Wednesday, June 30, 2010

Apparently now clumsiness causes childhood obesity.


Only it's not called clumsiness, it's called, "developmental coordination disorder" (DCD) and it reportedly is found in 5-6% of school aged children and according to the authors of a study published this week in the Canadian Medical Association Journal, kids with DCD are at higher risk of overweight and obesity.

The study looked at 2083 children of whom 111 were deemed to suffer from DCD (excluding kids who had physical or mental illnesses).

At baseline the Grade 4 DCD kids were already behind the eight ball having 15% higher mean BMIs and 13% higher waist circumferences than their coordinated peers - a trend that grew through Grade 6.

While this study certainly does seem to draw a strong correlation between clumsiness and obesity these findings can't even remotely be construed as meaning DCD kids' lack of exercise is the cause of the increase in risk - especially given the authors didn't measure how much any of the kids were exercising. Of course that didn't stop the authors from making that stretch in their abstract's introductory statement,

"Children with developmental coordination disorder have been found to be less likely to participate in physical activities and therefore may be at increased risk of overweight and obesity."
A statement which when considering the study is meant to determine whether or not DCD is associated with increased obesity risk certainly lends literary (not evidentiary) credence to the notion it's due to these kids' decreased activity levels.

So what else might be going on with here? Off the top of my head here are 3 other potential clumsy weight related confounders:

1. Perhaps the DCD kids drown their uncoordinated sorrows in a few extra Big Gulps every week. While that may seem trite, if the theory is that these kids aren't playing organized or even playground sports certainly it's plausible that they might eat more during their extra free time and may as well be more likely to be comforting themselves with food.

2. Perhaps the DCD kids are kids who come from less nurturing or less privileged homes where their parents may not have had the time, inclination or funds to support things like dance lessons, soccer camps or simple let play together time leading to lesser motor developments. In turn those same homes may well have different dietary and social environments that could account for the differences found herein.

3. Perhaps as my friend and colleague Arya Sharma suggested in his blog yesterday, it's the overweight and obesity that causes DCD rather than the other way around.

And I'd argue that one of those options is far more likely to be causal than a lack of exercise as frankly the amount of exercise that would need to be accrued by age 10 to account for such a significant difference in body weight would be truly phenomenal especially given the fact that other studies have found that even a ten fold difference in childhood exercise didn't impact on body weight.

Ultimately this is an interesting study with interesting results, I just wish it wasn't painted with the all too common exercise is the cure-all and cause-all for childhood obesity brush as I think it's much more likely that obesity leads to clumsiness rather than the other way around and likelier still that there's something else in the mix that's not being accounted for here.

Hopefully the next round of studies on these kids will either help elucidate a more plausible mechanism for the association or prove me dead wrong in that indeed it's all about exercise - either way, I'll be sure to blog about it.

Cairney, J., Hay, J., Veldhuizen, S., Missiuna, C., Mahlberg, N., & Faught, B. (2010). Trajectories of relative weight and waist circumference among children with and without developmental coordination disorder Canadian Medical Association Journal DOI: 10.1503/cmaj.091454

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Tuesday, June 29, 2010

A glimmer of hope for childhood obesity prevention!


Good gravy!

In an early release from the New England Journal of Medicine, researchers documented the effects of a 3 year, 21 school, 4,600 student, multi-pronged, intervention that spanned Grades 6 through 8 covering nutrition, physical activity, behavioural knowledge, communications and social marketing on the children's body mass indices, waist circumferences, fasting glucoses and fasting insulins.

The nutritional component targeted quantity, quality and energy of foods. The physical activity component was meant to increase baseline physical activity and to teach the energy components therein. The behavioural component targeted goal setting and self monitoring while the communication and social marketing component integrated it all.

Results wise - they were a bit odd but truly heartening nonetheless.

First the odd. Apparently not only did the 21 intervention schools demonstrate a reduction in the prevalence of overweight and obesity over the study's time span strangely so too did the controls.

Next the hopeful. There was a very nearly significant reduction in obesity in the intervention schools with kids there being 19% less likely to be obese at the end of the study than the beginning (p=0.05). There was also a statistically significant decrease in the percentage of intervention kids who ended up in the >90th percentile for BMI and waist circumference though the differences were relatively small. Interestingly, the intervention seemed to have a more dramatic impact on those who were overweight or obese to begin with at the study's start.

Now the important. While sugar wise there were no differences in fasting glucose between control and intervention schools, by Grade 8, the intervention schools' kids had better fasting insulins which if sustained, might in fact decrease their likelihoods of developing type 2 diabetes down the road.

But the most heartening piece has to be the fact that although the differences themselves were small, the study did indeed demonstrate that a multi-dimensional intervention grounded in energy balance, with explicit, appropriate and careful teaching about calories in and out, over just a 3 year period, in just a single venue, can in fact impact on the severity of obesity, its progression and its potential co-morbidities.

To me what this study really demonstrates is that in the race to build a levee for the flood waters of childhood obesity, while it may be of some benefit to target older kids in schools, ultimately to have a real impact we'll need to help affect a more dramatic environmental overhaul as has been done with the Epode study in France, yet here we have an example of an effective school based sandbag to help tame the flood.

But don't get too excited yet for as Yale's Dr. David Katz has mentioned, "To contain a flood no single sandbag will do" and while schools certainly are an important sandbag they need to be complemented multi-sectorially with interventions being initiated at much younger ages across entire communities and run indefinitely.

The part that had me almost jumping for joy? The fact that there are folks out there who have successfully and explicitly taught the unfortunately and strangely taboo subject of caloric balance to children - a subject ignored by the vast majority of weight-related public health interventions despite the fact that understanding caloric balance is undoubtedly the single most important cornerstone to navigating our modern obesogenic environment.

[For those interested the intervention materials themselves are extensive and are available online at the Healthy Study website.]

The Healthy Study Group (2010). A School-Based Intervention for Diabetes Risk Reduction New England Journal of Medicine DOI: 10.1056/NEJMoa1001933

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Monday, June 28, 2010

Hitting the gym harder for a decade won't do a thing for your weight.


I would have had the headline read, "Exercising exercise's confirmation bias" but figured that wouldn't be as grabby.

From the only publishable because the world has such a huge crush on exercise impacting on weight file comes the, Effect of change in physical activity on body fatness over a 10-y period in the Doetinchem Cohort Study published ahead of print in the American Journal of Clinical Nutrition.

The study is just one of many in a long string of studies that fail to show any dramatic benefit on weight from long term exercise.

This one?

The authors followed the 4,944 adult participants of something called the Doetinchem Study and they tracked weight and waist circumference change as a function of physical activity - both at baseline and if physical activity increased or decreased over a 10 year period.

Amazingly this thing got published. I say "amazingly" not because it was a particularly bad study and not because the results weren't particularly impressive, but rather because the conclusions drawn by the authors stand in stark contrast with their results.

Once again with this paper the authors themselves did all the heavy lifting on why exercise isn't the be-all (or perhaps even the be-any) of weight. Here are their comments:

"Random mixed-effects models showed that a single measurement of physical activity was not clearly related to change in body weight and WC over a 5-y period."
Translation? In their analysis of the data, how much you exercised at the start of this study didn't impact on your likelihood of overweight or obesity, or your waist size 5 years down the line.
"Analyses of repeated measures showed that compared with those who maintained their activity level, those who increased their physical activity over a 5-y period had less gain in WC and possibly in body weight. Most importantly, these effects were sustained (although not statistically significant) in the consecutive 5 y for WC and for body weight."
Translation? People who upped their exercise from baseline had their waist circumferences grow less (though they still grew) than those who didn't, but they weren't significantly lighter. Also, while this lesser gain in waist circumference was found to be significant over the course of the first 5 year period study, it wasn't found to be significant over 10.

Statistical significance or insignificance aside, what type of spectacular results are we talking about? The folks who reported a marked increase in exercise over a decade found themselves a whole 1.2lbs lighter ten years later than the folks who didn't and had waist circumferences half a centimetre (roughly a fifth of an inch) smaller.

Huzzah?

This of course leads me to conclude that this study is in fact consistent with the bulk of the evidence which suggests that in the absence of dietary interventions exercise does not dramatically impact on weight over time. It also leads me once again to beg researchers to stop focusing on weight as an exercise study's primary endpoint and instead focus on those things more likely to demonstrate the incredible benefits of exercise - things such as high blood pressure, cholesterol levels, arthritis, cardiovascular fitness and overall quality of life. Oh, and also beg authors that when using weight as an exercise study's endpoint, to draw conclusions that don't fuel the fire of the fallacy of exercise being a primary driver of weight just because that's what people want to hear.

What did it lead these authors to conclude?
"An increase in physical activity was associated with a statistically significant lower gain in body weight and in WC, which was maintained during the following 5 years. These findings support the need for public health programs that promote physical activity."
Yeah, that's what these statistically insignificant and basically inconsequential results support. We should fund public health programs designed to help with weight by promoting increases in physical activity so that in a decade people will gain 1.2 fewer pounds and have 0.5cm smaller waists. That sounds like a great way to spend limited resources.

Good grief.

Again I've got to ask, what the frak is up with the peer reviewers for the American Journal of Clinical Nutrition?

May, A., Bueno-de-Mesquita, H., Boshuizen, H., Spijkerman, A., Peeters, P., & Verschuren, W. (2010). Effect of change in physical activity on body fatness over a 10-y period in the Doetinchem Cohort Study American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2010.29404

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Saturday, June 26, 2010

Saturday Stories


Commercial Free Childhood takes on some irony and Toy Story 3.

Harriet Hall describes her recent experience in dissing what apparently was a sacred quacker-cow.

Pharmalot pauses over the low down on male andropause.

Skeptic North's Erik Davis on how you just can't trust common sense.

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Friday, June 25, 2010

Best soccer goal ever!

At least that's what I think the commentator who was calling it would say.

Doesn't matter what language you speak, today's video speaks the language of Funny Fridays!

Have a great weekend.



[Hat tip to my friend and sensei Claudio]

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Thursday, June 24, 2010

I call "Bullshit" on Penn and Teller


Thanks to Ottawa Skeptics founder and Reality Check podcast host Jonathan Abrams for passing on a link to Penn and Teller's recent Bullshit! episode on fast food.

Up front I'll tell you I've been a big Bullshit! fan and for those who aren't familiar basically it's a show where mouthy magicians Penn and Teller question the facts behind commonly held beliefs, institutions and ideals.

For the vast majority of the topics they cover, I really don't have an expert opinion and generally I've tended to agreed with Penn and Teller's take on just how backwards some people think about a certain subject matter.

They're also magicians and when I've seen them perform their tricks, I've been wowed.

That said, I wonder if I'd have been just as wowed were I a magician and was able to see through their misdirection and sleight of hand.

With regards to their Bullshit! episode on fast food, given that I do know a fair bit about fast food, obesity and nutritional advocacy, I can tell you it sure wasn't tough to see through their misdirection and sleight of tongue.

The episode (and you can watch it below and draw your own opinions) hinges on some simple premises:

1. Opponents of fast food want it regulated out of existence.
2. Opponents of fast food believe that eating it makes you fat.
3. Opponents of fast food think those who eat it are inherently lazy or otherwise flawed.
4. Opponents of fast food think there's a conspiracy among fast food purveyors to create addictive foodstuff.
5. Opponents of fast food want the government to control everything we eat.
6. Proponents of fast food are hard working mothers and fathers who rely on it to serve healthy meals on the quick to their families.

I'll get to those points in a moment but first let me talk about who they decided to interview to champion the anti fast food cause. Her name is MeMe Roth and she's certainly the lunatic fringe of anti-obesity activism. I've blogged about her loathsomeness in the past and not surprisingly she's got some pretty loony things to say (go figure - when you interview someone from the lunatic fringe you'll get some pretty wild statements). Choosing MeMe to represent the anti-fast food argument would be like choosing Pat Robertson to represent modern Christianity or Osama Bin Laden to represents the tenets of 21st century Islam.

With regards to the show's main arguments, plainly put they're asinine.

Healthy eating advocates don't believe that eating fast food magically causes weight gain - they know that caloric imbalance does, and that restaurants fast and slow alike, are a huge contributor to that imbalance. They know that over the course of the past 30 years people have stopped cooking, and more and more dollars are being spent on food purchased outside of the home, foods with boatloads of calories, cups of salt and buckets of sugar - things that aren't good for our health.

Healthy eating advocates don't believe in banning fast or slow food, they believe in empowering people with enough information to make healthier and more educated choices in all restaurants and about protecting our most vulnerable and most precious resource - our kids from predatory marketing practices.

Being a healthy eating advocate myself I can tell you what I want to see change:

- I want a level playing field where people are provided with calorie counts at point of purchase in clearly visible locations so as to help those people make informed caloric decisions.

- I want to end the predatory practice of targeting children too young to discern truth from advertising with spots that extol the virtues of nutritional garbage or cartoon characters that beckon from the grocery aisle.

- I want taxes in place that discourage the consumption of products that are exceedingly unhealthy (and here I can't fault Penn and Teller, but since their show aired there's proof out of Harvard that sugar-sweetened taxes do indeed work to reduce soda consumption) which in turn impacts on the bottom line of Canada's health care expenditures, GDP and my taxes. And it's not as if there isn't precedent here. Regulating unnecessary risk is certainly part of the purvey of government, especially a government in a country with socialized medicine. From tobacco taxes, to seat-belt and helmet laws, to licensing requirements etc., governments do it all the time.

- I want changes in fast food zoning around schools as studies have shown disproportionate placement of fast food locations within walking distance of them.

The one argument I agreed with in this episode was the fact that governments are considering creating soda taxes while simultaneously subsidizing the production of corn. That is a ridiculous dichotomy as the artificially low prices of corn (and consequently high fructose corn syrup) are one of the primary drivers of cheap calories.

The biggest bullshit in this episode? For me it had to be the skinny active family who were talking about how much time they save with fast food. How long does it take to make oatmeal or some eggs for breakfast? How long would it take to do a quick stirfry or make some sandwiches for supper? And $20 to feed a family of 4 for a single meal? I can feed my family of 5 healthily on less than half of that.

Penn and Teller sum up this episode by letting the skinny mom who feeds her kids a diet heavy in fast food state,

"It's up to everyone to choose what they want to eat"
And she's absolutely right and only truly loony folks like MeMe would argue otherwise. What I want, and what most healthy eating advocates want, is an environment that doesn't stack the deck in favour of selling fast food but rather stacks it in favour of informed, healthier choices.

Watching this episode and knowing a great deal about the subject matter certainly has me questioning Bullshit! as a whole. If this is how they report on fast food, who's to say that they don't grossly mischaracterize other arguments in other episodes?

If Penn and Teller really want to do a good Bullshit! episode let's see them take on the notion that it's faster or cheaper or just as healthy to buy fast food for your family than actually taking the time to cook. To that, and to pretty much this whole episode, I call bullshit.

Want to judge for yourself, here's the episode as posted on YouTube (until it gets yanked by Bravo):







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Wednesday, June 23, 2010

Kids would rather eat rocks covered with stickers than a fresh banana.

There has been a great deal of noise this week regarding cartoon characters and children's preferences, much of it stemming from a recently released study in Pediatrics that proved something every parent already knew - kids prefer foods branded with cartoon characters.

Something else parents already know - kids also prefer Happy Meals sold with toys which is explicitly why the Center for Science in the Public Interest announced yesterday their intention to sue McDonald's if they don't stop packaging toys with their Happy Meals,

"McDonald’s practices are predatory and wrong. They are also illegal, because marketing to kids under eight is inherently deceptive, because young kids are not developmentally advanced enough to understand the persuasive intent of marketing; and unfair to parents, because marketing to children undermines parental authority and interferes with their ability to raise healthy children."
While certainly not a statistically significant study, my favourite proof of this phenomenon came from the television program Dateline in 2006 where in the clip below you can watch kids tell their interviewer that they'd rather their parents place a rock with stickers into their lunchbox than an unfestooned banana.

(Clip's been finicky - if it doesn't work, head over here)



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Tuesday, June 22, 2010

Is your diet deficient in micronutrients?


That's what the findings of a recent paper that concluded 4 popular diets were deficient in micronutrients would state.

The paper in question took a look at micronutrient intakes if a person were to follow Atkins, South Beach, DASH or the Best Life diets, and from the very first sentence I knew it was going to be a tough read,

"Research has shown micronutrient deficiency to be scientifically linked to a higher risk of overweight/obesity and other dangerous and debilitating diseases"
Oh really? I guess it's a zinc deficiency that's leading people to consume more calories than ever before.

This read became doubly painful as I had to then read the reference that he was using to support his assertion that micronutrient deficiency and obesity are causally linked,
"Micronutrient deficiency has been shown to cause an 80.8% increase in the likelihood of becoming overweight or obese"
It was a study published in the journal Economics and Human Biology entitled, Micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt and without spending too much time on that study which was also poorly designed, let me simply point out that data collected on a small sample of mothers in Egypt who were subdivided into the poor and the extremely poor, does not even if true, automatically extrapolate to the rest of the world except by authors stretching to find references to help make their papers seem more important.

Back to this paper, the author indeed demonstrates that following the aforementioned 4 diet plans people won't meet their micronutrient RDIs. What he didn't bother mentioning was that unless you're eating obesity inducing volumes of foods, regardless of what you're putting in your mouth, you're probably not going to meet your micronutrient RDIs and so really, if you're worried about micronutrients you should be on a basic multivitamin whether you're on a marquee diet or not. Instead the author makes this statement,
"The implications of this study are significant and far-reaching."

"Consequently, with global obesity being a very real and serious condition it should be of some concern to the millions of individuals worldwide, following one of this study’s four popular diet plans, or similar, using whole food alone, that based on the findings of this study, micronutrient deficiency is inevitable."
Scary sounding, but more nutritional fear mongering than truly concerning and an issue certainly not unique to dieters.

Ultimately this was a non-study. It was a completely expected result which the author spectacularized by inventing a causal link with obesity where there is none.

So imagine my non-surprise when I got to the end of the study and read this,
"JBC (the author) is the CEO of Calton Nutrition, a private corporation that researches the causation and prevalence of micronutrient deficiency worldwide. Due to the results of its research Calton Nutrition is in the process of developing a multivitamin"
Peer review, shmeer review.

(The most important (and not discussed) part of the study? If the author's calculations are correct the DASH diet, when followed, leads people to consume 2,200 calories - enough to cause weight gain for a woman with a healthy body weight.)

Calton, J. (2010). Prevalence of micronutrient deficiency in popular diet plans Journal of the International Society of Sports Nutrition, 7 (1) DOI: 10.1186/1550-2783-7-24

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Monday, June 21, 2010

Ferrero's worried you'll stop eating Nutella if you know what's in it.


I love this story.

The EU is en route to creating a front of package labeling program for processed foods.

The program will require fat, salt and sugar content to be clearly labeled on package fronts and has lead Paolo Fulci, VP of Ferrero, maker of Nutella, to note that the EU approach carries, "risks" and that it could,

"influence even the habits and the most intimate aspects of one's personal sphere, like the genuine and healthy pleasures that are passed among generations"
Which of course serves as a great quote to help explain the point of nutritional labeling reform.

So what's scaring Paolo Fulci?

I'm guessing that he thinks that if people actually knew that each and every tablespoon of Nutella contains an astonishing 4 teaspoons of sugar (in Europe Nutella has more sugar than here in Canada where each tablespoon has 3 teaspoons of sugar) it just might influence how much Nutella they consume.

The most amazing part of the story?

Apparently an Italian government official founded a support group specifically for Nutella. He's called it "Hands off Nutella" and together he and the group are accusing the EU of "nutritional fundamentalism".

How dare we nutritional fundamentalists suggest people have the right to know what they're eating.

We're madmen!

[BTW - judging by the incredulous emails, people seem very confused that there can be 4 teaspoons of sugar in a tablespoon of Nutella. What people are forgetting is that the volume of sugar in a solid will be much, much less once dissolved.]

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Saturday, June 19, 2010

Saturday Stories


Harvard Business Review on why the author returned his iPad.

The Ottawa Citizen's John Robson on the rampant anti-semitism among Canada's political left.

Ethicist Chris MacDonald has started a new food ethics blog - here's his brief take on how intensive agriculture may in fact be environmentally sound.

Obesity Panacea's Peter Janiszewski get a reality check while travelling in Peru. We really do have it easy here in North America.

The New York Times calls out the Big Food funded Center for Consumer Freedom's Richard Berman as a for-profit advocate.

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Friday, June 18, 2010

The world's dumbest cat?

Thanks to loyal blog reader Kim for sending this one my way.

Today's Funny Friday may well be the world's dumbest cat.

Have a great weekend!


Dumb Cat Can't Figure Out How To Drink - Watch more Funny Videos

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Thursday, June 17, 2010

2010 American Dietary Guidelines vs. 2007 Canada's Food Guide


Two days ago the 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans was released previewing the changes set to come for the official American dietary guidelines.

Given it's only 3 years post the release of Canada's Food Guide, one might imagine that the recommendations ought to be pretty similar as not too much has changed in the evidence-based nutrition landscape.

Of course that assumes that the 2007 Food Guide is evidence-based (a bad assumption).

A quick peek at the Executive Summary of the Report reveals their calls to action. Let's take a peek at them and see if they're reflected in Canada's 2007 Food Guide:

1. Reduce the incidence and prevalence of overweight and obesity of the US population by reducing overall calorie intake.

Canada's Food Guide? Provides zero guidance in helping Canadians reduce caloric intake.

2. Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds.

Canada's Food Guide? Puts zero emphasis on legumes, nuts or seeds and happily recommends that half of our grain be refined.

3. Increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

Canada's Food Guide?
Does recommend we increase the amount of seafood we consume but puts no limits or cautions on meat consumption. Includes whole milk, pudding and chocolate milk in their online guidance meant to steer Canadians to appropriate dietary choices.

4. Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium.

Canada's Food Guide? Has a blanket recommendation to reduce sugary foods and fats but provides very little guidance on salt and as mentioned, recommends half the grains we consume be refined.

The report also emphatically states,

"The obesity epidemic is the "single greatest threat to public health in this century"
And yet Canada's Food Guide is in and of itself obesogenic (my prior posts on this matter here, here and here).

Now of course these are just the recommendations of the advisory committee and it remains to be seen how these calls to action are actually incorporated into the final guidelines but one thing's for certain, Canada's Food Guide does not reflect our current understanding of the impact of nutrition on chronic disease and for those in the nutritional know, it is a national embarrassment.

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Wednesday, June 16, 2010

The two questions to ask before you indulge.


Food is both a comfort and a pleasure and to live a life that denies the ability to use food for those means is called a diet and it's something that ultimately you're likely to quit.

Dietary indulgences are a luxurious part of life and given we're all effectively the best hunters this planet has ever seen, they're easily obtainable and we can "catch" them anywhere.

While of course there's no such thing as the eat whatever you want, whenever you want, as much as you want weight management plan, blindly cutting out the less healthy (but often yummy) stuff may well over time lead you to abandon your entire weight management strategy.

So the next time you're considering an indulgence rather than blindly saying, "I'm not allowed", or, "Whatever, tonight's a write-off", here are the two questions you might try to ask yourself:

1. Is it worth the calories?

To answer the question certainly knowing the calories is important. The fact is, some indulgences simply aren't worth their calories and asking the question you'll eliminate a fair percentage.

2. How much of it do I need to be happy?

By asking this question you're avoiding the "write-off" situation where you throw caution to the wind, pay no attention, eat as much as your body wants, and then wind up feeling guilty about the amount you consumed.

A followup to this question is that if you've finished the amount you thought you needed to be happy and you're still not, simply ask the question again and again until such time as you're content.

Remember, there are many variables that go into these decisions and some days are worth more calories than others - birthdays, holidays, vacations to name just a few, so the answers to these questions vary day by day.

Ultimately life includes indulgences, and rather than try to blindly restrict them why not work on their thoughtful reduction.

Choose with your brain, not with your body.

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Tuesday, June 15, 2010

Badvertising: Nestlé's Boost "Nutritious Energy" (2.5x the nutritious energy of Coca Cola)


First let me thank Nestlé Nutrition for sponsoring the Canadian Obesity Network's Student Meeting (and therefore for sponsoring my talk).

Now that the thank you is out of the way let me ask Nestlé Nutrition what they were smoking when they labelled their Boost beverage with the words, "Nutritious Energy".

I came across the bottles in a big bowl at the conference and intrigued by vague and meaningless "Nutritious Energy" billing, I had a peek at the nutrition facts panel.

The first three nutritious ingredients?

1. Water
2. Sugar
3. Corn syrup (Sugar)

The number of teaspoons of sugar per 237ml bottle?

10.25!

The calories?

240

Percentage of calories from sugar?

68%

How does it compare to Coca Cola?

2.5x the calories and 1.5x the sugar.

So if you think throwing a bit of fat, protein and some vitamins into a Coca Cola along with an extra 3.5 teaspoons of sugar would make it, "nutritious", than by all means drink Boost, but be prepared for it to potentially not taste so good - as one fellow conference goer said when I mentioned I was going to blog about it,

"And it tastes like chalky shit. Can't leave that out."


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Monday, June 14, 2010

Adventures of a loudmouth (why I do what I do)


This past Friday I was given the honour of delivering a keynote dinner talk at the 2010 Canadian Obesity Network's Student Meeting.

The meeting brought together the future of Canadian obesity research and the bright eyed enthusiasm there was a joy to see.

Unlike much of my blogging, the talk I gave wasn't particularly inflammatory. I called it, "Adventures of a Loudmouth" and by means of examples from my life I encouraged the students to be vocal advocates for those things they believe in.

Ultimately that's what drives me to write this blog.

Some folks have said I write it to encourage patients to come to my office, but in the 5 years I've been blogging, and of the thousands of folks I've met in my office, I can only remember one who said the blog brought them there.

Other folks have said that I write it to be "popular"or for "fame", yet I have zero doubt that my writing this blog has closed more doors to me than it's opened.

The answer's much simpler. I write it because I believe that it's incredibly important to speak up about those things that matter to you. I write it because I believe it's one of my responsibilities as a physician to advocate for better health. I write it because I believe that shining a spotlight on programs, policies and attitudes that either willfully or inadvertently make it more difficult for consumers to make healthier choices for their families is something that I must do given that many of those who might want to speak up, are silenced by their institutional and professional ties which preclude them from biting the hands that feed them.

Ultimately I write it because I love to, and just as I did during the early days of the blog, I'd write it even if virtually nobody read it.

After the talk was over Diane Finegood asked me a very fair and relevant question. She asked me if I ever consider the unintended consequences of my blogging.

The answer's yes.

I don't doubt my blog has hurt some good people, and I'm genuinely sorry about that. I don't doubt that from time to time some of my posts have been over the top and more angry or personal than they needed to be and I'm sorry about that too. But what I can't be sorry for is speaking up about what I believe in and it's something you shouldn't ever be sorry for either.

To save you the time of watching the talk, the recipe for leveraging your PhD or MD into loudmouth advocacy is:

1 short set of initials that help lend credibility and open doors
1 small soapbox
1 tsp soundbites
100s of tablespoons of broken records
1 large swimming pool full of luck

Of course if you're just planning on cooking advocacy at home the recipe's much shorter:

Live the life you want your family to live, and relish every minute of it.

[If you are interested in watching me speak, I've uploaded my talk to Vimeo (unlike Youtube, Vimeo doesn't impose a ridiculous 10 minute maximum on their clips) and embedded it below. It might not be me at my fieriest or my most eloquent but it's certainly me being sincere and speaking from the heart.]

(Kudos to Angela and Zach for organizing such a great conference and thanks for letting me be a part of it)

Adventures of a Loudmouth: Leveraging your initials into advocacy from Yoni Freedhoff on Vimeo.



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Saturday, June 12, 2010

Saturday Stories


Sorry, very slow week for me reading wise.

The Washington Post details how small changes can make huge differences in school cafeterias.

Video wise, here's a stunner of a world champion free diver "base jumping" under water:



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Friday, June 11, 2010

When BP spills a cup of coffee

Funny but also oh so sad at the same time.

Have a great weekend!

(email subscribers - hit the blog to watch)



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Thursday, June 10, 2010

Dairy prevents heart attacks?


A sarcastic thank you to Scott Gavura from Science Based Medicine and Science Based Pharmacy whose tweet lead me to suffer through reading the latest in a never ending stream of Big Milk sponsored published info-studies.

This one?

Funded by Big Milk with a first author who has had speaking gigs with the Swedish Dairy Association and the International Dairy Federation this study has been reported as being proof that dairy consumption reduces the risk of heart attacks.

The study?

The authors, via a prospective case-control study, looked at blood levels of dairy biomarkers vs. heart attacks in 444 men and women and 556 controls over a 12 year period.

The findings?

Well according to Reuters,

"The researchers found that people with the highest levels of milk fat biomarkers, suggesting they consumed the most dairy fat, were actually at lower risk of heart attack; for women, the risk was reduced by 26 percent, while for men risk was 9 percent lower."
But of course that's before the authors controlled for confounders.

What confounders might there be?

Well surely diet's a huge one, right? Sure they're measuring dairy biomarkers but there are umpteen other dietary confounders that impact on heart attack risk - processed meats, whole grains, sodium, etc.

Well guess what?

Not only was the statistical control for diet ridiculously weak (they only controlled for reported intake of fruits and vegetables), it was incomplete as the authors admitted that dietary information was absent for at least 19% of the participants where they didn't fill out dietary surveys at all and that there was also a percentage of participants where their dietary surveys were excluded because they weren't scanned in and another group where their surveys were excluded because they were incomplete.

But rather than pick apart the study myself I'll simply let the authors shout out the value of their own research with direct quotes from their paper,
"It was not possible to delineate the exact mechanism behind the relations or exclude a more beneficial lifestyle pattern in milk fat consumers."

"The significant trends for both men and women were, however, lost after multivariable adjustment"

"Intakes of total milk products and 15:0+17:0 were not related to a first MI in this study"
So to summarize?

After doing a terrible job of controlling for confounders utilizing an underwhelming design with likely at least 25% of subjects not having dietary records, there was no statistically significant trend to report between dairy biomarkers and risk of heart attacks and yet Reuters and hundreds of other media outlets reported the findings as proof of magic dairy goodness and the American Journal of Clinical Nutrition happily published the non-findings.

Is there any wonder why Big Milk funds these studies?

(and a side question, how do these studies make it through peer review?)

Warensjo, E., Jansson, J., Cederholm, T., Boman, K., Eliasson, M., Hallmans, G., Johansson, I., & Sjogren, P. (2010). Biomarkers of milk fat and the risk of myocardial infarction in men and women: a prospective, matched case-control study American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2009.29054

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Wednesday, June 09, 2010

Mmmm, chip flavoured edible paper frankenfood.


Slim chips!

Zero-calories because they're indigestible hardened pieces of flavoured, coloured paper!

Delicious!

[Via Consumerist]

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Tuesday, June 08, 2010

How schools can fundraise without junk food.


Yesterday my local paper published an article detailing the woes of school administrators who are facing a future without the ability to peddle junk food to their students.

Featured in the story is a Mr. Neal Hill. He's the school council chairman of Hopewell Public School which happily sells its children pizza one week and then subs the next. His quote regarding the pending policy shift that would preclude such sales?

"It’s a completely laudable policy with a completely ludicrous execution"
Ludicrous execution? Either something's allowed, or it's not. Here the government is suggesting that fundraising for schools at the expense of our children's health is something that's not allowed - just as I imagine it would not be allowed for schools to fundraise selling other unhealthy options such as cigarettes or drugs despite both being big money makers.

What I think is truly ludicrous is someone who is interested in the health and well being of children bemoaning losing the ability to routinely sell them products (and brand loyalties) that are unequivocally unhealthy.

According to the article Neal is miserable about losing the $22,000 his school raises annually from junk food sales.

$22,000 is all it costs to convince schools to peddle garbage to their children?

That's not ludicrous, that's pathetic - and it gets worse.

According to Holy Cross School's Maureen Godin they sell out to the tune of only $5,000 a year

Now maybe I'm fooling myself, but I really can't see it being all that difficult to raise $5,000 or even $22,000 annually from non-junk food means in schools that likely have hundreds of students.

Off the top of my head here are 3 non-junk food fundraising ideas that together and well executed I imagine would easily raise $22,000:

1. Grandparent days:

Once a year hold a special day for grandparents where grandparents are encouraged to come to the school, attend a special production of some sort (and charge for it - $10/grandparent x 500 kids is a lot of money), be given a tour of the school (especially parts that could benefit from additional funding), and then get hit up for money. Grandparents, unlike parents of young children, might well have some disposable income as many will still be working, have a paid off mortgage and no kids left at home. They're also likely to be just as, if not more concerned than parents for their grandchildren's future given they have a past with which to contrast what they're seeing. My sister's kids' school in Washington DC does this with apparently impressive results.

2. Sell the stairs:

Where do kids go multiple times a day? Up and down the school's stairs. Want to raise some cash? Renovate the stairwells so kids spend more time there (lighting, paint, signage etc.) and then sell wall space for ads. While I'm not partial to ads directed at children as a whole, they're certainly a lesser evil than school sponsored junk food. So no food ads, but perhaps toy companies and sporting goods (Nike, Adidas, and sports store chains) for the younger kids , sporting goods, clothing manufacturers, car companies and summer job recruiters for the older ones.

3. Adopt a neighbourhood:

I can't take credit for this idea, I first heard it from Yale's Dr. David Katz. The idea's simple. Get each school to adopt the surrounding streets and parks that make up their school's immediate neighbourhood. Once every few weeks get a different few classes of kids out en masse for an hour with garbage bags and have them do a a clean up and then either go door to door or send out a mass mailing asking local residents to support the initiative. Given neighbourhoods around schools are often populated with parents of young children who in turn are the very folks that utilize the parks and streets for recreation, they're quite likely to dig into their pockets in support of a project that helps clean up their kids' local environments - especially if the reasons behind it are spelled out explicitly in the call for funds.

Now I'm not regularly involved in fundraising for schools, and therefore I'm certain that these are just 3 of dozens of strategies that could be put in place to help schools meet their financial needs without having to do so on the backs of their children's health and hopefully one day the notion of schools selling junk food to students will be just as ludicrous as the notion of schools selling them cigarettes.

What a sad statement that school administrators appear to be just giving up rather than using creativity and spirit to come up with healthy solutions.

What a terrible example they're setting for the children.

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Monday, June 07, 2010

My Aquavee swim treadmill review!


Ever hear of Endless Pools?

They're these $5-15,000 pools that you can install or retrofit into your existing pool that allow you to swim against a current. Effectively they allow you to swim endlessly even in your own tiny pool.

Ever hear of Aquavee? It's a $79.99 set of bungee cords, suction cups and an inflatable belt that (cost) effectively allows you to swim endlessly even in your own tiny pool.

I finally hooked mine up this past weekend (dead simple, took all of 1 minute) and am pleased to say, it's worth every penny. Had a 30 minute swim and my only complaint is some chafing from the belt on my right upper abdomen that I suspect was due to one of the suction cups coming loose and me swimming slightly off centre for the last 10 minutes.

Now I'm not a particularly good swimmer (as the video below will attest to), but to my unskilled stroke, it felt pretty much the same as swimming laps in my local community centre.

Would be perfect for travelling too as it would turn small hotel pools into endless ones.

Fabulous product Aquavee - would make a great Father's Day gift.

Here's the $79.99 Amazon link - make sure to select the correct size (S, M or L sized belts).

Here's a video of me using it in my pool (and yes I know I'm a crappy swimmer).

[Update: RD and blog reader Helene emailed me about another product - Stretchcordz that's even cheaper that ties to your pool's ladder. Google it and see if you can find a distributor]



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Saturday, June 05, 2010

Saturday Stories


Knife skills for toddlers.

I've often been heard to tell people, "Don't get sick in July" and now there's proof summer illness is a really bad plan.

My friend Travis over at Obesity Panacea explains why you should exercise even if it doesn't make you lose weight.

Macleans covers the calories on menus debate (and I'm quoted).

My friend Dr. Sharma explains how you've got to take your weight loss plans day by day.

The ever thoughtful Daniel Gordis on the flotilla debacle.

And lastly here's the latest Symphony of Science video - this one the Case for Mars.



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Friday, June 04, 2010

What happens when an engineer owns a dog

Today's Funny Friday takes labour saving to the next level.

Have a great weekend!



[Hat tip to Nathalie!]

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Thursday, June 03, 2010

Ontario's new push for mandatory menuboard calories


As I've said before, it's not a matter of, "if" we'll see mandatory menuboard calorie labeling here in Canada, but rather a matter of, "when" and it might be sooner than you think.

Yesterday NDP MPP France Gelinas introduced a new bill, the Healthy Decisions for Healthy Eating Act, 2010, which would require chain restaurants with more than 5 locations and a gross annual revenues of $5 million or more to post calorie counts directly on menus and menuboards.

For background on why this is an important move for Ontarians, feel free to have a peek at a letter I co-signed that was sent by the Centre for Science in the Public Interest yesterday to Ontario's Ministry of Health and Minister of Health Promotion.

The passage of such a bill wouldn't be to police what people are choosing, but rather to ensure people are in fact enabled with enough data to make informed decisions.

If we want people to begin to take greater responsibility for living healthier lifestyles, we have to enable them to do so, and mandatory calorie labeling is certainly one great big step in the right direction.

Three cheers for France Gelinas - we need more MPPs and MPs willing to tackle our toxic food environment, rather than take the easy and ill informed road of simply blaming individuals.

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Wednesday, June 02, 2010

Will carrying around a fake lump of fat help you lose weight?


That's certainly what the folks over at mypetfat.com want you to think.

According to them, buying a "pet" 5lb, 1lb or travel size blob of fake plastic fat will help to keep you motivated.

They recommend putting your 5lb pet in your fridge, by the cookie jar,on the table or by the scale.

What they're not telling you?

That they're selling the same anatomical fat models you'll find pretty much everywhere else but by marketing them to dieters and folks who are desperate enough to buy fat replicas to serve as table centre pieces, they feel justified in doubling the average retail price.

If you want yours, head over to the Anatomical Chart Company and buy one from them, and if you'd like to see the mypetfat site yourself, you'll have to type it into your browser as I don't want to reward their clearly predatory pricing with a link.

[Hat tip to my colleague and coworker Dr. Erik Howarth]

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Tuesday, June 01, 2010

Is air pollution responsible for rising rates of diabetes?


A recent study says so.

The study, Traffic-related Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study set out to look at 1,775 non-diabetic middle aged women and their incidence of developing type 2 diabetes over a 16 year period as a function of their exposure to traffic-related air pollution.

The study was conducted in Germany and the authors hypothesized that particulate matter air pollution may promote the development of type 2 diabetes with the proposed mechanism having to do with the development of subclinical inflammation in response to the pollution and that in turn impairing glucose metabolism.

The researchers compared women leaving in the "highly industrialized" Ruhr district those living in two rural reference counties. They controlled for socio-economic status, smoking, second hand smoke exposure, occupational pollutant exposure, home heating with fossil fuels, and body mass index.

The main outcome measure of the study was a physician's diagnosis of diabetes during the course of the study.

The results?

Living closer to traffic was associated with a 15% increased relative risk of developing type 2 diabetes for every increase in interquartile range in particulate matter or nitrogen dioxide.

So, should you move to the country?

Not based off this study.

Two huge flaws. The first? The end point was physician diagnosed diabetes. Sounds like a fair end point but having worked in rural and urban centres I can tell you the access to physicians in rural settings is not comparable to urban ones. Consequently without controlling for physician visits (or even having a physician) this study may simply be a reflection of the fact that the rural folks don't have physicians to actually diagnose them with diabetes.

The second? And this one should have been a deal breaker for the peer reviewers, the study didn't control for diet.

Given the incredible impact of diet on the development of type 2 diabetes, not controlling for diet in a study looking at the development of type 2 diabetes is rather mind boggling. Diets with consumptions of the highest quartile of refined carbohydrates confer a 400% relative risk increase in the development of type 2 diabetes when compared diets inclusive of the highest quartile of whole grain consumption. Given the differences in availabilities of fast food and farm fresh foods in urban versus rural settings, and given the small relative risk increase found in this study, there's no doubt diet differences could easily account for all of it.

So, while there may indeed be ills associated with air pollution, this study does nothing to suggest that diabetes is one of them.

(Sorry for the late post. Experimenting a bit with timing)

Krämer, U., Herder, C., Sugiri, D., Strassburger, K., Schikowski, T., Ranft, U., & Rathmann, W. (2010). Traffic-related Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study Environmental Health Perspectives DOI: 10.1289/ehp.0901689

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