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Food Guide, to Where?

October 4, 2012

Cute, right? No. Terrifying. Terrifying to guess at what single-digit age this child will develop diabetes; at what age they will apply for disability social assistance due to the pain in their knees; when their mood will reach the point where they feel too defeated to go outside.

Do you know where your food comes from? Many people are making an effort to buy organic, look for farm-direct or local options, and educate their families about healthy choices and food origins.

And do you know what to eat? A fad-diet gurus’ best selling book, that lady at work who keeps telling you she lost 10 lbs (that same 10lbs she loses and gains again each week), and some talk show MD are frequent sources of dietary info. Surely there is a more credible place to go. Our doctors only get a few hours of nutrition in the med school curriculum. Your friendly, free local nutritionist doesn’t exist. And our government? They are concerned! They have task forces to discuss and statistics to show that the epidemic of obesity is real and it’s bad. It’s really bad. We know it.

‘Fat’ people know they are fat. Their doctors and kids are starting to nag them. None of us make the choice to maximize our waistline. Only the exception enjoys being overweight and accepts the negative health outcomes and social stigma that comes with it. If you don’t, what are you to do?

The provincial government tell us to exercise. The Feds revised the food guide, bringing it up to date and making it more culturally inclusive. But does it tell us we are fat? No. Does it tell us to eat less? Not really. Obesity experts argue that following it will only make us fatter. What?!

The new food guide continues to incorporate industry pressure and the inertia of tradition into what is potentially the only ‘reliable’ source of nutrition information that makes it into the homes of Canadians. This fabulous CBC article shares the history of the guide and how it has been developed over time. With roots in an era of malnourishment, it would be easy to understand why the current edition is so dramatically different. However, it isn’t.

Screenshot of one page of the digitally-available current Food Guide

Portions are confusing and probably too numerous in the grains and meats department. Unhealthy choices are not clearly and prominently condemned. I struggle to not wonder if the current guide is a recipe for failure, rather than a beacon for healthy change. If you read the article, you might be outraged at learning that the committee, bowing to industry pressure, downgraded their recommendations against unhealthy foods in a previous iteration. That bias persists.

The old magic rainbow Canada’s Food Guide.

Growing up, the iconic rainbow of food utopia hung on our fridge and said to me: “no one’s perfect, but if we were, we’d eat like this.” Was I wrong? It’s the same idea as any physician guideline that the provinces release, like the one I follow for the management of hypertensive patients in my care. I’m not perfect and many aspects of the guideline don’t incorporate the unique aspects of the patient, like the allergies or side effects they may experience from the suggested medications. However, together, we stick as close as we can to the guide to ensure evidence-informed decisions tailored to the needs of the patient, namely not wanting a heart attack or stroke to rip into their life. The guideline wasn’t influenced by drug companies and it doesn’t have a rainbow or pretty pictures. It is the inspiration to strive to do the best we can versus the crappy problem of elevated blood pressure.

A snapshot from part of the British Columbia Hypertension – Detection, Diagnosis and Management Guidelines

Obviously Canada’s Food Guide has plenty of merits. It might be a good first step in getting a person interested in what they eat, and it might enable another to start changing how they choose or what portions they intake. I remain leery. My profound displeasure at hearing about the evolution of Canada’s Food Guide triggered my desire to share the concern and reject the validity of this ‘modern’ tool.  Sadly, it wasn’t the first time encountering an obviously – excuse my Bill and Tedness – bogus justification for weakening the food guide.

In Nunavut, a territorial food guide which incorporates traditional aspects of the Inuit diet has been around for years. In 2011 it was revised to be more simple and to better reflect the varying degrees with which people blend store-bought and “country food” components to create their diets. We were asked to read over the new guide and were given opportunities to question the nutritionist who visited our health centre to help us adopt this new guide. It looks nice, it’s simple enough to be practical and a good teaching tool, and it emphasizes the healthful aspects of a traditional diet. Unfortunately, it is egregiously ineffectual at highlighting the harms of processed foods; these get a little section on the last page that uses no indication of harm other than the word “Unhealthy.” In my mind this is insufficient acknowledgement of the tendency of many to, for example, drink upwards of 6 cans of pop daily [*This is my anecdote, which I expect most HCPs in Nunavut would corroborate. The studies haven't been done; one study from 20 years ago shows that Alaskan Inuit youth drank 4x the North American average of pop.]

Back and front of Nunavut’s Food Guide

Although it was only my first or second time in Nunavut, my naivete was not sufficient to suppress my outrage at certain details. The most telling? The fact that they had incorporated “Pilot biscuits” – nothing but flour, lard, and sugar in cookie form – in the wheat & grains section of their guide. “Why?,” we asked. “Well the Inuit on the committee indicate that has been a staple in their diet for decades. We suggested it be removed but they told us that doing so would ensure alienation of most Inuit. We had to leave the cookies in.”

Eye rolls. Guffaws. Anger. Distrust. We in the room are mostly not Inuit. I am hardly an expert regarding Inuit or aboriginal people. Admittedly, being politically correct matters less to me than facilitating others to be healthy and informed. Some might say it is culturally insensitive to not accommodate the Inuk request. However, it seems even more insensitive to create double standards for health and, even in the subtlest way, to deny anyone the best opportunity for health by providing them with half-measures. Even though the guide a good start when you’ve got nothing else, it pains me to recommend it because I am not confident in the process that created it.

The bottom line is this: Just as in guidelines against hypertension, we don’t write:

be sure to add lots of salt to your food, because we know you like it and will do so anyway,

we shouldn’t promote unhealthy foods or directives in our healthy food guide. If people chose to eat them, no problem, that’s their choice, but we all deserve the guidance of a perfect rainbow food guide.

——

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5 Comments leave one →
  1. October 4, 2012 10:46 am

    Right on!!!!
    I share your outrage about the nutritional state of the Inuit.When nearly half of the children arrive in school without any breakfast the last few days before the next welfare cheque , because there was no food in the house, since the money was spent on smoking and gambling. If there was money to buy food it is mainly junk. It is cheaper and the Inuit palates have been conditioned to like that crap. Shame on the government failing to provide better information and failure to do a bit of “social engineering” in subsidizing healthy foods and taxing the crap that makes people unhealthy and sick.
    In the early 80’s there was hardly any diabetes among the Inuit. Now it is even present in the very young. We,” white society” first gave them alcohol and STD’s and tuberculosis, TV bingo etc among other “useful” gifts and now we continue on that pattern of willfully destroying a culture of self reliance and amazing survival technology.
    I am not advocating a return to the nomadic life of hunting and fishing, living in igloos or tents, but with hard unbiased science and technology we can do a whole lot better.

    Marco Terwiel

    • October 4, 2012 5:01 pm

      Hi Marco –

      I am drafting something on Food (In)security, but I keep going back to the drawing board. I feel like the problem is bigger than high prices. I know there are northern subsidies and huge deductions/tax allowances that are meant to help with the high cost of living; I’m having a hard time concluding as to how far these should stretch and how much of the lack of access to fresh food is secondary to loss of means by spending on alcohol/junk food/cigarettes/marijuana/bingo instead.

      It’s shaping up to be a pretty heated issue and I, like you, am seeing social intervention as the only option for change. Is this the responsibility of the Federal Goverment? The GN? Or is it up to Nunavummiut to ask for help or create change?

      I’m also wondering where the data is. For example, how come no one is surveying pop intake in northern households? Should I be doing this? Can getting a better sense of the problem help to solve it?

  2. October 4, 2012 4:08 pm

    Thanks for a sensible critique Jess — But I have to say, I really don’t think that the Canadian, or the Nunavut, food guide have *anything* to do with the obesity epidemic — there are numerous other evils to fight before we can confidently remove those food guide diagrams from our high school cafeteria walls and home fridges in my opinion. First of all — that picture you show, in which half one’s plate is filled with vegetables, is just plain impracticable if you take into account the cost of (fresh) fruits and vegetables up North and the average family income in the communities — and we could very easily extend that argument to fresh and bio veggies here in the south too. The cheaper options, as we both are aware, are almost always the unhealthy ones. Also impracticable are the stores themselves — have you ever walked into a WaltMart SuperStore? They’re horrifying!! SP and I couldn’t find an other grocery store on our way back to QC when we drove through the northern US, and I had to look for a good 15 minutes in the “rice” alley to find plain white rice — forget brown. Three quarters of their monstrously huge rice alley was filled with salty and sugary “cook-in-5-minutes” seasoned rice boxes (and the white rice was hidden at foot level). I’m not sure what the stores are like in Nunavut, but my guess is that it doesn’t look anything like a farmer’s market.

    I really think that those guides try to be user-friendly, and practicable for their targeted audiences. It is not the people who decide to switch from a bio diet to a raw bio diet that those guides are concerned with; it is precisely to those who drink 6+ cans of pop that they engage with. And in this sense, if a cookie is what it takes to help convince somebody to improve his/her diet, a cookie it is! I’m no doctor and no nutritionist, so please correct me if I’m wrong, but if we could all only remember the two basic rules that those diagrams try to print in our minds with their bright colors and simplistic designs — Fill up (more than) half your plate with veggies, (less than) a quarter with meat and (less than) a quarter with grains; and Exercise half an hour a day — there wouldn’t be an obesity epidemic: pilot cookies or not, food guides targeted to a specific community or not. In this sense, there’s really NOTHING disturbing to me in a food guide that allows its audience to eat something sweet or salty or even processed once in a while, since at this moment in time only a sad minority of North American families actually serve dinner plates that are half filled with veggies, and exercise at all. In most cases anyways, once somebody reaches those health standards for themselves, she/he will continue to make improvements to their health along a wide range of “lifestyle” decisions (in its broadest definition), which, as you also know from working up North, can often be far removed from what one eats… And if I’m being too idealistic here (I’m hearing SP in my head..), maybe we can agree to take off the food guide diagrams from our fridges and high school cafeteria walls (along with the pilot cookies, FINE,) once every single North American family serves dinner plates that are half-filled with vegetables — which has to start with giving us the financial means AND critical tools to do so.

    Finally (I’m almost done, sorry), let’s not be naive: There ARE double standards –institutionalized double standards even– for health, but also for education and housing between southern and northern communities in Canada. I do not think we can ask a 6 year-old to play the Sibelius violin concerto; all the same, we can’t ask a morbidly obese teenager to run a marathon; there are “double standards” here too which we have to take into consideration. But with bright colors and simple/clear/graphic short-term goals, maybe some of us can help some others take their first step towards that ideal.

    Hope all is well, we miss you,
    We’ll be in Yellowknife in March for the Caribou festival!! All (three!) of us. :)
    V, SP & our 30-week frog, xx.

    P.S. One of the best articles I’ve read lately about the obesity epidemic: http://www.theatlantic.com/magazine/archive/2012/06/the-perfected-self/308970/2/

    • October 4, 2012 4:53 pm

      Thanks for the considered reply, V.

      I agree with a lot of what you say. The idea of portioning and changing the ratios of the food groups we select is a really strong way to improve our health. However, in the video attached to the CBC article, you could see how challenging it was for a family to even figure out what a portion was. It must have been an immense challenge to make the guide as clear and simple as it is, and unfortunately it’s still a challenge to interpret.

      I don’t think the food guide is the root cause of obesity, but I think it COULD be part of the solution – and it isn’t, yet. Food insecurity in the North is an enormous issue and I tried to leave it out of this post as I’ll write about it separately. Of course, it is not a separate issue and what good are guidelines if people don’t even have access to the items that are recommended, or education in critical-thinking and health-literacy? We have to make other healthy lifestyle choices easy, and that’s a very difficult thing to do!

      Nunavut has had some success with small-scale programs. I’ve seen tiny initiatives – like a bulletin board in the health centre in a community of less than 500 – obviously affect people. Discussing diet with one woman, she told me “I stopped drinking pop. I saw that poster, and that ziploc bag that shows all the sugar that is in Coke, and I stopped. I nag my grandkids but they keep drinking it. I don’t know what to do…” These posters and pamphlets and TV ads will help some people begin the change they need to.

      You’re right – the pilot cookies are not a huge problem in and of themselves. We all eat treats once in a while. For me, I saw the pilot biscuit inclusion as a representation of the corruption or weakening of the guide. I just can’t accept that we water down the message in the interests of industry or cultural sensitivity.

      Perhaps I’ve focused too much on the negative. The Food Guide _is_ a starting place, but I think we can make it better.

      (I’ve saved the article and will read it on the plane tomorrow, thanks! And glad to hear that you’ll make it to the NWT again, I’m sure it will be a great time of year.)

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