Saturday, December 30, 2017

Saturday Stories: The UN, The Skid Row Fixer, And Polar Bear Propaganda

By Arturo de Frias Marques
Daniel Gordis, in Bloomberg, cogently explaining why Israelis don’t care how the UN votes.

Eddie Kim, in DT News, on Wendell Blassingame, the skid row fixer.

Tim Edwards, in The Walrus, with the problem with polar bear propaganda.

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Thursday, December 28, 2017

How Your New Year's Resolution To Up Your Exercise Might Lead You To Up Your Weight

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2014 and given it's New Year Resolution time, figured this might be worth revisiting.
File this study under reality.

Researchers were curious whether or not labelling exercise "fat-burning" (as many exercise machines do) would have an impact on how much food a person ate post exercising.

The protocol was simple. Subjects were brought individually to a lab and were told they were there to evaluate newly developed training software for bike ergometers. They were then equipped with a heart rate monitor and completed a 20 minute low-moderate intensity cycle. Participants were randomly assigned to have one of two posters tacked to the wall in front of them while they rode. The first had a poster stating, "Fat-burning exercise – developing training software for exercise in the fat-burning zone.", and the second, "Endurance exercise – developing training software for exercise in the endurance zone." Following their rides subjects were told they could help themselves to snacks while completing a survey and were offered water and pretzels. Pretzels consumed were measured by means of a scale before and after each participant.

The results?

"Fat-burning" labels did have some impact, but I'm not going to dwell on it. Instead I want to point out that across both treatments participants burned on average 96 calories during their rides and they then proceeded to eat 135 calories (41% more calories than they burned) of post-exercise pretzels.

Combine these results with those from a study published a few weeks ago that people who went for a walk and told they were "exercising" consumed 41% more calories from indulgent desserts and drinks following a post-walk lunch than those who were told they were walking for "fun".

We do eat because we exercise and I think in large part it's because we've been taught that we're supposed to - both by the food industry (see up above) and sadly too, by public health departments (see down below with the "Less Sit, More Whip" City of Ottawa bus poster) and health professionals who have markedly overplayed exercise's role in weight management.

If you are interested in weight loss, make sure that regardless of how much you're exercising, you're paying attention to to food as well.

Lose weight in the kitchen, gain health in the gym.

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Tuesday, December 26, 2017

Docs! Please Stop Telling Patients How Many Pounds They Need to Lose!

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2014.
I don't think a week goes by without a patient in my office recounting how at their last physical their doctor told them how many pounds they ought to try to lose. Sometimes those MDs will be going by BMI tables and aiming patients at a BMI less than 27. Othertimes those MDs will be pulling those numbers right out of their proverbial butts with random guesses of how much would be "good" or "healthy".

No doubt too, in the majority of cases, the recommendation to lose a particular amount of weight didn't come with any useful advice on how exactly those pounds were supposed to get lost.

So fellow MDs, if you're reading this, if you think weight is having a negative impact on one of your patient's health or quality of life I do think a respectful discussion of the issue is warranted. But before you go down that road you need to know a few things.

Firstly you need to know that despite what society teaches, we don't have direct control over our weights. Sure, indirectly behavioural choices can influence weight, and yes, we can likely suffer ourselves down to whatever weight we choose, but suffering doesn't last, and consequently the direct control of losing "x" pounds - that's nonsense - if desire, guilt or shame were sufficient to lead to specific amounts of loss the world would be quite slim.

Secondly you need to understand that if you have no useful weight management advice to offer beyond the less than useful, "try to eat less and move more", all you're really doing is undermining your doctor-patient relationship as the likelihood of your patients not wanting to lose if their weights are truly affecting their health or quality of life, is likely close to zero, and yet here you are, their doctor, telling them something they already know, inferring quite clearly that you think that if they just put their minds to it they could make it happen, while simultaneously offering them no actionable help or support whatsoever.

Docs, if you're concerned about one of your patients' weights, make sure you have a realistically actionable plan to help them with. If you yourselves are providing lifestyle advice, please consider personally living by that advice for at least a month or two to ensure it's remotely realistic and to help you to understand what your patients might face as challenges with it. If you don't plan on providing any advice yourself, please explore your community's options and find an organization or an individual that you personally research in regard to their program's safety, efficacy and ethics. And lastly, don't ever target numbers on scales as there's simply no way to ensure your patients will get there, nor is there necessarily any need that they do given that markedly subtotal losses, when combined with lifestyle changes (or even lifestyle changes alone without weight loss), are likely more powerful medically than any drug you have ever prescribed.

Putting this another way, as my friend Dr. Jamie Beckerman is liable to say, the goal is the road, not the destination.

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Wednesday, December 20, 2017

Does Your Doctor Know How To Weigh Your Child? I'm Betting Many Don't.

Image Source
As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2014.
On the surface it doesn't sound all that difficult.

Ask child to stand on scale. Weigh. Record weight. Done.

Working with parents of children with obesity, it seems many doctors nowadays feel it's important to add in some judgement or scary statistics such that after 'weigh' and before 'done' comes a speech on the dangers of weight along with the implicit or explicit suggestion that the child is responsible - either for gaining the weight or for not losing it.

I don't think that's fair. Moreover, I don't think it's helpful and I think it may well do harm.

It's not fair, especially with younger children, given that they're not in charge. They don't do the grocery shopping. They don't cook the meals. They don't set the example. They live the lives their parents teach them to live. They're life's passengers, not the drivers.

It's not helpful because speeches or stats without action plans by definition aren't helpful.

It's potentially harmful because the negative emotions bound to be generated by this sort of an interaction may well erode a child's self-esteem, body image, and their relationship with food. It may also lead that child's parents to adopt a knee-jerk pattern of restriction, guilt and shame that is far more likely to make matters worse than better.

The safest way for a physician to weigh a child is to tell the truth as to why weights are important. The truth is that children need to be weighed because medication is dosed dependent on a child's weight and therefore physicians need to have fairly current weights on their growing patients in case they fall ill and require a prescription. And should a physician have a concern about a child's weight I'd encourage them to have a discussion with that child's parents with the child absent and clearly, there's not much point even having the discussion unless that physician has suggestions or resources beyond the tritely useless truism of "eat less, move more".

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Monday, December 18, 2017

High School Phys-Ed Horror Story Highlights Risk of Tying Exercise To Weight Loss

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2014.
Thanks to Jonathan Clow for sharing this story with me.

So last year a PE teacher at Huron Park Secondary School in Woodstock, Ontario had their Grade 10 co-ed class use scales and measuring tapes in front of one another to calculate their body mass indices. Why? Because his gym class for the semester was to include once weekly circuit training that consisted of ten 90 second stations of burpees, weighted squats and other squat variations, mountain climbers, with no breaks, then a water break then 2 more circuits at 60 seconds and 30 seconds each without a break in between. At the end of the semester the kids were to once again publicly re-weigh and measure themselves in order to see how much weight their once weekly circuit training helped them to lose.

Oh, and he also allegedly informed the kids whose BMIs were elevated to begin with that they would likely develop diabetes.

No doubt the PE teacher was well-intentioned and felt that both public shame and just a bit of moving around would help his students because as far as he was concerned weight is an "energy balance" issue between in and out and that if he just had the kids up their "out", the problem would be solved. I've no doubt too, that his sentiments represent the societal norm rather than an exception.

I'm told the kids mounted a boycott and letter writing campaign to the school but am unsure on how it all shook out. Fingers crossed for the kids.

I'd imagine there are many more such PE based horror stories out there, and if the teacher or school is reading this, perhaps he might have a peek at this meta-analysis of school PE programs which demonstrated yet again (and yes I know I'm a broken record), that weight wise, kids aren't going to outrun their forks, or this study that suggests negative experiences in high school PE may well discourage the adoption of a commitment to lifelong exercise.

Bottom line for all of us - exercise should be cultivated and promoted on the basis of health and fun, and fat shaming has no place (or utility) in society let alone in a high school's curriculum.

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Wednesday, December 13, 2017

Juice is NOT a F@*#ing Fruit Part II

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2014 and this piece on juice.
Juice is an incredibly frustrating beverage. Despite packing the same caloric and sugary punch of Coca-Cola, unlike sugared soda, juice's undeserved health halo regularly leads to its provision, consumption (and often over consumption) in the name of nutrition - especially to and by our children.

And kids really shouldn't be drinking the stuff, or at the very least, not in the name of health.

The Canadian Pediatric Society and the American Academy of Pediatrics both recommend that juice be capped for kids at half a cup daily. And make no mistake, the capping isn't because juice is so damn good for the kids that we don't want them to drink too much of it, but rather because every glass contains 5 teaspoons of sugar (or more) and calories which won't be compensated for with decreased portions at their next meals.

The World Health Organization also considers juice to be nothing more than a sugar delivery vehicle and in their recent draft guidelines on sugar consumption specifically call out juice as a source of undesirable free sugars.

Yet there's this piece that came across my Newswire just last week. It was a press release put out by Coca-Cola (makers of Minute Maid) and Breakfast Club of Canada and it featured Teresa Piruzza, MPP for Windsor West and Minister of Children and Youth Services launching the newest Ontario Breakfast Club, which judging from the press photo up above involves the indoctrination of children into believing that fruit juice is a healthy part of their breakfast and the provision of juice boxes (containing more juice than our experts' daily recommended maximum), festooned with cartoon characters that in turn might further increase a child's consumption and desire for same.

Can you imagine a similar scene with the Minister of Children and Youth Services grinning and handing out Vitamin C fortified soda, in cartoon covered cans, to children in the name of breakfast?

According to the press release,
"Breakfast Club of Canada supports healthy breakfast programs at 1,266 schools, supporting nearly 130,000 children and serves close to 21 million breakfasts every year and that Minute Maid® has partnered with Breakfast Club of Canada since 2003, donating Minute Maid® juices to support programs across Canada."
Breakfast I'm all for, but marketing sugar water to children and washing it in BS "corporate social responsibility", food insecurity, and health, is incredibly misguided, and incredibly sad.

(And if you're looking for Juice is NOT a F@*#ing Fruit Part I click here)

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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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