The precautionary principal in the garden of obesogens

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Today's post is a follow-up to the previous post on the pervasiveness of environmental contaminants and pollutants and the potential link to obesity, particularly in utero. As I left off, much research remains to be conducted to definitively link specific industrial chemicals (known endocrine disruptors), which are highly prevalent in our society, to obesity.

The precautionary principal is used to protect public health and has various interpretations. In general, it says that complete evidence of harm does not have to exist before steps can be taken to protect members of society from harm (Weir et al, 2010). In this post, I'd like to discuss a Canadian-specific framework for applying the precautionary principal in relation to suspected obesogens, public health, environmental health, and our overall North American lifestyle.

 Historically, there has been a general failure in North America and Europe to determine potential negative public health and environmental effects from industrial chemicals before manufacture and widespread use (Wordsworth et al, 2007).  This likely explains why every person or animal that has ever been tested has had detectable levels of endocrine-disruptors in their bodies.

"An analysis by the Environmental Protection Agency in 1998 found that, of the 3,000 chemicals that are used in the highest volumes in the United States (3), forty-three per cent had no testing data at all that would establish their basic toxicity. Only 7 per cent had a full set of safety tests (4). For chemicals used in lower volumes, even less information was available (5)." (Wordsworth et al, 2007).

The European Union is no better. And we Canadians don't have a lot to be proud of either:

More recently, in September 2006 the Canadian government concluded one of the most extensive reviews of substances ever undertaken. The government identified more than 4,000 suspect chemicals in Canada with the potential to be persistent, bioaccumulative and “inherently toxic” (8)." (Wordsworth et al, 2007).

Does this mean that the precautionary principal is not relevant? If the link between certain endocrine-disruptors and obesity is found to be causal, is it already too late? I think it's a no to both, but truly unfortunate to have to put ourselves in this situation in the first place. Applying the principal, particularly when it has to do with the environmental sector and public health, is far from straightforward, as you will see.

Weir et al (2010) propose a framework for applying the precautionary principal in Canada (10 Guiding Questions). There are two parts. The first assesses the degree of certainty to which the relationship between a risk (in this case certain chemicals) and harm (obesity and other potential health outcomes) can be considered causal. They use Sir Bradford Hill's 9 criteria for causation. Anybody with an epidemiology background should know what these are. I'm not going to list them here, simply because they're not really necessary for what I am going to talk about. What I am interested about is the second part, the remaining 9 questions, and Weir et al's discussion.

2. Is the harm associated with the suspected exposure serious?
3. Is the suspected exposure widespread?
4. Is there an observed increase in the incidence of the suspected harm that is temporally associated with increased exposure?
5. Is the harm associated with the suspected exposure difficult to treat or reverse?
6. What are the economic and non-economic costs and benefits of action and non-action?
7. Are the proposed control measures proportional to the level of risk? Are the economic costs of removing the exposure minimal? Are the health and societal costs of removing the exposure minimal?
8. Are comparable situations being treated similarly according to a standard of practice?
9. Is the level of the protective measures consistent with equivalent areas in
which scientific data are available?
10. If precautionary measures are adopted, is there any new evidence to reduce the level of uncertainty about harm and benefit?

Going by these questions, yes obesity is serious and yes exposure is widespread. I would say that at this point, #4 can only be answered in animal studies. Obesity has been difficult to treat and reverse and it has multiple determinants. Number 6 and 7 are where it starts to get tricky. Because obesity has multiple determinants (i.e. is complex) and because of lack of evidence, it's hard to say whether decreased use of these chemicals would result in less obesity and related diseases and therefore lower healthcare costs and other indirect costs like absenteeism/presenteeism. 

Weir et al contend that the appropriateness of applying the precautionary principal increases "when the economic and social costs of removing the exposure are small relative to the suspected harm." These chemicals no doubt make life easier for us - are we willing to give up a certain level of convenience to live without them, at least until adequate replacement substances are found (I have faith in technology to remedy this gap rather quickly)? Are we willing to knowingly gamble with our economy? I could answer for myself, but I'm sure that many others would disagree, some with valid points. 

At the same time, Weir et al add that appropriateness of applying the principal increases "when the health costs of removing the exposure are minimal; and when, in addition to the uncertain harms, there are known health, economic or social harms caused by the exposure." I can't see health costs associated with removing obesogens; worse case,  procedures with medical equipment made with obesogens are no longer possible until replacement substances are found. Obesogens also have known negative impacts on the environment and suspected health impacts that go beyond obesity. I am unaware of comparable situations that could be used to address #8 (that doesn't mean there aren't any), and we're not even close to answering #9 and #10 yet. 

This is only the tip of the iceberg. Based on this quick run-through, I hope you grasp the complexity of this problem. What do you think? Is it too late to apply the precautionary principal? Is applying the principal even relevant for obesity, or worth the potential negative social and economic effects? Is not applying it worth further environmental damage? 



Weir E, Schabas R, Wilson K, & Mackie C (2010). A Canadian framework for applying the precautionary principle to public health issues. Canadian journal of public health. Revue canadienne de sante publique, 101 (5), 396-8 PMID: 21214055

Pervasiveness of environmental contaminants: what does this mean for obesity?

Everybody knows that obesity results from energy in being greater than energy out, right? Okay, we know that it's a lot more complex than that, but what if obesity could arise separate from this? We're pretty wedded to the idea that diet and physical activity are major risk factors, so it may be a little disconcerting to learn that a new body of research suggests that being exposed to "obesogens," chemicals in the environment (usually man-made), may program us to be fat. In this first post, I will provide a very basic overview of obesogens, leaning heavily on two reports. In the second post of this two-part series, I will discuss what this means in terms of the precautionary principal versus level of evidence.

CBC (the Canadian Broadcasting Company) aired a documentary earlier this year that discussed the puzzling results of scientists researching endocrine-disrupting chemicals. Their original projects were not about fat, but their lab animals turned out to be unusually heavy after being exposed to these chemicals. The documentary can be accessed here. You can have a sneak-peek by viewing the trailer below.



We know that fat tissue acts like an endocrine organ. Since endocrine-disrupting chemicals include a wide variety of substances it is difficult to generalize mechanisms of actions. The Endocrine Society gives the following broad definition (Diamanti-Kandarakis et al, 2009):

"An endocrine-disrupting substance is a compound, either natural or synthetic, which through environmental or inappropriate developmental exposures alters the hormonal and homeostatic systems that enable the organism to communicate with and respond to its environment."

 In general though, it is thought that obesogens mimic hormones, which can increase the size of fat cells, increase the number of fat cells or negatively affect appetite, metabolism, and/or food preferences (Holtcamp, 2012). Much of the evidence to date has been from animal studies, but there are many epidemiological studies linking exposures of 15-20 chemicals during fetal and infant development to infant and child weight status (Holtcamp, 2012). Take for instance, smoking during pregnancy - there is fairly persuasive epidemiological evidence linking this to obesity in children (Oken et al, 2008).  There is also some evidence for an effect of endocrine-disrupting chemicals on adult weight status; however this is a burgeoning area of research that is need of more studies (Tang-Péronard et al, 2011). 

Obesogens (those in addition to the byproducts of smoking) are found everywhere - in industrial solvents/s and their byproducts (PCBs), plastics (BPA), plasticizers (phthalates) in PVC, organotins, pesticides (atrazine, DDE), surfactants used to reduce friction (PFOA), and pharmaceutical agents (DES) (Diamanti-Kandarakis et al, 2009)(Holtcamp, 2012). We are exposed to these chemicals by drinking contaminated water, eating contaminated food, breathing contaminated air, or coming into contact with contaminated soil.  In industrial areas, chemicals can leach into the soil and contaminate the ground water, and may bio accumulate in both humans and animals. The web of contamination is so complex that areas considered "prestine"and remote from the original site that produced the chemical, have been found with levels of the chemical (Diamanti-Kandarakis et al, 2009). Many of these obesogens are also found in items we may or may not use every day. Examples include: medical devices, some canned foods, cash register receipts, designer handbags, items made of Gore-tex(TM), wallpaper, vinyl blinds, tile, and vacuum cleaner dust, air fresheners, laundry products, personal care products, items with Scotchgard(TM) (e.g. carpets, furniture, and mattresses), non-stick cook-ware, and microwaveable food items. There are also potential dietary obesogens including phytoestrogens (soy) (Diamanti-Kandarakis et al, 2009) and MSG (monosodium glutamate) (Holtcamp, 2012).  
  

Many endocrine-disruptors demonstrate an inverted U-shaped dose-response association. This means that with medium "doses" of the chemical, obesity risk increases. But at low and high doses, the risk decreases. This likely depends on the chemical and other factors as some endocrine-disruptors have been found to increase risk at very low or very high levels.  Estimating the level of exposure that leads to a negative outcome is complex in a living, human population. It depends on sex, age at exposure, length of exposure, the mix of chemicals one is exposed to, and innate lag between exposure and effect (Diamanti-Kandarakis et al, 2009), to name a few. 

The link between these chemicals and obesity can only be considered exploratory and hypothesis-generating at this point. Nonetheless, endocrine-disruptors can be detected in all animals and humans (Diamanti-Kandarakis et al, 2009). Some researchers link this to the fact that even individuals on the low end of the BMI distribution are increasing in weight (hinting that obesogens may be the cause of everyone increasing weight on a population scale). I'm not so sure that this link can be made given the drastic change in our food system and our increasingly sedentary lifestyle. I'll delve more into what this may mean in the next post.  


Holtcamp, W. (2012). Obesogens: An Environmental Link to Obesity Environmental Health Perspectives, 120 (2) DOI: 10.1289/ehp.120-a62

Is cooking the silver bullet to the obesity epidemic?

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Many writers (e.g. Mark Bittman), journalists, researchers, scientists, and celebrity chefs (e.g Jamie Oliver), believe that if people cooked more, obesity wouldn't be such a big issue. While I agree with this observation generally and feel that it could probably be good for the environment too, I don't think it is something that on its own could ever be effective in our capitalist society.

First, how can cooking our own meals help the obesity epidemic? Meals and snacks eaten outside of the home generally have more calories than those made in the home. Simplistically, if you consume more calories than you expend on a regular basis, you're going to gain weight. There is also some evidence that eating more frequently outside of the home is related to an increased body weight. Preparing your own meals also cuts down on packaging, particularly if you eat a lot of fast food, which is better for the environment. And preparing your own meals means just that - as Yoni Freedhoff recently commented, nuking something doesn't count.

Cooking is a skill. It requires time. I've frequently heard that cooking skills have been on the decline (although I can't give a you specific source for that). I'd guess, because they're not necessary anymore (abundance of prepared, tasty food), and perhaps due in part (please feminists don't hate me) to the emergence of the two-working-parent family; the housewife social norm is disappearing. People, therefore, need to be taught how to cook; and to cook food that tastes at least as good as what could be bought pre-made. Where and how would this happen? Sure,we can get at kids in schools, but what about their parents? Adults are a less captive audience. Second, people don't feel like they have time.  They're stressed. Everyone is. But, this is particularly tough for people on lower incomes, trying to make ends meet. They know the value of healthy eating but lack time and resources. Thus, sometimes being able to get prepared foods for relatively cheap is valued much more highly than cooking skills and being able to cook one's own meals. Some people can't even afford places to live that have enough room for cooking equipment anyway. Given the current state of global economic affairs, I imagine, that these scenarios will only become more frequent.  

If we want to people to cook more, it's not simply a matter of setting up social marketing campaigns and saying "hey you guys, you should cook more." There needs to be education programs in schools, the workplace, and the community, as well as changes in policies to support those trying to get by (minimum living supplement, housing and energy subsidies, etc.), workplace policies that are family friendly, egalitarian, and aim to reduce stress, etc. To his credit, I believe Bittman does allude to these nuances in his new book. So these are the first prerequisites (or 'upstream' factors) for being able to cook more in our society.

Second, social norms need to change. Bittman and others have also suggested this - that valuing cooking and eating needs to become the societal norm. In North America, I'd say we value eating. We can get incredibly good tasting food pretty much anywhere, but we eat it 'on the run'. What we don't value anymore is appreciating the food, and the social aspects of eating - that social interaction when cooking and eating with family/friends.  Changing this norm runs hand in hand with the incredible convenience of our society; being exposed to such an abundance of food that's ready made for us. I find it mind boggling the amount of 'stuff', not even just food, that is available for consumption. Take Walmart for example. Everything is convenient and available to us at very little cost. I'm not even sure that we knowingly value the convenience of having someone else prepare our meals - it's just something that we take for granted - it just is. Cooking is an effort and if we don't feel like doing it, we know we can get prepared food easily elsewhere. I didn't feel like cooking the other day, so opted to get sushi take-out instead. That took all of 5 min. And I do it more than I care to admit...

I doubt that in a capitalist society like ours, decreasing the number of products out there for consumption is a viable option. I don't think that taking away convenience would work either (aside from some sort of environmental or man-made catastrophe). So, if both stay, there is really no incentive to cook. Sure, some efforts may have some sort of impact. But the reality is that we have pre-made food all around us, all the time. Plus, we'd need to have the prerequisites in place that I talked about above. This may be difficult given that many in society do not value collectivism, and oppose government intervention (read: the 'nanny' state). What could work in the mean time?  

I don't mean to say here that people should not cook - because I'm not saying that. We need to cook more, absolutely, but I'm skeptical about it having an impact on the obesity epidemic. Prepared food needs to change (e.g. fast food meals, pre-made meals in grocery stores). It needs to become healthier, with smaller portion sizes. Meals need to have more veggies and legumes; there needs to be more options with less meat. Prepared food needs to have taste that rivals its unhealthy competitors (with less salt); and it needs to preserve the convenience factor to be competitive. Packaging should also be biodegradable and we should use less of it. We should also strive to produce food locally, mostly to support local farmers, but also for other reasons that might be debated (read: environmental). Marketing of these healthier foods needs to be creative to maximize dollars spent, as for example, McDonald's marketing budget exceeds many countries' GDP.

I'm drawn to Portland, Oregon as an example of what could happen elsewhere in North America, to rival the dominant fast food chains and pre-made meals sold in grocery stores. Portland is considered a world-class city for street food. City policies allow local vendors to set up shop on semi permanent pods in private parking lots. Food is cheap, and there are over 700 food carts; therefore, lots of variety to chose from. Street food vendors are popular with the workers at lunchtime, tourists, and the after bar crowd. Food carts also promote sustainability and walkability, but in many cities, zoning and public health policies limit their proliferation. Vancouver is moving slowly to allow more street vendors to operate within its borders. In Ottawa, it's non-existent, save for examples like the Stone Soup Foodworks Truck, a mobile food vendor selling soups, sandwiches, salads, and tacos made from local, organic producers. Throughout most of the school year this truck can be found on the campus of the University of Ottawa, but it also frequents events throughout the city. There has been an attempt by the broader community in Ottawa to try and start a street food movement - but it doesn't look to have gained enough steam at this point to provide much sway to city officials.

Street food in Portland, Oregon (CC image)

  
Best case scenario is that wide sweeping social reform would make us less worried about income, and transform our time-use, allowing for more time to cook real food. We'd be able to acquire cooking skills throughout the life course, and social norms would change; knowledge of and respect for where our food comes from, cooking and eating, and the social interaction when cooking and eating would become highly valued in our society (particularly North American society). Because I envision that this will be difficult, I think that in the mean time, the content of prepared food needs to fundamentally change and that street vendors could be a more sustainable way to combat traditional fast food.

What are your thoughts? Agree? Disagree? Would love to hear them.



Lachat, C., Nago, E., Verstraeten, R., Roberfroid, D., Van Camp, J., & Kolsteren, P. (2012). Eating out of home and its association with dietary intake: a systematic review of the evidence Obesity Reviews, 13 (4), 329-346 DOI: 10.1111/j.1467-789X.2011.00953.x

Bezerra, I., Curioni, C., & Sichieri, R. (2012). Association between eating out of home and body weight Nutrition Reviews, 70 (2), 65-79 DOI: 10.1111/j.1753-4887.2011.00459.x

Troy LM, Miller EA, & Olson S (2011). Hunger and Obesity: Understanding a Food Insecurity Paradigm: Workshop Summary Institute of Medicine

Does a randomized social experiment shed light on the link between neighborhoods and obesity?

cc image:  ZoL87 on Flickr

 Determining the potential for residential characteristics to influence the development of obesity is a difficult endeavor. There are a multitude of reasons for this, but one I want to focus on is the research design of the study. Most research in this area has been cross-sectional (looking at one point in time only).  The problem with these studies is that we have no idea what came first, the neighborhood characteristic or obesity. There is also the issue of self-selection. Certain people may prefer to live in certain types of neighborhoods for a variety of reasons that may be related to weight; thus it’s not the neighbourhood characteristic(s) per se that explains the association with weight status, it’s something else that we haven’t measured. Longitudinal studies are better but tend to be based on cohort studies where the main intent was not to examine neighbourhood level effects. This means that the researcher has to use whatever information has been collected, and usually this gives an incomplete picture. Plus, there’s the attrition issue. People get fed up after a while, and some drop out of the study. This decreases power to detect significant differences and can introduce bias if dropout is in some way related to the outcome. 

So, imagine my surprise when I learned about a randomized social experiment with obesity as the outcome.  Randomization balances the exposure [neighbourhood characteristic(s)] on known and unknown confounders, and rectifies the issue of temporality. Randomized controlled trials are the gold-standard in clinical epidemiology, but for ethical and economic reasons, are usually not feasible in social epidemiology (randomizing people to smoke, for instance, would never fly).

The study, published by Jens Ludwig and crew in the New England Journal of Medicine, was based on the Moving to Opportunity for Fair Housing Program, conducted by the US Department of Housing and Urban Development (HUD). The basic premise of this experiment was to determine how best to provide housing for those in need. Briefly, 4498 families with children living in public/project housing in high poverty neighbourhoods in Baltimore, Boston, Chicago, Los Angeles, or New York, were randomly allocated to one of three groups in the years 1994-1998 (one quarter of those eligible):

1.       The MTO low poverty voucher group which received rental vouchers usable only in low-poverty areas (where < 10% of residents were poor), along with counseling and assistance in the search to find a private rental unit (n = 1788)

2.      The traditional voucher group, which received rental vouchers where there were no restrictions on where the family could relocate, as well as support ordinarily given to families by local public housing authorities (n =1312)

3.      The control group, which received no vouchers but remained eligible for public/project housing and other social programs, otherwise the status quo (n=1398)

For the most part, families were headed by African-American or Hispanic single mothers. From 2008-2010, health outcomes of female adults (usually the family head) were measured and included height, weight, and level of glycated hemoglobin.

Now, not all families moved or used the vouchers. The study used an intent-to-treat analysis which analyzes individuals based on groups to which they were assigned.  This is the least biased and most conservative way to analyze a study like this.  So even though a family may have been assigned to the MTO group but did not move to a low poverty neighbourhood, they would still be analyzed as part of the MTO group.   

In the MTO group, 48% used the vouchers, in contrast to 63% in the traditional group.  All groups were comparable at baseline in terms of 57 characteristics including age, race/ethnicity, marital status, employment, education, and federal assistance, for example.  One year after randomization, the neighbourhood poverty rate was significantly lower in the MTO group, but this difference attenuated (still remained significant) at 5 and 10 y, as families in the control group moved to lower poverty areas on their own.  Additionally, the proportion of women that said they felt safe/very safe in their neighbourhood, and the proportion that said neighbourhood adults would intervene in youth anti-social activity  (defined as collective efficacy) were significantly higher in the MTO compared to the control group at 4-7 y and 10-15 y post-randomization. These same significant differences were seen for the traditional versus the control group, although there was no difference in collective efficacy at 10-15 y.    

At 10-15 y of follow-up, after adjustment for baseline characteristics and allocation procedures, the prevalence in each category of extreme obesity was significantly lower in the MTO group (BMI ≥ 35 = 31.1%, and BMI ≥ 40 = 14.4%) compared to the control group (BMI ≥ 35 = 35.5%, and BMI ≥ 40 = 17.7%). There was no difference in obesity defined as BMI ≥ 30. The prevalence of elevated glycated hemoglobin was also lower in the MTO versus the control group (16.3% versus 20%).  Differences were in the same direction but not significant between the traditional versus the control group.

This study was interesting to me mainly because of its design. Yes, significant differences were found, and interestingly, even with such low compliance. But there are some important things to keep in mind when interpreting the results of this study:

=> Significant differences were for severe obesity, not for overweight or obesity in general.

=> No baseline data was available for BMI or glycated hemoglobin so changes could not be assessed (the authors state that this should not affect internal validity, which I tend to agree with, especially if they found no significant differences in 57 baseline characteristics).

=> Allocation of participants and data collection procedures were extremely complicated; in many cases information was not collected from participants (even though they were eligible and appeared not to have refused), or they were randomly excluded. Perhaps because of word limits, reasons for treatment of participants during these processes were not clear to me.

=> Only one quarter of those eligible actually applied to be randomized.

=> I am wondering if exposure to environments after the initial move (e.g. subsequent moves) may have confounded associations.  But I can’t really work out why this would be different across groups, given randomization, unless attrition was higher in one group versus another. Attrition is an issue in longitudinal study designs in general, but doesn’t appear to be an issue in this study (although, in light of what I said in the previous paragraph, I have trouble following calculation of response rates).  I think the issue of multiple moves, and duration of time spent in each neighbourhood, warranted more of a discussion in the actual paper (some descriptive measures of neighbourhood characteristics were weighted by time spent in each neighbourhood, but I don’t think the main analysis accounted for this).

=> Is it the change in environment characteristics (and which ones are important), or just the move itself that is responsible for significant differences? Even though there were no significant differences between the MTO (had to move to a low poverty area) and the traditional group (who had no restrictions of where to move) in terms of the health outcomes, the authors say that differences approached significance for glycated hemoglobin, which they say, suggests that a change in the environment is important. I’m not sure if the results they are referring to can really support this assertion. It’s also evident that the traditional group moved to more affluent areas anyway so a comparison of the two groups in this regard may be moot.  

=> This is a high-poverty, minority sample that examined adult women only. Although it may have higher relative internal validity for a social study, it lacks external validity or “generalizability” to other population subgroups.

- To expand a little on the high-poverty issue, I hypothesize that lower income individuals are more tied to their residential neighbourhoods (less mobile) than more affluent people (due largely to lack of access to a car). Thus, they accrue more exposure time than more affluent people. In this vein, I think residential environments are less important for more affluent individuals compared to those who are worse off. I also think that context in the US is likely not generalizable to the Canadian context (e.g. ghettoization based on racial segregation and poverty).

=> There is evidence that MTO families moved to areas lower in poverty but similar in racial distribution. These new areas still had more poverty than the country average.

=> Neighbourhoods themselves are not static entities, but were treated as such in this study.  Some research has indicated that when change is considered, disadvantage is the same in the MTO versus the control group

=> Even though neighbourhood cohesion and safety were not outcomes, they are potential reasons for why significant differences were seen. However, the measures employed in the study were based on single items, which I find hard to accept that they accurately captured what they were supposed to measure.

=> Finally, this study was based on individuals as the unit of allocation and analysis, not neighborhoods. Thus, this was not a study of a neighbourhood-level intervention.  Population interventions such as those for neighbourhoods are generally more cost-effective than those targeted to individuals.  A discussion of the two in regards to the MTO study is provided by Sampson (2008).

All in all, the MTO is, and I’ll quote Sampson, “a major contribution to the long tradition of experimental social science.” There are certainly methodological issues with it, but I think that the NEJM study provides fairly strong evidence that small decreases in neighbourhood poverty can decrease prevalence of diabetes and extreme obesity in a highly disadvantaged population.  

Ludwig J, Sanbonmatsu L, Gennetian L, Adam E, Duncan GJ, Katz LF, Kessler RC, Kling JR, Lindau ST, Whitaker RC, & McDade TW (2011). Neighborhoods, obesity, and diabetes--a randomized social experiment. The New England journal of medicine, 365 (16), 1509-19 PMID: 22010917

Would you pay for child slave labour-free chocolate bars?

CC Image: cocoa beans

Today is Valentine’s Day, the day of chocolate treats. But have you ever considered where your chocolate comes from? Like, at the beginning of the supply chain, with cocoa beans? Neither had I, until a few days ago. Now, my appetite for chocolate has substantially diminished, especially knowing that most of the chocolate I have eaten to date has likely not been child slave labour-free.

The chocolate industry is a multi-billion dollar global industry including key players such as Nestle and Hershey. The world loves chocolate. Our waistlines may be a testament to that.

About 60% of the world’s cocoa beans are grown in the poor West African countries of the Ivory Coast and Ghana. We depend on these countries for our chocolate, but these governments depend on cocoa for the revenue they provide in taxes. The locals depend on cocoa, simply to put food on the table.

Such inequity has led to one of the worst forms of child labour. Children are trafficked in these two countries, working long hours harvesting cocoa beans, often with dangerous equipment like machetes, with little food, no school, and no pay. Money goes to their traffickers, who are often family members who desperately need the money.

This grave problem is highlighted in an eye-opening documentary that was recently aired on the CBC (available only for another month). A BBC journalist bravely goes undercover in these poor countries to determine for himself the extent of child slave labour, as well as what the world’s cocoa companies are doing to remedy both child trafficking, and inequities leading to trafficking (it turns out unsurprisingly, not nearly enough).

The journalist also poses as a cocoa bean buyer and makes some chocolate of his own: a chocolate bar made with 100% child labour, clearly marked and all. Would you buy it after seeing this? Probably not; all of those interviewed were appalled. But would you pay more for child slave labour-free chocolate?     

This demonstrates clearly that things we do on one side of the world can have far reaching effects. Our demand for chocolate in the West fuels child labour. Not knowing is one reason for inaction, but now we know; meaning that now there are no excuses for not demanding and paying more for child slave labour-free chocolate. The next step will be a labeling issue, like Fair trade coffee, allowing us to recognize the more socially responsible companies. 

Global health should be everybody’s problem.

We shouldn't be giving cooking the finger

Happy New Year and all that jazz. The last few months have been a bit hectic for a variety of reasons, some of which I'd like to forget :)  I am going to try to post on a more or less two-post per month schedule, but am also trying to finish this damn PhD, and now am teaching! We'll see how it goes... 

Today's post is more of a pet-peeve of mine.  

There is some evidence to show that eating out of home is related to consuming more energy and more energy from fat; results that appear to be more consistent among adults than children. Presumably, 'out of home' means eating prepared meals at fast food or sit-down restaurants. The authors of this review, however, indicate that the definition of 'out of home' was context-dependent. That's important to keep in mind, but for the sake of my argument, let's just say that eating out more often, compared to cooking your own meals, is related to consuming more calories and can plausibly be related to obesity.  Also, I would imagine that if we cooked for ourselves or family-members more often, we'd be eating substantially less salt and waste less food and packaging.

Now, I am an advocate of eating more home-cooked meals, as are many of my colleagues; however, the problem is much more nuanced than simply blaming people and telling them they need to cook more. One such nuance is marketing...I absolutely hate this marketing campaign by Boston Pizza: Finger cooking and giving cooking the finger...It's admittedly funny and catchy, but makes me angry and sad all at the same time, and also suggests that males might be incompetent (as pointed out by a male friend of mine).

 I enjoy watching Jim Treliving on CBC's Dragon's Den.  He's certainly nicer than Kevin O'Leary. From their dealings I get that it's all about making money. The more successful a marketing campaign, the better it is for the company. But this particular campaign crosses the line for me Jim. I don't even watch TV that often and I see it all the time. I've never seen a restaurant or fast food company actively target a social norm in this way. We need to make cooking at home easier, cheaper, more convenient, and stop marketing campaigns like this. Otherwise, cooking, along with the skills that go with it, will go the way of the woolly mammoth.