Saturday, March 30, 2019

Saturday Stories: Vaping Risks, Doomsday Fungus, And A Friend With Cancer

Julia Belluz, in Vox, covers what we do and don't know about the risks of vaping.

Ed Yong, in The Atlantic, with the worst disease ever record.

Aaron E. Carroll, in The New York Times, on what his friend's cancer taught him about the healthcare system. 

(Photo by Lindsay Fox from Newport beach, United States - Vaping, CC BY 2.0, Link)

Wednesday, March 27, 2019

If You're Calling For A Ban On Bottled Water, But Not On Bottled Sugar Water (Soda, Juice, Sports Drinks, etc), You're Doing It Wrong

Apparently two former city Councillors, and some "water advocates" from a group named the Ottawa Water Study/Action Group, are lobbying the City of Ottawa to ban the sale of bottled water in all municipal buildings.

They rightly argue that Ottawa city tap water is terrific, and that the sale of bottled water is destructive to the environment.

But here's the thing.

All the other plastic bottles in the vending machine, you know, the ones that are just water with some sugar and flavour, they're in the very same bottles, and their consumption, unlike water's, isn't good for health.

So if you enact a ban on bottled water, but allow the sale of sugared waters, you're likely to shift sales to them, will do little to nothing towards for the environment, and you'll be promoting unhealthy beverages. Not something I can get behind.

I'm all for banning the sale of plastic bottles, but all plastic bottles, not just the ones containing the only actually healthy beverage being sold.

Monday, March 25, 2019

Shoppers At UK Supermarkets That Got Rid Of Checkout Aisle Junk Food Purchased 16% Less Small Pack Junk Food One Year Later

So it wasn't a randomized trial, but the results were interesting nonetheless.

In the UK, a number of supermarkets electively decided to stop the sale of impulse buy small pack checkout aisle junk food. Researchers curious about the impact had a peek at their sales data.

What they found was encouraging and they detailed their findings in their article Supermarket policies on less-healthy food at checkouts: Natural experimental evaluation using interrupted time series analyses of purchases. Plainly put, when compared with purchases from supermarkets still selling checkout aisle small pack junk, shoppers purchased 16% less small pack junk food from supermarkets that didn't offer checkout aisle junk food temptations.

Given the ubiquity of junk food in checkout aisles, and here I'm not just talking about the supermarket, but pretty much any and every checkout aisle, cleaning them up is a very real target in improving our food environment. And before you say it can't be done, it's been done with tobacco's "Power Walls" (but some irony here in that at least some of the new walls hiding cigarettes are being used to advertise junk food)

Saturday, March 23, 2019

Thursday, March 21, 2019

If You Tie Exercise To Weight Loss It Can Lead To Statements And Recommendations Like These

I've long called for a rebranding of exercise to promote it on the basis of all of its incredible benefits, and explicitly not in the name of weight loss.

While on paper there's no doubt that people can lose weight through exercise (and in research studies too), in practice they generally don't. And though there's also definitely the suggestion that exercise helps to keep weight off (or serves as a marker or inspiration for maintaining a whole slew of weight responsive behaviour changes), when it comes to public health, I believe focusing on weight loss as the outcome of choice in exercise interventions risks those interventions' dissolution when weight loss doesn't occur.

Helping to make my point is a recent study published in the American Journal of Preventative Medicine. The study, Implementing School-Based Policies to Prevent Obesity: Cluster Randomized Trial, looked at the impact school based nutrition and physical activity policies had on weight.

The study found that while school based nutrition policies seemed to have an impact on weight over time, school based physical activity policies didn't.

Not measured of course, or at least not mentioned, were the impacts those physical activity policies might have had on other health related parameters (blood pressure, blood sugar, non-alcoholic fatty liver disease, mood, sleep, attention, learning, physical literacy, and more) - things that I think the literature would support as being far more likely to see exercise-related improvements.

But it's the study's abstract's conclusion that got me, as I think it does a great job of highlighting the risk of clinging to exercise as an important driver of weight loss. Here it is in its entirety (highlighting mine),
"This cluster randomized trial demonstrated effectiveness of providing support for implementation of school-based nutrition policies, but not physical activity policies, to limit BMI increases among middle school students. Results can guide future school interventions."
Suffice to say I think it'd be an incredible shame if results like these guide any future school related physical activity interventions, as the benefits of exercise are myriad, something these results wholly ignore, and if these results guide anything, they'd guide the avoidance or elimination of school based physical activity policies which would let kids down on so many levels.

Tuesday, March 19, 2019

Why I Don't Celebrate Marketing Fruit To Children By Way Of Cartoon Characters

A few weeks ago I noticed the Center for Science in the Public Interest giving kudos to Disney and to The Lego Movie for their licensing of their cartoon characters to sell pineapples and bananas.

I don't share their enthusiasm.

In part that's because neither Disney nor the Lego Movie have any qualms licensing their characters to sell crap to kids. McDonald's recently announced that Disney's happily taking many millions of dollars from them (actual dollar cost not announced, last was $100 million) to once again include Disney toys in their Happy Meals, while the Lego Movie, well they're already in Happy Meals.

But my bigger objection is that we shouldn't be targeting children with advertising in the first place because why should anything be advertised to a population that has been shown to not be able to discern truth from advertising? And so even if the advertisements happen to fit with your definition of what's good for kids, it doesn't change the fact that it's plainly unethical to allow advertising to target children period.

Saturday, March 16, 2019

Saturday Stories: Feast Burden, Old Hate, And Wellness Cults

Bobbie Ann Mason, in The New Yorker, on the burden of the feast.

Isaac Chotiner, in The New Yorker, with a not at all gentle interview of Holocaust historian Deborah E. Lipstadt on the oldest hatred.

Margaret McCartney, in the Globe and Mail, on not falling prey to the cult of wellness.

Wednesday, March 13, 2019

Coca-Cola's New Simply Smoothie Strawberry Banana Contains 11.5 Teaspoons Of Sugar Per Cup

I should probably be putting "smoothie" in sneer quotes when discussing this new product.

The ingredients in this "smoothie" aren't simply water, strawberries, and bananas but rather they're strawberries, bananas, and apple, grape, and lemon juices.

Perhaps that's why in an 11.5oz serving of it, there's 44g of sugar (responsible for 85% of its 200 calories). For reference, drop for drop, actual Coca-Cola contains 15% less sugar and 33% fewer calories.

But of course no one confuses Coca-Cola for a healthy beverage.

But Coca-Cola (Simply's parent company) sure hopes you confuse this "smoothie" with one given they've festooned it with front of package shout outs that explicitly suggest it's good for you.

I'm also confused by its nutrition.

The ingredients report that 11.5oz of banana strawberry "smoothie" provides 1g of fibre - that's less than what would be found in just a 5th of a small banana, and yet to eat 44g of sugar from small bananas, you'd have to consume 18x that amount. And the 35% Vitamin C? You'd get that from just 2 strawberries.

Unless it's you doing your own blending (and even then, remember it's not likely to be as filling and you'll be able to consume a great deal more) eat your fruit, don't drink it.

Monday, March 11, 2019

Why Fund Or Publish Diet Studies That Have Little Relationship With Real Life?

I'm honestly not trying to be mean, but that was the thought that went through my mind when I read the recently published study, Log Often, Lose More: Electronic Dietary Self‐Monitoring for Weight Loss which purports to explore the relationship between food diary use and weight loss.

Don't get me wrong, I'm a huge proponent of using a food diary. Whether it's tracking calories, carbohydrates, macros, or whatever, there's ample evidence to suggest that tracking helps to maintain new behaviours, but is that what this study showed?

Well it did show that those keeping a food diary and using it more often had greater weight loss during a 24 week behavioural weight loss intervention.

So what's my problem?

I have two (well, two related to this study, clearly many overall).

The first is that the food tracker utilized was web based, and not a smartphone app. It's a minor quibble, but nonetheless, app based food diaries are the norm, why not use them? Given we have our phones wherever we go, but not our desktops and laptops, that might make a real difference to the percentage of people using them (and yes, I realize there are web browsers on phones, but that's just not the same).

I'm guessing the reason a smartphone app wasn't used is that using one would not have provided the researchers with the minutes users spent tracking, which brings me to my second, and more significant, concern.

Apparently, in the first month, successful users (those who ultimately lost more than 5% of their presenting weights) were shown to be using that web based food diary 23-24 minutes daily. And though some of that is likely consequent to learning curve, by month 6 it was still taking them 15-16 minutes of effort to record their daily meals and snacks.

Those are extremely high numbers. Having once done a stretch of 3 years of not missing a single day's use of, first a web based, and then an app based food diary, I can tell you that in short order, it really shouldn't take longer than 2-3 minutes daily to track. The learning curve is at most 2-3 weeks, and once beyond that, useful food diaries keep track of your entered meals and snacks such that re-entering them is a simple as a click.

Or at least that's how it should be.

Which means that the users in this study were either taught the world's least efficient means of keeping a food diary, or the web interface utilized was just awful (or both).

Either way, I'm not sure how the results of this study help much. Because while I'm definitely a believer when it comes to the benefits of food diary use, it would seem to me that what this study actually measured are the outcomes of people so incredibly dedicated to their behaviour change efforts, that they bothered putting up with an awful and time consuming food diary for 6 months.

[for some expanded thoughts from me on keeping a food diary, here's a piece I wrote for Greatist a number of years ago, and for full disclosure, I'm currently closing in on beta-testing our office's own food diary and behaviour change smartphone app]

Saturday, March 09, 2019

Wednesday, March 06, 2019

No, New York State Academy Of Family Physicians (@NYSAFP), Sugar Sweetened Milk Is Not "Essential", Just Ask The @AAFP

So what possible reason could the New York State Academy of Family Physicians (NYSAFP) have to highlight in their weekly eNews circular sent to 10,447 family physicians and students, an article that claims, "Flavored milk is essential" and "a tasty way for kids to get the 9 essential nutrients that they need"?

I think it's a fair question given the World Health Organization, the Centers for Disease Control, and yes, the NYSAFP's parent organization, the American Academy of Family Physicians (AAFP) all recommend that added sugars contribute no more than 5-10% of total daily calories, and yes, chocolate milk contains heaps of added sugar.

In fact, the American Academy of Family Physicians explicitly discourages the consumption of sweetened or flavoured milk stating,
"It is important that you stay hydrated. However, drinks that contain sugar are not healthy. This includes fruit juices, soda, sports and energy drinks, sweetened or flavored milk, and sweet tea."
And I'm guessing the answer won't surprise you either.

The answer is money.

Specifically, $2,300.

Because that's how much the NYSAFP charges companies for a "Product Showcase" feature that goes out in 13 separate emails to reach those 10,447 family physicians and students.

That's $177 per mailing.

And what does that $177 buy the American Dairy Association North East?

Well of course it buys the ad space, exposure, and frequency, but it also buys credibility.

I'll let the NYSAFP explain,

So NYSAFP, if you're reading, please issue a correction, and to that end, here's an invitation for you. If you'd like to send out some information about what happens when chocolate milk is removed from school lunches to your 10,447 physician and student members, please take this as my permission to freely republish my blog post that covered the study on this very matter that found that taking chocolate milk out of schools did not affect the students' total daily milk or dairy consumption, that on average all students were meeting their daily recommended amounts of dairy (recommendations which by the way are almost certainly higher than the evidence would suggest they need be), that kids who swapped from chocolate milk to white milk drank pretty much the same amount of white as they did chocolate (unless you think 4/5ths of a tablespoon of milk is a lot), and that by removing chocolate milk from the school, in the first month alone nearly half of the initial chocolate milk drinkers switched to white and in so doing, saved themselves piles of calories and the nearly 2 full cups of monthly added chocolate milk sugar.

Or at the very least, kill that ill-advised ad and maybe revisit your policies around vetting sponsors.

[Thanks to Beth Locke for sending the NYSAFP's eNews my way]

Monday, March 04, 2019

Surprise? Offering In Class Breakfasts of Cereal, Muffins, Juice, and Milk For 2.5 Years Increases Obesity In Students

Yup, it's true.

Offer children in-class breakfasts consisting of cereal, muffins, juice, and milk for 2.5 years and compared with children in schools not offering those in-class breakfasts, their weights end up being, "significantly higher".

Those are the results of a study recently published in JAMA Pediatrics, and really, they don't seem all that surprising.

Firstly, the breakfasts were offered to all children, regardless of whether this was, as Hobbits might say, second breakfast

But more to the point, would anyone expect a not likely to be sating breakfast consisting of cereal, muffin, juice, and milk, to have a positive impact on weight or health (and I should take the time here to point out that the study authors were not in charge of what schools chose to feed their students)?

As I've ranted many times, what a person eats for breakfast likely matters a great deal to satiety, health, weight and what have you. I've also ranted on the dangers of lumping studies of specific meals (in this case ultra-processed carbs washed down with a bunch of liquid calories) and then opining on the benefits of "breakfast" as a meal.

Food insecurity is real, and finding the means to ensure children eat healthy meals is laudable, but feeding children who are already at increased risk of chronic diseases, meals that may themselves increase the risk of developing chronic diseases, probably isn't in their best interest, and given that, as one of the study's authors Kate Bauer noted on Twitter,
"all breakfasts met the federal School Breakfast Program requirements"
it sure makes one wonder whether America's federal School Breakfast Program could stand for some revision?

Saturday, March 02, 2019

Saturday Stories: Not Killing Babies, "Top Doctors", And Sobriety

David McMillan
Dr. Jennifer Gunter, in The New York Times, sharing her sorrow to tell America that no, she didn't kill her baby, nor are any doctors executing children at birth [as an aside and as a Canadian, I find it mind boggling and horrifying that these statements need to be made in 2019 America]

Marshall Allan, the journalist, in ProPublica, on how he was named one of America's "Top Doctors".

David McMillan, co-chef-owner of legendary Montreal restaurant Joe Beef, in bon app├ętit, with a phenomenal read on his finding sobriety and the impact it's had on those around him.