Saturday, November 18, 2006

What Can You Do?

Well if you haven't guessed it already, my first piece of advice is, don't follow Canada's Food Guide. It's not even remotely reflective of our current understanding of the effects of food on chronic disease prevention, it's rife with the involvement of politics and the food industry and if you do choose to follow it, you'll probably gain weight.

Does the fact that Health Canada is about to release this Food Guide without allowing for any further input or revisions upset you? Does it bother you that it's what's going to be taught to your children in schools, handed out in doctors' offices and taught as gospel to dietitians across Canada? Do you find it frustrating that those Canadians who are concerned enough to look for help with either nutrition or weight management will be pointed towards a terrifically flawed food plan?

If it does, then consider actually doing something about it.

Noise actually does make a difference and one of the best ways to make noise is to write or better yet call your local MP and explain to them your concerns. If you're not sure who your MP is, no worries, simply click here and using your postal code, you will be provided with your local MPs name, telephone number, fax number and email.

If you'd like, cut and paste the following brief message, modify it as you see fit and email away,

Dear (insert your MP's name here),

I am writing to you today to voice my concern regarding the pending release of the revised Canada's Food Guide to Healthy Eating. The recommendations being made by the draft guide are not reflective of science and medicine's current understanding of the impact of diet on chronic disease prevention, including but not limited to obesity.

Considering the fact that at least 25,000 Canadians die annually due to diet and weight related illnesses at a cost to Canada of over $6 billion dollars, to ignore this issue would be a grave mistake.

It has been 14 years since the Food Guide's last revision. Expert physicians and representatives from the non-profit nutritional advocacy group the Centre for Science in the Public Interest have testified before the House of Commons Standing Committee on Health as to the dietary shortcomings of this pending release.

I am writing to you today to urge you to ensure that before a new Food Guide is released and before we are subjected to another 14 years of inaccurate dietary advice and consequently unnecessary morbidity and mortality for Canadians, that both the draft Food Guide and the process by which its recommendations are crafted be reviewed.

Another way to make noise is to spread this series around. The link to the kick off of this series is here:

Please link to it on your websites, blogs, any forums you might frequent and in emails to your friends and families lists. The more people who are aware of how Health Canada has handled these Food Guide revisions, the more likely that meaningful improvements take place.

In terms of an evidence-based plan for healthy eating, look no further than the picture at the top of this post. That's a picture of Dr. Walter Willett's Healthy Eating Pyramid. Not only is it evidence based, but part of that evidence was Dr. Willett's proof that following it demonstrated a markedly reduced risk of chronic diseases vs. following the American (and for all intents and purposes the Canadian) Food Guide. For a detailed trip through his recommendations, pick up his fabulous book, Eat, Drink and be Healthy

With regards to weight management, you have to separate the concept of healthy eating from weight management. Healthy eating wise, stick to Dr. Willett's pyramid. Weight management wise, lessons learned from the National Weight Control Registry along with my experiences with close to 1,000 patients suggest the following Top Ten style list to be extremely important for successful weight management:
  1. Figure out how many you burn in a daytime. The best calculator I've found to do this is located here. Eating 500 fewer Calories per day should lead to a weekly 1lb weight loss.
  2. Keep track of what you're eating - whether via a food diary, routine eating or your own system, knowing how many Calories you've had is extremely helpful in guiding your decisions. There are online resources to do so including Calorie King ($30/yr) and Spark People (free).
  3. Don't lose too quickly. Remember, if you don't like the way that you're losing weight, you're almost certainly going to gain it back when you stop living that way. The only way to lose weight rapidly is to eat far too little, and unless you plan on eating far too little forever, it's not a good plan.
  4. Don't get hungry! Eat 3 meals and 3 snacks daily, not going more than 3 hours without eating. Waiting until you're hungry to eat will of course lead to more challenges - we don't crave green leafy salads when we're hungry
  5. Try to include protein with each meal and snack as protein is more filling, delays the body's absorption of carbohydrates and helps smooth out the body's insulin response.
  6. Practice Calorie awareness! Before I buy anything I look at the price tag. Before I eat anything, I check out the Calories. Doesn't mean I don't eat high Calorie items from time to time, it's just that I pick and choose when. Not knowing the Calories before I ate would be like me shopping by handing out blank checks.
  7. Eat breakfast! Make sure that you have at least 300 Calories, that it's within at most an hour of waking and that protein's included.
  8. Minimize eating out. If you're not in charge of the cooking, you're not in charge of the Calories and Calories sell. A restaurant's job is to bring you back. Their portions will be larger and their ingredients higher in Calories. It's extremely challenging to lose weight with frequent meals out.
  9. Don't drink your Calories. Liquid Calories don't help with feeling full. Fruit juice drop per drop has more Calories than Coca Cola. Milk as discussed in a prior post, may not be the healthiest drink in the world. I recommend lots of water and taking advantage of the myriad of zero-calorie beverages available. While much to do has been made about potential risks of sweeteners, every rigorous scientific study has found them to be safe, however even if you want to worry about the potential for a remote or rare risk, there's no doubt there are greater risks with weight.
  10. Find as many ten minutes as possible to exercise (brisk walking, housework, playing with your kids all count). Exercise for weight management is cumulative - it's like going to the bank. If you deposit $10 four times a day at the end of the day you've got $40, you don't need 40 minute blocks of exercise to make a difference. Aim if you can for between 250-350 minutes of exercise weekly. A great book on the subject is the No Sweat Exercise Plan by Harvard cardiologist Dr. Harvey Simon
Not included in the Top Ten list but perhaps more important than anything is the following: Don't set number goals. There are lots of numbers that you might try to pick on or goal set with - weight, body mass index, body fat percentage, waist circumference, waist-to-hip ratio. Frankly they're not that useful. They're really only useful for two things. Firstly you can use them to try to work out whether or not your weight carries with it any medical risk and secondly you can use them as potential calls to action, but I've got to reiterate, don't set goals with them.

The only goal worth setting is living the best you can. If you can't eat less and you can't exercise more within the context of a lifestyle that you're actually enjoying, then whatever your weight is, it's great. Remember that even a 5% weight loss has a significant medical benefit.

I hope you enjoyed this series on Canada's Food Guide and while I'm not holding my breath, maybe with enough noise you won't soon be reading an editorial written by me about how bad our new Guide is when it does officially get rolled out.

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