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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