And boy does it ever. I’ve been railing on about how bad it is for nearly a decade now, and just a few weeks ago, Dr. Mary L’Abbe, the Chair of the University of Toronto’s Department of Nutritional Sciences, along with her graduate student, Mahsa Jessri published their paper, “The Time for an Updated Canadian Food Guide Has Arrived (Full Text)“. After reading it, I invited them to write me a guest post, and here one is as written by PhD candidate Jessri.
Since 1942, Canada has published food guides with a strong emphasis on meeting nutrient requirements. Canada, like many other Western countries, however, experienced a nutritional transition decades ago where widespread micronutrient deficiency was replaced with overconsumption of energy-dense foods and calories. This phenomenon has resulted in a drastic increase in diet-related chronic diseases, such as obesity, type 2 diabetes and cardiovascular diseases; thus we now need dietary recommendations targeted specifically towards the types of foods associated with maintaining a healthy body weight and preventing chronic diseases. Recently we published a critical review of 2007 Eating Well with Canada’s Food Guide (EWCFG) calling for an urgent update to these national Canadian dietary guidelines. Now you may be asking what are the limitations of EWCFG 2007 and why it needs an “urgent update”?
Firstly, if you add up the calories recommended for the four food groups: Fruits and Vegetables, Grain Products, Meat and Alternatives, Milk and Alternatives, and healthy oils (essential calories) for each age and sex group, the total would be higher than the recommended energy requirement for Canadians, confirming the claims made by previous researchers that following the EWCFG leads to overconsumption of calories. There is also no room left for the calories from “other foods” (e.g., high fat and sugary products) which are completely omitted from the 2007 EWCFG, which is another problem. We know from the Canadian national nutrition survey data that nearly 1/4 of the calories consumed by Canadians are from “other foods”; food guides from most other countries leave some calories for these treats that we sometimes eat – which further suggests that EWCFG is obesogenic in nature. Equally important, the same number of servings are recommended for all physical activity levels, with no different recommendations for a sedentary individual and a very highly active athlete.
As pointed out by other researchers, the Canadian EWCFG was highly influenced by the food industry; one-third of all stakeholders involved in consultations were from the food industry who could therefore have influenced much of its development.
Another important issue that’s lacking in the current food guide is consideration of cultural dietary behaviors. We know that one in every 5 Canadians was a visible minority in 2011 and yet our EWCFG 2007 neglects their cultural food preferences and practices, and instead recommends one eating pattern for all, while we already know there is more than one way of healthy eating. Of course, the first step towards development of a comprehensive evidence-based, culturally-sensitive dietary guideline would be to collect food intake information from multi-ethnic individuals in Canada. Unlike other countries, Canada does not have a plan for conducting multiethnic nutrition surveys.
These along with other limitations mentioned in our article, call for an evidence-based unbiased action for drafting a new Canadian food guide using the most recent national Canadian nutrition survey, considering the changes in food supply, the epidemics of chronic diseases, and using a socio-ecological perspective of different food patterns. Such an “ideal” Food Guide would be more focused on maintaining a healthy body weight and reducing the risk of chronic diseases, rather than preventing nutrient deficiencies – which Canadians have a very few of!
The other day I was reading about point-of-action queues and their impact on stair climbing behaviour and I came across this study, ‘Take the stairs instead of the escalator’: effect of environmental prompts on community stair use and implications for a national ‘Small Steps’ campaignIt’s a straight forward paper that looked at 8 studies and the impact they found stair climbing prompts in heavily trafficked areas had on stair climbing behaviours.
The authors found that simple point-of-action signage and prompts led to a nearly 5% increase in stair climbing among women and half that among men. Their work also predicted that every week those signs stayed in place led to 2200 new stair users.
And yet, despite these terrific and pretty much cost and effort free interventions, the authors tempered their conclusions (both in the abstract and of course the larger piece) with negativity stating,
“The projected effect on correcting energy imbalance appears small, suggesting that this intervention alone will not have a potent effect on leveraging population-level body weight or obesity prevalence“
But as I’ve calculated before, to burn the calories of a small Snickers bar you’d need to climb 122 flights of stairs.
That researchers apparently wondered whether or not a few extra daily flights of stair climbing in malls and office buildings would have a dramatic, let alone any, impact on weight, frightens me. Truly, that weight was included as a discussion piece in this study speaks to just how widespread, even among those who really ought to know better, is the erroneous belief that physical activity is such a large player in weight that even tiny increases to it might lead to weight loss.
I’ve asked before whether or not anyone is aware of any public health intervention that has led to a sustained and objectively measurable increase in the activity level of a population (adults, kids, both, whatever)
Unfortunately, I’ve yet to hear of any exciting outcomes (nor have I by the way for simply telling people to eat better).
As I see it, the value of exercise as health promoting is well known. Public health campaigns that in turn simply spread that message, probably aren’t teaching people anything new, and consequently, may not lead to any sustained changes in behaviour.
And that’s precisely what researchers in Japan recently found whereby a 3 year-long, cluster randomized controlled trial designed to evaluate extensive, community wide interventions designed to encourage more physical activity, failed to show any significant benefits.
The interventions were definitely not trivial either, but they were definitely all geared to try to encourage conscious, individual behaviour change. According to the paper, they included,
“(1) Information delivery.
Flyers, leaflets, community newsletters, posters (those are them up above), banners, and local audio broadcasts.
(2) Education delivery.
Outreach health education program and mass- and individual encouragement by professionals during community events. Mass-encouragement included a motivating talk and demonstration of PA using a common procedure to ensure standardization of the intervention and individual encouragement including face-to-face promotion of PA while waiting for
community health check-ups
(3) Support delivery.
Development of social support, i.e., promoting encouragement by community leaders and lay health workers; material support, i.e., arranging for residents to obtain light-reflective material for walking safety, pedometers, and videotapes and DVDs on flexibility and muscle-strengthening activities at each relevant community center; and professional support, i.e., establishing a call center for questions about PA and requests for outreach“
Now to be fair, evaluation was by way of survey, though given that asked people generally overestimate their activity levels, if anything you would expect a survey to be more likely to yield a positive result than for instance accelerometry data. Ultimately though, there were no significant improvements found. Not to over-all activity, not to walking, not to flexibility (though there was a positive trend), and not to muscle strengthening.
I think this speaks to the fact that good intentions fail in the face of day to day life, and that if we want to see population wide increases in physical activity, we’ll likely need to effect that by way of point of action changes (such as signs placed on escalators and elevators suggesting a person might want to instead take the stairs) and re-engineered built environments that make increased activity the unconscious default, or at the very least, the easier choice.
If I looked at 279,000 men and women for a decade and studied whether or not they qualified for the Boston Marathon, but I didn’t actually look to see if they were runners, and if they were runners I didn’t bother exploring what their training plans and distances were like, but instead simply looked at how many people from that 279,000 qualified for Boston, I’m guessing I’d be left with an incredibly small number.
And yet, that’s pretty much exactly what the latest depressing weight loss study did. They followed 279,000 men and women for ten years to see what was the probability of those with obesity losing back down to “normal” weight (a BMI less than 25). They didn’t exclude people who weren’t trying to lose weight or who might not have wanted to lose weight. They also didn’t pay any attention to the means with which those who did lose weight only to regain it lost it in the first place.
The odds weren’t good. Over the course of a decade, only 1 in 210 men with obesity, and 1 in 124 women managed to bring their weights down to a place where a table would define them as “normal“.
It’s not particularly surprising. Putting aside the surprising fact that this study didn’t exclude people who weren’t trying to lose weight, it remains that the vast majority of folks trying to lose weight these days do so by undertaking ridiculous diets. Go figure people don’t sustain the results of ridiculous diets; weight lost through suffering comes back when you get sick of suffering. This study of course misses all of that.
And is getting down to a “normal” weight really the right yardstick to measure success? I mean getting down to a BMI under 25 is to weight loss what qualifying for the Boston Marathon is to running. Most runners will never qualify, and consequently qualifying would be a very poor way to measure whether or not people were runners.
But what if you change the goal posts?
If for instance, you set out to study the number of runners who continue to enjoy running as often and as much as they’re able to enjoy, rather than simply the number of runners who qualified for Boston, well suddenly the number of runners will be much much higher, though of course not all of those who take up running, keep up with it either.
Extended that to weight, if the goal posts become your “best weight” which is whatever weight you reach when you’re living the healthiest life that you can enjoy, suddenly the numbers change.
How much do they change?
Looking at, for instance, the 8 year data from the LOOK AHEAD trial, where lifestyle changes were thoughtful and the goal wasn’t qualifying for Boston, 8 years out and 1 in 2 of the participants were maintaining losses of greater than 5 percent of their presenting weights, and more than 1 in 4 were maintaining losses of greater than 10 percent.
So did the publication of this depressing study add to obesity’s literature? Quantifying the number of people who don’t qualify for the Boston Marathon of weight loss, without quantifying how many of them were actually runners, and what sort of training program they were adopting doesn’t strike me as a helpful addition.
I also can’t help but wonder what the impact the publication and coverage of studies like these have on individuals who might be considering lifestyle change – both in terms of reinforcing idiotic goalposts, and in terms of them even starting out of the gates.
Or at least that’s the conclusion you might draw after reading a study recently published in the Journal of Health Psychology.
The study, How does thinking in Black and White terms relate to eating behavior and weight regain? explored what the authors referred to as “dichotomous” thinking and whether or not it had an association with weight regain.
Dichotomous thinking is commonplace in weight management. It encompasses the notions of “good” and “bad” foods, cheat days, forbidden foods, and for many, adhering to its rules is the cornerstone of their efforts. Dichotomous thinkers are the all-or-nothing’ers, the perfectionists, and they are legion.
By way of a survey, researchers explored scores of the validated Dichotomous Thinking in Eating Disorders Scale (DTEDS) and their correlations with weight regain among 241 Dutch respondents. They found that for each 1 unit increase in DTEDS, there was a 142.4 percent increase in the odds of regaining weight compared to maintaining it. When controlled for BMI, those odds decreased and became less exciting but in a sense, in their place, came the finding that for each 1 unit increase in BMI, there was an increase in DTEDS by 0.043 – meaning weight itself seemed to associate with dichotomous thinking.
What does this all mean? Well, food serves as both comfort and celebration and perhaps, not respecting those roles leads people to undertake strict and traumatic diets replete with dichotomous thoughts which in turn may well be a formative driver of a lifetime of yo-yo dieting and higher weights.
Life is a rich tapestry of colours and not just black and white. Ditch the dichotomies and embrace imperfection.
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