Weekend Roundup, December 14, 2012
As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts: Should Public Health Campaigns Change Their Messages? Should Public Health Focus on Calories In? XXX Foods Does More Sleep Increase Physical Activity in Kids? Post Doc in Obesity Management Have a great Sunday! (or what is left of it) AMS Edmonton, AB
Hindsight: Canadian Obesity Practice Guideline
In 2006, following months of work by an extensive panel of Canadian experts under the commendable leadership of David Lau, the Canadian Medical Association Journal (CMAJ) published the first evidence-based Canadian guidelines on obesity prevention and management. This guideline, which covers everything from public policies to clinical management and identifies considerable research gaps, presented over 70 evidence-based recommendations. Since then much has happened in the field of obesity and it would be high time to revisit some of these topics. However, such a monumental undertaking requires both funding and a champion. While such extensive guidelines are a considerable academic exercise, their impact on practice may be modest, as sometimes too much can be less. Rather, simpler recommendations that are based on straightforward actionable items, such as outlined in the 5As of Obesity Management, may well have a far greater impact on changing obesity practice than the 72 recommendations of the over 170-page long guideline document. Nevertheless, six years later, these guidelines provide an interesting perspective on the evidence and thinking in the field at the time. A surprising amount has changed in the past six years. AMS Edmonton, AB
Should Public Health Focus on Calories In?
To many, obesity is simply a matter of calories in and calories out – they call on the laws of physics, forgetting that living organisms follow the laws of physiology (which I have referred to as “biology messing with physics”). Thus, while on paper, a solution to eating an extra 100 calories could easily be countered by simply expending those extra calories in exercise, in real life this simply does not work. Firstly, as argued before, the simplistic reasoning that a few extra calories a day can account for pounds of annual weight gain are simply wrong. It does in fact take consistent and long-term daily excess caloric intake in the order of several 100 extra calories a day to sustain progressive weight gain (see here for a more detailed discussion of this point). Expecting anyone to compensate for a daily excess of 100s of calories through volitional activity is bound to fail. Furthermore, as also argued before, much of the benefit of regular physical activity on weight loss is probably mediated through its effect on energy intake – thus physical activity is far more related to energy in than energy out. But this is not what this post is about. Rather, in a paper just published in BMC Public Health, Jacob Shelley (winner of a Canadian Obesity Network Student award) from the University of Toronto, argues that public health messaging with regard to the obesity epidemic should be reframed as policies to address caloric overconsumption. As he states: “A policy cacophony exists when different policy solutions have been developed to address a single issue, and then must compete with one another for support, funding, and implementation. With competing theories about the root causes of obesity, and many plausible although limited solutions being proffered, the resulting “noise” renders it nearly impossible to determine what policies would be most effective. Consequently, as policymakers call for stronger evidence, the evidence continues to support competing policy options, leaving policymakers unsure of which policies to implement. More evidence may simply exacerbate the obesity policy cacophony, especially given the difficulty of translating evidence into policy.” “This paper argues that to address the policy cacophony it is necessary to rethink the problem of obesity, and more specifically, how the problem of obesity is framed. This paper argues that the frame “obesity” be replaced by the frame “caloric overconsumption”, concluding that the frame caloric overconsumption can overcome… Read More »
Should Public Health Campaigns Change Their Messages?
The following is an Op-Ed that appeared in several Canadian news outlets: Exercise is good for you. Eat more fruits and vegetables. Stop smoking. Drink less alcohol. Such messages abound in public health campaigns, and are based on the assumption that at-risk individuals will ultimately change their behaviour and mitigate their risk by living healthier. But according to a study just released by Statistics Canada, that is not the case. In fact, the 12 years of longitudinal data from the Canadian National Population Health Survey among Canadians aged 50 or older shows that three in four smokers with respiratory disease do not quit smoking; most people with diabetes or heart disease will not become more physically active and virtually no one diagnosed with cancer, heart disease, diabetes or stroke will increase their intake of fruit and vegetables. This does not bode well for public-health promotion campaigns that simply appeal to Canadians to give up unhealthy behaviours to reduce their future risk of disease. If even those who are most likely to immediately benefit from changing their lifestyles fail to live healthier, what is to be expected of those for whom such recommendations merely promise better health somewhere in the distant future? Or, if even already having the condition does not change behaviour, why would we expect mere fear of developing the condition to be enough of a motivator? The solution cannot be more drastic or broader messaging. One would assume that people with chronic diseases are already being provided a fair dose of health education and messaging from their health providers, certainly more than could ever be offered to the general public through broader health-information campaigns. As many experts in health promotion are well aware, knowledge and warnings are the least effective measures to change health behaviours. This is why many call for health policies that ban or restrict access to tobacco, alcohol and unhealthy foods as well as punitive measures, including taxation and fines or higher health premiums for those who persist. However, such measures fail to acknowledge the key drivers — why people adopt unhealthy behaviours in the first place — and why these behaviours are so difficult to change. Most people make decisions about what they eat based on taste, cost and convenience rather than on health benefits or health risks. Most people fail to exercise regularly because they either lack the time or simply do not… Read More »
XXX Foods
On Monday, my good friend and colleague Yoni Freedhoff posted a short video on YouTube, which has since gone viral (congratulations my friend!). The gist of the story (but please check it out for yourself), is that Big Food is preying on kids by promoting unquestionably unhealthy processed foods with deceptive (not to say nonsensical) health claims. But, as he hastens to point out, this is not the fault of the food industry. Rather he puts the blame squarely on the shoulders of the politicians and regulators for not creating a level playing field for food producers, that sets clear boundaries to what they can and cannot do to promote their products (especially to kids!). As Yoni points out, the video highlights a clear dilemma that may not have an easy or fair solution. On the one hand, you have Big Food doing exactly what they should be doing, namely making money for their shareholders by selling as much food as possible to whoever will buy it – all measures are fair game. On the other hand, you have policy makers reluctant to step in to create rules of engagement, which would set clear boundaries to what Big Food can and cannot claim on their packages and by what means they can or cannot promote their products. I, for one, am not surprised that regulators are reluctant to step in. For one, the devil lies in the details of regulating exactly what may or may not be acceptable. Take added sugar for example. Where exactly, would you draw the line on this? What amount of added sugar crosses the boundary of being unacceptable – 2 grams, 5 grams, 10 grams, 20 grams per serving? And what about products, which can rightly claim that they “contain no added sugar”, because they “naturally” consist of little else than sugar (as illustrated in the video) – how would you even begin to regulate those? If it is not the foods themselves that can be regulated, would it perhaps be easier to regulate how these foods are marketed and sold? For tobacco (a ridiculously simple problem by comparison), it was easy to impose advertising and marketing bans – no amount of tobacco is healthy – if the product contains tobacco – you tax, ban, and otherwise regulate it – easy-peasy. But how and where exactly would you draw the line for a food product?… Read More »
Watch Dr. Sharma in the News!
Listen to Dr. Sharma!
