Yoni Freedhoff M.D. 2013-05-21T17:21:57-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.ca/author/index.php?author=yoni-freedhoffCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Yoni Freedhoff M.D. Good old fashioned elbow grease.The Real Biggest Losers? The Show's Audiencetag:www.huffingtonpost.com,2013:/theblog//3.24739342013-01-14T17:19:18-05:002013-03-16T05:12:02-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
Last week, reinvigorated by some fresh young blood, season 14 of the prime-time weight loss extravaganza known as The Biggest Loser enjoyed its most watched premiere in its nine-year history. And when I say young blood I mean it, as this season marks the first time that The Biggest Loser has included children in the mix -- two 13-year-olds and one 16-year-old round out the cast.
While I personally find the show to be an emotionally and physically abusive, misinformative, horror show, it's clearly beloved and trusted by many -- that record premiere was reported to have been viewed by over 7-million people. And while my personal opinions shouldn't concern you, the peer-reviewed medical literature stemming from The Biggest Loser, as well as the AAP's implicit endorsement of the show, should.
Perhaps not surprisingly given what appears to be the overarching theme of the show -- that obesity is the individually controlled consequence of gluttony and laziness -- a study published in the journal Obesity this past May demonstrated that watching even a single episode of The Biggest Loser dramatically increased hateful weight bias among viewers -- an effect that was heightened among non-overweight viewers.
Given this season's causal billing as a "big, bold mission: to tackle the childhood obesity epidemic head-on," no doubt viewers are going to be looking to the teachings of The Biggest Loser to help with their children's struggles. Therefore along with being taught that obesity is treatable by means of incredible amounts of vomit-inducing exercise, severe dietary restriction, and never-ending servings of guilt and shame, the medical literature suggests viewers will also be taught that failure is an obese child's personal choice -- something that their bullies have been saying forever. Indeed increasing hateful weight bias is the last thing America's already over-bullied overweight children need as a recent study on bullying published in the journal Pediatrics found that the odds for being bullied for an overweight child were 63 per cent higher than their lighter peers.
The metabolic impact of The Biggest Loser's weight loss formula of exercising a minimum of 4 hours a day while enduring a highly restrictive diet has also been studied. Using indirect calorimetry and doubly labelled water researchers determined that by week 30 participants' metabolisms were decimated -- they had slowed by 504 more calories per day than would have been expected simply as a consequence of their losses. This led the study's authors to conclude (emphasis mine):
"Unfortunately, fat free mass preservation did not prevent the slowing of metabolic rate during active weight loss, which may predispose to weight regain unless the participants maintain high levels of physical activity or significant caloric restriction."
This finding may help to explain why according to the three Biggest Loser alumni I recently interviewed, 85-90 per cent of participants regain their weight, and where more often than not those who do sustain their losses have translated those losses into careers as personal trainers or motivational speakers.
The fact that The Biggest Loser trainers have gone on record this year and formally reported that they won't yell at the show's children is a testament to the ugliness of the show as a whole. And regardless of how the children are treated, it doesn't change what seems to be the show's ultimate message: that happiness, self worth, success, and pride are wholly determined by the numbers on a scale and that people, now including children, who remain obese are lazy gluttons who just don't want it badly enough. As horrifying as that message is, more horrifying that it's being promoted under the AAP's own banner as the show has recruited Dr. Joanna Dolgoff as their pediatrician and new on-screen character. Reading her biography on NBC's The Biggest Loser page reveals just six words in that she's also an, "official spokesperson for the American Academy of Pediatrics."
The biggest losers each and every season aren't in fact the contestants, they're the viewers. By watching The Biggest Loser and basing their devoted adoration only on the proverbial "after" pictures, but not the "after-after" pictures, viewers are being taught non-sustainable approaches to weight management that in turn the medical literature suggests promote hatred of those who struggle with their weight, and potentially of themselves.
That children are involved in the show this year will likely increase the number of children watching and in so doing increase already rampant school-based weight-related child bullying. It may well also lead young overweight or obese viewers to feel even more guilt, shame and self-loathing than they already feel which in turn might heighten their risks of developing body image and eating disorders. Truly, if guilt, shame or self-loathing were sufficient for weight loss the world would be skinny as those who struggle with their weight, especially children, have no shortage of those particularly painful emotions.
Please do the right thing. Speak up about The Biggest Loser. I would argue that it's poisoning an already sick nation and right now it would appear that you're in fact fully and officially on board.
Sincerely,
Yoni Freedhoff, MD
Assistant Professor, University of Ottawa
Faculty of Medicine
Medical Director, Bariatric Medical Institute
]]>The Video the Food Industry Doesn't Want You to Seetag:www.huffingtonpost.com,2012:/theblog//3.22719182012-12-11T00:17:45-05:002013-02-09T05:12:01-05:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
Unfortunately, just three days prior to the event, I was uninvited without the courtesy of an explanation or an apology. Given I already had the day booked off, it was too late to rebook the patients I'd cancelled, and that I'd already put together my slide deck, I decided to record my talk and post it online.
The good news is that online I don't have a time keeper and because I'm not speaking solely to the food industry, I don't need to be as gentle with my messaging as I'd planned. Also good news is who I'll now be able to reach. Rather than just a small room full of food industry executives who might politely listen but weren't likely going to cultivate change, I'll have a global audience.
From policy makers, to public health authorities, to professors, physicians/dieticians and other allied health professionals, to journalists and nutrition bloggers -- the Internet's a big place. You'd almost think Fleishman-Hillard, the PR and communications firm responsible for my last minute dis-invitation were working for me and not for the food industry as no doubt my message has already made far more of an impact than it would ever have done in that breakfast hall.
So here's my talk. It's about what the food industry could do to improve public health, why they're not going to, and what we can do about it. But before you click it, a quick request -- I want you to share it by means of every socially networked channel and email contact you have, because if the communications firm hired by the food industry to help cultivate good Big Food PR didn't want it heard, I figure it probably ought to get spread.
Yoni Freedhoff, MD, is an assistant professor of family medicine at the University of Ottawa, where he's the founder and medical director of the Bariatric Medical Institute -- dedicated to non-surgical weight management since 2004.
Dr. Freedhoff sounds off daily on his award-winning blog, Weighty Matters.]]>Why You Shouldn't Put Your Child On A Diettag:www.huffingtonpost.com,2012:/theblog//3.13992032012-04-03T17:22:46-04:002012-06-03T05:12:01-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
And of course it's not just medical problems these kids face. Studies on bullying behavior demonstrate kids with obesity are 2 to 3 times more likely to be bullied than their skinnier peers (Kukaswadia, 2011). Add that to the incredibly pervasive societal stigma against those with obesity, and it's hard to imagine that obesity isn't having a terrible impact on these kids' self esteem.
So if childhood obesity is so problematic, why wouldn't I suggest we treat it?
It's not the primary problem.
I'll repeat that. Childhood obesity is not the primary problem -- or, to put it slightly differently, kids are not the problem. There's not an epidemic loss of willpower among 5 year olds, yet already by first grade, 1 in 3 children in America will be overweight or obese. The kids these days are no different than when we were kids. What's different is the world our kids are growing up in. Today's world is a Willy Wonkian dietary dystopia. It's an environment filled with nutritional misinformation, predatory advertising, misguided crop subsidies and aisles and aisles of ultra-processed boxes masquerading as food. It's a world where kids can't step on a blade of grass without being rewarded with a treat, where school fundraisers occur in Chick-Fil-A, and where Olympic gold medalists like Shawn Johnson, Chris Bosh, Apolo Ohno and Elana Meyers are busy helping to peddle chocolate milk to children as a "recovery" drink. (I've got to ask. What could these kids possibly be doing where for "recovery" they need a beverage can contain 20% more calories and double the sugar of a full-sized Snickers bar?) Our world is the disease, and childhood obesity is just the symptom, and as a physician I know that while it's nice to treat symptoms, it's always more important to cure diseases.
But I guess, given that we're not about to cure the world, it's fair to ask, "Shouldn't we treat the symptom?" Again, I draw on my training to answer. I was also taught that we shouldn't offer treatments without evidence to back up both the treatment's efficacy and its safety.
So is there a safe and effective diet for children? One that reproducibly, in a substantial and significant percentage of cases and in a sustainable manner, causes weight loss or prevents excessive gain? Unfortunately, the answer is plainly "no." And don't be lulled into thinking, "Yes, but we'll just have those kids eat less and exercise more." If it were that simple, do you think we'd still have a problem? Do you think these kids and society as a whole want to be bullied and victimized because of their weights? That they're choosing to purposely go out of their ways to "eat more and exercise less"? If you do, then I suppose you must also think playing the stock market is easy, because all you have to do is "buy low and sell high." But even if you're of the school that believes such an intervention or diet exists, is there data out there that tells me that administering that diet isn't going to irreparably damage a child's lifelong relationship with food, with their body image, or with their self-esteem?
I don't treat children in my practice, nor do I put my adult patients on prescriptive "diets." My oath as a physician to "do no harm" is one I take seriously, and given that I'm not aware of any diet plan for children that's actually proven to be safe, effective, and sustainable, picking up in my office where the schoolyard bullies left off, or suggesting that a parent do so, isn't something I'm comfortable recommending. And believe you me, as is evidenced by the story in Vogue, a physician's expectation of parental action isn't necessarily what's actually going to happen once that parent gets his or her kid home. Moreover, I've got to ask, if full-grown, insightful, incredibly motivated, intelligent, mature adults with clearly weight responsive medical conditions struggle with long-term weight management and "dieting," how can anyone imagine that a young, innocent, immature, not-fully-developed-frontal-lobed child is going to be able to pull it off?
There is good news, though. There have been a number of studies now that demonstrate treating the parents can help the child (Golan, 2004, Boutelle, 2012). That's why I'll regularly recommend that, to treat individual cases of childhood obesity, we should be treating their parents and not the children. What I teach the parents in my practice is to live the lives they want their children to live, and to never, ever, put an emphasis on doing so for weight-related reasons (their own or their children's). It's about cultivating and nurturing healthy living behaviors -- as regardless of a child's weight, every family, including those with skinny little rails, can benefit from more family-based cooking with whole, healthful ingredients, from active parents who carve out fitness time for themselves and their families, from less screen time and from more warmth. Those healthy living behaviors apply to every weight.
I've seen too many patients in my adult office who trace their struggle with food and weight back to a well-intentioned doctor and his or her straight talk about their "not so little anymore bellies" -- or to a well-intentioned Mom or Dad who took them at an incredibly young age to Weight Watchers. Coupling that with the clear-cut fact that studies on parental feeding behaviors in kids demonstrate that being more restrictive backfires and leads to further dietary disinhibition and weight struggles (Scaglioni, 2011), I can't in any good conscience recommend that children be placed on diets.
Until we have that reproducible, sustainable, effective and safe diet that we can prescribe with confidence, where we're assured we'll be doing no harm, I think we should stick to the parents, and also to rage against the world. The kids have it tough enough already.
Atif Kukaswadia, Wendy Craig, Ian Janssen, William Pickett (2011) Obesity as a Determinant of Two Forms of Bullying in Ontario Youth: A Short Report. Obes Facts 2011;4:469-472
Moria Golan and Scott Crow (2004) Targeting Parents Exclusively in the Treatment of Childhood Obesity: Long-Term Results Obesity Research 12, 357-361
Boutelle KN, Cafri G, & Crow SJ (2012). Parent Predictors of Child Weight Change in Family Based Behavioral Obesity Treatment. Obesity doi:10.1038/oby.2012.48
Silvia Scaglioni, Chiara Arrizza, Fiammetta Vecchi, and Sabrina Tedeschi (2011) Determinants of children's eating behavior Am J Clin Nutr December 2011 vol. 94 no. 6 Suppl2006S-2011S]]>What's Really Wrong With Georgia's Childhood Obesity Campaigntag:www.huffingtonpost.com,2012:/theblog//3.11856772012-01-05T11:20:51-05:002012-03-06T05:12:01-05:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/ads cut straight to the point -- childhood obesity is real and we can't continue to turn a blind eye towards it.
The ads have also been rather soundly criticized by experts who worry about their impact on the already rampant biases that are endured by children with obesity.
But the ads may well be necessary. Georgia has the second highest obesity rate in the country, and there's no doubt finding a means to reduce those rates, especially the childhood ones, would be a worthwhile endeavour.
So will these ads help?
I sure don't think so.
Blog continues after slideshow
Instead they steer parents and children to a website full of rather useless one-line recommendations. If it were as easy as the ads say ( "When you are watching TV as a family, get up and move during the commercials--try running in place, dancing or jumping jacks."), do you really think we'd have a problem? The website also encourages parents to speak to their children's doctors about the problem. But given that the vast majority of medical schools and residency programs teach pretty much nothing about nutrition and obesity, I'm not particularly hopeful their doctors' advice will be any more sage than the website's.
Without a doubt, the question of whether these ads stigmatize obesity further is an important discussion to have (and for the record, I think these ads simply highlight the issue, not stigmatize it), but I guess what I'm trying to say is this: Lost in the discussion of stigma, the reporters and experts have seemingly forgotten one very important fact. That fact? We simply don't yet have a reproducible and reliable treatment program that results in significant and sustained weight loss in children.
So while I'm all for public health campaigns to address childhood obesity, it's not the individual victims that I think we should be focusing on -- it's the world they're growing up in.
To help illustrate my point, try to imagine childhood obesity as a flooding river with no end in sight. While teaching children how to swim might help temporarily in keeping them afloat, given that the flood isn't abating, chances are, even with the best swimming instructions, the kids are going to get tired and sink. So while swimming lessons certainly can't hurt, what we really need to be shouting about doing is actually changing their environment and building them a levee.
The real problem with these ads is that they suggest that we're going to solve this problem on an individualized, case-by-case basis.
Childhood obesity is the symptom. The environment is the cause.
If we want a cure, it's the cause we need rally against and not the symptom.
Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, an Assistant Professor of Family Medicine at the University of Ottawa, and his personal website, Weighty Matters, is ranked among the world's top health blogs.
]]>Do You Know How to Feed Your Children?tag:www.huffingtonpost.com,2011:/theblog//3.11168022011-11-28T16:45:41-05:002012-01-28T05:12:01-05:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
Parental feeding practices have been the subject of a great deal of research, and this month, the American Journal of Clinical Nutritionpublished a handy summary of it all.
Here are the top 10 take home messages:
Pressuring kids to eat fruits and vegetables and markedly limiting their access to sweets and fatty snacks, along with using food as a reward are all strongly linked with disinhibited children's eating patterns.
The more inconsistent parents are with either eating schedules or serving healthy vs. unhealthy foods, the greater the negative impact of the parenting styles listed in the first point above.
Having at least one parent at the family meal is associated with better consumption of fruit and vegetables, and a lower risk of skipping breakfast.
Adopting a knee-jerk pattern of dietary restriction with an overweight child may drive that child to be more, not less, likely to overeat.
The availability and exposure to foods at home most certainly affects children's long-term food selections and preferences.
The earlier and more broadly a child is exposed to different foods, the healthier that child's eventual adult diet.
The more fruits and vegetables available at home the more fruits and vegetables your kids will consume.
The more fruit juice and breakfast bars available at home the less actual fruits and vegetables your kids will consume
The greater the frequency of meals in front of the television and/or the lesser the frequency of family meals, and/or the greater the use of food as a reward, the higher your kids' intake of sugar sweetened beverages.
And number 10?
I'll quote directly from the paper, as it pretty much sums up everything else up:
"Children like what they know and eat what they like."
So to make sure your children know healthy, here are some straightforward prescriptions for healthy at-home eating:
Encourage a wide and varied healthy diet introducing new foods frequently and early.
Don't pressure your children to eat (one-bite rules are fine), or withhold dessert unless they eat their veggies.
Don't reward them with food.
Disband the "clean your plate" club.
Keep plenty of fruits and vegetables handy, accessible, visible, washed and prepared and literally smile at your kids when they eat them.
Sit at the table and eat with your kids.
Don't skip meals.
Dramatically minimize meals out and takeout.
Ensure that as many meals as possible a week involve the transformation of raw ingredients (not mixing boxes).
Involve your kids in cooking.
Or put even more simply?
Live the lives you want your children to live.
Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, and his personal website, Weighty Matters, is ranked among the world's top health blogs.]]>Tim Hortons Junkies, Prepare to Gain Weighttag:www.huffingtonpost.com,2011:/theblog//3.9417032011-08-30T12:28:59-04:002011-10-30T05:12:02-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/ are getting rid of their smallest size coffee and shifting everything else up to one size larger? What was once a medium is now a small, a large is now a medium, and so on and so forth.
Just for kicks, let's talk calories.
Let's say you're a double-double drinker (as many Canadians are -- for my American friends, a double-double is double cream, double sugar). Let's also say that you have two a day (meaning your Tim's fix was two small double-doubles daily). If you continue to order up the same, given Tim's new larger sizes, how many extra calories could you be consuming a year? I estimated the calorie intake using Tim Hortons' nutrition calculator.
Small: 18,250 extra calories (roughly 5lbs more).
Medium: 18,250 extra calories (roughly 5lbs more).
Large: 29,200 extra calories (roughly 8lbs more).
So for those keeping score, or if you yourself are a Tim's junkie, if you gain weight consequent to these changes, it's not necessarily because of your genetics, it's not necessarily because of inactivity or a lack of "willpower," and it's not necessarily because of epigenetics, obesogens, advertisements or ill-directed crop subsidies. It could be because of one single, solitary change in your daily food environment.
Think anything else has changed in our food environment since let's say the 1970s? How many other changes have there been that have been foisted on us that impact on weight?
What year did chocolate milk start in school lunch programs, or vending machines show up in school halls? When did pizza and ice cream days become entrenched as fundraisers? Which genius decided that kids need treats each and every time they step on a blade of grass outside, or "sports drinks" when we were all just fine with water? How large has your go-to fast food combo grown? What meal is your boss bringing in for you to eat while you work late? How many foods are you buying that your parents used to make from scratch? How many times are you going out to eat or buying takeout because your day is spent tethered to an electronic leash and your evening chauffeuring kids around when you used to be free-range?
I could go on, and on, and on.
The world has changed. While there are certainly hundreds of factors involved in societal weight gain, there's no doubt (in my mind at least), the most important factor by far is the environment we've got not choice but to live in, and if we really want to see things change, it's the environment we need to work on.
Now of course bodies aren't perfect math formulas, and not every Tim's drinker's going to gain weight -- but some are. And that said, daily Tim's coffee drinkers, maybe now's the time to make the switch to black?]]>Body Fat Percentage Scales for Children?tag:www.huffingtonpost.com,2011:/theblog//3.9172442011-08-15T09:38:21-04:002011-10-15T05:12:02-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
Scale company Tanita is now marketing a specially designed body-fat/weigh scale for children between the ages of five and 17.
Now I've blogged before about how I think body fat percentage scales are a bad idea to begin with, but to target them at children bring them to a whole new level of horror.
Five-year-olds don't need to have their body fat, or their weights measured; they need healthy food and good parental role modeling.
So instead of punishing your child by buying them a body fat percentage scale, may I suggest that if you're not already doing so you:
Cook healthy meals from whole ingredients for each and every meal.
Have sit-down family dinners each and every night (remembering they don't need to be gourmet -- kids do love peanut butter sandwiches).
Involve your children in meal (and school lunch) preparation.
Track the added sugars in your childrens' diets and try to limit to no more than 45 grams daily (remembering that some days should be exceptions too - sugar is part of childhood, it just needn't be a daily part).
Ensure that the only fruit they eat is actual fruit -- no juices, Roll-Ups, Chews, or mashes.
If they're older than two, make their milk white and skim, not brown and sugary.
Ensure that your children eat protein with every meal and snack, and that they start their days off with a wholesome, protein-inclusive breakfast.
Make restaurant meals and takeout (including supermarket prepared takeout meals) exceedingly rare events.
Engage your family in family-based physical activity -- weekend hikes, nightly walks, signing up for community races, landscaping, home improvement projects, lawn mowing, snow shoveling, etc.
Lastly you've got to remember that if you're worried about your kid's weights, don't put it on them. It's not their problem, it's yours, and if you think you're going to fix it by yelling at them, weighing them, shaming them, food policing them, etc., you're going to be disappointed, and your kid is going to be miserable.
If you want your kids to change the way they're living, you're going to have to change the way your whole family is living - and frankly it isn't about weight. All of those behaviours up above? It doesn't matter if your kids are heavy or thin, those strategies will benefit each and every family, though the likelihood is that if weight is an issue in your family, those changes will help far more than any scale ever could.
Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, and his personal website, Weighty Matters, is ranked among the world's top health blogs.]]>Health Canada's Cadmium-Coated Hypocrisytag:www.huffingtonpost.com,2011:/theblog//3.9094012011-07-26T10:54:21-04:002011-09-25T05:12:01-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/proposed a guideline to limit cadmium in children's jewelry.
Why?
Because if kids accidentally ingest it, cadmium carries with it a number of medical risks.
In my opinion, it should be banned; after all that's what governments are supposed to do with toxins. Here's our Health Minister Leona Aglukkaq's take on a government's role:
"Consumer products that pose a danger to human health or safety may not be manufactured, distributed, imported or sold in Canada. This proposed guideline makes our expectations of industry clear."
So why then are trans fats not banned?
According to Sally Brown, chair of Health Canada's Trans Fat Task Force, trans fats are a "toxic" killer that should be removed from the food chain as soon as possible, and "the longer we wait, the more illness and in fact death will happen, so we know we have to get it out of our food supply."
"There is no safe amount of trans consumption," she added.
Tony Clement, the then Minister of Health said in June 2007 (in a speech that I can no longer find on Health Canada's websites) that if in two years a voluntary approach didn't remove the substance from our food supply, regulations would be put in place.
And here we are, over two years past that overly generous deadline, and Health Canada's guideline to limit cadmium, this despite the fact that I've found that the harmful substance Canadian children are most likely to ingest is trans fat (adults too).
In my opinion, if Health Canada actually cared about our health, trans fats would have been gone back in 2007, no voluntary free pass, and no lip service about potential regulations.
I believe that the only reason trans fat isn't gone is because politically, it's more challenging to do, and I think that at the end of the day it would seem as if Health Canada cares more about politics, than it does about the health of Canadian children.
Thank goodness there's no powerful pro-cadmium jewelry lobby here, because if there were, it would likely still be hanging around too.]]>Campbell's Soup Re-salting Belies True Corporate Responsiblity... Profittag:www.huffingtonpost.com,2011:/theblog//3.9011612011-07-20T09:05:23-04:002011-09-19T05:12:02-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
Oh sure, corporations need to ensure they sell safe products, and they need to treat their employees fairly and such, but as far as "corporate social responsibility" goes, there's really no such thing.
That's not to say there can't be corporations who provide incredible contributions to worthy causes, it's just to say that it's their choice to do so, and not their "responsibility," and that at the end of the day, their responsibility, especially when discussing publicly traded companies, is for profit. Simply and fairly put, if a corporation's socially-responsible moves negatively impact their bottom line, you can rest assured, they'll move to eliminate them.
The Campbell Soup Company's original de-salting was a move trumpeted both by Campbell and by many public health organizations, as a shining example of so-called corporate social responsibility.
In Canada, the Campbell Company has milked sodium reduction for all it's worth, producing at least two television spots congratulating themselves. The first involved Hilton, a Campbell employee who, "questioned all the salt." They then filmed Hilton standing in a room where the salt the Campbell Company had removed reached his waist. The second involved Michael, another Campbell employee, who admitted that he didn't feel comfortable feeding Campbell soups to his children, "he didn't always feel right serving them at home." They then filmed him eating with his family with the then sodium reduced soup he could presumably feel good about.
Public health organizations and health care professionals bought into it hook, line and sinker.
Blood Pressure Canada even awarded Campbell's a "Certificate of Excellence" to commend Campbell for "the company's continuing sodium reduction efforts and industry leadership."
Their fawning over Campbell's was certainly understandable given the powerful statements the corporation kept making. For example, Philip Donne, President of Campbell Company of Canada, in a press release from just one short year ago, referencing last year's Sodium Working Group call to reduce sodium consumption, stated that he believed the call to action was an urgent one:
"We are pleased to see that many of our peer food companies are joining us in efforts to advance their sodium reduction programs. And for those who don't sense the urgency, the Sodium Working Group's recommendations may be just the motivation they need."
Or how about that of Andrea Dunn's, the Campbell Company's , Nutrition Strategy Manager who in that same year old press release explained, "Campbell Canada's approach of gradual and consistent sodium reduction is helping to adjust our consumers' palates to the taste of healthier sodium levels".
So what do you think the Campbell Soup Company will tell Hilton and Michael now that the sales of their less salty broths faltered, and in response out came their corporate shakers? Will Blood Pressure Canada rescind their award, and will Campbell's stop bragging about it? Will Andrea Dunn quit in protest, and will Philip Donne, who when awarded Blood Pressure Canada's award stated, "We know there is still more work to be done and we are hopeful our leadership will inspire industry changes," ponder on his leadership inspiring industry change for increased sodium?
Not a chance.
And what of the public who were led to believe that health steadied the hands of Campbell's?
At the end of the day people need to remember that corporations don't do things out of the goodness off their hearts, they do them out of the goodness of their balance sheets. Sure, if corporations can make money anddo good, they will, and good for them, but please don't ever kid yourself about true corporate responsibilities, as by definition they boil right down to plain old dollars and cents.
Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, and his personal website, Weighty Matters, is ranked among the world's top health blogs.
]]>Obesity Is Not the New Smoking, and Fat Is Not Our New Tobaccotag:www.huffingtonpost.com,2011:/theblog//3.8798942011-06-27T14:05:35-04:002011-08-27T05:12:01-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
Smoking is a singular behavior.
Now I don't want to minimize the difficulty of nicotine addiction, or the impact of factors such as poverty, advertising and culture on the decision to start smoking, but it is important to recognize that starting and stopping smoking involve one single behavior -- lighting or not lighting a cigarette. One behavior, governed by choice.
Obesity is not a choice, nor is it the consequence of one singular behavior.
People don't choose to become obese, and while choice and free will are involved in lifestyle design, they're certainly not lifestyle's only determinants.
Genetics, co-morbid medical conditions, psychology, pace of life, socio-economics, environmental obesogens, governmental failings in the provision of evidence-based nutrition and energy balance/caloric information, the unregulated self-help quackery of the commercial weight management programs, the confusion and contradictions of over 60,000 diet books, glossy magazines that promote quick fixes, reality television that promotes inane, non-sustainable and frankly dangerous treatment, crop subsidies that allow highly processed, hyperpalatable, hypercalorific foods to be sold for pennies, front-of-package labeling that confer health-halos to junk food, the demise of the family meal and the fall of cooking, predatory advertising targeting adults and children alike, a culture that promotes the provision of food at every event however small, super-sizing of restaurant portions, lack of caloric information at point of sale, medications which cause weight gain, juice and chocolate milk being promoted as healthy choices, public health messaging that wrongly suggests exercise is sufficient to "balance" calories consumed, epigenetic changes that occur in the womb, eating as a defense or a reaction to emotional, physical or sexual abuse.....
Honestly, I could go on.
Of course there are choices involved in personal weight management, but the playing field is anything but level. Go back through that list up above and consider life 60 years ago, when obesity was a rarity rather than a norm. Most of the list would be gone. Also consider the fact that none of that list reflects the failings of people as individuals, but rather it reflects our collective failing of protecting our environment. What we're dealing with today is a state sponsored, massively un-level playing field, superimposed on our most powerful physiologic survival drive. Go figure we've got a problem.
So no, obesity is not the new smoking and fat is not the new tobacco. The folks who say they are, whether they realize it or not, are part of the problem, as the notion that obesity's the new smoking fuels the hateful bias that dealing with it is as easy as butting out.
If it was as simple as pushing away from the table, everyone who wanted to be would be slim.
Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, and his personal website, Weighty Matters, is ranked among the world's top health blogs.]]>Why the Body Mass Index Is Pretty Stupidtag:www.huffingtonpost.com,2011:/theblog//3.8714942011-06-07T12:46:06-04:002011-08-07T05:12:02-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
A few weeks ago I got into a gentle and congenial Twitter spat with Rebecca Scritchfield. Rebecca is a registered dietitian, and she's a great fan, and an expert practitioner, of intuitive eating -- using inner cues, not calories, to help guide dietary choices.
Me? I don't intuit my eating as well as Rebecca and so I food diarize every last ounce of food that goes into my mouth. Rest assured, I'm not pathological about it. I don't use my food diary to judge what I've eaten, instead I use it to help guide what I eat, and I teach my patients to do the same. To me, looking at the calories when I eat is akin to looking at price tags when I shop -- and just like price isn't the only consideration when shopping, neither are calories the only consideration when eating. We use food in our lives to both celebrate and comfort, and consequently caloric literacy definitely doesn't always lead to low-calorie choices.
In my Twitter discussion with Rebecca, I had noted that food diarizing protects against mindless eating by allowing for the use of calories in decision making.
Rebecca pointed out that you don't need to count calories to eat mindfully, and that there were other ways of journaling.
So who's right?
Should you intuitively eat, or should you count calories?
And looking at an even larger picture, should you do low-carb, slow-carb or low-fat? Should you include cheat days or no-cheat days? Should there be forbidden foods, or should everything go? These questions could go on and on.
The National Weight Control Registry, the world's largest prospective study of folks who have been successful with long-term weight management, keeps track of the means with which people lost prior to their registration. There's no doubt about it, those folks are good at weight management, with the average registrant having lost about 65 pounds, keeping it off for more than five years. What the Registry has taught us is that while there are some behaviours that are shared by a large majority of registrants (like eating breakfast and exercising), there is also tremendous variety in the registrants' weight management approaches.
Checking in with Amazon.com just now, I found 64,231 titles with the word, "diet" in them. And frankly, they probably all 'work.' Of course classic dieting, under-eating and over-exercising, while likely to lead you to a temporary result, is far less likely to get you into the Registry. Instead you need to actually like your life or you're very unlikely to keep living (or weighing) that way.
It's about living the healthiest life that you can enjoy, not the healthiest life that you can tolerate, because if your life is simply tolerable, you're not likely to keep living that way. To take an extreme example, while becoming a teetotaling, vegan, shut-in, marathon runner might well help you to manage your weight, is that a life you'd be willing, or even able, to live with forever?
Remember, too, that weight is a complex reflection of literally dozens of different variables. Some will indeed be within your control, while others won't. Therefore in regard to change, while I'm certain that there will be some things in your life that you can change to help manage your weight, I'm equally certain that there will be some things in your life, affecting your weight, that you either won't be able, or won't be willing, to change.
Consequently all of those numbers that come out of scales -- weight, body mass index, body-fat percentage -- none of them are particularly useful. I could use them to talk about your risk of developing weight-related medical conditions, but I don't bother, at least not in a counselling context as I don't find the fear approach to be helpful. You could use the numbers as calls to action -- to decide that you're going to do something. But what neither of us, and frankly no one should do, is use those numbers to set goals. The only goal that's fair to set is to live the healthiest life that you can enjoy.
Why?
Because there's simply no point in you trying to live a life you can't sustain. While you may not reach some table's definition of 'ideal,' is there anything other than weight in your life where you consider 'ideal' to be your goal? Why is it that every other area of your life you're rightfully proud and satisfied with your personal best? Why isn't your personal best good enough weight wise?
So what should you do? Whatever works for you. Whatever you can honestly see yourself doing for the rest of your life, and therefore the answer to the question as to whether Rebecca or I was right with our approach to dealing with mindless eating -- both of us and neither of us. The answer would all depend on the individual we were counselling.
If there were one right way, we'd all be doing it.
Dr. Yoni Freedhoff, MD is known as a "nutritional watchdog" for his advocacy efforts for improved public policies regarding nutrition and obesity. He is the founder and Medical Director of the Bariatric Medical Institute, dedicated to the (nonsurgical) treatment of overweight and obesity since 2004, and his personal website, Weighty Matters, is ranked among the world's top health blogs.]]>Thanks Skechers, But No, My Little Girls Don't Need Butt Shaping Shoestag:www.huffingtonpost.com,2011:/theblog//3.8687412011-05-31T09:05:04-04:002011-07-31T05:12:02-04:00Yoni Freedhoff M.D. http://www.huffingtonpost.com/yoni-freedhoff/
So what am I worried about now? Well, I'm not worried about the kindergarten bad boy who might try to convince my daughters to drink chocolate milk behind our garden shed. I'm worried about folks like the ruthless and downright evil marketers who think that my four and six-year-olds' self-esteem is fair game for them to target (thankfully my baby's still safe).
So what's got me fired up?
Skechers Shape-Up shoes.
While their existence is painfully stupid for adults, the fact that Skechers now makes its Shape-Up shoes for little girls is just plain wrong.
In case you aren't familiar with Shape-Ups, they're uncomfortable looking shoes with convex bottoms that are supposedly designed to help create, "more toned leg and buttock muscles", and, "may help burn calories."
Science and evidence be damned, they're an industry unto themselves, and now they're being targeted at children, including my pre-schooler.
The obnoxious cartoon ad aimed at my children is being aired by Nickelodeon and the Cartoon Network, and it shows pictures of boys dressed in hotdog, cupcake and ice cream cone costumes that can't keep up with cool, skinny, uber-made-up, Heidi in her skin tight shirt, mini skirt, and her new Shape-Ups. They even offer a lace-free Velcro version that presumably is meant for my four-year-old.
Do my little girls really need to worry about their butts?
The sad truth is, my girls are almost certainly facing a lifetime of advertisements that will be geared to make them feel like their looks are inadequate. They'll regularly be made to feel that their bodies are too fat, their lips insufficiently red, their skin too rough, their hair too frizzy, their breasts too small, and their butts too big. Magazines, TV spots, product placements, celebrity spokespeople -- there will be no shortage of unrealistic expectations to eat away at my babies' self-esteem.
Yet somehow I didn't expect them to start to encounter them before they lost all of their baby teeth.