Saturday Stories: Willpower, Crosswords, and Conference Questions

Daniel Engber in Slate asks whether or not one of the world's most cited willpower experiments was just BS.

Oliver Roeder in FiveThirtyEight covers the scandalous world of crossword plagiarism.

Dave Levitan in Slate with a piece that rings so unbelievably true to me about audience "questions" at conferences.

Today's Funny Friday Video is a Mere 5 Seconds Long

But they're quality seconds.

Have a great weekend!

How Is It Possible Reebok Banned Soda Sales Before Hospitals Did?

Seriously.

Today Reebok announced that it'll no longer be selling soda at its headquarters. Why? Here's President Matt O'Toole,

“The goal for us here at Reebok is simple - to be the very best fitness brand in the world and to inspire everyone who touches our brand - consumers, fans, and employees – to reach their potential. And our mission starts right here, with our own people ... we felt removing sugary products from our HQ was simply the right thing to do. As a fitness company, we know how important it is to move – to use our body as it was meant to be used - but what we put in our bodies is equally as important.”

That hospitals haven't yet figured this out is beyond shameful.

Nothing Will Change If You Change Nothing

There's no denying the fact that change is difficult.

Whether you're hoping to improve nutrition, weight, fitness, relationships, work, school, parenting - truly whatever - change itself, and not necessarily the actual changes, is the real challenge.

Finding motivation is also relatively easy, at least when compared with maintaining motivation, and therein hunting for small victories, building a system that reminds you of the changes you're trying to adopt and why you're trying to adopt them, these can go a long, long, way.

Recently my friend (and husband to the world's greatest literary agent) Brad shared a video with me about a man, his dog, and sustained change.

It's definitely worth a watch.

Canada's Senate Set to Tackle the Food Industry

Last week saw the publication of the Canadian Senate's Report Obesity In Canada A Whole-of-Society Approach for a Healthier Canada. My friend and colleague Dr. Arya Sharma criticized the report for not recognizing the pervasive and damaging nature of weight bias in Canada, and on this he and I strongly agree.

But Dr. Sharma voiced more concerns, broadly, that the report did not focus sufficiently on the treatment or research of obesity, and that it's stuck in the "Eat-Less Move-More" paradigm.

On these two points we both agree and disagree.

On treatment, the primary challenge is that there simply isn't a gold standard non-surgical approach to champion. The secondary challenge is that even were there such an approach, there's a dearth of physicians and allied health professionals trained and interested in delivering it. To that end I was encouraged to see the report's recommendation calling for improved physician training in nutrition and exercise - a need I recently wrote about, and to promote the use of counselling to help (a call that may relate to remuneration).

On research, I wholly agree with Dr. Sharma, it was surprising not to see a call for investment in studies and research meant to inform future best practices, both in terms of obesity treatment, but also prevention and public policy.

On Eat-Less Move-More, here I can't fully agree with Dr. Sharma's concerns. Ultimately eating less is required if we're to see changes to weight, and moving more is required if we're to see health risks mitigated, and there is a role for education and support of the public eating less and moving more directly. And had the Senate's report focused solely on the individual as the driver of change, I would have been equally disappointed, but that's not what their report does.

Instead the Senate's report focuses primarily on the food industry's direct and indirect influences on consumer choice.

The report's recommendations include:

• Banning food and beverage advertisements to children (where food advertisements have been proven to increase kids' eating)
• A sugar sweetened beverage tax which in turn may help both to decrease consumption due to economic considerations, and potentially to raise funds that in turn might further healthful eating or obesity treatment/research (I would be very disappointed were a tax enacted without some mechanism to ensure at least some of the funds raised would be earmarked for health)
• Improving access to nutritious food in Canada's northern communities (places where the exorbitant costs of healthful foods may preclude their purchase)
• Revising Canada's Food Guide to adopt a meal based approach and to have the guide speak strongly against the consumption of ultra-processed foods (and in so doing lay the groundwork to remove front-of-package health claims and the notion that juice is a fruit equivalent)
• Ensuring that the revision of Canada's Food Guide excludes the direct involvement of food industry representatives (which will help to ensure the recommendations are evidence, and not interest, based, where food industry interest always favours increased, not decreased, consumption patterns)
• Ensuring that the revision of Canada's Food Guide looks specifically at the science (or lack thereof) underpinning its excessively saturated fat phobic stance and that it changes the serving based focus that both nutrition professionals and the public have deemed confusing and unhelpful.
• Reforming our current system of front-of-package health claims (which will help to reduce the health haloing of ultra-processed foods)
• Exploring the possibility of using a unified front-of-package rating system (which in turn has been shown with some systems to improve dietary choices)
• Adding menu board calories in chain restaurants (which will help to inform, but not dictate, consumer choice)
• Creating a public awareness campaign on healthy eating that specifically calls out ultra-processed foods and champions cooking (could there be a report on nutrition or obesity that didn't include a public education component?)

Again, back to Dr. David Katz' sandbag analogy. We have a flood. To date, as a society, Canada has focused primarily on the encouragement of swimming lessons to fight the current, and while swimming lessons are always worthwhile (and indeed included in this Senate report as well), here we finally see an arm of government calling for the building of a levee against one of the flood's primary sources - the food industry.

Happy to see this, and it's about time.

Saturday Stories: Shuttle Engineers, Muslim Soldiers, and Not So Safe Spaces

Major Alaa Waheeb

Howard Berkes, via NPR, on how listeners' letters in response to a story on the Challenger disaster helped to sooth now 87 year old, former Challenger engineer Bob Ebeling's misplaced guilt.

Anthony Berteaux, in The Tower, covering University "safe spaces" that are safe for everyone but Jews.

Major Alaa Waheeb, in Jewish News, speaks passionately about his experiences as at once an Israeli, an Arab, and as Israel's highest ranking Muslim officer.

Bad Lip Reading Meets Ted Cruz!

Oh, today's Funny Friday is fabulous. And frankly, I think the bad lip reading version of Cruz' ad is more effective and compelling than the original.

Have a great weekend.

Oh, and #MakeDonaldDrumpf again!

"To Assist In Achieving Goal Patient Was Given: Nothing" #MDFail

Yesterday Canada's Senate released their report on obesity which focused primarily on prevention. I'll likely review that some next week, but today I want to talk about how physicians are approaching obesity in their offices. The short answer is not well.

Bluntly, it's not just that the average doctor isn't skilled in treating obesity, it's that the average doctor doesn't treat obesity.

That photo up above, that's the actual chart note, provided by an actual physician, to a friend of mine with obesity who had gone to see them for help.

The note's pretty clear in terms of why she was going to see the MD - her goal as stated was to weigh less than 200lbs.

The MD noted her barriers, reviewed them with the patient and then, the kicker.

"To assist in achieving goal patient was given: Nothing"

You shouldn't be surprised though. Physicians can't treat conditions they aren't taught to treat, and obesity medicine is incredibly underrepresented in the medical curricula of both medical schools and medical residency programs.

And it's not just obesity medicine that's not being taught to our future physicians, they're also not being taught about nutrition or physical activity.

One recent study of Canadian medical students highlighted the fact that the majority of those polled not only weren't comfortable in discussing nutrition with their patients, but that they also weren't taught how to identify credible sources of nutrition information.

Another recent study, this time of American physicians, found that more than half received no formal teaching around physical activity and consequently, may not be prepared to counsel their patients on how to adopt exercise safely and realistically.

And yet lifestyle, made up in large part of nutrition and physical activity, has been said to help prevent or treat an estimated 80% of chronic non-communicable diseases.

Putting the how we got here question aside, reading that physician's note I couldn't help but wonder whether the MD who wrote it was struck by the cruel poetry of its last line, as in just 9 words he or she pretty much summed up how most people with obesity feel about the help their physicians have offered.

Got Spin? Dairy Farmers of Canada Talks Sugar With The Senate

Chocolate milk brochure and colouring book sent home this year with Ontario kindergarteners as part of  the Elementary School Milk Program

Unless you're a subscriber to Blacklock's Reporter you probably didn't see this story, but last week Canada's Standing Senate Committee on Agriculture and Forestry met to discuss market access to Canada's agricultural and forestry products.

Invited to this particular chat were representatives from Dairy Farmers of Canada including their President Wally Smith, and their Executive Director Caroline Émond.

During the discussion, Nova Scotia Senator Kelvin Ogilvie, took issue with the way the Dairy Farmers of Canada represented the sugar in chocolate milk in the materials presented to the Committee,

"I came across some remarkable statements about the amount of sugar and the fact that the sugar in chocolate milk is not an issue and we shouldn't be concerned about that. It shocked me, quite frankly, because sugar is a serious contributor to the obesity problem that we have in Canada and around the world.

Just to take a quick example, a 250 millilitre glass — that's one quarter of a litre, for those of you who want to follow this — of chocolate milk, 1 per cent, has 160 calories and contains 25 grams of sugar. A glass of Coca Cola of about the same size is 100 calories and 26 grams of sugar.

Now I understand there are other things in the glass of chocolate milk, but the idea that you can state unequivocally in here that there should be no concern whatsoever about the sugar in chocolate milk astounds me. It would take an ordinary person in ordinary exercise approximately an hour and a half to work off that many calories. It would take a vigorous workout to do it in half an hour. The issue is not just the amount of calories; it is in fact the amount of sugar. They are empty calories, they are high calories and they contribute negatively to health overall.

I was startled to see that. I happen to like chocolate milk, by the way. I had never seen a statement such as that and I'd like your reaction."

The non-answer provided to him by Ms. Émond didn't satisfy Senator Ogilvie and he minced no words calling her on that,

"You have spoken to obfuscate the issue, and I congratulate you on that.

In the basic white milk, there is far less sugar, so you actually have significant added sugar in here, and it is the added sugars, absolutely, that are the very serious issue."

Ms Émond responded that she understood Senator Ogilivie's concerns, and perhaps tried to reassure him by explaining that Dairy Farmers of Canada markets chocolate milk responsibly - to athletes,

"We position chocolate milk as a sport recovery beverage. It's a great positioning and it works well with athletes and sporting people who are using chocolate milk as a recovery beverage instead of energy drinks, which are, again, empty calories. We try to position the product in the best possible light. I understand your concern."

Huh?

I wonder how Ms. Émond and Dairy Farmers of Canada would explain all the photos on this page?

You see they're all photos of the marketing materials that Dairy Farmers of Canada recently distributed to elementary school children and their parents as part of their Elementary School Milk Program.

And front and centre in those materials that are marketed to Canada's youngest school children and their parents are the very claims that shocked Senator Ogilvie. And not only are the claims front and centre, but the brochure itself is clearly designed to position chocolate milk preferentially over white milk with 3 of the 4 pages of the brochure literally being brown (with only the back of the brochure promoting white milk), and the line, "Get your child off to a great start" framing a carton of the chocolate stuff.

The inside of the chocolate milk brochure up above

There's no denying that Dairy Farmers of Canada are doing their best to position chocolate milk as a recovery beverage to athletes, but there's also no denying that they're positioning it to children and their parents as health food. A positioning echoed by the brochure sent home with children last year.

Kindergarteners and elementary school children aren't athletes. Chocolate milk isn't health food. And Dairy Farmers of Canada, if their statement to the Senate was meant to suggest that they don't market chocolate milk to anyone other than athletes, are plainly lying.

[Thanks to Blacklock's Reporter's publisher Holly Doan for sharing the Senate transcript with me - I will attach a link to the full testimony once it's posted on the Senate Committee's webpage]

Saturday Stories: Sexual Assault, Gene Editing, and Over-Ambition

Molly Redden, in the Guardian, introduces us to the amazing 24 year old who could change how the US handles sexual assaults.

Erika Check Hayden in Nature ponders the ethics of editing your children's genes.

Erica Reischer in The Washington Post explaining why she thinks telling kids they can be anything they want to be may not be wise.

Did You Know That Canada Is In America's Presidential Race?

You know America can, and terrifyingly maybe will, do worse.

Today's Funny Friday is Canada's first ad in pursuit of the presidency.

Have a great weekend!

Vending Machines Earn Schools Way Less Than You Might Expect

Had a nice chat with a local school principal the other day about vending machines.

Their school has 5 vending machines serving 800 students. They made the school $2,000 last year, a number which is small not because sales are small, but rather because the school's cut is only 20%.

That's just $2.50 per student per year to sell them school sanctioned junk food.

And really, they are selling junk.

Despite Ontario's school food policy when this principal explored their school's vending machine options they discovered that despite explicit policies banning the sale of sport drinks, chips, etc., that's precisely what they were stocked with (actual photo up above and down below).

When I inquired as to the how and why I was told that the vending machine company fills up the machines, and that without enforcement, and despite some fanfare when the new Ontario school food policy was released, the vendor decided they didn't care. This principal had the company come back in and swap out the stuff that wasn't supposed to be there.

Now I've written before about how I think that baked chips are probably worse than fried due to the false impression provided that the chips are now somehow healthful, but putting that aside, what good's school food policy if no one enforces it?

Moreover, if school vending machines earn just $2.50 per student per year, what's the point of the machines in the first place? Whether by way of empty bottle drives, plant bulb sales, walkathons, or more, $2.50 a student isn't a particularly high bar to clear to get junk out of our schools.

Welch's Study Finds Grape Juice Makes You Smarter #NotTheOnion

Oh, and a better driver.

Really.

The findings were part of a study published ahead of print in the American Journal of Clinical Nutrition. The funded at least in part by Welch's study, Concord grape juice, cognitive function, and driving performance: 1 12-wk, placebo-controlled, randomized crossover trial in mothers of preteen children, started with 25 participants randomly assigned to consume 1.5 daily cups of Concord grape juice (containing 233 calories and more than a quarter cup of sugar (13.5 tsp)), or an energy and sugar matched non-concord grape juice "placebo" for 12 weeks followed by a cross-over of treatment arms.

19 participants described as "working mothers" completed the battery of cognitive tests, and 11 sufficiently completed driving simulations. Outcome measures for cognitive function included the number of correctly identified sequences, false positive responses, reaction times, a grooved pegboard assessment of manual dexterity (fill the holes with the pegs), and "Tower of Hanoi" testing. Outcome measures for driving performance included a 25 minute virtual driving scenario.

Now up front I should disclose I'm neither a statistician nor an expert in cognitive function testing so please consider that with my assessment. Ultimately, within the battery of tests (and there were plenty), a few in fact were found to show a statistically significant improvement in favour of the grape juice - most with p values of 0.05. Of course, do enough tests, and chance alone will dictate one will turn out to have a p value of 0.05. Putting that aside, I also can't help but question the significance, even if true, of for instance completing a psychomotor skill test in 60.4s vs. 63.2s (P < 0.05), or as it would pertain to driving, a "car following" accuracy of 0.96 vs 0.97 (P = 0.05).

Sounds like the authors may have wondered the same given their use of the word "subtle" in describing the improvements and their proviso when considering the battery of tests that were run,

"it is important to acknowledge that there were no effects on most cognitive outcomes".

Not surprisingly, that proviso did not stop Welch's from putting out a press release that opened with,

"New research by the University of Leeds in the UK suggests that drinking Concord grape juice daily can benefit certain aspects of memory and everyday tasks in people with stressful lifestyles – specifically working mothers".

So there you have it - the 13.5 teaspoons a day of sugar way to just barely, sort of, in a very small number of very specific tests, as revealed by an incredibly small sample size, make yourself smarter and a better driver.

[And to consider too - did these, acknowledged even by the authors to be meagre, findings really warrant publication in the American Journal of Clinical Nutrition, a journal with an impact factor (nearly 7) higher than roughly 95% of all other scientific journals, and one that was selected by the Special Libraries Association as one of the top 100 most influential journals in Biology and Medicine over the last 100 years? And/or does this just speak to impact factors' lack of utility?]

Saturday Stories: Selling Sugar, Complementary Medicine, Bullshit, and a Video

CSPI's summary of their report on how soda companies, facing sagging sales in North America, are turning to the developing world to sell sugar.

Pharmacist Scott Gavura in Science Based Medicine asks if it's ethical to sell "complementary" medicine.

Brian D. Earp in Quillette on "the unbearable asymmetry of bullshit"

And a bonus video from Dr. Trish Greenlaugh on "Real Rubbish vs. Evidence Based Medicine"

Don't Go To Jamba Juice, But Do Watch This Video of Adele at Jamba Juice

Today's Funny Friday involves Adele, with Ellen in her ear, pranking some hard working folks at Jamba Juice.

And if this tempts you to head to Jamba Juice, don't forget that many smoothies there contain the calories of Big Macs and pack in the neighbourhood of half a cup of sugar.

Have a great weekend!

RDs Gather in Peru For Secret Food Industry PR Conference

Yesterday was the last day of this year's Food 3000 conference held in Lima, Peru. The conference is for RDs and other nutrition influencers. In previous years, the conference, as pretty much all conferences are, was shared widely by way of hashtags, tweets, Instagrams and Facebook posts. This year however, there's silence. The word is that attendees were expressly told not to share their experiences. While clearly I can't tell you what's going on there this year, I thought I would take the occasion to bump up a post I wrote back in 2014 that covered that year's Food 3000 conference. Given the sentiment these days on the merits and risks of food industry partnerships, I can't say it's surprising to learn that industry sponsored conference organizers would prefer secrecy.

The conference organizer is quite transparent BTW. Here's how they describe their role in working with RDs, and presumably the aim of this clandestine conference,

"The Porter Novelli food practice not only knows how to reach influencers, we are the influencers. Our team has seats on influential panels for the Institute of Food Technologists, Food Marketing Institute and the Academy of Nutrition and Dietetics to name a few. We have an in-house team of registered dietitians as well as a global network of influencers and researchers with whom we develop award-winning strategies and campaigns for our clients."

Here's that 2014 post:

Those of you who follow various nutrition professionals on Twitter have no doubt seen the #F3K hashtag these past few days.

Briefly, the #F3K hashtag stems from an annual influencers conference run by Porter Novelli, a multinational PR firm that boldly (and rather creepily) exclaims,

"We motivate people to change deeply ingrained behaviors rooted in cultural and social norms. Our results are greater than influencing people. We make them believe"

And here's Porter Novelli describing their annual PN Food3000 (#F3K) conference),

"We boast long-term relationships with the individuals and organizations that influence consumers’ attitudes, beliefs and behaviors related to food and health. The Food and Nutrition practice annually hosts PN Food3000, at which American Dietetic Association media spokespeople are exposed to the latest innovations and research in nutrition communications. Our team of expert communicators and registered dietitians helps clients devise intelligent strategies to introduce new products or line extensions against well-chosen market segments, including multicultural audiences. We are skilled in developing platforms that create a point of differentiation, establish strategic alliances and sponsorships, grow consumption and position brands for new growth segments."

And judging from the tweets emanating from this year's #F3K that took place in Amsterdam, they've done a bang up job and the sentiment from many non-attending RDs on Twitter is that those who did attend did so at least partially on the conference's industry sponsors' dimes.

I'm going to post these tweets without commentary. Most come from RDs at the conference, many of who boast large social networks and presumably are Academy of Nutrition and Dietetic spokespeople . And to be clear, the tweets are my own quick cherry picking. They're not meant to disparage or shame those who tweeted them (in many cases they're just quotes from speakers), but rather for readers here to consider the wisdom of these sorts of conferences and their promotion, as well as whether the hashtag #spon is sufficient to explain to the public that the tweets come from food industry sponsored talks (it wasn't for me - I had to ask someone what it meant).

[BTW - I did ask Porter Novelli for further information regarding sponsorship and program. They have yet to send a response. I can only suppose then that transparency doesn't make for good PR.]

Bravo! RT @CBDiekman: Congrats to #Mars international for working to increase kids interest in cooking and healthy eating. #F3K #spon
— joansalgeblake (@joansalgeblake) February 17, 2014

Check Your Facts: "Epidemics" are contagious & obesity is not contagious, so it's not an epidemic. Paul Rozin at #F3K
— Robyn Flipse (@EverydayRD) February 17, 2014

"Processed foods are not the problem - maybe they are the affordable solution- we just have to mk them healthier"DrDecker #F3K #spon
— Bonnie Taub-Dix (@eatsmartbd) February 16, 2014

#F3K is debunking one food myth @ a time #FactsOnly
— shani stjohn (@shanistjohn) February 16, 2014

#f3k #Amsterdam US #nutrition experts discuss how #dietarysupplements can fill in the nutrition gaps even if ya think you're eating right
— carolynoneil (@carolynoneil) February 15, 2014

Gr8t News! RT @CBDiekman: Flavored yogurt sugar content down from 19.5 grams to 12 grams per 100 g. #F3k #spon
— joansalgeblake (@joansalgeblake) February 15, 2014

@MelissaJoyRD @ lots of food joy #F3K Did ya know food processing can increase nutrients we need more of & reduce what we need to limit
— carolynoneil (@carolynoneil) February 15, 2014

We're too quick to blame the food industry rather than telling consumer to take responsibility for their eating habits #F3K #spons
— Mindy Hermann (@MindyHermannRD) February 15, 2014

Healthy eating requires - balance of foods, right portions, & proper prep. Don't worry about "processed" focus on right choices. #F3k #spon
— Connie Diekman (@CBDiekman) February 15, 2014

Processed food is called "unnatural" until there's a "natural" disaster and it's the only thing available & safe to eat. #f3k #spon
— Robyn Flipse (@EverydayRD) February 15, 2014

Good point“@joyofnutrition: Its not about processing but nutrient quality that should be one of the deciding factors on foods we eat #F3K”
— Vandana Sheth RD (@VandanaShethRD) February 15, 2014

#f3k Food processing is just a use of technology. What other technology do you want to give up- cell phone, Internet, infant formula? #spon
— Robyn Flipse (@EverydayRD) February 15, 2014

Processed is not 4-letter word. Some of healthiest foods would not be possible w/I technology. Whole grains just one example #F3K #spon
— Rachel Begun (@RachelBegunRD) February 15, 2014

Select foods that deliver the goods-processing is a vehicle 2 make more nutrients avail #F3K #spon
— Toby Smithson (@diabetesevryday) February 15, 2014

Food fortification plays a role in meeting nutrient needs of Americans. Processing helps enhance & preserve food quality.#F3K #spon
— Connie Diekman (@CBDiekman) February 15, 2014

#F3K "Processed" is not a dirty word. It provides food safety, variety in diet, affordability, palatability & more.
— Melissa Joy Dobbins (@MelissaJoyRD) February 15, 2014

#ActiveAdvice -processing foods allows us to progress not regress with our choices and self health #F3k
— Leslie Bonci (@lesliebonci) February 15, 2014

Myth-shopping on the perimeters of grocery stores are healthier. There are healthy options throughout store. Read labels & go w/ plan #F3K
— Joy Dubost (@joyofnutrition) February 15, 2014

How Dental Floss Can Help You With Weight Management Success

One of the most reproducible findings coming out of successful weight management programs is that attendance matters.

It would seem that regardless of approach, generally speaking, the longer the program and the more regular and frequent the attendance, the better the outcomes.

Though no doubt part of that effect is due to self-selection (people doing better are more likely to continue going), after working with patients on behaviour change for the past dozen years, I can tell you part is also due to what I refer to as the dental floss effect.

You know the one, where when you realize you've got a dentist appointment coming up you suddenly up your flossing game.

All this to say, whether it's a pay-for program, a buddy system, an online coach, or a local support group, having someone other than yourself to check in with may help you in fostering lasting change.

Saturday Stories: Media Bias, Ruining Lives, and Robin Hood

Zenobia Ravji, a Zoroastrian journalist, discusses her experiences in the Middle East and the bias she sees in its reporting.

Tess Owen in Vice covers Motherisk, describing it as the Canadian lab that spent 20 years ruining lives.

Simon Oxenham in Big Think tells the story of the Robin Hood of science who steals from the rich (scientific journals) and gives to the poor (the public).

"Cranberries are, I think we can all agree, nature's most disgusting berry"

Thanks to Dr. Dylan MacKay for reminding me that at 7:40 of this John Oliver piece of sugar, he covers cranberries - "cherries that hate you". Seemed fitting given #Craisingate.

Whole thing's well worth a watch.

Have a great weekend!

Weight, BMI, BF% - Should MDs Measure Things That Shouldn't Change Treatment?

Image Source

Something I struggle to understand is the medical community's (and much of the public's) use of some combination of weight, body mass index, body fat percentages, or waist circumferences as a means to determine whether or not a person might benefit from an exploration of their lifestyle.

While all of those measures to a degree do inform risk, are they really useful to the clinician in determining the need for the exploration of a person's lifestyle? Does it simply follow that if one or more of weight, BMI, body fat percentage, waist circumference or waist to hip ratio is high that said person's lifestyle isn't healthful, or that treatment (lifestyle, meds, or surgery) is required?

A more important question though would be if all of those numbers were in so-called healthful ranges, does that mean your patient's lifestyle shouldn't be explored?

I know plenty of people with weight whose lifestyles are tremendous, and plenty of folks without whose lifestyles are horrifying, and as such, regardless of numbers, clinicians are best to explore lifestyle with every single patient. Artificially hinging a discussion on lifestyle on a number which even with the best of intentions and efforts, might not change much, can both lead a person to abandon their efforts to live more healthful lives when things don't change, and preclude conversations that in turn might benefit your patients and their families.

The goal is the road (a healthful one), there is no destination (the numbers).

Craisins Are More Candy Than Fruit

A strange thing happened last week.

In response to a tweet that included the photo up above that inferred Craisins are a healthful handful of "Nature's Candy", I pointed out that Craisins were in fact candy, as in order to make them palatable, heaps of sugar are added.

That's not the strange part.

The strange part was the somewhat heated debate it seemed to spark on Twitter. One RD wrote to say that though there's more sugar than raisins, there's not that much more (I'll come back to the raisins in a bit), and that she'd certainly choose Craisins over chocolate chips for her trail mix.

So I decided to compare the two.

First, by weight, gram for gram the Craisins have 34% fewer calories than Hershey's semi-sweet chocolate chips (I'd say that's a good thing), but with 89% of the Craisins' calories coming from sugar (versus 46% of calories coming from sugar in the chocolate chips). Interestingly, when compared by weight with chocolate chips, Craisins have 10.5% less fibre (who knew chocolate chips had fibre?), and 18% more sugar.

If we compare them by volume though (as I think volume is probably the way most assemble trail mix), the Craisins come out a bit better still, containing just half the calories of the same volume of chocolate chips and with 10% less sugar. So maybe this RD's got it right - Craisins, as a sugar source for your trail mix, will provide a tiny bit less sugar than chocolate chips and at half the calories.

Next up was an RD who took issue with my use of the terms, "heaps", and "piles", to describe the sugar content of Craisins.

Now it's true that heaps and piles are not formal units of measure, but yes, to me the 5.4 teaspoons of sugar contained in the single serving package of Craisins featured in the original tweet can be fairly described as both a heap and a pile. Another way to consider Craisins' sugar content is to ask how much sugar is found per tablespoon of Craisins? The answer is that 60% of each tablespoon of Craisins is sugar, and therefore piles of Craisins definitely mean piles of sugar.

And now back to raisins. The same RD who didn't like my heaps and piles comment decided also to build a strawman argument (she misrepresented my argument to make it easier to attack) when faced with my answer that yes, 7 teaspoons of sugar per quarter cup serving of Craisins is a pile, and asked me if I was "against" raisins as well.

The answer's yes - if the question is the non-strawman version asking me if I'm also opposed to considering raisins a fruit equivalent.

It's true, unlike inedibly-tart-without-added-sugar Craisins, sugar isn't directly added to raisins, instead it's concentrated in them by way of dehydration. By volume raisins contain 4.17x the calories of red grapes, and 3.7x their sugar, and just one of those little, unlikely to help fill even a child up, 1.5oz boxes of raisins, contains 6.25 teaspoons of sugar representing 77.5% of the raisins' total calories. And they're not exactly nutritional powerhouses either as raisins pack little to nothing in the way of nutrients.

Here's are some breakdowns of the nutrients found in a 1.5oz box of raisins

Whereas a cup full of actual grapes, an amount likely to provide some real satiety, and containing 18% fewer calories and 9% less sugar than that tiny, not-filling box of raisins, brings a fair bit more in the way of nutrients.

All this to say - if you like Craisins, raisins or chocolate chips, by all means eat them, but know that the first two have far more in common with candy than they do with fruit and probably shouldn't be confused as healthful.

When it comes to Craisins and raisins, nature's candy is still candy.

Saturday Stories: Retired Cells, Brazilian Doctors, and Ancient Rome's Halftime Shows

Ed Yong in the Atlantic covers an exciting new anti-aging treatment prospect - getting rid of the body's retired cells (mouse model caveat applies).

Reed Johnson and Rogerio Jelmayer in the WSJ on the Brazilian doctors who sounded the alarm on Zika and microcephaly.

A must pre-Superbowl read in Live Science from New York Times bestselling historical non-fiction author Cristin O'Keefe Aptowicz on the horrors of the ancient Rome's damnatio ad bestias half-time show.

"Instead of Water, Might I Suggest an Ice Cold Bottle of Candy?"

Today's Funny Friday is funny because it's true. It's a soda commercial, without the marketing.

Have a great weekend!

The Calorie Clump Theory of Annual Weight Gain

It's a fairly frequent, and ridiculous sounding argument, and it's often brought up by those who suggest that calories don't count so as to highlight what a silly construct calories are. And truly, the suggestion that teeny tiny mismatches in energy intake are responsible for our average gain of 2lbs per year is ridiculous. It's a straw-man argument though.

Working with literally thousands of patients over the course of the past dozen years I can tell you people don't gain weight consequent to a slow, linear, one extra potato chip too many per day, sort of way. People gain weight consequent to big, giant, clumps of calories.

Sometimes those clumps come from restaurant meals. Sometimes those clumps come from vacations. Sometimes they come from religious holidays and family gatherings. Sometimes they come from comfort eating after an especially rough week. Sometimes they come from a weekend or a night out with the girls (or boys). Sometimes they come from burning the midnight oil. No doubt for most of us they come on our, and our kids' birthdays.

And none of this is to say that the quality of calories don't matter. They do, as the quality of our calories will directly and indirectly affect the size of our clumps. But there is no shortage of calorie clumps.

Even if these clumps when squished together made up only 5% of our years' days, and assuming each of those days provided only a conservative 500 calorie clump (I'm betting many day's clumps climb easily into the thousands), those clumps' contributions to calories could more than explain our slow, annual, average rise in weight - even if the remaining 95% of our days were in perfect caloric harmony.

"Constrained Energy Expenditures" and Not Outrunning Our Forks

A new study came out last week that further explained why it is that while exercise does burn calories, it doesn't help with weight management nearly enough to be fair.

The paper, "Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans", aimed to explore why it is that exercise's impact on energy expenditure doesn't appear to be linearly "additive" - meaning that studies on energy expenditure suggest that increases in exercise, don't come with a comparable increase in total daily calories burned. In part this is because with increasing exercise comes increasing exercise efficiency, but the remainder is less clear. Is there an "exercise" thermostat in our bodies that effectively dials down our activity levels outside of our workouts whereby if you workout hard in the gym in the morning you'll sit more and fidget less for the rest of the day?

Here the authors put forward their theory of "Constrained Total Energy Expenditure" to explain the phenomenon I've covered here a few times - that objectively measured energy expenditures don't seem to vary much the world over. From the first world to the third world, as a species we seem to share the same total daily energy expenditures each and every day. This fits with the authors' constrained hypothesis.

To test their constrained model they objectively evaluated energy expenditures, in 332, mixed-sex, adults drawn from Ghana, South Africa, Seychelles, Jamaica, and the United States. The measures they tracked were total energy expenditure by way of doubly labeled water method, resting metabolic rate by way of respirometry, and physical activity by way of wearable tri-axial accelerometers.

What they sought to learn was which model would be best represented by the subjects' objective measurements - additive or constrained? If additive you'd expect a linear increase in energy expenditure with activity. If constrained you'd expect adaptations to blunt increasing energy expenditure even as activity levels rose.

The authors found that the plot of their cross-sectional subjects' activity vs. energy expenditure wasn't linear and additive like the first graph, but rather was blunted and constrained like the second.

Also worth noting, the authors point out that regardless of which model you choose to believe in, their findings had physical activity accounting for only 7%–9% of the variation in total energy expenditure after controlling for anthropometric variables and population location. Translated this means that when it comes to energy balance, what you eat matters a hell of a lot more than how much you exercise regardless of how exercise contributes to energy balance. It also means that you're not likely to be able to outrun your forks.

Of course you shouldn't take this as a license not to exercise, as exercise is probably the single most important modifiable determinant of your health. Putting this another way, you lose weight in the kitchen, you gain health in the gym.

(Below is my keynote presentation for PHE Canada where I make the case for rebranding exercise)

Saturday Stories: Shared Genes, Not-Extinct Insects, and Aliens

David Epstein in ProPublica with a fascinating story of shared genetics.

Robert Krulwich with the tale of real life primordial giants.

Phil Plait in Slate on that star that maybe, just maybe, is powering an advanced alien civilization.

This Little Boy is a Cookie Ninja

Hide your cookies! Today's Funny Friday kid will steal them and you'll never find out!

Have a great weekend!

How Does 15 Thousand Million Dollars a Year for Nutrition Research Sound?

I've heard lots of options for what to do with soda tax revenues. From subsidizing fresh fruits and vegetables, to increasing funding to school lunch programs, to establishing obesity treatment centres and programs, and more.

Here's one more thought.

A penny per ounce soda tax would generate an estimated $15 billion per year in the US (and presumably near $1.5 billion per year in Canada).

Could those monies be used to put an end to all food industry funded studies, partnerships, and promotions?

Off the record I've been having some conversations with two very prominent, industry funded scientists. They'd love the opportunity to access non-industry sources of funding so as to remove any concerns related to conflicts of interest.

And honestly, $15 billion is a great deal of money. There'd be plenty to go around. For instance, a fund could be created to service research, but also to allow for non-profits to apply to have their food industry funding matched (in return for dropping their food industry funders), schools to eliminate food industry sponsored sports, pouring right contracts and vending machines, etc.

Suddenly all of the heated concerns and discussions around public private partnerships, research conflicts of interest, undue influence, would cease to exist.

Of course there's no guarantee soda tax revenues would be used for anything health or weight related and moving forward, if and when soda taxes are discussed, debated, and implemented, here's hoping that the money they generate will be earmarked for something health related, and not just used to pad to a government's bottom line.

In the US, the Colour of Obesity is Now Maroon

You've probably seen these maps before, but did you know that in 2013 they had to add a colour?

If you haven't seen the maps, they're from the CDC and they document the march of obesity in America over time. As the colours change, America gains weight, and in 2013 the first of now 3 States' rates of obesity cleared 35%.

Here's a thought. Maybe rather than continuing to talk about rising weights governments start doing something about it?

And given people haven't been purposefully trying to gain, and yet gaining we are, it's clear the environment also needs intervention as talking about personal responsibility doesn't seem to be doing the trick.

Sure it's always a good idea for people to know how to swim, and yes we should continue to encourage and provide swimming lessons, but this flood needs a levee.

Saturday Stories: Suicide Pacts, Last Days, and Kippahs

Julia Medew in The Sydney Morning Herald tells the true story of her parents' suicide pact - a must read.

Paul Kalinithi in the New Yorker on his last day as a surgeon.

Jonathan Tobin in Commentary on kippahs and the future of Europe.

Some Weeks Are Just Like This

But at least we're still breathing!

Hope you enjoy today's Funny Friday as much as my 3 pre-teen children (and I) did.

Have a great weekend!

Cut Sweet From Your Diet And Only Maybe You'll Need It Less

Lots of people try to reduce sugar, and of those who succeed, I'll regularly hear them tell me that after a little while, they no longer miss it. But are they not missing it much because their taste buds "change", or do they not miss it because of the psychological sunk costs of their personal investment into a low sugar diet?

Well that's what a recent PepsiCo study sort of set out to explore. Briefly, researchers randomized a small group of matched individuals to consume either a low-sugar, artificial sweetener free diet (40% reduction in simple sugars and total ban on artificial sweeteners), or a regular one for 3 months time after which they were told to consume whatever they wanted for the final month of the study. Participants tracked food by way of food diary, and given the nature of the experiment, clearly they weren't blinded to their study condition, and nor were the researchers. Each month of the study, participants were asked to rate the perceived sweetness of vanilla puddings and raspberry flavoured sweet drinks.

By month three the sugar and sweetener reduced folks were rating the pudding as 40% sweeter than the control diet group. They did not however rate it as any less (or more) delicious. There was also no change in their weight compared with the normal diet folks.

This was a small study, but that said, its findings aren't particularly heartening. If foods perceived as sweeter by those who have reduced their sugar intake are not also perceived as less enjoyable, the swap to a low-sugar diet won't be self-reinforcing and hence will be more prone to failing in the long term, and the fact that weight didn't change speaks to the notion that simply removing sugar from your diet isn't likely to be the weight-loss panacea some bill it to be. If only it were that simple.

Is The "100th Day" of School Really Worth Celebrating (With Junk)?

It's called "100th Day", and the first reference I could find to it was a kindergartner geared book published by Scholastic in 1996 called, "100th Day of School". Perhaps it hit the big time in 1999 when the New York Times featured a letter to the editor calling 100th Day "another February holiday".

It's meant to celebrate the kids being "100 days smarter", and for the younger kids, to provide an opportunity to practice counting to 100.

It's turned into yet another school sanctioned excuse to share junk food.

The letter up above was sent home to a friend of mine in Illinois with her kindergartner. Putting aside the fact that the teacher misspelled Froot Loops and seems to be a bit math challenged, here we've got a kindergarten teacher who seems to have just given up. 5 year olds are entertained by pretty much anything and consequently leaning on junk food to serve as a source of excitement and fun, beyond teaching 5 year olds that junk food serves as a source of excitement and fun, is also incredibly lazy. Or is the teacher just doing what one does on the 100th Day, and following through with what's considered normal?

Looking online it could be either.

I found plenty of similar letters:

But I also found plenty of ideas and celebrations that didn't involve food including this one that focused on activity

Add this to the pile of "just ones" that ultimately add up to a near constant parade of junk food being pushing on our kids. Birthday cupcakes, Valentine's Day, Halloween, Easter, Christmas, class-based rewards, and many, many, more - the opportunities for school based junk are plentiful.

Would love it if you'd head over to the Weighty Matters Facebook Page and let me know what the most ridiculous junk food tie-in your kids have had. I think mine would be when my eldest, at the age of 8, joined a school book club and instead of coming home and talking about the books, came home and talked about the help-yourself bowl of Twizzlers.

[Teachers, for a gazillion different 100th Day ideas, including tons of those that exclude junk food, here's a massive Pinterest collection of them, and if you're curious, the snacks in the first letter up above add up to 268 calories coming in part from their 5.4 teaspoons of sugar]

Saturday Stories: Looking Perfect, False Confessions, and Lost Canoeists

Jennifer Weiner in the New York Times asks, "When can women stop trying to look perfect?"

Douglas Starr in The New Yorker in 2013 discusses how police interrogation tactics can be run in order to produce false confessions.

Ben McGrath, also in The New Yorker, with a riveting story about a lost, solo, canoeist.

Sometimes Even Goats Need a Good Pep Talk

Today's Funny Friday video is just 6 seconds long. You've got 6 seconds for this goat whisperer I'm sure.

Have a great weekend!

Employing the "I Forgot To Buy It" Strategy for Healthier Pantries

In working with families who are trying to improve their homes' dietary choices, one of the barriers I regularly come across are worries about how kids will react to the removal of beloved, but perhaps not healthful, dietary staples (like the cookies masquerading as a wise choice up above).

It's probably an unnecessary worry.

The last thing I would recommend is the idiotic, TV-style, black garbage bag purge of your pantry that likely would come along with the admonition that the stuff in the bag isn't good and won't be brought back into the home ever again.

That style of an approach would no doubt put a child's back up, lead to frustration, conflict, and potentially help in cultivating an unhealthy relationship with food as a whole.

Instead I recommend something much simpler. "Forget"

Forget to buy it the next time you're at the supermarket, and when questioned by your kids as to the whereabouts of the products, apologize and tell them that you forgot.

Then buy it again somewhere down the road, and then when it next runs out, forget again to re-purchase, with lengthier and lengthier periods between repurchasing until your kids forget that the product was ever a regular part of their lives.

(Tackle foods you want to eliminate one by one using this method as "forgetting" a whole bunch of stuff all at once is pretty much an unspoken garbage bag purge.)

Are You Certain That For The Thing You're Certain About There's Certainty?

Certainty. When it comes to nutrition, healthful living, and weight loss advice, that's often what's being served.

There are anti-breakfast zealots who are just as passionate about no one ever needing breakfast as those who state that breakfast is an absolute must. There are low-fat fighters whose passionate beliefs, if embraced by the masses, will undoubtedly lead to new lines of unhelpful ultra-processed but high fat foods. And there are anti-calorie crusaders who'll have you believe that magically, in the context of a public that relies dramatically on boxes, jars, and restaurant meals, that calories won't count if you just choose wisely.

I could go on.

Honestly, even were the science of issues like those up above as black and white as many promote (it's not), in clinical practice, denying the fact that different approaches suit different people differently is a great way to fail patients.

All this to say, the opposite of dogma isn't dogma.

Saturday Stories: Non-Jewish Generals, Murder, and a Conversion

The report the High Level Military Group (HLMG) (here are the bios of the group made up of 11 non-Jewish, retired generals and military officials from five continents and a former UN war crimes prosecutor) on 2014's Gaza war.

Aman Sethi in The Guardian with a harrowing tale out of India involving exam fixing and murder.

Adrian Chen in The New Yorker and the amazing "conversion" of a Westboro Baptist Church member.

An Incredible Cravings Based Resolution-y Hello Parody

However you might have celebrated over the recent holidays, this Funny Friday Hello parody is for you!

Have a great weekend!

Mars Chocolates And "The Emotional Low Point of the Shopping Journey"

Flickr: bcostin

Describing their "deep understanding of the shopper" candy maker Mars reports working with retailers to try to entice consumers at "the emotional low point of the shopping journey" - checkout.

Mars explains that consumers at checkouts have three needs that retailers can meet: Refresh, Reward, and Remind.

Refresh, according to Mars, should consist of junk foods like gum, mints, beverages, and snacks, and take up 51% of checkout real estate.

Reward should be chocolate or non-chocolate candy and take up 39% of total checkout space.

Remind should be small items people might have forgotten like batteries and lip balm and take up just 10% of the checkout aisle.

Checkout is an area ripe for change. CSPI has been campaigning for candy free checkout aisles for some time, and some retailers have followed through citing consumer demand. I wonder if Mars' outreach has something to do with this changing tide?

Worth noting, the publishing industry would certainly be an ally in candy free checkout campaigns. Here is their frustrated response to Mars' push which they note, includes a "blatant omission of magazines". That said, given the contents and covers of checkout aisle magazines, it may be difficult to describe them as healthful either.

Is It Bad That Exercise Pills Might Be On The Horizon?

A little while ago I came across coverage and commentary about this article about the future possibility of pills that might in theory be able to replace exercise.

Predictably, the chorus of voices that rose up were full of indignation with sentiments that ultimately suggested that even if found to be incredibly effective, exercise pills would be the bastion of the lazy.

Is it lazy to want to improve your quality and quantity of life? Because that's what these pills would do if they did in fact provide people with the benefits of exercise. And yes, sure, it'd be lovely if everyone had the very real luxuries of possessing the health, time, money, and inclination to regularly and genuinely exercise, but except in the minds of those filled with I can do it and so should you lifestyle sanctimony, that's simply not the case for a large percentage of our real life population.