Saturday Stories: The Week in #COVID19 And Some Stories Worth Reading

Angeline Bernadel, LPN at West River Healthcare in Milford, died of COVID19 on April 4th, 2020, may her memory be a blessing

Achal Prabhala and Ellen ‘t Hoen, in The Guardian, on our eventual COVID19 treatment and cure and its inevitable control by the pharmaceutical industry.

James Hamblin, in The Atlantic, on why some people with COVID19 get so much sicker than others. 

Ari Feldman, in The Forward, on how Orthodox Jews are flocking by the thousands to donate convalescent plasma in the fight against COVID19.

Tomas Pueyo, in Medium, on what the world has taught us the dance must look like if we want to open things up. 

Tomas Pueyo, in Medium, on the COVID19 dance steps that you yourself might be able to take.

Maryn McKenna, in Wired, on the risk that COVID19 will worsen the existing crisis of antibiotic resistance. 

Colleen Farrell, in The New York Times, on what to say and not say to those working COVID19's frontlines.

Saturday Stories: This Week's Worthwhile COVID19 Reads Roundup

Dr. Huy-Hao Dao, 44,,who worked at Quebec’s Montérégie-Centre Integrated Health and Social Services Centre in Longueuil and sadly the first Canadian physician to die of COVID19, may his memory be a blessing.

Roxanne Khamsi, in Nature, on the incredible challenges we'll face producing and distributing a SARS-CoV2 vaccine if/when we find one.

Michael Specter, in The New Yorker, with a profile of America's real doctor - Anthony Fauci

Apoorva Mandavilli and Katie Thomas, in The New York Times, discuss what serology tests are, and whether they'll help us all get back to work.

Ed Yong, in The Atlantic, on our pandemic summer and how the only way out is through.

Maggie Koerth, in FiveThirtyEight, on COVID's destruction of our medical supply chains and how it's not impossible the entire world's supply of medical grade glass (used for vaccine vials for instance) has already been pre-purchased.

Terrie Laplante-Beauchamp, in the Globe and Mail, with her must-read 3 day diary of her experiences volunteering as an orderly in a Montreal based long-term care facility hit hard by COVID19.

William Hanage, in the Guardian, on why he thinks it's incredibly premature to be discussing peaks, second waves, and getting back to normal.

Saturday Story: Only One, Because For First Time in 15 Years, I Accidentally Deleted The Rest

Dr. Doug Bass, may his memory be a blessing, the first physician in NYC to die from COVID9

Sorry to those who enjoy these reads, but by accident, deleted the lot of them save one

Dhruv Khullar, in The New Yorker, on his work as a physician in NYC during the time of COVID19, and adrenaline, duty and fear.

Saturday Stories: Some Of This Week's Most Important #COVID19 Stories

You can follow Dr. Griggs on Twitter

Italian novelist, Francesca Melandri, in The Guardian, writes you a letter to you from Italy explaining what you're about to be facing.

Psychologist Stuart Richie, in Unherd, on why you might not want to trust psychologists on matters coronavirus

Ed Yong, in The Atlantic, with a characteristically great deep dive on whether or not we should all be wearing masks.

Harlan Krumholz, in The New York Times, needs you to know there are many false negative #COVID19 tests and why if you have symptoms, you should assume that's what you've got.

J. Kenji López-Alt, in Serious Eats, with the definitive guide to food safety and the coronavirus (a must read if you watched that long, scary, YouTube video about same)

Mary Chris Jaklevic, in HealthNewsReview, explains why you need to consider stories detailing #COVID19 scientific studies with caution.

Saturday Stories: Some Of This Week's Most Important #COVID19 Reads

Jennifer Yang, in The Toronto Star, speaks with 3 of Toronto's health care heroes.

Adam Rogers, in Wired, explains what convalescent plasma is and how it might help treat COVID19.

Ed Yong, in The Atlantic, being Ed Yong and writing an incredible piece on how this pandemic might end.

David Enrich, Rachel Abrams and Steven Kurutz, in The New York Time, on the sewing army rising up to help.

Helen Branswell, in STAT, summarizing all the we've learned to date about the SARS-CoV2 virus.

Daniela J. Lamas, in The New York Times, writing as a critical care physician in Boston on the unfathomable reality she's facing there.

Siddhartha Mukherjee, in The New Yorker, on how the coronavirus behaves inside of our bodies.

Saturday Stories: Still Just Coronavirus Links - Guessing It Might Be This Way For A Little While At Least

Gretchen Reynolds, in The New York Times, answers questions as to the safety of exercising in the face of COVID-19

Cornelia Griggs, in The New York Times,  a critical care physician in New York, explains why she needs you to know that the sky is falling.

Yascha Mounk, in The Atlantic, tries to explain why people aren't staying home despite incredible risks and ramifications of not doing so.

Ashleigh Tuite and David Fisman, in The Globe and Mail, both infectious disease epidemiologists, with their thoughts on how we might slow the burn of the COVID-19 forest fire.

Aaron E. Carroll and Ashish Jha, in The Atlantic, with their thoughts on how we can beat this coronavirus.

Pam Belluck, in The New York Times, needs you to know that though children uniformly have much milder cases of COVID-19 than adults, some will become seriously ill.

Manny Fernandez, in The New York Times, with a sobering read on how the coronavirus will impact the already impoverished.

Saturday Stories: #COVID19 #FlattenTheCurve #CancelEverything Edition

7 views on why social distancing is so important right now and why we have to "cancel everything". If you think that #COVID19 isn't a big deal, do take the time to read these pieces to learn why you're wrong (ordered solely by way of the order I happened to read them in).

Eliza Barclay and Dylan Scott, in Vox.

Tomas Pueyo in Medium

Yascha Monk, in The Atlantic

Helen Branswell, in STAT

André Picard, in The Globe and Mail

Sharon Kirkey in The National Post

Kaitlyn Tiffany in The Atlantic

Also, here's Wency Leung, in The Globe and Mail, on what you should do if you think you have COVID19, and here is the Toronto Star's infographic on what self-isolation should look like if it's determined that you've contracted the virus.

Siouxsie Wiles and Toby Morris / CC BY-SA

TikTok Is All About Fat Shaming These Days

I was driving with my 13 year old daughter on Saturday and we were just chatting. I asked her what was trending these days on her TikTok stream (in the past she'd been served up antisemitism)? Apparently it's fat shaming Lizzo.

I asked her to share some videos with me.

She sent over 10 in less than a minute.

Some representative examples to follow, but all this to say, TikTok, while hugely entertaining, is a cesspool of hate and bullying, and if your children use it, probably worth asking them every once in a while what's trending on their streams so that you can take the time at least to talk about it.

@noahswitzer98

Everyone please ##stop making ##lizzo memes ##fyp

♬ original sound - noahswitzer98

@nickring4

When you lose Lizzo while your whale watching 😂 ##greenscreen ##lizzo ##meme ##xyzbca ##xyzcba ##joke ##fyp ##memes ##tiktokmemes ##comedy ##comedicgenius

♬ ITs ANIT new girlfriend of your ex - its_anit

@yaboyg35

##greenscreenvideo ##lizzo ##meme ##tacticalnuke ##mw2

♬ original sound - yaboyg35

Saturday Stories: Elizabeth Warren, Enabling Antisemites, Marathon Cheats, and COVID19

Elie Mysal, in The Nation, with the depressing truth behind why Elizabeth Warren won't be America's next president. 

Sharon Otterman, in The New York Times, with an absolutely shocking story of enabled antisemitism from New Jersey (and I don't shock easily)

Derek Murphy, in Wired, on marathon cheaters and their investigators

[And if you don't follow me on Twitter or Facebook, here's the segment I did yesterday on CTV's The Social where we chatted about many things COVID19 (if geoblocked outside of a Canada, a VPN spoofing a Canadian server ought to work]

Australian Food Industry Launches World's Least Aggressive New Voluntary Self-Regulatory Effort

Waiting for any industry to self-regulate itself is just plain dumb. Honestly, industry's job is to protect and promote sales, and that's of course true for the food industry as well.

Self-regulation tends to crop up not out of altruism or doing the right thing, but rather as a means to forestall legislative regulatory efforts which in turn would prove to be more damaging to sales.

Take this recent initiative out of Australia which will see the food industry not advertising their junk to kids within 150m (500ft) of schools. 150 whole metres! While certainly not likely to do anything at all, it'll be especially useless perhaps in that the school buses themselves will be exempt, as of course will be the bus stops' shelters.

Oh, and as toothless as it is, it's also voluntary.

Really the only thing this initiative will do is provide the food industry with ammunition if and when facing calls for legislated regulation (something we're hearing more and more calls for) and to pretend that they care about anything other than profits.

It's always best to remember, as I've written before, the food industry is neither friend, nor foe, nor partner.

Saturday Stories: Coronavirus Edition

James Hamblin, in The Atlantic, on how yes, you're probably going to get the coronavirus.

Peter Daszak, in The New York Times, welcomes you to the age of pandemics.

Vivian Wang, in The New York Times, with the bad good news that most coronavirus cases are likely to be mild.

Zeynep Tufekci, in Scientific American, on what you can do to prepare for when the coronavirus spreads to your country.

Health Canada Fails Science And Canadians By Allowing Any Purported Weight Loss Supplements To Be Sold

The latest of many systematic reviews and meta-analyses of herbal supplements for weight loss plainly makes the case that there is no justification for their sale.

They. Don't. Work.

None of them.

None. Of. Them.

So why does Health Canada license and allow the sale of 1,128 natural products whose listed purported use is for weight management? Or of the 671 products that purport they'll improve sexual enhancement? Or of pretty much any of them?

Maybe the answer lies somewhere in the taxation of the $1.8 billion annual Canadian sales of vitamins and supplements?

Maybe it lies in well-intentioned hope?

Maybe it lies is political contributions and lobbying?

But the one place where it doesn't lie is in science. Shouldn't that be the only place that matters?

Saturday Stories: CRISPR Ethics, Auschwitz' Survivors' Warnings, And Illegal Abortion

Ethan Weiss, in STAT, with a personal essay about his daughter, albinism, CRISPR and ethics.

Jonathan Freedland, in The Guardian, with the last desperate warnings of Auschwitz' few remaining survivors.

Olga Khazan, in The Atlantic, on what abortion will look like if it once again becomes illegal.

Oh My God The Nutrition World Is Painful

Short post to say that watching people aggressively argue about their preferred diets of choice, and seeing reputable people willing to prop up the most shameless of medical hucksters if they happen to share a nutritional belief, and confirmation bias cherrypicking, and the endless debates about physiology, and meal timing, and breakfast, and fasting, and macronutrients, and lipids, and anti-science shilling, and multi-level marketing, and so much more, is so very tiresome.

As a clinician I know that what actually matters is how to help the person sitting in front of me, remembering that science, meal patterns, macronutrients, and physiology, may not always matter the way some study says they could or should in the face of an individual's life and personal preferences. Ultimately, and regardless of what I think is "right" on paper or right for me, my job is to help patients make sustainable changes that in turn lead them towards the healthiest life that they can actually enjoy.

Similarly, as a public health advocate, I know that if there were any amount of education, or a brilliantly crafted public health message, that in turn would effectively drive societal behaviour change we'd have all already changed all of our behaviours. I can also tell you that energies spent on initiatives relegated to personal responsibility, including but not restricted to those promoting one person's diet tribe, pale in importance to energies spent on initiatives relevant to changing the food environment. And there's no shortage of targets that span all dietary dogmas - from advertising to kids, front-of-package health claim reforms, junk food fundraising, the provision of free cooking skills to kids and adults, national school food programs and improvements, tax incentives and disincentives, and more.

All this to say, it's my opinion that these two flawed foci, that there's one best or right way and that personal responsibility will be our salvation, are the two main reasons why we can't have nice things in nutrition and nutrition related public health.

Saturday Stories: Man-Boobs, Formula, And Shattered Identities

James Hamblin, in The Atlantic, on the bizarre and unfounded man-boob based backlash to plant-based meat.

Hannah Ellis-Petersen, in The Guardian, on how formula makers target the mothers who can least afford it.

Sarah Zhang, in The Atlantic, on DNA testing and shattered identities.

Why Service Provision Fatally Confounds All Diet Studies (5:2 Intermittent Fasting Edition)

Last week I posted about a 5:2 intermittent fasting study that demonstrated terrible adherence with a 58% 5:2 drop out rate by the end of year one and where the average loss was 11lbs.

In response, Erik Arnesen shared another year long 5:2 intermittent fasting vs. continuous energy restriction study where the drop out rate at the end of year one was just 7% and the average loss was 20lbs! (and actually I blogged about this one in the past - tl;dr no difference in outcomes but 5:2 participants were hungrier)

If the diets were identical, why the tremendous difference in adherence and weight loss at a year?

Sure, could be different patient populations, but I'm guessing the much larger factor was the service provision. Because at the end of the day that's a huge part of what's being measured in any organized diet study. Not just in terms of how many visits or touch-points a particular program has, or what collateral materials and support they provide their participants, but also the rapport development, motivational ability, and teaching skills of the service providers themselves.

Having led an inter-professional team for 16 years, I can tell you that who you've got helping your patients/participants has a tremendous impact on their outcomes even within the same program's delivery.

So the next time you consider the outcomes of any study's diet arm, a question worth pondering is how much of those outcomes are consequent to the prescribed diet itself, and how much are consequent to the health care professionals administering it?

Saturday Stories: Gym Harassment, Toddler Milk, And Healthy Microbiomes

Sirin Kale, in The Guardian, on how harassment in the gym stops women from working out.

Olga Khazan, in The Atlantic, on the repulsive rise of toddler milk.

Michael Eisenstein, in Nature, on the hunt for what even constitutes a healthy microbiome

Year Long 5:2 Intermittent Fasting Study Reports It's No Better Or Worse Than A Horribly Restrictive Diet

I started out planning to write about a different paper - a one year post intervention followup of people who had completed a prior year of being randomly assigned to 5:2 style intermittent fasting (IF) (2 days a week consuming 400-600 calories) vs. continuous energy restriction (typical of eating less daily) which showed that there was no difference between the two, but when I read it I realized the story was in the initial intervention, not the follow up.

The initial intervention involved randomly assigning 332 people to one of 3 dietary interventions:  Continuous (daily) energy restriction (CER), week-on, week-off energy restriction, and a 5:2 intermittent fasting pattern involving 5 days of habitual intake and 2 very low energy diet days each week.

Of the only 146 completers, no differences were found between the diets in terms of weight loss, adherence, change in lipids, or fasting glucose.

And most of that is consistent with other studies of 5:2 IF which have found that it's no better or worse than any other approach when it comes to weight loss and biochemical changes. But what's not consistent is adherence being the same, wherein other studies tend to see more people quitting IF.

Digging the tiniest bit deeper into this two things stand out. Adherence was abysmal for both CER (49% drop out rate) and IF (58% drop out rate). But what was different here was what was involved in the CER arm. Women randomized to the CER arm were aimed at consuming only 1,000 calories daily for a year, while men were aimed at only 1,200 calories daily. That's a life-suckingly low number of calories for anyone to be aimed at and honestly it surprises me that researchers (and peer reviewers) would think that degree of continuous restriction would be worthy of study.

All this to say, that people were just as likely to report adherence to a misery inducing 1,000-1,200 calorie per day diet as they were to a 5:2 IF approach does not reflect well on the enjoyability (and consequently the broad applicability) of 5:2 style diets.

And for the inevitable trolls, I'm not knocking 5:2 IF. If you love it, terrific! Don't stop! But don't anyone expect it's a panacea for all comers.

Saturday Stories: Stretching, Microbiomes, And Supplements

Alex Hutchinson, in Outside, on why you probably don't need to stretch.

Peter J. Turnbaugh, in Nature, on diets and microbiomes.

Tamar Haspel, in The Washington Post, asks why people are spending $35 billion on supplements if they don't do anything?

[And if you don't follow me on Twitter or Facebook, here's a piece I wrote for Elemental on how when it comes to the Biggest Loser, there are no winners]

Study Published Stating The Daily Mile Doesn't Improve Childhood Obesity Speaks To Risks Of Tying Weight To Exercise

Published this week in the International Journal of Obesity is Effectiveness and cost-effectiveness of The Daily Mile on childhood weight outcomes and wellbeing: a cluster randomised controlled trial whereby researchers reported on the impact a school year worth of 15 minutes of daily running had on children's BMIs.

It's an odd study in that we're talking about 15 minutes of running per day which literally no one should expect to have a marked effect on childhood obesity given both math (15 mins of children running, jogging, or walking a mile probably doesn't even burn the calories of a single Oreo) and the fact that multiple meta-analyses have shown that even far more involved school based PE initiatives don't have an impact on childhood obesity.

It's also odd because The Daily Mile itself doesn't tie itself to weight,

"The aim of The Daily Mile is to improve the physical, social, emotional and mental health and wellbeing of our children – regardless of age, ability or personal circumstances"

And it's a problematic study in that consequent to the wholly predictable non-exciting outcome, it's the sort of study that might be used as a means to discourage the program's continuation.

What might have been studied instead? How about the impact of the Daily Mile on marks, concentration, endurance, or physical literacy (note, they attempted to do some of this, but data collection was too poor for them to make many conclusions), or if there was a strong desire to tie it to something medical, how about blood pressure, heart rate recovery, mood, sleep, or lipid levels?

As I've said many times, dumbing down exercise to weight management shortchanges both the benefits of exercise and the realities of weight management, and frankly doing that in the name of a program that sees kids running an extra 15 minutes a day, and then seeing that published in a credible journal, speaks to just how pervasive and dangerous that practice is.

If The Microbiome Is As All Important As We're Led To Believe Isn't That's All The More Reason Not To Mess With Yours?

There's no denying the hype around the microbiome with buzz suggesting that it's integral to anything and everything - from our immune systems, to obesity, to dementia.

So let's for a moment agree that it is.

Even if we do, it's difficult to imagine there would be one universal "best" mircobiome makeup spanning age, sex, race, diet, geography, comorbidities, etc. Meaning even if we had thoughts about what a "healthy" microbiome was, what's healthy for one person might not be healthy for another.

But back to us agreeing they're hugely important and implicated in everything.

If that's the case, should you really be purposefully trying to mess with yours given we basically haven't even begun to study the impact of messing with them over time?

Me?

I'll stick to the basics.

Saturday Stories: Coping, Flu Shot Crusading, And Conspiracying

Thomas Harding, in The Guardian, on surviving the loss of his teenage son.

Jason McBride, in Toronto Life, with a profile of the inimitable flu shot crusader Jill Promoli.

Jane Coaston, in Vox, on the conspiracy theories fuelling New York's exploding antisemitism.

Should Statistically Significant But Clinically Meaningless Outcomes Still Be Reported As Significant?

Rather than call out the specific paper that led to this blog post (I also don't want to add to its Altmetrics), just a question.

If your systematic review findings demonstrate that a particular supplement/food/diet led to an average total weight loss of 0.7lbs is it appropriate to describe that effect as significant even if statistically you believe you're able to make that claim?

Personally, I don't think so.

Especially not when we're discussing food, because as Kevin Klatt recently pointed out on his blog, there are no food placebos. and as John Ionnidis pointed out, we eat thousands of chemicals in millions of different daily combinations which markedly challenges our ability to conclusively opine about the impact of any one food.

Worse though, is the fact that the media (both traditional and social), won't bother to qualify their enthusiasm when describing these findings and instead will report them as beneficial, significant, and important, as of course will PubMed warriors.

So how to fix this? Perhaps including a qualifying, "but not likely to have any clinical relevance" statement in the abstract might lead to more balanced media coverage (or less media coverage ) which in turn would be less likely to report significant but clinically meaningless outcomes as important, which ultimately would be good for science and scientific literacy.

Saturday Stories: Black Medical Academics, Brittany Ran A Marathon, And Body Positivity

Uché Blackstock, in STAT, on why black academic physicians like her are leaving their positions.

Sam Brennan, in Fit Is a Feminist Issue, on how she watched Brittany Runs a Marathon so you don't have to.

Virginia Sole-Smith, in Elemental, asks whether the fitness industry and body positivity can co-exist?

Product Reformulation Means Sugar Taxes Work Even If People Don't Buy Less As A Consequence

Taxes work to decrease purchasing, and the higher the tax, the greater their impact. Period.

Which is why it's always struck me as odd when people question whether or not sugar-sweetened beverage (SSB) taxes would affect SSB purchases (and consequently consumption).

But let's leave that odd debate aside for a moment. If the goal of SSB taxes is to decrease added sugar consumption (which it explicitly is, while it is explicitly not about weight loss as societal obesity is not singularly caused by SSB consumption, and decreasing SSB consumption is healthy at every weight), it would appear that SSB taxes will decrease sugar consumption even if they don't decrease purchasing.

How?

Because when SSB taxes are enacted, the beverage industry reformulates its products.

And at least according to this bulletin from the World Health Organization, they do so not insignificantly!

Of the 83 products they surveyed in both 2014 (before the UK's SSB tax) and in 2018 (after the UK's SSB tax), the mean sugar content decreased by 42% (from 9.1 g/100mL to 5.3 g/100mL) while the mean energy content decreased by 40% (from 38 kcal/100mL to 23 kcal/100mL). Putting this into the context of a standard 355ml can - that would represent 2.45 fewer teaspoons of sugar and 53 fewer calories per can.

And this was in response to a fairly nominal tax. Presumably larger taxes would drive larger (or more expansive) reformulations which of course would also be coupled with decreased purchasing as has been shown to not at all surprisingly occur where enacted.

All this to say, this is yet another reason why if you're living somewhere without an SSB tax, my bet is that it's a matter of when, not if, you will be.

Saturday Stories: Larry David, Elizabeth Wurtzel, And The Ebola Vaccine

Brett Martin, in GQ, profiles the inimitable Larry David

Elizabeth Wurtzel, in Medium, discussing her life's final year

Helen Branswell, in STAT, with the story of how scientists on 3 continents together produced an Ebola vaccine

Photo of Elizabeth Wurtzel by Blonde1967; this photo was taken with an iPhone SE by my mother, Lynne Winters - Own work, CC BY-SA 4.0, Link

Canadian Donut Chain Launches Donut Flavoured Cereal And People Are Angry. Why I Think There Are Better Things (And Worse Cereals) To Be Angry About.

So last week saw the Canadian launch of timbits cereal and as evidenced by the number of people have sent press releases about it to me, not everyone is pleased.

Timbits, for readers who don't know, are donut holes from Canadian donut chain giant Tim Hortons.

People are upset because apparently this sugary cereal is over the top and somehow extra wrong or extra awful.

But why?

Tim Horton's certainly isn't in the business of protecting or promoting public health. Nor is Post Foods. Nor should anyone expect either to be.

Presumably the sugar is a concern for people, and at 17g per cup (4.25 teaspoons), it's definitely not an insignificant amount, but it's not more than many other sugary cereals, and is in fact less than Post Raisin Bran which packs 24% more sugar at 21g (5.25 teaspoons) per cup.

All this to say, it's difficult to get angry with Tim Horton's or Post Foods for trying to sell food as selling food is literally their only job, and frankly this food isn't any worse than comparable foods they're already selling.

So what should the cereal aisle make people angry about?

How about laxity in advertising laws that allows for cartoon characters to be festooned on boxes of sugary cereals and prey on children? Or laxity in front-of-packaging laws that allow Froot Loops boxes to brag about their whole grain or vitamin D content? Or the failure of our government to create a front-of-package warning system like the one that was enacted in Chile.

What would life in Canadian cereal aisles look like if we followed Chile's lead?

Here's Frosted Flakes before and after Chile's laws came into effect

Sure looks great to me.

(And for the grammar police, 'donut' is how Tim Hortons spells doughnut)

How Much Do You Like Your Diet? Given Adherence Likely Dependent On Enjoyment, Our Recent Paper Set Out To Quantify That

Back in 2012, I wondered aloud about creating a scoring system for dietary enjoyment. I blogged about it a few times here and there, and happily, a wonderful team of researchers in New Zealand took notice. Now, thanks to the hard work of Michelle Jospe, along with Jillian Haszsard, and Rachel Taylor, the first step towards its formal use has been taken.

Our paper, A tool for assessing the satisfaction of a diet: Development and preliminary validation of the Diet Satisfaction Score, was published late last year and it details our Diet Satisfaction Score's preliminary reliability and validity.

With the help of the 1,604 people (spanning 24 different countries!) who answered our survey questions, as well as 6 diverse experts (thanks to Melanie Dubyk, Kevin Hall, Scott Kahan, Silke Morrison, Marion Nestle, Sherry Pagoto, Arya Sharma and Ethan Weiss), we arrived on the following questions geared to address various aspects of dietary adherence and satisfaction

The simplest way to think of the Diet Satisfaction Score's use is the higher the overall score (each question is answered on a 5 point Likert scale and the final DSS score is calculated by way of taking the mean of all available items yielding a total score between 1 and 5), the greater an individual's satisfaction/enjoyment of that diet is. The hypothesis then would be higher scores correlating with better adherence and consequently better/sustained weight loss.

And that's what our preliminary findings suggest whereby each 1-point higher Diet Satisfaction Score correlated with a 1.7 week longer diet duration. It was also found that compared with those who had abandoned their diets, those maintaining them reported larger losses.

The value of a simple and quick score like this to individuals would be as a means to assess how much (or how little) they were enjoying their diets taking into account more than just whether they like the foods they're eating, but also the impact their chosen diet might be having on related aspects of life (socializing, time, cost, etc.). Those evaluating their new diets and finding their scores low, might explore means to tweak their diets, or to try new ones.

The DSS score's value to clinicians would be as a quick means to screen their patients' efforts and perhaps to use the tool to help trouble shoot, or to triage referrals to professional resources such as registered dietitians.

The value of the DSS score to researchers would be using this tool with shorter term studies as a means to predict whether or not their studied diets are likely to be sustainable (as who really cares how much weight a person might lose on a particular short term diet if few people would actually sustain it).

Of course now what's required is the repeated use of the Diet Satisfaction score in a long-term prospective trial. The good news is that because the tool, like me, is diet agnostic, it can be administered with any and all dietary strategies. Should you be interested in using the Diet Satisfaction Score in your trial Dr. Jospe is the person to contact and her contact information is just this one click away.

Saturday Stories: Suleimani, Left And Right Antisemitism, And Home Cooking Challenges

Dexter Filkins, in The New Yorker, with the definitive piece on who was Qassem Suleimani

Isaac Chotiner, also in The New Yorker, on the rise in antisemitism from both the left and the right.

Amanda Mull, in The Atlantic, on how modern life gets in the way of our home cooked best intentions

[And if you don't follow me on Twitter or Facebook, My first byline for the New York Times is a balm for aggressive New Year's resolutions, nutrivangelistic diet gurus, magic food stories, and all other forms of healthy living hyperbole]

Teachers, Stop Teaching Kids To Reward Anything and Everything With Junk Food And Candy!

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2016.

The past 50 years of so have seen scads of unhealthy societal changes to how we use food, and near the top of that heap lies our now normalized use of junk food to reward, pacify, and entertain our children at every turn.

Take the jelly bean prayer up above. That was sent home with RD Nadine Devine's Junior Kindergartener in honour of Easter.

WWJD? Not that.

Or this needs-to-be-seen-to-be-believed note that was sent home with another friend's 5 year old.

I imagine that the teachers responsible for those two examples don't see either as unwise as why question normal behaviours? If everyone does them, they must be ok.

Yet I'd wager that if those same two Kindergarten teachers reflected on the lesson their use of classroom junk food is teaching their incredibly impressionable, young, students, they would recognize that teaching incredibly young children that it is normal to reward even the smallest of victories or celebrations with junk food is not in their students' best interests.

Teachers, if you're reading this, so far as rewarding kids go, it's not difficult to do so without candy. Extra-recess, dressing your teacher up in funny clothing, being in charge of school announcements, a classroom dance party, have a class outside, hand out "no-homework" passes, stickers, bookmarks, etc...

I know that teachers care deeply about their students, which is why I genuinely believe that putting an end to junk-food classroom rewards is something that society, and teachers, can fix.

[And for some suggestions as to how you might begin to approach this with one your children's teachers, coaches, whatever, here's something I wrote a few years ago about shutting down your children's sugar pushers]

It's More Important To Teach Your Kids to Cook Than to Play Soccer

Photo courtesy of yoshiyasu nishikawa 

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2016.

Yes, I know there will be people whose challenges and circumstances are real and severe enough that they genuinely can't ensure their kids learn how to cook before leaving home. This post isn't for them. This post is for everyone else.

For the first time in history the average American family is spending more money in restaurants than they are in grocery stores.

Kids are leaving home now knowing more about how to play soccer or hockey than they do about how to cook meals from fresh whole ingredients.

That's so incredibly unfortunate, not only for those kids, but for their future families.

Cooking is a life skill and it's a parents job to teach those before they leave home. If you aren't comfortable with cooking yourself, take the opportunity to learn with your kids. Your kids learning how to cook will serve not only to help them in providing themselves and their futures with healthful meals, but will also save them money during their lean years and will likely reduce their risk of developing a myriad of diet-related, chronic, non-communicable diseases.

Whether by way of the ridiculous amount of online recipes and resources, or enrolling in a cooking course or supper club, cooking, like any skill, is obtained by way of practice. It doesn't matter if you're not good at cooking now. Take the time, and there's no doubt you'll get there.

Saturday Stories: Snowflakes, Forgetting, And Fat Shaming

James Hatch, in Medium, on going back to College at age 52 and his semester with Yale's snowflakes.

Alvin Rosenfeld, in Tablet, on the perils of forgetting the Holocaust as the age of survivors draws to a close.

Latoya Shauntay Snell, on Huffpost, on marathon running, fat shaming, and concern trolls.

The Food Industry Spends A Cancer Moonshot On Advertising Every 3 Weeks

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2016.

Some perspective.

Did you hear about the "Cancer Moonshot 2020"?

In their words,

"The Cancer MoonShot 2020 Program is one of the most comprehensive cancer collaborative initiatives launched to date, seeking to accelerate the potential of combination immunotherapy as the next generation standard of care in cancer patients."

And so what's the cost of this ambitious program over the course of the next 5 years?

$1 billion.

Sound impressive?

Maybe less so when you consider that according to AdAge, in 2014 alone, the top 25 US food industry brands spent just shy of 15x that amount advertising their products.

That's a moonshot worth every 3 weeks!

Spread that out over the billion dollar moonshot's 5 year duration and suddenly you realize that through 2020 the food industry will spend 75 times more money trying to get you to buy Coca-Cola, KFC, Cheerios, Dunkin, etc., than the government will be spending on their "MoonShot" to cure cancer.

If we want to see population level improvements to diet, no doubt that part of the requirement will be food industry advertising reform. Banning advertising that targets kids altogether, reforming front-of-package claims, cracking down on deceit, and more, because with a cancer moonshot of food industry advertising every three weeks, consumers don't stand a chance if we don't.

[And of course the other issue worth noting is how incredibly irresponsible it is to promote a 5-year, billion dollar investment as a cancer moonshot.]

School "Hot Lunches" Are Beyond Awful. How Did We Let Them Happen?

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2016.

A friend on Twitter sent the photo up above to me. It's this week's hot lunch offering for his kid's school's kindergartners through Grade 6ers.

Hot dogs, donuts, and juice.

Really?

And then of course there's pizza days, sub days, and various other awful food days that not only serve kids literal fast food, but in so doing also teach kids that it's a totally normal/alright to have fast food each and every week.

Parents would jump in front of buses for their children, and yet packing them a healthy lunch everyday isn't doable? Clearly it's not a money thing as $5 for a hot dog, a donut and a juice box certainly doesn't make this hot lunch a value proposition.

How did we get here as a society?

More importantly, how do we leave?

Why You Should Probably Just Ignore All Breakfast Studies

By Evan-Amos (Own work) [CC0], via Wikimedia Commons

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2016.

Ugh, breakfast stories.

Such a frustrating topic in nutrition as for both health reporters and diet gurus it would seem that there is no middle ground, breakfast is positioned either as essential or pointless.

Well I'll tell you what's pointless - "breakfast" studies.

I'm putting breakfast in quotations because virtually all the is it good for you or not breakfast studies seem to study breakfast as a whole.

Seems to me that regardless of your chosen end point (be it weight, appetite, hunger, adiposity, heart disease, insulin, school performance, whatever) what a person eats for breakfast will matter a great deal, and just studying whether or not a person ate breakfast, will lump together bowls of Froot Loops with almond topped steel cut oats, and Pop Tarts with summer vegetable omelettes.

My experience, born out of a dozen years of working with thousands of patients on weight management, has been that for most, a protein rich breakfast benefits all-day satiety, whereas a bowl of ultra-processed, sugar-fortified carbs, doesn't. And please note, I said most, not all.

Ultimately breakfast matters for some and not for others, and if you're curious whether or not it's important for you, what you choose to eat for breakfast is going to play a big role in your answer.

And for the love of everything holy, please, please, stop reporting on "breakfast" studies, whether you or they are pro or con, as if they're able to make conclusions about the utility of breakfast as a whole.

No Diet Works For Everyone, And Every Diet Works For Someone

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2016

Two weeks ago Kevin Hall and I had our diet commentary published in The Lancet. Not surprisingly, we upset some folks - primarily low-carbers. Some accused us of being low-fat cheerleaders. Others that we fostered an "animus" towards low-carb diets.

While I can't speak for Kevin, I can honestly state that I'm totally fine with low-carb diets. For some people they're a life changer and our office is happy to work with patients on them. I've also got nothing against low fat, Paleo, intermittent fasting, vegan, gluten-free, or any other diet that has a name.

What matters most to me, and what was also the crux of our commentary, is whether or not a person likes their chosen diet enough to sustain it. Food is not simply fuel. Food is comfort, food is celebration, and food serves as the foundation of a huge part of our social lives. Regardless of whether or not one diet vs. another diet affords a person an additional few pounds of loss (or even whether or not it confers specific health benefits) pales in importance to whether or not a person likes that diet's style of eating enough to live with it for good

As noted in our piece, every diet out there has its long term success stories, and so moving forward, if you see anyone out there suggesting their diet is the best (or that your diet is the worst) rest assured they have an agenda. Their agenda might simply reflect an n=1 mentality of, "it worked for me therefore it's what you should do", it might reflect basic post-purchase rationalization, or it might reflect genuine science and studies that infer greater short term losses or potential health benefits. But if they can't wrap their heads around adherence (which on an individual basis is an expression of whether or not you like what you're eating and don't miss what you're not) as any diet's long term's most critical component, their ideology is showing.

Temporary efforts will only yield temporary outcomes no matter how exciting the outcomes might be in the short run.

Saturday Stories: Statistical Lies, Cell Phone Location Tracking, and Survivors

Stephen Senn, in Error, on lies, damn lies, and statistics (ok, really just on statistical lies) as they pertain to personalized medicine

Stuart A. Thompson and Charlie Warzel, in The New York Times, with what will surely win them a Pulitzer, on how cellphone tracking companies probably know everything about your life. Then read this incredible follow up story on tracking President Trump. And finally this piece on how to protect your own data somewhat.

Avital Chizhik-Goldschmidt, in Forward, interviews and photographs 5 inspiring women survivors of the Holocaust

Why Every Holiday Season Should be All-You-Can-Eat!

Ok, yes, the headline is very clickbait-y as there's a crucial qualifying word missing.

Thoughtfully

This holiday season should be all-you-can-thoughtfully-eat, where thoughtfully means asking just two questions before each and every indulgence.

1. Is it worth it?
2. How much do I need to be happily satisfied?

As I've said many times before, food isn't just fuel. As a species we use food for comfort and for celebration and no doubt for most of us, the answers to those two prior questions will be different in December than in January.

And here's a promise. If you don't ask those questions every indulgence will be worth it and you'll have far more of each than you need to be happily satisfied.

(this post was first published back in 2014)

Saturday Stories: Judaism's Executive Order, Reunited Lovers, And The Benefits Of Weight Loss

David Schraub, in The Atlantic, discusses, with great nuance and balance, the issues surrounding Trump's executive order regarding Jewish identity.

Keren Blankfield, in The New York Times, on lovers reunited 72 years after their affair in Auschwitz.

Kevin Bass, in his blog Nutritional Revolution, reviews how not only is long term weight loss possible, even small losses have been shown to markedly reduce the risk of death, and how those benefits are treated very differently than lesser benefits from medication and screening.

#IfYouServeItWeWillEatIt Vegetarian Conference Food Nudge RCT Edition

As I've noted before (usually in the context of soda and junk food) if you serve it, we will eat it, even if the 'we' are a bunch of medical or dietetic professionals.

But what happens if you serve healthier fare? And what happens if you give people a little nudge towards it?

A recent study sought to explore that and prior to 3 conferences, randomized attendees into receiving one of the following two options to consider for their lunch choices

Group 1 (this was the non-vegetarian default ask): At the conference a non-vegetarian buffet will be served for lunch. Please state here if you would like to have a vegetarian dish prepared for you: __________________________________.

Group 2 (this was the vegetarian default ask): At the conference a vegetarian buffet will be served for lunch. Please state here if you would like to have a non-vegetarian dish prepared for you:__________________________________.

You know what happened next.

At all 3 conferences, whatever was highlighted as the default lunch option was chosen by the vast majority for lunch.

At the first conference, the vegetarian choice increased from 2% to 87%. At the second conference it increased from 6% to 86%. And at the third conference it increased from 12.5% to 89%.

You know what would have certainly led to even higher numbers? No non-vegetarian options. And to be clear, I'm not suggesting vegetarian diets are a panacea, there are plenty of unhealthy vegetarian foods, but this simple study illustrates the power afforded to conference organizers in terms of what's being served and how it's being presented to attendees. The same of course would be true of any venue where meals and/or snacks are presented.

Given we eat what we're served, it seems to me to be a straightforward expectation, at least for medical and dietetic conferences, that we're served healthy options.

[Thanks to my friend and colleague David Nunan for sharing this study with me, and you should follow him on Twitter if you don't already]

Saturday Stories: Chaos, Hatred, And Ethos

Joshua Hammer, in GQ, writing on chaos at the top of the world.

Bari Weiss (and whether you loathe her or not everyone should read this harrowing article), in the New York Times, on how the global surge in Jew hatred should not be written off as isolated incidents of bigotry.

Rachel Laudan, in The Hedgehog Review, on the establishment of a modern culinary ethos.

(photo source)

Dear @OttawaCitizen, Your 83 Word Byline Free Drink Milk "Artice" Isn't Journalism And It Contributes to Scientific Illiteracy

Now to be clear, I'm not a journalist, though I have written my fair share of articles for various publications (including the Ottawa Citizen).

What I would never have submitted, let alone gotten away with, would be an 83 word (truly, that pic above is all there is), byline free, advertorial replete with a large photo promoting milk consumption in the name of Vitamin D and calcium citing a "report" that urged Canadians to drink milk, and mentioning "experts" three times, without actually naming the report or the experts.

Though I'm not sure which report the 83 words is referring to, my friend and PhD/RD Dr. Kevin Klatt (who you should absolutely be following on Twitter) was able to steer me to this study looking at non-dairy milk consumption and vitamin D levels in Canadian children which clearly demonstrates drinking non-cow's milk leads to lower, but still fine, vitamin D status markers.

He noted, as actually cited experts should, that vitamin D's daily recommended intake (DRI) levels were derived from intake studies performed in very high northern latitudes so as to remove the confounding issue of sunlight, and that consequently daily recommended intake levels are far more than are necessary to maintain safe vitamin D levels for everywhere but the far north. He also pointed out,

"there's not very strong evidence to suggest that not consuming milk places one at risk of having Vitamin D status in the range of insufficiency."

And though it may surprise you given the certainty of the 83 words up above, the data on dietary intake and Vitamin D are so limited that anyone who has concerns about their vitamin D status, regardless of whether they drink milk or not, should have their levels checked and not simply assume milk will be magical. Or better yet, not try to drink their way to higher levels of Vitamin D if they're concerned and simply take supplements (with meals if this is your plan as Vitamin D is a fat soluble vitamin)

Given the full court press the Canadian dairy industry has been making since our new Food Guide rightfully relegated dairy to simply a source of protein rather than suggest it is a unique food group, I can't help but wonder if this published seeming advertorial is consequent to their efforts and overtures, and while it might play to at least 50 years of Canadian dairy marketing, the Ottawa Citizen should know better than to simply pass along uncritical food takes suggesting magic benefits to specific foods to a population primed to believe them.

(Thanks to my friend and colleague Andrew Kujavsky for sending the photo of the article my way)