Canada's Food Guide to Unhealthy Eating

Canada's Food Guide to Healthy Eating is an oxymoron.

Everything the Food Guide should be - an evidence-based, easy to understand and implement guide to lead Canadians to follow a pattern of eating that will minimize their risk of developing chronic diseases (including obesity) - it isn't. What's worse is that the proposed revision to the Food Guide, which as we speak is ready for it's release on an unsuspecting public, is still horribly flawed.

[NOTE: Original post updated to include information on the final, disappointing product]

I testified on some of the Food Guide's deficiencies in the House of Commons back in September. Since then Health Canada was recalled to the Standing Committee on Health, and on Halloween, the Standing Committee passed a motion to have the proposed revision to the Food Guide tabled before the Committee.

The next week I was asked to speak to the Canadian Medical Association regarding my concerns (Health Canada was also invited to present their case). My understanding of the outcome is that the CMA has expressed their concerns directly to Tony Clement, the Minister of Health.

Please follow the links below to explore the bizarre revision process, the involvement of the food industry, the dismissal of evidence-based research and the end results of 3 years of "work" at Health Canada.

1. Big Food Has a Seat - Health Canada's bizarre inclusion of the Food Industry in the shaping of the Guide
2. Broken from the Get Go - Get this, the revised Food Guide is based off of current Canadian dietary patterns....where 40% of all vegetables consumed are potatoes with over half of the potatoes being consumed coming from french fries or potato chips
3. At Least You'll Get Enough Zinc - Health Canada cares a lot about nutrients...not so much about foods. Last time I checked, I eat foods, not nutrients.
4. Consultation? What Consultation? - I suppose if by consultation you mean what fonts you like then yes, there was an extensive consultative process
5. Please Eat White Bread - Why Wonder Bread's more in touch with the evidence on whole wheat than Health Canada.
6. All Fat is Bad - Fat phobia still runs rampant at Health Canada.
7. All Meat is Good, and Please Eat More of it - Beef farmers rejoice, Health Canada recommends Canadians eat more beef and still doesn't tell us fish is a healthier choice.
8. Eat Less Fruit and Vegetables - Amazingly that's part of Health Canada's new recommendations
9. Drink Lots and Lots of Milk - Don't worry about all that research that suggests that in fact it might not be so good for you.
10. A Match NOT Made in Heaven - The 1997 Nutrient File and Canada's Food Guide working together to increase obesity.
11. Oh, and you Can't have Ketchup - How Health Canada has ignored 25% of your dietary energy intake.
12. Guidance? What Guidance? - The sage advice of the Food Guide on how to manage your weight
13. Health Canada's Quobesities - My favourite quotes from Health Canada officials on the matter of the Food Guide.
14. What Can You Do? - Some ideas about how to make your concerns known, and where can you turn to for sound dietary advice?
15. Epilogue - A Grading of the final February 2007 version of Canada's Food Guide.
16. The Bad Joke they Call "My Food Guide" - Did you know Health Canada thinks Chocolate Milk, Pudding and Muffins are healthy choices?
17. Why the Food Guide Matters - How the Food Guide impacts the average Canadian, including those who don't read the Food Guide.
18. Who Won the Food Guide Sweepstakes - Which of the many Food Industry interests squeezed the most out of their involvement in the revision?
19. ? = 88.5 - (61.9 x age [y])+ PA x { (26.7 x weight [kg]) + (903 x height [m]) } + 20 - Health Canada's almost unspeakably useless means of helping you determine your personal Calorie needs

At the very base of this post there's a little envelope icon. Please click it. Send the post to yourself and then use your own email account to cut, paste and forward that enclosed link to all of your friends and family. If you're a blogger, please link to it. If you're a medical student or a dietetic student, please forward it off to your listservs. I will be updating this post with links to the entire series as it gets published. With enough public concern something can be done before the Food Guide is released.

The Center for Science in the Public Interest estimates that every year in Canada 21,000-47,000 Canadians die from diet and weight related illnesses that cost taxpayers between $6.6 and $11 billion dollars a year.

I believe that Canadians deserve a Food Guide that reflects medicine's best understanding of the effect of diet on chronic disease prevention.

I also believe that Canadians deserve a Food Guide that will not make them gain weight if they follow it.

Tomorrow: Big Food Has a Seat - Health Canada's bizarre inclusion of the Food Industry in the shaping of the Guide.

Big Milk

The milk industry is completely unscrupulous. Their claims range from of course, osteoporosis prevention, to weight loss, to PMS treatment and more.

Dr. Willett, in a critique of Canada's pending Food Guide (next week will be all Food Guide, all week and will highlight many of Dr. Willett's concerns on the nutritional deficiencies of the Food Guide and mine on the fact that it will almost certainly, if followed, lead you to gain weight) stated,

"the draft Canadian guidelines advocate large amounts of dairy products. There is really not a credible scientific basis for this. The usual justification is that this will reduce osteoporosis and fractures, but large prospective studies consistently show no benefit of high dairy consumption on fracture incidence."

and,

"The high dairy intake would not be a major issue if it were clearly safe. However, the US Guidelines completely ignored a very substantial body of data showing increased risks of aggressive and fatal prostate cancer with high dairy consumption. Also, many studies have found increased risks of ovarian cancer with high dairy consumption. Although the findings for ovarian cancer have not been entirely consistent, a recent meta-analysis of prospective studies found about a 25% increase in ovarian cancer with lactose intake equivalent to three glasses of milk per day."

But we'll get into all of this next week. Today's Funny Friday (I realize that's tough to see so far in this post)!

Today for your viewing pleasure I'm featuring milk commercials and their outrageous claims. One thing I can definitely say positively about the milk industry, they sure do make great ads.

1. Osteoporosis Prevention (from the California Fluid Milk Products Advisory Board)

2. PMS Prevention (from the Got Milk campaign)

3. Grow muscles and a giant balloon head (from the Milk, It Does a Body Good campaign)

4. Be "Big" and stop worrying about bullies (from the Milk, It Does a Body Good campaign)

They're even more unscrupulous in Japan....

5. Grow very tall.

6. Enhance your bust


Lastly, here's how the folks from the Family Guy perceive where milk ads are going.

BC "Bans" Junk Food In Hospitals

Don't get too excited.

On Tuesday Gordon Campbell, BC's premier, announced that by 2009 "junk food" will be phased out of vending machines from all government owned buildings (including hospitals).

While that sounds lovely there are some obvious shortcomings of that statement.

Firstly, what will constitute junk food?

In a prior post I talked about Slammers, a new skim milk based chocolate bar in a bottle which meets at least the American Beverage Association/Clinton Foundation and the American federal government's dairy checkoff program which will be sold in vending machines in elementary schools. I imagine 100% juice will be there as well, in servings sizes larger than those recommended for children and adults by the proposed Beverage Guidance Panel championed by, you guessed it, Dr. Walter Willett (along with Barry Popkin, Lawrence Armstrong, George Bray, Benjamin Caballero and Balz Frei).

Secondly, what about the junk food restaurants?

I was horrified to learn that The Ottawa Heart Institute is bringing in a Tim Horton's.

What a nice one stop shop.

Chase down your quadruple bypass with one of Tim Horton's new Sausage, Egg and Cheese breakfast sandwiches with 20gr of saturated fat and 920mg of sodium. Gotta keep business, I mean patients, coming I guess.

I'll have to get to Funny Friday later...right now I'm too ticked off.

Pathetic.

Low Carb Diets again Prove Safe

My patients will tell you, there's no particular diet that I believe to be better than another for weight management.

I only have two real rules regarding diets and weight management:

1. If you want to lose weight, you have to eat fewer calories than you burn.
2. If you want to keep it off, you have to actually like what you're eating.

I've often said that if anyone ever walked into my office and told me that they love low-carb diets, lose weight on them but don't stick to them because they're scared they're not healthy I'd simply tell them to get back to low-carbs and get out of my office.

Fact is low carb dieting has proven itself to be safe time and time again.

Well, it's time again, again.

Yesterday in the New England Journal of Medicine Thomas Halton and colleagues (including Walt Willett) published a 20 year retrospective study utilizing data from the 82,802 nurses in the Nurses Health Study who have completed their extensive dietary questionnaires, looking at the rate of development of heart disease as a function of low-carb dieting.

I'll just skip straight to their conclusion,

"Our findings suggest that diets lower in carbohydrate and higher in protein and fat are not associated with increased risk of coronary heart disease in women. When vegetable sources of fat and protein are chosen, these diets may moderately reduce the risk of coronary heart disease."

Frankly my only problem with low-carb diets is the fact that most people find them far too restrictive to stick to....and of course, if you don't like the way you lose the weight, it'll never stay off.

64-198

Sad day in Canada.

Bill C-283 (to put calories on menus) voted down in the House 64-198.

Guess the government prefers watching the $11 billion dollars currently lost yearly to weight related illness grow rather than empower Canadians with more information to help guide their choices.

To see the Center for Science in the Public Interest's statement on this sadly unsurprising outcome, click here.

Stupidest Products Ever or Brilliant Exercise Inventions?

I'm at a bit of a loss here.

As far as I'm concerned, it's not just one incredibly stupid product, it's a whole incredibly stupid product line.

Treadmills, exercise bikes and cross trainers for children ages 3-8.

Gymkids is the braintrust behind the idea.

And these things aren't cheap. $200 or so per product.

Now I'm not knocking kids exercising, but why can't a parent just buy a kid some shoes and play with them? Or a bike? Or a jungle gym?

Gymkids explicitly states on their website that, "Supervision by a responsible adult should be undertaken at all times."

I would love to meet the parents that actually sit around watching their kids walk on itty-bitty treadmills instead of playing with them.

My wife suggested that perhaps it was for parents who themselves use home gyms so if the parent was working out, the kid could too - That said, can you picture a 3 year old running on a treadmill for any sustainable length of time?

Do other people think these are ridiculous or am I being overly critical?

Why Does the City Waste my Tax Dollars?

Yesterday I received a couriered package from the City of Ottawa Public Health department. I imagine every doctor in Ottawa received the same package (or at least every family doc).

In this high priority package was a list of upcoming flu shot clinics, a reader survey, the Physician’s update newsletter, a list of communicable diseases that I’m bound to report to the Ministry of Health, a form that I can fax to receive Ottawa Public Health immunization documents, a flyer from the Centretown Community Health Centre on their Community Diabetes Education Program, a handout on how to start a patient on insulin (in English and in French), a phone list for physicians/health care providers in the Ottawa Public Health Department and 20 fifteen page minibooks called, “Influenza Pandemic – Are YOU ready (with ‘you’ indeed being emphasized by means of a magnifying glass on the cover).

I especially like the minibook. There’s a handy dandy top ten list of emergencies that the City of Ottawa could face:

1. An infectious disease outbreak
2. An earthquake
3. A radiation-related emergency
4. Water contamination
5. A lifeline (sewer system) failure
6. An ice storm
7. An act of terrorism
8. An explosion
9. A demonstration or riot
10. A hazardous material spill.

The package weighed 1.3lbs!

First question of course is does the City actually believe their disaster planning handout is a useful thing for residents to have? Do people truly not realize that washing your hands is a good idea with a flu outbreak? Does it really help to be told to expect 80 deaths per day during a hypothetical outbreak?

More important question, why wasn’t it mailed to me rather than wasting my tax dollars on god knows how much in courier costs?

I couldn't resist, I had to know - wanna know how much money was wasted?

Playing around on DHL's website (that's who shipped these materials) based on the package's size and weight I came up with a rough cost of $15 for that shipment.

Using the CPSO Doctor Search tool I identified 1050 family doctors in Ottawa. Simple math says $15,750 spent yesterday to send something that I would imagine 99% of family doctors will chuck into the garbage with little more than a cursory glance.

Of course I have no idea if they've restricted their mailing just to family docs. If they sent it out to all the docs, the CPSO site says there are 3,359 doctors in Ottawa. That's $50,385 in courier costs.

Some more bad news - they ship stuff like this out 3 times per year! If we assume similar sized shipments and costs, that's $47,250 per year if exclusively sent to family docs and $151,155 per year if sent to all docs.

[UPDATE: My Ottawa sources (a local OB/GYN among them) inform me that indeed, ALL doctors in Ottawa received the mailing!]

Much as I think the content was useless, even if I thought the content were valuable, it certainly wasn't an emergency and could easily have been sent in plain old mail. Last time I checked, no disasters in Ottawa. If it had been sent regular old mail Canada Post's site says it would have cost roughly $6.60 per.

I'm curious if this is a problem restricted to Ottawa or whether there is a pandemic of spending at our various public health units.

UPDATE: See most recent post detailing City's investigation

Wendy's - The New Authority on Nutrition!

What a coup for Wendy's!

They've teamed up with the American Dietetic Association to bring you a new website called Wendy's Mom-RD.

Here's a quote from the home page,

"Wendy's and the American Dietetic Association developed the Mom-RD program to provide moms with useful information that empowers them to make smarter choices when it comes to feeding their families"

Contrast that statement with Wendy's new slogan, "Do what tastes right".

What's the ADA doing getting in bed with Wendy's? For the life of me, other than money, I can't imagine what would motivate the ADA to team up with a company that uses toys and advertising to sell high calorie, non-nutritious food to children (currently they're using the Peanuts to sell Kids' meals).

Wanna know what's in a Kids' meal? Even one of their healthier meals, the one advertised on the Kids' Meal section of Wendy's website, the turkey sandwich with the 2% milk and the granola with yogurt, has 650 calories, 8 grams of artery clogging saturated fat and a whopping 1,280 grams of sodium.

Next question, have you ever met a kid who actually ordered the turkey sandwich with milk and granola? I'm actually scared to crunch the numbers for the Jr. Bacon Cheeseburger, the kids' fries and the pop.

Amazingly, in the website's section on, "10 Tips for Cutting Calories and Fats" they don't explicitly mention, "Don't eat at Wendy's".

Such a shame that the ADA and our Canadian equivalent the DoC (Dietitians of Canada) are far from shy from courting Big Food dollars.

Support Bill C-283

Please find below a letter from Mr. Bill Jeffery, the Canadian National Coordinator of the Centre for Science in the Public Interest. It has to do with the pending vote (this coming Wednesday!) on Bill C-283 that would require large chain restaurants to have calories listed on their menus.

As I'm sure you've guessed already, I'm all for this Bill.

Unfortunately my piece in support of it that will be coming out in the next Farm Boy flyer will apparently be two days too late.

Below are links to allow you to "Fax" your MP (all you need is your postal code, the wonders of the internet will do the rest) and the means to look up their phone number.

Don't be part of the silent majority. Take two minutes, follow the links and maybe, just maybe, the little guy'll win one vs. Big Food.

"Take 10 minutes, today, to help ensure that labels of fresh meat and processed food, and menus at large chain-restaurants are required to provide key nutrition information! This will complement the information require on many packaged foods since December 2005.

Parliament is scheduled to vote on Bill C-283 this Wednesday, November 8th.

Wednesday's vote is too close to call. All parties are being heavily lobbied by the large chain restaurants. (Mom & Pop restaurants and small chains would be exempt). You can help ensure that your MP thinks first about the public interest, and the health and pocketbooks of your family and the 100,000 or so other constituents in your riding, instead of yielding to pressure from a few self-serving food companies.

You can send a free, Internet-based fax from Fax Your MP to support Bill C-283 (food labelling). As long as you know your postal code, the "Fax-Your-MP" tool will automatically identify your MP's name and correct fax number. Of course, add a few personal words of your own to the model letter we've prepared for you. It will make your letter have even more impact!

If at all possible, send the fax right now. The vote is scheduled for Wednesday, but MPs are very busy and, if they don't receive the fax by Tuesday afternoon, there's a chance they won't see your letter before they cast their vote.

The Centre for Science in the Public Interest has been working hard for nearly four years to convince MPs to support this bill, and now is a critical juncture. You could help even more by following-up on your letter with a quick phone call to your MP's office (in the riding or Ottawa) and the office of Minister of Health, Tony Clement. If your MP is not available to talk to you, leave a voice mail message or ask the staff to tell your MP (and Minister Clement) that you support the bill and you hope all MPs will too! You can find MPs' phone numbers in the blue pages of your local phone directory, by calling 1-800-0-Canada (1-800-622-6232), or by visiting the Parliament of Canada web-site: MPs' Phone Numbers .

I hope you can make the time to help support this campaign at this critical juncture and forward this e-mail to your friends, colleagues and any listerves or newsgroups you think might interested.

-Bill

---------------------------------------------
Bill Jeffery, LLB, National Coordinator
Centre for Science in the Public Interest
Suite 4550, CTTC Bldg.
1125 Colonel By Drive
Ottawa, Ontario K1S 5R1
CANADA
Website: http://www.cspinet.org/canada (Fax Your MP is also available on our home-page by clicking on the "Fax Your MP" icon near the bottom of our home-page.)

CSPI is a non-profit health advocacy organization specializing in nutrition and food safety issues with offices in Ottawa, and Washington, D.C. CSPI's Ottawa health advocacy office is primarily funded by more than 100,000 subscribers to the Canadian edition of Nutrition Action Healthletter. CSPI does not accept funding from industry or government and Nutrition Action does not carry advertisements.

To join our Action Alert list, visit: http://www.cspinet.org/canada/e_activists.html

Ever Wonder What it Would be Like to Get Hit by 1,000s of Pies?

I find Japanese television to be both spellbinding and jaw dropping.

Here, for Funny Friday, is a 3-part video of a Japanese television show which from what I can gather involves an unfortunate gentleman who for some reason has agreed to spend an entire day getting hit by cream pies.

The clips are lengthy, the humour builds slowly, but boy did I enjoy them.

I especially liked it in the first clip when the man tries to make himself some toast and one of the cream-pie ninjas throw a pie in his toaster. I also liked the third segment when the man while trying to sleep is awoken by an older woman coming out of his closet and then eating the cream off the pie guy's face (this scene potentially not for younger eyes).

The pies begin at the 2:06 mark in the first video and then they just don't stop.

Clearly I'm a simple, simple man.

Have a great weekend!

"Just Like Home" Quobesity

Perhaps this should be a "Obesimage".

Saw this in our Toysrus flyer today.

It's called the Just Like Home Deli shop play set.

Looking at the picture I see hot dogs, hamburgers, onion rings, potato chips, doughnuts, chocolate milk, juice, ketchup and mustard, white bread, pancakes with butter, cookies and bacon.

Wanna argue with me and say, "Come on Yoni, it says it's a deli shop play set, you're twisting the picture".

Fine, here's the same company's Just Like Home 60 piece food set.

Pizza, doughnuts, cola, cookies, hot dogs, orange juice, ice cream, waffles, cheesecake, french fries, bacon, chocolate and perhaps a butter tart?

I think the vegetables are thrown in so the parents who buy the kit can say,

"Come on Timmy, you can't play with your french fries until you finish playing with your carrots!"

..... Just like home.

Do Restaurants Trigger Binge Eating?

Hot off the Reuters newswire is a story about how perhaps eating at restaurants triggers binge eating.

The story builds off a paper by Dr. Gayle M. Timmerman from the University of Austin Texas who published a study on the matter in the Western Journal of Nursing Research.

In the study Dr. Timmerman utilized food diaries to track the dietary intake of 71 self-reported binge eaters and 46 dieters who don't have a bingeing history. They then tracked calories consumed in restaurants by bingers and non-bingers and concluded that binge eaters were more likely to binge in restaurants.

I have two major problems with the study.

The first is the fact that food diary work is notoriously inaccurate in terms of intake, but more importantly, food diary work is often extremely stressful and difficult for patients who truly suffer with binge eating disorder. The fact that only 3 of the 117 food diaries were excluded due to questionable content to me suggests immediately that something's up with this study because there's no way that if you asked 117 folks to keep a food diary, that 97.5% actually kept them, let alone kept them accurately enough to be worth inclusion into a study.

The second problem I have is that what was not included in the analysis was daily caloric distribution.

One of the primary triggers for binge eating behaviours is hunger. The most common cause of hunger in our society is meal and snack skipping. While the study did control for total daily calories, not discussing caloric distribution to me makes it impossible to interpret the results.

One of the most commonly adopted backfiring strategies for many dieters involves the notion that if they know they're going to go out for dinner, they'll cut back on their daytime calories to compensate for those they'll consume at night. Often this will involve skipping meals or skipping snacks or purposely having very light meals that day.

This of course then leads to hunger and combining hunger with a restaurant and a predisposition to binge eating is a recipe for.......you guessed it, binge eating.

Dr. Timmerman concludes that,

"Restaurants provide ample delicious food cues which when coupled with negative emotions provide a high risk environment that challenges non-purge binge eaters' control of food intake."

I would likely want the data reanalyzed for frequency of meals, distribution of protein and I imagine the conclusion that would then be drawn would look something like,

"Restaurants provide ample delicious food cues which when coupled with meal skipping, snack skipping and hunger provides a high risk environment that challenges everyone's, especially binge eaters', control of food intake."

As I've said many times before - you don't crave green leafy salads when you're hungry.

Best advice I can give is the same advice I give my patients:

Never sit down to any meal, especially a restaurant meal, hungry.

Overweight? Don't Blame Suburbia

I've had a bone to pick for a long time with folks who feel that our rapidly growing waistlines are attributable to a lack of exercise.

I have an even bigger bone to pick with those who say our lack of exercise is due to growing rates of urban sprawl.

Fact is, the numbers for me just don't add up.

It's a very unfair thing - the number of calories burned through exercise isn't anything to write home about. Therefore I struggle with the notion that weight in society is going up due to a lack of exercise let alone a lack of simply being able to walk to your corner store.

Many studies have reported that the less walkable neighbourhoods of suburbia contribute to obesity and they conclude that by reporting that the percentage of those who are overweight or obese are higher in areas of urban sprawl.

The problem with that argument is that we really don't know if it's cause or effect.

That is perhaps, until now.

In a paper that came out of my alma matter, Lawrence Frank at the University of Toronto has published a very nice piece of research. In a paper entitled, Fat City: Questioning the Relationship Between Urban Sprawl and Obesity he does just that (question the relationship).

Basically what Dr. Frank hypothesized is that perhaps weight in fact impacts on choice of neighourhood, rather than neighbourhood impacting on weight.

He and his team took data from the very unsexily named Confidential Geocode Data of the National Longitudinal Survey of Youth 1979. They followed 6,000 individuals during a 6 year study period. They tracked these individuals' residential addresses and weights over time. What they were looking for was whether or not individuals gained weight when they moved to a more sprawling neighbourhood or lost weight when they moved to a less sprawling one.

To summarize a fairly complicated paper is Dr. Frank's conclusion,

"Overall we find no evidence that neighbourhood characteristics have any causal effect on weight"

I also agree wholeheartedly with their statement,

"It follows immediately from our results that recent calls to redesign cities in order to combat the rise in obesity are misguided."

That's not to say there's no value in improving the "walkability" of neighbourhoods - I'm all for that, but I'm for it to encourage fitness, a very important determinant of health. What it won't do is affect weight.

The math's just not there.

Operation Play-Doh a Great Success!

Hope everyone had a great Halloween.

I did my own experiment this Halloween.

I had read an article in the Journal of Nutrition Education and Behavior that suggested kids would be just as happy choosing toys as they would candy on Halloween.

My wife and I put that to the test last night.

We offered kids the choice between sugar-free gum and Play-Doh. The Play-Doh came in these individual packs and we bought 50 of them for $15.

I'd say 80% of the kids chose Play-Doh and virtually 100% of the parents were thrilled we weren't handing out more candy.

The best line of the evening came from a 7 or 8 year old goblin. When offered the choice between Playdoh and gum he asked,

Umm...the Play-doh, can you eat it?

When we told him no, he chose the gum.

The picture by the way, that's me and my beautiful daughter. Sorry it's blurry. One of my patients actually made me the Burger King costume.

I think it's a fitting costume...after all, Halloween's supposed to be scary.

The Incredible Eating Reminder Gizmo

One of the most basic tenets of successful weight loss and weight maintenance is that if your life includes hunger, success is going to be a huge challenge.

Hunger is one of the most basic human drives. Hundreds of millions of years of evolution have taught us to eat when we're hungry, and guess what, it's also taught us what foods have calories. We don't crave green leafy salads when we're hungry.

One of the best and easiest ways to minimize hunger in your life is to ensure that you practice pre-emptive eating. Eat before you get hunger and you'll have a much easier time controlling portions and choices.

Problem is, there's no internal cue to tell you to eat before you get hungry.

I've often recommended to patients that they buy watches that beep at them when it's snack time (I recommend no more than 3 hours between meals and snacks). Only thing is, those watches are kinda ugly.

In comes a patient with a brilliant solution. She bought a vibrating alarm pillbox. It's got five alarms and it's easy to set. She keeps hers in her pocket and when it vibrates, she eats.

I found one on Amazon.com for $14.95 and it's linked here:

Great idea!

Big Food Quobesity

Here's a doozy. In fact, it's such a doozy, it'll take up two quotes.

They're from the Director of Public Affairs for Refreshments Canada and they took place this past September in the Legislative Assembly of British Columbia during a meeting of the Select Standing Committee on Health. The meeting of course was to discuss the issue of the growing rate of childhood obesity in Canada.

The Director was painting a rosy picture of the refreshments offered to school children. There's water, juice, milk, sports drinks, diet beverages, juice drinks (read sugar drinks), and was also bragging that the serving sizes were capped at 355ml....one serving of which of course would exceed the American Academy of Pediatrics recommendations on juice consumption by 27%.

Anyhow, here's why it's a good idea to have larger servings and non-nutritional beverages in our schools,

We believe that offering students a variety of beverages, while encouraging the shift toward nutritious and low-calorie options, will help them develop positive attitudes toward healthy eating.

AND

Dietitians we consulted supported the expanded choices in the high schools, saying that high school students need the opportunity to use more sophisticated critical-thinking skills. They also told us that high school students need to develop an awareness of how their food and other health choices may impact health later in life.

So come on everyone, they're just trying to help our children with their critical thinking!

They're good people.

Telegrams for Beyond the Grave

So I was all excited to have launched a new feature - Funny Fridays and had a great clip up of Steve Carrell from the Daily Show getting his daily vegetables from "all-vegetable" Crisco.

Unfortunately last night Comedy Central decided to lawyer up and all of their clips on youtube are gone.

So I had to find something else.

In honour of Halloween, here's Afterlife Telegrams.

For just $5, a "terminally ill volunteer" will memorize your telegram and deliver it when he dies.

I'm not making this stuff up.

Team Hoyt

Maybe you've seen these folks before on the blogosphere. I hadn't. I came across them at one of our web developer's blogs

Reading about them on his blog, I thought it must be a hoax.

It's not.

I'm going to do what virtually everyone who's blogged about the Hoyts have done - paste an article in its entirety into my blog. For good measure, I'm also going to throw in two remarkable videos.

To call them inspirational would be an understatement.

Never say, "I can't" again.

(Article from Rick Reilly, Sport Illustrated)

I try to be a good father. Give my kids mulligans. Work nights to pay for their text messaging. Take them to swimsuit shoots.

But compared with Dick Hoyt, I suck.

Eighty-five times he's pushed his disabled son, Rick, 26.2 miles in marathons. Eight times he's not only pushed him 26.2 miles in a wheelchair but also towed him 2.4 miles in a dinghy while swimming and pedaled him 112 miles in a seat on the handlebars — all in the same day.

Dick's also pulled him cross-country skiing, taken him on his back mountain climbing and once hauled him across the U.S. on a bike. Makes taking your son bowling look a little lame, right?

And what has Rick done for his father? Not much — except save his life.

This love story began in Winchester, Mass., 43 years ago, when Rick was strangled by the umbilical cord during birth, leaving him brain-damaged and unable to control his limbs.

"He'll be a vegetable the rest of his life," Dick says doctors told him and his wife, Judy, when Rick was nine months old. "Put him in an institution."

But the Hoyts weren't buying it. They noticed the way Rick's eyes followed them around the room. When Rick was 11 they took him to the engineering department at Tufts University and asked if there was anything to help the boy communicate. "No way," Dick says he was told. "There's nothing going on in his brain."

"Tell him a joke," Dick countered. They did. Rick laughed. Turns out a lot was going on in his brain.

Rigged up with a computer that allowed him to control the cursor by touching a switch with the side of his head, Rick was finally able to communicate. First words? "Go Bruins!" And after a high school classmate was paralyzed in an accident and the school organized a charity run for him, Rick pecked out, "Dad, I want to do that."

Yeah, right. How was Dick, a self-described "porker" who never ran more than a mile at a time, going to push his son five miles? Still, he tried. "Then it was me who was handicapped," Dick says. "I was sore for two weeks."

That day changed Rick's life. "Dad," he typed, "when we were running, it felt like I wasn't disabled anymore!"

And that sentence changed Dick's life. He became obsessed with giving Rick that feeling as often as he could. He got into such hard-belly shape that he and Rick were ready to try the 1979 Boston Marathon.

"No way," Dick was told by a race official. The Hoyts weren't quite a single runner, and they weren't quite a wheelchair competitor. For a few years Dick and Rick just joined the massive field and ran anyway, then they found a way to get into the race officially: In 1983 they ran another marathon so fast they made the qualifying time for Boston the following year.

Then somebody said, "Hey, Dick, why not a triathlon?"

How's a guy who never learned to swim and hadn't ridden a bike since he was six going to haul his 110-pound kid through a triathlon? Still, Dick tried.

Now they've done 212 triathlons, including four grueling 15-hour Ironmans in Hawaii. It must be a buzzkill to be a 25-year-old stud getting passed by an old guy towing a grown man in a dinghy, don't you think?

Hey, Dick, why not see how you'd do on your own? "No way," he says. Dick does it purely for "the awesome feeling" he gets seeing Rick with a cantaloupe smile as they run, swim and ride together.

This year, at ages 65 and 43, Dick and Rick finished their 24th Boston Marathon, in 5,083rd place out of more than 20,000 starters. Their best time? Two hours, 40 minutes in 1992 — only 35 minutes off the world record, which, in case you don't keep track of these things, happens to be held by a guy who was not pushing another man in a wheelchair at the time.

"No question about it," Rick types. "My dad is the Father of the Century."

And Dick got something else out of all this too. Two years ago he had a mild heart attack during a race. Doctors found that one of his arteries was 95% clogged. "If you hadn't been in such great shape," one doctor told him, "you probably would've died 15 years ago."

So, in a way, Dick and Rick saved each other's life.

Rick, who has his own apartment (he gets home care) and works in Boston, and Dick, retired from the military and living in Holland, Mass., always find ways to be together. They give speeches around the country and compete in some backbreaking race every weekend, including this Father's Day.

That night, Rick will buy his dad dinner, but the thing he really wants to give him is a gift he can never buy.

"The thing I'd most like," Rick types, "is that my dad would sit in the chair and I would push him once."

Way to go Hoyts!

Legal Seafoods' Food Porn

Here I go stealing again. This time from the Center for Science in the Public Interest - perhaps my favourite group of non-profit nutritional advocates.

They've coined a term in their fantastic newsletter Nutrition Action. The term is Food Porn. It refers to foods that may well be enjoyable and tasty delicious, but either from a nutritional or a calorie perspective...not so hot.

It's going to be a new periodic feature on the blog.

Today's is example was on the menu last night at Legal Seafoods.

It was a special. Surf & Turf for two. Wanna know what was in it?

A 32 ounce steak, a 2.5lb lobster and 2 side dishes of our choice.

My estimated number of calories - 8000, not including drinks or dessert.

Yum?

It's Nice to Meet one of your Heroes

It's even nicer when they're nice.

When I was first considering changing my professional direction to obesity medicine I did a lot of reading.

One of the first books I came across was Dr. Walter Willett's Eat, Drink and Be Healthy. It's an evidence-based approach to examining what was healthy to eat and why.

I adored the book (it's of course linked on the side).

I read a lot, and continue to read a great deal.

It amuses me how much I look up to these men and women. The ones who do remarkable research, write elegant and intelligent journal articles. The ones who further our understanding of science and medicine.

When I see them in conferences I'm thrilled to be around them. I've even played with the idea of bringing their books and articles to be signed...but then I thought that would be too creepy.

A few days ago I had the pleasure of meeting Dr. Willett and you might say I had the pleasure of stalking him first.

He had a cloud of groupies like me hovering around him after a lecture. I waited and waited to speak with him, but the cloud didn't dissipate. Finally the cloud disappeared but he walked back into the lecture hall.

Following him and trying to look non-threatening, I sat down behind him. At the end of the lecture I asked him if I could have a moment of his time.

You see, Canada's Food Guide is about to be re-released and to my eyes, it is not even remotely reflective of our current best understandings of the role of diet on the prevention of chronic disease.

I've said as much in the House of Commons, but I'm not sure how loud my voice is.

I asked Dr. Willett if he would be kind enough to review the draft guide and offer his expert opinion. After all, in the world of voices on nutrition, there are not many, if any, louder than Dr. Willett's.

He agreed to do so and within 24hrs. had provided a thoughtful review of the Guide.

His conclusions I'll share with you another time (he didn't like it so much), I don't want to spoil this post with data.

This is just a thank you post.

Thanks Dr. Willett.

Penn & Teller's Bullsh!t does NAASO!

So what would you do?

One of your favourite "expose" shows wants to interview you, but the reason you love the show is because it's so entertaining due to how great the hosts are at skewering those dumb enough to be interviewed by them?

Guess I'm pretty dumb.

I love Penn and Teller's Bullsh!t show and when some guys with a camera asked me for an interview and told me they were freelancing for Bullsh!t...well surprisingly it wasn't a dilemma so we'll have to watch in March or April when they do their obesity expose and see if I got on.

As some of you may know, the NAASO - the Obesity Society's annual meeting is probably the largest obesity conference of the year. 5 consecutive streams of presentations with over 2,000 attendees from all over the globe.

Small wonder Bullsh!t came here, because with that many people some of them are bound to put their feet in their mouths.

Thing is I didn't mind being interviewed because I believe in what I'm doing with every fibre of my medical being.

Hopefully they won't make me look any stupider than I actually am.

Hey wait a sec...

My First Million Dollar Idea

Again I'm stealing from bookofjoe. I can't help it. He's a great blogger. He often offers up his million dollar ideas for free to the first person willing to build them.

Well, here, up for grabs, is my first million dollar idea.

Sitting in an obesity conference all day long, you get to thinking about obesity.

Certainly one of the problems with regards to the development of obesity is the fact that if it sets in before the end of childhood, the likelihood is, it's going to stick.

One of the problem with childhood obesity is that the children are themselves consumers. And while you and I hopefully make health a priority in our lives, kids are dramatically swayed by marketing, with corporations preying on our children's unholy attachments to folks like Dora and using her simply to sell the pre-requisite Dora cereal and in general encourage children to consume highly refined, less nutritious foods.

I believe it was Dateline (or maybe 60 minutes...it was one of those shows) that showed children were in fact more likely to choose a rock with stickers of Sponge Bob on it for a snack, than a poor old banana.

Seeing that picture of the laser etched fruit got me thinking....

Why can't we laser etch Sponge Bobs and Doras and all sorts of cartoon characters onto our fruit and vegetables?

Now I know that this isn't going to in and of itself do a heck of a lot to stem the tide of obesity, but hey, if it'll help promote nutrition in our children, and at the same time generate profits for fruit and vegetable growers (both from increased purchase and from folks like Nickoledeon) it certainly can't hurt.

Probably a lot more than a million bucks for the person who can present Disney, Nickoledeon and others a means to market their cartoons on actually healthy products.

It's easier to die than to win at McDonald's!

Hat tip to Fast Food News for their expose on just how unlikely you'll win anything good playing the returning McDonald's Monopoly promotion.

To win even the smallest prize (a small McFlurry, a medium fries or a breakfast sandwich) your odds are 1 in 7.2 (that's seven nutritious trips to McD's!)

It gets more fun when we forget about the food and move on to the bigger ticket items.

Your odds of winning a Sony home theatre and flat panel HDTV are 1 in 91,697,000!

Your odds of winning a trip to Vegas are 1 in 114,621,250!

Your odds of winning a $50,000 prize are 1 in 3,500,000,000!

Your odds of winning the $5,000,000 grand prize are 1 in 41,497,391,309!

To put this in perspective for you I turned to the National Safety Council.

Buckle your seatbelts; you are 4,994 times more likely to die in a car accident this year than win the TV.

Hold onto that bannister; you are 625 times more likely to die falling down stairs this year than win the trip to Vegas.

Maybe drinking's not so fun; you are 4,729 times more likely to die from accidentally choking on your own vomit this year than win the $50,000.

and lastly....

Maybe move to Slovenia; you are a staggering 2,529,865 times more likely to get murdered this year than win the $5,000,000 grand prize.

Ain't stats grand?

Calories from your toolbar!

Readers of this blog will know that I'm a strong believer in knowing about calories.

I don't believe in good calories or bad calories, I just think they're a good thing to be aware of.

The fact is, the currency of weight is calories. While certainly every single body is different and there are genetic differences in the ways people gain and lose weight, there's no doubt that in order to lose weight you need to eat fewer calories than you burn and that in order to gain weight you have to eat more calories than you burn.

For those reasons, I think it's a good idea to know calories. The analogy I like to draw upon is money.

Before I slap down my credit card, I like to look at the price tag of whatever it is I want to buy. Doesn't mean that price is the only thing that affects whether or not I'll buy something, but it definitely will factor into my decision making process.

Same thing for me with calories.

Knowing the calories in a food before I consume it factors into my decision as to whether or not I think it's worth it.

Calorie king, a brand and a website is a great place to look up calories, and I recently discovered that they've got a toolbar that installs with both Firefox and Internet Explorer where you can look up calories right off your toolbar.

Thanks Calorie King!

Hurray for Disney!

Wow, never thought I'd utter those words!

Today Disney issued a press release stating that by 2008 it will have placed voluntary limits on trans fats, added sugars and remarkably calories in not only its theme parks but also its licensed and promotional products.

This is fairly remarkable stuff considering Disney has a very lengthy history of helping sell fast foods, sugared cereals and more and they have capitalized for literally decades on the inherent trust with their brand name.

Kelly Brownell, in his excellent book Food Fight (linked on the sidebar), recounts a story one of his colleagues told him about their four-year-old daughter at the supermarket seeing Betty Crocker's Disney Princess Fruit Snacks with Cinderalla, Snow White and the Little Mermaid on the box.

Daughter: "I Want that."
Mother: "What is it?"
Daughter: "I don't know."

Bottom line, Disney's got a lot of clout in the Supermarket.

Good on ya Disney.

Don't Drink the Cough Syrup!

A patient asked me yesterday how many calories were in cough syrup. She'd been sick for a week and figured that she's been going through close to 8 teaspoons a day.

You know, I'm not usually surprised by calories.

This time I was floored. 15 calories per teaspoon!

Doesn't sound like much to you?

Drop per drop cough syrup has ELEVEN times the calories of Coca Cola!

To put that in perspective, my patient, by having the recommended maximum of 8 teaspoons a day, was drinking the equivalent number of calories of 1.2 cans of Coke.

There is some good news. There are sugar free cough syrups out there. I found one from Robitussin. I love their description of the product, it's almost a Quobesity,

"Robitussin® Cough Sugar-Free DM is specially formulated for diabetics, and health conscious consumers"

I can't completely disagree with them.

What they're inferring of course is that if you're not health conscious, feel free to choose their other cloyingly sweet, ridiculously high in calorie, products.

Quobesity

Last week was my wife's birthday and as per our family's tradition, she picked her dinner of choice.

Just because I practice obesity medicine certainly doesn't mean I'm a perfectly healthy eater, nor do I preach to my patients that they need to be. It's about living the healthiest life a person can enjoy, not living the healthiest life there is.

I believe that one of the worst things someone trying to lose weight can do is to irrationally restrict dangerous foods. Doing so creates what I call "forbidden foods" which in turn have been shown by Christopher Fairburn to be very common triggers for binge eating (His book, Overcoming Binge Eating is linked on the sidebar and is certainly the best self-help book for binge eating disorder ever written).

What can happen to folks with forbidden foods is that when they do finally decide to have some, not knowing when they'll get some next, they tend to binge on it. Often post-binge guilt is tremendously demoralizing and may lead a person to in fact binge more due to the now severe emotions, and those binges can sometimes lead a person to abandon their weight loss effort altogether.

In my practice I've literally written prescriptions for chips, chocolate, ice cream, pizza, chinese foods and more so as to get rid of the notion of danger foods.

There's a simple question to ask yourself about any high-calorie food, "What's the least amount of ______ I need in my life to like my life".

We ordered from a local place that truly makes great Chinese takeout.

Today's Quobesity comes from the front of the menu.

I highlighted it to help you read it.

It reads,

Healthy, low fat foods, cooked in 100% vegetable oil

Let me tell you, that food was dripping with health!

Should you Weigh Yourself Daily?

Yesterday's New England Journal of Medicine reports a study conducted by one of the biggest names in weight maintenance research - Rena Wing.

Rena heads up the National Weight Control Registry along with another fella named Jim Hill. The Registry was established in the 90s to help flesh out the factors involved in successful weight loss maintenance. To get into the registry you must have lost 30lbs and kept it off for 1 or more years.

The article in NEJM looks at the application of a maintenance program delivered either via telephone, the internet or face to face.

Not surprisingly, those with more face time were better at maintaining their weight loss.

The media however has picked up on another statistic from the article - those that weighed themselves more frequently seemed to keep the weight off better.

Having heard Rena present her findings at last year's American Heart Association Obesity Lifestyle and Cardiovascular Disease Symposium (which by the way was one of the best basic overviews of obesity I've ever been to and it's available online here for free!) I asked her what I thought was an important question.

What I wonder is whether or not success leads to daily weighing or whether daily weighing leads to success?

What I mean of course is I would imagine that those folks doing well with their lifestyles, would be more likely to use the scale to reinforce their successes, while those doing poorly may in fact be reticent to step on a scale for fear of what it might tell them.

Where there's no doubt is the fact that nipping weight regains in the bud is integral in successful weight maintenance.

What I would also like to point out is that while you're losing weight, I'm not a fan of daily weigh-ins. The fact is that weight fluctuates quite dramatically due to water retention, constipation and clothing and therefore daily weighing can at times be incredibly demoralizing as you might feel you're doing everything right and the scale shows you're up in weight.

I usually recommend that during weight loss, weigh once weekly, stark naked, Wednesday mornings (so as to provide a buffer from the weekend), and while I still don't know who's the chicken and who's the egg with daily weights during maintenance, I do recommend to my patients that once they've stopped losing weight, stepping on the scale daily and watching the trend can be very helpful.

I think it just keeps a person's head in the game, the fact is if you've got a body that has the genetic gift of being able to store calories for the future, it's not a terrible idea to track where you're at.

Put your Health Check where your Mouth is!

I don't know if the Heart and Stroke Foundation folks read my blog, but if they do, this post won't be news to them.

Over one year ago now, I first met with some of the great folks over at the HSF to discuss their obesity platform.

The HSF has done a bang-up job of getting involved in educating the public about the risks of obesity, and likely has steered some to seek help with weight loss.

The good news stops there.

Problem is that without any guidance on where to go for help with weight loss, and with so many unethical, non-evidence based, commission paying, product pushing, weight loss scams and snake-oil salesman, likely the HSF is helping to market consumer fraud.

Even worse, because most patients tend to blame themselves for their failures at weight maintenance (even if the blame lies with the program), the HSF may actually make it less likely for people to effectively treat their weight as they may see their most recent failed attempt as their last.

It's been a year since I presented my arguments to the HSF. At the time they seemed very genuinely interested in discussing the potential use of the pre-existing Health Check program (currently being used to identify "healthy" foods in groceries and restaurants) to weight loss programs - that way consumers could look to see if the weight loss program they were considering was ethically and scientifically sound.

They invited me to come and speak at one of their policy planning meetings, but then a month prior told me that I got bumped to the next meeting, I then got bumped again and I haven't hear back from them.

Next I took this idea to the Canadian Obesity Network and again received a great deal of interest and in fact they ran a straw poll where over 75% of respondents thought it was a good idea for them to provide weight loss program ratings.

Unfortunately nothing has happened since then.

I find it very confusing that public health agencies and nutritional advocates make such strong (and often scary) statements about the risks of obesity and then do nothing to help guide patients to responsible weight loss programs.

Someone has to step up.

"Not Your Father's PE"

That's the title from a great article from John Cawley and colleagues out of the Hoover Institution and Education Next.

Not that anyone's going to listen to what they have to say.

You see they're saying things that most people don't want to hear.

They're saying that PE in schools is not going to be the magic bullet to our childhood obesity problem.

According to the article, adding an additional 200 minutes of PE time into a week led high school boys to report being active only an additional 7.6 minutes more per week!.

Perhaps the failure here has to do more with genetics and less with motivation.

A fascinating piece was published recently in the International Journal of Obesity. In it Dr. TJ Wilkin and colleagues proposed the existence of an "activitystat" in children whereby by means not yet elucidated (they propose neuro-hormonal regulation) somehow children are programmed to trend towards a specific amount of activity, and then not do more.

The study used uniaxial accelerometers (for objectifying the children's levels of activity) and then compared total daily activities in children with widely varied access to PE.

They included children from a school where they were receiving 9 hours of PE per week (of course a private prep school) to one where they were receiving 2.2 hours per week (a public school with an "Activemark Gold" award for their devotion to PE) to one where they were receiving 1.8 hours per week (an inner city school with no special provisions or facilities for exercise).

What was remarkable was that after all was said and done, all the kids were equally active (or equally inactive depending on how you choose to spin the article).

The kids who exercised more at school, exercised less at home and vice-versa.

To put this all into a different perspective. To burn off one Slammer, a kid would need to be vigourously active for over 30 minutes.

According to Dr. Cawley, assuming a kid only drinks one of these weekly, we'll have to add 10 hours of PE just to burn it off.

Too bad about those vending machines....you think maybe if we got rid of them altogether, or stocked them solely with water, zero-calorie beverages and skim milk (plain old skim milk), that we'd have more success than trying to make kids move?

Such a shame that politically, that'll be more of a challenge.

We live in a very strange world

Not only because this event actually took place, not only because someone televised it, but mainly because of the use of the term, "athlete", by the commentators and the fact that one can make a living as a "professional eater".

Like-a-Bike

It's not a bike, but it's like-a-bike.

My wife wouldn't let me buy one, she said it was too expensive.

Basically picture a small, toddler friendly bicycle with no pedals. By using their feet, children are able to propel themselves forward and by lifting their feet up, they're able to start to learn how to balance.

Apparently kids who use these basically graduate to two-wheelers and skip the training wheels.

On the website there's a great video of a kid tooling around on one.

I may have to buy one without my wife's permission.

Quobesity

Went down to the House of Commons again yesterday to watch the Standing Committee on Health's continued focus on Childhood Obesity.

What was striking was how little some of the "experts" knew about the subject at hand.

A number of the experts were economists and indeed, when it came to their opinions on the effects of "fat taxes", I would not question their knowledge bases. It's when they strayed from their subject at hand when the quobesity flowed thick.

One gentleman concluded that the reason for childhood obesity had nothing to do with eating and everything to do with a lack of exercise.

He surmised that he already knows what's healthy, that he can "just ask his butcher just to cut some of the fat off of his steaks", but that it's lack of exercise that has led the World to gain weight.

He continued to wax philosophic on this culminating with today's quobesity installment.

"Why can't they just make a healthier chip? You know, I bet there already are healthy chips, I bet they sell them in health food stores."

The Wee-Ride

As the newspapers will tell you virtually daily, childhood obesity rates are growing rapidly. Parents will often call me to ask me what they should do about their overweight kids and generally my answer's always the same - treat your lifestyles.

Kids are not going to live lives different from their parents. Live the life you want your child to live, and that includes healthy regular eating with no meal skipping or snack skipping, calorie awareness and exercise.

Perhaps the easiest way to exercise is to focus on what I often call "Functional Exercise" rather than gyms, and perhaps one of the best functional exercises is going out for family walks or bike rides.

The Wee-Ride looks like a great option in place of one of those rear baby carriage thing. With the Wee-Ride you can talk easily with your child while riding and not have to worry about what's going on behind you. You can also buy an additional mounting bar so the Wee-Ride can be swapped between parental bikes.

Remember of course, once your child is old enough to ride, a better option would be their own bike.

Tomorrow I'll post on a great bike related product for toddlers.

Quobesity

A new periodic feature on Weighty Matters will be Quobesity - quotes that in one way or another embody what's wrong and hopefully, occasionally, what's right with relation to our attitudes and knowledge about weight and weight related matters.

This quote comes from this past Sunday's Run for the Cure (for breast cancer research) where I'm proud to say that BMI won the Corporate Spirit Award by raising more money than any other team in Ottawa (not bad for a "corporation" with 5 full time employees) - we raised over $30,000!

As we were leaving the event some young teenagers working for McCain's were distributing their latest product - Smooth-EEZ, basically a just add milk and stir smoothie.

We asked them how many calories were in the servings and their response is today's Quobesity

"Oh not many! There's no sugar added - it's sweetened with honey!"

For the record, more calories drop per drop than Coca Cola.

Geek-a-Cycle

Hot on the heels of bookofjoe's treadmill desk comes the self-proclaimed "Geek-a-Cycle".

Touted as a means to pedal your way to a healthier you.

May not cause dramatic weight loss, but certainly ala Dr. Levine's NEAT hypothesis of weight management, it certainly can't hurt.

Yours for just $349.95, computer equipment not included.

Slammers - Coming soon to a school near you

Horrifying. Here's an example of Big Food gone bad.

The press release touts their 99% fat-free-ness and their smaller 8oz serving sizes. It also brags how they meet the newer American Beverage Associate guidelines.

Here's their quote, "We saw an opportunity to create 'kid friendly', 99% reduced fat milk that is not only delicious to students, but also makes parents happy from a health and nutrition standpoint. We moved quickly to design a new package, and are proud to be the first company to provide vendable milk that meets the guidelines."

Wanna know what's in 'em?

According to the nutritional information (that took way too many clicks to get to) drinking just one of these will give your child 340 calories, more than DOUBLE the calories in a can of Coca Cola and almost 10 teaspoons of sugar.

I think that the parents that are being made "happy from a health and nutrition standpoint" better learn how to read nutrition facts labels. Might be good for them to know too that if their child's a 6 year old girl, that one drink likely accounts for 25% of the total number of calories she needs in a daytime!

Shame on Coca Cola for trying to market something so unreasonably unhealthy as a nutritious choice for children.

Food Industry Spin Doctors

Yesterday I was given the honour of speaking in front of the Canadian House of Commons Standing Committee on Health on the subject of childhood obesity.

The panel I was on included one other clinician (a dietitian from London), an indigenous person's nutritional advocate, and then 3 corporate spokespersons representing a diverse range of companies from the restaurants, to Coca Cola, to Kentucky Fried Chicken.

Amazingly, but entirely not surprisingly, the industry spokespeople did their best to spin things in their favour.

The party line of course is that because obesity is so complex and multifactorial, to pick on any one thing as a cause would be inappropriate. I actually agree with that statement to a degree, but have a difficult time with the conclusion of all of these industry reps that therefore we should not pick on any of the various and multiple factors.

The Restaurant Industry's spokesperson tried to explain how mandatory labeling on menus of calories would be impossible due to supply chain variety. Amazingly she did that in the same breath that she mentioned the 42% of restaurant chains who voluntarily carry nutrition information in brochure form. I highly doubt that these brochures change with the supply chain.

She also questioned the value of putting calories on menus and stated that there has never been any evidence to suggest that calories on labels help. In fact that's not true. In a study available online, a high school, without providing any extra classes on the subject, simply posted calories on their cafeteria's menuboard. Immediately they noticed students choosing lower calorie options.

Certainly it would not take a degree in dietetics to know that the 2900 calorie Aussie Fries appetizer at the Outback steakhouse might be a poor choice.

Next was the beverage industry where there was much bragging about how they voluntarily took pop out of schools and replaced it with fruit drinks, juice and sports drinks. The spokesperson even bragged about the size of their containers: 250ml (8oz) containers for elementary schools, 300ml (10oz) for middle schools and 355ml (12oz) for high schools.

I of course had to point out that the expert advisory panel for the American Academy of Pediatrics with representatives from the Canadian Pediatric Society recommend that for children between 1-6 years old juice intake should be limited to 125-175mls (4-6oz) and from 7-18 years old limited to 250-355mls) and therefore every child through grade 9, with a single serving from the vending machine, actually exceeds daily recommended intake of juice. I would also like to note here that the daily recommended intake of fruit "drinks" and sports drinks is 0ml.

Remember drop per drop there are more calories in orange juice than Coke.

Now I don't blame the industry at all. They're doing their job. It's just a shame that more often than not, there's not someone there to unspin them.

Are you Giving your Kids Chocolate Bars for Breakfast?

Would you feed your children chocolate bars for breakfast?

If you answered, "of course not" but give your children sugary cereals, you'd better get ready to revise your answer.

If you read food labels regularly, this might not be news, but if your child is eating a sugary cereal for breakfast, they're probably having as much or more sugar than they would if they ate a chocolate bar.

Some equivalents (based on a 50gm or 1.75oz serving):

Kellogg's Fruit Loops = 5.6 teaspoons sugar = Dark Chocolate Kit Kat Bar
Nestle Nesquick = 5.8 teaspoons sugar = Twix Bar
Post Sugar Crisps = 6.6 teaspoons sugar = Snickers Bar

Remember too that many kids will have more than one bowl.

So what should you do?

Try to give your kids cereals with 6-7 grams of fibre per serving, and unfortunately you have to be a bit cautious with the lower sugar cereals as well as often they may compensate with more carbohydrates and more calories.

Is it time yet to cut the sugary cereal out of the pantry?

French Women DO get fat!

You may have seen this book on the bookshelves. It's been a national best seller all over the world. Unfortunately it seems, the french women, aren't reading the book (or perhaps, like 98-99% of diet books, it fails in the most important part of weight management - sustainability).

A national survey conducted annually in France show that in fact overweight and obesity rates are rising rapidly. Currently 42% of France's population over the age of 15 is either overweight or obese.

It should be pretty telling to consumers. As of today, there are over 178,285 different diet books for sale on Amazon.com. If any single one of them was dramatically better than another, doctors offices worldwide would be prescribing it. In fact in the history of medicine, there has yet to be a study the definitively proves one diet is better than another for weight loss.

In my office at the Bariatric Medical Institute, there are no prescribed diets. Every person is an individual, with different cultural backgrounds and different dietary likes and dislikes.

Here are the only two criteria that matter for diet and weightloss:

1. You eat less calories than you burn (that will help you lose the weight)
2. You like what you're eating (that will help you keep it off)

Quiznos Calories

Many times I've heard patients complain that they can't find any calories for Quiznos Subs. It's the subject of many angry rant blogs. I agree it's ridiculous that Quiznos USA refuses to release their nutritional information but the same cannot be said about Quiznos Australia. Over there their nutritional information is posted.

Now it's true not all the subs are the same as in the States, but given the nature of franchises I would imagine the numbers may well be comparable.

Only problem is their calories are listed in kilojoules.

To convert Kilojoules to Calories simply divide the number of kilojoules by 1000 and multiply by 239.

If you're worried about Calories, don't order the large white bread classic italian. It'll cost you 6755 kilojoules or 1614 calories, more than many of us burn in a daytime.

McDonald's donates $2 million for obesity research

Today McDonald's, in reference to the problem of childhood obesity reported that they "felt we needed to get greater education in this area" and therefore decided to donate $2 million in obesity research funding to the Scripps Institute.

Now by no means am I bashing McDonald's for funding research, nor am I bashing them for wanting to know more about childhood obesity, or even for the way they make their money.

I am however shocked that they feel the need to donate $2 million to help them to understand how they might play a greater role in the prevention of childhood obesity.

Without even wading into the debate about marketing food to children, how about they simply start dramatically reducing the portion sizes and calories counts of their children specific foods?

Hey, McDonald's, if you'd like to pay me even just $200,000 I'll help you out...anyone over there reading this? Anyone?

Star*!%*&ucks!

Ok, I admit I took some blogger license with the post title. I've got nothing against Starbucks and in fact enjoy their coffee very much.

I am however going to use them to illustrate why the visible posting of calories on food items would be helpful.

Let's take a hypothetical 45 year old 150lb woman who like most North Americans, is inactive. According to the metabolism calculator I've referred to in a prior post, she likely burns 1800 calories daily.

Like most days, she decides she's going to hit Starbucks for coffee and breakfast. Having read about the health benefits of whole grain oats she chooses the Island Oat Bar and a Caramel Frappucino (hold the whip cream).

The Island Oat Bar has 760 calories including a heart busting 8 grams of saturated fat while her frappucino has 390 calories for a grand total of 1150 calories (more calories than 2 Big Macs or 4 McDonald's Cheeseburgers) or 65% of her total daily burned calories. Small wonder she's gaining weight and small wonder when she goes to her doctor to complain, she reports, "But I really don't eat very much". The fact is, not very much of high calorie food can still lead people to high calorie intakes.

As far as I'm concerned, it's only a matter of time until there is legislation to have calories on menuboards. Until that time, the onus is on each of us to find the calories ourselves.

A great website to look up calories is www.calorieking.com.

Remember you can gain weight on an all-salad diet if you eat enough salad and you can lose weight on an all ice-cream diet so long as you don't eat too much.

At the end of the day, it's the calories that count.

NEWSFLASH: Being overweight isn't good for you!

In what I'm sure will be a disappointment to those individuals who still persist in denying that there is medical risk associated with obesity a landmark study was published in today's New England Journal of Medicine.

527,265 people were followed for over a decade in determining the risk of weight on life expectancy. The study was controlled for ethnicity, smoking status, education, physical activity and alcohol consumption.

During the 10 years of follow up 42,173 men and 19,144 women died. The death curves were U shaped with dramatic increases in risk as weight climbed.

These data also included 186,000 non-smokers. In that group the risk of death from obesity and overweight was substantially strengthened.

When restricting their observations to those who were free of preexisting diseases again there was a strengthening of the relationship between weight and death.

The bottom line's not really news - being overweight or obese is bad for your health.

The Fat Clock

You know those clocks that count? The ones that post a real-time count of things like a country's accumulating national debt, number of people on earth, people dying of various diseases?

Well there's a new clock on the block - the Fat Clock. Using a fairly sophisticated home-made algorithm the Diet Detective website has a clock posting the running tally of the weight of all Americans. It takes into account birth rate, death rate, population age and other variables.

According to the clock, Americans are currently gaining 1,267 pounds per minute!

Walk away (briskly) from depression

A great deal of well designed research has been published demonstrating that exercise is just as good, if not better, than antidepressants for mild to moderate depression.

One of the best papers on the matter was published in 2000 in the journal Psychosomatic Medicine. In it Michael Babyak and his co-authors randomly assigned 156 depressed adults to one of three groups: Zoloft, Exercise, or Zoloft plus exercise. They then looked at depression after 4 months and again after 10 months utilizing the fairly standard Hamilton Rating Scale for Depression.

Exercise involved 10 minutes of warmup followed by 30 minutes of moderate intensity cycling, jogging or brisk walking and finally by 5 minutes of cool down. This was performed 3 times per week.

The results were impressive. After 16 weeks of treatment all groups showed significant reductions in their depressive symptoms. Medication worked faster, but by week 16 exercise had caught up. What was more impressive were the results at 10 months - those exercising had lower remission rates than those on Zoloft or a combination of Zoloft and exercise.

The authors summarized their results with the following statement, "Each 50-minute increment in exercise per week was associated with a 50% decrease in the odds of being classified as depressed"

Bottom line: Don't throw out your pills, but slowly, along with your doctor, it may be reasonable to try to trade your drugs for some great shoes and a minor committment to exercise.

That's one scary cookie jar!

Here's a cookie jar you don't want to get your hands stuck in - the Shockolate Vault designed to keep you away from your goodies.

Not recommended by me as a diet aid, definitely recommended by me as a gag gift, the Shockolate Vault, can be set to "protect" your valuables or goodies for a given period of time. Try to get to them before the time is up and "there will be shocking consequences".

Would make for some interesting, amateur science experiements.