Alberta's Ministry of Health recommends post meal cheese to prevent cavities?!

Christine, a blog reader and bariatric nurse from Alberta, sent me an email last week tipping me off to Alberta's The Amazing Little Cookbook.

The book, published by the "Healthy U" arm of Alberta's Ministry of Health, is a cookbook meant for children that aims to teach them how to cook healthy meals.

So what's my proverbial beef?

Simple. The recipes represent lowest common denominator nutrition. Nary a whole grain to be found. White bread, white flour, added salt, processed cheese, instant oatmeal, processed meats, bouillon cubes, tortilla chips, white pastas, oodles of juices, oodles of store bought sauces, gobs of ice cream and squeezes of fudge sauce.

And it wasn't just the recipes that got to me.

Smattered throughout the book are tidbits of "helpful" information.

Here are a few that caught my eye,

"Try not to portray food as "good" or "bad." Encourage a healthy attitude towards food — all foods in moderation can be part of a healthy diet."

"Chocolate milk is just as nutritious as white. It has no more sugar than unsweetened orange juice - and kids think it’s a treat. Only you need to know its good for them too!"

"A cheesy smile is a good smile! Eating a piece of cheese after a meal or snack may actually prevent cavities because it helps protect against tooth decay."

Yes, Alberta's Ministry of Health in a cookbook specifically commissioned to help teach healthy eating to children teaches kids that there's no such thing as a bad food, that chocolate milk's a great choice and that eating cheese after a meal prevents cavities.

Hmm, those messages sure sound like Big Dairy messages.

And hey, when you look closer you find that of the 59 recipes, 49 include dairy products.

So colour me not surprised when I reached the end of the book to find the "Special Thanks" given to the Dairy Council of Alberta on the last page.

What an incredible waste of an opportunity to teach kids the joys of healthy cooking with whole fresh ingredients and provide some useful nutritional guidance. Instead Alberta's Ministry of Health has allowed their province's Dairy Council to put out a cookbook where the recipes basically scream out nutritional surrender; where they encourage child readers to grow themselves out of junk food; where they explicitly tell kids there's no such thing as junk food; where milk, even chocolate milk is magic; and where rather than make the crazy recommendation that kids brush their teeth after meals to prevent calories, advises them to eat cheese.

Brilliant work Alberta.

Dietitians - a question for you.

The question's simple and I don't think there's necessarily a "right" answer though I'm sure you'll be able to guess where I lean.

But before I get to my question, I need to give you some background.

This Sunday's local paper brought with it a magazine called, Ottawa Family Life. In the magazine was an article written by a local dietitian. The article was about calcium.

The author (and this time I'm going to leave the RD's name out as unlike other times this one isn't shilling for the food industry), who clearly subscribes to the there's a calcium emergency out there and milk's a magic, miracle food camps, gives a whole long list of things parents should do to ensure their kids get enough dairy.

Among the suggestions:

Make milk the main beverage at meals.

Make hot cocoa with milk instead of water.

Make cream soups with milk instead of water.

Have chocolate milk as a snack.

Choose milk or chocolate milk as the post-game sport drink of choice.

Drink milk yourself to show your child how important it is.

They also recommend that if your child is lactose intolerant that you look for vitamin D and calcium fortified juices to serve them.

Now I'm not going to get into the fallacy of a societal calcium emergency or magic milk claims (though for readers who are curious where my thoughts lie - weight bearing exercise and adequate vitamin D intake are likely more important for bone health than calcium), I'm going to focus on calories. They're never mentioned.

So here's a registered dietitian telling parents to serve their children chocolate milk as snacks, actually suggesting that kids need a post-game sports drink (they certainly don't) and that it ought to be chocolate milk, that kids who are lactose intolerant get calcium and vitamin D from fortified juices (despite calls to limit juice consumption in children to 1/2 - 1 cup daily) and that basically any dish that can be spiked with milk should be.

Chocolate milk twice a day, even just a glass twice a day, would provide your child with the caloric equivalent of nearly a litre of Coca Cola a day along with 12 teaspoons of sugar.

Making this all the more astounding to me is the fact that when I Googled this dietitian I found out that they work (or at least worked) at the Ottawa Civic's Weight Management Clinic and therefore is certainly no stranger to the risks of not paying attention to calories.

So here's my question for all my dietitian readers (and anyone else who might want to weigh in).

Given the problem of adult and childhood obesity, should that be an overarching consideration when writing articles or giving talks and interviews that provide dietary advice to society, especially those involving recommendations for children?

(Another way to think about it? If 65-70% of the adult population routinely developed scurvy over the course of their lives, do you think there'd ever be an article written on dietary advice for children that didn't include a discussion on the importance of citrus fruit?)

Healthy Dads, Healthy Kids, and Unhealthy Peer Review.

Last week Colby Vorland tweeted a link to a new study that looked at the impact of a lifestyle modification program geared at overweight fathers and their children.

The study set out to randomly investigate something called the Healthy Dads, Healthy Kids Program - a 3 month program that delivers 10 hours of behavioural change counseling to overweight dads and their kids (where the kids showed up for 4 of those). The study looked at dads' and kids' weights at the end of the program and 3 months later, and for a control group they used dads and kids on the program's waiting list.

The 6 month outcomes were quite predictable.

Healthy dads lost significantly more weight (15lbs vs zip), and had statistically significant improvements in their waist circumferences, blood pressures and physical activity compared to controls. Importantly, they did not report any difference in their dietary intakes.

Healthy kids showed an increase in physical activity and their mothers reported a dramatic decrease in the kids' caloric intake, reporting them eating on average 20 calories less per kilogram. Given the reported average weight of the children was 33kg, that'd be a decrease of 660 calories per kid per day - yet there was no change in weight in the children.

So is this a slam dunk? Should we be rolling out this program across the globe?

Not yet.

You see there's an enormous flaw in the study, and it's a flaw that the folks who designed the study absolutely knew beforehand. Simply put, if you graph weight loss over time for virtually any weight management program, the losing phase lasts roughly 6 months which is then almost invariably followed by the regaining phase.

Put another way, it's not particularly exciting to see a program effectively leading to weight loss at 6 months given that pretty much any intervention can do so. In fact I'd go so far as to say that publishing 6 month results of a weight loss program is a knowingly misleading thing to do and something that should be considered heavily by peer reviewers when evaluating such papers.

Furthermore the study illustrates the difficulty of food frequency questionnaires in accurately tracking intake because here we've got a pile of kids who are apparently not governed by the laws of thermodynamics in that they're supposedly exercising significantly more and purportedly eating dramatically less and yet they aren't losing any weight.

Dads wise - the study's fairly predictable too. Having treated over one thousand men in my program I can tell you, without frequent and explicit guidance to the contrary, men tend to hit the gym hard and fast and ignore food. While that may work in the short run, I've never seen it work in the long run in the absence of dietary change.

So before you enroll in one of these programs I'd suggest you wait for the 18 month data.

Of course the cynic in me says that data's never going to get published, not because of the International Journal of Obesity's negative publication bias, but rather because it's not data the researchers will likely want to brag about.

Morgan, P., Lubans, D., Callister, R., Okely, A., Burrows, T., Fletcher, R., & Collins, C. (2010). The ‘Healthy Dads, Healthy Kids’ randomized controlled trial: efficacy of a healthy lifestyle program for overweight fathers and their children International Journal of Obesity DOI: 10.1038/ijo.2010.151

Saturday Stories

Ridiculously dedicated University professor allows himself to be sunk in a car in a lake dozens of time to determine the best way to escape a submerged car.

Doctors in NYC are giving away coupons for fruits and vegetables to help fight childhood obesity.

My friend and colleague Dr. David Haslam on who ought to be considered for bariatric surgery.

The craziest hiking video I've ever seen (below)

Schadenfreude pranks

Continuing on the theme of honesty (see yesterday's blog post), I've got to be honest with you, while I know what the folks in this clip do is awful, and while I'm sure were I a victim I'd be livid, I can't help but find this Funny Friday clip incredibly funny.

Have a great weekend!



[Hat tip to my friend and sensei Claudio who is getting ready to open a dojo in Ottawa - stay tuned for more details]

On Confirmation Biases, Twitter and Blogs

Confirmation bias is something I mention here from time to time.

While simple in principle, in practice it's really quite important, especially for people who read blogs, or use Twitter or Facebook.

Confirmation bias dictates that most people prefer information that supports their own beliefs. In turn this tends to lead people to accept things as true with lesser amounts of evidence if they agree with their preformed beliefs, and dismiss things, sometimes irrespective of the evidence, if those things don't agree with them. Like the cartoon above, it can also lead people to hear what they want to hear, rather than what's actually being said.

My bet would be that as a consequence of confirmation bias we tend to only follow and read folks who more often than not espouse opinions with which we agree which in turn may serve only to further solidify our own confirmation biases.

Of course there are a lot of folks who'll staunchly state that they don't have a confirmation bias, that they're evidence-based thinkers.

I can't help but doubt them.

Confirmation bias is something that's tough to shake, and while I like to think of myself as evidence-based, I'm sure that over the years confirmation bias has swayed me one way or the other on many occasions, both in my interpretation of research and my writings therein.

To help readers of this blog navigate my postings, and while I believe the current state of the evidence supports the following statements, I'd like to lay bare my biases. So here are the most salient (and obvious) of the lot as they pertain to my regular postings:

- Food, not fitness, is the primary societal driver of obesity.
- The food industry only cares about your health when it affects their bottom lines.
- Obesity's primary cause is environmental change, not individual lack of willpower.
- Calories are the currency of weight, not fat, carbs or proteins.
- Whole grains are healthier than refined.
- The risks of red meat consumption greatly outweigh the benefits but ultimately are small when considered absolutely.
- Dairy is not a magic food worthy of its own "group"
- The Canadian Government panders more to industry concerns than public health concerns when it comes to nutrition

There are probably more, but those are the ones that leap to mind.

So happy reading and while I promise to try to not let my confirmation biases get the best of me (or you) and will do my best to accurately and fairly interpret studies and report, the likelihood is they'll probably still be there sometimes lurking in the shadows.

MS's controversial "liberation procedure" provides a lesson in obesity bias.

I opened up the paper yesterday morning to see dueling columns discussing the controversial and currently highly experimental liberation procedure for multiple sclerosis.

The columns came one day after a front page City section story detailing one individual's anecdotally positive experiences having paid for the procedure himself overseas.

The first column, penned by Paula Simons, calls on provincial health plans to only fund proven therapies.

The second, penned by a gentleman named Bart Bakker who himself suffers with MS, calls on the provinces to follow Saskatchewan's lead in that according to Premiere Brad Wall, they plan on funding trials of the procedure.

The trials are likely to be exceedingly expensive and while as an evidence based clinician I welcome them, given the research that's already been published on the procedure, I wonder whether that'll be money well spent or whether Saskatchewan will be just funding hope. I also wonder whether there are proven treatments for other conditions that Saskatchewan's doing a poor job of funding where that money might be better spent.

The reason Saskatchewan's premiere Brad Wall gave for the funding?

"I think it's incumbent on us to explore what hope exists around this and to answer as many questions as we can"

So what does this have to do with obesity?

Well far from an experimental procedure, obesity has a proven surgical treatment. Studies have demonstrated that gastric bypass surgery increases longevity and decreases morbidity, curing many chronic conditions in the process, while markedly improving quality of life.

Saskatchewan's gastric bypass surgery program?

There's a single bariatric assessment centre in Saskatchewan and it's located in Regina. That's a single centre for a province that's 588,276 square kilometres (277,100 square miles), an area slightly larger than the great State of Texas. That's one single, solitary assessment centre for a population of just over a million people, roughly 30,000 of whom would meet the surgical criteria for bariatric surgery.

Oh, and for icing on the proverbial cake, Saskatchewan boasts Canada's second highest provincial rate of obesity.

I called Saskatchewan's lone bariatric surgical centre yesterday. I was told that if I sent in a referral that, "it would be at least 2 years" before my patient would get seen and then they'd need to complete a 6 month pre-surgical program which would involve a minimum of 6 visits. I was also told that the province won't pay for any travel expenses incurred for non Regina residents trying to get surgery and that once the pre-surgical program was completed there'd be an additional wait of many months before the surgery because currently they're only performing one a week.

Putting that math to play, at one surgery a week, if even 10% of Saskatchewan's surgically eligible folks wanted to consider surgery it would take the province roughly 58 years to meet the demand. Good news though, the very kind person I spoke with on the phone mentioned they're hoping to soon be able to do 2 a week so that'll bring the wait down to 29 years.

So to recap. On the one hand, a procedure that's experimental at best has the Premiere of Saskatchewan crowing about hope and wanting to spend money funding its research. On the other hand his province has a woefully underfunded bariatric surgery program for a proven procedure that not only increases both quality and quantity of life but also simultaneously decreases health care costs and in the long run would save the province money.

So has Brad Wall ever said anything about bariatric surgery?

If he has, I certainly couldn't any find mention of it.

So why not?

As far as the world goes, obesity is still a disease of willpower. Premieres and the public simply want to blame individuals for their weight, whereas MS is not something that a person is generally blamed for contracting.

Though of course in our socialized medical system, even if it were a disease of willpower, given that bariatric surgery has been proven to save health care dollars, Premieres should be busting down doors trying to get the job done.

So have people really changed over the course of this past 30 years? Is there really an epidemic lack of willpower?

I guess that's what's causing early puberty in increasingly obese 7 year old girls. These 7 year olds nowadays. No willpower.

Another reason to avoid Wonder Bread.

As if you needed another.

Straightforward study that explored the impact of the great social experiment in which the past 40 years of low-fat recommendations have placed us.

The study looks at the risk of having a heart attack as a function of macronutrients in 57,053 Danes over a 12 year period and then re-analyzes risk on the basis of the glycemic indices of their carbohydrate choices.

The researchers used two models to investigate the risk of heart attack with a higher energy intake from carbohydrates and a concomitant lower energy intake from saturated fats (just like what we're still being told to do by national dietary guidelines, health organization and health related NGOs). The first model looked at macronutrients as a percentage of total energy intake. The second model further subdivided the carbohydrates into tertiles of dietary glycemic index. Both models controlled for alcohol intake, smoking status, physical activity and hypertension.

The results probably won't surprise you.

Folks who replaced saturated fats with high glycemic index carbohydrates (Wonder Bread for instance), had a statistically significant increase in their risk of heart attack, and while not statistically significant, replacing saturated fats with low glycemic index carbs appeared protective.

What's surprising to me aren't these results but rather the fact that the blind low-fat message is still being put out there by governments and health organizations who if they don't know better, certainly should.

What we should be telling folks to do is substitute healthy fats for unhealthy ones and perhaps more importantly, telling folks to substitute low glycemic index carbohydrates for high (or more simply put, whole for refined).

Jakobsen, M., Dethlefsen, C., Joensen, A., Stegger, J., Tjonneland, A., Schmidt, E., & Overvad, K. (2010). Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index American Journal of Clinical Nutrition, 91 (6), 1764-1768 DOI: 10.3945/ajcn.2009.29099

Pregnant? Eating for 2? More like eating for 1.2.

When I practiced more traditional family medicine and saw my pregnant patients many rationalized rapid and extreme weight gains as a rite of pregnancy and not a worry because after all, they were "eating for two".

It's probably time to rethink those attitudes.

Last week a paper was published in the Lancet which looked at a within family comparison of pregnancy weight gain and baby birth weight.

The study was rather enormous in scope capturing 513,501 women and their 1,164,750 children. The findings were pretty straightforward too - babies of women who gained more than 50lbs during their pregnancies were roughly 1/3lb heavier at birth than those of women who gained between 17-22lbs.

Moreover, compared to those gaining 17-22 pounds, the bigger gaining mothers were 1.7 times more likely to have a high-birth-weight baby, and those gaining more than 53 pounds were 2.3 times more likely to do so.

Doesn't sound like much, but there are some other things to keep in mind when considering the results.

Excessive pregnancy related weight gain is a very real driver of sustained maternal obesity, and bigger babies have been shown to be at greater risk of becoming obese adults.

Why do bigger babies have a greater likelihood of turning out to be obese adults? The working theory in the paper is that the intra-uterine environments of babies born to women with greater pregnancy weight gains are different and that these differences in turn impact on dietary behaviours over the child's lifetime.

Of course it's also possible that the dietary habits in homes of women who gain excessive weight during pregnancy differ from those who don't with these differences nurturing (rather than naturing) an impact on dietary behaviours over the child's lifetime.

Either way one thing's for certain - pregnancy is a wonderful opportunity to explore your diet and remember that the "two" you're eating for, ain't exactly an equal in size.

Eating for 1.2 sounds about right.

David S. Ludwig, & Janet Currie (2010). The association between pregnancy weight gain and birthweight: a within-family comparison The Lancet : 10.1016/S0140- 6736(10)60751-9

Saturday Stories

Commercial Free Childhood's Josh Golin wonders why his 20 month old already knows who Elmo is.

Before you sneer at the lady pushing the stroller riding a segway you ought to read the whole story.

It's tough to find an MD who supports home births. Harriet Hall of Science Based Medicine explains why.

Michele Simon on how Pepsi's buying up health experts to help bolster their image.

Lastly, here's a video parody of Journey's Don't Stop Believin' by Ottawa Skeptics. It's called Don't Start Believin'.

Cross species bullying (size does matter)

Poor dog.

Have a great weekend!

(email subscribers have to head to the blog to watch the video)

Canada's trans-fat failure.

The release of Canada's National Sodium Working Group's recommendations led me and many reporters to lament the lack of regulatory teeth.

Of course if we look at what's happened with the recommendations of Health Canada's Trans-Fat Task Force, the one that did have regulatory teeth, it begs the question of whether or not these task forces and working groups are only being put together to make Canadians feel as if someone cares about their health, rather than to actually effect change.

To recap, the Trans-Fat Task Force was industry inclusive, which meant that industry had veto power. Still, in June 2006 when the food industry inclusive task force released their recommendations, formal regulations were their immediate call to action,

"Foods purchased by retailers or food service establishments from a manufacturer for direct sale to consumers be regulated on a finished product or output basis, and foods prepared on-site by retailers or food service establishments be regulated on an ingredient or input basis."

Yup, the group that included Big Food actually called for regulations. They even included a timeline,

•Draft regulations be published in the Canada Gazette, Part I, by June 2007;

•Regulations be finalized and published in the Canada Gazette, Part II, by June 2008;

•A basic phase-in period be set at one year from the date of entry into force of the final regulations"

So what did our feckless government do with these recommendations that had the explicit approval of the food industry? After a year of doing nothing, in June 2007 then Health Minister Tony Clement gave the food industry a two-year free pass, calling for them to voluntarily reduce trans-fats in the food supply,

Said Clement at the time,

"Today industry is being given notice they have two years to reduce the levels of trans fats or Health Canada will regulate their use."

Well it's 411 days after that deadline, and over four years since the task force's final report, and yet we have still not heard a peep from Health Minister Leona Aglukkaq as to when we'll see regulations. This despite the fact that on April 22nd, 2010 she readily admitted voluntary efforts had failed.

So why the wait?

According to Sally Brown, the chairperson of the Trans-Fat Task Force,

"The regulations are written, they're sitting there waiting to be promulgated",

She went on to state,

"It's alarming that something so clear, so well-researched, consultations that were a year-and-a-half long involving national and international experts from the health side and the food industry, came up with a clear consensus that this stuff has to be out, and it's still in. It's time."

So while we may lament the lack of regulatory teeth in the Sodium Working Group's recommendations, perhaps our concern is misplaced. Because even with regulatory recommendations, the likelihood is our government won't do anything anyhow.

As an aside, I do wonder whether or not there are grounds here for a class action lawsuit. A government task force recommends formal regulations. The government ignores those recommendations opting instead for a voluntary approach and promises a regulatory approach should the food industry's voluntary efforts fail. The government then admits that the voluntary approach has failed yet still does nothing despite the fact that the regulations have already been written and both the public and private sectors are clamouring for their adoption. Meanwhile, the Centre for Science in the Public Health estimates that since the release of the Trans Fat Task Force recommendations and their subsequent dismissal by the government, 12,000 Canadians have died due to the continued inclusion of trans-fat in our food supply.

Why the food industry's thrilled with Canada's Sodium Working Group

With the release of Canada's Sodium Working Group's recommendations last week I imagine champagne corks were flying in Canada's food industry's boardrooms.

Why?

1. There's no call for regulation. There's no call even for the most conservative recommendations like for instance limiting the amount of sodium per serving in toddler foods. With no call for regulation, there's no cause for urgency. With no cause for urgency, there's no cause for change. With no cause for change, there's no cause for spending any money reformulating and repackaging products.

2. The call to post nutritional information on menu boards includes both calories and sodium. You might think industry would be upset by this. I'd guess you'd be wrong. I'd guess you'd be wrong because by coupling the call to action with a call to post both calories and sodium, the call is far less likely to be heeded. It simply adds a degree of difficulty to any push for menuboard reform and that of course in turn makes it far easier to fight.

3. With the call to adopt the recommendations of the US' Institute of Medicine report on front-of-pack food labeling the food industry is likely hopeful that their recommendations will be more lenient than ours - a likely case scenario given that front-of-package health claims are far easier to make in the States than in Canada and so even with reform, they're still likely to allow the Canadian food industry to enjoy a robust expansion in their front-of-package labeling allowances.

All said and done, the Sodium Working Group's recommendations, while broad reaching in theory, aren't particularly likely to be broad reaching in practice and demonstrate quite clearly why the inclusion of the food industry at the decision making table is a completely irresponsible practice.

While the food industry is certainly a "stakeholder" in federal dietary recommendations and reforms, their role should be relegated to that of a consultancy whereby they're asked and encouraged to provide as much input as they'd like to a committee free of industry influence. That committee would in turn take the food industry's concerns into account when creating a series of recommendations whose primary goal is to improve the health of Canadians, not protect the wealth of Big Food.

[Tellingly, when I was asked by Health Canada a few weeks ago to participate in a post-hoc survey on the implementation and design of Canada's 2007 Food Guide there was a question as to whether or not there were "stakeholders" who should have been consulted or whose concerns may have fallen by the wayside. I of course suggested that the question should also have asked whether or not there were stakeholders who should not have been consulted or whose concerns were overly represented in our awful Food Guide.]

The good, the bad and the ugly of Canada's recent sodium working group.

Last week saw the release of the recommendations of Health Canada's Sodium Working Group (SWG) - a "multi-stakeholder" group with representation from public health folks, health related NGOs, the government and the food industry.

The group was established in October 2007 and it's taken them nearly 3 years to come up with a series of recommendations meant to tackle the problem of sodium intake in Canada.

Overall, I was pleasantly surprised by the recommendations themselves, though not by their lack of regulatory backing, and in fact I think some are more important than the media's given them credit.

So first the good.

Shockingly good in fact.

The SWG's recommendations that Canada's Food Guide be revised to provide guidance on calories (and sodium) and updated far more frequently are exceedingly important. They're important because they're the first official admission that the 2007 Canada's Food Guide leaves much to be desired. So much so apparently, that a "multi-stakeholder" working group on sodium decided to make it a point to point it out.

I was also pleased to see a call to action for nutritional fact panel reform so that there would no longer be such things as serving sizes that suggest they're a third of a cookie and that the percent daily value of sodium be calculated using the goal of 1,500mg rather than 2,300mg.

Next, the bad.

Unsurprisingly bad.

The working group's recommendations are completely toothless. They couldn't even get the food industry to agree to a regulatory approach to the reduction of sodium in toddler foods. Of course that's not particularly surprising given the food industry was effectively given veto power at the table which is I suspect also why it's taken nearly 3 years for the SWG to come up with their recommendations.

Finally, the ugly.

Hideously, hideously ugly.

By creating a, "multi-stakeholder" working group, Health Canada has continued its maddening and reckless practice of including the food industry at tables whose discussions and recommendations are meant to serve public health.

As one SWG member said to me on Friday afternoon,

"Effectively Health Canada has asked the food industry to help guide public health policy"

because as this person described it to me, industry made the process exceedingly challenging whereby even the smallest victories necessitated industry catering compromises.

Anyone else out there think it's horrifying that Health Canada most assuredly believes the food industry's interests are as important a consideration in the creation of public policy as is our health?

Stay tuned tomorrow for a, "what's in it for the food industry post" regarding the SWG.

Consumers ignore the fine print when considering the health risks of fortified foods.

While this was far from an easy paper to read, its results are important nonetheless.

Researchers in France set out to determine the impact on purchasing behaviour that health claims, health risks and scientific uncertainty had when posted on yogurts.

The study used Danacol, a Danone yogurt that's enriched with plant sterols and marketed as a means to help lower cholesterol.

The subjects included folks with and without cholesterol problems and they were asked to compare taste and what they were willing to pay for 6 cups of the sterol enriched yogurt knowing the retail price for a comparable plain yogurt.

The taste testing was blind whereby the yogurts' containers were covered with aluminum foil. Once taste testing was completed subjects were provided with information regarding phytosterols in general and then asked what they were willing to pay for the enriched yogurt as compared with plain yogurt. They were then provided information about health risks and scientific uncertainty associated with phytosterols and then asked again what they'd be willing to pay.

The results I'm sure made every food marketer's day. While messaging of health benefits positively skewed purchase price, even among folks without cholesterol problems, health risk and scientific uncertainty messaging only had an impact on those without cholesterol issues, but rather than bring the price a person'd be willing to pay down to zero (which you might expect given there's risk reported and they don't have a cholesterol problem) they reported they'd still buy it, just not at an inflated price with a bizarre 38% of them reporting that they would in fact, eat Danacol in the future, despite not having cholesterol problems and despite being aware of the health risks and scientific uncertainties associated with phytosterols.

Ultimately this article served to prove, at least in the case of yogurt, that health claims sell and more importantly, that the little bits of fine print that describe how there's scientific uncertainty and even risks associated with the products, don't discourage their consumption.

A shame that the article is so painful to read as I do think the results, though not surprising, are important and something that governments should bear in mind when considering the regulation of fortified foods and their consequent health claims.

Marette, S., Roosen, J., Blanchemanche, S., & Feinblatt-Mélèze, E. (2010). Functional food, uncertainty and consumers’ choices: A lab experiment with enriched yoghurts for lowering cholesterol Food Policy DOI: 10.1016/j.foodpol.2010.04.009

Saturday Stories

A wonderful interview with Marion Nestle on how Big Food hijacked nutrition.

Colby Vorland on conflicts of interest and the American Dietetic Association.

The New York Times on whether or not science should be a prerequisite for medical school.

Steven Novella of Neurologica explains why you might want to stop taking your calcium supplement!

Babies like watermelons!

Sadly my baby's probably too big to recreate this Funny Friday's now viral YouTube video.

Have a great weekend!

Breaking News: Canada's Sodium Working Group's Recommendations

It's not often I'm thrilled with something the government's had a hand in but today I'm thrilled with the recommendations that have come from Canada's Sodium Working Group.

CSPI posts the highlight reel which includes:

Reducing the Nutrition Facts table’s “daily value” for sodium from 2,400 mg to 1,500 mg, mandate standardized serving sizes as the basis for reporting nutrition information, and retrofit labels to facilitate improved consumer understanding after the US Institute of Medicine’s report on front-of-pack food labelling is published in 2011

Mandate prominent placement of sodium and calorie information at chain restaurants serving standardized fare;

Ensure regulatory standards for products using protected names like cheese and pickles to permit the use of low-sodium salt substitutes;

Include sensible sodium limits in government food-service policies and procurement contracts (e.g., for schools, hospitals, and the military);

Retrofit advice in Canada’s Food Guide on caloric intake and sodium.

But please folks, don't hold your breath until these get done. Not to be a killjoy but I can't help but think of the wonderful recommendations that came out of Canada's 2006 Trans-fat Task Force which have yet to be acted upon.

England's health officials continue to prove they're among the dumbest in the world.

Hat tip to my friend and colleague Arya Sharma for his tweet which pointed me to the latest from across the pond.

Apparently Anne Milton (pictured up above) the British parliamentary under-secretary of state for health, has called upon GPs to start calling their patients "fat" so as to "inspire" them to take, "personal responsibility" for their weight.

Of course the notion that obesity is a disease of the individual, of "personal responsibility" and not a disease of a toxic, obesogenic environment is one near and dear to the food industry's so-called heart.

As I've reported this week on my blog, the messages the food industry want shouted from the rooftops include:

- There's no such thing as a bad food.
- Obesity is caused by inactivity and treated through exercise.
- It's about "balancing" energy in vs. energy out.
- It's about taking "personal responsibility".

And lately British health officials have been singing all four.

I know I have some British readers and wondering if you folks might know - is there a transparent means whereby money spent by the food industry lobby on your politicians can be tracked? Given what's come out of the mouths of your officials these past 2 years, I'd be willing to wager tens of millions of pounds are involved.

To add to Anne's crystal clear clarion call of stupidity, here's a quick recap of what were once only the wet dreams of British food marketers yet now are their daily realities:

Jan. 2009 - England's government launches 3 year "Change4Life", food industry funded and government overseen program replete with useless messages of the, "Eat less, exercise more" camp with emphasis on the "exercise more".

June 2010 - England's Health Minister Andrew Lansley slams Jamie Oliver inspired school lunches campaign that led to the removal of processed garbage from middle schools.

July 2010 - England's Health Minister Andrew Lansley spews the food industry party lines of, "there's no such thing as a bad food", to the Faculty of Public Health in London while informing them of the British government's divestment of any involvement in Change4Life. He then tells them he's turning over direct control of Change4Life to the food industry and in return for their continued funding he's promised not to regulate them.

July 2010 - England strips their Food Standards Agency (FSA) of their food labeling responsibilities because they had been pressing for the adoption of front-of-package traffic light labeling. Now that labeling's been formally returned to the hands of industry's best friend Andrew Lansley, guess what? No traffic lights.

All I can say is good thing they've no longer got an exclusively socialized medical system over there for so long as the likes of Anne Milton and Andrew Lansley are at their health system's helm, that system's in big trouble.

Can extremely low fat diets lead to obscene conflicts of interest? (Dean Ornish edition)

That's certainly the question I'd love to ask Dr. Dean Ornish.

Who's he?

Well he's perhaps the most famous low-fat diet guru of all time and the founder and President of the non-profit Preventive Medicine Research Institute in Sausalito, California.

His career has been exceedingly illustrious. Ornish is a best-selling author, a world-class researcher, an award-winning physician and he was voted "one of the most interesting people of 1996" by People magazine, one of the "TIME 100" in integrative medicine, one of LIFE magazine's "fifty most influential members of their generation" and one of Forbes magazine's "seven most powerful teachers in the world."

Pretty lofty stuff.

So what does one of the most powerful teachers in the world and one of the most influential members of their generation want to teach you?

Usually it's how to eat an almost insanely low-fat diet but not when he's working for the Mars chocolate, confectionery and beverage conglomerate. When he's working for Mars he wants to help feed you Big Food's party line that,

Feeling good is all about balance. It’s important to balance work life with time spent with loved ones, it’s important to find a balance between what we eat and how much we exercise

He also wants to feed you the other Big Food party line that there's no such thing as a "bad food", something I blogged about a ways back.

Now I don't disagree entirely with Ornish in that a sustainable lifestyle does need to include such things as chocolate bars, but I'm not about to start selling them for Mars Inc.

Not so with Dr. Ornish. His message, that joy is a powerful medicine, when grabbed hold of by Mars' marketers gets spun into this message taken directly from their website,

"At Mars, our products provide opportunities for people across the world to practice pleasure in balance every day. Mars chocolate products should be enjoyed in moderation as part of a healthy and well-balanced lifestyle – and bring people small moments of joy in the process. In fact, our vision is to make more moments of joy in more places, bringing more smiles into the world. We’re in the business of making people feel good, and that means being a part of a balanced and healthy lifestyle that supports your physical and emotional well-being. .

We love being a part of many different kinds of chocolate moments.

• A child sharing a treat with a friend.
• Parents enjoying a quiet moment together at the end of a busy day.
• A small celebration after a successful meeting.
• Sweet memories from holidays, parties and gatherings.

More Moments. More Places. More Smiles."

Not less chocolate - more.

More chocolate in more places.

How many joyful chocolate moments is Ornish helping to sell? Again, according to the Mars website,

"At Mars, we're responsible for more than 500 million chocolate moments each day! And our vision is to make more moments of joy in more places - bringing more smiles into the world."

And now Dr. Dean Ornish, one of our generation and world's most influential teachers, lends (sells) his powerful voice to that vision, a vision that can be summarized as.

More, not less; there is no such thing as a "bad food"; and really all you need is a balanced active lifestyle.

Shameful is too soft a word to describe Dr. Ornish's cozy conflict of interest with Mars.

That said I probably shouldn't be surprised. After all, before Dean Ornish was using his world class influence and teaching abilities to sell chocolate bars, he was using it to sell Big Macs.

"Exercise is Medicine" (and a great smokescreen for Big Food)

Further to my post from yesterday regarding the innocence by association test for conflicts of interest comes "Exercise is Medicine".

Exercise is Medicine is a laudable organization whose aims are,

"To make physical activity and exercise a standard part of a disease prevention and treatment medical paradigm in the United States.

and,

"For physical activity to be considered by all health care providers as a vital sign in every patient visit, and that patients are effectively counseled and referred as to their physical activity and health needs, thus leading to overall improvement in the public's health and long-term reduction in health care cost."

It has great buy-in too with a massive list of supporters that include the who's who in health promotion.

So why am I knocking it?

It's not so much that I'm knocking it, more I'm questioning its role, as Big Food conspiracist that I am, I see a dual role for Exercise is Medicine.

On the one hand its role is to encourage exercise for health - a true, valuable and important endeavour.

But on the other hand, its other role is to serve its founding sponsor Coca-Cola, in the promotion of the assertion that the best means to deal with our current obesity epidemic is to ensure that people exercise. Or to put it another way, that sugary soda's not a bad thing so long as you live an active lifestyle.

The "obesity can be treated effectively through exercise alone" message, crucial to the purveyors of high calorie foods everywhere, is indeed spread by Exercise is Medicine,

"This is just the beginning. Hopefully, the insurance and medical communities will soon realize that the most effective way to treat and prevent a wide variety of obesity-related conditions is through exercise."

- Press release from Exercise is Medicine founding partner Anytime Fitness, June 28th, 2010

"As a whole, people are significantly less active today, even compared to just 20 years ago. When we look at the data that shows how diseases like obesity and diabetes are rapidly increasing, there's an obvious correlation to the decline in physical activity.

Even though everyone has heard it before, something as simple as taking the steps instead of an elevator can make a big difference. It's too easy to consume a massive amount of calories and sit at a desk all day - both of which have negative consequences to our health. We need to remember to take breaks during the day to take a ten minute walk. Any bit of activity is better than being sedentary."

- Press release for Exercise is Medicine quoting Sandra Billinger, PT, PhD, FAHA, research assistant professor in the KU Physical Therapy and Rehabilitation Science department, June 9th, 2010

"Dr. Sallis poses this question to health-care providers: "What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? Certainly."

Well, there is one prescription available to you that will do just that. It's called exercise."

- Dr. Robert Sallis, past President of the American College of Sports Medicine (a founding partner of Exercise is Medicine) to Charleston's Sunday Gazette-Mail, March 7th, 2010

"The International Health, Racquet & Sportsclub Association (IHRSA) announced today their partnership with the Institute of Lifestyle Medicine (ILM); a division of Harvard Medical School's Department of Physical Medicine and Rehabilitation and of Spaulding Rehabilitation Hospital. IHRSA and ILM join together to fight the global obesity epidemic by working to improve physician knowledge of the science and benefits of physical activity, and to increase the practice of physician-prescribed exercise."

- Press release from Active Doctors, an organization whose President is part of Exercise is Medicine's Task Force, May 19th, 2009

"In an effort to decrease the prevalence of childhood obesity and promote physical activity to children, the American College of Sports Medicine (ACSM) has announced a partnership with the Youth Fitness Coalition (YFC). This partnership will feature ACSM's Exercise is Medicine(TM) initiative, designed to encourage America's patients to incorporate physical activity and exercise into their daily routine, and YFC's signature program, Project ACES (All Children Exercise Simultaneously)."

- Press release from the American College of Sports Medicine, March 10th, 2009

The message that obesity can be prevented or treated with exercise is an important one to the food industry as it shifts the blame for obesity from the consumption of their calorific products to a decline in fitness, a link which at best is described as debatable and at worst, inconsequential. It also fuels Big Food's ability to preach about what Coca-Cola refers to as, "an active, balanced lifestyle", McDonald's a, "balanced, active lifestyle" and "it's what i eat and what i do ... i'm lovin' it" campaign, Pepsi a, "balanced lifestyle", Unilever a, "balanced diet and lifestyle", Mars a "well-balanced lifestyle", and Nestlé' a, "balanced lifestyle".

That the message is being spread by Exercise is Medicine and sometimes directly and other times by extension by the exceedingly reputable organizations included in Exercise is Medicine 397 signatory partners helps embolden the purveyors of calorific foods to make statements like Pepsi CEO's Indra Nooyi's,

"If all consumers exercised, did what they had to do, the problem of obesity wouldn't exist."

And Coca-Cola's President Sandy Douglas',

"And we're for active lifestyles, with more than 6 billion Diet Coke packages helping the National Heart, Lung and Blood Institute remind women about the importance of staying active and maintaining a healthy weight, and our support of physical activity initiatives like Exercise Is Medicine."

Ultimately, while exercise is indeed medicine, Exercise is Medicine again illustrates the risks and inherent conflicts of interest consequent to Big Food partnerships, and I would argue these risks and conflicts shouldn't come as a big surprise.

Why?

Because Big Food doesn't care about your health; they don't care about your well-being; and they don't care if you exercise. All Big Food cares about is whether or not you'll buy their products, and certainly every single dollar they spend on programs such as Exercise is Medicine are earmarked to further that goal. A goal Coca-Cola's certainly meeting as last week they reported North American sales volume growth for the first time in two years which led Coca-Cola CEO Muhtar Kent to proclaim,

"We firmly believe that North America will be a growth market of great opportunity for the next 10 years and beyond"

So while the notion of Big Food capitalizing on their investments in programs such as Exercise is Medicine to fuel sales isn't in and of itself surprising, what is surprising to me is the fact that well intentioned individuals, along with top-notch medical and public health organizations, don't seem to realize it, or simply don't care.

[For some further reading on what I think about "balanced, active lifestyles", please have a read of the article I co-authored this year, Running Away with the Facts on Food and Fitness, published in the journal Public Health Nutrition]

Expanding the Definition of Conflict of Interest - Big Food Edition

This month the Annals of Family Medicine published a point/counterpoint discussion of last year's awful decision by the American Academy of Family Physicians (AAFP) to partner up with Coca-Cola.

Howard Brody, arguing that the AAFP's deal was clearly a conflict of interest, explains that by definition a conflict of interest,

"arises when individuals or organizations enter into a set of arrangements which under usual circumstances would lead to the reasonable presumption that they will be tempted to put aside their primary interests in favor of a secondary set of interests."

and that,

"It is true that where a conflict of interest exists, no actual unethical behavior has necessarily arisen."

Meaning that simply having the opportunity for a conflict of interest is in and of itself a conflict, and certainly having Coca Cola fund and/or write educational materials on beverage consumption for the AAFP in return for $600,000 sure smells like a conflict of interest waiting to happen.

Howard then does a fine job of describing the most common arguments against perceived conflicts which include:

Premature accusations: How can you accuse the AAFP of having a conflict? You haven't even seen the educational materials yet!

The other party's not evil: There's no conflict - just because Coca-Cola contributes to obesity doesn't make their parent company evil.

It'd be wrong not to engage: Conflict or not, it'd be wrong not to enter into a partnership with Coca-Cola because we'd be missing out on an opportunity to influence their behaviour for the good.

Counterpoint was delivered by Lori Heim, current President of the AAFP (I interviewed her about the Coca-Cola partnership when it went down).

Basically Lori's argument boils down to Howard's premature accusations piece as she notes,

"Integral to this discussion is the transparency of the interaction, the rules governing the interaction, and the outcome of the agreement. Examined only in a philosophical vacuum, issues of conflict of interest and the underlying ethics governing behavior become an ideological straitjacket."

She then goes on to talk about the AAFP's great core values, the scourge of obesity in society and finally how great the educational materials are on the AAFP site and cites two statements that explicitly call for a reduction in sugar sweetened beverages.

You know, I agree with Lori - you can't examine the partnership in a philosophical vacuum, nor a practical one. What do I mean? Well while the duelling Annals pieces were an interesting read, I think they're rather beside the point as I'd argue there's a further litmus test for a conflict of interest, one that a philosophical or practical vacuum would ignore. I'm calling it the, "innocence by association" test.

Here's the basic premise: If your partnership with a corporation, regardless of the details or outcomes of that partnership, provides that corporation with the ability to use your partnership as a means to defend products, practices or positions that in turn are contrary to your or your organization's primary obligations, then partnership with said corporation should rightly be described as a conflict of interest.

In this case, if Coca Cola can or does use their partnership with the AAFP, an organization whose obligations lie with the betterment and protection of public health, to defend products, practices or positions which in turn are harmful to public health, then AAFP's partnership with Coca-Cola should be considered a conflict of interest.

So can or do they?

Let's ask Sandy Douglas, President of Coca-Cola North America.

Here's Sandy on April 6th 2010 in the Atlanta Journal-Constitution citing Coca-Cola's partnership with AAFP as part of his case for why soda taxes aren't necessary or appropriate,

"We're for education, through support for organizations such as the American Academy of Family Physicians, which is providing consumers science-based information about sweeteners."

Want to see another similar type example?

Here's Coca-Cola Canada's Amy Laski defending Coca-Cola's sponsorship of the 2010 Winter Olympics (sorry the article itself isn't linkable),

"We formed a red ribbon panel of experts from organizations such as the Heart and Stroke Foundation and the Canadian Diabetes Association to nominate torchbearers for Coca-Cola who committed to leading more active lifestyles and encouraging others to do the same."

Maybe I'm just a simple man, but to me it seems pretty black and white. If you enter into a partnership with an organization whose products are anathema to you or your organization's aims it's a conflict of interest. The fact that the AAFP doesn't admit to that in the case of Coca-Cola is shameful and disingenuous and frankly I'd have preferred it if they simply came out and admitted the truth - yes, it's a terrifically unsavory conflict of interest, but hey, we needed the money.

Brody, H. (2010). Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues The Annals of Family Medicine, 8 (4), 354-358 DOI: 10.1370/afm.1140

Heim, L. (2010). Identifying and Addressing Potential Conflict of Interest: A Professional Medical Organization's Code of Ethics The Annals of Family Medicine, 8 (4), 359-361 DOI: 10.1370/afm.1146

Saturday Stories

Bad Science's Ben Goldace on how he was slandered by an incompetent millionaire.

A touching love story from Auschwitz.

Good, Bad, and Bogus explains why small studies aren't all that exciting.

Dan Gardner talks politics, privacy and governmental hypocrisy.

The dumbfoundingly eloquent Dr. David Katz doesn't disappoint with his take on the next generation of weight loss drugs.

Stormtroopers invade the NYC subway.

How badly do I wish I was part of this Funny Friday's video making?

Once a Star Wars nerd, always a Star Wars nerd.

Have a great weekend!

Health Halos and Kellogg's new FiberPlus Antioxidants Cereals

Brian Wansink coined the term, "Health Halo" when he was studying consumer behaviours when faced with healthier sounding front of package statements and restaurants perceived as healthier.

Words like, "low fat", "low carb", while not formal health claims in terms of function, still have strong influence on consumer perception, ingestion and likely purchase.

I couldn't help but think of Dr. Wansink's work yesterday when I read an article in the Big Food e-tradezine Food Navigator. The article detailed Kellogg's new cereal brand that they claim, "makes no health claims".

One of my favourite blogs, Fooducate, covered this cereal a few days ago, but when I saw that, "makes no health claims" piece, I had to weigh in myself.

The cereals, will be part of Kellogg's new FiberPlus Antioxidants Cereals and their launch comes right on the heels of the Federal Trade Commission's slap for Kellogg's suggesting their cereals improved, "Immunity".

Want to take a guess at how many ingredients there are in their Kellogg's FiberPlus Antioxidants Berry Yogurt Crunch? I guarantee you'll be wrong.

82!

Here they are in all their splendor with the 12 different sugar sources highlighted for good measure.

WHOLE GRAIN WHEAT, SUGAR, RICE, CHICORY ROOT FIBER, MIXED BERRY FLAVORED CLUSTERS (ROLLED OATS, SUGAR, OAT FIBER, CORN BRAN, CORN SYRUP, WHEAT STARCH, HONEY, YELLOW CORN FLOUR, CORN CEREAL, CANOLA OIL, NATURAL AND ARTIFICIAL FLAVORS, FRUCTOOLIGOSACCHARIDES, MODIFIED CORN STARCH, SOYBEAN OIL, SALT, CARAMEL COLOR, MALT EXTRACT, STRAWBERRY POWDER, CITRIC ACID, GLYCERIN, BHT [PRESERVATIVE], RED #40, BLUE #2, CELLULOSE GUM, GREEN #3, BLUE #1, RED #40 LAKE, BLUE #2 LAKE), MODIFIED WHEAT STARCH, SOLUBLE CORN FIBER, MALT FLAVORING, SALT, ROLLED OATS, FRACTIONATED PALM KERNEL OIL, INULIN, OAT FIBER, NONFAT DRY MILK, CORN BRAN, MODIFIED CORN STARCH, GLYCERIN, WHEAT STARCH, CORN SYRUP, HONEY, APPLE PUREE CONCENTRATE, YELLOW CORN FLOUR, STRAWBERRIES, BLUEBERRIES, VITAMIN A PALMITATE, NATURAL AND ARTIFICIAL FLAVORS, KIWI JUICE CONCENTRATE, WHEY, MONOGLYCERIDES, SOY LECITHIN, CORN STARCH, NONFAT YOGURT POWDER (HEAT TREATED AFTER CULTURING), CANOLA OIL, INVERT SUGAR, STRAWBERRY JUICE CONCENTRATE, ASCORBIC ACID (VITAMIN C), CINNAMON, FRUCTOOLIGOSACCHARIDES, RED RASPBERRY JUICE CONCENTRATE, GUAR GUM, BLUEBERRY JUICE CONCENTRATE, NIACINAMIDE, MALT EXTRACT, CARAMEL COLOR, CITRIC ACID, VITAMIN D, ALPHA TOCOPHEROL ACETATE (VITAMIN E), BHT (PRESERVATIVE), PYRIDOXINE HYDROCHLORIDE (VITAMIN B6), RIBOFLAVIN (VITAMIN B2), THIAMIN HYDROCHLORIDE (VITAMIN B1), BETA CAROTENE (SOURCE OF VITAMIN A), FOLIC ACID, VITAMIN B12.

So what does 82 ingredients including not 1, not 2, not 3, not 4, not 5, but 6 different artificial colours (including one that now has to have a warning label slapped on it in the EU) buy you nutritionally?

170 calories per cup dry (not wonderful for a cereal)
200mg of sodium (meh)
10g of fibre (holy crap - no pun intended)
12g of sugar (3 teaspoons worth)
And a smattering of vitamins including some "antioxidants"

Kellogg's of course isn't stupid. They're simply expecting consumers who don't take the time to think about what they're eating and read food labels to be saying, "you had me at antioxidants" when they walk down the cereal aisle.

Sure, there's no formal health claim, but that doesn't change the fact that this Frankencereal is banking on the words "FiberPlus" and "Antioxidants" to serve a health halos whose job it is to dupe you into thinking that what's in the box is good for you, which it probably is.....if you're a shareholder.

A rose may be a rose but perhaps a calorie's not a calorie

File this one under cool data!

Simple study published in Food and Nutrition Research to look at the differences between whole foods and processed foods and the calories the body utilizes to metabolize them (something called diet induced thermogenesis and also known as the thermic effect of food).

18 subjects were enrolled in a cross-over study (meaning they each ate both test meals) whereby the thermic effect of food was measured following the ingestion of two different cheese sandwiches.

One cheese sandwich was made with cheddar cheese and a multi-grain bread containing whole sunflower seeds and whole-grain kernels, while the other cheese sandwich was made with white bread and processed cheese.

Both sandwiches contained the same number of calories.

The results?

While subjects reported that the whole food sandwich was tastier, both sandwiches conferred equal levels of satiety, and in a not completely surprising, but ultimately fascinating result, eating the whole food sandwich led to roughly double the thermic effect of food than the processed sandwich and that effect lasted nearly an hour longer than the processed meals.

Why wasn't this surprising?

Whole grains take longer to digest due to the protective fibrous sheath that processing removes. We also would expect the whole grain sandwich to have more protein and fat (which it did) which in turn delays the speed with which the body is able to break down its accompanying carbohydrates.

Calorically what does this mean?

It takes more energy to release the nutrients of the whole food sandwich with the differences between meals resulting in a 9.7% increase in the net energy gain of the processed food meal.

Translation?

Eat processed crap and you're effectively consuming 10% more calories than you would be were you eating healthier whole food alternatives.

Now this is a small study and certainly it's too soon to extrapolate this across the board, but were it to be true for all processed foods, given their viral spread across the developed world these past 30 years, and given that a 10% net energy gain is huge, this might be another great reason to ditch the Wonder bread and Velveeta.

Barr, S., & Wright, J. (2010). Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure Food & Nutrition Research, 53 DOI: 10.3402/fnr.v54i0.5144

Burger King - Stricter Nutritional Criteria than Health Check!

Last week Burger King Canada announced new nutritional criteria for their advertised kids' meals. I'll come back to that word, "advertised" in a bit, but wanted to look at what Burger King thinks their healthier kids' meals should contain:

1. No more than 560 calories
2. No more than 600mg of sodium
3. Less than 30 percent of the calories from fat
4. Less than 10 percent of calories from saturated fat
5. No added trans fat
6. No more than 10 percent of calories from added sugars

Doesn't sound particularly healthy to me. 560 calories is still more than a child should consume in a single meal. 600mg of sodium is half a day's worth. The calories from fat and saturated fat stuff I don't care too much about. No trans fats - seems like a no brainer. I was pleased however to see the no more than 10% of calories from added sugars as that's the World Health Organization's recommendation.

So basically it's a bit of healthier window dressing but certainly nothing brag worthy.

Nothing brag worthy unless of course you're comparing Burger King's new guidelines with those of the Heart and Stroke Foundation's awful misinformation program Health Check.

What does Health Check have to say about restaurant kids' meals?

1. No caloric limits
2. Allows up to 720mg of sodium
3. Similar limit on total fat
4. Similar limit on saturated fat
5. Allows 5% of fat to be artery clogging trans-fat (and here I thought zero trans fat was a "no-brainer")
6. No limit on added sugar

Man, if I was the marketing director of Burger King's brand I'd be all over this as for those keeping score, compared with Burger King's, Health Check's kids' meals allow for unlimited calories, ignore added sugar, allow for a whopping amount of trans-fat and allow for 20% more sodium.

So should we be cheering for Burger King? I'm not. Ultimately this is just smoke and mirrors as their new dramatically stricter than Health Check but still weak nutritional criteria only apply to their "advertised" kids meals and likely is just another ploy to appease parents and try to steer governments away from considering regulations.

Interesting too that a day after the announcement the media was all over it and rightly pointed out the hollowness of Burger King's pledge. What a shame the media doesn't hold Health Check and the Heart and Stroke Foundation up to the same degree of scrutiny.