Monday, April 29, 2019

New Study Suggests ADHD Steers Children To An Unhealthy Diet, Not The Other Way Around

To be taken with a grain of dietary recall data, but a new study, Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort, found that an ADHD diagnosis led children to a less healthy diet, whereas less healthy diets did not lead children to ADHD.

The study was conducted in the Netherlands and it followed 3,680 children starting at age 6 and then ending when they reached the age of 10.

Put plainly, though more ADHD symptoms at age 6 were associated with less healthy diets at age 8, diet quality at age 8 was not associated with ADHD symptoms at age 10.

There are a number of proposed pathways to help explain how ADHD might affect diet quality. ADHD and its impulsivity may increase the risk of binge eating or loss of control eating, and the impact of ADHD on neurotransmitters may affect hunger and fullness. It's also possible that some parents of children with ADHD may offer foods their children prefer in order to decrease risk of conflict and/or reward desired behaviour.

Clearly more research on this would be welcome.

Saturday, April 27, 2019

Saturday Stories: Freds, Sexism in Science, and Anti-Vaxx Marriage

Danielle Kosecki, in Medium, with her defense of Freds (less serious cyclists, and disclosure, I am one).

Mallory Picket, in The New York Times Magazine, on sexism in science's highest echelons.

Anonymous, in The Cut, on marriage with an anti-vaxxer.

Tuesday, April 23, 2019

Move More, Eat More? New Study Suggests People Do Eat More When They're More Active, But Not Much

One of the possible reasons that in freely living humans exercise doesn't seem to add up to weight loss as math might predict is that freely living humans might eat back their burned calories. Some may do so consequent to increased hunger. Others to a sense of virtue and the inclination to reward themselves for their hard work. Others still because marketing has convinced them that they must refuel, recover, replenish, etc..

A new study,Activity energy expenditure is an independent predictor of energy intake in humans, published this year in the International Journal of Obesity, set out to look at this phenomenon.

Now to be clear, the study certainly wasn't designed to explain exercise's impact on weight. It was just 7 days long and it involved the retrospective analysis of data from 5 prior studies and did not directly measure energy expenditure or energy intake. Instead researchers utilized estimated energy expenditure by way of heart rate and indirect calorimetry data, and energy intake by way of known to be problematic food diaries.

My stats skills are nowhere near good enough to comment on the various treatments of the data, but here's the scatter plot of the impact of energy expenditure on energy intake.

The increase in energy intake the authors attributed to energy expenditure wasn't high, roughly 3% of total daily calories (around 70 in this sample), an amount too small to explain away exercise's often uninspiring impact on weight loss.

Truth be told, I'd have predicted the difference to be larger as eating more consequent to exercise is something I know many people do for one or more of the various reasons mentioned above.

Of course none of this changes the fact that exercise has tremendous health benefits at any weight and that weight shouldn't be your driver for upping yours if you're able.

Saturday, April 20, 2019

Saturday Stories: IN MICE, Cancer, and Future Dementia

James Heathers, in Medium, explains why he started the Twitter account that only ever tweets "IN MICE"

Anne Boyer, in The New Yorker, on what cancer takes away.

Tia Powell, in Elemental (on Medium), on how she's preparing for her future dementia.

Wednesday, April 17, 2019

RDs! We're Hiring! Looking To Fill A Full-Time Permanent And Possibly Some Part-Time Positions

Will copy our job posting below, but the tl;dr version is we're both growing (our digital distance tool is deep into development and should be ready for beta-testing come late spring or early summer) and one of our wonderful RDs will be heading off on maternity leave. Consequently, we're looking for some great RDs!

Prior applicants are welcome by the way. In fact many of the RDs we've hired over the years had applied more than once.

Here's the posting. Please send resume and letter of interest to
The Bariatric Medical Institute (BMI) in Ottawa, an inter-professional weight management office that includes medical doctors, personal trainers, registered dietitians, a social worker, a clinical psychologist, and a therapy dog, is looking for a permanent full time dietitian to join our professional and unique team.

We are looking for an individual who loves working with people and technology, is great at multi-tasking, is a team players, thrives off of challenges and responsibility, and wants to utilize his or her skills in making a dramatic positive difference in people’s lives.

Responsibilities will include:
  • Collaboration with interprofessional team members.
  • One-on-one counselling sessions to motivate and help patients live the healthiest they can.
  • One-on-one counselling sessions with parents of children struggling with weight to help them navigate a healthy eating environment.
  • One-on-one counselling sessions to help prepare patients for bariatric surgery as well as post-surgery sessions to help patients ensure that they succeed.
  • Design individualized nutrition plans based on each individuals’ unique lifestyles, metabolic rates and dietary likes and dislikes.
  • Write for BMI’s different social media outlets: Website, blog, vlog, and monthly newsletter.
The skills you’ll need:
  • Exceptionally strong motivational counselling skills.
  • Must have excellent listening skills, empathetic and sensitive to patient’s needs. We do not ever utilize negative reinforcement in our counselling.
  • Able to adapt nutrition advice to recent scientific research with thoughtful critical appraisal.
  • Must be innovative and give patients realistic and helpful nutrition advice.
  • Positive and non-restrictive approach to weight management.
  • Comfortable giving presentations.
  • Possess sound professional judgment, initiative and enthusiasm.
  • Good time management skills and ability to organize.
  • Excellent computer skills, and comfort with social media
  • Strong cooking skills.
The requirements we’re looking for:
  • Minimum one year of clinical experience
  • Registered Dietitian
  • Member of the College of Dietitians of Ontario and in good standing (or willingness and ability to join).
  • Master level clinicians are preferred, although not required.
  • Previous experience working in weight management and childhood obesity is an asset.
  • Working with us you will have access to a full gym facility as well as shower and change rooms. Physical activity and healthy living are the primary focus of our work and therefore we view your active lifestyle as a great asset.
Because we are looking for the best candidate our wages are highly competitive with those in the community and after the 3 month probation period, medical and dental benefits are part of our package.

We look forward to hearing from and meeting with you.

Are You Successfully Maintaining A Weight Loss OR Have You Recently Quit A Diet? If Yes To Either Question, Please Spare 2 Minutes For Our Research (Shares Welcome!)

Back in 2012 I first posted my wish for there to be a questionnaire that would serve to help individuals and researchers determine how easy or difficult a particular diet would be to follow.

I called it the Diet Index Enjoyability Total or DIET score, and my hope was that by using a series of simple Likert scales (descriptive scales from 1-10), researchers could set out to evaluate a particular weight loss approach's DIET score where high scores would identify diets that could actually be enjoyed, and where low scores would identify under-eating, highly restrictive, quality of life degrading, dieting misery. This would be useful both to individuals who could use the DIET score to evaluate whatever approach they were considering, but might also serve as a surrogate for shorter term diet studies to give a sense as to whether or not there's a low or high likelihood of long term adherence to a particular study's strategy.

I'm happy to report that thanks to the hard work of Michelle Jospe and Jill Haszard of the University of Otago, along with your responses, we have completed the DIET score's qualitative review and this survey is meant as a simple pilot to test the hypothesis that higher scores associate with longer term success, and we hope, that once collected, these results will be compiled along with our qualitative review for the DIET Score's first published preliminary study!

So again, if you're currently following a diet, or if you've recently quit a diet, we would greatly appreciate it if you were able to take just a few minutes of your time to fill out our quick survey by clicking here.

Thank you in advance!


[Today's survey is the final one (hopefully) before we submit our paper on the DIET SCORE. Consequent to our first two surveys we tweaked our questions to make them more relevant and representative by way our your comments and expert feedback. Even if you filled our survey out last time, if you've been successful on your diet (any dietary strategy or approach, we're not picky) OR if you've recently quit your diet, we'd dearly love to hear from you and we promise, it will barely take 2 minutes to complete]

Monday, April 15, 2019

Coca-Cola Claims It Doesn't Market Soft Drinks To Kids, Announces New Star Wars Themed Bottles For Disneyland And Disney World

Coca-Cola has gone on record to state,
"Parents tell us they prefer to be the ones teaching their children about beverage choices. That's why for over 50 years we've adhered to a company policy that prohibits advertising soft drinks to children"
So clearly their newly announced plans to sell Star Wars themed bottles at Disneyland and Disneyworld must be targeting adults.

Nothing wrong with a liquid candy company trying to sell liquid candy (that's their literal job after all), but don't lie and pretend you don't target children with your marketing or that you care about anything other than profit.

Monday, April 08, 2019

The Joe Rogan Experience Gary Taubes And Stephan Guyenet Debate And All That's Wrong With Modern Day Dieting Discourse

First some disclosures. As far as diets go, I'm egalitarian. I believe that the best diet for you may be the worst diet for someone else, and that all diets work by way of reducing caloric intake, but that calories from different foods will have differing impacts upon health and satiety. As far as Gary and Stephan go, I like both of them. I've had the opportunity to have a number of offline conversations with Gary over the years and though I'm guessing we generally spent the majority of our time in those chats disagreeing with one another (sometimes rudely), for reasons I find difficult to pin down, I've always enjoyed them. Stephan is someone whose work I've been reading for years and whose opinion I respect and value. And the 3 of us, in 2017, were involved with the Cato Institute for an online debate on sugar.

With those out of the way, onto the debate.

I certainly hadn't planned on writing about it. And I won't spend too much time nitpicking the discussion. Suffice to say, as many already have, it seemed that Gary the journalist relied on stories to make his points, while Stephan the scientist relied on studies. Gary constantly interrupted Stephan, and somehow also managed to recurrently mispronounce his name (despite corrections), and Stephan, perhaps as a consequence, at times treated Gary dismissively.

If you're looking for a more detailed play by play of the entire 2 hours and 37 minutes, by all means, here's Layne Norton's fairly exhaustive (and even time stamped) coverage, but what I want to cover today are a few thoughts inspired by the debate rather than the debate itself.

Much of the low-carb high-fat (LCHF) (now in many cases interchangeable with #Keto) world has raged on for years about mainstream medicine and science's disregard for their chosen diet and theories. An old photocopy of an American Heart Association pamphlet from 1991 that indeed promotes sugar consumption gets trotted out as some sort of gotcha for 2019. Young keto adherent physicians proudly tweet of the "torture" they experience reading opinions on diets other than their own (disclosure - including mine). Cardiologists with bestselling LCHF diet books write breathless articles in newspapers championing the idea that everything you've been taught about diet and heart disease is wrong and encourage the specific consumption of saturated fat. Self identified "science journalists" (note, this isn't actually a dig at Gary but rather others) who purport to care about evidence embrace and amplify the most idiotic of theories, stories, or comments so long as they suit their narratives. And if a study contradicts any of the aforementioned folks' belief systems, the fault is said to no doubt lie with the methodology, or the researcher being conflicted (as Gary repeatedly suggested in the debate when discussing the work of his former NuSi hire Kevin Hall, as well as Jim Hill and colleagues' metabolic ward study that utilized direct calorimetry to show that people gained equal amounts of weight when overfed fat or carbs), or both. And of course pretty much all of the most vocal gurus, even the ones from prestigious institutions like Harvard, appear more than happy to extend their credibilities to prop up whatever medical quack (Mercola, Oz, Hyman, etc.) is willing to promote them.

For various reasons, listening to this debate reminded me of all of that.

Despite Gary's very real comment in regard to diet related chronic disease and society that,
"Tragic shit is going on"
it would seem to me that the bulk of the energy spent by the loudest of the LCHF/#Keto crowd is mustered trying to prove everyone else is wrong or conflicted, and that there is only one, true, right, best, diet - a message that's especially off putting when it comes from MDs, given every single day physicians are reminded that different treatments work differently for different people - sometimes predictably, and sometimes not so much - which is why for instance for hypertension there are at least 10 different classes of medications, and multiple options within each.

The starkest difference between Gary and Stephan I think comes at the 2:24:08 mark where Stephan details how much he loved Gary's Good Calories, Bad Calories and how he found it so persuasive that he personally adopted a LCHF diet, but that then he turned from the historical narratives conveyed in Good Calories, Bad Calories, to the science, and he found that the science told a different story. Not a story that suggested LCHF was a bad diet, or the wrong diet, or an unhelpful diet, but just that the science underlying Gary's hypothesis doesn't hold water for Stephan. And then, over the course of the next few minutes, in what I can only assume is his rebuttal, Gary tries to narratively explain Stephan's personal, subjective, experiences on LCHF diets, and then discounts the various studies Stephan mentions as being poorly designed while trotting out one study he does like from the 60s that to his reading, supported his assertions.

And I know this wasn't the point of the debate - it was a debate after all - but wouldn't it be grand if instead of the constant need of so many (and yes, there are definitely exceptions - see note at end) to promote LCHF/#Keto as the one right, best, only, diet, LCHF/#Keto proponents, especially those who are themselves researchers and health professionals, took a deep breath and realized that if tragic shit is indeed going on, that perseverating on motives rather than data, and fanning the flames of online outrage mobs, and propping up quacks like Mercola and Hyman, and promoting the worst examples of science and opinion so long as it suits their narratives, and fear-mongering around statins, and spreading the bizarre notion that there's only one right diet and that anyone who suggests otherwise is wrong and likely conflicted, while I suppose providing fodder for online debates, is indefensible, unhelpful, and a very real reason why there's far less embrace and research of a strategy that absolutely has a place in the treatment and prevention of diet and weight related diseases.

(And for an example of a keto adherent physician who bucks the aforementioned trend, look no further than cardiologist Ethan Weiss who just the other day penned this great post about keto, LDL, and treatment, all the while embracing science and reason)

Saturday, April 06, 2019

Saturday Stories: Disney Money, Fertility Doctor's Secrets, And The Gefilte Manifesto

Sarah McVeigh, in The Cut, with an interview of Abigail Disney (yes, that Disney), on what it's like having more money than you could ever spend.

Sarah Zhang, in The Atlantic, on the fertility doctor's secret.

Daniel Summers, in Arc, with a lovely piece on how a Jewish Cookbook is helping him to reclaim his lost heritage.

Wednesday, April 03, 2019

Coca-Cola Funded ISCOLE Trial Continues To Conclude Lack Of Exercise Drives Childhood Obesity

When it comes to associations, causality matters - the importance of which is easily understood when considering childhood obesity and inactivity. Whether inactivity leads to kids to gain weight, or whether weight leads kids to become inactive have very different implications

My publicly expressed bias is that childhood obesity drives inactivity, and there's data to support that assertion including this study whereby when observed over time in 8-11 year olds, weight gain predicted inactivity, while inactivity did not predict weight gain, leading the authors of that study to conclude,
"adiposity is a better predictor of PA and sedentary behavior changes than the other way around."
As to what's going on, if I were to venture a guess, it'd be some combination of obesity related abject bullying (multiple studies demonstrate bullying is associated with decreased physical activity and obesity has been shown to be the number one target of schoolyard bullying, not to mention the fact that bullies may make fun of heavier kids when exercising explicitly), being one of the worst/slowest on a team, and increased effort involved, that lead heavier kids to decreased MVPA (moderate-to-vigorous physical activity).

Now I've blogged before about the Coca-Cola funded ISCOLE trial almost entirely ignoring the possibility that childhood obesity drives inactivity rather than the other way around, and recently, another study came out of the ISCOLE group that did the same.

(and if you're interested, here's a published discussion of the emails between ISCOLE investigators and Coca-Cola that not surprisingly suggests that these relationships have the very real potential to influence the framing of results even if funders not involved in study design)

The study, Joint associations between weekday and weekend physical activity or sedentary time and childhood obesity, published in the International Journal of Obesity, looked at weekday and weekend levels of MVPA and sedentary time in 9-11 year old children in 12 countries and their associations with obesity.

Yes, they were found to be associated.

Though they do have a single throwaway line speaking to causality,
"It is not known whether lower levels of physical activity are the cause or the consequence of obesity",
that did not stop them from writing this as their final line and conclusion,
"Since children have more discretionary time during weekend days than weekdays, children should be encouraged to increase physical activity during weekend days, especially a high level of MVPA"
which while true on the basis of health as a whole, when framed in the explicit context of childhood obesity as it is in this paper, seems to deny the much more likely case that weight simply slows kids down.

And honestly, that matters.

It matters because one of the most predominant stereotypical narratives of obesity is that it is a disease of laziness, and ISCOLE's recurrently utilized framing supports that stigmatizing message. It also matters because, if considered at least by the parents I regularly see in my office, inactive children with obesity are being regularly judged (and sometimes even shamed or bullied) by their well-intentioned parents for not being active enough to lead them to lighter weights and I can't help but wonder if this would still be the case if the meat of the discussions in these sorts of papers focused on the barriers to physical activity erected by childhood obesity itself?

I would love to see more research done on the various mechanisms by which childhood obesity might contributes to inactivity, and more longitudinal studies designed to test causality, rather than paper after paper with conclusions that to my confirmation bias at least, ignore the many reasons why kids with obesity are understandably less likely to be physically active, and in so doing, fail those poor kids.