In recent years, considerable media coverage has focused on the rising rates of obesity in Canada for both children and adults.
Here in New Brunswick, we are, regrettably, among the leaders in the country. While the numbers vary between surveys, recent indicators reveal 63 per cent of adult New Brunswickers and up to 36 per cent of New Brunswick children to be overweight or obese. At the most extreme classifications of obesity, New Brunswick adults have the highest rates in all of Canada.
According to the World Health Organization and Health Canada, health risk levels increase with higher rates of overweight and obesity. To most accurately determine health risks for individuals, other factors including lifestyle habits, fitness, Body Mass Index and other health conditions must be taken into consideration.
Obesity comes with personal, health and economic costs for individuals and societies, and here in New Brunswick we are heavier, more sedentary, smoke and drink more and eat fewer vegetables than most other Canadians.
Healthy individuals are better able to live happy, fulfilling and self-sufficient lives, and healthy communities are not overburdened with unaffordable and unsustainable health-care costs.
Overweight and obese individuals live with increased risks of associated health challenges, which include risks of heart disease and stroke, hyptertension, Type 2 Diabetes, various cancers, sleep disorders, back and joint pain, depression, complications in pregnancy and delivery and a shorter life span.
A compromised quality of life including issues related to education, relationships, and actual and potential income are also attributable to overweight and obesity. Obese individuals cost the health care system approximately 30 per cent more over their lifetimes and physical inactivity has an economic burden of its own.
For the province of New Brunswick, what is of great concern is the increased economic burden of caring for an aging population with high rates of obesity and related disease and the indirect costs related to loss of productivity and premature death.
Unless prevention, management, and treatment of obesity are addressed aggressively, directly and comprehensively by both the New Brunswick government and also at the federal level, these rates of overweight and obesity will continue to rise, along with their burdens on individuals and taxpayers.
Aren't we already dealing with this problem?
Such complexity seems to have resulted in a wide number of disconnected initiatives without adequate evaluation of success factors. What is working, and what isn’t working? While levels of childhood obesity appear to have levelled off over the last few years, rates for adults continue to climb. Unfortunately, many of those overweight children become overweight adults, and many overweight adults in turn become obese.
In order to understand this phenomenon, we need further research in this area. Given that the eastern provinces of Canada have higher rates of not only obesity but also chronic disease, we need to better understand geographical variation so that we can better deal this epidemic of obesity. We need model programs, such as the LEAP! initiative (Learning, Eating, Activity Programme) we had in the Faculty of Kinesiology at the University of New Brunswick.
However, in the meantime, what can be done now to prevent further obesity, and to help those currently living with obesity manage their condition? And why should anything be done at all?
If the problem is so complex, how is it possible to figure out where to begin? If no one strategy works for everyone, then how can everyone be helped? Who should be responsible for changing the obesity trajectory in New Brunswick?
The direct costs of obesity to the health care system are staggering, and with rates unlikely to subside, we are in a state of crisis. As hard as it may be to believe, things will get worse if we do not take action!
1. Leadership and political accountability
Establish a provincial government mandate, an accountability framework and a clear responsible centre (a minister) with resources to drive a mandate for change.
'We cannot afford to continue to treat symptoms and we cannot afford the “ silos” and disconnects of government.' - Gabriela Tymowski
Presently, the majority of government resources (dollars and staffing) are dedicated to addressing the problems “after the fact” and most of these are simply addressing the symptoms caused by overweight and obesity.
Dollars and resources must be moved to preventative interventions where the impact will have a much more lasting affect and greater return on our taxpayer dollar.
Additionally, the existing government programs and services to address the issues of overweight and obese New Brunswickers are spread rather vaguely across several government departments, namely the Department of Health with all its divisions and branches, the awkwardly named and mandated Department of Healthy and Inclusive Communities, the Department of Social Development and various others.
There needs to be specific and direct accountability for dealing with obesity and this needs to be centralized within one department which is well and sustainably resourced. We cannot afford to continue to treat symptoms and we cannot afford the “ silos” and disconnects of government.
2. More specific government action
The provincial government should address the economic and political components of our modern environment, which is engineered to promote obesity and the nature of the disease vectors (high energy foods and physical inactivity).
It needs to improve school lunch programs. Call upon a game-changer, such as Britain’s Jamie Oliver, who overhauled the way we think of school lunches and what is served to children. He met then-British prime minister Tony Blair and made the case that obesity was an epidemic and had to be a top priority.
This led to the government initiative, “the School Food Trust,” with its motto, “Eat better. Do better.” Oliver created a food revolution, and New Brunswick needs change of this scale. While we do have some school initiatives at present they are in fact falling short; guidelines have no teeth. We need policies that are supported and enforced.
Another consideration is the establishment of a government-wide directive to all government departments on the purchase of healthier food to serve at their own internal functions and public events. For example, why is the default not local, seasonal plant-based offerings, particularly fresh vegetables and fruit?
Critics may argue that some people don’t like those foods, or costs might increase. Any additional costs might be ameliorated by the boost to the local economy and certainly by not contributing further to the existing problem. Perhaps a little paternalism from the government is necessary, especially when they’re using tax dollars.
3. Getting New Brunswickers to move more
Choose one starting point for everyone to rally behind and physical activity is ideal. Even modest increases in activity could result in substantial cost savings.
Canadian researchers at Queens University in 2005 suggested a 10 per cent reduction in physical inactivity has the potential to reduce direct health care expenditures by $150 million a year, even more in today’s dollars. Additionally, given that people who begin exercising are often motivated to improve their eating habits, we could see some positive changes in lifestyle habits in our province.
Virtually every single one of us has the capacity to move more today. Move towards standing rather than sitting, walking rather than standing, walking outside, walking faster outside, for those who are able: run, bike, ski, skate.
We live in one of the most beautiful and safe provinces in Canada. Exercise is medicine and it’s the most efficient and cost-effective method available. See Australia’s excellent initiative on exercising with chronic diseases and prevention through exercise.
4. Stop the 'We need more hospitals, we need more doctors' rhetoric
Our health-care system must move towards prevention, an upstream approach. A number of physicians in New Brunswick are now equipped with prescription pads for exercise, an excellent initiative by the New Brunswick Medical Association.
To support physicians and their patients, the government should expedite the training, education and hiring of accredited exercise professionals such as kinesiologists in the province. Provide access for all to these professionals, in the same way that many health plans include coverage for physiotherapists, occupational therapists and massage therapists.
Require that all health centres and hospitals in the province hire these accredited exercise professionals as part of their health teams, and make them accessible to all. We train these professionals here in the province: hire them.
The evidence is indisputable that exercise is a panacea for a wide range of ill health. Prevent obesity and manage those already overweight and obese with exercise. Manage the associated diseases such as Type 2 Diabetes and heart disease with exercise, not expensive pharmaceuticals and physician visits.
No, it’s not easy. But it’s what we need to do. Australia has a head start on this approach.
5. Use carrots and sticks in the tax system
Support people in their efforts. Offer tax incentives for the purchase of bicycles, in-line skates, fitness club memberships, dance and exercise classes, exercise equipment, encourage active transportation, and so on. Ensure that all citizens benefit, not only those in higher tax brackets. This approach needs to be evaluated carefully to ensure the costs of such programs are well spent dollars.
In the opposite direction, consider taxing sugar-sweetened beverages which contribute empty calories. Sugar, high-fructose corn syrup and other caloric sweeteners are a significant contributor to the obesity epidemic.
To support children’s rights to live, learn and play in environments that support and promote health, New Brunswick government could follow Quebec’s lead and prohibit all advertising directed at children younger than 13, and further prohibit the placement of junk food products in media consumed by children and prohibit junk food and advertisement of junk foods in schools, sports facilities and play areas.
6. Public infrastructure: If you build it, they will use it
Always include the interests of pedestrians and cyclists in all building and renovations. Ensure bike lanes and sidewalks are available and safe. Separate bike lanes from vehicular traffic to help cyclists feel and be safer, which may lead to increased use.
Require that new public buildings, office buildings, etc. have shower facilities and safe places to store bicycles so that people may commute easily to work, and exercise during their work days.
Make the stairways in every public building easily accessible and pleasant to use. Often they are hidden away from the main entrances, overly narrow or inconvenient. While we do not have any data, it appears that paving the trails in Fredericton has lead to increased use by people of all ages, and the recent installation of adult playgrounds allow the trails may also lead to improved fitness.
7. Personal responsibility.
Each of us needs to take personal responsibility for managing our own well being to ensure we are as healthy as possible. Doing so will reduce our dependency on an overburdened social and health-care system, result in significant savings to taxpayers and more importantly, improve our quality of life.
Research has shown that many of us do not recognize the implications of overweight and obesity in ourselves or in our children, and even if we do, many do not consider it to be the serious health problem that it is. It is becoming more difficult to do so when so many children and adults around us are also overweight, and sadly, this includes our most influential leaders, such as teachers, health professions, and politicians.
Let’s make better choices, and daily physical activity and healthy eating choices must be a priority. We need preventative measures to avoid many of the illnesses and debilitating conditions brought on by imprudent lifestyle choices.
The government has a leadership role in regulations, policies and legislation that should ensure safe consumable goods but ultimately, we can make better choices: the first one is to move, and the second is to move more, and finally we can eat healthier foods.
The tipping point for New Brunswick’s self sufficiency is in a new healthy direction that needs to start today with each of us making a personal commitment to healthy lifestyles and healthy choices on a daily basis. This is not always easy, but necessary, given the overall health profile and fiscal realities facing New Brunswick taxpayers.