Metabolically Healthy Obesity and the Risk of Type 2 Diabetes

The term "metabolically healthy obesity" is generally thought to describe excess weight in individuals who don't have any weight-relatable medical conditions. When discussing whether or not these individuals should be counselled to lose weight many point to their potential risk of developing weight-relatable conditions as a reason to do so, and truly, that makes good sense, though looking at the data from my friend and colleague Arya Sharma, it would appear that truly metabolically healthy obesity carries virtually no excess mortality risk - at least not over the 16 years of NHANES data they studied. In Arya's work (graph from same up above) those individuals who are at no risk are staged as EOSS zero - which means that they truly had no discernible weight relatable issues whatsoever - they indeed had metabolically healthy obesity.

So how then to explain the outcomes from a paper published yesterday in Obesity Reviews? The paper, Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies, was a meta-analysis using data from the English Longitudinal Study of Aging and it concluded that those with what they defined as "metabolically healthy obesity" had a 4 fold higher risk of developing type 2 diabetes over a 6 year period than individuals with "metabolically healthy normal weight". The authors then conclude,

"Prospective evidence does not indicate that healthy obesity is a harmless condition."

But before you agree with them there's something important you need to know. Whereas Arya (rightly as far as I'm concerned) defines metabolically healthy obesity (EOSS 0) as an individual who has ZERO weight-relatable conditions, the authors here considered a person to have "metabolically healthy obesity" even if they had one of the following issues: hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol or adverse triglycerides.

Rather disingenuous don't you think, to describe the increased relative risk of developing type 2 diabetes in individuals who are most assuredly not metabolically healthy as purely consequent to their weight?

Regardless of your weight, if you have hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol or adverse triglycerides then you are not metabolically healthy, and studies that explicitly suggest otherwise aren't doing anyone any favours, nor answering any questions about risks in those with truly metabolically healthy obesity.

Talk About Commitment to a Low-Carb, Sugar Free Lifestyle

So what do you do if you're young, wealthy, and an ardent believer in a low-carb, sugar free lifestyle?

Well if you're Meredith Loring and Sami Inkinen you plan a 2400 mile unsupported low-carb, sugar-free, row (meaning they're hauling their food with them - just not carbs or sugar) from San Francisco to Honolulu - a trip only twelve people have ever managed before. They've dubbed it the Fat Chance Row.

Food wise between them they'll be consuming 14,000 calories daily with a breakdown of 70% fat, 20% protein and 10% carbohydrates.

They're rowing or a cause too and looking for donations where 100% of the proceeds will go to anti-sugar crusader Dr. Robert Lustig's Institute for Responsible Nutrition.

Regardless of where your dietary beliefs lie, you have to admire their spirit, and reading through their site, they seem like fun folks, but watching their blog's videos and just pondering their challenge, you know it won't be a picnic. Sami knows that too as evidenced by my favourite quote from their website which came from his bio,

"Sami’s married to Meredith and hopes that the expedition doesn’t change that fact.".

I look forward to watching their progress. They embark this June.



[h/t to the Cutting Factory's Michèle Hozer]

Saturday Stories: Saving Lives, Drug Prices, and Protein

80,000 hours ponders how many lives a doctor actually saves in a career.

Andre Picard in the Globe and Mail explores the need for, no matter how painful, dispassionate analysis in setting drug prices.

Kris Gunnars over on Authority Nutrition covers dietary protein.

[And if you don't follow me on Twitter or Facebook here's my interview with Anna Maria Tremonti for CBC's The Current where we had the luxury of time to really discuss The Diet Fix, and here's a piece I did for the Globe and Mail rebutting Margaret Wente's ill-informed assertion that menu board calories are a bad plan]

Today Funny Friday Being Replaced by Awesome Science Friday!

Such a heart warming video I felt I had to share even though it's not Funny.

Here's Professor Andre Linde and his reaction upon hearing the news that his 30 year old theory regarding the big bang had been proven to be true - something that my theoretical physicist mother tells me is a huge, huge, almost certain to win him a Nobel Prize deal.

Science!

For Sugary Cereal Maker Kellogg's There's No Such Thing as Sugar

For those of you who still think the food industry is a helpful part of the solution to our modern day weight and nutrition woes I present the Kellogg's Together Counts label reading course.

Together Counts is the food industry's self-congratulatory attempt to be part of the dialogue regarding weight, nutrition and health in society today. My cynical view is that it's there to help to forestall the inevitable industry unfriendly legislation that we will see down the road. It's also there to foment misinformation.

Take this piece for example. It's entitled, "Eyes on the Prize: How to Spot Wholesome Foods" and it's written by Together Counts partner and sugary cereal kingpin Kellogg's. The article's about how to read a food label because as the article states,

"at least 60% of Americans are in fact paying more attention to the numbers on the food packages they buy. But if you don’t know what to look for on the label—or are only noticing the calories—chances are you’re not seeing the complete picture of your favorite eats. As a member of the Together Counts™ program, Kellogg’s wants to make it easy to keep your eyes on nutritional value with these quick tips."

Hurray for Kellogg's!

So let's say you take this Kellogg's course. What should you look at when evaluating Kellogg's Honey Smacks? Well according to Kellogg's you should consider their serving size, fat and cholesterol, fibre content, sodium and vitamins. Well by those measures this stuff sure is pretty awesome!

Let's see, pretty clear cut serving size, almost no fat, very low sodium, and TONS of vitamins!

You know I'd imagine most cereals would score highly in the Kellogg's version of wholesome food land. They're all low in fat, sodium, and cholesterol, and they're fortified with vitamins.

What's that?

You think perhaps when considering foods people should also look at sugar?

Well only if you think that a product that by weight is quite literally 55.6% sugar (Kellogg's Honey Smacks) isn't a wholesome food, and if you learn how to read a food label by means of Kellogg's teaching - you won't.

Does Your Doctor Know How to Weigh Your Child? I'm Betting Many Don't.

Image Source

On the surface it doesn't sound all that difficult.

Ask child to stand on scale. Weigh. Record weight. Done.

Working with parents of children with obesity, it seems many doctors nowadays feel it's important to add in some judgement or scary statistics such that after 'weigh' and before 'done' comes a speech on the dangers of weight along with the implicit or explicit suggestion that the child is responsible - either for gaining the weight or for not losing it.

I don't think that's fair. Moreover, I don't think it's helpful and I think it may well do harm.

It's not fair, especially with younger children, given that they're not in charge. They don't do the grocery shopping. They don't cook the meals. They don't set the example. They live the lives their parents teach them to live. They're life's passengers, not the drivers.

It's not helpful because speeches or stats without action plans by definition aren't helpful.

It's potentially harmful because the negative emotions bound to be generated by this sort of an interaction may well erode a child's self-esteem, body image, and their relationship with food. It may also lead that child's parents to adopt a knee-jerk pattern of restriction, guilt and shame that is far more likely to make matters worse than better.

The safest way for a physician to weigh a child is to tell the truth as to why weights are important. The truth is that children need to be weighed because medication is dosed dependent on a child's weight and therefore physicians need to have fairly current weights on their growing patients in case they fall ill and require a prescription. And should a physician have a concern about a child's weight I'd encourage them to have a discussion with that child's parents with the child absent and clearly, there's not much point even having the discussion unless that physician has suggestions or resources beyond the tritely useless truism of "eat less, move more".

Guest Post: The Food Industry Understands Nudge Theory Too

Today's guest post comes from Jill Avis. Jill is a PhD student studying under the supervision of Dr. Geoff Ball in the Department of Pediatrics at the University of Alberta. Her thesis work relates to innovative approaches for the prevention and management of pediatric obesity.

The Negative Nudge

Many readers will be familiar with an approach to behaviour change that has gained popularity in recent years – the nudge. This concept is well-described by Thaler & Sunstein as "the navigation of individuals toward optimal choices without restriction of other options" – in other words, ‘libertarian paternalism.’ For example, placing healthier food options in more visible, convenient locations in school cafeterias or altering the default option to consent for organ donation.

Today, I want to talk about the nudges that work in counterproductive directions – what I call the ‘negative nudge’. Yoni’s blog post last Tuesday reinforced the reality that big corporations, (e.g., Coca-Cola) have the power to sway consumers toward food choices of questionable quality. Not only are we faced with a growing number of processed foods in our food environment, but portion sizes and product packaging have increased substantially, creating a ‘perfect storm’ that encourages us to eat more and more. When paired with the chance of a trip, keepsake “cup,” and a tacit endorsement by Coca-Cola, it is not surprising that people consume increasing amounts of unhealthy foods and drinks.

In Thaler & Sunstein’s book, Nudge, the authors discuss dual process theory, which proposes two processes to explain our decision making - the rational, conscious system and the automatic, unconscious system. This theory may help to explain the disconnect between positive intention and behaviour; individuals who make an explicit pact to ‘shape-up’ or ‘be healthy’ (aka the rational system) face factors processed by the automatic system, which can inhibit adherence to their initial intention. Examples include temptation and mindlessness, or stickier influences, such as endorsements by big corporations. In our food environment, it is difficult to decipher which information is genuine and which is a marketing tactic.

When I stopped in for my daily coffee at the local Second Cup, I took a double-take at one of their advertisements to celebrate 35 years in business; #34 states, “We’ve learned there is a much tastier way to enjoy an apple a day with our caramel apple latte.” Now, do I think that Second Cup had the purposeful intention of negatively influencing Canadians’ already poor eating habits? No. But I believe they are using their power for corporate benefit (profit!) by giving a ‘negative nudge’ to our food choices; share-holders and franchisees seem to be interested in their profit margin at the expense of individuals’ decision-making and dietary quality. This is just one example of the pervasiveness of ads that negatively nudge us – it’s clear we need more nudges that move us in the positive direction.

Salad Does Not a Healthful Menu Make!

Just a short public service post that you can share with whichever of your powers that be that might need it.

Just because your fast service menu or restaurant offers salad doesn't suddenly make your menu healthful.

[And if you're not familiar with the meme, it comes from here]

Saturday Stories: Autism, Murder, and the Food Environment

Ron Suskind in the New York Times with an amazing story centred around his autistic son and Disney.

Andrew Solomon in the New Yorker exploring the agony of being the father of a ruthless killer.

David Sherman in the Ottawa Citizen with a rarity - a news piece that tackles the food environment as a cause of obesity rather than simply blame our supposed lack of willpower.

[And if you don't follow me on Twitter I was doing a bit of media this week. Some highlights include this Breakfast Television interview where I tried a lemon pepper cleanse and this segment on CTV's The Social where I think I might have made Jann Arden and the rest of the ladies a little bit sad by the end.]

This Video Kinda Makes me Wish I was a Gastroenterologist!

Today's Funny Friday looks like a great deal of fun (at the expense of people coming out of the meds that tend to accompany colonoscopies and in the name of colon cancer awareness).

Have a great weekend!

Parental No Files: 9:00AM Class Trip to Disney's Frozen Edition

The institution of eating food at the movies. Where did it come from? Is it just a great excuse (as if we need excuses these days) to snack on junk food?

And it would seem it doesn't matter when we head there, or how old the movie goers might be, the snacks must go on!

Have a peek at that form up above. It was sent to me by a Niagara Region RD named Sandy Maxwell. It was the form sent home from school to one of her friends whose 5 and 7 year olds were slated to take a school trip to see Frozen....at 9am in the morning!

As you can see, no worries about them not having access to junk, and of course, Mom could just say "no" - I'm sure her kids won't mind being the only ones left out of the junky festivities and heck if they do, that couldn't affect their long term relationship with food, could it? Definitely making moms and dads say "no" is the far wiser course of action than a no-junk default and instead requiring moms or dads who want their kids to have junk at 9am in the morning to have to actively seek it out.

Ugh.

UK Based Smartphone App Turns Stair Climbing Into a Game

Love this Step Jockey app out of London.

Apparently stairs there are being labelled with gameified with signs that can be scanned by the app which in turn keeps track of calories burned and stairs taken.

It's being backed by the UK Department of Health and NHS London via the Small Business Research Initiative (SBRI).

That said, I have two concerns.

Firstly it's an energy output app with seemingly no discussion or accounting for energy input - which may well lead individuals to feel like their few flights of daily stairs warrants rewards of dietary indulgence ("because I exercised" foods).

But the more important issue I have is that it's being promoted as a means to lose weight.

Exercise is about health, but were weight management attainable solely on the basis of taking the stairs, the world be a much slimmer place.

I'm all for exercise, but its branding needs to change from one of weight control to one of health, and institutions like the UK Department of Health and NHS London should be leading that charge, not contributing to the misinformation embraced by the food industry that our forks are out-runnable.

Can We Enact Bloomberg's Cup Size Limit at the Movies Please?

I went to the movies a few weeks ago with my wife (we saw Gravity in Imax 3D - can't say I recommend it).

On the way out I noticed a giant Coca-Cola advertisement, and as I'm wont to do, I wandered over to have a closer look.

It highlighted a contest to win a ski vacation in Whistler and you could also buy a commemorative cup at the concession stand.

"Cup" is an interesting term though for a container that holds 44oz (1.3 litres) of sugared soda. For those who care that's 526 calories of Coca-Cola coming from its astonishing 36 teaspoons of sugar!

I can't imagine there are many people on the planet who consciously want to consume 1.3 litres of Coca-Cola with their movie, but I bet many unconsciously do simply consequent to the fact that the only commemorative size available shares more in common with a bucket than a cup.

Kid Targeted Ads for "Healthy" Food Likely to Sell Unhealthy Food Later

Here's another reason why we should be banning all food advertising targeting children and not just the ads targeting junk (and it's not all that surprising) - brand associations last.

But knowing that to be true and proving it matters is different and that brings us to a fascinating (but somewhat challenging to read) series of studies conducted by Paul Connell, Merrie Brooks and Jesper Nielsen who aimed to explore whether or not,

"the messages of fun and happiness so common in children’s advertising create lasting affective associations that cloud people’s judgments about the featured products for the rest of their lives?"

And more to the point here,

"can childhood advertising exposure cause biased evaluations for new products introduced years or even decades later if the same advertising stimuli are used?"

Which translated to our modern day environment where the food industry is angling to avoid legislation designed to ban their ads and instead voluntarily limit their advertising to so-called "healthier" items (or even just to use their mascots to highlight other issues like literacy as in the McDonald's initiative seen in the photo up above) might be asked if the creation of positive brand associations might increase the likelihood of future adult consumption of the truly awful?

Their answer was yes in that they found that it was the positive brand associations with childhood advertising characters that influenced an adult's belief that sugary cereals were more healthful. Older adults who were exposed to Tony the Tiger as children, but not to Coco the Monkey, rated old school Tony's pre-sweetened Frosted Flakes as more healthful than modern day Coco's Kellogg's Cocoa Pops after an exposure to advertising to both, whereas younger adult study participants who had been exposed to both brand mascots rated the cereals equally following exposure to advertising to both.

To suss things out further and rule out the possibility that the mascot simply evoked positive consumption memories they conducted a second experiment whereby people were shown either advertisements involving Ronald McDonald and Toucan Sam (both utilized heavily in advertising for decades including during the childhood of this experiment's participants), or simple photos and descriptors of McDonald's fries or Froot Loops along with accurate brand labels. Participants were then asked to rate the healthfulness of McDonald's fries or Kellogg's Froot Loops. The thinking was that if the ads in the first experiment had triggered a memory of consumption rather than an emotional brand attachment and that memory was responsible for the bias, the photos of those actual childhood foods ought to lead to that same outcome. But they didn't, and again, it was found that ads featuring beloved childhood characters biased adults' opinions on the healthfulness of junk food.

For me though the strangest part of the study had nothing to do with the experiments, but rather the conclusions of the lead author who reported to The Daily Mail,

"We suggest that parents discuss the persuasive nature of advertising with their children, and encourage them to develop critical thinking skills in response to advertising messages."

I found this to be strange in that it seems mind-boggling to me that a professor of marketing is suggesting that despite the billions of dollars a year spent on highly sophisticated advertising targeting children, that the call to action is to suggest that parents have a chat with their kids rather than a call to put an end to kid targeted advertising in the first place (though to be fair, the newspaper may have simply left out that quote).

Saturday Stories: Formaldehyde, Viruses, and Facts up Front

Tara Haelle in Slate wonders whether or not our worries about formaldehyde are justified.

Carl Zimmer in the New York Times describes the resurrection of a 30,000 year old, never before seen, virus (I found this story terrifying even though the virus only infects amoeba).

Marion Nestle skewers the food industry's new commitment to fronts of packages.

And if you wanted to help a researcher out one has asked me to post the following request:

Calling all health care practitioners with an interest in paediatric healthcare! Researchers at Holland Bloorview Kids Rehabilitation Hospital and University of Toronto are looking for input from health care practitioners through a short, anonymous online survey to share your feedback and opinion on the development of a new health screening tool for children: The Healthy Body Scorecard. It aims to address some of the limitations associated with the use of Body Mass Index (BMI) alone and provide a user-friendly tool that will help identify the heath needs of children aged 2-18.

Please follow this link for more information and the survey

[And if you don't follow me on Twitter or Facebook want to mention that my book The Diet Fix, as one of Indigo's online top 50 bestsellers, is currently 50% off (click here to order if you'd like), and here's a segment I did with Global's The Morning Show where I explain how I don't think our struggles with weight have to do with a lack of willpower. And here's a post I wrote from Tom Venuto's blog Burn the Fat on perception vs. reality when it comes to food diaries.]

Paul Rudd, Olympian Alana Nichols and Conan Team Up for Funny Friday

Today's a two part Funny Friday.

The first is a supercut of the movie clip Paul Rudd brings along (regardless of what movie he's actually promoting) when he visits Conan.

The second is a more recent Conan visit made by para-Olympian Alana Nichols.

Have a great weekend!

The Salvation Army Health Washed Rice Krispy Treats this Christmas

To be sure it's lovely that Kellogg's donated $30,000 to the Salvation Army this past Christmas.

But please don't think it was done out of the goodness of their hearts as corporations are bound by their fiduciary responsibility to their shareholders not to have hearts.

No, instead their job is to spend money wisely on promotions that in turn improve their sales.

In this case kids were required to make Rice Krispy treats, take photos of them, and share them on social networks and in return Kellogg's gave money to The Salvation Army. Kellogg's also cultivated a tremendous amount of good will by means of the shared photos, and no doubt, positive emotional branding for their products - branding that I'm sure they're hoping will fuel the next generation's lifelong cereal purchases. And all it cost them was $30,000 - a heckuva lot cheaper than traditional adverting and a truly tremendous return on their investment.

In a season already filled with indulgences, I'm not sure we needed more reasons to indulge, and while it's impossible not to agree that the cause was great, it's important not to ignore the fact that it wasn't altruism that fuelled the program, and that at some point we as a society need to face up to the fact that we have dumbed fundraising down to selling and promoting junk food and candy.

Pizza Is Health Food Don't You Know!

Loved this photo that Colby Vorland shared a ways back.

And as ridiculous as it might sound to you to describe Papa Murphy's pizza as health food, you have to take a minute today to read Parke Wilde's discussion of how the USDA has spent literally tens of millions of dollars promoting American pizza consumption.

As far as how effective they were, and I hope Parke doesn't mind, I'm stealing his screen grab of the USDA's reporting on per capita cheese consumption since 1995.

In case you weren't aware, as far as North American teens go - pizza's the number two source of calories and number one source of sodium in their diets.

Thatsalotta pizza!

It Only Took 5 Years but Today my Book is Live!

Can you imagine if pregnancies lasted for 60 months? In a way I can because it was back in 2009 when I first started writing the book that over the course of the past 5 years has matured into The Diet Fix and is today available to all.

Never let anyone tell you otherwise, writing a book and bringing it to market is an enormous undertaking, and one that I never could have done without my fantastic agent Yfat Reiss Gendell, my editor and champion Leah Miller and the whole team from Harmony, my readers and patients who inspire me daily, and most of all my incredible wife - who is the real reason for everything good in my life.

If you're interested in a copy, below are a pile of links to various online booksellers.

Review wise:

• Here is pharmacist Scott Gavura explaining in Science Based Medicine why he thinks The Diet Fix is a science-based guide for anyone that seeking credible and sustainable advice on permanent weight loss.
• Here is health journalist David Despain calling The Diet Fix "a game changer".
• Here is health writer and MPH Patrick Mustain in Scientific American suggesting, "if any diet book works it's going to be this one"
• And here are two Q&As I've done regarding The Diet Fix, here's one I did with Jane Langille for Costco Connections, and here's another I did with Hemi Weingarten for Fooducate.

Guest Post: Are Brazil's New National Dietary Guidelines the World's Best?

Photo by Luciana Christante of Mercado Ver-o-Peso in Brazil

A few weeks ago Brazil announced the launch of their new national dietary guidelines. Unlike those from North America, Brazil's focuses on the real issue at hand - we've stopped cooking. At least half of our average food dollar is now being spent on foods purchased outside the home and of the foods we bring in, the amount of processed foods have doubled since just the 1980s. So how did Brazil do it? How did Brazil, rather than join North American in issuing a misguided, nutrient focused, and food industry friendly dietary guideline, put out an actually useful and thoughtful food guide? Here to explain is Dr. Jean-Claude Moubarac who himself was involved in Brazil's guidelines' creation.

Tips from the tropics
Brazil’s new dietary guidelines focus on food and the enjoyment of meals

Suddenly, it may be that Canada can gain inspiration from Latin America. On February 10th the federal Ministry of Health of Brazil issued the final draft of a new guide not only to food and nutrition, but also to the enjoyment of healthy meals. The guide has been approved at this stage by the Minister of Health. It is now out for public consultation. The guide at this stage in Portuguese, and can be seen here.

Announcing the guide on her blog, Food Politics author and New York University professor Marion Nestle says: ‘Now if only our Dietary Guidelines Advisory Committee would take note and do the same. Would you like us to have sensible, unambiguous food-based guidelines like these?’

After obtaining a PhD from the School of Public Health at Université de Montréal, I spent the last two years in São Paulo, Brazil’s biggest city, during the time the new guide was being prepared. I was a member of the University of São Paulo team responsible to the Ministry of Health for developing the guide, also with support and guidance of the Pan American Health Organization. I had the privilege of participating in the work of preparing the guide, supervised by my post-doctoral mentor and world-renowned authority on diet and health Professor Carlos Monteiro.

The guide preparation has also been supported by workshops held in 2011 and 2013, involving researchers, other health professionals and educators, and civil society organisations, from all regions of Brazil.

The guide is designed to prevent and protect against all forms of malnutrition. These include undernutrition, already in sharp decline in Brazil. Its main focus is the same as any guide issued in North America, to prevent and control overweight and obesity, and chronic diseases such as diabetes, all now sharply increasing in Latin America.

This Brazilian guide goes further. It is not just concerned with avoiding obesity and disease. It is also designed to encourage positive good health and well-being among all Brazilians.

The guide takes into account the latest scientific evidence. It is written in a style attractive to everybody interested in their own health and that of their family and community. It is also designed for use by policy-makers, educators, and all those responsible for food supplies. And as another innovation, it takes as a starting point, what the Brazilian people from all social classes actually eat every day.

All the advice in the guide has been summed up in three ‘golden rules’. These are universal. Everybody in the world will benefit from following them:

• Make fresh and minimally processed foods the basis of your diet
• Use oils, fats, sugar and salt in moderation when preparing dishes and meals
• Limit consumption of ready-to eat food and drink products.

Most countries are now faced with rapidly rising rates of obesity and related chronic diseases. The Brazilian guide is a whole new look at food and nutrition. It takes a broad and comprehensive view of health, including the social, cultural, economic amd environmental dimensions of food systems and supplies and so of dietary patterns. In particular it examines the central role of different types of processing on the quality of diets.

The ten main recommendations in the guide are:

1. Prepare meals from staple and fresh foods.
2. Use oils, fats, sugar and salt in moderation.
3. Limit consumption of ready-to-consume food and drink products
4. Eat regular meals, paying attention, and in appropriate environments.
5. Eat in company whenever possible.
6. Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption.
7. Develop, practice, share and enjoy your skills in food preparation and cooking.
8. Plan your time to give meals and eating proper time and space.
9. When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.
10. Be critical of the commercial advertisement of food products.

Patricia Jaime, Ministry of Health coordinator of Food and Nutrition, the pivotal point of contact in Brazil for the guide, makes a statement that resonates in other countries and all over the world. She says:

"We need to protect and preserve the Brazilian tradition of enjoyment of meals as a central part of family, social and workplace life. The planning of meals, exchange of recipes with friends, and involvement of the whole family in preparing food to enjoy together, are all part of a healthy life. Of course it is true that making meals at home takes time. But this is time we can share with our loved ones, including children. Freshly prepared meals are still cheaper than ready-to-consume snack and drink products. Also, protecting personal and family good health and well-being will save time and money spent on health care"

Public health and nutrition professionals in Canada agree that new ways of thinking are needed to face and deal with the obesity and diabetes crises. Our food system is saturated with ready-to-consume ultra-processed food products that are intrinsically unhealthy. We often hear that today people have little or no time to cook “real” food and to share meals. Maybe this is true. Or maybe it’s a question of what we most value in life and to what we choose to give the highest priorities.

So here is a whole new idea. Maybe our inspiration to appreciate the value of freshly prepared meals will come from Brazil, and the global South.

Jean-Claude Moubarac has a background in anthropology and a PhD in public health. He undertook his post-doctoral studies in public health and nutrition at the School of Public Health at the University of São Paulo in Brazil. He is committed to an integrated approach to health which involves taking into account its social, cultural, economic, political and environmental dimensions. His mission includes devising, developing and helping to enact rational public policies and effective actions to improve the quality of dietary patterns and of food systems, so as to reverse current trends in obesity and related chronic diseases and to protect and enhance good health and well-being. He now coordinates an international research program studying the role of cooking and of food processing in shaping dietary practices, with implications for diet quality and obesity, in low, middle and high income countries. He recently participated in the development of Brazil's new official national dietary guidelines. He is a member of an expert committee convened by the UN Food and Agriculture Organization in order to devise guidelines for the incorporation of food processing into dietary surveys.

Saturday Stories: Foreign Aid, Salt Lessons and Unilever

Photo from Michele Simon's excellent Eat Drink Politics

Jonah Ogles in Outside explores the impact of his sponsorship of a child in Haiti.

Candace Choi from the AP covers the inanity of dietitians being taught about salt by a chip maker.

Andrew Sullivan in The Dish discusses (and swears about) the Guardian's new marriage to Unilever.

[And if you don't follow me on Twitter or Facebook here's a very brief excerpt from my book with my top ten tips for enjoying a healthful vacation (and BTW, if you order The Diet Fix today by clicking here it'll ship on Tuesday!).]

And here's another bonus - thanks to Catherine Mulvale for sharing this powerful and awesome spoken word poem. A must watch.

I'm Really Not Sure Why This Made Me Laugh

Today's Funny Friday's a quick one.

And all I can say is you'll have to wait for 35 seconds to get where I know you'll want to go.

Have a great weekend!

More of What's in it for Coca-Cola to be Tied to Charities (and Bloggers)

Here's a short tweet exchange that covers the "what" succinctly. It stems from, get this, a "nutrition" conference organized by Coca-Cola and put on for non-nutrition expert bloggers.

The first tweet in the exchange was a non-attendee expressing their frustration that the invited bloggers weren't able (or didn't want) to see the inherent conflict of Coca-Cola hosting a nutrition conference for them.

The second was a blogger explaining it's totally cool because Canadian public health icon ParticipACTION and the World Wildlife Fund charity both work with Coca-Cola.

If @ParticipACTION & @WWF are onboard why can't we be? There's a lot of good work being done at @cocacola_ca @emma_willer #koconversations
— Mayahood (@fitzpatrickmaya) December 12, 2013

Innocence by association is not an insignificant return on their investment.

And if you care to see more of why Coca-Cola hosts conferences for bloggers have a peek at these other #KOConversations tweets (just get past the first few from non-attendees that happened after the fact and were actually critical).

Think Before You Link!

Periodically I put this plea out - especially to those of you with positions of influence in your fields and/or large numbers of friends and followers.

THINK BEFORE YOU LINK!

Before you link to the press release about that study that says chocolate is a weight loss aid, or that dieting raises the risk of developing diabetes, or that low-carb causes heart disease, or that kids with obesity eat less than kids without, take the time to actually read the source article and critically appraise it just as you would with an article whose press release didn't fit your own personal narratives or confirmation biases.

Or at the very, very, least - indicate to your followers that you haven't actually read the study in the tweet or status update itself.

Think before you link - you owe it to those who trust you.

New Canadian Health Minister Continues Assault on Health

In a classic move of trying to bury government nonsense by means of timing the news this past Christmas Eve Health Canada pushed out a press release by our new Health Minister Rona Ambrose highlighting what it sees as Canada's 2013 public health victories.

In the press release Minister Ambrose states,

"Canadians expect the foods they eat, the health products they take and the consumer products they use to be safe"

Breathtaking hypocrisy from a government that not only has reversed their decision to regulate unnatural trans-fats out of the food supply, but to also stop their program of trans-fat marketplace surveillance.

Shame on you Minister Ambrose, and on the Harper government, for continuing your fatal dithering on the trans-fat file.

Deepak Chopra Thinks People With Obesity Are Lazy, Gluttonous, Monsters

Or so it would seem from his video for something called, "The Weightless Project", which according to Chopra is "an initiative, where any attempt at shedding a few pounds results in funds that will help the undernourished".

Somber almost creepy music, headless plodding bodies, an obese man in an undershirt blankly staring forward holding a television remote, large butts hanging precariously over picnic table benches, cars pulling up to drive-thrus, scary obese silhouettes in dark alleys, and all of this juxtaposed with images of starving children and poverty to bring us to the video's ultimate message of if you folks with obesity just get off your lazy asses you can not only help yourselves, but also feed the poor.

Don't believe me?

Think I'm exaggerating?

Watch the video:

.

[Deepak, for more on why the portrayal of people with obesity matters please visit Yale's Rudd Center]

Saturday Stories: Goals, Trolls and Brazil

A fabulous piece by Jeff Haden in Inc. on why you shouldn't bother setting goals (you'll see why it's great when you read it).

Chris Mooney in Slate discusses the evidence that proves internet trolls are genuinely horrible people.

Marion Nestle provides a translation of Brazil's fabulous new food based dietary guidelines (no nutrient nonsense)!

[And if you don't follow me on Facebook or Twitter, here's my piece from the Globe & Mail and how just 2 minutes of effort a day can double your weight loss.]

This 8 Year Old Boy is Now a Hero of Mine

With self-confidence and talent that I can only dream of this little Indian boy dances his way to my heart and to today's Funny Friday.

Have a great weekend!

Olympians Target Children for their Food Industry Sponsors

One of the most obvious reasons for the food industry to partner with sport is to help deflect blame for diet and weight related illnesses away from their products and onto inactivity. But there's another reason they get involved - to reach impressionable children (often younger than those they claim not to target) and create lasting emotional brand attachments.

For instance a few months ago ParticipACTION offered up their sponsor Coca-Cola (yup, Coca-Cola is ParticipACTION's largest sponsor and to date has given them $10 million) the opportunity to send their brand ambassadors out to meet kids. It was called a "Teen Challenge" but looking at Coca-Cola's promotional video of the event (screengrab up above, video linked here), it would seem teens were not the predominant attendees.

And in comes Coca-Cola branded Patrick Chan, a highly charismatic figure skating Olympic hero to brighten up their days.

Had a blast surprising these young athletes today! @ParticipACTION @Cocacola_ca pic.twitter.com/W0v9p4eZSw
— Patrick Chan (@Pchiddy) December 11, 2013

Same goes for a Coca-Cola branded Olympian speedskater Marianne St-Gelais,

I got the chance to meet these @particiPaction #teenChallenge participants - so much fun @cocacola_ca pic.twitter.com/4Gy1IcVZyu
— Marianne St-Gelais (@mastgelais) December 10, 2013

And here's Coca-Cola branded BMX Olympian biker Sarah Walker at a Let's Move 60 event.

@swbmx amazing time today and it was fantabulous to meet you xD pic.twitter.com/s3UrLOxAqt
— Eden (@VengeanceSoBitt) December 13, 2013

But it's not just smiles given out at these sorts of food industry sponsored charitable sport events. Here's an email from someone who wishes to remain nameless describing their recent trip to a Coca-Cola sponsored, Olympian attended, event. But before we get to their description, here's a photo from the Coca-Cola press corp that accompanied their headline, "Fruit and Veggie Fest Teaches Children About Healthy Living"

Looks and sounds great, right?

Here's that non Coca-Cola paid for coverage of the event I mentioned receiving,

"Dispatch from the Coke’s Health and Wellness Promotion:

I just was required to take a group of kids to a Coca Cola-sponsored Fruit and Veggie Festival. The other partners were Boys and Girls Clubs of America and Wellpoint. The event started with a welcome which featured:

• Key message: Eat lots of fruits and veggies kids
• Olympic athletes: One who is also a Coca-Cola executive and the other was Gale Devers, Olympic gold medalist.
• A thank you to Coca-Cola.

The kids were engaged in an obstacle course, zumba, crafts, and fruit and veggie snack making tables. There were also 4 food trucks handing out tastings of vegetarian tacos and sandwiches. The kids were also served Dasani Water and neon-blue Powerade Zero.

After a significant amount of eating, and a small amount of physical activity, the youth exited with bags of trinkets and water bottles, an 8-inch Subway sandwich, and more bottled Dasani and Powerade.

The small crowd of black and latino children was very well documented by photographers and videographers.

I am pretty sure the kids didn't leave the event with a message of “Eat and drink less.” I am sure there was atleast 1000 calories provided to each child in a 2 ½ hour period.

In fact, I believe the message they existed with was stuff your face, and then some, and wash it down with Coke products was reinforced."

"Sponsored" Tweets from the #F3K Food & Nutrition Influencer Conference

Those of you who follow various nutrition professionals on Twitter have no doubt seen the #F3K hashtag these past few days.

Briefly, the #F3K hashtag stems from an annual influencers conference run by Porter Novelli, a multinational PR firm that boldly (and rather terrifyingly) exclaims,

"We motivate people to change deeply ingrained behaviors rooted in cultural and social norms. Our results are greater than influencing people. We make them believe"

And here's Porter Novelli describing their annual PN Food3000 (#F3K) conference),

"We boast long-term relationships with the individuals and organizations that influence consumers’ attitudes, beliefs and behaviors related to food and health. The Food and Nutrition practice annually hosts PN Food3000, at which American Dietetic Association media spokespeople are exposed to the latest innovations and research in nutrition communications. Our team of expert communicators and registered dietitians helps clients devise intelligent strategies to introduce new products or line extensions against well-chosen market segments, including multicultural audiences. We are skilled in developing platforms that create a point of differentiation, establish strategic alliances and sponsorships, grow consumption and position brands for new growth segments."

And judging from the tweets emanating from this year's #F3K that took place in Amsterdam, they've done a bang up job and the sentiment from many non-attending RDs on Twitter is that those who did attend did so at least partially on the conference's industry sponsors' dimes.

I'm going to post these tweets without commentary. Most come from RDs at the conference, many of who boast large social networks and presumably are Academy of Nutrition and Dietetic spokespeople . And to be clear, the tweets are my own quick cherry picking (to see all the tweets, click here). They're not meant to disparage or shame those who tweeted them (in many cases they're just quotes from speakers), but rather for readers here to consider the wisdom of these sorts of conferences and their promotion, as well as whether the hashtag #spon is sufficient to explain to the public that the tweets come from food industry sponsored talks (it wasn't for me - I had to ask someone what it meant).

[BTW - I did ask Porter Novelli for further information regarding sponsorship and program. They have yet to send a response. I can only suppose then that transparency doesn't make for good PR.]

Bravo! RT @CBDiekman: Congrats to #Mars international for working to increase kids interest in cooking and healthy eating. #F3K #spon
— joansalgeblake (@joansalgeblake) February 17, 2014

Check Your Facts: "Epidemics" are contagious & obesity is not contagious, so it's not an epidemic. Paul Rozin at #F3K
— Robyn Flipse (@EverydayRD) February 17, 2014

"Processed foods are not the problem - maybe they are the affordable solution- we just have to mk them healthier"DrDecker #F3K #spon
— Bonnie Taub-Dix (@eatsmartbd) February 16, 2014

#F3K is debunking one food myth @ a time #FactsOnly
— shani stjohn (@shanistjohn) February 16, 2014

#f3k #Amsterdam US #nutrition experts discuss how #dietarysupplements can fill in the nutrition gaps even if ya think you're eating right
— carolynoneil (@carolynoneil) February 15, 2014

Gr8t News! RT @CBDiekman: Flavored yogurt sugar content down from 19.5 grams to 12 grams per 100 g. #F3k #spon
— joansalgeblake (@joansalgeblake) February 15, 2014

@MelissaJoyRD @ lots of food joy #F3K Did ya know food processing can increase nutrients we need more of & reduce what we need to limit
— carolynoneil (@carolynoneil) February 15, 2014

We're too quick to blame the food industry rather than telling consumer to take responsibility for their eating habits #F3K #spons
— Mindy Hermann (@MindyHermannRD) February 15, 2014

Healthy eating requires - balance of foods, right portions, & proper prep. Don't worry about "processed" focus on right choices. #F3k #spon
— Connie Diekman (@CBDiekman) February 15, 2014

Processed food is called "unnatural" until there's a "natural" disaster and it's the only thing available & safe to eat. #f3k #spon
— Robyn Flipse (@EverydayRD) February 15, 2014

Good point“@joyofnutrition: Its not about processing but nutrient quality that should be one of the deciding factors on foods we eat #F3K”
— Vandana Sheth RD (@VandanaShethRD) February 15, 2014

#f3k Food processing is just a use of technology. What other technology do you want to give up- cell phone, Internet, infant formula? #spon
— Robyn Flipse (@EverydayRD) February 15, 2014

Processed is not 4-letter word. Some of healthiest foods would not be possible w/I technology. Whole grains just one example #F3K #spon
— Rachel Begun (@RachelBegunRD) February 15, 2014

Select foods that deliver the goods-processing is a vehicle 2 make more nutrients avail #F3K #spon
— Toby Smithson (@diabetesevryday) February 15, 2014

Food fortification plays a role in meeting nutrient needs of Americans. Processing helps enhance & preserve food quality.#F3K #spon
— Connie Diekman (@CBDiekman) February 15, 2014

#F3K "Processed" is not a dirty word. It provides food safety, variety in diet, affordability, palatability & more.
— Melissa Joy Dobbins (@MelissaJoyRD) February 15, 2014

#ActiveAdvice -processing foods allows us to progress not regress with our choices and self health #F3k
— Leslie Bonci (@lesliebonci) February 15, 2014

Myth-shopping on the perimeters of grocery stores are healthier. There are healthy options throughout store. Read labels & go w/ plan #F3K
— Joy Dubost (@joyofnutrition) February 15, 2014

Diet Book Review: James Fell & Margaret Yúfera-Leitch's Lose it Right

Before I get to the review I have many disclosures. I've known James for years and have worked with him on many stories in his job as a columnist for all sorts of folks including the LA Times, the Chicago Tribune and Chatelaine. We share a Canadian publisher and editor. I received a review copy of his book a while ago (and wrote a cover blurb for it), and he recently wrote a very kind review of my book The Diet Fix. I'm featured a bunch in Lose it Right. But wait, it gets even more conflicted. James is also one of those folks who by means of us working together on all sorts of stuff led us to even touch base outside of social media. James is a friend.

So, now that all that's off my chest, I'll tell you a bit more back story. When I first "met" James he really lived up to his moniker at the time of, "In Your Face". That he was. James has a very in your face style of writing, but what became clear rather quickly, an in your face style of living. He's never short of an opinion, nor is he ever shy about sharing his with you. And that's not a bad thing, it's just James. When our shared publisher reached out to me to consider writing a blurb for James' book (and he mine), I was actually hesitant. My worry was simple. While being a huge fan of his writing style, and while it certainly seemed from what I'd read of his that our opinions were in line with one another, I worried about not liking his book. I didn't think it would be awful or anything, but given our long working relationship and our shared publisher, I wondered what I would do if I didn't love it.

I needn't have worried.

Despite my extreme familiarity with the subject matter, and despite having read truly dozens and dozens of diet books, I can honestly state that I have never had more fun reading one than I did reading Lose it Right.

Its subtitle does it justice, "A Brutally Honest, 3-Stage Program to Help You Get Fit and Lose Weight Without Losing Your Mind" as that's really what it's all about. No bullsh*t, just straight shooting laced with James' humour and Margaret's evidence base. Their 3 stages are straightforward. The first is the background they feel will help to inspire your lifestyle changes. The second are the preparations you'll need to enact those changes. The third are the whats and the hows of the changes they're aiming you at.

There aren't any real time frames attached to how long each stage will take, nor are there any nonsensical inflexibilities in their guidance. The crux of Lose it Right is that exercise, while not in and of itself useful in burning a whole boatload of calories, is essential in inspiring, fuelling and sustaining healthful lifestyles. They get into what they call the "virtuous cycle" whereby their theory is that exercise, "enhances ability to make wise food choices and makes you crave healthy fuel", and that said healthy fuel, "increases energy and positive attitudes about being active". And that definitely fits both with an evidence base that states that those who exercise more score higher on surveys of healthful living behaviours, and with my experiences working with literally thousands of patients trying to change their lives.

Ultimately Lose it Right is a doable healthy living business plan (James is an MBA grad) that lays out not only what changes you have to make to open your healthful living business, but also the return you can expect on your investment, as well as the blueprints for how to enact change, and it's a plan I can honestly endorse.

Should you want your own copy, here's an Indigo link and here's an Amazon link (its publication date is April 1st). So far it's only available here in Canada, though I'm guessing it'll ship wherever you might be.

You can also read James on his blog Six Pack Abs, and Margaret on hers Psychology and Appetite

[And FYI - while I was asked to write a blurb for the book, I was never asked to write this review, nor is James or our shared editor aware that I'm writing it.]

Saturday Stories: Olympic Hunger Games, Sugar Law, and Sugar Tax

Riveting piece by former Olympian Samantha Retrosi on why she feels the Olympics are like The Hunger Games.

When Marion Nestle says that an article on food politics is worth reading I listen! Here's a fascinating piece of investigative journalism by Eric Lipton in the New York Times on the rivalry between the Corn Refiners and Big Sugar

Lance Knobel in Berkeleyside discusses the possibility of Berkeley becoming the first city to impose a soda tax in the US.

[And if you don't follow me on Twitter or Facebook, here's this week's US News and World Report column on why you shouldn't take a flying leap at healthy.]

Bad NFL Lip Reading Part 2

For those of you just coming out of your post Super Bowl NFL withdrawal and even for those who aren't actual football fans, today's Funny Friday is sure to make you smile!

Have a great weekend!

Are You Ready for "Sport Recovery Beer"? (Sadly Not The Onion)

No, this is not The Onion. It's "Lean Machine Sport Recovery Beer", and if this product ever makes it to shelves in Canada it will demonstrate well and truly that Health Canada doesn't give a flying you-know-what about what's being marketed and sold to consumers.

This seems smart.

So what is a "sport recovery beer"? It's beer. Beer advertised as healthful. Beer with marketing that suggests it will help you with your "muscle recovery", provide you with "electrolyte replenishment" and "Anti-Oxidants", and support your, "Immune system", and in so doing, "allow your body to recover quicker and more fully".

As far who Lean Machine feels is their target market, try this on for size straight from their website,

"Lean Machine will be known as a 'FIT BEER' and it will be marketed primarily to the Young Adults, 19-32 years of age. This age group represents the largest consumer of ready to drink beverages. Consumer research has indicated that this target group has a strong desire to purchase and consume quality tasting ready to drink beverages, and if available, they will switch from their current brands."

And while I too long for health food beer (and cancer fighting chicken wings, and blood pressure lowering potato chips), I desperately hope that Health Canada, and frankly governments the world over, will ensure that all of the money spent on developing and branding this beer is poured right down the proverbial drain and ban its sale long before it ever starts actively preying on our teens.

[And if you prefer research to greedy, immoral, marketing BS and you're considering this beer you ought to also consider the results of this recent study that found post-exercise alcohol impairs muscle recovery and adaptation - h/t Kevin Tipton]