news & trends

Body Weight Words Matter! Reflecting on the New Canadian Adult Obesity Clinical Practice Guidelines

For most people their body weight is a personal issue. However people living in larger bodies face hurtful stigma including language surrounding obesity and overweight.  Developed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, the new Canadian Adult Obesity Clinical Practice Guidelines represent the first comprehensive update in Canadian obesity guidelines since 2007.[1]

Decades of research in behavioral and nutrition science suggest that it’s time to update our clinical approach and recognize that some patterns of communication about body weight are more helpful than others. Registered dietitians are deeply involved in this discussion and here are some of the topline messages from leading experts that stood out to us:

  1. Body Mass Index (BMI) is NOT an accurate tool for identifying obesity related complications [2]
    BMI is a widely used tool for screening and classifying body weight but it’s been controversial for decades.  A person’s BMI number is generated by considering their height in relation to their weight and it tells us about the size of the person’s body.  Experts now agree that more information than BMI is needed to determine whether a person is sick or healthy.
  2. Patient-centered, weight-inclusive care focuses on health outcomes rather than weight loss 1,2
    Remember to ask permission before discussing body weight and respect the person’s answer. Health issues are measured by lab data and clinical signs. These can include blood pressure, blood sugar or reduced mobility. Shift the focus toward addressing impairments to health rather than weight loss alone.
  3. Obesity is NOT simply a matter of self-control and the ‘eat less, move more’ advice is insufficient1
    The effects of a dieting lifestyle are burdensome. Evidence-based advice must move beyond simplistic approaches of ‘eat less and move more’. For example, in recent years researchers gained a better understanding of clinical evidence and body weight biology. These include the amount of food energy absorbed through the gut, the brain’s role in appetite regulation and the thermic effect of eating.[3] Environmental factors such as where people live, work and food availably also have an influence on body weight.
  4. People of higher weights should have access to evidence informed interventions, including medical nutrition therapy
    There is a lot of misinformation about body weight so evidence-based health management is key. One of the recommended interventions is to include personalized counselling by a registered dietitian with a focus on healthy food choices and evidence-based nutrition therapy.
  5. Recognize and address weight bias and stigma
    People with excess body weight experience weight bias and stigma. Weight bias is defined as negative weight–related attitudes, beliefs and judgements toward people who are of higher weight. This thinking can result in stigma which is acting on weight-based beliefs such as teasing, bullying, macroaggressions, social rejection and discrimination towards people living in larger bodies. People may also internalize weight stigma and criticize themselves or others based on body weight.
    Experts consider that changes to language can alleviate the stigma of obesity within the health-care system and support improved outcomes for both people living in a larger body and for the health-care system. 3,[4],[5],[6]

In our Body Weight Words Matter! chart below we provide several examples of communication interventions to help assess your attitude and reduce body weight bias. Body Weight Words Matter INFOGRAPHIC N4N (Click here to download your copy of the PDF Body Weight Words Matter INFOGRAPHIC N4NN ) Body Weight Words Matter

References:

[1] Obesity Canada (2020) Canadian Adult Obesity Clinical Practice Guidelines (CPGs) https://obesitycanada.ca/guidelines/

[2] Obesity Canada (2020) CMAJ Obesity in adults: a clinical practice guideline https://www.cmaj.ca/content/cmaj/192/31/E875.full.pdf

[3]   Rubino et al. (2020) Joint international consensus statement for ending stigma of obesity. Nature Medicine  www.nature.com/medicine

[4] Obesity UK (2020) Language Matters: Obesity https://cdn.easo.org/wp-content/uploads/2020/07/31073423/Obesity-Language-Matters-_FINAL.pdf

[5] Puhl, R. et.al (2016) Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies. Pediatric Obesity,

[6] Puhl R., Peterson J. L., Luedicke J. (2013). Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int. J. Obes.  https://www.nature.com/articles/ijo2012110

What’s the Definition of Unhealthy Food and Beverages for Children?

summer, childhood, leisure and people concept - group of happy k

On May 8, 2018, Health Canada published an updated on its proposed direction for the development of regulations to restrict marketing of unhealthy foods and beverages to children. Here’s what you need to know.

Background
In 2015, the Government of Canada made a commitment to restrict the marketing of unhealthy foods to children (M2K). In 2016, Senator Greene Raine introduced Bill S-228 –the Child Health Protection Act – which would protect children’s health by prohibiting the marketing of unhealthy food and beverages to children. This is a key element of Health Canada’s Healthy Eating Strategy, which aims to curb obesity and chronic disease among all Canadians. On June 10, 2017, Health Canada launched a 75-day public consultation.

Update on proposed direction
Bill S-228 was studied by the House of Commons Standing Committee on Health from April 18 to 30, 2018. During this study, two amendments were made to the Bill:
– To define “children” as persons under the age of 13 (instead of age 17) which follows suit with the Quebec Consumer Protection Act; and
– To require Parliament to review the legislation within 5 years of the Act coming into force, particularly to assess whether the age limit of 13 years results in increased advertising to teenagers.

What’s next?
Health Canada is developing regulations to implement the proposed prohibition on the advertising of unhealthy foods and beverages to children. The approach will be modelled after Quebec where restricted marketing of all products and services to children has been in effect since the late 1970s.

The new regulations propose to define “unhealthy” food as food that exceeds the threshold for the nutrient content claims “low in sodium/salt”, “low in saturated fat”, and / or “low in sugars” OR as food that carries a front-of-package symbol (a symbol which is proposed to appear on any food that contains 15% or more Daily Value [15% DV] for sodium, saturated fat and / or sugars).

Under this proposed definition, here are examples of food that would / would not be allowed to be marketed to children:

Foods without marketing restrictions

• Vegetables or fruits (fresh, canned, frozen) without added ingredients (e.g. sodium, sugars)
• Low sodium french fries
• Peanut & nut butter, natural
• Plain nuts & seeds
• Plain fluid milk from skim to 3.25%
• Unsweetened plant-based beverages
• Yogurt (plain)
• Cereal, ready to eat, wheat, shredded
• Cereal, hot, oats, minute/quick, dry
• Plain whole grains (e.g., barley, quinoa, brown rice, oats)
• Low sodium crackers
• Low sodium breads
• Snacks (plain popcorn, low sodium chips)
• Plain pasta
• Plain legumes (e.g. beans, lentils)
• Lean cuts of meat and poultry
• Plain fish and seafood

Foods subject to marketing restrictions
• Processed meat
• Soft drink, regular
• Condiments
• Confectioneries
• Most vegetables or fruits (fresh, canned, frozen) with added ingredients (e.g. salt, sugars)
• Fruit & vegetable juices
• Regular french fries
• Peanut & nut butter, fat and sugar added
• Candied or salted nuts & seeds
• Flavoured fluid milk
• Sweetened plant-based beverages
• Most sugar-sweetened ready-to-eat breakfast cereals
• Instant sugar-sweetened oatmeal
• Most crackers
• Most breads, white and whole wheat
• Snacks (flavored popcorn, chips)
• Most muffins, brownies, cookies, cakes
• Meat & poultry breaded, coated, with sauces, etc.
• Fish & seafood breaded, coated, with sauces, etc.

Health Canada is also setting out:
– Factors to determine if an advertisement is directed at children through child-focused settings, media channels and advertising techniques; and
– Exemptions to the prohibition, such as for children’s sports sponsorship.

Later this year, Health Canada will publish the detailed regulatory proposal in Canada Gazette, Part I at which time, members of the public and interested stakeholders will have an opportunity to provide feedback. We’ll keep you posted and let you know when it’s time to voice your opinion!

International Trends

Food regulations are changing all around the globe and we’re keeping an eye on international policies that may impact your business. Click here to discover more about 3 impactful changes – USA Menu Labelling, Ireland Sugar Tax and WHO Marketing to Kids. Contact us to discuss more about these emerging trends and the connection to your business and health and wellness.

  1. USA Menu labelling goes national
Menu labelling usa N4NN news May 2018
(Image source: FDA.GOV)

USDA’s menu labelling has reached the compliance deadline.  As of May 7, 2018 USA consumers now have access to calorie and nutrition information in restaurants and similar retail food establishments that are part of a chain with 20 or more locations. This information inspired competition among producers to formulate food in ways that make it more healthful. In 2017, Ontario became the first province in Canada to include mandatory menu labelling of calories. What’s your plan to leverage the power of food? Are you using science-based attributes to make your foods healthier? We are Registered Dietitians who can help!

Source: US Food & Drug Administration, Menu Labeling Requirements and Marion Nestle PhD www.foodpolitics.com

  1. Ireland’s new sugar tax on soft drinks takes effect May 1st.
sugar tax N4NN news May 2018
(Image source Independent ie Newsdesk)

 

Irish consumers are now seeing that high-sugar drinks have become more expensive under the Sugar Sweetened Drinks Tax. The 16c tax applies to water or juice-based drinks with between 5-8g of sugar per 100ml. The soft drinks tax rises to 24c per litre for varieties with more than 8g of sugar.

The tax only applies to water and juice-based drinks with added sugar. Fruit juices and dairy products are exempt from the tax on the ground that they offer some nutritional value.

Regulators expect soft drinks companies will reformulate their products in order to avoid the tax. The move has been welcomed by the Irish Heart Foundation.  It is hoped the sugar tax will play an important role in tackling Ireland’s obesity crisis, with one in four Irish children currently overweight or obese.

Back here at home, the North West Territories is considering a sugary drink tax in 2018-2019.

Source: Independent.ie Newsdesk

  1. UN WHO weighs in against Marketing to kids

WHO M2K N4NN news May 2018 M2K N4NN news May 2018
(Image source:WHO.org & Nutrition for NON Nutritionists)

UN health officials consider plan to ‘outlaw’ fast food giants from charitable work with kids says a memo reported in the news. UK media says WHO calls for ‘stringent regulation’ to block firms, such as KFC and McDonalds from marketing fast food to under the age of 18. This report is consistent with published WHO workplan to end childhood obesity. This implementation plan included tackling the marketing of unhealthy foods and non-alcoholic beverages to children. The Commission advised to adopt, and implement effective measures, such as legislation or regulation, to restrict the marketing of foods and non-alcoholic beverages to children and thereby reduce the exposure of children and adolescents to such marketing.

Marketing to Kids (M2K) is a key issue in Canada too. On May 1, 2018, the House of Commons Standing Committee on Health proposed to reduce the age of restriction to under age 13 (from under age 17). Final regulations are expected to be released in June.

Source: WHO Executive Board 140th session, Steve Hawkes, Deputy Political Editor The SUN(UK)

3 Tips to Overcoming Weight Bias

Did you know that weight bias and discrimination are real and rampant? A recent study looking at news stories in media found that 72% of images and 77% of videos stigmatized  people with obesity[1].  With so much weight bias in our society, what can we do to help?  As dietitians we reviewed the science and bring you these 3 tips to help stop the weight bias, with hopes that we can all make lasting positive change in response to weight shaming, stigma and discrimination. 

N4nn weight bias 2017 2017-11-26_20-25-57

  1. BECOME AWARE – Do you have a weight bias? A first step in addressing weight stigma is to become aware of our own potential attitudes and assumptions about body weight. What do you think and say about people with obesity? Did you know being called “fat” is the most common reason children are bullied?[2] A Harvard University survey reveals many people have an automatic preference for ‘thin people’ relative to ‘fat people’.[3] This survey is based on an Implicit-Association Test (IAT) that anyone can take, and measures the implicit attitudes and beliefs that people are either unwilling or unable to report. The WEIGHT-IAT asks you to distinguish images of people who are described as ‘obese’ or ‘fat’ and people who are ‘thin’. Try the IAT here: https://implicit.harvard.edu/implicit/selectatest.html – and select the Weight IAT to discover whether you have a hidden weight bias.
  1. SPEAK WITH COMPASSION Use words that hurt less. At a recent nutrition symposium, we learned about research that shows the choice of words we use can have different impacts on people with obesity. [4]

words we use obesity bias N4NN 2017 11-27_14-57-23

  • Body weight should not be a topic of social conversation. It’s a deeply personal subject for most people. Even as a health professional, ask permission to speak about body weight.
  • Use person first language rather than describe people by their disease. ex. Saying “a person with obesity” is person first langauge. Saying “an obese person” is not person first language. It’s the same way you would say a person “has a broken leg” rather than say they “are a broken leg.”
  1. SHOW RESPECT – Every body deserves to be treated with respect and dignity. Are YOU ready to help STOP the weight bias? Here are some tips:
  • Notice weight shaming and speak up when you hear inappropriate comments or jokes. Talk about someone’s performance, enthusiasm or other positive attributes rather than talking about their weight. If you notice someone blaming a person for their weight, remind yourself and others “We don’t know their story, so don’t blame them for their size.”
  • Shift the focus from weight to health and well-being.
  • Adjust your attitude – if you change your thoughts, your feelings and actions will follow.[5]

The journey toward well-being starts with how we eat and dietitians have the knowledge, compassion and flexibility to help Canadians achieve their goals. If you have questions about food and health contact a Registered Dietitian for reliable, life-changing advice.

[1] Heuer C, Puhl R.  Obesity stigma in online news: A visual content analysis.   Journal of Health Communication.   2011

[2] Puhl, R. et.al Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies. Pediatric Obesity, 2016

[3] Harvard University, Project Implicit Sourced Nov 2017 https://implicit.harvard.edu/implicit/selectatest.html

[4] Adapted from Puhl, Peterson, Luedicke 2013

[5] Michael Vallis, Canadian Obesity Network Presentation 2011

Intermittent Fasting – the new weight loss trend?

Clock made of spoon and fork, isolated on white background

Fasting has been practiced for centuries around the world, typically for religious reasons. Now, intermittent fasting is becoming a trendy way to lose weight. But does it really work and should you try it?

There are a few variations of intermittent fasting:

Alternate day fasting was researched by Dr. Krista Varady who is an Associate Professor of Nutrition at the University of Illinois in Chicago. The idea is to alternate back and forth between eating about 500 calories one day and then eating a moderate high-fat diet the next day. In her research trials, she found that adults lost an average of 11 pounds in 12 weeks. Plus, the alternate day fasting lowered the participants’ levels of the “bad” LDL (Low Density Lipoprotein) cholesterol which helps to lower their overall risk for heart disease.

The 5:2 fasting diet is a modified version of the alternate day fasting diet. The general idea here, according to proponent Dr. Mark Mattson, is to eat no more than 500 calories on two non-consecutive days each week. On the other five days of the week, you can eat your usual diet. Mattson is a Professor of Neuroscience at the John Hopkins University. In his research, overweight and obese women who followed the 5:2 diet for six months lost just slightly more weight than women who were following a low calorie diet. Mattson is now exploring whether this diet can help improve brain health in seniors.

Time-restricted eating is another type of intermittent fasting where you only eat during a small window of time. This includes ideas such as a longer nighttime fast (for example, not eating from 7 pm to 6 am) or eating just one big meal a day instead of three typical meals. Animals who fast in these ways do lose weight, but there are hardly any scientific studies with people.

Here’s our advice:

1. Intermittent fasting is not easy.
In fact, 10 to 20% of participants who try intermittent fasting find it too difficult and quickly stopped. Those who stick with the diets admit that it is very challenging for at least the first few weeks.
2. Intermittent fasting isn’t a miracle weight loss cure. The studies show that you can lose about the same amount of weight whether you fast intermittently or just cut back on calories every day.
3. Intermittent fasting is NOT for everyone. For example, if you are pregnant, underweight or have type 2 diabetes, then intermittent fasting is not suitable and can be dangerous for you.
4. The best “diet” is the one you can stick with for the rest of your life. Healthy eating is about enjoyment, not deprivation. If you’re interested in trying intermittent fasting, perhaps start with the least extreme option of extending your nighttime fast. Think of the motto “Done after dinner.” Eat your dinner and then skip any bedtime snack. Refuel with a good breakfast in the morning.
5. Talk to a registered dietitian for safe and expert advice on diets and weight loss.

Bridging the Gap between Nutrition Science and Culinary Arts

ambition nutrition June 2016

We recently attended the AMBITION NUTRITION conference  at George Brown College in Toronto where academic professionals, dietitians, culinary experts, and industry leaders joined for an interactive day to examine the gaps and opportunities that exist between research, education, nutrition, diet, and culinary arts. Here are some of the top insights posted on twitter by thought leaders at #AmbitionNutrition…

  • “Public is confused about #nutrition says @Dmozaffarian” @SueMahRD
  • “@davidludwigmd advice is to replace highly processed casrbs we healthy fats #weightloss” by @SueMahRD
  • “Lets fall in love with food again! @MichaelMossC” by @SueMahRD
  • “Nutrition is emotional & personal – 1 person 1 meal at a time struggle” by @LuciaWeilerRD
  • “Food is #1 cause of poor health in the world-yet NOT on e-health record-pay more attention 2 diet 4 health @Dmozaffarian” by ‏@LuciaWeilerRD
  • “Diet quality is the driving force behind obesity” @Dmozaffarian by @JenniferSygo
  •  “Eat less and move more” advice (is too simple and) does not work!…” by‏ @JarRraSummer
  •  “Let’s not vilify foods & stop focusing on the bad ~ let’s flip this & add more good “back to basics” food to our day.” ‏@MairlynSmith
  • “Your diet is like dating. You have to get to know your diet or it will never last.” @DougMcNish
  • “It’s not the “bad” in the diet that causes problems. It’s too little of the “good” – Eat veg fish beans @Dmozaffarian” ‏@CaraRosenbloom
  • “It is all about the quality of your diet not calories in/out when it comes to wt loss & risk of disease @Dmozaffarian” by @ShaunaLindzonRD
  • “Villifying any food may be the gateway to orthorexia @JennSygo” by ‏@TrishBitesLife
  • “Creating a healthy and positive food environment has to come from the policy level, not the individual level.” @ConfessionsRD
  • “Good point re: menu labelling – may cause people to choose lower cal options regardless of their quality @Dmozaffarian” ‏by @chelseaallenrd
  • “Cilantro haters is not your fault! Blame the Soapy taste on your genes!” @elsohemy by @LuciaWeilerRD
  • “ Chefs make nutrition recos come to life! Dietitian says pick your fave veg oil!” by @LuciaWeilerRD

 

 

 

 

Senate Report on Obesity

Senate-report-Obesity-in-Canada-p1-normal

Almost 2/3 of adults and 1/3 of kids are overweight or obese. The obesity crisis is a complex issue. What can be done?

In their report Obesity in Canada released earlier this month, the Standing Committee on Social Affairs, Science and Technology made 21 recommendations to chart a course for a leaner, healthier future. Here are some of the key recommendations which are generating a healthy discussion:

– The federal government assess the options for taxation levers with a view to implementing a new tax on sugar-sweetened as well as artificially-sweetened beverages.
– The Minister of Health:

  • immediately undertake a complete revision of Canada’s food guide in order that it better reflect the current state of scientific evidence.
  • reassess the daily value applied to total carbohydrates based on emerging evidence regarding dietary fat and the fat promoting nature of carbohydrates and require that the daily intake value for protein be included in the Nutrition Facts table.
  • assess whether sugar and starch should be combined under the heading of total carbohydrate within the Nutrition Facts table and report back to this committee by December 2016.
  • encourage nutrition labelling on menus and menu boards in food service establishments.

    Obesity is a multi-factorial issue with no easy solution. Join in our upcoming Nutrition for NON-Nutritionists course (April 20, 2016) to get our in-depth POV on these recommendations and issues, or contact us to discuss how these recommendations will impact your business innovations and communications.

  • Excise tax recommended on sugar-sweetened beverages

    DC sugar tax position paper - 2

    On February 9th, the Dietitians of Canada released a position paper recommending that an excise tax of at least 10-20% be applied to sugar-sweetened beverages sold in Canada. Sugar-sweetened beverages are defined as soft drinks/pop, fruit drinks, sports drinks, tea and coffee drinks, energy drinks, sweetened milks/milk alternatives, and any other beverages to which sugar has been added.

    According to the position paper, there is moderate evidence linking consumption of sugar-sweetened beverages to excess weight, obesity, and chronic disease in children and adults. An excise tax, unlike a sales tax, is levied before the point of purchase so that the price of the product itself will be higher. Since price is a major factor influencing food choices, it is thought that the excise tax will deter Canadians from purchasing sugar-sweetened beverages and lead to an overall lower consumption of them.

    For the greatest impact, the Dietitians of Canada suggest that the taxation measures be combined with other policy interventions such as increasing access to healthy foods while decreasing access to unhealthy foods in schools, daycares, and recreation facilities; restrictions on the marketing of foods and beverages to children; and effective, long-term educational initiatives.

    Sugar and sugar taxes are definitely hot nutrition issues. How do these issues affect your personal and business lives? We’ll share our insights and additional research at our upcoming Nutrition for NON-Nutritionists annual course – join us and be a part of the discussion!

    “Eat Less, Eat Better”…is it that simple? Rethinking our message about healthy eating and obesity

     

    Will we solve the obesity crisis by simply telling people to “eat less and eat better”? A one-day health professional forum was held in Toronto on April 28th to rethink our messages about food and obesity. The event featured key leaders in obesity research/treatment and health communications:

    • Dr. Ayra Sharma (Chair for Obesity Research and Management, University of Alberta)
    • Ted Kyle (Founder, ConscienHealth)
    • Sue Mah (President, Nutrition Solutions and Co-Founder, Nutrition for NON-Nutritionists)

    Here’s what these experts were saying…

     

    Dr. Ayra Sharma
    Chair for Obesity Research and Management, University of Alberta

    • Obesity is a complex chronic disease.
    • Simplistic messages about obesity are misleading, can promote unhealthy weight obsession and promote bias and discrimination.
    • Prevention and intervention strategies should focus on improving health behaviours rather than on just changing body weight.

    Ted Kyle
    Founder, ConscienHealth

    • Use respectful, people-first language that is free of bias and stigma – e.g. “unhealthy weight” or “high BMI” instead of “fat” or “morbidly obese”.
    • “Obese” is a harmful label. “Obesity” is a disease.
    • Shift the conversation from “being obese” towards health.

     

    Sue Mah
    President, Nutrition Solutions and Co-Founder, Nutrition for NON-Nutritionists

    • “Eating better” means cooking, eating together and enjoying food.
    • Consumers are bombarded with food/nutrition messages that simply don’t “have the scientific muster to present as fact” (quoting Dr. Oz here!)
    • Health and nutrition communications needs to be creative to capture consumers’ attention.
    • From celebrities and chefs to dietitians and politicians, everyone has a role in being a champion for change.