Thursday, September 30, 2010

Best Weight: A practical guide to office-based obesity management

This week the book that I coauthored with my friend, colleague and fellow blogger Dr. Arya Sharma was published by the Canadian Obesity Network.

Arya and I first met 5 years ago at an Obesity Society conference where we had the chance to sit and chat for a while. We kept in touch periodically via email and I think it was at the next year's conference when Arya asked me if I wanted to help him to finish a book he'd already begun to write (for those of you who don't know Arya, he's a dynamo, doing more in a month than most do in a year and he had found that his book had hit his back burners). I was only too happy to help and slowly but surely together we finished it up and I want to take the time here to sincerely thank Arya for involving me in something that was such a joy to work on.

The book isn't geared to the general public (though certainly it's not written in a manner that would make it inaccessible to them), rather it's geared towards allied health professionals who want to improve their skills and knowledge in dealing with their obese patients.

The book's fairly short and I think an easy read. It's not meant to be an exhaustive tome that slowly takes you step by step through the pathophysiology of obesity and dryly explores the usual party lines of treatment. Instead it's the culmination of both Arya and my experiences with this terribly under serviced patient population and put plainly, it's the book I wish I had when I first opened my doors.

We didn't write the book to make money, we wrote it to try to help and I'm thrilled that by the good graces and generosity of our publisher, the Canadian Obesity Network, that our book is freely available for download in PDF format (the only catch there is you've got to join the network - membership however is free).

[Of course if you want to buy your own hard copy you can. It's being sold right now by (for 12.05), (for $10.39) and Barnes and Nobles (for just $9.35)]

Wednesday, September 29, 2010

A personal request for help.


On October 3rd I'm running in the CIBC Run for the Cure, a charity run supporting breast cancer research.

I'll be running with my wife and 3 darling daughters and for me it's a day to be active with my family, a day to teach my children about the importance of giving, and of perseverance, and of kindness.

This will be the 5th year I've participated in the Run for the Cure. To date I've helped to raise over $10,000.

I've had some folks try to tell me that there's too much money spent on breast cancer research. That fundraising for breast cancer is disproportionate to its burden of illness and could be better spent elsewhere.

I don't buy into that.

Sadly there's no shortage of diseases that are underfunded.

There's also no shortage of death and suffering due to breast cancer.

When there's only a few dozen diseases left in the world, perhaps then we can quibble about where we ought to sink our dollars.

Until then, give generously, as often as you can, to as many causes as you can afford.

If you're a regular reader of my blog you'll know that I put a tremendous amount of work into my daily posts. I do it because I love to do it. My blog's not monetized (and never will be) and doesn't have ridiculous ads promoting dubious weight loss solutions and nobody pays me here for my opinion.


Last year, the generosity of my readers raised $250. I'm hoping you folks beat that this year.

To donate click the link below which will take you to my donations page. You can choose to give anonymously, you can use a credit card and if you donate more than $10, you'll receive a tax receipt.

Click here to visit my personal page.

Tuesday, September 28, 2010

Badvertising: vitaminwater healthifies poutine!

So just a few kilometres South, Coca Cola's vitaminwater is in the midst of lawsuit that aims to prove that vitaminwater's labeling is deceptive and falsely confers the notion that it's healthy for you.

Here, sadly, there's no such lawsuit and hence ads like the one up above whose copy,

"if poutine is part of your routine"
(where poutine is a distinctly Canadian concoction of french fries covered in cheese curds, smothered in gravy) suggests that miraculously sugar water with a few scant vitamins will negate the risks of an unhealthy diet, still litter our magazines.

Here's an alternate way to interpret the ad.

Perhaps Coca Cola's practicing honesty in advertisement whereby the ad is meant to explain how only folks so nutritionally ill-informed or unconcerned that they routinely consume poutine would also routinely consume vitaminwater?

Monday, September 27, 2010

Obesity and overeating are hilarious? (Mike and Molly Review)

You may have heard about Mike and Molly. It's a new sitcom about two morbidly obese overeaters who meet at an Overeaters Anonymous meeting and fall in love. It's directed by veteran sitcom guy James Burrows (Laverne and Shirley, Taxi, Cheers, Frasier, Friends, Will and Grace and many more) and I counted 23 explicitly fat jokes in the 20 minute series premiere.

The sitcom itself, aside from the fat focus, is pretty formulaic and nothing to write home about.

But what about the fat jokes?

To be honest, I'm not sure what to think.

On the one hand the jokes weren't cruel or intentionally launched to hurt the characters' feelings. They were more along the lines of the types of jokes that might be cracked about a person's strange taste in clothing.

On the other hand, joking about obesity, a condition that for some causes dramatic personal, social and medical angst and suffering, seems callous regardless of intentions - I've never seen any sitcoms about cancer.

I guess the question I'm left with is whether or not the normalization of making jokes at the expense of a person's weight is wise, and while the show's jokes are good natured, I suspect the general public's versions will often be of a different flavour and I worry that this show simply adds to society's unfounded belief that fat jokes are fair game.

Did you see it? What did you think?

Saturday, September 25, 2010

Saturday Stories

A supremely cool scalable graphic of the known universe.


Wanna get rid of your fruit flies?


Friday, September 24, 2010

Ottawa readers only please!

Just a quick post for my Ottawa readers.

Saturday October 2nd, to help raise money for breast cancer research, my office's 3 stellar personal trainers (Kelly, Katie and Phil) are donating their time and expertise in the hopes that you'll donate your money and in so doing buy yourself a great workout.

The workouts will be one-on-one training sessions taking place here at BMI and we'll be charging $20 (cash) for a 30 minute session with ALL proceeds going towards BMI's Run for the Cure team effort.

Whether you want a targeted training session or perhaps you'd like a program designed for you, you're not going to find better rates anywhere in town.

Spots run between 11am and 2pm and are limited and going fast.

If you're interested, please call our front desk at 613.730.0264 and Wendy can get you organized.

575 West Hunt Club, Suite 100

(We're in the mall with Rona and Canadian Tire at the corner of West Hunt Club and Merivale and we're in the building at the corner of Lancelot and West Hunt Club directly across the street from the Catholic School Board)

Lessons your daughters learn from Disney's princesses


Today's Funny Friday is a two-fer. Two brilliant clips from Second City both of which made me cringe given the countless times my beautiful daughters have watched The Little Mermaid and Beauty and the Beast.

Have a great weekend!

[Via the Marketing, Media and Childhood blog]

Thursday, September 23, 2010

You know your school food policy sucks when...




Think kids might have more than one slice?



I do.



Wednesday, September 22, 2010

Some is good. More is better. Everything counts.

That's my 8 word manifesto for fitness.









Tuesday, September 21, 2010

POM Wonderful said whatnow?

From the, "they said whatnow?" file comes the latest from POM Wonderful.

You know POM - they're the makers of the pomegranate juice that their marketers want you to believe is seemingly miraculous in its ability to confer health.

Well last week POM Wonderful announced that they were suing the Federal Trade Commission on the grounds that the FTC's insistence on having a minimum of two clinical, human trials and pre-market Food and Drug Administration approval for certain claims is a breach of their first amendment right to free speech. Apparently POM Wonderful believes that FTC shouldn't be able to set the bar on what constitutes, "competent and reliable scientific evidence".

In a sweetly ironic statement, POM's suit complains,

"The new FTC rules essentially bar POM from discussing or disclosing the results of its research and the benefits of its products"
Yes. How dare the FTC suggest that the results of research matter in making a health claim?

With that as a requirement how is POM ever to promote its own "research".

Monday, September 20, 2010

Heart and Stroke still marketing for Boston Pizza

The love affair between the Heart and Stroke Foundation and and mega sponsor Boston Pizza, an affair that's spawned Valentine shaped pizzas, Jump Rope for Pizza and Health Check'ed awful restaurant fare, continues with the Heart and Stroke Foundation's Hoops for Heart campaign.

What's Hoops for Heart?

Hoops for Heart is a Heart and Stroke Foundation run, in school fundraising program, where students shoot basketball hoops in the school's gym to raise money to give to the Heart and Stroke Foundation.

Why does the Heart and Stroke Foundation think it's important to learn about heart health at a young age?

Well according to Hoops for Heart it's because,

"We know that healthy habits are developed early in life. By staying active now, maintaining a healthy body weight, and learning to make sensible choices, youth can help decrease their risk of future heart disease and stroke."
And what's a healthier habit than going out to eat in restaurants? They're great places to make sensible choices that help to maintain healthy body weights, right?

But of course the Heart and Stroke Foundation doesn't think food has much to do with childhood obesity. Just ask the Hoops for Hearts website,
"Why the increase in obesity? The main reason is a lack of physical activity"
Yeah, it's all about lack of exercise. I guess that's why the Heart and Stroke Foundation, by means of their Health Check program and coupons like these, has no qualms about discouraging actual cooking and encouraging the consumption of highly processed boxed foods and meals out.

And about those meals. I cracked out the calculator to have a peek at Boston Pizza. Here's what I found:

Use your $5 off coupon and share a starter, eat a main and split a dessert and you'll be downing on average 1,603 calories and 3,392mg of sodium. Oh, and the only beverage that breakdown includes is water.

If you happen to find one of the only 5 Health Check'ed items actually enticing enough to order in lieu of regular Boston Pizza fare but still split a starter and share a dessert you'll be quaffing 1,059 calories and 1,578mg of sodium. Water for you too.

The last time I slammed the Heart and Stroke Foundation for providing free kids meal coupons for participating in the Jump Rope for Heart campaign, Marco Di Buono, director of research for the Heart and Stroke Foundation of Ontario, defended the practice by saying,
"Recognizing the number of meals outside the home that families do consume, we would much rather send them to an organization that has healthy options on the menu than leave them without any indication of where they can take their families for healthy eating opportunities"
You know, if the Heart and Stroke Foundation truly bought its leaders' spin, don't you think that at the very least they would ensure that their Boston Pizza coupons only be applicable towards those healthy options?

Of course the whole argument is flawed to begin with - can you imagine if the Canadian Cancer Society, recognizing the fact that many people still smoke provided everyone with coupons for light cigarettes?

Two of the primary drivers of both obesity and chronic disease are food dollars spent outside the home along with the consumption of highly processed foods inside the home. With their abhorrent and irresponsible Health Check program, rather than recognize the world as broken and try to fix it by encouraging (gasp) cooking, Health Check is happily duping Canadians into thinking that they can eat responsibly in restaurants and enjoy big box fulls of highly processed trash.

There's a word in Yiddish that does a fair job describing Health Check. Health Check's a "shanda" where the definition of "shanda" is a shameful, scandalous, disgrace. Only problem in regard to calling Health Check a shanda is that the word isn't strong enough.

(Speaking of shandas, did you know that Boston Pizza's seasonal vegetables which are an optional accompaniment for their "Famous Mains" have 830mg of sodium in them?)

Saturday, September 18, 2010

Saturday Stories

Alex Bogusky writes on how God has recalled his book series.

Steve Novella from Science Based Medicine does a great job explaining the science behind the safety of aspartame.

The LA Times wonders if adrenal fatigue and Wilson's temperature fatigue are real diseases.

Orac from Respectful Insolence explains what pareidolia is by means of the lamest example of it he's ever seen.

Travis and Peter from their shiny new PLoS digs host a great 5 parter on the metabolically healthy obese.

James Fell eviscerates the Bowflex in the LA Times.

Friday, September 17, 2010

I have no idea why this made me laugh

Today's Funny Friday video is a seal who yells like a man.

I don't know why it made me laugh, but I've watched it 3 times now.

Have a great weekend!

Thursday, September 16, 2010

The, "but parents can just say no" argument.

An emailer to me hit it hard on the nail yesterday. They wrote,

"To change public attitudes about food for kids, the idea that feeding fast food to kids is "normal" has got to be changed."
I think it's the normalization of feeding fast and junk foods to kids that fuels the, "parents can just say no" argument regularly used to defend things like ice-cream sandwich days at elementary schools, McDonald's bus safety days for 4 year olds, school bake sales, pizza days, etc.

Basically anytime somebody suggests that giving junk foods to kids is a bad plan, there's an angry commenter out there who has to point out that parents don't have to give in.

There's really no beating around the bush about this one, it's an asinine argument.

It's asinine for a number of reasons.

Firstly it's asinine because there's a huge percentage of parents who either don't care about, don't think about, or don't have time to pay attention to the notion that what their children eat has an impact on their health, so while it may be something the angry commenter thinks should and could happen, the reality is that for a huge number of families it just ain't gonna.

Secondly it's asinine because it ignores the bigger picture. Children aren't only influenced by their parents. If their school makes take-out a pizza a weekly event, regardless of whether a child eats it or not, it normalizes the practice. Worse, because it's promoted by a source of trust and guidance, the practice may well be perceived as harmless or even healthy.

Thirdly it's asinine because even parents who care, aren't likely to always or potentially ever say "no". Why? Don't they care about their kids? Sure they do. Problem is that in the grand scheme of parental "no"s, not allowing their child to enjoy what every other kid in the class is enjoying isn't likely a battle that even health conscious parents are likely to regularly pick.

Lastly it's asinine because it ignores the real villains in these stories. The bad guys here aren't permissive parents, and believe it or not, the bad guys aren't the fast or junk food industries either. The real bad guys in these stories are the schools, and hospitals, and city officials who welcome this crap through their doors with open arms.

Yes, junk food is everywhere. Yes, our children are bound to be exposed. Yes, we as parents have to do our best to help arm our kids with defenses to see through advertising and to understand nutrition.

But what shouldn't we have to do?

We shouldn't have to wage these wars in our children's schools, or in our hospitals, or in our city arenas. We shouldn't have situations where foods that our teachers, our doctors and our public health officials recommend we avoid get sold in their own backyards.

Bad nutrition kills, and in a sense, with obesity as a consequence and with the impact of obesity on quality of life, it maims, and while I don't think junk food can or even should be legislated out of existence, I think becoming an apologist for the fast food industry and a defender of nutritionally indefensible publicly run junk food programs on the basis of the, "parents can just say no" argument, is a far more egregious avoidance of parental responsibility than letting your kids join their classmates for a slice of pizza or take a McDonald's colouring book home from Ottawa School Bus Safety Awareness day.

Wednesday, September 15, 2010

Reading more effective than running for weight loss?

In a sense.

In an article published in this fall's Journal of Consumer Affairs, Dr. Bidisha Mandal set out to determine the impact that food label reading and exercise had on weight.

She used data from the National Longitudinal Survey of Youth which in turn has followed 12,686 middle aged men and women, and included in the survey were questions regarding the use of food labels, as well as questions regarding levels of physical fitness.

Mandal divided folks into those who read food labels always/often and folks who regularly participated in vigorous activity. She then further subdivided folks into those who were trying to lose weight, those who trying to stay about the same weight and those who weren't trying to do anything about their weight. Finally she analyzed data from the 3,706 folks who between 2002 and 2006 who consistently reported actively trying to manage their weight.

She then looked at 4 different subgroups:

1. Folks who neither read food labels nor participated in vigorous physical activity
2. Folks who read food labels and participated in vigorous physical activity
3. Folks who read food labels but did not participate in vigorous physical activity
4. Folks who did not read food labels but did participate in vigorous physical activity

She then used some over my pay grade statistics that included this fancy looking equation

To determine the effects of label reading and vigorous exercise in various combinations on weight management.

What she found was rather fascinating.

First the expected - folks who are trying to manage their weight who read food labels and vigorously exercise are the folks who are the most successful.

Now the unexpected (for some). Folks who are trying to manage their weight who read food labels but don't exercise are more successful than those who are trying to manage their weight who exercise, but don't read food labels.

Bottom lines?

1. Knowledge is power.
2. It's easier to not eat calories than to burn them.

Tuesday, September 14, 2010

Counterpoint. A guest post defending Ottawa's School Bus Safety Awareness Day

I don't usually use guest posts, but I received a thoughtful and heartfelt counterpoint to my arguments about the utility of School Bus Safety Awareness Day.

The guest poster is Kathleen Both, the owner of a local school bus company. Now I certainly don't see eye to eye with Kathleen and still believe that the lessons taught on School Bus Safety Awareness day, while undoubtedly important, are also undoubtedly straightforward and can certainly be taught at school rather than be served up by McDonald's.

Before I get to her letter, she also updated me on some additional school bus related deaths.

In addition to the 3 deaths that I detailed, Kathleen provided me with details of 8 more. Of those 8, five occurred where kids bent over to pick something up in front of the bus and were subsequently killed when the bus pulled away, 2 were killed by cars that didn't stop for the school bus and 1 was due to a bus being rear ended. So while it would certainly seem quite reasonable, and in fact important, that kids be repeatedly taught to look both ways before crossing the street and to not pick anything up from the ground in front of a school bus, I still don't see the need for that teaching to require any special events sponsored by a hungry advertiser.

Ultimately reading her post I was saddened to learn how the Ottawa School Board has seemingly taken what began as a thoughtful proactive program meant to help teach kids about school bus safety, and probably more importantly reduce their fears, and instead co-opted it as a marketing opportunity for McDonald's. I don't think the Ottawa School Board, regardless of finances, should be selling access to our children to the highest bidder, and while I do realize we live in a dollars and cents world, if the choice was between having this day run by McDonald's versus canning the day and instead upping school bus safety awareness at school, my vote would be for the latter.

Here's her post:

I am writing to you to express my disappointment in your complete dismissal of a program that has been extremely beneficial for the past 19 years. Before publishing such derogatory comments, a little research should have been in order to fully appreciate the School Bus Safety Awareness Day, its history, rationale, objectives and goals.

In the late 1980’s there were several fatalities of young children involving school buses in the Ottawa area. Something I’m sure young parents today are unaware of, but something that can never be forgotten by anyone in the school bus industry, or any parent of a child that age at that time.

In 1990, my father, owner of M.L. Bradley Ltd., attended a school bus convention in the Kitchener/Waterloo area where he learned of a “First Time Rider” program hosted by a local independent operator. Dad thought the idea was great and with the vision of creating the safest environment possible for our passengers, he decided to host a similar program. At that time, four year old kindergarten was also being introduced to many schools resulting in twice as many preschoolers on the bus. Dad had a saying, one we repeat to our drivers on a regular basis, to always remember that “Children are carefree, not careless.”

The first annual “School Bus Safety Awareness Day” was held in our garage at M.L. Bradley Ltd. in downtown Navan in August 1991. With very limited advertisement in the East end, we hosted close to 600 people in our small wash bay. The program was identical to the one today and was designed to appeal to all learning styles...auditory, visual, and most importantly, practical. Registration (to put the name on the certificate), video of “Winnie the Pooh,” bus ride with a chance to “practice” safely crossing the road, a library of safety information, and an opportunity to spend all the time necessary to feel comfortable on a stationary bus. We absorbed all of the costs and our drivers graciously donated their time and expertise. All of the school board officials were in attendance and were quite intrigued by the concept. Local newspapers praised our efforts and parents appreciated the opportunity to introduce their youngsters to the bus. The only disappointment was that Dad, terminally ill, did not get to witness his initiative.

The school boards recognizing the effectiveness of this program are to be commended for their proactive approach in adopting the School Bus Safety Awareness Day for the past 19 summers. I sat on a committee with other bus operators and school board officials that planned and polished details that involved, at that time, coordinating 5 school boards and numerous school bus operators. Everyone worked together towards a common goal ...improving the safety of children on the bus. We designed logos and printed our own colouring books all with unbiased images of dinosaurs. The drivers’ reward for volunteering for the day was receiving a ball cap and t-shirt with the dinosaur logo.....and the kids and parents the thousands....and yes, they were served an optional snack.

Some dedicated, responsible parents teach their young ones the proper way to ride a bus. However, a few extra reminders and a priceless opportunity to actually practice and be guided in the proper way to cross the road, an unforgettable jingle about bus safety, led by “Winnie the Pooh” has gone a long way for many. Not only do children and parents (some of whom have never been on a school bus themselves) get safety reminders, but the day also serves to alleviate the stress for thousands. There are many, many, many children who are anxious and fear leaving their home on the first day of school. The “Safety Awareness Day” provides an opportunity to get rid of those first day jitters and realize that the big yellow machine is not going to swallow them up. The drivers and school board officials who are present to answer parents’ questions help to alleviate stress felt by adults in sending their kids off to school for the first time.

School bus operators are not paid for the day but provide vehicles, gas and drivers and pay them out of their own pockets. This is a huge expense today given the cutbacks in the industry however; all school bus operators recognize the value and often are able to identify who has attended the safety awareness day. Similarly, the school boards open their buildings to host the event and in the past several years, have economically accepted the support of McDonald’s to alleviate some of the costs by providing the art work for all the handout material (placemats, pamphlets, brochures, certificates). They also provide muffins and coffee for the volunteers and drivers and lunch for them in addition to providing the attendees optional orange drink, cookies, vouchers, coffee for the parents, napkins, cups sugar etc.

I was formerly an elementary school teacher. At the request of my Dad, I got my bus license when I was off having a child and I drove a loaded bus once. When I returned, I vowed to never, ever do that again. It is a very difficult, thankless, stressful job that carries with it an incredible amount of responsibility with very low pay. I wish that I had read about your impression prior to the first day of school. I would have invited you to go for a ride...perhaps on a bus with three school runs....with terrified 3 year olds who speak little English but who remember to wait for a hand signal from a driver, who can sing “Winnie’s” song, or who remember not to not run across the road to show their parents their chocolate pudding finger painting. All things that you hoped they had learned or were reminded of by our drivers and Winnie the Pooh. Or perhaps you would have appreciated a ride home where there’s no one waiting, or where a child has inadvertently been put on the wrong bus, or where there are 20 children disembarking all at once and a car has crossed through your lights. Maybe you would appreciate the efforts and understand why we started this day.

Instead, unfortunately, you seem to be caught up in a very minute portion of the day. “School Bus Safety Awareness Day” is voluntary for students and parents as is the drink and snack. Facts show that school bus safety has improved since 1991 inception of the day. Maybe a few of the parents that sadly lost a child to a regrettable school bus accident would have given the world for such a program…including the fast food.

Remember, children are carefree, not careless.

Kathleen Both
Owner, M.L. Bradley Ltd.

Monday, September 13, 2010

More on the partnership between the Ottawa School Board & McDonald's

Last week I posted about Ottawa's School Bus Safety Awareness Day.









But the story gets worse.


Cue loud facepalm!



To help him, I'll spell it out here.


Saturday, September 11, 2010

Saturday Stories

Time Magazine chooses anti-Semitic memes over balanced reporting.

Daniel Gordis helps to explain the term "Salonfähig".

The LA Times on the unfair origins of the phrase, "jump the shark".

Science Based Medicine on ghost writing the world to HRT.

Ottawa's Dan Gardner (not DJ Dan Gardner) explains the difference between anecdote and evidence.

Friday, September 10, 2010

Signs the world has too many signs.

A rare non-video Funny Friday.

The photos speak for themselves.

Have a great weekend!



Saudi Arabia


Thursday, September 09, 2010

Why taxpayers should care about bariatric surgery.

Bariatric surgery is a tough sell to the often ill informed general public.

Invariably when stories are run about the cost of paying for gastric bypasses, the comments tend towards the suggestion that tax dollars shouldn't be spent on this type of surgery and instead the folks who need it should simply eat less and exercise more.

In other words, the public thinks that because ultimately obesity can be described as the result of a mismatch between energy intake and expenditure, that medical care, life prolonging, quality of life improving, co-morbid disease curing medical care, shouldn't be offered through our provincial health care plans.

Suggesting that we not operate on the obese because in theory all they'd need to do is eat less and move more is simply an exercise in biased weightism and ignorance. But frankly, even were it to be true, that argument shouldn't apply here in Canada. Thankfully our medical system is one that doesn't care about cause. We still treat smokers who develop emphysema and lung cancer, and we readily patch up drunk drivers who most certainly know better.

I'd argue though, that those same angry folks, who I'm sure are multi-millionaires because they know the secret of the stock market - buy low and sell high, when faced with the dollar and cents realities of bariatric surgery, might decide to change their tune.

The thing is, regardless of the cause of the problem, folks who qualify for bariatric surgery are quite often very sick folks. Sick to the point that they cost our health care system a great deal of money - money that's spent on increased physician and hospital visits and medications. They also cost our economy in terms of lost productivity, days off work, and in some cases, frank disability.

They cost our country so much in fact that one Canadian study determined that the $16,000-$18,000 cost of the surgery is recouped in a scant 3.5 years following surgery, and given the incredible long term results of the surgery, both in terms of increasing longevity and decreasing morbidity, the surgery should not only be thought of as one that has a rapid cost recovery, it should be thought of as one that if readily available, could save our country hundreds of millions of dollars in direct and indirect health care costs.

So has our country made bariatric surgery readily available?

No, and recently in Ontario, the Ministry of Health has made it more difficult to obtain.

Prior to November 2009 Ontario physicians were able to directly access out of country surgical centres to operate on in need bariatric patients. From start to finish, from submission of an application to Ministry to the day of surgery, that process used to take 4-6 months. However in November 2009 the Ontario government reported it would no longer allow physicians to apply directly for out of country surgery, instead patients would need to be seen at one of five provincial bariatric assessment centres. Using Ottawa as an example, since November 2009 the wait to be seen by our assessment centre has gone from 4-6 months, to over a year with the wait for surgery likely bordering on two years.

Why? Sheer numbers. Yesterday the CBC reported that currently there are 1200 people on just the Ottawa Civic's wait list and I've been told that 300 more are added to that list monthly. Given that our government's announcement for increased access to bariatric surgery in Ontario reported a 2012 aim of a 2,025/year surgical capacity for the entire province, it would seem that by means of Ottawa alone, every 7 months Ontario's bariatric surgery wait times will grow by an additional year. Add in the folks clamouring for access at the other 4 Ontario assessment centres, couple that with the fact that Ontario's not operating anywhere near their hoped for capacity, and toss into the mix the growing demand for these surgeries and I wouldn't be at all surprised if every 3-4 months wait times in Ontario increased by a further year.

There's another large fly in the government's ointment. Given the nature of health care in Canada, where operating rooms and operating times are precious, Canadian surgeons, world class as they may be, simply don't have the opportunity to do the same number of cases as their American counterparts which may be why in a recent news report, a representative for the Ottawa surgical centre reported that their death rate was 1/70 and that they were aiming to get that down to the 1/200 death rate that has been reported as this surgery's average mortality rate. The only problem there is the fact that the 1/200 rate is an aggregated rate for all surgical centres and certainly in the past, Ontario physicians only accessed centres that had been designated surgical centres of excellence by the American Society for Metabolic and Bariatric Surgery. The centre I used to access reported to me that their mortality rate was 1/1250.

Ontario's Ministry of Health has reported that the reason they shut down access to the States was to improve access to care in our own province, but rather than improve access to care, in less than a year their changes have quadrupled waiting times and increased surgical mortality rates by an order of magnitude and I believe they're also costing us a great deal more money.

The Ministry of Health reports that the cost of the procedure is $10,000 less when performed here in Canada than when performed down South. That's an odd statement given that the CBC yesterday reported that the case cost per procedure here in Ontario is $17,200, a price tag that's virtually identical to the ones the province was paying those surgical centres of excellence in the States. Furthermore, what that Ontario price tag doesn't take into account are the costs incurred by patients remaining on a waiting list for years at a time - a cost estimated by one study to be in the neighbourhood of $900/month. Consequently I would estimate that having a patient wait for 2 years for this surgery would likely cause the total health care costs for the procedure to be at least double what they would have been were access to the American centres available.

Estimates put 3% of the population as qualifying for bariatric surgery. Taking Ontario's 12,000,000 residents that would mean there are 360,000 potential surgical candidates. Of course not everyone is going to want to opt for surgery, but even if only 5% of those who qualify sought access, Ontario would have to find the capacity to perform 18,000 surgeries. Given that our newly increased capacity is only 2,025 and combine that with the continued increase in weight of our population, the cost and risk of very sick patients remaining on a waiting list, the increased surgical risks here at home, and the exceedingly rapid payback once the surgery is performed, my recommendation is that not only do we immediately reopen access for physicians to apply for their patients' out of country surgeries, we mount a campaign to educate them how to do so.

Ultimately what all this means is the question of how we got to this point in socialized medicine Canada really doesn't matter, and while I believe societal obesity is a disease of the environment, if you want to retain the biased stance that somehow obesity should be blamed on individuals and is a disease whose treatment should not be publicly funded, you'd be best to bear in mind that your bias and ignorance are likely costing you and your country a fortune.

[Yesterday I was on CBC's Radio One Ottawa Morning discussing this issue. To listen to that interview click here or listen on the embedded player below.]

Wednesday, September 08, 2010

Why are there no nuts in Honey Nut Cheerios?

Or to ask the question differently, do you think Honey Nut Cheerios contains nuts?

You'd think so wouldn't you.

You'd be wrong.

There are no actual "nuts" in Honey Nut Cheerios.

What there is, and it's the second to last of 18 ingredients behind the 6 different types of sugar representing ingredients 2, 3, 4, 5, 7 and 9, is, "natural almond flavour".

What is, "natural almond flavour"?

Well according to Eric Schlosser's book Fast Food Nation it's benzaldehyde which in turn is generally derived from peach and apricot pits.

Can't say I blame Cheerios on this one though. Do you think "Honey Benzaldehyde Cheerios" would sell? It just doesn't seem to have the same zing and really, what good are ethics when it comes to sales?

[Hat tip to my wonderful wife]

Tuesday, September 07, 2010

McDonald's and the Ottawa District School Board teach kids that voluntary food industry regulation is useless.

(Yup, that's Ronald McDonald's signature up there)

So our fitness director Kelly's littlest boy is starting junior kindergarten this year.

As part of his orientation he had to attend a, "School Bus Safety Awareness Day". Apparently school bus safety is something that requires a special teaching program. Somehow kids these days need detailed schooling, special events even, to learn the incredibly complicated concepts of, "don't stand up while the bus is moving", "line up and don't push other kids when getting on or off", and "make sure you have your stuff with you before you leave the bus".

The program, a joint venture between the Ottawa Student Transportation Authority, the Ottawa-Carleton District School Board and the Ottawa Catholic School Boards, according to its home page, includes as part of the "learning", a bus safety certificate, colouring books and refreshments all provided by the program's sponsor - McDonald's.

According to Kelly the refreshments were, "some sort of orange flavour crystal drink in Mc. D cups", along with, "choco chip Quaker granola bars". The kids also received coupons for free soft serve ice cream at McDonald's and McDonald's colouring books and place mats.

McDonald's of course is a proud founding signatory of the voluntary, industry created, Canadian Children's Food and Beverage Advertising Initiative.

According to the initiative,

"The food and beverage industry in Canada is committed to advertising and marketing products to Canadian children in a responsible way to help prepare them to make wise decisions about healthy dietary choices and healthy lifestyles . We recognize that the special nature and needs of children requires particular care and diligence on the part of advertisers."
I suppose the special nature and needs of children requires extra diligence for advertisers to ply 4 year olds with fruit drinks, chocolate granola bars, free ice cream and pre-schooler swag.

But wait, doesn't the advertising initiative, an initiative for which McDonald's was a founding sponsor, explicitly ban the advertisement of food or beverage products in elementary schools?
"Participating companies will remain committed to adhering to standards established by schools individually and by school boards overall. Furthermore, participants will commit to not advertising food or beverage products in elementary schools."
I guess the answer is, "sort of". I say sort of because there's a footnote to that edict that states they can do whatever they want so long as the program's "educational",
"This limitation will not apply to displays of food and beverage products, charitable /not-for-profit activities including fundraising, public service messaging and educational programs."
That sure is a useful initiative.

Gee thanks Ottawa School Boards. Brilliant job. Thrilling that you're giving out food garbage along with coupons for free ice cream and McDonald's colouring books to 4 year olds - and for such an important educational cause. I mean without School Bus Safety Awareness day, I doubt any kid would ever figure out how to sit safely in their seat on a yellow school bus. It's a wonder any of we grown ups made it.

[Hat tip to BMI's fitness director Kelly DeBruyn whose son I'm sure benefited tremendously from what sounds like an incredibly important program]

UPDATE Sept. 9th, 2010: Received a phone call today from the school board. Details likely part of future post but they wanted me to inform readers that the program's voluntary and that kids aren't there all day - it's taught drop-in style

Saturday, September 04, 2010

Saturday Stories (expanded no post on labour day edition)

"Children have to learn how to be bored. They could start by reading this."

Blogging and skeptical buddy Jonathan skewers the Canadian Medical Association for their call to ban mixed martial arts and not homeopathy.

Ezra Levant wants us Canadians to boycott The Gap (I'm in).

The New York Times covers an MD I had the pleasure and honour of briefly training with during my clerkship - Dr. Donald Redelmeier. I was always terrified when he was at morning report as his intellect was as intimidating as his research was fascinating.

Dan Gardner wonders why we aren't more scared of lawn mowers.

Mmmmmmmm....Immortal burger

Dr. Arya Sharma takes on the NEJM story on the risks of meridia.

Lastly here's an incredible video on the creation of an empathic civilization - well worth watching even just to marvel at the production. Click here if you're an email subscriber or if the video below doesn't work.

Friday, September 03, 2010

Rear window (cat version)

Ok, not exactly, but today's Funny Friday video does have a window, does have a cat and is indeed rather creepy.

Have a great weekend!

Peeping Tom Cat

Thursday, September 02, 2010

Is the childhood obesity epidemic just a myth?

That's basically the case that Anytime Fitness is making with their new "Coalition of Angry Kids" campaign.

They're suggesting that all the blame for childhood obesity be laid at parental feet.

The point of the campaign of course is to shock.

The argument has some merit. After all, kids don't shop for household food, kids don't generally pack their own lunches and kids don't decide how often their families ought to eat out.

Of course kids also don't pay for billions of dollars of advertisements that entice them to eat junk food. They don't build drive thrus on every corner or put junk food supermarkets in every gas station. Kids don't set menus for their schools' cafeterias and they don't ask that their parents work 14 hour days to put food, whatever food on the table.

Ultimately it comes down to the fact that while it is indeed a parent's job to help their child navigate healthily through an incredibly unhealthy environment, the problem is, most parents aren't equipped to do so.

What am I talking about?

Take a peek at the post from a few days ago that had a registered dietitian, in a reputable newspaper calling for kids to be served chocolate milk and juice. Go visit your kids' school cafeteria and see what's being sold - and make sure you keep your eyes open for the vending machines en route. Wander down the aisles of a supermarket and take a peek at the nutritional fact panels of all of the food packages that extol their health benefits despite huge numbers of calories and make sure you take special note of programs like Health Check which encourage you to replace your child's fruit with fruit-concentrate (sugar) sweetened candy. Watch a few hours of children's TV and watch the ads that if your kid's less than 10, they're likely to internalize as truthful.

Our environment is broken and it takes skill, time and awareness to navigate, and while yes, it's ultimately a parent's responsibility to feed their children, I wonder, given the world we live in, does the average parent really stand a chance?

Wednesday, September 01, 2010

Who's going to launch Ontario's first lawsuit over access to bariatric surgery?

Note the question is, "who's" going to launch, not, "will someone" launch a suit.

I think it's inevitable.


Because Ontario, with much fanfare, over the course of the past year has revamped the process which used to allow for a 4-6 month start to finish process for the provision of bariatric surgery resulting in 2 year waits and lengthening wait lists.

The reason a lawsuit's inevitable isn't the simple fact that Ontario's new process has more than quadrupled the wait time for surgery, the reason a lawsuit's inevitable is because Ontario announced that the purpose of its revisions were,

And that,
"Bariatric surgery can help resolve several health conditions, such as diabetes, hypertension and dyslipidemias. Dyslipidemias is a condition that can lead to atherosclerosis, the hardening of the artery walls, which can restrict blood flow to the heart. Bariatric surgery can also reduce other obesity-related conditions, such as hypertension (high blood pressure), osteoarthritis (a painful joint disease), ischemic heart disease, stroke and some cancers"
So instead of reducing wait times, they've dramatically increased them, for a procedure that they themselves admit resolves multiple medical comorbidities which in turn cause permanent, cumulative damage.

And the wait lists just keep getting longer. In less than a year, the wait time for surgery at the Ottawa hospital has nearly quadrupled, increasing from a minimum of 6 months to a wait of closer to 2 years, this despite their ramping up of their surgical program, and given the nature of health care in Ontario, the lack of OR time and the fact that there simply aren't resources to build new hospitals within the publicly funded system, the likelihood is for these lists to continue to grow, not to shrink.

Couple those facts with the fact that the complication and mortality rates for bariatric surgery are currently dramatically higher in Canadian hospitals and I'd say it'd be a damn good case to take to the courts. Important too to note that the increased risks here in Canada aren't because our doctors are any less skilled, but rather because our doctors have fewer operating room hours available to them and the learning curve for this surgery is steep and unforgiving. My calculations for one centre here in Ontario include death rates at least 3x higher than the American centres I used to be able to access for my patients (the two centres we used in the States both had death rates lower than 0.2%, with one reporting a 0.08% death rate on 3,640 surgeries) and while over time I expect Ontario's complication rates to eventually decrease to those of the States, somehow that's not immediately reassuring.

Finally, for whatever lawyer eventually reads this post, the argument that costs matter is a fair one here in socialized medical Canada, but a faulty one. It's faulty because while it is possible that the actual sticker price for the day of the surgery is lower here in Canada, that's not the whole cost. There's the cost of having these patients sit on waiting lists for two years where Canadian data have demonstrated markedly increased health care utilization for these patients and where one estimate put the average health care cost at $900/month/patient on the wait list (therefore a two year wait list here in Ontario increases costs to Ontario by $16,200 per patient - roughly the cost of the surgery in the States to begin with), there's the cost for the ancillary testing that seems to be the standard of care here in Ontario which isn't the standard of care in the surgical centres of excellence in the States (endoscopies, ultrasounds, etc.), then there's the cost of the team of educators (a cost factored into the American sticker price), the cost of the lost productivity of these individuals for the 2 years they wait, and the cost of dealing with higher rates of complications and deaths. All told I'd guess that the cost of bariatric surgery in Ontario, with it's now 2 year wait, is triple what it used to be when the cases were expedited to American centres of excellence.

As I've posted before, the decision to put the cork in the bottleneck of out of country bariatric surgery approvals was almost certainly a wholly financial decision and even though surgeries in Canada likely cost our system triple those performed in the States, and even though each surgery has been proven to pay for itself here in Canada by means of decreased health care costs in just 3.5 years, if there's not enough money up front to pay for the demand, we simply can't offer it.

Of course that's not what the government said when they explained the new system, and that's why when the lawsuits inevitably come, and mark my words they will, Ontario's going to lose.