Ontario Docs Call For an Anti-Tobacco Approach to Childhood Obesity

Yesterday (October 23, 2012), Ontario’s doctors proposed aggressive new measures to tackle childhood obesity that are modelled largely on anti-tobacco campaigns and propose that similar measures be imposed on ‘obesity-causing foods’.

In the case of tobacco, measures included tax increases, public information (including disturbing images of diseased lungs and other graphic depictions of the negative effects of smoking), removal of retail tobacco displays, and advertising bans.

In analogy to such measures, the specific recommendations to reverse the course of childhood obesity include:

– Increasing taxes on junk food and decreasing tax on healthy foods;
– Restricting marketing of fatty and sugary foods to children;
– Placement of graphic warning labels on pop and other high calorie foods with little to no nutritional value;
– Retail displays of high-sugar, high-fat foods to have information prominently placed advising consumer of the health risks; and
– Restricting the availability of sugary, low-nutritional value foods in sports and other recreational facilities that are frequented by young people.

These recommendations add to previous recommendations calling for

– Legislation that would require calorie contents to be listed adjacent to the items on menus and menu boards at chain restaurants and school cafeterias;
– An education campaign to help inform Ontarians about the impact of caloric intake on weight and obesity; and
– Making physical activity/education mandatory throughout high school.

In a quote that accompanies this announcement, Doug Weir, President of the Ontario Medical Association notes that,

“The time for gentle admonitions has come and gone. We need to fight this problem with proven tools like tax incentives and graphic warnings. There is an enormous body of evidence that these measures work.”

Regular readers of these pages, would not be surprised to learn that I am not entirely happy with these proposals and would have several ‘bones to pick’ with such an approach to tackling obesity in kids (or anyone else).

Rather than calling for populistic and unproven policy strategies, many of which fall in the categories of tax, ban, shame, blame, scare, punish, and have yet to prove effective in any jurisdiction in preventing childhood (and ultimately adult) obesity, I would have much preferred Ontario’s doctors to turn inward to look at steps that they could themselves take to better tackle this epidemic in their offices (such as perhaps implement the 5As of Obesity Management in their practices?).

It is no secret, for example, that most doctors (like most health professionals) have only a rather cursory understanding of the complex sociopsychobiology of obesity and that their often insensitive approach to counselling patients presenting with weight problems leaves much to be desired.

Recent surveys show that the vast majority of obese Canadians have never been counselled on their weight by their physicians and few patients would even consider asking their docs for advice on weight management. Furthermore, where offered, this advice seldom goes beyond ‘eat-less-move-more’ platitudes, that are about as effective as telling someone with depression to ‘cheer up’.

While I certainly agree that physicians have an important role in advocacy and policy recommendations to improve public health, I believe that they have an even greater responsibility to ensuring that the services they provide in their offices address the problem at hand.

It is at this level that comparisons between tobacco consumption and obesity break down: cigarette smoking is a behaviour, being obese is not.

This brings me to the second issue with these recommendations in that linking overconsumption of sugary and fatty foods to the obesity epidemic without any qualifiers, does little more than reinforce stereotypes that obese people are obese simply because of the (willful?) overconsumption of such foods. Research in fact shows little correlation between individual behaviours and body weight – many who seldom consume such foods are overweight – many who do, are not. This, reinforcement of stereotypes, which in turn leads to greater anti-weight bias and discrimination, could have easily been avoided had the call been made in more general terms (i.e. to improve the health of all Ontarians) rather than simply framing it as a response to childhood obesity (would a similar call not have been justified even if we didn’t happen to have an obesity epidemic?).

The third issue, however, is that the simplistic and populistic nature of these recommendations fails to even in passing acknowledge the complex ‘whys’ of this epidemic – no mention of lack of sleep, stress, use of electronic communication and entertainment devices, mental health issues, helicopter parenting, or countless other drivers of the obesity epidemic that may have more to do with the root causes of obesity than whether or not kids have easy access to fatty and sugary foods.

Obviously, Ontario’s docs calling on kids to sleep more, on parents to spend more meaningful time with their kids, or on Ontarian’s to eat more home cooked meals, may not have seemed as ‘sexy’ as calling for taxes, bans, or unpleasant graphics on food packages.

Nevertheless, if these recommendations provide the opportunity for a greater public discussion on the real issues underlying this problem, this announcement may in the end have had some benefits.

And perhaps, the docs will in the end decide to step up to the plate and call out to their colleagues to take a greater interest in offering obesity treatments to their patients – treatments based on a deeper etiological understanding of this complex and heterogeneous condition than can be expected from the lay public.

Edmonton, Alberta

photo credit: Vicki & Chuck Rogers via photopin cc