Applied Research Collaborations for Health (ARCH) is the research group for Dr. Sara Kirk. Sara Kirk holds a Canada Research Chair in Health Services Research within the School of Health and Human Performance at Dalhousie University and a cross-appointment with the IWK Health Centre.

ARCH uses a social-ecological approach to understand lifestyle factors influencing health status and health services utilization, particularly in relation to excessive weight gain. In particular, ARCH is looking at how obesity is managed within the health setting, as well as in understanding the contribution of the "obesogenic" environment to population weight status.

With the Halifax Skating Oval now open, the debate over corporate sponsorship continues. ARCH Director Dr Sara Kirk co-authored an opinion piece that has been published in the Chronicle Herald. This article calls for a debate on the ethics of corporate sponsorship in our communities and public spaces, particularly when the sponsorship involves products that have been linked with negative health outcomes. Click here to read the full story.

ARCH is a supporter of an exciting opportunity for graduate students looking to publish.

Health Science Inquiry is a Canada-wide science journal for graduate students based at the University of Toronto.  To date, they have published two issues and have held successful partnerships with both The Lancet Infectious Diseases (TLID) and the Canadian Medical Association Journal (CMAJ).  The first issue on the H1N1 pandemic saw one of our submissions published in an August 2010 issue of TLID, while the second issue on cancer resulted in the publication of a submission in an October 2011 issue of the CMAJ.

For the next issue, the theme will be obesity and diabetes and is currently accepting submissions to be published in June 2012.  HSI has partnered with the International Journal of Obesity this year, and full details of this partnership and submission instructions can be found online at http://hsinquiry.sa.utoronto.ca/.

Students are encouraged to e-mail healthscienceinquiry@gmail.com or Tarra Penney (tpenney@dal.ca) at ARCH, who is participating as a Senior Editor,  if they have any questions.  We hope you are able to make a contribution to this fantastic opportunity to explore the issue of obesity and diabetes with your fellow graduate students from across the country.

Just as Halifax Council have caved in and agreed to offer naming rights for the new Halifax Skating Oval to an alcohol company, a new report from the UK provides further damning evidence of the shortsightedness of this decision.  The report, published today in the British Cancer Journal found that more than 100,000 cancers – equivalent to one third of all those diagnosed in the UK each year – are being caused by smoking, unhealthy diets, alcohol and excess weight.  It is clear that the environment that we live in, including the relentless marketing of unhealthy food products and alcohol has a big role to play. With 45% percent of cancers being preventable by lifestyle changes, why on earth are we still allowing corporate sponsorship to invade our lives to such an extent?  Click here to read the  press release from leading UK cancer charity, Cancer Research UK.

A key news story over recent weeks in Halifax has been focused on a proposal to have alcohol sponsorship of the newly constructed Halifax Oval. Although Council voted against the proposal, the debate has continued and today Council meets again, with the topic likely to be revisited. In the interests of a balanced debate on the issue, here is the text of an email, sent by ARCH director Dr Sara Kirk to the Save the Oval campaign, outlining why alcohol sponsorship is a public health issue.

“I write in response to your post on savetheoval.ca regarding the issue of Molson sponsoring the Oval. In your post you urge people to contact their councillor to overturn the decision to reject Molson as a sponsor. You state that the argument put forward by critics does not make any sense, that “The City every year takes money from beer companies for Natal Day, Canada Day, (both have beer sales) and just last week, the tree lighting ceremony. The City owned Metro Centre is covered in beer and alcohol signs, and once again, alcohol sales happen in the presence of families. Let us also remember that we watch TV and sports programs which also feature alcohol ads, and still manage to provide our own children with responsible education on proper alcohol consumption”. This is missing the point. Just because it has always happened that way does not mean we should continue this approach. You see no reason for Molsons not to be corporate sponsors. Do you also see no conflict in having tobacco sponsorship on there too? Alcohol is a poison, a drug, but one that is socially acceptable and therein lies the problem. Because drinking is the cultural norm, it is not seen as a big issue, but that does not make it right to take sponsorship from a company that promotes drinking, just as we as a society agreed it was not right to take sponsorship from tobacco companies. The Oval will be a family facility, one that will be promoting a healthy behaviour, i.e. physical activity, which as you point out has massive benefits. Yet, in endorsing a company that promotes an unhealthy behaviour with a facility that promotes a healthy one, what kind of message are we sending to our children? There is overwhelming evidence from the World Cancer Research Fund Policy Report that our current food and activity environments need to change, as well as changing individual behaviour.

Just because alcohol is legal, it does not mean we should take sponsorship from alcohol companies for a facility that has health in mind. Nobody is suggesting prohibition, but we need to have a debate as a society about the morals of corporate sponsorship that has far greater benefits for the company than it does the population. Nova Scotia, like other Atlantic Canadian provinces, is among the unhealthiest in Canada and much of the burden of disease is associated with diseases that are directly linked to our behavioural choices. The unhealthy choice is the norm in our society, and healthy behaviour is the abnormal behaviour. Until we shift the culture to one where the healthier choice is the easier choice, we will continue to spend unsustainable amounts of money on a health care system that can no longer cope with the burden of chronic disease. Do we want to spend more on health care to combat alcohol-related disease, as well as tobacco-related disease and diseases caused by physical inactivity and unhealthy eating, for a paltry $400k that will perpetuate a culture that leads to unhealthy behaviours being the norm?

I may be a minority view in this debate but I applaud the Mayor, the council members and the Government for taking such leadership in this issue. Public health means serving the public good and sponsorship from Molson for the Oval does not serve the public good. If Molson are such good corporate sponsors, how about they provide money without their name plastered all over the Oval?”

For research evidence on the issue of sponsorship of unhealthy products see:

Sponsorship of Sport by Tobacco and Alcohol Companies: a Review of the Issues

Food and drink sponsorship of children’s sport: who pays?

Food company sponsors are kind, generous and cool”: (Mis)conceptions of junior sports players

Yesterday Dr Sara Kirk, ARCH director, participated in a phone-in on CBC Maritime Noon about discussing weight issues in children. You can listen to the full podcast through the CBC website by clicking here. Here are some key points to bear in mind when discussing weight issues with children:

• Weight is a sensitive issue, for adults as well as children, and we don’t want to damage a child’s self-esteem at a vulnerable time.  An ill-thought out comment could set a child on the path to an eating disorder or even further weight issues if it leads them to focus on their weight as a measure of their self-worth.  Don’t tease your child about their weight; parents are reported as the most common source of weight stigma.

• It is important to frame any discussion around health not weight.  Physical activity and healthy eating are not just important for maintaining a healthy weight, they are important behaviours for all of us – we all need to eat healthily and be more physically active to improve our health. Create an environment at home that makes it easy to eat healthily and be physically active.

• Children are more likely to make healthy changes if the whole family is taking steps to make improvements in their lifestyle. Parents need to model healthy behaviours for their children.   Frame discussions on what the child can eat or do, rather than on what they can’t eat or do (such as eating more fruit and vegetables and playing outside ). Focus on healthy, sustainable changes.

• Obesity is a complex issue and not just an issue of eating too much and doing too little – environment and culture plays an important role. We need to create environments that support health behaviours rather than focusing on individuals. When we view weight issues as an individual problem, it does not take account of the complexity of the issue and the vast number of factors that influence it – the way we live our lives, design our cities, the money we have available for adopting healthy behaviours. It is critical to recognise these external factors.

Finally, if you are concerned about your child’s weight, ask your family doctor or pediatrician for advice and support.

I am a big fan of Yoni Freedhoff and his Weighty Matters blog. Yesterday, he posted a strangely named post about toothbrushing, so, intrigued, I went over to read it. His excellent post spoke about how we had to learn to brush our teeth, but then it becomes automatic after a while. We don’t necessarily enjoy it but it is something we recognise as important. He then equated the same logic with physical activity. But what I really liked was his eight word sound bite for physical activity – “some is good, more is better, everything counts”. This put me in mind of a similar snappy sound bite for healthy eating, by Michael Pollen – “eat food, not too much, mostly plants”. Can these two be combined? How about “Eat food, not too much, mostly plants and be active – some is good, more is better, everything counts”?. That’s 18 words… wouldn’t it be great to be able to agree on such a prescription for healthy active living that conveys such complex issues as eating and activity behaviours, without oversimplifying the issue. Can anyone do any better?

Dr Arya Sharma’s excellent blog today poses the question “does youth sport prevent obesity?”. He cites the findings of a systematic review published in Current Sports Medicine Reports that found no clear pattern of association between body weight and sport participation. What the researchers did find were seven studies that compared the diet of sport participants with non-participants. These studies reported that youth involved in sport were more likely to consume fruits, vegetables, and milk, and also more likely to eat fast food and drink sugar-sweetened beverages and consume more calories overall. As ARCH has previously observed and published, participation in sports is often accompanied by a food environment that is not conducive to good health, something the food industry underplays. Coupled with the time pressures that many parents experience with getting children and youth to and from sporting activities, it is any surprise that nutrition suffers? Hence, ARCH and the Atlantic Health Promotion Research Centre are conducting a study to explore these issues. The study is called TIME (Tools, Information, Motivation and the Environment) for Health and more details can be found here.

Following on from a study published earlier this year, which looked at health costs associated with overweight and obesity in children in Nova Scotia, ARCH director Dr Sara Kirk, along with Dr Paul Veugelers and other collaborators from the University of Alberta, have published a follow-up study that is now available online in the Journal of Pediatrics. This study found that overweight and obese children had higher health care utilization across a range of diagnoses, in particular for internalizing disorders, asthma, other respiratory disorders, obesity, otitis media, and chronic adenoid/tonsil disorder. These findings have implications for our health care system, with greater attention needed to the relationship between more common childhood conditions and overweight and obesity. To view a summary of the paper, click here.

Income levels and eating breakfast are two factors that determine if a child will be obese. This comes from a recent report released by Dr. Wendy Young, Memorial University’s Canada Research Chair in Healthy Aging, on which ARCH director Dr Sara Kirk is a co-author.

With funding from the Canadian Institutes of Health Research, the research studied a large population of Grade 7 children in Halton, Ontario. They looked at the association between body mass index (BMI) and modifiable individual-level risks (such as physical activity and nutrition); modifiable environmental risk factors (such as environments that are human modified, including homes, schools, workplaces, and location of physical activity and nutritional environments); and neighbourhood education levels.

“If you look at the federal government’s national dialogue on healthy weights the Ministers of Health have just launched [Our Health Our Future: A National Dialogue on Healthy Weights], this kind of research is essential to the dialogue they’re inviting on actions we need to take to ensure healthy weights for Canadians,” noted Dr. Young. “They see this kind of dialogue as a key step in curbing childhood obesity.”

Dr. Young wrote the report after the Region of Halton decided to take action to reduce childhood obesity, which according to researchers is now an epidemic. Halton created the Healthy Weights: Halton Takes Action initiative, and started to plan changes to their environment such as developing walkable and bikeable communities and increasing the availability of healthy food choices. But they wanted to know if these changes would make a difference. If communities make it easier for children and their families to make healthy choices, will fewer people become obese? And which healthy choices matter the most? To answer these questions, the Halton Region Health Department partnered with Dr. Young to better see how physical and nutritional environments affect healthy weights.

Using survey data from Halton’s Our Kids Network collected in 2006, Dr. Young and her team concluded that socio-economic status and an active lifestyle were still the most powerful predictors of healthy weight in children. Poverty had a negative impact on children’s weight. Meanwhile, whether a child ate breakfast helped maintain a healthy weight. The amount of time spent in front of an electronic screen also mattered. The most significant predictor of lower BMI levels in the Grade 7 children, however, was their active lifestyle score—a combined score of physical activity, lower screen time, and eating breakfast regardless of socio-economic status or the sex of the student. However, BMI for girls was significantly lower than for boys (10.4 per cent of girls were overweight or obese, compared to 17.6 per cent of boys surveyed).

However, students who lived in a walkable neighbourhood were not more likely to have an active lifestyle than other students. As well, students who lived close to a fruit and vegetable store were not more likely to eat fruits and vegetables and fruit and vegetable consumption was also not associated with BMI.

But Dr. Young admits there are some limitations with this study. “For example, the uniformity of Halton neighbourhoods and that fact that most families have a car could explain some of these unexpected results. “Also, our measurements of the built environment are based on adult concepts that may not apply to children. For example, it’s unlikely that increasing access to sidewalks to shopping, postal services, and legal services reflect destinations of 12-year-olds and would increase their physical activity,” explained Dr. Young. “Walkability, or the way the environment facilitates getting places on foot, may be less important for children than playability. In addition, the data was self-reported so the children may not have accurately reported their height and weight, physical activity or fruit and vegetable consumption.”

To view the full report, please visit www.mun.ca/nursing/about_us/FINAL_REPORT_HALTON_July_2011.pdf.

This week, a Nova Scotian woman made headlines by writing her own obituary. Lillian’s post on Yoni Freedhoff’s excellent blog Weighty Matters was a poignant and heartfelt plea for greater awareness of the need for obesity surgery, but the waiting list is 10 years long and she fears she may die before she receives the surgery. Weight loss surgery is one of the few evidence-based approaches to obesity and can lead to substantial and sustained weight loss. It is not an easy solution, but for those, like Lillian, who have struggled with weight issues for many years, it really can be a lifesaver. We applaud Lillian for her brave decision to speak out. However we at ARCH were shocked by the outpouring of vitriol that followed Lillian’s post. These highlight just how prevalent and pervasive weight bias and stigma are in our culture, and how strongly held is the belief that if people could just find some will power then they could easily lose weight, that the problem was her own fault and that she did not deserve help. Given the work that we at ARCH, and others around the world, are doing to understand the complex issue of obesity, we posted the following response:

The polarized views that are expressed in a number of responses to this post really highlight how little we truly understand or care about those individuals with weight issues. Lillian lives in Nova Scotia, where we also live. More than 60% of Nova Scotians are overweight or obese, yet there is precious little to support them. We are not knocking the provincial health system, we are stating a fact. Nova Scotia is actually leading the country in the promotion of policies to support healthy behaviours, but for those with an established weight problem, the picture is very different. We have just completed two research studies in the province. In the first, we created an asset map of weight loss opportunities province-wide. In terms of health care driven, evidence-based approaches to weight management, we found very few and those we found were not well funded or consistently available. We found zero treatment options for individuals with eating disorders if that disorder was also associated with excessive weight gain. In terms of unproven gimmicky weight loss opportunities, we found countless expensive options for the public to choose from, the majority of which pereptuated the myth that weight loss is both quick and easy. In our second study, we looked at how weight is managed in the province across multiple perspectives and found issues of blame to be one of many significant barriers to management especially between individuals and health professionals. These beliefs and preconceptions prevent meaningful and supportive dialogue between individuals and their health care providers, further exacerbating the problem.

Beyond the individual, we live in an environment that actively discourages the very behaviours that support healthy weights. Obese people are told to eat less and move more, yet our environment promotes the opposite behaviours – eat more and move less. Healthy behaviours are actually the abnormal behaviours in our society. But when people succumb to this obesogenic environment, society wags its finger at them, thereby reinforcing the notion that obesity is a simple matter of overeating and under-activity. This, in turn, creates and reinforces the bias, blame and stigma that Lillian describes in her obituary. A few posters have already pointed out that obesity is complex. Addressing it is also complex and will require changes across multiple levels of society, not just in the realm of health, but in how our towns and cities are designed, in how we regulate our food supply and in developing an awareness that excess weight is not a character flaw. When the rest of society actually understands that, we may see better management of obesity and a reduction in rates. In the meantime, brave individuals like Lillian, who seek to raise awareness of the issue, will continue to be demonized for what many view as a personal failing, rather than a societal one.