Health Canada Fails Science And Canadians By Allowing Any Purported Weight Loss Supplements To Be Sold

The latest of many systematic reviews and meta-analyses of herbal supplements for weight loss plainly makes the case that there is no justification for their sale.

They. Don't. Work.

None of them.

None. Of. Them.

So why does Health Canada license and allow the sale of 1,128 natural products whose listed purported use is for weight management? Or of the 671 products that purport they'll improve sexual enhancement? Or of pretty much any of them?

Maybe the answer lies somewhere in the taxation of the $1.8 billion annual Canadian sales of vitamins and supplements?

Maybe it lies in well-intentioned hope?

Maybe it lies is political contributions and lobbying?

But the one place where it doesn't lie is in science. Shouldn't that be the only place that matters?

Product Reformulation Means Sugar Taxes Work Even If People Don't Buy Less As A Consequence

Taxes work to decrease purchasing, and the higher the tax, the greater their impact. Period.

Which is why it's always struck me as odd when people question whether or not sugar-sweetened beverage (SSB) taxes would affect SSB purchases (and consequently consumption).

But let's leave that odd debate aside for a moment. If the goal of SSB taxes is to decrease added sugar consumption (which it explicitly is, while it is explicitly not about weight loss as societal obesity is not singularly caused by SSB consumption, and decreasing SSB consumption is healthy at every weight), it would appear that SSB taxes will decrease sugar consumption even if they don't decrease purchasing.

How?

Because when SSB taxes are enacted, the beverage industry reformulates its products.

And at least according to this bulletin from the World Health Organization, they do so not insignificantly!

Of the 83 products they surveyed in both 2014 (before the UK's SSB tax) and in 2018 (after the UK's SSB tax), the mean sugar content decreased by 42% (from 9.1 g/100mL to 5.3 g/100mL) while the mean energy content decreased by 40% (from 38 kcal/100mL to 23 kcal/100mL). Putting this into the context of a standard 355ml can - that would represent 2.45 fewer teaspoons of sugar and 53 fewer calories per can.

And this was in response to a fairly nominal tax. Presumably larger taxes would drive larger (or more expansive) reformulations which of course would also be coupled with decreased purchasing as has been shown to not at all surprisingly occur where enacted.

All this to say, this is yet another reason why if you're living somewhere without an SSB tax, my bet is that it's a matter of when, not if, you will be.

Canadians Who Care About Science Might Not Want To Vote NDP

I have to admit, I found this story jaw dropping.

The federal NDP health critic, Don Davies, is opposed to plans geared to rein in the wild, wild, west of natural health products and supplements that prey on desperate Canadians.

The proposed regulations are meant to require, gasp, that natural health products have evidence to prove they're both safe and effective before they're allowed to be sold.

In the CBC story, Davies even parroted the common line that it's too expensive for supplement makers to conduct studies to prove their products work. That statement contrasts poorly with the other one he gave in the same article where he reports the natural health industry enjoys $12 billion in Canadian revenue and $2 billion in exports.

But even were it true, that there's a presumably want-to-be federal Health Minister arguing we shouldn't require proof of safety and efficacy for products being sold to Canadians in the name of treating their medical conditions, for anyone who cares even an iota about science, should be a non-starter.

And it gets worse.

Davies, in trying to push his post-science world view, was encouraging people to sign a petition developed by the Health Action Network Society (HANS), a Vancouver charity with a history of spreading anti-vaccination claims, but they themselves noted that they were not working with him directly.

Shame, shame, shame, indeed.

Canada's New Food Guide's Biggest Missed Opportunity (And How To Fix It)

As I mentioned last week, Canada's new Food Guide is a giant step forward.

But having read through all the published materials to date, and putting aside things that are beyond the ability of a food guide to address (like food insecurity for instance), I do believe there's one very large missed guidance opportunity - nutrition, kids and sports.

As it stands, I couldn't find anything.

And that's a shame because there's a huge amount of misinformation out there about kids  "refuelling", "recovering", or "rehydrating". There's also a massive industry built to prey on kids and their parents telling them that they need electrolyte enhanced sugar water, or chocolate milk every time they move for a few minutes. There are community races that teach kids running a 5km fun run that they need a banana, bagel, juice, and a protein bar for their 40 minute trot. There are league run programs like Tim Hortons' "I just played I'm thirsty" to bring kids and their parents in and cultivate brand loyalty. There are partnerships between dairy producers and the NFL designed to promote chocoloate milk, and I guess determined not to be left out, Nesquik partnered with the American Youth Soccer Organization to sell chocolate syrup.

And as any parent today knows, snack time for pretty much any organized sport is a sport-washed junk parade.

Consequently, I would have loved to see a section of Canada's Food Guide's guidance devoted to kids and sports. A section that explained that if it's less than an hour, probably the only thing the kids need is water - and even then, only if they're thirsty. And that there are no sugary beverages that kids can quaff that will appreciably improve their performance, or help them to recover, and that when it comes to organized sport, leagues and coaches should be encouraged to affect changes to see sidelines and post game snacking relegated to the water and fruit slices of yesteryear. Though that guidance alone would not lead to immediate change, having it be part of Canada's Food Guide would support public health advocates and parental champions in their efforts to affect change, and over time, slowly seep into the public consciousness.

As to how to fix it?

Well here's the thing. In 2019 the new Food Guide need not be a static set of documents. Living online the guide can expand, contract, and change on an evidence-based and as needed basis. Which means there's nothing stopping Health Canada from spending the tiny bit of time required to suss out this topic and publish it alongside already available guidance.

Here's hoping we see it soon.

Now That Canada's Food Guide Has Markedly Improved, What's Left For Canadian Nutrition And Public Health Advocates To Champion?

Ok. So we have an exciting new food guide here in Canada, but please don't think that means there's nothing left to push for in Canadian nutrition policy.

Back in 2009, I published a piece about the top 10 nutritional hills worth fighting on.

Included on that list were:

• An evidence based food guide
• A national trans fat ban
• Mandatory menu-board calories

So it's nice that at least some progress has been made.

Though far from exhaustive, and in no particular order, here are 6 hills still worth fighting on (adapted from that same original post):

1. We need to get fast food out of our schools. Though pizza days, sub days, shawarma days, and more may well raise a bit of money for our school system, and may give parents a day where they need not pack their kids a lunch (assuming they haven't taught their children to do so - and here I'll say that yes, kids can do so, even kids as young as 8 or 9), I don't think those ends justify the means. And here I don't care if the fast food pizza (or whatever) is formulated in a way to satisfy a nutrition policy document, because it doesn't change the fact that school provided branded fast food weekly just because it's Thursday teaches children, even those who don't order it, that fast food is a normal and healthy part of weekly life. Given that some schools have a different fast food offering every day of the week, consider the message that's teaching our children.
2. We need a national school food program. Canada is one of very few Western nations that does not support a publicly funded national meal program for its students. It has been shown that school food programs markedly improve the mental and physical well being of students who utilize them with some reporting increases in standardized test scores, less illness, better discipline and improved alertness. According to Dr. David Butler-Jones, Canada's former Chief Medical Officer of Health,

   "When children go to school hungry or poorly nourished, their energy levels, memory, problem-solving skills, creativity, concentration and behaviour are all negatively impacted. Studies have shown that 31% of elementary students and 62% of secondary school students do not eat a nutritious breakfast before school. Almost one quarter of Canadian children in Grade 4 do not eat breakfast daily and, by Grade 8, that number jumps to almost half of all girls. The reasons for this vary – from a lack of available food or nutritious options in low-income homes, to poor eating choices made by children and/or their caregivers. As a result of being hungry at school, these children may not reach their full developmental potential – an outcome that can have a health impact throughout their entire lives"

   If interested, sign this formal House of Commons e-petition to the government requesting one.
   
3. We need to ban advertising to children. Plain and simple, young children are not able to discern the difference between truth and advertising and consequently I believe it's entirely unethical to allow marketers to target them. Furthermore food, and specifically unhealthy food, is the number one source of television commercials seen by children. Frankly to me whether or not they impact childhood obesity rates (they do) is beside the point as I think targeting children period is unethical.The somewhat heartening news is that unlike in 2009, there's action now, with Bill S-228 having passed its third reading in Canada's House of Commons, but given it has yet to receive royal assent, it still needs support.
4. We need a soda tax. Nanny state alarmists tend to try to paint soda taxes as a draconian cash grab and an infringement of civil liberties, but really what's generally called for is a nominal tax on beverage manufacturers for each ounce of sugar-sweetened beverages produced which would raise the cost of a can of soda by roughly 12 cents. Hardly a huge amount of money for each individual but likely to generate well over $1 billion annually in Canada which if utilized to fund such things as a National School Food Program, would be an unbelievably beneficial tax (and according to studies would also result in a 10% decrease in national soda consumption). And as far as the tax being regressive, as my friend RD Andy Bellatti has been heard to say, try diabetes, and also have a peek at this piece which expands on this thought in The Lancet.
5. We need to put an end to front-of-package health claims, or at the very least, dramatically rein them in. Sure, the new food guide states, "be aware of food marketing", but why should the onus be on the consumer to turn packages over to ensure that the claims on the front aren't deceitful, or that the product in the package isn't nutritional chaff? There's a great deal of room to improve our reality where Kellogg's can brag about Froot Loops' Vitamin D content and whole grains on the front of its boxes. Personally, I'd prefer a marketplace with no health claims, and though I don't think we're going to necessarily get there, boy does there look nice.
6. We need to treat the supplement industry (and their purveyors) the same way we do pharmaceuticals. Plainly, if a product is being sold to treat a medical condition, the same burden of proof we require of pharmaceuticals (actual evidence of safety and efficacy) should be applied to so-called nutraceuticals. That would mean a huge hit to supplement sales given Canada's Natural Health Product Directorate is comfortable accepting stuff like traditional use claims as a means to receive approval. Doing so costs Canadians in more ways than one in that not only do these products often cost a significant amount of money, but some will certainly forgo actual medical care and evaluation in place of shameless hucksters who prey upon fear, goodwill, and personal misfortune by selling hope in bottles.

Here's hoping that I can cross a few more of these off my list over the coming decade.

The Only Thing Public Health And The Food Industry Fully And Firmly Agree Upon About Canada's Next Food Guide Is That It Definitely Matters

Generally speaking, there probably isn't much that public health professionals and the food industry agree upon when it comes to Canada's imminent new Food Guide.

Briefly, public health would like to see the Guide discouraging the consumption of sugar sweetened beverages, ultra-processed foods, processed meats, trans-fats, and see a swap recommended so that people are encouraged to replace their saturated fats with unsaturated fats. Public health would also like to see the Guide discourage frequent use of restaurants, encourage cooking, and promote the free-from-distractions consumption of those cooked meals, ideally with loved ones, on a regular basis. There's more, but that's the basic gist.

The food industry would like to see the Guide avoid the discouragement of any particular food, would like to see dairy maintaining its undeserved separate food category while simultaneously not admonishing against chocolate milk, saturated fat swaps, and would like soft, ambiguous language around processed foods and more.

But there is one area where public health and the food industry wholeheartedly agree - they both agree that the Guide matters a great deal and it wields real influence on the eating patterns of Canadians.

No, Canadians don't shop with the Guide in hand, but industry relies on the Guide's messages in their marketing and sales. For instance, if the Guide, as drafts suggest, has indeed eliminated the dairy category and rightly lumped dairy in with other sources of protein, the dairy industry may no longer be able to suggest to kids (even kindergartners), parents, educators and more that we need a particular number of servings of dairy per day. This in turn, along with the removal of chocolate milk as a dairy equivalent, will likely, over time, affect school milk programs, and will certainly impact the "dairy educators" that schools bring in to chat with students. It will also preclude the dairy industry's ability to buy skewed surveys designed to provide a veneer of health to their products, to launch apps to ensure you're having enough, and when articles are written about dairy in the media, no longer will there be a throw away line included about how many servings the Guide recommends daily.

And all of that will undoubtedly affect dairy sales.

Which of course is why the dairy industry has mounted a years long campaign to try to prevent changes to the Guide's dairy recommendations. They've sent in letters to Health Canada and ministers, they've seeded the media with interviews and concerns, and they've even created an astroturf front group called "Keep Canadians Healthy" that pushed Facebook ads to the public encouraging them to be concern and upset about the plans to downgrade dairy, and provided the public with a call to action and a fill in the blank form to mail their MPs (scroll down through the link to see).

So the next time you hear someone cluelessly (or insidiously) suggesting that the Guide doesn't matter (like the feckless Canadian Taxpayers Federation did on CBC's The National two days ago for instance), remember that pretty much the only area where public health and the food industry fully agree in regards to the Guide is the fact that it matters a great deal to what Canadians buy, and consequently, to what Canadians eat.

Dominic Cardy, New Brunswick's Minister of Education, Champions School Chocolate Milk Sales In Name of Hunger, Poverty, Food Insecurity, And Fundraising

Before the break, New Brunswick's new Conservative government proudly honoured their promise to restore the elementary school sanctioned sale of chocolate milk.

Never mind that the World Health Organization and Canada's Heart and Stroke Foundation have explicitly called for the marked limitation of the free sugars provided to children.

Never mind that the Director General of Health Canada's Office of Nutrition Policy and Promotion (the folks in charge of the Food Guide), Dr. Hasan Hutchinson, has been on record since February 2014 that chocolate milk's inclusion in the 2007 (and sadly still current) Food Guide was a mistake - a mistake which almost certainly will be remedied when (if) the Food Guide's revisions are ever published.

Never mind that research on what happens when chocolate milk sales are stopped in schools found that stopping the sale of chocolate milk in schools did not affect the students' total daily milk or dairy consumption, that on average all students were meeting their daily recommended amounts of dairy, that kids who swapped from chocolate milk to white milk drank pretty much the same amount of white as they did chocolate (unless you think 4/5ths of a tablespoon of milk is a lot), and that by removing the sale of chocolate milk from the school, in the first month alone nearly half of the initial chocolate milk drinkers switched to white and in so doing, saved themselves piles of calories and the nearly 2 full cups of monthly added sugar.

No, the New Brunswick Conservatives clearly know better, and in late December, Dominic Cardy, their Minister of Education and Early Childhood Development, explained what it was about chocolate milk that made its sale in schools so important - calories. In an interview with the CBC, Cardy explained that selling chocolate milk in schools was important because, "Would you rather have kids have some calories in their stomach or none? You need the calories to start with"

So the sale of chocolate milk in schools is to ensure New Brunswick children consume enough calories? Given New Brunswick's own health council reports the province's rates of childhood obesity are among the highest in the country, I wouldn't have thought that was a problem, and that's putting aside the fact that white milk provides calories too.

And honestly, I wondered if perhaps he was misquoted, or his words were used out of context.

Apparently not. Oh, and also, there's more.

On Twitter, Cardy doubled down on his kids need calories therefore elementary schools need to sell them chocolate milk stance, and then added in that my concerns were due to my privilege and that the sale of chocolate milk was also there to address hunger,

And when RD Karine Comeau quickly pointed out that if food insecure New Brunswick children were the concern, enabling and promoting the excess consumption of sugar in that vulnerable population, a population already at increased risk of chronic disease, probably isn't in their best interest, and instead perhaps an emphasis should be placed on increasing their access to fresh fruits and vegetables, Cardy agreed but stated that the problem with the prior policy was, "yanking milk and juice with no replacement plan"

Yet milk and juice had not been "yanked". You might have noticed that I've bolded the word "sale" throughout this piece - the reasoning is simple - the policy that Cardy and the New Brunswick Conservatives have reversed was the end of school chocolate milk sales. Meaning there was never a ban on chocolate milk (or juice) - they weren't "yanked", they simply weren't sold. Nor were (or are) schools distributing chocolate milk freely to hungry, impoverished children. And when schools weren't selling it, there was nothing stopping a parent from sending their kids with a thermos of chocolate milk (or a juice box) to school, or signing their kids up for the white stuff's sale.

And finally, Cardy calls the concerns of various public health professionals, "self-righteous indignation", and shifts the goalposts a fifth time (from hunger, to poverty, to food insecurity, to yanking) to fundraising. As if there are no other ways to raise funds for schools than by selling sugar.

And perhaps here it's worth repeating, Cardy is New Brunswick's Minister of Education and Early Childhood Development. Drink that in for a moment.

(And reporters who will inevitably be covering the new Food Guide's eventual release, if the Guide, as expected, calls for a limitation on sugar-sweetened milk, I'd suggest an interview with Mr. Cardy with a focus on his chocolate milk beliefs and New Brunswick's school food policy might make for a delicious side story)

Once Again I'll Ask, Where The Hell Is Canada's New Food Guide?

This post was first published back in June. Since then, still no Food Guide, as well as the real possibility that not releasing the Guide influenced the New Brunswick provincial election, and just this past week, an incredible dive into juice, food politics, and our as yet unpublished guide. I really can't wrap my head around why it's not out yet beyond politics. That's not something this country should be proud of.

In case you missed the news, New Brunswick recently banned the sale of chocolate milk and juice in their schools.

It's a welcome move, and one that will be undoubtedly be adopted nation wide following the long delayed publication of Canada's next Food Guide.

Canada's Food Guide, last published in 2007, inexplicably and explicitly, reports that chocolate milk is a healthy dairy choice (that it also suggests dairy is such a magical food that it requires it's own Food Guide category is a whole other kettle of inexplicability). Or maybe it isn't that inexplicable in that on the then Food Guide's 12 member advisory committee was Sydney Massey, the Nutrition Education Manager and Spokesperson for the BC Dairy Foundation, where their homepage at the time featured the campaign,

"Don't tell Mom, but Chocolate Milk is good for you"

The next one, won't.

I know this in part because back in 2014, Dr. Hasan Hutchinson, the Director General of Health Canada's Office of Nutrition Policy and Promotion (the office in charge of the Food Guide), agreed with me during our then debate, that chocolate milk shouldn't be deemed a health food by our Food Guide,

"One thing we're doing right now is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"

And in May 2015 he was quoted by the CMAJ on juice stating,

"You won’t be seeing that anymore … and there’ll be a fair number of new materials coming out in the next few months."

I also know this because even McDonald's appreciates that chocolate milk, with more calories and sugar drop per drop than Coca-Cola, shouldn't be routinely offered to children.

So here's my first question.

If, in 2007, Canada's Food Guide had explained that chocolate milk is to milk what apple pie is to apples, and that it should be considered a treat rather than a health food, and that no, juice is not the same as fruit, do you think we'd be seeing these actual responses and comments posted on Facebook and on the CBC article in response to the news out of New Brunswick?

"How the hell can juice be bad for you I doubt orange and apple and cranberry juice is bad for your health CFDA would have ban the stuff decades ago"

"It is crazy and stupid. especially since the school officials are comparing the natural sugars found In the cocoa that makes it chocolate to the artificially added high fructose corn syrup used to sweeten coca cola."

"Ugh get a life people! Chocolate milk is some parents only option to get their kids to drink milk. And as far as juices they sell apple and orange at school so are they now telling us apple and OJ juices are bad??"

"I agree, pop and juice fine. Chocolate milk is filled with nutrients."

Because the thing is, though no one shops with Canada's Food Guide in hand, its recommendations do permeate national consciousness. And more to the point of this post, they inform school food policies. Once the new Food Guide is published, and assuming it explicitly recommends limiting sugar sweetened beverages and juice (and it will), all provinces will undoubtedly soon fall in line with New Brunswick (unless of course the Conservatives, as they promised prior to their election, repeal the ban).

And here's the most pertinent question. It's been 5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3.5 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

Chocolate Milk And Health Canada's Inaction On Canada's Food Guide Just Cost The New Brunswick Liberals The Election

Yesterday there was an election in New Brunswick.

The Conservatives won by a single seat.

So what was the main issue New Brunswickers were voting for or against in this election?

Believe it or not, it was chocolate milk in schools, which was described by the Toronto Star as the issue at, "the centre of the New Brunswick election campaign".

Seriously.

The centre of the New Brunswick campaign was whether or not the sale of chocolate milk would be banned in New Brunswick schools, with Blaine Higg's Conservatives saying "No", and the Liberals Brian Gallant saying, "Yes".

PC Leader Blaine Higgs with Blair and Ashton having Chocolate milk on The Big Blue Bus. pic.twitter.com/MIuRn56AIy

— Paul D'Astous (@d_astous) August 31, 2018

But here's the thing.

If Canada's Food Guide stated that sugar-sweetened milks were not nutritionally equivalent to white milk, and that in fact sugar-sweetened milk consumption should be limited to half a cup daily in children, school chocolate milk sales wouldn't have been an election issue in the first place, as with that admonition, schools almost certainly would have put an end to the daily sale of an item Canada's Food Guide recommends kids explicitly limit.

And there's very little doubt that the next Food Guide, if it's ever released, won't be kind to chocolate milk. And that's not just me reading the tea leaves, it's also me remembering when Dr. Hasan Hutchinson, the Director General of the Health Canada unit responsible for the Food Guide stated, over 4 years ago (honestly, what could we possibly still be waiting for) during a public debate that we held,

"One thing we're doing right now (Note: Right now means February 2014) is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"

So the next time someone tells you that Canada's Food Guide doesn't matter you remind them that Health Canada's inexplicable foot dragging on its much needed revision just cost the New Brunswick Liberals the election.

(Stay tuned, because on Thursday, I'm going to post an incredibly innovative solution to the issue of chocolate milk in schools)

From The Journal Of Well-Intentioned Facepalms: St. Catherines' City Council Bans Vending of Bottled Water, Keeps Bottled Soda

So St. Catherine's City Council, presumably in a bid to be environmentally conscious, has banned the sale of bottled water in city facilities.

So St. Catherine's City Council, presumably in a bid to be environmentally conscious, has banned the sale of bottled water in city facilities.

As to what will replace the bottled water, and what will still be on sale?

Bottled actual soda, bottled diet-soda, bottled flat vitamin fortified soda (juice), and bottled sugar sweetened water (sport drinks and flavoured waters).

So no decrease in plastic bottle sales, and all at the expense of the healthiest beverage they'd previously been selling.

And this isn't a one-off apparently. According to the article written about St. Catherines' decision, similar water bottle bans exist in Niagara Falls, London, Burlington and Toronto.

Reminds me of a guest post here from a few years ago that spoke to the short-sighted war on bottled water which somehow manages to forget, sugar water also comes in bottles, and it's a lot worse for your health.

[Thanks to Mandy Robb Kasper for sending my way]

Where The Hell Is Canada's New Food Guide?

In case you missed the news, New Brunswick recently banned the sale of chocolate milk and juice in their schools.

It's a welcome move, and one that will be undoubtedly be adopted nation wide following the long delayed publication of Canada's next Food Guide.

Canada's Food Guide, last published in 2007, inexplicably and explicitly, reports that chocolate milk is a healthy dairy choice (that it also suggests dairy is such a magical food that it requires it's own Food Guide category is a whole other kettle of inexplicability). Or maybe it isn't that inexplicable in that on the then Food Guide's 12 member advisory committee was Sydney Massey, the Nutrition Education Manager and Spokesperson for the BC Dairy Foundation, where their homepage at the time featured the campaign,

"Don't tell Mom, but Chocolate Milk is good for you"

The next one, won't.

I know this in part because back in 2014, Dr. Hasan Hutchinson, the Director General of Health Canada's Office of Nutrition Policy and Promotion (the office in charge of the Food Guide), agreed with me during our then debate, that chocolate milk shouldn't be deemed a health food by our Food Guide,

"One thing we're doing right now is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"

And in May 2015 he was quoted by the CMAJ on juice stating,

"You won’t be seeing that anymore … and there’ll be a fair number of new materials coming out in the next few months."

I also know this because even McDonald's appreciates that chocolate milk, with more calories and sugar drop per drop than Coca-Cola, shouldn't be routinely offered to children.

So here's my first question.

If, in 2007, Canada's Food Guide had explained that chocolate milk is to milk what apple pie is to apples, and that it should be considered a treat rather than a health food, and that no, juice is not the same as fruit, do you think we'd be seeing these actual responses and comments posted on Facebook and on the CBC article in response to the news out of New Brunswick?

"How the hell can juice be bad for you I doubt orange and apple and cranberry juice is bad for your health CFDA would have ban the stuff decades ago"

"It is crazy and stupid. especially since the school officials are comparing the natural sugars found In the cocoa that makes it chocolate to the artificially added high fructose corn syrup used to sweeten coca cola."

"Ugh get a life people! Chocolate milk is some parents only option to get their kids to drink milk. And as far as juices they sell apple and orange at school so are they now telling us apple and OJ juices are bad??"

"I agree, pop and juice fine. Chocolate milk is filled with nutrients."

Because the thing is, though no one shops with Canada's Food Guide in hand, its recommendations do permeate national consciousness. And more to the point of this post, they inform school food policies. Once the new Food Guide is published, and assuming it explicitly recommends limiting sugar sweetened beverages and juice (and it will), all provinces will undoubtedly soon fall in line with New Brunswick.

And here's the most pertinent question. It's been 4.5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

ParticipACTION Report Cards Remind Us Every Year How Badly We're Failing Canadian Children

(Originally posted in 2016. Since nothing's changed, reupping it with 2018 data)

We suck at helping our kids to be active.

Here are the past 14 years of ParticipACTION kids' activity report card grades (click on 2018 for this year's edition):

2018: D+
2017: Didn't happen
2016: D-
2015: D-
2014: D-
2013: D-
2012: F
2011: F
2010: F
2009: F
2008: F
2007: F
2006: D
2005: D

So what has Canada done about it?

From my vantage point, it sure doesn't seem like much.

As to what we could we doing, I'm honestly not sure.

One thing I am sure of though, simply telling kids to be more active (or telling them and/or their parents how inactive they are) clearly isn't doing a whole heckuva lot. We need changes that change the default.

If you're a parent, I've blogged about the simple solution you could employ to help your kids move more (move with them).

If you're an educator, how about making every classroom/student reward an active one instead of relying on junk food (same goes for all of your various fundraising endeavours)? Oh, and get rid of inane over-protective schoolyard rules like bans on hard balls that effectively stifle active play.

If you're a city planner, how about more time and attention paid to developing safe, comprehensive, and unified biking and walking infrastructure?

And consider too the fact that decreasing kids' physical activity may well also be influenced by their rising weights (and not the other way around). I've worked with so many parents who report that as their kids gained weight, suddenly their interest in favourite activities waned. The why is something people either forget or overlook. Kids are cruel. Being picked last because you're slow, or simply not being able to keep up, would make most kids not want to play. One comment about "jiggling" while a kid runs is liable to lead a kid to stop running. Not wanting to change in front of your peers because of fat jokes and weight bias makes is another common hurdle. Here we need to see calls to action to tackle weight bias, and continued work towards improving the way we use food with our children, and ideally ending the regular use of foods by our kids' schools, teachers, coaches, cities, scout leaders, friends' parents, etc. to reward, pacify, and entertain them at every turn.

So how many more years of reading these depressing report cards before we either stop issuing them, or actually do something about the problem?

If You Need Proof The Food Industry Doesn't Care About You, Look No Further Than Smucker's "No Sugar Added" Jam

So I was shopping the other day.

We were making a dish that included apricot jam in a sauce and I was having a peek at the various offerings on the shelves.

I grabbed Smucker's Apricot Jam and noted that the front of its package highlighted the "fact" that it had "no sugar added".

The label of course told a different story.

It told me that the second ingredient was "white grape juice concentrate", which is likely on the order of 60% sugar by weight.

So yes, sugar was added.

I expressed my indignation on Twitter and Smucker's responded to tell me that they appreciated my feedback, that the concentrated white grape juice was meant to add "fruit flavor" as well as serve as a sweetener, and that according to the letter of the law, it was legal for them to state that their product contained no added sugar.

We appreciate your feedback. White grape juice concentrate provides added fruit flavor, and acts as a sweetener as well. Please know, we follow all CFIA labeling guidelines, including full disclosure of the total grams of sugar in each product, as listed on the Nutrition Facts.

— Smucker's (@smuckers) May 1, 2018

Now the good news is that at least in Canada, the addition of white grape juice concentrate, which of course is just the addition of sugar, will soon preclude Smucker's front-of-package "No Sugar Added" claim.

But of course if Smucker's actually wanted to do right by its customers it wouldn't be waiting for the Canadian Food Inspection Agency's regulations to change.

But that's not what Smucker's is about. Smucker's, like pretty much all publicly traded food industry players, is about profit, and their "No Sugar Added" jams are great case studies in how we shouldn't wait for the food industry to do the right thing, because unless the right thing aligns with profits, they're not going to do it.

Some Evidence Canada's New Food Guide Will Care About Evidence

Though there's no white smoke signifying the publication of a new Food Guide billowing out of Health Canada's food directorate's chimney, there are some signs that when it's finally published, it may be evidence based.

Take for example this story.

It details the concerns of Conservative agriculture critic John Barlow and it contained some heartening quotes.

Here's my favourite,

"It is very clear…that Health Canada is going in a direction that is detrimental to our agriculture sector, detrimental to our food processors as well as our producers on the ground."

Now while I feel for any sector impacted by the future Guide's recommendations, that Health Canada is not actively capitulating to agricultural interests suggests that perhaps instead, it's sticking with science as its underpinning.

According to Barlow, his office has been flooded with concern from a broad range of agriculture groups who are nervous about Health Canada's new policy of not kowtowing to industry,

"I want to really stress this point. These letters are not only from the livestock industry or the dairy industry, there’s letters in here from grain growers, the horticulture associations — none of them want us as a government, in this food guide document, to be picking winners and losers. They all want to be successful."

While there may well be some disagreement among health professionals as to what truly constitutes a healthy diet, where there likely is no disagreement is the notion that the desires of various agricultural sectors to be "successful" doesn't factor in to dietary health at all.

And just as an odd aside, in the same article is a quote from Agriculture Minister Lawrence MacAulay who was asked to comment about agricultural concerns. His response?

"Without a question, what I want to see is Canadians make sure that they express their view on what’s presented and that’s why things are gazetted. My opinion — really, it’s Canadians opinion that really reflects what takes place on this and anything else that’s gazetted to make sure that is what they do want to have happen."

Here's hoping that's not how policy works in Canada, as while not bashing the public, I'm pretty sure Food Guides shouldn't be built on what Canadians' personal opinions about food happen to be.

So bring on the evidence, and for the matter, bring on the new Food Guide. Remind me again, why are we still waiting?

Canada, Where Dr. Feelgood Beer Sales Are Banned, But Vitamin Water's Are Allowed

What's wrong with this picture?

Last month the Liquor Control Board of Ontario banned the sale of Dr. Feelgood IPA on the basis that the snake encircling the hops paddle, coupled with the prescriptive looking ℞ in the D℞., would implicitly lead consumers to believe that the beer was a health food.

Yet Vitamin Water's liquid candy sales are just dandy (including of course in stores frequented by children). And so too are the hundreds, if not thousands, of packaged foods that explicitly purport to confer health benefits, not to mention an entire industry of supplements that promise health miracles.

It is so disappointing that Canada continues to allow the food industry to dupe consumers with impunity.

(And for the record, and not just because I enjoy IPAs, I think the LCBO is overreaching here, while Health Canada and the CFIA don't bother lifting any fingers at all)

Food Industry Furious With Health Canada's Front-of-Package Plans

If Health Canada takes Chile's lead, we too might see Frosted Flakes boxes change from looking like those on the left to looking like those on the right.

When industry is furious with a government proposal it's a safe bet that proposal is likely to affect their sales, and so when I learned that the food industry was incensed by Health Canada's front-of-package plan proposals (Aric Sudicky, a final year medical resident who was rotating through our office at the time, watched the recent roundtable style consultation hosted to discuss the implementation of what will be a Canada wide front-of-package program, via teleconference and reported to me that industry was none too pleased), I wanted to learn more.

Now this post isn't going to delve into whether or not those are the best 3 targets for front-of-package symbols, instead I want to focus on the lobbying and machinations of industry.

First though, a tiny bit of background.

In creating a new front-of-package symbol for Canadian consumers, what Health Canada doesn't want is a program that emphasizes so-called positive nutrients as 50 percent of Canadian package fronts already have those (put there by the food industry directly to help sell food), or one that requires a second step of thinking to interpret (eg studying the nutrition facts table) as that has been shown to lead to misunderstanding, or a hodgepodge of programs (as more than 150 front-of-package labeling programs have already been documented in Canada) .

What Health Canada does want is a single, standardized system, that involves a prominent symbol, that's consistently located, that doesn't require nutritional knowledge to understand, to help consumers identify products with high levels of nutrients that Health Canada deems are concerning to public health, that by itself provides the required interpretation for its meaning. Such a system would be consistent with the core recommendations made by the U.S. Institute of Medicine.

Breaking it down further, what Health Canada wants is a system that conveys simple to understand information, rather than one that presents data requiring interpretation.

Further still?

Health Canada wants warnings.

In their recent meeting, Health Canada presented their wants to food industry stakeholders, as well as the evidence they feel supports them, and invited them to submit their thoughts and suggestions for a symbol to fit Health Canada's 4 design principles:

1. Follow the "high-in" approach
2. Focus only on the 3 nutrients of public health concern (sugar, sodium, and saturated fat)
3. Be 1 colour (red) or black and white; and
4. Provide Health Canada attribution

As to what this might look like, here are some mockups put together jointly by the Canadian Cancer Society, Canadian Medical Association, Canadian Public Health Association, Diabetes Canada, Dietitians of Canada, and the Heart and Stroke Foundation.

Given that warning symbols aren't likely to be good for business, I was curious as to industry's response to the ask.

Suffice to say, industry is indeed unhappy.

The Retail Council of Canada wants Health Canada to implement instead an instruction for consumers to turn products around and study their nutrition facts tables, and they don't want Health Canada's name mentioned on the symbol. They are apparently worried that including Health Canada's name on the symbol might be misinterpreted as a government endorsement which in turn would lead consumers to eat more of the products with the warning labels. They're also apparently simultaneously worried that if the symbol utilized is already recognized to be a danger symbol, it could lead consumers to believe there is a food safety risk, and that if used, children, accustomed to seeing these symbols on foods, might lead them to think that cleaning supplies with danger symbols are safe to consume.

The Food Processors of Canada used bold to point out that, "the meeting didn't agree to anything", and that, "Health Canada has lost its way on the obesity issue". They think that what's needed is more public education, not a front-of-package warning program.

The Canadian Beverage Association expressed their, "deep concerns", and that though they were happy to have been included in the meeting, their definition of "deep and meaningful dialogue" with industry should include a process whereby industry participants would all discuss and agree upon what the program would entail.

Food and Consumer Products of Canada also wanted to express their disappointment that they weren't provided the opportunity to be more directly involved in crafting the proposal's criteria and their concerns about "the integrity and transparency of the consultation process". They sent a second note expressing their hope that the criteria still have room to evolve and that their preference is for traffic lights as they believe, "information – good and bad – builds on consumer literacy".

Dairy Farmers of Canada expressed their concern that the proposed warning system lacks the nuance required "to distinguish between nutrient-dense and nutrient poor foods" (sweetened milk will likely be slapped with a high in sugar warning), and that they'd be happy to support, especially, "if coupled with exemptions for nutritious dairy products", those programs that would provide data for consumers to study and interpret (like for instance the Facts Up Front program illustrated below).

There was however, one response from industry that was heartening. It was from Nestlé, whose representative reported being, "a little embarrassed" by how industry presented their views during the roundtable, and, "that Nestlé is not fully aligned to some of the comments that were made by some of our trade associations, and a few of us are feeling very frustrated."

Whatever comes of all of this, one thing's for sure. The food industry's near uniform opposition to Health Canada's proposed front-of-package warning label criteria is strong indirect evidence in support of their utility, as for the food industry, salt, sugar, and fat are the drivers of profitability and palatability, and they'll oppose anything they worry might limit their use.

So kudos to Health Canada for sticking to their guns, and also for honouring their pledge to make this process transparent by sharing with me industry's responses.

(and if you clicked on any of the industry letters to read, this is the post roundtable letter from Health Canada to which they're all referring).

Good Lord! British NHS Just Banned Surgeries For Patients With Obesity (And Smokers)

In what is perhaps the world's most biased and blame based health policy, A British NHS just banned patients with obesity or who smoke from receiving elective surgeries in a bid presumably to inspire encourage help whip and prod people into losing weight (or quitting smoking - but I'm not going to touch on smoking in this piece, not because I agree with the policy, but rather because it's not my area of expertise).

The policy's two primary presumptions are ignorant and misguided.

The first has to do with the value of BMI as a clinical tool. While it's true that the risks of medical complications and morbidities rise with weight, BMI is a measure of bigness, not health. Half of the NFL have been reported to have BMIs greater than 30, as did my friend and colleague Dr. Spencer Nadolsky pictured below in his wrestling days when he sported a BMI of 32.

The second presumption is that obesity is a disease of personal responsibility and choice. While no doubt weight can be dumbed down to eat less, move more, I still find it shocking that public health professionals and policy makers exist who believe that somehow people with obesity simply haven't absorbed enough societal guilt, shame, and discrimination to finally lose weight.

Of course, even if you do want to embrace personal responsibility as the sole cause of obesity, medicine isn't about blame. We patch up drunk drivers and folks who don't wear seat belts. We treat people with asthma who don't bother keeping up with their puffers, pneumonias exacerbated by the early discontinuation of antibiotics, and the psychotic breaks of folks who stop their antipsychotics.

Oh, you want surgical examples?

How about liver transplants in patients who once suffered with alcoholism; or how about one that doesn't involve a so-called vice at all - heart bypasses on folks who simply didn't bother to take their blood pressure, cholesterol or diabetes medications?

We operate on them all in a timely manner, and so we should, but yet here the NHS feels comfortable discriminating against people with obesity, because they apparently still feel justified discussing obesity on the basis of blame based causation.

But putting those two erroneous presumptions aside, the notion that blame based medicine is something that the UK wants to adopt is plainly repugnant. Medicine's not about blaming and shaming. Life is complicated. And even if a person has the time and personal health to allow a run at intentional behavior change, how high on the list of priorities do you think healthy living lies for someone whose children struggle with substance abuse, or whose debts are staggering, or whose spouse is hobbled with post-traumatic stress disorder? Or someone with any of those same issues who is also unemployed?

Clinically useless truisms aside, obesity is complicated, and moreover we have yet to discover a non-surgical, reproducible, and uniformly effective plan for the management of obesity. And while there's no argument about the fact that in a ideal world everyone would take it upon themselves to live the healthiest lives possible, there's two problems with that argument. Firstly, not everyone is interested in changing their lifestyle, and secondly, statistically speaking, the majority of even those who are interested and successful with lifestyle change will ultimately regress. Meanwhile the burden of suffering that the elective surgery those with obesity are being denied may add to absenteeism, presenteeism, pain, depression, and more.

If someone from the NHS' clinical commissioning groups (CCGs) in Hertfordshire (who thought up this loathsome, biased, and backwards policy) is reading this, I want to remind you of the NHS Constitution's first guiding principle:

"The NHS provides a comprehensive service, available to all

It is available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status."

Either you're going to have to reverse this idiotic policy, or amend that statement above to explicitly exclude those with obesity.

For shame.

(In rushing this post through, I utilized paragraphs from a number of previous stories I've written about obesity, blame, and bias)

UK Gov's ParkLives Kids' Exercise Partnership Markets Coca-Cola

ParkLives is a joint project between Coca-Cola and the British government that aims to promote free physical fitness activities at local UK parks.

At least that's what's in it for the British government.

What's in it for Coca-Cola?

Well of course they can spin it as strong corporate social responsibility which helps their claim that they're on team health and in so doing provide themselves with ammunition to possibly forestall or block industry unfriendly legislation.

But there's more.

There's marketing.

A recent study set out to look at the ParkLives project through the lens of advertising.

The study analyzed two weeks worth of #ParkLives tweets during two separate weeks. The first week was during a week of school vacation (where the marketing might be expected to be thicker and the events more frequent), while the second was during the school year, but spanning National Fitness Day.

Every identified tweet was then coded for category of content (marketing or otherwise)

Over the two weeks of collection, 318 tweets containing 216 images were identified, and of those, 57% included a Coca-Cola logo (usually on banners or staff shirts).

The authors note that the exposure to Coca-Cola branding is perhaps more powerful here in that with ParkLives, Coca-Cola is associated with fun, healthy, family activities.

The authors' take on all of this?

"ParkLives is indicative of a CSR project that aims to create a health halo around a brand and influence wider socio-ecological factors by guiding public discourse and directing opinion on the determinants of public health issues away from corporate influence and toward individual responsibility"

Partnerships, by definition, benefit both involved parties. Perhaps governments shouldn't be helping out in the business of marketing the world's largest liquid candy brand.

Could Health Canada's Future Front-of-Package Stoplights Reform Deceptive Claims?

So on Monday I blogged about how there are plenty of foods of dubious nutritional quality with fronts-of-package claims that while legal, are deceptive.

Looking ahead, there is the chance that Health Canada will be implementing a national front-of-package food labeling program which in turn would highlight products' higher than desired nutrient contents (perhaps by way of stoplights for instance).

So here's my straightforward suggestion.

Regardless of the system implemented, if a product's ingredients score it a front-of-package warning from Health Canada, that product's packaging should be legally prohibited from including any front-of-package health claims or inferences (where inferences for example would be a package of Froot Loops shouting out to its inclusion of whole grains or Vitamin D, but without an actual functional health claim).

Though imperfect, this simple step might help tilt the playing field ever so slightly away from the food industry's current unfair advantage.

Guest Post: A Lawyer Weighs In On Canada's Proposed Kid Ad Ban

Early last week there was a surprising piece in Blacklock's Reporter that suggested that Canada may be reconsidering its plans to ban the advertising of junk food to children (an election piece of Prime Minister Trudeau's and part of Health Minister Philpott's mandate letter). After seeing it, I contacted Canadian public health lawyer Jacob Shelley and asked him if he'd be so kind as to share his legal thoughts. He kindly agreed.

Restricting food and beverage marketing to children has long been identified as a necessary public health strategy to reduce diet-related chronic diseases, including obesity. It is a strategy endorsed by the World Health Organization and has been the focus of the Stop Marketing to Kids Coalition in Canada over the past few years (the Coalition has called for the implementation of its Ottawa Principles, which bans food advertising to youth and children under 16). Not surprisingly, there was considerable excitement in the public health community when Prime Minister Justin Trudeau identified “introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec” as a top priority for protecting public health in his Minister of Health Mandate Letter.

Québec’s Consumer Protection Act prohibits, with some exceptions, all commercial advertising to children under thirteen years of age (s. 248). In 1989 the Supreme Court of Canada upheld the Québec ban as a constitutionally valid limitation on the freedom of expression, protected by section 2(b) of the Charter of Rights and Freedoms in the seminal case of Irwin Toy v Québec.

In Canada, expression is considered a “fundamental freedom”, and because of its importance, the courts have consistently held that section 2(b) requires a large and liberal interpretation. Commercial speech, which includes advertising, is among the types of expression that the Charter seeks to protect. The courts have held that commercial expression serves an important public interest, one that goes beyond its economic value, because it allows consumers to make informed choices. Even so, the government can impose restrictions on expression. A limitation on the freedom of expression can be justified if the government is able to demonstrate that it is reasonable, an assessment based on the Oakes test.

This is what occurred in Irwin Toy, where a majority of the Supreme Court found that the Québec ban was justified, even though it infringed on the freedom of expression. The Court was particularly concerned about the vulnerability of children to advertising. It held: “the evidence sustains the reasonableness of the legislature's conclusion that a ban on commercial advertising directed to children was the minimal impairment of free expression consistent with the pressing and substantial goal of protecting children against manipulation through such advertising.”

Since Irwin Toy, the Supreme Court has upheld other bans on commercial speech, most notably, commercial speech related to tobacco products. In Canada v JTI-MacDonald, the Court unanimously held that the restrictions placed on tobacco advertising and marketing were justified restrictions on the freedom of speech. Of particular note, the Court held, “when commercial expression is used for the purpose of inducing people to engage in harmful and addictive behaviour, its value becomes tenuous” (para 47).

Through Irwin Toy and JTI-MacDonald, the Canadian jurisprudence clearly establishes that (i) children are vulnerable and need to be protected from manipulative advertising and (ii) commercial expression that induces harmful behaviour(s) has tenuous value. It would seem apparent, then, that restricting advertising to unhealthy food products to children – the strategy the government appears to have adopted – is relatively low-hanging fruit. After all, the government could do more, as Irwin Toy involved restricting all advertising directed to children. While there may be some details to iron out – such as what age should the ban use and determining what constitutes unhealthy foods – the overall strategy seems to be in accordance with Canadian law.

Thus it was surprising to read that Health Canada may be backing away from meaningful restrictions on food advertising to children out of fear of industry lawsuits (note: this has not been confirmed or reported elsewhere).

UPDATE: Health Canada was kind enough to tweet a response after this article was posted.

Have no fear: HC is committed to restricting marketing to kids and is taking action. See https://t.co/0qIZDHG1Of

— Health Canada (@HealthCanada) July 24, 2017

What is there to be afraid of, exactly? Certainly industry lawsuits were expected the moment PM Trudeau penned his mandate letter. It would be unrealistic to expect the food industry to accept any governmental oversight of advertising to children – kids are big business, after all, and restricting food advertising to children will have a discernable impact on the industry’s bottom line. The industry is not interested in any regulation.

To avoid regulatory interference, the industry has created its own self-regulatory framework that it frequently touts. It includes the Broadcast Code for Advertising to Children and the Canadian Children’s Food & Beverage Advertising Initiative (this is in addition to individual corporate promises). Such frameworks are often considered to be largely ineffective, lacking transparency and accountability. Recent research suggests that advertising of unhealthy foods to children has increased in recent years. Self-regulation, simply put, isn’t working.

If the industry does initiate a lawsuit, we can be sure that it will cloak its claim in Charter language, but this should not be mistaken as interest in protecting Canadian’s freedom of expression. Rather, it seeks an unbridled free market, one that allows it to continue to target vulnerable children in order to increase profits.

When PM Trudeau announced Canada would impose restrictions on the marketing of unhealthy foods and beverages to children, the world noticed. Canada now has the opportunity to become a global leader when it comes to restricting marketing to kids. It would be a shame if the fear of industry push-back impeded current efforts, especially when the courts have already made it abundantly clear that children are more important than commercial expression.

Have your say: Health Canada is currently seeking feedback on its approach to restricting marketing unhealthy food and beverages to children, and you can do so by visiting here.

Jacob Shelley is an Assistant Professor with the Faculty of Law and the School of Health Studies in the Faculty of Health Sciences at Western University. His primary area of research is the role of law in promoting public health and preventing chronic disease, with a focus on diet-related chronic diseases. Follow him on Twitter here.