Friday, April 28, 2017

The Simpsons Takes on Trump's First 100 Days in Office

Today's Funny's funny all right, and yet at the same time, not so much.

Have a great weekend!

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Wednesday, April 26, 2017

The Cult of Personal Responsibility Only Extends To Obesity #COS17

Yesterday saw the release of the Canadian Obesity Network's Report Card On Access To Obesity Treatment for Adults which grades the availability of obesity treatment options in Canada.

While you're welcome to peek at the report, its bottom line is that despite obesity's growth and prevalence, whether it's behavioural programs (and full disclosure, I run one), medications, or surgery, virtually nothing is covered aside from surgery, and among the report's findings, not a single provincial drug benefit plan covers the cost of pharmacotherapy for obesity, nor do any of the Federal Public Drug Benefit Programs.

And it's important to be clear here too as to what CON is talking about when calling for increased access to obesity treatment options. This isn't about vanity. According to CON, obesity,
"should be diagnosed by a qualified health professional using clinical tests and measures that assess health, not size"
and that it matters because,
"obesity is a leading cause of type 2 diabetes, high blood pressure, heart disease, stroke, arthritis, cancer and other health problems. It also affects peoples’ social and economic well-being due to the pervasive social stigma around it. Weight bias can increase morbidity and mortality, and is associated with significant employment, healthcare and education inequities."
The responses to the report (in the comment sections of various stories) are anything but surprising and can be summed up by the quotes obtained by the National Post from Senator Kelvin Ogilvie in discussing the report with him
"Obesity, to be blunt, is very largely a lifestyle issue", he said.

It would seem that according to Senator Ogilvie people with obesity have done this to themselves, and similarly, if they just wanted to badly enough, they could fix things stating,
"So, at some point people have to take some responsibility for their own management, and obesity is one of those areas around which, with some initial medical advice and guidance, people do have the opportunity, largely, to manage it on their own."
Now rather than expound on how the provision of health care should not be blame based, or discuss the fact that only ignorance and weight bias leads a person to cite personal responsibility as obesity's answer while simultaneously discussing the appropriateness of medical attention and treatment for a myriad of other chronic non-communicable diseases (diabetes, heart disease, arthritis, many cancers, mood disorders, and many more) which are all also preventable and/or treatable by way of lifestyle, I want to bring your attention to a new study that just came out in JAMA that explored the use of cholesterol lowering medications in patients who had just suffered a heart attack.

You'd imagine that someone who had just survived a heart attack would be an incredibly motivated patient - one that would likely take on behaviour changes to try to prevent a recurrence. Now this study didn't look at the far more difficult behaviour changes involving dietary overhauls and the adoption of regular exercise that would be required in the management of obesity, this study looked at whether or not post-heart attack patients took their daily recommended cholesterol lowering medication - a behaviour that no one could argue requires much effort.

Cholesterol lowering medications are recommended post-heart attack because people who have had heart attacks are at much higher risks of more heart attacks and these medications have been shown to reduce those risks.

Before getting into this study, I should point out that a prior study had found that less than 30% of Medicare beneficiaries 65 to 74 years of age who were hospitalized for heart attacks filled their prescription for statins within 90 days of discharge. That means that the vast majority of patients who'd had heart attacks didn't even bother to try to take on the behaviour change of filling the prescription for, let alone taking, a medication shown to reduce their risk of having another.

This study wanted to explore the rest - the minority of post-heart attack patients who did fill their prescriptions for cholesterol lowering medications, and it followed nearly 60,000 patients hospitalized for a heart attack who filled their prescription for a high dose of cholesterol lowering medication within 30 days of discharge and then tracked the medication's continued usage.

6 months later 32% had stopped taking it with high adherence. 2 years later and 60% weren't taking it as directed, and 20% had stopped taking it altogether.

Pulling the two studies together (which while not statistically fair is something I'm going to do to make a point anyways) suggests that of those patients on Medicare between the ages of 65 and 74 who had a heart attack, 2 years later only 8% were actually following through on the recommended behaviour change of taking a daily high dose statin.

I bring this up because it demonstrates that behaviour changes, even those that as effortless as taking a daily medications, are challenging to sustain.

Regardless of just how tone deaf it is in the face of decades of global increases in weight, to suggest the useless truism of "eat less move more" as a practical approach to the millions of Canadians whose weights are affecting their health or quality of life, the fact is that sustained changes in behaviour challenge each and every one of us regardless of how beneficial those changes might be.

Change being difficult is part of the human condition, and the provision of health care should not be dependent on a person's success therein. Denying that only when it comes to obesity? Well that's just ignorance, or bias, or both.

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Monday, April 24, 2017

Will Candy With 30% Less Sugar Just Make Matters Worse?

Once reformulated this candy will "only" be 36.5% free sugar by weight 
A few weeks ago I blogged about the new lower in sugar Kit Kat bar that contains 4 fewer calories than the old bar (with 0.7g less sugar). The front of its package doesn't shout out about lower sugars though, instead it hypes "extra milk and cocoa".

It was the first example I'd seen of the inevitable future of ultra-processed treats that are being designed and launched under the banner of sugar as our global, singular, dietary boogeyman.

While there's little doubt we over consume sugar, and that sugar is one of the primary drivers of hyper-palatability and obesity, if the marketplace sees an influx of "now with 30% less sugar" ultra-processed foods, I'm not sure they won't make matters worse.

And that's precisely the sort of thing we're going to see as evidenced by this new line of Nestlé candy which according to this news story, will be sold alongside the original candy "with a 30% less sugar banner on the packaging"

Sounds an awful lot like the early 1990s when we saw the launch of "Fat-Free" Snackwell cookies (and more of course).

Will the "Now With 30% Less Sugar" banner lead people to buy candy more often? To eat candy more frequently? To eat more candy at each sitting? To grudgingly give in to their naggy kids and pack it in their lunches because it's less bad? Or will it lead to an overall reduction in free sugars and calories consumed?

For the majority of folks, my money's on all of the former, and none of the latter.

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Saturday, April 22, 2017

Saturday Stories: Car Currency, SuperBabies, and a Supplement Scheme

Debbie Weingarten in Longreads explains the relationship between the currency of cars and how to leave a husband.

Heather Kirk Lanier in Vela on how superbabies don't cry.

Charles Rusnell and Jennie Russell in CBC News highlight a government funded Vitamin D supplement scheme.

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Friday, April 21, 2017

Buddy Mercury Sings His Ode To Post November 8th, 2016 America

And I have to say, I'm right there with today's Funny Friday's Buddy.

Have a great weekend

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Thursday, April 20, 2017

For Beginners, Maybe Cooking Shouldn't Be "Healthy"

Serious Eats' 3 Ingredient Stovetop Mac & Cheese
Having worked with literally thousands of patients on improving the quality of their diets I can tell you that the most common barrier I hear to their adoption of more regular home cooked meals is a real or perceived lack of skill or talent at it.

Sometimes their beliefs stem from personal experiences and experiments. Other times they come from one or more family members who have complained about a particular dish (rather than be thankful that someone took the time to cook for them).

I can also tell you that many of the folks who don't cook regularly believe that if they were to start doing so, they'd need to be cooking "healthy" foods.

Why sure, cooking especially healthy meals is a nice aspiration, but if you're a beginner in the kitchen, why not instead focus on cooking meals that while perhaps not incredibly healthy, are meals that you're confident that you or your family will enjoy?

The goal really is to gain comfort in the kitchen and/or to gain the trust of your family members that you can cook yummy things.

So if you're a beginner in the kitchen, maybe cutting your cooking teeth on less healthy meals will encourage you to gain the skills and comfort you'll need to slowly improve your repertoire, and in so doing make the kitchen a room in which you actually enjoy spending time.

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Monday, April 17, 2017

Hey MDs, Scales Measure Gravity, Not Health, And Not Lifestyle

Today's guest post comes from long-time reader Sarah Trend who shared with me the handout she received on leaving her most recent endocrinology appointment. She also provided me with her thoughts and kindly agreed to let me share them with you. All this to say, if you're an MD the only thing your patient's weight tells you is the gravitational pull of the earth on them at a given moment in time. It tells you nothing about the presence or absence of health, nor does it tell you anything about their lifestyles. And if you're planning on providing lifestyle related advice, best you explore your patients' actual lifestyles first - regardless of their weights. Plenty of people with higher weights have incredibly healthful lifestyles, and many people with lower weights live awfully unhealthy lives.
I went to the endocrinologist this morning. The PA had me step on the scale and she recorded my weight. There was no discussion whatsoever with her or with the doctor about my weight. Imagine my surprise when I reviewed the "follow up" instructions - photo attached.

For the record, I weigh about 5 lb more than their "long term goal weight". I am 5'8". Had there been any discussion whatsoever, the doctor would have learned that the "weight loss tips" are not of much value to me: I only drink water. I do not eat fast food. I eat breakfast (hard-boiled egg and some fruit) every morning. I watch, at most, one 30-minute TV show a day. My husband does all grocery shopping. We cook >95% of our meals at home (from scratch, not boxes) and I take leftovers for lunch every day. Many of these meals are vegetarian. I get 4-5 hours of vigorous exercise every week - in fact, before my appointment I ran 3.25 miles at a pace of 9:22/mile. I only take the stairs at work. I get >10K steps each day.

Also, my blood pressure, as taken by his PA in the appointment, is 91/56.

So yes, I would really like to lose 10-15 vanity pounds, but that is all they are - vanity pounds. And yes, my weight is a few pounds above a BMI of 25. Had he had a conversation with me, he would have learned that I worked 61 straight 12-16 hour days at the start of this year. Some days, yeah, I grabbed a bag of peanut M&Ms or skittles from the snack cupboard in the office. Because I'm a human. And also - my period is due, so I'm up about 3 pounds of water weight from that.

I am so angry. Is this what passes for medical advice now? Meaningless random comments about weight loss with no conversation about health? I am appalled that an endocrinologist (who presumably sees patients with a variety of weight issues) thinks this is appropriate. Thought you might like to see it.

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Saturday, April 15, 2017

Saturday Stories: Horseshoe Crabs, Math Proofs, and Fentanyl Addiction

By Asturnut (talk) - I (Asturnut (talk)) created this work entirely by myself., CC BY-SA 3.0, Link
Caren Chesler in Popular Mechanics on the irreplacable medical marvel that is horseshoe crab blood.

Natalie Wolchover in Wired on the retired German statistician who solved one of mathematics most elusive proofs.

Darryl Green (as told to Katherine Laidlaw) in Toronto Life details his journey from successful ER physician to a fentanyl addiction.

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Friday, April 14, 2017

Life Is A Real-Life Episode of Veep

I can't imagine you didn't catch Sean Spicer's recent press conference. If it weren't so horrifying, it'd fit perfectly in HBO's apparently prescient presidential comedy Veep as is evidenced by today's Funny Friday.

Have a great weekend!

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Wednesday, April 12, 2017

No, Grade 1 Teachers Shouldn't Use Fun Dip To Teach Adjectives

And here I thought I could no longer be shocked by the gratuitous use of junk food to reward, entertain, or pacify kids.

Silly me.

Thanks to a friend who'd rather remain anonymous, I learned that her son's Grade 1 class was given Fun Dip to eat and write about in an exercise on adjectives.

Little did they realize they were also being taught about marketing, and about how giving kids junk food has become so normalized, that their teacher didn't see anything wrong with this lesson.

That the use of candy as a teaching tool didn't give this particular Grade 1 teacher enough pause to not follow through speaks not to her skills as a teacher, but rather to just how pervasive this sort of practice has become. People don't question normal behaviour, but just because something's been normalized, does not make it wise.

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