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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.

AMS
Edmonton, Alberta

photo credit: Vicki & Chuck Rogers via photopin cc

8 Comments

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

    but overeating is a behaviour. Drinking sugar is a behaviour. Eating wheat products is a behaviour. Watching TV is a behaviour. These we can ban these at personal level. It is not a solution, but a good start, and reduces the problem.

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  2. I see Dr. Sharma’s point, but I also see these types of policies as being a piece of the puzzle. Of course it would be beneficial if doctors were effectively counseling each client that came in the door, but I think there are hundreds of pieces to this puzzle and I don’t see why making people more aware of what is in the foods they are eating is a bad thing to do. I didn’t read the Medical Association release from October 23, but I would hope that they also see these policies as only one part of the puzzle.

    I am curious to know if Dr. Sharma feels that there is an absolute abundance of empty calories in our food system. In my opinion, regardless of if a person is overweight or not, encouraging more nutritious choices (therefore discouraging less nutritious choices) would benefit anyone’s health.

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  3. Fredt obviously didn’t read the rest of the article where you say “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.”

    Thanks so much for your thoughtful and thorough breakdown of why the OMA’s recommendations are garbage. It’s unlikely to go anywhere anyway, as the the premier is out of the office (resigned) and the legislature therefore isn’t in session.

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  4. Actually, the issues created by fatty and sugary foods are more related to metabolic disorder than to obesity. Sharma’s work shows that EOSS 0 (obese with no comorbidities) don’t have metabolic disorder but lots of skinny people do. If the recommendations were related to that and not obesity they would make sense. Just related to obesity, they don’t make sense. Sugar and fat don’t cause obesity.

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  5. It is hard to balance comments on this topic, as we are all enthusiastic about any method to fight obesity, yet we have discourage comments made by the OMA that discredit physicians. OMA seemed to get little advice from knowledgeable researchers and clinicians in the field before waisting time and my OMA money on this campaign. We want an OMA childhood obesity campaign and putting a label on grapefruit juice may be worth discussing, but knowledge clinicians (Arya and Yoni) should have been consulted. Taxing “junk food”, has very weak science behind it, criminalizing food may be an problem, as there are many questions, to ask and answer before the OMA makes recommendations like these.

    Some history – When we criminalized “fat” as a macronutrient (1980s) north americans became fatter due to the substitution of refined carbohydrates. If we tax sugar, will people move to Gatorade (see Yoni’s blog on this, and yesterday’s news on the toxic nature of these beverages).

    The OMAs messages was somewhat simplistic, short sighted, unscientific, and a bit irresponsible. I do think we will get some good coming from this, the dialogue, and hopefully a repeal of the HSF (heart and stroke foundation’s) embarrassing Health Check Logo.

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  6. Overeating is a symptom of anxiety. Just as those who smoke were dealing with anxiety. The real question is how does anyone deal with anxiety in a safe healthy manner.

    I know that in my case anxiety can cause binge eating patterns. I also read in “Scientic American Mind” that people with sczophrinia (spelling may be out) have a greater releif of the anxiety–which is nearly fatel–with the mindless action of smoking.

    Putting calories beside the price is an eftective way to help educate people as to how much they are really eating; it worked in the one weight wise module that had calories on versus price was a real eyeopener.

    The last thing that should be done in Alberta is introduce a sales tax. That would be political suicide for the party that did. there is the option of banning certain sizes or certain foods–but not sales tax.

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  7. I think that the point Dr. Sharma is making – and that a lot of commentators are missing – is that linking junk food to fat kids doesn’t make sense and would be incredibly stigmatizing.

    Let’s take a food we can probably all agree would not make a good dietary staple: deep fried, heavily salted pork rinds. Definitely not a health food.

    Now, if they were to put a picture of a clogged artery onto packages of pork rinds, that would make a reasonable amount of sense. Eating a lot of pork rinds would tend to clog your arteries, whether you’re fat or thin. The picture would be yukky and disturbing, and everyone can agree that a clogged artery is a bad and unhealthy thing to have.

    Let’s say that instead of a picture of a clogged artery, there was a picture of a headless fat kid. This would say to people “Pork rinds cause fat kids. This fat kid’s body is disgusting and equivalent to a disease. Having this body would be a terrible.”

    Now, imagine you’re a fat kid. That looks like your body. Maybe you eat a lot of junk food, but then again, maybe you never touch it. Maybe you have health problems, but maybe you’re glowing with good health and won’t have any health problems for 50 years or more. Either way, the ad is labelling your body as disgusting, diseased, and a result of eating “bad” food. It’s going to eat away at your self confidence and encourage bullying.

    It’s an incredibly stupid approach, unless these doctors just hate fat people and want to hurt them. Very, very bad idea. I’m so glad you’re speaking out on this.

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  8. It appears that the quality of food from the processing end has not been considered here. The policy approach recommended is very likely from the wrong end of the pipe. Consumption has happened, which is the primary goal of companies that produce the crappy food (unscientific term but can’t think of a better one) – the more the better regardless of quality.

    As a ‘waste manager’ for local government I see daily what our consumption oriented society produces. If the billions of types of products (including food) were not available, I doubt I would see the remnants of them in the garbage that fills up our landfills (43% of our disposed waste stream is organics – primarily food). Today, by regulation in many Provinces, producers of products are responsible for the end of life of their product (e.g. tires, oil, TVs) and the consumer pays for this through a green fee at point of sale. Maybe food producers should be responsible for the health outcomes of their products. Far fetched I know, but lets move this up the pipe.

    If big agri-food business didn’t produce the products, they would not be available to consume by additive addicted consumers. If all I had was a farmers market, backyard garden, and maybe a health food store in my town, my choices would be limited. Knowing the security and wholesomeness of the products we consume is crucial to making the best choices, as well as understanding the origin and quality of food. As I see in my field, the majority of consumers just need more information. If anything, policy makers should work with the producers of food, making them more responsible for the quality and consequences of their products.

    I’m so relieved that ‘food security organizations’ are working in parallel with Dr. Sharma to expose all angles of the issue.

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