All the Rocky Movies in 5 Seconds Flat!

Better late than never!

Today for Funny Friday are all the Rocky movies in 5 seconds flat. It's not the best Funny Friday video I've ever posted, but hey, it's 5 seconds of your life and worth a quick chuckle!

Have a great weekend!

Dr. Sharma and I have Single Bypasses!

What you see above is a picture of me and my friend and colleague Dr. Arya Sharma (The guy on the left. The guy with the stethoscope? That’s the Grill’s owner “Dr.” Jon) at the Heart Attack Grill (blogged about previously here), but really what you're seeing is a picture of Arya and me practicing what we preach.

You might think that my statement above doesn't make sense, after all, the Canadian Medical Association Journal labeled me a "nutritional watchdog" and I run a behavioural weight management program and Arya, well Arya's the head of Capital Health's Weight Wise - the country's largest tertiary care bariatric centre and the scientific director of the Canadian Obesity Network, how could us eating - "flatliner" fries and "single bypass" burgers reflect our practices?

Simple - we preach that food and calories, while worth monitoring for nutrition and weight, are also used in life for comfort and celebration, and if you can't use food for comfort and celebration from time to time, you're probably on a diet and long-term, it's probably going to fail.

In terms of my lifestyle, excluding vacations and conferences I probably eat out a maximum of twice a month and just like most folks, I enjoy the taste of some foods that are let's say less than optimally nutritious, and sometimes I'll indulge. However what I don't do is give myself a carte blanche during those meals out - instead I choose the healthiest option that I think I'll enjoy so for instance at the Heart Attack Grill I had the single bypass (rather than the double, triple or quadruple), shared a fries with Arya and had water to drink.

As I regularly say weight management and healthy eating - they're about living the healthiest lives you can enjoy, not the healthiest lives you can tolerate. The former's a liveable lifestyle, the latter's just another short-term diet.

So if you're in Phoenix and you're so inclined, the Heart Attack Grill might well be worth a visit, but as the posting on their door states in big, bold, red writing,

"Caution! This Establishment is BAD for your Health!"

[Hat tip to Joe from Active Living magazine who inadvertently reminded me that the Heart Attack Grill was in Phoenix]

An APPEAL to end exercise-only obesity interventions!

(Or why it's not about exercise)

The study is entitled, "A Program Promoting Exercise and Active Lifestyle". In it, 196 overweight (average BMI nearly 30) carefully selected for motivation and affinity to start exercising individuals were asked to exercise at moderate to vigorous intensity for 60 minutes a day, 6 days a week, for a year! To ensure objectivity, subjects were provided with logbooks and heart rate monitors and adherence was excellent. Men in the study averaged 370 weekly minutes of exercise, and women 295.

Subjects were not instructed to make dietary changes.

So if weight loss were about exercise, certainly you would expect that after a year of an hour a day, 6 days of week of exercise, that weight would be lost in a dramatic manner.

The results?

Over the course of the year, men lost an average of 3.5lbs and women 2.6lbs.

Readers of my blog will know that I'm all for exercise - reason being is that it's one of the single most important determinants of health and that doing it psychologically bolsters patients who've lost weight and helps them keep their focus on their weight loss behaviours (including dietary changes).

Clearly what it won't do is by itself lead to dramatic weight loss.

Therefore I would argue that studies and public health interventions for obesity that focus exclusively on exercise or increasing day to day activity can no longer be considered ethical as we know that the outcomes will be dismal. My other concern of course is that since we know these interventions are doomed to failure, by throwing public health care dollars at interventions whose success will be measured on the basis of weight, we're going to drain the pot of public health dollars for obesity treatment and potentially make it less likely to receive funding in the future from once burned, twice shy stretched federal, provincial and municipal governments.

How TVs in Kids' Rooms Raise Obesity Risk

Mea culpa - thanks to the Canadian contingent at this year's Obesity Society conference, I've probably had too many drinks (Thanks to Arya, Dawn, Tara and Danielle) and someone told me once that I shouldn't drink and blog. Of course if you have a daily blog, sometimes you might not have as much choice as you'd want.

Life of course includes occasional indulgences and given that I've got two beautiful little girls and a busy office, my once a month or so nights out are certainly welcome.

The conference was wonderful as always and certainly got me thinking.

I heard a talk the other day regarding childhood obesity and it recounted how dramatically the risk of childhood obesity rises when a child has a television set in their room.

It's such a dramatic increase in risk (I believe in the neighbourhood of a 61% increase in relative risk) that I was never able to understand the mechanism behind it as the studies will generally control for dietary intake and some lifestyle factors suggesting an almost magical response to advertising.

I'm not sure anyone knows the answer but this conference made me wonder, could it simply be that kids with TVs in their bedrooms sleep far less because they're busy watching TV all night long?

Stay tuned this week for some debriefing from the conference, including my review of the Heart Attack Grill.

Scariest Fries Ever?

Came across these beauties on the blog Supersized Foods.

For just $8 you can start a slow death by fries....but oh, the cheesy, potato-y goodness.

For more fried foods available at the LA County Fair (where this shot was taken), head over to the blog that dropped this fry bomb - LAist where they have the photo evidence of deep fried pretty much everything you could imagine from frog legs, to twinkies to of course bricks of cheese fries.

Anyone care to take a guess at the calories?

My guess?

3,500 or so.

Do you think they serve a kids' size?

Are Pink Mohawks an Effective Form of Contraception?

This Sunday is the annual CIBC Run for the Cure.

Over the past 4 years our office has raised over $100,000 to support breast cancer research and programs and this year's no exception - with offline donations we're well over $25,000.

To help the cause Rob Matthews, our fitness director, challenged our team that if anyone raised over $2,500 he'd allow them to shave him a mohawk and dye it pink.

Today for Funny Friday is video evidence that he's a man of his word.

If you like this blog and you haven't done so already, please consider sponsoring Rob in his Run for the Cure effort - anyone willing to get a pink mohawk to support breast cancer research deserves support in my book. Tax receipts are issued and the online run website (run out of CIBC - a major Canadian bank) is encrypted, safe and takes credit cards.

If you'd like to donate to his fundraising efforts, simply click here!

Have a great weekend and good on ya Rob.

I Say Something Nice about KFC!

Perhaps in his old age the Colonel's getting soft, or maybe he's just seeing the writing on the wall?

Yesterday YUM Brands, KFC's parent company, announced that their restaurants (which also include Taco Bell, Pizza Hut, Long John Silver's and A&W) will be voluntarily placing calorie counts on menus at ALL American locations!

This announcement came a day after the State of California passed legislation requiring all chain restaurants (more than 20 locations statewide) to do the same.

Great job Colonel, and frankly smart as given that eventually it's going to be a federal law so why not score some good press by doing it now voluntarily?

Hey Colonel, why not Canadian locations?

[Hat tip to BMI's Lorne]

Disband the Clean Your Plate Club!

What's one of the worst clubs your kid can join?

The clean your plate club - a club likely born out of war rationing back during WWII.

Here's a thought - if your kids aren't cleaning their plates perhaps you're serving them too much?

Or maybe it's that they've grown accustomed to trying to save their appetites for the tastier stuff offered to them after the meal.....but does dessert really need to be served nightly?

Are there risks to not forcing your child to clean your plate?

None that I can think of - emotionally well-adjusted children won't let themselves starve.

My recommendation?

Lose the club - you can spell "waste" two ways.

Your choice.

A Citizen's Petition to Ban Weight Loss Supplement Claims

You've all seen them. They line the shelves of even reputable pharmacies (guess the owners care more about dollars than providing quality care) - the umpteen miracle pills, potions and lotions that promise to cause your body to disobey the laws of thermodynamics and lose weight with no effort.

Unfortunately the FDA and its Canadian counterpart have done virtually nothing to reign in these ridiculous products.

Well at least in the States perhaps there's change in the air as the American Dietetic Association, the Obesity Society, Shaping America's Health and GlaxoSmithKline have all teamed up and submitted a, "Citizen's Petition" to the FDA to determine that dietary supplements claiming to in any way shape or form assist in weight loss, be subject to the same rules and regulations that govern disease claims on supplements.

The petition would therefore apply to the usual suspects, "fat-burning", "cellulite reduction", "increases metabolism", "reduces appetite", "increases satiety", and "blocks absorption" of dietary carbohydrate or fat.

It would require the nutraceutical companies, before being allowed to print their over-the-top ludicrous labels, to in fact provide scientific evidence as to the safety and efficacy of their products.

While I'm not holding my breath, I am willing to keep my fingers crossed (proverbially of course - after all I'm Jewish and it's almost Yom Kippur).

As the video below extols, "Don't Buy the Lie"

Consumers Sue Applebees, Chilis, Macaroni Grill and On the Border for Calorie Fraud

One of the main arguments that restaurant associations use with politicians when trying to dissuade them from supporting bills making menu posted calories mandatory is that it'll cost a fortune to police.

Well, at least in the States (where I'm told there are more lawyers than in the rest of the world combined), perhaps it'll be policed by the people.

Witness the new class action lawsuits being launched against Applebee's, Chili's, On the Border and Macaroni Grill for calorie and nutritional fraud.

The suits state,

"Defendant's actions and practices, including misrepresenting nutritional content of menu items, facilitating the menu inaccuracies, and/or allowing the food to be prepared in a manner which changes the nutritional content without adequate disclosure, is an unfair, unlawful and deceptive business practice in violation of the California Civil Legal Remedies Act, Civil Code section 1750, et seq.; the California Unfair Competition Law, Business and Professions Code section 17200 et seq.; the California False Advertising Law, Business and Professions Code section 17500, et seq.; and have resulted in the Defendant's unjust enrichment"

I've got to say, I think it's great that someone's standing up for themselves. Certainly the only folks who care about calorie counts are folks trying to lower them and if Big Food has been willful in their deception, they should not only be ashamed of themselves, they should pay.

I've also got to say that the description of the consequences of eating more calories than you'd planned as, "unjust enrichment", is an absolutely delightful use of the English language.

UPDATE: A kind lawyer who reads my blog has let me know that "unjust enrichment" actually refers to the unjust enrichment of the pockets of the restaurant due to the misleading representations of the food.

I like my interpretation better.

Darth Vader eats at the Death Star

Even galactic overlords get hungry.

Today for Funny Friday is British comedian Eddie Izzard's interpretation of Darth Vader hitting the death star cafeteria - re-enacted with Lego of course (warning, some strong language).



[Hat tip to my friend and colleague Arya of Edmonton's Weight Wise and the blog Obesity Notes]

A Million Dollar Idea?

I hope so.

And while it doesn't belong to me, certainly I've thought about doing just what Mark Bakker, an Edmonton electrician did - set up a healthy fast food restaurant.

Now I'm not just talking about serving healthy foods.

I'm also talking about providing point of purchase, smack on the menu calorie counts for all foods sold, and of course using foods that themselves have more evidence for health.

Mark's restaurant takes many fast food staples and improves upon the intrinsic quality of their ingredients while trimming away their calories.

While not every item's terrifically low in calories (and Mark, you really need to work on lower calorie kid options), none are left up to the imagination.

Take a gander at their menu by clicking here.

If you live in Edmonton, why not pop on by. It's called Healthfare and it's located at 10865 - 23 Avenue, and if you want to read more about it, click here (maybe he'll sell you a franchise).

Good luck Mark!

I Get Mail (but not answers) From Sobey's!

Last week I emailed Sobey's what I thought to be a lucid argument as to why their advertising campaign that suggests eating Compliments Balance products will lower calories, salt, cholesterol and fat is misleading.

So either I was wrong in thinking my arguments were lucid, or Sobey's is avoiding directly addressing my concerns.

To reiterate my concerns - I'm concerned because Sobey's is making claims they cannot support - claims that to me certainly add up to health fraud.

To her credit, Belinda Youngs, Chief Marketing Officer of Sobey's does report that she will ensure that their, "marketing executions" are revisited. I of course will periodically report on whether or not this revisitation has resulted in removal of the ads promising undeliverable health miracles.

(As an aside - what do you think would happen to all of these programs that are now officially married to the Food Guide if someone or someones other than me came out and bashed it?)

Here's Ms. Young's response,

"Dear Dr. Freedhoff,

Thank you for your feedback on our Compliments Balance products and our partnership with Health Check.

Canadian consumers have different dietary needs depending on the end-goal they want to achieve, such as disease prevention, weight control or overall healthier dietary lifestyle. On this principle, the Compliments Balance program was developed in partnership with the Heart and Stroke Foundation's Health Check program to provide consumers with healthier options for managing their personal diets.

Such dietary needs as defined by dietitians and physicians may require a higher intake of key nutrients such as fibre, vitamins or minerals like vitamin C and calcium, or lower levels of less desirable nutrients such as fat, sugar or sodium. It is for this reason that we stand by our Compliments Balance statement of "Find your healthy balance".

All our Compliments Balance products meet the nutrient criteria of the Health Check program. We stand by Health Check as the only independent and transparent food information program in our country that is based on Canada's Food Guide.
.
Healthy choices are a very personal matter depending on the overall goal that our customers want to achieve. Delivering this message through clear communication is our main objective and we will revisit our marketing executions to ensure that this is the case.

We are strong supporters of the recommendations established in Canada's Food Guide and other similar guidelines developed by Canadian health agencies that have been used to develop our Compliments Balance program.

Sincerely,
Belinda Youngs
Chief Marketing Officer"

A personal "jihad" on food

One of my patients has declared that her fight with weight is her own personal "jihad" and has started her own blog to detail her experiences while striving to change her lifestyle.

Of course in this day and age the word "jihad" is loaded with religious connotation - a point not lost on her and she eloquently describes on her blog her choice of nomenclature,

"According to information retrieved from Wikipedia today, the word jihad means "strive" or "struggle". Anyone who has weight issues, especially weight issues that they have had from childhood, knows that a "struggle" is just what it is.

Additionally, one of the four categories of jihad in Muslim teaching is the Jihad al-Nafs, or the jihad against oneself. It is believed in some of the more moderate circles that the prophet Muhammed taught that this form of jihad is greater than actual warfare. While it refers to the inner struggle by believers to keep the Muslim faith, I think almost every human being, regardless of the belief system to which they ascribe, has a daily internal struggle of some kind - for me, it is my weight. I struggle with temptations to over indulge and frustration when I face obstacles or criticism. I strive to stay motivated. I strive to stick to my plans for exercise and portion control."

Her blog is one part food diary, one part real diary.

She's an excellent writer and has been doing a remarkable job in chronicling her journey into learning to live a thoughtfully reduced (rather than blindly restricted) lifestyle.

For those of you who are interested, you can follow along on her "jihad" by heading over to her blog Why Weight?

Thanks to HvnSntRN for allowing us a peek into her life.

Super Mario meets with Reality

Seth MacFarlane is best known for his work on the television show the Family Guy, but recently he's been working on a whole slew of net-based cartoon shorts for Burger King.

Now I don't really know what this cartoon has to do with Burger King, but I do know it's today's Funny Friday and it tells the true story of just what happened after Nintendo's Super Mario beat the big boss to rescue the princess.

Have a great weekend!

(Oh, and be sure to scroll down on the blog to see a new picture sent to me from the Dietitians of Canada conference of a huge tray of PC miracle health brownies!)



[Hat tip to BMI's fitness director Rob]

President's Choice Miracle Health Brownies!

President's Choice Blue Menu Two-Bite Brownies!

According to the back,

"Good For You never tasted so good!

45% less fat than farmer's market two-bite brownies

High in fibre

No Hydrogenated oil, like all PC Blue Menu products

2.5g of prebiotic soluble fibre from chicory root inulin per 38g serving"

But it was when I read the side that I really got the scoop,

"A healthy diet low in saturated and trans fats may reduce the risk of heart disease. PC Blue Menu Two-Bite Brownies are low in saturated and trans fats"

So I of course immediately ate the whole bag - I don't want heart disease!

[Hat tip to Erica for kindly buying these heart disease busting brownies for me and click any picture to see them for yourselves]

UPDATE:Those PC guys are no dummies - they're expert marketers!

So who are they marketing the miracle health brownies too?

Well according to dietitic student and blogger Vincci (check out her blog Ceci n'est pas un food blog (Not a Food Blog)" there was a huge tray of them at the most recent Dietitians of Canada conference alerting everyone that these miracles have a GI index of just 39!

Thankfully we have Vincci out in McGill teaching her classmates how to think critically about the foods they're being asked to market.

Are you a Bad Parent?

"Their day. Made by Mom.

My kids are always on the go. That's why at breakfast it's important to give them food that helps keep them going throughout their busy day - like Nutella. Kids love the delicious taste of Nutella. And I love that it's made from natural ingredients, contains no preservatives or artificial colour and is a source of Vitamin E. I feel good about making Nutella part of my kids' nutritious breakfast."

I don't think you're a bad parent if you feed your kids Nutella - for many kids it's a sometimes food treat that they genuinely enjoy (go figure, it's spreadable candy).

I would however worry if you let yourself get duped by Nutella's advertising into thinking it's part of a "nutritious" breakfast, and that because it doesn't have preservatives or artificial colour and is a source of vitamin E it's a smart choice.

You might as well just spoon 100% natural, no preservatives added honey into your kids' mouths and call it "nutritious".

Of course, if you do choose to go the honey route, remember to spoon in 36% more honey than Nutella, because Nutella's got 36% more calories spoon per spoon than the honey.

Don't want to spoon in honey? How about 100% natural, no preservatives added pure white table sugar? Of course if you go the sugar route for every tablespoon of Nutella you'd planned on feeding the kids you'll have to give them 2 tablespoons of sugar to make sure they get the same amount of "nutritious energy" that the Nutella would have provided.

Trees - Nutritional Miracles!

Yup, it grows on trees so of course have "as much as you want".

You know trees were put on the planet by God to serve us and provide us with incontestably wonderful nutrition.

Nothing bad could ever come from a tree, right?

The BBC must have got it wrong when they suggested that eating the manchineel tree's fruit can be deadly, or that standing under the tree when it rains is a bad plan because if water drops off the tree onto your skin it'll cause blisters and burns, or that if you decide to cut down the tree and burn it the smoke that gets into your eyes can lead to blindness.

Who cares that the Sun Rype Rio Red Grapefruit Juice drop per drop has 15% more calories and 10% more sugar than Coca Cola? Certainly not the Heart and Stroke Foundation's Health Check program that happily sold them their logo! I guess it's because they're "natural" calories and "natural" sugars, that they magically won't contribute to obesity and consequently heart disease - right?

I'd also ignore the warnings of the American Academy of Pediatrics and nutrition professionals the world over that recommend strict limitations be put on juice drinking - because trees of course are smarter than them.

All hail the miraculous power of trees to bring only goodness and light to the world.

Oy vey.

I Send Mail

This week's going to be misleading ad week.

To kick it off I'm bringing you a new advertising campaign from Canadian supermarket chain Sobey's. Whether it was intentional or not I don't know (it may simply reflect ignorance), but at least superficially it appears as if they're trying to leverage consumer trust in Health Check, combined with unsubstantiated health claims, into sales (click the picture above to see the campaign).

I found the campaign to be so misleading that I've written a letter that I've sent this morning to Ms. Belinda Young, Sobey's Executive Vice President of corporate brands. I also copied the letter to the Canadian Competition Bureau.

Here's the letter:

Dear Ms. Young,

My name is Yoni Freedhoff and I’m a physician in Ottawa whose practice focuses exclusively on nutrition and weight management.

While shopping at one of my local Sobey’s the other day I was appalled to see what I felt was an incredibly misleading marketing of your partnership with Health Check (photo attached).

There were 3 separate advertisements (posters) that shared the same copy which reads,

“Find your healthy balance. Looking to lower your cholesterol (check) reduce fat (check) cut back on calories or sodium (check)? Every compliments balance product meets the criteria of the Heart and Stroke Foundation’s Health Check program.”

Putting aside my well-known condemnation of what I feel to be the Heart and Stroke Foundation’s grossly underpowered, nutritionally short-sighted, misleading front-of-package Health Check program, they themselves state that, “Health Check is not a weight loss or calorie restriction program”. The program does not in fact possess any criterion that limits calories in Health Check items. Regarding calories and your Compliments Balance products, I’m sure your customers would be surprised to learn that despite Health Check having no formal criteria for calories, Sobey’s is comfortable suggesting these products will help, “cut back on calories”. They would surely be surprised to learn that items such as your Compliments Balance Original Granola cereal in fact contain bowl for bowl almost double the calories of most breakfast cereals including such sugary nutritional voids as Cocoa Puffs, Cap’n Crunch and Frosted Flakes.

As far as sodium levels go, the Heart and Stroke Foundation along with:

• The Canadian Medical Association
• The College of Family Physicians of Canada
• The Canadian Hypertension Society
• The Canadian Stroke Network
• The Canadian Diabetes Association
• The Canadian Pharmacist Association
• The Canadian Council of Cardiovascular Nurses
• The Canadian Public Health Association
• The Canadian Heart Failure Network
• The Canadian Cardiovascular Society
• The Canadian Society of Internal Medicine
• The Canadian Nurses Association
• The Canadian Association of Cardiac Rehabilitation
• Dietitians of Canada; and
• Blood Pressure Canada

have all signed off on Canada’s National Sodium Policy Statement that recommends Canadians target 1500mg as their daily sodium maximum. Yet for reasons inexplicable to most health care professionals Health Check has not adopted those more stringent recommendations. What this means of course is that Health Check options such as your Compliments Balance Penne Bolognese with 900mg of sodium in fact contain more than 60% of the total daily recommended value endorsed by virtually every credible medical organization in Canada – an amount far higher than someone trying to “cut back on their sodium” should consume in one serving.

Regarding cholesterol – I fail to see how eating Health Check products or Compliments Balance products will lower one’s cholesterol. Health Check’s meagre nutritional criteria do not directly address cholesterol. There are no requirements that items awarded Health Checks are lower in contained cholesterol, nor are there requirements that Health Check items include ingredients that have in fact been shown to lower cholesterol. Certainly there are no published studies that would suggest that eating Health Check items or Compliments Balance items such as Compliments Balance Fudge Brownie Frozen Yogurt or Compliments Balance Lean Italian Meatballs will help “lower your cholesterol”.

Diet and weight related diseases in Canada have been estimated to kill 25,000 Canadians a year and obesity and nutrition are certainly among the most reported non-political topics in our media today. Consequently, improving weight and eating healthier are desires shared by many Canadians. Given the pace of our modern lifestyles and the average individual’s confusion surrounding nutrition, it’s quite disheartening to see claims in your advertisements that simply aren’t true – claims that could lead individuals with heart disease to consume far more sodium than their conditions would allow potentially endangering their health; claims that may lead people to believe that so long as they choose Compliments Balance products they’ll lower their cholesterol; and claims that suggest by choosing Compliments Balance products people will lose weight or maintain a healthy weight..

My blog, Weighty Matters, is read coast-to-coast and has had over 80,000 visitors this year. It is read by a large number of Canadian dietitians, physicians and other allied health professionals directly involved in the provision of one-on-one nutritional counseling as well as public health professionals involved in Canadian nutrition policy that I am sure will be curious as to your explanation for these misleading advertisements. Our alarm is that these advertisements clearly misinform your more vulnerable and impressionable customers – those concerned about their weights and their health.

I will be posting this letter on my blog and as well as sending a copy to the competition bureau. In the spirit of open communication and fairness, I will also post your reply on Weighty Matters.

I look forward to your response.

Sincerely,

Dr. Yoni Freedhoff, MD CCFP Dip ABBM
Medical Director, Bariatric Medical Institute

[Hat tip to my wonderful wife who noticed the posters by the refund desk]

The Most Frighteningly Intense Child in America?

Mea culpa to start - I stole the headline from Best Week Ever.

My other option was also on Best Week Ever and that was,

"AAAAAAaaaahhhhhhhhHHH, I'M TYLER WEAVER!!!!"

Without the headline, I'm not sure this clip would have made Funny Friday.

With the headline though, it sure made me laugh.

Tyler, if you're reading this, we're laughing with you - somehow I can envisage this clip playing at your wedding.

Please don't hurt me.

Have a great weekend!

Grading the Media on Health Reporting

Not sure how I found my way onto it, but stumbled upon a great website called, "Health News Reviews" that gives grades to the media in their reporting of health stories.

Yesterday they tackled the alarmist Associated Press piece on obesity leading to adolescent liver transplants for non-alcoholic fatty liver disease.

They graded the piece a 4/10 with points lost on:

Engaging in disease fear mongering

Not discussing the costs of liver transplants or routine liver testing in adolescents

Not discussing the potential harms of liver transplantation

Not quantifying the benefits of non-surgical management

Not comparing surgical approaches to non-surgical approaches

Not evaluating the quality of the evidence reported on in the story

Given that the mass media's job is to sell media and not to necessarily report accurately, fairly or responsibly, it's great to see a site help navigate the good stories from the bad.

Exercise is still not the answer

The media's a-buzz with reports out of Amish country that our "fat genes" can be beaten but that it's gonna take 3-4 hours of activity a day to beat them!

They're reporting on a study that 705 Amish who were then investigated for the possession of a gene known to be involved in obesity.

The study found that of those folks possessing two copies of the FTO gene, if they were active for 3-4 hours a day they were a whole 15lbs lighter than the least active folks.

Basically this study confirms what I've been saying over and over again - the amount of exercise necessary to dramatically affect weight is in an of itself exceedingly dramatic.

Good news?

Not really, not even for the Amish, as here we have a study that says even if you exercise 3-4 hours a day more than your sedentary buddy that's only going to make you 15lbs lighter than they are once the barns are built.

My advice?

As always, as far as energy balance goes I'd stack my chips on energy-in.

(That said, given the incredible splash in the press I wonder who's going to be the first to open a residential, "Live like the Amish" weight loss program?)

The iPhone Treadmill?

In the stupider than you could imagine category, today I'm bringing you the, "Fingermill".

It's an iPhone application that,

"turns your device into a treadmill for your fingers"

According to the product page,

"Fingermill is a fun game that will keep you amused and your fingers in good shape"

Want yours?

$0.99 on iTunes.

[Hat tip to loyal blog reader Rob (not fitness director Rob)]

28% of Doctors give Nutritional Advice?!

At least in California.

A survey of 46,000 residents revealed that 34% of residents said their doctors discussed exercise with them and 28% said their doctors discussed nutrition.

Not surprisingly, the media is painting this as a shockingly low number. I think it sounds shockingly high.

I think it's high because frankly most doctors simply aren't taught about nutrition and exercise.

I wonder if comments along the lines of,

"you should try to eat healthier"

"you should try to find more time to be active"

"you should try to eat less"

count?

They shouldn't you know.

Telling someone who's asking for advice on weight loss or healthy living that they should, "eat less and exercise more" is just about as useful as telling someone who's clinically depressed that they should simply, "buck up".

If we want to have doctors really be able to pull their weight in obesity prevention and healthy living promotion we're going to have to go back to the drawing boards in medical schools and residency programs and really teach doctors concrete useful tips that they can give their patients.

Until then I'm afraid, with rare exceptions, we're going to be stuck with most doctors giving vague to the point of useless nutritional and lifestyle advice.

Has your doctor ever given you any concrete, useful recommendations on diet or exercise?

Priorities

For today's Funny Friday I've got a great ad.

It's a great example of how no matter what the consequences, once you set your priorities, it sometimes takes real strength not to let circumstances lead you astray.

Lunch - Back to School Edition

I hope you don't live in Harrisonburg VA because if you do your poor children might find something looking a lot like that picture above on their plate this week for lunch.

Apparently the Harrisonburg VA school system decided it'd be a great idea to post pictures of their school lunches on their website.

I guess they didn't anticipate what would happen once the blogosphere grabbed hold of them.

Here are some of the descriptive commentaries found online on non-Harrisburg VA school system websites to accompany the photos,

"This might explain the increase in heart attacks among Harrisonburg sixth graders."

"It’s no coincidence that the abbreviation for this dish is “BM.”"

"If you cut white bread up into rectangles and give it a European name, it’s still slices of white bread."

"As you can see, the corn dog is such a complete nutritional package that it needs no sides."

"This sandwich used to be called the “Ebola Chicken Sandwich."

Do you know what your kids are being served?

If there are some intrepid kids or parents out there who come across any particularly egregious examples of non-nutritious fare at their schools, feel free to take some sleuthy photos and send them my way.

[Hat tip to Brad via HolyTaco (where you can see all the pics in all of their unholy glory]

Quobesity - Back to School Edition

Given that I've had a huge influx of readers since I originally coined the term "quobesity", I'll define it for you again:

Quobesities are 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

Today's a what's wrong post.

So who's suggesting that childhood obesity is preventable by encouraging kids to play marbles and hide and seek?

It's the Local Government Association (LGA) of England of which represents more than 400 councils in England and Wales.

They went so far as to issue a top ten list of games for kids to play this coming school year. They called it the,

"Top Ten playground games to (hop)scotch obesity levels"

Want to know what made the top ten?

* British Bulldog
* Tag
* Stuck in the Mud
* Oranges and Lemons
* What’s the Time, Mr Wolf?
* Hopscotch
* Skipping
* French elastic
* Marbles
* Hide and Seek

I'll reiterate for newer readers. I'm all for exercise. It's perhaps one of the single most important determinants of health and we should be doing all we can to promote more of it. The issue I've got is suggesting that exercise is going to have an impact on childhood obesity rates.

Case in point?

A press release that suggests that a spirited, rip-roaring game of marbles is going to help stem the tide of childhood obesity.

Good grief.

Frankenfood - Back to School Edition

Cause nothing says "nutritious" like Fruit Loops and Corn Pops!

You know I do realize that scarfing down sugary cereals is a rite of childhood, but come on now,

"And you can feel good about giving them a nutritious snack"

Perhaps when compared with a bag of pure white table sugar.

Speaking of a comparison with pure white table sugar....44% of the calories of each "loop" comes from pure white table sugar.

What could be more nutritious than sugar?

[Hat tip to my friend Julie from Dinner with Julie]

Meatatarianism?

One thing Big Food's great for are great ads.

Designed to help roll out their Meatatarianism concept, the new viral video from Wendy's is no exception and it's today's Funny Friday.

Have a great weekend!

Family Doctor Wait Times?!

For those of us who live in Canada we're used to the concept of physician wait times. 6 months to see a specialist is far from uncommon but wait times to see your own family doctor?

I saw a patient yesterday who kindly gave me permission to anonymously discuss her story.

Over the weekend she developed acute pancreatitis. She's not a drinker (most common cause) and really the docs in the ER were stumped as to what was going on and concerned about whether or not things were going to get worse.

In terms of my patient, she was in a great deal of pain but not so much that she would require admission to hospital and therefore she was instructed to follow up with her family doctor within 2 days for further blood tests and to see how she was doing.

My patient, a health professional herself, called her doctor's office to make an appointment and explained the situation.

She was told that the earliest available appointment was 3 weeks away.

I don't understand that.

When I was training to be a family physician I was taught always to leave some emergency slots in my schedule to accommodate the unexpected. When I was a practicing family physician I had those slots and frankly even if they were full if there was a true emergency, I'd see the patient regardless. Even now in my specialized practice if a patient calls for a non-weight related emergency I'm happy to find time for them.

Why?

Not because I'm an exceptional doctor or human being, but rather simply because that's what doctors are supposed to do.

Shockingly the story I've recounted above is far from an isolated one.

What's happening to health care in Canada? Have you had similar experiences?

Tell Time with Chocolate

Seen by me first on Gizmodo I bring you the "Chococlock".

Who doesn't need a clock that every hour on the hour spits out a ball of chocolate to the tune of the Dance of the Sugar Plum Fairy?

If that's not enough you can hit bypass and it'll spit them out every second.



From the product page,

"Despite its silly premise, this kooky clock can actually assist in the workplace (stick with us here). Simply use your hourly chocolate treat as an incentive and that annual report will be finished in no time. "

Ingenious?

Want one?

$37 by clicking here.

Calorie Counting's For the Dogs

Literally.

In one heck of a sign of the times I bring you Pup-peroni's new 50 Calorie snack pouch for pooches.

You see it's not just people who are gaining weight.

According to the organization Stop Canine Obesity,

"The American Veterinary Medical Association (AVMA) has estimated that there are 41.2 million pet dogs in the United States. Other sources estimate 40 percent of those dogs, approximately 17 million, are overweight or obese."

I find this canine obesity epidemic fascinating.

Should we blame lack of gym class? Fast-food? Less walkable neighbourhoods? Maternal imprinting? Air conditioners? Big food advertisements? Celebrity product endorsements? Not fidgeting enough? TVs in their rooms? XBOXs? The internet? Their transition from a manual labour workforce to holding desk jobs? Over-protective parents? Human adenoviruses? High-fructose corn syrup? Artificial sweeteners? MSG? Social networks? Early weaning? Pesticides and industrial chemicals? Sleep deprivation?

Or could it simply be that we're feeding them too much food?

[FYI: One of my favourite authors on the subject of food, politics and nutrition, Marion Nestle, has just released her latest work Pet Food Politics. Not having read it, I can't formally review it, but I can tell you that my copy is en route from Amazon.]

Did Michael Phelps Sell Out?

There's been a lot of uproar in obesity circles over Michael Phelps' endorsement deals with Kellogg's Frosted Flakes and McDonald's. Some folks have even forwarded me the articles figuring I'll take out my mallet and hammer Micheal good.

Well folks, sorry to disappoint.

While I certainly don't think that Mr. Phelps' choice of partners belies a healthy lifestyle, where in the Olympic rulebook does it say he's only allowed to endorse healthy products?

Sure, in an ideal world Mr. Phelps might have turned down those endorsements but in place of what? Does someone have millions of dollars to throw at him to endorse broccoli?

Mr. Phelps isn't a doctor, a dietitian or public health advocate. He's a swimmer. If you really want to pick on someone for their inappropriate McDonald's endorsement try dietitian Dr. Rovenia Brock (aka Dr. Ro) or physician Dr. Dean Ornish.

Stephanie, one of my office's front-desk administrators had this to say,

"Although he has the opportunity, he isn't required to set a wonderful example. Working hard and winning a bunch of gold medals in sports... I guess that just isn't a good enough example.

Putting his face on something kids are already eating and possibly inspiring them to try swimming or sports in general, now that's awful!"

I couldn't have written it better myself.

Demitri Martin's Flip Chart Comedy

Folks who watch the Daily Show will immediately recognize the name Demetri Martin.

Those who don't, prepare to meet him.

He's a young comedian with a very unique approach to humour and so today for Funny Friday I bring you Mr. Martin and his flip chart.

Have a great weekend!

Eating Well with Canada's Food Guide at McDonald's!

Ever wonder how many, "Canada's Food Guide" servings you'll get from a Happy Meal?

Well wonder no more!

On McDonald's website is a handy dandy page called Canada's Food Guide Facts.

It'll help teach you how the juice you order for breakfast at McDonald's is really 2.5 servings of fruit; how their refined white flour, processed cheese, red meat based cheeseburger counts as 2 servings of grain, 1/4 serving of milk and 1/2 a serving of meat; and how consuming Newman's own caesar salad dressing (with 480mg of sodium per tablespoon) helps you to get the recommended daily servings of unsaturated fats.

Of course it'll also help teach you just how nutritionally weak our Food Guide is given how easily McDonald's can describe how well their food fits into it.

Certainly were there in fact stringent and evidence-based guidelines backing up the Food Guide, there'd be explicit limitations on such things as juice consumption, refined grains, red and processed meats and high calorie, high sodium salad dressings and likely no McDonald's hearts Canada's Food Guide webpage.

Which "Natural" Weight Loss Supplements Really Work?

Simple.

The ones laced with prescription weight loss drugs.

You see the thing is, there is far less regulation with nutraceuticals than pharmaceuticals.

With real drugs potency and ingredients are tested, studies are conducted to determine efficacy and safety and mandatory reporting of serious adverse effects exists.

The same can't be said about "natural" products.

Perhaps this is why on a weekly basis I get a report from Health Canada detailing the week's latest recalls.

This week?

This week's lineup includes:

Dan Bai Shou Shen Su (Found to contain undeclared thyroid hormones and sibutramine)

Karntien (Found to contain undeclared sibutramine and N-desmethylsibutramine)

Karntien Easy to Slim (Found to contain undeclared sibutramine and N-desmethylsibutramine)

More Slim (Found to contain undeclared sibutramine)

Soloslim (Found to contain undeclared sibutramine and illegal in Canada synephrine)

Honestly, if there really was a natural product that was both effective and safe for weight loss, do you think it'd be a secret? Of course not, quite the opposite as the company that made it would ensure that a copy of the studies proving the product's safety and efficacy were on every single physician's and reporter's desk in the world.

Bottom line?

When it comes to "natural" weight loss products. If your doctor doesn't recommend a particular weight loss aid it's safe to assume that to date it hasn't been proven to be safe and effective and therefore also safe to assume it's probably a waste of your money and potentially a risk to your health.

Oh, and if you think that doctors don't recommend "natural" products because of a global conspiracy to keep people ill, may I suggest you go to see the new X-Files movie.

Obesity is Still not about Exercise!

You need more proof that we're not going to put a dent in childhood obesity with exercise?

Fine.

Published ahead of print in the Archives of Diseases of Childhood is a simple study that looked at 300 children from 54 different schools in the city of Plymouth in the UK.

Dr. Brad Metcalf et al. followed the children for 4 years (from the age of 5 to 8) and looked for associations between the variables of physical activity, body mass index, body fat percentage and some metabolic blood parameters.

Guess what?

There was no association found between the amount the children exercised and their body mass indices or body-fat percentages over time despite the fact that amongst the children there was a ten fold difference in the amount of physical activity that did not in fact change over the course of the study.

That finding is so powerful I'm going to rewrite it big and bold:

Despite the fact that some kids were ten times more active than their peers, their 4 year long, ten-fold increase in exercise did not help them maintain healthier body weights or body fat percentages!

The exercise wasn't all for naught however as metabolic parameters were in fact better in the exercisers.

I wonder how many more studies need to come out before it becomes mainstream to know that exercise as a component of obesity is minor at best?

The Olympics have nothing to do with obesity

Maybe someone should mention that to Canadian Olympic gold medalist Silken Laumann.

Silken, when criticizing Canada for not funding amateur athletics as an explanation for our early dearth of medals, jumped onto the obesity horse to try to ride her point home,

"We have this perception that we are into sports, that we're a sports-minded country, but when you look at it, inactivity and obesity are a real challenge to this country"

Her comments spurred the Ottawa Citizen editorial board to readily agree and they stated that increasing funding for amateur athletics,

"not only would it increase the pool of future Olympians, but it would make a dent in rising obesity and diabetes rates."

Well I've got news for Silken and the Citizen - the country with the most medals of the games also holds the global gold medal for the highest national obesity rates (USA) while the country in second (China), holds the gold medal for gaining weight faster than any other nation in the world.

As I've blogged about over and over and over again, energy-in matters far more to obesity rates than energy-out.

I'd love to chat with Silken about this one day, as over the course of the past two years she's been quoted over and over and over again linking Canada's childhood obesity problem with a lack of sport. Unfortunately in so doing, Silken, whose voice carries a great deal of weight with Canadians, is perpetuating a belief that if acted upon (through the establishment of obesity prevention programs focusing on energy-out) will waste valuable time and resources that could instead be spent on helping Canadians with understanding and modifying their energy-in.

Menu Board Calories Hit the Funny Pages

I love it when Funny Fridays involve nutrition but today it's an extra special Funny Friday as today I've got a double header and both items are about menu board Calories.

First up we have Doonesbury. Amazingly, Gary Trudeau has now been writing his often biting, left leaning, comic strip Doonsebury for 40 years giving us his view of the world. This past week menu board calories hit his strip with Trudeau detailing how the posting of menu board calories at "McFriendly's" is affecting customers and regular pothead character Zonker. The series is remarkable too in that it means that menu board calories have hit the big time with the issue reaching a level of social conscious high enough to make the strip understandable and comical to its readers. Click the picture above to enlarge the strip enough to read.

Next up we have a youtube video that Marion Nestle posted a few days on her fantastic blog What to Eat. It was put together by the California Center for Public Health Advocacy and it involves them asking folks to figure out fast food calories using Big Food's answer to menu boards - brochures.

Have a great weekend!



[Hat tips to my mom and Cynthia for sending along the Doonesbury works]

Seriously? Deep Fried Green Beans?

Rob, BMI's fitness director, picked them up from me from a local supermarket.

According the the package they're called, "Mixed Vegetable Chips" and ingredients include sweet potatoes, squash, carrots, green beens, taro, non-hydrogenated canola oil, dextrin and salt.

I took the photo with the gum beside it to provide some perspective as to how small the container actually is.

Care to venture a guess as to the calorie content?

Would you be surprised if I told you that little container has just a hair fewer calories than a large supermarket bag of potato chips?

Having tasted them, if I'm going to spend the calories, I'll take the chips.

I wonder how many people out there buy them to be, "healthier"

(The label below - it's not for the whole container, it's for 100g. According to the top of the container, the net weight is 222g for 999 calories)

What Does the Greatest Olympian in History Eat?

Can't tell you how many people have been forwarding Michael Phelps' meal plan to me.

In case you're incredibly disconnected with the Olympics, Michael Phelps is a swimmer who has now won more gold medals than any Olympian in history.

NBC's coverage of Mr. Phelps is almost as prodigious as his breakfast and as part of their coverage they covered, you guessed it, his breakfast.

So what does a 23 year old swimming phenom eat?

Apparently nothing he cooks for himself.

He's been instructed to eat between 8,000 and 10,000 Calories daily.

Breakfast as reported by Bob Costas consists of,

"Three sandwiches of fried eggs, cheese, lettuce, tomato, fried onions and mayonnaise, add one omelet, a bowl of grits, and three slices of french toast with powdered sugar, then wash down with three chocolate chip pancakes"

You can eat like Michael Phelps too....provided you're 23 years old, 6 feet 4 inches tall and have been swimming 5 hours a day since the Athens Olympics in 2004. If that doesn't sound like you, I'd recommend cutting back some on the calories.

Thanks to everyone who sent this in - here's a clip from NBC.

The Oreo Episode of 7th Heaven

Can't say I've ever watched the show, but thanks to a post by Parke Wilde on his wonderful blog US Food Policy, I'm pretty sure I don't want to.

His post was about their 218th episode entitled, "Secrets" - an episode whose entire premise is that eating cookies leads people to tell each other their secrets. The thing is, it's not just any cookie that loosens lips, it's specific to Oreos due to presumably paid product placement.

I've included Parke's clip below, along with one other, but some background before you watch the clips.

Oreos are owned by Kraft.

Kraft is one of those corporations who have managed to appease critics and politicians by crafting their own voluntary guidelines regarding targeting children with junk food advertising.

They pledged not to target children back in January 2005 and specifically made mention to Oreos.

So when was that 7th Heaven episode aired?

April 17th, 2006.

Of course Kraft will say that 7th Heaven is a "family" show and therefore they're not exclusively targeting kids. Gee thanks Kraft.

The FCC is investigating but of course without any regulatory teeth, I'm not sure what they expect to be able to do.

Still think "voluntary" is a good idea?

Stupidest Obesity Headline Ever?

Not the one above this post, but rather one by Reuters published on August 6th, 2008.

The article had to do with a study recently published in Obesity that looked at predictions for overweight and obesity in the US for the coming few decades.

The hypothetical study wanted to address the question of what might happen to healthcare expenditures attributable to weight and weight related disease if rising rates of obesity continued unabated.

Certainly if you simply draw a straight line on a graph eventually everyone on the planet will be overweight or obese, but natural phenomena do not occur in straight lines and natural distribution will ensure that eventually we will hit a zenith.

The authors knew this too and simply put it together as a hypothetical question.

Reuters perhaps took it a little too seriously with their alarmist headline,

"All U.S. adults could be overweight in 40 years"

For their efforts Reuters has earned my first quobesity post in some time.

Don't Watch on a Full Stomach

Today for Funny Friday, an absolute classic Saturday Night Live skit with Will Ferrell and Juliana Margulies.

How they manage to keep straight faces for the few moments they do before cracking up is beyond me.

Have a great weekend!

See more funny videos at Funny or Die

Leslie Beck Bashes Juice

And rightly so!

In her (for my non-Canadian readers, Leslie is a prominent Canadian registered dietitian) most recent column Leslie reviews a number of studies that rolled out of the Archives of Internal Medicine.

Her conclusions, while certainly not shocking, are bang on,

"You need to count calories (not grams of fat), lay off sugary drinks and increase your consumption of fruits and vegetables if you want to ward off Type 2 diabetes"

and,

"Soft drinks, fruit drinks and even fruit juice supply extra calories that can promote weight gain. Research suggests we don't register the calories we drink as well as the calories we eat. Liquid calories don't fill us up, so we don't compensate for them by eating less food."

So why am I bothering to post about this?

Because unfortunately too many allied health professionals are still snowed by the juice industry and fewer still are willing to openly call for the limitation of juice despite the fact that evidence-based nutrition would encourage you to consume your fruits and vegetables, not drink them.

Kudos to Leslie for publicly bucking that trend!

Update on Hospital Cafeteria Food

Just thought I'd bring you an update on what's gone on with the hospital food issue.

Following Don Butler's excellent piece on my hospital food adventures in the Citizen the Canadian Medical Association Journal invited me and that doc I've blogged about from the East coast Rob Stevenson, to co-author an editorial about our experiences.

That editorial, available online was posted last week and in turn that led to a flurry of activity and potentially even some change.

The day after the editorial was published the Quebec Minister of Health Dr. Yves Bolduc announced (link is in French) that he would see to it to ensure that healthy foods would in fact be served in Quebec hospitals. There were also a myriad of articles across the country covering what to most allied health professionals is a no-brainer issue and I was thrilled to see in the comment sections for these articles, it's a no-brainer for most Canadians too who see improving hospital cafeteria options as an obvious, necessary and medically responsible thing to do.

A few days ago I was invited onto Steve Madely's show (hosted by Mark Sutcliffe) to talk a bit further and I was pleasantly surprised that the interview was pretty lengthy and really allowed me to flesh out the issue for the listeners. If you're curious, you can click the player below to hear it (if you're an email subscriber and the player doesn't work, just head over to the blog):

Lastly this coming weekend Dr. Barry Dworkin has invited me onto his now nationally syndicated show Sunday Housecall to discuss this an other issues (you can listen online by clicking here at 3:30pm Sunday August 10th or tune into CFRA in Ottawa).

Who says a few loud voices can't affect change?

Shocker - Kids' Meals in Restaurants have too many Calories!

Apropos to my post from yesterday is a story that broke embargo at noon and honest to goodness, I had no idea it was going to hit.

It was from one of my favourite groups, the Centre for Science in the Public Interest (CSPI), the non-profit nutritional advocacy group who also publish the informative and surprisingly affordable monthly newsletter Nutrition Action (ad free and only $24 per year).

What did they do this time?

They calculated the Calories in 1,474 different kid meals available at big chain fast food and semi-fast food restaurants.

The results?

93% of them had more than a third of the Calories an average child would need in a daytime and 86% were too high in sodium.

So going back to yesterday...if activity rates haven't changed in the past 30 years and obesity rates have tripled.....and if restaurant meals for kids have too many calories as do restaurant meals for adults....and if eating out Calories now account for a full 1/3 of daily kid Calories ya think there be a connection?

Darn tootin'!

Oh, and about the recommendation that when you eat out you should just substitute for healthier fare - two comments. Firstly, healthier does not mean lower in Calories and many foods thought of as healthy may in fact be surprisingly unhealthy. Case in point, substitute chocolate milk for soda and you might well be providing your children with more Calories, saturated fat and sugar than the small soda had in the first place. Secondly, how many of you think your kids will let you get away with ordering Burger King's new apple fries in place of real ones? In addition to? Maybe. In place of? Forget about it.

Easy bottom line here. Worried about your kid's weight? Don't (or only very rarely) take them out to eat.

[BTW, if you live in Ottawa, check out CJOH at 6:25pm where I may well be chatting about this and potentially other nutrition news]

Obesity is NOT about inactivity

I've been saying that forever - the math just isn't there.

Thankfully other people have been out there proving it.

People like Drs. Westerterp and Speakman who in May of this year published a fascinating paper in the International Journal of Obesity.

The paper looked at energy expenditure experiments conducted since the 80s. The experiments were gold-standard style as they used doubly labeled water to track results. Many health professionals, the media and the general public might assume that since obesity rates have risen dramatically since the 80s, energy expenditure (the scientific term for activity) must have declined in turn.

Imagine their surprise to read this paper which showed that not only has the developed world's average daily energy expenditure remained the same, it does not differ significantly from that of the third world (a conclusion also reached in that paper I blogged about that compared the energy expenditure of suburban Chicagoans to Nigerian subsistence farmers).

Given that there are ultimately only two components to energy balance (in and out), and given that "out" over the course of the past 30 years has remained the same, once again I'm going to say if we want to see any progress in the war on obesity it's going to have to come from shifting the focus to "in".

I've Seen this Look Before

It was back in 2006 in the Canadian House of Commons.

Granted the look then also included some anger.

It came from Health Canada officials who were called back by the Standing Committee on Health following my testimony on the Food Guide's inexcusable shortcomings.

About a minute or two after I sat down in the gallery all of a sudden all 4 Health Canada folks turned around and gave me a withering glare.

Can't say I blame them either, I certainly hadn't made their lives any easier.

Fortunately for me, I don't wither easily.

So today for Funny Friday I bring you the dramatic kitty in what I'm sure will end up being a viral internet classic (the video, not this post).

Have a great weekend!