Promoting healthy weights using population-based interventions in Canada – Key messages
Godefroy E Guindon
University of Waterloo (Ontario)
What’s the problem?
Overweight and obesity is one the most significant public-health issues in Canada and is driven by a complex interplay of factors.
The prevalence of overweight and obesity in Canada, and in turn, its associated health and economic burden, is significant and growing. Obesity rates over the last three decades have roughly doubled, resulting in approximately one in four Canadian adults and 8.6% of children and youth being obese. This combined with the myriad co-morbidities associated with overweight and obesity place strain on already over-stretched health systems.
Promoting healthy weights at a population level is challenging due to the need to address a broad array of inter-related biological, behavioural, community and societal and environmental factors that contribute to overweight and obesity.
Current approaches to promoting healthy weights are not integrated and don’t focus on the underlying determinants of overweight and obesity.
What do we know (from systematic reviews) about three viable options to address the problem?
Option 1 – Information and skills building
One high-quality review found that promising education-related strategies include the use of a school curriculum that includes healthy eating, physical activity and body image, teaching fundamental movement skills, and education for teachers and staff to implement health-promotion strategies. Medium-quality reviews highlighted: that information and education campaigns are effective at increasing knowledge and consumption of healthy food; the importance of tailoring information provided through education interventions; the potential benefits of including computer-based interventions as a supplement to standard weight-loss interventions; and that the use of nutrition labels is consistently linked to healthier diets.
Option 2 – Programs to support healthy settings
Several systematic reviews found benefits related to this option. High-quality reviews found evidence to support positive effects for school-based programs, obesity prevention programs targeted to children aged six to 12, and tailored walking-promotion interventions. Several reviews (including one high-quality review) found evidence to indicate some benefit to workplace interventions (particularly those that were multi-component and target both exercise and dietary habits). Also, medium- and low-quality reviews found that intensive multi-component screening programs were most effective and that a well-designed built environment has a beneficial association with levels of physical activity and obesity rates.
Option 3 – Guidelines and policies to enable healthy food and physical activity environments
Several high- and medium-quality reviews found benefits for financial incentives and price measures that affect demand for high-energy foods and beverages, and healthy foods, as well as indirect evidence of benefits for interventions aimed at restricting and reducing food and beverage marketing targeted at children. High-quality reviews found that: financial incentives have a positive effect on both food purchasing and weight loss; television influences food and beverage preferences, purchase requests, short-term consumption as well as adiposity; and food promotion influences children’s food purchasing. Medium-quality reviews found that prices, taxes and subsidies were significantly associated with the demand for food and beverages.
What implementation considerations need to be kept in mind?
Potential barriers to promoting healthy weights using population-based interventions in Canada can be identified at the level of individuals (e.g., low health literacy levels), providers (e.g., lack of coordination and collaboration between providers within and between sectors), organizations (e.g., lack of consistency of educational material between schools and other settings), and system level (e.g., lack of coordinated policies between municipal, provincial and federal governments).
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