Tuesday, July 16, 2013

What the Tiny Archipelago of Vanuatu Can Teach Us About Obesity's Causes

Vanuatu is an archipelago in the South Pacific made up of 68 inhabited islands with 255,737 residents (as of early 2012). The islands are all in various stages of economic development and given the uniformity of the population (98% are Melenasian) the islands and their inhabitants in a sense can be considered a natural experiment of health transition consequent to progress which allows researchers to try to determine which elements of change are responsible for increasing rates of non-communicable diseases (NCDs) like obesity.

And that's exactly what researchers did.

In a study published in the journal Obesity, researchers assessed body composition and behavioural patterns including diet, physical activity and substance use on three islands that varied in their degree of economic development. They then analyzed relationships among their measures. One of the islands was characterized by small rural villages made up of subsistence farmers. The other was also rural but their main economy was tourism. The third was Vanuatu's urban capital city.

Researchers asked questions about: Ancestry, family history of NCDs, occupation, education, subsistence related activities, 24 hour dietary recall, frequency of sports and sedentary behaviours and substance use. The researchers measured: BMI, body fat percentage (both by means of bioimpedance analysis and multiple skin folds), waist circumference, and waist to hip ratio.

The findings weren't all that surprising, yet still are worth reviewing. Risk of obesity, increased body fat percentage, increase waist circumferences and waist to hip ratios all went up in lock step with degree of economic development.

And the biggest predictor of weight change? Processed food consumption - in this case tinned fish canned in oil or sauce served with instant noodles or rice (versus the more traditional fresh fish with root crops and vegetables).

As would be expected, physical activity and sedentary behaviour had much weaker associations with weight change than did diet.

Unfortunately convenience foods aren't particularly convenient for health.

Monday, July 15, 2013

Guest Post: What Reading That Artificial Sweeteners "Study" Actually Told Me

Today's guest post comes from Colby Vorland. You can always count on Colby to carefully read source articles before weighing in on them. Like me, Colby has no vested interest in whether or not artificial sweeteners are risky or beneficial, but also like me, Colby prefers to rely on evidence to inform his opinions rather than conjecture or gut beliefs. So when I saw him wading into the fray on this irresponsibly published piece (you'll understand what I mean when you read Colby's post), I invited him to summarize his concerns here (and he's also done so in even greater and fully referenced detail on his excellent blog, Nutritional Blogma)

An opinion article in the journal Trends in Endocrinology and Metabolism by Dr. Susan Swithers about artificial sweeteners made for scary articles last week. Here is a small sampling:
And many, many more. Her message reached millions.

These news pieces were largely based on a press release from the journal publisher (Cell Press) titled "The dark side of artificial sweeteners". The press release and article argue that artificial sweeteners increase risk of obesity, diabetes, and metabolic syndrome (and therefore heart disease). It is true that some research associates artificial sweeteners with these outcomes, but it is also true that some research does not. With a look at the article, there are a number of mistakes and/or misleading things about it, and it does not reflect all the evidence. Below I review the article's sections on artificial sweeteners and obesity, diabetes, metabolic syndrome, and heart disease. Dr. Swithers and others have done interesting neuroscientific rodent work with artificial sweeteners which is the second half of her article which I do not review here.

Here is what is missing from media stories about this publication:
  • This was not a systematic review of all research. In fact, the oldest paper on artificial sweeteners cited was published in 2007. There are a lot of studies published prior to 2007 on this topic.
  • All of the cited studies were trying to support a view that artificial sweeteners are harmful, and all studies suggesting artificial sweeteners have no relationship with disease were ignored as you can see below.
  • Strangely, these are not the fault of Dr. Swithers, but the requirements of the journal: "Opinions should present a personal viewpoint on a research-related topic, rather than a balanced review of this topic." They also note that you should not cite meta-analyses, and there is a reference limit.
So to summarize - the journal specifically requests non-balanced articles of only recent research, then puts out hyped press releases without saying this, and as a consequence, frightens millions of people. To me, scientific "opinions" should be based on a dispassionate analysis of the whole relevant evidence-base, whereas this is simply irresponsible, and it should change.

Weight
  • Swithers cites 2 observational studies that purportedly show a relationship between artificial sweeteners and weight gain.
  • The first made no statistical adjustments for any dietary variables.
  • The second found a cross-sectional relationship but not a longitudinal relationship, the latter being a stronger study design. 
  • There are stronger designs not cited (for example Mozaffarian et al. (2011) and de Koning et al. (2011)) that found associations between lower weight and higher artificially sweetened beverage intake.
  • A review not cited Anderson et al. (2012) concludes "there is no evidence that low-calorie sweeteners can be claimed to be a cause of higher body weights in adults."
Metabolic Syndrome
  • Next Swithers discusses observational studies associating artificial sweeteners with metabolic syndrome, citing 4 studies.
  • The first I blogged about and I would not say it shows there is an association.
  • The other 3 did find positive associations between diet soda and metabolic syndrome, but all of the papers caution about interpretation and suggest that diet soda could be a marker of poor diet/lifestyle habits or be the result of associations with other dietary variables.
  • Diabetics consume 3 times more diet soda per day than non-diabetics (Mackenzie et al. (2006)), so it may be that many of these associations are simply the result of people with new disease diagnoses switching to diet soda, rather than diet soda promoting disease.
Diabetes
  • The first study that Swithers cites to support an association between artificial sweeteners and diabetes actually showed no associations after all statistical adjustments. This is incorrectly described in the article.
  • In the second study cited, Swithers discussed only 1 of 2 cohorts within the study and ignored the other (which found no association).
  • The third citation is the only one that appears correctly described.
  • This last study is cited as supporting a positive association between at least 1 artificially sweetened beverage per day and diabetes, but there was no overall relationship with full statistical adjustments. Swithers then notes that in participants of normal weight at baseline there was a positive association, however she doesn't note that there was no relationship in those with overweight or obesity.
Cardiovascular Disease
  • Finally, 4 studies are cited that purportedly associate artificial sweeteners with hypertension and cardiovascular disease.
  • For the first and second, Swithers notes a positive association in the "age-adjusted model" but doesn't note that there is no longer an association all statistical adjustments are made.
  • The third does support a positive association, and indeed in 3 large cohorts. But we don't have good reason for why this is.
  • The last one I also blogged about here, which paradoxically found that sugar-sweetened beverages do not increase heart attack and stroke risk but artificially-sweetened beverages do. This study has a small number of participants and therefore a small number of cardiovascular events in each group and therefore I am not sure it is appropriate to draw conclusions without more studies.
Human Trials
  • Swithers only looks at human trials in the past 5 years (2 of them).
  • The first suggests that children consuming artificial sweeteners don't gain as much weight as those drinking sugary beverages, but there is no water group so it is dismissed.
  • The second is oversimplified and therefore misrepresented, as there were some beneficial effects from using diet drinks compared to water.
  • Swithers does not cite a meta-analysis (because the journal requirements wouldn't let her anyway) by de la Hunty and colleagues (2006) of short-term human trials that suggests substitution of sugar with aspartame/other sweeteners reduces total calories.
When all evidence is considered, it is a much more nuanced story. In my opinion, the evidence is weighted toward artificial sweeteners being fine. I would recommend the scientific statement by the American Heart Association and the American Diabetes Association published last year for a good review of human research on the subject. We do need more long-term human studies on metabolic outcomes and weight, but it seems like substituting sugar with artificial sweeteners does generally result in a small reduction in calorie intake.

Colby Vorland is a nutritional science graduate student. He blogs about various research topics in nutrition at http://www.nutsci.org and is on Twitter @nutsci.

Saturday, July 13, 2013

Saturday Stories: Heaven, Old Age, and Popeye

Esquire's Luke Dittrich wonders whether or not there really is "Proof of Heaven".

One of our time's greatest thinkers (Oliver Sacks) on what it means to him to be turning 80.

Maria Popova talks spinach, decimal places and Popeye.

[And if you don't follow me on Twitter or Facebook this week's US News column of mine is on whether or not there are "healthier" processed foods, and here's an interview I did on NPR's Air Talk with Larry Mantle on juice cleanses]

Friday, July 12, 2013

Forget Rube Goldberg Machines, The World Needs More Dog Goldberg Ones

Today's Funny Friday is a brilliant example of taking a tired old idea and making it very, very new again.....with dogs.

Have a great weekend!

(email subscribers head to the blog to watch)



Thursday, July 11, 2013

So What Happens to Employee Health After a Year of Treadmill Desk Walking?

Not as much as one might hope or guess.

This month's Obesity journal details a year long study conducted at a financial services corporation in Minneapolis where 36 sedentary office workers had their desks swapped with treadmill desks.

The treadmill desks cost roughly $126,000 ($3,500 or so a piece - that's a photo of one up above from Steelcase) so no doubt any company considering making this switch will want to evaluate the outcomes.

So what were they?

Well it isn't about to help folks lose piles of weight, but maybe a teeny tiny bit. As far as statistically significant differences go there were four. A 3lb weight loss, a 7% rise in HDL, a 1.6 inch decrease in waist circumference and a 3 point drop in systolic blood pressure.

As far as impact on activity and sedentary time goes - a $3,500 treadmill desk led workers to take on average 852 more steps a day and decrease their sedentary time by 43 minutes a day.

The desks weren't found to lead to any changes in workplace performance (for the better or for the worse).

The questions I can't answer are:

1. Would these extremely modest improvements lead to sufficient health care savings so as to be cost effective enough for a corporation to consider the desks' capital cost outlay?

2. How/why did having a treadmill desk in place of a sitting one only lead participants to be 43 minutes less sedentary and increase their daily steps by just 852?

Wednesday, July 10, 2013

Former Biggest Loser Contestant Sued For Weight Regain

That I'm not a fan of The Biggest Loser won't come as a shock to anyone. I think it's a hideous spectacle of every toxic attitude society has ever had regarding weight that teaches a nation that self worth is measured in pounds and that people who struggle with obesity are truly just lazy gluttons who don't want it badly enough.

Regarding those Biggest Losers who do manage to keep off their weight (and according to the former contestants I've interviewed that's a very small number) I've always said that the Losers who keep it off may well do so consequent to having translated their weight losses into careers as product spokespeople, celebrity trainers and motivational speakers.

Well maybe even that's not enough to help maintain the severity of a Biggest Loser lifestyle as one such Loser, Tara Costa, is apparently being sued because she'd gained back enough weight (according to news reports she had regained 29% of her Biggest Loser losses) that one of the companies for who she was a paid spokesperson felt that they could no longer use her in their advertising and that her weight gain in turn was in breach of her contract which specified that she needed to, "maintain her current level of fitness and conditioning".

Tuesday, July 09, 2013

Washington State Dairy Council Serving Kids Dessert for Breakfast

And not only serving it to them, but encouraging them to eat it so that they get entered into a contest to win an iPad as you can see from this poster that was up in a Bethel, Washington elementary school (and kindly, anonymously, punted my way).

This dairy industry funded scheme leads me to ask two questions: 1. Is dessert for breakfast a better plan than no breakfast? 2. Is advertising breakfast dessert to elementary school kids as being something that will improve their grades, give them more energy and make them more friends wise?

Not saying I know the answers, but certainly I have to believe that someone who actually cared about kids' nutrition could have found a non-dessert offering that would have fit the bill.

BTW - this contest/promotion conducted in Washington's Bethel school district - one I've covered before when their district's actual child nutrition staff literally sold fundraising fast food pizzas - clearly the "nutrition" folks over in Bethel's school district are in the ends-justify-the-means camp of selling out health for dollars.

[And in case you're interested, here's this dessert's nutritional breakdown....it's basically a bowl of sugar]

Monday, July 08, 2013

Vemma - The Multilevel Marketing Scheme Preying on Your Teens

Talk about chutzpah!

I'm guessing most readers of this blog are already familiar with multi-level marketing schemes involving glorified magic juices - but Vemma's the first such scheme I've come across that's reportedly targeting teens to become pushers, I mean, "brand agents".

An alert put out by the Toronto District School Board to all of its Superintendants notes,
"a company called Vemma is approaching students through Facebook to become “brand agents” (sales representatives) to sell their drink Verve! The drink is not sold in stores. They target middle and high schools students (ages 14 to 16 and over). They have a strong marketing plan, there is a cost for the start-up kit, and messaging on their website tells students that becoming a Verve Brand rep will help them develop leadership and business skills, as well as make them a lot of money. There is also an incentive program that offers cars and more. The students are strongly encouraged to recruit others as “brand agents”."
And so what's Verve? It's Vemma's version of Red Bull replete with this grab bag of "medicinal" ingredients,

But I guess if you're already a company that is comfortable selling theoretical hope as magic, preying on children to peddle your wares isn't much of an ethical stretch.

[Hat tip to my wonderful Canadian editor Random House's Pamela Murray]

Friday, July 05, 2013

An Adorable 6 Year Old Sings Her Heart Out (Trust Me, It's Worth a Click)

Today's Funny Friday comes courtesy of America's Got Talent and it involves a very talented 6 year old singer and her 9 year old brother.

Have a great weekend!

(email subscribers, head to the blog to watch)



Thursday, July 04, 2013

A 4th of July Reflection - Is Junk Food Part of America's National Heritage?

[Sidelined from actual writing by having to pick up a sick daughter, for the 4th of July here's a repurposed 2012 piece from here in Canada. American readers - today, while wandering through the various official, state-run, festivities, have a peek at the foods being served. Is junk food America's national heritage or is it all in good fun and celebration? It's true, humanity, likely since time immemorial, has celebrated with food but do our celebrations these days go too far? Or do they occur too often? Or is everything hunky dory? And of course, if you see anything truly crazy, snap a photo and send my way at yonifreedhoff over on gmail or via Twitter (@yonifreedhoff)]

Sigh.

This past weekend we took our 3 little girls to Hog's Back park. It's all at once a lock station, water control dam, retaining dam and lookout point, and it's been part of Canada since the Rideau Canal was opened way back in 1832. It's beautiful and it's maintained by Parks Canada.

In that picture up above you can see my kids and wife looking down over the falls, but what's in that red circle that I've highlighted nestled among the trees?

Here's a close up:


Yup, it's a Lone Star cantina. Here's the menu:


Nary a healthy choice to be had.

But this post isn't really about Hog's Back, or Parks Canada, or Lone Star. It's about hypocrisy, duplication and inaction.

From my vantage point here in Canada, more specifically Ottawa, Ontario here's what I see:

(CANADA) February 27th, 2012 - The Federal Minister of Health Leona Aglukkaq launches the national Summit on Healthy Weights and concludes her remarks with,
"Let's work together to create environments that help make the healthier choice, the easier choice."
(OTTAWA) May 7th, 2012 - The City of Ottawa publishes their Healthy Eating, Active Living and Healthy Weights 2012" report that rightly notes,
"the settings in which we live, learn, work and play, which can influence the choices we make including the food we consume"
(ONTARIO) May 18th, 2012 - The Province of Ontario announces the establishment of their Healthy Kids Panel whose aims include,
"minimizing the factors that contribute to obesity during childhood"
Is it all just feel good blather? If our federal, provincial or municipal governments truly wanted to start improving our children's environments and setting a leadership example for change would chimichangas really be sold in one of Canada's National Heritage Sites? Similarly, if change were really on the menu, would our schools, hospitals, arenas and community centres still be selling no name junk food? Wouldn't we be seeing a much larger investment in water fountains, farm to table programs, cooking skills classes and caloric literacy?

So much talking!

I know I'm a broken record, but we don't need more talking. Back in 2006 the House's Standing Committee on Health, over the course of eight months, heard hours and hours worth of testimony (including mine) which in turned helped to shape their March 2007 report Healthy Weights Healthy Kids.

How much expert testimony and consideration did the Committee hear? By my count, over eight months they heard from 111 different experts representing 65 different public and private institutions whose reports the Committee then summarized in a formal 60 page report with 42 explicit recommendations.

Does anyone think that the science has change dramatically over the course of the past 5 years? Were 111 different experts too few? Why are we duplicating an extensive 2007 federal effort at not one, not two but rather three different levels of government and why are we paying for that effort's recurrent duplication?

Let's finally stop talking and start doing and at the very least someone please get the damn chimichangas out of our park!  And please don't talk to me about the importance of giving people "choices".  The world is full of them, that's not changing, people will have plenty of horrible choices to choose from - but when it comes to our publicly funded institutions, the only choice should be health.

Wednesday, July 03, 2013

Book Review: Michael Moss' Salt Sugar Fat: How the Food Giants Hooked Us

[Full disclosure - was sent a review copy by the publisher]

With Salt Sugar Fat: How the Food Giants Hooked Us, Pulitzer Prize winning investigative journalist Michael Moss has laid out the foundation and blueprints of the inevitable future raft of class action lawsuits targeting the food industry for knowingly and scientifically designing products that encourage their over-consumption despite their known and well understood risks.

While I’m no lawyer, I did recently have the occasion to have breakfast with newly graduated law student and fructose shunning paediatric endocrinologist Dr. Robert Lustig (Author of Fat Chance: The Bitter Truth About Sugar) and when I asked Dr. Lustig about burden of proof (as unlike tobacco, it seems less clear that the food industry had sufficient knowledge of the potential harm of their products) his legal opinion was that there was plenty.

Take the recent findings of a study that demonstrated foods advertised as healthful for children actually contain higher per gram amounts of sugar than their adult version's counterparts. According to Moss' interview with Julie Mennella, one of the food industry's science incubator Monell Chemical Senses Center's food biopsychologists (if that isn't a creepy term in the context of Big Food I don't know what is) not only are those discrepancies by design, it would seem that it’s very clearly understood that they’re important to that child,
“What basic research and taste in children is shedding light on – and why the foods that they’re making for children are to high in sugar and salt – is they are manipulating or exploiting the biology of the child. I think that anyone who makes a product for a child has to take responsibility because what they are doing is teaching the child the level of sweetness or saltiness the food should be. They’re not just providing a source of calories for a child, they’re impacting the health of that child”
And so begins Moss’ tour of where industry knows what it's doing may well be causing harm. It’s important here to point out that the food industry is simply doing what the food industry does which is strive to always sell more of their products, but what will matter to future litigators is whether or not they understood that their marketing and processing of the products would contribute to harm.

In regard to obesity and still with Monell and sugar, Moss speaks with Michael Tordoff who recounts a study conducted on the beverage industry’s behalf in 1990 looking at the impact of consuming 40oz per day of diet soda vs 40oz per day of regular soda for a period of 3 weeks. Diet soda had no impact on weight, while during the regular soda arm, where the soda was sweetened with high fructose corn syrup, subjects gained half a pound per week.

Moss’ skills as a world class investigative journalist shine throughout with him somehow obtaining quotes from former Coca-Cola executives noting that their marketing efforts boiled down to one question and one question only,
“How can we drive more ounces into more more bodies more often”,
and,
“teenagers became the battleground for early brand adoption,”
and, in regard to the food industry's "promise" not to market to kids under the age of twelve,
“magically, when they would turn twelve, we’d suddenly attack them like a bunch of wolves."
Broadly Moss explains that the typical practice for the food industry has been once one of the core pillars of salt, sugar or fat fall out of societal favour, for manufacturers to simply swap to a new pillar leading me to wonder whether we’re about to experience the low salt, low sugar era of high fat processed foods and whether or not that will be a useful formula or whether it will bring with it its own health concerns?

The book is a painful joy to read. Painful because it does a bang up job of demonstrating just how screwed we all are – not only in that the food industry is savvier and scarier than we might imagine, but in the complicity of government to look the other way, or at times, as with the beef checkoff program, divert public funds to fight industry unfriendly messages as was done when the World Cancer Research Fund concluded that consuming processed meats raised the risk of developing cancer.

Salt Sugar Fat also speaks to the marketing of “better for you”, “healthier” brand extensions which according to Moss, if done right, actually boost sales for the original less healthy mainline products – where these less awful versions actually serve as gateways to the awful brands, and likely, as Brian Wansink has shown, lead to excess Health Halo’d consumption in their own rights.

The most fascinating part of the book for me had to do with a Frito-Lay executive named Dwight Riskey who was an expert in salty cravings. Riskey joined Frito-Lay in 1982 and at that time their predictions were dire. Studies had demonstrated that as we age we become less interested in salty snacks and consequent to the timing of the baby boom the prediction was that salty snack consumption was going to drop. Amazingly to Riskey and the rest of the food industry, rather than drop, sales were climbing. I found this part to be fascinating as it validated something I see regularly in my office. Riskey theorized that the rise in sales of salty snacks in contradiction with their predicted demise was due to a phenomonon that according to food industry data took root in the early 1980s - meal skipping. The 3 square meals days were dying as people were rushing out to start their increasingly frenetic lives. And most folks, in my experience, when they skip meals and snacks, get hungry, and like every supermarket and food executive knows (and as do we all), go shopping hungry and you’re much more likely to have a stroll down the chip aisle than if you go shopping on a full stomach. We simply don’t crave green leafy salads when we’re hungry – we crave salt, sugar and fat the holy trinity that in fact made up the entirety of Riskey’s product line.

That the food industry’s job is to sell food isn’t in and of itself a surprise to anyone, though it’s a pleasure to read Moss’ recounting of their aims and how he truly hammers home the fact that regardless of how socially responsible their campaign sounds, ultimately it's designed to sell product, and while not part of the book, here's a short video from the Cannes Lion advertising awards put together by Kellogg's detailing the partnership between Frosted Flakes and ESPN (skip to 1:30 to see the impact on sales).


Kellogg's describes the impact of their ESPN/Frosted Flakes partnership

My favourite quote from the book no doubt was this one, delivered by ex-Coca-Cola wunderkind Jeffrey Dunn in reference to why he felt there’s not likely to be a so-called smoking gun vilifying his company,
“The gun is right there. It’s not hidden. That’s the genius of Coke.”,
As for my endorsement - simply put - if you eat food you should read this book.

Want a copy? Click here for an Amazon Associates link.

Tuesday, July 02, 2013

Canada's Capital City's Official Canada Day Celebrations Included The Pepsi Taste Challenge?!

From the WTF files.

Honestly, was there not a single person involved in the planning and organizing of Ottawa's Canada Day celebrations that didn't speak up and point out that perhaps "The Pepsi Taste Challenge" and the consumption of sugared soda isn't something to do in the name of "Family Fun" (that's how it was billed in the program)?


As far as how it happened - well that's easy. Pepsi was a "major sponsor" of Ottawa's Canada Day celebrations.

Hurray?

Because what says Canada more than drinking soda?

Hey wasn't Ottawa's Mayor once the Minister of Health Promotion? Mayor Watson, did this event promote health?

[Hat tip to BMI's Director of Operations Lorne Segal]

Monday, July 01, 2013

University of Waterloo Celebrates Canada Day with Gluttony Contest

Image Source
Competitive eating's about as nonsensical a "contest" as one could imagine.

And while I personally wish it would just go away, even I can appreciate its appeal as being akin to slowing down driving by the scene of gruesome accident.

What struck me though was this statement from the University of Waterloo's Canada Day celebrations press release,
"The show will also include a challenge for current Waterloo students to see if they can match the pro-eater Timbit for Timbit"
Sigh.

Higher education - courtesy of the University of Waterloo.

[Hat tip to Dr. Terry Polevoy]

Saturday, June 29, 2013

Saturday Stories: Godin, Rudeness, Tragedy

The usual brilliance by marketer Seth Godin on the marketing of junk food.

A great piece in the Wall Street Journal explores why we're ruder online than in real life.

Gene Weingarten in the Washington Post from 2008 with one of the most gripping, harrowing and tragic articles I've ever read.

Friday, June 28, 2013

The Ultimate Dog Shaming Video

Today's Funny Friday involves a cute (bad) dog named Maymo.

Have a great weekend!

(email subscribers, head to the blog to watch)



Thursday, June 27, 2013

Kaiser Permanente Tells New Parents to Limit Soda for Toddlers to 1 Can a Day?!

Thanks to a blog reader who wishes to remain anonymous today I'm presenting to you what was presented to her at her baby's 1 year checkup.

It's a patient education pamphlet on feeding your 1 year old and it includes the admonition to limit sodas to no more than 1 can each day.

Ummm......what?

Wednesday, June 26, 2013

Parental "No" Files: Elementary School Fundraising "Reward" Edition

Thanks to blog reader Cara McMaster whose son attends Ontario's Valley Central Public School.

Apparently as a thank you to the kids for their School Community Association (SCA) fundraising efforts the entire school was "rewarded" with an SCA funded lunch from McDonalds.

Because what better way to spend the money kids have raised for their school than on cheeseburgers, hamburgers and chicken nuggets, and what better message could there be for kids than McDonald's is a reward for a job well done?

Of course parents could just say, "no". It's not as if your child would feel different, left out or be picked on because he or she pulled out a brown bag while everyone else in the entire school tucked into their burgers, right?

Tuesday, June 25, 2013

(Not the Onion) Canadian Government Teaming Up with Donut Giant Tim Horton's To Fight Diabetes

Who better to team up with than a national doughnut chain to tackle the increasingly pressing issue of diabetes prevention among Canada's First Nations' youth?

The announcement, made by Health Minister Leonna Aglukkaq, details the launch of what they're calling, "Play for Prevention" which in turn no doubt will put the focus on exercise as the preventative medicine, and not of course on the fast food culture that permeates society as a whole. That's not to say that exercise can't help, but I'm fairly certain that in the history of public health interventions there has never been one that has been proven to have led to a long term significant and sustained increase in activity among teenagers (or anyone else for that matter).

It's a brilliant move for Tim Horton's of course. For the ridiculously low price of just over $72,000 Tim Horton's partnership with the Canadian government makes it far less likely that we will see such initiatives as the establishment of zoning laws that would prevent Tim Horton's franchises from setting up shop within a certain distance of schools, or hard hitting public health messaging focused on getting Canadians out of restaurants and fast food establishments as a whole. It will also undoubtedly be utilized in the fight against mandatory menu board calorie labeling as proof positive of Tim Horton's and the restaurant industry being "part of the solution".

And fellow Canadians get ready for many more such partnerships as the Harper government has decided that these partnerships are the cornerstone and future of quality public health interventions and has formally put out a request for many more of them.

[Hat tip to Twitter's Robert Ablenas for kicking my way.]

Monday, June 24, 2013

Will Calling Obesity a Disease Cause Harm?

Some folks sure think so.

While there's no doubt there's always a risk of unintended consequences (and no doubt too that we should always be on the lookout for them to deal with them as they arise), exploring the arguments that arose last week with the AMA's description of obesity as a disease it would seem people are up in arms about some odd stuff. Here's a summary of the most common arguments against that I was able to find followed by some thoughts of my own:

1. Calling obesity a disease will cause insurance rates to rise

All of today's insurance policies require heights and weights and people are already regularly and routinely being rejected or penalized consequent to their weights.

2. Healthy people with obesity will now have a label of having a disease.

Given weight's visibility, they already do, except now society labels them as lazy and gluttonous. While labels are always misguided, which label do you think leads to more stigma?

3. People with obesity will now be able to call in sick simply consequent to their weight

This one's too stupid to bother with.

4. If we label people with obesity as "sick", they'll no longer want to try to lose weight.

Since when do we label people as "sick"? Are people with asthma "sick"? And moreover, are people newly diagnosed with asthma deciding not to take puffers due to their new "labels"?

5. Calling obesity a disease will increase eating disorders.

There is zero evidence that would suggest that this is a real risk. Established eating disorder risk factors include youth, being female, family history, mood disturbances, restrictive dieting, life upheaval, and certain career paths (ballet dancers, actors, models, gymnasts, etc). And while some are bound to comment that restrictive dieting will increase consequent to a disease definition (with no evidence to suggest this to be true), I'm hopeful that even were it true that over time a new way of thinking about obesity will help to illuminate the nonsense and medically unsound nature of highly restrictive dieting.

6. Calling obesity a disease will increase the severity of weight loss approaches.

Actually treating obesity as a disease would mean evaluating it as we do any other disease - as part of a whole picture and with varied penetrance (sticking with asthma, there's mild that requires an occasional puff or two all the way through a spectrum to major that requires regular and multiple medications). And we do have a means to do this with obesity - the Edmonton Obesity Staging System where for instance those with an Edmonton Obesity Stage of zero or one likely wouldn't be recommended treatment of any sort, but rather watchful waiting.

7. Calling obesity a disease will increase the notion that scales measure health.

While this in indeed a faulty notion I'm confused as to how we'll increase a notion that however faulty is already accepted by nearly everyone on the planet? The only direction left to go on this one is down.

8. Calling obesity a disease will lead people to think that it's contagious.

Do you think that asthma is contagious? How about glaucoma? Hardening of the arteries? Arthritis?

And then lastly,

9. Because lifestyle changes might treat obesity, labelling obesity a disease will dissuade folks from making healthful changes.

Here's some news for you. Lots of diseases are preventable or treatable through healthy lifestyles including hypertension, high cholesterol, coronary artery disease, diabetes, ischemic stroke, osteoporosis, cataracts, erectile dysfunction, and oh yeah, 40% of all cancers to name just a few. Yet no one has a problem with those diseases leading folks to consider pharmacologic or surgical interventions to help manage them. But then the world doesn't implicitly loathe people with cancer I suppose.

Saturday, June 22, 2013

Saturday Stories: Feminism, Starbucks' Calories, and Cancer

Fill in the blank, "I need feminism because ________"

Great take by The Atlantic's Corby Kummer on Starbucks' new plan to nationally roll out menu board labels ahead of the rest of the country.

The Globe and Mail's Andre Picard setting us straight on cancer breakthroughs, "We cannot suspend our critical faculties because of wishful thinking."

[And if you don't follow me on Twitter or Facebook, here's an unabridged interview that I did with CTV's Avis Favaro on the question of whether or not obesity is a disease and another with CFRA's Mark Sutcliffe.]

Friday, June 21, 2013

True Facts About the Aye Aye

I can't get enough of these Ze Frank videos.

Today's Funny Friday is his coverage regarding true facts about the aye aye.

Have a great weekend

(email subscribers, head to the blog to watch)



Thursday, June 20, 2013

Parental "No" Files: Ontario Science Centre Edition

Well it's sort of a feel good story.

A while back journalist Angela Mulholland noticed something strange at the Ontario Science Centre - as part of their video games exhibit the cafeteria was selling what they called "Gamer Grub" which in turn was a horrific combination of a 591ml soda, a bag of chips and a chocolate bar.

Well, there were complaints and after nearly 3 months the Science Centre changed the offering.

Now don't get me wrong, the now named, "Smart Gamer's Combo" is world's better and in that sense this is a feel good story.

But two questions for me remain.

1. Why would the Science Centre want to perpetuate the un-scientific (and un-smart) notion that gaming requires fuel at all?

2. And even if gaming did require fuel, why would the Science Centre suggest that "smart" gamers' fuel should at least partially be made up of candy (in this case the nutritional black hole that is a Rice Krispie square)?

Wednesday, June 19, 2013

Gadget Review: T-Fal Actifry Family Not So Deep Fryer

Full disclosure: Was provided with a free tester from T-Fal

You know I wasn't always interested in nutrition. In fact I once couldn't have cared less about nutrition which might help to explain why I literally buried two deep fryers consequent to using them so often that they died and it was only at the insistence of my now-wife, then girlfriend, that I didn't replace the second one.

That is not until my parents bought me a T-Fal Actifry (which I reviewed way back when) for a birthday gift.

The premise is simple. It heats up real hot, has a rotating stirring arm, and consequently allows you to "fry" using just a small amount of cooking oil and in so doing, keep calories lower. Think of it like a self stirring wok of sorts.

Well T-Fal's been active and they've made a few newer units. One has dual cooking levels allowing you to cook multiple dishes at once and then there's the one I've been test driving which is a newer and much larger version of mine named the T-Fal Actifry Family (a good thing as my family is newer and larger than when I was gifted that first unit).

This time around I was determined to try to cook more than simply fries as while the unit truly puts baked oven fries to shame (just don't expect them to be as sinfully delicious as genuinely deep fried versions), at $250 a unit, that's an expensive french fry maker.

So I tried a bunch of dishes. I made my girls fried bananas, made some sloppy joes, fried up some chicken wings and drumsticks, and made homemade chicken shawarma.

From that batch I had 3 misses and one home run.

The bananas simply squished too much and the girls didn't find them particularly flavourful. The sloppy joes were a disaster. The turning arm isn't capable of breaking up ground meat so I ended up breaking it up by hand. It also wasn't able to stir together the various liquid ingredients as I added them. It also cooked unevenly with the meat nearest the centre burning some. The chicken was alright, but don't expect to leave the skin on as even if you do, the machine will strip it off during cooking - that said the meat was cooked evenly and was moist - but I'll stick with oven broiling.

The home run was the shawarma. The recipe is here but instead of the cumin, nutmeg and cardamom I followed the recipe for the Ras el Hanout from Epicurious for the spicing (the cookbook that came with the fryer called for Ras el Hanout which is how/why I looked it up). We coupled the recipe with homemade hummus and homemade pita and Israeli salad and the result was a unanimous keeper - from my visiting grandmother-in-law to my tiny kids, we all loved it.

At the end of the day I can wholeheartedly recommend the T-Fal Actifry as an awesome gift, and the family unit is really quite large - more than large enough to handle fries for everyone or a dinner stir fry.

I just wish the price were low enough that I could recommend it as a personal purchase - as it is, it's simply too expensive.

Tuesday, June 18, 2013

Is Home Cooking Really the Mount Everest of Parenthood?

That's the very appropriate question in a sense being asked by author and journalist Maryn McKenna in response to a recent piece in the New York Times' Motherlode column where KJ Dell'Antonia, inspired by the work of folks like Michael Pollan and Mark Bittman, vowed to, for one whole week, eschew processed in place of home cooked.

I wholeheartedly agree with Maryn - the fact that one week of home cooking is seen as sufficiently challenging to warrant a New York Times Motherlode column is proof positive that when it comes to healthy living, society is well and fully broken.

Bring back home economics!

Monday, June 17, 2013

Parental "No" Files: Historical Landmarks Edition (you gotta see this to believe it)

Everything that's wrong with society's constant need to shower kids with sugar encapsulated in one ad,
"During the War of 1812 young kids entered Fort York full of courage strength and pride. This weekend they'll leave full of cookies, cake and candy"
Worse than the event itself is the fact that its establishment likely didn't give anyone at the Fort York Foundation even a moment's pause - that's how normalized this practice has become.

[Thanks to Family Food Project's Edie Shaw-Ewald and blog reader Christine Hepburn for both taking the time to send me copies.]


Saturday, June 15, 2013

Saturday Stories: Photoshop, Soda Bans and Darwin

Photo from Civil Eats' piece linked below
A photo collection of celebrities before and after Photoshop. (Make sure you scroll right to the end to see Taylor Lautner's shot.)

Kristin Wartman on Civil Eats with a piece on soda and freedom that observes, "When Beyoncé tells us what to drink we listen; when Bloomberg does, there’s outrage."

An oldie but a goodie - Evolutionary biologist Richard Dawkins' open letter to Prince Charles in which he dances with Darwin. My favourite line of the piece has to be this one, "It may sound paradoxical, but if we want to sustain the planet into the future, the first thing we must do is stop taking advice from nature. Nature is a short-term Darwinian profiteer."

[And if you don't follow me on Twitter or Facebook, here's my more recent US News and World Report piece on whether or not we really need to refuel kids after "exercise"]

Friday, June 14, 2013

Ever Wonder What Dogs Think?

Ze Frank does.

And today's Funny Friday are his thoughts therein in Sad Dog Diaries.

Have a great weekend!

(Email subscribers, head to the blog to watch)



Thursday, June 13, 2013

Gadget Review: My Month with BodyMedia's LINK Armband

My past 28 days of use summary
A month ago the kind folks from BodyMedia sent me one of their LINK armbands to test drive. I was excited as I'm clearly into collecting and quantifying data - for instance I haven't missed an entry in my food diary for over 2 years and regularly log my workouts on Fitocracy.

I was curious to see if having access to real time activity data would change my own exercise behaviours.

For me the short answer is probably not. I did love the information I got from the LINK, I checked it regularly, but more to see how much I'd done rather than to push myself to do more. I also questioned the data some.

As far as what the LINK tracks it covers calories it thinks you burned, calories you tell it you ate, how long it thinks you were moderately or vigorously active, how many steps it thinks you took and how long it thinks you slept.

My iPhone summary for a particularly active day....and then the chicken wings got me
The LINK armband (it's the one the The Biggest Loser contestants use) sits just above your bicep via a stretchy band with a velcro fastening. It's not water proof so you've got to take it off in the shower and the band does get sweaty with vigorous workouts (but is washable). The other issue I had with it was as a shirt and tie wearing guy. I found it tough to put back on without taking off my shirt.

Tough to put on without taking off shirt

I have to admit, I notice wearing it. When I loosen it to the point of not feeling it periodically I will lose the connection to my arm (it sounds a few notes to say it's signing off) and keeping it tight I definitely feel it all day long and every once and a while the area in contact with the skin gets a bit itchy.

Following the data is easy if you have a Bluetooth enabled Smartphone whereby you simply press a button on the armband and your data will then stream live to your phone. You can also use your phone to upload your data to the website tracker.

Food wise I'm not using their food diary. Instead the LINK syncs with myfitnesspal (my current tracker) which is quite convenient. What I don't find convenient however is that communication is two way in that the LINK tells myfitnesspal that I've burned calories and myfitnesspal then tries to tell me to eat more to make up for them. For folks using a LINK in the context of weight management, this may well inspire, "because I exercised" over-indulgences.

As far as the data's accuracy, I personally think it's overestimating some. While I do workout an average of 4-6x weekly, I'm convinced it sometimes tracks my typing as activity. Apparently I'm not the only one thinking this way as Gretchen Reynold's NYTs piece yesterday speaking to the accuracy of a whole pile of these sorts of monitors references the armband that overestimated typing too.

The price for the unit seems quite fair in and around $100 depending on the retailer, but I am a bit surprised by the monthly fee for the website and app. My understanding is that the website will only provide you with very basic information without a subscription while the app won't work at all. Given the now highly competitive landscape of exercise trackers, and with this one being slightly less wieldy consequent to the armband (rather than a bracelet or something pocketable), I'd expect they'd be better off throwing in as many free bells and whistles as possible.

All in all I'm not sure if this gets my buy recommendation. I say I'm not sure because to be fair, I haven't tried out any other trackers. I think I'd be more comfortable recommending if it weren't for the subscription fees as all of my other complains and issues were minor.

That's my month long data summary up above - now if someone could just teach me how to sleep better.

Wednesday, June 12, 2013

Is Coca-Cola's Latest Calorie Dictionary Ad Purposely Deceptive?

You be the judge.

Below is the embedded copy of Coca-Cola's most recent anti-obesity advertisement. It's called, "Calorie Dictionary".

Watching Calorie Dictionary the inference is that it's incredibly easy to burn off the calories of a Coke.

They show various activities and then their apparent calorie counts. They also, at the beginning, note that the calorie values are for 5 minutes of the activity shown. Clearly though Coca-Cola expects the brief mention of 5 minutes to be forgotten as the bulk of their portrayed activities in real life are only momentary, like hugging a friend, falling, jumping out of a tree, or zipping up a dress which according to Coca-Cola respectively burn 7, 18, 11 and 12 calories. Seems to me that the message Coca-Cola is trying to hammer home is that calories are way easier to burn than you thought and that if you just move a teeny little bit, you can easily burn off their sugar water. Too bad it's not a truthful one.

According to the commercial if you spend 50 minutes (divided into 5 minute blocks) hugging people, swinging a sledgehammer, climbing fences, falling off mechanical bulls, jumping out of trees, running, shouting, lifting young children onto your back, diving to the ground, and zipping up a dress then you too will burn the number of calories you'd find in a 13.5 oz bottle of Coca-Cola.

Such nonsense, and more to the point, want to know what's way easier? Not drinking them.

(And if you wanted to burn off the much more ubiquitous 20oz bottle you'll need to combine 75 minutes worth of 7.5 minute blocks of those same ridiculous examples.)



So what say you? Purposely deceptive or a helpful part of the "solution"?

Tuesday, June 11, 2013

Could Truly Terrifying Rise in Anti-psychotic Meds for Children be Fueling Childhood Obesity?

Of all of the drug related causes of obesity out there perhaps none is more powerful than the gain associated with anti-psychotics. In adults gains of literally dozens of pounds are regularly seen.

A recent story by Postmedia's Sharon Kirkey on a new study out of BC to be published in the Canadian Journal of Psychiatry reports that in Canada, despite a total lack of evidence suggesting their safety in children (and moreover an almost total lack of studies involving children at all), since just 1996 second generation child anti-psychotic use has quadrupled.

While there's no singular cause for obesity, for children prescribed these meds obesity may come close to an inevitability. If your young child is currently on anti-psychotic meds, especially if they're on them for sleep, please consider making an appointment with your prescriber to discuss if there aren't in fact alternatives available.

Monday, June 10, 2013

Parental "No" Files: High School Track Meets

Today's guest post comes from University of Manitoba's Dr. Joyce Slater who last week dropped her 14 year old son off at a high school track meet. Judging from her email if you want your kids eating healthfully you'll either need to say "No" you can't go to the meet, or pack a lunch.
Hi Yoni - here’s another one from the “children’s foodscape”.

This morning I dropped my son off at his track meet and as we were entering the field, I noticed the “buffet” set up for the kids for the day.

The picture’s not great, but it does show the large chip display behind the sport drinks and 500ml+ juices. The red bucket had the traditional soft drinks, and on the far left were large chocolate milks. And yes, there was a flat of water bottles. Mains were “hotdogs” and “cheese dogs”. Desserts were chocolate bars, gummy candies and a cooler of cream “treats” (dairy group!!).

I expressed my dismay to which my son said “but there’s fruit and water!” I said that tiny bowl of fruit in the centre is dwarfed by all the other junk, and its main purpose is to say “hey, we have some healthy food so we’re covered off!” - to which he agreed. He also said he didn’t want the water because it was a waste of plastic. He did, however, work me down to a plain hotdog (he wanted the cheese dog - at 9:30 a.m.!)

Now, I’m not volunteering at the snack stand, and I applaud any busy parent or teacher who gives their time in the community for things my children benefit from. But talk about a mixed message we are giving our kids! Manitoba has one of the most progressive school nutrition policies in the country - guess it doesn’t apply to school track meets.

Joyce Slater
Winnipeg


Saturday, June 08, 2013

Saturday Stories: Cancer, Paleo, Cardboard Boxes and a Must Read

Reuters health report Debra Sherman was recently diagnosed with terminal stage 4 lung cancer. She's started a blog to discuss her experiences.

Lots of folks questioning the paleo narrative lately - here's an interesting piece from Scientific American. (Of course even were the narrative totally BS, I'd venture most folks' paleo diets are exceedingly healthful given the emphasis on actual cooking.)

The BBC explains why Finnish babies sleep in cardboard boxes (and perhaps why they have one of the lowest infant mortality rates in the world).

A must read by Kasey Edwards, "When your mother says she's fat"

Friday, June 07, 2013

I Dare You Not to Love this Video

Today's Funny Friday is the greatest cover ever of the Beatles' Don't Let Me Down.

Have a great weekend!

(email subscribers head to the blog to watch)



Thursday, June 06, 2013

Yesterday the Pope Blessed the Clean Your Plate Club

Yup.

Yesterday Pope Francis made the case for the preservation of one of the unhealthiest clubs around - the clean your plate club - saying that, "throwing away food is like stealing from the table of those who are poor and hungry".

Maybe I'm splitting hairs here, but I sure wish he'd have asked people to serve and make do with less food rather than bless the consumption of whatever's on your plate simply because it's there.  Given this day and age's portion sizes eating what's there will be more likely to have us treating our bodies like dumpsters than temples.

I know Pope's are supposed to be infallible, but being Jewish I'm quite comfortable doubting (and encouraging you to ignore) this particular message.

Wednesday, June 05, 2013

Food Frequency Questionnaires Suck Say Who's Who of Obesity Researchers

Hot off the heels of my blog post about giant pears, last week a letter to the editor of the American Journal of Clinical Nutrition was published. It was signed by some very familiar names in obesity research and its title is also its summary, "Self-report-based estimates of energy intake offer an inadequate basis for scientific conclusions".

The letter was triggered by a recently reported and heavily publicized study that suggested energy intake has decreased significantly since 2003-2004 - with an average reported decrease of 98 cals/day. The letter's authors note that the data used to come up with the exciting decrease has been shown to be flawed before, and moreover, that it would appear as if bias in reporting of energy intake may be increasing (perhaps due to increased attention and bias versus those with obesity). They also note that were it in fact true the population ought to have lost an average of nearly 8lbs since 2003.

Their final conclusion is firm and one I agree with in regard to studies designed to look at ways to prevent or treat obesity,
"Going forward we should accept that self reported energy intake is fatally flawed and we should stop publishing inaccurate and misleading energy intake data."

Signed,

Dale Schoeller
Steven Blair
Steven Heymsfield
David Allison
James Hill
Richard Atkinson
Barbara Corkey
Nikhil Dhurandhar
Eric Ravussin
Kevin Hall
John Kral
John Foreyt
Diana Thomas
Edward Archer
Michael Goran
Berit Heitmann
Barbara Hansen
[And for good measure, up above is another of my collection of photos of gigantic fruit - this time a 10oz plum bigger than an apple.]

Tuesday, June 04, 2013

Did You Hear the One About the McDonald's CEO Losing Weight Eating McDonald's Everyday?

Yeah, I did too and that's him up above.

His 20lbs McDonald's fueled weight loss has been all over the news.

But here's the thing. At the end of the day if the bioavailable calories you consume are less than those that you burn you lose.

The fact weight can be lost eating at McDonald’s everyday is not news, but the fact that the news is covering it is. What the coverage suggests is that the world still doesn’t understand weight management because if it did there wouldn’t be news stories on the guy who ate fewer calories than he burned and lost weight.

Monday, June 03, 2013

1.5 Trillion Calories!

According to press releases and nonsensically breathless articles like this one out of Forbes, last week's announcement from the food industry that they'd removed 1.5 trillion calories from the food supply was huge.

But is it?

When broken down by person it amounts to 14 fewer calories purchased per person per day last year from vending machines, convenience stores, drug stores, grocery stores, supermarkets and mass merchants.

And that's not a bad thing and were it truly consequent to the food industry shaving calories off their products it'd certainly be worth our giving them a gentle pat on the back, but I guess I'm stuck trying to understand both the market forces that may have led to the reduction, as well as whether or not the reduction occurred despite the food industry's best efforts, not because of them.

Could the reduction not simply reflect shifting societal attitudes and norms and in fact have occurred despite the food industry's persistent, tenacious, merciless and at times deceitful and ethically questionable marketing of salt, sugar and fat?

I'm curious too to see the independent non-industry analysis of these results which is currently being undertaken by Dr. Barry Popkin and his colleagues.

All that said, 14 fewer calories per day aren't likely to take us too far given that estimates suggest we're eating 500 more calories per person per day since the early 1970s. Still plenty of work to do on the remaining 486.

Saturday, June 01, 2013

Saturday Stories: Drug Edition! Oxycontin, Cocaine and Coca-Cola

No doubt one of my favourite TV shows of all time was The Wire, a David Simon series on drug culture and policing in Baltimore. In this great piece on The Raw Story he "eviscerates the dystopia creating war on drugs".

A fascinating (long) piece from the New York Times on how cocaine overlords make money.

And today's truly must read piece from Human Journalism, The “Coca-Colization” of Mexico, the Spark of Obesity (and they have the gall to say they're working hard to be part of obesity's solution)

For my Ottawa readers - CHEO is conducting a study to validate a new kids food menu. If you've got (or are) a kid between the ages of 10-17 and want more details, click here.

[And if you don't follow me on Twitter or Facebook, here's this week's US News and World Report column on which you should treat first - weight or depression as well as a brief piece I did in support of a talk I'll be giving in Vermont...this on the world's unwitting sugar soldiers]

Friday, May 31, 2013

Brilliant Burger King Advertisement Unveils Hands Free Personal Trough

Sorry to advertise for Burger King....but this ad must be shared and Funny Friday's definitely the day to share it.

Have a great weekend!

(email subscribers head to the blog to watch)

[Hat tip to friend and blog reader Jesse Elliot]



Thursday, May 30, 2013

Badvertising: Cookies, They're Not Just for Breakfast Anymore (Bear Paws Morning Snack)

Today's is a guest posted Badvertising example found by Toronto dietitian and fellow public health crusader Rebecca Davids.

I've blogged in the past about breakfast cookies - and with Dare's Bear Paws Morning Snack cookies can now claim their rightful role as snack food too.

Wonder when I'll be blogging about the world's first dinner cookie?
Hi Yoni -

Have you seen this yet?

They're Bear Paws - "Morning Snack" - and yes, this is actually what they are calling the cookie with a 'yogurt' filling. Funny, I usually like my yogurt from the fridge, not packaged between sugar, more sugar and processed flour.

Apparently, the kids in the commercial (and by default, all kids) need a cookie snack to 'keep them going" in the morning because they like to play. Parents should 'feed the fun'

Feed the fun?? Seriously??

Very interesting focus on the morning snack as well - I'll say when my kids were in kindergarten, their teachers used to make kids eat their "healthy" snack in the morning and save their "junky" snack for the afternoon. Notice how the assumption was all kids showed up with a 'junky' snack... but I digress. I'm just dismayed at the additional level of up-marketing this product to the level of a 'healthy, morning snack". I see how that will feed right into a parents desire to give their kid 'healthier' versions of snack foods.

OK - enough rant from me.

Best,

Rebecca Davids, MSc, RD

PS - An interesting addendum as we were discussing this product at an RD meeting yesterday. A dietitian mentioned that she's seen these products pop up on child care menus at morning snack. Unfortunately, Dare's marketing tactics seem to be working.
For those keeping score, even Dare thinks they're cookies as that's what they're calling them on their nutrition facts panel online:

And if you really want to see awful, check out this frankenfood's commercial: