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- 1. Sheet1RegionProduct TypeItemProjected Sales 2022 (in millions)Projected Sales 2027 (in millions)Projected Sales 2032 (in millions)legacy202220272032legacy202220272032legacy20222 0272032AmericasLegacyA90.86.4mean A 7.17068965527.02758620693.2413793103standard diviation A5.26607842443.0198055652.6409749982value of coefficient A73.4389%42.9707%81.4769%AmericasLegacyA8.57.83.2mean B7.11034482767.25689655172.7431034483standard diviation B4.69743078922.47479306732.5977798935value of coefficient B66.0647%34.1026%94.7022%AmericasLegacyA1311.28.6mea n C7.156.91551724142.7034482759standard diviation C4.12132877573.41830992023.8441555328value of coefficient C57.6410%49.4296%142.1945%AmericasLegacyA87.58.1mean D6.72807017547.36666666672.8245614035standard diviation D5.1584450313.75891004973.5461891367value of coefficient D76.6705%51.0259%125.5483%AmericasLegacyA10.214.18.3A mericasLegacyA15.512.68.9New202220272032new2022202720 32New202220272032AmericasLegacyA10.811.47.6mean A16.738181818212.09454545458.2963636364standard diviation A2.87701561612.24015692092.2852962881value of coefficient A17.1883%18.5220%27.5458%AmericasLegacyA7.512.87.2mea n B17.120370370412.17636363648.4036363636standard diviation B3.32728744642.52864797992.1808903751value of coefficient B19.4347%20.7669%25.9517%AmericasLegacyA4.410.36.6mea n C18.309259259312.05740740748.1222222222standard diviation C2.65025940482.53098547832.1408574077value of coefficient C14.4750%20.9911%26.3580%AmericasLegacyA15.46.65mean D17.638181818212.49454545458.0509090909standard diviation D3.35716430762.09579987222.1982208907value of coefficient D19.0335%16.7737%27.3040%AmericasLegacyA11.29.34.5Am ericasLegacyA13.79.65.5AmericasLegacyA9.611.75.6Americas
- 7. icasNewD1914.99.5AmericasNewD13.79.38AmericasNewD18.3 12.77.3AmericasNewD17.49.810AmericasNewD11.88.96.4Amer icasNewD19.412.87.7AmericasNewD16.211.38.1AmericasNew D20.612.47.3AmericasNewD1010.77.5AmericasNewD20.214.17 .6AmericasNewD15.812.37.1AmericasNewD17.113.18.6Americ asNewD13.613.19.7AmericasNewD15.311.47.1AmericasNewD2 3.314.99.2AmericasNewD20.315.68.6AmericasNewD18.212.37. 3AmericasNewD22.113.18.5AmericasNewD17.310.67.2America sNewD17.3129.4AmericasNewD1912.17.5AmericasNewD20.61 2.78.6AmericasNewD1810.37.6AmericasNewD12.210.86.4Amer icasNewD16.910.75.6AmericasNewD14.77.94.3AmericasNewD 15.810.66.3AmericasNewD18.311.46.6AmericasNewD19.813.57 .1AmericasNewD15.810.66.8AmericasNewD20.813.47.1Americ asNewD14.49.24.9AmericasNewD15.511.72.1AmericasNewD20 .213.32.2AmericasNewD12.810.34.3 Sheet2 Sheet3 2018 Winning Essays Spring I met “Wanda” in the lobby of the motel that served as a family homeless shelter. At the front desk, Dr. Chatterjee and I passed a colorful display of Hostess pastries before we walked over to tour her family’s room. As she swiped her key card to open the door, we could not miss that her key card was also a $5 coupon for three Domino’s Pizzas. Yet neither these temptations nor the challenges of cooking with a bathroom sink and microwave deterred Wanda from preparing a nutritious meal for her family. Her motivation to eat healthfully came to mind as I analyzed transcripts of focus group discussions I had with students during my senior thesis on healthy eating during college. “I’m young. I’m in college. I can eat what I want with no consequences,”
- 8. explained one classmate. “Maybe if we were 60 and had diabetes we’d be more willing to make a sacrifice in our diet,” said another. I was shocked to learn that even my fellow Harvard varsity hockey teammates drafted by the NHL had little concern for healthy eating. Maybe college had too many unhealthy food temptations. I wondered if I could encourage students to overcome this like Wanda had. As a varsity hockey player, I found that when I began to pay more attention to eating nutrient-rich foods, I noticed a considerable change in how I felt and functioned on and off the ice. I set out to learn all I could about nutrition and wellness to maximize my training. Thinking my peers would eat better if they knew more about their food, I implemented a study of traffic-light food labels (green: healthy, red: less healthy) in cafeterias on campus. My study, published in the American Journal of Public Health, included 12 Harvard dining halls which served 6400 undergraduates and over 2.6 million food and beverage portions. Although the labels provided nutrition information in a simple color-coded format, I learned the same label could give vastly different meanings. Two weeks after I implemented the labels in Harvard dining halls, a small but important number of students raised concerns that the traffic-light labels could exacerbate eating disorders. Late one Saturday night, I received an email from “Diana,” a classmate who was disturbed by the labels and recounted personal struggles with bulimia. The issue promoted widespread discussion about the implications of food labels on campus, and I wondered if I should continue the study. Since college-age women are at risk for eating disorders, I carefully considered the implications of a red label that discouraged selection of particular foods. Although the majority of students viewed such a label as a simple, convenient way to provide information, a small minority thought a red “stop-light”
- 9. label could be triggering for those struggling with an eating disorder. On the other hand, college cafeterias could be an effective intervention site. University students gain weight faster in their first year at college than average Americans at the same age, and they begin to develop lifelong eating patterns. Two editorials in the Harvard student newspaper, titled “A Red Light for Food Labels,” and “Cross Your T’s, Dot Your… Food?” highlighted the controversy of the labeling and how differently people value food. One editorial believed the traffic- light labeling “let students know the moral value of their food” and that this type of food labeling is inherently faulted because “meals are not ‘good’ or ‘bad.’” To the contrary, I had a significantly different attitude towards food that I shared with many of my teammates. I found that as a varsity athlete, I felt better when I ate certain nutrient-rich, “good” foods and performed better on the ice. What began as a practical labeling study to share this knowledge with my classmates, opened me up to a totally different and important outlook on eating that I had not personally experienced. I needed to find a way to balance both of these perspectives. I got to work immediately with the faculty advisers and student members of the Eating Concerns Hotline and Outreach group at Harvard to redefine the traffic-light label colors as “nutrient- rich choice” (green), “nutrient-neutral choice” (yellow), and “there’s a more nutrient-rich choice in yellow or green” (red). The use of “choice” in the messaging aimed to make labels less judgmental, and the use of “nutrient” highlighted that calories did not influence the label color. Stepping back, the controversy over the labeling made me realize how complex it can be to try to influence people’s behavior to achieve good health on a wider scale. Healthy eating is extremely personal, and can carry different meanings for different people. Working with people to understand their
- 10. backgrounds and helping them overcome challenges to reach their health potential is truly captivating. This cemented my desire to pursue medicine where I would be in a unique position to do just that. I so admire women like Wanda who despite many barriers, are working hard to take care of their own health. In June 2016, I started teaching a nutrition workshop, “Cooking Without Kitchens,” to homeless families living in temporary shelters and motels. In these classes, I begin with a nutrition lesson, and then give cooking demos of recipes. Using a microwave, I craft meals that can be made on limited budgets within the shelters such as poached eggs, spaghetti, spinach lasagna, tacos, and red lentil salad. These experiences have taught me that we are unlikely to find a one-size-fits-all approach to healthy lifestyles. Efforts to improve student health on a large scale will likely require preparatory work, including student involvement at all stages of development and implementation with iterative improvements based on periodic student feedback, to ensure that interventions are effective and that people are comfortable with them. As a future doctor, I am thrilled to continue this work more broadly to inspire and empower others to explore the adoption of healthy habits that meet unique mental, physical, and social needs. 2017 Winning Essays Fall The year is 2017. Social media fitness experts, diet plans, and “the five secret tips to your best body” are ubiquitous. There are unlimited online tutorials on how to lose weight and get the perfect beach bod, but how about living a healthy lifestyle? Most online health and wellness plans advertise that customers
- 11. will lose 20 pounds in two months on their revolutionary diet. Or that their secret supplement will make consumers feel more energized and promote weight loss. Then the two months are up the supplement pills are exhausted and people return to eating the same foods as before and anxiously await the next fitness trend. In addition, most workout plans are temporary. They only last around eight weeks and provide a few stagnant workouts and exercises that the individual will rarely revisit. Health and wellness is not merely a sprint to the finish line in a race of who can see the fastest results. Health and wellness is a marathon journey that lasts a lifetime. My fitness journey began when I was about eleven years old in the 6th grade in my hometown Teaneck, New Jersey. I keenly remember the fear and anxiety that came with being overweight at that age. Taking off my shirt in the gym locker rooms and exposing my overgrown chest and rotund stomach was a terrifying experience. I anxiously surveyed the room for peering eyes before I ducked into a corner to quickly change shirts. I quickly learned to do this out of habit and the other kids that didn’t suffered the consequences. The embarrassment was compounded when I was unable to keep up in my physical education class; barely hanging on to the bar during the flex arm hang with all my peers snickering in amusement. Or being one of the last to cross the finish line whenever we had a race. One time I tried to do the rope climb after I saw a boy reach the top and everyone greeted him with roars of applause. When my classmates saw me approach they whispered under their breath, “he’s too fat to climb it” and walked away because I was to fat to deserve their attention. I couldn’t wrap my feet around the rope. And every overweight middle school student can relate to the dreaded moment in health class when they reach the health and wellness chapter and the students incessantly look around the room to find someone that meets the endomorph body type description.
- 12. I decided I finally had enough when in that same health class we encountered was to get fit and be healthy. We read about obvious nutrition tips like eating fruits and vegetables and drinking water and basic exercises like running and jumping rope. Then, of course, the popular good-looking boy that could easily do twenty pushups blurted out “ Isaiah can’t run!” I’ll never forget this moment. His words changed my life forever. They are the single most pivotal reason I am here today. My whole class keeled over in laughter. I couldn’t open my mouth to protest. I couldn’t defend myself. I was paralyzed with the truth. That was the moment that I decided what was truth and what was a lie. I took control of what was fact and fiction. I began my health and wellness journey doing pushups and sit-ups in my bedroom before I went to sleep. I could only amass about four half pushups and twenty sit-ups in which I could barely get my shoulder blades off the ground. But I persisted. The exercise I did at my home formed the basis for the passion and love I have for fitness today. I began to enjoy playing recreation soccer and basketball and continually asked my mother to sign me up for the next year. As I grew older I became healthier but I was still missing several elements of a healthy lifestyle. I was still very similar to the majority of Americans. When I wasn’t playing a recreation sport I lived a sedentary lifestyle. Currently in America 20% of the population is considered obese (stateofobesity.org). Technology has largely hindered rather than helped Americas health. People can sit on their couches and watch T.V. for hours at a time. Moreso, streaming services such as Netflix allow people to binge watch whole seasons of shows varying up to 20 episodes in one sitting. As I entered high school I learned what having a healthy lifestyle is. I no longer binged watched T.V. and I participated in my schools sports; track and cross-country. In addition, I did
- 13. strength training in the gym to make be a better athlete. Squats and deadlifts gave me leg power and core stability; clean and presses made me explosive; Pushups and pull-ups gave me the upper body stretch to generate force and run faster; and abdominal workouts gave me the core strength to finish the last 100 meters of a race as fast as I could. I improved my nutrition by avoiding greasy foods, eating healthier, and drinking more water. For example I dilute sports drinks with water because of their high sugar content. As I enter into college I am implementing these healthy habits into a concrete routine of health and wellness. I have a schedule of varied workouts like basketball, high intensity interval cardio, heavy weight lifting, body weight drills, running, swimming etc. Furthermore I am improving my healthy lifestyle in college. Actively abstaining from drugs and alcohol that inhibit motor abilities is tantamount to a healthy life. Furthermore I get approximately eight hours of sleep, an often overlooked but necessary part of health and wellness that is crucial to mental and emotional health. Meditation is also a good way of alleviating mental and emotional stress that can lead to overeating. Fitness should be a permanent routine woven into the fabric if one’s life and maintaining a healthy lifestyle requires resilience dedication and devotion, things that don’t come easy, but the benefits are life changing. Spring I have lost 100 pounds by adopting a healthy lifestyle. I learned a wellness secret for college students along the way. My journey of discovery began one day in Civics class. “Ronald, it’s your turn,” said Mrs. Hirayama. “Oh, okay,” I stuttered. I was in the 12th grade, and it was my turn to present. “Don’t trip; don’t trip!” screamed the voice in my head as I
- 14. stood. Not only did I trip, but I fell straight on my face. The class erupted. I did not know what hurt more: my face, or the fact that Mrs. Hirayama was laughing too. Eventually, I made it to the front of the room. At this point, my knees took on lives of their own, shaking madly like Shakira’s hips. I opened my mouth. The only sound came from the ticking clock. I stared at the students as they stared back at me. My lips quivered in silence. Half the students were shaking their heads, as was the teacher. “Ronald, sit down,” said Mrs. Hirayama.The bell rang; school was out. I felt like my heart had been shred apart. On my way home, a couple of Civics classmates rode their bikes past me. “Get outta the way, useless pig!” they yelled. I found myself burning with shame. Deprecating remarks like these were typical of my teen years as I struggled with both obesity and autism. Not only did I struggle with repetitive motions with my knees and lips, but I also struggled to articulate words. I also had difficulty reading both body language and sarcasm. I simply could not tell if people were joking or being serious. Furthermore, I laughed at the wrong times and had the tendency to stare at people without blinking. My weight further reduced my self-confidence. I felt trapped. However, there was one person who saw potential in me. In a concerned tone, my friend Nehemiah said: “Life is short; you only get one body!” He was right. I realized I could be the first in my family to take a stand against obesity. While I walked home that fateful day, I resolved to be different from my unhealthy parents. I pushed myself to transcend my depression and obesity problems. I challenged myself to start living.
- 15. I asked for Nehemiah’s coaching, and together we created a diet and exercise regimen. I promised him I would lose 30 pounds. By persisting with Nehemiah and holding myself accountable, I was actually able to lose 100 pounds over two years, starting at 260 pounds and ending at 160 pounds. I broke down in tears several times in my journey. However, in my moments of self- doubt, I used the memory of my failed presentation in Civics class. That was the last time I would allow a class, along with the teacher, to laugh at me. My desire to triumph over pain was channeled into real weight loss results. In addition, my confidence and social skills drastically improved as I continually lost weight. The members at my local church saw my physical transformation and social improvement. In turn, I became an inspiration and volunteered to create the Fitness Association. Along with a select group of people, I was able to empower others on issues related to health, fitness, and nutrition. In the end, we helped hundreds of people in turning their habits around. For example, young Bobby and Sally learned to pack their own sandwiches to school instead of eating unhealthy, oily school food. In addition, Mr. Li set a goal to bike to work three times a week, and he ended up losing over 20 pounds. I was able to influence people and inspire them to change their lives for the better. In my journey of losing weight and helping others, I uncovered a profound lesson: habits are more powerful than emotions in achieving health and wellness. The key to great health, then, lies in leveraging solid habits with the compounding effect. The compound effect occurs when small habits accumulate over time to produce remarkable long term results. If one is living in the compounding zone, one will continually push oneself beyond one’s perceived limitations. For instance, whenever I became tired during exercise, I would push myself to do extra sets. I
- 16. would jog for an extra minute at the end of my runs, and I would eat extra fruits beyond my quota for each day. When these actions in the compounding zone became a consistent habit, my bodily progress became truly impressive. By adding a companion to my schedule to hold myself accountable, I was able to generate sustained results. I also learned that the key to sustaining healthy habits is to change one’s exercises. Indeed, the body adapts to the same routines used over time. The FITT principle (changing the Frequency, Intensity, Time interval, or Type of exercise) can be used to vary one’s workout schedule. That said, healthy living is a lifetime endeavor because it requires one to alter exercise routines to prevent the body from plateauing. In all, the secret to a healthy lifestyle involves leveraging novelty in one’s life. When variable workouts are consistently performed with the compounding effect, results will skyrocket over time. Such habits can be initiated during one’s college years and can be sustained over a lifetime by partnering with someone with similar fitness goals. Indeed, I have taken advantage of these strategies and remain committed to a lifetime of healthy habits. I invite you to jump aboard. 2016 Winning Essay A bowl of trail mix – a curated mixture of almonds, walnuts, dried apricots and dark chocolate morsels – sits beside me as I write. I wonder if I will be denied this scholarship because of the last chocolate chip I munched. But that chocolate chip keeps me going. By giving myself choice, living a healthy life has become a way of life. Sustaining a healthy lifestyle has never been easy for me. When I first began college, I mindlessly enjoyed the unlimited ice cream and chocolate chip waffles on Saturday mornings. I had
- 17. days when ice cream on top of my waffles made for a classic pick- me-up morning feast. I eventually realized, however, that this meal had the exact opposite effect of a “pick-me-up”. I felt lethargic and tired. I was first surprised and then became depressed once my jeans became a little too snug. Like many college students, I bounced between extensive varieties of diets. The 1200-calorie days. Fat- free foods. Zero-carb diet. The ketogenic approach. Many of these diets were great for a few days, even weeks. Then, I’d get a sniff of fresh chocolate chip cookies or a grilled cheese sandwich. Sometimes, it would simply be a carton of full-fat yogurt. When I’d have one of these “cheat” bites, my entire day of dieting would crumble apart and I’d resort to overeating, perhaps it was even binge eating. I would not be able to concentrate on school or immediate assignments. Rather, I’d take the day off while eating all the sinful foods I had restrained from myself. There were days I would eat until my stomach hurt. There were nights I hated my body and myself. I would feel useless and simply go to sleep. The next day, the diet would start again. To overcompensate, I’d go half a day without eating. Needless to say, I never lost a sustainable amount of weight during this period of dieting. More importantly, I was unhappy, unproductive and very unhealthy. A year later, I began studying for the MCAT – a crucial time for any premedical student. While studying for the exam, my days were jam-packed with study sessions and summer school so I didn’t have much time to think about my diet. I fell into a rhythm of waking up early each morning and eating four home- cooked meals everyday. Every evening, I would go to the gym so I could energize myself without the need for caffeine. I slept by midnight everyday and made sure to get 8 hours of sleep. Studying for the MCAT was like training for a marathon; I didn’t want to cram and made sure I had ample energy to study diligently for the entire summer. Suddenly, it wasn’t so hard to eat healthy on a regular basis. No urgent cravings and no binge
- 18. eating. With the exam only weeks away, food was not the center of my attention. Today, I am twenty pounds lighter than my first year of college. I am mindful of what I eat and how much I eat. However, I hold myself to no restrictions. A philosophy of healthy living as a lifestyle allows me to enjoy day by day. I’ve learned to forgive myself and celebrate milestones. These changes have brought me ample more happiness and pride than my weight loss. As a medical student, I have the great pleasure to learn from physicians who value the art of medicine as much as the science behind it. One physician in particular is Dr. Sheffield, an endocrinologist at Kaiser Permanente. During a lecture on obesity, he asked us, “Which two specialties in medicine express the most compassion?” According to a survey, the answer was oncology and pediatrics. His rationale behind the answer was that both of these specialties have something special in common; oncologists and pediatricians never blame the patient for his or her disease. Then, Dr. Sheffield asked us to consider the following hypothetical situation: “It’s 2 AM, and you’re the physician on call. An obese, diabetic man just suffered a heart attack from exacerbated atherosclerosis.” He wondered how many of us would blame the patient, “if only the patient watched what he ate”. He urged us to think like an oncologist or pediatrician and be more compassionate towards our patients. I think back to my difficult and ongoing journey towards maintaining a healthy lifestyle. I will never blame my patient for his or her inability to sustain a nutritious diet. I have learned from my personal and academic experiences that healthy living is really a challenge of a lifetime. I strive to eat mindfully, exercise frequently, sleep well and perhaps most importantly – forgive myself. Eating well and losing weight is hard. Maintaining healthy habits to be sustained over a lifetime
- 19. is even more difficult. I have realized that I will not lose weight in a day, nor will I gain it overnight. The best and most practical approach is to forgive myself and move on with the day. No day should be wasted because of a chocolate chip cookie.