If Pokémon Go Doesn't Keep People Moving, What Chance Does Public Health Have?

You remember Pokémon Go, right? I remember when it launched I was giving a talk in LA, and honestly it seemed as if the entire city was trying to catch Pokémon. Flash forward a year or so and I can't remember that last time I saw anyone trying to catch one.

I was curious about whether or not people were still playing and so I hunted around online a bit and found a few articles.

What I learned was, during that launch time last summer there were 28.5 million global daily users. That same article has it that by January, just 5 months later, the number of daily players had dropped by 80%.

Or has it dropped even further than that? Certainly if this Reddit thread can be believed, it has, as the thread asserts that a large percentage of active players now are

• "Bots used by scanners -- Who knows how many bot accounts are out there.
• Multi-account players -- Based on concerns of gym shaving, this appears to be prevalent, but there is no way to determine how many "alt" accounts are out there.
• Account Sellers -- Overlapping 1 and 2, there are many accounts that are floating around out there for sale that have been either leveled by bots or by hand."

All this to say, that the 5 month drop off rate of the most viral and widely launched augmented reality game is somewhere between 80 and 90%, strikes me as more evidence that rather than promoting flashy, feel-good, new online tools and commercials that stand virtually no chance at inspiring sustained behaviour changes, we need to spend our energies and efforts on environmental engineering to squeeze more activity out of our normal lives (eg. cycling and walking infrastructure, tax incentives or disincentives, stairwell renovations and signage, etc.), forcefully building the opportunity for exercise back into our kids' lives (eg. the return of proper school recess), and lobbying our politicians for same.

And maybe it's just my cynicism, but I do find it odd that despite our global and possibly total failings at inspiring intentional, because-it's-good-for-you, behaviour change, both with food and fitness, that as a society we still seem to be clinging to the notion somehow, someone, somewhere, will figure out the golden message, app, or website that will set us all straight. At this point, and certainly in the developed world, it's hard to imagine that the problem is a lack of education as to the benefits of exercise and/or a healthful diet.

Forks vs. Feet for Obesity: The Great Debate Part II (Next Week in #Toronto)

Which is more critical to obesity treatment and prevention - our forks, or our feet?

That's the subject of my upcoming debate with the inimitable Dr. Bob Ross.

It's actually a redo of our prior debate from 2011 on the same topic (which you can watch here if you'd like).

It's being presented by the Toronto chapter of the Canadian Obesity Network (CON) and it's taking place at 5pm on Tuesday June 6th in the Ben Sadowski Theatre of Mount Sinai Hospital.

Tickets are just $15 with proceeds going towards the support of the chapter's activities (and you can buy them in advance by clicking here).

My prediction?

There's going to be far more agreement than you might imagine.

Also?

It should be a lot of fun.

Hope to see you there!

Saturday Stories: Special End Of Life Edition

Have an hour and bit this weekend? Spend it listening to the podcast Sickboy who interviewed friend and one of our office's former RD's, 37 year old Candace Reid, whose husband Layton (whose brilliant letter to his metastases I published as a guest post on this blog last September) died this January, on life Newly Widowed.

Carol Cowan-Levine in The Walrus on the failure of Canada's healthcare system and the death of her daughter by suicide.

Catherine Porter in The New York Times on the living wake and medically assisted death of John Shields.

Parents, How Many Of These Scenes Resonate For You?

As a father of three, today's Funny Friday sure was familiar.

Have a great weekend!

No Coke and Pepsi, Adding Fibre and Pro-Biotics Doesn't Make Liquid Candy Healthy

As the liquid candy business falters, Coca-Cola and PepsiCo are desperately turning to the addition of pro-biotics and fibre to their juices and sodas in a bid to sustain their sales.

First up is Coca-Cola Plus. Launched in Japan each bottle of the diet soda beverage has 5gr of added insoluble fibre. According to its official press release,

"Drinking one Coca-Cola Plus per day with food will help suppress fat absorption and help moderate the levels of triglycerides in the blood after eating"

And a statement to that effect will apparently be placed directly on the front of the bottle.

Next up is PepsiCo's juice arm's offering of Tropicana Essentials Probiotics, which along with its 7.25 teaspoons of sugar per glass (which incidentally is more sugar per glass than Pepsi), is reported to pack,

"more than 1 billion active probiotics in each serving"

What will they do for you?

According to PepsiCo they will,

"work to promote gut health"

Desperate times call for desperate measures I suppose.

[Sorry, earlier version had Coca-Cola, not PepsiCo making Tropicana]

An Incredibly Belated Review of James Hamblin's Terrific New(ish) Book

Full disclosure: I received an e-copy of Hamblin's If Our Bodies Could Talk: A Guide to Operating and Maintaining a Human Body for review from James' publisher Doubleday. I should also disclose, I was likely predisposed to enjoying this book as I've long been incredibly fond of Hamblin's Twitter feed and Atlantic pieces. I'd have written this sooner, but I have this rule of not writing about things I haven't actually read myself and it took me longer than I expected - not because I didn't enjoy it, but more because I fall asleep in about two seconds flat every night. Also, if you use the Amazon links I provide, Amazon will send me a tiny commission.

James Hamblin is a medical doctor. But he doesn't practice medicine in its traditional seeing his own patients sense, instead his practice involves the translation of health into words for whoever wants to read them as he decided to pursue journalism and writing rather than the much safer path of radiology. Hamblin's main platform is his work with The Atlantic where he's a senior editor, and he's also a must-follow (if you like wonderfully dry humour) on Twitter.

Hamblin's book, If Our Bodies Could Talk: A Guide to Operating and Maintaining a Human Body, was published back in December. Simply, it's a collection of questions spanning various topics about health, the human body, followed of course by Hamblin's science-informed answers. It's also a lot of fun.

From questions like,

"Why don't eyelashes keep growing"

(and answers that include, "For three months, then, the hair is called a "club hair". It is, like so many people in clubs, outwardly fin-looking but actually dead at the roots"), to

"Does the G-spot exist?"

(and Hamblin's admonishment, "never liken it to a bike tire"), to

"What about Smartwater?"

(where Hamblin helps you to learn that "electrolyte enhanced" means "bullshit"), the book covers a lot of ground.

Because each question and answer are fairly short, the book makes for excellent bed time reading (in that sense it reminded me some of another book I loved - Bill Bryson's A Short History of Nearly Everything). And along with the humour and pith, comes a great deal that's both fascinating and informative (did you know that the hyperbole of carrot eating leading to better night vision arose in part as an attempt to conceal Britain's discovery of radar in World War II, or that Ben Carson (yes, that Ben Carson), played an important role in the treatment of an exceedingly rare and devastating brain disease?).

So why do you need this book when you can simply Google those very same questions? I think Hamblin covers this aptly by noting that

"Googling health information is roughly as reliable for finding objective answers as picking up a pamphlet on the subway floor"

The book is a delight. Suitable too for those parents like me who want to teach their children, without lecturing, that critical appraisal is sadly necessary in this day and age (another recommendation here is to listen to the podcast Science Vs. with them).

If you're looking for a book that entertains while it educates and you'd like to purchase a copy for yourself, here's an Amazon link to it for my American readers. And if you're living here in Canada - this one's for you (though at least when I was typing this, it would still be cheaper to use the American link).

Saturday Stories: Slavery, Young Physicians, and Sexism

Alex Tizon in The Atlantic with an article on modern day slavery that I can't imagine you haven't read, but on the off chance, find some time and do so.

Suzanne Koven in The New England Journal of Medicine with her letter to a young female physician.

Eve Forster in Vox on sexism in science and her telling social experiment.

Schoolhouse Rock's "I'm Just a Lie" (Thanks Jimmy Kimmel)

For those of us old enough to remember, "I'm Just a Bill", todays' Funny Friday is sure to bring a smile. A sad one though.

Have a great weekend!

Guest Post: Public Health RD Questions Ontario's Calorie Labelling Rollout

Last week an RD who'd prefer to remain anonymous asked me if they could share their thoughts on Ontario's new calorie labelling initiative with my readers. I readily agreed, and I agree with much of this post. I'm strongly supportive of calorie labelling, but the rollout certainly could have been more thoughtful. And while I agree with all of this RD's closing points, I don't see calorie labelling vs. other changes as being either or - I'd like to see them all.

On January 1st of this year it became mandatory for restaurants with at least 20 locations in Ontario to post the calories on their menus. Many dietitians and other healthcare professionals rejoiced as this information would help people to make better, or at least more informed choices when eating out. Personally, I was a little more skeptical. From what I had seen from other places implementing similar legislation resulted in little if any change in eating habits. We are always talking about evidence-informed decision making in healthcare, yet this legislation from the Ministry of Health and Long-term Care seemed to be based more on appearances than on evidence.

There were problems from the start. Training for public health inspectors (who are responsible for enforcing the legislation) didn’t take place until just over a month before the legislation took effect. It was made very clear to the PHIs that they were to only ensure that eating establishments adhere to the legislation; i.e. that calories were posted in the appropriate places in large enough font and that the contextual statement was posted. They were not to question the calorie counts posted. Some of you might remember the time everyone got upset about Chipotles posting the calories for just the chorizo in a wrap, rather than for the entire wrap. Well, if something like this were to happen in Ontario, unless a complaint came from the public, the PHIs have no recourse. They might see calories posted that seem blatantly incorrect but they have been instructed not to question them. Restaurant owners and operators need only use means that they “reasonably believe” to determine the calorie counts. That means that calorie counts could be determined by a bomb calorimeter (accurate) or by myfitnesspal (questionable) as long as the owner believes it to be accurate. The Ministry declined to provide PHIs with any guidance as to what methods and tools would be appropriate so they are left to take restaurant owners at their word.

Framing this as an initiative to decrease childhood obesity was a huge mistake in my mind. Teaching children to calorie count is not healthy or helpful. Nor is simply providing calorie amounts to parents when caloric needs vary so much among children. Sometimes providing just a little information can be dangerous. I’m sure that the government meant well and they thought this would be a great visible way to show that they’re tackling childhood obesity while downloading the cost onto restaurant owners, win-win. However, this legislation should have been targeted toward adults only. Children should never be counting calories.

The point of this legislation is ostensibly to help the public make informed choices. To that end, you would think that there would have been a public education campaign launched well in advance of the implementation of the legislation. You would be wrong. Despite numerous requests from public health dietitians, and assurances that public education was coming, it wasn’t until over a month after the legislation came into effect that any “education” was undertaken. As a dietitian, I was expecting information on how to use the newly available calorie postings to make better choices. Boy was I wrong. Instead, the Ministry released a series of ads that read more like fast food advertisements and essentially just say “calories are now on menus”.

Let’s fill our kids with ideas about eating right.

A post shared by Ontario Government (@ongov) on Mar 8, 2017 at 11:36am PST

The calories in your food are being revealed. Look for them on menus today. Depending on age and activity, an average of 2000 calories a day is recommended for teens.

A post shared by Ontario Government (@ongov) on Mar 28, 2017 at 1:44pm PDT

I see these and I think, “wow! Poutine and hash browns are so low in calories. They’re not as bad a choice as I thought.” Not at all the message that I think should be coming through this campaign. It’s embarrassing that the government used our tax dollars to pay people to come up with these terrible ads. Apparently they focus group tested them and the teens thought they were hilarious. Perhaps they can’t tell the difference between laughing with you and laughing at you? Regardless, there should have been someone working on this campaign who saw that it wasn’t sending the intended message (check out the comments). They should also realize that simply telling people that calories are posted on menus isn’t sufficient to aid them in appropriately using this information. As it stands, it only serves to help those who are already health conscious and who know roughly how many calories per day they should be consuming. They should have been giving people the information and tools to better understand and use the calorie counts.

Does putting calories on menus even work? There was a recent webinar by Health Evidence on this and they said that on average, it led to reductions of about 70 calories per day. Which sounds great except that the average caloric intake of people in the studies was about 3000 calories a day, about 1000 calories more than the recommended daily calories for an average adult. So, yes, putting calories on menus may lead some people to choose items with fewer calories but if they’re still consuming about 900 more calories than they need I’m not sure that’s anything to write home about.

Calories are only one piece of information and I worry about putting too much emphasis on it. Restaurant meals tend to be obscenely high in sodium but the calories won’t tell us anything about this. Calories also don’t tell us if a menu item is nutrient dense or nutrient void. It can make it appear that deep-fried foods are equal to salads.

Something else to consider, beyond the concerns I mentioned above about the accuracy of the methods used to determine the calorie counts, is the human factor. Even if the calories are accurately measured, that’s based on the sample as provided by the restaurant which you can bet is going to put that food in the best light possible. Do you really think that line cooks in a restaurant, or teenagers at Five Guys are concerned about portioning things so that meals contain the same number of calories as is posted on the menus? I doubt it. they’re probably using more oil on that stir-fry or scooping extra fries onto that plate. It’s pretty safe to assume that the actual number of calories in any given menu item is going to be higher than the number posted on the menu so take the number on the menu with a grain of salt.

I’m sure that there are people reading this thinking “but at least they’re doing something. What would you do?” I would bring back mandatory home ec in schools. I would help to ensure better access to and affordability of nutritious foods across the province. I would provide more support and funding for healthy eating and food literacy initiatives for all ages. Instead of accepting that people are going to eat out regularly, and assuming that providing calories on menus is going to make people healthier, we should be encouraging people to get in the kitchen.

Guest Post: Local Teacher's Tips For Cultivating Healthy Classrooms

One of this blog's long time readers is a local teacher, Heather Crysdale. On Facebook she regularly adds thoughtful comments to my posts around kids and school - so much so that I asked her if she'd be interested in writing a guest post with some of her ideas on how to make a classroom a healthy place. Happily she agreed! Here are her thoughts - proving that yes, you can cultivate healthy classrooms, it just takes some thought and creativity:

Modelling Healthy Living in a Primary Classroom:

It can be a challenge to create a classroom where healthy activity levels and food choices are promoted. Here are some of the ways I try to promote healthy lifestyles in my classroom.

Modelling Health Activity Levels:

Being an active Role Model:

The students know that I am an older teacher (e.g., 55 plus) and that I make a conscious effort to stay active. They see me walk to school daily with my husband and little dog, rain or shine, in all seasons. I share with them when I plan to go skate skiing, kayaking, cycling or to go to the yoga studio. I think it is important for them to see people of all ages, and genders, being active.

On May 7th (2017) the families in my class raised $500, to support my CN Cycle for CHEO (Ericsson 70 km) ride.

Physical Fitness Embedded in Daily Physical Activities (DPA), Gym and Special Event Days:

During the autumn and the spring, students do a morning run three times a week, and a group dance (Dancemania) twice a week before heading up to class. In the winter, students do body break dances on Go Noodle (https://www.gonoodle.com) or stair climbing in school for their DPA. We also have special fitness based days (e.g., a Winter Walk to School Day, a Bike Day, five days of Skating at Dulude Arena, etc.) With staff and students taking part in these activities, fitness and fun is the goal for everyone!

Modelling Healthy Eating Habits:

Setting an Example with Nutritious Lunches:

When the students see me eating a healthy lunch (e.g., a sandwich, soup, salad and/or leftovers from home), I am modelling good choices for them. When I see students enjoying a healthy food item during a Nutrition Break, I might comment on how tasty the food looks. If a child has a less healthy food item in their lunch bag, it is not up to me to critique the food choice. Food shaming is disrespectful, unhealthy and poor behaviour modelling for a teacher. Packed lunches from home reflect a family’s food culture, food prep skills and/or budget.

Mindful Eating:

At our school, we make a real effort to encourage the students to eat mindfully. At the beginning of the year, I bring in a basket of apples from the Parkdale Market. Each child gets to hold an apple, while listening to the story No Ordinary Apple. A Story About Eating Mindfully. Students are reminded to eat their food slowly and quietly, using all five senses to truly enjoy their food. Students show more gratitude for their food, when they learn how it got to their plate (from seed to platter)!

Food-Free Birthdays Celebrations:

If every birthday in class was celebrated with Pinterest worthy treats, the students would have cupcakes and candies at least 20 times in the school year. In my classroom, I encourage parents to provide food- free birthday treats to celebrate student birthdays. I heard about this idea at an OPHEA (Ontario Physical Health and Education Association) conference. Parents have followed through by sending in dollar store bouncy balls that each child used in the gym, by sending in Perler beads for the students to make Melty bead creations and by donating games and puzzles for the students to enjoy on the birthday, and afterwards too. The students enjoy these birthday games, crafts and puzzles!

Activity Based Holiday Treats:

Special holidays, like Halloween and Valentine’s Day, can mean overindulging in candy corn, caramels, cinnamon hearts and chocolate kisses. Instead, the students might have roasted Pumpkin seeds or fruit skewers as a treat. On these special days, the students in my class usually get a little gift bag from me. Instead of giving them food items, I always make them a handmade, handwritten card. Gift ideas might include themed pencils, erasers, notebooks, books and passes to skate or swim at City of Ottawa pools and arenas. The students enjoy the writing, reading and sporting activities!

Sugar and Salt Free Math Activities:

Instead of using food items for graphing and sorting, the students in my class use Legos, plastic counters and other reusable manipulatives. Or, they use seasonal materials found in nature (e.g., leaves, pine cones and oak keys). They still enjoy sorting and graphing, without having to eat unhealthy foods in the process.

A Focus on Intrinsic vs. Extrinsic Rewards:

One of the tenets of our Alternative school is that we do not give out rewards for good behaviour, effort or work. The goal is to have students behave well, make an effort and work hard, and then experience the intrinsic satisfaction of a job well done. That means no stickers or other extrinsic rewards…and therefore no candies or other sugary treats!

Tower Gardening:

One of my teaching colleagues, Tiiu Tsao, is growing greens in her classroom (e.g., Leaf lettuce, Yau Choy and Basil). She has borrowed the Tower Garden from the Parkdale Food market. The students had an opportunity to taste the produce that they grew. Pure Kitchen is purchasing the produce for its restaurant. Profits from the sale of these greens to Pure Kitchen are then returned to the Parkdale Food Market. What a great way to learn about fresh food growing, harvesting and eating!

On these special days, the students in my class usually get a little gift bag from me. Instead of giving them food items, I always make them a handmade, handwritten card. Gift ideas might include themed pencils, erasers, notebooks, books and passes to skate or swim at City of Ottawa pools and arenas. The students enjoy the writing, reading and sporting activities!

Growing Up Organic:

Several other colleagues are working toward creating an on-site school garden. Growing Up Organic (a garden and farm based educational program for children) is providing startup workshops for students. The workshops include the following topics: soil exploration, seed saving, planning a garden, planting a salad garden, seed starting and transplanting. The goal is to teach students greater food literacy and food skills. Ideally, they hope to create a sustainable garden that produces produce that can be shared amongst community members, including the Parkdale Food Centre.

Conclusion:

It takes a community to create an environment where children can learn, by example and through practice, to develop life-long fitness and nutritional habits. Together, we can make a difference!

Heather Crysdale is a teacher at Churchill Alternative Public School. She has been teaching in the Public School system for over 30 years. In 2014, Heather was awarded the Ottawa Carleton District School Board (OCDSB) Staff Health and Safety Award, for making an outstanding and significant contribution, over an extended period of time, to Health and Safety. Heather has been married to Douglas Abraham for 25 years. She is the mother of two twenty-something young men. Heather enjoys paddling her sprint kayak on the Rideau River. She likes to swim, cycle and skate ski in the Gatineau Park, and practice yoga at Pure Yoga. She is constantly seeking ways to move and eat well as well as to promote healthy lifestyles. In her spare time she likes to make cards and to knit!

The opinions expressed in this post are the author's own and do not necessarily reflect the ideas of the Ottawa Carleton District School Board.

Saturday Stories: Sewer Viruses, Nuremberg, and Stillborn Photography

Azeen Ghorayshi on Buzzfeed on life saving sewer viruses.

Lesley Stahls' interview for 60 minutes on what the last surviving Nuremberg prosecutor wants the world to know.

Seema Marwaha in Macleans on photography and stillborns.

I'm Not Sure My Mom Knows How To Text

But Jimmy Kimmel's staffs' moms sure do, and here they are for your Mother's Day Funny Friday

Have a great weekend!

If You Serve It, We Will Eat It (Ontario Medical Association Edition)

For the past 4 years or so (not sure exactly), I've been a delegate to the Ontario Medical Association and as such, along with a few hundred of my MD peers, attend their biannual council meetings.

The councils are each a terrific opportunity to see the passion and energy of my colleagues, and also a great opportunity to see how strongly our food environment impacts upon our freedom of choice.

22g of sugar (4.5tsp) per bar (more than in a Snickers)

Short version? Because all of the MDs here are human, when faced with indulgent dietary choices, they choose them.

Soft drinks, potato chips, pastries, and candy bars (Clif bars with as much sugar as a Snickers) - all of these are offered to us during our meals and snacks.

Offered at lunchtime. By afternoon break, 2 bags remained

And guess what? Once offered, away they go.

And yet I'd be willing to wager that were these options not provided by the council organizers, not a single physician would have walked over to the hotel's variety shop to buy them.

If even the Ontario Medical Association enables and encourages terrible dietary choices at physician events, why would anyone expect better from others?

Until we stop leaning on the theoretical ability of people "just saying no" as the sole means to address a food environment that offers and pushes nutritional chaff at every turn, we're not likely to ever see change.

Childhood Obesity, Bullying, Shame and Inactivity (In That Order?)

Last week, while enjoying the Canadian Obesity Network's biennial Summit, I attended a lecture about childhood obesity and physical activity. One of the slides presented demonstrated a robust correlation between weight and inactivity - and the thrust of the lecture was that there was likely a strong element of causality to it.

That correlation certainly fits with the findings of the Coca-Cola funded ISCOLE trial, which examined the relationships between lifestyle and weight among over 6,000 9-11 year olds from 12 different countries and found the greatest correlation with weight was with physical activity.

But I do wonder about directionality.

Working for the past 4 years with the parents of children with obesity, I can tell you that it's an incredibly common story to hear about the kid who used to love dance, or hockey, or soccer, or swimming - who suddenly stopped wanting to participate. Why'd they stop? Maybe because they no longer felt comfortable.

What do I mean? Take a moment and consider how you might feel about physical activity as a child if:

• Someone had made fun of how you looked in your gym clothes or uniform
• Someone had laughed at how you jiggled when you ran
• Whether anyone had ever said anything, you were self-conscious about those two points above
• You had experienced weight-related bullying in the past that made the likelihood of being bullied while exercising a credible possibility
• You were one of the slowest kids on your team, or on the track, or in the pool
• No one ever passed the ball to you

And that's just regarding organized play and sport. The same questions would apply to active play, and so too would the question of whether or not you had friends to play with, as sadly, especially among kids with the highest weights, many don't.

Research on the impact of childhood bullying on physical activity exists, but it's scant. That said, it definitely supports the notion that children who are victims of bullying are less likely to be physically active (Study 1, Study 2, Study 3). Given that weight is the number one source of childhood bullying (by a substantial margin), I would love to see bullying explored as a co-variable in studies like ISCOLE, where their findings are often utilized to infer that inactivity leads kids to develop obesity, and not that obesity leads kids to become inactive. That latter directionality was found in the study Fatness predicts decreased physical activity and increased sedentary time, but not vice versa: support from a longitudinal study in 8- to 11-year-old children, which concluded,

"Our results suggest that adiposity is a better predictor of physical activity and sedentary behavior changes than the other way around."

The ISCOLE trial, in its introduction, speaks to the existence of bullying consequent to childhood obesity, as well as obesity related social isolation - but neither are considered by the authors as possible confounding variables when it comes to inactivity. In fact, in the study's entire discussion, this is the only mention of correlation not necessarily representing causation (for any of the examined associations)

"Finally, given the cross-sectional study design, cause-and-effect inferences cannot be made, and we cannot exclude the possibility that unmeasured confounding variables may explain some of the observed relationships."

But given the plausible path from obesity to inactivity, along with the impact these sorts of studies have on public health and policy discussions, I sure wish it had included a more fulsome discussion therein.

Saturday Stories: Prison, Climate Change, and Waffle House

Ashley C. Ford in Refinery 29 on her relationship with her father after his 30 years in prison.

Sharon Lerner in The Intercept on how a climate change denier discovered science.

Daniel E. Slotnick in The New York Times on the incredible life of Waffle House co-founder Thomas Forkner

Have You Ever Had A Friendship Like This?

Best friends. Let's hope today's Funny Friday features got adopted/purchased together.

Have a great weekend!

New Study Suggests If Anything, Fasting More Difficult For Long Term Weight Loss

You might be able to buy a bowl like this here.

Now let me be clear right out of the gate, the study I'm about to discuss found that alternate day fasting led to just as much weight loss as tracking calories. But there was one difference.

The study, a randomized, controlled, year long affair assigned 222 patients to either:

1. Alternate day fasting
2. Daily calorie restriction
3. Nothing

For the first 3 months, both the fasting group and the calorie restriction group received all their meals from the study coordinators. For the next 3 months, both groups were encouraged to reduce their energy intake by 25% per day. The fasters were told to consume 25% of their baseline daily calories as a lunch (between 12 pm and 2 pm) on fast days and 125% of their baseline daily calories split between 3 meals on alternating feast days. The calorie restrictors were told to consume 75% of their baseline daily calories split between 3 meals. For the last six months, following the calculation of total daily energy expenditure (by way of doubly labeled water), participants were instructed to maintain their body weights. Fasters were advised to consume 50% of their calculated energy needs at lunch on fast days, and 150% of their energy needs split between 3 meals on alternating feast days. Restrictors were told to stop restricting and instead to consume 100% of their energy needs split between 3 meals.

Throughout it all, both intervention groups received support and counselling from RDs.

The study's primary outcome was weight loss. Physical activity was controlled for and calculated by two 1 week periods of accelerometer use. Dietary adherence was monitored by way of food recall.

Secondary outcomes were blood pressure, heart rate, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting glucose, fasting insulin, C-reactive protein, and homocysteine concentrations.

Weight loss wise, as you can see from the graph, at virtually no point in time during the year long study was there was a difference found between fasters and restrictors (triangles and squares).

There were also no statistically significant changes found to body composition between the groups.

At 12 months, there were also no differences to be found in any of the secondary outcomes or measures.

In fact the only difference the researchers found was to adherence.

More people dropped out of the fasting intervention (38%) than of the restricting intervention (29%).

I'm not sure how surprising that finding is, as fasting may be challenging for many with respect to lifestyle including to family meal times, socializing with friends, and eating with coworkers.

Or maybe it leads people to be more hangry?

All this to say, if you enjoy fasting as a lifestyle, go for it. But no, it doesn't appear, at least not from this study, that fasting has any magical properties.

People Self-Medicate With Chunky Monkey Because Chunky Monkey Works

In what's not likely news to those who use food for comfort during times of stress, a recent small study found that at least in regard to the over-consumption of sweet beverages, the sugary ones (and not the artificially sweetened ones), led subjects who were consuming them to lower levels of stress induced cortisol.

The study recruited 19 women without obesity to a parallel-arm, double-masked diet intervention with three phases:

1. A 3.5 day in-patient pre-intervention where participants were provided a low-sugar baseline diet.
2. A 12 day outpatient intervention where participants were instructed to consume one serving of either an artificially sweetened provided beverage or a sugar sweetened provided beverages (and they of course weren't told which they were provided with) with each meal while not consuming any additional sweetened beverages
3. A 3.5 day in-patient intervention where participants were provided with identical diets except for their assigned beverage differences

During the second day of each pre-intervention inpatient period, and after the 12-day outpatient intervention, participants completed an fMRI task designed to induce a stress response which included, " a timed mental arithmetic task and negative feedback" that has been shown in the past to induce physiologic stress which is reflected in elevated cortisol levels and the activation of the limbic system (a part of the brain involved in emotion).

What'd the researchers find?

In what will come as no surprise to anyone who's ever comforted themselves with sugary foods, the sugar drinking subjects were less stressed in that the consumption of beverages with sugar, but not with aspartame, decreased stress-induced cortisol production and led to greater hippocampus activation (an area of the brain inhibited during stress).

Now this was a small study, and limited just to sugar, but I'd bet that were this repeated, this time with a combination of sugar and fat (like the combo you'd find in Chunky Monkey for instance), you'd see an even greater response.

Food's definitely not just fuel.