This is a true story. Meet Ricky (not his real name), he’s 11 years old and weighs 236 pounds. He has two older sisters, Yvonne and Sandra (not their real names), 16 and 17 years of age respectively. Yvonne weighs 225 pounds and Sandra 218 pounds. Their mother, who is also overweight, concerned about her children, sought out Troy, a personal trainer I know well, to work with her children to help them lose weight and get in shape.
Within a few weeks of working with the children, Troy quickly found out some of the obstacles they would have to overcome to achieve their goals. Every Wednesday is “pizza day” at Ricky’s school; Ricky looks forward to “pizza day” and routinely eats 12 slices of pizza himself each and every Wednesday. At home, Ricky typically eats what he wants, when he wants and the majority of times Ricky selects the least healthy options available to him in the fridge and cupboards.
Troy decided to visit Ricky’s school on their track and field day and based on Troy’s observation “about 40-50 per cent of the kids were overweight and out of shape”.
This real-life family scenario supports the data surrounding childhood obesity. Today, over 50 per cent of Ontario adults and 25 per cent of children are overweight. Childhood obesity has more than doubled in the last 25 years. Today, many more youth under 18 present more than one risk factor for heart disease and stroke: they have high blood pressure, high cholesterol and some are being diagnosed with diabetes. Essentially you have children developing and living with what used to be considered adult or even old age diseases. This is bad news for the young person whose quality and length of life will be severely affected if they are not able to reverse the process.
A few weeks ago I was invited by Elvenia Gray-Sandiford, founder of TransformNation, to participate in its second annual Symposium on Conquering Childhood Obesity at the University of Toronto in Mississauga with partners Big Brothers, Big Sisters of Peel, East Mississauga Community Health Centre and the Social Planning Council of Peel. TransformNation is a non-profit community organization that provides after-school nutrition and physical activity programs in the Mississauga area along with a summer camp through partnerships with local grocers, parks and recreation and individual schools. The children in the various programs learn how to prepare simple nutritious meals and are encouraged to participate in a wide range of physical activity games and sports. All programs, including the week-long summer camps, were free to participants.
Last year, TransformNation, with the support of former MPP, Peter Fonseca, submitted Bill 170 to establish April as Childhood Obesity Awareness Month. The Bill passed the first of three required readings.
I was impressed with a number of the symposium presentations including The Geography of Food presentation by secondary school teacher, Kingsley G. Hurlington and the students of Bur Oak Secondary School in Markham. The Geography of Food is a course Hurlington developed and delivers to his Grade 10 students which teaches them how to think about food from the field to the table. Students take a close look at food marketing and advertising practices, food manufacturing and processing, learning how to create a local food system that includes backyard gardens, and the benefits of local foods. One of the students who made the presentations commented: “Everything is not what it seems in the food industry…a lot is put into the marketing and appearance of the food…and you can eat really healthy at home”. Another said that “if you can’t pronounce it (items on the ingredients list), don’t eat it”.
Hurlington presented The Geography of Food course to the Ministry of Education last year for consideration of implementation into the Ontario curriculum.
Another program, the Mississauga Fruit Tree Community Organization, helps members in the community to access and share surplus fruits by harvesting fruit from local backyard fruit trees and dividing the bounty between homeowners, volunteers and food banks. The program allows fresh, organic fruit to be diverted from becoming food waste to become a source of accessible and affordable food – particularly to low-income groups, families or children through community partners such as food banks, churches, schools and social service agencies.
All of the programs described are elements of an active solution to not only childhood obesity but for the development of healthier populations, communities and marketplaces.
Last September, the Ontario Liberals implemented a new province-wide policy to ensure schools only provided healthy and nutritious foods. That means no more high-sugar soft drinks, chips, deep-fried potatoes, greasy burgers and the like. Not all students welcomed the long overdue step in the right direction. In fact, one symposium member commented that many students simply converge onto the nearby community centre and form a line in front of the vending machine to get their sugary snacks and pop.
Hurlington told city councillor, Chris Fonseca, honorary chair of the symposium, that “there seems to be a disconnect between the schools and the city…it appears the city is making profit off the students at lunch time”, which raised the point that similar policies and legislation need to be in the marketplace so that access to unhealthy foods is increasingly difficult everywhere. Fonseca agreed that “all levels of government, federal, provincial, regional and municipal, need to communicate better” to ensure we are all on the same page and working together.
Interestingly, Ontario NDP health critic, France Gelinas, recently introduced a private member’s bill that if passed would compel the larger chain restaurants (with five or more stores) to post calorie counts beside their menu items. Last year the Ontario Medical Association made the same recommendation leading up to the provincial election. In addition to the calorie content, there is growing concern and evidence about the high sodium content in the Canadian diet and its contribution to escalating hypertension rates. The recommended sodium intake for an adult is 1500 milligrams daily, however, the average adult in Ontario consumes twice that amount. Clearly, marketplace legislation is needed that would require food manufacturers, retailers and restaurants to produce and sell Ontarians food items that are health-promoting perhaps with a simple labelling system (red light, yellow light, green light) so that any consumer can understand to make healthier choices.
Ontario Minister of Health and Long-Term Care, Deborah Matthews, has shown interest in some of these ideas and recently announced the formation of an Ontario Healthy Kids Panel that will provide her with recommendations to meet the government’s target of reducing childhood obesity by 20 per cent over five years.
In addition to the recent establishment of the Ontario Healthy Kids Panel, in the fall of 2010 federal, provincial and territorial health ministers and/or Health Promotion/Healthy Living endorsed Curbing Childhood Obesity: A Federal, Provincial, and Territorial Framework for Action to Promote Healthy Weights. The emerging report, Our Health Our Future – A National Dialogue on Healthy Weights, which was released in September 2011, made a number of recommendations to address healthy growth and development through legislation, education and research. It called for stronger government regulations and policies to increase the availability and accessibility of nutritious foods such as community kitchens and gardens, farmer’s markets, support for local food production and food security and taxing unhealthy food items. It also called for government restrictions on marketing and advertising of unhealthy foods to children. In the area of education, recommendations were made to institutionalize physical activity, food preparation and nutrition literacy in the schools, better education for health and child care workers to identify and address childhood obesity through their work, and increase access to dieticians and nutritionists. Recognizing that parents and the home provide the first opportunity for children to create the social, physical and cultural attitudes and practices concerning food attention is also placed on maternal and baby health education. In terms of research, the report suggested further research was needed to better access health needs and risk factors and to improve our monitoring tools.
One of my concerns with all the excellent recommendations that have been put forward by these various initiatives and reports is that whether we are trying to eradicate childhood obesity, diabetes, cancer, heart disease or mental health, we must connect, bind and marry the best elements of existing chronic disease strategies to the best elements of a poverty reduction strategy that seeks equity and dignity for everyone because it is well known (generally speaking) that the richer you are, the healthier you are. If we truly want to raise the bar for everyone, we must consider the social determinants of health and apply progressive policies in the area of employment equity, housing, the cost and funding for post-secondary education, minimum wage and so forth.
Returning to Ricky and his sisters, a year later Ricky has lost over 50 pounds and his sisters have done well too. However, in the United States physicians are now considering screening for high blood pressure among six years olds! We have a lot of work to do.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or firstname.lastname@example.org