Does Food Branding Make Kids Obese?

Walk down the middle aisle of the grocery store. (You know, the part of the store you as a healthy eater normally avoid?) Notice any bubbly, smiley cartoon celebrities decorating the boxes of not-so-healthy foods?

We bet you’ll see more than a few. Hello, Spongebob! Hi, there, Dora! And isn’t that Scooby-Doo on those yummy “fruit” chews?

Does this “character-driven marketing” and food branding matter?

Advertising, food and kids

In North America, according to national health surveys, about 17-18% of kids under 18 are obese. In the United States, obesity prevalence among children and adolescents has almost tripled since 1980.

One of the factors that may explain the increase in childhood obesity is the approximately $10 billion a year that food and drink companies spend on marketing to children and youth. In fact, experts estimate that the average kid sees more than 10,000 food commercials in a year. That’s nearly 83 hours or 3.5 days of commercials (at 30 seconds per commercial). Pretty sobering.

Add the information that most of these ads promote fast food or sugary snacks, and it gets even scarier. I guess the hundredth repeat of that new Disney movie on Blu-Ray doesn’t seem so bad now. At least it doesn’t include ads.

To make things worse, one study found that kids between the ages of 4 and 6 years old thought that even Gummi bears and graham crackers tasted better if they came decorated with a favourite cartoon character. In other words, even inherently appealing sugary foods tasted better if kids associated them with their favourite characters.

I think we’d all be surprised if this $10 billion of investment in targeted marketing didn’t change kids’ behaviours. The question is: how?

Research question

This week’s review looks at how branding changes children’s eating behaviours—with some interesting results.

Keller KL, Kuilema LG, Lee N, Yoon J, Mascaro B, Combes AL, Deutsch B, Sorte K, Halford JC. The impact of food branding on children’s eating behavior and obesity. Physiol Behav. 2012 Mar 16. [Epub ahead of print]

Methods

All studies were done on children under 10. Researchers measured the children’s body weight and BMI.

It’s hard to use an absolute BMI for children who might vary widely in their growth and development, so researchers often used a BMI z-score instead, which compares BMI based on percentiles (in other words, kids’ BMI relative to other kids the same age) instead of absolute values.

Study #1

Researchers provided test meals to children aged 4 to 6 years old. The children got to eat as much of the test meals as they wanted. Some of the foods were branded and some weren’t.

Study #2

7- to 9-year olds were given what is called a Stroop task. You’ve probably seen a Stroop effect. It’s how your brain reacts when you see a word that doesn’t seem to match an image it is paired with.

For example, reading the word RED in blue makes your brain slow down a bit to process the information. Distracted by the incongruent colour, you have to work extra hard to figure out the word’s meaning.

In the food brand version of the Stroop task, researchers showed the kids pictures of food with the wrong label. Then they took this one step further by showing them either unbranded or branded pictures of food with labels. Figure 1 shows an example from the study.

Figure 1 - Example images in the Food Brand Based Stroop Task. 1a is unbranded congruent, 1b is branded congruent, 1c is unbranded incongruent, and 1d is branded incongruent. Children were asked either to “read the word” or “name the picture.” Time to respond to each task was recorded and averaged across congruent vs. incongruent tasks. (Modified from Keller et al. 2012)

Study #3

The last study tried to figure out if branding could be used to encourage positive, healthy food choices. The researchers put popular characters (like Elmo) on containers of vegetables and fruit to see if 4- to 6-year olds would eat more healthy stuff.

Randomly, some of the kids were put in the intervention group or the control group. All groups received 24 8-ounce plastic containers with pre-washed and portioned beets, broccoli, carrots, red peppers, pineapple and blueberries.

For the first two weeks everybody got plain plastic containers. For weeks 3 through 6, the intervention group received decorated containers. Decorated containers featured each kid’s favourite cartoon character and a sticker inside that the kids could use to collect a prize at the end of the following week.

Results

Study #1 – Branded versus unbranded

Overall, kids seemed to eat just as much unbranded food as branded food. But when the researchers analysed the overweight kids’ results versus the normal-weight kids’ results, things got very interesting.

Normal-weight kids ate about 45 calories less when foods were branded, but overweight kids ate about 40 calories more when foods were branded.

Why normal-weight kids ate less branded food than unbranded food is a bit murky, but there’s another difference that is buried in the study: The branded food came packaged, while the unbranded food was unpackaged. Maybe normal-weight kids can’t be bothered to open up a package, or maybe overweight kids are especially intrigued by packages. But at this point, the jury’s still out. No one really knows.

Study #2 – Food brand Stroop task

First, the food brand Stroop task works just as well as the colour Stroop task. In other words, it makes the brain do a little hunh???

It took about 2 extra seconds for normal-weight kids to make sense of the mislabelled pictures of food (comparable to the delay in the colour test). So the test’s design seems valid.

But here’s an interesting wrinkle. The higher an individual’s BMI z-score, the more interference, or the longer it took to recognize the food when the name and picture didn’t match. The overweight kids took 2 seconds longer than normal weight kids to answer when the name and picture didn’t match.

Higher scores on incongruent tasks were interpreted as an increased cognitive bias toward food brand images. In other words, the food brands “hooked” and “hijacked” overweight kids’ attention more effectively.

Study 3 – Can Elmo sell vegetables?

In this study, kids in the intervention group ate more fruits and vegetables throughout the study. Even before the cartoon characters were on the containers these kids were eating more fruits and vegetables than the control!

However, the intervention group ate 20 g more of fruits and veggies per day after adding Elmo to their snacks, compared to the control group who showed no change.

What does that mean? Since simply participating in the study increased their consumption of fruit and veggies, it’s hard to say for sure that Elmo’s smiling face was what persuaded them to eat even more healthy foods as the study progressed—though it’s likely.

This happens in research sometimes. Really, all that can be done is to perform the study again with a new group.
All we can say for now is that using branding to promote healthy food such as fruits and vegetables could work, and this study suggests that associating cartoon characters with healthy foods may increase the number of vegetables kids eat.

Conclusion

It’s no surprise that food branding is a big visual cue that can change how much kids eat. What is surprising is that overweight kids seem to be particularly susceptible to the lure of branded foods (which are typically processed foods that are higher in calories, refined sugars and starches, and fats).

Are they overweight because they’re more likely to respond to branding? And why are they more affected by branding? We don’t know yet. Maybe they’ve also been exposed to more branded and fewer unbranded foods — so they’re trained, in a sense, to “eat branded.”

This study doesn’t yet explain what causes what. Maybe some kids are more susceptible to branding cues than others. Those more-susceptible kids eat more branded foods, thus increasing their overall exposure to and familiarity with the foods, which they then come to expect… making them more susceptible to branding again…

Or, maybe kids start with the same susceptibility to branding, and then learn to be more aware of branding cues depending on what’s around them in their environment. Again, we don’t know yet.

Bottom line

Food branding does work. No surprise — otherwise nobody would pay for it. But it seems that some kids are more susceptible to branding than others, and that could be the reason these kids are overweight. It’s hard to say without more studies, because this one shows only correlation, not causation.

References

Centers for Disease Control. Obesity rates among all children in the United States. Data from the National Health and Nutrition Examination Survey, 2009.

Connor, S. Food-related advertising on preschool television: Building brand recognition in young viewers. Pediatrics 118 (2006): 1478–1485.

Harrison, K., & Marske, A. L. Nutritional content of foods advertised during the television programs children watch most. American Journal of Public Health 95 (2005): 1568–1574.

Mediascope. Issue brief: Children, health, & advertising. Los Angeles, CA: Author, 2000.

Roberto CA, Baik J, Harris JL, Brownell KD. Influence of licensed characters on children’s taste and snack preferences. Pediatrics 126 no.1 (July 2010):88-93.

Shields, Margot. Overweight Canadian children and adolescents. Data from Canadian Community Health Survey. Statistics Canada, 2004.

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Red Meat: Is It Bad For You?

Lessons from hormone replacement therapy studies

In the last 20 years women were told that hormone replacement therapy decreased risk of heart disease. Then suddenly, we were told that hormone replacement therapy increased risk for heart disease. What happened?

What happened was the original studies weren’t carefully controlled, randomized experiments. For instance, researchers didn’t randomly give some women hormone replacement and some women a placebo, then compare. Instead researchers just collected data on women’s health and whether these women took hormone replacements.

The problem was that women taking hormone replacement therapy were of higher socioeconomic status (middle class) than the women who didn’t (lower economic status). So, the social status was a larger determinant of heart disease than hormones. Worse, researchers realized that when hormone therapy was given randomly it increased risk of heart disease. Ooops.

Correlation is not causation

Just because two things happen at the same time or in the same person (correlation), it doesn’t mean that one thing causes the other (causation).

So, women who were less likely to have heart disease were also more likely to take hormone replacement therapy (HRT). But HRT wasn’t what caused the lower rates of heart disease — the two were simply correlated.

A fun analogy that’s often used is the correlation between ice cream consumption and drowning.

Ice cream consumption goes up at the same time that drowning does. Does ice cream cause drownings? Well, unless you fall off a boat while trying to grab your dropped soft-serve cone, probably not. Both ice cream consumption and drownings go up in warmer weather — people eat more, people swim and boat more.

In other words, before we burn down Baskin Robbins to prevent water-related deaths, we need to remember that phenomena might occur together, but one doesn’t necessarily cause the other.

This has implications for a recent study on the relationship between health and red meat.

Pan A, Sun Q, Bernstein AM, Schulze MB, Manson JE, Stampfer MJ, Willett WC, Hu FB. Red Meat Consumption and Mortality: Results From 2 Prospective Cohort Studies. Arch Intern Med. 2012 Mar 12. [Epub ahead of print]

Methods

Since it’s pretty much impossible to get a bunch of volunteers and have them eat different amounts of red meat for over twenty years, this study checked in with people every four years to ask them how much red meat they ate.

This research article is actually a combination of two different studies:

• one study was all men (Health Professionals Follow-up Study with over 35,000 men);
• the other was all women (Nurses’ Health Study with over 80,000 women).

There are a few potential problems with these studies.

Problem 1: Food recall is poor

First, every four years researchers contacted the study participants gave these volunteers and asked how often they ate various things in the past year.

I don’t know about you, but I have a hard time remembering what I ate this morning. So asking me to remember how often I ate something last year probably won’t get you an accurate answer.

Another problem with this method is that even if people can remember what they ate, they can’t accurately remember how much. People generally aren’t very good at guessing serving sizes even when they’re sitting in front of the food — never mind remembering it a year later.

For fun you can keep a food log for a week, then 6 months or 12 months later do the questionnaire from this study without peeking at your original log. Then compare. How close are you?

Problem 2: Many factors affect outcome

The second problem is that this study isn’t an experimental study. It’s an observational study.

These people weren’t randomly assigned to a meat-eating group (including exact amounts of meat they had to eat) or the no-meat-eating group. Nor were they sorted by similarities — i.e. other things they might have in common, such as other health behaviours.

Instead, everybody just did what they normally did and told the researchers, as best as they remembered. What does that mean? Meat eating isn’t the only difference between these groups.

In the last 20 to 30 years people have been told by nearly every medical authority that red meat is bad for you. If you’re someone concerned about your health, you might have taken that advice seriously and cut down on red meat. And, if you’re someone concerned about your health, you probably also:

• eat more fruits and vegetables;
• eat more unprocessed foods in general;
• don’t drink much, or smoke; and
• do other health-promoting behaviours, like exercise.

Is there one factor that explains your better health? Probably not.

If you’re not concerned about your health, maybe — sure — you eat burgers and bacon. But if you’re not someone who’s overly concerned about your health, you also probably smoke, drink, and drive without your seatbelt. In fact, red meat may be the least of your problems. Heck, maybe red meat is actually saving you from the effects of your smoking.

The point is that with this kind of study design, you can never know for sure, because so many other factors are involved.

And what about people who are fit and healthy and careful about their diets and lifestyle and who eat plenty of red meat in the form of grass-fed lean beef and wild game? Like, say, me and many folks on the PN team? Sure, we’re a minority, but you have to factor us in.

OK, now it’s just getting totally complicated. But you see, that’s the problem with an observational study. It’s messy.

Results

When I read a study I don’t read the results section until after I look at the tables and graphs and get my own interpretation of the data. Then I read the results to see how the researchers interpreted their data. Yup, with any data there is interpretation.

People were sorted into 5 groups, based on how much red meat they said they ate. Group 1 ate the least red meat and Group 5 ate the most meat.

Cholesterol

After looking at the first table what struck me was that the data suggested that the more red meat men and women ate, the less likely they were to have high cholesterol (see Figure 1).

Well… that’s counter-intuitive, isn’t it?

Figure 1: Meat consumption and cholesterol levels

Calories

The next thing that struck me was people’s calorie reports. Group 1 (the lowest rate of red meat consumption) reported unusually low energy intakes.

The men remembered eating 1659 calories per day, which is almost exactly how much energy the average 40 year old guy who has a normal body mass index (BMI) (177 cm tall, 70 kg) would need if he stayed in bed and did nothing (basal metabolic rate = 1648).

Meanwhile the women remembered eating 1202 calories per day, about 80 calories below the average women’s BMR.

Now, if you’ve seen the average North American lately, you might join me in being somewhat suspicious of these rather austere calorie reports. Nevertheless, if it’s even close to accurate, it’s interesting.

Men and women who ate more red meat were also more likely to smoke and drink. They had a higher BMI and ate more calories (though fewer fruits and vegetables) while being less physically active.

Playing with statistics

Since, again, people who ate more red meat were more likely to do things that weren’t good for them (e.g. smoke more while being less physically active) the researchers had to do a statistical correction to control for these things that didn’t involve red meat consumption.

After correcting for these other things eating more red meat (either processed or unprocessed) was associated with increased risk of cardiovascular disease, cancer and death in both men and women.

One of the most interesting findings in this study is when researchers corrected for cholesterol and saturated fat, they found only a partial decrease in risk of eating red meat and cardiovascular disease. Cholesterol and saturated fat in red meat are only a small part of why eating more red meat is related to higher risks of heart disease.

What else could be in red meat that’s bad for us? Well, iron, for one thing. Excess iron is also partially related to cardiovascular disease, particularly in men.

Eating 1 serving of unprocessed red meat (including fast food hamburgers, which is a debatable categorization) per day increased risk of dying by 13%, but eating 1 serving of processed meat (bacon or hot dog) per day increased the risk by 20%.

Conclusion

So what does this all tell us? Let’s get behind the scary headlines about how steak is going to kill us all, and look at what this study actually tells us.

Food recall isn’t accurate… or truthful

How good are you at remembering what you ate last year? And how good are you a guessing how much you ate?

In this study the group that said they ate the least amount of red meat ate so few calories that they were starving. Chances are they weren’t starving for over 20 years, so it’s more likely they couldn’t accurately remember what they ate — or told the researchers what they thought they should have been eating.

Confounding variables

As much as you try to use stats to correct for things that may also create risk factors, you can’t. You can’t know every risk factor, nor their relative role. For instance, what if:

• people who ate more red meat also had stressful jobs? (After all, there aren’t too many vegans on mining crews.)
• people who didn’t eat red meat were more likely to be well-educated, affluent professionals, which is a group with lower early death rates?
• people who ate red meat were more likely to live in certain areas?

If you’re just using observational data you can never isolate a single factor to know for sure.

Red meat quality

Since fast food burgers were considered “unprocessed” red meat, meat quality could also be more of an issue than meat itself.

After all, it seems like lean, grass-fed, hormone-free, antibiotic-free beef from happy cows would probably be different than fatty, corn-fed, hormone-laced, antibiotic-bathed beef from cows in crowded feedlots… never mind beef that’s been processed through the fast food factory.

Bottom line

This study found that red meat increases the risk of cardiovascular disease, cancer and death, but there are so many methodological problems with the study, it’s hard to take these findings seriously.

My recommendation: Stick with the PN guidelines:

• incorporate a variety of sources of lean protein in your diet
• eat whole, unprocessed foods
• eat lots of vegetables and fruits
• avoid simple and refined carbohydrates
• eat naturally occurring “good fats”; avoid industrially produced trans fats and hydrogenated fats
• buy the best quality food you can afford — including grass-fed, pastured beef if you can manage it
• keep doing all the habits that — overall — add up to good health

A regular fitness routine is part of overall health, regardless of whether it involves red meat.

Learn more

To learn more about making important improvements to your own nutrition and exercise program, check out the following 5-day video courses.

They’re probably better than 90% of the seminars we’ve ever attended on the subjects of exercise and nutrition (and probably better than a few we’ve given ourselves, too).

The best part? They’re totally free.

To check out the free courses, just click one of the links below.

• Exercise and Nutrition Crash Course for Women

• Exercise and Nutrition Crash Course for Men

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Minor Changes Help Cancer Survivors

A few weeks back we discussed the problem with making extreme New Year’s resolutions, especially crash diets. Well, about now, people have likely started falling off the I’m going to lose x pounds wagon, and the number of people at the gym has started dwindling. (Good news for those of you who are regular gym-goers — now your equipment is free!)

Part of the problem is perfectionitis. Perfectionitis is a widespread problem that can happen everywhere, to nearly anyone.

Key symptoms include statements like this:

• “I’ve missed a few workouts; I guess that’s the end of my goal to get fit.”
• Or, “Since I’ve already eaten one sour cream glazed donut I might as well finish off a pint of ice cream.”

Perfectionitis comes from two sources:

• the mistaken belief that others are successful because they are perfect; and
• undervaluing small improvements like reduced blood pressure, or a daily 10-minute walk, despite these things doing a lot more for your survival than 6 pack abs.

When did it become more important to have abs than to improve your chance of living another 5 years?

This week’s review looks at a group that had to deal with feeling grossly “imperfect”: folks over 70 years old who are overweight cancer survivors. No magazine cover boys or girls here. How did they cope? Good question — and the answer may surprise you.

But first, let’s talk more about cancer.

Cancer: The most feared disease

I know many people who live in fear of getting cancer. It seems somehow more sinister than other diseases. Only once in my life did I have to sit down because of bad news: when my mom was diagnosed with ovarian cancer and immediate exploratory surgery was booked.

What is cancer?

Cancer occurs when your cells have a critical typo in their DNA, which screws up the switch that tells them to stop growing. When you grow normal cells in a petri dish they stop growing when they touch each other. But when you grow cancer cells, they don’t stop until they run out of food.

A few more steps, like spreading to other tissues or getting a blood supply, push abnormal benign cells into malignancy.

As bad as cancer is, there are some uses for cancer cells. For instance, cells from an extremely aggressive cervical cancer tumour from a women in the 1950s became the first cells that could be used for research, since the cells could survive in a petri-dish. In fact, these cells are still used today (for an interesting account of this, see The Immortal Life of Henrietta Lacks).

What causes cancer?

1. Genetics
2. Age
3. Lifestyle

Despite people being fixated on genetics of cancer, most cancers can’t (yet) be explained by a known gene mutation or a family history of cancer. For example, only 5-10% of all breast cancers are linked to known genetic mutations (BRACA1 & BRACA2). Rarely does your DNA forecast your inevitable destiny.

However, the older you are, the greater your risk of most cancers, simply because the older you are, the more typos your cells accumulate.

So you can’t control your genes. You can’t control your age. But you can control your lifestyle (and hence your genetic expression — in other words, how your existing “blueprint” gets executed).

For example, lifestyle can include:

• how much body fat you carry (within a certain range)
• how much regular exercise you get
• what kind of diet you eat

More body fat, less physical activity and eating a Western diet high in processed foods and low in whole fresh foods all increase your risk of cancer.

To read more about nutrition and cancer see All About Cancer and Nutrition.

Diet, exercise and cancer survivors

Compared to the average Joe or Jane, cancer survivors are at greater risk of getting cancer a second time as well as other cardiovascular disease, osteoporosis, and diabetes. Thus diet and exercise is even more critical for this group.

This week’s review looks at exercise and diet for cancer survivors.

Morey MC, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA. 2009 May 13;301(18):1883-91.

Methods

Over 600 cancer survivors with at least 5 years of being cancer-free participated in this study. They were between 65 and 91 years old and had BMI (body mass indexes) between 25 and 40 kg/m² (classified as overweight).

Participants were diagnosed and treated for either colorectal, breast and prostate cancer (see Table 1 for the breakdown).

Table 1 – Cancer type

You might be thinking that this seems like a pretty mature group with an average age of 73, but actually for these type of cancers it’s a pretty good representation. The median age (where half the people are younger and half the people are older) to be diagnosed with prostate, breast, or colorectal cancer is 68, 61 and 71 years old. Some quick math to calculate age plus post-recovery period of 5 years, and you’re right around early seventies.

Study design

Half the participants got 12 months of diet and exercise counselling over the phone (intervention group). The other half of the participants were put on a waiting list (control group). After the 12 months the control group got the same counselling that the intervention group received.

In other words, both groups eventually got the same treatment.

Intervention

The intervention group received:

• a personally tailored workbook;
• a series of newsletters;
• 15 phone counselling sessions (15- 30 minutes long); and
• 8 automated phone messages prompting exercise and diet habits.

Recommendations included 15 minutes strength training at home every other day, 30 minutes of cardio every day, 7-9 servings of fruits and vegetables, and to limit saturated fat to 10% of energy intake. All in all, nothing too drastic.

To help the participants with the recommendations, each person received:

• a pedometer
• exercise bands (3 sets of different resistance)
• a poster showing 6 lower body exercises (no mention of what these exercises were in the article)
• a table guide to food portioning
• personalized record logs to self-monitor daily exercise and food intake

Measures

To figure out if the diet and exercise intervention did anything, the researchers had everybody complete two questionnaires and weigh themselves before and after the intervention.

The questionnaires were designed to evaluate physical function. The Short Form-36 Health Survey (SF-36) was used to figure out overall physical function; the Late Life Function and Disability Index (LLF) looked specifically at lower body function.

Questions on these surveys include things like:

• Do you have difficulties stepping up to and down from curbs?
• Do you have difficulties going up and down stairs?
• Do you need to use a hand rail when you use the stairs?

Not “How much do you deadlift?” Or “How many chin ups can you do?”

This is a whole new perspective to what “functional” actually means, and what would constitute “functional training”.

The higher the score on the SF-36 and the LLF, the better — a high score means that people can do as many functional things as possible, and have few limitations.

Results

Change in physical function

Before the study the scores from the physical function questionnaires were 76 out of 100 for overall function and 78 out of 100 for lower body function for both groups. (Remember, the higher the score, the better.)

After 12 months of the study, the control group dropped nearly 5 points and the intervention group dropped 2 points in the overall function questionnaire (SF-36). In the lower-body-specific questionnaire (LLF) the control group dropped around 2 points, with the intervention group keeping steady.

As strange as it seems in this case, intervention was successful because there was less decline or maintaining. Sometimes “progress” just means slowing decline, or simply staying in the same place when life and physiology are pushing you backwards.

Weight and BMI

Part of the reason the intervention group had less physical deterioration was probably that they lost a few more pounds than the control — 2 kg compared to 0.9 kg for the controls. That works out to a slight drop in BMI for both groups too (0.7 for the intervention and 0.3 control).

Overall health-related quality of life

The SF-36 questionnaire has a health-related quality of life sub-section that includes general health, pain, vitality, social functioning and mental health. Just like the physical function results, the quality of life results showed that the intervention group had less of a drop in scores compared to the control, except for pain, where there was no difference between groups after a year.

Conclusion

Even modest improvements to healthy routines can help people stay more functional as they age — even if people are starting off at a serious disadvantage because of age, weight, and/or chronic disease.

Just getting people to move a little more and eat a little better for a year helps.

In this study, having older, long term cancer survivors exercise up to 45 minutes most days and eat 7-9 serving of fruits and vegetables while eating less saturated fat helped them stave off physical decline better than those who stayed with the status quo.

Could a better diet and exercise program work better? Probably, but that’s kinda the point. You have a group of people who have significant health challenges and even relatively minor changes helped.

Many of us get caught up in doing things “perfectly” or getting optimal results. As soon as “perfect” doesn’t happen we toss the whole thing. What?! A whole month has passed and I don’t fit in my skinny jeans and have 9.32% body fat?! This sucks! I give up!!

So here’s the simple secret:

• Do things a little bit better, consistently.
• Get back on track when you wander off.
• Keep at it.

If you’re looking for a p-word, opt for persistence and patience, not perfection.

Bottom line

Every little bit helps. Everyone can improve their health, fitness, and function — even if that just means slowing an inevitable decline.

No matter how bad your situation is, getting regular movement and improving your diet will improve your health and ability to navigate the demands of daily life.

Forget about perfect and all-or-none; and think “a little better” and “one small step at a time”. And sometimes not losing ground is a win.

In January 2012, we included some young cancer survivors in our Lean Eating program, to see whether Lean Eating can help these folks improve their health and function. To read more, see here.

Click here to join the waiting list.