Today’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 firstname.lastname@example.org for a discount.
We would like to acknowledge the financial support of our sponsors.
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.
Today’s guest post comes from Kristy Wittmeier, PhD (and CON Bootcamper), a physiotherapist at the Winnipeg Health Sciences Centre and Director of Knowledge Translation at the Manitoba Centre for Healthcare Innovation. She has a special interest in physical activity as a tool to prevent and manage obesity-related conditions in youth. Her current positions and affiliation with the Children’s Hospital Research Institute of Manitoba allow her to combine research and practice to improve patient outcomes. Twitter: @KristyWittmeier
If you were trying to build a coordinated provincial strategy to promote healthy weight in children and youth, where would you start? This has been a question on the minds of a team of healthcare providers and researchers in Manitoba for some time now.
Manitoba has the highest rate of type 2 diabetes in children in Canada, a condition that is in part related to obesity. In Manitoba, youth are diagnosed with type 2 diabetes at a rate 20 times higher than in any other province.
There are well-established, multidisciplinary clinical programs in our province that work with youth living with type 2 diabetes. For example, the Diabetes Education Resource for Children and Adolescents, which has existed since 1985, runs two weekly clinics and an outreach program for youth affected by type 2 diabetes.
Recently, the diabetes care team joined forces with pediatric kidney specialists in the province to provide a combined clinic for youth affected by both type 2 diabetes and kidney complications.
Manitoba is also home to the Maestro Project, which helps teens living with type 2 diabetes navigate what could otherwise be a difficult transition from pediatric to adult health care services and teams.
Similarly, research teams that include community advisors and families are tackling important questions related to the origins of type 2 diabetes and exploring innovative interventions to improve the health and quality of life for kids with this diagnosis.
Members of the DREAM (Diabetes Research Envisioned and Accomplished in Manitoba) Theme at the Children’s Hospital Research Institute of Manitoba are studying important biological, social and psychological factors linked with early kidney disease in youth with type 2 diabetes in a study called iCARE (Improving renal Complications in Adolescents with type 2 diabetes through REsearch).
While we have made significant progress in the area of type 2 diabetes care and research, we have made less progress in the areas of prevention and treatment of obesity in children and youth. We are one of the few provinces in Canada without a specialized clinical team dedicated to pediatric obesity. We lack a comprehensive provincial strategy that can link health care providers to each other, or to existing community programs that might help families. Gaps in services can leave families without access to care that could help their children. This is the issue that we have decided to tackle in a study that was recently funded by the Children’s Hospital Research Institute of Manitoba.
Our study is called “Mapping the state of pediatric weight management programs in Manitoba.” We will start with a survey within Manitoba, to identify existing programs that are available to families affected by obesity in our province. We want to know what is currently available. Where can health care providers refer families? And importantly, what resources are missing in our province to be able to provide an evidence-based approach to pediatric weight management?
While the title suggests we are solely focused on Manitoba, we are in fact looking to shape our provinces’ approach by learning from others across Canada and the United States.
To do this, the second part of the study will involve updating a 2010 study that mapped Canadian pediatric weight management programs to understand what has changed on the national landscape. What new programs exist and where? What programs are no longer offered and why?
Then we will move on to more in-depth conversations with members of the eight clinics involved in the Canadian Pediatric Weight Management Registry (CANPWR), and an additional eight clinics in the United States to better understand how their approaches evolved, barriers and successes that they have experienced and other key learnings that they can share to help inform a Manitoba approach.
Once we have brought the information from these activities together, we will hold a meeting for families, community members, clinicians, researchers, healthy living organizations and policy makers in the province. We will look at the data together and prioritize the next important steps on this journey.
We all need to work together to build healthier families, healthier communities and healthier populations. This novel approach that integrates the experiences and priorities of others will ensure that when we launch a new direction for pediatric obesity management in Manitoba, it will be relevant and targeted to everyone’s needs.
With all the concern about the impact of obesity on metabolic and cardiovascular health, it is often forgotten that after smoking, obesity is the single most important risk factor for many common cancers, including of course breast cancer.
The importance of this relationship is again documented by Marian Neuhouser and colleagues in a paper published in JAMA Oncology.
The study examines the associations of overweight and obesity with risk of postmenopausal invasive breast cancer after extended follow-up (about 13 years) in the Women’s Health Initiative (WHI) clinical trials, involving over 67,000 postmenopausal women ages 50 to 79 years at 40 US clinical centers..
Overall, 3388 invasive breast cancers were observed over the follow-up period with women who were overweight or obese having increased risk that was related to their degree of excess weight.
Compared to normal weight women, individuals with Class II and III obesity had a 60% greater risk for invasive breast cancer with an almost 2-fold greater risk for estrogen receptor–positive and progesterone receptor–positive breast cancers.
Class II and III obesity was also associated with a 2-fold greater risk for larger tumor size, positive lymph nodes and deaths.
Furthermore, risk was increased in women with a baseline BMI of less than 25.0 who gained more than 5% of body weight over the follow-up period.
Given this importance of obesity for breast cancer, one can only wonder just how much of the Cancer research funding raised by the Pink Ribbon campaign and other Cancer charities, finds its way into research on obesity treatment and prevention – can’t say I know of any cancer funding that has knocked on the doors of my fellow obesity researchers.
The recent report card on physical activity released by Participaction strongly recommends (unsupervised) free play as a means to increase physical activity in kids.
But free play has far greater benefits on children’s development than just physical fitness, especially when there is an element of risk involved.
That is the conclusion of a paper by Marianna Brussoni and colleagues, published in the International Journal of Environmental Research and Public Health.
For their paper, risky play was defined as play that involves an element of danger, including the possibility of physical injury. Such types of play include play at height, speed, near dangerous elements (e.g., water, fire), with dangerous tools, rough and tumble play (e.g., play fighting), and where there is the potential for disappearing or getting lost.
This systematic review of 21 relevant research studies shows that risky outdoor play not only improves physical health (despite the inherent risk of injuries and even death), but also social health and behaviours, risk for injuries, and reduced aggression.
Specifically, studies have shown improvements in risk detection and competence, increased self-esteem and decreased conflict sensitivity and conflict resolution, better developed motor skills, enhanced social behaviour, greater independence, improved risk management strategies, and the ability to negotiate decisions about substance use, relationships and sexual behaviour during adolescence.
Obviously, risky behaviour is risky – according to the researchers,
“In Canada, approximately 2,500 children age 14 and under are hospitalized annually as a result of playground falls (play at height)—81% are for fractures.”
Nevertheless, weighing all of the available evidence, the researchers came to the following conclusions:
“Although these findings are based on ‘very low’ to ‘moderate’ quality evidence, the evidence suggests overall positive effects of risky outdoor play on a variety of health indicators and behaviours in children aged 3-12 years. Specifically, play where children can disappear/get lost and risky play supportive environments were positively associated with physical activity and social health, and negatively associated with sedentary behaviour.
Play at height was not related to fracture frequency and severity. Engaging in rough and tumble play did not increase aggression, and was associated with increased social competence for boys and popular children, however results were mixed for other children.
There was also an indication that risky play supportive environments promoted increased play time, social interactions, creativity and resilience.
These positive results reflect the importance supporting children’s risky outdoor play opportunities as a means of promoting children’s health and active lifestyles.”
Clearly, these finding go against the popular policies that focus on harm reduction and making kids’ play environments as safe as possible.
Perhaps these policies are doing more harm than good – as always, you never know where the unintended consequences of well-meant public policies rear their ugly head.
This 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.
“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.”
Time to set your kids free!