Wednesday, June 10, 2015

My Testimony to Canada's Senate Regarding Obesity and Action

This afternoon I'll be speaking with Canada's Standing Senate Committee on Social Affairs, Science and Technology, who have been tasked with examining and reporting on the rising incidence of obesity in Canada and to provide recommendations as to what to do about it. My testimony, along with the question and answer period afterwards, will be webcast and starts at 4:15pm EST.

Good afternoon. My name is Yoni Freedhoff and I’m a physician, an Assistant Professor of Family Medicine at the University of Ottawa, and I have dedicated my professional career to the study and treatment of obesity. I'm very grateful for the invitation to speak with you today.

9 years ago I had the similar opportunity to speak with the House of Commons' Standing Committee on Health who were working on a report very much like the one you’ve been tasked to produce. Their 72 page report’s recommendations, though not necessarily describable as bold, did call for action. Now, nearly a decade later, while admirably we’re still talking about obesity in Canada, action has remained a rarity.

Some cling to the notion that obesity is a problem of personal responsibility, suggesting that somehow, over the course of the past 60 years, that not just Canada but the world as a whole, has suffered an epidemic loss of willpower. They suggest that consequent to the fact that on paper obesity can be prevented by the judicious use of forks and feet, that governments need not be involved in its prevention. Yet this flood of diet and weight related illness is poised to cripple Canada’s health care system, and to date, in responding to this flood, we’ve focused on education, on public health messaging campaigns, and on calls to action designed to spur conscious, individual change. Floods aren’t well treated by way of isolated, individual change, as swimming lessons, no matter how thoughtful, well-designed, or societally embraced, won’t stem rising tides, and even the strongest swimmers get tired. That doesn’t mean people shouldn’t learn how to swim or that we shouldn’t encourage them to do so, but when there’s a flood it’s a government’s responsibility to build levees, and when it comes to this flood, I’m not sure Canada’s bothered to fill even a single sandbag.

It’s important to recognize that no single sandbag can stop a flood. That fact is perhaps part of the problem as often that truth cripples action as it allows detractors to rightfully argue, “that sandbag won’t cure or prevent obesity”. And they’re absolutely correct in their criticism. Not only will single sandbags not stop floods, but also the nature of flooding is such that it is impossible to predict which of a levee’s sandbags will prove to be the most important ones. But that truth doesn’t mean we shouldn’t be filling sandbags.

There is no shortage of potential sandbags. The rise of obesity has been consequent to dozens, if not hundreds of changes we’ve made to our environment such that now, the default for the majority of the population is weight gain. People don’t choose to gain weight. Weight gain happens consequent to a world that requires each of us, if we want to eat healthfully, to actually go out of our way to do so. It’s a world where packages of ultra-processed foods laden with hyperpalatibility’s bet you can’t eat just one’s holy trinity of salt, sugar and fat are legally allowed to brag about the fact that they also happen to contain Vitamin D, or Omega-3s, or whole grains on the fronts of their packaging, where what our children are taught in schools that they shouldn’t be regularly eating is regularly provided to them in those same schools’ cafeterias and vending machines, where the food industry is allowed to market to children, where our Food Guide is non-evidence based and if followed, might well lead a person to gain weight, and where our nutrition fact panels are so confusing and unwieldy that our government has launched not one, but now two campaigns designed to help Canadians understand how to use them.

If we want to see change we need to re-engineer our Willy Wonkian food environment such that healthful becomes the default choice, and that hyperprocessed junk food needs to be actively sought out rather than not only actively avoid but also actively provided. Though there is no consensus as to which sandbags will have the greatest impact, or which should be filled first, the ones I believe would be both beneficial and within the purview of the federal government would include:
  • Revising Canada’s Food Guide and mandating its regular reassessment
  • Joining the rest of the G8 nations and establishing a national school food program that includes the integration of curriculum designed to teach children about nutrition, food and healthful cooking.
  • Banning the marketing of all food to children.
  • Mandating the provision of contextualized calories on menu boards of chain restaurants, coffee shops, movie theatres, etc.
  • Effecting nutrition fact panel reform so as to utilize realistic and standardized serving sizes, decrease confusion and ambiguity, identify added sugars, and include whole package caloric information.
  • Effecting front-of-package health claim reform so as to disallow the use of nutrient based health claims and promotions.
  • Adopting a rigorous, engaging, and evidence-based national front of package nutrition guidance label (eg. The UK’s stoplight system and/or Nuval)
  • Taxing sugar-sweetened beverages.
  • Subsidizing fresh fruits and vegetables.
No one sandbag will stop a flood, but the longer we spend discussing but not filling sandbags, the worse this flood will become and the more havoc it will wreak. While it’s always a great time for discussion and debate, we need action, as the longer we continue to wait to actually do something, the greater the threat to Canadians’ health, and to health care as we know it.