A Large Swath of Nutrition Research is Based On Lies

A Sample Completed Memory Based Dietary Assessment (Not Mine)

Well maybe "lies" is too strong a word as not all of the omissions are wilful, but the fact of the matter is, as a whole, we're nearly useless at memory-based dietary assessments, and yet they serve as the underpinning of a tremendous amount of dietary research which in turn is used to craft public health policy and dietary recommendations.

In a paper published today in Mayo Clinic Proceedings, Edward Archer and colleagues thoroughly review the futility of memory-based dietary assessments, and while I don't share Archer's overarching belief that the bulk of obesity is explicable on the basis of maternal obesity's impact on developing fetuses, or his contrarian viewpoint that diet is not a major risk factor for disease, his paper does an admirable job of destroying the notion that 24-hour dietary recalls and food frequency questionnaires (FFQs) are useful.

Before getting to the meat of the paper, back to Archer's assertion that diet is not a major risk factor for disease. To illustrate that point Archer notes,

"This hypothesis is supported by multiple lines of evidence, such as a 40% decline in the age-adjusted mortality rate from 1969 to 2010, a progressive decades long reduction in age-adjusted cardiovascular disease incidence and mortality, and a 1.5% per annum reduction in age adjusted mortality rates from all major cancers as well as significant reductions in lung cancer incidence in men and women between 2001 and 2010."

Given that cigarette smoking has decreased dramatically in that same time period (see graph below),

and the fact that smoking is America's number one cause of death and lung cancer, and is a major cause of cardiovascular disease, that rather than point to smoking cessation as the improvements' probable cause, he instead suggests, absent of any pathophysiological explanation or hypothetical mechanism, that the standard American diet is responsible for the observed decrease in death and lung cancer, is plainly bizarre. All the more so when considering the impact the introduction of Westernized diets have been seen to have on non-communicable disease risks in populations the world over.

That aside (and truly, I wish it weren't part of the paper as it detracts from its impact), the paper's a worthwhile read. With an expansive review of the literature, Archer explains not only how far off the mark dietary recall is (up to 80% of some recall studies include dietary patterns that are "physiologically implausible"), but why, covering studies that explain how,

"24hr and food frequency questionnaires can be most accurately defined as mere attributions based on mental experiences that are strongly influenced by the respondents' idiosyncratic qualities (ie, education), previous memories and information, knowledge and beliefs, motives, goals, habitual behavior, and the social context in which the memories are encoded or reported."

He also asserts that the design of memory based dietary assessments itself inspires false reporting and posits that,

"it is not a question of whether FFQs induce false reporting, but to what extent".

Finally Archer discusses the criteria for scientific research and he suggests that memory based dietary assessments are,

"akin to creation science in that they fail to meet the basic requirements of scientific research"

in that they are not independently observable or measurable (reporting you've eaten an apple, and how much of that apple you ate, isn't the same as having your apple eating independently observed and the amount of apple you consumed measured), they are easily and regularly falsified, they lack validity, and they are unreliable. This leads Archer to call the discipline of nutrition epidemiology "pseudoscience", stating that,

"when a person provides a dietary report, the data collected are not actual food or beverage consumption, but rather an error prone and highly edited anecdote regarding memories of food and beverage consumption"

and hence,

"do not meet the basic requirements of the scientific method and, by definition, are pseudoscientific when presented as actual estimates of energy or nutrient consumption."

Notwithstanding the non-evidence based ease with which Archer dismisses the potential impact of diet on health, this paper soundly illustrates the need for the rapid development and adoption of an objective means to track dietary choices - something the technologies of today are well suited to provide.

Click Here For the Secret to Staying Perfectly Hydrated This Summer

Drink water when you're thirsty.

Saturday Stories: Steve Prefontaine, Dave Sackett, and Andrew Jennings

Mary Pilon in Grantland on the last run of Steve Prefontaine.

Iain Chalmers and Andrew Oxman at Cochrane pay tribute to the late and truly great Dave Sackett.

Michael Miller in The Washington Post on how Andrew Miller, a curmudgeonly old journalist, brought down FIFA.

And also the nameless. Please take the time to watch this spectacular visualization of both war and peace throughout history - it's time very well spent.

Unconscious People Don't Want Tea

Thanks to Leah Dagenais for sending this week's Funny Friday video...though it's not actually funny in the usual Funny Friday way. No, this video's far sadder than it is funny. I wish the world wasn't the sort of place that made a video like this one worth sharing.

Have a great weekend.

Cookbook Review: Save with Jamie: Shop Smart, Cook Clever, Waste Less

Today's cookbook review comes from our office's stellar RD Rob Lazzinnaro, and for disclosure, Rob chose on his own volition to take Jamie's book out from the library and I asked him if he wouldn't mind writing a review.

Save with Jamie: Shop Smart, Cook Clever, Waste Less

Jamie Oliver is not only a talented chef but also one of the most outspoken ambassadors for home cooking, healthy eating and getting healthy food into schools. Recent example being his petition fighting for food education and his creation of the food revolution day and campaign. Jamie’s many television shows and campaigns around food in school and getting folks in the kitchen are inspirational, and his first cookbook back in 2000,The Naked Chef, even helped me to tackle new recipes outside of my comfort zone for the first time. More recently, with his good friend Gennaro Contaldo, he helped me rediscover some Italian classics that I had eaten frequently as a child. You can imagine my excitement when I ran across his book Save with Jamie, which was published a couple of years ago, while looking for cookbooks with budget in mind. All praise aside: I promise to do my best to review this cookbook as I do any other, without bias and guided by the four questions I ask in reviewing any cookbook.

1.Are nutrition facts included?

The calorie count per serving is indicated in clear view beside each recipe, as well the book has a five page rundown in the index of the fat, saturated fat, carbohydrates, and sugar for all of the book's recipes. I would have appreciated to see protein, fiber and sodium in the rundowns as they are key when choosing a well balanced recipe. *p.s. Jamie, if you need a consultant for your next book you know who to contact.

2. Are the recipes accessible and well balanced?

Absolutely! The general theme of the book is how to save by cooking in batch, cooking with cheaper proteins, using your freezer, and using every last bit of any food item. I give preference to recommending recipes that have a good balance of healthy protein, carbs/fiber, and fats which most of Jamie's dishes achieve. It is worth noting that some recipes may be too calorically dense to be eaten regularly, but all depending on your caloric requirements of course.

3. Is it free from nutrition myths and non-evidence based diet recommendations?

It is very important to me that any book providing nutritional recommendations beyond nutrient breakdowns try to do so through a nutrition professional. The author/chef may have good intentions but their advice needs to be guided by evidence. What I love about Jamie’s cookbooks and his general brand is that he focuses on what he does best which is creating delicious and accessible meals, the healthy aspect is that you cooked it yourself from scratch. He does not preach about certain diets or health fads; refreshing. The cookbook sticks to basic cost savings, stretching ingredients, using every last scrap, meal prep & storage, and delicious recipes.

4. Are the recipes engaging and delicious?

Absolutely! This is of course where Jamie’s cookbooks shine. All of the recipes have very beautiful and enticing photographs with easy to follow instructions. In Save with Jamie, he essentially pulls and then re creates classically delicious comfort dishes from around the world, which makes for one of his most culturally diverse cookbooks to date.

I highly recommended this cookbook as it is a stand out in Jamie’s Collection.

To buy your own copy, here is an Amazon Associates link from Canada (looks like the US stock is gone)

A Question You Might Want Ask Yourself More Often

"What would I tell my best friend?"

Working for the past 12 years to help people affect lifestyle changes, I'm still regularly amazed by how hard on themselves people are.

We all fall down. Considering whether or not your personal internal castigation is fair or not is important to the long-term likelihood of your success as if you regularly, unfairly, kick yourself when you're down, you're less likely to ever bother getting back up.

If you find the question confusing, or its implementation challenging, the next time you get down on yourself for some sort of lack of follow through imagine the counsel you would provide to your best friend or closest loved one if they found themselves in your exact situation.

My guess is that you'd be terrific at actively encouraging your loved one to look for the positive, and in so doing, increase your loved one's likelihood of getting back up.

You deserve to treat yourself with just as much love and respect as you treat those to who you are closest.

Are you treating yourself fairly?

Relentless Environmental Junk Food Tide Drowns Obesity Conference Menu

They tried. I know they tried. I know they tried because our office's RD Rob Lazzinnaro was on the food committee for the recent Canadian Obesity Network's (CON) Summit.

Not only did the food committee work with the hotel to ensure the mains were healthful, they also had some simple instructions. No liquid calories, and no junk food.

So what happened?

Well, on the first day right next to the sign from CON about eliminating liquid calories was a bowl of cinnamon churros.

Thrilled the @CanObesityNet not providing liquid calories at #COS15. Maybe next year we can tackle the churros? pic.twitter.com/EH8uyqf4xV

— Yoni Freedhoff, MD (@YoniFreedhoff) April 28, 2015

Juice, and not just juice but ridiculously leanwashed sugar bombs by Odwalla were present at most workshops. And along with lunch on at least one of the days came a bag of Doritos.

@YoniFreedhoff was only gone for a few hours when the muffins and doritos came out at #COS15 ;) pic.twitter.com/V2TlK6IOyo

— Ashley Hurley RD (@AshleyHurleyRD) May 1, 2015

Having helped to organize a conference myself a few years ago, we experienced the same phenomenon. We had very explicit instructions around soft drinks and juice, and yet, despite those explicit instructions, in 2 of the 3 venues for our travelling road show, out the soft drinks and juice came.

A few weeks later and Rob was now battling the provision of muffins at a public health event meant to promote healthful eating for kids. The muffins suddenly appeared on the already agreed upon menu when a food service provider offered to provide them free of charge. For most intents and purposes commercial muffins are more fairly describable as cupcakes, and certainly their provision at this even would continue to perpetuate the notion that somehow cupcakes without icing are healthful choices. What was striking wasn't simply that one of the health professionals organizing the event gave the muffins an "ok", but that when Rob brought up his concerns, he was faced with indifference from his colleague.

Society's normal is junk food. It's the default. It's a tide. It's difficult to stop the tide. But we'll keep trying.

If You Perceive Exercise to Be a Misery, You Might Eat More When Done

"Because I exercised"

3 words that sink weight loss efforts and lead to the consumption of many a yummy treat.

Who out there hasn't felt like they deserved some dietary loving following a righteous sweat session, and a simple study out of Germany published last year concluded that you're even more likely to eat back your exercise if your gym equipment tells you that your exercise was in the "fat burning zone". But there was this weird catch.

The study randomly assigned participants to ride on bike trainers where half rode with a sign in front of them highlighting their ride was part of an experiment to develop training software for the "fat burning zone", while the other half, doing the same amount and intensity of riding, rode with a sign in front of them highlighting their part in an experiment to develop training software for "endurance".

At the end of their rides all riders were offered pretzels and water.

The "fat burning zone" riders, and here's the weird catch, varied in their response to the signage.

Riders who reported high levels of fatigue and distress ate more pretzels in the "fat burning zone" treatment than riders reporting fatigue and distress in the "endurance" treatment UNLESS they reported having enjoyed their exercise whereupon riders who reported enjoying their exercise, ate fewer pretzels in the so-called "fat burning zone" than "endurance".

Now putting aside the fact that "fat burning zones" are BS that should simply be ignored, and that exercise is for health, not weight, for me this study reinforced the importance of finding an exercise that you enjoy, because if exercise is perceived by you to be a misery, it would follow you'll be more likely to feel like you earned a reward "because you exercised" - a hypothesis that this paper suggests has merit.

Saturday Stories: Chocolate, Ethics, the CDC, and Polio

John Bohanon in i09 with a story about chocolate, research, the media, and an ethically questionable sting operation.

And if you did read John's piece, you must take the time to read Rachel Ehrenberger's Science News coverage of the ethics of same.

Jeanne Lenzer in the BMJ on how even the CDC is on the take and how that might be affecting their decisions and recommendations.

Peter Kavanagh in the Walrus reminding us what life was like when polio walked the earth.

You've Got the Golden Touch

Need a quick distraction? Open up today's Funny Friday in full screen and place your finger in the middle.

Have a great weekend!

When It Comes to Lifestyle Change, Timing Matters

Great ideas don't always share great timing.

One of the questions I ask during my first visit with a patient is,

"Looking at your life - time, stress, health, work, home, kids, mood, etc. - is now a good time to try to affect change?"

I think it's an important question because sometimes life justifiably gets in the way of great intentions.

Given lifestyle change requires planning, concentration, organization, and effort, and given those qualities are at times realistically challenged by real-life, sometimes it might be better to not set yourself up for struggle, and instead, respect reality and wait for reality to settle down before embarking on the road to change.

The Future of Exer-Gaming Looks Magically Bright

Currently, exer-gaming has been pretty much a fizzle when it comes to actual exercise. Gamers burn a precious few calories playing the games and the consoles have been shown to gather dust soon after purchase.

I'm guessing though, with the rise of augmented reality the future of exer-gaming will be bright indeed and I'm betting too, Magic Leap will be a major part of it.

Magic Leap does look like magic. In brief, the company, which recently received half a billion dollars in funding from Google, Qualcomm, and Legendary Pictures, and no, that's not a typo - half a billion dollars, is working on what might as well be magic. It's a headset that beams virtual images directly onto your retina so as to augment the reality of what you're seeing in the world around you.

Not sure what that means?

Have a peek at this YouTube trailer of what wearing a Magic Leap might be like:



Now picture the marriage of this technology, kids, and parkland. Whether it's running around within a first-person shooter, or playing baseball in your local diamond Magic'ed up to look like Fenway Park, or trying to score a goal on a virtual Martin Brodeur, or playing the world's coolest game of laser tag - I can't wait to see what's in store.

"The Duff" - 2015's Popular, Horrifying, Fat Shaming Teen Movie

I don't horrify easily.

And yet The Duff horrifies me. It's a teen movie that has grossed over $33 million and it's about "the duff".

What's a "duff"?

It's the, "designated ugly fat friend" of a pretty, popular, girl.

No, I'm not kidding.

Here's the trailer, which for the record, has been viewed over 10 million times on YouTube,



Maybe the movie somehow manages to not teach girls to hate themselves, but given I was alerted to the movie's existence by a high school teacher who informed me that the term had made its way to their school's hallways and lunchroom, I'm guessing not.

Saturday Stories: Conflicts of Interest, Jersualem, and Impossible Complexity

Great piece by Dr. Susan Molchan on Health News Review on the conflicts of interest inherent in medical journals which in turn are reliant on pharma industry advertising.

Matti Friedman in Tablet with just a spectacular and realistic essay on the confusion that is Jerusalem.

Wasim Maziak in Emerging Themes in Epidemiology wonders whether or not it's even possible to design studies capable of conclusions when it comes to diets, lifestyles and other complexities.

If Gandhi Took a Yoga Class

Probably the title of the post should read, "if hugely irreverent and free with the swear words Gandhi took a yoga class", as that's pretty much the set up for today's Funny Friday.

Have a great weekend!

Money Laundering, Food Industry Style?

I'm betting many nutrition, medical, and health professionals would be uncomfortable giving a talk sponsored by the Corn Refiners Association (the high-fructose corn syrup lobby).

But what if the talk wasn't sponsored by the Corn Refiners, but rather by something that sounded like a medical institute? Optically being a speaker for what sounds like a medical institute would sure look a heck of a lot less like something a person like me might suggest is a conflict of interest.

A few months ago I came across this symposium held at the American Society of Nutrition's (ASN) most recent Scientific Sessions and Annual Meeting. The symposium was all about how misunderstood sugar is - a conclusion that no doubt would be welcomed by the high-fructose corn syrup promoting Corn Refiners Association, so when I saw that it was a "Sponsored Satellite Symposium" I figured it must have been sponsored by them.

Except it wasn't.

Instead it was organized and sponsored by the Rippe Lifestyle Institute. But I did recognize the name Rippe, as James Rippe is a man who at one time was reported to take home a $41,000 monthly retainer from the Corn Refiners Association. Looking to his Lifestyle Institute, it reports partnerships with Kraft, Coca-Cola, Welch's, Dr. Pepper, Snapple, General Mills, McDonald's, Kellogg's, Orville Redenbacher, Hunt's, and yes of course, the Corn Refiners Association.

David Despain, a health journalist, happened to be at Rippe's Institute's sponsored symposium. According to him the symposium included breakfast and was attended by roughly 50 people. According to the ASN's sponsorship page, symposia run sponsors between $15,000 and $50,000 (and I imagine that cost doesn't include breakfast).

So, taking a conservative estimate at costs, and including breakfast, Rippe's Institute likely spent tens of thousands of dollars to tell 50 people that sugar was a-ok. This of course leaves me wondering how spending that kind of money on a grand total of 50 people would be worth the Institute's while, which in turn makes me wonder if their sponsorship was just a novel means to money/conflict-launder the Corn Refiners' agenda?

(Oh, and just as a by the by, this particular symposium appears to have been approved for continuing professional education credits by the Academy of Nutrition and Dietetics.)

[Note: Original post had also stated that symposia was hard on artificial sweeteners - have changed post to reflect fact that I was mistaken therein and talks were in fact, in anything, pro-NNS]

You Almost Certainly Don't Need to Replenish Your Electrolytes

The sport drink industry is a massive one. Estimated at nearly $7 billion in 2012 (and it was growing), the industry preys in part on the notion that because our sweat is salty, we need to replace it, and to replace it quickly.

But do we?

A study published way back in 1991 tried to answer that question.

The researchers took 8 cyclists and ran them through 6 gruelling hours of intermittent cycling in an 86°F room of 50% humidity, and kept their intensities at 55% of their VO2 Max. Each cyclist repeated this exercise 3 times on 3 separate occasions and 3 separate conditions. Once with no water or sports drink, the next time with just water, and lastly with just a sports drink where in both the water and sports drink treatments both were provided in quantities sufficient to replenish their volume of losses to sweat. The cyclists would cycle for 13 minutes, and then take a 2 minute break during which their heart rate, rectal temperature, and their perceived exertion were measured. Blood was drawn at the 15 minute mark and at hours 2, 3, 4, 5, and 6 to measure plasma sodium and plasma aldosterone.

The results were striking and easy to describe.

Simply put, if the study is to be believed:

1. You don't need to hydrate yourself at all during non-dramatic bouts of exercise. Certainly if you're thirsty, that's your sign to drink, but if you're not thirsty, probably no need. In this experiment's case, when drinking nothing, these cyclists DID have to stop the experiment short, but only after a long 4.5 hours of cycling (where the experiment was stopped short due to a marked rise in core temperature, heart rate and perceived exertion).

2. Unless you're exercising vigorously for longer than 6 hours straight, you don't need a sport drink to replenish your "electrolytes", because in this study, there was no difference in plasma sodium levels between the water drinkers and the electrolyte drinkers even after 6 hours of heavy-duty exercise!

I asked my friend Alex Hutchinson, author of the fantastic Which Came First Cardio or Weights his thoughts on the matter and he put it rather succinctly,

"electrolytes are irrelevant in the vast majority of situations".

So definitely don't ignore your body's cues and do drink to satisfy any thirst you might have when you're exercising, but if your exercise isn't extreme and it's less than 6 hours in duration, you probably need never "replenish" your electrolytes.

[And just as a reminder of what's in most sport drinks, below is my homemade Powerade video from a few years ago]

Mislabelling Physical Activity a "Vaccine Against Obesity" Carries Risk

"By having regular physical activity including sports and non-sport activity, movement, and not to be sedentary, it's the best vaccine against obesity"

- Jean-Michel Borys, Director EPODE European Network, at Coca-Cola funded "Together We Move" summit.

And yet, study after study after study demonstrate that even heroic amounts of exercise seem to at best lead people to gain weight slightly more slowly, and certainly not to lose.

In kids a 10 fold difference in objectively measured daily activity did not protect again obesity, nor did the vast majority of all RCTs involving school PE in three separate meta-analyses (1, 2, 3).

In adults there was no amount of exercise that prevented weight gain in nurses in the Nurses Health Study over a 13 year period, nor was there an amount of exercise able to prevent gain in this 20 year CARDIA study, nor in this 33 year long Norwegian study.

I asked Dr. Borys two weeks ago on Twitter if he could provide me with some evidence that would support his very strong, and very Coca-Cola friendly, statement.

I have yet to hear back.

Exercise is the world's best drug, it's just not a weight loss drug, and saying that it is does a disservice to both exercise and weight loss.

Saturday Stories: Optogenetics, Yogi Berra, and Fact Resistance

John Colapinto in The New Yorker on the breakthrough in optogenetics (and also what optogenetics is).

Dave Kaplan in the Wall Street Journal with an incredible story of kindness and Yogi Berra.

Andy Borowitz, also in The New Yorker, describes the alarming rise in fact resistant humans.

If You Can't Pronounce It, You Shouldn't Eat It?

Today's Funny Friday covers the practice of pronunciation as a metric for edibility.

Have a great weekend!

If You Can't Pronounce It, You Shouldn't Be Eating It from Funny Or Die

Rebranding Exercise: My Keynote Address for PHE Canada (Video)

A few weeks ago I had the great pleasure of delivering the keynote address for Physical Health and Education Canada's annual national conference.

The title of my talk was "Rebranding Exercise" and it makes the case for detaching exercise from weight loss and reattaching it to health.

As to why exercise needs to be rebranded? By preventing cancers, improving blood pressure, cholesterol and sugar, bolstering sleep, attention, energy and mood, and doing so much more, exercise has indisputably proven itself to be the world’s best drug – better than any pharmaceutical product any physician could ever prescribe. Sadly though, exercise is not a weight loss drug, and so long as we continue to push exercise primarily (and sadly sometimes exclusively) in the name of preventing or treating adult or childhood obesity, we’ll also continue to short-change the public about the genuinely incredible health benefits of exercise, and simultaneously misinform them about the realities of long term weight management.

Video's below where you'll also find links to every journal article I mention in the talk listed in order of appearance. The first 28 minutes has me covering the evidence with as much animation as standing behind a podium allows, but if you just want to see me get fired up and explain why rebranding exercise is important, skip ahead to the 28 minute mark where I extricate myself from the clutches of the podium and watch from there.

Huge thanks to PHE Canada and Doug Gleddie for the invite and to Brent Gibson from PHE Canada for recording and posting the talk.



References:

1. Physical activity at the government-recommended level and obesity-related health outcomes: a longitudinal study (Early Bird 37)
2. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis
3. Physical Activity Interventions in Schools for Improving Lifestyle in European Countries
4. Physical activity and cardiovascular risk factors in children: meta-analysis of randomized clinical trials
5. The impact of school-time activity on total physical activity: the activitystat hypothesis (EarlyBird 46)
6. Do extra compulsory physical education lessons mean more physically active children - findings from the childhood health, activity, and motor performance school study Denmark (The CHAMPS-study DK)
7. Fatness leads to inactivity, but inactivity does not lead to fatness: a longitudinal study in children (EarlyBird 45)
8. Current physical activity guidelines for health are insufficient to mitigate long-term weight gain: more data in the fitness versus fatness debate (The HUNT study, Norway)
9. Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals
10. Energy Expenditure and Adiposity in Nigerian and African American Women
11. Energy expenditure does not predict weight change in either Nigerian or African American women
12. Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies
13. Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men: A Randomized, Controlled Trial
14. Effect of change in physical activity on body fatness over a 10-y period in the Doetinchem Cohort Study
15. Maintaining a High Physical Activity Level Over 20 Years and Weight Gain
16. A Meta-Analysis of Pedometer-Based Walking Interventions and Weight Loss
17. Exercise effect on weight and body fat in men and women
18. Effect of Exercise on 24-Month Weight Loss Maintenance in Overweight Women
19. Impact of physical activity interventions on anthropometric outcomes: systematic review and meta-analysis
20. Weight training, aerobic physical activities, and long-term waist circumference change in men
21. Population estimates of Australian children's exposure to food and beverage sponsorship of sports clubs

Coca-Cola's "Together We Move" Promotes The Nutritionally Indefensible

So what do you do if you're a company whose flagship product packs a massive caloric punch while providing virtually nothing redeeming in the way of nutrition and the world has started yelling about your company's product's role in rising rates of diet and weight related illnesses? Why you buy sport of course.

I mean what else could you do? Your product isn't defensible nutritionally, and that coupled with that same product's absolutely merciless marketing means you've got to deflect attention.

And what better deflection than sport? Sport is healthful, which may, by extension, lead people to think of your flagship product as less awful, ties your company's branding to the joy associated with exercise and competition, infers that diet and weight related diseases are not your product's fault but rather the fault of individual inactivity, opens the door to marketing directly to children, and allows you to claim that you're doing your part to help when facing product unfriendly legislation which you're working tirelessly to forestall.

If I were that company's CEO, I'd do the same. What other choice would I have?

Whoever at Coca-Cola managed to put together their Together We Move program and its subsequent purchase of sport in Europe, sadly they deserve a raise.

6 Year Old Tapped to Help Develop Coca-Cola's Latest Ad Campaign

And really, why wouldn't Coca-Cola tap a 6 year old given that the target market for cartoons are in fact children.

Here's the development team from ad giant Wieden+Kennedy explaining how a 6 year old's input helped shape Coca-Cola's new spot by informing the world view of an adorable mutt,

"Sure, occasionally one (dog) dials 911 or wins America’s Got Talent, but for the most part, dogs are idiots. That’s why we love them,” explained Todd. “They have the curious, imaginative minds of a six year old–specifically mine–who thinks every stick is excalibur, every bit of string is a lightning whip,” added Kylie. “Dogs don’t see a heap of two-week old laundry; they see a castle ready to be defended, then napped in. Where we see a cumbersome vacuum cleaner, they see an alien robot loudly singing its home planet’s anthem. At least that’s what my six year old told me.”

For their part, Coca-Cola regularly and staunchly denies targeting children with advertising.

So have a peek at the screencap above, and watch the ad below, and then you tell me, what demographic do you think this ad is designed to appeal to most?

Double Standards for Conflicts of Interest at the BMJ

On April 8th, an editorial was published in the British Journal of Sports Medicine (published by the BMJ). The editorial had to do with the fact that exercise doesn't seem to help much with weight loss and consequently, we should probably stop tying the two together - and it's an opinion I share.

But today I'm not blogging about the editorial or about exercise, but rather what happened next.

Shortly after the article was published, it was removed following, "an expression of concern".

A few weeks later and the article's back up, and according to the journal, the concern had to do with two undeclared conflicts of interest. One author did not disclose that he is a paid advisor to Atkins, and another did not disclose that he wrote a diet book.

Curiously, on March 13th, just 3 weeks prior to the publication of this piece, another editorial, this one positing that in fact it is a lack of exercise that is driving obesity, was published by the very same British Journal of Sports Medicine.

That piece, authored by Steven Blair, Gregory Hand, and James Hill, have no author declarations of conflict whatsoever (though it does point out that the organization the editorial is announcing was funded by Coca-Cola). Yet Blair and Hill together have authored 21 books on the importance of exercise, and a quick Google search for both certainly reveal very close relationships with Coca-Cola (including this recent $2.5 million grant from Coca-Cola to Blair and Hand on the very subject of their editorial), along with a bevy of board appointments to organizations whose interests would be benefited by interest in "energy balance".

Leaving me to wonder three things:

1. Who submitted the "expression of concern" to the BMJ?
2. Should the BMJ be doing a better job exploring authors' conflicts before publication?

and,

3. Are these sorts of conflicts important to disclose?

Saturday Stories: Baltimore, Overkill, and Cancer Greeting Cards

The Wire's writer David Simon in The Marshall Project on the anguish of Baltimore.

Atul Gawande in the New Yorker on what he calls an avalanche of unnecessary medical care.

Kristin Hohenadel in Slate highlights Emily McDowell's line of greetings cards - the ones she would have wanted to receive while undergoing her own treatment for cancer.

The World's Best Rendition of the ABCs?

Today's Funny Friday is a definite maybe for best ABCs.

Have a great weekend!

Will Weighing Yourself Daily Help You to Lose More Weight?

That's what a recent study seemed to show....or did it?

The study, Weighing Every Day Matters: Daily Weighing Improves Weight Loss and Adoption of Weight Control Behaviors, is one that I'd have rejected if I were involved in its peer review.

The reason's simple.

The study retrospectively looked at frequency of weighing among just 47 patients who were asked to weigh themselves daily on scales that transmitted data back to the researchers. They were also provided with a weight loss program. Effectively, there were no controls as somewhat inexplicably, rather than provide the weight loss program to patients who were told explicitly not to weigh themselves daily, the "control" group was a group that was provided with zero instructions on weight management.

The authors found that those weighing more frequently did better.

What the authors did not ascertain was cause and effect as perhaps simply those who were doing better with their weight loss effort weighed themselves more frequently.

My experience with thousands of patients says that they did, and that conversely, those who knew they weren't doing so well, were actively avoiding the scale because they didn't want to see it.

Anyone who has ever struggled with weight and gone on a diet will tell you scale seduction and scale avoidance are very, very, real.

Exploiting The Most Powerful Emotional Branding Opportunity Life Has to Offer

Thanks to Jean-Claude Moubarac for sending along this partnership between Mondelēz owned chocolate bar Milka and ultrasound clinics in Buenos Aires.

Apparently it was a promotion of a new chocolate bar flavour and the bars were provided to women to be consumed immediately prior to undergoing a 3D ultrasound of their unborn child.



I honestly can't imagine a more powerful branding opportunity for Milka, but where I'm stuck is figuring out what was in it for the ultrasound clinics?

Anyone reading from Argentina who can shed some light, please shoot me a tweet or leave a comment over on Facebook?

[Thanks to Luis for uploading some subtitles to the ad. Even more exploitative with them.]

Minute Maid Orange Juice and a Masterclass in Leanwashing

Today I've got another amazing video for you. It's from Minute Maid and truly, every parent needs to watch it.

Parent need to watch it not because it has anything to do with Minute Maid orange juice, a product that can be thought of as flat Coca-Cola with a tiny smattering of vitamins (as drop for drop Minute Maid and Coca Cola have virtually identical sugar and calorie profiles), no, parents need to watch it because it's genuinely great.

While juice is totally fine to give your kids as a treat (as far as how often and how much I'd recommend giving them no more juice than you would soda pop), giving it to them regularly wouldn't be a practice I'd think is fairly describable as the campaign's #doinggood, nor is juice something I'd describe as being full of goodness. Full of sugar maybe, but goodness not so much.



Oh, and if you think I'm kidding about their push of juice as "goodness", take 30 more seconds and watch the campaign's companion video:

Amazing Aussie Video Explains Why Serving Sizes Are Nonsense

Now this is a terrific video.

It helps to explain why serving sizes, as posted, can be incredibly misleading.

But interestingly, it ends with a call to accept the Australian Dietary Guideline's serving sizes as "right". Personally "right" is a bit ridiculous too. There are lots of variables that affect dietary intake. Sure, I think serving sizes should reflect real world consumption patterns and that having some sort of more realistic reference frame would be useful, but telling people that 12 French fries are a serving, is a recipe to have that person ignore the rest of your dietary advice as well.

Have a watch. Truly, it's worth one.

Saturday Stories: Beans, Radioactive Water, and Pap Tests

Jack Aldwinkle on Quartz covers the cross-bred bean that might help feed a warming planet.

Alex Hutchinson in the New Yorker wonders whether or not we should be worried about radioactive Fukushima water?

Tara Haelle in NPR on the fascinating and challenging nuances of cervical cancer screening.

South Park Takes On the USDA's Dietary Guidance

Thanks to blog reader Kristy for sending me today's Funny Friday serving of the USDA's dietary guidelines. While I'm not espousing the accuracy, I do think it illustrates much of the tenor of discussion today.

Have a great weekend!


The USDA Finally Got The Food Pyramid Right from Raudne Tervis on Vimeo.

Flowerly Words, Horoscopes, and the Culture of Magical Belief

The other day I had a piece published in the Globe and Mail about the shortcomings of Canada's Food Guide.

Hearteningly, the piece was hugely popular, meaning the public seems to actually care about the Guide which to me at least, offers hope that when it's next revised, Canada will be watching rather carefully which in turn might influence both the process and the outcome.

During the day I received an email pointing out to me that my piece was the most popular piece in the paper. I asked how that person knew and they pointed me to a ranking posted on the paper's website sidebar.

I had a peek at that same sidebar yesterday morning.

Want to know what the most popular piece in the paper was?

The horoscope.

Papers still publish horoscopes?

No doubt horoscopes alone aren't to blame, but is it any wonder that Dr. Oz can have a show promising miracles with flowery words if magical belief and thinking is popular enough not only for the public to read about it, but for reputable newspapers to publish and enable it as if both normal and real?

Australian Grade School Targeting Kids' Liquid Sugar with Water Only Policy

Liquid calories, and especially those that are sugar-sweetened, are the lowest hanging fruit on the tree of dietary improvement.

Whether for control of calories, or as a means to reduce consumption of free sugars, getting juice and sugar-sweetened milk out of our kids schools, a place where they spend the majority of their weeks' waking hours, might have an impact.

In that vein, Merrigum Primary School in Australia recently announced it had become a "Water Only School", the principles of which include:

• Ensuring drinking water is available to students at all times.
• Permitting children to bring only water to school.
• Providing no sweet drinks through lunch orders or canteens.
• Ensuring staff model the behaviour by not bringing sweet drinks to school.

And as far as the water goes, there are no bottles - it's all tap!

Personally, I love this initiative, and hope it spreads, but I also know that many might see it as overly controlling. Perhaps at the very least schools could be "Water Only" in terms of the liquids they offer/sell to students on campus which in turn would leave it exclusively to parents to decide what to send.

[Thanks to Rosemary Rich for sending this my way]

Don't Forget, Almost No One Clicks Your #SoMe Links

I've done enough posts now about the dangers of Twitter and social media that I've decided it's worth a blog tag (#SoMe), and so here's the latest.

When you send out a Tweet, please don't forget that the vast, vast, majority of your followers aren't going to click your link (and those that do click, the vast, vast, majority of them probably won't actually read the article they click to). Even if you consider every single Twitter user "engagement" as a link click, I'd bet that for most of your tweets, 5% or less will actually bother to click through.

What that means is that if you're a trusted authority, you owe it to your followers to ensure that your message is the message of the tweet itself. Meaning sharing a hyperbolic headline, or the title of a weak study, without your own qualification in those 140 characters, may lead your followers to believe the hyperbole or that the crappy study you linked to because it was "interesting", was in fact important.

Bottom line, if you think a study's hugely preliminary, say so. If it's an animal model, say so. If you haven't read the actual study, say so. And if it's just bollocks, please don't link to it at all.

Curious about your Twitter Analytics, click here and have a peek.

Saturday Stories: Skin, GMOs, and Forensics

Desmond Cole in Toronto Life explains his life in the skin he's in.

Mark Lynas in the New York Times discusses his conversion to becoming pro-GMO.

Dahlia Lithwick in Slate horrifies with her story on decades of knowingly false FBI forensics.

Does Your Cat Need Braces?

Loved this Funny Friday video about what a visit with a completely honest veterinarian might be like. It's tongue in cheek of course, but some of it sure rang true for me.

Have a great weekend!

Guest Post: Why This MD Can No Longer Be Called Dr. Dum Dum

Many months ago, pediatrician Kevin Wineinger, reached out to me to let me know of a battle he'd be waging - the battle to change his office's practice of providing lollipops to children following their vaccinations. I asked him if he might take a moment to share his story with you. Reading it, keep in mind the fact that no single raindrop thinks it's responsible for the flood. Here's to one less raindrop.

As a primary care physician with a special interest in tackling obesity, I spend a large portion of my day pointing out the obstacles between my patients and a healthier lifestyle. In the United States, these stumbling blocks are everywhere and often cloaked in legitimacy by people or groups that hold sway over consumer confidence. Say for instance, the placement of a seal of approval by The Academy of Nutrition and Dietetics on a Kraft Singles package. I rant and rave to anyone within earshot when I see this happen in my town or on social media.

Until this fall, I was the pot calling the kettle black. I was a Dum-Dum dealer.

Dum-Dums are a 25-calorie lollipop with a waxy wrapper, paper stick and a host of delightful flavors. Last year, an assortment of Dum-Dums were available at our clinic’s checkout desk and were the reward for many a teary-eyed toddler following their immunization.

The irony of our post-vaccination lollipop dawned on me last summer. In one room, I was passing out tips on how to navigate our obesogenic environment with an adult patient who had diabetes and obesity. In the next room I would counsel a 4 year old’s parents on the importance of food choices at this age.

“The growth charts are important and are a component of our discussion regarding food intake, but more importantly you and your family are establishing life-long behaviors pertaining to food.”

  -Dr. Kevin Wineinger (that is me) mere seconds before I offered a lollipop if they were brave for their immunizations.

Duh. Wrong message, bad role-modeling. I was sending the signal that tears and sadness could be washed away by junk food.

I knew what I had to do. I was going after the lollipops.

I was ready to support my position of a lollipop-free clinic and prepared for fierce resistance from my colleagues on our Office Improvement Committee. When I had the floor during the meeting, I delivered my request to remove lollipops and replace them with stickers. I was met not by resistance or acceptance, more like ambivalence. Someone suggested we finish out the lollipops already purchased. I offered to buy them. They relented. Motion passed.

After a period of adjustment, our clinic is now lollipop-free and everyone seems happy with their Captain America and Elsa stickers. Our vaccination rates have not plummeted, nor have our patient satisfaction scores. In fact, some parents were happy with the change because the Dum-Dums often made a mess or caused fights between siblings.

Obesity is obviously multi-factorial and studies to identify the effects of small interventions such as lollipop removal will not likely produce significant results. Additionally, many would argue that a 25 calorie treat after a yearly vaccine is a drop in the calorie bucket and has no impact on their long term health. However, this type of reward runs contralateral to many of our recommendations regarding snacks and their usage in behavioral modification. Progress in our march toward a more reasonable food environment will be marked by numerous small victories that seem inconsequential to most people at the time.

Dr. Kevin Wineinger is a Family Medicine physician in Central Indiana, who has set his sights on the 500 calorie snacks and juice drinks passed out to his son’s Little League team after the game. Seriously!?!? You can find him on Twitter!

Do You Think the American Lung Association Would Mind Tobacco Sponsorships?

I think they might.

I mean let's say for a moment that the American Diabetes Association decided to launch a fundraiser and they took money from Philip Morris, Altria, Reynolds American, Inc. and Imperial Tobacco.

I'm pretty sure they'd get some flak for that, and probably some directly from the American Lung Association (ALA).

Coming from the American Lung Association however, it'd be rather hypocritical flak.

Was watching my Twitter feed this past weekend and came across the American Lung Association's Fight for Air Climb fundraiser. According to them it's,

"one of the American Lung Association's signature fundraising events. With events in more than 65 cities, participants young and old climb to raise funds in support of the mission of the American Lung Association: to save lives by improving lung health and preventing lung disease."

Some of the event's sponsors?

• Coca-Cola
• Dunkin Donuts
• The Krystal Company (a burger joint)

I know the food industry's money's as green as everyone else's, but clearly, as we've seen with tobacco, lines can be drawn regarding whether or not the means justify the ends.

A Bunch of Photos of Coca-Cola Not Marketing to Kids

Coca-Cola Vienna City Marathon (Austria)

Or maybe they are marketing to kids.

Clearly they're photos of Coca-Cola's involvement and sponsorship of kid sport. But marketing?

Yup.

Not that it's exactly news that corporations sponsor sport because it's good marketing, but it was news to me at least that Coca-Cola was transparent about their involvement therein calling it quite plainly, "sports marketing".

So here are some more photos of Coca-Cola's sports marketing. Marketing that's clearly targeting the kids they always deny targeting (though it's true, some of the kids here look 12 years old, which according to Coca-Cola, means they're no longer children and hence fair game).

Coca-Cola's Powerade Final Four Dribble Event (USA)

Coca-Cola Soccer Camp (Brazil)

Coca-Cola "What's Your Sport" Campaign (Serbia)

Coca-Cola Cup (Poland)

Coca-Cola WNBA Fit (USA)

Greek Ministry of Health Taps Coca-Cola to Teach Kids Healthy Living #NottheOnion

From the #NotTheOnion files comes this partnership whereby Greece, under the auspices of their Ministry of Health and supported by their Ministry of Education, has been teaching Greek schoolchildren a healthy living curriculum designed by Coca-Cola.

Want to guess what's being taught?

Hydration, lots of hydration (it's both the base of the program's pyramid, and coincidentally, also the base of Coca-Cola's profits), followed by a hefty dose of "energy balance" - burning the right amount of calories to "balance" those going in.

Truly, you couldn't make partnerships like this up.

Saturday Stories: Doonsebury Hebdo, Zombies Run!, and The Fermi Paradox

David Frum, in The Atlantic, covers Doonesbury's Gary Trudeau's victim blaming over at Charlie Hebdo.

Naomi Alderman, via Medium, covers how and why she, a woman who refers to herself as a fat girl, created a best selling fitness app (one which I BTW use regularly and adore - thanks Naomi!)

Tim Urban will scramble your brain in The Fermi Paradox where he ponders the many possible reasons why we haven't met E.T. yet.

What The Hell Are Your Upstairs Neighbours Doing?

Even if you've never had an upstairs neighbour, today's Funny Friday will be enlightening.

Have a great weekend!



[Hat tip to our office's DOO Lorne Segal]

Climbing Stairs Isn't About Burning Calories

Have you seen the photo up above floating around your Twitter or Facebook feeds?

I sure have.

And yes, you do burn calories climbing and descending staircases. 0.17 calories per stair climbed, and 0.05 calories per stair descended, according to one source I found. Given there are 12 steps in the average flight of stairs, heading up and then back down would burn you somewhere between 2.5 and 5 calories. So for instance, if you wanted to climb the stairs enough to burn the calories of a Snickers bar, you'd need to climb 122 or so flights.

The message that calories can be burned through stair climbing (or parking in the furthest spot, or getting off the bus one stop sooner, etc.) in quantities enough to be exciting is problematic in that it reinforces the erroneous notion exercise burns boatloads of calories which in turn might lead a person to more readily believe that taking stairs burns enough calories to justify treats or portion sizes they'd otherwise not consider. It also runs the risk of a newly motivated person deciding to stop taking the stairs and parking further away when their weight inevitably doesn't change as a consequence.

And stopping taking the stairs would be a shame given that when it comes to health, exercise is the world's best drug - it's just not a weight loss drug - and tying stair climbing (or any exercise) to calorie burning rather than health, misinforms the public about both.