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A Mediterranean Diet for the Prairies: The Pure Prairie Eating Plan

PPEP coverToday’s guest post comes from Catherine B. Chan and Rhonda C. Bell, Professors in Human Nutrition at the University of Alberta. It describes their Pure Prairie Eating Plan (PPEP) and how they went about developing this rather unique venture into eating local.

Healthy eating is a key factor in preventing and treating chronic diseases such as heart disease, stroke, cancer and diabetes. According to the World Health Organization, good nutrition is one of 4 key factors that could help postpone or avoid 90% of type 2 diabetes and 80% of coronary heart disease.

The Mediterranean Diet has gained popularity as a healthy diet, but evidence gathered through research on Canadian prairie­grown products (canola, flax, barley, pulses, dairy and meats) demonstrates that many local foods have similar nutritional qualities and would be more acceptable and accessible to people who live in Alberta, Saskatchewan and Manitoba.

Our recent project was conceived to develop, test and demonstrate the potential health benefits of a dietary pattern based on foods that are commonly grown and consumed in a “made in Canada” menu plan.

How the Pure Prairie Eating Plan (PPEP) was developed

The original purpose of the menu plan was to help people with type 2 diabetes adhere to the nutrition recommendations of the Canadian Diabetes Association (CDA) by focusing on healthy food choices with a local flavour. The menu plan concept integrates knowledge gained through research related to consumer behavior, behavior change, and nutritional quality of dairy, meats,
canola, pulses and grains.

During its development, it was recognized that a diet healthy for people with diabetes is a diet healthy for everyone. This notion was reinforced in a Consensus Conference with people living with type 2 diabetes, who felt strongly that their diet should not be different from others.

This approach provided knowledge that formed the basis of a 4-­week menu plan focused on foods that are grown and readily available in the Canadian prairies. The plan consists of 28 days of diabetes-­friendly menus including 3 meals and 3 snacks each day, approximately 100 recipes, tips for healthy eating, pantry and grocery lists and other helpful information.

If followed consistently, the menus meet the recommendations of Eating Well with Canada’s Food Guide on a daily basis, and over 1 week averages approximately 2000 kcal/day with macronutrient distribution consistent with health recommendations.

The menus also provide total fibre between 25 and 50 g/day. Many of the recipes have been obtained from our provincial agricultural commodity groups (see http://pureprairie.ca/our­sponsors/).

The recipe ingredients feature many homegrown foods from each food group. They are quick and easy to make…and tasty!

Our Research Findings

Funding was secured through the Alberta Diabetes Institute to pilot test the menu plan concept in a 12-­week intervention that measured both quantitative (disease biomarkers) and qualitative (acceptability, accessibility and acceptability) responses to the menu plan of 15 people with type 2 diabetes.

The results, published in the Canadian Journal of Diabetes, showed that most participants liked the menu plan and their A1c decreased by an average of 1%.

However, many were not used to cooking from scratch and cited time as a barrier to using the menu plan more. The benefits of the menu plan included more structure in participants’ diets, increased frequency of snacking, increased awareness of food choices, purchasing healthier foods and better portion control.

Participants were aware of better blood sugar control. Participants were pleased with the variety of food choices and liked the taste of the recipes. They also liked the flexibility of the menu plan.

In the second phase, which included 73 participants, we included a 5-­week curriculum delivered in a small­group setting with a facilitator and included assessment of hemoglobin A1c as a measure of blood sugar control as well as cardiovascular risk factors. Nutrient intake was assessed using a computer­based 24-­hour recall system called WebSpan.

In this study, 86% of those enrolled completed all aspects of the programme, including the 3­-month follow­up. On average, there were decreases in A1c (­0.7%), body mass index (­0.6 kg/m2) and waist circumference (­2 cm). (Note that a decrease in A1c of 0.5% is considered to be a clinically relevant improvement in blood sugar control.)

Although the weight loss was relatively small, it correlated with the reduction in A1c more strongly than any other factor examined.

Analysis of nutrient intakes showed decreases in total energy intake (­127 kcal/day), total fat (­7 g), total sugar (­25 g) and sodium (­469 mg).

The Pure Prairie Eating Plan (PPEP)

With promising outcomes regarding the nutritional adequacy and acceptability of the menu plan, and with encouragement from Alberta agricultural commodity groups and others, we packaged and re­branded the menu plan as the Pure Prairie Eating Plan (PPEP): Fresh Food, Practical Menus and a Healthy Lifestyle.

PPEP is available for purchase in selected bookstores throughout the prairies and proceeds from its sale will be used to further research into improving the lifestyle behaviours of Canadians with or at risk of chronic diseases.

For a listing of bookstores currently stocking PPEP, or to buy online, click here

Healthcare providers wishing to purchase 6 copies or more can contact info@pureprairie.ca for a discount.

We would like to acknowledge the financial support of our sponsors.

The Authors

Dr. Catherine Chan is Professor of Human Nutrition and Physiology at the University of Alberta. Her research (Physical Activity and Nutrition for Diabetes in Alberta, PANDA) focuses on the development, implementation and evaluation of healthy behavior interventions as well as on identification and testing of healthy food ingredients. She is also the Scientific Director for the
Diabetes, Obesity and Nutrition Strategic Clinical Network of Alberta Health Services.

Dr. Rhonda Bell is Professor of Human Nutrition and leader of the ENRICH project (Promoting Appropriate Maternal Body Weight in Pregnancy and Postpartum through Health Eating) at the University of Alberta. The ENRICH project aims to develop and promote practical strategies for women to maintain healthier weights during and following pregnancy.

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Canadian Obesity Network’s Toronto Chapter Takes Off

CON-Toronto Chapter Executive

CON-Toronto Chapter Executive

As regular readers may know, the Canadian Obesity Network is currently promoting the creation of local chapters across Canada. This is part of the Network’s strategy to continue growing and engaging researchers, health professionals, and others with an interest in obesity prevention and management to network and break down silos.

Following the very successful launch of local Obesity Network chapters in Calgary and Hamilton, last night saw the inaugural meeting of the Toronto Chapter (CON-YYZ), which got together to appoint their new executive and to exchange ideas on local activities that this chapter can pursue in the future.

I had the opportunity of joining in for part of this meeting via Skype and was delighted to see the diversity of attendees and their enthusiasm – certainly a promise of great things to come.

For anyone interested in learning more about how to start your own local CON chapter, more information is available here.

I look forward to seeing a number of new Obesity Network chapters created across Canada, as we continue to seek better ways to fight weight-bias, discrimination and find better ways to prevent and manage obesity.

@DrSharma
Edmonton, AB

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The Biggest Risk Is Keeping Kids Indoors

Participaction report card 2015This week, Participaction released the 2015 report card on activity in Canadian kids (a yearly exercise formerly undertaken by Healthy Active Kids), and its message is simple – send your kids outside to play!

This is how Participaction defines the protection paradox:

“We may be so focused on trying to intervene in our children’s lifestyles to make sure they’re healthy, safe and happy, that we are having the opposite effect….We overprotect kids to keep them safe, but keeping them close and keeping them indoors may set them up to be less resilient and more likely to develop chronic diseases in the long run.”

And it works best when you send the kids out alone – here is what research shows:

  • Grade 5 and 6 students who are often or always allowed to go out and explore unsupervised get 20% more heart- pumping activity than those who are always supervised.
  • 3- to 5-year-old kids are less likely to be active on playgrounds that are designed to be “safer,” because many kids equate less challenging with boring.
  • Children and youth are less likely to engage in higher levels of physical activity if a parent or supervising adult is present.

Safe is boring – who would have guessed?

And here’s even more research to support this idea:

  • Kids with ready access to unsupervised outdoor play have better-developed motor skills, social behaviour, independence and conflict resolution skills.
  • Adventure playgrounds and loose parts playgrounds, which support some exposure to “risky” elements, lead to an increase in physical activity and decrease in sedentary behaviours.

Simply stated:

“We need to consider the possibility that rules and regulations designed to prevent injuries and reduce perceived liability consequences have become excessive, to the extent that they actually limit rather than promote children’s physical activity and health. Adults need to get out of the way and let kids play.”

The full report card can be downloaded here.

Time to set your kids free!

@DrSharma
Edmonton, AB

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How Do We Protect Our Kids From Being Judged For Their Weight?

sharma-obesity-pima-indian-kidsIf the lively response to last week’s post on the question of whether or not Sarah Hoffman is qualified to serve as Alberta’s health minister based on how people judge her size teaches us anything, it sure makes eviden the simple-minded thinking about obesity that is so pervasive in our society (thanks to all my bold readers, who stepped in to share their stories).

The problem, however, is not just that adults get judged by the general public (who may be forgiven for their ignorance) – the problem goes much deeper.

Thus, a study by Kenney and colleagues from the Harvard School of Public Health, published in the International Journal of Obesity, shows that worse educational outcomes for children living with obesity may be simply due to how teachers perceive them, rather than their objective performance.

The study includes 3362 children participating in the Early Childhood Longitudinal Study—Kindergarten Cohort (ECLS-K), who were studied longitudinally from fifth to eighth grade.

While an increase in BMI z-scores (a measure of childhood weight gain) from 5th to 8th grade showed no association to actual academic ability in standardized test scores, teacher’s perceived kids with higher BMI z-scores as to be poorer at math and in reading.

Interestingly, it was not just the teachers who rated heaver kids as poorer students, the larger students rated themselves as being less capable than they actually were – perhaps a reflection of how their teachers’ attitude towards them was reflected in their self-worth.
Here is how the researchers put it rather bluntly,

“From 5th to 8th grade, increase in BMI z-score was significantly associated with worsening teacher perceptions of academic ability for both boys and girls, regardless of objectively measured ability (standardized test scores).”

The implications of this finding are self-evident.

If teachers, who should know better, misjudge academic ability based on kids body weights (despite the lack of difference in objective tests), which in turn leads the kids to have less confidence in their own abilities, it is easy to see how this may well set them off on a trajectory leading to lower academic performance and thus a less bright start – a self-fulfilling prophecy, if I ever saw one.

Even if we do not care about adults being judged or discriminated against because of their size (and we should), the fact that our kids are also being judged by their teachers, who should know better, must set off all kinds of alarm bells.

Have you experienced weight-bias or discrimination in educational settings? I’d love to hear your story.

@DrSharma
Edmonton, AB

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Obesity Is Not Smoking – Period!

Hon. Sarah Hoffman, Minister of Health and Minister of Seniors, Alberta

Hon. Sarah Hoffman, Minister of Health and Minister of Seniors, Alberta

The recent appointment of the Hon. Sarah Hoffman (NDP) to the post of Health Minister in Alberta has (as expected) prompted a wide range of remarks regarding her suitability for the job – not because of her qualifications as an administrator (these are uncontested) – but her size!

In a slurry of comments ranging from misguided misogynistic remarks (sadly, including by members of the former government) to outright personal insults, the social media frenzy around this topic is anything but unexpected.

The general story line is that someone living with obesity, who is thus obviously “unhealthy”, is not qualified be a health minister.

Indeed, one letter writer in the Edmonton Journal likens putting someone living with obesity in this position, to appointing a health minister who smokes – a fatal (but common) misconception of what obesity actually is.

For one, smoking is a behaviour – living with obesity is not!

When you inhale the smoke of a cigarette you are doing something (a behaviour) – when you gain (or lose) weight, it is something your body does (whether you want it to or not).

This distinction is fundamental: when I stop smoking, I become a non-smoker – end of story!

When I try to lose weight, my body will do everything it possibly can to resist losing weight. My appetite will increase, my metabolic rate will slow down, my body temperature will decrease, my thyroid function will decrease, my sense of taste and smell will increase, as will my risk-taking behaviour and my susceptibilty to stress. All of these changes (often referred to as the “starvation response”) will work day-and-night to “sabotage” my efforts and in 95% of people who set out to lose weight, these mechanism will eventually win out – even years after starting on their diet.

Every person I know who has ever lost a considerable amount of weight and is keeping it off, describes this as a daily on-going struggle. They are well aware that even the slightest interruption to their routine, an illness, an injury, a new medication, even just relationship issues or financial stressors and – boom – their weight is back, whether they like it or not.

This is why the WHO, the FDA, the AMA and a growing number of health organisations around the world are now calling obesity a chronic disease, because sadly, we have yet to find a cure for this condition.

Despite what celebrity pundits and the weight-loss industry may want you to believe, there are no easy solutions and try as they may, most people with excess weight will have to fight hard simply not to get any heavier.

So for one, even if Sarah Hoffman wanted to lose a few pounds, the chances that she will keep them off on her own in the long term are slim (unless of course she happens to belong to the lucky 5%). If she is looking for medical treatment, even surgery, I wish her good luck trying to access those services here in Alberta – welcome to the waiting list!

The other assumption underlying the criticism of Minister Hoffman, is the notion that obesity is a direct reflection of someone’s health behaviours – i.e. eating too much junkfood or not exercising.

Believe me that I have seen many patients in my clinic, who rarely (if ever) touch junk food, who spend hours in the gym, and still weigh in at 350 lbs or more. There is (and has been for a long time) enough scientific evidence to support the fact that people vary remarkably in their susceptibility to weight gain (and weight loss). The amount of weight gained by eating exactly the same amount of excess calories can vary as much as 5-fold between individuals.

So for all we know, Sarah Hoffman (like most people living with excess weight) is already well-informed and concerned about her diet and I’d hardly be surprised if, despite her busy schedule, she does manage to squeeze in as much physical activity into her daily routine as she possibly can.

But, irrespective of all of the above, there are simply so many different causes of weight gain (from genetics, to mental health, to sleep deprivation, to stress, to eating norms and culture, adverse childhood experiences, to medications – even perhaps the bugs that happen to live in your gut), that judging someone about their health knowledge or behaviours by looking at their size is truly laughable.

Indeed, who better to have as a health minister, than someone living with a chronic disease?

Would anyone seriously object to Sarah Hoffman’s appointment as Health Minister, were she living with diabetes, chronic kidney failure, coronary artery disease, HIV/AIDS, depression or for that matter cancer (even lung cancer)?

The only real difference between obesity and any of the above conditions is that obesity is visible for anyone to see (and apparently fair game for anyone to comment on).

Whether or not Sarah Hoffman turns out to be a capable and competent health minister remains to be seen – I am certain that neither her success nor failure will have anything to do with her size.

Perhaps it will take a Health Minister living with obesity, to finally create a health system, where people living with obesity are treated with compassion and respect and, most importantly, can find the help and treatments that they need.

@DrSharma
Edmonton, AB

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