Saturday, May 18, 2019

Saturday Stories: Dietary Guidelines, "Vaccine Injury", and "Chronic Lyme"

Kevin Bass, in his blog Nutritional Revolution, with the data driven case on how you can't blame people following dietary guidelines for a country's obesity rates.

James Hamblin, in The Atlantic, on the truth behind vaccine injury compensation.

Abby Hartman, in It's Training Cats and Dogs, with her first person account on walking to, and then away from, treatment for "chronic lyme disease".

Pic By Alan R Walker - Own work, CC BY-SA 3.0, Link

Tuesday, May 14, 2019

Calling People Successfully Maintaining Long Term Weight Loss "Unicorns" Is Dehumanizing, Unhelpful, And Misleading (And No, 95% Of Weight Loss Efforts Don't Fail)

A few weeks ago I tweeted about a patient of mine who is maintaining a 19% weight loss for 2 years, and who attributes her success to keeping a food diary and tracking calories, as well as to including protein with every meal and snack.

The point of my tweet was a simple pushback to those who want to claim that calories don't count or that counting can't help (like The Economist for instance whose recent article entitled Death of the calorie was the main reason I bothered to tweet), and those who claim that the only way to lose weight is their way (these days that's usually either #keto or #lchf).

A great many folks weighed in with their success stories, and some pointed to the National Weight Control Registry (where their over 10,000 registrants have kept off an average of 70lbs for 5.5 years). Others though weren't having it.

Instead they asserted that 95% of diets fail, that the weight loss industry was predatory (much of it is, no argument there), and called people who have succeeded "unicorns".

Unicorns. Not people. Mythical creatures.

And the implication of course is clear. Sustained weight loss is impossible. Those who succeed aren't human, or to succeed they employ superhuman efforts, sometimes even described as disordered eating and/or that those who succeed must be miserable. Consequently, trying is futile and those offering help (like me, as to be clear I am the medical director of a behavioural weight management centre) are unethical and are motivated by greed (despite the obvious irony that those championing explicitly non-weight loss programs are targeting the very same population of people and regularly charge a great deal of money for their services).

But boy, there sure are a heck of a lot of unicorns roaming around for something that supposedly fails 95% of the time. Putting aside the anecdotal facts that we all know people who have maintained weight losses, as well as my own office based experiences, this 2010 systematic review found that one year later 30% of participants had a weight loss ≥10%, 25% between 5% and 9.9%, and 40% ≤4.9%. In the LOOK AHEAD study, 8 years later, 50.3% of the intensive lifestyle intervention group and 35.7% of the usual care group were maintaining losses of ≥5%, while 26.9% of the intensive group and 17.2% of the usual care group were maintaining losses of ≥10%. Here's the DIRECT trial where mean weight loss at 2 years was 7.5% with 24% of participants maintaining losses greater than 22lbs. And in the recent year long DIETFITS study the average weight loss of all participants was 5%, with over 25% of participants losing more than 10% of their weights.

The Examine.com waterfall plots of the DIETFITS data

(And for an interesting thought experiment, have a peek at this thread from Kevin Bass that argues that even if the 95% failure number were true, those outcomes would be worlds better than the vast majority of medical treatments currently being offered for other chronic diseases)

So where does this 95% number come from? I could imagine it to be true if the goalpost for successful weight loss was total weight loss and reaching a so-called "healthy" or "normal" BMI. But that would be as useful a goalpost as qualifying for the Boston Marathon would be for running whereby the vast majority of marathoners won't ever run fast enough to qualify to run Boston. Does that mean non-qualifiers should be discouraged from running and told that running is impossible? It's also important to contextualize failures. If the methods being undertaken to lose weight are misery inducing overly restrictive diets, it's not people who are failing to sustain them, it's that their diets are failing to help them (which, with full disclosure, is the premise of my book The Diet Fix).

As far as what needs championing, it's certainly not failure. Given the medical benefits of weight loss, as well as the real impact weight often has on quality of life (especially at its extremes), what we need to collectively champion are the embrace of a plurality of treatments (including ethical behavioural and surgical weight management programs and greater access to them), along with more effective medications. What can simultaneously be championed is the removal of blame from the discussion of weight, fighting weight bias and stigma, recognizing that a person need not have a so-called "healthy" or "normal" BMI, that scales don't measure the presence or absence of health nor measure lifestyles, respecting people rights to have zero interest in losing weight or changing their lifestyles, that there is value to changing behaviours around food and fitness regardless of whether weight is lost as a consequence, and acknowledging that intentionally changing lifestyle in the name of health reflects a tremendous degree of privilege that many people simply don't possess.

Given the evidence maybe we can stop with the unhelpful, dehumanizing, and misleading unicorn talk, and while we're at it, stop telling everyone that failure is a foregone conclusion.

Saturday, May 11, 2019

Monday, May 06, 2019

What's The Point of Tracking Your Calories With a Food Logging App?

First up, the quantity and quality of calories matter both to health and to weight. You can't gain without a surplus. You can't lose without a deficit. And the quality of the calories you're consuming will affect health and satiety which in turn will affect the quantity of them that you consume. Moreover, the bioavailable calories you consume will differ by food, and also likely differs by individual (which is why some gain and lose with more ease than others).

Next up, we're crappy food historians. We may forget portions, choices, or both, not all the time, but certainly some of the time. We can't possibly know what's in meals we haven't cooked ourselves. And even if we are cooking ourselves, most aren't going to be weighing and measuring everything and eyes are terrible at both.

And a recent study confirms some of the above whereby researchers looking at users of myfitnesspal found the average user was missing nearly a meal's worth of calories a day (445). Yet studies on food diary use pretty much invariably report they markedly benefit weight loss efforts.

Personally, though I think having some rough inaccurate sense of caloric intake is valuable (if you were in a foreign country and didn't know the exchange rate, price tags would still be somewhat helpful), more valuable is the use of the food diary to remind yourself that you're trying to eat thoughtfully and likely differently.

Human nature being what it is, without a system designed to consciously remind you to change your usual default behaviours, you're likely to drift back to those behaviours, healthy or not, and a food diary, even if inaccurate, if kept in real-time, will remind you many times a day that you're trying to change.

So long as you're not using your food diary as a tool of judgment, as it's not meant to be there to make you feel badly about your choices, chances are it'll be of benefit, and likely it'll be of benefit regardless of what it is you're tracking (calories, macros, carbs, whatever) and even if inaccurate, because it's primary job is to serve you as your constant change reminder service, not as your judge and jury.

Saturday, May 04, 2019

Saturday Stories: Holocaust Memorial Day, Poway, And Synagogue Metal Detectors

Lori Gilbert-Kaye, may her memory be a blessing, murdered for being Jewish
A few days ago it was Holocaust Memorial Day, the day we commemorate the murder of 1 out of every 3 living Jews on earth prior to World War II. A week ago saw another murder for the crime of being Jewish, this time in California. Before that it was Pittsburgh. Though there's not much I can do about any of this, at least I can call your attention to these three pieces that try to weave it all together

Daniella Greenbaum Davis, in The Spectator, on antisemitism's new normal.

Rabbi Yisroel Goldstein, in The New York Times, on how being almost killed by a terrorist last week has affected his resolve.

Carly Pidlis, in Tablet Magazine, on how Jews can no longer simply consider themselves safe in America.

Monday, April 29, 2019

New Study Suggests ADHD Steers Children To An Unhealthy Diet, Not The Other Way Around

To be taken with a grain of dietary recall data, but a new study, Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort, found that an ADHD diagnosis led children to a less healthy diet, whereas less healthy diets did not lead children to ADHD.

The study was conducted in the Netherlands and it followed 3,680 children starting at age 6 and then ending when they reached the age of 10.

Put plainly, though more ADHD symptoms at age 6 were associated with less healthy diets at age 8, diet quality at age 8 was not associated with ADHD symptoms at age 10.

There are a number of proposed pathways to help explain how ADHD might affect diet quality. ADHD and its impulsivity may increase the risk of binge eating or loss of control eating, and the impact of ADHD on neurotransmitters may affect hunger and fullness. It's also possible that some parents of children with ADHD may offer foods their children prefer in order to decrease risk of conflict and/or reward desired behaviour.

Clearly more research on this would be welcome.

Saturday, April 27, 2019

Saturday Stories: Freds, Sexism in Science, and Anti-Vaxx Marriage

Danielle Kosecki, in Medium, with her defense of Freds (less serious cyclists, and disclosure, I am one).

Mallory Picket, in The New York Times Magazine, on sexism in science's highest echelons.

Anonymous, in The Cut, on marriage with an anti-vaxxer.

Tuesday, April 23, 2019

Move More, Eat More? New Study Suggests People Do Eat More When They're More Active, But Not Much

One of the possible reasons that in freely living humans exercise doesn't seem to add up to weight loss as math might predict is that freely living humans might eat back their burned calories. Some may do so consequent to increased hunger. Others to a sense of virtue and the inclination to reward themselves for their hard work. Others still because marketing has convinced them that they must refuel, recover, replenish, etc..

A new study,Activity energy expenditure is an independent predictor of energy intake in humans, published this year in the International Journal of Obesity, set out to look at this phenomenon.

Now to be clear, the study certainly wasn't designed to explain exercise's impact on weight. It was just 7 days long and it involved the retrospective analysis of data from 5 prior studies and did not directly measure energy expenditure or energy intake. Instead researchers utilized estimated energy expenditure by way of heart rate and indirect calorimetry data, and energy intake by way of known to be problematic food diaries.

My stats skills are nowhere near good enough to comment on the various treatments of the data, but here's the scatter plot of the impact of energy expenditure on energy intake.

The increase in energy intake the authors attributed to energy expenditure wasn't high, roughly 3% of total daily calories (around 70 in this sample), an amount too small to explain away exercise's often uninspiring impact on weight loss.

Truth be told, I'd have predicted the difference to be larger as eating more consequent to exercise is something I know many people do for one or more of the various reasons mentioned above.

Of course none of this changes the fact that exercise has tremendous health benefits at any weight and that weight shouldn't be your driver for upping yours if you're able.

Saturday, April 20, 2019

Saturday Stories: IN MICE, Cancer, and Future Dementia

James Heathers, in Medium, explains why he started the Twitter account that only ever tweets "IN MICE"

Anne Boyer, in The New Yorker, on what cancer takes away.

Tia Powell, in Elemental (on Medium), on how she's preparing for her future dementia.

Wednesday, April 17, 2019

RDs! We're Hiring! Looking To Fill A Full-Time Permanent And Possibly Some Part-Time Positions

Will copy our job posting below, but the tl;dr version is we're both growing (our digital distance tool is deep into development and should be ready for beta-testing come late spring or early summer) and one of our wonderful RDs will be heading off on maternity leave. Consequently, we're looking for some great RDs!

Prior applicants are welcome by the way. In fact many of the RDs we've hired over the years had applied more than once.

Here's the posting. Please send resume and letter of interest to jobs@bmimedical.ca
The Bariatric Medical Institute (BMI) in Ottawa, an inter-professional weight management office that includes medical doctors, personal trainers, registered dietitians, a social worker, a clinical psychologist, and a therapy dog, is looking for a permanent full time dietitian to join our professional and unique team.

We are looking for an individual who loves working with people and technology, is great at multi-tasking, is a team players, thrives off of challenges and responsibility, and wants to utilize his or her skills in making a dramatic positive difference in people’s lives.

Responsibilities will include:
  • Collaboration with interprofessional team members.
  • One-on-one counselling sessions to motivate and help patients live the healthiest they can.
  • One-on-one counselling sessions with parents of children struggling with weight to help them navigate a healthy eating environment.
  • One-on-one counselling sessions to help prepare patients for bariatric surgery as well as post-surgery sessions to help patients ensure that they succeed.
  • Design individualized nutrition plans based on each individuals’ unique lifestyles, metabolic rates and dietary likes and dislikes.
  • Write for BMI’s different social media outlets: Website, blog, vlog, and monthly newsletter.
The skills you’ll need:
  • Exceptionally strong motivational counselling skills.
  • Must have excellent listening skills, empathetic and sensitive to patient’s needs. We do not ever utilize negative reinforcement in our counselling.
  • Able to adapt nutrition advice to recent scientific research with thoughtful critical appraisal.
  • Must be innovative and give patients realistic and helpful nutrition advice.
  • Positive and non-restrictive approach to weight management.
  • Comfortable giving presentations.
  • Possess sound professional judgment, initiative and enthusiasm.
  • Good time management skills and ability to organize.
  • Excellent computer skills, and comfort with social media
  • Strong cooking skills.
The requirements we’re looking for:
  • Minimum one year of clinical experience
  • Registered Dietitian
  • Member of the College of Dietitians of Ontario and in good standing (or willingness and ability to join).
  • Master level clinicians are preferred, although not required.
  • Previous experience working in weight management and childhood obesity is an asset.
  • Working with us you will have access to a full gym facility as well as shower and change rooms. Physical activity and healthy living are the primary focus of our work and therefore we view your active lifestyle as a great asset.
Because we are looking for the best candidate our wages are highly competitive with those in the community and after the 3 month probation period, medical and dental benefits are part of our package.

We look forward to hearing from and meeting with you.

Are You Successfully Maintaining A Weight Loss OR Have You Recently Quit A Diet? If Yes To Either Question, Please Spare 2 Minutes For Our Research (Shares Welcome!)

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 thanks to the hard work of Michelle Jospe and Jill Haszard of the University of Otago, along with your responses, we have completed the DIET score's qualitative review and this survey is meant as a simple pilot to test the hypothesis that higher scores associate with longer term success, and we hope, that once collected, these results will be compiled along with our qualitative review for the DIET Score's first published preliminary study!

So again, if you're currently following a diet, or if you've recently quit a diet, we would greatly appreciate it if you were able to take just a few minutes of your time to fill out our quick survey by clicking here.

Thank you in advance!

Yoni

[Today's survey is the final one (hopefully) before we submit our paper on the DIET SCORE. Consequent to our first two surveys we tweaked our questions to make them more relevant and representative by way our your comments and expert feedback. Even if you filled our survey out last time, if you've been successful on your diet (any dietary strategy or approach, we're not picky) OR if you've recently quit your diet, we'd dearly love to hear from you and we promise, it will barely take 2 minutes to complete]

Monday, April 15, 2019

Coca-Cola Claims It Doesn't Market Soft Drinks To Kids, Announces New Star Wars Themed Bottles For Disneyland And Disney World

Coca-Cola has gone on record to state,
"Parents tell us they prefer to be the ones teaching their children about beverage choices. That's why for over 50 years we've adhered to a company policy that prohibits advertising soft drinks to children"
So clearly their newly announced plans to sell Star Wars themed bottles at Disneyland and Disneyworld must be targeting adults.

Nothing wrong with a liquid candy company trying to sell liquid candy (that's their literal job after all), but don't lie and pretend you don't target children with your marketing or that you care about anything other than profit.

Monday, April 08, 2019

The Joe Rogan Experience Gary Taubes And Stephan Guyenet Debate And All That's Wrong With Modern Day Dieting Discourse

First some disclosures. As far as diets go, I'm egalitarian. I believe that the best diet for you may be the worst diet for someone else, and that all diets work by way of reducing caloric intake, but that calories from different foods will have differing impacts upon health and satiety. As far as Gary and Stephan go, I like both of them. I've had the opportunity to have a number of offline conversations with Gary over the years and though I'm guessing we generally spent the majority of our time in those chats disagreeing with one another (sometimes rudely), for reasons I find difficult to pin down, I've always enjoyed them. Stephan is someone whose work I've been reading for years and whose opinion I respect and value. And the 3 of us, in 2017, were involved with the Cato Institute for an online debate on sugar.

With those out of the way, onto the debate.

I certainly hadn't planned on writing about it. And I won't spend too much time nitpicking the discussion. Suffice to say, as many already have, it seemed that Gary the journalist relied on stories to make his points, while Stephan the scientist relied on studies. Gary constantly interrupted Stephan, and somehow also managed to recurrently mispronounce his name (despite corrections), and Stephan, perhaps as a consequence, at times treated Gary dismissively.

If you're looking for a more detailed play by play of the entire 2 hours and 37 minutes, by all means, here's Layne Norton's fairly exhaustive (and even time stamped) coverage, but what I want to cover today are a few thoughts inspired by the debate rather than the debate itself.

Much of the low-carb high-fat (LCHF) (now in many cases interchangeable with #Keto) world has raged on for years about mainstream medicine and science's disregard for their chosen diet and theories. An old photocopy of an American Heart Association pamphlet from 1991 that indeed promotes sugar consumption gets trotted out as some sort of gotcha for 2019. Young keto adherent physicians proudly tweet of the "torture" they experience reading opinions on diets other than their own (disclosure - including mine). Cardiologists with bestselling LCHF diet books write breathless articles in newspapers championing the idea that everything you've been taught about diet and heart disease is wrong and encourage the specific consumption of saturated fat. Self identified "science journalists" (note, this isn't actually a dig at Gary but rather others) who purport to care about evidence embrace and amplify the most idiotic of theories, stories, or comments so long as they suit their narratives. And if a study contradicts any of the aforementioned folks' belief systems, the fault is said to no doubt lie with the methodology, or the researcher being conflicted (as Gary repeatedly suggested in the debate when discussing the work of his former NuSi hire Kevin Hall, as well as Jim Hill and colleagues' metabolic ward study that utilized direct calorimetry to show that people gained equal amounts of weight when overfed fat or carbs), or both. And of course pretty much all of the most vocal gurus, even the ones from prestigious institutions like Harvard, appear more than happy to extend their credibilities to prop up whatever medical quack (Mercola, Oz, Hyman, etc.) is willing to promote them.

For various reasons, listening to this debate reminded me of all of that.

Despite Gary's very real comment in regard to diet related chronic disease and society that,
"Tragic shit is going on"
it would seem to me that the bulk of the energy spent by the loudest of the LCHF/#Keto crowd is mustered trying to prove everyone else is wrong or conflicted, and that there is only one, true, right, best, diet - a message that's especially off putting when it comes from MDs, given every single day physicians are reminded that different treatments work differently for different people - sometimes predictably, and sometimes not so much - which is why for instance for hypertension there are at least 10 different classes of medications, and multiple options within each.

The starkest difference between Gary and Stephan I think comes at the 2:24:08 mark where Stephan details how much he loved Gary's Good Calories, Bad Calories and how he found it so persuasive that he personally adopted a LCHF diet, but that then he turned from the historical narratives conveyed in Good Calories, Bad Calories, to the science, and he found that the science told a different story. Not a story that suggested LCHF was a bad diet, or the wrong diet, or an unhelpful diet, but just that the science underlying Gary's hypothesis doesn't hold water for Stephan. And then, over the course of the next few minutes, in what I can only assume is his rebuttal, Gary tries to narratively explain Stephan's personal, subjective, experiences on LCHF diets, and then discounts the various studies Stephan mentions as being poorly designed while trotting out one study he does like from the 60s that to his reading, supported his assertions.

And I know this wasn't the point of the debate - it was a debate after all - but wouldn't it be grand if instead of the constant need of so many (and yes, there are definitely exceptions - see note at end) to promote LCHF/#Keto as the one right, best, only, diet, LCHF/#Keto proponents, especially those who are themselves researchers and health professionals, took a deep breath and realized that if tragic shit is indeed going on, that perseverating on motives rather than data, and fanning the flames of online outrage mobs, and propping up quacks like Mercola and Hyman, and promoting the worst examples of science and opinion so long as it suits their narratives, and fear-mongering around statins, and spreading the bizarre notion that there's only one right diet and that anyone who suggests otherwise is wrong and likely conflicted, while I suppose providing fodder for online debates, is indefensible, unhelpful, and a very real reason why there's far less embrace and research of a strategy that absolutely has a place in the treatment and prevention of diet and weight related diseases.

(And for an example of a keto adherent physician who bucks the aforementioned trend, look no further than cardiologist Ethan Weiss who just the other day penned this great post about keto, LDL, and treatment, all the while embracing science and reason)

Saturday, April 06, 2019

Saturday Stories: Disney Money, Fertility Doctor's Secrets, And The Gefilte Manifesto

Sarah McVeigh, in The Cut, with an interview of Abigail Disney (yes, that Disney), on what it's like having more money than you could ever spend.

Sarah Zhang, in The Atlantic, on the fertility doctor's secret.

Daniel Summers, in Arc, with a lovely piece on how a Jewish Cookbook is helping him to reclaim his lost heritage.

Wednesday, April 03, 2019

Coca-Cola Funded ISCOLE Trial Continues To Conclude Lack Of Exercise Drives Childhood Obesity

When it comes to associations, causality matters - the importance of which is easily understood when considering childhood obesity and inactivity. Whether inactivity leads to kids to gain weight, or whether weight leads kids to become inactive have very different implications

My publicly expressed bias is that childhood obesity drives inactivity, and there's data to support that assertion including this study whereby when observed over time in 8-11 year olds, weight gain predicted inactivity, while inactivity did not predict weight gain, leading the authors of that study to conclude,
"adiposity is a better predictor of PA and sedentary behavior changes than the other way around."
As to what's going on, if I were to venture a guess, it'd be some combination of obesity related abject bullying (multiple studies demonstrate bullying is associated with decreased physical activity and obesity has been shown to be the number one target of schoolyard bullying, not to mention the fact that bullies may make fun of heavier kids when exercising explicitly), being one of the worst/slowest on a team, and increased effort involved, that lead heavier kids to decreased MVPA (moderate-to-vigorous physical activity).

Now I've blogged before about the Coca-Cola funded ISCOLE trial almost entirely ignoring the possibility that childhood obesity drives inactivity rather than the other way around, and recently, another study came out of the ISCOLE group that did the same.

(and if you're interested, here's a published discussion of the emails between ISCOLE investigators and Coca-Cola that not surprisingly suggests that these relationships have the very real potential to influence the framing of results even if funders not involved in study design)

The study, Joint associations between weekday and weekend physical activity or sedentary time and childhood obesity, published in the International Journal of Obesity, looked at weekday and weekend levels of MVPA and sedentary time in 9-11 year old children in 12 countries and their associations with obesity.

Yes, they were found to be associated.

Though they do have a single throwaway line speaking to causality,
"It is not known whether lower levels of physical activity are the cause or the consequence of obesity",
that did not stop them from writing this as their final line and conclusion,
"Since children have more discretionary time during weekend days than weekdays, children should be encouraged to increase physical activity during weekend days, especially a high level of MVPA"
which while true on the basis of health as a whole, when framed in the explicit context of childhood obesity as it is in this paper, seems to deny the much more likely case that weight simply slows kids down.

And honestly, that matters.

It matters because one of the most predominant stereotypical narratives of obesity is that it is a disease of laziness, and ISCOLE's recurrently utilized framing supports that stigmatizing message. It also matters because, if considered at least by the parents I regularly see in my office, inactive children with obesity are being regularly judged (and sometimes even shamed or bullied) by their well-intentioned parents for not being active enough to lead them to lighter weights and I can't help but wonder if this would still be the case if the meat of the discussions in these sorts of papers focused on the barriers to physical activity erected by childhood obesity itself?

I would love to see more research done on the various mechanisms by which childhood obesity might contributes to inactivity, and more longitudinal studies designed to test causality, rather than paper after paper with conclusions that to my confirmation bias at least, ignore the many reasons why kids with obesity are understandably less likely to be physically active, and in so doing, fail those poor kids.

Saturday, March 30, 2019

Saturday Stories: Vaping Risks, Doomsday Fungus, And A Friend With Cancer

Julia Belluz, in Vox, covers what we do and don't know about the risks of vaping.

Ed Yong, in The Atlantic, with the worst disease ever record.

Aaron E. Carroll, in The New York Times, on what his friend's cancer taught him about the healthcare system. 

(Photo by Lindsay Fox from Newport beach, United States - Vaping, CC BY 2.0, Link)

Wednesday, March 27, 2019

If You're Calling For A Ban On Bottled Water, But Not On Bottled Sugar Water (Soda, Juice, Sports Drinks, etc), You're Doing It Wrong

Apparently two former city Councillors, and some "water advocates" from a group named the Ottawa Water Study/Action Group, are lobbying the City of Ottawa to ban the sale of bottled water in all municipal buildings.

They rightly argue that Ottawa city tap water is terrific, and that the sale of bottled water is destructive to the environment.

But here's the thing.

All the other plastic bottles in the vending machine, you know, the ones that are just water with some sugar and flavour, they're in the very same bottles, and their consumption, unlike water's, isn't good for health.

So if you enact a ban on bottled water, but allow the sale of sugared waters, you're likely to shift sales to them, will do little to nothing towards for the environment, and you'll be promoting unhealthy beverages. Not something I can get behind.

I'm all for banning the sale of plastic bottles, but all plastic bottles, not just the ones containing the only actually healthy beverage being sold.

Monday, March 25, 2019

Shoppers At UK Supermarkets That Got Rid Of Checkout Aisle Junk Food Purchased 16% Less Small Pack Junk Food One Year Later

So it wasn't a randomized trial, but the results were interesting nonetheless.

In the UK, a number of supermarkets electively decided to stop the sale of impulse buy small pack checkout aisle junk food. Researchers curious about the impact had a peek at their sales data.

What they found was encouraging and they detailed their findings in their article Supermarket policies on less-healthy food at checkouts: Natural experimental evaluation using interrupted time series analyses of purchases. Plainly put, when compared with purchases from supermarkets still selling checkout aisle small pack junk, shoppers purchased 16% less small pack junk food from supermarkets that didn't offer checkout aisle junk food temptations.

Given the ubiquity of junk food in checkout aisles, and here I'm not just talking about the supermarket, but pretty much any and every checkout aisle, cleaning them up is a very real target in improving our food environment. And before you say it can't be done, it's been done with tobacco's "Power Walls" (but some irony here in that at least some of the new walls hiding cigarettes are being used to advertise junk food)



Saturday, March 23, 2019

Thursday, March 21, 2019

If You Tie Exercise To Weight Loss It Can Lead To Statements And Recommendations Like These

I've long called for a rebranding of exercise to promote it on the basis of all of its incredible benefits, and explicitly not in the name of weight loss.

While on paper there's no doubt that people can lose weight through exercise (and in research studies too), in practice they generally don't. And though there's also definitely the suggestion that exercise helps to keep weight off (or serves as a marker or inspiration for maintaining a whole slew of weight responsive behaviour changes), when it comes to public health, I believe focusing on weight loss as the outcome of choice in exercise interventions risks those interventions' dissolution when weight loss doesn't occur.

Helping to make my point is a recent study published in the American Journal of Preventative Medicine. The study, Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial, looked at the impact school based nutrition and physical activity policies had on weight.

The study found that while school based nutrition policies seemed to have an impact on weight over time, school based physical activity policies didn't.

Not measured of course, or at least not mentioned, were the impacts those physical activity policies might have had on other health related parameters (blood pressure, blood sugar, non-alcoholic fatty liver disease, mood, sleep, attention, learning, physical literacy, and more) - things that I think the literature would support as being far more likely to see exercise-related improvements.

But it's the study's abstract's conclusion that got me, as I think it does a great job of highlighting the risk of clinging to exercise as an important driver of weight loss. Here it is in its entirety (highlighting mine),
"This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions."
Suffice to say I think it'd be an incredible shame if results like these guide any future school related physical activity interventions, as the benefits of exercise are myriad, something these results wholly ignore, and if these results guide anything, they'd guide the avoidance or elimination of school based physical activity policies which would let kids down on so many levels.

Tuesday, March 19, 2019

Why I Don't Celebrate Marketing Fruit To Children By Way Of Cartoon Characters

A few weeks ago I noticed the Center for Science in the Public Interest giving kudos to Disney and to The Lego Movie for their licensing of their cartoon characters to sell pineapples and bananas.

I don't share their enthusiasm.

In part that's because neither Disney nor the Lego Movie have any qualms licensing their characters to sell crap to kids. McDonald's recently announced that Disney's happily taking many millions of dollars from them (actual dollar cost not announced, last was $100 million) to once again include Disney toys in their Happy Meals, while the Lego Movie, well they're already in Happy Meals.



But my bigger objection is that we shouldn't be targeting children with advertising in the first place because why should anything be advertised to a population that has been shown to not be able to discern truth from advertising? And so even if the advertisements happen to fit with your definition of what's good for kids, it doesn't change the fact that it's plainly unethical to allow advertising to target children period.

Saturday, March 16, 2019

Saturday Stories: Feast Burden, Old Hate, And Wellness Cults

Bobbie Ann Mason, in The New Yorker, on the burden of the feast.

Isaac Chotiner, in The New Yorker, with a not at all gentle interview of Holocaust historian Deborah E. Lipstadt on the oldest hatred.

Margaret McCartney, in the Globe and Mail, on not falling prey to the cult of wellness.

Wednesday, March 13, 2019

Coca-Cola's New Simply Smoothie Strawberry Banana Contains 11.5 Teaspoons Of Sugar Per Cup

I should probably be putting "smoothie" in sneer quotes when discussing this new product.

The ingredients in this "smoothie" aren't simply water, strawberries, and bananas but rather they're strawberries, bananas, and apple, grape, and lemon juices.

Perhaps that's why in an 11.5oz serving of it, there's 44g of sugar (responsible for 85% of its 200 calories). For reference, drop for drop, actual Coca-Cola contains 15% less sugar and 33% fewer calories.

But of course no one confuses Coca-Cola for a healthy beverage.

But Coca-Cola (Simply's parent company) sure hopes you confuse this "smoothie" with one given they've festooned it with front of package shout outs that explicitly suggest it's good for you.

I'm also confused by its nutrition.

The ingredients report that 11.5oz of banana strawberry "smoothie" provides 1g of fibre - that's less than what would be found in just a 5th of a small banana, and yet to eat 44g of sugar from small bananas, you'd have to consume 18x that amount. And the 35% Vitamin C? You'd get that from just 2 strawberries.

Unless it's you doing your own blending (and even then, remember it's not likely to be as filling and you'll be able to consume a great deal more) eat your fruit, don't drink it.

Monday, March 11, 2019

Why Fund Or Publish Diet Studies That Have Little Relationship With Real Life?

I'm honestly not trying to be mean, but that was the thought that went through my mind when I read the recently published study, Log Often, Lose More: Electronic Dietary Self‐Monitoring for Weight Loss which purports to explore the relationship between food diary use and weight loss.

Don't get me wrong, I'm a huge proponent of using a food diary. Whether it's tracking calories, carbohydrates, macros, or whatever, there's ample evidence to suggest that tracking helps to maintain new behaviours, but is that what this study showed?

Well it did show that those keeping a food diary and using it more often had greater weight loss during a 24 week behavioural weight loss intervention.

So what's my problem?

I have two (well, two related to this study, clearly many overall).

The first is that the food tracker utilized was web based, and not a smartphone app. It's a minor quibble, but nonetheless, app based food diaries are the norm, why not use them? Given we have our phones wherever we go, but not our desktops and laptops, that might make a real difference to the percentage of people using them (and yes, I realize there are web browsers on phones, but that's just not the same).

I'm guessing the reason a smartphone app wasn't used is that using one would not have provided the researchers with the minutes users spent tracking, which brings me to my second, and more significant, concern.

Apparently, in the first month, successful users (those who ultimately lost more than 5% of their presenting weights) were shown to be using that web based food diary 23-24 minutes daily. And though some of that is likely consequent to learning curve, by month 6 it was still taking them 15-16 minutes of effort to record their daily meals and snacks.

Those are extremely high numbers. Having once done a stretch of 3 years of not missing a single day's use of, first a web based, and then an app based food diary, I can tell you that in short order, it really shouldn't take longer than 2-3 minutes daily to track. The learning curve is at most 2-3 weeks, and once beyond that, useful food diaries keep track of your entered meals and snacks such that re-entering them is a simple as a click.

Or at least that's how it should be.

Which means that the users in this study were either taught the world's least efficient means of keeping a food diary, or the web interface utilized was just awful (or both).

Either way, I'm not sure how the results of this study help much. Because while I'm definitely a believer when it comes to the benefits of food diary use, it would seem to me that what this study actually measured are the outcomes of people so incredibly dedicated to their behaviour change efforts, that they bothered putting up with an awful and time consuming food diary for 6 months.

[for some expanded thoughts from me on keeping a food diary, here's a piece I wrote for Greatist a number of years ago, and for full disclosure, I'm currently closing in on beta-testing our office's own food diary and behaviour change smartphone app]

Saturday, March 09, 2019

Wednesday, March 06, 2019

No, New York State Academy Of Family Physicians (@NYSAFP), Sugar Sweetened Milk Is Not "Essential", Just Ask The @AAFP

So what possible reason could the New York State Academy of Family Physicians (NYSAFP) have to highlight in their weekly eNews circular sent to 10,447 family physicians and students, an article that claims, "Flavored milk is essential" and "a tasty way for kids to get the 9 essential nutrients that they need"?

I think it's a fair question given the World Health Organization, the Centers for Disease Control, and yes, the NYSAFP's parent organization, the American Academy of Family Physicians (AAFP) all recommend that added sugars contribute no more than 5-10% of total daily calories, and yes, chocolate milk contains heaps of added sugar.

In fact, the American Academy of Family Physicians explicitly discourages the consumption of sweetened or flavoured milk stating,
"It is important that you stay hydrated. However, drinks that contain sugar are not healthy. This includes fruit juices, soda, sports and energy drinks, sweetened or flavored milk, and sweet tea."
And I'm guessing the answer won't surprise you either.

The answer is money.

Specifically, $2,300.

Because that's how much the NYSAFP charges companies for a "Product Showcase" feature that goes out in 13 separate emails to reach those 10,447 family physicians and students.

That's $177 per mailing.

And what does that $177 buy the American Dairy Association North East?

Well of course it buys the ad space, exposure, and frequency, but it also buys credibility.

I'll let the NYSAFP explain,

So NYSAFP, if you're reading, please issue a correction, and to that end, here's an invitation for you. If you'd like to send out some information about what happens when chocolate milk is removed from school lunches to your 10,447 physician and student members, please take this as my permission to freely republish my blog post that covered the study on this very matter that found that taking chocolate milk out of schools did not affect the students' total daily milk or dairy consumption, that on average all students were meeting their daily recommended amounts of dairy (recommendations which by the way are almost certainly higher than the evidence would suggest they need be), that kids who swapped from chocolate milk to white milk drank pretty much the same amount of white as they did chocolate (unless you think 4/5ths of a tablespoon of milk is a lot), and that by removing chocolate milk from the school, in the first month alone nearly half of the initial chocolate milk drinkers switched to white and in so doing, saved themselves piles of calories and the nearly 2 full cups of monthly added chocolate milk sugar.

Or at the very least, kill that ill-advised ad and maybe revisit your policies around vetting sponsors.

[Thanks to Beth Locke for sending the NYSAFP's eNews my way]

Monday, March 04, 2019

Surprise? Offering In Class Breakfasts of Cereal, Muffins, Juice, and Milk For 2.5 Years Increases Obesity In Students

Yup, it's true.

Offer children in-class breakfasts consisting of cereal, muffins, juice, and milk for 2.5 years and compared with children in schools not offering those in-class breakfasts, their weights end up being, "significantly higher".

Those are the results of a study recently published in JAMA Pediatrics, and really, they don't seem all that surprising.

Firstly, the breakfasts were offered to all children, regardless of whether this was, as Hobbits might say, second breakfast



But more to the point, would anyone expect a not likely to be sating breakfast consisting of cereal, muffin, juice, and milk, to have a positive impact on weight or health (and I should take the time here to point out that the study authors were not in charge of what schools chose to feed their students)?

As I've ranted many times, what a person eats for breakfast likely matters a great deal to satiety, health, weight and what have you. I've also ranted on the dangers of lumping studies of specific meals (in this case ultra-processed carbs washed down with a bunch of liquid calories) and then opining on the benefits of "breakfast" as a meal.

Food insecurity is real, and finding the means to ensure children eat healthy meals is laudable, but feeding children who are already at increased risk of chronic diseases, meals that may themselves increase the risk of developing chronic diseases, probably isn't in their best interest, and given that, as one of the study's authors Kate Bauer noted on Twitter,
"all breakfasts met the federal School Breakfast Program requirements"
it sure makes one wonder whether America's federal School Breakfast Program could stand for some revision?

Saturday, March 02, 2019

Saturday Stories: Not Killing Babies, "Top Doctors", And Sobriety

David McMillan
Dr. Jennifer Gunter, in The New York Times, sharing her sorrow to tell America that no, she didn't kill her baby, nor are any doctors executing children at birth [as an aside and as a Canadian, I find it mind boggling and horrifying that these statements need to be made in 2019 America]

Marshall Allan, the journalist, in ProPublica, on how he was named one of America's "Top Doctors".

David McMillan, co-chef-owner of legendary Montreal restaurant Joe Beef, in bon app├ętit, with a phenomenal read on his finding sobriety and the impact it's had on those around him.

Monday, February 25, 2019

More On Set Points And Why I'm Not Fond Of Them

Seems my last post struck many different chords depending on the lens with which it was read.

Some people read it as stating that they're not trying hard enough.

Others read it as there's no point in trying.

Others agreed with me.

So for clarity, here's a bit more.

Me stating that lifestyles matter, that sociology matters, that our lives' patterns matter, and that they in turn help to explain why people often regain all of their lost weight when what's usually an overly restrictive weight loss effort is abandoned isn't me stating that people ought to be able to just tough out overly restrictive weight loss efforts. It's me pointing out that if your weight is currently stable, you're in equilibrium. You have, like we all do, an average daily caloric intake and output which of course includes things beyond your control (including genetics, medical co-morbidities and medications, job requirements and responsibilities, caregiver responsibilities, and more), out of the realm of your conscious ability to control (food marketing, societal and social norms, the constant, usually well-intentioned thrust of food at every turn, and more), and things that are unfair to expect you to control (largely the normal use of food to socialize with your friends and families). These are the sorts of the things that make up something some refer to as your "expososome", and I think the impact emigration tends to have on weight, which depending on your starting and finishing countries may well increase or decrease yours, is a clear example of how it influences your equilibrium. But regardless of your expososome, yes, there are things within your control to change that can affect your weight (though definitely not free from being influenced from many of those out of control factors) like how many meals you cook and your cooking skills, your liquid calorie consumption, your frequency of meals and snacks, the macronutrient composition of your diets, exercise, and more. And it's also true that for some, their lives' realities preclude intentional behaviour change.

What I was talking about yesterday, are the people who regain all of the weight they've lost with any given effort. These tend to be people who ultimately, for various reasons, are unable to continue with their change efforts. Instead, likely, not all at once, their efforts wane, then end, and those people find their way back to all of the original behaviours, factors, and choices that they were living with prior to their changes, which in turn brings back all of their old calories, eventually bringing their weights back to that same place where they were before (or perhaps even slightly higher consequent to metabolic adaptation leading them to burn fewer calories at a comparable weight than prior to their weight loss effort).

Why does this happen?

I think for a significant percentage of people it happens because the changes they employed were too severe. Maybe they were perpetually hungry, or denying themselves foods they loved and enjoyed, or they cut out entire food groups, or they found themselves unable to enjoy a meal out with friends, or regularly having to cook multiple meals (one for them, and one for their family). In short, the efforts many people undertake aren't by definition sustainable. They're for-now efforts, not for-good efforts. And I think the reason so many choose those types of approaches is that society (including the public health and research communities) generally describe total weight loss as the goalpost, and so people take on extreme efforts, because that's pretty much the only way to get there.

On the other hand, those individuals who lose weight and keep it off? While they nearly never are people who lose every last ounce that some stupid table says they should, there are huge numbers of them who've managed to lose a subtotal amount of weight and keep it off. Knowing these people, reading about these people, their most common denominator is that they enjoy the new lifestyles they've crafted sufficiently so as not to perceive them as suffering.

So if you want to lose weight, you're going to have to change some of those things that are within your control to change, but you're also going to have to pick changes that you can honestly enjoy if you want to keep the weight you lose, off. And different people, for a whole host of reasons, will have fewer things they're able to change, not to mention the fact that life and circumstances will also have a say as time goes by. But for everyone, change generally means embracing imperfection, still eating food for comfort and celebration, still socializing with friends and family, and more. And the degree of changes you'll be able to sustain will undoubtedly be impacted by many things beyond your control, and your physiology will undeniably limit your losses and the amount you're able to change without suffering. But that doesn't mean that physiology will prevent you from ever making any changes.

Maybe, if we all aimed for smaller, more realistic, less extreme, but all the while plainly sustainable changes, and as a society we stopped with Biggest Loser style efforts, and we redefined success, we'd see a great deal more of it.

Why I Still Have Issues With Set Point Theory And Weight Regain

Last week I watched a few people who I both follow and respect chat about set point theory - you know, the one that posits your body defends a particular weight such that after you lose, your body will in a sense strive to get back to where it started. And I tried to do so with an open mind, I really did, but I guess my own confirmation biases got the best of me because the conversation left me sighing.

That's not to say metabolic adaptation doesn't exist. It most certainly does. Metabolic adaptation is the catch-all term that refers to the very real fact that weight loss leads to a decrease in resting metabolism, a decrease in the thermic effect of meals (the cost of metabolizing what you eat), decreased energy cost of physical activity, and to changes to hunger hormones which in turn might well lead you to eat more. In general this also leads to the very real fact that weight loss is far from linear and that it usually stops sooner than expected or desired.

But it's the set point blamed regain back to starting weights that I struggle with conceptually.

Why?

Because generally speaking, it's presented as physiologically driven. My belief is that while metabolic adaptation definitely and somewhat depressingly affects how much weight might be lost with any given effort, it's really sociology that drive the bulk of most people's regains.

What I'm getting at is that people don't regain most or all of their lost weight because their bodies effectively tell them to, they regain most or all of their lost weights because when they quit whatever diets they were on, they revert back to the diets they were consuming beforehand, and by diets, I also mean lifestyles.

For instance, they might stop packing their lunches and head back to their cafeterias, food courts, or drive thrus. They might resume their regular nights out with friends and go back to drinking more alcohol and/or sugar-sweetened beverages. They might bring back some (or more likely all) of the snack foods and indulgences that they'd cut out while "being good". They might return to their older pre-established automated portion sizes and of course their older pre-established dietary staples.

In short, people regain their lost weights when they regain their lost lifestyles, as doing so brings them directly back up to their pre-weight loss average daily caloric intakes which in turn supported their pre-weight loss weights.

Which brings me back to another seminal confirmation bias of mine. The more weight you'd like to permanently lose, the more of your life you'll need to permanently change, which is why the world's best diet for you, is the one you actually enjoy enough to sustain. No, it might not lead you to lose as much as a magic wand would allow because metabolic adaptation does occur, but if you actually enjoy your new diet, and you don't head back to your old lifestyle when you quit the overly strict diet that's leaving you miserable, you need not worry that somehow, magically, due to a "set point", you're going to end up right back where you started.

Saturday, February 23, 2019

Saturday Stories: Weight Hate, Sucky Recess, And The Fall Of UK Labour

Ted Kyle, Caroline Apovian, and Amanda Velazquez, in Medscape, respond to Medscape's recently posted fat shaming, hate-speech, garbage fire, of an editorial.

Naomi Buck, in The Globe and Mail, on why recess sucks now.

Stephen Daisley, in The Spectator, on the beginning of the end of the UK's Labour party.

Tuesday, February 19, 2019

Guest Post: The Problems With Balancing Accuracy And Reach In Science Communication: What To Do When Even Journals Want To Contribute To Media Hype (HIIT Edition)

Last week saw the publication of a new study in the BJSM entitled (highlighting mine), "Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT)". Understandably intrigued given a prominent medical journal was suggesting there was a magic bullet for fat loss, I clicked through, and then reading the piece I learned that the amount of fat lost that the BJSM was calling a "magic bullet" was a 1 pound difference, one which the study's abstract's conclusion described as, "a 28.5% greater reductions in total absolute fat mass (kg)". Duly surprised, I then took to Twitter to poke around and found that one of the study's authors, James Steele, was tweeting out a corrective thread to his own study's hype - hype which understandably and predictably led to an onslaught of media overreach. Intrigued, I approached him directly to ask about the discordance in tone between his tweets and his study's title and conclusion, and he sent me such a thorough and thoughtful response (explaining how it was the BJSM's editor who'd changed both), that I asked him if he'd mind my sharing his thoughts here as a guest post. Suffice to say, in my opinion, medical journals and their editors shouldn't be in the business of clickbait hype, as it diminishes themselves, research, and furthers societal scientific illiteracy by suggesting that such things as "magic bullets" for weight or fat loss can conceivably exist.
I was first slightly concerned that the findings would be overhyped and potentially misrepresented when I saw the press release that was sent to the media. I was forwarded various requests by our institutions news team and saw the wording of the first line of which was
Short bursts of high intensity exercise are better for weight loss than longer sessions in the gym, research suggests.
My colleague James Fisher noted to me that he also thought the press release didn’t reflect the findings accurately and wondered whether the title change resulted in the perception of a different finding.

The original title in our submission to the journal was
"Comparing the effects of interval training versus moderate-intensity continuous training on body adiposity: is it possible to find a signal in the noise? A systematic review and meta-analysis"
which was chosen as an homage to Nate Silvers' book and the use of meta-analysis to find the ‘signal’ from among the ‘noise’ of conflicting findings in smaller studies The paper underwent peer review as normal and we made changes suggested by the reviewers to improve the manuscript; but, none of the reviewers commented on the title if I recall. After the reviewers were happy with the paper and had no further changes they wanted we received a recommendation that it be published, but with minor revisions which were suggested by the editor. Most of the revisions suggested where helpful as they seemed to be aimed at improving readability of the manuscript. However, it was also suggested that the title was changed, as well as the addition of the percentage difference to the conclusion of the abstract. This was suggested to be intended to attract more attention to the article, make it seem more compelling, and ensure recognition was received for the work. I didn’t particularly like the newly suggested title, nor did some of my co-authors, but it was not strictly saying that anything ‘was’ a ‘magic bullet’ and so I did not push the issue. I must confess I did not at the time notice the seemingly minor change to the abstract conclusion though. I personally dislike the presentation of % values in this manner as to me they are often misleading and detract from whether the absolute values are really meaningful or not (a big problem in sport and exercise IMO wherein a lot of studies make interventions seem better than they are by reporting % values). The value is not inaccurate, but it does lead the less wary reader to potentially draw the wrong conclusions.

I did suspect that the changes were suggested because the paper would likely be selected for a press release which turned out to be correct. I’m glad the paper got some wide coverage, but wanted to make sure it was covered in a nuanced manner. So I tweeted a little thread to try and provide some balance and when I was interviewed about it on BBC World Service I also made sure to provide as balanced a commentary as I could in the time permitted.

It doesn’t surprise me that the media initially interpreted things to be saying that ‘HIIT’ (high-intensity interval training) was better than ‘MOD’ (moderate-intensity continuous training) for fat loss without considering all the nuance… that’s just how it goes sadly. I also can empathize with the journal and publisher in wanting to try and increase the reach of the work that they publish. To my mind if we can widen the reach of good science, and raise appreciation of its importance, then that’s a good thing. This is something I’d like to be able to do more of. But, though this is good in principle, in execution it proves to be difficult. It’s tough to get the nuance across because science is hard and most people aren’t really able to understand it. I guess it’s part of the media cycle though. The wider media wants ‘stories’ and just regular boring old science doesn’t make for a good story. So to get the wider media’s attention journals and academic publishers need to try and make things seem more exciting. In that process though nuance gets lost. However, I can’t think of any other way to communicate science more widely at the moment. I guess what we need to ensure is that, once the media get hold of a story and want to run it, the actual scientists themselves are the ones they speak to and interview so they end up with a platform and captive audience to explain the nuance and implications in an understandable manner. At least, that’s what I’ve tried to do and hope I achieved.

I think if I was able to ‘do over’ this example specifically then I would have likely pushed back more on the issues. I would like to have kept the original title and would have argued for this position as I suspect my co-authors likely would have too. I definitely would have pushed back on the change to the abstract conclusion and will be more vigilant to these issues in future. In likelihood this might have meant the paper would have been less ‘impactful’ as a story for the media. But it would have meant that the paper itself didn’t contribute to any potentially misleading publicity. The publisher could have still put out the press release as they desired… Can’t stop them from doing that. But at least the paper would have better reflected what we found in full. I think I would advise authors who face similar situations to make sure they think and have a conversation about this. We all want our work to reach the widest audience to hopefully have the biggest impact possible. But we don’t in the process want it to distort in terms of its message. Make sure to discuss it with your co-authors and the journal/publisher and find the right balance so that scientific integrity is retained, whilst reach is maximized. It’s tough to do, but worth striving for IMO.

Dr James Steele is the Principal Investigator at the ukactive Research Institute, and Associate Professor of Sport and Exercise Science at Solent University. James completed his BSc (Hons) in Applied Sport Science in 2010, and hid PhD examining the role of lumbar extensor resistance training in chronic low back pain in 2014. He has extensive experience of research and applied consultancy in the area of physical activity, exercise, and sport from over the past decade, working with a wide range of populations ranging from elite athletes across a range of sports, to the general population across the lifespan, and both those who are healthy and diseased. James has published numerous peer-reviewed articles and delivered several invited talks at international conferences on a variety of areas relating to sport, strength and conditioning, physical activity and exercise, health and fitness. He was appointed to the Expert Working Group revising the Chief Medical Officers Physical Activity Guidelines for the UK and is a Founding Member of the Strength and Conditioning Society, as well as the Society for Transparency, Openness, and Replication in Kinesiology, and member of both the British Association of Sport and Exercise Sciences and the American College of Sports Medicine.