Wednesday, August 30, 2017

Could Health Canada's Future Front-of-Package Stoplights Reform Deceptive Claims?

So on Monday I blogged about how there are plenty of foods of dubious nutritional quality with fronts-of-package claims that while legal, are deceptive.

Looking ahead, there is the chance that Health Canada will be implementing a national front-of-package food labeling program which in turn would highlight products' higher than desired nutrient contents (perhaps by way of stoplights for instance).

So here's my straightforward suggestion.

Regardless of the system implemented, if a product's ingredients score it a front-of-package warning from Health Canada, that product's packaging should be legally prohibited from including any front-of-package health claims or inferences (where inferences for example would be a package of Froot Loops shouting out to its inclusion of whole grains or Vitamin D, but without an actual functional health claim).

Though imperfect, this simple step might help tilt the playing field ever so slightly away from the food industry's current unfair advantage.

Monday, August 28, 2017

The Canadian Food Inspection Agency Asks For Examples of Deceptive Food Labels

Saw this tweet from the CFIA and so I decided to take a supermarket field trip and found plenty of what I would describe as deceptive food labels.

5 teaspoons of sugar per bar along with 210 calories 
31% more sugar cup per cup than Froot Loops
By weight, this product is 48% sugar
Cookie for cookie more than double the sugar of an Oreo
Drop for drop more sugar and calories than Coca-Cola
With 2.75tsp of sugar per "Twist", contains the sugar of 2.3 actual Twizzlers
Each popsicle contains the sodium found in 93/100ths of one single grain of table salt (along with 2 teaspoons of sugar)

But here's the problem, none of the products' labels above break any Canadian packaging laws, and if the labelling laws themselves explicitly permit deceptive labels, consumers don't stand a chance.

Why have a system where the onus is on the consumer to study the products' nutrition fact panels to determine if their healthy front of package claims are supported?

Saturday, August 26, 2017

Saturday Stories: Anne Frank Center, Post-Truth America, and Front Lawn Farming

Before you share that next clever Anne Frank Center for Mutual Respect zinger, please read Albert Eisenberg in National Review on how the center is a disgrace to Anne Frank's name and memory, and Emma Green in The Atlantic, with her detailed history of the center.

Kurt Anderson in the Atlantic with a great but depressing longread on how America has lost its collective mind.

Arielle Dollinger, in the New York Times, on the rise of front lawn farmers.

[And for those who don't follow me on Twitter or Facebook, I've decided to try to resurrect my Weighty Mutters podcast. You can find it on Anchor, iTunes, and Google Play]

Wednesday, August 23, 2017

PSA: Scales Measure Gravity, Not Health, Happiness, Success, or Effort

Just a periodic reminder that scales measure the gravitational pull of the earth at a given moment in time - nothing else.

Scales don't measure the presence or absence of health.

Scales don't measure happiness.

Scales don't measure success.

And scales don't measure effort.

Too many people believe scales measure things other than gravity, and for some, those beliefs lead them to abandon their best efforts.

If you're ever curious about how you're doing, consider the fact that the answer to that question has to do with the doing.

Are you cooking more frequently? Minimizing your liquid calories? Decreasing your restaurant reliance? Not drinking to excess? Cultivating sleep? Exercising as much and as often as you can reasonably enjoy? Keeping a food diary of some sort?

The answer to those questions (and of course that list isn't exhaustive, nor will all questions apply to all people) are how you're doing.

Please don't confuse what you weigh with how you're doing. Though there's often overlap, they're definitely not one in the same.

Monday, August 21, 2017

UC Davis Now Marketing HealBe Calorie Counting Indiegogo Scam

Do you remember HealBe?

They're the Russian company that raised over $1 million on Indiegogo in 2014 for a wearable that was supposed to track, just by your wearing it, how many calories you consumed.

They've been rightly pilloried for years by Pando Daily including a delicious quote from ZDogg on their technology who described it as
"some straight Ghostbusters, Peter Venkman bullshit"
Plainly put, the device hasn't delivered on its promises to magically measure the calories you consume, though it does deliver something - money into the pockets of its owners who don't seem to have any scruples about selling to a desperate population a device that hasn't been proven to work (review from Engadget here).

And if you don't believe me about the proof, the quote that HealBe's co-founder Stanislav Povolotsky gave Pando Daily's James Robinson succinctly sums it up,
"Proof, yeah… that is a tough piece for us."
And proof shouldn't be hard to come by. Controlled feeding for even just a few days while wearing the GoBe wearable and poof, if validated, a goldmine, not only for the investors, but for obesity researchers and the public the world over.

That 3 years after launch they're still nowhere, without a single peer reviewed publication, speaks volumes.

And with that all said, I just can't wrap my head around the fact that just a few months ago, researchers at the University of California Davis, entered into a 5 year agreement with HealBe to study their device.

Now I know what's in it for HealBe. Marketing.

As to what's in it for UC Davis?

There I'm at a loss.

Saturday, August 19, 2017

Saturday Stories: Charlottesville, Charlottesville, and Charlottesville

United States of America, 2017
Emma Green in The Atlantic, on why Charlottesville marchers were obsessed with Jews.

Alan Zimmerman, president of Congregation Beth Israel in Charlottesville, VA, in Reform Judaism, recounts his experiences during the march.

And if you haven't yet spent the time to watch VICE's short Charlottesville documentary, please do.

Thursday, August 17, 2017

Who Will Be The First To Sue A Fertility Treatment Centre For Weight Discrimination?

Did you know that women are regularly denied service from fertility clinics simply because of their weights?

I've met dozens of women struggling to conceive, who though healthy, exceeded a BMI threshold (usually in the neighbourhood of 35), and consequently were denied the opportunity to undergo fertility treatments and start a family.

I remember one who recounted how the fertility doctor who saw her suggested that perhaps God didn't want her to have a child (because she was unable to lose weight), but generally the reasons they're provided tend to focus on safety to them or to their future baby.

It's always struck me as arbitrary and biased as there are other conditions that confer risk that aren't exclusionary, and so I was thrilled to read a recent paper taking on the arguments in Human Reproduction Open. The paper, It is not justified to reject fertility treatment based on obesity, in my mind lays a basic groundwork for a future lawsuit.

It explains how though the risks of hypertensive disorders, gestational diabetes and caesarean sections are indeed higher in pregnancies of women with obesity, suggesting that this is a justification for withholding fertility treatment is dramatically weakened when considering that fertility treatments are not withheld from women with diabetes who in turn are at higher risks of developing hypertensive disorders, stillbirths and premature labour.

Similarly, when addressing the risks to the child - congenital malformations, premature birth with related morbidity, macrosomia and shoulder dystocia, future obesity, and a higher risk of metabolic syndrome - the authors note that children of women with diabetes also have increased risks of congenital anomalies, macrosomia and shoulder dystocia, and premature birth with related morbidity.

In speaking with an obstetrician friend, they pointed out that what's genuinely required (and unfortunately often absent or weak) is a frank discussion with the patient with obesity about the risks of the pregnancy - which indeed are real - but that denial of treatment simply on the basis of weight, is not justifiable. At worst it's conscious weight bias, at best, unconscious. Either way, it's ugly.

Monday, August 14, 2017

Dear Reporters, The Cure For Obesity Is Unlikely To Be For Sale On Indiegogo

Last week a reporter contacted me looking for a quote.

She was doing a story on a $449 weight-loss product that is being sold on Indiegogo.

Briefly, the device reportedly works by stimulating the vestibular nerve, which, according to the people selling it, triggers the body to reduce fat storage, and all with just one hour of wear per day!

Of course there's this proviso (emphasis mine),
"Used in conjunction with a healthy diet and regular exercise the average user should notice a significant difference in body fat percentage."
Does the product have peer reviewed studies proving it works?

Of course not.

But it does have an unpublished preprint hosted freely online featuring a 6 person treatment group, only half of who completed the treatments.

The preprint also features a 3 person control group who somehow managed to post an 8.6% increase in truncal fat and a 6% increase in total body fat during the study's short 4 month period.

And it includes the authors' assertion that neither group changed their diet and exercise habits - this despite the fact that the authors didn't track their subjects' diet and exercise habits, and also despite the fact that the control group gained a significant amount of fat in a very short period of time.

After looking at all of this, I politely declined the reporter's request for an interview, as a story at this point on this product, even with a dissenting voice in it, is not simply premature, it's unethical. It's unethical not simply because it further perpetuates the narrative that magic, quick, and easy exists in regard to weight management, but because as is evidenced by the product's Indiegogo page, a story, any story, on this already for sale evidence-free product will be used by its manufacturers to market it to a desperate, constantly preyed upon population (who at the time of this post's writing, have already given this product's promoters $728,463 USD)

Now I realize that reporters are busy, and many don't have the background to pick apart studies, but I'd like to propose that the simple rule of,
"Don't cover medical devices being sold on Indiegogo or Kickstarter as a means to magically treat anything"
is probably a safe one, and one that I wish went without saying.

Thursday, August 10, 2017

The Strange New Reason Why You Shouldn't Drink Sugar With Your Meals

Granted, it's a small study, but its results were interesting.

The study, Postprandial energy metabolism and substrate oxidation in response to the inclusion of a sugar- or non-nutritive sweetened beverage with meals differing in protein content, looked at the impact sugar sweetened beverages had on the appetite suppression benefits of higher protein meals.

The authors note that,
"increasing dietary protein while maintaining energy intake produces a greater and more prolonged thermic effect and greater total energy expenditure",
that protein,
"potentially increases fat oxidation by up to 50%,"
"decreasing protein consumption may stimulate an increase in energy intake in an attempt to maintain a constant absolute intake of dietary protein",
and that,
"a 1.5%E decrease in dietary protein intake increases energy intake from carbohydrates and fats by 14%, perhaps in an attempt to increase protein intake from less protein-rich food sources (and point out that) in a 4-day in-patient ad libitum crossover feeding trial, a 5%E decrease in dietary protein intake produced a 12% increase in total energy intake"
So the authors were curious whether or not the inclusion of a sugary beverage would change the impact that a high protein meal had on consumption, appetite, and fat oxidation, and to explore, they studied those variables in 27 adults (without obesity) on two separate occasions in a direct (room) calorimeter after the consumption of a sugar-sweetened beverage or a non-nutritive sweetened beverage along with meals that varied in protein composition (15% vs. 30%).

The authors found, as expected (and certainly in line with the experiences I've seen among thousands of patients), that meals with higher protein content decreased hunger, increased fullness, and decreased the desire for fatty/salty/savory foods (sweet desires weren't affected).

The authors also found that when consumed along with a higher protein meal, sugar sweetened beverages increased the desire for fatty/salty/savory foods, and simultaneously decreased diet induced thermogenesis (the energy spent on processing/storing food), and fat oxidation (which the authors postulate may lead to a greater tendency of the body to store fat).

All this to say, treating sugar sweetened beverages (including juice) like the liquid candy that they are, and consuming them as treats, in the smallest quantities you need to be happily satisfied, rather than drinking them along with your meals, is probably a good plan.

Tuesday, August 08, 2017

The Canadian Cancer Society Wants You To Drink Sugar And Eat At Chipotle

A few years ago I pointed out the hypocrisy of the Canadian Cancer Society encouraging people to eat Domino's pizza in the name of fundraising.

I noted that sure, fast food pizza here and there isn't going to kill you or give you cancer, but that there's little doubt that one of the major drivers of our society's struggles with diet and weight related illnesses is the normalization of fast and junky foods as regular, everyday parts of our lives.

My belief is that this normalized culture of convenience is in part encouraged by the cause-washed use of candy and junk food for fundraising - a practice which may have been inconsequential (and rare) 60 years ago, but superimposed on our health issues today, is just plain wrong (and constant). And it's especially wrong when adopted by health organizations whose cause, like that of the the Canadian Cancer Society, is itself impacted by low quality diets.

So this year's Canadian Cancer Society junk food partners are Chipotle, PepsiCo, and the Dole Food Company.

The Canadian Cancer Society's partnership with Chipotle sees them encouraging a trip to the giant fast food burrito maker in the name of 50% of a single day's sales, while their partnership with PepsiCo and Dole come from one of their flagship events - the Run For The Cure - where PepsiCo and Dole serve as the Run's, "National Official Suppliers". As such, at the finish line of the short 5km fundraising run (which of course isn't of a distance long enough to worry about any fuel or hydration needs), PepsiCo and Dole will be there to market hand out the beverages that the Run For The Cure website notes provide participants, year after year, with "delicious refreshment".

Of course they'll also provide participants with piles of sugar given that Dole Sparklers, a "real fruit beverage", pack 4 teaspoons of free sugar per can, while Real Tea's offerings can pack up to a whopping 12 per bottle depending on flavour.

It's a good thing then I guess that the Run For The Cure is on October 1st rather than September 30th given that in September the Canadian Cancer Society's fundraising effort is a much more appropriate Sugar Free September initiative

And as the Canadian Cancer Society is explicitly aware, fruit drinks and sweetened tea, are common sources of free and added sugars in our diets.

One of the other reasons why these partnerships are so unwise is the way they're utilized by the junk food partner. For instance Dole's gone ahead and leveraged their partnership for in store sales of their sugar water by using it to cause-wash their products directly.

Given that the last time around the Canadian Cancer Society reported they were incredibly proud of their partnership with Dominos, I imagine this time will be no different.

Not sure pride is the emotion I'd recommend when reflecting on their comfort with junk food fundraising.

Thursday, August 03, 2017

Will Weighing Yourself Daily Really Help You Lose Weight?

There are no shortage of people and stories who'll report that one of the easiest things you can do to help yourself lose weight is to weigh yourself daily.

And there are plenty of journal articles too, like this one which came out just last week, that concluded,
"these data extend the possibility that daily self-weighing may be important for prevention of unwanted weight gain"
The problem with the majority of these studies however, is that they're not randomized trials designed to compare the intervention of weighing oneself daily to not, but rather they're either longitudinal studies, or retrospective studies, that look at weight loss and whether or not there's an association with daily weighing.

That matters a great deal because it certainly might follow, and this would be consistent with the experiences I've observed in working with thousands and thousands of patients, that when people know they're struggling with their diets and lifestyle changes, they avoid stepping on the scale, and therefore my bet would be that daily weighing is simply a marker for people who are doing well with their efforts.

So have there been randomized controlled trials of daily weighing on weight loss?

Surprisingly, I could only find one that isolated daily weighing as the primary weight loss intervention. It was a study which randomized 183 adults with obesity to weigh themselves daily, or not, and both groups were given weight loss advice that was known to be ineffective. That last bit is important if you're trying to suss out whether or not daily weighing itself provides benefit.

The authors' conclusion?
"As an intervention for weight loss, instruction to weigh daily is ineffective. Unlike other studies, there was no evidence that greater frequency of self-weighing is associated with greater weight loss."
I also wonder about whether or not daily weighing might lead to increased recidivism? Though I couldn't find any studies that looked at daily weighing and its association with patient dropout, given that day to day weight fluctuations are normal, and that weight loss (and life as a whole) isn't often a straight, consistent, line, I worry that those weighing themselves daily will provide themselves with more opportunities to be discouraged and hence, more likely to quit their intentional weight loss efforts in frustration.

In our clinic we recommend our patients weigh themselves weekly, on Wednesday mornings, naked, after pee, before breakfast, with the rationale being it's important to ensure weight gains, if they're occurring, are noted, because if you're off course, it's easy to gain a great deal of weight in a short period of time and avoiding the scale because you know things aren't going well might lead you to gain more than you would have were you aware of your trend.

Tuesday, August 01, 2017

How Is Reading with Ronald (McDonald) Still A Thing?

There's no denying there's a fair bit of grey to the black and white world of corporate sponsorship and public private partnerships, but the Reading With Ronald program probably doesn't fall into that category.

Simply put, Reading With Ronald sees public libraries inviting Ronald McDonald to read to kindergarteners.

Publicly funded institutions that by definition are trusted by children shouldn't be used to market anything, let along junk food, to children.

That these events occur doesn't speak so much to incompetence though, they speak to how normal it is in society today for us to pretend that corporate interests in events like these are altruistic, and not just marketing.