Diet Book Review: The Fast Diet

[Full disclosure: I was given a copy of the book by the publisher]

The question everyone seems to be asking today is whether or not intermittent fasting (meaning an occasional fasting period of up to a day not a lengthy fast/cleanse) is a viable weight loss strategy.

The answer's rather simple. If a person can happily incorporate fasting of any sort into their lives, and that in turn lowers their weekly available energy intake, then yes, fasting may well be a useful strategy. On the other hand, if fasting challenges your quality of life sufficiently to make the intervention too much to bear long term, well then no, fasting's not for you.

As far as fasting goes, there seem to be three primary schools these days. There's Martin Berkhan's Leangains system (the system popularized without credit in The 8 Hour Diet) which at its base involves fasting for roughly 16 hours a day, there's Brad Pilon's Eat. Stop. Eat. which at its base involves 1 or 2 weekly 24 hour food fasts interspersed with healthful eating, and there's today's featured review of The Fast Diet which takes researcher Krista Varady's work on what she's called alternate day modified fasting (ADMF) and bookifies it for the masses. At its base, ADMF (and The Fast Diet) simply involves ensuring there are two days weekly where calories consumed are in the 500-600 range.

The book was written by non-practicing physician turned journalist Dr. Michael Mosley and his journalist co-author Mimi Spencer and it leads with the theory that because humans evolved during times of severe dietary insecurity, where fasting was the unavoidable norm, that fasting has unique properties that in turn are healthful and protective. And while that may be true, it certainly has yet to be proven as the science is nowhere near conclusive yet just as the authors themselves point out on the second introductory page,

"Scientists are only just beginning to discover...".

Putting aside the fact that many of our closest primate relatives do in fact graze all day (chimpanzees for instance), I'm not sure this theoretical line of reasoning really matters in lieu of evidence, though certainly it does provide a reason to consider the possibility that fasting has interesting properties.

Sadly, the cautionary comment that the science of fasting is young was a rarity in this book that takes hyperbole, conjecture, anecdote and hope to truly dramatic levels and even just 5 pages following the "just beginning" statement the state of the evidence has somehow morphed into,

"The scientific evidence was extensive and compelling".

Odd that statement in the context of this book given the vast bulk of the book is quite literally built off the personal (and clearly conflicted) anecdotal evidence of Dr. Mosley and Ms. Spencer's own experiences with their diet - one might have thought that were there actually extensive and compelling evidence a medically trained award winning journalist might have preferred to rely on it to tell the story rather than what he ate for breakfast.

When The Fast Diet does venture into evidence based research the bulk of it comes from mice and rats - useful models to start with no doubt, but of course results from rodent studies are not automatically translatable into humans. One of the book's primary theories is that fasting is helpful because it reduces circulating levels of IGF-1 (insulin like growth factor 1) which in the case of a particular strain of mouse, might be implicated in many disease processes including aging and cancer. And while I am by no means an expert in intermittent fasting or IGF-1, it strikes me as odd that in the few studies I found on medline that specifically looked at IGF-1 levels and intermittent fasting in human subjects following the ADMF protocol espoused by The Fast Diet, there wasn't a consistent effect on IGF-1. One study I looked at showed a decrease in IGF-1 only when energy restriction was accomplished by means of a 10 week liquid ADMF diet, while the other, actually showed little change or even a small rise in IGF-1 levels following a full 6 month trial of ADMF dieting by overweight women. But rather than report on the effect one of the longest and largest trials of ADMF dieting in overweight humans that showed no change to circulating IGF-1 Dr. Mosley chose to report on his own personal drop in IGF-1 levels while following his diet - an odd thing considering the randomized trial he didn't cite was in fact conducted by Dr. Krista Varady - the researcher responsible for The Fast Diet's actual regimen and one of the book's most regularly featured personalities.

Dr. Mosley's self reporting doesn't end there. He also happily self reports that his fasting glucose level went down consequent to his fasting....but of course he also happened to have lost 10% of his body weight - an amount more than sufficient to explain his biochemical improvements, and he reports that his memory seemed to have improved as evidenced by his results in an online test he took twice.

Dr. Mosley's section covers other purported benefits of ADMF fasting - most propped up almost entirely by theoretical or non-human based underpinnings with his take being that ADMF fasting staves off Alzheimer's, prevents cancer, improves chemotherapy, lengthens your lifespan, improves your memory, decreases depression, and of course helps you to lose weight and improves your cholesterol.

The next half of the book was written by Ms. Spencer who doubles down on the "evidence" by stating,

"There is evidence from trials conducted by Dr. Michelle Harvie and others that this approach will help you lose weight, reduce your risk of breast cancer, and increase insulin sensitivity",

though Dr. Harvie's provided citation refers only to a paper looking at the impact of fasting on biochemical markers and not in fact fasting's actual impact on long term weight management, breast cancer risk or insulin sensitivity. Later on she goes further to describe intermittent fasting's benefits as,

"widely accepted disease-busting, brain-boosting, (and) life-lengthening".

But really her section is more about how to actually wield the diet - one which no doubt includes putting up with hunger. Here's how she describes it,

"While hunger pangs can be aggressive and disagreeable like a box of sharp knives, in practice they are more fluid and controllable than you think".

Unfortunately there's yet to be long term data to back that up as she herself notes a few pages further in,

"While the long-term experience of intermittent fasters in still under investigation, people who have tried it comment on how easily it fits into everyday life".

Now whether that's true or simply the effect of post-purchase rationalization it flies some in the face of Dr. Varady's work with ADMF dieters which showed that folks randomized to intermittent fasting ala The Fast Diet's style for 6 months were far less likely than those randomized to more traditional caloric restriction to want to sustain the intervention (58% vs. 85%).

And it's Ms. Spencer's section that really dives into the nonsensical stating that despite losing weight, and with no recommendation to exercise, by fasting you'll not only not see a drop in muscle mass, you'll see a rise, and that your food preferences will change such that,

"you'll start to choose healthy foods by default, not by design".

She also goes on to state that,

"heavier subjects respond brilliantly to intermittent fasting",

yet did not provide a reference. And that's rather crucial in a book that relies on personal anecdote rather than published evidence, or at the very least, clinical experience. From what I can gather neither Dr. Mosley nor Ms. Spencer actually work with individuals who struggle with their weights and I don't think it's a given that the experiences of a woman whose starting BMI was 21.4 (or Dr. Mosley's of 26.4) would necessarily be applicable to those who struggle with their weights to begin with.

Putting my many objections to the reporting of hope and theory as fact, one thing bothered me throughout. If the putative benefits of fasting stem from evolving during centuries of dietary insecurity why would fasting's benefits be expected of diets that even on "fasting" days provided 1/3-1/4 of most folks' daily calorie requirements? Seems to me if you are convinced by the early evidence, and indeed there is some, that fasting confers some biochemical advantages then you should in fact fast, rather than eat and call it fasting.

Ultimately here's a diet book based primarily on theoretical conjecture and mouse studies that's propped up almost exclusively by the personal experiences of two professional journalists neither of which had obesity to begin with nor working with patients trying to manage their weights, where statements such as,

"studies and experience show that intermittent fasting will regulate the appetite, not make it more extreme"

fail to come with citations, and where on the very same page the statement,

"It all points to a healthier, leaner, longer old age, fewer doctors' appointments, more energy, greater resistance to disease"

coexists with the butt covering,

"yet science is only just starting to catch up".

So if you want to try fasting as a means to control available energy intake - by all means go for it, but as the authors in rare moments of clarity between wild conjectures and unsupported statements point out, the science is still far too young to be conclusive.

Remember, as always, the most important factor to consider when analyzing your diet is whether or not you like your life while you're losing your weight, as whatever weight you lose with an effort you ultimately abandon is almost certainly going to return when you head back to the life you were living before you lost.

Guest Post: Do Medical Schools Teach Future Doctors About Weight Management?

In my day to day I often will supervise residents or medical students who have taken it upon themselves to learn more about obesity medicine. I say taken it upon themselves because despite diet and weight related/responsive conditions being huge contributors to a physician's caseload, medical schools and residency programs don't seem to think that nutrition and weight management are worth teaching.

For the past few weeks, Jill Trinacty, a fourth year medical student from the Annapolis Valley, Nova Scotia who will be graduating from Dalhousie University this spring, has been shadowing me here in the office. She will be completing her upcoming residency in Internal Medicine in Ottawa. She enjoys running, cycling and has an interest in obesity medicine, and when I asked her if she'd be willing to write a blog post on what she'd learned about obesity medicine prior to joining me here, she happily obliged. And to be clear - I asked her to focus on what she'd learned regarding obesity yet long term readers here know that healthful living is of concern to anyone at any weight and that the principles that might be involved in weight management and obesity specifically no doubt apply to everyone, and that scales measure neither health nor lack thereof.

Here's what she had to say:

I am in my fourth year of medicine. I have one week left of clinical placements. One exam left to write. One stage to walk across and then I will be set loose on the world as an MD!

But wait.

I entered medical school four years ago knowing I wanted to be a “doctor”. I didn’t know which kind or what exactly it would entail but I envisioned myself changing lives and promoting “health”. Health to me meant eating nutritiously, being physically active, and generally being well. It seemed pretty straight forward. I wasn’t sure how I would go about inspiring people to be healthy but medical school would teach me that – right?

First year medical school set about teaching the basics of anatomy and physiology. Surely they would talk about obesity, weight management, basal metabolic rate, energy expenditure. No? Ok. Second year came around and again more physiology and medical basics. They measured our heights, weights, fasting glucose, lipids. Awesome! Now you’re going to demonstrate how to use these seemingly meaningless numbers to segway to leading a healthy lifestyle. No? Ok.

Clerkship. This is it. Rotating through all these medical specialties will be when I learn how to counsel people about healthy lifestyles, nutritious food, physical activity. After all, it applies to every area of medicine right? I started with surgery. Between gallstones, bariatric surgery, knee replacements, cancer, there were lots of opportunities to discuss obesity management. I heard a lot about obesity on those rotations, but it came in the form of murmurings and harsh comments. Pediatrics – this is the place to talk about it! We touched on nutrition and slightly on obesity in one lecture. We talked about iron deficiency anemia and growth theoretically. We practiced asking about dietary consumption. Did I once counsel on obesity? No. Ok. OBGYN, surely with all the risks of obesity during pregnancy and the opportunity to teach women to live a healthy life in hopes they will pass that on to their child. No? Ok. Psych, you’re up! The side effects of obesity and metabolic disorders from medications alone should provide ample opportunity to counsel on lifestyle, especially in a population that may have limited means of income. No? Ok. Internal medicine, you’ve got it all! Hypertension, diabetes, heart attacks, obstructive sleep apnea, hypoventilation syndrome. I was lucky enough to rotate through endocrinology department but the clinic was pressed for time and resources, and very few students experience this rotation.

So now I am finished medical school. I realize I have learned very little about how to manage and counsel on obesity – and so have my classmates. In a recent poll of my class of 2013, although many felt comfortable discussing obesity, they felt ill-prepared to effectively manage it and those that did say they felt they had some weight management strategies found that it came from a few select doctors or their own personal weight management challenges. Obesity affects a great deal of the population, affects every specialty and subspecialty and yet we don’t learn how to effectively manage it? We need to do a better job of recognizing the problem, reflecting on our own health behaviours and prioritizing teaching on the issue. If we’re not teaching our future physicians how to manage obesity effectively, who can people turn to for weight management help?

Badvertising: Christie's Now Calling Cookies "Fruit Krisps"

In case last week's posting of Cherry 7-Up Antioxidant still didn't convince you the food industry will say or do anything to sell food, here are Christie's new "Banana Fruit Krisps".

You know you have to hand it to Christie's marketing department as their new "Banana Fruit Krisps" sure do make cookies sound more healthful, especially since they're made with "REAL FRUIT" and are a "Sensible Solution".

Because that's what they are - cookies - as Banana Fruit Krisps' calories and sugar content are virtually identical to Chips Ahoy's, yet I'm pretty sure these are meant to sound good for your children, whereas Chips Ahoy - at least those you know are treats.

[Hat tip to my wonderful wife]

Saturday Stories: Nannies, Homeopathy and the Harlem Shake

Sarah Conly in the NYTs gives 3 cheers for the nanny state

Bioethicist Chris MacDonald questions Rexall's (a Canadian pharmacy chain) homeopathic offerings.

Kevin Ashton explains how you didn't make the Harlem Shake go viral, corporations did.

[And if you don't follow me on Twitter or Facebook, here's this week's US News and World Report piece on the risks of second hand junk food, and embedded below is the Al Jazeera piece I helped with in interviewing Sugar Salt Fat's Michael Moss]

Heavy Metal Toddler Sings About Laundry and Little Red Riding Hood

She seems like a sweetie!

Today's Funny Friday just goes to show you anyone can love metal.

Have a great weekend.

(email subscribers you'll need to head to the blog to watch)

What Did You Expect? Coca-Cola's Newest Anti-Obesity Ad Blames Chairs, Not Coke.

So did anyone honestly think Coca-Cola cared about obesity? That the Superbowl Coca-Cola halftime ad that talked of all calories counting meant that they'd encourage people to drink less of their sugar water?

Silly world says Coca-Cola. It's not about the sugar water. It's about chairs. Chairs make people fat.

Here's Coca-Cola's first missive in its new found commitment to "fight overweight and sedentary lifestyle" shows a man rising up against the chairs of the world....and buying the 10 teaspoons of sugar water otherwise known as a fully loaded 12oz Coke.

Again, you really can't make this stuff up.

[UPDATE #1: After you watch the video vilifying chairs, make sure you click here to have a gander at some absolutely delicious sugary irony

UPDATE #2: After a few folks questioned the veracity of the ad suggesting it was a fake or a parody I contacted Publicis Spain (the agency credited) and they responded to tell me that it is indeed a real Coca-Cola advertisement]

Badvertising: Cherry 7-Up Antioxidant. No That's Not a Typo

The next time you get into an argument with an apologist for the food industry who suggests that your concerns for the industry's lack of ethics are unfounded please just pull out this post and photo.

Behold - Cherry 7-Up Antioxidant.

From the you can't make this stuff up file.

Why The Food Industry is Neither Friend nor Foe

This past weekend I had the pleasure and honour of debating Dr. Derek Yach at the American Heart Association's Epidemiology and Prevention, Nutrition and Metabolism Conference and the debate we were asked to have was entitled, "Food Industry: Friend or Foe". While I argued the "Foe" side, I actually think the debate title was a misnomer. Ultimately the food industry is neither friend nor foe as both assume that industry has the luxury of consistent intent beyond profit.

I don't think that it does.

That's not a mean spirited statement, just a truthful one as were a corporation to promote a product or program that ultimately undermined the corporation or their profits, that product or program would be dropped - just as we saw when Campbell's re-salted their soups, when Ruby Tuesday's lost their now legally required pre-emptive posting of calories on menus, and when Dr. Yach's former employer PepsiCo renewed their commitment to their core brands by upping their advertising buys for sugared soda and hiring teen idol Beyonce to be a brand spokesperson despite their stated aim of becoming the world's most profitable health and wellness corporation.

Ultimately if profits align with health then the food industry is absolutely going to be public health's friend. And if profits and health collide, then the food industry is absolutely going to be public health's foe. And honestly I think it's a failure of both sides of this argument to consider industry's ability to circumstantially be both friend and foe that leads to the black and white arguments that we should either be working with, or shunning industry.

My line in the sand in the debate was my usual one. I think dialogue, debate and the individual provision of counsel to the food industry in the grand scheme of things may well be in public health's best interests as it may in fact help industry to find those rare areas where health and profits do indeed collide, however once we add our institutional backing to the food industry I think we provide them with an almost irresistible means to further sales, whether by positive brand associations, misguided co-branded sales, ammunition with which to fight industry unfriendly legislation by validating the claim that they're working with so-and-so to be part of the solution, and the co-branded promotion of nonsensical messaging like balancing energy intake with output (never you mind our sugar water, you just need to exercise). Consequently I don't think public health organizations should formally partner with the food industry.

I'll be using the same slide set at the Canadian Obesity Network Conference in May where I'll be part of a panel discussing this very topic and I'm hoping to post them then. And hey, if you're near to or wanting an excuse to visit Vancouver between May 1-4, the conference looks great!

The Weight Loss Surgery Foundation of America and Me in May in Vegas

On Saturday May 18th I'll be speaking in Las Vegas on behalf of the Weight Loss Surgery Foundation of America (WLSFA) at their annual Meet and Greet. I certainly won't be the only speaker for this two day event and the keynote speaker this year is Carnie Wilson.

So who are the WLSFA?

They're a charitable organization that raises money to help pay for bariatric surgeries for those who can't afford them.

For those of you who don't know, I'm not a surgeon, but I am a supporter of bariatric surgery. Despite the public's regular knee jerk negativity to bariatric surgery (that folks who need simply aren't trying hard enough, that it's an easy way out, that it's the path of laziness, etc.), when performed by skilled surgeons, and when supported by well designed pre and post surgical education and appropriate patient selection, it increases life expectancy, decreases or cures many medical co-morbidities and improves many aspects of quality of life. I've covered this strange bias before on my blog when it came to the surgical management of diabetes, and if you're in the camp of surgery is just plain wrong, every time and for everyone, I'd encourage you to read it, as the message therein applies wholeheartedly to bariatric surgery as well.

Now bariatric surgery isn't a miracle and it has both risks and adverse effects, but I'll tell you, if I were unable to lose weight and maintain that loss any other way, and if my weight was negatively affecting my quality and quantity of life and health, I wouldn't hesitate to explore it as an option.

My talk will be the first one I'm giving from the pages of my upcoming book, The 10 Day Reset: Why Everything You Know About Dieting is Wrong and How to Fix It, and I'm excited to be able to donate my time, energy and thoughts to this worthy cause. If you or a loved one has bariatric surgery or are considering bariatric surgery, I'd encourage you to come on out.  If you'd like to attend you can either click that link up above, or contact the WLSFA directly by phone at 415-234-9074, or via email at: info@wlsfa.org

Saturday Stories: Twix (sort of), Willpower and More on Big Cup Bans

Great short post from my friend Hemi Weingarten the founder of Fooducate on front of package calorie labeling and chocolate bars.

Friend, former overweight kid, now co-founder of Fitocracy and fitness phenom Dick Talens on the myth of willpower.

The NYTs Mark Bittman with a great piece on the failed (so far) Bloomberg cup size ban.

[And if you don't follow me on Facebook or Twitter no US News and World Report column this week, but I did do a segment you can watch with Canada AM on the recent abstract that says drinking soda will kill you.]

Also, here's a research request from some folks over in Toronto working on a new health screening tool for kids:

"Calling all health care practitioners with an interest in paediatric healthcare! Researchers at Holland Bloorview Kids Rehabilitation Hospital and the University of Toronto are looking for Physicians, Dietitians, Nurses and Health Psychologists to participate in a short, anonymous online survey (click here) to share their 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. Everyone who completes the survey can enter a draw for a $150 gift card."

True Facts About the Dung Beetle

Today is Friday! And that means it's time for a break from anger and consternation.

Today's Funny Friday video is more from Ze Frank's brilliant series of "True Facts".

Have a great weekend!

(email subscribers you need to head to the blog to watch)

Biggest Loser Pediatrician Joanna Dolgoff Promotes Unsafe Weight Loss to 7 Million Viewers?

Screencap above and show transcript down below courtesy of Shannon Russell

This story will be told primarily in tweets. Not mine, but rather Dr. Dolgoff's.

So is rapid weight loss in children safe?

Not according to Dr. Dolgoff.

Here's her tweet from January 7th where she appropriately cautioned a 15 year old that losing 36% of her body weight in just 29 weeks and 3 days was not safe.

It's a message reiterated regularly and appropriately by Dr. Dolgoff in her recent Twitter stream.

Here she cautions that weight loss should be "slow and steady",

Here she reiterates that rapid weight loss in children isn't safe,

And here she explains that the Biggest Loser approach, one that sees adults losing between 25% and 50% of their weights in 22 weeks (there's no clear answer as to exactly how long the show is. Best guesses out there are somewhere between 20 and 24 weeks and The Biggest Loser executive producer Dave Broome, when I asked him on Twitter, ignored me) is extreme and unrealistic,

The reason Dr. Dolgoff cautions against rapid weight loss in children is twofold. Firstly the only way to lose weight rapidly is to take on extremes of effort - dramatic under-eating and massive over-exercising - neither of which represent a sustainable strategy for anyone at any age. More importantly though, when it comes to rapid weight loss in children it's thought that rapid weight loss potentially risks negative effects on pubertal development and on lean tissue, while simultaneously putting children at greater risk of developing eating disorders.

But don't take my word for it, here's Dr. Dolgoff's own website from back in 2011 on the subject of rapid weight loss in children (the admonition is still on her program Red Light Green Light's page, but thanks WayBackMachine for providing a version that can't be altered by the site's owners),

"Child weight loss is very different from adult weight loss for many reasons. First and foremost, children need a sufficient number of calories to support their growth and development. We cannot limit fat as much as we do in adults because children need fat for continued brain development. We also don’t want to limit carbohydrates which are essential for growth and energy. In fact, most studies show that low carbohydrate diets are neither safe nor effective for children.

It is not safe for children to lose weight too quickly. Weight loss in children must be closely monitored by a doctor to make sure that no nutritional deficiencies are developing and that growth and development is appropriate. We recommend that all patients see their pediatricians routinely while following our program.

We aim for a slow, steady, and healthy rate of weight loss, approximately one half pound to one pound per week. It is not safe for children to routinely lose weight more quickly than that. Of course, there may be some weeks when your child loses more than one pound but in general, sticking to a half pound to one pound per week is ideal.

Remember, your children are still growing. So even if they don’t lose a pound (but rather maintain their current weight) and continue to grow, they will get thinner. We call this “growing into their weight”. In fact, for younger kids, we don’t aim for any weight loss; we aim for weight maintenance and continued growth.

"Ok, so Dr. Dolgoff really isn't a fan of rapid weight loss in kids.

Or isn't she?

Last week on The Biggest Loser Dr. Dolgoff was shown congratulating 13 year old Biingo on losing 25% of his body weight in just 11 weeks! Now to be fair, TV is a manipulated media so perhaps that segment was shot past the 11 week mark, but certainly it wasn't presented to viewers as such. Instead it was presented to them as Biingo's 11 week accomplishment. Here's a transcript of what she said to Biingo (and to America),

"I have here a body mass index curve, it's a way to measure levels of body fat, and when we first met you, you were in the purple and at a real risk for medical problems. In just a few months of making healthy choices, you have gone from the purple all the way down to the yellow. Biingo has lost 25% of his body weight."

And here's her excited tweet:

Then at the finale this past Monday we found out that 13 year old Biingo lost 43lbs in the 22 weeks, 13 year old Lindsay 47lbs and 17 year old Sunny 51lbs and though they didn't announce percentiles I'd venture that each and every one of their losses represented somewhere in the neighbourhood of losing near 30% of their body weights in just 22 weeks. For the show's children to lose 30% of their body weights in just 22 weeks puts their results right in line (and even in some cases exceeding) those of the show's adults, especially when considering not fully grown 13 year olds' resting energy expenditures are likely less than those of fully grown, taller, heavier, adults. What that means to me is that the kids, while not living on the ranch but while under Dr. Dolgoff's supervision and oversight, were as or more extreme in their weight loss efforts than the show's over-the-top, run till you puke, never eat a cookie, competing for $250,000/$100,000 adults.

And while these massive weight losses in barely pubertal children may have put the kids at personal risk, what of the viewers' children? Roughly 7 million people watch The Biggest Loser, which means 7 million people have just been taught that children, if pushed hard enough, if they just want it badly enough, can lose dramatic amounts of weight in truly rapid fashion and that pediatricians support that degree of loss. I wonder how many parents who watched The Biggest Loser this year are going to start riding their overweight children and forcing them to undertake incredible amounts of exercise while simultaneously severely restricting their diets thinking that's their kids' tickets to slim?

Sigh.

So are there any thoughts out there as to why Dr. Dolgoff's caution against rapid weight loss for the 15 year old hoping to lose 36% of her body weight in 29 weeks didn't apply to the three children she regularly reports on Twitter that she "loves" whose care she was responsible for overseeing while on The Biggest Loser? Or why she's comfortable serving as a cheerleader for a show that teaches America that rapid weight loss in children is awesome when she clearly appears to have at least once thought differently? Has she simply changed her mind?

American Academy of Pediatrics - would still love to see some actual leadership from you on this one. You need to speak up about kids on this show. You're failing them on this.

Read This If You're Trying to Cultivate a New Habit

People talk about cultivating new habits all the time. While I've busted the 3 weeks myth over on US News and World Report thinking on habits led me to ponder flossing.

Flossing is easy, cheap, quick and good for you. And I'd bet there are truly large numbers of people out there who despite on occasion going through spurts of months of regular flossing, fall off the flossing wagon.

Why?

Because flossing fails to fall into the two categories of things that truly allow us to form "habits". Those two categories are easy to define. There are those things we actually enjoy doing and those things we simply must do. For the actually enjoy category it's certainly not difficult to sustain those behaviours and often this category includes behaviours that may not be "good" for us like snacking on junky yummy food, after dinner drinks, favourite show watching, obsessive social network checking, etc. The must do category on the other hand, that'll include things that we might not honestly enjoy, but things we simply don't have a choice but to do and might include getting up each week day to go to work or school, cleaning up after our kids, etc.

Flossing?

Not sure there's anyone out there who'd say that they "enjoy" flossing, and certainly there's no truly immediate repercussions of not doing it to suggest it must be done, which may well be why in my own life, despite having had 6 month or longer stretches of daily flossing, I've also had those stretches end for no particularly good reason - this despite the fact that I'd been doing it for quite a long time, long enough that I might have thought it was a "habit".

If you're aiming to improve upon your lifestyle, diet or health, your best bet is to try to find a way to truly enjoy your desired change, or more likely, convince yourself that it is something you simply "have" to do (for instance I am not a natural lover of exercise, but I've convinced myself it's something I have to do - both in the context of walking my talk, and also in the context of setting a good example for my children), because otherwise, just like flossing, what might feel like a truly established habit can disappear in a flash....until of course the week before your next dentist appointment.

Juice is NOT a F@*#$*&g Fruit!

In case you're not aware, Canada's official Food Guide formally recognizes half a cup of juice as a fruit equivalent. This of course despite both the Canadian and American Pediatric Societies putting a half cup maximum on juice consumption in young children and a full cup for everyone else.

Not surprisingly  juice manufacturers hone right in on the Food Guide's recommendations and use them as a means to market their products to parents like that seen on the advertisement for grape juice up above. And don't forget too, children are taught the Food Guide as gospel in grade school and it serves as the backbone of any institutional food program (including daycares and preschools).

So are Canadian children drinking too much juice?

Good god yes.

A recent study published in Applied Physiology Nutrition and Metabolism set out to determine Canadian fruit and vegetable consumption.

Their findings?

The average Canadian child between the ages of 2 and 8 is consuming 50% more than their recommended juice maximums. But that's not the whole story. Some kids are chugging tons of the stuff with the 75th percentile of 2-3 year olds drinking 2.5x as much which means 25% of Canadian preschoolers are drinking even more than that!

Juice is sugar water with vitamins. It has drop per drop the same amount of sugar as soda pop and in some cases more (like that grape juice which has double the sugar of Coca-Cola - 10 staggering teaspoons a glass). Liquid calories don't satiate, and they don't pack the fibre and phytonutrients of actual fruit.

So do you think the Food Guide's inclusion of juice as a fruit, or to put it differently the Food Guide's failure to admonish against juice consumption might have something to do with its consumption among Canadian preschoolers?

I sure do. And while it's not true causal proof, looking to Australia, a country where their Food Guide explicitly discourages juice consumption and sets the same half cup maximum as the Canadian and American Pediatric societies, my read of this report has their average 2-3 year olds drinking only a third of a cup of juice a day.

Bottom line?

Our Food Guide stinks and what it says does matter.

Guest Post: How a 7 Year Old Boy Came to Ask, "Do I Look Fat?"

One of my Facebook readers sent me a message telling me about the experience she had after allowing her son to watch a few episodes of this season's The Biggest Loser. I asked her if I could repost it as a guest blog.

Meet Tara Newman.  She is a mom, fitness enthusiast, and an advocate for healthy living. She has a Master's Degree in Organizational Psychology and works full time as a Human Resources Manager. She spends most of her time trying to keep up with her active family.

How a 7 Year Old Boy Came to Ask, "Do I Look Fat?"

My son recently told me he wants to be 100 pounds so he can be on TV. You’re probably thinking “What an odd comment,” or “Where did that come from?” Well, you see, I allowed my seven-year-old child to watch The Biggest Loser this season – the first to feature kid participants.

I am not writing to critique the show, give advice, pass judgment or claim to have any answers. I am not a doctor, nutritionist, registered dietitian, exercise physiologist or even a personal trainer. I am simply sharing my experience as a mother, fitness enthusiast, and health-conscious individual.

I know some of you started judging me the second you realized I allowed my son to watch The Biggest Loser. That’s okay, I have thick skin. However, I think you will see that I am a fairly rational being who meant no harm. I might even be a bit like you.

I am a working mom with two kids. Like many of you, my life gives new meaning to the word busy. Aside from my own activities, my husband competes in triathlons, and my kids have their fair share of athletics. Family fun day is always an active experience.

We are conscious eaters. Our diet consists of loads of plants and limited prepackaged items. We steer clear of preservatives as much as possible. And absolutely NO high fructose corn syrup or hydrogenated oils. We participate in a CSA (community supported agriculture) program, which allows us to show the kids where our food comes from. If they’re at a birthday party, they eat the cake. We strive for balance without instilling any body image issues or phobias.

When I let my seven-year-old watch The Biggest Loser, my goal was to expand his worldview by observing people who live differently, have him hear what it’s like to be an overweight child, and (hopefully!) help him understand why Mommy and Daddy work hard to ensure we live the healthiest lifestyle for us. I am not an over-analyzer and have a pretty positive personality; it didn’t even cross my mind that allowing my son to watch the show might have any negative outcomes.

Having kids on the show made it seem more appropriate. Otherwise I would have deemed it adult content. I don't usually watch the show. It’s not representative of our lifestyle or beliefs. It seems strange now that we watched this season at all, let alone as a family.

As my son watched these episodes, he did what I expected. He expressed empathy for the contestants as they shared their life stories. He cheered them on as they faced their challenges and weigh-ins. He was angry when these children spoke about being bullied. He spoke about how he felt lucky to grow up in a house where everyone was “healthy” and had active lifestyles.

What I didn't expect were the random “Do I look fat?” or “Am I getting fat?” or “Can I step on the scale?” questions that started creeping into our daily dialogue. I was blown away the day he said he wanted to be 100 pounds or more so he could go on TV. (For reference, my son is about 58 pounds, medium height with a muscular build.)

I didn't dwell on his desire to gain weight so he can be on TV. Not that I didn't take it seriously, I just didn't think it was something I wanted to “play up.” As a mother, my wish to do right by my children trumps all. I do believe when you pay too much attention to something, it begins to grow into something greater than it might really be – kind of like the boyfriend you kept around too long because your parents despised him.

I like to focus my kids on what they CAN do instead of what they can’t do. As the situations above came up, I continued to redirect him (and my daughter) to our family’s healthy habits: we get plenty of sleep, we drink water, we eat lots of fruits and veggies, we try new things (especially foods), and we get our hearts pumping.

Before writing this post, I spoke to my son about his experience watching The Biggest Loser. Did he really want to gain weight just to be on TV?

My son talked about healthy habits but admitted he didn't learn them from the show, he learned them from Mom and Dad. He also admitted that while he knows he shouldn't want to be over 100 pounds, being on TV would be “really cool.” Alas… the mind of a seven-year-old.

I don’t regret my decision. I take full accountability for my actions. I was able to reinforce the importance of positive body image and discuss healthy weight loss with my son. Building healthy, fit, well rounded, and emotionally well adjusted kids starts in the home and has nothing to do with mass marketed ‘reality’ TV.

Be confident in the life you lead, be present in the decisions you make, and be cautious of how you go about trying to expand your child’s worldview.

Saturday Stories: Convenience, Losers and Low-Carb Athletics

A must read piece from the Atlantic looking at whether or not convenience meals actually save families time.

This one's an oldie, but an interview with yet another Biggest Loser alumnus on just how awful life on the Biggest Loser ranch is and more behind the scenes dirt regarding injuries and weights.

Here's Alan Aragon recounting his recent debate with Jeff Volek regarding low-carb's value to high level athletes (and in so doing tweaking my own personal confirmation bias that while low-carb may be great for some, one size certainly doesn't fit all when it comes to diets)

[And if you don't follow me on Twitter or Facebook, here's the interview I did on Air Talk with Larry Mantle regarding the ethics of kids being on the Biggest Loser with executive producer David Broome, and here's my weekly column for US News and World Report and what I see as the inconvenient truth of healthy living.].

There Are Some Papers iPads Can't Replace!

Today's Funny Friday video comes from blog reader Cheryl and in just a few short moments this brilliant advertisement covers at least one piece of paper the iPad can't replace.

Have a great weekend!

(email subscribers head to the blog to watch)

Sandbags, Swimming Lessons and Soda Cups

According to the Director of Yale’s Prevention Research Centre David Katz, as a society when it comes to obesity we’re facing a flood. I’d argue we’re facing many. We’re facing a flood of empty sugary calories. We’re facing a flood of childhood obesity and we’re facing a flood of diet related chronic diseases. And all of these floods have been here for some time now. In regard to obesity, rates have been rapidly rising for decades and while there have been a few hesitant blips here and there suggesting a leveling off or even slight dips, in a best case scenario that would signify that our flood waters have crested which while certainly better than rising, is far from reassuring. In regards to empty sugary calories and more specifically those coming from sugar sweetened beverages, the recent and slight dip in soda consumption may well be more than offset in the sharp rise in sugar-sweetened sport and energy drink consumption and still sees soda consumption at rates nearly double those of the 1970s. In regards to diet related chronic diseases what I was taught in medical school in the 1990s as “adult onset diabetes” is now regularly diagnosed in elementary school aged children. There’s no denying these are floods.

When faced with a literal flood rather than these proverbial ones, a government’s responsibility is clear - mobilize resources and get to work - first building levees and then ultimately upgrading infrastructure so as to guard against a future recurrence. Levee building follows a pattern too. Fill more sandbags than are likely required and stack, stack, stack, where no single sandbag would ever be expected to do the job in and of itself.

So what sort of response has government adopted in response to our combined floods of obesity, added empty sugars and diet related diseases? For the most part, and with rare exceptions, rather than build levees and stack sandbags the government’s primary response has been to focus on swimming lessons and to suggest or support the notion that personal responsibility, education and attention should serve to deal with these floods rather than sandbags.

Two days ago we saw the demise of a novel sandbag in New York City when State Supreme Court Justice Milton A. Tingling Jr. quashed the plan that would have seen a New York City ban on the sale of servings of sugar sweetened beverages larger than 16oz - a size which in the 1950s Coca-Cola advertised, “Serves 3 Over Ice-Nice”. Justice Tingling ruled that this sandbag was imperfect as it left other sugar-sweetened beverages like flavored milk off the hook, that it would not be stacked in each and every levee, and that it would be difficult to administer. No doubt there is truth in all of Justice Tingling’s concerns. The cup size ban would be difficult to administer, wouldn’t affect sales of even 2 liter bottles of the stuff in corner stores, and no doubt would not in fact stop the overconsumption of sugary beverages. But it would have been a sandbag.

The inconvenient truth here is that we do have a flood, and until we stop equivocating over making perfect sandbags, people, including our children, will continue to drown as our experiences with the rising flood waters of the past 30 years have clearly demonstrated that no amount of swimming lessons are sufficient to fight the relentless current that’s sweeping us to ill health. Flooding precludes the luxury of perfection, and until the government recognizes that fact for these very real floods and starts stacking sandbags, don’t expect the flood plains to empty any time soon.

Washington's Bethel School District Is Part of the Problem

On February 28th I received an email from an employee who wishes to remain nameless who works for Washington's Bethel School District.

That email contained two emails, sent just 5 hours apart, that clearly demonstrate that Bethel School District just doesn't get it.

The saddest part is that I've no doubt these emails are representative of the norm, not the exception.

We need to disentangle ourselves from our normalized reliance and embrace of junk food and Bethel School District should know that providing every district employee (that's who the emails went out to) with encouragement and permission to eat out is part of the problem and not part of the solution.

2/28 3:05pm

Hey Everyone,

Roy Elementary would like to invite you to join them for their McTeacher Night. It is scheduled for TONIGHT, Thursday, February 28th from 5-7pm at the McDonalds located at 14900 Pacific Ave. in Spanaway.

2/28 8:25pm

Child Nutrition staff are selling Leonardi's pizza to raise money for their chapter (these are delicious pizzas!)

Money raised will be used for a scholarship for a student who will be applying themselves into the culinary arts program. Each kitchen will be taking orders now through March 7, 2013:

Pepperoni Pizza, Sausage Pizza and Cheese Pizza, 2 Pizzas for $15 or $8 each

Orders will be picked up by Child Nutrition staff on March 14th. You will need to pick up your pizza at Liberty Middle School on March 14 between 2pm and 4pm. These pizzas will be just in time for your St. Patrick's Day festivities!

Please contact your school's kitchen staff if you have questions or to place an order.

Checks should be made payable to: WSNA Bethel Chapter 30

What Reading that Give Dieters Money to Lose Weight Article Actually Told Me

Wow did this paper get more press than it deserved, and it's not even a paper!

For background, if you haven't heard people are tweeting and posting links to a story that suggests, "Cash Can Coax Dieters to Lose Weight" while that same story has made headlines the world over.

Not one to post links to abstracts or press releases without reading the paper, but intrigued by the attention, I set out to find the paper and read the study.

So what'd I learn from the read?

Firstly that there's actually nothing to read. There is no published study. Here we're talking about an abstract that was presented 3 days ago at a cardiology conference.

Secondly I learned that regardless of the fact that the folks who were paid cash did better, "better" meant losing 9.1lbs in a year vs. 2.3lbs, and a dropout rate of 38% vs. 74%. Now the dropout rate in the cash group is pretty typical for a behavioural weight loss intervention, perhaps ever so slightly better than average even, but certainly nothing to write home about if the suggestion is that cash helps with adherence. And what's there to be made from the staggering 74% dropout rate in the control group that received the same freely provided intervention? My take is that the intervention they used must be truly awful as how bad does your freely provided weight loss intervention have to be to yield a drop out rate of 74%?

And what of the losses? 9.1lbs? Considering the press release reports the participants' average BMIs ranged between 30 and 40, the 9.1lb intention to treat loss to me sounds like pretty much what you would expect in a well designed behavioural weight management program without cash incentives, while the 2.3lb loss is lower than would be expected of a well designed program.

Lastly I learned that the abstract's presenter/author disclosed a financial relationship with a company called GymPact which as you might guess, uses financial incentives and disincentives in encouraging people to exercise.

The one thing I didn't learn is anything about long-term outcomes. I'd argue that especially with an intervention like monetary incentivization we need the long-term data as I'd bet that for many the money involved might lead them to "try harder" which while you might think that'd be a good thing, my experience has taught me the opposite. Whereby if the money led a person to be all the more strict with their lifestyle changes they'd be far less likely to sustain that degree of strictness when the incentive to do so disappeared.

I can't fathom why this abstract made headlines. The weight loss was minimal. The drop out rate abysmal. The study too short. And it's just an abstract! One thing however is certain - the fact that this abstract with really lame outcomes captured the world's attention is a truly terrifying statement as to what passes for news these days when it comes to obesity.