Tuesday, July 31, 2012

Announcing My Next Venture - TrenchTalks!

Have you ever suffered through a terrible medical education conference?

Well suffer no more!

Are you sick of conferences where speakers end their talks with, "we need to do more research on this"; or where the discussion centers around animal models, or where the subjects are awesome but the speakers just read off of slides, or where it's all fine and fascinating, but ultimately the talk does nothing to help your with your actual patient care?  Well I and some friends decided to do something about it - we created TrenchTalks!

What are TrenchTalks? They're what's been missing from Continuing Medical Education (CME). Highly entertaining speakers who don't read off slides and are passionate about their topics; only discussions and recommendations that are immediately clinically relevant to your practice; great venues; pots of coffee that don't disappear between talks; and an understanding that you're there not only to learn, but also to actually enjoy yourselves!

TrenchTalks are geared towards allied health professionals of all flavors and our first TrenchTalks series (where I'll be one of the speakers) is perhaps not surprisingly about the clinical management of patients with obesity.  No ivory tower speakers here.  We're from the trenches and for the trenches giving you nothing you can't use in your own practices tomorrow and delivering it in a single, minimally-practice-disrupting single day of learning.

We'll be speaking at TrenchTalks Obesity in Ottawa on October 10th at the Museum of Nature, in Montreal on October 11th at the OMNI Hotel, and in Toronto on October 12th at the new Trump Tower.

To learn more about TrenchTalks and/or to reserve your seat please visit our website at www.TrenchTalks.com, and if you're interested in attending, don't delay in buying a ticket as to ensure we are able to deliver you truly high quality education, seats are limited and are being sold on a first come first served basis.

Finally, a cure for boring!

Monday, July 30, 2012

Weight is Food. Health is Fitness.

A fascinating albeit small study out of PLoS ONE adds to my personal confirmation bias that the driving force behind societal weight gain isn't a decrease in burnt calories, but rather an increase in consumed ones.

Now to date we've seen doubly labeled water studies (our current gold standard in measuring total daily caloric expenditures) which have demonstrated that we're not burning any fewer calories now than we did in the early 1980s, and that we city folks living in North American luxury burn just as many daily calories as folks living in developing nations.

Here the authors took things one step further back into human history and using doubly labeled water they measured the energy expenditure of 30 Hadza foragers - a hunter gatherer society that live in a savannah-woodland area in Tanzania (that's a few Hadza up above).

According to the authors,
"the Hadza hunt and gather on foot with bows, small axes, and digging sticks, without the aid of modern tools or equipment"
The authors hypothesized that if a lack of physical activity were responsible for the rapid rise in global obesity, that the Hadza's lifestyles ought to burn a great many more calories than ours.

Not surprisingly the Hadza were found to be highly physically active and quite lean (their average BMI was reported as roughly 20). But what about their daily burns?  The authors found that energy expenditure among both Hadza men and women did not differ from those of men and women living in our modern day utopia.

The authors report too that their multivariate analyses confirm that the lack of difference is independent of weight (meaning that the increased calories associated with simply carrying heavier weights here in North America don't account for the equivalency of findings) and body composition differences (lean and fat mass).

Interestingly too the authors did not find any correlation between total daily Hadza walking and their total energy expenditures meaning that regardless of how many kilometres they walked daily, they burned roughly the same number of calories.

All of these findings led the authors to hypothesize,
"that TEE may be a relatively stable, constrained physiological trait for the human species, more a product of our common genetic inheritance than our diverse lifestyles"

We haven't slowed down at all over the course of these past 50 years and perhaps not since the Pleistocene era which lasted from roughly 2.5 million to 11,700 years ago.

Further translation?

If we haven't slowed down in 11,700 years and yet our weights have risen dramatically the only other possibility, and it's the one I subscribe to, is that we're eating a lot more than we used to.

But please don't read this piece and think that exercise isn't important. Instead read it and recognize that while your weight may be primarily determined by what you eat, there's likely nothing more beneficial to your health than regular exercise. The gym may not make you slim, but study after study after study reports that it will keep you living longer, and living better - and those outcomes are far more important to your quality and quantity of life than what your stupid scale might tell you in the morning.

Saturday, July 28, 2012

Saturday Stories: Whooping cough and an Olympic Double Shot

The Globe and Mail's Andre Picard on the deadly resurgence of whooping cough.

Just in time for the Olympics the Atlantic has a slide show primer on performance enhancing drugs.

The Lancet and their Olympic themed editorial on Big Food sponsorship aptly titled, "Chariots of Fries"

Friday, July 27, 2012

MUST WATCH! "One Grain More" - Funniest Nutrition Video Ever Made!

Today's Funny Friday is a must, must, must watch as it may well be the funniest gluten/grain based video ever made and an homage to my favorite musical of all time to boot (Les Miserables).

(email subscribers, you've got to head to the blog to watch)

[Hat tip to my cousin Robin]

Thursday, July 26, 2012

Why I Don't Buy the "I Don't" Approach to Dietary Discretion

Not sure if you caught the LA Times last week and their piece on the utility of using the words, "I Don't", in place of, "I Can't", when considering a dietary indulgence. The crux of the piece is that when you want a cookie let's say, rather than tell yourself that you can't have one, tell yourself that you don't eat them.

The recommendations didn't come out of nowhere either, they came from a paper published in August's Journal of Consumer Research where researchers found that when it came to resisting cravings self talk saying, "I don't", was 3 times as effective as saying, "no", and 8 times as effective as saying, "I can't".

My issue isn't with whether or not the words, "I don't", are good ones (clearly they're better than "no" and "I can't"), my issue is whether or not blind restriction is a sustainable long term strategy.  My experience says that it isn't, and that blind restriction, the belief that if you're trying to manage weight or live healthfully you simply can't (or don't) eat nutritionally bereft but hedonically wonderful foods, is one of the reasons so many dieters ultimately fail.

Thinking you're going to live a life where you're not allowed to take pleasure from food? I don't think that's realistic and I don't think it's a good plan as I agree with the article, we're hardwired to enjoy the bad stuff.

As always I'm a broken record. It's about the healthiest life that you can enjoy, not the healthiest life that you can tolerate, and that means the smallest amount of bad-for-you indulgence that you need to enjoy your life, and that amount should definitely not be none.  Saying "I don't" every time you face the desire to take pleasure from food just means that you're on a diet - something that history has likely already taught you is a temporary state of being.  If you really want to say I don't, how about saying, "I don't diet", the next time you think that blind restriction is the way to go.

Wednesday, July 25, 2012

How Did This Become OK?

Thanks to Twitter's @teacherace for clipping this coupon for me to see.

Today's post is short and almost literally sweet.

Where did we go wrong as a society such that the foods being advertised to moms and dads up above are the staples that many (most?) feel safe and comfortable feeding their children?

Tuesday, July 24, 2012

An Open Letter to Canada's Auditor General Regarding Health Canada

Yoni Freedhoff
Medical Director, Bariatric Medical Institute
Assistant Professor, University of Ottawa
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5

July 24th, 2012

Michael Ferguson
Auditor General
Office of the Auditor General of Canada
240 Sparks Street
Ottawa, Ontario
K1A 0G6 Canada

Dear Mr. Ferguson,

My name is Yoni Freedhoff and I'm a physician and public health advocate. I am writing to you today in regard to the actions of Health Canada, and to be very clear, I'm not writing to you to consider their public health decision making, but rather to inform you of willfully mismanaging public funds in their creation of task forces and working groups whose recommendations are summarily rejected nearly the moment they're reported.

The first such example involved our Trans-Fat Task Force. Struck in 2005, the Task Force consisted of 24 members and involved the commissioning of a literature review, 3 full day face to face meetings, 5 teleconferences, 2 public consultations and the writing of a 116 page final report. The Task Force called for a regulatory approach to reducing trans-fats in Canada's food supply. Then Minister of Health Tony Clement elected instead to launch a 2 year trial program of voluntary reductions followed by regulation if voluntary efforts failed.   Unfortunately voluntary reductions did fail, yet rather than implement the regulations promised by Minister Clement, Minister Aglukkaq elected instead to extend the taxpayer funded trans-fat surveillance program.  In April 2010, she herself reported that the program's,
"results indicate that further reductions are needed to fully meet the public health objectives and reduce the risk of coronary heart disease."
However just last week she reported that the surveillance program was,
"a time-limited initiative that ran its course",
and summarily ended it. As a taxpayer I'm quite concerned by all of this. From initially ignoring their own undoubtedly expensive task force's advice, to establishing an undoubtedly expensive surveillance program, to extending that surveillance program rather than follow through with the promise of regulation if it failed, to finally eliminating the program and not enacting a regulatory approach ultimately it means a great deal of public money was wasted.

The next example involves Health Canada's Sodium Working Group. Struck in 2007, the group was tasked with developing a population-health strategy to reduce sodium in the diets of Canadians. Their report was released on July 29th, 2010 and it made two dozen recommendations meant to bring down Canadian salt consumption. 8 months later and Health Canada announced that rather than follow the expert recommendations they themselves commissioned (at a reported cost of $1,000,000), that they would instead seek further guidance from the Food Expert Advisory Committee - a committee with strong ties to the food industry - and that the Working Group was to be disbanded. This led one member of the original working group to state,
"What's the government doing? They got the group of experts and industry people together and spent three years putting together a strategy. Now they're trying to find some other people to give them a different strategy? It just doesn't make any sense."
No it doesn't. And it also costs us a great deal of money.

While I realize it's beyond the purvey of your office to determine the scientific soundness of Health Canada and Minister Aglukkaq's decisions, as a taxpayer I need to ask, why are many millions of taxpayer dollars being spent to fund expensive expert advisory panels and surveillance programs if their recommendations are simply to be wholly and completely ignored?

Respectfully yours,

Yoni Freedhoff, MD
Medical Director, Bariatric Medical Institute
Assistant Professor, University of Ottawa
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5

Monday, July 23, 2012

Canada's Health Minister Fails Canadians Yet Again

But first let's take a trip through time and tell a tale of two cities.

The year was 2006.

Here in Ottawa a federally appointed "Trans-Fat Task Force" was exploring the issues of trans-fats and considering what if anything the government ought to do about them.

Head south a few hundred miles and over in NYC they'd already made their trans-fat decision, and they announced plans to ban trans-fat with a series of phased in regulations set to begin in 2007.

Flash forward to 2007 and Canada's Trans-Fat Task Force recommended taking an approach similar to that of NYC, however our then Minister of Health Tony Clement decided to give the food industry a free-pass and a trial of self imposed trans-fat reductions, but with the promise of regulations in 2 years should reductions fail.

Moving to 2009 and with NYC's trans-fat ban fully phased in, here in Ottawa our current Minister of Health Leonna Aglukkaq formally reneged on her predecessor Tony Clement's promise and took trans-fat regulation off the table, this despite the fact that according to Postmedia reporter Sarah Schmidt, Health Canada's own cost-benefit analysis reported a trans-fat ban would provide a net benefit to Canadian society of $9 billion over 20 years, and despite the head of Health Canada's trans-fat task force labeling trans-fat,
"a toxic killer that needs to be removed from the food supply as soon as possible."
Further fast forward to April 22nd, 2010 and Ottawa saw the briefest glimmer of hope for trans-fat regulation in that Leonna Aglukkaq herself admitted the voluntary approach to trans-fat reduction had failed stating of trans-fat surveillance,
"The results indicate that further reductions are needed to fully meet the public health objectives and reduce the risk of coronary heart disease."
Now flash forward to last week when two things occurred. NYC saw the publication of a study in the Annals of Internal Medicine that reported on the incredible success seen in trans-fat reduction consequent to their ban. And what did we see in Ottawa?

In Ottawa we saw Leonna Aglukkaq continue her reign as the worst Minister of Health this country has ever seen in that rather than announce Canadians have been subjected to enough trans-fat and that regulation was to be phased in, instead she reported that she's terminated the trans-fat monitoring program, this despite Health Canada's own advisory panel calling for renewed surveillance to bolster the case for regulation.

Ms Aglukkaq, how do you sleep at night?

Saturday, July 21, 2012

Saturday Stories: Big Produce, Kids and Racial Eating

Appetite for Profit's Michele Simon writing for HuffPo covers the fascinating story of how even the produce industry lobby is more concerned with profit than health.

Dawn Friedman from Brain Child via the UTNE Reader on why bullying kids to lose weight won't work (brief quote from me in the piece).

Aydrea Walton in a piece from last August on "Eating While Black". Food's complicated.

Friday, July 20, 2012

If Someone Had Time to Do This, You Have More Time Than You Think

Today's Funny Friday video in a sense is about time. I can't fathom how long this took to make, but time is one of those things we often feel we don't have enough of, and I'm guessing all of us, if we're truly being honest with ourselves, have more of it than we admit.

Have a great weekend!

(email subscribers, you've got to visit the blog to watch, and new subscribers, Friday's my day off ranting)

Thursday, July 19, 2012

The BMJ's Amazing Shock and Awe Assault on Sport Drink Science


Wow, WOw, WOW!

What words would you use to describe a situation where one of the world's most prominent medical journal publishes, not just one article critical of a specific category of food, but seven such articles, and where those articles come to the conclusion that the food is being marketing on the basis of food industry funded hype and collusion?

I'd use the words, "Thank You"!

You'll definitely hear about it in the news today as the British Medical Journal has 7 incendiary pieces that are highly critical of sport and energy drinks, their Big Food parents and the researchers that are conflicted by them.

The first piece, Research: The evidence underpinning sports performance products: a systematic assessment has researchers analyzing sport drink advertising and identifying an astonishing 431 performance enhancing claims for 104 different products. Those claims were "backed up" by references made on the products' websites to 146 references. Of those 146, the authors could only actually find half of them, and of that half,
"84% were judged to be at high risk of bias",
while only 3 were deemed to be of high quality and of low risk of bias. Ultimately the authors not surprisingly concluded that,
"The current evidence is not of sufficient quality to inform the public about the benefits and harms of sports products"
The next piece, The truth about sports drinks sees BMJ's Investigations Editor Deborah Cohen explore the funding and financial ties between sports drinks' parent Big Food companies and professional sport organizations and expert advisory panels. Her hard hitting piece is absolutely fascinating and covers how sport drink friendly messaging evolved and later became questionably incorporated into official medical and sport recommendations, often by advisory boards with multiple members on sport drink payrolls.

Then the BMJ tackles the EFSA's criteria for sport drink claims in, How valid is the European Food Safety Authority’s assessment of sports drinks?. The authors were highly critical of the two claims approved by the EFSA, that sport drinks, "improved water absorption during exercise" and that they helped with "maintenance of endurance performance" stating that the EFSA asked Big Food to supply the references upon which their decision was based, had no formal criteria to evaluate which studies warranted inclusion in the analysis (Big Food submitted non-peer reviewed book chapters, opinion pieces, etc), and that of those studies supplied to the EFSA many were absent methodologies.

For the "maintenance of endurance" claim the authors combed through the 26 scientific studies presented to the EFSA and concluded 19/26 were of poor quality; that 89% of the subjects were men; that 73% of the subjects were endurance trained men; that 65% of subjects were endurance trained men between the ages of 20 and 30; and that only one measured performance in a race setting.

For the "improved water absorption during exercise" claim, there were only 22 scientific studies of which 17 were deemed to be of poor quality, and where of the predominantly male subjects only 3 studies included people over the age of 30 and not a one had an outcome that included performance in a race or a sporting event.

The next explosion comes from Tim Noakes, the Discovery Health Chair of Exercise and Sport Science from the University of Capetown in his commentary on, Role of hydration in health and exercise where his take can succinctly be summarized as, if you get thirsty you should drink and that over-hydration is much more common and dangerous risk to the athlete than dehydration.

Next up is an analysis of the science behind the GSK sport drink Lucozade's claims that it boosts performance in, Forty years of sports performance research and little insight gained where the authors' conclusion says it all,
"From our analysis of the current evidence, we conclude that over prolonged periods carbohydrate ingestion can improve exercise performance, but consuming large amounts is not a good strategy particularly at low and moderate exercise intensities and in exercise lasting less than 90 minutes. There was no substantial evidence to suggest that liquid is any better than solid carbohydrate intake and there were no studies in children. Given the high sugar content and the propensity to dental erosions children should be discouraged from using sports drinks."
And there's still more!

Next authors explore the marketing of sports drink through social media and user endorsements in, Medicine and the Media: Miracle pills and fireproof trainers: user endorsement in social media. Not surprisingly, Big Food are savvy marketers, and Facebook and Twitter let them get away with making claims that even the EFSA would frown upon. Basically what companies do is try to encourage "user-generated content" which in turn they can then claim they didn't themselves write.

Next comes mythbusting in, Mythbusting sports and exercise products. Among the busted myths,
  • The colour of urine accurately reflects hydration (nope)
  • You should drink before you feel thirsty (nope)
  • Energy drinks with caffeine or other compounds improve sports performance (nothing other than equivocal benefit from caffeine)
  • Carbohydrate and protein combinations improve post-workout performance and recovery (nope)
  • Branched chain amino acids improve performance or recovery after exercise (subjectively did help, objectively equivocal)
  • Compression garments improve performance or enhance recovery (performance probably not, recovery yes)
Finally there is another piece on how to stay hydrated in, Commentary: To drink or not to drink recommendations: the evidence. Their 4 conclusions?
  1. There's a wide range of hydration within which our amazing bodies work wonderfully.
  2. Freely chosen rates of fluid intake among elite athletes match sport body recommendations (0.4-0.8 litres per hour).
  3. Intake at rates higher than sport body recommendations confer no advantages.
  4. Athletes who lose the most body mass during marathon, ultra-marathon or Ironman races do the best
These articles are all unbelievably important, both in regard to the recommendations we give ourselves and our children, as well as in regard to just how unwise it is to let Big Food push an agenda.  They are not our friend.

Huge props to the BMJ and to their investigative partner BBC Panorama for this groundbreaking series.

Wednesday, July 18, 2012

Flooding 101: Sandbags Over Swimming Lessons

[Had penned this in response to a commentary published this past weekend in the Globe and Mail. While I'm disappointed the Globe didn't want to publish it to provide balance to an article that I feel inexcusably misinformed their readers, the good news is that I have my own publishing platform.

Before reading my piece, you may want to have a peek at Patrick Luciani's Pop a Few Myths About Obesity]
Pop a Few Myths Perpetuated by Patrick Luciani

It looks like Patrick Luciani has solved the complexity of public policy for all of us by dumbing down the discussion of a novel and harmless approach to decreasing the consumption of soda (the Draconian measure of (gasp) limiting vendors' cup sizes to a half litre but not limiting the number that can be purchased) into a straw man argument that suggests that given a limit on New York City cup sizes won’t in and of itself solve the obesity crisis, that it’s clearly a pointless and ridiculous endeavour.

That was easy! Forget about the fact that when building a levee against a flood pointing out the fact that a single sandbag isn’t going to do the trick is a purposely asinine argument for a flood control policy analyst to make. 

But before we get carried away talking about levees and swimming lessons, let’s dispense with the myths that Mr. Luciani uses to defend the consumption of sugar water as being non-contributory to health woes.

Myth 1: The recent decline in soft drink consumption is laudable

Mr. Luciani presents a 30% decrease in per-capita Canadian soft drink consumption as evidence that there’s no need for intervention. Presenting this data in a vacuum is not only unwise, but also disingenuous. There are many sugared beverages out there and while soft drink consumption may have fallen to a still staggering 82 litres per Canadian per year, presenting the fall positively belies the fact that during the time soda consumption has decreased there has been a tremendous concomitant surge in the consumption of sugar spiked energy drinks and sports drinks. In fact one recent report on global energy drink sales states that the average growth rate has been 10 percent per year for each of the past five years.

Myth 2: Cherry picked data is useful

While it’s true that the article that Mr. Luciani himself reports, “has its limitiations”, suggested that soft drink consumption wasn’t linked to obesity in children, that doesn’t change the fact that there are studies that reveal the opposite to be true including the meta-analysis conducted by Harvard’s David Ludwig and published in Lancet which revealed that for each additional soda a child drinks on a daily basis their risk of developing obesity rises by 60%. Nutritional epidemiology is indeed a very tricky business, but no doubt cherry picking articles and presenting a rare outlier as being sufficient to discredit cursorily mentioned contradictory prior studies does not further intelligent debate.

Myth 3: Taxing food and beverages will be difficult so we shouldn’t try

Mr. Luciani suggests that because it will be difficult to determine what should and should not be taxed, that we therefore shouldn’t consider taxes as a means to shift consumption patterns. I have some news for Mr. Luciani, our current Excise Tax Act already does exactly that by making very specific suggestions for the collection of food taxes, many of which certainly don’t seem to make much nutritional sense. For instance the Excise Tax Act specifically singles out club soda, salads, vegetable and fruit trays and small bottles of water as taxable when sold in retail stores. Certainly shifting the taxes that are already currently being collected on healthful items onto glasses of sugar water would be a painless first step to take. Moreover, the simple fact that singular interventions won’t impact upon the complexity that is obesity shouldn’t paralyze the implementation of singular interventions as just as obesity has no one cause, it will have no one cure.

Myth 4: The fact that the food industry has healthier choices means they’re the good guys

The fact a particular industry makes healthier products doesn’t indemnify their risky ones. Altria for instance makes both shredded wheat and Marlboro cigarettes and I’d imagine even Mr. Luciani would struggle to suggest interventions designed to decrease smoking weren’t worthwhile on that ridiculous basis.

The food industry has a fiduciary responsibility to profit, not to protect our health. It’s important too, especially in this current climate to remember that profits aren’t built solely on sales. Profits are also built on public perception and the ability to make the case that industry unfriendly legislative efforts are unnecessary because the food industry is part of the solution. Mr. Luciani suggests McDonald’s, Pepsi and Coca Cola are all “going healthy to stay ahead of the market”. I’d argue they’re going healthy to stay ahead of legislation and scrutiny and to cultivate champions like Mr. Luciani who may be more inclined not to care that Coca-Cola’s stated aim is to double its profits in a decade because it makes zero-calorie beverages as well as its perennial profit-making full sugared version that according to Coca-Cola themselves along with other sugared sodas is responsible for an astonishing 2.5-3% of the total calories currently being consumed by Canadians. Putting 3% into perspective, since 1970 average Canadian loss adjusted per capita calorie consumption has risen by roughly 500 calories a day. If we’re currently averaging the 3,372 calories reported by the Canadian Sugar Institute, the 101 calories of soda being consumed daily would account for 20% of the total calorie excess we’ve seen since 1970 and consequently is an obvious, logical and nutritionally responsible target for intervention, especially given the complete and utter lack of nutritive value in its consumption.

Myth 5: Because Canada’s Food Guide isn’t evidence based we can’t trust the government to make smart decisions

It’s easy to agree that Canada’s Food Guide fails to reflect our current understanding of the impact of diet on chronic disease, but the fact that the government has failed to create a truly evidence based food guide has absolutely nothing to do with whether or not interventions to reduce the consumption of sugar water would be beneficial to the health of Canadians of all weights, shapes and sizes.

Mr. Luciani is right to state that obesity is incredibly complex and consequently there will be no, “top-down simple solution”, but suggesting education alone will suffice? Does Mr. Luciani truly believe Canadians don’t know that drinking 82L of sugared soda a year isn’t a healthy plan? Our current environment is flooded with calories with a torrential current that relentlessly, forcefully and tirelessly pushes Canadians young and old to consume far too many of them. When faced with a flood a government’s first job ought to be building a levee, not Mr. Luciani’s recommended course of action - more swimming lessons. And indeed, no single sandbag will suffice, and there will even be sandbags that serve no purpose, but that doesn’t mean we shouldn’t be systematically stacking them.

Tuesday, July 17, 2012

What Every Diet Study Needs - The DIET Score

Yesterday I lamented about the regular publication of short term and medium term diet studies and how ultimately they add little to no true value to society in that short term losses in no way, shape, or form guarantee their long term maintenance. Given that people seem capable of putting up with the most god-awful and inane diets around, being able to put up with a study protocol for a few months seems a given. It's what happens once the study's over that would truly add clinical value.

Now I realize that dollars don't materialize out of thin air, and that the likelihood is that good idea or not, we're still not going to see an automatic shift from short term, to long term data reporting. To that end, I'd like to offer a work around.

Before I get to it, some non-evidence based experiential theory,
If you don't like your life when you're losing weight you're going to gain it back!
The ability of a body to gain weight isn't something that's "curable", and therefore if weight's the outcome being measured, treatment must be continued forevermore if results are to be maintained. If treatment's too much of a misery, if the diet's too strict, too sparse, too confusing, too anything, well I'm betting it's not going to be too lasting.

Even more simply put,
Weight lost through suffering will almost certainly be regained.
So if my purported truisms are in fact true, why is it the that I have never seen any consideration of dietary quality of life in a weight loss study's methodology and evaluation?

The way I see it, if there were a measure with which dietary satisfaction could be evaluated, even if it's a short term study, you might get a sense as the liveability of the diet and the lastability of its affects. If everyone in the study felt the intervention was a misery you might gather there'd be a damn good chance the intervention won't be long lasting. On the other hand, if the majority reported an intervention as being enjoyable, you might think more folks will continue with it long term.

So I'd like to propose the Diet Index Enjoyability Total (DIET) score whereby using a series of simple Likert scales (descriptive scales from 1-10), researchers could set out to evaluate a particular weight loss approach's DIET score where high scores represented lives that could actually be enjoyed and low scores represented the usual under-eating, over-exercising, highly restrictive, quality of life degrading, misery that are most modern day diets.

What sorts of "enjoyability" items could be scored?
  • Hunger
  • Cravings
  • Feelings of fullness/satisfaction
  • Need to cook special meals for other family members
  • Ability to still eat out with friends and family
  • Energy levels and feelings of general well-being
  • Complexity of dietary requirements
  • Dietary flexibility vs. monotony
  • Rigidity of dietary requirements (ie forbidden foods/food groups and impact on quality of life)
  • Expense/cost of dietary requirements (ie expensive foods, supplements, etc.)
10 items yielding a score of 100. Now scores wouldn't necessarily correlate with degree of loss, but I'd be willing to bet, the higher the score, the greater the long term utility of the diet which ultimately matters far more than the amount of initial loss.

Any of my obesity researcher readers willing to take this on?  I'll happily help!

Monday, July 16, 2012

No More Short Term Diet Studies!

Today's just a short rant.

Had the occasion this weekend to leaf through some of my unopened stack of the medical journal Obesity.

In them I came across various short term and medium term diet studies.

While some of them were certainly interesting, I'm not sure how much value they add to the literature. What I'm getting at is that regardless of whether or not a short term intervention affects weight loss or weight maintenance, the importance of that fact is lost in comparison with whether or not the intervention affects a truly long term change.

So long as calories and overall intake arereduced, weight is going to be lost, but of course losing's no big trick, the trick's keeping it off.

Sure it's nice to read about your work with diet x, y, or z, but unless you can show me that the impact of your intervention lasts longer than a year or two, for me it's just going to get slotted into the same shelf occupied by literally 10s of thousands of diet books - possible solutions for the right individual, but far from universally applicable.

So obesity researchers, please, rather than publish your short terms studies, couldn't you just keep them going a while longer, or at the very least promise you'll keep them going after publishing your short term outcomes with the intention of trying to publish the longer term ones even if negative?  Yes it'll be more expensive and challenging, and no, I don't know where the money or resources will come from, but at least when you publish you'll be providing the world with truly useful information rather than perhaps a testament to the fact that in the short term, people are willing to put up with almost anything to lose weight.

[Stay tuned tomorrow for what I see as an absolute must for EVERY weight loss study and yet something I've never seen included in any study I've ever read]

Saturday, July 14, 2012

Saturday Stories: Weight Maintenance, Lustig, and Calories

James Fell explains the secret to long term weight maintenance to the Chicago Tribune.

Evelyn at the Carb Sane-Asylum shows no mercy in evaluating sugar fearing Robert Lustig's do as I say, not as I do lifestyle.

Dr. Jules Hirsch, emeritus professor and emeritus physician in chief at Rockefeller University takes on the is a calorie a calorie question in the New York Times.

Friday, July 13, 2012

Don't Mess With Canada's BBQ Chips

Today's Funny Friday is a warning for all of my American readers - when you're in Canada, don't you effen' touch our BBQ chips!

(Gotta say, it's pretty grand to be fortunate enough to live in a country where this is considered news)

Have a great weekend!

[Remember, email subscribers need to head to the blog to watch]

Thursday, July 12, 2012

What The Food Industry Does At a Public Health Policy Table

Beatrice Martha Webb 1858-1943
Yesterday I had the pleasure of presenting some of my thoughts to the Ontario Childhood Obesity Healthy Kids Panel. It was a lively discussion and I'm hopeful that I provided them with some figurative food for thought and was certainly heartened by the undeniably evident gravity with which committee members have taken to their task.

While a brief blog post won't be sufficient to suss out my presentation and our discussions I can tell you that my contribution's overarching theme was that what we require is an attack, not on childhood obesity, but on an environment where the proverbial life current relentlessly pushes us all, old and young alike, to consume too much food, too many unhealthy products, and too many calories. The default for the majority in this environment is gain. Not gain by their choosing, but gain because swimming against a relentless and powerful current isn't a sustainable, realistic or fair strategy for surviving what for the past 40 years of environmental change has turned into an increasingly violent flood. Ultimately we need to change the defaults and in addressing the flood, we therefore need to focus our limited resources on building levees, not on swimming lessons.

Of course there is one group who would be diametrically opposed to a default that led to lesser levels of consumption - the folks who make a living selling consumption - the food industry. Buying less food, buying fewer calories and fewer low-caliber, highly profitable calories (processed, highly pulverized, corn-subsidy subsidized, sweetened, fattened, super-sized and yet evolutionarily delicious to our mouths calories) is not good for the business of food and product manufacturers.

While there are a number of members of this task force who have theoretical conflicts of interest due to ties to the food industry (and it's important to note that the perception of a possible conflict of interest is in fact the very definition of a conflict of interest and that having a conflict therefore doesn't necessitate ever acting consequent to the conflict), there is one member whose actual job it is to represent them. What was perhaps telling was the fact that during my presentation and during the question and answer period that followed that member was furiously taking notes while all of the other members were actively engaging in conversation and discussion.

Do you think those notes were meant to further the fight against the currents driving childhood obesity? Were they points of agreement? Were they ways the food industry could build on my call to action that we need to change the default such that people will buy less food? And why did this member not engage in a discussion with me while there?

I don't know the answers to those questions, but I'd be willing to wager that unlike everyone else at the table, given that member's actual paying day job is to protect the interests of the food-selling corporations they represent, that those notes weren't about points of agreement. I also think that not engaging me was certainly in part consequent to knowing my less than friendly viewpoint, but also likely in part due to the fact that engaging me directly would be far more challenging given my background than engaging and reviewing my words and views once I was gone. What I'd wager the notes were for was to ensure my objections and concerns were noted such that either on their own or with the help of their colleagues, that they work on their best possible spins so as to champion those few recommendations the food industry could live with (at least on paper), and also how to best defuse or dilute those recommendations that would in fact certainly hurt sales (like for instance a frank ad ban on children's advertising and a reform of front of package labeling to disallow nutrient based health claims that dupe people into buying boxes of junk spiked with a vitamin).

It's truly a shame that there are both real and potential conflicts of interests at that table, and given the sophistication of the food industry the simple math that there are more non-conflicted members than conflicted ones doesn't make it any better. Consider this. The food industry representative's living depends in part on their skills as an expert communicator and they also have tremendous resources at their disposal to try to work on messaging to support their members' interests, whereas the public members, they're just people who care and are experts in their various professions - professions that don't require them to be experts in spin - who will be going back to their real day jobs until the next meeting, whereas being at the meeting IS the food industry representative's job.

I concluded my presentation by referring the members to the story of Beatrice Martha Webb. Webb was a woman ahead of her time and along with helping to co-found the London School of Economics, she was also a member of an important government task force that was considering the notion of social equity. Unhappy with the recommendations that were shaping up in the meetings, Webb elected to champion the publication of a minority report which allowed dissenting members to have their voices heard without the need for unanimity. For Webb, her disagreements with the recommendations the committee was set to make were so important and formative to what she viewed as right and wrong, that dilution of her convictions to achieve a compromise was not an acceptable option to her.

It's been said that the person in the relationship who cares the least wields the most power, and when it comes to the health of children there's no doubt representatives of the food industry will care the least, not because they're horrible people, but simply because caring about health is only within their mandate if it doesn't negatively impact upon (or if it improves upon) sales or public perception (which in turn affects sales).

While you might argue that the food industry should have a say at these meetings, I think it's absolutely unconscionable that they've been given a vote.

Wednesday, July 11, 2012

Gear Review: My Cold Cup - Cheaper and Healthier Than Your Kids' School Milk Program

[Full disclosure - 2 cups provided to me for my kids to test drive]

Ottawa mom and engineer Gwenda Lindhorst-Ko had enough. Her son Jonathan was part of his school's milk program and it was chocolate milk he was drinking. The reason? The white milk didn't taste as good.

Now while many folks (me included) may have just immediately said, "Duh, kids like sugar", not Gwenda, and she wondered whether or not serving temperature may have something to do with it as after all, less than ice cold white milk isn't the best tasting beverage in the world. And she didn't just stop there, she decided to test her hypothesis by engineering and producing a product she's called, "myColdCup".

It's pretty easy to describe. Think a BPA free, stainless steel, 250mL thermos with a freezable insert and a kid friendly, leak proof lid. Basically you freeze the small insert and then snap it onto the inside of the lid, fill your cup with milk (or whatever beverage you want to stay cold) and away you go.

According to Gwenda it'll keep milk at lower than a fridge cold 4 degrees Celsius for 5 hours. According to my kids, "it was really cold, even at the end of the day!". Given it's meant to be carting milk around Gwenda also ensured it was wide mouthed so that it's easy to clean.

While there's definitely an outlay cost ($24.99), given the cost of home poured milk versus school based cartons, it'll pay for itself long before a school year's over.

If you're sick of your kids' school milk program choices and you're looking for an alternative, of if you just want the ability to keep your kids' (or your own) beverages cold, I'd recommend you give myColdCup a good look.

Available for purchase locally in Ottawa, or globally online via www.myColdCup.com

Tuesday, July 10, 2012

Issues with "Based on a 2,000 Calorie Diet"

"Based on a 2,000 Calorie Diet"

That's the wording you'll find in the footnotes of our nutrition fact panels. Moreover it's repeated in the media regularly.

But is it useful?

Is the regular printing and reporting of a population average that includes men and women, tall and short, sick and healthy, young and old, active and inactive, a good idea even if it does have the proviso that yours may be higher or lower?

I understand that the numbers are there for the ridiculous and frankly nutritionally disinformative breakdown of "nutrients", but I would imagine that for many they serve as a caloric anchor. Something to aim for that's safe.

Yet the average woman on 2,000 calories will almost assuredly gain weight, while the average man on 2,000 calories will almost assuredly go hungry.

We need nutrition fact panel reforms.

We need to de-emphasize the nutrient based approach to box-based nutritional disclosures and actually emphasize real world portions, and I think part of those reforms needs to include more useful caloric guidance and at the very, very least, providing average values for men and women separately.

Calories are definitely not the be all and end all of nutrition, but they're certainly a major determinant therein. We need a better way to inform the public about their calorie needs than simply reporting on an average.

Have you ever aimed at 2,000 calories because that's what was reported to you as appropriate?

Monday, July 09, 2012

Fast Westernized Food, Not Fitness or Weight, Increases Diabetes and Heart Disease Risk

What cool data.

Researchers from the Universities of Minnesota, Singapore and Pittsburgh joined together to explore the impact of westernized eating on the incidence of type 2 diabetes and fatal heart attacks in Chinese Singaporeans between the years 1993-1998.

It was a unique study population in that the authors report that western-style fast food intake in east and southeast Asia only became somewhat prominent in the very late 80s and early 90s.  The authors also had data on the subjects' age, smoking habits, alcohol, education, BMI, total caloric intake, exercise and sleep duration.

The final analysis involved 43,176 participants and self-reported incidence of type 2 diabetes and death from coronary heart disease were scored against fast food intake (derived from a food frequency questionnaire specifically designed to discern between western style fast food and traditional Asian fast food) and controlled for those variables listed above.

Individuals who reported eating western style fast food more than twice weekly had a 27% increased risk of developing type 2 diabetes and a 56% increased risk of a fatal heart attack compared with those who reported not eating western style fast food. Things were worse for those who reported eating western style fast food more than 4x weekly with their risk of fatal heart attack being increased by 80%.

But that's not the fascinating part, this is. Not only were those risks independent of the various potential confounding controls, but according to the authors and contrary to what you might expect, participants who reported more frequent westernized fast food were younger, less likely to be hypertensive, more educated, smoked less and were more likely to be physically active - and those behaviours still didn't protect them from the risks of junk food.

Now of course there are real and dramatic limitations to this study with the two largest being that food frequency questionnaires stink as a whole and in this case were only administered once and that self reported diabetes rates may miss many who had diabetes at the outset of the study. That said, if these results are valid it would suggest that the denormalization of restaurants and processed convenience foods and the renormalizing of our kitchens and true whole ingredient transformative cooking are important public health targets - independent of any concerns or interventions geared to tackle obesity. 

Fast food's bad for everyone, regardless of their weights.  This week, if it's not something you do regularly, how about one from scratch homemade meal?

[Free PDF of the paper by clicking here]

Saturday, July 07, 2012

Friday, July 06, 2012

A Dora the Explorer Movie I'd Even Watch

Today's Funny Friday is for all you fellow parents out there who've had to suffer through the relentless yelling that is Dora the Explorer (seriously, why does she have to yell everything?).

Have a great weekend!

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

Thursday, July 05, 2012

Badvertising: Sweetwashing Products Made Entirely of Sugar

Ever come across the term, "Unsweetened" on the front of a package?  How about, "No Sugar Added"?

They're there to make you feel that the product inside the box is a healthy one.

A quick peek at the back of the box is probably in order.

Take Mott's Fruitsations Unsweetened Strawberry Fruit Rockets for instance. Reading the ingredients you'll find that they include both, "Concentrated Strawberry Puree", and, "Concentrated Fruit Juices".

And what are concentrated purees and juices?

Sugar.  Plain old sugar.

So how much extra sugar is this sweet-washed "unsweetened" strawberry flavoured red goo packing?

Double what you'd find in an equivalent weight of actual strawberries.

Think that's bad?

Check out all of these:

3 teaspoons of sugar per 18g serving (66% sugar by weight  responsible for 80% of calories) coming from  concentrated apple purees and juices.  10X the sugar of 18g of actual apples.

2.75 teaspoons of sugar per 14g serving (79% sugar by weight  responsible for 98% of calories) coming from concentrated apple, pear, strawberry and grape purees and juices.  15.7X the sugar of 14g of actual strawberries.

9.25 teaspoons of sugar per 250mL serving (sugar responsible for 99% of calories) coming from concentrated grape, apple and raspberry juices.  One cup of this juice contains the equivalent amount of sugar as would 6.9 cups of actual raspberries.

9.5 teaspoons of sugar per 250mL serving (sugar responsible for 101% of calories?) coming from concentrated grape, cranberry and apple juices.  One cup of this juice contains the equivalent amount of sugar as would 9.5 cups of actual cranberries.
And who's right there helping with the sweetwashing by providing their seal of approval to products that are almost literally pure sugar?  Why the Heart and Stroke Foundation as its Health Check logo is on each and every one, which in case you weren't aware is meant to signify,
"The Health Check logo tells you the food or menu item has been reviewed by the Heart and Stroke Foundation’s registered dietitians and can contribute to an overall healthy diet"
Is there really a dietitian on the planet that would recommend the consumption of products made virtually entirely out of sugar?

Produce NOT products!

Wednesday, July 04, 2012

Badvertising: Mott's Fruitsations Fruit Rockets Insult Apples (and Intelligence)

Mott's Fruitsations Fruit Rockets Unsweetened Apple,
"....now in a convenient on the go pouch. It's 100%* fruit in a fun, new pack you can take anywhere"

Finally a way to transport "apples" conveniently without all that awful mess. So what if these "apples" need "natural flavours" to make them taste like apples (hence the asterisk up above)? So what if my kids don't get the fibre and phytonutrients of unprocessed actual apples? So what if giving them products like this may lead them to think health comes just as easily in highly processed packaged foods?


You know what else has a fun pack you can take anywhere?

Frickin' apples!

Buy produce, not products!


(oh, and in case you can't see it, these have the Heart and Stroke Foundation's Health Check logo - way to go HSF)

Tuesday, July 03, 2012

The Future of Exergaming May be Bright, But The Present is Less Than Dim

I think it's pretty clear now. We should be taking the "Exer" off the word "Gaming".

While I've no doubt there are a few folks out there who can truly work up a sweat gaming, the studies that have been published to date have demonstrated exergaming outcomes that would be generously described as lackluster.

But I have hope. In fact a huge amount of hope in that I think the future of exergaming is not only incredibly bright, but I think it's nearly here.

What I'm expecting we'll see in the next few years is a convergence of technologies. GPS and accelerometry along with augmented reality and powerful peripherals like smartphones, devices such as the as yet unreleased Google glasses and devices specifically built as active gaming platforms. The first generation of this sort of convergence already exist (see my review for the amazing iPhone running app - ZombiesRun!) and truly, as an ex-gamer myself, can't wait for the future where I think these sorts of technological convergences will make exercising incredible fun.

We're all consumers of time, kids too, and if we ever want to see people truly getting a sweat on gaming, the games are going to have to be varied, immersive, and not relegated to a traditional television based console like that photo up above. The fun quotient just isn't high enough to sustain the behaviour. As consumers of time we decide the time spent on those sorts of games just isn't worth the limited pleasure derived from them. Good news is that the technology to make the time more valuable already exists - it just needs a bit more polish.

Can't wait!