Welcome to ARCH


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.

Obesity News and ARCH Updates

Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management

April 17th, 2014

A new publication, led by ARCH director Dr Sara Kirk, has been published in Qualitative Health Research. The paper explores how obesity is managed in the health care system across multiple perspectives.In this research, we examined the experiences of individuals living with obesity, the perceptions of health care
providers, and the role of social, institutional, and political structures in the management of obesity. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a
growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them. Click here to view the paper. Click here to view a summary of the article on Dr Arya Sharma’s blog.

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Management, Publications , , , , ,

Weighing up the options for promoting health

March 5th, 2014


Sara Kirk, PhD, Canada Research Chair in Health Services Research, Research Associate with the Atlantic Health Promotion Research Centre and Full professor in the School of Health and Human Performance at Dal.

A new study on rising rates of obesity was published on March 3rd and has generated a lot of media interest. The trend analysis, by Laurie Twells and colleagues in Newfoundland, makes depressing reading – since 1981, the prevalence of obesity has increased by 200%, and rates in the Atlantic provinces are among the highest in the country. The health budget in Nova Scotia currently consumes more than 50% of the total budget, with much of this needed to address the burden of chronic disease in this province. Nova Scotians are among the least healthy in the country – with the highest rates of heart and lung diseases and the second-highest rates of diabetes and hypertension. We also have the highest proportion of individuals with multiple chronic conditions. Obese children have 21% higher physician and hospital costs than their normal weight peers (Kuhle et al, 2010), a cost differential that will only increase as these children age, threatening to overwhelm our health system unless we do something about these disturbing trends.

The reasons for the increasing rates of obesity and associated chronic diseases is complex. One key factor is that we live in an “obesogenic environment” – an environment that promotes the unhealthy choice as the default choice and in which healthy behaviour is the abnormal behaviour. Schools are one place where we can help our children to learn about healthy eating and active living, where we should be modelling the behaviours we want our children to adopt, yet these healthy messages are undermined by the constant barrage of unhealthy foods promoted by the food industry and a culture that equates junk food with “having fun”.  Junk food is everywhere and cheap to buy, but it is costing us dear in increasing rates of poor health. Time pressures mean that we have less time to prepare healthier, home-cooked meals or to sit down as a family to eat. Ironically, time pressures to engage in physical activity can limit our ability to eat family meals at home – a case of one healthy behavior threatening to displace another in our crazy world (Chircop et al, 2013).

There is a glimmer of hope and that rests with all of us. As a society, we need to look at the bigger picture and recognize the multitude of factors that influence our ability to eat a healthy diet and be physically active, such as income, availability, education and culture, to name a few. It will take time to reorient our physical and social environments to promote health rather than hinder it. But there are some quick wins – things that we can all do to improve our health. Evidence suggests that children who are involved in meal preparation and enjoy meals with their families also have healthier diets. With March being nutrition month, there is no better time to make plans to eat more healthily – “simply cook and enjoy”.

For information on Nutrition Month, visit http://www.dietitians.ca/Your-Health/Nutrition-Month/Nutrition-Month-2014.aspx


Chircop A, Shearer CL, Pitter R, Sim M, Rehman L, Flannery M, Kirk, SF. (2013). Privileging physical activity over healthy eating: “Time” to choose? Health Promotion International 2013; doi: 10.1093/heapro/dat056.

Kuhle S, Kirk S, Ohinmaa A, Yasui Y, Allen A, Veugelers P (2011). Use and cost of health services among overweight and obese Canadian children. International Journal of Pediatric Obesity April 2011, Vol. 6, No. 2: 142–148.

Twells LK, Gregory DM, Reddigan J, Midodzi WK (2014) Current and predicted prevalence of obesity in Canada. CMAJ opne, DOI: 10.9778/cmajo.20130016.

Posted by Cindy


Event Announcement

February 26th, 2014

CON-SNP Event Poster Final PDF

Posted by Cindy


How much physical activity do children and youth obtain through summer day camps?

February 4th, 2014


A summary of:

Zarrett et al.: Environmental and social-motivational contextual factors related to youth physical activity: systematic observations of summer day camps. International Journal of Behavioral Nutrition and Physical Activity 2013 10:63.

Guest post by Mike Arthur*

An approach to increasing physical activity (PA) among children and youth is to ensure that leaders in settings where they live, work and play maximize PA. One such setting is summer or seasonal day camps that are sponsored by municipal recreation departments and youth serving organizations. Can day camps claim that they contribute to the 60 minutes of moderate to vigorous PA that are required for health benefits? Researchers at The University of South Carolina tested this.

Four camps sponsored by municipalities, YMCA, 4H, and Boys and Girls Clubs participated. Each camp was full day (8 – 4pm); all summer, had a PA component, optional arts and crafts, and field trips. They served 47, 54, 120 and 263 campers for a total of 483. Two camps served a low SES population. Trained observers used a tool called the System for Observing Play and Leisure Activity measured PA ( SOPlay). Campers were observed and coded every 15 minutes for 4 days over 2 weeks. Observed PA was classified as sedentary, walking/moderate or vigorous. Leader behaviors, availability of equipment and space, and motivational climate were also measured.

What did these researchers find?
• Youth were sedentary for 72% of the observations; moderately active 13.8%, and vigorously active 13.8%. Observations were not translated into minutes of PA.
• Males were slightly more active than females
• Higher resourced camps had more PA for males but not females.
• There was little physical activity promotion by camp staff. Staff observed campers but did not encourage, praise, or demonstrate PA.
• Camps with highly organized activities with rules did not promote PA. It may be that structured activities spent too much time on explaining rules, team selection; and turn taking.

What can practitioners learn from this research?
Day camp planners and managers should make PA an explicit goal for day camps by:
• Ensuring that staff are aware of the need for kids to meet PA guidelines (i.e., daily 60 minutes of mod to vigorous activity) and educated on how to promote PA through encouragement, praise, modeling, and minimizing rules and structure.
• Engaging staff and youth in discussions about other ways to increase PA in day camps.
• Developing and using simple tools to observe activity levels of camper and staff, in order to monitor and evaluate whether desired activity levels are being met.

*  Mike Arthur is a recently retired ( 2013 ) Manager, Physical Activity with the Government of Nova Scotia. His primary interests have been working with governments, non government organizations and researchers to ” make the case ” for physical activity as a public health priority. He strongly believes that an evidence base combined with local knowledge and experience is an ideal combination to produce effective comprehensive physical activity strategies and initiatives.

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The blame game

January 15th, 2014

An article published yesterday in CBC news puts all the blame on parents for “enabling kids’ candy addiction”. The article makes important points about the overabundance of candy in children’s daily lives and the role of parents in setting rules and limits related to food. But it fails to ask why we all accept this role of candy/junk food and what we can do to make bigger changes in our environment and culture. Oh yes – and pointing blame at the low-income, single mother for sending their child to school with candy will only reinforce the stigma that she is facing every day to provide her family with nutritious food. Let’s get away from the blame game and work toward more comprehensive, sustainable solutions than “just say no” to kids. (See Dr. Yoni Freedhoff’s Weighty Matters blog for much more discussion on the “parental no.”)

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ARCH research featured on Dal News

January 14th, 2014

‘Balancing the Scales: Promoting Healthy Weight Management without Blame or Shame’ is a recently completed research project, led by ARCH Director Dr Sara Kirk. The project explored multiple perspectives on how weight issues are managed in the Nova Scotia health care system through interviews with individuals seeking support for weight management, health care professionals and policy-makers. We observed how the management of weight within the health care system is rife with weight bias, stigma and blame, across all three groups. These issues hindered the relationship between health care providers and the individuals they worked with, and prevented weight issues from being managed in a way that was supportive and sensitive to issues of weight bias. The rich narratives that we obtained from our participants have subsequently been developed into a dramatic presentation that depicts the relationship between a health professional and an individual seeking support for managing their weight. The setting is the office of a family doctor. Internal dialogue (directed at the audience) and external dialogue (directed at each other) highlight the spoken and unspoken tensions around weight management that were so powerfully described by our participants. Our findings clearly highlight some of the barriers in weight management within a system that is not designed to support individuals who are seeking support for weight management. These findings are being used to stimulate debate about how weight issues are managed, and as an interprofessional education tool with a variety of health professional students as a way to support a more open, non-judgmental and collaborative dialogue around managing weight issues with clients. The drama has subsequently been developed into a three hour inter professional workshop called ‘Behind the Scenes’. An article about our recent workshop at Dalhousie University (held in November 2013) is featured in the Dal News this week.

BTS Team: Sara Kirk, Megan Aston,  Sheri Price, Renee Lyons, Laurene Rehman, Michael Vallis, Janet Curran. Original project funded by the Nova Scotia Health Research Foundation, interprofessional workshops funded by the Canadian Institutes of Health Research

Posted by Cindy

Health care, Management, Treatment , , ,

10 recommendations for cancer prevention that make good resolutions

January 7th, 2014

As another year gets underway, many of us will have set, and perhaps even broken, our New Year’s resolutions for the coming months. January is the classic month for implementing lifestyle changes for better health, after the excesses of the holidays, but changing behaviours is pretty challenging, even for those of us who work in the health promotion field. In a short video from the annual conference of the American Institute for Cancer Research, researchers and health professionals talk about the 10 recommendations for cancer prevention, and which ones they find difficult to follow:

And here is a summary of what those recommendations are, with links for more information:

  1. Be as lean as possible without becoming underweight.
  2. Be physically active for at least 30 minutes every day.
  3. Avoid sugary drinks. Limit consumption of energy-dense foods.
  4. Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
  5. Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
  6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
  7. Limit consumption of salty foods and foods processed with salt (sodium).
  8. Don’t use supplements to protect against cancer.
  9. * It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods.
  10. * After treatment, cancer survivors should follow the recommendations for cancer prevention.

*Special Population Recommendations

If you are still sticking to your resolutions – well done! If not, don’t be disheartened as sustained behaviour change is a challenge. Instead, see if there is something else in the list that might be easier and try that instead. Good luck!

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Community, Media , , ,

Getting the message out: Using technology to spread health research (by Logan Lawrence)

November 4th, 2013


I recently had the pleasure of attending the 42nd annual Canadian Association of Gerontology conference. A number of topics were discussed in relation to older adults, such as improving care for individuals with dementia, making our healthcare system more age-friendly, and changing the environment to better accommodate our aging population. However, one unexpected topic that struck me was how researchers need to do a better job of using technology to deliver our findings to the people who can benefit from them.

One of the keynote speakers, Paula Span, personified the role technology can play in communicating a message. Despite being a writer for the New York Times and an instructor at the Columbia University School of Journalism, what Ms. Span might be best known for is “The New Old Age Blog.” With a Facebook page, website, and thousands of Twitter followers, Ms. Span is one of an increasing number of professionals who are using technology to spread their work. And while these tools may seem obvious to a journalist, the point of Ms. Span’s talk was that health care professionals need to adopt these technologies to keep people informed.

Some health care professionals have already started using technology to engage a wider audience. GeriPal, a blog put together by 3 medical residents at the University of California, San Francisco, has close to 1 400 000 views and allows people of all levels of education and experiences to share information and stories about aging and medicine. Dr. Brian Goldman is an Emergency Room physician that explores controversial issues within the medical community on the CBC Radio podcast “White Coat, Black Art”.  Other notable health care professionals who use technology as a way to get people talking about health issues include obesity researchers Dr. Arya Sharma and Dr. Yoni Freedhoff, both of whom offer their take on the latest news and treatments in the world of obesity (links at the end of the post).

These initiatives are not alone.  There has recently been a big push in the research community to expand on knowledge dissemination. Knowledge dissemination (along with the terms knowledge synthesis, exchange, and application) is part of the broader idea of knowledge translation (or “KT”), which aims to ‘translate’ research results so they are easier to understand and use, and circulate this information to non-academic communities.  This line of thinking may be related to the delay between a medical discovery and it’s clinical application; some studies estimate that it can be anywhere from 5 to 20 years before new and improved techniques actually become the norm. Now, researchers are heavily encouraged to think about how they will actually use their findings, including who they plan on telling. This forces researchers to do some legwork in getting their findings out to people who can use them, instead of results being buried in dusty journals or heard only by fellow researchers at conferences.

Knowledge dissemination initiatives can take many forms: publishing research results in community newsletters, newspapers and press releases, passing information on to community health organizations, hosting public workshops and debates, or taking information online and blogging about it (much like this blog!)  In the end, the point is to take research results further than ever before and start a conversation with as many people as possible. In this way, outlets like blogs and social media take research out of the hands of researchers and provide health care professionals and the public with knowledge that was once only accessible to individuals who had a PhD after their name.

So what does this mean to people who aren’t producing research? For starters, both health care professionals and the average person have improved access to the latest research, which is increasingly being produced in a form that most can understand.  This also means that the average person can start asking for information they can actually understand. More and more institutions (universities, hospitals, government agencies) not only have Facebook pages, websites, and Twitter feeds, but they may also employ people who are skilled at getting information out in a format and level of expertise that most people can understand.  And if, as a researcher, you are interested in using technology for this purpose, the time has never been better; many institutions are beginning to offer workshops on ‘clear writing’ and how to tailor forms of social media to meet your goals.

As the public increases their demand for accessible, understandable research findings, researchers are encouraged to make their findings easy to access and understand – and technologies like blogs and social media might just be their best bet. More people learning is always a good thing, so let’s work on getting the word out, and start a conversation that includes as many people as possible.

The New Old Age Blog          http://newoldage.blogs.nytimes.com/

GeriPal                                    http://www.geripal.org/

White Coat, Black Art          http://www.cbc.ca/whitecoat/

Dr. Arya Sharma                   http://www.drsharma.ca/

Dr. Yoni Freedhoff:               http://www.weightymatters.ca/

Knowledge Translation:       http://www.cihr-irsc.gc.ca/e/39033.html

Logan Lawrence is currently completing his Masters of Science in Kinesiology at Dalhousie University, where he is researching physical activity in cancer survivors. His interests include knowledge translation, clear language, and health promotion in older adults.

Posted by Cindy

Health care, Media

Halloween Horrors

October 31st, 2013


Halloween is only once a year so it’s OK for kids to have candy right? If it truly was once a year then maybe.  Here is the problem with the “everything in moderation” mantre: Our current culture is anything but moderate when it comes to celebrating with food.  Children are facing an unprecedented challenge to their future life expectancy – the presence of energy dense, nutrient poor junk food that is available everywhere they go.  This is never more true than during times of celebration.

The idea that Halloween is one night of the year (“so let kids be kids” as is suggested in this report: http://canadaam.ctvnews.ca/halloween-candy-why-parents-should-indulge-their-kid-s-sweet-tooth-1.1520082) is a misperception.  When we factor in the multiple events that accompany Halloween – parties, classroom and school events, and candy give-aways at malls and stores – Halloween, like Christmas, can last a week or two and the impact on a healthy diet can be far worse than one might think.

The bigger problem, of course, is that celebrations like these are actually becoming indistinguishable when we consider how often children are exposed to junk food in their daily lives.  It is even difficult these days to define what is a treat?  Is once a week a treat? Once a day? What foods even count as a treat? If it is a chocolate bar or candy, then most kids consume these every day, sometimes several times a day and not just at Halloween. If a treat is defined as something that is limited then fruits and vegetables are more likely to fit into that category than candy! Is it any wonder we have an epidemic of unhealthy eating and physical inactivity that is contributing to rising rates of chronic disease?

Energy dense, nutrient poor foods are available 24/7 so how do we protect our kids from this onslaught? When your kids return on Halloween night with their sackfuls of junk, have them pick their top three items and eat those, while the rest are put away for another day.  Younger kids may like the idea of the ‘switch witch’, who takes away candy in the night and gives a small gift like a toy instead – something that will last longer is often more attractive than candy that will be gone just as soon as they can eat it.

If you have lots of kids visit on Halloween, consider giving out non-food items – glow sticks, temporary tattoos, erasers and so on. And if you are planning a halloween party, fruits and vegetables can be made into some pretty cool things – carrot stick fingers, melon brains, lanterns carved out of oranges and bananas frozen onto popsicle sticks. With all the wonderful healthy local produce available in the fall, why not give out apples or pears or use pumpkins as “best-costume” prizes as one school has done? Halloween doesn’t just need to be about junk – with a little imagination we can model the true meaning of moderation.

Posted by Cindy

Nutrition, Opinion, Uncategorized

Athlete endorsement in food marketing

October 7th, 2013

A paper published today in Pediatrics is gaining attention from different news sources in Canada, including the CBC and the Globe and Mail, and asking the important question of the impact that professional athletes can have in marking unhealthy foods and beverages to children. We know that food marketing can lead to increases in food intake and brand preferences and the role of professional athletes play in sport may lead to public perception that they are a credible source of knowledge on a healthy lifestyle.  In this study, endorsement information was gathered for one hundred professional athletes on the basis of Bloomberg Businessweek’s 2010 Power 100 rankings and the nutritional quality of the foods was assessed.  LeBron James (basketball), Peyton Manning (football), and Serena Williams (tennis) were highest on the list for unhealthy food and beverage brand endorsements but local NS hockey hero Sidney Crosby also appeared on the list for his endorsement of Gatorade, Dempsters Bread and Tim Hortons.

This study provides important evidence of the normalcy of professional  athlete endorsement and their contribution to the promotion of unhealthy food and beverages.  With the vivid memory of Canadian athlete endorsement for McDonalds during the Vancouver 2010 Olympics (Patrick Chan and Cassie Campbell to name a few), I hope this evidence will encourage our 2014 Olympic athletes to think critically about the contradictory messages they are promoting to our children.

Posted by jessielee