Ottawa Citizen Nutrition Watch Week 9 - Not yet.

I'm not sure what the hold up is but it looks like I'm still at bat for nutrition at the Citizen.

My impression had been that a nutritional analysis program was being test driven last week and hence I figured that this week I wouldn't be spending my early morning calculating calories for Citizen recipes. Unfortunately when I opened up today's paper, nutritional analyses were no where to be found.

(for a recap - click over here to understand what this is all about)

Before I get to this week's fare, I'd like to introduce you to Dr. Paul Boivert. Paul's a friend and colleague from Quebec where he's also the communications director of Quebec's federation of Kinesiologists. Paul practices what he preaches having a penchant for good nutrition and engaging in seemingly insane amounts of swimming (generally 4km or more a day, 5 days a week). Here's what Paul had to say to the Citizen,

"Dear Ottawa Citizen Editors,

I congratulate you for publishing interesting healthy recipes in your newspaper.

Many fast food chains make available the Nutrition facts of their foods on the paper place mats and grocery stores sales food with Nutrition facts of the packaging. These information are important for most consumers for better evaluate the nutritional value of foods.

It is the same thing with recipes. It helps to better evaluate the portions to be served for a family and the value of a meal related to salt, fat and calories content, which matter enormously in a weight management program and health concerns like hypertension and prevention of heart diseases.

These information would be a great value if added at the end of your recipes. Unfortunately, these information are missing in your recipes as published recently.

I encourage you, then, to do so for the benefits of your invaluable readers.

Thanks for your support and the consideration of my request,

Paul Boisvert, Ph.D., PEC-SCPE, kinésiologue
Directeur des communications
Fédération des kinésiologues du Québec
http://www.kinesiologue.com/"

If you haven't yet written the Citizen to politely encourage them on this initiative and thank them for their attention, please take a few moments today to do so. Please send kind words of encouragement to Editor-in-Chief Gerry Nott, Food Editor Ron Eade and Wendy Warburton by clicking here.

Here are today's recipes' nutritional breakdowns:

Lamb rack with chimichurri sauce
(per serving if serving 2): 1,429 calories, 49g saturated fat, 691mg sodium, 6g total carbs

Seared duck breast with heirloom tomato, herbs, corn and focaccia salad
(per serving): 424 calories, 3g saturated fat, 95mg sodium, 51g total carbs

Cashew-encrusted halibut with citrus aioli
(per serving): 971 calories, 10g saturated fat, 172mg sodium, 49g total carbs

Cisco Ottawa Bluesfest asian coleslaw
(per serving if serving 4): 115 calories, 1g saturated fat, 52mg sodium, 8g total carbs

Cisco Ottawa Bluesfest couscous salad
(per serving): 468 calories, 4g saturated fat, 44mg sodium, 51g total carbs

Cisco Ottawa Bluesfest roasted beet salad
(per serving if serving 4): 204 calories, 2g saturated fat, 142mg sodium, 16g total carbs

[All recipes calculated using Mastercook 9.0. Today it took roughly 2 minutes per recipe]

Are Canadian restaurants allowed to make health claims?

Somehow I doubt it, but I'm not sure.

Regardless of whether it's legal or not, check out Thai Express' new promotion,

"Feed your Brain

Beef Stir Fry with Eggplant and Vegetables on Rice with a 16oz beverage

Nasunin found in the eggplant skin is a potent antioxidant and free radical scavenger that has been shown to protect cellmemBRANES from damage"

Yup, what could be better for you than fried red meat over white rice with a sugared soda chaser?

I wish there were something we could put in the drinking water that would protect the general public from consuming junk food in response to ridiculous over-simplifications and extrapolations of basic science research.

[Hat tip to loyal blog reader Émilie]

Life after the Biggest Loser

I'm not a big fan of the Biggest Loser.

For those of you who aren't familiar with it the Biggest Loser is a "reality" television show that features extremely overweight folks living on a ranch for 6 months and undereating and overexercising in order to lose weight and potentially win $500,000.

Not exactly the reality that most of my patients face.

In terms of the show's participants life post-show is a mixed bag. Some will parlay their weight loss into new lifestyles and in some cases, new careers.

Unfortunately others won't fare as well.

Now while it's certainly true that there is recidivism with all weight loss programs my beef is not that contestants regain weight, it's what they're taught. Watching the Biggest Loser I can't help but feel that the message it ultimately teaches is that all weight is bad and the scale is the only determinant of how you're doing.

Me?

I think scales tell you what you weigh whereas you tell yourself how you're doing, where how you're doing depends on what you're actually doing. Are you eating in a manner that is both healthy and enjoyable? Are you exercising as much as you can happily include into your busy life?

I came across this article and video online detailing the struggles of a former runner up on the Biggest Loser - Kai. It's well worth the read. Here's a snippet,

"The philosophy of the show -- to radically change diets and exercise patterns of obese people -- seemed to have a hidden message about her character, Zwierstra said. It seemed to say that weakness made people fat. If they just had discipline, if they weren't lazy, they could be thin."

There was a video too - I've included it below. Sadly it's a lot more real than the Biggest Loser will ever be.

344 Pounds - a guy on a journey

I like this guy.

I don't agree with everything he's said and done, but really, who cares if I agree with everything or not.

His name is Tyler and in January he decided that he was going to lose some weight. At the time he weighed 344 pounds and he's set himself a goal of losing 150 of those. He's also set himself up with a blog.

What I love about Tyler's blog is his use of social media to help get him where he's aiming to go. He's using it to keep track of his progress, he's using it to document his journey to one day show his young family who he was during this time period, and he's using it for motivation because for him putting everything out there inspires him.

He tracks his daily calories there (I'd be encouraging him to add in more snacks and better sports nutrition as well as upping his calories a fair bit), he chronicles his own experiences with what works for him in changing his foodscape and fitnesscape, he details his workouts, graphs his weight change, and he even invites commenters on board to help increase the duration of his workout (links and comments add time).

Tyler's found a way to go that he's enjoying and he's certainly losing weight.

Tyler, if you're reading this my main piece of advice for you, whatever you're doing to lose weight, you've got to be prepared to do it forever if you want the weight to stay off.

Best of luck Tyler.

www.344pounds.com

WHO declares latest Evian ad a pandemic!

This ad's certainly gone viral in a hurry!

Today's Funny Friday is Evian's newest campaign.

Have a great weekend!

Ottawa Citizen Nutrition Watch Week 8 - Hope!

And now I can report cautious optimism.

While I can't report on the specifics I can say things are moving forward at the Citizen - this despite CanWest's financial difficulties and staff squeezing and consequently a real testament to the Citizen's dedication to their readers.

(for a recap - click over here to understand what this is all about)

My hope is that this will be one of the last times I'll have to post the Citizen's nutritional information for them!

If you haven't yet written the Citizen to politely encourage them on this initiative and thank them for their attention, please take a few moments today to do so. Please send kind words of encouragement to Editor-in-Chief Gerry Nott, Food Editor Ron Eade and Wendy Warburton by clicking here.

So this week, no additional pressure, no additional letters, just today's recipes' nutritional breakdowns:

Chickpea Curry
(per serving if serving 4): 285 calories, 2g saturated fat, 985mg sodium, 38g total carbs.

Avocado Salad
(per serving): 232 calories, 3g saturated fat, 11mg sodium, 10g total carbs

Cedar-Planked Salmon with Watercress Sauce
(per serving if serving 4): 292 calories, 1g saturated fat, 141mg sodium, 13g total carbs.

[All recipes calculated using Mastercook 9.0. Today it took roughly 2 minutes per recipe]

Has your chicken been "plumped"

Apparently chicken plumping sells $2,000,000,000 of salt water per year in the USA.

What's plumping?

Plumping involves injecting "fresh" chicken with water, salt and sometimes seaweed extract to make the chicken look juicier yet still retain the label, "all natural". Plumping can also raise the amount of sodium per serving of chicken to almost as much as you'd find in a serving of french fries.

How do you defend yourself against being plumped?

Simple. Read the ingredients. If they include water, salt and/or carrageenan you're buying salt water along with your chicken at $4.99 or so a pound.

[Via the WSJ]

Fortified ice cream - an osteoporotic miracle?

Oy.

From the labs at Unilever comes a study that calcium absorption following the consumption of calcium fortified ice-cream was comparable to absorption following the consumption of milk.

Huzzah!?

I suppose that given obesity's ability to increase bone density, by creating calcium fortified ice-cream we might finally have the "natural" cure for osteoporosis.

Some great quotes from the researchers in Food Navigator,

"Concerns over the unhealthy image of ice cream appear unfounded however, with the ice cream being “formulated responsibly in terms of nutritional profile”, wrote van der Hee and her co-workers. Indeed, the energy value for both did not exceed 115 kcal"

So no worries - because no one ever eats more than one serving of ice-cream, right?

van der Hee, R., Miret, S., Slettenaar, M., Duchateau, G., Rietveld, A., Wilkinson, J., Quail, P., Berry, M., Dainty, J., & Teucher, B. (2009). Calcium Absorption from Fortified Ice Cream Formulations Compared with Calcium Absorption from Milk Journal of the American Dietetic Association, 109 (5), 830-835 DOI: 10.1016/j.jada.2009.02.017

Supermarket salads - less healthy than Big Macs?

I've had many patients tell me reassuringly,

"don't worry about my lunches out, I usually go to the supermarket and just buy a salad"

Um, about that salad....

You see a newspaper in England decided to put some of those supermarket salads to the test. They bought a bunch and had them sent to nutritional labs for analysis.

The results (click the photo up top to see them enlarged)?

More calories and more sodium than Big Macs with comparable amounts of saturated fat (though greater amounts of healthy unsaturated fats).

Bottom line?

As always, calories and nutrition are not intuitive. The only way to truly know what you're having is to make it yourself.

Food still junk at Ottawa Hospitals

Today's one of those rare days when something comes up that knocks Funny Friday to the backseat.

Early morning readers of the Citizen may already know this (click here to read the article in the Citizen) but we've revisited Ottawa hospital cafeterias 14 months after we first showed up with my trusty little video camera to see what if anything has changed.

If you recall (and if you don't just click here) 14 months ago I visited Ottawa's hospital cafeterias and I was appalled by the lack of healthy hospital food and so too was the Citizen and later the Canadian Medical Association Journal.

In anycase, a few weeks ago I was speaking with Don Butler from the Citizen and invited him to join me on another cafeteria tour. This past Tuesday we visited cafeterias at CHEO, the Heart Institute, the Civic and the General and sadly, nothing has changed.

I've written a letter to the CEOs of the hospitals (which I'll post below) asking if they would be willing to personally commit to improving the nutrition in their hospitals and I've extended a standing invitation to Don Butler to join me annually to revisit Ottawa's hospital fare to see how things are going.

Bottom line - hospital cafeterias shouldn't simply be no-name junk food restaurants. If anything hospital cafeterias should serve as examples of healthy eating and extend their role as leaders in the provision of health care to their dietary offerings.

[BTW - below the letter are a few videos we shot while walking around and you can hear Don and I discussing some of the available cafeteria fare]

Dear Drs. Kitts, Roberts and Bilodeau,

My name is Yoni Freedhoff and I'm a physician located in Ottawa with special interests in nutrition and in public health advocacy. A little over a year ago I spent some time touring the cafeterias of Ottawa’s various hospitals and was appalled by what I found. Rather than catering to good health and chronic disease prevention by offering nutritious foods I found that Ottawa's hospital cafeterias functioned more as no-name junk food providers and served foods that we as health professionals strongly advise our patients to avoid. Menus generally consisted of a slew of deep-fried fare, trans-fat containing soups, over-sized sandwiches, greasy pizza, walls of chips and soda pop, ice-cream bins, and giant muffins. I published my findings on my blog Weighty Matters and the Ottawa Citizen quickly picked up on the story and wrote a front page piece detailing the situation and followed it up with an editorial that rightly called for the hospitals to clean house in their cafeterias. The CMAJ then got in the mix and invited me to pen an editorial on the matter wherein we called on hospitals to put an end to this deep-fried hypocrisy.

So has there been change? On Tuesday of this week the Citizen's Don Butler and I visited the cafeterias of your hospitals to see what, if anything, had changed. I was disheartened by what we found.

In Mr. Butler's original article an Ottawa Hospital physician reported to him that detailed nutritional information would soon be posted to help patients and staff make more informed and hopefully healthier choices. 14 months later no such posting was visible. 14 month ago Mr. Butler was told that there was already program in place that steered people to healthy choices - "Healthwise". Apparently these reportedly healthy and wise choices are meant to identify meals containing fewer than 500 calories and 800mg of sodium and according to the Heart Institute's VP of communications, "if you see the symbol, you'll know you're eating the right stuff.". The "right stuff"? Since when are meals containing 800mg of sodium, "the right stuff" at a Heart Institute or anywhere else for that matter? Frankly I also doubt the validity of the Healthwise claims regarding calories as one of the "Healthwise" choices 14 months later was fish and chips whereby there's simply no way the calories of deep fried fish and chips come up shy of 500; and regarding sodium every soup on the menu received a "Healthwise" award, yet at the Greenery (the Civic cafeteria) where the only available nutritional information is for soup, only 3 of the 43 listed soups contain less than 800mg of sodium per serving with the average being 957mg.

And about those soups. Did you know that of the Civic and General's 43 listed soups almost 50% of them contain trans-fat (with some having as much as 3g) and almost 50% have more than 1,000mg of sodium per serving?

How is the provision of lowest common denominator nutrition good medicine?

The arguments against reforming hospital cafeterias are both predictable and hollow and usually go as follows:

1. Selling healthy food won't be profitable.

Firstly since when did the hospital as profit centre become the hospital's mission? I thought that hospitals were public institutions geared to provide patients with excellence in health care. Given the incredibly important role of nutrition as a determinant of health and the incredibly important role of the hospital as role model and community leader, serving junk food does not fit either bill. But putting idealism aside, since when does serving healthy foods preclude profit? The Compass Group, the world's largest institutional provider of retail food service delivery, in 2007 attributed part of its rising profits on it's increased focus on healthy foods, and Capital Health in Alberta has in fact demonstrated that not only is serving healthy fare in a hospital feasible but that it's dramatically more successful than their traditional cafeterias. Their Healthy Trendz concept implemented in 19 different hospital based cafeteria and snack bar venues resulted in an overall 67% growth in revenue totalling $12.1 million and a 33% increase in the number of transactions.

2. We're not the food police, (or grown adults should be allowed to choose for themselves).

No we aren't the food police and grown ups are responsible for their own choices. While frankly I am not averse to hospitals selling exclusively healthy foods, to request that hospitals provide healthy, reasonably priced, flavourful options alongside less healthy fare surely does not constitute policing. Regarding choice - absolutely adults are free to make their own choices, however it is surely the hospital's duty to allow patients to make informed decisions as to their care. Given the role of good nutrition in health care, I would argue it is the hospital's responsibility to ensure patients make informed choices therein by at the very least posting nutritional information for each and every item sold. This is not in and of itself a difficult endeavour and certainly menu board calorie posting is slowly becoming law across the globe; was called for by the OMA on April 7th in a press conference; and is currently being debated in the Ontario legislature in the form of Bill 156. Given that Dana Hospitality, the food service provider for the Heart Institute (and perhaps the other hospitals as well), reports directly on their website that, "We provide Nutrient and Ingredient Content Information About the Food We Serve", I can't understand what might be stopping our hospitals from sharing that information with their staff and patients.

3. Healthy food doesn't taste good (or we already sell salads).

Believe it or not this was an argument put forth by an Ottawa Hospital spokesman when Mr. Butler wrote his article last year. I'm saddened to have to include a discussion of this argument here given how nonsensical it is, but nonetheless it will likely come up again. While it may be true that the creation of healthy, flavourful foods that will sell in a cafeteria takes a modicum more creativity than deep frying a potato, that certainly doesn't mean it isn't a doable endeavour. And yes, the hospitals do sell salads. Of course there is far more to healthy eating than simply salads and certainly there needs to be healthy, non-salad bar based options available for main dishes and snacks as well. And about those salads - while the hospitals do indeed sell them, their cost is astronomical. At $1.25 per 100grams the average cost of a plated salad the day we were observing seemed to fall in the $7-8 range - far more expensive then the less healthy, fried, value-meal styled servings at the hospitals various fry counters and sandwich bars and certainly not a price conducive to encouraging their purchase or consumption.

Hospitals should not be in the business of making business for themselves by serving foods known to be contributors to the development of a myriad of chronic diseases, especially not in the absence of healthy choices and readily available nutritional information. Frankly I think it's downright shameful that the very institutions built to protect our health feel comfortable serving junk food not only to their patients but also to the thousands of hardworking and dedicated allied health professionals who have committed their lives to protecting and promoting health, and then when challenged seem to myopically talk of profits rather than focusing on opportunity - the opportunity to become community leaders in what healthy cafeterias can constitute.

Drs. Kitts, Roberts, and Bilodeau, I'd like to ask each of you, are you willing to personally commit to making nutrition a priority in your hospitals?

Sincerely,Yoni Freedhoff, MD
Medical Director, Bariatric Medical Institute

Ottawa Civic Hospital


Ottawa General Hospital


Children's Hospital of Eastern Ontario