Saturday, January 31, 2015

Saturday Stories: Linus Pauling, Political Cupcakes, and Life Happiness

Megan Thielking in Vox.com on the story of Vitamin C and Linus Pauling.

Dr. Dan Taber in his own blog wondering when did cupcakes become a political pawn?

Nico Pitney in HuffPo on what 1,500 elders taught one gerontologist about life and loving.

[And if you don't follow me on Twitter or Facebook and you missed me on TVO's The Agenda or on The National talking milk and sugar, clips are embedded below]





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Friday, January 30, 2015

A Must Watch of Jimmy Kimmel's Taking on "Cold Pressed Jüce"

Love the Kimmel, and today he's hosting a fabulous Funny Friday.

"Feel it go through your lungs, your liver, your spleen"

Have a great weekend!



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Thursday, January 29, 2015

Sobey's #BetterFoodForAll Campaign Promotes Health, Sales and Woo

I really wanted to love this campaign.

Sobey's Better Food for All program positions itself as a campaign designed to increase the love of real food, cooking and health, and so with hope in mind, I headed over to their site to find out.

Parts of it really are great. There are easy to make nutritious recipes courtesy of Jamie Oliver. There are Twitter, Facebook and Instagram campaigns where people can share their real food successes. There's also some helpful posts on the blog including some tips for getting kids into the kitchen more and some ideas for packing a healthy lunch, but much of the content is doing a disservice to readers.

In just the first few entries readers were told that lemon juice improves body alkalinity (what you eat has no bearing on your blood's alkalinity), that the sugar-delivery vehicle known as kids' yogurt was, "the ultimate grab-and-go snack" (might as well be feeding kids melted ice-cream), promoted the magical benefits of "fresh-pressed juice" (there aren't any), and told people that you need to refuel after you work up a sweat (unless you've sweat for a truly heroic amount of time, you almost certainly don't).

Sobey's, while I'm incredibly supportive of your aim of improving cooking skills and getting kids and families back into the kitchen, educating the public about healthful eating should by definition exclude both pitching them crappy products and publishing and disseminating to them non-evidence based woo.

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Wednesday, January 28, 2015

Kudos to Coca-Cola. No, Really.

The applause definitely need not be big, but Coca-Cola is actually doing something I can applaud them for, or more accurately, they're not doing something that I can applaud them for.

Yesterday in Canada, Coca-Cola announced that they're reducing the calories in their flagship Coca-Cola beverage by 8% (given all calories in Coca-Cola come from sugar that also means a sugar reduction of 8%), and the article where I read about all of this also notes that in the near future they will be replacing their ubiquitous 20oz bottles with 16.9oz bottles. All told that means that people accustomed to drinking from 20oz bottles of Coca-Cola, if they don't up their consumption levels as a consequence, will see their Coca-Cola calories and sugar fall by 20%.

Now don't misread me, drinking Coca-Cola, even with 8% less sugar, isn't in your health's best interest, and given 8% less of a very large number is still a large number, the kudos aren't for the reformulations. The kudos are for the fact that, at least according to the article, Coca-Cola isn't going to launch a marketing campaign touting their now ever so slightly calorie and sugar reduced soda. Frankly, that surprises me some, as having packaging shouting, "now with less sugar", or, "lower calories than ever before", along with a concomitant TV and print ad, "we care about your health therefore we decided to....." campaign might well have led consumers to purchase more of the stuff, and/or consequent to the health halo effect of suggesting there was an improvement, have lead to greater per person frequency and/or amounts of consumption - and greater sales.

But they're not doing that.

Sure, these changes are likely being made in order to save money (especially the reduction in bottle size which I would be flabbergasted were it to be accompanied by a cost reduction), and no doubt they'll still bundle reports of these changes into their efforts at forestalling regulations that would negatively impact sales by using them to suggest that they're working hard to try to help, but truly, if they don't advertise them, it just means that regular users will be consuming ever so slightly less of the awful stuff and they won't even know it.

So truly, teeny-tiny kudos to you Coca-Cola Canada, but forgive me if my toast is with water.

(and as you might imagine, should there be a marketing campaign or a packaging change that suggests this newer, ever so slightly less awful Coca-Cola is somehow improved or better for you, I'll be loudly retracting my kudos in a follow up blog post)

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Tuesday, January 27, 2015

Canada's New Adult Obesity Treatment Guidelines Exclude Actual Treatment

Yesterday saw the publication of the Canadian Task Force on Preventive Health Care’s
Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care
From the title you might think that in it there will be guidelines for both behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care, but you’d be mistaken.

The 13 page guidelines ultimately provide only four recommendations to Canada’s family physicians, and none involve Canada's family physicians providing any actual treatment.

The guidelines recommend that Canada's family physicians measure the BMI of everyone over the age of 18 who doesn’t have an eating disorder or who is pregnant, and they refer to this as a "strong" recommendation based on "very low-quality evidence"

First off, I don’t understand how anyone can strongly recommend doing something for which there is only very low-quality evidence of benefit or utility. Moreover, why BMI? BMI is a simple measure of bigness and as such BMI does not measure the presence or the absence of health. As my friend and colleague Dr. Arya Sharma told Helen Branswell from the Canadian Press, the Task Force might have just as well have recommended we measure our patients' clothing sizes as they provide the same amount of useful information.

Choice of measurement aside, what does the Task Force tell physicians to do with the BMI they just measured? First, they tell Canadian physicians not to offer any formal interventions aimed to help prevent weight gain for their patients whose BMI's are classified as "normal" (which given we're talking about a minority of the population in fact make their weights "abnormal" if we must use that nomenclature). Next they tell physicians if their patient's BMI exceeds 27, and that patient is at risk of diabetes, they should really consider referring them to a structured behavioural intervention, and if they’re not at risk of diabetes, but have a BMI over 27, to still consider that same referral, just not quite as strongly. Lastly they tell physicians not to routinely offer any patients, of any weight, pharmacologic interventions geared to help with weight management.

Put more simply, the sum total of guidance provided by the Task Force to Canadian physicians is to measure their patients' bignesses, and if they’re concerned about their bignesses, to refer them to formal weight management programs which, if we’re talking about programs that include regulated health professionals as their providers, barely exist in Canada (full disclosure, I’m the medical director of one such program).

But here I’ll tell you something. The Task Force isn’t to blame and they didn't do anything wrong. Their guidelines quite effectively sum up some inconvenient truths about the state of the evidence when it comes to weight management.
  1. The medical literature still leans on BMI as if it’s a useful measure in and of itself and more patient centred approaches such as Dr. Sharma's EOSS score haven't yet been established as superior to BMI (his is).
  2. Despite decades of clinical study there really isn’t any gold standard approach to help medically manage a person’s weight, and frankly many of the studies that have been conducted are for programs that almost by their very definition aren't sustainable in their approaches.
  3. Most family doctors lack either the resources, background, or time to help patients with weight management in the context of brief, sporadic, primary care visits.
  4. The most successful medical weight management programs are those with structured approaches, interdisciplinary teams, frequent appointments and are of long duration.
  5. Medications for weight management prescribed in the absence of a behavioural intervention don't work very well
All that said, I do think there's plenty family physicians can do to help improve their patients’ health and mitigate their weight relatable and responsive risks. Taking the time to really understand a patient’s lifestyle history (every patient, not just those with more bigness), can highlight problems and issues that family physicians may well feel comfortable addressing without the need for a behavioural team. Helping patients to improve their lifestyles may well also help with weight, but even if it didn’t, no doubt it would help in the prevention or management of the dozens and dozens of other chronic conditions responsive to, and affected by, the way we live. Exploring eating patterns, cooking, meals out, liquid calories, parental feeding practices, fitness, sleep, relationships, friendships, job stress, kid stress, parent stress, socio-economic realities, etc., and helping patients to overcome or reduce barriers to improving same is well within the purvey and skill set of a good primary care provider and would benefit patients regardless of their weights.

Ultimately we need to stop perpetuating the myth that scales are able to measure the presence or absence of health, because until we do so we'll be failing patients with and without obesity alike, as paradoxically, in creating clinical practice guidelines that summarize what we do and don't know about the management of weight and weight alone, those same guidelines will by definition encourage physicians to ignore, or refer onwards, the actionable lifestyle determinants of health of all of their patients.

Put more simply, health cannot be weighed.

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Monday, January 26, 2015

Guest Post: The Unexpected Side Effects of Significant Weight Loss

You can buy this photo here.
The other day in my office a patient of mine was telling me about some of the surprises she's faced since losing a great deal of weight. Having known her for some time and familiar with her insight and writing abilities, I asked if she was interested in writing a guest post (anonymously or as she chose, with attribution) about them. Happily she agreed, as I imagine will you when I tell you it's terrific, powerful, happy and sad all at the same time.
Nine months ago, I had a gastric bypass. When I told people what I was going to do, they were shocked. I wasn't that big. Was I really sure I wanted to do something so drastic? Couldn't I try just one more time to lose weight? Shouldn't a gastric bypass be reserved for people who are sick and fat, instead of just sick and tired of being fat?

Here's my response: the decision to have major surgery with very real consequences was not taken lightly. It took an entire year from the time Dr Freedhoff first suggested it until I was ready to be referred to the program. But once I made the decision, I wanted it to be done with. I wanted my new life to begin.

I did everything right - I researched, I read, I went to a psychologist, I made sure that both my head and my heart were ready for the significant change in my life. I followed every instruction that my surgeon gave me to the letter. And my results have been spectacular.

I went from a BMI of 41 to a BMI of 25, or exactly normal. My body fat percentage went from the high 40s to the low 20s. My blood pressure went from an average of 126/85 to 106/55. I lost almost 90 pounds, and went from a size 20 to a size 8/10. In short, I am "normal", though in reality, I think I'm actually smaller than average. I look taller and 5 years younger. And I'm happier than I've ever been before.

Still, there is something about my weight loss that upsets me in a fairly fundamental way - I have moved from being invisible to visible, and it is both uncomfortable and enraging.

When I was fat, I was invisible. I could go into a high end store (like Holt's or Coach) and never have a sales person approach me, never get asked if I need assistance. I could go to the gym and do my thing in total isolation, giving the chin nods to the few other plump ladies working out at the same time as me, commiserating in our matching t-shirts (because Canada is not polite enough to sell more than one style/colour of a plus sized work out shirt).

Now when I go to a store, salespeople fawn over me. I went into a store one day and a sales person brought me every single dress they had in my size, one after another. I went into another and they ran down this list of hidden sales that I would never even have dreamed existed. This enrages me - was I not deserving of fashion, style, taste, good deals, lovely accessories? Was I not deserving of being treated like a human being? This part of my weight loss makes me angry, and reminds me to never, ever ignore someone because they are fat.

Now when I go to the gym, people look at me. Not just my other round sisters, but men. They look me up and down and assess me, they try to engage me in conversation, they offer me tips on my squat form. This makes me so uncomfortable - it's not something I've ever experienced and, although my friends tell me this is modern flirting, it makes me feel dirty, like an object. It makes me feel unsafe for the first time in my life. I went from a sisterhood of the invisibles to being an object of the male gaze. I still give my chin nods to my ladies, and I still tell them that they're doing great. Now though, they look at me like I'm not one of them, like I have no right to applaud their efforts, and this makes me a little bit sad - I lost my gym-going community.

And then there are the well-meaning, the beneficent, the ones who cannot understand what their words mean.
"You look so much younger.. taller... better... prettier... smarter" (that one was tough).

"You're not going to lose more weight, are you? You're done, right? Maybe you should eat more - you don't want to lose too much."

"I wish I could have that surgery - it's such an easy way to lose weight."
These are my friends, my colleagues, the people with whom I casually interact. I don't know what to say to them other than that my body will regulate itself, I'm eating until I'm full, I eat all sorts of foods but some of them randomly make me sick and I'm still learning about my new digestive system and do you really think this is easy, because it isn't.

I take a ton of B12 (injections and pills) and special calcium that I have to order from the US and a whole lot of vitamin D and iron and folic acid and I can't take anti-inflammatories and have you ever tried to use tylenol for back pain because it really doesn't work. I tried to go for brunch last week and had to bail out in the middle of a great conversation because my stomach suddenly rejected what I put in it and yes, that means I vomited it up. I can't eat salted caramel, which should be a crime against humanity. I can't drink too quickly because that traps gas in my system, and I can't eat something that's too sweet because that causes me to feel queasy and start sweating, like I'm having a major panic attack. I have wrinkles of extra skin on my inner thighs and under my chin and my brilliant white stretch marks are like a ECG tracking its way across my abdomen. This isn't easy. I just make it look that way.

Do I regret my gastric bypass? Not for a second. I feel like losing the weight has allowed the real me to be seen by more than just my intimates. It's just going to take a long while to get used to not being invisible anymore.

Kerry Colpitts is an Ottawa resident and proud public servant, a fan of finding the right balance between being active and laying on the sofa, watching Netflix.

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Saturday, January 24, 2015

Saturday Stories: Animal Welfare, Black Fathers, and 'P' Values

Michael Moss in the New York Times with an incredibly disturbing piece on research and animal welfare.

John H. Richardson in Esquire with an equally disturbing piece with Michael Brown's father.

Regina Nuzzo in Nature takes on the p value and statistical validity.

[And if you don't follow me on Twitter or Facebook, here's a segment that I did with The Social on food myths that need to die.]

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Friday, January 23, 2015

A Deliciously Tongue in Cheek Mitchell and Webb Dinner Party

Please don't take it too seriously, but do enjoy today's Funny Friday video. It's great!

Have a lovely weekend!



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Wednesday, January 21, 2015

Guest Post: More on that Dreamy Ottawa School Food Program

This guest post is from Sally Collins, a local teacher and real food enthusiast who was inspired to try to make a difference in her students' education by ensuring their education included a healthy focus on healthy food. Here's a follow up highlighting some of what she's done with the $50,000 grant she received from Ontario's Ministry of Education in support of healthy eating initiatives.
In my guest post on June 2nd, 2014, I told you about the $50,000 healthy eating grant that our high school, Norman Johnston Alternate, had received. In that post I outlined our plans for spending it. Since then, we’ve had a chance to follow through on many of those ideas, including building raised garden beds and growing produce that students use in our nutrition classes. Additionally, we built a new kitchen, had a dietitian and guest chefs visit, and took students to work in a gourmet restaurant. It’s been a busy time to say the least!

One initiative in particular I’d like to share more with you today is the healthy eating camp we ran at the end of October. Two colleagues and I took eighteen of our students to Camp IAWAH, near Westport, Ontario, for a three- day cooking and eating extravaganza. It was a blast!

At the camp, the students cooked all our meals under the guidance of the camp chef. Between meals, my colleagues and I taught the students about kitchen safety, food labels, the food industry, nutrition claims, and basic nutrition. We knew the students would have low tolerance for a classroom setting so we taught them primarily through games and other highly participatory activities.

On the last day, students began their major projects. They worked in groups to plan activity days that would be held at the school throughout the school year. The purpose of these days would be to encourage their peers back at home to get excited about healthy eating. One group planned a veggie race that would involve classes competing to design aerodynamic vegetables on wheels while enjoying some vegetable snacks. Another group planned salad-bar days for the whole school. Yet another group designed an Iron Chef competition. Students would compete to see who could make the best dish given certain parameters, such as “include quinoa”.

Along with the official healthy eating activities, we also had time for indoor rock climbing, a terrifying night hike, and a camp fire with complete with cheesy songs, like “Down by the Bay”. We didn’t get a lot of sleep, but it was worth it!

A healthy eating camp like this one could be feasible for almost any school, even without the benefit of a grant, because it follows the model of many outdoor education classes that are currently being offered. We tied all of our activities to a food and nutrition course from the Ontario curriculum, so students were able to earn a food and nutrition credit from their work at the camp as long as they followed through with a few remaining assignments. If your high school would like to provide more food and nutrition classes to students but doesn’t have flexibility in its timetable, you might consider this as an option. If any teachers or administrators would like information on costs or access to our schedule, instructional materials, or teaching activities, my colleagues and I are happy to share. The only hitch is that if you improve on our plans, you have to return the favour and share with us! You can contact me at: sally.collins@ocdsb.ca.

I’ll close with reflections from some of the students who were at the camp,
I learned how to read the nutrition facts behind the food we eat. I loved everything about the camp and really hope I get the opportunity to do it again with all the same people,” Natasha Paquette.

I learned cooking is not really as hard as it seems,” Cara Ladouceur.

There are a lot of things that I could take back and use at home, like why you season chicken. There are also a lot of salads that I learned to make,”
Taylor Lalonde.

The kitchen staff were amazing and made cooking fun,” Samuele-Lyn LaRocque.

I loved working with actual cooks,” Justice Shanks.

I have learned helpful tips and trips on how to replace unhealthy food that I like with healthier options, while still retaining flavour. I have learned how to read labels and recognize what is healthy and what is not. Now that I know how to be more health conscious I can share that knowledge with people around me,” Cameron Jette.
Sally Collins has been teaching with the Ottawa Carleton District School Board since 1998, but just started teaching food and nutrition two years ago. This was when she developed a passion for cooking and eating real food as she worked towards her own 85lb weight loss. She is now somewhat of an evangelist, telling the unenlightened how much better life can be with healthy food. She especially loves cooking for her family, Scott, Sage (7), and Riley (5).

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Tuesday, January 20, 2015

Guest Post: The Culinary Institute of America Meets PepsiCo.

Last week my friend and one of Canada's foremost chefs, Frédéric Morin, shared a photo that he'd seen on Twitter highlighting a Culinary Institute of America cooking challenge where the special ingredients were PepsiCo products. I immediately asked if he'd like to weigh in with his thoughts and here is his guest post. And by the way, Fred's irreverence is nearly as delicious as his restaurants.
Just another exciting mystery basket competition at The Culinary Institute of America (CIA). I always hated culinary challenges, food gets tepid, judges get all reality TV on you and the boxes are filled with sadness. In this case sadness was tempered by Lays chips, Pepsi and the “healthy” Sun Chips.

Young cooks go to the CIA because it is the ivy league of cooking schools, or at the least perceived to be. Its “still” (I say still because with years I came to value work experience over academic experience, in my field that is) a venerable mark on one's résumé, but with yearly tuition upward of $35,000 it is obviously not given to everyone with a knife roll and a pair of clogs to attend.

So what's there? Superb facilities, grounds that looks straight out of a 70’s love movie, and delicious and very intelligent restaurants ran by students, amongst them the Paul Bocuse* restaurant. The CIA also publishes very complete and comprehensive books on such topics as pastry, charcuterie, and multiple aspects of cooking, books that I use frequently as reference.

My apprenticeship in the trade of cooking, as for many others, was fuelled and sustained in part by Doritos and Pepsi, I admit. There always was this “wholesomeness” fatigue, seemingly, where peeling sun chokes for an hour, or brushing chanterelles with a toothbrush, made me not hungry for such food, but when had a bag of chips I did so feeling like I do when I open the second (third??!) bottle, or when I finally convince myself that rest is more important than exercise, a pugilistic opposition of angel and demon, on my shoulder like Fred Flintstone used to experience. It's alight, it felt great to feel wrong.

Of course classic French repertoire contains not so “clean” dishes as curly fries, but they are called Pommes de terres Chatouillard, and crinkle cut chips are Pommes de terres Gaufrettes, and there are countless other gems of the sort. But take the Chatouillard, it's potatoes, never refrigerated, peeled and shaped as a tube (the trims used for potato leek soup, perhaps), then a skewer is stuck in the middle and a knife is rotated while resting on the skewer resulting in a spring shape like potato. The potatoes are then fried in two successive baths of rendered lard kept at very specific temperature, and at the end you get a puffed curly fry that is really light and delicious with roast duck. It's quite complex and as a matter fact it's sometimes part of the exam to become a Meilleurs Ouvriers de France. But being hard to make renders it elusive and expensive, and as such, hard to eat a bag full! The process also brings the craftsman to understand the importance of cooking temperatures in order to avoid oil absorption, the many varieties of potatoes, and the correct way to store and use them, etc. All that to say that in most cases what's really important is not always the end result, but how it's made, and what is learned through the process.

Some wine is harvested manually, on specific plots of land and made very carefully in order to provide something that reflects the “who,when and where”, and then there is Ménage à Trois. Pepsi, Doritos, Ménage à Trois does not have a seat at the venerable table of Hand Made. Simply, the apprenticeship process is all about learning how to MAKE, while a bag of Doritos is already MADE, and most of the effort is put into not telling you what's in it.

Sure you can have a caloric based defence argument, and say that a big dinner at Joe Beef is 2000 calories, but again, I don't eat there everyday, in fact I almost never and nor do I wish it upon you too frequently. You enjoy, celebrate, offer to someone and yourself this fun, delicious episode in your week, month or year, and the calories you'll consume there are made of stuff people grow, the name of the farmer is printed on the Quebec rib-eye label, and at first sign of GMO** my staunch partner David quickly purged the taps of major beers.

I do not know the offals of this corporate deal between PepsiCo and the CIA. Maybe this hard earned money will help students deal with the always increasing cost of Tostitos, who knows! I once felt good knowing that CIA was stoically resisting this shit storm of Dinner Drive ins and Dives, but no more.

* Paul Bocuse is a French chef in Lyon, he has three Michelin stars for longer than I have years, and a nice French rooster tattoo on his shoulder. His cooking is amazingly delicious and last that I know, his rouget en croûte de potatoes was not 86’ed in favour of a rouget en croûte de Doritos.

** when in doubt abstain.

Fred (all in his words) co-owns Joe Beef, Liverpool House and Vin Papillion restaurants in Montreal, and is the co-author of The Art of Living According to Joe Beef. He fathered three offspring that currently prevent him from living a second youth behind the stoves. He also wishes he had gone to College. He divides his time between being fat, becoming slim, being slim and becoming fat. He lives close enough to Montreal, to call it Montreal. And you can follow him on Twitter


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Monday, January 19, 2015

What I Learned By Actually Reading that New School Chocolate Milk Study

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I was amazed by the uproar the publication of a Dairy Farmers of Canada funded chocolate milk study inspired last week. The study, "Impact of the removal of chocolate milk from school milk programs for children in Saskatoon, Canada", at least according to the breathless press release and the resulting press coverage apparently concluded, "it's chocolate milk, or no milk at all for many children", and while it's no surprise given the funding that the spin was chocolate milk positive (including the study's mind-numbing use of the word, "enhanced" to describe sugar-sweetened milk), after reading the actual study, I'm beyond gobsmacked.

The study methodology was pretty straight forward. For 4 weeks they offered elementary school children both chocolate milk and white milk and measured how much of each they drank and how much went to waste. Next, they stopped providing the chocolate milk for 4 more weeks and kept measuring. Lastly, they brought back the chocolate milk option for a final 4 weeks of measurements.

Now hold onto your hats. As readers of the press are likely to already know the study found,
"the children waste more milk when it’s plain."
How much more waste you ask? Just 4/5ths of a tablespoon more a day. Yup, if you actually read the study you find out that when chocolate milk disappeared the kids drank a scant 12mL less per day than they did when chocolate milk was available. If these numbers continued, kids who drank milk would drink about a cup less milk a month for a grand total of just 9.6 fewer cups over the course of their entire chocolate milk free 200 day school year.

Or would they? What about the kids who stopped drinking milk altogether because they could no longer get chocolate? Well when the researchers tried to quantify total daily consumption of milk for all students they found,
"that students’ total milk intake at home, or milk consumption at school, did not change across the study phases."
The researchers also found,
"that on average students were meeting the 3–4 servings per day recommended by Canada’s Food Guide for 9- to 13-year-olds"
and that school milk only accounted for 13%–15% of total dairy consumed.

What else did the researchers find? Well if you want a non-Dairy Farmers of Canada "enhanced" spin on things, the researchers also found that in just the first month following the removal of school chocolate milk the number of students drinking white milk increased by 466%! A number which might well have increased further over time as palates and norms in the schools changed. And what happens to former chocolate milk drinkers when they swap Beatrice 1% chocolate milk for Beatrice 2% white? Well over the course of each week they'll drink 22 fewer teaspoons of added sugar and over the course of a 200 day school year, 14,000 fewer calories and 19 fewer cups of added sugar.

So to sum up. The study found that taking chocolate milk out of schools did not affect the students' total daily milk or dairy consumption, that on average all students were meeting their daily recommended amounts of dairy (recommendations which by the way are almost certainly higher than the evidence would suggest they need be), that kids who swapped from chocolate milk to white milk drank pretty much the same amount of white as they did chocolate (unless you think 4/5ths of a tablespoon of milk is a lot), and that by removing chocolate milk from the school, in the first month alone nearly half of the initial chocolate milk drinkers switched to white and in so doing, saved themselves piles of calories and the nearly 2 full cups of monthly added chocolate milk sugar.

If anything this study lends very strong support for those thinking schools shouldn't be offering sugar sweetened milk to students.

Clearly the reporters didn't bother to actually read the study. Shouldn't they have?

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Saturday, January 17, 2015

Saturday Stories: FFQs, Rape Culture, and Water Fountains

A telling piece by Eliza Barclay in NPR about David Allison's new study that posits in nutrition, when it comes to food frequency questionnaires, something is worse than nothing (disclosure, I was part of the working group involved in the study).

A scathing piece from Anne Kingston in Macleans on Margaret Wente and rape culture.

A strangely fascinating piece from Joe Satran in the Huffington Post on the history of water fountains.

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Friday, January 16, 2015

I Don't Care if This Video Doesn't Get Many Likes Because Canada!

For readers who don't know winter in Newfoundland, Canada is not for the faint of heart. It's full of biting cold, crazy snows, power failures, and Star Wars fans with clearly a little bit of extra free time on their hands to all of which this Funny Friday video attests.

Have a great weekend!



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Thursday, January 15, 2015

ADHD Drug Vyvance for Binge Eating Disorder?

Yesterday a study was published in JAMA Psychiatry. In it researchers looks at the impact of 14 weeks of 3 different doses of lisdexamfetamine (Vyvance) on binge eating disorder and weight in 260 patients via a randomized, double-blind, parallel-group, forced dose titration, placebo-controlled trial. Eligibility for the study included meeting the DSM-IV criteria for binge eating disorder, having a BMI between 25 and 45, and being between the ages of 18 and 55. There were a boatload of exclusion criteria with perhaps the most important being having any other eating or psychiatric disorder, having had a history of substance abuse, or having been recently treated with a psychostimulant, or having had a recent psychological or weight management treatment history.

The study's primary endpoint was the number of self-scored binge eating days, and among the secondary endpoints was weight.

The results were striking, especially in those taking the highest dose who nearly stopped binging.

Weight loss was also not insignificant, again, especially with the higher dose, with those folks losing an average of nearly 10lbs over the 11 weeks (versus an average loss of 1/5th of a pound for those taking a placebo).

Unfortunately there were also side effects with dramatically more people in the highest dosing arm reporting dry mouth, and insomnia. All told 5% of the highest dosing arm dropped out due to adverse effects.

While far from conclusive, this study is promising. Binge eating disorder is a tremendously difficult condition to endure. Psychologically it can be devastating due to overwhelming feelings of guilt which in turn can lead to decreased self-esteem and decreased perceived self-efficacy. Right now treatment for binge eating disorder involves cognitive behavioural therapy, and indeed, there's fair success, but were there a safe medication that could be used as an adjunct to counselling, speaking personally, I'd be thrilled.

There's still lots of work to be done to prove long term efficacy, safety, and tolerability. Fingers crossed.

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Wednesday, January 14, 2015

Why I'm Resigning my Membership in The Obesity Society

For those of you who don't know, The Obesity Society (TOS) is, according to them,
"North America's premier scientific organization devoted to understanding obesity"
And I wholeheartedly agree, they really are, which is why I'm anything but happy to be resigning my membership.

I've been a member for the past decade, and I do my utmost to attend their annual meeting (now known as Obesity Week).

Paying to be a member of a professional organization, to me at least, means that you believe the organization's mission and methods to be congruent with your own, and sadly, that's no longer the case with me and TOS.

My concerns began in early 2013. That was when TOS published their, "Guidelines for Accepting Funds from External Sources" position paper. In it TOS,
"expressly eliminates all forms of evaluation or judgment of the funding source"
and instead,
"TOS chooses to focus its ethical mission on transparency in disclosing the sources of funding, clear stipulations outlining our commitment to the ethical use of funds, and a commitment to non-influence of the funding sources over the scientific aspects of funded projects and TOS as a whole."
Lastly they stipulated,
"TOS should seek funding from as wide a variety of donors as possible."
Many, myself included, felt that without explicitly saying so, these guidelines were designed as a means to open the door for TOS to seek and take money from the food industry.

Shortly thereafter TOS struck their, "Food Industry Outreach Task Force", which seems to have morphed into their "Food Industry Engagement Council", the most recent meeting of which included representatives from Kellogg's, PepsiCo, Nestlé, Dr. Pepper and Ocean Spray. There appears to be no doubt that TOS meant what they said back in early 2013.

To be clear, I'm all for dialogue, debate, and discussion with the food industry, but I just can't support taking their money, formally working with them on joint projects, or giving them votes at tables. To be sure, in these difficult fiscal times, for public health organizations, the benefit of food industry partnerships is funding. But partnerships of course need to benefit both parties, and for the food industry, partnering with health organizations has much to offer. Public health partnerships provide the food industry with high gloss brand polish, they may lead to direct or indirect co-branded sales, they may confer undeserved positive emotional brand associations, they may silence or soften industry or product criticism, they may provide industry with ammunition to fight industry unfriendly legislative efforts, and they necessitate that the partnered public health group water down public health messaging that may conflict with their partnered private industries' bottom lines.

Put plainly, a public company cannot invest in a group, program, or intervention that in turn would ultimately serve to decrease sales more than not being involved in that same group, program, or intervention. Doing so would not only be an affront to their shareholders, it'd be grounds for their lawsuits.

Let’s hope I’m wrong in thinking history won’t look kindly on these partnerships, that public-health efforts won't be hindered by them, and that instead I’ll look back one day and think I made much ado about nothing, but until then, while I'll still likely see you at Obesity Week, this is why I'll no longer be sporting a "TOS Member" ribbon on my badge.

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Tuesday, January 13, 2015

How Much Does it Cost to Have Professional Athletes Call Your Donut Shop Healthy?

Well you could ask professional basketball player Tristan Thomas or professional hockey player Hayley Wickenheiser as both have recently been named, "Nutrition Ambassadors" by Tim Hortons.

They're both part of a larger health-washing campaign designed to make you think that Tim Horton's is a health food destination.

From magazine advertisements featuring whole ripe tomatoes or "12 grain" "wholesome" (but not wholegrain) bagels, to the athletes, to a new "nutrition and wellness" webpage, to a zippy new slogan, "More Good to Love", are the days of donuts and Timbits numbered?

Of course not.

Tim Hortons is, was, and always will be first and foremost a donut shop, and while sure you can order options that aren't nutritionally awful, less bad isn't the same thing as good, and if you're encouraged by Tristan Thomas, Hayley Wickenheiser, or a picture of a tomato to consider more healthful eating, why not skip your next visit to Tim Horton's altogether?

[Thanks to the many folks who sent this my way, oh, and by the way, for those who watch their sodium, that tiny bowl of veggie soup along with that plain 12 grain bagel in the atheletes' pic up above together pack 1,120mg]

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Monday, January 12, 2015

Canadian Cancer Society "Incredibly Proud" of Partnership with Domino's Pizza

Last week I posted about the partnership between the Canadian Cancer Society and Domino's Pizza, a partnership which led the Canadian Cancer Society to encourage its followers to fulfill their "eat more veggies" New Year's resolution by ordering fast food pizza and telling them that doing so would be akin to ordering hope.

The folks from the CBC's The 180 read my piece and interviewed me about it. They also interviewed Rowena Pinto, the Vice President of Public Affairs and Strategic Initiatives with the Canadian Cancer Society's Ontario Division.

Paraphrasing, Pinto told The 180,
  • That the Canadian Cancer Society was, "incredibly proud", and "very, very, happy", with their relationship with Domino's Pizza
  • That the partnership was above board because there has never been a study that specifically links pizza to cancer
  • That people are going to eat pizza anyways so it's a good idea for the Canadian Cancer Society to take advantage of that
  • That the campaign wasn't in fact telling people to go get pizza but rather was only geared for Domino's existing customer base (a point that The 180 took Pinto to task over)
  • That everything is ok in moderation.
Sure, fast food pizza here and there isn't going to kill you or give you cancer, but there's little doubt that one of the major drivers of our society's struggles with diet and weight related illness is the normalization of fast and junky foods as regular, everyday parts of our lives. This normalized culture of convenience is certainly in part encouraged and permitted by the healthwashed use of candy and junk food for fundraising - a practice which may have been inconsequential (and rare) 60 years ago, but superimposed on our health issues today, is just plain wrong (and constant). And it's especially wrong when adopted by health organizations whose causes are themselves impacted by low quality diets like that of the Canadian Cancer Society who by serving as a champion and/or an apologist for our fast food culture, is championing and apologizing for a major contributor to cancer risk as well as so many other diet relatable diseases.

Often, doing what's right isn't the same thing as doing what's easy, but that doesn't mean doing what's right shouldn't be done. Selling illness in the name of health should not be the business of the Canadian Cancer Society, and given both during the radio interview and then later on Twitter, the Canadian Cancer Society felt it important to point out that there were more dollars involved than just the $10,000 of this particular campaign, I must also apparently point out that no amount of money will make the wrong thing right. Somehow I would have thought that the Canadian Cancer Society would have already known that.

[Listen to the whole interview here]

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Friday, January 09, 2015

#JeSuisCharlie #JeSuisAhmed #JeSuis ...

Frédéric, Franck, Jean, Elsa, Stéphane, Philippe, Bernard, Moustapha, Michel, Bernard, and George.

RIP.

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Thursday, January 08, 2015

Lasers, Smoking, and Why Hospitals Need to be More than Just Landlords

Last month I had a meeting at the Ottawa Hospital's Civic campus. On my way through the hospital I passed by something called the Omega Laser Stop Smoking Clinic. According to their literature,
"laser therapy treatment is a non-invasive method used to balance the energy flow between meridians",
and is reported by them to work in a manner comparable to acupuncture on smoking cessation.

Look to the medical literature on both acupuncture and laser therapy for smoking cessation and you'll likely find your way to a 2014 Cochrane review on both which among their findings note that,
"Acupuncture was less effective than nicotine replacement therapy (NRT) and not shown to be better than counselling.",
and regarding the use of lasers,
"The evidence from two trials using laser stimulation was inconsistent. The seven trials of electrostimulation do not suggest evidence of benefit compared to sham electrostimulation"
That this clinic operates out of the Ottawa Hospital is especially odd given the adjacent Ottawa Heart Institute is home to Dr. Andrew Pipe, who is justifiably described as one of the world's foremost experts on smoking cessation (and he definitely doesn't advocate for the use of lasers).

But it gets stranger.

According to the literature I picked up in the clinic, for an extra $100 (on top of the $300 treatment cost) Omega Laser,
"will target an extra set of acupuncture points which will boost your metabolism as well as help to suppress your appetite."
and according to their voice message they also provide a bottle of "True Craving" described as
"supplements which will help you to reduce your sugar and carbs in your body".
Which of course is just nonsense.

This all leaves me scratching my head.

Should hospitals be providing a tacit health halo to practices and products that don't have an evidence base to support them? Don't hospitals have a responsibility to the public to be more than just landlords?

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Wednesday, January 07, 2015

This Is What 7 Years of Real-Life Weight Management Looks Like

It isn't a straight line.

The graph up above is from a patient of mine that I've been seeing since the fall of 2007 (for you Americans, the weight axis is in kg).

The fact that her loss is anything but a straight line is pretty damn normal because truly nothing in life is a straight line.

What's not normal, or at least what isn't common, is that year and a half segment from the fall of 2008 through the spring of 2010 where her weight pretty much stayed the same. Not that people's weights can't or don't stabilize, but rather that most folks who are trying to manage their weights tend to give up if the scale doesn't keep going down.

Of course had she given up back then she probably wouldn't have gone on to lose 50 more pounds and may well have regained the 35 or so she had lost before her weight first stabilized.

Weight loss is about embracing your own personal best. At the time she wasn't losing her job required a great deal of travel and consequently she was reliant on many more restaurant meals and far less organization in her dietary life. When that changed, she started to lose again.

If you look carefully at the graph you'll see a little uptick in her weight over this past holiday season. She's not sweating it. Her experience has taught her that if she tries decrease her intake too quickly, it'll lead her to binging and so instead she's cutting her calories back down a little bit at a time.

All this to say, and I've said it before, success is about consistency, embracing imperfection, and being proud of your best, where your best is the healthiest life that you can enjoy living, not the healthiest life that you can tolerate.

Her best, and yours, are great, and scales can't help you to determine what your best is.

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Tuesday, January 06, 2015

10 Easy Ways to Save Your Money and Improve Your Health in 2015

Who wouldn't want to both save money and improve their health? If you're looking for some ways to do so, here are some quick thoughts:
  1. Unless you have a medically proven reason or need, stop buying vitamins and supplements that at best provide only the most marginal of benefits to your health (estimated savings $100-$1,000/yr).
  2. Reduce your dinners out (including sit down, fast food, take-out, and supermarket take-out) by 50% across the board (estimated savings $1,000-$5,000/yr depending on family size and meal out frequency).
  3. Never eat lunch out unless someone else is buying or unless you have a business obligation to do so (estimated savings $500-$3,000/yr).
  4. Cancel cable or satellite TV, buy an HDTV antenna (so you can still watch your local sports, news and some TV), and use Netflix, Hulu Plus, Amazon Prime or some other comparable service (estimated savings even after expenditures $250-$1,000/yr).
  5. Buy a thermos or a travel mug and a great coffee maker and kick your fancy coffee habit (estimated savings even post purchases $100-$500/yr)
Now of course there will be readers who spend more and less on various aspects of those points, but if there are readers where all 5 apply, making these changes might save them between $1,950 and $10,500 dollars.

As far as what to do with that windfall?
  1. Join a CSA farm share to increase your consumption of fresh fruits and vegetables (estimated average annual cost $400-$1,000 depending on size of share)
  2. Join a great local community centre or gym (estimated annual cost of $200-$600)
  3. Buy some used recreational fitness equipment (bikes, skis, snowshoes, etc.) from your local buy and sell (estimated one time cost of $200-$400)
  4. Take a cooking class at your local Community College (estimated cost of $100-$300)
  5. Save it all and use it for a stress relieving active vacation, or stress relieving debt relief.
(And sure, some of your own personal numbers and mileages will vary.)

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Monday, January 05, 2015

Canadian Cancer Society's Strategic Goals Include You Eating More Pizza

Despite the very clear link between dietary choices, obesity (pizza is one of the top sources of excess calories of children) and cancer, and instead of encouraging Canadians to eat out less, for the last 3 months of 2014, the Canadian Cancer Society partnered up with Domino's pizza for checkout fundraising to the tune of just $10,000. I say "just" because according to the Canadian Cancer Society's 2013 annual report their revenues border on $200 million.

It's also an odd partnership given the fact that the Canadian Cancer Society's own Corporate Relationship Policy no doubt ought to have forbid it given the partnership requirements that,
"The corporate relationship is consistent with the Canadian Cancer Society’s strategic goals and priorities.

The company in question is in good standing and is an appropriate reputation match and strategic fit with the Canadian Cancer Society.

There is no real or perceived conflict of interest.
"
Of course if you read further into the Canadian Cancer Society's partnership guidelines you'll learn that they are explicitly happy to accept money from fast food folks so long as there are healthy options on the menu somewhere.

But the Canadian Cancer Society doesn't stop at asking for an extra dollar at the Domino's till, they also help Domino's more directly by promoting and health-washing Domino's pizza by providing slices of it to participants of their provincial Relay For Life Youth events.

And there's more. On Facebook the Canadian Cancer Society told its 63,000 fans that if their New Year's Resolution included getting more veggies, they could do so at Domino's Pizza. Oh, and that ordering Domino's pizza is the same as ordering "hope" and helps those living with cancer.



And don't worry if you don't happen to enjoy Domino's, the Canadian Cancer Society also regularly partners with Boston Pizza.

Sigh.

I wouldn't have thought that the Canadian Cancer Society would need to read about it, but if they or anyone else is interested, here's why we as a society should be putting an end to fast food fundraising.

(Thanks to Michelle Good for sending my way)

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