I just received a very thoughtful email from Jeremy Veillard VP, Research and Analysis Canadian Institute for Health Information (CIHI) whose time and attention I certainly appreciate.
Here's are his thoughts, presented without commentary, regarding CIHI's recent report, and its reporting.
Dear Dr. Freedhoff,
Please feel free to share this response with your readers.
We have read your blog and the responses to it with interest, and wanted to clarify a few things about our Obesity in Canada report:
The goal of our report was to examine the prevalence and risk factors associated with obesity at a population level. It was never meant as a clinical tool, or to offer prescriptions at an individual level. For example, nowhere does the report or media release suggest that 15 minutes of exercise a day could eliminate obesity among Canadians. Our population-based analysis does however show that physical activity is one of the most important predictors of obesity after adjusting for other available risk factors (a point shared by Dr. Paul Boisvert on your blog).
Your point about caloric intake is taken. However, it is extremely difficult to measure and estimate caloric intake in general population-level health surveys such as the ones used for this report (especially using self-reported and recalled measures). We have therefore had to turn to the frequency of fruit and vegetable consumption as an approximation of diet quality. And while as you note, increased fruit and vegetable consumption does not equate with low caloric intake, it has been shown in other research to be a valid approximation of diet quality when exact measures of food intake are not available (see for example, Garriguet 2009 in Health Reports).
There is no question that obesity has risen quite dramatically over the past 30 years in Canada, and changes in activity and diet have played a role. The more complicated question then becomes, how do we create social and physical environments where healthy choices become the “easy choice” for Canadians? As part of the report release, we have conducted more than 30 interviews with media outlets across Canada and the message that we have been getting out is the same as yours: that obesity is complex and that a multi-faceted approach and policies are necessary to tackle it. The “spin” and over-simplification of the report’s findings are unfortunate. We are nevertheless pleased that the report has generated a healthy discussion on obesity across the country – including in blogs like this one.
VP, Research and Analysis
Canadian Institute for Health Information (CIHI)