Running Head: OBESITY IN CANADA

Obesity in Canada

Ashwajit Kamble

Norquest College

HEED 1000

Scholarly Paper

Reginald Nugent

May 21, 2014

OBESITY IN CANADA 2

Abstract

Obesity is a multi-factorial disorder, which is usually correlated with dispositions

such as diabetes, hypertension and other cardiovascular diseases, osteoarthritis and

certain cancers. The causes of, and contributors to; obesity are complex and multifaceted.

Our understanding of the underlying factors that contribute to obesity is often incomplete,

spread out between different studies and research findings. They include not only

individual choices (what to eat and whether to be active), but also environmental and

social determinants that shape people’s ability to make healthier choices. The

management of obesity will, therefore, require a comprehensive range of strategies

focusing on those with existing weight problems and also on those at high risk of

developing obesity. Hence, prevention of obesity during childhood should be considered

a priority as there is a risk of persistence to adulthood. This paper provides information

on the phenomenon of overweight and obesity in Canada in terms of prevalence, health

implications and economic burden. This paper also highlights various preventive aspects

and treatment procedures of obesity with special emphasis on the future of the health

issue.

.
OBESITY IN CANADA 3

Introduction

As in other parts of the developed world, obesity rates in Canada have increased

dramatically over the last few decades. Obesity is linked to a number of chronic diseases

like diabetes, coronary heart disease and hypertension. As a result, of the increase in these

chronic diseases due to obesity, the sustainability of the Canadian health care system is

significantly affected. A recent analysis estimated the total direct costs attributable to

overweight and obesity at $6.0 billion, which corresponds to 4.1% of total Canadian

health care expenditures (Anis, Zhang, Bansback, Guh, Amarsi & Birmingham, 2010).

Description of Health Issue

Statistical evidence to indicate prevalence

Over almost the past 3 decades, the prevalence of obesity, defined by a body mass

index (BMI) of 30 or higher, has alarmingly increased in many parts of the world. In

Canada, the prevalence of obesity began to increase steadily in the 1980s. According to

the 1985 Canadian Health Promotion Survey, about 6.1% of Canadian adults were found

to be obese, compared with 18.1% reported from the findings of the 2010 Canadian

Community Health Survey (CCHS) (Sassi & Devaux, 2012, Katzmarzyk & Mason, 2006,

Statistics Canada Canadian Community Health Survey, 2009–2010).

Demographics

Obesity rates for both men and women increase with age, starting at age 20 and

continuing until age 65 and then the rate declines. Men were more likely to be overweight

than women, finding that was consistent across all provinces. According to the findings
OBESITY IN CANADA 4

of CCHS (2010), an increased prevalence in obese class I was reported for men across all

provinces and women were more likely than men to be classified as obese class II and III.

There was also a higher prevalence for the overweight and obese class I categories in the

older age categories (40–59 and ≥ 60 yr) compared with the younger group. In children

boys (12.7%) were reported to be obese than girls (6.0%). Data also showed that obesity

rates are high among off reserve Aboriginal adults (24.8%), compared to the Non-

Aboriginal (16.6%) adults.

Effects on the Community

Obesity affects us by contributing to multiple elements of health and well-being.

Obesity drives economic costs that affect obese people in addition to their families and

loved ones. The monetary cost of obesity also affects society and larger economies. It

affects physically by impairing your ability to perform normal, daily, recreational

physical activities by yourself and with others. It may affect your physical health by

increasing your risk for a wide variety of chronic diseases, such as diabetes,

cardiovascular disease, hypertension, liver disease as well as breast, colon and prostrate

cancer. Obesity increases your risk of developing skin problems (impetigo and impaired

wound healing) and gynecological problems (infertility and irregular menstrual periods).

It affects you psychologically by diminishing your quality of life. It can inflict emotional

strain that contributes to comfort eating and additional weight gain. Failure to lose weight

may worsen the physiological effects of obesity by creating a negative self-image and

diminish your self-control. Other psychological effects of obesity may include

depression, shame, self-doubt and sexual problems. Obesity affects us socially by

contributing to social isolation and discrimination. The mobility impairments associated

OBESITY IN CANADA 5

with obesity may lead you to avoid public places or avoid using public facilities. You

may isolate yourself from others as a result of the emotional and physiological effects.

Social isolation may also increase your risks of mortality and morbidity. It affects the

society financially because obese people spend more on health and work related expenses

than people with normal weight. Obesity-related diseases may cause millions of lost

workdays and thus contributes to annual wage losses (Hramiak et al., 2007).

Financial burden

The analysis of the study conducted by Economic Burden of Illness in Canada,

between 2000 and 2008 showed that the annual economic burden of obesity in Canada

increased by $735 million, from $3.9 to $4.6 billion. These studies defined economic

burden of obesity as both the direct costs to the health care system (i.e., hospital care,

pharmaceuticals, physician care and institutional care) and indirect costs to productivity

(i.e., the value of economic output lost as a result of premature death and short- and long-

term disability). These studies focused on eight chronic diseases consistently associated

with obesity. In a recent analysis, the total cost of obesity has been estimated to be $4.3

billion (2005 dollars); $1.8 billion in direct healthcare costs and $2.5 billion in indirect

costs (Jannssen & Diener, 2005).

Health related risks

Coronary heart disease: The risk for coronary heart disease (CHD) increases as

the body mass index increases. A waxy substance called plaque build up inside coronary

arteries in CHD, which narrows or blocks the arteries causing angina or heart attack.
OBESITY IN CANADA 6

Obesity can also cause heart failure condition in which heart can’t pump enough blood to

meet body’s demands (Guh et al., 2009).

High blood pressure: The chance of having high blood pressure is greater if the

person is overweight or obese (Guh et al., 2009).

Stroke: Excessive build up of plaque can cause an area of plaque to rupture

causing a blood clot to form. This clot if close to your brain can block the flow of blood

and oxygen to the brain and cause a stroke. As BMI rises the risk of having a stroke

increases (Guh et al., 2009).

Type 2 Diabetes: Most people who have diabetes type 2 are overweight, and it is

one of the leading causes of early death (Guh et al., 2009).

Abnormal blood fats: Being obese or overweight increase the risk of having

high levels of triglycerides and LDL (bad) cholesterol and low levels of HDL (good)

cholesterol (Guh et al., 2009).

Cancer: Being overweight or obese increase the risk for colon, breast,

endometrial and gallbladder cancers (Guh et al., 2009).

Osteoarthritis: This is a common problem affecting knees, hips and lower back

which occurs if the protective tissue at the joint wears away. This happens to obese

people because extra weight can put more pressure and wear on joints (Guh et al., 2009).

Sleep apnea: Obese people have more fat stored around the neck which narrows

the airway, making it hard to breathe and causing sleep apnea (Guh et al., 2009).
OBESITY IN CANADA 7

Obesity Hypoventilation Syndrome: This is a breathing problem that affects

obese people which can lead to serious health problems and may even cause death (Guh

et al., 2009).

Reproductive problems: Obesity causes menstrual issues and infertility in

women (Guh et al., 2009).

Gall stones: Gallstones are mostly made up of cholesterol and people who are

obese are at high risk of having gall stones (Guh et al., 2009).

Selection & Analysis of Programs/ Services

The national and international literature review introduced various approaches to

fight obesity and address obesogenic environments. It can be classified into three main

categories (Sacks, Swinburn & Lawrence, 2009):

1. Health services and clinical interventions that target individuals;

2. Community-level interventions that directly influence individual and

group behaviours; and

3. Public policies that target broad social or environmental determinants.

Effective obesity prevention requires a multifaceted, long-term approach which

involves interventions that operate at multiple levels and in complementary ways.

Individual based Interventions

OBESITY IN CANADA 8

The recommendations to health care professionals by the 2006 Canadian clinical

practice on the management and prevention of obesity in adults and children provided

strategies for the prevention, screening and management of obesity in clinical and

community health settings. The guidelines suggested the following interventions:

 Behavior modification training or therapy, including family-oriented behavior

therapy for children (Vallis, 2007).

 Dietary interventions, such as an energy-reduced diet (Mendelson et al., 2007).

 regular physical activity in adults (Prud'homme et al., 2007)

 combined dietary and physical activity therapy (Vance, Hanning & McCargar,

2007)

 For some individuals, bariatric surgery and prescription medications (Sellers,

2007).

Brief training sessions, shared care with other health professionals and dietitian-

led programs were suggested by 2009 Cochrane Collaboration review of health

professionals’ management of overweight and obesity to further investigate and

demonstrate how the practice or organization of care could be improved (Harvey et al.,

2009). Evidence on obesity prevention in adults have shown that face to face

communications are more effective than remote communications, and even though these

approaches have demonstrated inconsistent results they have been associated with weight

loss or changes in diet and physical activity in adults. The challenge individual
OBESITY IN CANADA 9

interventions face even if they are effective in promoting weight loss is avoiding weight

regain. Various studies have suggested interventions like self monitoring, regular physical

activity and nurse counseling and support to prevent relapse. However, increased risks of

binge eating and unhealthy weight control have been associated with frequent self

monitoring (Ross, 2009).

Community based Interventions

These interventions include programs delivered in key settings, such as

workplaces and schools, as well as both targeted and universal public educational and

information campaigns delivered through print, broadcast and online media. One example

of a comprehensive campaign that targets multiple risk British Columbia’s Act Now BC

(Geneau et al., 2009) is one of the example of comprehensive campaign that targets

multiple risk factors (e.g., physical inactivity, low fruit and vegetable consumption,

smoking, overweight and obesity, and alcohol use during pregnancy). One common

community-level health promotion tool is social marketing campaigns that emphasize

physical activity, healthy eating and/or healthy weights. Canada’s ParticipACTION

(physical activity) and 5 to 10 a Day (fruit and vegetable consumption) are some

examples of social marketing campaigns that use mass media strategies. Some

evaluations, which have been published, have focused almost exclusively on measuring

campaign awareness, public attitudes and knowledge, whereas others have focused on a

specific behavior being targeted, such as physical activity within a specific target

population. The contribution that mass media campaigns can make to obesity prevention

or management, as well as the manner by which they influence behavior needs further

study to understand them more clearly (Faulkner et al., 2009). Studies conducted
OBESITY IN CANADA 10

identified a number of initiatives that were effective in influencing two of the key

behavioral factors known to affect obesity: physical activity and healthy eating. The most

promising approaches included the following (Flynn et al., 2006):

 point-of-decision prompts such as signage encouraging the use of stairs;

 school-based interventions for children and youth (e.g., increased

frequency/duration of physical education classes, additional training for teachers);

 Comprehensive worksite programs that include counseling, education,

incentives and access to supportive facilities such as locker rooms, showers and gyms;

 point-of-purchase strategies, such as menu and shelf labeling, to increase the

purchase and consumption of healthier foods;

 Workplace, school and municipal policies and environmental supports that

increase access to healthier foods and beverages (e.g., in vending machines restaurants

and cafeterias);

 Systematic nutrition reminders and training for health care providers.

Targeted programs in clinical settings, schools and work places most frequently

reported positive outcomes (Flynn et al., 2006).

Public Policies

There are several physical, social and economic factors that limit the effectiveness

of public health efforts to promote healthy weight by encouraging individuals and

families to make healthier choices. Various studies have shown that material deprivation
OBESITY IN CANADA 11

is associated with higher BMI for women, although not for men. Environmental factors

that serve as barriers to physical activity are the lack of safe and assessable spaces for

children to play and a built environment that promotes motorized transportation than

active commuting. Environmental factors can also be linked to food choices, diet quality

and obesity. Some public policy strategies that address the key influence on obesity,

physical activity and nutrition that have been discussed or implemented are as follows:

 Subsidy programs to support healthy eating (e.g., the Food Mail Program

for northern Canada the Northern Fruit and Vegetable Pilot Program in Ontario and

community-based food security initiatives);

 Land development, urban planning and transportation planning that

promote active commuting and recreational physical activity;

 Food labeling to help consumers understand the health implications of

their choices;

 Regulation of marketing to children, particularly for energy-dense,

nutrient-poor foods and beverages;

 Financial incentives to promote physical activity (e.g., the Children’s

Fitness Tax Credit and the Federal Tax Credit for Public Transit); and

 Financial disincentives, such as a tax on “unhealthy” foods and beverages.

Evidence from public health experiences suggests that an intervention if it is long

term and multifaceted in nature is more likely to be effective. It should be tackling

multiple drivers and factors simultaneously. Integrating evaluation into program

development and implementation helps to improve the responses. Ongoing evaluations

OBESITY IN CANADA 12

could support the continual realignment and enhancement of resource investments by

facilitating the emergence of new knowledge (Lemmens et al., 2008).

The Future of the Health Issue

According to an article published in CMAJ, obesity rates in Canada tripled

between 1985 and 2011, from 6% to 18%, with significant increases in the very obese

categories; it is projected that approximately 21% of Canadian adults will be obese by

2019. Obesity has an associated annual cost in Canada estimated at between C$4.6 and

C$7.1 billion. Interestingly, there has been a sharp rise in the number of extremely

overweight adults, with the highest proportion of obese adults in the Atlantic Provinces

and the lowest in wealthy and healthy British Columbia. In five provinces of

Newfoundland and Labrador, Nova Scotia, New Brunswick, Saskatchewan and Manitoba

there will be more adults who are overweight and obese than adults with a healthy weight

by 2019. By 2019, it is estimated that most (55.4%) of the Canadian adult population will

be classed as overweight (34.2%) or obese (21.2%) and the researchers estimate that the

prevalence for obese classes I, II and III will increase to 14.8%, 4.4% and 2.0%,

respectively (Twells, Gregory, Reddigan & Midodzi, 2014).

“These results raise concern at a policy level, because people in these obesity

classes are at a much higher risk of developing complex care needs,” the authors write

“In Canada, there is no country-wide coordinated effort to address the adult obesity

epidemic…without a complete synthesis of what each province is doing, it is very

difficult to know if these differences can be explained by the uptake or implementation of

federal, provincial, community-wide or local initiatives”. They cite the example of

OBESITY IN CANADA 13

provincial variations that exist in the provision of bariatric surgery, as well as the training

or lack of training of health professionals in weight management and the lack of patient

access to dieticians and psychologists. “An improved understanding of why such

substantial interprovincial variations exist is necessary, including a focus on evaluating

existing policies, programs and approaches to the prevention, management and treatment

of obesity,” the authors conclude (Twells, Gregory, Reddigan & Midodzi, 2014).

Addressing the factors that contribute to obesity early in a person’s life helps

reduce the likelihood of being overweight or obese in adolescence and adulthood. So my

recommendation to prevent this obesity epidemic is to tackle it early. Some suggestion to

defeat this epidemic is by making social and physical environments where children live,

learn and play more supportive of physical activity and healthy eating, by identifying the

risk of overweight and obesity in children and addressing it early, by looking at ways to

increase the availability and accessibility of nutritious foods and to decrease the

marketing of foods and beverages high in fat, sugar and/or sodium to children.

Conclusion

The important factors in promoting health and helping Canadians live longer,

healthier lives while preventing disease, disability and injury are healthy weights,

physical activity and healthy eating. Canada has established a strong foundation for

health promotion and chronic disease prevention over the past four decades. The task

now is to build on that foundation and continue to learn and adapt. Canada can continue

moving toward the vision of a healthy nation in which all Canadians experience the

conditions that support the attainment of good health. As an important step in reversing
OBESITY IN CANADA 14

obesity trends in Canada Federal, Provincial and Territorial governments, are committed

to working collaboratively to curb obesity and promote healthy weights in Canadians.

Governments will continue to learn through the implementation of successful initiatives

across the country, and to share their expertise in order to expand and build on what

works. Everyone has a role to play in reducing the risk of disease, disability and injury, in

promoting health, and in helping children and youth have the healthiest possible start in

life. Collaboration is the key - effectively addressing obesity and supporting healthy

weights calls for a sustained, cross-governmental and multi-sectoral, multi-faceted

response at all levels.

OBESITY IN CANADA 15

References

Advanced Techniques Help Dieters Reach Weight Goals ... (n.d.). Retrieved from

http://www.losingweightsfast.com/advanced-techniques-help-dieters-reach-

weight-goals/

Anis, A.H., Zhang, W., Bansback, N., Guh, D.P., Amarsi, Z., Birmingham, C.L. (2010).

Obesity and overweight in Canada: an updated cost-of-illness study. Obesity

Reviews, 11(1):31-40.

Curbing Childhood Obesity: A Federal, Provincial and ... (n.d.). Retrieved from

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/framework-cadre/2011/hw-os-2011-

eng.php

Current and predicted prevalence of obesity in Canada: a ... (n.d.). Retrieved from

http://cmajopen.ca/content/2/1/E18.full

Cost Of Obesity Gpi Atlantic | Download Pdf Ebook. (n.d.). Retrieved from

http://downloadpdfebook.herokuapp.com/tag/cost-of-obesity-gpi-atlantic

2006 Canadian clinical practice guidelines on the management and prevention of obesity

in adults and children (2007).Canadian Medical Association Journal 176(8): 1–

117.

Faulkner, G et al. (2009). ParticipACTION: Baseline Assessment of the Capacity

Available to the 'New ParticipACTION': A Qualitative Study of Canadian

OBESITY IN CANADA 16

Organizations," International Journal of Behavioral Nutrition and Physical

Activity 6: 87.

Flynn, M.A. et al. (2006). Reducing Obesity and Related Chronic Disease Risk in

Children and Youth: A Synthesis of Evidence with 'Best Practice'

Recommendations,Obesity Reviews 7: 7-66.

Geneau, R. et al. (2009). Mobilizing Inter-sectoral Action to Promote Health: The Case of

Act Now BC in British Columbia, Canada, Public Health Agency of Canada.

Guh, D. et al., (2009). "The Incidence of Co-Morbidities Related to Obesity and

Overweight: A Systematic Review and Meta-Analysis," Public Health 9, 88.

Harvey, E et al. (2009). Improving Health Professionals' Management and the

Organization of Care for Overweight and Obese People, Cochrane Database of

Systematic Reviews No. CD000984.

How Is Obesity Affecting Us Today? | LIVESTRONG.COM. (n.d.). Retrieved from

http://www.livestrong.com/article/347708-how-is-obesity-affecting-us-today/

Hramiak, I. et al. (2007). Assessment of obesity and its complications in adults,

Canadian Medical Association Journal; 176(8): 36-49.

Janssen, I., Diener, A. (2005). Economic Burden of Obesity in Canada in 2005

Katzmarzyk, P.T., Mason, C. (2006). Prevalence of class I, II and III obesity in Canada,

Canadian Medical Association Journal; 174:156-7.

OBESITY IN CANADA 17

Lemmens, V. E. P. P. et al. (2008). A Systematic Review of the Evidence Regarding

Efficacy of Obesity Prevention Interventions among Adults, Obesity Reviews 9:

446-455.

Mendelson, R. et al. (2007). Dietary Interventions for the Treatment of Obesity in Adults,

Canadian Medical Association Journal 176(8):57-59.

New Food Collaborative in Ontario - News : Reel Food. (n.d.). Retrieved from

http://reelfood.org/news/

Obesity: An overview on its current perspectives and ... (n.d.). Retrieved from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC421736/

Obesity in Canada: snapshot - Public Health Agency of Canada. (n.d.). Retrieved from

http://www.phac-aspc.gc.ca/publicat/2009/oc/index-eng.php

Obesity in Canada - Healthy Living - Public Health Agency of ... (n.d.). Retrieved from

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/econo-eng.php

Obesity rates in Canada have tripled in less than 3 decades ... (n.d.). Retrieved from

http://www.xndo.com/article/48048-obesity-rates-in-canada-have-tripled-in-less-

than-3-decades

One in five Canadians will be obese by 2019 | Bariatric News. (n.d.). Retrieved from

http://www.bariatricnews.net/?q=news/111385/one-five-canadians-will-be-obese-

2019
OBESITY IN CANADA 18

Prud'homme, D. et al. (2007). Physical Activity and Exercise Therapy – Adults,

Canadian Medical Association Journal 176 (8): 64-66.

Public Health Agency of Canada (2000). Economic Burden of Illness in Canada, Ottawa,

2009 (in press).

Ross, R. (2009). The Challenge of Obesity Treatment: Avoiding Weight Regain,

Canadian Medical Association Journal 180: 997-998.

Sassi, F., Devaux, M. (2012). OECD obesity update 2012. Paris: Organisation for

Economic Co-operation and Development. Available:

www.oecd.org/health/49716427.pdf.

Sacks, G., Swinburn, B. & Lawrence, M. (2009). "Obesity Policy Action Framework and

Analysis Grids for a Comprehensive Policy Approach to Reducing Obesity,"

Obesity Reviews 10: 76-86.

Sellers, E. (2007). Pharmacotherapy and Bariatric Surgery for the Treatment of Obesity

in Children and Adolescents, Canadian Medical Association Journal 176 (8): 89-

91.

Statistics Canada Canadian Community Health Survey, Share File 2009–2010.

Trakia Journal of Sciences, Vol. 6, No. 4, pp 22-28, 2008 ... (n.d.). Retrieved from

http://tru.uni-sz.bg/tsj/TJS-Vol.6%20N4%202008/shishkova%20redacted.pdf
OBESITY IN CANADA 19

Twells, L. K., Gregory, D. M., Reddigan, J., & Midodzi, W. K. (2014). Current and

predicted prevalence of obesity in Canada: a trend analysis. Retrieved May 20,

2014, from http://cmajopen.ca/content/2/1/E18.full

Vallis, M. (2007). Behavoiur Therapy. Canadian Medical Association Journal, 176(8):

54-56.

Vance,V., Hanning, R. M., & McCargar, L. (2007). Combined Diet and Exercise Therapy

for the Treatment of Obesity in Adults, Canadian Medical Association Journal

176, 60-64.

Weight management experiences of overweight and obese ... (n.d.). Retrieved from

http://www.phac-aspc.gc.ca/publicat/cdic-mcbc/32-2/ar-01-eng.php

What Are the Health Risks of Overweight and Obesity? - NHLBI, NIH. (n.d.). Retrieved

from http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks.html