Regulations, Interventions and Evaluation of Policies and Plans that Prevent Obesity
and related Chronic DiseasesThe Canadian Experience
How to Succeed?
Regulations, Interventions and Evaluation of Policies and Plans that Prevent Obesity
and related Chronic DiseasesThe Canadian Experience
How to Succeed? Mary R. L’Abbé, PhD
Director, Bureau of Nutritional Sciences, Food Directorate
Health Canada
Health and Nutrition Summit, Chile, March 2008
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Overall Goal of GSOverall Goal of GS
Article 17 “To promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, community, national and global levels that, when taken together, will lead to reduced disease and death rates related to unhealthy diet and physical activity”
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Regulations, Intervention and
Evaluation of Policies
Regulations, Intervention and
Evaluation of Policies
• Who we are, the Regulator's Role
• Information for consumers
• Dietary Recommendations
• Surveillance, research and evaluation
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Bureau of Nutritional Sciences,
Food Directorate
Bureau of Nutritional Sciences,
Food Directorate
• Only one part of the Health Portfolio which also includes the Office of Nutrition Policy and Promotion, First Nations and Inuit Health Branch, Public Health Agency of Canada, Canadian Institutes of Health Research, and many other Departments …
• The Health Products and Food Branch (HPFB) is Canada's federal authority responsible for the regulation of health products and food by: Minimizing the health risk factor to Canadians, while maximizing the safety
provided by the regulatory system Promoting conditions that enable Canadians to make healthy choices and
providing information so that they can make informed decisions about their health
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BNS - Who We Are, BNS - Who We Are, What We Do What We Do BNS - Who We Are, BNS - Who We Are, What We Do What We Do
Nutrition Research DivisionNutrition Research Division
Nutritional Quality and Safety• Food fortification• novel fibres, sodium, transSpecial Purpose Foods• Infant Formulas• nutritional supplementsLabelling and Claims• Nutrition labelling• nutrient content claims• health claims• Front-of-pack symbols
Nutritional Quality and Safety• Food fortification• novel fibres, sodium, transSpecial Purpose Foods• Infant Formulas• nutritional supplementsLabelling and Claims• Nutrition labelling• nutrient content claims• health claims• Front-of-pack symbols
Laboratory Research-Nutritional Molecular Biology Section,-Nutritional Metabolism Section• Method development to support regulations• Laboratory nutrition research• National Reference Laboratory for Canadian Health Measures Survey
Laboratory Research-Nutritional Molecular Biology Section,-Nutritional Metabolism Section• Method development to support regulations• Laboratory nutrition research• National Reference Laboratory for Canadian Health Measures Survey
Surveys Section• food composition databases (Canadian Nutrient File)•survey methodology• national food consumption surveys (CCHS) and nutritional status (CHMS) surveys
Surveys Section• food composition databases (Canadian Nutrient File)•survey methodology• national food consumption surveys (CCHS) and nutritional status (CHMS) surveys
Nutrition Evaluation Division
Nutrition Evaluation Division
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GS Recommendations Re: Information for
Consumers
GS Recommendations Re: Information for
Consumers
• Article 40 “Governments should provide accurate and balanced information…(3) Marketing, advertising, sponsorship and
promotion … to deal with the marketing of food to children.
(4) Labelling
(5) Health Claims
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(3) Marketing, advertising, sponsorship
and promotion to children
(3) Marketing, advertising, sponsorship
and promotion to children
• In Canada, Food and Drug Act and Regulations apply to labelling and advertising;
• Section 5(1) prohibits false and misleading• Does not specifically address advertising to children• Recent developments:
Voluntary industry code adopted in 2007; 1st year progress announced in Feb 2008
Canadian Parliamentary Standing Committee on Health Report “Healthy Weight, Healthy Kids” March 2007
Chronic Disease Prevention Alliance of Canada (CDPAC) “Policy Consensus Forum on Obesity and the Impact of Marketing on Children” recommendations for regulations banning the marketing of “unhealthy” foods to children, March 2008
• TV broadcast licences require pre-approval of children's’ advertising by industry self-regulatory board
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(4) Nutrition Labelling(5) Claims
(4) Nutrition Labelling(5) Claims
• 1996: Government of Canada’s Nutrition for Health: An Agenda for Action, identified food label information as means toward healthier eating habits
• 1998: Food Directorate undertook a Nutrition Labelling Policy Review
• 2000: Minister of Health announced regulations mandating nutrition labelling on virtually all pre-packaged foods
• 2002: Nutrition Labelling and claims regulations adopted (Canada Gazette, Part II), mandatory by 2005
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• Health Claims: conditions and criteria for authorizing disease risk reduction health claims
• Nutrient Content Claims (47): updated criteria and requirements supported by science
• Mandatory “Nutrition Facts” table on most pre-packaged foods including declaration of energy and 13 nutrients
(4) Nutrition Labelling(5) Claims
(4) Nutrition Labelling(5) Claims
Nutrition Labelling
Nutrient Content Claims
Health
Claims
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(4) “Nutrition Facts” table
(4) “Nutrition Facts” table
Core list of Calories and 13 nutrients always declared.
The nutrient information based on a specified amount of food as sold.
For macronutrients, actual amount in the stated serving of the food is listed.
% Daily Value (%DV) indicates the relative amount of the nutrient in the stated serving.
Optional closed list of 30 additional nutrients. Note: must be declared if subject of a claim or if added.
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(4) Nutrient Content Claims - 2 types
(4) Nutrient Content Claims - 2 types
• Level of a nutrient contained in a food Involves definitions and conditions for using specific terms, limits
synonyms: Free High, Low Good source Light No added fat …
• Comparative Claimscompares the nutrient levels and/or energy value of two or more
foods Examples: “reduced”, “less than”, “fewer”, “increased”, “more
than”
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(4) Nutrient content claims
(4) Nutrient content claims
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(5) Health Claims Allowed in Canada
(5) Health Claims Allowed in Canada
• General Health Claims E.g., “With only 1 gm of fat, this is a healthy choice” Logos of a “heart”, company or Association sponsored symbols These are not regulated; just guidelines
• Biological Role Claims re: how a nutrient in a food contributes to good health Acceptable claims for over 20 nutrients in current guidance E.g., “Calcium aids in the formation and maintenance of bones and teeth” List of acceptable claims maintained; do not need regulatory authorization
• Disease Risk Reduction Claims linking a healthy diet with specific characteristics, to reduced risk of disease Pre-approval is required to review evidence substantiating claim and
regulations required to authorize their use and establish conditions for claim
E.g., “A healthy diet rich in a variety of vegetables and fruit may help reduce the risk of some types of cancer”
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Disease Risk Reduction Health
Claims
Disease Risk Reduction Health
Claims
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• Statement of the claim is defined in two parts: Characteristics of the diet associated with the disease risk
reduction Characteristics of the food that make it a suitable part of the
diet
• Conditions are placed on the food in order to carry the claim Contains 100 g or less cholesterol per 100 g Meets the conditions for “free or low” in saturated fats
• Conditions are placed on the label Label shall include the amounts of sats and trans
Regulating Disease Risk Reduction
Health Claims
Regulating Disease Risk Reduction
Health Claims
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Current & future work on labelling
and claims…
Current & future work on labelling
and claims…• Modernized Framework for Health Claims
Policy consultation released Nov 2007• Substantiation of Claims• Food/NHP Interface; added bioactives• Managing a Broader Range of Function Claims• Front of Package Claims and Symbols• Eligibility Criteria for Foods to carry Claims; definition of “healthy” foods
• Labelling of fresh meats, seafood and poultry, raw fruits and vegetables High interest by industry associations and health professionals
• Restaurant food labelling Voluntary guidelines (2006).
• Same core information and order as required for nutrition labelling• More than 25 major chains representing >40% of establishments• In-store, brochures, websites etc
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Canadian Nutrient File (CNF)
Canadian Nutrient File (CNF)
• Maintained by FD’s Nutrition Surveys Section
• Canada’s national reference food composition database
• Contains information on 143 nutrients and food components for over 5500 foods
• Accessed by governments, practitioners, food industry, academia, etc.
• Critical in developing Canada Food Guide
• Serves as basis for national and provincial food consumption surveys
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CNF Online: Search by Food
Nutrients/portion
CNF Online: Search by Food
Nutrients/portion
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Nutrient Value of Some
Common Foods
Nutrient Value of Some
Common Foods
• The Nutrient Value of Some Common Foods is an extremely popular condensed, printed version of nutrient information for users who prefer this format.
• A new version, free of charge, will be available at the end of March 2008.
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GS recommendations re: Surveillance
GS recommendations re: Surveillance
• Article 46 “Governments should invest in surveillance, research and evaluation re:… Dietary habits
• Canada Community Health Survey (CCHS) 2.2 Nutrition, 2004
Patterns of physical activity • CCHS, CHMS
Nutrition-related biological risk factors• Canadian Health Measures Survey (CHMS), 2008-09
• Biomonitoring, e.g. MIREX - Human breast milk analyses
Nutrient contents of food products• Canadian Nutrient File, 2007 (9th version)
• Total Diet Survey
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GS - Dietary Recommendations
GS - Dietary Recommendations
Article 22: States the recommendations for diet for populations and individuals:
achieve energy balance and a healthy weight
limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and towards elimination of trans-fatty acids
increase consumption of fruits, vegetables and legumes, whole grains and nuts
limit intake of free sugars
limit salt (sodium) consumption from all sources and ensure that salt is iodized.
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Eating Well with Canada’s Food Guide
Eating Well with Canada’s Food Guide
• Updated Food Guide released in Feb 2007 following 5-year review
• Points to the Nutrition Facts table as a tool for comparing the nutrient content of foods
• Key message: Choose products containing less fat, saturated fat, trans fat, sugar and sodium
• Promotes consumption of fruits, vegetables and legumes, whole grains and nuts
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Canada’s Food Guide
Canada’s Food Guide
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First Nations, Inuit and Métis Food
Guide
First Nations, Inuit and Métis Food
Guide
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Other dietary interventions for
Canadians…
Other dietary interventions for
Canadians…
• Trans fat
• Sodium
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Trans fat intake in 1995 - Canada vs.
other countries
Trans fat intake in 1995 - Canada vs.
other countries
0
1
2
3
4
5
6
7
8
9
CA
NIC
E
USA
NO
RN
ETB
ELU
K
SW
ED
ENFR
AG
ERFIN
SPA
PO
RITA
JAP
CH
I
8.4 g/day
Hulshof et al. (1999); Zhou et al.(2003); Ratnayake and Chen (1995)
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Trans-fatty acid content of human milk samples from
various countries
Trans-fatty acid content of human milk samples from
various countries
012345678
Can
ada
1995
Can
ada
1999
USA
198
4U
SA 1
985
Den
mar
k 19
95F
ranc
e 19
95G
erm
any
Spai
n 19
83N
iger
ia 1
991
Chi
na 1
997
Suda
n 19
95
Hon
g K
ong
1997
Canada 1995: 198 samples collected from all 9 provinces of Canada (Ratnayake Lipids ’95) Canada 1999: 103 samples from BC (Innis AJCN ‘99)
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Canada’s Trans Fat Intakes
Canada’s Trans Fat Intakes
• During the mid1990’s, one of the highest intakes in the world (8.3 g per day)
• In 2005, Health Canada estimated an average intake of 4.9 g (2.2% energy)
• Influenced by consumer awareness and mandatory trans fat labelling regulations introduced in 2002 and mandatory by 2005.
• Still above current recommendations of WHO. Intakes should be <1% of total energy (2.2 to 2.7g)
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Estimated trans fat intakes in Canada in
1995 and 2005
Estimated trans fat intakes in Canada in
1995 and 2005
0123456789
1995
2005
200?
WHO Recommended
Level8.3g
4.9g
2-2.7g
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The Task Force released its final report June 2006
The Task Force released its final report June 2006
http://www.hc-sc.gc.ca/fn-an/nutrition/gras-trans-fats/tf-ge/tf-gt_rep-rap_e.html
Co-Chairs:
• President, Heart and Stoke Foundation of Canada
• Director, BNS, Health Canada
Members:
• Balanced representation of academics, health and consumer NGOs, industry and government
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• Limit the TFAs in foods through regulation Vegetable oils and soft, spreadable margarines – 2% of
total fat content All other foods – 5% of total fat content
• Also provided information on healthier alternatives for each sector of the food industry (e.g., baking, frying etc.)
• Would enable Canadians to achieve limits recommended by WHO in Global Strategy Diet, Physical Activity and Health (WHO, 2004)
Trans Fat Task Force Final Report
June 2006
Trans Fat Task Force Final Report
June 2006
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Ministerial Announcement
June 20, 2007
Ministerial Announcement
June 20, 2007
• HC would adopt the TFTF’s recommendations on TFA limits
• Industry was given 2 years to reduce TFA
• If significant progress has not been made, HC will develop regulations
• Commitment to publish results of trans fat monitoring program (TFMP) on HC website
• Consistent with Government’s plan to modernize food safety system: “It should provide new and better information on food risks in the
Canadian marketplace and involve industry and Canadians to address those risks.” (Food and Consumer Product Safety Action Plan)
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• Release included data on food samples from 2005, 2006, and spring 2007.
• Included: pre-packaged foods:
• cookies, crackers, frozen potato products (ex. frozen french fries), frozen chicken strips/nuggets, granola bars, and muffins
foods from restaurant and fast food chains: • chicken strips/nuggets, donuts, fish products, french fries,
miscellaneous fast foods (ex. apple turnovers and hashbrowns), muffins, and onion rings
Release of first data set - December 20,
2007
Release of first data set - December 20,
2007
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in all food categories targeted, saw success in reducing level of TFA
in many cases this was achieved by using healthier alternatives and not increasing levels of saturated fats
it was noted that results from lab analyses were consistent with information provided in the Nutrition Facts table on the sampled products food labels
Highlights from first data set
Highlights from first data set
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Snapshot of pre-packaged foods meeting
the 5% limit in 2006
Snapshot of pre-packaged foods meeting
the 5% limit in 2006
* The foods that were sampled represented the top selling brands for each food category and accounted for more than 80% of sales within that food category.
37** The foods that were analyzed were sampled from the major fast food chains.
Snapshot of foods from major fast food chains
meeting the 5% limit in 2007
Snapshot of foods from major fast food chains
meeting the 5% limit in 2007
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Example of progress made from 2005-2007 Example of progress made from 2005-2007
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Company Product Name/
Description
Sampling Date
Fat
(% by weight of food)
TFA1
(% of total fat)
SFA2
(% of total fat)
TFA +SFA
(% of total fat)
A&W French Fries Oct 2006 16.4 34.9 17.2 52.1
A&W French Fries March 2007 14.4 1.0 6.9 7.9
Arby’s French Fries March 2007 15.8 30.2 11.3 41.5
Kelsey’s French Fries March 2007 15.1 1.3 9.1 10.4
KFC French Fries Oct 2006 16.9 37.2 24.3 61.5
KFC French Fries March 2007 15.7 1.7 8.0 9.7
McDonald’s French Fries Oct 2006 18.8 8.8 48.7 57.5
1 TFA = trans fat, 2 SFA = saturated fat
Example: fast foods french friespartial data
Example: fast foods french friespartial data
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Focus on Sodium in Canada
Focus on Sodium in Canada
• Mandatory Nutrition Labelling Regulations (Dec 2002) Sodium one of the core nutrients Six nutrient claims related to sodium and salt such as “low in sodium”, “reduced in
sodium” “salt-free” … Health claim indicating that a healthy diet containing foods high in potassium and
low in sodium and reduced risk of high blood pressure
• IOM Dietary Reference Intakes for the electrolyte nutrients, including sodium (2004) Harmonized nutrient recommendations for Canada and the US. Indicates that the majority of Canadians exceed the UL for sodium
• ‘Framework for Cooperation on Chronic Diseases Agreement’ (Jan 2005) - signed by Federal Minister of Health Includes implementation of Global Strategy on Diet, Physical Activity and Health
• Forum: Dietary sodium as a public health issue for Canadians (March 2007) general agreement that it is time to take action to reduce sodium intake
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Sodium intake in Canada 1,2
Sodium intake in Canada 1,2
Age group (y)
Adequate Intake, AI (mg/day)
Tolerable Upper
level, UL (mg/day)
Usual sodium intake by
Canadians (mg)
% of population
greater than UL
1 to 3 1000 1500 1903 76.84 to 8 1200 1900 2677 92.7
9 to 13 1500 2200Male 3555 97.4
Female 2962 83.4
14 to 18 1500 2300Male 4142 97.2
Female 2936 82.2
19 to 30 1500 2300Male 4083 98.8
Female 2743 73.0
31 to 50 1500 2300Male 3634 92.2
Female 2778 70.8
51 to 70 1300 2300Male 3345 85.8
Female 2587 63.7
>70 1200 2300Male 2874 76.7
Female 2294 44.2
From the 2004 Canadian Community Health Survey (CCHS 2.2) – Nutrition1
2excludes salt added in cooking and at the table)
1Health Reports, Statistics Canada 18(2): 47-52, 2007.
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• Formation of WG: Announced by Minister of Health October 2007
• Mandate: To develop, implement and oversee a population-health strategy for the successful reduction of the sodium content of the diets of Canadians
• Strategy: To help Canadians maintain and improve their health by developing a strategy for reducing dietary sodium intake by Canadians through three pronged approach: Education/consumer awareness Guided voluntary reduction of sodium levels in processed
food products and foods sold in food service establishments Research
• 1st meeting held March 2008
Multi-stakeholder Working Group (WG)
Multi-stakeholder Working Group (WG)
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Work UnderwayWork Underway
• Detailed analysis of food sources of sodium• Data gathering process on work underway re:
Programs to educate/inform consumers and health professionals on sodium, blood pressure and health,
Industry programs to voluntarily reduce sodium levels in processed foods and foodservice foods,
Research on:• consumer’s perspective re sodium as a risk factor in hypertension
and re sodium reduction efforts• how taste mechanisms factor into food choices with respect to
sodium• technical challenges/solutions associated with reducing sodium
levels in the food supply.
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• Development of strategic framework: (first year) Develop a Strategic Framework that includes goals, action
plans to guide implementation and methods of assessment to determine success
• Implementation Stage: (April, 2009 - onwards) The Multi-Stakeholder Working Group will oversee
implementation and monitor progress according to timelines and methods of assessment outlined in the Strategic Framework.
Sodium WG StepsSodium WG Steps
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Muchas gracias! Thank You !
Muchas gracias! Thank You !
• Food and Nutrition – Health Canada http://www.hc-sc.gc.ca/fn-an/index_e.html
• Food and Nutrition Surveillance http://www.hc-sc.gc.ca/fn-an/surveill/index_e.html
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Recent Actions to reduce trans fat
Recent Actions to reduce trans fat
• 2002: Regulations for mandatory nutrition labelling passed which included trans fats. “trans free” defined as <0.2 g and must be “low” in sats introduced
• 2004: Parliamentary discussions and motion on trans fat• 2005: Trans Fat Task Force established • 2005: End of phase in period for nutrition labelling• 2006: Trans Fats Task Force released its final report,
recommending regulated limits• 2007: Food Guide includes trans and sat fats • 2007: Government commitment to monitor trans in Canada;
use regulation if necessary in 2 years• 2007: Release of first set of trans fat monitoring data• Businesses continues voluntary reductions
