Thursday, June 30, 2016

Need Some Kids' Health Good News And Inspiration? You've Got To See This!

Today's guest post comes from Middlesex County RD Nadine Devin. I had the great pleasure of meeting Nadine in person last week when Dr. Dan Flanders and I flew down to chat with her community about childhood obesity. What's incredibly powerful about small communities is that unlike big cities, they're nimble. Nadine has been instrumental in helping to guide her community into changing their children's food environment, and wonderfully, she's getting broad buy-in. And do yourself a favour, watch the embedded video too. This is what change can and should look like. Huge kudos to Nadine and to Middlesex County!
As a mother and an advocate for child health, it concerns me that the favoured team sideline snack is a salty or sugary treat like candy, chips, cookies, Freezies and juice boxes, and that gone are the days of serving orange slices and watermelon after a game. We all sign our kids up for sports to keep them active and healthy but these snacks are not in line with that mission.

The average child is consuming at least three times more daily sugar then recommended. At the same time, 60% of children are not consuming the recommended amount of vegetables and fruit. When these two situations combine, the danger is their increased risk of heart disease, cancer, diabetes, weight gain and dental cavities.

But there is good news! Evidence shows that health outcomes in children improve when communities work collaboratively to support the healthy choice. Small changes in our food environment can illustrate to our children that water, vegetables and fresh fruit are vital and enjoyable and that treat foods have a time and a place.

Change doesn’t happen by itself. It happens when one person makes one decision to lead the change and illustrate how others can follow suit.

I have the pleasure of managing a provincial grant for the County of Middlesex as part of the Healthy Kids Community Challenge, a Province of Ontario initiative designed to improve the health of children 12 years and under. In May 2016, I put a challenge to local soccer and baseball coaches to "bring back healthy sideline snacks". The challenge was simple - when it is a parent's turn to supply snacks for the team, they are asked to bring only water, vegetables and fresh fruit.

Those who challenge social norms can face harsh criticism, so I wanted to make the change easier for coaches. For their leadership, players and coaches would be awarded with a recognition package including stainless steel water bottles for each team member, insulated water jugs, certificates, a team plaque and public recognition.

I hoped for five teams, and was thrilled to have sixteen sign up for the challenge! The feedback has been overwhelmingly positive. To see for yourself, check out the following video of star players and coaches.

To build on this call to action, the County of Middlesex recently launched our Lead the Change Healthy Kids Community Challenge Recognition Awards. The mission? To inspire agencies across the County to adopt changes in their organizational practices that limit the provision and marketing of sugary drinks and snacks, and model the wonders of water, vegetables and fresh fruit. Successfully awarded sites will receive public recognition for their efforts. We hope that this acknowledgment by peers and the community will reinforce the acceptability of these ‘new norms’ and empower momentum in agencies across the County. One change at a time, we can build a food environment that supports our current and future generations in being the healthiest they can be.

To inspire local action, we interviewed six County of Middlesex champions who have led the change in their respective agencies by modeling and supporting the healthy choice. These stories illustrate that change can happen, it will be accepted, and you too can make a difference in your community.

Looking for inspiration? Check this out (Yoni note: You must watch this!)

Nadine Devin, RD MHSc., is the Project Manager for the County of Middlesex Healthy Kids Community Challenge. For more information on the Challenge you can visit online, or follow on Facebook or on Twitter. You can read more on the history of the Healthy Kids Strategy here.

Monday, June 27, 2016

"Tell Me I'm Fat", A Spectacular Episode of This American Life

I'm going to start with the bottom line - you need to listen to this episode of This American Life.

It's a podcast in 5 acts.

Act 1 is Lindy West's inspirational tale. She covers the freedom and power she gained from "coming out" as fat and eschewing society's desire for her to be on a never ending quest for thin.

Act 2 is Elna Baker's explanation for why she believes that her life could not be the same were she to regain the tremendous amount of weight that she's lost and why she still tortures herself to keep it off.

Act 3 is Roxane Gay's discussion of why she's not able to get to that Lindy West level of self-acceptance and her thoughts on the difference between "super morbidly obese", and "Lane Bryant fat".

Act 4 is Daniel Engber's recounting of the Christian evangelical take on weight loss

Act 5 is Lindy West again, telling us about how her husband proposed and its significance in terms of her weight and self.

If you can't listen to it today, please bookmark this and come back to it.

While I'm not going to go into a lengthy post on the details of the podcast, it did leave me with one question. What's a less common unicorn? The person who successfully loses a pile of weight and keeps it off (and for a prior blog post on the idiotic weight loss goalposts society has set and why we need to change them click here), or the person who manages like Lindy West, to fully slough off the shackles of societal expectations leaving themselves truly free from the weight biased shame and guilt the world constantly foists on them?

(And though I have yet to read it, Lindy West's new book Shrill is definitely going on my summer reading list.)

Saturday, June 25, 2016

Saturday Stories: Bloody Plant Burgers, Jesus' Wife, and GMO Safety

Mark Lynas in the Cornell Alliance for Science says the debate over GMO safety is over.

Ariel Sabar in The Atlantic asks if Jesus had a wife?

Lindsay Hoshaw at NPR discusses the hopefully soon to be in my belly blood plant meat replacement burger.

Friday, June 24, 2016

If You Speak Turkish This is Probably NSFW or Kids

If you don't speak Turkish, today's Funny Friday is damn funny.

Have a great weekend!

Wednesday, June 22, 2016

Heinz Sued by Aussie Consumer Watchdog For Peddling Sugar As Vegetables

That Kraft Heinz in Australia advertised products that by weight were nearly 70% sugar as, "nutritious food" and "99 percent fruit and veg" sounds more than a bit dubious.

The products targeted toddlers, and no doubt their claims were there to assuage parents' concerns about the contents that looked and tasted like candy.

Well yesterday the state based Australian Competition and Consumer Commission (ACCC) took action and commenced legal proceedings in federal court.

Beyond not buying into the notion that products that are nearly 70% sugar by weight can be fairly described as nutritious the ACCC is also concerned that,
"rather than encouraging children to develop a taste for nutritious food, these Heinz Shredz products are likely to inhibit the development of a child’s taste for natural fruit and vegetables and encourage a child to become accustomed to, and develop a preference for, sweet tastes"
Unfortunately misleading advertisements are not unique to Australia.

While it's no doubt the food industry's job to sell food, doing so with deceit should not be tolerated. Kudos to the ACCC for acting.

If you're keen on seeing a bunch more, yesterday the presentation I published in 2012 on misleading advertising cleared 400,000 views.

Monday, June 20, 2016

The Aspire Assist: Surgical Bulimia Or A Case Study In Weight Bias?

I can't tell you how many people have contacted me about the Aspire Assist. What's been genuinely shocking to me is that the sentiment surrounding the online commentary, as well as the emails I'm receiving, is hugely reflective of weight bias - including from colleagues who I know are champions in the fight against weight related stigma. I wrote this post when the Aspire Assist was first launched, and I'm updating and reposting it in the hopes of triggering at least a little bit of reflection.
Is this new device simply a condemnable medical bulimia machine?

That's certainly the tenor of the discussion out there as generally the reports on this are either pretty angry or simply express revulsion.

Superficially it really does sound horrifying, and undeniably, at first blush it's not what I would consider to be the intervention I'd always hoped for. But when researching the story of course I needed to know - what type of studies have been done on it to date?

Believe it or not, their very early data's interesting. Now this isn't peer reviewed published data, just a presentation, but in it they describe the 111 patients who were randomized to receive an Aspire Assist. 74% of them completed the year long study (vs. only 50% of the control group who received the same lifestyle counselling as the Aspire Assist group but no Aspire Assist).

The results were dramatic. This 15 minute long outpatient endoscopic procedure led completers to lose nearly 40lbs on average representing a loss of 15% of their presenting weights. The completers of the control group meanwhile lost on average just 4lbs.

Not surprisingly, there were post-operative adverse effects - the most common being irritation or granulation of the stoma (the exit port). There were only 4 subjects who reported "serious" adverse effects and all were quickly resolved.

Eating behaviours were also monitored. Pre-surgically subjects were screened for binge-eating, bulimia, and night eating syndrome. None of the Aspire Assist patients were reported to experience worsened eating behaviours, while one control subject developed bulimia.

Interestingly, self-reported data actually demonstrated improvements in Aspire Assist subjects' eating behaviours with more thorough chewing, more water consumption greater meal planning, more mindful eating, and decreased calorie consumption (confirmed by the fact that losses were greater than would be predicted by simple aspiration).

And as far as tolerability goes, the vast majority reported satisfaction with the device, with 93% of survey respondents reporting that they would be somewhat or very likely to recommend it to others.

Comparing the Aspire Assist to the other endoscopic bariatric procedure, the intra-gastric balloon (a procedure that has not been raked over society's coals) the Aspire Assist appears to lead to markedly larger losses with greater response rates and fewer serious adverse effects.

So yes, back to the shock, horror and repulsion, while I readily agree that on its surface both the premise and procedure is less than appetizing, I'm pretty sure that safety and efficacy, not grossness, are what determine the utility of an intervention. If larger, longer, studies reproduce these results whereby the Aspire Assist doesn't lead to or exacerbate disordered eating, involves minimal risk, has minimal adverse metabolic or nutritional consequences, and leads to sustained losses which in turn had demonstrable medical or quality of life benefits, why wouldn't I consider it?

As I've written before it'd be wonderful if everyone lived incredibly healthful lifestyles and in turn those incredibly healthful lifestyles guaranteed weight loss (they don't BTW), but I think my job as a physician is to ensure people are equipped to make informed decisions, not to make decisions for them, or to judge the ones that they make. If the Aspire Assist proves to be both safe and efficacious in the long run, I'll happily discuss its pros and cons with each and every suitable patient. I'll also happily discuss more traditional bariatric surgery, pharmacotherapy, purely behavioural therapy and also the option of doing absolutely nothing with them. And I'll do it all in a nonjudgmental manner too - because my job is to ensure my patients are aware of the risks and benefits of all of their treatment options, including watchful waiting, and then to support them in whatever informed decision they make. To do otherwise in my mind is contrary to the spirit of medicine and suggests one of two exceedingly common and unfair weight biases. First the one that often angrily asserts that unless a person is willing to make formative lifestyle changes, they're not worthy of being helped, or the second - that if only patients wanted it badly enough, they'd just fix themselves. Honestly, if desire were sufficient is there anyone out there who'd struggle with anything?

So is the Aspire Assist brilliant or brutal? Given it's just been born, it's going to be at least a decade before we'll even have the chance of having the robust long term data to make an informed decision. Until then all I can really say is that I'm looking forward to reading it.

Friday, June 17, 2016

Sweary Ninja Dad vs. Cruel Son (+ Eggs)

Today's Funny Friday video features a dad with far more co-ordination and grace that I could ever dream of.

Oh, and a schmuck of a son.

And raw eggs.

Have a great weekend!

Thursday, June 16, 2016

ParticipACTION Report Cards Remind Us Every Year How Badly We Suck

We suck at helping our kids to be active.

Here are the past 12 years of ParticipACTION kids' activity report card grades (click on 2016 for this year's edition):
2016: D-
2015: D-
2014: D-
2013: D-
2012: F
2011: F
2010: F
2009: F
2008: F
2007: F
2006: D
2005: D
So what has Canada done about it?

From my vantage point, it sure doesn't seem like much.

As to what we could we doing, I'm honestly not sure.

One thing I am sure of though, simply telling kids to be more active (or telling them and/or their parents how inactive they are) clearly isn't doing a whole heckuva lot. We need changes that change the default.

If you're a parent, I've blogged about the simple solution you could employ to help your kids move more (move with them).

If you're an educator, how about making every classroom/student reward an active one instead of relying on junk food (same goes for all of your various fundraising endeavours)? Oh, and get rid of inane over-protective schoolyard rules like bans on hard balls that effectively stifle active play.

If you're a city planner, how about more time and attention paid to developing safe, comprehensive, and unified biking and walking infrastructure?

And consider too the fact that decreasing kids' physical activity may well also be influenced by their rising weights (and not the other way around). I've worked with so many parents who report that as their kids gained weight, suddenly their interest in favourite activities waned. The why is something people either forget or overlook. Kids are cruel. Being picked last because you're slow, or simply not being able to keep up, would make most kids not want to play. One comment about "jiggling" while a kid runs is liable to lead a kid to stop running. Not wanting to change in front of your peers because of fat jokes and weight bias makes is another common hurdle. Here we need to see calls to action to tackle weight bias, and continued work towards improving the way we use food with our children, and ideally ending the regular use of foods by our kids' schools, teachers, coaches, cities, scout leaders, friends' parents, etc. to reward, pacify, and entertain them at every turn.

So how many more years of reading these depressing report cards before we either stop issuing them, or actually do something about the problem?

Monday, June 13, 2016

IWK Health Centre Hospital Leads, Stops Soda and Juice Sales.

IWK Health Centre's new, free, hydration station (thanks to IWK's Barbara Whynot for sharing)
We've created a world whereby the default option is usually junk, and where if you're trying to eat healthfully saying "no" to crap is almost a continuous requirement.

Wouldn't it be great if it were the other way around? Where the crap was there if you sought it out, but where the default was healthful?

Well Halifax' IWK Health Centre Hospital has got your back - last week they stopped selling sodas (both sugar sweetened and artificially sweetened), sport drinks, and juice and in their stead, installed free infused water "hydration stations".

This is the sort of leadership I expect from hospitals (see this editorial I co-authored back in 2008 calling out hospitals' deep-fried hypocrisy) but which is so rarely seen.

Huge kudos to IWK Health Centre, and here's hoping other hospitals, schools, arenas, libraries, government offices, and more take note that some profits just aren't worth it.

Saturday, June 11, 2016

Friday, June 10, 2016

Conan O'Brien at the Noryangjin Fish Market

Today's Funny Friday sees Conan O'Brien taking a tour of Korea's famous Noryangjin Fish Market where among other things they sell "fake penis".

Have a great weekend

Wednesday, June 08, 2016

Real Life Weight Loss: Are You Up 2, Or Down 30?

It's something I see all the time. Someone's done an incredible job at cultivating a new lifestyle and has also lost weight.

Then life throws them a kick of some sort (illness, injury, mood disturbance, holiday, birthday, vacation, promotion, etc.) and things go a bit awry and those new behaviours slide and some weight is regained.

Really, that's real life. Our efforts, our motivation, our stressors, our responsibilities - they're not straight lines.

And with most areas of our life, we're cool with that. We appreciate that our best efforts will vary.

But not so much with weight management.

Often times with weight management, slight, real-life related slides in behaviours and rises in weight, lead people to quit altogether. Suddenly they're up two pounds, frustrated, and worse, considering themselves failure and their efforts impossible.

It's times like these that I tend to remind people, like I did yesterday in my office with the patient whose chart is up above, who has lost over 30lbs over the past 16 months and recently regained 2, that it's their choice whether they want to perceive their outcome as being up 2, or down 30.

If things aren't going your way, if you're unhappy with what you've been doing or not doing, rather than beat yourself up about it, reframe, respect reality, and them remember that the best question you can ask yourself is, "What can I do right now that will help a little", and then do it.

Monday, June 06, 2016

Why You Should Probably Just Ignore All "Breakfast" Studies

By Evan-Amos (Own work) [CC0], via Wikimedia Commons
Ugh, breakfast stories.

Such a frustrating topic in nutrition as for both health reporters and diet gurus it would seem that there is no middle ground, breakfast is positioned either as essential or pointless.

Well I'll tell you what's pointless - "breakfast" studies.

I'm putting breakfast in quotations because virtually all the is it good for you or not breakfast studies seem to study breakfast as a whole.

Seems to me that regardless of your chosen end point (be it weight, appetite, hunger, adiposity, heart disease, insulin, school performance, whatever) what a person eats for breakfast will matter a great deal, and just studying whether or not a person ate breakfast, will lump together bowls of Froot Loops with almond topped steel cut oats, and Pop Tarts with summer vegetable omelettes.

My experience, born out of a dozen years of working with thousands of patients on weight management, has been that for most, a protein rich breakfast benefits all-day satiety, whereas a bowl of ultra-processed, sugar-fortified carbs, doesn't. And please note, I said most, not all.

Ultimately breakfast matters for some and not for others, and if you're curious whether or not it's important for you, what you choose to eat for breakfast is going to play a big role in your answer.

And for the love of everything holy, please, please, stop reporting on "breakfast" studies, whether you or they are pro or con, as if they're able to make conclusions about the utility of breakfast as a whole.

Saturday, June 04, 2016

Saturday Stories: Journalism, an Abandoned Baby, and Male Entitlement

Matthew Herper in Forbes worries less about cell phones causing cancer and more about the future of journalism.

Nanette Asimov in The San Francisco Chronicle with the inspirational story of a baby found abandoned in a box at SF State University.

James Fell, someone who knows his way around a curse word, with his understandably viral piece on male entitlement and how she doesn't owe you shit. If you're a man, I'd say it's required reading.

Friday, June 03, 2016

Can Your Oven Mitts Do This?

Today's Funny Friday video's an odd one, and yes, there are oven mitts.

Have a great weekend!

Wednesday, June 01, 2016

Coca-Cola Provides Pediatricians with Prescription Pads, and Kids with Diplomas

Today's guest post comes from my friend and stellar RD Andy Bellatti who some might not know is originally from Argentina. One of his contacts there sent him some photos of an almost unbelievable Coca-Cola partnership. As soon as I saw it, I offered up my blog for him to share more.
Last week, Fernando D'Ippollito – a pediatrician in Argentina – sent me the image that accompanies this post: a “diploma of good behavior” for his patients.

The diploma reads:

Today, (DATE), this certificate was awarded to (PATIENT'S NAME) because Dr. (DOCTOR's NAME) asked them to:

__ Stick Out Their Tongue
__ Cough
__ Take Deep Breaths
... and this was done without crying or complaining.

The bottom right of the diploma reads “Your pediatrician” and provides a signature line for the doctor.

The most disturbing detail – Coca-Cola's logo – is in the lower left-hand corner.

According to Dr. D'Ippollito, this diploma template Рalong with a Coca-Cola branded prescription pad Рwas given to all members of the pediatrics department at his hospital (Jos̩ Penna Hospital in Buenos Aires) by a visiting Coca-Cola representative Рa visit that can only happen with approval from hospital administration.

It appears his hospital's administration has not gotten the memo. Criticism and abandonment of soda industry partnerships with health organization finally jumped from “fringe” to “mainstream” after last year's Global Energy Balance Network (GEBN) debacle, which resulted in global headlines, the disbanding of GEBN, Coca-Cola's notorious chief science and health officer stepping down, an end to the ties between Coca-Cola and the American Academy of Pediatrics as well as the Academy of Nutrition and Dietetics (the former severed ties with Coca-Cola, the latter was dumped by Coca-Cola) and a variety of monetary “transparencydisclosures from the soft drink giant.

2016 has only added more PR nightmares for the soft drink industry. Nancy Brown, CEO of the American Heart Association, recently published an open letter to Big Soda calling for an end to marketing to children. This letter came just days after a new report by the Center for Science in the Public Interest which detailed the many ways in which Coca-Cola continues to targets children, despite pledges to not advertise to children under the age of 12.

Today, keeping distance from the soda industry for a health institution or organization isn't progressive and courageous as it is a basic display of integrity and commitment to health.

Back to this Coca-Cola branded “good behavior” diploma nonsense (how is that for advertising to the 12-and-under crowd?): does Coca-Cola have ties with Argentina's national pediatric organization? That is unknown for now; the group's website page on sponsorship is, curiously, blank. The answer, though, is “very likely.” In March, Chile's Pediatric Society received plenty of negative attention after Coca-Cola sponsored its annual conference. And, earlier this month, it was revealed that Coca-Cola has generously donated to Spain's Academy of Pediatrics.

The point of these initiatives – which barely make a dent in Coca-Cola's operating budget – is to align the brand with health authorities in order to gain public trust. A sports figure hawking soda in a television commercial sells “cool”, but a pediatrician advertising soda via a “good behavior” diploma or a prescription pad is supposed to provide peace of mind to parents.

The best move health professionals – including, but not limited to, doctors, nurses, and dietitians – can make is encourage all patients, regardless of age, to limit or avoid sugar-sweetened beverages. In the case of Dr. Ippolitto, he tells me he and his fellow hospital colleagues saw this initiative for what it is: a cynical, and failed, attempt at buying the good graces of hard-working doctors.

Andy Bellatti, M.S., R.D., is a Las Vegas–based dietitian. He is also a co-founder and the strategic director of Dietitians for Professional Integrity, a group that advocates for ethical and socially responsible partnerships within the Academy of Nutrition and Dietetics. You can also follow Andy on Twitter and Facebook.