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

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

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

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

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

You've Got the Golden Touch

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

Have a great weekend!

When It Comes to Lifestyle Change, Timing Matters

Great ideas don't always share great timing.

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

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

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

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

The Future of Exer-Gaming Looks Magically Bright

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

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

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

Not sure what that means?

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



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

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

I don't horrify easily.

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

What's a "duff"?

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

No, I'm not kidding.

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



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

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

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

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

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

If Gandhi Took a Yoga Class

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

Have a great weekend!

Money Laundering, Food Industry Style?

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

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

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

Except it wasn't.

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

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

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

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

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

You Almost Certainly Don't Need to Replenish Your Electrolytes

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

But do we?

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

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

The results were striking and easy to describe.

Simply put, if the study is to be believed:

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

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

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

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

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

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

Mislabelling Physical Activity a "Vaccine Against Obesity" Carries Risk

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

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

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

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

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

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

I have yet to hear back.

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

Saturday Stories: Optogenetics, Yogi Berra, and Fact Resistance

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

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

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

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

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

Have a great weekend!

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

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

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

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

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

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

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



References:

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

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

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

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

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

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

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

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

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

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

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

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

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

Double Standards for Conflicts of Interest at the BMJ

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

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

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

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

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

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

Leaving me to wonder three things:

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

and,

3. Are these sorts of conflicts important to disclose?

Saturday Stories: Baltimore, Overkill, and Cancer Greeting Cards

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

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

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

The World's Best Rendition of the ABCs?

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

Have a great weekend!

Will Weighing Yourself Daily Help You to Lose More Weight?

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

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

The reason's simple.

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

The authors found that those weighing more frequently did better.

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

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

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

Exploiting The Most Powerful Emotional Branding Opportunity Life Has to Offer

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

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



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

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

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

Minute Maid Orange Juice and a Masterclass in Leanwashing

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

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

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



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

Amazing Aussie Video Explains Why Serving Sizes Are Nonsense

Now this is a terrific video.

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

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

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

Saturday Stories: Beans, Radioactive Water, and Pap Tests

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

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

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

South Park Takes On the USDA's Dietary Guidance

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

Have a great weekend!


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