Back in January we had the pleasure of joining Go Venture SKN’s first hike of the year which was to the summit of Mount Liamuiga.  This was such a wonderful experience, personally and physically (great exercise!), so we thought we’d share it.

About Mount Liamuiga

To give you a bit of background, Mount Liamuiga is a 3,792-foot volcano found in the north-western region of the beautiful Caribbean island of St Kitts. The peak of Mount Liamuiga is the highest point in St Kitts and it has a steep-walled, 1-km wide crater.

The last confirmed eruption of the volcano was 1800 years ago, reports of eruptions in 1692 and 1843 have yet to be confirmed. So, it’s pretty much considered a dormant volcano except for some active fumaroles in the crater and two periods of earthquake swarms from 1988 to 1989 and 1999 to 2000.

Our Hike

We have had our eye on the great Mount Liamuiga for some time, contemplating a hike up to its peak and then down into its crater.  We’d heard stories of how challenging the hike is, so that had deterred us until this opportunity arose and we thought “How difficult can it really be?” –  we certainly found out!

The Go Ventures SKN team (our guides for this hike) was great, we loved their positive energy and great customer service throughout the process starting with keeping us informed in the lead up to the day of the hike and giving us a quick check-in call the day before to brief us on what to expect (it usually rains at the peak) and what to bring (snacks, drinks, water resistant clothing etc).

It was a fairly early start on the day of the hike (7:15am meeting time) and after a warm welcome, an introduction and driving up to the starting point, we began the hike at about 8am.

Our hike up to the peak was amazing, I can’t provide you with a description that would do justice to the beautiful scenery we encountered as we made our way through the lush rain-forest that covers the slopes leading up to the top of the mountain.

As I looked around, I marvelled at the intricate arrangement of trees and plants – roots were beautifully intertwined, smaller plants were happily sharing living space and creeping along huge imposing trees and unusual root structures led from tree to tree.

I was surprised to learn that the rain-forest wasn’t home to many insects or animals.  I was expecting to dodge spiders and other creepy crawlies, and possibly spot some interesting animals along the way. Not at all. Our Go Ventures SKN guides explained that you rarely see any signs of insects (just a few snails sleeping under leaves) and the monkeys that are found in large numbers all over the island don’t venture out to the mountains.  So, it was pretty uneventful from that point of view, thank goodness!

It Was Tough!

The hike was tough with a capital T!

After about an hour I was absolutely exhausted, and we weren’t even half way to the top of the mountain. I didn’t think I would make it. The hiking trail is rocky and there was a lot of climbing, as in holding on to rocks and trees and climbing up (or in my case being pushed up by my husband!). I had envisioned a nicely landscaped path that would gradually lead us up the mountain. This was not the case and to be honest, I am glad it wasn’t a nicely landscaped path. This was much better, I got an excellent workout and it was fun, even though at times I was ready to quit because I was so tired and my heart was pounding.

As we climbed further and further up the mountain, the temperature steadily dropped and by the time we got to the top of the mountain (over 2 hours after we started), it was freezing cold and raining heavily. Thank goodness we came prepared with our raincoats.

Sadly, the rain was so heavy and the cloud cover at the summit so thick that we couldn’t go down into the crater for safety reasons. We tried to wait it out, but alas the rain and cloud wouldn’t let up. So, we braved the rain as much as we could, had our packed lunch, took in the fresh air and as much of the view as we could whilst in the midst of quite dense cloud cover and then proceeded to make our way back down the mountain.

The hike back down was just as tough and made all the more challenging by the rain, so it was quite slippery. I had a few close calls but managed to make it back down in one piece and still smiling. I loved it!

All in all, the hike took us 5 hours. This included quite a few breaks and a 30-minute stop at the top of the mountain. By the end of the hike we were muddy, wet and exhausted but I was feeling invigorated and inspired by my encounter with nature.

Some Lessons Learnt

Nature is such a great teacher. As I was making may way up and down Mount Liamuiga, I reflected on the wisdom this old mountain had to offer. Lessons that speak to our wellbeing.

We can be so focused on getting to our destination that we forget to enjoy the journey

About an hour or so into the hike, I was one determined lady. I was going to get to the top of the mountain even if it killed me. This meant I was laser focused on that objective and had stopped looking around to truly appreciate the journey up the mountain. It wasn’t until one of the Go Ventures team members said: “Turn around and look at that view” did I realise that I was missing the best part of the hike – the beauty, the unusual trees and the artwork created by the way in which all the vegetation was connected. It was at that moment that I stopped focusing so much on getting to the top and started to really take in the scenery and appreciate the beauty all around me.

Life can be like that too. We can be so focused on getting to the top of our careers or achieving a particular goal that we don’t enjoy our experiences in their entirety . Oftentimes,  when we get to our destination it is often too late to really appreciate the journey or we’re so focused on moving on to the next goal that we forget to take a moment to bask in our success or take time out to enjoy the important things in the journey of life, like our family and friends.

The need for real connection in communities

One thing Mount Liamuiga kept teaching me with every footstep is the need for real human connection in our communities.

In this fast-paced world we live in, it’s hard to form a real community that is connected, where there is genuine interest and concern about each other. This means people can become very isolated and lonely and miss out on forming important friendships and relationships.

As I looked at the rain-forest community, I could see the connections that make the rain-forest a thriving eco-system. Trees and plants are interconnected. Larger plants provide support to smaller plants helping them reach the sunlight, plants with deep root systems provide much-needed grounding to those that need it and root systems talk to each other daily – there is constant contact and checking-in.  No one is left behind or alone.

This made me think that it’s important for us to make time for face-to-face interactions so that we can begin build genuine relationships within our community, making our communities stronger.

The importance of silence

One thing that struck me, particularly on the way back down the mountain, when the guides had switched off the music, was how quiet the rain-forest was. It was a bit eerie at first. I was expecting to hear signs of life, but nope, it was extremely quiet.  It was hard to believe that despite the rain-forest being packed with trees, plants and sleeping snails, it was really quiet. It got me thinking that I am not used to being still. I am used to so much noise. If it’s not the TV, it’s music, podcasts and radio. If it’s not that then it’s my inner noise – constant worrying, inner thoughts, thinking, planning and endless restlessness.

The two hours of peace and quiet during the hike started to feel like bliss. Time to clear my mind and reflect. I didn’t realise how mentally tired I was, and the silence gave my mind a much-needed break.  Mentally I never felt better than in those moments of silence. It had been a tough few months and this moment of peace had been the medicine I needed to usher in a sense of peace.

A short video of our hike to Mount Liamuiga

We All Need a Nature Break

This hike was a wonderful experience .The beauty of our surroundings, being at one with nature, getting some good exercise and the positive vibes from Go Ventures SKN made this a memorable experience. This hike highlighted the importance of the great outdoors in improving our mental wellbeing and giving us the opportunity to recover from the pressures of modern-day life.

Find Out More

Do you live in St Kitts or will you be visiting St Kitts soon? Then we highly recommend that you give the Go Ventures SKN team a call and book a hike with them. You can visit their Facebook page to find dates for their next hikes.

If you want to find out more about the wellbeing benefits of the outdoors, then check out a guest blog post from Capital Garden Services about gardening and wellbeing here

Childhood obesity is a major health issue in the Caribbean with 1 in 3 children being overweight or obese. Being obese and overweight in childhood is linked to the development of a number of health issues such as diabetes and hypertension, and it also negatively impacts a child’s mental health. These health issues can follow children into adulthood with children affected by obesity, or who are overweight, having an increased risk of becoming overweight or obese adults and developing non-communicable diseases such as cancer and heart disease in later life.

Childhood obesity is a significant challenge here in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin island state were overweight and 14% were obese. More recently, in 2017, a UNICEF report published that 26% of children in St Kitts and Nevis are obese.

Childhood Obesity Solutions

To combat childhood obesity we have to ensure that children adopt a healthy lifestyle and one approach is to explore how we can reduce the consumption of products that are high in sugar, salt and saturated fat. One strategy is to focus on nutrition education and making it easier for to parents identify which foods are high in these components, so they can easily make healthy choices when they purchase groceries.

Front-of-Pack Nutrition Labelling

Front-of-pack nutrition labelling has been introduced in many countries to provide a quick and easy way for consumers to assess the health of the foods they purchase. Currently there are several front-of-pack nutrition labelling systems with the main options being:

Summary indicators. These include the Health Star Rating developed by Food Standards Australia New Zealand which gives foods a 1 to 5-star rating based on their healthfulness and France’s Nutri-score which puts foods into five categories, A to E, based on how healthy they are deemed to be.

The traffic light system. This uses the colour code green, amber and red to communicate whether products have a low, medium or high level of salt, sugar and saturated fat based on daily intake references.

Warning labels. This uses a ‘high-in’ label to inform consumers that foods are high in certain nutrients

Front-of-Pack Nutrition Labelling Consultation in the Caribbean

Caribbean countries are starting to explore the introduction of front-of-pack nutrition labels. The CARICOM Regional Organisation for Standards and Quality held a consultation from 15^th October 2018 to 31^st January 2019 on pre-packaged food labelling which included front-of-pack food labelling. The labelling system being explored is warning labels and we were pleased to have been able to submit a response to their consultation.

Our Views

• We support the introduction of front-of-pack nutrition labels in the Caribbean
• We believe that front-of-pack nutrition labels present a quick, easy and useful way of communicating the healthiness of pre-packaged foods
• We believe that front-of-pack labelling provides information in a way that is easier to understand, with respect to healthiness, than back-of-pack nutrition labelling
• We believe more work is needed to determine which front-of pack  labelling system would be most effective in the Caribbean
• We believe that a full assessment is required to determine if front-of-pack food labels will influence consumer behaviour in the Caribbean and if not, why not
• We feel that if the ‘high-in’ labels are to be used, the colour of the labels should be reconsidered, from black to red. This is important so that we begin to steer dialogue away from black always being seen as a negative, which has a wider societal context with regards to race and ethnicity
• We believe a standard international front-of-pack nutrition label is required to ensure consistency and to prevent confusion

Next Steps

CARICOM Regional Organisation for Standards and Quality will review all the comments it has received from throughout the region and decide on a way forward with respect to nutrition labelling of pre-packaged foods.

We look forward to seeing how the strategy for FOP labelling in the Caribbean develops and are pleased to see this action being taken on this matter.

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References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012
3. Kanter, R., Vanderlee, L., & Vandevijvere, S. (2018). Front-of-package nutrition labelling policy: Global progress and future directions. Public Health Nutrition, 21(8), 1399-1408. doi:10.1017/S1368980018000010

World Cancer Day is on 4^th February and it  gives the world the opportunity to come together to raise awareness and campaign on key issues to improve the care, support and treatment given to patients.

Organisers, the UICC,  announced that the theme for World Cancer Day is #IAmAndIWill and this theme highlights that fact that whoever you are, you have the power to reduce the impact of cancer for yourself, the people you love and for the world.

The campaign therefore encourages everyone to make a commitment by using the hashtag and sharing who you are and what you will commit to in order to tackle cancer.

Our #IamAndIWill Commitment for 2019-2021

Our World Cancer Day commitment is to focus on children and raise awareness of the fact that overweight or obese children are more likely to become overweight or obese adults, and being overweight as an adult increases a person’s risk of developing cancer. In  fact, the World Cancer Research Fund has found that being overweight or obese throughout adulthood is linked to an increased risk of developing 12 types of cancer.

Our campaign appeals to parents to reduce their children’s future cancer risk by ensuring they’re a healthy weight now, and this can be achieved by ensuring that children:

• Are physically active and take part in 60 minutes of physical activity every day
• Eat a healthy diet

Childhood obesity is a significant challenge here in St Kitts and Nevis. A PAHO report revealed that 33% of secondary school children in the twin island state were overweight and 14% were obese. More recently, in 2017, a UNICEF report stated that 26% of children in St Kitts and Nevis are obese.  We have to tackle childhood obesity to improve the health of our children to ensure they become happy, healthy adults.

We believe that by beating childhood obesity we can also contribute to beating cancer, and other non-communicable diseases (NCDs).

“I am Lake Health and Wellbeing and I will make an impact by spreading the word

about childhood obesity increasing a child’s future cancer risk” – #IamAndIWill

What We’re Doing Beyond World Cancer Day

Our work doesn’t stop after World Cancer Day, we’re working to beat childhood obesity all year round through our new childhood obesity prevention project. 

We’re currently working on developing innovative resources to get children active so they can easily get to and maintain a healthy weight.

How You Can Get Involved

You can get involved by raising awareness on social media and sharing your thoughts on this issue. You can use any of the images below or the short video clips below.

                                                               

                                                               

Also, we’d love it if you could support us by making a donation, which will go towards our childhood obesity prevention project.

You can make a donation below:

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Thank you for any support you’re able to provide and we hope you’ll join us for World Cancer Day to #BeatChildhoodObesity and #BeatCancer

References

1. UNICEF, Situation Analysis of Children in the Federation of St Kitts and Nevis, UNICEF Office for the Eastern Caribbean Area and the Government of St Kitts and Nevis, Christ Church, Barbados, 2017
2. PAHO, Health in the Americas, 2012: St Kitts and Nevis, PAHO, 2012
3.  World Cancer Research Fund, Diet, Nutrition, Physical Activity and Cancer: A Global Perspective,  World Cancer Research Fund International, London, UK, 2018.

Back in 2013 we conducted a survey to understand the needs of women affected by fibroids. As we conducted this survey, we kept hearing very strong words and phrases describing how living with fibroids was affecting the mental health of women.

“I have hated life at times because of fibroids. I feel like I am being punished for something.”

“Depression from feeling that my only options were drugs or surgery”

“Fear of not being able to have children”

“Just a constant fear of what they could become”

As a result of this we started to explore this issue further by speaking to women who attended our fibroids awareness events and soon realised that this was a much wider problem. To compound this issue there was little information available, at the time, about the emotional impact of fibroids and no services to support women with fibroids in addressing these issues.

So, we decided to reach out to counsellor, Olivia Haltman, the founder of OH Services to speak at our Fibroid Focus event, a conference we held in 2016 for women with fibroids.

Olivia gave an excellent presentation that explored the emotional impact of fibroids explaining how fibroids can affect not just women’s physical health but their mental health too. The reaction from women after her presentation was profound, a stunned recognition that:

• Other women feel the way I do
• What I have been feeling isn’t trivial
• Someone articulated exactly how I was feeling in a way that I never could
• There is a way to address this aspect of my experience with fibroids

Following this event OH Services began work on developing their first 4-week online course on the emotional impact of fibroids. Not only was it a first for them but, to our knowledge, it is the first ever course on this topic. This course was launched in November 2018 and we had the pleasure of attending.

Over the 4 weeks OH Services created a safe space for women to come together to discuss the emotional impact of fibroids. As we listened to the discussion, we realised this was the first time that attendees were exploring this side of fibroids, and it was challenging. They were given the opportunity to reflect and explore their emotions and how these have been impacted by their experience with fibroids.

Ms Haltman explained with some clarity what specific emotions many women feel categorising them into the emotions that women may experience before and after a diagnosis, as well as some general emotions.

We learnt of the fear, anxiety and uncertainty that can occur in the lead up to a diagnosis which is particularly significant as many women with fibroids have symptoms weeks, months and sometimes years before receiving a confirmed diagnosis.

We also learnt of the emotional toll that managing symptoms such as pain, heavy bleeding and anaemia can have on a woman’s quality of life, affecting her personality, relationships, effectiveness at work and restricting the activities she can participate in.

Ms Haltman also described the difficulty of having to deal with treatment decisions, the potential of  a loss of fertility and the possibility of a recurrence after treatment.

The discussions during this course were insightful and thought-provoking and to ensure that participants made the most of each session, participants were given activities after each session to consolidate their learning.

The course ended on a positive note, one of hope and sisterhood with Ms Haltman taking participants through methods and techniques to address these emotions and start a self-development journey.

We really liked that the way this course was delivered. It was interactive and practical with participants being split up into groups to share experiences and explore specific topics. Also, the homework ensured that what was learnt in each session was explored further and applied immediately.

This course fills a huge gap and we believe it is much-needed so that women with fibroids have the support they need. Therefore, we highly recommend this course to anyone who has been affected by fibroids or is supporting a friend, family member or client with fibroids.

The next course starts on 6^th March at 7pm UK time and you can register online here or for more information you can email ohservices@counsellor.com

More Resources and Information

• Fibroids and Your Mental Wellbeing – a fact sheet by Lake Health and Wellbeing and OH Services
• OH Services – Improving the Mental Wellbeing of Our Community
• Podcast: We Talk to Olivia Haltman About the Emotional Impact of Fibroids
• OH Services Starts an Online Forum for Women With Fibroids

Early-bird registration ends soon for our fibroids and exercise webinar, in just a few days!

This webinar will focus on ‘The Importance of Exercise, Relaxation and Me-Time. ‘ and will take place on Saturday 23rd February at 11am AST (that’s 3pm GMT or 10am US Eastern Time).

In this third webinar we are pleased to have as a guest speaker Candice Bryan, the Founder and CEO of Noire Wellness. Candice will discuss the impact that exercise, physical activity and stress have on fibroids and how you can take control, balance your hormones and alleviate your symptoms through exercise, relaxation and having a bit of me-time.

“If sport and physical activity were a drug, it would be regarded as a miracle.” ~ Professor Dame Sally Davies, Chief Medical Officer, Department of Health, UK

Discounted Early Bird Tickets Are Now Available

Early bird tickets for this webinar are available until 23rd Jan and are just $10 (about £8) and you can book your place and find out more here or make a quick payment below using your credit card.  After 23rd Jan tickets are $15 (about £11).

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Previous Webinar

Did you miss the first webinar in our series: Fibroids, Diet and Hormones with guest speaker Le’Nise Brothers,  Registered Nutritional Therapist and the Founder of Eat Love Move?

Have no fear, you can download and purchase the recording of this webinar for just $15 and you’ll have on-demand access to this in-depth session on fibroids, diet and hormones which guides you through the changes that you can make to improve your hormonal health and therefore alleviate the symptoms associated with fibroids. Find out more and download this webinar here

More Information 

We hope that you’ll join us on 23rd Feb  for this really interesting online event and if you have any questions, please don’t hesitate to get in touch with us at events@lakehealthandwellbeing.com and you can book your place here

Cancer Research UK has reported that its scientists have developed a very comprehensive method of predicting a women’s risk of developing breast cancer.

This work was recently published in Genetics in Medicine where it was explained that by combining information on family history, genetics and other factors like weight, age at menopause, alcohol consumption and use of hormone replacement therapy, scientists are able to determine a woman’s breast cancer risk.

What makes their prediction more precise than previous methods is that researchers, for the first time, included 300 genetic indicators for breast cancer in their risk calculation.

This piece of work has led to the development of an online calculator that General Practitioners (GPs) in the UK can use in their surgeries. Currently this online  calculator is being tested by GPs, nurses and genetic counsellors before it is released nation-wide. The hope is that this tool will enable healthcare professionals to explore early detection and prevention strategies for women based on their risk and therefore improve survival rates for breast cancer.

Although this work is very exciting more work is needed, as expressed by lead author, Professor Antonis Antoniou, who said:

“It could be a game changer for breast cancer because now we can identify large numbers of women with different levels of risk – not just women who are at high risk.

This should help doctors to tailor the care they provide depending on their patients’ level of risk. For example, some women may need additional appointments with their doctor to discuss screening or prevention options and others may just need advice on their lifestyle and diet.

“We hope this means more people can be diagnosed early and survive their disease for longer, but more research and trials are needed before we will fully understand how this could be used.”

Additionally, Dr Richard Rope, Cancer Research UK’s GP expert warned that:

“Research like this is hugely exciting because in the future it will enable us to offer much more tailored care which will benefit patients and make best use of the services that we have available.

“Although having an increased risk of breast cancer means a woman is more likely to develop the disease – it’s by no means a certainty. A woman at high risk may never get breast cancer just as a woman at low risk still could. But any woman with concerns should speak to her GP to discuss the options.”

For more information on this work, you can read Cancer Research UK’s research paper here

Hon. Hazel Brandy-Williams, the Junior Minister for Health in Nevis, has joined FIT’s National Weight Loss Campaign (a project that we have been working on).

Hon Brandy-Williams will be leading by example and allowing the cameras to follow her journey as she endeavours to lose weight and get fit and healthy.

Find out more about day 1 of Hon Brandy-Williams’ journey and why she decided to take part in the video below.

The National Weight Loss Campaign starts on 26th Jan and you can join too by registering at to take part by emailing admin@fitwellnesscenter.com or calling (869)-662-8749

We’ve been working with the FIT Wellness Centre in Nevis and assisting with their National Weight Loss Campaign.  We’re delighted to let you know that this campaign gets started on 26th January at the FIT Park, Bath Plains, Nevis.

Director of the FIT Wellness Centre, Mr David Walwyn, was recently interviewed about the campaign and you can read a nice write-up of his interview by Nevis Pages below. 

To register for the National Weight Loss Campaign, please visit the sign-up page here 

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Update: The start date for the National Weight Loss Campaign has been pushed back, a new date will be released shortly.

Article by Nevis Pages:

David Walwyn of the Fit Wellness Center on Nevis, in a recent interview, explained that the National Weight loss campaign will be officially launched at the Fit Park, on the 26th of January.

Welcome back to our Gardening and Health Blog Series!

So far, this blog series has mostly discussed the benefits that gardening can have on your physical health. However, getting green fingered can also have a hugely positive effect on your mental health and wellbeing. This month’s post is brought to you by the folks at Capitial Garden Services and focuses on the mental health benefits of gardening which they illustrate very effectively in their infographic here.

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The famed biologist, E.O. Wilson, once quipped that “Nature holds the key to our aesthetic, intellectual, cognitive and even spiritual satisfaction.” He coined the term Biophilia to describe human kind’s innate need to connect with the natural world, positing that this is why we tend to find it soothing to spend time in the great outdoors.

Numerous studies have highlighted various mental health and therapeutic benefits of gardening. For example, gardening has been found to energise the body and mind. The process of tending to plants has also been proven to help people develop nurturing skills. It has even been found to improve sleep quality. These outdoor activities can help to reduce stress by providing a much-needed refuge from the stresses of the fast-paced modern world.

In particular,  gardening is a perfect opportunity to practice mindfulness. By completing tasks that connect you with the natural world, you can engage all of your senses to appreciate the various sights, sounds, smells, tastes and textures of your surroundings. There are a few things you can do to put a mindful spin on common gardening jobs. For example, before getting started take a few moments pause to breathe and meditate. It’s also a good idea to incorporate elements into your garden design that stimulate the various senses, for example wind chimes or scented flowers.

To learn more, take a look at the infographic below from the team at Capital Garden Services which offers some great insights on why gardening is good for your mental wellbeing and provides several tips on how to garden for good mental health.

Infographic

Check out Capital Garden Services infographic on gardening for good mental health below.

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Previous Blogs

If you missed the previous blogs in this series you can read through them here:

1. Improving Our Health and Wellbeing Through Gardening: An Introduction
2. How I Got Started
3. Growing Tomatoes
4. Growing Okra
5. Growing Peppers
6. Sour Oranges and Mangoes
7. Soursop and Guava

The Caribbean Moves campaign is growing with a third Caribbean country launching their version of this initiative. On 7^th December 2018, Trinidad and Tobago joined the Caribbean Moves family with the launch of TT Moves at the Brian Lara Promenade, in Port of Spain, Trinidad.

Trinidad and Tobago’s Health Minister Terrence Deyalsingh explained that this campaign is just one of their approaches to reduce the incidence of non-communicable diseases in their Caribbean nation. He stated that this campaign is a continuation of their plan to move the public from an unhealthy to a healthier lifestyle, explaining that:

“When I say a healthier lifestyle, I mean how we eat, how we exercise, controlling our stress levels, moving away from this, as social-media electronic toys which shackle us to a device and we sit down.

“We have to start to exercise some more. Simple walking, simple jogging. We have to bring into our diets healthier options like fruits. Today we are giving out fruits and fruit trees. We want people “to gradually change their lifestyles, not change today for tomorrow.”

The launch of TT Moves follows the launch of Barbados Moves in October 2018 with more Caribbean nations expected to join the movement in 2019.

Caribbean Moves is an initiative launched in 2018 that is based on the successful Jamaica Moves  campaign and focuses on physical activity, healthy eating and age appropriate health checks. They’re in the process of establishing a secretariat and their remit is to develop an implementation schedule, coordinate activities and strengthen existing work in the Caribbean Region.

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Picture Credit: Anil Rampersad, pictured is  Terrence Deyalsingh,  the Minister of Health for Trinidad and Tobago