Running Head: OBESITY IN CANADA

Obesity in Canada
Ashwajit Kamble
Norquest College
HEED 1000
Scholarly Paper
Reginald Nugent
May 21, 2014

OBESITY IN CANADA

Abstract
Obesity is a multi-factorial disorder, which is usually correlated with dispositions
such as diabetes, hypertension and other cardiovascular diseases, osteoarthritis and
certain cancers. The causes of, and contributors to; obesity are complex and multifaceted.
Our understanding of the underlying factors that contribute to obesity is often incomplete,
spread out between different studies and research findings. They include not only
individual choices (what to eat and whether to be active), but also environmental and
social determinants that shape peoples ability to make healthier choices. The
management of obesity will, therefore, require a comprehensive range of strategies
focusing on those with existing weight problems and also on those at high risk of
developing obesity. Hence, prevention of obesity during childhood should be considered
a priority as there is a risk of persistence to adulthood. This paper provides information
on the phenomenon of overweight and obesity in Canada in terms of prevalence, health
implications and economic burden. This paper also highlights various preventive aspects
and treatment procedures of obesity with special emphasis on the future of the health
issue.

OBESITY IN CANADA
Introduction
As in other parts of the developed world, obesity rates in Canada have increased
dramatically over the last few decades. Obesity is linked to a number of chronic diseases

like diabetes, coronary heart disease and hypertension. As a result, of the increase in these
chronic diseases due to obesity, the sustainability of the Canadian health care system is
significantly affected. A recent analysis estimated the total direct costs attributable to
overweight and obesity at $6.0 billion, which corresponds to 4.1% of total Canadian
health care expenditures (Anis, Zhang, Bansback, Guh, Amarsi & Birmingham, 2010).
Description of Health Issue
Statistical evidence to indicate prevalence
Over almost the past 3 decades, the prevalence of obesity, defined by a body mass
index (BMI) of 30 or higher, has alarmingly increased in many parts of the world. In
Canada, the prevalence of obesity began to increase steadily in the 1980s. According to
the 1985 Canadian Health Promotion Survey, about 6.1% of Canadian adults were found
to be obese, compared with 18.1% reported from the findings of the 2010 Canadian
Community Health Survey (CCHS) (Sassi & Devaux, 2012, Katzmarzyk & Mason, 2006,
Statistics Canada Canadian Community Health Survey, 20092010).
Demographics
Obesity rates for both men and women increase with age, starting at age 20 and
continuing until age 65 and then the rate declines. Men were more likely to be overweight
than women, finding that was consistent across all provinces. According to the findings

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of CCHS (2010), an increased prevalence in obese class I was reported for men across all
provinces and women were more likely than men to be classified as obese class II and III.
There was also a higher prevalence for the overweight and obese class I categories in the
older age categories (4059 and 60 yr) compared with the younger group. In children
boys (12.7%) were reported to be obese than girls (6.0%). Data also showed that obesity
rates are high among off reserve Aboriginal adults (24.8%), compared to the NonAboriginal (16.6%) adults.
Effects on the Community
Obesity affects us by contributing to multiple elements of health and well-being.
Obesity drives economic costs that affect obese people in addition to their families and
loved ones. The monetary cost of obesity also affects society and larger economies. It
affects physically by impairing your ability to perform normal, daily, recreational
physical activities by yourself and with others. It may affect your physical health by
increasing your risk for a wide variety of chronic diseases, such as diabetes,
cardiovascular disease, hypertension, liver disease as well as breast, colon and prostrate
cancer. Obesity increases your risk of developing skin problems (impetigo and impaired
wound healing) and gynecological problems (infertility and irregular menstrual periods).
It affects you psychologically by diminishing your quality of life. It can inflict emotional
strain that contributes to comfort eating and additional weight gain. Failure to lose weight
may worsen the physiological effects of obesity by creating a negative self-image and
diminish your self-control. Other psychological effects of obesity may include
depression, shame, self-doubt and sexual problems. Obesity affects us socially by
contributing to social isolation and discrimination. The mobility impairments associated

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with obesity may lead you to avoid public places or avoid using public facilities. You
may isolate yourself from others as a result of the emotional and physiological effects.
Social isolation may also increase your risks of mortality and morbidity. It affects the
society financially because obese people spend more on health and work related expenses
than people with normal weight. Obesity-related diseases may cause millions of lost
workdays and thus contributes to annual wage losses (Hramiak et al., 2007).
Financial burden
The analysis of the study conducted by Economic Burden of Illness in Canada,
between 2000 and 2008 showed that the annual economic burden of obesity in Canada
increased by $735 million, from $3.9 to $4.6 billion. These studies defined economic
burden of obesity as both the direct costs to the health care system (i.e., hospital care,
pharmaceuticals, physician care and institutional care) and indirect costs to productivity
(i.e., the value of economic output lost as a result of premature death and short- and longterm disability). These studies focused on eight chronic diseases consistently associated
with obesity. In a recent analysis, the total cost of obesity has been estimated to be $4.3
billion (2005 dollars); $1.8 billion in direct healthcare costs and $2.5 billion in indirect
costs (Jannssen & Diener, 2005).
Health related risks
Coronary heart disease: The risk for coronary heart disease (CHD) increases as
the body mass index increases. A waxy substance called plaque build up inside coronary
arteries in CHD, which narrows or blocks the arteries causing angina or heart attack.

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Obesity can also cause heart failure condition in which heart cant pump enough blood to
meet bodys demands (Guh et al., 2009).
High blood pressure: The chance of having high blood pressure is greater if the
person is overweight or obese (Guh et al., 2009).
Stroke: Excessive build up of plaque can cause an area of plaque to rupture
causing a blood clot to form. This clot if close to your brain can block the flow of blood
and oxygen to the brain and cause a stroke. As BMI rises the risk of having a stroke
increases (Guh et al., 2009).
Type 2 Diabetes: Most people who have diabetes type 2 are overweight, and it is
one of the leading causes of early death (Guh et al., 2009).
Abnormal blood fats: Being obese or overweight increase the risk of having
high levels of triglycerides and LDL (bad) cholesterol and low levels of HDL (good)
cholesterol (Guh et al., 2009).
Cancer: Being overweight or obese increase the risk for colon, breast,
endometrial and gallbladder cancers (Guh et al., 2009).
Osteoarthritis: This is a common problem affecting knees, hips and lower back
which occurs if the protective tissue at the joint wears away. This happens to obese
people because extra weight can put more pressure and wear on joints (Guh et al., 2009).
Sleep apnea: Obese people have more fat stored around the neck which narrows
the airway, making it hard to breathe and causing sleep apnea (Guh et al., 2009).

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Obesity Hypoventilation Syndrome: This is a breathing problem that affects

obese people which can lead to serious health problems and may even cause death (Guh
et al., 2009).
Reproductive problems: Obesity causes menstrual issues and infertility in
women (Guh et al., 2009).
Gall stones: Gallstones are mostly made up of cholesterol and people who are
obese are at high risk of having gall stones (Guh et al., 2009).
Selection & Analysis of Programs/ Services
The national and international literature review introduced various approaches to
fight obesity and address obesogenic environments. It can be classified into three main
categories (Sacks, Swinburn & Lawrence, 2009):
1.

Health services and clinical interventions that target individuals;

2.

Community-level interventions that directly influence individual and

group behaviours; and

3.

Public policies that target broad social or environmental determinants.

Effective obesity prevention requires a multifaceted, long-term approach which

involves interventions that operate at multiple levels and in complementary ways.
Individual based Interventions

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The recommendations to health care professionals by the 2006 Canadian clinical

practice on the management and prevention of obesity in adults and children provided
strategies for the prevention, screening and management of obesity in clinical and
community health settings. The guidelines suggested the following interventions:

Behavior modification training or therapy, including family-oriented behavior

therapy for children (Vallis, 2007).

Dietary interventions, such as an energy-reduced diet (Mendelson et al., 2007).

regular physical activity in adults (Prud'homme et al., 2007)

combined dietary and physical activity therapy (Vance, Hanning & McCargar,
2007)

For some individuals, bariatric surgery and prescription medications (Sellers,

2007).
Brief training sessions, shared care with other health professionals and dietitian-

led programs were suggested by 2009 Cochrane Collaboration review of health

professionals management of overweight and obesity to further investigate and
demonstrate how the practice or organization of care could be improved (Harvey et al.,
2009). Evidence on obesity prevention in adults have shown that face to face
communications are more effective than remote communications, and even though these
approaches have demonstrated inconsistent results they have been associated with weight
loss or changes in diet and physical activity in adults. The challenge individual

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interventions face even if they are effective in promoting weight loss is avoiding weight
regain. Various studies have suggested interventions like self monitoring, regular physical
activity and nurse counseling and support to prevent relapse. However, increased risks of
binge eating and unhealthy weight control have been associated with frequent self
monitoring (Ross, 2009).
Community based Interventions
These interventions include programs delivered in key settings, such as
workplaces and schools, as well as both targeted and universal public educational and
information campaigns delivered through print, broadcast and online media. One example
of a comprehensive campaign that targets multiple risk British Columbias Act Now BC
(Geneau et al., 2009) is one of the example of comprehensive campaign that targets
multiple risk factors (e.g., physical inactivity, low fruit and vegetable consumption,
smoking, overweight and obesity, and alcohol use during pregnancy). One common
community-level health promotion tool is social marketing campaigns that emphasize
physical activity, healthy eating and/or healthy weights. Canadas ParticipACTION
(physical activity) and 5 to 10 a Day (fruit and vegetable consumption) are some
examples of social marketing campaigns that use mass media strategies. Some
evaluations, which have been published, have focused almost exclusively on measuring
campaign awareness, public attitudes and knowledge, whereas others have focused on a
specific behavior being targeted, such as physical activity within a specific target
population. The contribution that mass media campaigns can make to obesity prevention
or management, as well as the manner by which they influence behavior needs further
study to understand them more clearly (Faulkner et al., 2009). Studies conducted

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10

identified a number of initiatives that were effective in influencing two of the key
behavioral factors known to affect obesity: physical activity and healthy eating. The most
promising approaches included the following (Flynn et al., 2006):
point-of-decision prompts such as signage encouraging the use of stairs;
school-based interventions for children and youth (e.g., increased
frequency/duration of physical education classes, additional training for teachers);
Comprehensive worksite programs that include counseling, education,
incentives and access to supportive facilities such as locker rooms, showers and gyms;
point-of-purchase strategies, such as menu and shelf labeling, to increase the
purchase and consumption of healthier foods;
Workplace, school and municipal policies and environmental supports that
increase access to healthier foods and beverages (e.g., in vending machines restaurants
and cafeterias);
Systematic nutrition reminders and training for health care providers.
Targeted programs in clinical settings, schools and work places most frequently
reported positive outcomes (Flynn et al., 2006).
Public Policies
There are several physical, social and economic factors that limit the effectiveness
of public health efforts to promote healthy weight by encouraging individuals and
families to make healthier choices. Various studies have shown that material deprivation

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11

is associated with higher BMI for women, although not for men. Environmental factors
that serve as barriers to physical activity are the lack of safe and assessable spaces for
children to play and a built environment that promotes motorized transportation than
active commuting. Environmental factors can also be linked to food choices, diet quality
and obesity. Some public policy strategies that address the key influence on obesity,
physical activity and nutrition that have been discussed or implemented are as follows:

Subsidy programs to support healthy eating (e.g., the Food Mail Program

for northern Canada the Northern Fruit and Vegetable Pilot Program in Ontario and
community-based food security initiatives);

Land development, urban planning and transportation planning that

promote active commuting and recreational physical activity;

Food labeling to help consumers understand the health implications of

their choices;

Regulation of marketing to children, particularly for energy-dense,

nutrient-poor foods and beverages;

Financial incentives to promote physical activity (e.g., the Childrens

Fitness Tax Credit and the Federal Tax Credit for Public Transit); and

Financial disincentives, such as a tax on unhealthy foods and beverages.

Evidence from public health experiences suggests that an intervention if it is long

term and multifaceted in nature is more likely to be effective. It should be tackling
multiple drivers and factors simultaneously. Integrating evaluation into program
development and implementation helps to improve the responses. Ongoing evaluations

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OBESITY IN CANADA
could support the continual realignment and enhancement of resource investments by
facilitating the emergence of new knowledge (Lemmens et al., 2008).
The Future of the Health Issue
According to an article published in CMAJ, obesity rates in Canada tripled
between 1985 and 2011, from 6% to 18%, with significant increases in the very obese
categories; it is projected that approximately 21% of Canadian adults will be obese by
2019. Obesity has an associated annual cost in Canada estimated at between C$4.6 and
C$7.1 billion. Interestingly, there has been a sharp rise in the number of extremely
overweight adults, with the highest proportion of obese adults in the Atlantic Provinces
and the lowest in wealthy and healthy British Columbia. In five provinces of

Newfoundland and Labrador, Nova Scotia, New Brunswick, Saskatchewan and Manitoba
there will be more adults who are overweight and obese than adults with a healthy weight
by 2019. By 2019, it is estimated that most (55.4%) of the Canadian adult population will
be classed as overweight (34.2%) or obese (21.2%) and the researchers estimate that the
prevalence for obese classes I, II and III will increase to 14.8%, 4.4% and 2.0%,
respectively (Twells, Gregory, Reddigan & Midodzi, 2014).
These results raise concern at a policy level, because people in these obesity
classes are at a much higher risk of developing complex care needs, the authors write
In Canada, there is no country-wide coordinated effort to address the adult obesity
epidemicwithout a complete synthesis of what each province is doing, it is very
difficult to know if these differences can be explained by the uptake or implementation of
federal, provincial, community-wide or local initiatives. They cite the example of

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provincial variations that exist in the provision of bariatric surgery, as well as the training
or lack of training of health professionals in weight management and the lack of patient
access to dieticians and psychologists. An improved understanding of why such
substantial interprovincial variations exist is necessary, including a focus on evaluating
existing policies, programs and approaches to the prevention, management and treatment
of obesity, the authors conclude (Twells, Gregory, Reddigan & Midodzi, 2014).
Addressing the factors that contribute to obesity early in a persons life helps
reduce the likelihood of being overweight or obese in adolescence and adulthood. So my
recommendation to prevent this obesity epidemic is to tackle it early. Some suggestion to
defeat this epidemic is by making social and physical environments where children live,
learn and play more supportive of physical activity and healthy eating, by identifying the
risk of overweight and obesity in children and addressing it early, by looking at ways to
increase the availability and accessibility of nutritious foods and to decrease the
marketing of foods and beverages high in fat, sugar and/or sodium to children.
Conclusion
The important factors in promoting health and helping Canadians live longer,
healthier lives while preventing disease, disability and injury are healthy weights,
physical activity and healthy eating. Canada has established a strong foundation for
health promotion and chronic disease prevention over the past four decades. The task
now is to build on that foundation and continue to learn and adapt. Canada can continue
moving toward the vision of a healthy nation in which all Canadians experience the
conditions that support the attainment of good health. As an important step in reversing

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obesity trends in Canada Federal, Provincial and Territorial governments, are committed
to working collaboratively to curb obesity and promote healthy weights in Canadians.
Governments will continue to learn through the implementation of successful initiatives
across the country, and to share their expertise in order to expand and build on what
works. Everyone has a role to play in reducing the risk of disease, disability and injury, in
promoting health, and in helping children and youth have the healthiest possible start in
life. Collaboration is the key - effectively addressing obesity and supporting healthy
weights calls for a sustained, cross-governmental and multi-sectoral, multi-faceted
response at all levels.

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