Fat is slowly becoming Public Health Enemy Number One, replacing cigarettes and Big Tobacco on the hit lists of leadingedge public-health advocates in Canada—and for good reason! Obesity now surpasses smoking as a cause of chronic illness and health-care costs, and it appears to be on the rise in every country in the world.

In its February 10 news release, headlined “Report Cards on Canada’s Health: Heart and Stroke Foundation Warns Fat Is New Tobacco,” Dr. Anthony Graham, a cardiologist and spokesperson for Canada’s Heart and Stroke Foundation, commented that “the prevalence of this serious health risk is almost exactly what we faced with tobacco use 30 years ago–when half of Canadians smoked.” Since that time, Graham notes, smoking rates have dropped by half, but over those same three decades the country has been losing ground in the area of overweight and obesity.

“We continue to face the impact that tobacco use has on our society,” says Dr. Graham. “At the same time, we are confronted by the reality that almost half of Canadians are overweight or obese.” In fact, according to the Heart and Stroke Foundation, almost two thirds (12.1 million) of Canadian adults (ages 20 to 64) are overweight and/or smoke.

The Scope and Costs of “Fattiness” in Canada

Overweight and obese Canadians are at greater risk of developing a variety of chronic diseases that can lead to premature death. Fully 47 per cent of Canadians are now overweight, and child and youth obesity rates have accelerated in recent years, although thankfully more recent data indicates a levelling off of the portion of the population that is overweight.

The unhealthy physical outcomes of being overweight comprise a very long list, including: cardiovascular disease; heart disorders; strokes; hypertension; impaired immune response; rheumatoid arthritis; various cancers (of the Esophagus, gastric cardia, colorectal and renal cell); type-2 diabetes; gall-bladder disease; gout; impaired respiratory function; liver disease; urinary stress incontinence; pancreatitis; sleep apnea; lower-back pain; foot problems; and exceptional complications of injuries and infections following wounds.

The social and psychological impacts are also many, some devastating. They include reduced self-confidence and self-esteem; being subject to ridicule, bullying and taunts; social withdrawal and isolation; and even clinical disorders, the most common being depression.

Partially because of the length of this list of medical and socialpsychological impacts of overweight, the economic costs are enormous and already rival the impact of smoking. Societal costs include the enormous burden placed on the medicare system–the vitality of which, is already substantially strained.

One admittedly conservative approach to measuring costs to the public purse for health-care interventions is to determine the payments made through the Medicare system for obesity-related illnesses. Medical researchers at the University of British Columbia and St. Paul’s Hospital, both in Vancouver, reported in an edition of the Journal of the Canadian Medical Association that the total direct burden for Canadian taxpayers in 1997 was $1.8 billion.

Fat: Private Trouble or Public Issue?

What is being forgotten in much of the professional discourse and expression of concern by nutritionists is that, while controlling weight must and perhaps always will be a personal issue, it is, even more fundamentally, a matter of politics and economics.

The over-expansive girth of the population is very much a public- policy matter. Yet, like smoking, environmental waste, family violence and child abuse, overweight and obesity problems will, predictably, go largely unrelieved as a characteristic of contemporary Western societies–at least as long as the problem of an overweight population is almost exclusively treated as an essentially private trouble to be addressed with health counselling and healthmessage campaigns urging healthy food choices.

Like stubborn smoking habits, fatty foods and their corporate pushers must be challenged by angry and effective activists, mean lawyers and, eventually, gutsy political leaders willing to tackle irresponsible small businesses, politicians with a contempt for public solutions and, most important, callous corporations. Ultimately law suits and properly enforced legislation and policies with teeth are needed.

To date, however, Canadians are not convinced.

Canadians Weigh In on the Nature of the Solution

The big question on everyone’s mind is: Could public policies be implemented, similar to those being used to curb tobacco consumption, to address excess weight?

When the Heart and Stroke Foundation surveyed Canadians about who is responsible for finding answers to this issue, only one in six suggested that some level of government should take the lead. It is interesting that only two per cent felt the food industry should show leadership. Over half said it was a personal responsibility.

On the other hand, according to Dr. Peter Katzmarzyk, epidemiologist and Heart and Stroke Foundation spokesperson, “We live in an environment that promotes obesity, and individuals alone can’t solve this problem. According to Katzmarzyk, “The way our society is structured makes it difficult for many people to integrate healthy eating and daily physical activity into their lives. For example, in many cases urban development has reduced opportunities to integrate physical activity into daily life, such as walking to the store or informal sports.”

Contemporary Eating Habits

Human genetics, defined by thousands of years of evolution, orients our appetites to seek out and eat large quantities of fat, sugar and calories in general. The difference between most of our evolutionary history and today is that we no longer live with lengthy stretches of food scarcity. Yet food with high fat and sugar content is everywhere–and we are far more sedentary than the physical activity required in most pre-industrial modes of production. In the advanced capitalist countries, food at the retail outlet is relatively cheap, especially tasty food processed in ways that make it unhealthy. It is even cheaper for corporate food processors and wholesalers. The low prices at the farm gate are, of course, much to the chagrin of so many farmers, who forever operate on the brink of bankruptcy, and farm labourers who work long hours in both North America and offshore, often for a mere pittance.

Much of today’s commercially shaped diet is in fact developed by large corporations seeking to maximize mass consumption in the consumer market; it is thus routinely engineered with fat, sugar, colouring and flavours to exploit our biological urges. It is only a slight exaggeration to say that children have lost their appetites for real food and have replaced them with addictions to the fats, salts, spices and sugars that are used to sell food.

To date, the issue has not captured the same intensity of passion among Canada’s health advocates as it has among their American counterparts. Nor have mission-oriented journalists taken up the cudgel like their stateside colleagues. South of the 49th parallel, there has been a relatively lengthy list of serious magazine articles, television profiles and several books focusing on the subject in the past half decade. Books like Eric Schlosser’s Fast Food Nation (2001), Marion Nestle’s Food Politics (2002), Kelly Brownell’s Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis, and What We Can Do About It (2004), to name but a few, have served to raise the profile of the overweight issue in that most overweight of Western countries, the United States. Canada’s fourth and fifth estates have not shown near the same interest.

Recent U.S.-based studies indicate that those who are obese can lose more than 10 years of life compared to their normal-weight peers. Obesity and smoking is a double-barrelled threat that can cost even more years of life.

Numerous studies have identified several factors contributing to the upswing in obesity, including increased corn-sugar (fructose) use in sweetening foods, increased consumption of sport drinks and soda pop, candy and pop-vending machines in schools, and supersizing of fatty and sugar-concentrated drinks, snacks and convenience foods as contributing to obesity and overweight in children. Reduction in physical-activity programming in schools, increased sedentary time interacting with electronic games and watching videos and television, and the reduction of physical worktime expenditure in most occupations: these are all factors frequently cited as being contributors to the growth in number of people who are overweight or obese.

Possibly because people in large cities tend to walk more than those in more rural areas, rural people are more likely than urban dwellers to be overweight.

The Heart and Stroke Foundation points out that only 43 per cent of Canadians are physically active. That fact combines with the fact that the convenience of calorie-dense foods–as opposed to healthier choices like vegetables and fruit–in quick-service restaurants, convenience stores and even gas stations make it harder for Canadians to make healthy choices.

“Our obsession with speed and quick solutions is one of the reasons weight is such a problem throughout North America,” says Heart and Stroke Foundation spokesperson and dietitian Rosie Schwartz. “We want fast foods and fast solutions. But the truth is that we have to get back to basics. And, for the sake of the next generation, we have to instill these habits in our children.”

Physical Inactivity: A Problem with an Inegalitarian Profile

Nutrition and fitness intersect individual and family income levels and social class in complicated ways. But overweight conditions and obesity are now a greater risk for the poor–especially for kids. When children are provided with suitable fitness and recreation outlets, with opportunities to get fit, develop social skills and enhance their sense of self, they have better physical and emotional health, and they even perform better academically. Yet the lowest- income families, including Aboriginal children in inner cities and on reserves, experience a substantial disadvantage in their recreational participation.

In 2000, the Canadian Council on Social Development reported on the results of changes in the participation of Canada’s children in recreational activity, with measures taken in 1994 and 1996 from data secured through the National Longitudinal Survey of Children and Youth (NLSCY). The survey showed mixed results, but it clearly identified the impact of low income on recreation.

The NLSCY data indicated that, over the 1994-96 study period, overall there was a decline in children’s participation in sports and art lessons. During that period, there was little change in child participation levels in clubs or community organizations, and computer and video-game participation also remained stable. Summercamp participation actually increased. Yet poor children tended to lack access to many recreational activities that were available to the more affluent members of their age cohort.

In all types of recreational activities measured, the lowest-income children participated less frequently than did children in the highest- income families. The programs included: aquatics, athletics, arts, after-school programs and drop-in programs. Obstacles to participation by low-income children included user fees in some programs (like aquatics), unavailable transportation, inadequate parental support, social and cultural barriers, limited facilities, high equipment costs and a lack of volunteers in low-income areas.

Tipping the Scales against Corporate Fat Promoters and

Unhealthy Lifestyles

So, how to take on Big Food and its vendors, both big and little? Here’s a short list of remedies for the public sphere, which, taken together, should make a difference:

1. As the World Health Organization (WHO) recommends, overall strategies should be aimed at producing an environment that supports improved eating and physical-activity habits throughout the entire community. Special supports should be provided to those neighbourhoods and rural areas in which economic disadvantages create exceptional challenges.
2. The food supply as a whole must be modified by reducing saturated and trans fat in foods. Activists, NGOs, unions and healthcare organizations should lobby and work with elected leaders and incumbent government administration to achieve this.
3. Pressure should be applied to the federal government to put regulations in place to enforce nutritional standards.
4. Creative means must be developed to restrict the distribution and advertising of “junk foods” (energy-dense, nutrient-poor foods) to children. Inflate taxes on junk foods and beverages, at both the grocery store and restaurant, and provide tax relief for healthy foods and drinks. Remove junk foods from elementary- and high-school vending machines and cafeterias. Lobby school boards and school officials to pull pop and other sugar-laden fruit drinks out of schools. Healthy eating should also be encouraged in schools through training in practical food skills and by adopting health nutrition standards for school meals.
5. Encourage restaurants to make healthy choices at reasonable prices available in restaurants. Demonstrations in front of restaurants, wholesalers and sit-down “extended coffee” demonstrations are useful vehicles for making a point–especially if the press and media are invited to attend.
6. Make nutritional information available to parents at the point of purchase in restaurants and grocery stores, and lobby for improved nutritional labeling and information in fast-food restaurants (Note: On any given day, 30 per cent of kids living in North America visit a fast-food restaurant). Parents should have access to nutrition information on the overhead and table menus to help make informed choices at the point of purchase.
7. Physical activity should be promoted in schools. A variety of recreational activities that involve physical activity should be incorporated into school curricula.
8. Workplaces should be encouraged to promote physical activities and healthy eating by providing exercise and changing facilities and by adopting healthy nutrition standards.
9. Improving the standard of living of all sectors of society, especially within often neglected Native or minority populations, should be a priority for public-health campaigns.

Richard Thatcher is a health and social-policy consultant and freelance journalist based in Saskatchewan.

This article appeared in the May/June 2004 issue of Canadian Dimension .