Monday, October 31, 2016

Why Will It Take Health Canada 5-10 Years to Clean Up Nutrition?

Image Source
In case you missed it, last week the Honourable Dr. Jane Philpott, Canada's Minister of Health, announced that changes were afoot to nutrition in Canada.

On the menu?
  • A much needed revision for Canada's Food Guide
  • A ban on the advertising of food to children
  • A front-of-package labeling program designed to help consumers better navigate the grocery store
  • A ban on trans-fats (something promised by a former Minister of Health back in 2007)
  • A nutrition facts panel that included information on added sugars
None of this is surprising - both from an evidence based perspective, and from a mandate perspective, as in his mandate letter to Dr. Philpott, Prime Minister Justin Trudeau made it clear, these were matters he wanted addressed calling for,
"introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec; bringing in tougher regulations to eliminate trans fats and to reduce salt in processed foods, similar to those in the United States; and improving food labels to give more information on added sugars and artificial dyes in processed foods."
What is surprising though is the announced timeline of 5-10 years to implement.

I can't wrap my head around that.

While clearly change doesn't happen overnight, I can't come up with a plausible explanation for why Canadians will be forced to wait for up to a full decade for these changes as: It's also worth noting that in Canada, a government's mandate's duration is four years and as of this Friday, the first of them is done.

Having had the pleasure and honour of meeting with Dr. Philpott in the past, I am very comfortable stating my belief that if she were able, these changes would occur far faster than the timeline she's laid out. Which leads me to assert, admittedly without proof, that the food industry lobby in Canada is far more influential than anyone would believe.

[For more on this, definitely have a peek at the award winning journalist Holly Doan's terrific CPAC piece on this government's mandate regarding obesity (disclosure - I'm in it). To watch the video when you get to the link, click the language button below the video to get it rolling as clicking the arrow doesn't do it]

Saturday, October 29, 2016

Saturday Stories: Men Behaving Horribly Edition

Image Source
Michelle Hamilton in Runners World on running while female.

Dorothy Beal in Active with an open letter to men from female runners.

Roxane Gay in Glamour on how to handle street harassment.

Friday, October 28, 2016

I Would So Vote For Gerald

Today's Funny Friday is perhaps the best campaign advertisement ever.

Vote for Gerald!

Have a great weekend!

Wednesday, October 26, 2016

How To Learn To Stop Worrying and Start Loving Halloween

(This post first published October 24th, 2013)

It's coming.

And I'm not really all that worried. At least not about Halloween night.

The fact is food's not simply fuel, and like it or not, Halloween and candy are part of the very fabric of North American culture and to suggest that kids shouldn't enjoy candy on Halloween isn't an approach I would support.

That said, Halloween sure isn't pretty. On average every Halloween sized candy contains in the order of 2 teaspoons of sugar and the calories of 2 Oreo cookies and I'd bet most Halloween eves there are more kids consuming 10 or more Halloween treats than less - 20 teaspoons of sugar and the calories of more than half an entire package of Oreos (there are 36 cookies in a package of Oreos).

So what's a health conscious parent to do?

Use Halloween as a teachable moment. After all, it's not Halloween day that's the real problem, the real problem are the other 364 days of Halloween where we as a society have very unwisely decided to reward, pacify and entertain kids with junk food or candy (see my piece on the 365 days of Halloween here). So what can be taught on Halloween?

Well firstly I think you can chat some about added sugar (and/or calories), and those rule of thumb figures up above provide easily visualized metrics for kids and parents alike.

Secondly it allows for a discussion around "thoughtful reduction". Ask them how many candies they think they'll need to enjoy Halloween? Remember, the goal is the healthiest life that can be enjoyed, and that goes for kids too, and consequently the smallest amount of candy that a kid is going to need to enjoy Halloween is likely a larger amount than a plain old boring Thursday. In my house the kids have decided upon 3 pieces - so our kids come home, they dump their sacks, and rather than just eat randomly from a massive pile they hunt out the 3 treats they think would be the most awesome and then take their time enjoying them.

The rest?

Well it goes into the cupboard and gets metered out at a rate of around a candy a day....but strangely....and I'm not entirely sure how this happens, maybe it's cupboard goblins, but after the kids go to sleep the piles seem to shrink more quickly than math would predict. I've also heard of some families donating candy to a local mission or homeless shelter, and others who grab glue guns and make a Halloween candy collage.

A few years ago we discovered that the Switch Witch' territory had expanded to include Ottawa. Like her sister the Tooth Fairy, the Switch Witch, on Halloween, flies around looking for piles of candy to "switch" for toys in an attempt to keep kids' teeth free from cavities for her sister. The joy and excitement on my kids' faces when they came downstairs on November 1st that first Switch Witch year was something to behold.

And if you do happen upon our home, we haven't given out candy since 2006 and we haven't been egged either. You can buy Halloween coloured play-doh packs at Costco, Halloween glow sticks, stickers or temporary tattoos at the dollar store (glow sticks seem to be the biggest hit in our neighbourhood), or if your community is enlightened, you might even be able to pick up free swim or skate passes for your local arena (they run about 50 cents per so if you're in a very busy neighbourhood this can get pricey).

[Here's me chatting about the subject with CBC Toronto's Matt Galloway]

Monday, October 24, 2016

Are Conflicts of Interest In Nutrition Less Worrisome?

Today's guest post comes from public health ethicist Daniel Goldberg. It has to do with conflicts of interest in nutrition. I've found it fascinating to watch otherwise evidence based individuals suggest that conflicts of interest in nutrition don't matter. That somehow, unlike the risks proven to exist with conflicts in medicine - where highly paid physicians have been shown to be influenced by cheap lunches and plastic pens - that the suggestion that conflicts in nutrition might influence opinions, research, attitudes, and more, is ridiculous. It's not.
The Academy of Nutrition and Dietetics ("AND") recently held its annual meeting. According to registered dietitian Andy Bellatti (and others), during her opening talk, the President of the AND, Lucille Beseler, opined on the rising concerns over financial conflicts of interest among nutritionists and dietitians:
"I'm not so weak-minded that I would make a decision on receiving a pen."
In the course of researching, writing, and teaching about conflicts of interest among health professionals for over a decade, what I have come to marvel at the most is the apparent ease with which leading health professionals insist on a kind of willful ignorance regarding the cognitive science underlying concerns over COIs. This is amazing to me because of the irony: members of professions presumably dedicated to basing their practice on the best evidence proceed to engage concerns over COI with almost no awareness whatsoever of what the best evidence actually suggests regarding the impact of conflicts of interest on human behavior.

This is why, in December of 2015, I published a small chart with explanation in BMJ entitled "COI Bingo." I grew so exasperated with the same tired justifications for financial COIs that I categorized the standard responses into a Bingo chart (up above)

Reasonable people of good conscience can, of course, disagree on whether the behavior of partiality that occurs in the presence of COIs are morally justified, and on the appropriate remedies, if any, for such behavior. But the argument should proceed with all stakeholders fully aware of what the cognitive science actually suggests regarding the impact of COIs on health professional behavior.

What does that evidence show? Beyond a shadow of a doubt, gifts almost certainly do influence health professionals' behavior, at least in the aggregate. Not only have we documented this finding itself ad nauseum, we also have powerful causal explanations that elucidate the mechanisms by which even gifts of de minimis value influence health professional behavior. Virtually all human societies exchange gifts -- they promote social cohesion and are therefore a critical adaptive mechanism. One of the ways gifts accomplish such cohesion is because they tend to automatically, unconsciously create a desire to reciprocate on the part of the recipient.

Commercial industries are well-aware of this phenomenon, which is why they provide such gifts. The gift exchange also cements the relationship with industry, which that in which commercial industry is most interested. The tighter the relationship that exists between commercial industries and health professionals, the more likely it is in the broad run of cases that behavior of partiality will occur. COIs have to be understood iteratively -- the existence of a financial COI does not imply that bad behavior will necessarily take place in any given case. But over the long run of cases, the existence of financial COIs makes shenanigans much more likely -- a conclusion which is -- again -- extremely well-documented in both experimental and uncontrolled (i.e., real-life) conditions.

That these kinds of gifts "work" in the health professions to serve the interests of the "donor" is therefore beyond dispute. Moreover, some of the more darkly amusing findings in the COI literature document our own immunity bias: while we imagine ourselves much less likely to be influenced by pens and mugs, we have serious concerns that the professional sitting next to us may have their judgment clouded if they accept gifts from commercial industry:

Steinman, Shlipak & McPhee 2001
Maybe any given health provider will indeed remain entirely uninfluenced by deep entanglements with commercial industry. But the evidence establishes beyond all doubt that the odds are forever not in your favor.

Ultimately, far too many stakeholders seem willing to wade into the fray with a perfect, almost studied indifference to the significant evidence base regarding COIs. This is itself an ethical problem -- mistakes themselves are not ipso facto morally blameworthy -- but mistakes made because health professionals did not bother to examine an available evidence base and ground their practice in that evidence come much closer to moral failure.

Daniel S. Goldberg is a faculty member in the Center for Bioethics & Humanities at the University of Colorado Anschutz Medical Campus. He is trained as an attorney, a historian, and a public health ethicist.

Saturday, October 22, 2016

Friday, October 21, 2016

I Never Knew You Could Eat Shoelaces Either

Today's Funny Friday involves Jimmy Kimmel, $14 shoes, and some people who really love Kanye.

Watching it I couldn't help but consider it in the context of this election. Blind faith is one powerful drug.

Have a great weekend!

Wednesday, October 19, 2016

What Is It About Cows That Makes The Word "Heifer" An Insult?

On Monday I wrote about how no one seemed to notice or care about the use of the term "heifer" as an insult in a story that went viral on Facebook.

That led to a whole pile of hoopla which, putting aside some of the more unhinged outrage and misrepresentation, ultimately boiled down to: that the term might not have been meant as a weight related slur, and/or that the flight attendant on its receiving end wasn't fat, and/or that really, who cares, she was upset and so it was justified.

Despite the fact that I've never seen or heard the term heifer used for purposes other than fat shaming (see for example the usage I'm accustomed to here and here from past also gone viral stories), and that all the various urban dictionaries and definitions online state that heifer is a pejorative term for a woman with obesity, it's of course possible that in this circumstance it wasn't meant as a weight related insult but rather as a general slur, and that heifer has become a term that some use in place of "bitch".

Which in turn speaks to the point I was making which is that we're so accustomed and innured to weight related insults, jokes, and judgement, that derisive terms with clear relationships to appearance and weight have become entrenched and even defended as being acceptable parts of our general vocabulary and vernacular regardless of whether or not they're marginalizing to an undeniably and regularly discriminated against population.

And where exactly do people think the pejorative part of the term comes? Is there something else obvious and well known about cows, besides their size and seeming laziness, to serve the general public as the word heifer or cow's driver of scorn?

Heifer or cow, wielded as an insult, regardless of intent, furthers the gluttonous, stubborn, lazy, narrative of obesity, and so yes, I'm going to continue to call it out, and that me doing so apparently upsets people, speaks directly to why doing so is worthwhile.

Monday, October 17, 2016

Black Doctor Recounts Blatant Racism, Spreads Blatant Weight Bias

By now you've probably already heard the story about Dr. Tamika Cross. She's a 4th year medical resident at the University of Texas Health Science Centre and she was on a flight when she tried to answer an overhead ask for an onboard physician to tend to an in-flight medical emergency. Instead of her help being welcomed, she was dismissed by some combination of racism and sexism as the flight crew would not believe that she, a black woman, was a physician.

She wrote up her undeniably awful experience on Facebook and the post went viral and at least at the time of me writing this, has been shared over 45,000 times, has received over 130,000 reactions, and has inspired the awesome #WhataDoctorLooksLike hashtag on Twitter.

The story was picked up by dozens of media outlets including The Washington Post, The New York Times, The Guardian, but missing in all of their coverage was the term Dr. Cross used to describe the flight attendant.

She called her a heifer.

Weight bias is a real social justice issue. Briefly, weight bias has proven medical and psychological consequences, it has been shown to reduce a person's earning potential, affect their hiring and advancement opportunities, and restricts their academic advancement (click the link if you don't believe me). Weight bias is also now the number one cause of schoolyard bullying.

Consider for a moment this same story but instead of stating,
"Then this heifer has the nerve to ask for my input on what to do next about 10 mins later",
Dr. Cross had said,
"Then this kike has the nerve to ask",
"this chink",
"this wop".
Would the story have had the same pickup? Or would the story have even been picked up at all?

I have yet to read a single piece about Dr. Cross' blatantly racist treatment mention her use of the term heifer which in turn speaks to just how normal and acceptable weight bias is. Moreover, that a person who was blatantly judged on the basis of her appearance, who notes in her own post that blatant discrimination on any grounds is "not right", calmly wields a derogatory appearance based slur as if it's no big deal, shows just how far society still has to go on this very real issue.

Racism and sexism are inexcusable. Weight bias should be too.

[For more on the realities of weight bias, please consider a tour around the Rudd Centre's Weight Bias and Stigma page]

Saturday, October 15, 2016

Saturday Stories: Rape Silence, Chemical Weapons, and ICU Delirium

Lauren McKeon in Toronto Life on her 15 years of silence when it came to her 3 rapes.

The Associated Press with a terrifying story of how $3,000 buys a person a deadly chemical weapon that could kill thousands.

Usha Lee McFarling in Stat on ICU delirium (I've seen it, it's awful)

Friday, October 14, 2016

Watch This To See If You're An "Entitled Testosterone Monster"

Today's Funny Friday, where Samantha Bee covers the Billy Bush Trump tapes and more, isn't safe for work or watching around young kids. And that's an amazing statement given it's a story, albeit by a late night comic host, about an actual presidential candidate. No doubt it's more horrifying than funny, but do watch it - she's awesome.

Have a great weekend.

Thursday, October 13, 2016

If Health Canada Won't List Free Sugars, These Frustrated Researchers Will

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', continued push for Health Canada to require free sugars to be included on Canada's nutrition fact panels.
The World Health Organization recommends that we limit free sugar intakes to a maximum 10% of calories a day. But there are many factors that hinder our ability to abide by these guidelines, far more than support it. First of all, it’s pretty difficult to picture what 10% of calories looks like. Sure I can tell you that for the average adult it’s about 50g or 12 teaspoons, but would that really help you all that much? Most of the free sugar we eat is coming from inside candies and sweets, cereal, beverages, and baked goods, so we can’t easily see how much free sugar is in the food. To abide by the World Health Organization’s recommendations, free sugar needs it to be included on the nutrition facts table.

The United States is planning to include the amount of added sugar (similar to free sugar) on their food label. But here in Canada, the latest proposal to change the nutrition label did not include free sugar on the label. In fact, we discussed the importance of including added sugar on Canada’s nutrition label in a previous blog post on Weighty Matters.

But in the meantime, we weren’t about to just sit around and wait. In light of this difficult predicament we took it upon ourselves to calculate the free sugar content of over 15,000 Canadian packaged foods and beverages, published it for open-access use, and found some interesting results along the way. Using the University of Toronto’s Food Label database, which has nutritional and ingredient information, we calculated the amount of free sugar in each product using a 6-step algorithm tailored for just this purpose. Here’s what we found:
  1. A lot of foods have free sugar in them. Sixty-five percent to be exact. That means its probably harder to find a packaged food that doesn’t contain free sugars, although the proportion was a lot lower in certain food groups like vegetables, nuts and seeds, dairy products and cereals and grains and highest in desserts, sugars and sweets, and bakery products.
  2. Free sugar accounts for 62% of total sugar. Although this was much higher for sweets, bakery products, desserts, and beverages and much lower for fruits and vegetables.
  3. There is a wide range of free sugar in a food category. This means two things: 1) when choosing a product, there may be a similar one that has less free sugar available; and 2) successful reformulation is possible. Having similar items, some with less free sugar, acts as proof showing that, yes, this food can be made with less free sugar and consumers will still buy it!
  4. There are 152 ways to say “free sugar” in the Ingredient List. It’s no wonder free sugar is considered a “hidden” source of calories. For instance, ‘table sugar’ was listed 40+ ways including all dehydrated, dried, granulated, concentrated, refined, coarse, evaporated, solid, powdered, and liquid variants of cane juice, sugar, and sucrose.
  5. 1/5 of total calories come from free sugar. Of course this ranged between food groups, with the highest at 70% of calories coming from free sugar in beverages. Consuming foods that have more than 10% of calories from free sugar increases the likelihood of exceeding dietary recommendations.
We are hopeful that these results will support of interventions and policies (including labelling free sugar on the nutrition label!) to limit excess free sugar consumption. The detailed information we provided in this study can be used as a benchmark to monitor changes in free sugar contents overtime, identify areas and targets to focus reformulation efforts, direct educational messages, and can be linked to national nutrition surveys to evaluate free sugar consumption and monitor associated health outcomes.

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.

Tuesday, October 11, 2016

New Canadian Senate Bill Calls For a Ban on Marketing Food to Kids

It's shocking that we allow anything to be advertised to young children, but its doubly shocking we allow "food" to be advertised to them. I put the word food in scare quotes because frankly given what's generally advertised to children, calling it food is generous. Sure it's technically consumable, but it's far from healthy fare. Here in Canada, and the world around, the foods advertised to children (and adults too I might add) are unsurprisingly dominated by the food industry's profit drivers - ultra-processed foods laden with salt, sugar, and/or fat, because it's not the food industry's job to promote healthy eating, it's the food industry's job to profit.

The thing is, times have changed. Whereas when I watched the Kool Aid Man crash through walls during commercials running through Saturday morning cartoons, today's kids are watching far more sophisticated commercials running nearly 24/7 on multiple media platforms. Worse, the kids who are watching today's advertising are developing chronic, non-communicable, diet-related diseases that when I went to medical school were only found in adults.

And don't kid yourself into thinking that marketing doesn't matter. While there are some who like to suggest that kids are, or with brief teaching can be made, media literate and that presumably the food industry is simply wasting literally billions of dollars on marketing that's just window dressing, the evidence states otherwise. Children who see advertisements are more likely to prefer branded foods, especially those high in sugars and fats, and that those advertisements lead kids to eat more of them. , and more food in general (including foods not being advertised). And in a study published recently, researchers suggested that food marketing to kids may alter the psychological and neurobiologic mechanisms of children's food decisions leading the researchers to state,
"Food commercials may prompt children to consider their liking and wanting of specific food items, irrespective of the lack of any health benefits. This increased emphasis on taste may make it even more difficult for relevant caregivers to encourage healthy food choices."
So with all of that in mind I can't tell you how pleased I am that The Honourable Nancy Greene Raine has introduced a bill in Canada's Senate that if passed would prohibit marketing of all food and beverages to children under the age of 13.

There really aren't any arguments to support the food industry's current advertising practices. Capitulating to the food industry by supporting the current status quo isn't about freedom of speech. Freedom of speech shouldn't extend to preying on our most precious, and vulnerable population.

Please consider voicing your support by clicking here and signing up to encourage your MP to support this bill.

Friday, October 07, 2016

Sometimes You Just Need a Little Silly to Start Your Day

And if that's you today, here's Joaquin Phoenix' forehead.

Just watch it.

Have a great weekend!

Wednesday, October 05, 2016

There's No Hydration Emergency, and Soda's Liquid Candy

Branding matters.

For soda makers, that their product's base is water means they can market or deflect around hydration and thirst.

But there is no hydration emergency.

If the body says drink, definitely do so, and water of course is your best bet.

Yet the world around has a bad habit of making it seem all the more complicated. Recently the New York Times wrote about "surprising ways" to stay hydrated. It covered the new "hydration index" study funded by the European Hydration Institute (EHI). The index ranks drinks according to their hydration abilities. Among other findings it reported that regular soda is as hydrating as water.

The EHI might be fairly described as the Global Energy Balance Network of hydration as it was founded by Coca-Cola at a cost of just over $7 million USD, and the study's lead author, a prior consultant and speaker for Coca-Cola, is the chairman of the EHI's scientific advisory board and the vice-chair of the EHI's board of trustees.

College Humor recently put out a great debunking of the hydration emergency. Have a peek!

All this to say that soda benefits from the hydration emergency message as it healthwashes their product in a way that leads people to think of soda as something more than just liquid candy.

So yes, definitely drink if you're thirsty, but drink water, not candy.

Monday, October 03, 2016

FitBits Aren't Supposed to Make You Lose Weight

It's been all over the news these past few weeks, a recent study reported that not only didn't wearing a FitBit as part of a weight loss program lead to increased weight loss, it led to decreased weight loss.

Does it really matter one way or the other?

The question that matters is whether or not FitBits led wearers to exercise more, not whether it led anyone to lose weight.

According to that same 2 year study, the answer to whether or not FitBit users moved more was no.

That's both disappointing and not particularly surprising. It's disappointing because moving more can markedly improve health and quality of life at any weight. It's not particularly surprising because no one has yet figured out how to affect a population based sustained increase in physical activity.

No doubt there are specific individuals who are motivated by their trackers and do in fact sustain long term changes to behaviour, but once again here we have an outcome that speaks against the ongoing singular focus of personal responsibility as the means to improve healthy living.

If we want people to move more we need to find ways to make doing so easier, more fun, and/or more valuable. Simply telling them to move more, or apparently showing them how little or how much they move, isn't going to be enough in and of itself.

[UPDATE: The study though did have a major limitation in that it used a now obsolete wearable. It's possible that the results with newer wearables would differ. Here's Aaron Coleman's coverage of same. Thanks to @Chimbo23 for pointing me to it.]

Saturday, October 01, 2016

Saturday Stories: 2 Great Reads

David Samuels in Tablet with Shimon Peres' last interview. The world, not just Israel, has lost a giant.

Susan Schneider Williams in Neurology with a heart-wrenching first person account of her husband Robin Williams' descent into Lewy body dementia.

[And if you don't follow me on Facebook or Twitter, here's the piece I published this week in US News and World Report on how you should check your privilege before you talk about personal responsibility and healthy living]