Heart and Stroke still marketing for Boston Pizza

The love affair between the Heart and Stroke Foundation and and mega sponsor Boston Pizza, an affair that's spawned Valentine shaped pizzas, Jump Rope for Pizza and Health Check'ed awful restaurant fare, continues with the Heart and Stroke Foundation's Hoops for Heart campaign.

What's Hoops for Heart?

Hoops for Heart is a Heart and Stroke Foundation run, in school fundraising program, where students shoot basketball hoops in the school's gym to raise money to give to the Heart and Stroke Foundation.

Why does the Heart and Stroke Foundation think it's important to learn about heart health at a young age?

Well according to Hoops for Heart it's because,

"We know that healthy habits are developed early in life. By staying active now, maintaining a healthy body weight, and learning to make sensible choices, youth can help decrease their risk of future heart disease and stroke."

And what's a healthier habit than going out to eat in restaurants? They're great places to make sensible choices that help to maintain healthy body weights, right?

But of course the Heart and Stroke Foundation doesn't think food has much to do with childhood obesity. Just ask the Hoops for Hearts website,

"Why the increase in obesity? The main reason is a lack of physical activity"

Yeah, it's all about lack of exercise. I guess that's why the Heart and Stroke Foundation, by means of their Health Check program and coupons like these, has no qualms about discouraging actual cooking and encouraging the consumption of highly processed boxed foods and meals out.

And about those meals. I cracked out the calculator to have a peek at Boston Pizza. Here's what I found:

Use your $5 off coupon and share a starter, eat a main and split a dessert and you'll be downing on average 1,603 calories and 3,392mg of sodium. Oh, and the only beverage that breakdown includes is water.

If you happen to find one of the only 5 Health Check'ed items actually enticing enough to order in lieu of regular Boston Pizza fare but still split a starter and share a dessert you'll be quaffing 1,059 calories and 1,578mg of sodium. Water for you too.

The last time I slammed the Heart and Stroke Foundation for providing free kids meal coupons for participating in the Jump Rope for Heart campaign, Marco Di Buono, director of research for the Heart and Stroke Foundation of Ontario, defended the practice by saying,

"Recognizing the number of meals outside the home that families do consume, we would much rather send them to an organization that has healthy options on the menu than leave them without any indication of where they can take their families for healthy eating opportunities"

You know, if the Heart and Stroke Foundation truly bought its leaders' spin, don't you think that at the very least they would ensure that their Boston Pizza coupons only be applicable towards those healthy options?

Of course the whole argument is flawed to begin with - can you imagine if the Canadian Cancer Society, recognizing the fact that many people still smoke provided everyone with coupons for light cigarettes?

Two of the primary drivers of both obesity and chronic disease are food dollars spent outside the home along with the consumption of highly processed foods inside the home. With their abhorrent and irresponsible Health Check program, rather than recognize the world as broken and try to fix it by encouraging (gasp) cooking, Health Check is happily duping Canadians into thinking that they can eat responsibly in restaurants and enjoy big box fulls of highly processed trash.

There's a word in Yiddish that does a fair job describing Health Check. Health Check's a "shanda" where the definition of "shanda" is a shameful, scandalous, disgrace. Only problem in regard to calling Health Check a shanda is that the word isn't strong enough.

(Speaking of shandas, did you know that Boston Pizza's seasonal vegetables which are an optional accompaniment for their "Famous Mains" have 830mg of sodium in them?)

Saturday Stories

Alex Bogusky writes on how God has recalled his book series.

Steve Novella from Science Based Medicine does a great job explaining the science behind the safety of aspartame.

The LA Times wonders if adrenal fatigue and Wilson's temperature fatigue are real diseases.

Orac from Respectful Insolence explains what pareidolia is by means of the lamest example of it he's ever seen.

Travis and Peter from their shiny new PLoS digs host a great 5 parter on the metabolically healthy obese.

James Fell eviscerates the Bowflex in the LA Times.

I have no idea why this made me laugh

Today's Funny Friday video is a seal who yells like a man.

I don't know why it made me laugh, but I've watched it 3 times now.

Have a great weekend!

The, "but parents can just say no" argument.

An emailer to me hit it hard on the nail yesterday. They wrote,

"To change public attitudes about food for kids, the idea that feeding fast food to kids is "normal" has got to be changed."

I think it's the normalization of feeding fast and junk foods to kids that fuels the, "parents can just say no" argument regularly used to defend things like ice-cream sandwich days at elementary schools, McDonald's bus safety days for 4 year olds, school bake sales, pizza days, etc.

Basically anytime somebody suggests that giving junk foods to kids is a bad plan, there's an angry commenter out there who has to point out that parents don't have to give in.

There's really no beating around the bush about this one, it's an asinine argument.

It's asinine for a number of reasons.

Firstly it's asinine because there's a huge percentage of parents who either don't care about, don't think about, or don't have time to pay attention to the notion that what their children eat has an impact on their health, so while it may be something the angry commenter thinks should and could happen, the reality is that for a huge number of families it just ain't gonna.

Secondly it's asinine because it ignores the bigger picture. Children aren't only influenced by their parents. If their school makes take-out a pizza a weekly event, regardless of whether a child eats it or not, it normalizes the practice. Worse, because it's promoted by a source of trust and guidance, the practice may well be perceived as harmless or even healthy.

Thirdly it's asinine because even parents who care, aren't likely to always or potentially ever say "no". Why? Don't they care about their kids? Sure they do. Problem is that in the grand scheme of parental "no"s, not allowing their child to enjoy what every other kid in the class is enjoying isn't likely a battle that even health conscious parents are likely to regularly pick.

Lastly it's asinine because it ignores the real villains in these stories. The bad guys here aren't permissive parents, and believe it or not, the bad guys aren't the fast or junk food industries either. The real bad guys in these stories are the schools, and hospitals, and city officials who welcome this crap through their doors with open arms.

Yes, junk food is everywhere. Yes, our children are bound to be exposed. Yes, we as parents have to do our best to help arm our kids with defenses to see through advertising and to understand nutrition.

But what shouldn't we have to do?

We shouldn't have to wage these wars in our children's schools, or in our hospitals, or in our city arenas. We shouldn't have situations where foods that our teachers, our doctors and our public health officials recommend we avoid get sold in their own backyards.

Bad nutrition kills, and in a sense, with obesity as a consequence and with the impact of obesity on quality of life, it maims, and while I don't think junk food can or even should be legislated out of existence, I think becoming an apologist for the fast food industry and a defender of nutritionally indefensible publicly run junk food programs on the basis of the, "parents can just say no" argument, is a far more egregious avoidance of parental responsibility than letting your kids join their classmates for a slice of pizza or take a McDonald's colouring book home from Ottawa School Bus Safety Awareness day.

Reading more effective than running for weight loss?

In a sense.

In an article published in this fall's Journal of Consumer Affairs, Dr. Bidisha Mandal set out to determine the impact that food label reading and exercise had on weight.

She used data from the National Longitudinal Survey of Youth which in turn has followed 12,686 middle aged men and women, and included in the survey were questions regarding the use of food labels, as well as questions regarding levels of physical fitness.

Mandal divided folks into those who read food labels always/often and folks who regularly participated in vigorous activity. She then further subdivided folks into those who were trying to lose weight, those who trying to stay about the same weight and those who weren't trying to do anything about their weight. Finally she analyzed data from the 3,706 folks who between 2002 and 2006 who consistently reported actively trying to manage their weight.

She then looked at 4 different subgroups:

1. Folks who neither read food labels nor participated in vigorous physical activity
2. Folks who read food labels and participated in vigorous physical activity
3. Folks who read food labels but did not participate in vigorous physical activity
4. Folks who did not read food labels but did participate in vigorous physical activity

She then used some over my pay grade statistics that included this fancy looking equation


To determine the effects of label reading and vigorous exercise in various combinations on weight management.

What she found was rather fascinating.

First the expected - folks who are trying to manage their weight who read food labels and vigorously exercise are the folks who are the most successful.

Now the unexpected (for some). Folks who are trying to manage their weight who read food labels but don't exercise are more successful than those who are trying to manage their weight who exercise, but don't read food labels.

Bottom lines?

1. Knowledge is power.
2. It's easier to not eat calories than to burn them.

Counterpoint. A guest post defending Ottawa's School Bus Safety Awareness Day

I don't usually use guest posts, but I received a thoughtful and heartfelt counterpoint to my arguments about the utility of School Bus Safety Awareness Day.

The guest poster is Kathleen Both, the owner of a local school bus company. Now I certainly don't see eye to eye with Kathleen and still believe that the lessons taught on School Bus Safety Awareness day, while undoubtedly important, are also undoubtedly straightforward and can certainly be taught at school rather than be served up by McDonald's.

Before I get to her letter, she also updated me on some additional school bus related deaths.

In addition to the 3 deaths that I detailed, Kathleen provided me with details of 8 more. Of those 8, five occurred where kids bent over to pick something up in front of the bus and were subsequently killed when the bus pulled away, 2 were killed by cars that didn't stop for the school bus and 1 was due to a bus being rear ended. So while it would certainly seem quite reasonable, and in fact important, that kids be repeatedly taught to look both ways before crossing the street and to not pick anything up from the ground in front of a school bus, I still don't see the need for that teaching to require any special events sponsored by a hungry advertiser.

Ultimately reading her post I was saddened to learn how the Ottawa School Board has seemingly taken what began as a thoughtful proactive program meant to help teach kids about school bus safety, and probably more importantly reduce their fears, and instead co-opted it as a marketing opportunity for McDonald's. I don't think the Ottawa School Board, regardless of finances, should be selling access to our children to the highest bidder, and while I do realize we live in a dollars and cents world, if the choice was between having this day run by McDonald's versus canning the day and instead upping school bus safety awareness at school, my vote would be for the latter.

Here's her post:

I am writing to you to express my disappointment in your complete dismissal of a program that has been extremely beneficial for the past 19 years. Before publishing such derogatory comments, a little research should have been in order to fully appreciate the School Bus Safety Awareness Day, its history, rationale, objectives and goals.

In the late 1980’s there were several fatalities of young children involving school buses in the Ottawa area. Something I’m sure young parents today are unaware of, but something that can never be forgotten by anyone in the school bus industry, or any parent of a child that age at that time.

In 1990, my father, owner of M.L. Bradley Ltd., attended a school bus convention in the Kitchener/Waterloo area where he learned of a “First Time Rider” program hosted by a local independent operator. Dad thought the idea was great and with the vision of creating the safest environment possible for our passengers, he decided to host a similar program. At that time, four year old kindergarten was also being introduced to many schools resulting in twice as many preschoolers on the bus. Dad had a saying, one we repeat to our drivers on a regular basis, to always remember that “Children are carefree, not careless.”

The first annual “School Bus Safety Awareness Day” was held in our garage at M.L. Bradley Ltd. in downtown Navan in August 1991. With very limited advertisement in the East end, we hosted close to 600 people in our small wash bay. The program was identical to the one today and was designed to appeal to all learning styles...auditory, visual, and most importantly, practical. Registration (to put the name on the certificate), video of “Winnie the Pooh,” bus ride with a chance to “practice” safely crossing the road, a library of safety information, and an opportunity to spend all the time necessary to feel comfortable on a stationary bus. We absorbed all of the costs and our drivers graciously donated their time and expertise. All of the school board officials were in attendance and were quite intrigued by the concept. Local newspapers praised our efforts and parents appreciated the opportunity to introduce their youngsters to the bus. The only disappointment was that Dad, terminally ill, did not get to witness his initiative.

The school boards recognizing the effectiveness of this program are to be commended for their proactive approach in adopting the School Bus Safety Awareness Day for the past 19 summers. I sat on a committee with other bus operators and school board officials that planned and polished details that involved, at that time, coordinating 5 school boards and numerous school bus operators. Everyone worked together towards a common goal ...improving the safety of children on the bus. We designed logos and printed our own colouring books all with unbiased images of dinosaurs. The drivers’ reward for volunteering for the day was receiving a ball cap and t-shirt with the dinosaur logo.....and the kids and parents came....by the thousands....and yes, they were served an optional snack.

Some dedicated, responsible parents teach their young ones the proper way to ride a bus. However, a few extra reminders and a priceless opportunity to actually practice and be guided in the proper way to cross the road, an unforgettable jingle about bus safety, led by “Winnie the Pooh” has gone a long way for many. Not only do children and parents (some of whom have never been on a school bus themselves) get safety reminders, but the day also serves to alleviate the stress for thousands. There are many, many, many children who are anxious and fear leaving their home on the first day of school. The “Safety Awareness Day” provides an opportunity to get rid of those first day jitters and realize that the big yellow machine is not going to swallow them up. The drivers and school board officials who are present to answer parents’ questions help to alleviate stress felt by adults in sending their kids off to school for the first time.

School bus operators are not paid for the day but provide vehicles, gas and drivers and pay them out of their own pockets. This is a huge expense today given the cutbacks in the industry however; all school bus operators recognize the value and often are able to identify who has attended the safety awareness day. Similarly, the school boards open their buildings to host the event and in the past several years, have economically accepted the support of McDonald’s to alleviate some of the costs by providing the art work for all the handout material (placemats, pamphlets, brochures, certificates). They also provide muffins and coffee for the volunteers and drivers and lunch for them in addition to providing the attendees optional orange drink, cookies, vouchers, coffee for the parents, napkins, cups sugar etc.

I was formerly an elementary school teacher. At the request of my Dad, I got my bus license when I was off having a child and I drove a loaded bus once. When I returned, I vowed to never, ever do that again. It is a very difficult, thankless, stressful job that carries with it an incredible amount of responsibility with very low pay. I wish that I had read about your impression prior to the first day of school. I would have invited you to go for a ride...perhaps on a bus with three school runs....with terrified 3 year olds who speak little English but who remember to wait for a hand signal from a driver, who can sing “Winnie’s” song, or who remember not to not run across the road to show their parents their chocolate pudding finger painting. All things that you hoped they had learned or were reminded of by our drivers and Winnie the Pooh. Or perhaps you would have appreciated a ride home where there’s no one waiting, or where a child has inadvertently been put on the wrong bus, or where there are 20 children disembarking all at once and a car has crossed through your lights. Maybe you would appreciate the efforts and understand why we started this day.

Instead, unfortunately, you seem to be caught up in a very minute portion of the day. “School Bus Safety Awareness Day” is voluntary for students and parents as is the drink and snack. Facts show that school bus safety has improved since 1991 inception of the day. Maybe a few of the parents that sadly lost a child to a regrettable school bus accident would have given the world for such a program…including the fast food.

Remember, children are carefree, not careless.

Respectfully,
Kathleen Both
Owner, M.L. Bradley Ltd.

More on the partnership between the Ottawa School Board & McDonald's

Last week I posted about Ottawa's School Bus Safety Awareness Day.

To briefly summarize it's a day where the Ottawa School Boards have opted to have McDonald's foot the bill for a drop-in program where 4 years olds can learn how to get on and off a yellow school bus. In return, McDonald's is given free rein to give trusting preschoolers junk food, coupons for ice cream and McDonald's colouring books and place mats. In other words, in the name of school bus safety, the Ottawa School Board has invited McDonald's to put your 4 year old children in their advertising gun sights.

A few days after my post went live I received a concerned phone call from the school board. The gentleman who phoned me was quite upset with my characterization of School Bus Safety Awareness Day. He wanted to inform me that it began 18 years ago following 3 school bus related deaths and that it was an invaluable resource for parents and their children.

Before I get into the invaluable resource stuff, let's talk about the school bus deaths. Were kids unschooled in school bus safety responsible for them? To figure that out, I decided to look them up.

I searched Google's newspaper archive for Ottawa school bus deaths for the years 1980-1992, and indeed, I found 3.

The first was a 17 year old girl who was thrown from the backseat of the bus when it hit a speed bump while traveling 50km/hr. The driver of that bus was charged with dangerous driving, careless driving and failing to report an accident. The second was an Aylmer boy who dropped a bunch of hockey cards in front of the school bus and when he bent over to pick them up, the driver ran him over. The third occurred when two school buses had a head on collision and a boy was killed.

So based on those deaths I'd say if anyone needs School Bus Safety Awareness day it'd be school bus drivers though even there I'd argue that 3 deaths in 30 years of school bus driving sounds pretty good considering the number of kids, buses, kilometres involved and frequency of just general accidents.

Now back to School Bus Safety Awareness day being an invaluable resource. That confused me some, as personally I find the whole notion of there being a need for a special School Bus Safety Awareness Day to border on the ridiculous. Parents already teach their children to look both ways before they cross the road, how much more difficult would it be for them to also teach their children not to push other kids in line, to take their seats on the bus, not to leave their bags in the aisle, and not to pester their drivers?

Think I'm exaggerating and that the school board gentleman's right, that there's really complicated stuff that gets taught to the kids? Stuff that's so important that the Ottawa School Board's got no choice but to invite McDonald's to market to your 4 year olds to pay the bills for this program? Well then why don't you have a peek at the brochure that's presumably given out during the event and you can read the curriculum for yourself.

But the story gets worse.

So while this gentleman was trying to impress upon me the incredible importance and value of the teaching that goes on at the event he casually mentioned that attendance isn't mandatory and that kids who don't attend receive safety instruction at school.

Cue loud facepalm!

So you mean to tell me Mr. School Board guy that you can teach the same stuff at school without plying 4 year old children with sugary fruit drinks, chocolate chip granola bars, free McDonald's soft-serve ice cream along with a pile of preschooler McDonald's branded swag?!

The part that's truly mind-boggling? That this gentleman, despite having all of the above pointed out to him, and despite his very genuine and well-intentioned concern for the children, was unable or unwilling to see McDonald's involvement as problematic. He seemed to think that I've got it in for McDonald's specifically and despite a lengthy and civil discussion, I'm not sure I was able to convey to him the source of my extreme consternation.

To help him, I'll spell it out here.

While I'm flabbergasted that the Ottawa School Board doesn't see any problem handing out sugary juice drinks, chocolate chip granola bars and soft-serve ice cream coupons to preschoolers, I'm absolutely appalled that the Ottawa School Board invites anyone, let alone McDonald's, to target innocent 4 year olds with advertising all in the name of a program that they themselves apparently recognize as being non-essential and easily taught at school.

Saturday Stories

Time Magazine chooses anti-Semitic memes over balanced reporting.

Daniel Gordis helps to explain the term "Salonfähig".

The LA Times on the unfair origins of the phrase, "jump the shark".

Science Based Medicine on ghost writing the world to HRT.

Ottawa's Dan Gardner (not DJ Dan Gardner) explains the difference between anecdote and evidence.

Signs the world has too many signs.

A rare non-video Funny Friday.

The photos speak for themselves.

Have a great weekend!

Cambodia



Taiwan



Saudi Arabia



Germany?

Why taxpayers should care about bariatric surgery.

Bariatric surgery is a tough sell to the often ill informed general public.

Invariably when stories are run about the cost of paying for gastric bypasses, the comments tend towards the suggestion that tax dollars shouldn't be spent on this type of surgery and instead the folks who need it should simply eat less and exercise more.

In other words, the public thinks that because ultimately obesity can be described as the result of a mismatch between energy intake and expenditure, that medical care, life prolonging, quality of life improving, co-morbid disease curing medical care, shouldn't be offered through our provincial health care plans.

Suggesting that we not operate on the obese because in theory all they'd need to do is eat less and move more is simply an exercise in biased weightism and ignorance. But frankly, even were it to be true, that argument shouldn't apply here in Canada. Thankfully our medical system is one that doesn't care about cause. We still treat smokers who develop emphysema and lung cancer, and we readily patch up drunk drivers who most certainly know better.

I'd argue though, that those same angry folks, who I'm sure are multi-millionaires because they know the secret of the stock market - buy low and sell high, when faced with the dollar and cents realities of bariatric surgery, might decide to change their tune.

The thing is, regardless of the cause of the problem, folks who qualify for bariatric surgery are quite often very sick folks. Sick to the point that they cost our health care system a great deal of money - money that's spent on increased physician and hospital visits and medications. They also cost our economy in terms of lost productivity, days off work, and in some cases, frank disability.

They cost our country so much in fact that one Canadian study determined that the $16,000-$18,000 cost of the surgery is recouped in a scant 3.5 years following surgery, and given the incredible long term results of the surgery, both in terms of increasing longevity and decreasing morbidity, the surgery should not only be thought of as one that has a rapid cost recovery, it should be thought of as one that if readily available, could save our country hundreds of millions of dollars in direct and indirect health care costs.

So has our country made bariatric surgery readily available?

No, and recently in Ontario, the Ministry of Health has made it more difficult to obtain.

Prior to November 2009 Ontario physicians were able to directly access out of country surgical centres to operate on in need bariatric patients. From start to finish, from submission of an application to Ministry to the day of surgery, that process used to take 4-6 months. However in November 2009 the Ontario government reported it would no longer allow physicians to apply directly for out of country surgery, instead patients would need to be seen at one of five provincial bariatric assessment centres. Using Ottawa as an example, since November 2009 the wait to be seen by our assessment centre has gone from 4-6 months, to over a year with the wait for surgery likely bordering on two years.

Why? Sheer numbers. Yesterday the CBC reported that currently there are 1200 people on just the Ottawa Civic's wait list and I've been told that 300 more are added to that list monthly. Given that our government's announcement for increased access to bariatric surgery in Ontario reported a 2012 aim of a 2,025/year surgical capacity for the entire province, it would seem that by means of Ottawa alone, every 7 months Ontario's bariatric surgery wait times will grow by an additional year. Add in the folks clamouring for access at the other 4 Ontario assessment centres, couple that with the fact that Ontario's not operating anywhere near their hoped for capacity, and toss into the mix the growing demand for these surgeries and I wouldn't be at all surprised if every 3-4 months wait times in Ontario increased by a further year.

There's another large fly in the government's ointment. Given the nature of health care in Canada, where operating rooms and operating times are precious, Canadian surgeons, world class as they may be, simply don't have the opportunity to do the same number of cases as their American counterparts which may be why in a recent news report, a representative for the Ottawa surgical centre reported that their death rate was 1/70 and that they were aiming to get that down to the 1/200 death rate that has been reported as this surgery's average mortality rate. The only problem there is the fact that the 1/200 rate is an aggregated rate for all surgical centres and certainly in the past, Ontario physicians only accessed centres that had been designated surgical centres of excellence by the American Society for Metabolic and Bariatric Surgery. The centre I used to access reported to me that their mortality rate was 1/1250.

Ontario's Ministry of Health has reported that the reason they shut down access to the States was to improve access to care in our own province, but rather than improve access to care, in less than a year their changes have quadrupled waiting times and increased surgical mortality rates by an order of magnitude and I believe they're also costing us a great deal more money.

The Ministry of Health reports that the cost of the procedure is $10,000 less when performed here in Canada than when performed down South. That's an odd statement given that the CBC yesterday reported that the case cost per procedure here in Ontario is $17,200, a price tag that's virtually identical to the ones the province was paying those surgical centres of excellence in the States. Furthermore, what that Ontario price tag doesn't take into account are the costs incurred by patients remaining on a waiting list for years at a time - a cost estimated by one study to be in the neighbourhood of $900/month. Consequently I would estimate that having a patient wait for 2 years for this surgery would likely cause the total health care costs for the procedure to be at least double what they would have been were access to the American centres available.

Estimates put 3% of the population as qualifying for bariatric surgery. Taking Ontario's 12,000,000 residents that would mean there are 360,000 potential surgical candidates. Of course not everyone is going to want to opt for surgery, but even if only 5% of those who qualify sought access, Ontario would have to find the capacity to perform 18,000 surgeries. Given that our newly increased capacity is only 2,025 and combine that with the continued increase in weight of our population, the cost and risk of very sick patients remaining on a waiting list, the increased surgical risks here at home, and the exceedingly rapid payback once the surgery is performed, my recommendation is that not only do we immediately reopen access for physicians to apply for their patients' out of country surgeries, we mount a campaign to educate them how to do so.

Ultimately what all this means is the question of how we got to this point in socialized medicine Canada really doesn't matter, and while I believe societal obesity is a disease of the environment, if you want to retain the biased stance that somehow obesity should be blamed on individuals and is a disease whose treatment should not be publicly funded, you'd be best to bear in mind that your bias and ignorance are likely costing you and your country a fortune.

[Yesterday I was on CBC's Radio One Ottawa Morning discussing this issue. To listen to that interview click here or listen on the embedded player below.]

Why are there no nuts in Honey Nut Cheerios?

Or to ask the question differently, do you think Honey Nut Cheerios contains nuts?

You'd think so wouldn't you.

You'd be wrong.

There are no actual "nuts" in Honey Nut Cheerios.

What there is, and it's the second to last of 18 ingredients behind the 6 different types of sugar representing ingredients 2, 3, 4, 5, 7 and 9, is, "natural almond flavour".

What is, "natural almond flavour"?

Well according to Eric Schlosser's book Fast Food Nation it's benzaldehyde which in turn is generally derived from peach and apricot pits.

Can't say I blame Cheerios on this one though. Do you think "Honey Benzaldehyde Cheerios" would sell? It just doesn't seem to have the same zing and really, what good are ethics when it comes to sales?

[Hat tip to my wonderful wife]

McDonald's and the Ottawa District School Board teach kids that voluntary food industry regulation is useless.

(Yup, that's Ronald McDonald's signature up there)

So our fitness director Kelly's littlest boy is starting junior kindergarten this year.

As part of his orientation he had to attend a, "School Bus Safety Awareness Day". Apparently school bus safety is something that requires a special teaching program. Somehow kids these days need detailed schooling, special events even, to learn the incredibly complicated concepts of, "don't stand up while the bus is moving", "line up and don't push other kids when getting on or off", and "make sure you have your stuff with you before you leave the bus".

The program, a joint venture between the Ottawa Student Transportation Authority, the Ottawa-Carleton District School Board and the Ottawa Catholic School Boards, according to its home page, includes as part of the "learning", a bus safety certificate, colouring books and refreshments all provided by the program's sponsor - McDonald's.

According to Kelly the refreshments were, "some sort of orange flavour crystal drink in Mc. D cups", along with, "choco chip Quaker granola bars". The kids also received coupons for free soft serve ice cream at McDonald's and McDonald's colouring books and place mats.

McDonald's of course is a proud founding signatory of the voluntary, industry created, Canadian Children's Food and Beverage Advertising Initiative.

According to the initiative,

"The food and beverage industry in Canada is committed to advertising and marketing products to Canadian children in a responsible way to help prepare them to make wise decisions about healthy dietary choices and healthy lifestyles . We recognize that the special nature and needs of children requires particular care and diligence on the part of advertisers."

I suppose the special nature and needs of children requires extra diligence for advertisers to ply 4 year olds with fruit drinks, chocolate granola bars, free ice cream and pre-schooler swag.

But wait, doesn't the advertising initiative, an initiative for which McDonald's was a founding sponsor, explicitly ban the advertisement of food or beverage products in elementary schools?

"Participating companies will remain committed to adhering to standards established by schools individually and by school boards overall. Furthermore, participants will commit to not advertising food or beverage products in elementary schools."

I guess the answer is, "sort of". I say sort of because there's a footnote to that edict that states they can do whatever they want so long as the program's "educational",

"This limitation will not apply to displays of food and beverage products, charitable /not-for-profit activities including fundraising, public service messaging and educational programs."

That sure is a useful initiative.

Gee thanks Ottawa School Boards. Brilliant job. Thrilling that you're giving out food garbage along with coupons for free ice cream and McDonald's colouring books to 4 year olds - and for such an important educational cause. I mean without School Bus Safety Awareness day, I doubt any kid would ever figure out how to sit safely in their seat on a yellow school bus. It's a wonder any of we grown ups made it.

[Hat tip to BMI's fitness director Kelly DeBruyn whose son I'm sure benefited tremendously from what sounds like an incredibly important program]

UPDATE Sept. 9th, 2010: Received a phone call today from the school board. Details likely part of future post but they wanted me to inform readers that the program's voluntary and that kids aren't there all day - it's taught drop-in style

Saturday Stories (expanded no post on labour day edition)

"Children have to learn how to be bored. They could start by reading this."

Blogging and skeptical buddy Jonathan skewers the Canadian Medical Association for their call to ban mixed martial arts and not homeopathy.

Ezra Levant wants us Canadians to boycott The Gap (I'm in).

The New York Times covers an MD I had the pleasure and honour of briefly training with during my clerkship - Dr. Donald Redelmeier. I was always terrified when he was at morning report as his intellect was as intimidating as his research was fascinating.

Dan Gardner wonders why we aren't more scared of lawn mowers.

Mmmmmmmm....Immortal burger

Dr. Arya Sharma takes on the NEJM story on the risks of meridia.

Lastly here's an incredible video on the creation of an empathic civilization - well worth watching even just to marvel at the production. Click here if you're an email subscriber or if the video below doesn't work.

Rear window (cat version)

Ok, not exactly, but today's Funny Friday video does have a window, does have a cat and is indeed rather creepy.

Have a great weekend!


Peeping Tom Cat

Is the childhood obesity epidemic just a myth?

That's basically the case that Anytime Fitness is making with their new "Coalition of Angry Kids" campaign.

They're suggesting that all the blame for childhood obesity be laid at parental feet.

The point of the campaign of course is to shock.

The argument has some merit. After all, kids don't shop for household food, kids don't generally pack their own lunches and kids don't decide how often their families ought to eat out.

Of course kids also don't pay for billions of dollars of advertisements that entice them to eat junk food. They don't build drive thrus on every corner or put junk food supermarkets in every gas station. Kids don't set menus for their schools' cafeterias and they don't ask that their parents work 14 hour days to put food, whatever food on the table.

Ultimately it comes down to the fact that while it is indeed a parent's job to help their child navigate healthily through an incredibly unhealthy environment, the problem is, most parents aren't equipped to do so.

What am I talking about?

Take a peek at the post from a few days ago that had a registered dietitian, in a reputable newspaper calling for kids to be served chocolate milk and juice. Go visit your kids' school cafeteria and see what's being sold - and make sure you keep your eyes open for the vending machines en route. Wander down the aisles of a supermarket and take a peek at the nutritional fact panels of all of the food packages that extol their health benefits despite huge numbers of calories and make sure you take special note of programs like Health Check which encourage you to replace your child's fruit with fruit-concentrate (sugar) sweetened candy. Watch a few hours of children's TV and watch the ads that if your kid's less than 10, they're likely to internalize as truthful.

Our environment is broken and it takes skill, time and awareness to navigate, and while yes, it's ultimately a parent's responsibility to feed their children, I wonder, given the world we live in, does the average parent really stand a chance?

Who's going to launch Ontario's first lawsuit over access to bariatric surgery?

Note the question is, "who's" going to launch, not, "will someone" launch a suit.

I think it's inevitable.

Why?

Because Ontario, with much fanfare, over the course of the past year has revamped the process which used to allow for a 4-6 month start to finish process for the provision of bariatric surgery resulting in 2 year waits and lengthening wait lists.

The reason a lawsuit's inevitable isn't the simple fact that Ontario's new process has more than quadrupled the wait time for surgery, the reason a lawsuit's inevitable is because Ontario announced that the purpose of its revisions were,

"keeping Ontarians healthy, reducing wait times and providing better access to doctors and nurses."

And that,

"Bariatric surgery can help resolve several health conditions, such as diabetes, hypertension and dyslipidemias. Dyslipidemias is a condition that can lead to atherosclerosis, the hardening of the artery walls, which can restrict blood flow to the heart. Bariatric surgery can also reduce other obesity-related conditions, such as hypertension (high blood pressure), osteoarthritis (a painful joint disease), ischemic heart disease, stroke and some cancers"

So instead of reducing wait times, they've dramatically increased them, for a procedure that they themselves admit resolves multiple medical comorbidities which in turn cause permanent, cumulative damage.

And the wait lists just keep getting longer. In less than a year, the wait time for surgery at the Ottawa hospital has nearly quadrupled, increasing from a minimum of 6 months to a wait of closer to 2 years, this despite their ramping up of their surgical program, and given the nature of health care in Ontario, the lack of OR time and the fact that there simply aren't resources to build new hospitals within the publicly funded system, the likelihood is for these lists to continue to grow, not to shrink.

Couple those facts with the fact that the complication and mortality rates for bariatric surgery are currently dramatically higher in Canadian hospitals and I'd say it'd be a damn good case to take to the courts. Important too to note that the increased risks here in Canada aren't because our doctors are any less skilled, but rather because our doctors have fewer operating room hours available to them and the learning curve for this surgery is steep and unforgiving. My calculations for one centre here in Ontario include death rates at least 3x higher than the American centres I used to be able to access for my patients (the two centres we used in the States both had death rates lower than 0.2%, with one reporting a 0.08% death rate on 3,640 surgeries) and while over time I expect Ontario's complication rates to eventually decrease to those of the States, somehow that's not immediately reassuring.

Finally, for whatever lawyer eventually reads this post, the argument that costs matter is a fair one here in socialized medical Canada, but a faulty one. It's faulty because while it is possible that the actual sticker price for the day of the surgery is lower here in Canada, that's not the whole cost. There's the cost of having these patients sit on waiting lists for two years where Canadian data have demonstrated markedly increased health care utilization for these patients and where one estimate put the average health care cost at $900/month/patient on the wait list (therefore a two year wait list here in Ontario increases costs to Ontario by $16,200 per patient - roughly the cost of the surgery in the States to begin with), there's the cost for the ancillary testing that seems to be the standard of care here in Ontario which isn't the standard of care in the surgical centres of excellence in the States (endoscopies, ultrasounds, etc.), then there's the cost of the team of educators (a cost factored into the American sticker price), the cost of the lost productivity of these individuals for the 2 years they wait, and the cost of dealing with higher rates of complications and deaths. All told I'd guess that the cost of bariatric surgery in Ontario, with it's now 2 year wait, is triple what it used to be when the cases were expedited to American centres of excellence.

As I've posted before, the decision to put the cork in the bottleneck of out of country bariatric surgery approvals was almost certainly a wholly financial decision and even though surgeries in Canada likely cost our system triple those performed in the States, and even though each surgery has been proven to pay for itself here in Canada by means of decreased health care costs in just 3.5 years, if there's not enough money up front to pay for the demand, we simply can't offer it.

Of course that's not what the government said when they explained the new system, and that's why when the lawsuits inevitably come, and mark my words they will, Ontario's going to lose.

If Your Kids Hated Apples, Would you Feed Them Apple Pie?

What a great line! Credit goes to Ann Cooper of Chef Ann, and it was included in the New York Times' recent piece on the controversy surrounding schools and chocolate milk.

You know where I stand.

Chocolate milk's a liquid chocolate bar and should be consumed as a treat, not as a staple.

The "milk's got magical nutrients that make the calories and added sugars not scary" camp thinks that calcium and vitamin D are so important and kids are in such dire bone straits that they need to be coerced by sugar into drinking a beverage that we adults used to drink without a fight (probably because chocolate milk wasn't an option).

What boggles my mind is that despite the terrifying growth of childhood obesity and the absence of any robust, credible, tangible, evidence based long term negative consequence to kids not drinking huge amounts of milk (let alone chocolate milk), it seems that my camp's the minority.

I read an article last week about pushing milk hard in the Hamilton Spectator. It was written by registered dietitian Vicki Edwards who works for Hamilton's Public Health Services.

Here's Vicki's case for chocolate milk,

"Milk is a healthy beverage choice and is especially important for your calcium and vitamin D on a daily basis.

But surveys show that both teens and adults are not consuming the recommended number of Canada Food Guide servings of milk and alternatives for good health.

Adding chocolate or other flavourings to milk can enhance the taste and encourage more milk consumption.

Chocolate milk contains about the same amount of sugar as unsweetened juice.

And almost half of that is the naturally occurring sugar, lactose, which is also found in white milk.

And chocolate milk is a more nutritious replacement for other sweetened beverages such as pop, fruit beverages and sports drinks."

So Vicki, I'm assuming you know this, but in case not, the reason juice isn't sweetened with added sugar is because natural juice naturally contains a tremendous amount of sugar- 5 teaspoons a glass - which is one of the reasons why the American Academy of Pediatrics and the Canadian Pediatric Society recommend that kids 6 and under have a maximum 125mL of the stuff and that everyone else cap themselves at 250mL. Consequently, your statement comparing chocolate milk to juice does two public disservices. Firstly it encourages the consumption of more chocolate milk and secondly it suggests juice is a healthy beverage with no consumption limits.

In terms of the the nutrition of chocolate milk - you cannot look at foods and evaluate them on the basis of specific nutrients while ignoring others. Were Coca Cola to create a beverage with the same amount of protein, calcium and vitamin D as chocolate milk, I'm fairly certain you wouldn't be encouraging its consumption. Of course that'd be a shame because were there such a beverage it'd likely be a healthier choice than chocolate milk given that chocolate milk contains 80% more calories drop per drop than Coca Cola, and in case you hadn't heard, childhood obesity's a bit of a problem here in Canada.

So please Vicki, while I know I'm giving you a hard time here, the circulation of the Hamilton Spectator is 105,160, and I think you owe it to them to ensure that the recommendations you make are in fact nutritionally sound, and while we're certainly entitled to disagree, I'd love to see the evidence base that would support the ad libitum consumption by children of a beverage that has 80% more calories drop per drop than Coca Cola simply as a means to provide them calcium and vitamin D.

Nutrition policy in Britain hits bottom and digs.

Good lord.

First they abolished their national school lunch program.

Next they killed their front of package labeling plan.

Then they turned over control of their anti-obesity public health campaign to the food industry. Then they promised them they wouldn't regulate them.

After that they stripped their Food Standards Agency of their labeling oversight.

Then the British parliamentary under-secretary of state for health recommended that GPs start calling their obese patients, "fat".

Now?

Now they've recommended that basically anything that has a fruit or vegetable in it be counted towards the goal of their "5-A-Day" campaign for fruits and vegetables.

Stuff that'll be included now?

Godawful processed cereal bars, salty tomato sauces, sugar syrupy fruit salads and lots and lots of potatoes.

My prediction?

A decade or two from now Britain will overtake the United States for the title of the world's most obese nation, because while the States is far from perfect, public policy when it comes to nutrition and obesity, albeit slowly, is improving, while in Britain it seems it's free falling down the nutritional poop chute.

[Hat tip to Twitter's @evidencematters]

Saturday Stories

An evidence based discussion on whether or not high fructose corn syrup is inherently evil.

How much do I love Skeptic North's new feature - Health Canada Approved? A lot!

My friend Arya on a new study that wonders whether or not diabetes and pre-diabetes in pregnancy has a role to play in a heightened susceptibility to obesity in children?

David Katz takes on that ridiculous editorial that called for the dispensation of cholesterol lowering medications with your fast food meals.

A nut allergy skeptic learns about nut allergies the very hard way.

Never argue with an ibex!

I think it's probably fair advice to never argue with anything or anyone that doesn't speak the language you're arguing in, but as is evidenced by this week's Funny Friday video, really, don't argue with an ibex.

(Not sure if you'll feel the same way but I spent much of the time I wasn't laughing watching the video wishing the ibex would gore the annoying human with his horns)

Health Check's rotten tomato

Further to yesterday's post on the Heart and Stroke Foundation announcement that they finally figured out that chocolate milk and french fries aren't healthy choices comes an across the Health Check board reduction in their program's allowable levels of sodium.

Truly, the reductions are significant with some criteria and product categories now actually representing sodium levels that would in fact be considered low.

But not tomato juice.

According to these newer, more stringent criteria, tomato juice (and all vegetable juices and all soups), are still allowed to contain 480mg of sodium per serving.

480mg is in fact still quite a lot. One glass of Heart and Stroke Foundation endorsed tomato juice will now provide you with 32% of their own recommended daily maximum of 1,500mg and as any dietitian (and the Heart and Stroke Foundation themselves) will tell you, you should try to aim for foods that contain no more than 10% of your total daily recommended maximums.

Now one might argue that you can't expect people to tolerate a rapid reduction in sodium and so it's being reduced in a stepwise fashion with this reduction representing a 26% decrease in sodium from the prior Health Check allowance of 650mg. Only problem with that argument is that there are many categories in this most recent revision, where Health Check has reduced their sodium allowances by 50% and some where they've reduced it by 70%.

So what is so magical about tomato juice?

Looking at Medline records since 1950 there have been a grand total of 216 articles that included "tomato juice" as a keyword.

Looking at all of their abstracts, there were 3 that were worth noting:

The first, out of Finland, detailed a very small, very short study that looked at a 3 week low tomato product diet vs. a 3 week high tomato product diet on the LDL concentrations of 21 healthy individuals. The high tomato folks were given 400mL of tomato juice and 2 tablespoons of ketchup daily so results certainly can't be isolated to the juice. This short, small study found a decrease in LDL concentration in the high tomato diet of 12%.

The second, out of Connecticut, was a rat study whereby rats were force fed tomato juice for 3 weeks and then had their hearts extracted from their bodies and subjected to 30 minutes of no blood flow followed by 2 hours of restoration of blood flow. Those rats who had been force fed tomato juice's hearts had smaller areas of infarction than those who hadn't.

The third, out of Harvard, examined the intake of lycopenes and tomato based foods, including juice, and the risk of cardiovascular disease in 39,876 middle aged women over a 7.2 year period. Of all of the tomato based products examined, only tomato sauce and pizza were seen to have potential cardiovascular disease lowering effects.

Those sure don't sound like good reasons to continue to explicitly encourage Canadians to consume 32% of their total recommended daily sodium intake from one glass of the stuff.

Similarly there's soups where again, Health Check allows for 480mg per serving where a serving is in fact a single cup (despite the fact that in the real world people drink bowls (2 cups)).

So what's so special about soups and vegetable juices that they are allowed to contain 25% more sodium than each and every one of the 58 other single product categories in the Health Check universe?

The cynic in me says that what's so special about them is that among the denizens of the Health Check brand there is perhaps no company that has more products with Health Checks than the Campbell Soup Company who also happen to own V8. Therefore unlike some of Health Check's other corporate partners, a major change to soup and vegetable juice criteria would be decidedly bad for business and corporate relations for Health Check.

What do the folks from Health Check have to say about it?

Well once upon a time Terry Dean, the General Manager of Health Check was paraphrased by the Toronto Star as stating that,

"while some Health Check products may have a sugar or sodium content that is higher than optimal, the product must have redeeming nutritional value, such as calcium or fibre"

He himself stated further,

"In every case, there are two or three nutrients it has to have"

Ahhhhh, magic nutrients.

So Terry please tell me, what redeeming, magic, "two or three nutrients", does tomato juice and soup have that make them worthy of 32% of your total daily sodium allotment and a criteria limit 25% higher than virtually everything else you Check?

[Thanks to Twitter's @girldownthelane for the new and improved headline]

Health Check finally figures out chocolate milk and french fries aren't healthy!

What amused me the most about the Heart and Stroke Foundation's latest press release that announced that chocolate milk (and other sweetened milks) and french fries would no longer be awarded Health Checks was this line,

"Supporting the leadership role the Heart and Stroke Foundation is taking to combat obesity"

You mean by publishing reports about childhood obesity and not mentioning calories even once?

Or by having nutritional criteria for Health Check that don't include calorie limits?

Or maybe it's by giving out coupons for kids' meals at Boston Pizza where the meals can easily contain a full days worth of calories?

Or maybe it's by providing a Health Check to Slush Puppies?

Or maybe it's by giving out their seal of approval to foods based on serving sizes that are likely half of what people tend to eat?

Or maybe it's by giving that same seal to fruit-concentrate sweetened candy with more calories than actual candy and in so doing misinforming parents into thinking they're giving their kids fruit?

Leadership?

Leaders don't need to wait for the American Heart Association to come out and say added sugars are bad before they stop endorsing chocolate milk. Leaders don't need to pussy foot around issues of calories and children. Leaders don't need to hold hands with Canada's industry influenced Food Guide. Leaders don't maintain programs that are built on shaky foundations.

Leaders admit when they're wrong and don't try to sugar coat their mistakes. Leaders make tough calls, tough choices and do what's right regardless of what's come before. Leaders actually make substantive changes all on their own.

So while I'm thrilled that the Heart and Stroke Foundation, after over a decade of explicitly endorsing the consumption of chocolate milk and french fries as healthy choices, has finally (thank to the American Heart Association) figured out that they're not, I can only continue to hope that one day they'll actually demonstrate true leadership and make the sweeping changes that would be required to actually make the Health Check program nutritionally sound, relevant and helpful.

KFC, Pizza Hut, Taco Bell, and A&W treat you to free "exercise".

Aren't they sweet.

It's part of their, "Keep it Balanced" campaign which is meant to perpetuate the myth that exercise can out-train a bad diet.

Here's what Yum! brands wants you to know about how easy it is to maintain a healthy weight and still enjoy your KFC,

"Keep It Balanced means making informed choices and combining a sensible, balanced diet with appropriate exercise in order to maintain a healthy lifestyle. The food and beverages you consume put energy into your body and physical activity helps burn these calories. It's a simple formula: Energy In = Energy Out."

Yeah dummy, it's simple.

For instance, let's say you decide to have a 3 piece KFC dinner along with a medium fries and a Pepsi. That'd be 1,670 calories in.

Want 1,670 calories out?

Well perhaps that's unfair, you need some calories to live, let's say of that 1,670 calorie meal, 1,000 of 'em are more than you need and you'd like to simply burn through physical activity.

Here's a menu of options that'll do that for you:

- 1 hour of running at 6.7 miles and hour
- 2 hours of low impact aerobics
- 3.5 hours of weight lifting
- 7 hours of sex

And to help they're offering a free 1 month fitness membership. Not in an actual gym mind you, on an online fitness tracking website called eFitForMe.

Nothing screams fitness like a website membership.

Keep it balanced people!

Oh, and don't forget - also buy low and sell high in the stock market. That way not only are you going to be super skinny, you'll be super rich!

Easy, peasy.

Walking and cycling to work prevents obesity?

Hmmm.

I'll admit up front that I can't access the full text of the article Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data, so I can't comment on methodology.

The study was large in that it looked at 14 countries, all 50 US states and 50 of the largest US cities for a relationship between active transportation (walking and cycling to work) and obesity.

The abstract (and the media) strongly suggest that walking and cycling to work helps to prevent obesity.

Now there's no doubt that a daily human powered commute, unless you happen to live next door to work, would in fact burn a significant number of annual calories and consequently could easily play a role in weight.

There's also no doubt in my mind that at least here in North America, it's a rather unique person who walks or cycles to work.

Anectdotally I can think of 4 people off the top of my head who without fail cycle to work, rain, shine, sleet, snow or hail.

They're all health nuts.

Whether or not all daily human powered commuters are health nuts isn't something I can claim, but I'd be willing to wager that the lifestyle habits of human powered North American commuters are dramatically different than the folks who rely on internal combustion engines (Europeans may be different as their built environments may make walking or cycling a more commonplace choice).

At the very least, controlling for the dietary choices of the self-propelled would be extremely important in the correlation/causation discussion, and while I can't with any certainty claim that the authors didn't control for diet, if they did, it'd have been a herculean feat given how many different geographic locations they studied.

But let's say that's not the case.

Let's say that in fact diet's not a player in these findings.

Now let's look at Great Britain.

According to the Journal of Physical Activity and Health, nearly 40% of folks in Great Britain walk or cycle to work as you can see in that graph up above. According to that same graph, obesity rates in Great Britain are up at roughly the 22% mark.

Australia and Canada, both with rates of obesity nearly identical to Great Britain's, show active transport rates 1/4 and 1/2 of Great Britain's respectively. Shouldn't Canadians and Australians be markedly heavier (or Brits markedly lighter)?

Ok, so a couple of outliers don't disprove everything do they?

Fine. Well how about time?

Wouldn't rate of change over time matter more than absolute rates when it comes to a discussion of obesity rates and the impact of an intervention that presumably had been there as part of the culture, prior to the most recent sets of measurements? What I'm getting at is that if active transportation is indeed an effective vaccine against an increasingly obesogenic environment, then perhaps we might expect to see not only lower rates of obesity, but also slower rises in those rates in countries where there is more active transportation.

Looking at Great Britain again, according to the BBC, obesity rates have nearly quadrupled over the course of the past 25 years whereas in the US, according to the CDC, over the past 25 years obesity rates haven't quite doubled. How is it that despite all this active transportation Great Britain's obesity rates are rising nearly twice as fast?

Correlation doesn't prove causation which is precisely why I'm not getting excited about this study and also why I'm not trying to claim that active transportation actually raises the rate at which countries gain weight.

My take on all of this?

Comparing between countries isn't likely to be helpful as countries have widely divergent food and eating environments which if not controlled for, would make interpretation of results very challenging.

Comparing within countries (cities and states) isn't likely to be helpful as folks who cycle to work likely live far healthier lifestyles than those who don't and would consequently have a multitude of factors that would contribute to their being slimmer than their driving neighbours.

But maybe I'm making a fool of myself with this post in that the authors did explore all of these issues and really, walking and cycling to work are crucial. Don't think I'll lose sleep tonight worrying about that.

Bottom line for me. Walking or cycling to work is an exceedingly healthful thing to do, and would in fact likely help you to manage your weight, but increasing bike lanes and walking paths aren't likely interventions that're going to impact a whole population, they're ones that might impact a small, already health conscious subset.

Pucher, J., Buehler, R., Bassett, D., & Dannenberg, A. (2010). Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data American Journal of Public Health DOI: 10.2105/AJPH.2009.189324

Ode to Joy - Muppet style

Today's Funny Friday video has one of my favourite muppets performing one of my favourite classical pieces.

Have a great weekend!

(email subscribers who want to watch, head over to the blog)

Every nutrition professional must read this!

I've long argued that we live in the nutritional dark ages where belief seems to trump science and evidence in the creation of nutritional public health policy and recommendations.

Moreover even in cases where science is purported to be a cornerstone (for instance Canada's Food Guide), I believe the wrong science is given too much sway.

Putting aside my concerns regarding the hijacking of Canada's Food Guide by the food industry and political interests, the Guide was built explicitly to ensure Canadians met their recommended dietary allowances of various nutrients and micronutrients and as I've noted before, the bulk of the science on the interaction of diet on chronic disease prevention centres on the consumption of different patterns of foods, not nutrients.

In an editorial that clearly nails my confirmation biases square on their heads, Drs. Dariush Mozaffarian and David Ludwig take on this madness, and they do such an amazing job discussing the issue that I'm going to reprint a pile of it for those without institutional journal access to read,

"Nutritional science has advanced rapidly, and the evidence now demonstrates the major limitations of nutrient based metrics for prevention of chronic disease. The proportion of total energy from fat appears largely unrelated to risk of cardiovascular disease, cancer, diabetes, or obesity. Saturated fat—targeted by nearly all nutrition-related professional organizations and governmental agencies—has little relation to heart disease within most prevailing dietary patterns. Typical recommendations to consume at least half of total energy as carbohydrate, a nutrient for which humans have no absolute requirement, conflate foods with widely divergent physiologic effects (eg, brown rice, white bread, apples). Foods are grouped based on protein content (chicken, fish, beans, nuts) despite demonstrably different health effects. With few exceptions (eg, omega-3 fats, trans fat, salt), individual compounds in isolation have small effects on chronic diseases. Thus, little of the information found on food labels’ “nutrition facts” panels provides useful guidance for selecting healthier foods to prevent chronic disease.

In contrast with discrete nutrients, specific foods and dietary patterns substantially affect chronic disease risk, as shown by controlled trials of risk factors and prospective cohorts of disease end points. Fruits, vegetables, whole grains, and nuts are consistently associated with lower risk of disease. Fish consumption reduces risk of cardiac mortality, belying categorization with other protein sources. Conversely, processed meats, packaged and fast foods, and sugar sweetened beverages increase chronic disease risk. The effects of foods likely reflect complex, synergistic contributions from and interactions among food structure, preparation methods, fatty acid profile, carbohydrate quality (eg, glycemic index, fiber content), protein type, micronutrients, and phytochemicals. Healthy eating patterns share many characteristics, emphasizing whole or minimally processed foods and vegetable oils, with few highly processed foods or sugary beverages. Such diets are also naturally lower in salt, trans fat, saturated fat, refined carbohydrates, and added sugars; are higher in unsaturated fats, fiber, antioxidants, minerals, and phytochemicals; and are more satiating. Thus, a focus on foods increases the likelihood of consuming more healthy nutrients and fewer calories and decreasing chronic disease risk, whereas the opposite has arguably occurred through decades of nutrient-focused guidelines.

The nutrient-based approach may foster dietary practices that defy common sense. Countless highly processed products are now marketed in which refined carbohydrate replaces fat, providing an aura of healthiness but without actual health benefits. School nutrition guidelines specify a minimum number of total calories but a maximum proportion of fat calories, and foods like gelatin desserts and sugar-sweetened low-fat milk have been used to achieve these nutrient targets. Based primarily on consideration of a few nutrients, a national obesity prevention program categorizes whole-milk yogurt and cheese with donuts and french fries as foods to eat occasionally; sauteed vegetables and tuna canned in vegetable oil with processed cheese spread and pretzels as foods to eat sometimes; and fresh fruits and vegetables with trimmed beef and fat-free mayonnaise as foods to eat almost anytime. Taking the nutrient approach to self serving extremes, the food industry “fortifies” highly processed foods, like refined cereals and sugar-sweetened beverages, with selected micronutrients and recharacterizes them as nutritious. These marketing ploys provide little public health benefit and could potentially produce harm.

The prevailing nutrient-focused approach has broad consequences, influencing food-labeling priorities, school lunch and low-income food assistance policies, industry and restaurant product formulations, and public perceptions of healthier vs unhealthy foods. This focus contributes to confusion, distracts from more effective strategies, and promotes marketing and consumption of processed products that nominally meet selected nutrient cut points but undermine overall dietary quality. The relatively recent focus on nutrients parallels an increasing discrepancy between theory and practice: the greater the focus on nutrients, the less healthful foods have become. As national and international organizations update dietary guidelines, nutrient targets should largely be replaced by food-based targets. Such change would facilitate translation to the public, correspond with scientific advances in chronic disease prevention, mitigate industry manipulation, and remedy widespread misperceptions about what constitutes healthful diets.

Although this approach may seem radical, it actually represents a return to more traditional, time-tested ways of eating. Healthier food-based dietary patterns have existed for generations among some populations. Modern nutritional science now provides substantial evidence for how foods and food-based patterns affect health, guiding the design of more effective approaches for the prevention of chronic disease."

AMEN!