Real Life Weight Loss: Are You Up 2, Or Down 30?

It's something I see all the time. Someone's done an incredible job at cultivating a new lifestyle and has also lost weight.

Then life throws them a kick of some sort (illness, injury, mood disturbance, holiday, birthday, vacation, promotion, etc.) and things go a bit awry and those new behaviours slide and some weight is regained.

Really, that's real life. Our efforts, our motivation, our stressors, our responsibilities - they're not straight lines.

And with most areas of our life, we're cool with that. We appreciate that our best efforts will vary.

But not so much with weight management.

Often times with weight management, slight, real-life related slides in behaviours and rises in weight, lead people to quit altogether. Suddenly they're up two pounds, frustrated, and worse, considering themselves failure and their efforts impossible.

It's times like these that I tend to remind people, like I did yesterday in my office with the patient whose chart is up above, who has lost over 30lbs over the past 16 months and recently regained 2, that it's their choice whether they want to perceive their outcome as being up 2, or down 30.

If things aren't going your way, if you're unhappy with what you've been doing or not doing, rather than beat yourself up about it, reframe, respect reality, and them remember that the best question you can ask yourself is, "What can I do right now that will help a little", and then do it.

Why You Should Probably Just Ignore All "Breakfast" Studies

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

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.

Saturday Stories: Journalism, an Abandoned Baby, and Male Entitlement

Matthew Herper in Forbes worries less about cell phones causing cancer and more about the future of journalism.

Nanette Asimov in The San Francisco Chronicle with the inspirational story of a baby found abandoned in a box at SF State University.

James Fell, someone who knows his way around a curse word, with his understandably viral piece on male entitlement and how she doesn't owe you shit. If you're a man, I'd say it's required reading.

Can Your Oven Mitts Do This?

Today's Funny Friday video's an odd one, and yes, there are oven mitts.

Have a great weekend!

Coca-Cola Provides Pediatricians with Prescription Pads, and Kids with Diplomas

Today's guest post comes from my friend and stellar RD Andy Bellatti who some might not know is originally from Argentina. One of his contacts there sent him some photos of an almost unbelievable Coca-Cola partnership. As soon as I saw it, I offered up my blog for him to share more.

Last week, Fernando D'Ippollito – a pediatrician in Argentina – sent me the image that accompanies this post: a “diploma of good behavior” for his patients.

The diploma reads:

“Today, (DATE), this certificate was awarded to (PATIENT'S NAME) because Dr. (DOCTOR's NAME) asked them to:

__ Stick Out Their Tongue
__ Cough
__ Take Deep Breaths
... and this was done without crying or complaining."

The bottom right of the diploma reads “Your pediatrician” and provides a signature line for the doctor.

The most disturbing detail – Coca-Cola's logo – is in the lower left-hand corner.

According to Dr. D'Ippollito, this diploma template – along with a Coca-Cola branded prescription pad – was given to all members of the pediatrics department at his hospital (José Penna Hospital in Buenos Aires) by a visiting Coca-Cola representative – a visit that can only happen with approval from hospital administration.

It appears his hospital's administration has not gotten the memo. Criticism and abandonment of soda industry partnerships with health organization finally jumped from “fringe” to “mainstream” after last year's Global Energy Balance Network (GEBN) debacle, which resulted in global headlines, the disbanding of GEBN, Coca-Cola's notorious chief science and health officer stepping down, an end to the ties between Coca-Cola and the American Academy of Pediatrics as well as the Academy of Nutrition and Dietetics (the former severed ties with Coca-Cola, the latter was dumped by Coca-Cola) and a variety of monetary “transparency” disclosures from the soft drink giant.

2016 has only added more PR nightmares for the soft drink industry. Nancy Brown, CEO of the American Heart Association, recently published an open letter to Big Soda calling for an end to marketing to children. This letter came just days after a new report by the Center for Science in the Public Interest which detailed the many ways in which Coca-Cola continues to targets children, despite pledges to not advertise to children under the age of 12.

Today, keeping distance from the soda industry for a health institution or organization isn't progressive and courageous as it is a basic display of integrity and commitment to health.

Back to this Coca-Cola branded “good behavior” diploma nonsense (how is that for advertising to the 12-and-under crowd?): does Coca-Cola have ties with Argentina's national pediatric organization? That is unknown for now; the group's website page on sponsorship is, curiously, blank. The answer, though, is “very likely.” In March, Chile's Pediatric Society received plenty of negative attention after Coca-Cola sponsored its annual conference. And, earlier this month, it was revealed that Coca-Cola has generously donated to Spain's Academy of Pediatrics.

The point of these initiatives – which barely make a dent in Coca-Cola's operating budget – is to align the brand with health authorities in order to gain public trust. A sports figure hawking soda in a television commercial sells “cool”, but a pediatrician advertising soda via a “good behavior” diploma or a prescription pad is supposed to provide peace of mind to parents.

The best move health professionals – including, but not limited to, doctors, nurses, and dietitians – can make is encourage all patients, regardless of age, to limit or avoid sugar-sweetened beverages. In the case of Dr. Ippolitto, he tells me he and his fellow hospital colleagues saw this initiative for what it is: a cynical, and failed, attempt at buying the good graces of hard-working doctors.

Andy Bellatti, M.S., R.D., is a Las Vegas–based dietitian. He is also a co-founder and the strategic director of Dietitians for Professional Integrity, a group that advocates for ethical and socially responsible partnerships within the Academy of Nutrition and Dietetics. You can also follow Andy on Twitter and Facebook.

Guest Post: Given What Else is Sold in Bottles, Are We Too Hard on Water?

Today's guest post comes from Ottawa based labour lawyer Sean Bawden. After I tweeted about not seeing any bottled water (but plenty of bottled chocolate milk) at the recent Ottawa Race Weekend, he wrote back to point out that perhaps in part it's because we've so vilified bottled water's provision. He also wondered about why it is we don't vilify other bottled beverages the same way. Sure, sugar's on the radar with them, but the environment? Not so much. I asked him if he'd be interested in fleshing out his thoughts and he kindly agreed.

Why I (Foolishly) Stopped Buying Bottled Water
Sean P. Bawden

From time-to-time I will find myself somewhere away from my home or office, in need of a beverage and without a reusable container. The most common such occurrence was when I formerly taught at Algonquin College. I would arrive at the college to deliver a two-hour or three-hour lecture and wanted something wet to get through the same.

I did not need anything more than simple water. To both Algonquin’s credit and my own, I did adopt the practice of bringing a stainless steel water bottle, which I could easily refill on campus – but there were times when I forgot the bottle either at home or the office and needed to either purchase a single-use, disposable container or go without until I got home.

On those occasions where I elected to buy something, I did not buy a simple bottle of water; I bought something else. Part of my reason for buying something other than water was the social stigma associated with buying bottled water. Bottled water is seen as wasteful and unnecessary (See this video as an example); a stigma that did not seem to attach to a similar disposable bottle if filled with something other than water. Peer pressure can be intense and notwithstanding being the professor and therefore ‘in charge’ I did not want to feel judged by my students.

Upon reflection this decision making was foolish. A plastic bottle is a plastic bottle; any environmental concerns and any objections to the use of such containers should apply equally, regardless of the container’s contents.

More to the point, all I really needed was water – which is the principal ingredient in all other options. So why did I buy something filled with sugar or some form of alternative? In part, I believe, because I have been socialized to believe that buying bottled water is wrong.

I wish to be clear, there is no reason or excuse for buying bottled water to consume where one has access to both a reusable container and world-class municipal facilities, as we do in Ottawa. However, once one had committed to purchasing a single-use, disposable beverage container, water should be a socially acceptable option in the same way all other beverages are viewed.

Notwithstanding once being a student of environmental law I cannot say that I recall ever seeing a campaign against the use of single-use containers generally; only bottled water specifically.

This stigma needs to end for public health reasons. Water and nothing more than water is very often all that one needs. On those occasions where one is ‘forced’ to purchase a single-use beverage container, having plain old water as its contents should not be viewed negatively.

Sean P. Bawden is a lawyer practicing with Kelly Santini LLP in Ottawa, Ontario. He practices in the areas of employment law and civil litigation. He has also taught Trial Advocacy for Paralegals and Small Claims Court Practice at Algonquin College in Ottawa.

Sean Bawden is also the author of the employment-law blog “Labour Pains”

Saturday Stories: Poverty, Cancer, Self-Criticism, and 13 Tears

Christopher Jenks, in the New York Review of Books, covers why America's poor have become so much more impoverished.

Ginger Gorman, in news.com.au, with a conversation about cancer no one is having. (It’s not brave. Or inspirational).

Maria Popova, in Brain Pickings, on self-criticism and the Stockholm Syndrome of the super-ego.

Dr. Donna Neufeld with her poem crying 13 tears (via Facebook).

Bet You've Never Been As Hungry as This Great Dane

Today's Funny Friday.

Just watch it.

Have a great weekend!

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

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?

Could "Psychological Stress" Explain The Biggest Losers' Metabolisms?

Seems extremely unlikely to me only in that there's no obvious pathophysiological mechanism that could help to explain why the show's psychological distress led to permanent and disproportionate metabolic adaptation.

And though that's what I told the reporter from the New York Post, she left out the "doubtful" proviso and left in the "possible".

The thing is, it's unclear why The Biggest Loser's contestants' metabolisms seem slower than would be expected simply as a consequence to weight loss. They're also slower than the metabolisms of patients who've had bariatric surgery and lost similar amounts of weight.

Could their greater degrees of metabolic adaptation be due to the nature of the show itself? Sure. But as I told the reporter Maureen Callahan, over and over again in fact, it's also possible that losing 40-50% of your body weight without surgery, regardless of approach, is responsible.

And yes, despite what the article misquoted me as saying, plenty of people have lost 40-50% of their body weights without surgery, but generally those losses occur with extremes of effort (like they do on The Biggest Loser). What I'd like to know is whether or not losing comparable amounts of weight slowly would lead to similar outcomes?

That'd be a challenging thing to figure out because losing that much weight slowly is a rarity. Of course that doesn't mean it doesn't happen, it just means that it's rare. It also means that randomizing people to lose 40-50% of their body weights with non-extreme efforts isn't feasible.

Lastly, though I think when it comes to weight loss The Biggest Loser's Dr. Huizenga is either deluded, unethical, or clueless, I never claimed to know him personally.

Bottom line. The Biggest Loser is a horror show (I've written extensively about it over the years), but so too is Maureen Callaghan's reporting on it for The New York Post.

Saturday Stories: OxyContin Hell, Trumpist Mobocracy, Anti-Zionism

Harriet Ryan, Lisa Girion and Scott Glover in the LA Times with a hell of a story about oxycontin hell.

Robert Kagan in the Washington Post on Trump, fascism and "mobocracy".

Frequent Israel critic Michael Koplow on his blog Ottomans and Zionists on what he calls the crisis of anti-zionism.

If Meat Eaters Acted Like Vegans

Parts of today's Funny Friday video made me laugh out loud.

Have a great weekend!

(and BTW, I've nothing against vegans - but this was damn funny)

Dr. Andrew Stokes On That New Excess Weight is Healthier Study

Last week saw the publication of yet another study looking to quantify risk with weight, and like some studies have found in the past, the conclusion was that some excess weight might in fact be beneficial to health. From my perspective, the question of "what weight is healthiest" is flawed in and of itself. As I tend to prattle on, the goal for all of us, regardless of our weights, should be to stack our personal decks as much as is realistically possible by living with the healthiest life that we can honestly enjoy. These studies, whatever their findings, tend to emphasize that scales can usefully measure health. I don't wholly agree, but that said, I invited Andrew Stokes, a researcher with a special interest in the association between weight and mortality, to give us his take on the new research.

A new study published in JAMA finds that the BMI value associated with the lowest risk of dying shifted from the normal to overweight range between 1976-1978 and 2003-2013. The study is short on explanations for this puzzling finding, but does offer up the possibility that people with overweight and obesity are receiving better treatment and thus living longer than they did in earlier decades.

An alternative explanation for these findings is a flawed research design. Although some of the coverage, including on NPR and on Ted Kyle’s obesity blog, pointed out the potential pitfalls of using BMI as a proxy measure of body fat, they miss a more fundamental problem with this study, a problem that is shared by many other studies of the health consequences of obesity.

The problem, which I discussed in a previous post on Yoni’s blog, is the reliance on weight assessed at a single point in time. Disregarding weight history is a problem because people who have long maintained a weight in the normal range are mixed together with those who formerly had overweight or obese and lost weight. Although some of the weight loss in the latter group is healthy weight loss, much of it is tied to conditions such as heart disease, cancer, COPD and other ailments. Because of this—as several recent studies have shown — including the weight losers as part of the normal weight category obscures the substantial benefits associated with maintaining a normal body weight.

In the JAMA study, attempts were made to address this bias (referred to by epidemiologists as confounding by illness) but the measures taken were ad hoc and incomplete, leaving plenty of room for the bias to creep into the estimates. Unfortunately, there is no way of knowing from the data presented how the composition of the normal weight category changed across the cohorts studied. It could be that as a result of differences in age composition or smoking status across cohorts, that a larger fraction of the normal weight group in the later cohort once had overweight or obesity, which could explain the apparent finding of the nadir of the BMI mortality relationship increasing across cohorts.

The substantial discrepancy in length of follow-up across cohorts may have also compromised the comparison (median length of follow-up was 19.8, 11.0 and 4.6 years in the 1976-1978, 1991-1994 and 2003-2013 cohorts, respectively). Length of follow-up has been shown to be a significant effect modifier of the association between excess weight and mortality, with shorter duration follow-up often leading to greatly attenuated effects. The findings of the JAMA study are consistent with bias due to duration effects, with the risks getting progressively weaker between the first cohort in which follow-up was greatest and the last cohort in which follow-up was shortest. Although the authors acknowledge the possibility and present several tables and sensitivity analyses aimed at testing for duration effects, the results are not entirely convincing.

The problems discussed above raise doubts about how much we should take away from the new JAMA study. Although it is possible that the nadir of the BMI-mortality curve has shifted over time, this study is far from conclusive on the matter. A more likely explanation behind the striking pattern is that it is a spurious result of a flawed study design.

Andrew Stokes is an Assistant Professor in the Department of Global Health at Boston University. His research is focused on the causes and consequences of the global obesity epidemic and developing novel approaches to combating obesity at the population level through interventions that target aspects of the social and physical environment. You can also follow him on Twitter.

No Mott's, Watered Down Juice Doesn't Help Kids #StartStrong

Mott's for Tots is watered down juice. As in they took juice and added water and then sold it to you at the same price as the non-watered down stuff.

Watered down juice is not "love".

Watered down juice won't help your kids "#startstrong"

Watered down juice shouldn't share or exceed the cost of regular.

Juice is not a healthful beverage.

Treat juice like soda pop and give it to your kids in the smallest amounts you can get away with (aim for less than half a cup a day).



[Thanks to Patti for sending my way]

Saturday Stories: Discarded Life, Expensive Medicine, and Un-Assimilation

Alexander Masters in The Guardian on the discarded life he found, pieced together, and published.

Antonio Regalado in MIT Technology Review on the lessons learned from the world's most expensive medicine.

Rivka Bond in The Times of Israel with a piece that I strongly relate with on becoming un-assimilated.

[And ICYMI, I wrote a piece for Vox that hit their number one status for a while on whether or not long term weight loss really was impossible.]

The Must-Watch John Oliver "Science" Video

On the remotely off chance you haven't seen it, today's Funny Friday video is an incredible effort by Last Week Tonight's John Oliver to highlight just how poorly science is covered and publicized as well as "hacked"

Have a great weekend!

Top Ten Changes I'd Like to See in Canada's New Food Guide

While Canada's Food Guide's revision has yet to be announced, all signs point to soon. The department has gone on record multiple times over the course of the past few years stating that changes were required, and with our new Liberal government and its terrific appointment of Dr. Jane Philpott to Minister of Health, I'm confident that change is coming.

Though there are many things I'd like to see change with the Guide's next iteration, here are ten things (in no particular order) that I see as its most important to-dos:

1. A revision process that is insulated from the food industry. Sure, let industry submit their recommendations, but make sure those submissions are made public, and as opposed to last time around, don't give the food industry seats on Food Guide advisory panels.
2. Remove juice's fruit equivalency and provide an explicit recommendation as to the maximum amount of juice a child should drink in a day (half a cup).
3. Caution against the consumption of sugar-sweetened beverages and specifically include sugar-sweetened milk and milk alternatives as well as 100% juice as products worth minimizing.
4. End the Guide's nutrient focus. Last time around the Guide's primary purpose was to ensure Canadians' nutrient requirements were being met. This time around I hope to see a food focused guide where the emphasis is on broad patterns of eating.
5. Remove the number of servings recommendations altogether. Our country doesn't have a problem with eating too little and research has been done proving that Canadians underestimate serving sizes and virtually no one does (or will) weigh and measure their foods.
6. Caution against the regular consumption of processed red meats.
7. Recommend that artificial trans-fats be "avoided" rather than simply "limited"
8. Get rid of the "Dairy and alternatives" group altogether. These are not magic foods. They're better off being in part of a protein category.
9. Downgrade the Guide's saturated fat phobic messages and replace them with the simple suggestion to swap saturated fats with unsaturated whenever possible.
10. Simultaneously discourage restaurant meals and ultra-processed foods while pushing home cooking and meals eaten together around tables.

It's been nearly a decade since Canada's awful current Food Guide was released. It's definitely time for change.

Why I'll Never Prescribe a Very-Low-Energy Diet

A VLED is a "very low energy diet", and it's defined as one providing fewer than 800 calories per day. These programs are generally administered by physicians, are expensive, often take the form of meal replacement shakes, and usually last for around 12 weeks.

Multiple meta-analyses on VLEDs have been conducted, and generally their findings haven't been particularly exciting. Either they've concluded they aren't worth prescribing, or they've concluded that there isn't sufficient information for a conclusion.

Well add another meta-analysis to the pile. This one, published in March in Obesity Reviews, had what I found to be a very odd conclusion, and I'll get there in a bit. Ultimately the researchers findings were that when compared with a standard, and non-extreme, behavioural weight loss program, 3-5 years later, VLED patients will have lost 2.86lbs more.

Bare in mind too, VLEDs are challenging for patients. Can you imagine 12 weeks of just shakes? I've heard stories of people having to bring their meal replacement shakes to weddings, or to chug them in place of Christmas dinner. VLEDs have risks too. Gallstones from overly rapid losses, disproportionate loss of muscle mass, and electrolyte abnormalities.

So when I read that 5 years later, with VLED diets being shown to affect an additional half pound lost per year, and with their associated risks, and their not insignificant costs (both actual dollars and the cost to a patient's ability to live a normal life), I figured that certainly, the authors' conclusion will have to be that there's not much point in recommending them to patients.

Nope.

Despite VLEDs being found to barely lead to additional losses, despite their risks and their costs, the study's authors concluded,

"Adding a VLED to a behavioural weight loss programme produces greater weight loss in the medium and longer term than a behavioural programme alone. Such programmes appear well-tolerated. Current advice against their use for routine weight loss in medical clinics should be reconsidered."

Huh? Am I missing something?

While there are true success stories with every approach (including VLEDs), weight lost through suffering tends to come back.

Saturday Stories: Howard Jacobson, Marlene Carter, and Kristopher Pena

Source: Clive James

A truly incredible video of Man Booker prize winning author and journalist Howard Jacobson discussing anti-Zionism and Antisemitism (hard to believe there are people this eloquent out there).

Kenneth Jackson in APTN News on the pending death sentence of Marlene Carter.

Matthew Teague in The Guardian on Kristopher Pena and the story of his solitary confinement in Florida

Does Your Mom Even Text?

Mine doesn't. But today's Funny Friday video Moms sure do.

Hope you have a great Mother's Day weekend!