Canada's Right Wing Fraser Institute Pours Their Special Stupid on Obesity

It's so biased, massaged, and cherry picked that it's almost not worth commenting on, but given it may well be all over the Canadian news today here's my brief comment on the Fraser Institute's Obesity In Canada polemic.

Cherry picked data can support anyone's position. Here the Fraser Institute presents many cherries in an aim to prove that obesity rates haven't been rising, that obesity is not a medical concern worthy of alarm, and that government interventions that target obesity are folly and have already proven themselves to be ineffective.

To make their case they start out by publishing a great many graphs of various age groups vs. their self-reported body mass indices that are meant to impress readers that obesity rates aren't rising in Canada. While you're welcome to go take a peek at all of them, here's a graph of Canadian obesity rates that isn't part of the Fraser Institute's report:

As you can see, it demonstrates a near tripling in self-reported obesity rates since the mid 70s and it also reveals a not-so-surprising fact. When you call people up on the telephone and ask them to self-report how tall they are and how much they weigh, they magically wind up taller and lighter than their realities. To be more precise according to a 2014 Statistics Canada report, men's self-reported BMI's are 9% lower than in actuality, while women's are 6% lower. So when considering the Fraser Institute's graphs, none of which include any data prior to 2003 and most only from 2005 (clearly they went to the Fox school of how best to use an axis to make a point), you have to keep in mind that along with purposely and disingenuously ignoring the very dramatic rise in Canadian weights since the 1970s, all of their graphs present self-reported data and hence also knowingly and markedly under-report the actual weights of Canadians.

Regarding obesity not being a medical concern the report rightly begins by castigating BMI as a measure of health. BMI truly is a crappy measure which is why we who actually work with patients prefer the use of the Edmonton Obesity Staging System which in turn considers weight's impact on health. The fact that BMI is a sub-par measure of health isn't disputed by anyone, though you wouldn't know that from the Fraser report. Next the report cherry picks from the research to pull those papers that demonstrate less awful morbidity and mortality with obesity but yet do so with that same crappy BMI value that the report so rightly said was a poor measure as it falsely includes people with great health but higher weights. Chutzpah aside, this is a common attack on initiatives aimed at helping to either treat or prevent overweight and obesity and it's an odd one. Even the most conservative of data would suggest thousands of weight relatable deaths per year in North America. How many deaths would the Fraser Institute consider to be an alarming number? And of course it's not just about mortality there's morbidity to consider and when considered in the context of weight, morbidity markedly affects mortality as seen by Dr. Sharma's work below where mortality as a function of weight is plotted on the basis of EOSS score (higher scores represent individuals who have accumulated multiple weight responsive and relatable conditions)

And the chutzpah doesn't end there. Despite the Fraser Institute's report asserting that obesity doesn't dramatically increase mortality, later in this same report they go on to explain why obesity won't in fact be a burden on the healthcare system because those with obesity will die so much younger that their earlier than expected deaths will offset any potential increase in healthcare costs (and irony aside, following this logic I'm looking forward to the Fraser Institute's next likely report, The 3 Most Expensive S's in Canada: Seat-belts, Street-signs and Speed-limits)

The stupid culminates with the report's discussion of the failure and folly of government intervention. Like Margaret Wente before them, the Fraser Institute refuses to appreciate that there will never be a singular solution or intervention that will have an impact on obesity. Society's increasing weights are consequent to the perfect storm style convergence of dozens and dozens of changes to our environment. Getting worked up about singular interventions not working is akin to getting mad at a single sandbag for not stopping a flood.

Overall it's an idiotic read but not a surprising one given the source, after all, this is the same organization that as recently as 1999 put out, Passive Smoke: The EPA's Betrayal of Science and Policy which,

"highlighted the absence of any scientific evidence for linking cancer with second-hand smoke"

The first line of the Fraser Institute's mission statement is

"Our vision is a free and prosperous world where individuals benefit from greater choice, competitive markets, and personal responsibility."

which was translated brilliantly by Steven Lewis as stating,

"Public health care sucks because it must suck, because it’s public. Therefore, let’s gather skewed estimates on a hot-button issue, retail them as hard data, and lure Canadians toward the promised land of private medicine."

A perfect description of their most recently spun drivel.

Saturday Stories: No Sugar, Pay-to-Play Journals, Chemophobia, and Heart Healthy Foods

Source

Slate's L.V. Anderson eviscerates the new book Year of No Sugar calling it "a How-To Manual for an Eating Disorder".

McGill's Joe Schwartz eats the Food Babe for breakfast in The Gazette and calls out her non-evidenced based chemophobic fear mongering.

Tom Spears in the Ottawa Citizen exposes the dark underbelly of "evidence-based" studies and the pay-to-play scientific journal industry.

And Summer Tomato's Darya Pino explains why she'll never tell you to eat heart healthy foods.

[And if you don't follow me on Twitter or Facebook, here's my piece from US News and World Report explaining how Oregon's ban on chocolate milk was anything but a backfire, here's a Random House giveaway for 5 signed copies of my book The Diet Fix, and here's Runner's World's Alex Hutchinson's Three Good Books on Nutrition column (spoiler, mine's one of them)]

Can I Buy Thai Life Insurance in Canada

Today's not a Funny Friday, but rather an uplifting one with a spectacular commercial for Thai Life Insurance.

Not entirely sure what the commercial has to do with life insurance, but I'm definitely buying what it's selling.

Have a great weekend!

The 8th Myth of Modern Day Dieting: There's One Best Diet

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

Different strokes for different folks is definitely true diet wise, and it's dead simple to know if you're on the best diet for you. Just ask yourself the question, "Could I happily live like this forever?", and if the answer's "no", you're on the wrong diet. The corollary's true too - if the answer's "yes", and if you're happy with your health, don't let any diet guru or zealot try to tell you different.

The 7th Myth of Modern Day Dieting: Some Foods Must Be Forbidden

Source

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

I'd bet I've written more actual prescriptions for chocolate than any other physician in North America. While of course there's no all-you-can eat chocolate weight loss program, there's also little doubt that if chocolate is one of the loves of your life, the likelihood of you living forever-more without it is slim to none. It's about the smallest amount of chocolate you need to like your life, and for most chocolate lovers, zero isn't a sustainable amount.

The 6th Myth of Modern Day Dieting: Cheat Days Are Wise

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

That up above?

That's a photo of The Keg's carrot cake à la mode. I once referred to it at the world's most dangerous piece of cake because who in their right mind would ever guess it contained more than a day's worth of calories?

While I'm all for thoughtful indulgences (and even that piece of carrot cake if you've thoughtfully decided it's worth it), in our current non-intuitive, hyper-calorific food environment, cheat days, even cheat meals, can easily sink your weight management efforts. The answer to the question, "is it worth it?", is a personal one, but if you don't even ask the question because the day or the meal's a "cheat", you're liable to bite off far more than you'd have thoughtfully decided was actually worth chewing.

The 5th Myth of Modern Day Dieting: You Can Outrun Your Fork

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

80% of your modifiable weight is likely determined by your dietary choices leaving only 20% for your fitness choices. While exercise has truly fantastic health benefits and markedly mitigates the risks of weight, you're far more likely to lose weight in your kitchen than you are in your gym, and if you're exercising solely for the purpose of weight management, you run the risk of quitting perhaps the single healthiest behaviour you could adopt if and when the scales don't fly down. Unless you plan on spending a heroic part of each and every day running, you're not going to outrun your fork.

Saturday Stories: Hustles, HIV, and Watching

James Robinson in Pando Daily covers what he calls the Healbe Hustle, and why perhaps you should never trust or use Indiegogo.

Dr. Max Pemberton in The Spectator presents a compelling case for why he'd rather be diagnosed with HIV than diabetes.

And a heart breaking post by medical student Shara Yurkiewicz in her Scientific American column and an experience that in one way or another all of us MDs have sadly shared more than once.

[And if you don't follow me on Twitter or Facebook embedded below is a chat I had with Erica Ehm on why parental nos simply aren't sufficient to defend our children against the onslaught of junk food.]

A Great Use for Condoms, Nutella, Mentos, and Coca-Cola

Now I don't speak one word of Italian, but that didn't stop me from enjoying the heck out of today's Funny Friday science video involving condoms, nutella, mentos, Coca-Cola, and a very lovable Italian.

Have a great weekend!

The 4th Myth of Modern Day Dieting: You Shouldn't Eat Unless You're Hungry

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

For those who struggle with dietary control I can't imagine a more dangerous piece of advice than, "you should wait until you're hungry to eat". Hunger influences choice. Shop at the supermarket hungry and you'll see that influence in action. Sit down to a meal hungry and while you're not shopping from an aisle, instead you'll be shopping from your fridge, cupboard, plate or a menu and no doubt, your choices will be different. On the other hand, organize your eating so that you're not hungry, and then you've got a shot, as "willpower", when it comes to dietary choice, is often simply the absence of hunger.

The 3rd Myth of Modern Day Dieting: Dieting Must Be Difficult

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

Simply put, weight lost through suffering comes back. While there's no doubt that weight management and healthful living require effort, if the efforts required include regularly facing off with hunger, blindly denying yourself foods you enjoy, or following a dietary regime that doesn't fit your tastes, they're not going to last.

Whatever program or diet you undertake, the most important predictor of your likelihood of long-term success is being able to answer, "yes" to the question, "could you happily live this way for the rest of your life", with the key word there being, "happily".

The 2nd Myth of Modern Day Dieting: Scales Measure Health

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

Scales don't measure the presence or absence of health. Nor do they measure happiness, self-worth, or success. Scales measure one thing, and one thing only. Scales measure weight.

The 1st Myth of Modern Day Dieting: It's About Willpower

A few weeks ago I shot some short videos in my office covering the 13 myths of modern day dieting that I wrote about in The Diet Fix. Believing in these myths can break anyone's weight management efforts. Over the coming days I'll be publishing them online.

The first myth of modern day dieting is that willpower is required. Yet people often spend more willpower on weight management than any other area of their lives. Has there really been an epidemic global loss of willpower over the course of the past 60 years? I don't think so. We as a society haven't changed, the world around us has. In this day and age, and in this toxic food environment, weight struggles aren't a willpower issue, they're as Yale's Dr. David Katz would put it, a skillpower issue.

Saturday Stories: Malaria, Secret Surveillance, and Tamiflu Stockpiling

A fabulous long read from Ed Yong on why malaria keeps beating our best drugs.

A gripping piece from the BBC on the bad old days in Romania and the transcript of one woman's childhood.

Julia Belluz in Macleans covers the disappointing data on Tamiflu, and wonders why Canada's still stockpiling it (and why PHAC seems muzzled to talk about it).

[And if you don't follow me on Twitter or Facebook, on US News and World Report this week I ask whether or not milk and juice may be contributing to some children's struggles with weight, and here's a review of The Diet Fix and James Fell and Margaret Yufera-Leitch's Lose it Right written by the National Post's RD columnist Jennifer Sygo.]

If I Move to Japan, I think I'll Join this Gym

Thanks to trainer to the stars and friend Chad Landers for steering me to this unbelievably inspirational Funny Friday Japanese exercise video.

It's one of those that you have to see to believe.

Have a great weekend!

Guest Post: On the CBC, Homeopaths are Now Medical Experts?

Received an email yesterday morning from my friend, lawyer, author, Canada Research Chair in Health Law and Policy, and evidence-based science champion Professor Timothy Caulfield who was quite upset about the inclusion of a homeopathic doctor on an expert health panel convened by the CBC for their flagship news program The National. While Tim (side note - his mother greatly preferred Timothy so if you don't know him and already always call him Tim (like me and virtually everyone else), and you happen to meet him, stick with Timothy) isn't anti-complementary medicine, he is very pro-evidence, and when it comes to homeopathy the evidence is in and it's not complementary. As I often do with my blog when a friend has something to say, I invited Tim to write a guest post explaining his concerns, and he kindly obliged:

An Open Letter to CBC's Peter Mansbridge from Prof. Timothy Caulfield

Dear Peter Mansbridge:

I couldn’t sleep last night. And it is your fault.

The last thing I watched before I went to bed was The National’s new health panel. And it left me we a deep feeling of despair. I couldn’t shake the sensation that we are slipping into some kind of bizarre all-knowledge-is-relative Dark Age.

The panel has three “experts”, including the terrific and science-based Danielle Martin and Ali Zentner. The third is Bryce Wylde, a self-described homeopathic doctor (he has a diploma from the Ontario College of Homeopathic Medicine) and advocate for, among a host of other scientifically unproven therapies, “natural health” and supplementation.

Now, I don’t know Wylde. He seems like a nice, engaging individual – particularly when he is on Dr. Oz talking about how he “travels the globe in search of Mother Nature’s fountain of youth”. He does this with a mixture of scientific-sounding babble (“vasodilate blood to the brain”?) and everything-natural-is-good boyish enthusiasm. He is, no doubt about it, entertaining.

But including an advocate of homeopathic medicine – one of the most derided and scientifically preposterous of alternative therapies – on a national and highly respected TV news program as a “medical expert” and legitimate source of evidence-based health information is simply wrong. He wasn’t presented as an outsider. His views were not cast as extreme and scientifically questionable. And this was not Dr. Oz, Oprah or an infomercial.

The inclusion of Wylde on this panel is a wonderful (and depressing) example of the phenomenon of false balance. Naturally, it is always good to keep an open mind and to get different perspectives on important issues. I suspect that was the goal the CBC had in mind when they decided to include Wylde. But using a homeopath to comment on biomedical issues is like using an astrologer to balance the views of Stephen Hawking.

I won’t dissect the scientifically questionable comments he made on The National – such as his advocacy of supplements (which he markets on his website – a practice that creates an obvious conflict of interest) and his statements about the health value of organic food. I am more concerned about the impact of putting this perspective on a respected show like The National. It legitimizes pseudoscientific ideas – which may have serious adverse health consequences – and makes it more difficult for the public to differentiate between real and junk science.

The CBC decision is particularly frustrating given that there are so many wonderful, science-based health scholars in Canada, including many who explore the issues associated with and evidence surrounding alternative therapies (such as Drs. Heather Boon at the University of Toronto and Sunita Vohra at the University of Alberta).

So, Mr. Mansbridge, I sincerely hope you look for a different, science-based, commentator for your health panel. I need the sleep.

Timothy Caulfield
Canada Research Chair in Health Law and Policy
Trudeau Fellow
Author of The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness
@CaulfieldTim

Timothy Caulfield is a Canada Research Chair in Health Law and Policy and a Professor in the Faculty of Law and the School of Public Health at the University of Alberta. He has been the Research Director of the Health Law Institute at the University of Alberta since 1993. Over the past several years he has been involved in a variety of interdisciplinary research endeavours that have allowed him to publish over 250 articles and book chapters. He is a Fellow of the Trudeau Foundation, a Health Senior Scholar with the Alberta Heritage Foundation for Medical Research and the Principal Investigator for a number of large interdisciplinary projects that explore the ethical, legal and health policy issues associated with a range of topics, including stem cell research, genetics, patient safety, the prevention of chronic disease, obesity policy, the commercialization of research, complementary and alternative medicine and access to health care. Professor Caulfield is and has been involved with a number of national and international policy and research ethics committees, including: Canadian Biotechnology Advisory Committee; Genome Canada’s Science Advisory Committee; the Ethics and Public Policy Committee for International Society for Stem Cell Research; and the Federal Panel on Research Ethics. He has won numerous academic awards and is a Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences. He writes frequently for the popular press on a range of health and science policy issues and is the author of The Cure for Everything: Untangling the Twisted Messages about Health, Fitness and Happiness (Penguin 2012).

Jenny Craig Thinks Calling People "Circus Fat" is Good for Business?

Caricature by Don

Now I'm no marketing guru, I'm just a doctor with a blog, and so maybe I'm missing something, but somehow my head says that using the term, "Circus Fat", to describe people who struggle with weight shouldn't be good for business for a company whose business it is to help people lose weight.

I hope I'm right as weight bias shouldn't be rewarded or encouraged, and no doubt Jenny Craig ought to know better.

Watch for yourself, maybe you have a different sense of humour than me.



[h/t to Twitter's Sue J.]

Have You Ever Encountered the "What's Your Better Idea?" Fallacy

Last week I did the math on Girl Scout cookies only to discover that their sale annually contributes over three quarters of a million pounds of trans fat and thirty million pounds of sugar to the American diet. I then suggested that the charitable sale of trans-fat laden, sugary cookies is a practice that in this day and age can no longer be considered charitable and instead is part of our growing dietary woes.

This upset people, and it also brought up the, "what's your better idea" fallacy. It's a fallacy of distraction in that a practice or a program can most assuredly be fairly described as awful regardless of whether or not a solution for said practice or program is proposed.

Logical fallacies are a frustrating bunch and familiarizing yourself with their various incarnations is well worth your time. Here's a handy dandy poster highlighting some of the most common ones.

Have you ever been faced with frustrating logical fallacies?

Badvertising: Dr. Joey's Skinny Chews

Do you think chewing on a tiny fibre filled candy would leave you feeling full?

Given there are no clinical trials out there, your guess is as good as mine, and mine sure isn't confident.

And yet here are Dr. Joey's Skinny Chews advertised to be

"the perfect long- lasting “on the go” treat to keep you on track to make healthier choices"

Dr. Joey instructs consumers,

"Next time you have a sweet tooth or a hunger pang that just won't quit – enjoy a couple Dr. Joey's Skinny Chews"

So what's in them?

Here's their nutrition facts panel:

How long do you think a couple of those will last you?

For comparison, wanna know the calories and sugar in an equivalently weighted 12grams of Tootsie Rolls? 7 more calories, and 0.7g more sugar. Doesn't seem so exciting to me, but if the fact that Dr. Joey's Skinny Chews truly are an ever so slightly better choice than Tootsie Rolls is exciting to you, please keep in mind that you're not likely to confuse Tootsie Rolls with a healthy between meal snack. And with nearly 60% of Skinny Chews' calories coming from sugar which in turn is responsible for over 40% of each Chew's actual physical weight, "healthy" seems quite a stretch.

But I'd bet people are confusing Skinny Chews with healthy because as as Dr. Joey mentioned to the dragons on Canada's venture capitalism reality show Dragons Den,

"People aren't buying a bag Dragons, they're buying 6 bags"

No real surprise there because who wouldn't be seduced by "Skinny" candy and no doubt, "Chocolate....with benefits" is a way better slogan than, "slightly less sugary candy with inulin".

Guess it's a good thing for sales that I wasn't hired as Dr. Joey's marketer.

[UPDATE: And then there's cost with Facebook commenter Cecilia noting 30 Skinny Chews are being sold for $16.97 at Canadian Walmarts, whereas you can buy 400 Tootsie Roll Midgees (at an American Walmart so they're likely a touch more expensive here) for $4.98.]

Saturday Stories: ADHD, Tuberculosis, and False Balance

Ryan D'Agostino in Esquire on how an astonishing 1 in 7 boys are diagnosed with ADHD.

A terrifying Storify from Maryn McKenna highlighting the rise and risk of drug resistant tuberculosis.

David Kroll in Forbes covers Dr. Paul Offit's call to jail (figuratively) journalists for false balance stories.

And last but not least, a fabulous New York Times short film about a physician who left it all to become Slomo.

Dogs and Disappearing Treats Make For a Great Two Minute Smile

It's all over the net so you may well have seen it, but if you haven't seen today's Funny Friday video, it's definitely worth a watch.

Have a great weekend!

You Won't Believe How Much Sugar and Trans-Fat the Girl Scouts SellEach Year

A few weeks ago, Dr. John Mandrola, my collegue in both blogging and medicine, published a piece critical of the Girl Scouts for continuing to sell their sugar and trans-fat laden cookies. Yesterday I was asked to chat with AirTalk's Larry Mantle about it.

In preparing for the piece I decided to do a little math homework (which unfortunately I got backwards on AirTalk yesterday where I under-reported trans-fat and over-reported sugar).

Using Wikipedia's sales data on Girl Scout Cookies, along with Xfinity's trans fat and sugar charts I crunched numbers on just how much trans-fat and sugar the sale of Girl Scout cookies injects into America.

The numbers shocked even me.

Assuming a likely low-ball 0.25g of trans-fat per trans-fat containing Girl Scout cookie serving (they're allowed to claim 0g trans fat if less than 0.5g per serving), and excluding the sales of those cookies known to be truly 100% trans-fat free, Girl Scout cookies saddle America with over three quarters of a million pounds of trans-fat annually (and in case you need a reminder, non-naturally occurring trans-fat is a toxin unsafe in any amount).

And sugar?

Wow. The average amount of sugar per two cookies sold is in the neighbourhood of 7g and the average package contains 20 cookies. Doing the math tells me that each year the Girl Scouts are selling over thirty million pounds of sugar. That's 3.5 billion teaspoons of sugar the Girl Guides are adding to the American food supply in the name of charitable fundraising.

Just as John notes on his blog, today isn't 50 years ago. What might have been a semi-innocuous practice when it began is now part of the problem, and given our current burden of diet and weight related illness, no matter how worthy the cause it can no longer be considered charitable to sell sugar and trans-fat.

[Math: 0.25g trans fat/serving x 8 servings avg/box x 200,000,000 boxes/year x 0.88 (% of cookie sales where partially hydrogenated an ingredient) / 1,000g/kg x 2.2lb/kg = 774,400lbs trans fat/year

7g sugar/2 cookies x 20 cookies avg/box x 200,000,000 boxes/year / 1,000g/kg x 2.2lb/kg = 30,800,000lbs of sugar/year]

Oh How I Wish These Awful New Kids' Toys Were an April Fools Joke

Hurray. I can buy my kids their very own branded play OPI nail salon, Dairy Queen store, Sprinkles cupcake bakery and Claire's jewellery retailer.

[h/t to my wonderful wife who saw these for sale in our local Walmart]

Should We be Treating Type 2 Diabetes With Bariatric Surgery?

I'm resurrecting this piece consequent to yesterday's online first publication in the New England Journal of Medicine of the 3 year data that continues to support the use of bariatric surgery to treat type 2 diabetes.

In case you missed the news, two recent studies (here and here) published in the New England Journal of Medicine demonstrated dramatic superiority of surgery over intensive medical management in the treatment of type 2 diabetes.

Now I'm not going to get into the studies here and dissect them for you, but I think that they were well done studies, and while admittedly we still don't know what their long, long, term benefit will be, at 2 years out, they look damn good with surgery coming out worlds better than "intensive medical therapy" for the treatment (and remission in many cases) of type 2 diabetes.

Of course time's definitely a fair concern. Meaning what if 5 or 10 years down the road the folks who had the surgery are no better off than those on medical therapy? Thing is, based on what we know already about the surgeries involved, all have well known 5 year data, and the bypasses and diversions much longer than that, and those studies, while they weren't specifically designed to look at diabetes alone, did look at weight and medical comorbidity regains, and I certainly don't recall anything that suggested diabetes returned with a vengeance.

So basically here we have a surgical intervention that is dramatically better than a medical one, for a condition that causes cumulative damage and can wreak havoc on a person's quality and quantity of life.

Yet many MDs, allied health professionals and health reporters, including some who I know, respect, and admire, are taking this opportunity to discuss how we shouldn't be looking to surgical solutions for diabetes because patients could instead use their forks and feet. While there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress - the simple fact remains that we don't yet have a proven, reproducible and sustainable approach to lifestyle change.

And what of those folks not wanting to change?  I say, "so what?".   Since when did MDs, allied health professionals or health columnists earn the right to judge others on their abilities or desires to change? Our job is to provide patients with information - all information - including information on lifestyle change, medical management and surgery. We can even provide patients with our opinions as to which road we think may be best for them, and why, but honestly, given the results from these studies, I'm not sure how anyone could make an evidence based case that surgery isn't a very real and powerful option that ought to be discussed with all of their type 2 diabetics with overweight or obesity.

Unless of course that someone has some form of weight (or simply anti-surgery) bias.

Let me give you another example. Let's say there was a surgical procedure that folks with breast cancer could undergo that would reduce their risk of breast cancer recurrence by roughly 30%.  Do you think anyone would question a woman's desire to have it? I can't imagine. And yet lifestyle - weight loss and exercise has indeed been shown to reduce risk of breast cancer recurrence by 30%. Think people would dare suggest the women choosing surgery were, "taking the easy way out", that they should just use their forks and feet?

We've got to get over ourselves.

Until we have a proven, remotely comparable, reproducible, sustainable, non-surgical option, if you bash the surgical option on its surface for being "easy", or "wrong", you might want to do a bit of soul searching as to whether or not you're practicing good medical caution, or if instead you're practicing plain, old, irrational bias.

[and for new readers to ensure there's no confusion - I'm not a surgeon]

Juice is NOT a F@*#ing Fruit Part II

Juice is an incredibly frustrating beverage. Despite packing the same caloric and sugary punch of Coca-Cola, unlike sugared soda, juice's undeserved health halo regularly leads to its provision, consumption (and often over consumption) in the name of nutrition - especially to and by our children.

And kids really shouldn't be drinking the stuff, or at the very least, not in the name of health.

The Canadian Pediatric Society and the American Academy of Pediatrics both recommend that juice be capped for kids at half a cup daily. And make no mistake, the capping isn't because juice is so damn good for the kids that we don't want them to drink too much of it, but rather because every glass contains 5 teaspoons of sugar (or more) and calories which won't be compensated for with decreased portions at their next meals.

The World Health Organization also considers juice to be nothing more than a sugar delivery vehicle and in their recent draft guidelines on sugar consumption specifically call out juice as a source of undesirable free sugars.

Yet there's this piece that came across my Newswire just last week. It was a press release put out by Coca-Cola (makers of Minute Maid) and Breakfast Club of Canada and it featured Teresa Piruzza, MPP for Windsor West and Minister of Children and Youth Services launching the newest Ontario Breakfast Club, which judging from the press photo up above involves the indoctrination of children into believing that fruit juice is a healthy part of their breakfast and the provision of juice boxes (containing more juice than our experts' daily recommended maximum), festooned with cartoon characters that in turn might further increase a child's consumption and desire for same.

Can you imagine a similar scene with the Minister of Children and Youth Services grinning and handing out Vitamin C fortified soda, in cartoon covered cans, to children in the name of breakfast?

According to the press release,

"Breakfast Club of Canada supports healthy breakfast programs at 1,266 schools, supporting nearly 130,000 children and serves close to 21 million breakfasts every year and that Minute Maid® has partnered with Breakfast Club of Canada since 2003, donating Minute Maid® juices to support programs across Canada."

Breakfast I'm all for, but marketing sugar to children and washing it in BS "corporate social responsibility", food insecurity, and health is both incredibly misguided, and incredibly sad.

(And if you're looking for Juice is NOT a F@*#ing Fruit Part I click here)

Saturday Stories: Best Diet, Failing Kids, and Parasites

James Hamblin in the Atlantic covers the world's healthiest diet.

Hanna Rosin, also in the Atlantic, wonders whether we should be letting our kids fail more?

And lastly, here's a fabulous TED talk from Ed Yong about how parasites may be controlling our actions.

Did You Know that Oreos Are Responsible for the World's Cocaine Supply?

Today's Funny Friday video is truly shocking.

Gunpowder, cocaine, and more coming from Oreo's secret "unmaking" plants (some swearing).

Have a great weekend!

Health Canada Allows Cupcakes to Claim They're a Source of Calcium and Iron

Just in case you need more convincing that Canada's front-of-package labelling law's laxity leads to nonsensical front-of-package health claims look no further than Duncan Hines' new Strawberry Flavoured Cupcakes whose package reports they're a source of calcium and a source of iron.

And honestly, even if there were calcium and iron emergencies in the population (there aren't), and even if these cupcakes provided a significant amount of either (they don't - 6% of both per cupcake), nothing will change the fact that they're cupcakes and that cupcakes, while delicious, will never be healthful.

So what's in these calcium and iron containing cupcakes? Here's the ingredient list:

Sugar, Enriched Bleached Wheat Flour, Vegetable Oil Shortening [Palm Oil], Strawberry-Flavoured Bits [Sugar, Corn Syrup, Corn Cereal, Partially-Hydrogenated Vegetable Oil (Cottonseed And/Or Soybean), Modified Cornstarch, Citric Acid, Natural And Artificial Flavours, Colour], Sodium Bicarbonate, Sodium Aluminum Phosphate, Dicalcium Phosphate, Monocalcium Phosphate, Wheat Starch, Propylene Esters, Mono And Diglycerides, Sodium Stearoyl-Lactylate, Salt, Dextrose, Cellulose Gum, Xanthan Gum, Citric Acid, Natural And Artificial Flavour, Artificial Flavour, Colour. Frosting Mix: Powdered Sugar [Sugar, Cornstarch], Cream Cheese Powder [Cream Cheese (Cream, Milk, Skim Milk, Whey, Bacterial Culture, Salt, Microbial Enzyme), Whey, Natural Flavour, Tocopherol, Ascorbyl Palmitate], Natural And Artificial Flavour).

The onus shouldn't be on Canadians to have to study the backs of packages' nutrition facts panels to determine if the claims made on the fronts of those same packages hold true, and while you might think to yourself that no-one's going to get duped by a cupcake box, not only would I bet that you're wrong and that those claims may well influence some to consider them to be less unhealthy than they are, I would remind you that there are many other products that are equally but far less obviously awful whose packages dupe the best of us on a daily basis.

[h/t to Random House's Cassandra Sadek]

Canadian Breast Cancer Foundation Fundraising with Healthwashed Junk Food

Sigh.

Junk food fundraising is so common place nowadays that virtually no one blinks an eye when they see it. Worse still, in many cases the dollars received in lieu of healthwashing are minimal.

Take for instance the new partnership between the Canadian Breast Cancer Foundation (CBCF) and the so-called Canadian Healthy Vending company. In return for the use of the CBCF logo on their Max! Healthy Vending Machines the CBCF will receive $48,000.

In discussing the partnership Holly Henderson, the Canadian Breast Cancer Foundation’s Senior Director of Corporate Programs, explains why she feels the fit is good,

"The Foundation is particularly excited about this program as it allows us to extend our message about the importance of healthy lifestyles and reducing breast cancer risk. It’s never too early or too late to take steps to help reduce risk by making healthy choices and learning more about breast health."

So what healthy choices are sold in the pink and healthwashed Max! Healthy Vending Machines? Pretty much the same crap that's in any vending machine only this machine calls its contents healthy. There's sugared soda like Natural Brew Cream Soda (9.5 teaspoons of sugar) and Blue Sky Organic Soda New Century Cola (sweetened with 10 teaspoons organic cane sugar). There are cookies like Enjoy Life's Chocolate Chip and Snickerdoodles (each with the same calories and sugar of Oreos) and chocolate bars like Green & Black's Milk Chocolate (nutritionally nearly identical to the iconic Hershey's Milk Chocolate bar). And of course there are potato chips like Old Dutch Baked Ketchup Chips (which according to the nutritional information on the Old Dutch website chip per chip actually contain more calories and more sodium than their non-baked Old Dutch Ketchup Chip brothers).

These are not what I would describe as healthy snacks. In fact I've argued before that these sorts of snacks are worse than their non-healthwashed counterparts given the likelihood of their overconsumption or more frequent purchase consequent to their healthwashing. No doubt too, regularly consuming these sorts of products might in fact lead a person to gain weight. As far as weight and breast cancer goes, the links, though correlative, still give cause for concern. According to the National Cancer Institute, obesity increases the relative risk of developing post menopausal breast cancer by 50%. They also report that maintaining a body mass index of 25 could prevent 11,000 to 18,000 deaths per year from breast cancer in U.S. women over age 50, that breast cancer is more likely to be detected at a later stage in women with obesity, and that weight gain during adulthood has been found to be the most consistent and strongest predictor of breast cancer risk in studies in which it has been examined.

Shameful.

UPDATE: Crazy that it ever happened in the first place, but the good news is that the CBCF's contract with Canadian Healthy Vending has recently expired and they've no plans to renew!

Metabolically Healthy Obesity and the Risk of Type 2 Diabetes

The term "metabolically healthy obesity" is generally thought to describe excess weight in individuals who don't have any weight-relatable medical conditions. When discussing whether or not these individuals should be counselled to lose weight many point to their potential risk of developing weight-relatable conditions as a reason to do so, and truly, that makes good sense, though looking at the data from my friend and colleague Arya Sharma, it would appear that truly metabolically healthy obesity carries virtually no excess mortality risk - at least not over the 16 years of NHANES data they studied. In Arya's work (graph from same up above) those individuals who are at no risk are staged as EOSS zero - which means that they truly had no discernible weight relatable issues whatsoever - they indeed had metabolically healthy obesity.

So how then to explain the outcomes from a paper published yesterday in Obesity Reviews? The paper, Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies, was a meta-analysis using data from the English Longitudinal Study of Aging and it concluded that those with what they defined as "metabolically healthy obesity" had a 4 fold higher risk of developing type 2 diabetes over a 6 year period than individuals with "metabolically healthy normal weight". The authors then conclude,

"Prospective evidence does not indicate that healthy obesity is a harmless condition."

But before you agree with them there's something important you need to know. Whereas Arya (rightly as far as I'm concerned) defines metabolically healthy obesity (EOSS 0) as an individual who has ZERO weight-relatable conditions, the authors here considered a person to have "metabolically healthy obesity" even if they had one of the following issues: hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol or adverse triglycerides.

Rather disingenuous don't you think, to describe the increased relative risk of developing type 2 diabetes in individuals who are most assuredly not metabolically healthy as purely consequent to their weight?

Regardless of your weight, if you have hypertension, impaired glycaemic control, systemic inflammation, adverse high-density lipoprotein cholesterol or adverse triglycerides then you are not metabolically healthy, and studies that explicitly suggest otherwise aren't doing anyone any favours, nor answering any questions about risks in those with truly metabolically healthy obesity.

Talk About Commitment to a Low-Carb, Sugar Free Lifestyle

So what do you do if you're young, wealthy, and an ardent believer in a low-carb, sugar free lifestyle?

Well if you're Meredith Loring and Sami Inkinen you plan a 2400 mile unsupported low-carb, sugar-free, row (meaning they're hauling their food with them - just not carbs or sugar) from San Francisco to Honolulu - a trip only twelve people have ever managed before. They've dubbed it the Fat Chance Row.

Food wise between them they'll be consuming 14,000 calories daily with a breakdown of 70% fat, 20% protein and 10% carbohydrates.

They're rowing or a cause too and looking for donations where 100% of the proceeds will go to anti-sugar crusader Dr. Robert Lustig's Institute for Responsible Nutrition.

Regardless of where your dietary beliefs lie, you have to admire their spirit, and reading through their site, they seem like fun folks, but watching their blog's videos and just pondering their challenge, you know it won't be a picnic. Sami knows that too as evidenced by my favourite quote from their website which came from his bio,

"Sami’s married to Meredith and hopes that the expedition doesn’t change that fact.".

I look forward to watching their progress. They embark this June.



[h/t to the Cutting Factory's Michèle Hozer]

Saturday Stories: Saving Lives, Drug Prices, and Protein

80,000 hours ponders how many lives a doctor actually saves in a career.

Andre Picard in the Globe and Mail explores the need for, no matter how painful, dispassionate analysis in setting drug prices.

Kris Gunnars over on Authority Nutrition covers dietary protein.

[And if you don't follow me on Twitter or Facebook here's my interview with Anna Maria Tremonti for CBC's The Current where we had the luxury of time to really discuss The Diet Fix, and here's a piece I did for the Globe and Mail rebutting Margaret Wente's ill-informed assertion that menu board calories are a bad plan]

Today Funny Friday Being Replaced by Awesome Science Friday!

Such a heart warming video I felt I had to share even though it's not Funny.

Here's Professor Andre Linde and his reaction upon hearing the news that his 30 year old theory regarding the big bang had been proven to be true - something that my theoretical physicist mother tells me is a huge, huge, almost certain to win him a Nobel Prize deal.

Science!

For Sugary Cereal Maker Kellogg's There's No Such Thing as Sugar

For those of you who still think the food industry is a helpful part of the solution to our modern day weight and nutrition woes I present the Kellogg's Together Counts label reading course.

Together Counts is the food industry's self-congratulatory attempt to be part of the dialogue regarding weight, nutrition and health in society today. My cynical view is that it's there to help to forestall the inevitable industry unfriendly legislation that we will see down the road. It's also there to foment misinformation.

Take this piece for example. It's entitled, "Eyes on the Prize: How to Spot Wholesome Foods" and it's written by Together Counts partner and sugary cereal kingpin Kellogg's. The article's about how to read a food label because as the article states,

"at least 60% of Americans are in fact paying more attention to the numbers on the food packages they buy. But if you don’t know what to look for on the label—or are only noticing the calories—chances are you’re not seeing the complete picture of your favorite eats. As a member of the Together Counts™ program, Kellogg’s wants to make it easy to keep your eyes on nutritional value with these quick tips."

Hurray for Kellogg's!

So let's say you take this Kellogg's course. What should you look at when evaluating Kellogg's Honey Smacks? Well according to Kellogg's you should consider their serving size, fat and cholesterol, fibre content, sodium and vitamins. Well by those measures this stuff sure is pretty awesome!

Let's see, pretty clear cut serving size, almost no fat, very low sodium, and TONS of vitamins!

You know I'd imagine most cereals would score highly in the Kellogg's version of wholesome food land. They're all low in fat, sodium, and cholesterol, and they're fortified with vitamins.

What's that?

You think perhaps when considering foods people should also look at sugar?

Well only if you think that a product that by weight is quite literally 55.6% sugar (Kellogg's Honey Smacks) isn't a wholesome food, and if you learn how to read a food label by means of Kellogg's teaching - you won't.

Does Your Doctor Know How to Weigh Your Child? I'm Betting Many Don't.

Image Source

On the surface it doesn't sound all that difficult.

Ask child to stand on scale. Weigh. Record weight. Done.

Working with parents of children with obesity, it seems many doctors nowadays feel it's important to add in some judgement or scary statistics such that after 'weigh' and before 'done' comes a speech on the dangers of weight along with the implicit or explicit suggestion that the child is responsible - either for gaining the weight or for not losing it.

I don't think that's fair. Moreover, I don't think it's helpful and I think it may well do harm.

It's not fair, especially with younger children, given that they're not in charge. They don't do the grocery shopping. They don't cook the meals. They don't set the example. They live the lives their parents teach them to live. They're life's passengers, not the drivers.

It's not helpful because speeches or stats without action plans by definition aren't helpful.

It's potentially harmful because the negative emotions bound to be generated by this sort of an interaction may well erode a child's self-esteem, body image, and their relationship with food. It may also lead that child's parents to adopt a knee-jerk pattern of restriction, guilt and shame that is far more likely to make matters worse than better.

The safest way for a physician to weigh a child is to tell the truth as to why weights are important. The truth is that children need to be weighed because medication is dosed dependent on a child's weight and therefore physicians need to have fairly current weights on their growing patients in case they fall ill and require a prescription. And should a physician have a concern about a child's weight I'd encourage them to have a discussion with that child's parents with the child absent and clearly, there's not much point even having the discussion unless that physician has suggestions or resources beyond the tritely useless truism of "eat less, move more".

Guest Post: The Food Industry Understands Nudge Theory Too

Today's guest post comes from Jill Avis. Jill is a PhD student studying under the supervision of Dr. Geoff Ball in the Department of Pediatrics at the University of Alberta. Her thesis work relates to innovative approaches for the prevention and management of pediatric obesity.

The Negative Nudge

Many readers will be familiar with an approach to behaviour change that has gained popularity in recent years – the nudge. This concept is well-described by Thaler & Sunstein as "the navigation of individuals toward optimal choices without restriction of other options" – in other words, ‘libertarian paternalism.’ For example, placing healthier food options in more visible, convenient locations in school cafeterias or altering the default option to consent for organ donation.

Today, I want to talk about the nudges that work in counterproductive directions – what I call the ‘negative nudge’. Yoni’s blog post last Tuesday reinforced the reality that big corporations, (e.g., Coca-Cola) have the power to sway consumers toward food choices of questionable quality. Not only are we faced with a growing number of processed foods in our food environment, but portion sizes and product packaging have increased substantially, creating a ‘perfect storm’ that encourages us to eat more and more. When paired with the chance of a trip, keepsake “cup,” and a tacit endorsement by Coca-Cola, it is not surprising that people consume increasing amounts of unhealthy foods and drinks.

In Thaler & Sunstein’s book, Nudge, the authors discuss dual process theory, which proposes two processes to explain our decision making - the rational, conscious system and the automatic, unconscious system. This theory may help to explain the disconnect between positive intention and behaviour; individuals who make an explicit pact to ‘shape-up’ or ‘be healthy’ (aka the rational system) face factors processed by the automatic system, which can inhibit adherence to their initial intention. Examples include temptation and mindlessness, or stickier influences, such as endorsements by big corporations. In our food environment, it is difficult to decipher which information is genuine and which is a marketing tactic.

When I stopped in for my daily coffee at the local Second Cup, I took a double-take at one of their advertisements to celebrate 35 years in business; #34 states, “We’ve learned there is a much tastier way to enjoy an apple a day with our caramel apple latte.” Now, do I think that Second Cup had the purposeful intention of negatively influencing Canadians’ already poor eating habits? No. But I believe they are using their power for corporate benefit (profit!) by giving a ‘negative nudge’ to our food choices; share-holders and franchisees seem to be interested in their profit margin at the expense of individuals’ decision-making and dietary quality. This is just one example of the pervasiveness of ads that negatively nudge us – it’s clear we need more nudges that move us in the positive direction.

Salad Does Not a Healthful Menu Make!

Just a short public service post that you can share with whichever of your powers that be that might need it.

Just because your fast service menu or restaurant offers salad doesn't suddenly make your menu healthful.

[And if you're not familiar with the meme, it comes from here]

Saturday Stories: Autism, Murder, and the Food Environment

Ron Suskind in the New York Times with an amazing story centred around his autistic son and Disney.

Andrew Solomon in the New Yorker exploring the agony of being the father of a ruthless killer.

David Sherman in the Ottawa Citizen with a rarity - a news piece that tackles the food environment as a cause of obesity rather than simply blame our supposed lack of willpower.

[And if you don't follow me on Twitter I was doing a bit of media this week. Some highlights include this Breakfast Television interview where I tried a lemon pepper cleanse and this segment on CTV's The Social where I think I might have made Jann Arden and the rest of the ladies a little bit sad by the end.]

This Video Kinda Makes me Wish I was a Gastroenterologist!

Today's Funny Friday looks like a great deal of fun (at the expense of people coming out of the meds that tend to accompany colonoscopies and in the name of colon cancer awareness).

Have a great weekend!

Parental No Files: 9:00AM Class Trip to Disney's Frozen Edition

The institution of eating food at the movies. Where did it come from? Is it just a great excuse (as if we need excuses these days) to snack on junk food?

And it would seem it doesn't matter when we head there, or how old the movie goers might be, the snacks must go on!

Have a peek at that form up above. It was sent to me by a Niagara Region RD named Sandy Maxwell. It was the form sent home from school to one of her friends whose 5 and 7 year olds were slated to take a school trip to see Frozen....at 9am in the morning!

As you can see, no worries about them not having access to junk, and of course, Mom could just say "no" - I'm sure her kids won't mind being the only ones left out of the junky festivities and heck if they do, that couldn't affect their long term relationship with food, could it? Definitely making moms and dads say "no" is the far wiser course of action than a no-junk default and instead requiring moms or dads who want their kids to have junk at 9am in the morning to have to actively seek it out.

Ugh.

UK Based Smartphone App Turns Stair Climbing Into a Game

Love this Step Jockey app out of London.

Apparently stairs there are being labelled with gameified with signs that can be scanned by the app which in turn keeps track of calories burned and stairs taken.

It's being backed by the UK Department of Health and NHS London via the Small Business Research Initiative (SBRI).

That said, I have two concerns.

Firstly it's an energy output app with seemingly no discussion or accounting for energy input - which may well lead individuals to feel like their few flights of daily stairs warrants rewards of dietary indulgence ("because I exercised" foods).

But the more important issue I have is that it's being promoted as a means to lose weight.

Exercise is about health, but were weight management attainable solely on the basis of taking the stairs, the world be a much slimmer place.

I'm all for exercise, but its branding needs to change from one of weight control to one of health, and institutions like the UK Department of Health and NHS London should be leading that charge, not contributing to the misinformation embraced by the food industry that our forks are out-runnable.

Can We Enact Bloomberg's Cup Size Limit at the Movies Please?

I went to the movies a few weeks ago with my wife (we saw Gravity in Imax 3D - can't say I recommend it).

On the way out I noticed a giant Coca-Cola advertisement, and as I'm wont to do, I wandered over to have a closer look.

It highlighted a contest to win a ski vacation in Whistler and you could also buy a commemorative cup at the concession stand.

"Cup" is an interesting term though for a container that holds 44oz (1.3 litres) of sugared soda. For those who care that's 526 calories of Coca-Cola coming from its astonishing 36 teaspoons of sugar!

I can't imagine there are many people on the planet who consciously want to consume 1.3 litres of Coca-Cola with their movie, but I bet many unconsciously do simply consequent to the fact that the only commemorative size available shares more in common with a bucket than a cup.

Kid Targeted Ads for "Healthy" Food Likely to Sell Unhealthy Food Later

Here's another reason why we should be banning all food advertising targeting children and not just the ads targeting junk (and it's not all that surprising) - brand associations last.

But knowing that to be true and proving it matters is different and that brings us to a fascinating (but somewhat challenging to read) series of studies conducted by Paul Connell, Merrie Brooks and Jesper Nielsen who aimed to explore whether or not,

"the messages of fun and happiness so common in children’s advertising create lasting affective associations that cloud people’s judgments about the featured products for the rest of their lives?"

And more to the point here,

"can childhood advertising exposure cause biased evaluations for new products introduced years or even decades later if the same advertising stimuli are used?"

Which translated to our modern day environment where the food industry is angling to avoid legislation designed to ban their ads and instead voluntarily limit their advertising to so-called "healthier" items (or even just to use their mascots to highlight other issues like literacy as in the McDonald's initiative seen in the photo up above) might be asked if the creation of positive brand associations might increase the likelihood of future adult consumption of the truly awful?

Their answer was yes in that they found that it was the positive brand associations with childhood advertising characters that influenced an adult's belief that sugary cereals were more healthful. Older adults who were exposed to Tony the Tiger as children, but not to Coco the Monkey, rated old school Tony's pre-sweetened Frosted Flakes as more healthful than modern day Coco's Kellogg's Cocoa Pops after an exposure to advertising to both, whereas younger adult study participants who had been exposed to both brand mascots rated the cereals equally following exposure to advertising to both.

To suss things out further and rule out the possibility that the mascot simply evoked positive consumption memories they conducted a second experiment whereby people were shown either advertisements involving Ronald McDonald and Toucan Sam (both utilized heavily in advertising for decades including during the childhood of this experiment's participants), or simple photos and descriptors of McDonald's fries or Froot Loops along with accurate brand labels. Participants were then asked to rate the healthfulness of McDonald's fries or Kellogg's Froot Loops. The thinking was that if the ads in the first experiment had triggered a memory of consumption rather than an emotional brand attachment and that memory was responsible for the bias, the photos of those actual childhood foods ought to lead to that same outcome. But they didn't, and again, it was found that ads featuring beloved childhood characters biased adults' opinions on the healthfulness of junk food.

For me though the strangest part of the study had nothing to do with the experiments, but rather the conclusions of the lead author who reported to The Daily Mail,

"We suggest that parents discuss the persuasive nature of advertising with their children, and encourage them to develop critical thinking skills in response to advertising messages."

I found this to be strange in that it seems mind-boggling to me that a professor of marketing is suggesting that despite the billions of dollars a year spent on highly sophisticated advertising targeting children, that the call to action is to suggest that parents have a chat with their kids rather than a call to put an end to kid targeted advertising in the first place (though to be fair, the newspaper may have simply left out that quote).