Obesity Society Series

 

July 2011 

 

Obesity Society Series: Obesity in North America – Unique National ‘Obesity Identities’

Part 1: Canada.

As our former name would suggest, the Obesity Society serves not only the United States, where we are headquartered, but also encompasses very important constituencies to the north and south (Canada and Mexico). Our colleagues in those countries continue to combat the growing obesity epidemic in earnest just as we do here in the United States. What we may not discuss very frequently is that despite some cultural similarities each country within this triad of nations faces unique cultural, social and political challenges in the fight to ebb their regional versions of this worldwide epidemic. While it would be impossible to do justice to the unique attributes of each of these cultures in one newsletter item let’s consider this a starting point for a brief, multinationally focused series that will highlight the similarities and differences amongst our neighboring nations. As you read this you may very well be thinking of how your unique knowledge and experience may add depth to this discussion. That is why we ask that you feel free to comment using the email address at the end of this article, so we might draw from our membership some information, resources and ideas regarding the unique challenges faced by those of you working in these regions.

 

On the heels of the Canadian National Obesity summit held in Montreal PQ in April of 2011, today’s newsletter topic focuses on Canada. Recently the United States Department of Health Statistics published a report on the prevalence of adult obesity in Canada and in the United States1. The report points out that in the United States since the 1960s, measured height and weight have been collected in what we know as the National Health and Nutrition Examination Survey (NHANES) however, by contrast in Canada, similar efforts based on nationally representative samples of the population had not been routinely gathered leaving researchers to glean these data from a diverse and often inconsistent range of data sources. This changed in 2007 with the start of the Canadian Health Measures Survey (CHMS), which represents an effort to collect consistent ongoing data much like that collected in NHANES.

 

The goal of this National Center for Health Statistics report is to compare estimates of the prevalence of obesity between Canadian and American adults. It provides some illuminating comparisons that may challenge us to recognize more readily that Canada and the United States are in some ways very similarly affected yet in many ways distinctive in terms of the obesity epidemic. For example, from 2007–2009, the prevalence of obesity in Canada was 24.1%, whereas in the United States it was more than 10 percentage points higher (34.4%). These differences remained when men and women were considered separately. Interestingly, for Class III obesity Canada and the United States each had reasonably similar rates (3.5 and 5 % respectively). So what may have led to the differences between nations in terms of overall obesity rates? Some interesting contributors are noted in the report. With Non-Hispanic White populations most similar across countries (Canada 26%, USA 33%) the difference in the general population estimates is largely attributed to the cultural landscape with the majority of non-white Americans being from groups traditionally more affected by obesity (Hispanic and African America) whereas in Canada the majority of non-white citizens is comprised of East/Southeast Asian persons for whom the prevalence of obesity is less than for white Canadians. Finally, while there appear to be baseline differences in prevalence in Canada vs. the United States, the trajectory of the increases over several decades appears quite similar which may suggest that very similar forces are at work both in contributing to the rise in obesity as well as our apparent mutual lack of success in combating the problem at a public health level.

 

 In considering Obesity in Canada and the United States it is also essential to consider those subgroups of the general population that may be more affected and or underserved in terms of access to reputable treatment options. According to the NHANES data reported by Flegal et al 2 Non-Hispanic blacks (73.7%) had greater prevalence of obesity than did Non-Hispanic Whites (67.5%) each of which were lower than the estimates for all Hispanics (76.9%). According to the Department of Health and Human Services Office of Minority Health http://minorityhealth.hhs.gov/templates/content.aspx?ID=6456 , based on CDC 2009 prevalence data, African Americans were 1.5 times more likely to be obese as compared with Non-Hispanic Whites. Furthermore, data on Native Americans from the same sources http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=537&ID=6457 suggest American Indian/Alaskan Natives are 1.6 times as likely to be obese than Non-Hispanic whites.

 

In Canada, few studies have been conducted examining race/ethnicity in relation to overweight/obesity prevalence; However Tremblay et al 3 indicate prevalence among comparable groups in Canada based on 2003 data to be 50% among Non-Hispanic Whites, slightly below 50% for Blacks, slightly above 50% for Latin Americans with only 22% of the East/Southeast Aisian population reporting overweight/obesity. Overweight amongst white, off-reservation Aboriginal persons was markedly higher at 63%. The report goes on to include estimates taking into account income/poverty levels, education and other potentially important influences. Similar to Tremblay et al., data from the Public Health Agency of Canada indicates that obesity is a growing issue and major public health concern amongst members of Canada’s first nations also http://www.phac-aspc.gc.ca/publicat/2009/oc/index-eng.php. The report states alarming obesity statistics among Canada’s First Nation citizens and particularly amongst children:

Self-reported data from 2002/03 suggest that obesity rates are high among First Nations adults (36.0%), youth (14.0%) and children (36.2%). In 2007, the self-reported obesity rate among off-reserve Aboriginal adults was 24.8%, compared to 16.6% for non-Aboriginal adults.  

 

Who is in the fight?

Of course efforts to fight the obesity epidemic are global with scientists and clinicians around the world joining forces through international organizations like The Obesity Society and the International Association for the Study of Obesity to combat this multifaceted, chronic metabolic disorder and threat to public health. In addition there are regional associations and/or networks devoting considerable time and effort locally to coordinate the battle. In Canada, The Canadian Obesity Network - Réseau Canadien en Obésité (CON-RCO) represents a consistent and growing presence devoted to organizing resources throughout Canada in the fight to curb the obesity epidemic http://www.obesitynetwork.ca/ . Taken from their website:

 

The mission of CON-RCO is to act as a catalyst for addressing obesity in Canada and to foster knowledge translation, capacity building, and partnerships among stakeholders so that researchers, health professionals, policy makers and other stakeholders may develop effective solutions to treat, and to prevent obesity.  

CON-RCO's vision is to reduce the mental, physical and economic burden of obesity on Canadians.

According to Arya Sharma MD., Scientific Director of CON-RCO and Chair in Obesity Research and Management at the University of Alberta, "Although we are still a young network, CON-RCO can certainly already be credited for bringing together and creating a growing and diverse community of obesity researchers, health professionals, policy makers and other stake holders to address Canada's obesity problem; we are particularly proud of our work towards building and fostering students and new professionals, who now run successful chapters at most Canadian universities."

The group recently sponsored the Canadian National Obesity Summit, a semi-annual event designed to bring all with an interest in the Canadian obesity epidemic together to share information and ideas. There are some excellent videos of keynote addresses from the Canadian National Obesity Summit available online at http://hosting2.epresence.tv/obesitynetwork/1/page/Home.aspx including conversations on public health policy considerations and initiatives in Canada.

In presenting this information, we hope we have provided a snapshot of the obesity issue in Canada and welcome input and suggestions for future articles highlighting issues both unique to the Canadian obesity issue and shared among nations. We also invite you to attend The Obesity Society’s 29th Annual Scientific Meeting in Orlando, Florida – October 1-5, 2011 to network with your international colleagues. Look in months to come for further information on obesity in Canada, Mexico, and from around the world as we seek to better understand this global epidemic.

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References:

1. Shields M, Carroll MD, Ogden CL. Adult obesity prevalence in Canada and the United States. NCHS data brief, no 56. Hyattsville, MD: National Center for Health Statistics. 2011.

2. Katherine M. Flegal; Margaret D. Carroll; Cynthia L. Ogden; Lester R. Curtin Prevalence and trends in obesity among US adults 1999-2008 JAMA. 2010;303(3):235-241.

3. Tremblay MS Perez CE Ardem CI Bryan SN Katzmarzyk PT Obesity, overweight and ethnicity Health Reports, Vol. 16, No. 4, June 2005 Statistics Canada, Catalogue 82-003

 

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