Thank you!

Just a quick thank you to the readers here.

Today Reader's Digest announced that Weighty Matters won their "Get Healthy" 2011 blogging award.

Thanks for reading, and for those who did, thanks for voting.

Indirect proof that menu board calories help

There have been a series of conflicting journal articles regarding the utility of menu board calorie posting in affecting change and often folks like me will latch onto methodologies in order to explain results that we might not expect.

Putting aside the evidence-based conclusions, today I want to offer an indirect proof that menu board calorie posting will help people navigate caloric choice.

According to Bloomberg, movie theatre conglomerates are lobbying the American congress to exempt them from the food labeling law that would require they post the fact that their large popcorns contains pretty much the same number of calories (1,460) you'd find in 6 McDonald's hamburgers (1,500).

Of course if menu board calories didn't impact sales, there ought not to be any reason to care, and it sure ain't the cost of changing the actual menu boards as guaranteed their lobbying efforts costs are orders of magnitude higher than making new signs.

I know, not an evidence-based study but certainly one which suggests to me that when faced with some of the more obscene caloric realities out there, diners (and movie goers), will in fact choose differently.

Lots of your tax dollars, not even remotely hard at work.

Talk about badvertising.

I blogged once before about the uselessness of the new %DV campaign.

That's the campaign that tells Canadians to look at the percent daily values of foods' nutrition fact panels to choose more of the ones they want and less of the ones they don't. Basically it promotes blind nutritionism and explicitly teaches Canadians not to care about actual foods, but rather about useless things like what percentage of daily vitamin A they have in them.

Well guess what? Now Health Canada's spending our hard earned money by buying advertising space in magazines and food packaging to spread this completely unhelpful, and potentially even harmful means of evaluating foods.

And why?

Well presumably Health Canada must think their current nutrition fact panels are confusing to Canadians.

So here's a thought. Health Canada, putting aside the utility of your educational messaging, if you think that our nutrition fact panels are so confusing that you need to mount a tax-payer funded campaign to help people understand how to use them, don't you think that perhaps instead it might be smarter to fix the food labels themselves and then not spend our hard earned money?

Just sayin'.

Is "Fourth Meal" contributing to rising obesity rates?

Never heard of "Fourth Meal"?

According to Taco Bell it's, "the meal between dinner and breakfast", and kidding aside, it makes me think.

Certainly for College students out partying, Fourth Meal's pretty normal. I certainly had my share of Fourth Meals back in the day.

But what about the rest of us?

I'm betting that Fourth Meal is far more common than most might think. Now it may not be a formalized meal, but I know that night eating is certainly a prevalent affair. And it may actually only be "Second Meal" as that person may well have skipped breakfast and lunch.

I'm guessing there are a great many packs of cookies and whole bags of chips that make up home based Fourth Meals.

My take on night eating is that more often than not it's a response to poorly organized daytime eating and that once a person's eating every 2-3 hours, with sufficient calories and protein, nighttime struggles (and Fourth Meals) tend to disappear.

Don't believe me? It certainly can't hurt to try.

Here's what I'd recommend:

Breakfast within 60 minutes of waking up.

Eating every 2-3 hours.

Meals with a minimum of 300 calories for women and 400 calories for men.

Snacks with a minimum of 100 calories for women and 150 calories for men.

8 or more grams of protein with every meal and snack.

A deafening nutritional silence.

4 years ago now, Canada's latest Food Guide landed. As readers here know, I'm not a fan, but what's interesting to me here is that unlike art, opinions on the Food Guide should be objectively defensible, not subjectively spinnable.

Objectively means that strengths and weaknesses can be discussed in the context of evidence, and while it's true that nutritional epidemiology is an inexact science, I would argue that there are many aspects to Canada's Food Guide that are nutritionally indefensible. For instance:

1. The Food Guide recommends you simply "limit" rather than avoid trans-fat. In fact in the section on margarine it states, "Choose soft margarines that are low in saturated and trans fats". Do you know what "low" means? Me neither. And why not, "free of trans-fat" rather than "low"?

2. The Food Guide is fine if half your carbohydrates are highly refined and processed.

3. The Food Guide thinks it'd be just dandy for you to get your protein from processed meats.

4. The Food Guide explicitly advises you to worry about saturated fat.

5. The Food Guide is silent on calories and instead suggests if you "eat healthy", you'll maintain a, "healthy weight".

6. The Food Guide tells the entire country to drink 2 cups of milk daily. 2 cups of milk represents 2 Food Guide servings of dairy. Of course the Food Guide also advises that kids between 2-9 and adults between 19-50 are only supposed to have 2 servings of dairy a day. Guess the only member of my family of 5 that can eat cheese is my 19 month old, but only for 5 more months.

7. The Food Guide tells the entire country to consume 2-3 tablespoons of unsaturated fat in the form of oils daily - including guidance steering Canadians to those soft margarines that are "low" in trans-fat. That's 24-36lbs worth of unsaturated fat oil calories a year.

8. The Food Guide suggests a half a cup of juice is a fruit serving equivalent, and provides zero guidance on maximal daily juice amounts.

There are more areas where I take issue with the Guide, but let's just look at those 8.

Trans-fats - Health Canada's own trans-fat task force has called for its regulation and has stated that it's unsafe, "in any amount".

Refined carbohydrates and their increased consumption due to the decades long low-fat social experiment we've been in are almost certainly contributing to chronic diseases including type 2 diabetes, obesity and heart disease recently leading Frank Hu, one of the world's foremost experts in obesity and diabetes to state,

"The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today"

Processed meats have been tied conclusively enough to risk of cancer for the World Health Organization, while the Canadian Cancer Society and Britain's National Health Service have both specifically called for its reduced consumption.

Calorie wise, there's no doubt that calories are a major determinant of nutritive value and that "healthy" is not synonymous with low-calorie. How much guidance a Food Guide should provide on calories may well be debatable, but that it should be provide some guidance is not.

The milk and unsaturated oil recommendations are untenable with the evidence base. Put very simply, and putting aside the ridiculous incongruence with the Guide's maximal dairy servings allotment, there is no study anywhere that would demonstrate the specific inclusion of 2 glasses of milk or 2-3 tablespoons of oil daily as being beneficial to the prevention of any particular chronic disease. Certainly ensuring one uses healthier oils in their cooking's a good plan, but advising Canadians to ensure they consume 36lbs of unsaturated oil a year? These recommendations at best are blind nutritionism, and at worst reflect the undue influence wielded by Sydney Massey (the then Nutrition Education Manager and Spokesperson for the BC Dairy Foundation whose actual mission statement involves specifically increasing milk consumption) and Sean McPhee (the then leader of a 95,000 person strong industry group representing Canada's oilseed growers) who together sat on the elite 12 member advisory panel to the 2007 Guide's formation. Given their actual jobs were to try to sell milk and oil, can you imagine them advocating for anything but? Should they have been at that table? Would you want Exxon to inform gulf oil drilling policy?

And lastly juice. The American Academy of Pediatrics, and the Canadian Pediatric Society have recommended parents limit their children to a total of half a cup of juice daily with an absolute maximum of 1 cup. With drop per drop the same number of calories and sugar as sugared soda, and with no benefits towards satiety, juice is vitamin-enhanced sugar water. There are no juice trees out there.

None of these issues are nutritionally defensible. They weren't in 2007 and they aren't now. And don't fall into the trap of thinking that the Food Guide doesn't matter, it most certainly does.

Consequently the silence from Canadian health organizations is deafening.

Where are the clarion calls for a revision to the Food Guide? Why the silence? Shouldn't folks like the Dietitians of Canada be breaking down the doors of Health Canada demanding something be done? Or how about the newly formed Canadian Nutrition Society of who their president Leah Gramlich has proudly proclaimed,

"We are Canada’s leading experts in nutrition science, policy, and practice across the entire food – health spectrum."

Where are the Ontario Society of Nutrition Professionals in Public Health, the Canadian Pediatric Society, and the Canadian Medical Association? Where are the Canadian Cardiovascular Society, the College of Family Physicians of Canada, the Canadian Cancer Society, and the Canadian Diabetes Association? How about the Centre for Science in the Public Interest, the Heart and Stroke Foundation and the Canadian Stroke Network?

All of these organizations know our Food Guide is failing Canadians, and their silence means that likely we'll have to wait for another decade before we actually see any revisions.

Why the silence? Well you'll have to ask them. Certainly it's easier to be silent than to criticize, but at what cost? Propagation of nutritional ignorance and misdirection? Increased morbidity and mortality? More business?

And they could certainly affect change. If they somehow admitted that their mandates necessitated them to advocate for the nutritional health of Canadians, and they joined together in calling for a Food Guide revision, how could the government ignore them?

These organizations should be demanding more from our government. Canadians deserve more. Food Guide apologists should take a moment to stand back and truly ask themselves if the Food Guide reflects what they understand to be the current state of nutritional evidence, and if it doesn't, they should stop apologizing for it and start demanding change. While indeed nutrition isn't black and white, there's no excuse that forgives our national eating guidelines from inaccurately reflecting our current understanding of the evidence.

Also please keep in mind, the silence here isn't just deafening, it's deadly.

Weighty Matters now on Facebook

I have no idea whether or not this will show up in the email feeds, but I wanted to let you know that I've finally put together a Facebook page for Weighty Matters.

The page will carry a feed of the blog and also tidbits that aren't perhaps long enough for full blog posts, along with links and conversation.

www.facebook.com/WeightyMatters

So if you prefer Facebook to news readers, now there's an option.

Hope you're having a great weekend!

Yoni

Saturday Stories (super extended edition)

Way cool and informative radiation dose info-graphic.

NPR tells the story of a Soviet cosmonaut who flew a suicide mission to save his comrade Yuri Gagarin.

The New York Times covers quinoa and how increased global demand is impacting on its prices in its home country of Bolivia.

George Monbiot from the Guardian on how the Japanese nuclear accident has made him pro-nuclear power.

Fast Company on how carrots became the new junk food.

Weight Maven Beth Mazur covers how unfortunate the typical obesity's bad for your health reporting is when it comes to mortality risks.

William Heisel interviews Michele Simon (who I'm excited to meet next month) about BIG FOOD.

And lastly, here's another wonderful video from Symphony of Science that demonstrates the incredible marriage of Carl Sagan and autotone:

Thank God it's Friday

Today's Funny Friday video - sometimes we all feel this way.

Remember to tell your kids to stay in school.

Have a great weekend!

Ottawa Hospital finally follows through with cafeteria reform!

Yesterday, nearly 3 years after they first told the Ottawa Citizen they'd be initiating a nutrition labeling plan in their cafeterias, the Ottawa Hospital announced that point of service electronic calorie, sodium and fat content will be made available to customers.

They'll also be implementing their own version of Health Check whereby a little green apple will signify meals they deem healthy.....er...sort of......well not really. Let me explain.

Only two criteria will determine whether or not a meal will get a little green apple. Those criteria? Sodium content and total fat.

Sodium content? That seems like a reasonable determinant to include, but unfortunately it would appear that the levels they adopted were those put forth by the Heart and Stroke Foundation's Health Check program. That means a large entree can have up to 960mg of sodium and a small 720mg. Given sodium's total recommended daily maximum is 1,500mg, that's an awfully generous "healthy" amount.

Total fat? Again, probably a consequence of not building criteria from scratch but rather from existing, underpowered programs like Health Check and EatRight Ontario, the hospital's adopted total fat as an important nutritional determinant. Problem there is that it's not. The notion that total fat in one's diet is in and of itself responsible for the development of chronic disease or obesity has been soundly refuted over the course of the past decade or so of nutritional research.

There's probably also risk in clinging to it.

Dr. Frank Hu, one of the world's leading obesity and diabetes researchers and professor of nutrition at Harvard was recently quoted as saying,

"The country’s big low-fat message backfired. The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today."

So while I recognize the safety of working within the context of established programs, unfortunately if the established programs aren't in fact evidence-based, up to date, or nutritionally sound, the outcomes, while perhaps politically safe, may not be particularly stellar.

I'm also confused by the notion of a check based on just two nutritional determinants of health. I'd argue that such a check is potentially worse than no check as it will undoubtedly confer a health halo to foods that may well be chalk full of calories, refined carbohydrates, sugar, and trans-fat.

Interestingly the hospital has already distanced itself from the suggestion that their apple check'ed choices are in fact "healthy". In an article published yesterday in the Ottawa Citizen, Frances Furmankiewicz, the hospital's Director of Nutrition and Food Services was quoted as stating,

"So we're not saying they're healthy, they're healthier"

And while that may be the glass-half full version of looking at things, my glass-half empty version still maintains that "less bad" is not the same as "good", especially given the lack of any real criteria to reflect even "healthier", and the inherent risks associated with outdated, blindly low fat messaging.

All that said, I'm thrilled there will be point of sale nutritional information provided, and that apparently there will be healthier options available.

Here's hoping that given their will to launch the program, they'll also have the will to improve upon it.

Stay tuned for a video tour over the coming few weeks, but for now, congratulations to the Ottawa Hospital for starting what I hope over time will prove to be a much more substantial initiative.

UK says eat less beef & Canada spends tax $s encouraging eat more.

Peter Fricker from the Vancouver Humane Society noticed an interesting contrast a few weeks ago.

First the UK's Scientific Advisory Committee on Nutrition recommended people aim to consume less than 70g per day of red and processed meat. Their Department of Health agreed, and indeed, their national dietary recommendations now include, aiming for a maximum of 70g daily.

They based their recommendations on their take of the medical evidence, which was by no means slam-dunk conclusive, but was suggestive enough to them (and me for what it's worth), to recommend limits.

Contrast those recommendations with these two recent Canadian announcements.

1. Agriculture ministers announce 19 pilot projects for enhanced meat trade

"Farmers and processors are proud of their safe, high quality meat and we're working together to help them sell their steaks or chops to their provincial neighbours," federal Agriculture Minister Gerry Ritz stated in a release following Friday's ministerial meeting. "Breaking down trade barriers at home and abroad will yield greater returns for our meat industry and benefit all Canadians."

and,

2. Canada Government help for giant beef processor

"Canada's biggest domestically-owned beef packing firm will get $1.6 million in government grants toward new systems expected to help double its ground beef processing capacity at Brooks, Alta"

So while the UK Government urges its citizens to scale back on their red and processed meat consumption, Canada extends helping hands (and taxpayer money) to encourage growth in meat sales, production and consumption.

And Health Canada's recommendation? 150-225g daily.

How's that possible? It's the same pot of evidence.

It's possible because nutritional epidemiology isn't mathematics. There isn't one obviously right answer and therefore it's always up for interpretation and interpretation can be influenced by a whole slew of things.

Take Canada for instance. Do you think the facts that Canada's the 6th largest beef exporter in the world and that beef's a $23 billion industry here could have anything to do with our Government's meat generosity?

Too bad nutrition's not as clear cut a science as we all wish it could be, and too bad that politics and industry will always be a huge influence on the recommendations of Health Canada - a non-arms length arm of Government.

The "food fascists" have won at Toronto's Sick Children's hospital?

An article in yesterday's Globe and Mail detailed how the Toronto's Hospital for Sick Children has decided not to renew Burger King's lease.

Sadly the move is rather meaningless given the hospital still happily houses Pizza Pizza, Subway and Tim Horton's franchises, and having worked at Sick Kid's when I was a resident, it's not as if their cafeteria doesn't serve equally unhealthy fare.

But meaningless or not, it's a step in the right direction as hospitals should not be thought of as profit centres, and bigger pictures need to be taken into account.

While many commentators on the Globe and Mail's articles raged on about how the "food fascists", or the, "modern Puritans" have won I can't help but wonder if they think things through.

While indeed it's true that sick children's spirits can be uplifted by less than healthy foods, it's certainly not as if junk food can't be purchased elsewhere and brought in. Hospitals selling unhealthy foods and promoting unhealthy brands and lifestyle practices are anathema to the concept of a hospital as a vanguard of health. Also important to consider, in our single payer health care system, the sale of unhealthy foods, however profitable, are ultimately bad for business. It's bad for business both by means of the hospital further normalizing the purchase and consumption of nutritional garbage for children, and it's bad for business in that while the children are hopefully only going to be there for days at a time, the staff spend their lifetimes walking those halls and eating that food.

Hospital food has a long way to go before it can rightly serve as an example to which other institutions strive. That said, here's hoping we puritanical food fascists notch more and larger victories on our bedposts - these symbolic ones, while nice, don't make a whole heck of a lot of difference.

(Apropos image of a shuttered Burger King inside Toronto's Sick Kids' hospital from the Consumer Complaints blog)

Heart and Stroke dietitian labels Health Check useless.

So what do you think is the point of a front-of-package health claims program?

I would imagine that most people would answer that a front-of-package health claims program ought to allow for easy comparisons between different foods. Certainly that'd be my definition.

Comparison between foods would be a rather important feature as presumably the front-of-package claim system is meant to be utilized as a shopping shortcut.

With that in mind, I found a recent post by Katie Jessop, a Heart and Stroke Foundation Health Check dietitian, to be very telling. The post was entitled,

"How can you possibly compare one food to another?"

In the post Katie rightly points out that with Health Check, it's in fact impossible to compare foods.

Why?

Because according to Katie (and wholeheartedly agreed upon by me), in regard to the nutritional criteria the Health Check program evaluates,

"The dimensions we have chosen are limited"

And that's a nutritional understatement.

Health Check generally only evaluates 3-4 different nutritional criteria, and it does so on a black and white basis. There's no attempt whatsoever made by Health Check to weight certain nutritional determinants as being more important than others, meaning their outdated take on low-fat carries just as much weight as their take on low-sodium, and far more than their non-existent take on refined carbohydrates.

Contrast that with Nuval, my favourite front-of-package program which in fact scores more than 30 nutritional determinants using a weighted algorithm designed by some of the most important names in the history of nutritional epidemiology. Using Nuval shoppers can easily and confidently compare the health benefits of any two foods as every food in the Supermarket will receive a Nuval score between 0-100.

Health Check on the other hand is so useless that you can't even use it to compare virtually identical Health Check'ed items to one another.

Case in point?

Those cans of diced tomatoes up above. Two have Health Checks, one doesn't.

Health Check'ed can #1, Aylmer Diced Tomatoes: 290mg sodium/half cup
Health Check'ed can #2, Aylmer Diced Tomatoes, no salt added: 20mg sodium/half cup

Can #1 has more than 14x as much sodium as can #2, yet both carry the same Check mark?

Moreover, my wife and I have noticed that not all stores carry the no salt added Aylmer tomatoes.

Therefore enter the no Health Check'ed can, Selection Diced Tomatoes: 160mg sodium/half cup.

But it's in fact basically identical to Health Check'ed can #1, with roughly half the sodium?

Guess they didn't want to pay the Heart and Stroke Foundation to belong to their misinformation program.

Health Check is a useless program. It fails to score all items in a supermarket making it easy to miss healthier, non-Check'ed items; it has no gradations to its Check making it impossible to compare even Health Check'ed items; and as so rightly noted by Health Check dietitian Katie Jessop, it only scores a very limited range of nutritional criteria and in so doing makes Health Check a program which you can't possibly use to compare one food to another.

How anyone who cares about nutrition and public health can work for Health Check is beyond me.

Saturday Stories

John Rennie over at his PLoS blog The Gleaming Retort covers Mehmet Oz, "the great and gullible"

Vivian Krause has some tough questions for David Suzuki on whether or not he's purposely misleading Canadians on the dangers of farmed salmon.

Marion Nestle runs down a few recent examples of public private partnerships with the soft drink industry.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Remember that intensely stupid high-fructose corn syrup ad?

You know the one.

The moms at the party and they're chatting about HFCS?

If you can't remember, here it is.



Well that's not today's Funny Friday.

Today's Funny Friday is Saturday Night Live's recent spoof of it.

Whether HFCS is worse for you than just plain sugar is an ongoing area of study. Of course regardless of the outcome, one fact remains - just plain sugar's bad enough.

Have a great weekend!



If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Village on a Diet epilogue: Weight loss=Exercise, Obesity=Laziness

Yesterday I finally got around to watching the final episode of Village on a Diet - Canada's answer to The Biggest Loser.

The episode saw the experts going back to Taylor to see how everyone was doing.

Oh, but not all the experts. Perhaps because they were barely included in the show they didn't bother bringing back the registered dietitian or the clinical psychologist.

The show wasn't surprising, and that wasn't a good thing.

So did they keep it off? Some did and some didn't. Some gained and some lost, just as anyone might have imagined. One thing for certain was maintained, in fact I'd say it was hammered home - the show's overarching message that weight loss is all about exercise.

The show visits Brent and Sheena who were discussing their post-miscarriage struggles. They blamed their lack of commitment to exercise, "The exercise hasn’t really been my priority lately", said Brent. Dr. Ali, while certainly understanding of the major life event they'd gone through, was then shown to explain to Brent and Sheena that if they don't exercise 30-60 minutes a day they're 10x less likely to keep their weight off.

Next we see Jamie head to the gym to impress trainer Mike. He works her to the point where it appears she throws up into her mouth - cause you know it doesn't really count unless there's vomit.

Next we revisit Colleen. She hasn't done very well. There's no discussion surrounding her food at all, just her dropping off fitness. As a solution Dr. Ali explains to her that her, "assignment for the year", is to be on the treadmill every day at 1pm. Here the show also makes a point of spending precious airtime having Colleen explain away obesity to laziness as Colleen explains directly to the camera that it's laziness that has kept her from success.

Her daughter Sarah's done surprisingly well. Surprising because she was stubborn about change during the time the CBC was in Taylor. She ascribes her success to? You guessed it - exercise. But given the exercise she reports doing is walking the track at a gentle pace for 15 minutes when she can find the time, I'm thinking her success has far more to do with the fact that she also reports she's no longer eating junk food and that she's making healthier meals for herself and her family.

And there's lots of tears and thank yous - with every last one of them going to the personal trainers.

So there you have it Canada, just move more.

In the end, Village on a Diet should have been titled, Village on an Exercise Program, and the show Dr. Sharma brilliantly coined, "a Nightmare on ELMM (Eat Less, Move More) Street", was predominantly just a Nightmare on MM Street because at least according to the CBC's chosen clips, food, or anything else for that matter, has nothing whatsoever to do with it.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Badvertising: GE's new weight loss laundry machine?!

This has got to be the dumbest and stretchiest (as in a long, long stretch) attempt to jump on the global weight loss bandwagon that I've ever seen.

Enter the GE Profile Laundry Pair.

According to the press release I received, "More Sleep Helps Fight Hunger Pains", your new GE laundry machine's going to help you sleep more.

How?

Well apparently if you wash a small load of laundry that weighs 2.5lbs or less, rather than removing it to throw into the dryer, you can stay asleep and the machine will basically spin/air dry the load itself, all night long. Then, when you wake up in the morning it'll be dry. According to GE there'll be,

"No more waiting up past midnight for the big transfer from washer to dryer"

Huh? The "big transfer"? WTF?

But even if "the big transfer" existed, how exactly is that going to help with weight?

GE are you really trying to suggest that people are so disorganized that they can't remember to put their laundry loads in before 11pm, and they're doing laundry so frequently that this is going to be a sleep saver which in turn will impact on weight?

But even if that were true, here's the thing. Any home that's so busy that laundry gets left until midnight is a home full of kids and let me tell you, 2.5lb loads aren't going to cut it.

But why stop with weight GE?

How about a press release talking about how it helps infertile couples conceive (more time for hanky panky)? Or maybe it can help get families out of debt (more time for working)? Or maybe help get your kid into med school (more time for studying)?

Or maybe, just maybe, you could just stick to press releases about how great your machines are at doing laundry, because anything else would be just, plain, stupid.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Do after school sports help fuel childhood (and adult) obesity?

No study to talk about today, just some thoughts.

Society often likes to revert to the, "when we were kids we used to play outside" speech to help explain away childhood obesity.

I've blogged about that one before but in short, I think it's a ridiculous argument on two fronts.

Firstly, how active were we when we were leisurely riding our bikes, climbing trees or playing in parks? Were we active enough to burn boatloads of calories? Not me.

Secondly I think it's ridiculous because like it or not, this world is full of electronic wonders, and not only are they all here to stay, but as time goes by they'll become further and further enmeshed in society. Video games will provide more, not less entertainment and engagement, and the internet and our social media connectivity is likely to become indispensable parts of even our children's lives.

We mustn't forget that children are also consumers of time. Consequently they're going to spend their free time on the activities that they enjoy the most. When we were kids that meant spending time at home with our parents and 12 crappy channels of TV vs. playing outside. Now? It's a whole new ball game.

What all of this means is that even if you subscribe to the argument that in fact our when we were kids leisure time activities were in and of themselves protective against obesity by virtue of either the calories they burned or in some indirect fashion, on calories consumed, it doesn't change the fact that time changes all, and we're not likely going to find ways to make outdoor leisure activity as comparatively attractive to kids as it once was.

So what does this have to do with after school sports? Just those first few words, "When we were kids".

When we were kids after school sports weren't a big deal.

Sure I remember a summer soccer league and some swimming lessons, but for the most part, sport was had at school and usually in the form of intramurals. Leagues ran before school, during lunch and after school, and everyone, not just the elite athletes, were involved. Looking at schools nowadays it would seem that not only have phys-ed classes disappeared, but so too has a great deal of that inclusive, in-school competition.

But even if your kids' school has great intramurals and phys-ed, I'd be willing to wager you're spending a great many more evenings shuttling your children out to hockey, dance, soccer and gymnastics than your parents did with you when you were a kid. While these classes may well improve our children's health through fitness, I can't help but wonder whether or not they fuel obesity through shifts in prioritization, dietary choice, and learned behaviour.

What do I mean?

I can't tell you how many of my patients describe their late afternoon and early evening lives as child carrying convoys. They'll describe only having a few brief moments after they return home from work to bundle their kids up before driving them to their various events. And what's suffering as a consequence? Food. Family meals disappear, and if they still have them, they end up being something that can be whipped together exceedingly quickly at home (and quick isn't usually synonymous with healthy or low calorie), or food is bought on the run in a drive through or on site in places like arenas.

In turn these quick-serve, express-organized, fitness evenings do a great deal of harm to go along with the exercise they provide. Firstly they help to teach children that fitness is a more valuable priority than food in terms of available time - better to exercise than pack a lunch or cook a meal. Secondly, after school exercise may feed entire families rapidly prepared highly processed junk food (either reheated boxes at home or fast food bought on the run). Thirdly, they help to make the cook together, sit together, eat together meal the exception, rather than the rule. And while the children may not yet be suffering as a consequence of this type of lifestyle, no doubt they're also internalizing it as the example by which they'll likely organize their future adult lives.

I don't have an easy solution to offer. Tightly squeezed schools may no longer have the means or the money to fund and organize rigorous intramural programs and as the father of 3 young girls, I know how much they enjoy their after school activities, and how important I think they are to their physical development and health. However we aim our household priority on the family meal, not the fitness, and we try to schedule after school activities accordingly.

Do take a moment to consider your weekday after school arrangements. Ask yourself if you're taking any nutritional shortcuts that you can change, and at the very, very least, why not make at least one weeknight weekly, a sacred, activity free evening, and together as a family, cook a healthy meal from scratch, and sit, talk and enjoy each others' company?

[And while there's no study yet that I've seen to look at this, my friend and colleague Dr. Sara Kirk and her team out East have recently been awarded a grant to study this very phenomenon. May the statistical power Gods smile on them all, and stay tuned to this blog in 2015 or so to see her results]

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Badvertising: Corazonas' cholesterol lowering stupidity

For a lesson in why front of package health claims are a terrible, dangerous, and deceptive practice look no further than Corazonas.

Who are they?

Well they're a company whose entire product line is leveraged by large, loud, front of package health claims.

They're also a company whose entire product line consists entirely of junk food. Cookies and potato chips to be exact.

And while you might be able to make the case that at least Corazonas cookies and potato chips are quite as bad for you as their alternatives, not quite as bad for you certainly doesn't suggest good for you, and psst, guess what? I've got a secret to tell you, COOKIES AND POTATO CHIPS AREN'T HEALTHY FOODS!

Now that doesn't mean you shouldn't ever eat them, it just means you should eat the smallest amount of them that you need to enjoy your lives.

And please, for the love of everything holy, don't ever eat them with the impression that doing so will be good for your health - because that's just plain stupid.

[Coincidentally Fooducate, one of my favourite blogs, covered Corazonas in their post yesterday. Check it out!]

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Saturday Stories

Civil Eats' eulogy for the societal demonization of saturated fats?

David Katz discusses his recent study which busted the myth that health foods cost more.

Very cool study reported on by the Globe and Mail blog's Stephen Gordon on peer influence on fast food consumption in teens.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Incomprehensible shouting - America's new official language

Today's Funny Friday is another gem from the Onion.

Have a great weekend!


Incomprehensible Shouting Named Official U.S. Language

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Your rights and Ontario's bariatric surgical wait times

Today's a guest post from an anonymous writer who has sadly had first hand experience of how poorly Ontario's bariatric surgical program is being run - a frightening state of affairs given that Ontario is far and away the most progressive province in Canada when it comes to bariatric surgery.

Here this writer recounts his experience in getting Ombudsman Ontario involved where according to Ontario's Ombudsman's website,

"The Ombudsman’s job is to ensure government accountability through effective oversight of the administration of government services."

Health care of course is indeed a government service and if you remember from a post a ways back, Ontario's target wait times for a Priority II general surgery (like a gastric bypass), is in fact a scant 4 weeks, and even if you want to try to make the case the bariatric surgery is "elective", 26 weeks is the wait time target.

The writer believes that perhaps if more people made Ontario's Ombudsman aware of not only the incredibly long wait times, but the bureaucratic run around often associated with bariatric surgery in Ontario (for instance when my office called Ottawa they out right refused to provide us with any information at all regarding wait times, waiting lists, appointments etc. and stated clearly it was their policy to never disclose such information to anyone), that perhaps things might improve.

Here's what he had to say:

Bariatric Surgery Wait Times and Customer Service

Long wait times and poor customer service do not need to go hand-in-hand in Ontario, but it sure feels that way. Fortunately, there is a way to dramatically increase your chances of being treated with some respect by having your calls returned and perhaps finding out where you are on the waiting list.

What you need is an influential friend. Let me introduce you to Ombudsman Ontario, and how they helped my wife, and how they might be able to help you. These are the same folks who investigated police actions at the G20 summit, and found that the Ministry of Health and Long Term Care's policy on one cancer treatment "verges on cruelty", with their communications in the matter being "blatantly misleading".

They haven't really been aware of the problems in the bariatric system because nobody has been complaining to them. It's time to start. Complaining to the Ombudsman is not an appeal, with a lot of requirements. You can phone them, email them, write them... and they respond... promptly.

Within a week of my wife's letter, they were calling to follow up and investigate. Within two days, they had contacted both Windsor and Hamilton to find out what was going on. Another two days, and there a call from Windsor with information from Hamilton about a missing test, and an expected wait time.

There was a lull and the Ombudsman's office thought they were done and everything was going well, except that it looked like Hamilton was gearing up for a repeat of the assessment done in Windsor, and not willing to set an appointment with a surgeon until after that.

My wife called the Ombudsman again to explain that it looked like this was going to be wait time upon wait time. They stepped in again.

I'll cut to today's highlight. There was a call from a representative at the Ministry of Health to make sure that my wife received the message from Hamilton Bariatric for two appointments including one next Tuesday with the surgeon because Hamilton's coordinator had not yet heard that my wife had already confirmed with booking clerk.

My wife's complaint to the Ombudsman was treated as a Customer Service issue. The Ombudsman will not make medical decisions, or dictate to either the Ministry of Health or the bariatric centers. From my perspective, what they will say to the Ministry and bariatric centers is, "This is your system. Make it work."

A large number of complaints might cause the Ombudsman to escalate their investigation to one that looks at the system itself instead of just service for a single patient. This could benefit all of the patients stacked up awaiting assessment or surgery.

If you are stuck on Ontario's wait list, then you probably have something to complain about. It could be not having calls returned, not being told when to expect an appointment, having to re-do assessments, bad wait time data, or just excessive wait time. Even if contacting the Ombudsman doesn't speed up the process, you may be pleasantly surprised at being treated with respect.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Canada's new childhood obesity strategy wastes valuable time

Continuing in their proud tradition of ignoring their own recommendations, on Monday the Canadian Government unveiled the establishment of a "national dialogue" on childhood obesity.

The "dialogue" aims to ask Canadians what we should do about childhood obesity.

Now I'm not knocking Canadians, but can you think of any other public health crisis where the Government's sole "action" involved a, what-do-you-think-we-should-do national campaign, where we're asking questions like,

"Are you between 13-18 years of age? Share an idea in the Youth Forum"

Does Canada really need a, "Youth Forum"? While engaging Canadians isn't in of itself a bad idea, are we truly that completely clueless on what actual steps might be helpful in reducing the burden of childhood obesity?

Of course not. In fact in 2006 the Canadian Government's Standing Committee on Health heard months of expert testimony (including mine) on the problem of childhood obesity. Those consultations resulted in the publication of their March 2007 report, Healthy Weights for Healthy Kids, which in turn provided 8 pages of concrete recommendations, and the establishment of a, "national dialogue" on childhood obesity wasn't one of them.

So what did they recommend?

To summarize:

More research into childhood obesity

More funding for advertising campaigns designed to educate about childhood obesity

A call to implement the findings of the trans-fat task force

Research on the special needs of first nations Canadians in the battle on obesity

Improvement of nutrition labeling

Better data collection for research

The sharing of data with health professionals

The identification of what will become the "lead agency" on childhood obesity in Canada

The finding of means to reduce the costs of "nutritious" foods to the more remote parts of Canada

The tracking of children's' involvements in sports

Improvement of school health and fitness curricula

New funding for improved infrastructure in schools for healthy fitness and food choices

The evaluation of the efficacy of the ban against advertising to children in Quebec.

And have they followed through with even one of those recommendations?

Not that I'm aware of.

The time for dialogue is long gone. The time for action is here. Yet instead of action, instead of actually following through with the recommendations that our tax money has already paid for, Leona Aglukkaq and the Harper Government have chosen to do absolutely nothing, and instead replace actual action with ridiculous, feel good lip service that will ultimately do more to waste time than to do good.

Help COACH Canada in healthy, ethical, evidence-based weight management!

One of the many bees in my bonnet is Canada's wholly unregulated weight loss industry. My friend and colleague Arya Sharma and I penned an editorial a few years back, and that in turn has spurred some preliminary research by the Public Health Agency of Canada into the problem, but sadly on the street, nothing has changed.

Of course Arya and I aren't folks who like to sit back and wait. On my end I've helped, along with Arya and 11 other Canadian clinicians and researchers, to found a new non-profit organization to help steer Canadian policy makers to weight-related evidence (more on that in a month or so) and Arya, we'll he's gone and applied to create a new National Centre of Excellence specifically geared towards helping Canadians help themselves in their weight management efforts.

It's to be called COACH and it stands for Canadian Obesity Awareness and Control Initiative for Health. It's aim will be to provide consumer-friendly guidance to help Canadian kids, families and adults find and use available resources to manage their weight.

It's an idea that's long overdue. It'll draw not only upon the knowledge of the professional members of the Canadian Obesity Network, but also on yours.

We need to give Canadians who battle their weight a voice. COACH will be their megaphone.

Now it's not exactly a done deal and to see it happen, COACH needs your support.

To steal directly from Arya's blog:

The Network is looking for your help:

1) If you are willing to step up and support this proposal with your name and personal story, or if you can speak for someone struggling with obesity (e.g. yourself, a close friend or family member, a patient group, etc.), or represent an organisation that can reach and engage Canadians living with obesity - we want to hear from you!

2) As “Ambassador” for COACH, your job is to help determine the direction and nature of COACH initiatives and to carry the torch for COACH into your communities and organisations.

3) You can help fine-tune the proposal - make a compelling case, tell a convincing story, and ensure that COACH truly addresses a need that will help Canadians better deal with this complex and unforgiving condition that destroys self-esteem, relationships, health, and wealth.

If you would like to support this initiative, please click here and add your name.

The more names and stories, the greater the potential for federal funding.

Please forward this post to anyone you think may help with this initiative

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Canadian Vitaminwater class action lawsuit launched!

I wonder if they're use the same defense as they seem to be doing in the American class action suit. The, how could anyone possibly take our advertising seriously defense. According to the law firm Hordo and Bennett,

"These putative class actions allege that the Defendants' committed deceptive or unfair trade practices by marketing Vitaminwater as a healthy beverage, in circumstances where a standard 591 ml. bottle of Vitaminwater contains 32 grams of added sugar. In comparison, the American Heart Association recommends that the maximum daily consumption of added sugar not exceed 25 grams for woman and 37.5 grams for men."

Wanna get in on the action? Right now the suits have only been launched in Alberta and British Columbia however the law firm's intake form includes all of the other provinces as well. Not sure what that means. Either way, here's the link to the lawsuit, and here's the link to become a class action member. Oh, and hey, sugar water? It's probably not going to replace flu shots anytime soon. [Hat tip to Hordo and Bennett articling student David Volk]

Saturday Stories

PhD in Parenting covers the cluelessness of city officials who think it'd be just dandy for Pepsi to name city sport facilities.

Skeptic North's Erik Davis on why Big Herba can definitely afford to do clinical research.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

It's bleeping Sesame Street!

Today's Funny Friday just goes to show you that a few well placed "bleeps" can make comedy gold.

Have a great weekend!



[Hat tip to Body for Wife's always entertaining James Fell]

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Attendance based gym pricing. Go more = pay less!

I love this idea.

It's called Gym-Pact and the premise is simple.

Sign up for a discounted rate for personal training, gym memberships, yoga, etc. and pledge a specific level of attendance. Discounts vary based on contract length and pledge frequency.

Here's the catch.

Each time you miss you get dinged $10.

You get one week vacation every 6 months and if you're sick or injured, a doctor's note will pay off your penalties.

I know as well as anyone that motivating yourself to exercise is difficult. Zero doubt in my mind, money, and therefore Gym-Pact, can help.

Right now, only in New York, but hopefully Gym-Pact or enterprising copycats will spring up at gyms near you.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 21st and you're welcome, if you're so inclined, to vote daily.

Menu board calories matter to those who care.

There's been some negative press on menu board calories with many studies (including a recent one with adolescents) suggesting they don't drive change at all.

My gut's told me that the studies are premature and perhaps poorly designed, but guts are not something a person can hang their hat on (too slippery and cylindrical I guess).

That said, my gut's told me a few things.

Firstly it's told me that perhaps fast food restaurants aren't places where we'll see major changes. After all, people go to fast food restaurants to get specific foods. People go for their Big Mac's, their nuggets, their chicken buckets. People go to get foods that they specifically enjoy and putting calories on menu boards may be less likely to change their behaviour as the variety at fast food restaurants isn't much to get excited about and moreover, people already know what they're going to buy before they're at the counter.

Secondly it's told me that these things take time. When the surgeon general first started warning people about the dangers of smoking people didn't just suddenly throw out all of their cigarettes. Changes in attitudes towards smoking took a great deal of time and had someone pointed at the surgeon general's warning and said, "look, it didn't work so let's stop telling people not to smoke", I suspect there'd be a great many more smokers today. Menu board calories will likely need both time and caloric context to have impact.

Thirdly it's told me that looking at all comers isn't wise. By no means is everyone who enters a fast food establishment trying to control their weight or calories, and so looking at all comers may average out a real impact on the smaller percentage of people who actually do want to utilize that information.

Well guess what, my gut might be right - at least on point number 3.

A preliminary report out of New York City found that of the roughly 15% of fast food patrons who report caring about calories, they eat 106 fewer calories per outing than those who don't care or who ignore the counts.

Now the study's not been published yet so it may well have methodological flaws, but even if it does I think the study of folks who want to use the numbers is a much more useful means of analyzing impact.

My gut also wonders whether or not having calories on menu boards, along with public health campaigns on caloric literacy, will increase over time the percentage of folks who report caring.

So for all of those folks out there who've been so keen on jumping on the look it doesn't work bandwagon, perhaps you guys should have a sit down with my gut, or at the very least, give this experiment more time.

Lying about bariatric surgery isn't the way to fix the system.

On Friday the Ontario Liberals put out a press release detailing the “savings” garnered by their $75 million investment in bariatric surgery. They report a “savings” of $10,000 for every patient who receives bariatric surgery in Ontario versus out-of-country, and that in 2010/11 they will have “saved” $45 million and in 2011/2012 an additional $21 million.

Those numbers, and their enthusiasm, are a farce.

Prior to November 2009 and the establishment of Ontario’s bariatric registry program, a two-page application was required of physicians to access out-of-country bariatric surgery for their patients. A committee at the Ministry of Health would review the application and if a patient met appropriate surgical criteria they would be approved for out-of-country consultation. From start to surgery this process took 6 months and the total price tag for the province, including both pre-operative and post-operative appointments and management of complications, along with the surgery and resulting hospital stay, was exactly $18,050 US dollars.

Therefore, according to their reported, “savings” of $10,000 per patient that ought to mean that per procedure surgical cost in Ontario is $8,000, yet the true cost was recently reported by the Ministry of Health to be $17,200.

Suddenly that $10,000 per patient "savings" has been reduced to $850.

Sadly, that’s not the whole story. Demand for bariatric surgery in Ontario greatly outstrips supply. In Ottawa since the establishment of the bariatric registry and the denial of out-of-country requests, patients I have referred have been waiting between 7-12 months to receive their surgical orientations following which they will likely be required to wait an additional 9-12 months for surgery. All told wait lists are now between 1-1.5 years longer than when out-of-country surgeries were an option. To truly discuss cost “savings” the cost of waiting needs to be taken into account.

A 2004 Canadian study did just that and looked at the direct medical costs attributable to bariatric surgical waits. That study concluded that an additional 1.5 years of waiting costs the Canadian health care system $5,900 in direct health care costs, with each year of waiting thereafter costing $4,500. It’s important too to point out that the study did not even try to account for the substantial indirect costs associated with decreased productivity and increased disability also seen in pre-operative patients.

So how many patients are currently awaiting surgery?

At a family medicine conference in November 2010, Dr. Mehran Anvari, the co-leader of Ontario’s bariatric registry, reported that the average number of monthly referrals for bariatric surgery in Ontario had reached nearly 900 , reflecting an unanticipated and rapid rise in demand. Therefore even were demand to stay the same, given the Ministry’s prediction of 2011 seeing 2,085 Ontario surgeries, every 2.3 months the wait list will grow by an additional year.

So back to the “savings”.

Taking even a conservative estimate of an additional 1.5 years of waiting for an Ontario surgery rather than an expedited out-of-country procedure, despite a “savings” of $850 per patient in surgical costs and follow ups, the 3,000 waiting patients won’t save one dime of taxpayer money. Instead their surgeries will ultimately cost Ontarians an additional $15.3 million in direct health care expenditures and many more in indirect costs. Were wait times to grow to 2.5 years due to growing demand, those additional direct health care costs would reach $48 million.

The thing about surgery in Ontario is that we only have so many operating rooms. There simply isn't a way to markedly increase access to one type of surgery without either spending more money on more operating rooms, or bumping other surgeries. Given we don't have the funds to build new hospitals, given there are in the neighbourhood of 360,000 surgically eligible Ontarians, and given a rapidly rising demand, within the current Ontario framework, waits can go nowhere but up.

Here in Ottawa I've heard a third surgeon has been brought on board and that instead of operating 2 days a week the bariatric surgeons will be operating 3 days a week. I've also heard that they're ramping up the number of orientation sessions. Of course I've also been told that Ottawa's backlog is the worst in the Province.

Hopeful folks may read into this that things are going to happen much faster and that the wait lists here will decrease.

Cynical folks may read into this that getting people into orientation sessions quickly may simply increase the wait from orientation to surgery.

Certifiably cynical folks like me wonder if more rapid access to orientation will be used as a means to cook the books by suggesting that patients are no longer "waiting" once they've been oriented.

Frankly I'm rooting for hopeful, but rooted in certified cynicism.

Either way, Ontario should certainly be commended for leading the country in providing access to bariatric surgery; however the premature elimination of the out-of-country option rather than saving money is in fact costing taxpayers tens of millions of dollars a year and is prolonging the suffering of thousands of sick Canadians.

Telling it any different is a downright lie.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.