Cancer hospital approves free cigarette give away fundraising!

Somehow I doubt it.

I mean, accepting donations or funds raised by corporations whose very products contribute to the burden of disease in your hospital would be anathema to your responsibility as a hospital to promote public health and combat disease, wouldn't it?

But what if your hospital really, really needed the money?

Um, it's a tobacco company handing out free cigarettes and simultaneously asking for hospital donations.

Yeah, there's not too much debate there. It's not good, right?

So why do our hospitals, specifically our children's hospitals, regularly partner up with the purveyors of sugary treats to raise money in their names?

These photos, taken by an anonymous tipster from Toronto, show a recent Dairy Queen Guinness Book of World Records attempt at making the world's largest ice cream cake. Stamped right on the sign, "donations to Sick Kids Hospital will be accepted" in lieu of course of free ice cream cake.

And the same happens here in Ottawa where CHEO regularly partners up with Dairy Queen to raise funds.

I wonder what the HALO team at CHEO think about these partnerships - they're the folks who are busily researching means to try to help combat the rapid rise in childhood obesity in Canada.

Guessing they might think that children's hospitals probably shouldn't be in the brand polishing business for Dairy Queen.

That same tipster did some quick calculations.

The cake?


Through it, Dairy Queen distributed 5,000lbs worth of calories, 4,276.8lbs of added sugars and 44.5lbs of trans fat all with the blessing (they used Sick Kids' logo - they had their explicit blessing) of the Hospital for Sick Children.

These partnerships have got to stop.

I know, I know, fast food's not going away, and children definitely still need to enjoy cake from time to time, but that doesn't mean it's ethical or responsible for hospitals to help in its sale or promotion.

Hospitals used to sell cigarettes too you know.

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Who Cares if 3,500 Calories Don't Make a Real Life Pound?

If there's a more painful discussion in nutrition and obesity these days beyond the one that circles the question, "Do 3,500 calories really make up a pound?", I don't know what it is.

So here are some truths.

• People are not walking math formulas whereby if they have 3,500 more or less calories than they burn they'll gain or lose a pound.
• 3,500 calories of one food or type of food will likely have a different impact on health, hunger, thermic effect, and weight than 3,500 calories of another food or type of food.
• Different people have different caloric efficiencies whereby they are seemingly able to extract more calories from food or reserves than others and lose weight with more difficulty (and gain with greater ease).

And yet here's the only truth that matters.

From a weight management perspective, the currency of weight is calories. While exchange rates undoubtedly do vary between foods and between individuals, you'll always need your own personal deficit to lose, and surplus to gain.

All other discussion, while certainly academically interesting, given there are no other alternate measures available to track, or tests to determine individual responses to different calorie sources, serves to foment confusion.

If weight's your concern, more important than anything else is finding a life that you enjoy that contains fewer calories than before. Getting stuck in the minutia of what type of calories may lead to an every so slightly faster or greater loss, rather than truly crafting a life that's enjoyable (and hence sustainable), might help in the short run, but will almost certainly defeat you in the long.

Will Calling Obesity a Disease Cause Harm?

Some folks sure think so.

While there's no doubt there's always a risk of unintended consequences (and no doubt too that we should always be on the lookout for them to deal with them as they arise), exploring the arguments that arose last week with the AMA's description of obesity as a disease it would seem people are up in arms about some odd stuff. Here's a summary of the most common arguments against that I was able to find followed by some thoughts of my own:

1. Calling obesity a disease will cause insurance rates to rise

All of today's insurance policies require heights and weights and people are already regularly and routinely being rejected or penalized consequent to their weights.

2. Healthy people with obesity will now have a label of having a disease.

Given weight's visibility, they already do, except now society labels them as lazy and gluttonous. While labels are always misguided, which label do you think leads to more stigma?

3. People with obesity will now be able to call in sick simply consequent to their weight

This one's too stupid to bother with.

4. If we label people with obesity as "sick", they'll no longer want to try to lose weight.

Since when do we label people as "sick"? Are people with asthma "sick"? And moreover, are people newly diagnosed with asthma deciding not to take puffers due to their new "labels"?

5. Calling obesity a disease will increase eating disorders.

There is zero evidence that would suggest that this is a real risk. Established eating disorder risk factors include youth, being female, family history, mood disturbances, restrictive dieting, life upheaval, and certain career paths (ballet dancers, actors, models, gymnasts, etc). And while some are bound to comment that restrictive dieting will increase consequent to a disease definition (with no evidence to suggest this to be true), I'm hopeful that even were it true that over time a new way of thinking about obesity will help to illuminate the nonsense and medically unsound nature of highly restrictive dieting.

6. Calling obesity a disease will increase the severity of weight loss approaches.

Actually treating obesity as a disease would mean evaluating it as we do any other disease - as part of a whole picture and with varied penetrance (sticking with asthma, there's mild that requires an occasional puff or two all the way through a spectrum to major that requires regular and multiple medications). And we do have a means to do this with obesity - the Edmonton Obesity Staging System where for instance those with an Edmonton Obesity Stage of zero or one likely wouldn't be recommended treatment of any sort, but rather watchful waiting.

7. Calling obesity a disease will increase the notion that scales measure health.

While this in indeed a faulty notion I'm confused as to how we'll increase a notion that however faulty is already accepted by nearly everyone on the planet? The only direction left to go on this one is down.

8. Calling obesity a disease will lead people to think that it's contagious.

Do you think that asthma is contagious? How about glaucoma? Hardening of the arteries? Arthritis?

And then lastly,

9. Because lifestyle changes might treat obesity, labelling obesity a disease will dissuade folks from making healthful changes.

Here's some news for you. Lots of diseases are preventable or treatable through healthy lifestyles including hypertension, high cholesterol, coronary artery disease, diabetes, ischemic stroke, osteoporosis, cataracts, erectile dysfunction, and oh yeah, 40% of all cancers to name just a few. Yet no one has a problem with those diseases leading folks to consider pharmacologic or surgical interventions to help manage them. But then the world doesn't implicitly loathe people with cancer I suppose.

Why The Food Industry is Neither Friend nor Foe

This past weekend I had the pleasure and honour of debating Dr. Derek Yach at the American Heart Association's Epidemiology and Prevention, Nutrition and Metabolism Conference and the debate we were asked to have was entitled, "Food Industry: Friend or Foe". While I argued the "Foe" side, I actually think the debate title was a misnomer. Ultimately the food industry is neither friend nor foe as both assume that industry has the luxury of consistent intent beyond profit.

I don't think that it does.

That's not a mean spirited statement, just a truthful one as were a corporation to promote a product or program that ultimately undermined the corporation or their profits, that product or program would be dropped - just as we saw when Campbell's re-salted their soups, when Ruby Tuesday's lost their now legally required pre-emptive posting of calories on menus, and when Dr. Yach's former employer PepsiCo renewed their commitment to their core brands by upping their advertising buys for sugared soda and hiring teen idol Beyonce to be a brand spokesperson despite their stated aim of becoming the world's most profitable health and wellness corporation.

Ultimately if profits align with health then the food industry is absolutely going to be public health's friend. And if profits and health collide, then the food industry is absolutely going to be public health's foe. And honestly I think it's a failure of both sides of this argument to consider industry's ability to circumstantially be both friend and foe that leads to the black and white arguments that we should either be working with, or shunning industry.

My line in the sand in the debate was my usual one. I think dialogue, debate and the individual provision of counsel to the food industry in the grand scheme of things may well be in public health's best interests as it may in fact help industry to find those rare areas where health and profits do indeed collide, however once we add our institutional backing to the food industry I think we provide them with an almost irresistible means to further sales, whether by positive brand associations, misguided co-branded sales, ammunition with which to fight industry unfriendly legislation by validating the claim that they're working with so-and-so to be part of the solution, and the co-branded promotion of nonsensical messaging like balancing energy intake with output (never you mind our sugar water, you just need to exercise). Consequently I don't think public health organizations should formally partner with the food industry.

I'll be using the same slide set at the Canadian Obesity Network Conference in May where I'll be part of a panel discussing this very topic and I'm hoping to post them then. And hey, if you're near to or wanting an excuse to visit Vancouver between May 1-4, the conference looks great!

A Food Industry/Public Health Partnership I Could Support

A few weeks ago I at a talk I was giving in Halifax I was asked by my colleague Dr. Geoff Ball if I was still diametrically opposed to partnerships between public health organizations and the food industry.

My answer was, "Yes".

That said, over the past few years of my very vocal opposition to such partnerships I've been regularly challenged to come up with a mechanism that I could in fact stand behind.

So for what it's worth, here's what I've been considering.

What if there were a nutritional research fund that was financially supported by the pooled resources of the food industry, but governed by academics?

Where the various food industry players who want to be "a part of the solution", put their money where their mouths were - with unrestricted grants to this hypothetical fund?

Those monies would then be distributed on the basis of merit and need to nutritional research projects by means of academics with no industry ties.

The food industry folks could still talk of their being part of the solution by means of corporate social responsibility reports that would highlight the money they're sinking selflessly into the fund, while researchers wouldn't be beholden to the food industry, nor would projects be chosen on the basis of what the food industry believed would result in product favourable outcomes. Keeping the food industry at arms length would also preclude industry's use of health organization's logos or specific researcher's good names to sell their products and healthwash their brands.

It's not a perfect system as the industry players could still use their involvement in the fund as proof of their playing ball and might leverage that involvement into political gains and deflecting industry unfriendly legislation, but compared with the mess that currently exists consequent to these partnerships - I'd call an arrangement like this one as close to a win-win that I could imagine.

Do You Know the Difference Between a Diet "Cheat" and a Life "Choice"?

I hear it all the time,

"I cheated on my diet"

Really?

You cheated?

What does that mean?

Does that mean you ate a food that was high in calories? That you used food for a role other than fuel?

Isn't that just a choice?

Sure I believe that all choices need to be informed, and to inform a dietary choice, if weight's a consideration, quantity and calories may well matter, but the simple fact that you decided that food was a pleasure in your life? Well if you can't make that choice from time to time I'd argue you're cheating on living a realistic life, and that cheat's probably more likely to lead your diet to fail than any other.

Is Obesity a Disease?

Way smarter folks than me have duked this one out before, and while obesity has its own slot in the International Statistical Classification of Diseases (ICD-9), the debate of whether or not it's truly definable as a disease is often a heated one.

My take?

Personally I'd describe obesity as the natural consequence of placing a collection of truly ancient genes, genes forged over millions of years of incredible and constant dietary insecurity and upheaval, into an insane, calorific, modern day, dietary utopia. In other words? Obesity and overweight are our bodies' normal, natural, responses to the world they find themselves living in.

But unlike many other natural responses to our environments, obesity frequently carries with it real risks to both quality and quantity of life. Yes there are certainly people even with class III obesity who are exceedingly healthy, but that truth certainly wouldn't negate the case for obesity as a disease as many diseases have varied penetrances, and for a large percentage, especially at its extremes, obesity carries marked medical impact.

So is obesity an actual "disease"?

While I'd happily argue that obesity is a disease of the modern day environment, I'll more happily argue that unless we label obesity a disease, even if you happen to think it's not, we're less likely to see real formative changes in the way we deal with and view obesity as a society.

The fact is that right now the accepted global viewpoint is that if obesity is a disease it's a disease of willpower, of gluttony, of sloth. Consequent to that viewpoint we see tremendous, hateful and harmful weight bias that starts as bullying in elementary school and continues unabated for life.  Stereotype and bias targeting those people with obesity impacts upon their access to healthcare, employment, human rights and societal acceptance. Weight stereotyping also fuels the nonsensical weight loss quackery that steals money and hope, the well intentioned but misdirected public health campaigns that vilify obesity without offering tangible targets for change, and it's what allows medical schools and other allied health professional training programs, to virtually ignore thoughtful obesity related education - even if only to impress upon the students a non-blame based, you can in fact be fit and fat, approach.

Now there are indeed arguments that can be made regarding the risks of defining obesity as a disease, but when I've heard people discuss these risks, I've always been struck by the fact that those risks most commonly identified already exist. People already face discrimination by insurance companies consequent to weight, they already face difficulties with promotions/employment because of their weight, they already are labeled because of their weight, etc.

Were obesity to become accepted as a chronic disease, one that reflects a natural consequence of ancient genes in a modern day toxic environment, over time I would expect to see a change in societal attitudes. And there has been precedent for such a change - depression. The 60s and 70s saw society believing that people with depression need only, "pull themselves up by their bootstraps", yet now depression is readily accepted as a condition deserving of care, attention, empathy and most importantly, a lack of blame.  Shifting the focus to obesity as a disease might also lead to environmental targeting of blame and consequently, environmental targeting of treatment.

My hope is that one day obesity will be seen as a modern day scourge, a day when the trite advice "all you need to do is eat less and exercise more" is seen by the general public as over-simplified nonsense, a day where obesity's not thought to be about personal weakness, a day where obesity's known to have a a wide and varied penetrance, a day where obesity's treatment would range from absolutely nothing in those with no medical consequences, to behavioural therapy, to drugs, to surgery, and one where allied health professionals were skilled enough to know when and if obesity's treatment was actually necessary.

A day when people who struggle with obesity aren't made to feel like if they just wanted it badly enough, they'd magically wake up with a mindset that ultimately would see them to permanent weight loss, because the thing is, one thing people don't lack is desire, and if desire and strength of conviction were actually all that were required, no one would be reading this blog post, and everyone would be whatever weight they dreamed of being.

Paula Deen has Diabetes and takes Victoza. So What?

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.

Why Soda Taxes Aren't Fat Taxes and a few Other Thoughts

Soda taxes are regularly being promoted and described as "fat taxes", "sin taxes" or "obesity taxes".

They're none of those things.

Why?

Some reality:

• It's not a sin to drink soda
• Skinny folks drink it too
• Yes, the calories in soda are a real and likely player in our growing rates of obesity....and so are the calories in a great many other foods.

Taxes on sodas are meant to discourage an unhealthy behaviour - drinking boatloads of sugar. That's a bad plan both for people with, and for those without obesity. The World Health Organization has recommended that no more than 10% of everyone's daily calories come from added sugars. In regard to added sugars, sugared soda's certainly the most clear and present target, and especially here in Canada where medicine is socialized, discouraging behaviours that contribute to the burden of disease (and hence healthcare expenditures) is certainly in the Government's purvey, and hence the consideration of a soda tax.

So I think a better definition would be an, "unhealthy indulgence tax", which is the same way I'd describe tobacco's taxation.

But will a soda tax actually help decrease the burden of chronic disease?

No one knows. Some mathematical modeling has suggested it will, but even the best models can't truly predict real world behaviours.  For instance, in this model they predict that 40% of the calories no longer consumed consequent to the tax would end up being consumed in increased milk and juice calories. But what if Big Beverage jumped on the tax to more heavily market juice? Given their job is to make money and given that every soda company worth its salt also sells juice, I wouldn't bet against that marketing. If the calorie and free sugar reduction disappears in the consumption of non zero-calorie beverage alternatives to soda, then the benefits of less soda would also disappear.

And what of the dollars raised? Is there any assurance that those dollars would be spent on healthcare? I remember a similar promise here in Ontario where the Liberal Government implemented a Health Care Premium that was promised to help fund the health care system but ended up funding water infrastructure.

Oh, and one last thing. Sometimes folks argue that this tax would be punitive to the poor. It's true that the lower your income, the more impacted by a tax you would be, but some perspective might help. First, the cost of a soda with inflation adjusted dollars has dropped 33% since 1978 (see chart up above) and most folks are recommending a less than 33% tax on the stuff. Second, on average we're all consuming 3x as much soda as we did back in the early to mid 1960s. So whatever a person is currently spending on soda, if that person continued to spend the exact same amount, but soda prices rose by 33%, on average that person would still be consuming double the per capita soda consumption of the mid 1960s. Double the soda consumption of the mid 60s doesn't sound too cost prohibitive to me.

So am I pro soda tax?

Yes, but cautiously. I say cautiously because of all those questions up above, and because I wonder about these sorts of taxes actual implementation. Ideally soda taxes would be rolled out with public education campaigns that talk of liquid calories, and ideally too, it'd be a tax that would apply to all sugar sweetened beverages (including both milk and juice). I'm not too confident those criteria would be met. But I'm supportive because at the end of the day, whether you have weight to lose or not, drinking less sugar is likely in our health care systems' best interest, and sugar sweetened beverages are by far the biggest, sweetest target.

Are you a Talk Walker, or a Walk Talker - My Challenge to Health Professionals

In health care it definitely helps if you know what your patients are going through.

It's not essential of course, thankfully there are far more diseases that I can treat than I have personal experience with, but common grounds give understanding and empathy that books and lectures simply can't.

But I'm not talking about diabetics being better at treating diabetics. I'm not talking about drugs or rehabilitative exercises.  Here I'm talking about the things we ask our patients to do in the hopes of improving the health of their lifestyles.

Because let's face it, when it comes to healthy living, health professionals sure are great at providing advice, but that's not to say the advice is always great.  I wonder how much better a health professional's healthy living advice would be if they actually lived it themselves?  At the very least, it would provide that health professional with a true understanding of what it takes to follow through, and at best, it would highlight recommendations that from a doability perspective, might stand a bit of work.  Either way, it'll help to provide true, genuine, empathy.

So if you're a health professional, my question to you is this. Do you actually walk your talk, or do you just talk it?

Me?

While I discuss a great many things with my patients, boiling it down, the bare bones thrust of my lifestyle recommendations usually involve eating every 3 hours, always including protein, tracking calories, weighing and measuring food, cooking (actually transforming raw ingredients) and exercising as often as they can enjoy.

And I'm not posting that to have a debate about the recommendations themselves.  Different approaches for different people, bodies and goals.  Some will succeed with 3 meals a day, some with intermittent fasting, some with truly low carbs, some with meal replacements, etc.  What I care most about is that a patient likes their approach enough to continue with it.  And while we have those recommendations up above as our base, we're happy to work with our patients on any approach they feel they might be able to sustain because the suggestion that there's only one way to go flies in the face of the evidence base.  Why I'm posting it here is so that you'll know what our base recommendations are so that you can judge whether or not I'm doing them myself.

Because I'm a bit of an open book. My food diary is publicly available on Tweet What you Eat. At the time of writing today, I haven't missed tracking a meal or a snack for 248 consecutive days. I'm not obsessing about it either - it doesn't consume my every waking moment of time or attention.  In fact, at this point I doubt it takes me more than 5 minutes a day of effort, and it's certainly not about being perfect. Have a peek and you'll see what I mean. For instance you'll find that this past weekend I went out twice to eat, including one insanely calorific pilgrimage for ribs. Scroll around some more and you'll see I also sometimes miss snacks, really enjoy alcohol, and also am partial to potato chips and sour patch kids. Good, bad, and ugly, I track it all - because it's not for judgment, it's just to know what the heck is going on and where and when I might stand to tighten my reins. 

Fitness diary wise, I use a new online service called Fitocracy.  Picture Facebook/Twitter, meets an exercise diary, meets an online role playing game. No, you don't pretend to be a dwarf and roll 20 sided dies for your constitution, but the more you exercise, the more you level up, and you can also complete quests, log, save and receive scores for your usual workouts (or your functional activities, they don't need to be gym based), and reach a community of folks who think exercise is important enough to get excited about. I've been tracking on Fitocracy for a little over a month and find it's a great way to stay on top of my goals and it does help give me a bit of a boost in motivation. Want to see what I'm doing exercise wise? Click here and feel free.

Now maybe I'm a bit hard core about this tracking business but of course I'd argue that the evidence base is solidly with me on its incredible value in cultivating healthy behaviours.

My challenge to you?

If you're a health professional, and you're providing lifestyle advice to your patients, commit, for at least a one month period, to make your life an open book, and not only try to live the life you encourage your patients to live, encourage them to watch!

Provide them with links to your profiles and maybe they'll even cheer you on. Honestly, if you've never tried to walk your talk, how can you truly be sure you're putting people on a walk-able path?

Dick Talens, the formerly obese teen role playing gamer turned fitness machine and Founder of Fitocracy has kindly provided me with some invites (it's still in a semi-closed beta).

If you're an allied health professional (including all you healthy living researchers and journalists), click here and not only will you be signed up, but you'll automatically be joined to the group I started just 2 days ago (Update:  Have been told that after clicking the link you need to sign up manually rather than a Facebook or Twitter connect). It's called The Talk Walkers.  Also?  Spread this post to all of your email, Twitter and Facebook colleagues and encourage them to do the same.

If you're not a health professional click here and you can still sign up and get immersed into one of the literally dozens of other groups, or simply decide to tool around with it on your own. (Update:  Have been told that after clicking the link you need to sign up manually rather than a Facebook or Twitter connect).

If you're not doing so already, it's definitely time you walked your talk.  You owe it not only to yourselves, but to your patients.

(Thanks Dick, for the links - to read more about Dick and Fitocracy, here's CNN's coverage)

MyPlate - America's new, irrelevant "food icon"

A great many folks have been asking me to weigh in on the new American "food icon" My Plate that was launched last week.

First the good.

It's dead simple.

It's worlds better than the confusing pyramid it's replacing. It can theoretically actually help guide what a person might put on their plate without requiring them to wade through pages of reading (like Canada's Food Guide does).

Its simplicity is certainly its greatest strength.

Nutritionally though, it does fall down some, and while I could get into nitty gritty, I've only got three to really harp on starting with the full plate itself.

While it may sound ridiculous, I don't think that encouraging a full plate's a great plan. The fact is, we've got big plates, and while the accompanying website does provide caloric guidance, all the MyPlate icon does is suggest your plate should be full.

The second is that like our Food Guide, it doesn't provide much guidance as to the quality of different types of proteins, fats and carbohydrates.

Lastly, I don't think milk/dairy deserves it's own billing as dairy's just a protein source with calcium, and not a magic fairy food that confers the health of immortal unicorns.

But really, it's the broader picture stuff that really matters, as this food icon does nothing to actually address the underlying problems we've got nutritionally in society. It's for that reason why even if it manages to affect plate level changes, America will remain massively messed up nutritionally (not that we're any better).

For instance:

It doesn't address crop subsidies that make highly processed food incredibly cheap to produce and purchase.

It doesn't address the fact that on an annual basis the amount of food dollars we spend outside the home are growing.

It doesn't address the fact that home cooking is a dying art and that the food industry has hoodwinked many of us to believe that opening a few boxes and mixing things together actually counts as cooking.

It doesn't address the fact that we serve our children nutritional garbage in schools.

It doesn't address the nutritionism that among other ridiculousnesses, has folks championing chocolate milk as a means for kids to get calcium.

It doesn't address the front-of-package health claims that help to sell foods by means of their health haloing effects.

It doesn't address predatory targeting of children by Big Food manufacturers.

But of course, how could it?

Ultimately our respective Food Guides and Plates? They can't change the world they're being brought into, and until there's a concerted effort brought to bear to change our world, we aren't likely to see much in the way of useful dietary change.

Is sodium a dietary red herring for the effects of processed foods?

You may have read or heard about a research paper that came out a few weeks ago in JAMA. The study followed 3,681 Europeans and looked for relationships between sodium excretion (the gold standard means of determining sodium intake), and cardiovascular disease and death.

The study's findings were in contrast with what most would have expected. Though higher sodium excretion did in fact correlate with higher blood pressures, surprisingly, it also correlated with decreased mortality.

So what's going on here?

Well here are two obvious possibilities:

1. We've been barking up the wrong tree sodium wise, and sodium's not something the general public should be worrying too much about (unless they suffer from congestive heart disease or hypertension).

2. We're right, sodium's bad, and this study, due to methodological limitations, shouldn't be one that influences us on not lowering our sodium intake.

I think there's at least one more possibility:

3. Sodium's isn't a causal agent of disease but instead given that processed foods are phenomenally high in sodium, is a useful biomarker for the degree of processed foods a person's consuming, and that it's the huge volumes of sugar and pulverized flour (that's more often than not packaged with gobs of sodium) that's actually causal for cardiovascular disease and death.

This study, where data was amassed from European countries from in some cases as far back as 26 years ago, may be looking at a days gone by Europe where processed foods and meals out were anything but the norm, and where a high sodium consumption reflected some other, in this case protective, dietary pattern. I wonder if the study were repeated here and now in North America, if the findings wouldn't stand in stark contrast, with sodium excretion here likely reflecting a highly processed lifestyle which in turn would correlate dramatically with cardiovascular disease?

Of course if option #3's viable it would mean that sodium reduction will likely only benefit those who rely on a return to actual cooking to reduce their dietary sodium, and not to those who eat large volumes of sodium reduced processed foods.

The great news is that science marches ever forward, and while it may take some time, eventually we'll have solid answers. Until then, and before I'd worry about absolute sodium intake, I'd recommend we all work on markedly reducing our consumption of processed and restaurant foods.

No doubt in my mind, sodium be damned or not, if we could all just re-discover our kitchens, the world would rapidly become a much healthier place.

Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovský J, Kawecka-Jaszcz K, Nikitin Y, Staessen JA, & European Project on Genes in Hypertension (EPOGH) Investigators (2011). Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA : the journal of the American Medical Association, 305 (17), 1777-85 PMID: 21540421

Musings on the muffins at the Canadian Obesity Network conference.

Yesterday marked the end of the Canadian Obesity Network's 2nd National Summit, and once again, CON threw a great conference.

For folks who care about nutrition, conferences can be tough events, and despite it having been a CON conference, the food was still challenging.

Take breakfast yesterday morning - a giant mound of muffins, fresh fruit, juice, and coffee. Nary a protein source to be found, and the muffins almost certainly each packing 500 calories and piles of sugar.

Now all told, the food at the CON conference was in fact better than most, but still likely was a long way from healthy.

The reason healthy conference food's a challenge is because to a large degree, the conference organizers are at the mercy of the hosting hotel, and with food often being left to the end to arrange, conference organizers may not have much energy or leverage to advocate for health.

To that end, I have a few suggestions for CON to consider when organizing their 2013 3rd National Summit in Vancouver - suggestions that would be applicable not just to CON, but for anyone organizing a major event.

- If healthy meals aren't always options, at the very least empower conference goers with nutritional information. In CON's case, prior to the conference why not lean on some RD members to crunch the numbers in the meals that are to be served, and then create little cards that can be placed in front of choices such that at least choices can be informed. I wonder too if this information isn't something that could actually generate sponsorship revenue with nutritional information cards having logos or visible sponsorships attached.

- Leverage meal costs/choices at the very outset of organizing. Talking food options from the get go may allow for configuring healthier menus as part of actually sealing the deal, and may also provide enough lead time for the hotel to round up ingredient lists for nutritional analysis.

- Potentially provide fewer meals. Sounds crazy, but that'll keep conference costs down, while at the same time allowing people to make their own choices. If there's a talk scheduled and the only thing available a big mound of muffins, most folks will have a big, honking muffin. On the other hand, start the talks a bit later and let folks fend for their own meals, and at least those who care, which at a CON conference I would hope would be a few, will find healthier options.

But please don't take this post as a slam. Conferences are enormous things to organize, and CON did an absolutely phenomenal job. More of a focus on food would just have been the proverbial icing on an already fabulous cake.

That said, I'm holding out hope for icing in 2013 in Vancouver!

Enough with the "fat taxes"! #CON11

My friend and colleague Arya wrote a blog post the other day where he took some issue with the concept of legislation that targeting obesity.

I don't disagree with him. I can't say it any more plainly. We shouldn't be passing legislation that targets obesity. Such legislation undoubtedly will just fuel further bias and stereotype and will almost certainly do more harm than good.

But yet I'm all for soda taxes, changes to our agricultural subsidy system, tax incentives to encourage exercise, banning advertising targeting children, and posting calories on menus.

Am I an oxymoron? (And yes, I realize many readers may be giggling and thinking, no, you're just a moron).

I don't think so.

The reason I don't think so is that all of those legislative efforts, they're only "fat taxes" and "obesity legislation" if you look at them through obesity blinders.

Yes, all of those interventions on paper might impact on obesity, but none of them target obesity, instead they target unhealthy products and unhealthy behaviours - products and behaviours that are unhealthy for everyone, not just for individuals with obesity.

All Canadians ought to drink less sugar sweetened beverages. All Canadians ought to exercise more. All Canadians would benefit from shifting agricultural subsidies to make healthy foods cheaper and unhealthy foods more expensive. All Canadian children should to be protected from predatory advertising. And all Canadians could stand to be empowered with caloric information at point of sale.

So let's stop talking about fat taxes and obesity legislation, and instead let's take a step back and recognize that these initiatives are there to empower, encourage and persuade healthier lifestyles both for persons with obesity and for persons without. We need to stop talking about them in terms of obesity as to do so is unfair, inaccurate, and potentially dangerous.

The fact is, we can all stand to make healthier choices.

Do Disney World foods reflect what North American palates want?

If so, we're all doomed.

I just came back from a week in Disney World, and while I'd been warned about the food, I don't think anything could have prepared me for just how bad it was.

And while yes, I do mean bad in the sense of how awful everything tasted, I mainly mean bad in the sense of how there was barely a healthy option to be found.

One morning we had a character breakfast with the princesses in the Norwegian pavilion at Epcot. They served breakfast "family" style, which meant for our family of 7 (my 5, which includes a baby, along with my parent in-laws), they brought out two heaping mounds of food (a photo of the remains of one such mound up above). In total they served us 26 strips of bacon (yes, I counted), a bunch of sausages, two piles of the saltiest scrambled eggs I've ever tasted, and this cloyingly rich potato dish with cheese and cream. Oh, and we were also meant to eat from the all you can eat buffet of pastries, cereals, cheeses, meats etc. When we asked the server about the salty eggs, his answer was, "yeah, they make them with a lot of salt", and when I looked around the room, most of the plates were empty.

Now I realize people don't go to Disney World for the food, but my thinking is that Disney of all companies, has a pretty darn good idea of what people want. They've been in this business for a long time, and Disney World alone hosts 17 million visitors a year. If this is what the North American palate wants, insane portions, mounds of salt, creamy everything, and no healthy choices, we're in big trouble.

[So why go to Disney? Well yes they serve awful food, and yes they contribute to the culture of consumerism, and also to the objectification of women. Of course they also contribute to very happy little kids (the 3 in this video are mine), and it's difficult not to love them for providing experiences like this: (email subscribers will need to hit the blog to see the video)]

If the last 10lbs are the "hardest", you're doing something wrong.

I can't tell you how many times I've heard that statement. There are even TV shows and bootcamps dedicated to those "last" 10 pounds.

What does that mean "last"?

For most people out there it means the last 10 pounds to go before getting to a pre-set number goal.

But why are they "harder"?

They'd only be harder if a person felt that successively more and more suffering and sacrifice are what's required for weight management.

Ultimately if you have to try that much harder to lose them, they're probably not staying off, because if those 10lbs require efforts above and beyond what you're comfortable living with happily ever after, their loss will only last so long as you sustain your now super-human efforts.

Simply put, whatever interventions, diets, exercises, etc. you employ to lose the weight - if you don't sustain them, your weight'll return, and so will those "last 10 pounds".

They also might not be the only 10, as for many, regain is so demoralizing that folks often abandon all of their interventions, and not only will those "last" 10 come back, eventually the "first" 10 will too.

Every other area of life people are comfortable with their personal bests as wonderful goals. Why is it that with weight people strive to be "ideal", often at the expense of a liveable life?

Your actual last 10lbs? They should come off as easily as the first. Slower? Absolutely, after all, there's less of you, so you'll burn fewer calories, but if they take any extra effort, that may just come back to haunt you.

Please step away from the Doggy-Bag.

Restaurant food's calories are non-intuitive, invisible, and insane!

I remember watching a recent TV show that had calorie counts from restaurant meals. This particular restaurant was a fancy-shmancy one. The kind with the big plates and the small, little portions in the middle.

Anyhow, this one lady decided to order a beet salad as an appetizer, followed by fish, served on vegetables, served on couscous.

Total calories for her meal? Over 2,100.

Crazy!

So let's say she was doing the pretty common dieting practice of only eating half her meal. She'd still be downing an astounding 1,050 for the meal (not including beverage or dessert).

And if she got a doggy-bag?

She'd be doing it again for lunch.

I get it. I'm thrifty too, and if I paid for it, I feel I ought to bring it home. But really, is it worth the calories?

My advice?

If it's an awesome meal - by all means, have it again for lunch, calories be damned.

But if it's not. If it's just a meal. Why not just leave those calories behind at the restaurant?

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Is food life's only true constant?

Food's not just fuel.

If it were, we'd have calorie tablets, everyone would be real skinny, and I'd be working emerg somewhere.

Food's a lot of different things to a lot of different people, but for all of us, at different times, food's friendship, comfort, solace, celebration and cheer.

And food pretty much never lets you down.

You could have the best marriage, kids, parents, job, hobby, friends in the world, but from time to time, you'll hit some rough patches.

Your comfort food on the other hand?

It'll never let you down. It's a constant. Whatever you need it for, it'll deliver. Each and every time.

Its ability to make you feel better? Don't kid yourself that it's all in your head, it's also in your body. Food has the power to change your body's immediate physiology.

That's why I believe it's about the healthiest life you can enjoy, not the healthiest life you can tolerate, because food has a great many roles, and it needs to still be able to be your rock from time to time.

Should Canada pull out of the Olympics?

$772 million.

That's the figure that a Spanish University would estimate it cost Canadians to secure our fourteen 2010 Winter Olympic gold medals.

Even putting aside the dollars spent on hosting the Olympic games, $772 million is an awful lot of money to be spending on elite athletes.

I can't help but ponder the value of those Olympic golds to our country. Is there any? People may talk of inspiration, and even were it to be true that Canadians are inspired by excellence in sport, is there any evidence to suggest that inspiration translates into any sustainable action?

Somehow I doubt it.

What I don't doubt however is that our Olympics helped sell a lot of Coca Cola, and that Olympic heroes sell a lot of Wheaties, McDonald's and other less than ideal foods.

I think the concept of the Olympics is a beautiful one.

Unfortunately I think the execution these days not only wastes a tremendous amount of resources that could be used to improve the shape of society, it also helps fuel the success of those very industries that have helped lead to our healths' demise.

Makes me wonder, if we're talking about sport, what $772 million could do for everyday kids, rather than for our super-powered, temporary heroes?

The weekend realities of weight management.

Does this sound like you - healthy living strategies going great all week long followed by a weekend that's less put together? Consequently you see yourself lose weight all week, only to gain it back each weekend?

Many of my patients struggle with weekends. As I've blogged before, despite not feeling that way, weekends make up nearly 30% of the week, and the sad weight management truth is, a disorganized 30% can outweigh a beautiful 70%.

To put this into some numbers. Let's say during the work week, through your own personal strategies (be they balanced deficits, low-carb, counting points, exercise, combination approaches, etc) you managed to create a true 400 calorie daily deficit. Enjoyed daily, that would likely lead you to lose a pound every 8-12 days allowing for some differences in individual variation in energy efficiencies.

But then the weekend comes. You might go out with friends (food is an essential part of our celebratory and social lives); you might be less organized with eating so as to invite more of a hormonal drive to eat; you might want to kick back and have a few drinks to unwind. Truthfully, given the calorific world we live in, it wouldn't be difficult at all to amass 800 calorie daily surpluses over the weekend, rather than 400 calorie deficits.

Then it's back to your work week, and even if you're fabulous about getting right back to calorie-deficit inducing behaviours, you'll be spending Monday through Thursday just erasing your weekend surpluses, leaving you with one lonely day a week to actually lose weight.

What's so incredibly frustrating for patients with this all too common scenario, is that in actual fact, the vast majority of their week, they're managing things wonderfully, and so it feels (and is) incredibly unfair that two days a week can effectively erase five.

I don't preach that weekends can't be indulgent, I don't tell people to stop eating out, and I don't tell people they're not allowed to drink. We're on this planet once, and for many, indulgences on weekends are a welcome end to each and every week. However, I do preach that at the very least, you ensure your weekends are well organized in terms of food, so that if you do choose to indulge, you choose to do so because it's worth it, and not simply because you're hungry.