Here we go again: another panel on childhood obesity, this one appointed by Ontario Premier Dalton McGuinty.
Now that Canadians have stopped talking about the Constitution, the state of the nation's waistlines seems to have replaced the amending formula and the division of powers as a subject for official scrutiny. Scarcely a year passes, or even six months, without another panel, study, commission or research project into the tubbiness of Canadians, especially young people.
If by study alone, coupled with ineffectual measures, obesity could be solved, the problem would have been licked. But it remains, a threat to the health of individuals today and tomorrow and, of course, a drain today and tomorrow on the health-care system.
In the past few years, before the McGuinty panel, governments have repeatedly pledged to do something. In 2010, the federal, provincial and territorial ministers issued a ringing Declaration on Prevention and Promotion that said Canada “is showing leadership in making prevention and promotion a priority.” Really?
According to the Conference Board, Canada in 2010 ranked 14th of 24 countries in overall health outcomes. More than 24 per cent of Canadians were obese in 2009, a rate considered “epidemic” by health-care experts, up from 14 per cent in 1979. Data from the Organization for Economic Co-operation and Development show Canadians among the least fit people in the industrialized world.
According to a Sport Canada report in 2008, the share of people aged 15 and older who reported actively participating in sport had dropped to 25 per cent from 45 per cent in 1992. (The only serious improvement in health prevention has been the drop in smoking rates to 17 per cent today from 45 per cent in the 1960s.) Following the portentous Declaration of 2010, federal and provincial ministers were at it again in 2011, announcing a “national dialogue” in the battle against obesity. They had perhaps forgotten about the 2005 federal-provincial plan called the “Integrated Pan-Canadian Healthy Living Strategy” that was all about making Canadians thinner, fitter and healthier.
For those with a historical bent, the very best Canadian report on making people healthier was written in 1974 under the direction of health minister Marc Lalonde. Titled “A New Perspective on the Health of Canadians,” it was hailed internationally as cutting-edge stuff. Since then, a mountain of subsequent reports – to say nothing of the endless health columns in newspapers – have merely gone over the ground in Mr. Lalonde's report.
The OECD has been perhaps the best institution internally probing health promotion and prevention, especially obesity. Its researchers have looked at studies from many countries and figured out what works and what doesn't.
Generally speaking, most of what Canada has been trying has failed, but that, of course, will not stop governments from continuing to try.
First, forget about exhortation campaigns encouraging people to get fit. They fail every time. Second, taxing fatty drinks or food doesn't work. It puts money into government treasuries but it doesn't change behaviour very much.
The best results came from targeted work with at-risk individuals (not the entire population) by physicians but also – and this was a key finding – dieticians who work with people on an ongoing basis. In other words, the advice from physicians has to be accompanied by follow-up work from dieticians, another reason why physicians and other health-care professionals should work together in clinics.
The OECD found populations in member countries are getting heavier and less healthy. Despite all the efforts to reverse the trend, the OECD concluded that “most interventions were shown to have only a limited impact on the overall scale of the obesity problem.”
Surprised? In Canada, the largest number of people live in suburbs where the car rules. The average television set is on in the average Canadian household more than 20 hours a week, and kids who leave television gravitate to other kinds of screens: video games on iPads or the computer. Fast-food advertisers drown the airwaves. And so on.
The core reason for poor health habits is overwhelmingly linked to income. The poorer you are, the poorer your health. Deal with income inequalities and the population will be healthier. Appoint another panel, and nothing will happen.