Saturday, February 28, 2015

Saturday Stories: Chris Kyle, CAM, and a 'P' Value Ban

Michael J. Mooney covers the real life story of American Sniper Chris Kyle.

Edzard Ernst asks whether or not "complementary and alternative medicine" is good or bad for kids.

Steven Novella covers the story of the first science journal to ban significance testing.

[And if you don't follow me on Twitter or Facebook, here's the piece I wrote for US News and World Report on the new US Dietary Guidelines Advisory Committee's recommendations and below is the segment I did with The Social on exericse]

Friday, February 27, 2015

A Laugh More Infectious than Measles

Today's Funny Friday video is of a Russian baby with a tremendously wonderful laugh.

Have a great weekend!

Thursday, February 26, 2015

When Intermittent Fasting is No Longer Intermittent Fasting

Jean Fortunet [CC BY 1.0], via Wikimedia Commons
For those of you not familiar, there are three main intermittent fasting camps. There are the folks who truly fast for 1 or 2 days weekly and who eat as sensibly as they can enjoy on the non-fasting days (folks like Brad Pilon), there are the folks who have an 8 hour eating window following a 16 hour fast (folks like Martin Berkhan), and then there are folks who alternate sensible days of eating with days of very-low calories, where those calories are typically consumed at once at midday. It's the last group I'll be talking about and I think it would be fair to say that Krista Varady is this group's primary researcher and champion.

Recently she published a new study whereby she compared the impact of having those 500 calories all at once midday, vs. spread out in smaller meals or consumed at dinner time on weight loss and some metabolic parameters. According to her study, it was undertaken in part because of the low levels of tolerability found among new adherents to her style of dieting. The findings were straightforward. A full 20% of each treatment arm dropped out before the 8 weeks were over which no doubt speaks to the challenge of this style of eating. Weight loss and metabolic changes were roughly the same between groups.

Reading this study, two things kept nagging at me. The first was the use of the word "fasting". Can you really describe a day where you eat a bunch of small meals (or really anything at all) fasting? Doesn't strike me as alternate day fasting, strikes me more as alternate day very-low-calorie-dieting, or maybe alternate day protein-sparing modified fasting (and for the record, I never understood that term either), and I can't help but wonder if part of the challenge with adherence is the negative associations people might have with the word, "fasting". And the second thing of course was the dropout rate. 20% in just an 8 week study strikes me as extremely high. Consequently, while no doubt a useful strategy for some, I can't say that I'm hopeful this approach will suit too many.

Wednesday, February 25, 2015

Another Study for the "You Can't Outrun Your Fork" File

Published this month in the Journal of General Internal Medicine was a study that looked at the impact of an interventionist led program geared towards increasing physical activity in sedentary women with overweight and obesity.

The outcome of the intervention was in one sense quite significant - at 3 months the women randomly assigned to the interventionist led group reported performing nearly 4x as much exercise as the women randomly assigned to a self-directed intervention. Unfortunately though, by month 12, that difference shrank to the point of no longer being statistically significant.

Why did their exercise drop off so much?

Perhaps it was because of the fact that exercising more at 3 months didn't result in any increase in weight loss for the interventionist led group, which, like it does with gym goers every New Year's season, may have led those folks exercising more at month 3 to have long since given up exercising more by month 12 following the repeated frustration of scales that didn't do what was hoped of them.

Overselling exercise's benefits to weight while underselling its benefits to health, does a disservice to both.

Tuesday, February 24, 2015

There's No Question that Nothing Will Change if you Change Nothing

The inconvenient truth of healthful living?

It requires effort.

Just make sure that your efforts are enjoyable as the more extreme the effort, the more short-lived it's likely to be.

Monday, February 23, 2015

Consistency's a Far Better Goal than Perfection

Consistency in doing your best, where your best will vary day by day. Sometimes variance will be consequent to things out of your control (illness, travel, celebration, tragedy), and sometimes variance will be within your control, with the point being, no one's perfect, and the harder you try to be, the surer you'll fail.

(Sorry for brevity, still sick!)

Friday, February 20, 2015

Coordination is Not a Dog Given Right

Grace neither, and today's Funny Friday video will make these points well.

Have a great weekend!

Thursday, February 19, 2015

You Can Stack Your Deck, But You Can't Get a New One

Still too sick to feel up to writing so no new post today either. Can't remember why but this ad came to mind the other day. Thought it was worth a repost.

Long time readers will know, I'm a slow runner.

I was thrilled a few weeks ago to break a 5 minute km pace on a 4km run (roughly a 7.5mph pace, nothing particularly brag worthy), and I had to really kill myself to do it, and the distance sure wasn't all that long.

Then I came across this video that highlighted an absolutely brilliant advertisement from ASICS.

Their challenge? Race against Olympic caliber marathoner Ryan Hall for just 60ft and see if you can keep up.

Ryan's best marathon time? 2:04:58. That translates to a pace of nearly 12.6mph for 26.2 miles!


And enlightening.

There are only a few Ryan Hall's in the world. Don't try to be one of them. Instead, as I've been yammering on about for some time, set your goal to do your best and never be discouraged if it's not as good as someone else's. Sure So-And-So might be losing weight faster than you, but really, why does it matter?

We've all got a deck of cards in life. We can stack them, but we can't swap them out.

Stack your deck as best you can, but don't ever be discouraged if your deck isn't as stacked as someone else - that's just real life.

If you want to see Ryan Hall run, and the brilliant ASICS ad, watch the video below (email subscribers, head to the blog to watch).

Wednesday, February 18, 2015

A Few Immediate Openings in our Office's Childhood Obesity Treatment Program.

Sorry, no new post today. I've done and caught what I believe to be influenza and it has really knocked me off my feet. This post highlights our office's Family Reset program - a program for parents of children between the ages of 5-12 whose weights are of concern. We still have a few of our 2014 allocated spots available, but if we don't use them by the end of March, we'll lose them and would hate to see them go to waste. If you're concerned about your child, have a read, and if you're in Ottawa and you're interested, please give us a call at 613-730-0264 and we'll be able to see you within the next few weeks.
A little over a year ago our office launched the Family Reset program - a program designed to work with the parents of 5-12 year old children whose weights are of concern. Some parents were worried about their children's potential future health concerns. Others were worried about current weight related bullying or self-esteem issues and weren't sure how best to help their kids. We wanted to put together a program and a team of health professionals to address all aspects of weight - from health to bias, from body image to fitness. Briefly, the fully funded (there's zero cost to families) program's highlights include:
  • All parents are followed by a physician.
  • All parents receive 6 months of unlimited one-on-one counselling from a registered dietitian, behaviourist and exercise specialist who will work on family health, parenting, nutrition, healthy active living and the cultivation of healthy attitudes surrounding weight and body image. Parents will continue to meet with all team members following those 6 months at prescribed intervals, but if the need arises, emergently as well.
  • All parents who themselves have overweight or obesity will be provided with BMI’s existing 6 month behavioural weight management program which also includes unlimited access to all team members, as well as on-site group fitness classes three times weekly for 6 months.
  • Five group classes for children, led by a specialized social worker/behaviourist with sessions focusing on self-esteem, anti-bullying, body image and stereotypes, depression, anxiety, and anger management. There will be no emphasis or discussion on weight at these meetings aside from how weight might play into the emotions and issues being discussed.
  • One group class for adults with overweight or obesity led by a clinical psychologist on common psychological roadblocks to self-efficacy.
  • Ten hours of one-on-one therapy with a clinical psychologist for parents struggling with mental health issues such as depression and anxiety as improving the treatment of mood disturbances will likely improve those parents' interactions with their children
  • Seasonal group fitness outings designed for families led by exercise specialists to introduce families to different active living options.
  • Two group cooking classes for all parents at a rented outside facility designed to teach basic cooking and meal preparation skills. Thanks too to the generosity of best selling cookbook authors Greta and Janet Podleski, each family will receive a free copy of their latest compilation The Looneyspoons Collection which was Canada's best-selling cookbook of 2012.
Today I wanted to touch on the outcomes to date.

While we haven't yet done any statistical crunching, the outcomes are pretty much what one might expect. Many kids lost weight. Some kids stopped gaining weight. Some kids continued to gain but gained more slowly. Some kids weights and gains didn't see change. That range makes sense too because parenting is fairly described as role model, guide, support and then hope for the best. Put another way, as every parent knows, no matter how badly we want something from or for our children, there simply isn't any way to guarantee we can make it happen.

The adults too had outcomes across the board. From small losses, to one couple who together over the course of their year with us, lost 191 lbs.

But one thing I'm confident of, every single family coming through our Family Reset program, learned how to approach health and weight free from nonsense, free from weight-bias, and learned how to improve upon their family's lifestyles in a manner that was body-image and self-esteem friendly, and one which regardless of weight, benefits health.

Ottawa parents, if you have a child 12 and under whose weight places them in the 85th percentile (for a calculator click here) or higher and would like to be considered for our Family Reset program please give our office a call at 613-730-0264, or send Tori an email and we will quickly contact you to set up an appointment to discuss our program further.

[And Ottawa folks, please feel free to share this post with your various social networks]

Tuesday, February 17, 2015

Guest Post: Why Has the Fitness Industry Become Elitist?

Jonathan Goodman is a fitness trainer turned social media and business development guru. I met Jonathan when he asked me to come and give a talk for one of his events and recently he reached out to ask if he might share a piece with the readers here.

The fitness landscape has become fragmented and polarizing. This is making for an elitist divide not just between the converted and the unconverted, but between different factions of the converted.

When people say, “I need to work my way up to the gym” it saddens me. Have we really created a fitness environment where people feel like they’re not ready to get into shape? The gym should be a sanctuary where all are welcome.

Physical activity has given me confidence and purpose. As a result, I’ve dedicated my life to improving the quality of fitness instruction. But there are a number of reasons why people aren’t comfortable in our gyms, and the first step is recognizing that there is a problem.

Cognitive dissonance and the emergence of filter bubbles

The seminal observational study of cognitive dissonance from 1956, When Prophecy Fails, starts by saying, “a man with conviction is a hard man to change. Tell him you disagree and he turns away. Show him facts or figures and he questions your sources. Appeal to logic and he fails to see your point.

The parallel between the cult studied in When Prophecy Fails and many fitness cults that have emerged today is troubling. I’ll use “paleo” to illustrate my point because, while there’s nothing wrong with eating the way that many paleo pundits advise, the entire premise behind it is absurd.

The narrative is enticing – our ancestors ate a certain way and therefore we should eat a certain way. Unfortunately, the narrative has been proven to be untrue. One would think that if a concept is proven to be untrue then interest in it would dwindle, but, in this case, the opposite has happened. So why do people who identify themselves as “paleo” continue to become more numerous and their desire to spread a false narrative growing?

When Prophecy Fails provides some insight into the five conditions that lead to the observed “increased fervor following the disconfirmation of belief”. They are:
  1. A belief must be held with deep conviction and it must have some relevance to action, that is, to what the believer does or how he behaves.
  2. The person holding the belief must have committed himself to it; that is, for the sake of his belief, he must have taken some important action that is difficult to undo.
  3. The belief must be sufficiently specific and sufficiently concerned with the real world so that events may unequivocally refute the belief.
  4. Such undeniable dis-confirmatory evidence must occur and must be recognized by the individual holding the belief.
  5. The believer must have social support.
And don’t think that I’m picking on paleo. Many of the fitness cults like CrossFit and biohacking that exist today meet these conditions as well.

Cognitive dissonance refers to the differing of two beliefs that do not fit together. It results in discomfort, anxiety, and pain. The common response when faced with dissonance is to search for consonance to override the painful experience. One of the most common ways to do so is to look for social support, and this is where filter bubbles come into the picture.

The Filter Bubble

Eli Pariser is credited with popularizing the term “filter bubble” to describe the burgeoning personalized web. Every click, like, share, or comment that you make online is tracked and fed into a giant information bucket, sorted, and sold. The result is that your digital profile continues to evolve in the eyes of advertisers. Search has become reverse search. Google, Facebook, and thousands of other sites know who you are and what you like and show you information that is agreeable to you.

What it comes down to is this, “if you’re not the consumer than you are the product.”

Conspiracy theorists may be wearing tin hats, but I argue that the main problem is not that Big Brother is watching. The problem is that our ability to experience and think is being diminished with every passing day. Awareness is built upon associative connections, or reference points. There are no acquired emotions and feelings. How you make sense of information is in reference to something that you already know to exist.
Eli Pariser sums up the problem when he said,
Just as the factory farming system that produces and delivers our food shapes what we eat, the dynamics of our media shape what information we consume. Now we’re quickly shifting toward a regiment chock-full of personally relevant information. And while that can be helpful, too much of a good thing can also cause real problems. Left to their own devices, personalization filters serve up a kind of invisible autopropaganda, indoctrinating us with our own ideas, amplifying our desire for things that are familiar and leaving us oblivious to the dangers lurking in the dark territory of the unknown.
Whether you know it or not, you’ve been building a bubble around yourself. Increasingly dissonant information is being hidden from you and your resulting consonance is growing. These bubbles act to filter out any dissonant information before it arrives and, when it does arrive, ample support is already there to support pre-existing notions.

For society at large it means that factions exist. And these factions are just as exclusive as they are inclusive.

Why has the gym become elitist?

Now that I’ve briefly discussed the problem of arranging into groups, I’d like to cover some other topics that lead to an elitist fitness divide between the converted and unconverted.

1. Everyday boasting masked as motivation

Motivational sayings (often referred to as fitspo) superimposed over a half-naked photoshopped body have been around for years. What’s new is that sites like Facebook and Instagram have brought them into everybody’s homes. While these photos are nice to look at I’d argue they aren’t helping anybody. Instead they’re acting as a way for the already in-shape to show off.

While the person sharing the quote might be doing it under the guise of motivation, it’s not motivational to those who really need it. It’s a new method of boasting.

The most common reason why people share material on the Internet is a concept called selective self-representation. In essence, sharing is a way to show off or receive perceived social support on stuff that a person is unconfident about. Not only that, but people who rank lower on scales of emotional stability share more often. The motivational quote that is being shared isn’t altruistic. It’s being done because the sharer feels like it will make him or her appear a certain way to people who he or she wants to impress.

Think about it – who within your Facebook friend group shares motivational material? Is it the people who don’t exercise or really ripped workout nuts? One of the largest reasons that people share material on the Internet is to show off what they already do. Richard Dawkins, in the Selfish Gene, was the first to coin the term “meme” when he said,
Just as genes propagate themselves in the gene pool by leaping from body to body via sperms or eggs, so memes propagate themselves in the meme pool by leaping from brain to brain, via a process which, in the broad sense, can be called imitation.
When people think of memes they usually think of cat pictures and superimposed text on images of celebrities. I’d like to coin a new phrase: “the selfish meme”, as an evolution of Dawkins’ original idea because I don’t believe that altruism exists online. Memes are released with the creator’s best intentions in mind and they spread purposely through networks by people who have something to gain from passing them along whether we’re willing to admit it or not.

Large companies know this and are taking advantage of it.

Instead of spending lots of money on TV and print ads, smart companies are superimposing a motivational phrase on a picture of an attractive, and usually photoshopped, person. The result is that the picture spreads and the company gets free advertising. This behaviour is perpetuating an elitist gym environment and an unrealistic ideal.

People who don’t exercise aren’t stupid. They know they should be in the gym and already feel bad about not doing it. They don’t need a picture of a beautiful person with an oft-repeated slogan to remind them to “just do it”.

2. Over-information

Dogma’s are created and broken every day. Conflicting information is common and everyone seems to be an expert that has stumbled upon the “next best thing”. Fact is there isn’t a next best thing. Exercise is beautiful in its simplicity. The next best thing may be slightly better or slightly worse than the last best thing. It does however confuse the hell out of anybody reading it.

Somebody new to the gym has no idea who or what to listen to. The reality is that if they picked one source and followed it they’d succeed. This is irrelevant of how profound the information is.

I get the need to continually innovate and am a proponent of the scientific method. However the nature of building a brand around one way of doing things forces the creator into the opposite of the scientific method – that is, if proven wrong, be willing to change. The minute that a business revolves around a singular idea it becomes near impossible for the purveyor of that idea to change if proven wrong. If you’ve built a business around the paleo narrative, for example, and the narrative is proven false, you have no choice but to cling to it. This is wrong.

Another issue is that it’s also a lot easier to sell the newest method of fat loss than it is to get somebody excited about the tried and tested method. The contrarian method of gaining exposure is also adding to the problem and its use is growing.

For somebody new to exercise, the task is daunting with the first steps being the hardest. Not knowing what program is “best” adds to the struggle. What bothers me is the “best” program probably isn’t even the best. Unless you’ve got at least a year of serious strength training under your belt, stop looking for “the best”. Choose a program and start today.

The problem compounds upon itself when conflicting theories are written as fact. Somebody who has never exercised before will benefit from steady-state cardio, as an example. It’s not as evil as it’s cracked up to be. It may not be the most efficient way to exercise but it’s stood as an entry point for a lot of people to get their bearings in the gym. Sit on a bike for a couple weeks until you feel comfortable. Then start throwing weights around.

Let’s break down the barriers

The problems are real and they’re growing. In order to reverse the trend I see three solutions.

The first solution is exceedingly simple. If you’re already comfortable in the gym, work to make it a more comfortable place for others. When you see somebody unfit that’s new in your club, smile and introduce yourself.

When the person is leaving try to find something pertaining to his or her workout to complement. Say that you’re looking forward to seeing him or her in the gym again. In the coming days and weeks attempt to introduce that person to others in your gym. If he or she becomes a member of the community odds are they your new friend won’t fall off the workout wagon again.

The next solution is to understand the power of social modelling.

Motivational posters don’t motivate people unless they’re already exercising. Self-efficacy (the belief that one can achieve) is at its highest when the person feels that the model is the same as them. For it to be effective the demographic, background, injuries etc. must all be taken into consideration.

If you really want to motivate others in an altruistic sense you’d be passing around success stories of all types of people from all different backgrounds. I’m not talking about passing around sensationalistic stories about massive weight losses. I’m talking about real people, real struggles, and real successes.

The last solution is to leave your insular community stop confusing people.

Recognize that you’ve created a filter bubble around yourself. If you ascribe to one particular way of exercising or eating that fine, but it’s not for everybody. What you see in your searches and feeds was chosen for you because of actions that you’ve previously taken. I urge you not only to read opposing opinions, but also to introduce others to them.

The fitness world is becoming elitist. The fit have created a daunting atmosphere where the unfit don’t feel welcome. Filter bubbles reinforce our preconceived notions, reinforce our consonance and downplay any cognitive dissonance, and provide us ample support from others for ideas that might have already been proven wrong.

Think before you share a sweaty photoshopped image about whom you’re really trying to motivate and what you’re really getting out of it. Consider the “next best thing” that you’re peppering your friends, family members, or blog readers with and think hard about the effect it’s really having.

Jonathan Goodman is the author of Ignite the Fire, a book that teaches how to become a personal trainer and build a successful career. To learn more about his personal training books and free collaborative resource for trainers, go to the Personal Trainer Development Center.

Saturday, February 14, 2015

Saturday Stories: A BMJ Sugar Special Edition

I'm not sure how long these will all remain free and so today's Saturday Stories is a collection of stories that were all just published in the British Medical Journal.

Sugar: spinning a web of influence

Sugar’s web of influence 2: Biasing the science

Sugar’s web of influence 3: Why the responsibility deal is a “dead duck” for sugar reduction

Sugar’s web of influence 4: Mars and company: sweet heroes or villains?

Commentary: Sweet policies

[And if you don't follow me on Twitter or Facebook, here's the episode I shot recently with CBC Marketplace busting some Lousy Labels]

Friday, February 13, 2015

Must Watch Video! American Kids React to Global Breakfasts

What a great Funny Friday video! Funny, fascinating and topical!

Thanks to Chad Nippard for sending my way.

Have a great weekend!

Thursday, February 12, 2015

A Brief PSA Request. Don't Be a PubMed Warrior.

Having vast amounts of information freely available is a wonderful thing, but please, for the love of anything you consider holy or important, don't use abstracts you found in PubMed searches to prove your point (in comments, or on social media) unless you've actually read the full text of the article you're citing, and simultaneously you feel that you understood the article's methodology and limitations enough to think it worth sharing.

Thank you.

Wednesday, February 11, 2015

More and More Gyms Posting the Calories Burned Through Exercise

It would seem to me that the only rationale for the posting of gym based calorie burns would be for weight management.

Sure, some folks may well use them to maximize the calories they burn through exercise, but I can't help but wonder whether others will use them as a rationale for eating back their exercise? I also have real doubts about some of the numbers listed - to my eyes they seem rather inflated which in turn might present someone concerned with calories a false sense of security.

Seems to me this would be an area ripe for study.

Does posting this information help people with weight management, or paradoxically might it make it more difficult?

Tuesday, February 10, 2015

It's Never "Just One"

Did you know that February 7th was "National Eat Ice Cream for Breakfast" Day?

Surprising as it was for me to learn that we North Americans find so few opportunities to eat ice cream that we also need a special day to encourage its consumption, far more surprising was watching The Cleveland Clinic, "America's No. 1 Heart Hospital", tweeting out encouragement to its 346,000 followers to feed ice-cream to their children for breakfast in the name of this important National holiday.

I called them out on their encouragement (their tweet has since been deleted, that's just a screenshot up above), and what happened next was sadly not even remotely surprising. People rose to The Cleveland Clinic's give your kids ice-cream for breakfast endorsement's defence. Here's a smattering from my blog's Facebook page:

And of course it's reasonable to have a treat once in a while, but really? Once in a while? Do we really live in a society that only "once in a while" indulges? Are we really deficient in our collective intake of ice-cream?

Much to our population's health's chagrin, when it comes to food, the word "treat" doesn't really have much meaning anymore, because how can you call something that's constant, that's encouraged for truly the most pointless of reasons (like up above), a "treat"?

That the Cleveland Clinic initially felt comfortable sending out their original tweet, and that people felt it important to rise to that tweet's defence, speak to just how pervasive and normal the constant use of treats has become in our lives. Yes, food is comforting. Yes, food is pleasurable. And yes, we should absolutely ensure our lives include the joy that comes from dietary indulgences, but for the folks coming to National Eat Ice-Cream for Breakfast Day's promotional defence, these days, it's never "just one".

Monday, February 09, 2015

New Brunswick MDs and RDs Team Up to Make School Menus Matter

It's menus like this one that New Brunswick's MDs and RDs hope to change
Over in New Brunswick the the New Brunswick Medical Society and the New Brunswick Dietitians in Action have joined forces for a second round of their "Make Menus Matter" campaign.

The campaign, launched in 2013, aimed to explore what was being served to children in New Brunswick schools. At the time they collected school menus and asked kids to post pictures of their meals.

Well the data is in and it's not pretty. According to their analysis, 71% of school meals didn't comply with New Brunswick's school food policy. What is pretty, is that New Brunswick's health professionals are trying to do something about it and are providing reports of their school by school analyses to New Brunswick's Department of Education, are writing letters to schools that aren't in compliance to offer them help and assistance, and with a repeat of their 2013 campaign, are driving discussion in their communities.

But it's not all bad news. There were some great success stories, and they're highlighted here in the Make Menus Matter Where to Eat in New Brunswick Schools Guide, and they include what sounds like a wonderful Farm to School program and a kid cooked meal program both being run out of Cambridge-Narrows Community School.

Here's hoping sustained attention, awareness, and assistance lead this ongoing program to make a difference.

Friday, February 06, 2015

Yoga Meets Pets (Not a Great Combo for Yoga)

Today's Funny Friday video is for all the yoga loving pet owners out there.

Have a great weekend!

[Hat tip to our Director of Operations Lorne]

Thursday, February 05, 2015

The Co-Opting of Social Issues to Generate Brand Goodwill

Literacy, clean drinking water, schools in third world countries, children's hospitals, sport fundraising, women's rights, end of life care, HIV, recycling, endangered species, national park rehabilitation, obesity, food security, breast cancer, and so many more - these are just a few of the many social issues that the food industry has latched onto in an effort to build goodwill and to cultivate positive, emotional, passionate brand associations loyalty.

It's a smart move too, because calling out the food industry's disingenuous partnerships leads defenders to lean on the partnered social issue's need for support as either clear cut evidence of the inherent goodness of the food industry, the short-sightedness of the critic, or that the ends justify the means.

During this most recent Superbowl, Coca-Cola, a sugar water company, launched their new #Makeithappy campaign geared to combat online bullying. Looking to the hashtag, sports heroes, celebrities, do-gooder NGOs, and the public have all signed on to the campaign, and in their tweets, are actively tying one of the world's greatest contributors to chronic disease and suffering (sugar sweetened beverages), to "happiness".

Brilliant marketing.

But it's marketing, not altruism.

Here's a quick quote from Forbes' Jeff Fromm which sums up why Coca-Cola is trying to #MakeitHappy,
"After all, what’s more meaningful than an adorable kid, who has faced a lifetime of challenges spreading messages of hope and happiness? Coke will likely receive positive millennial feedback for the advertisement, which I predict will inspire millennials who are already pro the “anti-hate” messages that brands are promoting today. As a result, millennials will become more attached to Coca Cola as a brand instead of just the product offerings. The #MakeitHappy campaign combines everything it takes to earn millennial love, which ultimately translates into millennial dollars."
Society has already determined that there are limits to the co-opting of social issues to generate brand goodwill in that money from the tobacco industry, while no doubt just as green as that of Coca-Cola, is no longer welcome - the means have been deemed unjustified.

I wonder how many more years it'll take before the door gets right shut on industries whose products and practices foment illness, from latching on to social causes to gain a gleam of goodness in their plain and simple pursuit of sales?

Wednesday, February 04, 2015

The Idiotic Musings of Patrick Luciani on "Fat Taxes" and Obesity

I suppose I need to create a Patrick Luciani blog tag as this is now the third time I've been moved to write about one of his opinion pieces.

Once again he's come out swinging about "fat taxes" suggesting that it's ridiculous to think they'll be the answer to obesity.

I wholeheartedly agree. It is absolutely ridiculous to suggest that "fat taxes" will be the answer to obesity, and nobody other than Luciani is doing so. It's ridiculous because given the complexity Luciani himself ascribes to obesity, there will be no singular intervention that will have a remarkable impact. Complex problems tend not to have simple, singular solutions - it's the, "but that single sandbag won't stop the flood" argument, and truly, that's a breathtakingly stupid argument.

Clearly, the McKinsey Institute, in their report that Luciani cites, understands that single sandbags don't stand a chance, as they promote many sandbags, including soda taxes, in their levee building, obesity fighting, recommendations. Regarding soda taxes specifically, the McKinsey Institute concluded that in the UK alone, soda taxes would save nearly 500,000 disability-adjusted life years (DALYs) at less thane one fifth the cost per DALY when compared with the surgical option that Luciani cites as a presumably sounder choice.

Luciani also waxes on about the regressive nature of a soda tax, but as Andy Bellatti has pointed out, chronic diseases like type 2 diabetes are far more regressive, and really, is it useful or ingenuous to discuss fat taxes as "regressive" when the impact of a 10% soda tax on a person drinking even 1L of the stuff a day would clock in at roughly 8 additional daily cents?

Indeed, a soda tax is just one of many behaviour influencing sandbags, but that said it appears to be a pretty robust looking sandbag - at least in Mexico, but you wouldn't know that from Luciani's screed, because instead of reporting on the actual outcomes of Mexico's newly enacted sugar sweetened beverage tax, he chose instead to opine that by taxing soda the sale of beer in Mexico might rise. Of course had he reported on the actual preliminary Mexican SSB tax results, the data is incredibly positive, whereby in the first four months following the implementation of the tax, there was a 10% decrease in the purchase of sugar sweetened beverages along with a concomitant 13% increase in the purchase of plain water!

Lastly, unlike Luciani, I don't perseverate around obesity as the rationale for discouraging the consumption of sugar sweetened beverages as sodas are no less unhealthy for those without weight than for those with it.

There are genuine worries that Canada's health care system will be unable to cope with the costs of the rising tides of diet and weight related illnesses. Yet when faced with what for example the Canadian Diabetes Association has called, "an economic tsunami", Luciani's only 4 recommendations are for swimming lessons - portion control, parental education, surgery, and weight management programs - interventions that work on a case-by-case basis, and even then, require resources our current medical system simply doesn't possess, and while I'm happy to see those sandbags filled as best we're able, suggesting that they alone will stem the flood is plain idiocy. As that same McKinsey Report that Luciani very clearly cites,
"Education and personal responsibility are critical elements of any program aiming to reduce obesity, but they are not sufficient on their own. Other required interventions rely less on conscious choices by individuals and more on changes to the environment and societal norms. They include reducing default portion sizes, changing marketing practices, and restructuring urban and education environments to facilitate physical activities."
Honestly, I can't fathom Luciani's motivation for sticking to, and recycling, his incredibly, almost unfathomably stupid, guns. Why is anybody's guess. Post-purchase rationalization? Sunk costs? Overt conflict of interest? Or alternatively perhaps it's me and those McKinsey folks who have been drinking some pretty heavy duty Kool-Aid?

(Oh, and please click on Patrick Luciani's post tag down below and you can read more about his various strawmen. Here's hoping he's running out of papers willing to publish them.)

Tuesday, February 03, 2015

Take Food, Not Vitamins

That's the take home message from an opinion paper published this week in the journal Medicine entitled, "Micronutrient Deficiencies, Vitamin Pills, and Nutritional Supplements".

In it Emilie Combet and Christina Buckton sought to summarize whether or not there's evidence to suggest that there's benefit to taking multivitamins and other supplements.

They point out that our bodies are incredibly well adapted to handle different levels of nutrient intakes and that we have mechanisms that help us to deal with shortfalls and surpluses of most supplements and that as a consequence, for true deficiency states to occur, usually a great deal of time (and dietary deficiency) needs to pass. They also point out that more is not always a good thing and that high levels of vitamins and minerals consequent to supplementation can in fact confer risk.

They suggest there are only 2 situations where good evidence would suggest a person should consider supplements.
  1. To correct specific and demonstrated deficiencies due to inadequate dietary intake (eg. a documented case of iron deficiency)
  2. To supplement people with disease states where requirements are heightened (critically ill patients), or absorption is compromised (inflammatory bowel disease, post-bariatric surgery, etc.)
The third situation that they highlight is the one that's most contentious, "to promote health and performance and protect against future chronic diseases in healthy adults". They note that there are in fact a few very specific situations where this would be true - folic acid before and during pregnancy and vitamin D in elderly institutionalized women, but that for the most part, meta-analyses of available supplement trials not only haven't been found to show benefit, they've actually shown harm (including for B-carotene, vitamin E, vitamin A and multivitamins).

As you might have already gathered, their conclusion is to eat a nutritionally balanced diet and not bother with supplements unless there's a real and non-theoretical need. My addition to that conclusion would be to suggest that unless there's a real reason for you to spend it, the money you're currently spending on supplements would be far better spent on any or all of:
  • Fresh fruits and vegetables
  • Cooking classes
  • Great new lunch boxes in which to pack your home-made lunches
  • Exercise equipment or clothing that might help you to move more
  • Dance lessons
  • Good room darkening blinds to improve your sleep
  • Etc!
Being concerned enough about your health to buy vitamins and supplements, while no doubt full of hope, probably isn't the best place for you to be spending your energy and concern. Instead, pretty much anything you can do that would improve the basics building blocks of health that we know matter so much - food, physical activity, happiness, and sleep, would stand a far greater chance of actually making a difference to your quality, and potentially quantity, of life than buying bottles full of wishful thinking.

Monday, February 02, 2015

Parents, Have You Ever Sought Help From an MD for Your Kid's Weight?

If you have, I'd love it if you could please take 2 minutes of your day to fill out this brief 6 question survey from the Centre for Effective Practice.

The survey is designed to see where physicians and nurse practitioners might be dropping the ball with parents who are looking for help for their kids' weights. The survey is part of a larger project (full disclosure, I'm helping out as its clinical lead) for The Ministry of Health and Long-Term Care (MOHLTC) and the Ontario College of Family Physicians to develop material for healthcare providers over the next 3 years.

Working with parents of children whose weights are of concern I've been surprised by the range of stories I've heard from parents who had sought help from the medical system. Sometimes they were positive and full of thoughtful and actionable advice. And sometimes they were less than helpful, with parents given incredibly trite advice and with very young children being chastised directly, and even rudely, by physicians in their offices. What I don't know is if there's a norm, and if the interactions had positive or negative impact upon the kids or parents. Perhaps there are some common challenges or best practices, which if identified, can be addressed in the materials developed by this project over the course of the next few years.

Again, if you've had experiences with your child's primary provider regarding weight, whether positive or negative, it would be terrific if you could take just a moment to click here and fill out this short questionnaire, and if you could also share this request on your Facebook pages and Twitter feeds, it would be greatly appreciated.

Maybe together we can do some good.

Warm thanks,