Not everything's caused by obesity: Brain and memory function edition

Good lord.

I know people like to blame obesity for everything. Every disease, every problem - everything.

You know what I'm blaming on it today? Authors' and peer reviewers' attitudes about their studies and results.

Last Tuesday I was asked by CTV to read a study that was pending publication in the Journal of the American Geriatrics Society so that I could comment on it for the national news. The study looked at 8,745 women between the ages of 65-79 free of dementia and evaluated their weight and waist to hip ratios in relation to their scores on the 3MSE, a modified mini-mental state examination validated to give an overview of cognitive function.

So I read the study.

Want to know what I found out?

That after controlling for age and education the test scores of folks whose BMI's were <25 were 95.2 while those whose BMIs were >40 were 94.1. I also discovered that the authors failed to provide the p value (the number whereby you'd see what the likelihood simple chance would lead to the result) for that comparison but they did provide a p value for the larger difference when age and education weren't controlled for and guess what, that p value, the one that looked at an even larger variance in test scores, wasn't even close to significant (at 0.10 there was a 10% likelihood the result occurred solely due to chance).

Another odd result? Women with abdominal weight distributions (apples) scored better than those with truncal distributions (pears) suggesting that unlike pretty much everything else weight related, abdominal obesity was protective against this supposed negative impact on cognition.

So basically in a best case scenario the authors could conclude that obesity may lead people to score a single percentage point lower on a test of global cognition but they'll point out at least that the difference in scores could easily have occurred due to chance. Worst case? They'll make it sound important so that they could get published.

My take? I took it to read that obesity doesn't lead to any statistically significant differences in a test of global cognition and that consequently it would seem that obesity and cognition aren't too tightly linked - a result that perhaps is bolstered by the fact that abdominal obesity appeared to be beneficial (though I should note, it may simply be due to the fact the researchers didn't measure waist circumference properly as rather than use a consistent bony landmark they used the floating umbilicus).

So what did the authors conclude?

"Higher BMI was associated with poorer cognitive function in women with smaller WHR....Further research is needed to clarify the mechanism for this interaction".

What I wrote back to CTV was the following,

"It would have to be an unbelievably slow news day for this to make the rotation."

And yet it was all over the news.

Sigh.

The media? I can forgive them, they're just trying to sell stories.

The authors? I can almost forgive them too as certainly negative publication bias might have precluded this piece and it's a publish or perish world.

The peer reviewers? I got nothin'.

Kerwin, D., Zhang, Y., Kotchen, J., Espeland, M., Van Horn, L., McTigue, K., Robinson, J., Powell, L., Kooperberg, C., Coker, L., & Hoffmann, R. (2010). The Cross-Sectional Relationship Between Body Mass Index, Waist-Hip Ratio, and Cognitive Performance in Postmenopausal Women Enrolled in the Women's Health Initiative Journal of the American Geriatrics Society DOI: 10.1111/j.1532-5415.2010.02969.x

Saturday Stories

The shocking, sugary truth behind the recent massive recall of Froot Loops and kin.

Kim Hebert from Skeptic North takes on Canada AM's health coverage.

CSPI wonders why Americans are subsidizing the purchase of sugary soda?

Pharmacist Scott Gavura rips apart Health Canada's decision to rubber stamp hundreds of unapproved natural "health products".

How to rock a karaoke bar!

Simple, be a rock star to begin with.

Today's Funny Friday video is entertaining, funny and oddly heartwarming as it covers Jewel, in a disguise, singing Jewel songs at a karaoke bar and for reasons I can't seem to really pin down, I'd rate this one a must watch.

Have a great weekend!

Undercover Karaoke with Jewel from Jewel

Why the world needs Calories 101

Small wonder the world struggles with obesity.

The world is obscenely calorific. Calories are everywhere. Restaurant salads can have over 1,000. Kids' meals even more and with our supersized foodscape, almost nothing is safe.

So let's shift gears and talk money.

Let's pretend you got dropped into an exotic foreign country and while there were price tags on everything, you didn't know the exchange rate. Sure you might know that more was more expensive, but could you really be sure you weren't overspending?

Or how about if you got hired for a job but weren't told your salary. How would you budget your monthly expenditures?

Now back to calories.

In a survey conducted by the International Food Information Council Foundation (a Big Food funded organization), only 12% of those surveyed knew how many calories they burned a day.

What that means of course is that Americans (and probably it's a finding that's true the world over) don't have a clue how many calories they need in a daytime, and so even though calories are posted on nutritional facts panels and in some jurisdictions even on menu boards, how are they going to do any good?

These results should serve to alert allied health professionals and public health officials that in the absence of an anchoring statement regarding how many calories a person needs, initiatives like mandatory menu labeling will fall deaf on ignorant ears.

What we really need are public health officials to provide us with a Calories 101 campaign (like the one in the photo up above from New York's forward thinking, "Read 'Em Before You Eat 'Em" campaign) because if people don't know how many they've got to spend in a day, how can they possibly be expected to navigate our increasingly obesogenic food environment?

Canada's only national food radio show? CBC's the Main Ingredient.

Recently I had the pleasure of being interviewed by Khalil Akhtar for the CBC's new weekly food show The Main Ingredient.

I was asked to chat about Canada's Food Guide and its contributions to obesity.

Having listened to the show's first 3 episodes I can certainly vouch for its entertainment and interest value and would encourage you to have a listen.

All of the shows are hosted online at the CBC's The Main Ingredient homepage and the episode I'm in can be found here (I come on at roughly the 9:14 mark).

Kudos to the CBC for recognizing that not only is food delicious, it's fascinating.

The Main Ingredient airs on CBC Radio One Mondays at 11:30 a.m. (3:30 p.m. NT) and Fridays at 7:30 p.m. (8 p.m. NT) and on Sirius satellite radio channel 137 Mondays 4:30 p.m., Thursdays 1 p.m., Fridays 3 a.m. and Saturdays at 6:30 p.m. (all times ET).

Chewable Lipitor candy for kids?

Thanks to blog reader Craig for forwarding me a report on the EU's approval of a new chewable tablet of Lipitor (the cholesterol lowering medication) geared for use in kids ages 10 and up.

And according to a study published yesterday in the Journal Pediatrics, the market's probably bigger than once thought. The lead researcher of the study, one where over 20,000 kids' cholesterol levels were screened, was quoted by the Wall Street Journal as stating that current pediatric cholesterol screening guidelines would have missed 36% of kids with, "seriously high LDL".

Sigh.

England - the stupidest country in the world (when it comes to obesity)?

Wow.

Wow, wow wow.

How's this for the dumbest thing you've ever heard a country do to help combat obesity - England has just turned over the reins for it's already crappy Change4Life program (I've blogged about it before) to the food industry and in return for Big Food's help the government's already promised not to mess with them anymore when it comes to things like labeling, taxes or other nutritional regulations or reforms.

I have no words and as regular readers know, it's tough to render me speechless.

Wow.

As Marion Nestle put it on her blog,

"Moral: Expect no public health messages about eating less, or further restrictions on health claims from this campaign."

[Here's The Observer's scathing editorial about the decision.]

Carl's Jr.'s bid to out-gross KFC's Double Down

First found by the folks over at Food Beast (that's their picture too - thanks Food Beast!) may I introduce to you the Foot Long Cheeseburger.

While there are no numbers on it yet, if we take a look at Carl's Jr.'s bacon cheeseburger's calories and multiply by 3 it may well run you in the neighbourhood of 2,460 calories and 5,070mg of sodium.

For those who like comparisons that'd be eating the caloric and sodium equivalent of roughly 5 KFC Double Downs.

Cost per calorie? Well we can't use the $4 cost because that doesn't include bacon but $7 apparently does so that'd be 3.5 calories per penny.

Head over to Food Beast to read their review and check out their pics.

Saturday Stories

Ezra Levant takes on Michael Ignatieff's speech on human rights where he states Canada can learn lessons from China, positive ones, on justice.

Peter from PhD Nomads and Obesity Panacea muses on friendships lost and what's important in life.

Never take dietary advice from Baba Ramdev!

Journalist Gaia Vince explains how Seed Magazine (the Scienceblog overlords), aren't strangers to questionable editorial decisions and then Emily Anthes quickly backs her up.

Apple provides Apple apostles with friends

Do you know an Apple apostle?

The Onion News Network does and that's what today's Funny Friday clip is all about.

Have a great weekend!


New Apple Friend Bar Gives Customers Someone To Talk At About Mac Products

PepsiCo. tries to buy credibility by buying ScienceBlogs

Wow.

For evidence based bloggers like me the news that ScienceBlogs has just published a new nutrition blog, Food Frontiers was shocking news. It was shocking because it's not being written by some hand-selected blogger, it's being written by Pepsi Cola.

So why does that matter?

Because PepsiCo.'s job isn't to push science or evidence based nutrition, Pepsi's job is to push calories and products that increase shareholder's value with no concern for the public good (unless the public good happens to sell products).

The irony on the blog itself is sugary sweet as well given that Pepsi's products have dramatically increased the burden of disease over the course of the past half century and yet their new ScienceBlog is reporting they're there to,

"Discuss the science behind the food industry’s role in addressing global public health challenges"

PepsiCo. of course isn't stupid. Their job is to make themselves look like the good guys and partnerships with folks like ScienceBlogs allow them to whitewash their sugary laundry in a way that simple press releases cannot.

Of course it's not just me who's upset - have a peek at some of ScienceBlog's own bloggers who are chomping at their own bits:

Orac from Respectful Insolence - Blindsided by my corporate overlords and PepsiCo

Peter Lipson from White Coat Underground - Rethinking blog networks and ethics

Grrlscience from Living the Scientist Life (with a URL that includes how she really feels) - Pepsi Ethics

Alex Wild from Myrmecos - Enjoy a nice cold Pepsi today.

Mark C. Chu-Carroll from Good Math, Bad Math - Seed, Conflicts of Interest and Sleaze.

Jason G. Goldman from The Thoughtful Animal - A Pepsi Blog? Initial Thoughts.

Janet D. Stemwedel from Adventures in Ethics and Science - Welcome to Inescapable Conflict of Interest

Abel Pharmboy from Terra Sigillata - PepsiCo Food Frontiers blog did not have to be a #sbFAIL

Martin Rundkvist from Aardvarcheology - An Egoistic Perspective on the Pepsiblog Debacle

John Wilbanks from Common Knowledge - Of Pepsi and ScienceBlogs...

John Dupuis from Confessions of a Science Librarian - A Teachable Moment

Joshua Rosenau from Thoughts from Kansas - More on Pepsi

And so far Sharon from Causobon's Book, James Hrynyshyn from Class: M, Rebecca Skloot from Cuture Dish, Erik Klemetti from Eruptions Mark Chu-Carroll from Good Math, Bad Math, Chris Rowan and Anne Jefferson from Highly Allochtonous, Brian Switek from Laelaps, Mike from Mike the Mad Biologist, Alex Wild at Myrmecos, David Dobbs at Neuron Culture, Scicurious at Neurotopia, Eric Michael Johnson from The Primate Diaries, Dave Bacon from The Quantum Pontiff, Blake Stacey from Science after Sunclipse, and Maryn McKenna from Superbug, have either gone on hiatus or quit in disgust.

That's 33% of all current ScienceBloggers either pissed off or gone due Seed's strange decision to start selling blogs.

Interestingly here's what Seed Media Group has to say about how ScienceBlogs goes about choosing their bloggers,

"We have selected our 80+ bloggers based on their originality, insight, talent, and dedication and how we think they would contribute to the discussion at ScienceBlogs."

And yet for Food Frontiers there's no particular voice they've chosen as according to the Food Frontiers sidebar,

"All editorial content is written by PepsiCo's scientists or scientists invited by PepsiCo and/or ScienceBlogs"

My advice to Seed Media - if you're not going to dump Food Frontiers, at the very least change your ScienceBlogs About Us page to reflect the fact that you'll also sell anyone a blog if the price is right because if you didn't haul in a huge wad of dough for this asinine move then you're crazier than I imagine and given who you've just sold out to, I think you're pretty freakin' crazy.

[Update 10:32AM - The word on Twitter is that ScienceBlogs will be dumping Food Frontiers though I haven't seen anything official anywhere

Update 11:01AM - Official word]

Heart and Stroke Jump Rope for Pizza

Ever hear of the Heart and Stroke Jump Rope for Heart program? Basically school children across Canada skip rope to fundraise for the Heart and Stroke Foundation.

According to the Heart and Stroke Jump Rope for Heart parents' page the program is important because,

"The biggest threat today is childhood obesity, with 26% of Canada's children (2 - 17 year olds) being overweight or obese - over 1.6 million!

JUMP FOR A HEALTHIER TOMORROW

At the Heart and Stroke Foundation, we're working hard to stop this trend through programs like Jump Rope for Heart."

One of my reader's elementary school kids participated in this year's Jump Rope for Heart and you wanna guess what they and all their friends received for jumping rope for a few minutes? They each received a coupon for a free kid's meal at Boston Pizza, a Heart and Stroke Foundation mega-sponsor.

I've blogged about the unholy partnership between Boston Pizza and the Heart and Stroke Foundation before with regards to their Valentine's Day heart shaped pizzas and the Health Check restaurant program, but this really takes it to a new level of abominable.

Why?

Before I get into some numbers, bare in mind that the recommended maximal number of calories per kid's meal is 400 and that a child's recommended daily total sodium intake is 1200mg, and that childhood obesity is the primary driver behind the Heart and Stroke Jump for Heart program.

Now, doing the math on the Heart and Stroke Jump for Heart coupon kid's'meals, the average meal (and full disclosure here, I admittedly didn't include the "Baked Salmon" main or the "Steamed Vegetables" side because what kid in their right mind would order them when eating out at Boston Pizza) contains 742 calories and 1,197mg of sodium - 2 meals worth of calories and a full day's worth of sodium.

But that's just the average. If your kid eats the Boston Pizza grilled chicken sandwich with mayo, a side of fries, a juice and a "Monster Cookie", they'll consume a Heart and Stroke Foundation sponsored 1,293 calories and 2,220mg of sodium along with 10 teaspoons of sugar for good measure.

So there's a few great lessons for these impressionable kids - unhealthy food is a fabulous reward for good deeds and that a few minutes of light exercise earns a highly processed, high calorie, high sodium and high sugar meal.

Oh but parents, don't worry. According to the Jump Rope for Heart website,

"When your child participates, they learn the importance of physical activity, healthy eating and social responsibility."

Because what's healthier than your child eating a full day's worth of calories and two days worth of sodium in one meal at Boston Pizza, and what's more socially responsible than a for-health, non-profit organization like the Heart and Stroke Foundation encouraging families to eat out at restaurants to help combat the scourge of childhood obesity?

Fire. Them. All.

Built environments impact on obesity through food, not fitness.

Chalk up another causal win to food in the battle of what's responsible for our current obesity epidemic - this time in the arena of built environment.

Built environment is the term given to the neighbourhood you live in. It has to do with things like walkability, parks, bike paths, sidewalks and all the various and sundry that city planners can do to try to shape your use of where you live.

Built environment is also a hot button issue at obesity conferences with researchers trying to find ways to get people moving more through smarter urban planning.

My belief is that casually moving more doesn't matter too much with regards to obesity. There's simply no amount of sidewalks or bike paths or beautiful parks that you could put in a neighbourhood to help with the issue of obesity because obesity is primarily about energy intake, not energy output, and really no amount of leisurely strolling is going to negate our horrendously calorific food environment.

But built environment does matter. What matters about the built environment though is food and how close you are to it, and what type it is.

In a study published this month in the Journal of Planning Education and Research Samina Raja et al looked at the influence of built and food environments on 172 women's BMIs in Erie County New York between 1999-2004.

What did they find?

1. The more restaurants within walking distance the higher the BMI (p=0.037).

2. The closer you live to a healthful food destination (supermarket), the lower the BMI (p=0.025).

3. Walkability didn't make one whit of difference.

Interestingly the authors listed the fact that they didn't know the types of restaurants as a limitation and suggested that there might be healthier ones. I'd argue, with exceedingly rare exceptions, restaurant food, regardless of whether it's sit down, stand up, casual, or fancy, has non-intuitively, astronomically large numbers of calories.

Ultimately what matters isn't the sidewalks, it's where they take you.

Raja, S., Li Yin, ., Roemmich, J., Changxing Ma, ., Epstein, L., Yadav, P., & Ticoalu, A. (2010). Food Environment, Built Environment, and Women's BMI: Evidence from Erie County, New York Journal of Planning Education and Research, 29 (4), 444-460 DOI: 10.1177/0739456X10367804

How do you know you're on a "good" diet?

Simple. You like it.

What do I mean?

Tolerating a diet's not good enough. If you're only tolerating your new lifestyle you're certainly not likely to keep living it.

Food wise - you can't be regularly battling hunger, it can't be making you feel unwell and your life has to be "normal" meaning you should be able to include food for comfort, food for celebration, with no forbidden foods.

Fitness wise - you can't be running out of time, running out of energy, hurting yourself or hating it.

Ultimately you're aiming for a lifestyle where you can't happily eat any less and you can't happily exercise any more.

Sure we can all improve our lifestyles but to use an extreme example, do you really think you can be a tee-totaling vegan, shut-in, marathon runner forever?

If you can't happily eat less, you're not going to eat less. If you can't happily exercise more, you're not going to exercise more.

Your goal should be your personal best recognizing that the best lifestyle you can enjoy and the best lifestyle that you can tolerate are two very different things.

Is there any other aspect of your life about which you're striving to be "ideal"?

Saturday Stories

Torontoist discusses their experience on the ground with the moronoic protestors at Toronto's G20.

The New York Times does a great job covering the controversy surrounding Dr. Zamboni's new-fangled treatment for MS and here's a report on a study that refutes Zamboni's initial findings.

Harvard toxicologist Julie Goodman tells moms to keep using BPA containing products.

Pharmalot has an interesting piece on the limits of conflicts of interest in scientific publishing. I think ultimately the question can be thought of as is confirmation bias a conflict of interest? Since we all have them, I guess we're all conflicted.

I want a piece of Bubbie's strudel!

Today's Funny Friday is another gem from Old Jews Telling Jokes.

Have a great weekend!

Honest ad executive calls for kids' advertising ban

His name is Alex Bogusky and he's the "Chief Creative Insurgent" (aka the boss) of MDC Partners who according to Wikipedia are the 10th largest advertising agency in the world (and who have one of the coolest websites I've ever seen). Consequently he certainly knows more than you or I do about the ins, outs, evils and lies of advertising and since his clients have included the likes of Burger King, Domino's and Coca Cola to name just a few, he also probably knows more about how Big Food markets than we do.

So what has Alex recently called for on his blog? An advertising award given to the consumer brand that

"takes into consideration all the potential effects of their marketing and have built a plan that carefully avoids abusing the power of advertising"

He's calling it the Cannes Crystal Grand Prix Lion.

More specifically he's calling for a ban on advertising to children as he believes that cognitively they're simply unable to see the world in shades of gray and hence are defenseless,

"As we all know from experience, children are not small grownups. Their brains are fundamentally different, the big difference being that right hemisphere brain development doesn’t really kick in until the age of twelve. This is important because without the right hemisphere involved, all decisions and concepts are very black and white....And this leaves them fundamentally and developmentally unequipped to deal with advertising in the way an adult can."

The picture he paints of a post-children advertising ban is indeed rosy. He sees improved eating as Moms and Dads won't be caving into the pressure to buy their kids the crap their televisions tell them they want and by extension he sees improved parent-child relationships and increased childhood self-esteem. He sees increased incentives for kids to get involved in free thinking play as television networks built off the backs of children's nag power/advertising dollars crumble and kid TV becomes less lucrative to air. He sees companies being forced to make healthier kids' foods as now it'll be left to Mom and Dad to determine what should enter their homes and he sees those companies feeling better about themselves.

Alex once turned down Burger King's kids' marketing campaign and hopes that somewhere out there a major Big Food player's public relations team is going to decide that it'd be well worth it to call for and support a ban on advertising to kids. He figures that North America's ready to applaud just such a move and that applause would serve that insightful firm as all the marketing it needs.

Head over to Alex' blog and be sure to read his whole piece.

Kudos to Alex Bogusky!

Apparently now clumsiness causes childhood obesity.

Only it's not called clumsiness, it's called, "developmental coordination disorder" (DCD) and it reportedly is found in 5-6% of school aged children and according to the authors of a study published this week in the Canadian Medical Association Journal, kids with DCD are at higher risk of overweight and obesity.

The study looked at 2083 children of whom 111 were deemed to suffer from DCD (excluding kids who had physical or mental illnesses).

At baseline the Grade 4 DCD kids were already behind the eight ball having 15% higher mean BMIs and 13% higher waist circumferences than their coordinated peers - a trend that grew through Grade 6.

While this study certainly does seem to draw a strong correlation between clumsiness and obesity these findings can't even remotely be construed as meaning DCD kids' lack of exercise is the cause of the increase in risk - especially given the authors didn't measure how much any of the kids were exercising. Of course that didn't stop the authors from making that stretch in their abstract's introductory statement,

"Children with developmental coordination disorder have been found to be less likely to participate in physical activities and therefore may be at increased risk of overweight and obesity."

A statement which when considering the study is meant to determine whether or not DCD is associated with increased obesity risk certainly lends literary (not evidentiary) credence to the notion it's due to these kids' decreased activity levels.

So what else might be going on with here? Off the top of my head here are 3 other potential clumsy weight related confounders:

1. Perhaps the DCD kids drown their uncoordinated sorrows in a few extra Big Gulps every week. While that may seem trite, if the theory is that these kids aren't playing organized or even playground sports certainly it's plausible that they might eat more during their extra free time and may as well be more likely to be comforting themselves with food.

2. Perhaps the DCD kids are kids who come from less nurturing or less privileged homes where their parents may not have had the time, inclination or funds to support things like dance lessons, soccer camps or simple let play together time leading to lesser motor developments. In turn those same homes may well have different dietary and social environments that could account for the differences found herein.

3. Perhaps as my friend and colleague Arya Sharma suggested in his blog yesterday, it's the overweight and obesity that causes DCD rather than the other way around.

And I'd argue that one of those options is far more likely to be causal than a lack of exercise as frankly the amount of exercise that would need to be accrued by age 10 to account for such a significant difference in body weight would be truly phenomenal especially given the fact that other studies have found that even a ten fold difference in childhood exercise didn't impact on body weight.

Ultimately this is an interesting study with interesting results, I just wish it wasn't painted with the all too common exercise is the cure-all and cause-all for childhood obesity brush as I think it's much more likely that obesity leads to clumsiness rather than the other way around and likelier still that there's something else in the mix that's not being accounted for here.

Hopefully the next round of studies on these kids will either help elucidate a more plausible mechanism for the association or prove me dead wrong in that indeed it's all about exercise - either way, I'll be sure to blog about it.

Cairney, J., Hay, J., Veldhuizen, S., Missiuna, C., Mahlberg, N., & Faught, B. (2010). Trajectories of relative weight and waist circumference among children with and without developmental coordination disorder Canadian Medical Association Journal DOI: 10.1503/cmaj.091454

A glimmer of hope for childhood obesity prevention!

Good gravy!

In an early release from the New England Journal of Medicine, researchers documented the effects of a 3 year, 21 school, 4,600 student, multi-pronged, intervention that spanned Grades 6 through 8 covering nutrition, physical activity, behavioural knowledge, communications and social marketing on the children's body mass indices, waist circumferences, fasting glucoses and fasting insulins.

The nutritional component targeted quantity, quality and energy of foods. The physical activity component was meant to increase baseline physical activity and to teach the energy components therein. The behavioural component targeted goal setting and self monitoring while the communication and social marketing component integrated it all.

Results wise - they were a bit odd but truly heartening nonetheless.

First the odd. Apparently not only did the 21 intervention schools demonstrate a reduction in the prevalence of overweight and obesity over the study's time span strangely so too did the controls.

Next the hopeful. There was a very nearly significant reduction in obesity in the intervention schools with kids there being 19% less likely to be obese at the end of the study than the beginning (p=0.05). There was also a statistically significant decrease in the percentage of intervention kids who ended up in the >90th percentile for BMI and waist circumference though the differences were relatively small. Interestingly, the intervention seemed to have a more dramatic impact on those who were overweight or obese to begin with at the study's start.

Now the important. While sugar wise there were no differences in fasting glucose between control and intervention schools, by Grade 8, the intervention schools' kids had better fasting insulins which if sustained, might in fact decrease their likelihoods of developing type 2 diabetes down the road.

But the most heartening piece has to be the fact that although the differences themselves were small, the study did indeed demonstrate that a multi-dimensional intervention grounded in energy balance, with explicit, appropriate and careful teaching about calories in and out, over just a 3 year period, in just a single venue, can in fact impact on the severity of obesity, its progression and its potential co-morbidities.

To me what this study really demonstrates is that in the race to build a levee for the flood waters of childhood obesity, while it may be of some benefit to target older kids in schools, ultimately to have a real impact we'll need to help affect a more dramatic environmental overhaul as has been done with the Epode study in France, yet here we have an example of an effective school based sandbag to help tame the flood.

But don't get too excited yet for as Yale's Dr. David Katz has mentioned, "To contain a flood no single sandbag will do" and while schools certainly are an important sandbag they need to be complemented multi-sectorially with interventions being initiated at much younger ages across entire communities and run indefinitely.

The part that had me almost jumping for joy? The fact that there are folks out there who have successfully and explicitly taught the unfortunately and strangely taboo subject of caloric balance to children - a subject ignored by the vast majority of weight-related public health interventions despite the fact that understanding caloric balance is undoubtedly the single most important cornerstone to navigating our modern obesogenic environment.

[For those interested the intervention materials themselves are extensive and are available online at the Healthy Study website.]

The Healthy Study Group (2010). A School-Based Intervention for Diabetes Risk Reduction New England Journal of Medicine DOI: 10.1056/NEJMoa1001933

Hitting the gym harder for a decade won't do a thing for your weight.

I would have had the headline read, "Exercising exercise's confirmation bias" but figured that wouldn't be as grabby.

From the only publishable because the world has such a huge crush on exercise impacting on weight file comes the, Effect of change in physical activity on body fatness over a 10-y period in the Doetinchem Cohort Study published ahead of print in the American Journal of Clinical Nutrition.

The study is just one of many in a long string of studies that fail to show any dramatic benefit on weight from long term exercise.

This one?

The authors followed the 4,944 adult participants of something called the Doetinchem Study and they tracked weight and waist circumference change as a function of physical activity - both at baseline and if physical activity increased or decreased over a 10 year period.

Amazingly this thing got published. I say "amazingly" not because it was a particularly bad study and not because the results weren't particularly impressive, but rather because the conclusions drawn by the authors stand in stark contrast with their results.

Once again with this paper the authors themselves did all the heavy lifting on why exercise isn't the be-all (or perhaps even the be-any) of weight. Here are their comments:

"Random mixed-effects models showed that a single measurement of physical activity was not clearly related to change in body weight and WC over a 5-y period."

Translation? In their analysis of the data, how much you exercised at the start of this study didn't impact on your likelihood of overweight or obesity, or your waist size 5 years down the line.

"Analyses of repeated measures showed that compared with those who maintained their activity level, those who increased their physical activity over a 5-y period had less gain in WC and possibly in body weight. Most importantly, these effects were sustained (although not statistically significant) in the consecutive 5 y for WC and for body weight."

Translation? People who upped their exercise from baseline had their waist circumferences grow less (though they still grew) than those who didn't, but they weren't significantly lighter. Also, while this lesser gain in waist circumference was found to be significant over the course of the first 5 year period study, it wasn't found to be significant over 10.

Statistical significance or insignificance aside, what type of spectacular results are we talking about? The folks who reported a marked increase in exercise over a decade found themselves a whole 1.2lbs lighter ten years later than the folks who didn't and had waist circumferences half a centimetre (roughly a fifth of an inch) smaller.

Huzzah?

This of course leads me to conclude that this study is in fact consistent with the bulk of the evidence which suggests that in the absence of dietary interventions exercise does not dramatically impact on weight over time. It also leads me once again to beg researchers to stop focusing on weight as an exercise study's primary endpoint and instead focus on those things more likely to demonstrate the incredible benefits of exercise - things such as high blood pressure, cholesterol levels, arthritis, cardiovascular fitness and overall quality of life. Oh, and also beg authors that when using weight as an exercise study's endpoint, to draw conclusions that don't fuel the fire of the fallacy of exercise being a primary driver of weight just because that's what people want to hear.

What did it lead these authors to conclude?

"An increase in physical activity was associated with a statistically significant lower gain in body weight and in WC, which was maintained during the following 5 years. These findings support the need for public health programs that promote physical activity."

Yeah, that's what these statistically insignificant and basically inconsequential results support. We should fund public health programs designed to help with weight by promoting increases in physical activity so that in a decade people will gain 1.2 fewer pounds and have 0.5cm smaller waists. That sounds like a great way to spend limited resources.

Good grief.

Again I've got to ask, what the frak is up with the peer reviewers for the American Journal of Clinical Nutrition?

May, A., Bueno-de-Mesquita, H., Boshuizen, H., Spijkerman, A., Peeters, P., & Verschuren, W. (2010). Effect of change in physical activity on body fatness over a 10-y period in the Doetinchem Cohort Study American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2010.29404

Saturday Stories

Commercial Free Childhood takes on some irony and Toy Story 3.

Harriet Hall describes her recent experience in dissing what apparently was a sacred quacker-cow.

Pharmalot pauses over the low down on male andropause.

Skeptic North's Erik Davis on how you just can't trust common sense.

Best soccer goal ever!

At least that's what I think the commentator who was calling it would say.

Doesn't matter what language you speak, today's video speaks the language of Funny Fridays!

Have a great weekend.



[Hat tip to my friend and sensei Claudio]

I call "Bullshit" on Penn and Teller

Thanks to Ottawa Skeptics founder and Reality Check podcast host Jonathan Abrams for passing on a link to Penn and Teller's recent Bullshit! episode on fast food.

Up front I'll tell you I've been a big Bullshit! fan and for those who aren't familiar basically it's a show where mouthy magicians Penn and Teller question the facts behind commonly held beliefs, institutions and ideals.

For the vast majority of the topics they cover, I really don't have an expert opinion and generally I've tended to agreed with Penn and Teller's take on just how backwards some people think about a certain subject matter.

They're also magicians and when I've seen them perform their tricks, I've been wowed.

That said, I wonder if I'd have been just as wowed were I a magician and was able to see through their misdirection and sleight of hand.

With regards to their Bullshit! episode on fast food, given that I do know a fair bit about fast food, obesity and nutritional advocacy, I can tell you it sure wasn't tough to see through their misdirection and sleight of tongue.

The episode (and you can watch it below and draw your own opinions) hinges on some simple premises:

1. Opponents of fast food want it regulated out of existence.
2. Opponents of fast food believe that eating it makes you fat.
3. Opponents of fast food think those who eat it are inherently lazy or otherwise flawed.
4. Opponents of fast food think there's a conspiracy among fast food purveyors to create addictive foodstuff.
5. Opponents of fast food want the government to control everything we eat.
6. Proponents of fast food are hard working mothers and fathers who rely on it to serve healthy meals on the quick to their families.

I'll get to those points in a moment but first let me talk about who they decided to interview to champion the anti fast food cause. Her name is MeMe Roth and she's certainly the lunatic fringe of anti-obesity activism. I've blogged about her loathsomeness in the past and not surprisingly she's got some pretty loony things to say (go figure - when you interview someone from the lunatic fringe you'll get some pretty wild statements). Choosing MeMe to represent the anti-fast food argument would be like choosing Pat Robertson to represent modern Christianity or Osama Bin Laden to represents the tenets of 21st century Islam.

With regards to the show's main arguments, plainly put they're asinine.

Healthy eating advocates don't believe that eating fast food magically causes weight gain - they know that caloric imbalance does, and that restaurants fast and slow alike, are a huge contributor to that imbalance. They know that over the course of the past 30 years people have stopped cooking, and more and more dollars are being spent on food purchased outside of the home, foods with boatloads of calories, cups of salt and buckets of sugar - things that aren't good for our health.

Healthy eating advocates don't believe in banning fast or slow food, they believe in empowering people with enough information to make healthier and more educated choices in all restaurants and about protecting our most vulnerable and most precious resource - our kids from predatory marketing practices.

Being a healthy eating advocate myself I can tell you what I want to see change:

- I want a level playing field where people are provided with calorie counts at point of purchase in clearly visible locations so as to help those people make informed caloric decisions.

- I want to end the predatory practice of targeting children too young to discern truth from advertising with spots that extol the virtues of nutritional garbage or cartoon characters that beckon from the grocery aisle.

- I want taxes in place that discourage the consumption of products that are exceedingly unhealthy (and here I can't fault Penn and Teller, but since their show aired there's proof out of Harvard that sugar-sweetened taxes do indeed work to reduce soda consumption) which in turn impacts on the bottom line of Canada's health care expenditures, GDP and my taxes. And it's not as if there isn't precedent here. Regulating unnecessary risk is certainly part of the purvey of government, especially a government in a country with socialized medicine. From tobacco taxes, to seat-belt and helmet laws, to licensing requirements etc., governments do it all the time.

- I want changes in fast food zoning around schools as studies have shown disproportionate placement of fast food locations within walking distance of them.

The one argument I agreed with in this episode was the fact that governments are considering creating soda taxes while simultaneously subsidizing the production of corn. That is a ridiculous dichotomy as the artificially low prices of corn (and consequently high fructose corn syrup) are one of the primary drivers of cheap calories.

The biggest bullshit in this episode? For me it had to be the skinny active family who were talking about how much time they save with fast food. How long does it take to make oatmeal or some eggs for breakfast? How long would it take to do a quick stirfry or make some sandwiches for supper? And $20 to feed a family of 4 for a single meal? I can feed my family of 5 healthily on less than half of that.

Penn and Teller sum up this episode by letting the skinny mom who feeds her kids a diet heavy in fast food state,

"It's up to everyone to choose what they want to eat"

And she's absolutely right and only truly loony folks like MeMe would argue otherwise. What I want, and what most healthy eating advocates want, is an environment that doesn't stack the deck in favour of selling fast food but rather stacks it in favour of informed, healthier choices.

Watching this episode and knowing a great deal about the subject matter certainly has me questioning Bullshit! as a whole. If this is how they report on fast food, who's to say that they don't grossly mischaracterize other arguments in other episodes?

If Penn and Teller really want to do a good Bullshit! episode let's see them take on the notion that it's faster or cheaper or just as healthy to buy fast food for your family than actually taking the time to cook. To that, and to pretty much this whole episode, I call bullshit.

Want to judge for yourself, here's the episode as posted on YouTube (until it gets yanked by Bravo):

Kids would rather eat rocks covered with stickers than a fresh banana.

There has been a great deal of noise this week regarding cartoon characters and children's preferences, much of it stemming from a recently released study in Pediatrics that proved something every parent already knew - kids prefer foods branded with cartoon characters.

Something else parents already know - kids also prefer Happy Meals sold with toys which is explicitly why the Center for Science in the Public Interest announced yesterday their intention to sue McDonald's if they don't stop packaging toys with their Happy Meals,

"McDonald’s practices are predatory and wrong. They are also illegal, because marketing to kids under eight is inherently deceptive, because young kids are not developmentally advanced enough to understand the persuasive intent of marketing; and unfair to parents, because marketing to children undermines parental authority and interferes with their ability to raise healthy children."

While certainly not a statistically significant study, my favourite proof of this phenomenon came from the television program Dateline in 2006 where in the clip below you can watch kids tell their interviewer that they'd rather their parents place a rock with stickers into their lunchbox than an unfestooned banana.

(Clip's been finicky - if it doesn't work, head over here)

Is your diet deficient in micronutrients?

That's what the findings of a recent paper that concluded 4 popular diets were deficient in micronutrients would state.

The paper in question took a look at micronutrient intakes if a person were to follow Atkins, South Beach, DASH or the Best Life diets, and from the very first sentence I knew it was going to be a tough read,

"Research has shown micronutrient deficiency to be scientifically linked to a higher risk of overweight/obesity and other dangerous and debilitating diseases"

Oh really? I guess it's a zinc deficiency that's leading people to consume more calories than ever before.

This read became doubly painful as I had to then read the reference that he was using to support his assertion that micronutrient deficiency and obesity are causally linked,

"Micronutrient deficiency has been shown to cause an 80.8% increase in the likelihood of becoming overweight or obese"

It was a study published in the journal Economics and Human Biology entitled, Micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt and without spending too much time on that study which was also poorly designed, let me simply point out that data collected on a small sample of mothers in Egypt who were subdivided into the poor and the extremely poor, does not even if true, automatically extrapolate to the rest of the world except by authors stretching to find references to help make their papers seem more important.

Back to this paper, the author indeed demonstrates that following the aforementioned 4 diet plans people won't meet their micronutrient RDIs. What he didn't bother mentioning was that unless you're eating obesity inducing volumes of foods, regardless of what you're putting in your mouth, you're probably not going to meet your micronutrient RDIs and so really, if you're worried about micronutrients you should be on a basic multivitamin whether you're on a marquee diet or not. Instead the author makes this statement,

"The implications of this study are significant and far-reaching."

"Consequently, with global obesity being a very real and serious condition it should be of some concern to the millions of individuals worldwide, following one of this study’s four popular diet plans, or similar, using whole food alone, that based on the findings of this study, micronutrient deficiency is inevitable."

Scary sounding, but more nutritional fear mongering than truly concerning and an issue certainly not unique to dieters.

Ultimately this was a non-study. It was a completely expected result which the author spectacularized by inventing a causal link with obesity where there is none.

So imagine my non-surprise when I got to the end of the study and read this,

"JBC (the author) is the CEO of Calton Nutrition, a private corporation that researches the causation and prevalence of micronutrient deficiency worldwide. Due to the results of its research Calton Nutrition is in the process of developing a multivitamin"

Peer review, shmeer review.

(The most important (and not discussed) part of the study? If the author's calculations are correct the DASH diet, when followed, leads people to consume 2,200 calories - enough to cause weight gain for a woman with a healthy body weight.)

Calton, J. (2010). Prevalence of micronutrient deficiency in popular diet plans Journal of the International Society of Sports Nutrition, 7 (1) DOI: 10.1186/1550-2783-7-24

Ferrero's worried you'll stop eating Nutella if you know what's in it.

I love this story.

The EU is en route to creating a front of package labeling program for processed foods.

The program will require fat, salt and sugar content to be clearly labeled on package fronts and has lead Paolo Fulci, VP of Ferrero, maker of Nutella, to note that the EU approach carries, "risks" and that it could,

"influence even the habits and the most intimate aspects of one's personal sphere, like the genuine and healthy pleasures that are passed among generations"

Which of course serves as a great quote to help explain the point of nutritional labeling reform.

So what's scaring Paolo Fulci?

I'm guessing that he thinks that if people actually knew that each and every tablespoon of Nutella contains an astonishing 4 teaspoons of sugar (in Europe Nutella has more sugar than here in Canada where each tablespoon has 3 teaspoons of sugar) it just might influence how much Nutella they consume.

The most amazing part of the story?

Apparently an Italian government official founded a support group specifically for Nutella. He's called it "Hands off Nutella" and together he and the group are accusing the EU of "nutritional fundamentalism".

How dare we nutritional fundamentalists suggest people have the right to know what they're eating.

We're madmen!

[BTW - judging by the incredulous emails, people seem very confused that there can be 4 teaspoons of sugar in a tablespoon of Nutella. What people are forgetting is that the volume of sugar in a solid will be much, much less once dissolved.]

Saturday Stories

Harvard Business Review on why the author returned his iPad.

The Ottawa Citizen's John Robson on the rampant anti-semitism among Canada's political left.

Ethicist Chris MacDonald has started a new food ethics blog - here's his brief take on how intensive agriculture may in fact be environmentally sound.

Obesity Panacea's Peter Janiszewski get a reality check while travelling in Peru. We really do have it easy here in North America.

The New York Times calls out the Big Food funded Center for Consumer Freedom's Richard Berman as a for-profit advocate.

The world's dumbest cat?

Thanks to loyal blog reader Kim for sending this one my way.

Today's Funny Friday may well be the world's dumbest cat.

Have a great weekend!


Dumb Cat Can't Figure Out How To Drink - Watch more Funny Videos

2010 American Dietary Guidelines vs. 2007 Canada's Food Guide

Two days ago the 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans was released previewing the changes set to come for the official American dietary guidelines.

Given it's only 3 years post the release of Canada's Food Guide, one might imagine that the recommendations ought to be pretty similar as not too much has changed in the evidence-based nutrition landscape.

Of course that assumes that the 2007 Food Guide is evidence-based (a bad assumption).

A quick peek at the Executive Summary of the Report reveals their calls to action. Let's take a peek at them and see if they're reflected in Canada's 2007 Food Guide:

1. Reduce the incidence and prevalence of overweight and obesity of the US population by reducing overall calorie intake.

Canada's Food Guide? Provides zero guidance in helping Canadians reduce caloric intake.

2. Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds.

Canada's Food Guide? Puts zero emphasis on legumes, nuts or seeds and happily recommends that half of our grain be refined.

3. Increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.

Canada's Food Guide? Does recommend we increase the amount of seafood we consume but puts no limits or cautions on meat consumption. Includes whole milk, pudding and chocolate milk in their online guidance meant to steer Canadians to appropriate dietary choices.

4. Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains, especially refined grains that are coupled with added sugar, solid fat, and sodium.

Canada's Food Guide? Has a blanket recommendation to reduce sugary foods and fats but provides very little guidance on salt and as mentioned, recommends half the grains we consume be refined.

The report also emphatically states,

"The obesity epidemic is the "single greatest threat to public health in this century"

And yet Canada's Food Guide is in and of itself obesogenic (my prior posts on this matter here, here and here).

Now of course these are just the recommendations of the advisory committee and it remains to be seen how these calls to action are actually incorporated into the final guidelines but one thing's for certain, Canada's Food Guide does not reflect our current understanding of the impact of nutrition on chronic disease and for those in the nutritional know, it is a national embarrassment.

The two questions to ask before you indulge.

Food is both a comfort and a pleasure and to live a life that denies the ability to use food for those means is called a diet and it's something that ultimately you're likely to quit.

Dietary indulgences are a luxurious part of life and given we're all effectively the best hunters this planet has ever seen, they're easily obtainable and we can "catch" them anywhere.

While of course there's no such thing as the eat whatever you want, whenever you want, as much as you want weight management plan, blindly cutting out the less healthy (but often yummy) stuff may well over time lead you to abandon your entire weight management strategy.

So the next time you're considering an indulgence rather than blindly saying, "I'm not allowed", or, "Whatever, tonight's a write-off", here are the two questions you might try to ask yourself:

1. Is it worth the calories?

To answer the question certainly knowing the calories is important. The fact is, some indulgences simply aren't worth their calories and asking the question you'll eliminate a fair percentage.

2. How much of it do I need to be happy?

By asking this question you're avoiding the "write-off" situation where you throw caution to the wind, pay no attention, eat as much as your body wants, and then wind up feeling guilty about the amount you consumed.

A followup to this question is that if you've finished the amount you thought you needed to be happy and you're still not, simply ask the question again and again until such time as you're content.

Remember, there are many variables that go into these decisions and some days are worth more calories than others - birthdays, holidays, vacations to name just a few, so the answers to these questions vary day by day.

Ultimately life includes indulgences, and rather than try to blindly restrict them why not work on their thoughtful reduction.

Choose with your brain, not with your body.

Badvertising: Nestlé's Boost "Nutritious Energy" (2.5x the nutritious energy of Coca Cola)

First let me thank Nestlé Nutrition for sponsoring the Canadian Obesity Network's Student Meeting (and therefore for sponsoring my talk).

Now that the thank you is out of the way let me ask Nestlé Nutrition what they were smoking when they labelled their Boost beverage with the words, "Nutritious Energy".

I came across the bottles in a big bowl at the conference and intrigued by vague and meaningless "Nutritious Energy" billing, I had a peek at the nutrition facts panel.

The first three nutritious ingredients?

1. Water
2. Sugar
3. Corn syrup (Sugar)

The number of teaspoons of sugar per 237ml bottle?

10.25!

The calories?

240

Percentage of calories from sugar?

68%

How does it compare to Coca Cola?

2.5x the calories and 1.5x the sugar.

So if you think throwing a bit of fat, protein and some vitamins into a Coca Cola along with an extra 3.5 teaspoons of sugar would make it, "nutritious", than by all means drink Boost, but be prepared for it to potentially not taste so good - as one fellow conference goer said when I mentioned I was going to blog about it,

"And it tastes like chalky shit. Can't leave that out."

Adventures of a loudmouth (why I do what I do)

This past Friday I was given the honour of delivering a keynote dinner talk at the 2010 Canadian Obesity Network's Student Meeting.

The meeting brought together the future of Canadian obesity research and the bright eyed enthusiasm there was a joy to see.

Unlike much of my blogging, the talk I gave wasn't particularly inflammatory. I called it, "Adventures of a Loudmouth" and by means of examples from my life I encouraged the students to be vocal advocates for those things they believe in.

Ultimately that's what drives me to write this blog.

Some folks have said I write it to encourage patients to come to my office, but in the 5 years I've been blogging, and of the thousands of folks I've met in my office, I can only remember one who said the blog brought them there.

Other folks have said that I write it to be "popular"or for "fame", yet I have zero doubt that my writing this blog has closed more doors to me than it's opened.

The answer's much simpler. I write it because I believe that it's incredibly important to speak up about those things that matter to you. I write it because I believe it's one of my responsibilities as a physician to advocate for better health. I write it because I believe that shining a spotlight on programs, policies and attitudes that either willfully or inadvertently make it more difficult for consumers to make healthier choices for their families is something that I must do given that many of those who might want to speak up, are silenced by their institutional and professional ties which preclude them from biting the hands that feed them.

Ultimately I write it because I love to, and just as I did during the early days of the blog, I'd write it even if virtually nobody read it.

After the talk was over Diane Finegood asked me a very fair and relevant question. She asked me if I ever consider the unintended consequences of my blogging.

The answer's yes.

I don't doubt my blog has hurt some good people, and I'm genuinely sorry about that. I don't doubt that from time to time some of my posts have been over the top and more angry or personal than they needed to be and I'm sorry about that too. But what I can't be sorry for is speaking up about what I believe in and it's something you shouldn't ever be sorry for either.

To save you the time of watching the talk, the recipe for leveraging your PhD or MD into loudmouth advocacy is:

1 short set of initials that help lend credibility and open doors
1 small soapbox
1 tsp soundbites
100s of tablespoons of broken records
1 large swimming pool full of luck

Of course if you're just planning on cooking advocacy at home the recipe's much shorter:

Live the life you want your family to live, and relish every minute of it.

[If you are interested in watching me speak, I've uploaded my talk to Vimeo (unlike Youtube, Vimeo doesn't impose a ridiculous 10 minute maximum on their clips) and embedded it below. It might not be me at my fieriest or my most eloquent but it's certainly me being sincere and speaking from the heart.]

(Kudos to Angela and Zach for organizing such a great conference and thanks for letting me be a part of it)

Adventures of a Loudmouth: Leveraging your initials into advocacy from Yoni Freedhoff on Vimeo.

Saturday Stories

Sorry, very slow week for me reading wise.

The Washington Post details how small changes can make huge differences in school cafeterias.

Video wise, here's a stunner of a world champion free diver "base jumping" under water:

When BP spills a cup of coffee

Funny but also oh so sad at the same time.

Have a great weekend!

(email subscribers - hit the blog to watch)