Saturday, November 18, 2006

Guidance? What Guidance?

Obesity and overweight rates in Canada are skyrocketing. Official statistics state that almost two thirds of our population is overweight or obese. Fact is, the number actually probably closer to three quarters. If you click on the picture above you'll see obesity rates (overweight not included in slide) based off of measured Canadian heights and weights whereas all the official statistics are based off of self-reported heights and weights - turns out when Health Canada calls to ask how tall and heavy we are, many Canadians under report their weight and/or over report their height.

So if 65-75% of the population is overweight or obese, and if obesity costs Canada close to $7 billion per year in direct health care and lost productivity costs, and if obesity is responsible for the death of 1 in 10 Canadians between the ages of 20 and 64, and if at one of obesity's root causes are the foods we're choosing, and if the Food Guide revision was launched with obesity as a primary focus, and if we ignore the fact that the calorie models are flawed and that by focusing on nutrients we ignore the bigger picture of chronic disease prevention (including but not limited to obesity), then what sage advice does this new Food Guide provide Canadians on how to manage their weight?

For your benefit, I am going to copy every single statement from the Food Guide that relates to what they refer to as "Healthy Weight".
  1. Aim for the number of choices recommended in "Your Guide to Daily Food Choices" for your age and sex.
  2. Try not to eat too much more or too much less.
  3. Be aware of your portion sizes. Use the Food Guide to assess how much you eat.
  4. Choose foods and beverages that are lower in Calories and fat
  5. Be physically active each day
  6. Eating the amount of food suggested in "Your Guide to Daily Food Choices" should help adults achieve and maintain a healthy weight. You can tell if you are eating too much or too little food by how your weight changes over time.
  7. If you are at a healthy weight and find that you need more calories, have more choices from the four food groups.

So let me get this straight. Obesity's one of the main reasons Health Canada launched the revision process, contributes dramatically to our health care expenditures, kills tens of thousands of Canadians each year and the sum total of their advice is weigh yourself daily and if you gain weight eat less? Gee, that's helpful.

I especially like the point that explicitly tells Canadians that if they're at a healthy weight and need more calories, they should eat more! Doesn't eating more calories cause weight gain? Shouldn't there instead be guidance on how to utilize behaviour and food choices so as to minimize, if not eliminate hunger?

The problem is Health Canada seems mired in the ridiculous notion that "Healthy Eating" leads you to "Healthy Weights". Healthy eating and weight management are two completely separate entities. Healthy eating involves the foods that you choose, while weight management involves the Calories you choose. You can gain weight eating only salad if you eat enough of it.

Don't believe me? Here's a sample diet that our registered dietitian Shawna Hunt created and presented to Health Canada at our sit down meeting. She designed it using the draft Food Guide and adhered to its every rule and recommendation as applied to women between the ages of 18-50. It's meant to represent what a person might consume while trying to "Eat Healthy", but without understanding Calories. Eat it and you'll consume 2800 Calories of very healthy food. She even went light on the "Other" foods despite the fact that as you've read, they make up 25% of the energy you're consuming.

So if obesity's a great concern for Health Canada, and if "Energy" is measured in Calories, why isn't there some guidance surrounding Calories.

Do you think it would be useful to know roughly how many Calories your body burns in a daytime? If you knew how many Calories you burned, it would almost certainly influence your decisions as to what to eat. The easiest analogy is money. You need to know how much money you make in order to determine not only how much you can spend, but also to give you an understanding of the value of money because if you don't know how much money you make, knowing how much something costs becomes much less useful. Similarly, if you don't know how many Calories you burn, that big, bold first piece of information on the Nutrition Facts label, Calories, can't help you as much. It's less helpful because while of course you know that more Calories lead to heavier weights, if you don't know how many you burn, you won't know how much is too much.

If we take that hypothetical, sedentary, 5ft 4inch 50 year old woman, she would likely do well to know that at a healthy weight, she only burns on the order of 1500 Calories per day. Knowing that may make her think twice about whether or not she needs the 750 Calorie Starbucks Island Oat bar featured in a prior post.

Sadly, when discussing this very issue, Health Canada resorted to out and out lying. Here's the exchange from the October 24th meeting at the House of Commons. Health Canada had just been asked if they knew about my concerns regarding their lack of Caloric guidance,
"It is a perspective that I know has been expressed by him, and it is a perspective that isn't shared widely by others. We take this very seriously. We don't just casually say we don't agree with something. We are very careful about this.

I can take tell you that we've actually met with the scientific director of the Canadian Obesity Network, Dr. Sharma. We asked him whether he thought we should be talking about Calories. His answer was no."
Actually, his answer was "Yes".

Unbeknownst to Health Canada, Dr. Sharma and I had just spent the weekend at the Obesity Society conference in Boston and we found some time to chat. Among other discussions, we had talked about the value of Caloric guidance and the role of what I'll call Caloric awareness in helping our country's obesity concerns. I emailed him about what Health Canada had reported that he'd said and here's his response,
"Interesting, because I also just heard from Mary Bush.

I don't think I ever said Calories are not important and no guidance should be given ...

I think I did agree in general that there should be some guidance for normal Caloric intake - making it clear that there is a range compatible with maintaining a normal weight and that individuals' requirements may vary ...

I think, all I said was that I did not feel strongly about Calorie counting - but I agree that for people to have some idea of their requirements and some general idea about how many Calories are in what foods would be helpful."
So did Health Canada knowingly lie? Probably not. The slightly nicer than lying option, is that when Dr. Sharma clearly stated that he thought some basic Caloric guidance would be useful, Health Canada wasn't actually listening they were just hearing.

As I've been saying throughout this series, the issues I'm bringing up are not medical secrets. The fact that at the end of the day eating more calories than you burn leads to weight gain - is not a surprise or a secret to Health Canada, it's just that Health Canada clearly chooses what it wants to hear rather than relying on best evidence to guide their guidance.

Tomorrow: Health Canada's Quobesities - My favourite quotes from Health Canada officials on the matter of the Food Guide.

Yesterday: Oh, and you Can't have Ketchup - How Health Canada has ignored 25% of your dietary energy intake.