Nutritional Harm Reduction

When the brain is fed too much fast fuel and not enough building material, the logical conclusion is some combination of craving, and mood, behavior and concentration problems (Ross, 2002). Weight and energy are likely to be problems too. And long term, the addictive relationship with processed foods lead us into chronic degenerative disease.

As holistic doctor Sherry Rogers (1995) pointed out, the diagnosis is inconsequential compared to the biochemical and environmental causes of the problem. If obesity, diabetes, problems with alcohol, depression, anxiety and learning issues share common roots in diet and lifestyle, then knowing which changes to make matters more than naming the disease. These issues often cluster in individuals and cluster in families. Which ones express in this or that person or family is a matter of individual biological vulnerability, but the need for a diet of uncontaminated whole foods holds true for all of them.

Costly Addiction

There is not agreement on what the most costly addiction is. Alcohol, drugs and cigarettes commonly top the list because we are not accounting for the obesity and diabetes epidemics as consequences of addictive food. Given that these and most of the modern health scourges relate to diet, environment, and lifestyle, it’s easy to argue that the food supply is the most costly addictive agent. Working with the idea that an addiction is a relationship with a material or activity which one repeatedly does in spite of the known negative consequences, refined food is the most expensive addiction in our culture. It is costly both in human and dollar terms, but the price tag is often hidden. We aren’t taught to think of treatments for depression, ADHD, diabetes or cardiovascular disease as externalized costs of buying cheap food. They are. These treatments really belong in the grocery budget because they are the pricey consequences of eating cheap, processed food. Dependency on these foods creates the need for medical, educational, and counseling expenditures that would not be necessary if we avoided them in favor of whole foods.

Until we recognize our relationship with the processed food supply as a pervasive cultural addiction, we won’t see significant progress with obesity, diabetes, cardiovascular disease, depression, etc. because processing foods is the primary biochemical cause (Ross, 2000). Turning around the epidemics will require reducing harm culture-wide by supporting changes in the content of our diets, improving digestion, and adjusting the timing and circumstances under which we eat. For some people, changing diet and lifestyle will be enough, for others, not. Supplemental nutrients will be necessary. Either way, harm reduction thinking will be required because unlike alcohol, drugs and cigarettes, food is not something from which we can totally abstain. Harm reduction is all we have to work with.

To summarize, the major health and mental health scourges that relate to diet and lifestyle call for individual and culture-wide attention to the elements of nutritional harm reduction, including:

• Learning to make good observations about what’s going on in your body
• Improving the content of the diet to include uncontaminated whole foods
• Supporting better digestion
• Using timing to mitigate the effects of favorite processed foods
• ​Improving the settings and circumstances under which we eat
• Using nutritional supplements when good food is not enough

Leaving the nutritional status of the physical body out of the healing and recovery equations is a pervasive oversight in our medical and recovery cultures. Why, even the disciplines that train people to work with addicts, school children with learning issues, and people with depression and anxiety are not educating their students in the relationship between food and mood, behavior, addiction, and learning issues.

Our member Carrie didn’t know relief from her panic attacks was within arm’s reach. She just needed somebody to ask her the right questions. Here’s her story:

“Learning to be a better observer of my own experience required having somebody in my life asking the right questions. I thought I had an anxiety disorder. There were certain times and certain places where I would have panic attacks, for no good reason. When I went to get a bunch of blood work done, it turned out my blood sugar was out of range and low, but nobody in the clinic picked up on that and I didn’t know what that meant. As soon as I came to Suppers meetings, everybody seemed to have an education about the symptoms of low blood sugar. So I learned too. The shakes, sweats, desperation, and mood swings all related to poor food choices and skipping meals. They asked things like; do you binge on carbohydrates; do you get really hungry mid morning if you eat a bagel for breakfast; and is it worse when you forget to eat? Everything they asked, I said, Yes, Yes, Yes. I’ve been a slave to food, cranky, anxious, depressed, and scared of my own mood swings for years. I started writing down everything I ate, not changing the menu, just writing it all down. The conclusion leapt off the page at me as soon as I asked myself the right questions. All I needed was to practice some nutritional harm reduction by eating breakfast, eating more protein, and eating sweets only after a good meal. I’m still a little whacky, but I never feel like my heart is off to the races except when I cheat really badly on an empty stomach.”

Content

Nutritional harm reduction through content is a simple (if not easy) matter of eating more food that supports health and less food that detracts. The rules are ridiculously simple: Eat single, fresh, whole foods. That’s all.

At Suppers meetings, we often use organic ingredients, but we aren’t rigid about it. The menus are free of wheat, dairy products, sugar, and caffeine since these are the most common drug-like foods. We aren’t saying you should never eat these things again; we are saying these items are the most common consequence causers. If these or other specific foods are responsible for your cravings, anxiety, or depression, then a therapeutic diet free of them will give you relief, that is, after you’ve withdrawn from them. We acknowledge that what we teach is a pristine, baseline diet that most people will not want to follow perfectly. Most people come in wanting to know how to responsibly manage cheating. Our rule of thumb is this: Once you know how to practice ideal eating for you and know how you feel on healthy foods, you ought to be able to live well and really enjoy yourself doing 70 to 85% of what’s ideal for your biologically individual body. The trick is to observe and honor your personal biochemistry and learn nutritional harm reduction, like differentiating between desserts and snacks.

The rationale for changing to a diet of whole foods appears throughout the pages of the Suppers program. Here is the fundamental reason: The evolutionary pressures that shaped humans designed us for a natural diet of locally grown, whole foods, food not altered much by refining processes (Bond, 2007). There were no alternatives. Our taste preferences for sweet, salt, and fat were shaped by the combination of two pressures: vital importance and low supply. Nature created a way to be sure we’d work hard to get enough of the things that were low or unreliable in supply by connecting the eating of them to the comfort or pleasure centers of the brain. The development of problems with alcohol, diabetes, obesity, and many common mental health problems hinge on quirks of metabolism that made ancient man seek hard-to-find foods that are now cheap and plentiful, a formula for disaster. Referring to the taste for alcohol, Rogers alerted us thirty years ago to the possibility that biologically vulnerable people could develop foolish appetites. We now know that’s because ingesting refined foods and drinks is like mainlining to the comfort centers of your brain. They are more like drugs than food. And with the content of food supplies becoming more refined globally, the global epidemic of diabetes is the logical conclusion. Absent processed, refined food and beverage, and there is not a whole lot to eat that’s habit-forming or that draws us into dependent relationships.

Supplements can’t compensate for a diet that’s totally out of sync with human evolution. But they can help with the cravings and increase your chances of succeeding at the changes you seek to make. When you try to get back to foods more like what humans were designed to eat, you are likely to feel disappointment eating just whole foods and experience intense cravings for what you had before. That’s to be expected. Your body is used to foods that are more like drugs (fast carbs) when what it needs is slow fuel (low starch carbs) and building blocks (fats and protein). That’s why we created a support group.

There are a few more foods that act like drugs in some people. If a particular food is a drug-like trigger for you (corn and potatoes have this effect on some people), you may have to abstain from that food, just like a real alcoholic has to abstain from drink. But the most common ones are wheat, dairy, and sugar. It’s simple to sort out whether or not a suspect is in fact the culprit; it just involves learning how to observe your experience, a skill we teach at Suppers.

Here is the story of Jim, who learned that a few of his favorite “contents” were affecting his mood, weight, and work life. He called it “Shutter Speed”:

“I’m a photographer. I quit drinking over a decade ago and never looked back. But I still have lots of issues with food, particularly weight. At a Suppers meeting I finally heard a story that sounded like me when a woman described the benefits she realized from trying a diet for people with blood type O, my type. I needed quick results and I needed a how-to manual. I got both (See D’Adamo, 1996). The biggest trouble makers for me turned out to be my favorite things: bread, cheese, and coffee. Unfortunately, they fuel my appetite and keep me eating all day. I was in a pattern of manipulating my moods and energy level with these things, particularly the coffee. I decided to try quitting because her story sounded so much like my story.

When I don’t eat bread and cheese, I’m less hungry overall, and I lose weight. When I cheat, I get drawn into feeding throughout the day.

The Suppers program keeps me in the process of improving my diet incrementally and accepting myself when I fall off the bread wagon. Am I eating a perfect diet? No. Have I reduced the damage I do to this body? Yes. And each success makes the next success a little closer at hand.”

Jim authored a true t-shirt line, “Never underestimate the power of a home-cooked meal.”

Read the Label

Technically speaking, if the contents are listed on a label, what you’re holding is not a single, whole food. Single, whole foods don’t need labels; everyone can tell what they are from looking. But this is the real Western world, and most people are eating foods that come with labels to read. You can practice harm reduction by looking out for the following mood- and health-compromising ingredients: things you can’t pronounce and don’t recognize as food, dyes, all forms of sugar (like corn syrup solids, fruit juice concentrate, honey, molasses, high fructose corn syrup or any other words that end in “ose”, maple syrup). In general, if two products seem very similar, say peanut butters, the one with fewer ingredients is likely to be the healthier choice.

Here is Cindy’s journey through food labels:

“Today my friend and I crack up talking about our early parenting days, thinking we were such great mothers reading all those food labels. I read every label and then threw the food in the cart. I’d done my job.

I think we were both expecting the food manufacturers to write “poison” in the list of ingredients; that’s what it would have taken to penetrate our brains.

Today I’m a bit more educated. My first choice is to buy single foods so there are no labels to read, one chicken, two apples, three sweet potatoes. But there are still a few things that I buy for convenience, operating as I do in the 70 – 85% of the ideal range.

For example, it took a year for my kids and me to come to terms with all the things we’d give up in order to avoid red dye. All my son’s favorite candy had red dye. After clearing him out for a few weeks, I handed him a “fruit snack” with Red 40, our challenge to see if in fact the dyes were affecting his mood as I suspected. He immediately turned green about the gills on Red 40 and handed the rest back to me. The headache and malaise were immediate. I no longer had to do a sales pitch for healthy food, he got it himself, ‘That’s what did it to me, Mom’. He wouldn’t tell you this, but I will: he used to be constipated a lot too, and making these changes has cleared up that problem as well.

It was too soon to get cocky about my brilliant parenting, however. The kids still had occasional, inexplicable meltdowns. As it turned out, my son’s favorite salad dressing had Red 40 in it too. Figuring salad dressing was healthy because it makes him eat salad, it never occurred to me to read the label. I guess the 70 – 85% rule can’t apply to label reading.

Having had so much success with Suppers recommendations myself, I wanted to rehabilitate my whole family overnight.

They had other ideas.

So we went slowly, very slowly. First we had powwows about changing to healthier versions of favorite treats, health food store junk food, if you will. But it was an improvement. We replaced anything that had the word ‘hydrogenated’ in it. We learned all the different names for sugar. We were merciless about high fructose corn syrup and a little gentler on other forms of sugar.

As they cleaned up, they started noticing good food tastes better. My daughter is a reluctant eater and very petite. Little by little by little her tastes changed, and even she wanted the organic chicken, not because it’s virtuous but because it tastes so much better. It’s a bit hard on the budget, but how much is it worth to me to have kids who eat well and don’t melt down anymore. A lot!

It was a tearful day when we went through the pantry, throwing out the favorite foods with dyes, corn syrup, and white flour. But by preparing slowly for this day, my kids and I had developed a taste for better food and demonstrated to ourselves the huge payoffs in terms of mood, bowel function, and freedom from headaches.”

Digestion

You practice nutritional harm reduction when you support good digestion, for example, by supplementing with digestive enzymes or replacing nutrients you don’t absorb well because of damage to your gut from pathogens, environmental toxins, and poor food. This is a complicated problem that may require professional help, but here’s an example of how it works: A person who self-medicates for anxiety with alcohol is in a vicious cycle because the very nutrients needed to be stress hardy are the ones depleted or not absorbed when one drinks more than a small quantity of alcohol. The person whose digestion is compromised because of years of drinking may need professional help learning which nutrients must be restored to speed biological recovery. (See Ross, 2002, and Larson, 1997.) The good news is that guts heal. And they do so faster when you eat foods and take nutrients that provide the building blocks of strong digestion.

“You are what you eat” is only partly true. A more accurate adage would be “You are only what you absorb of what you eat.” If your digestion is not in top form, you could be eating a perfect diet of organic, whole foods and still not get the benefits from them. Look at it this way: Biologically, the brain is downstream from the gut (Bock, 2008). Whatever the deficiencies in your digestion, there will be consequences for the brain, the organ that is the most sensitive to what you eat. Again, poor diet and weak digestion can affect mood, behavior and learning long before ending up in diabetes or heart disease. The brain is affected first with fatigue, depression, anxiety, spacey feelings, or poor concentration.

How do you know if your digestion is compromised? Here are some tip-offs:

For the person who will not practice abstinence from highly refined carbohydrates like cakes, candy, or white bread, harm reduction through timing can effectively reduce the glycemic index of a favorite food. The potential for damage from these foods goes down if these foods are taken on a stomach full of whole foods, i.e., as dessert. In Suppers language, snacks are the exact same foods you’d eat at a meal. Snacks promote health. They provide the building blocks for strong bodies and stable mood. If a food is not a health-promoting meal item, it’s a dessert. A piece of roasted chicken is a snack. Chips are not; they’re dessert. A cup of homemade soup is a snack, a cup of cocoa is not; it’s dessert. An apple is a snack. Apple pie is not; it’s dessert. If something is made from single, whole ingredients, it passes for a snack. If it’s milled like a flour or otherwise processed, it must come after a meal to reduce its impact on your blood sugar and mood chemistry.

Breakfast

Another important timing strategy is called breakfast. Skipping breakfast can set you up for bouts of fatigue, anxiety, craving, and binges for the whole rest of the day (Ross, 2002). Eating a breakfast of whole foods, including some protein, can set you up for more stable blood sugar and reduced desire for sweets and coffee. You could think of it as a form of pre-emptive eating.

Following is another excerpt from the story of one of our founders, Cindy, who says, “My epiphany came in a bowl of chili”:

“Counter to everything I feel like doing first thing in the morning, I ate chili. I decided to try some breakfast chili to see if there was anything to this theory about setting yourself up for a better mood all day by starting with protein. The effect was immediate. A bowl of turkey chili shielded me from the spinning and ranting that normally followed the prized first cup of coffee that got me out of bed in the morning. Just this change alone had rippling benefits throughout the family, but I didn’t stop there. Chronic depression and anxiety lifted after I went cold turkey off of coffee. My negativity vaporized, along with the hot flashes. Even when I didn’t sleep well, a bad night didn’t destroy me anymore.

It’s painful for me to tell you that something I love as much as I love AA has a shortcoming. Those first years in the program were profoundly life changing. But it was not there that I learned I have a body and that that matters. It took many years of seeking in other places to make this discovery. In my 13th year of sobriety, I realized what I had been doing was throwing program and therapy at a depressed brain. I’ve been working the Suppers program for two years, and still the most profound, single improvement came when I had my epiphany in a bowl of chili.”

Another form of pre-emptive eating is snack timing. Remember, a snack is the same as a meal item. All the rest has to go on the dessert list. For people on the blood sugar/mood chemistry rollercoaster, a well timed snack can make the difference between having a panic attack and maintaining relative stability or triggering a binge and resisting the impulse.

In order to find out which foods work for interventive eating, it will probably be necessary to do a food/mood observation chart and track your reactions across the day.

Here is Rosella’s story, the case of a psychotherapist who learned to manage her eating disorder through a nutritional harm reduction timing strategy:

“I have been a psychotherapist for over 30 years and have had an eating disorder my whole adult life. Wild horses could not have separated me from my mountain of popcorn or candy binges. Years of psychoanalysis did not bring me any closer to sustaining a normal weight or managing these impulses. Periods of weight loss on diet programs were interspersed with defiant bouts of eating and weight gain.

My husband encouraged me to look at the possibility that my food choices themselves had emotional and psychological consequences. He’s very oriented to including the physical body in a holistic approach. What emerged from my food/mood chart was that my body was going into low blood sugar hormonal emergency mode most afternoons. We tested several foods for me to eat pre-emptively. The results were clear: When I ate a dish of lentils at 4:00, I turned off the trigger. Over the years I have made great strides. Whereas I initially resisted having the homework assignment of eating one piece of fruit a week, I now relish fruits and vegetables. It did take a while to acquire the taste for them. I needed lots of support and that’s what the Suppers program patiently provides.

Today I am always within 5 pounds of my ideal weight. I still indulge in all my favorite foods and drinks socially and occasionally popcorn or candy. The difference between then and now is that I can get right back on track the next day as long as I eat something like a dish of lentils before I feel the trigger.”

Circumstances

The calorie content of food is not the only thing making us sick and fat. Stress and the circumstances under which we eat count too. Here’s an interesting one: Your metabolic rate is lower while watching TV than while sleeping. So your body is burning less energy while you mindlessly watch TV than while you sleep. That makes eating while watching TV a doubly deadly invitation to obesity.

Mindful vs. Mindless Eating

At Suppers we always sit down and take our time eating the food we’ve prepared from scratch. One of our members, Brooke, shared her experience getting coached in mindful eating (See Albers, 2003). Here is Brooke’s story, “I’m NOT satisfied”:

“My entire being interacts with the food I eat. I watch my husband –- much bigger than I -– push away from the table feeling satisfied after the meal I’ve prepared, and I wonder at his capacity to feel satisfied. I’m not satisfied!

Insulin dependent diabetes struck me at age 39. For a year after my diagnosis, my life revolved around re-learning how to eat and manage this disease. My goal was to eat in a way that reduced the units of insulin I’d have to take in order to keep my blood sugar stable and feel good.

This was no small task. Diabetes is a chronic disease. It is with you every minute of every day, and there is no such thing as taking a vacation from diabetes. To keep blood sugars in the healthy range, you must think about every morsel of food you put in your mouth and take the appropriate amount of insulin to move the glucose out of your blood and into your cells. This takes a lot of work, training, and brain energy. I’ve had to deal with the lonely, sad, tired, dejected feelings when I just wanted what I wanted, not caring about calories or blood sugar effects. One day, I dug into a container of locally produced organic ice cream. How much more wholesome could I be! It had the added virtue of being a fund-raiser for the local school garden. Couldn’t my pancreas give me special dispensation for a worthy cause? The holy ice cream did a terrible number on my blood sugar since after taking two small bowls of it, I went back to the freezer for the container and just mindlessly ate out of it while reading a pile of newspapers I had missed during the week. UGH! I knew I shouldn’t be eating it, but it tasted so good and helped ease my anxiety.

Sometimes I actually fight with myself -– in my head –- in terms of what snack I will reach for. I know I don’t want carbs and should reach for –- and usually do -– veggies, high fiber crackers, cheese, hummus, if I have some around, and chicken soup. I try to have a container of one of the Suppers soups on hand for any meal and in between. Since the Suppers soups are mostly protein, veggies with lots of fiber, and good fats, they’re very low in carbs and do not result in much of a change in my blood sugars. I am trying to tailor–make an integrated approach for myself, combining good food choices and working with a counselor who teaches mindful eating.

Some of the initial exercises were very powerful and have stuck with me: Use nice dishes that make you feel happy and proud of what you are eating. Make it look nice. Chew slowly; put your fork down between bites; close your eyes and really taste the food, enjoy it. Of course, sit down to eat. But I am not always good at this. It seems so unfair that I have to be vigilant, while others like my husband are simply satisfied.

I have pursued many avenues to gain a greater awareness of my eating habits, including hypnosis, meditation and yoga, and other forms of relaxation and breathing. In the Suppers program I have accepted that my best chance at making good matches between my problems and personal solutions will involve identifying all the active forces that make me hungry, sad, and dejected. My experience with fish oils has taught me that certain changes are necessary but not sufficient to stabilize my mood. Taking enough Omega 3 fat produced the single most dramatic change in my mood since I started the program. My hormonal and menopausal depressions seem to have disappeared! Plus I just lost my taste for coffee and now start my day with a soothing cup of hot green tea. The tea does not seem to spike my blood sugars like coffee did every morning. I learned about the benefits of Omega 3s and getting off coffee from discussions at Suppers meetings and the successes realized by others sitting at the table. I don’t know what my ultimate recipe for success will turn out to be, but I do know that slowing down and eating more mindfully will be part of the package. So will taking supplements for the things my body just doesn’t have enough of.”

Brooke makes an important point. Making improvements in any of the key areas –- content, digestion, timing, and circumstances –- can reduce harm. But to experience vibrancy, you may have to stick with the program long enough to identify all your issues and match the solutions to the problem. At Suppers we draw an analogy to a man hobbled by ten nails in his foot: If you remove nine nails, what will you have? A man hobbled by one nail in his foot. Still hobbled, still wondering how close he is to addressing all the changes he has to make to get relief.

The Suppers promise is to stick by you and help with just about everything you can do without a doctor to improve your health and – for people in recovery – make sobriety more doable.

Eating While Drinking

If you are not an alcoholic and abstinence is not your goal, you can reduce the effects of alcohol by having it with whole foods, including protein, high fiber and low starch vegetables, and high quality fat. Good food slows the absorption of alcohol. An empty stomach speeds it up. Combining alcohol with refined foods like white bread or chips will not have the same benefit since refined foods feed into the same biological pathways for poor blood sugar regulation and unhappy mood chemistry as the alcohol.

Stress

The circumstances under which you eat profoundly affect your ability to absorb nutrients from food. If appealing to your vanity helps, think of it this way: Eating while stressed is fattening; eating while relaxed is slimming. Eating while stressed is aging. Eating while relaxed is restorative.

In “The Anger Eater”, our member Raquel recounted an adult child story that demonstrates the tight bond of emotional life and eating life. By reducing food-induced anguish through nutritional harm reduction, she was better able to cope with the emotional turmoil.

Here is Raquel’s story:

“My relationship with food has always been tightly coupled to anger. As a child, I lived in a turbulent household. The unpredictability of my father’s alcohol-induced rages turned me into a timid, fearful child. Since the angry tirades usually occurred late in the evening, I spent my youth feeling tired and nervous, ever vigilant for the possibility of a bad event, even when things were relatively calm. I ate candy for comfort and energy. My father was also a controlling, invasive parent, and I came to think of myself as an individual who was incapable of an independent thought or action. As I grew older, my anger at my home situation grew as well, and I used food as a weapon against myself. I ate less and less, hoping that if I were small, I would be less noticeable and less likely to become a victim to my father’s angry, frightening behavior and be invisible to his constant need to control my actions and decisions. I also thought, at some level, that it would be preferable to disappear instead of feeling helpless to change or escape from my home situation.

Our number one national addiction is not alcohol, drugs or cigarettes. It’s food. Poor quality food is responsible for more preventable health and mental health problems than any other source. And the national menu of processed foods is so addictive that many of us have lost the taste for foods that support life. This makes the standard American diet a gateway to obesity and diabetes, addictions, and many mental health problems including anxiety and depression. We cannot abstain. That leaves us with nutritional harm reduction.

The way in to the problem suggests the way out: If eating and drinking processed foods and beverages got you into this mess to begin with, then returning to whole foods is the way out. At very least, you can mitigate the damage by thoughtfully adjusting the content, timing, digestion, and circumstances under which you eat food.

Quick Tips For Nutritional Harm Reduction

• Go slowly. Avoid rebellion.
• Drink water: half your weight in ounces each day.
• Involve eaters in the food preparation, the more ownership, the more participation.
• Exercise more control at the grocery store so there’s less needed at home.
• Schedule snacks and make sure they happen.
• Have good food ready to go, you’ll be hungry.
• Don’t clean your plate.
• Go for color; Grandma was right.
• 70 – 85% of what’s ideal for you is a good goal except for foods that are like drugs.
• for you, the items from which you must abstain.
• Eat at tables.
• Buy mostly food that doesn’t have a list of ingredients.
• Avoid eating while stressed, at least go for less stressed.

NHR Continuum

Holistic models don’t lend themselves very well to continua, but with feet pressed to the fire to make this visual, a continuum of nutritional harm reduction would look something like this. Of course, people will do best making improvements in the order in which they are most likely to be successful. Starting with a drinking and driving alcoholic and ending with a thoroughly detoxed person:

1. Drinking and driving
2. Drinking with a designated driver
3. Quitting, managing alcohol cravings with coffee, coke, and chocolate
4. Reducing dependence on coffee and sweets by introducing health food store junk food
5. Trying supplements to manage craving and improve nutritional status
6. Reducing craving, managing mood with NHR strategies like
7. Drinking more water
8. Eating breakfast
9. Timing snacks
10. Mitigating the effects of high glycemic index foods with low ones
11. Learning to observe how your body interacts with food
12. Healing digestion with food and supplements
13. Eating with people who are good for your digestion
14. Eating mindfully
15. Developing alternate sources of pleasure, besides food and drink Eating regularly in the warmth of the family table
16. Increasingly using organic foods
17. Establishing a meditation or other stress reduction practice
18. Undergoing a biomedical detox, colon cleansing
19. Establishing the habit of regular, meaningful physical activity