Doctors Manitoba - Obesity solution simple, but not easy unless everyone plays a part

Obesity solution simple, but not easy unless everyone plays a part

July 2009

Unhealthy eating and physical inactivity remain a growing problem in Canada, whose national obesity rates outrank most other developed countries. Nearly a quarter of Canadians are obese, up from 10 per cent in the early 1990s.

The solution seems so simple - daily exercise and a nutritious diet. Yet apparently, it's not easy for the average Canadian to embrace as a way of life...at least not acting alone.

Determined action is required to make it easier, and everyone has a part to play. Specific steps are outlined in the new Doctors Manitoba Policy on Physical Activity and Healthy Weights. Adopted by the Board of Directors in May 2009, on recommendation of the Public Health Issues Committee, it is based largely on a same-titled CMA policy. Highlights are summarized and excerpted here, including the 14 recommendations listed below.

1	Doctors Manitoba calls on federal, provincial, territorial and municipal governments to commit to a long-term, well-funded Canada-wide strategy for healthy living.	Health and economic costs The policy begins by identifying the serious health consequences of obesity, which physicians see in their practices every day. Economic costs to Canada add up to nearly $2 billion per year, or 2.4 per cent of total direct health care expenditures. This does not take into account indirect costs such as lost productivity, disability insurance, reduced quality of life and psychological impact. Shortcomings of commonly used weight loss methods are cited in relation to information from myriad media sources, as well as popular diets, drugs and surgical treatment. Soaring rates of overweight and obesity are a problem of modern living. Cultural and technological change have had a radical effect on the lifestyles of children and adults alike. High-fat, high-calorie fast foods are easily available at relatively low cost, including on school menus. Many people work in sedentary jobs and commute by car. Sprawling suburbs, designed in proximity to multi-lane traffic routes and big box shopping malls, are not conducive to walking or cycling. Children's leisure pastimes have shifted from active play to extended hours in front of a television of computer screen. Budget constraints have reduced exposure to physical education and sport in schools. Since the epidemic of overweight and obesity has many causes, the policy notes, a variety of solutions are recommended as part of a comprehensive strategy. The intent is not to blame or stigmatize people who are overweight or obese, but rather to create conditions that make it easy to incorporate healthy eating and physical activity into their daily lives. Everyone plays a role Everyone has a potential role to play in promoting physical activity and healthy weights: individuals and families, schools, workplaces and communities, the food industry and governments, as well as physicians and other health professionals. A national strategy should ensure that resources are available in every instance. Policy recommendations 1, 2 and 3 are pertinent to strategy development. Individuals and families Ultimately, the policy acknowledges, individuals take responsibility for making healthy choices in their lives. But weight loss and exercise can be daunting if it means changing a lifetime of unhealthy behaviour. Healthy habits are easier to maintain through life if acquired in childhood and encouraged by the family. Resource materials providing guidance on healthy eating, physical activity and calorie needs should be widely distributed to families in a user-friendly format. Governments and health care providers should work together to provide consistent information, guidance and support. Parents should ensure that children balance the time spent on passive activities with active recreation. See recommendation 4. Schools Schools can be an important influence on children's eating and physical activity habits, as encouraged in policy recommendations 5, 6 and 7. Further, schools are urged to address the financial and other barriers preventing after-hours use of school recreation facilities. This can be especially beneficial for children from low-income families who cannot afford recreation fees or sports equipment. Governments should financially support schools in implementing comprehensive health and physical education programs. Workplaces Increasingly, employers are recognizing that workplace programs to improve diet and physical activity among employees can be effective and may reduce absenteeism and drug insurance costs. This is reflected in policy recommendation 8. Some are building on-site fitness facilities or entering into agreements with off-site fitness centres to provide programs for their employees. Workplace provisions such as showers, bike racks and other amenities also can help employees integrate physical activity with their on-the-job routine. Communities Recommendation 9 addresses the role of healthy communities in encouraging organized physical activity and making active lifestyles easy for citizens. Steps in this direction include: developing and maintaining a community-wide network of walking and cycling paths; zoning to ensure amenities are within walking distance of homes; increased funding and improved access to sport and recreation facilities; and building code revisions to make stairs an accessible, pleasant and safe option to taking the elevator. Food industry A successful national strategy to promote healthy weights requires the partnership and collaboration of food manufacturers by reducing the salt, sugar, saturated fat, trans-fat and calorie content of pre-prepared meals; offering a variety of nutritious foods and portion sizes on restaurant menus and providing information about calorie and nutrition content; restricting advertising and in-store promotion of high-sugar, high-fat foods, particularly those aimed at children;providing user-friendly consumer information about food products, including complete nutrition content and accurate advertising claims; and increasing the amount of information provided on product labels; for example, by including the percentage of calories as fat. Government policies Health Canada has already undertaken to promote nutrition and exercise through initiatives such as product labelling improvements, distribution of resource materials and public education programs. Governments at all levels can build on thesse activities with new public policy initiatives as per recommendations 10, 11 and 12. Some have advocated tax incentives to encourage participation in physical activity and choice of nutritious, low-calorie foods. In recommendation 13, Doctors Manitoba calls for further exploration of such measures to assess whether they would actually have this effect.
2	Doctors Manitoba calls on all stakeholders to develop, as an urgent priority, an action plan to address the obesity epidemic in Canada, with the goal of increasing by 15% within 10 years the proportion of Canadians who are at a healthy weight.
3	Doctors Manitoba urges all levels of government to commit to a strategy for increasing the physical activity levels of all Canadians, with the target of a 10% increase in each province and territory within 10 years.
4	Doctors Manitoba recommends that all Canadians work toward achieving and maintaining a healthy weight by: educating themselves about their dietary needs and about the calorie count and nutrition content of foods; and engaging in physical activity, with the goal of at least 30 minutes of moderate activity per day.
5	Doctors Manitoba calls on school boards to provide at least 30 minutes of active daily physical education for all primary and secondary grades, given by trained educators in the field.
6	Doctors Manitoba recommends that schools provide access to attractive, affordable, healthy food choices and make nutritional information available to those who want it, to be consistent with the food industry.
7	Doctors Manitoba calls on relevant levels of government to ban the sale of high-calorie, nutrient-poor foods in all primary, intermediate and secondary schools in Canada and to initiate programs aimed at encouraging healthy food consumption in schools.
8	Doctors Manitoba encourages employers/unions to actively promote the health of their employees/members by providing access to fitness facilities and healthy food choices in cafeterias.
9	Doctors Manitoba calls on communities to create environments that encourage healthy and active living and on federal, provincial and territorial governments to support them in this endeavour.
10	Doctors Manitoba calls on governments to increase access by all Canadians to nutritious food at affordable prices.
11	Doctors Manitoba calls on governments to explore ways to restrict the advertising and promotion of high-calorie, nutrient-poor foods.
12	Doctors Manitoba calls on governments to set rigorous standards for food labeling and for the advertising of health claims for food.
13	Doctors Manitoba recommends that governments explore tax incentives as a component of a national strategy for healthy living.
14	Doctors Manitoba recommends that governments at all levels invest in evidence- based research on healthy eating and physical activity and share the results of this research with all Canadians.
Click to access the complete Doctors Manitoba Policy on Physical Activity and Healthy Weight.

Surveillance and research

Doctors Manitoba also agrees there is a need to continue gathering statistics on Canadians' weight and analyzing possible causes of weight changes. Research investment should address: best measures for assessing overweight and obesity; effectiveness of weight management and treatment programs; and the effect of policy interventions on healthy eating and physical activity and on rates of obesity and obesity-related disease. According to recommendation 14, the results should be shared with all Canadians.

Physicians and the health sector

Evidence-based guidelines and protocols for counselling patients about physical activity and healthy weight should be promoted widely among physicians and other health professionals. They should be encouraged to stay up to date as new knowledge develops and to incorporate the most effective interventions into their practices. To the same end, Doctors Manitoba supports significant expansion of pertinent medical school curriculum, as well as CME courses and clinical practice tools.

In addition, Doctors Manitoba supports other medical associations in seeking adequate physician compensation for counselling patients on healthy weight and physical activity.

Health Promotion