think she ended up not needing it because of Pnina’s food,” Ms. Ramo said, referring to the intravenous nourishment. Joely said, “I can still eat what I love, and that makes me feel better and special.”

Now an outpatient, Joely says she looks forward to her doctor’s appointments several times a week because she can eat lunch at the hospital.

As soon as her health is more stable, she will return home to Fort Lauderdale, Fla. “I can’t wait to go home so I am with my dad and brothers again and I can see the roses on our front yard,” she said, “but I am going to miss Pnina’s cooking.”

Ms. Peled, who was born in Israel, grew up in Brooklyn helping out at her father’s doughnut shop and his two Israeli restaurants. After culinary school, she worked at restaurants including Becco and Eleven Madison Park, then became executive chef at Jolly Hotel Madison Towers (overseeing its Cinque Terre restaurant, among others). She switched to the hospital, she said, in hopes of making a bigger impact with cooking: “I didn’t feel like I was doing service to society by being a restaurant chef,” she said.

At Sloan-Kettering, Ms. Peled’s small office is filled with thank-you cards and pictures from patients, and as she walks through the pediatric ward, she is showered with compliments from children and their parents.

“Food is about bringing people together and making them happy,” she said. “I might not have realized this when I started my career, but to do that for people who have cancer is the reason I became a chef.”

A version of this article appeared in print on January 16, 2011, on page MB1 of the New York edition.

The Grass Is Fake, but the Splendor Real

CITY CRITIC

The Grass Is Fake, but the Splendor Real

Emily Berl for The New York Times

The grass and trees in Park Here are fake, but some visitors stay all day. Margot Spiker and Patrick Kelly read by artificial light amid plastic foliage stapled to wooden trunks. More Photos »

By ARIEL KAMINER

Published: January 14, 2011

REPRINTS

Last Wednesday, the day of the snowpocalypse — or was it the snowmageddon, or the snow-my-God or whatever else the weather-fatigued headline writers had resorted to — Central Park was awash in white. Prospect Park in Brooklyn was a freezing no man’s land. And Van Cortlandt Park in the Bronx was almost invisible under all that the wind had delivered.

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But at the park on Mulberry Street, between Kenmare and Spring in NoLIta, summer was just unfolding. Warm, happy people were peeling down to their T-shirts and soaking in the sunshine, while others were spreading picnic blankets and gazing up through the lush canopy of foliage. Some flopped down on the hearty carpet of green, curled up against one another and, lulled by the gentle chirping of birds, settled in for a nap.

It’s not truly a park, at least not in any sense that the parks department might recognize; it is the simulacrum of a park, an indoor copy that in weather like this becomes more real than the city’s broad but dormant expanses. The pseudopark, which occupies the Openhouse Gallery through the end of the month and which is open to the public every day from 11 a.m. to 6 p.m., beckons visitors with a vibrant gardenlike environment and a warm, sunny glow (along with, at certain hours, food vendors like Luke’s Lobsterand Mexicue).

It’s no great feat of agricultural engineering. The floor covering is artificial turf, not sod, despite the example that “The New York Earth Room,” just a few blocks away, has set for decades. The trees are plastic foliage stapled to wooden trunks. The sunlight emanates from light boxes designed to treat seasonal affective disorder. The birds chirp through a sound system.

And beyond that? Park Here, as it’s called, is just the same white walls you see in any gallery, with exposed electric fixtures, hanging theatrical lights and a big industrial heating unit. It shouldn’t fool anyone. And yet it does: office workers looking for a break, couples looking for each other’s arms, the daily yoga class in the corner and, of course, the inevitable stroller brigade, all just relaxing and playing and letting down their guard in a way they would never do if the fake foliage was not there. Some arrive when the park opens and stay all day.

“This used to be an art gallery,” one of the picnickers told his barefoot friend.

“This is an art gallery,” she said authoritatively. “This is someone’s installation.”

Not quite. Openhouse calls itself a gallery but functions mostly as an events space, a rentable temporary home for pop-up shops, parties, publicity events and the like. The so-called installation is the work not of a solitary artist exploring the tension between nature and artifice but of a series of corporate partnerships set in motion by the people who run the place.

For Openhouse, then, Park Here is nothing revolutionary, just a clever way to keep the place’s name in circulation during a slow season. Fine. But for the people who amble in, flop down, spread out, lie on top of each other, flirt, relax, catch up or check out, it’s something more: an experiment in urban sociology.

Strolling around the place and watching the strangers at play, Dalton Conley, a New York University sociologist who has written about growing up in the city, observed that it was a quintessential New York phenomenon.

“One of the factors which, despite perceptions, makes it easy to parent here is that there are no backyards, so you’re not atomized,” Professor Conley said. “You just go to a park,” he said, and automatically find a bunch of other kids to play with. Parks have the same effect on adults, throwing them into close and easy proximity, and promoting unexpected social encounters.

Similar results have been achieved in other unnatural settings, most recently whenPipilotti Rist took over MoMA’s second-floor atrium with an oversize video installation and an enormous round couch on which viewers could just lie back and take it — and each other — all in. But that was under the protective cover of high art. It was critically sanctioned. It was safe. Park Here, in contrast, is just some random storefront, and the people flopped about it don’t necessarily have anything more in common than a preference for being inside to being outside. (Or is it the other way around?)

“As a permanent thing, people probably would say, ‘We need real grass,’ ” Professor Conley said. “But as a temporary thing, they accept the lack of verisimilitude. In fact, I bet some of it is ironic.”

Maybe it’s more fun, that is, because it’s more fake.

Or maybe, in a city so starved for nature that a stroll through a greenmarket can feel like a restorative encounter with the great outdoors, New Yorkers are simply willing to cling to whatever crude substitutes we can find. Maybe we are like those monkey babies in the psychology experiments who pathetically tried to hug a terrycloth doll. In the depths of a January snowstorm, even a terrycloth doll is better than nothing. And the results of this experiment suggest that the ability to respond to even such unconvincing stimuli is an adaptive trait for urban survival.

New Yorkers like to think no one can put anything over on them. But the field data from Park Here shows we enjoy putting one over on ourselves. At some point, during a long and lazy afternoon — sometime after lunch but before my nap — I sneezed. “Gesundheit,” said one of the people lounging by the seesaw. “Allergies,” said her friend.

Israel Tests on Worm Called Crucial in Iran Nuclear Delay

By WILLIAM J. BROAD, JOHN MARKOFF and DAVID E. SANGER

Published: January 15, 2011

REPRINTS

This article is by William J. Broad, John Markoff and David E. Sanger.

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Nicholas Roberts for The New York Times

Ralph Langner, an independent computer security expert, solved Stuxnet.

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How Stuxnet Spreads

Times Topics: Israel | Iran

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President Mahmoud Ahmadinejad of Iran toured the Natanz plant in 2008.

The Dimona complex in the Negev desert is famous as the heavily guarded heart of Israel’s never-acknowledged nuclear arms program, where neat rows of factories make atomic fuel for the arsenal.

Over the past two years, according to intelligence and military experts familiar with its operations, Dimona has taken on a new, equally secret role — as a critical testing ground in a joint American and Israeli effort to undermine Iran’s efforts to make a bomb of its own.

Behind Dimona’s barbed wire, the experts say, Israel has spun nuclear centrifuges virtually identical to Iran’s at Natanz, where Iranian scientists are struggling to enrich uranium. They say Dimona tested the effectiveness of theStuxnet computer worm, a destructive program that appears to have wiped out roughly a fifth of Iran’s nuclear centrifuges and helped delay, though not destroy, Tehran’s ability to make its first nuclear arms.

“To check out the worm, you have to know the machines,” said an American expert on nuclear intelligence. “The reason the worm has been effective is that the Israelis tried it out.”

Though American and Israeli officials refuse to talk publicly about what goes on at Dimona, the operations there, as well as related efforts in the United States, are among the newest and strongest clues suggesting that the virus was designed as an American-Israeli project to sabotage the Iranian program.

In recent days, the retiring chief of Israel’s Mossad intelligence agency, Meir Dagan, and Secretary of StateHillary Rodham Clinton separately announced that they believed Iran’s efforts had been set back by several years. Mrs. Clinton cited American-led sanctions, which have hurt Iran’s ability to buy components and do business around the world.

The gruff Mr. Dagan, whose organization has been accused by Iran of being behind the deaths of several Iranian scientists, told the Israeli Knesset in recent days that Iran had run into technological difficulties that could delay a bomb until 2015. That represented a sharp reversal from Israel’s long-held argument that Iran was on the cusp of success.

The biggest single factor in putting time on the nuclear clock appears to be Stuxnet, the most sophisticated cyberweapon ever deployed.

In interviews over the past three months in the United States and Europe, experts who have picked apart the computer worm describe it as far more complex — and ingenious — than anything they had imagined when it began circulating around the world, unexplained, in mid-2009.

Many mysteries remain, chief among them, exactly who constructed a computer worm that appears to have several authors on several continents. But the digital trail is littered with intriguing bits of evidence.

In early 2008 the German company Siemens cooperated with one of the United States’ premier national laboratories, in Idaho, to identify the vulnerabilities of computer controllers that the company sells to operate industrial machinery around the world — and that American intelligence agencies have identified as key equipment in Iran’s enrichment facilities.

Seimens says that program was part of routine efforts to secure its products against cyberattacks. Nonetheless, it gave the Idaho National Laboratory — which is part of the Energy Department, responsible for America’s nuclear arms — the chance to identify well-hidden holes in the Siemens systems that were exploited the next year by Stuxnet.

The worm itself now appears to have included two major components. One was designed to send Iran’s nuclear centrifuges spinning wildly out of control. Another seems right out of the movies: The computer program also secretly recorded what normal operations at the nuclear plant looked like, then played those readings back to plant operators, like a pre-recorded security tape in a bank heist, so that it would appear that everything was operating normally while the centrifuges were actually tearing themselves apart.

The attacks were not fully successful: Some parts of Iran’s operations ground to a halt, while others survived, according to the reports of international nuclear inspectors. Nor is it clear the attacks are over: Some experts who have examined the code believe it contains the seeds for yet more versions and assaults.

“It’s like a playbook,” said Ralph Langner, an independent computer security expert in Hamburg, Germany, who was among the first to decode Stuxnet. “Anyone who looks at it carefully can build something like it.” Mr. Langner is among the experts who expressed fear that the attack had legitimized a new form of industrial warfare, one to which the United States is also highly vulnerable.

Officially, neither American nor Israeli officials will even utter the name of the malicious computer program, much less describe any role in designing it.

But Israeli officials grin widely when asked about its effects. Mr. Obama’s chief strategist for combating weapons of mass destruction, Gary Samore, sidestepped a Stuxnet question at a recent conference about Iran, but added with a smile: “I’m glad to hear they are having troubles with their centrifuge machines, and the U.S. and its allies are doing everything we can to make it more complicated.”

In recent days, American officials who spoke on the condition of anonymity have said in interviews that they believe Iran’s setbacks have been underreported. That may explain why Mrs. Clinton provided her public assessment while traveling in the Middle East last week.

By the accounts of a number of computer scientists, nuclear enrichment experts and former officials, the covert race to create Stuxnet was a joint project between the Americans and the Israelis, with some help, knowing or unknowing, from the Germans and the British.

The project’s political origins can be found in the last months of the Bush administration. In January 2009, The New York Times reported that Mr. Bush authorized a covert program to undermine the electrical and computer systems around Natanz, Iran’s major enrichment center. President Obama, first briefed on the program even before taking office, sped it up, according to officials familiar with the administration’s Iran strategy. So did the Israelis, other officials said. Israel has long been seeking a way to cripple Iran’s capability without triggering the opprobrium, or the war, that might follow an overt military strike of the kind they conducted against nuclear facilities in Iraq in 1981 and Syria in 2007.

Two years ago, when Israel still thought its only solution was a military one and approached Mr. Bush for the bunker-busting bombs and other equipment it believed it would need for an air attack, its officials told the White House that such a strike would set back Iran’s programs by roughly three years. Its request was turned down.

Now, Mr. Dagan’s statement suggests that Israel believes it has gained at least that much time, without mounting an attack. So does the Obama administration.

For years, Washington’s approach to Tehran’s program has been one of attempting “to put time on the clock,” a senior administration official said, even while refusing to discuss Stuxnet. “And now, we have a bit more.”

Finding Weaknesses

Paranoia helped, as it turns out.

Years before the worm hit Iran, Washington had become deeply worried about the vulnerability of the millions of computers that run everything in the United States from bank transactions to the power grid.

Computers known as controllers run all kinds of industrial machinery. By early 2008, theDepartment of Homeland Security had teamed up with the Idaho National Laboratory to study a widely used Siemens controller known as P.C.S.-7, for Process Control System 7. Its complex software, called Step 7, can run whole symphonies of industrial instruments, sensors and machines.

The vulnerability of the controller to cyberattack was an open secret. In July 2008, the Idaho lab and Siemens teamed up on a PowerPoint presentation on the controller’s vulnerabilities that was made to a conference in Chicago at Navy Pier, a top tourist attraction.

“Goal is for attacker to gain control,” the July paper said in describing the many kinds of maneuvers that could exploit system holes. The paper was 62 pages long, including pictures of the controllers as they were examined and tested in Idaho.

In a statement on Friday, the Idaho National Laboratory confirmed that it formed a partnership with Siemens but said it was one of many with manufacturers to identify cybervulnerabilities. It argued that the report did not detail specific flaws that attackers could exploit. But it also said it could not comment on the laboratory’s classified missions, leaving unanswered the question of whether it passed what it learned about the Siemens systems to other parts of the nation’s intelligence apparatus.

The presentation at the Chicago conference, which recently disappeared from a Siemens Web site, never discussed specific places where the machines were used.

But Washington knew. The controllers were critical to operations at Natanz, a sprawling enrichment site in the desert. “If you look for the weak links in the system,” said one former American official, “this one jumps out.”

Controllers, and the electrical regulators they run, became a focus of sanctions efforts. The trove of State Department cables made public by WikiLeaks describes urgent efforts in April 2009 to stop a shipment of Siemens controllers, contained in 111 boxes at the port of Dubai, in the United Arab Emirates. They were headed for Iran, one cable said, and were meant to control “uranium enrichment cascades” — the term for groups of spinning centrifuges.

Subsequent cables showed that the United Arab Emirates blocked the transfer of the Siemens computers across the Strait of Hormuz to Bandar Abbas, a major Iranian port.

Only months later, in June, Stuxnet began to pop up around the globe. The Symantec Corporation, a maker of computer security software and services based in Silicon Valley, snared it in a global malware collection system. The worm hit primarily inside Iran, Symantec reported, but also in time appeared in India, Indonesia and other countries.

But unlike most malware, it seemed to be doing little harm. It did not slow computer networks or wreak general havoc.

That deepened the mystery.

A ‘Dual Warhead’

No one was more intrigued than Mr. Langner, a former psychologist who runs a small computer security company in a suburb of Hamburg. Eager to design protective software for his clients, he had his five employees focus on picking apart the code and running it on the series of Siemens controllers neatly stacked in racks, their lights blinking.

He quickly discovered that the worm only kicked into gear when it detected the presence of a specific configuration of controllers, running a set of processes that appear to exist only in a centrifuge plant. “The attackers took great care to make sure that only their designated targets were hit,” he said. “It was a marksman’s job.”

For example, one small section of the code appears designed to send commands to 984 machines linked together.

Curiously, when international inspectors visited Natanz in late 2009, they found that the Iranians had taken out of service a total of exactly 984 machines that had been running the previous summer.

But as Mr. Langner kept peeling back the layers, he found more — what he calls the “dual warhead.” One part of the program is designed to lie dormant for long periods, then speed up the machines so that the spinning rotors in the centrifuges wobble and then destroy themselves. Another part, called a “man in the middle” in the computer world, sends out those false sensor signals to make the system believe everything is running smoothly. That prevents a safety system from kicking in, which would shut down the plant before it could self-destruct.

“Code analysis makes it clear that Stuxnet is not about sending a message or proving a concept,” Mr. Langner later wrote. “It is about destroying its targets with utmost determination in military style.”

This was not the work of hackers, he quickly concluded. It had to be the work of someone who knew his way around the specific quirks of the Siemens controllers and had an intimate understanding of exactly how the Iranians had designed their enrichment operations.

In fact, the Americans and the Israelis had a pretty good idea.

Testing the Worm

Perhaps the most secretive part of the Stuxnet story centers on how the theory of cyberdestruction was tested on enrichment machines to make sure the malicious software did its intended job.

The account starts in the Netherlands. In the 1970s, the Dutch designed a tall, thin machine for enriching uranium. As is well known, A. Q. Khan, a Pakistani metallurgist working for the Dutch, stole the design and in 1976 fled to Pakistan.

The resulting machine, known as the P-1, for Pakistan’s first-generation centrifuge, helped the country get the bomb. And when Dr. Khan later founded an atomic black market, he illegally sold P-1’s to Iran, Libya, and North Korea.

The P-1 is more than six feet tall. Inside, a rotor of aluminum spins uranium gas to blinding speeds, slowly concentrating the rare part of the uranium that can fuel reactors and bombs.

How and when Israel obtained this kind of first-generation centrifuge remains unclear, whether from Europe, or the Khan network, or by other means. But nuclear experts agree that Dimona came to hold row upon row of spinning centrifuges.

“They’ve long been an important part of the complex,” said Avner Cohen, author of “The Worst-Kept Secret” (2010), a book about the Israeli bomb program, and a senior fellow at the Monterey Institute of International Studies. He added that Israeli intelligence had asked retired senior Dimona personnel to help on the Iranian issue, and that some apparently came from the enrichment program.

“I have no specific knowledge,” Dr. Cohen said of Israel and the Stuxnet worm. “But I see a strong Israeli signature and think that the centrifuge knowledge was critical.”

Another clue involves the United States. It obtained a cache of P-1’s after Libya gave up its nuclear program in late 2003, and the machines were sent to the Oak Ridge National Laboratory in Tennessee, another arm of the Energy Department.

By early 2004, a variety of federal and private nuclear experts assembled by the Central Intelligence Agency were calling for the United States to build a secret plant where scientists could set up the P-1’s and study their vulnerabilities. “The notion of a test bed was really pushed,” a participant at the C.I.A. meeting recalled.

The resulting plant, nuclear experts said last week, may also have played a role in Stuxnet testing.

But the United States and its allies ran into the same problem the Iranians have grappled with: the P-1 is a balky, badly designed machine. When the Tennessee laboratory shipped some of its P-1’s to England, in hopes of working with the British on a program of general P-1 testing, they stumbled, according to nuclear experts.

“They failed hopelessly,” one recalled, saying that the machines proved too crude and temperamental to spin properly.

Dr. Cohen said his sources told him that Israel succeeded — with great difficulty — in mastering the centrifuge technology. And the American expert in nuclear intelligence, who spoke on the condition of anonymity, said the Israelis used machines of the P-1 style to test the effectiveness of Stuxnet.

The expert added that Israel worked in collaboration with the United States in targeting Iran, but that Washington was eager for “plausible deniability.”

In November, the Iranian president, Mahmoud Ahmadinejad, broke the country’s silence about the worm’s impact on its enrichment program, saying a cyberattack had caused “minor problems with some of our centrifuges.” Fortunately, he added, “our experts discovered it.”

The most detailed portrait of the damage comes from the Institute for Science and International Security, a private group in Washington. Last month, it issued a lengthy Stuxnet report that said Iran’s P-1 machines at Natanz suffered a series of failures in mid- to late 2009 that culminated in technicians taking 984 machines out of action.

The report called the failures “a major problem” and identified Stuxnet as the likely culprit.

Stuxnet is not the only blow to Iran. Sanctions have hurt its effort to build more advanced (and less temperamental) centrifuges. And last January, and again in November, two scientists who were believed to be central to the nuclear program were killed in Tehran.

The man widely believed to be responsible for much of Iran’s program, Mohsen Fakrizadeh, a college professor, has been hidden away by the Iranians, who know he is high on the target list.

Publicly, Israeli officials make no explicit ties between Stuxnet and Iran’s problems. But in recent weeks, they have given revised and surprisingly upbeat assessments of Tehran’s nuclear status.

“A number of technological challenges and difficulties” have beset Iran’s program, Moshe Yaalon, Israel’s minister of strategic affairs, told Israeli public radio late last month.

The troubles, he added, “have postponed the timetable.”

The Hazards of the Couch

January 12, 2011, 2:43 PM

The Hazards of the Couch

By RONI CARYN RABIN

Sean Marc Lee/Getty Images

Many of us sit in front of a computer for eight hours a day, and then go home and head for the couch to surf the Web or watch television, exchanging one seat and screen for another. Even if we try to squeeze in an hour at the gym, is it enough to counteract all that motionless sitting?

A mounting body of evidence suggests not.

Increasingly, research is focusing not on how much exercise people get, but how much of their time is spent in sedentary activity, and the harm that does.

The latest findings, published this week in The Journal of the American College of Cardiology, indicate that the amount of leisure time spent sitting in front of a screen can have such an overwhelming, seemingly irreparable impact on one’s health that physical activity doesn’t produce much benefit.

The study followed 4,512 middle-aged Scottish men for a little more than four years on average. It found that those who said they spent two or more leisure hours a day sitting in front of a screen were at double the risk of a heart attack or other cardiac event compared with those who watched less. Those who spent four or more hours of recreational time in front of a screen were 50 percent more likely to die of any cause. It didn’t matter whether the men were physically active for several hours a week — exercise didn’t mitigate the risk associated with the high amount of sedentary screen time.

The study is not the first to suggest that sedentary activities like television viewing may be harmful. A study last year found that men who spent more than 23 hours a week watching TV and sitting in their cars were more likely to die of heart disease than those who sat for 11 hours a week or less, even if they exercised. And a 2009 study reported that young children who watchone and a half to five and a half hours of TV a day have higher blood pressure readings than those who watch less than half an hour, even if they are thin and physically active.

Another small study found that when overweight adults cut their TV time in half, they burned more calories than those who watched five hours or more a day. Children whose TV time is cut tended to eat less, but that wasn’t true for adults. And the light activities adults filled their time with, like reading and playing board games, actually burned more calories than watching TV.

In both the United States and Britain, people are spending three to four hours a day on average watching television, said the study’s author, Emmanuel Stamatakis, of the department of epidemiology and public health at University College London.

“This is excessive,” he said. “It is more than 20 percent of total waking time for most people.” And, he added, “it’s 100 percent discretionary.”

During the study’s follow-up period, from 2003 to 2007, 325 men died of various causes, and 215 suffered a heart attack or other cardiac event. Even after adjusting for differences in weight, smoking, occupational physical activity and risk factors like diabetes, high blood pressure and other longstanding illnesses, as well as marital status and social class, those who spent four hours or more of their leisure time in front of a screen each day were 50 percent more likely to have died. Those who spent two hours a day in front of a screen for entertainment were 2.2 times more likely to have had a cardiovascular event.

Recreational screen time has an “independent, deleterious relationship” with cardiovascular events and death of all causes, the paper concluded, possibly because it induces metabolic changes.

One possible mechanism, demonstrated in animal studies, is that being sedentary may affect lipid metabolism. Prolonged inactivity appears to sharply reduce the activity of an important enzyme called lipoprotein lipase, which is responsible for breaking down circulating blood lipids and making them available to muscles for energy, Dr. Stamatakis said. Lowered enzyme activity leads to higher levels of fats and triglycerides in the blood, and to a higher risk of cardiovascular disease. Exercise has very little impact on the enzyme’s activity, he said.

Extended sitting may also lead to high levels of low-grade inflammation, which can also lead to heart disease, Dr. Stamatakis said. A marker of low-grade inflammation called C reactive protein was about three times higher in the study participants who spent the most time slouched in front of a screen.

The study focused on recreational screen time because it’s the easiest to curtail, Dr. Stamatakis said. But he encouraged employees who work at computers all day to get up and take breaks and short walks periodically.