Monday, July 15, 2019

From The Journal Of If Only It Were That Easy: Walking To School Was Not Associated With Lower Weights In 4-7 Year Olds

Walking school buses for kids are often promoted on the basis that if more kids were involved with them, their weights, fitness, and maybe even learning would improve.

Wouldn't that be great? After all, it's a relatively inexpensive intervention and one it seems everyone can at least theoretically get behind.

But does it work?

This is definitely not a good news story, nor frankly is it all that surprising, but here it is - recently the MOVI‐KIDS Study set out to explore whether or not there was an association between active transport in 4-7 year olds and their weights, fitness, and cognition.

The study involved 1,159 children in Spain and they were categorized on the basis of whether the active components of their school commutes totalled more or less than 15 minutes and then tested and measured to explore walking to school's possible impact. Heights and weight were measured, a validated cardiorespiratory fitness test was administered, as were multiple batteries of validated cognitive tests. Efforts were also made to control for familial socio-economic status, as well as of course the children's ages and sexes.

As you might have gathered, the walkers were found to be no better off on any studied variable with the authors very plainly concluding,
"Walking to school had no positive impact on adiposity, physical fitness, and cognition in 4‐ to 7‐year‐old children."
Too bad. Truly.

I have to say too, I did scratch my head reading the next bit of their conclusion though,
"it would be of interest for future studies to examine the intensity and duration of active commuting to school necessary to provide meaningful benefits for health and cognitive performance."
I can't say I agree with them here as I'm not sure lengthy, intense, daily school commutes for 4 year olds is something we need to explore regardless of their impact on anything. Moreover, I don't need to see "meaningful benefits" to want to continue promoting more movement and play in our children, and if we buy into the need for same, we'll risk the cessation of programs that don't prove themselves to provide perhaps broader reaching or more dramatic outcomes than could ever be fairly expected of them.

Tuesday, July 09, 2019

Only 41% Of People Who Were Given Free Preventive Medications Following Their Heart Attacks Were Still Taking Them 1.5 Years Later

You might think that having a heart attack would be motivating when it came to behaviour change, and that taking medications is a very straightforward behaviour.

And yet.

The Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial set out to study whether or not cost had a role to play in why so many patients, even post heart attack, don't take the medications prescribed to them in the hopes of preventing another one by freely providing them with those medications.

Results wise, though the group receiving free preventive medications were taking more of them than the group that did not, at the end 1.5 years, only 41% of those receiving all their medications for free, medications prescribed to them after they had an actual heart attack, were taking them.

So file these results under human beings, even when faced with knowledge, and in this case knowledge coupled with a very real glimpse at mortality, struggle to maintain even the easiest of behaviour changes, and consider that in the context of the trope of education and personal responsibility as the sole means to target diet and weight related diseases. If we want to see population level changes, we're going to need to change the food environment.

Saturday, July 06, 2019

Tuesday, July 02, 2019

Cancer Research UK (@CR_UK) Launches Awful New Fat Shaming Advertising Campaign

According to Cancer Research UK's new public advertisements, obesity is apparently the new smoking.

What that means of course is that by formally adopting, amplifying, and promoting the message that obesity, like smoking, is a choice people make, Cancer Research UK fuels hateful weight based stigma.

More amazing perhaps is that the aim of the campaign is to apparently target the environment with their ads steering people, in the small print that people will likely miss and certainly can't click on in train stations, to their web page calling for an end to junk food advertising to kids.

Obesity is the normal consequence of normal people living in abnormal, obesigenic, environments. Obesity often has hugely negative impacts upon health and quality of life (especially at its extremes), fuelled in no small part by the never ending blame, shame, and scorn heaped upon those who have obesity by society, and yet here is Cancer Research UK's campaign to further justify that weight hate.

Shame on them. They absolutely should have known better.

Saturday, June 29, 2019

Monday, June 24, 2019

On Instagram, RD Working For Welch's Implies That Drinking Welch's Grape Juice Won't Raise Your Blood Sugar (By @DylanMacKayPhD)

Today's guest post comes from Dylan MacKay. Dylan is a nutritional biochemist who has type 1 diabetes and when I saw RD Marie Spano's Instagram post, I knew he would have both personal and professional thoughts to share and so I invited him to do so.
I don’t know what it is with grapes but they always seem to be raisin my ire…

I mean as a person with type 1 diabetes, a PhD in Human Nutritional Science, and who does diabetes research and occasionally clinical trials looking at glucose response, maybe I’m not the one to talk about this, but I just can’t not.

Recently a Welch’s (*cough* big grape juice) "nutrition advisor" posted the above nutrition translation travesty on Instagram.

This really surprised me because when I have low blood sugar I often drink grape juice, How am I still alive? I mean I can honestly say there are times grape juice may have saved my life (by raising my blood sugar). Yet you could potentially look at this Instagram post and fairly think
drinking 100% juice made from polyphenol-rich fruit juice does not raise your blood sugar
unlike apparently that bad candy or pop that raises your blood sugar.

That would be of course 100% wrong.

Polyphenols are not magic sugar blockers, otherwise we would be using them to treat diabetes and you would get serious gastrointestinal upset from eating berries and grapes. I feel like you don’t even really need to be an RD to see this messaging is bad (Seriously, Welch’s advisors, how much do you get paid for your credibility?). Especially on a social media platform, where someone might not scroll to the end of the associated comment and look at the “reference” provided.

Speaking of the reference used for this knowledge translation crime, it is for a review article called Impact of Dietary Polyphenols on Carbohydrate Metabolism and having reviewed it I can say it does not support the claim in that post. Most of the article talks about animal or cell culture results that show polyphenols may impact glucose digestion or absorption, but there's nothing in the article showing it stops it. It even concludes that
To confirm the implications of polyphenol consumption for prevention of insulin resistance, metabolic syndrome and eventually type 2 diabetes, human trials with well-defined diets, controlled study designs and clinically relevant endpoints… are needed.
The closest thing in the article supporting the Instagram post is
The shape of the plasma glucose curve with reduced concentrations in the early phase and a slightly elevated concentration in the later phase indicates delayed response due to berry consumption
about a study done with 12 healthy participants looking at berry puree (rich in polyphenols). The polyphenols (or something else in the berries) changed the timing of the blood sugar elevation.

I suppose the Welch’s RD nutrition advisor might say
well actually Dylan, changing the shape of the blood sugar elevation means it doesn’t actually raise blood sugar like candy
and we could get into a long argument of how you define “like”. When people are arguing over minutia or semantics big food companies have won.

This type of nutrition misinformation advertising works because ultimately it is designed to ruin peoples’ trust in nutritional science and nutrition experts (especially RDs). If consumers are confused and can’t trust anything in nutrition, they are ripe for the next trend or fad or advertising claim. That is a good thing for companies, but a bad thing for people.

If you like grape juice, drink it, I sometimes do when I have low blood sugar (I have chugged maple syrup for that too so…), but know that grape juice will raise your blood sugar, and liquid calories, like those found from the 9 teaspoons of sugar per glass of grape juice, are an easy way to go over on your energy intake. Most of us are trying to avoid excess energy intake, so for that, in my opinion, you can’t beat water.

Dylan MacKay PhD is a nutritional biochemist and an Assistant Professor at the University of Manitoba in Winnipeg. He is also a Clinical Trialist at the George and Fay Yee Center for Healthcare Innovation. Dylan has a special interest in human clinical trials related to lifestyle and diabetes. He is originally from St. John’s, Newfoundland where he started his graduate studies at Memorial University.

Saturday, June 22, 2019

Saturday Stories: Anti-Vax Conferences, Vulnerable Child Syndrome, and Taffy Brodesser-Akner

Anna Merlan, in Jezebel, in what she learned getting kicked out of America's biggest anti-vax conference.

Rachel Pearson, in The New Yorker, on vulnerable child syndrome

Jen Ortiz, in Cosmopolitan, with a fabulous profile of celebrity profiler and author of the book I ordered on my kindle yesterday Fleishman is in Trouble's Taffy Brodesser-Akner

[And if you don't follow me on Twitter or Facebook, here's my most recent piece for Medscape on what actually works for obesity at a population level (hint, it's not shame, blame, or fear)]

Wednesday, June 19, 2019

Scotland's "National Walking Strategy" Actually Increased Recreational Walking (A Tiny Bit) For The Whole Population!

Cynically, I've been known to ask for examples of population based initiatives that actually led to sustained increases in physical activity (with the expectation of there not being any).

Well, I can't do so anymore as Scotland's managed to increase recreational walking by 13% over a 6 year period for the whole of their population!

Their National Walking Strategy targeted Scotland's 5 million residents with messages about the health benefits of walking.

The strategy involved multiple sectors including:
  • Communication and public education.
  • Transport and the environment.
  • Urban design and infrastructure.
  • Health and social care.
  • Education.
  • Community-wide approaches.
  • Sport and recreation.
And together their aim was to create a culture of walking by way of developing better walking environments that supported ease and convenience.

How to counsel patients on physical activity became a topic in medical schools. The Daily Mile encouraged 1,000 schools to help every student walk, run, or jog a mile a day, increased funding for active transport programs was obtained including a doubling of infrastructure funding for same, #SoMe was leveraged to share encouragement and information to the public, and community walking programs were launched nationwide.

Now before you get too excited, the bar was low to begin with whereby the increase in walking represented the self-report of walking at least 30 minutes for recreation once over the past month, but at least it's a start.

Changing behaviour requires more than just education and a good reason to do so, it also requires a change to social norms and culture, as well as environmental engineering. Clearly there's more to do in Scotland and elsewhere, but nice to see that these needles might actually be movable.

Photo by Kim Traynor [CC BY-SA 3.0], via Wikimedia Commons


Saturday, June 15, 2019

Saturday Stories: Quantum Solutions, Stockpiled Insulin, and Multiple DNA Tests

Jana Asenbrennerova, in Quanta Magazine, on how a gifted grad student’s solution to a fundamental problem in quantum computing is an incredible breakthrough.

Maris Kreizman, in the New York Times, on why she's stockpiling insulin in her fridge.

Rafi Letzler, in Live Science, discusses the results of his 9 different commercial DNA tests.

Photo Richard Wheeler (Zephyris) at en.wikipedia - Originally from en.wikipedia; description page is/was here., GFDL, Link