Monday, August 14, 2017

Dear Reporters, The Cure For Obesity Is Unlikely To Be For Sale On Indiegogo

Last week a reporter contacted me looking for a quote.

She was doing a story on a $449 weight-loss product that is being sold on Indiegogo.

Briefly, the device reportedly works by stimulating the vestibular nerve, which, according to the people selling it, triggers the body to reduce fat storage, and all with just one hour of wear per day!

Of course there's this proviso (emphasis mine),
"Used in conjunction with a healthy diet and regular exercise the average user should notice a significant difference in body fat percentage."
Does the product have peer reviewed studies proving it works?

Of course not.

But it does have an unpublished preprint hosted freely online featuring a 6 person treatment group, only half of who completed the treatments.

The preprint also features a 3 person control group who somehow managed to post an 8.6% increase in truncal fat and a 6% increase in total body fat during the study's short 4 month period.

And it includes the authors' assertion that neither group changed their diet and exercise habits - this despite the fact that the authors didn't track their subjects' diet and exercise habits, and also despite the fact that the control group gained a significant amount of fat in a very short period of time.

After looking at all of this, I politely declined the reporter's request for an interview, as a story at this point on this product, even with a dissenting voice in it, is not simply premature, it's unethical. It's unethical not simply because it further perpetuates the narrative that magic, quick, and easy exists in regard to weight management, but because as is evidenced by the product's Indiegogo page, a story, any story, on this already for sale evidence-free product will be used by its manufacturers to market it to a desperate, constantly preyed upon population (who at the time of this post's writing, have already given this product's promoters $728,463 USD)

Now I realize that reporters are busy, and many don't have the background to pick apart studies, but I'd like to propose that the simple rule of,
"Don't cover medical devices being sold on Indiegogo or Kickstarter as a means to magically treat anything"
is probably a safe one, and one that I wish went without saying.

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Thursday, August 10, 2017

The Strange New Reason Why You Shouldn't Drink Sugar With Your Meals

Granted, it's a small study, but its results were interesting.

The study, Postprandial energy metabolism and substrate oxidation in response to the inclusion of a sugar- or non-nutritive sweetened beverage with meals differing in protein content, looked at the impact sugar sweetened beverages had on the appetite suppression benefits of higher protein meals.

The authors note that,
"increasing dietary protein while maintaining energy intake produces a greater and more prolonged thermic effect and greater total energy expenditure",
that protein,
"potentially increases fat oxidation by up to 50%,"
that
"decreasing protein consumption may stimulate an increase in energy intake in an attempt to maintain a constant absolute intake of dietary protein",
and that,
"a 1.5%E decrease in dietary protein intake increases energy intake from carbohydrates and fats by 14%, perhaps in an attempt to increase protein intake from less protein-rich food sources (and point out that) in a 4-day in-patient ad libitum crossover feeding trial, a 5%E decrease in dietary protein intake produced a 12% increase in total energy intake"
So the authors were curious whether or not the inclusion of a sugary beverage would change the impact that a high protein meal had on consumption, appetite, and fat oxidation, and to explore, they studied those variables in 27 adults (without obesity) on two separate occasions in a direct (room) calorimeter after the consumption of a sugar-sweetened beverage or a non-nutritive sweetened beverage along with meals that varied in protein composition (15% vs. 30%).

The authors found, as expected (and certainly in line with the experiences I've seen among thousands of patients), that meals with higher protein content decreased hunger, increased fullness, and decreased the desire for fatty/salty/savory foods (sweet desires weren't affected).

The authors also found that when consumed along with a higher protein meal, sugar sweetened beverages increased the desire for fatty/salty/savory foods, and simultaneously decreased diet induced thermogenesis (the energy spent on processing/storing food), and fat oxidation (which the authors postulate may lead to a greater tendency of the body to store fat).

All this to say, treating sugar sweetened beverages (including juice) like the liquid candy that they are, and consuming them as treats, in the smallest quantities you need to be happily satisfied, rather than drinking them along with your meals, is probably a good plan.

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Tuesday, August 08, 2017

The Canadian Cancer Society Wants You To Drink Sugar And Eat At Chipotle

A few years ago I pointed out the hypocrisy of the Canadian Cancer Society encouraging people to eat Domino's pizza in the name of fundraising.

I noted that sure, fast food pizza here and there isn't going to kill you or give you cancer, but that there's little doubt that one of the major drivers of our society's struggles with diet and weight related illnesses is the normalization of fast and junky foods as regular, everyday parts of our lives.

My belief is that this normalized culture of convenience is in part encouraged by the cause-washed use of candy and junk food for fundraising - a practice which may have been inconsequential (and rare) 60 years ago, but superimposed on our health issues today, is just plain wrong (and constant). And it's especially wrong when adopted by health organizations whose cause, like that of the the Canadian Cancer Society, is itself impacted by low quality diets.

So this year's Canadian Cancer Society junk food partners are Chipotle, PepsiCo, and the Dole Food Company.

The Canadian Cancer Society's partnership with Chipotle sees them encouraging a trip to the giant fast food burrito maker in the name of 50% of a single day's sales, while their partnership with PepsiCo and Dole come from one of their flagship events - the Run For The Cure - where PepsiCo and Dole serve as the Run's, "National Official Suppliers". As such, at the finish line of the short 5km fundraising run (which of course isn't of a distance long enough to worry about any fuel or hydration needs), PepsiCo and Dole will be there to market hand out the beverages that the Run For The Cure website notes provide participants, year after year, with "delicious refreshment".

Of course they'll also provide participants with piles of sugar given that Dole Sparklers, a "real fruit beverage", pack 4 teaspoons of free sugar per can, while Real Tea's offerings can pack up to a whopping 12 per bottle depending on flavour.

It's a good thing then I guess that the Run For The Cure is on October 1st rather than September 30th given that in September the Canadian Cancer Society's fundraising effort is a much more appropriate Sugar Free September initiative

And as the Canadian Cancer Society is explicitly aware, fruit drinks and sweetened tea, are common sources of free and added sugars in our diets.

One of the other reasons why these partnerships are so unwise is the way they're utilized by the junk food partner. For instance Dole's gone ahead and leveraged their partnership for in store sales of their sugar water by using it to cause-wash their products directly.

Given that the last time around the Canadian Cancer Society reported they were incredibly proud of their partnership with Dominos, I imagine this time will be no different.

Not sure pride is the emotion I'd recommend when reflecting on their comfort with junk food fundraising.

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Thursday, August 03, 2017

Will Weighing Yourself Daily Really Help You Lose Weight?

There are no shortage of people and stories who'll report that one of the easiest things you can do to help yourself lose weight is to weigh yourself daily.

And there are plenty of journal articles too, like this one which came out just last week, that concluded,
"these data extend the possibility that daily self-weighing may be important for prevention of unwanted weight gain"
The problem with the majority of these studies however, is that they're not randomized trials designed to compare the intervention of weighing oneself daily to not, but rather they're either longitudinal studies, or retrospective studies, that look at weight loss and whether or not there's an association with daily weighing.

That matters a great deal because it certainly might follow, and this would be consistent with the experiences I've observed in working with thousands and thousands of patients, that when people know they're struggling with their diets and lifestyle changes, they avoid stepping on the scale, and therefore my bet would be that daily weighing is simply a marker for people who are doing well with their efforts.

So have there been randomized controlled trials of daily weighing on weight loss?

Surprisingly, I could only find one that isolated daily weighing as the primary weight loss intervention. It was a study which randomized 183 adults with obesity to weigh themselves daily, or not, and both groups were given weight loss advice that was known to be ineffective. That last bit is important if you're trying to suss out whether or not daily weighing itself provides benefit.

The authors' conclusion?
"As an intervention for weight loss, instruction to weigh daily is ineffective. Unlike other studies, there was no evidence that greater frequency of self-weighing is associated with greater weight loss."
I also wonder about whether or not daily weighing might lead to increased recidivism? Though I couldn't find any studies that looked at daily weighing and its association with patient dropout, given that day to day weight fluctuations are normal, and that weight loss (and life as a whole) isn't often a straight, consistent, line, I worry that those weighing themselves daily will provide themselves with more opportunities to be discouraged and hence, more likely to quit their intentional weight loss efforts in frustration.

In our clinic we recommend our patients weigh themselves weekly, on Wednesday mornings, naked, after pee, before breakfast, with the rationale being it's important to ensure weight gains, if they're occurring, are noted, because if you're off course, it's easy to gain a great deal of weight in a short period of time and avoiding the scale because you know things aren't going well might lead you to gain more than you would have were you aware of your trend.

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Tuesday, August 01, 2017

How Is Reading with Ronald (McDonald) Still A Thing?

There's no denying there's a fair bit of grey to the black and white world of corporate sponsorship and public private partnerships, but the Reading With Ronald program probably doesn't fall into that category.

Simply put, Reading With Ronald sees public libraries inviting Ronald McDonald to read to kindergarteners.

Publicly funded institutions that by definition are trusted by children shouldn't be used to market anything, let along junk food, to children.

That these events occur doesn't speak so much to incompetence though, they speak to how normal it is in society today for us to pretend that corporate interests in events like these are altruistic, and not just marketing.

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Saturday, July 29, 2017

Wednesday, July 26, 2017

Should You Buy The World's First DNA Based Weight Loss App?

This week saw the release of embodyDNA a, "DNA based weight loss app".

According to the press release, for the low, low, price of just $188.99, to work alongside your new food diary, you can order a saliva kit to have your DNA analyzed and then you'll receive results telling you to do such things as reduce your sugary drinks, limit your calories, avoid empty calorie foods, get plenty of sleep, and include protein in your diet.

Or, alternatively, you could not spend $188.99 and you could do those same things.

Doesn't seem like a tough call to me.

While the notion of personalized DNA based recommendations is exciting, paying $188.99 for a test that'll tell you things you already know to be a good plan is about as far along as the science has gone.

So let me save you your hard earned cash and give you some straight forward advice:
  • Keep a food diary
  • Reduce restaurant and ultra-processed meals
  • Cook meals made with fresh whole ingredients and eat them free from distractions
  • Include protein with all of your meals and snacks
  • Minimize all caloric beverages (especially sugar sweetened beverages and alcohol)
  • Cultivate good sleeps and good friends
  • Don't smoke
  • Exercise as much and as often as you can enjoy
Do those things and you can safely, and possibly forever, ignore the latest hype.

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Monday, July 24, 2017

Guest Post: A Lawyer Weighs In On Canada's Proposed Kid Ad Ban

Early last week there was a surprising piece in Blacklock's Reporter that suggested that Canada may be reconsidering its plans to ban the advertising of junk food to children (an election piece of Prime Minister Trudeau's and part of Health Minister Philpott's mandate letter). After seeing it, I contacted Canadian public health lawyer Jacob Shelley and asked him if he'd be so kind as to share his legal thoughts. He kindly agreed.
Restricting food and beverage marketing to children has long been identified as a necessary public health strategy to reduce diet-related chronic diseases, including obesity. It is a strategy endorsed by the World Health Organization and has been the focus of the Stop Marketing to Kids Coalition in Canada over the past few years (the Coalition has called for the implementation of its Ottawa Principles, which bans food advertising to youth and children under 16). Not surprisingly, there was considerable excitement in the public health community when Prime Minister Justin Trudeau identified “introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec” as a top priority for protecting public health in his Minister of Health Mandate Letter.

Québec’s Consumer Protection Act prohibits, with some exceptions, all commercial advertising to children under thirteen years of age (s. 248). In 1989 the Supreme Court of Canada upheld the Québec ban as a constitutionally valid limitation on the freedom of expression, protected by section 2(b) of the Charter of Rights and Freedoms in the seminal case of Irwin Toy v Québec.

In Canada, expression is considered a “fundamental freedom”, and because of its importance, the courts have consistently held that section 2(b) requires a large and liberal interpretation. Commercial speech, which includes advertising, is among the types of expression that the Charter seeks to protect. The courts have held that commercial expression serves an important public interest, one that goes beyond its economic value, because it allows consumers to make informed choices. Even so, the government can impose restrictions on expression. A limitation on the freedom of expression can be justified if the government is able to demonstrate that it is reasonable, an assessment based on the Oakes test.

This is what occurred in Irwin Toy, where a majority of the Supreme Court found that the Québec ban was justified, even though it infringed on the freedom of expression. The Court was particularly concerned about the vulnerability of children to advertising. It held: “the evidence sustains the reasonableness of the legislature's conclusion that a ban on commercial advertising directed to children was the minimal impairment of free expression consistent with the pressing and substantial goal of protecting children against manipulation through such advertising.”

Since Irwin Toy, the Supreme Court has upheld other bans on commercial speech, most notably, commercial speech related to tobacco products. In Canada v JTI-MacDonald, the Court unanimously held that the restrictions placed on tobacco advertising and marketing were justified restrictions on the freedom of speech. Of particular note, the Court held, “when commercial expression is used for the purpose of inducing people to engage in harmful and addictive behaviour, its value becomes tenuous” (para 47).

Through Irwin Toy and JTI-MacDonald, the Canadian jurisprudence clearly establishes that (i) children are vulnerable and need to be protected from manipulative advertising and (ii) commercial expression that induces harmful behaviour(s) has tenuous value. It would seem apparent, then, that restricting advertising to unhealthy food products to children – the strategy the government appears to have adopted – is relatively low-hanging fruit. After all, the government could do more, as Irwin Toy involved restricting all advertising directed to children. While there may be some details to iron out – such as what age should the ban use and determining what constitutes unhealthy foods – the overall strategy seems to be in accordance with Canadian law.

Thus it was surprising to read that Health Canada may be backing away from meaningful restrictions on food advertising to children out of fear of industry lawsuits (note: this has not been confirmed or reported elsewhere).

UPDATE: Health Canada was kind enough to tweet a response after this article was posted. What is there to be afraid of, exactly? Certainly industry lawsuits were expected the moment PM Trudeau penned his mandate letter. It would be unrealistic to expect the food industry to accept any governmental oversight of advertising to children – kids are big business, after all, and restricting food advertising to children will have a discernable impact on the industry’s bottom line. The industry is not interested in any regulation.

To avoid regulatory interference, the industry has created its own self-regulatory framework that it frequently touts. It includes the Broadcast Code for Advertising to Children and the Canadian Children’s Food & Beverage Advertising Initiative (this is in addition to individual corporate promises). Such frameworks are often considered to be largely ineffective, lacking transparency and accountability. Recent research suggests that advertising of unhealthy foods to children has increased in recent years. Self-regulation, simply put, isn’t working.

If the industry does initiate a lawsuit, we can be sure that it will cloak its claim in Charter language, but this should not be mistaken as interest in protecting Canadian’s freedom of expression. Rather, it seeks an unbridled free market, one that allows it to continue to target vulnerable children in order to increase profits.

When PM Trudeau announced Canada would impose restrictions on the marketing of unhealthy foods and beverages to children, the world noticed. Canada now has the opportunity to become a global leader when it comes to restricting marketing to kids. It would be a shame if the fear of industry push-back impeded current efforts, especially when the courts have already made it abundantly clear that children are more important than commercial expression.

Have your say: Health Canada is currently seeking feedback on its approach to restricting marketing unhealthy food and beverages to children, and you can do so by visiting here.

Jacob Shelley is an Assistant Professor with the Faculty of Law and the School of Health Studies in the Faculty of Health Sciences at Western University. His primary area of research is the role of law in promoting public health and preventing chronic disease, with a focus on diet-related chronic diseases. Follow him on Twitter here.

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