Tuesday, May 22, 2012

Ontario's Expert Childhood Obesity Panel Conspicuously Lacking in Experts

Did you hear?  Ontario is planning on reducing childhood obesity by 20% in the next 5 years!

I first heard that target when I was contacted by Ontario Health Minister Deb Matthews' office back in early February. They wanted to chat with me about my thoughts regarding childhood obesity. I told them that I thought it was a symptom of a broken environment and that unless they focus on the environment as their target for change, they're not going to get anywhere. That'd be like trying to deal with chronic flooding not by building a levee, but rather by focusing on swimming lessons. Furthermore I told her that if the campaign targets obesity itself as the problem, that it might well increase societal weight bias and stigma as it suggests a blame and shame based individualized cause of obesity.  I also told her that I thought their 20% reduction in 5 years target was miles beyond hopeful.

I'm guessing what I had to say wasn't what they wanted to hear as I was not invited to join her office's Healthy Kids Panel.

So who was invited to join?

The panel is made up of a random hodge podge of folks. It's being co- chaired by a very nice former local politician turned newly minted hospital CEO and the dynamic head of a national encourage kids to exercise program. Having spoken with both in the past, I've no doubt they'll be able to "build consensus" (that's what the Ontario Healthy Kids Panel's webpage suggests they're there to do) among the members, but will the consensus be useful?  That would depend on the members.  So who is on their expert panel which according to the Healthy Kids Panel webpage, "possess(es) a broad understanding of childhood obesity"?:
  • 2 physicians, neither of who list obesity even as an interest on their own official bio pages.
  • A PhD researcher who while interested in obesity, is interested in the impact of the baby's in womb environment on obesity - fascinating, but far from prime time when it comes to interventions.
  • A Registered Nurse without any special interest in obesity mentioned in her Ontario Healthy Kids Panel bio.
  • A "young First Nations mother" (that's how she's billed by her official bio) who refers to herself as a "Senior Communications Specialist" on her LinkedIn page. 
  • An "award winning journalist and mother of 3". Despite trying, I couldn't find any mention of her having a special interest or expertise in obesity.
  • The Senior Vice President of Health and Wellness for Loblaw Companies Limited - a massive Canadian grocery store chain.
  • The President of YMCA Ontario.
  • A healthy living cookbook author and caterer.
  • The Executive Director of the Propel Centre for Population Health Impact whose biography doesn't list obesity as an interest or background.
  • The CEO of the Health Strategy Innovation Cell at Massey College and author of XXL: Obesity and the Limits of Shame. He has a true interest and expertise in obesity and while I may not share all of his views, I'm glad at least there's one person on the panel where obesity is a major part of their life's work.
  • The Vice-President, Food Policy Scientific and Regulatory Affairs with Food and Consumer Products of Canada - a food industry advocacy organization
  • A marketing and advertising expert with no reported special interest in obesity.
  • The head of the Canadian national office of Right to Play - a wonderful organization that aims to improve the lives of children through play. His biography lists no special interest or background in obesity.
  • The MPP for Scarborough-Agincourt and Parliamentary Assistant to the Minister of Community Safety and Correctional Services. According to Google, the word "obesity" doesn't appear once on her official campaign webpage.
I don't doubt the panel's sincerity for a moment, but caring about children or childhood obesity is not the same thing as having expertise, and while there are one or two panel members who truly do have expertise in childhood obesity, shouldn't there be more?  Moreover, do you really think the panel chairs are going to be able to build any consensus that would impact negatively on the food industry given their representation at the table?

As a highly complex and multi-factorial problem perhaps the silver-ish lining is that there is no shortage of initiatives we could undertake to tackle childhood obesity. Here's hoping that when I blog about this panel's actual recommendations down the road I'll be referring back to this post as prematurely negative and will speak glowingly of the panel's plans.

So here's my plea to the panel - please make me look bad.  Put out something more useful than just the same old, eat less move more drek we've all come to know and loathe.  Actually tackle issues like predatory food industry marketing and front-of-package deceptions, nutrition facts panel reforms, actually useful school food policies including the removal of sweetened milk from sale, childhood advertising bans, the return of home economics, zoning laws for fast food around schools, innovative incentive or disincentive taxation, an explicit recommendation that juice be limited to a maximum half a cup a day and that it's basically just flat soda with a smattering of vitamins and certainly not a fruit equivalent, a true discussion of energy balance that explicitly hammers home the fact that exercise is insufficient by itself to make any dent in weight, a campaign designed to combat caloric illiteracy, mandatory calorie labeling in restaurants, a fight against the ugly prevalence of weight bias, a massive campaign designed to increase home cooking by specifically recommending we eat out less frequently in restaurants and purchase fewer boxed meals - just to name a few.

There's nothing I'd love more than to have to eat a huge serving of crow.

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  1. Was there anyone in that panel that worked directly with obese children? As a nutritionist working in primary care I work with obese children in clinical settings and also in preventive programs implemented by the public health department. The target of these government programs is always the children and never the parents (only one targets the parents but it isn't implemented nationally) or the surrounding environment. In Portugal we have the same problems as Canada, we need to increase health literacy including food and nutrition, change the laws that regulate food industry, increase local production food, teach the people how to cook again. And no putting a pizza on the microwave isn't cooking. We lost the traditional knowledge about food, people are fed with wrong information about what is "healthy" from the food industry and the government just sits back and watch an increase of over 100% of childhood obesity in a decade.
    Our panels of "experts" are the same as yours, full of people that don't have an idea how complex is the obesity problem.

  2. I wonder whether you feel there is any contradiction in you advising them to focus on environment, not obesity itself -- and then criticizing them for having a panel comprising environmental representatives rather than obesity experts?

  3. I feel similarly whenever I see "experts" consulted regarding weight-loss maintenance. Rarely is there an actual maintainer. People think the NWCR has figured it all out -- get a quote from Rena Wing or James O. Hill and you know everything you need to know. That makes me sad and angry. The NWCR has gone blind; it allowed its hypothesis to morph into an agenda. It started out wanting to identify the behaviors that maintainers employ and then replicate them in others. Problem is, they don't care to know our behaviors beyond Eat Less Move More, and they feverishly try to replicate that, but have been unsuccessful in increasing the number of maintainers in the US. (What a joy if they realized that there is great value in proving the null hypothesis after 20 years of promoting Eat Less Move More! Not likely to happen when Rena Wing is inclined to accept contracts from SlimFast and the like.) The NWCR does not ask its maintainers about our home cooking techniques, we are not asked about our shopping strategies and what quality criteria we apply to food (I would bet we eat a lot less processed food and a lot more organic than most), we are not asked about macronutrient management to control insulin-triggered hunger. All the food questions seem to assume a 1970s plate, with a protein and 2 or 3 cooked sides. We aren't asked about our salad eating, and I would bet most of us are salad-eating fools. We are not asked to supply blood, urine or saliva samples to analyze our endocrine profiles, nor are we subjected to ANY empirial research, per se. We're condescendingly told to fill out surveys, and even though we supply our physician's names (presumably to keep us honest) they don't check with them. I bet a lot of people are lying and have regained. They hound us when we won't send a survey back, but most of us are torn because we know we are answering the WRONG questions, but they are uninterested in knowing the right ones. Sorry to take you off track, but the whole idea of "experts" just makes me seethe!

    A person entering college has an 8 percent chance of exiting with a doctorate. A person entering a weight-loss diet to lose more than 10% of highest established weight has a 3% of maintaining that loss at five years. But hey, I'm no expert, right?

    1. Thank you for this comment, I appreciated reading it. In addition to the things that you mentioned (I really wish I saw more emphasis from the perspective of people who have actually maintained weight loss), I wish I saw more from NWCR about weight loss maintenance after weight loss surgery. Maybe I am missing something and that is not within their purview, but it seems to me that it would be relevant, since surgery does not guarantee weight loss or weight loss maintenance and the people who have surgery to initially take weight off have to employ some of the same strategies as people who never did have surgery. It does seems to me that there are both similarities and differences in the tricks and tips that people employ to maintain weight loss who have had surgery from those who have not, and I wish NWCR would include surgery patient's stories.

      I also just have to add that it is not just doctors and media, etc. who don't want to hear the real deal about weight loss maintenance, I find that nobody really wants to hear the real story. I have people ask me all the time how I keep the weight off, but when I tell them the truth (healthy food, watching caloric intake, not wasting time and energy hating on myself) they really don't want to hear it, they just want to hear what diet plan I am on.

    2. Ah, Marianne, we are sistahs. I hear you about people NOT wanting to hear the truth. I'm glad to see that you get the futility of self-hate (or for that matter any hate) in this issue.

      What's a bit disconcerting about the NWCR is that they HAVE, to my knowledge, added surgical maintainers to the database in recent years, but they are playing fast and loose with their narratives and aren't always clearly distinguishing between us. We are, indeed, very different physically and hormonally.

    3. Truth1:15 pm

      That is so so true. As a maintainer of a 125 pounds weight loss for over 15 years AND a nutritionist, I can also vouch for the fact that no one wants to hear the truth about weight loss. They do not want to hear me admit that almost each and every day is a struggle. They don't want to hear that after 15 years I still weigh and measure a good portion of my food. They don't want to hear about the obese woman who used to go to the gym and work out with the men because my gym had no "ladies only" area.

      They want to know what diet and what pills I used. They don't want to hear about personal responsibility, either. Hmmmm.... even with education and personal experience with morbid obesity, which began in childhood, I was not contacted for input or a place on the panel either....

  4. I think the biggest issue in Obesity is that for most the issue is an addiction. Childhood obesity is because sugar is the only drug kids has access to.

  5. I completely agree with cr8tiveCandy. Some of those individuals may not have listed "obesity" as an interest, but do target the areas that you wanted to see. For example, the Propel Executive Director background lists physical activity, healthy eating, and environmental approaches on the page you linked. From your intro to this topic, it seems like this is what you would want to see.

    Looking at some other profiles on that link, I can see that a lot of information was left out. The "cookbook author" that you refer to is also a professor in a faculty of health and a nutritionist. Since these facts have been exaggerated (or omitted) to support your negative view, the post loses some credibility. This could have been a great post calling on the panel to do a stellar job and consider the suggestions that you've made, but instead it's been sullied by the selective presentation of facts and negativity.

    Finally, while I do agree that some individuals listed may not have as much "obesity expertise" to contribute to the panel, I do think they can have a positive role in the process. Academics are learning that a panel of health experts can come up with theoretically wonderful solutions, but without input from individuals with expertise in other ares (e.g. marketing, community programming), the proposed solutions may not be as realistic or impactful.

    I also hope the panel does a great job and changes your perspective!

  6. For sure, the food environment needs to be altered before headway against obesity, diabetes, and non-communicable diseases can be made. The big impediment, however, is food industry educational activity; specifically, the International Food Information Council Foundation(IFICF). Here's what the IFICF says about itself:

    "Incorporated as a public education foundation in 1991 and based in Washington, DC, the International Food Information Council Foundation is independent and not-for-profit. We do not lobby or further any political, partisan, or corporate interest. We bring together, work with, and provide information to consumers, health and nutrition officials, educators, government officials, and food, beverage, and agriculture industry professionals. We have established partnerships with a wide range of credible professional organizations, government agencies, and academic institutions to advance the public understanding of key issues. For example, we have a long-standing relationship with the U.S. Department of Agriculture Center for Nutrition Policy and Promotion as part of the Dietary Guidelines Alliance, a public-private partnership focused on the U.S. Dietary Guidelines for Americans and the MyPlate Food Guidance System. Recognizing the global nature of food safety, nutrition and health issues, the Foundation extends its mission internationally. We share education materials with an independent network of Food Information Organizations and partners from around the world. We also serve as a news media resource. We provide science-based information to the media and refer journalists to our 350 independent, credentialed experts on a variety of nutrition, food, and safety topics...We believe in the importance of educating health and nutrition professionals. We regularly host Continuing Professional Education (CPE) programs which are offered in person and via Web cast, and have developed a series of Commission on Dietetic Registration, the credentialing agency for the American Dietetic Association, CPE-approved learning modules on a variety of subjects."

    Arguably, the IFICF is the most pernicious corporate supply chain protection scheme ever devised. And the major problem is what it teaches about saturated fats and omega-6 industrial seed oils. For example:

    "Some of the food components Americans are recommended to reduce are saturated and trans fats which are also known as "solid fats" because they are generally in solid form at room temperature. Conversely, Americans are encouraged to consume more unsaturated fats while not exceeding their recommended total fat intake. Unsaturated fats are also known as "liquid oils" as they are generally in liquid form at room temperature. By replacing "solid fats" with "liquid oils," potential health risks could be decreased or even avoided, as the mono-and polyunsaturated fats in liquid oils are associated with lower levels of total and LDL cholesterol and cardiovascular protection."

    To summarize, the IFICF shapes nutritional doctrine taught to experts. The experts formulate the government's dietary advice. The government's Dietary Guidelines are considered the last word on what constitutes healthy eating. Does this bring to mind that old cliché about the fox guarding the hen house?

    For more on this, Google - David Brown IFICF

  7. I'm betting the panel will waste a big pile of $$ on a fancy website with high-end designer graphics to present the following "pointers": drink milk for calcium and strong bones, don't drink soda, get more exercise, and #1, DON'T BE FAT (OR YOU ARE A LOSER). Heard it all before. Hasn't worked so far.

  8. Well, good luck with your plea. HBO's Weight of the Nation clearly had lots of obesity "experts" available in its production. While parts 3 and 4 did touch on the environmental issues you mention, parts 1 and 2 were really all about eat less move more, including these recommendation in the poorly named "Choices" episode:

    1. Start with small steps
    2. Make realistic goals
    3. Seek support
    4. Keep portions under control
    5. Track your caloric intake

    A ha. It's apparently my "choice" to be obese because I don't do these things sufficiently well.

    I'm sure that's it.

  9. Yoni, your deep knowledge and experience base as well as your style and fresh, practical perspective could only add value to the panel, and I would like to see you on it. I'll drop Deb Matthews a line.

  10. I agree with Judy Farrant, you need to be on that panel. I'll send the minister a note and I might volunteer myself as well. I'm not a doctor or scientist but I have a lifetime of experience with yo-yo dieting, body shame and depression-related weight gain. I can present myself as evidence that haranguing kids about weight loss at a time when their body images are still forming (I went on my first diet at age 11) does far more harm than good. I often wonder what I'd weigh now if I'd just left well enough alone.

  11. Truth1:36 pm

    I agree completely with stopping predatory marketing, deceptive advertising on packages, TV and other media, nutrition facts panel reforms, changes to school food policies and correct information about energy balance and fat gain.

    But, I also think that emphasis also needs to be placed on learning. and not just for kids. People need to be encouraged to think for themselves and make good choices despite tricky and false advertising, or how to eat as healthfully as possible even in a less than good food situation. We are supposedly in the highest order of intelligence, yet we don't seem to have a desire to work our brain cells and LEARN. We can't just keep blaming the food industry 100% for our lack of knowledge, restraint and planning. They play a role, yes. But there needs to be some personal accountability too. Like the old ads said, "It's what you know".

    Lastly, while childhood obesity is a problem, adult obesity is a problem too. It should be remembered that adults act as examples and teachers of children. I watch shows where people are eating frogs and barbecued bats... I find it gross, but if I had grown up in certain geographical areas where that food was eaten, then that's what my mother would have given me. If that was the case, then I suppose I would consider bat wings a treat. We need top continue to help educate adults so that they themselves can be healthier and educate the youth.

    In closing, I don't understand why you have a problem with the one panel member who has an interest in obesity while still in the womb. Research his proving that babies born to obese mothers (during pregnancy) are starting out behind the obesity '8 ball' as soon as they are born. These studies are the ultimate in 'nipping childhood obesity in the bud'. I don't understand why you have an issue with this person being on the panel.

  12. Don't wast your time Dr. Freedhoff with this government panel. It is just another 'smoke and mirror' image the government presents, so they can say they are doing something for childhood obesity. Nothing really will get done, but they will alter the statistics to show, that they have reduce childhood obesity. Meanwhile tax payers will pick up the bill for this useless mockery of a panel. Same old, same old government crap. If anyone thinks this is being negative, then you are naive when it comes to government.

  13. Anonymous8:00 am

    I have so much respect for you Dr. Freedhoff! I just wish these 'panels' etc., had the same respect for you & your opinions - after all, this is a passion & life work for you. I just never understand why you are constantly given the 'what the hell does he know!' attitude - because they know - YOU KNOW what you're talking about. If these people studying obesity etc. would actually get real maybe there'd be progress instead of the same ol dead end bs they hand out. :(

  14. Anonymous7:07 pm

    This new panel has the opportunity to develop a truly effective collaboration to create change.

    Anything else is a political effort to democratize various points of view.

    This does not work.

    Look outside the usual suspects for the effort to have a value forward effect.