Monday, December 11, 2017

Teaching Your Kids To Cook Is More Important Than Teaching Them To Play Soccer Or Hockey

Source: USAG-Humphreys' Flickr
So this post, originally published at US News and World Report a few years ago, will be the last of this recent sled of in defence and support of home cooking.
Once upon a time, not so long ago, people ate out for a reason. Maybe it was in celebration of an anniversary, a birthday or a promotion. Maybe it was out of necessity to seal the deal with an important prospective client. Or maybe it was the understandable consequence of travel. But one thing's for sure — we didn't used to eat out simply because we could. Eating out was special.

Growing up in the 1970s, meals out were exceedingly rare for my family. Aside from our every-other-year family vacations, I'd bet we only ate out once every few months or so — and almost always to mark an occasion. I don't think we were atypical in how we spent money on food back then; as a society, the 1970s saw roughly 30 percent of our food dollars spent on food prepared outside of the home. Today North American society is over 50 percent.

Working in my office, I'd venture my average patient is eating out three to four times a week. And yet, it's not laziness that drives their frequent meals out. Regular meals out are simply North America's new normal. And it's a new normal that I think is a huge player in our collectively poor health.

While there is no one singular cause for our societal struggle with diet and weight-related conditions, one of the primary drivers is our unbelievably frequent use of restaurants, cafeterias and take-out food. Sometimes we justify these choices because there's a "low-fat", or "low-carb", option or something that sounds safe and healthful, and sometimes we convince ourselves it's due to a lack of time — that we honestly don't have the five or so minutes it would take each morning to brown-bag a lunch.

But I'd bet that most of the time we don't even think about whether we should or shouldn't be eating out. And we don't think about it, because the regular use of restaurants, or of supermarket take-out, or of nuking a box or assembling a jar of this with a box of that and calling it cooking, is just what we all do. And generally people don't question conventions that simply reflect regular behaviour.

I'd go further and say that families are often looked at with scorn when the vast majority of their meals are transformed from minimally processed and fresh whole ingredients. The "normal" of convenience has people seeing the cooking family as having an "obsession" with health or nutrition beyond what "normal" people consider to be healthy.

At the end of each day, we're all consumers of the exact same amount of time. While no doubt, there are those who have far tougher lives than others, and some work far longer hours, there was a time when each and every last family out there, regardless of how rough their circumstances, was obligated to find the time to prioritize cooking as part of day-to-day requirements, because there simply was no alternative. And while there are definitely people whose life circumstances truly make regular cooking an impossible and unreasonable goal, there are definitely others who have been convinced, or have convinced themselves, that it's not doable.

Now I'm not trying to romanticize the foods we all once cooked. I'm certain many a meal from those days would have turned many a dietitian white with horror. But I'd argue that the simple act of cooking — a health-preserving life skill — is a skill that risks extinction. In some families, regular home cooking is a phenomenon not seen for three generations.

My guess is that even the worst home-cooked-from-fresh-whole-ingredients meals from back then were likely to be lower in calories, sodium, and sugar than many healthy-sounding restaurant choices today. More importantly, those meals were far more likely to involve shared meal preparation and cleanup along with their consumption as a family ritual, around a table free from today's drone of kitchen-based TV sets and the pings and beeps of emails, tweets and Facebook updates from our electronic leashes.

So what have we prioritized in cooking's place? Kids' organized sports? Longer work hours? Our favourite TV shows? Text messaging? Social media?

Boiling it down to its essence, ultimately what we've prioritized as more important than cooking is convenience. Moreover, we go out of our way to convince ourselves (as does the food industry) that convenience can still confer health, that those boxes that claim they contain healthy nutrients and those menu items that include vegetables are in fact good for us. But looking around us — and given the urgency of the problem and the never-ending call to arms to fix it — it sure doesn't seem as though convenience is doing a very good job.

The inconvenient truth of health is that healthy living does require effort. There are no shortcuts.

And if you're looking for the one thing you can do that would most dramatically improve your or your family's health, my money would be on you prioritizing the regular, uninterrupted use of your kitchen. Prioritize it at the expense of your electronic tethers and, yes, even at the expense of your children's after-school sports, as teaching your children the life skill of cooking trumps their need to learn how to play soccer - and if you have time in your life for that, you definitely have time in your life for this.

And please don't misread this as if I'm suggesting that change need be absolute or all at once. Maybe commit to cooking one additional meal a week, and it certainly need not be complex. The goal is to cultivate love affairs with our kitchens, but that doesn't mean you'll be madly in love from day one, and while I don't think we should stop taking advantage of the miraculous times that we live in and should still enjoy and savour some wonderful meals out, we should be aiming at making eating out special again — a rare and exciting treat. In other words, aim to eat out for occasions, and not just because it's Tuesday.

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Thursday, December 07, 2017

Introducing #15by15, My Wife's Life Skill Challenge For Our (And Your) Family

Our family's current week's meal plan as laid out by our 10 year old on Sunday (it's a magnetic whiteboard that lives on our fridge)
Today's guest post comes from my wonderful wife Stacey who has recently implemented a new challenge for us - she calls it #15by15 - where 15 is the minimum number of meals we want each of our kids to know how to make, entirely by themselves, by the age of 15.
Fifteen by fifteen”. That’s what I told my kids when they recently helped to make our menu plan for the week, and this time were instructed to add in one meal each that they would cook from scratch, with or without my help.

I’m not going to lie, there was some whining. My three kids, now aged eight, ten and thirteen, have been helping to create menu plans that include breakfast, snacks, lunch, dinner and even treats for several years now (ht stands for "Halloween Treat" - they generally last them an entire year), as well as cooking with me and/or my husband. The kids take turns doing this from week to week because they recognize that we all have different favourites, and they want to make sure that theirs are included.

Our kids also recognize that for a household to run well, and for their mom to yell less (because, well, life is stressful enough without having to worry about each meal and snack that comes next), we all need to pitch in and help. This includes other household chores, like doing the laundry, loading and unloading the dishwasher, setting and clearing the table, taking care of the cat's food and litter, and taking out the trash, among others. My kids know that while these are not particularly fun activities, they are life skills, and that they aren’t likely to be taught how to do them anywhere but home.

In my mind, perhaps the most important of all of these life skills, is the skill of cooking.

From the time my kids were old enough to provide constructive criticism of mine or my husband’s cooking escapades, they have also been asking that we teach them how to make particular favourites before they move out. And so, with that, came our promise to them,
"When you leave home, you will leave with a cookbook of family favourite recipes, an Instapot (because they’re awesome), and a minimum of fifteen meals that you can make completely on your own from scratch."
And while there may have been whining when first announced (and perhaps even a bit of trepidation from me as I thought about the mess that would be my kitchen on at least a tri-weekly basis (I'm not including the nights my husband cooks, god-bless his mess)), my kids have fully embraced this new goal, reminding us that it is their turn to cook, with my older two kicking us out of the kitchen when they're up – which is beyond awesome, because they know that I have difficulty stepping back and allowing them to do their thing, and clearly they are more than capable.

While I can’t say that there hasn’t been an impact on the cleanliness of my kitchen, I can say that the mess has been worth making in reaching the goal of my kids becoming self-sufficient and capable of cooking with fresh, whole ingredients. They are well on their way to being able to cook fifteen meals by the time that they are fifteen years old, and, at least to date, they continue to be excited in finding and cooking new recipes, and full of pride as our family consumes them.

If you have a young family, perhaps you can consider taking on the #15by15 challenge too.

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Tuesday, December 05, 2017

You'll Gladly Die for Your Children; Why Won't You Cook for Them?

Today the Heart and Stroke Foundation published a report by Dr. Jean-Claude Moubarac that found Canada's biggest consumers of ultra-processed food are our children. Canadian kids between the ages of 2-18 are consuming over half of their calories from ultra-processed foods, and kids aged 9-13, are closing in on 60%. When I read the report, one which clearly suggests that cooking is a lost art, it reminded me of this article which I first published in USNews and World Report in 2013 (and I'll have more on this subject from my wife on Thursday)..
I'm a parent of three. I hold no illusions that I'm a uniquely dedicated parent or that my love for my kids is greater than anyone else's. And like all parents, should the opportunity arise, I'd gladly, immediately and unquestioningly give my life for their's. And it's my firm belief in the incredible and powerful love of parents for their children that regularly leads me to scratch my head and wonder: Why it is that while most every parent would happily die for their children, it's an increasingly rare parent who will cook for them?

I've heard all of the explanations—time, cost, after-school activities, lack of cooking skills, picky eaters, etc. But ultimately, I think the real reason parents who would die for their children are comfortable feeding them from boxes and drive-thrus isn't due to a lack of love or concern. It's because society has been so firmly and conclusively duped into believing that doing so is both safe and healthful that it has become our new normal.

Remember that the foods we feed our children are, quite literally, their building blocks. Consequently, we are building a nation of children constructed from the food industry's deceptively and, at times, deceitfully marketed salt, sugar and fat offerings of convenience.

But more than that, the manner in which we feed our children is the model from which they're likely to draw upon to feed their futures. If fast and processed food assembly make up the bulk of their childhood "cooking" experiences, where actual cooking is a grumbling rarity relegated to holiday dinners, do you think your children are likely to take the time to cook and look after their nutrition as young adults or as parents themselves?

The statistics are ugly. Nearly half of our food dollars are being spent on restaurant and out-of-the-home convenience foods. In our homes, the percentage of food dollars being spent on processed foods has doubled since just the early 1980s. But again, we're not eating this way because we don't value health or love our children. We're eating this way because the food industry has festooned boxes of salt, sugar, fat and pulverized white flour with claims of added "nutrients" and health benefits; they've also convinced us that mixing, pouring, stirring and adding is "cooking."

The fact the food industry has succeeded in doing this in part may have to do with our species-wide desire for convenience, because, at the end of the day, it's simply not about time. Recent reports put the average American in front of a television for 34 hours a week and on the Internet for another eight–sure sounds like time's something of which we actually have plenty.

Fixing this problem will require more than just trying to make parents feel guilty. At this point, many parents have been led by lax front-of-package labeling and advertising laws to faithfully believe that the boxes they're feeding their children do in fact conveniently and healthfully replace fresh, whole-ingredient cooking. Plus, they themselves may have grown up in homes where actual home cooking was anything but the norm and may not know how to cook.

So what should we do? Here's a start:

• We need to take away the food industry's upper hand in the supermarkets. We need to change labeling laws and hamstring the ability of the food industry to hoodwink harried parents into believing that a sometimes-comfort food like mac and cheese can ever be a smart choice. Why should the onus be on the consumer to turn boxes over to study the nutrition facts panel to ensure that the claims on the front of the package are supported by its actual contents? Moreover, are consumers actually equipped to do this from a nutrition-education perspective?

• We need to bring back home economics. Sadly, there are many families in which regular home cooking was last seen three generations ago. I think children shouldn't be allowed to graduate high school without knowing how to cook 10 simple, healthful, fresh, whole-ingredient meals on their own. As well, we should consider using our schools' abandoned kitchens after hours to help teach basic cooking skills to families as a whole.

• We need to denormalize the reliance on convenience when it comes to feeding our children. As a society, we need to prioritize our kitchens as the healthiest and most important rooms of our homes. And we'll likely need hard-hitting public health campaigns that criticize the food and restaurant industry as well as nutrition education in schools.

The shift from regular home cooking to the mess we're in now didn't happen overnight, and it's going to take time to reverse. We need to rise up and reclaim our kitchens and shift the balance of power from the food industry to loving moms and dads who no doubt would die for their children and, if empowered to do so, I've no doubt would cook for them, too.

We need to champion produce and not products, and we needed to have started yesterday.

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Saturday, December 02, 2017

Saturday Stories: Professor Piffle, Opioids, and Weight Lifting

By U.S. Navy photo by Mass Communication Specialist 1st Class Brock A. Taylor [Public domain], via Wikimedia Commons
Ira Wells, in The Walrus, with a story more for we Canadians on Jordan Peterson, the Professor of Piffle.

Admiral James Winnefeld, in The Atlantic, on how no family is safe from the opioid epidemic.

Alex Hutchinson, with his new gig in Outside, on how if you want to delay death, you should probably be lifting weights.

[And thanks to the great generosity of friends, family, and readers, this year's Movember fundraising amounted to $4,553. If you'd like to watch my kids shave off my moustache, here's that video]

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Wednesday, November 29, 2017

Picture Books Shouldn't Teach Toddlers To Be Self-Conscious About Weight

A patient brought in this picture book.

It's apparently from a series of picture books about "Pot Bellied Buddies"

It's about a bunny who as a consequence of eating too many carrots, no longer fits in his bunny hole.

And so what did the bunny do?

Well he decided to "cut back a little, and exercise"

Another patient brought in a Thomas and Friends book.

In it, kids are introduced to, "The Fat Controller"

And when exploring other Thomas and Friends characters I learned there's also a "Thin Controller". There are no other body based descriptors of any other characters. Weight is apparently an important distinction.

In the past I've noted weight biased messaging in:

A beloved and award winning children's author's book
Harry Potter
The Princess Bride
A kid's movie whose entire premise rides on the suggestion that being fat is horrific
The Muppets reboot
Scooby-Doo
Johnny Test
Max and Ruby

and

An attraction at Disney's Epcot Center.

That weight hate and stereotyping is so prevalent in children's books and movies speaks to how deeply ingrained weight bias is in society today. Parents, please be on the lookout for this sort of messaging, and when (not if) you come across it, use it as an opportunity to have a thoughtful discussion with your kids about why it's wrong.

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Monday, November 27, 2017

Whether Or Not You Can Outrun A Bad Diet Depends On Your Finish Line

If you're trying to run away from weight, the likelihood of you succeeding without also addressing your diet is pretty darn low.

On the other hand, if you're trying to run towards health, well then my money's on your feet.

Exercise is, second only perhaps to not smoking, the most important health behaviour anyone can cultivate.

Whether you're running to reduce the risk or burden of most chronic diseases, or to preserve and improve your functional independence, or to reduce pain, live longer, improve sleep, bolster mood, gain strength, lengthen endurance etc., increasing and sustaining regular exercise, regardless of weight and independently of diet, is incredibly powerful.

And I'm not aware of there being any credible voices suggesting otherwise.

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Saturday, November 25, 2017

Saturday Stories: Window Girl, Graffiti Kids, And Iron Lungs

Lane Degregory in Floridian on the girl in the window (apparently an update to this 2008 story is imminent).

Mark McKinnon in The Globe and Mail on the graffiti kids who sparked the Syrian war.

Jennings Brown in Gizmodo on the last few people living in iron lungs.

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Wednesday, November 22, 2017

10 Easy Non-Junk Food Rewards Teachers Can Dole Out

It happens in my kids' classes too. Teachers use junk food to reward academic accomplishments, good behaviour, fundraising and other social initiatives.

I'm sure the intentions are good. Rewarding desired behaviours reinforces the behaviour. Of course it also reinforces the rewards.

Teachers teaching their students, usually their very young students, that candy and pizza are rewards for every job well done no matter how small, might not be a great lesson for kids.

Moreover, there are so many better rewards that could be metered out.

In no particular order, here are ten (some whole class, some single kid), and please feel free to share this post and list with the your children's teachers. Honestly, they care about your kids, but they may not have thought about the issue much, and they're just doing what's nowadays considered to be normal.

1. An extra period of recess
2. An in class dance party
3. Dress up (or down) days (PJs, costumes, fancy clothes, whatever)
4. Class put in charge of school PA system for the day
5. Painting a hallway or classroom mural
6. Stickers or temporary tattoos
7. Sit wherever you want for a period (teacher's chair, floor, under desk)
8. Get out of one night of homework free card
9. Phone a kid's parents to tell them how terrific their kid is
10. Scrabble/boggle/other sort of educational game competition/hour

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Monday, November 20, 2017

Of Course You Can Be Fit And Fat

Undeniably fit ultra-marathoner Mirna Valerio (from a 2015 Runner's World story (am quoted))
How about I pose a different question.

Can you be fit and have diabetes?

Of course you can. It'd be ridiculous to suggest otherwise.

So why doesn't the question of whether or not a person can be fit and fat sound equally ridiculous?

Why instead do we regularly see articles like this recent one from the New York Times that cover the "controversy" of the fit fat person?

In part it's because these stories conflate fitness with being free from other chronic diseases and/or from the risk of developing other chronic diseases.

But is that the average person's definition of fitness?

I don't think so.

I think most people think of fitness as the thing one gains as a consequence of regular exercise. That's why when it comes to the question of can you be fit and have diabetes, it sounds ridiculous as of course you can exercise and have diabetes.

Well guess what, you can also exercise and have obesity.

And in fact, that same study on which the New York Times based their article, didn't even try to quantify whether or not exercise provided health and/or quality of life benefits to people with obesity (of course exercise does). It simply looked at the heart disease risk of people with obesity, who didn't have other chronic medical conditions.

So basically the study concluded that obesity ups cardiovascular disease risk, not that those with obesity couldn't be fit.

And exercise mitigates, to varying degrees, the risks associated with virtually all chronic diseases, and obesity is no different.

Coming back to why we see stories in even the world's most reputable newspapers framing fitness and fatness as a controversy, well I think it just comes down to weight bias - specifically the trope that assumes that anyone with obesity must be lazy, because without that bias as a backdrop, there really isn't much of a story.

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Saturday, November 18, 2017

Saturday Stories: Gene Drives x 2, and The Uncounted

By Mariuswalter (Own work) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
Ed Yong, in The Atlantic, on how New Zealand's war on rats might change the world (and not necessarily for the best).

Carl Zimmer, in The New York Times, on why scientists believe gene drives (like the one discussed in Ed Yong's article) are too risky to employ.

Azmat Khan and Anand Gopal, also in The New York Times, with an incredible piece of journalism on the accuracy, or lack thereof, of America's bombing of ISIS.

And lastly, if you enjoy my blog, please consider a donation to my Movember fundraising for men's health initiatives. Thanks to the generosity of friends, family and readers, I'm 91% of the way to my $3,500 goal. You can give anonymously and it's fully tax deductible. Just click here! No donation is too small.



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Thursday, November 16, 2017

Physicians Best To Have Practiced What They Preach Regarding Lifestyle

A few days ago I put out a tweet that stated that physicians (and with more characters here I'll say other allied health professionals as well) shouldn't give lifestyle advice unless they've followed it themselves. Given it led to a varied discussion, thought I'd expand more here.

First, I'm talking primarily about diet and fitness advice which pertain to any diet/fitness responsive condition or simply on healthy living as its own aim.

Second, while I think it'd be terrific if all physicians continually walked their talks, this isn't a reasonable expectation. What is however reasonable, at least in my opinion, is that a physician providing lifestyle advice has spent at least some time following their own advice (barring of course any physical or medical limitations that might preclude same).

Living the whys, wherefores, real-life challenges, and logistics, of their own lifestyle advice provides physicians with insights and empathy that in turn will help in their understandings of their patients' struggles and barriers. That understanding is likely to improve the counselling and support those physicians provide.

Whether it's keeping a food diary, following a particular diet, cooking the majority of meals from fresh whole ingredients, exercising a particular amount each week or day, mindfully meditating, etc - spending a real amount of time doing so (my non-evidence based suggestion would be for a month at least) will make you a better clinician.

[And to be clear, as there were those online who wanted to extrapolate my statement into one that suggested physicians must themselves all live incredibly healthful lives and maintain certain weights - that's definitely not what I'm saying, nor of course does weight provide real insight into the health of a person's lifestyle (as plenty of people with obesity live healthy lives, and plenty of people without don't).]

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Tuesday, November 14, 2017

Early Childhood Physical Activity Does Not Vaccinate Against Obesity

By Pete (originally posted to Flickr as determination_0970) [CC BY-SA 2.0], via Wikimedia Commons
It's not uncommon when I meet parents of children with obesity for them to tell me either that it doesn't make sense because their child is extremely active, or that inactivity is to blame for their child's struggles.

And while my confirmation bias is that weight leads to inactivity in kids rather than inactivity to weight, data is somewhat mixed, with some studies finding total daily energy expenditure in very young children is associated with lesser weight gain, and others, not.

One of the shortcomings of prior studies were that they focused primarily on energy expenditure measured during a child's first year of life, and didn't cover the period known as adiposity rebound whereby BMI typically decreases until the age of 4-7 years before beginning to increase through late childhood.

A recent small study, High energy expenditure is not protective against increased adiposity in chldren, included that time period.

Briefly, 81 subjects who were classified as either at low risk of developing obesity (in that they had lean mothers with an average BMI of 19.5), or at high risk (mothers with an average BMI of 30.3), were recruited, and 53 remained through to the study's conclusion of 8 years. Three measures of adiposity at 8 years were collected - BMI percentile, BMI Z-score, and percent body fat. Total energy expenditure was measured using doubly labelled water at 4 months, 2, 4, 6, and 8 years of age (though only 58% of all total measurements were collected). Body composition was measured by way of bio-impedance analysis at ages 0.25 and 2 years, and by way of DEXA at ages 4 and 6.

What was found was that total daily energy expenditure increased with body size, but,
"there was no evidence supporting the hypothesis that a low habitual TEE for that body size leads to subsequent increase in BMI or % body fat"
Nor was there an association between measures of adiposity at age 8 and total energy expenditure between the ages of 0.25 and 6 years.

The authors overarching conclusion is that when it comes to the genesis of childhood obesity, it's energy in, not energy out.

I can't help but wonder, were that to be the prevailing belief, would parents with concerns about their children's weights be more conscious of their children's diets (especially liquid calories and purchased meals) as energy-in is something that many parents deemphasize during our initial discussions.

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Saturday, November 11, 2017

Saturday Stories: Trump's USDA, ORBITA, and 'Woman, Black',

Michael Lewis in Vanity Fair on Trump's USDA.

James Hamblin in The Atlantic covers the ORBITA trial and wonders how much of heart disease is a state of mind?

Future physician Chika Oriuwa with her spoken word poetry slam 'Woman, Black'



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Thursday, November 09, 2017

More Evidence That More Exercise Doesn't Up Total Daily Calorie Burn

Why is it that exercise doesn't seem to help appreciably with weight loss (and for those who enjoy building strawmen out there, note I'm talking about weight loss, not fat loss, nor fitness, nor health)?

One possible reason is that many people eat back their exercise in the form of a reward for doing it, or because they have been taught by savvy marketers that they need to refuel or recover something or other.

Another possible reason is that upping intentional exercise may lead bodies to decrease unintentional calorie burn (decreased fidgeting/NEAT, decreased autonomic tone, etc.) and also by way of improved exercise efficiency.

Overarchingly the latter theory is called constrained energy expenditure, and the evidence on all of this is early, and somewhat mixed.

Well a few months ago another block was added to the pile (at least for older women without obesity) suggesting constrained energy expenditure is a real phenomenon. It was a study published in Physiological Reports and it detailed the impact that a 4 month long moderate-intensity walking program had on the total daily energy expenditures of older women without obesity.

The study's 87 included participants reported being physically inactive, and weren't found to have any significant medical issues. The group was randomized into either receiving one of 2 doses of moderate intensity exercise for 4 months. Importantly, the exercise itself was supervised. Before and after measurements included resting energy expenditure (via indirect calorimeter), total daily energy expenditure (via doubly labeled water), body composition (via DEXA), graded exercise test (via treadmill VO2 max), physical energy expenditure (TDEE*0.9-RMR (to account for thermic effect of food reduced by 10%), and NEAT (by subtracting exercise energy expenditure - physical activity energy expenditure).

When it was all said and done, the lesser group added an average of 105 minutes of walking to their weeks, while the higher group added 160 minutes to their weeks.

There was a teeny tiny bit of weight lost in both groups (1.7lbs), and a tiny change to body fat percentage (-0.7%), but there were no between group differences. Expectedly, V02max improved more in the larger amount of exercise group.

What didn't change?

Everything else.

Despite marked increases in intentional exercise, and marked differences in adhered to doses of exercise, there were no differences found for participants' total daily energy expenditures, resting metabolic rates, NEAT, non-exercise physical activity or even total physical activity.

These results changed some when they further analyzed the data as they determined that those patients with higher baseline levels of physical activity showed lower levels of NEAT (important to note, difference did not reach statistical significance) post 4 months of exercise, whereas those with lower levels of baseline activity experienced decreases to resting metabolism with exercise (authors suggested latter might be due to weight loss, but given how small weight loss was, I find this confusing as the RMR drops were not small).

All this to say when it comes to exercise and its impact on calories burned, it's clearly far from a simple math formula. It's also incredibly unfair to weight. But as always, when it comes to improving health, nothing beats it.

[Thanks to Matt Woodward for sharing this study with me]

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Monday, November 06, 2017

Guest Post: Special K Nourish Ad Perpetuates Supermom Nonsense

I've never been a fan of Kellogg's Special K's pretending to give a crap advertising, and so when I received an email from longtime reader Rosemary, who was unimpressed to say the least with one of their latest ads (embedded at the end of this post), I asked her if I could share her thoughts. She kindly agreed. Raw to say the least, and though I don't fully agree with every sentiment expressed herein, I'm betting they'll resonate with many.
I know soooo many women (and men!) that eat these products - thinking they are a whole / healthy choice.

This ad is so much ugh. Of course they had to throw in the shot of the well-endowed woman in the bra. "Casually getting dressed" ... while literally stuffing her face. Geneen Roth would not approve! Lol.

The whole "I am woman hear me roar - I can do anything - I am fierce - around food / being in charge of the food / feeding the kids - this media trope is so such nonsense. I dont know any women that work / live / eat the way this ad depicts.

Just perpetuating that myth -women- no, we don't deserve time carved aside to eat calmly - we are just too damn busy being everything to everyone. Just perpetuates this super mom woman role nonsense.

Most women I know / especially those with young school age children LOATHE grocery shopping / planning meals / making lunches / cleaning up (cuz let's face it, cooking proper whole foods is more work) / and just generally feeling the societal pressure to excel to be creative (and inspired! (Oh shut up Jamie Oliver))- about feeding their families. (And isn't this just code for "if you love your family you should be obsessing about this too like every other delusional Martha Stewart wannbe? Most of us are just so exhausted from overwork / we lose the motivation. In secret, we all admit how much we hate it and what drudgery it is.)

And there Kellogg's is trying dutifully to hit all their "diversity notes" - woman motorcycle mechanic / buzzcut lgbt-ish rainbow wristband girl - / It is all so contrived.

They are depicting the overworked woman - and they are the solution, when in fact, eating their crap that masquerades as "breakfast" and "food" probably actually contributes to feeling exhausted - re unstable blood sugar - carby weight gain - making one less energized to shop and prepare. It's a cycle.

I know when I eat next to no processed food - my energy levels are great. After about 4 days of not eating any crap.

The cereal is 10g's of sugar per 3/4 cup serving. That would maybe cover the bottom of the cereal bowl. No one eats only 3/4 cup of cereal when they pour a bowl.

And the granola bars are even worse - palm oil - and many different forms of sugar. Cane in the chocolate and corn syrup.

No reply necessary - yer bizzy - just wanted to pass it along.



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Saturday, November 04, 2017

Saturday Stories: Global Trolling, Pain Empires, and Fake News Towns

A non-bylined piece (at least not that I could see) in The Economist explaining how the world has been trolled and why social media is to blame.

Patrick Radden Keefe in The New Yorker on the Sackler family and their empire of pain.

Caitlin Dickerson in the New York Times on what fake news did to Twin Falls, Idaho

[If you find this blog entertaining, interesting, and/or valuable, know I'll never ask you for money to read it, nor will I subject you to ads, but I will, once a year, ask you for donations to support my #Movember efforts. Please to report I'm nearly halfway to my $3,500 fundraising goal! Click here to give. No amount is too small, you'll get a tax receipt, and if you don't want it known by me or anyone else that you hang out here from time to time, you can give wholly anonymously as well.]


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Wednesday, November 01, 2017

And So It Begins (#Movember)

And so it begins (again).

This month I pledge to grow my something of a Pedro Pascal inspired lip-terpillar in the name of raising awareness (and $s) for men's health.

If you enjoy my blog, a blog fully free from advertising, I'd like to ask you to donate to my Movember fundraising efforts. I've kicked them off by donating $100 myself and I'm hoping to raise more than last year's $3,500.

Contrary to what some believe, Movember is not a prostate cancer charity per se, and though some of its funds do support prostate cancer research and treatment, Movemeber supports multiple men's health initiatives including those involving mental health, suicide, body image, eating disorders, testicular cancer, substance abuse, and more. Regarding prostate cancer, I was pleased to see that Movember encourages patients to speak with their physicians about the value (or lack thereof) of PSA screening, rather than suggesting it's a good idea for one and all.

Donating is easy. Just click here and give! And of course, Movember is a registered charity, so all donations are fully tax deductible.

In return I vow to continue to blog freely, to never allow advertisements, and to regularly post pictures of what might well have been an effective form of birth control in my home had I sported it year round back in the day.

For me the ask is also personal. My father was diagnosed with prostate cancer when I was in medical school, and soon I'll need to start wrestling with whether or not with that strong family history, I should walk the slippery slope of testing. My oldest cousin Marshall - we lost him to substance abuse.

Every dollar counts, no donation is too small.

(And if you want, you can make your donation anonymously so no one (me included) will know you hang out here from time to time.)

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Monday, October 30, 2017

Food Industry Furious With Health Canada's Front-of-Package Plans

If Health Canada takes Chile's lead, we too might see Frosted Flakes boxes change from looking like those on the left to looking like those on the right.
When industry is furious with a government proposal it's a safe bet that proposal is likely to affect their sales, and so when I learned that the food industry was incensed by Health Canada's front-of-package plan proposals (Aric Sudicky, a final year medical resident who was rotating through our office at the time, watched the recent roundtable style consultation hosted to discuss the implementation of what will be a Canada wide front-of-package program, via teleconference and reported to me that industry was none too pleased), I wanted to learn more.

Now this post isn't going to delve into whether or not those are the best 3 targets for front-of-package symbols, instead I want to focus on the lobbying and machinations of industry.

First though, a tiny bit of background.

In creating a new front-of-package symbol for Canadian consumers, what Health Canada doesn't want is a program that emphasizes so-called positive nutrients as 50 percent of Canadian package fronts already have those (put there by the food industry directly to help sell food), or one that requires a second step of thinking to interpret (eg studying the nutrition facts table) as that has been shown to lead to misunderstanding, or a hodgepodge of programs (as more than 150 front-of-package labeling programs have already been documented in Canada) .

What Health Canada does want is a single, standardized system, that involves a prominent symbol, that's consistently located, that doesn't require nutritional knowledge to understand, to help consumers identify products with high levels of nutrients that Health Canada deems are concerning to public health, that by itself provides the required interpretation for its meaning. Such a system would be consistent with the core recommendations made by the U.S. Institute of Medicine.

Breaking it down further, what Health Canada wants is a system that conveys simple to understand information, rather than one that presents data requiring interpretation.

Further still?

Health Canada wants warnings.

In their recent meeting, Health Canada presented their wants to food industry stakeholders, as well as the evidence they feel supports them, and invited them to submit their thoughts and suggestions for a symbol to fit Health Canada's 4 design principles:
  1. Follow the "high-in" approach
  2. Focus only on the 3 nutrients of public health concern (sugar, sodium, and saturated fat)
  3. Be 1 colour (red) or black and white; and
  4. Provide Health Canada attribution
As to what this might look like, here are some mockups put together jointly by the Canadian Cancer Society, Canadian Medical Association, Canadian Public Health Association, Diabetes Canada, Dietitians of Canada, and the Heart and Stroke Foundation.

Given that warning symbols aren't likely to be good for business, I was curious as to industry's response to the ask.

Suffice to say, industry is indeed unhappy.

The Retail Council of Canada wants Health Canada to implement instead an instruction for consumers to turn products around and study their nutrition facts tables, and they don't want Health Canada's name mentioned on the symbol. They are apparently worried that including Health Canada's name on the symbol might be misinterpreted as a government endorsement which in turn would lead consumers to eat more of the products with the warning labels. They're also apparently simultaneously worried that if the symbol utilized is already recognized to be a danger symbol, it could lead consumers to believe there is a food safety risk, and that if used, children, accustomed to seeing these symbols on foods, might lead them to think that cleaning supplies with danger symbols are safe to consume.

The Food Processors of Canada used bold to point out that, "the meeting didn't agree to anything", and that, "Health Canada has lost its way on the obesity issue". They think that what's needed is more public education, not a front-of-package warning program.

The Canadian Beverage Association expressed their, "deep concerns", and that though they were happy to have been included in the meeting, their definition of "deep and meaningful dialogue" with industry should include a process whereby industry participants would all discuss and agree upon what the program would entail.

Food and Consumer Products of Canada also wanted to express their disappointment that they weren't provided the opportunity to be more directly involved in crafting the proposal's criteria and their concerns about "the integrity and transparency of the consultation process". They sent a second note expressing their hope that the criteria still have room to evolve and that their preference is for traffic lights as they believe, "information – good and bad – builds on consumer literacy".

Dairy Farmers of Canada expressed their concern that the proposed warning system lacks the nuance required "to distinguish between nutrient-dense and nutrient poor foods" (sweetened milk will likely be slapped with a high in sugar warning), and that they'd be happy to support, especially, "if coupled with exemptions for nutritious dairy products", those programs that would provide data for consumers to study and interpret (like for instance the Facts Up Front program illustrated below).

There was however, one response from industry that was heartening. It was from Nestlé, whose representative reported being, "a little embarrassed" by how industry presented their views during the roundtable, and, "that Nestlé is not fully aligned to some of the comments that were made by some of our trade associations, and a few of us are feeling very frustrated."

Whatever comes of all of this, one thing's for sure. The food industry's near uniform opposition to Health Canada's proposed front-of-package warning label criteria is strong indirect evidence in support of their utility, as for the food industry, salt, sugar, and fat are the drivers of profitability and palatability, and they'll oppose anything they worry might limit their use.

So kudos to Health Canada for sticking to their guns, and also for honouring their pledge to make this process transparent by sharing with me industry's responses.

(and if you clicked on any of the industry letters to read, this is the post roundtable letter from Health Canada to which they're all referring).

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Saturday, October 28, 2017

Saturday Stories: Motherisk, Blood Tests, and Kim Jong Nam

CC BY-SA 3.0, Link
Rachel Mendleson, in the Toronto Star, with Part I of her incredible reporting on the fallout from the Mortherisk scandal.

Christie Aschwanden, in Five Thirty Eight, details her experiences with direct to consumer blood tests in the name of athletics.

Doug Bock Clark, in GQ, with the strange but true story of Kim Jong Nam's assassination.

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Monday, October 23, 2017

Hey American Youth Soccer Organization, Kids Don't Need Sugar To Play

It's difficult to overstate just how aggressively the American Youth Soccer Organization (AYSO) allows Nesquik to push chocolate milk on their young players.

The reason why is simple. In 2014, AYSO partnered with Nesquik and named it, "the official “Chocolate Milk” of AYSO."

Nesquik's AYSO enabled health washing centres around the supposedly "ideal ratio" in chocolate milk of carbohydrates to protein that "can help refuel and restore exhausted muscles".

"Exhausted muscles"?

I did a straw poll on Twitter of parents whose kids play soccer.

94% of the 269 respondents reports their kids as actually moving for less than 60 minutes per soccer outing, with vast majority of respondents reporting less then 30 minutes of movement.
Those poll results correspond nicely with those found by objective measures and published in Pediatric Exercise Science whereby accelerometers revealed that kids only spend 17 minutes of a 50 minute soccer match engaging in moderate-to-vigorous activity.

Now putting aside the discussion of ratios and whether chocolate milk has a special role in "refueling", it's difficult for me to imagine that anyone would suggest that kids moving for less than 30 minutes at a stretch (or even an hour), have "exhausted muscles" that need any special attention.

But I'd be wrong, because Registered Dietitian Tara Collingwood is out there for Nesquik to tell parents that chocolate milk is a healthy, perhaps even necessary, choice.

I know this because a close friend of mine and father of recently AYSO soccer enrolled twin 8 year olds and a 5 year old, has been sending me the signed by Collingwood promotional materials that arrive courtesy of AYSO in his inbox.

Here are Collingwood's "Hydration Guidelines" that recommend not only post game chocolate milk, but also suggest kids quaff 4-8oz of a sports drink for every 15 minutes played.

Here's Collingwood's post game snacks handout which of course includes chocolate milk.

Here's Collingwood's grocery list that includes chocolate milk (with its nearly double the per drop calories of Coca-Cola along with 2.5 teaspoons of added sugar per cup) in her list of "best foods"

Here's Collingwood's game day recommendations, which if my calculations are remotely accurate, would provide my friend's barely moving 5 and 8 year olds with somewhere between 400-600 game based calories, and more than a day's worth of added sugar (especially if drinking sport drinks ever 15 minutes as she recommends) apiece.

And here's Collingwood touting chocolate milk as one of 5 "must-have" foods alongside spinach, salmon, bananas, and whole wheat wraps.

And please don't think that AYSO cares enough about your kids to not allow Nesquik to target them directly with marketing either.

Nesquik has also paid Latina Mommy Bloggers to spread the word about the miraculous marriage of soccer and sugar-sweetened milk.

Here's another

And another

And another

In fact there are many, many, more.

AYSO, if you honestly cared about kids' health and sports nutrition, you'd put an end to this partnership, as Collingwood's love of chocolate syrup notwithstanding, it's nutritionally indefensible.

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Saturday, October 21, 2017

Saturday Stories: 3 #MeToo Stories

Image Source: The Daily Beast
Scott Rosenberg, in Deadline Hollywood, says everybody knew.

Jim Beaver, on Facebook, and why he won't say #MeToo.

Kristen Patrick in the CMAJ on #MeToo in Medicine.

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Thursday, October 19, 2017

Good Lord! British NHS Just Banned Surgeries For Patients With Obesity (And Smokers)

In what is perhaps the world's most biased and blame based health policy, A British NHS just banned patients with obesity or who smoke from receiving elective surgeries in a bid presumably to inspire encourage help whip and prod people into losing weight (or quitting smoking - but I'm not going to touch on smoking in this piece, not because I agree with the policy, but rather because it's not my area of expertise).

The policy's two primary presumptions are ignorant and misguided.

The first has to do with the value of BMI as a clinical tool. While it's true that the risks of medical complications and morbidities rise with weight, BMI is a measure of bigness, not health. Half of the NFL have been reported to have BMIs greater than 30, as did my friend and colleague Dr. Spencer Nadolsky pictured below in his wrestling days when he sported a BMI of 32.

The second presumption is that obesity is a disease of personal responsibility and choice. While no doubt weight can be dumbed down to eat less, move more, I still find it shocking that public health professionals and policy makers exist who believe that somehow people with obesity simply haven't absorbed enough societal guilt, shame, and discrimination to finally lose weight.

Of course, even if you do want to embrace personal responsibility as the sole cause of obesity, medicine isn't about blame. We patch up drunk drivers and folks who don't wear seat belts. We treat people with asthma who don't bother keeping up with their puffers, pneumonias exacerbated by the early discontinuation of antibiotics, and the psychotic breaks of folks who stop their antipsychotics.

Oh, you want surgical examples?

How about liver transplants in patients who once suffered with alcoholism; or how about one that doesn't involve a so-called vice at all - heart bypasses on folks who simply didn't bother to take their blood pressure, cholesterol or diabetes medications?

We operate on them all in a timely manner, and so we should, but yet here the NHS feels comfortable discriminating against people with obesity, because they apparently still feel justified discussing obesity on the basis of blame based causation.

But putting those two erroneous presumptions aside, the notion that blame based medicine is something that the UK wants to adopt is plainly repugnant. Medicine's not about blaming and shaming. Life is complicated. And even if a person has the time and personal health to allow a run at intentional behavior change, how high on the list of priorities do you think healthy living lies for someone whose children struggle with substance abuse, or whose debts are staggering, or whose spouse is hobbled with post-traumatic stress disorder? Or someone with any of those same issues who is also unemployed?

Clinically useless truisms aside, obesity is complicated, and moreover we have yet to discover a non-surgical, reproducible, and uniformly effective plan for the management of obesity. And while there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress. Meanwhile the burden of suffering that the elective surgery those with obesity are being denied may add to absenteeism, presenteeism, pain, depression, and more.

If someone from the NHS' clinical commissioning groups (CCGs) in Hertfordshire (who thought up this loathsome, biased, and backwards policy) is reading this, I want to remind you of the NHS Constitution's first guiding principle:

"The NHS provides a comprehensive service, available to all

It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status."
Either you're going to have to reverse this idiotic policy, or amend that statement above to explicitly exclude those with obesity.

For shame.

(In rushing this post through, I utilized paragraphs from a number of previous stories I've written about obesity, blame, and bias)

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Wednesday, October 18, 2017

PepsiCo Confirms They Care About Profit, Not Health

This post is not an indictment of PepsiCo.

In fact I've picked on PepsiCo far less than I have on Coca-Cola over the years because for the most part, PepsiCo hasn't cynically pretended that health mattered to them as vocally as has Coca-Cola.

For PepsiCo, health was always about sales. They simply wanted to make money selling less awful junk food.

Well, that hasn't worked out so well, and so PepsiCo, in a 3rd quarter investors meeting a few weeks ago, did as companies do when faced with disappointing sales figures - they pledged to increase their marketing of their flagship sugary beverages (Pepsi and Mountain Dew).

This shouldn't surprise anyone.

PepsiCo's job is to maximize their profits, and while there may be times when profits and public health collide, if they don't, PepsiCo will protect their interests, not yours and mine.

And this post comes with a serving of especially delicious irony in that just one day after PepsiCo's announcement that they were going to pump their sugary fare, PepsiCo's VP of marketing Gary So published this piece on Medium about how great PepsiCo's commitment is to reducing the consumption of calories and sugar from beverages.

As I've said before, the food industry is neither friend, nor foe, nor partner.

[Thanks to Consumerist Community Editor Laura Northrup for pointing me to the AP piece]

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Monday, October 16, 2017

My Kids Go Trick or Treating. Yours Probably Should Too.

(A variation of this post was first published October 24th, 2013)

It's coming.

And I'm not really all that worried. At least not about Halloween night.

The fact is food's not simply fuel, and like it or not, Halloween and candy are part of the very fabric of North American culture, and so to suggest that kids shouldn't enjoy candy on Halloween isn't an approach I would support.

That said, Halloween sure isn't pretty. On average every Halloween sized candy contains in the order of 2 teaspoons of sugar and the calories of 2 Oreo cookies and I'd bet most Halloween eves there are more kids consuming 10 or more Halloween treats than less - 20 teaspoons of sugar and the calories of more than half an entire package of Oreos (there are 36 cookies in a package of Oreos).

So what's a health conscious parent to do?

Use Halloween as a teachable moment. After all, it's not Halloween day that's the real problem, the real problem are the other 364 days of Halloween where we as a society have very unwisely decided to reward, pacify and entertain kids with junk food or candy (see my piece on the 365 days of Halloween here). So what can be taught on Halloween?

Well firstly I think you can chat some about added sugar (and/or calories), and those rule of thumb figures up above provide easily visualized metrics for kids and parents alike.

Secondly it allows for a discussion around "thoughtful reduction". Ask them how many candies they think they'll need to enjoy Halloween? Remember, the goal is the healthiest life that can be enjoyed, and that goes for kids too, and consequently the smallest amount of candy that a kid is going to need to enjoy Halloween is likely a larger amount than a plain old boring Thursday. In my house our kids have determined 3 candies are required (and I'm guessing likely a few more on the road) - so our kids come home, they dump their sacks, and rather than just eat randomly from a massive pile they hunt out the 3 treats they think would be the most awesome and then silently learn a bit about mindful eating by taking their time to truly enjoy them.

The rest?

Well it goes into the cupboard and gets metered out at a rate of around a candy a day....but strangely....and I'm not entirely sure how this happens, maybe it's cupboard goblins, but after the kids go to sleep the piles seem to shrink more quickly than math would predict (though last year my oldest told me she believed it was her parents eating them and that she was going to count her candies each night). I've also heard of some families who grab glue guns and make a Halloween candy collage, and dentist offices who do Halloween candy buy-backs.

Lastly, a few years ago we discovered that the Switch Witch' territory had expanded to include Ottawa. Like her sister the Tooth Fairy, the Switch Witch, on Halloween, flies around looking for piles of candy to "switch" for toys in an attempt to keep kids' teeth free from cavities for her sister. The joy and excitement on my kids' faces when they came downstairs on November 1st that first Switch Witch year was something to behold, and is already a discussion between them this year.

And if you do happen upon our home, we haven't given out candy since 2006 and we haven't been egged either. You can buy Halloween coloured play-doh packs at Costco, Halloween glow sticks, stickers or temporary tattoos at the dollar store (glow sticks seem to be the biggest hit in our neighbourhood), or if your community is enlightened, you might even be able to pick up free swim or skate passes for your local arena (they run about 50 cents to a dollar per so if you're in a very busy neighbourhood this can get pricey).

[Here's me chatting about the subject with CBC Toronto's Matt Galloway]

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Saturday, October 14, 2017

Saturday Stories: Deaths, Blubber, and Running

Robert Fine and Jeffery Michel in Baylor University Medical Center Proceedings with their piece, Viaticum, on two different types of deaths.

Jonathan Reisman in Slate with a story of seal blubber and nutritionism run amuck.

Alex Hutchinson in Runners World with his final column there on what he calls the seven pillars of running wisdom (spoiler - it's not only applicable to running).

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Thursday, October 12, 2017

Small Study Suggests Body Contouring Surgery Augments Bariatric Surgery

Source: Kayla Butcher's GoFundMe page for skin removal surgery
One of the nearly inevitable adverse effects of bariatric surgery is loose, excess, skin, and generally speaking, the only recourse for dealing with it is more surgery.

Here in Canada, whereas bariatric surgery is covered by our healthcare system, with the exception of medically necessary panniculectomies, post bariatric surgery body contouring surgery is not.

Putting aside both quality of life and aesthetics as rationale for skin removal surgery (and there are very reasonable arguments supporting both), here's a new one (at least for me). If the outcomes of this small study hold true, body contouring surgery may dramatically enhance long term weight loss outcomes.

The study was retrospective and it sought simply to compare the long term weights of those who had both body contouring surgery and bariatric surgery with those who only had bariatric surgery.

Interestingly, the study found that while weight loss was comparable between subjects 2 years post bariatric surgery at 35.6% in the bypass/contouring group and 30.0% in just bypass group (with the 5% additional difference perhaps explicable simply on the basis of the weight of removed skin), with time, the just bypass group regained significantly more weight. By 5 years (the duration of the study), the bypass/contouring group were maintaining a 30.8% loss, while the just bypass group had regained such that they were only maintaining a 22.7% loss.

Now this was a small study, and retrospective rather than randomized - in turn this might mean that the association is related to other factors (for instance socio-economics as body contouring is expensive and clearly those that can afford it, may well have other privileges and circumstances that might be beneficial to post-surgical weight management). Also worth noting that the 5 year losses of the just bypass group aren't as high as seen in other bariatric surgery studies.

Am looking forward to more research on this (ideally randomized), as for many post bariatric surgery patients, excess skin has a dramatically negative effect on their quality of life, and perhaps, if it was shown that body contouring surgery helped patients maintain their losses, insurers and governments might cover the procedure.

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Tuesday, October 10, 2017

Should We Be Treating Type 2 Diabetes With Bariatric Surgery?

Photo By Mr Hyde 
I'm resurrecting and tweaking this piece, for the third time now, consequent to the publication in the New England Journal of Medicine of the 12 year data that continues to strongly support the use of bariatric surgery to treat type 2 diabetes.
In case you missed the news, a recent study published in the New England Journal of Medicine demonstrated dramatic benefits of bariatric surgery in the treatment of type 2 diabetes.

Now I'm not going to get into the study here in great detail, but it followed 1,156 patients from for 12 years and divided them into 3 groups. Those who sought and chose not to have bariatric surgery. Those who sought and had bariatric surgery. And those who did not seek nor have bariatric surgery. Researchers examined all of them at baseline, 2 years, 6 years, and 12 years in terms of whether they had type 2 diabetes, hypertension, or hyperlipidemia.

The results were striking.

With a follow up rate of 90% at 10 years researchers demonstrated that not only were patients 12 years post bariatric surgery maintaining an average loss of 77lbs/26.9% (the non-surgical groups at 12 years lost an average of nothing), but that amoung those patients who had diabetes pre-surgically, 12 years later, 51% were in remission. And for those who are curious about such things as odds ratios, the odds ratio for the incidence of type 2 diabetes at 12 years was 0.08 (95% CI, 0.03 to 0.24) for the surgery group versus the non-surgery group.

(and though they weren't quite as striking, the surgery group at 12 years also had markedly higher remission rates and lower incidences of both hypertension and hyperlpidemia)

So basically here we have a surgical intervention that is dramatically better medical management for type 2 diabetes - a condition that causes cumulative damage and can wreak havoc on a person's quality and quantity of life.

Yet many MDs, allied health professionals and health reporters, including some who I know, respect, and admire, regularly discuss how we shouldn't be looking to surgical solutions for diabetes because patients could instead use their forks and feet. While there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress - the simple fact remains that we don't yet have a proven, reproducible and sustainable approach to lifestyle change of any sort.

And what of those folks not wanting to change? I say, "so what?". Since when did MDs, allied health professionals or health columnists earn the right to judge others on their abilities or desires to change? Our job is to provide patients with information - all information - including information on lifestyle change, medical management and surgery. We can even provide patients with our opinions as to which road we think may be best for them, and why, but honestly, given the results from these studies, I'm not sure how anyone could make an evidence based case that surgery isn't a very real and powerful option that ought to be discussed with all of their patients with type 2 diabetes and obesity.

Unless of course that someone has some form of weight (or simply anti-surgery) bias.

Let me give you another example. Let's say there was a surgical procedure that women with breast cancer could undergo that would reduce their risk of breast cancer recurrence by roughly 30%. Do you think anyone would question a woman's desire to have it? I can't imagine. And yet lifestyle - weight loss and exercise has indeed been shown to reduce risk of breast cancer recurrence by 30%. Think people would dare suggest the women choosing surgery were, "taking the easy way out", that they should just use their forks and feet?

We've got to get over ourselves.

Until we have a proven, remotely comparable, reproducible, sustainable, non-surgical option, if you bash the surgical option on its surface for being "easy", or "wrong", you might want to do a bit of soul searching as to whether or not you're practicing good medical caution, or if instead you're practicing plain, old, irrational bias.

[and for new readers to ensure there's no confusion - I'm not a surgeon]

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