Originally I'd titled this post, Operation Palate Plasticity, but then as I wrote it, I realized it's only the supporting part of this story.
So where to begin. Well, we've got 3 little girls, and I've certainly learned both from experience and from reading medical literature, that if there's a food they reject, the best way for us to get them to eat it is to try, try, try, try, try (and add a whole pile more tries), again.
Our home's rule is simple. You have to eat one bite of everything that's put on your plate. If you don't like it after a bite, you don't need to have more, and there's always at least a few different choices per meal (but second meals aren't prepared to replace wholly rejected first ones).
My oldest probably took 30 runs at green leafy salads until she started eating them without pause. My middle kid, 30 runs at sweet potatoes. And the baby? So far she still eats pretty much anything.
Apparently kids' palates are rather plastic, and just like I tell the girls, if you try a food enough times, eventually your tongue will learn to like it.
Well one day a little over a month ago I got to thinking. I wonder if my palate's got any plasticity left?
To test it I chose coffee.
Once upon a time I had been a classic Canadian double-double drinker. By med school I'd swapped cream out for whole milk. Opening up my practice here I swapped down to skim milk and Splenda, but I never could go black.
I tried here and there, but I found black coffee to be more than repulsive. I found it bitter, angry and at odds with my mouth.
Given I drink coffee daily, usually 2 cups, I figured what better item than hideously black coffee to to test whether or not I could retrain my taste buds.
July 29th I started the experiment. The coffee was vile. Hate my mouth vile. I suffered through 2 vile coffees daily for a few weeks, and then, somehow, they went from being absolutely vile, to just being bad. A week later, and suddenly they were tolerable, and as I sit and type now, I'm enjoying my black coffee greatly.
60 cups of coffee is what it took to retrain my palate.
I'd estimate that 60 cups is somewhere on the order of 1,800 sips (comparable in a sense to our one bite rule). So in my n=1 personal experiment, my adult palate appears to be 60 times less plastic than my kids'.
So where am I going with all of this?
I'm going to our children, and not just mine, but yours too.
If children grow up in homes where their palates are trained to enjoy highly processed, highly salted, nutritionally bereft boxed foods, take out meals and restaurants, what chance do you think they'll have at retraining their palates as adults to enjoy more healthful fare? What chance do you think their kids will have?
Eighteen hundred reintroductions is what it took to retrain my adult palate.
Do you think there are many adults who'll bother doing that with anything?
Wouldn't it be easier to train your kids' palates right from the get go setting them up for lifelong dietary success, rather than take the processed and restaurant way out and set them up for a potentially lifelong dietary struggle?
I sure think so.
(A bit more on this tomorrow.)
Wednesday, August 31, 2011
Tuesday, August 30, 2011
Thanks to Rachel Link and everyone else who sent me coverage about Tim Horton's elimination of their smallest size, and the shifting of all their sizes to one size larger.
So just for kicks let's talk calories.
Let's say you're a double-double drinker (as many Canadians are - for my American friends, a double double is double cream, double sugar). Let's also say that for each respective cup, you have two a day (meaning your Tim's fix was two small double doubles daily). If you continue to order up the same, given Tim's new larger sizes, how many extra calories will you be consuming a year?
- New Small: 18,250 extra calories (roughly 5lbs more).
- New Medium: 18,250 extra calories (roughly 5lbs more).
- New Large: 29,200 extra calories (roughly 8lbs more).
So for those keeping score, or if you yourself are a Tim's junkie, if you gain weight consequent to these changes, it's not because of your genetics, it's not because of inactivity or a lack of "willpower", and it's not because of epigenetics, obesogens, advertisements or ill-directed crop subsidies. It's because of one single, solitary change in your daily food environment.
Think anything else has changed in our food environment since let's say the 1970s? How many other changes have there been that have been foisted on us that impact on weight?
What year did chocolate milk start in school lunch programs, or vending machines show up in school halls? When did pizza and ice cream days become entrenched as fundraisers? Which genius decided that kids need treats each and every time they step on a blade of grass outside, or "sports drinks" when we were all just fine with water? How large has your go-to fast food combo grown? What meals is your boss bringing in for you to eat while you work late? How many foods are you buying that your parents used to make from scratch? How many times are you going out to eat or buying takeout because your day is spent tethered to an electronic leash and your evening chauffeuring kids around when you used to be free-range?
I could go on, and on, and on.
The world has changed. While there are certainly hundreds of factors involved in societal weight gain, there's no doubt (in my mind at least), the most important factor by far is the environment we've got not choice but to live in, and if we really want to see things change, it's the environment we need to work on.
Now of course bodies aren't perfect math formulas, and not every Tim's drinker's going to gain weight - but some are. And that said, daily Tim's coffee drinkers, maybe now's the time to make the switch to black?
More on that tomorrow.
Monday, August 29, 2011
So last week I started my 5th decade of life.
I`m really good with it, as the alternative to getting older (not getting older) sounds infinitely worse, and the fact is, I could count my blessings all day long and still need a few more days to finish. I have my health, a wonderful wife, terrific kids, a fulfilling and fascinating job, and a semi-exciting life.
Many of my patients worry about things like birthdays and what their inevitable celebrations will do to their weight management plans.
If your life excludes birthday cake on birthdays, that sure isn't much of a life.
And that goes for so many other events, celebrations and dietary indulgences.
It's part of the human condition to use food to celebrate. It's also part of the human condition to use food to comfort, and food makes up an integral part of the social fabric of our lives.
Try to take those roles away from food and while you might lose faster, my guess is over time you'll throw in your lifestyle change towel altogether as those overly strict changes aren't part of a healthy lifestyle, they're part of an unhealthy diet.
So go through those two questions I once posted on for before you indulge and do remember, you're only here once - you'd better enjoy it.
Thanks to my wonderful wife who I adore for giving me the family of my dreams and an R2D2 meat cake.
(for those who are wondering - the head is a basically meatloaf covered in tricked out mashed potatoes, while the body is made of 5 batches of Rice Krispies treats, more marshmallows than you can shake a stick at and covered with homemade fondant and edible marker)
Saturday, August 27, 2011
Arya Sharma clarifies the implications of a low EOSS score.
Marion Nestle takes on the "Portfolio" cholesterol lowering diet and calls it out as a hidden drug trial.
The story I believe I gave wheels to (my blog post was linked to and covered by two professional health reporter blogs back on June 20th....then the stories started coming out) regarding the flaws behind the contagious obesity story rolls ever forward
Mark Bittman covers the new American Food Corps!
Friday, August 26, 2011
Somehow I don't think so.
That said, today's Funny Friday video certainly suggests freshness.
Have a great weekend!
(email subscribers, visit the blog if you'd like to watch)
Thursday, August 25, 2011
"Fat Children Eat Less Than Their Thinner Peers". That's the tweet Linda Bacon from HAES fame sent out to her followers at 9:55am yesterday morning.
It certainly fits the HAES narrative that the world's completely backwards in regard to anything and everything weight related.
Sadly it also continues Linda's confusing practice of tweeting bad data.
Linda's HAES platform, whether you agree or disagree with it, rests on the shoulders of her critical analysis of the medical literature on obesity, and her take is that many of the studies with which researchers and clinicians have vilified obesity, were either poorly designed or poorly analyzed.
But yet here's Linda promoting a Medscape news piece on a non-peer reviewed, poster presentation from a pediatric conference, where the findings are readily debatable.
The poster whose findings she was authoritatively retweeting, tracked the dietary recall of 12,316 children between the ages of 1 and 17 years of age.
Tweet and actual data accuracy aside, what the researchers truly reported wasn't that all fat children eat less than their thinner peers, but rather that the caloric intake of overweight and obese kids aged 1-7 exceeded that of their thinner peers but that the pattern "flipped" at age 7.
So what does "flipped" mean?
According to the poster, 9-11 year old kids with overweight and obesity reported consuming 1,988 calories daily, while their thinner peers reported consuming 2,069 (a difference of 4% which I'd venture isn't likely to be a statistically significant one). The study's 15-17 year olds with overweight and obesity reported consuming 2,271 calories daily, while their thinner counterparts reported 2,537 (a difference of 12%).
But can we really trust the dietary recall of children with overweight and obesity?
I'm not trying to be harsh. This world is not kind to overweight and obese children (or adults), and Linda would certainly know better than most of the stigma, bias and bullying those kids likely face on a daily basis - potentially even from their parents, their schools and their physicians. I don't think it would be an even remotely surprising finding that when participating in dietary recall surveys, children with overweight and obesity, especially older children who've had more time to experience hateful weight bias, might be more likely to under report.
So is there data to suggest that's a real possibility? Could these kids be under-reporting by more than the 12% seen in the oldest age group?
In fact just this past February there was a review paper published in the International Journal of Pediatric Obesity titled, Assessing dietary intake in children and adolescents: Considerations and recommendations for obesity research. Regarding under-estimation, here's what the review paper's authors had to say,
"One of the most robust findings in dietary studies of children and adolescents is the positive association between under reporting and increased body fatness, particularly in adolescents (4,14,15). This is consistent with studies in overweight and obese adults (16). The extent of mis-reporting irrespective of weight status increases with age and has been reported as 14% of energy intake in 6-year-olds (17), 25% in 10-year-olds (18) and 40% (4,19) to 50% (14) in obese adolescents.."The authors further report that the type of study most likely to suffer from under-reporting is the very type performed for the poster in question,
"Studies characterising under-reporting have focused on total diet assessment methods and in particular, energy intake"To be clear, I think Linda Bacon's contribution to the field of overweight and obesity research, as well as public policy and attitude, is tremendously important. I just can't rationalize the scientifically critical Linda Bacon with her Twitter persona that seems to just retweet anything that satisfies the HAES narrative, no matter how weak or poorly designed the study (or in this case, the poster) may be.
There's got to be a better way to fight misinformation and statistically indefensible conclusions than the promulgation of misinformation and statistically indefensible conclusions.
Magarey, A., Watson, J., Golley, R., Burrows, T., Sutherland, R., McNaughton, S., Denney-Wilson, E., Campbell, K., & Collins, C. (2011). Assessing dietary intake in children and adolescents: Considerations and recommendations for obesity research International Journal of Pediatric Obesity, 6 (1), 2-11 DOI: 10.3109/17477161003728469
Wednesday, August 24, 2011
Yes, I said "Calorie Free". Not "Fat free", or, "Sugar free" - "Calorie Free", and according to the Walden Farms website, they've been selling "Calorie Free" foods since 1972.
And they have lots of options.
From, "Flavored Chocolate Syrup", to "Peanut Spread", to "Alfredo Pasta Sauce", to "Chipotle Ranch Dressing", there's a zero-calorie condiment for every occasion.
So what's in 'em?
Here are the ingredients for the "Peanut Spread",
"Triple Filtered Purified Water, Cellulose Gum, Salt, Corn Starch, Xanthan Gum, Natural Fresh Roasted Peanut Flavoring, Natural Peanut Extract, Peanut Flour, Caramel Color, Sucralose, Sodium Benzoate"(You know, for when double-filtered purified water just won't do.)
Clearly Walden Farms is marketing these towards folks worried about calories, and given that I count mine, I was certainly curious what these jars of chemical alchemy tasted like, and so was our office's dietitian Mark.
We both tried the Peanut Spread, Marshmallow Dip and the Raspberry Fruit Spread, while Mark also sampled the Buttermilk Ranch Dressing.
Here are Mark's thoughts, "
I first tried the fruit spread on its own (about a tablespoon’s worth) at room temperature. It was extremely sweet and left a stale-sweet aftertaste that didn’t go away until I munched on some almonds about 30 minutes later. Texture-wise, it looked like any other jelly and it had a maroon colour, which was a little off-putting. I decided to give it another shot over the weekend, this time after it had been refrigerated and on toast with peanut butter. I scooped two tablespoons onto some whole-grain toast and topped it with two tablespoons of natural peanut butter. It didn’t taste any better – still too sweet and it had a lingering, stale aftertaste. Overall, I wouldn’t recommend this product as it simply does not taste as good as other jams or jellies.My take on those products? My mouth's still mad at me. Certainly among the very worst things that have ever been in it.
What pairs well with jam? Peanut butter, of course. I consider myself a pb connoisseur. From natural to chunky, Jiffy to Kraft, I’ve tried them all. With no peanuts in sight, I was curious as to how Walden Farms would pull it off. Opening the jar reveals a butterscotch-coloured gelatin-like substance. I sampled a small amount on the end of a knife. The taste: think super-salty play-doh. And, like the raspberry spread, the taste lingers long after you’ve swallowed. I can’t say that this is the worst peanut butter I’ve ever had because it’s not peanut butter. But it does rank as one of the worst things I have ever tasted.
And lastly the salad dressing. When I eat salads, I like to have a lot of dressing. But dressing is often quite high in calories, so I was excited to try Walden Farms' calorie-free buttermilk ranch dressing. Could I finally douse my salad in dressing without worrying about the calories? Sadly, no. I added it to a salad comprised of lettuce, tomato, green peppers and plain croutons. It poured like traditional dressing and had the standard white-opaque colour of ranch dressing. Where it failed is in the flavour department. I struggle with how to describe the flavour – it tastes like ranch dressing, just really bad ranch dressing. The flavour is flat and it has a chemical-like aftertaste.".
Of all of the products, their Marshmallow Dip was the truest in taste. Still cloyingly sweet. Still a horrible chemical aftertaste. But then so too does actual Fluff.
These products are horror shows in bottles. While I'm all for reducing calories, you need to actually enjoy the foods you're eating, and unless you've got a tongue covered in scar tissue, enjoying these products isn't something I can readily imagine you'll be able to do.
So if you pass by Walden Farms products in the supermarket, please, for the love of all that's holy, don't stop.
Tuesday, August 23, 2011
Another great guest post!
I'm sure you've noticed how over the years, the "small" sizes in restaurants have been growing progressively larger, for example at McDonald's where the small fries today are larger than the regular fries they opened with.
Well today's guest poster, Jean Paetkau, a journalist in BC, noticed this too and forwarded me a rant about this very phenomenon and a cookie the size of her face!
Here in Victoria ... we have a real passion for organic food and local produce. We love our cafes that serve soy based cheeses and non-GMO wheat. But despite the healthy intentions of local bakeries .. it doesn't stop them from selling COOKIES THE SIZE OF MY FACE.Jean Paetkau is an associate producer with All Points West at CBC in Victoria. She also worked on the award winning CBC food show "The Main Ingredient" last summer.
One of my favourite bakeries that is walking distance from my work .. used to sell two sizes of chocolate chip cookies. The two different sizes of the cookies were ... in my opinion ... LARGE and LARGER.
During the few breaks I get as a hard working journalist ... I will often head down to this bakery. Recently, I was very disappointed to discover that they stopped selling LARGE cookies and now they only sell the LARGER.
I am considering boycotting the bakery simply because I don't want to buy (or eat) a COOKIE THE SIZE OF MY FACE. Some critics might say that I should just purchase the LARGER cookie and eat half one day .. and save the rest for later. Well ... I am a member of the human race and we are notoriously bad at eating only part of the treat sitting on our desk or lurking in our fridge.
I don't go to McDonalds because I don't want to be supersized. But I also don't want to eat a COOKIE THE SIZE OF MY FACE.
To the bakeries of the world: I appreciate organic ingredients, and grain that was raised without cruelty. But how about portion sizes that leave me without a guilty conscience and an expanding waist.
Monday, August 22, 2011
Today's guest posting comes courtesy of author, columnist, blogger, athlete and even physicist, Alex Hutchinson. Last week I emailed him to ask him his opinion regarding the validity of gym equipment calorie counts, and following a brief exchange he kindly agreed to provide me with a guest posting on why treadmills are liars. His blog Sweat Science is a must read for me and if it's not on your blogroll, it should be.
So here's Alex to answer the question, "Can your treadmill really count calories?"
Lately I’ve been having a lot of fun with the new 2011 Compendium of Physical Activities, which has a snazzy new website that allows you to compare the calorie-burning powers of pretty much any activity you can think of, from coal mining to water aerobics to butchering small animals. It’s pretty simple: each activity is assigned a number that tells you how many calories you burn per kilogram of body mass per hour.
Alex Hutchinson is a columnist with the Globe and Mail and a senior editor at Canadian Running magazine. His new book, “Which Comes First, Cardio or Weights? Fitness Myths, Training Truths, and Other Surprising Discoveries from the Science of Exercise,” was published in May. He blogs about the science of fitness at www.sweatscience.com.
As a way of comparing the demands of different activities, it’s great. But there’s a problem when you try to apply those numbers to yourself. Personally, I’m pretty sure that if I tried to butcher a small animal, I’d end up burning a huge number of calories because my heart would be racing, and I’d do it all wrong and end up chasing a headless chicken around and around the yard. But the Compendium doesn’t know that about me: it only knows my weight.
That’s the same problem faced by the cardio machines at the gym. They count calories in basically the same way the Compendium does (and in some cases probably rely on exactly the same data): researchers study a few “average” volunteers and figure out how many calories per kilogram of body weight they burn at different intensities. But none of us is “average.”
If you have more body fat than average, you’ll burn fewer calories per kilogram of total body weight. That means the number on the treadmill (or elliptical or exercise bike) is an overestimate. If you’re less aerobically fit than average, on the other hand, you’ll burn more calories than the treadmill thinks. Other factors like height, age and sex also skew the results – not to mention more obvious things like using the handrails to support some of your bodyweight, which is a common cheat on the elliptical and treadmill that the machine doesn’t take into account.
But all of these factors are relatively minor compared to the most misleading part of exercise machine calorie counts: the difference between gross and net calorie burns. For example, an 80-kg woman walking for an hour at 2.5 mph will burn 240 calories, according to the treadmill. But if she had spent that hour lying on the couch, she would have burned 80 calories just to stay alive – so she really only burned an extra 160 calories by exercising. That’s an overestimate of 50 percent!
The lower the intensity of the exercise, the bigger the difference between gross and net calorie numbers. If you want to make a back-of-the-envelope correction, you can subtract 1 calorie for every kilogram of bodyweight per hour of exercise from the cardio machine’s number. Still, that’s just going to give you a very rough estimate. For meaningful feedback, it’s probably better to focus on things like how far you went, how fast, how hard – and how it made you feel.
Saturday, August 20, 2011
A double header this week from Science Based Medicine. I'm sure there were many other fabulous stories....was just too busy a week for me to read much.
Science Based Medicine on homeopathic bullying.
A second hit from Science Based Medicine - this one from Scott Gavura on what he's calling "Gavura's Law" - the Godwin's law of alternative medicine discussion.
Friday, August 19, 2011
Thursday, August 18, 2011
That was the question that leaped to mind after looking at one of the appendices of the recent Edmonton Obesity Staging System paper in the CMAJ.
Looking at the graphic up above (if you click it, it'll get larger), it would appear that the earlier NHANES III cohort (1988-1994) included a significantly higher percentage of so-called, "fit and fat" folks, as compared with the later NHANES 1999-2004 cohort.
In the later cohort, the percentage of the study population with an EOSS score of zero (meaning folks with overweight and obesity and no medical or life related co-morbidity) was pretty much zero, whereas in the earlier cohort it would appear that over 15% of overweight folks had an EOSS score of zero, as did just under 10% of folks whose BMIs ranged between 30 and 35 and just over 5% of folks whose BMIs were greater than 35.
Now I'm far from a statistician, but certainly were than any stats savvy folks reading this post, I'd be very curious to know if that differences up above were statistically significant. Given the size of the cohorts and the dramatic differences seen, I'd be surprised if they weren't.
In terms of what's going on?
According to Obesity Panacea's Travis Saunders', one possibility is that the distribution of our weight is changing, and that where we're carrying it is the problem, with increasing abdominal distribution weight-independently increasing our risks of developing a constellation of different chronic diseases.
Travis forwarded me a paper written by Ian Janssen, Margot Shields, Cora L. Craig and Mark S. Tremblay that looked at differences in waist circumferences and 5 skinfold thicknesses for given weights between 1981 and 2009. What they found was that for any given weight, waist circumferences were higher, as were skinfold thickness values.
Their conclusion in the paper seems downright prescient when applied to that graph up above,
"These findings suggest that even in the absence of a change in population obesity prevalence as determined by BMI, the population health consequences of obesity seem likely to increase more than anticipated"Given the impact of exercise on distribution of body weight, this definitely lends ammunition to ongoing exercise promotion efforts, and combining that impact along with the results of the second EOSS paper, the one that suggests lifestyle dramatically attenuates EOSS staged risk, and together they would suggest that exercise promotion should take obesity treatment out of the rationale for exercise, and instead focus on exercise/health at any size.
To suss things out further, I'd love to see which weight related co-morbidities increased in the later years cohort - certainly knowing which co-morbidities are on the rise, would help in understanding what exactly's going on.
So whether it's increased abdominal distribution of weight or not, it would certainly seem that there's something else out there, something other than absolute weight, that's increasing morbidity in the population with overweight and obesity. My recommendation is that we redouble our efforts to figure out what that something else is and work on it, as I'm guessing we'll have more luck treating it, than we do treating weight.
Padwal, R., Pajewski, N., Allison, D., & Sharma, A. (2011). Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity Canadian Medical Association Journal DOI: 10.1503/cmaj.110387
Janssen, I., Shields, M., Craig, C., & Tremblay, M. (2011). Changes in the Obesity Phenotype Within Canadian Children and Adults, 1981 to 2007–2009 Obesity DOI: 10.1038/oby.2011.122
Jennifer L. Kuk, Chris I. Ardern, Timothy S. Church, Arya M. Sharma, Raj Padwal, Xuemei Sui, & Steven Blair (2011). Edmonton Obesity Staging System: association with weight history and mortality risk Appl. Physiol. Nutr. Metab., 36, 570-576 : 10.1139/H11-058
Wednesday, August 17, 2011
What's portion paralysis?
That's when your brain and your eyes have become so accustomed to a particular portion size for a particular meal, that change isn't even remotely automatic.
But sometimes it's wise to reduce portions.
Take me for instance. In December I injured my back - pretty badly. Consequently my exercise regime went out the window. Rehab was very slow. Despite knowing better, I didn't adjust my portions with my drop off in exercise and sure enough, over 3 months time, I gained a tiny bit of weight.
When I realized what was going on, I resumed keeping a careful food diary and re-recognized which were my higher calorie meals.
One really stuck with me. It was pita pizza - a go-to meal for when I'm in a hurry and I want comfort-y food, but certainly not terrifically low in calories. Back in my exercising days, I'd have 3 pitas worth, and so my simple quick fix, was to downshift my pita pizza portion to only have 2. What was fascinating to me, was that especially when I was in a hurry or distracted, despite mentally decided to eat less, sometimes I'd literally forget.
And sometimes I still do, and before I know it, there are 3 out on the pizza stone.
It's important for me to mention, it's not because I'm still hungry after 2, that I eat 3. I think that it's just after years of always having 3, unless I consciously challenge my portion sizes, whether it's pita pizzas or otherwise, I automatically revert to my established larger portions.
I've lost the weight I gained, and I'm slowly starting to retrain, but given this experience I've taken to really analyzing what I feel I need portion wise prior to cooking or plating, and more often than not, I'm having just a tiny bit less than what had become habitual, and more importantly, I'm not missing what's gone.
Do you have any automated portions?
Tuesday, August 16, 2011
Last week I was invited onto Brian Lilley's Byline, a SunTV prime time news hour. I had contacted SunTV in response to a discussion that had aired the night before - one between Byline's host Brian Lilley and Ezra Levant. They were discussing Lillian Coakley.
For those of you who aren't familiar with Lillian's story, she's a Nova Scotian with extreme obesity, who out of frustration with her Province's 10 year bariatric surgical wait times, penned a mock obituary which I posted on my blog.
Ezra, when considering her case, suggested that while she doesn't want to be a burden on her children, that she, "apparently wants to be a burden on everyone else." Ezra then claimed that not only does Lillian have obesity, she has, "entitle-mania", suggesting it was an inflated sense of entitlement to health care that led her to believe bariatric surgery should be expeditiously covered (or even covered at all).
Brian then opined that he didn't think that Tommy Douglas (the father of socialized medicine in Canada), would have wanted bariatric surgery covered and Ezra agreed, "I don't think that in Tommy Douglas' time , even being fat was considered a health care issue, it was a personal responsibility issue". Next Ezra offered advice to folks like Lillian, "If you don't want to be fat, exercise, or eat less", and concluded by asking, "Why doesn't she take some personal responsibility".
I couldn't embed the video, so if you'd like to watch it yourself, click here.
I was glad they invited me to provide some balance to their chat, but here it's important for me to point out that their take on the story wasn't particularly unique, nor was it particularly ugly. Now don't get me wrong, it was ugly, but it was not any more ugly than the vast majority of commentators' takes out there, and certainly not unique to right wing viewpoints as evidenced by the commentators over at the Toronto Star.
It was important to me to go on the show to address their 3 main arguments.
The first had to do with burdening our health care system. I pointed out that statistically speaking, it's a far greater financial burden on our health care system to let Lillian wait on a waiting list for 10 years than to operate, with surgical costs being fully recouped in just 3.5 years.
Next, regarding responsibility I pointed out that virtually everyone who tries to intentionally lose weight on their own gains it back, and even putting aside the fact that commentators as a whole have no idea what Lillian has, or hasn't tried for weight loss, it's a fair bet that even were she to successfully lose weight, she'd gain it back and that here we're basically condemning her because she's incapable of doing something that pretty much everyone else is also incapable of doing.
Lastly I pointed out that it's an incredible double standard to suggest blame and personal responsibility be considered when determining if obesity treatment is worthy of public funding. Even if you were to continue to believe that obesity is entirely preventable/treatable by means of personal responsibility, the fact is a huge proportion of our health care expenditures are spent on patients who could have avoided or prevented their maladies. Perhaps the easiest example would be the incredible number of patients who require interventions as a simple consequence of their not bothering to take their prescribed medications. Whether it's diabetics, hypertensives, or hyperlipidemics who don't take their meds, - these folks cost our system an incredible fortune in dialysis, strokes, heart disease, and more, and yet no one, not even Ezra or Brian, is going to suggest we not treat them, or that we grill them about their medication use prior to providing them with life saving care. And here their issues stem from simply not taking their meds daily, whereas Lillian's stems from her inability to do something more than 95% of us fail to do - sustain a significant weight loss.
Saddest of all though had to be the graphic that SunTV chose to run to promote my piece. That's a still of it up above.
And it's the attitudes behind that image that we're fighting against. We're fighting against a society where the media feels comfortable promoting blatant, ugly stereotypes - because while I can certainly understand Brian and Ezra's views in regard to Lillian's case (they're pretty common off the cuff views after all), they don't excuse the hateful bias of the gluttonous slob obesity narrative that their graphic supports.
Cartoon gluttony aside, it's a shame that SunTV, despite choosing Brian and Ezra's anti-Lillian rant for posting on their website, didn't choose to provide their web viewers with balance by posting my interview as well.
If you want to watch my piece, you can do so here (or see it embedded down below).
Monday, August 15, 2011
There's a great deal of fear mongering out there regarding obesity, but is obesity really the killer it's made out to be?
The answer's a touch more complicated than you might think, and new studies whose authors include some of Canada's brightest obesity researchers, are helping to shed some light on obesity's true risks.
The first, published a moment ago in the CMAJ was written by Rad Padwal, Nicholas Pajewski, David Allison and Arya Sharma, and it detailed the use of the Edmonton Obesity Staging System in estimating obesity related mortality. The researchers used date from NHANES surveys to explore mortality as it would pertain to BMI versus the EOSS.
The findings were striking.
When mortality was analyzed as a function of BMI, there was a fairly linear relationship that did not discriminate between overweight or the 3 classes of obesity (BMI 30-35, 35-40 and >40), however when analyzed as a function of EOSS, which in turn takes into account the existence and severity of weight-related co-morbidities, a very different picture emerged.
What was found was that as EOSS rose, so too did risk, and importantly, folks who were obese, but who did not have any weight related co-morbidities, over a 16 year span, showed virtually no increased risk of death, where as those with an EOSS of 3, only 60% survived the 16 years.
The second study, authored by Jen Kuk, Chris Arden, Tim Church, Arya Sharma, Raj Padwal, Xuemei Sui and Steven Blair, looked at a different cohort of individuals, this time from the Aerobics Center Longitudinal Study. Their findings were almost the same. Folks with EOSS stage 0/1 had no greater risk of all cause mortality over 16 years, while those of EOSS stages 2/3 showed markedly increased risk. Importantly here, this study also controlled for fitness and dietary factors and found that when included in the analysis, fitness and improved diet eliminated the excess mortality risk for all but EOSS stage 3!
These results are extremely important in that the EOSS is able to identify folks who are more likely to benefit from treatment. The flip side of that coin is that the EOSS is also able to identify folks whose doctors can stop lecturing them to lose weight, as at least from a mortality and cardiovascular disease perspective, EOSS 0/1 folks don't seem to have any increased risks.
[Important to note here, the second study did find that cancer risk was elevated regardless of EOSS stage.]
These results are especially important for countries like Canada where fiscal restraints and socialized medicine means that there is far more demand than supply for bariatric surgery. The EOSS may help to appropriately triage those folks who are most in need of urgent care.
These studies also validate what I think most folks know to be true. Healthy lifestyles minimize weight related risks even in the absence of a so-called healthy body weight.
That's when today's real post goes live.
How come? Well noon's when the embargo lifts on two studies co-authored by my friend and colleague Arya Sharma (and also friend and colleague Jennifer Kuk, along with a bunch of pretty fancy names).
In part how indeed it is entirely possible for a person to be obese and not suffer ill health.
Saturday, August 13, 2011
A few moments ago a tweet from Andrew Tobert rang up on Tweetdeck.
He was tweeting about a WebMD advertorial that explicitly states not only is sugar not bad for you, it's actually good for you and that your children can eat nearly as much of it as adults,
"A panel of world health experts recently reviewed the scientific evidence and concluded that a high sugar intake is not related to the development of heart disease, diabetes, high blood pressure or cancer.The advertorial was written by Kellogg's and according to WebMD, they have sole discretion over content.
Sugar was also not connected to behavioural problems like hyperactivity in children.2-3 As well as this, the panel did emphasise the beneficial role that carbohydrates like sugars play in health.
Children do have different needs to adults, so they have different Guideline Daily Amounts (GDAs) for sugar. But not as different as you might think.
Because they are active and growing, children are not vastly different to the "average person" used on the front of the pack. In fact, for sugar, it is very similar indeed."
I decided to clip that pic up above from the website, as I'm guessing the page will probably get yanked - it's spreading like wildfire on Twitter.
I wonder who the BootsWebMD genius was who decided giving sponsors sole editorial control over content was a good idea?
Anyone out there still wonder about the intentions of Big Food?
Still think it'd be a great idea to partner with them, that they're part of the solution?
A great article in Slate on how antioxidants don't work!
My piece in the Canadian Medical Association Journal detailing issues of weight bias in transplant medicine.
The New York Times take on the obesity is socially contagious controversy.
Stephan Guyenet covers the most recent example of Gary Taubes' rather characteristically rude style of interacting with folks who don't believe in carbohydrates being the sole contributors to societal obesity, then a day later, Stephan politely, but deeply, buries Gary's oversimplified dogma.
Friday, August 12, 2011
Thursday, August 11, 2011
I heard about it when Linda Bacon from HAES tweeted a link to a press release about it multiple times, calling it "Myth Busting". Knowing that Linda knows how to critically appraise a journal article, I figured it'd be worth reading the actual study.
I was wrong.
The study looked at one solitary day's 24hr. dietary recall collected from 11,182 children between the ages of 2-18 years of age, and then compared candy intake to overweight and obesity status in those same children.
Now dietary recall is known to be fraught with error, especially when it comes to less than healthy foods.
So is there evidence of error here?
Well according to their results, only 30% of children have candy on a daily basis, where candy means a sugar candy or chocolate (more on that in a bit).
That sure sounds like an awfully small number.
And of the kids who actually admitted eating candy, how much were they found to be eating?
One chocolate bar worth for teens aged 14-18 and about 2/3 of a chocolate bar worth for kids aged 2-13.
That sounds like an awfully small number too.
Now maybe kids really don't eat candy any more. Maybe the world's changed more than I've envisioned and only 3 out of 10 children eat candy daily, and do so in rather tempered amounts. And maybe candy's not only not bad for you, but it's good for you, specifically good for you in regard to weight in that this study found that the kids who reported eating candy, were 22 to 26 percent less likely to have overweight or obesity!
Of course the other possibility is that it's just an awful study that doesn't fairly lend itself to any conclusion whatsoever (pro or con).
And while we're at the awful study angle, given that this is a study where the authors' conclusion and the public relations spin is that candy's not bad for you, and apparently is protective against overweight and obesity, I think it's probably also worth asking what wasn't counted as candy?
Cookies, freezies, ice-cream, pudding, fruit roll ups, cake, pie, etc. Just chocolate candy and sugar candy. So what else wouldn't fit? Any other junk food - chips, pretzels etc.
The only conclusion I'm able to fairly draw from this study is that those of us who have any degree of Twitter influence, we really have to hold ourselves to a higher standard of retweeting. It's always tempting to retweet a press release or a blog post about a study that fits within our own confirmation biases, but before we do, we should really feel obligated to first read the actual study and evaluate it just as critically as we would those studies that don't fit neatly within our personal narratives.
E. O'Neil, C., L. Fulgoni Iii, V., & A. Nicklas, T. (2011). Association of candy consumption with body weight measures, other health risk factors for cardiovascular disease, and diet quality in US children and adolescents: NHANES 1999–2004 Food & Nutrition Research, 55 DOI: 10.3402/fnr.v55i0.5794
Wednesday, August 10, 2011
- If you can't happily eat any less, you're not going to eat any less.
- If you can't happily exercise any more, you're not going to exercise more.
- If you don't like the life you're living, you're not going to keep living that way.
- If you accept your personal best at everything else in life, why not weight?
- If you can't use food both for comfort and celebration then you're on a diet that ultimately you're going to quit.
- Simply tolerating your life isn't good enough.
- There are some things in your life, affecting your weight, that you're not going to be able to change.
- Your best weight is whatever weight you reach, when you're living the healthiest life you actually enjoy.
- The more weight you'd like to permanently lose, the more of your life you'll need to permanently change.
- Reality isn't reality television, and it most certainly does include chocolate.
Tuesday, August 09, 2011
But also don't hide them too!
What am I talking about?
A recent study out of Volumetrics' Barbara Rolls' lab that found incorporating pureed vegetables into 3-5 year olds' bread, pasta sauce, and chicken noodle casserole reduced energy intake in kids by 12%! And don't worry, Dr. Rolls has shown these same type of effects over and over again in adults.
That's not an insignificant, or unexpected reduction - decreasing the energy density of food by adding in piles of pureed vegetables means if you eat the same portion you always eat, you'll consume fewer calories.
You'll also consume more fibre, vitamins and minerals and phytonutrients.
While I do think it's crucial to continually encourage your children (and yourselves) to consume more whole, actual, real, visible, vegetables, there's nothing stopping you from mucking not just with their recipes, but yours too.
So puree to your hearts content, AND don't forget to start with a salad.
[According to Amazon.com, The Sneaky Chef is the highest rated hide the veggies cookbook around]
Spill, M., Birch, L., Roe, L., & Rolls, B. (2011). Hiding vegetables to reduce energy density: an effective strategy to increase children's vegetable intake and reduce energy intake American Journal of Clinical Nutrition DOI: 10.3945/ajcn.111.015206
Monday, August 08, 2011
And you thought Happy Meals exploited children.
Thanks to blog reader, colleague, and the Head, Food Policy Research Initiative, Ontario Tobacco Research Unit, Catherine Mah, for finding and forwarding this jaw dropper.
Background on this one (also thanks to Catherine) - "Shokuiku" is the Japanese term for "food education", and according to her,
"Key areas of shokuiku focus include over and underweight, agriculture, education, and (a key one) cultural promotion. Driving forces for the creation of shokuiku were declining public trust in the food system, changing social and cultural dynamics related to food, and concerns about domestic agricultural self-sufficiency. The policy was legislator driven, launched during the Koizumi administration days, and a national Food Education Basic Law was adopted in 2005."Shokuiku lessons are generally delivered in elementary school, and according to Catherine are,
"about addressing food deskilling among young people: food handling (including growing and cooking) skills, food safety, learning about where food comes from, "traditional" Japanese food, benefits of eating breakfast, the food guide, healthy eating/eating patterns to prevent NCDs (in Japan, referred to as "lifestyle diseases"), benefits of eating with your family."Sounds great, right?
Yes in fact, it does sound great. I wish our elementary students had shokuiku lessons.
So what's the jaw dropper?
The lesson plans are being drawn up by McDonald's.
Unfortunately, my Japanese is a little bit rusty (non-existent), so I had to rely on Google's translation service to peek at the site. Clicking over here will take you to McDonald's shokuiku main site, while clicking here will take you to their supplementary kids' shokuiku site.
I couldn't see anything awful on my cursory tour. No recommendations for French fries, no Ronald teaching class, so see, this is just an example of a great public-private partnership....or is it?
I found what appears to be a chapter in a textbook written by someone named Mark Frank. It details an exercise to translate a few of the shokuiku lessons to English.
Get prepared to shudder, here's lesson one - on food mileage,
"To introduce the concept of food mileage to young children, students in the Food and Communications class started from the question, "Where does a McDonald's Cheeseburger come from?" Researching this from the Japanese McDonald's homepage and other sources they found the beef comes from Australia, the cheese comes from New Zealand, and the bread comes from wheat grown in the US and Canada....Examining the rest of the McDonald's menu they learned that the chicken in the McNuggets comes from China, the fish from the Filet 'O Fish comes from Russia and the potatoes in the French fries come from the United States.....So why is this a jaw dropper? Shouldn't McDonald's been praised for their work? What's wrong with teaching about food miles using McDonald's as an example?
The lesson for children was divided into three parts: vocabulary practice, a map exercise, and a quiz. First using picture cards the various ingredients of a McDonald's menu were introduced: Hamburger, cheese, fish, chicken, potatoes, lettuce, tomato, wheat and bun....."
On the one hand, it's undeniably great that Japanese schoolchildren are learning about healthy eating. On the other hand, with lesson plans being delivered by McDonald's, lesson plans on healthy eating, delivered to children under the age of 12, where the lessons have children as young at 6 literally studying McDonald's menu and doing "research" on the McDonald's Japanese homepage, do you think that maybe, just maybe (and I'm being sarcastic here), that McDonald's is hoping that those school children will associate McDonald's branding of their healthy eating classes, and hence McDonald's as a whole, with healthy eating? Or at the very least are hoping to introduce an entire generation of Japanese school children to the wonders of the McDonald's menu (which of course includes the requisite kids' site)?
Of course they are.
Do you think there'll be a lesson that explicitly suggests that eating out is one of the primary drivers of obesity and chronic disease, and that actively discourages frequenting restaurants for reasons of convenience?
Of course there won't. In fact, in that translated lesson plan here's a reference I found regarding eating out,
"Our college and our community are literally surrounded by rice paddies, bean fields, and small vegetable gardens. At the same time, our college is also surrounded by the food most college students, young families and children eat: family restaurants, ramen, McDonald's, franchise restaurants and 100 yen sushi shops. Both contain mysteries; both are separated from our understanding by walls that can be overcome by shokuiku."And even putting aside the potential for these lessons to influence the attitudes of school children as to the healthfulness of McDonald's, were there ever a call out in Japan for legislation that in turn might have a potential negative impact on McDonald's ability to sell food to school children (advertising reforms, zoning law changes, Happy Meal toy bans, etc.), do you think that their involvement in shokuiku wouldn't immediately be trotted out as evidence they're part of the solution, and not the problem?
Of course it would.
But I'm guessing such a call will be a long time coming. Why? Because these McDonald's Japanese shokuiku lessons? They have the imprimatur of the Japanese Ministry of Education.
So here's my question. How does one weigh the obvious benefits of utilizing McDonald's massive resources to put together lessons plans on healthy eating, with the more insidious and in many cases unmeasurable risks inherent to this public-private partnership?
Truly, I don't know the answer - your thoughts would be greatly appreciated.
Saturday, August 06, 2011
Mr. Epidemiology explains why you should get your kids eating breakfast!
Fabulous blog post on why you should and shouldn't hate Rob Ford (Toronto's mayor).
Marion Nestle explains where that standard 2000 calorie/day allotment came from.
Friday, August 05, 2011
A few Saturdays ago I got to the office at 7:30am to work on various writing projects, and despite an ample supply of coffee literally called, "Kick Ass", I was down.
I was down that is until I took a few minute break and happened to catch this week's Funny Friday video (bad language alert) featuring the "All Balls Brawl".
(email subscribers, you have to visit the blog to watch the video, and yes, the humour is juvenile).
Have a great weekend!
Thursday, August 04, 2011
First, some background.
In early July, the well respected Cochrane Review folks put out a piece on dietary salt reduction and cardiovascular disease. Their review basically had three non-overlapping and somewhat contradictory conclusions. The first (gleaned from their plain language summary) was,
"Cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease"The second was,
"Our ﬁndings are consistent with the belief that salt reduction is beneﬁcial in normotensive and hypertensive people"While the third was,
"The challenge for clinical and public health practice is to ﬁnd more effective interventions for reducing salt intake that are both practicable and inexpensive"The media pretty much only reported on that first bit, with headlines screaming, "It's Time to End the War on Salt", "Review says salt not responsible for heart attacks", "Study Denies Any Link between Sodium Intake and Heart Risk", and "Now salt is safe to eat — Health fascists proved wrong after lecturing us all for years".
I blogged about how it seemed to me, many of the journalists who wrote about the Cochrane Review, must not have bothered reading it, given the message it contained, truly wasn't the message they conveyed. Of course I'm just some doc with a blog, and admittedly, I'm not a statistician, nor am I a hypertension researcher, maybe I misread something?
Well, Drs. Feng J. He and Graham A MacGregor are hypertension researchers (and certainly their likely confirmation bias' are that salt's bad), and they decided to pen a commentary on the Cochrane Review that was published this past week in the Lancet.
Summarizing their commentary - if you exclude the one paper in the Cochrane Review's analysis that was poorly designed (the one on patients with heart failure whose diuretic medications weren't adjusted when patients were placed on low-salt diets (a bad plan) which had negative outcomes for salt reduction), the remaining 6 papers, when combined to increase power, demonstrated a statistically significant reduction in cardiovascular events with salt reduction, and a non-statistically significant reduction in all cause mortality.
It's a very compelling little commentary, as confirmation bias or not, their arguments seem quite rational, and while it received some play in the press, it didn't receive near the same play as what seems to be the preferred new controversial narrative, that salt's no longer a worrisome thing.
So that leads me to my question, one I've posed before, is the ultimate responsibility of the journalist to the public, or to the press?
My idealism has me on the side of the public, but my cynicism (realism?) has me on the side of the press, knowing full well that telling the public what they want to hear will trump evidence more often than not.
Too bad too, think of the immense public health benefits of a unified press corps that preferentially reported science over hype, truth over contrarianism, and thoughtful discussion over grabby headlines.
Wednesday, August 03, 2011
If it's a sign of the times, it's a sign of how truly backwards we are as a society when it comes to weight management.
Scale company Tanita is now marketing a specially designed body-fat/weigh scale for children between the ages of 5-17.
Now I've blogged before about how I think body-fat percentage scales are a bad idea to begin with, but to target them at children bring them to a whole new level of horror.
5 year olds don't need to have their body-fat or their weights measured, they need healthy food and parental role modeling.
So instead of punishing your child by buying them a body-fat percentage scale, may I suggest that if you're not already doing so you:
- Cook healthy meals from whole ingredients for each and every meal.
- Have sit down family dinners each and every night (remembering they don't need to be gourmet - kids do love peanut butter sandwiches).
- Involve your children in meal (and school lunch) preparation.
- Track the added sugars in your childrens' diets and try to limit to no more than 45 grams daily (remembering that some days should be exceptions too - sugar's part of childhood, it just needn't be a daily part).
- Ensure that the only fruit they eat is actual fruit - no juices, rollups, chews, or mashes.
- Make their milk white and skim, not brown and sugary.
- Ensure your children eat protein with every meal and snack, and that they start their days off with a wholesome, protein inclusive, breakfast.
- Make restaurant meals and take out (including supermarket prepared takeout meals) exceedingly rare events.
- Engage your family in family based physical activity - weekend hikes, nightly walks, signing up for community races, landscaping, home improvement projects, push lawnmowers, snow shoveling, etc.
Lastly you've got to remember - if you're worried about your kid's weights, don't put it on them. It's not their problem, it's yours, and if you think you're going to fix it by yelling at them, weighing them, shaming them, food policing them, etc. - you're going to be disappointed, and your kid is going to be miserable.
If you want your kids to change the way they're living, you're going to have to change the way your whole family's living - and frankly it isn't about weight. All of those behaviours up above? Doesn't matter if your kids are heavy or thin, those strategies will benefit each and every family, though the likelihood is, if weight's an issue in your family, those changes will help far more than any scale ever could.
Tuesday, August 02, 2011
Too bad the picture's going to give this one away, I'd have loved to have had you guess.
You might have guessed, fresh fruit, fresh vegetables, quality grains - but you'd have been very, very wrong.
According to an article I read in Today's Dietitian magazine about "Healthful Vending in Today's School", the correct answer is apparently "popped" potato chips.
So what's so "healthy" and "better for you" about Popchips?
Well best I can gather is that they have 20% fewer calories than potato chips, but the same amount of sodium, and no more in the way of fibre or protein.
You know what they also have due to the inanity of articles like the one in Today's Dietitian?
A Health Halo that lets school boards pat themselves on the back about what a great job they're doing with their students and misinforms students about a product that at best, with a huge stretch, could be described as every so slightly less bad than potato chips.
If this product truly strikes today's dietitians as "healthy", or, "better for you", then I'd say there's something terribly wrong with today's dietitians.
Only silver lining here is that I'm pretty sure Today's Dietitian, is going to prove to be a valuable source of blog-worthy nutritional madness, as according to the magazine's Media Kit, it's,
"a powerful marketing vehicle for nutrition products and services. Our partners let our reputation work for them, and those partnerships have helped thousands of companies enlighten and educate a responsive audience of more than 110,000 RDs and nutrition professionals about their products, brands, and companies."Translation?
All the nutritional spin that's fit to print.
Monday, August 01, 2011
According to a survey reported on in the tradezine Nutraingredients, consumers are more inclined than ever to ignore the unhealthy contents of their foods, so long as a healthy nutrient has been added.
I imagine too that one of these days Health Canada will actually succeed in its seemingly never ending quest to make it easier for food and product manufacturers to "fortify" foods at their discretion with vitamins and minerals and when that day comes, look out.
Coupling our dimming nutritional intellect, with a food corporation's insatiable (and understandable) race to profits, along with the blessing of Health Canada to lipstick up every nutritional pig, and pretty soon there won't be any food-containing cardboard boxes that don't extol the virtue of an added ingredient.
(Psst - potato chips, no matter what's in 'em, aren't good for you. Delicious? Sure. A treat? Sure. Something to eat to prevent heart disease? Sadly, no.)