Well another year's come and almost gone.
Hope you enjoyed reading the blog as much as I've enjoyed writing it.
Stay tuned in January when I've got a world exclusive on a story that is perhaps the most horrifying and irresponsible thing Health Canada's ever set out to do (and from me that's saying a lot!) - unless someone gets to it first. It may be a few weeks into January. It's a complicated story to tell properly and if Health Canada succeeds it won't only affect Canada but countries the world over.
I'm taking a blog-cation until January 4th and just in case you missed them the first time around, here's my favourite posts of each month of 2009.
The Lancet hates the UK's new obesity initiative.
Read how two little French towns are curing childhood obesity.
Why isn't Canada banning canned soft drinks?
Irony Alert: Kellogg's named one of the world's most ethical companies.
Health Canada set to fortify junk food.
Thoughtful elementary students ignored in quest for healthier cafeteria food.
PETA - Eating animals OUT, objectifying women IN.
Watch Maple Leaf Foods VP joke about the worst listeria outbreak in Canadian history.
Hypocrisy and the Heart and Stroke Foundation's kids report.
Silence and blind faith cripple hope for Canadian nutritional reform.
Of course there is such a thing as a bad food.
Ontario residents to wait even longer for bariatric surgery.
Thursday, December 24, 2009
Posted by Yoni Freedhoff at 5:30 AM
Wednesday, December 23, 2009
For many who battle with weight, holidays can be times of stress and more often than not folks adopt one of two equally detrimental but diametrically opposite coping strategies - I'll call them the wrist slappers and the write-offers.
The wrist slappers are the folks who believe that long term success with their weight depends solely on "willpower", on being able to "resist temptation", to "just push away from the table", or to simply avoid placing themselves in situations where high calorie options are available. These folks fail in the long run because frankly who wants to live a life that restricts the use of food for pleasure? These are often the "hardcore" dieters that on an annual or semi-annual basis decide to "buckle down" and lose the weight and then inevitably when they get sick of suffering, gain it back.
The write-offerss are the folks who are concerned about their weight but figure because it's a holiday they needn't think about calories at all. They'll eat what they want, when they want and how much they want with their only consideration as to amount being pleasure. These are often folks who believe in "cheat days" and who regularly make excuses for why they needn't think about the foods they're consuming. Birthdays, office parties, religious holidays, vacations, highly stressful days become write-offs. Then the write-offs spill over to days that they've "blown it", weekends and busy times at work. They're often folks who practice scale avoidance when they're in a write-off period and they can gain 3-5 pounds a week during their days of abandon.
Instead of wrist-slaps and write-offs how about try thoughtfulness? What's that? That's where the only limits are imposed thoughtfully. You take stock of the situation, factor in the date or circumstance, have an inkling about calories, have eaten regularly throughout the day to make sure you're not fighting ghrelin's hunger demons and you ask yourself of whatever indulgence you're consider, "How much of that do I need to be happy?". Then you have that amount. If you want more after, ask the question again, "How much more of that do I need to be happy" and repeat until you're satisfied.
Life includes celebratory foods and certainly holidays may make the answer to the question, "How much of that do I need to be happy" a great deal higher than plain old boring days and that's a-ok.
Tuesday, December 22, 2009
Many months ago I wished I had my hands on T-Fal's Actifry deep fryer which promoted itself as being capable of "frying" 2.2lbs of French fries using a single tablespoon of oil.
Happily my generous parents answered my wish and bought me one for my birthday.
So, was it everything I'd hoped for?
There's zero doubt that it makes far, far tastier French fries than our homemade oven baked versions or storebought oven baked.
The fries are very crispy on the outside and soft like a fry should be on the inside, but they're not quite deep fried.
We've been using the Actifry more lately to make sweet potato fries as sweet potatoes are far healthier choices than regular potatoes.
Given the machine's design, it's not going to replace a person's deep fryer for many items other than French and stir fries, but my biggest beef with the Actifry? Cost. The thing's stupidly expensive. $299 for a heated, teflon-coated ceramic pan with a rotating arm? That price puts this item in the realm of gift only where the best gifts are those things you want but could never in a million years justify buying for yourself.
Have you been naughty or nice this year?
Monday, December 21, 2009
It's a rarity when an established product gets a useful makeover.
Today's usefully made over product? The scale.
Now I've posted a fair bit about scales over the years. I've talked about scale seduction, scale avoidance and how often you ought to be weighing yourself.
An overarching theme to all my thoughts and comments on scales has to do with the fact that how much you weigh isn't important, what's important is what you're doing about what you weigh. Similarly there are no ideal weights and you shouldn't strive to achieve a specific BMI. Instead you should strive to live the healthiest lives you can enjoy whatever your weight is living that life, well that's what I call your "best weight".
I've watched scales beat people up regularly. Someone's doing phenomenally well, has lost dozens of pounds and then they stand on a scale and it's not down enough, not down at all or slightly up and suddenly they forget about the fact they may be down dozens of pounds and the fact that they're living a healthier lifestyle and instead they focus on that 1 pound gain that suddenly has them feeling like they're failures. Similarly I've had people who just can't get past the actual number on the scale and regardless of how incredibly they're changing their lifestyles for the better, every time they see that number it defeats them.
Enter the Quantum Scale.
The Quantum Scale is a scale built for one and the premise is simple - it doesn't ever tell you your weight. Step on the scale for the first time and internally the scale registers your weight and saves it. Everytime you step on it thereafter it tells you how many pounds up or down you are from when you first stepped on the scale. I love it because it de-emphasizes the what you actually weigh aspect of the equation.
Now it's not perfect, and I've got a few recommendations for the company:
- I recommend they enable a feature that would limit the number of times per day or week that it's used. Stepping on a scale multiple times a day just proves that you're too tied to your scale. Having the option of the scale locking you out and allowing for either a single daily or a single weekly weigh-in would help combat scale addiction.
- I recommended they add a small flashing LED that similarly would go off after a pre-set time of not weighing oneself so as to combat scale avoidance.
- I recommended they increase the width and depth of the scale so as to make it easier for larger folks to stand on.
- I recommend they create a raised, angled or detached readout so that folks who may have difficulty seeing the number can mount it off to one side or have it high enough that they can see the numbers.
Right now the scale is good to up to 330lbs. Hopefully newer versions will have higher weight capacities as well.
Despite those features that I wish were present indeed in my mind this is a quantum leap forward in scale design.
If you want one of your very own you can buy them from their website for $89 and if you add in the code QSXMAS then at least for now you'll get yours for $66.75.
Saturday, December 19, 2009
Stories that managed to capture my minuscule attention span this week:
The New York Times Thomas Friedman on "Going Cheney" on Climate
Apocalypse When from the National Review Online discusses what they feel to be a much more real and pressing threat than global warming.
Do you have an hour to spare? If so you might find the Economist sponsored debate between Kelly Brownell Director of Yale's Rudd Centre and Big Food's Melanie Leach on whether or not governments should play a greater role in food and nutrition policy. (I voted "Yes")
Friday, December 18, 2009
For those of you who weren't aware, I'm a simple man.
Perhaps that's why I found Saturday Night Live and Alec Baldwin's "Schweaty" balls skit so amusing and why it's today's Funny Friday! If you don't like childlike humour, please don't watch it.
Have a great weekend!
(Email subscribers, hit the blog to watch the video)
[Hat tip to my apparently equally juvenile friend Brad]
Thursday, December 17, 2009
But Dr. Jennifer Kuk and Dr. Chris Arden from my undergraduate Alma mater York University in Toronto recently published a paper that looked at 6,011 adults and then subdivided them into those who were "metabolically normal" and obese and "metabolically abnormal" and obese and then followed those individuals' mortality rates over the course of 10 years.
Obesity doesn't generally occur in the absence of metabolic abnormalities (only about 6% of the obese folks fall into this slot), but when it does, it's still associated with the same increase in risk of all-cause mortality.
A little while ago I had the chance to interview Dr. Kuk about her study.
Click below to download the audio file, or you can listen on the embedded player (won't work with email subscribers) and hear Jen discuss her findings.
Click here to download this podcast or click here to subscribe in iTunes!
Kuk JL, & Ardern CI (2009). Are metabolically normal but obese individuals at lower risk for all-cause mortality? Diabetes care, 32 (12), 2297-9 PMID: 19729521
Wednesday, December 16, 2009
This just popped up on my eBay tracker and it was too stupid, I mean good, not to share.
A user aptly named "Bumglo" has put up an "Anti-obesity vaccine" called "Sculptural Metabolize" that apparently will help you "Loss weight".
This is a very special vaccine because unlike actual vaccines, the vial being sold is only a one month supply where you inject it into your own bum (not Bumglo's) twice a week for eight weeks.
Bumglo is reporting it's safe, with hundreds of thousands of successful treatments worldwide.
I guess doctors like me aren't actually selling it because it would certainly put us out of business.
Someone should open up a Wikipedia page for Bumglo. Oh, and while you're at it, give a shout out to the Nobel folks too.
Thank you Bumglo for curing obesity.
It's a phenomenon that baffles me.
Well versed, intelligent, thoughtful and well intentioned health and nutrition professionals who have latched onto a notion that must warm of the heart of Big Food executives the world over - that less bad is in fact good.
I see it constantly:
Front-of-package programs that throw their endorsements on "foods" like oven-baked French-fried and "enriched" Minute Rice (Heart and Stroke's Health Check, I'm looking at you) where the endorsements don't tell consumers the choices are less bad, they tell them they're good; school food advocates promoting chocolate milk and juice as good because they have a smattering of nutrients and as such are less bad than pop; vending machines that have stoplight guidance systems suggesting that baked chips are in fact good choices when at best they're just less bad than their fully fried friends.
Less bad is not good!
- A 4% tax hike, while less bad than a 10% tax hike is still a tax hike.
- A speeding ticket for going 15 over while less bad than a ticket for going 40 over is still a speeding ticket.
- A conviction for manslaughter, while less bad than a conviction for first degree murder, still means you're going to jail.
If we want to further nutrition reform in society we need to start calling things out for what they are.
There are bad foods. In fact there are probably more bad foods now than ever before and just because something's less bad it doesn't make it good. By not calling out bad foods for what they are we're putting society at a disadvantage and allowing food manufacturers to play on an uneven playing field.
Stopping playing by rules that don't make nutritional sense.
You should eat the smallest amount of bad foods that you need to be happy, and you shouldn't kid yourself, or worse yet anybody else, into thinking they're good.
Nutritional advocates who claim less bad is good belong in Bizzaro-world.
Bad is bad. Period. And that's ok.
Now everyone take a deep breath.
Tuesday, December 15, 2009
Long term readers of my blog may recall a post I wrote back in 2007 when I reviewed the first generation of the Wovel - the shovel on a wheel. That's me with that original Wovel at my old home and my old driveway (more on that later).
I loved the original Wovel but had some beefs.
Well sometimes writing a blog has perks as the President of the company that makes the Wovel happened on my post and he asked me if I would be willing to re-review his latest Wovel iteration (I believe it's a 3rd generation product).
I of course said sure.
Now Ottawa's been hit with a bit of snow. We had our first snowfall of the year totalling 20cm and then a second of 5cm a few days later.
I tried the SnoWovel out on both.
Even though I already thought the original Wovel was great this is a vastly improved product. It's lighter and so it's certainly easier to wield and for me anyhow, its improved adjustability allowed for an easier throw of the snow. Handles now come standard (that was one of my original complaints) and despite having a stupidly large driveway (really stupidly large - it's one of those ones that is both semicircular in front and rectangular on the side towards the garage), I managed with the 5cm snow to wovel it all in about 45 minutes - only 15 mins longer than it would have taken me to snowblow (and I've got a self-propelled 13hp monster) and I imagine at least 3 times as fast as I would have been able to shovel it.
Due to the design I wasn't out of breath, and I wasn't bending over and straining my back. The only muscles that hurt on me were my shoulders which after 45 minutes were definitely burning a bit.
I can't say the same about wovelling the heavy snow. Trying to wovel 20cm of snow was rough and from a gigantic driveway while certainly doable, would likely have taken me 2 hours and truly significant pain in my shoulders. I switched to the snowblower.
An added bonus regarding the new version is it's easily foldable which save space in the off season.
Now it's not a perfect product (no product is). Where I ran into trouble was where cars had hard packed the snow leading up to the garage. Trying to wheel over those spots the SnoWovel would get stuck. That said it didn't take much to get over them and even my snowblower doesn't generally dislodge that tight packing. In fact on the parts of the driveway that didn't have hard packed snow the SnoWovel managed to get right down to the surface whereas the snowblower tended to leave a tiny layer of snow.
Bottom line for me? For light snow under 10cm I plan to use the SnoWovel season long. For heavier snows, I'll stick to the snowblower, of course that's primarily because of just how stupidly large my driveway is. If it were smaller there'd be no reason whatsoever to hire a service or buy a snowblower - it'd be all SnoWovel all the time heavy snow and all.
An already fabulous product made markedly better - what's not to love?
$119.95 on Amazon.com and also available in Canada at the Home Depot (though I couldn't find the Snowovel online, only accessories).
You can visit the SnoWovel's official website here.
Monday, December 14, 2009
Looking at the picture up above doesn't the juxtaposition of togas and mittens strike you as a tad odd? Perhaps even staged? Perhaps even staged on behalf of Coke?
Call me a curmudgeon or a conspiracist, but I can't help but be cynical about the 2010 Olympic Torch relay which like the relays of 8 of the past 10 Olympic games has been officially sponsored by Coca Cola (a brand apparently associated with the Olympics in one capacity or another since 1922).
Why does Coke sponsor the Olympics?
But wait, there are no Coca-Cola logos on the torch bearers' uniforms. No, but there are Coke logos everywhere else. And I know you'll probably think I'm crazy but I do question the red of the gloves. You might think the gloves are red because the Olympics are in Canada, but have a peek at the photo below and compare the red of the mittens to the red of the flag. The mittens of course are Coke Red.
Research on the use of colour in branding is pretty clear - as part of a comprehensive campaign it can play an integral role in,
"strengthen(ing) existing perceptions at a subconscious level, and its identification with the brand can be used to trigger an established image."But even putting minutia like glove colour aside, ask anybody who's gone to see the Torch swing by and they'll tell you the vehicles are Coke vehicles (check out the truck at 43s in the video below), the little flags the kids wave are Coke branded flags and Coke/Olympics branded products are everywhere.
So what image is Coke trying to cultivate by associating itself with the Olympics?
I can think of two. The first being what Coke likes to call, "healthy active living". To that end Coke selected a number of notable Canadians involved in active living to be official torchbearers. They included Dr. Mark Tremblay, the director of Healthy Active Living and Obesity Research (HALO) at the Children's Hospital of Eastern Ontario and the chief scientific officer at Active Healthy Kids Canada, Kelly Murumets, President & CEO, ParticipACTION, Elio Antunes, Chief Operating Officer, ParticipACTION, Pam Jolliffe, CEO of Boys and Girls Clubs of Canada and Harvey Anderson, Professor, Departments of Nutritional Sciences and Physiology, Faculty of Medicine, University of Toronto. Coke not surprisingly bragged about their active living torchbearer ambassadors in a press release as examples of Coke's dedication to,
"address obesity by encouraging active, healthy living through its products, programs and policies"So aside from their inclusion in an image involving healthy living and a comically ironic commitment to fight childhood obesity, it's the second image that I think is more important to them. I think Ottawa's own Dr. Mark Tremblay really hit the real branding nail on the head in his comments on what the torch means,
"It's something that touches very deep into the soul about the importance of good in the world and striving for your best — trying hard and believing in yourself — and all these good things you want to convey to your children and the people around you. I think it's all captured in that."Now what company wouldn't want to be subconsciously associated with that?
And just to be clear, I'm not sitting up on a high horse with a mouth full of sour grapes because I didn't get to carry the Torch and I'm not even saying that I'm certain I would have turned it down if offered. Coca-Cola or not, what an incredible experience it would be to carry the thing.
That said a small part of me wonders whether or not I'd have had the balls to go Sinead O'Connor on the Torch and during my relay pull out a photo of a can of Coca-Cola and rip it in half and yell, "Fight the real enemy"?
What a shame that the International Olympic Committee is either not wanting or not able to find a corporate Torch sponsor that isn't in fact the antithesis of the very things the games represent - active, healthy lifestyles.
Grimes, A., & Doole, I. (1998). Exploring the Relationships Between Colour and International Branding: A Cross Cultural Comparison of the UK and Taiwan Journal of Marketing Management, 14 (7), 799-817 DOI: 10.1362/026725798784867581
Saturday, December 12, 2009
Stories that managed to capture my minuscule attention span this week:
My friends over at Obesity Panacea chatting about the Lancet's thought piece on the reduction in cardiovascular deaths that one might expect with the adoption of different forms of transportation.
An absolutely fabulous video from the Symphony of Science project. Awesome!
Friday, December 11, 2009
So this is a semi-serious Funny Friday but for someone to use Beavis and Butthead in this manner made me grin.
So have a peek and learn a little bit about why Climategate's not much of a gate at all.
(Email subscribers you've got to visit the blog to watch)
Thursday, December 10, 2009
So the folks from Wild Planet were kind enough to send me a few of their kids games and the one that caught my fancy was Mouse-ke-TAG.
Unlike the Wii, Mouse-ke-TAG has kids running all over the house.
Very simple to play. There are 4 Disney characters with embedded RFID chips. Scatter these over a room or home and then set the kids loose with Mickey's Playhouse with embedded RFID reader. The Playhouse recognizes the characters when placed on top and tells the kids through clues which character to look for.
You can play different ways too. My kids (5 and 2.5) liked it best when they were on the timed mode and they had to run as fast as they could back and forth between characters.
They probably were running around for a good half hour.
Great game for a rainy day, snowy day or just an indoor day and supports up to 6 players.
Not sure how much fun it'd be for just one child to play but get a bunch together and this may well run them tired.
My only complaint? The characters fall of their bases too easily. I'd recommend gluing them down.
For ages 2 and up (the box says 3 but my 2.5 year old had no issues).
Wednesday, December 09, 2009
And we've got to find ways to get it more attention!
It's called "The Ryerson Declaration" and it stems from the 2009 Ryerson University workshop, Beyond Nutritionism: Rescuing Dietetics through Critical Dialogue and according to the Dietitians of Canada Practice Blog, the Ryerson workshop gave birth to a new focus in dietetics that attendees referred to as, "Critical Dietetics".
Unlike nutritionism, the aim of Critical Dietetics is to answer tough questions utilizing critical appraisal and an evidence based approach. Questions such as,
"What counts as “knowing” in dietetic practice? How do we, as nutrition professionals, come to know what we don’t know? How does the evidenced-based culture of dietetics give voice? Where does dietetic culture render silence? What is it that we have already accomplished as a profession? In what ways do we continue to evolve? How can we further build upon the rich roots of our profession? What do we envision for the future of our profession?"The Ryerson Declaration then is a manifesto of sorts calling for change whereby,
"It invites constructive dialogue and challenges us to discuss, debate, and rethink what we know and how we know it. It is a generative and collective effort which understands that strength comes from diversity and debate."It's this type of thinking that may see dietetics rise from the realm of belief based nutritionism to evidence based science and allow for debates with passion, but not anger, and end the current state of affairs where people take disagreements personally and emotionally rather than with thoughtful critical appraisal.
The post on the DC site is getting very little play. I know quite a few Canadian RDs read this blog - I hope you all take the time to pop over there read all about it and hopefully sign onto the declaration.
[Hat tip to blogging friend, Canadian RD and gastronomic explorer Vincci who linked to the declaration on her blog yesterday]
Tuesday, December 08, 2009
Sure looks that way for as of November 1st there are new hoops to jump through for physicians trying to access a bariatric surgical consult for their patients.
On the surface, surgical criteria couldn't be more straightforward:
A. BMI >35 and <40>Meet those criteria and theoretically you should be cleared for surgery. Problem is in Ontario we have far more demand than we have supply. Consequently last year Ontario funded 1,660 out of province bariatric surgeries, triple the number from 2006. The rapid increase is likely due to the fact that more and more physicians (and patients) are recognizing the utility of bariatric surgery; spreading word of mouth from those who've had success; and the publication of long term results that undeniably demonstrate increased longevity and decreased morbidity post-operatively. In other words, physicians and patients are recognizing bariatric surgery for what for many it is - a quantity of life prolonging and quality of life improving procedure. Consequently demand will only be going up.
- Coronary heart disease.
- Obstructive sleep apnea
- Medical refractory hypertension despite optimal medical management
B. BMI >40 for greater than 2 years
So how many Ontarians qualify for bariatric surgery?
Estimates put roughly 3% of Ontario's population as being appropriate bariatric surgical candidates - that'd be 345,000 people.
So what's our government doing about it?
On February 7th, 2007 the McGuinty liberals announced that they'd be increasing funding for Ontario based bariatric surgery and providing sufficient funding to support 225 additional annual bariatric surgeries at the Humber River Regional Hospital. That press release flaunted this statement,
"Today’s initiative is part of the McGuinty government’s plan for innovation in public health care, building a system that delivers on three priorities - keeping Ontarians healthy, reducing wait times and providing better access to doctors and nurses."On February 23rd, 2009 this initiative was expanded upon and it was announced that Ontario would be spending an additional $75 million dollars so that by 2011/2012 Ontario's bariatric surgical capacity will be 2,085 cases per year.
Why spend the money?
Firstly there's the estimate that for every procedure done in Ontario rather than out-of-country the Province will save $10,000. Secondly there's this statement from the backgrounder put out along with the announcement,
"Bariatric surgery can help resolve several health conditions, such as diabetes, hypertension and dyslipidemias. Dyslipidemias is a condition that can lead to atherosclerosis, the hardening of the artery walls, which can restrict blood flow to the heart. Bariatric surgery can also reduce other obesity-related conditions, such as hypertension (high blood pressure), osteoarthritis (a painful joint disease), ischemic heart disease, stroke and some cancers."Translation - it's a remarkably effective surgery that increases longevity and decreases co-morbidity (in fact eliminating most weight related co-morbidity).
So let's look at the initiative.
So far the Ministry has established a total of five regional assessment centres - locations where physicians are supposed to refer their patients if they're interested in bariatric surgery. The five are Humber River Regional Hospital in Scarborough, St. Joseph's Healthcare in Hamilton, Guelph's General Hospital, the Ottawa Hospital, and Windsor Regional Hospital. Once referred it's up to those centres to determine need. According to Ministry sources I spoke with, more are planned.
But wait a second, do we really need to have our patients seen by another physician to determine eligibility and won't that also markedly hamstring folks who don't happen to live in one of the cities with designated centres? Aren't the surgical criteria extremely straightforward? Shouldn't a minimum of 6 years of medical education equip physicians with the ability to determine suitability?
Personally I think so, and certainly doctors as a general rule are great at following flowcharts but given the added costs here, I readily agree that there should be a step to ensure that indeed the patients are suitable. Before the establishment of these centres there was a committee that reviewed applications and turnaround was in the neighbourhood of 4 weeks to approval. If the patient didn't meet criteria then the committee either rejected the application or requested further information from the referring physician.
Speaking to folks working with the committee they were getting swamped (not just with requests for bariatric surgery but also other out-of-country needs) and clearly something needed to change.
But is there really a need for a committee? Couldn't the Ministry with some of that $75 million create an online application, accessible by physicians, that in turn screens itself and would automatically eliminate those folks who weren't clear cut surgical candidates based off pre-determined and pre-programmed criteria, and in those cases where outright rejected or where other factors may necessitate further assessment - age, psychiatric history, etc., perhaps those could be the folks who should be assessed at a regional assessment centre?
Alright, so how are these centres working at reducing wait times like the press release suggested? Well, just 1 month ago when we didn't have these centres the wait would have been a maximum of 4 weeks to approval for a surgical consultation, what about now?
Our front-desk administrator Wendy called the assessment centres and here's what she found out:
Ottawa: They outright refused to provide us with any information. They refused to tell us the length of the waiting list or how many people were on it. Wendy was polite. She explained she was calling from a physician's office and she was told that their policy, regardless of who was calling, is not to divulge any information. They also told Wendy that if she were a patient on that list that it would be their policy not to tell her when they thought we might be seen.
Windsor: They didn't really know. They told Wendy that it would be a minimum of 1-3 months but when pressed they admitted that they really had no idea and that they had well over 100 consults that hadn't even been contacted for appointments yet.
Guelph: They were extremely helpful and pleasant. Wendy was told that if we had a patient to refer that the next available date would be May 10th (a 6 month wait).
St. Joseph's Health Centre: Over the course of the past week Wendy called 4 times and left 2 messages. No one ever called us back and we were never able to reach a human being.
Humber River Regional: Wendy left 2 messages and I also had one of their staff surgeons email them a request on our behalf and so far, no one has gotten back to us. UPDATE: They finally got back to us (almost 2 weeks later) and the wait is between 12 and 14 months.
Not exactly promising stuff.
So is there any way to get a patient to an out-of-country surgeon without the regional assessment unit? Yes. There's a criteria that the patient needs to be assessed by the unit OR needs to have failed a 3 month inter-disciplinary management of their obesity that specifically includes physicians and dietitians in patient care. That said, there are very few inter-disciplinary weight management programs in Ontario (mine being one of them, and off the top of my head I can only think of 4).
Now despite the fact that my patients will in fact still have timely access to out-of-country surgeries I am slightly uneasy with that requirement. Why? Well even though I'm incredibly proud of the services we provide in my offices, to date there has yet to be a medically managed program reproducible enough to serve as a "gold standard". What I mean is that medical weight management is a service that depends highly on the staff providing it and while good behavioural programs can indeed yield great outcomes, I feel that requiring a 3 month trial of such a program in the absence of a reproducible gold standard may be an unreasonable requirement which in some cases will just end up costing patients 3 months of time and some amount of money given that OHIP doesn't cover ancillary health care services like dietitians.
Given that the number of out-of-country bariatric surgery cases tripled since 2006 to 1,660 and with no reason to believe that the rise in demand won't continue to be extremely rapid, and given that the Ontario surgical centres established aren't yet at their 2011/2012 capacity I have no doubt that demand will continue to dramatically outstrip supply and consequently wait times will likely be far greater with this new system than when we physicians could access out-of-country bariatric surgery for our patients directly (rather than through the additional step of a regional assessment centre).
Having spoken to one person intricately involved in the establishment of these new rules I was given the impression that they viewed this surgery as comparable to a hip replacement, and just like hips, waits of 1-2 years to have the surgery are less than ideal but still completely acceptable. I disagreed. While living with a painful hip certainly impacts on quality of life, it doesn't impact on quantity. Living with severe obesity and its many co-morbidities certainly risks dying from weight-related complications prior to your surgical date and risks permanent damage as a consequence of disease processes and the physical effects of the weight itself.
At the end of the day I think this is all about money. At some point there was a high level discussion where somebody took a look at the ever increasing amount of money flowing South of the border and somebody said we've got to figure out a way to stop this flow. Given that we live in a nation of socialized medicine money's a very fair concern and even if each and every one of these surgeries in the long run saves the Province money by reducing long term health care costs for these patients and increasing their productivity and ability to work, if you don't have the money up front you can't make the investment.
I just wish the Ministry would have come out and said that it was wholly about money rather than suggest it was about wait lists and access to care since the waits are now much, much longer, and only likely to grow, and with the rare exceptions of folks like me with an inter-disciplinary program backing them up, access to care has become more difficult to obtain. Really, by not actually coming right out and saying it's about money the Province is far less likely to address money as a problem. and consequently it's less likely that people will be actively looking and advocating for novel solutions to increase Ontario based surgical availabilities such as the establishment of public-private partnerships (so called P3 hospitals) to build privately built and publicly funded baratric surgical hospitals and the public also won't see a great example of a massive crack in our publicly funded healthcare system and if you don't see cracks you tend not to look for ways to repair them.
I'm hoping this is just an example of growing pains and that my worries won't pan out but so far this new system, in its current state, effectively puts a cork in what was already a bottleneck.
Monday, December 07, 2009
Check this out - here a quote from a Health Check promotion,
"Health Check is trans fat free! All Health Check grocery products and restaurant menu items meet the trans fat levels recommended by a federal task force of health professionals, government and industry including the Heart and Stroke Foundation. The Health Check criteria are in line with the recommendations of the Trans Fat Task Force: trans fat in vegetable oils and soft margarines be no more than 2% of total fat and for all other foods that trans fats be limited to no more than 5% of total fat."Gee, and here I thought trans-fat free meant zero grams of trans fat.
You wanna know who managed to set a more stringent trans fat requirement?
Kentucky Fried Chicken where there's not an item on the menu that has more than 3% trans fat.
To put 5% into some context.
Most folks' diets range between 20 and 30% of total daily calories from fat which would represent roughly 60grams of fat.
Health Check would therefore allow a consumption of 2-3g daily of trans-fat and call itself trans-fat "free".
So does the Heart and Stroke Foundation know that 2-3g of trans-fat daily is bad for you?
I'd say so, check out these quotes from Heart and Stroke Foundation President Sally Brown,
"Trans fats are a "toxic" killer that need to be removed from the food chain as soon as possible"You know, while I realize that the removal of trans-fat can be challenging, given that Sally Brown's Heart and Stroke Foundation actually administers the Health Check program, what exactly is stopping them from creating nutritional criteria that are justifiably laudable? Why would they cater to Big Food to allow even 1%, let alone 5% trans-fat in Health Check approved products (excepting of course naturally occurring trans-fat)? And if they're so concerned with your health and well being, why is it I even have to ask?
National Post Jan. 11th, 2007
"We want this toxin - which is what it is - removed from our food supply"
CNews, Apr. 5th, 2007
"There is no safe amount of trans consumption."
The Windsor Star, Jun. 5, 2007
Saturday, December 05, 2009
Stories that managed to capture my minuscule attention span this week:
My friend and colleague Arya Sharma's take on that University's plan to force students with BMIs over 30 to take a healthy lifestyle course.
The National Posts' series pittinig naturopaths vs. skeptics continues in lieu of Bill 179's likely passage (the Bill allowing naturopaths to prescribe actual drugs). Here's a taste from the discussion around the study of naturopathy,
"A masters degree in unicorn breeding from an unaffiliated college does not mean that unicorns exist"For my Canadian and other cold weather iPhone equipped readers Instructables has a do-it-yourself post on how to make any pair of gloves touchscreen sensitive.
Friday, December 04, 2009
Thursday, December 03, 2009
You no longer have to tell your kids not to eat the Play-doh because now there's Yummy Dough!
Yes, Yummy Dough.
First you play with it, then you bake it, then you eat it!
Sure sounds "yummy". Grab "dough" with multiple grimy unwashed hands. Rub it and mold it into shapes on unwashed tables and floors (stray hairs equal free protein). Then eat!
[Of course homemade Play-doh has always been edible. Water, flour, cream of tartar, salt and food colouring. Guess if I had just been smart enough to add sugar, I'd be rich.]
Wednesday, December 02, 2009
Readers of my blog may remember a few weeks ago when I posted regarding a University of British Columbia professor who in a milk advertisement dramatically overinflated dairy’s role in treating high blood pressure even ignoring her own research's negative results in the process. I wondered whether or not it was her strong ties to the milk industry that influenced her decisions therein. There was a very interesting comment left that day by an anonymous medical student at the University of British Columbia. He or she reported,
"Dr. Barr gave us a lecture recently in medical school. She did NOT declare ANY affiliation with the dairy industry. At one point she told us that lactose intolerance is exaggerated and everyone should drink a cup of milk. The lactose intolerant people in our class were not impressed..."That made me wonder, should University professors disclose their potential conflicts of interest before lecturing students? I certainly don't remember any professors disclosing their ties to anyone during my medical school days at the University of Toronto yet it's an obligatory practice for those same professors to do so at conferences and in journal articles.
To me this seems like a dangerous double standard as one might argue that students are far more vulnerable than full fledged physicians and researchers in critically appraising data. Given the incredible power differential between professor and student and the intrinsic trust one places in the purveyors of their education I wondered about the ethics of such a lack of disclosure and so I contacted Dr. Chris MacDonald to chat about this further. Chris teaches Philosophy, including business ethics, at Saint Mary's University in Halifax, Canada, and is a non-resident Senior Fellow at Duke University's Kenan Institute for Ethics. He is a member of the Editorial Board of the Journal of Business Ethics and in 2008 he was named one of the "100 Most Influential People in Business Ethics" by Ethisphere Magazine. Chris is also the author of the Business Ethics Blog.
Click below to download the file, or you can listen on the embedded player (won't work with email subscribers) and hear Chris discuss his take on lecture based conflict of interest disclosure.
Click here to download this podcast or click here to subscribe in iTunes!
Tuesday, December 01, 2009
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 ORThat'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.
1 chicken breast or leg
1 hamburger patty
1 fish fillet
1 pork chop
1 to 2 eggs
½ cup (125 mL/75 g) canned tuna or salmon
6 large scallops or shrimp"
(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.