Saturday, November 09, 2019

Saturday Stories: Mary Cain, Fatal Powerpoint, And Echo Chambers

Mary Cain, in the New York Times, tells her story of the intersection of abuse and elite sport.

Jamie, in McDreeamie Musings, on the Powerpoint slide that killed 7 people.

C Thi Nguyen, in Aeon, on the dangers of echo chambers

And if you haven't had a chance to donate yet to my lipterpillar, and you find some value or enjoyment from this blog, please consider and remember, every dollar counts. So far this year the generosity of friends and family have helped to raise $1,640. Movember is a tax deductible charity and you can give anonymously if you'd prefer. And of course, as I've mentioned, Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, & testicular cancer. To donate, simply click here

Wednesday, November 06, 2019

"Severe" Energy Restriction Better For Weight Loss Than "Moderate" Energy Restriction?

Well according to this new RCT it is - in it they found that patients randomly assigned to 4 months of severe energy restriction (65-75% restriction of energy by way of total meal replacement/all liquid diet) followed by 8 months of moderate energy restriction (25-35%), at 12 months, lost significantly more weight than those assigned from the get go to the same degree of moderate energy restriction.

Hurrah?

So first off it's not remotely surprising that putting two groups on the exact same diet (25-35% energy restriction) but starting one group off with 4 months of extreme energy restriction sees those who had the extreme jump start lose more in total.

Secondly, it would appear that the extreme folks have a weight gain trajectory that may well erase the differences over time.

And thirdly, this got me thinking. Behavioural weight loss programs, because they don't involve products (unless medications are being tested, and here they were not), have outcomes that are likely significantly dependent on both material, and perhaps more importantly, on the service providers. Consequently I do wonder about the ability of any of these sorts of studies to be applicable to other offices or programs. Meaning here at least, it would appear the extreme folks did better, and the moderate folks dropped out more often (perhaps consequent to slower than desired initial losses), but would the same necessarily be true at a different site, with the same restrictions but with different service providers, collateral materials, attention and support?

I'd venture those things matter a great deal more than is generally ever mentioned in the medical literature.

And a Movember update! If you enjoy these posts (or even if you don't but you hate read them for something to rage about thereby adding some extra meaning or identity to your life) would love your tax deductible donation to my lipterpillar's growth (and remember, you can give anonymously too). And though I have a family history of prostate cancer (hi Dad!) I think it's important to note that beyond prostate cancer Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, and testicular cancer. And while I will never charge a penny or host an advertisement on this site, I will, on an annual basis, ask for your donation to this cause. To donate, simply click here

Tuesday, November 05, 2019

Just Because Your Cafeteria Has A Salad Bar Does Not Make It Healthy

A few months ago I visited the Ottawa Hospital's Civic campus and decided to have a peek over at the cafeteria.

It won an award you see, an "Award of Recognition" to be exact, which according to the plaque was for,
"significant achievement in creating a supportive, healthy, nutrition environment across hospital retail food settings"
A supportive and health nutrition environment you say?

Um, about that:


Sigh

Saturday, November 02, 2019

Saturday Stories: Bad Nutrition Advice, Nell Scovell, And The Memo Method Of Fitness

Shauna Harrison, herself both a fitness instruction and a Ph.D. in public health, in Self, is begging you to stop taking nutrition advice from your fitness instructors.

Nell Scovell, in Vanity Fair, with an amazing piece of writing about her pre-#MeToo era interactions with David Letterman, and what it was like to sit down with him a decade later to discuss it.

Lindsay Crouse, Nayeema Raza, Taige Jensen and Max Cantor, in the New York Times, with just a lovely video on Guillermo PiƱeda Morales, a.k.a. Memo, and his fitness methodology.

Lastly, I've had many people write to me over the years about their enjoyment of Saturday Stories in particular. If that's you, and if it moves you, today is #Movember 2nd! and your donations  are my ෴'s fertilizer! You give, I grow. And beyond prostate cancer Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, & testicular cancer. To donate, simply click here

Photo by Pete Souza - Cropped from https://www.flickr.com/photos/whitehouse/3994558942, Public Domain, Link

Thursday, October 31, 2019

Ideally Only Donut Conferences Should Be Handing Out Free Donuts #FNCE #RDChat #IfYouServeItWeWillEatIt

Lots of hoopla on nutrition Twitter this week because RD Tracey Fox questioned the wisdom of serving donuts at the Academy of Nutrition and Dietetics (AND) annual Food and Nutrition Conference and Expo (FNCE).

Hyperbole and fallacious arguments from both sides ensued.

The people hating on the donuts predictably likened sugar to *checks tweets, sighs* heroin and cigarettes, while the people defending them, their arguments are probably fairly summed up in this tweet:

It's these arguments that I want to very briefly address.
  1. Dietitians, and everyone else, are allowed to eat donut holes whenever they want, and criticizing the provision of donut holes at a dietetic conference does not suggest otherwise.
  2. No, the *giant eye-roll* consumption of one donut hole doesn't cause chronic disease, nor does criticizing the provision of donut holes at a dietetic conference suggest otherwise.
  3. No, donuts were not the only food served at FNCE, nor does criticizing the provision of donut holes at a dietetic conference suggest otherwise.
  4. Criticizing the provision of donut holes at a dietetic conference isn't shaming colleagues (but that tweet up above using sneering straw men to call out the RD who doesn't think donuts should be served at a dietetic conference sure is)
As I've written before in reference to a physician conference I attended where they were serving soda, Clif bars, and potato chips as a snack, human beings, including MDs and RDs, when faced with freely provided indulgent choices, tend to choose them, and I can't help but wonder had they not been offered how many RDs would have gone for a donut or cookie run?

And of course it's not "just one". We are all constantly faced with indulgent choices being offered to us freely to christen every event no matter how small, and we've created a food environment whereby we have to go out of our way to make healthy choices and to actively, regularly, say no to indulgent ones. Now I think indulgent choices are part of life, an enjoyable part at that, and ones that I even actively encourage my patients to make, but I also think it would be in everyone's best interest were that food environment reversed, where the healthy choices are the defaults and indulgent choices are readily available for anyone who wants to go out of their way to get them.

And by the way, at FNCE this year they were certainly readily available. The decadent Beiler's Bakery was 92ft away from the Pennsylvania Convention Centre, while more pedestrian Dunkin' was 135ft away.

Yes, the constant provision of junk food is a societal norm, but it certainly need not be.

And honestly, if even the Academy of Nutrition and Dietetics enables and encourages poor dietary choices at RD events, why would anyone expect better from others?

Until we stop leaning on the theoretical ability of people "just saying no", or that the provision of healthy choices somehow erases the provision of junk, as the primary means to address a food environment that incessantly offers and pushes nutritional chaff at every turn, we're not likely to ever see change, and frankly this is a charge that AND should be leading.

Monday, October 28, 2019

Yes, My Kids Eat Candy On Halloween And So Should Yours

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

It's coming.

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

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

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

So what's a health conscious parent to do?

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

Well firstly I think that if you'd like, you can chat some about added sugar and those rule of thumb figures up above provide easily visualized metrics for kids and parents alike.

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

The rest?

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

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

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

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

Saturday, October 26, 2019

Saturday Stories: Meat, Diets, and German Antisemitism

James Hamblin, in The Atlantic, with his typically insightful thoughts, this time about whether meat is good or bad for you.

Kim Tingley, in the New York Times Magazine, asks why isn't there one best diet for everyone?

Andrew Mark Bennett, in Tablet, on modern day German antisemitism and what German Jews are doing about it..

[And if you don't follow me on Twitter or Facebook, had a chat with the ladies from The Social yesterday about vaccinations]

Thursday, October 24, 2019

Elementary Teachers Union (@ETFOeducators) Misleads Its 83,000 Members When Explaining Cutting Benefits' Actual Dietitian Coverage In Place Of Dial-A-Dietitian

Thanks to a person who wishes to remain nameless, I was recently alerted to the fact that the Elementary Teachers Federation of Ontario, a union representing 83,000 elementary teachers and education workers, have removed coverage for Registered Dietitians (RDs) from their benefits plan.

By way of background, here in Ontario, RDs are one of a limited number of regulated health professionals, and of course are the only profession dedicated exclusively to nutrition. Also here in Ontario (and pretty much everywhere), diet and weight related diseases have long since reached epidemic proportions.

As to why ETFO has delisted RDs, the province's only regulated nutrition professionals, according to a document distributed to their members it's because,
"these free services are now available through Ontario Telehealth"
But are they?

Telehealth RDs answer one-off nutrition questions by way of phone calls. They are most assuredly not there to provide individual counselling or comprehensive ongoing care.

Plainly, cutting RDs from ETFO benefits is shortsighted, and suggesting that actual RD services are the equivalent of a Dial-A-Dietitian service designed to answer simple questions is an outright lie.

If you're an ETFO member I'd encourage you to share this post, and to contact the ETFO ELHT Board of Trustees to ask that RD coverage be reinstated.

Monday, October 21, 2019

The Journal of Nutrition Describes Gut Bacteria Prevotella Abundance As "The Key To Successful Weight Loss" Following Short Study Where Subjects With No Prevotella Lost Comparable Amount Of Weight

Hype around preliminary findings, animal studies, cell culture studies, underwhelming studies, and more is the clickbait that sells papers and likes. Some of the time hype comes from journalists, sometimes from press-releases, and sometimes from the authors themselves. Today's blog post sees the hype coming from an invited oped published by the American Society of Nutrition's flagship The Journal of Nutrition.

The oped, entitled, The Key to Successful Weight Loss on a High-Fiber Diet May Be in Gut Microbiome Prevotella Abundance, was written in reference to the results of the study entitled, Prevotella Abundance Predicts Weight Loss Success in Healthy, Overweight Adults Consuming a Whole-Grain Diet Ad Libitum: A Post Hoc Analysis of a 6-Wk Randomized Controlled Trial.

The op-ed described the "key" to successful weight loss on a high-fiber diet as gut microbiomes containing an abundance of the bacterium Prevotella, and was written to amplify the - hold onto your hats now - findings from a very small, very short study that was not originally designed to test the relationship between Prevotella abundance and weight, that found a whole 3.5lb greater weight loss among the 15 study subjects with the highest Prevotella abundance vs. the lowest (but still present amount) when consuming a whole grain (WG) diet.

But wait, there's more!

Though it's confusing because of the way they reported weight loss, the same study found that particpants with microbiomes containing no Prevotella also lost weight on a WG diet. In fact, looking at the study's diagram detailing the losses between groups it sure appears as if subjects whose microbiomes contained no Prevotella (0-P) lost statistically comparable amounts of weight as those whose microbiomes contained the most Prevotella (High-P).


So to summarize, people with microbiomes containing what The Journal of Nutrition called, "the key to weight loss on a high-fibre diet" lost pretty much the same amount of weight as people with none of it on a high-fibre diet. Oh, and that key that worked as well as not having a key at all? If we make the enormous leap that it was causal, it led to a 3.48lb weight loss. Whoop whoop?

Bottom line I guess is that if you're going to describe something at the "key" to successful weight loss on a whole grain diet in the title of an op-ed in a prominent journal, and where we're talking about a 4lb weight loss, but having none of that key leads you to lose pretty much the same amount of weight, not only is that not much of a key, but it's incredibly irresponsible as it blatantly contributes to the ongoing erosion of societal scientific literacy and promotes the harmful and erroneous belief that magic exists when it comes to weight loss.

[Also, unless I'm misreading the very small amount of actual data provided, it would seem that the authors of the study also reported the difference between high Prevotella and low Prevotella groups wrong whereby the high group was found to have lost 4lbs (-1.8kg), and the low 0.5lbs (-0.22kg), but rather than report a -1.58kg (3.48lb) difference between the two, they added their losses and reported a -2.02kg (4.45lb) difference.]



Tuesday, October 15, 2019

Real World Self-Selected Intermittent Fasting (IF) Vs. Continuous Energy Restriction (CER) Study Sees 73% of IF and 61% of CER Participants Not Lasting Even 6 Months

So what happens when you offer people with obesity the choice between 5:2 style intermittent fasting (IF) (very-low calories (VLC) 2 days weekly with 5 days of less restricted eating) and more traditional caloric restriction 7 days a week? Would encouraging people to choose between two strategies increase their likelihoods of successful weight management a year later? Would one group lose more weight than the other? Would adherence be the same?

That were the question post-doc RD Rona Antoni and colleagues set out to explore and they recently published a paper discussing their results.

197 patients with obesity presenting to the Rotherham Institute for Obesity were offered the choice between 5:2 IF (630 calories from liquid meal replacements on the VLC days), or an aimed 500 calorie continuous energy restriction (CER) 7 days per week with diet based off that recommended by the UK's dietary guidelines. Both groups received support from specialist obesity nurses for 6 months and were also asked to return for measurements and discussion at one year. All were also provided with access to, "a variety of specialist facilities, resources and multidisciplinary specialists including exercise and talking therapists", and all were reviewed in clinic monthly where measurements were taken (weight, total body fat, fat-free mass (FFM), waist circumference, systolic and diastolic blood pressure and an overnight fasted blood sample) and adherence was discussed.

99 patients chose IF, and 98 chose CER. 6 months later, 73% of IF patients and 61% of CER patients had dropped out. At one year, 83% of IF and 70% of CER patients were lost to follow up.

Of those who quit IF by 6 months, 18% explicitly reported they did so because they could not tolerate the diet, something that none of the CER drop outs reported, other IF drop outs reported they quit due to fainting or hypoglycemia on VLC days.

Regarding completers' weight losses at 6 months, the IF patients lost a statistically significant, but likely clinically meaningless, 4lbs more than the CER group. All blood measures (including fasting glucose, insulin, hsCRP, and lipids) were found to be the same between groups. Blood pressure changes were also not different between groups.

At one year, the 17 remaining IF patients were found to have regained their lost weight, while the 30 CER patients were found to be maintaining their albeit small amount (3%) of weight loss.

So what to make of this study?

I think the most striking finding was the overall 66% attrition rate across both arms. Certainly this study does not suggest that IF is an easier regime to follow than CER (at least not when provided at the Rotherham Institute for Obesity - given weight management support is a service and not a product, it's certainly possible that different providers might have seen different outcomes for both arms, but I do think this speaks to the challenge of scalability of behavioural interventions). But what I really think this study highlights is the fact that the real-world likelihood of purely dietary interventions treating our increasing weights is very low indeed. Instead, we need more tools for treatment (certainly including medications and surgeries), and more importantly, if we're going to see change, we're going to need environmental level changes to turn this boat around.

As to whether IF or CER will work for you don't forget that one person's horribly restrictive diet is another person's happy lifestyle. If you're trying to find your own right road, even if the first road fails, and even if angry diet gurus and zealots try to tell you there's no other road, keep trying different forks until you find the one that suits you best, as when it comes to diets, adherence is all that matters in the end, and if you don't like the way you're living, you're not likely to keep living that way.

Saturday, October 12, 2019

Saturday Stories: Jimmy Dorsey's Generosity, Eating Disorder Recovery, And New Coke

Petula Dvorak, in The Washington Post, with two incredible stories, the first about hunting for one man whose generosity and $80 helped launch an incredible career, and then the story about finding that man - Jimmy Dorsey

Amelia Boone, in Race Ipsa Loquitur, discusses her eating disorder recovery.

Tim Murphy, in Mother Jones, on the murder of New Coke.

Monday, October 07, 2019

Dear @BowlCanada, Selling Chocolate Should Not Be A Prerequisite For A Child To Play In Your Leagues

This is not the first time someone has shared the story of a kids' sports league that requires junk food fundraising, but it may be the first time that the league's program coordinator explicitly stated that the child of a parent willing to pay a bit more instead of being stuck selling $50 of chocolate wouldn't be welcome.

I've said it before and will say it again, our food culture is broken and junk food fundraising is just one small aspect of that, and when you question social norms, no matter how broken they might be, don't be surprised when you get pushback. But damn, it's depressing.

Here is the redacted email exchange I was forwarded

Parent:
Hello,

My kids’ dad signed our child up for bowling and is telling me I have to sell half of these chocolates.

I asked for information and the lane said that Bowl Canada mandates this.

So I have a few things to ask.

I’ve noticed that General Mills is a sponsor. Do they make the chocolates and are they the party that is behind this arrangement?

Why chocolate when we are in the midst of an obesity epidemic? Especially for an organization encouraging health? There are all sorts of fundraisers. If given the chance I would gladly purchase fresh vegetables through Peak of the Market, for example.

Also, why not give parents the option of giving a donation for tax deductible purposes rather than making them buy a bunch of poor quality chocolate that is probably connected to child labour? You’d still cover the costs you are hoping for.
Bowl Canada Program Coordinator
Dear [Redacted],

We are happy to hear that your child will be registering for bowling this season! Yes, Youth Bowl Canada has one official fundraiser each year and our tried and true method of raising funds, to help keep costs down for families, is the sale of chocolates.

Every two years, Youth Bowl Canada considers proposals from many companies offering an array of products, with various levels of monetary return which benefits all levels of bowling in Canada. Chocolate companies can repeatedly offered the best deal to not only bowling, but to schools, community clubs, etc.

General Mills was a sponsor of Bowl Canada last year, however it was simply a free game of bowling offer on select food products in stores. They have not wished to quote on our fundraisers in the past.

I hope I have addressed your concerns. Please feel free to reply should you have any further questions
.
Parent
Hi [Redacted].

Thanks for your quick response. My understanding is, then, that these chocolate sales are mandatory if we want our kids in bowling. Is that correct?

If not correct, if this fundraiser is optional, no big deal; I don’t have to take part in something I find morally objectionable in order for my kid to have this opportunity.

If correct, that you require these chocolate sales, I would urge Bowl Canada to reconsider this policy, for 3 reasons.

1. It is objectionable to force fundraising on families. Some people are very good at this kind of stuff. Others have anxiety or lack the connections to have people to sell to. Sometimes the families least able to support a fundraiser are the ones whose kids most need this kind of programming.

2. This does not support physical health. As I mentioned, obesity is a major issue in society. I can appreciate that you are looking for good money makers but I think non-profits should be mindful of other considerations.

3. Why not give parents the option of something else? I am not going to sell these chocolates. If I end up buying half from my kids’ dad I will end up with chocolate I don’t want in my house and maybe end up throwing it out. I will have spent what? $50 on chocolate so Bowl Canada can get $20? I’d much rather just give you the $20 profit you are looking for. Why not just give me that option rather than making me spend more money than is necessary?

4. Chocolate is ethically problematic. Most chocolate manufacturers have child labour and harsh conditions as part of the production process. This is wrong and I believe what we support with our money should not hurt other people.

So I find myself between a rock and a hard place: I love my kid in bowling, it has been great for him. But I don’t think it’s right to force me to take part in something I find morally objectionable.

Please reconsider your policy.
Bowl Canada Program Coordinator
Hi [Redacted].

Yes, chocolate sales are required for the YBC program to participate in all YBC programs and events.

I will, however forward your concerns on to those that review YBC policies for future consideration.

Regards
Ugh.

Monday, September 23, 2019

Weekly Elementary School Pizza Sales Nets Just $8.57 Per Student Per Year

Last week I gave a talk to some parents at my youngest daughter's elementary school.

The talk was about our ridiculous food environment where we are all the proverbial frogs in pots of water that have slowly been heated to a boil, where food, especially junk food, is constantly used to reward, pacify, and entertain our children as well as to fundraise for every cause.

Ironically, the day before the talk I received an email from the school's parent council extolling me to sign my daughter up for weekly pizza days. In it I was told,
"The most valuable fundraiser is Pizza Mondays. $0.50 of every order, every week goes to the [redacted]. It's a win/win/win! One less lunch for you to make, a delicious (and nutritious) slice of pizza for your child and $16.50 to the [redacted]!"
Looking past the wisdom (or lack thereof) of children been taught by their school week in and week out, from Kindergarten to Grade 7, that fast food pizza is a normal, weekly, "nutritious", meal, I couldn't help but wonder just how valuable it really was in terms of fundraising, and so I asked principal.

She told me that the school's Pizza Mondays cut raises $6,000 per year (12,000 slices served).

There are 700 students in the school.

$6,000/700 students/year = $8.57/student/year

And if Pizza Mondays are the most valuable fundraiser, then perhaps it'd be fair to assume that in total, the school raises $10,000/year in food sale initiatives. That would be $14.30 per kid per year.

Is there really no other way to raise $14.30 per kid than selling them, and normalizing, weekly (or multiple times per week) junk food?

I think there probably is, and here are 3 suggestions each of which by itself might do the job, let alone together (and these are just 3 ideas, there are so many more out there as well).

Fundscrip
Fundscrip is simple to describe. Parents buy gift cards from Fundscrip for stores they already shop at (supermarkets, gas stations, hardware stores, clothing stores, business and school supply stores, toy stores, book stores, electronic stores, restaurants etc.). The gift cards work just like regular gift cards (meaning they work just like cash) and are mailed directly to parents' homes, and the school receives 2-5% (depending on the store) of the value of the gift cards. Given the average family of 4 in Canada's weekly grocery bill runs in at a reported $220, if even only 10% of the school's parents got involved, and if they only used the cards to cover half of their grocery costs, the 3% kickback to the schools would raise $12,000. And that's just by way of groceries!

Grandparents' Day
Many schools run grandparents' days. Simply put they involve inviting all the kids' grandparents to school, putting on some sort of song and dance production, giving the proud grandparents a tour, and either charging them a nominal fee for tickets ($5), or simply soliciting donations during the event (and perhaps annually having a singular cause which then gets branded for that year's grandparents if monies raised). 700 elementary students should conservatively mean at least 1400 grandparents. If only half of them attended, and an average of $5/grandparent was raised, that would bring in $3,500.

School Parents' Goods and Services Auction
With 700 families in our child's school, there are clearly a great many different professions represented among the parents. Creating a night whereby parents can donate goods or services (with a cut to the school) is a great way to both raise money, and raise interest and awareness of the parent body's businesses. Lawyers might donate a discounted will consultations, I could donate work with one of our RDs, or with our personal trainers, artists could donate their art, restauranteurs could donate meals, etc. Done right, and certainly once established as a valuable annual event, there's no reason why this couldn't raise $3,000-$10,000.

The bottom line is that schools truly don't need to sell junk food to children to raise money as there are plenty of other means to do so. Yes, school sold junk food is convenient for parents who aren't keen on making lunches every day, but given we are literally building our children out of what we feed them, and that weekly (daily in some cases) school junk food sales teaches kids, even those who don't order them, that daily junk food is a normal, healthy part of life, taking the time to pack those lunches (or to teach our kids how to pack lunches themselves) is well worth it.

Saturday, September 21, 2019

Wednesday, September 18, 2019

Canadians Who Care About Science Might Not Want To Vote NDP

I have to admit, I found this story jaw dropping.

The federal NDP health critic, Don Davies, is opposed to plans geared to rein in the wild, wild, west of natural health products and supplements that prey on desperate Canadians.

The proposed regulations are meant to require, gasp, that natural health products have evidence to prove they're both safe and effective before they're allowed to be sold.

In the CBC story, Davies even parroted the common line that it's too expensive for supplement makers to conduct studies to prove their products work. That statement contrasts poorly with the other one he gave in the same article where he reports the natural health industry enjoys $12 billion in Canadian revenue and $2 billion in exports.

But even were it true, that there's a presumably want-to-be federal Health Minister arguing we shouldn't require proof of safety and efficacy for products being sold to Canadians in the name of treating their medical conditions, for anyone who cares even an iota about science, should be a non-starter.

And it gets worse.

Davies, in trying to push his post-science world view, was encouraging people to sign a petition developed by the Health Action Network Society (HANS), a Vancouver charity with a history of spreading anti-vaccination claims, but they themselves noted that they were not working with him directly.

Shame, shame, shame, indeed.

Monday, September 16, 2019

Let's Stop Using The Terms "Healthy Weight" And "Normal Weight"

Words matter, and your weight cannot determine whether you're "healthy", or "normal".

Honestly.

Firstly, scales don't measure the presence or absence of health, and so the term "healthy weight", means literally nothing.

Secondly, the CDC defines a "normal weight" as one giving a person a BMI between 18.5 and 24.9 yet if we were using the word normal correctly, it would differ by country and would reflect its population's mean BMI. So in Nauru for instance normal weight would be a person whose BMI was 32.5, whereas in Eritrea it would be someone whose BMI was 20.5. Given mean BMIs in the US and Canada are 28.8 and 27.2 respectively, in North America, it should be considered abnormal to have a BMI between 18.5 and 24.9.

So what could we use instead?

Risk based terms.

Weight, though not a guarantee for any medical problem, does increase the risk of many, and so I'm proposing that rather than terms which confer judgment, we categorize weight as low-risk, medium-risk, and high-risk, and by doing so we'll stop the erroneous use of healthy and normal terminology that constantly and insidiously promotes weight bias, shame, and stereotype.

Saturday, September 14, 2019

Saturday Stories: Crane Wife, Domestically Violent Cops, and Brain Boosting

CJ Hauser, in The Paris Review, with the crane wife.

Kyle Hopkins, in Propublica, on the village where every cop has been convicted of domestic violence.

Kaitlyn Tiffany, in Vox, on brain boosting.

Monday, September 09, 2019

If There Were Quick, Easy, Flying Leaps That Lasted, You'd Have Already Taken Them

The saying is that long journeys begin with first steps, not flying leaps, and if there were flying leaps that routinely led to lasting change, you'd have already taken them.

It's a straightforward message, but when applied to weight management, diet culture regularly asks us to ignore it.

The inconvenient truth of healthy living is that it will certainly require effort.

Yes, there are likely those who will succeed by changing everything all at once, but for most, slowly building and layering change, and respecting the fact that their roads will absolutely also see their share of disappointments and setbacks, is the way to finally get somewhere.

Your first step might be as small as losing one restaurant meal a week in place of cooking, or trying to reduce your sugar sweetened beverages by 50%, or actually scheduling a day to buy, or a service to deliver, weekly groceries, but if you choose steps you can actually accomplish without suffering, you're more likely not to fall, which in turn, will help keep you moving forward.

Wednesday, September 04, 2019

Why You Should Turn Off Your TV And Holster Your Devices Before You Eat

Ok, it's a short study and it relied on dietary recall, but if taken at face value, the results certainly suggest you should be turning off your devices and eating away from the TV.

The study involved the 3 day recall of both diet and media use among 473 individuals.

Plainly, researchers found that meals that were consumed along with some form of media distraction contained 149 more calories. They also found that people consuming those extra calories at a media meal did not compensate by eating less at their next meal.

Given how easy it is to do this, and how by doing so you might even strengthen some interpersonal relationships by eating with friends or family around a table, you really have almost nothing to lose by trying, except perhaps a few calories.

Saturday, August 31, 2019

Saturday Stories: Suicide, Goop, Vaccines, And Kurbo

Connie Schultz, in Creators, on what to say (and not say) to someone whose loved one has died by suicide.

Amanda Mull, in The Atlantic, on what Goop really sells.

Richard Conniff, in National Geographic, on the world before vaccines.

[And if you don't follow me on Twitter or Facebook, here's my take on Weight Watcher's new kids Kurbo app and how while Weight Watchers might know kids aren't likely to lose much weight, do the kids?]

Monday, August 26, 2019

The Rewards Project - A Registered UK Charity Geared At Putting An End To Sugary School Rewards

So it's back to school time, and zero doubt, many of your kids are going to have teachers and schools who will use candy and junk food as a reward.

It's a shame too, not just because they'll be providing your kids with junk, but also because they'll be teaching them, over and over and over, that junk is a reward for anything and everything.

I've written before about easy non-junk food rewards for teachers, I've also written about how you might want to approach things with your kids' sugar pushers, and I even kept track one year of just how much junk other people were offering my kids. What was clear from the response to all of these pieces was just how prevalent this problem was, and just how frustrated parents are.

Well as a sign of those times, in the UK, a new charity has popped up called The Rewards Project and its mission is trying to change this common practice. Click through and you'll find some sample letters to send to your child's school (though I think they'd be much better were they to offer some alternatives and suggestions in them and as I wrote about and linked above, lead with praise for the school and its teachers).

All this to say, if there are charities popping up geared at tackling this issue, clearly there's a real appetite out there for change. In turn this suggests - and my experiences with my kids' schools and more would definitely support this notion - that your kids' schools and teachers might be more open to changing things than you might think.

You'll never know unless you try.

(Thanks to Dr. Miriam Berchuk for sending this my way)

Saturday, August 24, 2019

Saturday Stories: Fitness Evolution, Soda Taxes, and Tick Saliva

James Steele, in The Evolution Institute, on how evolution best informs exercise.

Jeremy B. White, in The Agenda, on how the food industry may be winning the war against soda taxes.

Sarah Zhang, in The Atlantic, marvels about tick saliva.

Monday, August 19, 2019

9 Great Suggestions For Improving The Quality Of Dietary Research (And 1 That According To @JamesHeathers Is "Deeply Silly")

Last week saw the publication of an op-ed authored by Drs. David Ludwig, Cara Ebbeling, and Steven Heymsfield entitled, "Improving the Quality of Dietary Research". In it they discuss the many limitations of dietary research and chart a way forward that includes the following 9 great suggestions,
  1. Recognize that the design features of phase 3 drug studies are not always feasible or appropriate in nutrition research, and clarify the minimum standards necessary for diet studies to be considered successful.
  2. Distinguish among study design categories, including mechanistic, pilot (exploratory), efficacy (explanatory), effectiveness (pragmatic), and translational (with implications for public health and policy). Each of these study types is important for generating knowledge about diet and chronic disease, and some overlap may invariably exist; however, the findings from small-scale, short-term, or low-intensity trials should not be conflated with definitive hypothesis testing.
  3. Define diets more precisely when feasible (eg, with quantitative nutrient targets and other parameters, rather than qualitative descriptors such as Mediterranean) to allow for rigorous and reproducible comparisons.
  4. Improve the methods for addressing common design challenges, such as how to promote adherence to dietary prescriptions (ie, with feeding studies and more intensive behavioral and environmental intervention), and reduce dropout or loss to follow-up.
  5. Develop sensitive and specific biomeasures of adherence (eg, metabolomics), and use available methods when feasible (eg, doubly labeled water method for total energy expenditure).
  6. Create and adequately fund local (or regional) cores to enhance research infrastructure.
  7. Standardize practices to mitigate the risk of bias related to conflicts of interest in nutrition research, including independent oversight of data management and analysis, as has been done for drug trials.
  8. Make databases publicly available at time of study publication to facilitate reanalyses and scholarly dialogue.
  9. Establish best practices for media relations to help reduce hyperbole surrounding publication of small, preliminary, or inconclusive research with limited generalizability."
But there is one recommendation that seems at odds with the rest,
Acknowledge that changes to, or discrepancies in, clinical registries of diet trials are commonplace, and update final analysis plans before unmasking random study group assignments and initiating data analysis.
For those who aren't aware, clinical registries are where researchers document in advance the pre-specified methods and outcomes being studied by way of an observational experiment. The purpose of pre-registration is to reduce the risk of bias, selective reporting, and overt p-hacking that can (and has) occurred in dietary research.

Now to be clear, I'm a clinician, not a researcher, and I'm not sure how commonplace changes to or discrepancies in clinical registries of diet trials are, but I'm also not sure that's an argument in their favour even if they are. I do know that recently two of the authors claiming registry changes are commonplace were found to have modified one of their pre-specified statistical analysis plans which if it had been adhered to, would have rendered their results non-significant.

But commonplace or not, is it good science?

To answer that question I turned to James Heathers, a researcher and self-described "data thug" whose area of interest is methodology (and who you should definitely follow on Twitter), who described the notion of accepting that changes and discrepancies to clinical registries were commonplace was, "deeply silly".

He went on to elaborate as to why,
First of all - the whole definition of a theory is something which sets your expectations. the idea that 'reality is messy' does not interfere with the idea that you have hypothesis driven expectations which are derived from theories.

Second: there is nothing to prevent you saying "WE DID NOT FIND WHAT WE EXPECTED TO FIND" and then *following it* with your insightful exploratory analysis. In fact, that would almost be a better exposition of the facts by definition as you are presenting your expectations as expectations, and your after-the-fact speculations likewise.

Third: if you have a power analysis which determines there is a correct amount of observations necessary to reliably observe an effect, having the freedom to go 'never mind that then' is not a good thing by definition.

Fourth: The fact that changes were made is never ever included in the manuscript. i.e. they are proposing being able to make changes to the protocol in the registry *without* having to say so. it's a 'new plan' rather than a 'changed plan'.

Fifth: If you can still do the original analysis then no-one will ever believe that you didn't change the plan after looking at the data. you have to protect yourself, and the best way to do that is to follow your own damned plans and be realistic from the get.
Lastly, Heathers is unimpressed with the argument that registry changes are A-OK because they're commonplace, and he discussed ancient Aztecan punishments for those citing it.

All this to say, there's plenty of room to improve the quality of dietary research. Here's hoping the bulk of these suggestions are taken to heart, but please don't hold your breath.

Saturday, August 17, 2019

Tuesday, August 13, 2019

Kellogg's Partners With Random House To Use Free Books To Sell Ultra-Processed Sugary Junk Food To Children

To be clear, neither Random House, nor Kellogg's, should be fairly expected to do the right thing when it comes to health.

Kellogg's job is to sell food. Random House's job is to sell books. Nothing more, nothing less.

So it's hard to get mad with either company for their "Feeding Reading" initiative which provides parents with permission or excuse to buy their children such health foods as:
  • Frosted Flakes
  • Pop-Tarts
  • Eggos
  • Nutrigrain Bars
  • Froot Loops
  • Rice Krispie Treats
  • Apple Jacks
  • Frosted Mini-Wheats (note, unfrosted mini-wheats are not eligible)
  • Corn Pops
  • Raisin Bran
  • Krave
  • Keebler cookies
  • Cheez-its
  • Austin crackers
  • Pringles
Truly, not a single choice parents or children should be encouraged to make. All ultra-processed, sugary, junk (and some crackers and potato chips).

Again, no reason to expect either Random House or Kellogg's to be doing the right thing by kids, but in my opinion, their clear partnership in doing the wrong thing here certainly doesn't reflect well on either of them.

Tuesday, August 06, 2019

The Recipe For Aging Gracefully And Adding Life To Your Years

No one wants aging to happen to them, and yet.

While eventually we'll all lose the fight, that doesn't mean we can't go down swinging, and the good news is the recipe for aging without frailty is exceedingly straight forward and was recently spelled out in a systematic review published in the British Journal of General Practice.

The magic formula the 46 included studies pointed to? A mix of regular strength training with regular protein supplementation.

Spelled out a bit further?

20-25 minutes of strength training 4x per week and the purposeful inclusion of protein with every meal and snack (or alternatively, two daily protein supplements providing 25g of protein each).

Though the aforementioned formula won't guarantee a long life, the evidence certainly suggests it'll help to provide a better one adding life to your years if not years to your life.