AGING POPULATION
COSTS AND SPENDING
FOR-PROFIT
HEALTH MORE THAN HEALTHCARE
INTERNATIONAL HEALTH SYSTEMS
MENTAL HEALTH
MORE NOT ALWAYS BETTER
OBESITY
PATIENT PAYS
PHARMACEUTICAL POLICY
SUSTAINABILITY
WAITING FOR CARE
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Obesity

ObesityTopic_May72013_000022214756Medium.jpg

Obesity

What’s the Issue?

Obesity rates have been increasing at an alarming rate: More than 1 in 4 Canadian adults are obese and childhood obesity has tripled in the past 25 years. The trend in childhood obesity is particularly alarming since excess weight in children tends to persist into adulthood. Rising obesity rates parallel the increasing prevalence of diabetes, heart disease, hypertension, cancer, and a number of other diseases. Obesity is also associated with increased indirect costs through decreased workplace productivity, restricted activity, and increased absenteeism.

While the obesity issue is more complex, it is worth considering lessons from the regulation of tobacco and alcohol. Obesity, like smoking and alcohol abuse, is not simply the result of individuals making bad decisions, but strongly influenced by the social and commercial environment that puts some individuals at higher risk for certain behaviours. Some risk factors for obesity include the promotion and availability of high-calorie foods, limited access to affordable healthy foods, lack of time for meal preparation, lack of cooking skills, and barriers to physical activity. Like the steps taken towards tobacco and alcohol control, there is a growing sense of urgency that government action is necessary to reverse the current upward trends in weight.

What has changed in the last 20-25 years that is causing Canadians to gain weight? Although, simply speaking, weight gain results when more calories are consumed than the body requires, there is a complex interplay between environment, culture, socioeconomic and biological factors, all of which have changed over the last several decades.

The food industry is perceived by many health experts as a substantial part of the obesity crisis because it encourages food-heavy environments. The available calories and portion sizes of foods and beverages have increased markedly. Food is widely available, not just at grocery stores and restaurants, but also at gas stations, drug stores, and vending machines, to name just a few. When we’re presented with so much food, most of us will eat more without even thinking about it, making us more vulnerable to overeating.

The average Canadian has also become less physically active. Although half of Canadian adults (52.5%) report that they are physically active, only 15% are meeting national guidelines when activity is measured with an accelerometer. Obese individuals tend to have sedentary leisure time pursuits. Canadian youths are accumulating more than 6 hours of screen time on weekdays and many studies show that TV viewing is associated with greater calorie intake or poorer diets.

Obesity is a complex health issue to address. No single intervention is going to solve this problem. While physical activity is important in improving health, increasing physical activity by itself is unlikely to be effective in weight control. High priority should be given to interventions that help to reduce the number of calories people consume and to do this, the government and the food industry have key roles to play.

The government can develop proactive strategies to reduce caloric consumption. Some of the promising regulatory approaches include:

  • Discouraging higher calorie consumption by enforcing portion sizes. For example, food and beverage portions that exceed a certain number of calories per serving would clearly display these calories and/or incur a higher tax.
  • Banning food and beverage ads targeting children.
  • Zoning laws prohibiting fast food sales near schools.
  • Regulating nutrition claims on packaging.

The government can also reform nutrition fact panels. Nutrition information on packaging is not expressed in ways that are meaningful to the average consumer. There is a need for a robust national food scoring and labeling system to help consumers determine how a typical serving of the food fits into a healthful daily diet.


Evidence

  • Fast Food FACTS 2013, issued by the Yale Rudd Center for Food Policy & Obesity, examines the nutritional quality of fast food, and how restaurants market their foods and beverages to children and teens. The report examines 18 of the top restaurant chains in the United States, and updates a similar report released in 2010.
  • Obesity in Canada. Obesity in Canada is a joint report from the Canadian Population Health Initiative of the Canadian Institute for Health Information and the Public Health Agency of Canada. The joint report examines the prevalence of obesity among adults, children, youth and Aboriginal Peoples; presents new analyses of the determinants of obesity using innovative measures; and reports on the impact of obesity in Canada. In addition, Canadian and international lessons learned in obesity prevention and reduction are highlighted.
  • The Active Healthy Kids Canada Report Card on Physical Activity for Children and Youth is an evidence-informed communications and advocacy piece that provides a comprehensive assessment of Canada’s “state of the nation” each year on how, as a country, we are being responsible in providing physical activity opportunities for children and youth. See the 2013 Report Card here.
  • The latest report from the School of Population Health at the University of British Columbia on mapping obesity rates across Canada shows an all-time high, with the prevalence of obesity highest in Eastern and Northern Canada.
  • Infographic: Obesity rates are now at 25-29 per cent in most provinces and more than 30 per cent in the Atlantic provinces, Nunavut and the Northwest Territories.
    Gotay, C., Katzmarzyk, P., Janssen, I., Dawson, M., Aminoltejari, K., Bartley, L. (2013). Updating the Canadian obesity maps: An epidemic in progress. Canadian Journal of Public Health, 104(1). Retrieved from http://journal.cpha.ca/index.php/cjph/article/view/3513
  • 31% of Canadian kids are overweight or obese.
  • The report by Centers for Disease Control and Prevention highlights five regulations used in reducing alcohol consumption that could help address the obesity epidemic.
  • RAND corporation summarizes key studies on the causes of obesity, its economic and health consequences, and potential food and environmental strategies for prevention.
  • The built environment influences how much energy individuals expend. The director of the Columbia University’s Built Environment and Health project, Dr. Andrew Rundle, says “I see a role of personal responsibility, but I strongly believe that we have organized our society such that my will power is constantly being challenged”. How where we live is making us obese.
  • 44% of physicians are overweight and obese in North America. Healthcare providers like an average person are simply “stuck” in obesogenic environments.
  • Research briefs by RAND highlight the role of neighborhoods in stimulating physical activity and reducing the risk of obesity. “Neighborhoods exert a powerful effect on residents’ physical activity and thus that neighborhood design should be considered a public health issue”.
  • Lessons from the Amish: a study revealed that the Amish maintained low obesity rates despite high caloric and fat intakes, as well as having a gene variation that makes them susceptible to obesity. The key factor was their level of physical activity.
  • McMaster health forum: Evidence on the obesity problem in Canada and a promising range of options to address the problem. “Promoting healthy weights using population based interventions in Canada”.
  • A growing number of initiatives that are part of a larger effort in curbing the obesity epidemic signal the urgency for reducing consumption of sugary drinks, which are the biggest source of calories in the American diet.
  • From Alberta, the Sugar Shocker education kit includes “an activity to help teach students about making healthy drink choices”.
  • Quebec’s Weight Coalition reports “taxing sugar sweetened beverages: a promising measure for obesity prevention”.
  • Standardization of portions, such as the Bloomberg’s regulation on portion size, may be one of several effective strategies to promote moderate consumption while still allowing for individual choice. The report also highlights other policy options that could be effective.
  • There are many state and local policy options to reduce food marketing, especially junk food, to children. The Food Marketing Workgroup recommends policy guides and model policies on addressing food marketing at schools.
  • A report by Centers for Disease Control and Prevention shows evidence on how implementing a state policy that restricts the sale of junk foods and soda in schools can successfully achieve strong nutrition standards and maintain revenue from food sales.
  • Fat Chance! For Evidence, One Size Does Not Fit All in the Public Health War on Obesity. A study that casts doubt on whether being overweight is associated with a shorter life span has sparked 2013’s first public health controversy—and a fiery one at that.
  • Canadian nutrition label claims are often misleading.
  • A report prepared by Center for Science in the Public Interest makes a case for reforming food labels.
  • The US is adopting a national food scoring system called NuVal, which enables consumers to easily compare the health benefits of any food. Canada’s Heart and Stroke Health Check program only scores a very limited range of nutritional criteria and does not permit product comparison.

Our Commentaries

  • Teenagers at risk from junk food advertisements
    Teenagers at risk from junk food advertisements
    By Tom Warshawski and Mary Lewis
  • In the fight for kids’ attention, parents don’t stand a chance
    In the fight for kids’ attention, parents don’t stand a chance
    By Monique Potvin Kent
  • A sugar-sweetened beverage tax is not the answer
    A sugar-sweetened beverage tax is not the answer
    By Natalie Riediger
  • SHIMMIN_Five things every Canadian should know about obesity
    Five things every Canadian should know about obesity
    By Carolyn Shimmin

Browse All Commentaries View French Commentaries

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Denis Daneman, MBBCh, FRCPC
University of Toronto
Chronic Disease and Social Determinants of Child Health
416-813-6122 | [email protected]


Yoni Freedhoff, MD
University of Ottawa
Nutrition, Obesity, Weight Management
613-730-0264 | [email protected] | @YoniFreedhoff


Michael Hayes, PhD
University of Victoria
Health Inequities, Disability and Child Obesity
250-853 3108 or (c) 250 818 2410 | [email protected]


Jan Hux, MD, SM, FRCPC
University of Toronto
Diabetes Risk Factors, Chronic Disease
800-226-8464 | [email protected]


Jennifer Kuk, PhD
School of Kinesiology and Health Science
Weight Management, Health Promotion, Lifestyle Interventions
416-736-2100 ext 20080 | [email protected]


John Millar, MD, FRCP(C), MHSc
University of British Columbia
Public Health, Health Policy, International Health
604-922-0995 or (c) 604-785-9058 | [email protected] | @JohnMillar10


Kim Raine, PhD, RD, FCAHS 
University of Alberta
Social Factors and Interventions in Obesity and Food
780-492-9415 | [email protected]




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    Our Topics

    AGING POPULATION
    COSTS AND SPENDING
    HEALTH MORE THAN HEALTHCARE
    INTERNATIONAL HEALTH SYSTEMS
    FOR-PROFIT
    MENTAL HEALTH
    MORE NOT ALWAYS BETTER
    OBESITY
    PATIENT PAYS
    PHARMACEUTICAL POLICY
    SUSTAINABILITY
    WAITING FOR CARE


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