Canadian Nurse

https://infirmiere-canadienne.com/blogs/ic-contenu/2017/03/05/bientot-un-guide-alimentaire-canadien-mis-a-jour

Mar 05, 2017, By: Laura Eggertson

Amidst criticism that Canada’s Food Guide was influenced too heavily by industry and too little by solid research, Health Canada is conducting a comprehensive revision of the guide as part of a broader strategy for healthy eating in Canada.

“The current food guide is an all-in-one policy and education tool, so needs to be transformed to better meet the needs of different audiences,” says Ann Ellis, a manager of dietary guidance for Health Canada and one of the key officials shepherding the revision.

The guide’s emblematic rainbow of food groups is familiar to legions of schoolchildren, dietitians and health-care professionals across the country. Transforming it is a complicated task, which the federal Liberal government has committed to completing by the end of its first mandate in 2019. To begin with, the guide must work in tandem with other elements of a new healthy eating strategy.

The start of the process was an evidence review that scanned recent nutritional literature. Published by Health Canada in 2015, the review concluded most Canadians still aren’t eating enough fruit and vegetables, dairy products and whole grains. As well, a third of their total calories are from food high in fat, sugar or salt. Most people are also deficient in key nutrients including calcium, magnesium, zinc, vitamins C, A and D, and potassium and fibre.

Unhealthy diets are contributing to obesity and chronic illnesses such as diabetes  — a challenge the new guide and an accompanying guidance document will attempt to prevent. But any changes Health Canada introduces are apt to run afoul of critics, including chronic disease and obesity experts, representatives of agricultural marketing boards, consumers gripped with the latest low-carb, superfood-based fads, and academics evaluating all those interests.

For example, the current guide drew criticism from Sylvain Charlebois, a professor in food distribution and policy at Dalhousie University, for incorporating “commodity-driven recommendations … supported by weak science,” as he wrote in a Globe and Mail article (Dec.  6). The guide recommends Canadians consume two or more servings of milk or other dairy products daily; in his opinion, that recommendation played largely to the interests of Dairy Farmers of Canada, the national organization representing dairy farmers.

He points to other choices for the consumption of calcium, including tofu, leafy green vegetables and other foods that may resonate more with Canada’s multicultural society.

“You can feel right now that the way it’s designed, the food guide really allows for Canadian agriculture to prosper on consumers’ plates,” Charlebois says. “But the food guide is also about sound nutrition, not just about economic development.”

Some health-care professionals who use the guide regularly, such as public health nurse Michelle Johnson, feel the document also lacks resonance with young people. She says this group is bombarded with diet messages that emphasize protein over carbohydrates and tout the health benefits of so-called superfoods rather than a balanced eating approach.

For example, the current guide advises women aged 19 to 50 to eat six to seven grain products per day, and men of that age to eat eight grain products daily. “People look at that and they think that’s too much,” says Johnson. She works for Prairie Mountain Health, one of Manitoba’s regional health authorities, and is based in Boissevain, Man. “Some of those people are then not seeing it as a helpful guide because they see it as not realistic for themselves.”

She would like to see the new guide use averages when recommending portion amounts from each food group. She’d also like to be able to dispense guides tailored for age ranges, from toddlers to seniors.

Johnson’s comments are among the suggestions Health Canada gathered through an online consultation process involving a questionnaire, which ran last year from October to December. Ellis says Health Canada is analyzing those comments and will post a summary on its website this spring.

Although it’s premature right now to know what new content the guide will contain, the final product may look different, Ellis says. Health Canada is considering creating different types of tools and resources aimed at various audiences.

She confirms that in late 2017, Health Canada will issue a dietary guidance policy document for policy-makers and health-care professionals. Key messages for the public will also be released at that time.

That decision pleases Dietitians of Canada, says Kate Comeau, a registered dietitian and the organization’s spokesperson. It has urged Health Canada to revert back to its pre-2007 practice, which included releasing a separate guidance document providing background and explanations for the food choices and examples contained in the guide itself. “It’s really hard to have all that (a policy document and a guidance tool) in one document.”

Comeau says dietitians want different tools, including a guide for seniors and a more visual guide for people with low literacy levels. In addition, members of her organization have suggested that the new guide distinguish between minimally processed and ultra-processed foods and address the issue of whether the food Canadians consume is ecologically and economically sustainable, as well as affordable. A summary of recommendations from Dietitians of Canada members was submitted to Health Canada in December.

First published in 1942 to help Canadians eat a balanced, nutritious diet while coping with wartime rationing, the guide has since been updated seven times, most recently in 2007. That’s the version that sparked criticism from Charlebois and others. In response, Health Canada has said that during these consultations, government officials will be transparent about any contact or meeting with industry — a measure of transparency Comeau applauds.

“It’s important that the public is confident and that the information that’s in the guide is based on the best available scientific evidence,” she says.

Nurses, dietitians and other stakeholders, including the general public, can again weigh in during the next round of online consultations on the guide, beginning in May or June. Although no concrete date had been announced at time of print, Ellis encourages nurses to participate and says the department may also conduct focus groups. “We’re interested to hear … what the nursing community thinks and what would be most useful to them.”

Health Canada plans to release the new tools, including recommendations on amounts and types of foods, and additional resources for the public by late 2018.

Clearer labels, less salt, sugar and advertising: the healthy eating strategy

Health Canada’s healthy eating strategy is designed to promote public health by ensuring Canadians have the best possible information about what is in our food, know what constitutes a healthy diet and increase their access to better, more nutritious food.

The process involves revising Canada’s Food Guide to help Canadians eat healthier diets and, in doing so, reduce the burden that diet-related chronic diseases places on the health-care system. The new tools and resources will work together with changes to nutrition and ingredient labelling on prepackaged food (see “Food for Thought” ). Those changes include grouping similar ingredients together, standardizing serving sizes and identifying high levels of sugar, fat and sodium.

In addition, the problem of our unhealthy appetite for salty foods is being tackled. Health Canada is working with the provinces and stakeholder groups, including the Dietitians of Canada, on a public awareness campaign to help Canadians reduce sodium intake. This spring, consultations will begin on setting new voluntary targets for manufacturers to reduce the sodium in their products.

Ottawa is taking a harder stance on trans fats, however. Last November, consultations began on amending the Food and Drugs Act to prohibit the use of partially hydrogenated oils, described as the main source of industrially introduced trans fats in food sold in Canada. The government is likely to give industry a transition period to stop using the offending oils.

Health Canada also announced it will introduce restrictions on the marketing of unhealthy food and beverages to children. The move is being driven in part by a private member’s bill that Senator Nancy Greene Raine has introduced to ban all food and beverage advertising aimed at children (see “Food for Thought”).

Finally, the federal government has also pledged to improve Nutrition North Canada, a program that provides retailers with a subsidy intended to reduce the high cost of food in the North and make healthy choices, such as fruits and vegetables, more accessible and affordable. Health Canada is consulting with community members about ways to improve the program, which has been widely criticized for not subsidizing consumers directly. The government has not yet announced changes in response to the consultations.

Laura Eggertson is a freelance journalist in Ottawa, Ont.