Saturday, August 18, 2018

Saturday Stories: Glyphosphate, Glyphosphate, And Katie Stubblefield

Robert O'Conner, in Medium, with his expert thoughts on glyphosphate (RoundUp) and cancer.

Andrew Kniss, in his blog, with his expert thoughts on glyphosphate and cancer.

Lynn Johnson, in National Geographic, with an incredible story about Katie Stubblefield's face and life.

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Tuesday, August 14, 2018

Study Finds Giving Prebiotics To Kids Doesn't Change Their Energy Intake And Ups A Major Hunger Hormone Yet Still Concludes Prebiotics Have Potential To Help With Childhood Obesity?

Today will be discussing a study that had kids randomly assigned to taking either 8g oligofructose enriched inulin (prebiotic) per day or placebo (maltodextrin) for 16 weeks.

The study's pre-registered primary outcome measure, as recorded in ClinicalTrials.gov, was change in baseline fat mass at 16 weeks.

Secondary outcome measures (as recorded) were changes in baseline appetite at 16 weeks (assessed with visual analog scales and an eating behavior questionnaire), and objective appetite measures including a weighed breakfast buffet, weighted 3-day food records, and serum satiety hormone levels.

(Not preregistered as an outcome of interest? Body weight change or BMIz score.)

Outcome wise, here's a snapshot of the study's abstract:
Reading through the study, here's what I found as outcomes:
  • According to their 3 day food diaries (but be aware, food diaries are notoriously inaccurate), there was no difference in 3 day energy intake between the prebiotic and placebo arms.
  • When all ages were included in the analysis, there was no difference in all-you-can-eat breakfast buffet energy intake between the probiotic and placebo arms, BUT, by dividing the kids into those between the ages of 7-10 and 11-12, suddenly, but only in the older group, kids ate less breakfast in the prebiotic arm, while in the younger group, they ate more.
  • The hunger hormone ghrelin was found to be significantly elevated in those taking the prebiotic (an increase of 28%) from baseline, whereas placebo was not demonstrably different from baseline (an increase of 8%).
  • There was no difference reported in subjective post-breakfast buffet hunger in either group
  • There was no difference reported in subjective eating behavior questionnaires between groups, but parents reported improvements in fullness, but equally in both prebiotic and placebo groups.
  • The primary outcome of change in baseline fat mass was not mentioned anywhere in the study.
The authors' conclusions about a prebiotic supplement that was shown to markedly increase hunger hormone levels, that didn't decrease 3 day food diary energy intake, that didn't change all-you-can-eat breakfast buffet energy intake (unless you arbitrarily after the fact divided up the kids into those aged 7-10 and 11-12), and where the study's registered primary outcome wasn't mentioned in the study itself sure look differently than what you might expect, with their concluding sentence being,
"This simple dietary change has the potential to help with appetite regulation in children with obesity"
I also found it surprising that the study was free to read, and given the incredibly unexciting findings, it's more difficult to imagine the authors paying for its open access. Easier to imagine the company that makes the prebiotic that a randomized controlled trial published in an impactful journal explicitly concluded, "has the potential to help with appetite regulation in children with obesity" (even though it didn't), paying the extra fees as open access articles generally gather more citations.

As to what Beneo, the manufacturer of the prebiotic used in this study had to say, I found these quotes in an article published on the trade-zine Nutraingredients at the time of the study's publication,
"Beneo regards this research of highest importance",
and despite the study not even remotely coming to this conclusion also added,
"The intake of 8g of prebiotic inulin (Orafti Synergy 1) in a glass of water prior to dinner is a simple dietary intervention that supports children in their weight management efforts. The results show that they were naturally eating less (YF: no they didn't) than the control group having maltodextrin"
Beneo also put out an excited press release to publicize the study.

And you can bet your bottom dollar, it's studies and conclusions like this one that supplement companies use to suggest great benefits to their products, and it's also studies like this one where I wish the journal employed open peer review as I can't fathom how this one got through as is.

Lastly, while the authors didn't report any conflicts of interest with this particular study, the supplements and placebos were provided by Beneo, and it was noted that one of the authors had previously enjoyed funding from Beneo. Unfortunately there is no mention as to who paid for this study's open access.

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Thursday, August 09, 2018

Book Review: The Complete Guide to Weight Loss Surgery

Today's guest post comes from our office's newest RD Alex Friel who has reviewed a book for people considering or having bariatric surgery (full disclosure, was provided with a feee copy of the book by the authors)
Thinking about weight loss surgery? You’re not alone. Bariatric surgery has been shown to be one of the most effective treatments for obesity and the number of people who undergo the procedure is steadily rising every year. Here at BMI, I work with many different clients. Some are considering bariatric surgery, others are actively preparing for it, and still more have undergone the procedure and are adjusting to life with a new anatomy. At every stage of the weight loss journey, it helps to be well informed.

Last week I was introduced to a new book written by registered dietitians Lisa Kaouk and Monica Bashaw. It’s a worthwhile read so I thought I’d share it with you. ‘The Complete Guide to Bariatric Surgery’ draws from their experiences as Weight Loss Surgery (WLS) dietitians and the many patients they have counseled over the years. Here’s what I liked:
  • It’s from a trusted source. The registered dietitian (RD) credential means that Lisa and Monica are trained in the science and physiology of human nutrition. Their training and practice is regulated in much same way as that of our doctors and nurses so you can rest assured that the recommendations they make are tried, true, and grounded in evidence.
  • Written in a conversational style, the book is an easy and entertaining read (or at least as entertaining as a book about a surgical procedure can probably be). There’s no jargon and you won’t need a degree in medicine or nutrition to make sense of the topics covered.
  • Because the topics are drawn from the real life concerns and questions of more than 5000 patients, the book provides an honest glimpse into the realities of life after WLS. It’s a useful reference, not only for those who are considering WLS and those who have had it, but also for the friends and family who are their cheerleaders and support system.
  • If you’ve ever anxiously wondered if your experience is normal, this book can provide some fast reassurance. The table of contents allows you to quickly skim questions at a glance and is organized into topic sections that range from ‘Tolerance Issues’ to ‘Hair Loss’ to ‘Emotional Changes and Support.’
  • Much like this post, it’s short, sweet, and to the point. You won’t need to set aside hours of time to get through it.
My only critique is that the authors don't provide much information on additional resources, support groups, or further reading. It’s good to be aware of what’s available. Obesity Canada, for example, functions as a resource hub for professionals and lay people alike. In addition to educational webinars and videos, they also link to tools you can use to access greater health benefits for obesity care. The Bariatric Cookery, run by food writer Carol Bowen Ball, hosts a wonderful collection recipes to try at every stage of the WLS journey. As a former WLS patient herself, Carol’s first-hand experience lends the site a level of authenticity that is hard to top. Finally, a quick search on Google or Facebook will undoubtedly reveal a whole host of virtual WLS forums and support groups. Find one that resonates with you.

The Complete Guide to Bariatric Surgery is available for purchase on Amazon. It’s also available as an e-book at www.baritricsurgerynutrition.com.

Alex Friel, MSc, RD is a nutrition science nerd and one of the newest dietitians to join the BMI team. She’s convinced that everyone has a passion for food (even if they don’t know it yet) and is always on the lookout for her next favorite recipe. Alex spent six years living in Atlanta, Georgia where she completed a BSc and MSc in Nutrition Science at Georgia State University. Much to the chagrin of her dinner guests, she also gained an appreciation for collard greens and okra that persists to this day.

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Tuesday, August 07, 2018

Have You Been, Or Are You, On A Diet? Please Take 2 Minutes To Review This Brief Survey About How Easy Or Difficult It Is/Was.

Back in 2012 I first posted my wish for there to be a questionnaire that would serve to help individuals and researchers determine how easy or difficult a particular diet would be to follow.

I called it the Diet Index Enjoyability Total or DIET score, and my hope was that by using a series of simple Likert scales (descriptive scales from 1-10), researchers could set out to evaluate a particular weight loss approach's DIET score where high scores would identify diets that could actually be enjoyed, and where low scores would identify under-eating, highly restrictive, quality of life degrading, dieting misery. This would be useful both to individuals who could use the DIET score to evaluate whatever approach they were considering, but might also serve as a surrogate for shorter term diet studies to give a sense as to whether or not there's a low or high likelihood of long term adherence to a particular study's strategy.

I'm happy to report that the first work on using the DIET score has been conducted by Michelle Jospe at the University of Otago in New Zealand as part of the SWIFT trial, and her and Jill Haszard's early look at the data is promising.

Part of the process required to validate a questionnaire involves a qualitative review to see whether or not it's easy to use, comprehensive, and unbiased.

UPDATE: .....we did it! Thanks to everyone who already clicked! We've collected a sufficient number of responses. Do stay tuned though, because in the next rounds of data collection we'll be looking to explore DIET scores from those who are both doing wonderfully on specific diets, as well as collecting information about those diets people couldn't sustain and we'll need every response we can get!

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Saturday, August 04, 2018

Saturday Stories: 2 on Corbyn's Anti-Semitism, 2 on Ecological Disasters, And 1 on Weight Bias

Helen Lewis, in New Statesman, on Jeremy Corbyn and anti-Semitism

Jamie Rogers in The Spectator, on how Britain's Labour Party is no place for a Jew

Ian Graber-Stiehl, in Gizmodo, on the ecological disasters that are our front lawns

Nathaniel Rich, in The New York Times, on the ecological disaster that is our planet

And if you don't follow me on Twitter or Facebook, this week I helped with CBC's The Current's story on weight bias in healthcare (listen button is just below the photo)

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Thursday, August 02, 2018

Apparently Some Parents Are Hiring Fortnite (A Video Game) Coaches For Their Kids. Wish They'd Hire Them Cooking, Budgeting, And Critical Appraisal Coaches Instead

Now I can't imagine it's a commonplace practice, but yesterday the Wall Street Journal published a piece about parents hiring coaches to help their children gain skills and level up in Fortnite, a first person shooter video game.

The mind boggles.

Dare to dream of an alternate universe, where instead of hiring their children video game tutors, parents hired coaches to help teach their kids life skills like cooking, making and keeping a budget, or critical appraisal. Or better yet dream of parents going out of their way to do so themselves, and of a school system that weaves those sorts of actual life skills throughout their curricula from K-12.

We can dare to dream, can't we?

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Monday, July 30, 2018

No Parents, Your Children Aren't "Stealing Food" (And Some Thoughts On How To Silently Cultivate Better Choices)

It's a concern I hear not infrequently when meeting with parents of children with obesity - that their son or daughter is "stealing" food.

I have no doubt too, that in some cases, those kids received some perhaps well-intentioned, but I think very misplaced, ire about it.

The stories are all pretty similar, and often occur on weekends or after school whereby parents come home and find evidence that their child has raided the fridge, cupboard, or freezer by way of wrappers, cans, dirty dishes, or a much emptier than before container.

As to what's happening, some thoughts.

First off, we all did it. I remember "stealing" Voortman Strawberry-Turnovers pretty much every Saturday morning while my parents were sleeping and I was watching cartoons. Some mornings I'd put away 6 of them.

And why did I do it?

Because they're were delicious, and I was hungry, and I was a kid, and they were there, and because I could.

Secondly, we all still do it. Who doesn't grab a handful of this, or a package of that, multiple times a week or even daily?

Plainly put, grabbing yummy, readily available, oftentimes calorie dense and unhealthy foods is part of the human condition.

And though I appreciate that parents who may be concerned about their children's weights and/or eating patterns find this behaviour alarming, believing there to be something wrong with their children, or that their children lack "willpower", is unwise and unfair.

If you're worried about your children's (or your own) grazing habits, here are a few things for you to consider.
  • Take an inventory of the "stolen" foods in your home. Are they cookies, candy granola bars, drinkable ice-creams yogurts,  soda, flat-soda juice, etc.? If so, could you buy them less frequently? And eventually not at all?
  • Are your children's other meals and snacks designed to be filling? Are they large enough? Do they include protein? Are they eating them or do they skip meals? Ensuring you're providing your children with filling, regular meals and snacks may lead them to come home less driven to raid the cupboards. And if they're skipping meals and snacks, are they doing so consequent to your own example?
  • Are your children worried they'll simply never get anything "good"? If your home is highly restrictive around treats, and your children don't know when they'll next be offered one, grabbing one when you're not there is not a surprising outcome. To combat snack and treat based food insecurity, plan them into your child's week and ensure they're made aware that they'll be getting them - and this too may provide you with a great opportunity to work on weekly treat-inclusive menu planning with your family which in turn is an important life skill.
  • Make the stuff you want them to eat more of more readily accessible and inviting. Wash all fruits and vegetables when you get home from the grocery store and leave them in visible, easy to reach, inviting bowls while relocated the stuff you'd prefer they eat less of to cupboards and drawers that require more effort to see. And note, I'm not recommending hiding anything or locking it away, just ensuring that the easiest things to see and eat and the foods you'd prefer that they grab.
So, if your kids are grabbing stuff, instead of approaching them with anger or overt concern, instead try to approach them with genuine curiosity to find out what's going on, and then turn back to that list up above. If they just really like those things they're grabbing, then planning them into the menu may help. If they report they're starving, exploring their daytime eating patterns and choices to look for ways to ensure they get enough to eat so as to not arrive home famished. If they report there wasn't anything good to grab, brainstorm other options and make sure they're readily available and visible.

And lastly don't forget who we're talking about. If the expectation of regularly making healthy choices just because they're healthy isn't a fair expectation for all of us fully grown adults (and it's not), why would it be fair to expect that of your children?

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Saturday, July 28, 2018

Saturday Stories: Gwyneth Paltrow, Ellen Maud Bennett, and Pauline Mara

Taffy Brodesser-Akner, in the New York Times Magazine, with the best writing of any story I've read this year, on Gwyneth and her GOOP - a rare must read recommendation.

Ellen Maud Bennett's obituary, in the Times Columnist, where her experiences with fat shaming and dismissive physicians are recounted, and where her final wish encourages everyone with obesity not to let medical professionals get away with blaming everything on weight without exploring other possibilities.

Steven Isserlis, in the Telegraph, recounts his wife, Pauline Mara's, alternative cancer treatment.

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Monday, July 23, 2018

The Obesity Society Weighs In On Soda Taxes To......Double Checks Notes......Caution Against Them

The Obesity Society (TOS), who in their own words are,
"the leading scientific membership organization advancing the science-based understanding of the causes, consequences, prevention and treatment of obesity in order to improve the lives of those affected."
has finally weighed in on soda taxes.

In their formal press release, The Obesity Society Calls for More Research on Sugar-Sweetened Beverage Tax (and reminder, it costs money to issue press releases), TOS called into question the benefits of soda taxes stating,
"Countries across the globe have generated headlines recently over their efforts to tax sugar, tobacco and alcohol products. Even though tobacco and alcohol taxation has helped to reduce consumption and save lives, these beneficial effects have not yet been proven for taxing sugar-sweetened beverages (SSBs)."
They go on to quote TOS President-elect Steven Heymsfield as stating that they may not help with obesity,
"Although taxing SSBs might generate revenue that can be used to promote other healthy food items, the net outcome may not necessarily decrease overweight and obesity rates in the United States or worldwide"
And finally they suggest that soda taxes may confer health risks, with a quote from TOS' Vice-president Lee Kaplan,
"I believe that we have a primary responsibility to carefully dissect what we know about the effects of taxing SSBs on obesity from its other potential health benefits and risks, and to promote additional research where necessary to clarify areas of debate and identify new opportunities for progress.
It's a bizarre press release.

It is either ignorant, or purposefully disingenuous, of Heymsfield and TOS to frame soda taxes as if they hinge on obesity and put forward the straw man that a singular intervention is unlikely to have a remarkable impact on global weights. Complex problems tend not to have simple, singular solutions - it's the, "but that single sandbag won't stop the flood" argument, and truly, it's breathtakingly dense, especially in that reducing the excessive consumption of sugar-sweetened beverages is desirable for people at any weight and is the explicit aim of the tax with a secondary aim of raising funds to support other public health initiatives.

Regarding potential health risks of soda taxes and the need for more research before considering, the data is quite clear (which is why the soda industry is fighting so vigorously against them), sugar-sweetened beverage taxes decrease sugar-sweetened beverage consumption and increase healthier beverage consumption while providing the greatest potential health benefits to low income consumers.

It's also worth noting that TOS' suggestion that we need to wait for more data before acting runs counter to the recommendations of:
  • The World Health Organization
  • The American Heart Association
  • The American Medical Association
  • The Canadian Medical Association
  • The Australian Medical Association
  • The American Cancer Society
  • The American Public Health Association
  • The Cancer Action Network
  • The National Association of Chronic Disease Directors
  • The National Association of County and City Health Officials
  • The National Association of Local Boards of Health
  • The Heart and Stroke Foundation
  • Diabetes Canada
and many, many, more.

How TOS and its executives serving the soda industry as merchants of doubts versus a truly global initiative to reduce the consumption of sugar sweetened beverages helps push TOS' mission,
"to promote innovative research, effective and accessible care, and public health initiatives that will reduce the personal and societal burden of obesity"
is lost on me.

As to why TOS is taking a stance so directly in line of the one being pushed hard by the sugar-sweetened beverage industry itself is anybody's guess, though it's worth pointing out that TOS has had a very close relationship with the food industry, including Coca-Cola who used to fund their travel grants, and PepsiCo and Dr. Pepper to who TOS' food industry outreach committee reached out directly following its inception (leading me to publicly resign my membership in TOS) at roughly the same time they released their new "Guidelines for Accepting Funds from External Sources" position paper (removed from TOS' website but still available here) refuses to allow even the consideration of funding as a source of bias and,
"expressly eliminates all forms of evaluation or judgment of the funding source"
Suffice to say, I have yet to regret my decision to resign my membership in The Obesity Society, and I can't help but wonder whether this press release and stance will be the last straw for others.

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Saturday, July 21, 2018

Saturday Stories: #ShareAStoryInOneTweet, Hospital Food, And Dangerous Bullshit

Lisa Rosenbaum, in NEJM, covers the viral medical hashtag #ShareAStoryInOneTweet (and cites my tweet in it as well).

Kate Washington, in Eater, on why hospital food is so awful.

Jen Gunter, in her blog, on dangerous bullshit, and why you should never consider GOOP, or Dr Mark Hyman, to be a credible voice

[And if you don't follow me on Twitter or Facebook, had a great time chatting with the lovely ladies from The Social about multiple ways you might foster a healthier path in under 5 minutes (and sorry Americans, I believe it's geoblocked so if you want to watch, you'll need to use a Canadian VPN server)]

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Thursday, July 19, 2018

From The Journal Of Well-Intentioned Facepalms: St. Catherines' City Council Bans Vending of Bottled Water, Keeps Bottled Soda

So St. Catherine's City Council, presumably in a bid to be environmentally conscious, has banned the sale of bottled water in city facilities.

So St. Catherine's City Council, presumably in a bid to be environmentally conscious, has banned the sale of bottled water in city facilities.

As to what will replace the bottled water, and what will still be on sale?

Bottled actual soda, bottled diet-soda, bottled flat vitamin fortified soda (juice), and bottled sugar sweetened water (sport drinks and flavoured waters).

So no decrease in plastic bottle sales, and all at the expense of the healthiest beverage they'd previously been selling.

And this isn't a one-off apparently. According to the article written about St. Catherines' decision, similar water bottle bans exist in Niagara Falls, London, Burlington and Toronto.

Reminds me of a guest post here from a few years ago that spoke to the short-sighted war on bottled water which somehow manages to forget, sugar water also comes in bottles, and it's a lot worse for your health.

[Thanks to Mandy Robb Kasper for sending my way]

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Monday, July 16, 2018

Does When You Eat Affect Your Circadian Rhythm, Metabolism, Appetite, Physical Activity, And More? A "Big Breakfast" Study Aims To Explore.

By Amin - Own work, CC BY-SA 4.0, Link
The fight over "breakfast" among diet gurus and social media warriors is so tiresome.

Firstly it's tiresome because "breakfast" means different things to different people, and yet conclusions about the utility of the meal as a whole are regularly made despite the fact that a bowl of Froot Loops is likely to have a very different impact on fullness than a couple of eggs and a piece of toast.

Secondly it's tiresome because what works for one person, may well not work for another, and no doubt when it comes to weight and dietary control, for some, breakfast will be crucial, while for others, it'll be inconsequential, and others still, potentially problematic.

In my clinical experience, though clearly coloured by my own confirmation biases, a protein rich breakfast with minimal liquid calories benefits more people than not, and whether that applies to you is easily tested on your own.

With all that out of the way, I wanted to talk a bit about an upcoming study coming out of the UK. The Big Breakfast Study: Chrono‐nutrition influence on energy expenditure and bodyweight aims to explore the impact of breakfast by way of a randomized controlled trial comparing morning-loaded vs. evening-loaded weight loss diets on people with excess weight, and where all components of energy intake and energy expenditure will be monitored throughout.

That researchers' hypothesis is that breakfast will make a positive difference, and their thinking is that part of the reason why may be the effect of breakfast on circadian rhythm, which in turn effects changes to metabolism, hormonal and metabolite regulation, appetite, ingestive behaviour, and physical activity.


The researchers second study, the Mealtime Study, which over 10 weeks, will compare front loaded morning calorie dieting with bottom loaded end of day calorie dieting in a crossover design where all food will be provided to participants.

And finally their third study will be looking at 5 hour "phase shifts", analogous perhaps to what shift workers regularly experience (and who have been shown to have higher rates of obesity), and the shifts' impact on "the patterns of energy expenditure, metabolism and gastric empty-ing and related endocrine pathways"

Very much looking forward to these studies' results, but that said, I won't be holding out hope that their findings will stop people from extrapolating their personal breakfast biases as applicable, without exception, to everyone, when the fact remains, different strokes will work for different folks.

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Saturday, July 14, 2018

Saturday Stories: Personal Biohacking, A Justifiably Cranky Oncologist, and Aztec Human Sacrifice

1587 AZTEC MANUSCRIPT, THE CODEX TOVAR/WIKIMEDIA COMMONS
Jacqueline Detwiler, in Popular Mechanics, with her personal biohacking journey.

Richard Harris, in NPR, covers the world's crankiest tweeting oncologist Vinay Prasad (disclosure, I'm a fan)

Lizzie Wade, in Science, on the massive scale of Aztec human sacrifice.

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Wednesday, July 11, 2018

New Intermittent Fasting Study: No Magic Weight Loss Benefits. Hungry Making.

If you even remotely follow dieting zeitgeist, there's no doubt you've come across intermittent fasting.

Briefly, intermittent fasting involves, yes, intermittently fasting. Sometimes for 8 hours a day. Sometimes for 24 hours. Sometimes even more.

And if you're wondering if it's for you, the simple answer is, if you find it helps you to control calories and weight, and you enjoy it enough to keep doing it, then go for it.

But putting aside the needing to enjoy living with it part for a moment, and assuming everyone could happily follow this strategy forever, would intermittent fasting lead to a greater weight loss than plain old old-fashioned dieting?

That was the question researchers in Norway recently took on, and their paper, Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial, has some answers.

The style of intermittent fasting they chose to study was the 5:2 style, whereby 5 days a week you eat normally, and then 2 days a week you eat no more than 400 calories if you're a woman, or 600 calories if you're a man. They compared a year worth of this approach to a year worth of reducing total daily calories by the same theoretical amount as the 5:2 fasting would provide but spread out evenly over 7 days rather than the 2. In all, 112 middle aged people with obesity were randomly assigned to one of the two treatments and then followed for a year - the first 6 months being a weight loss effort, and the next 6 months weight maintenance. All participants received individualized counselling, were trained in cognitive behavioural methods to help with adherence, and encouraged to follow, whether fasting or not, a Mediterranean style diet. The outcomes studied were weight loss, waist circumference, blood pressure. lipids (including ApoB), glucose, HbA1C, CRP, and RMR.

Participants were also asked to rate their degrees of hunger, well-being, and overeating quarterly.

Follow up was terrific, with only 4 lost in the intermittent fasting group, and 3 in the continuous.

Outcomes wise, at a year, weight loss (and the spread of weight loss with identical percentages of participants achieving 5-10% and >10% weight loss) and weight circumference were the same. There was also no difference to the various measured metabolic parameters.

In fact pretty much the only between group difference was hunger, whereby the intermittent fasters, when rating, "I have often felt hungry while on the diet", reported significantly more hunger (p=0.002).

Which brings me back to my wholly unsurprising tl:dr summary: Intermittent fasting provides no magical weight loss benefits, and is hungry making, but if you enjoy it, it'll probably work just as well, but not better, than anything else.

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Monday, July 09, 2018

Registered Dietitian Christine McPhail Reviews The Picky Eater Project: 6 weeks to Happier, Healthier, Family Mealtimes

Today's guest post, a review of The Picky Eater Project 6 weeks to Happier, Healthier, Family Mealtimes, was written by Christine McPhail MSc RD. Full disclosure: I was given a review copy of the book by Dr. Muth.
I work with parents, and picky eating is a common issue. Fortunately, there are some general recommendations that I can review such as following the division of responsibility in feeding, where parents are responsible for the what, when and where of feeding and children are responsible for whether they eat and how much they eat out of what parents offer. Within this, I ask parents to focus on neutrality when offering different foods, bridging from foods their family already enjoys, involving children in grocery shopping, growing food and cooking for buy-in and avoiding pressure in general to eat more or less of certain foods.

The most important part of addressing picky eating with my clients is working on practical steps collaboratively with them. That’s where I have found the resources within The Picky Eater Project: 6 weeks to Happier, Healthier, Family Mealtimes by Natalie Digate Muth MD, MPH, RDN, FAAP and Sally Sampson from CHOPCHOP MAGAZINE to be very insightful and useful.

Here is what I liked about this book:
  • It is a project. The book is very interactive and includes goal setting, action planning strategies, and ways to measure your progress at each stage of the project. Each section also uses to do/check lists.
  • Picky eating is defined and explained and the book follows examples from real life families as they progress through the project. This shows families that it’s OK to stumble when they are trying to make changes and it allows them to see the recommendations translated into realistic outcomes.
  • The concept of picky-free parenting allows parents to review their current behaviours around food to see if there is anything they could change in their behaviour that may be influencing their child’s picky eating behaviours. This also aligns well with learning about the Division of Responsibility in Feeding.
  • There is a focus on changing your home food environment with sample pantry lists, snack lists, a how to use herbs and spices resource, recipes etc. which can be a useful tool for parents especially when they are tried and tested!
  • Involving kids in the kitchen has its own section with a focus on age-appropriate kitchen tasks, tips for beginner chefs, meal ideas and recipes. This is so important for families to review and understand as we know that kids who participate in meal preparation are more likely to WANT to try new foods.
  • Similarly, there is a section on involving kids in grocery shopping, growing foods, and visiting local farms with a focus on learning about food but also math and literacy skills too. It’s all buy-in and family involvement.
  • Family meals are a primary focus of the picky eating project with tips on how to make them a priority, meal planning, meal time rules, and even packed lunch mix and match ideas.
  • The project does not leave out all of the other factors and people that can either support or hinder your efforts to have your family eat a wider variety of foods. Those important people include peers, school staff, caregivers, grandparents etc. As the section is appropriately titled…it takes a village!
  • To finish up the project, there is a section that addresses that behaviour change is hard! I think this is important for parents to understand but it’s equally important to for them to have tips on how to make changes stick. The focus is on starting small, using SMART goals, having a plan, anticipating problems, and involving your kids the whole way!
  • The last section of the book discusses severe picky eating and when to seek more professional help. I was impressed with this because it identifies red flags for parents to watch out for so they know when they may need to incorporate health professionals into their journey.
The only issue I had about the picky eating project was the risk associated with labelling your child as picky i.e. they live up to the expectation. On the other hand, with the family-focussed nature of the book the journey is not simply for the “picky” child, it’s for the whole family to expand their palette in an open and honest way that includes all family members.

Christine McPhail MSc, RD is one of our Registered Dietitians at the Bariatric Medical Institute (though is moving on soon to work with the eating disorders team at Hopewell). Christine has worked in academic, clinical and public health nutrition settings and has been fortunate to have worked on projects relating to food sustainability, food security, food policy and politics, childhood nutrition, body image, and school nutrition programs. She believes in the power of connecting with your food from farm to table. She feels fortunate to share this passion with her clients, as she helps them strengthen their relationship with food and learn more about nutrition.

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Thursday, July 05, 2018

Guest Post Highlighting How The Fat Acceptance Movement Isn't Always All That Accepting

Source: Obesity Canada Image Bank
Today's guest post is from my good friend and colleague Dr. Ximena Ramos-Salas, and she penned it at my request after I saw her being attacked on social media by fat acceptance advocates. Why? Certainly not because she doesn't support fat acceptance, but rather because she also believes that if a person with obesity wants medical help to try to reduce weight that for them may be having a detrimental impact on their health or their quality of life, they should have access to it. And herein she writes about a strange dichotomy, whereby it would seem that for at least some of the more vocal members of the fat acceptance community, one cannot be simultaneously supportive of fat acceptance, and also of the promotion of the treatment of obesity. Ximena (and I) would disagree
The Dichotomy of Obesity and Fat Acceptance Narratives

The field of weight bias is diverse, and there are scholars working in medical, social, and political sciences and across disciplines such as psychology, obesity, eating disorders, health care, and policy (1).  Although, we might expect a common goal (i.e. eliminate weight bias and stigma) between these fields of research, their narratives can be quite dichotomized.

While working on my doctoral dissertation I had the opportunity to learn from many of these research areas and disciplines. In my opinion, these areas and disciplines are not mutually exclusive and there is room for constructive collaborations.  In a recent commentary, my colleagues and I deconstructed these dichotomized narratives to help us understand the tensions between them (2).  We argue, that while we should always remain critical of our own academic and personal perspectives, practices, and beliefs, a basic tenet of scholarship is to be able to have a respectful dialogue with other scholars.

Unfortunately, based on my recent experiences working between these narratives, I have decided that I am no longer willing to engage in what I consider disrespectful personal attacks.

It all started when I participated in a panel discussion regarding the use of person-first-language (to which I was invited by the organizers to advocate for). The panel discussion quickly escalated into a broadside against the medical establishment labeling obesity as a chronic disease. Rather than debating the pros and cons of people-first language, the panelists launched head on into ad hominem attacks on obesity scholars, questioning both our morality and ethics.

While I argued that using person-first-language was a widely accepted approach in the chronic disease world to accommodate and support individuals in the health system, fat-acceptance advocates argued that calling obesity a chronic disease is a major social injustice because it implies that all fat people are ill and need to lose weight.  This, in their minds, actually increased weight bias and stigma.

Never mind that in my view (and that of an increasing number of obesity experts) obesity needs to be diagnosed and treated as a chronic disease only when weight affects a person’s health.

Never mind that as a life-long feminist, I am a strong believer in promoting body diversity and inclusivity.

Never mind that my own engagement and research is entirely dedicated to fighting weight bias and discrimination in health, education, and policy setting (3, 4, 5, 6, 7).

None of this seemed relevant – there was simply no room for respectful discussion or thoughtful exchange of perspectives.

To be fair, I fully understand and support the notion that people who identify as fat deserve to be treated with respect and should not be pressured into seeking medical help that they don’t want or need. On the other hand, I also fully understand and support people with obesity, who have made the personal decision to reach out for help and strongly feel that they should have access to adequate and respectful health care, including access to evidence-based obesity treatments.

Last year, I watched the same type of attacks on Obesity Canada’s (formerly known as Canadian Obesity Network) Facebook page. In response to a post about bariatric surgery, I witnessed how very quickly, a discussion of the pros- and cons- about bariatric surgery turned into a moral and dogmatic shouting match.  While individuals, who had chosen to undergo bariatric surgery asked to be respected for their decision, the fat acceptance proponents accused them of having internalized weight bias and, by supporting bariatric surgery, being guilty of supporting “eugenics” against fat individuals. Once again, the argument was made the framing obesity as a chronic disease increases weight bias.

However, findings from a recent Canadian study indicate that understanding obesity as a chronic disease has a positive impact on emotions which can in turn reduce negative attitudes against people with obesity.  Hence, framing obesity as a chronic disease and using person-first-language may be a way to reduce weight bias.

Despite growing evidence that framing obesity as a chronic disease may reduce weight bias, personal attacks towards my research on obesity has continued. In response to an article about my research on the University of Alberta’s School of Public Health website, I was once again personally attacked. This time, the attacks related to me being a thin person doing fat research. Apparently, as a thin person I “cannot be trusted to do work on fatness or fat people”.  Once again, I was accused of trying to eliminate fat people and contributing to medical eugenics.

Whether or not the modest overlap between the narratives allows for finding a common ground that can lead to a constructive discussion remains to be seen.  But the way forward cannot lie in resorting to disrespectful personal attacks and questioning the opponents’ intentions and morality.  Clearly, we all want the same thing, which is for all people to be treated with dignity and respect, regardless of their size or weight.

1. Nutter S, Russell-Mayhew S, Arthur N, Ellard JH. Weight Bias as a Social Justice Issue: A Call for Dialogue. Canadian Psychology. 2018;59(1):89-99.
2. Ramos Salas XF, M.; Caulfield, T.; Sharma, A.M.; Raine, K. Authors' response to Invited Commentary by Brady and Beausoleil. CanJPublic Health. 2017;108(5-6):e646-e647.
3. Ramos Salas X. The ineffectiveness and unintended consequences of the public health war on obesity. Canadian Journal of Public Health. 2015(1):79.
4. Ramos Salas X, Fohan, M., Caulfield, T., Sharma, A.M., Raine, K. A critical analysis of obesity prevention policies and strategies. Canadian Journal of Public Health. 2017;108(5-6):e598-e608.
5. Ramos Salas X, Forhan M, Sharma AM. Diffusing obesity myths. Clinical Obesity. 2014(3):189.
6. Forhan M, Ramos Salas X. Inequities in Healthcare: A Review of Bias and Discrimination in Obesity Treatment. Canadian Journal of Diabetes. 2013;37(3):205-209.
7. Puhl RM, Latner JD, O'Brien KS, Luedicke J, Danielsdottir S, Ramos Salas X. Potential Policies and Laws to Prohibit Weight Discrimination: Public Views from 4 Countries. Milbank Quarterly. 2015;93(4):731 741p.

Ximena Ramos Salas has a PhD in Health Promotion and Sociobehavioural Sciences from the School of Public Health at the University of Alberta. She is Managing Director of Obesity Canada (formerly the Canadian Obesity Network), and technical consultant with the World Health Organization Regional Office for Europe. As a population health researcher, she is exploring the unintended consequences of obesity prevention policies for people with obesity. Her research goal is to spark solutions that will prevent the perpetuation of weight bias and obesity stigma and create more effective population health approaches.

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Tuesday, July 03, 2018

Guest Post: What Happens to Weight Bias when Obesity is Named a Disease?

Source: Obesity Canada's Image Bank
Today's guest post is a group one coming from Sarah Nutter and Shelly Russell-Mayhew from the University of Calgary Werklund School of Education, and Cara C. MacInnis from the University of Calgary, Department of Psychology. It's a post detailing their recent study on the impact labeling obesity as a chronic disease has on weight bias.
In the years leading up the declaration of obesity as a chronic disease, much debate surrounded the possible impact that the label of ‘disease’ would have on weight bias in the general public. Opinions at the time were strongly divided, and remain so today. Our research team (also comprised of JH Ellard from the University of Calgary and Dr. AS Alberga from Concordia University) found one research study investigating the impact of labeling obesity a disease on weight bias, conducted by Hoyt and colleagues. We set out to extend this research by examining a number of different factors that we felt important when considering the impact that declaring obesity a disease would have on weight bias attitudes.

Most notably, we examined the impact that the declaration of obesity as a disease had on emotions towards people living with obesity. In addition, we were curious about how the degree to which people believe that the world is a place where people get what they deserve (i.e., good things happen to good people; bad things happen to bad people) might affect weight bias when obesity was declared a disease. Finally, we wondered how participants’ satisfaction with their own body weight might influence how this labeling was perceived in terms of weight bias scores.

Residents of either Canada or the U.S. (n=309) read one of three articles. The first two articles were identical in content, providing factual information about obesity; The only difference between these two articles was the description of obesity as a disease versus not a disease. The third article was unrelated to obesity.

Respondents that read the article stating that obesity is a disease had more positive emotions towards individuals with obesity compared to respondents who read either of the other two articles. This increase in positive emotion then contributed to less negative attitudes (weight bias) towards people with obesity. We also found that, for respondents who strongly believed that the world is a place where people get what they deserve, reading the obesity is a disease article (vs. the others) was related to less blame towards individuals with obesity, which in turn predicted less weight bias. Finally, among respondents who were the most satisfied with their body weight, reading the obesity is a disease article (vs. the others) was also associated with lower blame towards individuals with obesity.

Our finding that reading about obesity as a disease had an impact on the emotions of our respondents is particularly noteworthy.

In research related to other stigmatized conditions, the promotion of a genetic explanation for a condition has been associated with more negative reactions. The findings from this study suggest that understanding obesity as a disease has a positive impact on emotions, which then has a positive impact on overall attitudes towards people living with obesity. Findings from this study also support the idea that reducing blame might be an avenue to reduce weight bias attitudes. This provides interesting directions for future research, which could examine other factors that increase positive emotions or reduce blame towards people with obesity. Labelling obesity a disease seems to be related to less weight bias for individuals who hold strong beliefs about people getting what they deserve and who are satisfied with their own body weight at least in terms of reducing blame. Future research should aim to understand why this seems to be the case.

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Saturday, June 30, 2018

Saturday Stories: @SelfMagazine's Fantastic Weight Issue

With a break from the norm here, I wanted to share with you Self Magazine's incredible weight issue (warning, if you do read them all, you'll find a couple of quotes from me here and there)

Carolyn Kylstra with an introductory Letter From The Editor

Ashley C. Ford with Tess Holiday's Health Is None Of Your Business

Carolyn Kylstra with How Should a Health Brand Talk About Weight?

Lindy West with The Way We Talk About Bodies Has Changed. What We Do About It Comes Next.

Jes Baker with Nope, I’m Not Trying to Lose Weight

Sonya Renee Taylor with The House Next Door

Leah Lakshmi Piepzna-Samarasinha with I Help Manage My Chronic Illness With My Diet, but Don't You Dare Call It 'Clean Eating'

Your Fat Friend with Weight Stigma Kept Me Out Of Doctors’ Offices for Almost a Decade

Elisabeth Poorman MD with Why It's Not Productive to Just Tell a Patient 'You Have to Lose Weight' (note from me - this piece had one thing missing for me. In it Dr. Poorman discussed how lifestyle is more important to discuss than weight. Wholly agree. But the implication from the piece is that lifestyle only need be discussed with patients with obesity who inquire about weight loss. I think lifestyle is something that should be discussed with every single patient regardless of their weights.)

Nora Whelan with her photo-essay Everyday Athletes Talk About What Strength Means to Them

Sarah Jacoby with The Science on Weight and Health

Kevin Klatt wth Why Weight Loss Diets Fail

Melissa A. Fabello with Skinny Shaming Is Not the Same as Fat Phobia

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Wednesday, June 27, 2018

Why Have School Food Policies If They're Not Followed Or Enforced?

A recent photograph from a school cafeteria that's clearly non-compliant with school food policy
It's a simple question.

Why bother with school food policy making if schools aren't going to follow and/or enforce them?

(And please don't read this as me stating that the policies themselves are solid to begin with - that's a whole other rant).

But they're definitely not enforced.

From the treats and candies handed out to 8 year olds writing standardized tests, to the constant junk food fundraising, to the sodas above - the lists go on, and on.

And I'm not suggesting I've got a solution.

Clearly the resources to go from school to school to check aren't there.

And clearly schools and their administrations care about the kids.

So it's not about a lack of concern, and there's no practical way to police things.

I think the fact that schools are still consistently selling, giving, rewarding, and entertaining children with junk food speaks simply to the fact that over the years those practices have become so entrenched, they're considered normal, and hence, aren't even considered as behaviours worthy of scrutiny.

I'm curious. What's the most ridiculous example from your child's school?

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Monday, June 25, 2018

Where The Hell Is Canada's New Food Guide?

In case you missed the news, New Brunswick recently banned the sale of chocolate milk and juice in their schools.

It's a welcome move, and one that will be undoubtedly be adopted nation wide following the long delayed publication of Canada's next Food Guide.

Canada's Food Guide, last published in 2007, inexplicably and explicitly, reports that chocolate milk is a healthy dairy choice (that it also suggests dairy is such a magical food that it requires it's own Food Guide category is a whole other kettle of inexplicability). Or maybe it isn't that inexplicable in that on the then Food Guide's 12 member advisory committee was Sydney Massey, the Nutrition Education Manager and Spokesperson for the BC Dairy Foundation, where their homepage at the time featured the campaign,
"Don't tell Mom, but Chocolate Milk is good for you"
The next one, won't.

I know this in part because back in 2014, Dr. Hasan Hutchinson, the Director General of Health Canada's Office of Nutrition Policy and Promotion (the office in charge of the Food Guide), agreed with me during our then debate, that chocolate milk shouldn't be deemed a health food by our Food Guide,
"One thing we're doing right now is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"
And in May 2015 he was quoted by the CMAJ on juice stating,
"You won’t be seeing that anymore … and there’ll be a fair number of new materials coming out in the next few months."
I also know this because even McDonald's appreciates that chocolate milk, with more calories and sugar drop per drop than Coca-Cola, shouldn't be routinely offered to children.

So here's my first question.

If, in 2007, Canada's Food Guide had explained that chocolate milk is to milk what apple pie is to apples, and that it should be considered a treat rather than a health food, and that no, juice is not the same as fruit, do you think we'd be seeing these actual responses and comments posted on Facebook and on the CBC article in response to the news out of New Brunswick?
"How the hell can juice be bad for you I doubt orange and apple and cranberry juice is bad for your health CFDA would have ban the stuff decades ago"

"It is crazy and stupid. especially since the school officials are comparing the natural sugars found In the cocoa that makes it chocolate to the artificially added high fructose corn syrup used to sweeten coca cola."

"Ugh get a life people! Chocolate milk is some parents only option to get their kids to drink milk. And as far as juices they sell apple and orange at school so are they now telling us apple and OJ juices are bad??"

"I agree, pop and juice fine. Chocolate milk is filled with nutrients."
Because the thing is, though no one shops with Canada's Food Guide in hand, its recommendations do permeate national consciousness. And more to the point of this post, they inform school food policies. Once the new Food Guide is published, and assuming it explicitly recommends limiting sugar sweetened beverages and juice (and it will), all provinces will undoubtedly soon fall in line with New Brunswick.

And here's the most pertinent question. It's been 4.5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

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Saturday, June 23, 2018

Saturday Stories: False Hope, Dr. Ruth, and Opioids

By Rhododendrites - Own work, CC BY-SA 4.0, Link
Lindsay Gellman, in Longreads, on German alternative cancer treatment clinics catering to foreigners and selling very expensive hope .

George Packer, in the New Yorker, with another reason to adore Dr. Ruth.

Elisabeth Poorman, in Common Health, with her personal take as a physician on the opioid crisis.

[And if you don't follow me on Twitter or Facebook, here's a recent episode of my much neglected Weighty Mutters podcast where I chat with my 11 year old about sports drinks and track and field days]

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Wednesday, June 20, 2018

ParticipACTION Report Cards Remind Us Every Year How Badly We're Failing Canadian Children

(Originally posted in 2016. Since nothing's changed, reupping it with 2018 data)
We suck at helping our kids to be active.

Here are the past 14 years of ParticipACTION kids' activity report card grades (click on 2018 for this year's edition):

2018: D+
2017: Didn't happen
2016: D-
2015: D-
2014: D-
2013: D-
2012: F
2011: F
2010: F
2009: F
2008: F
2007: F
2006: D
2005: D

So what has Canada done about it?

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

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

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

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

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

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

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

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

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Monday, June 18, 2018

Dear @ChronicleHerald, Publishing Industry Talking Points As "Commentary" Does A Disservice To Your Readers

More than one person shared this "Commentary" published last week by The Chronicle Herald entitled,
"Keep Canadian juice on the table for better health"
It was written by Pierre Turner and it asserted that 100% fruit juice is a source of essential nutrients and phytochemicals and that by extension juice is
"essential in helping to treat or reverse some of our leading causes of death, including heart disease, type 2 diabetes and hypertension."
The commentary goes on to talk about how juice helps combat food insecurity, that it's nutritionally equivalent to fruit, and that the food guide is going to explicitly encourage people to consume moderate amounts of ice-cream and bacon, but to avoid juice, and that these recommendations in turn will worsen Canada's rates of diabetes, obesity, and heart disease.

Now as ridiculous as the piece is, it's not particularly surprising given the author is vice-president Quality, Sustainability, Research and Development at Lassonde Industries. It even says so at the end of the piece.

Want to take just one guess as to what Lassonde Industries produces?

So did The Chronicle Herald, who reports in their Vision statement that they're proud of their integrity, get paid for this juice industry advertorial disguised as opinion, and was this just an example of their promise to,
"innovate to remain a relevant and competitive channel for advertisers to reach their consumers."?
Or was this just poor judgement?

Either way, publishing industry talking points as if they're thoughtful commentary does a disservice to readers, who instead should be taught to eat their fruit, not drink it, and also that the World Health Organization, Canada's Heart and Stroke Foundation, the American Academy of Pediatrics, and more all recommend explicitly limiting fruit juice's consumption. Yes, if people followed these recommendations it would be decidedly bad for the juice industry, but why that's a concern of The Chronicle Herald (unless they're being paid), is beyond me.

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Saturday, June 16, 2018

Saturday Stories: Plagues, Emotional Abuse, And Being Black in America

Triumph of Death by Bruegel the Elder
Ed Yong, in The Atlantic, with his sobering thoughts on what will happen when the next big plague hits.

Chloe Dykstra, in Medium, writes about her years of emotional and sexual abuse at the hands of her then partner.

Olga Khazan, in The Atlantic, with her masterful must read story covering why being black in America is hazardous to your health.

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Thursday, June 14, 2018

Guest Post: Celebrated Canadian Chef Fred Morin Reflects Darkly Following His Friend Anthony Bourdain's Death

I've had the pleasure of knowing Fred (co-owner/chef at Montreal's Joe Beef, Liverpool House, Le Vin Papillon, and Mon Lapin) since we met on a panel during the 2012 Trottier Symposium. One of the things I never did, but always wanted to, was ask him to let me know when his friend Anthony Bourdain was coming to town as I, like it seems everyone, found Bourdain's authenticity and manner intoxicatingly cool. I didn't ask because it would have been the opposite of cool to do so, I'd have been comparably, insufferably, boring, and it would have overstepped our friendship, and so too, when I heard the news of Bourdain's death, and my mind immediately turned Fred, and I wondered what his thoughts were and how he was doing, I didn't feel it would be appropriate for me to add to his likely large pile of inquiry. All that said, he contacted me a few days later with some dark reflections, and I think they're very much worth reading, even if they may shine a light on things in a manner that is unsettling. People, and life, are complicated.
Recently as I lost a friend, we all lost a hero. Most struggle to grasp why our culinary knights while basking in praises and porcine dripping can still pay rent on such a dark den within the tenements of their souls. Here is a short tale of how and why based on my livings.

There is an ancient proverb that say’s that war killed many folks but not nearly as much as the table!

The chubby teen didn’t attend prom, for a slew of made up reasons, mostly because he was a chubby teen. He failed at getting shit done although all the while labelled as somewhat a genius, I could extend, explore and extrapolate on the topic and throw his parents and teachers into the crosshairs of his own failure, but he pays a good chunk of cash weekly to decipher what is etched deep in the confines of his “why”.

School, life and jogging were arduous tasks that he fractioned into infinite parts of bearable duration, hoping that soon enough more had passed than remained to come, until it was over for good. Until someone told him that cooking might be what he was chasing since his early days, and whatever academic pursuit that stood in his path should be dropped out of, wise words.

Time spent cooking, the coup de feu, the dinner rush, there was no “prior”, there was no later, all the boxes on the list; checked! The shrieking grind of the dot matrix printer sounded to him like a cheer from his corner-man, 45 veal chops to prep, 45 veal chops to cook, 45 veal chops to re-order, bliss! Nothing left undone, forgotten, no neglected to-do’s . Everything tasted great, when he left, surfaces were clean and reeked appropriately of bleach.

The pudgy teen had fun, but he couldn’t find sleep, 44 chops were great but the 45th was a bit rough, perhaps he who ate it didn’t know real veal from tenderize Tyson shit!? The waiter dropped the wrong knife? Or the supplier sent us shit calf! Anyway, he rehearsed the shit stew he will lay thick onto the innocents. He fell asleep, but printer woke him up, there was no printer.

55 veal chops, 75 veal chops, 90 veal chops; the pudgy teen is a warrior, a hero, his skin now bears the seared branding of his culinary kin. The printer still shrieks at 4 am but he doesn’t hear it because he hopped along with the tribe for some beers, a lot of them.

He missed the shriek of the printer, but the calls he didn’t, he got up, sobered up and went, he picked up his tribe-mates, from the ground they fell on, from jails and from the psych wards.

Now half an hour after the printed used to buzz, he would expects the phone to bling, most of the time it doesn’t, when it doe’s he’s there in an instant to sanitize the grounds and heal the troops after the bloodbaths. Sometimes it rings and it’s just bad news, but he’s not going back to bed; overdoses and murder suicide are no lullabies.

The beers, Jagger bombs and Player lights no longer dampen the bleeps of the 4 am calls, furthermore, it sorts of make you tired. Cocaine is conveniently priced and packaged, it certainly doesn’t mute the rings, but the buzz generated by this circle jerk of tongue chewing dick heads redoing the world with false promises effectively muffles it.

Among the fans of pudgy teen’s veal chop are a few doctors, and pudgy teen, not completely honest, opens up about his anxiety and his inability to sleep. Sure, he omits a few details; the thefts, the betrayals, the powders and the liquids. After all the life of a chef without the inclement add-ons it's harsh enough to legitimize a Xanax script!

Solace! The beer numbs the anger of the night’s mistakes, the vodka catalyses the beer’s effect, but cocaine is there to help you go further, Xanax will soon shield the rising sun, awesome.

Most of his culinary heroes count their achievements in vintages and grams, anyways, he looks up to them, they seem happy doing it, he will get there someday, just has to dial in the dosage.

He misses the phone calls, fish didn’t come in, later that night, 5 or 6 veal chop sucked. Of course, it not his fault, he’s not cooking them anymore, using the people skills he learned however he could, he addresses the situation, a dish basket nearly misses his head, later the dishwasher stabs a happy go lucky manager with a bottle.

Pudgy kid took from his paycheck to pay the night chef on site, so the House could serve Grey Goose until 3am.

Earlier that night, a food writer managed to snatch a table at 9:30, between the Buddha Bar replays and the budding DJ remixes of U2. Not glorious, it’s obvious. Will be either stars in print or stars on pills.

Pudgy teen worked long shifts so now another voice joined the choir of screams, he’s never home, leaves too early and can’t stop looking at his phone. But he’s a cool dude now and he drinks champagne, he’s an epicurean Mohican, not a trashy line cooks that drinks beer, he tells himself that.

When the Champagne swells his forehead a bit too much he moves to craft beers and small batch spirits, helping the small farms and artisans in the process. He makes wise decisions, socially inclined choices of intoxicants. He drinks from magnums to lower his bottle count, lays down early, or so he was told.

But he’s not cooking 45 chops a day anymore, there’s no ways he could. People who flock in love him for who he has become, a legendary glutton, an emotional cesspool of epic proportions who turned to wheat grass and one liners to limp his way thru service.

He stacks fatty cuts, and metaphors, skillfully intersects them with meaty opinions, he gets quoted by media folks.

Pudgy kid is grown up, mostly happy now, but still stuck; between wine soaked layers of truffles, pills and crafty banter.


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Wednesday, June 13, 2018

The American Heart Association's Alliance For A Healthier Generation Labels Diet Coke and Pop-Tarts (And More) As "Smart Snacks" For Kids

In case you're not familiar with it, the Alliance For A Healthier Generation is the name given to the partnership program founded by the American Heart Association, The Clinton Foundation, and The Robert Wood Johnson Foundation with pretty what at first glance looks like pretty much every food industry corporation on earth.

The Alliance's stated mission is,
"to create healthy changes that build upon one another and create a system, a nation, that makes the healthy choice the easy choice"
So what are some healthy choices according to the Alliance's Amazon based,
"One Stop Shop for Healthier Generation vetted Smart Snacks and products for students in and out of school"?
Here are some select choices:

How is it possible that the American Heart Association, The Clinton Foundation, and The Robert Wood Johnson Foundation would describe a child washing down a bag of Doritos or a Pop-Tart with a can of Diet Coke as them consuming a Smart Snack?

Anyone?

(My answer of course is because the Alliance For A Healthier Generation is a partnership with the food industry whose job is to promote sales, not to protect health, but as to why these particular products were deemed Smart, and the larger question of why partnering with the food industry was considered a thoughtful plan, there you've got me)

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