Monday, October 20, 2014

Guest Post: Obesity, Cancer, and Mental Health. What Links Them All?

Today's guest post comes from Dr. Sandro Demaio - a rising public health champion. When he asked me if I'd write something for him, I jumped at the chance to ask him to write something for me!

There's been a lot of discussion about obesity. Whether or not it's a disease (as it is in the USA now). How this label would positively or negatively influence action taken by society and governments in addressing this large and growing burden.

This conversation is important, but I have noticed very often it ends with confusion. Questions around why we begin talking about obesity - and end discussing mental health, cancer, heart disease or diabetes. To make hings even more confusing, the term 'Non-Communicable Diseases' might even be mentioned.

So what is the link between all of these diseases, and why can we not have a discussion about obesity, without talking about a range of seemingly unrelated ailments?

Well the reality is that all these diseases are actually highly interrelated. Obesity, diabetes, heart disease, cancers, lung diseases and mental illness (all combined are called Non-Communicable Diseases, or NCDs) largely share the same drivers or "risk factors". Things like an unhealthy diet, using tobacco, drinking alcohol and not getting enough exercise are all related to, or direct drivers of obesity and diseases like diabetes and some cancers. What's more confusing though, is that obesity itself puts us at higher risk for diabetes and some cancers, as does diabetes for heart diseases - for example.

Taking a step back though, the overlap becomes even more apparent. Because at a time when as much as two-thirds of many countries are overweight or obese (and obesity is rapidly rising in even the poorest nations), this is not an issue that comes down to 'stupid individuals making poor choices'. The reason we have a poor diet, or smoke, or don't get enough exercise - is largely due to the built environment around us, the ubiquitous nature of junk-food and alcohol advertising, the way our cities are designed, the structuring of our food system, the subsidies that make unhealthy foods cheap, the over-focus of treatment at the expense of prevention in our health systems, the lack of integrated health education in schools and so on...

These are the structural and social determinants of health, and disease.

Let's just look at food for a moment - which is a leading risk factor for disease worldwide with poor diet driving obesity, diabetes, heart disease, some cancers and more. We can say that people eat poor diets because of poor choices, but I don't really buy this. Do we really make informed, un-coerced decisions on what we eat? We buy that chocolate bar because it's delicious, but also because we are bombarded with advertising which makes us want it. They use psychologists and behavioural studies to develop the right flavour, size and packaging. They place it at the check-out because they know we will impulse buy it - that is, we never really wanted it. The sugar in that bar is cheap because our governments (more so in the USA nd Europe) subsidises the cost of sugar production and having eaten the bars as a child due to clever marketing specifically pointed at young people, we associate chocolate with happy memories.

My point is that in a nation where 2 in 3 of us are overweight or obese, something much bigger is going on that simply 'stupid people making poor choices'.

My other point is that whilst we might think of these diseases as separated outcomes, they actually have common root causes, risk factors and social determminants. Many of them far beyond the health sector.

Some biting food for thought.


In the month of October, NCDFREE is running a campaign called The Face of NCDs. Here are some crowd-sourced reflections on the overlaps between these diseases, from people like you around the world.

"The idea of NCDs as a result of broader social engineering, rather than from the intentions of individuals, is something that needs to be more widespread. Too much of our approach to conditions like diabetes, pulmonary disease, and heart attacks blames the sufferer when we should be looking to the societal and economic determinants of health. When two thirds of Australians are overweight, there have to be larger forces at work than the personal failings of patients." - Oscar, Australia

How ironic is it that man created antibiotics and medicines that keep us alive, but also created societal structures, alcohol, cigarettes and processed foods that are killing us? We need to realize that NCDs are problems of the way we constructed our societies and that there is a way out.” - Signe, Denmark

"In more and more countries being overweight or obese is the norm. Its the most shocking sign that our food system is simply failing. It’s going to take concerted effort from governments, the food industry and the public to make the changes needed to tackle this problem. Failure to do so will have catastrophic consequences for humanity.” - Henry, Denmark

"Coming from the US and living in Denmark has shown me the massive influence that political and public infrastructures have on health-related behavior. It can be argued that an unhealthy lifestyle is simply a matter of individual choice, but when roads are designed for automobiles rather than bicycles or when cheap, highly processed foods are available in excess rather than moderation, the odds are stacked up against you from the start.” - Hillary, USA

"Major sporting events often talk about leaving a legacy to inspire the youth of today to live a more physically active lifestyle. However these same events, which are watched by billions around the world, are sponsored by leading food and drinks companies which are contributing to the current global epidemic of obesity and type 2 diabetes. Is this the legacy we really want to leave?”- Jack, Denmark

For more stories, head to today.

Dr Alessandro Demaio trained and worked as a medical doctor in Melbourne, Australia. While working as a doctor at The Alfred Hospital, he completed a Masters in Public Health including field-work in Cambodia. In 2010, Alessandro relocated to Denmark and completed a PhD fellowship in Global Health with the University of Copenhagen, focusing on Non-Communicable Diseases.

In 2013 Dr Demaio co-founded NCDFREE, a global social movement against NCDs – reaching more than 1.5 million people in its first year. His team convened two international launches and has made 4 short advocacy films; two in collaboration with the World Health Organization.

Currently, he holds a Postdoctoral Fellowship at Harvard Medical School and continues a part-time role as Assistant Professor at the Copenhagen School of Global Health. He also serves on the Advisory Board of the EAT: Stockholm Food Forum.

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Saturday, October 18, 2014

Saturday Stories: Viola Vanclief, Environments, Ebola x 2, and Marathons

Viola Vanclief
Garrett Therolf in the LA Times tells the haunting story of Viola Vanclief's too short life.

Brad Stulberg in The Harvard Public Health Review makes the case for levee building over swimming lessons in behaviour change.

Josephus Weeks, the nephew of Ebola victim Thomas Eric Duncan, with a must read story in The Dallas News on why his uncle's death might have been preventable.

Frank Bruni in The New York Times on how Ebola has highlighted our messed up health priorities and asks, among other things, if you've had your flu shot?

Alex Hutchinson in Runner's World with an amazing example of why the Internet's a great place to write, with his incredibly presented piece on what it's going to take to run a sub 2 hour marathon.

[And if you don't follow me on Facebook or Twitter, here's my piece this week from US News and World Report where I make the case for "Guerrilla Nutrition."]

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Friday, October 17, 2014

Dear Kitten, About that Dog

Today's Funny Friday video has Ze Frank lending his comedic styling to a cat food commercial. It's fantastic.

Have a great weekend!

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Thursday, October 16, 2014

What Actually Reading that Fast vs. Slow Weight Loss Study Taught Me

I imagine this one will be all over the news today, and superficially I can certainly see why - a new study reportedly proves that if you lose weight fast or slow, 3 years later, regardless of the speed you lost your weight, you'll have gained back the same amount. This of course flies in the face of the advice that slow and steady wins the weight loss race.

Read the actual paper and the story becomes far less exciting.

In brief, study participants were randomized to either lose weight quickly with an all-liquid meal replacement shake program (Optifast), or to lose weight slowly using that same Optifast shake to replace one to two meals daily. Once a target weight loss of 15% was reached all patients who got there were then instructed to follow Australia's national dietary guidelines and to see a dietitian once every 3 months for the next 3 years.

Over that same 3 year period, everyone, regardless of whether they lost weight with Optifast quickly, or lost weight with Optifast slowly, regained the same amount of weight when following Australia’s national dietary guidelines – guidelines not even remotely designed for weight management or satiety (15% protein, 30% fat, 55-60% carbs) - while being provided with very little in the way of ongoing support.

Put another way, being prescribed a weight loss program that involves zero changes to lifestyle (aside from drinking shakes in place of meals), and then once weight is lost quickly or slowly, being told to follow a diet not designed in any way shape or form for weight management while receiving infrequent ongoing support, is clearly equally ineffective.

The fact that weight lost comes back when the intervention you undertook to lose the weight is stopped is anything but surprising, and yet that is precisely what was done with both the rapid losers and the slow losers. That there was no difference in their rate of regain speaks more to the authors' failure of recognizing obesity as a chronic condition, which like any chronic condition, returns once treatment is stopped, than it does to the speed participants lost weight using weight loss interventions that they were explicitly instructed to stop once their weight was lost.

The more weight you'd like to permanently lose, the more of your life you'll need to permanently change. All this study proves is that temporary changes lead to only temporary results and that what matters to your longterm success isn't the speed with which you lose your weight, but whether you lose your weight with a lifestyle that you enjoy enough to sustain.

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Wednesday, October 15, 2014

The New York Times, Ebola, and "Immune Boosters"

While we may tell ourselves we live in a time of enlightenment, when it comes to our health, one walk through a pharmacy or health food store's aisles of Dr. Oz-esque nonsense and nostrums, and it's easy to see we're certainly not all the way there yet.

And while I fully expect the likes of both tabloid television and tabloid journalism to ascribe super powers to supplements without the requirement of super proof of those same powers, for some reason (naiveté I'm guessing) I wouldn't have expected the same from the New York Times. And yet...

Yesterday I clicked on a link to a story in the Times that detailed a reporter's experiences travelling from Liberia to New York in this new context of Ebola. When I got to this sentence, had I been drinking coffee I might have spit it out,
"I carried a blue canvas handbag crammed with wallet, laptop, two cellphones, passport, change of clothing, bleach wipes, and two Ziploc bags full of the malaria pills and immune boosters I had been taking for the two weeks I had been covering the Ebola outbreak".
Immune boosters?

To date, there are no products that I'm aware of that have been found to have a direct connection between their ingestion and heightened immunity. Sure, there are some theoretical connections (probiotics for instance), but nothing that would make me not scratch my head about the New York Times' journalist (and her editor) who felt that including a casual mention of "immune boosters" as if they were, akin to malaria pills, real and obvious things to pack (and take), in an article about Ebola, during a time of knee jerk medical paranoia, was in the public's best interest.

Why? Well beyond the responsibility a credible newspaper has in providing the public with fact and not fiction, there may be risk to those pharmacy shelf/health food store products that purport to boost immunity, because if they actually did, they would likely cause harm. Mark Crislip of Science Based Medicine explains this succinctly,
"If you really, truly, could boost your immune system, you would almost certainly increase your risk for thrombotic events."
The reason there would be risk is that a genuinely boosted immune system is pro-inflammatory which in turn would increase your risk of thrombotic events (like strokes, heart attacks, blood clots, and embolisms).

That a New York Times reporter is not only comfortable purchasing and taking products purported to "boost" her immune system, let alone casually including a mention of them in her article (and having that casual inclusion get past her editor), is a true testament to us needing far more regulation when it comes to our aisles of nonsense.

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Tuesday, October 14, 2014

The Recipe for the Perfect Family Meal

Yesterday a fascinating new study published in Pediatrics. Researchers studied the video recordings of 120 families' meals for over a week to try to tease out what family meal factors were most associated with overweight and obesity in children. Not only were where the meals taking place studied, but also who was there, how long they lasted, and then what sort of interpersonal relationships were seen at the table (both between parents, between parents and kids, and between kids themselves).

Before I get to the results it goes without saying that these results can't distinguish between cause and effect - meaning that it's unclear if the relationships described by the study, if adopted, would in fact prevent weight gain (or lead to loss). That said, given how easy and straightforward many are, I thought it would be worthwhile to publish a simple recipe for healthful family meals based on the study's findings.

The Perfect Family Meal
  1. Takes place in the kitchen
  2. Lasts for 18 minutes or longer
  3. Has at least one (or ideally both) parents present
  4. Is consumed alongside attentive, warm and supportive conversation
  5. Includes a positive discussion of the foods involved (not a discussion in terms of weight or good/bad, but rather such things as where the food came from, what it might be like to grow it, other meals that might be enjoyable from similar/same ingredients, etc.)
and while not found to be significant in the study I'd still add:

       6.  No screens (TV, phones, or other).

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Saturday, October 11, 2014

Saturday Stories: Pink, a Backpack, Ebola, Glucola, and Home Cooking

The Chicago Tribune's Barbara Brotman on why some women with breast cancer dread the pink month of October.

A harrowing story in the New Yorker by Jennifer Gonnerman on a boy, a stolen backpack, and 3 years of his life.

A great piece of investigative journalism by a team from the Washington Post on the failures that have allowed for Ebola's rapid spread.

Dr. Jen Gunter delivers the Food Babe's most recent idiocy surrounding Glucola and OGTT testing.

Emily Landau in Flare (with some quotes from me) on the baby steps she's taken towards home cooking and the difference they've made in her life.

And here's the segment I did with CTV's The Social this week on sleep, sleep trackers, sleep aids, and sleep issues.

Also, if you're in Ottawa, here are the details on the free public lecture I'm delivering this coming Thursday October 16th at 7:00pm at Centrepointe Theatre for Ottawa Public Health (book signing following the lecture) - tickets are limited so register (freely) today!

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Friday, October 10, 2014

RUN! (And Don't Play with Ouija Boards)

I honestly think if I had been the subject of this week's Funny Friday video I'd need a new pair of pants.

Have a great weekend!

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Thursday, October 09, 2014

From the "Not the Onion" and "How Can This Not Be a Joke" File

The Aberdeen Health Foundation in Nova Scotia is celebrating the $4,925 they raised by hosting a McHappy Day at McDonald's (a multi-year fundraising tradition) and this year is using that money to help fund the purchase of a specialized bariatric chair for use in the Aberdeen Hospital.

Here's hoping that next year they don't sell cigarettes to help fund a new respirator.

(For newer readers, here's a piece I wrote on why we need to put an end to this sort of fundraising, and if anyone is interested in non-junk food fundraising, here are some recommendations from CSPI, which while specific to schools, are in many ways applicable to hospitals and health foundations (and certainly are so when we're talking about raising a grand total of $4,925)

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Wednesday, October 08, 2014

Community Races Shouldn't Promote Unhealthy Eating Practices

This past weekend my family and I continued our longstanding tradition of participating in CIBC's Run for the Cure (not to be confused with Komen's - a different beast altogether, though also in support of breast cancer research). We love it because it's a very accessible race for kids with lots of excitement, huge crowds with fun costumes, and a 1km option for little legs. Participating and learning about the race helps my children to learn about charity, community spirit, fundraising, and active living.

But it also teaches them that doing a teeny tiny bit of exercise warrants being fed, as the food tent is just steps from the finish line and loudspeakers (and food) beckon their visitations.

The fact of the matter is that neither a 1km nor a 5km run require any refuelling whatsoever as our bodies have more than sufficient supplies of fuel to get us through such short durations and distances. The myth that exercise warrants or deserves a food reward is part of our broken societal approach to food as a whole and may well be a contributor to the fact that despite the laws of thermodynamics suggesting they should do otherwise, exercise only interventions meant to address weight tend to fail miserably in part because we've been taught (and do) to eat "because we exercised".

And what of the food in the food tent? Well no doubt in large part due to our ridiculous national Food Guide that still lists juice as a fruit serving, there were post-breakfast (the race began at 9:30am) large cans of juice containing nearly 200 calories and 10 teaspoons of free sugar. There were also 260 calorie bagels with an additional 1.5 teaspoons of free sugar, bananas, and if you were lucky enough to get there first and were so inclined, they also had a few bottles of water (compare and contrast the bottled water availability to the boxes of juice cans in the photo up above that I took from the end of the table).

Of course this isn't unique to the Run for the Cure, but true of most short duration/distance community races (both charitable and not) that I've run. Given the organizations involved are deeply invested in improving health, either through charity or through fitness, their food offerings are an unwelcome contradiction of their aims.

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