Thursday, June 23, 2011

Why CIHI? Why?

What a mess.

While the causes of societal weight gain, and difficulty of sustained losses, are highly complex, at the end of the day, calories are involved.

Whether you believe the primary problem's about intake or output, there's no disputing that weight's about caloric mismatch. No doubt there are hundreds of factors involved in eating behaviours and choices, but ultimately, regardless of your personal ranking of the prioritized importance of those factors in why and how they lead us to excess calories, weight's about excess calories. Whether we're eating more of them because of our shift from fats to carbs, whether we're eating more of them because of our increasing reliance on convenience and meals outside the home, whether we're eating more of them because our pace of life and styles of eating cultivate increased hormonal drives to eat, or whether we're simply burning less of them, whatever the cause, in the end, calories are the currency of information that will inform both treatment and prevention.

So how is it that the very basic currency of information isn't mentioned even once in the 62 page report that was just published by the Canadian Institutes of Health Information?

Instead of actually discussing calories, the report glosses over them. It uses the term "energy", and then talks about correlations. Correlations between obesity and physical activity levels, which they then qualify by stating that much of the data's unreliable due to the difference between self-reported and measured activity; and correlations between "poor diet" and obesity with some passing mention of again, "energy". By not actually addressing calories directly, the report perpetuates the myths that exercise burns lots of 'em, and that eating "healthy" is synonymous with "low calorie".

Couple that with the press release that steered all of the Canadian media, and subsequently the Canadian public, to believe that 15 minutes of exercising, and eating more fruits and vegetables, are going to solve this incredibly complex problem, and suddenly we've gone from potentially helpful, to almost certainly harmful.

Basically what the press release did was mislead the Canadian public about the causes and complexity of obesity, hamstring us in terms of caloric literacy (as 15 minutes of exercise burns negligible calories, and the consumption of fruits and vegetables doesn't preclude a high calorie diet), and perpetuate the myth that obesity is a disease of laziness and gluttony.

The worst part of it all?

The report itself, aside from what I see as a mind-boggling omission of a discussion of calories in terms of the reports' own identified determinants of weight, and a frankly misinformed attribution of benefit to negligible amounts of exercise and diets high in fruits and vegetables, does a pretty good job of describing the complexity involved. So instead of furthering Canada's understanding of obesity, CIHI's exercise and diet discussion, along with their inane and phenomenally misdirected press release, ended up perpetuating harmful obesity myths and individually blame based stereotypes.

Such an incredible shame.

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  1. While I like the report for detailing the complexity of obesity determinants and describing the 3 categories of interventions with successfull examples of strategies, I found the press release communication strategy a pity.

    The press communique insisted mainly on prevalence instead of the determinants and solutions, and on this wrong supposition that putting all the population on 15 more min of physical activity or on more fruits and vegetables would save lives and resorb obesity.

    This is what happen when statisticians knowing obviously nothing about physiology talk about statistics. This was obvious when the representative of CIHI was interviewed before me to a popular radio show on radio-canada. He could not answer the questions otherwise than talking statistics, which was meaningless for the audience.

    By the way, I noticed that high alcohol consumption is absolutely not related to obesity in man but even protective in women! I always suspected that. Talking about calories, alcohol is not like other calories coming from sugar or fat, because it must be metabolyzed first into the liver before joining again other substrates into the circulation.

    I was also smiling that such report supported the importance of physical activiyy as a major (if not the most important) determinant of prevention of weight gain, a position I have been defending over the years.

  2. Mona Albano12:59 am

    The last time I picked up a government pamphlet about healthy eating, it dutifully rattled on about kilojoules, the metric equivalent of kilocalories or Calories as we call them. Possibly the PR writer wisely decided to avoid a confusing term and go for high-energy vs. low-energy foods. It might help if they called in a science communicator and a plain-language counsellor.