Why Health Check Matters

Yes, that is an ad promoting the consumption of a burger, and yes, that is the Heart and Stroke Foundation's Health Check with it's small print disclaimer that always says,

"This is not an endorsement"

Interesting thing here is the fact that the Heart and Stroke Foundation not only know it's an endorsement they in fact brag about it.

Here's Heart and Stroke Foundation registered dietitian Carol Dombrow quoted in a press release from 2005 detailing the Health Check on ground beef for burgers,

"The Health Check symbol complements mandatory nutrition labelling, in a 2004 research study, sixty-five percent of consumers recognized the Health Check logo as meaning the food is 'nutritious', 'healthy', 'good for you' or 'approved by the Heart and Stroke Foundation.' Sixty-eight percent agreed with the statement: 'I can rely on Health Check to help me make healthy food choices."

And how about her views on burgers specifically?

"With ground beef burgers being one of the most popular meats in the summer months, having the Health Check symbol in place now helps consumers understand that lean and extra lean ground beef can be part of a healthy diet."

So in fact the Heart and Stroke Foundation markets their Health Check as something that let's consumers know that a food is "nutritious", "health", "good for you" and "approved by the Heart and Stroke Foundation". You might even say they market their Health Check as something product manufacturers can put on their foods to sell more of them....sort of like an, what's that word again, ENDORSEMENT.

In that same press release David Ryzebol, the vice-president of public affairs for a large Supermarket firm concurred,

"Given a choice, most of our customers would choose a Health Check labelled product over one that doesn't have that designation"

Now back to beef - so that World Cancer Research Fund Report just came out - maybe Carol and the Heart and Stroke Foundation didn't know that red meat wasn't good for you and now they're going to take back that Health Check.

I wouldn't bet on it.

Of course, were it to be true that this is the first they're hearing that red meat's not a healthy choice it would reflect not a lack of research as the most recent report merely summarized existing literature, it would instead reflect either a lack of understanding of the research, a lack of reading of the research or a lack of caring about the research.

Unfortunately, none of those are really heartwarming options.

What it comes down to is the following question, is recommending something because it's not as bad as alternatives in its class a good idea?

Certainly my thoughts when it comes to folks like the Heart and Stroke Foundation should be an unequivocal, "NO!"

To falsely promote slightly less unhealthy foods as being good for you is just bad medicine and given that the HSF themselves state consumers who see their Health Check think, "the food is 'nutritious', 'healthy', 'good for you' or 'approved by the Heart and Stroke Foundation", I think it's unethical to boot as the HSF knows that their check lulls consumers into thinking that the food is good for them, not that the food is less bad for them than others like it.

So anyone want to take bets on whether or not Health Check rescinds its endorsement of red meat? Can you guess what answer my money's on?

(Side questions for all of my non Heart and Stroke Foundation dietitian readers - do you encourage your patients to eat beef burgers and promote them as healthy choices?)

And speaking of money, stay tuned tomorrow when I discuss just how much money Health Check makes and how that's likely to influence both their recommendations and their ability to change them.

The Heart and Stroke Foundation Responds

Just received an email from Sally Brown, the CEO of the Heart and Stroke Foundaiton of Canada in response to my letter of last week.

I will post it below along with my response, and let you draw your own conclusions.

I'm quite curious what you folks think.

Dear Dr. Freedhoff,

Thank you for sharing your comments with us.

We also appreciate your acknowledgement of the important role that the Foundation is playing in funding important heart disease and stroke research, and championing a healthy lifestyle.

For over 50 years, the Heart and Stroke Foundation has been a leader in promoting better health to Canadians, including providing information on nutrition and healthy eating. We introduced the Health Check™ program because we heard from Canadians that they were frustrated in their efforts to identify healthy food options in the grocery store, and all the nutrition advice in the world won’t help if people can’t apply it when they’re staring at the shelves.

To display the Health Check symbol, products must comply with nutrient criteria based on Canada’s Food Guide, which is accepted by most dietitians and health professionals as the best evidence-based source of Canadian nutrition information. We understand that you do not agree.

Health Check™ products are not judged on one sole nutrient, like fat, sugar or salt, but rather on the nutrient composition of the product, including beneficial nutrients like fibre and calcium. Overall, the product must be acceptable as a healthy choice based on specific criteria in each food category.

Health Check™ is designed to contribute to a general healthy diet – it is not a sodium restricted program for people already living with heart disease, or for people on a therapeutic diet. The program criteria are based on current Canadian recommendations. The Foundation is working hard to help Canadians reduce their intake of sodium to healthier levels, in part by working with manufacturers to bring sodium levels down in foods. The changes are ongoing but will take time. In fact, the National Sodium Policy Statement that you referenced, signed by the Heart and Stroke Foundation and other top health organizations in the country, calls for Canadians to reach the daily levels that you quoted by 2020.

In the case of sugar, there are no accepted, evidence-based “safe amounts” against which we can set our criteria, but we realized that leadership was needed on this issue, so our dietitians are in the process of establishing sugar criteria for the program, and we will work with food companies to bring sugar levels down even further in Health Check™ products.

Through Health Check™, we know that we are having a positive influence on the food supply, and contributing to the reduction of salt, saturated and trans fat, and sugar in food products. Companies are reformulating their products, and introducing new ones that meet the nutrient criteria required to qualify for the Health Check™ symbol. Consumers have responded very favourably to the program, and tell us we’re meeting our objective of helping them quickly and easily identify foods that can be part of a healthy diet.

Sincerely,
Sally Brown, CEO
Heart and Stroke Foundation of Canada

Here's my response in return,

Dear Ms. Brown,

Thank you very much for your response.

You are quite correct in noting that I am not fond of Canada’s Food Guide. I believe it is a nutritionally indefensible document that provides medically irresponsible dietary recommendations to the detriment of the health of Canadians.

I do realize that the HSF, like the AHA, has based its Health Check program off of national dietary recommendations and recognize too the political safety in such an approach.

I think it is truly a shame that political safety supplants best evidence in formulating and administering the Health Check program. Clearly refined flours, red meats, high levels of sodium and sugar are certainly not foods that our best evidence would suggest we strive to include as parts of our diets, nor would I have thought foods that along with a Disney character and a Health Check are promoted to our children.

Sincerely,
Dr. Yoni Freedhoff, MD CCFP Dip ABBM
Obesity Medicine
Medical Director, Bariatric Medical Institute

Comments?

Why the Food Guide Matters Part II

Roughly a year ago when I was initially writing my Canada's Food Guide to Unhealthy Eating series, I had a post detailing why the food guide matters.

I noted that not for one second do I think that Canadians put the Food Guide on their fridges or lug the ridiculously over sized 6 page document with them to the Supermarkets but rather that the Food Guide becomes Canada's nutritional backdrop.

Last week provided a stunning example.

Last week the World Cancer Research Fund released their report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective

The report is a brick. 517 pages long and it involved 9 independent teams of global scientists, hundreds of peer reviewers, 21 internationally renowned experts, and 5 years of time for them to review and analyze more than 7,000 large scale studies for the effects of diet on cancer.

Among their many conclusions was that red meat consumption is not very good for you. In fact they concluded that every 48 grams of processed meat consumed per day boosts the risk of colon cancer by 21 per cent and every 48 grams of red meat consumption beyond a weekly limit of 500grams increases colon cancer risk by 15 per cent.

Not surprisingly Big Meat was not happy with this report.

So who, or should I say what did they turn to for help to defend their product in their press release? Why Canada's Food Guide of course:

"Eating Well with Canada's Food Guide continues to recognize red meat in the diet. The Food Guide recommends 1 to 3 servings of Meat & Alternatives per day"

And in today's Edmonton Journal, a letter to the editor from the Beef Information Centre states,

"The Beef Information Centre has many resources that can help Canadians continue to make beef a part of a healthy eating pattern, in keeping with Canada's Food Guide."

Way to go Health Canada - once again, you've earned the moniker, Happy Corporations.

Oh, and still no word back from the Heart and Stroke Foundation.

Tomorrow will revisit the Heart and Stroke Foundation and their take on beef in explaining why Health Check matters.

Weird Searches Part III

I can't say I'm not looking forward to the weekend - it's been a long and angry week.

Haven't heard back from anyone over at the HSF.

Today being Friday, today's my day off making noise. So for Funny Friday today, here's my third installment of weird searches that hit my blog:

Where to take the best eyebrow shaping course in Ontario Canada

Pinch your nose to lose weight

Medicine to take on Mars

Did God create cokes and fast food?

Red meat gives me diarrhea

Things in Canada to be depressed about

News about fungus in Gatorade

Does Glue have Calories?

The effects of eating uncooked bacon

2006/2007 email address of all gift shops in Sweden

Baked cheetos glycemic index

How to donate your body to a medical center at death in Phoneix

Medical donuts

Interesting bunch this time around.

Kind of sad that my blog comes up when searching for things in Canada to be depressed about. Red meat diarrhea guy, I'd probably cut back and person eating glue, I think Calories might be the least of your worries.

I sure hope the guy asking about uncooked bacon wasn't the guy who later searched for how to donate your body at death; and does anyone know if the medical donuts thing is a public company because I want in.

Have a great weekend!

An Open Letter to the Heart and Stroke Foundation

Regarding the Heart and Stroke Foundation the most pressing question for me is why exactly their Health Check program is making these nutritionally indefensible recommendations.

Best case scenario, it's simply outdated criteria, oversight and bureaucracy.

Worst case scenario, politics, the food industry and funding matter more than evidence based recommendations.

I've decided that perhaps the best way to get some answers is to ask, and so this morning I sent off a letter to Sally Brown, the Heart and Stroke Foundation's Chief Executive Officer, Stephen Samis, the Heart and Stroke Foundation's Director of Health Policy, and Terry Dean the General Manager of Health Check.

Here's the letter that I sent:

Dear Ms. Brown, Mr. Samis and Mr Dean,

I'm writing to you today to express my concerns and ask some questions regarding the Heart and Stroke Foundation's Health Check program.

Firstly let me say that in principle I think the Health Check program is a wonderful idea - given the incredible variety of products in the marketplace and given the incredible impact an unhealthy diet and weight have on health, steering Canadians to healthy choices should in fact be something that more organizations strive to do.

I also want to commend the HSF for their co-signatory status on the National Sodium Policy Statement that rightly identified dietary sodium reduction as an important national goal. In that statement the HSF and others recommended that Canadians limit their dietary sodium intake to less than 1500mg per day and were those recommendations followed it was estimated that this would result in the prevention of 1 in 7 stroke deaths, 1 in 11 coronary artery disease deaths, 1 in 14 of all deaths and 1 in 6 cases of hypertension.

Similarly deserving of commendation are the Heart and Stroke's stance on the need to treat and prevent obesity in Canadians. In the HSF position paper on obesity one of the calls to action is, "Encourage and promote healthy food choices and restrict the advertising of 'junk foods' (energy dense, nutrient-poor foods) to children, for example during children's television programming and in schools.".

With that as background, since starting to pay attention to the Heart and Stroke's Health Check program, I have been regularly shocked and frankly appalled by many of the products, recipes and meals that have secured Health Checks and am very concerned that the Health Check program is not only not steering Canadians to healthier choices, but rather steering Canadians to truly unhealthy ones.

I have a very difficult time understanding how the Health Check program is comfortable providing Health Checks to meals that alone contain 1,260mg of sodium (the Health Check'ed Boston Pizza entree of the Thai Chicken Wrap), beverages that contain 961mg per glass (V8Go Smooth and Seasoned) and children's entrees that per serving provide 850mg (Compliments Junior Clubhouse Diner, which therefore provides per single serving more than 3/4s the HSF recommended amount of sodium for children and 2/3rd the recommended amount for adults).

I have a very difficult time understanding why the Health Check program has deemed it appropriate to extend their seal to the Compliments Junior line of foods - a line of foods clearly targeting children with energy dense, nutrient poor foods including Milk Buddies (sugar sweetened milk beverages that have as much sugar drop per drop as sugared soda and almost double the Calories), Clubhouse Diner Macaroni and Cheese (refined white flour and processed cheese pasta), red meat Mickey Burgers (each containing 0.5grams of trans fat) and processed potato Alpha-Taters - all utilizing Disney characters to entice children from the grocery store aisles.

I also have a difficult time understanding why it is that refined white flour products can ever meet Health Check criteria, this despite an irrefutable wealth of evidence that prove their contribution to the development of metabolic syndrome; that red meat products can ever meet Health Check criteria despite their clear contribution to breast cancer, colon cancer (reaffirmed yesterday by the report of the World Cancer Research Fund) and diabetes; and that sugar and Calories are not currently criteria that are considered at all - thereby allowing products like Welch's Grape Juice, a juice that drop per drop almost double the Calories and sugar of sugared soda (10.5 teaspoons of sugar per glass and 170 Calories; enough Calories whereby one glass a day would provide over 17lbs of Calories per year) to receive a Health Check.

Lastly I have a difficult time understanding how the Heart and Stroke Foundation can put it's name on a calendar (the Heart and Stroke Healthy Living Calendar 2008) where recipes contained therein call for cooking with butter, non-skimmed milk, and regular soy sauce leading to recipes where single servings contain 999grams of sodium.

To say that I'm disappointed in both the Heart and Stroke Foundation and Health Check would be a tremendous understatement.

I have been blogging about these matters for some time and if you'd care to review all of my entries and concerns, please feel free to head over to my Heart and Stroke post summaries by clicking here.

I'm hoping you can shed light on my concerns.

I would be very pleased to share your responses with my readers.

Sincerely,
Yoni Freedhoff, MD
Medical Director, Bariatric Medical Institute
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5

If any of my readers would care to write any of these individuals just click their names below:

Sally Brown, CEO of the Heart and Stroke Foundation

Stephen Samis, Director of Health Policy of the Heart and Stroke Foundation

Terry Dean, General Manager of Health Check

I'll keep you all posted of any responses I receive.

Heart and Stroke Foundation Health Check Sells Junk Food to Children

It's a dream made in marketing heaven: Disney plus the Heart and Stroke Foundation, plus misleading advertisements, plus a scared public = $$$

The ad shouts out,

"No artificial colours.
No artificial flavours.
No added hydrogenated oils"

Unfortunately it leaves out,

"Plenty of added sugar.
Lots of unhealthy foods.
We're preying on your good intentions."

Let's look at a few examples:

First up, we've got the Heart and Stroke Foundation teaming up with Buzz Lightyear to entice your children to have Milk Buddies.


It's a sugar sweetened milk beverage whose second ingredient is sugar. In fact, it's got 22 grams of sugar per serving along with 140 calories. That's 5.5 teaspoons of sugar and 140 Calories for 200mls. Drop per drop that's the same amount of sugar found in Coca Cola and almost double Coke's Calories. Super Healthy!

Next up is Clubhouse Diner - pasta and cheese.


Here we've got the Heart and Stroke Foundation teaming up with Mickey Mouse and Donald Duck. The front of the box screams out, "Good Source of Calcium", but leaves out "even better source of metabolic syndrome inducing refined white flour" and, "a fantastic source of sodium", as this white flour based pasta dish provides your kids a mind-numbing 850mg of Heart and Stroke Foundation endorsed sodium per serving. That's more than three quarters of the sodium the Heart and Stroke Foundation wants your kids to eat in a day. Yay?!

Next we've got Mickey Burgers.



Mickey Mouse, Donald Duck and the Heart and Stroke Foundation team up to sell our kids "healthy" red meat. The box even tells parents,

"Good source of protein which helps build and repair body tissues. Source of calcium to help build strong bones."

Good source of Calcium? How about good source of colon cancer? Yummy.

Lastly, here are Alpha-Taters.


Yes, the Heart and Stroke Foundation and Toy Story's Woody are indeed encouraging your children to consume Tater-Tots. Yes they have fewer Calories than real tater tots, yes they contain less sodium, but does that mean that they're healthy? They're still processed potatoes with as noted before, potatoes being a food that increases the risk of diabetes development due in part to the body's almost instantaneous conversion of potato starch to sugar.

So to summarize, using the much maligned practice of using cartoon characters to market unhealthy foods to children the Heart and Stroke Foundation and Disney are marketing sugar sweetened drinks that have more Calories than sugared soda, wallops of sodium, refined white flour, burgers and tater-tots as healthy.

Kind of telling to me that this partnership was featured in Kids Screen Magazine where Kid Screen is an actual organization dedicated to teaching marketers how to target children through advertisements.

Gee thanks Heart and Stroke Foundation Health Check, you guys are a phenomenal help.

Heart and Stroke Foundation Pours on the Salt

So what's a Heart and Stroke Foundation Health Check again?

If you remember, Health Check is a program run by the Heart and Stroke Foundation who note,

"When you shop, look for the Health Check symbol. It's a simple tool to help you make food choices that are part of a healthy diet. Every food with the Health Check symbol has been evaluated by the Heart and Stroke Foundation's dietitians to make sure it is part of a healthy diet."

So what foods have Health Checks?

In the past I've posted about the Health Check on red meat, a food that study after study identifies as a major health risk - from breast cancer (in post-menopausal women, intake of just 60 grams per day increased their risk of breast cancer by 57%), to colon cancer (people who ate the most red meat were almost 40% more likely to develop colon cancer), to diabetes (for every increase in the number of daily servings of red meat there was a 26% increase in the risk of developing diabetes).

I've posted about the Health Check on chocolate muffins for children where the 8 teaspoons of sugar per muffin literally make up a third of the muffin's weight.

I've posted about the Health Check on French fries and even putting aside the horrifying contradiction of a Heart and Stroke Foundation recommending that we consume French fries, potatoes increase blood sugar and insulin levels nearly as fast as pure white table sugar which is potentially why in a 20 year study looking at 84,555 women there was an increased risk of type II diabetes in women with higher potato consumption.

I've posted about the Health Check on refined white flour, a substance that dramatically increases the risk of developing metabolic syndrome.

I've posted about the Health Checks on restaurant foods where they have endorsed foods with a full day's worth of sodium.

Lastly I've posted about the Health Check on "natural" sugar where they endorsed a juice product that effectively is a glass of water, sweetened with 10.5 teaspoons of sugar, along with a smattering of vitamins.

Today I've got one more. The Health Checked beverage that contains 600mg of sodium in just two thirds of a cup. It's called V8Go Smooth and Seasoned.

Let me ask you, putting aside for a moment the fact that it's just mind-bogglingly stupid for the Heart and Stroke Foundation to be endorsing a product where in 2/3rds of a glass you'll get over half their recommended daily sodium intake, how many folks out there are only going to pour 2/3rds of a glass? Fill your glass and now you'll get 961mg of sodium - almost a full day's worth.

Unbelievably, it gets worse. While I've always held out hope that this was all reflective of a woeful lack of oversight by the Heart and Stroke Foundation on their arm's length Health Check program, last week I realized this wasn't the case.

Last week I received the Heart and Stroke Healthy Living Calendar 2008.


On the cover it states,

"Make a date with health! Fourteen months of recipes and health tips brought to you by the Heart and Stroke Foundation"

So would you assume that all the recipes therein are healthy?

Let's look at two (click 'em for enlargements).

First, Chicken-Lemon Stir-Fry.


According to the Heart and Stroke Foundation's recipe, it's made with butter, 1% milk and is that really 3tbsp of soy sauce? Did you know that soy sauce, per tablespoon, has 335mg of sodium? Did you know that there was such a thing as light soy sauce with less sodium? Did you know that each serving of this stir-fry has 999mg of sodium?! Do you think maybe the vegetables could have been stir-fried in a non-stick wok with a few sprays of cooking oil rather than a tablespoon each of butter and oil? Can you believe that that Heart and Stroke Foundation just suggested butter was a healthy choice to cook with? Also, isn't there such a thing as skim milk?

Next let's look at the Superb Rigatoni and Cauliflower Au Gratin.


Once again the Heart and Stroke Foundation's recipe includes a tablespoon of butter, a tablespoon of vegetable oil and 3 cups of 1% milk. This Heart and Stroke Foundation endorsed recipe gives you 965mg of sodium per serving.

To put these sodium numbers back into perspective, here are the Heart and Stroke Foundation's recommended sodium targets published in the National Sodium Policy Statement they co-released last week.

Ages 4-8 - 1,200mg daily

Ages 9-50 - 1,500mg daily

Ages 50-70 - 1,300mg daily

I can't think of enough adjectives to describe just how plain wrong it is for the Heart and Stroke Foundation to be endorsing these unhealthy choices as good for you. If I were working at the Heart and Stroke Foundation, heads would roll.

But I'm not done. Stay tuned for tomorrow when we'll talk about how the Heart and Stroke Foundation pushes junk food on your children.

The Hypocrisy of the Heart and Stroke Foundation

You know, it upsets me to have to write these posts about the Heart and Stroke Foundation. They are a tremendous organization and are advocacy champions for a healthy lifestyle and tireless fund raisers in support of much needed valuable research into the treatment and prevention of cardiovascular disease.

Unfortunately, their organization and affiliated organizations, while exemplary in many aspects, also suffer from some egregious shortcomings - shortcomings that dramatically undermine their own solid recommendations to achieve and maintain a healthy body weight and reduce dietary sodium consumption.

By means of introduction, let's start with something positive - the National Sodium Policy statement that was released last week and endorsed by the Heart and Stroke Foundation of Canada.

The statement, available online here, calls for a dramatic reduction in sodium intake by the year 2020. According to the statement, here's why:

The World Health Organization estimates hypertension is the leading risk factor for death.

Hypertension is the most frequent diagnosis for Canadian adults visiting a family physician.

Antihypertensive therapy is one of the most expensive categories of medications.

In Canada almost 46% of women and 38% of men aged 60 and over are taking antihypertensive medications.

Hypertension is a multi-factorial condition associated with obesity, family history, physical inactivity, alcohol, smoking and dietary factors, including high sodium intake.

Limited attention has been focused on the importance of reducing dietary sodium as a key measure in reducing the risk for and management of hypertension.

The average Canadian diet contains about 3500 mg of sodium per day.

The Tolerable Upper Intake Level for sodium intake for health is 2300mg per day as recommended by the Institute of Medicine of the National Academies.

It is estimated that one million Canadians have hypertension caused by excess dietary sodium and that this generates more than 430 million dollars per year in direct health care costs.

Reducing dietary sodium intake within the context of a healthy diet can substantially reduce the incidence of hypertension among Canadians who have normal blood pressure. Therefore a population health approach to reducing dietary sodium is an appropriate strategy.

The report also provides sodium intake targets by age and I'm going to highlight 3 age groups:

Ages 4-8 - 1,200mg daily

Ages 9-50 - 1,500mg daily

Ages 50-70 - 1,300mg daily

So just how great would it be if we were actually able to achieve that type of sodium reduction? According to the policy statement this would:

Prevent 1 in 7 stroke deaths

Prevent 1 in 11 coronary heart disease deaths

Prevent 1 in 14 of all deaths

Prevent 1 in 6 cases of high blood pressure

Stay tuned this week as I revisit how despite their signature on the National Sodium Policy statement, the Heart and Stroke Foundation's Health Check program allows you to meet your total daily sodium requirements in one meal, how Health Check advertises and pushes junk food on your children, and how Health Check blindly avoids considering Calories or sugar ingredients worth actually checking.

Are you a Grease Blotter?

Do you use your napkin to try to blot the grease out of your food?

I've seen plenty of folks blotting away at fast food restaurants (might make an interesting study - how much can physically be blotted out), but I've never seen any of them do this....

Today for Funny Fridays (again, lots of new subscribers this week - Friday's are my day off commentary and my day on Funny.....videos often need to be viewed on site rather than through email subscription...today's is worth a visit) is the best use of McDonald's french fry grease that I've ever seen.

Have a great weekend!

New York vs. Calories Round II

Back in good old Ottawa after a great conference. Saw some fascinating talks and met many very interesting folks.

Came back and saw New York is going to take another swing at Big Food.

City health commissioner Thomas Frieden has reworked the regulation following the original's defeat in appeals court.

The regulation would only affect restaurants of 15 chains or more thus sparing smaller mom and pop establishments the cost of determining Calorie counts and making menuboard changes.

The defeated regulation had only applied to those restaurants that already had posted information online or in brochure form. The new one applies to any chain with 15 or more locations regardless of whether they've already posted Calories.

Remember, Big Food won the case not because of their fabulous arguments (like the one that says that it'd be too confusing for consumers to understand the new menus like the one above from Subway), but rather because it broke some federal statute.

I'm guessing that without an Arnold-style veto, this one's going through.

Quiznos must not be thrilled.

Lose Weight by Osmosis

Today I'm going to talk about a study that I had thought of doing and now clearly don't have to.

It's about something I've termed, "osmotic weight loss"

Simple study - 357 husbands and wives weighed themselves and completed self-reported food and lifestyle inventories at the onset of an intensive lifestyle intervention and 12 months later. They then compared these with the same data from a control group of 357 husband and wife teams at the beginning and end of a diabetic education program. The catch is, only one member of the husband and wife teams was actually enrolled in the weight loss, or diabetes education, programs.

The untreated spouses at 12 months also completed a questionnaire detailing the number of high and low fat foods in the home, the number of snack foods in visible locations and something called the Exercise Environment Questionnaire.

The results?

Untreated spouses in the diabetes program lost 0.19% of their starting body weight while the spouses from the intensive lifestyle intervention weight loss program lost 2.7% of their starting weights. The untreated weight loss spouses also reported decreased availability and access to high-fat and snack foods in their homes. Exercise wise, there was no difference.

So what does this teach us? Lifestyle interventions affect more than simply the program participant. The reason I wanted to do this study was the simple fact that I observe the same phenomenon constantly in my patients' families.

The next study I'd like to see would be a comparison of osmotic weight loss between different weight loss programs and approaches.

My hypothesis would be that less sustainable approaches (all liquid diets, heavy use of supplements, highly restrictive approaches, etc.), would not share a spousal osmotic relationship perhaps due to the non-enjoyable and non-sustainable nature of the participants' interventions.

Remember, unless you actually enjoy your lifestyle as you lose your weight, you're liable to gain it back and here clearly if you in fact do enjoy your lifestyle, others around you might well take notice and learn from your successes.

Osmosis works.

Maybe You Didn't Earn that Latte

Yesterday was another fine day at the Obesity Society conference with so many fascinating abstracts presented.

I'm going to fill you folks in on the work of a very dynamic speaker and clearly talented researcher, Dr. Tim Church.

Tim's gang wanted to explore whether or not exercise led patients to "overcompensate" with food - meaning they wanted to see whether or not we rewarded our exercise with more food than we earned.

It was truly an elegant experiment.

Firstly individuals had to sign an informed consent paper that explicitly stated that the study being conducted was not in fact a weight loss study, but rather a study on the effects of exercise on blood pressure and fitness. The authors simply didn't want people influenced by the thought that they were involved in a weight loss study.

For 6 months, 464 post-menopausal women were randomly assigned to a control group of no supervised exercise, 72 minutes, 136 minutes or 192 minutes per week of exercise. The exercise was kept at moderate intensity and it involved using a treadmill or an exercise bike and all of the exercise was supervised exercise so that they would not have to rely on unreliable self-reported amounts.

Retention for the study was great with 94%, 87% and 93% retention in the treatment arms.

Fitness showed a non-surprising and beautiful dose dependent response with more exercise leading to greater improvement.

Weight however was a different story.

The 72mins per week group lost on average 1.3kg over the 6 months.

The 136mins per week group lost on average 1.9kg over the 6 months.

And the 192mins group, did they lose 2.5kg?

Nope, they only lost 1.3kg.

It gets more interesting.

When they looked at the actual data points what they saw was that weight loss progressed well during the first 10 weeks of the 192mins per week group, but that was during their so-called, "ramping up" period whereby they couldn't have simply started these folks at 192mins per week, so they were ramping them up to 192mins. Almost as soon as they did reach their 192mins mark, weight loss slowed down to a crawl.

Now remember, I mentioned this was an elegant study. The authors, anticipating the skeptics, wanted to eliminate an obvious confounding question. Did the folks who were exercising the most simply do less the rest of the week because they were either too tired from exercise, or felt that they didn't need to worry about day-to-day activity because they were good at getting their pump on? Nope. Tim and his buddies had subjects wear pedometers daily to ensure that the exercise didn't have an effect on non-exercise activity and steps across the board were in fact the same.

So what can we conclude?

It's got to be an intake thing again. Whether the increased exercise led to an actual increase in hunger or whether it simply made folks falsely confident of what they were allowed to eat (the calories they earned through exercise) isn't clear, but what is clear - more exercise led to disproportionate increases in intake.

Maybe you didn't earn that extra Latte.

Don't Blame the Escalator

Today kicks off a week from NAASO (The Obesity Society) as I'm writing from New Orleans where they're having their annual scientific assembly. Every year I come to this conference I'm amazed at the incredible amounts of brains and passion that are being poured into obesity research worldwide. The conference is enormous and boasts over 2,000 attendees from the four corners of the world.

This week I'm going to try to highlight some of what I feel are among the conferences most interesting presentations and studies.

The first takes us to Nigeria - rural Nigeria in fact, where Lara Dugas and her colleagues went to study the effects of the energy expended in daily activity on weight gain. They followed 153 rural Nigerian women (over 20% of them subsistence farmers) and measured their total daily energy expenditures (the total calories they burned all day long), their resting daily energy expenditures (the calories they burn at rest) and then inferred the calories they burned through daily activity.

They then compared the data from rural Nigeria with the same data taken from a group of women from urban Chicago (where over 50% of them were unemployed).

They then followed these women for 3 years.

Some of the results were not surprising.

The Nigerians were much lighter - average weight was 128lbs and BMI of 23.1 vs. those from urban Chicago where average weight was 184lbs and BMI of 31.

Here's the surprising result.

Calories burned through daily activity did not differ between the skinny rural Nigerian subsistence farmers and the obese unemployed urban Chicagoans.

Come again? The subsistence farmers and the unemployed urbanites burned the same number of daily Calories in activity? Haven't we been blaming obesity at least partially on the poison fruits of development? Aren't dish washers, escalators, cars, and elevators stealing our Calories away from us? Shouldn't the skinny Nigerian farmers be burning far more Calories? Isn't that part of why they're so skinny?

I sure would have thought so - and from the reactions in the room, so did most other folks.

Second non-surprising result?

No measure of energy expenditure, not resting, total or that from activity, was associated with weight change in either group over the 3 years and in fact, the rate of change in body weight over the 3 years was virtually identical in Nigeria and Chicago.

Why isn't that surprising? What that result says is that the Calories you burn don't dictate your weight and that instead what dictates your weight are the Calories you consume. The only surprise here is the fact that rate of weight gain is the same in rural Nigeria vs. urban Chicago where one might have thought greater access to high Calorie foods would have led to a dramatically more rapid gain in Chicago (though I should note, the Chicagoans had higher total energy expenditures as a consequence of their higher weights and consequently for them to gain weight at the same rate as the Nigerians does in fact necessitate eating more, just not tons more).

So if you take these results as valid (and it really was a very well designed study), they basically conclude that the environment as it pertains to activity, doesn't matter, that you can't blame the escalators, and shocker of all shockers (there's the sarcasm), energy intake matters far more than energy output in the establishment of obesity.

Colbert 2008

In case you missed the announcement, Stephen Colbert is running in the South Carolina presidential primary.

Today for Funny Friday is his announcement (for those new subscribers, Funny Fridays are my day off frustration).

Have a great weekend!

(Email subscribers may need to visit the blog to see the clip)

Duh!

Yesterday saw the most expensive, "Duh!" moment I've seen in a long time.

Yesterday the UK Government's think tank Foresight published a study that involved over 250 experts that concluded,

"The technological revolution of the 20th century has led to weight gain becoming inevitable for most people, because our bodies and biological make-up are out of step with our surroundings"

Gee, ya think?

You mean people aren't trying to become overweight? It's not just one gigantic social experiment gone awry whereby the entire world, every person in every single country on the planet, has colluded to flummox scientists by willfully trying to gain weight for the past 50 years?

Wanna read the bullet points that summarized the whole of their 2 year long, 250 expert advised, so damn big it crashed my browser trying to download it, work?

Most adults in the UK are already overweight. Modern living ensures every generation is heavier than the last – `Passive Obesity’.

By 2050 60% of men and 40% of women could be clinically obese. Without action, obesity-related diseases will cost an extra £45.5 billion per year.

The obesity epidemic cannot be prevented by individual action alone and demands a societal approach.

Tackling obesity requires far greater change than anything tried so far, and at multiple levels: personal, family, community and national.

Preventing obesity is a societal challenge, similar to climate change. It requires partnership between government, science, business and civil society.

Brilliant! Earth shattering! Ground breaking!

Anyone want to venture a guess how much this report must have cost?

If there are other governments out there thinking about putting together experts and spending gajillions of dollars researching this - I'll do it for half price and it'll be on your desk in the morning.

Calorie Awareness has been Terminated

Boy, I sure wouldn't want to face Big Food in a fight.

So far they've trounced the Province of Ontario (Bill C-283 to put Calories on menus voted down in the house), the State of New York (a judge ruled a State law requiring Calorie information on menus broke Federal laws) and now they reveal that they control the Terminator as yesterday Governor Schwarzenegger vetoed bill SB120 - a bill that would have required posting of Calories on menus in chain restaurants across the State of California.

The quote from Dr. Harold Goldstein, executive director of the California Center for Public Health Advocacy sums it up pretty well,

"By vetoing Senate Bill 120, the governor not only denies Californians of the basic information they need to make healthy decisions when dining out but he completely contradicts his commitment to the health of Californians"

Think it's not important, think having Calories on menus is an overblown issue? Please let me know who you are so I can sell you some stuff without telling you the price - my daughters' college funds need some topping up.

And now I must placate our new ruling overlords.

Big Food, I'm sorry I give you such a hard time on this blog. I love Calories. Everyone should eat tons of them and no one deserves to know how many they're having. Restaurants are part of the solution, not the problem. Your voluntary online programs are more than sufficient and anyone too lazy to remember to visit your websites before they go out, anyone too disorganized to decide where they're eating at the start of every day, doesn't deserve your incredible online caloric help. Oh, and of course it makes complete and total sense that putting the exact same information that's found on your voluntary online websites into your menus and on your menuboards would be impossible because of supply chain variability - the fact that the calories and information on your website doesn't change does not for one moment take any steam out of that argument.

Please don't terminate me....I have two beautiful little girls....I love you!

A Terrible Way to Start your Day

Meet Hardee's new Country Breakfast Burrito.

Here's Brad Haley, one of the marketing geniuses over at Hardee's (not being mean here, actually think they've done a phenomenal job marketing unhealthy, ridiculously high calorie foods) discussing their new breakfast offering,

"It's an entire country breakfast in the palm of your hand. It represents the first time that hungry breakfast customers can get eggs, bacon, ham, hash browns and sausage gravy in a portable form that can easily be eaten on the go. True breakfast fans are really going to enjoy the Country Breakfast Burrito once they get their hands on it."

MMMMmmmm

Wanna know what else your $2.69 buys you?

920 Calories, 60grams of fat and 1,970mg of sodium.

Today I'm adding a new feature to my Frankenfood segments - cost per Calorie.

0.29 cents a Calorie - so a penny buys you 3.45 calories.

And people still hem and haw about how obesity is super complex and we can't figure out how we got to this point?

How's this for a theory? How about because Calories are insanely cheap and every single one of us is genetically hardwired, after hundreds of millions of years of evolution, to really like them?

So remember, Country Breakfast Burrito - enough Calories to feed a country.

[Hat Tip: Angela over from CTV's Healthblog, a place where sometimes my posts visit]

Set your Treadmill Free

For those of us living in the Northern parts of the world, life is starting to get colder and for many of us, that means that the inspiration to exercise is starting to become more difficult as getting yourself out the door for a walk or run in the cold is definitely more challenging.

You see the thing is that people when it comes right down to it, are consumers of time. If we're lucky we might each find, interspersed throughout our days, a few precious blocks of time where we're not working, where we're not at our children's beck and call, where we're not eating, not on the telephone and not sleeping.

Those of us trying to include exercise in our lives then hope that somehow, during those fleeting free moments we can inspire our selves to use them to do intentional exercise.

Recognizing that these free moments vary in time and duration many of us have decided you know what, we might not have the time (or desire) to pack it up during those moments and head out to a gym, so instead we went and brought the gym home by going out and buying treadmills and exercise equipment.

And what did we do with our great intentions and our new equipment? We banished them to our basements - out of sight, in a part of our homes that often is less welcoming, beside the kitty litter and the boxes, atop the cold unfinished concrete floor.

We might have used them for a few weeks after that. You see the money spent on them was fresh in our minds and consequently it raised the value of time spent with the equipment - by using it we didn't feel like we had wasted our money. But as our memory of money spent dwindles, too often so too does our use of the equipment.

If you want to actually use your home exercise equipment, you need to find new ways to increase the value of the time you spend with it and one of the easiest ways is to put it back in your line of sight. Seeing it may remind you you've got it and potentially even of the money and good intentions that brought it into your home. Put it somewhere where you can see it, and ideally somewhere you think might be enjoyable to use it - staring out a window, at a television, whatever.

If you choose to put it in front of a television, consider "conscripting" your favourite shows whereby you create a rule that only allows you to watch them while on the treadmill (never mind the speed, just get on it). Alternatively you could set up a reward system whereby if you log enough time, you get a specific reward.

Bottom line, unless you create an environment that includes some measure of enjoyment in your exercise, an environment that increases rather than decreases the value of the time you spend doing it, well guess what, you're probably not going to be doing much of it for long.

Set your treadmills free!

Tortured Words by John Oliver

If you want to see why the Daily Show's still worth watching, watch today's Funny Friday clip all the way through.

Would love to see a similar clip with the words, "Healthy", "Whole wheat", "fat-free" and "low-carb".

Have a great weekend!

Don't Buy Girl Guides of Canada Cookies

A patient of mine just brought in a box of Girl Guide of Canada cookies that her daughter is selling.

I'm frankly gob-smacked that according to the nutrition facts label there are still 1.5grams of trans-fats in 3 of these teeny weeny cookies.

Girl Guides of Canada are quite aware of this. In fact in their cookie FAQ on their website they state,

"Girl Guides of Canada is aware of health issues surrounding particular processed foods, including cookies, and is committed to maintaining the quality of Girl Guide cookies while keeping these concerns in mind.

Currently, saturated fats are the only viable alternative to trans fats in biscuit-type foods and any reformulation in the trans fat levels of Girl Guide cookies will result in a different taste and texture. GGC is currently investigating reformulation options. All options will be examined to ensure that Girl Guide cookies maintain the taste, texture and freshness consumers expect and enjoy, as well as a nutrition profile that adheres to new regulations."

Did they really just try to sell me on a rationale that states there's simply no way to remove trans-fat from cookies without ruining their taste and texture?

I guess there are no cookies at all in Denmark (where the country is wholly trans-fat free), or at least no cookies that taste good or have good texture.

Makes me wonder too how Voortman's managed to remove trans fat from every single cookie product they make.

Now I'm not knocking cookies. Cookies are one of life's pleasures. I'm not knocking Girl Guides, they do great work. What I'm knocking is Girl Guides clearly irresponsible laziness in not insisting that trans-fats be immediately removed from their cookies.

If this ticks you off at all, feel free to write Girl Guides of Canada, but since we know from their FAQ that they already know about your concerns, I'd suggest that until they're addressed, you simply stop buying Girl Guide Cookies.

Contact information for Girl Guides of Canada:

To send Girl Guides of Canada an email, click here

or you can mail or call them at:

Girl Guides of Canada National Office
50 Merton Street
Toronto, ON M4S 1A3
Phone: 416-487-5281
Fax: 416-487-5570

1-800-507-7564