The growing Canadian energy gap: more the can than the couch?

Food Literacy and Dietary Intake in German Office Workers: A Longitudinal Intervention Study

Widespread patterns of poor dietary behavior are a key factor causing the increasing prevalence of chronic diseases around the world. Research has provided initial insights into the potential of food literacy (FL) to empower individuals to improve their dietary behavior. However, studies on FL interventions in working adults are scarce. The intervention delivered in this study was a comprehensive 3-week full time education-based workplace health promotion program (WHPP) that provided the participants with in-depth knowledge and skills regarding nutrition and health. We aimed to investigate the short- and long-term effects of the WHPP on FL and dietary intake (DI) and to examine the association between FL and DI in a sample of 144 German office workers (30.0% female). Using two random intercept mixed linear regression models, we found significant strong improvements for both FL (β = 0.52, p < 0.0001) and DI (β = 0.63, p < 0.0001) after the WHPP when compared to baseline. Significant long-term improvements at 18 months were strong for FL (β = 0.55, p < 0.0001) and weak for DI (β = 0.10, p < 0.0001). FL showed a significant moderate effect on DI across all measurement time points (β = 0.24, p < 0.0001). We conclude that well-designed WHPPs can induce long-term improvements in FL and DI, and that FL can be viewed as an asset to further expand food-related knowledge and skills and to enhance dietary behavior. Our study fills a gap of long-term findings regarding the role of FL in WHPPs and supports the idea of implementing FL in the development of comprehensive WHPPs to improve DI.

Cross-associations between physical activity and sedentary time on metabolic health: a comparative assessment using self-reported and objectively measured activity

Purpose

Physical activity and sedentary time have distinct physiologic and metabolic effects, but little is known about their joint associations.

Methods

The Canadian Health Measures Survey (n = 5950) was used to (i) examine the joint relationship between active/non-sedentary (referent group), active/sedentary, inactive/non-sedentary and inactive/sedentary phenotypes on obesity and metabolic health; and (ii) compare these relationships when using objective (accelerometer) total activity or subjective (self-report) leisure-time measures. Weighted associations for the metabolic syndrome (MetS), individual MetS components, 1+ disease (1 or more of diabetes, myocardial infarction, stroke, cardiovascular disease) and obesity were estimated using logistic regression.

Results

After adjustments, the odds (OR, 95% CI) of 1+ disease (OR = 3.05, 1.47-6.34) and abdominal obesity (OR = 2.75, 1.16-6.55) were higher in the inactive/sedentary group versus the referent group (OR = 1.00) when measured objectively. Within self-report leisure-time groups, elevated odds were observed for the inactive/sedentary group for MetS, obesity, abdominal obesity and elevated triglycerides. Inactive/non-sedentary and active/sedentary groups were similarly protective when measured by accelerometer.

Conclusion

Using accelerometer data, the inactive/sedentary group was at higher risk for 1+ disease and abdominal obesity only, whereas the active/sedentary and inactive/non-sedentary groups were not at higher risk for any health outcome.

The Impact of U.S. Free Trade Agreements on Calorie Availability and Obesity: A Natural Experiment in Canada

INTRODUCTION

Globalization via free trade and investment agreements is often implicated in the obesity pandemic. Concerns center on how free trade and investment agreements increase population exposure to unhealthy, high-calorie diets, but existing studies preclude causal conclusions. Few studies of free trade and investment agreements and diets isolated their impact from confounding changes, and none examined any effect on caloric intake, despite its critical role in the etiology of obesity. This study addresses these limitations by analyzing a unique natural experiment arising from the exceptional circumstances surrounding the implementation of the 1989 Canada-U.S. Free Trade Agreement.

METHODS

Data from the UN (2017) were analyzed using fixed-effects regression models and the synthetic control method to estimate the impact of the Canada-U.S. Free Trade Agreement on calorie availability in Canada, 1978-2006, and coinciding increases in U.S. exports and investment in Canada's food and beverage sector. The impact of changes to calorie availability on body weights was then modeled.

RESULTS

Calorie availability increased by ≅170 kilocalories per capita per day in Canada after the Canada-U.S. Free Trade Agreement. There was a coinciding rise in U.S. trade and investment in the Canadian food and beverage sector. This rise in calorie availability is estimated to account for an average weight gain of between 1.8 kg and 12.2 kg in the Canadian population, depending on sex and physical activity levels.

CONCLUSIONS

The Canada-U.S. Free Trade Agreement was associated with a substantial rise in calorie availability in Canada. U.S. free trade and investment agreements can contribute to rising obesity and related diseases by pushing up caloric intake.

Healthy food procurement and nutrition standards in public facilities: evidence synthesis and consensus policy recommendations

INTRODUCTION

Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity. This is a concern given that public facilities often provide a significant amount of food for consumption by vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and/or serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada.

METHODS

To inform further policy action on healthy food procurement in a Canadian context, we: (1) conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food, and (2) hosted a consensus conference in September 2014. The consensus conference invited experts with public health/nutrition policy research expertise, as well as health services and food services practitioner experience, to review evidence, share experiences, and develop a consensus statement/recommendations on healthy food procurement in Canada.

RESULTS

Findings from the evidence synthesis and consensus recommendations for healthy food procurement in Canada are described. Specifically, we outline recommendations for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers.

CONCLUSION

Implementation of healthy food procurement policies can increase Canadians' access to healthier foods as part of a broader vision for food policy in Canada.

A voluntary nutrition labeling program in restaurants: Consumer awareness, use of nutrition information, and food selection

Health Check (HC) was a voluntary nutrition labeling program developed by the Heart and Stroke Foundation of Canada as a guide to help consumers choose healthy foods. Items meeting nutrient criteria were identified with a HC symbol. This study examined the impact of the program on differences in consumer awareness and use of nutritional information in restaurants. Exit surveys were conducted with 1126 patrons outside four HC and four comparison restaurants in Ontario, Canada (2013). Surveys assessed participant noticing of nutrition information, influence of nutrition information on menu selection, and nutrient intake. Significantly more patrons at HC restaurants noticed nutrition information than at comparison restaurants (34.2% vs. 28.1%; OR = 1.39; p = 0.019); however, only 5% of HC restaurant patrons recalled seeing the HC symbol. HC restaurant patrons were more likely to say that their order was influenced by nutrition information (10.9% vs. 4.5%; OR = 2.96, p < 0.001); and consumed less saturated fat and carbohydrates, and more protein and fibre (p < 0.05). Approximately 15% of HC restaurant patrons ordered HC approved items; however, only 1% ordered a HC item and mentioned seeing the symbol in the restaurant in an unprompted recall task, and only 4% ordered a HC item and reported seeing the symbol on the item when asked directly. The HC program was associated with greater levels of noticing and influence of nutrition information, and more favourable nutrient intake; however, awareness of the HC program was very low and differences most likely reflect the type of restaurants that “self-selected” into the program.

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Findings suggest a very modest impact of the voluntary nutrition labeling program.

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Overall awareness of nutrition information was higher in HC restaurants.

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However, awareness of the HC program and symbol was very low.

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Differences in consumption may reflect the type of restaurants in the program.

The effects of calorie labels on those at high-risk of eating pathologies: a pre-post intervention study in a University cafeteria

OBJECTIVES

The aim of the study was to examine the effect of a public policy (menu labelling) on those at high-risk for eating pathologies. Specifically, the study looked for any adverse effects related to eating disturbance level.

STUDY DESIGN

The study employed a pre-post intervention design. Baseline collection took place in October 2012. One week prior to follow-up in November 2012, calorie labels were displayed next to virtually all menu items in a University cafeteria. Labels remained throughout the entire duration of follow-up.

METHODS

Participants were female undergraduates (N = 299). At baseline and follow-up, a survey assessed eating disturbance level (Eating Attitudes Test-26), emotional state, frequency of engaging in unhealthy weight-related behaviours, and calorie consumption.

RESULTS

Generalized estimating equations were used to test changes in negative outcomes over time in response to calorie labels. Calorie consumption did not significantly decrease from baseline (mean = 660.5 kcal) to follow-up (mean = 600.5 kcal; P = 0.104). There were no changes in emotional states such as body image satisfaction (P = 0.447), anxiety (P = 0.595), positive affect (P = 0.966), negative affect (P = 0.576), and unhealthy weight-related behaviours such as binging (P = 0.268), exercising excessively (P = 0.847), or restricting calories (P = 0.504). Additionally, there were no interactions between eating disturbance level and time.

CONCLUSIONS

Overall, no adverse outcomes were found for this at-risk population. Calorie labels did not differentially affect those with higher levels of eating disturbance. Future research should focus on examining the impact of calorie labels among those with clinical eating disorders.

A randomized trial of calorie labeling on menus

BACKGROUND

Food consumed outside the home accounts for a growing proportion of the North American diet and has been associated with increased obesity.

PURPOSE

To examine the effect of nutrition labeling on menus on awareness, use, and food consumption, including the impact of "traffic light" labeling and adding other nutrients.

METHODS

Blinded, randomized trial with 635 Canadian adults conducted in 2010-2011. Participants ordered a free meal from one of four experimental menus: 1) no nutritional information shown, 2) calorie amounts only, 3) calorie amounts in "traffic lights", and 4) calorie, fat, sodium, and sugar shown in "traffic lights". Recall of nutrition information, knowledge of calorie content and nutrient consumption were assessed.

RESULTS

Participants in the calorie conditions were more likely to recall the calorie content of meals and to report using nutrition information when ordering. The calorie content of meals was not significantly different across conditions; however, calorie consumption was significantly lower among participants in the Calorie-only condition compared to the No information condition (mean=-96 kcal, p=.048).

CONCLUSIONS

Menu labeling increased awareness and use of nutrition information and reduced consumption. Adding "traffic lights", fat, sodium, and sugar amounts to menus had little impact compared to calorie-only labeling.

Monitoring and benchmarking population diet quality globally: a step-wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

Objective food environments and health outcomes

BACKGROUND

Pathways by which food environments affect residents' diet-related outcomes are still unclear. Understanding pathways may help decision makers identify food environment strategies to promote healthy diets.

PURPOSE

To examine the hypothesis that residents' perceptions mediate the relationship between objective food environment and residents' diet quality and weight status.

METHODS

In the Waterloo Region, Ontario, objective food environment data were collected from 422 food stores and 912 restaurants using the Nutrition Environment Measure Survey in Stores and Restaurants, a shelf-space measure of fruits and vegetables, and the Retail Food Environment Index. Waterloo Region households (n=2223) completed a subjective food environment perception survey; household members (n=4102) self-reported weight, height, and waist circumference. A subsample (1170 individuals within 690 households) completed diet records. Food environment data were collected in 2010; respondent data were collected from 2009-2010; and data were analyzed in 2012. A series of gender-specific models were conducted to test mediation, adjusting for household income, car ownership, age, and education level.

RESULTS

Residents' perceptions did not mediate the relationship between objective measures and diet-related outcomes; instead, results revealed the direct effect of several objectively measured factors of the food environment (notably food access and relative food affordability) on outcomes. Perceptions generally were not associated with diet-related outcomes.

CONCLUSIONS

These results reveal that in this setting, strategies aimed at improving residents' perceptions may be less effective than those acting directly on food environments to improve food access and relative food affordability.

Food consumption patterns in preschool children

PURPOSE

Healthy eating during early childhood is important for growth and development. Eating Well with Canada's Food Guide (CFG) provides dietary recommendations. We investigated patterns of food consumption among preschool children and attempted to determine whether these children's intakes met nutrition recommendations.

METHODS

Between 2005 and 2007, four- and five-year-old children (n=2015) attending 12 Edmonton-region public health units for immunization were recruited for a longitudinal study on determinants of childhood obesity. The children's dietary intake at baseline was assessed using parental reports.

RESULTS

Overall, 29.6%, 23.5%, 90.9%, and 94.2% of the children met recommendations for vegetables and fruit, grain products, milk and alternatives, and meat and alternatives, respectively. In addition, 79.5% consumed at least one weekly serving of foods in the "choose least often" group. Significant differences existed in consumption of food groups across socioeconomic and demographic groups. For example, 82.9%, 84.7%, and 75.9% of preschool children from neighbourhoods of low, medium, and high socioeconomic status, respectively, consumed at least one food in the "choose least often" group (χ² =16.2, p<0.001).

CONCLUSIONS

Consumption of vegetables and fruit and grain products was low among participants, and intake of "choose least often" foods was high. Consumption of foods also differed among socioeconomic and demographic groups. To encourage healthy eating among children, public health professionals should target groups who do not meet the CFG recommendations.