Before 2007, the last major revision to Canada's Food Guide was in 1992 - a full 15 years before. Despite the gap, it is not an insignificant government document destined for a dusty book shelf. It has far reaching implications, with schools, hospitals, retirement homes and other institutional settings directly deriving their menus from the it. However, it's methodology and final recommendations have come under heavy criticism for being a product of "big food" and "a recipe for dramatic increases in premature death resulting from chronic diet-related disease."Given this, how valid is the 2007 version of the Canada Food Guide and what is its utility in practice?
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Critics have pointed to a number of changes calling into question the guide:
1. Health Canada's Food Guide Advisory Committee included representatives from organization with a vested interest changing the food guide. 25% of parties in the review were from the food industry and included the BC Dairy Council, the Vegetable Oil Industry of Canada, Food and the Food Consumer Products Manufacturers of Canada (representing Cadbury, Pepsi-Cola, Conagra).
2. The food guide is "obesogenic." The fewest calories anyone following the new guide would consume daily is 1700 (females aged 19–50), assuming they only drank water, didn't use salad dressing or have dessert. A middle-aged, sedentary woman of average height would burn about 1500-1900 calories per day.
3. Curious changes have been made to serving sizes. For example, lower consumption of fruits and vegetables (for most categories, a daily intake of 5–8 servings, as opposed to the 5–10 recommended in the 1992 edition) has been recommended, as has more consumption of meat (an intake of 4 servings for men, instead of the 2–3 urged in 1992). The Food Guide also includes a My Food Guide section allowing customization of serving guidelines, that based only on age and gender without taking into account acitivty level, height and other factors, is infact misleading.
4. In June 2010, the 2010 Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans was released. When compared to the 2007 Canadian Food Guide, significant differences are present calling into question the use of evidence based recommendations. For example, the US guidelines suggest increasing the intake of seafood and fat-free/low-fat milk products and consume moderate amounts of lean meats, poultry, and eggs, whole milk, pudding and chocolate milk The Canadian Food Guide does not recommend an increase in the amount of seafood and puts no limits or cautions on meat consumption. It lists in their online guidance.
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Article in CMAJ
Dr Yoni Freedhoff, a family doctor practicing bariatric medicine has been the guide's most vocal critic and outlines his concerns in the press and in his blog:
Canada's Food Guide to Unhealthy Eating
Big Food Has a Seat
2010 American Dietary Guidelines vs. 2007 Canada's Food Guide
The Bad Joke that is "My Food Guide"
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The following is Health Canada's explanation of their process and methodology in developing the Canada Food Guide.
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Health Canada and the Food Guide
In 2004 HC undertook a significant revision of the food guide in a effort to respond to changes in Canadian food habits and to address concerns with the last iteration of the food guide in 1992. This led to a revised food guide in 2006. Criticisms of the old food guide included vague terms such as ‘moderation’, poor representation of ethnic and multicultural foods and a sense that the guide itself had become visually outdated.
In terms of its evidence base HC used a computer modeling processes to determine what food intake patterns ought to be among Canadians of various age and gender groups. Food composites (a measure of various nutrient values) were generated and compared against daily recommended intakes (DRIs) of various nutrients. After a number of attempts, HC arrived at a simulated diet for Canadians in terms of nutrient quantity.
In the second step, HC used surveys that showed what real foods were being eaten by Canadians as a way to test their models and to arrive at how much of actual food should be eaten by people to achieve an appropriately nutritious diet. Essentially, the first step of the process arrived at a diet based on abstract nutrient counts, whereas the second step converted these into actual foods that people might consume. Eventually, by cycling between these two steps, the Food Guide as it stands was developed.
HC describes the strengths of the food guide as ‘flexibility, simplicity, visual appeal, widespread awareness and its consistency with current science’. HC promotes the Food Guide as non prescriptive, reflecting food that is both available in the market and food that is widely consumed already by Canadians.
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Food for Thought
When we are asked to advise patients on obesity, eating to manage chronic disease and eating at various stages of growth and development, we often cite the Food Guide as a tool that is available to help make healthy food choices.Indeed, allied health professionals may also use the Food Guide to help patients in their healthy lifestyle efforts.However, it is clear that these recommendations are not without a number of challenges and indeed, are not universally accepted.
The question is: should we be recommending the food guide as a tool for patients? If so, which patients are likely to benefit from it? For those patients who are unlikely to benefit, what alternatives do we have to offer them, and are we prepared to spend scant available resources to provide appropriate education?
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