Saturday, August 19, 2017

Saturday Stories: Charlottesville, Charlottesville, and Charlottesville

United States of America, 2017
Emma Green in The Atlantic, on why Charlottesville marchers were obsessed with Jews.

Alan Zimmerman, president of Congregation Beth Israel in Charlottesville, VA, in Reform Judaism, recounts his experiences during the march.

And if you haven't yet spent the time to watch VICE's short Charlottesville documentary, please do.

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Thursday, August 17, 2017

Who Will Be The First To Sue A Fertility Treatment Centre For Weight Discrimination?

Did you know that women are regularly denied service from fertility clinics simply because of their weights?

I've met dozens of women struggling to conceive, who though healthy, exceeded a BMI threshold (usually in the neighbourhood of 35), and consequently were denied the opportunity to undergo fertility treatments and start a family.

I remember one who recounted how the fertility doctor who saw her suggested that perhaps God didn't want her to have a child (because she was unable to lose weight), but generally the reasons they're provided tend to focus on safety to them or to their future baby.

It's always struck me as arbitrary and biased as there are other conditions that confer risk that aren't exclusionary, and so I was thrilled to read a recent paper taking on the arguments in Human Reproduction Open. The paper, It is not justified to reject fertility treatment based on obesity, in my mind lays a basic groundwork for a future lawsuit.

It explains how though the risks of hypertensive disorders, gestational diabetes and caesarean sections are indeed higher in pregnancies of women with obesity, suggesting that this is a justification for withholding fertility treatment is dramatically weakened when considering that fertility treatments are not withheld from women with diabetes who in turn are at higher risks of developing hypertensive disorders, stillbirths and premature labour.

Similarly, when addressing the risks to the child - congenital malformations, premature birth with related morbidity, macrosomia and shoulder dystocia, future obesity, and a higher risk of metabolic syndrome - the authors note that children of women with diabetes also have increased risks of congenital anomalies, macrosomia and shoulder dystocia, and premature birth with related morbidity.

In speaking with an obstetrician friend, they pointed out that what's genuinely required (and unfortunately often absent or weak) is a frank discussion with the patient with obesity about the risks of the pregnancy - which indeed are real - but that denial of treatment simply on the basis of weight, is not justifiable. At worst it's conscious weight bias, at best, unconscious. Either way, it's ugly.

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Monday, August 14, 2017

Dear Reporters, The Cure For Obesity Is Unlikely To Be For Sale On Indiegogo

Last week a reporter contacted me looking for a quote.

She was doing a story on a $449 weight-loss product that is being sold on Indiegogo.

Briefly, the device reportedly works by stimulating the vestibular nerve, which, according to the people selling it, triggers the body to reduce fat storage, and all with just one hour of wear per day!

Of course there's this proviso (emphasis mine),
"Used in conjunction with a healthy diet and regular exercise the average user should notice a significant difference in body fat percentage."
Does the product have peer reviewed studies proving it works?

Of course not.

But it does have an unpublished preprint hosted freely online featuring a 6 person treatment group, only half of who completed the treatments.

The preprint also features a 3 person control group who somehow managed to post an 8.6% increase in truncal fat and a 6% increase in total body fat during the study's short 4 month period.

And it includes the authors' assertion that neither group changed their diet and exercise habits - this despite the fact that the authors didn't track their subjects' diet and exercise habits, and also despite the fact that the control group gained a significant amount of fat in a very short period of time.

After looking at all of this, I politely declined the reporter's request for an interview, as a story at this point on this product, even with a dissenting voice in it, is not simply premature, it's unethical. It's unethical not simply because it further perpetuates the narrative that magic, quick, and easy exists in regard to weight management, but because as is evidenced by the product's Indiegogo page, a story, any story, on this already for sale evidence-free product will be used by its manufacturers to market it to a desperate, constantly preyed upon population (who at the time of this post's writing, have already given this product's promoters $728,463 USD)

Now I realize that reporters are busy, and many don't have the background to pick apart studies, but I'd like to propose that the simple rule of,
"Don't cover medical devices being sold on Indiegogo or Kickstarter as a means to magically treat anything"
is probably a safe one, and one that I wish went without saying.

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Thursday, August 10, 2017

The Strange New Reason Why You Shouldn't Drink Sugar With Your Meals

Granted, it's a small study, but its results were interesting.

The study, Postprandial energy metabolism and substrate oxidation in response to the inclusion of a sugar- or non-nutritive sweetened beverage with meals differing in protein content, looked at the impact sugar sweetened beverages had on the appetite suppression benefits of higher protein meals.

The authors note that,
"increasing dietary protein while maintaining energy intake produces a greater and more prolonged thermic effect and greater total energy expenditure",
that protein,
"potentially increases fat oxidation by up to 50%,"
"decreasing protein consumption may stimulate an increase in energy intake in an attempt to maintain a constant absolute intake of dietary protein",
and that,
"a 1.5%E decrease in dietary protein intake increases energy intake from carbohydrates and fats by 14%, perhaps in an attempt to increase protein intake from less protein-rich food sources (and point out that) in a 4-day in-patient ad libitum crossover feeding trial, a 5%E decrease in dietary protein intake produced a 12% increase in total energy intake"
So the authors were curious whether or not the inclusion of a sugary beverage would change the impact that a high protein meal had on consumption, appetite, and fat oxidation, and to explore, they studied those variables in 27 adults (without obesity) on two separate occasions in a direct (room) calorimeter after the consumption of a sugar-sweetened beverage or a non-nutritive sweetened beverage along with meals that varied in protein composition (15% vs. 30%).

The authors found, as expected (and certainly in line with the experiences I've seen among thousands of patients), that meals with higher protein content decreased hunger, increased fullness, and decreased the desire for fatty/salty/savory foods (sweet desires weren't affected).

The authors also found that when consumed along with a higher protein meal, sugar sweetened beverages increased the desire for fatty/salty/savory foods, and simultaneously decreased diet induced thermogenesis (the energy spent on processing/storing food), and fat oxidation (which the authors postulate may lead to a greater tendency of the body to store fat).

All this to say, treating sugar sweetened beverages (including juice) like the liquid candy that they are, and consuming them as treats, in the smallest quantities you need to be happily satisfied, rather than drinking them along with your meals, is probably a good plan.

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Tuesday, August 08, 2017

The Canadian Cancer Society Wants You To Drink Sugar And Eat At Chipotle

A few years ago I pointed out the hypocrisy of the Canadian Cancer Society encouraging people to eat Domino's pizza in the name of fundraising.

I noted that sure, fast food pizza here and there isn't going to kill you or give you cancer, but that there's little doubt that one of the major drivers of our society's struggles with diet and weight related illnesses is the normalization of fast and junky foods as regular, everyday parts of our lives.

My belief is that this normalized culture of convenience is in part encouraged by the cause-washed 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 cause, like that of the the Canadian Cancer Society, is itself impacted by low quality diets.

So this year's Canadian Cancer Society junk food partners are Chipotle, PepsiCo, and the Dole Food Company.

The Canadian Cancer Society's partnership with Chipotle sees them encouraging a trip to the giant fast food burrito maker in the name of 50% of a single day's sales, while their partnership with PepsiCo and Dole come from one of their flagship events - the Run For The Cure - where PepsiCo and Dole serve as the Run's, "National Official Suppliers". As such, at the finish line of the short 5km fundraising run (which of course isn't of a distance long enough to worry about any fuel or hydration needs), PepsiCo and Dole will be there to market hand out the beverages that the Run For The Cure website notes provide participants, year after year, with "delicious refreshment".

Of course they'll also provide participants with piles of sugar given that Dole Sparklers, a "real fruit beverage", pack 4 teaspoons of free sugar per can, while Real Tea's offerings can pack up to a whopping 12 per bottle depending on flavour.

It's a good thing then I guess that the Run For The Cure is on October 1st rather than September 30th given that in September the Canadian Cancer Society's fundraising effort is a much more appropriate Sugar Free September initiative

And as the Canadian Cancer Society is explicitly aware, fruit drinks and sweetened tea, are common sources of free and added sugars in our diets.

One of the other reasons why these partnerships are so unwise is the way they're utilized by the junk food partner. For instance Dole's gone ahead and leveraged their partnership for in store sales of their sugar water by using it to cause-wash their products directly.

Given that the last time around the Canadian Cancer Society reported they were incredibly proud of their partnership with Dominos, I imagine this time will be no different.

Not sure pride is the emotion I'd recommend when reflecting on their comfort with junk food fundraising.

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Thursday, August 03, 2017

Will Weighing Yourself Daily Really Help You Lose Weight?

There are no shortage of people and stories who'll report that one of the easiest things you can do to help yourself lose weight is to weigh yourself daily.

And there are plenty of journal articles too, like this one which came out just last week, that concluded,
"these data extend the possibility that daily self-weighing may be important for prevention of unwanted weight gain"
The problem with the majority of these studies however, is that they're not randomized trials designed to compare the intervention of weighing oneself daily to not, but rather they're either longitudinal studies, or retrospective studies, that look at weight loss and whether or not there's an association with daily weighing.

That matters a great deal because it certainly might follow, and this would be consistent with the experiences I've observed in working with thousands and thousands of patients, that when people know they're struggling with their diets and lifestyle changes, they avoid stepping on the scale, and therefore my bet would be that daily weighing is simply a marker for people who are doing well with their efforts.

So have there been randomized controlled trials of daily weighing on weight loss?

Surprisingly, I could only find one that isolated daily weighing as the primary weight loss intervention. It was a study which randomized 183 adults with obesity to weigh themselves daily, or not, and both groups were given weight loss advice that was known to be ineffective. That last bit is important if you're trying to suss out whether or not daily weighing itself provides benefit.

The authors' conclusion?
"As an intervention for weight loss, instruction to weigh daily is ineffective. Unlike other studies, there was no evidence that greater frequency of self-weighing is associated with greater weight loss."
I also wonder about whether or not daily weighing might lead to increased recidivism? Though I couldn't find any studies that looked at daily weighing and its association with patient dropout, given that day to day weight fluctuations are normal, and that weight loss (and life as a whole) isn't often a straight, consistent, line, I worry that those weighing themselves daily will provide themselves with more opportunities to be discouraged and hence, more likely to quit their intentional weight loss efforts in frustration.

In our clinic we recommend our patients weigh themselves weekly, on Wednesday mornings, naked, after pee, before breakfast, with the rationale being it's important to ensure weight gains, if they're occurring, are noted, because if you're off course, it's easy to gain a great deal of weight in a short period of time and avoiding the scale because you know things aren't going well might lead you to gain more than you would have were you aware of your trend.

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Tuesday, August 01, 2017

How Is Reading with Ronald (McDonald) Still A Thing?

There's no denying there's a fair bit of grey to the black and white world of corporate sponsorship and public private partnerships, but the Reading With Ronald program probably doesn't fall into that category.

Simply put, Reading With Ronald sees public libraries inviting Ronald McDonald to read to kindergarteners.

Publicly funded institutions that by definition are trusted by children shouldn't be used to market anything, let along junk food, to children.

That these events occur doesn't speak so much to incompetence though, they speak to how normal it is in society today for us to pretend that corporate interests in events like these are altruistic, and not just marketing.

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Saturday, July 29, 2017

Wednesday, July 26, 2017

Should You Buy The World's First DNA Based Weight Loss App?

This week saw the release of embodyDNA a, "DNA based weight loss app".

According to the press release, for the low, low, price of just $188.99, to work alongside your new food diary, you can order a saliva kit to have your DNA analyzed and then you'll receive results telling you to do such things as reduce your sugary drinks, limit your calories, avoid empty calorie foods, get plenty of sleep, and include protein in your diet.

Or, alternatively, you could not spend $188.99 and you could do those same things.

Doesn't seem like a tough call to me.

While the notion of personalized DNA based recommendations is exciting, paying $188.99 for a test that'll tell you things you already know to be a good plan is about as far along as the science has gone.

So let me save you your hard earned cash and give you some straight forward advice:
  • Keep a food diary
  • Reduce restaurant and ultra-processed meals
  • Cook meals made with fresh whole ingredients and eat them free from distractions
  • Include protein with all of your meals and snacks
  • Minimize all caloric beverages (especially sugar sweetened beverages and alcohol)
  • Cultivate good sleeps and good friends
  • Don't smoke
  • Exercise as much and as often as you can enjoy
Do those things and you can safely, and possibly forever, ignore the latest hype.

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Monday, July 24, 2017

Guest Post: A Lawyer Weighs In On Canada's Proposed Kid Ad Ban

Early last week there was a surprising piece in Blacklock's Reporter that suggested that Canada may be reconsidering its plans to ban the advertising of junk food to children (an election piece of Prime Minister Trudeau's and part of Health Minister Philpott's mandate letter). After seeing it, I contacted Canadian public health lawyer Jacob Shelley and asked him if he'd be so kind as to share his legal thoughts. He kindly agreed.
Restricting food and beverage marketing to children has long been identified as a necessary public health strategy to reduce diet-related chronic diseases, including obesity. It is a strategy endorsed by the World Health Organization and has been the focus of the Stop Marketing to Kids Coalition in Canada over the past few years (the Coalition has called for the implementation of its Ottawa Principles, which bans food advertising to youth and children under 16). Not surprisingly, there was considerable excitement in the public health community when Prime Minister Justin Trudeau identified “introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec” as a top priority for protecting public health in his Minister of Health Mandate Letter.

Québec’s Consumer Protection Act prohibits, with some exceptions, all commercial advertising to children under thirteen years of age (s. 248). In 1989 the Supreme Court of Canada upheld the Québec ban as a constitutionally valid limitation on the freedom of expression, protected by section 2(b) of the Charter of Rights and Freedoms in the seminal case of Irwin Toy v Québec.

In Canada, expression is considered a “fundamental freedom”, and because of its importance, the courts have consistently held that section 2(b) requires a large and liberal interpretation. Commercial speech, which includes advertising, is among the types of expression that the Charter seeks to protect. The courts have held that commercial expression serves an important public interest, one that goes beyond its economic value, because it allows consumers to make informed choices. Even so, the government can impose restrictions on expression. A limitation on the freedom of expression can be justified if the government is able to demonstrate that it is reasonable, an assessment based on the Oakes test.

This is what occurred in Irwin Toy, where a majority of the Supreme Court found that the Québec ban was justified, even though it infringed on the freedom of expression. The Court was particularly concerned about the vulnerability of children to advertising. It held: “the evidence sustains the reasonableness of the legislature's conclusion that a ban on commercial advertising directed to children was the minimal impairment of free expression consistent with the pressing and substantial goal of protecting children against manipulation through such advertising.”

Since Irwin Toy, the Supreme Court has upheld other bans on commercial speech, most notably, commercial speech related to tobacco products. In Canada v JTI-MacDonald, the Court unanimously held that the restrictions placed on tobacco advertising and marketing were justified restrictions on the freedom of speech. Of particular note, the Court held, “when commercial expression is used for the purpose of inducing people to engage in harmful and addictive behaviour, its value becomes tenuous” (para 47).

Through Irwin Toy and JTI-MacDonald, the Canadian jurisprudence clearly establishes that (i) children are vulnerable and need to be protected from manipulative advertising and (ii) commercial expression that induces harmful behaviour(s) has tenuous value. It would seem apparent, then, that restricting advertising to unhealthy food products to children – the strategy the government appears to have adopted – is relatively low-hanging fruit. After all, the government could do more, as Irwin Toy involved restricting all advertising directed to children. While there may be some details to iron out – such as what age should the ban use and determining what constitutes unhealthy foods – the overall strategy seems to be in accordance with Canadian law.

Thus it was surprising to read that Health Canada may be backing away from meaningful restrictions on food advertising to children out of fear of industry lawsuits (note: this has not been confirmed or reported elsewhere).

UPDATE: Health Canada was kind enough to tweet a response after this article was posted. What is there to be afraid of, exactly? Certainly industry lawsuits were expected the moment PM Trudeau penned his mandate letter. It would be unrealistic to expect the food industry to accept any governmental oversight of advertising to children – kids are big business, after all, and restricting food advertising to children will have a discernable impact on the industry’s bottom line. The industry is not interested in any regulation.

To avoid regulatory interference, the industry has created its own self-regulatory framework that it frequently touts. It includes the Broadcast Code for Advertising to Children and the Canadian Children’s Food & Beverage Advertising Initiative (this is in addition to individual corporate promises). Such frameworks are often considered to be largely ineffective, lacking transparency and accountability. Recent research suggests that advertising of unhealthy foods to children has increased in recent years. Self-regulation, simply put, isn’t working.

If the industry does initiate a lawsuit, we can be sure that it will cloak its claim in Charter language, but this should not be mistaken as interest in protecting Canadian’s freedom of expression. Rather, it seeks an unbridled free market, one that allows it to continue to target vulnerable children in order to increase profits.

When PM Trudeau announced Canada would impose restrictions on the marketing of unhealthy foods and beverages to children, the world noticed. Canada now has the opportunity to become a global leader when it comes to restricting marketing to kids. It would be a shame if the fear of industry push-back impeded current efforts, especially when the courts have already made it abundantly clear that children are more important than commercial expression.

Have your say: Health Canada is currently seeking feedback on its approach to restricting marketing unhealthy food and beverages to children, and you can do so by visiting here.

Jacob Shelley is an Assistant Professor with the Faculty of Law and the School of Health Studies in the Faculty of Health Sciences at Western University. His primary area of research is the role of law in promoting public health and preventing chronic disease, with a focus on diet-related chronic diseases. Follow him on Twitter here.

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Saturday, July 22, 2017

Saturday Stories: Sham Surgeries, Plastic Mice Penises, and Gooplandia

Christie Aschwanden in Five Thirty Eight discusses the powers of sham surgery.

Ed Yong in The Atlantic with a story that begins with a plastic mouse penis.

Beth Skwarecki in Lifehacker details her strange trip to Gooplandia.

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Wednesday, July 19, 2017

On Respecting Reality And Moving Forward

As anyone who has ever suddenly lost a loved one will tell you, there's a great deal of processing to be had to comprehend what's happened.

Having just come back from a hiking trip with my father in Italy's breathtaking Dolomites (we'd booked long before my mother's death and yes, that's a photo from our trip up above), and having had now 5 weeks to try to wrap my head around what seems still at times an impossibility, I'm feeling like it's time to get back at things.

Not sure I'll be fully up to speed for a while, but I'm at the point where I feel that I have enough mental real-estate to start writing again.

I didn't before. Our realities often precludes our best intentions, and it's important to respect that.

My newly darker reality before was such that my best efforts in life excluded all sorts of behaviours. From more regular exercising, to healthier eating, to more moderated drinking, to being more engaged with my loved ones, to writing this blog, and to so much more.

Spending time kicking yourself because you've fallen down will not likely accelerate your ability to get back up, and no doubt life ensures that at times, we all fall down.

The most important question to ask yourself when life isn't going according to plan or when your deck of cards is ugly is, "what can I do today that will help even a little"?

Truthfully, some days the answer may be little to nothing at all.

One day though, there'll be something more formative to do. And today (well yesterday really), mine was to type this out.

Our best efforts in life are dynamic, but that doesn't mean that they're not our bests, and the fact that our bests during difficult times might not be all that impressive when measured against our bests during easy times, doesn't make them any less worthy of pride.

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Monday, June 19, 2017

One Last Tribute To My Trailblazing Mother Helen Freedhoff

The last week was an incredibly difficult one with our family reeling from the sudden and unexpected death of my mother.

During the course of the week I reached out to Hilda Bastian as I felt that as a fellow trailblazer for women in STEM, she might be interested in my mother's career.

After reading about her, Hilda offered a nearly unbelievable kindness - over the course of her own weekend, Hilda put together a Wikipedia entry for my mother (click here to read it) which I was able to share with my father before having to leave Toronto.

Through his many tears also came, "how lovely, how lovely", and "what a tribute!"

Were my mother still alive, an incredibly modest and private person, she'd have been embarrassed (maybe even mad at me for indirectly facilitating) and might have asked that the entry be removed, but since she's unable to complain, and as I and her family is intensely proud of her accomplishments, consider my sharing them my last opportunity as her son to shake her tree a bit (please also find our eulogies below).

With the shiva over I will slowly be returning to social media and blogging. Will be returning to Twitter and Facebook first, and blogging a touch later. With Jewish mourning, the first 30 days have a special significance and so I'm thinking I'll start blogging again (aside from this post of course) once they're complete part way through July.

[My deep and heartfelt thanks to Hilda for her compassionate kindness and generosity in putting my mother's Wikipedia page together.]

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Monday, June 12, 2017

Remembering My Mother (And Why I Won't Be Around As Much For a While)

Dr. Helen Freedhoff January 9th, 1940 - June 10th, 2017
My mother was her own force of nature, and tragically, wholly unexpectedly, and thankfully without suffering, she died on Saturday. To say our family is in shock is an understatement. My mother lived life on her own terms, both for the better, and at times for the worse, but there was never an instant in my life where I didn't know how fiercely she loved me, nor where I didn't love her back.

A theoretical physicist who received her PhD from the University of Toronto she was a trailblazer for women in science. Her work in science is baffling to me. I read the titles of her papers, and while I understand some words here or there, they might as well be written in a foreign language - one of her students told me that this paper is one of which she was especially proud. She once explained to me how it was she went about choosing what to study. The gist was that she would look at experimental results that people could not explain, and then if she thought that the solution would be mathematically elegant, she'd get to work. And while I may not be telling that story perfectly accurately, that's how I remember it anyhow. We've no doubt, that had it not been for mandatory retirement (she missed its abolition by 2 years), she'd have still been teaching.

It was my mother who taught me, again for better or for worse, to always speak my mind and not to be shy, even with criticism. Below is the obituary we're placing in the papers - and I thought I'd share it here as well and let it fly out into the ether. Love you Ma, can't believe you're gone, and will always be proud to be your son.

Helen (Henchy) Sarah Freedhoff (nee Goodman)

Passed away suddenly on Saturday June 10, at the cottage she loved in Muskoka at the age of 77.

She was predeceased by her parents Sholom and Ethel Goodman (Kohl)

She will be dearly missed by her husband Stephen of 57 years, her daughter Michal (Michael Van Leeuwen), her son Yoni (Stacey Segal), her brother David Goodman, her grandchildren, Rena, Zahava, Talia, Sammy, Leah, Vivienne, and Yael who adored their Omi, and many nieces and nephews. Sister-in-law of Judith and Aubrey Golden,Sylvia Goodman (late brother Irving), and Doba Goodman.

Helen was born in Toronto and excelled in the sciences, having graduated from the University of Toronto with the highest marks and was awarded the Governor General’s Gold medal. She went on to obtain a PH.D in physics and was appointed an assistant professor at York University in 1967. At the time of her appointment, she believed she may have been the only woman in Canada teaching at the university level in her field.

She took a keen interest in her students and was responsible for many of them under her guidance continuing their careers in science. She was soft spoken, a voracious reader, had taken up piano again upon retirement, was an expert ken-ken solver, a weekly yoga practitioner, and maintained a meticulous household

Funeral service at Benjamin’s Park Memorial Chapel 1:30 Monday June 12.

Shiva at 38 Alexandra Wood. Morning services daily at 7:45 a.m. Evening services at 8:45 p.m. Shiva will conclude Sunday morning, June 18.

Donations in memory can be made to Associated Hebrew Schools, Ethel and Sholom Goodman Fund, (416) 494-7666

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Saturday, June 10, 2017

Friday, June 09, 2017

Former Mexican President Vicente Fox Is All Kinds of Hilarious

Honestly, today's Funny Friday bit, with Fox lecturing Trump about the wall, is just genius.

Don't miss it.

Have a great weekend!

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Thursday, June 08, 2017

Canadian Nutrition Society Calls 13 Daily Teaspoons of Added Sugar "Moderate"

To be fair, it wasn't the Canadian Nutrition Society (CNS) directly who told attendees of their recent annual scientific conference that consuming 13 daily teaspoons of added sugar represented a "moderate" amount, it was the handout they stuffed into all their conference swag bags that did.

That handout, available here, had this to say,
"In 2004 Canadian consumption of added sugars was about 11% of daily energy intake (53g or 13 tsp per day), according to an analysis of dietary intake data from the Canadian Community Health Survey. Average intake ranged from 9.9% of energy in adults aged 19 and above to 14.1% of energy in adolescents aged 9-18 years. This is generally considered to be a moderate amount"
Given it was authored by The Canadian Sugar Institute, it's wholly understandable that they're not lining up with the World Health Organization or Canada's Heart and Stroke Foundation in considering 12 teaspoons of added sugars per day a daily maximum, and 6 teaspoons of sugar per day a better goal. Less understandable though for the CNS.

According to the CNS, their aim is to,
"foster the next generation of skilled nutritionists, thereby building a better and healthier future for all Canadians"
I struggle to see how providing the food industry with the ability to influence and directly access the next generation of nutritionists would fit within that mandate.

(Thanks to the dietetic student attendee who sent me the handout, and for the record, I feel the same way about medical organizations providing pharma with the opportunity to stuff medical conferences' swag bags with their marketing materials)

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Monday, June 05, 2017

Definitely Don't Take Your Kids To See Red Shoes And The Seven Dwarfs

Via Tess Holiday on Twitter
Want to know how socially acceptable weight bias is?

There's a movie coming out, for children, about, what if Snow White were fat?

The trailer highlights the apparently hilarious horror.

The pervasiveness of weight bias in children's movies, TV shows, and books is a near constant.

Can you imagine how you'd feel if you were a little girl with obesity and you saw this poster (let alone the movie)? Or if you were a schoolyard bully that hadn't yet started targeting kids for their weights (weight by the way is the number one target of bullies by a long shot).

It's horrifying that weight bias is so normalized that a movie studio signed off on this. Hopefully, with awareness, ticket sales will be sufficiently bad and the outcry sufficiently loud, so as to dissuade future such projects.

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Saturday, June 03, 2017

Saturday Stories: Opioid Origins, Trump Loneliness, and the Confederacy.

By Infrogmation of New Orleans - Own work, CC BY-SA 4.0, Link
Pamela Leung, Erin Macdonald, Irfan Dhalla and David Juurlink in New England Journal of Medicine expose the 1980 letter to the editor that may be responsible for today's epidemic of opioid addiction.

Rebecca Solnit in Literary Hub with an amazing piece of writing on the loneliness of Donald Trump.

New Orleans' Mayor Mitch Landrieu in The Atlantic with the speech he gave to explain why his city's confederate monuments had to come down.

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Friday, June 02, 2017

This Commercial Almost Makes Me Want To Watch Shark Week

But not quite.

That said, today's Funny Friday video is a gem for those of us old enough to be Seal fans.

Have a great weekend!

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Wednesday, May 31, 2017

If Pokémon Go Doesn't Keep People Moving, What Chance Does Public Health Have?

You remember Pokémon Go, right? I remember when it launched I was giving a talk in LA, and honestly it seemed as if the entire city was trying to catch Pokémon. Flash forward a year or so and I can't remember that last time I saw anyone trying to catch one.

I was curious about whether or not people were still playing and so I hunted around online a bit and found a few articles.

What I learned was, during that launch time last summer there were 28.5 million global daily users. That same article has it that by January, just 5 months later, the number of daily players had dropped by 80%.

Or has it dropped even further than that? Certainly if this Reddit thread can be believed, it has, as the thread asserts that a large percentage of active players now are
  • "Bots used by scanners -- Who knows how many bot accounts are out there.
  • Multi-account players -- Based on concerns of gym shaving, this appears to be prevalent, but there is no way to determine how many "alt" accounts are out there.
  • Account Sellers -- Overlapping 1 and 2, there are many accounts that are floating around out there for sale that have been either leveled by bots or by hand."
All this to say, that the 5 month drop off rate of the most viral and widely launched augmented reality game is somewhere between 80 and 90%, strikes me as more evidence that rather than promoting flashy, feel-good, new online tools and commercials that stand virtually no chance at inspiring sustained behaviour changes, we need to spend our energies and efforts on environmental engineering to squeeze more activity out of our normal lives (eg. cycling and walking infrastructure, tax incentives or disincentives, stairwell renovations and signage, etc.), forcefully building the opportunity for exercise back into our kids' lives (eg. the return of proper school recess), and lobbying our politicians for same.

And maybe it's just my cynicism, but I do find it odd that despite our global and possibly total failings at inspiring intentional, because-it's-good-for-you, behaviour change, both with food and fitness, that as a society we still seem to be clinging to the notion somehow, someone, somewhere, will figure out the golden message, app, or website that will set us all straight. At this point, and certainly in the developed world, it's hard to imagine that the problem is a lack of education as to the benefits of exercise and/or a healthful diet.

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Monday, May 29, 2017

Forks vs. Feet for Obesity: The Great Debate Part II (Next Week in #Toronto)

Which is more critical to obesity treatment and prevention - our forks, or our feet?

That's the subject of my upcoming debate with the inimitable Dr. Bob Ross.

It's actually a redo of our prior debate from 2011 on the same topic (which you can watch here if you'd like).

It's being presented by the Toronto chapter of the Canadian Obesity Network (CON) and it's taking place at 5pm on Tuesday June 6th in the Ben Sadowski Theatre of Mount Sinai Hospital.

Tickets are just $15 with proceeds going towards the support of the chapter's activities (and you can buy them in advance by clicking here).

My prediction?

There's going to be far more agreement than you might imagine.


It should be a lot of fun.

Hope to see you there!

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Saturday, May 27, 2017

Saturday Stories: Special End Of Life Edition

Have an hour and bit this weekend? Spend it listening to the podcast Sickboy who interviewed friend and one of our office's former RD's, 37 year old Candace Reid, whose husband Layton (whose brilliant letter to his metastases I published as a guest post on this blog last September) died this January, on life Newly Widowed.

Carol Cowan-Levine in The Walrus on the failure of Canada's healthcare system and the death of her daughter by suicide.

Catherine Porter in The New York Times on the living wake and medically assisted death of John Shields.

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Friday, May 26, 2017

Parents, How Many Of These Scenes Resonate For You?

As a father of three, today's Funny Friday sure was familiar.

Have a great weekend!

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Thursday, May 25, 2017

No Coke and Pepsi, Adding Fibre and Pro-Biotics Doesn't Make Liquid Candy Healthy

As the liquid candy business falters, Coca-Cola and PepsiCo are desperately turning to the addition of pro-biotics and fibre to their juices and sodas in a bid to sustain their sales.

First up is Coca-Cola Plus. Launched in Japan each bottle of the diet soda beverage has 5gr of added insoluble fibre. According to its official press release,
"Drinking one Coca-Cola Plus per day with food will help suppress fat absorption and help moderate the levels of triglycerides in the blood after eating"
And a statement to that effect will apparently be placed directly on the front of the bottle.

Next up is PepsiCo's juice arm's offering of Tropicana Essentials Probiotics, which along with its 7.25 teaspoons of sugar per glass (which incidentally is more sugar per glass than Pepsi), is reported to pack,
"more than 1 billion active probiotics in each serving"
What will they do for you?

According to PepsiCo they will,
"work to promote gut health"
Desperate times call for desperate measures I suppose.

[Sorry, earlier version had Coca-Cola, not PepsiCo making Tropicana]

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Tuesday, May 23, 2017

An Incredibly Belated Review of James Hamblin's Terrific New(ish) Book

Full disclosure: I received an e-copy of Hamblin's If Our Bodies Could Talk: A Guide to Operating and Maintaining a Human Body for review from James' publisher Doubleday. I should also disclose, I was likely predisposed to enjoying this book as I've long been incredibly fond of Hamblin's Twitter feed and Atlantic pieces. I'd have written this sooner, but I have this rule of not writing about things I haven't actually read myself and it took me longer than I expected - not because I didn't enjoy it, but more because I fall asleep in about two seconds flat every night. Also, if you use the Amazon links I provide, Amazon will send me a tiny commission.
James Hamblin is a medical doctor. But he doesn't practice medicine in its traditional seeing his own patients sense, instead his practice involves the translation of health into words for whoever wants to read them as he decided to pursue journalism and writing rather than the much safer path of radiology. Hamblin's main platform is his work with The Atlantic where he's a senior editor, and he's also a must-follow (if you like wonderfully dry humour) on Twitter.

Hamblin's book, If Our Bodies Could Talk: A Guide to Operating and Maintaining a Human Body, was published back in December. Simply, it's a collection of questions spanning various topics about health, the human body, followed of course by Hamblin's science-informed answers. It's also a lot of fun.

From questions like,
"Why don't eyelashes keep growing"
(and answers that include, "For three months, then, the hair is called a "club hair". It is, like so many people in clubs, outwardly fin-looking but actually dead at the roots"), to
"Does the G-spot exist?"
(and Hamblin's admonishment, "never liken it to a bike tire"), to
"What about Smartwater?"
(where Hamblin helps you to learn that "electrolyte enhanced" means "bullshit"), the book covers a lot of ground.

Because each question and answer are fairly short, the book makes for excellent bed time reading (in that sense it reminded me some of another book I loved - Bill Bryson's A Short History of Nearly Everything). And along with the humour and pith, comes a great deal that's both fascinating and informative (did you know that the hyperbole of carrot eating leading to better night vision arose in part as an attempt to conceal Britain's discovery of radar in World War II, or that Ben Carson (yes, that Ben Carson), played an important role in the treatment of an exceedingly rare and devastating brain disease?).

So why do you need this book when you can simply Google those very same questions? I think Hamblin covers this aptly by noting that
"Googling health information is roughly as reliable for finding objective answers as picking up a pamphlet on the subway floor"
The book is a delight. Suitable too for those parents like me who want to teach their children, without lecturing, that critical appraisal is sadly necessary in this day and age (another recommendation here is to listen to the podcast Science Vs. with them).

If you're looking for a book that entertains while it educates and you'd like to purchase a copy for yourself, here's an Amazon link to it for my American readers. And if you're living here in Canada - this one's for you (though at least when I was typing this, it would still be cheaper to use the American link).

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Friday, May 19, 2017

Schoolhouse Rock's "I'm Just a Lie" (Thanks Jimmy Kimmel)

For those of us old enough to remember, "I'm Just a Bill", todays' Funny Friday is sure to bring a smile. A sad one though.

Have a great weekend!

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Wednesday, May 17, 2017

Guest Post: Public Health RD Questions Ontario's Calorie Labelling Rollout

Last week an RD who'd prefer to remain anonymous asked me if they could share their thoughts on Ontario's new calorie labelling initiative with my readers. I readily agreed, and I agree with much of this post. I'm strongly supportive of calorie labelling, but the rollout certainly could have been more thoughtful. And while I agree with all of this RD's closing points, I don't see calorie labelling vs. other changes as being either or - I'd like to see them all.
On January 1st of this year it became mandatory for restaurants with at least 20 locations in Ontario to post the calories on their menus. Many dietitians and other healthcare professionals rejoiced as this information would help people to make better, or at least more informed choices when eating out. Personally, I was a little more skeptical. From what I had seen from other places implementing similar legislation resulted in little if any change in eating habits. We are always talking about evidence-informed decision making in healthcare, yet this legislation from the Ministry of Health and Long-term Care seemed to be based more on appearances than on evidence.

There were problems from the start. Training for public health inspectors (who are responsible for enforcing the legislation) didn’t take place until just over a month before the legislation took effect. It was made very clear to the PHIs that they were to only ensure that eating establishments adhere to the legislation; i.e. that calories were posted in the appropriate places in large enough font and that the contextual statement was posted. They were not to question the calorie counts posted. Some of you might remember the time everyone got upset about Chipotles posting the calories for just the chorizo in a wrap, rather than for the entire wrap. Well, if something like this were to happen in Ontario, unless a complaint came from the public, the PHIs have no recourse. They might see calories posted that seem blatantly incorrect but they have been instructed not to question them. Restaurant owners and operators need only use means that they “reasonably believe” to determine the calorie counts. That means that calorie counts could be determined by a bomb calorimeter (accurate) or by myfitnesspal (questionable) as long as the owner believes it to be accurate. The Ministry declined to provide PHIs with any guidance as to what methods and tools would be appropriate so they are left to take restaurant owners at their word.

Framing this as an initiative to decrease childhood obesity was a huge mistake in my mind. Teaching children to calorie count is not healthy or helpful. Nor is simply providing calorie amounts to parents when caloric needs vary so much among children. Sometimes providing just a little information can be dangerous. I’m sure that the government meant well and they thought this would be a great visible way to show that they’re tackling childhood obesity while downloading the cost onto restaurant owners, win-win. However, this legislation should have been targeted toward adults only. Children should never be counting calories.

The point of this legislation is ostensibly to help the public make informed choices. To that end, you would think that there would have been a public education campaign launched well in advance of the implementation of the legislation. You would be wrong. Despite numerous requests from public health dietitians, and assurances that public education was coming, it wasn’t until over a month after the legislation came into effect that any “education” was undertaken. As a dietitian, I was expecting information on how to use the newly available calorie postings to make better choices. Boy was I wrong. Instead, the Ministry released a series of ads that read more like fast food advertisements and essentially just say “calories are now on menus”.

Let’s fill our kids with ideas about eating right.

A post shared by Ontario Government (@ongov) on

I see these and I think, “wow! Poutine and hash browns are so low in calories. They’re not as bad a choice as I thought.” Not at all the message that I think should be coming through this campaign. It’s embarrassing that the government used our tax dollars to pay people to come up with these terrible ads. Apparently they focus group tested them and the teens thought they were hilarious. Perhaps they can’t tell the difference between laughing with you and laughing at you? Regardless, there should have been someone working on this campaign who saw that it wasn’t sending the intended message (check out the comments). They should also realize that simply telling people that calories are posted on menus isn’t sufficient to aid them in appropriately using this information. As it stands, it only serves to help those who are already health conscious and who know roughly how many calories per day they should be consuming. They should have been giving people the information and tools to better understand and use the calorie counts.

Does putting calories on menus even work? There was a recent webinar by Health Evidence on this and they said that on average, it led to reductions of about 70 calories per day. Which sounds great except that the average caloric intake of people in the studies was about 3000 calories a day, about 1000 calories more than the recommended daily calories for an average adult. So, yes, putting calories on menus may lead some people to choose items with fewer calories but if they’re still consuming about 900 more calories than they need I’m not sure that’s anything to write home about.

Calories are only one piece of information and I worry about putting too much emphasis on it. Restaurant meals tend to be obscenely high in sodium but the calories won’t tell us anything about this. Calories also don’t tell us if a menu item is nutrient dense or nutrient void. It can make it appear that deep-fried foods are equal to salads.

Something else to consider, beyond the concerns I mentioned above about the accuracy of the methods used to determine the calorie counts, is the human factor. Even if the calories are accurately measured, that’s based on the sample as provided by the restaurant which you can bet is going to put that food in the best light possible. Do you really think that line cooks in a restaurant, or teenagers at Five Guys are concerned about portioning things so that meals contain the same number of calories as is posted on the menus? I doubt it. they’re probably using more oil on that stir-fry or scooping extra fries onto that plate. It’s pretty safe to assume that the actual number of calories in any given menu item is going to be higher than the number posted on the menu so take the number on the menu with a grain of salt.

I’m sure that there are people reading this thinking “but at least they’re doing something. What would you do?” I would bring back mandatory home ec in schools. I would help to ensure better access to and affordability of nutritious foods across the province. I would provide more support and funding for healthy eating and food literacy initiatives for all ages. Instead of accepting that people are going to eat out regularly, and assuming that providing calories on menus is going to make people healthier, we should be encouraging people to get in the kitchen.

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Monday, May 15, 2017

Guest Post: Local Teacher's Tips For Cultivating Healthy Classrooms

One of this blog's long time readers is a local teacher, Heather Crysdale. On Facebook she regularly adds thoughtful comments to my posts around kids and school - so much so that I asked her if she'd be interested in writing a guest post with some of her ideas on how to make a classroom a healthy place. Happily she agreed! Here are her thoughts - proving that yes, you can cultivate healthy classrooms, it just takes some thought and creativity:

Modelling Healthy Living in a Primary Classroom:

It can be a challenge to create a classroom where healthy activity levels and food choices are promoted. Here are some of the ways I try to promote healthy lifestyles in my classroom.

Modelling Health Activity Levels:

Being an active Role Model:
The students know that I am an older teacher (e.g., 55 plus) and that I make a conscious effort to stay active. They see me walk to school daily with my husband and little dog, rain or shine, in all seasons. I share with them when I plan to go skate skiing, kayaking, cycling or to go to the yoga studio. I think it is important for them to see people of all ages, and genders, being active.

On May 7th (2017) the families in my class raised $500, to support my CN Cycle for CHEO (Ericsson 70 km) ride.

Physical Fitness Embedded in Daily Physical Activities (DPA), Gym and Special Event Days:

During the autumn and the spring, students do a morning run three times a week, and a group dance (Dancemania) twice a week before heading up to class. In the winter, students do body break dances on Go Noodle ( or stair climbing in school for their DPA. We also have special fitness based days (e.g., a Winter Walk to School Day, a Bike Day, five days of Skating at Dulude Arena, etc.) With staff and students taking part in these activities, fitness and fun is the goal for everyone!

Modelling Healthy Eating Habits:

Setting an Example with Nutritious Lunches:

When the students see me eating a healthy lunch (e.g., a sandwich, soup, salad and/or leftovers from home), I am modelling good choices for them. When I see students enjoying a healthy food item during a Nutrition Break, I might comment on how tasty the food looks. If a child has a less healthy food item in their lunch bag, it is not up to me to critique the food choice. Food shaming is disrespectful, unhealthy and poor behaviour modelling for a teacher. Packed lunches from home reflect a family’s food culture, food prep skills and/or budget.

Mindful Eating:

At our school, we make a real effort to encourage the students to eat mindfully. At the beginning of the year, I bring in a basket of apples from the Parkdale Market. Each child gets to hold an apple, while listening to the story No Ordinary Apple. A Story About Eating Mindfully. Students are reminded to eat their food slowly and quietly, using all five senses to truly enjoy their food. Students show more gratitude for their food, when they learn how it got to their plate (from seed to platter)!

Food-Free Birthdays Celebrations:

If every birthday in class was celebrated with Pinterest worthy treats, the students would have cupcakes and candies at least 20 times in the school year. In my classroom, I encourage parents to provide food- free birthday treats to celebrate student birthdays. I heard about this idea at an OPHEA (Ontario Physical Health and Education Association) conference. Parents have followed through by sending in dollar store bouncy balls that each child used in the gym, by sending in Perler beads for the students to make Melty bead creations and by donating games and puzzles for the students to enjoy on the birthday, and afterwards too. The students enjoy these birthday games, crafts and puzzles!

Activity Based Holiday Treats:

Special holidays, like Halloween and Valentine’s Day, can mean overindulging in candy corn, caramels, cinnamon hearts and chocolate kisses. Instead, the students might have roasted Pumpkin seeds or fruit skewers as a treat. On these special days, the students in my class usually get a little gift bag from me. Instead of giving them food items, I always make them a handmade, handwritten card. Gift ideas might include themed pencils, erasers, notebooks, books and passes to skate or swim at City of Ottawa pools and arenas. The students enjoy the writing, reading and sporting activities!

Sugar and Salt Free Math Activities:

Instead of using food items for graphing and sorting, the students in my class use Legos, plastic counters and other reusable manipulatives. Or, they use seasonal materials found in nature (e.g., leaves, pine cones and oak keys). They still enjoy sorting and graphing, without having to eat unhealthy foods in the process.

A Focus on Intrinsic vs. Extrinsic Rewards:

One of the tenets of our Alternative school is that we do not give out rewards for good behaviour, effort or work. The goal is to have students behave well, make an effort and work hard, and then experience the intrinsic satisfaction of a job well done. That means no stickers or other extrinsic rewards…and therefore no candies or other sugary treats!

Tower Gardening:

One of my teaching colleagues, Tiiu Tsao, is growing greens in her classroom (e.g., Leaf lettuce, Yau Choy and Basil). She has borrowed the Tower Garden from the Parkdale Food market. The students had an opportunity to taste the produce that they grew. Pure Kitchen is purchasing the produce for its restaurant. Profits from the sale of these greens to Pure Kitchen are then returned to the Parkdale Food Market. What a great way to learn about fresh food growing, harvesting and eating!

On these special days, the students in my class usually get a little gift bag from me. Instead of giving them food items, I always make them a handmade, handwritten card. Gift ideas might include themed pencils, erasers, notebooks, books and passes to skate or swim at City of Ottawa pools and arenas. The students enjoy the writing, reading and sporting activities!

Growing Up Organic:

Several other colleagues are working toward creating an on-site school garden. Growing Up Organic (a garden and farm based educational program for children) is providing startup workshops for students. The workshops include the following topics: soil exploration, seed saving, planning a garden, planting a salad garden, seed starting and transplanting. The goal is to teach students greater food literacy and food skills. Ideally, they hope to create a sustainable garden that produces produce that can be shared amongst community members, including the Parkdale Food Centre.


It takes a community to create an environment where children can learn, by example and through practice, to develop life-long fitness and nutritional habits. Together, we can make a difference!

Heather Crysdale is a teacher at Churchill Alternative Public School. She has been teaching in the Public School system for over 30 years. In 2014, Heather was awarded the Ottawa Carleton District School Board (OCDSB) Staff Health and Safety Award, for making an outstanding and significant contribution, over an extended period of time, to Health and Safety. Heather has been married to Douglas Abraham for 25 years. She is the mother of two twenty-something young men. Heather enjoys paddling her sprint kayak on the Rideau River. She likes to swim, cycle and skate ski in the Gatineau Park, and practice yoga at Pure Yoga. She is constantly seeking ways to move and eat well as well as to promote healthy lifestyles. In her spare time she likes to make cards and to knit!

The opinions expressed in this post are the author's own and do not necessarily reflect the ideas of the Ottawa Carleton District School Board.

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Saturday, May 13, 2017

Saturday Stories: Sewer Viruses, Nuremberg, and Stillborn Photography

Azeen Ghorayshi on Buzzfeed on life saving sewer viruses.

Lesley Stahls' interview for 60 minutes on what the last surviving Nuremberg prosecutor wants the world to know.

Seema Marwaha in Macleans on photography and stillborns.

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Friday, May 12, 2017

I'm Not Sure My Mom Knows How To Text

But Jimmy Kimmel's staffs' moms sure do, and here they are for your Mother's Day Funny Friday

Have a great weekend!

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Thursday, May 11, 2017

If You Serve It, We Will Eat It (Ontario Medical Association Edition)

For the past 4 years or so (not sure exactly), I've been a delegate to the Ontario Medical Association and as such, along with a few hundred of my MD peers, attend their biannual council meetings.

The councils are each a terrific opportunity to see the passion and energy of my colleagues, and also a great opportunity to see how strongly our food environment impacts upon our freedom of choice.

22g of sugar (4.5tsp) per bar (more than in a Snickers)
Short version? Because all of the MDs here are human, when faced with indulgent dietary choices, they choose them.

Soft drinks, potato chips, pastries, and candy bars (Clif bars with as much sugar as a Snickers) - all of these are offered to us during our meals and snacks.

Offered at lunchtime. By afternoon break, 2 bags remained
And guess what? Once offered, away they go.

And yet I'd be willing to wager that were these options not provided by the council organizers, not a single physician would have walked over to the hotel's variety shop to buy them.

If even the Ontario Medical Association enables and encourages terrible dietary choices at physician events, why would anyone expect better from others?

Until we stop leaning on the theoretical ability of people "just saying no" as the sole means to address a food environment that offers and pushes nutritional chaff at every turn, we're not likely to ever see change.

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