Weighty Matters

Men are Stupid and I'm a Man

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 10 Feb 2012 10:30:00 +0000

What a brilliant commercial.

It's today's Funny Friday video, and if you can relate to it, we'd probably have got along great in University.

Have a great weekend!

(email subscribers, you need to head to the blog to watch)

What a World Without Ridiculous Front of Package Health Claims Would Look Like

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 09 Feb 2012 10:30:00 +0000

Here in Canada (and to a lesser degree since the class action lawsuit in the United States), Danone's all about health claims. Inferred health claims, overt health claims, the bottom line it would seem is that according to Danone Canada, their yogurt's basically medicinal.

Fly across the Atlantic to Europe and it's a completely different story. You see in Europe, the standard for making health claims is different that here in Canada. First off, in Europe you can't put a claim on a food's packaging until AFTER it's been approved by the European Food Safety Authority (EFSA). Secondly, the claims better be supported by substantial human research with quantifiable outcomes.

As far as Danone goes, they've now twice removed their immunity claims for Actimel (Danactive here in Canada) and their gut claims for Activia from consideration, as removing them from consideration is better than a "NO". They keep saying they don't understand the process well enough to submit their dossiers - a claim I'd certainly believe the first time around, but have a tougher time swallowing the second.

My thought is that while indeed Danone has done more real science on their ingredients than possibly any other food manufacturer, that the data, although suggestive, isn't yet conclusive and hence not sufficient.

So what's triggered this post? An article in industry friendly e-zine Nutraingredients.com with some quotes from some Danone folks.

"The European Union's uber-strict health claims regime may this year deliver a barren, claimless landscape to the world's biggest selling functional food category"

The horror!

So what does that mean?

Instead of the ridiculous packaging for Actimel (Danactive) that we have here in Canada and seen up above, we'll get this "barren, claimless" European version:

And then suddenly, instead of selling claims about immunity that Danone themselves feels are not scientifically rigorous to pass muster over in Europe, they'll have to just sell yogurt.

A guy can dream, can't he?

Book Review: Tim Caulfield's The Cure for Everything

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 08 Feb 2012 10:30:00 +0000

If you don't feel like reading the rest of this review I'll summarize it by saying, Tim Caulfield's The Cure for Everything is the perfect antidote to the idiotic glossy paged world we're stuck with and is a definite must read.

In fact I enjoyed reading it so much, that a few pages into the copy Penguin sent me, I headed over to Kobo and ponied up my own dough and bought an e-version so that I could read it that much more often by using it to make my recumbent bike interval training, not just bearable, but something I even kinda, sorta looked forward to.

You see Tim's book is something I'm not sure I've ever read before. I'd describe it as an "evidence-based romp" (words that I'd never thought I'd string together) and his clean writing and his truly delightful and delicious self-deprecating brand of humour makes you want to pick it up again and again.

Tim covers a fair bit of ground in his personalized debunking of the scads of bunk we face when considering self-improvement projects like fitness, diet, genetics, and chronic disease prevention. And when I say personalized, I mean it in that Tim takes himself through his own anecdotal n=1 journey through celebrity trainers, dieting (back to that in a moment), colonics, personalized gene testing, accupuncture and homeopathy.

I actually bookmarked huge swaths of the book with the intent of sharing with you some favourite passages, but sitting here now and writing this review, I don't want to. Not because I'm lazy, but because I don't want to spoil your read.

I will however point out the one area where the book and I disagree rather conclusively. Diet. I say, "the book", rather than Tim, because Tim and I met last October at the Canadian Obesity Network's conference and we took the opportunity to chat quite a bit and over the course of our discussion, I think I may have swayed him some from the success=suffering formula presented in the book. Personally I don't believe in white knuckling through hunger and cravings on an ongoing basis and rather encourage consuming the healthiest diet you can actually enjoy, and not striving for the healthiest diet you can tolerate, while simultaneously using time, macronutrients and sufficencies of calories to try to turn off physiologically driven dietary drive. I also think he gave Canada's Food Guide pretty much a free pass, though to be fair, weight loss was more the focus of the chapter than formal evidence based nutrition.

Diet notwithstanding, the book's undeniably fabulous. I couldn't recommend it more highly.

Tim, in a tribute to where you spent much of your time writing, close at hand while writing this review was an ice cold beer.

(If you'd like, you can follow Tim on Twitter)

[If you're in Canada, here's the Amazon.ca link.

If you're in the USA, you can pre-order on Amazon over here]

Does Dietary Elitism Scare People off "Healthy" Eating?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 07 Feb 2012 10:30:00 +0000

What is "healthy" eating?

I suppose everyone has their own definitions of what's involved, and certainly there are some dietary adherents where food becomes nearly a religion, but forget about them. I'm talking about the masses, the folks who don't spend their every waking moment living and breathing a particular dietary regime. What do your average Joes and Janes who aren't inherently keyed into nutrition picture when they hear the word, "healthy" regarding food?

My guess?

Sprouts - both brussel and otherwise.

And certainly salads. And maybe weird looking (to them) plates full of grains with currants or raisins. Maybe cottage cheese. Definitely lots of water.

Probably also they think "vegetarian" or "fancy", or "complicated".

And while "healthy" need not be any of those things, sometimes I do have to wonder whether or not part of the problem in inspiring the world to choose healthier food is that the notion that healthy's fancy is one that does in fact get regularly perpetuated by folks preaching eating healthfully.

Take for example last week's New York Times. In it readers are presented with Martha Rose Shulman's ideas for, "a week’s worth of light and simple ideas for dishes that travel well.....lunches they can take to work and eat at a desk". Her ideas? I'll present them in picture form down below, but among them they include the ingredients: Beet greens, Swiss chard, chickpeas, Lundberg Black Japonica Rice, edamame, soaked red lentils, dark sesame oil, walnut oil, pinenuts, lightly toasted cumin seeds, Aleppo pepper, fennel, nigella seeds, and peeled kohlrabi.

Really? Those are "simple"? If that's "simple" for healthy eating, I'd hate to see fancy. And I bet I'm not alone.

Could articles suggesting dishes like these are "simple" actually hinder progress towards nudging people back into their kitchens? Do we over complicate "healthy"?

Me? I'm pretty damn happy with my oven roasted chicken sandwich on whole grain bread with an apple, but I guess the problem with that "recipe" is that it wouldn't sell newspapers, books or glossy magazines.

So if the media is our primary influence on what is and isn't healthy, and if actually simple recipes don't grab readers, who's going to help get our nation re-learning how to cook actually simple, healthy meals?

I've got nothing. Do you have any ideas?

(all food photos taken by Andrew Scrivani)

Why that Diet Soda/Stroke Paper is Worthless and a Failure of Peer Review

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 06 Feb 2012 10:30:00 +0000

Ugh.

So without spending too much time on this, here's the thing, that paper that purported daily diet soft drink consumption was associated with several vascular risk factors including strokes? It's worthless, and it's a glaring failure of peer review.

Why?

Because the authors didn't even attempt to control for dietary quality, and moreover, the dietary recall data itself was obviously inherently flawed.

First the control issue. As I'm sure you're aware, what we eat has a tremendous impact upon our risk of developing various chronic diseases. Consequently not accounting for the folks who for instance ate 10 meals a week from fast food restaurants, take aways or diners, versus those who actually ate at home and transformed raw ingredients would likely skew the data. But even if you want to try to suggest that such differences would be accounted for by the dietitians conducting the dietary recall effort, if all you actually analyzed at the end of the day was amounts of consumed protein, carbohydrates and fats, what you'd fail miserably in doing would be to actually usefully compare the quality and caliber of the diets you were studying. By not looking at the quality of the macronutrients you'd be comparing quinoa to white rice, salmon to bacon, and olive oil to Crisco. Yet that's exactly what the authors did. And it's certainly not at all implausible that folks who regularly indulge in lower caliber dietary choices assuage some of their dietary guilt and build their own health halos by choosing a diet beverage over a fully loaded one.

But even if the authors accounted for (as they should have at the very least tried) meals out, vs transformed raw ingredients, as well as the actual quality of dietary macronutrients this study would still be useless.

Why?

Because according to the dietary recall data presented in their study, and despite an average body mass index of 28 (overweight), the self-reported overall caloric intake of the study population was a measly 1,575 calories, whereas 2000 NHANES data pegs the average for men between the ages of 59-79 to be between 2,123-2,590 and women between 1,596 and 1,828. And that's 12 year old NHANES data. Given what we've seen with obesity rates, it's certainly quite plausible if not exceedingly likely, that average caloric consumption has risen over the past decade and change.

So basically here we have a study where we know the self-reported dietary recall is inaccurate and where the authors didn't even attempt to account for the actual quality of the participants' diets, that's making conclusions about the impact of diet soft drink consumption on strokes and suggesting diet was a controlled for variable?

How this got through peer review is completely beyond me, but the worst part is the coverage. This paper got plenty of press making its publication not only an embarrassment to the Journal of General Internal Medicine and its peer review process, but also a powerful source of misinformation in a world that certainly doesn't lack for nutritional confusion.

Gardener, H., Rundek, T., Markert, M., Wright, C., Elkind, M., & Sacco, R. (2012). Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study Journal of General Internal Medicine DOI: 10.1007/s11606-011-1968-2

Saturday Stories: Simon Singh, Infographics and Food Allergies

yonifreedhoff@gmail.com (Yoni Freedhoff) — Sat, 04 Feb 2012 10:30:00 +0000

Fascinating interview with Simon Singh, the science writer who was sued for libel by the British Chiropractic Association following his critical remarks.

The Atlantic's Megan McArdle with a masterful takedown of infographics.

Science Based Medicine's Scott Gavura explains why food intolerance/allergy testing is pure quackery.

The World's Best Rendition of Suess' Oh the Places You'll Go

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 03 Feb 2012 10:30:00 +0000

Honestly, whoever it was that realized that Burning Man was a real life Suessian utopia was a genius.

Today's Funny Friday?

Dr. Suess' Oh the Places You'll Go as read by the attendees of Burning Man (and even if you don't know what Burning Man is, you'll get the gist pretty quick)

Have a great weekend!

(Email subscribers, head to the blog to watch)

Breathtaking Heart Health Hypocrisy from Health Minister Leona Aglukkaq

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 02 Feb 2012 10:30:00 +0000

So February is Heart Health Month, and yesterday in a supposed show of support, Canada's Health Minister Leona Aglukkaq released a statement spelling out what Canadians can do to help themselves live a heart-healthy lifestyle. In it she also brags about what the government's doing to help - primarily she points out they're funding basic research and a hodge podge of feel good, eat less, move more initiatives .

But to me that's not really doing anything, though rest assured, it's not as if Leona Aglukkaq's done nothing for heart friendly public policy. She's stifled it.

What am I talking about?

As far as Canadian public health initiatives that might have had a positive impact on heart health, here's her legacy:

Leona Aglukkaq disbanded her own office's Sodium Working Group and ignored their recommendations.

Leona Aglukkaq refused to accept a proposed plan for sodium reduction that had been prepared and approved by federal and provinicial health officials.

Leona Aglukkaq without any publicized actual discussion, and despite strong public support, refused to have her office even consider banning junk food ads that target children.

Leona Aglukkaq rather than actually acting on our Standing Committee on Health's recommendations regarding childhood obesity instead launched a useless portal for "dialogue".

And,

Leona Aglukkaq has thus far refused to enact a regulatory approach to trans-fat despite promises from her own office reporting that it would in fact do so if by June 2009 voluntary efforts were to fail, and also despite her own admission on April 21st, 2010 that fail those efforts most certainly had.

Considering Leona Aglukkaq's track record on heart healthy policy, her call to action to Canadians for Heart Health Month is both an embarrassment and a disgrace, and not coincidental to her inactions up above? "Embarrassment" and "disgrace" are the same two words that leap to mind, when I consider Ms. Aglukkaq's performance to date as Canada's Minister of Health.

Obesity in Women Linked to Living Near Parks?!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 01 Feb 2012 10:30:00 +0000

If you like your data clean, pretty and predictable, you probably don't want to read the rest of this post.

Researchers from my hometown here in Ottawa recently published a study ahead of print in the journal Obesity. The paper, Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City looked at a number of different built environment variables and their impacts upon the probability of both leisure time physical activity and overweight and obesity in the population.

The statistical models controlled for: Age, education, household income, smoking status, and, given we live in a city where there's a lot of snow, season of data collection.

The variables that were considered as potential neighborhood based influencers of physical activity and obesity were: Total bike and walking path length, number of free or minimally expensive indoor and outdoor recreational facilities, park area and green space, social cohesion, neighbourhood safety, number of grocery stores, fast food chains, convenience stores, specialty food stores and full service restaurants.

The findings?

In men, almost nothing mattered. In fact with weight, nothing at all mattered. Number of fast food joints, convenience stores, grocery stores, park space or recreational facilities - none of these things seemed to impact upon a man's weight. There was however one variable that correlated with increased physical activity. Crime rate. Yup, the more dangerous the neighbourhood, the more active the man, to the tune of a 14% increase in their odds of being physically active for every standard deviation increase in crime rate. Running away from the bad guys?

In women? With women for every standard deviation increase in park area they were found to be 17% more likely to be physically active. So far so good, but check this, for every same standard deviation increase in park area women were also 15% more likely to be overweight or obese. In fact the increased risk to overweight and obesity seen with increasing park size in women was only ever so slightly eclipsed by the 17% increased risk conferred to their weights by a standard deviation increase in numbers of convenience stores. The riskiest thing for women's weights according to this paper? Fast food restaurants with a 38% increased risk of weight for every standard deviation increase in those.

So what do these numbers mean? So many questions. Should inactive men be encouraged to live in dangerous neighbourhoods? Does nothing in a man's environment really matter to their weights? Should women rethink that new home they're considering beside the park?

I don't think so.

I think all these numbers mean is that the reasons why people gain weight and exercise, they're stupidly complicated and trying to suss out the impact of a dozen or two different criteria on this sort of ridiculous complexity, might in fact be turn out to be a bit of an exercise in statistically meaningful futility.

Prince, S., Kristjansson, E., Russell, K., Billette, J., Sawada, M., Ali, A., Tremblay, M., & Prud'homme, D. (2012). Relationships Between Neighborhoods, Physical Activity, and Obesity: A Multilevel Analysis of a Large Canadian City Obesity DOI: 10.1038/oby.2011.392

Help with Research Plea: Spousal Sabotage Edition

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 31 Jan 2012 10:30:00 +0000

Not sure if you remember, but a ways back I published a quick request for a survey a doctoral student was conducting on spousal sabotage.

Well, she's almost done collecting data, but needs just a few more answers to her short survey.

In the spirit of furthering our understanding of one of the many issues faced by folks trying to lose or maintain their weights, how about carving out a bit of time for her today? She's in the last slog of her data collection and she only needs 35 more people (who did not take an earlier version) to take the survey by clicking here!

Amanda is also draining the last of her dissertation funding by increasing the drawing for this round to 10 gift cards (one $100 card and nine $25 cards). Additionally, she is donating $1 for every completed survey to your choice of 1 of 5 charities (Playworks, The Carter Center, Teach for America, Susan G. Komen for the Cure, or MAP International).

If you can answer yes to all four of the following inclusion criteria questions, then consider taking her survey so she can complete her dissertation. Let's help Amanda become Dr. Amanda Harp!

1) Are you at least 18 years of age?
2) Have you been participating in a weight loss program for the past consecutive 5 weeks?
3) Have you been in a committed, cohabitating relationship for the past two years?
4) Do you ever feel like your partner/spouse gets in the way of your weight loss?

If so, you're invited to participate in an anonymous, online survey:

Please spread this far and wide. Tweet, FB share, Google + - whatever floats your boat. Honestly, how cool is it that social media's going to play a real role in completing this PhD?

[This survey should take approximately 30-45 minutes to complete. Responses cannot be traced back to participants. Any question may be left unanswered. Participation is voluntary and may be withdrawn at any time. Upon survey completion, you will be provided with an email address and subject line to enter a drawing for 1 of 10 gift cards (one $100 card and nine $25 cards). Each participant who completes the survey may also select to have $1 donated by the researcher to the participant’s choice of 1 of these 5 charities: Playworks, The Carter Center, Teach for America, Susan G. Komen for the Cure, or MAP International.]

Book Review: Alex Hutchinson's Which Comes First, Cardio or Weights?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 30 Jan 2012 10:30:00 +0000

Four word review?

I loved this book.

Slightly longer version?

For those of you who don't know, Alex is a columnist for the Globe and Mail. More importantly, he's an evidence-based journalist with a penchant for exercise. His book, Which Came First, Cardio or Weights? is his mythbusting exploration of the science behind fitness.

What I loved most about the book was that it busted myths that had pestered me for years. I learned not to worry too much about trying to time my breathing while running, but just to let nature take care of itself, that my body will adjust to running on pavement such that my knees will get pretty much the same beating as softer ground (which by the way, according to a quick Twitter communication with Alex means that you don't need to buy new running shoes unless the wear on the soles are uneven), that personal trainers actually demonstrably and significantly improve performance and muscle gains, and that the optimal post workout dose of protein is about 20g consumed within an hour of finishing.

The book's broken down into chapters that deal with various sports and sport related issues. Gear, physiology, aerobic exercise, strength and power, flexibility and cores, injuries and recovery, exercise and aging, weight management, nutrition and hydration, mind and body and the competitive edge. If you're like me with brief little pockets of reading time, each chapter is then subdivided into quick, digestible nuggets, and if you're really not into reading, ends with a handy, dandy point form summary of all the evidence-based pearls with none of the back story.

This book is a really should have for individuals with even a moderate interest in fitness.

This book is an absolutely must have you're doing your clients a disservice if you don't, for every personal trainer on the planet.

You can read Alex's current thoughts in his frequently updated Sweat Science blog, or you can follow him on Twitter

[If you're in the USA, here's the Amazon.com link

If you're in Canada, here's the Amazon.ca link]

Saturday Stories: Beheadings, "but it's natural", and muffins.

yonifreedhoff@gmail.com (Yoni Freedhoff) — Sat, 28 Jan 2012 10:30:00 +0000

The LA Times has a great piece on the natural fallacy.

Douglas Anthony Cooper and a delightful piece on how not to get beheaded in Mexico.

The Atlantic on why you should step away from that muffin!

Will a Little Kid Saying "Bye Bye" Brighten Your Day?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 27 Jan 2012 10:30:00 +0000

Sure would mine.

Today's Funny Friday video involves the wide eyed, friendly innocence of youth.

Have a great weekend!

(email subscribers, you've got to visit the blog to watch).

Are Weight Ignorant Allied Health Professionals the Exception or the Norm?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 26 Jan 2012 10:20:00 +0000

Probably the norm.

And frankly, I think it's unforgivable and that their ignorance belies the fact that weight bias is alive and well in allied health professions.

How is it possible that despite one third of the population having obesity that allied health professionals remain so clueless about how to even talk about weight, let alone how to manage weight related comorbidities, how to ensure they don't add to the problem with weight gaining medications, or how to assess whether that weight is truly problematic, or rather, a healthy variant of normal?

If 1 in 3 people had asthma, do you think allied health professionals would be beyond awesome at managing, counselling and dealing with it, along with recognizing when it's a big scary deal or rather a minor periodic inconvenience?

And it's only because we're talking about obesity that allied health professionals remain perfectly comfortable with their own ignorance. The fact that they can dismiss obesity as a moral failing of their patients - nothing to see here medically - helps to exonerate them mentally from having to actually help, counsel or treat the patient in front of them, or think about the problem's actual etiology. It also helps to exonerate them from actually taking it upon themselves to learn more - something they'd no doubt do were we talking about any other medical problem or condition that they might not know much about, but which affected over one third of their patient population.

Why the diatribe?

Today, my friend Travis Saunders, co-author of the blog Obesity Panacea, recounts his recent experience going to his doctor's. Brief background. Travis? He's stupid fit. He's the guy that makes you shake your head and wonder what kind of crazy crawled into him that makes him run, bike, and ski through sun, rain and snow, day in and day out. He's also an obesity researcher. A good one.

So what happened with Travis?

The nurse practitioner at his MD's office weighed him, saw that his BMI was nearing 25, and told him he should, "watch his weight" moving forward as he was nearing the "overweight" range.

You see Travis wasn't Travis to the nurse. He was BMI 24.5.

I suspect other folks visiting that nurse weren't Marge, or Bill or Peter, they were BMI 37, BMI 32, and BMI 29.

The fact that there was no thought on the part of the nurse? No consideration of Travis' lifestyle or actual health status? That's because I'd bet to her, weight's a very simple thing to deal with. It's not the complicated amalgam of hundreds of genetic, environmental, medical and behavioural contributors. It's not something that needs to be evaluated within the context of the whole. No. She's learned that when BMI is greater than 25, that's overweight, and when BMI's greater than 30, that's obesity. Easy peasy. No need for any further evaluation. Oh, and treatment? Easy, peasy too! Just, "watch your weight".

We all know how well that advice would work.

So is she a bad nurse? An exception? She's probably not either. You see as far as teaching goes, professional schools pretty much ignore obesity. That goes for medical schools, dietetic schools, nursing schools - etc. Instead they teach body mass indices, waist circumferences and waist to hip ratios. They teach numbers. But unlike virtually everything else that's taught, when it comes to obesity, those numbers stay in vacuums, where individuals and thorough and thoughtful exploration of the issue isn't taught or recommended, because sadly, even in medicine, obesity is still considered to be just a reflection of your patients' deadly sins, which is probably why Travis' nurse never even thought to consider him as a person rather than a number.

To read Travis' thoughts and experiences, head over to his blog and have a peek.

To my readers out there who are professors in various allied health training programs - what are your schools teaching about obesity? Is there a new tide turning?

I sure hope so.

Is Suffering Ever a Useful Strategy?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 25 Jan 2012 10:30:00 +0000

Probably, but first some brief back story to serve as an illustration.

I turned 40 in August. And like many with big birthdays I decided to make some resolutions and included among them was weight lifting. I'd been fair to middling at aerobic activities all my life, but had never really focused much on resistance training. The thing is, as far as health and aging goes, resistance training's probably king, and so....

Anyhow, since August, aside from a brief back injury, I've been working out nearly daily. I've been alternating weights with something aerobic and Monday, Monday was weights day.

I truly didn't want to go. Now there have been days here and there where I haven't fully felt like exercising, but Monday was by far the worst. I was dreading exercising. I was tired, and the last thing I wanted to do was my weights.

I procrastinated for near 10 minutes in my office and finally, grudgingly, headed back to my gym.

My routine our fitness director Kelly has me on right now is a pyramid. I've got 2 groupings of 5 exercises and I'm supposed to run through each of the exercises 3 times in succession.

By the end of the first set of the first two exercises in the first grouping I was already trying to rationalize either stopping altogether, or dropping it down to just 2 sets of each rather than 3.

Instead?

I sucked it up and did it all.

And I'm not going to blow smoke and tell you I was so glad when I was done, that I felt great and alive. I actually felt pretty miserable.

The reason I pushed through? Not because one day of exercise really matters in the grand scheme of things, but rather because I didn't have any good reason not to do it and I knew that if I gave myself permission for no particularly good reason to shirk my exercise, it'd be that much easier to give myself permission the next time.

Of course sometimes there are great reasons not to follow through with various best intentions, plans and resolutions, but when there's no good reason, and it's just you vs. you, I recommend not giving yourself that proverbial inch.

But wait, didn't I just post yesterday that suffering was a bad idea?

Yup, but there's a difference. If every single time I headed to the gym I loathed it, well that'd be a clear cut sign that I'd better find myself another way to exercise. That'd be excessive, non-sustainable suffering. On the other hand, if I generally enjoy it, and here and there I don't feel like it, well that's a clear cut sign I'd better stay on top of myself, as follow through and consistency are how habits are gained (or broken).

And it doesn't apply just to exercise, it's life in general. Our human nature can easily get the best of us, if we let it.

So whatever you're trying to accomplish, sometimes, for your greater good, it might be worth suffering through a rough day, as habits? Well they're the things that persist through thick and thin, but at their beginnings, sometimes you need to really muscle through the thins.

Canadian Politicians go on Public Diet and Misinform Nation

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 24 Jan 2012 10:30:00 +0000

Oy vey.

Toronto Mayor Rob Ford, and his City Councilman brother Doug, have gone on a very public diet. They've challenged other politicians and the general public to "Cut the Waist", and they've received a tremendous amount of media attention.

Yesterday was their first weigh-in.

The Mayor lost 10lbs in a week, and his brother Doug, 9.

What's their strategy?

Suffering.

More specifically according to this article,

"Running a lot, lifting weights and eating like a rabbit."

It's the classic diet plan. Under-eat and over-exercise and lose in a great big hurry.

Of course if that approach to weight management were useful, the world would be a much lighter place and I'd be doing something else for a living. I mean who hasn't tried that at least once? There'd also be a great many fewer gallbladders as weight loss that rapid markedly increases the risk of gallstone formation. We'd also be a heck of a lot weaker as rapid weight loss leads to disproportionate losses of muscle, which is why, when folks do go on extreme diets and lose rapidly, when they can no longer live a life of suffering and head back simply to their old lifestyles, they have a tendency to gain back more than they lost.

In this case the sadder story is the fact that their efforts are being broadcast to a nation, and rather than actually serve a valuable role models to a thoughtful and sustainable approach to healthy living, instead they're championing the same old stupidity that has plagued traumatic dieters for centuries.

Suffering. Willpower. Crazy amounts of sweat. And I'm guessing their fair share of salads and grilled boneless, skinless chicken breasts.

I don't wish ill on their efforts, but if someone's taking book odds on their weights two years from now, if this is how they're planning on losing it, I'd like to put my money on heavier than day one of their challenge.

Guest Post: Surgeon Chris Cobourn Defends Lap-Bands

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 23 Jan 2012 10:30:00 +0000

Readers of my blog might remember a post from just last week in which I detailed the results of a case-matched sample of folks who received gastric bypasses vs. those who received gastric banding where the results were exceedingly favorable to the bypass. One of my readers and colleagues, Dr. Chris Cobourn the medical director of Toronto's Surgical Weight Loss Centre (where both lap-bands and gastric balloons are inserted) read the post and responded with a thoughtful rebuttal.

As is my practice here, I asked if it'd be alright if I posted it on the blog, and I've done so without commentary:

Good Morning Yoni:

I read your blog this morning with a little more than the usual interest and would appreciate the opportunity to give you some feedback on the Gastric Band vs. Gastric Bypass article that you reference, and some of the more relevant literature on this subject. As a surgeon with extensive experience in Lap-Band surgery (LAGB), I think it is important to ensure your readers that Lap-Band surgery is nowhere near being “destroyed”.

The decision to have bariatric surgery is a serious one, and it is important that individuals be presented with a balanced approach and current information. The senior author is Dr. Michel Suter from Switzerland. Dr. Suter has published previous articles (1) in this field and has a reputation as being very critical of the Lap-Band. Due to his early experience with the gastric band, Dr. Suter is no longer performing the procedure, so the current study is another reiteration of his original and now outdated experience. I debated Dr. Suter on a panel at the IFSO meeting in Capri a few years ago, when he presented his series of 300 Lap-Bands performed over a 10 year period. It is unfortunate that the results of such a limited experience, a number of years ago are published as representative of today’s technique and experience in high volume centres.

My specific concerns about this paper are:

· This study is described as a Case-Matched study. Although better than a random comparison, it does not have the strength or validity of a prospective randomized trial. There have been very few randomized controlled trials comparing RYGB and LAGB. I have included two of them as attachments for you to review. Although these studies show better weight loss with RYGB compared to the Lap-Band, the authors raise important questions as to whether the difference in weight loss is clinically relevant. Both procedures induce weight loss substantial enough to resolve comorbidities and improve health which is the obvious goal.

· All of the patients in this report had Lap-Band prior to June 2005 and thus all had the procedure prior to the introduction of the latest model of Lap-Band. As well, an undisclosed number had their Lap-Band procedure with a technique that is no longer used. The peri-gastric technique that was used was shown to have a higher risk of complications and has not been used for at least 8 years.

· Recent research into the mechanism of action of the Lap-Band has changed the way we manage post operative counseling and band adjustments for our patients. Again this has been shown to have a significant effect on reducing post operative complications. The patients in this paper did not have the opportunity to benefit from this new knowledge and this has likely contributed to some of the problems that were discussed.

· The authors spend very little time discussing the short term complications of the either procedure. This is a significant omission when comparing LAGB and RYGB. The short term complications of RYGB have been consistently demonstrated to be more common, and more severe when compared to LAGB. As well, there is a definite mortality risk associated with RYGB that is not discussed or identified in the study. The failure to define and document “major morbidity” is a conspicuous deficiency in this study. The relevance of this study is diminished without this discussion.

In regards to the discussion of long term LAGB complications, I have a number of comments:

o The authors report a 10% incidence of esophageal dilatation. This is extremely high when compared to the current literature. It likely relates to the principles used in band adjustment and the type of older model of band that was used in this series.

o The authors report a 7.7% incidence of band erosion. This again is extremely high. At the Surgical Weight Loss Centre (SWLC), in our first 3500 bands our erosion rate is 7/3500 = 0.2%

o Port catheter leak rate of 6.8%. Once again this is very high. Our rate in 3500 bands is 1.5%

o The authors report a 6.8% incidence of band removal for various reasons. Band intolerance at SWLC leading to explantation is < 1%. The authors have a high rate of conversion from band to other procedures such as RYGB and BPD. In our practice, where quick and easy access to RYGB is not available, we continue to work with patients to resolve their problems rather than remove the band or convert. This is a major contributing factor as to why our band removal rate is so low.

o No comment is made about long term nutritional issues after RYGB, which are well described. Failure to acknowledge and discuss this potentially serious complication is a weakness of the study if their intent was to truly compare the procedures.

o The methodology used to compare long term complications is not well described. Some of the LAGB complications may be duplicated. As well, the severity of the complications is not accounted for. It is not appropriate to assume that all complications are “equal” when some can lead to major surgery and major morbidity and others require only minimal intervention.

One of the areas not discussed in the Suter paper is the well recognized rate of weight regain, starting at about 3 years after RYGB surgery. You get a hint of it by looking at Figure 1 in the paper but it was not discussed by the authors. This is an important issue for bypass patients that is unfortunately rarely mentioned. There is a good paper by O’Brien and colleagues comparing both band and bypass in the long term (2) that shows no statistical difference in excess weight loss after the first few years.

Despite the attention that this paper will attract, it is not a definitive statement on the subject. I am not sure that there will ever be such a paper. RYGB and Lap-Band are different procedure both designed to produce sustained and significant weight loss. Both have been shown to be effective at doing so in high volume centres of excellence that provide the operations using the latest techniques and that provide comprehensive follow up care.

We are in the process of publishing our results showing weight loss results comparable with other major centres, and with a very low rate of both long and short term complications. We have already published our low rate of short term complications with Lap Band surgery (3).

Lap-Band surgery is a reversible procedure which is a significant benefit, the benefit of which is underestimated. If research leads to an effective non-invasive or pharmaceutical treatment for obesity, patients could have their La-Bands removed with a simple procedure and then embrace the new treatment option. This option is not available to any other bariatric surgical procedures.

The risks of bypass and band are very different and well understood. Although the weight loss may be more rapid, and potentially a little better with bypass, I do not believe there is consensus that the difference is clinically relevant. Although band patients may have a higher chance of revision surgery, the revision procedures are rarely performed for serious or life threatening complications. Lap Band surgery is reversible which may be a benefit, but may also lead to a higher rate of conversion to other procedures if the results are less than anticipated. Realistic expectations should be established, and a full and frank discussion of the short and long term risks are critical and mandatory for both procedures.

I appreciate your time and would be happy to discuss this paper and all the issues around it at your convenience.

Best Wishes

Dr. Chris Cobourn | Medical Director and Surgeon

Surgical Weight Loss Centre

www.swlc.ca

References

1. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates Obes Surg. 2006 Jul;16(7):829-35.

2. Systematic review of medium-term weight loss after bariatric operations. O'Brien PE, McPhail T, Chaston TB, Dixon JB. Obes Surg. 2006 Aug;16(8):1032-40.

3. Laparoscopic gastric banding is safe in outpatient surgical centers. Cobourn C, Mumford D, Chapman MA, Wells L. Obes Surg. 2010 Apr;20(4):415-22.

Saturday Stories: Ivory towers, farmwashing and antibiotics

yonifreedhoff@gmail.com (Yoni Freedhoff) — Sat, 21 Jan 2012 10:30:00 +0000

The Atlantic and the broken economics of ivory tower research publications.

Andy Bellatti covers Kellogg's Farmwashing

Marion Nestle covers the topic of antibiotic overuse and the FDA's undersight.

Star Wars Doggy Nerdgasm

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 20 Jan 2012 10:30:00 +0000

I think I need to buy a VW.

Don't know if you remember last Superbowl's VW Star Wars themed ad....but today Funny Friday is apparently a teaser for this year's.

[BTW, true story - I marched down the aisle to the Star Wars theme. I had wanted to walk down to the Death March, but I made the newbie mistake of telling my now wonderful wife the name of the tune]

(Email subscribers, you have to head to the blog to watch)

Have a great weekend!

Paula Deen has Diabetes and takes Victoza. So What?

yonifreedhoff@gmail.com (Yoni Freedhoff) — Thu, 19 Jan 2012 10:30:00 +0000

I've been kicking this story around in my head since it came out.

Celebrity TV chef with obesity who makes repulsively, insanely, calorificly obscene foods (like the bacon, fried egg, doughnut burger of hers pictured up above) develops type II diabetes, doesn't tell anyone for 3 years, and then not only has a big reveal, but signs a deal to endorse an injectable hypoglycemic medication.

So what?

Certainly the blogosphere's abuzz with outrage over the irony, the hypocrisy and the message being sent, and while I agree it's ironic, nutritionally hypocritical and a rather sad message, try as I might, the furthest I get is plain disappointed - I just can't work up any consternation.

Sure, the food she promotes (and presumably eats) is ridiculously decadent calorically and not what any would describe as healthful. Sure eating that sort of food on a regular basis would likely lead you to weight gain which in turn will put you at a much higher risk of diabetes. Sure the message of, "don't worry about your diabetes, there's a drug for that, so keep eating whatever you want" isn't exactly a healthy one. But I'm still confused as to why people are so up in arms.

What I mean is, Paula's not an allied health professional, she's a TV chef with diabetes who cooks far from healthy fare, who apparently now takes Victoza, who frankly was never even remotely seen as a healthy living role model even before her diabetes diagnosis. Did people really look to her or her meals and think she or they were such a picture of health that on that basis they increased the frequency with which they actually prepared her recipes?

We all accept differing degrees of risk into our lives. Jaywalking, biking without a helmet, driving short distances without a seatbelt, smoking, drinking, drugs, processed meats, trans-fats, improper weight lifting techniques, avoiding the doctor, not taking our medications, etc. The fact that Paula wants to continue to risk her health by presumably continuing to eat her bacon fried mac and cheese? That's her business, and were she explicitly telling people her extravagances were healthy, it would certainly be horribly hypocritical, but that's not how she sold them or herself. Consequently I don't think she or her show are any more or less reprehensible now than before her diagnosis.

I guess really what I'm getting at is that I don't for one millisecond believe that the reason people so regularly eat terrible diets is because Paula Deen cooks appalling food on her show. That'd be giving Paula way too much credit.

So could good come from Paula's diagnosis and drug deal?

Maybe.

What if her diagnosis inspired people who were already eating horrible Paula Deen'esque diets to go to their doctors to get checked for diabetes, or if they already have diabetes, go and ask about whether or not Victoza would be suitable for them?

Great I say. If her being a spokesperson for Victoza leads to improved secondary prevention of type 2 diabetic complications then bully for her, and who knows, some people with newly Paula Deen inspired diagnoses may even elect, unlike apparently Paula, to make marked lifestyle changes.

Yes, it'd be lovely if we all ate exceedingly healthful diets, yes it'd be great if we all exercised regularly, and yes it'd be great if we rarely if ever cooked any of Paula Deen's ludicrous concoctions. But that's not everyone's world, and for those already living in Paula's, becoming more aware of type 2 diabetes and its treatments is probably a good thing.

Could Paula have taken this opportunity to become a healthy role model for America? Yes. Did she? Clearly not, and while I would have hoped that as a human being she would have seen value in that, her obvious refusal to step up to that plate leaves her playing the same role she always has - a B list celebrity chef whose claim to fame is cooking nutritionally repugnant food.

Too bad she didn't trade up and become someone laudable.

Gastric Bypasses Destroy Lap-bands in Head to Head Study!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Wed, 18 Jan 2012 10:30:00 +0000

While this wasn't a randomized or blinded trial, the results were striking.

442 case-matched patients were followed for 6 post-operative years. Half received a gastric bypass, and half a gastric band.

While early minor complications were higher in the gastric bypass group (triple the rate seen in banding), major complications were similar. Aside from that, it's all bypass with the bypassed patients enjoying quicker losses, larger maximal losses and significantly better maintenance of losses.

How much better?

After 6 years, for every failed gastric bypass, there were 4 failed lap bands (with failure determined by BMI greater than 35 or reversal of the procedure). For every 1 long-term bypass complication there were 2 lap band complications, and for every 1 re-operation of a bypassed patient, there were 2 of lap banded ones.

Given how damning these results were, the journal invited noted band surgeon Jacques Himpens from Brussels to try to provide some balance in an after article commentary.

Dr. Himpens critiques?

The study could have used surgeons known to be leading experts in banding and bypass.
The mechanistic failing of banding to impact on weight related gut peptides might turn out to be an advantage in the very long term.
The band is more readily reversible.

Of course Dr. Himpens also clearly stated that he himself agrees gastric bypass is a "better" procedure than gastric banding.

Seems like the decision of which surgery to have just became a great deal clearer for those who are considering one.

Romy, S., Donadini, A., Giusti, V., & Suter, M. (2012). Roux-en-Y Gastric Bypass vs Gastric Banding for Morbid Obesity: A Case-Matched Study of 442 Patients Archives of Surgery DOI: 10.1001/archsurg.2011.1708

McDonald's Invited to Teach Nutrition to 5th Graders in Connecticut?!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Tue, 17 Jan 2012 10:30:00 +0000

A ways back I blogged about how in Japan McDonald's was rolling out lesson plans for elementary students and in so doing, blatantly healthwashing their food.

In my head I somehow figured that this was a practice unique to Japan, and that a program like it could never exist in North America.

Boy was I wrong.

In what sounds like a carbon copy, the Connecticut Post reports on workshops conducted by McDonald's for Eli Whitney Elementary School's 5th and 6th graders.

What are the kids being taught?

Well according to 11 year old Shannon Mullings who's quoted in the piece,

"I learned that McDonald's can be very healthy for you if you make the right choices."

11 year old Jack Kyzer (that's him in the photo up above) was quoted as stating,

"It was the best thing that ever happened to me."

The mind boggles.

Not in so much as McDonald's is running this sort of a program, but rather that at least one school board and one set of school administrators think it's a good idea.

What do you think?

A Campaign Against Body Hatred Heads to the British Parliament

yonifreedhoff@gmail.com (Yoni Freedhoff) — Mon, 16 Jan 2012 10:30:00 +0000

Today in England two fascinating events are going on. Firstly, the British Parliament is holding an all party inquiry into the causes and consequences of body image anxiety in the United Kingdom. Secondly, a group of women who've been burned by the diet and beauty industry's predatory marketing and traumatic programs are staging a protest outside the inquiry's doors.

What are they protesting?

"The role of the diet industry in de-stabilising women and girls’ appetites and desires. We believe that eating disorders and the so-called ‘obesity epidemic’ are merely more visible extremes of a much bigger, everyday phenomena: that we are accepting fear and hatred of our own bodies like gravity, that we are accepting ‘I am not good enough’ as a fact."

I couldn't be more supportive of either endeavor.

On a daily basis in my office I see first hand the personal devastation caused by traumatic dieting and unrealistic societal body image ideals.

In my home I can't help but worry about my 3 wonderful, little, girls growing up in a world where weight is portrayed synonymously with laziness, gluttony, stupidity, and greed. I see it in kids' movies like Kung Fu Panda, in children's books like Harry Potter with his "piggy" cousin Dudley Dursley, and sadly I hear about it when I have bedtime chats with my 7 year old and ask her about who gets picked on in school.

That's not to say I'm not supportive of efforts geared to help folks lose weight, just that society's ideas of what those efforts involve, the insanely unrealistic goals, the incredibly non-sustainable diets, and the quest for artificial body image ideals - those need to go.

My office promotes no specific diets. There are no forbidden foods. There are no required products. The goals we encourage our patients to consider are non-weight based and non-numerical, and consequently we don't utilize so-called "ideal" body weights, body mass index tables or waist circumferences.

The only goal worth pursing? Living the healthiest life a person can enjoy. Period. People need to be able to be proud of themselves living those lives, regardless of their weights, and there's no doubt that the diet and beauty industries as a whole go out of their way to purposely make people feel like failures so as to create a revolving door of need.

Good luck to the protesters, and let's hope that the British Parliament actually takes them, and the inquiry, seriously.

[Hat tip to the Canadian Obesity Network's communication director, and my good friend, Brad Hussey]

Saturday Stories: Diaries, portions and the common cold

yonifreedhoff@gmail.com (Yoni Freedhoff) — Sat, 14 Jan 2012 10:30:00 +0000

BBC's Ouch blog asks if keeping a positivity diary help with your chronic illness?

Marion Nestle covers New York City's latest shocking ad campaign - portion size.

Scott Gavura from Science Based Pharmacy (and Science Based Medicine) drums down the evidence of every so called cold remedy or preventative in the book

Canada for President of the United States!

yonifreedhoff@gmail.com (Yoni Freedhoff) — Fri, 13 Jan 2012 10:30:00 +0000

What a crazy week....but perhaps not as crazy as America's GOP hopefuls.

Today's Funny Friday is Canada's pitch to become a candidate.

Warning - NSFW language and painful fun being made of both of our countries.

Have a great weekend!

(email subscribers, head to the blog to watch)