Sorry for the late post, the embargo lifted at noon.
Today's edition of the Canadian Medical Association Journal contains an editorial the I co-authored with Paul Hebert. In it we argue that partnerships between food conglomerates and health organizations should be avoided.
The risk is straightforward. Partnerships by definition serve to benefit both parties. For the health organizations the benefits involve some combination of money, resources and exposure. For the food industry the benefits include sales, brand image improvements (which in turn translates into sales) and spin which may serve to help deflect criticism or further political needs.
The increase in sales is problematic in that more often than not, the brands that partner with health organizations are the very brands whose images or products may be considered unhealthy. Moreover, the consumption of more food, even more healthy food, won't help with our obesity problem.
The usual Big Food suspects involved in such partnerships most often include purveyors of sugared soda, sweets, savory snacks and fast food. While arguments can be made that the funding they provide is helpful and at times may further the needs, aims or research of health organizations, it does so at the expense of those very health organizations serving as inadvertent pitchmen to help sell products that run contrary to their public health aims.
Some argue that since all private partnerships (meaning not just partnerships with Big Food) have their warts (things like environmental concerns, fair trade policies, child labour issues, etc.), that the call to action should be for health organizations to abandon all private partnerships. While there may be some merit to that argument it's important to explain the Big Food distinction in that partnership with them involves corporations whose products themselves contribute to the very burdens their partnered health organizations are striving to combat.
We all need to stop relying on the food industry. As individuals we need to renew the art of cooking from scratch with whole, healthful ingredients and stop kidding ourselves that reheating, stirring, and mixing count as home made meals. As health organizations we need to find new and novel means to raise funds and awareness. And while divestment may not be fair or easy, given our dire circumstances, can we really continue to afford not to?
These partnerships do not exist in a vacuum. Diet and weight related illnesses have become the number one preventable cause of death in North America. Health organizations need to divest themselves from Big Food partnerships lest they contribute unwittingly to that burden.
You'll find the full text of our editorial online at the Canadian Medical Association Journal]
Yoni Freedhoff, & Paul Hebert (2011). Partnerships between health organizations and the food industry risk derailing public health nutrition CMAJ
Monday, January 31, 2011
Saturday, January 29, 2011
Friday, January 28, 2011
Thursday, January 27, 2011
I know I'm beating a dead horse here, but I can't help it.
Yesterday morning I was flipping through my various RSS feeds and I came across the latest post on the Heart and Stroke Foundation's Health Check blog. It written by Devon Peart, a registered dietitian who also has a Masters in Community Nutrition. In the post Devon applauds Domino's for making a "healthy" pizza to offer kids as part of their school pizza days. Moreover she quite literally challenges Canadian pizza producers to make a Health Check approved pizza to serve to kids in schools for what Devon calls,
"a welcome change from routine for many school children"And she ends the post with, "Let's hope they take up the challenge!"
So I guess you should forget about the fact that childhood obesity rates are still rising and that kids as young as 6 are now developing type 2 diabetes. Forget too that every school food reform policy ever written feels school pizza days are anathema to healthy school food. You'd better also forget about the fact that our societal shift from actually cooking to the normalization of fast and restaurant food is stoking the rise in obesity and chronic disease and that food dollars spent outside the home have risen from the low 30s to nearing 60% since the 1970s. Not to mention that you should forget about the fact that the Heart and Stroke Foundation, as a for-health organization, should be bending over backwards to encourage home cooking, discourage processed foods, and all in all help to protect our children from the purveyors of fast food.
Why should you forget all of those things?
Because if you don't forget them how else are you to explain that here we have a registered dietitian with a Masters in Community Nutrition, supporting school pizza days as, "welcome changes from routine", explicitly inviting Canadian pizza makers to apply for a Heart and Stroke Foundation Health Check which the pizza folk would then use to help to dupe school children into thinking that store bought pizza is a healthy, good for them, Heart and Stroke Foundation approved, at least weekly meal.
Mind boggling, horrifying, and heartbreaking.
Wednesday, January 26, 2011
Today's ill advised Big Food partnership comes from McMaster University's Athletics Department where they've sold out their various Marauders, to McDonald's.
Though it's not clear from the press release how much McDonald's ponied up, their contribution's bought them, "presenter status" rights which means from now on the players of the games in multiple sports are going to be presented at the end of each game as the, "Big Macs of the Game".
But that's not all.
In what I'm sure has Hamilton's McDonald's owners salivating, their partnership with McMaster has also bought them the ability to influence youth in that McDonald's will now be running the Catholic Youth Organization "Small Fries Games", which will see community youth mingle with Marauder players during which time they will undoubtedly be bombarded with McDonald's advertising and coupons in events that by their nature will link McDonald's brand with fun, happiness and health.
Great job McMaster. Way to be socially responsible.
[Anonymous hat tip to a now quite disgruntled McMaster alumnus]
Tuesday, January 25, 2011
So could anything make a show that continually and falsely suggests to Canadians that exercising till you throw up is how best to lose weight any less helpful?
And we get it this week when the show starts off with the person who thinks it's, "pathetic" that she's only lost 5lbs, another who's upset she's only lost 2bs, another who can't see her 12lb loss, and a dad who thinks his young son's a failure and should be busting his hump 24/7 because he's only lost 9lbs.
Never mind that to lose faster than 1-3lbs per week pretty much necessitates non-sustainable approaches, this show's all about the non-sustainable, and while Dr. Zentner puts the dad in his place in her office, and later tries to make Jamie feel better about her 12lb loss, it doesn't seem as if she sat down the show's producers. Oh, and don't bother discussing energy balance with viewers - better just to think as the show suggests for most of the episode, that the town's just not working out hard enough.
But that's not all. Today we also get taught that healthy eating has to include ingredients that I'd bet the vast, vast majority of Canadians aren't familiar with, nor interested in. Think that's going to inspire viewers to want to change what they're eating? Think perhaps it would have been more helpful to explore healthy eating that didn't include tofu and quinoa?
Oh, and their registered dietitian's given a new nickname by British accent voice over guy - "calorie cop". Way to inspire Canadians to consider seeing dietitians.
But it's probably just TV. You know if I had to wager, I'd bet that in the town the Taylorites got far better treatment, advice and help than what viewers have been shown.
So why are Canadians getting the short end of the Village on a Diet stick?
I want to share part of a comment from last week's recap.
"These programs are popular as they are designed to produce a sense of unearned superiority in the audience, with pat,over simplistic solutions presented as the answer to complex problems (see eat less,move more)."I don't disagree.
It's interesting too, each week in the comments a few folks will tell me the show's inspirational, that I shouldn't rush to judgment, that great changes are taking place.
So let me ask you - would it be inspirational to watch a show about depression where people simply yelled at you to, "pull yourself up from your bootstraps"? Would you judge a show on stock market investing as lacking if the only formative advice they aired was, "buy low, sell high"? Would you consider a show teaching a family how to hold their breath as proof the family will be able to hold it forever?
I wish I could be applauding this show. I wish that each and every week I commented about how wonderfully the show tackled another facet of the struggle against obesity.
Ultimately I wish that it was a show that focused on education, not entertainment.
There's always Season 2.
Monday, January 24, 2011
Well not exactly, but bear with me.
You see last week the UK's watchdog Advertising Standards Agency ruled that Coca Cola's Vitaminwater advertisements stating their beverage was "delicious and nutritious" were misleading because,
"Because Vitaminwater contained about a quarter of a consumers GDA for sugar as well as the added vitamins, we considered that the description of Vitaminwater as ‘nutritious’ was misleading."So what's about a quarter of a consumer's GDA for sugar? 4-5 teaspoons.
What else has 4-5 teaspoons per glass?
Orange juice, apple juice and pretty much any other fruit juice. Some, like grape juice, have even more.
Of course there'll be those who argue that the sugar in the Vitaminwater is "added" sugar, but me? Sugar water's sugar water, whether the sugar was added by God or by machines is inconsequential. Think of it this way. If you took pure spring water and added to it 5 teaspoons of sugar and exactly the same amount of vitamins and minerals as you'd find in orange juice then for all intents and purposes nutritionally the beverage would just be orange juice. So if the UK Advertising Standards Agency is unhappy with Vitaminwater, I think they also ought to be unhappy with juice.
Saturday, January 22, 2011
I Came to Run crushes the Special K challenge.
Harriet Hall from Science Based Medicine and her take on Gary Taubes' Why We Get Fat.
Travis on Obesity Panacea wonders if fear and disgust will help people lose weight.
Dr. Oz hits rock bottom and digs, digs digs.
Arya Sharma takes a post away from me and does a better job than I would have explaining how the recent inactivity statistics from Canada prove that obesity ain't about exercise.
Friday, January 21, 2011
Thursday, January 20, 2011
Amazingly, despite the very basic fact that the food we provide our children is quite literally their bodies' building blocks, it would appear as if we're building our kids out of sugar and salt.
Researchers over in the UK wanted to get a better look at packed lunches and so they undertook at cross-sectional survey that had 1,294 8-9 year old kids from 89 different British public schools work with researchers on a tool called the, "Lunch Box Evaluation Questionnaire".
The results weren't heartwarming.
Sandwiches were the most commonly packed foods and were most unfortunately followed by candy, savory snacks and sweetened drinks. The food least eaten? Fruit. Most eaten? Candy.
Only 5.1% of packed lunches met what the study referred to as a "healthy standard" which consisted of, "a sandwich with protein filling (or alternative starchy and protein food), some vegetables, fruit, and a dairy product". 40% had both a confection and a savory snack (candies or cookies and chips). The average number of added teaspoons of sugar/lunch? 10.
Those sure don't sound like ideal building blocks.
Evans, C., Greenwood, D., Thomas, J., & Cade, J. (2010). A cross-sectional survey of children's packed lunches in the UK: food- and nutrient-based results Journal of Epidemiology & Community Health, 64 (11), 977-983 DOI: 10.1136/jech.2008.085977
[Hat tip to my friend and colleague Sara Kirk]
Wednesday, January 19, 2011
Ok, I'm not a math maven, but here's what I figure.
Their new "Trenta" size is 7oz more than their Venti.
Based off the caloric information for a Venti, if you order a, "Trenta 2% iced peppermint white chocolate mocha with whip", you'll be hauling in 904 calories.
What else has 904 calories?
2.2L of Coca Cola.
[Anyone out there still think mandatory calorie menu labeling's a bad idea?]
(image via the National Post)
Tuesday, January 18, 2011
This week on a Village on a Diet....
Food wise they're finally weighing in, and just like with fitness, it's food boot camp. Apparently you have to give up everything that's bad for you. Nothing about moderation, calorie awareness/consideration. Nope, instead Chef Jonathan, hands out bags of fresh vegetables and then later in the show has participants show up at a community centre to learn how to cook with them. During the cooking segment the CBC impresses upon us that they want Canada to think Taylor's a community of rubes. Chef Jonathan holds up some fennel, asks the room full of folks if anyone knows what it is, and the CBC then cuts to a few very confused faces and pipes in the sounds of crickets chirping.
So other than being given a bag of vegetables and standing in a gym sized room while a chef cooked up front did Taylorites learn anything about healthy eating, healthy cooking, or the interaction between food and weight? Well they learned about "portion control". No discussion of calories, just the same old, "servings" that confuse everyone and help no one. Energy density (calories per gram) makes servings a rather useless measure as identically sized servings of foods with different energy densities will clearly impact differently on weight. They might have even learned other things, but there wasn't much time in the roughly 25 seconds they gave to dietitian Maria Thomas. Later in the show trainer Garfield encouraged Taylorites to eat frequently.
Lastly Chef Jonathan heads over to the pizza restaurant and asks the owner to change her pizzas and at least this week, she seems on board with the proposed changes (though I sure wish they'd have done a nutritional breakdown of the recipe they used).
All in all, a fairly uneventful episode.
I've got a few nagging questions about the show.
What percentage of the Village is involved? If it's a village of 1,300 folks and if overweight and obesity are in the 70% range, that'd be 910 eligible townsfolk. Given that there's 2,000lbs in a metric ton, that'd mean each of those folks would have to lose 2.19lbs in 3 months if all were involved. As blog reader Martin Collis very rightly points out, the Hawthorne Effect ought to cover that and much, much more alone - and that's something which in my mind should obligate the CBC to make an unannounced return to Taylor 6 months or a year after filming to see how the town's doing without them.
Why did the CBC decide to make the townsfolk seem more stranded and helpless than they are? According to a comment left on Dr. Sharma's blog, the closest grocery store is 12 minutes away from Taylor - hardly far. The same commentator also noted that the walking trail VOAD suggested was never utilized is used plenty. It doesn't take isolation or a lack of facilities to struggle with weight - Canadians struggle with it everywhere. Why the pretence?
Most importantly, what is the CBC's ultimate aim with VOAD? If it's to inspire people to try to improve their fitness, I think they'd be far better off promoting SMART goal setting than boot camps. If it's to help people manage their weight, they've got to put more of a focus on food and also more of a focus on the "whys" of excess calorie consumption. Ideally I'd love to see VOAD explore eating patterns and help to educate Canadians. Explore macronutrients and educate Canadians about the importance of protein and the challenges of refined carbohydrates. Explore the examples parents set for their children. Explore the difficulties of finding time to make home cooked meals when working long hours or not even knowing how to cook. Explore the umpteen dozen myths about food and weight and take advantage of their gigantic soap box to help bust them.
What do you think the CBC's aim is with VOAD? Is it spectacle or support?
Monday, January 17, 2011
First some background.
Growing up I was a disaster romantically. Looking back it seems like either I was pining after someone who wasn't interested, or I was in the midst of some sitcom-esque, disastrous relationship with me playing a markedly overly dramatic, hapless suitor.
1993 was pretty typical. Crash and burn relationship, me thinking the world was ending and comforting myself by embracing my misery. I needed an outlet. At a Passover seder my cousin Amelia chatted with me about a new martial art she was taking. It was called Gorindo and she described it as spiritual, non-aggressive, a fantastic workout and a lot of fun.
I decided to give it a go and I trained right through medical school until I moved to Ottawa.
My sensei, Claudio Iedwab, is from Argentina. He's one of those lucky folks who in many ways has retained the enthusiasm of childhood and he's always got a mischievous gleam in his eye.
As a martial artist, Claudio's exemplary. In addition to his 6th dan in Gorindo, Claudio is also a 5th dan in Moo Duk Kwan Taekwondo, a 5th dan in Jujitsu, 3rd dan in Shotokan Karate-do and was once the South American Taekwondo Champion. He created Gorindo in response to what he felt was a North American overemphasis on the "martial", rather than the "art", and its name means five ring art. The five rings of Gorindo include Taekwondo (Moo Duk Kwan), Karate-do (Shotokan), Ju Jutsu, Savate (a French foot-boxing style) and Yoga.
Mentally for me Gorindo was a godsend. It helped to clear my head, improve my mood and helped me to focus during some difficult times. Physically it was also a godsend as by means of incredibly varied workouts, my chronic back pain disappeared. It has also helped me a great deal with my balance, flexibility, focus and coordination.
Thankfully, after moving to Ottawa I met my wonderful wife and as the best man at my wedding put it, he knew she was the one for me as there was no drama. Sadly, after moving to Ottawa, my Gorindo stopped. I tried to find a dojo I liked here, but every one I auditioned seemed to me to be either too aggressive, or too business-like for me to feel comfortable.
Two years ago I decided I'd try to track down Claudio just to say hi and I was thrilled to find out he was living in the Gatineau. He didn't have a dojo anymore - was working more on his other projects, but was still available for private teaching. I jumped on the chance to have him come and teach me privately and for nearly 2 years he'd come by my office twice a week to train. I think our training together relit his teaching bug and about a year ago he started to look for a location to open an Ottawa Gorindo dojo.
Finally last fall he found an old homestead that had been converted to office space that was just a few short minutes from my office. He calls it his, "candy box" and truly, it's a very special space. He's spent a few months working the kinks out of the new place and come this New Year, he's ready to start promoting it to the general public and I asked him if I could blog about it on his behalf.
So here's the scoop. If you're a blog reader and you're interested in trying something that for me was without exaggeration life changing, or if you've been looking for the opportunity to punch or kick me, Claudio's offered to extend to my readers a free month of training - no strings attached.
Pop in before February during class hours at 6 Deakin Street (Prince of Wales and West Hunt Club right near the Met church), or contact Claudio via email or give him a call - say you've come from Weighty Matters and away you go. There you'll have a chance to meet Claudio, his wife and 3rd dan Roxanne, and potentially you'll get your shot to get your shot at me.
Remember, this offer expires in February - and given that you've truly got nothing to lose and perhaps something wonderful to gain, why not take Claudio up on it?
Saturday, January 15, 2011
Mark Hyman wants us all to celebrate home cooked meals (great piece).
Watch my friends over at CBC Marketplace during their season premiere - Big Gym Ripoff.
If you followed all of Jen Melo's healthy eating rules, you'd be doing just fine.
Science Based Medicine's Mark Crislip takes on cranberry juice for urinary tract infections. My favourite quote?
"If you collect individual cow pies into a larger pile, it does not transmogrify into gold."
Friday, January 14, 2011
Thursday, January 13, 2011
I'm guessing that not to many people have had the chance to read Coca Cola's 2009-2010 corporate social responsibility report.
It's quite the feel good tome and it covers all the wonderful things Coca Cola has done for the world - from improving our health to saving the earth, and while undoubtedly Coca Cola will strive to make a positive impact on the world, it will only do so when and where such efforts are able to translate into more sales. This isn't in my mind evil behaviour, it's just the nature of being a public company - ultimately it's all about shareholder equity - if Coca Cola spends money recklessly on do-good efforts without returns on investments, the shareholders have a case to sue.
So reading through the report I came across the section on Corporate Responsibility and Sustainability. According to Coca Cola, by virtue of the 2010 Olympics they,
"engaged stakeholders at all levels, particularly those related to healthy active living and the environment."Sounds pretty great, no?
So who'd they engage?
Well according to the report among others they "engaged": the College of Family Physicians of Canada, the Canadian Obesity Network, the Ontario Medical Association, the Alberta Medical Association, the BC Medical Association and the Canadian Medical Association.
I was curious what "engaged" meant so I contacted my friends and colleagues at both the Ontario Medical Association and the Canadian Obesity Network.
Did they have sit downs with Coca Cola?
Did they advise them about anything health related?
Did they review their corporate social responsibility plans?
So what the heck did they do that landed them as bragging trophies for Coca Cola?
Well apparently they provided the Olympic Torch Relay committee with names of members for consideration of inclusion in the relay.
The same Olympic Torch Relay sponsored by Coca Cola.
That's the "engagement".
Oh, and in case you were wondering why Coca Cola wanted to sponsor the relay/Olympics?
Wednesday, January 12, 2011
|ParticipACTION's Kelly Murumets accepting her Live Positively Award from Coca Cola's Nikos Koumettis|
I've blogged about it many times before, but recently the Ottawa Citizen's Joanne Laucius decided to tackle the oxymoron that is the ParticipACTION/Coca-Cola partnership.
The deal Coca Cola made with ParticpACTION is worth $5,000,000 over 5 years. Hardly a huge amount of money to be partnered up with one of the most recognizable and well respected brands in Canada. In fact I'd venture that companies would have been lined up out the door trying to attach themselves to ParticipACTION's heritage brand coattails.
But apparently ParticipACTION was picky. They didn't want to partner with just anybody, they wanted to partner with Coca Cola. ParticipACTION's President and Coca Cola award recipient Kelly Murumets calls Coca Cola, "a responsible, effective partner". Never mind the fact that improving Coca-Cola's brand image will help to sell sugar sweetened beverages - a causal factor in childhood obesity. Never mind the fact that Coca-Cola and ParticipACTION's recent co-branded advertising campaign purposely misdirects people about calories. Coca-Cola knows what kids want (sugar-sweetened beverages?) and so they're the perfect partner?
How so Kelly?
"If we had partnered with an insurance company, we would not get kids' attention and get commitment to behaviour change"Why not? Doesn't ParticipACTION have the brand awareness necessary to make advertising headway?
According to Laucius' article, ParticipACTION's own partnership strategy document spells out what's in it for Coke,
"an effective partnership will leverage and extend each partner's assets (and partnerships) will further your own mission, but will also offer a return on investment for your partner organization."So while ParticipACTION is as unlikely to impact on childhood obesity rates this time around as last (during the original 30 year reign of ParticipACTION childhood obesity rates rose by nearly 300%), one thing they'll certainly be able to do. They'll be able to offer Coca-Cola a return on their investment.
ParticipACTION will help Coca Cola sell more Coke.
Tuesday, January 11, 2011
So has the Nightmare on ELMM street continued (Dr. Sharma's moniker - ELMM = eat less, more more)?
Notable this week?
There was also some good.
Now I recognize that there's no doubt that small-stepped sustainable lifestyle change doesn't always make for good television. As commentators on both my and Arya's blogs have noted, yelling at people to exercise and deriding them for their weights and perpetuating the stereotype of obesity being a disease of willpower makes for far more entertaining television than talking about food, and this episode with a focus on further "butt kicking" and folks who are filmed being repulsed by vegetables doesn't do much to bust those stereotypes.
But how much should ratings and "entertainment" matter to the CBC? Shouldn't the CBC be held up to a different standard than NBC (the home of The Biggest Loser)? After all, the CBC is funded by us, the taxpayers, and consequently entertainment value need not be their foremost consideration.
There's also no doubt the CBC could make this program great. It's clear that the producers of Village on a Diet are quite talented and were they to set their minds to it, I'm certain they could make thoughtful lifestyle change and environmental overhaul great TV. By means of example, you don't even need to leave the network. Not sure who out there saw it, but Jay Wortman's and the CBC's My Big Fat Diet which followed Jay and his work with Alert Bay, BC where he put that community on a low-carb diet that saw them losing weight and improving their biochemistries, was wonderful and didn't rely on ridiculous and inconsequential in the long run physical challenges.
Dr. Brian Goldman of White Coat, Black Art fame and a man whose public health advocacy efforts I greatly admire, suggests that I and others are missing an important point,
"As a nation, we have let the obesity crisis creep up on us like those unwanted kilos. Sometimes, you need shock therapy to grab peoples' attention. Shows like Village on a Diet do just that."And while I don't disagree with the notion of shock being useful, suggesting that Village on a Diet thus far has been a wise and laudable shock treatment is more than a stretch. Shocking people by perpetuating disparaging stereotypes about obesity isn't a great plan for the nation. Nor do I think that the celebration and publication of one of the primary things that needs to change - the notion that weight is an individual problem that's caused by laziness and cured primarily through exercise - as the means to solve the problem is a good one either.
I know that the CBC reads my blog, and I hope that the ongoing discussion, both here and in the comments, will help to shape the next season of Village on a Diet, because I don't think the CBC set out to perpetuate harmful stereotypes, I think they truly set out to do what they thought was best and were they able to turn this around, I think they'd be doing Canadians a tremendous service.
Looking forward to next week's apparently food focused episode.
Monday, January 10, 2011
It's rare that I've had the occasion to read a book whose premises I agree with (that we eat way too many carbs, that they in turn impact on our weights, and that weight-wise exercise isn't much to write home about), but whose arguments make me cringe. Gary Taubes' Why We Get Fat met that billing.
Let me start out by stating that I'm quite low-carb friendly and that I readily agree that science has proven that saturated fat has been wrongly demonized by the medical establishment for decades, including somewhat by me when I co-wrote my book in 2006/7 (a guy's allowed to learn, and it was in this spirit that I approached reading Taubes' book). Furthermore, I also agree that carbohydrates, more specifically the refined highly processed ones, contribute dramatically to both obesity and chronic disease and their reduction may well have a role to play in most folks' weight management efforts, and that a myopic view of dietary fat as causal to chronic disease and obesity has likely in and of itself, by means of a consequent dietary shift to carbohydrates, contributed dramatically to the rise in the societal prevalence of chronic disease and obesity.
All that said, I found Why We Get Fat to be an extremely difficult read. Not because the writing wasn't engaging. On the contrary, Taubes is an excellent writer. I found the book difficult to read because for reasons I can't understand, Taubes seems to have decided to abandon journalistic and scientific integrity in place of observational data, straw men and logical fallacy.
Taubes' manifesto is straight forward. Carbohydrates make us fat and they do so independently of the first law of thermodynamics. Forget about calories, you can eat as many or as few of those as you'd like, ultimately weight is purely about carbohydrates.
Why We Get Fat's observational data comes hard and heavy right out of the gates. Taubes posits that because there have been examples throughout history of impoverished peoples with high rates of obesity that the concept of a toxic environment (cheap calories and minimal exercise) being causal to our modern day weight woes must be false. Does Taubes really think that obesity has a singular cause? That there's only one pathway to weight gain? That because he can find obese impoverished people the environment's not involved? Apparently he does.
Straw men and logical fallacy? Try this one on for size. He tackles an observation made by Williams and Wood, researchers who'd studied exercise and weight. They found that even marathon runners tend to gain weight over time and suggested that in order to avoid that gain they'd have to run further each and every year. Taubes extrapolates to suggest that any middle aged runner wanting to stay lean will have to run half marathons five days a week to resist weight gain. Sounds ridiculous, right? He then concludes on that basis the calories-in/calories-out hypothesis couldn't possibly be true. But couldn't calories in and out still matter in these runners? Don't our lives change as we get older - less time, more disposable income, more responsibilities - all things that may cause increased reliance on both convenience and celebratory calories. And doesn't metabolism naturally slow as we age due to age-related sarcopenia - wouldn't that also lead a person to steadily gain weight even if all other things (intake and exercise based output) remained constant? Or couldn't the runners consistently be consuming more calories than they burn as a consequence of either exercise-induced hunger or overcompensated reward based intake, and that coupled with natural aging's effect on metabolism causes ever increasing weight gain in the absence of changing calories in or calories out?
Next Taubes' tackles the classic 20 calorie a day mismatch leading to 2 pounds of weight gain a year (roughly the average gain per year of North American adults) and then presents it literally which of course appears ludicrous and ridiculous. Are 3 extra chips a day causing you to gain weight? Of course not. Therefore according to Taubes' next straw man, calories in and calories out can't be causal for weight. Forget about the fact that calories can come in clumps. 3,500 calories in extra Christmas time treats doesn't sound to me to be too off the mark and those alone would take care of 175 of Taubes' 20 calorie days. Tack on a couple of birthday celebrations, a vacation and a visit or two to a Chinese buffet and we're more than done.
Next comes cows. Taubes shows us pictures of two cows. One an Aberdeen Angus - fatty and delicious looking. The other a Jersey milk cow - lean and chewy looking. He then goes on to state that it's not possible that breeders have simply manipulated genes to make the Aberdeen cow hungry and the Jersey cow active. Instead Taubes argues that genetic breeding has impacted on these cows partitioning of fat (one to flesh and one to milk production). While I don't disagree with him, his conclusion that their genes don't determine how many calories the animals consume, but rather what their bodies do with those calories doesn't in any way support or refute the notion of calories in or calories out. A quick Google image search had me staring at some pretty hefty Jersey cows and some Anguses with very visible rib cages, and I'm fairly confident that were female Angus cows given hormones and milked daily, they'd also have big full udders. Could it be that cows do in fact behave both according to the laws of thermodynamics and also according to their genetic makeups? That's where my money'd be in Vegas.
Taubes' own cognitive dissonance appears mid book and it led me to be briefly more hopeful. Taubes was going on about the first law of thermodynamics (TFLOT) (that energy can neither be created nor destroyed - the cornerstone of the calories in/out hypothesis of weight). He actually seemed to agree with TFLOT but then tried to suggest that talking about "overeating" is not the same thing as talking about "energy" and that the important question to ask is, "WHY",
"Why do we take in more energy than we expend? Why do we overeat? Why do we get fatter?"I agree, those are tremendously important questions and moreover I agree that macronutrient distributions (one's daily dietary spread of carbs, fats and proteins) for many folks likely play a big role in those whys.
Sadly Taubes takes a strange road to walk in following up on those whys. Taubes rages against the calories-in/calorie-out hypothesis stating that one would be, "hard-pressed to find (a concept) more damaging". He states the calorie concept has done, "incalculable harm", that it has fueled the obesity as a function of sloth and lack of willpower that lays blame squarely on each obese person's ample shoulders.
I wholly disagree with him. It's not the concept that's done so much harm, it's the misuse of the concept, its oversimplification and its grossly unfair, individualized, blame-based application. The danger and the harm lies solely with the failure of society and medicine to ask why are people consuming so many more calories - a failure Taubes so rightly pointed out just a few pages prior.
Amazingly, despite his embrace of the concept that different bodies do different things with the calories presented to them (as evidenced by his discussion of the fat partitioning of cows), next he comes at the reader with this painful series of questions,
"It's the environment we live in that makes us fat, we're being told, not just our weakness of will. Then why don't lean people get fat in this toxic environment? Is the answer only willpower?Could Taubes possibly be suggesting that genetic variation only impacts upon fat distribution and that it's silent in terms of dietary choices, inclination towards activity, non-exercise induced thermogenesis, the thermic effect of food, resting energy expenditures, etc? Does Taubes truly consider us all to represent a single genetic and metabolic lineage that should see us all uniformly responding the same way to a specific environment?
Taubes next talks of differences in fat distributions seen between men and women to support his assertion that the amount of fat is "exquisitely" regulated. To me all it suggests is that distribution is regulated. Then Taubes launches into a discussion of wild animals and points to the fact that hippos and whales don't get diabetes and "never get obese" as further proof for his theories. He states that no matter how abundant their food supply, wild animals will maintain a stable weight and never become obese. Really? Do we track the weights of wild animals? Is there an animal NHANES database on squirrels, frogs and crows, or is Taubes, a man who purports to be a "firm believer in science" really just relying on his own observational assessments of animals and at the same time extrapolating wild animals to be useful to this discussion as small little human models appropriate for comparisons? Even putting aside a lack of actual data to support his thesis, even were it to be true that animals never become obese, could it not also possibly be the case that wild animals, most of who don't have very good health care plans, don't have the luxury of living long enough or healthfully enough to maintain gains in weight and that disease and early death help keep their weights down?
And what of human "wild animals". Up until a hundred years or so ago, obesity was a rarity for free-living humans as well, and I don't think Taubes will dispute the fact that genes tend not to change dramatically in just 3 generations. Clearly something else is at play - but for Taubes it's not excess consumption of calories that make us fat. Instead he believes carbs make us fat independently of thermodynamics, and in turn our fat itself drives us to overeat.
To support his point Taubes continues to lean on anthropomorphizations and frighteningly non-scientific comparisons with other species. He talks of elephants and blue whales eating huge amounts because they're huge. He talks of mice that are bred to be obese who when starved to death, still have more adipose tissue at autopsy, but to me all that proves is the notion that the distribution of calories is regulated by the body, not that calories don't count. Then he suggests that marathon runners run not because they choose to, or that they want to embrace what they see as a healthy lifestyle, but rather because their muscle tissue is regulated to take up more calories and they're literally driven unconsciously to burn off those calories by, "a very powerful impulse to be physically active". Who cares that there's no evidence to suggest that's true - that sound awesome. The reason I'm not a marathon runner is that my actual body isn't forcing me to lace up my shoes. And here I thought it was because I don't have much free time. But wait a second, I'm pretty damn lean and my diet's in the neighbourhood of 45-50% carbs, how can that be if carbs make people fat independently of energy consumption? But forget about me, I'm a case study of one. Forget too about the thousands of folks in the National Weight Control Registry who manage to control their calories and maintain their weights on low-fat (and hence high carb) diets. Forget too about the multiple studies that have looked at isocaloric restriction and haven't found significant differences between different dietary macronutrient distributions. No, instead I think it'd be fair given Taubes' penchant for observational data for you to do a quick observational exercise of your own. Think for a moment about all your leanest friends and relations. Are they marathon runners, obsessive exercisers or hard-core low-carb dieters? Perhaps some are, but I'm willing to wager, the vast majority aren't. What's up with them? How do they (and I) fit into Taubes' hypothesis?
And then there are simple non-truths. At one point Taubes states,
"You don't get fat because your metabolism slows, your metabolism slows because you're getting fat."But as anyone who measures resting energy expenditures knows, metabolism actually rises as one gains weight due to the very simple fact that the more of a person there is, the more calories that person burns, and that significant weight loss almost invariably results in significant decreases in resting energy expenditures. Perhaps Taubes is referring to the individual who stays the same weight but loses muscle in place of fat - but of course as a seasoned writer, he knows that's not how readers will interpret his statement.
So what's the cause of everything according to Taubes? Oh yeah, carbs. In fact he states that the reason any diet works isn't because of caloric restriction, but rather it's due to carb restriction, with the corollary also being true - weight gain's not a consequence of caloric intake, but rather carb intake. Tell that to Twinkie Diet guy Mark Haub who lost 34% of his body weight eating 1,800 controlled, processed carby, junk food calories a day purchased from convenience stores.
To hammer his point home Taubes ignores the fact that correlation doesn't prove causality and talks of how it was during the 60s and 70s that doctors stopped believing in the low-carb route to weight management and how this coincided with the obesity epidemic as a means to prove his thesis. Of course nothing else has changed since the 60s or 70s to promote weight gain has it? I mean the world's exactly the same as back then, isn't it? Same number of restaurants, same dollars spent outside the home on food, same time spent preparing home cooked meals, same number of food commercials, same fast paced electronically tethered existence, same portion sizes, same number of available foods in the grocery store, same cost per calorie of food, same everything, right? No? You think that some or all of those things and dozens more might impact on weight? Me too.
Next he launches into antique medical textbooks and their takes on low-carb diets as proof of his manifesto. Does the fact that antique medical texts through until the mid 19th century recommend phlebotomy to treat asthma, cancer and pneumonia mean that we should start practicing it again?
Taubes next argument centres around the suggestion that carbs were not evolutionarily a part of our natural diet and that consequently we did not adapt to high carbohydrate diets. While I don't disagree with the suggestion, unlike Taubes I can't make the stretch that the foods we became adapted to eating during the millennia that our life expectancies were in our 30s and 40s necessarily have a bearing on our health and long lifespans today. He points to indigenous peoples of the world and comments on how when they kill an animal they eat, "virtually all" of its fat as proof that's a wise way to live and that fat's healthy for us, and while there's no doubt that the data on fat suggest it's not particularly scary, the fact that hunger-gatherers try to make the most out of every meal they catch doesn't impress me much to prove anything other than hunting's tough. Further to his discussion of evolutionary dietary adaptations he notes of our modern refined sugars and carbohydrates,
"That a diet would be healthier without them seems manifestly obvious."And here I thought scientists were supposed to rely on evidence, not what seems obvious to draw conclusions. Sadly what seems, "manifestly obvious" isn't always a good or true idea as was evidenced by our reliance on the logic of the obvious in recommending decades of hormone replacement therapy to postmenopausal women.
Next up is his discussion of the Maasai tribesmen who he reports don't have cancer, heart disease or obesity and traditionally were very-low carb eaters. Of course they were also nomads who wandered and hunted all day long with life expectancies of 42 years for men and 45 for women - hardly a lifestyle or lifespan we should aspire towards and certainly potential explanations in and of themselves for the Maasai's lack of heart disease and cancer - both diseases tightly associated with age and at least partially preventable by means of exercise.
So how does Taubes' explain the impact of carbs on weight? Amazingly he states,
"We know the laws of physics have nothing to do with it."Ultimately he embraces the notion that carbs make you fat regardless of the calories in/out hypothesis, rather than discuss such possibilities as carbs making you fat by having a lesser impact on satiety. Mid book I had hoped this was where he was going, but sadly, for reasons that are backed up by observation, inference, logical fallacy and straw men, apparently he's decided that living creatures are magical beings that live independently of the laws of physics and thermodynamics.
Taubes doesn't just rely on non-scientific argument, he also appears to be comfortable in ascribing his beliefs to other people and to omitting facts when its convenient. In discussing the World Cancer Research Fund's Food, Nutrition, Physical Activity and Cancer Report that concluded obesity and cancer were tightly linked he calmly states,
"If the expert authors of the report had paid attention to the science of fat accumulation ... they would have concluded the obvious: that the same carbohydrates that make us fat are the ones that ultimately cause these cancers"Yeah, I'm sure none of these folks know anything about the physiology of fat. On omission - there's no doubt that Taubes knows that between 5-10lbs of weight are lost on a low-carb diet due to the mobilization of the water stored with glycogen, yet when discussing the A TO Z Weight Loss study, he doesn't bother to mention that the 9lbs lost in the first 3 months of the study almost certainly included a significant percentage from the water lost due to the participants' adherence to ketogenic carb limitations and that some of their regain as they added carbs back in was also likely just water weight.
Finally Taubes talks of the individuals who have cut their carbs down to nothing and still can't lose weight. He quotes Wolfgang Lutz, an Austrian low-carb practitioner from the 50s as stating that those patients must have "reached a point of no return". Makes sense to Taubes because he doesn't believe that the laws of physics apply to people and therefore it wouldn't be consequential to him (or presumably Lutz) if perhaps those folks were simply consuming too many fat and protein based calories.
Why We Get Fat is certainly a book that will appeal to the masses as it pseudo-scientifically preaches that carbs are a magic food and that if you eat almost none of them - the diet he recommends includes 20 grams (less than an ounce) a day - you'll magically lose weight. Perhaps more appealingly, Taubes and Why We Get Fat also preach that you can eat as much fat and protein and you want and you'll never gain. Of course that's pretty much identical to the original Atkins' diet, and virtually all of the diets that Taubes himself references. You think that maybe, were it that easy the world would already be skinny? That low-carb would have continued its huge surge from the early 2000s (or the mid 1800s)? Why didn't it? Not because it doesn't work as for many folks it does - by means of folks on low-carb diets naturally eating, wait for it, smaller numbers of daily calories because they're not as hungry. No, ultimately I think that low-carb diets didn't continue to surge because most folks don't want to adhere to them as by their very definition they meet the classic definition of a "diet" - blind restriction and deprivation - things most folks don't want to live with for a lifetime.
At the end of the day Why We Get Fat's likely fate is to serve as the book for the next century's Taubes to point at, just as Taubes pointed at Banting's, in discussing how science has overlooked the horrors of carbs. Nothing new to see here, it's just another magic diet book.
The question that bothered me most throughout the book wasn't about carbs or thermodynamics, but rather why has Taubes chosen to argue his points like he's a Grade 9 student writing a high school science project rather than a well respected, scientific journalist? Some have suggested it's simply to sell books and have acerbically changed his name to Gary Taube$. I don't know, I think he was probably already doing pretty well for himself before this book was published. Perhaps the best explanation for why Taubes seems to have abandoned thoughtful journalism in place of this mess is his comment near the end of the book,
"One problem here is that when people, experts or not, decide to review the evidence on an issue dear to their hearts (me included), they tend to see what they want to see. This is human nature, but it doesn't lead to trustworthy conclusions."Well said, and readers of this book, are best advised not to forget it.
Saturday, January 08, 2011
Orac rips CNN's Sanjay Gupta a new one over his coverage of faith healer John of God
In the first of a series, the BMJ details Wakefields fraudulent accounts that led to his infamous MMR/Autism linkage paper.
My friend Arya Sharma covers Village on a Diet - be sure to read through to the comments as there's one left by Ali Zentner, the show's physician, followed by a thoughtful rebuttal by Arya.
Fabulous (a must click) flow chart from Darya Pino at Summer Tomato as to how to tell if you've chosen a "real" food at the supermarket.
A crazy underground video about places you've never been to in New York City (the Undercity).
Friday, January 07, 2011
My kids loved this Funny Friday video and so did I (we're all rather juvenile).
It doesn't need much in the way of introduction but certainly helps to illustrate the fact that there are talented people out there with way too much time on their hands.
Have a great weekend!
(Remember email subscribers, if you want to see it, you'll need to head on over to the blog)
Thursday, January 06, 2011
While of course there are lots of bad doctors out there, it's stories like this one that make my blood boil.
What's the story?
Well it's about an enterprising young physician named Dr. Alexander Hughes.
According to Dr. Hughes' publicist Kelly Striewski of B|W|R Public Relations (whose assistant Logan Hayes kindly emailed me the story and clearly didn't bother to spend even a moment reading my blog to see what I'm all about), Dr. Hughes is "attractive" and "young", and apparently he's also created a line of functional drinks (called unimaginatively "Function Drinks") that prominently report on their labels, "Created by Physicians" and purport to do all sorts off wondrous things.
So who's Dr. Alexander Hughes?
According to his employer the New York's Hospital for Special Surgery, Dr. Alexander Hughes is an assistant attending orthopedic surgeon who specializes in the surgical management of traumatic, degenerative, and deformity-related conditions of the cervical, thoracic, and lumbosacral spine. His website also provides a long list of conditions and disorders with which he's familiar.
Not shockingly for a spinal surgeon, but surprising given the drinks he's peddling, nutrition's not one of them.
Interestingly his profile reports that he has "special expertise" in, "enhancing patient experience and outcomes through innovation and clinical research.".
So does his publication list include any clinical research having to do with nutrition or functional ingredients?
Yet his Function Drinks - Urban Detox, Light Weight, Shock Sports and Alternative Energy, all sold explicitly on the back of Dr. Hughes' medical degree, apparently contain functional ingredients that will cure hangovers, burn fat, block sweet food cravings, "scrub smog", "speed your natural recovery", release energy and, "support proper circulation".
How a physician who purports to care about research is comfortable selling sugar water with fancy sounding ingredients with clinically unsubstantiated promises is beyond me. So too is how he can look his colleagues in the eyes and why the Hospital for Special Surgery, regardless of his surgical skill, wants a physician like that on their roster.
I also wonder whether or not his enterprise is even kosher as I'm pretty sure that here in Canada, were I to pimp out my degree on products making non-evidence based health claims, I would be censured by the College of Physicians and Surgeons of Ontario and forced to take my name and degree off of those products immediately lest I lose my license to practice medicine.
Remember folks, just because someone has a medical degree, it doesn't mean you should inherently trust them.
Wednesday, January 05, 2011
For a show called, "Village on a Diet", they sure do a lot of exercise.
The show's premise is pretty straight forward. There's a town in British Columbia called Taylor and it's not a particularly healthy town. Overweight and obesity run rampant, there's no grocery store, and residents rely on junk food and take out to eat. The town council, in a dramatized staged for TV scene vote to fix the health of their town and fly in 2 fitness trainers, a dietitian, a psychologist and a physician to help the town lose 2,000lbs in 3 months time.
And how are they going to do it? Why with, "a team of butt kicking experts" of course, because clearly the town must just be lazy. Gosh, weight management is so easy, just like Village on a Diet trainer Mike Veinot says, "If they stick to it, it works. It's a simple solution to a huge problem".
Yup, easy peasy.
The first episode provides the cookie-cutter, boot campy style exercising, replete with yelling, overexertion to the point of vomiting (there's a great way to get someone to love exercising), and teasers of folks running with hay bales, pulling cars and doing whole piles of exercises that people have come to expect from weight-loss television.
But hey, what about diet? Isn't what goes into our bodies responsible for 70-80% of what we weigh?
Yes, but the show doesn't let that bother them. In total they spent less than 20% of the show on food, a total of 8.5 minutes where basically all they taught viewers was that take out pizza's bad, junk food's bad, and that to succeed you've got to give up all your favourite foods and resist the temptation to ever eat them again. And even while talking about food, they focused on fitness, with one young boy whose eating habits they were exploring stating uncontested to the camera,
"The reason I'm probably overweight is because I don't get out that much, I just sit and play video games."Yeah, never mind what you're father's feeding your little body.
They also try to scare the townsfolk into action by having them take something they're calling, "The Body Age Test". You can take it too online at the Live Right Now website. But don't put too much stock in it. It told me my body age was 17.
Basically they've dumbed down the incredible challenge of successfully managing weight in an environment exceedingly hostile to weight management to be a MOVE MORE, eat less, it's so simple solution, and while I suspect the television cameras and the fact they'll have a national audience will indeed inspire Taylor to lose weight in the short run through classic under-eating and over-execising, if the first episode portends the town's 3 month approach, sadly I suspect their losses will be short lived.
Bottom line? This is a Village being put on a classic "diet" - nothing new here, and classic dieting has been shown in studies to fail in the long run over 95% of the time.
The one shining star of the show is Dr. Ali Zentner. While I can't understand why she'd lend her name to what so far seems like opportunistic and exploitative television, at least so far she strikes me as real, came off as warm, is a natural on camera, and I'd be willing to wager, unlike the show's trainers, behind the scenes with the townsfolk she'll be focusing on helping them to make more realistic changes. Time will tell.
Here's hoping the show gets better. Stay tuned for weekly recaps each Wednesday.
If you missed the show, you can catch it online here.
Did you see it? What did you think?
Tuesday, January 04, 2011
Is it an all liquid diet?
A fancy weight room and French foreign legion drill sergeants?
Hours of counseling?
So what is it?
It's a focus on food.
Exhibit A comes from the Pitie-Salpetriere Hospital in Paris where their obese and overweight patients are being given cooking classes. Patients are taught how to cook healthy, low calorie meals and in so doing are given a survival skill in navigating an obesigenic environment.
Exhibit B comes from the Beaupre School in Haubourdin, near Lille where students are given swipe cards to choose meals from the cafeteria. While the cafeteria does have options like fish and chips and pizza, the cards are smart and limit those choices to once weekly.
Obesity is an intake problem and while the question as to why society has started consuming so many more calories than in the past has yet to be answered one thing's for certain, any intervention that fails to address cooking and eating out isn't likely to lead to any remarkable outcomes.
Vive la cuisiner!
[Very belated hat tip to Kavita who passed me this tip in 2009 via the BBC]
Monday, January 03, 2011
Is that your weight loss plan? You're simply going to learn to eat less? You're going to choose smaller portions? You're going to "cut back"?
That's your plan?
If it were that easy, do you think you'd still have weight to lose?
If it were that easy, I'd be working in an emergency room somewhere because if all it took to lose weight were for people to simply, "eat less", the world would be skinny.
Ultimately what we choose to put on our plates reflects a sort of personal homeostasis - we put as much food on our plates as we feel we need to be satisfied. If you try to simply "cut back" without actually making any formative changes to the actual foods you eat and your timing of meals and snacks all you're going to wind up doing is feeling hungry, short changed and bitter for the short time you actually adhere to your overly simplified resolution.
You need to actually like your life with fewer calories. In order to do that, you're likely going to need to reformat your dietary organization so that you're using food in a manner that leads to less hunger and consequently more control.
My cardinal rules remain the same.
- 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.
- Limit refined/processed foods to the smallest amounts you need to be happy.
- Drink only as many calories as you need to enjoy your life (ie. minimize juice, alcohol, sugared beverages, milk etc.)
- Exercise for 40 mins or less and all you need is water. Exercise for more than 40 mins and add 100 carb based calories per 40 minute block to be consumed immediately before, during, or immediately after exercise.
- There should be no such thing as a forbidden food.
- Always, always, always, consider the calories of your dietary decisions in the same manner you consider price tags with your purchases.