Yesterday, the Canadian Standing Senate Committee on Social Affairs, Science and Technology released their report on the state of obesity in Canada.

Included in that report is a series of 21 recommendations.

As a health/fitness/politics junkie, this report is like catnip to me, so I was pretty eager to get my grubby little paws on a copy.

Let’s take a look inside….

The Cost of Obesity in Canada

The committee’s findings show the vast scope of this epidemic:

• Each year 48,000 to 66,000 Canadians die from conditions linked to excess weight;
• Nearly two thirds of adults and one third of children are obese or overweight; and
• Obesity costs Canada between $4.6 billion and $7.1 billion annually in health care and lost productivity

In short: Canada’s obesity problem is way too big to be ignored

How did this happen???

1. Nutrition

In terms of eating habits, the committee was told that since the 1980s, Canadians have decreased their intake of high fat foods and increased intakes of fruits and vegetables, as recommended by the food guide. However, consumption of processed, ready-to-eat and snack foods have shown the largest increase over this period.

Over this period of time (80s – present), a review of Canada’s food guide reveals that Canadians have been told to switch…

• from a diet of a modest number of daily servings reflecting a balance of whole foods
• to a low fat diet that permits significantly more servings per day, a large proportion of which should be grain products, or carbohydrates.

The committee was told that, as a result, the food guide may be recommending a diet that is nutritionally insufficient with respect to vitamins D and E, potassium and choline and that only by eating artificially fortified and highly-processed cereals can the diet provide adequate levels of calcium, iron and vitamin B12

• According to 2012 data only 40% of Canadians are eating even the lower recommended number of fruit and vegetables per day, 5 servings.
• The food guide recommends that adults should be consuming closer to 10 servings of fruits and vegetables each day.

At the same time, Manuel Arango, of the Heart and Stroke Foundation of Canada, indicated that as much as 62% of the Canadian diet can be categorized as highly-processed, a percentage that has been rising in recent decades at the expense of whole foods.

As a consequence of the increased intake of highly processed foods, sugar consumption has increased dramatically from 4 pounds annually per person 200 years ago to 151 pounds annually per person today.

The overwhelming consensus among witnesses with respect to food consumption trends was that the consequence of Health Canada’s evolving food guide and the increasing variety and availability of processed and ready-to-eat foods has been a pronounced decrease in consumption of whole foods and alarming increase in the consumption of ultra-processed foods.

As a result, Canadians are eating too much calorie-rich and nutrient-poor food.

In short: Canadians eat too much processed food and not enough real food. 

2. Physical Activity (or lack thereof)

Regarding physical activity, the committee heard that the participation rate in organized sport among Canadians has not declined in recent decades, and may have increased. However, several witnesses emphasized that although participation in such activities is encouraged, it does not by itself ensure that Canadians, especially children, are getting sufficient exercise.

They described how many of these activities include a significant amount of sedentary time and that they tend to lead people into thinking that they are doing more than enough to be considered as being physically active. Members heard, for example, sports such as hockey, soccer or basketball include a lot of instruction time outside of games, and a lot of bench time during games, when participants are idle.

More importantly, several witnesses suggested that it is the decline in active, free play among children and a decline in the activities of daily living among adults that have primarily contributed to an overall decrease in physical activity.

In 2011 the Canadian Society for Exercise Physiology  developed separate, evidence-based physical activity guidelines for four age-groups; children, adolescents, adults and seniors.

The physical activity guidelines recommend:

• 180 minutes per day for toddlers and pre-schoolers,
• 60 minutes a day for children and youth up to 17 years of age,
• 150 minutes per week for adults aged 18-64 years including some bone and muscle strengthening exercises,
• and similar guidance for seniors over 65 years with exercises aimed at improving balance and reducing the risk of falls.

In addition the guidelines recommend that:

• children under four not be sedentary for more than one hour at a time.
• Children and youth are advised to limit screen time to no more than two hours per day while limiting sedentary behaviour, indoor activities and motorized transport.

Unfortunately, a minority of Canadians are meeting these goals.

Although 50% of Canadians believe they meet the physical activity guidelines when asked, in fact, when objectively measured, only 15% of adults are actually getting the recommended 150 minutes of physical activity per week.

On average, Canadian adults obtain only 12 minutes of moderate to vigorous exercise per day.

Similarly, children and youth are largely failing to meet the recommended 60 minutes of daily exercise. According to Elio Antunes, President of ParticipACTION, less than 9% of children and youth are sufficiently active, and the proportion of active kids decreases with age.

The committee was told that only 7% of 5-11 years olds meet the physical activity guidelines and this proportion drops to only 4% for adolescents.

With respect to the sedentary guidelines, the committee heard that less than 15% of 3-4 year olds and only 24% of 5-17 year olds are meeting the recommendations.

In fact, members were told that children and youth are spending 38 to 42 hours per week in front of television, desktops, laptops, ipads and smartphones.

In short:  While we think we have increased our rates of physical activity via structured exercise (sports leagues, gym memberships, personal trainers, etc), we haven’t….our rates of daily physical activity continue to drop while our rates of sitting on our butts staring at screens have continued to rise.

To make it even worse, we are setting up our kids to be even lazier than we are.

So….what are we going to do about it???

In the discussions of what we can do to reverse the trend of obesity in Canada, participants kept coming back to Canada’s anti-smoking strategy.

Despite the obvious distinction that smoking is a completely unnecessary practice while eating is essential, witnesses noted several lessons that we have learned from the anti-smoking campaign:

1. the anti-smoking strategy employed several different approaches implemented by different levels of government.
2. the evidence-base of the negative health consequences had to be elucidated and presented clearly to Canadians.
3. the strategy had to bring about a societal change in terms of how smoking was viewed.
4. the change in behaviour would take time.
5. the strategy would not be popular with the industry.
6. and finally, the federal government provided the leadership for a pan-Canadian approach.

In their comparison of the anti-smoking strategy to any anti-obesity strategy, witnesses continued to emphasize the need for a comprehensive, health-in-all-policies, whole-of-society approach.

The committee was told that policies, wherever possible, should encourage or facilitate the pursuit of healthy lifestyles. In this regard, witnesses suggested that a health lens, should be applied to a range of policy development, across departments and across all levels of government. An effective all-of government platform would encourage the development of provincial and regional initiatives that promote healthy lifestyles. As such, the committee would like to see the federal government take aggressive measures to help Canadians achieve and maintain healthy weights.

In short:  While Canada’s successful anti-smoking strategy can serve as an effective model, we have to remember that obesity is a much more complex problem and as such requires a more comprehensive solution.

In that spirit, the “Obesity in Canada” Committee has come up with 21 suggestions for reversing Canada’s obesity problem.

Here’s the list….

Recommendation 1

The committee recommends that the federal government, in partnership with the provinces and territories and in consultation with a wide range of stakeholders, create and implement a National Campaign to Combat Obesity which includes goals, timelines and annual progress reports.

@healthhabits says:  This is exactly the kind of thing government should be good at. Bringing all sorts of disparate stakeholders together to work together towards a common goal. IMHO, this is a necessary step.

Recommendation 2

The committee recommends that the federal government:

• Immediately conduct a thorough assessment of the prohibition on advertising food to children in Quebec; and,
• Design and implement a prohibition on the advertising of foods and beverages to children based on that assessment.

@healthhabits says:  Quebec has had a prohibition on the advertising of all food and beverages to children under the age of 13 under its Consumer Protection Act11 for many years. Studying the effectiveness of this program to determine if it should be rolled out nationwide makes sense to me.

Recommendation 3

The committee recommends that the federal government:

• Assess the options for taxation levers with a view to implementing a new tax on sugar-sweetened as well as artificially-sweetened beverages; and,
• Conduct a study, and report back to this committee by December 2016, on potential means of increasing the affordability of healthy foods including, but not limited to, the role of marketing boards, food subsidies and the removal or reduction of existing taxes.

@healthhabits says:  Skip the study and just go ahead and slap a tax on sugar-sweetened as well as artificially-sweetened beverages AND take ALL of that money and use it to subsidize un-processed (aka real) food

Recommendation 4

The committee further recommends that the Indigenous and Northern Affairs Canada immediately:

• Address the recommendations made by the Auditor General with respect to the Nutrition North program and report back to this committee on its progress by December 2016

@healthhabits says:  Northern communities are much worse off in terms of overall nutrition and the cost of nutritious food in particular. Canada’s north is one giant food desert. As such, it may require special (aka expensive) intervention.

Recommendation 5

The committee further recommends that the federal government conduct assessments of the Children’s Fitness Tax Credit, the Working Income Tax Benefit and the Universal Child Care Benefit with a view to determining how fiscal measures could be used to help Canadians of lower socio-economic status, including our Aboriginal population, choose healthy lifestyle options.

@healthhabits says:  Skip the assessment, ditch the tax credits. They are designed to reward the well off & ignore the poor…which is just plain stupid as the poor are the ones driving Canada’s obesity epidemic. If we want to save healthcare & improve economic productivity, any physical activity incentives need to be directed primarily at the poor & secondarily at more affluent Canadians.

Recommendation 6

The committee recommends that the Minister of Health immediately undertake a complete revision of Canada’s food guide in order that it better reflect the current state of scientific evidence. The revised food guide must:

• Be evidence-based;
• Apply meal-based rather than nutrient-based principles;
• Effectively and prominently describe the benefits of fresh, whole foods compared to refined grains, ready-to-eat meals and processed foods; and,
• Make strong statements about restricting consumption of highly processed foods.

@healthhabits says:  All of these four recommendations sound great. 

Recommendation 7

The committee further recommends that the Minister of Health revise the food guide on the guidance of an advisory body which:

• Comprises experts in relevant areas of study, including but not limited to nutrition, medicine, metabolism, biochemistry, and biology; and,
• Does not include representatives of the food or agriculture industries.

@healthhabits says:  Agree 100%. Economic bias should not be allowed in Canada’s Food Guide…even if food lobbyists support an MPs re-election campaign.

Recommendation 8

The committee therefore recommends that the Minister of Health prohibit the use of partially hydrogenated oils, to minimize trans fat content in food, unless specifically permitted by regulation.

@healthhabits says:  Agree 100%

Recommendation 9

The committee further recommends that the Minister of Health:

• Reassess the daily value applied to total carbohydrates based on emerging evidence regarding dietary fat and the fat promoting nature of carbohydrates;
• Ensure that the regulatory proposals for serving size have addressed all of the concerns raised by stakeholders during public consultation, and,
• Require that the daily intake value for protein be included in the Nutrition Facts table.

@healthhabits says:  Every few years, nutrition experts flip-flop their positions on the relative healthfullness of the different macronutrients. One decade, we are supposed to avoid fat…then it’s carbs…then it’s “too much” protein, then we’re back to fats…and so on…

My suggestion is to avoid making blanket statements on the healthfullness (or lack thereof) of any macronutrient.

There is nothing wrong with eating fat or carbs or protein.

The problems start when people:

• start eating excessive quantities of overall calories
• demonize a single macronutrient and replace it with a highly-processed substitution
• choose poor quality highly-processed food over real food – fruit, veg, seeds, meat, etc.

With all of this said, I think that the consumer needs as much info about the quality of the food they are eating AND the gov’t can help them by requiring a total nutritional profile of every food product be made available on the company’s website

Recommendation 10

The committee further recommends that the Minister of Health assess whether sugar and starch should be combined under the heading of total carbohydrate within the Nutrition Facts table and report back to this committee by December 2016.

@healthhabits says:  Give us sugar totals, starch totals AND total carb totals.

Recommendation 11

The committee therefore recommends that the Minister of Health implement strict limits on the use of permitted health claims and nutrient content claims based on a measure of a food’s energy density relative to its total nutrient content.

@healthhabits says:  Agree 100%. I would also require any nutritional claims require scientific proof. Links to that science should be available from the products page on the company website. Make a claim…back it up.

Recommendation 12

The committee therefore recommends that the Minister of Health:

• Immediately undertake a review of front-of-package labelling approaches that have been developed in other jurisdictions and identify the most effective one;
• Report back to this committee on the results of the review by December 2016;
• Amend the food regulations to mandate the use of the identified front-of-package approach on those foods that are required to display a Nutrition Facts table; and,
• Encourage the use of this labelling scheme by food retailers and food service establishments on items not required to display a Nutrition Facts table.

@healthhabits says:  If you sell food in a package, you should be required to have a Nutrition Facts table as part of the packaging. As well, a website url pointing to a page with more complete nutrition info about the product should be included as well.

Recommendation 13

The committee therefore recommends that the Minister of Health encourage nutrition labelling on menus and menu boards in food service establishments.

@healthhabits says:  This is a little vague. How about something more specific like…calories, macronutrients, allergens listed in small print on the menu AND a more thorough nutritional analysis for each item on a separate booklet…and on their website as well.

Recommendation 14

The committee therefore recommends that the federal government increase funding to ParticipACTION to a level sufficient for the organization to:

• Proceed with Active Canada 20/20; and
• Become the national voice for Canada’s physical activity messaging.

@healthhabits says:  Based upon what I have seen from ParticipACTION in the past few years, I am not sure if giving them more money is the best idea. 

It may be simpler and more effective for Health Canada to hire the same PR flacks that put together Canada’s anti-smoking campaign and get them to focus on a “exercise more : play more : move more” style of message.

I’m not sure why we need ParticipACTION’s added layer of bureaucracy.

Why not…

• hold a public contest for ad/pr/marketing firms to come up with their best message to get Canadian’s active again
• have Canadians vote via the contest’s website/FB page/Twitter/etc
• award the winner the contract
• promote the heck out of the programs via internet, tv, radio and print.

And while we’re at it, why don’t we throw out a request to Canadian celebrities & athletes asking them to donate their time to film some short PSAs to add to the Health Canada Youtube channel.

Of course, I could be completely wrong about the fine folks who work for ParticipACTION. They may have exactly the kind of expertise to organize the kind of program needed to get Canadians active again.

Recommendation 15

The committee further recommends that the Minister of Health and the Minister of Sport and Persons with Disabilities together use the recently established National Health and Fitness Day to promote the Canadian Physical Activity Guidelines.

@healthhabits says:  I didn’t even know there was a National Health & Fitness Day. I guess that’s why they need the promotion.

Recommendation 16

The committee further recommends that the Public Health Agency of Canada provide sustained or bridged funding for pilot projects that have been assessed as effective.

@healthhabits says:  Hmmmmmmm who’s making the assessments? And what happens when they haven’t be PROVEN effective after a year or two of government $$$$ in their bank accounts?

Recommendation 17

The committee further recommends that the Minister of Health in discussion with provincial and territorial counterparts as well as non-governmental organizations already engaged in these initiatives:

• Encourage improved training for physicians regarding diet and physical activity; • Promote the use of physician counselling, including the use of prescriptions for exercise;
• Bridge the gap between exercise professionals and the medical community by preparing and promoting qualified exercise professionals as a valuable part of the healthcare system and healthcare team;
• Address vulnerable populations, such as Canadians of lower socio-economic status including Canada’s Aboriginal population, and pregnant women;
• Advocate for childcare facility and school programs related to breakfast and lunch programs, improved physical education, physical activity and nutrition literacy courses; and,
• Engage provincial governments in discussions about infrastructure requirements for communities that encourage active transportation and active play.

@healthhabits says:  All of the suggestions sound great…and yet they are couched in the kind of government bureaucracy speak that makes me lose all confidence. Can we please get a little less talk about what we want to do and a little more talk about how we’re going to do it!!!

Recommendation 18

The committee further recommends that the federal government provide funding under the New Building Canada Fund to communities for infrastructure that enables, facilitates and encourages an active lifestyle, both indoors and outdoors.

@healthhabits says:  If that means more walking paths, more bike paths and more walkable neighbourhoods…I am on board. If that means funding for arenas & pools…I have to disagree. We need to keep a focus on the cost : benefit ratio. Tax dollars don’t grow on trees.

Recommendation 19

The committee therefore recommends that the Public Health Agency of Canada implement a strategy to increase the visibility, uptake and use of the Best Practices Portal by stakeholders across the country.

@healthhabits says:  Never heard of the Best Practices Portal. At first glance, it seems a little meh, but the idea is solid. Give Canada’s docs a dedicated site to source info on reducing obesity & related diseases seems like a great idea.

Recommendation 20

The committee therefore recommends that Health Canada design and implement a public awareness campaign on healthy eating based on tested, simple messaging. These messages should relate to, but not be limited to:

• Most of the healthiest food doesn’t require a label;
• Meal preparation and enjoyment;
• Reduced consumption of processed foods; and,
• The link between poor diet and chronic disease.

@healthhabits says:  See my comments on funding ParticipACTION above. We don’t need multiple groups coming up with different public awareness campaigns. Have a contest, using the Canadian people as judges, ask Canadian celebrities & athletes for assistance

As well, bring back Home Ec in school.

Recommendation 21

The committee further recommends that Health Canada and other relevant departments and agencies, together with existing expertise and trusted organizations, implement a comprehensive public awareness campaign on healthy active lifestyles.

@healthhabits says:  See above….physical activity, diet and healthy active lifestyles should all be promoted AT THE SAME TIME.

What do you think???

Hit me up on Twitter or Facebook if you want to discuss.

Reference

• Obesity in Canada: A Whole-of-Society Approach for a Healthier Canada
• Report highlights

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