Thursday, January 24, 2008

Health Check's "Comprehensive" Approach

In the Canadian Press article that detailed some of my concerns with Health Check, Terry Dean chose to attack me and reported that my focus and my clinic's focus is, "very much on diet".

Of course, that's not even remotely true given that my office's staff includes physicians, registered dietitians, personal fitness trainers (with on-site facilities) and a clinical psychologist and that we actually don't have any particular diet that we espouse, nor any food that we forbid.

We do however, teach our patients a great deal about nutrition.

I think it's quite telling that rather than respond to my concerns the Heart and Stroke Foundation chose to question the messenger.

Telling, but not particularly surprising, given that their recommendations are quite indefensible as evidenced by their efforts to defend them last night on CBC's investigative journalism program Marketplace.

According to Terry Dean, Health Check's approach,

"is more of a comprehensive view that it's a public health model. It's not a sodium reduction problem, it's not a diet program, it's not a fat reduction program. Our program is based on the overall diet and general healthy eating recommendations."
and in the Ottawa Citizen article that came out the following day Mr. Dean, while admitting sugar and sodium levels were sub-optimal went on record to state that while perhaps suboptimal in one nutrient,
"In every case, there are two or three nutrients it has to have"
Two or three whole nutrients. You don't say.

So the question I've got for you today - do you think that a "comprehensive" approach to nutrition would only involve looking at 2-3 nutrients?

Looking at the Health Check criteria, here is a list of every thing Health Check considers in evaluating a product (and bear in mind, according to Terry only 2-3 things are considered per product):
  1. Fat
  2. Fibre
  3. Sodium
  4. Sugar
  5. Vitamin A
  6. Vitamin C
  7. Calcium
  8. Iron
  9. Folate
That's it, that's all.

So does Terry Dean really think that there are only 9 things worth considering when evaluating the nutritional value of a food? Nope, not if he agrees with his Health Check program he doesn't, because if he agrees with his Health Check criteria, he believes that there in fact are not 9 things worth evaluating per food item, he believe that there are only 3 or 4 things worth considering. If he believes in the "comprehensive" approach of Health Check he would therefore also believe that foods should be considered in if, then rule form whereby for example if a slice of bread has less than 480mg of sodium, is a source of fibre, and is low in fat and trans fat it's good with the Health Check folks irregardless of whether or not the grain is refined or how much sugar might have been added.

Contrast Health Check's 9 nutrient if then rules with the list of nutrients and nutritional concepts recently woven together by 14 of the world's experts in nutrition into a complex food rating algorithm known as ONQI and also featured on last night's program:
  1. Fiber
  2. Folate
  3. Vitamin A
  4. Vitamin C
  5. Vitamin D
  6. Vitamin E
  7. Vitamin B12
  8. Vitamin B6
  9. Potassium
  10. Calcium
  11. Zinc
  12. Omega 3 fatty acids
  13. Bioflavanoids
  14. Carotenoids
  15. Magnesium
  16. Iron
  17. Saturated fat
  18. Trans fat
  19. Sodium
  20. Sugar
  21. Cholesterol
  22. Fat quality
  23. Protein quality
  24. Energy density
  25. Glycemic load
Oh, and they apply all 25 criteria to every single food they rate.

Yup Terry, ensuring every food has "2 or 3 nutrients" is super comprehensive. Great job.

You know the Hindenburg looked great from afar as well.

[If you missed last night's show, CBC has it up on their website here.]

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  1. msdietitian6:45 am

    Dr. Freedhoff - I have to commend you and your staff for the great work that you do at the BMI in Ottawa. You are obviously quite passionate about your work, and have excellent outcomes to boot. As a registered dietitian working in both a private clinic and in health promotion efforts, I too have had many successes in weight management with my clients and their families, using a very balanced approach of healthy diet (including the Food Guide) and regular physical activity, with a dose of support.

    No food labeling programs are going to be black and white, nor can we expect them to be with the massive, on demand global food supply (that we've created over the past number of decades) and changes to policies that affect discretionary fortification. In fact, understanding nutrition information on food packaging is very challenging when you toss in the health claims on top of it all. At the highest level, if you were going to pick the major things to focus on in a product (gram for gram) - I too, would look for dietary fibre, fat (and type), and sodium content in the context of kcal. So I think Terry's point is appropriate given that it's a general health promotion focus (and his nutrient choices are in line with the required nutrients on the nutrition facts table).

    One thing that was missing from last night's presentation is that Health Check clears all fresh fruit and vegetables, and many other foods that we really DO want to emphasize in the diet. Having been familiar with the program since its inception, I'm also versed in what IS included, far beyond the prepackaged, processed foods. To that end, I look at Health Check products as a sometimes complement - not a be all and end all - to a balanced eating plan. Remember that the Foundation promotes vegetables and fruit, whole grains, etc first and foremost in all of its publications and presentations - I don't think we should ever forget this.

  2. Anonymous9:41 am

    ONQI does not takes Calories into consideration in its rating system. Does that not outrage you?

  3. ONQI does in fact take calories into consideration as it considers the energy density of food (calories per gram).

  4. msdietitian

    What part of "general health promotion focus" HAS to include high-sodium, high-sugared foods?!?! Why include unhealthy products that meet SOME of the guidelines? It does not make sense.

    We are being generally failed by this labelling system, and as the truth about it comes out, it undermines Heart and Stroke's credibility. That is what they should be concerned about.

    You as a dietitian can feel free to "look at Health Check products as a sometimes complement". the a average Canadain WILL look at that symbol as saying "The Heart and Stroke foundation says I can eat this and not worry about a Heart attack or Stroke."

    And that is not true.

  5. msdietitian1:31 pm


    as I said before, above all else, the foundation recommends a diet that is high in whole vegetables and fruit consumption, whole grains, lower fat milk and alternatives, and lean protein - legumes, nuts, seeds, fish, leaner meats - and one that is lower in salt/sodium, fat, and added sugars. By in large if we followed these directives, then we wouldn't have diets high in fat, sodium and sugar. In fact, if we really followed healthy lifestyle messages, we would be much better off, and probably wouldn't need to have labeled (or even processed! prepackaged! foods) - that's utopia.

    Reality is that most Canadians know the message to consume a diet "high in vegetables and fruits" not one that's high in processed foods, prepackaged goods; yet fail to do it time and time again for reasons that may fall way beyond sole personal control. However, I do believe that some personal discretion and common sense judgement needs to be had - Canadians are intelligent, know the message, but we don't act on it. That's the bigger issue.

    And yes, I do think that Health Check (and other labeling systems) can work. If my client shows an average daily sodium intake of 4500mg (which many of mine do), plus obesity and poor activity habits (so putting them at risk for metabolic syndrome, etc - sounds like most Canadians, right?), then I'm making BIG strides if I can help them reduce their consumption in a matter of weeks closer to 2300mg a day, and then working on new goals after that. And yes, that may include substituting some foods in their current diet to include some Health Check (and other) products that may be lower salt to a comparable they are currently consuming - and refuse to STOP consuming. Same with added sugars, fibre and fat content.

    The diet (and lifestyle habits) of Canadians is atrocious - and we really shouldn't be quick to blame the foundation for all of those faults. We want a global food system and big box grocery shopping? We've paid the consequences for that in a big way, including our health. In fact, I would applaud the foundation for its work on reducing total sodium use (and trans fat) within food industry so that consumers CAN be assured that they are purchasing foods that are produced much healthier.

    Health Check presents an alternative within the context of the way Canadians eat - you don't need to purchase the products; the nutrition facts, ingredients and other claims have not been removed so you can still make an informed choice. Democracy is a good thing.

  6. james3:24 pm


    I agree with everything you say - personal resposibility and all that is important.

    But I don't beleive that's the issue here. The issue is that Heart and Stroke Canada is labelling unhealthy products as "healthy" - ie approved by Heart and Stroke. When they should not be. So take the Health Check symbol off of high-sugar, high-sodium foods.

  7. msdietitian3:37 pm


    your points are noted. prepackaged and processed foods across the board need to have reductions in sodium and in added sugars, and unhealthy (unnecessary) fats; it will take a bit of time for food industry to respond due to changes in potential formulations, etc. i'm sure that many will be pleased of the updated criteria on their website (Health Check) which was released in early 2008 to comply with the 2007 food guide directives. It's another step in the right direction as companies who wish to continue with the program will need to comply with these criteria. as they say "eat your veggies and fruit, and go out and play".

  8. Anonymous4:09 pm


    The food industry may be pleased with the Health Check revisions but I'm sure not - mainly because they barely made any.

    See the doc's post that he called, "Health Check's Insignificant Revisions"

  9. msdietitian4:21 pm


    certainly, everyone is entitled to express their opinions. while I appreciate the concerns with sodium and Health Check, and in turn echo the concerns of sodium, etc in prepackaged, processed foods ACROSS the board, the overall dietary habits of Canadians need to be scrunitized here. We need to ensure through continued education and supportive policies that people choose whole vegetables and fruits, whole grains, and lean protein choices (milk/alternatives/etc) and do not rest the majority of their dietary intake in the hands of processed/prepackaged goods.

  10. Anonymous4:56 pm



    Let's hope then that the Heart and Stroke Foundation takes this opportunity to admit that they've been dead backwards on this and make changes to their criteria to as to do exactly what you're suggesting encourage "people choose whole vegetables and fruits, whole grains, and lean protein choices (milk/alternatives/etc)" - something their revised criteria fails miserably in doing.