Obesity in Canada: Let’s Stop Pretending
There is a concerning epidemic of expanding waistbands, overconsumption, and decreased activity happening around us that we are seemingly aware of but each day the problem is getting worse. This problem has a name, obesity, and though we try to tackle the issue, as dietitians and Health Canada work furiously to try to educate the public, the statistics demonstrate that these efforts are ineffective. According to Heart and Stroke Foundation of Canada (HSFC, 2007), nearly one quarter of Canadian adults, or 5.5 million people, are obese. Obesity has very direct implications for health and quality of life, and yet, though we talk about the obesity problem, as a society, we are prevented from addressing it directly because our focus on physical appearance makes us afraid of damaging fragile self-esteems, bruising body image, and influencing people to become depressed or perhaps anorexic. We need to stop pretending that obesity is solely a body image issue, as this prevents us from treating it for what it is – a health concern. We simply cannot ignore the impact obesity has for the health of Canadians.
Statistics available from the Public Health Agency of Canada (PHAC, 2011) compiling results from the 2007-2009 Canadian Health Measures Survey show that 44.1% of males and 29.5% of females are overweight, and 24.1% of males and 23.6% of females are obese. In total, the incidence of overweight and obesity amongst the population of Canada is close to a staggering two-thirds, at 62.1% (PHAC, 2011). Beyond that, another concerning trend is the increasing number of those falling within the higher classes of obesity, as PHAC (2011) also reports that between 1979 and 2004 the proportion of the population in class II doubled, and those within class III tripled. It appears that even as our society paradoxically becomes more informed on the impacts of nutrition and lifestyle towards health, our educational efforts to make the population healthier as a whole are seemingly not working.
Part of the problem is that some people aren’t aware that they are overweight or obese. Obesity is defined by body mass index (BMI), a score which is weight relative to height (weight in kg/height in m2). A BMI of 25-29.9 signifies overweight and greater than 30 indicates obesity with increased risk of mortality (HSFC, 2007). Waist circumference can also be used to assess obesity. Greater than 102 cm for men and 88 cm for women indicates an increased risk of disease, specifically diabetes, high blood pressure, heart disease and stroke according to HSFC (2007). Although 25% of the population is obese, the 2007 Community Health Survey (PHAC, 2009) indicated that only 17% of persons classed as obese categorized themselves this way, meaning that nearly 40% of obese Canadians obese do not see themselves as such. This demonstrates a large disconnect between individual perception and reality.
The significance of this issue cannot be dismissed, since obesity has important implications for health. In their book Food Wars, authors Lang and Heasman (2004) affirm that BMI is a useful indicator of risk of degenerative diseases, premature death, and disability, and have compiled the following list of diseases that are linked with overweight and obesity (p. 69):
- High blood pressure (hypertension)
- High blood cholesterol (dyslipidemia)
- Type II diabetes
- Insulin resistance, glucose intolerance
- Chronic heart disease
- Angina pectoris
- Congestive heart failure
- Cholelithiasis (gallstones)
- Cholescystitis (inflammation of the gallbladder)
- Obstructive sleep apnea and respiratory problems
- Some types of cancer (endometrial, breast, prostate, colon)
- Complications of pregnancy
- Poor female reproductive health
- Bladder control problems
- Uric acid nephrolithiasis (kidney stones)
- Psychological disorders (depression, eating disorders, low self-esteem)
Clearly, this is not just an issue of body image, but one of health.
There is vocal opposition, however, to viewing obesity as related to health that would argue that these types of statements dismiss personal freedom, that this stance devalues people and places too much significance on size, that individuals who are content with themselves should be able to be any size and still valued, and further what’s it to you? These types of statements though, miss the point, that this is not an individual problem, but a population one.
According to the Parliament of Canada (2005), the direct economic costs of obesity were estimated to be $1.8 billion in 1997. By 2005, the direct costs had skyrocketed to $4.3 billion, according to the Public Health Agency of Canada (2009), and with both direct and indirect costs considered this total was closer to $6.5 billion per year. These health care costs demonstrate how this is a universal problem, shared by all Canadians.
These steep costs to the healthcare system elucidate another point, that instead of treating the issue we are instead treating the effects of it, as we treat chronic diseases that are a result of obesity, instead of effectively preventing it. Preventing obesity means more effective public education, better resources and access for overweight and obese Canadians to nutritionists and dietitians in a similar way as they do currently to doctors and dentists, and a better food environment that doesn’t put such a large onus of responsibility on the individual for making healthier choices that are demonstrably difficult to make. We need to stop focusing on obesity as an issue of physical appearance and body image, and instead focus on its health impact. Since obesity is a major contributor of disease, this distinction would more effectively prevent the reduced quality of life that is a reality for nearly one quarter of Canadians.
Heart and Stroke Foundation of Canada (2007). Heart and Stroke Foundation of Canada position statement: Overweight, obesity, and heart disease and stroke. Heart and Stroke Foundation of Canada. Retrieved from http://www.heartandstroke.com/site/c.ikIQLcM WJtE/b.3799193/k.A1E1/Position_Statements__Overweight_obesity_and_heart_disease_and_stroke.htm
Lang, T., & Heasman, M. (2004). Food wars: A global battle for mouths, minds, and markets. New York, NY: Earthscan.
Parliament of Canada (2005). The obesity epidemic in Canada. Parliament of Canada. Retrieved from http://www.parl.gc.ca/Content/LOP/ResearchPublications/prb0511-e.htm
Public Health Agency of Canada (2009). Obesity in Canada – Snapshot. Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/publicat/2009/oc/pdf/oc-eng.pdf
Public Health Agency of Canada (2011). Obesity in Canada. Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/adult-eng.php
Figures – Public Health Agency of Canada. Retrieved from http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/oic-oac/