Thursday, March 31, 2016

Could Accurate Front-of-Package Food Photos Help People Eat Less?

Yesterday there was an interesting study published in Public Health Nutrition.

The study, "Frosting on the cake: pictures on food packaging bias serving size" explored four questions.

1. Do the calories of the foods pictured on fronts of packages exceed the calories stated on the package's per serving nutrition label?

Using cake mixes as an example the authors demonstrated that as pictured, with frosting, the slices of cake on the fronts of packages contained 134% more calories than the serving size calories published on the packages' nutritional facts panels.

2. Do people take extra ingredient calories into account when determining serving size?

Cornell undergrads were provided with two types of cake mix boxes and asked to estimate the "appropriate" number of calories per serving of cake.

One group of undergrads' boxes had photos of cake with frosting, while another group's boxes had photos of the same cakes unfrosted. The group with photos of cake with frosting were explicitly told that the frosting shown on the fronts of their packages' cakes was not included in the cake's back of box nutritional labeling. A third group was given boxes with photos of cake with frosting, but with no note regarding the frosting's calories not being included in the nutritional labelling.

The authors found that when there was no proviso about the frosting's calories not being included, the amount of calories that people believed were "appropriate" for a serving of cake rose dramatically.

3. Would clear front of package labelling about extra ingredients reduce serving size norms?

Using more undergrads, one group was provided with a box of cake mix that included a photo of cake with frosting and then asked to indicate what they thought would be a normal serving size, a second group was provided with boxes that included the frosting not included in calculations proviso, and the last group with boxes that included photos of frostingless cake. All groups used a series of cake slices that varied in size as determined by 100 calorie increments to make their selections.

The students who weren't told about the frosting, selected cake slices containing nearly double the calories of those told frosting calories were not included on the nutritional labelling.

4. Would labelling about extra ingredients reduce serving size norms in nutritionally savvy consumers?

Basically a repeat of question number 3, but with the participants being 44 food-service industry conference attendees.

With this group, despite being professional food service workers, when faced with the box without the proviso about frosting, though not nearly as significantly as with the undergrads, they too chose larger serving sizes.

Ultimately what this study suggests is that at least with cake, more accurate front of package food photography would influence how much consumers served themselves. The authors note that it is not at all uncommon for front of package food photos to include sauces, toppings and other supplemental extras that would not have been included in the product's labelling. There's also little doubt that in many (most?) cases, a boxed food's front of package photos are of servings much larger than the back panel's calculated serving size.

All of this to say that package reforms and legislative efforts need to consider more than just the nutrition facts panel, and that ensuring that front-of-package food photos accurately reflect both the panel's reported serving size, and that if there are extras, either they're accounted for on the panel, or a proviso is clearly provided stating that they're not, might influence that product's consumption.

[Reading the study my mind went immediately to cereal where serving sizes are usually in the neighbourhood of ½-¾ of a cup, and yet the bowls on fronts of boxes likely contain 2 cups or more.]

Tuesday, March 29, 2016

Teachers, Stop Teaching Kids To Reward Anything and Everything With Junk!

The past 50 years of so have seen scads of unhealthy societal changes to how we use food, and near the top of that heap lies our now normalized use of junk food to reward, pacify, and entertain our children at every turn.

Take the jelly bean prayer up above. That was sent home with RD Nadine Devine's Junior Kindergartener in honour of Easter.

WWJD? Not that.

Or this needs-to-be-seen-to-be-believed note that was sent home with another friend's 5 year old.

I imagine that the teachers responsible for those two examples don't see either as unwise as why question normal behaviours? If everyone does them, they must be ok.

Yet I'd wager that if those same two Kindergarten teachers reflected on the lesson their use of classroom junk food is teaching their incredibly impressionable, young, students, they would recognize that teaching incredibly young children that it is normal to reward even the smallest of victories or celebrations with junk food is not in their students' best interests.

Teachers, if you're reading this, so far as rewarding kids go, it's not difficult to do so without candy. Extra-recess, dressing your teacher up in funny clothing, being in charge of school announcements, a classroom dance party, have a class outside, hand out "no-homework" passes, stickers, bookmarks, etc...

I know that teachers care deeply about their students, which is why I genuinely believe that putting an end to junk-food classroom rewards is something that society, and teachers, can fix.

[And for some suggestions as to how you might begin to approach this with one your children's teachers, coaches, whatever, here's something I wrote a few years ago about shutting down your children's sugar pushers]

Saturday, March 26, 2016

Friday, March 25, 2016

"We Used To Eat Our Food, Now We Just Take Pictures Of It"

Today's Funny Friday video is about "Instagram Husbands". Am betting there are also plenty of "Instagram Wives".

Have a great weekend!

Wednesday, March 23, 2016

If You Want Your Kids To Play Outside, Play With Them!

I've said it before and I'm saying it again, the fact that when we were kids we played outside is meaningless today.

Honestly, when we were kids, we played outside because the only alternative to playing outside was staying inside and hanging out with our parents. Indoor entertainment was slim pickings. There was no Internet, no game consoles, no smartphones to text or play games on, and there were only a handful of channels on the television and none of them had regular kid friendly programming.

So go figure we played outside.

Kids are consumers of time just like adults. They'll choose to spend their free time them doing whatever they find the most fun. When we were kids that was invariably heading outside to play. Not so much now.

But for young kids at least, there is still one thing that trumps all others in terms of what kids will choose to do with their time, and that is to spend it with you.

Invite them out for a hike, a bike ride, shoot some hoops, or to kick a ball around. Encourage them to join you in training for a community run or their first triathlon (doing this with my eldest this year), or to head out to the pool for a swim, to go for a ski, a snowshoe, geocaching, or even just a jump through the puddles. Have them help you with preparing the ground and then maintaining a vegetable garden, building a tree house, a snow fort, or an epic slip and slide. There is no shortage of activities your kids will love to do with you.

So if you want your kids to play outside, play outside with them, and remember that every day that goes by, your influence on your children diminishes. Take advantage of the time you've got and teach them that a normal family life is an active one.

Monday, March 21, 2016

Blown Away By How Much Ultra-Processed Food North Americans Eat

Ultra-processed foods are,
"formulations of several ingredients which, besides salt, sugar, oils and fats, include food substances not used in culinary preparations, in particular, flavours, colours, sweeteners, emulsifiers and other additives used to imitate sensorial qualities of unprocessed or minimally processed foods and their culinary preparations or to disguise undesirable qualities of the final product"
In other words they're Cheetos and Lunchables, hot dogs and energy drinks, Oreos and Entenmanns, Lean Cuisine and Hot Pockets, etc.

And it seems that they make up the majority of foods currently being consumed by North Americans.

With prior research clearly implicating diets rich in ultra-processed foods in the development of chronic non-communicable diseases such as obesity, that ultra-processed foods provide nearly 60% of the total daily energy intake of Americans' diets is hugely concerning.

Honestly, as far as dietary advice goes, perhaps the easiest for you to follow would be to try to reduce your (and your family's) reliance on ultra-processed products.

But please don't grab a black garbage bag and head through your home tossing out the stuff, instead slowly start buying ultra-processed foods less often. Increase your use of your kitchen to transform fresh whole ingredients into meals and not simply as a place to mix boxes and jars of stuff together and call it cooking. And if your cooking skills aren't terrific, start with an easy cookbook or online resource and make a point of losing even just one ultra-processed meal and then slowly, surely, build up your confidence and your cooking repertoire.

Do so and I'd be willing to wager the improvement to the quality of your diet will greatly exceed that which you might accomplish by agonizing over comparatively minor details like trying to choose the "best" diet, focusing on your microbiome's health, "juicing", or doing whichever idiotic "detox" is the flavour of the month.

What we need is a swap from products to produce, and given our current food environment and societal food norms, that'll be no mean feat.

(And if you're Canadian, please don't be smug about our neighbours to the South's eating habits because according to research done by these same researchers, Canadians are actually worse off with nearly 62% of our energy intakes coming from ultra-processed fare.)

Saturday, March 19, 2016

Friday, March 18, 2016

How to Put Your Phone's Timer to Good Use in the Kitchen

I regularly use my iPhone's timer when cooking, but unlike today's Funny Friday video, when I do so it isn't funny.

Have a great weekend!

Thursday, March 17, 2016

New Spreadable Twix Bars Have Less Sugar Than Nutella

On the nearly impossible chance you still haven't accepted the fact that Nutella is just spreadable candy, I present to you actual spreadable candy. These new spreadable Twix bars just hit the UK, and per spoon these spreadable chocolate bars have 8% less sugar than Nutella.

And in case you missed it, here's me making my very own, "homemade", Nutella.

Wednesday, March 16, 2016

Guest Post: U of T's Chair of Nutrition Calls For Added Sugar Labelling

Today's guest post comes from PhD candidate and RD Jodi Bernstein. The post covers her, and her supervisor Dr. Mary L'Abbe, the University of Toronto's Earle W. McHenry Professor and Chair Department of Nutritional Sciences', recent call in the CMAJ (including this freely accessible CMAJ podcast) for Canada's new government to take the opportunity to ensure that added sugars are included on Canada's nutrition fact panels.

It has been nearly 15 years since the nutrition label in Canada has been revamped.

A lot has changed in the world of nutrition since then, particularly the evidence to limit our intake of free and added sugar.

But not all sugars are created equal when it comes to the health of Canadians and this should be reflected on our nutrition label.

Types of sugar
There are several ways to classify sugars according to where they come from and how they are consumed:
  • Naturally-occurring sugars are sugars that are found in their natural and original source, like the sugar consumed as part of an apple or in a glass of milk. These sugars are obtained from sources that, for the most part, form part of a healthy, balanced diet.
  • Free sugars are the sugars that have been removed from their natural source and are then consumed as is, or put back into foods and beverages, such as table sugar or fruit juice.
  • Added sugars refer specifically to the free sugars and syrups that are added to foods and beverages.
  • Total sugars that are on the current nutrition label is the amount of all the above combined.
Although all these types of sugars are chemically identical, free sugars and added sugars can be consumed in much larger quantities than naturally-occurring sugars. They can also be added into foods and beverages which would not normally contain any or as much sugar. Because of this, free and added sugars contribute to the increased health risks that accompany excess intakes of sugar.

Research on sugar and Health
In recent years, more evidence has emerged showing the adverse health effects associated with excess sugar intakes such as cardiovascular disease, obesity, diabetes and dental caries. A number of health organization including the World Health Organization, the United States Dietary Guidelines Committee, the UK Scientific Advisory Committee on Nutrition and the Heart and Stroke Foundation of Canada have all recommended limiting intakes of free or added sugars to a maximum of 5 to 10% of calories.

Added sugars labelling
Right now, only total sugars are on the nutrition label. Health Canada has proposed including a benchmark, or %Daily Value, on the label for total sugars to help consumers understand the amount. They are also proposing that food manufacturers will have to group all sugar-based ingredients together in the Ingredient List. However, these changes still don’t tell consumers how much sugar is added to the food they are eating.

Meanwhile, the United States has proposed including added sugars on their nutrition label along with a benchmark based on 10% of calories, which aligns with healthy intake guidelines.

Without listing the added (or free) sugar content on the nutrition label, it will be virtually impossible for Canadians to follow guidelines to limit added and free sugar intake to no more than 5% to 10% of calories. Without such labelling, it will be hard for consumers to know how much sugar is added to their food and to compare the amounts in different foods.

This year Canadians have elected a new federal government that has mandated the new Minister of Health to improve added sugars labelling. Let’s not lose this rare opportunity to update our Nutrition Facts table to ensure that Canadians can achieve the maximum public health benefits possible that are in line with the most recent scientific evidence.

In the absence of added and free sugars on the label, Canadian consumers can utilize apps such as One Sweet App, to track their free sugar consumption compared to World Health Organization recommendations.

Jodi Bernstein is a Registered Dietitian and has a Master’s in Public Health, specializing in community nutrition. She is currently a PhD Candidate in the Department of Nutritional Sciences at the University of Toronto. Her thesis focuses on sugars in the Canadian food environment.

Most recently, Jodi has developed an algorithm to estimate the free sugars contents of Canadian food and beverages. Results have since been used to populate One Sweet App, a mobile app that allows users to track their free sugars intakes and compare this to guidelines from the World Health Organization.

Dr. Mary L’Abbé is the Earle W. McHenry Professor and Chair of the Department of Nutritional Sciences, Faculty of Medicine, at the University of Toronto, where she leads a research group on Food and Nutrition Policy for Population Health. Dr. L’Abbé is an expert in public health nutrition, nutrition policy, and food and nutrition regulations, with a long career in in mineral nutrition research. Her research examines the nutritional quality of the Canadian food supply, food intake patterns, and consumer research on food choices related to obesity and chronic disease.

Dr. L’Abbé a member of several committees of the WHO including the Nutrition Guidance Expert Advisory Group on Diet and Health and the Global Coordinating Mechanism for NCDs; the former which recently released the WHO Guidelines on Sugars. Dr. L’Abbé was co-chair of the Canadian Trans Fat Task Force, led the Trans Fat Monitoring Program and served as Chair and vice-Chair of the Canadian Sodium Working Group. Before joining the University of Toronto, Dr. L’Abbe was Director, Bureau of Nutritional Sciences at Health Canada. Dr. L’Abbé holds a PhD in nutrition from McGill University and has authored over 180 peer-reviewed scientific publications, book chapters and government reports.

Monday, March 14, 2016

The Breathtaking Stated New Focus of American Nutrition Research

Diet related chronic non-communicable diseases (diabetes, hypertension, obesity, etc.) are flooding the world, and America's flood waters are among its highest.

Last week, in response to this flood, the US' Interagency Committee on Human Nutrition Research released the first Nutrition Research Roadmap designed to guide federal nutrition research into the future. Their focus? Individualized swimming lessons:
"Research that can lead to more individualized advice for promoting health and preventing disease."
Committee co-chair Catherine Woteki explains,
"Nutritional needs differ according to a number of factors, including an individual's age, their health status and their level of physical activity. Those needs can be tailored according to personal preferences, enabling each person to choose the foods that are right for them. The priorities outlined in the Roadmap will help us identify knowledge gaps and research opportunities that can help consumers make healthy choices."
That there are scientists out there, intra-agency scientists no less, that think the path out of this flood is going to be by way of more precisely advising individuals, on a case-by-case basis, rather than by way of environmental changes that affect global consumer behaviour and choice, is mind-boggling to me.

Saturday, March 12, 2016

Saturday Stories: Willpower, Crosswords, and Conference Questions

Daniel Engber in Slate asks whether or not one of the world's most cited willpower experiments was just BS.

Oliver Roeder in FiveThirtyEight covers the scandalous world of crossword plagiarism.

Dave Levitan in Slate with a piece that rings so unbelievably true to me about audience "questions" at conferences.

Friday, March 11, 2016

Today's Funny Friday Video is a Mere 5 Seconds Long

But they're quality seconds.

Have a great weekend!

Thursday, March 10, 2016

How Is It Possible Reebok Banned Soda Sales Before Hospitals Did?


Today Reebok announced that it'll no longer be selling soda at its headquarters. Why? Here's President Matt O'Toole,
The goal for us here at Reebok is simple - to be the very best fitness brand in the world and to inspire everyone who touches our brand - consumers, fans, and employees – to reach their potential. And our mission starts right here, with our own people ... we felt removing sugary products from our HQ was simply the right thing to do. As a fitness company, we know how important it is to move – to use our body as it was meant to be used - but what we put in our bodies is equally as important.
That hospitals haven't yet figured this out is beyond shameful.

Wednesday, March 09, 2016

Nothing Will Change If You Change Nothing

There's no denying the fact that change is difficult.

Whether you're hoping to improve nutrition, weight, fitness, relationships, work, school, parenting - truly whatever - change itself, and not necessarily the actual changes, is the real challenge.

Finding motivation is also relatively easy, at least when compared with maintaining motivation, and therein hunting for small victories, building a system that reminds you of the changes you're trying to adopt and why you're trying to adopt them, these can go a long, long, way.

Recently my friend (and husband to the world's greatest literary agent) Brad shared a video with me about a man, his dog, and sustained change.

It's definitely worth a watch.

Monday, March 07, 2016

Canada's Senate Set to Tackle the Food Industry

Last week saw the publication of the Canadian Senate's Report Obesity In Canada A Whole-of-Society Approach for a Healthier Canada. My friend and colleague Dr. Arya Sharma criticized the report for not recognizing the pervasive and damaging nature of weight bias in Canada, and on this he and I strongly agree.

But Dr. Sharma voiced more concerns, broadly, that the report did not focus sufficiently on the treatment or research of obesity, and that it's stuck in the "Eat-Less Move-More" paradigm.

On these two points we both agree and disagree.

On treatment, the primary challenge is that there simply isn't a gold standard non-surgical approach to champion. The secondary challenge is that even were there such an approach, there's a dearth of physicians and allied health professionals trained and interested in delivering it. To that end I was encouraged to see the report's recommendation calling for improved physician training in nutrition and exercise - a need I recently wrote about, and to promote the use of counselling to help (a call that may relate to remuneration).

On research, I wholly agree with Dr. Sharma, it was surprising not to see a call for investment in studies and research meant to inform future best practices, both in terms of obesity treatment, but also prevention and public policy.

On Eat-Less Move-More, here I can't fully agree with Dr. Sharma's concerns. Ultimately eating less is required if we're to see changes to weight, and moving more is required if we're to see health risks mitigated, and there is a role for education and support of the public eating less and moving more directly. And had the Senate's report focused solely on the individual as the driver of change, I would have been equally disappointed, but that's not what their report does.

Instead the Senate's report focuses primarily on the food industry's direct and indirect influences on consumer choice.

The report's recommendations include:
  • Banning food and beverage advertisements to children (where food advertisements have been proven to increase kids' eating)
  • A sugar sweetened beverage tax which in turn may help both to decrease consumption due to economic considerations, and potentially to raise funds that in turn might further healthful eating or obesity treatment/research (I would be very disappointed were a tax enacted without some mechanism to ensure at least some of the funds raised would be earmarked for health)
  • Improving access to nutritious food in Canada's northern communities (places where the exorbitant costs of healthful foods may preclude their purchase)
  • Revising Canada's Food Guide to adopt a meal based approach and to have the guide speak strongly against the consumption of ultra-processed foods (and in so doing lay the groundwork to remove front-of-package health claims and the notion that juice is a fruit equivalent)
  • Ensuring that the revision of Canada's Food Guide excludes the direct involvement of food industry representatives (which will help to ensure the recommendations are evidence, and not interest, based, where food industry interest always favours increased, not decreased, consumption patterns)
  • Ensuring that the revision of Canada's Food Guide looks specifically at the science (or lack thereof) underpinning its excessively saturated fat phobic stance and that it changes the serving based focus that both nutrition professionals and the public have deemed confusing and unhelpful.
  • Reforming our current system of front-of-package health claims (which will help to reduce the health haloing of ultra-processed foods)
  • Exploring the possibility of using a unified front-of-package rating system (which in turn has been shown with some systems to improve dietary choices)
  • Adding menu board calories in chain restaurants (which will help to inform, but not dictate, consumer choice)
  • Creating a public awareness campaign on healthy eating that specifically calls out ultra-processed foods and champions cooking (could there be a report on nutrition or obesity that didn't include a public education component?)
Again, back to Dr. David Katz' sandbag analogy. We have a flood. To date, as a society, Canada has focused primarily on the encouragement of swimming lessons to fight the current, and while swimming lessons are always worthwhile (and indeed included in this Senate report as well), here we finally see an arm of government calling for the building of a levee against one of the flood's primary sources - the food industry.

Happy to see this, and it's about time.

Friday, March 04, 2016

Bad Lip Reading Meets Ted Cruz!

Oh, today's Funny Friday is fabulous. And frankly, I think the bad lip reading version of Cruz' ad is more effective and compelling than the original.

Have a great weekend.

Oh, and #MakeDonaldDrumpf again!

Wednesday, March 02, 2016

"To Assist In Achieving Goal Patient Was Given: Nothing" #MDFail

Yesterday Canada's Senate released their report on obesity which focused primarily on prevention. I'll likely review that some next week, but today I want to talk about how physicians are approaching obesity in their offices. The short answer is not well.

Bluntly, it's not just that the average doctor isn't skilled in treating obesity, it's that the average doctor doesn't treat obesity.

That photo up above, that's the actual chart note, provided by an actual physician, to a friend of mine with obesity who had gone to see them for help.

The note's pretty clear in terms of why she was going to see the MD - her goal as stated was to weigh less than 200lbs.

The MD noted her barriers, reviewed them with the patient and then, the kicker.
"To assist in achieving goal patient was given: Nothing"
You shouldn't be surprised though. Physicians can't treat conditions they aren't taught to treat, and obesity medicine is incredibly underrepresented in the medical curricula of both medical schools and medical residency programs.

And it's not just obesity medicine that's not being taught to our future physicians, they're also not being taught about nutrition or physical activity.

One recent study of Canadian medical students highlighted the fact that the majority of those polled not only weren't comfortable in discussing nutrition with their patients, but that they also weren't taught how to identify credible sources of nutrition information.

Another recent study, this time of American physicians, found that more than half received no formal teaching around physical activity and consequently, may not be prepared to counsel their patients on how to adopt exercise safely and realistically.

And yet lifestyle, made up in large part of nutrition and physical activity, has been said to help prevent or treat an estimated 80% of chronic non-communicable diseases.

Putting the how we got here question aside, reading that physician's note I couldn't help but wonder whether the MD who wrote it was struck by the cruel poetry of its last line, as in just 9 words he or she pretty much summed up how most people with obesity feel about the help their physicians have offered.