Are you Giving your Kids Chocolate Bars for Breakfast?

Would you feed your children chocolate bars for breakfast?

If you answered, "of course not" but give your children sugary cereals, you'd better get ready to revise your answer.

If you read food labels regularly, this might not be news, but if your child is eating a sugary cereal for breakfast, they're probably having as much or more sugar than they would if they ate a chocolate bar.

Some equivalents (based on a 50gm or 1.75oz serving):

Kellogg's Fruit Loops = 5.6 teaspoons sugar = Dark Chocolate Kit Kat Bar
Nestle Nesquick = 5.8 teaspoons sugar = Twix Bar
Post Sugar Crisps = 6.6 teaspoons sugar = Snickers Bar

Remember too that many kids will have more than one bowl.

So what should you do?

Try to give your kids cereals with 6-7 grams of fibre per serving, and unfortunately you have to be a bit cautious with the lower sugar cereals as well as often they may compensate with more carbohydrates and more calories.

Is it time yet to cut the sugary cereal out of the pantry?

French Women DO get fat!

You may have seen this book on the bookshelves. It's been a national best seller all over the world. Unfortunately it seems, the french women, aren't reading the book (or perhaps, like 98-99% of diet books, it fails in the most important part of weight management - sustainability).

A national survey conducted annually in France show that in fact overweight and obesity rates are rising rapidly. Currently 42% of France's population over the age of 15 is either overweight or obese.

It should be pretty telling to consumers. As of today, there are over 178,285 different diet books for sale on Amazon.com. If any single one of them was dramatically better than another, doctors offices worldwide would be prescribing it. In fact in the history of medicine, there has yet to be a study the definitively proves one diet is better than another for weight loss.

In my office at the Bariatric Medical Institute, there are no prescribed diets. Every person is an individual, with different cultural backgrounds and different dietary likes and dislikes.

Here are the only two criteria that matter for diet and weightloss:

1. You eat less calories than you burn (that will help you lose the weight)
2. You like what you're eating (that will help you keep it off)

Quiznos Calories

Many times I've heard patients complain that they can't find any calories for Quiznos Subs. It's the subject of many angry rant blogs. I agree it's ridiculous that Quiznos USA refuses to release their nutritional information but the same cannot be said about Quiznos Australia. Over there their nutritional information is posted.

Now it's true not all the subs are the same as in the States, but given the nature of franchises I would imagine the numbers may well be comparable.

Only problem is their calories are listed in kilojoules.

To convert Kilojoules to Calories simply divide the number of kilojoules by 1000 and multiply by 239.

If you're worried about Calories, don't order the large white bread classic italian. It'll cost you 6755 kilojoules or 1614 calories, more than many of us burn in a daytime.

McDonald's donates $2 million for obesity research

Today McDonald's, in reference to the problem of childhood obesity reported that they "felt we needed to get greater education in this area" and therefore decided to donate $2 million in obesity research funding to the Scripps Institute.

Now by no means am I bashing McDonald's for funding research, nor am I bashing them for wanting to know more about childhood obesity, or even for the way they make their money.

I am however shocked that they feel the need to donate $2 million to help them to understand how they might play a greater role in the prevention of childhood obesity.

Without even wading into the debate about marketing food to children, how about they simply start dramatically reducing the portion sizes and calories counts of their children specific foods?

Hey, McDonald's, if you'd like to pay me even just $200,000 I'll help you out...anyone over there reading this? Anyone?

Star*!%*&ucks!

Ok, I admit I took some blogger license with the post title. I've got nothing against Starbucks and in fact enjoy their coffee very much.

I am however going to use them to illustrate why the visible posting of calories on food items would be helpful.

Let's take a hypothetical 45 year old 150lb woman who like most North Americans, is inactive. According to the metabolism calculator I've referred to in a prior post, she likely burns 1800 calories daily.

Like most days, she decides she's going to hit Starbucks for coffee and breakfast. Having read about the health benefits of whole grain oats she chooses the Island Oat Bar and a Caramel Frappucino (hold the whip cream).

The Island Oat Bar has 760 calories including a heart busting 8 grams of saturated fat while her frappucino has 390 calories for a grand total of 1150 calories (more calories than 2 Big Macs or 4 McDonald's Cheeseburgers) or 65% of her total daily burned calories. Small wonder she's gaining weight and small wonder when she goes to her doctor to complain, she reports, "But I really don't eat very much". The fact is, not very much of high calorie food can still lead people to high calorie intakes.

As far as I'm concerned, it's only a matter of time until there is legislation to have calories on menuboards. Until that time, the onus is on each of us to find the calories ourselves.

A great website to look up calories is www.calorieking.com.

Remember you can gain weight on an all-salad diet if you eat enough salad and you can lose weight on an all ice-cream diet so long as you don't eat too much.

At the end of the day, it's the calories that count.

NEWSFLASH: Being overweight isn't good for you!

In what I'm sure will be a disappointment to those individuals who still persist in denying that there is medical risk associated with obesity a landmark study was published in today's New England Journal of Medicine.

527,265 people were followed for over a decade in determining the risk of weight on life expectancy. The study was controlled for ethnicity, smoking status, education, physical activity and alcohol consumption.

During the 10 years of follow up 42,173 men and 19,144 women died. The death curves were U shaped with dramatic increases in risk as weight climbed.

These data also included 186,000 non-smokers. In that group the risk of death from obesity and overweight was substantially strengthened.

When restricting their observations to those who were free of preexisting diseases again there was a strengthening of the relationship between weight and death.

The bottom line's not really news - being overweight or obese is bad for your health.

The Fat Clock

You know those clocks that count? The ones that post a real-time count of things like a country's accumulating national debt, number of people on earth, people dying of various diseases?

Well there's a new clock on the block - the Fat Clock. Using a fairly sophisticated home-made algorithm the Diet Detective website has a clock posting the running tally of the weight of all Americans. It takes into account birth rate, death rate, population age and other variables.

According to the clock, Americans are currently gaining 1,267 pounds per minute!

Walk away (briskly) from depression

A great deal of well designed research has been published demonstrating that exercise is just as good, if not better, than antidepressants for mild to moderate depression.

One of the best papers on the matter was published in 2000 in the journal Psychosomatic Medicine. In it Michael Babyak and his co-authors randomly assigned 156 depressed adults to one of three groups: Zoloft, Exercise, or Zoloft plus exercise. They then looked at depression after 4 months and again after 10 months utilizing the fairly standard Hamilton Rating Scale for Depression.

Exercise involved 10 minutes of warmup followed by 30 minutes of moderate intensity cycling, jogging or brisk walking and finally by 5 minutes of cool down. This was performed 3 times per week.

The results were impressive. After 16 weeks of treatment all groups showed significant reductions in their depressive symptoms. Medication worked faster, but by week 16 exercise had caught up. What was more impressive were the results at 10 months - those exercising had lower remission rates than those on Zoloft or a combination of Zoloft and exercise.

The authors summarized their results with the following statement, "Each 50-minute increment in exercise per week was associated with a 50% decrease in the odds of being classified as depressed"

Bottom line: Don't throw out your pills, but slowly, along with your doctor, it may be reasonable to try to trade your drugs for some great shoes and a minor committment to exercise.

That's one scary cookie jar!

Here's a cookie jar you don't want to get your hands stuck in - the Shockolate Vault designed to keep you away from your goodies.

Not recommended by me as a diet aid, definitely recommended by me as a gag gift, the Shockolate Vault, can be set to "protect" your valuables or goodies for a given period of time. Try to get to them before the time is up and "there will be shocking consequences".

Would make for some interesting, amateur science experiements.

Are you ready for the McGym?

So on July 7th in Whittier California, McDonald's opened up the "R Gym"

"Equipped with stationary bicycles attached to video games, dance pads, basketball hoops, monkey bars, an obstacle course, and a host of other games, the R Gym is intended to provide a fun, easy and convenient way for children to increase their physical activity."

Well at least they're not trying to suggest that it will help combat childhood obesity, though they do state,

"McDonald's is committed to educating its customers about balancing food consumption and physical activity."

I wonder then if they'll educate customers that in order to "balance" that Happy Meal at the R Gym, they'd better budget at least 75 minutes of time for their children to pedal furiously because the 600 average Happy Meal calories will take over an hour of vigorous activity to burn off.

Somehow, I doubt they'll tell their patrons that.

Dying, literally, for a Big Mac

Much to my amazement, there exists a group of individuals who vehemently deny that obesity is medically risky. They're organized, write books and blogs, and often appear on national news shows claiming that it's all a big myth perpetuated through a combination of bias and capitalism. Should any of them read this blog, I would love their viewpoint on yet another in a never-ending line of well designed medical studies that clearly demonstrate the risks of obesity.

In this weeks Journal of the American Medical Association, Kathleen McTigue et al. looked at death rates and heart disease in 90,185 women following across 40 States for an average of 7 years.

Her results were not in the least bit surprising: The heavier the patient, the higher the death rate. For those with body mass indices between 30-35 death rates increased by 18%; for those with body mass indices between 35-40 death rates increased by 49%; and for those with body mass indices greater than 40 death rates rose by more than 100%.

An easier and far less scientific experiment is for you to think to yourself how many people dramatically overweight people you know who have made it past the age of 75. Speaking for myself and including the literally thousands of patients I used to have when I was working as a GP, along with the thousand or so I saw in stroke rehab, along with my friends and family, I can only think of around 30 over-75-year olds who had BMIs greater than 40, and none of them were living easy, carefree, healthy lives - they all had significant weight related co-morbidities that made their lives very difficult.

I'm all for beating down bias against obesity, and there's no doubt that some folks with significant amounts of weight to lose will lead long healthy lives unaffected by their weights. That being said, some smokers don't die from lung cancer, but of course that doesn't make smoking any healthier.

Low fat? Low carb? Who cares?

Cover your ears medical organizations, low-fat is not the magic bullet for weight management. The low fat movement, born out of the simple fact that there are more calories per gram of fat than there are per gram of carbohydrate or protein, is dying a slow, painful death. Medical professionals and governments around the globe have latched onto the low fat approach as not only the healthiest way to live, but also as the only way to lose weight. It seems that finally, that tide is turning.

Two days ago the American Heart Association released their 2006 dietary recommendations and for the first time in over two decades, they focused on the currency of weight - calories, rather than just a blanket statement about the reduction of dietary fat (for full text visit the journal Circulation and read the 16 page scientific report of the AHA).

Another blow to the low-fat proponents came from this months issue of the journal Obesity where Rena Wing and Jim Hill have continued their exemplary reporting on what it takes to not only successfully lose weight, but more importantly keep it off. In 1994 Drs. Wing and Hill established the National Weight Control Registry in order to study people who had lost at least 30lbs and kept it off for at least 1 year (actually the average results are even better with the average registrant having lost 67lbs and kept it off for 5 or more years). What they found originally was that those folks who were successful did so with low-fat approaches. Of course the late 80s and early 90s were the low-fat diet years so it is not altogether surprising that the folks who enrolled in the registry had tried low-fat approaches. What had always frustrated me was that people often used the data from the registry to suggest that therefore low-fat was the only way to go. Well guess what, they're wrong - the registry is changing. In the article in Obesity, it turns out that those folks entering the registry in the late 90s and early 2000s in fact were much less likely to be on a low-fat diet.

Bottom line of course is it doesn't matter if it's low fat, high fat, low carb or high carb, if you're happy and it's less calories, it's good.

Television with Sole

Gillian Swan, a design student in England, has designed yet another soldier in the fight against inactivity. Dubbed "Square Eyes" her unique shoe soles contain an electronic pressure sensor and a computer chip to record how many steps their wearer takes in a daytime. An embedded wireless transmitter then passes that information off to a receiver attached to the wearers television which decides based on the wearer's steps and exertion how much television they've earned that day. 100 steps = 1 minute of television.

Readers of my blog will know that I feel activity to be the smaller part of the equation with weight, but certainly any intervention that can help encourage (in this case perhaps force) children to be more active certainly cannot hurt.

A Healthy Search Engine

The internet is a scary place to research your medical information. Anybody and his brother can make a very credible looking website to provide medical "information" and unfortunately much of the time, that information is woefully inaccurate. At times it may even be dangerous.

Thankfully, the folks who brought us Quackwatch have put together their own peer-reviewed medical search engine - The Internet Health Pilot. It searches only through evidence-based medical information and therefore provides only safe, reliable and informative results.

Don't Sit Too Close to the Candy Bowl!

As anyone who's ever tried to lose weight before knows, proximity matters. Some foods simply can't be allowed into the house.

Now, thanks to Dr. Brian Wansink, we have proof that sitting too close to the candy bowl is probably a bad idea.

Dr. Wansink is the John S. Dyson Professor of Marketing at Cornell University and is the director of Cornell's Food and Brand Lab whose mandate it is to study "Why, What, When, and How Much We Eat".

In this months issue of the International Journal of Obesity Dr. Wansink details a study involving Hershey's Kisses.

The study was conducted over "Secretaries Week" where 40 secretatries from six different departments at the University of Illinois were given bowls of Hershey's Kisses. Each day each bowl was filled with 30 kisses. There were 20 clear bowls and 20 opaque bowls and there were four different study designs: Clear bowl right in front of you, opaque bowl right in front of you, clear bowl 6 feet away, opaque bowl 6 feet away. Every day researchers would swing by and count how many kisses were left in the bowl.

The results revealed that when the kisses were 6 feet away in an opaque bowl the average number of candies consumed per day was 3.1. 6 feet away in a clear bowl, 5.6, opaque bowl right in front of them, 4.6 and when in a clear bowl right in front of them, 7.7.

So not surprisingly, both visibility and proximity increase consumption. What was interesting was that proximity had a somewhat unexpected finding. When the food was more accessible people underestimated how many kisses they had vs. overestimating when further away.

A few bottom line messages. First, leave foods you want to eat more of in more visible and accessible locations. Don't banish your fresh fruits and vegetables to opaque crispers, leave them right out in the open on your fridge shelves and your countertops. Secondly, the bad stuff, don't necessarily throw it out but hide it behind other foods and banish it to the furthest reaches of your cupboard spaces. Lastly, if you ever get the chance to see Brian Wansinck give a lecture, jump at it - he's one of the best speakers I've had the pleasure of seeing.

Self-hate Weight

In this week's edition of the journal Obesity, there's a very sad article that quantifies just how pervasive the anti-fat bias in America really is.

It has long been established that obese people are stigmatized in education, employment and heath care. As well, it seems that the negative attitudes and stereotypes associated with obesity are acceptable in society given that we still regularly see them as the butt of jokes on television and in Hollywood.

It may surprise some readers here to learn that even obese people discriminate against the obese. In this study 37% of obese respondents reported that they preferred thin people, 27% of obese respondents said that thin people were more motivated and 27% of obese respondents said fat people were lazier.

This study also looked at "Personal trade-off items", meaning what would you be willing to give up or do in order to not be obese.

Of healthy weight individuals, 18% would rather give up 10 years of their lives than be obese, 36% would rather be divorced than be obese, 27% would rather be infertile than be obese, 21% would rather be severely depressed than be obese, 20% would rather be an alcoholic than be obese, 7% would rather lose a limb than be obese and 5% would rather be blind than be obese.

Now while those numbers are in and of themselves shocking, they become more shocking when you consider how the authors got their data. This study was funding and publicized by the Rudd Institute, an organization whose mission it is to address stigmatization and discrimination of obese individuals. The over 4000 respondents likely heard of the study either from the Rudd Institute's website, attending a presentation on weight sitigma given by one of the authors, or reading a news article on stigma that made reference to the website where the study's data were collected. Therefore the people who responded with such negative attitudes and stereotypes towards obesity were actually the people in society who might be expected to have the least amount of anti-fat bias.

Like the Rudd Institute says, "See the person, not the pounds". Clearly as a society, we still have a long way to go.

Track Calories with your Keychain!

I always recommend tracking calories to patients trying to lose weight. The simplest analogy is money, and the currency of weight in our bodies is calories. Before you buy anything, you need to know how much it costs.

Calorie counting can be difficult and while there are many free online services that can help track calories (www.sparkpeople.com, www.fitday.com) they still require hunting for calories.

No more. Enter Training Peak's Calorie Scanner which conveniently fits on your keychain and then scans the barcodes of the foods that you're eating. Couple that with Training Peak's online/desktop calorie software and all of a sudden those barcodes translate into calories and nutritional information.

Only problem I can see is that my from scratch spaghetti sauce doesn't come with a barcode.

Cost is a bit steep as well - $216.30 for a scanner with a one year subscription.

It's Depressing to Stop Exercising

This month the journal Psychosomatic Medicine published a very interesting paper on the effects of stopping exercise on mood.

Their study involved taking 40 regular exercisers (>30mins per time, >3times/week) who were not taking or receiving any psychological or psychiatric treatment, and simply asking 20 of them to stop exercising for two weeks. They then compared symptoms and mood between those who continued exercising versus those who stopped.

Within one week of stopping exercise, compared with folks still exercising the study subjects reported more fatigue and depressive symptoms which then worsened in week number two.

While we probably didn't need a study to prove this (anyone who exercises regularly and has to stop knows this to be true already), here is now proof of yet another reason not to stop exercising!

The HP Photosmart R927 Super Incredible Diet Plan

Perhaps in response to our growing waistlines HP has come up with a Super-Incredible-Diet-Plan - don't lose weight and use their cameras with their "slimming" feature and presto-chango you've lost weight.

The picture here shows the subtle changes the camera produces using Hurley from Lost fame.

If this isn't a sad statement about where we've come as a society, I don't know what is.

Today is Project ACES Day - Another misguided effort in the war on obesity.

I can't tell you how frustrated I get when events such as Project ACES are touted as soldiers in the fight against obesity.

Started by Len Saunders, a New Jersey schoolteacher in 1989 Project ACES (All Children Exercise Simultaneously) involves trying to get children across the world exercising for 15 minutes simultaneously.

Going to the Project ACES website it promotes itself as making, "fitness fun for kids", "promoting health and nutrition", "promoting sport and exercise", and "supporting physical education", and there is no doubt in my mind that all of those are worthy, wonderful and achievable goals for the Project.

You know what's not an achievable goal? Having 15 minutes of exercise a day put a dent in childhood obesity rates. Yet the AP describes Project ACES this way, "Students in all 50 states and at least 50 other countries were urged to exercise en masse for 15 minutes Wednesday, all to curb alarming rates of childhood obesity."

So why is it not reasonable to report Project ACES as an obesity intervention? Quite simply, exercise does not burn that many calories.

In fact I would argue that were the Canadian and American governments successful at getting every last citizen to exercise 30 minutes a day it would actually lead to North Americans growing even larger because then everyone would feel justified in rewarding their exercise with food. They would feel justified because our governments and countless allied health organizations constantly present the misguided notion that exercise alone is enough to lead to weight loss or prevent weight gain.

Fact is 30 minutes per day of exercise probably burns no more than 250 calories. Reward exercise with food 3 times a week and kiss 30 minutes of even daily exercise goodbye. It takes well over an hour of vigourous exercise to work off one Big Mac or a bag of potato chips.

If we are to succeed in preventing the rise of obesity in our countries, the focus has to be on food and more specifically on calories.

I can't tell you how many patients I've seen who've said to me, "I shouldn't be this weight because I exercise a lot", or, "It doesn't make sense because I only eat healthy food."

Obesity prevention, fitness and healthy eating are all extremely important determinants of health. To lump them all together as one effort takes away from the importance of each in our health and discourages those who "eat healthy" and "exercise" but don't lose weight, from ever trying.