The ignored consequences of obesity and nutrition policies: How a focus on weight influences psychosocial wellbeing

Background: Eating- and weight-related disorders, including eating disorders, disordered eating, and overweight and obesity, share many risk factors across all levels of the socioecological model. However, public health policies tend to focus primarily on the reduction and prevention of obesity, with little attention to the impact of such policies on disordered eating and related indicators of psychosocial wellbeing, including internalized weight bias, weight stigma, and body image. Young adults may be particularly vulnerable to weight-related policies, as they are in a critical period of developing lifelong dietary habits. Though a wide variety of population-level policies aiming to prevent obesity and improve nutrition have the potential to elicit unintended consequences (e.g., calorie menu labelling), little research has explored this phenomenon in real-world policy contexts. Purpose: The objectives of this dissertation were to: (1) investigate the impact of provincial menu labelling policies on disordered eating, internalized weight bias, weight stigma, and associated indicators of weight-related and psychosocial wellbeing among young adults; (2) explore young adults’ feelings, perceptions, and experiences with calorie labelling policies, and; (3) develop a holistic framework for the prevention of eating- and weight-related disorders that draws on systems science and facilitates examination of potential unintended consequences of weight-related policies. Three manuscripts addressed these objectives through longitudinal analyses of data from the Canada Food Study, a mixed-methods study among young adults, and a critical narrative review. Methods and results: The first manuscript (Chapter 4) is comprised of a longitudinal analysis that examined trends in the prevalence of disordered eating, internalized weight bias, experienced weight stigma, and associated indicators of weight-related and psychosocial wellbeing among Canadian young adults (n=689). Eight repeated measures logistic generalized estimating equations were conducted to assess changes over time for each of the outcomes of interest in relation to provincial calorie labelling policies in British Columbia (voluntary labelling), Ontario (mandatory calorie labelling), and Alberta, Quebec, and Nova Scotia (no labelling policy). The implementation of a calorie menu labelling policy did not significantly increase the odds of disordered eating, body image, internalized weight bias, experienced weight stigma, or other general indicators of mental health, though there were significant differences in these outcomes by sociodemographic factors, including gender, race/ethnicity, and weight perception. The second manuscript (Chapter 5) details a mixed-methods inquiry of young adults’ experiences with calorie labelling, with a focus on its implications for their relationships with food. Participants (n=13) were recruited from a campus-based menu labelling study and individual semi-structured interviews were conducted, followed by a survey assessing sociodemographic factors and risk of disordered eating and body esteem. The data were inductively coded and informed by social constructionist frameworks. Four key themes included: (1) participants’ support of and skepticism about labelling interventions, (2) the identification of knowledge and autonomy as mechanisms of labelling interventions, (3) the role of the individual’s and others’ relationships with food in experiences with labelling, and (4) disordered eating and dieting as lenses that shape experiences with interventions. The third manuscript (Chapter 6) presents a critical narrative review that posits the application of systems science concepts to consider unintended consequences for eating- and weight-related disorders in public health policy. Drawing upon multiple and often contradictory framings for policy approaches to obesity and eating disorders, the proposed theoretical framework outlines how public health nutrition policies can increase the risks of disordered eating, weight stigma, and related psychosocial constructs. Such a framework can be used to examine whether and how weight-centric approaches result in policy resistance (i.e., individuals are not successful in achieving “healthy weights”) and contribute to negative consequences. This framework will also empower researchers and practitioners to identify approaches to promote health holistically, including by reducing societal weight stigma and bias and its harmful implications. Conclusions: This dissertation contributes to our understanding of how nutrition and weight-related policies may impact psychosocial wellbeing and eating- and weight-related disorders more broadly. The findings of the empirical studies and the development of a theoretical framework contribute to the scarce literature on how a focus on weight in public health policy influences psychosocial wellbeing among young adults in Canada

Dieting and health-related behaviours among adolescent girls: A longitudinal analysis of data from a school-based study

Objective: Dieting to lose weight is extremely common among adolescents, especially girls, and is driven by multiple factors, including individual traits and societal standards regarding body weight and shape. Dieting is associated with poor diet quality, overweight and obesity, and increased risk of eating disorders. Also, according to the amassed cross-sectional and longitudinal research, dieting adolescent girls are more likely to engage in smoking, binge drinking, and breakfast-skipping than non-dieting girls. However, despite literature documenting these bivariate associations, we know little about whether there is a causal link between dieting to lose weight and these behaviours among Canadian adolescent girls. Further, there has been little research considering clustering of multiple risky behaviours with dieting. Methods: Using longitudinal data (2012-2014) from COMPASS, a school-based study conducted in Ontario (N=3,386), we prospectively explored associations between dieting to lose weight and clusters of health-compromising behaviours among adolescent girls. Dieting was defined as an intentional change in behaviour to achieve weight loss. Longitudinal, multilevel logistic regression models were used to investigate the relationship between dieting and each of smoking, binge drinking, breakfast-skipping, and clusters of these behaviours. Results: Over half of girls reported dieting to lose weight (54%) and a similar proportion (61%) self-reported heights and weights corresponding with a healthy BMI (61%). Over 80% of girls classified as dieters at baseline also reported dieting 2 years later. Girls who engaged in dieting at baseline were at a significantly elevated risk of smoking, binge drinking, and breakfast-skipping (OR=1.3 to 1.4) by follow-up than non-dieters. Dieting was also associated with engaging in combinations of these behaviours, with the highest risk for engagement in patterns of binge drinking/breakfast-skipping (OR=1.6) and smoking/binge drinking/breakfast-skipping (OR=1.6). Girls who dieted at baseline were also more likely to engage in a greater number of risky behaviours than non-dieters, regardless of what the actual behaviours were. Conclusion: Dieting is a persistent and pervasive behaviour among adolescent girls, with implications for engagement in other risky behaviours. The theoretical mechanisms underlying the observed clustering are complex, but these findings suggest the need for comprehensive interventions that use a systems lens to consider the array of relevant factors, and their interactions, among this population. Strategies that target a single behaviour may represent missed opportunities to address shared risk factors and may have unintended consequences for other behaviours. These findings are particularly salient given the dominant focus within health promotion on weight loss and maintenance as part of a war on obesity

Gaps in the Evidence on Population Interventions to Reduce Consumption of Sugars: A Review of Reviews

Kirkpatrick, S. I., Raffoul, A., Maynard, M., Lee, K. M., & Stapleton, J. (2018). Gaps in the Evidence on Population Interventions to Reduce Consumption of Sugars: A Review of Reviews. Nutrients, 10(8), 1036. https://doi.org/10.3390/nu10081036There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews published in English from January 2005 to May 2017 and considering research on interventions to reduce sugar intake. Twelve systematic reviews that considered price changes, interventions to alter the food available within specific environments, and health promotion and education programs were examined. Each of the identified reviews focused on sugar-sweetened beverages (SSBs). The existing literature provides some promising indications in terms of the potential of interventions to reduce SSB consumption among populations. However, a common thread is the limited scope of available evidence, combined with the heterogeneity of methods and measures used in existing studies, which limits conclusions that can be reached regarding the effectiveness of interventions. Reviewed studies typically had limited follow-up periods, making it difficult to assess the sustainability of effects. Further, there is a lack of studies that address the complex context within which interventions are implemented and evaluated, and little is known about the cost-effectiveness of interventions. Identified gaps speak to the need for a more holistic approach to sources of sugars beyond SSBs, consensus on measures and methods, attention to the implementation of interventions in relation to context, and careful monitoring to identify intended and unintended consequences.At the time that the work was undertaken, Sharon Kirkpatrick was supported by a Canadian Cancer Society Research Institute Capacity Development Award (grant #702855)

Weak Regulations Threaten the Safety of Consumers from Harmful Weight-Loss Supplements Globally: Results from a Pilot Global Policy Scan

Abstract Objective: To pilot a global policy scan assessing how governments worldwide regulate weight-loss supplements (WLS). Design: Experts on WLS policies from 30 countries that varied by World Bank income classification, with five from each of the six World Health Organization regions, completed an online survey on WLS regulation in their country. The survey covered six domains: legal frameworks; pre-market requirements; claims, labeling, and advertisements; product availability; adverse events reporting; and monitoring and enforcement. Percentages were calculated for presence or absence of a type of regulation. Setting: Experts were recruited through websites of regulatory bodies and professional LinkedIn networks and scientific article searches on Google Scholar. Participants: 30 experts, one from each country (i.e., researchers, regulators, other experts in food and drug regulation). Results: WLS regulations varied widely across countries and a number of gaps were identified. One country (Nigeria) has a minimum legal age to purchase WLS. Thirteen countries reported independently evaluating the safety of a new WLS product sample. Two countries have limitations on where WLS can be sold. In 11 countries, reports on adverse events related to WLS are publicly available. In 18 countries, safety of new WLS is to be established through scientific criteria. Penalties for WLS non-compliance with pre-market regulations exist in 12 countries and labeling requirements in 16 countries. Conclusions: Results of this pilot study document wide variability in national WLS regulations globally, exposing many gaps in important components of consumer protection regulatory frameworks for WLS, which likely put consumer health at risk

Tackling colourism through storytelling in an online course for public health professionals

Objective: Strategic storytelling can be used to reframe dominant cultural narratives and improve community health outcomes. This pilot study assessed the impact of an original, online 3-week e-course, delivered from November to December 2021, in increasing learners’ knowledge of and concern for the seriousness of skin-shade discrimination and the use of skin-lightening products in India, increasing learners’ understanding of storytelling-based communication techniques for public health promotion, and increasing learners’ intentions to use strategic storytelling for social change. Design, Setting and Method: The course used case-method pedagogy to address colourism and cosmetic skin lightening. Learners ( N = 25) completed a pre-course baseline survey on their knowledge and concerns regarding colourism and the use of skin-lightening products, as well as their expectations and interests in taking the course. Following course completion, learners completed a post-webinar survey. The Wilcoxon Signed-Rank test was used to assess differences from pre- to post-course surveys on quantitative items. Open-ended responses were also analysed using qualitative content analysis for recurring themes on learner interest and experience. Results: From pre- to post-course surveys, there were significant improvements in learners’ knowledge of skin shade discrimination and the use of skin-lightening products ( p < .05). Learners indicated being more concerned about the seriousness of skin shade discrimination post-course compared to pre-course. Learners also described a positive learning experience and indicated that the e-course enhanced their understanding of strategic storytelling. Conclusion: Findings highlight the importance of an original e-course that uses case-method pedagogy to build knowledge and skills that addresses the impacts of colourism on the health of Indian adolescents and provides new directions for future research on health education interventions that aim to tackle colourism

Top dietary sources of energy, sodium, sugars, and saturated fats among Canadians: Insights from the 2015 Canadian Community Health Survey

Dietary risk factors are major contributors to morbidity and mortality and there is significant attention to interventions to support healthy eating, including through the creation of a healthier food supply. The objective of these analyses was to inform interventions to support healthy eating by examining the top dietary sources of calories, sodium, sugars, and saturated fats among Canadians in relation to sex, age, and income. We drew upon data from the 2015 Canadian Community Health Survey, which collected interviewer-administered 24-hour dietary recalls from Canadians residing in the ten provinces, aged 1 year and above (n=20,176). Foods and beverages were grouped into 91 mutually-exclusive categories (e.g., 100% fruit juice, fruit drinks). Based on the average proportion contributed, the top 20 sources of each dietary component were identified for all individuals and by sex-age and income groups. The mean amount of each dietary component contributed by each category (per capita and per consumer) and the proportions of persons consuming items in each category were also examined. Top sources included commonly-consumed items (e.g., breads and flatbreads as sources of sodium), as well as those high in a given dietary component (e.g., soda as a source of sugars). A number of food and beverage categories were top contributors to more than one dietary component examined, suggesting possible priorities for intervention and future analyses. The identification of major sources of calories and nutrients of concern can inform population health efforts, such as reformulation, to improve the health of Canadians.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author