Saturday, February 15, 2020

Saturday Stories: Man-Boobs, Formula, And Shattered Identities

James Hamblin, in The Atlantic, on the bizarre and unfounded man-boob based backlash to plant-based meat.

Hannah Ellis-Petersen, in The Guardian, on how formula makers target the mothers who can least afford it.

Sarah Zhang, in The Atlantic, on DNA testing and shattered identities.

Tuesday, February 11, 2020

Why Service Provision Fatally Confounds All Diet Studies (5:2 Intermittent Fasting Edition)

Last week I posted about a 5:2 intermittent fasting study that demonstrated terrible adherence with a 58% 5:2 drop out rate by the end of year one and where the average loss was 11lbs.

In response, Erik Arnesen shared another year long 5:2 intermittent fasting vs. continuous energy restriction study where the drop out rate at the end of year one was just 7% and the average loss was 20lbs! (and actually I blogged about this one in the past - tl;dr no difference in outcomes but 5:2 participants were hungrier)

If the diets were identical, why the tremendous difference in adherence and weight loss at a year?

Sure, could be different patient populations, but I'm guessing the much larger factor was the service provision. Because at the end of the day that's a huge part of what's being measured in any organized diet study. Not just in terms of how many visits or touch-points a particular program has, or what collateral materials and support they provide their participants, but also the rapport development, motivational ability, and teaching skills of the service providers themselves.

Having led an inter-professional team for 16 years, I can tell you that who you've got helping your patients/participants has a tremendous impact on their outcomes even within the same program's delivery.

So the next time you consider the outcomes of any study's diet arm, a question worth pondering is how much of those outcomes are consequent to the prescribed diet itself, and how much are consequent to the health care professionals administering it?

Saturday, February 08, 2020

Tuesday, February 04, 2020

Year Long 5:2 Intermittent Fasting Study Reports It's No Better Or Worse Than A Horribly Restrictive Diet

I started out planning to write about a different paper - a one year post intervention followup of people who had completed a prior year of being randomly assigned to 5:2 style intermittent fasting (IF) (2 days a week consuming 400-600 calories) vs. continuous energy restriction (typical of eating less daily) which showed that there was no difference between the two, but when I read it I realized the story was in the initial intervention, not the follow up.

The initial intervention involved randomly assigning 332 people to one of 3 dietary interventions:  Continuous (daily) energy restriction (CER), week-on, week-off energy restriction, and a 5:2 intermittent fasting pattern involving 5 days of habitual intake and 2 very low energy diet days each week.

Of the only 146 completers, no differences were found between the diets in terms of weight loss, adherence, change in lipids, or fasting glucose.

And most of that is consistent with other studies of 5:2 IF which have found that it's no better or worse than any other approach when it comes to weight loss and biochemical changes. But what's not consistent is adherence being the same, wherein other studies tend to see more people quitting IF.

Digging the tiniest bit deeper into this two things stand out. Adherence was abysmal for both CER (49% drop out rate) and IF (58% drop out rate). But what was different here was what was involved in the CER arm. Women randomized to the CER arm were aimed at consuming only 1,000 calories daily for a year, while men were aimed at only 1,200 calories daily. That's a life-suckingly low number of calories for anyone to be aimed at and honestly it surprises me that researchers (and peer reviewers) would think that degree of continuous restriction would be worthy of study.

All this to say, that people were just as likely to report adherence to a misery inducing 1,000-1,200 calorie per day diet as they were to a 5:2 IF approach does not reflect well on the enjoyability (and consequently the broad applicability) of 5:2 style diets.

And for the inevitable trolls, I'm not knocking 5:2 IF. If you love it, terrific! Don't stop! But don't anyone expect it's a panacea for all comers.

Saturday, February 01, 2020

Wednesday, January 29, 2020

Study Published Stating The Daily Mile Doesn't Improve Childhood Obesity Speaks To Risks Of Tying Weight To Exercise

Published this week in the International Journal of Obesity is Effectiveness and cost-effectiveness of The Daily Mile on childhood weight outcomes and wellbeing: a cluster randomised controlled trial whereby researchers reported on the impact a school year worth of 15 minutes of daily running had on children's BMIs.

It's an odd study in that we're talking about 15 minutes of running per day which literally no one should expect to have a marked effect on childhood obesity given both math (15 mins of children running, jogging, or walking a mile probably doesn't even burn the calories of a single Oreo) and the fact that multiple meta-analyses have shown that even far more involved school based PE initiatives don't have an impact on childhood obesity.

It's also odd because The Daily Mile itself doesn't tie itself to weight,
"The aim of The Daily Mile is to improve the physical, social, emotional and mental health and wellbeing of our children – regardless of age, ability or personal circumstances"
And it's a problematic study in that consequent to the wholly predictable non-exciting outcome, it's the sort of study that might be used as a means to discourage the program's continuation.

What might have been studied instead? How about the impact of the Daily Mile on marks, concentration, endurance, or physical literacy (note, they attempted to do some of this, but data collection was too poor for them to make many conclusions), or if there was a strong desire to tie it to something medical, how about blood pressure, heart rate recovery, mood, sleep, or lipid levels?

As I've said many times, dumbing down exercise to weight management shortchanges both the benefits of exercise and the realities of weight management, and frankly doing that in the name of a program that sees kids running an extra 15 minutes a day, and then seeing that published in a credible journal, speaks to just how pervasive and dangerous that practice is.

Monday, January 27, 2020

If The Microbiome Is As All Important As We're Led To Believe Isn't That's All The More Reason Not To Mess With Yours?

There's no denying the hype around the microbiome with buzz suggesting that it's integral to anything and everything - from our immune systems, to obesity, to dementia.

So let's for a moment agree that it is.

Even if we do, it's difficult to imagine there would be one universal "best" mircobiome makeup spanning age, sex, race, diet, geography, comorbidities, etc. Meaning even if we had thoughts about what a "healthy" microbiome was, what's healthy for one person might not be healthy for another.

But back to us agreeing they're hugely important and implicated in everything.

If that's the case, should you really be purposefully trying to mess with yours given we basically haven't even begun to study the impact of messing with them over time?

Me?

I'll stick to the basics.

Saturday, January 25, 2020

Wednesday, January 22, 2020

Should Statistically Significant But Clinically Meaningless Outcomes Still Be Reported As Significant?

Rather than call out the specific paper that led to this blog post (I also don't want to add to its Altmetrics), just a question.

If your systematic review findings demonstrate that a particular supplement/food/diet led to an average total weight loss of 0.7lbs is it appropriate to describe that effect as significant even if statistically you believe you're able to make that claim?

Personally, I don't think so.

Especially not when we're discussing food, because as Kevin Klatt recently pointed out on his blog, there are no food placebos. and as John Ionnidis pointed out, we eat thousands of chemicals in millions of different daily combinations which markedly challenges our ability to conclusively opine about the impact of any one food.

Worse though, is the fact that the media (both traditional and social), won't bother to qualify their enthusiasm when describing these findings and instead will report them as beneficial, significant, and important, as of course will PubMed warriors.

So how to fix this? Perhaps including a qualifying, "but not likely to have any clinical relevance" statement in the abstract might lead to more balanced media coverage (or less media coverage ) which in turn would be less likely to report significant but clinically meaningless outcomes as important, which ultimately would be good for science and scientific literacy.

Wednesday, January 15, 2020

Product Reformulation Means Sugar Taxes Work Even If People Don't Buy Less As A Consequence

Taxes work to decrease purchasing, and the higher the tax, the greater their impact. Period.

Which is why it's always struck me as odd when people question whether or not sugar-sweetened beverage (SSB) taxes would affect SSB purchases (and consequently consumption).

But let's leave that odd debate aside for a moment. If the goal of SSB taxes is to decrease added sugar consumption (which it explicitly is, while it is explicitly not about weight loss as societal obesity is not singularly caused by SSB consumption, and decreasing SSB consumption is healthy at every weight), it would appear that SSB taxes will decrease sugar consumption even if they don't decrease purchasing.

How?

Because when SSB taxes are enacted, the beverage industry reformulates its products.

And at least according to this bulletin from the World Health Organization, they do so not insignificantly!

Of the 83 products they surveyed in both 2014 (before the UK's SSB tax) and in 2018 (after the UK's SSB tax), the mean sugar content decreased by 42% (from 9.1 g/100mL to 5.3 g/100mL) while the mean energy content decreased by 40% (from 38 kcal/100mL to 23 kcal/100mL). Putting this into the context of a standard 355ml can - that would represent 2.45 fewer teaspoons of sugar and 53 fewer calories per can.

And this was in response to a fairly nominal tax. Presumably larger taxes would drive larger (or more expansive) reformulations which of course would also be coupled with decreased purchasing as has been shown to not at all surprisingly occur where enacted.

All this to say, this is yet another reason why if you're living somewhere without an SSB tax, my bet is that it's a matter of when, not if, you will be.

Saturday, January 11, 2020

Saturday Stories: Larry David, Elizabeth Wurtzel, And The Ebola Vaccine

Brett Martin, in GQ, profiles the inimitable Larry David

Elizabeth Wurtzel, in Medium, discussing her life's final year

Helen Branswell, in STAT, with the story of how scientists on 3 continents together produced an Ebola vaccine

Photo of Elizabeth Wurtzel by Blonde1967; this photo was taken with an iPhone SE by my mother, Lynne Winters - Own work, CC BY-SA 4.0, Link

Thursday, January 09, 2020

Canadian Donut Chain Launches Donut Flavoured Cereal And People Are Angry. Why I Think There Are Better Things (And Worse Cereals) To Be Angry About.

So last week saw the Canadian launch of timbits cereal and as evidenced by the number of people have sent press releases about it to me, not everyone is pleased.

Timbits, for readers who don't know, are donut holes from Canadian donut chain giant Tim Hortons.

People are upset because apparently this sugary cereal is over the top and somehow extra wrong or extra awful.

But why?

Tim Horton's certainly isn't in the business of protecting or promoting public health. Nor is Post Foods. Nor should anyone expect either to be.

Presumably the sugar is a concern for people, and at 17g per cup (4.25 teaspoons), it's definitely not an insignificant amount, but it's not more than many other sugary cereals, and is in fact less than Post Raisin Bran which packs 24% more sugar at 21g (5.25 teaspoons) per cup.

All this to say, it's difficult to get angry with Tim Horton's or Post Foods for trying to sell food as selling food is literally their only job, and frankly this food isn't any worse than comparable foods they're already selling.

So what should the cereal aisle make people angry about?

How about laxity in advertising laws that allows for cartoon characters to be festooned on boxes of sugary cereals and prey on children? Or laxity in front-of-packaging laws that allow Froot Loops boxes to brag about their whole grain or vitamin D content? Or the failure of our government to create a front-of-package warning system like the one that was enacted in Chile.

What would life in Canadian cereal aisles look like if we followed Chile's lead?

Here's Frosted Flakes before and after Chile's laws came into effect

Sure looks great to me.

(And for the grammar police, 'donut' is how Tim Hortons spells doughnut)

Monday, January 06, 2020

How Much Do You Like Your Diet? Given Adherence Likely Dependent On Enjoyment, Our Recent Paper Set Out To Quantify That

Back in 2012, I wondered aloud about creating a scoring system for dietary enjoyment. I blogged about it a few times here and there, and happily, a wonderful team of researchers in New Zealand took notice. Now, thanks to the hard work of Michelle Jospe, along with Jillian Haszsard, and Rachel Taylor, the first step towards its formal use has been taken.

Our paper, A tool for assessing the satisfaction of a diet: Development and preliminary validation of the Diet Satisfaction Score, was published late last year and it details our Diet Satisfaction Score's preliminary reliability and validity.

With the help of the 1,604 people (spanning 24 different countries!) who answered our survey questions, as well as 6 diverse experts (thanks to Melanie Dubyk, Kevin Hall, Scott Kahan, Silke Morrison, Marion Nestle, Sherry Pagoto, Arya Sharma and Ethan Weiss), we arrived on the following questions geared to address various aspects of dietary adherence and satisfaction

The simplest way to think of the Diet Satisfaction Score's use is the higher the overall score (each question is answered on a 5 point Likert scale and the final DSS score is calculated by way of taking the mean of all available items yielding a total score between 1 and 5), the greater an individual's satisfaction/enjoyment of that diet is. The hypothesis then would be higher scores correlating with better adherence and consequently better/sustained weight loss.

And that's what our preliminary findings suggest whereby each 1-point higher Diet Satisfaction Score correlated with a 1.7 week longer diet duration. It was also found that compared with those who had abandoned their diets, those maintaining them reported larger losses.

The value of a simple and quick score like this to individuals would be as a means to assess how much (or how little) they were enjoying their diets taking into account more than just whether they like the foods they're eating, but also the impact their chosen diet might be having on related aspects of life (socializing, time, cost, etc.). Those evaluating their new diets and finding their scores low, might explore means to tweak their diets, or to try new ones.

The DSS score's value to clinicians would be as a quick means to screen their patients' efforts and perhaps to use the tool to help trouble shoot, or to triage referrals to professional resources such as registered dietitians.

The value of the DSS score to researchers would be using this tool with shorter term studies as a means to predict whether or not their studied diets are likely to be sustainable (as who really cares how much weight a person might lose on a particular short term diet if few people would actually sustain it).

Of course now what's required is the repeated use of the Diet Satisfaction score in a long-term prospective trial. The good news is that because the tool, like me, is diet agnostic, it can be administered with any and all dietary strategies. Should you be interested in using the Diet Satisfaction Score in your trial Dr. Jospe is the person to contact and her contact information is just this one click away.