"Mom, I should eat broccoli because Michelle Obama says I should eat broccoli."
What music to the ears of parents and policymakers!
A week ago, Canada 2020 hosted the fifth and final panel of the year in our signature speaker series, The Canada We Want in 2020. The topic was "confronting the crisis in public health," specifically how we can come together to combat obesity and related chronic diseases.
One of our panelists was the dynamic and accomplished Melody Barnes, former White House Director of Domestic Policy to President Barack Obama, and chair of the administration's task force on childhood obesity. Melody was also heavily involved in the First Lady's Let's Move! campaign aimed at persuading Americans to embrace healthy living.
Canadians are up against the same public health challenges as our American neighbours. According to recent data published in the Canadian Journal of Public Health, 25 per cent of the Canadian population is estimated to be obese. Obesity rates here in Ontario are above the national average at almost 29 per cent and, on the current trajectory, an estimated 70 per cent of Ontario's current kids will enter middle age obese or overweight.
Rates are already higher in other provinces and amongst particular social groups (aboriginal Canadians and those from lower socio-economic groups, especially disadvantaged women). In some Atlantic provinces obesity rates already exceed 35 per cent.
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The issue: As the "No Time to Wait: The Healthy Kids Strategy" report notes, there are more than 50 different genes that have been found to be associated with obesity, and likely more that haven't yet been uncovered. Some of these include genes that contribute to people feeling hungry, even when they're not. The potential solution: For some genes, breastfeeding has been found to help stave off these effects. A Harvard study also found that exercise can be another preventative measure.
The issue: Thanks to the way evolution works, our bodies tend to crave high-calorie foods over other types to ensure we have enough to sustain our energy — even when there's plenty of options around us. The potential solution: The answer could start in utero — correlations have been found between women eating high calorie foods while pregnant and children growing up with weight issues.
The issue: Just like for adults, getting enough sleep in childhood is closely linked to weight gain, and according to Time, children have been getting anywhere from 30 to 60 minutes less sleep in the past decade. The potential solution: Ensure children are getting the sleep they need, according to their age. For newborns (0-2 months), that's 12-18 hours; infants (3-11 months) 14-15 hours; toddlers (1-3 years), 12-14 hours; preschoolers (3-5 years) 11-13 hours; school-aged children (5-10 years) 10-11 hours; and adolescents (10-17 years) 8.5-9.25 hours.
The issue: While research is still being conducted on the relationship between weight and mental health, some links have been made with medication and weight gain, as well as a lack of self-esteem and less physical activity. The potential solution: Definitive research is still needed, but there's a potential for children falling into a vicious cycle of, for example, depression and not eating properly or exercising regularly. Incorporating physical activity can help reduce stress as well as potential for mental illness, while medical professionals can help advise on alternatives to medications that cause weight gain.
The issue: Parents point to a lack of time to prepare healthy meals, and are serving more fast food and processed food to their kids. The potential solution: Ensuring family meals are a regular occurrence, where both kids and parents pitch in with healthy menu ideas and preparing the food. This helps ensure everyone knows what ingredients are going into their bodies.
The issue: Fresh fruits and vegetables tend to cost more than fast food or prepared meals, and it can be difficult for families, especially those with less income, to buy healthy food all the time. The potential solution: One suggestion nutritionists often make is to buy frozen fruits and vegetables (not frozen meals) to cut down on costs and seasonality, making them an easy addition to most meals. Just watch out for seasonings, which can contain lots of sodium.
The issue: For smaller towns and communities, fresh food isn't available all year round, but fast food is plentiful. The potential solution: These so-called "food deserts" are an issue across the continent, but some potential innovative solutions have been cropping up, like mobile markets and fresh food in reclaimed regions like shipping containers, as CBC reported.
The issue: We might have a ton of information about nutrition at our fingertips, but not a lot of it is sinking in. According to the Panel, parents report not knowing how many calories their kids need each day, or what nutritional information on foods actually means. The potential solution: Reading articles about deciphering nutrition labels is always helpful, but giving kids a holistic education in school on their daily needs, and which foods will actually deliver them in a healthy manner, could also change the tide.
The issue: There's no question kids are more attached to electronics than ever before (as we all are), and it's impacting how much they are moving around. As the Panel reports, kids now spend 62 per cent of their waking hours sedentary. The potential solution: The CDC recommends children get at least one hour of physical activity each day, so parents need to make an effort to ensure that's happening with their children, whether it's walking to and from school, playing in the backyard or engaging in extracurricular activities.
The issue: Along the same lines of the issues with physical activity, the busier schedules get, the more likely kids are to get around by car and less by their own physical effort, whether that means walking, biking or even being pushed in a stroller. The potential solution: Planning enough time to allow children to walk to and from activities and school, and building that into the daily schedule. Stopping the reliance on the car will be good for the wallet, the earth and the body!
The issue: For kids who want to get involved in sports or extracurricular activities, this can mean a significant financial investment — and often for parents who can't afford it. The potential solution: Looking into secondhand equipment or even scholarships for sports is an option, as are lower-cost leagues or sports that require fewer pieces of equipment, such as track and field.
The issue: Along with busy schedules that compel parents to drive are neighbourhoods that do the same thing, thanks to a lack of sidewalks — or other areas that don't allow for outdoor playing, as when ball hockey is banned on streets. The potential solution: Finding open spaces in your neighbourhood for kids to play together, whether it's on playgrounds or even someone's big front yard. Parents can also band together to talk to town officials about restrictions in order to find a way to get kids moving.
The issue: A combination of potential dangers and parents who are possibly more nervous than those in generations past can make for situations where children aren't allowed to go outside and play, keeping them from their healthy physical activity. The potential solution: Talking to other neighbourhood parents about the issue can help create an organization that allows for kids to play safely together, possibly with a rotating chaperone.
The issue: The massive prevalence of junk food advertising directed at children — according to the Panel, in one week, 2,315 food-related ads were shown on free channels in Ontario and Quebec, 257 of which aired when at least 20 per cent of the audience was targeted at 2-to-17 year olds. The potential solution: The Ontario government is currently taking into consideration the recommendation that junk food ads be banned from being shown to kids, though nothing has yet been set in place.
The issue: This massive topic obviously affects everything from health to education to relationships. But when it comes to obesity, lower incomes mean fewer fresh foods, both in supermarkets and restaurants. It could also mean living in an area where such options aren't even available, and for immigrant families, not having access to (or enough time to prepare) traditional ingredients and meals. The potential solution: This issue encompasses almost every factor mentioned in the report, and each step forward from both a personal and governmental level can help alleviate the issues, if not completely correct them.
Childhood obesity is a particular problem: research shows that early onset obesity increases the risk factors for a range of chronic diseases -- including diabetes, coronary heart disease and atherosclerosis. Obesity in females during late adolescence is also associated with psychosocial behavioural abnormalities in adulthood.
If we are to change this trajectory, we need to consider evidence-based policy approaches that have successfully improved obesity-related health outcomes. The following are some of the key messages and insights that emerged at our event:
1. Promote healthy living without demonizing different body types.
The body-mass index is used to estimate overweight and obesity rates amongst different populations. However, in our efforts to address the growing obesity epidemic we should not be concerned with the final output (weight) but rather the inputs (sedentary lifestyles, eating food of poor nutritional quality, etc.) that affect our health outcomes. Obesity is simply a proxy measure for increased disposition to myriad chronic diseases that will lead to soaring costs of healthcare delivery and a diminishing quality of life in years to come.
2. We cannot educate our way out of this crisis.
Two of our panelists, Melody Barnes and Alex Munter (President and CEO of the Children's Hospital of Eastern Ontario) repeatedly emphasized this point. It is imperative to educate individuals about the importance of healthy eating and active lifestyles so that they can make informed choices. However, information alone is not sufficient: Canadians also need better access to nutritious lunches at school cafeterias, grocery stores that stock fresh produce at affordable prices, safer parks and recreation facilities and other health-promoting infrastructure. This is where governments have a particular role to play. With their support, the healthy choice can become the default choice.
3. Improving health outcomes is not just the responsibility of individuals but also of the collective "us."
Confronting the crisis in public health requires different (and sometimes opposing) forces including government, industry, NGO partners, health practitioners and individuals to act together. There is no magic bullet, no one miracle program and no single player that can succeed on its own. The programs and initiatives that deliver results have two things in common: they are uniquely tailored to address the specific issues faced by a given community and they are supported by multiple stakeholders.
In Canada, certain corporations stand out for their efforts to address the issue of obesity. For example, Coca Cola Canada has recently announced that it will make nutritional information more transparent by featuring calorie counts on the front of all packages. The company's new marketing guidelines include a self-imposed ban on buying advertising space in media directed at audiences comprising more than 35 per cent children under the age of 12. In addition, Coca Cola is supporting physical activity and nutritional education programs, such as the Breakfast Club of Canada. Loblaw is also making concerted efforts to bring in more nutritional information through its Guiding Stars program and its in-store dietitians.
Hopefully other companies will follow this lead. But it is also likely to take regulation (such as that proposed in Ontario's recent Healthy Kids Strategy) to make sure that young children are not subject to junk food advertising and, thus, that parents are better able to control the nutritional messages reaching their children. Such regulation has already proven to be very effective in Quebec where the ban that has been in place since 1980 is estimated to have reduced junk food consumption among children by 13 per cent.
Certainly, governments have an important role to play, and not just in the direct area of health promotion. As Alex Munter noted, the government of Ontario is addressing two key social determinants of health with its focus on poverty reduction and mental health and addiction. And the federal government is increasingly moving towards being a facilitator of partnerships and an enabler of best practice.
The First Lady of the U.S. has provided a very visible rallying point in that country -- people respond to her sheer force of personality. Children look up to her; they want to eat their vegetables for her. That's not a policy lever, but no one can say it's not effective.
Here in Canada we do not have such a figure, but, encouragingly, we do have a federal government that is becoming more active in this space and that has demonstrated, in its recently released 2013-2016 Preventing Chronic Disease Strategic Plan, that it has a good understanding of the challenges it must address. It sees itself as an information hub, willing to fund partnerships and to act as a catalyst in the prevention of chronic disease, much of which is attributable to obesity and overweight.
As Alex Munter reminded us, "public policy always lags culture, and the culture on healthy eating is changing fast." That bodes well for the future, but we should not underestimate the sustained effort that it will take to change the trajectory of ill-health into which we have fallen.