Monday, March 07, 2016

Canada's Senate Set to Tackle the Food Industry

Last week saw the publication of the Canadian Senate's Report Obesity In Canada A Whole-of-Society Approach for a Healthier Canada. My friend and colleague Dr. Arya Sharma criticized the report for not recognizing the pervasive and damaging nature of weight bias in Canada, and on this he and I strongly agree.

But Dr. Sharma voiced more concerns, broadly, that the report did not focus sufficiently on the treatment or research of obesity, and that it's stuck in the "Eat-Less Move-More" paradigm.

On these two points we both agree and disagree.

On treatment, the primary challenge is that there simply isn't a gold standard non-surgical approach to champion. The secondary challenge is that even were there such an approach, there's a dearth of physicians and allied health professionals trained and interested in delivering it. To that end I was encouraged to see the report's recommendation calling for improved physician training in nutrition and exercise - a need I recently wrote about, and to promote the use of counselling to help (a call that may relate to remuneration).

On research, I wholly agree with Dr. Sharma, it was surprising not to see a call for investment in studies and research meant to inform future best practices, both in terms of obesity treatment, but also prevention and public policy.

On Eat-Less Move-More, here I can't fully agree with Dr. Sharma's concerns. Ultimately eating less is required if we're to see changes to weight, and moving more is required if we're to see health risks mitigated, and there is a role for education and support of the public eating less and moving more directly. And had the Senate's report focused solely on the individual as the driver of change, I would have been equally disappointed, but that's not what their report does.

Instead the Senate's report focuses primarily on the food industry's direct and indirect influences on consumer choice.

The report's recommendations include:
  • Banning food and beverage advertisements to children (where food advertisements have been proven to increase kids' eating)
  • A sugar sweetened beverage tax which in turn may help both to decrease consumption due to economic considerations, and potentially to raise funds that in turn might further healthful eating or obesity treatment/research (I would be very disappointed were a tax enacted without some mechanism to ensure at least some of the funds raised would be earmarked for health)
  • Improving access to nutritious food in Canada's northern communities (places where the exorbitant costs of healthful foods may preclude their purchase)
  • Revising Canada's Food Guide to adopt a meal based approach and to have the guide speak strongly against the consumption of ultra-processed foods (and in so doing lay the groundwork to remove front-of-package health claims and the notion that juice is a fruit equivalent)
  • Ensuring that the revision of Canada's Food Guide excludes the direct involvement of food industry representatives (which will help to ensure the recommendations are evidence, and not interest, based, where food industry interest always favours increased, not decreased, consumption patterns)
  • Ensuring that the revision of Canada's Food Guide looks specifically at the science (or lack thereof) underpinning its excessively saturated fat phobic stance and that it changes the serving based focus that both nutrition professionals and the public have deemed confusing and unhelpful.
  • Reforming our current system of front-of-package health claims (which will help to reduce the health haloing of ultra-processed foods)
  • Exploring the possibility of using a unified front-of-package rating system (which in turn has been shown with some systems to improve dietary choices)
  • Adding menu board calories in chain restaurants (which will help to inform, but not dictate, consumer choice)
  • Creating a public awareness campaign on healthy eating that specifically calls out ultra-processed foods and champions cooking (could there be a report on nutrition or obesity that didn't include a public education component?)
Again, back to Dr. David Katz' sandbag analogy. We have a flood. To date, as a society, Canada has focused primarily on the encouragement of swimming lessons to fight the current, and while swimming lessons are always worthwhile (and indeed included in this Senate report as well), here we finally see an arm of government calling for the building of a levee against one of the flood's primary sources - the food industry.

Happy to see this, and it's about time.