Confronting obesity in Canada

COVID-19 has cast a shadow over many aspects of Canadians' health beyond simply making them sick. 

Its most immediately pernicious legacy may be with regards to obesity, as restrictions have forced adults and children to remain inside where they are more likely to overeat, exercise less and consume more junk food advertising. But there are also concerns, in the longer term, that the Canadian government's healthy eating strategy will be another casualty. 

At the moment, the outlook for an improved food environment remains bleak as policymakers focus on stamping out COVID-19 and reviving the economy. Enthusiasm for reform was already flagging even before the pandemic hit. While the early Trudeau government prioritized these health measures, it has since backed down when faced with industry opposition — and dire warnings about financial consequences. For the foreseeable future, concerns about COVID-19 will likely stall legislation further, even as studies highlight the danger for those living with obesity.

"Our world is set up so that people will just gain weight. It is the outcome of the food environment that we have created," says Jacob Shelley, assistant professor at Western University and co-director of the Health Ethics, Law & Policy Lab. "We need policies that will shift this environment and COVID makes it all that more important. But because of the pandemic, I'm afraid we are going to lose sight of all the other health problems."

Across the pond, there's already evidence that COVID-19 is both motivating politicians to reassess our obesogenic environment as well as spooking authorities into reversals. 

The Scottish government announced in late June it will "pause" measures to combat obesity in a bid to support industry. Meanwhile, British Prime Minister Boris Johnson, who blames excess weight for his COVID-19 near-death experience, has vowed to intervene, representing a dramatic about-face from his previous "libertarian" stance. New measures are due out soon, including an ad ban on unhealthy foods.

Studies have shown that being significantly overweight puts greater strain on the heart and lungs, complicating COVID-19 infections. The exaggerated immune response in people who are obese is also a problem.

According to Statistics Canada, more than 60 per cent of adults are overweight or obese. For decades, health care practitioners warned of the enormous costs associated with diet-related disease, both to individuals and society. In purely financial terms, these range from $4.6 billion to $7.1 billion annually. And while Canadians like to compare themselves favourably to their larger, Southern neighbours, it ranks among the heaviest in the developed world. The problem will likely get worse — obesity rates among children and youth have nearly tripled in the last 30 years.

Canada, along with many other countries, had promised significant reforms. In 2016, Health Canada launched the Healthy Eating Strategy, which among other measures, called for an updated food guide, restrictions of unhealthy food marketing to children and mandatory front-of-pack warning labels.

So far, only Canada's Food Guide, launched in early 2019, has seen the light of day, thanks to opposition from the business community, observers say. This is despite extensive talks with stakeholders on ad restrictions and food symbols. The food and beverage sector is the second-largest manufacturing industry in Canada, and the biggest manufacturing employer, responsible for nearly 290,000 jobs.

Some health experts are optimistic that measures eventually will be pushed through. "For sure, COVID has thrown a monkey wrench in the works," said Tom Warshawski, chair of the Childhood Obesity Foundation. Once the COVID fire is manageable, Warshawski added, legislation will get back on track. "They will make good. We can't afford not to."

But activists fear that the pre-COVID-19 food marketing inertia is more likely to continue in Canada. Particularly disappointing was the failure last year at the eleventh hour of Bill S-228, the Child Health Protection Act, which called for an ad ban of "unhealthy" food to children under 13. At the moment, only Quebec, which has the highest fruit and vegetable consumption per capita and second-lowest obesity rate in Canada (after British Columbia), has restrictions in place. Since 1980, the province has banned all commercial advertising to children under the age of 13 (not just for some food).

While Bill S-228 had at least some support from all parties and broad public appeal, heavy lobbying by the advertising and food industries scuppered its chance at the last moment, experts said. With the retirement of the bill's sponsor, Senator Nancy Greene Raine, the movement currently lacks a visible champion within the government.

Legislation "didn't come to fruition because of a lack of will or evidence. It died because of industry opposition," says Shelley. "There was this perfect policy window and it still didn't happen. It just kind of died and some of the enthusiasm died with it."

"It does seem like wind has gone from the sails of Health Canada's food strategy," says Bill Jeffery, the executive director of the Centre for Health Science and Law. Jeffrey did not support the proposed legislation, he says, partly because it was too easy for soft drink and fast food companies to skirt. He also worried it was too vulnerable to a legal challenge.

The long-promised mandatory front of package labelling — symbols that will highlight foods with high contents of sugars, sodium or saturated fats — stands a better chance of becoming a reality. "Health Canada is getting a lot of pushback [from the food industry], but this will happen," said Warshawski, who also expects ad restriction legislation within the next 12 months.

Health Canada said in an email its top priority is the pandemic, and cannot provide a date for when the final front-of-package labelling regulations will be published. "We however remain committed to the front-of-package labelling initiative."

To what extent obesity makes COVID-19, or any future pandemic, more dangerous is still under study. While age is by far the most significant predictor of a severe COVID-19 reaction and death, experts say being overweight is also a factor. A recent report found that the risk of critical illness doubled for those with obesity and was 44 per cent greater for people who were overweight. It also increases the risk of contracting the virus. 

 "Obesity primes your body to overreact," said Shelley. "If you layer on a COVID infection, you could have a really bad situation."

"The shocking thing might be how much people's body weight has risen during this period, which is only the most visible manifestation of poor diet," said Jeffery. "It feels like the government hasn't really been conscious of COVID-19's impact on the food and alcohol-related disease risk."