Stop the Presses

How Are We Doing and Where to Next, Canada?

The Conference Board of Canada, in association with the Centre for Food in Canada, released their report on “Improving Health Outcomes: The Role of Food in Addressing Chronic Diseases” this week, and the results show there are definitely areas for improvement (we’re putting it mildly!).

Of the three chronic diseases focused on in the report – heart disease, diabetes and cancer – food-related risk factors have only modestly changed at the population level, which supports the notion that rates will continue to rise as will the associated economic burden.

Here are some of the highlights (or lowlights, depending on your perspective!):

  • Knowledge and awareness: Knowledge of what a “healthy diet” looks like is improving, and Healthy Eating with Canada’s Food Guide is the second most-requested government document. Fat continues to be a major source of confusion though and food labels don’t seem to help clarify anything. We always say, there is a major difference between knowing and doing, as the rest of the report perfectly illustrates!
  • Caloric intake: As a whole, Canadians exist in a state of positive energy balance, where intake exceeds expenditure, often to a large degree. But is it Forks or Feet? The evidence for both is good, but more so for Feet… we have become less active and more inactive over time, and the availability of unhealthy choices has increased dramatically – not a good combination, as our waistlines show.
  • Alcohol: Most Canadians seem to follow moderation guidelines for alcohol consumption, with the majority of Canadians self-identifying as “light infrequent drinkers” (36%) or “light frequent drinkers” (32%).
  • Sodium: The average sodium intake is an estimated 3,400 mg per day, well above the upper limit of 2300mg/d. We are not alone is this struggle, however, as most other developed countries exceed their upper limits as well (though our fast food appears to be among the worst). Check out our previous post on the top sources of sodium in the diet – not necessarily where you would expect.
  • Fat: While it appears our overall consumption of “bad” fats – namely trans and saturated – has declined, 25% of Canadians continue to exceed the recommended daily fat intake.
  • Sugar: Average sugar intake is ~ 110 g per day, which accounts for 21% of total calories and is somewhere between the WHO and NIH recommended limits of 10% and 25% total calories, respectively. About 30% of our sugar intake comes from fruits and veggies (but this includes juice), while a whopping 35% comes from “other foods” like soft drinks and candy.
  • Veggies and Fruit: Between 2009 and 2010, the number of Canadians consuming a minimum of 5 servings daily dropped from 46% to 43%. Not a promising trend, but that degree of change in only one year (even considering margin of error) is startling, particularly given that year-round availability of veggies and fruit has improved.
  • Change in children: Children’s risk factors continue to worsen: kids are more likely to take in more energy then they need, log more hours in front of the TV, etc. Over the past three decades, pediatric obesity rates have skyrocketed from 15% to 26%!

While the report does a great job summarizing the evidence, it also identifies seven target “solution” areas to focus on:

  1. “Use population-wide strategies to address sodium and trans fat intake levels and other population-wide risks.” Bring back the Sodium Working Group and actually follow the Trans Fat Monitoring Program suggestions, Health Canada! Population-wide strategies require government intervention, plain and simple. Most manufacturers will not do it on their own – or they renege later when profits slide… If the government decides to intervene and legislate change, ongoing monitoring and outcome reporting are crucial to assess the success of such initiatives. You can impact “big food” by voting with your dollar. Be a smart consumer and send the message that you want healthy options. Read the labels and make the healthiest choices possible at the grocery store.
  2. “Focus on high-risk subsets of the population with specific dietary problems.” This is where it’s not just about prevention, it’s about management. We think those with obesity-related chronic health conditions should have access to ongoing follow-up to promote as much positive change as possible, and perhaps more importantly, reduce further deterioration. Every week I hear stories of clients struggling with significant health issues, like out-of-control blood sugar or sky-high cholesterol, yet they have never been referred to an specialist OR a dietitian! We need to better utilize and expand on specialized programs targeting high-risk patients: diabetes centres, weight management centres (no, we don’t mean Dr. Bernstein!) and chronic disease programs run by a multidisciplinary team of doctors, nurses, dietitians, kinesiologists and psychologists.
  3. “Concentrate efforts on the seriously overweight and the obese.” The report suggests primary physicians are key here. Aside from the obvious “wouldn’t it be nice if everyone had access to a family doctor” argument, research suggests that one-third of obese patients are not counselled to lose weight by their family doctor, perhaps because physicians want to avoid”shame and blame”. The Canadian Obesity Network is retooling their 2006 guidelines – we wonder if they will follow the American Medical Association with respect suggesting physicians have these “tough” conversations sooner rather than later? Of course, it’s not just about BMI; simple tools, like waist circumference measurement, can remove weight from the discussion somewhat and still give a strong indicator of risk.
  4. “Clarify nutritional content descriptions on labelling and packaging.” For starters, let’s have “serving sizes” that actually match up with realistic, which are not necessarily ideal, portion sizes! Another significant issue: the Nutrition Facts table is read, but not often understood. The report suggests a simpler strategy in lieu of our complicated table, such as the Traffic Light labelling in the UK. But who decides what’s red vs. green? Best to decide early on, so we avoid another “Health Check Symbol” in the marketplace…
  5. “Conduct further research on the social, economic, and psychological drivers of consumers’ food choices as the basis for designing policies that influence their behaviours.” Amen to that! Why is there such a disconnect between knowing and doing? Education is an essential step in promoting healthy lifestyle changes but we need to go beyond education to implementation. We know there are a multitude of factors affecting dietary choices, we just need to understand them better. This will help from not only a program planning perspective, but also empower clinicians to identify barriers/motivators and tailor interventions accordingly.
  6. “Provide information, expertise, funding, and programs to parents and schools to improve children’s food literacy, eating habits, and physical activity.” We agree 100% – but in this era of school-based cutbacks, how can we possibly add more to our teachers’ plates? Research shows time and time again that high levels of parental involvement are key. But how can we get buy-in from schools and parents, while avoiding stigmatizing children who are overweight and obese? By encouraging ALL students to learn how to eat and be active, not just a select few. Education Alberta is planning to implement a mandatory K – 12 Wellness Education Framework in 2014-15 encompassing “physical activity, healthy eating and psychosocial well-being”. Details are fairly vague at this point, bit it’s a step in the right direction.
  7. “Evaluate and invest more in successful programs.” Again, ongoing funding is essential here. Though we propose that there is some why-reinvent-the-wheel going on. The public-private debate may be controversial, but stay with us. Recent studies show that Weight Watchers is a successful weight loss program– why not encourage wider use of such programs and offer reimbursement or credit a health spending account when people take the initiative to sign up? While health authority-run weight loss programs will always exist and are successful for some, they are often plagued by inconvenient hours, long waitlists and significant attrition. Isn’t it better to also support well-established commercial programs? There is more than enough business to go around!

    We cannot possibly offer group or individual weight loss counselling for free to EVERY SINGLE person who needs/wants it. By partnering with private practice dietitians, as well as those select few commercial programs that actually promote a healthy lifestyle, we can not only reach more people but also potentially dissuade people from the “quick fix” or extreme diets out there. Wouldn’t it be more cost effective to at least partially reimburse for private dietitian time or Weight Watchers, as opposed to indirectly supporting weight cycling and unsustainable fad diets?

While the media release hits the major findings, we highly recommend downloading the full report. You can view the complete report for free by registering an account. Chapters 4 and 5 focus exclusively on how the government and industry need to get onboard. If only the health of Canadians was everyone’s top priority! We have to include everyday Canadians in the “everyone” too, because personal accountability has to fit in somewhere.

We leave you with an interesting passage from the report, which perfectly sums up the industry vs. consumer quagmire we are in with respect to healthy eating:

“Consumers’ dietary options ultimately depend on what the food industry produces and sells. However, what the industry produces and sells depends on consumer demand. The reality is that most consumers demand both healthy and unhealthy options.”


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