Wednesday, October 29, 2014

The Nutrition Debate #257: Non-surgical bariatric medicine

Does this sound like an oxymoron to you? It did to me, until I looked up the definition of “bariatric.” According to Merriam-Webster online, it means “relating to or specializing in the treatment of obesity.” And non-surgical bariatric medicine is what Yoni Freedhoff, MD, an Ottawa, Canada-based family doc and Assistant Professor at the University of Ottawa, practices.  He is also the founder of Ottawa’s non-surgical Bariatric Medical Institute, “a multidisciplinary, ethical, evidence-based nutrition and weight management centre,” according to his Blogger website, He quips in his “About Me” that, “Nowadays I’m more likely to stop drugs than start them.” He sounds like my kinda doc.

What brought Dr. Freedhoff (I’m gonna call him Yoni) to my attention, I think, was an email from my editor. “Sugar” has been one of her long-time “faves.” So, when Yoni heralded Canada’s Heart and Stroke Foundation’s (HSF) issuance of what he calls a “world leading sugar statement,” she gave me a heads up with this link. And within Yoni’s post, he provides this link to the HSF new position statement, “Sugar, Heart Disease and Stroke.”

Yoni describes the HSF position statement “as hard hitting as any I’ve read….” It provides “a slew of recommendations” for consumers, the Federal and Provincial Governments, and other regulatory bodies such as school boards. Some of the recommendations, such as taxing sugar sweetened beverages and “Bloomberg style” drinking cup size bans, I do not favor. Likewise they would have little chance of enactment in the more individualistic, civil-libertarian political environment of the U.S., but that’s not Yoni’s main thrust. It was what enabled the HSF to make their recommendations possible in the first place. It was the HSF’s decision to “divorce themselves from their throngs of food industry partners.”

Yoni’s dual exhilaration is clear. He begins, “Huge kudos for Canada’s Heart and Stroke Foundation,” and then he adds,

“Whether or not you agree with the HSF’s recommendations, one thing’s incredibly clear, the HSF is no longer the food industry’s partner – and that news is tremendous for Canadians as it’s amazing how forceful and broad-sweeping public health organizations’ recommendations can be when there’s no worry about upsetting industry partners.”

Yoni goes on, “While reading this position piece and in it the HSF’s clear unadulterated-by-industry voice, I couldn’t help but wonder what sort of forces Dietitians of Canada and the American Academy of Nutrition and Dietetics [formerly the American Dietetic Association] could be were they to divorce themselves from the throngs of food industry partners, for as it stands now, they’re both rather toothless and certainly not describable as drivers of change or true champions of health.” Boy, the Ottawa community is lucky to have this kind of doctor serving the “non-surgical bariatric” population.

Muckraking is a messy business, though. Many a good researcher, and practitioner as well, has had their career ruined by going against the flow, unable to get research funds or publication in a peer-reviewed journal, by trying to advance an alternative hypothesis or clinical approach to practicing medicine. That hasn’t deterred, among others, one of my favorite bloggers, Kris Gunnars, a medical student who blogs regularly at Authority Nutrition, an evidenced-based approach. His posts are always backed up with citations in the medical literature, and he’s got a big following.

Kris usually blogs about healthy eating, but occasionally he goes off on a tangent into the politics of nutrition. One of my favorites was in which he takes off on the same American Academy of Nutrition and Dietetics, the “professional” organization that is “the ‘biggest organization of nutrition professionals in the world’ – they are the ones in charge of licensing Registered Dietitians in the U.S.,” he says. Take a look at that link and open the links he provides to see what a mess – what a disgrace, really – our situation is.

Another post of Authority Nutrition is This one takes off on the American Diabetes Association (ADA), which still recommends that “people eat a low-fat, high-carb diet. According to them, diabetics should eat 45-65 grams of carbohydrates per meal.” Kris calls that acrime against humanity.
Still not convinced? Impossible, but here’s another anyway: Tell me you’re read these three Kris Gunnars’ posts at Authority Nutrition and still trust your government, your medical associations (whom doctors and Medicare use for guidelines) and food ‘manufacturers.’


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