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.