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Dear Reporters, The Cure For Obesity Is Unlikely To Be For Sale On Indiegogo
Last week a reporter contacted me looking for a quote.

She was doing a story on a $449 weight-loss product that is being sold on Indiegogo.

Briefly, the device reportedly works by stimulating the vestibular nerve, which, according to the people selling it, triggers the body to reduce fat storage, and all with just one hour of wear per day!

Of course there's this proviso (emphasis mine),
"Used in conjunction with a healthy diet and regular exercise the average user should notice a significant difference in body fat percentage."
Does the product have peer reviewed studies proving it works?

Of course not.

But it does have an unpublished preprint hosted freely online featuring a 6 person treatment group, only half of who completed the treatments.

The preprint also features a 3 person control group who somehow managed to post an 8.6% increase in truncal fat and a 6% increase in total body fat during the study's short 4 month period.

And it includes the authors' assertion that neither group changed their diet and exercise habits - this despite the fact that the authors didn't track their subjects' diet and exercise habits, and also despite the fact that the control group gained a significant amount of fat in a very short period of time.

After looking at all of this, I politely declined the reporter's request for an interview, as a story at this point on this product, even with a dissenting voice in it, is not simply premature, it's unethical. It's unethical not simply because it further perpetuates the narrative that magic, quick, and easy exists in regard to weight management, but because as is evidenced by the product's Indiegogo page, a story, any story, on this already for sale evidence-free product will be used by its manufacturers to market it to a desperate, constantly preyed upon population (who at the time of this post's writing, have already given this product's promoters $728,463 USD)

Now I realize that reporters are busy, and many don't have the background to pick apart studies, but I'd like to propose that the simple rule of,
"Don't cover medical devices being sold on Indiegogo or Kickstarter as a means to magically treat anything"
is probably a safe one, and one that I wish went without saying.
Saturday Stories: The Magnitsky Act, The Hateful Left, And Not So Safe Spaces
By VOA - Прокуратура призывает снять обвинения с подсудимого в деле Магнитского, Public Domain, Link
Julia Ioffe in The Atlantic explains why Russia hates the Magnitsky Act (and of course explains what it is)

Bari Weiss in the New York Times wonders whether the left will have more spine than the right in policing the hate in their ranks

Mark Joseph Stern in Slate on the one group not allowed in safe spaces.
The Strange New Reason Why You Shouldn't Drink Sugar With Your Meals
Granted, it's a small study, but its results were interesting.

The study, Postprandial energy metabolism and substrate oxidation in response to the inclusion of a sugar- or non-nutritive sweetened beverage with meals differing in protein content, looked at the impact sugar sweetened beverages had on the appetite suppression benefits of higher protein meals.

The authors note that,
"increasing dietary protein while maintaining energy intake produces a greater and more prolonged thermic effect and greater total energy expenditure",
that protein,
"potentially increases fat oxidation by up to 50%,"
that
"decreasing protein consumption may stimulate an increase in energy intake in an attempt to maintain a constant absolute intake of dietary protein",
and that,
"a 1.5%E decrease in dietary protein intake increases energy intake from carbohydrates and fats by 14%, perhaps in an attempt to increase protein intake from less protein-rich food sources (and point out that) in a 4-day in-patient ad libitum crossover feeding trial, a 5%E decrease in dietary protein intake produced a 12% increase in total energy intake"
So the authors were curious whether or not the inclusion of a sugary beverage would change the impact that a high protein meal had on consumption, appetite, and fat oxidation, and to explore, they studied those variables in 27 adults (without obesity) on two separate occasions in a direct (room) calorimeter after the consumption of a sugar-sweetened beverage or a non-nutritive sweetened beverage along with meals that varied in protein composition (15% vs. 30%).

The authors found, as expected (and certainly in line with the experiences I've seen among thousands of patients), that meals with higher protein content decreased hunger, increased fullness, and decreased the desire for fatty/salty/savory foods (sweet desires weren't affected).

The authors also found that when consumed along with a higher protein meal, sugar sweetened beverages increased the desire for fatty/salty/savory foods, and simultaneously decreased diet induced thermogenesis (the energy spent on processing/storing food), and fat oxidation (which the authors postulate may lead to a greater tendency of the body to store fat).

All this to say, treating sugar sweetened beverages (including juice) like the liquid candy that they are, and consuming them as treats, in the smallest quantities you need to be happily satisfied, rather than drinking them along with your meals, is probably a good plan.
The Canadian Cancer Society Wants You To Drink Sugar And Eat At Chipotle
A few years ago I pointed out the hypocrisy of the Canadian Cancer Society encouraging people to eat Domino's pizza in the name of fundraising.

I noted that sure, fast food pizza here and there isn't going to kill you or give you cancer, but that there's little doubt that one of the major drivers of our society's struggles with diet and weight related illnesses is the normalization of fast and junky foods as regular, everyday parts of our lives.

My belief is that this normalized culture of convenience is in part encouraged by the cause-washed use of candy and junk food for fundraising - a practice which may have been inconsequential (and rare) 60 years ago, but superimposed on our health issues today, is just plain wrong (and constant). And it's especially wrong when adopted by health organizations whose cause, like that of the the Canadian Cancer Society, is itself impacted by low quality diets.

So this year's Canadian Cancer Society junk food partners are Chipotle, PepsiCo, and the Dole Food Company.

The Canadian Cancer Society's partnership with Chipotle sees them encouraging a trip to the giant fast food burrito maker in the name of 50% of a single day's sales, while their partnership with PepsiCo and Dole come from one of their flagship events - the Run For The Cure - where PepsiCo and Dole serve as the Run's, "National Official Suppliers". As such, at the finish line of the short 5km fundraising run (which of course isn't of a distance long enough to worry about any fuel or hydration needs), PepsiCo and Dole will be there to market hand out the beverages that the Run For The Cure website notes provide participants, year after year, with "delicious refreshment".

Of course they'll also provide participants with piles of sugar given that Dole Sparklers, a "real fruit beverage", pack 4 teaspoons of free sugar per can, while Real Tea's offerings can pack up to a whopping 12 per bottle depending on flavour.

It's a good thing then I guess that the Run For The Cure is on October 1st rather than September 30th given that in September the Canadian Cancer Society's fundraising effort is a much more appropriate Sugar Free September initiative

And as the Canadian Cancer Society is explicitly aware, fruit drinks and sweetened tea, are common sources of free and added sugars in our diets.

One of the other reasons why these partnerships are so unwise is the way they're utilized by the junk food partner. For instance Dole's gone ahead and leveraged their partnership for in store sales of their sugar water by using it to cause-wash their products directly.

Given that the last time around the Canadian Cancer Society reported they were incredibly proud of their partnership with Dominos, I imagine this time will be no different.

Not sure pride is the emotion I'd recommend when reflecting on their comfort with junk food fundraising.
Saturday Stories: Vaginal Debunking, p-Values, and Dying
Meghana Keshavan in STAT profiles the great vaginal debunker Dr. Jennifer Gunter

Brian Resnick in Vox with a terrific explainer on p-values and scientific significance.

Cory Taylor in The New Yorker with her first person account of actively dying.
Will Weighing Yourself Daily Really Help You Lose Weight?
There are no shortage of people and stories who'll report that one of the easiest things you can do to help yourself lose weight is to weigh yourself daily.

And there are plenty of journal articles too, like this one which came out just last week, that concluded,
"these data extend the possibility that daily self-weighing may be important for prevention of unwanted weight gain"
The problem with the majority of these studies however, is that they're not randomized trials designed to compare the intervention of weighing oneself daily to not, but rather they're either longitudinal studies, or retrospective studies, that look at weight loss and whether or not there's an association with daily weighing.

That matters a great deal because it certainly might follow, and this would be consistent with the experiences I've observed in working with thousands and thousands of patients, that when people know they're struggling with their diets and lifestyle changes, they avoid stepping on the scale, and therefore my bet would be that daily weighing is simply a marker for people who are doing well with their efforts.

So have there been randomized controlled trials of daily weighing on weight loss?

Surprisingly, I could only find one that isolated daily weighing as the primary weight loss intervention. It was a study which randomized 183 adults with obesity to weigh themselves daily, or not, and both groups were given weight loss advice that was known to be ineffective. That last bit is important if you're trying to suss out whether or not daily weighing itself provides benefit.

The authors' conclusion?
"As an intervention for weight loss, instruction to weigh daily is ineffective. Unlike other studies, there was no evidence that greater frequency of self-weighing is associated with greater weight loss."
I also wonder about whether or not daily weighing might lead to increased recidivism? Though I couldn't find any studies that looked at daily weighing and its association with patient dropout, given that day to day weight fluctuations are normal, and that weight loss (and life as a whole) isn't often a straight, consistent, line, I worry that those weighing themselves daily will provide themselves with more opportunities to be discouraged and hence, more likely to quit their intentional weight loss efforts in frustration.

In our clinic we recommend our patients weigh themselves weekly, on Wednesday mornings, naked, after pee, before breakfast, with the rationale being it's important to ensure weight gains, if they're occurring, are noted, because if you're off course, it's easy to gain a great deal of weight in a short period of time and avoiding the scale because you know things aren't going well might lead you to gain more than you would have were you aware of your trend.
How Is Reading with Ronald (McDonald) Still A Thing?
There's no denying there's a fair bit of grey to the black and white world of corporate sponsorship and public private partnerships, but the Reading With Ronald program probably doesn't fall into that category.

Simply put, Reading With Ronald sees public libraries inviting Ronald McDonald to read to kindergarteners.

Publicly funded institutions that by definition are trusted by children shouldn't be used to market anything, let along junk food, to children.

That these events occur doesn't speak so much to incompetence though, they speak to how normal it is in society today for us to pretend that corporate interests in events like these are altruistic, and not just marketing.
Saturday Stories: What The Health, Carboholics, and Righteous Hatred
Ginny Messina, the Vegan RD, in Vegan.com, reviews the film What The Health and its "junk science".

Stephan Guyenet, on his own blog, responds to Gary Taubes' recent NYTs piece on "carboholics", and offers up a different, more science-pinned, narrative.

Jamie Palmer in Fathom, with an unflinching piece on the Left and the Israeli-Palestinian conflict: The path to righteous hatred.