Thursday, July 30, 2015

The Chair of Nutritional Sciences at UofT Says Canada's Food Guide Sucks

And boy does it ever. I've been railing on about how bad it is for nearly a decade now, and just a few weeks ago, Dr. Mary L'Abbe, the Chair of the University of Toronto's Department of Nutritional Sciences, along with her graduate student, Mahsa Jessri published their paper, "The Time for an Updated Canadian Food Guide Has Arrived (Full Text)". After reading it, I invited them to write me a guest post, and here one is as written by PhD candidate Jessri.
Since 1942, Canada has published food guides with a strong emphasis on meeting nutrient requirements. Canada, like many other Western countries, however, experienced a nutritional transition decades ago where widespread micronutrient deficiency was replaced with overconsumption of energy-dense foods and calories. This phenomenon has resulted in a drastic increase in diet-related chronic diseases, such as obesity, type 2 diabetes and cardiovascular diseases; thus we now need dietary recommendations targeted specifically towards the types of foods associated with maintaining a healthy body weight and preventing chronic diseases. Recently we published a critical review of 2007 Eating Well with Canada’s Food Guide (EWCFG) calling for an urgent update to these national Canadian dietary guidelines. Now you may be asking what are the limitations of EWCFG 2007 and why it needs an “urgent update”?

Firstly, if you add up the calories recommended for the four food groups: Fruits and Vegetables, Grain Products, Meat and Alternatives, Milk and Alternatives, and healthy oils (essential calories) for each age and sex group, the total would be higher than the recommended energy requirement for Canadians, confirming the claims made by previous researchers that following the EWCFG leads to overconsumption of calories. There is also no room left for the calories from “other foods” (e.g., high fat and sugary products) which are completely omitted from the 2007 EWCFG, which is another problem. We know from the Canadian national nutrition survey data that nearly 1/4 of the calories consumed by Canadians are from “other foods”; food guides from most other countries leave some calories for these treats that we sometimes eat - which further suggests that EWCFG is obesogenic in nature. Equally important, the same number of servings are recommended for all physical activity levels, with no different recommendations for a sedentary individual and a very highly active athlete.

As pointed out by other researchers, the Canadian EWCFG was highly influenced by the food industry; one-third of all stakeholders involved in consultations were from the food industry who could therefore have influenced much of its development.

Another important issue that’s lacking in the current food guide is consideration of cultural dietary behaviors. We know that one in every 5 Canadians was a visible minority in 2011 and yet our EWCFG 2007 neglects their cultural food preferences and practices, and instead recommends one eating pattern for all, while we already know there is more than one way of healthy eating. Of course, the first step towards development of a comprehensive evidence-based, culturally-sensitive dietary guideline would be to collect food intake information from multi-ethnic individuals in Canada. Unlike other countries, Canada does not have a plan for conducting multiethnic nutrition surveys.

These along with other limitations mentioned in our article, call for an evidence-based unbiased action for drafting a new Canadian food guide using the most recent national Canadian nutrition survey, considering the changes in food supply, the epidemics of chronic diseases, and using a socio-ecological perspective of different food patterns. Such an “ideal” Food Guide would be more focused on maintaining a healthy body weight and reducing the risk of chronic diseases, rather than preventing nutrient deficiencies - which Canadians have a very few of!

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Wednesday, July 29, 2015

Weight Is the Wrong Measure for Physical Activity Interventions

The other day I was reading about point-of-action queues and their impact on stair climbing behaviour and I came across this study, ‘Take the stairs instead of the escalator’: effect of environmental prompts on community stair use and implications for a national ‘Small Steps’ campaignIt's a straight forward paper that looked at 8 studies and the impact they found stair climbing prompts in heavily trafficked areas had on stair climbing behaviours.

The authors found that simple point-of-action signage and prompts led to a nearly 5% increase in stair climbing among women and half that among men. Their work also predicted that every week those signs stayed in place led to 2200 new stair users.

And yet, despite these terrific and pretty much cost and effort free interventions, the authors tempered their conclusions (both in the abstract and of course the larger piece) with negativity stating,
"The projected effect on correcting energy imbalance appears small, suggesting that this intervention alone will not have a potent effect on leveraging population-level body weight or obesity prevalence"
But as I've calculated before, to burn the calories of a small Snickers bar you'd need to climb 122 flights of stairs.

That researchers apparently wondered whether or not a few extra daily flights of stair climbing in malls and office buildings would have a dramatic, let alone any, impact on weight, frightens me. Truly, that weight was included as a discussion piece in this study speaks to just how widespread, even among those who really ought to know better, is the erroneous belief that physical activity is such a large player in weight that even tiny increases to it might lead to weight loss.

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Tuesday, July 28, 2015

Unless You're in an ER, if You Hear the Word "Detox", Run

Simple rule - if someone is trying to promote, defend, or encourage the use of a product they claim will remove toxins from your body, unless they're a physician in the emergency department or your kidney failure specialist, they're either dangerously ignorant, or unconscionably unethical.

And if you're trying to determine between ignorant and unethical, look to their education. If they haven't any, well then give them the benefit of the doubt and presume it's just well-intentioned, hopeful, ignorance. But if they are highly educated, like for instance Dr. Frank Lipman, who sells a $229 two-week cleanse he purports will,
"help to bind toxins, prevent their absorption and promote elimination"
Or Dr. Oz, who promotes a 3 day "Detox Cleanse" that he claims,
"Eliminates harmful toxins and resets your body"
I think it's probably safe to err on the side of unethical.

Recently the fabulous Australian consumer show The Checkout covered detoxing. If you've got a moment, take a peek.

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Monday, July 27, 2015

The Juvenile Diabetes Research Foundation's Disgraceful Fundraising

As far as junk food fundraising goes, I don't think there are any health charities worse than the Juvenile Diabetes Research Foundation.

While in the past they've been quick to defend their sale of some of the junk food world's least healthful choices by reminding critics that they are a charity supporting type 1 diabetes - an autoimmune disease - and not type 2 diabetes, I don't give a flying hoot. Selling illness in the name of health isn't something a health charity should be involved with, let alone a charity who regardless of the etiology of their cause's illness, should assuredly know better than to promote, permit, and encourage the sale and consumption of huge boluses of sugar.

So what has the JDRF sold to date? Pictorially here are three recent campaigns:

And now, on the backs of Mega-Jugs of Pepsi at KFC, Frosties at Wendy's, and deep-fried cheesecake at Denny's comes two other new-to-me initiatives.

There's the annual Root Beer Float Day for the JDRF with the Oakland Athletics (thanks Matt Poulton)

And then there's this one. Honestly, I'm still struggling to believe it's real, but it is. It comes from JDRF Australia where they have a "Jelly Babies Month" for the JDRF.

What are these Jelly Babies that the JDRF suggests you:
  • Place a box at work, in reception or in the staff room for your colleagues
  • Take a box to Saturday sport, the kids will love the Jelly Babies lollies after playing a hard game
  • Ask your local shops to place a box on their counter for their customers.
  • Consider your local bakery, butcher, chemist, supermarket or even the gym!
  • Ask your local club, like your sporting club, surf club, bushwalking club or book club to put a box on display for all members
  • Use Facebook to let your friends know that you are selling Jelly Babies lollies with natural colours and flavours
Well, they're candies. Literally.

Candies which by weight are 74% sugar, with each tiny Jelly Baby (they appear to be slightly larger than a gummy bear in size) packing more than a teaspoon of the stuff.

So once again I have to point out that it's time we put an end to junk food fundraising.

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Saturday, July 25, 2015

Saturday Stories: Mirna Valerio, Genohype, and Oliver Sacks

"9.13.09OliverSacksByLuigiNovi" by Luigi Novi. Licensed under CC BY 3.0 via Wikimedia Commons"
John Branton in Runner's World with just a fabulous and inspirational piece on ultra-distance runner Mirna Valerio.

My friend and fancy pants professor Tim Caulfield in the BMJ talking about the dangers of "Genohype".

The great Oliver Sacks in the NYTs discussing his outlook on life as seen through the lens of his terminal, metastatic cancer.

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Friday, July 24, 2015

"Stop Pushing Gross Fruits and Vegetables on Your Kids"

Funny or Die and Nick Offerman take on American school lunches in today's Funny Friday.

Have a great weekend!

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Thursday, July 23, 2015

3 Years of Telling People to Exercise More Doesn't Make Them Exercise More (at Least Not in Japan)

I've asked before whether or not anyone is aware of any public health intervention that has led to a sustained and objectively measurable increase in the activity level of a population (adults, kids, both, whatever)

Unfortunately, I've yet to hear of any exciting outcomes (nor have I by the way for simply telling people to eat better).

As I see it, the value of exercise as health promoting is well known. Public health campaigns that in turn simply spread that message, probably aren't teaching people anything new, and consequently, may not lead to any sustained changes in behaviour.

And that's precisely what researchers in Japan recently found whereby a 3 year-long, cluster randomized controlled trial designed to evaluate extensive, community wide interventions designed to encourage more physical activity, failed to show any significant benefits.

The interventions were definitely not trivial either, but they were definitely all geared to try to encourage conscious, individual behaviour change. According to the paper, they included,
"(1) Information delivery.

Flyers, leaflets, community newsletters, posters (those are them up above), banners, and local audio broadcasts.

(2) Education delivery.

Outreach health education program and mass- and individual encouragement by professionals during community events. Mass-encouragement included a motivating talk and demonstration of PA using a common procedure to ensure standardization of the intervention and individual encouragement including face-to-face promotion of PA while waiting for
community health check-ups

(3) Support delivery.

Development of social support, i.e., promoting encouragement by community leaders and lay health workers; material support, i.e., arranging for residents to obtain light-reflective material for walking safety, pedometers, and videotapes and DVDs on flexibility and muscle-strengthening activities at each relevant community center; and professional support, i.e., establishing a call center for questions about PA and requests for outreach
Now to be fair, evaluation was by way of survey, though given that asked people generally overestimate their activity levels, if anything you would expect a survey to be more likely to yield a positive result than for instance accelerometry data. Ultimately though, there were no significant improvements found. Not to over-all activity, not to walking, not to flexibility (though there was a positive trend), and not to muscle strengthening.

I think this speaks to the fact that good intentions fail in the face of day to day life, and that if we want to see population wide increases in physical activity, we'll likely need to effect that by way of point of action changes (such as signs placed on escalators and elevators suggesting a person might want to instead take the stairs) and re-engineered built environments that make increased activity the unconscious default, or at the very least, the easier choice.

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Wednesday, July 22, 2015

Dairy Queen Is Not A Partner in Health. Period.

There's no disputing the fact that Dairy Queen Blizzards are a rite of summer for many, nor am I even remotely suggesting that you shouldn't ever have one.

What I am suggesting is that organizations involved in health who encourage the sale of Blizzards in the name of fundraising, and in so doing, provide people with reason and permission to buy them, and further normalize the practice of junk food fundraising, regardless of the dollars involved, are hypocritical and doing a disservice to the healthful lifestyles they purport to be championing.

Treats nowadays are no longer consumed just, "once in a while", so defending this practice as if treats are a rarity, a one-of, is a strawman.

And the money's not so wonderful either.

When I crunched the numbers last year for Dairy Queen's Miracle Treat Day my best guess was that it raises roughly $20,000 per hospital per year in fundraising, or roughly 0.0001% of the average children's hospital's annual budget.

And though I definitely can't prove it, I wonder whether Miracle Treat Day might have inspired, or gave tacit permission to, Kidsport, an Ontario health based NGO geared at increasing sport among Ontario's children, to launch their own Blizzard fundraising event.

I've said it before and clearly I'll keep on saying it, it's time to put an end to junk food fundraising - feel free to click the link if you're interested in a more fulsome discussion as to why.

[Hat tip to Kat Murphy for sending me the Kidsport campaign]

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Tuesday, July 21, 2015

St. Michael's Hospital Foundation Tells Patients Honey and Maple Syrup Are Healthy

St. Michael's Hospital Foundation, in the summer issue of their patient magazine Urban Angel, have an article on sugar and ways to cut down its consumption.

Here's one of their recommendations,
"Another way to deal with (sugar) cravings is to explore alternative sweeteners in your recipes like applesauce, dates or bananas"
I wholly agree. But check out this next line,
"You might also consider unrefined products like organic honey and maple syrup"
They then, on the next page, go on to describe maple syrup as a source of zinc, manganese and calcium, containing 90% less sodium than sugar (less sodium?!), and that honey's slower absorption makes it better.

Healthwashing honey, maple syrup and agave nectar by perpetuating the naturalistic fallacy and using words like "organic" and highlighting trace minerals is not something any health foundation should be doing.

Free sugars are free sugars regardless of how "natural", "organic", or full of manganese they might be.

The Heart and Stroke Foundation would agree as they note,
"The Heart and Stroke Foundation’s position statement on sugar indicates that excess consumption of free sugars is associated with a number of adverse health effects. It encourages Canadians to avoid drinking their calories, including honey and syrups. Instead the Foundation encourages Canadians if they have a sugar craving to consume whole fruits, which are packed with heart-healthy minerals, vitamins and fibre."
For all intents and purposes honey, maple syrup and agave nectars are all free sugars and hence, the stuff we should be minimizing, not healthwashing.

If St. Michael's Hospital Foundation want to do right by patients, they should publish a prominent correction in their next issue.

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Monday, July 20, 2015

New Obesity Study From the Annals of Idiotic Goalposts

If I looked at 279,000 men and women for a decade and studied whether or not they qualified for the Boston Marathon, but I didn't actually look to see if they were runners, and if they were runners I didn't bother exploring what their training plans and distances were like, but instead simply looked at how many people from that 279,000 qualified for Boston, I'm guessing I'd be left with an incredibly small number.

And yet, that's pretty much exactly what the latest depressing weight loss study did. They followed 279,000 men and women for ten years to see what was the probability of those with obesity losing back down to "normal" weight (a BMI less than 25). They didn't exclude people who weren't trying to lose weight or who might not have wanted to lose weight. They also didn't pay any attention to the means with which those who did lose weight only to regain it lost it in the first place.

The odds weren't good. Over the course of a decade, only 1 in 210 men with obesity, and 1 in 124 women managed to bring their weights down to a place where a table would define them as "normal".

It's not particularly surprising. Putting aside the surprising fact that this study didn't exclude people who weren't trying to lose weight, it remains that the vast majority of folks trying to lose weight these days do so by undertaking ridiculous diets. Go figure people don't sustain the results of ridiculous diets; weight lost through suffering comes back when you get sick of suffering. This study of course misses all of that.

And is getting down to a "normal" weight really the right yardstick to measure success? I mean getting down to a BMI under 25 is to weight loss what qualifying for the Boston Marathon is to running. Most runners will never qualify, and consequently qualifying would be a very poor way to measure whether or not people were runners.

But what if you change the goal posts?

If for instance, you set out to study the number of runners who continue to enjoy running as often and as much as they're able to enjoy, rather than simply the number of runners who qualified for Boston, well suddenly the number of runners will be much much higher, though of course not all of those who take up running, keep up with it either.

Extended that to weight, if the goal posts become your "best weight" which is whatever weight you reach when you're living the healthiest life that you can enjoy, suddenly the numbers change.

How much do they change?

Looking at, for instance, the 8 year data from the LOOK AHEAD trial, where lifestyle changes were thoughtful and the goal wasn't qualifying for Boston, 8 years out and 1 in 2 of the participants were maintaining losses of greater than 5 percent of their presenting weights, and more than 1 in 4 were maintaining losses of greater than 10 percent.

So did the publication of this depressing study add to obesity's literature? Quantifying the number of people who don't qualify for the Boston Marathon of weight loss, without quantifying how many of them were actually runners, and what sort of training program they were adopting doesn't strike me as a helpful addition.

I also can't help but wonder what the impact the publication and coverage of studies like these have on individuals who might be considering lifestyle change - both in terms of reinforcing idiotic goalposts, and in terms of them even starting out of the gates.

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