Apparantly, I am obese. According to my Fitbit and Lose It apps, my Body Mass Index (BMI) places me in the obese range for my height and age. While I might take offense at this assessment and think that I am actually a healthy weight currently, it has made me pause and reflect on how I might become more healthy and what factors have contributed to my current state. As I think about how I compare to my friends, neighbors, colleagues, and patients, I notice that a growing number of us are heavy and getting heavier. In this blog post, I will explore obesity via a review of it’s health determinants, a multilevel model application, the prevalence and contributing factors in aboriginal peoples and vulnerable populations in Canada and a glimpse into what future health prospects are for Canadians with obesity.
Health Determinants and Obesity
Genetics, behaviors, and environmental factors like culture, socioeconomic status and physical environment are important determinants and contributors to obesity in Canada. By far, physical activity, sedentary behaviors, and diet have the biggest influence on obesity ("Determinants," 2011). Additional factors include social determinants like immigration status, socioeconomic status and community location, housing, urban vs. rural location, and marital status ("Determinants," 2011). Behavioral factors like smoking status, alcohol consumption, and fruit and vegetable consumption are also related ("Determinants," 2011).
Social Ecological Model and Obesity
How people become obese is a complex issue. Using Brofenbrenner’s Social Ecological Model, this complicated health issue may be explained by what happens at the individual, interpersonal, organizational, and community levels (Psychology Notes HQ, 2013). A focus on diet as a major contributing cause of obesity is explored next using this model.
Individual level
At the individual level, risk factors for weight gain include age, gender, caloric intake, and physical activity levels. Individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits, can affect diet and food consumption choices (Senate report, 2016).
Interpersonal level
At the interpersonal level, individuals’ weight is influenced by their social environment, including home and family life, social networks and supports, and social norms. Social norms influencing individual food consumption include eating out, eating as a social activity, and weekend eating (Senate report, 2016).
Organizational level
The organizational level includes schools and worksites. Individuals are affected by rules, regulations, programs and practices that these organizations implement and encourage. Organizations’ structures and processes can affect individual weight either positively or negatively. The availability of certain foods at a school, worksites, or health care settings can impact food consumption (Senate report, 2016).
Community level
The community level is where people live, work and play. Access to affordable, high quality and healthy food may be positively (or negatively) affected by policy change, political influence, and environmental changes (Senate report, 2016).
Obesity in Aboriginal Peoples in Canada
A recent study suggests that obesity among indigenous people in Canada has a prevalence of 37% on adults and that obesity rates in children have tripled over the past two decades(Kohladooz, Sadeghirad, Carriveaux, & Sharma, 2015). The table below, from a fact sheet generated by a public health innovation strategy focused on improving the health and nutrition of indigenous peoples in Ontario ("Obesity in indigenous youth," 2016, figure 2), summarizes contributing factors for childhood obesity.
Factors which contribute to obesity in indigenous youth
Obesity in other Vulnerable Populations in Canada
An increase in obesity and related co-morbidities like diabetes, hypertension, hyperlipidemia, and metabolic syndrome are increasingly prevalent among vulnerable sectors of the population such as immigrants and people of color and of low income. In Canada, one of the most vulnerable groups with respect to low socio-economic status is the aboriginal population where rates of obesity are very high for all ages of people living on and off reservations (Senate report, 2016).
Future Health Prospects for Obesity and it’s Impact on Healthcare in Canada
Obesity in Canada has increased by 200% since 1985 (Twells, Gregory, Reddigan, & Midodzi, 2014). Estimates of the economic burden of obesity in Canada range from $4.6 billion to $7.1 billion annually (Senate report, 2016). Projected increases and the resulting burden on the healthcare system indicate that there needs to be an increased focus on prevention, treatment, and management of obesity in Canada (Twells et al., 2014). Efforts to address obesity have largely been focused on behavior modification but some studies suggest that community outreach has a far great impact on altering obesity rates, especially among vulnerable populations (Janssen, 2013).
I have begun my own journey toward a healthier weight and face daily challenges of willpower and food choices. I am well-resourced and have the support of my family and friends as well as the means to buy health food and access fitness. I am quite fortunate in this regard. I wonder how an indigenous woman of my same age, with children similar to my own, living in a remote area of Ontario, might face her own journey toward better health? How might a Syrian refugee? My recent studies toward my Health Studies degree have helped me to better understand the complexity of obesity in Canada. I challenge ou to apply a similar lens to a health issue which you have become aware of in yourself, your family, or your community. I look forward to your comments.
References
Candib, L. M. (2007). Obesity and Diabetes in Vulnerable Populations: Reflection on Proximal and Distal Causes. Annals of Family Medicine, 5(6), 547-556. http://dx.doi.org/10.1370/afm.754
Janssen, I. (2013). The public health burden of obesity in Canada. The Canadian Journal of Diabetes, 37(2), 90-96. http://dx.doi.org/10.1016/j.jcjd.2013.02.059
Kohladooz, F., Sadeghirad, B., Carriveaux, A., & Sharma, S. (2015). Prevalence of overweight and obesity among indigenous populations in Canada: A systematic review and metaanalysis. Critical Reviews in Food Science and Nutrition, 57(7), 1316-1327. http://dx.doi.org/10.1080/10408398.2014.913003
Obesity in Canada: A whole-of-society-approach to a healthier Canada. [Report of the Standing Senate Committee of Social Affairs, Science, and Technology]. (2016). Retrieved from Senate Canada: https://sencanada.ca/
Obesity in Canada: Determinants and contributing factors. (2011). Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/obesitycanada/factors.html
Predictors of obesity among indigenous children and youth. (2016). Retrieved from http://www.healthyweightsconnection.ca/ModuleFile/resource?id=3506
Psychology Notes HQ. (2013, November 3 ). What is Bronfenbrenner’s Ecological Systems Theory? [Blog post]. Retrieved from https://www.psychologynoteshq.com/bronfenbrenner-ecological-theory/
Twells, L. K., Gregory, D. M., Reddigan, J., & Midodzi, W. K. (2014). Current and predicted obesity in Canada: A trend analysis. Canadian Medical Association Journal, 2(1), 18-26. http://dx.doi.org/ 10.9778/cmajo.20130016
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