Almost 7 years ago, while going through some personal issues, I made a terrible mistake and ended up being convicted of driving under the influence (DUI) in the State of California. It was a dark period in my life, but I have moved on and learned my lesson. This spring, however, my intoxicated driving conviction […]
Andrew Anthony, in The Guardian, on the casual and banal antisemitism that has overtaken England.
Helen Branswell, in STAT, on the retirement of Ebola warrior Pierre Rolin.
Caitlin Flanagan, in The Atlantic, on “jackbooted tots” vs. Senator Dianne Feinstein.
Harnessing the powerful emotion of awe for good or evil
Just what are your chromosomes doing while you’re sleeping?
Clam garden aquaculture on the west coast is 3500 years old
Man’s best friend comes to the rescue to inform declines in dog and man sperm
You’ve probably seen the meal prep trend online where dozens and dozens of meals are prepped in containers for the entire week? Holy moly. I can say that will probably never be me. I once tried an over-ambitious meal prep and not only did I end up with way too much food, but it took […]
So what possible reason could the New York State Academy of Family Physicians (NYSAFP) have to highlight in their weekly eNews circular sent to 10,447 family physicians and students, an article that claims, “Flavored milk is essential” and “a tasty way for kids to get the 9 essential nutrients that they need“?
I think it’s a fair question given the World Health Organization, the Centers for Disease Control, and yes, the NYSAFP’s parent organization, the American Academy of Family Physicians (AAFP) all recommend that added sugars contribute no more than 5-10% of total daily calories, and yes, chocolate milk contains heaps of added sugar.
In fact, the American Academy of Family Physicians explicitly discourages the consumption of sweetened or flavoured milk stating,
“It is important that you stay hydrated. However, drinks that contain sugar are not healthy. This includes fruit juices, soda, sports and energy drinks, sweetened or flavored milk, and sweet tea.“
And I’m guessing the answer won’t surprise you either.
The answer is money.
Because that’s how much the NYSAFP charges companies for a “Product Showcase“ feature that goes out in 13 separate emails to reach those 10,447 family physicians and students.
That’s $177 per mailing.
And what does that $177 buy the American Dairy Association North East?
Well of course it buys the ad space, exposure, and frequency, but it also buys credibility.
I’ll let the NYSAFP explain,
So NYSAFP, if you’re reading, please issue a correction, and to that end, here’s an invitation for you. If you’d like to send out some information about what happens when chocolate milk is removed from school lunches to your 10,447 physician and student members, please take this as my permission to freely republish my blog post that covered the study on this very matter that found that taking chocolate milk out of schools did not affect the students’ total daily milk or dairy consumption, that on average all students were meeting their daily recommended amounts of dairy (recommendations which by the way are almost certainly higher than the evidence would suggest they need be), that kids who swapped from chocolate milk to white milk drank pretty much the same amount of white as they did chocolate (unless you think 4/5ths of a tablespoon of milk is a lot), and that by removing chocolate milk from the school, in the first month alone nearly half of the initial chocolate milk drinkers switched to white and in so doing, saved themselves piles of calories and the nearly 2 full cups of monthly added chocolate milk sugar.
Or at the very least, kill that ill-advised ad and maybe revisit your policies around vetting sponsors.
[Thanks to Beth Locke for sending the NYSAFP’s eNews my way]
Yup, it’s true.
Offer children in-class breakfasts consisting of cereal, muffins, juice, and milk for 2.5 years and compared with children in schools not offering those in-class breakfasts, their weights end up being, “significantly higher“.
Those are the results of a study recently published in JAMA Pediatrics, and really, they don’t seem all that surprising.
Firstly, the breakfasts were offered to all children, regardless of whether this was, as Hobbits might say, second breakfast
But more to the point, would anyone expect a not likely to be sating breakfast consisting of cereal, muffin, juice, and milk, to have a positive impact on weight or health (and I should take the time here to point out that the study authors were not in charge of what schools chose to feed their students)?
As I’ve ranted many times, what a person eats for breakfast likely matters a great deal to satiety, health, weight and what have you. I’ve also ranted on the dangers of lumping studies of specific meals (in this case ultra-processed carbs washed down with a bunch of liquid calories) and then opining on the benefits of “breakfast” as a meal.
Food insecurity is real, and finding the means to ensure children eat healthy meals is laudable, but feeding children who are already at increased risk of chronic diseases, meals that may themselves increase the risk of developing chronic diseases, probably isn’t in their best interest, and given that, as one of the study’s authors Kate Bauer noted on Twitter,
“all breakfasts met the federal School Breakfast Program requirements“
it sure makes one wonder whether America’s federal School Breakfast Program could stand for some revision?
Dr. Jennifer Gunter, in The New York Times, sharing her sorrow to tell America that no, she didn’t kill her baby, nor are any doctors executing children at birth [as an aside and as a Canadian, I find it mind boggling and horrifying that these statements need to be made in 2019 America]
Marshall Allan, the journalist, in ProPublica, on how he was named one of America’s “Top Doctors”.
David McMillan, co-chef-owner of legendary Montreal restaurant Joe Beef, in bon appétit, with a phenomenal read on his finding sobriety and the impact it’s had on those around him.
Humans evolved to be virtuous and violent, says the author of ‘The Goodness Paradox’
Why Kim Jong Un travels with his own portable toilet
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Seems my last post struck many different chords depending on the lens with which it was read.
Some people read it as stating that they’re not trying hard enough.
Others read it as there’s no point in trying.
Others agreed with me.
So for clarity, here’s a bit more.
Me stating that lifestyles matter, that sociology matters, that our lives’ patterns matter, and that they in turn help to explain why people often regain all of their lost weight when what’s usually an overly restrictive weight loss effort is abandoned isn’t me stating that people ought to be able to just tough out overly restrictive weight loss efforts. It’s me pointing out that if your weight is currently stable, you’re in equilibrium. You have, like we all do, an average daily caloric intake and output which of course includes things beyond your control (including genetics, medical co-morbidities and medications, job requirements and responsibilities, caregiver responsibilities, and more), out of the realm of your conscious ability to control (food marketing, societal and social norms, the constant, usually well-intentioned thrust of food at every turn, and more), and things that are unfair to expect you to control (largely the normal use of food to socialize with your friends and families). These are the sorts of the things that make up something some refer to as your “expososome’, and I think the impact emigration tends to have on weight, which depending on your starting and finishing country may well increase or decrease yours, is a clear example of how it influences your equilibrium. But regardless of your expososome, yes, there are things within your control to change that can affect your weight (though definitely not free from being influenced from many of those out of control factors) like how many meals you cook and your cooking skills, your liquid calorie consumption, your frequency of meals and snacks, the macronutrient composition of your diets, exercise, and more. And it’s also true that for some, their lives’ realities preclude intentional behaviour change.
What I was talking about yesterday, are the people who regain all of the weight they’ve lost with any given effort. These tend to be people who ultimately, for various reasons, are unable to continue with their change efforts. Instead, likely, not all at once, their efforts wane, then end, and those people find their way back to all of the original behaviours, factors, and choices that they were living with prior to their changes, which in turn brings back all of their old calories, eventually bringing their weights back to that same place where they were before (or perhaps even slightly higher consequent to metabolic adaptation leading them to burn fewer calories at a comparable weight than prior to their weight loss effort).
Why does this happen?
I think for a significant percentage of people it happens because the changes they employed were too severe. Maybe they were perpetually hungry, or denying themselves foods they loved and enjoyed, or they cut out entire food groups, or they found themselves unable to enjoy a meal out with friends, or regularly having to cook multiple meals (one for them, and one for their family). In short, the efforts many people undertake aren’t by definition sustainable. They’re for-now efforts, not for-good efforts. And I think the reason so many choose those types of approaches is that society (including the public health and research communities) generally describe total weight loss as the goalpost, and so people take on extreme efforts, because that’s pretty much the only way to get there.
On the other hand, those individuals who lose weight and keep it off? While they nearly never are people who lose every last ounce that some stupid table says they should, there are huge numbers of them who’ve managed to lose a subtotal amount of weight and keep it off. Knowing these people, reading about these people, their most common denominator is that they enjoy the new lifestyles they’ve crafted sufficiently so as not to perceive them as suffering.
So if you want to lose weight, you’re going to have to change some of those things that are within your control to change, but you’re also going to have to pick changes that you can honestly enjoy if you want to keep the weight you lose, off. And different people, for a whole host of reasons, will have fewer things they’re able to change, not to mention the fact that life and circumstances will also have a say as time goes by. But for everyone, change generally means embracing imperfection, still eating food for comfort and celebration, still socializing with friends and family, and more. And the degree of changes you’ll be able to sustain will undoubtedly be impacted by many things beyond your control, and your physiology will undeniably limit your losses and the amount you’re able to change without suffering. But that doesn’t mean that physiology will prevent you from ever making any changes.
Maybe, if we all aimed for smaller, more realistic, less extreme, but all the while plainly sustainable changes, and as a society we stopped with Biggest Loser style efforts, and we redefined success, we’d see a great deal more of it.
Last week I watched a few people who I both follow and respect chat about set point theory – you know, the one that posits your body defends a particular weight such that after you lose, your body will in a sense strive to get back to where it started. And I tried to do so with an open mind, I really did, but I guess my own confirmation biases got the best of me because the conversation left me sighing.
That’s not to say metabolic adaptation doesn’t exist. It most certainly does. Metabolic adaptation is the catch-all term that refers to the very real fact that weight loss leads to a decrease in resting metabolism, a decrease in the thermic effect of meals (the cost of metabolizing what you eat), decreased energy cost of physical activity, and to changes to hunger hormones which in turn might well lead you to eat more. In general this also leads to the very real fact that weight loss is far from linear and that it usually stops sooner than expected or desired.
But it’s the set point blamed regain back to starting weights that I struggle with conceptually.
Because generally speaking, it’s presented as physiologically driven. My belief is that while metabolic adaptation definitely and somewhat depressingly affects how much weight might be lost with any given effort, it’s really sociology that drive the bulk of most people’s regains.
What I’m getting at is that people don’t regain most or all of their lost weight because their bodies effectively tell them to, they regain most or all of their lost weights because when they quit whatever diets they were on, they revert back to the diets they were consuming beforehand, and by diets, I also mean lifestyles.
For instance, they might stop packing their lunches and head back to their cafeterias, food courts, or drive thrus. They might resume their regular nights out with friends and go back to drinking more alcohol and/or sugar-sweetened beverages. They might bring back some (or all) of the snack foods and indulgences that they’d cut out while “being good“. They might return to their older pre-established automated portion sizes and of course their older pre-established dietary staples.
In short, people regain their lost weights when they regain their lost lifestyles, as doing so brings them directly back up to their pre-weight loss average daily caloric intakes which in turn supported their pre-weight loss weights.
Which brings me back to another seminal confirmation bias of mine. The more weight you’d like to permanently lose, the more of your life you’ll need to permanently change, which is why the world’s best diet for you, is the one you actually enjoy enough to sustain. No, it might not lead you to lose as much as a magic wand would allow because metabolic adaptation does occur, but if you actually enjoy your new diet, and you don’t head back to your old lifestyle when you quit the overly strict diet that’s leaving you miserable, you need not worry that somehow, magically, due to a “set point“, you’re going to end up right back where you started.
Ted Kyle, Caroline Apovian, and Amanda Velazquez, in Medscape, respond to Medscape’s recently posted fat shaming, hate-speech, garbage fire, of an editorial.
Naomi Buck, in The Globe and Mail, on why recess sucks now.
Stephen Daisley, in The Spectator, on the beginning of the end of the UK’s Labour party.
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This week’s Quirks question: The answer is you wouldn’t stand, you’d sink!
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Was inside the Jian Hing market at Markham and Lawrence on Family Day, looking for Filipino Pork Rinds. They have about 40 different varieties at Jian Hing. I’m not kidding, there’s a whole aisle devoted to nothing but. Fil…
Last week saw the publication of a new study in the BJSM entitled (highlighting mine), “Is interval training the magic bullet for fat loss? A systematic review and meta-analysis comparing moderate-intensity continuous training with high-intensity interval training (HIIT)“. Understandably intrigued given a prominent medical journal was suggesting there was a magic bullet for fat loss, I clicked through, and then reading the piece I learned that the amount of fat lost that the BJSM was calling a “magic bullet” was a 1 pound difference, one which the study’s abstract’s conclusion described as, “a 28.5% greater reductions in total absolute fat mass (kg)”. Duly surprised, I then took to Twitter to poke around and found that one of the study’s authors, James Steele, was tweeting out a corrective thread to his own study’s hype – hype which understandably and predictably led to an onslaught of media overreach. Intrigued, I approached him directly to ask about the discordance in tone between his tweets and his study’s title and conclusion, and he sent me such a thorough and thoughtful response (explaining how it was the BJSM’s editor who’d changed both), that I asked him if he’d mind my sharing his thoughts here as a guest post. Suffice to say, in my opinion, medical journals and their editors shouldn’t be in the business of clickbait hype, as it diminishes themselves, research, and furthers societal scientific illiteracy by suggesting that such things as “magic bullets” for weight or fat loss can conceivably exist.
I was first slightly concerned that the findings would be overhyped and potentially misrepresented when I saw the press release that was sent to the media. I was forwarded various requests by our institutions news team and saw the wording of the first line of which was
“Short bursts of high intensity exercise are better for weight loss than longer sessions in the gym, research suggests.”
My colleague James Fisher noted to me that he also thought the press release didn’t reflect the findings accurately and wondered whether the title change resulted in the perception of a different finding.
The original title in our submission to the journal was
“Comparing the effects of interval training versus moderate-intensity continuous training on body adiposity: is it possible to find a signal in the noise? A systematic review and meta-analysis“
which was chosen as an homage to Nate Silvers’ book and the use of meta-analysis to find the ‘signal’ from among the ‘noise’ of conflicting findings in smaller studies The paper underwent peer review as normal and we made changes suggested by the reviewers to improve the manuscript; but, none of the reviewers commented on the title if I recall. After the reviewers were happy with the paper and had no further changes they wanted we received a recommendation that it be published, but with minor revisions which were suggested by the editor. Most of the revisions suggested where helpful as they seemed to be aimed at improving readability of the manuscript. However, it was also suggested that the title was changed, as well as the addition of the percentage difference to the conclusion of the abstract. This was suggested to be intended to attract more attention to the article, make it seem more compelling, and ensure recognition was received for the work. I didn’t particularly like the newly suggested title, nor did some of my co-authors, but it was not strictly saying that anything ‘was’ a ‘magic bullet’ and so I did not push the issue. I must confess I did not at the time notice the seemingly minor change to the abstract conclusion though. I personally dislike the presentation of % values in this manner as to me they are often misleading and detract from whether the absolute values are really meaningful or not (a big problem in sport and exercise IMO wherein a lot of studies make interventions seem better than they are by reporting % values). The value is not inaccurate, but it does lead the less wary reader to potentially draw the wrong conclusions.
I did suspect that the changes were suggested because the paper would likely be selected for a press release which turned out to be correct. I’m glad the paper got some wide coverage, but wanted to make sure it was covered in a nuanced manner. So I tweeted a little thread to try and provide some balance and when I was interviewed about it on BBC World Service I also made sure to provide as balanced a commentary as I could in the time permitted.
It doesn’t surprise me that the media initially interpreted things to be saying that ‘HIIT’ (high-intensity interval training) was better than ‘MOD’ (moderate-intensity continuous training) for fat loss without considering all the nuance… that’s just how it goes sadly. I also can empathize with the journal and publisher in wanting to try and increase the reach of the work that they publish. To my mind if we can widen the reach of good science, and raise appreciation of its importance, then that’s a good thing. This is something I’d like to be able to do more of. But, though this is good in principle, in execution it proves to be difficult. It’s tough to get the nuance across because science is hard and most people aren’t really able to understand it. I guess it’s part of the media cycle though. The wider media wants ‘stories’ and just regular boring old science doesn’t make for a good story. So to get the wider media’s attention journals and academic publishers need to try and make things seem more exciting. In that process though nuance gets lost. However, I can’t think of any other way to communicate science more widely at the moment. I guess what we need to ensure is that, once the media get hold of a story and want to run it, the actual scientists themselves are the ones they speak to and interview so they end up with a platform and captive audience to explain the nuance and implications in an understandable manner. At least, that’s what I’ve tried to do and hope I achieved.
I think if I was able to ‘do over’ this example specifically then I would have likely pushed back more on the issues. I would like to have kept the original title and would have argued for this position as I suspect my co-authors likely would have too. I definitely would have pushed back on the change to the abstract conclusion and will be more vigilant to these issues in future. In likelihood this might have meant the paper would have been less ‘impactful’ as a story for the media. But it would have meant that the paper itself didn’t contribute to any potentially misleading publicity. The publisher could have still put out the press release as they desired… Can’t stop them from doing that. But at least the paper would have better reflected what we found in full. I think I would advise authors who face similar situations to make sure they think and have a conversation about this. We all want our work to reach the widest audience to hopefully have the biggest impact possible. But we don’t in the process want it to distort in terms of its message. Make sure to discuss it with your co-authors and the journal/publisher and find the right balance so that scientific integrity is retained, whilst reach is maximized. It’s tough to do, but worth striving for IMO.
Dr James Steele is the Principal Investigator at the ukactive Research Institute, and Associate Professor of Sport and Exercise Science at Solent University. James completed his BSc (Hons) in Applied Sport Science in 2010, and hid PhD examining the role of lumbar extensor resistance training in chronic low back pain in 2014. He has extensive experience of research and applied consultancy in the area of physical activity, exercise, and sport from over the past decade, working with a wide range of populations ranging from elite athletes across a range of sports, to the general population across the lifespan, and both those who are healthy and diseased. James has published numerous peer-reviewed articles and delivered several invited talks at international conferences on a variety of areas relating to sport, strength and conditioning, physical activity and exercise, health and fitness. He was appointed to the Expert Working Group revising the Chief Medical Officers Physical Activity Guidelines for the UK and is a Founding Member of the Strength and Conditioning Society, as well as the Society for Transparency, Openness, and Replication in Kinesiology, and member of both the British Association of Sport and Exercise Sciences and the American College of Sports Medicine.
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