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The recently published Weight‐based teasing is associated with gain in BMI and fat mass among children and adolescents at‐risk for obesity: A longitudinal study is an important paper for many well-intentioned parents, educators, and physicians who think that weight based teasing might help motivate a child to make behaviour changes that will lead them to weight loss.

In it authors followed 110 children at risk or with overweight or obesity for 8.5 years and tracked their weight and its association with weight-based teasing. They found that after adjusting and controlling for baseline sex, race, age, socio-economic status, BMI and fatmass, kids who reported the most teasing gained the most weight (p≤.007). Quantified, the authors found that the most teased kids’ fat masses increased by 91% more per year (1.4lbs/yr) than those not reporting weight based teasing.

While it’s important to note that causality can’t be proven here, certainly these results fit with the notion that if any amount of teasing led kids to lose weight, we’d be seeing dramatic reductions in childhood obesity rates because weight is far and away the number one target of school based bullies, and even at home, 60% of kids with excess weight report being teased about same.

If you have a child with obesity, sadly you can rest assured that they’ll receive plenty of shame, blame, fear, and bullying from the world around them, and if you’re worried about your child’s weight, instead of burdening them with it, ask yourself what you as a parent can do to help, where if nothing else, one thing for certain you can do is to make your home a safe space where weight is not something anyone’s welcome to joke about or comment on.

(and if you live in Ottawa, and you have a child between the ages of 5 and 12 whose weight is concerning, and you’re interested in our office’s parent-centric, Ministry of Health funded, inter-professional, Family Reset childhood obesity treatment program feel free to call us at 613-730-0264 and book an appointment to chat)

       

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Following every natural disaster, we see television news and online videos of destruction. Images of destroyed homes, cars and trucks flipped over, and boats well inland instead of in the water, show us the massive damage nature can cause. But for the thousands who are living through the seemingly unprecedented number of tornadoes, serious storms, and flooding, it’s not a video. It’s very real. The disasters are leaving thousands of families uprooted, with some losing loved ones.

But after the storms have passed over and the waters have receded, after the news cameras leave and people stop taking videos, the residents are left with not only putting their lives back together, but with the potential of serious illness or injury, after the fact.


While the emergency is occurring, the most important issue is survival. This means taking cover or evacuating. But once the imminent threat has left, other dangers may lurk. From broken water and sewage systems to terrified wild animals, survivors may be exposed to dangers they’ve never faced before.


Infection following a natural disaster is common in many areas. Infections can spread quickly in crowded shelters. People who walk around the disaster area can injure themselves by tripping on debris. They can cut themselves while trying to move things or be hit by material that may still be falling. Frightened pets and wild animals may be driven into unfamiliar territory and may bite.


With so many tornadoes touching down in North America this spring, I thought it would be a good idea to discuss the topic. A while ago, I wrote about the connection between national disasters for Sepsis Alliance, an organization I work with. If you would like to read more about the types of infections that could follow a natural disaster, visit Sepsis and Natural Disasters, found on the Sepsis Alliance website.

AC Shilton, in The New York Times, on the personal crash that sometimes follows a great accomplishment

Alice Hines, in The Cut, with just a bonkers and disturbing story on incels (involuntarily celibates) and plastic surgery.

Lindsay Jones, in Topic Magazine, on mothering without limits.

       

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Bettina Elias Siegel, in her blog The Lunch Tray, on what that recent ultra-processed study means for our children.

Nathaniel Penn, in GQ, with the case of the curious con who wouldn’t die.

James Angelos, in The New York Times, on Germany’s modern day antisemites.

       

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The Erin Weir debacle continues to haunt the federal New Democrats. It underscores party leader Jagmeet Singh’s seeming policy confusion and calls into question his political judgment.

It just won’t go away.

Weir is the Regina MP who was expelled from the NDP caucus last year and barred from running again for the party. His sin? He had dared to defend himself against charges of sexual harassment.

This week, the 37-year-old, lifelong New Democrat conceded that he won’t run under his party’s banner in the fall election. Nor will he run as an independent. He will sit this one out.

The Weir saga began with a 2018 email from NDP MP Christine Moore to fellow caucus members claiming that he had harassed not her but other, unnamed women. Singh almost immediately suspended Weir from caucus, while his office began a search for women willing to complain. Eventually, four were found. Three said Weir stood too close to them when talking and didn’t know when to shut up. The fourth said he had twice yelled at her over the issue of carbon tariffs — once during a policy debate and again later in an elevator.

At another time, these complaints might have been kept in perspective. But in the #MeToo frenzy of 2018, they were viewed as unforgivable political crimes. Weir was ordered to apologize to the “survivors” and take sensitivity training. He readily agreed, but with one exception. He didn’t see why he should apologize to someone for having heated words over a policy issue — even if that someone were female.

When his accuser was quoted anonymously on CBC, Weir responded to media requests for his side of the story. That, it seemed, was truly unpardonable. Singh expelled him from caucus and barred him from running for the NDP in the fall federal election.

In particular, Singh faulted him “for diminishing the finding of harassment by claiming that this was in fact a policy disagreement.” “It’s a bit Orwellian,” Weir told me in telephone interview this week. “If you try to defend yourself, it only proves that you’re guilty.”

In January, the Regina-Lewvan NDP constituency association asked Singh to reconsider and let Weir contest the nomination. Singh refused. Earlier, 68 prominent Saskatchewan New Democrats, including 13 former MPs, made a similar pitch. Singh dismissed that plea as coming from “people in a position of privilege.”

It was a comment that didn’t go over well in Saskatchewan.

The NDP will rue its treatment of Weir. It has been not only unfair but unproductive. A former economist for the Steelworkers Union, Weir has a keen understanding of the political economy of his home province.

On the issue of energy pipelines, for instance, he understands both the need to combat global warming and the dollars-and-cents reality of his constituents.

He favours construction of the controversial Trans Mountain pipeline expansion from Alberta’s tarsands to the Pacific Coast. In part that’s because the pipes for such a project are manufactured in Regina. In part, it’s because “to the extent that we continue to use oil,” pipelines are the safest way to move petroleum.

He says he is baffled that “the current leadership” of his party has taken no position on carbon pricing, given that this issue promises to be central to the October election.

He’s equally baffled that Singh opposes all oil pipelines but appears to favour building new natural gas pipelines in British Columbia. (In fact, the NDP leader has suggested, at different times, that he both supports and opposes a plan to pipe B.C. natural gas to the Pacific Coast for liquefaction and export to Asia.)

Many New Democrats will disagree with Weir on the pipeline question. But he’s right that the party needs to clarify its muddled position.

He’s also right that vigorous debate between those who happen to be men and those who happen to be women shouldn’t automatically be treated as sexual harassment. Such an approach does no sex any favours.

Thomas Walkom is a Toronto-based columnist covering politics. Follow him on Twitter: @tomwalkom

The  Star

This recent report from Health Canada about sugar consumption was an interesting read.

Not so much in terms of sugar, and yes, the report says we eat too much of it (I’ll come back to that) but rather in terms of dietary recall. It seems we’re getting worse at it.

According to their determination, whereby they compared dietary recall data’s caloric totals with those that would be predicted by a respondent’s age, BMI (measured, not self-reported), sex and activity levels, if your self-reported intake was less than 70% of that predicted, you were classified as an under-reporter, and if it was more than 142% of predicted, you were classified as an over-reporter.

Overall, compared with 2004, people were significantly more likely to under-report and less likely to over-report. In adults, under-reporters increased by 22% (from 28.2% to 34.5%), in kids aged 9-18 by 59% (from 16.5% to 26.3%), and in younger children it more than doubled (from 6.7% to 14.1%). Simultaneously, over-reporting dropped by 45% in adults (from 13.6% to 7.4%), in kids aged 9-18 by 41% (from 22% to 12.8%), and in young children by 35% (from 27.6% to 18%).

So how does this affect sugar consumption data?

Well you may have read that dietary sugar consumption is decreasing. And maybe it is (dietary recall data is fraught with error). But this data suggests that while consumption is shifting, with more added sugars coming from food and less from beverages, totals, if looking at plausible reporters only, have stayed pretty much the same, and has increased slightly in children.

As to what’s going on, could it be that with ongoing discussion of the dangers of unhealthy diets that people become less likely to want to disclose what they’re eating? Either way, it’s further evidence that we need a better way of tracking dietary intake and a possible confounder for those reporting that sugar consumption is decreasing.

       

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Kevin Bass, in his blog Nutritional Revolution, with the data driven case on how you can’t blame people following dietary guidelines for a country’s obesity rates.

James Hamblin, in The Atlantic, on the truth behind vaccine injury compensation.

Abby Hartman, in It’s Training Cats and Dogs, with her first person account on walking to, and then away from, treatment for “chronic lyme disease”.

Pic By Alan R Walker – Own work, CC BY-SA 3.0, Link

       

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A few weeks ago I tweeted about a patient of mine who is maintaining a 19% weight loss for 2 years, and who attributes her success to keeping a food diary and tracking calories, as well as to including protein with every meal and snack.

The point of my tweet was a simple pushback to those who want to claim that calories don’t count or that counting can’t help (like The Economist for instance whose recent article entitled Death of the calorie was the main reason I bothered to tweet), and those who claim that the only way to lose weight is their way (these days that’s usually either #keto or #lchf).

A great many folks weighed in with their success stories, and some pointed to the National Weight Control Registry (where their over 10,000 registrants have kept off an average of 70lbs for 5.5 years). Others though weren’t having it.

Instead they asserted that 95% of diets fail, that the weight loss industry was predatory (much of it is, no argument there), and called people who have succeeded “unicorns“.

Unicorns. Not people. Mythical creatures.

And the implication of course is clear. Sustained weight loss is impossible. Those who succeed aren’t human, or to succeed they employ superhuman efforts, sometimes even described as disordered eating and/or that those who succeed must be miserable. Consequently, trying is futile and those offering help (like me, as to be clear I am the medical director of a behavioural weight management centre) are unethical, and are motivated by greed (despite the obvious irony that those championing non-weight loss programs are targeting the very same population of people and regularly charge a great deal of money for their services).

But boy, there sure are a heck of a lot of unicorns roaming around for something that supposedly fails 95% of the time. Putting aside the anecdotal facts that we all know people who have maintained weight losses as well as my own office based experiences this 2010 systematic review found that one year later 30% of participants had a weight loss ≥10%, 25% between 5% and 9.9%, and 40% ≤4.9%. In the LOOK AHEAD study, 8 years later, 50.3% of the intensive lifestyle intervention group and 35.7% of the usual care group were maintaining losses of ≥5%, while 26.9% of the intensive group and 17.2% of the usual care group were maintaining losses of ≥10%. And in the recent year long DIETFITS study the average weight loss of all participants was > 5%, with over 25% of participants losing more than 10% of their weights.

The Examine.com waterfall plots of the DIETFITS data

(And for an interesting thought experiment, have a peek at this thread from Kevin Bass that argues that even if the 95% failure number were true, those outcomes would be worlds better than the vast majority of medical treatments currently being offered for other chronic diseases)

So where does this 95% number come from? Certainly I could imagine it to be true if the goalpost for successful weight loss was total weight loss and reaching a so-called “healthy” or “normal” BMI. But that would be as useful a goalpost as qualifying for the Boston Marathon would be for running whereby the vast majority of marathoners won’t ever run fast enough to qualify to run Boston. Does that mean non-qualifiers should be discouraged from running and told that running is impossible? It’s also important to contextualize failures. If the methods being undertaken to lose weight are misery inducing overly restrictive diets, it’s not people who are failing to sustain them, it’s that their diets are failing to help them (which, with full disclosure, is the premise of my book The Diet Fix).

As far as what needs championing, it’s certainly not failure. Given the medical benefits of weight loss, as well as the real impact weight often has on quality of life (especially at its extremes), what we need to collectively champion are the embrace of a plurality of treatments (including ethical behavioural and surgical weight management programs and greater access to them), along with more effective medications. What can simultaneously be championed is the removal of blame from the discussion of weight, fighting weight bias and stigma, recognizing that a person need not have a so-called “healthy” or “normal” BMI, that scales don’t measure the presence or absence of health nor measure lifestyles, respecting people rights to have zero interest in losing weight or changing their lifestyles, that there is value to changing behaviours around food and fitness regardless of whether weight is lost as a consequence, and acknowledging that intentionally changing lifestyle in the name of health reflects a tremendous degree of privilege that many people simply don’t possess. 

Given the evidence maybe we can stop with the unhelpful, dehumanizing, and misleading unicorn talk, and while we’re at it, stop telling everyone that failure is a foregone conclusion.

        

Say the word “dementia,” and most people think about Alzheimer’s disease. We can’t blame them; Alzheimer’s disease affects almost 6 million Americans and many millions more across the world. It is the most common cause of dementia. But d…

Kathleen Venema, in The Globe and Mail, on her mother and why we need to change the rules surrounding assisted death for those with dementia.

Sarah Zhang, in The Atlantic, on why there’s an underground market for old insulin pumps.

Markham Heid, in Medium, on how the evidence against the regular use of supplements is stronger than ever (happy to find this story for reader Pug Piper).

[And if you don’t follow me on Twitter or Facebook, here’s my first column for Medscape on what scales do and don’t measure and why that matters]

       

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First up, the quantity and quality of calories matter both to health and to weight. You can’t gain without a surplus. You can’t lose without a deficit. And the quality of the calories you’re consuming will affect health and satiety which in turn will affect the quantity of them that you consume. Moreover, the bioavailable calories you consume will differ by food, and also likely differs by individual (which is why some gain and lose with more ease than others).

Next up, we’re crappy food historians. We may forget portions, choices, or both, not all the time, but certainly some of the time. We can’t possibly know what’s in meals we haven’t cooked ourselves. And even if we are cooking ourselves, most aren’t going to be weighing and measuring everything and eyes are terrible at both.

And a recent study confirms some of the above whereby researchers looking at users of myfitnesspal found the average user was missing nearly a meal’s worth of calories a day (445). Yet studies on food diary use pretty much invariably report they markedly benefit weight loss efforts.

Personally, though I think having some rough inaccurate sense of caloric intake is valuable (if you were in a foreign country and didn’t know the exchange rate, price tags would still be somewhat helpful), more valuable is the use of the food diary to remind yourself that you’re trying to eat thoughtfully and likely differently.

Human nature being what it is, without a system designed to consciously remind you to change your usual default behaviours, you’re likely to drift back to those behaviours, healthy or not, and a food diary, even if inaccurate, if kept in real-time, will remind you many times a day that you’re trying to change.

So long as you’re not using your food diary as a tool of judgment, as it’s not meant to be there to make you feel badly about your choices, chances are it’ll be of benefit, and likely it’ll be of benefit regardless of what it is you’re tracking (calories, macros, carbs, whatever) and even if inaccurate, because it’s primary job is to serve you as your constant change reminder service, not as your judge and jury.

       

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Lori Gilbert-Kaye, may her memory be a blessing, murdered for being Jewish

A few days ago it was Holocaust Memorial Day, the day we commemorate the murder of 1 out of every 3 living Jews on earth prior to World War II. A week ago saw another murder for the crime of being Jewish, this time in California. Before that it was Pittsburgh. Though there’s not much I can do about any of this, at least I can call your attention to these three pieces that try to weave it all together

Daniella Greenbaum Davis, in The Spectator, on antisemitism’s new normal.

Rabbi Yisroel Goldstein, in The New York Times, on how being almost killed by a terrorist last week has affected his resolve.

Carly Pidlis, in Tablet Magazine, on how Jews can no longer simply consider themselves safe in America.

       

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