Saturday, December 07, 2019

Saturday Stories: Chaos, Hatred, And Ethos

Joshua Hammer, in GQ, writing on chaos at the top of the world.

Bari Weiss (and whether you loathe her or not everyone should read this harrowing article), in the New York Times, on how the global surge in Jew hatred should not be written off as isolated incidents of bigotry.

Rachel Laudan, in The Hedgehog Review, on the establishment of a modern culinary ethos.

(photo source)

Monday, December 02, 2019

Dear @OttawaCitizen, Your 83 Word Byline Free Drink Milk "Artice" Isn't Journalism And It Contributes to Scientific Illiteracy

Now to be clear, I'm not a journalist, though I have written my fair share of articles for various publications (including the Ottawa Citizen).

What I would never have submitted, let alone gotten away with, would be an 83 word (truly, that pic above is all there is), byline free, advertorial replete with a large photo promoting milk consumption in the name of Vitamin D and calcium citing a "report" that urged Canadians to drink milk, and mentioning "experts" three times, without actually naming the report or the experts.

Though I'm not sure which report the 83 words is referring to, my friend and PhD/RD Dr. Kevin Klatt (who you should absolutely be following on Twitter) was able to steer me to this study looking at non-dairy milk consumption and vitamin D levels in Canadian children which clearly demonstrates drinking non-cow's milk leads to lower, but still fine, vitamin D status markers.

He noted, as actually cited experts should, that vitamin D's daily recommended intake (DRI) levels were derived from intake studies performed in very high northern latitudes so as to remove the confounding issue of sunlight, and that consequently daily recommended intake levels are far more than are necessary to maintain safe vitamin D levels for everywhere but the far north. He also pointed out,
"there's not very strong evidence to suggest that not consuming milk places one at risk of having Vitamin D status in the range of insufficiency."
And though it may surprise you given the certainty of the 83 words up above, the data on dietary intake and Vitamin D are so limited that anyone who has concerns about their vitamin D status, regardless of whether they drink milk or not, should have their levels checked and not simply assume milk will be magical. Or better yet, not try to drink their way to higher levels of Vitamin D if they're concerned and simply take supplements (with meals if this is your plan as Vitamin D is a fat soluble vitamin)

Given the full court press the Canadian dairy industry has been making since our new Food Guide rightfully relegated dairy to simply a source of protein rather than suggest it is a unique food group, I can't help but wonder if this published seeming advertorial is consequent to their efforts and overtures, and while it might play to at least 50 years of Canadian dairy marketing, the Ottawa Citizen should know better than to simply pass along uncritical food takes suggesting magic benefits to specific foods to a population primed to believe them.

(Thanks to my friend and colleague Andrew Kujavsky for sending the photo of the article my way)

Wednesday, November 27, 2019

Toronto's SickKids Hospital New Oreos Fundraising Campaign

Because of course they are.

SickKids hospital has never shied away from junk food fundraising and their latest campaign sees them working with food giant Mondelez to promote the sale of Oreo cookies.

Mondelez of course is thrilled and sees this partnership as,
"a first step in a long-term partnership that will “allow for even more collaborative opportunities across portfolios and brands"
The partnership also benefits Dairy Farmers of Canada who are likely running damage control following the release of a Food Guide that rightly de-emphasized milk's unique importance in our diets and removed  our prior Guide's explicit recommendations around its consumption and instead simply included dairy in the protein foods grouping.

Dairy Farmers are likely worried about the impact the Food Guide's changes will have on their lucrative school milk programs and perhaps that's what underlying their stated campaign rationale of "helping kids reach their full potential”, which no doubt will have more weight with SickKids' push.

Apparently the campaign will include, "TV, cinema, digital, social media and public relations", and there's zero doubt that industry's expectations are despite the campaigns likely huge costs, they'll enjoy a return on their investment, either by way of direct sales, or by protecting current initiatives (like school milk programs).

As to what's in it for Sick Kids, of course it's just money. No doubt too that the amount of money SickKids is likely to get by way of fundraising with cookies, will be a fraction of what will be spent on the campaign to which they're lending their name and integrity to market them.

No doubt too, if this were about altruism for the Mondelez and Dairy Farmers, they'd just cut cheques.

Monday, November 18, 2019

The Corollary To If You Serve It We Will Eat It (If You Don't, We Won't)

I've written before how as human beings, if you serve it to us, we will eat it, with examples from medical conferences, medical resident events, and dietetic conferences, and published recently in JAMA Internal Medicine is it's corollary, if you don't serve it, we won't eat it, or at least we'll eat it less.

The paper, Association of a Workplace Sales Ban on Sugar-Sweetened Beverages With Employee Consumption of Sugar-Sweetened Beverages and Health explores what happened to sugar-sweetened beverage (SSB) consumption in the 10 months after the University of California at San Francisco banned their sale from campus and medical centre venues (including in their cafeterias, vending machines and retail outlets). People were of course still free to bring whatever beverages they wanted to work or school. Specifically researchers were interested in the impact the sales ban would have on those with heavy SSB intake (defined as a pre-intervention consumption of more than 12 fl oz daily for the prior 3 months).

For two months prior to the intervention, they canvassed for heavy intake participants, and once the SSB sales ban was enacted, half were randomly assigned to receive a 15 minute motivational intervention targeting SSB reduction, half were not, and 10 months later, all of their intakes were again explored.

The findings weren't particularly surprising. When SSBs aren't sold, fewer are consumed.

How much fewer?

Half as much overall, with those receiving the brief motivational intervention seeing their consumption decrease by roughly 75%, and those who didn't by 25% (though it should be noted, especially among those who received the motivational intervention, social desirability bias may have influenced their self-reported consumption reductions).

Bottom line though, it certainly stands to reason that if you don't serve or sell it, we won't eat or drink it, or at the very least, we'll eat or drink much less of it, and so as far as public health interventions go, likely wiser to reduce access to hyperpalatable and indulgent fare rather than simply encouraging people to just eat less of them.

Tuesday, November 12, 2019

New Systematic Review Concludes No One Will Ever Successfully Maintain Their Lost Weight. Or Does It?

From the Journal I Can't Believe This Ever Got Published (ok, in this case from Obesity Reviews) comes The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments.

The paper apparently is meant to be a counterpoint to other systematic reviews of long term weight loss where,
"conclusions are generally positive and give the impression that weight loss interventions work and that weight loss can be maintained"
Well we can't have that now can we?

It appears these authors sure couldn't because here are the criteria they used in selecting papers for their systematic review that concluded long term weight loss is impossible:
  1. Studies must have follow up periods of at least 3 years
  2. Patients must not have had any continued interventions during the follow up period
  3. Medications approved for weight management aren't allowed
So what they ended up with were 8 studies of varied protocols being administered temporarily for a chronic medical condition where half provided what by definition were only temporary interventions (3 with very low energy diets, and one with hospital provided food). But guess what, chronic medical conditions require ongoing treatment, and what happens when you actually provide it? Well you get studies that would spoil the impossible narrative as noted by the authors of this paper,
"several of the non-included studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow-up period."
Imagine that! Appropriately treating a chronic medical condition with continued interventions works!

And this notwithstanding the fact that many (most? all?) of those studies that provided ongoing interventions likely did not include the appropriate prescription of medications to either help with losses or to prevent regain (just as we would with any other chronic condition) because weight loss medications are almost always excluded from use in weight loss diet studies. Which is odd by the way. Consider hypertension for instance. Sure some people might be able to resolve theirs by way of such things as lower sodium diets, increased exercise, and weight loss, but there's zero doubt that patients with hypertension will receive regular ongoing follow up visits with their physicians, and where appropriate, will be prescribed medications to help. Why? Because that's how chronic condition are managed! Which is why we'll never see a systematic review of hypertension treatments demonstrating that brief lifestyle counselling and the explicit exclusion of medications didn't lead to lower blood pressure 3 years later.

Leaving me to wonder, why publish a paper with the literal conclusion,
"that the majority of high-quality follow-up treatment studies of individuals with obesity are not successful in maintaining weight loss over time"
when really all your systematic review (of just 8 papers all with different dietary/lifestyle interventions) has proven is that delimited, lifestyle counselling doesn't miraculously cure a chronic medical problem, and where you admit in your paper that the appropriate provision of ongoing care might well in fact lead to sustained treatment benefits?

But I don't really need to wonder. Because the only reason that this paper was conceived and published is because of weight bias, whereby obesity has different rules applied to it, in this case, the notion that unlike so many other chronic medical conditions that are impacted strongly by lifestyle changes (eg. hypertension, type 2 diabetes, GERD, heart disease, COPD, gout, osteoarthritis, osteoporosis, kidney stones, and many more) people believe that for obesity some brief counselling should be enough to do the job, because that in turn plays into the trope of obesity being a disease of willpower and a deficiency of personal responsibility.

(Thanks to Dr. Andrew Dickson for sending my way)

Thanks to your generosity I'm over 2/3s of the way to my $3,000 Movember fundraising goal. While I'll never monetize this blog, this is my annual fundraiser and if you find value here, consider a donation! Remember, every dollar counts, it's tax deductible, and you can give anonymously! To donate, simply click here

Saturday, November 09, 2019

Saturday Stories: Mary Cain, Fatal Powerpoint, And Echo Chambers

Mary Cain, in the New York Times, tells her story of the intersection of abuse and elite sport.

Jamie, in McDreeamie Musings, on the Powerpoint slide that killed 7 people.

C Thi Nguyen, in Aeon, on the dangers of echo chambers

And if you haven't had a chance to donate yet to my lipterpillar, and you find some value or enjoyment from this blog, please consider and remember, every dollar counts. So far this year the generosity of friends and family have helped to raise $1,640. Movember is a tax deductible charity and you can give anonymously if you'd prefer. And of course, as I've mentioned, Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, & testicular cancer. To donate, simply click here

Wednesday, November 06, 2019

"Severe" Energy Restriction Better For Weight Loss Than "Moderate" Energy Restriction?

Well according to this new RCT it is - in it they found that patients randomly assigned to 4 months of severe energy restriction (65-75% restriction of energy by way of total meal replacement/all liquid diet) followed by 8 months of moderate energy restriction (25-35%), at 12 months, lost significantly more weight than those assigned from the get go to the same degree of moderate energy restriction.

Hurrah?

So first off it's not remotely surprising that putting two groups on the exact same diet (25-35% energy restriction) but starting one group off with 4 months of extreme energy restriction sees those who had the extreme jump start lose more in total.

Secondly, it would appear that the extreme folks have a weight gain trajectory that may well erase the differences over time.

And thirdly, this got me thinking. Behavioural weight loss programs, because they don't involve products (unless medications are being tested, and here they were not), have outcomes that are likely significantly dependent on both material, and perhaps more importantly, on the service providers. Consequently I do wonder about the ability of any of these sorts of studies to be applicable to other offices or programs. Meaning here at least, it would appear the extreme folks did better, and the moderate folks dropped out more often (perhaps consequent to slower than desired initial losses), but would the same necessarily be true at a different site, with the same restrictions but with different service providers, collateral materials, attention and support?

I'd venture those things matter a great deal more than is generally ever mentioned in the medical literature.

And a Movember update! If you enjoy these posts (or even if you don't but you hate read them for something to rage about thereby adding some extra meaning or identity to your life) would love your tax deductible donation to my lipterpillar's growth (and remember, you can give anonymously too). And though I have a family history of prostate cancer (hi Dad!) I think it's important to note that beyond prostate cancer Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, and testicular cancer. And while I will never charge a penny or host an advertisement on this site, I will, on an annual basis, ask for your donation to this cause. To donate, simply click here