Healthy Weights · The following is the definition of a healthy weight used by the Haldimand-Norfolk Health Unit: A healthy weight is not a specific number on a scale and is individual

Healthy Weights Key Messages | 1

Healthy Weights

June 2016

K E Y M E S S A G E S

Adapted with permission of


Body weight, shape, diet and exercise tend to be fairly common topics of conversation in both

our professional and personal lives. Whether it is a passing remark to a co-worker about their weight loss, a casual chat with friends about the latest trendy diet or exercise fad, or planning a lunch meeting, these conversations often arise.

People receive information and messages about body weight and weight loss from a variety of sources, including family, friends, health professionals, media and celebrities. For better or for worse, this information helps shape a person’s perception of what a “healthy weight” is.

The following is the definition of a healthy weight used by the Haldimand-Norfolk Health Unit:

A healthy weight is not a specific number on a scale and is individual for each person. A healthy weight is the weight a person naturally is when they are living a healthy lifestyle, which includes healthy eating, active living, sleeping well and positive mental health.1

The following key messages are intended to help health unit staff contribute to a healthy organizational culture and also, as public health ambassadors, convey consistent healthy weights messaging throughout the community. The messages focus on health promoting behaviours to achieve a healthy weight, rather than focusing on weight loss strategies. While sleeping well and positive mental health contribute to a healthy weight, for the purposes of this document the focus will be on healthy eating and physical activity.

There is a growing trend of overweight and obesity in our community. About 30% of Canadian children and youth are at an unhealthy weight. Children with excess weight or obesity are more likely to grow up to be adults with excess weight or obesity. If this trend continues, by 2040 up to 70% of today’s children and youth will be adults with excess weight or obesity and at least half of children will be at an unhealthy weight.2

People with excess weight or obesity are more likely to develop chronic diseases such as type 2 diabetes. This also leads to increased health care costs. In 2009, obesity cost Ontario about $4.5 billion including high rates of lost productivity from missed school and work.3

A person’s health status cannot be determined based solely on body weight. Body mass index (BMI), calculated using weight and height, is often used to classify individuals into a category of either underweight, normal weight, overweight or obese. While BMI can be useful when looking at the health risk of a population, it is not always accurate at the individual level because it does not take body fat distribution, muscle mass, genetics or healthy behaviours into consideration. For example, a sedentary individual with a BMI of 24.0 (healthy category) is likely to have a higher risk of mortality than an active, muscular athlete with a BMI of 27.0 (overweight category). It is also possible for a person who is in the “normal” weight range to be lacking essential vitamins and minerals from their diet putting them at increased risk. Instead, looking at healthy behaviours, such as fruit and vegetable consumption and physical activity level, is a better way to assess an individual’s health risk.

Adoption and promotion of these healthy weights key messages will help reframe the conversation in our organization and our community in a positive way, shifting the focus from body weight to health at any size.

Healthy Weights Key Messages - Background

4 | Healthy Weights Key Messages

Strategies

1.1 Make the healthy choice the easy, fun choice

What a person chooses to eat goes well beyond simple will-power. Environmental factors such as portion sizes and marketing strategies lead people to consume significantly more food than they realize.4 In fact, individuals make over 200 food decisions per day (e.g. what to eat, where to eat, when to eat, etc.), many of which are made automatically without conscious thought based on the environment around them. Furthermore, having to make that many food-related decisions every day requires a significant amount of mental effort.5 Removing unhealthy snacks from common areas or replacing unhealthy vending machine

choices with healthier alternatives helps reduce the temptation and ‘convenience’ of unhealthy eating. Similarly, keeping stairwells, sidewalks and trails well maintained, or providing sports equipment and shower facilities for use on lunchtime or break encourages people to choose healthy options instead of remaining sedentary.

1.2 Be a role modelLeading by example is an effective way to reinforce any public health message. From a healthy weights lens, public health staff often have the opportunity to role model health-promoting behaviours to community members and partners. Frequent breaks, offering water during meetings, and following the Health Unit’s Healthy Eating Policy when providing snacks or lunch, are great examples.

Key Message #1:

Contribute to a culture that supports healthy weights


Scenario During a health unit in-service, you overhear a co-worker say that the food provided is “too healthy.” They comment that, “If someone else doesn’t have enough will power to stay away from the treats, why should everyone else have to be penalized?”

Research has found that eating habits have very little to do with willpower alone. Willpower can be thought of as a muscle that can get tired with overuse. This leaves a person more vulnerable to making less healthy food choices. Several other factors are at play when food decisions are being made:

• Physiological: foods high in fat and sugar can act in the brain similar to addictive drugs which promotes overeating

• Social: research has shown that people who eat more during social events are viewed as likeable, which may promote unhealthy eating

and drinking habits during social activities, such as workplace celebrations

• Environmental: people are likely to eat foods that are convenient and accessible. Food displayed in workplaces can promote eating regardless of hunger. Efforts to eat healthy can be undermined when less healthy alterna-tives are made available.

If we continue to blame unhealthy food choices solely on poor willpower, we miss the opportunity to make effective changes. In public health we advocate for healthy environments, and in our own workplace we can do this by making the healthy choice the easy choice when it comes to food.

1.3 Watch your words

Words are powerful. To convey a positive, health focused approach to body weight and lifestyle choices the terms “healthy eating” or “eating well” (rather than diet) and “physical activity” (instead of exercise) should be used to encourage more positive attitudes and behaviour change. Talking about food in a positive way focusing on the qualities (e.g. crunchy, colour, smell, taste) of the food has more of a positive impact on children and youth versus talking about how certain foods are “full of calories” or any other negative conno-tation in the hopes of demonizing a food.6 The

same goes for physical activity – instead of focus-ing on how activity will burn x amount of calories, talk about how enjoyable the activity is or how it makes you feel.

People-first language should also be used. For example, using language such as “diabetic person” conveys the message that they are their disease. Instead saying, “a person with diabetes”, is more respectful and puts the person first instead of the disease. Similarly, a person is not overweight or obese, but rather is a person with excess weight or obesity.


Strategies

2.1 Watch out for “weight bias” and accept that healthy people come in a variety of weights, shapes and sizes

Weight bias is any negative attitudes and views about obesity and people with obesity. Common beliefs include that those with obesity are lazy, eat unhealthy diets, and do not exercise.7 These negative associa-tions lead to considerable inaccuracies and stereo-types, and quantify health solely by factors such as weight and BMI. The stigma associated with obesity can lead directly to poor health outcomes such as disordered eating tendencies.8

2.2 Don’t discriminate based on weight - encourage everyone to improve their health

People who feel good about themselves and their bodies are more likely to have healthy self-esteem, and adopt healthy lifestyle attitudes and behaviours. Focusing on weight can increase stigma and weight bias, which promotes discrimination of people who have gained weight, and has a negative impact on mental health. As a result, people who have gained weight may then be less likely to eat healthy and be physically active.9 An environment which encourag-es and supports healthy eating and physical activity benefits everyone, regardless of weight.

2.3 Remember that weight is only one piece of the health picture

Weight is not an absolute indicator of health. A person who is thin is not necessarily healthy, and a person with excess weight is not necessarily un-healthy. It is a common belief that health is improved automatically through weight loss; however this is not always the case. People also have a common belief that there is an ideal body weight and shape and

that these factors are under the control of the indi-vidual, which is not true. This can cause people to try unhealthy methods to strive to obtain this ideal body shape (e.g. restrictive diets, excessive exercise, etc.). In fact, a person’s body weight and shape are influ-enced by more than simply “energy in and energy out.” Numerous other factors, such as genetics, hor-mones, sleep, environment, etc. also play a key role.

It is important to reflect on our own bias and perception of body size and shape, and also to understand that the causes of overweight and obesity can be com-plex and multifaceted. An example of this would be avoiding comments such as “You look great, have you lost weight?” This may be intended as a compliment however it reinforces the common misbelief that weight is associated with happiness, success and health. For the same reasons, it is also important to avoid self-degrad-ing comments such as “I feel fat today.”

2.4 Focus on health, not weight loss

The improvements to health and quality of life that result from healthy eating and physical activity can’t be emphasized enough. Weight loss isn’t guaran-teed and nor should it be the focal point. Incentives for weight loss, such as a workplace “biggest loser” competition, can lead to unhealthy practices, such as meal skipping.10 It is important to encourage healthy behaviours for everyone regardless of their body shape and size.

Key Message #2:

The goal is health, at any size


Scenario During a home visit, a parent expresses concern about her child’s weight by saying that he is “too chubby.” She asks you how she can help him lose weight.

It is important to teach children that self-worth is not related to how they look. Part of normal growth and development are weight and height spurts, and sometimes a weight spurt can come before a height spurt. Instead of focusing on weight, focus on healthy behaviours and reassure the parent that a child can be healthy at any size.

Parents should role model healthy eating at meals and snacks and positive body image attitudes for their children. Children should be

taught how to make informed decisions about what they eat, and be involved in planning meals, shopping and cooking. Food should not be used as a reward or punishment, as food should not be associated with love or acceptance.

Being active on your own, and as a family, is also an important way for parents to be positive role models. Enjoyable physical activity should be included each day in addition to limited screen time.


Strategies

3.1 Know that all foods can fit – follow the 80/20 principle

The 80/20 principle is simple – make nutritious food choices 80% of the time, and have the option to enjoy more indulgent foods 20% of the time.

The 80/20 principle is not a diet — it’s a lifestyle change that stresses the importance of balance and

moderation, concepts that rarely exist in fad diets. Under the 80/20 principle no foods are “off limits.” The principle takes into consideration the fact that food is more than just nourishment. Food is also an important part of culture, celebrations, religion, etc. and part of many social interactions. The goal is to promote healthy eating but still give people the freedom to occasionally eat their favourite dessert, go out socially and enjoy a meal with friends, or have a piece of birthday cake, without feeling guilty about what they are eating.

Anything that is too restrictive isn’t realistic for the long haul. Balance is key. In most cases, when people are too strict with their meals, or cut out an entire macronutrient group (e.g. carbs), it ends up backfiring. While they may be able to stick to this approach for a week or two, maybe even a month, inevitably they’ll learn this is not realistic or sustainable. Instead it puts them in a position to crave and binge on foods that were previously “off limits.” 11

3.2 Discourage fad diets – encourage a healthy lifestyle

Dieting doesn’t work. Research consistently shows that dieting is not effective in achieving long term weight loss.12 There is evidence that a reduction in weight can lead to health benefits for many adults who are overweight, however a fixation on losing weight can lead to unhealthy weight loss practices such as yo-yo dieting, weight cycling, excessive exercise and restrictive eating patterns, which is a detriment to their health long term.

An upstream prevention approach, that supports population based health-promoting behaviours from the start, can reduce the perceived need for fad, quick fix diets.

Key Message #3:

Healthy eating is a lifestyle. It doesn’t have to be ‘all or nothing’.


Scenario You are in a meeting with community partners and during a break one of your co-workers starts talking about a trendy new diet they are trying. They start recommending the diet to others at the meeting because they have seen a weight loss in the last few weeks.

Ninety-five percent of diets fail. As am-bassadors of the health unit, we need to ensure that the information we recommend and endorse is based on evidence. Com-munity members view health unit staff as a credible source of health information, and therefore we should be promoting healthy lifestyles, not ineffective fad diets.

Personal experiences (i.e. diets you’ve tried), even if you felt it worked for you, should not be promoted to others as a proven weight-loss method.

Fad diets can be unsafe and extremely ex-pensive. If a diet is not sustainable, a person is likely to regain back all of the weight they initially lost, if not more. This can create a yo-yo dieting cycle, which poses more health risks than if a person never initially lost any weight. Instead, health unit staff should be promoting healthy eating behaviours that focus on a balanced diet that is enjoyed.

3.3 Follow Canada’s Food Guide

The Haldimand-Norfolk Health Unit promotes the use of Canada’s Food Guide for all commu-nity members aged two years and older. Nutri-tion for Healthy Term Infants by Health Canada is available for children under the age of two to guide healthy eating. The guide describes an eating pattern that, when followed, provides all vitamins, minerals and other nutrients, and re-duces the risk of obesity, type 2 diabetes, heart disease, certain types of cancer and osteopo-rosis. The guide provides recommendations for the types and amounts of foods people should consume each day based on their age and gender. Additional recommendations include: eating breakfast every day, enjoying fruits and vegetables at all meals and as snacks, enjoying meals with family and friends, and savouring every bite.

3.4 Promote healthy eating practices (e.g. breastfeeding for infants, division of responsibility for children, eating together, etc.)

Breast milk is the best food for infants to pro-mote optimal growth and development. There is increasing evidence that suggests that a lower risk of developing obesity may be associated with the length of exclusive breastfeeding.13 14

The division of responsibility describes the relationship between the responsibilities of the parent and child during meal/snack times. Par-ents/caregivers should be responsible for what foods are served, when and where meals and snacks are served. The child is then responsible for how much to eat and whether or not to eat.15 This method allows children to follow their own natural hunger and satiety cues, and therefore prevents overeating. This method also allows children to try a variety of new foods without pressure, making it more likely for them to try and accept new foods.16

Eating together may have a positive influence on healthy eating and body weight, especially for children and adolescents. Research has found a significant association between family meals and higher vegetable intake and lower body mass index among children and youth.17


Strategies

4.1 Build activity, structured or unstructured, into daily routines

Research shows that when physical activity is pre-planned into daily routines, it becomes easier to implement.18 Moving more throughout the day can be as easy as going for a walk on breaks or after dinner, parking in a central location to run errands, doing chores around the house and taking the stairs whenever possible.

4.2 Promote physical activity for health benefits and enjoyment, rather than weight loss

There are many benefits to adopting a more active lifestyle, including improved fitness, strength and feeling better. These benefits can be achieved when activity happens in bouts of at least ten minutes, and can be accumulated throughout the day.19 The Canadian Physical

Activity Guidelines explain how much activity different age groups need.

Research has also found that adherence to physical activity programs is associated with the participants’ enjoyment in the activity. Being active with family or friends adds a fun, social element. Tossing a Frisbee at the beach or park, gardening, building snowmen and exploring local trails are great ways to move more. Active time together also allows parents to be positive role models for children, which increases the likelihood of children continuing to be active.20 21

4.3 Focus on physical literacy at all ages

Physical literacy is described as the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activity for life.22 Just as children need to learn their ABCs before they can read and write, and their 123s before they can do math, children and adults need to learn fundamental movement skills to participate in a variety of physical activities over the lifespan.23

Key Message #4:

Move more, in ways you enjoy


Scenario A Health & Wellness Committee at a local workplace is attempting to encourage their employees to be more active by organizing a Move It 2 Lose It competition for the month of May. Staff are asked to track calories burned and number of pounds lost over the course of the month, with the team with the highest totals winning a prize. The committee chair approaches the health unit for tips or resources they can share with the participants.

Encouraging and supporting staff to be more physically active is a terrific endeavour, as it has numerous benefits for both the employees and the employer. Healthier workforces have been shown to exhibit increased productivity, reduced absenteeism and enhanced staff morale.

As a public health ambassador, we should be reminding workplaces that their focus should be on encouraging staff to be active in ways they enjoy, as a part of their every-day lifestyle, rather than as a means to lose weight. Offer the workplace alternative ideas, such as:

• On the Move competition using a passport with a list of local trails or other types of non-traditional physical activities that staff can get stamped as they visit the locations.

• Break-time BINGO where cards with a variety of 10-15 minute physical activities are distributed and staff try to complete a row on their card.

• Switch it Up, Switch it Off contest where staff participate in a different physical activ-ity of their choice every evening for a week instead of watching TV. Have them take selfies of themselves performing each activity and post them on an internal board. Draw a prize winner from the photo submissions.

• Challenge employees to move more at work. Find creative ways to remind people to take standing and walking breaks at regular intervals throughout the day.

4.4 Limit screen time and long periods of sitting

Activities such as watching TV, playing video games and using smart phones and tablets are referred to as screen time. Excessive screen time has been identified as a stimulus for excessive eating and sedentary behaviour which increases the risk of developing overweight or obesity.24

Long periods of sitting – sedentary behaviour – has now been identified as its own risk factor, regardless of physical activity levels. In addition to daily structured and unstructured physical activity, the simple act of standing or walking throughout the day can lead to better health.25


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3. Katzmarzyk, P.T. (2011). The economic costs associated with physical inactivity and obesity in Ontario. Health and Fitness Journal of Canada, 4(4), 31-40.

4. Wansink, B. Mindless eating: why we eat more than we think. New York: Bantam Dell. 2006: 276p.

5. Wansink. B., & Sobal J. (2007). Mindless eating: The 200 daily food decisions we overlook. Environment and Behaviour, 39(1), 106-123.

6. Healthy Kids Panel. (2012). No Time to Wait: The Healthy Kids Strategy. Retrieved from http://www.health.gov.on.ca/en/common/ministry/publications/reports/healthy_kids/healthy_kids.pdf on February 16, 2016.

7. Salas, X.M. (2015). Understanding public perceptions of obesity related health messages. Nutrition Resource Centre Annual Meeting. Toronto. Available from http://opha.on.ca/getmedia/5b8db56a-38ff-4df0-b1f9-e8dbf936c91b/Motivating-or-stigmatizing-X-Ramos-Salas_1.pdf.aspx.

8. Dorfman, L., & Wallack, L. (2007). Moving nutrition upstream: the case for reframing obesity. Journal of Nutrition Education and Behaviour, 39, 45-50.

9. Puhl, R.M., & Heuer, C.A. (2010). Obesity stigma: Important considerations for public health. American Journal of Public Health, 100(6), 1019-1028.

10. Yoo, J.H. (2013). No clear winner: Effects of The Biggest Loser on the stigmatization of obese persons. Health Communication, 28(3), 294-303.

11. Polivy, J., Coleman, J., & Herman, P. (2005). The effect of deprivation on food cravings and eating behaviour in restrained and unrestrained eaters. International Journal of Eating Disorders, 38(4), 301-309.

12. Moyad, M.A. (2004). Fad diets and obesity – part III: a rapid review of some of the more popular low-carbohydrate diets. Urological Nursing Journal, 24(5), 442-445.

13. Von Kries, R., Koletzko, B., Sauerwald, T., et al. (1999). Breast feeding and obesity: a cross sectional study. British Medical Journal, 319, 147-150.

14. Dewey, K. (2003). Is breastfeeding protective against child obesity? Journal of Human Lactation, 19(1), 9-18.

15. Ellyn Satter Institute. (2015). Ellyn Satter’s Division of Responsibility in Feeding. Retrieved from http://ellynsatterinstitute.org/dor/divisionofresponsibilityinfeeding.php on February 16, 2016.

16. Schwartz, M.B., O’Connell, M., Henderson, K.E. et al. (2015). Testing variations on family-style feeding to increase whole fruit and vegetable consumption among preschoolers in child care. Childhood Obesity, 11(5), 499-505.

17. Berge, J.M., Jin, S.W., Hannan, P., et al. (2013). Structural and interpersonal characteristics of family meals: associations with adolescent body mass index and dietary patterns. Journal of the Academy of Nutrition and Dietetics, 113, 816-822.

18. Nies, M.A., Vollman, M, & Cook, T. (1998). Faciliators, barriers and strategies for exercise in European American women in the community. Public Health Nursing, 15(4), 263-272.

19. Tremblay, M.S., Warburton, D.E.R., Janssen, I. et al. (2011). New Canadian Physical Activity Guidelines. Applied Physiology, Nutrition and Metabolism, 36, 36-46.

20. Nies, M.A., Vollman, M, & Cook, T. (1998). Faciliators, barriers and strategies for exercise in European American women in the community. Public Health Nursing, 15(4), 263-272.

21. Sallis, J.F., Hovell, M.F., & Hofstetter, C.R. (1992). Predictors of adoption and maintenance of vigourous physical activity in men and women. Preventative Medicine, 21(2), 237

22. International Physical Literacy Association, (2014). Retrieved from www.physicalliteracy.ca on February 16, 2016.

23. Longmuir, P.E., Boyer, C., Lloyd, M. et al. (2015). The Canadian assessment of physical literacy: methods for children in grades 4 to 6 (8 to 12 years). BMC Public Health, 15(1), 767.

24. Tremblay, M.S., & Willms, J.D. (2003). Is the Canadian child obesity epidemic related to physical inactivity? International Journal of Obesity, 27, 1100-1105.

25. Biswas, A., Oh, P., Faulkner, G., Bajaj, R., Silver, M., Mitchell, M., & Alter, D. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis. Annals of Internal Medicine, 162(2):123-132.

References

Documents

Healthy Weights · The following is the definition of a healthy weight used by the Haldimand-Norfolk Health Unit: A healthy weight is not a specific number on a scale and is individual