Thursday, May 31, 2018

"Everything In Moderation" Does Not Apply To Giving Candy To Other People's Kids

I heard it most recently from a teacher explaining why it's no big deal that she gave her 8 and 12 year old students Smarties (Canadian M&Ms), Lucky Charms Bars, Smart Food, Goldfish Crackers and Freezies for various reasons including most recently, writing a standardized test.

It's just a variant of the, "but it's just one" cop out.

Both suggest that the indulgence is small, therefore the questionable offering is no biggie.

And for individuals, it's true. I don't think that there should be any forbidden foods. We should all be consuming the smallest amount of indulgences that we need to like our lives (my four food kryptonites are Sour Patch Kids, Ruffles, dark chocolate Reese's Peanut Butter Cups, and scotch).

But it's not true when referring to teachers choosing to give Smarties to 8 year olds because they were writing a standardized test.

Because firstly, it's not just one, and consequently it's not a moderate amount, because as anyone with children today knows, it's "just one" for other people giving kids junk food virtually every day, and some times multiple times a day.

And yes, while I have zero issue with children eating Smarties (mine just came back from Manhattan where one of their favourite stores was the M&Ms store), teachers teaching their 8 year old students that there's no occasion or effort too small to not warrant candy or junk food does not fit into my definition of a message that's healthy even in moderation.

With very rare exceptions (like another kid's birthday party, or Halloween), parents, and parents alone, should be the arbiters of how much candy or junk food their 8 year olds are offered, not teachers, who instead could/should serve as role models as to how to reward and inspire without messages like the one that same teacher who wanted me to know it was ok because "everything in moderation" posted to Twitter,
"Nothing says #inspirationaltreat like @Nestle #Smarties!"

Not an end of test dance party? An extra period of recess? Painting a celebratory class mural?

Though it's harsher than might be fair, and clearly written in exasperation, there was a comment left on my Facebook page by Robin Nelson VanDyke that I have a difficult time disagreeing with,

Honestly, and as I've been saying over and over again, it's not that teachers don't care, they do, it's that junk food for everything is so entrenched and normalized that when challenged people get defensive rather than reflective.

[If you're a teacher looking for non-junk food ideas, here's a great list and backgrounder to peek at]

Tuesday, May 29, 2018

A School Principal Blocked Me On Twitter Because I Suggested That 8 Year Olds Need Not Be Rewarded With Oreos For Writing A Test

In Grade 3 in Canada, many students write a standardized test for the Education Quality and Accountability Office (EQAO).

At one school, the kids' Principal tweeted out her note of encouragement, along with a photo of the test packages that the school had prepared for the 8 year olds. Included with each was a package of Oreo cookies.

My response was to point this out as a great example of how there is no longer any occasion too small to not use junk food to reward, pacify, or entertain children.

She blocked me.

Next the chief psychologist of a school board weighed in to state,
"I’m missing the reason for concern. I hope it isn’t unusual for children to be celebrated in schools for all sorts of achievements, activities, or just building a positive school culture."
Call me a dreamer, but I don't think positive school culture needs to be built out of Oreos.

That a principal, and the chief psychologist of a school board, both of who I have zero doubt care tremendously about their students, see no problem with schools teaching 8 year olds that junk food rewards effort and/or relieves stress really speaks to just how entrenched and normalized our unhealthy relationship with junk food has become.

How about an extra 15 minutes of recess in between test blocks if stress is a concern? Or stickers for a job well done, or a come in your PJs to write day if reward is the issue?

And taking a step even further back, should we really be teaching 8 year olds that the simple expectation of their writing tests in life is an event worthy of anything other than being proud that they did their best in writing and/or studying for it?

Saturday, May 26, 2018

Saturday Stories: American Anti-Semitism, Forgotten Palestinians, And On Being Smaller

Edward Joffe and Leon Kanner, murdered by Rasmea Odeh in her bombing of a supermarket in 1969
Karen Bekker, in The Forward, wonders why American anti-Semitism is no longer publicly disqualifying.

Terry Glavin, in Macleans, discusses how the Palestinians in Syria have all but been forgotten.

Colin Gillis, in Avidly, on being smaller.

Thursday, May 24, 2018

Kudos (Maybe) To Calgary Police For Handing Out Recreation Passes For Kids' Good Behaviour Rather than Sugar (Like Here In Ontario)

So here's the story.

Recently I saw a tweet highlighting a new Calgary Positive Ticket campaign whereby Angie Thiessen's daughter received a coupon redeemable for free access to a Calgary recreation facility because she was "caught" learning to ride her bicycle with a bike helmet.
Fantastic, right? Here's a longer piece discussing the program.

But then I saw this story about Calgary's positive ticketing program having handed out 2,350 coupons redeemable for a Macs Milk hot chocolate or Frosty over the course of the past 18 months.

So if the program's changed (and zero doubt that it should) from targeting kids with free advertising and emotional brand washing for sugar sweetened beverages, then kudos to Calgary.

Here's hoping!

Tuesday, May 22, 2018

Metabolically Healthy With Obesity, But For How Long? And Does It Matter?

Image Courtesy of the Canadian Obesity Network
I faced the first question a few weeks ago when I was speaking with a group of medical residents. The latter I'm asking here.

I had presented the EOSS related data that showed the risk of dying with an EOSS score of zero (meaning a person had a BMI greater than 30, but had no physical, metabolic or quality of life related signs or symptoms related to obesity) over the course of 6 years, was no higher than a person without obesity.

The residents wanted to know what percentage of patients with an EOSS score of zero remained at an EOSS score of zero, and moreover wouldn't there be benefits to trying to work on weight as a means to prevent progression even with an EOSS score of 0?

I pointed out that "working on weight" is fairly meaningless goal, but rather it would be exploring a patient's lifestyle related to food and fitness and then providing them with guidance on how to improve both that clinicians ought to be doing. More importantly I pointed out that this exploration should be undertaken with each and every patient regardless of their weights.

But it's a fair question, and there are a few studies looking at this including this one which was recently published in the Journal of The American College of Cardiology.

In it, the authors quantified what percentage of patients with metabolically healthy obesity (MHO) went on to develop metabolic syndrome over the course of the next dozen years.

The answer was of the 1,051 patients with MHO at the start of the study, 48% developed metabolic syndrome by the study's end. Those who did develop metabolic syndrome, unsurprisingly, were shown to have a heightened risk of cardiovascular disease (but not of all cause mortality by the way).

All this to say, there's little doubt that obesity increases the risks of developing various medical conditions, but in my opinion, and as I expressed to the medical residents, weight shouldn't dictate whether or not a physician explores a particular patient's lifestyle. Whether a person has an EOSS score of zero, or whether their weight is "normal", shouldn't preclude considering nutrition and fitness as important determinants of health.

Thursday, May 17, 2018

How Many Calories Your Meal Has May Depend On Which Tracker You're Using

First, let me get this out of the way.

The currency of weight is calories. True, not all calories have the same impact on health or satiety, and also true, people aren't walking math formulas, but that doesn't change the fact that you need a surplus of calories to gain and a deficit to lose, and that the false dichotomy suggesting it's only worth caring about either quality or quantity of calories is just plain dumb.

But the story here isn't about that. The story here stems from the fact that my office is currently in the development stage of a mobile app which in turn will include a food diary.

Right now we're trying to figure out which calorie and food database to licence, and as part of that process one of our office's terrific RDs, Lauren Lejasisaks, chose 4 online recipes and crunched numbers using myfitnesspal, calorieking, and another third party database that we're considering licensing.

Turns out, they're all different. And not by small margins! The very same ingredients entered into those 3 different databases yielded results that differed by as much as 40%.

As to which is right?

I have no idea.

And it probably doesn't matter as much as you might think.

Though there's certainly value in having an inkling of where you might be at calorie wise (or carb wise if you're tracking that instead), probably the bigger value of record keeping is in the context of its service as a conscious reminder of the behaviours that you're trying to change. And if you're keeping a food diary regularly, you'll be reminding yourself multiple times per day, and so long as you don't use your food diary as a negative, blunt, tool of judgement, those reminders will help you to make more informed and thoughtful dietary decisions.

Tuesday, May 15, 2018

The Ontario Science Centre Just Hosted Cheetos' 3-Day, Immersive, Kid-Targeted, Advertisement

From the WTF files comes Ontario's Science Centre's hosting of the Cheetos Museum this past Mother's Day weekend.

What's a Cheetos museum?

It's a mobile, immersive, advertising experience for Cheetos.

Was there any science you ask?


The "promotional activity" (that's what it was called by the Ontario Science Centre in a now no longer hosted webpage online) involved hunting for Cheetos with identifiable shapes, swinging on a Cheetos branded swing, and taking pictures with Cheetos' mascot Chester.
So why would the Ontario Science Centre have hosted it?


I mean it's difficult to imagine it was there for any other reason given there's zero scientific content. The timing also seems to suggest money as the likelihood is that Mother's Day weekend is one of the Science Centre's busiest of the year - and that would command higher dollars.

All this to say, a live exhibit demonstrating the science of marketing junk foods to kids, by marketing junk food to kids, probably isn't one I'd have recommended to the Ontario Science Centre.

(And I don't think the Ontario Science Centre is all that proud of it either given there's not a tweet or a Facebook post from them to be had about this particular promotional activity.)

[Thanks to Michelle Bernardo for sending my way]

Saturday, May 12, 2018

Saturday Stories: Blue Blood, Obesity, and "Silencing"

© Hans Hillewaert / 
Sarah Zhang, in The Atlantic, on the last days of the blue blood harvest.

Harmony Cox, in Narratively, on her life as a public health crisis.

Nathan Robinson, in Current Affairs, on being loud despite being "silenced".

Thursday, May 10, 2018

Pro-Tip: Copying Food Industry Press Releases Is Neither Helpful, Nor Journalism

So I saw this story published by Global News. It's about grain consumption in Canada and the headline sure is strong,
"University of Saskatchewan study shows importance of grain to Canada’s diet".
When I clicked through I read about researchers who by way of a cluster analysis of Canadians' grain consumption patterns, concluded that 80% of Canadians aren't eating enough grains and that as a consequence, they're apparently at risk of deficiencies in folic acid, some B vitamins and iron.

Oh, I also learned that
"there's less research supporting the benefits of enriched grain foods, sometimes referred to as refined grains"
and that refined grains are,
"important food sources for delivering key nutrients in the Canadian diet".
And that
"research suggests eliminating grain foods from diets is not associated with the body mass index (BMI)."
That the story reads like a press release is not a coincidence, because the same day the story ran, so too did this press release from the Healthy Grain Institute.

When I compared the two, it turns out that the Global News story was 49.5% identical to the Healthy Grains Institute press release.

Personally, I don't think the information in the press release warranted any news coverage, but if you're going to actually cover it, at the very least it'd be useful (and I think expected) to see:
  • That there actually isn't a published study, but rather just a presentation at a conference that was being hyped by a press release. 
  • Anything at all about what confounders were considered (or not considered) in the cluster analysis.
  • The proven and significant limitations of food recall based analyses.
  • The risks associated with increased intakes of refined grains. 
  • The funding of the "study" (not suggesting the research isn't useful, but rather that there isn't yet a published study to evaluate) by the Saskatchewan Wheat Development Commission (SWDC), the Alberta Wheat Commission (AWC), the Grain Farmers of Ontario and Mitacs, a Canadian not-for-profit funding agency supporting industry-academia collaborations
  • That Nutritional Strategies Inc. (the quoted co-researcher's employer (he's the VP)) provides food, nutrition and regulatory affairs consulting services for numerous food and beverage companies and food-related associations
Small wonder why people are confused about nutrition if food industry press releases about unpublished studies are copied and repackaged as news.

Monday, May 07, 2018

Why Do We Report on Diet Studies As If Patients Adhered To Their Prescribed Diets?

It happens all the time.

Researchers recruit participants for a diet study and randomize them to particular diets.

The participants don't adhere to said diets particularly well (and this is putting aside the known and glaring inaccuracy of dietary recall), and the macronutrient breakdowns of what they report eating are nearly always different from the macronutrient breakdowns of what they were instructed to eat.

And yet the researchers write up their studies as if their prescribed diets were followed, and consequently so too do journalists.

So here are my two asks.

1. Unless you're writing or reporting on diet studies conducted in metabolic wards, please treat their results with tempered enthusiasm.

2. And if the difference between two dietary outcome arms isn't likely to be clinically meaningful (like say the difference between weight losses of 3.3 kg, 4.6 kg, and 5.5 kg at two years (and bonus points if you get this reference right out of the gate)), maybe hold off on declaring one diet to be the world's best?

Saturday, May 05, 2018

Saturday Stories: Stolen Torahs, Yonah Krakowsky, and Cudjo Lewis

Erik Overbey Collection, The Doy Leale McCall Rare Book and Manuscript Library, University of South Alabama. Colorization by Gluekit
Daniel Estrin, in NPR, with an incredible whodunnit covering good (and bad) Samaritans, ancient torahs, and theft (replete with just gorgeous photos)

Yonah Krakowsky, in Toronto Life, on his life as both an Orthodox Jew, and as a gender-reassignment surgeon.

Zora Neale Hurston, posthumously in Vulture, with the story of of Cudjo Lewis, the final slave-ship survivor.

Thursday, May 03, 2018

If You Need Proof The Food Industry Doesn't Care About You, Look No Further Than Smucker's "No Sugar Added" Jam

So I was shopping the other day.

We were making a dish that included apricot jam in a sauce and I was having a peek at the various offerings on the shelves.

I grabbed Smucker's Apricot Jam and noted that the front of its package highlighted the "fact" that it had "no sugar added".

The label of course told a different story.

It told me that the second ingredient was "white grape juice concentrate", which is likely on the order of 60% sugar by weight.

So yes, sugar was added.

I expressed my indignation on Twitter and Smucker's responded to tell me that they appreciated my feedback, that the concentrated white grape juice was meant to add "fruit flavor" as well as serve as a sweetener, and that according to the letter of the law, it was legal for them to state that their product contained no added sugar.
Now the good news is that at least in Canada, the addition of white grape juice concentrate, which of course is just the addition of sugar, will soon preclude Smucker's front-of-package "No Sugar Added" claim.

But of course if Smucker's actually wanted to do right by its customers it wouldn't be waiting for the Canadian Food Inspection Agency's regulations to change.

But that's not what Smucker's is about. Smucker's, like pretty much all publicly traded food industry players, is about profit, and their "No Sugar Added" jams are great case studies in how we shouldn't wait for the food industry to do the right thing, because unless the right thing aligns with profits, they're not going to do it.