The proposed revised CanadaFood Guide is a recipe for dra-matic increases in premature
death resulting from chronic diet-related disease, some critics say.
Bill Jeffery, the Canadian coordinatorfor the US-based Centre for Science inthe Public Interest, says he can’t fathomthe rationale behind recommendinglower consumption of fruits and veg-etables (for most categories, a daily in-take of 5–8 servings, as opposed to the5–10 recommended in the 1992 edi-tion) and more consumption of meat(an intake of 4 servings for men, in-stead of the 2–3 urged in 1992).
“It will be disastrous for the health ofCanadians,” Jeffery says, noting that over25 000 Canadians die prematurely eachyear because of diet-related diseases andthat the WHO estimates nearly 5 years isshaved off life expectancy because ofdiet-related risk factors such as low fruitand vegetable intake.
But Health Canada says the revisedguide has undergone “comprehensive”scientific review and will promoteweight loss while preventing the onsetof chronic disease, contends MaryBush, director-general of the office ofnutrition policy and promotion. (Therevised guide was taken off the HealthCanada Web site during the federalelection. “We’re awaiting direction be-fore resuming consultations,” spokes-person Renee Bergeron says.)
The 1992 version of the guide wasconsidered the Canadian “bible” of nu-trition, with some 24 million copiesdistributed nationwide.
Health Canada’s review of the Guidebegan in 2003 and included stake-holder meetings and surveys of profes-sionals and consumers. In the fall of2005, Health Canada proposed a fold-out, 8-page guide to replace the current2-sided single sheet. It retains the con-cept of 4 core food groups — fruits andvegetables, grain products, milk prod-
ucts, and meats and alternatives —while adding 6 pages of advice on is-sues ranging from healthy eating andshopping tips to reading labels.
More substantively, the proposedguide tailors nutritional advice to ageand gender, while providing morespecificity on suitable serving sizes. In-stead of advising everyone to, for ex-ample, eat 5–10 servings of fruits andvegetables daily, the new guide recom-mends different daily intakes for 9 de-mographic categories: preschoolers,and 4 age groups (4–13, 14–18, 19–50and over 50), divided by gender.
Dr. Yoni Freedhoff, an Ottawa spe-cialist in obesity medicine, identifies anumber of deficiencies in the pro-posed guide: inadequate recognitionof the value of consuming morepolyunsaturated fatty acids or morewhole-grain products; a complicatedand confusing array of recommendedserving sizes; a total lack of guidanceon recommended daily caloric intake;and insufficient warnings about thedire consequences of eating high calo-rie foods in the so-called “others” cat-egory. Canadians now consume about600–800 calories worth of fried foodsand sugary desserts in this category.
“It’s obesogenic,” says Freedhoff.With help from a dietician, he calcu-lated that the fewest calories anyonescrupulously following the new guidewould consume daily is 1700 (femalesaged 19–50), assuming they only drankwater, didn’t use salad dressing or havedessert. In other demographic cate-gories, the daily intake topped 3200calories, again without extras.
“What it means is that should any-body who is of average height and size follow Canada’s Food Guide, there is avery, very good chance it will lead toweight gain.”
Both Freedhoff and Jeffery alsochide Health Canada for failing to fur-nish the scientific rationale for thechanges and allowing industry repre-sentatives to sit on its external FoodGuide Advisory Committee. The 12-member committee includes represen-
tatives from Food and Consumer Prod-uct Manufacturers of Canada, the Veg-etable Oil Industry Council and the BCDairy Foundation.
“It’s obscene that industry is in-volved,” Freedhoff says. “I would nothave Exxon developing Canada’s en-ergy policy.”
Health Canada’s Bush says suchcriticism is unfounded. Representativesof industry and other stakeholders wereinvolved because “philosophically, weabsolutely believe that if we’re going toimprove the nutritional health of Cana-dians, it takes all sectors to . . . under-stand their role.”
As for the changes, they’re rooted in“comprehensive” internal reviews ofnutrient standards recently developedby the US Institute of Medicine, WHO’s2003 report on Diet, Nutrition and Pre-vention of Chronic Disease and a 2005US Dietary Guidelines Advisory Com-mittee report.
Bush also dismisses concerns the
Proposed Canada Food
Guide called “obesogenic”
Health Canada’s proposed food guidecould prove less than fruitful, say critics.
Can
apre
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CMAJ • February 28, 2006 • 174(5) | 606
News
guide will contribute to obesity or en-courage consumption of fewer fruitsand vegetables. Rather, it offers a greaterdegree of specificity and precision by de-mographic group, she argues.
None of the changes are written instone, Bush adds, as Health Canadawill complete consultations and con-duct focus group testing before releas-ing the finished product — probablylater this year. Both exercises weresuspended until after the federal elec-tion, which may give influentialgroups such as the Dietitians ofCanada time to weigh in — providedits members can reach a consensus,says director of policy Lynda Corby.
Others are convinced Health Canadais on the right track. “Overall, the direc-tion seems appropriate,” says ElinorWilson, CEO of the Canadian PublicHealth Association.
“Given the obesity epidemic, pro-
Anew medical school in NewBrunswick is raising hopesthat the Maritime province will
be able to more effectively recruit andretain physicians from within its ownpopulation.
The New Brunswick Medical Train-ing Centre — the first of its kind in theprovince — will open its doors inMoncton in September.
Students and 18 new faculty membersfor the 4-year, French-language programare being recruited in a unique partner-ship between the University of Monctonand the University of Sherbrooke in Que-bec. The University of Sherbrooke willprovide the medical curriculum andgrant the degree, but the teaching will bedone at facilities in Moncton, allowingpotential New Brunswick doctors totrain in their home province.
Plans are also in the works for asatellite English program in Saint John,possibly by next year. Discussions areunder way with the University of NewBrunswick, and Memorial and Dal-housie universities.
“It’s a very positive thing for NewBrunswick,” says Dr. Rose Anne Good-ine, president of the New BrunswickMedical Society. “It’s a lot harder for ayoung person to imagine being a doc-tor if there isn’t a local program. I thinkthat having a local program opens thatdoor to more students.”
According to the Canadian Institutefor Health Information, New Brunswickand Prince Edward Island — the onlyprovinces without medical schools —had the lowest number of physiciansper capita in Canada in 2004.
Goodine says New Brunswick’s ex-isting physician shortage will compli-cate faculty recruitment for the newprograms. She hopes physicians con-tinue to see patients but also “partici-pate in more teaching.”
The Moncton program will hire thenew faculty over the next 3 years to han-dle clinical training, and hopes to grad-uate an average of 22 students a year,beginning in 2010. The Georges Du-mont Hospital in Moncton will be theaffiliated teaching hospital.
moting healthy eating is an importantpart of public policy,” says Dr. AryaSharma, chair of the Canadian ObesityNetwork. The guide is not a treatmentfor obesity, or diabetes or any othermedical condition, he adds. “This is forsomeone who is healthy and wants ahealthy diet.”
Sharma believes the proposed guideis based on the best available science,but acknowledges that contradictoryevidence is common in the nutritionsciences.
But Jeffery is so persuaded the revi-sions aren’t evidence-based that he rec-ommends Canadians look to the“Healthy Eating Pyramid” developed byDr. Walter Willett at the HarvardSchool of Public Health as a superior,independent alternative for nutritionadvice. — Wayne Kondro, Ottawa
DOI:10.1503/cmaj.060039
Australia’s most popular diet plan — and the government science in-stitute that backs it — is under fire for recommending excessive meatconsumption and for its links with the meat and livestock industry.
The Commonwealth Scientific and Industrial Research Organisation(CSIRO), Australia’s largest independent, scientific, industrial research body,touts the diet, published in book form as The CSIRO Total Wellbeing Diet, asbeneficial for all. But according to an editorial in Nature (2005;438:1052)“the published research indicates that it is superior to a high carbohydratediet only for a sub-population of overweight women with symptoms of meta-bolic dysfunction.” It states that marketing of the book as “scientificallyproven” was “decidedly unsavoury” and criticized Australia’s national re-search agency for attaching its name to the book.
Leading Australian nutritionists Rosemary Stanton and Dr. John Tickellrecently wrote an open letter to Prime Minister John Howard, expressing con-cern that the diet contains too much meat and asking him to review the book.
The CSIRO diet recommends 800 grams of red meat a week and up to 300grams of meat daily; the Australian Government’s Guide to Healthy Eatingrecommends 65 to 100 grams of lean red meat 3 to 4 times a week.
The Meat and Livestock Industry Australia partly funded the research thatsupports the dietary recommendations.
Responding to the debate the Australian Health Minister Tony Abbottbacked his government’s guidelines on the National Health and Medical Re-search Council Web site.
The CSIRO Total Wellbeing Diet has sold more than 550 000 copies inAustralia (outselling Harry Potter and The Da Vinci Code), and 100 000copies in the UK and New Zealand. It will soon be released in the US,Canada, India and South Africa. — Sally Murray, CMAJ
