Saturday Stories: Ultra-Processed Kids, Un-Dead Cons, And Modern German Antisemitism

Bettina Elias Siegel, in her blog The Lunch Tray, on what that recent ultra-processed study means for our children.

Nathaniel Penn, in GQ, with the case of the curious con who wouldn't die.

James Angelos, in The New York Times, on Germany's modern day antisemites.

According To This Comparison Of Canadian Dietary Recall Data, Underestimations May Help To Explain Purported Decreasing Sugar Consumption

This recent report from Health Canada about sugar consumption was an interesting read.

Not so much in terms of sugar, and yes, the report says we eat too much of it (I'll come back to that) but rather in terms of dietary recall. It seems we're getting worse at it.

According to their determination, whereby they compared dietary recall data's caloric totals with those that would be predicted by a respondent's age, BMI (measured, not self-reported), sex and activity levels, if your self-reported intake was less than 70% of that predicted, you were classified as an under-reporter, and if it was more than 142% of predicted, you were classified as an over-reporter.

Overall, compared with 2004, people were significantly more likely to under-report and less likely to over-report. In adults, under-reporters increased by 22% (from 28.2% to 34.5%), in kids aged 9-18 by 59% (from 16.5% to 26.3%), and in younger children it more than doubled (from 6.7% to 14.1%). Simultaneously, over-reporting dropped by 45% in adults (from 13.6% to 7.4%), in kids aged 9-18 by 41% (from 22% to 12.8%), and in young children by 35% (from 27.6% to 18%).

So how does this affect sugar consumption data?

Well you may have read that dietary sugar consumption is decreasing. And maybe it is (dietary recall data is fraught with error). But this data suggests that while consumption is shifting, with more added sugars coming from food and less from beverages, totals, if looking at plausible reporters only, have stayed pretty much the same, and has increased slightly in children.

As to what's going on, could it be that with ongoing discussion of the dangers of unhealthy diets that people become less likely to want to disclose what they're eating? Either way, it's further evidence that we need a better way of tracking dietary intake and a possible confounder for those reporting that sugar consumption is decreasing.

Saturday Stories: Dietary Guidelines, "Vaccine Injury", and "Chronic Lyme"

Kevin Bass, in his blog Nutritional Revolution, with the data driven case on how you can't blame people following dietary guidelines for a country's obesity rates.

James Hamblin, in The Atlantic, on the truth behind vaccine injury compensation.

Abby Hartman, in It's Training Cats and Dogs, with her first person account on walking to, and then away from, treatment for "chronic lyme disease".

Pic By Alan R Walker - Own work, CC BY-SA 3.0, Link

Calling People Successfully Maintaining Long Term Weight Loss "Unicorns" Is Dehumanizing, Unhelpful, And Misleading (And No, 95% Of Weight Loss Efforts Don't Fail)

A few weeks ago I tweeted about a patient of mine who is maintaining a 19% weight loss for 2 years, and who attributes her success to keeping a food diary and tracking calories, as well as to including protein with every meal and snack.

The point of my tweet was a simple pushback to those who want to claim that calories don't count or that counting can't help (like The Economist for instance whose recent article entitled Death of the calorie was the main reason I bothered to tweet), and those who claim that the only way to lose weight is their way (these days that's usually either #keto or #lchf).

A great many folks weighed in with their success stories, and some pointed to the National Weight Control Registry (where their over 10,000 registrants have kept off an average of 70lbs for 5.5 years). Others though weren't having it.

Instead they asserted that 95% of diets fail, that the weight loss industry was predatory (much of it is, no argument there), and called people who have succeeded "unicorns".

Unicorns. Not people. Mythical creatures.

And the implication of course is clear. Sustained weight loss is impossible. Those who succeed aren't human, or to succeed they employ superhuman efforts, sometimes even described as disordered eating and/or that those who succeed must be miserable. Consequently, trying is futile and those offering help (like me, as to be clear I am the medical director of a behavioural weight management centre) are unethical and are motivated by greed (despite the obvious irony that those championing explicitly non-weight loss programs are targeting the very same population of people and regularly charge a great deal of money for their services).

But boy, there sure are a heck of a lot of unicorns roaming around for something that supposedly fails 95% of the time. Putting aside the anecdotal facts that we all know people who have maintained weight losses, as well as my own office based experiences, this 2010 systematic review found that one year later 30% of participants had a weight loss ≥10%, 25% between 5% and 9.9%, and 40% ≤4.9%. In the LOOK AHEAD study, 8 years later, 50.3% of the intensive lifestyle intervention group and 35.7% of the usual care group were maintaining losses of ≥5%, while 26.9% of the intensive group and 17.2% of the usual care group were maintaining losses of ≥10%. Here's the DIRECT trial where mean weight loss at 2 years was 7.5% with 24% of participants maintaining losses greater than 22lbs. And in the recent year long DIETFITS study the average weight loss of all participants was 5%, with over 25% of participants losing more than 10% of their weights.

The Examine.com waterfall plots of the DIETFITS data

(And for an interesting thought experiment, have a peek at this thread from Kevin Bass that argues that even if the 95% failure number were true, those outcomes would be worlds better than the vast majority of medical treatments currently being offered for other chronic diseases)

So where does this 95% number come from? I could imagine it to be true if the goalpost for successful weight loss was total weight loss and reaching a so-called "healthy" or "normal" BMI. But that would be as useful a goalpost as qualifying for the Boston Marathon would be for running whereby the vast majority of marathoners won't ever run fast enough to qualify to run Boston. Does that mean non-qualifiers should be discouraged from running and told that running is impossible? It's also important to contextualize failures. If the methods being undertaken to lose weight are misery inducing overly restrictive diets, it's not people who are failing to sustain them, it's that their diets are failing to help them (which, with full disclosure, is the premise of my book The Diet Fix).

As far as what needs championing, it's certainly not failure. Given the medical benefits of weight loss, as well as the real impact weight often has on quality of life (especially at its extremes), what we need to collectively champion are the embrace of a plurality of treatments (including ethical behavioural and surgical weight management programs and greater access to them), along with more effective medications. What can simultaneously be championed is the removal of blame from the discussion of weight, fighting weight bias and stigma, recognizing that a person need not have a so-called "healthy" or "normal" BMI, that scales don't measure the presence or absence of health nor measure lifestyles, respecting people rights to have zero interest in losing weight or changing their lifestyles, that there is value to changing behaviours around food and fitness regardless of whether weight is lost as a consequence, and acknowledging that intentionally changing lifestyle in the name of health reflects a tremendous degree of privilege that many people simply don't possess.

Given the evidence maybe we can stop with the unhelpful, dehumanizing, and misleading unicorn talk, and while we're at it, stop telling everyone that failure is a foregone conclusion.

Saturday Stories: Assisted Death, Insulin Pumps, And Supplements

Kathleen Venema, in The Globe and Mail, on her mother and why we need to change the rules surrounding assisted death for those with dementia.

Sarah Zhang, in The Atlantic, on why there's an underground market for old insulin pumps.

Markham Heid, in Medium, on how the evidence against the regular use of supplements is stronger than ever (happy to find this story for reader Pug Piper).

[And if you don't follow me on Twitter or Facebook, here's my first column for Medscape on what scales do and don't measure and why that matters]

What's The Point of Tracking Your Calories With a Food Logging App?

First up, the quantity and quality of calories matter both to health and to weight. You can't gain without a surplus. You can't lose without a deficit. And the quality of the calories you're consuming will affect health and satiety which in turn will affect the quantity of them that you consume. Moreover, the bioavailable calories you consume will differ by food, and also likely differs by individual (which is why some gain and lose with more ease than others).

Next up, we're crappy food historians. We may forget portions, choices, or both, not all the time, but certainly some of the time. We can't possibly know what's in meals we haven't cooked ourselves. And even if we are cooking ourselves, most aren't going to be weighing and measuring everything and eyes are terrible at both.

And a recent study confirms some of the above whereby researchers looking at users of myfitnesspal found the average user was missing nearly a meal's worth of calories a day (445). Yet studies on food diary use pretty much invariably report they markedly benefit weight loss efforts.

Personally, though I think having some rough inaccurate sense of caloric intake is valuable (if you were in a foreign country and didn't know the exchange rate, price tags would still be somewhat helpful), more valuable is the use of the food diary to remind yourself that you're trying to eat thoughtfully and likely differently.

Human nature being what it is, without a system designed to consciously remind you to change your usual default behaviours, you're likely to drift back to those behaviours, healthy or not, and a food diary, even if inaccurate, if kept in real-time, will remind you many times a day that you're trying to change.

So long as you're not using your food diary as a tool of judgment, as it's not meant to be there to make you feel badly about your choices, chances are it'll be of benefit, and likely it'll be of benefit regardless of what it is you're tracking (calories, macros, carbs, whatever) and even if inaccurate, because it's primary job is to serve you as your constant change reminder service, not as your judge and jury.

Saturday Stories: Holocaust Memorial Day, Poway, And Synagogue Metal Detectors

Lori Gilbert-Kaye, may her memory be a blessing, murdered for being Jewish

A few days ago it was Holocaust Memorial Day, the day we commemorate the murder of 1 out of every 3 living Jews on earth prior to World War II. A week ago saw another murder for the crime of being Jewish, this time in California. Before that it was Pittsburgh. Though there's not much I can do about any of this, at least I can call your attention to these three pieces that try to weave it all together

Daniella Greenbaum Davis, in The Spectator, on antisemitism's new normal.

Rabbi Yisroel Goldstein, in The New York Times, on how being almost killed by a terrorist last week has affected his resolve.

Carly Pidlis, in Tablet Magazine, on how Jews can no longer simply consider themselves safe in America.

New Study Suggests ADHD Steers Children To An Unhealthy Diet, Not The Other Way Around

To be taken with a grain of dietary recall data, but a new study, Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa: Results from Bidirectional Analyses in a Population-Based Cohort, found that an ADHD diagnosis led children to a less healthy diet, whereas less healthy diets did not lead children to ADHD.

The study was conducted in the Netherlands and it followed 3,680 children starting at age 6 and then ending when they reached the age of 10.

Put plainly, though more ADHD symptoms at age 6 were associated with less healthy diets at age 8, diet quality at age 8 was not associated with ADHD symptoms at age 10.

There are a number of proposed pathways to help explain how ADHD might affect diet quality. ADHD and its impulsivity may increase the risk of binge eating or loss of control eating, and the impact of ADHD on neurotransmitters may affect hunger and fullness. It's also possible that some parents of children with ADHD may offer foods their children prefer in order to decrease risk of conflict and/or reward desired behaviour.

Clearly more research on this would be welcome.

Saturday Stories: Freds, Sexism in Science, and Anti-Vaxx Marriage

Danielle Kosecki, in Medium, with her defense of Freds (less serious cyclists, and disclosure, I am one).

Mallory Picket, in The New York Times Magazine, on sexism in science's highest echelons.

Anonymous, in The Cut, on marriage with an anti-vaxxer.

Move More, Eat More? New Study Suggests People Do Eat More When They're More Active, But Not Much

One of the possible reasons that in freely living humans exercise doesn't seem to add up to weight loss as math might predict is that freely living humans might eat back their burned calories. Some may do so consequent to increased hunger. Others to a sense of virtue and the inclination to reward themselves for their hard work. Others still because marketing has convinced them that they must refuel, recover, replenish, etc..

A new study,Activity energy expenditure is an independent predictor of energy intake in humans, published this year in the International Journal of Obesity, set out to look at this phenomenon.

Now to be clear, the study certainly wasn't designed to explain exercise's impact on weight. It was just 7 days long and it involved the retrospective analysis of data from 5 prior studies and did not directly measure energy expenditure or energy intake. Instead researchers utilized estimated energy expenditure by way of heart rate and indirect calorimetry data, and energy intake by way of known to be problematic food diaries.

My stats skills are nowhere near good enough to comment on the various treatments of the data, but here's the scatter plot of the impact of energy expenditure on energy intake.

The increase in energy intake the authors attributed to energy expenditure wasn't high, roughly 3% of total daily calories (around 70 in this sample), an amount too small to explain away exercise's often uninspiring impact on weight loss.

Truth be told, I'd have predicted the difference to be larger as eating more consequent to exercise is something I know many people do for one or more of the various reasons mentioned above.

Of course none of this changes the fact that exercise has tremendous health benefits at any weight and that weight shouldn't be your driver for upping yours if you're able.

Saturday Stories: IN MICE, Cancer, and Future Dementia

James Heathers, in Medium, explains why he started the Twitter account that only ever tweets "IN MICE"

Anne Boyer, in The New Yorker, on what cancer takes away.

Tia Powell, in Elemental (on Medium), on how she's preparing for her future dementia.

RDs! We're Hiring! Looking To Fill A Full-Time Permanent And Possibly Some Part-Time Positions

Will copy our job posting below, but the tl;dr version is we're both growing (our digital distance tool is deep into development and should be ready for beta-testing come late spring or early summer) and one of our wonderful RDs will be heading off on maternity leave. Consequently, we're looking for some great RDs!

Prior applicants are welcome by the way. In fact many of the RDs we've hired over the years had applied more than once.

Here's the posting. Please send resume and letter of interest to jobs@bmimedical.ca

The Bariatric Medical Institute (BMI) in Ottawa, an inter-professional weight management office that includes medical doctors, personal trainers, registered dietitians, a social worker, a clinical psychologist, and a therapy dog, is looking for a permanent full time dietitian to join our professional and unique team.

We are looking for an individual who loves working with people and technology, is great at multi-tasking, is a team players, thrives off of challenges and responsibility, and wants to utilize his or her skills in making a dramatic positive difference in people’s lives.

Responsibilities will include:

• Collaboration with interprofessional team members.
• One-on-one counselling sessions to motivate and help patients live the healthiest they can.
• One-on-one counselling sessions with parents of children struggling with weight to help them navigate a healthy eating environment.
• One-on-one counselling sessions to help prepare patients for bariatric surgery as well as post-surgery sessions to help patients ensure that they succeed.
• Design individualized nutrition plans based on each individuals’ unique lifestyles, metabolic rates and dietary likes and dislikes.
• Write for BMI’s different social media outlets: Website, blog, vlog, and monthly newsletter.

The skills you’ll need:

• Exceptionally strong motivational counselling skills.
• Must have excellent listening skills, empathetic and sensitive to patient’s needs. We do not ever utilize negative reinforcement in our counselling.
• Able to adapt nutrition advice to recent scientific research with thoughtful critical appraisal.
• Must be innovative and give patients realistic and helpful nutrition advice.
• Positive and non-restrictive approach to weight management.
• Comfortable giving presentations.
• Possess sound professional judgment, initiative and enthusiasm.
• Good time management skills and ability to organize.
• Excellent computer skills, and comfort with social media
• Strong cooking skills.

The requirements we’re looking for:

• Minimum one year of clinical experience
• Registered Dietitian
• Member of the College of Dietitians of Ontario and in good standing (or willingness and ability to join).
• Master level clinicians are preferred, although not required.
• Previous experience working in weight management and childhood obesity is an asset.
• Working with us you will have access to a full gym facility as well as shower and change rooms. Physical activity and healthy living are the primary focus of our work and therefore we view your active lifestyle as a great asset.

Because we are looking for the best candidate our wages are highly competitive with those in the community and after the 3 month probation period, medical and dental benefits are part of our package.

We look forward to hearing from and meeting with you.

Are You Successfully Maintaining A Weight Loss OR Have You Recently Quit A Diet? If Yes To Either Question, Please Spare 2 Minutes For Our Research (Shares Welcome!)

Back in 2012 I first posted my wish for there to be a questionnaire that would serve to help individuals and researchers determine how easy or difficult a particular diet would be to follow.

I called it the Diet Index Enjoyability Total or DIET score, and my hope was that by using a series of simple Likert scales (descriptive scales from 1-10), researchers could set out to evaluate a particular weight loss approach's DIET score where high scores would identify diets that could actually be enjoyed, and where low scores would identify under-eating, highly restrictive, quality of life degrading, dieting misery. This would be useful both to individuals who could use the DIET score to evaluate whatever approach they were considering, but might also serve as a surrogate for shorter term diet studies to give a sense as to whether or not there's a low or high likelihood of long term adherence to a particular study's strategy.

I'm happy to report that thanks to the hard work of Michelle Jospe and Jill Haszard of the University of Otago, along with your responses, we have completed the DIET score's qualitative review and this survey is meant as a simple pilot to test the hypothesis that higher scores associate with longer term success, and we hope, that once collected, these results will be compiled along with our qualitative review for the DIET Score's first published preliminary study!

So again, if you're currently following a diet, or if you've recently quit a diet, we would greatly appreciate it if you were able to take just a few minutes of your time to fill out our quick survey by clicking here.

Thank you in advance!

Yoni

[Today's survey is the final one (hopefully) before we submit our paper on the DIET SCORE. Consequent to our first two surveys we tweaked our questions to make them more relevant and representative by way our your comments and expert feedback. Even if you filled our survey out last time, if you've been successful on your diet (any dietary strategy or approach, we're not picky) OR if you've recently quit your diet, we'd dearly love to hear from you and we promise, it will barely take 2 minutes to complete]

Coca-Cola Claims It Doesn't Market Soft Drinks To Kids, Announces New Star Wars Themed Bottles For Disneyland And Disney World

Coca-Cola has gone on record to state,

"Parents tell us they prefer to be the ones teaching their children about beverage choices. That's why for over 50 years we've adhered to a company policy that prohibits advertising soft drinks to children"

So clearly their newly announced plans to sell Star Wars themed bottles at Disneyland and Disneyworld must be targeting adults.

Nothing wrong with a liquid candy company trying to sell liquid candy (that's their literal job after all), but don't lie and pretend you don't target children with your marketing or that you care about anything other than profit.

Saturday Stories: Nas Daily, Amateur Genealogy Detectives, and Adjunct Professors

Elhanan Miller, in Tablet, with a story I can't understand how I missed, on the delightful Arab Israeli social media star Nuseir Yassin, otherwise known as Nas.

Peter Aldhous, in Buzzfeed News, on just how easy it is to use genealogy databases to track people down.

Adam Harris, in The Atlantic, with the heartbreaking story of The Hunter and what it can mean to be an adjunct professor.

The Joe Rogan Experience Gary Taubes And Stephan Guyenet Debate And All That's Wrong With Modern Day Dieting Discourse

First some disclosures. As far as diets go, I'm egalitarian. I believe that the best diet for you may be the worst diet for someone else, and that all diets work by way of reducing caloric intake, but that calories from different foods will have differing impacts upon health and satiety. As far as Gary and Stephan go, I like both of them. I've had the opportunity to have a number of offline conversations with Gary over the years and though I'm guessing we generally spent the majority of our time in those chats disagreeing with one another (sometimes rudely), for reasons I find difficult to pin down, I've always enjoyed them. Stephan is someone whose work I've been reading for years and whose opinion I respect and value. And the 3 of us, in 2017, were involved with the Cato Institute for an online debate on sugar.

With those out of the way, onto the debate.

I certainly hadn't planned on writing about it. And I won't spend too much time nitpicking the discussion. Suffice to say, as many already have, it seemed that Gary the journalist relied on stories to make his points, while Stephan the scientist relied on studies. Gary constantly interrupted Stephan, and somehow also managed to recurrently mispronounce his name (despite corrections), and Stephan, perhaps as a consequence, at times treated Gary dismissively.

If you're looking for a more detailed play by play of the entire 2 hours and 37 minutes, by all means, here's Layne Norton's fairly exhaustive (and even time stamped) coverage, but what I want to cover today are a few thoughts inspired by the debate rather than the debate itself.

Much of the low-carb high-fat (LCHF) (now in many cases interchangeable with #Keto) world has raged on for years about mainstream medicine and science's disregard for their chosen diet and theories. An old photocopy of an American Heart Association pamphlet from 1991 that indeed promotes sugar consumption gets trotted out as some sort of gotcha for 2019. Young keto adherent physicians proudly tweet of the "torture" they experience reading opinions on diets other than their own (disclosure - including mine). Cardiologists with bestselling LCHF diet books write breathless articles in newspapers championing the idea that everything you've been taught about diet and heart disease is wrong and encourage the specific consumption of saturated fat. Self identified "science journalists" (note, this isn't actually a dig at Gary but rather others) who purport to care about evidence embrace and amplify the most idiotic of theories, stories, or comments so long as they suit their narratives. And if a study contradicts any of the aforementioned folks' belief systems, the fault is said to no doubt lie with the methodology, or the researcher being conflicted (as Gary repeatedly suggested in the debate when discussing the work of his former NuSi hire Kevin Hall, as well as Jim Hill and colleagues' metabolic ward study that utilized direct calorimetry to show that people gained equal amounts of weight when overfed fat or carbs), or both. And of course pretty much all of the most vocal gurus, even the ones from prestigious institutions like Harvard, appear more than happy to extend their credibilities to prop up whatever medical quack (Mercola, Oz, Hyman, etc.) is willing to promote them.

For various reasons, listening to this debate reminded me of all of that.

Despite Gary's very real comment in regard to diet related chronic disease and society that,

"Tragic shit is going on"

it would seem to me that the bulk of the energy spent by the loudest of the LCHF/#Keto crowd is mustered trying to prove everyone else is wrong or conflicted, and that there is only one, true, right, best, diet - a message that's especially off putting when it comes from MDs, given every single day physicians are reminded that different treatments work differently for different people - sometimes predictably, and sometimes not so much - which is why for instance for hypertension there are at least 10 different classes of medications, and multiple options within each.

The starkest difference between Gary and Stephan I think comes at the 2:24:08 mark where Stephan details how much he loved Gary's Good Calories, Bad Calories and how he found it so persuasive that he personally adopted a LCHF diet, but that then he turned from the historical narratives conveyed in Good Calories, Bad Calories, to the science, and he found that the science told a different story. Not a story that suggested LCHF was a bad diet, or the wrong diet, or an unhelpful diet, but just that the science underlying Gary's hypothesis doesn't hold water for Stephan. And then, over the course of the next few minutes, in what I can only assume is his rebuttal, Gary tries to narratively explain Stephan's personal, subjective, experiences on LCHF diets, and then discounts the various studies Stephan mentions as being poorly designed while trotting out one study he does like from the 60s that to his reading, supported his assertions.

And I know this wasn't the point of the debate - it was a debate after all - but wouldn't it be grand if instead of the constant need of so many (and yes, there are definitely exceptions - see note at end) to promote LCHF/#Keto as the one right, best, only, diet, LCHF/#Keto proponents, especially those who are themselves researchers and health professionals, took a deep breath and realized that if tragic shit is indeed going on, that perseverating on motives rather than data, and fanning the flames of online outrage mobs, and propping up quacks like Mercola and Hyman, and promoting the worst examples of science and opinion so long as it suits their narratives, and fear-mongering around statins, and spreading the bizarre notion that there's only one right diet and that anyone who suggests otherwise is wrong and likely conflicted, while I suppose providing fodder for online debates, is indefensible, unhelpful, and a very real reason why there's far less embrace and research of a strategy that absolutely has a place in the treatment and prevention of diet and weight related diseases.

(And for an example of a keto adherent physician who bucks the aforementioned trend, look no further than cardiologist Ethan Weiss who just the other day penned this great post about keto, LDL, and treatment, all the while embracing science and reason)

Saturday Stories: Disney Money, Fertility Doctor's Secrets, And The Gefilte Manifesto

Sarah McVeigh, in The Cut, with an interview of Abigail Disney (yes, that Disney), on what it's like having more money than you could ever spend.

Sarah Zhang, in The Atlantic, on the fertility doctor's secret.

Daniel Summers, in Arc, with a lovely piece on how a Jewish Cookbook is helping him to reclaim his lost heritage.

Coca-Cola Funded ISCOLE Trial Continues To Conclude Lack Of Exercise Drives Childhood Obesity

When it comes to associations, causality matters - the importance of which is easily understood when considering childhood obesity and inactivity. Whether inactivity leads to kids to gain weight, or whether weight leads kids to become inactive have very different implications

My publicly expressed bias is that childhood obesity drives inactivity, and there's data to support that assertion including this study whereby when observed over time in 8-11 year olds, weight gain predicted inactivity, while inactivity did not predict weight gain, leading the authors of that study to conclude,

"adiposity is a better predictor of PA and sedentary behavior changes than the other way around."

As to what's going on, if I were to venture a guess, it'd be some combination of obesity related abject bullying (multiple studies demonstrate bullying is associated with decreased physical activity and obesity has been shown to be the number one target of schoolyard bullying, not to mention the fact that bullies may make fun of heavier kids when exercising explicitly), being one of the worst/slowest on a team, and increased effort involved, that lead heavier kids to decreased MVPA (moderate-to-vigorous physical activity).

Now I've blogged before about the Coca-Cola funded ISCOLE trial almost entirely ignoring the possibility that childhood obesity drives inactivity rather than the other way around, and recently, another study came out of the ISCOLE group that did the same.

(and if you're interested, here's a published discussion of the emails between ISCOLE investigators and Coca-Cola that not surprisingly suggests that these relationships have the very real potential to influence the framing of results even if funders not involved in study design)

The study, Joint associations between weekday and weekend physical activity or sedentary time and childhood obesity, published in the International Journal of Obesity, looked at weekday and weekend levels of MVPA and sedentary time in 9-11 year old children in 12 countries and their associations with obesity.

Yes, they were found to be associated.

Though they do have a single throwaway line speaking to causality,

"It is not known whether lower levels of physical activity are the cause or the consequence of obesity",

that did not stop them from writing this as their final line and conclusion,

"Since children have more discretionary time during weekend days than weekdays, children should be encouraged to increase physical activity during weekend days, especially a high level of MVPA"

which while true on the basis of health as a whole, when framed in the explicit context of childhood obesity as it is in this paper, seems to deny the much more likely case that weight simply slows kids down.

And honestly, that matters.

It matters because one of the most predominant stereotypical narratives of obesity is that it is a disease of laziness, and ISCOLE's recurrently utilized framing supports that stigmatizing message. It also matters because, if considered at least by the parents I regularly see in my office, inactive children with obesity are being regularly judged (and sometimes even shamed or bullied) by their well-intentioned parents for not being active enough to lead them to lighter weights and I can't help but wonder if this would still be the case if the meat of the discussions in these sorts of papers focused on the barriers to physical activity erected by childhood obesity itself?

I would love to see more research done on the various mechanisms by which childhood obesity might contributes to inactivity, and more longitudinal studies designed to test causality, rather than paper after paper with conclusions that to my confirmation bias at least, ignore the many reasons why kids with obesity are understandably less likely to be physically active, and in so doing, fail those poor kids.

Saturday Stories: Vaping Risks, Doomsday Fungus, And A Friend With Cancer

Julia Belluz, in Vox, covers what we do and don't know about the risks of vaping.

Ed Yong, in The Atlantic, with the worst disease ever record.

Aaron E. Carroll, in The New York Times, on what his friend's cancer taught him about the healthcare system. 

(Photo by Lindsay Fox from Newport beach, United States - Vaping, CC BY 2.0, Link)

If You're Calling For A Ban On Bottled Water, But Not On Bottled Sugar Water (Soda, Juice, Sports Drinks, etc), You're Doing It Wrong

Apparently two former city Councillors, and some "water advocates" from a group named the Ottawa Water Study/Action Group, are lobbying the City of Ottawa to ban the sale of bottled water in all municipal buildings.

They rightly argue that Ottawa city tap water is terrific, and that the sale of bottled water is destructive to the environment.

But here's the thing.

All the other plastic bottles in the vending machine, you know, the ones that are just water with some sugar and flavour, they're in the very same bottles, and their consumption, unlike water's, isn't good for health.

So if you enact a ban on bottled water, but allow the sale of sugared waters, you're likely to shift sales to them, will do little to nothing towards for the environment, and you'll be promoting unhealthy beverages. Not something I can get behind.

I'm all for banning the sale of plastic bottles, but all plastic bottles, not just the ones containing the only actually healthy beverage being sold.