Monday, September 16, 2019

Let's Stop Using The Terms "Healthy Weight" And "Normal Weight"

Words matter, and your weight cannot determine whether you're "healthy", or "normal".

Honestly.

Firstly, scales don't measure the presence or absence of health, and so the term "healthy weight", means literally nothing.

Secondly, the CDC defines a "normal weight" as one giving a person a BMI between 18.5 and 24.9 yet if we were using the word normal correctly, it would differ by country and would reflect its population's mean BMI. So in Nauru for instance normal weight would be a person whose BMI was 32.5, whereas in Eritrea it would be someone whose BMI was 20.5. Given mean BMIs in the US and Canada are 28.8 and 27.2 respectively, in North America, it should be considered abnormal to have a BMI between 18.5 and 24.9.

So what could we use instead?

Risk based terms.

Weight, though not a guarantee for any medical problem, does increase the risk of many, and so I'm proposing that rather than terms which confer judgment, we categorize weight as low-risk, medium-risk, and high-risk, and by doing so we'll stop the erroneous use of healthy and normal terminology that constantly and insidiously promotes weight bias, shame, and stereotype.

Saturday, September 14, 2019

Saturday Stories: Crane Wife, Domestically Violent Cops, and Brain Boosting

CJ Hauser, in The Paris Review, with the crane wife.

Kyle Hopkins, in Propublica, on the village where every cop has been convicted of domestic violence.

Kaitlyn Tiffany, in Vox, on brain boosting.

Monday, September 09, 2019

If There Were Quick, Easy, Flying Leaps That Lasted, You'd Have Already Taken Them

The saying is that long journeys begin with first steps, not flying leaps, and if there were flying leaps that routinely led to lasting change, you'd have already taken them.

It's a straightforward message, but when applied to weight management, diet culture regularly asks us to ignore it.

The inconvenient truth of healthy living is that it will certainly require effort.

Yes, there are likely those who will succeed by changing everything all at once, but for most, slowly building and layering change, and respecting the fact that their roads will absolutely also see their share of disappointments and setbacks, is the way to finally get somewhere.

Your first step might be as small as losing one restaurant meal a week in place of cooking, or trying to reduce your sugar sweetened beverages by 50%, or actually scheduling a day to buy, or a service to deliver, weekly groceries, but if you choose steps you can actually accomplish without suffering, you're more likely not to fall, which in turn, will help keep you moving forward.

Wednesday, September 04, 2019

Why You Should Turn Off Your TV And Holster Your Devices Before You Eat

Ok, it's a short study and it relied on dietary recall, but if taken at face value, the results certainly suggest you should be turning off your devices and eating away from the TV.

The study involved the 3 day recall of both diet and media use among 473 individuals.

Plainly, researchers found that meals that were consumed along with some form of media distraction contained 149 more calories. They also found that people consuming those extra calories at a media meal did not compensate by eating less at their next meal.

Given how easy it is to do this, and how by doing so you might even strengthen some interpersonal relationships by eating with friends or family around a table, you really have almost nothing to lose by trying, except perhaps a few calories.

Saturday, August 31, 2019

Saturday Stories: Suicide, Goop, Vaccines, And Kurbo

Connie Schultz, in Creators, on what to say (and not say) to someone whose loved one has died by suicide.

Amanda Mull, in The Atlantic, on what Goop really sells.

Richard Conniff, in National Geographic, on the world before vaccines.

[And if you don't follow me on Twitter or Facebook, here's my take on Weight Watcher's new kids Kurbo app and how while Weight Watchers might know kids aren't likely to lose much weight, do the kids?]

Monday, August 26, 2019

The Rewards Project - A Registered UK Charity Geared At Putting An End To Sugary School Rewards

So it's back to school time, and zero doubt, many of your kids are going to have teachers and schools who will use candy and junk food as a reward.

It's a shame too, not just because they'll be providing your kids with junk, but also because they'll be teaching them, over and over and over, that junk is a reward for anything and everything.

I've written before about easy non-junk food rewards for teachers, I've also written about how you might want to approach things with your kids' sugar pushers, and I even kept track one year of just how much junk other people were offering my kids. What was clear from the response to all of these pieces was just how prevalent this problem was, and just how frustrated parents are.

Well as a sign of those times, in the UK, a new charity has popped up called The Rewards Project and its mission is trying to change this common practice. Click through and you'll find some sample letters to send to your child's school (though I think they'd be much better were they to offer some alternatives and suggestions in them and as I wrote about and linked above, lead with praise for the school and its teachers).

All this to say, if there are charities popping up geared at tackling this issue, clearly there's a real appetite out there for change. In turn this suggests - and my experiences with my kids' schools and more would definitely support this notion - that your kids' schools and teachers might be more open to changing things than you might think.

You'll never know unless you try.

(Thanks to Dr. Miriam Berchuk for sending this my way)

Saturday, August 24, 2019

Saturday Stories: Fitness Evolution, Soda Taxes, and Tick Saliva

James Steele, in The Evolution Institute, on how evolution best informs exercise.

Jeremy B. White, in The Agenda, on how the food industry may be winning the war against soda taxes.

Sarah Zhang, in The Atlantic, marvels about tick saliva.

Monday, August 19, 2019

9 Great Suggestions For Improving The Quality Of Dietary Research (And 1 That According To @JamesHeathers Is "Deeply Silly")

Last week saw the publication of an op-ed authored by Drs. David Ludwig, Cara Ebbeling, and Steven Heymsfield entitled, "Improving the Quality of Dietary Research". In it they discuss the many limitations of dietary research and chart a way forward that includes the following 9 great suggestions,
  1. Recognize that the design features of phase 3 drug studies are not always feasible or appropriate in nutrition research, and clarify the minimum standards necessary for diet studies to be considered successful.
  2. Distinguish among study design categories, including mechanistic, pilot (exploratory), efficacy (explanatory), effectiveness (pragmatic), and translational (with implications for public health and policy). Each of these study types is important for generating knowledge about diet and chronic disease, and some overlap may invariably exist; however, the findings from small-scale, short-term, or low-intensity trials should not be conflated with definitive hypothesis testing.
  3. Define diets more precisely when feasible (eg, with quantitative nutrient targets and other parameters, rather than qualitative descriptors such as Mediterranean) to allow for rigorous and reproducible comparisons.
  4. Improve the methods for addressing common design challenges, such as how to promote adherence to dietary prescriptions (ie, with feeding studies and more intensive behavioral and environmental intervention), and reduce dropout or loss to follow-up.
  5. Develop sensitive and specific biomeasures of adherence (eg, metabolomics), and use available methods when feasible (eg, doubly labeled water method for total energy expenditure).
  6. Create and adequately fund local (or regional) cores to enhance research infrastructure.
  7. Standardize practices to mitigate the risk of bias related to conflicts of interest in nutrition research, including independent oversight of data management and analysis, as has been done for drug trials.
  8. Make databases publicly available at time of study publication to facilitate reanalyses and scholarly dialogue.
  9. Establish best practices for media relations to help reduce hyperbole surrounding publication of small, preliminary, or inconclusive research with limited generalizability."
But there is one recommendation that seems at odds with the rest,
Acknowledge that changes to, or discrepancies in, clinical registries of diet trials are commonplace, and update final analysis plans before unmasking random study group assignments and initiating data analysis.
For those who aren't aware, clinical registries are where researchers document in advance the pre-specified methods and outcomes being studied by way of an observational experiment. The purpose of pre-registration is to reduce the risk of bias, selective reporting, and overt p-hacking that can (and has) occurred in dietary research.

Now to be clear, I'm a clinician, not a researcher, and I'm not sure how commonplace changes to or discrepancies in clinical registries of diet trials are, but I'm also not sure that's an argument in their favour even if they are. I do know that recently two of the authors claiming registry changes are commonplace were found to have modified one of their pre-specified statistical analysis plans which if it had been adhered to, would have rendered their results non-significant.

But commonplace or not, is it good science?

To answer that question I turned to James Heathers, a researcher and self-described "data thug" whose area of interest is methodology (and who you should definitely follow on Twitter), who described the notion of accepting that changes and discrepancies to clinical registries were commonplace was, "deeply silly".

He went on to elaborate as to why,
First of all - the whole definition of a theory is something which sets your expectations. the idea that 'reality is messy' does not interfere with the idea that you have hypothesis driven expectations which are derived from theories.

Second: there is nothing to prevent you saying "WE DID NOT FIND WHAT WE EXPECTED TO FIND" and then *following it* with your insightful exploratory analysis. In fact, that would almost be a better exposition of the facts by definition as you are presenting your expectations as expectations, and your after-the-fact speculations likewise.

Third: if you have a power analysis which determines there is a correct amount of observations necessary to reliably observe an effect, having the freedom to go 'never mind that then' is not a good thing by definition.

Fourth: The fact that changes were made is never ever included in the manuscript. i.e. they are proposing being able to make changes to the protocol in the registry *without* having to say so. it's a 'new plan' rather than a 'changed plan'.

Fifth: If you can still do the original analysis then no-one will ever believe that you didn't change the plan after looking at the data. you have to protect yourself, and the best way to do that is to follow your own damned plans and be realistic from the get.
Lastly, Heathers is unimpressed with the argument that registry changes are A-OK because they're commonplace, and he discussed ancient Aztecan punishments for those citing it.

All this to say, there's plenty of room to improve the quality of dietary research. Here's hoping the bulk of these suggestions are taken to heart, but please don't hold your breath.

Saturday, August 17, 2019