Saturday, January 21, 2017

Saturday Stories: Trolls, Trump Truth, and One Strange Story

Lindy West in The Guardian on why she's decided to leave Twitter for the trolls.

Eliot A. Cohen in The American Interest on telling the truth in the age of Trump.

Alison McCook in Science with a bonkers story about an out of control disagreement at Harvard.

[And if you don't follow me on Twitter or Facebook, Amby Burfoot published a very kind piece on our office in The Washington Post (but one error in it - we do keep food diaries and track things like calories - but we don't impose artificially scoldy ceilings with them)]

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Friday, January 20, 2017

Somehow This Video Seemed Appropriate To Today's Events

Though I'm not sure how funny the next few years are going to be.

Good luck to us all.

Have a great weekend!



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Thursday, January 19, 2017

Another RCT Where Revealing Genetic Risk Failed To Inspire Behaviour Change

The concept is clear - tell people what they're genetically at risk of developing and see them change their behaviours to encourage prevention as a consequence. It's a concept that in large part is fuelling the personalized medicine hype.

It's just that it doesn't seem to happen.

My friend Tim Caulfield has written about this extensively, including in this piece last year in The Atlantic, and now another study has come out to add to the pile of disappointments.

Published in PLoS in late November, the study looked at whether or not randomly assigning patients to receive genetic and phenotypic risk assessments regarding their potential future development of type 2 diabetes would change their behaviours as compared to those randomized to receive general advice.

What they found wasn't exciting. The addition of genetic testing information to lifestyle advice did nothing to increase physical activity, diet, weight, worry, or anxiety in the short term in those tested.

And while the researchers described the short duration of follow up as a weakness (it was 8 weeks), I think it might just as easily be describable as a strength in that one could argue that a person would be most likely to affect change while the iron of new information was hot, and that here, where no changes were observed immediately post risk provision, is more damning than would be demonstrating that changes dissipate with time.

From a clinical perspective, the other question that needs to be answered is whether or not the degree of change, if there were change, consequent to the inclusion of genetic testing to personalized, but not genetically informed, nutrition advice, would be superior? Putting this another way, if genetic testing affected change, would the changes it inspired be of greater clinical benefit than would healthy living advice provided by RDs and tailored, non-genetically, but certainly individually, to the person sitting in front of them?

And it would seem that's a fair thought given this quote by the founder and chief science officer of a company selling these sorts of nutrition related genetic tests who told the Wall Street Journal,
"For people who already eat a healthy diet, nutritional genetic testing might not be that useful"
All this to say, if you're keen for change, and if you have the money to spend on improving your health and diet, and unless you can afford both and that you also recognize these are very early days for nutritional genomics, save your blood and hire an RD to work with you on broader changes geared to help you find your way to a healthy diet.

(Disclosure: Though we could, our office doesn't offer nutritional genetic testing, but we do offer RD counselling)

[And if you're interested in another take on this industry, here's the piece Julia Belluz published about it yesterday]

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Tuesday, January 17, 2017

School-Based Obesity Prevention Policies Don't Up Eating Disorder Risk

One of the worries surrounding school based teaching on obesity prevention is that doing so will lead exposed students to eating disorders and/or unhealthy weight control behaviours.

To date, there hasn't been much research one way or the other to either support or refute that concern, but a recent paper published ahead of print in the Journal of the Academy of Nutrition and Dietetics is reassuring.

The study examined whether the implementation of school obesity prevention policies between 2008-2010 in Minnesota public secondary schools had any impact on the prevalence of students' weight control behaviours through 2010.

Hearteningly, not only wasn't there an increase in unhealthy behaviours following the launch of school based teaching around obesity, but there may have been a decrease, with researchers describing that those schools that specifically included the topic of eating disorders in their health education curriculum showed an inverse association with school level prevalence of any extreme weight control behaviours.

Not teaching kids about health seems backwards to me, and it's nice to have data to support the safety of doing so. Without exception, care needs to be taken in terms of what and how these topics are taught, but given the rise and risks of chronic, non-communicable, diet-related, diseases in children, hamstringing kids by ignoring relevant teaching and discussion won't do them any favours, while this study suggests that teaching them might.

Looking forward to further research on this, and hopefully too, surveillance that includes whether or not these sorts of initiatives increase, decrease, or don't affect, weight-based in-school bullying.

[And just a correction from yesterday's post. Health Canada's new labeling law, when considering products with small serving sizes, would instead use a 50g reference for determination of a "high in sugar" label and hence Nutella will indeed be "high in sugar". Sorry for the error!]

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Saturday, January 14, 2017

Saturday Stories: Russian Advice, One Weird Trick, and Supplements

Alexey Kovalev, in Medium, with his advice as a Russian journalist as to what journalists in post-Trump America should expect.

Patrick Mustain in The Daily Beast on the one weird trick that gave us Donald Trump.

Rebecca Robbins in Stat on the wild, wild, West that is the supplement industry.

[And if you don't follow me on Twitter or Facebook, here's my contribution to the online sugar debate (other debaters include Gary Taubes, Stephan Guyenet, and Terence Kealey)]

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Friday, January 13, 2017

When Everything Comes Up Green Day

Today's Funny Friday proves that apparently you can sing Green Day's Good Riddance to pretty much any tune.

Have a great weekend!



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Wednesday, January 11, 2017

A Must Read Guest Posting Apology

Yesterday I read a remarkable open letter of apology on Reddit from RoundRobinator. It was written by a man who was once regularly engaged in fat shaming and stereotyping, who following his own weight gain, was fat shamed himself. I asked him if he'd be willing to let me post it here, and he graciously agreed. It's a remarkable read.
I am the one who was giving you dirty looks in the grocery store.

I am the one who rolled their eyes at you in the restaurant.

I am the one who shared that insensitive meme.

I am the one who wouldn't play with you in elementary school, teased you in middle school, and pretended you didn't exist in high school.

I am the one telling you it is your fault. That you're disgusting and you're just lazy.

I have trolled this very subreddit before.

But I'm not anymore.

I took for granted being thin my whole life. I came from an active family, my mom was home to cook for us kids every night, and I was involved in sports from the time I could walk because that's just what I was told boys did.

I played varsity hockey all throughout high school, when I graduated I took a very physical job that kept me up and moving 8 to 10 hours a day. I only had time to drink coffee for breakfast, 20 minutes to inhale a burrito at lunch, then ate as big a dinner as I wanted plus a couple sodas and if it was the weekend more than a couple of beers.

I did not understand how someone becomes fat, I thought I knew beyond a shadow of a doubt that it was a conscious decision people made. Having this thin privilege handed to me my entire life I thought weight loss was like any other goal, it just took organization and willpower.

I hated fat people. I was enraged that my taxes were going up because they were using the healthcare dollars. I felt cheated when one sat next to me on the bus and spilled over into my seat. I didn't want my daughter to have overweight friends because I thought they were a bad influence. I didn't hire them at work because I thought they were weak and unmotivated.

Then, two years ago next week, I was in an emergency room being diagnosed with a complete rupture of my left Achilles' tendon.

It happened on the job, and they were so glad I wasn't suing that they didn't fight me on the six months of workers comp (an Achilles rupture is usually 4-6 months of recovery.)

Once the worst of the pain subsided, I was almost excited to be injured. I was getting paid time off, in bed all day, doing whatever I wanted.

And what I wanted to do was eat. All my hobbies are physical, and I had nothing to do with myself. I was at home all day, on bed rest for the first few weeks, then allowed limited movement as long as it didn't disrupt my cast.

I didn't realize how much more I'd been eating. Instead of coffee for breakfast I was having a couple eggs and a package of toasted waffles just to kill more time before I went back into my injury limbo. Not three hours later I'd make myself a big sandwich, with soda and chips, I'd eat dinner with my family but some nights it was so uncomfortable sleeping in my bulky cast that I'd end up eating a second dinner. You can see where I'm going with this.

It was when they decided I needed surgery, about three months after the injury, that I got the first wake up call. At my pre-op appointment, they weighed me. I went from being 170 pounds to 200. It had happened so gradually. I stayed in my pajamas all day. I'd only been leaving the house to go to PT or the doctor, and I wore sweatpants to those appointments. Sure I noticed my stomach was looser and my clothes were tighter, but I thought it was 10-15 pounds max, injury weight that would melt off when I got back to work. My doctors cautioned me that that wasn't the case.

But I was in denial. I shrugged it off and told myself once I was healed it would fall off without any effort on my part. I also told myself I'd cut back on the sweets.

I don't think I even made it to the end of that day before I told myself "you're injured, you shouldn't be stressing yourself out with crazy diets."

At the surgery I was 218. I told myself it was because the surgery was later in the day than my pre op appointment had been.

Recovery time, more denial, more recovery time, fast forward seven months after my injury, and I'm cleared to transition back in to work.

By this time I'd bought all new bigger clothes under the guise of these being my "injury clothes". I even joked that they were my "manternity" clothing.

But my coffee in the morning wasn't satiating me anymore. I found myself agitated, hungry, disorganized. I found myself stopping for Dunkin Donuts on the way in to work. Then my regular chicken burrito at lunch felt sparse. I missed my thick sandwiches, bags of chips, and limitless soda. Dinner, the same cycle. I told myself it was just the stress of transitioning back in to work, and once things calmed down I'd be back to normal.

Then things weren't going so well at work. My numbers dropped, I couldn't keep up with the other guys in my pod, and I was switched to desk work until I was "fully recuperated." If this injury weren't the result of their shitty protocols, I'd have likely been axed on the spot.

I was called in to an important meeting one morning and tried to button my shirt. Couldn't do it. And this was my "manternity" shirt. I couldn't even remember when I'd stopped buttoning my shirt like I used to do every morning.

I told myself I was going to start running. I had a 6 minute mile in high school, and I ran a marathon in my twenties. After a quarter of a mile I was in more pain than I was at the end of that marathon. Not in my Achilles' tendon either. My chest was burning, there was a radiating pain in my knees, my feet felt like I'd been running barefoot on gravel. But I told myself "Don't be a p*ssy, play through the pain. You've got to get in shape."

I'd gone out with what I thought was a conservative goal of running three miles. By the time I hit a mile, which took me 11 minutes, I was in so much pain I could barely think straight. And this is coming from someone who had the presence of mind to play "I Spy" with a three year old while getting a knuckles tattoo.

I was so out of breath I genuinely thought I was going in to anaphylactic shock (which I've experienced for real three times before).

It took me twenty minutes to even feel capable of walking home.

I thought it had to be a medical condition. Maybe a side effect of having taken so many anti inflammatory drugs during the recovery process. I thought my kidneys might be failing. I went to the doctor the very next day.

And she told me in no uncertain terms "The only thing wrong with you is that you're overweight. Running is not only going to be exceedingly difficult, but dangerous for your joints. Start with walking and build up to running. And I'd recommend you see a dietician sooner than later."

I thought "I don't need a dietician, weight loss is just about sticking it out." I went home and got rid of all the junk, I gave away all my Dunkin Donuts cards, and bought heaps of fruit and vegetables, I ate a boiled chicken breast and steamed broccoli for dinner and I wrote down the calories. And I thought "This is easy. See? Pathetic fat losers just can't put down the fork because they care more about their superficial wants than their health. Well, a strong guy like me isn't going to fall for that. I've been to hell and back in my lifetime, this is nothing."

3am, after a restless night, I got in my car and drove half an hour out of town to buy Chips Ahoy cookies. And I ate them alone in my truck. Not one or two of them. All of them. With a half liter of coke. I looked up and I couldn't even remember the exact moment I decided to go to the store or exactly how I'd talked myself into it. It was just a visceral frenzy.

Then I started to realize I might have a very real problem.

Queue a year and a few months of starting exercise programs and stopping exercise programs because of achy pains, not having the time between all my work (which, again, is behind a desk now), and discouragement from not seeing results. And fad diets, and quitting cold turkey, and weaning off, only to be hit with a craving so strong or something so stressful I blindly dive right back into it. And it wasn't a choice and it wasn't intentional and I didn't feel like I'd gamed the system or proud of myself. I was awash in guilt and shame and downright misery. At some junctures it was a guilt as powerful as I'd felt wen my mom's house was foreclosed on because I didn't make enough to take care of my family and her. It cut so deep I would have done almost anything to stop it.

I kept telling myself I could do this on my own and it was a test of strength and nothing I couldn't handle.

I didn't notice the subtle shifts in attitude at first.

I started encouraging my daughter to invite bigger kids to play with her and her friends, invite them to her birthday, and pick them for teams.

I'd see those people sharing stupid memes about fat people on the internet and think "Jesus Christ, and you call yourself an adult?" Then I saw a particularly ignorant "shock value" fat people meme, and decided I was going to unfriend whoever had shared it, so I clicked on it. It was a Facebook "memory" of a post I'd shared three years prior. I went and deleted it off my timeline reassuring myself I'd made up for that by now.

But the tipping point came one week ago.

I was power walking through the neighborhood, sweating bullets, feeling really proud of myself for not stopping for a breather in almost twenty minutes, when some guy drove by and made pig noises out his window at me. I was broken. I've been in bar fights, I've been hospitalized, I grew up with not one but two abusive stepfathers, I'm a fighter. But I was so hurt and broken and embarrassed that I just stood there. If some guy had done that to me when I was thin, there's a good chance I'd have hurled a rock at their window. But I couldn't think of anything to say or do because this time, on some level, I agreed with them.

And that's when I realized that was insane. Because of course I was trying my hardest. I'd been trying for years. I had to sacrifice a job I love, I haven't had sex in months, I buy all my clothes online, I dread going out into public, I try any diet that sounds promising, I undergo intense physical and psychological pain in an effort to get back in shape. Who is this guy to judge me? But I was that guy. I've changed but I'm still the same person who did those things in the past, even if I'd never dare to do them now.

I went to a dietitian today. It was the first time I'd stepped on a scale without diverting my eyes since my surgery. The few times nurses had weighed me I told them I wasn't interested in what the number was. And I stopped seeing the doctor long enough ago that I can't pinpoint exactly when. I have an appointment with her next week at the advice of the dieititian.

I'm 289 pounds.

And now, in this same subreddit where my old account, that was so toxic that I've since taken it down, was banned from, I'm coming for help.

Call it karma, it probably is. I don't know if you believe in a God, but I do, I think he did this intentionally because of the unchristian way I acted towards others. I was sick, I was nasty, I was the disgusting one.

I know you fight. I know you're not weak, you're the opposite, you're the strongest kind of person out there.

I am sorry for every look I every shot you. For anything I ever muttered under my breath. For every time I changed seats because of you. For the names I called you in school and for the dance I wouldn't be your date for. You deserved better than me anyways.

I apologize to each and every one of you who has ever been unfortunate enough to cross paths with a volatile prick like me who sought to make your personal private health concerns their business.

As devastating as this has been for me, a 6'2 guy with a deep voice, shoulder length beard and tattoos, I cannot comprehend how difficult and damaging it was for anyone who has to cope with this publicly accepted, encouraged even, abuse, as an innocent defenseless child.

I know now that you are so much more than your weight. I'm the weak one. I'm the wrong one. Now I'm the fat one.

And in all the ways that matter I'm still the same guy. I'm no longer the ignorant, mouthy, judgmental, abusive guy I was. But I'm the same loving father I was as a thin guy. I've got the same powerhouse work ethic I did as a thin guy. I'm still as much of a dog lover as I was as a thin guy. I've got the same level of faith, if not stronger, than I did as a thin guy. All the fundamental pieces of my identity and all the good things about me remain the same at any weight. And I was too blind to see it before, there is no such thing as a "fat person" there are only "people who are fat". That doesn't override or in any way undermine the other parts of their identity.

Of course I don't want to be this way and I didn't choose it. But even if someone does decide they want to stay fat, and they choose to accept it, you won't hear any judgement from me. Because this life is HARD. It is not the easy way out. It's the hardest I've ever worked and the most emotionally heightened state I've ever lived in in my entire life. I see now more than ever that what you do with your body is none of my business and I can't even begin to understand where you're coming from or what other factors are at play in your life.

I've been the worst kind of person and have undoubtably hurt people in ways I will never realistically comprehend. I'm a changed man now but that doesn't change the past and my actions.
`
Don't forgive me, I don't deserve forgiveness. I don't and nobody who acts like I did does. Don't forgive them, write them off. They don't deserve your attention, your wholeness, your love, or your time. They're ugly on the inside. I'm getting my soul in shape alongside all this, and I've done a lot of good work, and I've got a ways to go. But just..... just know that for whatever it is worth I was wrong. And I am sorry.

I've got a new eating plan from the nutritionist and an exercise plan too. And I'm going to work it as hard as I can. And even if I get to be 160 pounds of rock solid muscle and go on to win an iron man challenge, I'll never be stronger than I had to be when I was fat.

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Monday, January 09, 2017

Fisher-Price's New Kids' "Smart Cycle" Is All Sorts Of Huh?

With press coverage extolling that they can use it to "burn off the sugar", or "battle obesity" last week Fisher-Price released their so-called "Smart Cycle" geared towards kids between the ages of 3-6.

It's a stationary cycle with a built in stand for a tablet so that kids can play "learning" games while they sit in one indoor spot pedalling.

Because toddlers aren't much for active play? Because electronics need to be part of every single aspect of even the youngest child's life? Because little kids should be made to feel like they need to burn off their calories?

If you want your toddler to be more involved in active play, play with them. And if you're genuinely unable to (due to time/work/health/whatever), and you've got the money to spend on a "Smart Cycle" and a tablet, maybe invest in kids' shoes, outdoor clothes, actual bikes, jump ropes, balls, or really anything that gets them moving, having fun, improving their physical literacy, and developing their imaginations.

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Saturday, January 07, 2017

Saturday Stories: Mercola, Disappointments, and Acute Flaccid Myelitis

Probably not an actual picture of Dr. Mercola
Kate Knibbs for The Ringer with an absolutely must read article on Dr. Joseph Mercola - the "most honest man in medicine".

A rare funny (and short) Saturday Story from Bess Kalb in The New Yorker with "a selection of the worst 30 under 30".

Soumya Karlamangla in The Los Angeles Times with the sad and awful story of a new polio-like illness that's appearing in children.

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Friday, January 06, 2017

"They Don't Ever Go Away" - Parenthood in 34 Seconds

Every parent out there will be able to relate to today's Funny Friday video.

Have a great weekend!



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