Poor diet

The average Canadian is not eating a diet that promotes optimal health.  In general, we consume:

1. Too many calories (and too much fat and simple sugars) - average calorie intake for young adults (both genders) is suitable if one has a high activity level.  But most of us are somewhat  sedentary so calorie consumption is above optimal levels.  Excess calorie intake (relative to activity level) increases as we get older .  These are average population estimates and a significant percentage of young people under 18 have notably excessive calorie intake.  A big part of the problem is too much fat consumption. One quarter of children's caloric intake comes from food products not found within Canada’s Food Guide [1]. For middle aged adults, some 30% are consuming  fat above the recommended levels.  The main contributors to excess fat consumption are meat, fats and oils, sugars, snacking and eating fast food (Garriguet, 2006).  For older Canadians, sixty per cent of the calories  consumed come from ultra-processed food (i.e. packaged salty oily snacks, confectionary, soft drinks, frozen breakfast foods, packaged pizzas, and instant noodles) (Moubarac et al., 2013). In 2018, 36% of Canadian adults reported a body mass index that classified them as overweight and 27% as obese,  with elevated health risk from excess weight at 64% (Stats Canada, 2018). Ten per cent of Canadian children are obese (Canadian Obesity Network, n.d.).

2. Too few fruits and vegetables - across all age-sex combinations, vegetable consumption is significantly below recommended levels.  The problem is particularly acute in young people, with 53-71% below recommended levels (Shields, 2005; Garriguet, 2006).  Fruit and vegetable consumption improves somewhat as we age, but about half of us do not meet the requirements.

3. Too much salt - All age groups significantly exceed recommended salt intake (Garriguet, 2007).  Some dietary experts maintain that Canada's guidelines of tolerable intake are far too high, in which case we may be consuming more than double what is optimal for health.  The majority of salt intake for the average Canadian comes from processed foods (Salt Reduction Task Force report, 2010).

The consequence is that diet-related diseases are a leading cause of avoidable morbidity and mortality in Canada, costing our healthcare system billions of dollars each year at a time when health care budgets are stressed and other social services are underfunded because of the dollars allocated to health care. According to the World Health Organization,  the major diet-related diseases diabetes, cardiovascular disease, cancer, obesity, osteoporosis, and dental disease are caused in large part by unhealthy diets and lifestyles.  Some, in their view, have reached epidemic status (WHO, 2015).  In Canada, diet and physical activity could prevent about 50% of type II diabetes (Canadian Diabetes Association, 2010), 10% of heart disease (TFPC, 1997), one-third of cancers (particularly oral cavity and pharynx,esophageal, larynx, lung, bowel, stomach, breast, endometrial, and kidney cancers) (Canadian Cancer Society, 2015; Cancer Research UK; 2014; WHO, 2015). Belanger et al (2014) concluded that 30 000 deaths could be averted or delayed annually in Canada if diets were consistent with dietary recommendations. Sixty percent of the risk of a low birth weight birth is the nutritional status of an at-risk mom at the time of conception (TFPC, 1997).

With data from  the late 90s, Health Canada (2003) conservatively estimated the costs to the health care system and lost work productivity connected to diet-related preventable illness at over $6 billion annually. More recently,  Loewen et al. (2019) estimated that failing to meet Canada's healthy eating recommendations in 2018 had an economic burden of disease cost of $26 billion annually (direct and indirect costs), based on eating patterns from the 2015 Canadian Community Health Survey.  Underconsumption of healthy foods was a greater contributor to the direct economic burden than overconsumption of unhealthy ones. Jeffery (2019) estimated that better nutrition could save the economy $100-200 billion / year. Other reports have calculated the health care costs of specific conditions. Anis et al (2010) estimated the 2006 direct costs of overweight and obesity in Canada at $6 billion, or 4.1 per cent of Canada’s healthcare budget. A study commissioned by the Canadian Cancer Society,Canadian Diabetes Association, Childhood Obesity Foundation, Chronic Disease Prevention Alliance of Canada, and Heart & Stroke on the economic costs of diseases associated with sugary drink consumption concluded that such drinks would cause an additional 63,321 death, result in over 2 million lost healthy life years, and cost the health care system over $50 billion  over the next 25 years (Jones et al., 2015). Nshimyumukiza et al. (2018) estimated that with a drop in the number of Canadians who did not have a good diet from 83% to 76% (both shockingly high numbers) savings in economic burden of disease costs would fall by $133 million, but still leaving the burden at $13 billion in 2015. Regardless of the which studies have the most accuracy, the costs of failing to address diet-related diseases are enormous.

In contrast, diets rich in fruits and vegetables, minimally processed foods, complex carbohydrates, moderate levels of animal products, and limited simple sugars and processed oils have disease fighting properties. For indigenous peoples, it is well established that diets rich in traditional and country foods are demonstrably better for health and well being. Unfortunately, such diets are typically more expensive. Rao et al (2013) examined the costs of healthy and unhealthy diets in numerous countries, including Canada, by contrasting the price of  a diet rich in fruits, vegetables, fish, and nuts  with one  comprised largely  of processed foods, meat, and refined carbohydrates. The healthy diet added approximately $2,200 per year to the food bill for a family of four. Due to this increased cost of many high quality nutritious foods, compounded with the stresses of poverty (unemployment, substandard housing, isolation), Canadians who are poor are most vulnerable to these chronic health challenges.

These realities speak to the absence of food - health care integration."Canadians all pay, through publicly-funded health insurance, for the costs of individuals' food choices or hunger.  The food system, through which most people acquire food, carries no responsibility for the social consequences of consumption of its products.  Food companies bear no responsibility for the consequences of poor consumer information programming as it relates to the health dimensions of their product.  The efforts of ministries of health to promote healthy eating are frequently compromised by agribusiness expenditures encouraging unhealthy eating patterns." (TFPC, 1997).

According to the Ontario Food and Nutrition Strategy (2017), "The Ontario government spends nearly 50 per cent of the provincial budget on healthcare to treat those who are already sick, but only 0.35 per cent of the current budget is set aside for health promotion to prevent illness and chronic disease." And within that 0.35%, a significantly smaller proportion is devoted to food-related health promotion efforts.

Excess calorie consumption has implications beyond individuals and national borders.  Smil (2004, p. 22) observes from a population level perspective on biological calorie requirements vs. current consumption that,

weighted means for entire populations are rarely above 2,000 kcal/person. This means that per capita gaps between average availability and actual consumption are now greater than 1,000 kcal/day in every high-income country, with maxima approaching, or even surpassing, 1500 kcal/day. In order to account for inevitable food losses and to provide an adequate safety margin the average per capita food supply should be 30% above the needed mean of 2,000 kcal/capita, averaging no more than about 2,600 kcal/capita.

In his view, proper allocation of calories to the global population would feed an additional 350 million people.



[1] Coalition for Healthy School Food. https://foodsecurecanada.org/coalitionforhealthyschoolfood