Section 4: Our health our future – A national dialogue on healthy weights dialogue report – Key findings
4. Key Findings
Through a series of pan-Canadian events, and the utilization of online and social media tools, more than 1000 Canadians shared their ideas, suggestions and views on how to tackle childhood overweight and obesity. The themes and related ideas that emerge from the analyses are summarized here under four policy areas, adapted from FPT Framework for Action. The four policy areas are:
- Creating Supportive Environments: Making the social and physical environments in which children live, learn and play more supportive of physical activity and healthy eating;
- Decreasing the Marketing to Children of Food High in Fat, Sugar and/or Sodium;
- Increasing the Availability and Accessibility of Nutritious Foods; and,
- Taking Early Action: Identifying the risk of overweight and obesity in children, and addressing it early.
Figure 16. Ideas related to four policy areas adapted from the FPT Framework for Action
Text equivalent - Ideas related to four policy areas adapted from the FPT Framework for Action
A diagram of 4 circles, where each circle represents a policy area adapted from the FPT Framework for Action. The first circle is labelled “Creating Supportive Environments,”, the second circle is labelled “Decreasing the Marketing to Children of Food High in Fat, Sugar, and/or Sodium,”, the third circle is labelled “Increasing the Availability and Accessibility of Nutritious Foods,”, and the fourth circle is labelled “Taking Early Action”.
Each idea outlined in this section is accompanied by a dashboard, which helps organize the wide range of participant input gathered throughout the consultation process. The dashboard displays the number of times the idea was mentioned in both the in-person and online streams, as well as providing an overview of the different stakeholder groups who suggested the idea.
The following list outlines the abbreviations used in the dashboard tables:
|Number of mentions through in-person dialogues|
|Number of mentions through online submissions|
|AB||Aboriginal Organizations (e.g. Métis National Council)|
|AR||Academics and Researchers (e.g. Canadian Obesity Network)|
|CA||Caregivers (e.g. YMCA after-school programmers)|
|HP||Health Care Practitioners (e.g. doctors, nurses, community health workers, nutritionists)|
|IN||Industry (e.g. food and beverage, fitness)|
|NGO||Non-Governmental Organizations (e.g. Breakfast for Learning)|
|PT||Provincial and Territorial Stakeholders|
|Other||Other (e.g. non-specified online submissions)|
Policy Area 1: Creating Supportive Environments
Settings such as schools, communities, and the family environment can have a significant impact on the healthy growth and development of children and youth. This policy area refers to the social and physical environments in which children and youth live, learn and play, and aims to make them more conducive to and supportive of physical activity and healthy eating. According to the FPT Framework for Action, the topic of Creating Supportive Environments is multi-faceted.
Participants suggested a variety of ideas that touch on the availability of healthy foods and beverages, quality opportunities throughout the day for physical activity, and active and safe transportation options within such settings.
Actions must reach children throughout the various developmental phases of childhood, where they live, learn and play–in the family, at school and in the community. Healthy eating and physical activity are important for the healthy development of young children to reduce the risk of obesity later in life. For example, exclusive breastfeeding for at least the first six months of life can help to prevent overfeeding and reduce the risk of early childhood obesity.
Most children spend approximately half of their waking hours during the week in a school environment; therefore, school policies that may contribute to reducing obesity should be examined, including the types of foods and beverages served and sold in schools, the availability of physical activity and quality physical education opportunities, and the provision of active and safe transportation opportunities to and from school. Parents, schools, community organizations, local governments and other affected stakeholders should be encouraged to collaborate to devise strategies to reduce the amount of time children spend being inactive and encourage indoor and outdoor active play and activities.
Community design–in particular the built environment– also has a major impact on physical activity levels and access to nutritious foods. Regional and urban planning decisions can advance or hamper public health goals; therefore, collaborative leadership between all levels of government and sectors, as well as effective partnerships across health, municipal governments and urban planning are required to promote active and safe communities.
For most children, parents provide the first opportunity for creating the social, physical and cultural environments that promote healthy growth and development in all aspects of a child's life, including both physical and mental health. Therefore engaging and supporting families early in children's lifespan is also a key area for addressing this issue.
-Curbing Childhood Obesity – A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights, p.3
The largest cluster of ideas in Creating Supportive Environments was education and training, with participants recommending a number of ways in which youth and others could gain the knowledge to make healthy living choices. Participants suggested the expansion of food preparation instruction in schools to ensure that youth have a functional knowledge of how to choose and prepare nutritious food as they grow into adulthood. They identified the need for the delivery of quality information to inform the public at large on how to make healthy eating and living decisions. Thirdly, participants want more specific nutrition training for youth and the general public. This focus included greater awareness of how to make educated dietary choices – knowing how to interpret nutritional labelling information on prepared food packaging.
Many participants want more education for all ages on growing, harvesting, preparing, cooking and preserving food. As one Winnipeg participant stated,
Part of the issue is that we've lost the knowledge of how to prepare foods in our fast food culture. One of the most frequently recurring actions suggested was re-establishing home economics classes in schools, with the hope they would help teach children and youth basic cooking skills and healthy eating. Similarly, a number of participants suggested more experiential learning opportunities for students, to facilitate the sharing of traditional knowledge and practices around food, leverage community partnerships, and take academics [learning] to the land. This idea was especially popular among stakeholder participants in the three territories.
Media notes: collaboration for messaging- government, NGOs, researchers and industry- instead of everyone sharing their individual messages, collaborate on developing one set of messages)/ create specific content that is both creative and engaging for specific audiences
Participants advanced the need for providing better information on how to make healthy eating and living decisions. While industry participants were particularly supportive of healthy eating programming and campaigns for children (e.g. Concerned Children's Advertisers' Long Live Kids – The Science of Food), a wide range of participants - including caregiver, NGO, online, industry and media – emphasized providing education to parents and the wider community as well. Suggestions included increased access to nutritionists and dieticians (over the phone or in supermarkets), wide-reaching public education campaigns (e.g. PSAs), and schools promoting information dissemination to parents and youth on food choices for healthy lunches. Other participants, particularly those from media organizations, advanced the idea of developing educational materials through multisectoral collaboration, which could help provide all stakeholders with more consistent messaging on this issue. For example, one media participant suggested:
Instead of having everyone sharing their individual messages, we should collaborate to create one set of messages. This could then be used to develop more specific, creative content for different audiences.
Online participants think that educators need more material and resources on how to integrate healthy living and nutrition lessons into other classroom subjects throughout the school year.
Specific information on nutrition was suggested by participants, in addition to having greater access to general information on healthy living. Those representing industry and the Canadian Obesity Network, as well as some regional stakeholders, suggested better (which for some meant standardized) nutrition education in grades K-12, developed through a pan-Canadian approach. Participants believe that the development and implementation of a national nutrition disclosure framework would help educate consumers on the nutritional value of quick-serve food (at fast-food outlets, for example). They want campaigns such as the Nutrition Facts Education Campaign to be replicated to reach the general public and raise awareness of how to read and understand product labelling. As one Toronto youth participant stated,
The key to maintaining a healthy weight is awareness. There should be more workshops on nutrition science, so people can be aware of what they're actually eating.
The physical environments in which children and youth are raised emerged as the second most frequently recurring topic under Creating Supportive Environments. Participants asked for changes in how their communities are planned, to make outdoor physical activity easier and more (including more active transportation options such as sidewalks and bicycle infrastructure), and green spaces to allow for structured and unstructured play. Participants want access to schools in their communities after hours to allow for more opportunities for supervised physical activities. The third most popular idea in this cluster was to change zoning policies and regulations to influence the location of retail food outlets, particularly supermarkets and restaurants, with the goal of increasing access to healthy food choices.
Participants presented a number of ideas to build and develop communities that encourage outdoor physical activity, including active transportation. Actions were proposed by all stakeholder groups (except youth), and include safe and accessible sidewalks, bike trails and paths; creating more outdoor physical play areas throughout the community, including spaces where unstructured play can occur; and securing more protected green space. The development of a national cycling strategy was the second most popular idea overall in the online Idea Forum. In some of the territorial consultations, participants urged the development and re-establishment of the traditional First Nations trail system.
Some online participants advanced the need for school siting policies to encourage active forms of transportation, while caregiver participants suggested the need to have zoning that encourages safe, active transportation access to retail food outlets. Looking at community development, some participants want municipalities to incorporate healthy built environment requirements into their planning processes. For example, one caregiver participant suggested that communities could have a mandated number of parks and recreation centres within a prescribed distance. Additionally, many participants recognized the need for funds to maintain and facilitate accessibility to such infrastructure. In one of the self-organized dialogues with caregivers in Nova Scotia, one participant urged municipalities to reorient their municipal planning priorities, noting:
Communities are making the wrong choices...money should be spent on making outdoor public spaces more welcoming and usable...not for cobblestone sidewalks for the downtown area.
Some participants think that schools should be opened up after hours (evenings, weekends, summer) to the wider community, with the rationale that children and youth (as well as the broader population) would be granted supervised physical fitness facilities, and communities would be making good use of underutilized infrastructure. As one Vancouver caregiver participant explained quite simply,
We need to keep the doors open longer. Some participants took the idea even further, and envisioned some schools functioning as community centres. At the Aklavik Inuit National Committee on Health consultation, one participant explained that one significant barrier to increasing access to school facilities is the money required to operate the facilities (e.g. caretaker, heating, electricity). Dialogue around community access to school facilities was robust amongst participants at in-person consultations, but did not appear as frequently online.
This idea was supported by a number of caregiver and regional stakeholder participants, who suggested the need for zoning legislation to regulate the location of vendors that sell unhealthy foods (e.g. fast-food restaurants and convenience stores), with a particular focus on their proximity to schools. Similar to the Urban Planning Conducive to Physical Activity idea, participants also suggested that communities need to be zoned to afford easy access to essential services, such as grocery stores. For example, one participant put forth the idea that a mandated number of grocery stores be zoned within a prescribed distance to help make it convenient for people to buy and prepare their own fresh food. Another participant suggested the removal of land covenants (limitations on the re-development of commercial properties) on former supermarket sites that currently limit their reopening as supermarkets.
Participants put forth a number of suggestions to change the behaviours and attitudes of children, youth and other Canadians, which form the third largest cluster under the Creating Supportive Environments policy area. Most of the attention here focused on physical fitness. Participants showed strong levels of support for increasing the level of physical activity in all grades, from kindergarten through to twelve, including time for both structured and unstructured play. They also suggested that less emphasis be placed on competitiveness in sport, with more emphasis on finding personal enjoyment in being physically active, for example, through less traditional physical activities such as tai chi or archery. To change the way in which healthy living is thought of and perceived by youth and society at large, participants advocated a shift in focus away from a weight-centric language, to take into account the multitude of factors that make up healthy living.
Many participants presented the idea that regular physical activity in schools needs to be re-introduced in schools, which could be provided to students throughout the day in a number of ways. The most common action, which was suggested by many industry, caregiver, stakeholder, youth and online participants, was to mandate a minimum, standardized level of physical activity for students to complete each year. Other participants suggested reinstating longer, unplugged recess and lunch breaks with structured physical activities, making gym class a mandatory component of the curriculum from grades K-12, and hiring health and wellness teachers for each school to integrate healthy living into all facets of school life.
A number of regional stakeholder, caregiver, online, and Canadian Obesity Network participants emphasized the need to shift the conversation on childhood overweight and obesity from a weight-centred approach to healthy living. The idea was particularly popular in the online Idea Forum, where it was voted as the most popular idea overall. Many expressed concerns with the language, explaining weight as just one component of the broader goal of maintaining a healthy lifestyle. Many participants suggested that the term weight be treated with caution, as it is often associated with issues like body image dissatisfaction and dieting, which can lead to numerous health risks. As one Saskatoon stakeholder participant asked,
We have to take a close look at what we're trying to achieve – a population that weighs less, or a population that is healthier overall?
While none of the participant groups proposed alternative language definitively, there was some discussion during one stakeholder consultation around the term healthy growth and development. Participants saw this as representing a more holistic approach by effectively capturing other contributing factors, such as environment, education and mental health. Others suggested that society's attitudes toward body weight and body image in general need to change, with some asking the media to play a more active role in portraying realistic healthy body images.
Many participants want to lessen the overall focus on competitiveness and encourage structured and unstructured physical activity that is open to all levels of ability – in short, they want sports and physical activities to become more inclusive. They believed that this would address the over emphasis on the competitive aspect in sports, which includes the specialization in specific elite sports and all-star teams. Some felt that performance in gym class should not be graded, as a way of creating a more collegial atmosphere. As one Whitehorse stakeholder participant explained, Fun sports should be fun. A lot of kids are self-conscious and may not like team sports. Participants also suggested introducing more non-traditional physical activities (e.g. tai chi, archery) to help broaden the concept of sport and physical fitness in the minds of youth. They think that teachers need to work individually with their students to find activities that interest them (and communicating through report cards to encourage parents to share these activities). A few participants saw a role for students to play in leading and planning physical education classes, as a way of encouraging them to take more ownership.
1.4 Highlights of Other Ideas
In addition to ideas clustered around education and training, built environment and infrastructure, and behaviours and attitudes, participants presented a number of other ideas to create supportive environments for healthy living. They included: recognizing the important role that parents and families play in encouraging healthy living at home; ensuring ready access to affordable and widely available recreational programming; and using tax credits to reduce the cost of physical activity.
The fundamental role of the family unit as a supportive environment was identified, particularly online, as a way to help ensure the healthy growth and development of children and youth. Regional stakeholder, caregiver, youth and online participants recommended that the important role that parents play in encouraging healthy living at home must be recognized. They urged parents and caregivers to plan more physical activities with family members (and setting limits for sedentary activities), encouraging improvised and unstructured play around the house, and spending more time cooking and eating together. One Métis National Council participant cautioned against,
the over-institutionalization of activities that should already be a normal part of family life, which she rationed,
could have the unintended effect of weakening the child-parent relationship. On the other hand, some participants also discussed how a negative family environment (i.e. forms of abuse, neglect, lack of parenting skills) can compound the issue of childhood obesity.
The importance of affordable (free or low-cost) and widely available recreational programming was emphasized by a number of participants. Some suggested making public funding available for communities that want to promote and implement inexpensive health activities like running clubs, boot camps in public spaces, and pick-up sports leagues. One prominent example of an organized recreation program was brought up during the Toronto caregiver consultation, where a number of participants referenced the YMCA's CATCH Kids Club. Additionally, one participant emphasized the need for affordability, stating:
Working at the Y, we see how participation numbers for free activities are huge...and if it costs even a couple dollars more, participation drops dramatically.
Others suggested tax credits or subsidized registration fees and equipment to help increase participation of children from low-income families. One participant highlighted the importance of quality in recreational programming, suggesting tax credits for volunteers to take part in leadership training.
Participants, particularly those who took part online, contributed a number of novel ideas on how to use taxation to encourage healthy lifestyles. In addition to the common call for the taxation of foods high in fat, sugar, and/or sodium (as reported in later sections of this report), some want the federal Children's Fitness Tax Credit to be available to those on fixed incomes, or to citizens of all ages (thus allowing for families to participate together), and the waiving of GST/HST on expenses related to physical fitness (e.g. gym memberships, activity registration). Others suggested tax breaks for healthy living. These would be monitored by primary care providers or certified trainers who would relay individual health statistics (such as body mass index) directly to the Canadian Revenue Agency, which would provide a rebate or tax reduction if one's statistics were within a healthy range.
Policy Area 2: Decreasing the Marketing to Children of Food High in Fat, Sugar and/or Sodium
According to the FPT Framework for Action, children can be easily influenced by marketing, and most often are not aware of it. This policy area sees the reduction of child exposure to the marketing of certain foods and beverages as key to helping families consume fewer of them and make healthy choices with and for their children. As the Framework suggests:
Children are vulnerable, easily influenced, and have little control of their environments. Reducing their exposure to the marketing of foods and beverages high in fat, sugar and/or sodium will be key to decreasing consumption and assisting parents in making healthy choices with and for children.
-Curbing Childhood Obesity – A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights, p.4
Participants want action in a number of areas to reduce exposure to marketing. Many called for increased regulation of marketing, including the time of day, and physical location of advertisements. Others suggested changes to the way in which certain foods are displayed in retail environments. Many saw the need to increase media literacy, so that children and youth are provided with the knowledge and critical analysis required to make their own judgments on what they see being advertised. Lastly, they also saw a role for positive marketing, including more advertisements for healthy food options.
A range of actions aimed at placing greater restrictions on the marketing to children of unhealthy foods were suggested by participants. These actions reflected different levels of stringency, with the call for tighter restrictions appearing more frequently. This included limiting the total number of advertisements and/or restricting such marketing to certain times (e.g. not during peak times for children's television shows). Others presented the idea of restricting advertisements in certain locations, such as in high-impact retail areas and schools (some suggested making these marketing-free zones). Additionally, many youth participants suggested making advertisements for unhealthy foods more expensive. Some participants went even further and suggested banning any direct marketing to children. As some Yellowknife regional stakeholders discussed, outright bans would take into account how easily children are influenced, and their belief that they do not think they are influenced. Other participants spoke to perceived regulatory challenges in the current system, in which industry self regulates. As one Charlottetown regional stakeholder explained, regulation is not part of the framework right now, [because] it's voluntary. Another participant identified the need for national standards, arguing that regulatory enforcement is difficult when issues transcend regional, provincial, national and international jurisdiction.
Although many participants advocate stronger action in this policy area, there were some participants who disagreed with its premise. This was most evident in the industry and media consultations, with many of these participants advocating looking to the successes of existing initiatives to decrease advertising to youth. Some challenged the need to decrease marketing, questioning the evidence linking childhood obesity to foods high in fat, sugar and/or sodium, as well as the impact of marketing such foods. Other participants argued that there are more fundamental issues to address than marketing practices, including the important role of parents in helping their children make healthy lifestyle choices. One industry representative, for example, posed the question,
Why are we pointing the finger at restaurants and grocery stores? It's not because of Coca-Cola or McDonald's...it's the parents.
A number of industry participants also cautioned against the singling out of specific ingredients (e.g. fat, sugar, sodium) and automatically associating them with unhealthy foods.
A number of regional stakeholder, caregiver and Canadian Obesity Network participants suggested actions to address how food is marketed and presented in retail environments. For example, they advanced the idea that unhealthy items should not be placed in high-impact areas (e.g. checkout aisles), or at least placed so that they are not as visible or accessible to children. One Charlottetown regional stakeholder stated that such actions would help, create a more family-friendly shopping experience. Other actions included having food service providers promote the four food groups more actively, offering healthy food samples in supermarkets, creating more enticing visual displays for healthy foods in order to attract children, and having grocery stores provide in-store resources (e.g. dieticians on-staff, tours of the store, nutritious recipes) for customers seeking nutritional advice. As suggested by one participant,
Marketing is much more than just a commercial on TV.
Teaching individuals how to critically analyze messaging in a wide variety of media was promoted by many participants representing industry, caregivers and the Canadian Obesity Network. One media participant suggested that just as we have financial and digital literacy, we need media literacy. This means educating children and youth, as well as their parents, to recognize when and why they are being marketed to by companies. Many industry participants viewed media literacy education as the main solution for this policy area, advocating for a teach, don't protect' approach, as they did not think that bans would work. Similarly, as one Winnipeg regional stakeholder explained,
It's not just about regulations, but also about teaching people to be critical thinkers and media savvy.
Many participants pointed to the Concerned Children's Advertisers public service announcements on media literacy as a model upon which to build, and possibly the basis for developing and rolling out a standard curriculum for schools across Canada. Other participants envisioned the role of a grassroots, social marketing education campaign that would empower children to make the right choices for themselves.
In contrast to the first idea for this policy area, participants from nearly every stakeholder group think that marketing should be re-oriented to promote the more positive aspects of this issue, such as the variety of healthy food choices available to children and youth. Participants acknowledged that there was a lot of criticism on the negative impact that advertising can have, and also emphasized that the media is also a powerful tool to convey positive messages. The media's impact was discussed by some youth participants, with one Vancouver youth stating that,
In today's media there are a lot of stereotypes about how you're supposed to look. People don't realize how generic it is. I don't think there is a standard body type or weight...it's just about being healthy.
Many participants suggested creating a media environment that is more conducive to positive marketing overall. Some media participants suggested developing effective Public Service Announcements to push positive messages out to the public, as well as using print and broadcast media more actively to report on stories related to healthy, active living. In Saskatoon, some participants presented the idea that positive marketing be used to create consumer demand for healthy foods. Some industry representatives cited the popular milk marketing campaigns as an example of a successful healthy food initiative targeted at children and youth, particularly with the use of celebrities and other recognizable spokespersons. Similarly, an idea from the Toronto youth consultation involved developing a cartoon involving fruits and vegetables, which participants believed would help teach children how to eat healthy from an early age. Additionally, some participants suggested broadening the message to include a more holistic focus on healthy living, similar to the federal ParticipACTION program. Most of the participants supporting this idea felt that it would require a multisectoral effort, particularly between government and industry groups.
Policy Area 3: Increasing the Availability and Accessibility of Nutritious Foods
While decreasing the marketing to children of certain kinds of food and imparting knowledge of healthy food preparation are important, these efforts to encourage healthy eating and living will come to naught if children, youth and their parents do not have access to nutritious foods. This policy area focuses on finding ways to increase access to and availability of healthy food options, including in those communities challenged by their location. According to the FPT Framework for Action, there are several important factors that impede access to nutritious foods.
The healthy choice must be an available and easily recognizable option. Some communities in Canada are further challenged to adopt healthy eating practices–specifically, northern, rural and remote communities, which may not have the same access to nutritious foods. Social determinants of health, including income, also limit some families' ability to effectively make healthy choices.
-Curbing Childhood Obesity – A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights, p.4
Making healthy food more affordable was the most frequently recurring theme for this policy area. Participant ideas were clustered around three areas: government regulation, support for individuals with low incomes, and support for individuals in the North and remote communities. The first idea encompasses a range of actions that could be taken to decrease the price of nutritious foods and/or increase the price of unhealthy foods. The second and third ideas are aimed at supporting two groups that are particularly sensitive to food prices as a result of socioeconomic and geographic barriers. Many participants that proposed supporting individuals with low incomes identified poverty as a fundamental problem contributing to childhood overweight and obesity. Acknowledgement of the challenges that Canadians in the North face in accessing healthy foods was high. Participants also emphasized the need to ensure that marginalized groups are being engaged directly with this issue, as they may have specific needs that are often overlooked.
The most common action from participants called for a decrease in the price of healthy foods (e.g. fruits, vegetables, dairy, organic options) and/or an increase in the price of unhealthy foods (e.g. junk food, fast food). Many participants suggested that governments should play an important role in regulating food prices in order to make healthy foods more accessible and unhealthy foods less so, and identified a number of ways that this could be done. While numerous participant groups questioned the high cost of nutritious foods, these concerns were most clearly expressed in an Aboriginal and Winnipeg regional stakeholder consultations. Commenting on the price differentials between healthy and unhealthy food, one online participant shared,
I see it every day, where people can buy a full fast-food meal for roughly six dollars, or buy a pound of apples, which will not fill up an average adult, for the same price.
Participants noted a number of ways to regulate food prices, such as taxing unhealthy food (which was particularly popular with online participants, and akin to the way in which tobacco products are currently taxed), developing a coupon system for healthy food, and providing government subsidies for those who produce, transport and sell healthy food, particularly in northern and remote communities. Some put forth the idea that taxes levied on unhealthy food options be directed to decrease the price of healthy options. Many regional stakeholders felt that such regulations could help equalize prices between healthy and unhealthy food, particularly in remote areas. Some caregiver participants suggested the need to monitor food prices, possibly through a watchdog organization, before any regulatory actions are made.
Participants put forth a number of ideas on the impact of socioeconomic status on nutrition and healthy living. One Charlottetown regional stakeholder observed that:
One group that isn't here is the impoverished and working poor, who will have different needs and strategies...if we are looking at determinants, we really have to get everyone around the table involved.
While some suggested tax credits and subsidies to address accessibility concerns (including one online participant who proposed running mobile fruit and vegetable buses to sell low-cost produce in areas devoid of grocery stores), many presented ideas to tackle poverty at a more fundamental level. Poverty and food insecurity, according to participants, are significant impediments to healthy eating for many individuals across the country, including those in northern and remote areas. As a result, some regional stakeholder participants suggested developing and implementing provincial-level anti-poverty strategies, increasing social assistance rates, and increasing access to affordable housing.
If people don't have enough money to buy food, then that's a big barrier to eating a healthy, balanced diet, shared one regional stakeholder participant.
We were thinking that there are probably economic policies that would make disposable income more readily available, to make sure that families have a basic level of resources available to support themselves.
Participants offered ideas to address the specific barriers that Canadians in northern and remote communities face in accessing nutritious food. Throughout the engagement process, participants shared their experiences of how expensive it can be to buy healthy food items in isolated areas (e.g. $21 pineapple in Iqaluit). With the goals of equalizing the prices of healthy and unhealthy food within these communities and/or standardizing food prices across jurisdictions, the most common action was transportation subsidies, which would help reduce costs to consumers. Additionally, some participants suggested utilizing key structures and organizations already in place within these communities, such as Food Secure Saskatchewan, while another suggested increasing support for organizations that fund nutrition programs (such as breakfast programs). One participant suggested developing closer partnerships with grocery stores in northern communities, to ensure that healthy foods are stocked at affordable prices. Support for the Nutrition North program was high, which provides smaller northern communities with subsidies to help offset the cost of healthy food. Touting the success of the program, one participant from Yellowknife shared:
There's evidence that [the Nutrition North] program led to increases in consumption of calcium, whole grains, and fruits and vegetables.
The ideas included in this theme were some of the most strongly supported and highly discussed across all dialogues. Many participants felt that community-based actions, such as community gardens, community kitchens and meals, and supporting local food production were key to addressing childhood obesity. In contrast to many of the ideas that were gathered throughout the consultation process that require direct government actions, participants felt that the ideas clustered around community action represent ways for individuals to work together at the local level and make an impact themselves. In a number of dialogues, participants described the positive impact that such actions have had in their local communities. Although a wide range of participants proposed these types of ideas, caregiver and regional stakeholder participants were the strongest supporters.
All types of stakeholder groups suggested developing and fostering community gardens. As some regional stakeholders explained, these publicly-owned and -operated plots would help people recognize the importance of food security and self-sufficiency, particularly in the local context. Community gardens were also promoted as ways to create a social fabric between community members by providing the opportunity to get involved and support each other through a cooperative venture. Many participants suggested the creation of community gardens and greenhouses specifically for schools and childcare settings (e.g. YMCA Youth Centres), which would include an educational component for students. As one regional stakeholder explained, this could require
repackaging and selling the idea of gardening to people. During the Métis National Council consultation, participants shared examples of the positive impact that community gardens on donated Métis land have had in some communities, particularly in terms of helping children and youth develop their knowledge and skills of horticulture. However, one participant cautioned that
there are so many pockets of things going on...we need to have more coordination so that community gardens aren't threatening market gardens.
Participants suggested a range of actions to build the capacity of local food producers and make their products more accessible. Many felt that the buy local mentality needed to be more actively supported and promoted, through education, for example. More specifically, a number of regional stakeholders think that local farmers need more resources to sustain their business of providing local residents with food from the field to table. According to participants, this could include agricultural grants and subsidies which could help reduce the costs related to transportation, or taxes to deter the purchase of imported produce. Others suggested that local food production could be supported through schools. Some described the example of the Farm to School Healthy Choice Fundraiser, in which students sell bundles of fresh, locally grown fruits and vegetables at or below market price, and one youth in the online Idea Forum suggested the creation of small farmers' markets in schools.
The creation of community kitchens and meals, where members of the community come together in a public space to cook, share knowledge and skills, and socialize with one another, garnered much enthusiasm. It was suggested that these be developed in a number of different settings, including community centres, schools and workplaces. Participants believe that such settings will allow participants to share costs - as food is usually bought and cooked in bulk quantities - and allow for an investment of time in creating nutritious meals. At the Aklavik consultation, some participants felt that community kitchens should also focus on traditional foods. Similar to community gardens, the kitchens would be community-driven initiatives, although some participants suggested developing partnerships with relevant government departments (e.g. Education, Health and Social Services).
3.3 Highlights of Other Ideas
In addition to ideas clustered around food prices and building local capacity, participants presented a number of ideas to increase the availability of and accessibility to nutritious foods. This included making eating healthily more convenient, enhancing product labelling, and regulating access to and the formulation of junk foods'.
Many participants want action to ensure that healthy foods are the most convenient options available in schools, childcare settings, and recreation centres. For a number of regional stakeholder, online and Canadian Obesity Network participants, this would require mandating healthy food and nutrition policies in schools and childcare facilities. This could include developing standardized menus and reintroducing breakfast and lunch programs to provide nutritious meals and snacks at cost or for free. According to some caregiver participants, subsidies or grants could be provided to reduce the costs of such programs in educational settings. Other participants put forth the idea of introducing mobile fruit and vegetable carts to roam cities in the warmer months (similar to ice cream carts), and incentivizing the development of healthy fast food eateries (as youth in Port Coquitlam explained,
just like how fast food restaurants are everywhere!)
With the goal of providing consumers with direct, easy-to-understand nutritional information, many participants see a need for improved food product labelling standards. A wide range of actions were submitted by regional stakeholder, caregiver, Canadian Obesity Network, youth and online participants. The most common suggestion was to develop warning labels for foods considered unhealthy (e.g. high in fat, sugar and/or sodium), similar to how tobacco products are labelled. Another idea shared by many participants was the creation of an easy-to-understand rating system for pre-packaged foods. Participants cited the United Kingdom's traffic light labelling system as a model to consider, which categorizes food based on its content of fat, sugar and sodium – red, yellow and green markings indicates high, medium and low levels of those ingredients.
Participants also contributed actions to simplify the information provided by nutrition labels. One Canadian Obesity Network participant in Montreal suggested that,
Instead of having people understand things like percentage of daily value, we need to have a simpler language [like] this is high in sugar, this is low in fat'.
Similarly, one participant emphasized the need for plain language by asking,
Would the label be something your grandparents can read? Other actions included developing standardized portion sizes across jurisdictions and encouraging more honest, impartial advertising. This second action was especially popular amongst participants at the Port Coquitlam youth event, who felt that
if you're advertising unhealthy food, then you have to talk about the good and bad of your product. Some participants also suggested that these practices apply to any point of sale, such as calorie labelling introduced in large chain eateries in New York City and California. One online submission from industry, however, challenged the efficacy of oversimplified calorie counts on menus, citing the complex variety of menu options and combinations, the focus on calories over other nutrients, and the lack of evidence that such measures result in healthier choices.
Some participants suggested that the best way to increase the availability and access to nutritious foods is to ban or regulate more strictly foods high in fat, sugar and/or sodium. This idea was particularly popular amongst online participants. They suggested a variety of measures, including bans on the sale of junk food in schools, hospitals and recreation centres (rather than simply offering healthy alternatives, as explained in the Convenient Access to Healthy Food' category), outright bans on certain kinds of foods (such as carbonated beverages and sugary snacks), bans on the use of additives in the food supply chain (e.g. high-fructose corn syrup, colour, and growth hormones), the reduction of the use of fat, sugar and sodium in food through a program modelled on the recent Trans-Fat Task Force, the regulation of food portions in the service industry, and the implementation of age restrictions on the sale of energy drinks.
Policy Area 4: Taking Early Action
While children and youth need supportive environments to grow and develop, ready access to nutritious foods, and skills to make healthy living choices, the importance of the early years in a child's life was highlighted in the FPT Framework for Action, and emphasized by many participants. Through early identification of childhood overweight and obesity, and increased attention on the first five years of life, the focus of this final policy area, developmentally-appropriate interventions can be offered to children and their families. The Framework identifies key factors to consider when taking early action.
Regular monitoring of infant and child growth is key to identifying the risk of obesity early. When children are identified as being at risk, a range of developmentally appropriate interventions (e.g. building self-esteem, nutrition and physical activity) can offer children and their families a wealth of opportunities to address this important issue. Children who are at particular risk of obesity, or are already overweight and obese, need focused support to change both their eating practices and physical activity levels in order to attain a healthy weight. Improving parental awareness, knowledge and skills of healthy eating, and physical activity are also key to addressing this issue effectively.
-Curbing Childhood Obesity – A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights, p.3
The most popular theme under Taking Early Action was education and training. This focuses on providing parents, families and health practitioners with the knowledge and resources needed to have a positive influence on a child's health, particularly during their early years. Many participants felt that engaging parents and families was a fundamental component of addressing childhood obesity, largely because of the level of influence that they can have on a child's growth and development. They also emphasized support for practitioners – with a focus on capacity building, including ensuring that healthcare and childcare workers receive up-to-date training and educational resources.
Many regional stakeholder, caregiver, Canadian Obesity Network, media and online participants put forth the idea of engaging and educating parents and families as the priority action for Taking Early Action. As one Vancouver caregiver participant advised:
It's important to go to the parents themselves and find out what they think is limiting them.
With a focus on increasing awareness of healthy lifestyles and establishing healthy attitudes and behaviours during the early years, participants think that the development and distribution of evidence-based educational resources (e.g. courses, information sessions, social marketing campaigns or challenges, information packages) should focus on topics such as nutrition literacy, physical literacy and healthy growth and development. Participants noted that parents are an important source of influence and control over their children, and that families can lead by example by establishing and maintaining a healthy lifestyle. For example, one participant suggested that,
there needs to be a great emphasis on the parent's understanding of why it is important to develop physical activity skills at an early age...it leads to self confidence and the ability to perform the tasks needed to be healthy throughout their lives. To engage parents and families more effectively, media participants proposed developing creative messaging specifically for this demographic. Additionally, some media participants identified the need for a forum for concerned, passionate parents to get more involved with this issue at the community level. This could be achieved through local events and social media initiatives targeted at childhood obesity, as one participant referenced the impact that mommy bloggers have had on a number of issues.
Participants suggested that primary care and public health practitioners (e.g. family physicians, nurses, nutritionists, dieticians) should take a leading role and leverage community-based partners (e.g. schools, caregivers, local media) to get the message out and provide increased access to resources.
Participants suggested that practitioners be supported in their work with relevant, up-to-date training and educational resources. They recognized the important role that healthcare and childcare practitioners play in identifying the risk of obesity early and making appropriate interventions. At a higher level, some Canadian Obesity Network participants put forth the idea of more integration between health care providers, while some regional stakeholder participants suggested that a needs assessment of practitioners is necessary, to help enhance their skills in identifying and addressing childhood obesity. Some suggested training on the World Health Organization's revised growth charts. Participants also identified other actions: healthcare practitioners need to develop a better toolkit for the treatment and referral of overweight children; childcare practitioners need to better articulate and utilize Early Childhood Education principles, expectations and responsibilities in their work, with a focus on physical literacy; and school boards need to hire more trained and dedicated physical education teachers.
This theme was almost as popular education and training, which is encompassed by two key ideas: encouraging breastfeeding as an exclusive feeding practice and ensuring that a continuum of pre- and post-natal services are available to new mothers and their families. Many health care practitioner participants strongly supported breastfeeding, which they feel is essential to early childhood nutrition and health. In terms of pre- and post-natal services, participants proposed improvements in a range of areas, including surveillance and monitoring, and access to education and counselling. Additionally, many participants wanted to ensure high accessibility for such services, especially for those who may not be aware that they are available, or feel excluded due to socioeconomic barriers.
Participants presented a number of ideas to promote and increase the practice of breastfeeding, given it is a fundamental component of early childhood health and nutrition. Some regional stakeholder participants suggested that all provincial and territorial governments develop breastfeeding policies in collaboration with regional and community health units. More broadly, a number of participants supported the promotion of breastfeeding as the exclusive feeding practice for the first six months to one year of the child's life, with the goal of increasing breastfeeding initiation and retention rates over time. Some Canadian Obesity Network participants pointed to the example of Quebec, where breastfeeding promotion is used as a way to engage mothers with the issue of childhood obesity.
Ensuring a continuum of services during the pre- and post-natal periods was considered essential by a number of regional stakeholder, caregiver and Canadian Obesity Network participants. Most of the suggestions on this topic focused on providing mothers and the broader family with adequate prenatal monitoring and care, which would include access to education and counselling on topics like prenatal nutrition and birth weights. While many participants suggested that primary care and public health practitioners would take the lead, they also saw a role for professionals in childcare settings to provide such services. Some participants put forth the idea that services must accessible to everyone, regardless of socioeconomic or cultural background, so that
we are working on actions that aren't increasing disparity. Some Canadian Obesity Network participants presented the idea of broadening postnatal services including education, surveillance and monitoring, and noted that there should be
more than just general guidelines... [we should] make sure they are current. One Aklavik regional stakeholder participant emphasized the need for these types of services as soon as possible, suggesting,
[We need to support] parents so that they have the capacity to provide their children with a healthy lifestyle right from birth.
This theme focuses on improving the overall research capacity and data available on childhood obesity. Participants suggested two approaches to achieve this goal. The first was conducting a comprehensive assessment of health needs and risk factors, which would require a high level of collaboration between different groups in order to obtain accurate and robust information. The second idea was improving health monitoring tools and practices and engaging all relevant practitioners in their use and delivery. While less widely supported than the first idea, both healthcare practitioners and regional stakeholders believed that this would provide a more solid information base for tracking a child's growth and development, as well as making interventions if necessary.
Having robust, accurate and up-to-date research on childhood and youth obesity was a popular topic amongst participants. Participants suggested the need for more research on risk factors for childhood obesity, including the social determinants. This they saw this as a collaborative effort between provincial/territorial governments, private industry and research communities (e.g. academia, NGOs). Others put forth the idea of more community-based research, with the purpose of engaging individuals at the local level to determine when and where interventions can be made. Participants also suggested the need for research to address current gaps on childhood obesity, with regards to newborns, school-age children and massive self-underreporting, which one participant attributed to many people not understanding the difference between being overweight and obese. Other participants suggested further standardization of research across the country, conducting longitudinal, population-based screening for health, particularly for First Nations and Métis populations, and further developing data sets to provide a comprehensive view of existing information at both federal and provincial/territorial levels. Some regional stakeholder participants discussed existing early nutrition screening in some regions. Although this was standardized, they presented the idea that the program should be expanded through more proactive outreach to the most at-risk mothers and newborns, explaining,
We struggle because the folks that come to see us are often the ones that don't need [nutritional screening].
While participants put forth the idea that healthcare and childcare practitioners need more support in terms of education and training (as described in the Education and Training section), they also suggested more rigorous health monitoring, supported by effective, world-recognized tools. These include the redesigned World Health Organization growth charts, which outline a more comprehensive set of physiological growth and development standards for children and youth. This idea was especially popular among regional stakeholder participants in Saskatoon, who suggested more regular growth monitoring during a child's early years (e.g. until the age of five, most frequently during the first eighteen months). Some participants also wanted to re-examine monitoring based solely on the body mass index, as they suggested that this is based on how children should grow, not how they have grown and does not include the whole range of physical activities that a child may participate in. As a result, the need for a more composite measure was identified.
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