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BC Public Building and IH
Vending Policy: Workshop for Stakeholders
Cathy Richards, Registered Dietitian
Community Nutritionist, Interior Health
250-980-5049 [email protected] Winter/Spring 2009, IH Vending Workshops
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Who am I?
• Registered Dietitian
• Community Nutritionist, Interior Health, Seconded to MOH/MOE 2005-2007
– to develop “Guidelines for Food and Beverage Sales in BC Schools” & “Healthier Choices for Vending in BC Public Buildings”
• 2007 Contracted with Dietitians of Canada to help develop www.brandnamefoodlist.ca
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IH Healthy Food Committee • Mission Statement:
– To support IH’s mission of promoting wellness, by providing
an environment that enables healthy food and beverage
choices.
• Cross Sectoral – all departments in IH
• Key Members: – [email protected] (Purchasing)
– [email protected] (Food Service)
– [email protected] (Food Service)
– [email protected] (Chair, Director Food & Health)
– [email protected] (Community Nutrition)
– Also represented: Clinical Dietitians, Auxiliaries, Medical Health
Officers.
– Sponsor: Chris Mazurkewich
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Agenda
• Why Healthier Choices?
• Nutrition Issues
• Why Policy rather than education?
• What is the Policy?
• Revenue reporting and other responsibilities
• Agreement of Compliance for machine/box fillers
• Nutrition Criteria
• Brand Name Food List
• Break (10 minutes)
• Self Report for machine/box fillers
• Questions welcome throughout.
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Obesity Trends* Among Canadian Adults HPS, 1985
Source: Katzmarzyk PT. Can Med Assoc J 2002;166:1039-1040.
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
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Obesity Trends* Among Canadian Adults
NPHS, 1994 (*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Katzmarzyk PT. Can Med Assoc J 2002;166:1039-1040.
No Data <10% 10%-14% 15-19% 20%
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Obesity Trends* Among Canadian Adults
Provinces (measured) CCHS, 2004
Territories (self-report) CCHS, 2002
Data from: Statistics Canada.
15-19% 20 -24% 25-29% 30-34%
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Proportion of
Overweight/Obesity
in Adults
1999
BC
Nutrition
Survey
55%
1989
BC Heart
Health
Survey
44%
All surveys based on actual measurements, vs. self-reports.
Note – not directly comparable to childhood rates, as different
standards are used to define overweight vs. obese.
2004
CCHS
59%
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Vernon, BC
Cadet Camp
1954
1980
2007
Childhood Overweight/Obesity
1978/79 to 2004 :
14% to 26%
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Adults
• Causes of obesity naturally are
multifactorial
– Sweetened beverage consumption clearly
linked to increased risk of obesity and type
2 diabetes in adults
– BC Nutrition Survey 1999:
• too much of the wrong stuff
• too little of the right stuff
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Impact of Childhood Obesity Adapted from Dr. Tom Warshawski, BC Childhood Obesity Forum, 3/05, and other sources
Social Costs in
Childhood
Lowest self-reported quality of life (same as children
with cancer)
Decreased self esteem
Social marginalization
Health Costs in
Childhood
Sleep apnea
Joint problems
2.4 x higher risk of CV risk factors (cholesterol, HPB)
12 x higher risk of insulin resistance
asthmatic children who are obese need more
medicine, wheeze more, and use Emergency Rooms
more often
Social Costs in
Adulthood if obese at 7 years of
age
lower average income
lower marriage rates
fewer years of education
increased difficulties with daily life
Health Costs in
Adulthood
’Adult Onset’ Diabetes. Current rate in adults is 1 in
14. When today’s children grow up the rate is expected
to climb to 1 in 3.
Increased risk of most chronic diseases as an adult
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100.0%
41.6%
53.6%
71.3%
27.0%27.0%
27.0%
-0.6%
16.6%
28.4%
-10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18
Year
Pe
rcen
t
Total
Health
Education
Other
Revenue/Spending Scenario Revenue Growth – 3%
Education Growth – 3%
Health Growth – 8%
Balanced Budget
Other spending reaches zero by 17/18
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Some Goals for 2010
•increase the percentage of B.C. adults who eat at least
5 servings of fruits and vegetables daily by 20 per cent;
•reduce the percentage of B.C. adults who are
overweight or obese by 20 per cent;
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ActNow BC
Policy • 2005: Schools – all Food Sales
• 2007: BC Public Buildings – Vending only – BC government, Health Authorities, Universities, Colleges:
Provincial Compliance Order
• 2008: IH Vending Policy
Recommended
• 2005: Eat Smart Meet Smart (MeetWell) – http://www.actnowbc.ca/EN/healthy_living_tip_sheets/healthy_work
places/
• 2008: Municipalities, Rec Centres – all Food at events and sales
– http://www.stayactiveeathealthy.ca/
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Vegetables and Fruit
Consumption by Men
0
25
50
75
100
Less Suggested More
%
19-34
35-49
50-64
65-74
75-84
1999 BC Nutrition Survey
Canada’s Food Guide Recommended Amount
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Milk Products Consumption
by Women
0
25
50
75
100
Less Suggested More
%
19-34
35-49
50-64
65-74
75-84
1999 BC Nutrition Survey
Canada’s Food Guide Recommended Amount
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Bone Bank Withdrawals • About 90% of bone mass is gained in childhood and
adolescence.
• Sweetened drinks are replacing milk in children’s
diets
• 60% of boys and 80% of girls are deficient in calcium
(Whiting et al., J Can Diet Assoc., 1995)
Just a 5-10% deficit in
bone mass may result in a
50% greater lifetime
prevalence of hip fracture.
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Milk
Products
12%
Grain
Products
31%
Fruit and
Vegetables
14%
Meat and
Alternatives
18%
Other
25%
Sources of Energy From Canada’s Food
Guide – BC Nutrition Survey 1999 (Adults)
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For every additional can per day of
soda pop or sugar sweetened
drink consumed by children, their
risk of becoming obese increases
by:
60% (Ludwig et al., Lancet, Feb. 2001)
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World Health Organization
• We should get no more than 10% of our calories from added sugars:
– Child, 1600 calories/day = 160 calories from sugar, maximum = 10 tsp of sugar
– Teen, 15-20 tsp/day maximum
– Average Canadian teen’s intake from sweetened drinks alone (CCHS
2004):
• 17 tsp/day
• or 25 kg / year
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COMPARING DRINKS – % Juice & added sugars
DRINK STANDARD
SIZE % REAL JUICE
ADDED SUGARS (tsp)
Pops (except diet) 355 mL can 0% 9-11
100% Fruit Juice 340 mL can 100% None
V8® 100% Vegetable Juice 470 ml bottle 100% None (but salty!!)
Other Drinks:
Fruit flavoured, various 340 mL can 25-50% 6-11
V8 ® Splash – various 470 ml 25% 11-12
Ocean Sprays, Dole 12-100%
Fruitopia® - various 591 mL bottle Ave. 5% unavailable
Sobe® - various 591 mL bottle 0-10% 14-20
Snapple® - various 591 mL bottle 0-10% 16-18
Lemonades – various 340 mL can 0-10% 9-10
Iced Tea – various 350 mL can 0 6-8
Sports Drinks – various 591 mL bottle 0 9
Red Bull 250 mL can 0 7
Dairy:
2% Milk 250 mL carton N/a 0
2% Chocolate Milk 250 mL carton N/a 3-4
Yop yogurt drink® N/a Est. 3-4
Some Other Foods
Fruit Pie 1/6th 6
Fruited Yogurt 175 mL 5
Candy Bar 1 average 4-9
Ice Cream ½ cup 3
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Sodium • Acceptable intake:
– 1200 - 1500 mg/day
• Upper limit: – 1900 – 2300 mg/day
• In 2004, regardless of their age, Canadians’ average daily intake of sodium was far beyond the recommended UL, before using salt shaker
• BC Intake one of highest in Canada
• Potassium can help allay some of sodium’s health impact, but potassium intake below recommended in most Canadians – Potassium is high in fruit/veg
– Low in processed food
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Size Sodium (mg)
Subway Deli or 6” 670-1690
Little Caesars Personal Size 6-8” 800-910
Chips 43-50 g 140-1340
V8 Original 340 mL 870
V8 Reduced Sodium 340 mL 165
Mr. Noodles 1 pkg 1800
PC Blue Label Instant Soup 1 pkg 250-680
Sports Drinks (Powerade, Gatorade) 591 mL 75-250
Aquafina flavoured water (Sparkling
or Flavour Splash)
591 mL 75-130
Aquafina Pure (plain water) 591 mL 0
Diet Coke 591 mL 84
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Potential Benefits of Healthier
Vending Choices to Staff & Public
• Weight
• Energy/Attention
• General mental health
• Support for personal
choices
• Night shifts
• Reduced injuries?
• Reduced errors?
• Reduced sick time?
• IH models healthier
choices
• Support people for
patients, emerg
visitors -- healthier
choices help during
stressful times
• Reduced taxes in long
run
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Detriments
• Personal Choice?
– Actually, it’s improved
• Still lots of snacky choices
• Healthier choice is easier
• Can still bring other choices from home to have at work
• Fundraising?
– Many examples of stable or increased funding
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Tobacco Analogy
• Fear of loss of
revenue
• Resentment of Big
Brother
• IH models healthier
choices
• Reduced taxes in long
run
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Yes, But…Maybe if we educate everyone
better about healthy choices…
The Environment We Eat In Decisions about what and how much we eat are dictated by many factors
besides hunger & nutrition knowledge, often over-riding our best
intentions
Environmental factors influencing our choices (Wansink):
- Price
- Accessibility
- Portion size, combo deals
- Advertising
- Variety, exposure (> choices = > eaten)
Result is people are eating more than they need, more of the
wrong things, & less good-for-you wholesome foods
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Hershey’s Kisses
Eaten By
Secretaries
Clear
Bowl
Opaque
Bowl
On
Desk 9 6 ½
6 Feet
Away 4 4
Baby Carrots in a
Waiting Room (# eaten over 15 minutes)
Large
Bowl
Small
Bowl
Given to
customer 12 8
Placed in
corner 6 3
Accessibility
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100
strawberry
100
orange
100
lemon
100
grape
100
lime
100
licorice
600 mixed
together
Bowl of Jelly Beans
(all of same flavour) (same number) 4 colours : 40% less eaten than if 6 colours
-OR-
Jelly Beans, different flavours
6 bowls VS 1 bowl
Ate 12 Ate 23
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Size
• People sent home with a video AND
• 1 or 2 pound bag of M&M’s AND
• Medium or jumbo (twice the size) tub of popcorn for EACH member of the family – 1 pound M&M’s: ate 112 vs.
– 2 pound M&M’s: ate 156
– Ate ½ tub (medium or jumbo) of popcorn
Nutrition Action Healthletter, July/August 1998, The Pressure to Eat: Why We’re Getting Fatter (Brian Wansink interview)
8 oz 12 oz 16 oz 20 oz 34 oz
King Size
2005’s
Child
Size
Small Medium (32 oz or 1
Litre!)
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There’s
nothing
super about
super-
sizing…
Even
Superman
can’t afford
to eat
supersizes!
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New Years Eve
Valentine’s Day
St. Patrick’s Day
Easter
Mother’s Day
Father’s Day
Graduation 4th of July
Halloween
Thanksgiving
Christmas
Bridal / Baby Shower
But it’s only once in a while . . .
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“ …it would take 75 minutes of
biking for a young person to burn off
the calories in a (600 ml) bottle of soda”
http://www.cspinet.org/new/200309151.html
Activity alone can not make up for regular over-consumption of poor food choices
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“It’s not a ban on junk food, we’re just getting out of
the business of promoting it”
“Making the Healthier Choice, the Easy Choice”
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Dr. Brian Wansink: Food Psycologist/
Marketing Researcher
• “I believe we’re faced with the question of whether we have the cognitive ability to do what’s right for ourselves, or whether we’re simply hardwired to respond to our environment…
• Unfortunately, many (environmental) factors affect people on an unconscious level and can, indeed, be very powerful…
• Because of this, I believe we’d be better off trying to change or control our environment in a way that helps us make better, healthier food choices.
• Better yet, create an environment that eliminates poor nutrition choices as (conspicuous) options.”
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Canadian Clinical Practice
Guidelines for Prevention &
Treatment of Obesity:
4 of the 5 Key Messages
1. Obesity is a societal and public health
issue, not an individual issue
2. Predisposes to metabolic problems
3. Chronic disease therefore needs long
term solution…
4. Prevention requires changes in built
environment & workplace
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What about personal
responsibility?
42
Nutrition
Knowledge Biology
Environment Environment
Create an environment that
supports rather than undermines
personal responsibility
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Questions?
