Saturday, August 29, 2015

Saturday Stories: Not Broken Science, First Nations, and Bingo

Christie Aschwanden in Five Thirty Eight Science with a phenomenal piece on how science isn't broken.

Gloria Galloway in The Globe and Mail with a heartbreaking piece on Canada's First Nations' health care failings.

Daniel Goldberg in the British Medical Journal presents his fabulous game of conflict of interest bingo.

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Friday, August 28, 2015

American Kids Try Global School Lunches

Today's Funny Friday involves a bunch of kids trying a bunch of different typical school meals from around the globe. Worth watching even if just to see what's being served.

Have a great weekend!



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Thursday, August 27, 2015

Jersey Colour May Trump Need for Food Industry Sport Sponsorship

Never forget that the food industry's purchase of youth sport is about marketing and branding opportunities.

By way of example today I'll be discussing Mac's Convenience Stores' "Froster Active Kids" program.

First, for those who aren't aware, Frosters are Mac's Convenience Stores' answer to Slurpees.

Mac's conveniently spell out the requirements of teams who seek their sponsorship - among them:
  • The sports team must agree to send pictures of jerseys, events, etc that can be used to post on our social media pages. Please note that a Photo Release form must be signed by each parent and returned to FrosterActiveKids@macs.ca before funds can be released.
  • Where applicable: Sports team must disclose the expected number of audience for the events/tournaments. Froster Active Kids Program branding must be present at the event through team jerseys and potentially a banner.
  • Mac’s and Froster Active Kids Program branding must be presented on the team or the association’s social media, web pages and other branding opportunities.
  • Sampling opportunities for Mac’s will also be reviewed where applicable.
And then they get a great deal more specific in the application. What struck me from the application, is while there are plenty of questions about the sponsorship opportunities that would be afforded to Mac's, and of the aesthetic fit with Mac's logo, there were no questions, none, to help flesh out the deservedness or financial needs of the team.
Froster Active Kids Logo Exposure:
  • When does the season start and end? Click here to enter text.
  • How many jerseys will the logo appear on?: Click here to enter text.
  • Will the logo appear in colour or black and white? (colour preferred): Click here to enter text.
  • Will the logo appear on the home and away jersey, please clarify if only one: Click here to enter text.
  • What is the colour(s) of the jersey?: Click here to enter text.
  • Where will placement of the logo appear?: Click here to enter text.
  • What other logos will appear on the Jersey (including other corporate sponsor logos): Click here to enter text.
  • Can you send a team jersey to Mac’s with the number “15”? Click here to enter text.
  • Is there a team banner that Froster Active Kids will receive logo exposure on? Click here to enter text.
  • Additional opportunities for logo exposure i.e. hats, jackets, bags: Click here to enter text.
  • Will the Froster Active Kids logo appear on the webpage and the social media page? If so, please provide the link to both: Click here to enter text.
  • Will you be sending a team picture of the members wearing the jersey? Click here to enter text.
  • Is there an opportunity for Mac’s to provide coupons (i.e. BOGO Froster, Free Froster)?: Click here to enter text.
  • Is there an opportunity for Mac’s to come out to a tournament with a banner and sampling/coupons? If so, please describe: Click here to enter text.
  • Additional marketing opportunities: Click here to enter text.
While other programs may provide lip service to altruism, it's refreshing to see Mac's Convenience Stores boldly tell us that it's not about us, it's about them.

And how much are these sponsorships worth? A few hundred dollars? A few thousand? Would it really be impossible to raise these funds in other ways - ways that might also teach the kids important lessons? My three girls went door to door selling flower bulbs for their school this year. They raised nearly $250 in an afternoon. I also recently came across a group of kids sitting outside the local liquor store collecting empties from returning customers so as to collect the bottle deposits for charity. In the few minutes I purposefully spent watching, I didn't see a single person enter the store without donating their bottles to the kids. Back of the envelope calculation has them raising at least $100/hr/store of sitting there.

Given most teams are between 10 and 20 kids strong, and weekends are two days long and multiple times a month, I struggle with the notion that funds can't be raised without turning kids into walking billboards and providing fast food marketers access to children along with a priceless emotional branding opportunity.

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Wednesday, August 26, 2015

Pepsi Targeting Kids And Promoting Their Own "Energy Balance" Nonsense

And to help hammer their point home, PepsiCo has recruited the NFL's Manning brothers.

It's Gatorade's new "Sweat It To Get It" campaign, and their commercial spot has the football legends literally telling young teenage boys that 2 minutes of sweat buys them a Gatorade.



Regular Gatorade's first ingredient is water. Its second and third ingredients are sugar. 100% of its calories come from sugar. It also contains a tiny bit of sodium, and a tiny bit of potassium.

Most vending machine Gatorade is sold in 20oz bottles.

20oz of Gatorade contains 133 non-sating calories and just shy of 9 teaspoons of sugar.

2 minutes of moderate to high intensity exercise will burn at most 20 calories.

And just in case you're tempted to tell me that the Sweat It to Get It campaign targets university students (because despite the kids in the commercial looking way too young to be in University, the vending machines are to be set up there), you should know that Gatorade also has a comic book series entitled, "The League of Champions" pumping the beverage.

And for more on just how intensely Gatorade markets sugar water to children, have a read of Bettina Siegel's piece on Gatorade's G-Force and their high school infiltration.

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Tuesday, August 25, 2015

Guest Post: Food Policy is not About Sexy Results (by Dan Taber)

Today's guest post if by Dr. Dan Taber. I've been following Dan on Twitter for some time and have always enjoyed what he's had to say. When he recently published a study on school food, I reached out and invited him to write a guest post. He kindly obliged.

Food Policy Is Not About Sexy Results

Well … there’s good news and bad news.

It’s not the sexiest opening line when I’m discussing my research. Nobody who wants a simple solution to childhood obesity likes those words. I don’t like them, either, and yet I use them all the time. Food policy is a sexy topic, but food policy research tends to give complicated, unsexy answers.

Food policies are more like young professional athletes – they come with a lot of hype, and thus everyone is eager to label them a “success” or “failure,” but the truth is usually in the middle. My latest study on school nutrition standards provided a perfect example. Furthermore, the study illustrates how any food policy can have the maximum benefit – by knowing what the policy is good at, acknowledging what the policy is not good at, and realizing where complementary policies/sandbags are needed.

In this recent study, I collaborated with researchers from Bridging the Gap, the National Cancer Institute, and the University of North Carolina-Chapel Hill, to dig into the details of how schools adhered to nutrition standards for foods and beverages sold in schools outside of federal school meal programs (a.k.a. ‘competitive foods’). We also dug into whether adherence differed by local area income. Encouragingly, we found that middle schools tended to sell fewer unhealthy items if states had healthier competitive food standards, particularly among schools in low-income areas.

Good news, right?

Sort of. The encouraging results came with a catch, as there was no evidence that schools were offering more healthy foods and beverages instead. Sugar-sweetened beverages were sold less, but they were not necessarily being swapped for clean water.

Why not? Because that is not what competitive food laws do. Competitive food laws are commonly designed to limit sugar, fat, or calorie content of school foods and beverages, but they do not require healthy alternatives.

That’s not a criticism of competitive food laws; it’s simply a limitation. That said, it’s a limitation that can ultimately affect disadvantaged populations. Our study found that low-income schools were substantially less likely to sell healthy alternatives.

If unhealthy items are banned, but healthy alternatives are not provided, there’s a tsunami of unhealthy options waiting for populations that are already at a higher risk for obesity. Low-income areas tend to have more unhealthy options in the community, and as recently reported by the Rudd Center, food/beverage marketing actively targets racial and ethnic minority children.

When disadvantaged communities face the tsunami of unhealthy options outside of school, they are less likely to benefit from any positive changes within school. Last May, a team of researchers in the Bay Area reported that California’s competitive food laws were associated with a decline in obesity, but predominantly in high-income areas. Obesity trends in low-income areas didn’t budge an inch.

As I wrote for Beyond Chron at the time, these results are inevitable if you expect a magical cure to obesity. Any single policy or program can only do what it is designed to do.

Competitive food laws are good at what they do by limiting unhealthy options at school. This may improve weight status in the general population, as I also found in a longitudinal study in 2012. We need to acknowledge, however, that competitive food laws may be less effective in low-income areas.

That is when other policies and programs become more important. The National School Lunch Program in the U.S., for example, is designed to do the exact opposite of competitive food laws – i.e., require healthy items for school meals, particularly to benefit students from low-income households. As a complementary pair, competitive food standards and school meal standards can benefit all children.

Food systems, like any kind of system, work best when different parts enhance each other in this way. Systems do not change when we think that any single part is going to drive change on its own.

My latest study adds to the mountain of evidence that competitive food policies are good at what they do. But, like any policy or program, they can achieve more if we understand their limitations.

Understanding a policy’s strengths and limitations isn’t about declaring the policy to be a “success” or “failure,” the sexy answers we all want. It’s about giving us a roadmap to understand where further action is needed.

Dr. Taber is an Assistant Professor at the University of Texas School of Public Health, where he specializes in childhood obesity policy research and systems science. For years, he has evalauated the impact of policies that are designed to improve diet and physical activity behaviors in children. Multiple studies led by Dr. Taber were cited in the United States Department of Agriculture’s landmark “Smart Snacks” rule for competitive foods. His research has been featured in the New York Times, NPR, CNN, Wall Street Journal, and several other media outlets, and he writes about obesity policy news on his personal blog. You can also find him on Twitter or his website. He also teaches “Systems Thinking in Public Health” at UTSPH. This article represents his personal views; any views or opinions expressed do not represent the University of Texas.


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Monday, August 24, 2015

Book Review: Eat Like a Champion (A How To Feed Manual For Active Kids)

Today's guest post is by our office's own Rob Lazzinnaro who will be reviewing Jill Castle's Eat Like a Champion (which she sent me for review).
I work with families on a daily basis who are troubleshooting around how to provide proper sport nutrition for their kids - kids who are often also faced with weight issues. So when I was given the opportunity to review Eat Like a Champion by Registered Dietitian Jill Castle, I jumped on the chance as I'm also a big fan of Jill Castle's previous co-authored book Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School, and currently enjoy following her blog Just The Right Byte.

Jill’s new book, Eat like a Champion, focuses on recommended dietary approaches for young athletes. From high level athletes to gym class, the book is meant to be resource for any child that engages in regular physical activity. The question of what to feed their active kids is one I hear often in my office from parents regarding nutrition around sports, but parents soon learn that it is more complex than just the “what.” In her new book Jill Castle does dedicate a well deserved portion of the book to the “what” but also tackles the difficult food environment for athletes and how paying attention to a multitude of factors around eating can ingrain healthy habits in your young athlete for a life time.

The book is divided into ten chapters:
  1. The Growing Athlete Body and Brain
  2. The Starting Lineup: Major Nutrients
  3. The Second String: Vitamins and Minerals
  4. The Relief Pitcher: Fluids and Hydration
  5. Game Plan - One, Two, Three Meals
  6. Take a Time Out - Top Off with Snacks
  7. Foul Play - Supplements and Performance Aids
  8. Getting Off the Bench - Healing the Body with Food
  9. The Special Diet Dilemma
  10. Changing the Youth Sports Nutrition Landscape
And of those, five really stood out for me.

Matching Calories for Growth and Sport

Every person who picks up this book will have a child with different needs and energy requirements - there is no one size fits all when it comes to eating. The key is not to become overly obsessed with these numbers but hopefully use them as rough guidelines to help assess whether you're offering your child too little or too much - peace of mind really. Of course, the parent would have to loosely track the child's intake for 4-5 consecutive days (hopefully w/o the child knowing) to see where they are landing. The author also includes a useful table for changes in calorie requirements depending on the sport played.

Busting the Myth about Carbohydrates

Apologies Paleo adherents and wheat haters but this chapter focuses on evidence, which points to carbs not being inherently evil and how they can be a joyful part of our dietary lives. An excellent overview of choose most often carbs compared to choose less often is detailed here as well; aka, not all carbs are created equal. Finally, in children with high activity levels, carbohydrates can become vital for peak performance, as children are limited in their ability to store carbohydrates.

Foul Play - Supplements and performance aids

This section is a vital resource for parents wondering about the safety and efficacy of performance supplements. Hint: most supplements are not worth anyones time or money; and many are detrimental not beneficial to health. Good reference charts on supplements provided here.

Diets, Dieting and the Young athlete

The most important chapter in this book. Young athletes can set themselves up for a lifetime of dieting, body image issues, and eating disorders with the wrong information and ideas about ideal weight for sport and how weight is managed. In this chapter the author helps bust myths about the efficacy of popular diets and presents, more importantly, the dangers that come with a dieting mentality

Changing the Youth Sports Nutrition Landscape

I was absolutely thrilled this chapter was in the book because the field has become the tipping point around the normalization of junk food. We have all had the after game Slurpee, ice cream, or other frozen treat, and it was great when those items were indeed treats that we had less often. Nowadays when kids are playing sports 2-5 days a week and being offered treats after every game (these on top of the treats likely offered for every other event however small in their daily lives) they have become excessive. Point is, the exercise = food reward is not a positive behaviour we should be teaching our kids.

And there are also a few themes in the book that I struggled with:

1. Chocolate Milk

Throughout the book chocolate milk is recommended as a high protein healthful snack. Regardless of whether or not your children are elite athletes or just regular organized sport lovers, chocolate milk is a treat, and I fear that providing it to a child under the guise of it being a good fuel for sport may provide the wrong message. p.s An 8 oz glass of chocolate milk has 12 g or 3 tsp of added sugar - a 500ml carton - 25g or ~6 tsp added sugar.

2. The Focus on Micronutrients

I feel the chapters around the vitamins and minerals might be useful for an RD, but I wonder whether or not they'll provide much utility to the average family or child athlete.

3. Protein Supplements

There is some vilification of protein supplementation. Truth be told, I am not a strong advocate of protein supplementation, but there is no evidence that I'm aware of that would suggest unadulterated protein powders are unsafe for children to use, e.g. to balance a fruit smoothie with. If said protein powder is adulterated and has a sketchy wt.loss or endurance supplement added to it, then yes, please steer clear.

In summary, Jill Castle has once again provided a valuable resource on child nutrition, whether you are reading it as a health professional or as a curious parent. The book lays down a solid resource on what to eat and how to fuel yourself within varying degrees of activity. However where I found the most value was in the closer look at how we eat, supplementing safely, the dangers of dieting, and the treacherous food environment that all child athletes must face these days. Just in time for the school year, go Dillon Panthers! ;)

If you're interested in your own copy, here is an Amazon Associates link for Eat Like a Champion.

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Saturday, August 22, 2015

Saturday Stories: Palestinian Genocide, Iranian Anti-Semitism, and the Sabbath

Palestinian journalist Khaled Abu Toameh via The Gatestone Institute on the ongoing ethnic cleansing of Palestinians

Jeffrey Goldberg in The Atlantic on why Iran's raging antisemitism matters.

Oliver Sacks, again in the New York Times, with an incredible read on the Sabbath and more.

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Friday, August 21, 2015

Country Hip Hop the New Dance Craze

Today's Funny Friday video is a dance crazy that I'm hoping sweeps the nation.

Have a great weekend!



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Thursday, August 20, 2015

Guest Post: Dr. Kevin Hall Asks Is The Carbohydrate-Insulin Theory Dead?

For those who don't know Kevin, he's a researcher with the NIH and is undeniably one of the world's foremost experts in the area of metabolism. Last week he published a study that I tweeted out, "would be sure to rock the dogmatic", and it certainly did. There's been lots of angry comments and criticisms, and I thought it'd be great to hear from Kevin himself and I invited him to weigh in. And just as a reminder to readers, I have no horse in this race. As far as success with weight management goes, adherence is king and consequently I'm for any diet that a person enjoys enough to sustain. I also don't think low-carb diets are risky, I have patients in my office on low-carb diets, and I have been highly critical of studies that purported low-carb diets were dangerous when in fact it was more that those studies methodologies were poor. I put this proviso out there because when it comes to discussions about the tenets of low-carb dieting, the volume, and the nonsense, tends to rise rapidly.
Is the carbohydrate-insulin theory dead? Maybe not, but it’s at least wounded.

Thanks to Yoni for the invitation to describe our recent study in Cell Metabolism entitled Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity. But first, a bit of recent history:

In a 2010 blog post, journalist Gary Taubes berated nutrition scientists for not understanding the seemingly simple concept of controlling diet variables. He chastised the field for altering multiple diet components at once and said that controlling variables is something that even
school children are supposed to understand
The failure of nutrition scientists to understand this basic concept
has led to what may be another of the great misconceptions in modern nutrition research
Mr. Taubes then exposes the horrendous misconception:
carbohydrate-restricted diets are ‘valuable tools’ in the arsenal against overweight and obesity, but they’re just one of the dietary tools.”
Why was such a seemingly reasonable statement proclaimed to be a “great misconception”? Because, in Mr. Taubes’ view, the carbohydrate-insulin theory implies
that the only meaningful way to lose fat … is by reducing the amount of carbohydrates consumed.” [bold mine KH.]
Doubling down on this claim in his most recent book Why We Get Fat, Mr. Taubes states that
any diet that succeeds does so because the dieter restricts fattening carbohydrates…Those who lose fat on a diet do so because of what they are not eating – the fattening carbohydrates.
At the time, I read these proclamations with great interest. I had just begun collecting data from a carefully controlled metabolic ward study which is the first to avoid the confounding nature of changing multiple macronutrients at once. Thankful to have an understanding of clinical trial design equal to an average school child, I also realized that our study would directly test Mr. Taubes’ version of the carbohydrate-insulin theory which has become greatly influential.

We confined 19 consenting adults with obesity to a metabolic ward at the NIH Clinical Center for a pair of 2 week visits where all food intake and physical activities were monitored and controlled. For the first 5 days we fed people a standard baseline diet whose calories matched their energy expenditure and was composed of 35% fat, 15% protein and 50% carbohydrate with about 20% of total calories coming from sugar which is believed to represent a typical habitual diet. We then the cut diet calories by 30% for the next 6 days, either entirely through restricting carbohydrates (RC), keeping protein and fat at baseline, or selectively restricting fat (RF) keeping protein, carbs and sugar at baseline. On their first visit, the participants were randomly assigned the RC or RF diet. After a 2-4 week washout period, they returned for a second 2 week visit when the alternate diet was delivered. Therefore, both diets were studied in the same people.

The diet changes resulted in an average ~800 Calorie reduction from baseline and the composition of the RC diet was 21% protein, 50% fat, and 29% carbohydrate with ~8% sugar. The RF diet had the same calories and was 21% protein, 8% fat, and 71% carbohydrate with ~35% sugar. According to the carbohydrate-insulin theory, the RF diet should not lead to body fat loss because insulin secretion won’t decrease since total carbohydrates, sugar, and protein were unchanged from baseline. According to Mr. Taubes, if insulin doesn’t decrease, then fat is effectively trapped in fat cells. In contrast, because the RC diet decreased total carbohydrates and sugars, insulin secretion should decrease thereby mobilizing fat from fat tissue and increasing net fat oxidation resulting in body fat loss.

All but one of these predictions of Mr. Taubes’ version of the carbohydrate-insulin theory held true in our study. Unfortunately, a theory is disproven when any of its major predictions fail, and in this case the failure was a doozy!

Despite no significant change in insulin secretion, the RF diet resulted in body fat loss by all measures. This finding alone was enough to disprove the claim that body fat loss requires decreased carbohydrates and insulin secretion. Furthermore, the RF diet led to a significantly greater rate of fat loss than the RC diet using the most sensitive method for measuring body fat loss: metabolic balance. The other measurement of fat mass change (DXA) showed no statistically significant difference between the RF and RC diets, but this method is known to lack the precision required to detect such a small difference in body fat.

As you may have guessed, low-carb advocates have complained vehemently about many aspects of the study. One criticism is that the diets don’t emulate “real” low-carb or low-fat diets. However, we wanted to isolate the metabolic effects of restricting dietary carbohydrates versus fat. This made it arithmetically impossible to investigate a very low carbohydrate diet since dietary fat would have to be added to control for calories. This would commit the sin of not controlling as many diet variables as possible, and might lead to wearing the dunce cap in Mr. Taubes’ classroom. Nevertheless, the metabolic response to very low carbohydrate diets is an interesting question and one that we have invested some effort in studying, so stay tuned! [Whoa! Yoni here - you should click that link - describes the details concerning the now completed (but not yet published or discussed) 8 week! metabolic ward study done by Kevin.]

Another complaint is that the study only lasted for 6 days and therefore was not long enough for subjects to become “fat adapted”. However, it actually takes less than a week to reach a plateau in mobilizing fat from adipose tissue to provide the fuel required to support the increased fat oxidation which also reaches a plateau within 1 week. Many previous studies have observed this rapid transition to increase fat metabolism and it was also observed in our study with the RC diet. There is no evidence that fat oxidation increases after the first several days of cutting carbohydrates. However, this does not negate the fact that longer time periods, perhaps weeks, may be required to optimize exercise performance or improve general feelings of well-being on low carbohydrate diets. This is what most people mean when they say “fat adapted”, but exercise performance and cognitive function were not important for our study results.

Many of my critics in the low-carb camp have ignored the caveats that this basic human physiology study does not imply that low-carb diets don’t work. They may even be preferable for many people. I have repeatedly acknowledged that prescribing low-carb diets appears to be more effective in outpatient randomized controlled trials, at least for several months when diet adherence is likely to be highest. The question is why? Our small contribution is that Mr. Taubes’ version of the carbohydrate-insulin theory likely isn’t the explanation.

As a parting thought, imagine that the study results had been different. What if instead we found no changes in body fat with the RF diet? Would there still have been passionate objections from the low-carb community, or would this study have been touted as a major victory for the carbohydrate insulin theory?

Dr. Kevin Hall is a tenured Senior Investigator at the National Institute of Diabetes & Digestive & Kidney Diseases, one of the National Institutes of Health in Bethesda MD, where his main research interests are the regulation of food intake, macronutrient metabolism, energy balance, and body weight. Dr. Hall’s laboratory performs experiments in humans and rodents and develops mathematical models and computer simulations to help design, predict, and interpret the experimental data. Dr. Hall is the recipient of the NIH Director’s Award, the NIDDK Director’s Award, the Lilly Scientific Achievement Award from The Obesity Society, the Guyton Award for Excellence in Integrative Physiology from the American Society of Physiology, and his award-winning Body Weight Planner (Yoni note: Indirect blog post on this forthcoming) has been used by more than a million people to help predict how diet and physical activity dynamically interact to affect human body weight.

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Wednesday, August 19, 2015

This is How Coca-Cola Teaches "Energy Balance" to Kids

By way of example, two of their initiatives.

The first is called, "Get the Ball Rolling" and according to Caren Pasquale Seckler, VP of Social Commitment at The Coca-Cola Company, it was launched because,
"At that time, we made an important decision to take a public stand against obesity. And the reason is simple: Coca-Cola cares about the health and happiness of everyone who drinks our beverages.built on our Company’s global commitments to help fight obesity"
Read about the program on Coca-Cola's website and you'll learn that apparently fighting obesity for Coca-Cola means handing out Coca-Cola branded soccer balls, driving traffic to "MyCokeRewards" loyalty program (which no doubt collects personal information, allows for permission marketing, and of course markets their beverages directly), asking people to vote for their favourite national park, and bringing their "Happiness Trucks" to events where kids are apparently placed in giant cans of Coca-Cola to race around in (photo up above). Oh, and of course, Coca-Cola beverages are distributed as noted in this Coca-Cola piece on a Get the Ball Rolling event with the Texas Rangers and the Boys and Girls Clubs of America,
"All Boys & Girls Clubs participants and coaches received a José Guzmán autographed baseball, Powerade t-shirt and goodie bag and Coca-Cola “Open Happiness” soccer ball, along with plenty of Powerade and Powerade Zero."
Next up is Mixify. Mixify is a joint project between Coca-Cola, Dr. Pepper, PepsiCo, and the American Beverage Association.
The intervention seems geared to directly target teens and teaches them that following sweaty workouts you should eat "whatever you're craving",

And at their travelling road show of events, Mixify literally has children "balancing" what they drink with exercise as illustrated by their real life Jenga game.

So what do you think? Helpful altruism, or slick marketing?

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