Saturday Stories: Fitness and Health Aren't Enough, 3 Cheers For Our Immune Systems, And Omicron

By Soupvector - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=112983798

Sirin Kale, in The Guardian, with the life and death story of 42 year old triathlete, body builder, and anti-vaxxer John Eyers

Katherine J. Wu, in The Atlantic, on why you should be showing your immune system some love

Ewen Callaway & Heidi Ledford, in Nature, with a piece that may in fact be out of date despite being published 2 days ago, on what we do and don't know about Omicron.

In Yet Another Win, Bariatric Surgery Reduces Cancer Risk In Long Term Study

Before you read any further know that I'm NOT a surgeon.

I think it could be fairly argued that as far as surgical impact and benefits go, there are few that rival bariatric surgery.

Shown to prolong life, regularly push many chronic diseases including type 2 diabetes, hypertension, sleep apnea (and so many more) into remission, and dramatically improve subjective quality of life, for so many, bariatric surgery provides a new lease on life.

Well add to the aforementioned list a reduced risk of cancer. While not particularly surprising of course given the relationship between weight and some of our most common cancers, here's new data from the now over 2 decades old SOS study which demonstrates reduced cancer risk in patients who opted for surgery vs. weight matched medically managed controls. 

For those of us who have the good fortune of working with patients who've had bariatric surgery, we know just how life changing it can be. What's shocking though, is the comfort of those who don't work with this category of patients to look down on surgery, or fearmonger about it, and this sadly also includes people in the health care community..

The data is clear. Bariatric surgery is remarkable. That said, I'm hopeful that in 20-30 years, it'll no longer be necessary and will be replaced by medications that lead to surgical degrees of weight loss without the surgery. Until then however, I'm thankful the option of bariatric surgery exists, and if you're not, you're either ignorant or an ideologue.

Saturday Stories: Testing, Health Professional Long-haulers, And The Holocaust

Katherine J. Wu, in The Atlantic, with everything you really should know about the various modalities of COVID testing.

Ed Yong, also in The Atlantic, on health professionals who themselves are now facing the challenges of long-haul COVID.

Talia Bracha Lavin, on her substack, discusses the moral bankruptcy and abject idiocy of those utilizing Holocaust analogies for anything COVID related.  

[And finally, I'm so close! 90% of the way to my #Movember $3,000 fundraising goal. I'm also pleased to report that my Ted Lasso is doing just fine. If you're able to give, you can give anonymously, every bit counts, and that while I'll make this ask of those of you who are able annually, I promise I'll never charge a penny for anyone to ever read this content. Click here to donate!]

Every Diet Works For Someone, No Diet Works For Everyone, Diets Are Difficult - IF 2021 Edition

Joining an ever increasing cavalcade of studies of different diets that demonstrate they all work as well or as poorly as one another comes this week's A randomised controlled trial of the 5:2 diet published in PLoS. 

In it researchers randomly assigned 300 participants to receive either:

1) "Standard" brief contact in the form of a 20 minute chat, and the provision of a booklet discussing UK's national dietary guidelines and a leaflet of various local weight management resources, 

2) 20 minutes of Q&A on IF dieting and provision of a leaflet describing 5:2 style intermittent fasting (IF - where two non-consecutive days of the week people are instructed to eat 500-600 calories total), or 

3) That same IF leaflet and chat as above plus 6 weekly one hour group support sessions spread over the first 6 weeks of dieting.

What'd they find?

1) There was no difference in weight loss between groups at 6 months or 1 year post randomization (average loss of just under 4lbs but with some individuals up to 20lbs)

2) Roughly 50% of the participants of each group dropped out within the year

So I guess the same old unsexy conclusion as always. 

Every diet works for someone. No diet works for everyone. Why? Because diets are difficult to sustain unless you happen to enjoy the one you're on.

And to that end, stay far away from healthcare providers claiming there's one best way to lose. Your best diet is someone else's worst.

[Also, if you're able, please consider donating to my #Movember fundraising efforts. It's my one and only annual ask and I'm 80% of the way to my $3,000 goal. No amount is too small, you can give anonymously, and tax receipts are provided. Simply click here to donate, and if you're wondering how it's going, will post an updated picture this Saturday]

Saturday Stories: The Health-Care Workers, The Fight To Call It Aerosol, And Narratives, Counter-Narratives, And Social Drama

Ed Yong, in The Atlantic, covers the devastating impact managing patients with COVID has had on the world's health-care workers many of who are calling it quits.

Megan Molteni, in Wired, on the teensy tiny error that helped COVID kill by creating a fight over how it's spread. 

Trisha Greenhalgh, M Ozbilgin, and D Tomlinson, in Authorea, on the narratives, counter-narratives and social dramas that underwrote our discussion on how COVID spreads.

Also, if you're able, please consider donating to my #Movember fundraising efforts. It's my one and only annual ask and I'm 2/3rds of the way to my goal, no amount is too small, and tax receipts are provided. Click here to donate and if you're wondering how it's going, here's my Ted Lasso to date.

The World Health Organization, For #WorldDiabetesDay, Chose Fat Shaming And Stigmatization

Where to start with this?

First off there are more than 2 types of diabetes (I mean even the tweet lists 3), but really, recognizing World Diabetes Day with an infographic of a person with obesity in bare feet on a Lazy-Boy eating a giant bag of chips? 

That's certainly the gluttonous sloth narrative that much of society subscribes to, but the WHO? 

And yes, weight, diet, and physical activity correlate with diabetes risk, but for the WHO to dumb things down to people with type 2 diabetes are fat, lazy, gluttons? The mind boggles.

Never mind genetics, social determinants of health (including poverty, education, caregiving requirements, etc), co-morbid medical conditions, and more, the actual World Health Organization on World Diabetes Day, is stating if you have type 2 diabetes, it's your fault.

This of course also ignores the fact that there is just a staggering amount of privilege required to intentionally and permanently prioritize behaviour change around food and fitness in the name of health, and of course denies the reality of the thousands of genes and hormones known to be involved in the regulation of weight and dietary choices.

Perhaps this will serve as an opportunity for the WHO to take a closer look at weight and diabetes bias and stigma and focus some resources to help educate the world on the dangers and risks therein. For over 24 hours, they'd simply added a tweet to their offensive, misguided, and erroneous thread stating they'll take into account the feedback they've received in future messaging, then yesterday afternoon, they finally took it down. Here's hoping we see a thread about implicit and explicit bias from the WHO down the road

[Also, it's that time of year again, and should any of you want to donate to my Movember fundraising (am just over halfway to goal!), here's the link]

Saturday Stories: Aaron Rodgers, Vaccine Passports, And Doctors' Vaccinations

Kareem Abdul-Jabbar, in his substack, on the damage Aaron Rodgers has wrought on professional sports as a whole. 

Arthur Shaffer, interviewed in Healthy Debates, on the ethics and legalities of vaccine passports. 

Andrew McRae and Andreas Laupacis, in CMAJ, make the case for vaccination as a mandatory requirement for the in person practice of medicine. 

[It's that time of year again, and should any of you like to donate to my Movember fundraising, here's the link]

2021's Dumbest Scientifically Published Exercise Recommendation For The Treatment Of Obesity

[First written blog post since March 2020. What an awful 20 months. Though the pandemic is certainly not over yet, it feels like it's time to start writing again. Not sure what the frequency of posts will be, but it's nice to be back]

I wouldn't have believed it was real if I hadn't seen this phenomenon so many times before - a research study trying to tie their findings to the treatment of obesity despite the findings being either incapable of leading to clinically meaningful weight loss, or ridiculous to suggest in the first place. Here we've got both.

Published in Cell Reports Medicine, the paper Altered brown fat thermoregulation and enhanced cold-induced thermogenesis in young, healthy, winter-swimming men looked at the brown fat stores of Scandinavian men who alternate brief outdoor winter swims with a dash to the sauna 2-3x weekly. 

What'd they find?

The non-randomly selected winter swimmers, all 8 of them, whose average BMIs were 23.7 and whose average age was 25, were found, when exposed to cold, to generate more heat from their brown adipose tissue than their 8 age and weight matched controls. 

How many calories did that brown adipose tissue heat generation burn? If we take their results at face value (their results are orders of magnitude higher than found in a prior study of albeit older subjects), they report that during a "cooling period" of 30 minutes (there was no difference during a "comfort state"), resting energy expenditure was higher in the winter swimmers by an extrapolated 484kcal/24hours. They also reported that winter swimmers spent on average 11 weekly minutes in cold water. So during those 11 minutes the winter swimmers might well be burning 3.7 more calories than their non-winter swimming counterparts - the equivalent number you'd consume eating 1/10th of a carrot. 

The paper is full of various hypotheses to try to tease out the findings from this very small study. 

But what struck me was their final conclusion, 

"Finally, our findings motivate investigations of winter swimming as a lifestyle intervention for increased energy expenditure in obese subjects as a potential weight loss strategy."

Really? Your n=8, non-randomized, observational study of young men without obesity, that didn't control for any weight related variables, which showed that during their 11 minutes of winter-swimming the swimmers might burn 3.7 more calories per week for 4 months than non swimmers motivates investigations of winter swimming as a potential weight loss strategy in people with obesity?

Photo By Jaan Künnap - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=87539864

Saturday Stories: Hygiene Theatre, The Lost Plot, Caving To Antivaxxers, And a Brief Announcement From Me

Justin Ling, in Macleans, on the persistence of hygiene theatre

Sarah Zhang, in The Atlantic, on how we've lost the plot on COVID.

Andre Picard, in The Globe and Mail, on how now is the worst time for governments to be catering to antivaxxers

Announcement wise - well I think it's time for me to start blogging again. Though COVID is definitely not gone, with vaccinations coming for our children, I feel more comfortable amplifying topics not-COVID related. Look for first post back this week highlighting the stupidest appeal to obesity in a journal article that I've ever seen. Also, it's that time of year again, and should any of you want to donate to my Movember fundraising, here's the link

Saturday Stories: Bad Studies, 5-12s' Vaccinations, And Childism

James Heathers, in The Atlantic, on how the house of cards upon which ivermectin studies were built likely underpins much of science. 

Katherine Wu, in The Atlantic, with a Q&A with pediatrician and vaccine researcher Sallie Permar about the vaccination of children. 

Nisreen A. Alwan, in the BMJ, on how childism during the pandemic has seen governments failing to protect children