Saturday, July 30, 2011

Saturday Stories - Shoves, Rush and front page news!


The New York Time's Mark Bittman suggests a shove would do better than a nudge to help change eating habits.

Want your kid to get fit? James Fell wonders if you should buy him a drum set.

Lillian's story leaped from the pages of this blog to make front page news in Nova Scotia!

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Friday, July 29, 2011

I bet you don't love dogs this much!

Hold onto your stomachs for this Funny Friday.

Some mild foul language.

Have a great weekend!

(email subscribers, to watch the video, you'll need to visit the blog)



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Thursday, July 28, 2011

Medicine isn't about blame, it's about treatment


Yesterday this blog saw a guest posting from Lillian, a Nova Scotian who fears she'll likely die before she reaches the head of her province's 10 year cue for bariatric surgery.

A great many folks left comments (both here and on my Facebook page). Some were supportive. Some were full of self-righteous indignation. Others I chose not to publish as they were incredibly rude and hurtful.

The bottom line for virtually all of the upset commentators was that Lillian just ought to do something. That she ought to fix this problem herself. That clearly she'd just given up. That she wasn't trying hard enough.

It was the good ole, pull herself up by her bootstraps and take things into her own hands crap, or a variant of I did it, so so can she, and while I'm thrilled for the folks who've experienced their own successes, they don't necessarily translate to others.

For readers who don't know, I'm not a surgeon. I'm the medical director of a behavioural weight management program. And while I've seen with my own two eyes many a person lose enough weight to preclude surgery, I don't delude myself into thinking that downloading the solution to extreme obesity onto personal responsibility is everyone's answer.

If there were a non-surgical, reproducible and uniformly effective plan for the management of extreme obesity, I'd agree with you, but the fact is, there is no such plan.

Of course, even if you do want to embrace personal responsibility as the sole cause of obesity, medicine isn't about blame. We patch up drunk drivers and folks who don't wear seat belts. We offer smoking cessation programs. We treat asthmatics who don't bother keeping up with their puffers, pneumonias exacerbated by the early discontinuation of antibiotics, and the psychotic breaks of folks who stop their antipsychotics.

Oh, you want surgical examples?

How about lung reduction surgeries in smoking induced emphysema; liver transplants in former alcoholics; or how about one that doesn't involve a so-called vice at all - heart bypasses on folks who simply didn't bother to take their blood pressure, cholesterol or diabetes medications?

We operate on them all in a timely manner, and so we should, and the public doesn't generally say boo.

But yet in the case of bariatric surgery, many people are up in arms about its timely provision.

Why?

Because for obesity, many folks feel justified discussing its treatment on the basis of blame based causation.

The thing is, aside from obesity it would seem, medicine isn't about blame, it's about treatment, and if there's a proven and viable treatment option, at least here in Canada, people believe it should be readily accessible by our heavily taxed population, regardless of how and why their conditions developed in the first place.

At the end of the day, Lillian rightly sees bariatric surgery as hope. Emotionally it would see her bolstered by a success which for whatever reason, and it's not for anyone to judge, you haven't walked in her shoes, has eluded her. Economically it would save Nova Scotia likely tens of thousands of dollars of care and may improve the Province's GDP by increasing Lillian's ability and duration for gainful employment. Statistically and medically, it will prolong her life, cure her diabetes and sleep apnea, and potentially provide her with a springboard to retool her world, meet her grandchildren, and enjoy a fuller life.

Can you think of any other area of medicine, with an equally dramatically effective treatment option, where people would feel comfortable preaching about personal responsibility trumping a patient's desire or right to access said treatment?

I sure can't.

Lillian shouldn't have to wait 10 years on a wait list for a gastric bypass, and blame has no place in the ethical practice of medicine.

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Wednesday, July 27, 2011

Nova Scotian on 10 year wait for bariatric surgery pens her own obituary


Today's guest post comes from Lillian, a Nova Scotian who is currently on their province's 10 year wait list for bariatric surgery.

She doesn't think she's going to make it 10 years and so she decided to write her own obituary to raise awareness about the lack of funding for bariatric surgery - a procedure proven to prolong life, improve quality of life, and markedly reduce weight-related co-morbidity in those with extreme obesity.

What a sad and salient statement about our health care system.

"To whom it may concern,

Today I am sending you a copy of my obituary so when I die on a waiting list for weight loss surgery that is 10 years long you can see that I tried to get the help and attention needed and its NOT there for me or for anyone. My province's health care failed me and many others who struggle with weight and obesity. Thanks in advance for reading this but please pass this on to anyone who will listen and support this case. WE as tax payers and humans need to be heard and helped. People need to stop putting a stigma and sweeping weight loss surgery under the carpet and realize people are going to die on this waiting list. HELP us help ourselves. I will continue to send this off to anyone who will listen and media included.

Yours truly

Lillian

Lillian's Obituary

We are sad to inform you of the untimely passing of a young mother, sister daughter and friend. She died at a young age due to complication with obesity that she fought for years to overcome. She was the youngest child of 7 and she leaves behind her 2 sons, who both lived at home with her. Her entire life was lived for her boys who she loved immensely and were her pride and joy. She was survived by her 3 sisters and 3 brothers, along with many nieces and nephews and great nieces and nephews. She loved to sew and do crafts and was an awesome cook and loved to help others and would give what she could to anyone in need. She enjoyed comedy and good laughs. Lillian suffered many years with asthma, server high blood pressure, pain due to stress on her joints from her weight and in the last while was diagnosed with sleep apnea and diabetes. There will be no flowers at her request and the body will be cremated as she would hate to be a burden on her family and have to be carried away to her final resting place by a tractor so she spared her family with finding a mass amount of pallbearers and more stares and jokes about her weight as her beloved family mourns the loss of her as they did throughout her life. She would appreciate if you speak out and support Obesity Weight Loss Surgery and obesity awareness and write a letter to your local MLA and to anyone who will listen.


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Tuesday, July 26, 2011

Health Canada's latest health hypocrisy


Yesterday Health Canada effectively banned cadmium from children's jewelry.

Why?

Because if kids accidentally put it in their mouths, cadmium carries with it a number of medical risks.

And of course it should be banned, after all that's what governments are supposed to do with toxins. Here's our Health Minister Leona Aglukkaq's take on a government's role,

"Consumer products that pose a danger to human health or safety may not be manufactured, distributed, imported or sold in Canada. This proposed guideline makes our expectations of industry clear."
Begs the question of course, why then has the government failed to move on trans-fat?

According to the head of Health Canada's own Trans-Fat Task Force, trans-fats are,
"a "toxic" killer that need to be removed from the food chain as soon as possible"
where,
"the longer we wait, the more illness and in fact death will happen, so we know we have to get it out of our food supply"
and that,
"there is no safe amount of trans consumption"
Tony Clement, the then Minister of Health promised in June 2007 (in a speech that Health Canada conveniently no longer hosts on their websites) that if in 2 years a voluntary approach didn't remove the toxin from our food supply, that regulations would be put in place.

And here we are, over 2 years past that overly generous deadline, and Health Canada's banning cadmium, this despite the fact that the toxin kids in Canada are most likely to put into their mouths in Canada is trans-fat (adults too).

If Health Canada actually cared about our health, trans-fats would have been gone back in 2007, no voluntary free pass, and no lip service about potential regulations.

Only reason trans-fat isn't gone is because politically, it's more challenging to do, and at the end of the day Health Canada sadly, apparently cares more about politics than it does about the health of Canadian children.

(What it really means is that there isn't much of a pro-cadmium lobby here in Canada, because if there were, there likely wouldn't have been any announcements made yesterday.)

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Monday, July 25, 2011

Do high salt diets impair reading comprehension?


While I'm certainly not one to suggest people shouldn't champion their opinions, I think it's important to champion them based off facts and not headlines.

These past few weeks have seen a flurry of activity in the pro-salt camp that suggests we've been barking up the wrong tree.

A great many folks have linked to a recent article published in Scientific American. The article, It's Time to End the War on Salt, appears to be explicitly written in response to a newly published meta-analysis on salt reduction.

The meta-analysis, Reduced Dietary Salt for the Prevention of Cardiovascular Disease is reported by Scientific American as finding,

"no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure"
Scientific American then goes on to report on another study from May that found an association between dietary salt reduction and increased mortality in folks with congestive heart disease, to make it's case that, "it's time to end the war on salt".

So what's my beef? Certainly if the data suggests we've been barking up the wrong tree, we really ought to change our tune, after all, that's what evidence-based medicine's all about.

While that's true, it's also important to look critically at the actual data.

So let's look at those two studies that Scientific American uses to conclude that it's time to end the war on salt.

The Harvard School of Public Health explains that the increased mortality study cited by Scientific American, used only a single day of sodium excretion upon which to base all of their findings; that they didn't control for even basic confounding variables such as height, physical activity and total calories; and that there was a great deal of missing data from participants.

Unfortunately those are enormous problems, and certainly calls into question, if not outright negates, the utility of the paper's findings to draw any firm, actionable, opinions.

And what of the Cochrane Review?

Why don't I just quote directly from the opening line of the Review's Author Conclusion's section,
"Our findings are consistent with the belief that salt reduction is beneficial in normotensive and hypertensive people"
They then go on with their call to action,
"The challenge for clinical and public health practice is to find more effective interventions for reducing salt intake that are both practicable and inexpensive."
That sure doesn't sound like ending a war, it sounds like an RFP for new weapons.

So while I think healthy debate is in fact healthy, I would have thought that magazines like Scientific American, and many of the intelligent commentators on this and other blogs, would in fact do their due diligence to read and critically appraise studies, before getting on any particular bandwagon.

To put this another way, while it's wonderful to question, make sure your questions are based on sound science, not on sound bites, and while you might think salt's harmless, basing your conclusion on these recent papers and media reports isn't a reasoned decision.

Reminds me of a wonderful Yiddish proverb, "What you don't see with your eyes, don't invent with your mouth".

[And for other takes on some of this salt spin, have a read of the Globe and Mail's Carly Weeks' discussion on some of the conflicts of interest inherent to the spin, and Science Based Medicine's Scott Gavura who relates salt's recent reporting to confirmation bias]

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Saturday, July 23, 2011

Saturday Stories


Andy Bellatti with a fabulous post on how the dietetic profession hinders itself. If you're part of it, it's a must read!

Appetite for Profit's Michele Simon explains to Obesity Panacea why she thinks public-private partnerships between Big Food and health organizations are a bad idea.

The CDC updated their interactive obesity map.

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Friday, July 22, 2011

Hostess vitamin fortified, body-building snack cakes

Bodies can get built in many directions after all.

Thanks to Small Bites' Andy Bellatti for finding this gem for Funny Friday (email subscribers, you've got to head to the blog to watch).

Have a great weekend!



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Thursday, July 21, 2011

Campbell's only re-salting American soups


So a few days ago I blogged about the re-salting of Campbell's soups in response to lagging sales.

Andrea Dunn, Campbell's "Nutrition Strategy Manager" read the post and emailed me with a clarification,

"Good Evening Dr. Freedhoff,

In light of recent media coverage and today's update on Weighty Matters, I wanted to personally assure you that Campbell Canada remains committed to sodium reduction over time and clarify our Canadian approach.

In Canada, there are currently no plans to add salt back to our existing sodium-reduced varieties. It’s also important to note that the Select Harvest soups as well as four of Campbell’s condensed varieties that will be re-introduced in the US market are not available in Canada.

Campbell Canada has been a leader in sodium reduction since 2003. To date, we’ve removed the equivalent of more than 46 million teaspoons of salt from more than 100 of our recipes. Our approach remains to adjust Canadians palates to the taste of healthier sodium levels by gradual and consistent reduction over time. As an example, we’ve reduced Campbell’s Condensed Tomato soup by nearly 50 percent over the years and it now has five tomatoes per can.

Please let me know if you have any questions
."
I only had one question, and I emailed that to Andrea a few days ago, but haven't heard back.

I asked if she would care to comment on her American cousin's plans. While certainly there's public debate on the role of sodium reduction, it would seem from Andrea's email that Campbell Canada believes it to be quite important.

Should Andrea respond, I'll be happy to post the response for you readers.

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Wednesday, July 20, 2011

Leukemia and Lymphoma Society labels Krispy Kreme fundraisers, "heroes"


And maybe they are, but not because they're selling Krispy Kreme doughnuts, but rather because they're trying to support an important cause.

In case you're new to this story, short version was me blogging last week about folks fundraising for Leukemia and Lymphoma research by selling Krispy Kreme doughnuts. What I wondered aloud was whether or not fundraising for healthy causes by selling unhealthy products was the best way to fundraise.

My post caught the eye of Leukemia and Lymphoma Society Public Relations Director Andrea Greif who wrote me an email. Here's what she had to say,

"Your post, “Krispy Kreme for the Cure,” pokes fun at some participants of The Leukemia & Lymphoma Society’s Team In Training (TNT) for using sales of doughnuts as a fundraiser to help advance blood cancer research while they train for a marathon. However, your reference to some studies that allege a connection between obesity and leukemia must be taken seriously.

It is important to note that the recent meta-analyses referred to in your article, concluding that “excess body weight may increase the risk of developing leukemia," were neither randomized nor controlled by any other gold-standard approach.

Obesity does seem to associate with a slightly increased risk of leukemia, but this does not prove any causal link. Clearly, obesity is linked to serious health concerns, including diabetes, and studies have shown that fat stores can affect metabolism of some anti-cancer drugs which may at least partly explain the other leukemia finding you mention.

In any case, doughnuts eaten in moderation, especially by marathoners who need to carbo-load while training and running their races, are not the problem. TNT participants employ many creative methods to take on the challenge of fundraising for the cause, and surely there is no harm done in athletes enjoying the occasional doughnut. TNT participants are heroes in their own right, and are raising money to support the critical work of researchers who are heroes too
."
Now if you read my post, you'll know I didn't poke fun at anyone, but I suppose that's in the ear of the beholder.

What was interesting to me about Andrea's response is her rationalizations - that doughnuts eaten in moderation by marathoners aren't so bad, and presumably therefore, neither is selling them to raise money for the Leukemia and Lymphoma Society.

So I agree that doughnuts eaten in moderation by anyone aren't so bad, but of course that's not the point.

The point is that organizations who care about health shouldn't be in the business of selling unhealthy products, especially products that may have a link to the condition championed by their organization. The rationale isn't because eating a single doughnut will kill you, the rationale is that elevating the brand and consumption of unhealthy products in the name of a few research dollars isn't a fair trade.

The Leukemia and Lymphoma Society, along with all other health charities, should establish guidelines and rules governing fundraising which in turn would prohibit the sale of junk food, because even if the link to leukemia isn't ultimately found to be causal, junk food's link to a veritable mountain of other chronic disease undoubtedly is.

[Oh, and Andrea, one last thing. While you're right to point out that the gold standard of research are randomized trials, I'm pretty sure we're never going to see a trial that randomly assigns people to gain weight to test the hypothesis that weight is causally linked to leukemia. Instead we're probably going to need to rely on the very types of meta-analyses that you casually toss aside as not being important.

And about carbo-loading, you might want to have a peek here.]

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Tuesday, July 19, 2011

Are large amounts of exercise essential for weight loss maintenance?


Let me start things off by telling you that I do believe exercise to be extremely helpful in long term weight management. I'll also tell you that I'm a huge fan of the National Weight Control Registry. For those of you who aren't familiar with the Registry, Registrants are folks who are supremely good at maintaining their weight-losses. In fact, the average Registrant has lost 67lbs and kept it off for 5.5 years!

There's a great deal of variety in the Registry. Different types of dietary approaches and different strategies as a whole, but there are some commonalities, and exercise is one.

Studies on Registrants have their self-reported exercise as being quite high - an average of 58.6 minutes a day!

What we didn't have was an objective measurement of same, and sadly, despite a new study with Registrants and accelerometry, I'd argue we still don't, though it seems it wasn't the researchers fault.

26 Registrants were recruited to wear accelerometers for a full week and were matched with a never obese group, and an overweight, not Registrant control group.

The results were pretty interesting. Measured exercise actually turned out to be significantly less than self reported at 41.5 minutes a day (rather than nearly an hour), but was still of greater duration in Registrants than overweight non-Registrant controls and marginally more than never obese weight-matched controls.

But are the results useful? Do they really answer the question as to the importance of exercise in successful weight maintenance?

I'm not so sure. The problem I've got with the study's methodology is that Registrants were recruited with a description of the study's aim. Meaning that prior to enrolling they knew they were enrolling themselves in a study that involved objectively measuring their activity levels.

To me that's a big deal. It's a big deal because I would imagine that human nature would dictate that the folks who respond to just such a study are the ones who are the most proud of their activity levels (or the least embarrassed depending on how you want to look at it).

I suspect too that this was a limitation the authors were aware of as beside the disclosure in the methodology section is the parenthetic explanation, "(as required by our institutional review board)".

Another frustration from the study was the fact that individual data points weren't provided. Given the small number of subjects, I would have loved to see the distribution of minutes of exercise - especially given that in their discussion they mention that 2/3 of subjects engaged in >150 minutes weekly, and 1/3 of subjects >300. Did exercise reflect a normal distribution? Was it bimodal? Were there dramatic outliers?

Bottom line for me, I'd have loved to see this study performed with a random sample of Registrants, not a sample who may have self-selected for being more active. That's not to say the findings wouldn't necessarily be the same, but given this study's methodology, I wouldn't be hanging my hat on these results.

[Also fascinating (though not surprising) was the result that objectively measured exercise was significantly less than self-reported. Furthermore, if my assertion that folks who were better exercisers were more likely to have agreed to enroll, that result casts major doubt on the National Weight Control's finding of massive amounts of exercise being integral to maintenance.]

Catenacci VA, Grunwald GK, Ingebrigtsen JP, Jakicic JM, McDermott MD, Phelan S, Wing RR, Hill JO, & Wyatt HR (2011). Physical activity patterns using accelerometry in the national weight control registry. Obesity (Silver Spring, Md.), 19 (6), 1163-70 PMID: 21030947

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Monday, July 18, 2011

Campbell's soup resalting belies true corporate responsiblity - profit.


To be fair, and to be clear, at the end of the day, nothing can matter more to corporations than profit, as without profit, there'd be no corporations.

Oh sure, corporations need to ensure they sell safe products, and they need to treat their employees fairly and such, but as far as "corporate social responsibility" goes, there's really no such thing.

That's not to say there can't be corporations who provide incredible contributions to worthy causes, it's just to say that it's their choice to do so, and not their "responsibility", and that at the end of the day, their responsibility, especially when discussing publicly traded companies, is for profit. Simply and fairly put, if a corporation's socially responsible moves impact negatively on their bottom line, you can rest assured, they'll move to eliminate them.

Campbell's recent soup re-salting is a perfect example.

The Campbell Soup Company's original de-salting was a move trumpeted both by Campbell and by many public health organizations, as a shining example of so-called corporate social responsibility.

The Campbell Company milked it for all it was worth, producing at least two television spots congratulating themselves (email subscribers, videos are on the blog). The first involved Hilton, a Campbell employee who, "questioned all the salt". They then filmed Hilton standing in a room where the salt the Campbell Company had removed reached his waist. The second involved Michael, another Campbell employee, who admitted that he didn't feel comfortable feeding Campbell soups to his children, "he didn't always feel right serving them at home". They then filmed him eating with his family with the then sodium reduced soup he could presumably feel good about.

Public health organizations and health care professionals bought into it hook, line and sinker.

Blood Pressure Canada even awarded Campbell's a "Certificate of Excellence" to commend Campbell for "the company’s continuing sodium reduction efforts and industry leadership".

Their fawning over Campbell's was certainly understandable given the powerful statements the corporation kept making. For example, Philip Donne, President of Campbell Company of Canada, in a press release from just one short year ago, referencing last year's Sodium Working Group call to reduce sodium consumption, stated that he believed the call to action was an urgent one, "We are pleased to see that many of our peer food companies are joining us in efforts to advance their sodium reduction programs. And for those who don't sense the urgency, the Sodium Working Group's recommendations may be just the motivation they need".

Or how about that of Andrea Dunn's, the Campbell Company's so-called, "Nutrition Strategy Manager" who in that same year old press release explained, "Campbell Canada's approach of gradual and consistent sodium reduction is helping to adjust our consumers' palates to the taste of healthier sodium levels".

So what do you think the Campbell Soup Company will tell Hilton and Michael now that the sales of their less salty broths faltered, and in response out came their corporate shakers? Will Blood Pressure Canada rescind their award, and will Campbell's stop bragging about it? Will Andrea Dunn quit in protest, and will Philip Donne, who when awarded Blood Pressure Canada's award stated, "We know there is still more work to be done and we are hopeful our leadership will inspire industry changes", ponder on his leadership inspiring industry change for increased sodium?

Not a chance.

And what of the public who were led to believe that health steadied the hands of Campbell's?

At the end of the day people need to remember that corporations don't do things out of the goodness off their hearts, they do them out of the goodness of their balance sheets. Sure, if corporations can make money and do good, they will, and good for them, but please don't ever kid yourself about true corporate responsibilities, as by definition they boil right down to plain old dollars and cents.

video

video

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Saturday, July 16, 2011

Saturday Stories


Salon on vegetable price politics!

My new radio column for the CBC (this week we explored the call for child protective services for extreme childhood obesity).

Travis on Obesity Panacea begs you to stop sitting so damn much!

Arya does a great job covering the non mutually exclusive concepts of environmental impacts on weight and personal responsibility.

Marion Nestle covers salt!

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Friday, July 15, 2011

Not every kid's excited about learning to ride.

Not sure if you caught an inspirational video that went viral.

It was of a young lad who conquered riding his first two wheeler.

It's a great video and I'll post it below (email subscribers, you need to visit the blog to watch).

I'm guessing the kid in the second video, this week's Funny Friday, doesn't feel quite the same way.

Have a great weekend!





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Thursday, July 14, 2011

Can childhood obesity warrant child protective services?


That's what an editorial published in this week's JAMA, written by Lindsey Murtagh and David Ludwig states.

The main stream media is painting the authors' suggestion as alarming and extreme, but reading the actual editorial, I'd argue it's anything but.

The authors weren't writing about removing kids in homes with excessive junk food and XBOXs, and a few pounds that some chart or physician might suggest they ought to lose. The authors were writing about "severe pediatric obesity", which they defined as a BMI beyond the 99th percentile, and where interventions designed to help those kids' parents failed to help their children.

The authors argue that extreme pediatric obesity can be life threatening, that it can cause immediate and potentially irreversible medical complications, and that it can markedly shorten life expectancy. Surprisingly, not mentioned by the authors is the psychosocial impact of severe obesity on children, where studies have documented terrible bullying and stigmatization which in turn impact on a child's mental health and education.

According to American federal laws child abuse and neglect are defined as,

"any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm ... or an act or failure to act which presents an imminent risk of serious harm"
The authors estimate that for a child to be in the 99th or higher percentile for weight that they are likely consuming a minimum of 1,000 more calories per day. Put in some perspective, that would be the equivalent of 2-3 additional meals worth of calories daily.

To look at the issue of child protection broadly, for me, as a father, as physician and a member of society, if there's a family actively engaging in any behaviour that can dramatically and potentially permanently harm their child, and if with counselling and intervention they don't modify that behaviour, then yes, I think state intervention is appropriate.

To discuss this properly though, people need to understand what state intervention means, and what I gather from the press reports and their online commentators is that people don't understand how the system works. People don't seem to appreciate that the path from a visit from a child welfare organization, to a child's removal from that home, except in the case of suspected sexual or physical abuse, is not a rapid process.

I checked with my wife who used to work for the Children's Aid Society as a child protection worker, and according to her, in the case of obesity what this would entail would be starting with interviews and medical testing and evaluations to rule out any medical conditions that may be impacting on weight, or any other factors outside of parental control, followed by parental education and family visits with pediatric obesity teams and specialists, followed by regular visits and weigh-ins to assess impact. If the child in question continued to rapidly gain there may then be a circumstance where the child is placed temporarily in foster care and weight measured outside the home environment. If the child lost or maintained weight in foster care, that would bolster the case for there needing to be a change at home. If after what would almost certainly amount to more months of education and effort there were still no improvement, only then would there be the possibility of a more permanent removal.

Society wouldn't hesitate to address undernourishment as a risk worthy of state intervention. Given extreme overnourishment is a tremendous risk as well, why shouldn't severe childhood obesity be a child welfare concern?

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Wednesday, July 13, 2011

Krispy Kreme for the Cure!


Whoops, I'd better watch myself, the Susan G. Komen folks may send me a cease and desist letter for using the words, "for the Cure!".

Today's brand polishing opportunity comes on the heels of the Leukemia and Lymphoma Society's Team in Training who apparently are selling Krispy Kreme doughnuts to fundraise.


So what's the Leukemia and Lymphoma Society's Team in Training all about? It's a,

"year-round marathon training program reaches highly-motivated and dedicated women and men who are active consumers and interested in taking on the ultimate challenge of running or walking a marathon, completing a 100-mile century ride or a triathlon."
Participants are asked to help fund the research to end this disease once and for all.

And I get it, training's expensive, and fundraising's important, and why not lean on the generosity of Krispy Kreme to help?

That's a fair question, but so too is the question, what's in it for Krispy Kreme?

The answer may be as simple as altruism, but I think it's more likely about brand polish, as the practice of coupling an unhealthy product with a healthy cause is a great way to encourage people to feel good about buying the unhealthy product and helps to elevate the unhealthy brand as a whole.

In terms of the impact of obesity on leukemia?

A recent meta-analysis concluded,
"findings from this meta-analysis of prospective studies provide evidence that excess body weight may increase the risk of developing leukemia"
While other studies have demonstrated that
"obesity in children 10 years and older is associated with a 50% increased recurrence of acute lymphoblastic leukemia"
No one would ever raise money for lung cancer research by selling tobacco products, and while I realize it's an extreme parallel, I do think it's important to recognize that unhealthy products tie themselves to these types of causes because it benefits them, and while fundraising to help fund leukemia research is a wonderful and worthy cause, is there really nothing else these kind hearted, motivated folks could sell to fund their cure?

[Hat tip to CarrotLines' Wahiba Chair!]

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Tuesday, July 12, 2011

Does U2 think your weight is shameful?


No snark here, I just don't know the answer.

My friend and colleague Dr. Glenn Posner snapped the photo up above when he was at the recent U2 concert in Montreal.

According to him, the scoreboard had all sorts of statistics including:

How many births this year?
Deaths?
Deaths from smoking?
Population of the stadium?
World population?
Current time in different cities?
How many years the leader of Thailand spent under house arrest?
Amount of money government spends on education?


Another friend who went told me there were more, including number of people starving, homeless, unemployed, etc.

Sounds like the theme to a degree are things of which society might want to be ashamed.

So what's your take on their inclusion of,

"Overweight people in the world"?
Undoubtedly I see the world through weight-sensitive glasses, and consequently my read on this is that U2 considers it to be a shameful statistic, reflective of gluttony. If they wanted it to reflect a failing of our environment leading to global weight gain they'd have included statistics like,

Number of commercials for fast food a kid sees before they're 4.
Crop subsidies given to corn and HFCS vs. fruits and vegetables.
Percentage of parents who think juice is a fruit.
Percentage of kids who go to school without breakfast.
Percentage of schools with deep fryers.
Percentage of schools selling chocolate milk and sport drinks.
Average number of fast food restaurants within walking distance of a school.
Dollars spent on meals not cooked at home.
Percentage of families that still have family dinners every night.


Of course, maybe I'm just being overly sensitive. Am I reading too much into this?

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Monday, July 11, 2011

The American Journal of Clinical Nutrition's recent peer review failure.


There's got to be a better way than peer review, because if papers like this one can make it through, the system is broken.

The paper's entitled, Dairy attenuates oxidation and inflammatory stress in metabolic syndrome, and it's written by Renee Stancliffe, Teresa Thorpe and Michael Zemel.

The paper's aim was to study the impact of dairy on oxidative and inflammatory biomarkers in individuals with metabolic syndrome, following 12 weeks of being randomized to different levels of dietary dairy. They also measured waist circumference.

So what's got my feathers ruffled?

The whole point of this study was to determine the impact dairy intake had on oxidative stress and inflammation, yet the design of the study had the folks in the "low" dairy group substituting dairy with 3 daily servings of prepackaged non-dairy foods so as to maintain comparable macronutrient intakes between groups.

So? Wouldn't ensuring a uniform macronutrient intake be a good idea?

Absolutely, but not if the foods you use to ensure uniformity have a known impact on oxidative stress and inflammation! And so what was on the list of foods provided to the low-dairy folks? Among other things processed luncheon meats and trans-fat containing peanut butter crackers.

The authors do in fact mention this as a potential confounder in their conclusion, but certainly for me, given that there was no need whatsoever to provide the subjects trans-fat containing foods (there are plenty of trans-fat free cracker choices) or processed meats, it'd have been a peer review deal breaker.

Unfortunately, there's more.

Waist circumference was also a variable they measured, and they concluded that the higher dairy group significantly reduced their waist circumference and trunk fat. Yet they chose to measure waist circumference, not from an anatomical landmark, but rather from midway between the lateral lower rib margin and the ileac crest at mid-exhalation. While the NHLBI and NIH recommend using an anatomical landmark (the ileac crest), the WHO recommends the midway point described in this paper. However no one recommends mid-exhalation because that's a fairly impossible thing to measure. What this translates to mean is that there was ample room for subjective error, all the more so given that there's no mention of blinding at all in the study methodology.

Next there's their description of their diet modalities. They describe their dairy arms as, "low" and "adequate". Adequate is a subjective term. To me, adequate means sufficient, but certainly not ideal. While they might argue they used the term "adequate" because that arm consumed the USDA recommended number of dairy servings, then perhaps they could have used, "USDA recommended" in place of "adequate". Subjective adjectives have no place in a research paper, and it clearly suggests author bias as to the benefits of more dairy.

So do the authors have a conflict of interest?

Not according to them. The last line of the published paper clearly states,

"The authors reported no conflicts of interest"
Yet conflicts of interest are almost unavoidable in research. If you're an expert at something, chances are you've benefited from your expertise, and even if you feel that your benefits don't put you into conflict, conflicts of interest must be disclosed if there's a possibility that a person's interests could be even just be fairly perceived as a conflict.

So let me ask you, do you think it could fairly be perceived as a conflict of interest to be an author of a study aiming to look at the outcomes of differing degrees of dairy on inflammatory biomarkers and waist circumferences, that's designed with an entirely unnecessarily built in trans-fat containing inflammatory confounder, a lack of blinding, and a subjective means of measuring waist circumference, when you yourself have a patent on the use of dairy to affect fat loss? Or how about if you authored a diet book called, The Calcium Key, where one of your claims was that dairy would,
"Triple the rate of fat lost from your abdominal area–the "belly fat" that puts you at greatest risk for high blood pressure, high cholesterol, heart disease, and Type 2 diabetes"
If you answer, "yes", then the next question you've got to ask yourself is why Michael Zemel reported no conflicts of interest to the American Journal of Clinical Nutrition, and also just who the heck peer reviewed this paper, as clearly, if they didn't see a conflict with Zemel, then they don't know dairy literature well enough to have been chosen as a peer reviewer.

Of course you'd think the editors of the journal ought to have known about the conflict of interest too.

(BTW - This isn't the first time Zemel's withheld his conflicts of interest from a journal - see this note published by the editor of the International Journal of Obesity)

Stancliffe RA, Thorpe T, & Zemel MB (2011). Dairy attentuates oxidative and inflammatory stress in metabolic syndrome. The American journal of clinical nutrition PMID: 21715516

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Saturday, July 09, 2011

Saturday Stories


Slate covers the obesity is/isn't socially contagious story.

David Katz, MD, adds his voice to the discussion of Paleo.

Another hit from Slate - this time Christopher Hitchens and questions he'd like to ask the Gaza flotilla activists.

Travis, on Science of Blogging, asks the question, "Can we trust scientists who give TED talks?"

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Friday, July 08, 2011

Can I be your friend?

If you use Facebook or Twitter, today's Funny Friday video's a great watch.

If you don't, it'll leave you rather confused.

Have a great weekend!

(email subscribers need to visit the blog to watch)



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Thursday, July 07, 2011

Restaurant calories - a cautionary tale


Restaurant calories are stupid high.

Doesn't matter if what you're ordering sounds like it's made with healthy ingredients, the likelihood is that a single meal will have at least a half a day's worth of calories, and sometimes, a couple of days worth.

That's not the cautionary tale. This is.

A reader sent me an email the other day. His wife had eaten out at a big chain fast casual restaurant and had ordered a pasta dish. She'd eaten half of it, and brought the other half home, and gave it to my reader to bring for lunch the next day.

My reader happens to be someone who weighs and measures their food, and given this chain posted their calorie counts online, he figured he'd weigh it and calculate the calories involved.

Imagine his surprise when his wife's half eaten portion of pasta still weighed as much as the full portion listed on the chain's website. The actual plated restaurant portion therefore, had double the already large number of calories the chain claimed.

Coincidentally, later that same week, I saw another patient who happened to work in a kitchen at that very same chain. They told me that when the plated food doesn't look quite right, or if it's taken too long to prepare, they simply plate more food so that the customer, who might have been upset with the wait or the aesthetics, is instead thrilled with their portion size.

For me those two stories gave me my first pause regarding mandated calorie labeling. Not enough pause to change my view that it'll be exceedingly helpful to those who want to pay attention, but enough pause to worry that some folks may be lulled into a false sense of security, and that coincident with any legislative calorie labeling effort, should be a massive public health campaign to encourage from scratch, home cooking.

[Below is a quick clip from CBS on menu labeled calories - email subscribers, you need to head to the blog to watch]

video

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Wednesday, July 06, 2011

Burger King has a "Reading Club" for 6 year olds?


Le sigh.

A reader of mine from Smiths Falls (Upper Canada District School board) who wishes to remain anonymous forwarded me a scan of her 6 year old daughter's Burger King reading award. Her award? Free French fries.

A quick google search later and voila, while I couldn't find it on a formal Burger King Website, I did find it detailed on a South Dakotan school's website - the Burger King Reading Club.

So what's in it for Burger King?

1. Little children who'll associate Burger King with happiness, pride and winning.
2. Meals likely purchased for entire families who may well have otherwise not gone to BK.
3. A program they could theoretically brag about in their annual report, or leverage in arguments against policies like fast food outlet zoning around schools, in terms of their corporate social responsibility.

My reader writes,

"What bothers me is that it came from BK. Not Chapters, not even Toys R Us but BK. A fast-food joint. It's not like my kids don't get treats but there are far too many treats handed out at school and activities."
Worse still, I'm betting that BK doesn't even pay the school to have the program, but rather that the program was pitched to the school who adopted it voluntarily thinking it's a wonderful way to encourage kids to read.

Whether it's pizza day, ice-cream sandwich day, Burger King Reading Clubs, McDonald's school bus safety day, McDonald's report cards, etc. - schools need to get out of the business of promoting and selling fast food.

Schools should safe havens for our children. Fast food has no place in our schools, and I think programs like this one, and the ones I mention up above, are best described as well intentioned, but woefully misguided, dietary bullying.

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Tuesday, July 05, 2011

Heart and Stroke Foundation pushing video gaming for fitness now?


Yesterday I received a copy of the Heart and Stroke Foundation's monthly newsletter, "Healthline".

Headlining the issue?

A give away contest that clearly reveals a bizarre Heart and Stroke Foundation/Nintendo partnership where Nintendo, at the very least, has given them 30 "Wii Fit Plus Prize Packs".

So what's in it for Nintendo?

Here's what the Heart and Stroke Foundation has to say about those Wii Fits,

"By playing Wii Fit Plus a little every day, you, your friends and family can work toward personal goals of better health and fitness!"
Really?

I can play Wii Fit Plus "a little everyday" towards my goal of better health and fitness?

That sure doesn't reconcile with my take of the Wii medical literature. My understanding is that Wii Fit burns negligible amounts of calories, and has never been shown to have any significant impact on "fitness".

One study comparing Wii Fit Aerobics to treadmill use reported,
"Heart rate during Wii aerobics fell below the recommended intensity for maintaining cardiorespiratory fitness"
Another, looking at Wii Sports and kids reported,
"The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children."
Furthermore, another recent study demonstrated that video game playing increased food intake in adolescents.

Ultimately what we have here is a great example of the risks inherent to public/private partnerships between industry and health organizations. While at most you might argue that Wii Fit's a better choice than a sedentary gaming console, to suggest playing it "a little every day" will have any real impact on the personal goals of better health and fitness simply isn't evidence-based, and grossly misinforms anyone who's reading this Heart and Stroke Foundation circular. And really, should the Heart and Stroke Foundation be promoting video game use?

Unfortunately, I'm not surprised in the slightest by this promotion. After all, it fits perfectly with the Heart and Stroke Foundation's "less bad" equals "good" pattern they've so readily established with Health Check, much to the detriment of a trusting populace. Sadly, the Heart and Stroke Foundation promoting Wii Fit for exercise is no more beyond the pale than their Health Check program promoting restaurant and processed meals for healthy eating.

In effect what the Heart and Stroke Foundation's saying is - screw actual exercise and home cooked meals - they're for suckers! Instead let's get people playing Wii Fit and going to Boston Pizza for dinner!

And for what? A few dollars? Greater brand exposure? Some misguided belief that "less bad" will actually make a positive, rather than a negative difference?

So unbelievably sad.

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Monday, July 04, 2011

Ottawa-Carleton School Board still in bed with McDonald's


Groan.

Longer term readers may remember my post from last year regarding the Ottawa-Carleton District School Board's School Bus Safety Awareness Day, where along with learning about school bus safety, pre-school children are courted by McDonald's characters with McDonald's colouring books, "refreshments", and coupons for McDonald's soft-serve ice-cream.

The school board, upset with my characterization of the day, contacted me, and explained to me that despite their belief the learning was essential, that attendance wasn't mandatory (nix that essential bit), and that kids who didn't attend the McDonald's fest, would in fact receive school bus safety education at school.

I summed up my concerns stating,

"While I'm flabbergasted that the Ottawa School Board doesn't see any problem handing out sugary juice drinks, chocolate chip granola bars and soft-serve ice cream coupons to preschoolers, I'm absolutely appalled that the Ottawa School Board invites anyone, let alone McDonald's, to target innocent 4 year olds with advertising all in the name of a program that they themselves apparently recognize as being non-essential and easily taught at school."
So while I don't have much new to add this year, I wanted to bring it to my readers' attentions once again, as it's still here.

This year, I'm not the only one outraged.

Marc L., a parent and regular reader, sent me the scan of this year's flyer. Here's what Marc had to say about McDonald's day,
"When I received the invitation email/poster from my kids' school, I was flabbergasted! I can't believe the school boards are accepting sponsorship from McDonald's for this activity.

I don't think the activity itself is a complete waste of time, as it may help some anxious kids to familiarize themselves with the school bus before the first day of school. However, to be bombarded by McDonald's advertising and products that day, at the vulnerable age of 4, is wrong.

This is just another example of McDonald's doing whatever it can to reel in another generation of kids!

Look around you, our current generation's poor state of health is due in large part to junk food. We are dealing with an epidemic of obesity, leading to diabetes, heart disease and a host of other diseases. This is due in large part to the abundance of cheap, easily accessible junk food, which McDonald's actively promotes on a daily basis.

Are 4-year-olds capable of making informed decisions? NO! They are easily influenced and this type of activity drills in the message that McDonald's is the "good guy". This forms the child's schema of McDonald's and can definitely influence their attitude towards fast food for years to come (and McDonald's knows this all too well!).

We, as parents, have the responsibility of educating our children and leading by example.

The school boards also have an important role to play, as they spend more time with our children than we do as parents.

Should this activity be cancelled? No.

Should Yoni Freedhoff or BMI pay for it? No.

Should we boycott it on principle? Maybe.

I'll leave that up to the parents out there. As for myself, I think I'll pass."
(Interesting - no mention of McDonald's is made on the school board's official website for the "safety" day, yet that flyer sent to parents scanned in up above sure makes it clear what'll be going on.)

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Saturday, July 02, 2011

Saturday Stories


A great WSJ article on confirmation bias by Jonah Lehrer

Andy Bellatti's take on Gary Taubes and carb-o-phobia.

Carl Zimmer in the New York Times explains the difficulty of correcting bad science.

Travis from Obesity Panacea and Colby from Nutritional Blogma diss the Chocolate Milk Diet.

If you like Spam, you shouldn't read this article from Mother Jones.

Colby Vorland from Nutritional Blogma explains a recent paper that suggests our increase in caloric intake comes from increased eating occasions.

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Friday, July 01, 2011

At what age do people begin to get "cute" again?

These folks are cute.

Today's Funny Friday is all about the "click".

I'm pretty sure I'm headed to be the old guy in the video who yells out curmudgeonly "no"s from time to time.

My wife's a lucky lady.

Have a great weekend!

(email subscribers, you've got to visit the blog to view the video)



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