Tuesday, December 01, 2009

The Heart and Stroke Foundation swings and misses, again.


Imagine if you will if the Chartered Accountants of Canada published a self-help program for Canadians who've come on hard times and that in that guide there was a section on keeping a household budget and a balanced checkbook. Sounds pretty reasonable, right? Now imagine if in the instructions for budgeting and balancing that the Chartered Accountants of Canada recommended that purchases be tracked, not by their cost, but rather by number. How many shirts did you buy? How big was the car you purchased? How much gas, in litres, did you fill your car with? Sounds pretty stupid right? Shirts have widely varied costs, how big a car is certainly not the only variable in automobile cost and while you might know how many litres you've put in your car, unless you know the exact price of the gasoline you're not going to know how much you've spent. Bottom line, this would be an absolutely useless guide. I mean even if the rest of the guide was phenomenal with world-class, helpful articles and recommendations, the fact that the recession busting guide explicitly avoids telling users to track costs and plan monetary budgets sinks the vast majority of its potential utility.

Now enter the Heart and Stroke Foundation. They've created the Heart and Stroke Healthy Weight Action Plan which they describe as,

"not a fad diet, but is based on Canadian guidelines and clinical evidence for safe, sustainable weight loss."
So what's the foundation of successful behavioural weight management? Self-monitoring and indeed, it's the very first lesson in this extensive 12 lesson program. So what do the Heart and Stroke folks think you should be monitoring if you're worried about your weight? Servings. But wait a second, don't foods vary dramatically in caloric content? Isn't energy density, the number of calories per gram of a food, one of the seminal concepts in weight management? Wouldn't recommending recording but asking folks to not track calories but rather track servings be akin to the budget that asks you to track the number of purchases you made but not their costs?

It gets worse.

I decided to take a look at Heart and Stroke Foundation's guidance on servings. Tell me what's wrong with this statement, "
One serving of meat, fish or poultry is equivalent to 3 ounces (85 grams), about the size of a deck of cards OR

1 chicken breast or leg
1 hamburger patty
1 fish fillet
1 pork chop
1 steak
1 to 2 eggs
½ cup (125 mL/75 g) canned tuna or salmon
6 large scallops or shrimp"
That's their capital OR, not mine. While 3 ounces may reflect their recommended serving size, I've seen chicken breasts weigh 10oz, 8oz hamburger patties, giant fish fillets, and T-bone steaks can easily clock in at 16oz. But really even if they didn't have that gigantic misinforming OR statement let's consider the fact that a half cup of canned tuna contains 89 calories while a 3oz rib eye has 225 calories.

(Oh, and just in case there's a Canadian out there who actually bothered learning about serving sizes from Canada's Food Guide this tool's serving sizes differ significantly)

So in the entire first lesson do they mention calories at all? They do. They dutifully post Health Canada's daily recommended calories for adults - recommendations that only look at two variables: Age (they divide it into 3 multi-decade categories) and activity (again 3 categories),


This rudimentary chart fails to take into account a myriad of variables that affect weight, foremost among them the presenting height and weight of the individual who's looking for guidance. Yes, a tall, average weight 31 year old woman might well maintain her weight with an 1,800 calorie diet but make that women shorter and 49 and that 1,800 calories certainly isn't going to help her lose and if she's a healthy weight to begin with she's certainly going to gain. Oh, and age does matter. That same 31 year old woman by the time she hits 49 will burn on average 180 calories fewer per day. In a year that'd be 18lbs of difference.

Now contrast the Heart and Stroke's chart with an actual energy expenditure calculator like this one which would provide a far more accurate guesstimate given that it takes into account age, weight, height, body fat percentage, minutes of physicial activity and intensity of physical activity and then averages out multiple different means of energy expenditure calculation to come up with its estimate. And really, given that the Heart and Stroke's intervention is a web based resource it's completely inexcusable that such a calculator isn't built in.

So basically this resource put out by the Heart and Stroke Foundation designed to help Canadians with their weight management efforts barely glosses over the concept of energy intake and provides almost no guidance on how to use that larger fonted, bolded calorie count that leads off each and every nutrition facts panel.

You know looking through the resource it's clear they spent a huge amount of time developing it and some of the tools and articles are in fact quite useful. Ultimately though, by avoiding a real discussion and education detailing calories, the currency of weight, all they're doing is putting out the eat healthy diet. You know the one. The one where you simply try to eat healthier and exercise more. If that diet worked, we'd all be skinny.

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