Tuesday, May 31, 2016

Guest Post: Given What Else is Sold in Bottles, Are We Too Hard on Water?

Today's guest post comes from Ottawa based labour lawyer Sean Bawden. After I tweeted about not seeing any bottled water (but plenty of bottled chocolate milk) at the recent Ottawa Race Weekend, he wrote back to point out that perhaps in part it's because we've so vilified bottled water's provision. He also wondered about why it is we don't vilify other bottled beverages the same way. Sure, sugar's on the radar with them, but the environment? Not so much. I asked him if he'd be interested in fleshing out his thoughts and he kindly agreed.
Why I (Foolishly) Stopped Buying Bottled Water
Sean P. Bawden

From time-to-time I will find myself somewhere away from my home or office, in need of a beverage and without a reusable container. The most common such occurrence was when I formerly taught at Algonquin College. I would arrive at the college to deliver a two-hour or three-hour lecture and wanted something wet to get through the same.

I did not need anything more than simple water. To both Algonquin’s credit and my own, I did adopt the practice of bringing a stainless steel water bottle, which I could easily refill on campus – but there were times when I forgot the bottle either at home or the office and needed to either purchase a single-use, disposable container or go without until I got home.

On those occasions where I elected to buy something, I did not buy a simple bottle of water; I bought something else. Part of my reason for buying something other than water was the social stigma associated with buying bottled water. Bottled water is seen as wasteful and unnecessary (See this video as an example); a stigma that did not seem to attach to a similar disposable bottle if filled with something other than water. Peer pressure can be intense and notwithstanding being the professor and therefore ‘in charge’ I did not want to feel judged by my students.

Upon reflection this decision making was foolish. A plastic bottle is a plastic bottle; any environmental concerns and any objections to the use of such containers should apply equally, regardless of the container’s contents.

More to the point, all I really needed was water – which is the principal ingredient in all other options. So why did I buy something filled with sugar or some form of alternative? In part, I believe, because I have been socialized to believe that buying bottled water is wrong.

I wish to be clear, there is no reason or excuse for buying bottled water to consume where one has access to both a reusable container and world-class municipal facilities, as we do in Ottawa. However, once one had committed to purchasing a single-use, disposable beverage container, water should be a socially acceptable option in the same way all other beverages are viewed.

Notwithstanding once being a student of environmental law I cannot say that I recall ever seeing a campaign against the use of single-use containers generally; only bottled water specifically.

This stigma needs to end for public health reasons. Water and nothing more than water is very often all that one needs. On those occasions where one is ‘forced’ to purchase a single-use beverage container, having plain old water as its contents should not be viewed negatively.

Sean P. Bawden is a lawyer practicing with Kelly Santini LLP in Ottawa, Ontario. He practices in the areas of employment law and civil litigation. He has also taught Trial Advocacy for Paralegals and Small Claims Court Practice at Algonquin College in Ottawa.

Sean Bawden is also the author of the employment-law blog “Labour Pains

Saturday, May 28, 2016

Saturday Stories: Poverty, Cancer, Self-Criticism, and 13 Tears

Christopher Jenks, in the New York Review of Books, covers why America's poor have become so much more impoverished.

Ginger Gorman, in news.com.au, with a conversation about cancer no one is having. (It’s not brave. Or inspirational).

Maria Popova, in Brain Pickings, on self-criticism and the Stockholm Syndrome of the super-ego.

Dr. Donna Neufeld with her poem crying 13 tears (via Facebook).

Friday, May 27, 2016

Bet You've Never Been As Hungry as This Great Dane

Today's Funny Friday.

Just watch it.

Have a great weekend!

Thursday, May 26, 2016

School "Hot Lunches" Are Beyond Awful. How Did We Let Them Happen?

A friend on Twitter sent the photo up above to me. It's this week's hot lunch offering for his kid's school's kindergartners through Grade 6ers.

Hot dogs, donuts, and juice.


And then of course there's pizza days, sub days, and various other awful food days that not only serve kids literal fast food, but in so doing also teach kids that it's a totally normal/alright to have fast food each and every week.

Parents would jump in front of buses for their children, and yet packing them a healthy lunch everyday isn't doable? Clearly it's not a money thing as $5 for a hot dog, a donut and a juice box certainly doesn't make this hot lunch a value proposition.

How did we get here as a society?

More importantly, how do we leave?

Tuesday, May 24, 2016

Could "Psychological Stress" Explain The Biggest Losers' Metabolisms?

Seems extremely unlikely to me only in that there's no obvious pathophysiological mechanism that could help to explain why the show's psychological distress led to permanent and disproportionate metabolic adaptation.

And though that's what I told the reporter from the New York Post, she left out the "doubtful" proviso and left in the "possible".

The thing is, it's unclear why The Biggest Loser's contestants' metabolisms seem slower than would be expected simply as a consequence to weight loss. They're also slower than the metabolisms of patients who've had bariatric surgery and lost similar amounts of weight.

Could their greater degrees of metabolic adaptation be due to the nature of the show itself? Sure. But as I told the reporter Maureen Callahan, over and over again in fact, it's also possible that losing 40-50% of your body weight without surgery, regardless of approach, is responsible.

And yes, despite what the article misquoted me as saying, plenty of people have lost 40-50% of their body weights without surgery, but generally those losses occur with extremes of effort (like they do on The Biggest Loser). What I'd like to know is whether or not losing comparable amounts of weight slowly would lead to similar outcomes?

That'd be a challenging thing to figure out because losing that much weight slowly is a rarity. Of course that doesn't mean it doesn't happen, it just means that it's rare. It also means that randomizing people to lose 40-50% of their body weights with non-extreme efforts isn't feasible.

Lastly, though I think when it comes to weight loss The Biggest Loser's Dr. Huizenga is either deluded, unethical, or clueless, I never claimed to know him personally.

Bottom line. The Biggest Loser is a horror show (I've written extensively about it over the years), but so too is Maureen Callaghan's reporting on it for The New York Post.

Saturday, May 21, 2016

Saturday Stories: OxyContin Hell, Trumpist Mobocracy, Anti-Zionism

Harriet Ryan, Lisa Girion and Scott Glover in the LA Times with a hell of a story about oxycontin hell.

Robert Kagan in the Washington Post on Trump, fascism and "mobocracy".

Frequent Israel critic Michael Koplow on his blog Ottomans and Zionists on what he calls the crisis of anti-zionism.

Friday, May 20, 2016

If Meat Eaters Acted Like Vegans

Parts of today's Funny Friday video made me laugh out loud.

Have a great weekend!

(and BTW, I've nothing against vegans - but this was damn funny)

Wednesday, May 18, 2016

Dr. Andrew Stokes On That New Excess Weight is Healthier Study

Last week saw the publication of yet another study looking to quantify risk with weight, and like some studies have found in the past, the conclusion was that some excess weight might in fact be beneficial to health. From my perspective, the question of "what weight is healthiest" is flawed in and of itself. As I tend to prattle on, the goal for all of us, regardless of our weights, should be to stack our personal decks as much as is realistically possible by living with the healthiest life that we can honestly enjoy. These studies, whatever their findings, tend to emphasize that scales can usefully measure health. I don't wholly agree, but that said, I invited Andrew Stokes, a researcher with a special interest in the association between weight and mortality, to give us his take on the new research.
A new study published in JAMA finds that the BMI value associated with the lowest risk of dying shifted from the normal to overweight range between 1976-1978 and 2003-2013. The study is short on explanations for this puzzling finding, but does offer up the possibility that people with overweight and obesity are receiving better treatment and thus living longer than they did in earlier decades.

An alternative explanation for these findings is a flawed research design. Although some of the coverage, including on NPR and on Ted Kyle’s obesity blog, pointed out the potential pitfalls of using BMI as a proxy measure of body fat, they miss a more fundamental problem with this study, a problem that is shared by many other studies of the health consequences of obesity.

The problem, which I discussed in a previous post on Yoni’s blog, is the reliance on weight assessed at a single point in time. Disregarding weight history is a problem because people who have long maintained a weight in the normal range are mixed together with those who formerly had overweight or obese and lost weight. Although some of the weight loss in the latter group is healthy weight loss, much of it is tied to conditions such as heart disease, cancer, COPD and other ailments. Because of this—as several recent studies have shown — including the weight losers as part of the normal weight category obscures the substantial benefits associated with maintaining a normal body weight.

In the JAMA study, attempts were made to address this bias (referred to by epidemiologists as confounding by illness) but the measures taken were ad hoc and incomplete, leaving plenty of room for the bias to creep into the estimates. Unfortunately, there is no way of knowing from the data presented how the composition of the normal weight category changed across the cohorts studied. It could be that as a result of differences in age composition or smoking status across cohorts, that a larger fraction of the normal weight group in the later cohort once had overweight or obesity, which could explain the apparent finding of the nadir of the BMI mortality relationship increasing across cohorts.

The substantial discrepancy in length of follow-up across cohorts may have also compromised the comparison (median length of follow-up was 19.8, 11.0 and 4.6 years in the 1976-1978, 1991-1994 and 2003-2013 cohorts, respectively). Length of follow-up has been shown to be a significant effect modifier of the association between excess weight and mortality, with shorter duration follow-up often leading to greatly attenuated effects. The findings of the JAMA study are consistent with bias due to duration effects, with the risks getting progressively weaker between the first cohort in which follow-up was greatest and the last cohort in which follow-up was shortest. Although the authors acknowledge the possibility and present several tables and sensitivity analyses aimed at testing for duration effects, the results are not entirely convincing.

The problems discussed above raise doubts about how much we should take away from the new JAMA study. Although it is possible that the nadir of the BMI-mortality curve has shifted over time, this study is far from conclusive on the matter. A more likely explanation behind the striking pattern is that it is a spurious result of a flawed study design.

Andrew Stokes is an Assistant Professor in the Department of Global Health at Boston University. His research is focused on the causes and consequences of the global obesity epidemic and developing novel approaches to combating obesity at the population level through interventions that target aspects of the social and physical environment. You can also follow him on Twitter.

Monday, May 16, 2016

No Mott's, Watered Down Juice Doesn't Help Kids #StartStrong

Mott's for Tots is watered down juice. As in they took juice and added water and then sold it to you at the same price as the non-watered down stuff.

Watered down juice is not "love".

Watered down juice won't help your kids "#startstrong"

Watered down juice shouldn't share or exceed the cost of regular.

Juice is not a healthful beverage.

Treat juice like soda pop and give it to your kids in the smallest amounts you can get away with (aim for less than half a cup a day).

[Thanks to Patti for sending my way]

Saturday, May 14, 2016

Saturday Stories: Discarded Life, Expensive Medicine, and Un-Assimilation

Alexander Masters in The Guardian on the discarded life he found, pieced together, and published.

Antonio Regalado in MIT Technology Review on the lessons learned from the world's most expensive medicine.

Rivka Bond in The Times of Israel with a piece that I strongly relate with on becoming un-assimilated.

[And ICYMI, I wrote a piece for Vox that hit their number one status for a while on whether or not long term weight loss really was impossible.]

Friday, May 13, 2016

The Must-Watch John Oliver "Science" Video

On the remotely off chance you haven't seen it, today's Funny Friday video is an incredible effort by Last Week Tonight's John Oliver to highlight just how poorly science is covered and publicized as well as "hacked"

Have a great weekend!

Wednesday, May 11, 2016

Top Ten Changes I'd Like to See in Canada's New Food Guide

While Canada's Food Guide's revision has yet to be announced, all signs point to soon. The department has gone on record multiple times over the course of the past few years stating that changes were required, and with our new Liberal government and its terrific appointment of Dr. Jane Philpott to Minister of Health, I'm confident that change is coming.

Though there are many things I'd like to see change with the Guide's next iteration, here are ten things (in no particular order) that I see as its most important to-dos:
  1. A revision process that is insulated from the food industry. Sure, let industry submit their recommendations, but make sure those submissions are made public, and as opposed to last time around, don't give the food industry seats on Food Guide advisory panels.
  2. Remove juice's fruit equivalency and provide an explicit recommendation as to the maximum amount of juice a child should drink in a day (half a cup).
  3. Caution against the consumption of sugar-sweetened beverages and specifically include sugar-sweetened milk and milk alternatives as well as 100% juice as products worth minimizing.
  4. End the Guide's nutrient focus. Last time around the Guide's primary purpose was to ensure Canadians' nutrient requirements were being met. This time around I hope to see a food focused guide where the emphasis is on broad patterns of eating.
  5. Remove the number of servings recommendations altogether. Our country doesn't have a problem with eating too little and research has been done proving that Canadians underestimate serving sizes and virtually no one does (or will) weigh and measure their foods.
  6. Caution against the regular consumption of processed red meats.
  7. Recommend that artificial trans-fats be "avoided" rather than simply "limited"
  8. Get rid of the "Dairy and alternatives" group altogether. These are not magic foods. They're better off being in part of a protein category.
  9. Downgrade the Guide's saturated fat phobic messages and replace them with the simple suggestion to swap saturated fats with unsaturated whenever possible.
  10. Simultaneously discourage restaurant meals and ultra-processed foods while pushing home cooking and meals eaten together around tables.
It's been nearly a decade since Canada's awful current Food Guide was released. It's definitely time for change.

Monday, May 09, 2016

Why I'll Never Prescribe a Very-Low-Energy Diet

A VLED is a "very low energy diet", and it's defined as one providing fewer than 800 calories per day. These programs are generally administered by physicians, are expensive, often take the form of meal replacement shakes, and usually last for around 12 weeks.

Multiple meta-analyses on VLEDs have been conducted, and generally their findings haven't been particularly exciting. Either they've concluded they aren't worth prescribing, or they've concluded that there isn't sufficient information for a conclusion.

Well add another meta-analysis to the pile. This one, published in March in Obesity Reviews, had what I found to be a very odd conclusion, and I'll get there in a bit. Ultimately the researchers findings were that when compared with a standard, and non-extreme, behavioural weight loss program, 3-5 years later, VLED patients will have lost 2.86lbs more.

Bare in mind too, VLEDs are challenging for patients. Can you imagine 12 weeks of just shakes? I've heard stories of people having to bring their meal replacement shakes to weddings, or to chug them in place of Christmas dinner. VLEDs have risks too. Gallstones from overly rapid losses, disproportionate loss of muscle mass, and electrolyte abnormalities.

So when I read that 5 years later, with VLED diets being shown to affect an additional half pound lost per year, and with their associated risks, and their not insignificant costs (both actual dollars and the cost to a patient's ability to live a normal life), I figured that certainly, the authors' conclusion will have to be that there's not much point in recommending them to patients.


Despite VLEDs being found to barely lead to additional losses, despite their risks and their costs, the study's authors concluded,
"Adding a VLED to a behavioural weight loss programme produces greater weight loss in the medium and longer term than a behavioural programme alone. Such programmes appear well-tolerated. Current advice against their use for routine weight loss in medical clinics should be reconsidered."
Huh? Am I missing something?

While there are true success stories with every approach (including VLEDs), weight lost through suffering tends to come back.

Saturday, May 07, 2016

Friday, May 06, 2016

Does Your Mom Even Text?

Mine doesn't. But today's Funny Friday video Moms sure do.

Hope you have a great Mother's Day weekend!

Tuesday, May 03, 2016

The Lasting Damage of The Biggest Loser (Part II) - Lawsuit Edition

By Fayerollinson - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17999473
Yesterday saw the publication of an unbelievably damning paper that unequivocally condemned The Biggest Loser as a show that permanently damages contestants' metabolisms, and that it does so in a manner far greater than would have been expected by mathematical models based on contestants' ages, heights, weights, sexes and body compositions.

Now I know from chatting with former contestants, the show requires them to sign massive indemnity and non-disclosure agreements, and while I'm no lawyer, I wonder what legal standing former contestants might have to launch a class action lawsuit in response to the show's trashing of their metabolic futures?

Certainly, for consent to now be informed, participants must be told to expect that as a direct consequence of the show, when they're done, their metabolisms will burn far fewer calories than expected, and will leave them metabolically far worse off than were they instead to choose bariatric surgery.

If such informed consent is not obtained moving forward, I've little doubt there'd at least be a theoretical legal case. But even looking back, I can't help but wonder whether, indemnity waivers or not, there are grounds for former participants to sue the show for their severe metabolic damages? Certainly the writing was on the wall back in 2011 with the first Biggest Loser energy expenditure studies. And even if those hadn't been done, is not knowing a fulsome defence vs. inflicting lasting harm?

Monday, May 02, 2016

The Lasting Damage of The Biggest Loser (Part I)

I've written a great deal about The Biggest Loser over the years - none of it good. Today you're bound to read a lot of headlines about The Biggest Loser and its dramatic, devastating, and likely permanent damage to contestants' metabolisms (more on that from the author of the recent study in a few days), but that's not what I'm writing about today. Today I want to talk to you about a different sort of lasting Biggest Loser damage, and to illustrate, the story of Ali Vincent.

Vincent is The Biggest Loser's first female "winner". Back in Season 5 she lost 110lbs, and now they're back, and so is Vincent - she's been on a media tear and she's joined Weight Watchers in a bid to again lose weight.

Now Vincent regaining really isn't that much of a story. If your weight loss methods are not only a misery, but a misery that trashes your metabolism, go figure there's a good chance you'll regain. The story here is that apparently The Biggest Loser's brainwashing is so great that "once burned, twice shy" doesn't seem to apply.

And I'm not talking here about putting herself out there. While I do think it opens a person up to incredible scrutiny to lose weight publicly, that's clearly a personal choice, it's likely motivating while it's happening, and I've little doubt that in Vincent's case, it'll directly or indirectly earn her some modicum of further fame and or fortune. But where Vincent doesn't seem shy is to be once again adopting The Biggest Loser's competitive suffering to lose narrative.

Vincent has joined up with a website called DietBet, whereby she's leading online challenges that have people put up cash as part of a weight loss pledge that in turn allows them to win it back if they lose 4% of their weight in 4 weeks.

4% in 4 weeks is certainly doable. For a woman Vincent's age, height, and weight, it would probably require her to consume in the neighbourhood of a tightly controlled 1,000-1,200 calories daily. What's not doable though is living an enjoyable and normal life on 1,000 calories, and by the contest's very nature, no doubt the competition and prize money will inspire people to adopt non-sustainable approaches.

Pretty sure Vincent has some experience with what happens in the long run when you undertake a non-sustainable approach.

The Biggest Loser's philosophy embodies the very worst of modern day weight loss efforts. It teaches viewers that suffering is crucial, that you're a failure if you don't want to suffer forever, and that scales measure health and happiness. And sadly it would seem, while weight lost by way of The Biggest Loser doesn't seem to last, those toxic lessons do.

[Thanks to Nutrition Wonk for letting me know about Vincent's competitions on DietBet]