"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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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.