Tuesday, December 31, 2013

An Expanded Definition for Public-Private Partnership Conflict of Interest

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post includes the what and the why of my addition to the definition of conflicts of interest when it comes to public-private partnerships between health and food.
This month the Annals of Family Medicine published a point/counterpoint discussion of last year's awful decision by the American Academy of Family Physicians (AAFP) to partner up with Coca-Cola.

Howard Brody, arguing that the AAFP's deal was clearly a conflict of interest, explains that by definition a conflict of interest,
"arises when individuals or organizations enter into a set of arrangements which under usual circumstances would lead to the reasonable presumption that they will be tempted to put aside their primary interests in favor of a secondary set of interests."

and that,

"It is true that where a conflict of interest exists, no actual unethical behavior has necessarily arisen."
Meaning that simply having the opportunity for a conflict of interest is in and of itself a conflict, and certainly having Coca Cola fund and/or write educational materials on beverage consumption for the AAFP in return for $600,000 sure smells like a conflict of interest waiting to happen.

Howard then does a fine job of describing the most common arguments against perceived conflicts which include:

Premature accusations
: How can you accuse the AAFP of having a conflict? You haven't even seen the educational materials yet!

The other party's not evil: There's no conflict - just because Coca-Cola contributes to obesity doesn't make their parent company evil.

It'd be wrong not to engage
: Conflict or not, it'd be wrong not to enter into a partnership with Coca-Cola because we'd be missing out on an opportunity to influence their behaviour for the good.

Counterpoint was delivered by Lori Heim, current President of the AAFP (I interviewed her about the Coca-Cola partnership when it went down).

Basically Lori's argument boils down to Howard's premature accusations piece as she notes,
"Integral to this discussion is the transparency of the interaction, the rules governing the interaction, and the outcome of the agreement. Examined only in a philosophical vacuum, issues of conflict of interest and the underlying ethics governing behavior become an ideological straitjacket."
She then goes on to talk about the AAFP's great core values, the scourge of obesity in society and finally how great the educational materials are on the AAFP site and cites two statements that explicitly call for a reduction in sugar sweetened beverages.

You know, I agree with Lori - you can't examine the partnership in a philosophical vacuum, nor a practical one. What do I mean? Well while the duelling Annals pieces were an interesting read, I think they're rather beside the point as I'd argue there's a further litmus test for a conflict of interest, one that a philosophical or practical vacuum would ignore. I'm calling it the, "innocence by association" test.

Here's the basic premise: If your partnership with a corporation, regardless of the details or outcomes of that partnership, provides that corporation with the ability to use your partnership as a means to defend products, practices or positions that in turn are contrary to your or your organization's primary obligations, then partnership with said corporation should rightly be described as a conflict of interest.

In this case, if Coca Cola can or does use their partnership with the AAFP, an organization whose obligations lie with the betterment and protection of public health, to defend products, practices or positions which in turn are harmful to public health, then AAFP's partnership with Coca-Cola should be considered a conflict of interest.

So can or do they?

Let's ask Sandy Douglas, President of Coca-Cola North America.

Here's Sandy on April 6th 2010 in the Atlanta Journal-Constitution citing Coca-Cola's partnership with AAFP as part of his case for why soda taxes aren't necessary or appropriate,
"We're for education, through support for organizations such as the American Academy of Family Physicians, which is providing consumers science-based information about sweeteners."
Want to see another similar type example?

Here's Coca-Cola Canada's Amy Laski defending Coca-Cola's sponsorship of the 2010 Winter Olympics (sorry the article itself isn't linkable),
"We formed a red ribbon panel of experts from organizations such as the Heart and Stroke Foundation and the Canadian Diabetes Association to nominate torchbearers for Coca-Cola who committed to leading more active lifestyles and encouraging others to do the same."
Maybe I'm just a simple man, but to me it seems pretty black and white. If you enter into a partnership with an organization whose products are anathema to you or your organization's aims it's a conflict of interest. The fact that the AAFP doesn't admit to that in the case of Coca-Cola is shameful and disingenuous and frankly I'd have preferred it if they simply came out and admitted the truth - yes, it's a terrifically unsavory conflict of interest, but hey, we needed the money.

Brody, H. (2010). Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues The Annals of Family Medicine, 8 (4), 354-358 DOI: 10.1370/afm.1140

Heim, L. (2010). Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization's Code of Ethics The Annals of Family Medicine, 8 (4), 359-361 DOI: 10.1370/afm.1146

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Monday, December 30, 2013

Badvertising: Nestlé Boost's "Nutritious Energy"

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post explores what constitutes the "nutritious energy" of Boost.
First let me thank Nestlé Nutrition for sponsoring the Canadian Obesity Network's Student Meeting (and therefore unbeknownst to me for sponsoring my talk).

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

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

The first three nutritious ingredients?

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

The number of teaspoons of sugar per 237ml bottle?

10.25!

The calories?

240

Percentage of calories from sugar?

68%

How does it compare with Coca Cola?

2.5x the calories and 1.5x the sugar.

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


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Friday, December 27, 2013

The Amazing New Exercise Craze Set to Sweep the Nation

Today's Funny Friday redux explains how there's no excuses for you not to be exercising (if you've got a dog).

Have a great weekend!

Dog Gym - watch more funny videos


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Tuesday, December 24, 2013

What Would Make Kids Choose Rocks Over Bananas as Snacks?

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post highlights the incredible power of branding on children's preferences.
There has been a great deal of noise this week regarding cartoon characters and children's preferences, much of it stemming from a recently released study in Pediatrics that proved something every parent already knew - kids prefer foods branded with cartoon characters.

Something else parents already know - kids also prefer Happy Meals sold with toys which is explicitly why the Center for Science in the Public Interest announced yesterday their intention to sue McDonald's if they don't stop packaging toys with their Happy Meals,
"McDonald’s practices are predatory and wrong. They are also illegal, because marketing to kids under eight is inherently deceptive, because young kids are not developmentally advanced enough to understand the persuasive intent of marketing; and unfair to parents, because marketing to children undermines parental authority and interferes with their ability to raise healthy children."
While certainly not a statistically significant study, my favourite proof of this phenomenon came from the television program Dateline in 2006 where in the clip below you can watch kids tell their interviewer that they'd rather their parents place a rock with stickers into their lunchbox than an unfestooned banana.



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Monday, December 23, 2013

Burger King Cares More About Kids' Meals Than The Heart and Stroke Foundation

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post details the still true today fact that Burger King's "healthy" kids' meals criteria are stricter than the Heart and Stroke Foundation's Health Check's kids meal criteria - a pretty damning indictment.
Last week Burger King Canada announced new nutritional criteria for their advertised kids' meals. I'll come back to that word, "advertised" in a bit, but wanted to look at what Burger King thinks their healthier kids' meals should contain:

1. No more than 560 calories
2. No more than 600mg of sodium
3. Less than 30 percent of the calories from fat
4. Less than 10 percent of calories from saturated fat
5. No added trans fat
6. No more than 10 percent of calories from added sugars

Doesn't sound particularly healthy to me. 560 calories is still more than a child should consume in a single meal. 600mg of sodium is half a day's worth. The calories from fat and saturated fat stuff I don't care too much about. No trans fats - seems like a no brainer. I was pleased however to see the no more than 10% of calories from added sugars as that's the World Health Organization's recommendation.

So basically it's a bit of healthier window dressing but certainly nothing brag worthy.

Nothing brag worthy unless of course you're comparing Burger King's new guidelines with those of the Heart and Stroke Foundation's awful misinformation program Health Check.

What does Health Check have to say about restaurant kids' meals?

1. No caloric limits
2. Allows up to 720mg of sodium
3. Similar limit on total fat
4. Similar limit on saturated fat
5. Allows 5% of fat to be artery clogging trans-fat (and here I thought zero trans fat was a "no-brainer")
6. No limit on added sugar

Man, if I was the marketing director of Burger King's brand I'd be all over this as for those keeping score, compared with Burger King's, Health Check's kids' meals allow for unlimited calories, ignore added sugar, allow for a whopping amount of trans-fat and allow for 20% more sodium.

So should we be cheering for Burger King? I'm not. Ultimately this is just smoke and mirrors as their new dramatically stricter than Health Check but still weak nutritional criteria only apply to their "advertised" kids meals and likely is just another ploy to appease parents and try to steer governments away from considering regulations.

Interesting too that a day after the announcement the media was all over it and rightly pointed out the hollowness of Burger King's pledge. What a shame the media doesn't hold Health Check and the Heart and Stroke Foundation up to the same degree of scrutiny.

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Friday, December 20, 2013

The Best Ever Rendition of Ode to Joy

Today's Funny Friday video redux from 2010 has one of my favourite muppets performing one of my favourite classical pieces.

Have a great weekend!



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Thursday, December 19, 2013

Coca-Cola Communication Manager's Master Class in Epic Spin Doctoring

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post is my response to Coca-Cola's response to Dan Gardner's criticism of the Olympics accepting Coca-Cola as a sponsor.
What a heart warming story.

In a response to Dan Gardner's excellent column that called out Olympic sponsorships like Coca Cola and McDonald's as an anathema to the spirit of healthy living, Coca Cola's Canadian Communication Manager Amy Laski wrote a letter to the editor that detailed why Coke is great and why Coca Cola couldn't possibly be a player in obesity.

Her first argument? Coca Cola has been sponsoring the Olympics since 1928 but obesity rates really only started their spectacular rise in the very early 70s. Clearly if Coke's sponsorship of the Olympics had an impact on obesity, we should have seen obesity rates rise in the 30s and onwards.

Now that's a brilliant argument isn't it? I've actually never heard that one. Bravo Amy! Because people drank just as much Coca Cola back in 1928 as they do now, right? No? They didn't drink as much Coca Cola as now? Would that matter? I wonder what that graph up above would think about your argument?

Next Amy tells us that between 1999 and 2008 people consumed fewer soft drinks while at the same time physical activity dropped and so it couldn't be soft drinks and it must be inactivity that's led to rising obesity rates, right? Because really the only two variables in obesity are the amount of Coca Cola you drink and how active you are? And obesity only became a problem in and around 1999?

Amy also points out, in an argument reminiscent of the bad old days when doctors helped Big Tobacco in their attempts to convince the public cigarettes weren't bad, that Coca Cola created a "red ribbon panel" partnering up with the Heart and Stroke Foundation, ParticipACTION and the Canadian Diabetes Association and holds that out seemingly as proof of their great intentions (and at the same time highlighting just exactly why these organizations shouldn't be making deals with Big Food devils). I mean really, how could Coca Cola and soft drinks be bad if the Heart and Stroke Foundation, the Canadian Diabetes Association and ParticipACTION have teamed up with them? It's innocence by association don't you know?

Lastly Amy notes that soft drinks contribute 2.5% of total daily Canadian calories and then tries to slough that off as nothing.

2.5% of total daily calories consumed by Canadians come from soft drinks? That ain't nothing! The average Canadian currently consumes 2,400 calories. Now that's probably a very lowball figure as it's based off of always overly conservative dietary recall data. But even using that lowball figure that means each and every Canadian consumes 60 calories or two thirds of a can of a soft drink like Coca Cola daily. But of course not everyone consumes soft drinks. I bet between young children and folks who are watching their health or their weight it wouldn't be too much of a stretch to suggest that 33% of the population almost never drink soft drinks which means then that average soft-drinking Canadian consumes a can daily.

What happens if you drink a can of Coke daily for a year? Well you'd end up slurping up 32,850 calories along with nearly 40 cups of sugar. Drink a Coke a day for a decade and that'd translate to 94 pounds worth of Coca Cola calories and 400 cups (>200lbs!) of sugar.

Yeah, 2.5% of total daily calories is nearly nothing.

Reading her letter led me to wonder - is Amy Laski stupid, or does she just think we are?

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Wednesday, December 18, 2013

Ridiculous Serving Sizes - Costco Edition

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post is the consequence of mixing one registered dietitian with one mille-feuille pastry.

And unlike what you might expect, today I mean small.

Thanks to our wonderful dietitian Joanne Kurtz I now know how many pieces to cut a Costco mille-feuille (Napoleon) pastry if I wanted to adhere to their nutrition facts panel's serving information.

Apparently the answer's 34.

Now I realize that the math involved in calculating calories in more realistic servings isn't all the difficult, but that's certainly not something the average consumer's ever going to spend time doing even if they do bother to read the label.

A wonderful example of why Canada's practice of allowing corporations to publish completely arbitrary serving sizes is an unfortunate one.












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Tuesday, December 17, 2013

Coca-Cola to Enter the Competitive School Milk Market with Coca-Cola Pro?

For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. Today's post confused and upset a pile of folks. Guess it was just too believable - and isn't that a statement in and of itself.
In a surprise move the Coca Cola company announced the launch of its new product, Coca Cola Pro designed specifically for school children.

Said a company spokesperson,
"Children require extra attention for their nutritional needs. To that end we've designed Coca Cola Pro. Fortified with 8 grams of protein, 25% of their daily recommended value of calcium and 45% of their daily recommended value of vitamin D, Coca Cola Pro can help to ensure that your children grow up with strong bones and helps them to build the lean tissue important for their metabolisms."
Education Minister Leona Dombrowsky, when asked about the new beverage stated,
"Our goal is to ensure that kids have access to good and healthy food and Coca Cola Pro, despite having a bit of added sugar, helps to provide essential nutrients to our children. We hope to help make it available to school boards across Ontario to be run in concert with school milk programs."
Think that'd be nuts?

Think that a smidgen of protein, calcium and vitamin D couldn't possibly make Coca Cola a healthy beverage?

Well while Coca Cola Pro and those quotes up above aren't real, there is an equally ridiculous beverage being pushed on our children - chocolate milk.

Drop per drop when compared with the Coca Cola Pro I created, chocolate milk has identical amounts of protein, calcium and vitamin D with the added "benefit" of having 17% more sugar, 80% more calories and 590% more sodium.

And while Leona Dombrowsky didn't come out in strong support of Coca Cola, she did come out in strong support of chocolate milk.

You see Ontario had been considering a ban on 500mL cartons of chocolate milk. A few days ago they backed off that plan and Leona was quoted as stating (for real this time),
"Milk and chocolate milk is available in our schools because it is good for kids....Our goal is to ensure that kids have access to good and healthy food like milk and chocolate milk....You know, 'milk does a body good and that's what we want to make sure that our students have access to"
Yes Leona, what could be better for kids than a beverage that per 500mL carton contains 1/3 of a child's total daily sodium recommendation, 15.5 teaspoons of sugar and more calories than 10 pieces of licorice?

What could be better?

My mythical Coca Cola Pro. It'd have the same magic nutrients of milk but with less sugar, less sodium and fewer calories.

Yet somehow I don't think it's too bad that Coca Cola doesn't make it, instead I think it's too bad that Big Milk has so completely indoctrinated the world into thinking that milk's magic that no one bothers to question comments like Leona's, and that hoodwinked schools, parents, politicians and health professionals continue to defend chocolate milk's consumption.

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Monday, December 16, 2013

Health Canada and The Most Useless Nutrition Campaign in History


For the next few weeks I'm going to take some time off from blogging - but don't you fret, I've curated a collection of some of my favourite posts from 2010. First up is this one on Health Canada's %DV campaign. Sadly it's still running and sadder still our tax dollars have been spent promoting this in television commercials, glossy magazines and public transit ads

Readers of my blog are likely well aware that when it comes to Health Canada and nutrition I've got low expectations. That said, not even my lowered expectations were enough to prepare me for the mind-numbingly stupid new nutritional education campaign unveiled last Friday at a Longo's supermarket in Toronto.

The campaign had fanfare with a formal press release from Health Canada touting a, "Major Nutrition Labelling Initiative", replete with an important feeling press embargo and a razzle dazzle press conference with our own Minister of Health.

Multiple reporters contacted me prior to the event asking if I knew what was up, and a few opined that it was odd that Health Canada hadn't provided them with much pre-information. Of course it was only after the press conference that we all understood why they weren't given much - there wasn't anything to provide.

In a nutshell the hoopla was all stirred up for Health Canada to teach Canadians the following two points:
If a product has less than 5% of its percent daily value of whatever, that's a little.

If a product has greater than 15% of its percent daily value of whatever, that's a lot.
That's it, that's all, see you later folks.

Oh, and they've also got a shiny new website that tells you pretty much the same thing.

So here's the rub.

Canadians don't know a heck of a lot about nutrition and Health Canada's recommendation that you "use" the percent daily values to guide choices assumes far too much.

For example, let's say you're trying to compare two pretty much identical products that differ only in Vitamin A and Vitamin C levels - should you choose the one with more Vitamin A or the one with more Vitamin C? I don't know the answer, so why should you?

Here's another. What matters more? High levels of fibre and iron or low levels of sodium and saturated fat?

Most amazingly?

You know what's the very first number on our nutrition facts panel? Calories. You know what this latest campaign, rolled out explicitly with obesity as part of its rationale avoids teaching about? Calories.

How difficult would it have been for Health Canada to on their percent daily value page include a calculator to help determine a person's caloric needs and then instruct them on how to use that number to navigate nutrition fact panel calories?

Ultimately what Health Canada has done is to decline to actually affect a useful nutrition facts panel reform - one which would have done such things as eliminate the arbitrary, non-real world servings sizes, disallow the use of multiple sugar synonyms to make products appear as if sugar's only a minor ingredient, get rid of those micronutrient levels that no Canadians, not even nutrition professionals, really know how to utilize and serve only to confuse (really, do we have so much scurvy and night blindness that we actually need to list Vitamins C & A?), and instead they came up with a lame dog and pony show promoting mindless nutritionism and the dangerous notion that eating, "healthy" somehow protects weight.

I guess I've got to reset my Health Canada nutrition bar lower. Sadly, I think that'll now mean digging.

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Saturday, December 14, 2013

Saturday Stories: Lobotomies, Music, and Vitamins

Amazing multi-part piece by Jenn Ackerman and Tim Gruber for the Wall Street Journal on the sorry tale of WWII era American lobotomies.

Peter Reuell from Harvard busts the music lessons will make your kids smarter myth.

Fascinating piece by Carl Zimmer in the New York Times on the history of vitamins.

[And if you don't follow me on Twitter or Facebook, this week's US News Column has my vote for one of the healthiest 2014 New Years' resolutions you could make].

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Friday, December 13, 2013

You Shall Not Pass - Dog Edition

I dare you to watch today's Funny Friday video and not be amused.

Have a great weekend!



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Thursday, December 12, 2013

Who Cares if 3,500 Calories Don't Make a Real Life Pound?

If there's a more painful discussion in nutrition and obesity these days beyond the one that circles the question, "Do 3,500 calories really make up a pound?", I don't know what it is.

So here are some truths.
  • People are not walking math formulas whereby if they have 3,500 more or less calories than they burn they'll gain or lose a pound.
  • 3,500 calories of one food or type of food will likely have a different impact on health, hunger, thermic effect, and weight than 3,500 calories of another food or type of food.
  • Different people have different caloric efficiencies whereby they are seemingly able to extract more calories from food or reserves than others and lose weight with more difficulty (and gain with greater ease).
And yet here's the only truth that matters.

From a weight management perspective, the currency of weight is calories. While exchange rates undoubtedly do vary between foods and between individuals, you'll always need your own personal deficit to lose, and surplus to gain.

All other discussion, while certainly academically interesting, given there are no other alternate measures available to track, or tests to determine individual responses to different calorie sources, serves to foment confusion.

If weight's your concern, more important than anything else is finding a life that you enjoy that contains fewer calories than before. Getting stuck in the minutia of what type of calories may lead to an every so slightly faster or greater loss, rather than truly crafting a life that's enjoyable (and hence sustainable), might help in the short run, but will almost certainly defeat you in the long.

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Wednesday, December 11, 2013

Kudos to the New Brunswick Medical Society for Tackling School Food!

I love this initiative!

So the New Brunswick Medical Society has invited parents, teachers and kids to take pictures of their school food to share on the Society's Facebook page. The submissions weren't surprising. Plenty of awful fare of course (like that actual menu sent in up above), and also a tiny bit of good.

The point of the campaign is to raise awareness that Menus Matter, and that while New Brunswick physicians can't force schools or school food policy to change, they can certainly help lend a mirror and a voice to parental concerns.

Given our children are literally being built out of the foods we're serving them, asking the question of whether or not our schools should be building them out of pizza and chicken nuggets is an important question.

Good luck NBMS, and thanks to Society member and blog reader Dr. John Tobin for sending my way.

[And if the Ontario Medical Association is reading - I'd be happy to help spearhead a similar initiative here were there a desire.]

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Tuesday, December 10, 2013

Guest Post: Why I am Walking Away from HAES

Image Source
A few years ago I wrote a post detailing my concerns regarding the Health at Every Size (HAES) movement. My concerns are simple. While I'm a strong supporter of the notion that scales don't measure the presence or absence of health, it seems to me that HAES proponents often takes this concept further than it ought - both in terms of cherry picking and promoting confirmation bias tweaking data, and in terms of reacting aggressively when anyone suggests weight may be a valid source of concern to an individual or a physician. Yesterday I received an email from someone who has had some struggles with HAES and I asked if I might post their email anonymously so as to see if their experiences were unique and unfortunate for them, or par for the course and unfortunate for HAES.

I wanted to thank you and respond to your HAES article - but had no intention of reviving a nearly 2 year old thread. I recently walked away from the HAES movement, because, as you predicted in 2012, the proponents would use so little credible information that they wind up discrediting their reputation along the way. But not only that, but the localized followers have taken an even more drastic turn, and I feel that it has become somewhat dangerous.

Members of groups are either rabidly defensive, or walk on eggshells. After a recent blow-out it came to my attention that many of the HAES speakers may have some disordered health issues that are unresolved, and are using the program - not to promote health at any size, or to stop shaming people about body size - but to simply cover or hide coping mechanisms. You are not allowed to speak up and say things - things that ordinary people would say - without being accused of "triggering" HAES members - things like, "Some people decide to gain or lose weight for medical reasons".

To me, it became all too frightening that even speaking of someone gaining or reducing weight for a health or medical reason (or just because they want to, honestly) - as decided by patient and doctor - receives such a vehement backlash from the HAES community that you are, essentially, ousted. The "community" has become less about health at any size. It has become "Only healthy at larger sizes". It was noted that people who gained weight for health reasons were OK (that intentional weight change is acceptable). People who benefited from weight loss, however, were villains, lying, or anomalies. (Their intentional weight change is bad, offensive, and "dangerous") Health concerns for people at smaller sizes were/are irrelevant.

It is even more worrisome that unqualified individuals whose disordered habits may be triggered by the personal decisions of others are giving medical advice, and essentially encouraging people to stop listening to their doctors. The HAES people are right, the medical community (and individuals in it) are wrong.

That is downright terrifying.

I just thought I'd drop this note, because, well, people are walking away, and not just because of the lack of credibility. And it's too bad, too - because advocating health for everyone, and reducing stigma is an excellent thing. But alienating people because they have chosen health at a particular size - that does not fit into their overall agenda - is not the way to grow a movement.

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Monday, December 09, 2013

Guest Post: Health Canada is Partially, Fully and Just Plain Hydrogenated

[By our office's RD Rob Lazzinnaro]

Being the snoopy RD that I am, this past week I noticed a colleague’s peanut butter had “hydrogenated” vegetable oil in it. I was quick to decry,
Trans fat! Beware!”,
to anyone who would listen and sparking a discussion in the office around trans fat.

After a smidgen of more careful thought we agreed that if an ingredient list contained the words “partially hydrogenated” that there was no doubt it contained trans-fat, and that if an ingredient list contained the words "fully hydrogenated” that it meant no trans fat. However the question remained, what does the non-elaborated on lonely word “hydrogenated” mean in terms of trans-fat?

According to a statement from Health Canada,
The declaration of a ”hydrogenated" oil in the list of ingredients can refer to either a partially hydrogenated or a fully hydrogenated oil. Thus the term "hydrogenated" appearing in the ingredient list may or may not be indicating the presence of trans fats in the food product.
Not so helpful even for those reading labels, is it?

And what of the nutrition facts panel, can we look to it for guidance?

Not really as according to Health Canada,
"foods that contain 0.2g of trans fat or less per serving can be labelled trans-fat free
Sure, 0.2g seems small, but the words “per serving” are not standardized, meaning that serving sizes are much more arbitrary than real-world and as everyone knows, these often unreasonably small serving sizes can add up quickly. And how exactly is/was it determined that 0.2g of trans fat per serving is okay for the public to consume? Moreover, wouldn't Health Canada's guidelines mean the food industry could simply make their serving size smaller, use the term "hydrogenated", and then label their product “trans fat free?

In the United States, labelling laws and the wording is similarly ambiguous, with even higher allowable trans-fat amounts in a “trans-fat free” product at 0.5g/serving or less. BUT, the U.S is currently taking the right steps to try to eliminate partially hydrogenated oils from their entire food supply, and it would seem here that Health Canada is not only doing nothing, but they have made it exceedingly easy for the food industry to dupe even label reading Canadians.

So why is this important?

The Institute of Medicine (IOM) concluded that
there is no safe level of consumption of artificial trans fat.”,
while the head of Health Canada's own trans-fat task force labeled trans-fat a
"toxin unsafe in any amount".
My question for Health Canada is simple - why the ambiguous wording around an ingredient that is a known health risk, especially given your outright refusal to regulate it as your current definition seemingly only serves to benefit the food industry and not the public?

My recommendation for now is straightforward. When considering a product, unless you see the word "fully" right before "hyrdogenated", or if you see shortening anywhere in the ingredient list, put the item back on the shelf.

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Saturday, December 07, 2013

Saturday Stories: Death, Scientists and Healthy Obesity

Dilbert's creator, Scott Adams, reflecting on his father's chronic suffering in the context of legalizing doctor assisted death.

Food lawyer Ron Dearing and his great piece entitled, Scientists Behaving Badly.

My friend and obesity medicine guru Dr. Arya Sharma with his take on that new study about healthy and obese being contradictory terms.

[And if you don't follow me on Twitter or Facebook, my weekly US News and World Report column is on my belief that this holiday season should be an all-you-can-eat one]

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Friday, December 06, 2013

Serving Sizes Have Grown In Both Directions You Know

Good old The Onion.

Today's Funny Friday video is their report on the amazing skill of Americans (and I'll add Canadians) at compressing overly large sandwiches to fit into our mouths.

(I'm pretty good at this too if I do say so myself)

Have a great weekend!



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Thursday, December 05, 2013

Guest Post: I Am a Doctor, But I Don't Play One on TV

Today's guest post comes from my friend and colleague Dr. Valerie Taylor. Dr. Taylor is the Psychiatrist-in-chief at Women's College Hospital and an Associate Professor at the University of Toronto. She is currently the mental health lead for the Canadian Obesity Network and the Ontario Bariatric Network. Her research and clinical focus is on the overlap between obesity and mental illness, and a while back she told me a story that led me to ask her if she'd be willing to write about it for my blog? She agreed, and while she's left the identify of the Big Food player out, it's the gist here that's important.
Mark Twain has been attributed the quote “Be careful about reading health books. You may die of a misprint.” This is especially relevant in today's environment of medicine as entertainment, both because of its literal applicability and because if in fact it was not his actual quote, he was the celebrity spokesperson that gave it traction. Part of its staying power is because MARK TWAIN said it. That makes it cool.

I have dabbled on the fringes of the health as entertainment market and while I danced with the devil (a reality show host interview and a few questionable media speaking requests), I was unable to commit. In the end, my academic ethics and this uncomfortable feeling that no matter how pretty the wrapping was, ultimately I was being asked to pull a fast one on an unsuspecting population.

This occurred again recently when I was asked to be a spokes person for a large food organization. It sounded good: I simply had to talk about my research and how things like having positive self esteem was helpful for successful weight loss. Well, I believed that. I could support that message. All things were a go.

Then, thankfully, some one gave me some wise advice about reading the fine print. And giving the contract to my hospital lawyer for a once over. It seems that while the company in question was interested in my views on self-esteem and cognitive therapy, they were also interested in product placement and me saying their products caused weight loss and improved self-esteem. Which they do not.

At the 11th hour I once again turned down my chance for fame and fortune on the big screen, only to feel the wrath of said food company. The fact that they were prepared to basically perpetuate a hoax on an unsuspecting population, selling impossible outcomes on the back of my medical education and academic credibility did not really matter. Did I not want to be a star I was asked? Sure that sounds lovely I replied. I do not, however, want to be a charlatan.

Clearly not every M.D endorsing a product has compromised their morals and there are passionate, committed people who believe in what they are doing.

There are also those who use their credentials to add legitimacy to what would in other venues be ridiculed. So be careful what you watch and what you believe. And remember what Mark Twain said. Because if Mark Twain said it it must be true.

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Wednesday, December 04, 2013

Guest Post: In Pursuit of Good (Enough) by Jeannie Marshall

Photo by Sean Ganann
In case you weren't aware, I'm a huge Jeannie Marshall fan. I reviewed her first book, Outside the Box: Why Our Children Need Real Food Not Food Products way back when and we've been periodically in touch ever since. A little while back I invited her to consider a guest post here and she graciously obliged with a topic near and dear to my heart - embracing simple. (And if you'd like, her book is about to be re-released in the US under the title, The Lost Art of Feeding Kids: What Italy Taught Me About Feeding Kids, or you can order the original book from Canada)

Now that food is such a hot topic, it seems we’ve all become amateur nutritionists and aspiring gourmet chefs. While I’m happy that people are paying attention to their dinner, I’m starting to feel just a little oppressed. It seems that every cook with a food blog produces beautiful and complicated meals perfectly plated and expertly photographed. The profusion of these sites makes it feel like you have to make something unique every single night. The food industry, with its constantly changing products and new taste sensations, also fuels a drive for the “new.” All this is turning what was a fun, easy going part of my day into something competitive, even if the only person I’m competing with is myself. Of course, the explosion of food blogs and the general rise in interest in food and all its issues is a wonderful thing, but it’s exhausting if every dinner has to compare with something prepared by an expert.

I’ve lived in Rome for more than a decade now. And you might think the pressure to cook fantastic and gorgeous meals would be enormous. But it’s in Rome that I really learned to cook simple meals, with few but very high-quality ingredients (think of the basic tomato sauce: chopped tomatoes, a pinch of salt and some olive oil left to simmer. If you want to liven it up, you add an onion.) I’ve also learned to develop a repertoire of seasonal meals and this is what makes cooking and eating in Italy such a pleasure. Repetition is good. Romans have long looked forward to gnocchi on Thursdays and salt cod with chick peas on Fridays. My own winter menus consist of soups, beans with greens, lentil stews with meat or without, risotto with mushrooms, beef braised in wine, chicken cacciatore, pasta with roasted squash, all of it served with a heaping side dish of vegetables.

Now that Rome has finally turned cold, I made the first winter polenta. When I started cooking, my eight-year old son came in the kitchen and said: “Oh, I love polenta season.”

The first thing I did was put a pot of salted water on the stove to boil. Then I cut up a carrot and half a yellow pepper and put them on a plate with a handful of unsalted almonds so that when Nico came in to rhapsodize about polenta he might be enticed to pull up a chair, eat some raw vegetables and chat with me rather than withdrawing to the living room to sit on the carpet and yell “Mom, I’m bored.”

Then I started ripping kale leaves off their stems and soaking them in a big bowl of water to remove any loose dirt. My not-bored son actually helped me with this task, which freed me up to brown a little ground beef in a pot with a pinch of salt to extract the juices from the meat. On a whim I added a sprig of rosemary from the hearty little plant on the kitchen balcony. When the meat lost its raw red look, I dumped in a jar of crushed tomatoes, another pinch of salt, two bruised garlic cloves and a whole onion cut in half. I gave it all a stir and turned it down to a slow simmer. Then I cooked the vegetables in a little boiling water. By then the big pot of water was boiling and I started slowly adding cornmeal and whisked. I followed Marcela Hazan’s instructions but not completely. I let the cornmeal flow into the water a little faster than she suggests, but made sure it didn’t clump. I had to turn down the polenta briefly while I drained the vegetables, but it was fine. Just as my arm was getting tired from the stirring my husband arrived home from work. Nico had saved him a carrot stick and a few almonds.

I gave him enough time to pour us both a glass of red wine and then handed him a wooden spoon. Nico set the table and filled glasses with water. I poured olive oil and a squeeze of lemon over the kale and took it to the table. James plopped ungainly mounds of polenta into three bowls and I slopped sauce on, all the while grateful for the absence of photographers and celebrity chefs. Then I grated some parmesan cheese over top.

As the bowls hit the table, Nico lit the candles and James found Miles Davis on the iPod. After a few initial yums, and other remarks about how we’ve all been missing polenta since last winter, we talked about work and school and Nico’s new interest in the trumpet and the French horn.

It was simple and very good food. I wouldn’t hesitate to serve it to a guest if one were to suddenly knock on my door. It wasn’t elegant or unusual, but it was more than good enough to lure us to the table, to enjoy each other and to get on with the talking, which to me is the really nourishing part of the meal.

Recipe:

(BTW Marcella Hazan has a no-stir method for polenta, which is almost as good as the stir, stir, stir method.)

Polenta – adapted from Essentials of Classic Italian Cooking by Marcella Hazan

7 cups of water
1 tablespoon of salt
1 2/3 cups of course-grained yellow cornmeal (not instant polenta or fine cornmeal).

1. Bring the water to a boil in a large, heavy pot.

2. Add the salt, keep the water boiling at medium-high heat, and add the cornmeal in a very thin stream, letting a fistful of it run through nearly closed fingers. You should be able to see the individual grains spilling into the pot. The entire time you are adding the cornmeal, stir it with a whisk, and make sure the water is always boiling. (I allowed the cornmeal to go in a little faster, but I kept up the whisking so it didn’t clump.)

3. When you have put in all the cornmeal, stir constantly with a wooden spoon, bringing the mixture up from the bottom, and loosening it from the sides of the pot. Continue to stir for 40 to 45 minutes. The cornmeal becomes polenta when it forms a mass that pulls cleanly away from the sides of the pot. (Mine took less time, maybe 30 minutes.)

It should be thick, firm and slightly quivery.

Then, Marcella suggests turning the polenta out into a steel bowl that has been moistened with water and letting it cool. This moulds it into a dome shape. I didn’t bother. I just scooped it from the pot into our bowls.

Simple meat sauce:

2 tbsp olive oil
½ to ¾ of a pound of ground beef (depending on how meaty you like it)
Pinch of salt
Sprig of Rosemary
1 jar (700g) of crushed tomatoes (just tomatoes, with nothing added)
Pinch of Salt
2 peeled and slightly bruised cloves of garlic
1 medium onion, peeled and sliced in half but otherwise left attached at the ends

Pour the olive oil into the bottom of a heavy saucepan. Put the ground beef in the pan and turn the heat to medium (if you have time, allow the beef to come to room temperature before cooking it). Just as it starts to cook add a pinch of salt. Stir it around so it doesn’t stick and add the rosemary. When the meat is no longer raw looking, add the tomatoes, pinch of salt, garlic and the onion. Reduce the heat to a low, gentle simmer and stir it occasionally. * If you have time, you can first cook some chopped carrot and celery in the olive oil until they soften, then add the ground beef. I was just being lazy, and I didn’t do it. If you really have time, it is delicious with a proper ragu, but that takes a few hours of simmering. This meat sauce is quite good and quick.

Polenta makes a great base for other sauces. We like to prepare a basic tomato sauce and add some cooked mushrooms and a scoop of creamy gorgonzola. You can also serve it with beef or lamb stew and it’s lovely with chicken cacciatore.

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Tuesday, December 03, 2013

Guest Post: Book Review - Food To Eat (for Eating Disorder Recovery)

Today's guest posting comes from our office's RD Rob Lazzinnaro who reviewed fellow RD Lori Lieberman and her co-author Cate Sangster's Food to Eat: guided, hopeful & trusted recipes for eating disorder recovery. Truthfully I've had this book for a very long time and realizing that my pile of books seems to be getting taller, not shorter, I asked Rob for his take.

Eating disorders are a highly sensitive topic. As a Registered Dietitian determining how to approach clients struggling with an eating disorder can be difficult as the disorder can essentially destroy one's relationship with food, and the road back to healthy eating can be long. For many, food becomes a source of anxiety, social tension, fear, and sometimes can be seen as the enemy. Food to Eat is a combination of practical tips on rethinking and changing how one eats, paired with a large selection of recipes.

About the authors: Lori Lieberman is a Registered Dietitian with 26 years of experience working with eating disorders, while Cate Sangster has struggled herself with an eating disorder for over 20 years; the combination of their two perspectives proves invaluable.

A few items from the book that I really enjoyed:

1. The “outsmart your eating disorder(ED) voice” question & answer snippets placed throughout the book. Truly they provide valuable insight into possible fears and concerns about the topics addressed. I imagine these questions accumulated during the author’s many years of both clinical and personal experiences.
e.g.

• “So why would I take in fats, then, when they’re highest ounce for ounce (or gram for gram)?” [p.42]
• “But I’m not hungry so why should I eat?” [p.46]
• “But once I eat I get hungrier!” [p.46]
• “Why butter? Shouldn’t I use a healthier fat or none at all?” [p.68]

(you'll have to read the book to discover their answers)

2. In the segment called “putting it all together” [p.45-46] the authors provide recommendations for meal structure and timing, e.g. how often to eat. This brief overview provides an important starting point for addressing hunger. In my opinion it may be the most important segment of the book but as I point out below, I wish it were longer.

3. Some great recipes are included! Plenty of variety, textures, and cultural options with simple instructions that are accompanied by many of those fantastic ED voice Q&A’s. Also, the authors deserve a high five for including scratch dessert recipes in the book. While some might find their inclusion odd in an eating disorder book, in my opinion treats are a necessary part of any well thought out meal plan (though if your eating is disorganized and irregular, controlling them thoughtfully may prove exceedingly difficult).

A couple of items from the book that I think are important to flesh out:

1. I would have loved to see a longer discussion regarding the types of hunger that drive us. For many, reducing or eliminating physiological hunger through careful dietary organization can be a key factor in keeping emotional, environmental and social hunger cues at bay, which is why eating every 2-3 hours and not skipping meals may be one of the most powerful tools in the fight against eating disorders. That said, no doubt the content of what you eat may affect your hunger as well, which brings me to my next point.

2. Many processed and packaged food items are seemingly addictive in that they are designed to be difficult to resist, and our individual response to these items is not addressed in this book. Those struggling with an eating disorder may find it helpful to know that many foods items have been designed to be “triggers”. I am referring to processed food items that can send you in to a tailspin with just the right mix of sugar, fat and texture, and often leaving you hungrier after consuming them. I wonder the impact a shift from the highly processed world to a from scratch whole world might have on those struggling with eating disorders and dietary control issues?

Overall, the book proves to be an excellent initial guide for anyone personally struggling with an eating disorder. I also believe it can serve as a solid resource for clinicians.

If you'd like your own copy, here is an Amazon Associates link for purchase.

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Monday, December 02, 2013

Parental "No" Files: Doctor Specific/My Life Edition

This past weekend MD Management, a physician specific investment group, generously hosted Ottawa MDs and their children to a sneak preview of Disney's new movie Frozen (it was great BTW, and only one very indirect body image reference and no weight bias/stigma).

We were invited to arrive at 9:30am.

Along with our free passes, MD Management generously gave out stuffed bears to the kids.

But their generosity didn't stop there.

Free kid's combos for all kids which appeared to consist of 4 cups of movie popcorn, 16oz of sugared soda, and 1 tube of M&M minis for a total of 641 calories and 18 teaspoons of sugar at 9:30 in the morning!

Yes of course, parents can say "No" (and I did - my daughter and I shared half a small bag of popcorn (which when ordered resulted in a great deal of confusion behind the counter) and we brought water along), and yes, I get that movies and junk food are synonymous, and no doubt MD Management was just trying to be a good host (which they certainly were), but here's looking forward to the day when being a good host doesn't include the automated provision of junk food.

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