Monday, February 28, 2011

$29.99 Cheese Whiz?

There's a great deal of debate swirling around regarding various forms of junk food taxation, and while it will likely be quite a while before we see our sodas rise in price, northern Canada's in the midst of its own healthier eating through "taxation" experiment.

Ok, it's not exactly taxation, instead it's the removal of pre-existing shipping subsidies on some less healthy foods. Of course with the subsidies removed, retailers are passing on costs to consumers leading to $30 Cheese Whiz and $28 hydrogenated margarine among others.

You see here in Canada we subsidize shipping of food to our northern communities but perhaps in an effort to save money, perhaps in an effort to improve dietary choices, or perhaps in an effort to do both, the government has rolled out a new "Food Mail" program that removes subsidies from less healthy and unhealthy products.

Health Canada will also be getting involved by providing nutrition classes to the communities serviced by the Nutrition North Canada program.

So while you'll still be able to buy actual cheese on a subsidized dime, Cheese Whiz I guess will have to be relegated to Christmas.

Will be interesting to track consumption and disease patterns over the coming years.

[Hat tip to journalist Jessica Murphy who alerted me to the program and who wrote about it herself a little while back]

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Saturday, February 26, 2011

Saturday Stories

New York Time's Mark Bittman on the ridiculousness that is McDonald's oatmeal.

Consumers Reports covers serving sizes.

The McKinsley Quarterly has a great report on the economics of obesity and why governments should get heavily involved (requires free registration).

Melanie Warner says nice things about Big Food (and I don't disagree).

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Friday, February 25, 2011

Toddlers make sloppy drunks

That felt like an exceptionally long week.

Before you kick back with a few, remember, drink responsibly.

Today's Funny Friday is an example of what might happen if you don't.

Have a great weekend!

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Thursday, February 24, 2011

Dr. Oz - so corrupted by fame he even sells himself out?

The other day I received a note from the Dr. Oz PR team informing me of his upcoming show (aired two days ago) on the HCG diet.

For those of you who don't know, the HCG diet is one of those ridiculous injection diets. The kind where you see a physician who prescribes an insanely low number of daily calories (500) along with injections. Here in Canada those injections are usually B-vitamins , while in the States they're often Human Chorionic Gonadotropin (HCG injections for weight loss aren't kosher here in Canada).

The scientific literature on HCG as a weight loss aid is extremely clear. Randomized, double-blinded, placebo controlled trials have demonstrated that HCG shots don't work any better than shots of salt water at appetite suppression or weight loss.

In fact as Travis once pointed out on Obesity Panacea, the disclaimers on HCG providers' own websites speak for themselves as to HCG's utility,
"HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets"
The show was predictable. Dr. Oz spent the bulk of the show obtaining testimonials from HCG providers and dieters, mentioned how his wife has done the HCG diet, spent a scant amount of time with HCG detractors, mentioned that the complete and utter lack of medical evidence to support its use was counter-balanced by the 4 people he had in his audience who had succeeded in losing weight, called for further study, suggested it was worth a try, and wondered if future research into it may in fact lead to a cure for obesity.

And while that's shocking to anyone who cares about evidence based medicine, it's not so shocking for Dr. Oz as he's long since sold himself out to non-scientific, non-evidence based woo, even promoting a faith healer on his show.

What is perhaps news is a link sent to me by Weight Maven's Beth Mazur. It's a link to one of Dr. Oz' own webpages entitled, "The Shortcuts Dr. Oz Would Never Take" and it was posted just 3 short months ago.

The first shortcut "Dr. Oz would never take"?

The HCG Diet.

Here's what he said about it just 3 months ago,
"Initially, this diet may help you rapidly drop pounds. Ultimately, it destroys your metabolism, as you are essentially starving yourself. Another negative side effect is the loss of muscle mass, so much that you will no longer be able to effectively burn calories."
And now?
"If you find someone like Dr. Emma (the HCG provider he had on his show), I think it's worth trying"
And how much will it cost his viewers who take his advice to try the diet scientifically proven to be useless and the one he himself rightly reports is likely to dramatically impact on muscle mass, so much so that weight regain will be far more likely? Dr. Emma charges her patients $800 for 6 weeks of this sham treatment.

So thanks Dr. Oz for promoting the exploitation of your viewers, for embarrassing our shared profession, and for being such a stellar role model for how not to embrace fame and fortune.

Wednesday, February 23, 2011

Forget sidewalks, your built environment needs expensive gyms!

So do better built environments impact on obesity rates? Do sidewalks, recreation centres and greenspace really make a difference? And how do they make a difference? Do they decrease screen time or increase moderate to vigorous physical activity rates in residents?

Those were the questions that Janne Boone-Heinonen and Penny Gordon-Larsen set out to answer (presented at last year's Obesity Society Scientific Assembly). To do so they looked at data from the National Longitudinal Study of Adolescent Health along with a spatially and temporally linked geographic information system. Ultimately they explored the relationship between built environment during adolescence and subsequent obesity in young adulthood in 10,865 individuals and then also explored the impacts that the amounts and types of moderate to vigorous physical activity along with screen time had on those same subjects.

The results?

For women, built environments with more for pay physical activity facilities associated with lower rates of obesity, while less greenspaces associated with higher rates. For men, obesity rates were marginally lower with more for pay fitness facilities, but weren’t impacted by greenspace. Important to note here that walkability didn’t show any significant association either way.

So how about activity levels and screen time?

Again speaking to the importance of intake over output associations were unchanged after amounts and types of moderate to vigorous activity were accounted for. Screen time also didn’t matter one whit.

Of course what the study didn’t set out to explore was fitness levels and fat distribution, both factors which will impact on health, but certainly it would seem that this study too supports the notion that as far as absolute weight goes, it’s about what you put in your body, not about how you move it, and that building more parks and sidewalks, while potentially beneficial to health, aren’t likely to impact on weight.

The association with for pay facilities is interesting, especially given the fact that the amount of activity subjects were doing didn’t associate with their weights. Makes me wonder if the number of for pay facilities is just a surrogate marker for wealthier or more health conscious neighbourhoods, and that at least in the transition from adolescence to young adulthood, wealth and family health consciousness may be weight protective as some function of different dietary intake, peer pressure, or parental involvement.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Tuesday, February 22, 2011

The Biggest Loser destroys participants' metabolisms.

Talk about setting people up for long term struggle.

The term metabolic adaptation is given to the phenomenon whereby when a person loses a certain percentage of weight, their metabolisms slow by greater amounts. This process may be accelerated with more rapid weight loss as a consequence of the rapidly losing body metabolizing calorie burning muscle along with fat to make up for its massive energy deficit.

And as far as rapid non-surgical weight loss goes, there's probably no weight loss program more rapid that of the television show the Biggest Loser where it’s not uncommon for contestants to lose upwards of 150lbs at an averaged pace of nearly 10lbs a week.

Of course what’s different about the Biggest Loser as compared with most other non-televised rapid weight loss programs is the incredibly large amount of exercise concurrently involved.

While I would have hoped that this tremendous amount of exercise would have been protective against a major drop in metabolism, recently reported data states that it doesn’t.

In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories

That's basically a meal's worth of calories a day that Biggest Loser contestants no longer burn as a consequence of their involvement. Effectively that means they're eating an extra meal a day.

How do you think you'd do at maintaining your weight if you ate an extra meal a day?

The authors also reported that the folks with the largest metabolic adaptations (meaning folks whose metabolisms slowed the most) were the folks with the greatest weight losses. The authors then concluded that, “intensive lifestyle interventions” can overcome this phenomenon based on the fact that folks had lost their weight by the end of the show, not based on what happened to them after the cameras stopped rolling.

Sadly I think their conclusion speaks volumes as to the utility of the intervention as well as their own confirmation biases of wanting to believe the show to be good for their contestants. What it suggests to me is that the folks who were the most severe with their diet and exercise efforts lost the most weight but did so at the expense of much greater hits to their metabolisms. Consequently those same folks who lost the most and the fastest, if they want to keep their weight off, are going to have to work at it that much harder.

While some contestants of the Biggest Loser translate their new lifestyles into careers as product spokespeople or fitness trainers and hence have new external motivators to maintain their extreme behaviours, those who don’t I worry are doomed to regain their weight as, “intensive lifestyle interventions” are not the realm of the real world, they’re only the realm of “reality” television and those whose livelihoods and/or fame depend on them.

Case in point? That picture up above, that's Eric Chopin. He was the winner of the third season of the Biggest Loser. He lost just over 200lbs. He was on Oprah to talk about his massive regain. Think Eric dropped the ball? Not me. I think the Biggest Loser provided him with a nonsensical approach to weight management, and in the process, stacked his deck entirely against him.

(Originally this blog identified the person in the photo as Ryan Benson, the season 2 winner who also regained his weight)

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Monday, February 21, 2011

Diet Book Review: The Flex Diet (I like it)

It’s called the Flex Diet and it’s written by Dr. James Beckerman – a socially networked cardiologist working out of Portland, Oregon.

The book’s premise is simple and it's not actually a "diet". Rather than provide a set of Draconian rules that everyone has to follow, Jamie offers 200 different "solutions" to help you lose weight. The idea being you get to pick and choose which solutions sound doable to you.

The solutions are straight forward, well-laid out, and in the majority of cases easy to implement, and evidence based, while others (like using microwave meals in a pinch), also reflect reality and common sense.

Now I can’t say that I agree with every last one of Jamie's solutions, and personally I believe in a greater emphasis on caloric awareness and a lesser emphasis on pounds lost per week than Jamie seems to, but I suspect that were you to adopt even 10% of the book’s recommended solutions, you’ll likely lose some weight.

Four large enough quibbles I have to add for my readers.

1. If you choose the eat almonds solution do yourself a favour. Do figure out the calories involved. Indiscriminate handfuls of almonds, while certainly handfuls of a healthy food, are going to rack up the calories pretty darn quickly.

2 Artificial sweeteners. The data on the use of artificial sweeteners as part actual weight management efforts (both loss and maintenance) specifically demonstrate that they are in fact helpful, and while Jamie discourages their use, I don’t. Ultimately if I had to rank sweeteners in order of danger to health, sugar in its many forms would top the list. The studies that do show associations between sweeteners and obesity tend to be studies that look at all comers, small studies or are poorly designed studies. Those designs are problematic in that there’s a very real likelihood that folks drinking large amounts of diet soda have different dietary patterns and habits than folks who don’t and may feel their diet sodas provide them an allowance to choose unhealthy options by means of the health halo effect. This would hold true as well for the recent hullabaloo over the as-yet-unpublished study that linked diet sodas and strokes where the mass media seems to have completely forgotten that correlation doesn’t prove causality.

Of course if you can happily switch to no sweeteners – artificial or otherwise, that’d be ideal.

3. Fasts. I think they’re an awful plan and as someone who has tracked their calorie intake breaking the fast on Yom Kippur I’ll tell you it’s far easier to exceed your total daily burn consuming a single daily meal than by spreading things out well during the day and approaching each and every meal hunger free.

4. Hypnosis and Acupuncture. The data on both acupuncture and hypnosis on weight can be described as preliminary at best, and useless at worst. If weight management were about acupuncture or hypnosis there’d be a lot more acupuncturists and hypnotists and a great many more skinny people. If you want to spend money on something weight management wise how about spending it on my addition to the book - solution 201? Invest in high quality whole foods like a weekly CSA basket of vegetables.

4 quibbles out of 200 sure ain’t bad.

As with any weight management effort, success will only find those who sustain their lifestyle changes. When you're trolling through the solutions, make sure only to take on those that suggest to you that you'll be able to happily employ them forever.

Pick up the book. Chances are there’ll be something in it that speaks to you.

(Oh, and in case you’re wondering when I’m going to write a book – it’s 90% done and by no means is it a typical “diet” book either. Any publishers or agents reading my blog? Feel free to drop me an email. Almost ready to roll.)

For Canadians:

For Americans:

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Saturday, February 19, 2011

Saturday Stories

Penny from the great new blog Feedback Solutions for Obesity, tackles two interesting iPhone apps for tracking calories, and then covers a brilliant example of "Health Halos".

Colby Vorland sadly and rationally explains why chocolate isn't in fact a "super fruit".

Scott Gavura asks if you're really allergic to penicillin?

I'm mentioned in a new Canadian health blog being run by the folks over at the Li Ka Shing Knowledge Institute of St. Michael's hospital. The blog's called Healthy Debate and the article I'm in has to do with soda taxes.

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Friday, February 18, 2011

Andy Bellatti's wonderful Xtranormal healthy eating routine.

Andy's a Masters student on the road to becoming a registered dietitian (or maybe he's already there and hasn't updated his about me page) and he blogs regularly at Small Bites. Frankly if his premiere video is an indicator for the future, perhaps he should consider web comedy as an alternate source of income.

I do love when Funny Friday and nutrition collide.

Have a great weekend!

If you love this blog, please consider voting for Weighty Matters in Reader's Digests' Best Health Magazine's 2011 blog awards by clicking here. Voting's open through March 16th and you're welcome, if you're so inclined, to vote daily.

Thursday, February 17, 2011

Playing video games makes you eat more?

So if weight gain in kids isn’t associated with low levels of physical activity, why is it that increased screen time is associated with increased weight?

A very cool small study out of Denmark and Quebec aimed to start answering that question and preliminary results were presented at last years Obesity Society Scientific Assembly.

Researchers took 22 healthy, normal weight teen males and they had them complete two separate experimental conditions. In the first they played a seated hour of video games and then ate lunch. In the second they simply sat for an hour before eating. With each experimental condition, the guys were allowed to eat as much lunch as they wanted.

When they played the video games they did indeed burn more calories than they did at rest (about 20 calories more) but interestingly they ate on average 80 more calories at lunch. Subjects denied increased feelings of hunger and they didn’t compensate for the increase in lunch calories by eating fewer later in the day.

So why does video game playing cause increased calorie consumption? Who knows? The researchers in this study speculated that perhaps it has something to do with either an impairment in satiety signaling post play or by means of impacting on their “mental-stress induced reward system”.

Whatever the cause of the increased intake, it’s yet another blow to the conventional dogma of a direct output related causal link between inactivity and childhood obesity. That’s not to say that decreasing screen time won’t help, just that it may help by decreasing intake rather than by increasing output and that fact in turn should be strongly considered when designed public policy or future research dealing with the problem of screen time and childhood obesity prevention and treatment.

Makes me wonder whether or not simple public health messaging and campaigns discouraging snacking while playing, and don’t game within an hour of meal time would have more of an impact (and be more readily adopted) than trying to discourage screen time altogether?

I'm up for a new blogging award

Blogging's actually a tough job and given that I've explicitly avoided monetizing my blog, my rewards are engaged readers. Oh, and little badge thingies on my side bar.

If you're a fan of this blog and you want to help me get a new little badge-y thing, consider taking a moment and heading over to Reader's Digests' Best Health Magazine where Weighty Matters is up for one of their 2011 Best Health Blog Awards in the category of "Get Healthy".

And it wouldn't just be the badge - Weighty Matters would also be featured in Best Health Magazine's summer issue and in turn that'd help increase exposure.

To vote, simply click on the photo up above or click here and it'll take you to their voting page. You can vote each and every day up until voting closes on March 21st.

While you're there, have a poke around some of the other blogs - I found a few on there I hadn't seen before.


Wednesday, February 16, 2011

Think the gym's gonna make you slim? Think again.

Not sure why we're still funding exercise for weight loss studies as two recent comprehensive reviews of the medical literature have concluded that weight loss by means of exclusively exercise interventions run in the order of a 1-3% loss in response to >180 mins/wk of exercise and no loss at all if less than 150 mins/wk, but yet here's another one to discuss.

What's a bit different about this study is that it was long - 18 months and hence perhaps will yield a different outcome.

So what'd the study involve?

Dr. John Jakicic and colleagues recruited and followed 248 initially sedentary, overweight adults between 2003 and 2006 to examine the impact of exercise on their weights. Recruits' ages ranged between 18-55 and their BMIs between 25-29.9. To help ensure completion of this long study, subjects were paid $50 at each of their biannual assessments, but remuneration wasn't dependent on exercise, just following up.

The study set out to examine the effect of 3 different prescribed doses of moderate to vigorous exercise on body weight - self-help with no prescribed duration, 150 mins a week, or 300 minutes a week. Secondary outcomes included body composition, fitness and minutes of activity.

Methodology wise, let me tell you, for folks in the 150 and 300 minutes/week groups, this was the Cadillac of exercise interventions.

Those prescribed 150 minutes per week participated in a behavioural intervention to promote progression to and maintenance of those 150min/week of structured physical activity. Subjects were encouraged to spread their activity out over at least 5 days per week, in bouts of at least 10 minutes duration, with intensity being moderate to vigorous. During months 1-6 subjects attended weekly behavioural intervention sessions to encourage exercise, and during months 7-18 they attended two monthly group intervention sessions and received two monthly telephone calls such that weekly contact was sustained for the full 18 months of the study. Subjects also received "healthy eating" guidance, but were not prescribed calorie reduced diets, along with monthly newsletters pertaining to the study. They were also encouraged and invited to exercise-on-site with their intervention staff following their meetings as well as on weekends during the first 3 months.

Those prescribed 300 minutes per week enjoyed all of the same interventions as the 150 minutes per week group, they were just aimed higher.

The control or so-called, "self help" group only attended assessment visits biannually with no additional intervention or personal contact. They did however receive a physical activity self-help manual along with the same monthly newsletter as the activity groups.

The results?

Don't worry about holding on to your hats.

There was a very significant group x time interaction effect whereby there was a dramatic increase in activity from baseline. 18 months later the previously sedentary self-help folks were averaging 74.6 mins weekly, the 150 minute folks 66.1 mins weekly and the 300 minutes group 154.8 minutes weekly. The fact that there was no statistically significant difference in activity between the 150 minute intervention and self-help, this despite tremendous resources thrown at the 150 minute group, suggests to me that if you're going to encourage physical activity through a behavioural intervention you should go big or go home.

Intake wise, there was no between group differences and an overall self-reported decrease in intake averaging 201 daily calories.

Weight wise, there was no between group differences with percent weight change at 18 months in the 300 minute group being -1.2%, the 150 minute -0.9% and the self-help -0.7%.

The authors then subdivided folks into people who lost more than 3% of their weight, stayed within 3% of their weight and gained more than 3% of their weight and did some further analysis.

What'd they find?

Overall, despite an 18 month significant increase in exercise 72.6% of subjects either stayed the same or gained weight while only 27.4% lost more than 3% of their initial weight.

Looking at the losers specifically the authors did find a dose-dependent association with exercise however as the authors themselves noted,
"despite these findings, concluding that physical activity alone can result in the magnitude of weight loss observed in the weight loss within the retrospective secondary analysis may be misleading."

Because the losers ate better as measured by their more significant changes in their completed Eating Behaviour Inventories.

Worth spending a moment on too was the finding that a full 20% of participants gained more than 3% of their presenting weight over the course of this very rigorous exercise intervention. Sadly too, their weight gain was also associated with an increase in their abdominal adiposity - the bad apple place to put weight.

The good news?

A very minimal intervention ($150, newsletters and a self-help manual) led the initially sedentary self-help group to markedly increase their daily amount of exercise and also markedly improve their fitness as measured by the increase in time it took for those same individuals to achieve 85% of their age-predicted maximal heart rate - an improvement that almost certainly has health benefits.

Bottom line?

We have to stop linking exercise with weight loss. Exercise should be promoted for its phenomenal health benefits, not for its role in weight management.

Weight's about food, not fitness, whereas health's about both.

Jakicic, J., Otto, A., Lang, W., Semler, L., Winters, C., Polzien, K., & Mohr, K. (2010). The Effect of Physical Activity on 18-Month Weight Change in Overweight Adults Obesity, 19 (1), 100-109 DOI: 10.1038/oby.2010.122

Tuesday, February 15, 2011

Exercise won't prevent obesity in 8 year olds.

From the, “weight ain’t about exercise” file comes a small study that was reported on during the Obesity Society's 2010 Annual Scientific Assembly.

The presenters reported on the impacts of 6 years worth of energy expenditure data on children’s weights, BMIs, waist circumferences, fat percentiles and total fat masses at the age of 8. Forty-five children were investigated using doubly labeled water to determine total energy expenditures and both bio-impedance analysis and dual energy X-ray absorptiometry were used to explore fat free mass.

The working hypothesis of course was that kids with higher total energy expenditures (more active kids) should have lower BMIs and less fat mass than kids with the lowest energy expenditures.

There are two ways to look at the results. The more negative way to do so would be to harp on the fact that high levels of exercise didn’t associate with lower BMIs as gloomy, and in a move that may seem surprising to some of my readers, I'm not going to do that. Instead I find the results somewhat heartening in that at least as far as absolute weight goes, inactive kids are at no greater risk than active ones. For me that's somewhat heartening given how we can’t seem to figure out ways to make kids more active.

While far from a large study, the fact that there was no association found between energy expenditure and weight or body fat percentage is yet another redundant nail in the coffin of exercise being the answer to the prevention of childhood obesity.

That said, one thing the authors didn’t mention was whether or not there was any differences in the distribution of body fat among the more active kids in that there have been studies that demonstrate that while not having a marked impact on weight, exercise does seem to impact on how fat is distributed which in turn may well have an impact on health and weight related comorbidities.

Monday, February 14, 2011

Should the Auditor General be investigating Health Canada?

So let me get this straight Health Canada.

4 years ago you commissioned an industry inclusive National Sodium Working Group who finally, after years of back and forth negotiations, managed to come up with an agreed upon series of recommendations which they published now nearly 7 months ago in their comprehensive document Sodium Reduction Strategy for Canada.

And what's your response Health Canada?

To disband the Working Group itself and transfer their power over to the Food Regulatory Advisory Committee - a group with deep industry ties, and to hold more "Stakeholder" consultations with a survey and a call for input from industry ?

Um, wasn't industry part of the actual Working Group?

Given Health Canada's complete and utter disregard for the National Trans-fat Taskforce's industry inclusive recommendation that we regulate trans-fat in our food supply, a recommendation that's now nearly 4 years old, I guess I shouldn't be too surprised.

But here's the thing. My money and yours go to funding these Task Forces and Working Groups, and given the years of work involved in both, along with the time and expertise in researching writing and publishing their reports, I can't help but figure that the cost for the groups must be into the many millions. But those direct costs aren't the only ones taxpayers should consider and also worth considering are the costs of the increased morbidity and mortality associated with not following through with these groups' recommendations.

Personally I'd love to see an investigation into the whys and wherefores of these official governmental groups being ignored by the very government that's commissioning them - both from a political perspective in terms of pressure being brought to bear by special interest groups and in terms of money being wasted.

I also wonder whether or not there's a case now for a spouse or loved one has a case for a wrongful death lawsuit where their recently deceased partner had been eating trans-fats in restaurants Health Canada themselves have monitored and shown to be non-compliant with their call for voluntary trans-fat reduction? The case to my non-lawyer brain seems fairly straightforward. Health Canada and their Task Force have admitted that trans-fat in any amount is a risk to health, the government has demonstrated non-compliance with the voluntary call for reduction and they've failed to act both on the recommendations of the task force and their own promise of regulations were voluntary trans-fat reduction to fail.

At the very least, I sure wish they'd stop wasting my money on feel good working groups and task forces that they're clearly not planning to listen to anyhow.

Saturday, February 12, 2011

Saturday Stories

Diary of a Fat Dad (a confessional of sorts), covers his own struggles with food.

Beautiful infographic of rising global obesity rates since 1980.

PhDinParenting has a provocatively titled post, "Canadian women: We’re fat, our kids are fat, and we’re letting other people raise our children", where she covers some of the headlines last week had on moms and obesity.

Ouch! Had missed this one. Freakonomics blog on the New York Times unflatteringly covers the new Weight Watchers Point system (for the record, the concepts behind the new system seem sound to me with the exception of the zero-point fruit).

Did you catch the Superbowl ad that Big Food bought to combat the as yet non-existent soda tax?

Arya covers the science behind health at every size.

Friday, February 11, 2011

The Onion talks, "decoy Muslims".

Today's Funny Friday?

The Onion's statement on right wing North American xenophobia.

Have a great weekend!

Al Qaeda Populating U.S. With Peaceful 'Decoy Muslims'

Thursday, February 10, 2011

Badvertising: Jimmy D's French Toast Griddlers sure sound like villains to me.

Didn't Batman and Robin fight French Toast Griddlers?

These dastardly turkey sausages sandwiched between pieces of French toast epitomize the very essence of what I see as Frankenfood - highly processed muck slapped together that eliminate the need for cooking and beautify lowest common denominator nutrition.

So what's in 'em?

54 different ingredients culminating in an admittedly it could be worse 1/3 of your child's total daily recommended sodium intake.

The bigger problem here?

Buying into the notion, and in so doing, teaching your kids food comes from boxes and that cooking's for suckers.

How difficult is it to actually make an egg sandwich?

Wednesday, February 09, 2011

Badvertising: The Special K Challenge shows Kellogg's true obesity colours.

Well given what Kellogg's suggests will happen if you lose weight with the almost painfully stupid Special K challenge (just eat small amounts of cereal instead of substantive food and low and behold you'll lose weight) it would seem Kellogg's doesn't think too much of folks who are obese.

Taking an antonymous look at their ad yields something like this:
If you've got weight to lose you're probably a sad, anxious, dull, drab, meek, boring, timid, angry, cowardly, pessimistic, insecure, weak willed, lazy, stuck, indecisive, slob.
Gee Kellogg's, you guys really are special.

Tuesday, February 08, 2011

Badvertising: V8 V-Fusion tries to fuse your brain cells.

Really V8?

You're really trying to suggest that that V8 V-Fusion with 120 calories and more than 6 teaspoons of sugar and 0g of fibre per glass along with a bunch of Vitamin C is the equivalent of eating a half a cup of broccoli and half a cup of blackberries?

Funny thing.

That half cup of both broccoli and blackberries? Well together they'd contain only 46 calories, and they'd also contain 5g of fibre and only 1 teaspoon of sugar. They'd also contain all of the phytonutrients lost during juice processing and their sheer volume will help make you feel full.

You can't drink your fruit and vegetables!

Monday, February 07, 2011

Badvertising: Great job on your homework, here's a pie?

Saw this gem in a parenting magazine.

Bribe your kids to do their homework with pies.

This particular pie?

At 370 calories it's got as many as nearly a litre of Coca Cola. It's also got just shy of 6 teaspoons of sugar and get this, 650mg of sodium - almost double the sodium of two orders of large fries at McDonald's.

Perhaps if the mom in the photo had done her own homework growing up she'd know just how terrifically awful the product she's just served her daughter is and moreover perhaps she'd have learned better parenting skills than bribery to raise her children.

(Oh, and by the way, it's Badvertising week!)

Saturday, February 05, 2011

Saturday Stories

Yale and Nuval's Dr. David Katz dissects the new 2010 American Dietary Guidelines, while Food Fight's Melanie Warner mercilessly translates them.

Mark Bittman talks food policy manifesto in the New York Times.

Arya covers a recent study that revealed new MDs aren't interested in talking lifestyle change.

Travis warms my confirmations biases with his piece that calls for an end to linking inactivity and obesity.

Friday, February 04, 2011

A brilliant VW commercial

You can watch it on Funny Friday or during the Super Bowl.

Your choice.

Have a great weekend!

Thursday, February 03, 2011

Why I still think breakfast's part of weight management.

Much ado has been made of a recent study that suggested that eating large breakfasts added to total daily calorie counts with pretty much all coverage suggesting that folks trying to lose weight should think twice about having it, or more specifically, how much of it.

The study, published in advance of print in Nutrition Journal, monitored the dietary intake of 280 obese and 100 normal weight subjects for 10-14 days. Researchers were interested in total daily energy intake as a function of total daily breakfast calories.

Right off the bat this was a strange study as it would seem that virtually all of the subjects were eating 3 meals and 2 snacks daily - a pattern of eating that is not one I see regularly. Of the literally thousands of patients whose eating patterns I've explored, I'd venture a guess that 3 meals and between meals snacks were a regular and consistent pattern in no more than 10% of them. Of course this study was conducted in Germany and my practice population is Canadian, so perhaps this concern is unfounded in that perhaps Germans are great snackers and don't skip meals.

Ultimately the study concluded that in both normal weight and obese individuals who are weight stable, higher breakfast calories resulted in higher total daily calories.

The problem I have is that there are far more variables than simply breakfast that determine total daily satiety and satiety has a great deal of bearing on total daily intake as hunger will impact dietary quantity and choice. Other things that matter a great deal? Macronutrient distribution, timing of meals and snacks, sports nutrition and minimums of calories per meals and snack.

Folks reporting on this study have basically been telling people that if they want to lose weight, they should just eat less for breakfast. Of course telling someone to simply take what they're currently eating and eat less (for breakfast) falls into that nonsensical, oversimplified, nightmare on ELMM (eat less, move more) street scenario whose value and worth we all know too well. Moreover, according to news reports on the study, the primary driver of higher calories for breakfast was bread, which if refined, ain't going to help satiety much either and therefore perhaps it's not surprising that high breakfast calories led to great total weights as loading up on bread for breakfast will certainly impact total calories, but might not impact satiety and consequently not impact on rest of day eating patterns.

So is breakfast importance in weight management? Well 78% of the National Weight Control Registry eat breakfast daily. For those who aren't familiar, registrants have lost on average 67lbs and kept them off for over 5.5 years. They're great at managing their weight and while that number very clearly states that 22% of registrants don't eat breakfast daily, that the vast majority does speaks directly to breakfast's importance to most folks' long term strategies.

So while an interesting result and one perhaps worthy of further study in a population that's actually trying to lose weight, the fact that normal weight or obese individuals who have had stable weights for at least a year, eat more total daily calories on days they have larger breakfasts, doesn't change the fact that my recommendation for folks trying to lose weight is for breakfasts of at least 300 calories (though certainly >500 calories is probably overkill), consumed within 30-60 minutes of waking and containing a good source of protein, followed by well organized meals and snacks throughout the remainder of the day.

Schusdziarra, V., Hausmann, M., Wittke, C., Mittermeier, J., Kellner, M., Naumann, A., Wagenpfeil, S., & Erdmann, J. (2011). Impact of breakfast on daily energy intake - an analysis of absolute versus relative breakfast calories Nutrition Journal, 10 (1) DOI: 10.1186/1475-2891-10-5

Wednesday, February 02, 2011

Village on a Diet Episode 5 Recap: My last recap?

This show sure doesn't seem to be changing.

5 hours in and ultimately we're faced with a show that's reinforcing many of the worst stereotypes of obesity and weight loss. That obesity's a disease of laziness. That the obese are ignorant. That treatment involves massive amounts of exercise. That healthy eating must include esoteric health food and always, always, always exclude dietary vices. That weight management is about suffering and that if someone's not successful with weight management, it's because they're weak willed.

One of the most telling parts of this week's episode? Trainer Garfield is waxing on about how every week there are less folks involved in his challenges and then concludes that the town is failing him. I guess it didn't occur to him that perhaps he's failing the town.

Another? They had psychologist Adele Fox talk hypnosis for smoking cessation. Never you mind that the Cochrane meta-analysis of randomized trials shows hypnotherapy for smoking cessation is no better than no treatment on 6 month quit rates - let's tell all of Canada it's a great plan.

You want more? How about the completely disrespectful, looking a mile down his nose chef who walked into the 30 year old single mom's restaurant shop and basically told her she was failing Taylor when really all she was doing was putting food on the table for her children? His condescension literally drove her out of town.

It's pretty clear by now, this show isn't about best evidence or best practice, it's about best TV.

It's too bad too.

Sure, the townsfolk are going to lose their ton, but losing a few pounds per person's not particularly difficult and no doubt some folks will have been so strict as to lose whole piles. As the show's taught both viewers and Taylorites, all you need to do to lose weight is suffer. Of course there aren't too many folks out there who are willing, regardless of how much weight they might lose, to suffer forever, which is why folks who lose weight through suffering invariably gain it back when the scale stops whispering sweet nothings in their ears. Ultimately folks who lose weight suffering tend to go back to the lives they lived before they lost, which while not conducive to weight loss, were at least lives they enjoyed.

How amazing would it have been to have a show that broke the classic reality TV weight loss mould? Where the obese were treated compassionately. Where weights were explored from individual environmental, medical and psychological perspectives. Where treatment consisted more of education and empowerment about nutrition, energy balance and exercise than punishment. Where realistic goals were set and bolstered. Where the means to satiety were taught and cultivated. Where it was about nurturing realistic but still less than perfect lifestyles because striving for perfection is a recipe for failure.

Such a show would truly have the potential to positively impact a nation and a genre, not just a small town.

So no more recaps from me. Maybe I'll do a series recap down the road, but unless there's major change to the format, I'm not sure there's much left for me to say.

Tuesday, February 01, 2011

2011 Weighty Matters Annual Report on the Heart and Stroke Foundation

Coincident with the publication of this blog post the media's likely awash with news stories about the Heart and Stroke Foundation's 2011 Annual report on Canadians' health.

Guess what? It's not so good, and as with each and every Heart and Stroke Foundation annual report there are a myriad calls to action.

Noticeably absent of course?

Calls to action for the Heart and Stroke Foundation.

To that end I publish my Weighty Matters Annual Report on the Heart and Stroke Foundation. You'll notice it's pretty darn similar to last year's because, well, they haven't made any formative changes to their own shortcomings.

Makes me wonder - why does the Heart and Stroke Foundation expect folks and governments to clean up their houses when they're so clearly unwilling to clean up their own?

To the Heart and Stroke Foundation:

1. Rebuild the Health Check Program.

- Actually have the Heart and Stroke Foundation's Health Check program adopt the Heart and Stroke Foundation's own recommendation for a daily maximal intake of 1,500mg of sodium and adjust the program's criteria to bring them in line with the Canadian Stroke Network and Blood Pressure Canada's recommendation that maximal per serving sodium be 200mg.

- Create more than just a yes or no seal of approval so that foods with check marks can actually be compared to one another as there are often far healthier choices to be made even within comparable Health Check'ed products themselves.

- Evaluate all of the foods in the marketplace so that foods healthier but not a party to health check can be identified by consumers.

- Eliminate Health Check products made with refined grains (whether they're "enriched" or not).

- Eliminate beverages from the program. People should not be encouraged to drink their calories.

- Eliminate Health Check products where sugar is added as fruit juice concentrate or puree and in so doing recognize that sugar is sugar.

- Eliminate Health Check products containing processed meats and in so doing fall in line with organizations like the Canadian Cancer Society and current evidence based nutrition.

- Expand Health Check's nutrient criteria to include the literally dozens of nutritional determinants of health its current iteration ignores (right now the majority of Health Check categories only evaluate 3-4 nutritional criteria in awarding the seal).

- Eliminate restaurants from Health Check. The Heart and Stroke Foundation should be encouraging Canadians to eat out less and cook with whole foods more rather than enabling Canadians to eat out and feel a false security about their choices. "Less bad" is in fact still "bad".

2. Acknowledge the existence and importance of calories.

- Immediately add a robust energy expenditure online calculator and caloric education and guidance section to the Heart and Stroke Healthy Weight Action Plan which currently has only the most rudimentary caloric guidance.

- Add calories as a criteria to be considered for every product category in Health Check.

- Never again release any type of tool or report having to do with obesity without explicitly including and discussing calories.

3. Call for a revision to Canada's Food Guide

- The Heart and Stroke Foundation should call upon the federal government to immediately revise Canada's Food Guide reinforcing the Canadian Medical Association's call to have the Guide revised every 3-5 years to incorporate advances in our understanding of the impact of dietary choices on health.

4. Buy a mirror

Before criticizing federal and provincial governments, before chastising the public about their need to be more concerned about their determinants of health, the Heart and Stroke Foundation should take a good long look at themselves in the mirror. What might they see?

- Health Check'ed Slush Puppies.

- Health Check'ed vegetable juice with nearly a 3rd of their own daily recommended sodium maximum.

- A front-of-package labeling program that thinks 3-4 nutritional determinants of food are all that matter.

- Partnerships with Boston Pizza that lead to the sale of heart shaped pizzas on Valentines day (a practice akin to a lung association having a day where they promote cigarette sales in 7-11s where part of the proceeds of smoke sales would go to them) and the distribution of fast food coupons to children who fund raise for the Heart and Stroke Foundation.

- Dietitians that rather than promote home cooking would rather give up the fight altogether and instead encourage weekly school pizza days with "healthier" fast food pizzas - akin to a respirologist encouraging light cigarettes because people are already smoking.

- Reports on childhood obesity that don't mention the word calorie even once.

For such a proud and supposedly stalwart organization these glaring shortcomings besmirch their good name.

[For those wondering, Village on a Diet recap will be tomorrow]