Quick notes from over the holiday.

Updated 12.04.2014; reformatted 8.29.2015
Recognizing that I wasn't going to post over the Thanksgiving holiday, I collected links of interest and collected them in this post to be published once I was home. Obviously, I had internet connectivity over the break, but didn't want to do anything that seemed too much like working. And because I'm me, I didn't get around to finishing or polishing the prose until long after I'd returned. Be that as it may, what follows are brief remarks on articles I've recently read.

Will calorie counts change habits?

The New York Times covers the FDA's new regulations. Most people interviewed answer the above question negatively. Price and inconvenience are better ways to change behavior than providing information. Poor and uneducated people will be missed in this effort these folks say, which sounds very paternalistic to me.

I'm in favor of labeling, both in terms of calorie content and genetic engineering. Transparency is the best disinfectant. The food industry fears labeling because it assumes that customers will change their habits. Starbucks found that telling customers how many calories were in its items resulted in a 14% decline in calories purchased for food, but no change in the drink calories purchased. So there is some evidence that consumers will pay attention. The article doesn't mention if Starbuck's revenues were impacted, however.

I doubt that they were, because as a restaurant CEO interviewed recently on Bloomberg TV noted, what the calorie counts do is prompt the restaurant to offer lower calorie items for the small percentage of people who care about calories. In other words, they treat it as the source of potential new revenues. He noted that they offer the option to replace burger buns or fries with lettuce and salad. I'd have to compare the price of buns and potatoes to lettuce, but I doubt that margins are being squeezed there. They have to have lettuce on hand to make salads anyway.

Obesity researchers behaving badly

The Lancet published a small piece exposing the bad behavior obesity researchers at a recent conference in the United Kingdom. The reported bad behavior consisted of jokes about obese people, which is completely unacceptable. The story is another example of the power of transparency. Badly behaving researchers should be called out.

Realizing weight does affect health... nah, of course not.

An amazing story from Sarah Martindale,in which she discusses gaining weight to go from a 18/20 to a 20/22 and suffers mobility issues as a result. In addition to not being able to tie her shoes, she develops back pain. Of course weight loss is never considered, and she suffers until she realizes that it was all due to poor posture on a bad chair while working. (If she would stand while working, this would not be issue, but that's a topic for a different post.)

Martindale considers herself a body positive activist, meaning that bodies of all sizes are perfect and perfectly healthy (although she hedges at the end and notes that weight might contribute to health issues). Thus she was frustrated when the weight caused a shift in her ability to be mobile. Because in the end she solves the issue for the short term with a new chair, she's content again to be large. And I'm happy for her that she's happy, but I think it's delusional to increase in size, have issues develop and insist that the only factor that can't even be considered to play a role, is fat mass.

Could the days of lying about consumption be ending?

Asking people to recall what they eat and how much is fraught with error. In fact, the data are almost entirely useless, because people lie. Since most studies on nutrition and weight loss do just this (rely on dieter surveys) most are relatively useless. The only way to know how much subjects actually eat and move is to put them in a metabolic ward and provide them food and monitor their activity. In EVERY metabolic ward study EVER conducted, the energy balance equation holds. Every. Single. Time.

However, metabolic ward studies are hugely expensive, so they are rare and usually short term. A new tracking technology might offer a way to allow people to more accurately track their intake. I first read about it at Yoni Freedhoff's blog. Just about anything would be more accurate than food diaries for most people.

Attacking HAES Shibboleths

James Fell interviews Drs Sharma, Katz and Freedhoff as well as Linda Bacon for the Chicago Tribune. The article challenges many of the HAES* shibboleths, including the recent Flegal paper that seemed to show that fatter was healthier. To quote:

But a study just published in Population Health Metrics helps unskew it by looking at body weights over time instead of in a single snapshot. The study showed that people with stable, normal body weights through adulthood had low mortality rates, but those who were overweight or obese through adulthood but then lost weight have quadruple the mortality, because it's often illness-related weight loss.

On Facebook I asked Fell for, and received, a link to the full study he mentions. It's a very interesting paper. Rather than consider a snap shot of BMI (which is what Flegal et al did), the researcher considered how BMI changed over time. Many people lose weight when they are ill or old, and then die, which skews the mortality rate for normal weight people. Rapid weight loss is a signal to doctors that something is potentially going on (thus explaining the multiple thyroid tests I endured when I was losing weight. My doctor simply couldn't believe that I was just eating better and moving more.) This work directly and carefully refutes the Flegal results that the fat activists tout so vociferously. The reality is that being fatter is NEVER healthier.

Of course, Bacon didn't like the new study and presented the HAES talking points:

Bacon argued that most people won't succeed at weight loss, asserting that only 5 percent can sustain it. She called those who do succeed "statistical anomalies" whose habits are "akin to eating-disordered behavior and extreme amounts of exercise."

Katz and Freedhoff scoffed at the 5 percent claim, saying it lumps every bad study and fad diet in with more reasonable methods. Both agree that sustained weight loss, while not easy, is feasible when absurd diets are ignored and science-based methods that also incorporate exercise are employed.

Precisely.

On Facebook Fell noted that only Bacon didn't like his article, but Bacon doesn't like to be challenged, ever. At least that's my opinion after observing her interactions online. As an aside, I also got to point out to Fell and the Science "Babe" that Katz is a woo peddler. Neither was aware of it, but he is. I gave them the link to his 2010 "justification" of accepting homeopathy and reiki (reiki is not mentioned by name) but there’s plenty of evidence via Google if one chooses to look.

*Health At Every Size

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