Friday, July 01, 2016

A 15 Second Video That If You Own A Harmonica I'm Betting You'll Try

Today's Funny Friday video involves a vacuum cleaner and a harmonica.

Have a great weekend!

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Thursday, June 30, 2016

Need Some Kids' Health Good News And Inspiration? You've Got To See This!

Today's guest post comes from Middlesex County RD Nadine Devin. I had the great pleasure of meeting Nadine in person last week when Dr. Dan Flanders and I flew down to chat with her community about childhood obesity. What's incredibly powerful about small communities is that unlike big cities, they're nimble. Nadine has been instrumental in helping to guide her community into changing their children's food environment, and wonderfully, she's getting broad buy-in. And do yourself a favour, watch the embedded video too. This is what change can and should look like. Huge kudos to Nadine and to Middlesex County!
As a mother and an advocate for child health, it concerns me that the favoured team sideline snack is a salty or sugary treat like candy, chips, cookies, Freezies and juice boxes, and that gone are the days of serving orange slices and watermelon after a game. We all sign our kids up for sports to keep them active and healthy but these snacks are not in line with that mission.

The average child is consuming at least three times more daily sugar then recommended. At the same time, 60% of children are not consuming the recommended amount of vegetables and fruit. When these two situations combine, the danger is their increased risk of heart disease, cancer, diabetes, weight gain and dental cavities.

But there is good news! Evidence shows that health outcomes in children improve when communities work collaboratively to support the healthy choice. Small changes in our food environment can illustrate to our children that water, vegetables and fresh fruit are vital and enjoyable and that treat foods have a time and a place.

Change doesn’t happen by itself. It happens when one person makes one decision to lead the change and illustrate how others can follow suit.

I have the pleasure of managing a provincial grant for the County of Middlesex as part of the Healthy Kids Community Challenge, a Province of Ontario initiative designed to improve the health of children 12 years and under. In May 2016, I put a challenge to local soccer and baseball coaches to "bring back healthy sideline snacks". The challenge was simple - when it is a parent's turn to supply snacks for the team, they are asked to bring only water, vegetables and fresh fruit.

Those who challenge social norms can face harsh criticism, so I wanted to make the change easier for coaches. For their leadership, players and coaches would be awarded with a recognition package including stainless steel water bottles for each team member, insulated water jugs, certificates, a team plaque and public recognition.

I hoped for five teams, and was thrilled to have sixteen sign up for the challenge! The feedback has been overwhelmingly positive. To see for yourself, check out the following video of star players and coaches.

To build on this call to action, the County of Middlesex recently launched our Lead the Change Healthy Kids Community Challenge Recognition Awards. The mission? To inspire agencies across the County to adopt changes in their organizational practices that limit the provision and marketing of sugary drinks and snacks, and model the wonders of water, vegetables and fresh fruit. Successfully awarded sites will receive public recognition for their efforts. We hope that this acknowledgment by peers and the community will reinforce the acceptability of these ‘new norms’ and empower momentum in agencies across the County. One change at a time, we can build a food environment that supports our current and future generations in being the healthiest they can be.

To inspire local action, we interviewed six County of Middlesex champions who have led the change in their respective agencies by modeling and supporting the healthy choice. These stories illustrate that change can happen, it will be accepted, and you too can make a difference in your community.

Looking for inspiration? Check this out (Yoni note: You must watch this!)

Nadine Devin, RD MHSc., is the Project Manager for the County of Middlesex Healthy Kids Community Challenge. For more information on the Challenge you can visit online, or follow on Facebook or on Twitter. You can read more on the history of the Healthy Kids Strategy here.

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Monday, June 27, 2016

"Tell Me I'm Fat", A Spectacular Episode of This American Life

I'm going to start with the bottom line - you need to listen to this episode of This American Life.

It's a podcast in 5 acts.

Act 1 is Lindy West's inspirational tale. She covers the freedom and power she gained from "coming out" as fat and eschewing society's desire for her to be on a never ending quest for thin.

Act 2 is Elna Baker's explanation for why she believes that her life could not be the same were she to regain the tremendous amount of weight that she's lost and why she still tortures herself to keep it off.

Act 3 is Roxane Gay's discussion of why she's not able to get to that Lindy West level of self-acceptance and her thoughts on the difference between "super morbidly obese", and "Lane Bryant fat".

Act 4 is Daniel Engber's recounting of the Christian evangelical take on weight loss

Act 5 is Lindy West again, telling us about how her husband proposed and its significance in terms of her weight and self.

If you can't listen to it today, please bookmark this and come back to it.

While I'm not going to go into a lengthy post on the details of the podcast, it did leave me with one question. What's a less common unicorn? The person who successfully loses a pile of weight and keeps it off (and for a prior blog post on the idiotic weight loss goalposts society has set and why we need to change them click here), or the person who manages like Lindy West, to fully slough off the shackles of societal expectations leaving themselves truly free from the weight biased shame and guilt the world constantly foists on them?

(And though I have yet to read it, Lindy West's new book Shrill is definitely going on my summer reading list.)

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Saturday, June 25, 2016

Saturday Stories: Bloody Plant Burgers, Jesus' Wife, and GMO Safety

Mark Lynas in the Cornell Alliance for Science says the debate over GMO safety is over.

Ariel Sabar in The Atlantic asks if Jesus had a wife?

Lindsay Hoshaw at NPR discusses the hopefully soon to be in my belly blood plant meat replacement burger.

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Friday, June 24, 2016

If You Speak Turkish This is Probably NSFW or Kids

If you don't speak Turkish, today's Funny Friday is damn funny.

Have a great weekend!

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Wednesday, June 22, 2016

Heinz Sued by Aussie Consumer Watchdog For Peddling Sugar As Vegetables

That Kraft Heinz in Australia advertised products that by weight were nearly 70% sugar as, "nutritious food" and "99 percent fruit and veg" sounds more than a bit dubious.

The products targeted toddlers, and no doubt their claims were there to assuage parents' concerns about the contents that looked and tasted like candy.

Well yesterday the state based Australian Competition and Consumer Commission (ACCC) took action and commenced legal proceedings in federal court.

Beyond not buying into the notion that products that are nearly 70% sugar by weight can be fairly described as nutritious the ACCC is also concerned that,
"rather than encouraging children to develop a taste for nutritious food, these Heinz Shredz products are likely to inhibit the development of a child’s taste for natural fruit and vegetables and encourage a child to become accustomed to, and develop a preference for, sweet tastes"
Unfortunately misleading advertisements are not unique to Australia.

While it's no doubt the food industry's job to sell food, doing so with deceit should not be tolerated. Kudos to the ACCC for acting.

If you're keen on seeing a bunch more, yesterday the presentation I published in 2012 on misleading advertising cleared 400,000 views.

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Monday, June 20, 2016

The Aspire Assist: Surgical Bulimia Or A Case Study In Weight Bias?

I can't tell you how many people have contacted me about the Aspire Assist. What's been genuinely shocking to me is that the sentiment surrounding the online commentary, as well as the emails I'm receiving, is hugely reflective of weight bias - including from colleagues who I know are champions in the fight against weight related stigma. I wrote this post when the Aspire Assist was first launched, and I'm updating and reposting it in the hopes of triggering at least a little bit of reflection.
Is this new device simply a condemnable medical bulimia machine?

That's certainly the tenor of the discussion out there as generally the reports on this are either pretty angry or simply express revulsion.

Superficially it really does sound horrifying, and undeniably, at first blush it's not what I would consider to be the intervention I'd always hoped for. But when researching the story of course I needed to know - what type of studies have been done on it to date?

Believe it or not, their very early data's interesting. Now this isn't peer reviewed published data, just a presentation, but in it they describe the 111 patients who were randomized to receive an Aspire Assist. 74% of them completed the year long study (vs. only 50% of the control group who received the same lifestyle counselling as the Aspire Assist group but no Aspire Assist).

The results were dramatic. This 15 minute long outpatient endoscopic procedure led completers to lose nearly 40lbs on average representing a loss of 15% of their presenting weights. The completers of the control group meanwhile lost on average just 4lbs.

Not surprisingly, there were post-operative adverse effects - the most common being irritation or granulation of the stoma (the exit port). There were only 4 subjects who reported "serious" adverse effects and all were quickly resolved.

Eating behaviours were also monitored. Pre-surgically subjects were screened for binge-eating, bulimia, and night eating syndrome. None of the Aspire Assist patients were reported to experience worsened eating behaviours, while one control subject developed bulimia.

Interestingly, self-reported data actually demonstrated improvements in Aspire Assist subjects' eating behaviours with more thorough chewing, more water consumption greater meal planning, more mindful eating, and decreased calorie consumption (confirmed by the fact that losses were greater than would be predicted by simple aspiration).

And as far as tolerability goes, the vast majority reported satisfaction with the device, with 93% of survey respondents reporting that they would be somewhat or very likely to recommend it to others.

Comparing the Aspire Assist to the other endoscopic bariatric procedure, the intra-gastric balloon (a procedure that has not been raked over society's coals) the Aspire Assist appears to lead to markedly larger losses with greater response rates and fewer serious adverse effects.

So yes, back to the shock, horror and repulsion, while I readily agree that on its surface both the premise and procedure is less than appetizing, I'm pretty sure that safety and efficacy, not grossness, are what determine the utility of an intervention. If larger, longer, studies reproduce these results whereby the Aspire Assist doesn't lead to or exacerbate disordered eating, involves minimal risk, has minimal adverse metabolic or nutritional consequences, and leads to sustained losses which in turn had demonstrable medical or quality of life benefits, why wouldn't I consider it?

As I've written before it'd be wonderful if everyone lived incredibly healthful lifestyles and in turn those incredibly healthful lifestyles guaranteed weight loss (they don't BTW), but I think my job as a physician is to ensure people are equipped to make informed decisions, not to make decisions for them, or to judge the ones that they make. If the Aspire Assist proves to be both safe and efficacious in the long run, I'll happily discuss its pros and cons with each and every suitable patient. I'll also happily discuss more traditional bariatric surgery, pharmacotherapy, purely behavioural therapy and also the option of doing absolutely nothing with them. And I'll do it all in a nonjudgmental manner too - because my job is to ensure my patients are aware of the risks and benefits of all of their treatment options, including watchful waiting, and then to support them in whatever informed decision they make. To do otherwise in my mind is contrary to the spirit of medicine and suggests one of two exceedingly common and unfair weight biases. First the one that often angrily asserts that unless a person is willing to make formative lifestyle changes, they're not worthy of being helped, or the second - that if only patients wanted it badly enough, they'd just fix themselves. Honestly, if desire were sufficient is there anyone out there who'd struggle with anything?

So is the Aspire Assist brilliant or brutal? Given it's just been born, it's going to be at least a decade before we'll even have the chance of having the robust long term data to make an informed decision. Until then all I can really say is that I'm looking forward to reading it.

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Friday, June 17, 2016

Sweary Ninja Dad vs. Cruel Son (+ Eggs)

Today's Funny Friday video features a dad with far more co-ordination and grace that I could ever dream of.

Oh, and a schmuck of a son.

And raw eggs.

Have a great weekend!

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Thursday, June 16, 2016

ParticipACTION Report Cards Remind Us Every Year How Badly We Suck

We suck at helping our kids to be active.

Here are the past 12 years of ParticipACTION kids' activity report card grades (click on 2016 for this year's edition):
2016: D-
2015: D-
2014: D-
2013: D-
2012: F
2011: F
2010: F
2009: F
2008: F
2007: F
2006: D
2005: D
So what has Canada done about it?

From my vantage point, it sure doesn't seem like much.

As to what we could we doing, I'm honestly not sure.

One thing I am sure of though, simply telling kids to be more active (or telling them and/or their parents how inactive they are) clearly isn't doing a whole heckuva lot. We need changes that change the default.

If you're a parent, I've blogged about the simple solution you could employ to help your kids move more (move with them).

If you're an educator, how about making every classroom/student reward an active one instead of relying on junk food (same goes for all of your various fundraising endeavours)? Oh, and get rid of inane over-protective schoolyard rules like bans on hard balls that effectively stifle active play.

If you're a city planner, how about more time and attention paid to developing safe, comprehensive, and unified biking and walking infrastructure?

And consider too the fact that decreasing kids' physical activity may well also be influenced by their rising weights (and not the other way around). I've worked with so many parents who report that as their kids gained weight, suddenly their interest in favourite activities waned. The why is something people either forget or overlook. Kids are cruel. Being picked last because you're slow, or simply not being able to keep up, would make most kids not want to play. One comment about "jiggling" while a kid runs is liable to lead a kid to stop running. Not wanting to change in front of your peers because of fat jokes and weight bias makes is another common hurdle. Here we need to see calls to action to tackle weight bias, and continued work towards improving the way we use food with our children, and ideally ending the regular use of foods by our kids' schools, teachers, coaches, cities, scout leaders, friends' parents, etc. to reward, pacify, and entertain them at every turn.

So how many more years of reading these depressing report cards before we either stop issuing them, or actually do something about the problem?

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